record_id,title,abstract,keywords,authors,year,date,doi,label_included,duplicate_record_id
1,2007 ESH-ESC guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC),,amlodipine;angiotensin receptor antagonist;antihypertensive agent;atenolol;beta adrenergic receptor blocking agent;calcium antagonist;calcium channel blocking agent;candesartan;chlortalidone;dipeptidyl carboxypeptidase inhibitor;diuretic agent;eplerenone;eprosartan;felodipine;fosinopril;indapamide;irbesartan;lacidipine;lisinopril;losartan;nifedipine;nitrendipine;perindopril;placebo;ramipril;telmisartan;thiazide diuretic agent;unindexed drug;valsartan;verapamil;article;atherosclerosis;blood pressure measurement;cardiovascular risk;cerebrovascular accident;clinical protocol;clinical trial;cost effectiveness analysis;dementia;diabetes mellitus;diabetic hypertension;diet restriction;disease association;disease classification;drug contraindication;drug mechanism;drug megadose;drug potentiation;electrocardiogram;geriatric care;heart infarction;heart left ventricle hypertrophy;human;hypertension;kidney disease;laboratory test;lifestyle modification;medical society;metabolic disorder;neuroimaging;outcome assessment;practice guideline;priority journal;risk assessment;risk factor;women's health,,2007,,,0,
2,Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of the North American Menopause Society,"OBJECTIVE: To update the evidence-based position statement published by The North American Menopause Society (NAMS) in 2004 regarding recommendations for estrogen and progestogen use in peri- and postmenopausal women. DESIGN: NAMS followed the general principles established for evidence-based guidelines to create this updated document. An Advisory Panel of clinicians and researchers expert in the field of women's health was enlisted to review the 2004 NAMS position statement, compile supporting statements, and reach consensus on recommendations. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees. The position statements published by NAMS do not represent ""practice standards"" that would be codified and held up as standards by regulating bodies and insurance agencies. Rather, they are prevailing opinion pieces in a best effort attempt to incorporate current evidence into practical clinical recommendations. RESULTS: With the primary goal being to evaluate the risk-benefit ratio of peri- and postmenopausal estrogen therapy (ET) and estrogen-progestogen therapy (EPT) for both disease prevention and treatment of menopause-related symptoms, current evidence allowed for a clear distinction between areas of consensus and areas for which the Panel determined that there was inadequate evidence for any conclusion to be reached. The document lists all of these areas along with clear explanatory comments. A comprehensive list of key references is provided. The absence of evidence is also recognized in the list of needs for further research recommended by the Panel. CONCLUSIONS: Current evidence supports the use of ET or EPT for menopause-related symptoms and disease prevention in appropriate populations of peri- and postmenopausal women. © 2007 by The North American Menopause Society.",estradiol;estrogen;gestagen;placebo;progesterone;article;attributable risk;cerebrovascular accident;clinical practice;consensus development;depression;diabetes mellitus;drug dose comparison;drug megadose;early menopause;estrogen therapy;evidence based medicine;health insurance;hormone substitution;hot flush;human;ischemic heart disease;low drug dose;mammography;medical society;menopausal syndrome;night sweat;population research;postmenopause;postmenopause osteoporosis;practice guideline;premature ovarian failure;quality of life;risk benefit analysis;standard;symptomatology;treatment indication;unspecified side effect;vasomotor disorder;venous thromboembolism,,2007,,,0,
3,Transdermal drug delivery has ideal properties in the elderly,The transdermal route of drug delivery has many advantages over other routes; some of these advantages are particularly applicable to the elderly population. © 2008 Adis Data Information BV. All rights reserved.,apomorphine;buprenorphine;estradiol;estrogen;fentanyl;glyceryl trinitrate;insulin;levodopa;lisuride;nicotine;oxybutynin;physostigmine;progesterone;rivastigmine;rotigotine;selegiline;tacrine;testosterone;aging;Alzheimer disease;andropause;angina pectoris;anticholinergic effect;application site reaction;chronic pain;drug cost;drug delivery system;drug dosage form comparison;drug efficacy;drug formulation;drug mechanism;drug megadose;drug tolerability;heart left ventricle failure;hormone substitution;human;hypertension;insulin dependent diabetes mellitus;lung toxicity;major depression;nausea;osteoporosis;overactive bladder;Parkinson disease;postmenopause;short survey;side effect;somnolence;unspecified side effect;vomiting,,2008,,,0,
4,Estrogen and progestogen therapy in postmenopausal women,"This Educational Bulletin discusses the effectiveness of hormone therapy (HT) for relieving vasomotor and urogenital symptoms and the side effects associated with such treatment; considers the evidence concerning the effects of HT on the risk of osteoporosis and related fractures and on the risks of coronary artery disease, dementia, and colorectal cancer; and considers the longer term effects of HT on the risks of stroke, venous thromboembolism, and cancer of the breast, endometrium, and ovary. © 2008 American Society for Reproductive Medicine.",acetylsalicylic acid;conjugated estrogen;cyproterone;estradiol;estradiol valerate;estrogen;gestagen;medroxyprogesterone acetate;placebo;vitamin D;warfarin;article;atrophy;bleeding;breast cancer;breast tenderness;clinical feature;clinical trial;cognitive defect;colorectal cancer;controlled clinical trial;coronary artery disease;disease severity;drug efficacy;endometrium cancer;estrogen deficiency;estrogen therapy;hazard ratio;atrial fibrillation;heart infarction;hip fracture;hormonal therapy;hot flush;human;incidence;ischemic heart disease;mastalgia;menopausal syndrome;monotherapy;multiple cycle treatment;osteoporosis;ovary cancer;postmenopause;priority journal;quality of life;randomized controlled trial;risk assessment;risk reduction;senile dementia;side effect;spotting;cerebrovascular accident;treatment duration;treatment outcome;urine incontinence;urogenital tract disease;uterus bleeding;vagina bleeding;vaginal dryness;venous thromboembolism;weight gain;aspirin,,2008,,,0,
5,Donepezil: Syncope,,cholinesterase inhibitor;donepezil;Alzheimer disease;atrioventricular block;cardiovascular disease;heart arrest;human;note;faintness,,2008,,,0,
6,Disease management update,"The rapid expansion of disease management continues. A multitude of stakeholders and marketplaces are now involved in providing cost-effective quality healthcare for individuals and populations. To help you keep up to date with the very latest developments in disease management, this section of the journal brings you information selected from the disease management and pharmacoeconomic reporting service Pharmacoeconomics & Outcomes News.1 The following reports are selected from the very latest to be published across a broad range of literature sources. © 2008 Adis Data Information BV. All rights reserved.",antidepressant agent;influenza vaccine;neuroleptic agent;aged;arthritis;Australia;blood pressure;community care;cost;cost control;cost effectiveness analysis;dementia;depression;diabetes mellitus;disease management;fatty liver;genetic screening;health care cost;health care personnel;health care planning;health care quality;health program;health service;heart failure;heart muscle ischemia;hospitalization;human;hypertension;influenza vaccination;irritable colon;mammography;mental disease;neuropathic pain;osteoporosis;prescription;public health;quality of life;screening;self monitoring;short survey;Spain;treatment indication;vaccination,,2008,,,0,
7,Health card can be improved,,age distribution;allergic rhinitis;Alzheimer disease;breast cancer;cause of death;cerebrovascular disease;chronic respiratory tract disease;consultation;dementia;pollen allergy;health insurance;health survey;human;ischemic heart disease;lifestyle;lower respiratory tract;lung cancer;medical practice;obesity;pharmacist;prevalence;sex difference;short survey;suicide,,2008,,,0,
8,Aspirin in Alzheimer's disease (AD2000): a randomised open-label trial,"Background: Cardiovascular risk factors and a history of vascular disease can increase the risk of Alzheimer's disease (AD). AD is less common in aspirin users than non-users, and there are plausible biological mechanisms whereby aspirin might slow the progression of either vascular or Alzheimer-type pathology. We assessed the benefits of aspirin in patients with AD. Methods: 310 community-resident patients who had AD and who had no potential indication or definite contraindication for aspirin were randomly assigned to receive open-label aspirin (n=156; one 75-mg enteric-coated tablet per day, to continue indefinitely) or to avoid aspirin (n=154). Primary outcome measures were cognition (assessed with the mini-mental state examination [MMSE]) and functional ability (assessed with the Bristol activities of daily living scale [BADLS]). Secondary outcomes were time to formal domiciliary or institutional care, progress of disability, behavioural symptoms, caregiver wellbeing, and care time. Patients were assessed at 12-week intervals in the first year and once each year thereafter. Analysis of the primary outcome measures was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN96337233. Findings: Patients had a median age of 75 years; 156 patients had mild AD, 154 had moderate AD, and 18 had concomitant vascular dementia. Over the 3 years after randomisation, in patients who took aspirin, mean MMSE score was 0·10 points higher (95% CI -0·37 to 0·57; p=0·7) and mean BADLS score was 0·62 points lower (-1·37 to 0·13; p=0·11) than in patients assigned to aspirin avoidance. There were no obvious differences between the groups in any other outcome measurements. 13 (8%) patients on aspirin and two (1%) patients in the control group had bleeds that led to admission to hospital (relative risk=4·4, 95% CI 1·5-12·8; p=0·007); three (2%) patients in the aspirin group had fatal cerebral bleeds. Interpretation: Although aspirin is commonly used in dementia, in patients with typical AD 2 years of treatment with low-dose aspirin has no worthwhile benefit and increases the risk of serious bleeds. © 2008 Elsevier Ltd. All rights reserved.",ISRCTN96337233;acetylsalicylic acid;donepezil;placebo;aged;Alzheimer disease;article;brain hemorrhage;caregiver;clinical trial;confidence interval;control group;controlled clinical trial;controlled study;daily life activity;disease course;gastrointestinal hemorrhage;high risk population;hospital admission;human;ischemic heart disease;major clinical study;mental capacity;mental health;multiinfarct dementia;outcome assessment;priority journal;public health;randomized controlled trial;rectum hemorrhage;retina macula hemorrhage;seizure;statistical significance;thromboembolism;vagina bleeding;wellbeing,,2008,,,0,
9,Memantine: heart failure: harmful drug,,Alzheimer Disease/drug therapy;Europe;Heart Failure/*chemically induced;Humans;Memantine/*adverse effects/therapeutic use,,2009,Aug,,0,
10,From the North American Menopause Society a new statement in hormone therapy,,breast cancer;cognitive defect;dementia;depression;endometrium cancer;estrogen therapy;hormonal therapy;human;ischemic heart disease;medical society;menopause;mortality;North America;sexual function;short survey;urinary tract;vagina disease,,2009,,,0,
11,"First report ® American Medical Directors Association Annual Symposium Charlotte, NC; March 5-8, 2009",,analgesic agent;antibiotic agent;atorvastatin;carbidopa plus levodopa;cholinesterase inhibitor;corticosteroid;diazepam;fluticasone propionate plus salmeterol;furosemide;galantamine;glibenclamide plus metformin;glipizide;insulin;ipratropium bromide;ipratropium bromide plus salbutamol;long acting drug;low density lipoprotein cholesterol;memantine;oxybutynin;risperidone;salbutamol;salmeterol;simvastatin;warfarin;Alzheimer disease;chronic obstructive lung disease;chronic pain;disease exacerbation;drug substitution;drug withdrawal;geriatric disorder;goal attainment;human;ischemic heart disease;long term care;lung function;medical society;medication error;nursing home patient;osteolysis;pain assessment;perineal care;practice guideline;risk factor;short survey;symptom;urinary tract infection,,2009,,,0,
12,Doctors and climate change,,breast cancer;cardiovascular disease;climate change;death;dementia;depression;diarrhea;environmental temperature;flooding;food intake;greenhouse effect;greenhouse gas;health hazard;health practitioner;human;international cooperation;ischemic heart disease;livestock;lung cancer;malaria;malnutrition;note;physical activity;risk reduction;cerebrovascular accident;traffic,,2010,,,0,
13,Alzheimer's disease and dementia reduced by angiotensin receptor blockers,,amyloid beta protein;angiotensin receptor antagonist;cardiovascular agent;dipeptidyl carboxypeptidase inhibitor;lisinopril;Alzheimer disease;cardiovascular disease;cardiovascular risk;cognition;cohort analysis;dementia;diabetes mellitus;diastolic blood pressure;disease course;dose response;drug efficacy;atrial fibrillation;heart infarction;human;hypercholesterolemia;hypertension;morbidity;nursing home;proportional hazards model;renin angiotensin aldosterone system;short survey;cerebrovascular accident;systolic blood pressure;treatment response,,2010,,,0,
14,Regulatory action and news,,anticonvulsive agent;ofatumumab;bendamustine;benfluorex;carisbamate;comfyde;cyclophosphamide;ethyl eicosapent;fludarabine;icosapentaenoic acid ethyl ester;imiglucerase;influenza vaccine;lisuride;olanzapine;orciprenaline;peramivir;Pneumococcus vaccine;recombinant enzyme;rituximab;rosuvastatin;unclassified drug;velaglucerase alfa;abdominal pain;access to information;alanine aminotransferase blood level;arthralgia;article;aspartate aminotransferase blood level;Australia;backache;bipolar I disorder;cholesterol blood level;chronic lymphatic leukemia;dizziness;drug formulation;drug hypersensitivity;drug indication;drug information;drug marketing;drug safety;emergency treatment;enzyme replacement;European Union;fatigue;focal epilepsy;food and drug administration;Gaucher disease;headache;health care delivery;health care organization;heart disease;heart infarction;human;Huntington chorea;influenza A (H1N1);influenza A (H3N2);influenza B;Influenza A virus (H1N1);Influenza A virus (H3N2);Influenza B virus;leukopenia;mandatory reporting;mania;nausea;pandemic;partial thromboplastin time;pharmaceutical care;pneumococcal infection;practice guideline;progressive multifocal leukoencephalopathy;prolactin blood level;rash;restless legs syndrome;reverse transcription polymerase chain reaction;risk benefit analysis;risk management;schizophrenia;sedation;side effect;stomatitis;strain identification;Streptococcus pneumonia;cerebrovascular accident;triacylglycerol blood level;tumor lysis syndrome;valvular heart disease;virus identification;weakness;alupent;arzerra;cerezyme;crestor;nenad;prevnar;rituxan;treanda;zyprexa,,2010,,,0,
15,Definite evidence for the use of statins in conditions other than hyperlipidaemia and atherosclerosis is currently lacking,"HMG-CoA reductase inhibitors (statins) are widely used to lower lipid levels and improve outcomes in coronary artery disease. Although statins may provide additional non-atheroprotective benefits in numerous disease states, evidence for these benefits is limited and, for some indications, often conflicting and inconclusive. Currently, there is no definite evidence for the use of statins in conditions other than hyperlipidaemia and atherosclerosis. © 2010 Adis Data Information BV. All rights reserved.",statin (protein);albuminuria;aorta atherosclerosis;asthma;atherosclerosis;bone necrosis;brain ischemia;cardiovascular risk;cardioversion;chronic kidney disease;chronic obstructive lung disease;coronary artery disease;dementia;atrial fibrillation;heart death;heart failure;heart infarction;heart transplantation;heart ventricle arrhythmia;human;hyperimmunoglobulinemia D and periodic fever syndrome;hyperlipidemia;incidence;infection;kidney disease;kidney failure;lung fibrosis;lung transplantation;multiple sclerosis;neoplasm;osteoporosis;Parkinson disease;psychological well being;rheumatoid arthritis;sepsis;short survey;subarachnoid hemorrhage;vasospasm,,2010,,,0,
16,From Preserve's 2009 drug review: A recap of which new drugs to avoid,,acetylsalicylic acid;acetylsalicylic acid plus prasugrel;amlodipine;amlodipine plus olmesartan;amlodipine plus perindopril;betamethasone;betamethasone plus calcipotriol;bortezomib;calcipotriol;dienogest plus estradiol valerate;docetaxel;enalapril;enalapril plus lercanidipine;fosaprepitant;gefitinib;gemcitabine;ibritumomab tiuxetan;laropiprant;laropiprant plus nicotinic acid;lercanidipine;levonorgestrel;nicotinic acid;perindopril;postcoitus contraceptive agent;prasugrel;ranolazine;rosuvastatin;tacrolimus;ulipristal;unclassified drug;unindexed drug;acute coronary syndrome;aggression;agitation;allergic rhinitis;angioplasty;atopic dermatitis;attention deficit disorder;bipolar disorder;bleeding;blood toxicity;bone marrow toxicity;cancer recurrence;candidiasis;cardiovascular disease;cardiovascular risk;childhood disease;conjunctivitis;contraception;Crohn disease;dementia;depression;diabetes mellitus;drug contraindication;emergency contraception;epilepsy;eye disease;follicular lymphoma;gastrointestinal disease;gastrointestinal symptom;geriatric disorder;glaucoma;gynecologic disease;heart infarction;herpes labialis;herpes zoster;hip arthroplasty;human;Human immunodeficiency virus infection;hypercholesterolemia;allergic reaction;hypertension;interstitial pneumonia;iron deficiency;juvenile rheumatoid arthritis;kidney disease;knee arthroplasty;liver disease;non small cell lung cancer;menopause;mental disease;metabolic disorder;musculoskeletal disease;myeloma;neoplasm;neurologic disease;obesity;oral contraception;osteoporosis;otorhinolaryngology;ovary cancer;pain;pelvic inflammatory disease;peripheral neuropathy;pregnancy outcome;psoriasis;psoriasis vulgaris;pulmonary hypertension,,2010,,,0,
17,The surprise question,,phosphate;serum albumin;Canada;cancer patient;cerebrovascular disease;chronic kidney disease;comorbidity;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;disease control;health survey;heart disease;hemodialysis;holistic care;hospice care;human;hypertension;kidney failure;life expectancy;lung disease;medical decision making;medicare;mortality;neoplasm;nephrologist;nephrology;neurologic disease;palliative therapy;peripheral vascular disease;phosphate blood level;physician;predictor variable;priority journal;prospective study;psychosocial care;senescence;short survey;training,,2010,,,0,
18,Monitoring unwanted effects of antipsychotics,"Antipsychotic drugs are licensed as treatment for schizophrenia and other mental health disorders but can cause a range of unwanted effects that require close monitoring by, and close collaboration between, healthcare professionals across a range of settings. This applies to both first-generation and second-generation antipsychotics (FGAs and SGAs; sometimes known as conventional and atypical antipsychotics, respectively). Here we discuss monitoring for unwanted effects of antipsychotics in adults, with a particular focus on SGAs.",amisulpride;atypical antipsychotic agent;chlorpromazine;clozapine;haloperidol;lipid;neuroleptic agent;olanzapine;prolactin;quetiapine;risperidone;acute psychosis;aging;agranulocytosis;akathisia;Alzheimer disease;amenorrhea;aminotransferase blood level;article;blood pressure monitoring;body mass;cardiomyopathy;cardiovascular disease;cerebrovascular accident;cognition;constipation;dementia;diabetes mellitus;drug dose titration;drug megadose;drug withdrawal;dyslipidemia;dystonia;extrapyramidal symptom;feces impaction;galactorrhea;gynecomastia;heart rate;heart ventricle arrhythmia;hip fracture;hospital patient;human;hyperglycemia;hyperprolactinemia;hypersalivation;hypokalemia;hypotension;impaired glucose tolerance;intestine motility;lipid blood level;medical history;myocarditis;neuroleptic malignant syndrome;neutropenia;osteoporosis;paralytic ileus;parkinsonism;patient assessment;patient monitoring;patient transport;physical examination;pneumonia;practice guideline;prolactin blood level,,2011,,,0,
19,Modernizing the NHS: Observations and recommendations from the British Menopause Society,Women's health often declines in middle and old age for reasons that are avoidable. Simple measures including lifestyle change could make a significant difference. Education of women is all important. The BMS feels that the provision of a simple health check of all women at the age of 50 years would provide an excellent opportunity that would serve as a screening as well as an educational visit at which balanced information about appropriate treatments and lifestyle changes in natural and premature menopause should be given to empower women to make an informed choice.,Alzheimer disease;cancer screening;clinical effectiveness;cognitive defect;early diagnosis;health care delivery;health care personnel;health care policy;health care quality;hormone substitution;human;ischemic heart disease;lifestyle modification;medical society;menopause;osteoporosis;patient education;practice guideline;primary medical care;short survey;women's health,,2011,,,0,
20,From the literature,,"Brain Neoplasms/radionuclide imaging/therapy;Dementia/radionuclide imaging;Diagnosis, Differential;Dihydroxyphenylalanine/analogs & derivatives;Fluorodeoxyglucose F18/pharmacokinetics;Glioma/radionuclide imaging/therapy;Humans;Immunotherapy;Inflammation/etiology/radionuclide imaging;Lymphoma, Large B-Cell, Diffuse/radionuclide imaging/therapy;Methionine;Myocardial Infarction/complications/radionuclide imaging;Photochemotherapy;*Positron-Emission Tomography;Radiometry;Radiopharmaceuticals;Restless Legs Syndrome/radionuclide imaging;Sentinel Lymph Node Biopsy;Spinal Cord/metabolism/radionuclide imaging;Spine/radionuclide imaging;Thyroid Nodule/radionuclide imaging/surgery;Tomography, Optical;von Hippel-Lindau Disease/radionuclide imaging",,2012,Mar,,0,
21,Raised risk of MI among older patients starting antipsychotics,,atypical antipsychotic agent;cholinesterase inhibitor;Canada;cardiovascular risk;comorbidity;dementia;heart infarction;human;incidence;note;prescription;risk assessment;side effect,,2012,,,0,
22,"Singapore Health and Biomedical Congress, SHBC 2013","The proceedings contain 327 papers. The special focus in this conference is on Health and Biomedicine. The topics include: Reducing the rate of postoperative endophthalmitis over 11 years-results of a new intervention using intracameral antibiotics; corpus callosum morphology in first episode and chronic schizophrenia; differences in late cardiovascular mortality following acute myocardial infarction among three major Asian ethnicities; exploring relationship of retinal thickness on optical coherence tomography and visual acuity in patients with diabetic macular edema; medication reconciliation in outpatient hospital clinics; utilising discharge planning tools in an inpatient psychiatric rehabilitation services to promote positive clinical outcomes; seven-point subjective global assessment is more time sensitive than conventional subjective global assessment in detecting nutritional changes; Singapore hospice nurses perspectives about spirituality and spiritual care; enhanced infarct stabilisation and cardiac repair with an injectable PEGylated-fibrinogen hydrogel carrying vascular endothelial growth factor (VEGF); identification of tumour suppressive MicroRNAs in multiple myeloma by pharmacologic unmasking; use of a novel stereographic projection software to calculate precise area of peripheral non-perfusion and its correlation with manual grading; a protocol to reduce inter-reviewer variability in computed tomography measurement of orbital floor fractures; impact of genome wide supported psychosis susceptibility NRGN gene on thalamocortical morphology in schizophrenia; improved outcome of myeloma patients in a tertiary hospital; femoral neck fractures-factors affecting ambulatory status in elderly patients more than 65 years old who underwent hip hemiarthroplsty; exploratory factor analysis of the Zarit burden interview in a multi-ethnic Asian community sample; prevalence, awareness, treatment and control of hypertension among Singapore elderly residential population; predictive factors of unscheduled 15-day hospital readmissions; lost in transition-newly qualified registered nurses and their transition to practice journey; national healthcare group clinical educators reflection on web2.0's application in enhancing teaching and lifelong learning in medical education; determinants of clarification studies in medical education research; hypoglycemia management of patients with type 2 diabetes in primary care setting; photograph-assisted dietary review amongst type 2 diabetics in primary care; exploring the feasibility of advanced care planning in persons with early cognitive impairment; roles of miR-186 in circulating tumour cells (CTCs)-mediated metastasis in breast cancer; characterisation of the biological and clinical relevance of RUNX genes in natural killer T-cell lymphoma; a randomised controlled trial comparing single-injection and continuous femoral nerve blocks with patient-controlled analgesia; magnetic resonance imaging (MRI) changes in lower limbs in transition to frailty; prevalence of dilutional hyponatraemia in inpatients and outpatients in Singapore; a prospective randomised study on the patency period of the plastic anti-reflux biliary stent; an academic-practice collaboration through simulation learning; a multicentre study of physiotherapists' knowledge and perceptions in palliative care; post discharge pain experiences following total knee arthroplasty; characteristics of subjective QOL of elderly people with dementia in china and Japan; audit of readmissions to a palliative care unit in a tertiary hospital; factors affecting psychological distress in informal caregivers of Singapore elderly; prevalence of anaemia in patients on aspirin medication in a primary care setting; patient satisfaction with pharmacist-managed hypertension-diabetes-lipids clinic and its relation to medication adherence and beliefs about medication; anthropometric measures and cognition in the Singapore elderly; clinical decision support for high-priority drug-drug interactions; a normative study on the national universi y health system aphasia screening test; a pilot study on the integration of a cognitive-behavioral therapy-based computer game in the clinical treatment of childhood anxiety; barriers of whole-grain intake among healthcare workers in national healthcare group polyclinics; a novel approach to lead screening; effects of computed tomography contrast on bone scans; prevalence and predictors of employment among the Singaporean elderly; evaluating the impact of inpatient accelerated palliative radiation therapy programme in reducing inpatient hospitalisation; socio-demographic correlates of positive mental health; unravelling the relationship between obesity, schizophrenia and cognition; relationship between measures of mental health and functional impairment in primary care; body mass index of elderly persons in Singapore; improving the influenza and pneumococcal vaccination rate of eligible patients with chronic heart failure; reducing near misses from packing errors in inpatient pharmacy; pharmacy-led smoking cessation clinic in dermatology; investigation of high platelet count in random platelet unit and its viability; public attitudes towards mentally-ill persons in Singapore; revisiting the association between parental bonding and risk for psychopathology; pharmacist reviews and outcomes in nursing homes in Singapore; evaluation of the inpatient smoking cessation programme in tan Tock Seng hospital; community forums are effective in improving osteoporosis knowledge; profile of patients referred for podiatry services in primary care; novel use of tigecycline for multiple myeloma in vitro-alternative non-mitochondrial pathways; linking human leucine-rich repeat kinase 2 (LRRK2) gene mutation to cancer development; haploinsufficiency of TP53 in multiple myeloma; bioactive and conductive collagen scaffold for wound healing augmented by electrical stimulation; systematic discovery of novel cilia and ciliopathy genes through functional genomics in the zebrafish; extracellular matrix-based biohybrid skin substitutes; enzyme sensor system for determination of total cholesterol in human serum; intestinal microbial study of gout patients; differences in gut microbiome between schizophrenic patients and healthy individuals; changes in gait associated with sarcopenia; noncultured cellular grafting for vitiligo-a three-year follow-up study; bariatric surgery and its impact on sleep; clinico-epidemiological profile of moderate to severe paediatric atopic dermatitis; influenza vaccination of healthcare workers; a snapshot of audits in the phototherapy unit; a naturalistic longitudinal study in healthy children; retrospective study on autoimmune blistering disease in paediatric patients; association between CHA65S2 score and obstructive sleep apnoea; primary localised cutaneous amyloidosis; high STOP-BANG scores herald adverse perioperative outcomes; neurobehavioral outcomes after traumatic brain injury; extended outcomes by dialysis modality selection in incident patients with end-stage renal disease and ischaemic cardiomyopathy; laparoscopic gastrectomies in gastric cancer patients; survey on factors influencing medication adherence in psychiatric patients; serum brain-derived neurotrophic factor and metabolic indices in patients with schizophrenia; outcomes of non-Tbitrauma patients in a surgical intensive care unit; evaluation of patients screened for MERS-CoV infection at tan Tock Seng hospital, Singapore; thinking twice before using the LMA for obese and older patients-a prospective observational study; comparison study between two apheresis machines; diabetes knowledge in older adults with type 2 diabetes in Singapore; establishing an intensive care unit database; necrotising fasciitis of the head and neck; diabetic chronic kidney disease patients should increase protein intake; the skin-endocrine axis in the management of dermatology patients; dematiaceous mycoses of the skin in Singapore from 2003 to 2010; profile of hearing aids users in Singapore; factors that affect the degree of hearing loss at presentation and hearing aid s ge; cross diagnostic comparisons of quality of life between schizophrenia and bipolar disorder patients; value of hearing questionnaire in predicting hearing impairment; utility of self-perception of hearing loss questions in predicting hearing impairment; burnout, challenges and supportive factors in hospital doctors; exploring stereotypes in healthcare professions; health sciences virtual hospital game as a learning tool in nursing education; application of the RIME framework for education administrators' competencies; bed exit alarm as a novel tool for fall prevention; when prolonged preoperative fasting is a myth; time-motion study for nursing aides activities in a psychiatric hospital; impact of an advanced practice nurse-led heart failure clinic in a secondary hospital in Singapore; managing individuals with diabetes using the diabetes ambulatory stabilisation services (DASS); streamlining process flow for maintenance of 12-lead ECG machine in a cardiology ward; factors of rehabilitation outcomes in primary care physiotherapy; dietary intake of wholegrains of healthcare workers in national healthcare group polyclinics; management of patients with diabetes in two primary care podiatry clinics; preliminary evaluation of shoulder conditions in primary care physiotherapy; prevalence of alcohol problems among elderly in Singapore; prevalence and predictors of tobacco use in elderly Singaporeans; mortality predictors for operative hip fracture patients; a risk index to predict 30 days emergency hospital readmission; compliance of preoperative chest X-rays in anaesthesia clinic; predictors of mortality in patients with chronic kidney disease; continuity of care issues in the Singapore health system; factors influencing patients adherence to follow-up post bariatric surgery; a snapshot of audits in the phototherapy unit; health screening perceptions in Singapore-a grounded theory study; interactive dashboard for monitoring operating theatre operational efficiency; reducing violence through the use of structured therapies; early home visits by care coordinators help to reduce hospital readmission rate; evaluation of a workplace nutrition programme at a hospital; a review of the use of electroencephalography in autism spectrum disorder in the past decade; an alternate plastic packaging to reduce threat of e coli contamination; spatial epidemiology of tuberculosis in Singapore; development of a polarised cellular model for Chikungunya virus infection; summer-winter differences in total vitamin D concentrations in Singapore; effect of femoral nerve block on ambulation following total knee arthroplasty; development of a computer-based objective grading system for facial paralysis; a preliminary finding of EEG differences of children with disruptive behaviour disorders in Singapore; sex hormone concentrations in Singaporean men; deciding where to allocate diabetic educational resources; pseudoexfoliation syndrome at a Singapore eye clinic; corneal thickness in Asian keratoconus patients; reasons influencing non-adherence to medications in psychiatric patients; pilot study on nurses' perceptions towards different aspects of learning; oral conditions among dependent community-dwelling elderly persons; knowledge of osteoporosis among Singapore adults in national healthcare group polyclinics (NHGP) settings and knowledge adequacy of diagnosis and treatment plans of elderly patients on discharge from tertiary hospital.",health;Singapore;human;patient;hospital;aged;diabetes mellitus;primary medical care;health care;prevalence;schizophrenia;hospital patient;hospital readmission;hearing impairment;multiple myeloma;health care personnel;drug therapy;medical audit;Asian;gene;skin;mental patient;learning;tertiary health care;outpatient department;podiatry;medical education;mortality;osteoporosis;medication compliance;computer;outpatient;total knee replacement;femoral nerve;nerve block;follow up;serum;diagnosis;pilot study;hypertension;community;machine;pharmacist;hearing aid;smoking cessation;dermatology;heart failure;physiotherapy;adult;intensive care unit;morphology;bariatric surgery;phototherapy;palliative therapy;chronic kidney disease;nurse;pharmacy;computer assisted tomography;neoplasm;cognition;risk;non insulin dependent diabetes mellitus;mental health;child;computer program;diabetic macular edema;obesity;acute heart infarction;influenza;biomedicine;vaccination;lifelong learning;hypoglycemia;radiotherapy;day hospital;screening;nutrition;population;anxiety;monitoring;childhood;mass screening;anesthesia;cognitive therapy;screening test;aphasia;community sample;interview;decision support system;factorial analysis;cardiovascular mortality;hydrogel;hip;male;patient satisfaction;femur neck fracture;infarction;visual acuity;registered nurse;protein intake;Japan;China;quality of life;distress syndrome;caregiver;anemia;hospital physician;education;diet restriction;nursing assistant;mental hospital;advanced practice nurse;ward;rehabilitation;dietary intake;shoulder;drug interaction;university;hip fracture;thorax radiography;patient care;grounded theory;operating room;violence;grain;electroencephalography;autism;contamination;bone scintiscanning;employment;mobilization;facial nerve paralysis;disruptive behavior;functional disease;body mass;teaching;intracameral drug administration;dementia;spiritual care;apheresis;infection;pain;religion;optical coherence tomography;stomach cancer;physiotherapist;ischemic cardiomyopathy;multicenter study;kidney failure;simulation;biliary stent;traumatic brain injury;retinal thickness;amyloidosis;hyponatremia;hospice;leg;nuclear magnetic resonance imaging;influenza vaccination;rehabilitation center;ethnicity;endophthalmitis;sleep;patient controlled analgesia;myeloma;vitiligo;sarcopenia;gait;microbiome;hospital discharge;intestine;gout;injection;psychosis;randomized controlled trial;atopic dermatitis;longitudinal study;genome;retrospective study;sleep disordered breathing;cholesterol blood level;enzymic biosensor;dialysis,,2013,,,0,
23,"Migraines: can dementia, stroke or heart attack be next? New Harvard research confirms some links, rejects others",,*Dementia;Humans;Migraine Disorders;Myocardial Infarction;Risk Factors;*Stroke,,2013,May,,0,
24,Commentary: Increasing Awareness of a CV Problem With NSAIDs,,celecoxib;cyclooxygenase 2 inhibitor;diclofenac;etoricoxib;ibuprofen;naproxen;nonsteroid antiinflammatory agent;placebo;rofecoxib;Alzheimer disease;ankylosing spondylitis;brain ischemia;cardiovascular disease;cardiovascular risk;cardiovascular thrombotic death;cerebrovascular accident;coronary artery disease;drug recall;drug safety;elevated blood pressure;gastrointestinal toxicity;heart arrest;heart death;heart infarction;human;hypertension;intracardiac thrombosis;meta analysis (topic);note;osteoarthritis;randomized controlled trial (topic);rheumatoid arthritis;risk factor;sudden cardiac death;thrombosis;transient ischemic attack,,2013,,,0,
25,Peptide drugs: New research collaborations and new products,"We report on recent peptide drug discovery and licensing agreements, as well as on the latest generic peptide drug products available on the market.",amyloid beta protein[1-42];enfuvirtide;eptifibatide;exendin 4;hirulog;liraglutide;melusine;metformin;nesiritide;nonstructural protein 3;omega conotoxin MVIIA;parathyroid hormone[1-34];peptide;pioglitazone;prescription drug;recombinant protein;tetracosactide;unclassified drug;venom;algorithm;Alzheimer disease;biotechnological production;chronic pain;cost effectiveness analysis;derivatization;drug dosage form;drug industry;drug purity;drug research;enteric coated tablet;fluorescence resonance energy transfer;high throughput screening;Human immunodeficiency virus infection;intractable pain;licensing;non insulin dependent diabetes mellitus;non ST segment elevation myocardial infarction;osteoporosis;peptidomics;process optimization;protein expression;recombinant DNA technology;short survey,,2013,,,0,
26,Cancer study designs and other stories,,advanced cancer;Alzheimer disease;biochemistry;cancer prognosis;cancer research;cardiovascular mortality;Chinese;cognitive defect;congestive cardiomyopathy;depression;DNA modification;health survey;human;medical education;medical research;methodology;note;observational study;personalized medicine;primary medical care;priority journal;professional competence;professional development;rheumatoid arthritis;tooth implant,,2013,,,0,
27,Menopausal hormone therapy for the primary prevention of chronic conditions: Recommendation statement,,conjugated estrogen plus medroxyprogesterone acetate;estrogen;gestagen;article;breast cancer;cerebrovascular accident;deep vein thrombosis;dementia;endometrium cancer;female;gallbladder disease;hormonal therapy;human;hysterectomy;ischemic heart disease;lung embolism;postmenopause;randomized controlled trial (topic);risk assessment;United States;urine incontinence,,2013,,,0,
28,"Singapore Health and Biomedical Congress, SHBC 2013","The proceedings contain 327 papers. The special focus in this conference is on Health and Biomedicine. The topics include: Reducing the rate of postoperative endophthalmitis over 11 years-results of a new intervention using intracameral antibiotics; corpus callosum morphology in first episode and chronic schizophrenia; differences in late cardiovascular mortality following acute myocardial infarction among three major Asian ethnicities; exploring relationship of retinal thickness on optical coherence tomography and visual acuity in patients with diabetic macular edema; medication reconciliation in outpatient hospital clinics; utilising discharge planning tools in an inpatient psychiatric rehabilitation services to promote positive clinical outcomes; seven-point subjective global assessment is more time sensitive than conventional subjective global assessment in detecting nutritional changes; Singapore hospice nurses perspectives about spirituality and spiritual care; enhanced infarct stabilisation and cardiac repair with an injectable PEGylated-fibrinogen hydrogel carrying vascular endothelial growth factor (VEGF); identification of tumour suppressive MicroRNAs in multiple myeloma by pharmacologic unmasking; use of a novel stereographic projection software to calculate precise area of peripheral non-perfusion and its correlation with manual grading; a protocol to reduce inter-reviewer variability in computed tomography measurement of orbital floor fractures; impact of genome wide supported psychosis susceptibility NRGN gene on thalamocortical morphology in schizophrenia; improved outcome of myeloma patients in a tertiary hospital; femoral neck fractures-factors affecting ambulatory status in elderly patients more than 65 years old who underwent hip hemiarthroplsty; exploratory factor analysis of the Zarit burden interview in a multi-ethnic Asian community sample; prevalence, awareness, treatment and control of hypertension among Singapore elderly residential population; predictive factors of unscheduled 15-day hospital readmissions; lost in transition-newly qualified registered nurses and their transition to practice journey; national healthcare group clinical educators reflection on web2.0's application in enhancing teaching and lifelong learning in medical education; determinants of clarification studies in medical education research; hypoglycemia management of patients with type 2 diabetes in primary care setting; photograph-assisted dietary review amongst type 2 diabetics in primary care; exploring the feasibility of advanced care planning in persons with early cognitive impairment; roles of miR-186 in circulating tumour cells (CTCs)-mediated metastasis in breast cancer; characterisation of the biological and clinical relevance of RUNX genes in natural killer T-cell lymphoma; a randomised controlled trial comparing single-injection and continuous femoral nerve blocks with patient-controlled analgesia; magnetic resonance imaging (MRI) changes in lower limbs in transition to frailty; prevalence of dilutional hyponatraemia in inpatients and outpatients in Singapore; a prospective randomised study on the patency period of the plastic anti-reflux biliary stent; an academic-practice collaboration through simulation learning; a multicentre study of physiotherapists' knowledge and perceptions in palliative care; post discharge pain experiences following total knee arthroplasty; characteristics of subjective QOL of elderly people with dementia in china and Japan; audit of readmissions to a palliative care unit in a tertiary hospital; factors affecting psychological distress in informal caregivers of Singapore elderly; prevalence of anaemia in patients on aspirin medication in a primary care setting; patient satisfaction with pharmacist-managed hypertension-diabetes-lipids clinic and its relation to medication adherence and beliefs about medication; anthropometric measures and cognition in the Singapore elderly; clinical decision support for high-priority drug-drug interactions; a normative study on the national university health system aphasia screening test; a pilot study on the integration of a cognitive-behavioral therapy-based computer game in the clinical treatment of childhood anxiety; barriers of whole-grain intake among healthcare workers in national healthcare group polyclinics; a novel approach to lead screening; effects of computed tomography contrast on bone scans; prevalence and predictors of employment among the Singaporean elderly; evaluating the impact of inpatient accelerated palliative radiation therapy programme in reducing inpatient hospitalisation; socio-demographic correlates of positive mental health; unravelling the relationship between obesity, schizophrenia and cognition; relationship between measures of mental health and functional impairment in primary care; body mass index of elderly persons in Singapore; improving the influenza and pneumococcal vaccination rate of eligible patients with chronic heart failure; reducing near misses from packing errors in inpatient pharmacy; pharmacy-led smoking cessation clinic in dermatology; investigation of high platelet count in random platelet unit and its viability; public attitudes towards mentally-ill persons in Singapore; revisiting the association between parental bonding and risk for psychopathology; pharmacist reviews and outcomes in nursing homes in Singapore; evaluation of the inpatient smoking cessation programme in tan Tock Seng hospital; community forums are effective in improving osteoporosis knowledge; profile of patients referred for podiatry services in primary care; novel use of tigecycline for multiple myeloma in vitro-alternative non-mitochondrial pathways; linking human leucine-rich repeat kinase 2 (LRRK2) gene mutation to cancer development; haploinsufficiency of TP53 in multiple myeloma; bioactive and conductive collagen scaffold for wound healing augmented by electrical stimulation; systematic discovery of novel cilia and ciliopathy genes through functional genomics in the zebrafish; extracellular matrix-based biohybrid skin substitutes; enzyme sensor system for determination of total cholesterol in human serum; intestinal microbial study of gout patients; differences in gut microbiome between schizophrenic patients and healthy individuals; changes in gait associated with sarcopenia; noncultured cellular grafting for vitiligo-a three-year follow-up study; bariatric surgery and its impact on sleep; clinico-epidemiological profile of moderate to severe paediatric atopic dermatitis; influenza vaccination of healthcare workers; a snapshot of audits in the phototherapy unit; a naturalistic longitudinal study in healthy children; retrospective study on autoimmune blistering disease in paediatric patients; association between CHA65S2 score and obstructive sleep apnoea; primary localised cutaneous amyloidosis; high STOP-BANG scores herald adverse perioperative outcomes; neurobehavioral outcomes after traumatic brain injury; extended outcomes by dialysis modality selection in incident patients with end-stage renal disease and ischaemic cardiomyopathy; laparoscopic gastrectomies in gastric cancer patients; survey on factors influencing medication adherence in psychiatric patients; serum brain-derived neurotrophic factor and metabolic indices in patients with schizophrenia; outcomes of non-Tbitrauma patients in a surgical intensive care unit; evaluation of patients screened for MERS-CoV infection at tan Tock Seng hospital, Singapore; thinking twice before using the LMA for obese and older patients-a prospective observational study; comparison study between two apheresis machines; diabetes knowledge in older adults with type 2 diabetes in Singapore; establishing an intensive care unit database; necrotising fasciitis of the head and neck; diabetic chronic kidney disease patients should increase protein intake; the skin-endocrine axis in the management of dermatology patients; dematiaceous mycoses of the skin in Singapore from 2003 to 2010; profile of hearing aids users in Singapore; factors that affect the degree of hearing loss at presentation and hearing aid us ge; cross diagnostic comparisons of quality of life between schizophrenia and bipolar disorder patients; value of hearing questionnaire in predicting hearing impairment; utility of self-perception of hearing loss questions in predicting hearing impairment; burnout, challenges and supportive factors in hospital doctors; exploring stereotypes in healthcare professions; health sciences virtual hospital game as a learning tool in nursing education; application of the RIME framework for education administrators' competencies; bed exit alarm as a novel tool for fall prevention; when prolonged preoperative fasting is a myth; time-motion study for nursing aides activities in a psychiatric hospital; impact of an advanced practice nurse-led heart failure clinic in a secondary hospital in Singapore; managing individuals with diabetes using the diabetes ambulatory stabilisation services (DASS); streamlining process flow for maintenance of 12-lead ECG machine in a cardiology ward; factors of rehabilitation outcomes in primary care physiotherapy; dietary intake of wholegrains of healthcare workers in national healthcare group polyclinics; management of patients with diabetes in two primary care podiatry clinics; preliminary evaluation of shoulder conditions in primary care physiotherapy; prevalence of alcohol problems among elderly in Singapore; prevalence and predictors of tobacco use in elderly Singaporeans; mortality predictors for operative hip fracture patients; a risk index to predict 30 days emergency hospital readmission; compliance of preoperative chest X-rays in anaesthesia clinic; predictors of mortality in patients with chronic kidney disease; continuity of care issues in the Singapore health system; factors influencing patients adherence to follow-up post bariatric surgery; a snapshot of audits in the phototherapy unit; health screening perceptions in Singapore-a grounded theory study; interactive dashboard for monitoring operating theatre operational efficiency; reducing violence through the use of structured therapies; early home visits by care coordinators help to reduce hospital readmission rate; evaluation of a workplace nutrition programme at a hospital; a review of the use of electroencephalography in autism spectrum disorder in the past decade; an alternate plastic packaging to reduce threat of e coli contamination; spatial epidemiology of tuberculosis in Singapore; development of a polarised cellular model for Chikungunya virus infection; summer-winter differences in total vitamin D concentrations in Singapore; effect of femoral nerve block on ambulation following total knee arthroplasty; development of a computer-based objective grading system for facial paralysis; a preliminary finding of EEG differences of children with disruptive behaviour disorders in Singapore; sex hormone concentrations in Singaporean men; deciding where to allocate diabetic educational resources; pseudoexfoliation syndrome at a Singapore eye clinic; corneal thickness in Asian keratoconus patients; reasons influencing non-adherence to medications in psychiatric patients; pilot study on nurses' perceptions towards different aspects of learning; oral conditions among dependent community-dwelling elderly persons; knowledge of osteoporosis among Singapore adults in national healthcare group polyclinics (NHGP) settings and knowledge adequacy of diagnosis and treatment plans of elderly patients on discharge from tertiary hospital.",health;Singapore;human;patient;hospital;aged;diabetes mellitus;primary medical care;health care;prevalence;schizophrenia;hospital patient;hospital readmission;hearing impairment;multiple myeloma;health care personnel;drug therapy;medical audit;Asian;gene;skin;mental patient;learning;tertiary health care;outpatient department;podiatry;medical education;mortality;osteoporosis;medication compliance;computer;outpatient;total knee replacement;femoral nerve;nerve block;follow up;serum;diagnosis;pilot study;hypertension;community;machine;pharmacist;hearing aid;smoking cessation;dermatology;heart failure;physiotherapy;adult;intensive care unit;morphology;bariatric surgery;phototherapy;palliative therapy;chronic kidney disease;nurse;pharmacy;computer assisted tomography;neoplasm;cognition;risk;non insulin dependent diabetes mellitus;mental health;child;computer program;diabetic macular edema;obesity;acute heart infarction;influenza;biomedicine;vaccination;lifelong learning;hypoglycemia;radiotherapy;day hospital;screening;nutrition;population;anxiety;monitoring;childhood;mass screening;anesthesia;cognitive therapy;screening test;aphasia;community sample;interview;decision support system;factorial analysis;cardiovascular mortality;hydrogel;hip;male;patient satisfaction;femur neck fracture;infarction;visual acuity;registered nurse;protein intake;Japan;China;quality of life;distress syndrome;caregiver;anemia;hospital physician;education;diet restriction;nursing assistant;mental hospital;advanced practice nurse;ward;rehabilitation;dietary intake;shoulder;drug interaction;university;hip fracture;thorax radiography;patient care;grounded theory;operating room;violence;grain;electroencephalography;autism;contamination;bone scintiscanning;employment;mobilization;facial nerve paralysis;disruptive behavior;functional disease;body mass;teaching;intracameral drug administration;dementia;spiritual care;apheresis;infection;pain;religion;optical coherence tomography;stomach cancer;physiotherapist;ischemic cardiomyopathy;multicenter study;kidney failure;simulation;biliary stent;traumatic brain injury;retinal thickness;amyloidosis;hyponatremia;hospice;leg;nuclear magnetic resonance imaging;influenza vaccination;rehabilitation center;ethnicity;endophthalmitis;sleep;patient controlled analgesia;myeloma;vitiligo;sarcopenia;gait;microbiome;hospital discharge;intestine;gout;injection;psychosis;randomized controlled trial;atopic dermatitis;longitudinal study;genome;retrospective study;sleep disordered breathing;cholesterol blood level;enzymic biosensor;dialysis;NK T cell lymphoma;fracture;gastrectomy;extracellular matrix;cancer patient;zebra fish;functional genomics;observational study;data base;fasciitis;neck;eukaryotic flagellum;mycosis;electrostimulation;wound healing;breast cancer;bipolar disorder;hearing;questionnaire;self concept;burnout;stereotypy;occupation;health science;nursing education;administrative personnel;prevention;literature;metastasis;cardiology;orbit;haploinsufficiency;circulating tumor cell;gene mutation;tobacco;cognitive defect;in vitro study;planning;medication therapy management;nursing home;mental disease;photography;thrombocyte;therapy;professional practice;workplace;book;thrombocyte count;packaging;Escherichia coli;epidemiology;tuberculosis;model;chikungunya;summer;winter;perfusion;corpus callosum;diseases;pseudoexfoliation;eye;cornea thickness;keratoconus;electroencephalogram;electrocardiogram;plastic;antibiotic agent;vitamin D;microRNA;vasculotropin;fibrinogen;acetylsalicylic acid;lipid;alcohol;sex hormone;brain derived neurotrophic factor;collagen;leucine rich repeat kinase 2;tigecycline,,2013,,,0,22
29,Jellyfish stings and other stories,,amyloid;sumatriptan;Alzheimer disease;breast feeding;dementia;device therapy;drug efficacy;envenomation;heart failure;heart protection;heart ventricle arrhythmia;human;implantable cardioverter defibrillator;infertility therapy;jellyfish sting;migraine;obesity;priority journal;short survey;sudden cardiac death,,2014,,,0,
30,Cardiovascular disease,,beta adrenergic receptor blocking agent;cilostazol;article;cardiovascular disease;cardiovascular mortality;congestive heart failure;dementia;drug surveillance program;end stage renal disease;failure to thrive;heart arrhythmia;atrial fibrillation;heart death;hemodialysis patient;high risk population;human;kidney graft;peripheral occlusive artery disease;peritoneal dialysis;sudden cardiac death;survival time,,2014,,,0,
31,New findings underscore value of palliative care consultations,"A new study suggests that introducing palliative care consultations while patients are still in the ED, rather than waiting until after patients have been admitted, can significantly reduce inpatient length of stay. Experts say the approach may also improve quality of care while patients are in the hospital, and do a better job of meeting patient goals. *Researchers analyzed 1,435 palliative care consults, including 50 that took place in the ED over a four-year period. They found that consultation in the ED was associated with hospital stays that were 3.6 days shorter, on average, than the hospital stays of patients who received palliative care consults following admission to the hospital. * Palliative care typically includes an extensive goals-of-care discussion with patients and families, symptom management, and other services focused on meeting patient needs and improving quality of life. * Experts say the top four groups of patients who can benefit from goals-of-care discussions are patients with metastatic cancer, advanced congestive heart failure, advanced chronic obstructive pulmonary disease, and advanced dementia. *ED administrators interested in making improvements in their approach to palliative care should perform a needs assessment, forge partnerships with community resources, and identify a champion, according to palliative care experts.",article;emergency health service;health services research;human;palliative therapy;patient care;patient referral;United States,,2014,,,0,
32,Atypical neuroleptics in elderly patients: Acute kidney injury,,creatinine;olanzapine;quetiapine;risperidone;acute kidney failure;aged;controlled study;creatinine blood level;dementia;female;heart infarction;heart ventricle arrhythmia;hospitalization;human;hypotension;low drug dose;major clinical study;male;mortality;neuroleptic malignant syndrome;outcome assessment;pneumonia;rhabdomyolysis;short survey;urine retention;very elderly,,2015,,,0,
33,Limitations of Sacubitril/Valsartan in the Management of Heart Failure,"BACKGROUND:: The PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) trial was a double-blind trial that randomized 8442 patients with heart failure (HF) with reduced ejection fraction (HFrEF) to receive twice daily dosing of either 200 mg of LCZ696 or 10 mg of enalapril in addition to standard medical therapy for HF. AREAS OF UNCERTAINTY:: Limitations of this trial include (1) sacubitril has not been tested by itself in the treatment of HFrEF; (2) the maximum recommended dose of valsartan for the treatment of HFrEF was used in this trial, but the maximum recommended dose of enalapril for the treatment of HFrEF was not used; (3) a run-in phase was used in this trial to test the tolerability of LCZ696, and patients who had adverse effects in this period were excluded from randomization; (4) the percent of blacks enrolled in this trial was only 5%; (5) LCZ696 caused a 14% incidence of hypotension; (6) neprilysin inhibition might favor the development of Alzheimer dementia, which was not assessed in the PARADIGM-HF trial; (7) patients with severe symptomatic HF were underrepresented in this trial; (8) major exclusions from this trial included an acute coronary event in the last 3 months, severe pulmonary disease, hepatic impairment, and an estimated glomerular filtration rate <30 mL per minute per 1.73 m. DATA SOURCES:: Review of the PARADIGM-HF trial. RESULTS:: At 27-month follow-up, the PARADIGM-HF trial showed that compared with enalapril, LCZ696 reduced the composite of cardiovascular death or hospitalization for HF 20% (absolute risk reduction 4.7%, P < 0.001). CONCLUSIONS:: The numerous limitations discussed under the areas of uncertainty should be considered when prescribing LCZ696 for the treatment of HFrEF. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.",adverse drug reaction;Alzheimer disease;Black person;cardiovascular system;clinical trial;controlled clinical trial;controlled study;death;drug megadose;drug therapy;estimated glomerular filtration rate;follow up;gene inactivation;heart ejection fraction;heart failure;hospitalization;human;hypotension;liver failure;lung disease;major clinical study;morbidity;mortality;prescription;randomization;randomized controlled trial;risk reduction;side effect;uncertainty;visually impaired person;common acute lymphoblastic leukemia antigen;enalapril;endogenous compound;sacubitril;sacubitril plus valsartan;valsartan,,2016,,10.1097/mjt.0000000000000473,0,38
34,Relationship between Alzheimer's disease and heart failure,,Alzheimer Disease/*etiology;Cerebrovascular Circulation;Heart Failure/*complications;Humans;Risk Factors,,2016,Feb,10.7748/nop.28.1.13.s17,0,
35,PPI use and dementia,,esomeprazole;lansoprazole;omeprazole;pantoprazole;proton pump inhibitor;rabeprazole;age;aged;Alzheimer disease;cerebrovascular accident;cognition;comorbidity;cyanocobalamin deficiency;dementia;depression;diabetes mellitus;disease association;Germany;human;ischemic heart disease;multiinfarct dementia;note;polypharmacy;prescription;risk factor;sex;unspecified dementia,,2016,,,0,
36,Drug and device news may 2016,,17 methylnaltrexone;adalimumab;alogliptin;antineoplastic agent;atezolizumab;bendamustine;benzhydrocodone;biosimilar agent;certolizumab pegol;crizotinib;daptomycin;dianhydrogalactitol;diclofenac;generic drug;mometasone furoate;olodaterol plus tiotropium bromide;orphan drug;oxiconazole;oxycodone;pamrevlumab;pnt2258;polymyxin B;ridinilazole;saxagliptin;sildenafil;tofacitinib;tramadol;unclassified drug;unindexed drug;venetoclax;zolpidem;ablation device;Alzheimer disease;asthma;attention deficit disorder;breath analysis;cardiovascular equipment;cataract extraction;cerebrovascular accident;chronic lymphatic leukemia;Clostridium difficile infection;constipation;device approval;diabetic stomach paresis;drug approval;drug efficacy;emergency ward;gel;heart failure;heart patch;heartLight endoscopic ablation system;human;Human immunodeficiency virus infection;kidney carcinoma;lactose intolerance;liver disease;lung cancer;lung fibrosis;lymphoma;medulloblastoma;multicenter study (topic);multiple myeloma;note;ovary cancer;oxygenator;pacemaker;pain;pancreas cancer;phase 1 clinical trial (topic);phase 2 clinical trial (topic);phase 3 clinical trial (topic);psoriasis;psoriatic arthritis;randomized controlled trial (topic);rheumatoid arthritis;schizophrenia;seizure;spirulina breath test;tendinitis;transitional cell carcinoma;cimzia;cinqair;defitelio;evomela;fg 3019;humira;inflectra;kp201;nasonex;relistor;stiolto respimat;taltz;val 083;venclexta;vyxeos;xalkori;xeljanz;Micra,,2016,,,0,
37,Identifying patients at risk of inappropriate prescribing,,acetylsalicylic acid;amiodarone;anticoagulant agent;beta adrenergic receptor blocking agent;corticosteroid;digoxin;dipeptidyl carboxypeptidase inhibitor;estrogen;glitazone derivative;lithium;loop diuretic agent;metformin;methotrexate;neuroleptic agent;nonsteroid antiinflammatory agent;oral contraceptive agent;warfarin;asthma;chronic kidney disease;cross-sectional study;dementia;drug safety;general practice;groups by age;heart failure;high risk patient;human;inappropriate prescribing;international normalized ratio;note;patient identification;peptic ulcer;prevalence;total quality management;United Kingdom,,2016,,,0,
38,Limitations of Sacubitril/Valsartan in the Management of Heart Failure,"BACKGROUND:: The PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) trial was a double-blind trial that randomized 8442 patients with heart failure (HF) with reduced ejection fraction (HFrEF) to receive twice daily dosing of either 200 mg of LCZ696 or 10 mg of enalapril in addition to standard medical therapy for HF. AREAS OF UNCERTAINTY:: Limitations of this trial include (1) sacubitril has not been tested by itself in the treatment of HFrEF; (2) the maximum recommended dose of valsartan for the treatment of HFrEF was used in this trial, but the maximum recommended dose of enalapril for the treatment of HFrEF was not used; (3) a run-in phase was used in this trial to test the tolerability of LCZ696, and patients who had adverse effects in this period were excluded from randomization; (4) the percent of blacks enrolled in this trial was only 5%; (5) LCZ696 caused a 14% incidence of hypotension; (6) neprilysin inhibition might favor the development of Alzheimer dementia, which was not assessed in the PARADIGM-HF trial; (7) patients with severe symptomatic HF were underrepresented in this trial; (8) major exclusions from this trial included an acute coronary event in the last 3 months, severe pulmonary disease, hepatic impairment, and an estimated glomerular filtration rate <30 mL per minute per 1.73 m. DATA SOURCES:: Review of the PARADIGM-HF trial. RESULTS:: At 27-month follow-up, the PARADIGM-HF trial showed that compared with enalapril, LCZ696 reduced the composite of cardiovascular death or hospitalization for HF 20% (absolute risk reduction 4.7%, P < 0.001). CONCLUSIONS:: The numerous limitations discussed under the areas of uncertainty should be considered when prescribing LCZ696 for the treatment of HFrEF. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.",adverse drug reaction;Alzheimer disease;Black person;cardiovascular system;clinical trial;controlled clinical trial;controlled study;death;drug megadose;drug therapy;estimated glomerular filtration rate;follow up;gene inactivation;heart ejection fraction;heart failure;hospitalization;human;hypotension;liver failure;lung disease;major clinical study;morbidity;mortality;prescription;randomization;randomized controlled trial;risk reduction;side effect;uncertainty;visually impaired person;common acute lymphoblastic leukemia antigen;enalapril;endogenous compound;sacubitril;sacubitril plus valsartan;valsartan,,2016,,10.1097/MJT.0000000000000473,0,
39,Towards better patient care: Drugs to avoid in 2017,"• To help healthcare professionals and patients choose high-quality treatments that minimise the risk of adverse effects, in early 2017 we updated the list of drugs that Prescrire advises health professionals and patients to avoid. • Prescrire's assessments of the harm-benefit balance of new drugs and indications are based on a rigorous procedure that includes a systematic and reproducible literature search, identification of patient-relevant outcomes, prioritisation of the supporting data based on the strength of evidence, comparison with standard treatments, and an analysis of both known and potential adverse effects. • This fifth annual review of drugs to avoid has been extended to cover all drugs examined by Prescrire between 2010 and 2016 and authorised in the European Union, whereas previous reviews only considered drugs marketed in France. We identified 91 drugs that are more harmful than beneficial in all the indications for which they have been authorised in France or in the European Union. • In most cases, when drug therapy is really ne cessary, other drugs with a better harm-benefit balance are available. • Even in serious situations, when no effective treatment exists, there is no justification for prescribing a drug with no proven efficacy that provokes severe adverse effects. It may be acceptable to test these drugs in clinical trials, but patients must be informed of the uncertainty over their harm-benefit balance, and the trial design must be relevant. Tailored supportive care is the best option when there are no available treatments capable of improving prognosis or quality of life, beyond their placebo effect.",agomelatine;alemtuzumab;aliskiren;ambroxol;bezafibrate;bromhexine;canagliflozin;catumaxomab;ciprofibrate;cyclosporin A;dipeptidyl peptidase IV inhibitor;donepezil;flunarizine;mepolizumab;mequitazine;moxifloxacin;natalizumab;nintedanib;olaparib;panobinostat;pioglitazone;placebo;prucalopride;tacrolimus;tetrahydrolipstatin;tibolone;tolcapone;trabectedin;unindexed drug;vandetanib;acute myeloid leukemia;add on therapy;allergy;Alzheimer disease;anaphylaxis;article;asthma;atopic dermatitis;atrial fibrillation;autoimmune disease;autoimmune thyroiditis;behavior disorder;bladder cancer;bleeding;bradycardia;breast cancer;bullous pemphigoid;cancer chemotherapy;cardiovascular disease;chronic constipation;clinical trial (topic);collapse;controlled clinical trial (topic);coughing;cytopenia;depression;diabetes mellitus;diarrhea;digestive system perforation;drug approval;drug choice;drug efficacy;drug exposure;drug fatality;drug indication;drug marketing;drug recall;drug safety;dry eye;European Union;evidence based medicine;extrapyramidal syndrome;eye irritation;eye pain;faintness;fibrosing alveolitis;fracture;gastrointestinal symptom;genital tract infection;heart arrhythmia;heart disease;heart failure;heart muscle conduction disturbance;heart palpitation;hematologic disease;hepatitis;human;hyperoxaluria;hypersensitivity;hypertension;hypotension;idiopathic thrombocytopenic purpura;infection;infusion related reaction;intestine obstruction;ischemia;keratitis;ketoacidosis;kidney disease;kidney failure;liver disease;liver injury;malignant ascites;menopausal syndrome;mental disease;migraine;multiple myeloma;multiple sclerosis;muscle disease;myelodysplastic syndrome;non small cell lung cancer;opportunistic infection;outcome assessment;ovary cancer;pancreatitis;Parkinson disease;patient care;patient safety;personal experience;placebo effect;pneumonia;postmarketing surveillance;prognosis;progressive multifocal leukoencephalopathy;prostate cancer;QT prolongation;quality of life;risk benefit analysis;side effect;skin cancer;skin disease;skin lymphoma;soft tissue sarcoma;Stevens Johnson syndrome;study design;suicidal ideation;suicide;thyroid medullary carcinoma;toxic epidermal necrolysis;unspecified side effect;upper respiratory tract infection;urinary tract infection;venous thromboembolism;vitamin deficiency;vomiting;weight gain;weight reduction;wound healing impairment,,2017,,,0,
40,Influence of multimorbidity on cognition in a normal aging population: A 12-year follow-up in the Maastricht Aging Study,"Objective The prevalence of multimorbidity has risen considerably because of the increase in longevity and the rapidly growing number of older individuals. Today, only little is known about the influence of multimorbidity on cognition in a normal healthy aging population. The primary aim of the present study was to investigate the effect of multimorbidity on cognition over a 12-year period in an adult population with a large age range. Methods Data were collected as part of the Maastricht Aging Study (MAAS), a prospective study into the determinants of cognitive aging. Eligible MAAS participants (N = 1763), 24-81 years older, were recruited from the Registration Network Family Practices (RNH) which enabled the use of medical records. The association between 96 chronic diseases, grouped into 23 disease clusters, and cognition on baseline, at 6 and 12 years of follow-up, were analyzed. Cognitive performance was measured in two main domains: verbal memory and psychomotor speed. A multilevel statistical analysis, a method that respects the hierarchical data structure, was used. Results Multiple disease clusters were associated with cognition during a 12-year follow-up period in a healthy adult population. The disease combination malignancies and movement disorders multimorbidity also appeared to significantly affect cognition. Conclusions The current results indicate that a variety of medical conditions adversely affects cognition. However, these effects appear to be small in a normal healthy aging population. Copyright © 2010 John Wiley & Sons, Ltd.",adult;aged;aging;Alzheimer disease;article;asthma;bronchitis;cardiovascular disease;cerebrovascular disease;chronic obstructive lung disease;cognition;comorbidity;depression;ear disease;eczema;educational status;endocrine disease;eye disease;female;follow up;gastrointestinal disease;general practice;headache;heart arrhythmia;heart failure;human;insulin dependent diabetes mellitus;ischemia;longitudinal study;lung embolism;major clinical study;male;malignant neoplastic disease;medical record;medical record review;memory disorder;mental disease;migraine;mood disorder;motor dysfunction;neurologic disease;non insulin dependent diabetes mellitus;parkinsonism;peptic ulcer;phlebitis;prospective study;psoriasis;psychomotor performance;sex difference;skin ulcer;urinary tract disease;verbal memory,"Aarts, S.;Van Den Akker, M.;Tan, F. E. S.;Verhey, F. R. J.;Metsemakers, J. F. M.;Van Boxtel, M. P. J.",2011,,,0,
41,Risk reduction for cardiac events after primary coronary intervention compared with thrombolysis for acute ST-elevation myocardial infarction (five-year results of the Swedish early decision reperfusion strategy SWEDES Trial),"Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction compares favorably to thrombolysis. In previous studies the benefit has been restricted to the early postinfarction period with no additional risk decrease beyond this period. Long-term outcome after use of third-generation thrombolytics and modern adjunctive pharmaceutics in the 2 treatment arms has not been investigated. This study was conducted to compare 5-year outcome after updated regimens of PPCI or thrombolysis. Patients with ST-elevation myocardial infarction were randomized to enoxaparin and abciximab followed by PPCI (n = 101) or enoxaparin followed by reteplase (n = 104), with prehospital initiation of therapy in 42% of patients. Data on survival and major cardiac events were obtained from Swedish national registries after 5.3 years. PPCI resulted in a better outcome with respect to the composite of death or recurrent myocardial infarction (hazard ratio 0.54, confidence interval 0.31 to 0.95) compared to thrombolysis. This was attributed to a significant decrease in cardiac deaths (hazard ratio 0.16, confidence interval 0.04 to 0.74). The difference evolved continuously over the 5-year follow-up. After adjustment for covariates, a significant benefit remained with respect to cardiac death or recurrent infarction but not for the composite of total survival or recurrent myocardial infarction (p = 0.07). The observed differences were not seen in patients in whom therapy was initiated in the prehospital phase. In conclusion, PPCI in combination with enoxaparin and abciximab compares favorably to thrombolysis in combination with enoxaparin with a risk decrease that stretches beyond the early postinfarction period. Prehospital thrombolysis may, however, match PPCI in long-term outcome. © 2010 Elsevier Inc. All rights reserved.",NCT00806403;abciximab;acetylsalicylic acid;clopidogrel;enoxaparin;reteplase;adult;aged;article;blood clot lysis;clinical trial;controlled clinical trial;controlled study;dementia;disease registry;drug efficacy;emergency care;female;follow up;hazard ratio;heart death;human;intermethod comparison;ischemic heart disease;long term care;major clinical study;male;percutaneous coronary intervention;priority journal;randomized controlled trial;risk reduction,"Aasa, M.;Dellborg, M.;Herlitz, J.;Svensson, L.;Grip, L.",2010,,,0,
42,Mental capacity: Is it important in our daily practice?,,fibrinolytic agent;herbaceous agent;aged;bleeding;brain;case report;chronic kidney failure;clinical assessment;clinical practice;cognition;decision making;dementia;emergency ward;female;heart infarction;human;informed consent;intelligence quotient;law;male;medical ethics;medical information;mental capacity;note;outcome assessment;Pakistan;patient care;percutaneous endoscopic gastrostomy;physician;practice guideline;risk;risk assessment;thorax pain;treatment planning;treatment refusal;university hospital,"Abbasi, Y.;Dale, E.",2010,,,0,
43,Preclinical polymodal hallucinations for 13 years before dementia with Lewy bodies,"Objective. We describe a case of dementia with Lewy bodies (DLB) that presented long-lasting preclinical complex polymodal hallucinations. Background. Few studies have deeply investigated the characteristics of hallucinations in DLB, especially in the preclinical phase. Moreover, the clinical phenotype of mild cognitive impairment-(MCI-) DLB is poorly understood. Methods. The patient was followed for 4 years and a selective phenomenological and cognitive study was performed at the predementia stage. Results. The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS). The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB. Conclusions. This study extends the prognostic value of hallucinations for DLB to the preclinical phases. It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker. Finally, it confirms an association between hallucinations and visuoperceptual impairments at an intermediate stage of the disease course and strongly supports the hypothesis that hallucinations in the earliest stages of DLB may reflect a narcolepsy-like REM-sleep disorder. © 2014 Carlo Abbate et al.",rivastigmine;aged;akathisia;anterograde amnesia;apraxia;article;attention disturbance;auditory processing disorder;bradykinesia;bradyphrenia;brain cortex atrophy;Capgras syndrome;case report;cerebrovascular accident;Charles Bonnet syndrome;computer assisted tomography;daily life activity;daughter;delusion;delusional misidentification;differential diagnosis;diffuse Lewy body disease;disorientation;dysarthria;dysphasia;education;family history;female;follow up;hallucination;heart muscle ischemia;hostility;human;independent living;interview;leukoaraiosis;medical history;mental deterioration;Mini Mental State Examination;motor dysfunction;muscle rigidity;narcolepsy;neuroimaging;neuropsychological test;parasomnia;parkinsonism;patient autonomy;phenomenology;phenotype;polymodal hallucination;prognosis;psychometry;retrograde amnesia;speech disorder;very elderly;white matter injury;widow,"Abbate, C.;Trimarchi, P. D.;Inglese, S.;Viti, N.;Cantatore, A.;De Agostini, L.;Pirri, F.;Marino, L.;Bagarolo, R.;Mari, D.",2014,,,0,
44,Predictors of anticoagulation prescription in nursing home residents with atrial fibrillation,"OBJECTIVES: To determine predictors of oral anticoagulation (OAC) for atrial fibrillation (AF) in long-term care (LTC). DESIGN: Chart review. SETTING: Six LTC facilities in a metropolitan area. PARTICIPANTS: One hundred seventeen residents with AF identified from 934 total residents. MEASUREMENTS: Data was obtained from the medical chart, pharmacy record, and Minimum Data Set (MDS) regarding demographics, medical conditions, falls, fractures, gastrointestinal bleeding (GIB), peptic ulcer disease, dementia, anemia, and physical/cognitive function scales. The recursive partition algorithm was used to construct a model reflecting physician decision patterns that predict prescription of OAC. RESULTS: Among those 117 residents (12.5% of 934) who had AF (age, 84.6 +/- 8 years), OAC was prescribed for 54 (46%); aspirin or clopidogrel: 47 (40%); neither OAC nor any antithrombotic treatment (ATT): 25 (21%). Prior stroke was the primary determinant of OAC. Residents with prior stroke were less likely to be prescribed OAC if they had prior GIB, were non-Caucasian, or had no history of coronary artery disease (CAD). Those without a stroke were less likely to be prescribed OAC if they were younger, had dementia or lower functional status. CONCLUSION: Prior stroke was the primary predictor of OAC use. Our model suggests that physicians may also incorporate concerns of age, bleeding, cognitive and physical function, and ethnicity into the decision-making process. Further study is needed to explore the reasons why 21% of the residents receive neither OAC nor ATT, and why OAC may be less likely to be prescribed to non-Caucasian LTC residents.","Aged;Aged, 80 and over;Anticoagulants/*therapeutic use;Atrial Fibrillation/*drug therapy;Decision Trees;*Homes for the Aged;Humans;Logistic Models;*Nursing Homes;*Practice Patterns, Physicians';Stroke/drug therapy;Thrombolytic Therapy;United States;Warfarin/therapeutic use","Abdel-Latif, A. K.;Peng, X.;Messinger-Rapport, B. J.",2005,Mar-Apr,10.1016/j.jamda.2005.01.006,0,
45,Integrated single-label liquid-phase assay of APOE codons 112 and 158 and a lipoprotein study in British women,"Background: Apolipoprotein E (APOE) is an important element of lipid metabolism and, hence, cardiovascular disorders. APOE has 3 main allelic variants: ε3, ε4, and ε2. Of these, ε3 is the most common, followed by ε4 and ε2. The associations of these isoforms with cardiovascular disorders and Alzheimer disease have been widely studied in different populations. Most of the genotyping in these studies has been performed with gel-based methods, which have important limitations, particularly for large epidemiologic studies. We therefore developed an integrated ""one-tube"" liquid-phase assay. Methods: To measure APOE isoforms, we developed an integrated single-label liquid-phase fluorescence assay containing 2 PCR primers, 2 probes, and 2 quencher oligonucleotides. We used a 384-well LightTyper, but the assay would be generically applicable for use with any fluorescence detector with thermal ramp control. We validated this method and applied it in the British Women's Heart and Health Study. Results: There were 4 melting peaks, at 41, 56, 61, and 69 °C, which generated 6 distinctive patterns representing genotypic combinations of ε3, ε4, and ε2. The magnitude and direction of the associations found with total cholesterol, HDL-cholesterol, triglycerides, and estimated LDL-cholesterol were consistent with previous reports. Conclusion: The one-tube LightTyper assay presented here enables accurate, convenient, and economical genotyping of APQE and can be used for large epidemiologic studies. © 2006 American Association for Clinical Chemistry.",apolipoprotein E;cholesterol;genomic DNA;high density lipoprotein cholesterol;low density lipoprotein cholesterol;oligonucleotide;triacylglycerol;accuracy;adult;aged;Alzheimer disease;article;assay;cardiovascular disease;cholesterol blood level;codon;controlled study;female;fluorescence;genotype;human;hyperlipoproteinemia;ischemic heart disease;lipid analysis;lipid metabolism;major clinical study;nucleotide sequence;polymerase chain reaction;serum;single label liquid phase assay;cerebrovascular accident;triacylglycerol blood level;validation study;LightTyper,"Abdollahi, M. R.;Guthrie, P. A. I.;Smith, G. D.;Lawlor, D. A.;Ebrahim, S.;Day, I. N. M.",2006,,,0,
46,Outcomes of chronic subdural hematoma with preexisting comorbidities causing disturbed consciousness,"OBJECTIVE: Chronic subdural hematoma (CSDH) is widely treated by drainage through a bur hole opening. However, whether and how preexisting comorbidities causing disturbance of consciousness affect patient outcomes remains unclear. METHODS: The authors analyzed 188 consecutive patients with CSDH who were surgically treated at the Neurosurgery Institute of the Kyorin University School of Medicine between 2010 and 2012 and followed them for more than 90 days. The mean patient age was 77.0 years (range 33-101 years) and 56 were women. Patient outcomes including modified Rankin Scale (mRS) score, postoperative morbidity and mortality, and recurrence 90 days after initial surgery were analyzed according to preexisting comorbidities causing disturbance of consciousness. The comorbidities observed in 46 patients (24%) included dementia (30 patients), history of ischemic stroke (10 patients), psychiatric disorders (3 patients), and others (3 patients). RESULTS: Background characteristics of patients with comorbidities showed older patient age (p < 0.001), lower preoperative Glasgow Coma Scale score (p < 0.001), and higher preoperative mRS score (p < 0.001). The mean mRS score 90 days after the neurosurgical procedure was 1.2 in all 188 patients, which was significantly higher in those with comorbidities (p < 0.001). By 1-way ANOVA with repeated measures, interaction existed between the presence of comorbidities and mRS score, and improvement of mRS score was observed in smaller proportions of patients with comorbidities (p = 0.002). By multivariate logistic regression analysis, the presence of comorbidities, patient age, reoperation for recurrence, and preoperative mRS score were significantly related to poor outcomes, defined as mRS score of 3 or more at 90 days after surgery. Postoperative morbidity (p < 0.01) and mortality (p < 0.01) were significantly higher in those with comorbidities, whereas the rate of recurrence of CSDH was not significantly different. CONCLUSIONS The preexistence of comorbidities causing disturbance of consciousness affected severity and outcomes 90 days after surgical treatment of CSDH, and comorbidities were also correlated with aging.",adult;aged;aging;article;brain infarction;brain ischemia;cardiogenic shock;clinical outcome;comorbidity;consciousness disorder;dementia;esophagus carcinoma;female;Glasgow coma scale;human;lung embolism;major clinical study;male;mental disease;morbidity;neurosurgery;pneumonia;postoperative complication;postoperative hemorrhage;postoperative period;preoperative evaluation;priority journal;recurrent disease;reoperation;subdural hematoma;surgical mortality;transient ischemic attack;treatment outcome,"Abe, Y.;Maruyama, K.;Yokoya, S.;Noguchi, A.;Sato, E.;Nagane, M.;Shiokawa, Y.",2017,,10.3171/2016.3.jns152957,0,
47,Comorbility in the elderly: Epidemiology and clinical features,"Comorbidity has been defined as the presence of two or more diseases in the same subject and it represents a peculiar clinical characteristic of elderly patients. Advanced age is characterized by the presence in the same subject of multiple diseases due to an age-related increased of chronic diseases. Several indexes has been proposed to evaluate the comorbidity in the elderly: CIRS (Cumulative Illness Rating Scale), Kaplan-Feinstein index, Charlson index, Index of coexistent diseases (ICED) and Geriatric index of comorbidity (GIC). These methods show some difficulties especially in the cognitive impaired elderly patients. In a study from ""Osservatorio Geriatrico Campano"", a region of Southern Italy, it has been demonstrated that comorbidity is strictly correlated to mortality by studying the prevalence of single disease and comorbidity. In the mean time, the interaction among disease determines a large increase of the mortality risk at 12 years follow-up. Thus, comorbidity should be always taken into account especially in age-related epidemiological studies.",aging;Alzheimer disease;article;breast cancer;clinical feature;cognitive defect;comorbidity;congestive heart failure;correlation analysis;depression;diabetes mellitus;epidemiological data;follow up;geriatric disorder;human;Italy;knee osteoarthritis;methodology;mortality;prevalence;prostate cancer;quality of life;rating scale;risk assessment;risk factor,"Abete, P.;Testa, G.;Della Morte, D.;Mazzella, F.;Galizia, G.;D'Ambrosio, D.;Visconti, C.;Gargiulo, G.;Cacciatore, F.;Rengo, F.",2004,,,0,
48,Further evidence to support the role of infectious agets and-or immunologic sequelae in the causality of the chronic and degenerative disease of man,,"Aleutian Mink Disease/immunology;Animals;Antigen-Antibody Complex;Arteritis/immunology/microbiology;Cardiovascular Diseases/*immunology/*microbiology;Central Nervous System Diseases/*immunology/*microbiology;Chronic Disease;Coxsackievirus Infections/immunology;Creutzfeldt-Jakob Syndrome/immunology/microbiology;Dna;Equine Infectious Anemia/immunology;Glomerulonephritis/*immunology/*microbiology;Horses;Humans;Immunoglobulins;Kuru/immunology/microbiology;Lupus Erythematosus, Systemic/immunology;Malaria/immunology;Myocarditis/immunology/microbiology;Rheumatic Heart Disease/immunology;Streptococcal Infections/immunology;Subacute Sclerosing Panencephalitis/immunology/microbiology","Abinanti, F. R.",1970,Oct 30,,0,
49,"Age, frailty, disability, institutionalization, multimorbidity or comorbidity. Which are the main targets in older adults?","Objectives: Age, frailty, disability, institutionalization, multimorbidity or comorbidity are main risk factors for serious health adverse outcomes in older adults. However, the adjusted relevance of each of them in order to determine which characteristics must be of importance for health policies in this population group, has not been established. Design: Concurrent population-based cohort study. Setting: Albacete city, Spain. Participants: 842 participants over age 70 from the FRADEA Study. Measurements: Age, gender, institutionalization, frailty (Fried's criteria), previous disability in basic activities of daily living (BADL) (Barthel index), comorbidity (Charlson index), and multimorbidity (> 2 from 14 selected diseases) were recorded in the basal visit. The combined event of mortality or incident disability in BADL was determined in the follow-up visit. The risk of presenting adverse events was determined by Kaplan-Meier analysis and logistic regression adjusted for age, sex, and institutionalization. Results: Mean follow-up 520 days. 63 participants died (7.5%). Among the remaining 779, 191 lost at least one BADL (24.5%). The combined event of mortality or disability was present in 254 participants (30.2%). Age (OR 1.10, 95%CI 1.06-1.14), frailty (OR 3.07, 95%CI 1.63-5.77), disability (OR 2.19, 95%CI 1.43-3.36) and institutionalization (OR 2.73, 95%CI 1.68-4.44) were independently associated with the combined adverse event, but not comorbidity or multimorbidity. In subjects younger than 80, only frailty, disability and institutionalization were risk factors, and in those aged ≥ 80, only age, disability and institutionalization were. Conclusions: Health policies for older adults must take into account mainly frailty and disability in subjects younger than 80 and disability in those older than 80. The Journal of Nutrition, Health & Aging©.",ADL disability;adverse outcome;age;aged;anemia;article;asthma;Barthel index;bronchus disease;cerebrovascular accident;Charlson Comorbidity Index;chronic obstructive lung disease;cohort analysis;comorbidity;coronary artery disease;daily life activity;dementia;depression;diabetes mellitus;dyslipidemia;female;follow up;frail elderly;atrial fibrillation;heart failure;human;hypertension;institutionalization;major clinical study;male;mortality;parkinsonism;priority journal;risk factor;skin cancer;Spain;telephone interview;time of death,"Abizanda, P.;Romero, L.;Sanchez-Jurado, P. M.;Martinez-Reig, M.;Alfonso-Silguero, S. A.;Rodriguez-Manas, L.",2014,,,0,
50,Comorbid subjective cognitive decline and sleep apnea significantly increase the risk of incident dementia: results from the prevention of Alzheimer's disease with vitamin E and selenium study,"Background: Subjective memory complaints (SMC) reflect patientidentified deficits in memory and have been linked to increased risk of future dementia in non-demented (including cognitively intact) older adults, but the relationship between SMC and comorbid medical conditions is not well understood. Methods: Double-blind, placebo controlled 2x2 randomized controlled trial that transformed into an exposure cohort following discontinuation of supplementation in the SELECT parent trial. Setting: Prevention of Alzheimer's with Vitamin E and Selenium (PREADVISE) participants were assessed for incident dementia at 130 local clinical study sites in the United States, Canada, and Puerto Rico during the controlled trial phase and were later followed by telephone from a centralized location during the post exposure (observational) phase. PREADVISE enrolled a total of 7,547 non-demented men age 60 and older; 4,271 were able to participate in the observational study. Participants were interviewed at baseline for memory complaints (""Do you have more problems with your memory than most people?"") and presence of comorbidities including sleep apnea, stroke, hypertension, diabetes, history of traumatic brain injury (TBI), coronary artery bypass graft (CABG), and congestive heart failure. Results: Men who reported memory problems (SMC) (n=123) at baseline were significantly more likely to also report history of sleep apnea and TBI and had significantly worse scores on the baseline memory screen (Table 1). Cox proportional hazards regression revealed that the effect of baseline SMC depended on the presence of sleep apnea (p for interaction=0.015). Men who reported sleep apnea and SMC at baseline had 14.9 times (95%CI: 6.0-37.0) the hazard of incident dementia compared to men with sleep apnea but no SMC. For men without sleep apnea, SMC more than tripled the hazard (HR=3.86). History of CABG and stroke also significantly increased the hazard of incident dementia (Table 2). Conclusions: Memory complaints and comorbidities in non-demented older men strongly predicted future dementia in the PREADVISE cohort. Special care should be paid to management of comorbidities in older adult men who report memory problems, as these may be modifiable risk factors for dementia onset. (Table Presented).",sleep disordered breathing;risk;dementia;prevention;Alzheimer disease;human;memory;male;hazard;adult;cerebrovascular accident;randomized controlled trial (topic);exposure;telephone;controlled study;Puerto Rico;Canada;coronary artery bypass graft;proportional hazards model;United States;clinical study;randomized controlled trial;parent;traumatic brain injury;supplementation;diabetes mellitus;congestive heart failure;hypertension;observational study;risk factor;alpha tocopherol;selenium;placebo;Sr-compmed,"Abner, El;Ding, X;Caban-Holt, Am;Schmitt, Fa;Kryscio, Rj",2015,,,0,
51,Comorbid subjective cognitive decline and sleep apnea significantly increase the risk of incident dementia: Results from the prevention of Alzheimer's disease with vitamin E and selenium study,"Background: Subjective memory complaints (SMC) reflect patientidentified deficits in memory and have been linked to increased risk of future dementia in non-demented (including cognitively intact) older adults, but the relationship between SMC and comorbid medical conditions is not well understood. Methods: Double-blind, placebo controlled 2x2 randomized controlled trial that transformed into an exposure cohort following discontinuation of supplementation in the SELECT parent trial. Setting: Prevention of Alzheimer's with Vitamin E and Selenium (PREADVISE) participants were assessed for incident dementia at 130 local clinical study sites in the United States, Canada, and Puerto Rico during the controlled trial phase and were later followed by telephone from a centralized location during the post exposure (observational) phase. PREADVISE enrolled a total of 7,547 non-demented men age 60 and older; 4,271 were able to participate in the observational study. Participants were interviewed at baseline for memory complaints (""Do you have more problems with your memory than most people?"") and presence of comorbidities including sleep apnea, stroke, hypertension, diabetes, history of traumatic brain injury (TBI), coronary artery bypass graft (CABG), and congestive heart failure. Results: Men who reported memory problems (SMC) (n=123) at baseline were significantly more likely to also report history of sleep apnea and TBI and had significantly worse scores on the baseline memory screen (Table 1). Cox proportional hazards regression revealed that the effect of baseline SMC depended on the presence of sleep apnea (p for interaction=0.015). Men who reported sleep apnea and SMC at baseline had 14.9 times (95%CI: 6.0-37.0) the hazard of incident dementia compared to men with sleep apnea but no SMC. For men without sleep apnea, SMC more than tripled the hazard (HR=3.86). History of CABG and stroke also significantly increased the hazard of incident dementia (Table 2). Conclusions: Memory complaints and comorbidities in non-demented older men strongly predicted future dementia in the PREADVISE cohort. Special care should be paid to management of comorbidities in older adult men who report memory problems, as these may be modifiable risk factors for dementia onset. (Table Presented).",sleep disordered breathing;risk;dementia;prevention;Alzheimer disease;human;memory;male;hazard;adult;cerebrovascular accident;randomized controlled trial(topic);exposure;telephone;controlled study;Puerto Rico;Canada;coronary artery bypass graft;proportional hazards model;United States;clinical study;randomized controlled trial;parent;traumatic brain injury;supplementation;diabetes mellitus;congestive heart failure;hypertension;observational study;risk factor;alpha tocopherol;selenium;placebo;Sr-compmed,"Abner, E. L.;Ding, X.;Caban-Holt, A. M.;Schmitt, F. A.;Kryscio, R. J.",2015,,,0,50
52,Predictors for return to own home and being alive at 6 months after nursing home intermediate care following acute hospitalization,"Purpose: To investigate factors associated with ability to return home and being alive at 6 months, in a population of older community living patients selected for nursing home intermediate care after acute hospitalization. Methods: Prospective observational cohort study carried out between June 2011 and December 2012. Demographic and clinical information, comprehensive geriatric assessment (CGA) and patient outcomes were registered on consecutive patients admitted from both orthopaedic and medical hospital departments. Results: Five hundred and fifty-seven patients were included, median age was 86 years. Three hundred and forty (61%) patients had a medical and 217 (39%) an orthopaedic admission diagnosis. Median length of stay was 14 days. Eighty percent of the patients were able to return home and 89% were alive at 6 months. Low Timed up and go (TUG), indicating better physical function and high score on Barthel Index (BI) and Mini-Mental Status Examination (MMSE) were significantly associated with the ability to return home. A low level of the cardiac failure marker N-terminal pro-brain natriuretic hormone (NTpro-BNP) was significantly associated with being alive at 6 months. Conclusions: In post-acute intermediate care in nursing home, significant differences were demonstrated between patients concerning the ability to return home and being alive at 6 months. A low TUG, high BI and high MMSE were significantly related to the ability to return home while low NTpro-BNP was an independent predictor for being alive at 6 months. © 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.",amino terminal pro brain natriuretic peptide;aged;article;Barthel index;cohort analysis;community living;female;geriatric assessment;hospital admission;hospital department;hospital discharge;hospitalization;human;major clinical study;male;Mini Mental State Examination;nursing home;observational study;outcome assessment;prediction;priority journal;survival;very elderly,"Abrahamsen, J. F.;Haugland, C.;Nilsen, R. M.;Ranhoff, A. H.",2014,,,0,
53,Providing Acute Care at Home: Community Paramedics Enhance an Advanced Illness Management Program-Preliminary Data,"Models addressing urgent clinical needs for older adults with multiple advanced chronic conditions are lacking. This observational study describes a Community Paramedicine (CP) model for treatment of acute medical conditions within an Advanced Illness Management (AIM) program, and compares its effect on emergency department (ED) use and subsequent hospitalization with that of traditional emergency medical services (EMS). Community paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals' homes. They were also able to transport to the ED if needed. The CP model was implemented between January 1, 2014, and April 30, 2015 in a suburban-urban AIM program. Participants included 1,602 individuals enrolled in the AIM program with high rates of dementia, decubitus ulcers, diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease. Participants had a median age of 83 and an average of five activity of daily living dependencies (range 0-6). During the study period, there were 664 CP responses and 1,091 traditional EMS transports to the ED among 773 individuals. Only 22% of CP responses required transport; 78% were evaluated and treated in the home. Individuals that community paramedics transported to the ED had higher rates of hospitalization (82.2%) than those using traditional EMS (68.9%) (P < .001). Post-CP surveys showed that all respondents felt the program was of high quality. Results support the potential benefits of CP and invite further evaluation of this innovative care model.",Advanced Illness Management;Community Paramedicine;Mobile Integrated Healthcare;acute care;community paramedics,"Abrashkin, K. A.;Washko, J.;Zhang, J.;Poku, A.;Kim, H.;Smith, K. L.",2016,Aug 30,10.1111/jgs.14484,0,54
54,Providing Acute Care at Home: Community Paramedics Enhance an Advanced Illness Management Program—Preliminary Data,"Models addressing urgent clinical needs for older adults with multiple advanced chronic conditions are lacking. This observational study describes a Community Paramedicine (CP) model for treatment of acute medical conditions within an Advanced Illness Management (AIM) program, and compares its effect on emergency department (ED) use and subsequent hospitalization with that of traditional emergency medical services (EMS). Community paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals’ homes. They were also able to transport to the ED if needed. The CP model was implemented between January 1, 2014, and April 30, 2015 in a suburban–urban AIM program. Participants included 1,602 individuals enrolled in the AIM program with high rates of dementia, decubitus ulcers, diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease. Participants had a median age of 83 and an average of five activity of daily living dependencies (range 0–6). During the study period, there were 664 CP responses and 1,091 traditional EMS transports to the ED among 773 individuals. Only 22% of CP responses required transport; 78% were evaluated and treated in the home. Individuals that community paramedics transported to the ED had higher rates of hospitalization (82.2%) than those using traditional EMS (68.9%) (P <.001). Post-CP surveys showed that all respondents felt the program was of high quality. Results support the potential benefits of CP and invite further evaluation of this innovative care model.",furosemide;ipratropium bromide;methylprednisolone;ondansetron;salbutamol;acute disease;aged;article;cerebrovascular accident;chronic obstructive lung disease;community medicine;congestive heart failure;decubitus;dementia;diabetes mellitus;emergency care;emergency health service;female;health care quality;health care utilization;home care;hospitalization;human;major clinical study;malaise;male;observational study;patient transport;prospective study;protein calorie malnutrition;telemedicine;very elderly,"Abrashkin, K. A.;Washko, J.;Zhang, J.;Poku, A.;Kim, H.;Smith, K. L.",2016,,10.1111/jgs.14484,0,
55,The brain in congestive heart failure,"In the present paper we discuss two issues about relationships between congestive heart failure and the brain. First, major acute cerebrovascular events are very frequent among elderly people, but stroke does not appear to be frequently associated with congestive heart failure. Second, some cardiovascular conditions may determine progressive damage of cerebral tissue, with consequent impairment of cognitive functions. The association of cognitive impairment and cardiovascular diseases may dramatically increase morbility and mortality risks in the elderly. Recent studies seem to show that hypotension and congestive heart failure are risk factors for dementia in elderly people. In view of this data, an Italian multicentric study on congestive heart failure in hospitalized elderly patients (CHF Italian Study I) included a brief screening of cognitive abilities (MMSE). The presence of congestive heart failure induced a significant decrease of MMSE scores: mean MMSE score after statistical adjustment for the other variables was about one point lower in patients with congestive heart failure respect to elderly patients affected by heart disease but without congestive heart failure. A novel multicentric study (CHF Italian Study II) has been performed to identify cognitive functions more specifically impaired during congestive heart failure in the elderly. Preliminary data relative to 385 patients, confirmed that congestive heart failure may induce a generalized impairment of cognitive functions. These data have relevant clinical implications because they demonstrate that a multidisciplinary approach is necessary in these patients, both for prevention and rehabilitation therapy.",,"Acanfora, D.;Trojano, L.;Iannuzzi, G. L.;Furgi, G.;Picone, C.;Rengo, C.;Abete, P.;Rengo, F.",1996,Nov-Dec,,0,
56,An unusual presentation of Listeria monocytogenes rhombencephalitis,"We describe a case of 52-year-old woman with a medical history of Crohn's disease presented abrupt fever, asymmetrical multiple cranial nerve palsies and focal neurological symptoms localized to the brainstem. The patient was initially diagnosed with ischaemic stroke, because of acute clinical course and results of neuroimaging. Cerebrospinal fluid analysis revealed mild infection with negative Gram staining and culture. Final diagnosis of Listeria monocytogenes brainstem infection (rhombencephalitis) was set up on the basis of further clinical course and positive blood cultures. Listerial rhombencephalitis should be kept in mind in immunocompromised adult patients who develop fever, asymmetrical multiple cranial nerve palsies and focal neurological symptoms localized to the brainstem even without typical neuroimaging, cerebrospinal fluid findings and negative cultures. Early diagnosis and adequate antibiotic treatment is of crucial importance.",ampicillin;aripiprazole;C reactive protein;ceftriaxone;hypertensive factor;mesalazine;methylprednisolone;metronidazole;olanzapine;abdominal infection;abducens nerve paralysis;adult;article;artificial ventilation;bacterial infection;brain infection;case report;central left facial nerve palsy;computed tomographic angiography;computer assisted tomography;controlled study;Crohn disease;diffusion weighted imaging;diplopia;dysarthria;electrocardiography;facial nerve paralysis;female;fever;fluid attenuated inversion recovery imaging;gastrointestinal hemorrhage;general condition deterioration;hemiparesis;hemorrhoid;human;hypotension;hypoventilation;left sided weakness;Listeria monocytogenes;listeria rhombencephalitis;mental deterioration;middle aged;mild dysarthria;neuroimaging;ophthalmoplegia;pleocytosis;rare disease;resuscitation;schizophrenia;sudden cardiac death;tachycardia;thorax radiography;weakness,"Acewicz, A.;Witkowski, G.;Rola, R.;Ryglewicz, D.;Sienkiewicz-Jarosz, H.",2017,,10.1016/j.pjnns.2016.12.004,0,
57,No additional prognostic value of genetic information in the prediction of vascular events after cerebral ischemia of arterial origin: The PROMISe study,"Background: Patients who have suffered from cerebral ischemia have a high risk of recurrent vascular events. Predictive models based on classical risk factors typically have limited prognostic value. Given that cerebral ischemia has a heritable component, genetic information might improve performance of these risk models. Our aim was to develop and compare two models: one containing traditional vascular risk factors, the other also including genetic information. Methods and Results: We studied 1020 patients with cerebral ischemia and genotyped them with the Illumina Immunochip. Median follow-up time was 6.5 years; the annual incidence of new ischemic events (primary outcome, n=198) was 3.0%. The prognostic model based on classical vascular risk factors had an area under the receiver operating characteristics curve (AUC-ROC) of 0.65 (95% confidence interval 0.61-0.69). When we added a genetic risk score based on prioritized SNPs from a genome-wide association study of ischemic stroke (using summary statistics from the METASTROKE study which included 12389 cases and 62004 controls), the AUC-ROC remained the same. Similar results were found for the secondary outcome ischemic stroke. Conclusions: We found no additional value of genetic information in a prognostic model for the risk of ischemic events in patients with cerebral ischemia of arterial origin. This is consistent with a complex, polygenic architecture, where many genes of weak effect likely act in concert to influence the heritable risk of an individual to develop (recurrent) vascular events. At present, genetic information cannot help clinicians to distinguish patients at high risk for recurrent vascular events.",adult;aged;area under the curve;article;brain ischemia;cardiovascular disease;cardiovascular risk;cohort analysis;controlled study;female;follow up;genetic association;genetic risk;genotyping technique;heart infarction;heredity;human;incidence;major clinical study;male;prediction;prognosis;receiver operating characteristic;risk factor;single nucleotide polymorphism;vascular disease,"Achterberg, S.;Kappelle, L. J.;De Bakker, P. I. W.;Traylor, M.;Algra, A.;Van Der Graaf, Y.;Grobbee, D. E.;Rutten, G. E. H. M.;Visseren, F. L. J.;Moll, F. L.;Mali, W. P. T. M.;Doevendans, P. A.;Martin, F.;Holliday, E. G.;Sudlow, C.;Hopewell, J. C.;Cheng, Y. C.;Fornage, M.;Ikram, M. A.;Malik, R.;Bevan, S.;Thorsteinsdottir, U.;DeStefano, A. L.;Worrall, B. B.;Reiner, A. P.;Mitchell, B. D.;Clarke, R.;Levi, C.;Seshadri, S.;Boncoraglio, G. B.;Sharma, P.;Bis, J. C.;Gretarsdottir, S.;Psaty, B. M.;Rothwell, P. M.;Rosand, J.;Meschia, J. F.;Stefansson, K.;Dichgans, M.;Markus, H. S.",2015,,,0,
58,"Pain in European long-term care facilities: Cross-national study in Finland, Italy and the Netherlands","There have been very few and limited cross-national comparisons concerning pain among residents of long-term care facilities in Europe. The aim of the present cross-sectional study has been to document the prevalence of pain, its frequency and severity as well as its correlates in three European countries: Finland (north), Italy (south) and the Netherlands (western central). Patients (aged 65 years or above) were assessed with the Minimum Data Set 2.0 (MDS).The final sample comprised 5761 patients from 64 facilities in Finland, 2295 patients from 8 facilities in the Netherlands and 1959 patients from 31 facilities in Italy. The prevalence of pain - defined as any type of pain - varied between 32% in Italy, 43% in the Netherlands and 57% in Finland. In nearly 50% of cases, pain was present daily; there were no significant differences in pain prevalence between patients with cancer diagnosis and those with non-cancer diagnosis. Regardless of the different prevalence estimates, pain was moderate-to-severe in over 50% of cases in all the countries. In multivariate logistic regression models, clinical correlates of pain were substantially similar across countries: pain was positively correlated with more severe physical disability (ADL impairment), clinical depression and a diagnosis of osteoporosis. Pain was negatively correlated with a diagnosis of dementia and more severe degrees of cognitive deterioration. We conclude that pain is frequently encountered in long-term care facilities in Europe and that, despite cultural and case-mix differences, pain speaks one language. © 2009 International Association for the Study of Pain.",aged;article;cancer pain;chronic obstructive lung disease;controlled study;dementia;depression;diabetes mellitus;disease severity;Europe;female;Finland;health care facility;heart failure;hip fracture;human;Italy;major clinical study;male;mental deterioration;neoplasm;Netherlands;osteoporosis;pain;Parkinson disease;peripheral vascular disease;prevalence;priority journal;cerebrovascular accident,"Achterberg, W. P.;Gambassi, G.;Finne-Soveri, H.;Liperoti, R.;Noro, A.;Frijters, D. H. M.;Cherubini, A.;Dell'Aquila, G.;Ribbe, M. W.",2010,,,0,
59,Nutrition in palliative care,"Nutrition in palliative care and at the end of life should be one of the goals for improving quality of life. It is important to address issues of food and feeding at this time to assist in the management of troublesome symptoms as well as to enhance the remaining life. While this paper focuses upon the nutritional aspects of cancer in palliative care, the sentiments are applicable to other serious chronic illnesses such as advanced cardiac failure, chronic obstructive pulmonary disease and dementia. Cancer and its treatments exert a major impact upon physical and psychological reserves and at the end of life problems with appetite and the ability to eat and drink compound such impact. The aims of nutritional care minimize food-related discomfort and maximize food enjoyment. Identification of any nutritional problems can facilitate the employment of strategies which need to be discussed with the patient and their families and reviewed regularly as conditions change. Ethical questions will be raised concerning the provision of food and fluids to a person nearing the end of their life. Nurses need to acknowledge that food has greater significance than the provision of nutrients.",article;caloric intake;conflict;ethics;human;malnutrition;methodology;neoplasm;nurse attitude;nutritional status;nutritional support;palliative therapy;patient care planning;patient selection;psychological aspect;quality of life,"Acreman, S.",2009,,,0,
60,The Cognitive Ageing Nutrition and Neurogenesis (CANN) trial: investigating the effects of a flavonoid/fatty acid supplement on cognitive function,"Inclusion criteria: Male and female, aged 55 years and over Mild cognitive impairment (MCI) or subjective memory impairment (SMI) with no indication of clinical dementia or depression Willing and able to provide written informed consent. Understands and is willing and able to comply with all study procedures. Fluent in written and spoken English. In good general health including blood biochemical, haematological and urinalysis within the normal range at screening (as judged by the clinical advisor) Normal, or corrected to normal vision and hearing Right handed, for MRI Stable use of any prescribed medication for at least four weeks Exclusion criteria: Diagnosis of Alzheimer's disease (AD) or other form of dementia or significant neurological disorder Parent or sibling who developed premature dementia <60y (suggestive of a familial monogenic form of cognitive decline) Past history or MRI evidence of brain damage including significant trauma, stroke, learning difficulties or serious neurological disorder, including loss of consciousness > 24 hours History of alcohol or drug dependency within the last 2 years Other clinically diagnosed psychiatric disorder likely to affect the cognitive measures (as judged by clinical adviser) Existing diagnosed gastrointestinal disorders likely to impact on absorption of flavonoids and fatty acids (as judged by clinical adviser) Major cardiovascular event, e.g. myocardial infarction or stroke, in the last 12 months Carotid stents or severe stenosis Known allergy to fish or any other component in the intervention supplements Existing medical conditions likely to affect the study measures (as judged by clinical adviser) Uncontrolled hypertension (Systolic Blood Pressure (SBP) >140mmHg, Diastolic Blood Pressure (DBP) >90mmHg) BMI >40kg/m2 <Condition>Mild Cognitive Impairment;Subjective Memory Impairment</Condition> Fatty acid/flavonoid blend. Daily (for 12 months) ingestion of study product containing 1.5g EPA + DHA, and 550mg of cocoa flavanols, provided as a cocoa extract. Compliance will be monitored using daily study food logs completed by the participant after taking their study treatments, along with counting the number of returned treatments at each study session. Number of false positive responses during the picture recognition task of the CDR Computerized Cognitive Assessment System. This is a measure of cognitive function. To investigate whether study food has beneficial effects on brain structure and volume (and in particular the hippocampus, which is the main brain region associated with age related cognitive decline). This is assessed using MRI. ;Assess the impact of intervention on gut microflora speciation. Gut microflora speciation assessed by faecal sample.;Examine response to treatment according to baseline APOE status. APOE is assessed using a serum assay. ;Establish the impact of intervention on circulating biomarkers of cognition. Biomarkers to include BDNF, ß-amyloid, plasma lipids, inflammatory markers, nitric oxide and fatty acids, flavonoids and their metabolites (plasma and urine);Examine the effect of intervention on executive function (cognitive domain) as measured by the CDR battery and other validated instruments. ;Establish the impact of intervention on circulating biomarkers of cardiovascualr health. Biomarkers to include BDNF, ß-amyloid, plasma lipids, inflammatory markers, nitric oxide and fatty acids, flavonoids and their metabolites (plasma and urine);To investigate whether study food has beneficial effects on brain chemistry. This is assessed by MRI MRS scan. ; To investigate whether study food has beneficial effects on cerebrovascular (brain) blood flow. This is assessed by MRI.;Assess the impact of intervention on gut microflora metabolism. Gut microflora metabolism assessed by faecal sample.;Examine response to treatment according to baseline BDNF status. BDNF status is measured from a blood serum assay.;Examine the impact of intervention on language (cognitive domain) as measured on the CDR battery and other validated instruments Examine the impa t of intervention on visuospatial function (cognitive domain) as measured on the CDR battery and other validated instruments;Examine the impact of intervention on attention (cognitive domain) as measured by the CDR battery and other validated instruments",Sr-dementia,Actrn,2015,,,0,
61,"A randomised, double-blind, placebo-controlled, crossover trial investigating the effects of two nutraceutical combination formulas on mental fatigue, mood and neurocognitive performance in healthy adults","Inclusion criteria: Healthy adults aged 20 to 50 years Exclusion criteria: Participant experiences or evidence of delirium, confusion, or other disturbance of consciousness. Participant has any diagnosed illness or disorder affecting cognitive function or mood such as depression, anxiety, stroke or dementia. Individuals currently taking prescription medication other than a contraceptive pill. Any significant concurrent illness including any bleeding disorders, coronary heart disease, diabetes, gastrointestinal disorder. Any known or suspected food allergies (this would cover all ingredients in the investigational product). Participant has a recent history of (within 12 months of V1) or strong potential for alcohol or substance abuse. Participant is a female, who is pregnant, planning to be pregnant during the study period, or lactating. Condition: Mental fatigue ;Cognitive function ;Self-rated mood ;Cerebral blood flow and oxygen metabolism ;Brain biochemistry. Investigational products will be administered once orally (with approximately 1 week wash-out between investigational products). Participants will consume a different treatment each testing day. Each product consists of a powdered drink mix, which is to be dissolved in 500ml of water prior to consumption. The intervention will be consumed at the testing centre by healthy volunteers while under researcher supervision The following products will be investigated: ErgGo MOM contains: Green tea extract (130mg including 13mg of caffeine) Quercetin (100mg) Enzogenol (50mg) Magnesium (50mg) L-Theanine (25mg) Niacin (20mg) Vitamin B6 (2mg) Vitamin B12 (400mcg) Maltodextrin plus stevia (sweetener) and natural flavour/colour Citric Acid, Gum Acacia, Guar Gum, Xanthan Gum ErgGo POP contains: DMAE (dimethylaminoethanol, 200mg) Green tea extract (130mg including 13mg of caffeine) Quercetin (100mg) Caffeine (87mg) Enzogenol (50mg) Magnesium (50mg) L-Theanine (25mg) Niacin (20mg) Vitamin B6 (2mg) Vitamin B12 (400mcg) Maltodextrin plus stevia (sweetener) and natural flavour/colour Citric Acid, Gum Acacia, Guar Gum, Xanthan Gum Effects of supplementation on mental fatigue assessed by measuring changes in self-reported mental fatigue induced by the completion of the Cognitive Demand Battery (a cognitively taxing battery of tasks) Effects of supplementation on cognitive function assessed by measuring performance on both the Cognitive Demand Battery and the Swinburne University Computerized Cognitive Assessment Battery (SUCCAB);Effects of supplementation on self-reported mood assessed by the Bond and Lader Visual Analogue Scale;Effects of supplementation on brain function (functional brain activity, cerebral blood flow oxygen metabolism and brain biochemistry) assessed by Functional Magnetic Resonance Imaging (fMRI) and Magnetic Resonance Spectroscopy (MRS)",Sr-dementia,Actrn,2015,,,0,
62,Evaluation of donepezil transdermal delivery system (TDS) formulations versus oral donezepil (aricept) in healthy volunteers,"Inclusion criteria: - Has a Body Mass Index (BMI) between 18-32 kg/m2 (inclusive) as calculated using the site standard procedures. - Willing and able to discontinue all nonsteroidal anti-inflammatory drugs (NSAID) or COX-2 analgesic therapy, thirty days prior to Day 1 and until completion of the Study Exit Visit. This includes over-the-counter (OTC) pain medications and topical analgesics that contain an NSAID or COX-2. The use of NSAIDs or COX-2 medications at any time during the study and through to completion of the Study Exit Visit is prohibited and contraindicated. - If the subject is receiving allowed medications for the treatment of non-excluded medical conditions, the dose must be stable for at least twenty eight days before randomization on Day 1. Permitted medications must be consistent with the current label for oral donepezil (Aricept) tablets. - Women and men of child-bearing potential must agree to use adequate contraception prior to study entry, for the duration of study participation, and for ninety days following completion of therapy. Postmenopausal status will be verified by the absence of the menstrual cycle for twelve consecutive months or medical documentation of an oophorectomy or hysterectomy or bilateral tubal ligation and follicle-stimulating hormone (FSH) blood test at screening. FSH must be > 25.8 mIU/mL. Exclusion criteria: - Plasma donation within twenty eight days of screening or any blood donation or blood loss > 500 mL within three months of screening. - Unwilling to abstain from new strenuous physical exercise and from alcohol consumption for forty eight hours prior to scheduled PK blood draws at the clinic visits (subjects can maintain their normal exercise routine). - Has cuts, scratches/abrasions, scars, breaks in the skin surface, recent tattoos (within last six months) at the application site, skin with excessive hair, indications of sunburn, excessive skin tanning, stretch marks and/or similar abnormalities at the intended application sites which would affect absorption of the Investigational Product. - Must refrain from using tanning salons, saunas, or sun bathing during the conduct of the study. Must also avoid shaving of application site, waxing of application site, or use of lotion hair remover on or near application site from 48 hours before patch application and during the conduct of the study. - Must abstain from food or beverages containing grapefruit, starfruit, pomegranate, limes, seville oranges, pomelo and food or beverages containing > 5% the aforementioned fruits (examples are: fruit drinks, fruit punches, fruit cocktails, fruit aides) fourteen days prior to the first patch application and throughout the study. - Has a history of or is currently consuming high caffeine levels (greater than ten regular or espresso cups of coffee per day) and/or smoke more than twenty cigarettes per day for more than ten years (ex-smokers can be included in the study if they ceased smoking at least one year from the start of the study) - Significant cardiovascular disease, including moderate or severe congestive heart failure (ejection fraction of < 40%) or clinically significant stenosis or occlusion of a carotid or vertebral artery - Diabetes complicated with retinopathy (by history), neuropathy (by history or physical examination), or nephropathy (by serum creatinine > ULN or proteinuria > 0.2 g/L). Uncomplicated, stable diabetes that is well controlled and actively managed is not exclusionary. - Potential for occupational exposure to anticholinesterase agents in the three weeks prior to randomization or prior to the planned Study Exit Visit - Have a history of allergic reactions to medical grade adhesive tapes, sunscreens, cosmetics, lotions, fragrances, or latex. - Use of adjuvant analgesics, including antidepressants, anticonvulsants, selective serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine re-uptake inhibitors (SNRIs). The use of antidepressant therapy for depressive illness is permitted if judged to be clinically acceptable by the In estigator. - Use of any topical products without medicinal ingredient (including but not limited to perfumes, body lotions, sunscreens, spray or patch oils, creams and alcohol) on the area intended for patch application within forty eight hours prior to the first patch application until after the last sample collection of each period. Topical application of products without significant systemic absorption are allowed in areas other than the ones intended for patch application - Use of food or beverages containing xanthine derivatives, xanthine-related compounds and/or energy drinks from forty eight hours prior to each patch application until after the last pharmacokinetic blood sample of each treatment period <Condition>Alzheimer's Disease</Condition> This is a Phase 1, open-label, cross-over, randomized study in healthy subjects conducted in two parts. Part A of the study is a three-way cross-over, partially randomized (for the first two treatment periods) design to evaluate the PK, safety, tolerability and pharmacodynamics (PD) of two different formulations of donepezil administered from a TDS (Donepezil TDS LF 50 cm2 and Donepezil TDS HF 50 cm2) compared to oral donepezil (Aricept) in healthy subjects. Part B of the study is a two-way cross-over, randomized design to evaluate the adhesive properties, safety, tolerability and PK of a larger patch size donepezil TDS (either Donepezil TDS LF 150cm2 or Donepezil TDS HF 100cm2) with two different backing laminate compositions. Part A The following treatments will be administered in Part A of the study: Treatment A: Donepezil TDS LF 50 cm2 patch: 3 x 50 cm2 patches will be applied (total application area of 150 cm2) and worn for seven days, target dose 10 mg/day. An overlay will be applied to the patches. Treatment B: Donepezil TDS HF 50 cm2 patch: 2 x 50 cm2 patches will be applied (total application area of 100 cm2) and worn for seven days, target dose 10 mg/day. An overlay will be applied to the patches. Treatment C: Comparator ? donepezil hydrochloride 10 mg (Aricept), as a daily oral dose for seven days. A washout of at least 15 days between each treatment is allowed. Part B Part B will commence after at least the first six subjects have completed Day 11 of Treatment Period 1 in Part A. The TDS formulations to be assessed in this part of the study will be selected by the sponsor following review of the safety and PK data from the first six subjects in Part A. Based on these results either the two TDS LF or the two TDS HF formulations listed below will be administered in Part B of the study: Treatment D1: Donepezil TDS LF 150 cm2 patch with backing formulation 1: 1 x 150 cm2 patch will be applied and worn for seven days, target dose 10 mg/day. Treatment D2: Donepezil TDS LF 150 cm2 patch with backing formulation 2: 1 x 150 cm2 patch will be applied and worn for seven days, target dose 10 mg/day. Or Treatment E1: Donepezil TDS HF 100 cm2 patch with backing formulation 1: 1 x 100 cm2 patch will be applied and worn for seven days, target dose 10mg/day. Treatment E1: Donepezil TDS HF 100 cm2 patch with backing formulation 2: 1 x 100 cm2 patch will be applied and worn for seven days, target dose 10mg/day. There is a wash-out period of 10 days before starting the second period in Part B. A new set of participants will be recruited for Part B Part A ? Treatments A and B The following two transdermal patch formulations are being compared in Part A of this study: Donepezil TDS LF 50 cm2 (Treatment A) and Donepezil TDS HF 50 cm2 (Treatment B). Each formulation contains 90 mg donepezil per patch. Both Treatment A and Treatment B are transdermal patch formulations consisting of three layers. These formulations differ from each other with respect to the composition of the middle drug?in-adhesive layer and the donepezil delivery is anticipated to be approximately 3-fold higher for Donepezil TDS HF when compared to the LF formulation. Part A Treatment C In Australia Aricept is marketed by Pfizer Australia Pty Ltd. It is indicated for the treatment of mild, moderate and severe Al heimer?s disease. Donepez l hydrochloride 10 mg (Aricept), as an oral tablet, will be provided in bottles. The site pharmacy will dispense in a single use individualized dosing container according to the dosing schedule. Part B ? Treatments D1, D2, E1, E2 The Donepezil TDS LF formulations to be evaluated in this part of the study have a patch size of 150 cm2 and contain 270 mg donepezil per patch. The Donepezil TDS HF formulations to be evaluated in this part of the study have a patch size of 100 cm2 and contain 180 mg donepezil per patch. The TDS LF and HF with backing formulation 1 (Treatments D1 and E1, respectively) are comprised of 5 layers and differ in composition from the Part A TDS treatments by the addition of a thin adhesive layer and a stretchable woven fabric between the top backing layer and the drug-in -adhesive layer. The TDS LF and HF with backing formulation 2 (Treatments D2 and E2, respectively) are comprised of 3 layers and differ in composition from the Part A TDS treatments by the addition of a stretchable woven fabric in the drug-in-adhesive layer. Patches will be applied across the back for both parts of the study. Part A The primary objective of Part A of the study is:To evaluate the effects of formulation on the PK of two Donepezil TDS formulations, each worn for seven days. The primary PK variables for comparison in Part A will include: Cmax, AUC0?8 and AUC0-tau. ;Part B The primary objective of Part B of the study is: To evaluate the relative adhesive properties of two formulations of a larger donepezil TDS (100 cm2 or 150cm2 patch size) when applied for seven days. Adhesion will be assessed via a 5 point scoring scale by trained site staff. Part A To evaluate the safety and tolerability (including local skin tolerability) of seven day applications of two formulations of donepezil TDS (50cm2 patch size) ;Part A To compare the PK of donepezil and metabolite 6-O-desmethyl donepezil between 50 cm2 TDS applications and oral donepezil (Aricept) tablet administration. The primary PK variables for comparison in Part A will include: Cmax and AUC from blood samples.;Part A To compare the time course of RBC AChE activity between 50 cm2 TDS applications and oral donepezil tablet administration (Aricept).;Part B To evaluate the safety and tolerability (including local skin tolerability) of seven day applications of two formulations of a larger donepezil TDS (100 cm2 or 150cm2) This outcome will be asessed following an 8-point categorical scale used by trained study personnel only. ;Part B To compare the PK of donepezil between the two formulations of the larger patch size Donepezil TDS administered in Part B. The primary PK variables for comparison in Part B will include: Cmax and AUC from blood samples.;Part A and B To compare the PK of treatments administered in Part A and those administered in Part B. The primary PK variables for comparison for Part A and Part B will include: Cmax and AUC from blood samples.",Sr-dementia,Actrn,2015,,,0,
63,The effect of a Mediterranean diet with adequate dairy foods on cardio-metabolic and cognitive health outcomes,"Inclusion criteria: Free-living non-smoking men and women aged between 45 to 75 years with elevated systolic BP between 120mmHg and 140mmHg (high-normal range) and not on antihypertensive medication with at least 2 risk factors for cardiovascular disease (CVD): overweight/obese with body mass index 25kg/m2 or above waist circumference men >94cm, women >80cm dyslipidemia one of the following (fasted) : total cholesterol 5.5mM or above, triglycerides 2.0mM or above, low density lipoprotein cholesterol (LDL) 3.5 or above, high density lipoprotein cholesterol (HDL) men 0.9 and women 1.0 or below, impaired glucose tolerance (fasting glucose <7.0mmol/L) family history of CVD (myocardial infarction or sudden death before 55yrs for men or 65yrs for female 1st degree relatives) Family history of type 2 diabetes mellitus (T2DM) Exclusion criteria: Person considered by the investigator to be unwilling, unlikely or unable to comprehend or comply with the study protocol Previous/current traumatic head/brain injury, neurological or psychiatric conditions Previous stroke Use of anti-depressant, anxiety or neurological or psychiatric medication Current or recent (in the last 6 months) malignancy Major liver, kidney, respiratory, gastrointestinal disease Current CVD or angina Actively trying to lose weight Pregnancy/lactating Smoker Diagnosed T2DM Allergy/sensitivity to nuts, seafood, dairy foods etc. Illegal drug use or alcoholism Weight >135kg (DEXA limitations) Diagnosis of Alzheimer?s disease or dementia <Condition>Cardiovascular health;Cardiometabolic health;Wellbeing and cognitive performance</Condition> This is a randomised cross-over dietary intervention trial with two 8-week dietary phases (Mediterranean diet and low fat diet) separated by an 8 week washout period. Total duration of the trial is 24 weeks. At baseline, volunteers will meet with the dietitian, for approximately 30 minutes, and receive instructions regarding their dietary prescription for the next 8 weeks. Volunteers will be prescribed their allocated diet, receive a recipe book (The Mediterranean Diet, Catherine Itsiopoulos, Pan Macmillan Australia Pty Ltd) and a sample menu (if MedDairy group) to help guide food choices. Volunteers will be given advice on eating out strategies to assist with compliance to their allocated diet. They will be issued a diet checklist to ensure they are complying with the diet. During the MedDairy phase, volunteers will receive foods characteristic of the MedDiet (olive oil, canned fish, nuts etc.) to assist with compliance. All volunteers will be asked to maintain their usual exercise pattern. Volunteers will be asked to return fortnightly to see the dietitian (for 15-30 minutes), have their weight measured return checklists, collect study foods and discuss any problems that may have arisen during the intervention. During the washout periods between diet phases, volunteers will be asked to return to following their habitual diet. Mediterranean DAIRY diet (MedDairy) The MedDiet is characterised by a variety of foods including wholegrain cereals, nuts, legumes, olive oil, red wine, small amounts of red meat, low intakes of dairy (mainly yoghurt and cheese), fish, red wine, fruits and vegetables. For this study the MedDairy diet will be based on the PREDIMED-EVOO diet however volunteers will consume 3-4 serves of low-fat and regular dairy products including cheese, milk and yoghurt. To ensure we meet the Australian recommendations for dairy foods, we are recommending 3-4 serves of dairy foods per day. Guidelines for following the MedDairy diet are adapted from Estruch R et al 2013 NEJM, include: Abundant use of extra virgin olive oil for cooking and dressing vegetables and salad 3-4 daily servings of reduced fat milk (1 cup), yoghurt (200g) and tzatziki dip (200g), regular fat cheese (40g hard/semi-soft cheese, 120 g soft cheese) 2-3 or more daily servings of fresh fruits including 100% natural juices 3 or more weekly servings of legumes (75g per serve) 3 or more weekly servings of fish and seafood (at least one serv ng of oily fish (100g per serve) 3 or more weekly serving of nuts (7.5g hazelnuts, 15g walnuts, 7.5g almonds) or seeds (30g per serve) Ad-libitum consumption of wholegrain cereal products (bread, pasta, rice, cereal), nuts, fish, eggs and raw and cooked vegetables. Select white meats (poultry without skin) instead of red meats or processed meats (burgers, sausages, deli meats) Limit consumption of cured ham, red meat (remove all visible fat) to 1 or less serve/week Remove chicken skin Cook regularly (at least twice a week) with tomato, garlic and onion Dress vegetables, pasta, rice and other dishes with tomato, garlic and onion Eliminate or limit the consumption of cream, butter, margarine and discretionary foods Low-fat diet (LFD) The LFD will be based on the PREDIMED control diet (Estruch R et al 2013 NEJM) following American Heart Association in combination with local recommendations for the Heart Foundation of Australia. Volunteers will maintain the basis of their habitual diet however will be asked to modify their intake to choose low fat foods. Specifically : cook with little fat, remove / skim fats from foods, choose and purchase low fat foods Blood pressure will be determined by automatic oscillatory using a Digital Blood Pressure Monitor (UA-767PC). Blood pressure will be measured at each clinic visit by staff. On each occasion 4 readings will be taken, spaced 3 minutes apart. The first reading will be discarded and the mean of the 3 readings will be recorded. Volunteers will also monitor blood pressure twice daily at home for 6 days. Blood pressure will be measured every day for 1 week, immediately after waking, and before going to bed. On each occasion 4 readings will be taken, spaced 3 minutes apart. The first reading is discarded and the mean of the next 3 readings is taken. Clinic measured blood pressure, measured by automatic oscillometry while seated;The CAIDE Dementia Risk Score was developed to identify individuals at increased risk for developing dementia (20 years later) based on midlife presence of metabolic and vascular risk factors that would potentially benefit from preventative interventions to reduce their risk (Sindi 2015). The validated risk score is based on multifactorial risk estimation using age, education level, obesity, hypertension, hypercholesterolemia and physical inactivity. Normal risk of dementia is considered a score of 8-9, above normal risk for developing dementia is 10-15 and below normal risk is 0-7. The CAIDE will be assessed in volunteers aged between 45-65 years (validated in this age range). ;Framingham Risk Score is a gender specific calculator used to estimate an individual?s 10 year risk of developing CVD. The score is based on age/age range, gender, total cholesterol, dyslipidemia, blood pressure hypertension treatment and smoking and diabetes/impaired glucose tolerance. The FRS provides an indication of the possible benefits of prevention which is important for healthcare professionals in tailoring medical and dietetic advice. Individuals with low risk of having CVD in 10 years is 10% or less; intermediate risk is 10-20%, and high risk is 20% or more;Heart rate, measured by automatic oscillometry while seated;Cognitive performance will be assessed using the CANTAB 'registered trademark' computerised test battery: visual and verbal memory ;Cognitive performance will be assessed using the CANTAB 'registered trademark' computerised test battery: speed of processing (reaction and attention) ;Cognitive performance will be assessed using the CANTAB 'registered trademark' computerised test battery: executive function;Cognitive performance will be assessed using the CANTAB 'registered trademark' computerised test battery: social cognition;Cognitive performance will be assessed using the CANTAB 'registered trademark' computerised test battery: decision making;Lean body mass (DEXA);Abdominal body fat (DEXA);Fat mass (DEXA);Plasma total cholesterol;Plasma low density lipoprotein cholesterol;Plasma high density lipoprotein cholesterol;Plasma triglcyerides;Well-being will be fo ussed on health r lated quality of life based on outcomes reported by PREDIMED investigators (Henriquez Sanchez et al. 2012; Ruano et al. 2013) - Physical health-related quality of life will be assessed using the Short Form Health Survey (SF-36V2). ;Well-being will be focussed on health related quality of life based on outcomes reported by PREDIMED investigators (Henriquez Sanchez et al. 2012; Ruano et al. 2013)- mental related quality of life will be assessed using the Short Form Health Survey (SF-36V2). ;Well-being will be focussed on health related quality of life based on outcomes reported by PREDIMED investigators (Henriquez Sanchez et al. 2012; Ruano et al. 2013)- social health-related quality of life will be assessed using the Short Form Health Survey (SF-36V2). ;Mood state will be assessed using the Profile of Mood State Questionnaire (POMS);% body fat, assessed by dual Energy X-ray absorptiometry (DEXA);The fecal microbiome will be collected using the Omnigene GUT collection system. Volunteers will defecate in a plastic take-away container and then using the kit will sample a small amount of the stool, place it in the tube provided, screw the cap onto the tube and store in the collection envelope until delivered to the clinical trials facility. This is an easy non-invasive process.;Mood will be assessed using the Profile of Mood State (POMS) questionnaire (McNair 1971) which contains 65 words/statements that describe feelings people have in the past week including current day. . ;Addenbrooke?s Cognitive Examination Revised (ACE-R): The ACE-R is a brief cognitive test battery that has been validated for use to detect early cognitive dysfunction through scoring five difference cognitive domains (memory, attention/orientation, fluency, language and visuospatial). The maximum score is 100 (higher score reflects better cognitive performance) (Mioshi et al. 2006). This will be used at screening to rule out dementia and Alzheimer?s disease and as an outcome measure as it is sensitive in detecting very mild-cognitive impairment. ;Waist and hip circumference (in centimeters) will be measured according to the ISAK International Standards for Anthropometric Assessment. Waist/hip ratio will be calculated by dividing waist/hip circumference.;Insulin resistance calculated from serum insulin and glucose. Insulin resistance will be calculated using The Homeostasis Model Assessment (HOMA2) Calculator ;Plasma C-reactive protein (inflammatory marker);Mediterranean dietary adherence using 14-point MedDiet tool and weighed food records ;ApoE4 A blood sample for Apolipoprotein E-4 allele (APOE4, indicator of increased risk for Alzheimer?s Disease) will be taken and analysed using the TaqMan ""registered trademark' SNP Genotyping Assay kit (Applied Biosystems, Warrington, UK) (Koch et al. 2002). ;Body mass index, calculated as weight divided by height in metres squared. Weight will be measured using the same set of digital scales, while volunteers are wearing light clothing and no shoes. Height will be measured at time point zero only using a wall-mounted stadiometer (SECA, Hamburg, Germany) with volunteers in stockinged or bare feet.",Sr-dementia,Actrn,2016,,,0,
64,Efficacy of health promotion interventions in adults with lifestyle and health risk factors for dementia,"Inclusion criteria: Inclusion criteria are those used by the General Practice for referring patients to the Practice's Lifestyle Management Program which it offers for free. Adults who are overweight or obese (BMI (kg/m2)>= 25 and <=35), with a chronic health condition (such as high blood pressure, heart disease, type 2 diabetes or 'pre-diabetes', osteoporosis, osteoarthritis, PCOS, kidney or liver disease, depression/anxiety) and who live in the ACT and surrounding areas. In addition for our project, all participants will be required to have internet access at home, and agree to participate in the baseline and four follow-up assessments. Note: The LMP program involves a baseline and followup assessment when offered (i.e. not as a research condition) and patients are evaluted on outcomes in usual care, so the assessments for this trial were designed to coincide with usual care as far as possible. Exclusion criteria: Presence of life-threatening medical conditions and psychiatric conditions that would prevent participation in the trial, sensory deficits or mobility limitations that would prevent or substantially restrict the delivery of the assessment or intervention, poor English language skills, cognitive impairment defined as MMSE <24. <Condition>Risk of Alzheimer's disease and dementia;Unhealthy lifestyle;Cognitive decline;Cardiovascular disease risk</Condition> This project compares three different interventions: a risk reduction intervention called Body Brain Life-GP (BBL-GP) that is designed to reduce risk of cognitive decline; a Lifestyle Modification Program (LMP) that is designed to enhance general wellbeing and improve lifestyle to reduce risk of chronic disease, once a week making a total of six sessions; and an Active Control condition involving emails containing information about healthy lifestyle. BBL-GP is an intervention package that builds on two published interventions developed by our team: the BBL intervention (Trial ID:ACTRN12612000147886) and the Fitness for the Ageing Brain (FABs; Trial ID: ACTRN 12609000755235). For BBL-GP we revised our previously published interventions to include newly available health self-monitoring technology, we adapted our modules after extensive consumer evaluation, and included a more intensive physical activity program designed for a younger age-group. This revised program (Body Brain Life-Fit) was piloted with the general public (Trial ID: ACTRN12615000822583). The sample for the current project is adults in Primary Care who meet criteria to participate in the GP Practice's Lifestyle Management Program. These are the types of adults who a GP would refer to a dementia risk reduction trial in 'real life' and we are aiming to evaluate our intervention in a naturalistic context. Primary care is the appropriate setting for the implementation of this program because it is where adults with high risk of developing dementia are identified. Participants in the BBL-GP group will be required to complete 8 modules (dementia literacy, risk factors, physical activity, nutrition, health, cognitive activity, social activity and mood) delivered online, and receive an individually tailored one hour face to face physical activity session and where indicated an individually tailored one hour face to face nutrition intervention. They will complete one module per week, each taking approximately 30-40 minutes. Participants will receive an email reminding them of the next module (during the first 8 weeks of the trial). Participants who are late competing modules will receive up to 3 reminder emails. The first eight weeks will be spent completing the 8 modules and the following four weeks will be spent revising the materials in the modules. The session duration and frequency of the physical activity (PA) program will vary between participants based on individual tailoring. An exercise physiologist/physiotherapist will design an individual program for the participant, deliver this in a face-to-face workshop and monitor the physical activity program via the returned diaries and te ephone mon toring. For those not doing any regular PA at baseline, the target will be 150 minutes/week moderate intensity PA, for those doing less than 100 minutes/week, an additional 100 minutes/week will be prescribed and for those meeting the target, an additional 50 minutes/week will be prescribed. A diary in the format of a calendar returned monthly for 24 weeks, will be used to record PA and rating of perceived exertion. The dietary intervention will be provided to those individuals who have experienced significant weight gain in the last 6 months or indicate an unhealthy dietary pattern at the baseline assessment. A one hour face to face intervention will involve individually tailored dietary advice, formal dietary prescription, and a dietitian tailored plan. Participants will complete an online diary to record their dietary intake. Participants in the BBL group will be asked to continue being active and having a healthy dietary pattern after the completion of the intervention but they will be monitored through phone calls at week 4, 12 and 20. In addition, they will receive a general booster session at 12 months with a phone call and a mailed out booklet. Participants in the LMP group will receive group sessions on basic nutrition, meal planning, physical activity, health conditions, motivation and goals, medications, and sleep. This program will be provided by various he lth professionals (dietitian, exercise physiologist, nurse practitioner, psychologist, pharmacist and sleep physician) for a duration of 6 weeks. Each session will last for 2 hours. The course is currently run by the practice for their patients to assist them to improve their lifestyle and management of chronic disease and so it is a real-life comparison condition. This trial will be conducted to evaluate the efficacy of health promotion interventions (BBL-GP and LMP) compared with the Active Control. There will be 240 participants (80 in BBL-GP, 80 in LMP and 80 in the Actvie Control group) followed for 88 weeks from baseline. There will be 4 follow-up assessments (immediately after the completion of the intervention or at 13 weeks for the Active Control, and at 18, 36 and 88 weeks after commencement of the intervention). The Primary Outcome measure is the score on the ANU-ADRI. The ANU-ADRI is comprised of validated scales assessing 15 individual risk and protective factors for Alzhiemer's disease and dementia. Cognitive function will be assessed with tests of processing speed and task switching using Trail A and B, and Digit Symbol Modalities Test.;Moderate-vigorous Physical Activity (MVPA) is a continuous measure of activity that registers 3 or more Metabolic Equivalents of Task (METs) for 10 minutes or longer on an ActiGraph Link (http://actigraphcorp.com/products/actigraph-link/), which is worn for 7 days at baseline and at 18, 36, and 88 weeks follow ups. MVPA will be recorded in all three groups. Self-reported phyical activity will also be recorded using the IPAQ which is part of the ANU-ADRI.;Depressive symptoms score will be assessed with the Centre for Epidemiological Studies Depression Scale which is a continuous subscale of the ANU-ADRI. ;Cost evaluation of two health promotion interventions. Health outcomes will be assessed with SF12 health survey, Framingham coronary heart disease risk score, and Australian type 2 diabetes risk assessment tool (Ausdrisk). ;Diet quality will be assessed with Healthy Eating Quiz (http://healthyeatingquiz.com.au/)",Sr-dementia,Actrn,2016,,,0,
65,"An interventional study to evaluate the effects of formulation and dose on the Pharmacokinetics (PK, the measure of how the human body prcessed a substance) of up to four Donezepil Transdermal Delivery System (TDS, a patch that delivers a drug) formulations (50 cm2 patch size), worn for seven days, applied to the backs of healthy female participants","Inclusion criteria: 1. Caucasian female aged 50 to 80 years (inclusive) on the day of treatment allocation. 2. Has a Body Mass Index (BMI) between 18-32 kg/m^2 (inclusive) as calculated using the site standard procedures. 3. Must be willing and able to understand and participate in all scheduled evaluations by providing a signed and dated written informed consent prior to the initiation of any study procedures. 4. Women of child-bearing potential must agree to use adequate contraception prior to study entry, for the duration of study participation, and for ninety days following completion of therapy. Postmenopausal status will be verified by the absence of the menstrual cycle for twelve consecutive months or medical documentation of an oophorectomy or hysterectomy or bilateral tubal ligation and follicle-stimulating hormone (FSH) blood test at screening. FSH must be > 25.8 mIU/mL. 5. Willing and able to discontinue all nonsteroidal anti-inflammatory drugs (NSAID) or COX-2 analgesic therapy, thirty days prior to Day 1 and until completion of the Study Exit Visit. This includes over-the-counter (OTC) pain medications and topical analgesics that contain an NSAID or COX-2. The use of NSAIDs or COX-2 medications at any time during the study and through to completion of the Study Exit Visit is prohibited and contraindicated. 6. If the subject is receiving allowed medications for the treatment of non-excluded medical conditions, the dose must be stable for at least twenty eight days before treatment allocation on Day 1. Permitted medications must be consistent with the current label for oral donepezil (Aricept 'Registered Trademark) tablets. Exclusion criteria: 1. Dosing with an investigational product within sixty days prior to screening. 2. Plasma donation within twenty eight days of screening or any blood donation or blood loss > 500 mL within three months of screening. 3. Has skin color or tone that may not allow reliable evaluation of irritation. 4. Unwilling to abstain from new strenuous physical exercise and from alcohol consumption for forty eight hours prior to scheduled PK blood draws at the clinic visits (subjects can maintain their normal exercise routine). 5. Has intolerance to venipuncture and/or inability to comply with the extensive blood sampling required for this study or does not have suitable veins in both arms. 6. Has cuts, scratches/abrasions, scars, breaks in the skin surface, recent tattoos (within last six months) at the application site, skin with excessive hair, indications of sunburn, excessive skin tanning, stretch marks and/or similar abnormalities at the intended application sites which would affect absorption of the Investigational Product. 7. Must refrain from using tanning salons, saunas, or sun bathing during the conduct of the study. Must also avoid shaving of application site, waxing of application site, or use of lotion hair remover on or near application site from 48 hours before patch application and during the conduct of the study. 8. Must abstain from food or beverages containing grapefruit, starfruit, pomegranate, limes, seville oranges, pomelo and food or beverages containing > 5% the aforementioned fruits (examples are: fruit drinks, fruit punches, fruit cocktails, fruit aides) fourteen days prior to the first patch application and throughout the study. 9. Subjects with a history of or who are currently consuming high caffeine levels (greater than ten regular or espresso cups of coffee per day); heavy smokers who smoke more than twenty cigarettes per day. Exception will be made for lighter smokers and subjects on stable doses of nicotine patches. 10. Presence of any major psychiatric disorder if, in the opinion of the Investigator, the psychiatric disorder or symptom is likely to confound interpretation of drug effect/tolerability, or affect the subject?s ability to complete the study. 11. Significant cardiovascular disease, including moderate or severe congestive heart failure (ejection fraction of < 40%) or clinically significant stenosis or occlusion of a carot d or vertebral rtery. 12. Significant or chronic lung disease, including Chronic Obstructive Pulmonary Disease (COPD) and severe or unstable asthma. 13. Diabetes complicated with retinopathy (by history), neuropathy (by history or physical examination), or nephropathy (by serum creatinine > ULN or proteinuria > 0.2 g/L). Uncomplicated, stable diabetes that is well controlled and actively managed is not exclusionary. 14. Known or suspected systemic infection, including human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV), or tuberculosis (TB) or qualitative syphilis test as judged by the Investigator at screening. 15. History of severe allergy/hypersensitivity reactions or on-going allergy/hypersensitivity reactions, or history of hypersensitivity to donepezil or other drugs of the cholinesterase inhibitor class. 16. Potential for occupational exposure to anticholinesterase agents in the three weeks prior to treatment allocation or prior to the planned Study Exit Visit 17. History of cancer within five years of screening or between screening and treatment allocation, with the exception of non-metastatic basal cell carcinoma of the skin, carcinoma in situ of the cervix or non-progressive prostate cancer. 18. Transient Ischemic Attack (TIA) or stroke in the last three years. 19. History of suspected alcohol or drug dependence within two years of screening, or positive urine drug test at the screening or one day <Condition>Alzheimer?s Disease</Condition> 5mg TDS Treatment Period Treatment A: Donepezil TDS Formulation 1: 1 x 60 cm2 patch (contains 115.2 mg/patch donepezil HCl) will be applied and worn for seven days. An overlay will be applied to the patch. Treatment B: Donepezil TDS Formulation 2: 1 x 60 cm2 patch (contains 150 mg/patch donepezil HCl) will be applied and worn for seven days. An overlay will be applied to the patch. Treatment C: Donepezil TDS Formulation 3: 1 x 60 cm2 patch (contains 126 mg/patch donepezil HCl) will be applied and worn for seven days. An overlay will be applied to the patch. All formulations contain a rate controlling membrane made of microporous polypropylene, but the treatments differ in the composition of the drug-in adhesive layer: Treatment A: contains acrylic adhesive, crospovidone, sodium bicarbonate, glycerine, and two or three additional vehicles selected from triethyl citrate, sorbitan monolaurate, and lauryl lactate as inactive ingredients, with donepezil hydrochloride as the active ingredient. Treatment B: contains acrylic adhesive , colloidal silicon dioxide and/or Crospovidone, Eudragit EPO, glycerine and additional 2 or 3 vehicles or enhancers selected from triethyl citrate, , and lauryl lactate as inactive ingredients, with donepezil hydrochloride as the active ingredient. Treatment C: contains acrylic adhesive , colloidal silicon dioxide, Eudragit EPO, glycerine and additional 2 or 3 vehicles or enhancers selected from triacetin, sorbitan monolaurate, and lauryl lactate as inactive ingredients, with donepezil hydrochloride as the active ingredient. All formulations will be applied as one patch worn continuously for 7 days, applied to the lower back (preferred location is vertically along the spine) by a trained member of site staff. Participants will remain in the study facility for the duration of patch application and will constantly monitored to ensure compliance. 10mg TDS Treatment Period The treatment determined (by interim PK and safety analysis) to be the lead formulation will be selected and applied as 2 x 60cm2, 5mg/ day target dose (comprising of two individual patches, with total target dose 10mg/ day) worn continuously for seven days. Patches will be applied to the lower back (preferred location is vertically along the spine) by a trained member of site staff. Participants will remain in the study facility for the duration of patch application and will constantly monitored to ensure compliance. To evaluate the effects of formulation and dose on the pharmacokinetics (PK) of Donepezil transdermal delivery systems (TDS) appl ed for seven days. Plas a samples will be collected and the following PK parameters will be assessed: Cmax (maximum plasma concentration); Ctau (plasma concentration at end of dosing interval); AUC0-t=infinity (area under the plasma concentration-time curve from time 0 to infinity); AUCtau (area under the plasma concentration-time curve from time 0 to the end of the dosing interval); tmax (time to reach maximum plasma concetration); deltaz (first-order terminal-phase rate constant); and t1/2 (apparent terminal elimination half-life). To evaluate the safety and tolerability (including local skin tolerability) of seven day applications of each Donepezil TDS (60 cm2 patch size) treatment, as well as to data obtained from the oral arms of this study. Local tolerability evaluation will be performed by trained site staff using an eight-point Dermal Response Score scale: 0 = no evidence of irritation; 1 = minimal erythema, barely perceptible; 2 = definite erythema, readily visible; minimal edema or minimal papular response; 3 = erythema and papules; 4 = definite edema; 5 = erythema, edema and papules; 6 = vesicular eruption; 7 = strong reaction spreading beyond application site. Other effects will also be rated: 0 = no other effects; 1 = slight glazing; 2 = marked glazing; 3 = glazing with peeling and cracking; 4 = glazing with fissures; 5 = film of dried serous exudate covering all or part of the patch site; 6 = small petechial erosions and/or scabs. Not applicable for oral treatment periods.;To compare the PK of donepezil and metabolite 6-O-desmethyl donepezil between formulations of Donepezil TDS (60 cm2 patch size) and the oral arms of this study. This will be assessed with plasma samples. ;To compare the time course of RBC AChE (red blood cell acetylcholinesterase) activity between formulations of Donepezil TDS (60 cm2 patch size) and the oral arm of this study. Whole blood samples will be collected to assess this outcome.;To assess TDS adhesion. Trained site staff will score adhesion at the specified timepoints using the folling scale: 0 = greater than or equal to 90% adhered (essentially no lift off of the skin) 1 = greater than or equal 75% to <90% adhered (some edges only lifting off the skin) 2 = greater than or equal 50% to < 75% adhered (less than half of the system lifting off the skin) 3 = < 50% adhered but not detached (more than half the system lifting off of the skin without falling off) 4 = 0% adhered - patch detached (patch completely off the skin. Photographs are to be taken of the TDS patches: after application (but prior to overlay), post application of the overlay, at each scheduled adhesion assessment time point, prior to additional tape (if needed) and after taping.",Sr-dementia,Actrn,2016,,,0,
66,"Assessing compliance, acceptance, and tolerability of teriparatide in patients with osteoporosis who fractured while on antiresorptive treatment or were intolerant to previous antiresorptive treatment: An 18-month, multicenter, open-label, prospective study","Background: Teriparatide (parathyroid hormone [1-34] [ribosomal DNA origin]) stimulates new bone formation on trabecular and cortical (periosteal and/or endosteal) bone surfaces by preferential stimulation of osteoblastic activity over osteoclastic activity. It has been found to significantly reduce vertebral fractures by 65%, and nonvertebral fragility fractures by 53% in treatment-naive postmenopausal women who have previously suffered a vertebral fracture. Objective: This study examined the compliance, acceptance, and adherance of SC teriparatide 20 pg QD. Methods: In this 18-month, multicenter, openlabel, prospective study, women with postmenopausal osteoporosis, and men >30 years of age with either idiopathic or hypogonadal osteoporosis (with low bone mass [T-score of -1 or worse] and ≥1 fragility fracture), who had experienced a treatment-related adverse event (AE) or an inadequate response while receiving antiresorptive treatment, and who were willing to receive open-label teriparatide for ≥18 months were eligible. Compliance was defined as self-reported use of ≥80% of study medication. Acceptance of the injection pen was determined by scores obtained from questionnaires and rating scales measuring patients' perception. Patients self-reported on injection discomfort, ease of use, and the overall injection administration. Acceptance was assessed at baseline, and 3, 6, and 18 months. AEs were recorded at each clinical visit from the patients' self-reports. At the 3-month visit, a serum calcium level was drawn ≥16 hours after the previous teriparatide dose. Results: In this study, 116 patients-102 women with postmenopausal osteoporosis and 14 men (12 with idiopathic osteoporosis and 2 with hypogonadal osteoporosis)-were assessed for inclusion in the study. The mean (SD) age was 68.8 (11.1) years (range, 40-89 years) and the mean (SD) weight was 60.5 (11.7) kg (range, 37-87 kg). Seventy-three percent of the patients in this study had baseline spinal T-scores ≤-2.5, and 72% had fractured during treatment with an osteoporosis medication. Reported compliance was 89% at 6 months and 82% at 18 months. At baseline, 42% of patients were concerned about injection discomfort, and 43% were somewhat concerned with daily injections, while 7% were quite concerned. At 6 months, most patients reported much less concern (49%) or no concern (42%). Patient perceptions associated with learning how to use the pen injection, attaching the needle, holding the pen, and injecting the dose, improved during the first 6 months of the study. The most commonly reported AEs were dizziness, 12 (10.3%); nausea, 12 (10.3%); back pain, 9 (7.8%); and muscle cramps, 9 (7.8%). No AEs were believed to be associated with the use of the pen injection or teriparatide. Five patients had mildly elevated serum calcium concentrations (maximum value 2.8 mmol/L) at 3 months. However, all were normal on repeat testing ~4 weeks thereafter. Conclusions: This study found that teriparatide pen injection was well accepted in these patients, and acceptance rates improved during the first 6 months of treatment and, thereafter, improved slightly for ~18 months. Reported compliance remained high throughout the study (82%-89%). Teriparatide pen injection was a viable treatment in these osteopenic or osteoporotic patients with fragility fractures. © 2007 Excerpta Medica, Inc.",bisphosphonic acid derivative;calcitonin;parathyroid hormone[1-34];raloxifene;selective estrogen receptor modulator;vitamin D;abdominal distension;acute coronary syndrome;acute heart infarction;adult;aged;Alzheimer disease;arthralgia;article;backache;bone pain;breast carcinoma;clinical trial;congestive heart failure;controlled study;contusion;coughing;dizziness;drug efficacy;drug safety;falling;fatigue;female;glaucoma;headache;heart arrhythmia;atrial fibrillation;human;hypogonadism;injection site contusion;limb pain;lung disease;major clinical study;male;multicenter study;muscle cramp;musculoskeletal disease;nausea;neck pain;open study;osteoporosis;pain;patient compliance;patient satisfaction;pneumonia;postmenopause osteoporosis;prosthesis infection;rhinopharyngitis;rib fracture;self injection;self report;shoulder dislocation;side effect;sigmoid carcinoma;cerebrovascular accident;subdural hematoma;upper respiratory tract infection;weakness,"Adachi, J. D.;Hanley, D. A.;Lorraine, J. K.;Yu, M.",2007,,,0,
67,Dose-response gradients between a composite measure of six risk factors and cognitive decline and cardiovascular disease,"We created a composite risk factor index which includes 6 risk factors (diabetes, hypertension, obesity, depression, sedentary lifestyle, and current smoking) previously shown to be associated with cognitive decline (CD) and Alzheimer's disease (AD) as well as cardiovascular disease (CVD). Using 2011 Behavioral Risk Factor Surveillance System results for 95,147 adults ages ≥ 45 years we found that 77.3% of study adults reported ≥ 1 risk factor (RF) while < 1% reported all 6. Reporting any RFs increased risk for CD and CVD, with a dose-response gradient shown for increasing numbers of RFs from 0 to 6. Number of RFs, % of adults with CD and CVD respectively were: 0 RF: 5.8% w/CD, 4.4% w/CVD; 1 RF: 9.6% w/CD, 10.8% w/CVD; 2 RF: 12.7% w/CD, 17.6% w/CVD; 3 RF: 19.3% w/CD, 23.7% w/CVD; 4 RF: 24.6% w/CD, 29.7% w/CVD: 5 RF: 39.0% w/CD. 32.2% w/CVD; and all 6 RF: 54.4% w/CD and 43.7% w/CVD. Adjusted odds ratios (ORs) were similar except they tended to be higher for CVD compared with CD, with ORs for all 6 RF compared with 0 RF of 11.2 (95% confidence interval 5.2–24.3) for CD and 16.3 (8.5–31.2) for CVD. While dose-response gradients had been reported for individual RFs, our study found dose-response gradients for increasing numbers of RFs and similar strengths of associations for CD and CVD, plus adds prevalence results from a representative survey. The similarity between CVD and CD results supports evidence from other studies and suggests potential benefits of coordinating CVD and CD/AD prevention efforts.",adult;aged;Alzheimer disease;amnesia;angina pectoris;article;behavioral risk factor surveillance system;cardiovascular disease;cardiovascular risk;cognitive defect;confusion;dementia;depression;diabetes mellitus;disease association;female;heart infarction;human;hypertension;ischemic heart disease;major clinical study;male;middle aged;obesity;priority journal;risk factor;sedentary lifestyle;smoking;telephone interview;very elderly,"Adams, M. L.;Grandpre, J.",2016,,,0,
68,Comparison of Neuropsychological Patterns in Nigerians with different Heart Failure Phenotypes,"Objective: The aim of this study was to determine the influence of left ventricular dysfunction type on the pattern of neuropsychological dysfunctions among heart failure (HF) subjects. Method: A sub-analysis of the data of subjects recruited in a cross-sectional survey of cognitive dysfunction among Nigerians with HF was performed. Cognitive performance on the Community Screening Interview for Dementia (CSI'D), Word List Learning Delayed Recall (WLLDR), Boston Naming Test (BNT), and Modified Token Test (MTT) were compared between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Clinical and echocardiographic correlation analysis with cognitive performance was performed. Results: Subjects with HFpEF were impaired on the WLLDR (71.4% vs. 34.6%, p = .026). The group with HFpEF scored lower on the language domain (definition subscale) of CSI'D (p = .036), and WLLDR (p = .005). The performance on the MTT (p = .185) and BNT (p = .923) were comparable between the two groups. An inverse relationship was found between pulse pressure and delay recall (r = -.565 p = .003) among the cohort with HFpEF whereas body mass index, BMI (r = -.737, p = .023) and tricuspid valve E/A ratio, TVEA (r = -.650, p = .042) showed an inverse relationship with the total CSI'D score in the cohort with HFrEF. Conclusions: Cognitive dysfunction is largely similar between the two groups. Delay recall is however poorer among subjects with HFpEF. Regular cognitive screening is advocated among HF subjects to prevent non-adherence with therapeutic options.",Assessment;Cross-cultural/minority;Executive functions;Learning and memory;Mild cognitive impairment,"Adebayo, P. B.;Akintunde, A. A.;Adebayo, A. J.;Asaolu, S. O.;Audu, M.;Ayodele, O. E.",2017,May 01,,0,
69,Profile and Determinants of Neurocognitive Dysfunction in a Sample of Adult Nigerians With Heart Failure,"BACKGROUND: Heart failure (HF) in Africans is peculiar because subjects are younger than whites and have lower socioeconomic and educational level in addition to the high prevalence of hypertension-related etiology and increased mortality. Whereas cognitive dysfunction have been demonstrated among whites with HF, the prevalence and pattern of cognitive dysfunction among sub-Saharan African patients with HF have not been evaluated against this background. OBJECTIVES: The aim of this study is to determine the 1-year prevalence and the factors contributing to cognitive dysfunction in a cohort of Nigerian patients with HF. MATERIALS AND METHODS: In this cross-sectional case-control study, cognitive performance was evaluated in 111 consecutive individuals (60 HF patients and 51 controls matched for age, gender, and level of education) using the Community Screening Interview for Dementia, Word List Learning Delayed Recall, Boston Naming Test, and Modified Token Test. Other clinical and disease-specific variables were collated and correlated with cognitive performance. RESULTS: The mean total Community Screening Interview for Dementia, Word List Learning Delayed Recall, Boston Naming Test, and Modified Token Test scores were significantly lower among HF patients (P = < .001). The prevalence of global cognitive dysfunction was 90.0% in HF and 5.9% among controls (odds ratio, 15.3; 95% confidence interval, 5.08-46.01). Elevated systolic blood pressure, increased comorbidity index, and wide pulse pressure were significantly associated with poorer performance on at least 1 neuropsychological test. Using a multivariate linear regression analysis, pulse pressure retained its significance (P = .029; 95% confidence interval, -0.117 to -0.007) as the most important predictor of cognitive dysfunction in the cohort of HF patients. CONCLUSION: Cognitive dysfunction is prevalent among this sample of Nigerians with HF. Regular cognitive screening is therefore advocated among this high-risk group. Controlling comorbidities as well as blood pressure may improve cognitive performance among patients with HF.",,"Adebayo, P. B.;Akintunde, A. A.;Audu, M. B.;Ayodele, O. E.;Akinyemi, R. O.;Opadijo, O. G.",2016,Nov/Dec,10.1097/jcn.0000000000000289,0,
70,Cervical necrotizing fasciitis: management challenges in poor resource environment,"Necrotizing fasciitis of the head and neck is a rare and potentially fatal disease. It is a bacterial infection characterized by spreading along fascia planes and subcutaneous tissue resulting in tissue necrosis and likely death. It is commonly of dental or pharyngeal origin. Factors affecting the success of the treatment are early diagnosis, appropriate antibiotics and surgical debridement. Our study showed eight patients, five males and three females with mean age of 49.25 years (range 20–71 years). Clinical presentations were a rapidly progressing painful neck swelling, fever, dysphagia and trismus. The aetiology varied from idiopathic, pharyngeal/tonsillar infection, trauma and nasal malignancy. There were associated variable comorbidities (diabetes mellitus, HIV infection, hypertension and congestive cardiac failure). All the patients received early and aggressive medical treatment. The earliest time of surgery was 12 h after admission because of the poor financial status of patients. Three cases came in with complications of the disease and were not fit for extensive debridement under general anaesthesia. For them limited and reasonable bed side debridement was done. Mortality was 50 % from multiple organ failure, HIV encephalopathy, aspiration pneumonitis and septicemia. The duration of hospital stay for the patients that died ranged from 1 to 16 days and 4 to 34 days for the survivor. Our study heightens awareness and outlines the management challenges of necrotizing fasciitis of the head and neck in a poor resource setting.",adult;aged;article;aspiration pneumonia;cervical necrotizing fasciitis;clinical article;debridement;diabetic patient;disease association;dysphagia;female;fever;HIV associated dementia;hospitalization;human;male;medical record;middle aged;mortality;multiple organ failure;necrotizing fasciitis;priority journal;retrospective study;septicemia;surgical patient;swelling;trismus,"Adekanye, A. G.;Umana, A. N.;Offiong, M. E.;Mgbe, R. B.;Owughalu, B. C.;Inyama, M.;Omang, H. M.",2016,,,0,
71,Heart failure and risk of dementia: a Danish nationwide population-based cohort study,"AIMS: The association between heart failure and dementia remains unclear. We assessed the risk of dementia among patients with heart failure and members of a general population comparison cohort. METHODS AND RESULTS: Individual-level data from Danish medical registries were linked in this nationwide population-based cohort study comparing patients with a first-time hospitalization for heart failure between 1980 and 2012 and a year of birth-, sex-, and calendar year-matched comparison cohort from the general population. Stratified Cox regression analysis was used to compute 1-35-year hazard ratios (HRs) for the risk of all-cause dementia and, secondarily, Alzheimer's disease, vascular dementia, and other dementias. Analyses included 324 418 heart failure patients and 1 622 079 individuals from the general population (median age 77 years, 52% male). Compared with the general population cohort, risk of all-cause dementia was increased among heart failure patients [adjusted HR 1.21, 95% confidence interval (CI) 1.18-1.24]. The associations were stronger in men and in heart failure patients under age 70. Heart failure patients had higher risks of vascular dementia (adjusted HR 1.49, 95% CI 1.40-1.59) and other dementias (adjusted HR 1.30, 95% CI 1.26-1.34) than members of the general population cohort. Heart failure was not associated with Alzheimer's disease (adjusted HR 1.00, 95% CI 0.96-1.04). CONCLUSION: Heart failure was associated with an increased risk of all-cause dementia. Heart failure may represent a risk factor for dementia, but not necessarily for Alzheimer's disease.",Dementia;Epidemiology;Heart failure;Morbidity,"Adelborg, K.;Horvath-Puho, E.;Ording, A.;Pedersen, L.;Toft Sorensen, H.;Henderson, V. W.",2016,Sep 9,10.1002/ejhf.631,1,
72,Heart failure and risk of dementia: a Danish nationwide population-based cohort study,"Aims: The association between heart failure and dementia remains unclear. We assessed the risk of dementia among patients with heart failure and members of a general population comparison cohort. Methods and results: Individual-level data from Danish medical registries were linked in this nationwide population-based cohort study comparing patients with a first-time hospitalization for heart failure between 1980 and 2012 and a year of birth-, sex-, and calendar year-matched comparison cohort from the general population. Stratified Cox regression analysis was used to compute 1–35-year hazard ratios (HRs) for the risk of all-cause dementia and, secondarily, Alzheimer's disease, vascular dementia, and other dementias. Analyses included 324 418 heart failure patients and 1 622 079 individuals from the general population (median age 77 years, 52% male). Compared with the general population cohort, risk of all-cause dementia was increased among heart failure patients [adjusted HR 1.21, 95% confidence interval (CI) 1.18–1.24]. The associations were stronger in men and in heart failure patients under age 70. Heart failure patients had higher risks of vascular dementia (adjusted HR 1.49, 95% CI 1.40–1.59) and other dementias (adjusted HR 1.30, 95% CI 1.26–1.34) than members of the general population cohort. Heart failure was not associated with Alzheimer's disease (adjusted HR 1.00, 95% CI 0.96–1.04). Conclusion: Heart failure was associated with an increased risk of all-cause dementia. Heart failure may represent a risk factor for dementia, but not necessarily for Alzheimer's disease.",adult;age distribution;aged;Alzheimer disease;article;cohort analysis;dementia;Denmark;disease association;female;heart failure;human;major clinical study;male;multiinfarct dementia;risk assessment;risk factor;sex difference;very elderly,"Adelborg, K.;Horváth-Puhó, E.;Ording, A.;Pedersen, L.;Toft Sørensen, H.;Henderson, V. W.",2017,,10.1002/ejhf.631,0,
73,Risk of Stroke in Patients with Heart Failure: A Population-Based 30-Year Cohort Study,"Background and Purpose - The long-term risk of specific stroke subtypes among heart failure patients is largely unknown. We examined short-term and long-term risk of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in heart failure patients and in a general population comparison cohort. Methods - In this nationwide cohort study (1980-2012), we used Danish population-based medical registries to identify and follow (1) all patients hospitalized for the first time with heart failure and (2) a birth year-, sex-, and calendar year-matched general population comparison cohort. Age-, sex-, and comorbidity-adjusted stroke rate ratios were computed based on Cox regression analysis. Results - We included 289 353 patients with heart failure and 1 446 765 individuals from the general population in the analysis. One- and 5-year risks among heart failure patients were 1.4% and 3.9% for ischemic stroke, 0.2% and 0.5% for ICH, and 0.03% and 0.07% for SAH. The 30-day adjusted stroke rate ratio was increased markedly for ischemic stroke (5.08; 95% confidence interval, 4.58-5.63] and was also elevated for ICH (2.13; 95% confidence interval, 1.53-2.97) and SAH (3.52; 95% confidence interval, 1.54-8.08). Between 31 days and 30 years, risk of all stroke subtypes remained positively associated with heart failure (1.5- to 2.1-fold for ischemic stroke, 1.4- to 1.8-fold for ICH, and 1.1- to 1.7-fold for SAH) in comparison with the general population cohort. Conclusions - Heart failure was associated with increased short-term and long-term risk of all stroke subtypes, suggesting that heart failure is a potent and persistent risk factor for ischemic stroke, ICH, and SAH.",adult;aged;alcoholism;angina pectoris;article;atrial fibrillation;brain hemorrhage;brain ischemia;chronic kidney failure;chronic lung disease;cohort analysis;comorbidity;Danish citizen;dementia;diabetes mellitus;female;groups by age;heart atrium flutter;heart failure;heart infarction;hospitalization;human;hypercholesterolemia;hypertension;hypertriglyceridemia;intensive care unit;intermittent claudication;length of stay;major clinical study;male;malignant neoplasm;middle aged;obesity;population research;priority journal;sex difference;standardized incidence ratio;subarachnoid hemorrhage;temporal analysis;valvular heart disease;venous thromboembolism;very elderly,"Adelborg, K.;Szépligeti, S.;Sundbøll, J.;Horváth-Puhó, E.;Henderson, V. W.;Ording, A.;Pedersen, L.;Sørensen, H. T.",2017,,10.1161/strokeaha.116.016022,0,
74,Clinical spectrum of CADASIL and the effect of cardiovascular risk factors on phenotype: Study in 200 consecutively recruited individuals,"BACKGROUND AND PURPOSE-: Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is an inherited arteriopathy with clinical features that include recurrent lacunar stroke, migraine, and cognitive impairment. For reasons that remain unclear, there is great variability in the clinical expression of CADASIL, both between and within families. This study examined the clinical phenotype as well as any associations with risk factors and genotype in a large, prospective cohort. METHODS-: Two hundred symptomatic individuals from 124 families were recruited as part of a UK prevalence study of CADASIL and were seen subsequently in a national referral clinic. All were assessed by a standardized questionnaire and examination. RESULTS-: Mean age at assessment was 47.7 years and was 33.6 years at symptom onset. Migraine, usually with aura, was the most prevalent feature, affecting 75% of individuals. More than half had a history of stroke, with a mean age at onset of 46 years. Hypertension (odds ratio=2.57, P=0.007) and pack-years of smoking (odds ratio=1.07, P=0.001) were associated with an increased risk of stroke. A history of stroke was a significant risk factor for both dementia and disability. Mutations clustered in exon 4 of the NOTCH3 gene, which contained ≥71.4% of familial mutations. Four previously unreported mutations were found (T697C, C1279T, G1370C, and C1774T). No associations were identified between genotype and clinical phenotype. CONCLUSIONS-: Our data suggest that cardiovascular risk factors may modulate the clinical expression of CADASIL. The associations with hypertension and smoking suggest that risk factors should be treated aggressively in patients with CADASIL. © 2010 American Heart Association, Inc.",antidepressant agent;antihypertensive agent;cysteine;glycine;hypocholesterolemic agent;Notch3 receptor;threonine;warfarin;adult;amino acid substitution;article;brain disease;brain hemorrhage;CADASIL;cardiovascular disease;cardiovascular risk;clinical assessment;clinical examination;clinical feature;clinical trial;cognitive defect;cohort analysis;dementia;depression;diabetes mellitus;exon;family;female;gene mutation;genotype phenotype correlation;human;hypercholesterolemia;hypertension;major clinical study;male;migraine aura;onset age;prevalence;priority journal;prospective study;questionnaire;risk factor;smoking;cerebrovascular accident;symptom;United Kingdom,"Adib-Samii, P.;Brice, G.;Martin, R. J.;Markus, H. S.",2010,,,0,
75,"17q25 locus is associated with white matter hyperintensity volume in ischemic stroke, but not with lacunar stroke status","Background and Purpose-Recently, a novel locus at 17q25 was associated with white matter hyperintensities (WMH) on MRI in stroke-free individuals. We aimed to replicate the association with WMH volume (WMHV) in patients with ischemic stroke. If the association acts by promoting a small vessel arteriopathy, it might be expected to also associate with lacunar stroke. Methods-We quantified WMH on MRI in the stroke-free hemisphere of 2588 ischemic stroke cases. Association between WMHV and 6 single-nucleotide polymorphisms at chromosome 17q25 was assessed by linear regression. These singlenucleotide polymorphisms were also investigated for association with lacunar stroke in 1854 cases and 51 939 stroke-free controls from METASTROKE. Meta-analyses with previous reports and a genetic risk score approach were applied to identify other novel WMHV risk variants and uncover shared genetic contributions to WMHV in community participants without stroke and ischemic stroke. Results-Single-nucleotide polymorphisms at 17q25 were associated with WMHV in ischemic stroke, the most significant being rs9894383 (P=0.0006). In contrast, there was no association between any single-nucleotide polymorphism and lacunar stroke. A genetic risk score analysis revealed further genetic components to WMHV shared between community participants without stroke and ischemic stroke. Conclusions-This study provides support for an association between the 17q25 locus and WMH. In contrast, it is not associated with lacunar stroke, suggesting that the association does not act by promoting small-vessel arteriopathy or the same arteriopathy responsible for lacunar infarction. © 2013 American Heart Association, Inc.",adult;aged;article;brain ischemia;chromosome 17q;chromosome 17q 25;controlled study;disease association;female;gene locus;genetic association;genetic risk;genetic variability;human;lacunar stroke;major clinical study;male;priority journal;scoring system;single nucleotide polymorphism;white matter,"Adib-Samii, P.;Rost, N.;Traylor, M.;Devan, W.;Biffi, A.;Lanfranconi, S.;Fitzpatrick, K.;Bevan, S.;Kanakis, A.;Valant, V.;Gschwendtner, A.;Malik, R.;Richie, A.;Gamble, D.;Segal, H.;Parati, E. A.;Ciusani, E.;Holliday, E. G.;Maguire, J.;Wardlaw, J.;Worrall, B.;Bis, J.;Wiggins, K. L.;Longstreth, W.;Kittner, S. J.;Cheng, Y. C.;Mosley, T.;Falcone, G. J.;Furie, K. L.;Leiva-Salinas, C.;Lau, B. C.;Khan, M. S.;Sharma, P.;Fornage, M.;Mitchell, B. D.;Psaty, B. M.;Sudlow, C.;Levi, C.;Boncoraglio, G. B.;Rothwell, P. M.;Meschia, J.;Dichgans, M.;Rosand, J.;Markus, H. S.",2013,,,0,
76,Blood Pressure Measurement: A New Frontier?,,aorta pressure;arterial stiffness;augmentation index;blood pressure measurement;central aortic pressure;cerebrovascular accident;clinical practice;coronary artery disease;decision making;dementia;deterioration;diastolic blood pressure;exercise;heart failure;heart left ventricle hypertrophy;human;hypertension;medicare;note;practice guideline;priority journal;pulse wave;reimbursement;risk factor;sphygmomanometer;systolic blood pressure;tachycardia;Taiwan,"Adji, A.;O'Rourke, M. F.",2016,,,0,
77,Autoimmune diseases and cancer in elderly,,tumor antigen;tumor necrosis factor alpha;article;autoimmune disease;autoimmunity;cancer epidemiology;cancer mortality;carcinogenicity;cerebrovascular accident;comorbidity;dementia;frail elderly;heart failure;human;kidney disease;liver disease;neoplasm;paraneoplastic syndrome;pathophysiology;Sjoegren syndrome;temporal arteritis,"Adoue, D.",2008,,,0,
78,Seven-year survival rate after age 85 years: Relation to Alzheimer disease and vascular dementia,"Objective: To investigate the survival rate in very elderly individuals in relation to Alzheimer disease, vascular dementia, and other mental and physical disorders. Design: A 7-year longitudinal survey. Setting: Community and institutions in Gothenburg, Sweden. Participants: A representative sample of 494 people aged 85 years. Main Outcome Measures: Results of neuropsychiatric and physical examinations, key informant interview, and computed tomographic scan of the head. Information on mortality was obtained from the parish office. Results: The 7-year survival rate was higher in women (34.5%) than in men (203%). Alzheimer disease and vascular dementia predicted 30.7% of deaths in men and 49.7% of deaths in women according to a calculation of population attributable risk (PAR). A regression analysis showed that mortality in men was predicted by the presence of chronic obstructive lung disease (PAR, 18.8), Alzheimer disease (PAR, 16.0), vascular dementia (PAR, 14.7), cancer of the gastrointestinal tract (PAR, 10.2), and skin cancer (PAR, 6.2), and in women by vascular dementia (PAR, 29.4), Alzheimer disease (PAR, 20.3), cerebrovascular disorder (PAR, 12.1), congestive heart failure (PAR, 8.5), hypertension (PAR, 8.0), myocardial infarction (PAR, 6.5), and cancer of the gastrointestinal tract (PAR, 4.3). Life expectancy decreased with severity of dementia, although survival time in individuals with mild Alzheimer disease was not different from that in individuals without dementia. Conclusions: In extreme old age, Alzheimer disease and vascular dementia influence the mortality rate considerably. However, mild Alzheimer disease does not influence longevity, at least not during the first 7 years. These findings have important public health implications.",aged;Alzheimer disease;article;cerebrovascular disease;chronic obstructive lung disease;congestive heart failure;controlled study;digestive system cancer;female;heart infarction;human;hypertension;major clinical study;male;multiinfarct dementia;priority journal;regression analysis;sex difference;skin cancer;survival rate;Sweden,"Aevarsson, Ó;Svanborg, A.;Skoog, I.",1998,,,0,
79,PET/MRI: A new technology in the field of molecular imaging,"BackgroundThe introduction of the new simultaneous PET/MRI scanner opens new opportunities in functional imaging.Sources of dataThis article is based on the literature review and our personal experience of the first simultaneous PET/MRI scanner in the UK.Areas of agreementPET/CT is well established and a key component of management guidance in a range of diseases. MRI has superior soft tissue resolution, which is useful in the evaluation of many diseases.Areas of controversyThere are currently no guidelines regarding clinical use of PET/MRI, and those centres with a PET/MRI facility are undertaking research to look for a 'key application'.Growing points and areas timely for developing researchThis review briefly describes some of the technical advances, present comparisons with the diagnostic performance of current imaging modalities (PET/CT and MRI) and identifies potential indications and research directions. © The Author 2013.",3' fluorothymidine f 18;6 fluorodopa f 18;antineoplastic agent;choline f 18;fluciclatide f 18;fluorine 18;fluorodeoxyglucose f 18;gadolinium;pasireotide tetraxetan gallium ga 68;radiopharmaceutical agent;unclassified drug;amyloidosis;article;brain tumor;breast cancer;cancer chemotherapy;cancer localization;cancer radiotherapy;cancer staging;cancer surgery;cardiovascular magnetic resonance;contrast enhancement;degenerative disease;dementia;diffusion weighted imaging;functional magnetic resonance imaging;glioblastoma;head and neck cancer;human;lymphoma;meningioma;molecular imaging;myeloma;neuroendocrine tumor;nonischemic cardiomyopathy;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;osteosarcoma;Parkinson disease;persistent hyperinsulinemic hypoglycemia of infancy;PET scanner;positron emission tomography;priority journal;prostate cancer;sarcoidosis;soft tissue;susceptibility weighted imaging;thyroid medullary carcinoma;treatment planning;uterine cervix cancer,"Afaq, A.;Syed, R.;Bomanji, J.",2013,,,0,
80,Antibiotic prescription evaluation in the rehabilitation ward of a geriatric hospital,"Objectives: We aimed to identify the indications for antibiotic prescriptions made to patients hospitalized in the rehabilitation ward of a geriatric hospital. Our final objective was to assess those prescriptions. Patients and methods: Medical experts performed a prospective study of all antibiotic treatments prescribed in the rehabilitation ward over a 4-month period based on Gyssens' algorithm and on the local guidelines for anti-infective drugs. Treatments were considered appropriate when the indication, choice of agent, duration, and dose were approved by the experts. They were however considered unnecessary when the indication was incorrect, and they were deemed inappropriate when the experts approved the indication but considered that treatment modalities were not optimal. We also reviewed the prescription re-evaluation made 48 to 72. hours after treatment initiation. Results: We reviewed 142 prescriptions. Treatments had mainly been prescribed for respiratory tract infections (81 infections), urinary tract infections (41), skin infections (15), or abdominal infections (8). A total of 27 prescriptions (19%) were considered unnecessary mainly because a urinary tract infection diagnosis had been wrongly made (21 prescriptions). Half of the prescriptions were considered inappropriate: 38 prescriptions had an inappropriate spectrum of activity and 32 had an inadequate treatment duration. A total of 67 prescriptions (47.2%) had been reassessed 48-72. hours after treatment initiation. Overall, 25 prescriptions (17.6%) were considered appropriate and were reassessed 48-72. hours after treatment initiation. Conclusions: We now have a better understanding of antibiotic prescription in a rehabilitation ward context. We identified several points that need to be improved: update and improvement of the local guidelines, better training for prescribers, and creation of a supporting document for the reassessment of the prescriptions 48-72. hours after treatment initiation.",amoxicillin;amoxicillin plus clavulanic acid;antibiotic agent;beta lactam;ceftriaxone;ciprofloxacin;clarithromycin;cotrimoxazole;levofloxacin;macrolide;metronidazole;ofloxacin;pristinamycin;quinoline derived antiinfective agent;roxithromycin;vancomycin;abdominal infection;aged;article;chronic obstructive lung disease;clinical practice;controlled study;creatinine clearance;dementia;diabetes mellitus;drug efficacy;drug indication;drug use;dysphagia;female;gastrostomy;geriatric hospital;heart failure;hospitalization;human;inappropriate prescribing;major clinical study;male;malnutrition;medical education;Peptoclostridium difficile;practice guideline;prescription;prospective study;rehabilitation center;respiratory tract infection;skin infection;stomach intubation;urinary catheter;urinary tract infection;very elderly,"Afekouh, H.;Baune, P.;Abbas, R.;De Falvelly, D.;Guermah, F.;Haber, N.",2015,,,0,
81,Pre-hospital period in patients with myocardial infarction in Turkey: Methodological and statistical pitfalls,,bivariate analysis;cardiogenic shock;chi square test;dementia;education;emergency care;Fisher exact test;heart arrest;heart infarction;heart muscle reperfusion;hospital admission;hospitalization;human;hypercholesterolemia;ischemic heart disease;letter;mortality;obesity;prevalence;puerperal depression;risk factor;scoring system;sex difference;smoking;social status;statistical significance;therapy delay;Turkey (republic),"Afifi, M. M.",2007,,,0,
82,Geriatric congenital heart disease: Burden of disease and predictors of mortality,"Objectives: The study sought to measure the prevalence, disease burden, and determinants of mortality in geriatric adults with congenital heart disease (ACHD). Background: The population of ACHD is increasing and aging. The geriatric ACHD population has yet to be characterized. Methods: Population-based cohort study using the Quebec Congenital Heart Disease Database of all patients with congenital heart disease coming into contact with the Quebec healthcare system between 1983 and 2005. Subjects with specific diagnoses of congenital heart disease and age 65 years at time of entry into the cohort were followed for up to 15 years. The primary outcome was all-cause mortality. Results: The geriatric ACHD cohort consisted of 3,239 patients. From 1990 to 2005, the prevalence of ACHD in older adults remained constant from 3.8 to 3.7 per 1,000 indexed to the general population (prevalence odds ratio: 0.98; 95% confidence interval [CI]: 0.93 to 1.03). The age-stratified population prevalence of ACHD was similar in older and younger adults. The most common types of congenital heart disease lesions in older adults were shunt lesions (60%), followed by valvular lesions (37%) and severe congenital heart lesions (3%). Type of ACHD and ACHD-related complications had a minor impact on mortality, which was predominantly driven by acquired comorbid conditions. The most powerful predictors of mortality in the Cox proportional hazards model were: dementia (hazard ratio [HR]: 3.24; 95% CI: 1.53 to 6.85), gastrointestinal bleed (HR: 2.79; 95% CI: 1.66 to 4.69), and chronic kidney disease (HR: 2.50; 95% CI: 1.72 to 3.65). Conclusions: The prevalence of geriatric ACHD is substantial, although severe lesions remain uncommon. ACHD patients that live long enough acquire general medical comorbidities, which are the pre-eminent determinants of their mortality. © 2011 American College of Cardiology Foundation.",aged;article;chronic kidney disease;chronic obstructive lung disease;cohort analysis;comorbidity;congenital heart disease;controlled study;dementia;disease severity;female;gastrointestinal hemorrhage;geriatric patient;heart failure;heart infarction;heart septum defect;human;major clinical study;male;neoplasm;population research;prediction;prevalence;priority journal;survival rate;valvular heart disease,"Afilalo, J.;Therrien, J.;Pilote, L.;Ionescu-Ittu, R.;Martucci, G.;Marelli, A. J.",2011,,,0,
83,Is there any association between apolipoprotein E and angiotensin converting enzyme gene polymorphism in patients with Parkinson's disease and dementia in Turkish population?,"The genetic factors which predispose individuals to dementia in old age have not been fully defined. The ε4 allele of the gene encoding apolipoprotein E (Apo E) is the only well replicated genetic risk factor for non-autosomal dominant forms of Alzheimer's disease (AD). Recent reports indicate that the Angiotensin Converting Enzyme (ACE) Deletion (D) polymorphism is associated with a high risk for coronary heart disease and may effect longevity/survival into old age. Since there is no study concerning polymorphism of the Apo E and ACE gene and dementia subtypes in Turkish population, we have examined the these polymorphism in patients with dementia and Parkinson's disease. We determined the apo E and ACE genotypes for 21 patients with Parkinson's disease (PD), 45 patients with dementia and 29 age-matched healthy elderly controls in Turkish population. PCR (Polymerase Chain Reaction), RFLP (Restriction Fragment Length Polymorphism), and agarose gel electrophoresis techniques were used to determine the apo E and ACE genotypes. The apo E ε4 allele frequency was 0.047 for PD, 0.133 for dementia and 0.017 for controls. There was a significant association of Apo ε4 with dementia, but not with PD. And we found no association between ACE genotypes and dementia and PD.",apolipoprotein E;dipeptidyl carboxypeptidase;adult;aged;allele;Alzheimer disease;article;controlled study;dementia;female;gene deletion;genetic polymorphism;genetic predisposition;genotype;human;ischemic heart disease;major clinical study;male;Parkinson disease;survival time;Turkey (republic),"Aǧaçhan, B.;Yilmaz, H.;Aydin, M.;Isbir, T.",2000,,,0,
84,Unrecognized Cognitive Impairment and Its Effect on Heart Failure Readmissions of Elderly Adults,"OBJECTIVES: To determine whether 30-day readmissions were associated with presence of cognitive impairment more in elderly adults with heart failure (HF) than in those with other diagnoses and whether medical teams recognized cognitive impairment. DESIGN: One-year prospective cohort quality improvement program of cognitive screening and retrospective chart review of documentation and outcomes. SETTING: Academic tertiary care hospital medical unit with a cardiovascular focus and an enhanced discharge program of individualized patient education. PARTICIPANTS: Individuals aged 70 and older screened before home discharge (241 admission encounters; 121 with HF as a primary diagnosis, 120 without). The HF cohort included individuals with preserved and reduced ejection fraction. Individuals who had undergone transplantation, ventricular assist device implantation, or hemodialysis or who had a primary oncology diagnosis or hospice referral were excluded. MEASUREMENTS: Mini-Cog administered 48 hours or less before discharge, 30-day all-cause readmission rates, documentation of dementia or cognitive impairment, and caregiver education. RESULTS: Mini-Cog scores were less than 4 (indicating cognitive impairment) in 157 encounters (82 (67.7%) with HF, 75 (62.5%) without). Mini-Cog scores were similar in rate and distribution between groups. Individuals with HF and cognitive impairment had a significantly higher 30-day readmission rate than did the other groups (26.8% vs 13.2%; P = .01; HF, no cognitive impairment, 12.8%; no HF, no cognitive impairment, 13.3%; cognitive impairment, no HF, 13.3%). In individuals with HF and cognitive impairment, those with documented caregiver education had lower readmission rates than those without (14.3% vs 36.2%; P = .03). Fewer than 9% had documentation of cognitive impairment in the medical record. CONCLUSION: Cognitive impairment, which is frequently undocumented, may indicate greater risk of readmission for individuals with HF than those without. Screening for cognitive impairment, adapting discharge for it, and involving family and caregivers in discharge education may help reduce readmissions.",Mini-Cog;cognitive disorders;dementia;elderly;executive dysfunction;heart failure,"Agarwal, K. S.;Kazim, R.;Xu, J.;Borson, S.;Taffet, G. E.",2016,Sep 27,10.1111/jgs.14471,0,85
85,Unrecognized Cognitive Impairment and Its Effect on Heart Failure Readmissions of Elderly Adults,"Objectives: To determine whether 30-day readmissions were associated with presence of cognitive impairment more in elderly adults with heart failure (HF) than in those with other diagnoses and whether medical teams recognized cognitive impairment. Design: One-year prospective cohort quality improvement program of cognitive screening and retrospective chart review of documentation and outcomes. Setting: Academic tertiary care hospital medical unit with a cardiovascular focus and an enhanced discharge program of individualized patient education. Participants: Individuals aged 70 and older screened before home discharge (241 admission encounters; 121 with HF as a primary diagnosis, 120 without). The HF cohort included individuals with preserved and reduced ejection fraction. Individuals who had undergone transplantation, ventricular assist device implantation, or hemodialysis or who had a primary oncology diagnosis or hospice referral were excluded. Measurements: Mini-Cog administered 48 hours or less before discharge, 30-day all-cause readmission rates, documentation of dementia or cognitive impairment, and caregiver education. Results: Mini-Cog scores were less than 4 (indicating cognitive impairment) in 157 encounters (82 (67.7%) with HF, 75 (62.5%) without). Mini-Cog scores were similar in rate and distribution between groups. Individuals with HF and cognitive impairment had a significantly higher 30-day readmission rate than did the other groups (26.8% vs 13.2%; P =.01; HF, no cognitive impairment, 12.8%; no HF, no cognitive impairment, 13.3%; cognitive impairment, no HF, 13.3%). In individuals with HF and cognitive impairment, those with documented caregiver education had lower readmission rates than those without (14.3% vs 36.2%; P =.03). Fewer than 9% had documentation of cognitive impairment in the medical record. Conclusion: Cognitive impairment, which is frequently undocumented, may indicate greater risk of readmission for individuals with HF than those without. Screening for cognitive impairment, adapting discharge for it, and involving family and caregivers in discharge education may help reduce readmissions.",aged;article;cardiovascular disease;caregiver;cognitive defect;cohort analysis;dementia;disease association;educational status;elderly care;female;heart failure;hospital discharge;hospital readmission;human;major clinical study;male;medical record;patient participation;prospective study,"Agarwal, K. S.;Kazim, R.;Xu, J.;Borson, S.;Taffet, G. E.",2016,,10.1111/jgs.14471,0,
86,Perceived stress is associated with subclinical cerebrovascular disease in older adults,"Objective: To examine the association of perceived stress with magnetic resonance imaging (MRI) markers of subclinical cerebrovascular disease in an elderly cohort. Methods: Using a cross-sectional study of a community-based cohort in Chicago, 571 adults (57% women; 58.1% African American; 41.9% non-Hispanic white; mean [SD] age: 79.8 [5.9] years) from the Chicago Health and Aging Project, an epidemiologic study of aging, completed questionnaires on perceived stress, medical history, and demographics as part of an in-home assessment and 5 years later underwent a clinical neurologic examination and MRI of the brain. Outcome measures were volumetric MRI assessments of white matter hyperintensity volume (WMHV), total brain volume (TBV), and cerebral infarction. Results: Stress was measured with six items from the Perceived Stress Scale (PSS); item responses, ranging from never (0) to often (3), were summed to create an overall stress score (mean [SD]: 4.9 [3.3]; range: 0-18). Most participants had some evidence of vascular disease on MRI, with 153 participants (26.8%) having infarctions. In separate linear and logistic regression models adjusted for age, sex, education, race, and time between stress assessment and MRI, each one-point increase in PSS score was associated with significantly lower TBV (coefficient = -0.111, SE = 0.049, t[563] = -2.28, p = 0.023) and 7% greater odds of infarction (odds ratio: 1.07; 95% confidence interval: 1.01, 1.13; Wald ×2[1] = 4.90; p = 0.027). PSS scores were unrelated to WMHV. Results wereunchanged with further adjustment for smoking, body mass index, physical activity, history of heart disease, stroke, diabetes, hypertension, depressive symptoms, and dementia. Conclusions: Greater perceived stress was significantly and independently associated with cerebral infarction and lower brain volume assessed 5 years later in this elderly cohort. © 2014 American Association for Geriatric Psychiatry.",African American;aged;article;body mass;brain infarction;brain size;Caucasian;Center for Epidemiological Studies Depression Scale;cerebrovascular accident;cerebrovascular disease;clinical assessment;clinical evaluation;cognition;cross-sectional study;dementia;depression;diabetes mellitus;female;heart disease;human;human experiment;hypertension;laboratory test;male;medical history;neurologic examination;nuclear magnetic resonance imaging;perceived stress;Perceived Stress Scale;physical activity;smoking;stress;United States;white matter,"Aggarwal, N. T.;Clark, C. J.;Beck, T. L.;De Leon, C. F. M.;DeCarli, C.;Evans, D. A.;Rose, S. A. E.",2014,,,0,
87,Comorbidity in adult bone sarcoma patients: A population-based cohort study,"Background. Comorbidity is an important prognostic factor for survival in different cancers; however, neither the prevalence nor the impact of comorbidity has been investigated in bone sarcoma. Methods. All adult bone sarcoma patients from western Denmark treated at the Aarhus Sarcoma Centre in the period from 1979 to 2008 were identified through a validated population-based database. Charlson Comorbidity Index scores were computed, using discharge diagnoses from the Danish National Patient Registry. Survival was assessed as overall and disease-specific mortality. The impact of comorbidity was examined as rates according to the level of comorbidity as well as uni- and multivariately using proportional hazard models. Results. A total of 453 patients were identified. The overall prevalence of comorbidity was 19%. The prevalence increased with age and over the study period. In patients with Ewing/osteosarcoma, comorbidity was not associated with an increased overall or disease-specific mortality. However, patients with bone sarcomas other than Ewing/osteosarcoma had increased overall mortality. Independent prognostic factors for disease-specific survival were age, tumor size, stage at diagnosis, soft tissue involvement, grade, and surgery. Conclusion. The prevalence of comorbidity in bone sarcoma patients is low. Comorbidity impaired survival in patients with non-Ewing/nonosteosarcoma, histology. This emphasizes the importance of not only treating the sarcoma but also comorbidity. © 2014 Ninna Aggerholm-Pedersen et al.",acquired immune deficiency syndrome;adolescent;adult;age;aged;amputation;angiosarcoma;article;cancer chemotherapy;cancer diagnosis;cancer mortality;cancer patient;cancer prognosis;cancer radiotherapy;cancer size;cancer surgery;cancer survival;cause of death;cerebrovascular disease;Charlson Comorbidity Index;chondrosarcoma;chordoma;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;dementia;Denmark;diabetes mellitus;disease severity;disease specific survival;Ewing sarcoma;female;giant cell tumor;heart infarction;hemiplegia;hospital discharge;human;kidney disease;leiomyosarcoma;leukemia;liver disease;lymphoma;major clinical study;male;malignant fibrous histiocytoma;middle aged;neoplasm;osteosarcoma;overall survival;peripheral vascular disease;population research;prevalence;priority journal;soft tissue metastasis;solid tumor;ulcer;very elderly;young adult,"Aggerholm-Pedersen, N.;Maretty-Nielsen, K.;Keller, J.;Baerentzen, S.;Safwat, A.",2014,,,0,
88,Rethinking the dementia diagnoses in a population-based study: what is Alzheimer's disease and what is vascular dementia?. A study from the kungsholmen project,"OBJECTIVE: To explore the hypothesis that older adults often are affected by more than one disease, making the differential diagnosis between Alzheimer's disease (AD) and vascular dementia (VaD) difficult. METHODS: Incident dementia cases (n = 308) from a population-based longitudinal study of people 75+ years were investigated. The DSM-III-R criteria were used for the clinical diagnosis of dementia. Data on vascular disorders (hypertension, cerebrovascular and ischemic heart diseases, heart failure, atrial fibrillation, diabetes) as well as type of onset/course of dementia were used retrospectively to reclassify dementias. RESULTS: Only 47% of the AD cases were reclassified as pure AD without any vascular disorder. Among subjects with AD and with a vascular component, cerebrovascular disease was the most common (41%). Only 25% of VaD were reclassified as pure VaD. Further, 26% of the pure AD subjects developed a vascular disorder in the following 3 years. CONCLUSIONS: Both vascular and degenerative mechanisms may often contribute to the expression of dementia among the elderly. Most of the AD cases have vascular involvements, and pure dementia types in very old subjects constitute only a minority of dementia cases.","Aged;Aged, 80 and over;Alzheimer Disease/classification/*diagnosis/*psychology;Cohort Studies;Dementia/classification/*diagnosis/*psychology;Dementia, Vascular/classification/*diagnosis/*psychology;Diagnosis, Differential;Disease Progression;Female;Humans;Male;Population;Psychiatric Status Rating Scales;Retrospective Studies;Sweden","Aguero-Torres, H.;Kivipelto, M.;von Strauss, E.",2006,,10.1159/000094973,0,
89,Acute coronary syndrome in elderly – What is the place for invasive strategy?,"Background The elderly are less likely to undergo an invasive strategy for acute coronary syndrome (ACS). The aim is to determine the predictors for an invasive strategy and to evaluate the revascularization effect on outcome. Methods Retrospective analysis of ACS patients (P) with ≥80 years, admitted between 2010 and 2014, in a national ACS registry. P were divided in intervened (G1) and non-intervened (G2) groups. We determined predictors for an invasive approach – percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) – and compared the one year outcome between groups. Results From 11,113P admitted with ACS, 2014 had ≥80 years. 1025P were included in G1. Predictors for an invasive strategy were STEMI (OR 4.97; P < 0.001), previous PCI (OR 2.02; P < 0.001), sinus rhythm (OR 1.56; P = 0.002), haemoglobin at admission (OR 1.10; P = 0.003). Predictors of no intervention were female gender (OR 0.68; P = 0.002), previous ACS (OR0.67; P = 0.013), previous CABG (OR 0.60; P = 0.035), heart failure (OR 0.48; P < 0.001), stroke (OR 0.58; P = 0.002), dementia (OR 0.28; P < 0.001), heart rate (OR 0.99; P < 0.003) and ejection fraction < 50% (OR 0.68; P = 0.001). Hospital mortality was inferior in G1 (8.3% vs. 13.6%; P < 0.001), being conservative strategy (HR 2.63; P < 0.001), STEMI (HR 2.11; P = 0.001), dementia (HR 2.08; P = 0.021), inotropics (HR 9.82; P < 0.001) and ejection fraction <50% (HR 2.65; P < 0.001) predictors of mortality. In propensity score analysis, at one year follow up G1 had a better survival (88.9% vs. 79.6%; P < 0.001). Conclusion In elderly patients with ACS, an invasive strategy was associated with short and long-term survival advantage. The predictors for invasive intervention are STEMI, previous PCI, sinus rhythm and haemoglobin at admission.",beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hemoglobin;heparin;hydroxymethylglutaryl coenzyme A reductase inhibitor;low molecular weight heparin;nitrate;acute coronary syndrome;aged;article;atrioventricular block;cerebrovascular accident;coronary angiography;coronary artery bypass graft;dementia;European Union;female;heart arrest;heart failure;heart rate;hospital mortality;human;major clinical study;male;mortality;non ST segment elevation myocardial infarction;percutaneous coronary intervention;priority journal;retrospective study;ST segment elevation myocardial infarction;survival;treatment outcome,"Aguiar Rosa, S. A.;Timóteo, A. T.;Nogueira, M. A.;Belo, A.;Ferreira, R. C.",2017,,10.1016/j.eurger.2016.07.001,0,
90,The Copenhagen City Heart Study (Osterbroundersogelsen),"The Copenhagen City Heart Study, also known as ""Osterbroundersogelsen"", is a large prospective cardio-vascular population study of 20,000 women and men that was launched in 1975 by Dr Peter Schnohr and Dr Gorm Jensen together with statistician Jorgen Nyboe and Prof. A. Tybjaerg Hansen. The original purpose of the study was to focus on prevention of coronary heart disease and stroke. During the years many other aspects have been added to the study: pulmonary diseases, heart failure, arrhythmia, alcohol, arthrosis, eye diseases, allergy, epilepsia, dementia, stress, vital exhaustion, social network, sleep-apnoe, ageing and genetics. In this review we highlight unique aspects of the Copenhagen City Heat Study (CCHS) and its outcome in investigations of clinical and molecular aspects of health and disease in the regional and global population. To increase the impact of population studies with a focus on risk and prevention of cardiovascular and related diseases and to maximize the likelihood of identifying disease causes and effective therapeutics, lessons learned from past research should be applied to the design, implementation and interpretation of future studies.",,"Aguib, Y.;Al Suwaidi, J.",2015,,10.5339/gcsp.2015.33,0,
91,The Copenhagen City Heart Study (∅sterbroundersøgelsen),"The Copenhagen City Heart Study, also known as ""∅sterbroundersøgelsen"", is a large prospective cardio-vascular population study of 20,000 women and men that was launched in 1975 by Dr Peter Schnohr and Dr Gorm Jensen together with statistician Jørgen Nyboe and Prof. A. Tybjærg Hansen. The original purpose of the study was to focus on prevention of coronary heart disease and stroke. During the years many other aspects have been added to the study: pulmonary diseases, heart failure, arrhythmia, alcohol, arthrosis, eye diseases, allergy, epilepsia, dementia, stress, vital exhaustion, social network, sleep-apnoe, ageing and genetics. In this review we highlight unique aspects of the Copenhagen City Heat Study (CCHS) and its outcome in investigations of clinical and molecular aspects of health and disease in the regional and global population. To increase the impact of population studies with a focus on risk and prevention of cardiovascular and related diseases and to maximize the likelihood of identifying disease causes and effective therapeutics, lessons learned from past research should be applied to the design, implementation and interpretation of future studies. 2015 ElMaghawry, licensee Bloomsbury Qatar Foundation Journals.",aging;alcohol consumption;allergy;article;cerebrovascular accident;clinical examination;dementia;epilepsy;exhaustion;eye disease;genetics;heart arrhythmia;heart failure;human;ischemic heart disease;leisure;lung disease;medical research;mental stress;methodology;osteoarthritis;outcome assessment;physical activity;prospective study;public health;sleep disordered breathing;social network,"Aguib, Y.;Suwaidi, J. A.",2015,,,0,
92,"An open-label, multicenter, phase II study of bevacizumab for the treatment of angiosarcoma and epithelioid hemangioendotheliomas","Background: To determine efficacy and safety of bevacizumab, a recombinant humanized antibody against vascular endothelial growth factor (VEGF), in the treatment of metastatic or locally advanced angiosarcoma and epithelioid hemangioendotheliomas. Patients and methods: In this single-arm phase II trial, 32 patients were enrolled and they received bevacizumab 15 mg/kg IV infusion in 21-day cycles. Patients had disease that was deemed not surgically resectable, Eastern Cooperative Oncology Group (ECOG) performance status of <1, adequate organ function and had not received any radiation treatment in the last 28 days. Results: Of the 30 patients evaluated for efficacy and toxic effect, four (two angiosarcoma and two epithelioid hemangioendothelioma; 17%) had a partial response. Fifteen patients (11 angiosarcoma and 4 epithelioid hemangioendothelioma; 50%) showed stable disease with a mean time to progression of 26 weeks. Bevacizumab was well tolerated with only one grade 4 adverse event. Expected known toxic effects of the drug were manageable. Conclusion: Bevacizumab is an effective and well-tolerated treatment for metastatic or locally advanced angiosarcoma and epithelioid hemangioendotheliomas. Further phase III studies of bevacizumab in combination with other chemotherapeutic agents and/or radiation treatment are warranted. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.",bevacizumab;vasculotropin antibody;adult;advanced cancer;aged;alopecia;angiosarcoma;anorexia;arterial thromboembolism;article;bleeding;cancer growth;cancer prognosis;chemotherapy induced anemia;clinical article;congestive heart failure;cytokine release syndrome;dementia;digestive system perforation;dizziness;drug efficacy;drug hypersensitivity;drug induced headache;drug safety;drug tolerability;dyspnea;edema;enzyme defect;fatigue;female;forced expiratory volume;hemangioendothelioma;human;hyperglycemia;hypertension;infection;infusion related reaction;liver disease;male;metastasis potential;multicenter study;multiple cycle treatment;nausea;neurologic disease;open study;overall survival;pain;phase 2 clinical trial;pleura effusion;posterior reversible encephalopathy syndrome;priority journal;progression free survival;prospective study;proteinuria;side effect;thrombocyte count;thrombocytopenia;transient ischemic attack;treatment duration;treatment response;vein thrombosis;wound dehiscence,"Agulnik, M.;Yarber, J. L.;Okuno, S. H.;von Mehren, M.;Jovanovic, B. D.;Brockstein, B. E.;Evens, A. M.;Benjamin, R. S.",2013,,,0,
93,Primary palliative care for the general internist: Integrating goals of care discussions into the outpatient setting,"Background: Primary palliative care consists of the palliative care competencies required of all primary care clinicians. Included in these competencies is the ability to assist patients and their families in establishing appropriate goals of care. Goals of care help patients and their families understand the patient’s illness and its trajectory and facilitate medical care decisions consistent with the patient’s values and goals. General internists and family medicine physicians in primary care are central to getting patients to articulate their goals of care and to have these documented in the medical record. Case Report: Here we present the case of a 71-year-old male patient with chronic obstructive pulmonary disorder, congestive heart failure, and newly diagnosed Alzheimer dementia to model pertinent end-of-life care communication and discuss practical tips on how to incorporate it into practice. Conclusion: General internists and family medicine practitioners in primary care are central to eliciting patients’ goals of care and achieving optimal end-of-life outcomes for their patients.",aged;Alzheimer disease;amnesia;article;attitude to death;case report;chronic obstructive lung disease;clinical feature;confusion;congestive heart failure;diastolic dysfunction;dyspnea;fatigue;grief;human;internist;male;medical decision making;medical practice;outpatient;palliative therapy;patient preference;primary medical care;terminal care;very elderly,"Ahia, C. L.;Blais, C. M.",2014,,,0,
94,Back to basics: Informing the public of co-morbid physical health problems in those with mental illness,"Objective: Those with mental illness are at increased risk of physical health problems. The current study aimed to examine the information available online to the Australian public about the increased risk and consequences of physical illness in those with mental health problems and the services available to address these co-morbidities. Methods: A structured online search was conducted with the search engine Google Australia (www.google.com.au) using generic search terms mental health information Australia, mental illness information Australia, depression, anxiety, and psychosis. The direct content of websites was examined for information on the physical co-morbidities of mental illness. All external links on high-profile websites [the first five websites retrieved under each search term (n = 25)] were examined for information pertaining to physical health. Results: Only 4.2% of websites informing the public about mental health contained direct content information about the increased risk of physical co-morbidities. The Australian Governments Department of Health and Ageing site did not contain any information. Of the high-profile websites, 62% had external links to resources about physical health and 55% had recommendations or resources for physical health. Most recommendations were generic. Conclusions: Relative to the seriousness of this problem, there is a paucity of information available to the public about the increased physical health risks associated with mental illness. Improved public awareness is the starting point of addressing this health inequity. © 2012 The Royal Australian and New Zealand College of Psychiatrists.",glucose;neuroleptic agent;anxiety disorder;arthritis;article;Australia;awareness;blood glucose monitoring;blood pressure monitor;body weight;comorbidity;dementia;depression;doctor patient relation;glucose blood level;government;health education;health hazard;human;hypercholesterolemia;hyperglycemia;hypertension;Internet;ischemic heart disease;life expectancy;lifestyle modification;mental health care;mortality;non insulin dependent diabetes mellitus;physical disease;psychological well being;psychosis;public health;weight gain,"Ahire, M.;Sheridan, J.;Regbetz, S.;Stacey, P.;Scott, J. G.",2013,,,0,
95,Change in comorbidity prevalence with advancing age among persons with heart failure,"BACKGROUND: Comorbidity-a condition that co-exists with a primary illness-is common among older persons with heart failure and can complicate the overall management of this population. OBJECTIVES: To determine the relationship between advancing age and the prevalence and patterns of comorbidity among older persons with heart failure. DESIGN: Retrospective longitudinal cohort study PARTICIPANTS: A total of 201,130 Medicare beneficiaries with heart failure stratified into three age strata in 2001: 66-75, 76-85, and 86+ years, and followed over 5 years. MEASUREMENTS: (1) Prevalence of 19 conditions as identified by the Chronic Conditions Warehouse from Medicare claims data, characterized as concordant (related to heart failure) or discordant (unrelated to heart failure), and (2) overall comorbidity burden, defined as count of conditions. RESULTS: The median number of comorbidities rose from four (IQR: 2-5) to five (IQR: 4-7) among the young-old, and from 4 (IQR: 3-6) to 6 (IQR: 5-8) among the middle-old and oldest-old between 2001 and 2006. In 2001, the majority of concordant conditions were more prevalent among the youngest than oldest beneficiaries (e.g., diabetes 46.2% vs 26.9%; kidney disease 21.8% vs 18.4%), while the majority of discordant conditions were more prevalent among the oldest-old than youngest-old beneficiaries (e.g., dementia 39.6% vs 9.9%; hip fracture 9.5% vs 1.9%). Discordant conditions increased in prevalence faster among the oldest than youngest beneficiaries (e.g., dementia 13% points versus 9% points). CONCLUSION: Among older Medicare beneficiaries with heart failure, there is a higher overall burden of comorbidity and greater prevalence of discordant comorbidity among the oldest old. Comorbidity prevalence increases over time, with discordant comorbidity increasing at the fastest rate among the oldest old. This comorbidity burden highlights the challenge of effectively treating heart failure while simultaneously managing co-existing and unrelated conditions.","Aged;Aged, 80 and over;Aging/*pathology;Cohort Studies;Comorbidity;Dementia/epidemiology/pathology;Diabetes Mellitus/epidemiology/pathology;Female;Heart Failure/*epidemiology/*pathology;Hip Fractures/epidemiology/pathology;Humans;Kidney Diseases/epidemiology/pathology;Longitudinal Studies;Male;Prevalence;Retrospective Studies","Ahluwalia, S. C.;Gross, C. P.;Chaudhry, S. I.;Leo-Summers, L.;Van Ness, P. H.;Fried, T. R.",2011,Oct,10.1007/s11606-011-1725-6,0,
96,Impact of comorbidity on mortality among older persons with advanced heart failure,"BACKGROUND: Care for patients with advanced heart failure (HF) has traditionally focused on managing HF alone; however, little is known about the prevalence and contribution of comorbidity to mortality among this population. We compared the impact of comorbidity on mortality in older adults with HF with high mortality risk and those with lower mortality risk, as defined by presence or absence of a prior hospitalization for HF, respectively. METHODS: This was a retrospective cohort study (2002-2006) of 18,322 age-matched and gender-matched Medicare beneficiaries. We used the baseline year of 2002 to ascertain HF hospitalization history, in order to identify beneficiaries at either high or low risk of future HF mortality. We calculated the prevalence of 19 comorbidities and overall comorbidity burden, defined as a count of conditions, among both high and low risk beneficiaries, in 2002. Proportional hazards regressions were used to determine the effect of individual comorbidity and comorbidity burden on mortality between 2002 and 2006 among both groups. RESULTS: Most comorbidities were significantly more prevalent among hospitalized versus non-hospitalized beneficiaries; myocardial infarction, atrial fibrillation, kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and hip fracture were more than twice as prevalent in the hospitalized group. Among hospitalized beneficiaries, myocardial infarction, diabetes, COPD, CKD, dementia, depression, hip fracture, stroke, colorectal cancer and lung cancer were each significantly associated with increased hazard of dying (hazard ratios [HRs]: 1.16-1.93), adjusting for age, gender and race. The mortality risk associated with most comorbidities was higher among non-hospitalized beneficiaries (HRs: 1.32-3.78). CONCLUSIONS: Comorbidity confers a significantly increased mortality risk even among older adults with an overall high mortality risk due to HF. Clinicians who routinely care for this population should consider the impact of comorbidity on outcomes in their overall management of HF. Such information may also be useful when considering the risks and benefits of aggressive, high-intensity life-prolonging interventions.","Aged;Aged, 80 and over;Chronic Disease;Cohort Studies;Comorbidity;Female;Heart Diseases/complications/epidemiology;Heart Failure/*complications/*mortality;Hip Fractures/complications/epidemiology;Hospitalization;Humans;Kaplan-Meier Estimate;Kidney Diseases/complications/epidemiology;Longitudinal Studies;Male;Medicare;Prevalence;Prognosis;Pulmonary Disease, Chronic Obstructive/complications/epidemiology;Retrospective Studies;Risk Factors;United States/epidemiology","Ahluwalia, S. C.;Gross, C. P.;Chaudhry, S. I.;Ning, Y. M.;Leo-Summers, L.;Van Ness, P. H.;Fried, T. R.",2012,May,10.1007/s11606-011-1930-3,0,
97,"In-hospital mortality among patients with type 2 diabetes mellitus and acute myocardial infarction: Results from the national inpatient sample, 2000-2010","Background-Case-fatality rates in acute myocardial infarction (AMI) have significantly decreased; however, the prevalence of diabetes mellitus (DM), a risk factor for AMI, has increased. The purposes of the present study were to assess the prevalence and clinical impact of DM among patients hospitalized with AMI and to estimate the impact of important clinical characteristics associated with in-hospital mortality in patients with AMI and DM. Methods and Results-We used the National Inpatient Sample to estimate trends in DM prevalence and in-hospital mortality among 1.5 million patients with AMI from 2000 to 2010, using survey data-analysis methods. Clinical characteristics associated with in-hospital mortality were identified using multivariable logistic regression. There was a significant increase in DM prevalence among AMI patients (year 2000, 22.2%; year 2010, 29.6%, Ptrend<0.0001). AMI patients with DM tended to be older and female and to have more cardiovascular risk factors. However, age-standardized mortality decreased significantly from 2000 (8.48%) to 2010 (4.95%) (Ptrend<0.0001). DM remained independently associated with mortality (adjusted odds ratio 1.069, 95% CI 1.051 to 1.087; P<0.0001). The adverse impact of DM on in-hospital mortality was unchanged over time. Decreased death risk over time was greatest among women and elderly patients. Among younger patients of both sexes, there was a leveling off of this decrease in more recent years. Conclusions-Despite increasing DM prevalence and disease burden among AMI patients, in-hospital mortality declined significantly from 2000 to 2010. The adverse impact of DM on mortality remained unchanged overall over time but was age and sex dependent.",acute heart infarction;adult;age distribution;article;Asian;Black person;cardiovascular risk;cerebrovascular accident;comorbidity;controlled study;death;dementia;disease severity;dyslipidemia;heart failure;heart ventricle fibrillation;Hispanic;hospital patient;human;hypertension;kidney failure;mortality;neoplasm;non insulin dependent diabetes mellitus;obesity;peripheral occlusive artery disease;prevalence;priority journal;probability;quality control;risk factor;sensitivity analysis;shock,"Ahmed, B.;Davis, H. T.;Laskey, W. K.",2014,,,0,
98,An audit of resuscitation status decisions in an older adult psychiatric unit,,bipolar disorder;cardiopulmonary arrest;dementia;depression;hospital admission;human;letter;medical decision making;psychiatric department;resuscitation;schizophreniform disorder,"Ahmed, K.;Daniels, N.;Aswad, A.;Ng, N.;Cohen, V.",2011,,,0,
99,"Psychiatric comorbidity and 30-day readmissions after hospitalization for heart failure, AMI, and pneumonia","OBJECTIVE: In 2012, the Centers for Medicare and Medicaid Services implemented a policy that penalizes hospitals for ""excessive"" all-cause hospital readmissions within 30 days after discharge from an index hospitalization for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. The aim of this study was to investigate the influence of psychiatric comorbidities on 30-day all-cause readmissions following hospitalizations for HF, AMI, and pneumonia. METHODS: Data from 2009-2011 were derived from the HMO Research Network Virtual Data Warehouse of 11 health systems affiliated with the Mental Health Research Network. All index inpatient hospitalizations for HF, AMI, and pneumonia were captured (N=160,169). Psychiatric diagnoses for the year prior to admission were measured. All-cause readmissions within 30 days of discharge were the outcome variable. RESULTS: Approximately 18% of all individuals with index inpatient hospitalizations for HF, AMI, and pneumonia were readmitted within 30 days. The rate of readmission was 5% greater for individuals with a psychiatric comorbidity compared with those without a psychiatric comorbidity (21.7% and 16.5%, respectively, p<.001). Depression, anxiety, and dementia were associated with more readmissions of persons with index hospitalizations for each general medical condition and for all the conditions combined (p<.05). Substance use and bipolar disorders were linked with higher readmissions for those with initial hospitalizations for HF and pneumonia (p<.05). Readmission rates declined overall from 2009 to 2011. CONCLUSIONS: Individuals with HF, AMI, and pneumonia experience high rates of readmission, but psychiatric comorbidities appear to increase that risk. Future interventions to reduce readmission should consider adding mental health components.",Adult;Aged;Comorbidity;Female;Heart Failure/epidemiology/*therapy;Humans;Male;*Mental Disorders/epidemiology;Middle Aged;Myocardial Infarction/epidemiology/*therapy;Patient Readmission/*statistics & numerical data;Pneumonia/epidemiology/*therapy;Time Factors;United States/epidemiology,"Ahmedani, B. K.;Solberg, L. I.;Copeland, L. A.;Fang-Hollingsworth, Y.;Stewart, C.;Hu, J.;Nerenz, D. R.;Williams, L. K.;Cassidy-Bushrow, A. E.;Waxmonsky, J.;Lu, C. Y.;Waitzfelder, B. E.;Owen-Smith, A. A.;Coleman, K. J.;Lynch, F. L.;Ahmed, A. T.;Beck, A.;Rossom, R. C.;Simon, G. E.",2015,Feb 1,10.1176/appi.ps.201300518,0,
100,Cognitive impairment among elderly coronary heart disease patients,"BACKGROUND: Coronary heart disease (CHD) and decline in cognitive functioning and dementia are common problems in the elderly. Cardiovascular diseases (CVDs) are connected with vascular dementia, but less is known about cognitive functioning among elderly patients with CHD based on population studies. OBJECTIVE: To describe the associations between CHD and cognitive impairment among the elderly. POPULATION AND METHODS: Of the total population of the Lieto study (488 community-dwelling men and 708 women, >/=64 years old), the ambulatory patients with CHD (89 men and 73 women) and sex- and age-matched controls without any sign of CHD (178 men and 146 women) were selected to make up the study population. CHD was defined as the presence of angina pectoris or a past myocardial infarction. Cognitive assessment was based on the Mini-Mental State Examination (MMSE). RESULTS: The total MMSE scores, the MMSE subtest scores and the overall test-based cognitive functioning did not differ between patients and controls. Among men, higher MMSE subscores in orientation and language were related to more severe chest pain. According to logistic regression analyses, the cognitive impairment of men was associated with high age, the use of cardiac glycosides and physical disability. Among women, cognitive impairment was associated with high age and the use of antipsychotics. CONCLUSION: In general, CHD has no independent association with cognitive impairment among the non-institutionalized community-living elderly. Among men, however, a complicated CHD may negatively affect cognitive functioning.","Activities of Daily Living;Age Distribution;Aged;Aged, 80 and over;Aging/*physiology;Chest Pain/epidemiology;Cognition Disorders/*epidemiology/nursing/rehabilitation;Community Health Nursing/statistics & numerical data;Comorbidity;Coronary Disease/*epidemiology/nursing/rehabilitation;Disability Evaluation;Dyspnea/epidemiology;Female;Finland/epidemiology;Home Care Services/statistics & numerical data;Humans;Male;Mental Status Schedule;Middle Aged;Sex Distribution;Smoking","Ahto, M.;Isoaho, R.;Puolijoki, H.;Laippala, P.;Sulkava, R.;Kivela, S. L.",1999,,22069,0,
101,Extracranial disseminations,"An autopsy case of malignant lymphoma of the central nervous system which showed extracranial disseminations was presented. A 50-year-old man developed mental and physical slowness over one year prior to admission followed by dementia and consciousness disturbance without general physical symptoms. Physical examination on admission showed no lymph node enlargement, hepatomegaly, splenomegaly, or abdominal mass. Neurological examination revealed mild dementia, left positive Babinski and Chaddock reflexes, and bilateral positive frontal lobe signs. CT scan revealed low densitry areas with contrast enhancement in the white matter of the bilateral parietal lobes adjacent to the trigon of lateral ventricles. Without any therapy, the low density area in the left cerebral hemisphere on CT scan disappeared and the low density area in the right cerebral hemisphere became unenhanced. Any other lesions except brain were found despite of the extensive systemic examinations including schintigrams, echograms, gastrointestinal examinations, body CT scan, aspiration of bone marrow, and lymphography. Prymary intracranial malignant lymphoma was suspected and treated with steroid without any response. Subsequent radiation therapy made a transient improvement. But a few months later, the brain lesions gradually worsened, followed by general physical deterioration with diarrhea, pleural fluids, and ascites. Cytologic study of cerebrospinal fluid revealed neoplastic lymphocytes with atypical nuclei containing conspicuous nucleoli and mitosis, which were identified as B cell type malignant lymphoma by analysis using monoclonal antibody. The patient died of cardiac failure about two years after the initial symptom. The autopsy disclosed malignant lymphoma (diffuse lymphoma, large cell type, non cleaved, B cell type) of the brain with extracranial spreading, involving lungs, liver, kidneys, adrenal glands, and submucosal regions of esophagus, stomach, and small intestine. Extensive tumor growth was noted in the retroperitoneal lymph nodes. The bone marrow or the spleen was not involved. Considering the clinical course, systemic examinations and autopsy findings, this case was probably a primary intracranial malignant lymphoma with extracranial involvement. A primary intracranial malignant lymphoma with dissemination to extracranial regions has not been well documented in the past. Clinical presentation of only mental disturbance over one year without focal neurological symptoms and increased intracranial pressure, and CT scan findings of the low density area without contrast enhancement effect in the course of this case were of rare occurrence and interesting. The importance of cerebrospinal fluid cell analysis using monoclonal antibody to detect B cell type lymphoma was also to be stressed.",monoclonal antibody;adult;article;brain lymphoma;case report;computer analysis;computer assisted tomography;human;male;metastasis,"Aimoto, Y.;Ogata, A.;Fukazawa, T.;Tashiro, K.;Nagashima, K.",1990,,,0,
102,"Tramiprosate in mild-to-moderate Alzheimer's disease - A randomized, double-blind, placebo-controlled, multi-centre study (the alphase study)","Introduction: The aim of the study was to assess the clinical efficacy, safety, and disease-modification effects of tramiprosate (homotaurine, ALZHEMED™) in mild-to-moderate Alzheimer's disease (AD). Material and methods: Double-blind, placebo-controlled, randomized trial in 67 clinical centres across North America. Patients aged ≥ 50 years, with mild-to-moderate AD (Mini-Mental State Examination score between 16 and 26) and on stable doses of cholinesterase inhibitors, alone or with memantine. Intervention: 78-week treatment with placebo, tramiprosate 100 mg or tramiprosate 150 mg BID. Measurements: Alzheimer Disease Assessment Scale - cognitive subscale (ADAS-cog) and Clinical Dementia Rating - Sum of Boxes (CDR-SB) assessments were performed at baseline and every 13 weeks. Baseline and 78-week magnetic resonance imaging (MRI) hippocampus volume (HV) measurements were conducted in a subgroup of patients. Results: A total of 1,052 patients were enrolled and 790 (75.1%) completed the 78-week trial. Patient discontinuation and reasons for withdrawal were similar across groups. Planned analyses did not reveal statistically significant between-group differences. Lack of adequate statistical validity of the planned analysis models led to the development of revised predictive models. These adjusted models showed a trend toward a treatment effect for ADAS-cog (P = 0.098) and indicated significantly less HV loss for tramiprosate 100 mg (P = 0.035) and 150 mg (P = 0.009) compared to placebo. The incidence of adverse events was similar across treatment groups. Conclusions: The primary planned analyses did not show a significant treatment effect, but were confounded by unexplained variance. Post-hoc analyses showed a significant treatment-related reduction in HV loss. However, there was only a trend towards slowing of decline on the ADAS-cog and no slowing of decline on the CDR-SB. These results must be interpreted in consideration of the limitations of clinical and disease-modification outcome measures and their relationship, the heterogeneity of the disease and the impact of confounding demographic and clinical variables. Copyright © 2011 Termedia & Banach.",cholinesterase inhibitor;homotaurine;memantine;placebo;adult;aged;agitation;Alzheimer disease;anxiety;article;backache;brain size;congestive heart failure;coughing;depression;diarrhea;disease severity;dizziness;double blind procedure;drug dose comparison;drug efficacy;drug safety;drug withdrawal;falling;fatigue;female;headache;heart infarction;hippocampus;human;insomnia;major clinical study;male;multicenter study;nausea;nuclear magnetic resonance imaging;pneumonia;randomized controlled trial;rhinopharyngitis;side effect;faintness;upper respiratory tract infection;urinary tract infection;vomiting;weight reduction;alzhemed,"Aisen, P. S.;Gauthier, S.;Ferris, S. H.;Saumier, D.;Haine, D.;Garceau, D.;Duong, A.;Suhy, J.;Oh, J.;Lau, W. C.;Sampalis, J.",2011,,,0,
103,Effects of Rofecoxib or Naproxen vs Placebo on Alzheimer Disease Progression: A Randomized Controlled Trial,"Context: Laboratory evidence that inflammatory mechanisms contribute to neuronal injury in Alzheimer disease (AD), along with epidemiological evidence, suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) may favorably influence the course of the disease. Objective: To determine whether treatment with a selective cyclooxygenase (COX)-2 inhibitor (rofecoxib) or a traditional nonselective NSAID (naproxen) slows cognitive decline in patients with mild-to-moderate AD. Design: Multicenter, randomized, double-blind, placebo-controlled, parallel group trial, with 1-year exposure to study medications. Setting: Forty ambulatory treatment centers affiliated with the Alzheimer's Disease Cooperative Study consortium. Participants: Participants with mild-to-moderate AD (Mini-Mental State Examination score of 13-26) were recruited from December 1999 to November 2000 using clinic populations, referrals from community physicians, and local advertising. Stable use of cholinesterase inhibitors, estrogen, low-dose aspirin, and vitamin E was allowed. Participants with inflammatory diseases that might respond to the study medications were excluded. Of 474 participants screened, 351 were enrolled. Interventions: Once-daily rofecoxib, 25 mg, or twice-daily naproxen sodium, 220 mg, or placebo. Main Outcome Measures: The primary outcome measure was the 1-year change in the Alzheimer Disease Assessment Scale-Cognitive (ADAS-Cog) subscale score. Secondary outcome measures included the Clinical Dementia Rating scale sum-of-boxes, the Neuropsychiatric Inventory, the Quality of Life-AD, and the time to attainment of significant end points (4-point decline from baseline ADAS-Cog score, 1-step worsening on the global Clinical Dementia Rating scale, 15-point decline on the ADCS activities of daily living inventory, institutionalization, or death). Results: The 1-year mean (SD) change in ADAS-Cog scores in participants treated with naproxen (5.8 [8.0]) or rofecoxib (7.6 [7.7]) was not significantly different from the change in participants treated with placebo (5.7 [8.2]). Results of secondary analyses showed no consistent benefit of either treatment. Fatigue, dizziness, and hypertension were more commonly reported in the active drug groups, and more serious adverse events were found in the active treatment group than in the placebo group. Conclusion: The results of this study indicate that rofecoxib or low-dose naproxen does not slow cognitive decline in patients with mild-to-moderate AD.",acetylsalicylic acid;alpha tocopherol;cholinesterase inhibitor;cyclooxygenase 2 inhibitor;estrogen;ibuprofen;naproxen;nonsteroid antiinflammatory agent;placebo;rofecoxib;adult;aged;Alzheimer disease;ambulatory care;article;bleeding;clinical trial;cognition;congestive heart failure;controlled clinical trial;controlled study;death;disease course;disease severity;dose response;dose time effect relation;double blind procedure;drug hypersensitivity;drug selectivity;epidemiological data;fatigue;female;gastrointestinal symptom;heart infarction;human;hypertension;inflammation;intestine perforation;kidney failure;laboratory diagnosis;liver disease;major clinical study;male;Mini Mental State Examination;multicenter study;myalgia;nerve cell lesion;outcomes research;patient referral;peptic ulcer;population research;priority journal;psychiatric diagnosis;quality of life;randomized controlled trial;rating scale;risk assessment;scoring system;statistical significance;cerebrovascular accident;subdural hematoma;transient ischemic attack;vertigo;xerostomia,"Aisen, P. S.;Schafer, K. A.;Grundman, M.;Pfeiffer, E.;Sano, M.;Davis, K. L.;Farlow, M. R.;Jin, S.;Thomas, R. G.;Thal, L. J.",2003,,,0,
104,ISH ADA-01 Critical role of telomerase in regulating cerebral vascular function and redox environment,"OBJECTIVE: Flow mediated dilation (FMD) is the most physiological relevant form of endothelial-mediated vasodilation. Our laboratory has previously shown that telomerase, a ribo-nucleoprotein that counteracts telomere shortening, has a protective effect on endothelial function under conditions of oxidative stress in the human microcirculation. In the presence of coronary artery disease, decreased telomerase activity contributes to a shift in the mediator of FMD from atheroprotective nitric oxide (NO) to pro-inflammatory and atherogenic hydrogen peroxide (H2O2). Endothelial dysfunction in the cerebral vasculature has been directly linked to cerebral microbleeds and cognitive decline in models of stroke and dementia, thus we hypothesized that TERT plays a critical role in maintaining normal NO-mediated vasodilation in the cerebral vasculature. DESIGN AND METHOD: Using Crisp/Cas9 we generated a novel deletion model for TERT (the catalytic subunit of telomerase) in rats on the WKY background. Middle cerebral arteries (MCA) were isolated from wildtype (WT) and TERT rats, prepared for videomicroscopy, and FMD was measured. The mediator of FMD was determined using a pharmacological inhibitor of NO-synthase (L-NAME) and a scavenger of H2O2 (PEG-catalase). RESULTS: No changes in the magnitude of FMD were observed in MCA from TERT compared to WT rats (max dilation: TERT 71.97 +/- 14.7% vs. WT 80.9 +/- 10.6%; n>/=3; p > 0.05 two way ANOVA RM). In WT animals, pre-incubation with L-NAME abolished FMD while PEG-catalase had no effect on FMD (max dilation: L-NAME -5.8 +/- 7%; Peg-catalase 76.6 +/- 8.6%; n>/=3; p < 0.05). Conversely, in TERT animals FMD was not affected in the presence of L-NAME but abolished in presence of Peg-catalase (max dilation: L-NAME 57.8.0 +/- 16.5%; Peg-catalase -4.3 +/- 2.4%; n>/=3; p < 0.05). CONCLUSIONS: Telomerase deficiency causes a switch in the vasoactive mediator of FMD from NO to H2O2, creating a pro-oxidative environment in the cerebral vasculature. Understanding the regulatory role of telomerase in mediating this mechanistic switch may provide a novel therapeutic strategy for the treatment or prevention of cerebrovascular dysfunction.",,"Ait-Aissa, K.;Hockenberry, J.;Gutterman, D.;Geurts, A.;Beyer, A.",2016,Sep,10.1097/01.hjh.0000499955.72890.e7,0,
105,Cognition and quality-of-life outcomes in the targeted temperature management trial for cardiac arrest,,automated external defibrillator;clinical effectiveness;executive function;heart arrest;heart ventricle fibrillation;hospital discharge;human;induced hypothermia;mental deterioration;mortality;note;outcome assessment;priority journal;prognosis;quality of life;resuscitation;survival rate;treatment planning;unconsciousness,"Aiyagari, V.;Diringer, M. N.",2015,,,0,
106,Risk estimates for complex disorders: Comparing personal genome testing and family history,"Purpose:Personal genome testing allows the identification of single-nucleotide polymorphisms associated with an increased risk for common complex disorders. An area of concern in the use of personal genome testing is how risk estimates generated differ from traditional measures of risk (e.g., family history analysis). We sought to analyze the concordance of risk estimates generated by family history analysis and by personal genome testing.Methods:Risk categorizations for 20 complex conditions included in Navigenics personal genome testing were compared with risk categorization estimates derived from family history assessment using the kappa (κ) statistic.Results:The only conditions showing slight agreement between risk assessment methods were Alzheimer disease (κ = 0.131), breast cancer (κ = 0.154), and deep vein thrombosis (κ = 0.201) in females, and colon cancer (κ = 0.124) in males. Eighty-six individuals (11.4%) were found to have additional genetic risks not assessed by personal genome testing after family and medical history assessment, including 38 individuals with family histories suggestive of hereditary cancer syndromes.Conclusion: Discordance between personal genome testing and family history risk estimates suggests that these methods may provide independent information that could be used in a complementary manner. Results also support that eliciting family history adds value to overall risk assessment for individuals undergoing personal genome testing. © American College of Medical Genetics and Genomics.",abdominal aorta aneurysm;adult;aged;Alzheimer disease;article;breast cancer;colon cancer;deep vein thrombosis;familial cancer;family assessment;family history;female;genetic counseling;genetic risk;genome analysis;glaucoma;Graves disease;atrial fibrillation;heart infarction;hemochromatosis;hereditary nonpolyposis colorectal cancer;human;lactose intolerance;lung cancer;major clinical study;male;medical history;melanoma;middle aged;non insulin dependent diabetes mellitus;osteoarthritis;ovary cancer;prostate cancer;psoriasis;restless legs syndrome;macular degeneration;rheumatoid arthritis;risk assessment;sex difference;young adult,"Aiyar, L.;Shuman, C.;Hayeems, R.;Dupuis, A.;Pu, S.;Wodak, S.;Chitayat, D.;Velsher, L.;Davies, J.",2014,,,0,
107,The effects of age and gender on the relationship between HMGCR promoter-911 SNP (rs33761740) and serum lipids in patients with coronary heart disease,"BACKGROUND: Hydroxymethylglutaryl-Coenzyme A Reductase (HMGCR) catalyzes the rate-limiting step of cholesterol biosynthesis. This enzyme is the target of the widely available cholesterol lowering statins. In this population-based case-control study, the frequencies of -911 C>A polymorphism (rs3761740) of the HMGCR gene in patients with coronary heart disease (CHD) and healthy subjects were investigated and the correlations between the different genotypes and hypercholesterolemia with cardiovascular risk factors were analyzed. METHODS: The HMGCR genotypes were determined in 365 patients with CHD and 365 controls by PCR-RFLP assay. Anthropometric measurements were measured in all participants. RESULTS: There was no significant difference in the genotype frequencies of the HMGCR polymorphism between the male subjects of both patient and control groups, however, the HMGCR-CC genotype was found to be more frequent in female patients with CHD than female controls (p=0.002). The HMGCR-CC genotype showed higher total-cholesterol (TC) and LDL-cholesterol (LDL-C) levels than the CA+AA genotypes in male CHD patients (p=0.018). Due to this significant sex interaction, a multivariate analysis was conducted on the patient group. In the multivariate logistic regression analysis, the HMGCR-CC genotype was significantly associated with age<55 (OR=2.837, p=0.001) and TC >/= 5.18 mmol/L (OR=1.970, p=0.027) in male subjects. However, this association was not observed in female patients (p>0.05). This analysis confirmed that the HMGCR-CC genotype was associated with elevated TC levels in male CHD patients with age<55 years. CONCLUSION: These results suggest that age and sex modify the contribution of the HMGCR-911 polymorphism to fasting serum TC, LDL-C levels and risk of CHD.","Adult;Age Distribution;Age Factors;Case-Control Studies;Cholesterol/blood;Cholesterol, LDL/*blood;Coronary Disease/*blood/epidemiology/*genetics;Female;Gene Frequency;Genetic Association Studies;Genetic Predisposition to Disease;Humans;Hydroxymethylglutaryl CoA Reductases/*genetics;Male;Middle Aged;Multivariate Analysis;Polymorphism, Single Nucleotide;Prevalence;Promoter Regions, Genetic;Sex Distribution;Sex Factors;Ad;Alzheimer's disease;Bmi;Chd;Coronary heart disease;Dbp;Hdl-c;HDL-cholesterol;Hmgcr;Hwe;Hardy-Weinberg equilibrium;Hydroxymethylglutaryl-Coenzyme A Reductase;Ldl-c;LDL-cholesterol;Lipoproteins;Polymorphism;Sbp;Snp;Srebp;Single Nucleotide Polymorphism;Tc;Tg;Vldl-c;VLDL-cholesterol;body mass index;diastolic blood pressure;sterol regulatory element binding protein;systolic blood pressure;total-cholesterol;triglyceride","Akadam-Teker, B.;Kurnaz, O.;Coskunpinar, E.;Daglar-Aday, A.;Kucukhuseyin, O.;Cakmak, H. A.;Teker, E.;Bugra, Z.;Ozturk, O.;Yilmaz-Aydogan, H.",2013,Oct 10,10.1016/j.gene.2013.07.056,0,
108,The clinical features of takotsubo cardiomyopathy,"Background: Cardiologists have recently recognized a reversible form of heart failure of unknown origin characterized by a takotsubo-shaped hypokinesis of the left ventricle on left ventriculography. Aim: To clarify the clinical features of this cardiomyopathy. Design: Observational study. Methods: Seven patients with reversible ventricular dysfunction were followed for 4.5 years. Clinical course, routine examinations, and cardiac catheterizations in each patient were documented. Results: The cardiomyopathy developed in six elderly female and one male patients (mean age 75.3 years), all of whom had been exposed to stress. Cardiac enzymes did not significantly increase, but serum norepinephrine increased remarkably (1.19 ng/ml). Coronary angiography revealed normal coronary arteries. However, left ventriculography showed akinesis in the apical segments, together with hyperkinesis in the basal segments (a takotsubo shape). The abnormal kinesis normalized within 17.4 hospital days without any treatment in five patients, and with haemodynamic support for 3 days in the other two. Endocardial biopsies did not suggest any specific pathology. The cardiac events did not recur over a 1-4 year follow-up. Discussion: Coronary vasospasm, myocarditis and other substantial diseases previously described were ruled out as the cause of takotsubo cardiomyopathy in our subjects. Prognosis was good without any form of treatment, provided that the patients survived the severe heart failure state. Catecholaminergic or adrenoceptor-hyperactive cardiomyopathy may be the cause of this cardiomyopathy.",angiotensin 2 receptor antagonist;beta adrenergic receptor blocking agent;chlorpheniramine maleate;creatine kinase isoenzyme;creatine kinase MB;digitalis;dipeptidyl carboxypeptidase inhibitor;doxazosin;enalapril;famotidine;magnesium sulfate;maprotiline;metoprolol;nifedipine;noradrenalin;pilsicainide;pravastatin;procaterol;rilmazafone;theophylline;ticlopidine;adult;aged;angiocardiography;article;cardiomyopathy;clinical article;clinical feature;controlled study;coronary artery spasm;creatine kinase blood level;dementia;depression;disease course;electrocardiogram;emphysema;endocardial biopsy;female;atrial fibrillation;heart catheterization;heart failure;heart ventricle tachycardia;heart ventriculography;human;hypertension;male;myocarditis;noradrenalin blood level;priority journal;prognosis;two dimensional echocardiography,"Akashi, Y. J.;Nakazawa, K.;Sakakibara, M.;Miyake, F.;Koike, H.;Sasaka, K.",2003,,,0,
109,Identifying and verifying causes of death in Turkey: National verbal autopsy survey,"Objectives: The aim of this study was to identify the national, rural, and urban mortality rates, and to define the medical causes of death for the 0-28 days and 29 days-5 years age groups, as well as adult mortality in Turkey. Study design: A cross-sectional survey, which identified the causes of death using the verbal autopsy(VA) method, and a methodological study, which determined the validity of the verbal autopsy method was used in conjunction with each other. Methods: The verbal autopsy method, based on a representative sampling according to age and gender in Turkey, was used. A methodological study was additionally used, which determined the validity of the VA method. Results: The crude death rate calculated from the VA survey was 0.51% with rates of 0.60% in males, 0.42% in females, 0.48% in urban areas, and 0.56% in rural areas. Life expectancy at birth was 72.6 years for males and 77.2 years for females. The mean life expectancy at birth for both sexes together was 74.8 years. The VA form has a high degree of validity although no study or form can take the place of a records-based surveillance system with accurate information; the VA form is a useful tool for collecting data during certain periods or specific areas. However, healthcare providers must work towards establishing a well-designed, routine surveillance system in the long term. Conclusions: The mortality rates and life expectancies were consistent with other similar studies in the country and the Turkish VA method may be safely used to determine causes of death in countries with inadequate record and registry systems. © 2011.",acute heart infarction;adolescent;adult;age distribution;aged;Alzheimer disease;anorexia;article;asphyxia;asthma;coronary artery atherosclerosis;autopsy;bacteremia;birth injury;hematologic disease;brain hemorrhage;bronchus cancer;cardiovascular disease;cause of death;cerebrovascular accident;child;chronic kidney failure;chronic obstructive lung disease;controlled study;cross-sectional study;diabetes mellitus;diagnostic accuracy;diagnostic value;diarrhea;disease surveillance;disseminated intravascular clotting;essential hypertension;female;gastroenteritis;health survey;heart failure;human;hydrocephalus;immunopathology;infant;infant mortality;ischemic heart disease;life expectancy;liver cancer;low birth weight;lower respiratory tract infection;lung cancer;major clinical study;malaria;male;medical information system;meningitis;neonatal respiratory distress syndrome;newborn sepsis;pneumonia;prematurity;preschool child;reliability;safety;sensitivity and specificity;septicemia;sex difference;stillbirth;traffic accident;Turkey (republic);urban rural difference;validity;verbal autopsy survey,"Akgün, S.;Çolak, M.;Bakar, C.",2012,,,0,
110,Shunt-responsive parkinsonism and reversible white matter lesions in patients with idiopathic NPH,"Background: Idiopathic normal pressure hydrocephalus (iNPH) is a potentially treatable dementia and gait disorder with abnormal CSF dynamics. Objective: To investigate and characterize the changes in motor symptoms and CT and MRI features of iNPH before and after a shunt operation using specific evaluation criteria. Methods: We studied 17 definitive iNPH patients, diagnosed according to the clinical guidelines of both the Japanese Society of NPH and the International NPH Consultant Group, with ventricular enlargement (Evan's index > 0.3) and narrowed CSF spaces at the high convexity on CT scan and /or MRI. The pre- and post-operative evaluation criteria for the gait and motor disturbances included the Japanese NPH Grading Scale-Revised (JNPHGSR), the Timed ""Up and Go"" test and the motor sections of the Unified Parkinson Disease Rating Scale. For cognitive impairments, the JNPHGSR, Mini Mental State Examination, Frontal Assessment Battery and Trail Making Test were used. White matter lesions were rated from the CT and/or MRI using a validated visual rating scale. Results: All patients showed specific CT and MRI findings, consisting of diffusely-dilated Sylvian fissure, as well as narrowed CSF space at the high convexity. Fifteen patients (88%) showed white matter lesions on their CT or MRI images. These signs were ameliorated in all patients after the shunt operation. Evan's index and the mean total scores on the visual scale for white matter lesions also improved significantly. Clinically, the patients had frequent parkinsonism (71%), but relatively few had a history of either small-vessel diseases (29%), hypertension (41%) or diabetes (35%). All patients showed gait disturbances, and these symptoms, including postural instability and body bradykinesia, improved significantly after the operation. Over half also showed signs of cognitive impairment and urinary incontinence, and all such symptoms and signs improved significantly. Conclusion: iNPH often appears as a shunt-responsive type of parkinsonism and reversible white matter lesions among the geriatric population. © 2008 Springer.",aged;article;bradykinesia;brain damage;brain region;brain ventricle peritoneum shunt;cerebrospinal fluid;clinical article;clinical feature;cognitive defect;computer assisted tomography;diabetes mellitus;female;function test;gait disorder;heart ventricle hypertrophy;human;hypertension;idiopathic disease;male;microangiopathy;Mini Mental State Examination;motor dysfunction;motor performance;neuroimaging;neuroradiology;normotensive hydrocephalus;nuclear magnetic resonance imaging;outcome assessment;parkinsonism;postoperative care;preoperative evaluation;priority journal;rating scale;shunting;symptom;treatment outcome;treatment response;Unified Parkinson Disease Rating Scale;urine incontinence;white matter,"Akiguchi, I.;Ishii, M.;Watanabe, Y.;Watanabe, T.;Kawasaki, T.;Yagi, H.;Shiino, A.;Shirakashi, Y.;Kawamoto, Y.",2008,,,0,
111,Risks and benefits of hormone replacement therapy,"In contrast to observational studies, clinical trials examining the efficacy of hormone replacement therapy (HRT) have shown the overall negative or deteriorating effects of HRT in postmenopausal women. Particularly, the results of Women's Health Initiative (WHI) demonstrated that HRT was preventive of fractures and colon cancer but increased the risk of myocardial infarction, stroke and dementia in addition to breast cancer and venous thromboembolism. Conversely, recent progress in androgen research suggests the efficacy of androgen replacement therapy in elderly men, pending clinical trials.",Estrogen Replacement Therapy;Female;*Hormone Replacement Therapy/adverse effects;Humans;Male,"Akishita, M.",2008,Jan,,0,
112,Urologic problems in the elderly population,"Urological problems are observed commonly in elderly people, and taking care of geriatric patients represents a large portion of the daily routine in the practice of an urologist. Urinary incontinence and voiding dysfunction, nocturia, benign prostatic hyperplasia, prostate cancer, urinary tract infections and late on-set hypogonadism are the most common urologic problems seen in the geriatric age group. Most of these conditions are managed by medications that can affect cognitive functions, blood pressure, heart rate and rhytm, as well as balance, and these medications may interact with the other medications used daily for other conditions. Urinary pathologic conditions, such as incontinence and nocturia, can lead to significant morbidity in the frail elderly, often leading to falls and hip fractures. Surgical intervention is common for urologic diseases, especially for prostatic conditions, but must be carefully evaluated before initiation in geriatric patients.",alpha 1 adrenergic receptor blocking agent;alpha adrenergic receptor stimulating agent;androgen;androstanolone;cholinergic receptor;cholinergic receptor blocking agent;desmopressin;gonadorelin;gonadotropin;luteinizing hormone;muscarinic receptor blocking agent;narcotic agent;prolactin;prostate specific antigen;steroid 5alpha reductase inhibitor;testosterone;vasopressin;aging;article;bacteriuria;blood pressure;blurred vision;bronchitis;chronic obstructive lung disease;cognition;cognitive defect;congestive heart failure;constipation;dementia;diabetes mellitus;dizziness;drug dose reduction;dry eye;falling;glaucoma;heart rate and rhythm;hip fracture;human;hypogonadism;micturition;morbidity;nocturia;orchiectomy;orthostatic hypotension;pelvic floor muscle training;prostate cancer;prostate hypertrophy;prostatectomy;quality of life;randomized controlled trial (topic);sacral nerve stimulation;suburethral sling;tachycardia;transurethral resection;urinalysis;urinary tract disease;urinary tract infection;urine incontinence;weight reduction;xerostomia,"Akman, Y. R.;Başar, M. M.",2012,,,0,
113,An evaluation of the underlying causes of fall-induced hip fractures in elderly persons,"BACKGROUND: Falls are the major cause of hip fractures in elderly patients. The aim of this prospective study was to investigate the underlying causes of fall-induced hip fractures in the elderly. METHODS: The study included 32 patients (18 males, 14 females; mean age 78 years; range 57 to 95 years) who had proximal femoral fractures following an unexpected and sudden fall from about a meter height at a moment of lying, sitting, or standing position. Underlying causes of falls were sought, including previous falls, stroke, polyneuropathy, motion disorders, dementia, vision problems, fainting, vestibular pathologies, and cardiac diseases. RESULTS: Eight patients (25%) had a history of previous falls and 12 patients (37.5%) had a history of stroke. Polyneuropathy, Parkinson's Disease, and dementia were diagnosed in eight (25%), three (9.4%), and five (15.6%) patients, respectively. Twenty-one patients (65.6%) had neurologic diseases, 11 patients (34.4%) had cataract or other vision problems, eight patients (25%) had osteoarthritis and rheumatoid arthritis, 10 patients (31.3%) had vestibular pathologies, and 17 patients (53.1%) had cardiac diseases such as heart failure, orthostatic hypotension, ischemic heart disease, and arrhythmia. CONCLUSION: In order to prevent recurrent falls, risk factors associated with falls should be determined and preventive treatment and measures should be put into practice in elderly patients who have fall-induced injuries.",aged;article;cerebrovascular accident;elderly care;evaluation study;falling;female;hip fracture;human;male;middle aged;risk factor;statistics;Turkey (republic),"Aktaş, S.;Celik, Y.",2004,,,0,
114,An unusual swelling at the pacemaker pocket site,,steroid;aged;case report;chronic kidney disease;comorbidity;echography;human;hypertension;ischemic heart disease;long term care;male;medical device complication;multiinfarct dementia;note;pacemaker;pacemaker pocket infection;paroxysmal atrial fibrillation;priority journal;rheumatic polymyalgia;Stenotrophomonas maltophilia;steroid therapy;subclavian vein;swelling;thorax wall;vein thrombosis;very elderly,"Aktuerk, D.;Lutz, M.;Luckraz, H.",2014,,,0,
115,Age patterns of incidence of geriatric disease in the U.S. elderly population: Medicare-based analysis,"OBJECTIVES: To use the Medicare Files of Service Use (MFSU) to evaluate patterns in the incidence of aging-related diseases in the U.S. elderly population. DESIGN: Age-specific incidence rates of 19 aging-related diseases were evaluated using the National Long Term Care Survey (NLTCS) and the Surveillance, Epidemiology, and End Results (SEER) Registry data, both linked to MFSU (NLTCS-M and SEER-M, respectively), using an algorithm developed for individual date at onset evaluation. SETTING: A random sample from the entire U.S. elderly population (Medicare beneficiaries) was used in NLTCS, and the SEER Registry data covers 26% of the U.S. population. PARTICIPANTS: Thirty-four thousand seventy-seven individuals from NLTCS-M and 2,154,598 from SEER-M. MEASUREMENTS: Individual medical histories were reconstructed using information on diagnoses coded in MFSU, dates of medical services and procedures, and Medicare enrollment and disenrollment. RESULTS: The majority of diseases (e.g., prostate cancer, asthma, and diabetes mellitus) had a monotonic decline (or decline after a short period of increase) in incidence with age. A monotonic increase in incidence with age with a subsequent leveling off and decline was observed for myocardial infarction, stroke, heart failure, ulcer, and Alzheimer's disease. An inverted U-shaped age pattern was detected for lung and colon carcinomas, Parkinson's disease, and renal failure. The results obtained from the NLTCS-M and SEER-M were in agreement (excluding an excess for circulatory diseases in the NLTCS-M). A sensitivity analysis proved the stability of the incidence rates evaluated. CONCLUSION: The developed computational approaches applied to the nationally representative Medicare-based data sets allow reconstruction of age patterns of disease incidence in the U.S. elderly population at the national level with unprecedented statistical accuracy and stability with respect to systematic biases.","Age Distribution;Age Factors;Aged;Aged, 80 and over;Female;*Geriatrics;Humans;Incidence;Male;Medicare;United States/epidemiology","Akushevich, I.;Kravchenko, J.;Ukraintseva, S.;Arbeev, K.;Yashin, A. I.",2012,Feb,10.1111/j.1532-5415.2011.03786.x,0,
116,Time trends of incidence of age-associated diseases in the US elderly population: Medicare-based analysis,"OBJECTIVES: time trends of age-adjusted incidence rates of 19 ageing-related diseases were evaluated for 1992-2005 period with the National Long Term Care Survey and the Surveillance, Epidemiology and End RESULTS Registry data both linked to Medicare data (NLTCS-Medicare and SEER-Medicare, respectively). METHODS: the rates were calculated using individual medical histories (34,077 individuals from NLTCS-Medicare and 199,418 from SEER-Medicare) reconstructed using information on diagnoses coded in Medicare data, dates of medical services/procedures and Medicare enrolment/disenrolment. RESULTS: increases of incidence rates were dramatic for renal disease [the average annual percent change (APC) is 8.56%, 95% CI = 7.62, 9.50%], goiter (APC = 6.67%, 95% CI = 5, 90, 7, 44%), melanoma (APC = 6.15%, 95% CI = 4.31, 8.02%) and Alzheimer's disease (APC = 3.96%, 95% CI = 2.67, 5.26%), and less prominent for diabetes and lung cancer. Decreases of incidence rates were remarkable for angina pectoris (APC = -6.17%, 95% CI = -6.96, -5.38%); chronic obstructive pulmonary disease (APC = -5.14%, 95% CI = -6.78,-3.47%), and ulcer (APC = -5.82%, 95% CI = -6.77,-4.86%) and less dramatic for carcinomas of colon and prostate, stroke, hip fracture and asthma. Incidence rates of female breast carcinoma, myocardial infarction, Parkinson's disease and rheumatoid arthritis were almost stable. For most diseases, an excellent agreement was observed for incidence rates between NLTCS-Medicare and SEER-Medicare. A sensitivity analysis proved the stability of the evaluated time trends. CONCLUSION: time trends of the incidence of diseases common in the US elderly population were evaluated. The results show dramatic increase in incidence rates of melanoma, goiter, chronic renal and Alzheimer's disease in 1992-2005. Besides specifying widely recognised time trends on age-associated diseases, new information was obtained for trends of asthma, ulcer and goiter among the older adults in the USA.","Age Distribution;Age of Onset;*Aging;Alzheimer Disease/*epidemiology;Asthma/epidemiology;Cardiovascular Diseases/epidemiology;Diabetes Mellitus/epidemiology;Female;Goiter/*epidemiology;Humans;Incidence;Least-Squares Analysis;Linear Models;Lung Diseases/epidemiology;Male;Medicare/*trends;Melanoma/epidemiology;Neoplasms/*epidemiology;Renal Insufficiency, Chronic/*epidemiology;SEER Program;Sex Distribution;Sex Factors;Skin Neoplasms/epidemiology;Time Factors;Ulcer/epidemiology;United States/epidemiology;Medicare;age-associated disease;comorbidity;disease onset;older people;time trends","Akushevich, I.;Kravchenko, J.;Ukraintseva, S.;Arbeev, K.;Yashin, A. I.",2013,Jul,10.1093/ageing/aft032,0,
117,The use of endo-vascular balloon tamponade technique for the removal of a misplaced nephrostomy tube in the inferior vena cava: A case report,Introduction Inadvertent placement of a nephrostomy tube into the inferior vena cava (IVC) is an extremely rare complication with few reported cases in the literature. Case presentation We present a lady with obstructive uropathy in a solitary kidney in whom an attempt by the community radiologist to place a nephrostomy tube was complicated by wrong insertion into the IVC. This report illustrates how a safe non- surgical removal of this tube using an intravenous balloon tamponade technique was successfully applied. Discussion Intravenous placement of nephrostomy catheters into the inferior vena cava is extremely rare complication. A few case reports have been published in the literature. The majority of these cases were removed in the operating room under general anesthesia. Using Intravenous balloon tamponade technique for removal has not been previously reported. Conclusion Intravenous balloon tamponade technique is effective and is a good minimally invasive alternative to surgical removal of misplaced nephrostomy tube from IVC.,antibiotic agent;creatinine;hemoglobin;oxygen;potassium;aged;angiographic catheter;antibiotic therapy;article;balloon;blood pressure measurement;case report;cause of death;chronic kidney disease;computer assisted tomography;congestive heart failure;coronary artery disease;creatinine blood level;dementia;endovascular balloon tamponade;female;gastroesophageal reflux;heart disease;heart rate;hemoglobin blood level;human;hypertension;inferior cava vein;leukocyte count;medical history;nasal prong;nephrostomy;nephrostomy catheter;nephrostomy tube;obstructive uropathy;osteoporosis;oxygen saturation;oxygen therapy;patient history of nephrectomy;phlebography;potassium blood level;priority journal;pulse rate;pyelonephritis;solitary kidney;urinary catheter;urosepsis,"Al Zahrani, Y.;AlHarbi, S. R.;Wiseman, D.",2016,,,0,
118,Pure hippocampal sclerosis: A rare cause of dementia mimicking Alzheimer's disease,"Objectives: To identify patients with pure hippocampal sclerosis (HS) as a cause of dementia, to determine whether they have had histories of hypotension or hypoxia, and to compare the clinical features of patients with pure HS with a control group of AD patients without HS. Methods: In a retrospective study, the authors reviewed all 1771 cases received in their dementia brain bank from 1978 through 1996 to identify those patients with pure HS, defined as severe degeneration and gliosis of the CA1 sector and subiculum of the hippocampal formation in the absence of other significant dementing disease such as Alzheimer's changes. The control group included all patients received during the same period with severe AD without HS, infarcts, or other dementing disease. Results: Seven pure HS cases (0.4%) were identified. None had any episodes of syncope, hypotension, or hypoxia reported in association with dementia onset. Six had memory loss as the primary presenting symptom, and all became progressively demented. Forty-five AD patients without HS were identified for the control group. There were no clear clinical differences between the two groups with regard to sex, age at onset, risk factors for vascular disease, symptoms of cerebrovascular disease, treatment with tranquilizing medications, treatment for depression, or nursing home placement. There was a tendency for heart disease to be more prevalent and the duration of illness to be shorter in the patients with pure HS. Conclusions: Pure hippocampal sclerosis (HS) occurred in only 0.4% of our dementia patients. Clinically, the seven patients with pure HS were similar to our AD control group. Further research is needed to determine the causes of HS and why HS appears to mimic AD.",aged;Alzheimer disease;article;clinical feature;controlled study;disease association;gliosis;heart disease;hippocampus;human;hypotension;major clinical study;memory;nerve degeneration;priority journal;retrospective study;sclerosis,"Ala, T. A.;Beh, G. O.;Frey Ii, W. H.",2000,,,0,
119,Diabetes mellitus and quality of life in nursing homes,"Objectives: to describe the clinical profile of diabetes mellitus (DM) in elderly nursing home residents, as well as chronic complications and residents' perceptions of their quality of life. Material and methods: a cross-sectional descriptive study was performed in the residential setting through comprehensive geriatric assessment. The frequency of chronic diseases and geriatric syndromes in patients with diabetes was compared. In residents without cognitive impairment, perceived quality of life was determined through the COOP-WONCA questionnaire and cardiovascular risk was assessed with the Framingham scale. Statistical significance was set at P<.05. Results: a total of 190 residents were evaluated. The mean age was 83.1 years (SD 8.2) and 76.8% were women. Severe dependency was found in 50.5% and criteria for dementia were met by 57.0%. The prevalence of DM was 27.4%. DM predominated in women aged more than 80 years. A further 11 patients showed altered baseline glycemia (110-125 mg/dl). Among patients with DM there was a greater association with hypertension and vascular complications, as well as with urinary incontinence and overweight. HbA1C levels were <7% in 65% and the main treatment was oral antidiabetic agents. Cardiovascular risk was high or very high in nursing home residents with DM. Perceived quality of life was higher in diabetic residents without cognitive impairment than in residents without diabetes (P<.05). Conclusions: DM is highly prevalent among elderly residents of nursing homes. Comprehensive geriatric assessment is essential to evaluate potential risks and to optimize quality of life in these patients.",glucose;aged;article;cardiovascular risk;cerebrovascular accident;chronic disease;cognition;controlled study;dementia;diabetes mellitus;disease association;elderly care;female;geriatric assessment;glucose blood level;health survey;human;hypertension;ischemic heart disease;male;nursing home;patient attitude;quality of life;questionnaire;risk assessment;risk factor;urine incontinence,"Alaba Trueba, J.",2007,,,0,
120,Cognitive decline in heart failure,"Cognitive impairment (CI) is common in older adults with heart failure (HF). The prevalence of CI is higher among patients with HF than in those without. The spectrum of CI in HF is similar to that observed in the general population and may range from delirium to isolated memory or non-memory-related deficits to dementia. Both HF with reduced ejection fraction and HF with preserved ejection fraction have been associated with defects in different domains of cognition. Numerous risk factors have been shown to contribute to CI in HF. Additionally, various pathophysiological mechanisms related to HF can contribute to cognitive decline. These conditions are not routinely screened for in clinical practice settings with HF populations, and guidelines on optimal assessment strategies are lacking. Validated tools and criteria should be used to differentiate acute cognitive decline (delirium) from chronic cognitive decline such as mild cognitive impairment and dementia. CI in HF has been associated with higher rates of disability and impairment in self-care activities that may in turn increase healthcare cost, hospital readmission and mortality. Early detection of CI may improve clinical outcomes in older adults with HF. Appropriate HF management strategies may also help to reduce CI in patients with HF, and future research is needed to develop and test newer and more effective interventions to improve outcomes in patients with HF and CI.",Delirium;Dementia;Heart failure;Mild cognitive impairment,"Alagiakrishnan, K.;Mah, D.;Ahmed, A.;Ezekowitz, J.",2016,Nov,10.1007/s10741-016-9568-1,0,121
121,Cognitive decline in heart failure,"Cognitive impairment (CI) is common in older adults with heart failure (HF). The prevalence of CI is higher among patients with HF than in those without. The spectrum of CI in HF is similar to that observed in the general population and may range from delirium to isolated memory or non-memory-related deficits to dementia. Both HF with reduced ejection fraction and HF with preserved ejection fraction have been associated with defects in different domains of cognition. Numerous risk factors have been shown to contribute to CI in HF. Additionally, various pathophysiological mechanisms related to HF can contribute to cognitive decline. These conditions are not routinely screened for in clinical practice settings with HF populations, and guidelines on optimal assessment strategies are lacking. Validated tools and criteria should be used to differentiate acute cognitive decline (delirium) from chronic cognitive decline such as mild cognitive impairment and dementia. CI in HF has been associated with higher rates of disability and impairment in self-care activities that may in turn increase healthcare cost, hospital readmission and mortality. Early detection of CI may improve clinical outcomes in older adults with HF. Appropriate HF management strategies may also help to reduce CI in patients with HF, and future research is needed to develop and test newer and more effective interventions to improve outcomes in patients with HF and CI.",biological marker;brain natriuretic peptide;dipeptidyl carboxypeptidase inhibitor;anemia;article;atrial fibrillation;body mass;cardiac resynchronization therapy;chronic obstructive lung disease;cognitive defect;delirium;dementia;disease association;functional disease;heart failure;heart failure with preserved ejection fraction;human;hypotension;incidence;kidney function;morbidity;mortality;neuroimaging;pathophysiology;prevalence;self care;waist circumference,"Alagiakrishnan, K.;Mah, D.;Ahmed, A.;Ezekowitz, J.",2016,,10.1007/s10741-016-9568-1,0,
122,Comparison of two commonly used clinical cognitive screening tests to diagnose mild cognitive impairment in heart failure with the golden standard European Consortium Criteria,"INTRODUCTION: This study on mild cognitive impairment (MCI) in heart failure (HF) compares the utility of Montreal Cognitive Assessment (MoCA) to the Mini-Mental Status Exam (MMSE) for diagnosing MCI in a HF population when compared to the golden standard European Consortium Criteria (ECC). METHODS: Participants were recruited from the Alberta HEART study at the Mazankowski Alberta Heart Institute in Edmonton and St. Mary's hospital in Camrose. This study enrolled 53 community adults aged>50years: 33 HF and 20 controls. Participants were assessed using both the MMSE and MoCA for MCI. MCI was diagnosed using the golden standard, European Consortium Criteria. Sensitivity and specificity analysis, positive and negative predictive values, likelihood ratios and kappa statistic were calculated. RESULTS: The mean age was 72.8years (SD 8.4), 60.4% were females and 34% had underlying ischemic heart disease. Overall, two thirds of patients (22/33, 66%) with HF had MCI. In comparison to European Consortium Criteria, the sensitivity and specificity of MoCA were 82% and 91% in identifying individuals with MCI, and MMSE were 9% and 91%, respectively. The positive and negative predictive values for MoCA were 95% and 71%, and for MMSE were 67% and 33%, respectively. Kappa statistics showed good agreement between MoCA and consortium criteria (kappa=0.68) and a low agreement between MMSE and consortium criteria (kappa=0.07). CONCLUSION: Cognitive dysfunction is common in patients with HF. Overall, the MoCA seems to be a better screening tool than MMSE for MCI in HF patients.",Aged;Alberta/epidemiology;Cognition/ physiology;Cognitive Dysfunction/ diagnosis/epidemiology/etiology;Female;Follow-Up Studies;Heart Failure/ complications/epidemiology/psychology;Humans;Incidence;Male;Neuropsychological Tests/ standards;Prevalence;Reproducibility of Results;Retrospective Studies;Delirium;Dementia;Heart failure;Mild cognitive impairment,"Alagiakrishnan, K.;Mah, D.;Dyck, J. R.;Senthilselvan, A.;Ezekowitz, J.",2017,Feb 01,,0,
123,"Comparative use of different antihypertensive combinations at savar area, dhaka, bangladesh","Antihypertensive agents are class of drugs that are used to treat hypertension (high blood pressure) as well as other CVS disorders. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. Single-dose combination antihypertensive therapy is an important option that combines efficacy of blood pressure reduction and a low side effect profile with convenient once-daily dosing to enhance compliance as compared to monotherapy. The survey enabled to monitor 500 prescriptions and found most available combinations at Savar area in Bangladesh among which beta blockers with Ca-channel blockers was used most (89%) and the brand Fixocard of Incepta was the brand leader. © 2013 are reserved by International Journal of Pharmaceutical Sciences and Research.",acetylsalicylic acid plus clopidogrel;amdocal plus;amlodipine plus atenolol;amlodipine plus benazepril;amlodipine plus valsartan;angilock plus;angiotensin 2 receptor antagonist;antihypertensive agent;atenolol plus chlortalidone;atenolol plus nifedipine;beta adrenergic receptor blocking agent;calcium channel blocking agent;candesartan hexetil plus hydrochlorothiazide;dipeptidyl carboxypeptidase inhibitor;ecospirin plus;fixocard;hydrochlorothiazide plus irdesartan;hydrochlorothiazide plus losartan;hydrochlorothiazide plus ramipril;hydrochlorothiazide plus tamlesartan;hydrochlorothiazide plus valsartan;osartil;thiazide diuretic agent;unclassified drug;article;Bangladesh;combination chemotherapy;drug efficacy;human;medication compliance;monotherapy;prescription;treatment planning,"Alam, M. J.;Rahman, M. A.;Parul, R.",2014,,,0,
124,Hypoglycemia and brain death,"Introduction: Hypoglycemia is a frequent event in patients with diabetes mellitus (DM). When the reduction is severe and prolonged blood glucose can cause brain damage manifested by memory and/or cognitive impairment, dementia and brain death. The mechanisms involved in hypoglycemic neuronal death are varied and have as a common element the oxidative stress, which suggest that the greatest neuronal damage does not occur during the period of hypoglycemia, but possibly during glucose replacement. Case report: We report the case of a diabetic patient with hypoglycemia associated with prolonged diarrhea syndrome and hyporexia, who progressed to coma and death. Conclusions: The main limiting factor in the management of type 1 and 2 DM is hypoglycemia. Brain death secondary to severe reduction in blood glucose levels is rare, but it must be considered in patients with risk factors for prolonged hypoglycemia, due to the association with altered nutritional status, heart failure, kidney or liver disease, neoplasia, infection or sepsis. Knowledge of the mechanisms leading to neuronal death during glucose replacement, force us to be cautious after an episode of hypoglycemia, which avoid severe complications and even death.",glucose;anorexia;article;brain damage;brain death;case report;cognitive defect;coma;death;dementia;diabetes mellitus;diarrhea;disease association;disease course;disease severity;glucose blood level;human;hypoglycemia;memory disorder;oxidative stress,"Alatorre-Fernández, C. P.;Castro-Martínez, E.;Hernández-Erazo, I. D.;Balderas-Juárez, J.;Estévez-Sánchez, P.",2012,,,0,
125,Active Treatment of Senile Dementia,,"*Alzheimer Disease;*Codeine;*Dementia;*Geriatrics;*Heart Failure;*Intracranial Arteriosclerosis;*Mental Disorders;*Opium;*Psychotic Disorders;*Scopolamine Hydrobromide;*Strophanthins;*Urinary Incontinence;*Cerebral arteriosclerosis;*Heart failure, congestive;*Psychoses, presenile;*Psychoses, senile;*Scopolamine;*Strophanthin","Albert, E.",1964,Aug 7,10.1055/s-0028-1113157,0,
126,Depression among Older Adults after Traumatic Brain Injury: A National Analysis,"Objective Sequelae of traumatic brain injury (TBI) include depression, which could exacerbate the poorer cognitive and functional recovery experienced by older adults. The objective of this study was to estimate incidence rates of depression after hospital discharge for TBI among Medicare beneficiaries aged at least 65 years, quantify the increase in risk of depression after TBI, and evaluate risk factors for incident depression post-TBI. Methods Using a retrospective analysis, the authors studied Medicare beneficiaries at least 65 years old hospitalized for TBI during 2006 to 2010 who survived to hospital discharge and had no documented diagnosis of depression before the study period (N = 67,347). Results The annualized incidence rate of depression per 1,000 beneficiaries was 62.8 (95% confidence interval [CI]: 61.6, 64.1) pre-TBI and 123.9 (95% CI: 121.6, 126.2) post-TBI. Annualized incidence rates were highest immediately after hospital discharge and declined over the 12 months post-TBI. TBI increased the risk of incident depression in men (hazard ratio: 1.95; 95% CI: 1.84, 2.06; Wald χ2 = 511.4, df = 1, p <0.001) and in women (hazard ratio: 1.69; 95% CI: 1.62, 1.77; Wald χ2 = 589.3, df = 1, p <0.001). The strongest predictor of depression post-TBI for both men and women was discharge to a skilled nursing facility (men: odds ratio, 1.91; 95% CI, 1.77, 2.06; Wald χ2 = 277.1, df = 1, p <0.001; women: odds ratio, 1.72; 95% CI, 1.63, 1.83; Wald χ2 = 324.2, df = 1, p <0.001). Conclusion TBI significantly increased the risk of depression among older adults, especially among men and those discharged to a skilled nursing facility. Results from this study will help increase awareness of the risk of depression post-TBI among older adults.",age;aged;alcohol abuse;alcoholism;Alzheimer disease;article;comorbidity;depression;diabetes mellitus;disease severity;female;geriatric patient;heart failure;hospital discharge;human;incidence;ischemic heart disease;length of stay;major clinical study;male;medicare;nursing home;prevalence;race difference;retrospective study;risk assessment;sex difference;traumatic brain injury,"Albrecht, J. S.;Kiptanui, Z.;Tsang, Y.;Khokhar, B.;Liu, X.;Simoni-Wastila, L.;Zuckerman, I. H.",2015,,,0,
127,Benefits and risks of anticoagulation resumption following traumatic brain injury,"IMPORTANCE The increased risk of hemorrhage associated with anticoagulant therapy following traumatic brain injury creates a serious dilemma for medical management of older patients: Should anticoagulant therapy be resumed after traumatic brain injury, and if so, when? OBJECTIVE To estimate the risk of thrombotic and hemorrhagic events associated with warfarin therapy resumption following traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of administrative claims data for Medicare beneficiaries aged at least 65 years hospitalized for traumatic brain injury during 2006 through 2009 who received warfarin in the month prior to injury (n = 10 782). INTERVENTION Warfarin use in each 30-day period following discharge after hospitalization for traumatic brain injury. MAIN OUTCOMES AND MEASURES The primary outcomeswere hemorrhagic and thrombotic events following discharge after hospitalization for traumatic brain injury. Hemorrhagic events were defined on inpatient claims using International Classification of Diseases, Ninth Revision, Clinical Modification codes and included hemorrhagic stroke, upper gastrointestinal bleeding, adrenal hemorrhage, and other hemorrhage. Thrombotic events included ischemic stroke, pulmonary embolism, deep venous thrombosis, andmyocardial infarction. A composite of hemorrhagic or ischemic stroke was a secondary outcome. RESULTS Medicare beneficiaries with traumatic brain injury were predominantly female (64%) and white (92%), with a mean (SD) age of 81.3 (7.3) years, and 82%had atrial fibrillation. Over the 12 months following hospital discharge, 55%received warfarin during 1 or more 30-day periods.We examined the lagged effect of warfarin use on outcomes in the following period.Warfarin use in the prior period was associated with decreased risk of thrombotic events (relative risk [RR], 0.77 [95%CI, 0.67-0.88]) and increased risk of hemorrhagic events (RR, 1.51 [95%CI, 1.29-1.78]).Warfarin use in the prior period was associated with decreased risk of hemorrhagic or ischemic stroke (RR, 0.83 [95%CI, 0.72-0.96]). CONCLUSIONS AND RELEVANCE Results from this study suggest that despite increased risk of hemorrhage, there is a net benefit for most patients receiving anticoagulation therapy, in terms of a reduction in risk of stroke, from warfarin therapy resumption following discharge after hospitalization for traumatic brain injury. © 2014 American Medical Association.",warfarin;adrenal hemorrhage;aged;Alzheimer disease;anticoagulant therapy;article;bleeding disorder;brain hemorrhage;brain ischemia;cohort analysis;comorbidity;deep vein thrombosis;dementia;female;follow up;atrial fibrillation;heart failure;heart infarction;hospital discharge;hospitalization;human;hypertension;ischemic heart disease;lung embolism;major clinical study;male;medicare;outcome assessment;priority journal;retrospective study;sensitivity analysis;thrombosis;traumatic brain injury;upper gastrointestinal bleeding;valvular heart disease,"Albrecht, J. S.;Liu, X.;Baumgarten, M.;Langenberg, P.;Rattinger, G. B.;Smith, G. S.;Gambert, S. R.;Gottlieb, S. S.;Zuckerman, I. H.",2014,,,0,
128,Sex differences in mortality following isolated traumatic brain injury among older adults,"BACKGROUND Older adults have the highest rates of hospitalization and mortality from traumatic brain injury (TBI), yet outcomes in this population are not well studied. In particular, contradictory reports on the protective effect of female sex on mortality following TBI may have been related to age differences in TBI and other injury severity and mechanism. The objective of this study was to determine if there are sex differences in mortality following isolated TBI among older adults and compare with findings using all TBI. A secondary objective was to characterize TBI severity and mechanism by sex in this population. METHODS This was a retrospective cohort study conducted among adults aged 65 and older treated for TBI at a single large Level I trauma center from 1996 to 2012 (n = 4,854). Individuals treated for TBI were identified using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Isolated TBI was defined as an Abbreviated Injury Scale score of 0 for other body regions. Our primary outcome was mortality at discharge. RESULTS Among those with isolated TBI (n = 1,320), women (45% of sample) were older (mean [SD], 78.9 [7.7] years) than men (76.8 [7.5] years) (p < 0.001). Women were more likely to have been injured in a fall (91% vs. 84%; p < 0.001). Adjusting for multiple injury severity measures, female sex was not significantly associated with decreased odds of mortality following isolated TBI (odds ratio, 1.01; 95% confidence interval, 0.66-1.54). Using all TBI cases, adjusted analysis found that female sex was significantly associated with decreased odd of mortality (odds ratio, 0.73; 95% confidence interval, 0.59-0.89). CONCLUSION We found no sex differences in mortality following isolated TBI among older adults, in contrast with other studies and our own analyses using all TBI cases. Researchers should consider isolated TBI in outcome studies to prevent residual confounding by severity of other injuries.",alcohol;abdominal injury;age;aged;alcohol blood level;alcoholism;Alzheimer disease;arm injury;article;assault;chronic obstructive lung disease;clinical outcome;cohort analysis;controlled study;dementia;depression;diabetes mellitus;emergency health service;epilepsy;face injury;falling;female;Glasgow coma scale;head injury;heart arrhythmia;heart failure;hospital admission;hospital discharge;mortality;hospitalization;human;hypertension;injury scale;injury severity;ischemic heart disease;leg injury;length of stay;major clinical study;male;multiple trauma;neck injury;neurologic disease;Parkinson disease;patient transport;priority journal;retrospective study;sex difference;spine injury;systolic blood pressure;thorax injury;traffic accident;traumatic brain injury;very elderly,"Albrecht, J. S.;McCunn, M.;Stein, D. M.;Simoni-Wastila, L.;Smith, G. S.",2016,,,0,
129,Randomized controlled clinical trial of a home care unit intervention to reduce readmission and death rates in patients discharged from hospital following admission for heart failure,"METHODSThis randomized controlled clinical trial involved 279 HF patients who were discharged from a tertiary-care hospital between February 2001 and June 2002. Patients with dementia, terminal non-cardiac disease, or chronic obstructive pulmonary disease were excluded. Data collected included the cause of cardiac decompensation. A primarily educational intervention was implemented in the patient's home for up to 15 days after hospital discharge. Treatment was adjusted during the first week if necessary. The primary outcome measure was the 1-year cumulative incidence of readmission or death. Secondary measures were the incidence of readmission, mortality, and emergency department admission. Telephone interviews were carried out 3, 6 and 12 months after discharge, and clinical records were updated when necessary. Emergency department admission in the first 6 months was monitored.RESULTSAt 1-year follow-up, 62 of the 137 patients (45.3%) in the intervention group had been readmitted or died, compared with 75 of the 142 (52.8%) in the control group, (relative risk=0.86, P=.232). Among patients who suffered decompensation because failure to adhere to treatment, 16 of the 45 (35.6%) in the intervention group were readmitted or died, compared with 34 of the 56 (60.7%) control group patients (relative risk=0.59, P=.016).CONCLUSIONSThis intervention is feasible but, when applied indiscriminately to every discharged heart failure patient, the best that can be expected is only a modest reduction in readmission and death rates, which, in this study in particular, did not achieve statistical significance.INTRODUCTION AND OBJECTIVESTo determine the effectiveness of a primarily educational intervention in heart failure (HF) patients implemented in a home care unit.",Heart Failure [mortality] [therapy];Home Care Services;Patient Discharge;Patient Readmission [statistics & numerical data];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];aged;article;chronic obstructive lung disease/ep [Epidemiology];clinical trial;controlled clinical trial;controlled study;dementia/ep [Epidemiology];emergency ward;female;follow up;heart failure/dt [Drug Therapy];heart failure/ep [Epidemiology];heart failure/th [Therapy];home care;hospital discharge;hospital readmission;human;interview;major clinical study;male;patient compliance;patient education;randomized controlled trial;risk assessment;statistical significance;treatment outcome;angiotensin receptor antagonist/ct [Clinical Trial];angiotensin receptor antagonist/dt [Drug Therapy];angiotensin receptor antagonist/pd [Pharmacology];anticoagulant agent/ct [Clinical Trial];anticoagulant agent/dt [Drug Therapy];beta adrenergic receptor blocking agent/ct [Clinical Trial];beta adrenergic receptor blocking agent/dt [Drug Therapy];Sr-epoc: sr-vasc,"Aldamiz-Echevarría, Iraúrgui B;Muñiz, J;Rodríguez-Fernández, Ja;Vidán-Martínez, L;Silva-César, M;Lamelo-Alfonsín, F;Díaz-Díaz, Jl;Ramos-Polledo, V;Castro-Beiras, A",2007,,,0,
130,Randomized controlled clinical trial of a home care unit intervention to reduce readmission and death rates in patients discharged from hospital following admission for heart failure,"INTRODUCTION AND OBJECTIVES: To determine the effectiveness of a primarily educational intervention in heart failure (HF) patients implemented in a home care unit. METHODS: This randomized controlled clinical trial involved 279 HF patients who were discharged from a tertiary-care hospital between February 2001 and June 2002. Patients with dementia, terminal non-cardiac disease, or chronic obstructive pulmonary disease were excluded. Data collected included the cause of cardiac decompensation. A primarily educational intervention was implemented in the patient's home for up to 15 days after hospital discharge. Treatment was adjusted during the first week if necessary. The primary outcome measure was the 1-year cumulative incidence of readmission or death. Secondary measures were the incidence of readmission, mortality, and emergency department admission. Telephone interviews were carried out 3, 6 and 12 months after discharge, and clinical records were updated when necessary. Emergency department admission in the first 6 months was monitored. RESULTS: At 1-year follow-up, 62 of the 137 patients (45.3%) in the intervention group had been readmitted or died, compared with 75 of the 142 (52.8%) in the control group, (relative risk=0.86, P=.232). Among patients who suffered decompensation because failure to adhere to treatment, 16 of the 45 (35.6%) in the intervention group were readmitted or died, compared with 34 of the 56 (60.7%) control group patients (relative risk=0.59, P=.016). CONCLUSIONS: This intervention is feasible but, when applied indiscriminately to every discharged heart failure patient, the best that can be expected is only a modest reduction in readmission and death rates, which, in this study in particular, did not achieve statistical significance.",Aged;Female;Heart Failure/*mortality/*therapy;*Home Care Services;Humans;Male;Patient Discharge;Patient Readmission/*statistics & numerical data,"Aldamiz-Echevarria Iraurgui, B.;Muniz, J.;Rodriguez-Fernandez, J. A.;Vidan-Martinez, L.;Silva-Cesar, M.;Lamelo-Alfonsin, F.;Diaz-Diaz, J. L.;Ramos-Polledo, V.;Castro-Beiras, A.",2007,Sep,,0,
131,Knowledge and attitude of primary care doctors towards management of postmenopausal symptoms,"Background: According to the current recommendations, women with post-menopausal symptoms should be managed. Knowledge and perception of primary care physicians towards management of postmenopausal symptoms are deficient. Aim: The aim of the present study was to explore knowledge and attitude of primary care doctors towards management of postmenopausal symptoms. Methods: This study is a cross-sectional survey that was conducted from October to December 2010 in the five health regions in Kuwait. Two centers were selected randomly from each health region. All physicians who were currently working in the selected centers were asked to participate in the study. Out of 209 physicians, 142 agreed to participate and completed a self-administered questionnaire. Results: The study revealed that 82.4% of physicians had moderate knowledge about treatment options for postmenopausal symptoms, 88.0% discussed postmenopausal symptoms with their patients, and 45.1% of them either described or referred their patients for hormonal replacement therapy (HRT). The correct answers regarding 10 statements related to the Women Health Initiative finding were ranging from 2.8% to 78.9% which indicated low level of knowledge. Regarding the effectiveness of hormonal replacement therapy in postmenopausal women, the majority of the physicians agreed correctly that HRT is effective in prevention of osteoporosis (87.3%), treatment of vasomotor symptoms (83.7%), and treatment of vulvo-vaginal symptoms (82.4%). There was a variation among physicians opinion about the effectiveness of certain treatment options for managing hot flushes in postmenopausal women. Conclusion: The results suggest that there is a lack of primary care physicians knowledge and confidence in recognizing signs and symptoms of menopause and in identifying and prescribing appropriate management. © 2012 .",alpha tocopherol;belladonna alkaloid plus ergotamine tartrate plus phenobarbital;clonidine;conjugated estrogen plus medroxyprogesterone acetate;estrogen;gabapentin;gestagen;hormone;isoflavone derivative;mirtazapine;placebo;primrose oil;serotonin uptake inhibitor;trazodone;venlafaxine;abdominal pain;adult;aged;Alzheimer disease;Angelica sinensis;article;breast cancer;cancer risk;cardiovascular disease;cognitive defect;combination chemotherapy;controlled study;cross-sectional study;dementia;depression;drug approval;drug contraindication;drug efficacy;female;ginseng;heart infarction;high risk patient;hormone substitution;hot flush;human;ischemic heart disease;Kuwait;lifestyle modification;liver disease;low drug dose;male;medical education;menopausal syndrome;monotherapy;osteoporosis;physician;physician attitude;prescription;primary medical care;professional knowledge;red clover;sexual behavior;single drug dose;cerebrovascular accident;uterus disease;vagina bleeding;vasomotor disorder;vein thrombosis;vulvovaginal disease;wrinkle;yam;catapres;desyrel;effexor;neurontin,"Al-Eassa, A. A.;Al-Fadel, A. M.;Al-Ajmi, M. A.;Al-Najjar, A. A.;Makboul, G. M.;Elshazly, M.",2012,,,0,
132,Pleiotropic effects of statins and related pharmacological experimental approaches,"Statins, the most widely prescribed cholesterol-lowering drugs, are considered to be first-line therapeutics for the prevention of coronary heart disease and atherosclerosis. Statins act by inhibiting the enzyme 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase, the rate-limiting enzyme in endogenous cholesterol biosynthesis, which catalyzes the reduction of HMG-CoA to mevalonic acid. Inhibition of this enzyme has proven to be effective for lowering plasma total cholesterol, low-density lipoprotein-cholesterol, and triglyceride levels in humans and can therefore be useful to treat atherosclerotic and dyslipidemic disorders. However, the clinical benefits of statins appear to extend beyond their lipid-lowering effects. Besides reducing cholesterol biosynthesis, inhibition of mevalonate by statins also leads to a reduction in the synthesis of important intermediates, such as the isoprenoids farnesyl pyrophosphate and geranylgeranyl pyrophosphate. These intermediates are involved in the posttranslational prenylation of several proteins (e.g., Ras, Rho, Rac) that modulate a variety of cellular processes including cellular signaling, differentiation, and proliferation. Given the central role of these isoprenylated proteins in endothelial function, atherosclerotic plaque stability, platelet activity, coagulation, oxidation, and inflammatory and immunologic responses, it could be anticipated that these compounds may exert multiple beneficial effects in a broad spectrum of disorders including cardiovascular disease, osteoporosis, Alzheimer's disease and related vascular dementia, viral and bacterial infection, etc. This article summarizes these cholesterol-lowering-independent effects of statins, termed ""pleiotropic effects,"" and the underlying mechanisms, as well as the preclinical experimental approaches that would be useful to evaluate the effects of statins.",,"Alegret, M.;Silvestre, J. S.",2007,Apr 18,,0,
133,Mitochondrial DNA deletions inhibit proteasomal activity and stimulate an autophagic transcript,"Deletions within the mitochondrial DNA (mtDNA) cause Kearns Sayre syndrome (KSS) and chronic progressive external opthalmoplegia (CPEO). The clinical signs of KSS include muscle weakness, heart block, pigmentary retinopathy, ataxia, deafness, short stature, and dementia. The identical deletions occur and rise exponentially as humans age, particularly in substantia nigra. Deletions at >30% concentration cause deficits in basic bioenergetic parameters, including membrane potential and ATP synthesis, but it is poorly understood how these alterations cause the pathologies observed in patients. To better understand the consequences of mtDNA deletions, we microarrayed six cell types containing mtDNA deletions from KSS and CPEO patients. There was a prominent inhibition of transcripts encoding ubiquitin-mediated proteasome activity, and a prominent induction of transcripts involved in the AMP kinase pathway, macroautophagy, and amino acid degradation. In mutant cells, we confirmed a decrease in proteasome biochemical activity, significantly lower concentration of several amino acids, and induction of an autophagic transcript. An interpretation consistent with the data is that mtDNA deletions increase protein damage, inhibit the ubiquitin-proteasome system, decrease amino acid salvage, and activate autophagy. This provides a novel pathophysiological mechanism for these diseases, and suggests potential therapeutic strategies.","*Autophagy;Biomarkers/*metabolism;Cells, Cultured;DNA, Mitochondrial/*genetics;Gene Expression Profiling;Humans;Kearns-Sayre Syndrome/*genetics/metabolism;Oligonucleotide Array Sequence Analysis;Ophthalmoplegia, Chronic Progressive External/*genetics/metabolism;Proteasome Endopeptidase Complex/metabolism;*Proteasome Inhibitors;RNA, Messenger/genetics/metabolism;Reverse Transcriptase Polymerase Chain Reaction;*Sequence Deletion;Transcription, Genetic;Ubiquitin/metabolism","Alemi, M.;Prigione, A.;Wong, A.;Schoenfeld, R.;DiMauro, S.;Hirano, M.;Taroni, F.;Cortopassi, G.",2007,Jan 1,10.1016/j.freeradbiomed.2006.09.014,0,
134,Quantitative imaging of coronary blood flow,"Positron emission tomography (PET) is a nuclear medicine imaging modality based on the administration of a positron-emitting radiotracer, the imaging of the distribution and kinetics of the tracer, and the interpretation of the physiological events and their meaning with respect to health and disease. PET imaging was introduced in the 1970s and numerous advances in radiotracers and detection systems have enabled this modality to address a wide variety of clinical tasks, such as the detection of cancer, staging of Alzheimer's disease, and assessment of coronary artery disease (CAD). This review provides a description of the logic and the logistics of the processes required for PET imaging and a discussion of its use in guiding the treatment of CAD. Finally, we outline prospects and limitations of nanoparticles as agents for PET imaging.",Spect;ammonia N-13;blood-tissue exchange model;coronary blood flow;gamma camera;myocardial perfusion;oxygen-15;positron emission tomography (PET);quantitative imaging;tissue clearance,"Alessio, A. M.;Butterworth, E.;Caldwell, J. H.;Bassingthwaighte, J. B.",2010,,10.3402/nano.v1i0.5110,0,
135,Does comparative effectiveness have a comparative edge?,,acetylsalicylic acid;antibiotic agent;atypical antipsychotic agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;corticosteroid;dipeptidyl carboxypeptidase inhibitor;placebo;rofecoxib;tegaserod;troglitazone;warfarin;artificial heart pacemaker;asthma;awareness;blood pressure monitoring;cardiovascular disease;clinical practice;comparative study;congestive heart failure;coronary artery disease;cost effectiveness analysis;dementia;diabetes mellitus;evidence based practice;food and drug administration;health care cost;health care delivery;health care quality;health care system;health service;atrial fibrillation;human;hypertension;irritable colon;medical research;metabolic disorder;note;pain;priority journal;upper respiratory tract infection;aspirin,"Alexander, G. C.;Stafford, R. S.",2009,,,0,
136,Heart drugs under study focus on impact on metabolism,,atorvastatin;hydroxymethylglutaryl coenzyme A reductase inhibitor;placebo;pravastatin;rimonabant;acute coronary syndrome;Alzheimer disease;cardiovascular risk;clinical trial;comorbidity;disease course;drug effect;drug mechanism;drug safety;drug withdrawal;glycemic control;health care organization;human;insulin resistance;metabolic syndrome X;obesity;patient care;quality of life;risk factor;short survey;unspecified side effect;weight gain;weight reduction;acomplia;lipitor,"Alexander, W.",2004,,,0,
137,Outcomes of geriatric depression,"Improvement in the methodology of longitudinal investigations and increasing research interest in depressive disorders led to findings of clinical and heuristic importance. Outcomes, such as chronicity of depression, relapse, recurrence, and development of dementia, appear to be predicted by different clinical and laboratory findings. Chronicity of depression may be predicted by long duration of the current or previous episodes, coexisting medical illness, high severity of depression, nonmelancholic presentation, delusions, and perhaps cognitive impairment and neuroradiologic abnormalities. Predictors of relapse and recurrence of geriatric depression include multiple previous depressive episodes, high severity of illness, 'double depression,' presence of 'exit' events, and intercurrent medical illnesses. Development of dementia may be predicted by a transient dementia syndrome during a depressive episode ('pseudodementia'), onset of the first depressive episode in the senium, and neuroradiologic abnormalities such as cortical atrophy and rapidly evolving ventricular enlargement. Long-term antidepressant treatment, if not controlled by a research protocol, usually is of low intensity and has a questionable effect on the outcome of depression over a long period of time. For this reason, naturalistic treatment studies are useful for identifying subgroups of depressives and time periods of high risk for specific adverse outcomes. This knowledge is particularly important in frail elderly populations who are vulnerable to side effects of antidepressant treatments. The next step is to conduct controlled-treatment studies and examine the capability of antidepressant treatments to prevent adverse outcomes in the high-risk populations identified through naturalistic treatment studies. Controlled- treatment studies can provide findings that clinicians can use to assess the risk-benefit ratio of continuation and maintenance treatments of geriatric depression. The heuristic importance of knowing the outcome of geriatric depression is that it permits identification of clinically and, to some extent, biologically-homogeneous groups. Given the absence of specific and sensitive laboratory tests, outcome is perhaps the 'next best thing' to brain autopsy for subclassifying geriatric depression. Biologic measures of structural and functional abnormalities can then be used in homogeneous subgroups for the pursuit of pathophysiologic or etiologic studies.",aged;article;brain cortex atrophy;chronicity;cognitive defect;computer assisted tomography;dementia;demography;depression;disease severity;gerontopsychiatry;heart ventricle hypertrophy;human;life event;neuroradiology;onset age;personality;physical disease;prediction;recurrent disease;relapse,"Alexopoulos, G. S.;Chester, J. G.",1992,,,0,
138,Does 8-foot walk time predict cognitive decline in older Mexicans Americans?,"OBJECTIVES: To examine the association between 8-foot time walk and change in cognitive function over time in older Mexican Americans. DESIGN: Data used are from the Hispanic Established Population for the Epidemiological Study of the Elderly (1993-2001). SETTING: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: Two thousand seventy noninstitutionalized Mexican-American men and women aged 65 and older who had a Mini-Mental State Examination (MMSE) score of 21 or greater at baseline. MEASUREMENTS: Sociodemographic factors (age, sex, education, marital status), MMSE score, 8-foot walk time, body mass index, medical conditions (stroke, heart attack, diabetes mellitus, depression, and hypertension), and near and distant visual impairment. RESULTS: Using general linear mixed models, it was found that subjects with the slowest 8-foot walk time had a significantly greater rate of cognitive decline over 7 years than subjects with the fastest 8-foot walk time. There was a significant 8-foot walk time-by-time interaction with MMSE scores. Subjects in the lowest 8-foot walk time quartile had a greater cognitive decline over 7 years (estimate=-0.32, SE=0.08; P<.001) than those in the highest quartile. This association remained statistically significant after controlling for potential confounding factors. CONCLUSION: Slow 8-foot walk time in older Mexican-American adults without cognitive impairment at baseline was an independent predictor of MMSE score decline over a 7-year period. Slow 8-foot walk time may be an early marker for older adults in a predementia state who may benefit from early-intervention programs to prevent or slow cognitive decline. © 2007, The American Geriatrics Society.",academic achievement;age distribution;aged;article;body mass;cognition;cognitive defect;controlled study;dementia;demography;depression;diabetes mellitus;female;heart infarction;Hispanic;human;hypertension;major clinical study;male;marriage;Mini Mental State Examination;prediction;scoring system;senescence;sex ratio;statistical analysis;statistical significance;cerebrovascular accident;time;visual impairment;walking;walking speed,"Alfaro-Acha, A.;Al Snih, S.;Raji, M. A.;Markides, K. S.;Ottenbacher, K. J.",2007,,,0,
139,Vitamin D deficiency among the elderly: insights from Qatar,"OBJECTIVES: Vitamin D (VitD) deficiency is associated with comorbidities in the elderly. The present study investigates the prevalence of VitD deficiency among the elderly in Qatar. RESEARCH DESIGN AND METHODS: A retrospective study conducted between April 2010 and April 2012 that involved chart reviews. All elderly patients of age >/=65 years in geriatrics facilities including Rumailah hospital, skilled nursing facility and home healthcare services in Qatar were included in the study. MEASUREMENTS: Patient characteristics and outcomes were analyzed and compared according to the severity of VitD deficiency. Correlation of VitD with comorbidities was analyzed. Mean follow-up period was 6 months. RESULTS: A total of 889 patients were enrolled; the majority (66%) were females and the mean age was 75 +/- 8.7 years. Patient comorbidities included hypertension (76.5%), diabetes mellitus (63%), dyslipidemia, (47.5%), dementia (26%) coronary artery disease (24%) and cerebrovascular accident (24%). The mean baseline serum VitD level was 24.4 +/- 13.5 ng/ml; 72% of patients had VitD deficiency: mild (31%), moderate (30%) and severe (11%). Patients with severe VitD deficiency had significantly higher HbA1c levels compared with patients with optimal VitD (P = 0.03). High density lipoprotein (HDL-C) levels were significantly lower in severe VitD deficiency patients compared with optimal VitD patients (P = 0.04). There was a positive correlation between HDL-C and VitD level (r = 0.17, P = 0.001), whereas HbA1c levels showed negative correlation with VitD (r = -0.15, P = 0.009). CONCLUSIONS: A high prevalence of VitD deficiency (72%) was observed among the elderly in Qatar. Lower VitD was associated with higher HbA1c and lower HDL-C levels. Further studies are warranted to evaluate whether VitD supplementation controls diabetes mellitus (DM) and low HDL-C levels among the elderly.","Age Factors;Aged;Aged, 80 and over;Comorbidity;Female;Geriatrics;Humans;Male;Prevalence;Qatar/epidemiology;Retrospective Studies;Vitamin D Deficiency/*epidemiology;Elderly;Qatar;Vitamin D deficiency","Alhamad, H. K.;Nadukkandiyil, N.;El-Menyar, A.;Abdel Wahab, L.;Sankaranarayanan, A.;Al Sulaiti, E. M.",2014,Jun,10.1185/03007995.2014.900003,0,
140,Innovative curriculum for second year harvard-mit health sciences technology students: improving clinical skills with volunteer patients giving immediate feedback,"NEEDSAND OBJECTIVES: The Association of American Medical Colleges (AAMC) report on Learning Objectives for Medical Student Education in 1998 emphasized skillful communication with patients and their families as an important learning objective in medical school. The objective of this educaton inititiave was to improve communication skills by using volunteer patients to give immediate feedback. SETTING AND PARTICIPANTS: For the 2014 Introduction to Clinical Medicine (ICM) course, we created an innovative curriculum to prepare Harvard-MIT Health Sciences Technology (HST) students in the MD program using ""real"" patients from the new Brigham and Women's Hospital Volunteer Patient Teaching Corps. These patients ""role-played"" their real life experiences and gave immediate feedback on students' communication skills. Patient volunteers were identified, and clinical scenarios customized to reflect their health care experiences. DESCRIPTION: Scenarios ranged from delivering a cancer diagnosis to discussing medical mistakes, voluntary organ donation, and coronary artery disease with myocardial infarction in a young man, along with discussion of nursing home placement with the family of a patient with worsening Alzheimer's disease or with an incapacitating stroke. Resident and faculty teachers were recruited to facilitate the interaction between patient volunteers and students and to give additional feedback. A total of 32 students were randomly divided into two groups. Group A participated in the workshop in week 11 of ICM; Group B participated in week 12. Each group was further divided into teams of 4 students. Each Teaching Team, composed of a resident or faculty teacher and patient, reviewed the case, objectives/goals, and teaching points prior to the workshop. Each of the 4 clinical scenarios lasted 18min. The clinical scenario was taped to the door for students to read prior to entering the room. For week 11, we assigned each student a role. After anonymous student feedback, we modified the exercise to give each student an active role in the exercise and removed the passive roles of timekeeper and scribe. After each student role-played the part of the doctor, patients gave direct feedback on communication skills, supplemented by observations and recommendations from the resident or faculty teacher. Overall, each student had an opportunity to actively communicate in 50 % of the clinical scenarios. EVALUATION: All of the students (n=32) completed an anonymous written survey with a 100% completion rate. Overall, the two exercises combined were rated as excellent (on a Likert scale of 1 to 5 with 1 being excellent and 5 being poor) with a mean score of 1.468 (S.D. 0.621). The utility of real patients as teachers of communication skills received an overall excellent mean score of 1.218 (S.D. 0.608). Verbatim qualitative comments included: ""Great cases, real patients, felt real,"" ""Amazing! Please keep and expand,"" ""I love the feedback at the end."" At the end of the HST course, 21 of 27 students gave the workshop a perfect score of 1 on the Likert scale. DISCUSSION / REFLECTION / LESSONS LEARNED: An innovative second year student HST communications exercise received an overall excellent rating from the students. Immediate feedback from volunteer patients was the most highly praised and rated aspect of the exercise. We look forward to expanding the use of the Volunteer Patient Teaching Corps at HST and Harvard Medical School as a unique and powerful educational resource.",human;technology;student;feedback system;internal medicine;skill;volunteer;patient;society;health science;curriculum;exercise;communication skill;teacher;teaching;workshop;medical school;Likert scale;learning;interpersonal communication;health care;personal experience;hospital personnel;love;clinical medicine;cancer diagnosis;American;physician;male;education;cerebrovascular accident;medical student;female;nursing home;heart infarction;coronary artery disease;organ donor;error;Alzheimer disease,"Ali, N;Chung, C;Nayeb-Hashemi, H;Monette, D;Pelletier, S;Shields, Hm",2015,,,0,
141,Innovative curriculum for second year harvard-mit health sciences technology students: Improving clinical skills with volunteer patients giving immediate feedback,"NEEDSAND OBJECTIVES: The Association of American Medical Colleges (AAMC) report on Learning Objectives for Medical Student Education in 1998 emphasized skillful communication with patients and their families as an important learning objective in medical school. The objective of this educaton inititiave was to improve communication skills by using volunteer patients to give immediate feedback. SETTING AND PARTICIPANTS: For the 2014 Introduction to Clinical Medicine (ICM) course, we created an innovative curriculum to prepare Harvard-MIT Health Sciences Technology (HST) students in the MD program using ""real"" patients from the new Brigham and Women's Hospital Volunteer Patient Teaching Corps. These patients ""role-played"" their real life experiences and gave immediate feedback on students' communication skills. Patient volunteers were identified, and clinical scenarios customized to reflect their health care experiences. DESCRIPTION: Scenarios ranged from delivering a cancer diagnosis to discussing medical mistakes, voluntary organ donation, and coronary artery disease with myocardial infarction in a young man, along with discussion of nursing home placement with the family of a patient with worsening Alzheimer's disease or with an incapacitating stroke. Resident and faculty teachers were recruited to facilitate the interaction between patient volunteers and students and to give additional feedback. A total of 32 students were randomly divided into two groups. Group A participated in the workshop in week 11 of ICM; Group B participated in week 12. Each group was further divided into teams of 4 students. Each Teaching Team, composed of a resident or faculty teacher and patient, reviewed the case, objectives/goals, and teaching points prior to the workshop. Each of the 4 clinical scenarios lasted 18min. The clinical scenario was taped to the door for students to read prior to entering the room. For week 11, we assigned each student a role. After anonymous student feedback, we modified the exercise to give each student an active role in the exercise and removed the passive roles of timekeeper and scribe. After each student role-played the part of the doctor, patients gave direct feedback on communication skills, supplemented by observations and recommendations from the resident or faculty teacher. Overall, each student had an opportunity to actively communicate in 50 % of the clinical scenarios. EVALUATION: All of the students (n=32) completed an anonymous written survey with a 100% completion rate. Overall, the two exercises combined were rated as excellent (on a Likert scale of 1 to 5 with 1 being excellent and 5 being poor) with a mean score of 1.468 (S.D. 0.621). The utility of real patients as teachers of communication skills received an overall excellent mean score of 1.218 (S.D. 0.608). Verbatim qualitative comments included: ""Great cases, real patients, felt real,"" ""Amazing! Please keep and expand,"" ""I love the feedback at the end."" At the end of the HST course, 21 of 27 students gave the workshop a perfect score of 1 on the Likert scale. DISCUSSION / REFLECTION / LESSONS LEARNED: An innovative second year student HST communications exercise received an overall excellent rating from the students. Immediate feedback from volunteer patients was the most highly praised and rated aspect of the exercise. We look forward to expanding the use of the Volunteer Patient Teaching Corps at HST and Harvard Medical School as a unique and powerful educational resource.",human;technology;student;feedback system;internal medicine;skill;volunteer;patient;society;health science;curriculum;exercise;communication skill;teacher;teaching;workshop;medical school;Likert scale;learning;interpersonal communication;health care;personal experience;hospital personnel;love;clinical medicine;cancer diagnosis;American;physician;male;education;cerebrovascular accident;medical student;female;nursing home;heart infarction;coronary artery disease;organ donor;error;Alzheimer disease,"Ali, N.;Chung, C.;Nayeb-Hashemi, H.;Monette, D.;Pelletier, S.;Shields, H. M.",2015,,,0,140
142,Vascular access creation before hemodialysis initiation and use: A population-based cohort study,"Background and objectives In Canada, approximately 17% of patients use an arteriovenous access (fistula or arteriovenous graft) at commencement of hemodialysis, despite guideline recommendations promoting its timely creation and use. It is unclear if this low pattern of use is attributable to the lack of surgical creation or a high nonuse rate. Design, setting, participants, & measurements Using large health care databases in Ontario, Canada, a population-based cohort of adult patients ($18 years old) who initiated hemodialysis as their first form of RRT between 2001 and 2010 was studied. The aims were to (1) estimate the proportion of patients who had an arteriovenous access created before starting hemodialysis and the proportion who successfully used it at hemodialysis start, (2) test for secular trends in arteriovenous access creation, and (3) estimate the effect of late nephrology referral and patient characteristics on arteriovenous access creation. Results There were 17,183 patients on incident hemodialysis. The mean age was 65.8 years, 60% were men, and 40% were referred late to a nephrologist; 27% of patients (4556 of 17,183) had one or more arteriovenous accesses created, and the median time between arteriovenous access creation and hemodialysis start was 184 days.When late referrals were excluded, 39% of patients (4007 of 10,291) had one or more arteriovenous accesses created, and 27% of patients (2724 of 10,291) used the arteriovenous access. Since 2001, there has been a decline in arteriovenous access creation before hemodialysis initiation.Women, higher numbers of comorbidities, and rural residence were consistently associated with lower rates of arteriovenous access creation. These results persisted even after removing patients with,6 months nephrology care or who had AKI 6 months before starting hemodialysis. Conclusions In Canada, arteriovenous access creation before hemodialysis initiation is low, even among patients followed by a nephrologist. Better understanding of the barriers and influencers of arteriovenous access creation is needed to inform both clinical care and guidelines.",acute kidney failure;adult;aged;article;cerebrovascular disease;comorbidity;congestive heart failure;coronary artery disease;dementia;end stage renal disease;female;gender;hemodialysis;human;hypertension;leukemia;lymphoma;major clinical study;male;middle aged;observational study;peripheral vascular disease;retrospective study;rural population;smoking;vascular access;very elderly,"Al-Jaishi, A. A.;Lok, C. E.;Garg, A. X.;Zhang, J. C.;Moist, L. M.",2015,,,0,
143,The impact of “admit no bed” and long boarding times in the emergency department on stroke outcome,"Objectives: To examine and test the possible association between boarding time and stroke patients’ outcome. Methods: This study is a retrospective review of stroke patients presenting to the Emergency Department (ED) of King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia from 2007-2010. We excluded thrombolysis cases and those deemed critically ill. We collected time of stroke onset, ED arrival, decision to admit, and arrival to ward. Boarding time (BT) was defined as time of arrival to ward minus time of decision to admit. Primary outcome (PO) was defined as a composite of mortality, and/or any of post-stroke complications. Results: We included 300 patients with a mean age ± standard deviation of 69 ± 12 years, and 66.3% were men. The PO occurred in 37.7%. There was no association between BT and PO (odds ratio [OR]=0.9, p=0.3), or any of the secondary outcomes, such as, death (OR=0.97, p=0.5), severe disability (OR=0.97, p=0.3), pneumonia (OR=1, p=0.9), urinary tract infection (OR=1, p=0.9), or neurological deterioration (OR=0.8, p=0.1). Multivariate analysis included gender, age, stroke severity, subtype, hypertension, diabetes, coronary disease, atrial fibrillation, heart failure (HF), onset to ED, BT and ED wait time; only moderate to severe stroke, HF, and previous stroke predicted poor outcome. Conclusion: Although “admit no bed” was not associated with adverse effects, the results should be interpreted with caution, and early admission to the stroke unit should be encouraged.",adult;aged;article;aspiration pneumonia;brain hemorrhage;emergency ward;female;hospital admission;human;length of stay;major clinical study;male;mental deterioration;mortality;outcome assessment;retrospective study;stroke patient;urinary tract infection;venous thromboembolism,"Al-Khathaami, A. M.;Abulaban, A. A.;Mohamed, G. E.;Alamry, A. M.;Kojan, S. M.;Aljumah, M. A.",2014,,,0,
144,"Patient and implanting physician factors associated with mortality and complications after implantable cardioverter-defibrillator implantation, 2002-2005","BACKGROUND: Little is known about factors that influence survival and complications after implantable cardioverter-defibrillator (ICD) implantation in routine clinical practice. We examined patient and implanting physician factors associated with outcomes of ICD therapy in Medicare beneficiaries from 2002 through 2005. METHODS AND RESULTS: We limited this analysis to patients aged >or=65 with Medicare fee-for-service coverage who received an ICD between January 2002 and September 2005. The main outcome measures are time to postprocedural complications within 90 days and 1-year mortality. During the study period, 8581 patients had an ICD implanted by 1959 physicians. The number of procedures increased from 1644 in 2002 to 2374 in the first 3 quarters of 2005. The overall complication rate declined from 18.8% in 2002 to 14.2% in 2005 (P<0.001). Factors independently associated with an increased hazard of complications include chronic lung disease, dementia, renal disease, implantation by a thoracic surgeon, and implantation with removal/replacement. History of congestive heart failure, outpatient implantation, and more recent years of ICD implantation were associated with a lower risk of complications (P<0.05 for all factors). From 2002 to 2005, we observed a decline in 1-year mortality (P<0.001). CONCLUSIONS: We observed an appreciable increase in the number of ICD implants, which was associated with a significant decrease in the rate of complications and 1-year mortality. We identified factors associated with an increased risk of mortality and postprocedural complications that may support more nuanced treatment decisions than are currently possible.","Aged;*Clinical Competence;*Defibrillators, Implantable;Female;Follow-Up Studies;Heart Failure/*therapy;Humans;Incidence;Male;*Outcome Assessment (Health Care);*Physician's Role;Postoperative Complications/*epidemiology;Prosthesis Implantation/*adverse effects;Retrospective Studies;Risk Factors;Survival Rate/trends;Time Factors;United States/epidemiology;complications;defibrillation;mortality","Al-Khatib, S. M.;Greiner, M. A.;Peterson, E. D.;Hernandez, A. F.;Schulman, K. A.;Curtis, L. H.",2008,Oct,10.1161/circep.108.777888,0,
145,Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA,"BACKGROUND: While geographic disparities in stroke mortality are well documented, there are no data describing geographic variation in recurrent stroke. Accordingly, we evaluated geographic variations in 1-year recurrent ischemic stroke rates in the USA with adjustment for patient characteristics. METHODS: One-year recurrent stroke rates for ischemic stroke (International Classification of Diseases, 9th Revision codes 433, 434 and 436) following hospital discharge were calculated by county for all fee-for-service Medicare beneficiaries from 2000 to 2002. The rates were standardized and smoothed using a bayesian conditional autoregressive model that was risk-standardized for patients' age, gender, race/ethnicity, prior hospitalizations, Deyo comorbidity score, acute myocardial infarction, congestive heart failure, diabetes, hypertension, dementia, cancer, chronic obstructive pulmonary disease and obesity. RESULTS: The overall 1-year recurrent stroke rate was 9.4% among 895,916 ischemic stroke patients (mean age: 78 years; 56.6% women; 86.6% White, 9.7% Black and 1.2% Latino/Hispanic). The rates varied by geographic region and were highest in the South and in parts of the West and Midwest. Regional variation was present for all racial/ethnic subgroups and persisted after adjustment for individual patient characteristics. CONCLUSIONS: Almost 1 in 10 hospitalized ischemic stroke patients was readmitted for an ischemic stroke within 1 year. There was heterogeneity in recurrence patterns by geographic region. Further work is needed to understand the reasons for this regional variability.",African Americans;Age Factors;Aged;Bayes Theorem;Brain Ischemia/*epidemiology;Cohort Studies;Continental Population Groups;European Continental Ancestry Group;Female;Geography;Hispanic Americans;Humans;Male;Medicare;Recurrence;Regression Analysis;Risk Factors;Sex Factors;Stroke/*epidemiology;Time Factors;United States/epidemiology,"Allen, N. B.;Holford, T. R.;Bracken, M. B.;Goldstein, L. B.;Howard, G.;Wang, Y.;Lichtman, J. H.",2010,,10.1159/000274804,0,
146,"A high-dose preparation of lactobacilli and bifidobacteria in the prevention of antibiotic-associated and clostridium difficile diarrhoea in older people admitted to hospital: A multicentre, randomised, double-blind, placebo-controlled, parallel arm trial (PLACIDE)","Background: Antibiotic-associated diarrhoea (AAD) occurs most commonly in older people admitted to hospital and within 12 weeks of exposure to broad-spectrum antibiotics. Although usually a mild and self-limiting illness, the 15-39% of cases caused by Clostridium difficile infection [C. difficile diarrhoea (CDD)] may result in severe diarrhoea and death. Previous research has shown that probiotics, live microbial organisms that, when administered in adequate numbers, are beneficial to health, may be effective in preventing AAD and CDD. Objectives: To determine the clinical effectiveness and cost-effectiveness of a high-dose, multistrain probiotic in the prevention of AAD and CDD in older people admitted to hospital. Design: A multicentre, randomised, double-blind, placebo-controlled, parallel-arm trial. Setting: Medical, surgical and elderly care inpatient wards in five NHS hospitals in the UK. Participants: Eligible patients were aged ≥ 65 years, were exposed to one or more oral or parenteral antibiotics and were without pre-existing diarrhoeal disorders, recent CDD or at risk of probiotic adverse effects. Out of 17,420 patients screened, 2981 (17.1%) were recruited. Participants were allocated sequentially according to a computer-generated random allocation sequence; 1493 (50.1%) were allocated to the probiotic and 1488 (49.9%) to the placebo arm. Interventions: Vegetarian capsules containing two strains of lactobacilli and two strains of bifidobacteria (a total of 6 × 1010 organisms per day) were taken daily for 21 days. The placebo was inert maltodextrin powder in identical capsules. Main outcome measures: The occurrence of AAD within 8 weeks and CDD within 12 weeks of recruitment was determined by participant follow-up and checking hospital laboratory records by research nurses who were blind to arm allocation. Results: Analysis based on the treatment allocated included 2941 (98.7%) participants. Potential risk factors for AAD at baseline were similar in the two study arms. Frequency of AAD (including CDD) was similar in the probiotic (159/1470, 10.8%) and placebo arms [153/1471, 10.4%; relative risk (RR) 1.04; 95% confidence interval (CI) 0.84 to 1.28; p = 0.71]. CDD was an uncommon cause of AAD and occurred in 12/1470 (0.8%) participants in the probiotic and 17/1471 (1.2%) in the placebo arm (RR 0.71; 95% CI 0.34 to 1.47; p = 0.35). Duration and severity of diarrhoea, common gastrointestinal symptoms, serious adverse events and quality of life measures were also similar in the two arms. Total health-care costs per patient did not differ significantly between the probiotic (£8020; 95% CI £7620 to £8420) and placebo (£8010; 95% CI £7600 to £8420) arms. Conclusion: We found no evidence that probiotic administration was effective in preventing AAD. Although there was a trend towards reduced CDD in the probiotic arm, on balance, the administration of this probiotic seems unlikely to benefit older patients exposed to antibiotics. A better understanding of the pathogenesis of AAD and CDD and the strain-specific effects of probiotics is needed before further clinical trials of specific microbial preparations are undertaken. Evaluation of the effectiveness of other probiotics will be difficult where other measures, such as antibiotic stewardship, have reduced CDD rates. © Queen's Printer and Controller of HMSO 2013.",2007-002876-32;ISRCTN70017204;acetylsalicylic acid;aminoglycoside antibiotic agent;amoxicillin;amoxicillin plus clavulanic acid;ampicillin;antibiotic agent;antihypertensive agent;carbapenem derivative;cefaclor;cefalexin;cefixime;cefotaxime;cefradine;ceftazidime;ceftriaxone;cefuroxime;cephalosporin derivative;dipeptidyl carboxypeptidase inhibitor;flucloxacillin;gentamicin;penicillin derivative;penicillin G;piperacillin;piperacillin plus tazobactam;placebo;probiotic agent;proton pump inhibitor;quinoline derived antiinfective agent;tetracycline derivative;unindexed drug;abdominal pain;abscess;acute coronary syndrome;acute kidney failure;aged;agitation;anemia;angina pectoris;antibiotic associated diarrhea;aorta aneurysm;appendix abscess;artery thrombosis;article;aspiration pneumonia;behavior disorder;Bifidobacterium animalis;Bifidobacterium bifidum;bladder cancer;bleeding tendency;brain tumor;bronchiectasis;bronchospasm;cellulitis;cerebrovascular accident;cholecystitis;cholelithiasis;chronic kidney failure;chronic obstructive lung disease;clinical effectiveness;Clostridium difficile infection;congestive heart failure;connective tissue disease;constipation;controlled study;convulsion;cost effectiveness analysis;Creutzfeldt Jakob disease;cyst;decubitus;deep vein thrombosis;dehydration;dementia;device infection;diarrhea;disease duration;disease severity;diverticulitis;double blind procedure;drug capsule;drug cost;drug efficacy;drug exposure;drug fatality;drug hypersensitivity;drug intoxication;drug megadose;drug withdrawal;duodenum ulcer;dysentery;dyspnea;ear disease;eating disorder;eczema;empyema;esophagus cancer;external otitis;faintness;female;foreign body aspiration;gallbladder disease;gangrene;gastroenteritis;gastrointestinal disease;gastrointestinal hemorrhage;gastrointestinal symptom;graft infection;heart arrest;heart arrhythmia;atrial fibrillation;heart disease;heart failure;heart infarction;heart left ventricle failure;heart ventricle tachycardia;hematologic disease;hematoma;hematuria;hemorrhoid;herpes zoster ophthalmicus;hiatus hernia;hip fracture;hospital patient;human;hypercalcemia;hyperkalemia;hypertension;hypocalcemia;hypoglycemia;hypokalemia;hyponatremia;immunopathology;infection;infectious arthritis;infestation;inner ear disease;intestine ischemia;intestine polyp;intestine volvulus;ischemic heart disease;joint dislocation;kidney disease;kidney failure;Lactobacillus acidophilus;limb pain;liver abscess;liver cirrhosis;lung cancer;lung edema;lung embolism;lung fibrosis;lung infection;lymphatic system disease;major clinical study;male;mediastinum abscess;mediastinum disease;mental disease;metabolic disorder;metastasis;multicenter study;multiple myeloma;muscle swelling;musculoskeletal disease;myalgia;neoplasm;nephrolithiasis;neurologic disease;nonhodgkin lymphoma;nutritional disorder;oral bleeding;pancreatitis;parallel design;patient compliance;peptic ulcer;peritonitis;pleura effusion;pleura tumor;pneumonia;pneumothorax;polyp;psoas abscess;pyelonephritis;quality adjusted life year;quality of life;randomized controlled trial;randomized controlled trial (topic);rectum hemorrhage;respiratory tract disease;risk factor;sepsis;shunt infection;single drug dose;skin disease;skin ulcer;small intestine obstruction;stomach cancer;subdural hematoma;supraventricular tachycardia;swelling;thorax disease;thorax pain;transient ischemic attack;trigeminus neuralgia;ulcer perforation;umbilical hernia;United Kingdom;unspecified side effect;upper respiratory tract infection;urinary tract disease;urinary tract infection;urine retention;vascular disease;very elderly;viral upper respiratory tract infection;virus infection;wound dehiscence;wound infection,"Allen, S. J.;Wareham, K.;Wang, D.;Bradley, C.;Sewell, B.;Hutchings, H.;Harris, W.;Dhar, A.;Brown, H.;Foden, A.;Gravenor, M. B.;Mack, D.;Phillips, C. J.",2013,,,0,
147,Study of the comorbidities in hospitalized patients due to decompensated chronic obstructive pulmonary disease attended in the Internal Medicine Services. ECCO Study,"Objective: Evaluate comorbidity in patients hospitalized due to COPD in the Internal Medicine services. Methods: An observational, prospective and multicenter study. The Charlson index and a specific questionnaire were used. Results: A total of 398 patients, 353 men (89%), with mean age of 73.7 years (8.9) and mean FEV1 of 43.2% (12.5), were included. The most frequent comorbidities were: arterial hypertension (55%), arrhythmias (27%) and diabetes mellitus (26%). A total of 27% suffered heart failure, 17% coronary disease and 9% previous myocardial infarction. The number of associated chronic diseases was 3.6 (1,8). Score on Charlson index was 2.72 (2). Conclusions: The patients hospitalized due to decompensated COPD had an elevated comorbidity. © 2009 Elsevier España, S.L. All rights reserved.",acquired immune deficiency syndrome;adult;aged;alcoholism;anemia;article;cerebrovascular disease;chronic obstructive lung disease;comorbidity;connective tissue disease;coronary artery disease;dementia;diabetes mellitus;edema;female;heart arrhythmia;heart failure;heart infarction;hemiplegia;hepatitis;hospital patient;human;hypertension;kidney failure;leukemia;liver disease;major clinical study;male;metastasis;osteoporosis;patient selection;peripheral vascular disease;questionnaire;thromboembolism,"Almagro, P.;López García, F.;Cabrera, F. J.;Montero, L.;Morchón, D.;Díez, J.;de la Iglesia, F.;Roca, F. B.;Fernández-Ruiz, M.;Castiella, J.;Zubillaga, E.;Recio, J.;Soriano, J. B.",2010,,,0,
148,Two-year course of cognitive function and mood in adults with congestive heart failure and coronary artery disease: The Heart-Mind Study,"Background: Congestive heart failure (CHF) has been associated with impaired cognitive function, but it is unclear if these changes are specific to CHF and if they get worse with time. We designed this study to determine if adults with CHF show evidence of cognitive decline compared with adults with and without coronary artery disease (CAD). Methods: A longitudinal study was carried out of 77 adults with CHF (ejection fraction, EF < 0.4), 73 adults with a clinical history of CAD and EF > 0.6, and 81 controls with no history of CAD. The Cambridge Cognitive Examination of the Elderly (CAMCOG) was the primary outcome measure. Secondary measures included the California Verbal Learning Test (CVLT), digit coding and copying, Hospital Anxiety and Depression Scale (HADS), and the short form health survey (SF36). Endpoints were collected at baseline and after 12 and 24 months. Results: The adjusted CAMCOG scores of CHF participants declined 0.9 points over two years (p = 0.022) compared with controls without CAD. There were no differences between the groups on other cognitive measures. Participants with CHF and with CAD experienced similar changes in cognitive function over two years. Left ventricular EF and six-minute walk test results could not explain the observed associations. Conclusions: The changes in cognitive function and mood associated with CHF over two years are subtle and not specific to CHF. © International Psychogeriatric Association 2011.",adult;aged;article;cognition;congestive heart failure;controlled study;coronary artery disease;female;heart ejection fraction;Hospital Anxiety and Depression Scale;human;longitudinal study;major clinical study;male;mood;outcome assessment;Short Form 36,"Almeida, O. P.;Beer, C.;Lautenschlager, N. T.;Arnolda, L.;Alfonso, H.;Flicker, L.",2012,,,0,
149,"Prevalence, associated factors, mood and cognitive outcomes of traumatic brain injury in later life: the health in men study (HIMS)","BACKGROUND: The incidence of traumatic brain injury (TBI) is rising, as are its neuropsychiatric complications. This study aims to determine (1) the prevalence of TBI, (2) the association between history of past TBI and sociodemographic, lifestyle and clinical factors, and (3) the risk of depression and cognitive impairment in later life associated with exposure to TBI. METHODS: Cross-sectional study of a community-derived sample of 5486 Australian men aged 70-89 years. Information on TBI was retrieved from the Western Australian Data Linkage System (WADLS) and via self-report. We used the WADLS and self-report to ascertain history of past depression, and the Geriatric Depression Scale 15-items to assess current clinically significant symptoms of depression, defined by score >/=7. We defined cognitive impairment by a mini-mental state examination score <24 or a WADLS diagnosis of dementia. RESULTS: Nine hundred fifty-three men had history of TBI (17.4%). Factors associated with TBI included coronary heart disease, stroke, poor self-perceived physical health and falls. TBI increased the odds ratio of past (odds ratio (OR) = 1.55, 95% confidence interval (CI) = 1.21, 1.99) and current depression (OR = 1.77, 95% CI = 1.36, 2.32), as well as of cognitive impairment (OR = 1.23, 95% CI = 1.00, 1.51). The population fractions of depression and cognitive impairment attributable to TBI were 6.9% (95% CI = 3.3%, 10.3%) and 3.4% (95% CI = 0.0%, 6.9%). CONCLUSIONS: History of TBI is common in older men, and is associated with increased risk of depression and cognitive impairment. If this association is truly causal, then the effective reduction of events leading to TBI (e.g., motor vehicle accidents and falls) may also decrease the prevalence of depression and cognitive impairment in later life.","Aged;Aged, 80 and over;Australia;Brain Injuries/*epidemiology/etiology/psychology;Cognition Disorders/epidemiology/*etiology;Cross-Sectional Studies;Depressive Disorder/epidemiology/*etiology;Geriatric Assessment;Humans;Incidence;Life Style;Male;Odds Ratio;Prevalence;Risk Factors;Socioeconomic Factors;cognitive impairment;dementia;depression;epidemiology;traumatic brain injury","Almeida, O. P.;Hankey, G. J.;Yeap, B. B.;Golledge, J.;Flicker, L.",2015,Dec,10.1002/gps.4276,0,
150,Depression as a risk factor for cognitive impairment in later life: the Health In Men cohort study,"BACKGROUND: Depression is an established risk factor for dementia in later life, but it is unclear if this relationship is causal. This study aimed to determine if clinically significant depressive symptoms are likely to be causally related to cognitive impairment in later life. METHODS: Observational cohort study of 4568 men aged 70-89 years living in Perth, Western Australia, who were free of cognitive impairment at the beginning of follow-up. Current clinically significant depressive symptoms were defined by a score of 7 or more on the Geriatric Depression Scale 15 items. Past depression was ascertained via electronic medical records, by self-report or use of antidepressants. A score of 27 or less on the Telephone Interview for Cognitive Status modified or a recorded diagnosis of dementia in electronic medical records established the presence of cognitive impairment. RESULTS: During the 5-year follow-up, 534 men developed cognitive impairment, 811 died and 1455 were lost. The presence of clinically significant depressive symptoms at study entry was associated with increased risk rate (RR) of cognitive impairment (RR = 2.59, 95% confidence interval: 95%CI = 1.57-4.27), death (RR = 5.07, 95%CI = 3.32-7.75) and loss to follow-up (RR = 2.03, 95%CI = 1.32-3.13). These associations remained statistically significant after adjustment for age, country of birth, education, smoking history, and prevalence hypertension, diabetes, coronary heart disease and stroke. History of past clinically significant depressive symptoms was not associated with incident cognitive impairment (RR = 1.09, 95%CI = 0.78-1.52). CONCLUSIONS: The lack of association between past depression and cognitive impairment suggests that the link between depression and cognitive impairment is not causal and that the presence of clinically significant depressive symptoms in later life may herald the onset of cognitive impairment in at least some people.",cognitive impairment;dementia;depression;epidemiology;risk factors,"Almeida, O. P.;Hankey, G. J.;Yeap, B. B.;Golledge, J.;Flicker, L.",2016,Apr,10.1002/gps.4347,0,
151,Depression as a modifiable factor to decrease the risk of dementia,"Depression is an accepted risk factor for dementia, but it is unclear if this relationship is causal. This study investigated whether dementia associated with depression decreases with antidepressant use and is independent of the time between exposure to depression and the onset of dementia. We completed a 14-year longitudinal study of 4922 cognitively healthy men aged 71-89 years, and collected information about history of past depression, current depression and severity of depressive symptoms. Other measures included use of antidepressants, age, education, smoking and history of diabetes, hypertension, coronary heart disease, and stroke. The onset of dementia and death during follow-up was ascertained via the Western Australian Data Linkage System. A total of 682 men had past (n=388) or current (n=294) depression. During 8.9 years follow-up, 903 (18.3%) developed dementia and 1884 (38.3%) died free of dementia. The sub-hazard ratios (SHRs) of dementia for men with past and current depression were 1.3 (95% confidence interval (CI)=1.0, 1.6) and 1.5 (95% CI=1.2, 2.0). The use of antidepressants did not decrease this risk. Compared to men with no symptoms, the SHRs of dementia associated with questionable, mild-to-moderate and severe depressive symptoms were 1.2 (95% CI=1.0, 1.4), 1.7 (95% CI=1.4, 2.2) and 2.1 (95% CI=1.4, 3.2), respectively. The association between depression and dementia was only apparent during the initial 5 years of follow-up. Older men with history of depression are at increased risk of developing dementia, but depression is more likely to be a marker of incipient dementia than a truly modifiable risk factor.",,"Almeida, O. P.;Hankey, G. J.;Yeap, B. B.;Golledge, J.;Flicker, L.",2017,May 02,,0,
152,Effect of testosterone deprivation on the cognitive performance of a patient with Alzheimer's disease,,amlodipine;androgen;estrogen;famotidine;flutamide;isosorbide mononitrate;leuprorelin;perindopril;temazepam;testosterone;aged;Alzheimer disease;behavior;brain function;case report;cognition;cohort analysis;dementia;disease association;disease severity;gastritis;hormone inhibition;hormone substitution;human;hypertension;ischemic heart disease;letter;male;memory;patient monitoring;postmenopause;prostate cancer;quality of life;risk assessment;scoring system;testosterone blood level,"Almeida, O. P.;Waterreus, A.;Spry, N.;Corica, T.;Martins, G.;Martins, R. N.;Flicker, L.",2001,,,0,
153,Management of frail patients with acute coronary syndrome: a prospective and multicenter registry,"Background: Frailty is emerging as an independent marker of adverse cardiovascular outcomes. However, in the majority of cases, the decision making process is done without objective knowledge of frailty status. Our study aims to explore the most common clinical features associated with the decision to use of an invasive strategy in a subset of frail high-risk ACS patients >75 years. Methods: This prospective, multicenter and observational study included patients aged >75 years admitted due to type 1 myocardial infarction. Patients with dementia or in cardiogenic shock were excluded. Frailty was assessed by SHARE-FI index. Only frail patients were studied. Selection of revascularization strategy was left to clinician discretion and was performed without interference of frailty measurements or any study procedures. The main objective was to determine which clinical factors determined the use of an early invasive instead of a conservative strategy. We also aimed to evaluate the impact of an invasive treatment on overall prognosis. Results: From October '13 to November '15, a total of 236 patients were studied and 88 (37.3%) frail patients were included. Catheterisation was performed in 61 (69.3%) patients, and revascularization in 44 (50%). Aggressive treatment did not affect in-hospital length of stay or mortality. Patients who underwent invasive treatment were younger, more often female, with a preserved renal function and with a lower punctuation in CRUSADE bleeding score (Table). On multivariate analysis younger age, female sex and a lower punctuation in CRUSADE score predicted aggressive treatment. Conclusions: Among frail patients, being older, male or having a high punctuation in CRUSADE score may predict a conservative treatment. Invasive treatment may not change prognostic or in-hospital length of stay. Larger studies are needed to confirm this data. (Table Presented).",acute coronary syndrome;aged;bleeding;cardiogenic shock;catheterization;clinical feature;clinical trial;conservative treatment;controlled clinical trial;controlled study;dementia;female;heart infarction;hospital;human;invasive procedure;kidney function;length of stay;major clinical study;male;mortality;multicenter study;multivariate analysis;observational study;prognosis;register;revascularization,"Alonso, Gl;Pastor, Pueyo P;Pascual, Izco M;Sanmartin, Fernandez M;Marco, Del Castillo A;Martin, Asenjo R;Salvador, Ramos L;Marzal, Martin D;Recio, Mayoral A;Camino, Lopez A;Jimenez, Mena M;Zamorano, Jl",2016,,10.1177/2048872616663431,0,
154,Independent and interactive effects of blood pressure and cardiac function on brain volume and white matter hyperintensities in heart failure,"BACKGROUND: Reduced systemic perfusion and comorbid medical conditions are key contributors to adverse brain changes in heart failure (HF). Hypertension, the most common co-occurring condition in HF, accelerates brain atrophy in aging populations. However, the independent and interactive effects of blood pressure and systemic perfusion on brain structure in HF have yet to be investigated. METHODS: Forty-eight older adults with HF underwent impedance cardiography to assess current systolic blood pressure status and cardiac index to quantify systemic perfusion. All participants underwent brain magnetic resonance imaging to quantify total brain, total and subcortical gray matter volume, and white matter hyperintensities (WMH) volume. RESULTS: Regression analyses adjusting for medical and demographic factors showed decreased cardiac index was associated with smaller subcortical gray matter volume (P < .01), and higher systolic blood pressure predicted reduced total gray matter volume (P = .03). The combination of higher blood pressure and lower cardiac index exacerbated WMH (P = .048). CONCLUSIONS: Higher blood pressure and systemic hypoperfusion are associated with smaller brain volume, and these factors interact to exacerbate WMH in HF. Prospective studies are needed to clarify the effects of blood pressure on the brain in HF, including the role of long-term blood pressure fluctuations.","Aged;Aged, 80 and over;Atrophy/epidemiology/pathology/physiopathology;Blood Pressure/*physiology;Comorbidity;Dementia/epidemiology/pathology/*physiopathology;Female;Heart Failure/epidemiology/*physiopathology;Heart Function Tests;Humans;Hypertension/epidemiology/*physiopathology;Leukoencephalopathies/epidemiology/pathology/*physiopathology;Magnetic Resonance Imaging;Male;Mental Disorders/epidemiology/pathology/*physiopathology;Middle Aged;Blood pressure;Mri;brain;cardiac index;cognition;heart failure","Alosco, M. L.;Brickman, A. M.;Spitznagel, M. B.;Griffith, E. Y.;Narkhede, A.;Raz, N.;Cohen, R.;Sweet, L. H.;Hughes, J.;Rosneck, J.;Gunstad, J.",2013,Sep-Oct,10.1016/j.jash.2013.04.011,0,
155,Decreased physical activity predicts cognitive dysfunction and reduced cerebral blood flow in heart failure,"OBJECTIVE: Cognitive impairment in heart failure (HF) is believed to result from brain hypoperfusion subsequent to cardiac dysfunction. Physical inactivity is prevalent in HF and correlated with reduced cardiac and cognitive function. Yet, no longitudinal studies have examined the neurocognitive effects of physical inactivity in HF. The current study examined whether reduced physical activity increases risk for cognitive impairment and brain hypoperfusion over time in HF. METHODS: At baseline and 12 months later, 65 HF patients underwent neuropsychological testing, transcranial Doppler ultrasonography, and were asked to wear an accelerometer for seven days. RESULTS: Lower baseline step count and less time spent in moderate free-living activity best predicted worse attention/executive function and decreased cerebral perfusion at the 12-month follow-up. Decreased baseline cerebral perfusion also emerged as a strong predictor of poorer 12-month attention/executive function. CONCLUSIONS: Lower physical activity predicted worse cognition and cerebral perfusion 12 months later in HF. Physical inactivity in HF may contribute to cognitive impairment and exacerbate risk for conditions such as Alzheimer's disease. Larger studies are needed to elucidate the mechanisms by which physical inactivity leads to cognitive dysfunction in HF, including clarification of the role of cerebral hypoperfusion.","Accelerometry/methods;Aged;Aged, 80 and over;Cerebrovascular Circulation/*physiology;Cognition Disorders/*physiopathology/psychology/*ultrasonography;Female;Follow-Up Studies;Heart Failure/*physiopathology/psychology/*ultrasonography;Humans;Male;Middle Aged;Motor Activity/*physiology;Neuropsychological Tests;Predictive Value of Tests;Prospective Studies;Ultrasonography, Doppler, Transcranial/methods;Accelerometry;Cerebral blood flow;Cognitive function;Heart failure;Neuropsychology;Physical activity;Sedentary","Alosco, M. L.;Spitznagel, M. B.;Cohen, R.;Raz, N.;Sweet, L. H.;Josephson, R.;Hughes, J.;Rosneck, J.;Gunstad, J.",2014,Apr 15,10.1016/j.jns.2014.02.008,0,
156,Decreases in daily physical activity predict acute decline in attention and executive function in heart failure,"BACKGROUND: Reduced physical activity (PA) may be one factor that contributes to cognitive decline and dementia in heart failure (HF). Yet, the longitudinal relationship between PA and cognition in HF is poorly understood owing to limitations of past work, including single-time assessments of PA. This is the first study to examine changes in objectively measured PA and cognition over time in HF. METHODS AND RESULTS: At baseline and 12 weeks, 57 HF patients completed psychosocial self-report measures and a neuropsychological battery and wore an accelerometer for 7 days. At baseline, HF patients spent an average of 597.83 (SD 75.91) minutes per day sedentary. Steps per day declined from baseline to the 12-week follow-up; there was also a trend for declines in moderate-vigorous PA. Regression analyses controlling for sex, HF severity, and depressive symptoms showed that decreases in light (P = .08) and moderate-vigorous (P = .04) daily PA emerged as strong predictors of declines in attention/executive function over the 12-week period, but not of memory or language. CONCLUSIONS: Reductions in daily PA predicted acute decline in attention/executive function in HF, but not of memory or language. Modifications to daily PA may attenuate cognitive decline, and prospective studies are needed to test this possibility.",Acute Disease;Aged;Attention/*physiology;Cognition/*physiology;Cognition Disorders/*etiology/physiopathology/psychology;Executive Function/*physiology;Female;Follow-Up Studies;Heart Failure/complications/*physiopathology/psychology;Humans;Male;Middle Aged;Motor Activity/*physiology;Neuropsychological Tests;Prospective Studies;Self Report;Physical activity;accelerometry;cognitive function;heart failure,"Alosco, M. L.;Spitznagel, M. B.;Cohen, R.;Sweet, L. H.;Hayes, S. M.;Josephson, R.;Hughes, J.;Gunstad, J.",2015,Apr,10.1016/j.cardfail.2014.12.010,0,
157,Cardiac rehabilitation is associated with lasting improvements in cognitive function in older adults with heart failure,"OBJECTIVE: Heart failure (HF) is a known risk factor for cognitive impairment. Cardiac rehabilitation (CR) may attenuate poor neurocognitive outcomes in HF via improved physical fitness--a significant promoter of cognitive function. However, no study has examined the possible acute and lasting benefits of CR on cognitive function in persons with HF. METHODS AND RESULTS: Fifty-two patients with HF completed a 12-week Phase II CR program. All participants were administered neuropsychological testing and completed a brief physical fitness assessment at baseline, completion of CR (i.e. 12 weeks), and 12-month follow-up. Repeated measures analyses showed a significant time effect for both attention/executive function and memory (P < 0.05). Attention/executive function performance increased from baseline to 12 weeks and these gains remained up to 12 months; memory was unchanged from baseline to 12 weeks, but then improved between the 12-week and 12-month time points. Physical fitness improved from baseline to 12 weeks and these benefits were maintained 12 months later. Changes in physical fitness and cognitive function over time did not reach a statistically significant association, though poorer physical fitness was associated with decreased cognitive performance at the baseline and 12-month time points. CONCLUSIONS: CR is associated with both acute and lasting cognitive benefits in patients with HF. Prospective studies with extended follow-ups are needed to clarify the mechanisms that underpin cognitive improvements following CR (e.g., improved cerebral perfusion) and whether CR can ultimately reduce risk for cognitive decline and conditions like Alzheimer's disease in HF.",Aged;*Aging;Cognition Disorders/etiology/*rehabilitation;Exercise Test;Female;Follow-Up Studies;Heart Failure/complications/*rehabilitation;Humans;Male;Middle Aged;*Neuropsychological Tests;*Physical Fitness;Risk Factors;Sampling Studies,"Alosco, M. L.;Spitznagel, M. B.;Cohen, R.;Sweet, L. H.;Josephson, R.;Hughes, J.;Rosneck, J.;Gunstad, J.",2014,Aug,10.2143/ac.69.4.3036657,0,
158,Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure,"Heart failure (HF) has reached epidemic proportions and is a significant contributor to poor outcomes. HF is an established risk factor for Alzheimer's disease, vascular dementia, and abnormalities on neuroimaging. Moreover, up to 80 % of HF patients also exhibit milder impairments on cognitive tests assessing attention, executive function, memory, and language. The mechanisms of cognitive impairment in HF are not entirely clear and involve a combination of physiological processes that negatively impact the brain. Cerebral hypoperfusion and common comorbid conditions in HF are among the most commonly proposed contributors to poor neurocognitive outcomes in this population. Obesity is another likely risk factor for adverse brain changes and cognitive impairment in HF, as it is a known contributor to neurocognitive outcomes in healthy and patient samples. This paper reviews the literature on HF and cognitive function and introduces obesity as a significant risk factor for poor neurocognitive outcomes in this population. © 2013 Springer Science+Business Media New York.",amyloid beta protein;apolipoprotein E;apolipoprotein E epsilon4;brain derived neurotrophic factor;C reactive protein;ghrelin;interleukin 6;leptin;unclassified drug;allele;Alzheimer disease;article;autoregulation;bariatric surgery;body mass;brain atrophy;brain blood flow;brain ischemia;brain perfusion;brain region;cardiovascular risk;cognitive defect;comorbidity;demyelinating disease;depression;disease association;disease course;disease exacerbation;fitness;fractional anisotropy;FTO gene;functional neuroimaging;gene;genetic risk;heart failure;heredity;heterozygote;hospital readmission;human;hypertension;inflammation;mortality;multiinfarct dementia;neuroprotection;non insulin dependent diabetes mellitus;obesity;pathophysiology;physical activity;positron emission tomography;protein function;protein interaction;risk factor;sedentary lifestyle;sleep disordered breathing,"Alosco, M. L.;Spitznagel, M. B.;Gunstad, J.",2014,,,0,
159,Dietary Habits Moderate the Association Between Heart Failure and Cognitive Impairment,"Cognitive impairment is common in heart failure patients. Poor dietary habits are associated with reduced neurocognitive function in other medical populations, including diabetes and Alzheimer's disease. This study examined whether dietary habits help moderate the relationship between heart failure severity and cognitive function. A total of 152 persons with heart failure completed neuropsychological testing and a fitness assessment. Dietary habits were assessed using the Starting the Conversation-Diet questionnaire, a nutrition measure suggested for use in primary care settings. Moderation analyses showed that better dietary habits attenuated the adverse impact of heart failure severity on frontal functioning (b = 1.28, p < 0.05). Follow-up analyses revealed consumption of foods high in sodium was associated with reduced cognitive function (p < 0.05). This study suggests dietary habits can moderate the association between heart failure and performance on tests of attention and executive function. Longitudinal studies are needed to confirm and clarify the mechanisms for our findings. © 2013 Copyright Taylor and Francis Group, LLC.",aged;Alzheimer disease;article;cognition;cognitive defect;depression;diet;feeding behavior;female;heart failure;human;male;middle aged;physiology;quality of life;questionnaire;risk factor;severity of illness index;sodium intake;very elderly,"Alosco, M. L.;Spitznagel, M. B.;Raz, N.;Cohen, R.;Sweet, L. H.;Colbert, L. H.;Josephson, R.;van Dulmen, M.;Hughes, J.;Rosneck, J.;Gunstad, J.",2013,,,0,
160,Psychometrics of the Zarit Burden Interview in Caregivers of Patients With Heart Failure,"BACKGROUND: Identification of family caregivers who are burdened by the caregiving experience is vital to prevention of poor outcomes associated with caregiving. The Zarit Burden Interview (ZBI), a well-known measure of caregiving burden in caregivers of patients with dementia, has been used without being validated in caregivers of patients with heart failure (HF). PURPOSE: The purpose of this study is to examine the reliability and validity of the ZBI in caregivers of patients with HF. METHODS: A total of 124 primary caregivers of patients with HF completed survey questionnaires. Caregiving burden was measured by the ZBI. Reliability was examined using Cronbach's alpha and item-total/item-item correlations. Convergent validity was examined using correlations with the Oberst Caregiving Burden Scale. Construct validity was demonstrated by exploratory factor analysis and known hypothesis testing (ie, the hypothesis of the association between caregiving burden and depressive symptoms). RESULTS: Cronbach's alpha for the ZBI was .921. The ZBI had good item-total (r = 0.395-0.764) and item-item (mean r = 0.365) correlations. Significant correlations between the ZBI and the Oberst Caregiving Burden Scale (r = 0.466 for the caregiving time subscale and 0.583 for the caregiving task difficulty subscale; P < .001 for both) supported convergent validity. Four factors were identified (ie, consequences of caregiving, patient's dependence, exhaustion with caregiving and uncertainty, and guilt and fear for the patient's future) using factor analysis, which are consistent with previous studies. Caregivers with high burden scores had significantly higher depressive symptoms than did caregivers with lower burden scores (7.0 +/- 6.8 vs 3.1 +/- 4.3; P < .01). CONCLUSION: The findings provide evidence that the ZBI is a reliable and valid measure for assessing burden in caregivers of patients with HF.",,"Al-Rawashdeh, S. Y.;Lennie, T. A.;Chung, M. L.",2016,Nov/Dec,10.1097/jcn.0000000000000348,0,
161,Apolipoprotein E polymorphism and lipoprotein levels in a Gulf Arab population in Kuwait: a pilot study,"BACKGROUND: APOE polymorphism is believed to confer susceptibility to coronary heart disease (CHD) and Alzheimer's disease. It is well known that patterns of APOE polymorphisms differ between populations and ethnic groups, although most of the data available so far have been in whites. SUBJECT AND METHODS: We evaluated the frequencies of APOE genotypes and their relationships with serum levels of lipids, lipoproteins and apolipoproteins in two groups of Gulf Arab citizens: a control population of healthy voluntary blood donors (n=106), and a group of patients presenting to the lipid clinic for the first time with combined hyperlipidaemia (CH) (n=41). In both groups, fasting serum total cholesterol (TC), triglycerides (TG), HDL, LDL and apolipoprotein A1 and B levels were measured by routine autoanalyzer methods, and APOE genotyping was performed by validated PCR methods. The lipid and lipoprotein levels were related to the specific APOE allele frequencies. RESULTS: Allele frequencies were 5.7% for *E2, 85.4% for *E3, and 9.0% for *E4 in the healthy blood donor group. An essentially similar pattern was seen in the patients with CH. This APOE allelic distribution conforms to patterns described in Chinese, whites and South Asians. In both the blood donor and CH groups there were no consistent links between specific APOE pattern and serum lipoproteins, as would have been predicted from APO *E2 and APO *E4 frequencies. CONCLUSIONS: We conclude that APOE allelic patterns in healthy Kuwaiti blood donors and a smaller group of patients with CH do not satisfactorily predict circulating blood levels of lipids and lipoproteins.","Adult;Apolipoproteins E/*genetics;Arabs/*genetics/statistics & numerical data;Case-Control Studies;Female;Gene Frequency;Humans;Hyperlipidemias/blood/*ethnology/*genetics;Kuwait/epidemiology;Lipoproteins/*blood;Male;Pilot Projects;*Polymorphism, Genetic;Reference Values","Al-Shammari, S.;Fatania, H.;Al-Radwan, R.;Akanji, A. O.",2004,Sep-Oct,,0,
162,Attitudes of Saudi parents with a deaf child towards prenatal diagnosis and termination of pregnancy,"Objective: The aim of this study was to assess the attitudes of Muslim parents from Saudi Arabia with a deaf child towards prenatal diagnosis (PND) and termination of pregnancy (TOP) for deafness and 29 other genetic and medical conditions. Methods: A questionnaire mainly focused on parent's attitude toward PND and TOP for 30 different hypothetical scenarios for a series of genetic, non-genetic and non-medical conditions was completed by 70 Saudi parents with a deaf child. The results were compared and scored, and parents' comments were noted. Results: The attitude for PND was favorable (81.4%) and was influenced by the severity of the condition among men. Among women, it was influenced by cultural considerations. For TOP, average acceptance rate (25.2%) was lower than for PND. Attitudes toward TOP were fairly similar for men and women, as both groups would consider TOP for Alzheimer disease, cleft lip and palate, and cystic fibrosis. In addition, women also ranked high deafness and thalassemia for consideration of TOP. Acceptance for TOP was not influenced by gender, income, education level, number of children, or partner attending clinic. Conclusion: In the Saudi society, cultural consideration influences attitudes towards PND and TOP rather than the severity of the condition. © 2013 John Wiley & Sons, Ltd.",adult;Alzheimer disease;anencephalus;article;attitude to disability;autism;blindness;cleft lip;cleft palate;cultural factor;diabetes mellitus;Duchenne muscular dystrophy;dwarfism;education;epilepsy;female;fragile X syndrome;hearing impairment;heart infarction;human;Huntington chorea;income;Klinefelter syndrome;major clinical study;male;Muslim;multiple cancer;neoplasm;obesity;parental attitude;phenylketonuria;pregnancy termination;prenatal diagnosis;priority journal;quadriplegia;questionnaire;Saudi Arabia;schizophrenia;thalassemia;trisomy 13;trisomy 18;Turner syndrome,"Alsulaiman, A.;Mousa, A.;Kondkar, A. A.;Abu-Amero, K. K.",2014,,,0,
163,Delayed poststroke dementia: A 4-year follow-up study,"Objective: To assess patients who have had a stroke for the subsequent development of poststroke dementia (PSD) and to determine if the characteristics of delayed PSD (dPSD) vary in the long-term follow-up. Methods: Nondemented patients were followed from 6 months after stroke onset for 4 years. Dementia was diagnosed by International Classification of Diseases-10 criteria; dementia etiology was diagnosed by the National Institute of Neurological and Communication Disorders and Stroke/Alzheimer's Disease and Related Disorders Association and National Institute of Neurologic Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria. Neuroimaging and neuropsychological tests were repeated annually. Results: During a 2-year period, 191 stroke patients were enrolled. By the end of the follow-up period, 41 (21.5%) patients had developed dementia. At the Cox regression analysis, dPSD was associated with cortical atrophy (hazard ratio [HR] = 3.4, 95% CI 1.5 to 7.9), age (HR = 3.3, 95% CI 1.4 to 7.8), and multiple ischemic lesions (HR = 2.5, 95% CI 1.2 to 4.8). The Kaplan-Meier analysis showed a significant difference between the incidence of dPSD subtypes (log-rank test; p = 0.002). Conclusions: During the 4-year follow-up, the incidence of dementia increased gradually, shifting from an Alzheimer disease-type picture in the first years to a vascular dementia type later in years 2 to 4.",academic achievement;adult;aged;alcohol consumption;Alzheimer disease;article;brain atrophy;dementia;demography;diabetes mellitus;dyslipidemia;female;follow up;atrial fibrillation;heart infarction;human;hypertension;incidence;Kaplan Meier method;major clinical study;male;multiinfarct dementia;neuroimaging;neuropsychological test;poststroke dementia;priority journal;risk factor;smoking;statistical analysis;cerebrovascular accident;transient ischemic attack,"Altieri, M.;Di Piero, V.;Pasquini, M.;Gasparini, M.;Vanacore, N.;Vicenzini, E.;Lenzi, G. L.",2004,,,0,
164,Role of comorbidities in outcome prediction after status epilepticus,"Status epilepticus (SE) is associated with significant mortality and morbidity. A reliable prognosis may help better manage medical resources and treatment strategies. We examined the role of preexisting comorbidities on the outcome of patients with SE, an aspect that has received little attention to date. We prospectively studied incident SE episodes in 280 adults occurring over 55 months in our tertiary care hospital, excluding patients with postanoxic encephalopathy. Different models predicting mortality and return to clinical baseline at hospital discharge were compared, which included demographics, SE etiology, a validated clinical Status Epilepticus Severity Score (STESS), and comorbidities (assessed with the Charlson Comorbidity Index) as independent variables. The overall short-term mortality was 14%, and only half of patients returned to their clinical baseline. On bivariate analyses, age, STESS, potentially fatal etiologies, and number of preexisting comorbidities were all significant predictors of both mortality and return to clinical baseline. As compared with the simplest predictive model (including demographics and deadly etiology), adding SE severity and comorbidities resulted in an improved predictive performance (C statistics 0.84 vs. 0.77 for mortality, and 0.86 vs. 0.82. for return to clinical baseline); comorbidities, however, were not independently related to outcome. Considering comorbidities and clinical presentation, in addition to age and etiology, slightly improves the prediction of SE outcome with respect to both survival and functional status. This analysis also emphasizes the robust predictive role of etiology and age. © Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.",adult;article;cerebrovascular disease;chronic lung disease;clinical feature;comorbidity;congestive cardiomyopathy;connective tissue disease;dementia;diabetes mellitus;disease severity;epileptic state;female;functional status;heart infarction;hemiplegia;hospital discharge;human;Human immunodeficiency virus infection;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;mortality;neoplasm;peptic ulcer;peripheral vascular disease;priority journal;rating scale;Status Epilepticus Severity Score;tertiary health care,"Alvarez, V.;Januel, J. M.;Burnand, B.;Rossetti, A. O.",2012,,,0,
165,Prevalence and Risk Factors for Delirium in Acute Stroke Patients. A Retrospective 5-Years Clinical Series,"Background Delirium is characterized by disturbances of attention and cognition that cause functional decline and complications. The predisposing factors of delirium are age, male gender, systemic or metabolic disorders, dementia, and stroke. This study aims to evaluate the prevalence of delirium and to identify risk factors. Methods This is a retrospective study that includes patients admitted over 5 years with acute stroke. Patients with transient ischemic attack or venous thrombosis were excluded. Delirium was defined according the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Demographical characteristics, clinical–radiological profile, dependence on discharge (modified Rankin Scale score of ≥3 and Barthel Index < 65%), and mortality during hospitalization were compared between patients with and without delirium. Results A total of 1161 patients were admitted (910 ischemic and 162 hemorrhagic). During hospitalization, 118 patients presented with delirium (10.2%) and 93 died (8%). On discharge, 517 patients were dependent (44.5%). Delirium was significantly associated with age, male gender, cortical infarcts in anterior circulation, higher leukocyte count, cholesterol and fibrinogen levels, lower albumin, atrial fibrillation, previous diagnosis of Alzheimer's disease, and hemorrhagic stroke. Logistic regression results showed that only previous Alzheimer's disease was related to delirium (odds ratio 21.68 [95% confidence interval 1.190-395.026, P = .038]). Dependence on discharge was associated with delirium. Conclusions Ten percent of the patients presented with delirium associated with older age, Alzheimer's disease, and cortical anterior stroke. Patients with delirium had a higher risk of functional dependence on discharge.",albumin;C reactive protein;cholesterol;D dimer;fibrinogen;high density lipoprotein cholesterol;low density lipoprotein cholesterol;acute kidney failure;age;aged;alcohol consumption;Alzheimer disease;article;atrial fibrillation;B scan;Barthel index;blood cell count;blood clotting test;blood sampling;brain hemorrhage;brain ischemia;cholesterol blood level;computer assisted tomography;daily life activity;delirium;diabetes mellitus;disease classification;Doppler ultrasonography;DSM-5;erythrocyte sedimentation rate;female;gender;Holter monitoring;hospitalization;human;hypertension;intermittent claudication;ischemic heart disease;leukocyte count;lymphocyte count;major clinical study;male;metabolic disorder;morbidity;mortality;National Institutes of Health Stroke Scale;neutrophil count;pneumonia;prevalence;priority journal;pyrexia idiopathica;Rankin scale;retrospective study;risk assessment;seizure;smoking;stroke patient;transthoracic echocardiography;urinalysis;urinary tract infection,"Alvarez-Perez, F. J.;Paiva, F.",2017,,10.1016/j.jstrokecerebrovasdis.2016.11.120,0,
166,"NIH Asks Participants in Women's Health Initiative Estrogen-Alone Study to Stop Study Pills, Begin Follow-up Phase",,estrogen;gestagen;vitamin D;article;blood clot;breast cancer;clinical trial;cognitive defect;dementia;drug research;drug safety;drug screening;endometrium cancer;female;follow up;health;health care organization;heart disease;hip fracture;hormonal therapy;hot flush;human;ischemic heart disease;medical research;menopausal syndrome;postmenopause osteoporosis;research ethics;research subject;risk benefit analysis;side effect;cerebrovascular accident;vagina atrophy;vulva disease,"Alving, B.",2004,,,0,
167,The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT),"PURPOSE: To describe the design considerations of the Systolic Blood Pressure Intervention Trial (SPRINT) and the baseline characteristics of trial participants.METHODS: The Systolic Blood Pressure Intervention Trial is a multicenter, randomized, controlled trial that compares two strategies for treating systolic blood pressure: one targets the standard target of <140 mm Hg, and the other targets a more intensive target of <120 mm Hg. Enrollment focused on volunteers of age ?50 years (no upper limit) with an average baseline systolic blood pressure ?130 mm Hg and evidence of cardiovascular disease, chronic kidney disease, 10-year Framingham cardiovascular disease risk score ?15%, or age ?75 years. The Systolic Blood Pressure Intervention Trial recruitment also targeted three pre-specified subgroups: participants with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m(2)), participants with a history of cardiovascular disease, and participants 75 years of age or older. The primary outcome is first the occurrence of a myocardial infarction (MI), acute coronary syndrome, stroke, heart failure, or cardiovascular disease death. Secondary outcomes include all-cause mortality, decline in kidney function or development of end-stage renal disease, incident dementia, decline in cognitive function, and small-vessel cerebral ischemic disease.RESULTS: Between 8 November 2010 and 15 March 2013, Systolic Blood Pressure Intervention Trial recruited and randomized 9361 people at 102 clinics, including 3331 women, 2648 with chronic kidney disease, 1877 with a history of cardiovascular disease, 3962 minorities, and 2636 ?75 years of age.LIMITATIONS: Although the overall recruitment target was met, the numbers recruited in the high-risk subgroups were lower than planned.CONCLUSIONS: The Systolic Blood Pressure Intervention Trial will provide important information on the risks and benefits of intensive blood pressure treatment targets in a diverse sample of high-risk participants, including those with prior cardiovascular disease, chronic kidney disease, and those aged ?75 years.BACKGROUND: High blood pressure is an important public health concern because it is highly prevalent and a risk factor for adverse health outcomes, including coronary heart disease, stroke, decompensated heart failure, chronic kidney disease, and decline in cognitive function. Observational studies show a progressive increase in risk associated with blood pressure above 115/75 mm Hg. Prior research has shown that reducing elevated systolic blood pressure lowers the risk of subsequent clinical complications from cardiovascular disease. However, the optimal systolic blood pressure to reduce blood pressure-related adverse outcomes is unclear, and the benefit of treating to a level of systolic blood pressure well below 140 mm Hg has not been proven in a large, definitive clinical trial.","Adrenergic beta-Antagonists [therapeutic use];Angiotensin Receptor Antagonists [therapeutic use];Angiotensin-Converting Enzyme Inhibitors [therapeutic use];Antihypertensive Agents [therapeutic use];Calcium Channel Blockers [therapeutic use];Cardiovascular Diseases [complications];Clinical Protocols;Hypertension [complications] [drug therapy];Patient Care Planning;Renal Insufficiency, Chronic [complications];Sodium Chloride Symporter Inhibitors [therapeutic use];Sodium Potassium Chloride Symporter Inhibitors [therapeutic use];Systole;Treatment Outcome;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-htn","Ambrosius, Wt;Sink, Km;Foy, Cg;Berlowitz, Dr;Cheung, Ak;Cushman, Wc;Fine, Lj;Goff, Dc;Johnson, Kc;Killeen, Aa;Lewis, Ce;Oparil, S;Reboussin, Dm;Rocco, Mv;Snyder, Jk;Williamson, Jd;Wright, Jt;Whelton, Pk",2014,,10.1177/1740774514537404,0,168
168,The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT),"BACKGROUND: High blood pressure is an important public health concern because it is highly prevalent and a risk factor for adverse health outcomes, including coronary heart disease, stroke, decompensated heart failure, chronic kidney disease, and decline in cognitive function. Observational studies show a progressive increase in risk associated with blood pressure above 115/75 mm Hg. Prior research has shown that reducing elevated systolic blood pressure lowers the risk of subsequent clinical complications from cardiovascular disease. However, the optimal systolic blood pressure to reduce blood pressure-related adverse outcomes is unclear, and the benefit of treating to a level of systolic blood pressure well below 140 mm Hg has not been proven in a large, definitive clinical trial. PURPOSE: To describe the design considerations of the Systolic Blood Pressure Intervention Trial (SPRINT) and the baseline characteristics of trial participants. METHODS: The Systolic Blood Pressure Intervention Trial is a multicenter, randomized, controlled trial that compares two strategies for treating systolic blood pressure: one targets the standard target of <140 mm Hg, and the other targets a more intensive target of <120 mm Hg. Enrollment focused on volunteers of age ?50 years (no upper limit) with an average baseline systolic blood pressure ?130 mm Hg and evidence of cardiovascular disease, chronic kidney disease, 10-year Framingham cardiovascular disease risk score ?15%, or age ?75 years. The Systolic Blood Pressure Intervention Trial recruitment also targeted three pre-specified subgroups: participants with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m(2)), participants with a history of cardiovascular disease, and participants 75 years of age or older. The primary outcome is first the occurrence of a myocardial infarction (MI), acute coronary syndrome, stroke, heart failure, or cardiovascular disease death. Secondary outcomes include all-cause mortality, decline in kidney function or development of end-stage renal disease, incident dementia, decline in cognitive function, and small-vessel cerebral ischemic disease. RESULTS: Between 8 November 2010 and 15 March 2013, Systolic Blood Pressure Intervention Trial recruited and randomized 9361 people at 102 clinics, including 3331 women, 2648 with chronic kidney disease, 1877 with a history of cardiovascular disease, 3962 minorities, and 2636 ?75 years of age. LIMITATIONS: Although the overall recruitment target was met, the numbers recruited in the high-risk subgroups were lower than planned. CONCLUSIONS: The Systolic Blood Pressure Intervention Trial will provide important information on the risks and benefits of intensive blood pressure treatment targets in a diverse sample of high-risk participants, including those with prior cardiovascular disease, chronic kidney disease, and those aged ?75 years.","Adrenergic beta-Antagonists [therapeutic use];Angiotensin Receptor Antagonists [therapeutic use];Angiotensin-Converting Enzyme Inhibitors [therapeutic use];Antihypertensive Agents [therapeutic use];Calcium Channel Blockers [therapeutic use];Cardiovascular Diseases [complications];Clinical Protocols;Hypertension [complications] [drug therapy];Patient Care Planning;Renal Insufficiency, Chronic [complications];Sodium Chloride Symporter Inhibitors [therapeutic use];Sodium Potassium Chloride Symporter Inhibitors [therapeutic use];Systole;Treatment Outcome;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-htn","Ambrosius, W. T.;Sink, K. M.;Foy, C. G.;Berlowitz, D. R.;Cheung, A. K.;Cushman, W. C.;Fine, L. J.;Goff, D. C.;Johnson, K. C.;Killeen, A. A.;Lewis, C. E.;Oparil, S.;Reboussin, D. M.;Rocco, M. V.;Snyder, J. K.;Williamson, J. D.;Wright, J. T.;Whelton, P. K.",2014,,10.1177/1740774514537404,0,
169,A multilevel analysis of mortality following acute myocardial infarction in Norway: do municipal health services make a difference?,"OBJECTIVES: Studies link area features such as neighbourhood socioeconomic deprivation to poor health outcomes. However, there is a paucity of research based on representative data investigating the effects of area-level health services on mortality. This study examines the extent to which municipal health services account for municipal variation in all-cause and cardiovascular disease (CVD) mortality. We hypothesise that unfavourable municipal features (eg, fewer available places for rehabilitation) are associated with higher risk of mortality after accounting for patients' characteristics. DESIGN: Population data from Norwegian national/municipal registrars are analysed using multilevel logistic regression in this prospective cohort study. SETTING AND PARTICIPANTS: The analytic sample (9412 patients aged 18+ from 336 municipalities) constitutes 87.7% of the nationwide population of Norwegian adults who were hospitalised for acute myocardial infarction (AMI) in 2009 and discharged alive. PRIMARY OUTCOME MEASURES: All-cause and CVD mortality occurring within 365 days after the first day of hospitalisation for AMI. RESULTS: There was a small but significant variation at the municipal level in all-cause mortality (0.5%; intraclass correlation coefficient=0.005) but not CVD mortality. There were no significant fixed effects of municipal health services on mortality in bivariate models. Patients' characteristics (eg, gender, comorbidities) fully accounted for the observed municipal variation in mortality. Being male versus female (OR=1.21, 95% CI 1.02 to 1.43), or having been previously diagnosed with dementia versus not (OR=2.06, 95% CI 1.53 to 2.77) were also linked to higher odds of death. CONCLUSIONS: Municipal variation in all-cause mortality for Norwegian patients with AMI appears to be driven not by differences across municipalities in health service levels, but by differences across municipalities in the composition of patients. Focusing on chronic disease prevention and treatment, and tackling personal and structural risk factors embedded within patients' sociodemographic characteristics, may be especially beneficial for longevity.","Acute Disease;Adult;Aged;Aged, 80 and over;Female;*Hospital Mortality;Hospitals, Municipal/*statistics & numerical data;Humans;Logistic Models;Male;Middle Aged;Multilevel Analysis;Myocardial Infarction/*mortality;Norway/epidemiology;Prospective Studies;Risk Factors;Socioeconomic Factors;Municipalities;Norway;Public health;mortality","Ambugo, E. A.;Hagen, T. P.",2015,Nov 05,10.1136/bmjopen-2015-008764,0,
170,Epidemiological events related to decompensated heart failure,"Objective: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. Methods: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. Results: 209 patients were collected (average age: 786 ± 91; male: 52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved Most of decompensated were due to respiratory infections Ischemic-hipertensive cardiopathy was the most frequent aetiology of systolic disfunction. Average stay was 12.9 days with a mortality rate of 956%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. Conclusions: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials.It makes difficult to apply therapeutical interventions,previously well documented to be useful Copyright © 2008 Aran Ediciones, sl.",aged;article;cardiomyopathy;dementia;female;heart failure;human;hypertension;ischemic heart disease;major clinical study;male;observational study;respiratory tract infection;retrospective study;risk factor;systolic blood pressure;systolic dysfunction;tertiary health care,"Ameijeiras, A. H.;Núñez, M. P.;De Lafuente Cid, R.;Lado, F. L. L.;Fernández, L. H.;López, I. R.",2008,,,0,
171,Drugs used for psychiatric disorders,"Psychiatric disorders are common in the elderly. Antidepressants are probably underprescribed. In recurrent depression, lifelong prophylaxis may be required. Benzodiazepines can aggravate cognitive impairment and cause falls; they should not be used for chronic insomnia. Antipsychotic drugs are useful for the treatment of delusions and hallucinations but are less effective for disturbed behaviour in dementia sufferers. There are no satisfactory drugs for treating dementia at present, but promising palliative treatments for Alzheimer's disease are under trial.",antidepressant agent;antihistaminic agent;barbituric acid derivative;benzatropine;benzodiazepine derivative;chloral hydrate;clomethiazole;clonazepam;desipramine;diazepam;dosulepin;doxepin;flunitrazepam;fluoxetine;haloperidol;lithium;lorazepam;mianserin;moclobemide;neuroleptic agent;nitrazepam;oxazepam;phenelzine;prochlorperazine;temazepam;thioridazine;tranylcypromine;tricyclic antidepressant agent;aged;akathisia;anxiety neurosis;article;behavior disorder;blood dyscrasia;cognitive defect;constipation;delusion;dementia;drowsiness;drug withdrawal;dystonia;falling;gastrointestinal symptom;geriatrics;hallucination;hospitalization;human;insomnia;ischemic heart disease;mental disease;orthostatic hypotension;parkinsonism;priority journal;recurrent disease;schizophrenia;sedation;side effect;sleep disorder;tardive dyskinesia;thought disorder;urine retention;visual impairment;xerostomia,"Ames, D.;Chiu, E.",1993,,,0,
172,Driving decisions and dilemmas,,article;Australia;awareness;car;cataract;cognitive defect;community;cost;coxitis;dementia;diabetic retinopathy;diplopia;driver licence;driving ability;emphysema;epilepsy;general practice;general practitioner;hearing impairment;heart arrest;heart arrhythmia;hemianopia;human;knee arthritis;medical decision making;dark adaptation;non insulin dependent diabetes mellitus;nystagmus;occupational therapy;optometry;osteoporosis;outcomes research;physiotherapist;practice guideline;responsibility;safety;cerebrovascular accident;student;visual acuity,"Ames, E.;Chaplin, S.;Stevenson, B.;Kerr, I.",2001,,,0,
173,Clarifying dementia risk factors: Treading in murky waters,,antihypertensive agent;apolipoprotein E4;hydroxymethylglutaryl coenzyme A reductase inhibitor;proton pump inhibitor;aging;alcohol abuse;brain injury;cognition;dementia;disease association;education;human;ischemic heart disease;note;physical activity;risk assessment;risk factor,"Amjad, H.;Oh, E. S.",2016,,,0,
174,Apolipoprotein E in Creutzfeldt-Jakob disease 26,,apolipoprotein E4;age;allele;Alzheimer disease;controlled study;Creutzfeldt Jakob disease;ethnic difference;gene frequency;gene mutation;genetic susceptibility;human;ischemic heart disease;letter;methodology;priority journal;risk factor,"Amouyel, P.;Alperovitch, A.;Delesnerie-Laupretre, N.;Laplanche, J. L.",1995,,,0,
175,The renin angiotensin system and Alzheimer's disease,"Recent reports sustain the hypothesis of tight links between vascular and neurodegenerative diseases: associations between atherosclerosis lesions and Alzheimer's disease (AD), increased risk of AD for hypertensive subjects, decreased risk of dementia for elderly treated with hypotensive drugs, and a major impact of apolipoprotein E polymorphism, a protein of the lipid metabolism, on the occurrence of AD. All these results suggest that vascular determinants, both environmental and genetic, may predispose to or speed up dementia. As a major player of vascular homeostasis, the renin angiotensin system (RAS) proteins constitute an interesting source of candidate genes. Among these, the angiotensin I-converting enzyme gene (ACE), a central enzyme of the RAS, presents in its sequence a deletion (D)/insertion (I) polymorphism associated with variations of plasma ACE levels and with the risk of myocardial infarction. We explored the impact of this genetic polymorphism on the risk of cognitive impairment and of dementia in several epidemiological studies. Physiopathological hypotheses suggest a possible involvement of the RAS proteins in the occurrence and evolution of AD. Moreover, although inconsistent, several results of case-control studies tend to suggest that the ACE I/D genetic polymorphism may constitute a genetic susceptibility factor for dementia, reinforcing the hypothesis of a major implication of vascular risk factors in the occurrence of dementia.","Aged;Alzheimer Disease/*epidemiology/genetics/*physiopathology;Arteriosclerosis/complications/physiopathology;Great Britain;Humans;Middle Aged;Peptidyl-Dipeptidase A/*genetics;Polymorphism, Genetic;Renin-Angiotensin System/*physiology;Risk Factors","Amouyel, P.;Richard, F.;Berr, C.;David-Fromentin, I.;Helbecque, N.",2000,Apr,,0,
176,Prevalence of psychiatric disorders in older patients attending an Arab tertiary facility,,adult;aged;Alzheimer disease;anxiety disorder;chronic obstructive lung disease;clinical examination;cognitive defect;cross-sectional study;demography;diabetes mellitus;female;general practitioner;geriatric patient;hearing impairment;human;hypertension;ischemic heart disease;letter;major clinical study;major depression;male;mental disease;multiinfarct dementia;osteoarthritis;outpatient department;prevalence;Saudi Arabia;schizophrenia;tertiary health care;visual impairment,"Amr, M.;Amin, T. T.;Al-Rhaddad, D.;Sallam, K.",2013,,,0,
177,The validity of searching routinely collected general practice computer data to identify patients with chronic kidney disease (CKD): A manual review of 500 medical records,"Background. We conducted a search of 12 practices' routinely collected computer data in three localities across the UK and found that 4.9% of the registered population had an estimated glomerular filtration rate (GFR) of <60 ml/min/1.73 m2 (equivalent to stages 3-5 CKD). Only 3.6% of these were known to have renal disease. Although UK general practice is computerized, important clinical data might be recorded in letters or free-text computer entries and might therefore be invisible to the standard computer search tools. We therefore manually searched through all the records of patients with stages 3-5 CKD in one practice, to test the validity of the computer generated diagnosis and to see if other relevant information was missed by the computer search. Methods. We identified 492 people with stages 3-5 CKD using computer searching and then manually searched their computer records and written notes for any missed data. The dataset included cardiovascular morbidities and risk factors including diabetes; drugs which may impair renal function; known renal disease; and terminal diagnoses and dementia. Results. The manual searches only added four renal diagnoses to the 36 already identified. Although heart failure and stroke appear to be over-estimated by computer searches, other cardiovascular diagnoses were reliably recorded. Cardiovascular risk factors and drug recording is a strength of general practice computer data. It is complete and contemporary, though most patients had scope to have their cardiovascular risk reduced further. Eighty-four percent had a haemoglobin estimation, and a higher proportion with reduced renal function were anaemic (P < 0.001). Testing for proteinuria was less well recorded; negative stick tests were not recorded. Clinical diagnoses of prostatism and bladder outflow problems made these data hard to interpret. Conclusions. Automated searching of general practice computer records could provide a reliable and valid way of identifying people with stages 3-5 CKD who could benefit from interventions readily available in primary care. © The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.",adolescent;adult;aged;anemia;article;automation;cardiovascular disease;cardiovascular risk;child;chronic kidney disease;comorbidity;computer system;diabetes mellitus;disease course;female;general practice;heart failure;human;infant;major clinical study;male;medical record;priority journal;proteinuria;risk factor;cerebrovascular accident;United Kingdom;validation process,"Anandarajah, S.;Tai, T.;de Lusignan, S.;Stevens, P.;O'Donoghue, D.;Walker, M.;Hilton, S.",2005,,,0,
178,Influence of common herbal medicines and neutraceuticals on ocular surgery,"The use of herbal medicines and neutraceuticals is on the rise. This brief review provides a primer of the common herbal medicines that influence patient management in the perioperative period of ocular surgery. It is not intended to be a comprehensive review of this topic, but rather, aims to aid practicing ophthalmologists and anesthesiologists to better understand the influence of these agents on patient care.",alpha tocopherol;alprazolam;antithrombocytic agent;benzodiazepine derivative;chamomile;clopidogrel;cytochrome P450 3A4;digoxin;Echinacea purpurea extract;Ephedra sinica extract;fluoxetine;garlic extract;ginger extract;Ginkgo biloba extract;ginseng extract;heparin;herbaceous agent;Hypericum perforatum extract;kava extract;lavender oil;nonsteroid antiinflammatory agent;nutraceutical;primrose oil;sertraline;Tanacetum parthenium extract;thiazide diuretic agent;ticlopidine;tiratricol;unindexed drug;valerian;vitamin;warfarin;Aesculus hippocastanum;alfalfa;Aloe;alternative medicine;Alzheimer disease;amnesia;anesthesia;Angelica sinensis;anxiety disorder;Arctostaphylos uva-ursi;bleeding;blood clotting;celery;common cold;coriander;Crataegus;dandelion;depression;diet supplementation;eye surgery;Glycyrrhiza;hallucination;headache;heart arrhythmia;heart failure;heart infarction;herbal medicine;hot flush;human;Hydrastis;hypercholesterolemia;hypertension;Juniperus;kidney function;liver function;migraine;Momordica charantia;nausea;nose obstruction;patient care;perioperative period;photosensitivity disorder;seizure;short survey;cerebrovascular accident;subdural hematoma;thorax pain;thrombocyte aggregation inhibition;Verbenaceae;plavix;prozac;ticlid;zoloft,"Ananthanarayan, C.;Hurwitz, J.",2006,,,0,
179,Very mild to severe dementia and mortality: A 14-year follow-up - The odense study,"Background/Aims: To examine the mortality of very mildly to severely demented persons compared to nondemented persons. Methods: Participants in a randomly drawn population-based cohort study on dementia were followed for 14 years from 1992 to 2006. Participants were examined at baseline (3,065 nondemented and 234 prevalent demented), after 2 years (2,286 nondemented and 145 incident demented) and again after 5 years (1,669 nondemented and 124 new cases of dementia). Causes of death were ascertained in 884 nondemented and 286 demented participants. Survival for demented compared to nondemented persons was analyzed with the Cox proportional hazards model with time-dependent covariates adjusted for gender and age. Results: The hazard ratio of death (95% confidence interval) increased from 1.82 (1.55-2.14) for the very mildly demented to 9.52 (6.60-13.74) for the severely demented subjects. The demented participants died significantly more often of neurological causes other than dementia and of pneumonia than the nondemented participants. No other significant differences in causes of death were found. Conclusion: Dementia increased the risk of death. Even in the very early stages of dementia the risk of death was increased. Copyright © 2010 S. Karger AG, Basel.",acute heart infarction;age distribution;aged;Alzheimer disease;article;cancer mortality;cardiovascular disease;cause of death;controlled study;dementia;disease severity;female;follow up;human;lung disease;major clinical study;male;mortality;multiinfarct dementia;neurologic disease;pneumonia;priority journal;sex difference;survival rate;survival time,"Andersen, K.;Lolk, A.;Martinussen, T.;Kragh-Sørensen, P.",2010,,,0,
180,Can public health registry data improve Emergency Medical Dispatch?,"Background Emergency Medical Dispatchers make decisions based on limited information. We aimed to investigate if adding demographic and hospitalization history information to the dispatch process improved precision. Methods This 30-day follow-up study evaluated time-critical emergencies in contact with the emergency phone number 112 in Denmark during 18 months. 'Time-critical' was defined as suspected First Hour Quintet (FHQ) (cardiac arrest, chest pain, stroke, difficulty breathing, trauma). The association of age, sex, and hospitalization history with adverse outcomes was examined using logistic regression. The predictive ability was assessed via area under the curve (AUC) and Hosmer-Lemeshow tests. Results Of 59,943 patients (median age 63 years, 45% female), 44-45.5% had at least one chronic condition, 3880 (6.47%) died the day or the day after (primary outcome) calling 112. Age 30-59 was associated with increased adjusted odds ratio (OR) of death on day 1 of 3.59 [2.88-4.47]. Male sex was associated with an increased adjusted OR of death on day 1 of 1.37 [1.28-1.47]. Previous hospitalization with nutritional deficiencies (adjusted OR 2.07 [1.47-2.92]) and severe chronic liver disease (adjusted OR 2.02 [1.57-2.59]) was associated with a higher risk of death. For trauma patients, the discriminative ability of the model showed an AUC of 0.74 for death on day 1. Conclusion Increasing age, male sex, and hospitalization history was associated with increased risk of death on day 1 for FHQ 112 callers. Additional efforts are warranted to clarify the role for risk prediction tools in emergency medical dispatch.",adult;adverse outcome;article;assessment of humans;cerebrovascular accident;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;congestive heart failure;dementia;disease association;disease registry;dyspnea;emergency care;female;follow up;heart arrest;heart infarction;hemiplegia;Hosmer Lemeshow test;hospitalization;human;injury;kidney disease;liver disease;major clinical study;male;medical history;middle aged;nutritional deficiency;outcome assessment;peripheral vascular disease;priority journal;thorax pain;ulcer,"Andersen, M. S.;Christensen, E. F.;Jepsen, S. B.;Nørtved, J.;Hansen, J. B.;Johnsen, S. P.",2016,,,0,
181,"Healthy centenarians do not exist, but autonomous centenarians do: A population-based study of morbidity among danish centenarians","OBJECTIVE: To assess the prevalence of common illnesses in an unselected population of centenarians. DESIGN: A population-based survey. SETTING: Denmark. PARTICIPANTS: All Danes who celebrated their 100th anniversary between April 1, 1995 and May 31, 1996: 276 persons. MEASUREMENTS: All participants (including proxies) were visited at their domicile for an interview (sociodemographic characteristics, activities of daily living, living conditions, need of assistance from other people, former health and current diseases, current medication) and a clinical examination (dementia screening test, heart and lung auscultation, neurological assessment, height and weight, electrocardiogram, arm and ankle blood pressure, assessment of hearing and vision capacity, a short physical performance test, bio-impedance, lung function test, blood test). Further health information was retrieved from medical files and national health registers. RESULTS: Seventy-five percent (207) of eligible subjects participated in the study. Cardiovascular disease was present in 149 (72%) subjects. Osteoarthritis (major joints) was present in 54%, hypertension (≥140/≥90) in 52%, dementia in 51%, and ischemic heart disease in 28%. The mean number of illness was 4.3 (standard deviation (SD) 1.86). Only one subject was identified as being free from any chronic condition or illness. Sixty percent had been treated for illness with high mortality. In 25 autonomous (nondemented, functioning well physically, living at home) and 182 nonautonomous centenarians, comorbidities were equivalent. CONCLUSION: Because they have a high prevalence of several common diseases and chronic conditions, Danish centenarians are not healthy. However, a minor proportion was identified as being cognitively intact and functioning well.",analgesic agent;antibiotic agent;anticoagulant agent;antidepressant agent;antidiabetic agent;antihypertensive agent;bronchodilating agent;cardiovascular agent;corticosteroid;digoxin;diuretic agent;histamine H2 receptor antagonist;hypnotic agent;insulin;laxative;neuroleptic agent;proton pump inhibitor;sedative agent;aged;article;cardiovascular disease;chronic disease;comorbidity;Denmark;drug use;female;geriatric disorder;health care utilization;housing;human;hypertension;longevity;major clinical study;male;morbidity;osteoarthritis;population research;senile dementia,"Andersen-Ranberg, K.;Schroll, M.;Jeune, B.",2001,,,0,
182,More on data monitoring and large apparent treatment effects (multiple letters),,antineoplastic agent;atorvastatin;hydroxymethylglutaryl coenzyme A reductase inhibitor;pravastatin;simvastatin;acute myeloblastic leukemia;Alzheimer disease;amnesia;cancer adjuvant therapy;clinical trial;cognitive defect;coronary artery atherosclerosis;death;drug effect;drug safety;health hazard;human;letter;non small cell lung cancer;professional standard;thought disorder;treatment outcome,"Anderson, J. R.;Antuono, P.",2005,,,0,
183,Life after cardiac arrest: A very long term follow up,"Aim: To describe survival and causes of death after cardiac arrest (CA) and the life situation of very long term survivors. Methods: Individuals with successful resuscitation treated at the Sahlgrenska university hospital during 1995-1999 and presented in former CA publications were studied. Survival time and causes of death data were extracted from the individuals who had died's records. Very long term survivors were offered a follow up visit at home. Mini Mental State Examination (MMSE) used to describe cognitive abilities and EQ-5D to assess quality of life. The life situation was also explored. Results: 14 out of 104 possible participants had survived to follow up. The median time to follow up among the 8 who agreed to participation was 17 years. Out of the 8 participants, 4 failed to reach the cut off score of normal cognitive abilities in the MMSE and 7/8 participants did not reach the cut off score for normal cognitive function in the MoCA.Overall the participants were content with their life situation and QoL. However, a tendency towards lower scores on the cognitive testing and a lower self-reported QoL was observed. No depression, post-traumatic stress disorder or anxiety disorder were found. Conclusions: A CA may lead to permanent cognitive impairments and the risk of dementia may be higher because of the injuries sustained during the collapse. However, further studies with more participants are needed to fully determine the risk of cognitive impairment after a CA. Regarding life situation, there was a tendency of lower QoL with lower scores on the cognitive testing. With a new treatment paradigm, there is a need for long term studies regarding this new population.",adult;aged;article;cause of death;cognition;controlled study;distress syndrome;EuroQol 5 dimensions;female;follow up;human;life;long term survival;major clinical study;male;medical record;Mini Mental State Examination;neuropsychological test;out of hospital cardiac arrest;predictive value;priority journal;quality of life;rating scale;resuscitation;scoring system;self report;survival time;survivor;treatment outcome;university hospital,"Andersson, A. E.;Rosén, H.;Sunnerhagen, K. S.",2015,,,0,
184,Associations of Circulating Growth Differentiation Factor-15 and ST2 Concentrations with Subclinical Vascular Brain Injury and Incident Stroke,"Background and Purpose - Growth differentiation factor-15 (GDF-15) and soluble (s)ST2 are markers of cardiac and vascular stress. We investigated the associations between circulating concentrations of these biomarkers and incident stroke and subclinical vascular brain injury in a sample from the Framingham Offspring cohort. Methods - We followed 3374 stroke- and dementia-free individuals (mean age, 59.0±9.7 years; 53% women) attending the Framingham Offspring sixth examination cycle 11.8±3.0 years for incident stroke. A subsample of 2463 individuals underwent brain magnetic resonance imaging and neuropsychological testing ≈4.0±1.7 years after the sixth examination. Results - After adjustment for traditional cardiovascular risk factors, B-type natriuretic peptide, high-sensitivity C-reactive protein, and urine albumin levels, higher stress biomarker levels were associated cross-sectionally with lower brain volumes (β coefficients for intracranial volume comparing fourth [Q4] versus first biomarker [Q1] quartiles: -0.71% for GDF-15; P=0.002 and 0.47% for sST2; P=0.02) and worse performance on the visual reproduction test (β coefficients for Q4 versus Q1: -0.62 for GDF-15; P=0.009 and -0.40 for sST2; P=0.04). Higher GDF-15 concentrations were also associated with greater log-transformed white-matter hyperintensity volumes (β for Q4 versus Q1=0.19; P=0.01). Prospectively, a total of 203 (6%) individuals developed incident stroke/transient ischemic attack during follow-up. After multivariable adjustment, sST2 remained significantly associated with stroke/transient ischemic attack, hazard ratio for Q4 versus Q1 of 1.76, 95% confidence interval of 1.06 to 2.92, and P=0.03. Conclusions - Circulating GDF-15 and sST2 are associated with subclinical brain injury and cognitive impairment. Higher sST2 concentrations are also associated with incident stroke, suggesting potential links between cardiac stress biomarkers and brain injury.",albumin;biological marker;brain natriuretic peptide;C reactive protein;growth differentiation factor 15;peptides and proteins;soluble ST2;unclassified drug;adult;article;atrial fibrillation;blood vessel injury;brain damage;brain injury;brain ischemia;brain size;cardiovascular risk;cerebrovascular accident;cerebrovascular disease;cognition;cognitive defect;dementia;diabetes mellitus;educational status;female;heart left ventricle hypertrophy;human;hypertension;major clinical study;male;middle aged;mild cognitive impairment;neuroimaging;neuropsychological test;nuclear magnetic resonance imaging;outcome assessment;priority journal;smoking;subclinical vascular brain injury;systolic blood pressure;white matter,"Andersson, C.;Preis, S. R.;Beiser, A.;DeCarli, C.;Wollert, K. C.;Wang, T. J.;Januzzi, J. L.;Vasan, R. S.;Seshadri, S.",2015,,,0,
185,Alzheimer's disease (AD) with and without white matter pathology-clinical identification of concurrent cardiovascular disorders,"Clinical vascular features, either as manifest vascular disease or as cardiovascular risk factors were compared in AD with and without neuropathological white matter disease (WMD). The aim of the study was to investigate whether the presence of WMD and the severity of either AD pathology or WMD were associated with different cardiovascular profiles. A total of 44 AD cases were retrospectively studied. All the cases were neuropathologically diagnosed as AD with WMD (n = 22) and as AD without WMD (n = 22), respectively. The patients' medical records were studied with regard to their medical history and to somatic and neurological findings including arrhythmia, congestive heart failure, angina, myocardial infarctions, signs of TIA/stroke, diabetes mellitus, and blood pressure abnormalities, such as hypertension and orthostatic hypotension. In AD-WMD, hypertension, orthostatic hypotension as well as dizziness/unsteadiness were significantly more common than in AD without WMD. Cardiovascular symptoms were more frequent in AD-WMD than in the other group, though the difference did not reach statistical significance. Hypothetically, abnormal and unstable blood pressure levels underlie recurrent cerebral hypoperfusion, which may in turn leave room for the development of WMD. Furthermore, dizziness/unsteadiness may be a symptom reflecting the presence of WMD. © 2006 Elsevier Ireland Ltd. All rights reserved.",adult;aged;Alzheimer disease;anamnesis;angina pectoris;article;blood pressure monitoring;brain perfusion;cardiovascular disease;cardiovascular risk;clinical article;clinical feature;congestive heart failure;diabetes mellitus;disease association;disease severity;dizziness;female;heart arrhythmia;heart infarction;human;hypertension;male;medical record;neuropathology;orthostatic hypotension;priority journal;retrospective study;risk factor;statistical significance;cerebrovascular accident;transient ischemic attack;unsteadiness;white matter,"Andin, U.;Passant, U.;Gustafson, L.;Englund, E.",2007,,,0,
186,Antipsychotic drugs and myocardial infarction in patients with dementia,,Antipsychotic Agents/*therapeutic use;Cholinesterase Inhibitors/*therapeutic use;Dementia/*drug therapy;Female;Humans;Male;Myocardial Infarction/*chemically induced/*epidemiology,"Andrade, C.;Fernandes, P. P.",2012,Oct 8,10.1001/archinternmed.2012.3761,0,
187,The lifetime trajectory of schizophrenia and the concept of neurodevelopment,"Defining the lifetime trajectory of schizophrenia and the mechanisms that drive it is one of the major challenges of schizophrenia research. Kraepelin assumed that the mechanisms were neurodegenerative ("" dementia praecox""), and the early imaging work using computerized tomography seemed to support this model. Prominent ventricular enlargement and increased cerebrospinal fluid on the brain surface suggested that the brain had atrophied. In the 1980s, however, both neuropathological findings and evidence from magnetic resonance imaging (MRI) provided evidence suggesting that neurodevelopmental mechanisms might be a better explanation. This model is supported by both clinical and MRI evidence, particularly the fact that brain abnormalities are already present in first-episode patients. However, longitudinal studies of these patients have found evidence that brain tissue is also lost during the years after onset. The most parsimonious explanation of these findings is that neurodevelopment is a process that is ongoing throughout life, and that schizophrenia occurs as a consequence of aberrations in neurodevelopmental processes that could occur at various stages of life. © 2010 LLS SAS.",brain derived neurotrophic factor;nerve growth factor;nerve growth factor receptor;article;birth injury;brain atrophy;brain disease;brain metabolism;brain size;brain tissue;cerebrospinal fluid level;computer assisted tomography;electroencephalography;event related potential;genetic association;genotype;heart ventricle hypertrophy;human;hypothesis;illness trajectory;language disability;life cycle;longitudinal study;malnutrition;medical research;nerve cell differentiation;nerve degeneration;neuropathology;nuclear magnetic resonance imaging;onset age;pregnancy complication;protein defect;schizophrenia;social disability;synaptic efficacy;virus infection,"Andreasen, N. C.",2010,,,0,
188,Cognitive function after supplementation with B vitamins and long-chain omega-3 fatty acids: ancillary findings from the SU.FOL.OM3 randomized trial,"BACKGROUND: Rapid aging of the population worldwide necessitates a heightened concern about preventing cognitive decline. OBJECTIVE: We investigated the effects of B vitamins and omega-3 (n-3) fatty acid supplementation on cognition in a high-risk population. DESIGN: This was an ancillary study of the SU.FOL.OM3 (SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids) secondary prevention trial conducted in France between 2003 and 2009. The present sample included 1748 men and women aged 45-80 y with a history of myocardial infarction, unstable angina, or ischemic stroke and who were recruited via a network of 417 physicians. With the use of block randomization with stratification by sex, age, prior cardiovascular disease, and city of residence, participants were assigned in a 2 x 2 factorial design to 1 of 4 groups: 1) 5-methyltetrahydrofolate (folate, 0.56 mg) and vitamins B-6 (3 mg) and B-12 (0.02 mg), 2) eicosapentaenoic and docosahexaenoic acids (600 mg) in a 2:1 ratio, 3) B vitamins and omega-3 fatty acids, or 4) placebo. Cognitive function after 4 y of supplementation was assessed with the French version of the modified Telephone Interview for Cognitive Status. RESULTS: No significant main effects of group assignment on cognitive function were found; however, we found some evidence of disease history- and age-specific effects. In the subgroup with prior stroke, for example, participants assigned to receive B vitamins plus omega-3 fatty acids were significantly less likely to have a decreased score on the temporal orientation task than were those assigned to receive placebo (odds ratio: 0.43; 95% CI: 0.21, 0.86). CONCLUSIONS: If present, dietary effects on cognition are likely group-specific. These results could be useful in interventions aimed at preventing cognitive decline in high-risk individuals. This trial is registered at controlled-trials.com as ISRCTN41926726.","Aged;Aged, 80 and over;*Cognition;Dementia/etiology;*Dietary Supplements;Fatty Acids, Omega-3/*administration & dosage/blood;Female;Folic Acid/administration & dosage;Humans;Male;Middle Aged;Stroke/complications;Vitamin B 12/*administration & dosage;Vitamin B 6/*administration & dosage","Andreeva, V. A.;Kesse-Guyot, E.;Barberger-Gateau, P.;Fezeu, L.;Hercberg, S.;Galan, P.",2011,Jul,10.3945/ajcn.110.006320,0,
189,E-Health: A promising solution for optimizing management of chronic diseases. Example of the national e-Health project E-care based on an e-platform in the context of chronic heart failure,"Background. - Monitoring patients with heart failure by using telemedicine systems is a potential means for optimizing the management of these patients and to facilitate the job of health care professionals. We report the experience of the deployment of such a monitoring platform, through the E-care project. Methods. - The national e-heath project E-care has developed an ""intelligent"" communicative platform enabling the monitoring of patients with NYHA stages III and IV heart failure using non-invasive sensors. This project has been deployed since October 2013 in the Strasbourg UniversityHospital (in Strasbourg, France). Results. - To date, more than 180 patients have been included. The patient profile includedwas: elderly patient, with several chronic diseases (>90%), chronic heart failure in more than60% of cases, total loss of autonomy in 25%. The E-care system operated perfectly and the exper-imental phase enabled us to validate the technological choices. A qualitative survey helped topositively assess the system's ergonomics. A preliminary analysis of the relevance of alerts withour inference engine design resulted in no malfunction. Conclusion. - Preliminary results following the deployment of E-care system in hospitals appearto show that this platform will assist health care professionals, especially patient nurse ordoctor, by providing an automated processing of these sensors' transmitted data in order toearly detect and report signs of cardiac impairment.",anemia;article;atrial fibrillation;chronic disease;chronic kidney failure;chronic obstructive lung disease;dementia;diabetes mellitus;electrocardiography;experience;follow up;France;health care personnel;heart arrhythmia;heart failure;human;kidney failure;major clinical study;malignant neoplastic disease;New York Heart Association class;non insulin dependent diabetes mellitus;patient autonomy;phonocardiography;priority journal;qualitative analysis;respiratory failure;telehealth;telemonitoring;university hospital,"Andrès, E.;Talha, S.;Ahmed Benyahia, A.;Keller, O.;Hajjam, M.;Moukadem, A.;Dieterlen, A.;Hajjam, J.;Ervé, S.;Hajjam, A.",2015,,,0,
190,Evaluating treatments for the mood disorders: Time for the evidence to get real (multiple letters) 2,,antidepressant agent;placebo;anxiety;clinical trial;comorbidity;dementia;diabetes mellitus;drug efficacy;Hamilton Depression Rating Scale;heart infarction;human;letter;major depression;mental health center;mood disorder;population research;prediction;prognosis;psychiatry;reliability;risk assessment;treatment outcome,"Andrews, W.;Hickie, I.",2005,,,0,
191,Underuse in elderly adults: An underestimated suboptimal prescribing,,angiotensin 2 receptor antagonist;anticoagulant agent;antidepressant agent;antiosteoporotic agent;antithrombocytic agent;antivitamin K;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;drug;hydroxymethylglutaryl coenzyme A reductase inhibitor;nootropic agent;unclassified drug;vitamin D;aged;comorbidity;controlled study;dementia;depression;drug underuse;drug use;female;geriatric patient;health care quality;atrial fibrillation;heart failure;heart infarction;home;hospital admission;human;inappropriate prescribing;letter;major clinical study;male;Mini Mental State Examination;observational study;osteoporosis;prescription;secondary prevention;vitamin D deficiency;vitamin supplementation,"Andro, M.;Coutard, A.;Gentric, A.",2012,,,0,
192,"Safety, tolerability, and efficacy of PBT2 in Huntington's disease: A phase 2, randomised, double-blind, placebo-controlled trial","Background: PBT2 is a metal protein-attenuating compound that might reduce metal-induced aggregation of mutant huntingtin and has prolonged survival in a mouse model of Huntington's disease. We aimed to assess the safety, tolerability, and efficacy of PBT2 in patients with Huntington's disease. Methods: In this 26-week, randomised, double-blind, placebo-controlled trial, adults (≥25 years old) with early-stage to mid-stage Huntington's disease were randomly assigned (1:1:1) by a centralised interactive response system to once daily PBT2 250 mg, PBT2 100 mg, or placebo. Randomisation was stratified by site with a block size of three. Participants, carers, the steering committee, site investigators, study staff, and the study sponsor were masked to treatment assignment. Primary endpoints were safety and tolerability. The safety population consisted of all participants who were randomly assigned and had at least one dose of study drug. The principal secondary endpoint was cognition, measured by the change from baseline to week 26 in the main composite Z score of five cognitive tests (Category Fluency Test, Trail Making Test Part B, Map Search, Symbol Digit Modalities Test, and Stroop Word Reading Test) and scores on eight individual cognitive tests (the five aforementioned plus the Trail Making Test Part A, Montreal Cognitive Assessment, and the Speeded Tapping Test). The intention-to-treat population comprised participants who were randomly assigned and had at least one efficacy assessment after administration of study drug. This trial is registered with ClinicalTrials.gov, NCT01590888. Findings: Between April 18, 2012, and Dec 14, 2012, 109 participants were randomly assigned to PBT2 250 mg (n=36), PBT2 100 mg (n=38), or placebo (n=35) at 19 research centres in Australia and the USA. 32 (89%) individuals on PBT2 250 mg, 38 (100%) on PBT2 100 mg, and 34 (97%) on placebo completed the study. Six serious adverse events (acute coronary syndrome, major depression, pneumonia, suicide attempt, viral infection, and worsening of Huntington's disease) occurred in five participants in the PBT2 250 mg group, three (fall with subdural haematoma, suicide attempt, and hospital admission for stabilisation of Huntington's disease) occurred in two participants in the PBT2 100 mg group, and one (increasing aggression) occurred in a participant in the placebo group. The site investigators deemed all, except the worsening of Huntington's disease, as unrelated to study drug. 32 (89%) participants on PBT2 250 mg, 30 (79%) on PBT2 100 mg, and 28 (80%) on placebo had at least one adverse event. Compared with placebo, neither PBT2 100 mg (least-squares mean 0·02, 95% CI -0·10 to 0·14; p=0·772) nor PBT2 250 mg (0·07, -0·05 to 0·20; p=0·240) significantly improved the main composite cognition Z score between baseline and 26 weeks. Compared with placebo, the Trail Making Test Part B score was improved between baseline and 26 weeks in the PBT2 250 mg group (17·65 s, 0·65-34·65; p=0·042) but not in the 100 mg group (0·79 s improvement, -15·75 to 17·32; p=0·925); neither dose significantly improved cognition on the other tests. Interpretation: PBT2 was generally safe and well tolerated in patients with Huntington's disease. The potential benefit on executive function will need to be confirmed in a larger study. Funding: Prana Biotechnology Limited.",controlled study;human;Huntington chorea;safety;placebo,"Angus, D.;Herd, C.;Stone, C.;Stout, J.;Wieler, M.;Reilmann, R.;Ritchie, C. W.;Dorsey, E. R.;Helles, K.;Kayson, E.;Oakes, D.;Rosas, H. D.;Vaughan, C.;Panegyres, P. K.;Ames, D.;Goh, A.;Agarwal, P.;Churchyard, A.;Murathodizic, M.;Chua, P.;Germaine, D.;Lim, D. L.;Mack, H.;Loy, C.;Griffith, J.;Mitchell, P.;Corey-Bloom, J.;Gluhm, S.;Goldstein, J.;Levi, L.;Rosas, H. D.;Margolis, R.;Yoritomo, N.;Janicki, S.;Marder, K.;Clouse, R.;Singer, C.;Moore, H.;Padron, N.;Kostyk, S.;Daley, A.;Segro, V.;Kumar, R.;Anderson, K.;Drazinic, C.;Hennig, B.;Nance, M.;Molho, E.;Criswell, S.;LeDoux, M. S.;Guyot, S.;Iannaccone, A.;Jennings, B.;Leavitt, B. R.;Feigin, A.;Evans, S.;Wray, S.;Casaceli, C.;Orme, C.;Gao, S.;Oakes, D.;Watts, A.;Baker, K.;Labuschagne, I.;El-Dairi, M.;Fekrat, S.;Hersch, S.;Moscovitch-Lopatin, M.;Angus, D.;Herd, C.;Stone, C.;Ritchie, C. W.;Tanzi, R.;Targum, S.",2015,,,0,
193,Development and validation of cardiovascular risk scores for haemodialysis patients,"Background: A simple clinical tool to predict cardiovascular disease risk does not exist for haemodialysis patients. The long-term coronary risk Framingham Heart Study Risk score (FRS), although used in this population, may be inadequate. Therefore, we developed separate risk-scores for cardiovascular mortality (CVM) and cardiovascular morbidity & mortality (CVMM) in a Fresenius Medical Care-based haemodialysis patient cohort (AROii). Methods: Applying a modified FRS approach, we derived and internally validated two-year risk-scores in incident European adult patients randomly assigned to a development (N = 4831) or a validation (N = 4796) dataset. External validation was conducted in the third Dialysis Outcomes and Practice Patterns Study (DOPPS III) cohort. Additional discrimination comparing to the FRS was performed. Results: The overall two-year CVM and CVMM event rates were 5.0 and 22.6 per 100 person-years respectively. Common risk predictors included increasing age, cardiovascular disease history, primary diabetic nephropathy, low blood pressure, and inflammation. The CVM score was more predictive in AROii (c-statistic 0.72) and in DOPPS III (c-statistic 0.73-0.74) than the CVMM score (c-statistic 0.66-0.67 & 0.63 respectively). The FRS was not predictive of either CVM (c-statistic 0.54) or CVMM (c-statistic 0.56) in AROii. Conclusions: We describe novel, easy-to-apply and interpret CV risk-scores for haemodialysis patients. Our improved cardiovascular prediction performance over traditional (FRS) scores reflected its tailored development and validation in haemodialysis populations, and the integration of non-classical cardiovascular risk factors. The lower expected versus observed CVM and CVMM risk suggests the existence of novel cardiovascular risk factors in this patient population not measured in this study.",albumin;C reactive protein;calcium;creatinine;hemoglobin;acute heart infarction;adult;age;aged;albumin blood level;angina pectoris;aorta aneurysm;aorta dissection;artery embolism;artery occlusion;artery thrombosis;article;atherosclerosis;atrial fibrillation;body mass;brain hemorrhage;brain infarction;calcium blood level;cardiomyopathy;cardiovascular disease;cardiovascular mortality;cerebrovascular accident;cohort analysis;controlled study;creatinine blood level;diabetes mellitus;diabetic nephropathy;event free survival;female;Framingham risk score;gangrene;glomerulonephritis;heart arrest;heart atrium flutter;heart failure;hemodialysis patient;hemoglobin blood level;human;hypertension;hypotension;inflammation;interstitial nephritis;ischemic heart disease;kidney polycystic disease;lung embolism;major clinical study;male;morbidity;multiinfarct dementia;paroxysmal tachycardia;phlebitis;priority journal;protein blood level;smoking;systolic blood pressure;thrombophlebitis;transient ischemic attack;ultrafiltration;vascular disease,"Anker, S. D.;Gillespie, I. A.;Eckardt, K. U.;Kronenberg, F.;Richards, S.;Drueke, T. B.;Stenvinkel, P.;Pisoni, R. L.;Robinson, B. M.;Marcelli, D.;Froissart, M.;Floege, J.",2016,,,0,
194,Sacubitril + valsartan (ENTRESTOdegree) in chronic heart failure: favourable results in highly selected patients,"Standard medical treatment of chronic heart failure in patients with reduced left ventricular ejection fraction is based on an ACE inhibitor such as enalapril, a beta-blocker such as carvedilol, or a diuretic such as furosemide. An angiotensin II receptor blocker (ARB, alias sartan) such as valsartan is an alternative if the ACE inhibitor is poorly tolerated. * A fixed-dose combination of sacubitril + valsartan has been authorised in the European Union for patients with symptomatic chronic heart failure and reduced left ventricular ejection fraction. The active metabolite of sacubitril inhibits neprilysin, an enzyme whose actions include breaking down natriuretic peptides. * A randomised controlled trial of sacubitril + valsartan versus enalapril in 8442 patients with heart failure and a reduced left ventricular ejection fraction showed a statistically significant reduction in mortality with the combination: 17% versus 20% after a median follow-up of 27 months. The patients in this trial were relatively young and mildly symptomatic, had a marked decrease in the left ventricular ejection fraction but were stable on treatment with a beta-blocker, a diuretic and an ACE inhibitor or an ARB. Few patients had implantable cardiac devices. Patients who did not tolerate the gradual introduction (over 3 to 6 weeks) of the high-dose sacubitril + valsartan combination were excluded. It is not known whether the results were influenced by the use of a high-dose ARB in the sacubitril + valsartan group versus a standard dose of an ACE inhibitor in the enalapril group. * The sacubitril + valsartan combination exposes patients to the adverse effects of ARBs. A possible increase in the risk of angioedema should be borne in mind, as sacubitril inhibits bradykinin metabolism. This risk was probably underestimated in the principal trial. * The sacubitril + valsartan combination provoked more hypotension and hypokalaemia than enalapril, but less hyperkalaemia. * Neprilysin is involved in the breakdown of amyloid beta peptide in the brain. Inhibition of neprilysin by the active metabolite of sacubitril could conceivably increase the long-term risk of dementia. * Numerous interactions can be anticipated with the sacubitril + valsartan combination, including potentiation of furosemide and certain statins such as atorvastatin. In addition, additive adverse effects are likely with hypotensive drugs, for example. Renal failure, which is an adverse effect of valsartan, is a risk factor for sacubitril overdose.",age;angioneurotic edema/si [Side Effect];artificial heart pacemaker;cardiovascular mortality;cerebrospinal fluid;clinical practice;cognitive defect/si [Side Effect];combination chemotherapy;consciousness disorder/si [Side Effect];coughing/si [Side Effect];dementia/si [Side Effect];disease severity;dizziness/si [Side Effect];drug bioavailability;drug contraindication;drug efficacy;drug elimination;drug indication;drug industry;drug legislation;drug marketing;drug metabolism;drug potentiation;drug protein binding;drug safety;drug tolerability;dyspnea;edema;faintness/si [Side Effect];fatigue/si [Side Effect];fluid retention;follow up;food and drug administration;gastrointestinal disease/si [Side Effect];headache/si [Side Effect];heart failure/dt [Drug Therapy];heart failure/dt [Drug Therapy];heart left ventricle ejection fraction;high risk patient;hospitalization;human;hyperkalemia/si [Side Effect];hypoglycemia/si [Side Effect];hypokalemia;hyponatremia/si [Side Effect];hypotension/si [Side Effect];implantable cardioverter defibrillator;in vivo study;kidney failure/si [Side Effect];monotherapy;muscle cramp/si [Side Effect];nonhuman;pharmaceutical care;photosensitivity/si [Side Effect];physical activity;potassium blood level;randomized controlled trial (topic);review;risk factor;side effect/si [Side Effect];skin manifestation/si [Side Effect];sudden death;taste disorder/si [Side Effect];treatment duration;acetorphan/it [Drug Interaction];amyloid beta protein/ec [Endogenous Compound];angiotensin receptor antagonist/ae [Adverse Drug Reaction];angiotensin receptor antagonist/ct [Clinical Trial];angiotensin receptor antagonist/cm [Drug Comparison];angiotensin receptor antagonist/dt [Drug Therapy];atorvastatin/cb [Drug Combination];atorvastatin/it [Drug Interaction];beta adrenergic receptor blocking agent/dt [Drug Therapy];beta adrenergic receptor blocking agent/pd [Pharmacology];bradykinin/ec [Endogenous Compound];carvedilol/ct [Clinical Trial];carvedilol/dt [Drug Therapy];digoxin/dt [Drug Therapy];dipeptidyl carboxypeptidase inhibitor/ae [Adverse Drug Reaction];dipeptidyl carboxypeptidase inhibitor/ct [Clinical Trial];dipeptidyl carboxypeptidase inhibitor/cm [Drug Comparison];dipeptidyl carboxypeptidase inhibitor/do [Drug Dose];dipeptidyl carboxypeptidase inhibitor/it [Drug Interaction];dipeptidyl carboxypeptidase inhibitor/dt [Drug Therapy];dipeptidyl carboxypeptidase inhibitor/pd [Pharmacology];diuretic agent/dt [Drug Therapy];diuretic agent/pd [Pharmacology];enalapril/ae [Adverse Drug Reaction];enalapril/ct [Clinical Trial];enalapril/cm [Drug Comparison];enalapril/dt [Drug Therapy];furosemide/ct [Clinical Trial];furosemide/cb [Drug Combination];furosemide/it [Drug Interaction];furosemide/dt [Drug Therapy];membrane metalloendopeptidase/ec [Endogenous Compound];nonsteroid antiinflammatory agent/it [Drug Interaction];potassium/ec [Endogenous Compound];sacubitril/ct [Clinical Trial];sacubitril/cb [Drug Combination];sacubitril/it [Drug Interaction];sacubitril/dt [Drug Therapy];sacubitril/pk [Pharmacokinetics];sacubitril/pd [Pharmacology];sacubitril plus valsartan/ae [Adverse Drug Reaction];sacubitril plus valsartan/ct [Clinical Trial];sacubitril plus valsartan/cb [Drug Combination];sacubitril plus valsartan/cm [Drug Comparison];sacubitril plus valsartan/it [Drug Interaction];sacubitril plus valsartan/dt [Drug Therapy];sacubitril plus valsartan/to [Drug Toxicity];sacubitril plus valsartan/pr [Pharmaceutics];sacubitril plus valsartan/pk [Pharmacokinetics];sacubitril plus valsartan/pd [Pharmacology];valsartan/ae [Adverse Drug Reaction];valsartan/ct [Clinical Trial];valsartan/cb [Drug Combination];valsartan/cm [Drug Comparison];valsartan/it [Drug Interaction];valsartan/dt [Drug Therapy];angioneurotic edema;brain;clinical trial;controlled clinical trial;controlled study;dementia;drug combination;drug megadose;drug overdose;drug therapy;drug toxicity;gene inactivation;heart failure;hyperkal;mia;hypotension;kidney failure;major clinical study;metabolite;mortality;randomized controlled trial;side effect;amyloid beta protein;atorvastatin;beta adrenergic receptor blocking agent;bradykinin;common acute lymphoblastic leukemia antigen;enalapril;endogenous compound;furosemide;natriuretic factor;sacubitril;sartan derivative;valsartan,Anonymous,2017,,,0,
195,An autopsy case of Lafora body disease with interesting clinical symptoms (Japanese),"A man of 32 yr complained of transient amnesia. Five years later, during hospitalization for cardiac asthma, an abnormal EEG was found; later dementia gradually developed. From the age of 46 somnolent states were sometimes observed. He died, when 47 yr old, from heart failure. During his disease neither convulsions nor myoclonus had ever been noticed. There were no hereditary factors. Histopathologically, Lafora bodies were noted throughout the brain and ischemic lesions in the brain cortex could be found. In liver cells and heart muscle cells the same products of degeneration were demonstrated. Histochemical examination of these bodies revealed mucopolysaccharides or acid mucopolysaccharides. Electron microscopically, the Lafora bodies appeared to consist of aggregated fibrils of 70 to 120 Å and of highly dense granules. These granules sometimes formed a core in their central part. Lafora body disease is the name for a condition in which Lafora bodies are found. In the authors' opinion, this name should be used only when myoclonus epilepsy is present. The case described therefore is no more than a type of Lafora body disease.",glycosaminoglycan;amnesia;brain;cell inclusion;dementia;diagnosis;electroencephalography;electron microscopy;etiology;fatality;heart failure;heart muscle cell;histology;lafora body;liver cell;major clinical study;myoclonus epilepsy,"Anraku, S.;Kotorii, K.;Shingaki, Y.;Mae, A.",1974,,,0,
196,The promise of traditional medicines,"The usage of plants, plant extracts or plant-derived pure chemicals to treat disease become a therapeutic modality, which has stood the test of time. Today several pharmacological classes of drugs include a natural product prototype. Aspirin, atropine, ephedrine, digoxin, morphine, quinine, reserpine and tubocurarine are a few examples of modern drugs, which were originally discovered through the study of traditional cures and folk knowledge of indigenous people. A team work amongst ethnobotanists, ethnopharmacologists, physicians and phytochemists is must for the fruitful outcome on medicinal plants research. While the ethnopharmacologists have a greater role in the rationalization of combination of activities, the phytochemist's role will slightly shift towards standardization of herbal medicines. © 2010 Asian Network for Scientific Information.",acetylsalicylic acid;Aloe vera extract;Angelica sinensis extract;atropine;capsaicin;cascara sagrada;chamomile;colchicine;Crataegus extract;digoxin;dipeptidyl carboxypeptidase inhibitor;ephedrine;ginger extract;green tea extract;Hypericum perforatum extract;morphine;plant extract;plant medicinal product;primrose oil;quinine;reserpine;Ruscus extract;Sarcococca saligna extract;Senna extract;tea tree oil;tubocurarine chloride;turmeric;unclassified drug;unindexed drug;valerian;Viscum album extract;Alzheimer disease;article;burn;Cinchona;clinical effectiveness;Crocus;Curcuma longa;depression;drug indication;drug mechanism;drug potentiation;drug safety;eczema;ethnobotany;ethnopharmacology;gastrointestinal disease;gynecologic disease;heart disease;heart failure;herbal medicine;human;hypertension;indigenous people;malaria;malignant neoplastic disease;mastalgia;medicinal plant;motion sickness;myasthenia gravis;pain;pepper;phytochemistry;rhizome;Sarcococca saligna;senile dementia;skin infection;skin irritation;sleep disorder;standardization;traditional medicine;vein disease,"Ansari, J. A.;Inamdar, N. N.",2010,,,0,
197,Construct validity of the abbreviated mental test in older medical inpatients,"OBJECTIVES: To evaluate validity and internal structure of the Abbreviated Mental Test (AMT), and to assess the dependence of the internal structure upon the characteristics of the patients examined. DESIGN: Cross-sectional examination using data from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA) database. SETTING: Twenty-four acute care wards of Geriatrics or General Medicine. PARTICIPANTS: Two thousand eight hundred and eight patients consecutively admitted over a 4-month period. MEASUREMENTS: Demographic characteristics, functional status, medical conditions and performance on AMT were collected at discharge. Sensitivity, specificity and predictive values of the AMT <7 versus a diagnosis of dementia made according to DSM-III-R criteria were computed. The internal structure of AMT was assessed by principal component analysis. The analysis was performed on the whole population and stratified for age (<65, 65-80 and >80 years), gender, education (<6 or >5 years) and presence of congestive heart failure (CHF). RESULTS: AMT achieved high sensitivity (81%), specificity (84%) and negative predictive value (99%), but a low positive predictive value of 25%. The principal component analysis isolated two components: the former component represents the orientation to time and space and explains 45% of AMT variance; the latter is linked to memory and attention and explains 13% of variance. Comparable results were obtained after stratification by age, gender or education. In patients with CHF, only 48.3% of the cumulative variance was explained; the factor accounting for most (34.6%) of the variance explained was mainly related to the three items assessing memory. CONCLUSION: AMT >6 rules out dementia very reliably, whereas AMT <7 requires a second level cognitive assessment to confirm dementia. AMT is bidimensional and maintains the same internal structure across classes defined by selected social and demographic characteristics, but not in CHF patients. It is likely that its internal structure depends on the type of patients. The use of a sum-score could conceal some part of the information provided by the AMT.","Aged;Aged, 80 and over;Cognition Disorders/*diagnosis;Cross-Sectional Studies;Data Collection;Factor Analysis, Statistical;Female;Humans;Inpatients;Male;Middle Aged;Psychiatric Status Rating Scales/*standards;Sensitivity and Specificity","Antonelli Incalzi, R.;Cesari, M.;Pedone, C.;Carosella, L.;Carbonin, P. U.",2003,,68787,0,
198,Ranibizumab Combined With Verteporfin Photodynamic Therapy in Neovascular Age-related Macular Degeneration (FOCUS): Year 2 Results,"Purpose: To assess the efficacy and adverse-events profile of combined treatment with ranibizumab and verteporfin photodynamic therapy (PDT) in patients with predominantly classic choroidal neovascularization (CNV) secondary to neovascular age-related macular degeneration. Design: Two-year, multicenter, randomized, single-masked, controlled study. Methods: Patients received monthly intravitreal injections of ranibizumab 0.5 mg (n = 106) or sham injections (n = 56). All patients received PDT on day zero, then quarterly as needed. Efficacy assessment included changes in visual acuity (VA) and lesion characteristics and PDT frequency. Adverse events were summarized by incidence and severity. Results: At month 24, 88% of ranibizumab + PDT patients had lost <15 letters from baseline VA (vs 75% for PDT alone), 25% had gained ≥15 letters (vs 7% for PDT alone), and the two treatment arms differed by 12.4 letters in mean VA change (P < .05 for all between-group differences). The VA benefit of adding ranibizumab to PDT in year one persisted through year two. On average, ranibizumab + PDT patients exhibited less lesion growth and greater reduction of CNV leakage and subretinal fluid accumulation, and required fewer PDT retreatments, than PDT-alone patients (mean = 0.4 vs 3.0 PDT retreatments). Endophthalmitis and serious intraocular inflammation occurred, respectively, in 2.9% and 12.4% of ranibizumab + PDT patients and 0% of PDT-alone patients. Incidences of serious nonocular adverse events were similar in the two treatment groups. Conclusions: Through two years, ranibizumab + PDT was more effective than PDT alone and had a low rate of associated adverse events. © 2008 Elsevier Inc. All rights reserved.",NCT00056823;ranibizumab;verteporfin;abdominal pain;acute coronary syndrome;acute kidney failure;adult;aged;aneurysm;angioneurotic edema;arm fracture;artery occlusion;article;bacterial meningitis;cerebrospinal fluid fistula;cerebrovascular accident;chickenpox;cholelithiasis;clinical trial;congestive heart failure;controlled clinical trial;controlled study;contusion;coronary artery disease;coronary artery obstruction;dehydration;dementia;depression;disease severity;drug efficacy;endometrium cancer;endophthalmitis;eye infection;falling;female;gastroenteritis;atrial fibrillation;heart infarction;hip fracture;human;hypertension;incidence;inguinal hernia;intestine obstruction;laceration;lung tumor;major clinical study;male;multicenter study;multiple myeloma;osteoarthritis;pancreatitis;phase 1 clinical trial;phase 2 clinical trial;photodynamic therapy;pneumonia;postoperative infection;priority journal;randomized controlled trial;relapsing pancreatitis;age related macular degeneration;rotator cuff rupture;sepsis;side effect;single blind procedure;sinusitis;spinal compression fracture;thrombosis;thyroid cancer;transient ischemic attack;unstable angina pectoris;upper respiratory tract infection;urethra cancer;urinary tract infection;vertigo;visual acuity;lucentis;visudyne,"Antoszyk, A. N.;Tuomi, L.;Chung, C. Y.;Singh, A.",2008,,,0,
199,Mitochondrial Quality Control and Disease: Insights into Ischemia-Reperfusion Injury,"Mitochondria are key regulators of cell fate during disease. They control cell survival via the production of ATP that fuels cellular processes and, conversely, cell death via the induction of apoptosis through release of pro-apoptotic factors such as cytochrome C. Therefore, it is essential to have stringent quality control mechanisms to ensure a healthy mitochondrial network. Quality control mechanisms are largely regulated by mitochondrial dynamics and mitophagy. The processes of mitochondrial fission (division) and fusion allow for damaged mitochondria to be segregated and facilitate the equilibration of mitochondrial components such as DNA, proteins, and metabolites. The process of mitophagy are responsible for the degradation and recycling of damaged mitochondria. These mitochondrial quality control mechanisms have been well studied in chronic and acute pathologies such as Parkinson’s disease, Alzheimer’s disease, stroke, and acute myocardial infarction, but less is known about how these two processes interact and contribute to specific pathophysiologic states. To date, evidence for the role of mitochondrial quality control in acute and chronic disease is divergent and suggests that mitochondrial quality control processes can serve both survival and death functions depending on the disease state. This review aims to provide a synopsis of the molecular mechanisms involved in mitochondrial quality control, to summarize our current understanding of the complex role that mitochondrial quality control plays in the progression of acute vs chronic diseases and, finally, to speculate on the possibility that targeted manipulation of mitochondrial quality control mechanisms may be exploited for the rationale design of novel therapeutic interventions.",acute disease;apoptosis;cell fate;cell survival;cerebrovascular accident;chronic disease;heart infarction;metabolite;mitochondrial dynamics;mitochondrial toxicity;mitophagy;pathology;quality control;recycling;reperfusion injury;adenosine triphosphate;cytochrome c;deoxyribonucleoprotein;endogenous compound,"Anzell, A. R.;Maizy, R.;Przyklenk, K.;Sanderson, T. H.",2017,,10.1007/s12035-017-0503-9,0,
200,Effect of pneumonia on clinical course and prognosis after hip fracture,"The records of 38 elderly patients with hip fracture admitted to our hospital between January and December 2002 were retrospectively reviewed to determine the incidence and outcomes of medical complications. The mean age was 84.5 +/- 6.83 years old, 32 women and 6 men. 27 patients (71%) suffered from dementia. Of the 38 patients, 33 (86.8%) had one and more underlying diseases: hypertension 29, cerebrovascular episode 7, congestive heart failure 5, diabetes mellitus 4, gastric ulcer or chronic gastritis 3, ischemic heart disease 4, depression 2. Three patients had a past history of hip fracture. Fourteen patients (37%) developed medical complications after hip fracture, most frequently pneumonia (64%). Other complications were dizziness, nausea, congestive heart failure, choledocholithiasis, and GI tract bleeding. Eight patients who suffered pneumonia cancelled elective surgery. Severity of pneumonia was mild in 2, moderate in 5, and severe in 2. Both cases with severe pneumonia died in hospital. Patients with pneumonia (pneumonia group) were significantly older and had more severe dementia than patients without pneumonia (non-pneumonia group). Although there were no significant differences in physical ability between the two groups before admission, physical ability on discharge was lower in the pneumonia group. The pneumonia group had a significantly longer mean hospital stay than the non-pneumonia group. Our results suggest that the prevention of pneumonia is necessary to improve the outcome of hip fracture.",aged;article;female;hip fracture;human;male;mortality;pneumonia;prognosis;retrospective study,"Aoki, A.;Sato, T.;Igarashi, T.",2003,,,0,
201,Two case reports of group B streptococcal infective endocarditis complicated by embolism,"Streptococcus agalactiae (Group B streptococcus, GBS) is the major pathogen encountered in the perinatal period, although the incidence of GBS infection has recently increased among non-pregnant adults. Nevertheless, GBS infective endocarditis (IE) is uncommon and often accompanies aortic embolism. We experienced two cases of GBS IE. In Case 1, mobile vegetation of the aortic valve caused an infective cerebral aneurysm. In Case 2, the patient experienced an acute aortic embolic episode. Generally, early surgery for large mobile sites of vegetation is recommended as a class IIb therapy in the guidelines. GBS IE often exhibits a severe clinical course and specificity of vegetation. Therefore, early surgery should be considered in such cases.",ampicillin;atrial natriuretic factor alpha;brain natriuretic peptide;C reactive protein;ceftriaxone;diuretic agent;gabexate mesilate;gentamicin;noradrenalin;vancomycin;aged;Alzheimer disease;aorta valve regurgitation;article;bacterial endocarditis;bacterial growth;brain artery aneurysm;brain hemorrhage;brain hernia;case report;computer assisted tomography;congestive heart failure;coronary artery bypass graft;diastolic heart murmur;disseminated intravascular clotting;dyspnea;embolism;female;fever;heart left ventricle ejection fraction;human;lung congestion;septic shock;subarachnoid hemorrhage;subcortical hemorrhage;thorax radiography;transesophageal echocardiography;transthoracic echocardiography,"Aoyama, R.;Kobayashi, A.;Tubokou, Y.;Takeda, K.;Fujimoto, H.;Harada, K.;Kyo, S.",2015,,,0,
202,Focal cortical subarachnoid hemorrhage revealed by recurrent paresthesias: A clinico-radiological syndrome strongly associated with cerebral amyloid angiopathy,"Background: Focal subarachnoid hemorrhage (SAH) is often revealed by transient and recurrent focal neurological episodes. This cause is important to identify because it carries a high risk of intracerebral hemorrhage (ICH). We report the clinical, imaging and prognostic data of 17 patients with focal SAH revealed by short episodes of paresthesias mimicking transient ischemic attacks. Methods: The medical records and imaging data of patients with focal acute SAH at the cerebral convexity and at least one episode of focal paresthesia having attended the Neurology Department of Caen University Hospital in the last 10 years were retrospectively reviewed. Hemorrhagic lesions, ischemic lesions, cerebral microbleeds (CMBs), superficial siderosis, white matter changes (leukoaraiosis) and modified Boston criteria for cerebral amyloid angiopathy (CAA) were assessed. All patients or relatives were contacted after a median delay of 16 months in order to seek for new events (death, stroke, recurrent focal symptoms, ICH and dementia) that occurred since hospital discharge. Results: Seventeen patients (12 men) aged 69-96 years were identified. All but 1 had multiple, repeated, stereotyped and brief attacks of paresthesias, associated in some of them with motor and/or speech difficulties, but only 1 had a headache. SAHs were seen on CT scans in 15/17 patients and on T2* gradient-echo magnetic resonance imaging (MRI) in all patients. They were multiple SAHs in 14/17 patients, including at least 1 SAH in the central or pre- or postcentral sulcus contralateral to the symptoms in all patients. Five patients had punctate cortical hyperintensities on diffusion-weighted MRI. Eleven patients had CMBs, and 4 of them had more than 5 CMBs. Seven patients met the modified Boston criteria for probable and 10 for possible CAA. At follow-up, 5 patients had a subsequent ICH, 4 of whom had received antithrombotic treatments. Five patients died (1 from ICH). Six patients developed dementia. Conclusion: The combination of transient, repeated and stereotyped attacks of unilateral paresthesias with a contralateral sulcal SAH seems to preferentially occur in elderly people and is often indicative of CAA. Copyright © 2013 S. Karger AG, Basel.",acetylsalicylic acid;anticoagulant agent;anticonvulsive agent;clopidogrel;etiracetam;gabapentin;aged;article;brain hemorrhage;cardiovascular mortality;cerebrovascular accident;clinical article;computer assisted tomography;dementia;differential diagnosis;diffusion weighted imaging;disease association;drug withdrawal;female;follow up;headache;atrial fibrillation;human;ischemic heart disease;leukoaraiosis;male;medical record review;motor dysfunction;neuroimaging;nuclear magnetic resonance imaging;occlusive cerebrovascular disease;paresthesia;priority journal;prognosis;retrospective study;siderosis;speech disorder;subarachnoid hemorrhage;transient ischemic attack;university hospital;vascular amyloidosis;vein thrombosis;aspirin,"Apoil, M.;Cogez, J.;Dubuc, L.;Bataille, M.;De La Sayette, V.;Touzé, E.;Viader, F.",2013,,,0,
203,Predictors of severe stroke: Influence of preexisting dementia and cardiac disorders,"Background and Purpose - There is little research into the impact of prestroke dementia on stroke severity and short-term mortality. We included prestroke dementia, along with other risk factors, to determine independent predictors of stroke severity and early death in a community-based stroke study. Methods - All patients (n = 377) with a first-ever stroke were evaluated in terms of risk factors. Registration took place over a 12-month period. Stroke severity was evaluated with the National Institutes of Health Stroke Scale. Predictors of severe stroke and early death were analyzed in logistic regression models. The following independent variables were used: age, sex, living alone, arterial hypertension, ischemic heart disease, heart failure, atrial fibrillation, diabetes mellitus, transient ischemic attack, cigarette smoking, peripheral atherosclerosis, and dementia. Results - Risk factors for stroke were found in 82% of the patients. Heart failure, atrial fibrillation, and dementia were associated with more severe strokes. Dementia, atrial fibrillation, heart failure, and living alone were associated with death within 28 days of the event. Conclusions - These results raise the question of whether certain high-risk patients, ie, patients with atrial fibrillation, heart failure, and dementia, can benefit from more aggressive primary and secondary stroke prevention measures.",age;aged;article;atherosclerosis;smoking;clinical trial;controlled clinical trial;controlled study;dementia;diabetes mellitus;disease association;disease severity;female;atrial fibrillation;heart disease;heart failure;high risk population;human;hypertension;ischemic heart disease;logistic regression analysis;major clinical study;male;mortality;prediction;priority journal;prophylaxis;registration;risk factor;sex;cerebrovascular accident;time;transient ischemic attack,"Appelros, P.;Nydevik, I.;Seiger, Å;Terént, A.",2002,,,0,
204,"Poor outcome after first-ever stroke: predictors for death, dependency, and recurrent stroke within the first year","BACKGROUND AND PURPOSE: The purpose of this study was to define predictors of poor outcome after a first-ever stroke. We studied risk factors and stroke severity at baseline in relationship to death, dependency, and stroke recurrence within a year after the event. METHODS: The study included a community-based cohort of first-ever stroke patients. Subarachnoid hemorrhage was not included. All patients (n=377) were subjected to investigations regarding risk factors. Stroke severity was evaluated with the National Institutes of Health Stroke Scale, and dependency was defined according to the modified Rankin Scale. Multivariate regression models were used to analyze predictors of survival, dependency, and stroke recurrence. The following independent variables were used: age, sex, cohabitation status, cigarette smoking, dementia, hypertension, ischemic heart disease, heart failure, atrial fibrillation, diabetes mellitus, transitory ischemic attack, peripheral atherosclerosis, and stroke severity. RESULTS: The 1-year mortality was 33%. After 1 year, 37% of the survivors were dependent; 9% of survivors had a recurrent stroke within a year. Dementia, age, stroke severity, and atrial fibrillation were associated with death within a year. Dependency was associated with age, stroke severity, and heart failure. Stroke recurrence was predicted by age and dementia. CONCLUSIONS: In addition to age and stroke severity, heart diseases and dementia before the stroke seem to have an impact on mortality and recurrence after 1 year. Finding and, when possible, treating these prestroke conditions may affect stroke morbidity and mortality favorably.",Adult;Aged;Female;Heart Diseases/complications;Humans;Male;Middle Aged;Prognosis;Recurrence;Risk Factors;Stroke/*diagnosis/etiology/*mortality;Survival Analysis,"Appelros, P.;Nydevik, I.;Viitanen, M.",2003,Jan,,0,
205,Exon-level array CGH in a large clinical cohort demonstrates increased sensitivity of diagnostic testing for Mendelian disorders,"Purpose: Mendelian disorders are most commonly caused by mutations identifiable by DNA sequencing. Exonic deletions and duplications can go undetected by sequencing, and their frequency in most Mendelian disorders is unknown. Methods: We designed an array comparative genomic hybridization (CGH) test with probes in exonic regions of 589 genes. Targeted testing was performed for 219 genes in 3,018 patients. We demonstrate for the first time the utility of exon-level array CGH in a large clinical cohort by testing for 136 autosomal dominant, 53 autosomal recessive, and 30 X-linked disorders. Results: Overall, 98 deletions and two duplications were identified in 53 genes, corresponding to a detection rate of 3.3%. Approximately 40% of positive findings were deletions of only one or two exons. A high frequency of deletions was observed for several autosomal dominant disorders, with a detection rate of 2.9%. For autosomal recessive disorders, array CGH was usually performed after a single mutation was identified by sequencing. Among 138 individuals tested for recessive disorders, 10.1% had intragenic deletions. For X-linked disorders, 3.5% of 313 patients carried a deletion or duplication. Conclusion: Our results demonstrate that exon-level array CGH provides a robust option for intragenic copy number analysis and should routinely supplement sequence analysis for Mendelian disorders. ©American College of Medical Genetics and Genomics.",acrocephalosyndactyly;agammaglobulinemia;Alagille syndrome;Alstrom syndrome;angioneurotic edema;aniridia;article;Axenfeld Rieger syndrome;Bannayan Riley Ruvalcaba syndrome;basal cell nevus syndrome;Birt Hogg Dube syndrome;branchiootorenal syndrome;campomelic dysplasia;Coffin Lowry syndrome;cohort analysis;comparative genomic hybridization;congestive cardiomyopathy;controlled study;Cowden syndrome;diagnostic test;Duane radial ray syndrome;ectodermal dysplasia;EEC syndrome;epidermolysis bullosa dystrophica;exon;Feingold syndrome;female;gene deletion;gene duplication;gene mutation;genetic disorder;glycogen storage disease type 2;Goltz syndrome;hereditary multiple exostosis;Holt Oram syndrome;homocystinuria;human;hypohidrotic ectodermal dysplasia;Laron syndrome;leiomyomatosis;long QT syndrome;major clinical study;male;mendelian disorder;microphthalmia;multiple endocrine neoplasia;Norrie disease;ornithine transcarbamylase deficiency;osteogenesis imperfecta;paraganglioma;Peutz Jeghers syndrome;phenylketonuria;retinoschisis;Rett syndrome;Rubinstein syndrome;severe combined immunodeficiency;Smith Lemli Opitz syndrome;Smith Magenis syndrome;Sotos syndrome;subtelomeric deletion syndrome;Van der Woude syndrome;von Hippel Lindau disease,"Aradhya, S.;Lewis, R.;Bonaga, T.;Nwokekeh, N.;Stafford, A.;Boggs, B.;Hruska, K.;Smaoui, N.;Compton, J. G.;Richard, G.;Suchy, S.",2012,,,0,
206,"Safety, tolerability and immunogenicity of an immunotherapeutic vaccine (vanutide cridificar ACC-001 ) and the QS-21 adjuvant in Japanese individuals with mild-to-moderate Alzheimer's disease: A phase IIA, multicenter, randomized, adjuvant and placebo clinical trial","Background: Vanutide cridificar (ACC-001) is a novel immunotherapeutic vaccine for the treatment of Alzheimer's Disease (AD) composed of aminoterminal peptides (1-7) of amyloid beta (Abeta) conjugated to a CRM 197 carrier, designed to elicit an anti-Abeta antibody response while avoiding an Abeta (1-42)-directed T-cell response.Objective: To assess the safety and tolerability of multiple doses of ACC-001 in Japanese subjects with mild to moderate AD. Immunogenicity and exploratory efficacy assessments were also conducted. Methods: Subjects were treated with 3mg of ACC-001 with QS- 21 adjuvant (50mug), 10mug or 30mug of ACC-001 with/without QS-21, QS-21 alone, or PBS alone at day 1 and months 3, 6, 9, and 12, and followed for 12 months. Immunogenicity was evaluated by anti-Abeta IgG antibody titration. Exploratory efficacy evaluations included ADAS-Cog, DAD, NTB, and MMSE. Results: Forty subjects were randomized and treated with either QS-21 50mug alone; 3mug, 10mug, or 30mug of ACC-001 with/without QS-21 (n=6 for each group); or PBS (n=4). Thirty-two subjects (80%) completed the study and 8 subjects (20%) discontinued the study for reasons other than adverse events (AEs) or lack of efficacy. The most common (>2 subjects) treatment-emergent AEs (TEAEs) in the ACC-001 with/without QS-21 group were cataract, dental caries, injection site erythema/pain, pyrexia, nasopharyngitis, contusion, blood triglycerides increased, glucosuria, proteinuria, and back pain. Most TEAEs were mild (32 subjects) or moderate (3) in severity and self-limiting. Serious AEs were reported for 2 subjects: contusion, cholecystitis infective, and duodenal ulcer (ACC-001 3mug + QS-21, considered not related to study drug) and angina pectoris (ACC-001 30mug + QS-21, considered treatment related). No deaths occurred. High titer and sustained anti-Abeta IgG antibodies were observed in the ACC-001 with QS-21 groups. Addition of QS-21 was essential for high-titer responses. Due to a small number of subjects and intersubject variability, exploratory efficacy results did not support or refute a clinical benefit with ACC-001. Conclusions: Repeat administration of ACC-001 (3mug, 10mug, and 30mug) with/without QS-21 was generally safe and well tolerated. Addition of QS-21 was essential to elicit high-titer responses. High-titer, sustained, anti-Abeta IgG responses were observed with no apparent differences among the 3 ACC-001 doses tested.",safety;immunogenicity;Japanese;human;clinical trial;Alzheimer disease;contusion;cholecystitis;multiple drug dose;rhinopharyngitis;T lymphocyte;triacylglycerol blood level;antibody titer;cataract;antibody response;glucosuria;proteinuria;backache;fever;duodenum ulcer;death;angina pectoris;injection site;dental caries;Mini Mental State Examination;adjuvant;vanutide cridificar;vaccine;qs 21;placebo;blood group A antibody;immunoglobulin G antibody;amyloid;peptide;immunoglobulin G;diphtheria toxoid CRM197,"Arai, H.;Suzuki, H.;Yoshiyama, T.;Lobello, K.;Peng, Y.;Liu, E.;Ketter, N.;Margolin, R.;Jackson, N.;Fujimoto, Y.",2013,,10.1016/j.jalz.2013.05.564,0,
207,"Safety, tolerability and immunogenicity of an immunotherapeutic vaccine (vanutide cridificar ) and the QS-21 adjuvant in Japanese individuals with mild-to-moderate Alzheimer's disease: a phase IIA, multicenter, randomized, adjuvant and placebo clinical trial","Background: Vanutide cridificar (ACC-001) is a novel immunotherapeutic vaccine for the treatment of Alzheimer's Disease (AD) composed of aminoterminal peptides (1-7) of amyloid beta (Abeta) conjugated to a CRM 197 carrier, designed to elicit an anti-Abeta antibody response while avoiding an Abeta (1-42)-directed T-cell response.Objective: To assess the safety and tolerability of multiple doses of ACC-001 in Japanese subjects with mild to moderate AD. Immunogenicity and exploratory efficacy assessments were also conducted. Methods: Subjects were treated with 3mg of ACC-001 with QS- 21 adjuvant (50mug), 10mug or 30mug of ACC-001 with/without QS-21, QS-21 alone, or PBS alone at day 1 and months 3, 6, 9, and 12, and followed for 12 months. Immunogenicity was evaluated by anti-Abeta IgG antibody titration. Exploratory efficacy evaluations included ADAS-Cog, DAD, NTB, and MMSE. Results: Forty subjects were randomized and treated with either QS-21 50mug alone; 3mug, 10mug, or 30mug of ACC-001 with/without QS-21 (n=6 for each group); or PBS (n=4). Thirty-two subjects (80%) completed the study and 8 subjects (20%) discontinued the study for reasons other than adverse events (AEs) or lack of efficacy. The most common (>2 subjects) treatment-emergent AEs (TEAEs) in the ACC-001 with/without QS-21 group were cataract, dental caries, injection site erythema/pain, pyrexia, nasopharyngitis, contusion, blood triglycerides increased, glucosuria, proteinuria, and back pain. Most TEAEs were mild (32 subjects) or moderate (3) in severity and self-limiting. Serious AEs were reported for 2 subjects: contusion, cholecystitis infective, and duodenal ulcer (ACC-001 3mug + QS-21, considered not related to study drug) and angina pectoris (ACC-001 30mug + QS-21, considered treatment related). No deaths occurred. High titer and sustained anti-Abeta IgG antibodies were observed in the ACC-001 with QS-21 groups. Addition of QS-21 was essential for high-titer responses. Due to a small number of subjects and intersubject variability, exploratory efficacy results did not support or refute a clinical benefit with ACC-001. Conclusions: Repeat administration of ACC-001 (3mug, 10mug, and 30mug) with/without QS-21 was generally safe and well tolerated. Addition of QS-21 was essential to elicit high-titer responses. High-titer, sustained, anti-Abeta IgG responses were observed with no apparent differences among the 3 ACC-001 doses tested.",safety;immunogenicity;japanese;human;clinical trial;Alzheimer disease;contusion;cholecystitis;multiple drug dose;rhinopharyngitis;T lymphocyte;triacylglycerol blood level;antibody titer;cataract;antibody response;glucosuria;proteinuria;backache;fever;duodenum ulcer;death;angina pectoris;injection site;dental caries;Mini Mental State Examination;adjuvant;vanutide cridificar;vaccine;qs 21;placebo;blood group A antibody;immunoglobulin G antibody;amyloid;peptide;immunoglobulin G;diphtheria toxoid CRM197,"Arai, H;Suzuki, H;Yoshiyama, T;Lobello, K;Peng, Y;Liu, E;Ketter, N;Margolin, R;Jackson, N;Fujimoto, Y",2013,,10.1016/j.jalz.2013.05.564,0,
208,Relationship between cognitive impairment and echocardiographic parameters: A review,"With >24 million people affected worldwide, dementia is one of the main public health challenges modern medicine has to face. The path leading to dementia is often long, with a wide spectrum of clinical presentations, and preceded by a long preclinical phase. Previous studies have demonstrated that clinical strokes and covert vascular lesions of the brain contribute to the risk for developing dementia. Although it is not yet known whether preventing such lesions reduces the risk for dementia, it is likely that starting preventive measures early in the course of the disease may be beneficial. Echocardiography is a widely available, relatively inexpensive, noninvasive imaging modality whereby morphologically or hemodynamically derived parameters may be integrated easily into a risk assessment model for dementia. The aim of this review is to analyze the information that has accumulated over the past two decades on the prognostic value of echocardiographic factors in cognitive impairment. The associations between cognitive impairment and echocardiographic parameters, including left ventricular systolic and diastolic indices, left atrial morphologic parameters, cardiac output, left ventricular mass, and aortic root diameter, have previously been reported. In the light of these studies, it appears that echocardiography may help further improve currently used risk assessment models by allowing detection of subclinical cardiac abnormalities associated with future cognitive impairment. However, many limitations, including methodologic heterogeneity and the observational designs of these studies, restrict the scope of these results. Further prospective studies are required before integrating echocardiography into a preventive strategy.",aorta root;article;cognitive defect;echocardiography;epicardium;heart atrium enlargement;heart left atrium;heart left ventricle;heart left ventricle function;heart left ventricle mass;heart output;human;left ventricular diastolic dysfunction;left ventricular systolic dysfunction;risk assessment,"Arangalage, D.;Ederhy, S.;Dufour, L.;Joffre, J.;Van Vynckt, C. D.;Lang, S.;Tzourio, C.;Cohen, A.",2015,,,0,
209,"Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack","Background and purpose: Small vessel disease (SVD) and Alzheimer's disease (AD) are two common causes of cognitive impairment and dementia, traditionally considered as distinct processes. The relationship between radiological features suggestive of AD and SVD was explored, and the association of each of these features with cognitive status at 1 year was investigated in patients with stroke or transient ischaemic attack. Methods: Anonymized data were accessed from the Virtual International Stroke Trials Archive (VISTA). Medial temporal lobe atrophy (MTA; a marker of AD) and markers of SVD were rated using validated ordinal visual scales. Cognitive status was evaluated with the Mini Mental State Examination (MMSE) 1 year after the index stroke. Logistic regression models were used to investigate independent associations between (i) baseline SVD features and MTA and (ii) all baseline neuroimaging features and cognitive status 1 year post-stroke. Results: In all, 234 patients were included, mean (±SD) age 65.7 ± 13.1 years, 145 (62%) male. Moderate to severe MTA was present in 104 (44%) patients. SVD features were independently associated with MTA (P < 0.001). After adjusting for age, sex, disability after stroke, hypertension and diabetes mellitus, MTA was the only radiological feature independently associated with cognitive impairment, defined using thresholds of MMSE ≤ 26 (odds ratio 1.94; 95% confidence interval 1.28–2.94) and MMSE ≤ 23 (odds ratio 2.31; 95% confidence interval 1.48–3.62). Conclusion: In patients with ischaemic cerebrovascular disease, SVD features are associated with MTA, which is a common finding in stroke survivors. SVD and AD type neurodegeneration coexist, but the AD marker MTA, rather than SVD markers, is associated with post-stroke cognitive impairment.",aged;article;atrial fibrillation;brain atrophy;brain ischemia;cerebrovascular disease;cognition;cognitive defect;controlled study;depression;diabetes mellitus;female;human;hypercholesterolemia;hypertension;ischemic heart disease;lacunar stroke;major clinical study;male;medial temporal lobe;Mini Mental State Examination;neuroimaging;peripheral vascular disease;priority journal;transient ischemic attack,"Arba, F.;Quinn, T.;Hankey, G. J.;Ali, M.;Lees, K. R.;Inzitari, D.;Diener, H. C.;Davis, S.;Hankey, G.;Ovbiagele, B.;Weir, C. J.",2017,,10.1111/ene.13191,0,
210,Clinical trial of Vincimax (vincamine),,vincamine;aged;brain dysfunction;central nervous system;dementia;drug efficacy;drug screening;drug therapy;electrocardiography;heart;heart infarction;human cell;kidney disease;major clinical study;nervous system;theoretical study;therapy;vincimax,"Arbus, L.",1979,,,0,
211,Decreased cardiac output in humans during laparoscopic antireflux surgery: Direct measurements,"Objective: In a porcine model, we demonstrated that laparoscopic Nissen fundoplication causes a significant drop in cardiac output (30%) because it exposes both the peritoneal cavity and the mediastinum to CO2 under pressure. To determine if this occurs in humans, we examined cardiovascular physiology during laparoscopic Nissen fundoplication. Because of invasiveness required in this pilot trial, only six patients were studied. Methods: The arterial blood pressure (via radial arterial catheter) and the pulmonary artery diastolic pressure and cardiac index (via pulmonary artery thermodilution catheter) were measured at seven points in time during each laparoscopic Nissen fundoplication. Results: The systolic blood pressure decreased in all patients, and the cardiac index decreased in all but one patient. The exception was a patient with Huntington disease, in whom the cardiac output did not decrease. In four of the five patients, the cardiac output was lowest during hiatal dissection, and in the fifth, it was lowest after reverse Trendelenburg positioning. No significant change in the pulmonary artery diastolic pressure was noted. All patients received adequate intravenous fluid replacement (average, 58 ± 16 mL/kg) to support blood pressure. In one patient, with a particularly large paraesophageal hernia, profound hypotension (40/25 mm Hg) developed during the mediastinal phase of the procedure, and this patient required α-adrenergic support followed by laparotomy to eliminate a surgical cause (none found). Conclusions: Although it is a tremendous advance for patients, laparoscopic Nissen fundoplication can be associated with a significant reduction in cardiac output and blood pressure. Surgeons and anesthesiologists must be alert to changes reflecting these decreases during procedures, which violate both the peritoneal cavity and the mediastinum. We propose careful hemodynamic monitoring during these procedures, especially in patients with coronary artery disease or significant left ventricular dysfunction.",alpha adrenergic receptor stimulating agent;infusion fluid;adult;aged;article;clinical article;female;gastroesophageal reflux;heart index;heart output;hiatus hernia;human;Huntington chorea;hypotension;laparoscopic surgery;laparotomy;lung artery pressure;male;patient positioning;peroperative complication;pilot study;priority journal;stomach fundoplication;surgical technique;systolic blood pressure,"Are, C.;Hardacre, J. M.;Talamini, M. A.;Murata, K.;Frank, S.",2003,,,0,
212,Hemodialysis in the elderly: Do we need a special approach?,"Elderly dialysis patients with multiple comorbidities often have poorer tolerance to hemodialysis treatment than younger patients. Typical complications, such as intradialytic hypotension, cramps, atrial fibrillation and post-dialysis fatigue contribute to a rapid loss of independence in this vulnerable patient population. The underlying etiology is a reduced tolerance to intravascular volume changes during dialysis, which is caused by impaired cardiovascular hemodynamic responses in combination with uremic and/or diabetic autonomous neuropathy. Significant reduction in organ perfusion occurring in the intestines, liver, kidneys, heart and brain contribute to the development of inflammation, malnutrition, heart failure, frailty, depression and dementia. To protect vulnerable elderly dialysis patients from these fatal complications of intradialytic tissue hypoxia, the prescription of hemodialysis needs to be individually adjusted in numerous aspects to the sensitivities of multimorbid elderly patients.",article;atrial fibrillation;dementia;depression;diabetic neuropathy;elderly care;fatigue;frail elderly;heart failure;hemodialysis;hemodynamics;human;hypotension;hypoxemia;inflammation;malnutrition;muscle cramp;organ perfusion;prescription;uremic polyneuropathy,"Aregger, F.;Kuhlmann, M. K.",2016,,,0,
213,Inhomogeneous distribution of Alzheimer pathology along the isocortical relief. Are cortical convolutions an Achilles heel of evolution?,"Alzheimer's disease (AD) is neuropathologically characterized by neuritic plaques and neurofibrillary tangles. Progression of both plaques and tangles throughout the brain follows a hierarchical distribution which is defined by intrinsic cytoarchitectonic features and extrinsic connectivity patterns. What has less well been studied is how cortical convolutions influence the distribution of AD pathology. Here, the distribution of both plaques and tangles within subsulcal gyral components (fundi) to components forming their top regions at the subarachnoidal brain surface (crowns) by stereological methods in seven different cortical areas was systematically compared. Further, principle differences in cytoarchitectonic organization of cortical crowns and fundi that might provide the background for regionally selective vulnerability were attempted to identify. It was shown that both plaques and tangles were more prominent in sulcal fundi than gyri crowns. The differential distribution of pathology along convolutions corresponds to subgyral differences in the vascular network, GFAP-positive astrocytes and intracortical and subcortical connectivity. While the precise mechanisms accounting for these differences remain open, the presence of systematic inhomogeneities in the distribution of AD pathology along cortical convolutions indicates that the phylogenetic shaping of the cortex is associated with features that render the human brain vulnerable to AD pathology.",amyloid beta protein;glial fibrillary acidic protein;laminin;tau protein;aged;Alzheimer disease;amyloid plaque;article;astrocyte;brain cortex;brain weight;bronchopneumonia;clinical article;Clinical Dementia Rating;controlled study;female;heart infarction;human;human tissue;lung embolism;male;Mini Mental State Examination;neurofibrillary tangle;senile plaque;subcortex;synapse,"Arendt, T.;Morawski, M.;Gärtner, U.;Fröhlich, N.;Schulze, F.;Wohmann, N.;Jäger, C.;Eisenlöffel, C.;Gertz, H. J.;Mueller, W.;Brauer, K.",2017,,10.1111/bpa.12442,0,
214,Approach to death in the older emergency department patient,,advance care planning;article;chronic disease;chronic obstructive lung disease;consultation;decision making;dementia;doctor patient relation;dying;emergency medicine;emergency ward;gold standard;health care management;heart arrest;human;intensive care unit;intubation;pneumonia;priority journal;prospective study;quality of life;resuscitation;sepsis;terminal care,"Arendts, G.;Carpenter, C. R.;Hullick, C.;Burkett, E.;Nagaraj, G.;Rogers, I. R.",2016,,10.1111/1742-6723.12678,0,
215,Extremely prolonged ventricular asystole,We are reporting an extremely prolonged sinus arrest documented by Holter monitoring.,aged;article;artificial heart pacemaker;heart arrest;case report;electrocardiogram;female;heart atrium arrhythmia;heart ventricle arrhythmia;Holter monitoring;human,"Arias, M. A.;Puchol, A.;Castellanos, E.;Pachon, M.;Rodriguez-Padial, L.",2009,,,0,
216,Microencapsulated cell tracking,"Microencapsulation of therapeutic cells has been widely pursued to achieve cellular immunoprotection following transplantation. Initial clinical studies have shown the potential of microencapsulation using semi-permeable alginate layers, but much needs to be learned about the optimal delivery route, in vivo pattern of engraftment, and microcapsule stability over time. In parallel with noninvasive imaging techniques for 'naked' (i.e. unencapsulated) cell tracking, microcapsules have now been endowed with contrast agents that can be visualized by 1H MRI, 19F MRI, X-ray/computed tomography and ultrasound imaging. By placing the contrast agent formulation in the extracellular space of the hydrogel, large amounts of contrast agents can be incorporated with negligible toxicity. This has led to a new generation of imaging biomaterials that can render cells visible with multiple imaging modalities. Copyright © 2012 John Wiley & Sons, Ltd.",alginic acid;calcium ion;gadolinium;gold nanoparticle;polycation;streptozocin;superparamagnetic iron oxide nanoparticle;alopecia;article;cardiomyoplasty;cell suspension;cell tracking;cellular immunity;cerebrovascular accident;computer assisted tomography;cross linking;cytotoxicity;diabetes mellitus;epithelium cell;erectile dysfunction;fluorine nuclear magnetic resonance;heart infarction;human;Huntington chorea;liver cell;liver failure;mesenchymal stem cell;microcapsule;microencapsulation;monocyte;myoblast;Parkinson disease;priority journal;radiography;stem cell transplantation;survival rate;survival time;xenograft,"Arifin, D. R.;Kedziorek, D. A.;Fu, Y.;Chan, K. W. Y.;McMahon, M. T.;Weiss, C. R.;Kraitchman, D. L.;Bulte, J. W. M.",2013,,,0,
217,"Donepezil, anti-Alzheimer's disease drug, prevents cardiac rupture during acute phase of myocardial infarction in mice","BACKGROUND: We have previously demonstrated that the chronic intervention in the cholinergic system by donepezil, an acetylcholinesterase inhibitor, plays a beneficial role in suppressing long-term cardiac remodeling after myocardial infarction (MI). In comparison with such a chronic effect, however, the acute effect of donepezil during an acute phase of MI remains unclear. Noticing recent findings of a cholinergic mechanism for anti-inflammatory actions, we tested the hypothesis that donepezil attenuates an acute inflammatory tissue injury following MI. METHODS AND RESULTS: In isolated and activated macrophages, donepezil significantly reduced intra- and extracellular matrix metalloproteinase-9 (MMP-9). In mice with MI, despite the comparable values of heart rate and blood pressure, the donepezil-treated group showed a significantly lower incidence of cardiac rupture than the untreated group during the acute phase of MI. Immunohistochemistry revealed that MMP-9 was localized at the infarct area where a large number of inflammatory cells including macrophages infiltrated, and the expression and the enzymatic activity of MMP-9 at the left ventricular infarct area was significantly reduced in the donepezil-treated group. CONCLUSION: The present study suggests that donepezil inhibits the MMP-9-related acute inflammatory tissue injury in the infarcted myocardium, thereby reduces the risk of left ventricular free wall rupture during the acute phase of MI.","Alzheimer Disease/prevention & control;Animals;Blood Pressure/drug effects;Cells, Cultured;Cholinesterase Inhibitors/pharmacology;Electrophoresis, Polyacrylamide Gel;Heart/drug effects/physiopathology;Heart Rate/drug effects;Heart Rupture, Post-Infarction/*prevention & control;Humans;Immunohistochemistry;Indans/*pharmacology;Macrophages/*drug effects/enzymology;Male;Matrix Metalloproteinase 9/genetics/metabolism;Mice;Mice, Inbred C57BL;Myocardial Infarction/*drug therapy;Myocardium/enzymology/pathology;Piperidines/*pharmacology;Reverse Transcriptase Polymerase Chain Reaction","Arikawa, M.;Kakinuma, Y.;Handa, T.;Yamasaki, F.;Sato, T.",2011,,10.1371/journal.pone.0020629,0,
218,Delirium in long-term care setting: Indicator to severe morbidity,"We aimed to investigate the incidence and characterize predictors associated with delirium in elderly demented and functionally dependent LTC patients. Data collection included: demographic, clinical, functional, nutritional and cognitive data as well as blood counts and chemistry analysis. The tools used to detect delirium were the Confusion Assessment Method (CAM) and the Delirium Rating Scale (DRS), supported by clinical observation. The occurrence of delirium was 34%. The predominant primary etiologies for delirium were infections (58%), following by metabolic abnormalities (36%), and adverse drug effects (18%). The mean duration of delirium was 15.74 days (2-96 days). Independent predictors influencing duration of delirium were low plasma albumin level, high number of comorbid diseases, male gender, advanced age and presence of CVD. Complete resolution of the delirium was found in 33% (30/92), with persistence in 12% (11/92), and no change in 8% (7/92) of the patients. Forty-eight percent (44/92) of the patients died. Most deaths (50%) were in the first month. The main cause of death was infection related (70%), of which bronchopneumonia was predominant (39%), followed by sepsis (32%). Independent predictors of death were infection, advanced age, low plasma albumin level, dehydration and CHF. The early recognition, identification, correction and treatment of underlying conditions especially in very demented, uncooperative and functionally dependent patients may influence their outcome. Any changes in cognitive and functional status are critical in monitoring LTC patients. © 2010 Elsevier Ireland Ltd.",age distribution;aged;albumin blood level;article;bronchopneumonia;cerebrovascular accident;cluster analysis;comorbidity;Confusion Assessment Method;congestive heart failure;controlled study;dehydration;delirium;delirium rating scale;dementia;diabetes mellitus;disease severity;drug induced disease;elderly care;female;functional status;hip fracture;human;infection;ischemic heart disease;long term care;lung disease;major clinical study;male;metabolic disorder;Mini Mental State Examination;morbidity;mortality;neuropsychological test;outcome assessment;patient monitoring;priority journal;prognosis;sepsis;sex difference;treatment duration,"Arinzon, Z.;Peisakh, A.;Schrire, S.;Berner, Y. N.",2011,,,0,
219,Impact of dementia on payments for long-Term and acute care in an elderly cohort,"BACKGROUND:: Older people with dementia have increased risk of nursing home (NH) use and higher Medicaid payments. Dementia's impact on acute care use and Medicare payments is less well understood. OBJECTIVES:: Identify trajectories of incident dementia and NH use, and compare Medicare and Medicaid payments for persons having different trajectories. RESEARCH DESIGN:: Retrospective cohort of older patients who were screened for dementia in 2000-2004 and were tracked for 5 years. Trajectories were identified with latent class growth analysis. SUBJECTS:: A total of 3673 low-income persons aged 65 or older without dementia at baseline. MEASURES:: Incident dementia diagnosis, comorbid conditions, dual eligibility, acute and long-Term care use and payments based on Medicare and Medicaid claims, medical record systems, and administrative data. RESULTS:: Three trajectories were identified based on dementia incidence and short-Term and long-Term NH use: (1) high incidence of dementia with heavy NH use (5% of the cohort) averaging $56,111/year ($36,361 Medicare, $19,749 Medicaid); (2) high incidence of dementia with little or no NH use (16% of the cohort) averaging $16,206/year ($14,644 Medicare, $1562 Medicaid); and (3) low incidence of dementia and little or no NH use (79% of the cohort) averaging $8475/year ($7558 Medicare, $917 Medicaid). CONCLUSIONS:: Dementia and its interaction with NH utilization are major drivers of publicly financed acute and long-Term care payments. Medical providers in Accountable Care Organizations and other health care reform efforts must effectively manage dementia care across the care continuum if they are to be financially viable. Copyright © 2013 by Lippincott Williams & Wilkins.",accountable care organization;aged;arthritis;article;cerebrovascular accident;chronic obstructive lung disease;cognitive defect;cohort analysis;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;elderly care;emergency care;female;health care policy;hospitalization;human;hypertension;incidence;kidney disease;liver disease;long term care;lowest income group;major clinical study;male;medicaid;medicare;mortality;neoplasm;nursing home;priority journal;retrospective study,"Arling, G.;Tu, W.;Stump, T. E.;Rosenman, M. B.;Counsell, S. R.;Callahan, C. M.",2013,,,0,
220,Lipid peroxidation as a common pathomechanism in coronary heart disease and Alzheimer disease,"Oxidative processes are involved in aging as well as the pathogenesis of different degenerative diseases. In the last few years the role of low density lipoprotein oxidation in the development of artherosclerosis and coronary heart disease has become evident. Lipoprotein oxidation in plasma is used as a marker for disease progression. We were interested in the role of lipoprotein oxidation in Alzheimer's disease. For this purpose we developed methods to determine the in vitro oxidizability of cerebrospinal fluid and plasma lipoproteins of Alzheimer patients. In addition we measured the lipophilic and hydrophillic antioxidants, alpha-tocopherol (vitamin E) and ascorbate (vitamin C). Cerebrospinal fluid and plasma lipoprotein oxidation was found to be increased in Alzheimer's patients compared to controls and a corresponding decrease of antioxidant vitamins was found. In a pilot study, in vitro lipoprotein oxidation in cerebrospinal fluid of Alzheimer patients could be delayed by vitamin E and C supplementation. In conclusion these data show that increased lipoprotein oxidation could play an important role in Alzheimer's disease and possibly provide a rationale for the treatment of this disease with antioxidant drugs. The clinical effect of this therapeutical approach remains to be proved in long-term studies.",Aged;Alzheimer Disease/*physiopathology;Antioxidants/administration & dosage/metabolism;Cell Aging/*physiology;Coronary Artery Disease/*physiopathology;Female;Humans;Lipid Peroxidation/*physiology;Lipoproteins/metabolism;Male;Oxidative Stress/*physiology,"Arlt, S.;Kontush, A.;Muller-Thomsen, T.;Beisiegel, U.",2001,Dec,,0,
221,"Reader's response to ""Endocannabinoids - The brain's own marijuana - May be linked to the metabolic syndrome""",,cannabinoid;cannabinoid receptor;cannabis;endocannabinoid;aging;anxiety disorder;appetite;atherosclerosis;blood pressure;neoplasm;disease course;glaucoma;heart infarction;human;Huntington chorea;hypertension;learning;letter;metabolic syndrome X;mood disorder;motor coordination;motor dysfunction;multiple sclerosis;neuropathic pain;obesity;osteoporosis;Parkinson disease;spinal cord injury;cerebrovascular accident;symptom,"Armentano, P.",2006,,,0,
222,"β-amyloid (Aβ;) deposition in cognitively normal brain, dementiawith Lewy bodies, andAlzheimer's disease: A study using principal components analysis","The densities of diffuse, primitive, and classic β-amyloid (Aβ) deposits were studied in the temporal lobe in cognitively normal brain, dementia with Lewy bodies (DLB), familial Alzheimer's disease (FAD), and sporadic AD (SAD). Principal components analysis (PCA) was used to determine whether there were distinct differences between groups or whether Aβ pathology was more continuously distributed from group to group. Three principal components (PC) were extracted from the data accounting for 56% of the total variance. Plots of cases in relation to the PC did not result in distinct groups but suggested overlap in Aβ deposition between the groups. In addition, there were linear correlations between the densities of Aβ deposits and the distribution of the cases along the PC in specific brain regions suggesting continuous variation from group to group. PC1 was associated with the degree of maturation of Aβ deposits, PC2 with differences between FAD and SAD, and PC3 with the degree of spread of Aβ pathology into the hippocampus. Apolipoprotein E (APOE) genotype was not associated with variation in Aβ deposition between cases. PCA may be a useful method of studying the pathological interface between closely related neurodegenerative disorders.",amyloid beta protein;apolipoprotein E;presenilin 1;adult;aged;Alzheimer disease;amyloid plaque;article;bronchopneumonia;cause of death;clinical article;controlled study;density;dentate gyrus;diffuse Lewy body disease;familial Alzheimer disease;female;femur fracture;gastrointestinal hemorrhage;genotyping technique;heart infarction;hippocampus;histopathology;human;human tissue;hypothermia;inferior temporal gyrus;ischemic heart disease;lung edema;male;morphometrics;neuropathology;parahippocampal gyrus;peritonitis;postoperative hemorrhage;principal component analysis;shock;sporadic Alzheimer disease;temporal lobe,"Armstrong, R. A.",2012,,,0,
223,Report on four sedative plants in the treatment of female stress,,Crataegus extract;essential oil;herbaceous agent;Humulus lupulus extract;Melissa officinalis extract;Passiflora extract;plant extract;potassium pump;sedative agent;unclassified drug;valerian;Alzheimer disease;anorexia;article;bronchitis;coronary artery blood flow;Crataegus;diarrhea;heart failure;heart muscle;heart palpitation;helminthiasis;human;Humulus lupulus;insomnia;Melissa officinalis;menstruation disorder;muscle spasm;passion fruit;stress;tachycardia,"Arnal-Schnebelen, B.;Goetz, P.",2007,,,0,
224,Impact of cardiovascular risk factors on cognitive function: the Tromso study,"BACKGROUND AND PURPOSE: The role of cardiovascular risk factors in the pathogenesis of cognitive impairment and dementia remains still unclear. We examined the impact of cardiovascular risk factors on cognitive function in a large longitudinal population study. METHODS: Subjects were 5033 stroke-free men and women who participated in a longitudinal population-based study. Cardiovascular risk factors were measured at baseline, and cognitive function was assessed after 7 years of follow-up with verbal memory test, digit-symbol coding test, and tapping test. RESULTS: Diabetes, systolic blood pressure, and current smoking were independently associated with lower cognitive test results in men and women. Low physical activity was independently associated with lower scores in women. We found no consistent association between total-cholesterol, HDL-cholesterol, coronary heart disease or BMI, and cognitive test results. CONCLUSIONS: Diabetes, smoking, hypertension, and low physical activity were associated with lower cognitive test results. The study suggests that these modifiable risk factors should be emphasized in the prevention of cognitive decline.","Aged;Aged, 80 and over;Cardiovascular Diseases/*epidemiology/*physiopathology;Cognition Disorders/*epidemiology/*physiopathology;Cohort Studies;Comorbidity/trends;Dementia/*epidemiology/*physiopathology;Female;Humans;Longitudinal Studies;Male;Middle Aged;Norway/epidemiology;Risk Factors","Arntzen, K. A.;Schirmer, H.;Wilsgaard, T.;Mathiesen, E. B.",2011,May,10.1111/j.1468-1331.2010.03263.x,0,
225,"Paresis and unusual electrocardiographic signs in a severely hypomagnesaemic, hypocalcaemic lactating bitch","A severely hypocalcaemic, hypomagnesaemic lactating bitch exhibited clinical signs of pulmonary oedema, paresis, dementia, gastrointestinal ileus and urinary bladder atony. The total calcium, ionised calcium and magnesium levels were extremely low. The clinical picture was very different from the one typically encountered in canine lactation tetany, and instead resembled bovine postparturient paresis. Muscle tremors, rigidity and seizures were not part of the acute clinical picture, but rather atony, weakness and paresis. General muscle dysfunction probably resulted from the extremely low ionised calcium levels in combination with very low levels of magnesium and possibly potassium. Heart failure and atony of the urinary bladder and intestines were probably a result of the severe hypocalcaemia. The alteration in calcium to magnesium ratio may have depressed neuromuscular transmission, leading to paresis and atony. The unusual electrocardiogram possibly also resulted from abnormal magnesium and calcium cation levels.",animal;animal disease;article;case report;dog;dog disease;electrocardiography;female;hypocalcemia;lactation;magnesium deficiency;paresis;pathology,"Aroch, I.;Ohad, D. G.;Baneth, G.",1998,,,0,
226,The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: What does the study on global ageing and adult health (SAGE) reveal?,"Background: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as 'multimorbidity'. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs. Methods: Data was obtained from the WHO's Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries. Results: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases. Conclusions: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.",ADL disability;adult;age;aged;aging;angina pectoris;arthritis;article;asthma;cerebrovascular accident;China;chronic lung disease;correlation analysis;cross-sectional study;daily life activity;depression;diabetes mellitus;disease association;female;Ghana;health care need;health care system;health status;human;hypertension;India;lowest income group;major clinical study;male;mental health;Mexico;middle aged;morbidity;multimorbidity;physical capacity;prevalence;quality of life;regression analysis;Russian Federation;self evaluation;social status;South Africa;visual impairment;young adult,"Arokiasamy, P.;Uttamacharya, U.;Jain, K.;Biritwum, R. B.;Yawson, A. E.;Wu, F.;Guo, Y.;Maximova, T.;Espinoza, B. M.;Salinas Rodríguez, A.;Afshar, S.;Pati, S.;Ice, G.;Banerjee, S.;Liebert, M. A.;Snodgrass, J. J.;Naidoo, N.;Chatterji, S.;Kowal, P.",2015,,,0,
227,Should hypercholesterolemia be treated in frail elders?,,atorvastatin;cyclosporin A;erythromycin;fluindostatin;gemfibrozil;hydroxymethylglutaryl coenzyme A reductase inhibitor;lipid;mevinolin;nicotinic acid;placebo;pravastatin;simvastatin;aged;artery disease;article;cardiovascular disease;cause of death;controlled study;coronary artery disease;dementia;diabetes mellitus;diet;drug indication;female;heart infarction;human;hypercholesterolemia;hypertension;lipid blood level;male;metabolic disorder;mortality;myopathy;nursing home;side effect;cerebrovascular accident;sudden death;vascular disease,"Aronow, W. S.",2002,,,0,
228,Clinical Causes of Death of 2372 Older Persons in a Nursing Home During 15-Year Follow-up,,aged;Alzheimer disease;aneurysm rupture;aorta dissecting aneurysm;hematologic disease;brain hemorrhage;cardiovascular disease;cause of death;chronic obstructive lung disease;congestive heart failure;follow up;gastrointestinal disease;heart infarction;human;infarction;infection;kidney failure;letter;liver disease;major clinical study;neoplasm;nursing home patient;cerebrovascular accident;sudden death;thromboembolism,"Aronow, W. S.",2009,,,0,
229,Why and how we should treat elderly patients with hypertension?,"Double-blind, randomized, placebo-controlled studies have documented that antihypertensive drug therapy decreases cardiovascular events in older persons. In the Hypertension in the Very Elderly Trial, patients aged 80 years and older treated with antihypertensive drug therapy had at 1.8-year follow-up, a 30% insignificant decrease in fatal or non fatal stroke, a 39% significant decrease in fatal stroke, a 21% significant decrease in all-cause mortality, a 23% insignificant decrease in death from cardiovascular causes, and a 64% significant decrease in heart failure. The goal of treatment of hypertension in older persons is to decrease the blood pressure to <140/90 mm Hg and to <130/80 mm Hg in older persons with diabetes or chronic renal disease. Elderly persons with diastolic hypertension should have their diastolic blood pressure reduced to 80 to 85 mm Hg. There are no randomized controlled clinical trials supporting a target blood pressure of less than 130/80 mm Hg in elderly persons. The optimum diastolic blood pressure goal in elderly persons is unclear. Diuretics should be used as initial therapy in persons with no associated medical conditions. The selection of antihypertensive drug therapy in persons with associated medical conditions depends on their medical conditions. If the blood pressure is > 20/10 mm Hg above the goal blood pressure, drug therapy should be initiated with 2 antihypertensive drugs. Other coronary risk factors must be treated. © 2010 Bentham Science Publishers Ltd.",amlodipine;angiotensin receptor antagonist;atenolol;benazepril;benazepril plus hydrochlorothiazide;beta adrenergic receptor blocking agent;calcium channel blocking agent;candesartan;chlortalidone;clonidine;diltiazem;dipeptidyl carboxypeptidase inhibitor;diuretic agent;doxazosin;guanethidine;hydralazine;hydrochlorothiazide;indapamide;indapamide plus perindopril;minoxidil;nitrendipine;perindopril;placebo;reserpine;trandolapril plus verapamil;verapamil;add on therapy;angina pectoris;antihypertensive therapy;article;blood pressure regulation;cardiovascular risk;chronic kidney disease;cognitive defect;constipation;dementia;depression;diabetes mellitus;diastolic blood pressure;drug tolerability;fluid retention;follow up;headache;heart failure;hirsutism;human;hypertension;lifestyle modification;lupus like syndrome;mortality;pathophysiology;pericardial effusion;prevalence;sedation;side effect;cerebrovascular accident;systolic blood pressure;tachycardia;treatment response;weight reduction,"Aronow, W. S.",2010,,,0,
230,Current approaches to the treatment of hypertension in older persons,"Hypertension is a major risk factor for cardiovascular disease and is present in 69% of patients with a first myocardial infarction, in 77% of patients with a first stroke, in 74% of patients with chronic heart failure, and in 60% of patients with peripheral arterial disease. Double-blind, randomized, placebo-controlled trials have demonstrated that antihypertensive drug therapy reduces cardiovascular events in patients aged 65 to 79 years. In the Hypertension in the Very Elderly Trial, patients aged ≥ 80 years who were treated with antihypertensive drug therapy had, at 1.8-year follow-up, a 30% reduction in fatal or nonfatal stroke (P = 0.06), a 39% reduction in fatal stroke (P = 0.05), a 21% reduction in all-cause mortality (P = 0.02), a 23% reduction in cardiovascular death (P = 0.06), and a 64% reduction in heart failure (P < 0.001). Although the optimal blood pressure (BP) treatment goal in the elderly has not been determined, existing epidemiologic and clinical trial data suggest that a reasonable therapeutic BP goal should be < 140/90 mm Hg in persons aged < 80 years and a systolic BP of 140 to 145 mm Hg if tolerated in persons aged ≥ 80 years. Nonpharmacologic lifestyle measures should be encouraged both to prevent development of hypertension and as adjunctive therapy in persons with hypertension. Diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and calcium channel blockers have all shown benefit in reducing cardiovascular events in randomized trials. The choice of specific drugs depends on efficacy, tolerability, presence of specific comorbidities, and cost. Adverse effects from treatment, such as electrolyte disturbances, renal dysfunction, and excessive orthostatic BP reduction, should be avoided. © Postgraduate Medicine.",alpha adrenergic receptor blocking agent;amlodipine;angiotensin receptor antagonist;antihypertensive agent;beta adrenergic receptor blocking agent;bisoprolol;calcium channel blocking agent;carvedilol;clonidine;diltiazem;dipeptidyl carboxypeptidase inhibitor;diuretic agent;doxazosin;guanethidine;hydralazine;indapamide;indapamide plus perindopril;minoxidil;nebivolol;nifedipine;nitrendipine;perindopril;placebo;potassium sparing diuretic agent;ramipril;reserpine;telmisartan;unindexed drug;vasodilator agent;verapamil;angina pectoris;angioneurotic edema;antihypertensive therapy;article;blood pressure regulation;cardiovascular risk;cognitive defect;comorbidity;confusion;constipation;coronary artery disease;coughing;dementia;depression;diastolic blood pressure;diet therapy;drug choice;drug contraindication;drug efficacy;drug eruption;drug preference;drug safety;drug tolerability;elderly care;electrolyte disturbance;follow up;frail elderly;atrial fibrillation;heart failure;heart infarction;heart muscle ischemia;heart ventricle arrhythmia;high risk population;hirsutism;human;hypertension;hypertensive nephrosclerosis;kidney dysfunction;kidney failure;lifestyle modification;lupus like syndrome;mortality;multiinfarct dementia;nephrosclerosis;outcome assessment;pericardial effusion;peripheral occlusive artery disease;pressoreceptor reflex;prevalence;randomized controlled trial (topic);risk benefit analysis;risk reduction;sedation;side effect;sodium restriction;cerebrovascular accident;systolic blood pressure;taste disorder;treatment duration;treatment response;uremia;very elderly;weight reduction,"Aronow, W. S.",2012,,,0,
231,Hypertension: How to treat the elderly,"With the US population aging, it is important that the primary care physicians should work on controlling hypertension in the elderly. A therapeutic target of less than 140/90 mm Hg in persons aged 65 to 79 years, and a systolic blood pressure of 140 mm Hg and 145 mm Hg (if tolerated) in persons aged 80 years and older is reasonable. Avoid intensive lowering of the blood pressure in elderly persons, especially those with diabetes and coronary artery disease, as this might be poorly tolerated and could increase cardiovascular events. © 2013 HMP Communications.",angiotensin receptor antagonist;antihypertensive agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;clonidine;diltiazem;dipeptidyl carboxypeptidase inhibitor;diuretic agent;doxazosin;guanethidine;indapamide plus perindopril;perindopril;potassium sparing diuretic agent;reserpine;verapamil;age distribution;antihypertensive therapy;article;blood pressure measurement;cardiovascular disease;cardiovascular risk;cerebrovascular accident;cognitive defect;constipation;coronary artery disease;depression;disease association;general practitioner;geriatric patient;heart infarction;human;hyperkalemia;hypertension;monotherapy;multiinfarct dementia;pathophysiology;pressoreceptor reflex;priority journal;side effect;systemic vascular resistance;systolic blood pressure;treatment contraindication;United States,"Aronow, W. S.",2013,,,0,
232,Applying the new statin guidelines to the long-term care population,,atorvastatin;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;placebo;simvastatin;administrative personnel;aged;coronary artery atherosclerosis;cardiovascular disease;cardiovascular mortality;cardiovascular risk;cerebrovascular accident;cholesterol blood level;community;confidence interval;coronary artery disease;death;dementia;diabetes mellitus;drug efficacy;follow up;health care facility;heart failure;heart infarction;hemodialysis;hospice care;human;incidence;intermittent claudication;long term care;medical audit;meta analysis (topic);New York Heart Association class;note;nursing home patient;peripheral occlusive artery disease;population;practice guideline;prevalence;primary prevention;prognosis;proportional hazards model;prospective study;quality control;randomized controlled trial (topic);revascularization;risk assessment;risk reduction;secondary prevention;treadmill;treadmill exercise;treatment duration;vascular disease;walking,"Aronow, W. S.",2014,,,0,
233,Ten most important things to learn from the ACCF/AHA 2011 expert consensus document on hypertension in the elderly,"The American College of Cardiology Foundation/American Heart Association 2011 Expert Consensus Document on Hypertension in the Elderly has been published in the Journal of the American College of Cardiology and in Circulation, and will be published in the Journal of the American Society of Hypertension and the Journal of Geriatric Cardiology. This document has also been developed in collaboration with the American Academy of Neurology, the American Geriatrics Society, the American Society of Preventive Cardiology, the American Society of Hypertension, the American Society of Nephrology, the Association of Black Cardiologists, and the European Society of Hypertension. The present article is a short summary emphasizing the 10 most important things to learn from this document. © 2012 Scandinavian Foundation for Cardiovascular Research.",angiotensin receptor antagonist;antihypertensive agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;abdominal aorta aneurysm;aging;angina pectoris;antihypertensive therapy;aorta aneurysm;article;blood pressure regulation;cardiovascular risk;chronic kidney disease;circulation;comorbidity;consensus;diabetes mellitus;diastolic blood pressure;drug cost;drug efficacy;elderly care;geriatric care;atrial fibrillation;heart failure;heart infarction;heart left ventricle hypertrophy;human;hypertension;lifestyle modification;medical literature;medical society;mortality;multiinfarct dementia;peripheral occlusive artery disease;physical activity;prevalence;priority journal;risk reduction;smoking cessation;sodium restriction;sudden death;systolic blood pressure;weight control,"Aronow, W. S.;Banach, M.",2012,,,0,
234,"ACCF/AHA 2011 expert consensus document on hypertension in the elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents Developed in Collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology",,aliskiren;amiloride;amlodipine;amlodipine plus benazepril;atenolol;benazepril plus hydrochlorothiazide;bendroflumethiazide;bumetanide;captopril;chlortalidone;doxazosin;furosemide;hydrochlorothiazide;indapamide;lisinopril;losartan;methyldopa;metoprolol;nifedipine;nitrendipine;perindopril;pindolol;ramipril;spironolactone;thiazide diuretic agent;torasemide;triamterene;unindexed drug;valsartan;verapamil;abdominal aorta aneurysm;add on therapy;adipose tissue;adrenalin blood level;adrenergic system;adverse outcome;aging;albuminuria;aldosterone blood level;anemia;aneurysm;anticoagulant therapy;antihypertensive therapy;aorta aneurysm;aortorenal bypass;arterial stiffness;artery calcification;artery injury;artery occlusion;artery resistance;arthritis;article;Asian American;atherosclerosis;bleeding;blood pressure measurement;blood pressure regulation;blood vessel compliance;body weight;brain hemorrhage;brain ischemia;bypass surgery;calcium blood level;cardiovascular disease;cardiovascular risk;cause of death;cerebrovascular disease;cholesterol blood level;cholesterol embolism;chronic kidney disease;coffee;consensus development;constipation;coronary artery blood flow;coronary artery disease;creatinine blood level;dementia;diarrhea;diastolic hypertension;disease association;disease course;disease severity;drug antagonism;drug clearance;drug cost;drug distribution;drug elimination;drug fever;drug half life;drug indication;drug potentiation;drug response;drug safety;drug tolerability;dyslipidemia;echocardiography;electrocardiography;electrolyte disturbance;endothelial dysfunction;environmental factor;ethnic difference;exercise;femoral artery;geriatric disorder;glomerulus filtration rate;glucose blood level;glucose intolerance;gout;gynecomastia;headache;heart arrhythmia;atrial fibrillation;heart block;heart failure;heart left ventricle failure;heart left ventricle filling pressure;heart left ventricle hypertrophy;heart left ventricle mass;heart muscle contractility;heart muscle fibrosis;heart output;high risk population;Hispanic;hormonal therapy;human;hyperaldosteronism;hypercholesterolemia;hyperglycemia;hyperhomocysteinemia;hyperkalemia;hypertension;hyperthyroidism;hyperuricemia;hypokalemia;hypomagnesemia;hyponatremia;hypotension;hypothalamus hypophysis adrenal system;hypothyroidism;immobilization;impaired glucose tolerance;in-stent restenosis;ischemic heart disease;kidney artery stenosis;kidney disease;kidney dysfunction;lifestyle modification;lipid blood level;low drug dose;maximum tolerated dose;meta analysis (topic);metabolic syndrome X;microalbuminuria;microvasculature;mild cognitive impairment;monotherapy;mortality;natriuresis;Black person;nephrosclerosis;noradrenalin blood level;obesity;orthostatic hypertension;orthostatic hypotension;osteoarthritis;osteoporosis;patient compliance;percutaneous transluminal angioplasty;perfusion pressure;peripheral occlusive artery disease;plasma renin activity;postmenopause;potassium intake;practice guideline;prevalence;priority journal;professional knowledge;pseudohypertension;pulse pressure;pulse wave,"Aronow, W. S.;Fleg, J. L.;Pepine, C. J.;Artinian, N. T.;Bakris, G.;Brown, A. S.;Ferdinand, K. C.;Ann Forciea, M.;Frishman, W. H.;Jaigobin, C.;Kostis, J. B.;Mancia, G.;Oparil, S.;Ortiz, E.;Reisin, E.;Rich, M. W.;Schocken, D. D.;Weber, M. A.;Wesley, D. J.;Harrington, R. A.;Bates, E. R.;Bhatt, D. L.;Bridges, C. R.;Eisenberg, M. J.;Ferrari, V. A.;Fisher, J. D.;Gardner, T. J.;Gentile, F.;Gilson, M. F.;Hlatky, M. A.;Jacobs, A. K.;Kaul, S.;Moliterno, D. J.;Mukherjee, D.;Rosenson, R. S.;Stein, J. H.;Weitz, H. H.",2011,,,0,
235,"Women, myocardial infarction, and dementia in the very old","Dementia is a major public health problem among the very old. Available information on incidence and prevalence is sparse and variable; however, there appears to be a higher prevalence among very old women. We present data from a prospective study of initially nondemented community-residing elderly. There were 75 incident dementia cases (up to 7 years of follow-up) of which at least 47% were probable Alzheimer's disease. Based on a proportional hazards analysis, women were over 3 times more likely to develop dementia than men despite controlling for baseline demographic, psychosocial, and medical history variables. Poor word fluency and a high normal Blessed test score at baseline were also strong predictors of dementia. We did not find age, head trauma, thyroid disease, or family history of dementia to be risk factors. A new finding is that history of myocardial infarction (MI) is associated with dementia, such that women with a history of MI were 5 times more prone to dementia than those without a history. This observation was not true for men.","Aged;Aged, 80 and over;Bias (Epidemiology);Dementia/epidemiology/*etiology;Female;Humans;Intelligence Tests;Male;Morbidity;Myocardial Infarction/*complications/epidemiology;Prospective Studies;Psychiatric Status Rating Scales;Regression Analysis;Risk Factors;Sex Factors","Aronson, M. K.;Ooi, W. L.;Morgenstern, H.;Hafner, A.;Masur, D.;Crystal, H.;Frishman, W. H.;Fisher, D.;Katzman, R.",1990,Jul,,0,
236,"Finding off-targets, biological pathways, and target diseases for chymase inhibitors via structure-based systems biology approach","Off-target binding connotes the binding of a small molecule of therapeutic significance to a protein target in addition to the primary target for which it was proposed. Progressively such off-targeting is emerging to be regular practice to reveal side effects. Chymase is an enzyme of hydrolase class that catalyzes hydrolysis of peptide bonds. A link between heart failure and chymase is ascribed, and a chymase inhibitor is in clinical phase II for treatment of heart failure. However, the underlying mechanisms of the off-target effects of human chymase inhibitors are still unclear. Here, we develop a robust computational strategy that is applicable to any enzyme system and that allows the prediction of drug effects on biological processes. Putative off-targets for chymase inhibitors were identified through various structural and functional similarity analyses along with molecular docking studies. Finally, literature survey was performed to incorporate these off-targets into biological pathways and to establish links between pathways and particular adverse effects. Off-targets of chymase inhibitors are linked to various biological pathways such as classical and lectin pathways of complement system, intrinsic and extrinsic pathways of coagulation cascade, and fibrinolytic system. Tissue kallikreins, granzyme M, neutrophil elastase, and mesotrypsin are also identified as off-targets. These off-targets and their associated pathways are elucidated for the effects of inflammation, cancer, hemorrhage, thrombosis, and central nervous system diseases (Alzheimer's disease). Prospectively, our approach is helpful not only to better understand the mechanisms of chymase inhibitors but also for drug repurposing exercises to find novel uses for these inhibitors.","Alzheimer Disease/drug therapy/enzymology/pathology;Blood Coagulation/drug effects;Cardiovascular Diseases/drug therapy/enzymology/pathology;Chymases/*antagonists & inhibitors/chemistry/metabolism;Complement Pathway, Mannose-Binding Lectin/drug effects;Drug Design;Enzyme Inhibitors/*chemistry/pharmacology;Fibrinolysis/drug effects;Granzymes/antagonists & inhibitors/chemistry/metabolism;Humans;Leukocyte Elastase/antagonists & inhibitors/chemistry/metabolism;*Molecular Docking Simulation;Small Molecule Libraries/*chemistry/pharmacology;Structure-Activity Relationship;Systems Biology/*methods;Tissue Kallikreins/antagonists & inhibitors/chemistry/metabolism;Trypsin/chemistry/metabolism;User-Computer Interface;Alzheimer's disease;biological pathways;cardiovascular diseases;chymase;coagulation cascade;complement system;off-targets;systems biology, cancer","Arooj, M.;Sakkiah, S.;Cao, G. P.;Kim, S.;Arulalapperumal, V.;Lee, K. W.",2015,Jul,10.1002/prot.24677,0,
237,Clinical and investigative approaches in mitochondrial diseases. A review of 15 cases,"The results of laboratory investigations in concerning 15 patients suspected of mitochondrial disease (MD) are presented. Our purpose is to provide an outline of the investigative modalities that support the clinical suspicion and have been found to be useful in the diagnosis. Five clinical groups were studied including 5 exercise intolerances (2 with inflammatory myopathy), 3 with myopathies (1 with dilated cardiomyopathy), 2 with progressive external oftalmoplegia (1 associated with cerebellar ataxia+epilepsy+hypertrophic cardiomyopathy+pes cavus), 4 with encephalopathies (3 with myoclonic encephalopathies with ataxia and dementia and 1 with epilepsy and tremor), and 1 with metabolic acidosis and cardiomyopathy. We used the following categories of investigative procedures: clinical phenotype analysis including pedigree study, neurophysiological tests, bicycle ergometric evaluation, neuroimaging, microscopic study of skeletal muscle biopsy, post-mortem examination, biochemical assays and molecular genetic studies. EMG showed myopathic changes in 5 cases, features of neuropathy in 2, mixed myopathic and neuropathic pattern in 1 and nonspecific changes in 3. EMG was normal in 3 patients. The most common skeletal muscle abnormalities were variation in fiber size (60%), lipid inclusions (33.3%), oxidative subsarcolemmal aggregates (26.7%) and ragged-red fibers (26.7%). Electron microscopy revealed mitochondrial abnormalities in 8 out of 14 patients' muscle biopsies, and in myocardiac and hepatic tissues of another. Site of biochemical defect was located in 12 patients. Complex I defect in 6, complexes I+IV deficiencies in 3, complex II defect in 1, complex IV deficiency in 1, complexes II+IV deficiencies in 1, and complex III defect in 1. In 2 patients the biochemical defect was not located. Mitochondrial DNA alterations were not found in 7 investigated patients. The clinical spectrum of MD has become increasingly wider. After the clinica suspicion, the diagnosis depends up on the appropriate use of skeletal muscle biopsy, biochemical investigations and molecular genetic techniques. Conventional EMG and automatic measurement of the electromyogram are particularly helpful in confirming the clinical suspicion in patients with predominantly central nervous system disease or in cases in which clinical signs are few.",mitochondrial DNA;adolescent;adult;article;biopsy;brain;child;chronic progressive external ophthalmoplegia;computer assisted tomography;electromyography;female;genetics;human;Kearns Sayre syndrome;male;MELAS syndrome;MERRF syndrome;middle aged;mitochondrial encephalomyopathy;mitochondrial myopathy;nuclear magnetic resonance imaging;pathophysiology;pedigree;phenotype;radiography;skeletal muscle,"Arpa, J.;Campos, Y.;Cruz Martínez, A.;Gutiérrez Molina, M.;Arenas, J.;Alonso, M.;Plaza, I.;Morales, C.;Palomo, F.;Barreiro, P.",1994,,,0,
238,"Prevalence and impact of dementia-related functional limitations in the United States, 2001 to 2005","These analyses examined the relationship between dementia and comorbid conditions with respect to degree of functional impairment and emotional impact. Analyses were conducted using National Health Interview Survey (2001 through 2005) data from a subset of individuals aged ≥60 years with activity limitations attributed to dementia, senility, or Alzheimer disease compared with those whose limitations were attributed to other conditions. The mean number of limited activities was 6.84 (95% confidence interval: 6.48-7.20) for persons with dementia-related limitations and 4.87 (95% confidence interval: 4.81-4.93) for those with limitations not dementia related. Both groups reported similar prevalence of diabetes, acute myocardial infarction, heart disease, prostate cancer, breast cancer, angina, and emphysema; respondents with dementia-related functional limitations were more likely to report diabetes, depression or anxiety, and vision problems as being related to functional limitations. Persons with dementia-related functional limitations were also more likely than persons with non-dementia-related functional limitations to report feeling sad, hopeless, worthless, nervous, and that ""everything is an effort."" Improving or maintaining functional independence in patients with dementia will likely require a multifaceted approach across disease states. Additional research will help define the impact of dementia on the development and progression of functional limitations related to comorbidities. © 2010 by Lippincott Williams & Wilkins.",acute heart infarction;aged;Alzheimer disease;angina pectoris;anxiety;article;breast cancer;comorbidity;controlled study;dementia;depression;diabetes mellitus;emphysema;female;functional disease;heart disease;human;major clinical study;male;prevalence;priority journal;prostate cancer;senility;visual disorder,"Arrighi, H. M.;McLaughlin, T.;Leibman, C.",2010,,,0,
239,"Microinfarct pathology, dementia, and cognitive systems","BACKGROUND AND PURPOSE - Little is known about the role of microinfarcts in dementia and cognition. We examined microinfarcts and dementia, global cognition, and 5 cognitive systems in community-dwelling older persons. METHODS - Four hundred twenty-five subjects enrolled in the Religious Orders Study underwent annual clinical evaluations, including 19 neuropsychological tests and assessment for dementia, and brain autopsy (39% men; mean age at death, 87; Mini-Mental State Examination score, 21). Neuropathologic examination documented the presence, number, and location of chronic microinfarcts on 6-μm hematoxylin-eosin-stained sections from cortical and subcortical regions. Multiple regression analyses adjusted for age at death, sex, education, macroscopic infarcts, Alzheimer disease pathology, and Lewy bodies. RESULTS - Microinfarcts were present in 129 of 425 (30%) persons (54 cortical, 80 subcortical, 49 multiple); 58 of 129 (45%) of persons with microinfarcts did not exhibit macroscopic infarcts. Persons with microinfarcts had increased odds of dementia (OR, 1.77; 95% CI, 1.07-2.92), especially those persons with multiple cortical microinfarcts. Microinfarcts were also associated with lower average global cognition (estimate, -0.287; SE, 0.113; P=0.012), particularly for persons with multiple cortical microinfarcts. Microinfarcts were specifically associated with lower episodic memory (estimate, -0.279; SE, 0.138; P=0.044), semantic memory (estimate, -0.391; SE, 0.130; P=0.003), and perceptual speed (estimate, -0.400; SE, 0.117; P<0.001). In addition, single, multiple, and cortical microinfarcts were associated with worse semantic memory and perceptual speed (all P<0.028). Neither macroscopic infarcts nor AD pathology modified these associations (all P>0.154). CONCLUSIONS - Microinfarcts are common, and persons with multiple cortical microinfarcts have higher odds of dementia. Microinfarcts are also associated with lower cognition, specifically perceptual speed and semantic and episodic memory. © 2011 American Heart Association, Inc.",aged;Alzheimer disease;article;brain infarction;clinical evaluation;cognition;dementia;episodic memory;female;human;Lewy body;major clinical study;male;Mini Mental State Examination;neuropsychological test;priority journal;semantic memory,"Arvanitakis, Z.;Leurgans, S. E.;Barnes, L. L.;Bennett, D. A.;Schneider, J. A.",2011,,,0,
240,Diabetes and parkinsonian signs in older persons,"We examined the relation of type 2 diabetes mellitus to parkinsonian signs in older persons. Participants were 1030 women and men (mean age 80.3 y, education 14.5 y, Mini-Mental State Examination 27.9) without dementia or Parkinson disease, enrolled in the Rush Memory and Aging Project, an epidemiologic study of aging. We used separate linear and logistic regression models, adjusted for age, sex, and education, to examine the relation of diabetes, identified by history and medication inspection, to each of the scores of global parkinsonian signs and 4 separate parkinsonian signs. Diabetes was present in 140 (14%) participants. Most participants had mild parkinsonian signs. Diabetes was associated with a more severe global parkinsonian signs score (beta=0.20, SE=0.10, P=0.05) and postural reflex impairment-gait disturbance (beta=0.40, SE=0.17, P=0.02), but not with bradykinesia, rigidity, or tremor. Associations were no longer significant after controlling for vascular risk factors or conditions, particularly body mass index and congestive heart failure. Overall, there was no evidence that vascular variables modified the relation of diabetes to parkinsonian signs. In summary, we found that diabetes was associated with parkinsonian signs, especially postural reflex impairment-gait disturbance, and that vascular factors may play a role in this association.","Aged;Aged, 80 and over;Body Mass Index;Cardiovascular Diseases/*complications;Diabetes Mellitus, Type 2/*complications;Female;Gait Disorders, Neurologic/complications/epidemiology;Heart Failure/complications;Humans;Male;Parkinsonian Disorders/*complications/*epidemiology;Risk Factors;Smoking","Arvanitakis, Z.;Wilson, R. S.;Bienias, J. L.;Bennett, D. A.",2007,Apr-Jun,10.1097/WAD.0b013e31805ba768,0,
241,A controlled study on edema in elderly inpatients,"The clinical background relating to edema in elderly inpatients was investigated, in terms of various items in elderly (aged greater than or equal to 65) cases with edema (n = 96) and without edema (controls, n = 95). Both groups were matched for sex, age, and underlying diseases. As compared with the control patients, the patients with edema had longer hospital stays with more disabled status, and showed less activity of daily living (ADL). The rates of bed-restricted patients, dementia patients, and patients with decubitus, muscle atrophy, or incontinence were found to be significantly higher in the patients with edema. The measurement of biochemical parameters revealed that the patients with edema had significantly lower levels of serum albumin, Na, Cl, creatinine, and uric acid, in contrast to higher levels of C-reactive protein. According to the classification of the assumed causes of edema, we divided the patients with edema into five groups; group 1 (n = 33): edema associated with immobilization, group 2 (n = 18): edema due to heart failure, group 3 (n = 15): edema on paretic limbs, group 4 (n = 6): edema due to hypoproteinemia, group 5 (n = 5): edema associated with liver cirrhosis. Both group 1 and group 4 patients had lower levels of hemoglobin and albumin, whereas group 3 patients had higher scores of ADL, higher blood pressure, and higher levels of hemoglobin and albumin. These results suggest that immobilization and restriction in bed, as well as malnutrition, were important factors in causing edema in elderly inpatients.","Activities of Daily Living;Aged;Aged, 80 and over;Edema/blood/*epidemiology;Female;Hemoglobins/metabolism;*Hospitalization;Humans;Immobilization;Male;Risk Factors;Serum Albumin/metabolism","Asai, K.",1990,Mar,,0,
242,Dementia severity of the care receiver predicts procoagulant response in Alzheimer caregivers,"BACKGROUND: The procoagulant factor D-dimer has been shown to be associated with thrombus formation and degradation as seen with conditions such as myocardial infarction and unstable angina. Research has demonstrated that spousal dementia caregivers have elevated levels of D-dimer relative to their non-caregiving peers. OBJECTIVE: The objective of this study was to determine the relationship of basal level and laboratory stressor-induced concentration of D-dimer to severity of dementia in spousal care recipients. METHODS: Seventy-one elderly caregivers were compared with a comparison group of 37 non-caregivers (average age: 71 years). Clinical Dementia Rating (CDR), a global measure of dementia, was used to assess severity of spousal dementia. Plasma D-dimer was measured at baseline and in response to an acute speech stressor. RESULTS: Regression analysis revealed a significant positive association between severity of spousal dementia and caregiver D-dimer, both at baseline and in response to acute stress, while controlling for age. The model examined an exponential relationship, with D-dimer increasing progressively across the span of dementia stages. DISCUSSION: Dementia severity of the care recipient was associated with increasing hypercoagulability among elderly caregivers. Effect size estimates suggest that such D-dimer increases may have clinical implications, particularly among late-stage caregivers.","Aged;*Alzheimer Disease;Biomarkers/metabolism;*Caregivers/psychology;Female;Fibrin Fibrinogen Degradation Products/*metabolism;Humans;Linear Models;Male;Middle Aged;Predictive Value of Tests;Risk Factors;Severity of Illness Index;*Spouses/psychology;Stress, Psychological/*blood/etiology;Thrombophilia/blood/psychology","Aschbacher, K.;von Kanel, R.;Dimsdale, J. E.;Patterson, T. L.;Mills, P. J.;Mausbach, B. T.;Allison, M. A.;Ancoli-Israel, S.;Grant, I.",2006,Aug,10.1097/01.JGP.0000227969.36850.eb,0,
243,Medical comorbidity and functional status among adults with major mental illness newly admitted to nursing homes,"Objective: This study compared comorbid conditions and functional status among elderly and nonelderly individuals with mental illness who were newly admitted to nursing homes (N=286,411). Methods: Data were drawn from the Centers for Medicare & Medicaid Services national registry of nursing home residents from the Minimum Data Set in 2008. Results: Among newly admitted individuals with schizophrenia, those younger than 65 accounted for a majority (60.3%) of admissions and had lower rates of medical illnesses and were more likely to be classified as low-care status than individuals who were 65 or older. Most (81%) new admissions with depression were 65 or older. Among all nonelderly admissions, individuals with depression had the highest rates of medical comorbidity. Conclusions: Many adults younger than 65 with schizophrenia who were newly admitted to nursing homes lacked clinical indications for skilled nursing care. In contrast, higher rates of medical conditions among nonelderly adults with depression underscored the need for integrated psychiatric and medical care in nursing homes.",ADL disability;adult;age distribution;aged;Alzheimer disease;article;bipolar disorder;chronic obstructive lung disease;cognitive defect;comorbidity;congestive heart failure;daily life activity;dementia;depression;diabetes mellitus;female;functional status;health status;heart disease;human;major clinical study;male;medicaid;medicare;mental disease;nursing home;nursing home patient;obesity;Parkinson disease;schizophrenia;cerebrovascular accident,"Aschbrenner, K. A.;Cai, S.;Grabowski, D. C.;Bartels, S. J.;Mor, V.",2011,,,0,
244,Are Members of Long-Lived Families Healthier Than Their Equally Long-Lived Peers? Evidence From the Long Life Family Study,"BACKGROUND: The Long Life Family Study (LLFS) is a multicenter longitudinal study of exceptional survival among members of long-lived sibships (probands), their offspring, and spouses of either group. For these four ""roles"", we asked: Does membership in a long-lived family protect against disease? METHODS: We used 2008-2010 Beneficiary Annual Summary Files from the Centers for Medicare & Medicaid Services (CMS) to compare prevalences of 17 conditions among 781 LLFS participants in Medicare with those of 3,227 non-LLFS matches from the general Medicare population. Analyses accounted for nesting within LLFS families. RESULTS: Seven conditions were significantly less common among LLFS probands than their matches: Alzheimer's, hip fracture, diabetes, depression, prostate cancer, heart failure, and chronic kidney disease. Four diseases not strongly linked to mortality (arthritis, cataract, osteoporosis, glaucoma) were significantly more common for LLFS probands. Despite fewer people and less disease in those roles, LLFS offspring and LLFS spouses of either generation also had significantly lower risk for Alzheimer's, diabetes, and heart failure. CONCLUSIONS: Common, severe mortality-associated diseases are less prevalent among LLFS probands and their offspring than in the general population of aging Americans. Quality-of-life-limiting diseases such as arthritis and cataract are more prevalent, potentially through more diagnosing of milder forms in otherwise healthy and active individuals. LLFS spouses are also relatively healthy. As the younger cohorts age into Medicare and develop more conditions, it will be important to see whether these tentative findings strengthen.","Aged;Aged, 80 and over;Family;Female;Humans;*Longevity;Male;Genetics;Health Services;Longevity;Morbidity;Resilience","Ash, A. S.;Kroll-Desrosiers, A. R.;Hoaglin, D. C.;Christensen, K.;Fang, H.;Perls, T. T.",2015,Aug,10.1093/gerona/glv015,0,
245,In-patient workload in medical specialties: 2. Profiles of individual diagnoses from linked statistics,"We analysed hospital use for 58 common clinical conditions in the medical specialties, using data from the two districts covered by the Oxford record linkage study 1968-1986. Episode rates, person rates, and ratios of multiple admissions per person were computed. In young adults, poisoning was the most common reason for admission. In older adults, the most common clinical conditions included atherosclerotic diseases and smoking-related lung diseases. Comparing the first and last time periods studied, admission rates increased by 10% or more in 37 of the 58 conditions, including 7 of the 10 conditions with the highest overall hospitalization rates. Conditions in which admissions increased by 10% or more included myocardial infarction, other ischaemic heart disease, chronic obstructive lung disease, asthma, pneumonia, diabetes, poisoning, dementia, prostate cancer and breast cancer among others. Workload declined by 10% or more in 13 conditions, including stroke, subarachnoid haemorrhage, hypertension, thyrotoxicosis, acquired hypothyroidism, and tuberculosis. Secular trends in hospital use are generally attributable either to changes in disease frequency in the population or to changes in clinic- or hospital-based technology and practice.",adolescent;adult;age;aged;article;asthma;atherosclerosis;breast cancer;chronic obstructive lung disease;dementia;diabetes mellitus;heart infarction;hospital admission;hospital patient;hospitalization;human;hypertension;hypothyroidism;intoxication;ischemic heart disease;lung disease;medical specialist;pneumonia;priority journal;prostate cancer;statistics;cerebrovascular accident;subarachnoid hemorrhage;thyrotoxicosis;tuberculosis;United Kingdom;workload,"Ashton, C. M.;Ferguson, J. A.;Goldacre, M. J.",1995,,,0,
246,Prion-associated dilated cardiomyopathy,"Creutzfeldt-Jakob disease is a spongiform encephalopathy affecting 1 individual per million population per year. We report on a previously healthy 43-year-old patient who presented with the simultaneous onset of a movement disorder, encephalopathy, cognitive decline, and dilated cardiomyopathy, and was found to have spongiform encephalopathy on brain biopsy. Although her neurological features could be explained by Creutzfeldt-Jakob disease, the etiology of the dilated cardiomyopathy could not be established. Finally, special staining of the endomyocardial biopsy specimen revealed the presence of abnormal prion, possibly infectious scrapie prion. As an exhaustive search for familial, ischemic, infectious, autoimmune, toxic, and metabolic causes of dilated cardiomyopathy was unrevealing, the presence of abnormal prion in the cardiac muscle suggested the possibility of prion-induced dilated cardiomyopathy in our patient.",prion protein;adult;anamnesis;article;case report;cerebrospinal fluid analysis;clinical feature;comorbidity;congestive cardiomyopathy;Creutzfeldt Jakob disease;diagnostic approach route;diagnostic imaging;diagnostic test;disease course;electrocardiography monitoring;electroencephalogram;female;heart catheterization;heart muscle biopsy;hospice care;human;immunohistochemistry;laboratory test;medical examination;neuroimaging;patient transport;priority journal,"Ashwath, M. L.;DeArmond, S. J.;Culclasure, T.",2005,,,0,
247,"Inclusion body myositis, muscle blood vessel and cardiac amyloidosis, and transthyretin Val122Ile allele",Typical of sporadic inclusion body myositis muscle biopsies are vacuolated muscle fibers containing intracellular amyloid deposits and accumulations of 'Alzheimer-characteristic' proteins. There is no muscle blood vessel or cardiac amyloidosis. We report on a 70-year-old African- American man homozygous for the transthyretin Val122Ile allele who has both sporadic inclusion body myositis and cardiac amyloidosis. His unique pathological features included transthyretin immunoreactivity in prominent muscle blood vessel amyloid and congophilic amyloid deposits within vacuolated muscle fibers.,amino acid;prealbumin;aged;allele;article;blood vessel;case report;gene mutation;genetic analysis;genetic susceptibility;heart amyloidosis;human;human tissue;inclusion body myositis;male;muscle biopsy;muscle cell;priority journal,"Askanas, V.;Engel, W. K.;Alvarez, R. B.;Frangione, B.;Ghiso, J.;Vidal, R.",2000,,,0,
248,Hypertension prevalence and prescribing trends in older us adults: 1999-2004,"To describe hypertension trends in US adults aged 65 years and older using Medicare Current Beneficiary Survey (MCBS) data, a cross-sectional, nationally representative health examination survey from MCBS files between 1999 and 2004 was investigated. Overall, 62% of beneficiaries, or an estimated 20 million US adults aged 65 years and older, were hypertensive as extrapolated from MCBS data. From 1999 to 2004, the prevalence rate of hypertension increased from 59% to 65% (P<.001). Nonwhite persons and women had a higher prevalence of hypertension than whites and men. A history of diabetes mellitus, prior myocardial infarction, coronary artery disease, or stroke was significantly associated with hypertension treatment. In addition, significant geographic variation in treatment was noted. There was a significant increase in hypertension prevalence in older Medicare beneficiaries from 1999 to 2004. Women, patients 85 years and older, and nonwhite patients were less likely to be treated with antihypertensive medications, and significant geographic variation existed in treatment. © 2009 Wiley Periodicals, Inc.",beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;thiazide diuretic agent;age;aged;anamnesis;antihypertensive therapy;article;Caucasian;chronic obstructive lung disease;comorbidity;coronary artery disease;cross-sectional study;dementia;diabetes mellitus;female;geography;heart infarction;hospitalization;human;hypertension;major clinical study;male;medicare;neoplasm;prescription;prevalence;priority journal;race difference;sex difference;smoking;cerebrovascular accident;trend study;United States,"Aslam, F.;Haque, A.;Agostini, J. V.;Wang, Y.;Foody, J. M.",2010,,,0,
249,ECG changes in a case of attempted partial hanging,"This is a case of attempted partial hanging that behaved like a cerebrovascular accident. The serial electrocardiograms (ECGs) showed the characteristic ST and T-wave changes, QT prolongation and U waves later reverting to normal over a period of one month. © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.",calcium;catecholamine;accessory nerve injury;adult;amnesia;arterial gas;artery thrombosis;article;blood pressure measurement;brain edema;brain vasospasm;case report;catecholamine release;cerebrovascular accident;coronary hemodynamics;dementia;electrocardiography;emergency care;female;hanging;heart muscle ischemia;human;hypokinesia;hypoxemia;Korsakoff psychosis;mydriasis;oxygen saturation,"Aslam, M.;Maurya, S. P.",2013,,,0,
250,Etiologies and delirium rates of elderly ED patients with acutely altered mental status: a multicenter prospective study,"Objectives Altered mental status (AMS) is a challenging diagnosis in older patients and has a large range of etiologies. The aim of this study was to investigate the nature of such etiologies for physicians to be better aware of AMS backgrounds and hence improve outcomes and mortality rates. Methods This prospective observational study was conducted at 4 emergency departments. Patients 65 years and older who presented to the emergency department with acute AMS (≤1 week), with symptoms ranging from comas and combativeness, were eligible for inclusion in this study. The outcomes, etiologies, Richmond Agitation and Sedation Scale scores, and the presence of delirium were recorded. Results Among 822 older patients with AMS, infection (39.5%) and neurological diseases (36.5%) were the most common etiologies. The hospital admission and mortality rates were 73.7% (n = 606) and 24.7% (n = 203), respectively. The mortality rate rose if AMS persisted for more than 3 days. Delirium was observed in 55.7% of the patients; these individuals had higher durations of AMS than those without delirium (median, 24 hours; interquartile range, 3-48 hours; median 6 hours, interquartile range, 3-48 hours, respectively; P = .010). Notably, delirium was observed in more than two-thirds of neurological patients. Conclusions The most common causes of AMS were infection and neurological diseases. Delirium was associated with AMS in nearly half the patients. Moreover, the rates of hospitalization and mortality remained high.",new drug;abscess;acute disease;acute heart infarction;acute kidney failure;aged;alcohol consumption;alertness;altered mental status;Alzheimer disease;anaphylaxis;anemia;dissecting aortic aneurysm;aortic rupture;article;bacterial endocarditis;biliary tract disease;brain damage;brain ischemia;carbon monoxide intoxication;cellulitis;chronic obstructive lung disease;clinical outcome;cognitive defect;coma;complete heart block;congestive heart failure;conversion disorder;delirium;digestive system perforation;disease exacerbation;drug overdose;emergency patient;emergency ward;encephalitis;epileptic state;female;follow up;gastroenteritis;gastrointestinal hemorrhage;heart arrhythmia;hospital admission;human;hydrocephalus;hypercalcemia;hypercapnia;hyperglycemia;hyperkalemia;hypernatremia;hypertension encephalopathy;hypoglycemia;hypokalemia;hyponatremia;hypothermia;hypoxia;ileus;intensive care unit;lethargy;liver failure;lung embolism;major clinical study;male;meningitis;mental deterioration;mental health;methanol poisoning;morbidity;mortality rate;multicenter study;non ST segment elevation myocardial infarction;observational study;organophosphate poisoning;pancreas disease;Parkinson disease;pneumonia;pneumothorax;priority journal;prospective study;psychosis;Richmond Agitation Sedation Scale;schizophrenia;sepsis;stimulus response;stupor;subarachnoid hemorrhage;toxicology;transient ischemic attack;typhlitis;urinary tract infection;vestibular neuronitis;wakefulness,"Aslaner, M. A.;Boz, M.;Çelik, A.;Ahmedali, A.;Eroğlu, S.;Metin Aksu, N.;Eroğlu, S. E.",2017,,10.1016/j.ajem.2016.10.004,0,
251,Epidemiology of drug-disease interactions in older veteran nursing home residents,"OBJECTIVES: To describe the prevalence of and factors associated with drug-disease interactions (DDIs) in older nursing home residents according to the American Geriatrics Society 2012 Beers Criteria. DESIGN: Cross-sectional. SETTING: Fifteen Veterans Affairs Community Living Centers. PARTICIPANTS: Individuals aged 65 and older with a diagnosis of dementia or cognitive impairment, a history of falls or hip fracture, heart failure (HF), a history of peptic ulcer disease (PUD), or Stage IV or V chronic kidney disease (CKD). MEASUREMENTS: Medications that could exacerbate the above conditions (DDIs). RESULTS: Three hundred sixty-one of 696 (51.9%) eligible residents had one or more DDIs. None involved residents with a history of PUD, one involved a resident with CKD, and four occurred in residents with HF. Of 540 residents with dementia or cognitive impairment, 50.7% took a drug that could exacerbate these conditions; the most commonly involved medications were antipsychotics (35.4%) and benzodiazepines (14.4%). Of 267 with a history of falls or hip fracture, 67.8% received an interacting medication, with selective serotonin reuptake inhibitors (33.1%), antipsychotics (30.7%), and anticonvulsants (25.1%) being most commonly involved. Using separate multivariable logistic regression models, factors associated with DDIs in dementia or cognitive impairment and falls or fractures included age 85 and older (adjusted odds ratio (aOR) = 0.38, 95% confidence interval (CI) = 0.24-0.60 and aOR = 0.48, 95% CI = 0.24-0.96, respectively), taking five to eight medications (aOR = 2.06, 95% CI = 1.02-4.16 and aOR = 4.76, 95% CI = 1.68-13.5, respectively), taking nine or more medications (aOR = 1.99, 95% CI = 1.03-3.85 and aOR = 3.68, 95% CI = 1.41-9.61, respectively), and being a long-stay resident (aOR = 1.80, 95% CI = 1.04-3.12 and aOR = 2.35, 95% CI = 1.12-4.91, respectively). CONCLUSION: DDIs were common in older nursing home residents with dementia or cognitive impairment or a history of falls or fractures.","Accidental Falls/statistics & numerical data;Aged;Aged, 80 and over;Cognition Disorders/epidemiology;Cross-Sectional Studies;Dementia/epidemiology;*Drug Interactions;Female;Heart Failure/epidemiology;Hip Fractures/epidemiology;Humans;Kidney Failure, Chronic/epidemiology;Male;*Nursing Homes;Peptic Ulcer/epidemiology;United States/epidemiology;*Veterans;Beers criteria;drug-disease interactions;nursing homes","Aspinall, S. L.;Zhao, X.;Semla, T. P.;Cunningham, F. E.;Paquin, A. M.;Pugh, M. J.;Schmader, K. E.;Stone, R. A.;Hanlon, J. T.",2015,Jan,10.1111/jgs.13197,0,
252,Clinical guidelines for older adults with diabetes mellitus 9,,glucose;cerebrovascular disease;cognitive defect;dementia;diabetes mellitus;frail elderly;glucose blood level;human;ischemic heart disease;letter;life expectancy;microangiopathy;morbidity;postprandial state;practice guideline;priority journal;prognosis;risk factor,"Aspray, T. J.;Unwin, N.",2006,,,0,
253,Predictors of mobility in medically unstable elderly patients with hip fractures: A preliminary study in a geriatric ward 2,,albumin;acquired immune deficiency syndrome;albumin blood level;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;decubitus;dementia;demography;depression;diabetes mellitus;frail elderly;geriatric patient;heart infarction;hemiplegia;hip fracture;human;incontinence;kidney disease;letter;leukemia;liver disease;lymphoma;multiple organ failure;patient mobility;peripheral vascular disease;physiotherapy;prediction;prognosis;rehabilitation medicine;treatment outcome;neoplasm;ulcer;ward,"Atalay, A.;Turhan, N.",2007,,,0,
254,Homocysteine: An emerging cardiovascular risk factor that never really made it,"Serum total homocysteine (tHcy) has been implicated in promoting venous thromboembolic events and atherosclerosis, manifested as coronary heart disease, stroke or peripheral arterial disease. Dietary supplementation with B vitamins that lower tHcy concentrations was expected to reduce cardiovascular disease (CVD) risk. However, recent metaanalyses of prospective observational studies and randomized controlled trials failed to show a role of tHcy in the pathogenesis of vascular disease or a benefit of B vitamins in CVD events. This review analyzes recent data on the potential of tHcy to cause health problems (if any) and the role of vitamin B supplementation in preventing them. © Athyros et al.","5,10 methylenetetrahydrofolate reductase (FADH2);cyanocobalamin;folic acid;homocysteine;placebo;pyridoxine;simvastatin;thromboxane B2;artery disease;article;atherosclerosis;cardiovascular disease;clinical trial;congestive heart failure;coronary artery bypass graft;coronary artery disease;deep vein thrombosis;dementia;diet supplementation;drug dose comparison;genetic polymorphism;heart infarction;human;hypercholesterolemia;hyperhomocysteinemia;ischemic heart disease;lung embolism;priority journal;risk factor;risk reduction;cerebrovascular accident;venous thromboembolism;vitamin supplementation","Athyros, V. G.;Tziomalos, K.;Karagiannis, A.;Mikhailidis, D. P.",2010,,,0,
255,The analysis of clinical outcomes and the ethical aspects in tube feeding decision,"Objective: Deciding whether to iniziate artificial enteral nutrition (EN) in patients with severe cognitive impairment or with permanent vegetative state is a common dilemma. The decision is based not only an clinical grounds but also on ethical aspects. Recent studies have not demonstrated that tube feeding can improve important outcomes; many authors discourage this practice in severely demented patients. The aims of this study are to control if the nutrition support team management of enterally fed patients improves outcomes and to present a flow-chart comprehensive of biological and ethical aspects. Methods: This is one of the few studies in literature describing the use of EN in an area where all candidates are assessed by a nutrition support team: 8 patients were in Hospital, 39 patients in nursing homes and 61 patients at home. We have included 108 patients, mean age 78.2 years, 38 males and 70 females. We have followed the guidelines of the Italian Society of Parenteral and Enteral Nutrition (SINPE) for the clinical indication of EN. The quarterly follow-up has been prolonged up to 14 years. The following parameters were analyzed: diagnoses, nutritional indices, pressure scores, complications, mortality, ADL e IADL scales, Norton scale, Pfeiffer test, Karnofsky index. Results: Demented patients were 82.4% of the cohort. The first month mortality rate was 7.4% and 23.1% at one year. The mean survival was 674 days. The main complications of NGT versus PEG have been aspiration 15.5% and 7.9%, tube dislodgment 62.2% and 4.7%, and tube clodging 11.1% and 7.9%, respectively. EN was delivered by PEG in 62 patients, NGT in 45 patients and jejunostomy in one patient. Conclusion: In our study the mortality rate was nearly half of rates reported in literature and the survival approaches two years. Almost all complications have been mild and could be managed adequately throughout; their prevalence is low if confronted to the long period of follow-up, for a whole of 73.953 days. This positive outcome may be the result of the selection and follow-up program supervised by the nutrition support team. How should we treat psycogeriatric patients who no longer eat? We believe that the answer to this complex dilemma should consider not only biological but also ethical aspects and should offer to the patient an alternative treatment to enteral nutrition.",aged;article;aspiration pneumonia;cohort analysis;controlled study;daily life activity;dementia;diarrhea;enteric feeding;female;follow up;geriatric care;heart arrest;home care;hospital patient;human;intermethod comparison;Italy;jejunostomy;Karnofsky Performance Status;major clinical study;male;medical decision making;medical ethics;mortality;nose feeding;nursing home;nutritional support;percutaneous endoscopic gastrostomy;practice guideline;prevalence;survival time;treatment indication;treatment outcome,"Attanasio, A.;Bedin, M.;Mantineo, G.;Stocco, S.;Tagliapietra, M.;Cecchetto, G.;Vecchiato, E.",2006,,,0,
256,"Predictors of obtaining follow-up care in the province of Ontario, Canada, following a new diagnosis of atrial fibrillation, heart failure, and hypertension in the emergency department","OBJECTIVE: Patients with cardiovascular diseases are common in the emergency department (ED), and continuity of care following that visit is needed to ensure that they receive evidence-based diagnostic tests and therapy. We examined the frequency of follow-up care after discharge from an ED with a new diagnosis of one of three cardiovascular diseases. METHODS: We performed a retrospective cohort study of patients with a new diagnosis of heart failure, atrial fibrillation, or hypertension, who were discharged from 157 non-pediatric EDs in Ontario, Canada, between April 2007 and March 2014. We determined the frequency of follow-up care with a family physician, cardiologist, or internist within seven and 30 days, and assessed the association of patient, emergency physician, and family physician characteristics with obtaining follow-up care using cause-specific hazard modeling. RESULTS: There were 41,485 qualifying ED visits. Just under half (47.0%) had follow-up care within seven days, with 78.7% seen by 30 days. Patients with serious comorbidities (renal failure, dementia, COPD, stroke, coronary artery disease, and cancer) had a lower adjusted hazard of obtaining 7-day follow-up care (HRs 0.77-0.95) and 30-day follow-up care (HR 0.76-0.95). The only emergency physician characteristic associated with follow-up care was 5-year emergency medicine specialty training (HR 1.11). Compared to those whose family physician was remunerated via a primarily fee-for-service model, patients were less likely to obtain 7-day follow-up care if their family physician was remunerated via three types of capitation models (HR 0.72, 0.81, 0.85) or via traditional fee-for-service (HR 0.91). Findings were similar for 30-day follow-up care. CONCLUSIONS: Only half of patients discharged from an ED with a new diagnosis of atrial fibrillation, heart failure, and hypertension were seen within a week of being discharged. Patients with significant comorbidities were less likely to obtain follow-up care, as were those with a family physician who was remunerated via primarily capitation methods.",access to care;ambulatory-sensitive cardiovascular disease;continuity of care;emergency department;primary care,"Atzema, C. L.;Yu, B.;Ivers, N. M.;Rochon, P. A.;Lee, D. S.;Schull, M. J.;Austin, P. C.",2017,Aug 14,,0,
257,Therapeutic benefits of methylene blue on cognitive impairment during chronic cerebral hypoperfusion,"Chronic cerebral hypoperfusion, a risk factor for mild cognitive impairment and Alzheimer's disease, affects mitochondrial respiration and memory consolidation. Therefore, drugs that improve mitochondrial function may be appropriate cognitive treatments for cerebral hypoperfusion. Methylene blue (MB) crosses the blood-brain barrier and at low doses serves as an electron cycler in the mitochondrial electron transport chain. Previous studies implicate MB in both memory enhancement and neuroprotection. We treated rats that underwent permanent bilateral carotid occlusion (2VO) or sham surgery with daily 4 mg/kg USP MB or saline for one month. Animals went through a battery of behavioral tests, including open field, visual water maze, and odor-recognition tasks. 2VO rats showed worse performance in the visual water task without showing differences in general motor activity, visually guided swimming ability or odor recognition. Daily MB attenuated the deficits in visual learning and memory that resulted from cerebrovascular insufficiency. During training on three different discrimination problems in the visual water task, all animals were able to reach a criterion of 8/10 correct trials, but 2VO animals took longer to learn each problem and showed lower performance in a challenging memory probe. However, animals that received daily post-session MB performed significantly better than saline-treated subjects both during training and during the memory probe. This is the first study to demonstrate that MB attenuates learning and memory deficits caused by carotid occlusion. The results suggest that MB may be beneficial for conditions involving chronic cerebral hypoperfusion, such as mild cognitive impairment, vascular dementia, and Alzheimer's disease.","Analysis of Variance;Animals;Association Learning/drug effects/physiology;Coronary Occlusion/*complications;Disease Models, Animal;Enzyme Inhibitors/*therapeutic use;Exploratory Behavior/drug effects/physiology;Locomotion/drug effects/physiology;Male;Methylene Blue/*therapeutic use;Mild Cognitive Impairment/*etiology/*prevention & control;Motor Activity/drug effects/physiology;Odors;Rats;Rats, Long-Evans;Recognition (Psychology)/drug effects/physiology;Carotid occlusion;cerebral hypoperfusion;cognitive impairment;memory enhancement;methylene blue","Auchter, A.;Williams, J.;Barksdale, B.;Monfils, M. H.;Gonzalez-Lima, F.",2014,,10.3233/jad-141527,0,
258,Galantamine treatment of vascular dementia: A randomized trial,"BACKGROUND: To evaluate efficacy and safety of galantamine for patients with vascular dementia (VaD). METHODS: In this multinational, randomized, double-blind, placebo-controlled, parallel-group clinical trial, 788 patients with probable VaD who also satisfied strict centrally read MRI criteria were randomized to receive galantamine or placebo. Efficacy was evaluated using measures of cognition, daily function, and behavior. The primary efficacy measures were the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-cog/11) and the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADL) total score. Secondary outcomes included the Clinician's Interview Based on Impression of Change-Plus Caregiver Input (CIBIC-plus), Neuropsychiatric Inventory, and EXIT-25 for assessment of executive functioning. Safety and tolerability were also monitored. RESULTS: Patients treated with galantamine had a greater improvement in ADAS-cog/11 after 26 weeks compared with placebo (-1.8 vs -0.3; p < 0.001). There was no difference between galantamine and placebo at week 26 on the ADCS-ADL score (0.7 vs 1.3; p = 0.783). Improvement in global functioning measured by the CIBIC-plus associated with galantamine approached significance (p = 0.069). A difference between treatment groups for EXIT-25 favoring galantamine was detected (p = 0.041). Safety data revealed that 13% of galantamine and 6% of placebo patients discontinued treatment because of adverse events. CONCLUSIONS: Significance was not reached for both co-primary endpoints. Galantamine was effective for improving cognition, including executive function, in patients with vascular dementia, with good safety and tolerability. However, improvement in activities of daily living with galantamine was similar to that observed with placebo. Copyright © 2007 by AAN Enterprises, Inc.",galantamine;placebo;aged;alzheimer disease assessment scale cognitive subscale;alzheimer disease cooperative study activities of daily living inventory;anorexia;article;behavior;clinical trial;clinician interview based on impression of change plus caregiver input;cognition;controlled clinical trial;controlled study;daily life activity;dizziness;double blind procedure;drug blood level;drug dose increase;drug efficacy;drug fatality;drug half life;drug monitoring;drug safety;drug screening;drug tolerability;drug withdrawal;ECG abnormality;falling;female;functional assessment;heart infarction;human;hypertension;injury;major clinical study;male;multicenter study;multiinfarct dementia;nausea;neuropsychiatric inventory;pneumonia;priority journal;randomized controlled trial;rating scale;scoring system;side effect;treatment outcome;urinary tract infection;vomiting,"Auchus, A. P.;Brashear, H. R.;Salloway, S.;Korczyn, A. D.;De Deyn, P. P.;Gassmann-Mayer, C.",2007,,,0,
259,Introduction to the Analysis of Survival Data in the Presence of Competing Risks,"Competing risks occur frequently in the analysis of survival data. A competing risk is an event whose occurrence precludes the occurrence of the primary event of interest. In a study examining time to death attributable to cardiovascular causes, death attributable to noncardiovascular causes is a competing risk. When estimating the crude incidence of outcomes, analysts should use the cumulative incidence function, rather than the complement of the Kaplan-Meier survival function. The use of the Kaplan-Meier survival function results in estimates of incidence that are biased upward, regardless of whether the competing events are independent of one another. When fitting regression models in the presence of competing risks, researchers can choose from 2 different families of models: modeling the effect of covariates on the cause-specific hazard of the outcome or modeling the effect of covariates on the cumulative incidence function. The former allows one to estimate the effect of the covariates on the rate of occurrence of the outcome in those subjects who are currently event free. The latter allows one to estimate the effect of covariates on the absolute risk of the outcome over time. The former family of models may be better suited for addressing etiologic questions, whereas the latter model may be better suited for estimating a patient's clinical prognosis. We illustrate the application of these methods by examining cause-specific mortality in patients hospitalized with heart failure. Statistical software code in both R and SAS is provided.",hemoglobin;sodium;urea;age;article;breathing rate;cardiac patient;cardiovascular risk;cause of death;cerebrovascular disease;chronic obstructive lung disease;dementia;heart death;hemoglobin blood level;hospital admission;human;incidence;liver cirrhosis;neoplasm;priority journal;prognosis;sodium blood level;statistical analysis;survival;systolic blood pressure;urea nitrogen blood level,"Austin, P. C.;Lee, D. S.;Fine, J. P.",2016,,,0,
260,Logistic regression had superior performance compared with regression trees for predicting in-hospital mortality in patients hospitalized with heart failure,"OBJECTIVE: To compare the predictive accuracy of regression trees with that of logistic regression models for predicting in-hospital mortality in patients hospitalized with heart failure. STUDY DESIGN AND SETTING: Models were developed in 8,236 patients hospitalized with heart failure between April 1999 and March 2001. Models included the Enhanced Feedback for Effective Cardiac Treatment and Acute Decompensated Heart Failure National Registry (ADHERE) regression models and tree. Predictive accuracy was assessed using 7,608 patients hospitalized between April 2004 and March 2005. RESULTS: The area under the receiver operating characteristic curve for five different logistic regression models ranged from 0.747 to 0.775, whereas the corresponding values for three different regression trees ranged from 0.620 to 0.651. For the regression trees grown in 1,000 random samples drawn from the derivation sample, the number of terminal nodes ranged from 1 to 6, whereas the number of variables used in specific trees ranged from 0 to 5. Three different variables (blood urea nitrogen, dementia, and systolic blood pressure) were used for defining the first binary split when growing regression trees. CONCLUSION: Logistic regression predicted in-hospital mortality in patients hospitalized with heart failure more accurately than did the regression trees. Regression trees grown in random samples from the same data set can differ substantially from one another.","Aged;Aged, 80 and over;Data Interpretation, Statistical;Female;Forecasting;Heart Failure/*mortality;Hospital Mortality/*trends;Humans;Logistic Models;Male;Ontario/epidemiology;ROC Curve;Risk Assessment","Austin, P. C.;Tu, J. V.;Lee, D. S.",2010,Oct,10.1016/j.jclinepi.2009.12.004,0,
261,Are there specific prognostic factors for acute coronary syndrome in patients over 80 years of age?,"Purpose. - In elderly patients, the prognosis of acute coronary syndrome is bleak and the impact of geriatric factors is as yet unknown. The purpose of this work was to identify factors predictive of poor outcome at Month 6 in a population of elderly subjects admitted into hospital with acute coronary syndrome. Materials and methods. - One hundred and thirty-two patients over 80 years of age were compared with 127 patients under 80, all admitted into a cardiology intensive care unit with acute coronary syndrome between May 2006 and January 2007, vis-à-vis outcome, mortality and cardiovascular events, both during the hospital stay and six months later. Results. - Coronary angiography was performed in fewer of the over-80 group (85.6% versus 97.7%, p<0.001) but revascularisation rates were comparable in both groups (75.6% versus 78.9%, p=0.58). During the hospital stay, the incidence of complications was higher (68.8% versus 38.1%, p<0.0001) in the older patients as was mortality (18.2% versus 3.2%, p=0.0001). At Month 6, all-cause mortality was higher in the octogenarians (28.0% versus 10.6%, p<0.001). The independent variables associated with Month 6 all-cause mortality in the over-80 group were: systolic blood pressure of less than 100 mmHg, an admission heart rate of over 100 bpm, a history of cardiovascular disease, acute coronary syndrome with ST segment elevation in the anterior territory, and the absence of chest pain. Conclusion. - In elderly patients admitted into hospital with acute coronary syndrome, geriatric parameters do not seem to affect prognosis which is dominated by cardiac variables. © 2008 Elsevier Masson SAS. All rights reserved.",acetylsalicylic acid;aldosterone antagonist;amiodarone;angiotensin 2 receptor antagonist;anticoagulant agent;antidepressant agent;antithrombocytic agent;benzodiazepine;beta adrenergic receptor blocking agent;calcium channel blocking agent;clopidogrel;dipeptidyl carboxypeptidase inhibitor;diuretic agent;fibric acid derivative;fibrinogen receptor antagonist;fibrinolytic agent;heparin;hydroxymethylglutaryl coenzyme A reductase inhibitor;hypnotic agent;insulin;neuroleptic agent;nitric acid derivative;nootropic agent;oral antidiabetic agent;proton pump inhibitor;acute coronary syndrome;adult;aged;angiocardiography;article;cardiology;cardiovascular disease;cardiovascular risk;controlled study;coronary artery recanalization;dementia;diabetes mellitus;factorial analysis;female;geriatrics;heart rate;hospital admission;hospitalization;human;intensive care unit;major clinical study;male;mortality;outcome assessment;prediction;prognosis;risk assessment;risk factor,"Austruy, J.;El Bayomy, M.;Baixas, C.;Elbaz, M.;Lairez, O.;Dumonteil, N.;Boudou, N.;Carrié, D.;Degroote, P.;Galinier, M.",2008,,,0,
262,,"Older adults move less, making them prone to deconditioning and a host of other consequences including stiffness, weakness, cardiovascular changes, decreased balance, cognitive disorders, insomnia, mood changes, and adverse effects on appetite, to name a few. Because the benefits of aerobic exercise and physical activity are so powerful and pervasive in reversing the consequences of inactivity, the Centers for Disease Control and Prevention (CDC) have established guidelines for all adults of 150 minutes of moderate-intensity physical activity comprising aerobic and strengthening activity. Yet, the majority of older adults do not engage in any aerobic activity (CDC, 2013). Aerobic exercise is so important for health and chronic disease management that its prescription is a core competency for most health-care providers. This chapter reviews the effects of aging on aerobic capacity, the benefits of aerobic exercise across many common chronic diseases, and an evidence-based exercise prescription based on appropriate screening for a variety of conditions common to older adults.",aerobic capacity;aerobic exercise;aging;Alzheimer disease;arthritis;cardiorespiratory fitness;cardiovascular disease;cardiovascular risk;chronic disease;diabetes mellitus;evidence based practice;exercise;exercise test;heart disease;heart failure;human;hypertension;lung disease;mass screening;metabolic equivalent;obesity;osteoporosis;peripheral occlusive artery disease;prescription;six minute walk test;walk test,"Avers, D.",2016,,10.1891/0198-8794.36.123,0,
263,"Current Resources for Evidence-Based Practice, January/February 2013",,estrogen;gestagen;advanced cancer;article;breast cancer;breast feeding;breast feeding education;cerebrovascular accident;chronic disease;clinical effectiveness;deep vein thrombosis;dementia;developing country;drug efficacy;drug safety;drug tolerability;evidence based practice;gallbladder disease;heart infarction;hormonal therapy;human;ischemic heart disease;lung cancer;lung embolism;maternal attitude;maternal care;postmenopause;pregnancy outcome;priority journal;risk assessment;risk benefit analysis;risk factor;urine incontinence;vaginal delivery,"Avery, M. D.",2013,,,0,
264,Long-term cognitive decline in older subjects was not attributable to noncardiac surgery or major illness,"BACKGROUND:: Persistent postoperative cognitive decline is thought to be a public health problem, but its severity may have been overestimated because of limitations in statistical methodology. This study assessed whether long-term cognitive decline occurred after surgery or illness by using an innovative approach and including participants with early Alzheimer disease to overcome some limitations. METHODS:: In this retrospective cohort study, three groups were identified from participants tested annually at the Washington University Alzheimer's Disease Research Center in St. Louis, Missouri: those with noncardiac surgery, illness, or neither. This enabled long-term tracking of cognitive function before and after surgery and illness. The effect of surgery and illness on longitudinal cognitive course was analyzed using a general linear mixed effects model. For participants without initial dementia, time to dementia onset was analyzed using sequential Cox proportional hazards regression. RESULTS:: Of the 575 participants, 214 were nondemented and 361 had very mild or mild dementia at enrollment. Cognitive trajectories did not differ among the three groups (surgery, illness, control), although demented participants declined more markedly than nondemented participants. Of the initially nondemented participants, 23% progressed to a clinical dementia rating greater than zero, but this was not more common after surgery or illness. CONCLUSIONS:: The study did not detect long-term cognitive decline independently attributable to surgery or illness, nor were these events associated with accelerated progression to dementia. The decision to proceed with surgery in elderly people, including those with early Alzheimer disease, may be made without factoring in the specter of persistent cognitive deterioration. © 2009 the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc.",abdominal aorta aneurysm;aged;allergy;Alzheimer disease;anemia;article;asthma;burn;bypass surgery;carbon monoxide intoxication;carpal tunnel syndrome;cellulitis;cholecystectomy;cholecystitis;chronic obstructive lung disease;clinical assessment;clinical decision making;cohort analysis;colon resection;complete heart block;controlled study;cystectomy;deep vein thrombosis;dehydration;disease course;diverticulitis;diverticulosis;Dupuytren contracture;electrolyte disturbance;esophagus resection;eye surgery;female;foot surgery;fracture;gastrectomy;gastrointestinal hemorrhage;general aspects of disease;gout;Guillain Barre syndrome;health center;atrial fibrillation;heart failure;heart infarction;hiatus hernia;hip arthroplasty;human;hysterectomy;inguinal hernia;intestine obstruction;knee arthroplasty;lobectomy;longitudinal study;lung embolism;major clinical study;male;mastectomy;mental deterioration;model;neck dissection;nephrostomy;nerve regeneration;open reduction;orthopedic surgery;osteomyelitis;osteosynthesis;partial mastectomy;pelvis surgery;peptic ulcer;pneumonia;priority journal;proportional hazards model;pseudogout;retrospective study;seizure;sinusitis;supraventricular tachycardia;surgical technique;therapy effect;thrombophlebitis;thrombotic thrombocytopenic purpura;thyroidectomy;transurethral resection;United States;university;urinary tract infection,"Avidan, M. S.;Searleman, A. C.;Storandt, M.;Barnett, K.;Vannucci, A.;Saager, L.;Xiong, C.;Grant, E. A.;Kaiser, D.;Morris, J. C.;Evers, A. S.",2009,,,0,
265,Measuring the cost-effectiveness of lipid-lowering drugs in the elderly: the outcomes research and economic analysis components of the PROSPER trial,"Little information exists to quantify the functional status and economic consequences of lipid-lowering therapy in elderly patients. We describe the design of the cost-effectiveness component of the first large, randomized, placebo-controlled trial of lipid-lowering therapy in subjects aged 70 years or older. The PROspective Study of Pravastatin in the Elderly at Risk has randomized 5804 men and women 70-82 years old, with existing vascular disease or related risk factors, to receive 40 mg/d of pravastatin or placebo. The cost-effectiveness study will be based on within-trial observations of differences between the two study arms in rates of myocardial infarction, stroke and related vascular disease outcomes (including vascular dementia). In addition to comparing within-trial clinical outcomes, we will model the projected changes in life expectancy and cardiovascular outcome rates that would be seen with lifelong use of the drug, based on the risk reduction rates seen in the trial as well as baseline observational data from the three countries where the trial is being conducted (Scotland, Ireland and the Netherlands). A state transition (Markov) model will be constructed to estimate the likely states of health, functional status and health care resource utilization (including lipid-lowering drug costs) in a cohort of elderly patients with versus without pravastatin therapy over a series of 1-year cycles until death. In addition, a standard measure of utility (the Health Utilities Index) will be administered to all study subjects to permit calculation of quality-adjusted life-years gained with this regimen. This approach will make it possible to go beyond the calculation of a single endpoint for each subject, and to translate the trial findings into definitions of effectiveness and outcomes that will be relevant to the ongoing debate concerning how best to relate the benefits of such medications to their costs.","Aged;Aged, 80 and over;Anticholesteremic Agents/*economics/therapeutic use;Cardiovascular Diseases/prevention & control;Cost-Benefit Analysis/*statistics & numerical data;*Direct Service Costs;Female;Humans;Ireland;Life Tables;Male;Markov Chains;Multicenter Studies as Topic;Netherlands;Pravastatin/*economics/therapeutic use;Quality-Adjusted Life Years;Randomized Controlled Trials as Topic/*methods/statistics & numerical data;Risk;Scotland;Software Design","Avorn, J.;Benner, J.;Ford, I.;Ganz, D. A.;Gaw, A.;Glynn, R. J.;Jackson, J.;Lagaay, A. M.;Schneeweiss, S.;Walley, T.;Wang, P. S.",2002,Dec,,0,
266,Neuroprotective role of BNIP3 under oxidative stress through autophagy in neuroblastoma cells,"Reactive oxygen species (ROS) are produced due to oxidative stress which has wide range of affiliation with different diseases including cancer, heart failure, diabetes and neurodegenerative diseases like Alzheimer's disease, Parkinson's disease, ischemic and hemorrhagic diseases. This study shows the involvement of BNIP3 in the amplification of metabolic pathways related to cellular quality control and cellular self defence mechanism in the form of autophagy. We used conventional methods to induce autophagy by treating the cells with H2O2. MTT assay was performed to observe the cellular viability in stressed condition. MDC staining was carried out for detection of autophagosomes formation which confirmed the autophagy. Furthermore, expression of BNIP3 was validated by western blot analysis with LC3 antibody. From these results it is clear that BNIP3 plays a key role in defence mechanism by removing the misfolded proteins through autophagy. These results enhance the practical application of BNIP3 in neuroblastoma cells and are helpful in reducing the chances of neurodegenerative diseases. Although, the exact mode of action is still unknown but these findings unveil a molecular mechanism for the role of autophagy in cell death and provide insight into complex relationship between ROS and non-apoptotic programmed cell death.","Apoptosis;Autophagy/*drug effects;Cell Line, Tumor;Cell Survival;Humans;Hydrogen Peroxide/adverse effects;Membrane Proteins/genetics/*metabolism;Neuroblastoma/metabolism/*pathology;*Oxidative Stress;Plasmids/genetics;Proto-Oncogene Proteins/genetics/*metabolism;Reactive Oxygen Species/metabolism","Awan, M. U.;Hasan, M.;Iqbal, J.;Lei, R.;Lee, W. F.;Hong, M.;Qing, H.;Deng, Y.",2014,Sep,10.1007/s11033-014-3444-7,0,
267,Genetic Autonomic Disorders,"Genetic disorders affecting the autonomic nervous system can result in abnormal development of the nervous system or they can be caused by neurotransmitter imbalance, an ion-channel disturbance or by storage of deleterious material. The symptoms indicating autonomic dysfunction, however, will depend upon whether the genetic lesion has disrupted peripheral or central autonomic centers or both. Because the autonomic nervous system is pervasive and affects every organ system in the body, autonomic dysfunction will result in impaired homeostasis and symptoms will vary. The possibility of genetic confirmation by molecular testing for specific diagnosis is increasing but treatments tend to remain only supportive and directed toward particular symptoms. © 2013 Elsevier Inc.",benzodiazepine derivative;clonidine;dopamine beta monooxygenase;fludrocortisone;midodrine;mitochondrial DNA;neurotrophic tyrosine kinase receptor type 1;noradrenalin transporter;tyrosine kinase receptor;unclassified drug;Allgrove syndrome;article;autonomic dysfunction;autonomic neuropathy;disease association;disease classification;dysautonomia;erythromelalgia;Fabry disease;familial amyloid polyneuropathy;familial rectal pain syndrome;fragile X syndrome;gene;gene mutation;genetic association;genetic disorder;hereditary sensory and autonomic neuropathy;homeostasis;human;IKBKAP gene;Kearns Sayre syndrome;Leber hereditary optic neuropathy;Leigh disease;Menkes syndrome;mitochondrial encephalomyopathy;MNGIE syndrome;neurotransmission;ntrk1 gene;pain;Prader Willi syndrome;protein deficiency;Rett syndrome;sodium channelopathy;symptomatology,"Axelrod, F. B.",2013,,,0,
268,The importance of cognitive component of comprehensive geriatric assessment in home-living elderly patients,"Introduction: We aimed to apply a protocol of comprehensive geriatric assessment including comorbidity, self-reported disability, cognitive state, socio-economics, nutritional state, and spiritual issues in a sample of elderly patients and to test the same variables in middle-aged patients. We also targeted to identify the determinants of functional decline and to estimate cognitive and nutritional levels in elderly patients. Materials and Method: Randomly allocated 137 geriatric and middle-aged participants living at home were included in the study. Comprehensive geriatric assessment was performed for all patients. Results: Functional level, education level, monthly income (TL), spouse and friend support, and scores of Mini Mental State Examination and Mini Nutritional Assessment Tests were lower in elderly than middle-aged participants. Cognitive state measured by Mini Mental State Examination was the major determinant of functional and nutritional level. Conclusion: Strategies to increase physical activities and to strengthen cognitive abilities in the elderly should be developed.",acquired immune deficiency syndrome;adult respiratory distress syndrome;aged;angina pectoris;anxiety disorder;arthritis;article;asthma;cerebrovascular disease;chronic lung disease;chronic obstructive lung disease;cognition;comparative study;congestive heart failure;connective tissue disease;controlled study;daily life activity;degenerative disease;dementia;depression;diabetes mellitus;educational status;female;friend;functional assessment;functional status;gastrointestinal disease;geriatric assessment;hearing impairment;heart infarction;hemiplegia;human;income;intervertebral disk disease;kidney disease;leg movement;leisure;leukemia;liver disease;lymphoma;major clinical study;male;marriage;mental health;Mini Mental State Examination;neurologic disease;nursing home patient;nutritional assessment;nutritional status;obesity;osteoporosis;panic;peripheral vascular disease;physical activity;social behavior;social security;social support;solid tumor;spiritual care;spouse;cerebrovascular accident;neoplasm;visual impairment;work,"Ayhan, F. F.;Ceceli, E.;Usta, M.;Kurultak, D.;Borman, P.",2010,,,0,
269,A Call for Collaboration: Improving Cardiogeriatric Care,"With the population aging, there is an exponential increase in the prevalence of cardiovascular disease (CVD). Congestive heart failure (CHF) is considered the ""poster child"" of the blend of CVD, multimorbidity, and frailty in the aging population. Traditionally, from the cardiologist's point of view, the top multimorbidities in CHF are hypertension, ischemic heart disease, hyperlipidemia, anemia, and diabetes. However, the care of these patients is confounded by common geriatric conditions (multimorbidity, dementia, medication intolerance, frailty) contributing to functional disability, reduced quality of life, and increased hospitalization. Given a 3-fold increase in the number of patients with CHF within the next couple of decades, we must act now. We need to address complex care coordination and integrated disease management as part of the continuum of care, including advance directives and patient preferences. Research and educational curricula must address clinical practice guidelines appropriate for the frail elderly with multimorbidities. Improved care of the older patient with cardiac disease is dependent on a new model of collaboration and teamwork between primary care physician, geriatrician, and cardiologist to accommodate the fundamental heterogeneity of aging and the patients' choices. Collaborative cardiogeriatric clinics have started. The goal of these clinics is to provide integrated care and education for older patients and their caregivers, with the objective of improving quality of life and function. These clinics are also designed to build educational capacity for medical trainees and provide an ongoing research environment. This prototype of a sustainable model will be used to assess methods by which cardiogeriatric clinics could be introduced into standard clinical medical practice.",,"Azad, N. A.;Mielniczuk, L.",2016,Sep,10.1016/j.cjca.2016.01.025,0,270
270,A Call for Collaboration: Improving Cardiogeriatric Care,"With the population aging, there is an exponential increase in the prevalence of cardiovascular disease (CVD). Congestive heart failure (CHF) is considered the “poster child” of the blend of CVD, multimorbidity, and frailty in the aging population. Traditionally, from the cardiologist's point of view, the top multimorbidities in CHF are hypertension, ischemic heart disease, hyperlipidemia, anemia, and diabetes. However, the care of these patients is confounded by common geriatric conditions (multimorbidity, dementia, medication intolerance, frailty) contributing to functional disability, reduced quality of life, and increased hospitalization. Given a 3-fold increase in the number of patients with CHF within the next couple of decades, we must act now. We need to address complex care coordination and integrated disease management as part of the continuum of care, including advance directives and patient preferences. Research and educational curricula must address clinical practice guidelines appropriate for the frail elderly with multimorbidities. Improved care of the older patient with cardiac disease is dependent on a new model of collaboration and teamwork between primary care physician, geriatrician, and cardiologist to accommodate the fundamental heterogeneity of aging and the patients' choices. Collaborative cardiogeriatric clinics have started. The goal of these clinics is to provide integrated care and education for older patients and their caregivers, with the objective of improving quality of life and function. These clinics are also designed to build educational capacity for medical trainees and provide an ongoing research environment. This prototype of a sustainable model will be used to assess methods by which cardiogeriatric clinics could be introduced into standard clinical medical practice.",aging;anemia;article;cardiovascular disease;congestive heart failure;dementia;demography;diabetes mellitus;disability;elderly care;human;hyperlipidemia;hypertension;ischemic heart disease;life expectancy;phenotype;priority journal;quality of life,"Azad, N. A.;Mielniczuk, L.",2016,,10.1016/j.cjca.2016.01.025,0,
271,Substance use among iranian cardiac surgery patients and its effects on short-term outcome,"BACKGROUND:: We assessed the prevalence of substance use among patients undergoing coronary artery bypass graft and valve surgery in northwest Iran. We evaluated the postoperative complications and in-hospital mortality of patients with substance dependence and abuse. METHODS:: In this prospective, observational study, we interviewed 600 patients during the preoperative visit in a tertiary referral educational hospital in northwest Iran. The definition of substance abuse and dependence was according to DSM-IV criteria. Postoperative complications and in-hospital mortality of patients with substance (cigarette, opium, and alcohol) dependence and abuse were compared with those in control patients who did not use these substances. RESULTS:: In 600 studied patients, the prevalence of cigarette smoking was 42.1% (ex-smokers 26.0% and current smokers 16.1%), prevalence of opium use was 12.0% (opium abuse 7.0% and opium dependence 5.0%), and alcohol consumption was 8.1% (alcohol abuse 7.4% and alcohol dependence 0.7%). The prevalence of cigarette smoking was 58.9% in men and 7.6% in women (P = 0.001). Postoperative cardiac complications in current smokers (21.5%) and ex-smokers (20.5%) were not significantly different from the control group (28.2%). Also, pulmonary complications were not different in current smokers (24.7%) and ex-smokers (17.9%) from the control group (26.8%; P = 0.196). However, in men, pulmonary complications in current smokers were more prevalent than in the control group (P = 0.044). In opium and alcohol dependents and abusers, postoperative complications were not statistically different from the control group (all P values >0.05). No increase was observed regarding in-hospital mortality in patients with substance use. CONCLUSIONS:: In cardiac surgery patients in northwest Iran, the prevalence of cigarette smoking is relatively low (very low in women), as is alcohol use, compared with Western countries; however, opium use is twice as prevalent. We found higher pulmonary complication rates in men who smoked, but no increase in postoperative cardiopulmonary complications and in-hospital mortality rates in patients who abused opium and consumed alcohol. Copyright © 2009 International Anesthesia Research Society.",alcohol;opiate;acute lung injury;adult;adult respiratory distress syndrome;aged;agitated depression;alcohol consumption;alcoholism;article;atelectasis;cerebrovascular accident;smoking;clinical assessment;clinical trial;coma;controlled study;convulsion;coronary artery bypass graft;delirium;dementia;depression;Diagnostic and Statistical Manual of Mental Disorders;drug dependence;female;hallucination;heart arrhythmia;heart disease;heart infarction;heart surgery;heart valve replacement;human;hypertension;Iran;lung disease;major clinical study;male;mortality;neurological complication;observational study;opiate addiction;outcome assessment;pneumonia;pneumothorax;postoperative complication;preoperative evaluation;prevalence;priority journal;prospective study;short course therapy;substance abuse;surgical risk;surgical technique;tertiary health care;tobacco dependence;treatment outcome,"Azarasa, M.;Azarfarin, R.;Changizi, A.;Alizadehasl, A.",2009,,,0,
272,"On the opinion of the European Commission ""Scientific Committee on Food"" regarding the tolerable upper intake level of vitamin E (2003)",,acetylsalicylic acid;alpha tocopherol;beta carotene;dipeptidyl carboxypeptidase inhibitor;warfarin;abdominal cramp;Alzheimer disease;angina pectoris;anticoagulant therapy;atherosclerosis;blood analysis;blood cell count;blood chemistry;blood clotting;cardiovascular risk;clinical observation;clinical trial;diarrhea;drug tolerability;follow up;gastrointestinal symptom;health care organization;high risk population;human;hypertension;incidence;ingestion;insulin dependent diabetes mellitus;laboratory test;letter;medical expert;methodology;mortality;population research;prothrombin time;science;senescence;smoking;standard;cerebrovascular accident;toxicity;vitamin intake;vitamin supplementation;aspirin,"Azzi, A.;Brigelius-Flohé, R.;Kelly, F.;Lodge, J. K.;Özer, N.;Packer, L.;Sies, H.",2005,,,0,
273,"Novel Index to Quantify the Risk of Surgery in the Setting of Adult Spinal Deformity: A Study on 10,912 Patients from the Nationwide Inpatient Sample","Study Design: Retrospective review of the Nationwide Inpatient Sample from 2001 to 2010, a prospectively collected national database. Objective: Structure an index to quantify adult spinal deformity (ASD) surgical risk based on risk factors for medical complications, surgical complications, revisions (R), mortality (M) rates, and length of hospital stay. Summary of Background Data: Evidence supporting ASD surgery cost-effectiveness and anticipating surgical risk is critical to evaluate the risk/benefit balance of such treatment for patients. Materials and Methods: Discharges ages 25+, 4+ levels fused, diagnoses specific for scoliosis, and refusions. Five multivariate models determined independent risk factors that increased the risk of ≥1 for medical complications, surgical complications, R, M, and length of hospital stay. Models controlled for age, sex, race, revision status, surgical approach, levels fused, and osteotomy utilization. Odds ratios (ORs) were weighted using Nationwide Inpatient Sample weight files and based on their predictive category: 2 times for revision predictors and 4 times for mortality predictors. Predictors with OR≥1.5 were considered clinically relevant. Fifty points were distributed among the predictors based on their accumulative OR to establish a risk index. Results: A total of 10,912 ASD discharges were identified (mean age: 62 y; 73% females; 14% revision cases). The structured risk index incorporated the following factors based on accumulative ORs: Pulmonary circulation disorder (42.05), drug abuse (21.86), congestive heart failure (15.25), neurological disorder (17.31), alcohol abuse (13.24), renal failure (11.64), age>65 (12.28), coagulopathy (11.65), level +9 (6.7), revision (3.35), and osteotomy (3). These risk factors were scored: 14, 7, 5, 5, 4, 4, 4, 4, 2, 1, 1, respectively. Three risk thresholds were proposed: Mild (0-10), moderate (10-20), severe >20/50 points. Conclusions: This study proposes an index to quantify the possible risk of morbidity before ASD surgery that will help patients, health insurance companies, and socioeconomic studies in assessing surgical risk/benefits. Level of Evidence: Level III.",amphetamine;cannabis;cocaine;nicotine;opiate;phencyclidine;psychedelic agent;psychostimulant agent;sedative agent;adult;alcohol abuse;article;blood clotting disorder;congestive heart failure;dementia;drug abuse;female;hospital discharge;human;hypertension;ketoacidosis;kidney failure;length of stay;major clinical study;male;mortality;neurologic disease;osteotomy;pancreatitis;postoperative complication;prospective study;psychosis;respiratory tract disease;retrospective study;scoliosis;spine malformation;surgical risk,"B.G, D. Iebo;Jalai, C. M.;Challier, V.;Marascalchi, B. J.;Horn, S. R.;Poorman, G. W.;Bono, O. J.;Cherkalin, D.;Worley, N.;Oh, J.;Naziri, Q.;Spitzer, A.;Radcliff, K.;Patel, A.;Lafage, V.;Paulino, C. B.;Passias, P. G.",2017,,10.1097/bsd.0000000000000509,0,
274,Oxidative damage impact on aging and age-related diseases: Drug targeting of telomere attrition and dynamic telomerase activity flirting with imidazole-containing dipeptides,"It has been documented that telomere-associated cellular senescence may contribute to certain age-related disorders, including an increase in cancer incidence, wrinkling and diminished skin elasticity, atherosclerosis, osteoporosis, weight loss, age-related cataract, glaucoma and others. Shorter telomere length in leukocytes was associated crosssectionally with cardiovascular disorders and their risk factors, including pulse pressure and vascular aging, obesity, vascular dementia, diabetes, coronary artery disease, myocardial infarction (although not in all studies), cellular turnover and exposure to oxidative and inflammatory damage in chronic obstructive pulmonary disease. It has been proposed that telomere length may not be a strong biomarker of survival in older individuals, but it may be an informative biomarker of healthy aging. The data reveal that telomere dynamics and changes in telomerase activity are consistent elements of cellular alterations associated with changes in proliferative state and in this article these processes are consequently considered as the new therapeutic drug targets for physiological control with advanced drug delivery and nutritional formulations. In particular, the presence of highly specific correlations and early causal relationships between telomere loss in the absence of telomerase activity and replicative senescence or crisis, and from the other side, telomerase reactivation and cell immortality, point to new and important treatment strategies or the therapeutic manipulation during treatment of age related disorders and cancer. Once better controls and therapeutic treatments for aging and age-related disorders are achieved, cellular rejuvenation by manipulating telomeres and enzyme telomerase activity may reduce some of the physiological declines that accompany aging. In this work, we raise and support a therapeutic concept of using non-hydrolyzed forms of naturally occurring imidazoledipeptide based compounds carnosine and carcinine, making it clinically possible that slowing down the rate of telomere shortening could slow down the human aging process in specific tissues where proliferative senescence is known to occur with the demonstrated evidence of telomere shortening appeared to be a hallmark of oxidative stress and disease. The preliminary longitudinal studies of elderly individuals suggest that longer telomeres are associated with better survival and an advanced oral nutritional support with non-hydrolyzed carnosine (or carcinine and patented compositions thereof) and patented N-acetylcarnosine lubricant eye drops are useful therapeutic tools of a critical telomere length maintenance that may fundamentally be applied in the treatment of age-related sight-threatening eye disorders, prolong life expectancy, increase survival and chronological age of an organism in health control, smoking behavior and disease.",amyloid A protein;C reactive protein;carcinine;carnosine;dipeptide;DNA polymerase;intercellular adhesion molecule 1;interleukin 10;interleukin 1beta;interleukin 2;interleukin 6;interleukin 8;reactive oxygen metabolite;telomerase;tumor necrosis factor alpha;unclassified drug;vascular cell adhesion molecule 1;vasculotropin;aging;article;cardiovascular disease;cell proliferation;chromatin immunoprecipitation;chronic obstructive lung disease;diabetes mellitus;dose response;drug targeting;enzyme activity;glaucoma;human;life expectancy;multiinfarct dementia;obesity;osteoporosis;oxidative stress;physical disease by developmental age;priority journal;pulse pressure;real time polymerase chain reaction;senescence;senile cataract;smoking;telomere;telomere shortening;tissue injury;wrinkle,"Babizhayev, M. A.;Vishnyakova, K. S.;Yegorov, Y. E.",2014,,,0,
275,Accumulation of dipeptide repeat proteins predates that of TDP-43 in frontotemporal lobar degeneration associated with hexanucleotide repeat expansions in C9ORF72 gene,"Aims: Frontotemporal lobar degeneration (FTLD) and motor neurone disease are linked by the possession of a hexanucleotide repeat expansion in C9ORF72, and both show neuronal cytoplasmic inclusions within cerebellar and hippocampal neurones which are TDP-43 negative but immunoreactive for p62 and dipeptide repeat proteins (DPR), these being generated by a non-ATG RAN translation of the expanded region of the gene. Methods: Twenty-two cases of FTLD from Newcastle were analysed for an expansion in C9ORF72 by repeat primed PCR and Southern blot. Detailed case note analysis was performed, and blinded retrospective clinical impressions were achieved by review of clinical histories. Sections from all major brain regions were immunostained for TDP-43, p62 and DPR. The extent of TDP-43 and DPR pathology in expansion bearers was compared with that in 13 other previously identified cases from the Manchester Brain Bank with established disease. Results: Three Newcastle patients bearing an expansion in C9ORF72 were identified. These three patients died prematurely, two from bronchopneumonia within 10 months and 3 years of onset, and one from myocardial infarction 3 years after onset. In all three, DPR were plentiful throughout all cerebral cortical regions, hippocampus and cerebellum, but TDP-43 pathological changes were sparse. The severity of DPR pathological changes in these three patients was similar to that in the Manchester series, although the extent of TDP-43 pathology was significantly less. Conclusion: Widespread accumulation of DPR within nerve cells may occur much earlier than that of TDP-43 in patients with FTLD bearing expansion in C9ORF72. Dipeptide repeat inclusions may precede TDP-43 accumulation in patients with C9ORF72 repeat expansions.",dipeptide repeat protein;protein;protein p62;TAR DNA binding protein;unclassified drug;adult;aged;article;brain region;bronchopneumonia;C9ORF72 gene;cerebellum;clinical article;clinical feature;correlation analysis;disease severity;female;frontotemporal dementia;gene;gene structure;genetic analysis;heart infarction;hexanucleotide repeat;hippocampus;histopathology;human;human tissue;immunohistochemistry;male;medical history;middle aged;molecular pathology;nerve cell;nucleotide repeat;polymerase chain reaction;priority journal;Southern blotting,"Baborie, A.;Griffiths, T. D.;Jaros, E.;Perry, R.;McKeith, I. G.;Burn, D. J.;Masuda-Suzukake, M.;Hasegawa, M.;Rollinson, S.;Pickering-Brown, S.;Robinson, A. C.;Davidson, Y. S.;Mann, D. M. A.",2015,,,0,
276,Humanin is expressed in human vascular walls and has a cytoprotective effect against oxidized LDL-induced oxidative stress,"AIMS: Humanin (HN) is a 24-amino acid peptide that has been shown to have an anti-apoptotic function against neuronal cell death caused by Alzheimer's disease. Increased oxidative stress, one of the major factors contributing to this cell death, also plays an important role in the inflammatory process of atherosclerosis. The current study was designed to test the hypothesis that HN is expressed in the human vascular wall and may protect against oxidative stress. METHODS AND RESULTS: HN expression in the vascular wall was detected by immunostaining in the endothelial cell layer of human internal mammary arteries (n = 5), atherosclerotic coronary arteries (n = 17), and sections of the greater saphenous vein (n = 3). HN mRNA was expressed in the human aortic endothelial cells (HAECs). Cytoprotective effects of HN against oxidative stress were tested in vitro in HAECs. Pre-treatment with 0.1 microM HN reduced oxidized LDL (Ox-LDL)-induced (i) formation of reactive oxygen species by 50%, (ii) apoptosis by approximately 50% as determined by TUNEL staining, and (iii) formation of ceramide, a lipid second messenger involved in the apoptosis signalling cascade, by approximately 20%. CONCLUSION: The current study demonstrates for the first time the expression of HN in the endothelial cell layer of human blood vessels. Exogenous addition of HN to endothelial cell cultures was shown to be effective against Ox-LDL-induced apoptosis. These findings suggest that HN may play a role and may have a protective effect in early atherosclerosis in humans.","Adult;Aged;Apoptosis;Cells, Cultured;Ceramides/metabolism;Coronary Artery Disease/metabolism/pathology;Coronary Vessels/metabolism/pathology;Cytoprotection;Endothelial Cells/*metabolism/pathology;Humans;Immunohistochemistry;In Situ Nick-End Labeling;Intracellular Signaling Peptides and Proteins/blood/genetics/*metabolism;Lipoproteins, LDL/*metabolism;Mammary Arteries/metabolism/pathology;Middle Aged;*Oxidative Stress;RNA, Messenger/metabolism;Reactive Oxygen Species/metabolism;Saphenous Vein/metabolism/pathology","Bachar, A. R.;Scheffer, L.;Schroeder, A. S.;Nakamura, H. K.;Cobb, L. J.;Oh, Y. K.;Lerman, L. O.;Pagano, R. E.;Cohen, P.;Lerman, A.",2010,Nov 1,10.1093/cvr/cvq191,0,
277,New therapeutic pathways in the RAS,,"1 (4 dimethylamino 3 methylbenzyl) 5 diphenylacetyl 4,5,6,7 tetrahydro 1h imidazo[4,5 c]pyridine 6 carboxylic acid;sacubitril plus valsartan;angiotensin[1-7];azilsartan;cgen 856;diminazene aceturate;ema 401;endothelin A receptor antagonist;membrane metalloendopeptidase;n ethylcarbamoyl 3 [4 (5 formyl 4 methoxy 2 phenyl 1 imidazolylmethyl)phenyl] 5 isobutyl 2 thiophenesulfonamide;nicotinoyltyrosyl(n benzyloxycarbonylarginyl)lysylhistidylprolylisoleucine;nitric oxide;sparsentan;unclassified drug;valsartan;Alzheimer disease;article;binding affinity;drug efficacy;drug half life;heart failure;human;hypertension;multicenter study (topic);obesity;phase 1 clinical trial (topic);phase 2 clinical trial (topic);phase 3 clinical trial (topic);pulmonary hypertension;renin angiotensin aldosterone system;ave 0991;cgp 42112a;lcz 696;pd 123319;re 021","Bader, M.;Santos, R. A.;Unger, T.;Steckelings, U. M.",2012,,,0,
278,Microglia: Activation in acute and chronic inflammatory states and in response to cardiovascular dysfunction,"Microglia are the resident immune cells in the central nervous system and are constantly monitoring their environment. After an insult, they are activated and secrete both pro- and anti-inflammatory mediators. Thus, they can have both detrimental and protective actions. Microglia are activated in many conditions that involve chronic inflammation such as Alzheimer's and Parkinson's diseases and in neuropathic pain. Following cerebral ischemia and stroke, microglia are activated and acutely contribute to neuronal loss and infarct damage. Chronically, in this condition, neuroprotective actions of activated microglia include clearance of the dead cells and secretion of neurotrophins. Of great interest is the recent observation that following myocardial infarction, there is increased inflammation within the hypothalamus and a marked increase in activated microglia. © 2010 Elsevier Ltd.",neurotrophin;Alzheimer disease;brain ischemia;cardiovascular disease;cell activation;cell function;gene activation;heart infarction;human;microglia;neuropathic pain;Parkinson disease;protein secretion;short survey;cerebrovascular accident,"Badoer, E.",2010,,,0,
279,Serum uric acid is associated with better executive function in men but not in women: Baseline assessment of the ELSA-Brasil study,"BACKGROUND: Serum uric acid (SUA) may protect against free radical stress damage and was previously linked to cognitive impairment in older adults, but evidence in middle-aged adults is scarce. PURPOSE: We sought to analyze whether SUA is associated with cognitive performance in apparently healthy middle-aged participants in the ELSA-Brasil cohort study. METHODS: We excluded participants older than age 65, those taking allopurinol, benzbromarone, or medications that could impair cognitive performance, those with previous stroke, and those with incomplete data on cognitive tests or SUA. The Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Test (CERAD-WLMT), the Semantic Fluency Test (SFT), and the Trail Making Test version B (TMT) were used as dependent variables. Sex-specific linear regression models were used to assess the association between SUA and cognitive tests, adjusted by age, education, hypertension, dyslipidemia, diabetes, smoking, alcohol consumption, body mass index, coronary heart disease, renal function, depression, aspirin use, thyroid function, and menopausal status (in women). We used the Bonferroni procedure to control for the false discovery rate associated with multiple comparisons. RESULTS: We analyzed cross-sectional data from 6751 women and 5464 men. Mean age and standard deviation (SD) of the sample was 49.6 (SD 7.4) years for men and 49.9 (SD 7.3) years for women. The majority of men (52%) and women (51%) were white. Mean SUA value was 4.75 (SD 1.16) mg/dL in women and 6.44 (SD 1.39) mg/dL in men. Multivariate linear models showed no association in women and a significant inverse association between SUA levels and TMT (beta=-3.106, 95% CI=-4.594; -1.618, p=0.0004) in men. CONCLUSION: In a middle-aged subset population, SUA is associated with better performance on an executive function test in men, but not in women in the ELSA-Brasil cohort study.",268B43MJ25 (Uric Acid);Adult;Aged;Brazil;Cognition;Cross-Sectional Studies;Executive Function;Female;Humans;Linear Models;Male;Middle Aged;Multivariate Analysis;Prospective Studies;Risk Factors;Sex Factors;Uric Acid/ blood,"Baena, C. P.;Suemoto, C. K.;Barreto, S. M.;Lotufo, P. A.;Bensenor, I.",2017,Jun,,0,
280,Free radicals and grape seed proanthocyanidin extract: importance in human health and disease prevention,"Free radicals have been implicated in over a hundred disease conditions in humans, including arthritis, hemorrhagic shock, atherosclerosis, advancing age, ischemia and reperfusion injury of many organs, Alzheimer and Parkinson's disease, gastrointestinal dysfunctions, tumor promotion and carcinogenesis, and AIDS. Antioxidants are potent scavengers of free radicals and serve as inhibitors of neoplastic processes. A large number of synthetic and natural antioxidants have been demonstrated to induce beneficial effects on human health and disease prevention. However, the structure-activity relationship, bioavailability and therapeutic efficacy of the antioxidants differ extensively. Oligomeric proanthocyanidins, naturally occurring antioxidants widely available in fruits, vegetables, nuts, seeds, flowers and bark, have been reported to possess a broad spectrum of biological, pharmacological and therapeutic activities against free radicals and oxidative stress. We have assessed the concentration- or dose-dependent free radical scavenging ability of a novel IH636 grape seed proanthocyanidin extract (GSPE) both in vitro and in vivo models, and compared the free radical scavenging ability of GSPE with vitamins C, E and beta-carotene. These experiments demonstrated that GSPE is highly bioavailable and provides significantly greater protection against free radicals and free radical-induced lipid peroxidation and DNA damage than vitamins C, E and beta-carotene. GSPE was also shown to demonstrate cytotoxicity towards human breast, lung and gastric adenocarcinoma cells, while enhancing the growth and viability of normal human gastric mucosal cells. The comparative protective effects of GSPE, vitamins C and E were examined on tobacco-induced oxidative stress and apoptotic cell death in human oral keratinocytes. Oxidative tissue damage was determined by lipid peroxidation and DNA fragmentation, while apoptotic cell death was assessed by flow cytometry. GSPE provided significantly better protection as compared to vitamins C and E, singly and in combination. GSPE also demonstrated excellent protection against acetaminophen overdose-induced liver and kidney damage by regulating bcl-X(L) gene, DNA damage and presumably by reducing oxidative stress. GSPE demonstrated excellent protection against myocardial ischemia-reperfusion injury and myocardial infarction in rats. GSPE was also shown to upregulate bcl(2) gene and downregulate the oncogene c-myc. Topical application of GSPE enhances sun protection factor in human volunteers, as well as supplementation of GSPE ameliorates chronic pancreatitis in humans. These results demonstrate that GSPE provides excellent protection against oxidative stress and free radical-mediated tissue injury.","Animals;Anthocyanins/pharmacokinetics/*pharmacology;Antioxidants/pharmacokinetics/*pharmacology;Apoptosis/drug effects;Ascorbic Acid/pharmacology;Biological Availability;Cardiovascular Diseases/prevention & control;Dose-Response Relationship, Drug;Flow Cytometry;Free Radical Scavengers/pharmacokinetics/pharmacology;Free Radicals/*antagonists & inhibitors;Humans;Keratinocytes/cytology/drug effects;Kidney Diseases/prevention & control;Liver Diseases/prevention & control;Neoplasms/prevention & control;Plant Extracts/chemistry/*pharmacology;*Proanthocyanidins;Seeds/chemistry;Vitamin E/pharmacology;beta Carotene/pharmacology","Bagchi, D.;Bagchi, M.;Stohs, S. J.;Das, D. K.;Ray, S. D.;Kuszynski, C. A.;Joshi, S. S.;Pruess, H. G.",2000,Aug 7,,0,
281,Genetic variation: ExAC boosts clinical variant interpretation in rare diseases,,cardiomyopathy;copy number variation;disease association;genetic variability;human;note;phenotype;prion disease;priority journal;rare disease,"Bahcall, O. G.",2016,,,0,
282,In vitro efficacies of clinically available drugs against growth and viability of an acanthamoeba castellanii keratitis isolate belonging to the T4 genotype,"The effects of clinically available drugs targeting muscarinic cholinergic, adrenergic, dopaminergic, and serotonergic receptors; intracellular calcium levels and/or the function of calcium-dependent biochemical pathways; ion channels; and cellular pumps were tested against a keratitis isolate of Acanthamoeba castellanii belonging to the T4 genotype. In vitro growth inhibition (amoebistatic) assays were performed by incubating A. castellanii with various concentrations of drugs in the growth medium for 48 h at 30C. To determine amoebicidal effects, amoebae were incubated with drugs in phosphate-buffered saline for 24 h, and viability was determined using trypan blue exclusion staining. For controls, amoebae were incubated with the solvent alone. Of the eight drugs tested, amlodipine, prochlorperazine, and loperamide showed potent amoebicidal effects, as no viable trophozoites were observed (>95% kill rate), while amiodarone, procyclidine, digoxin, and apomorphine exhibited up to 50% amoebicidal effects. In contrast, haloperidol did not affect viability, but all the drugs tested inhibited A. castellanii growth. Importantly, amlodipine, prochlorperazine, and loperamide showed compelling cysticidal effects. The cysticidal effects were irreversible, as cysts treated with the aforementioned drugs did not reemerge as viable amoebae upon inoculation in the growth medium. Except for apomorphine and haloperidol, all the tested drugs blocked trophozoite differentiation into cysts in encystation assays. Given the limited availability of effective drugs to treat amoebal infections, the clinically available drugs tested in this study represent potential agents for managing keratitis and granulomatous amoebic encephalitis caused by Acanthamoeba spp. and possibly against other meningoencephalitis- causing amoebae, such as Balamuthia mandrillaris and Naegleria fowleri. Copyright © 2013, American Society for Microbiology. All Rights Reserved.",amiodarone;amlodipine;apomorphine;digoxin;haloperidol;loperamide;phosphate buffered saline;prochlorperazine;procyclidine;Acanthamoeba castellanii;Acanthamoeba castellanii keratitis;akathisia;Alzheimer disease;amoeba (life cycle stage);amoebal infection;angina pectoris;article;assay;Balamuthia mandrillaris;culture medium;cyst;delirium;diarrhea;dystonia;erectile dysfunction;genotype;granulomatous amebic encephalitis;growth inhibition;headache;heart arrhythmia;atrial fibrillation;heart atrium flutter;in vitro study;infection;inoculation;keratitis;meningoencephalitis;migraine;Naegleria fowleri;nausea;Parkinson disease;parkinsonism;priority journal;schizophrenia;trophozoite;vertigo,"Baig, A. M.;Iqbal, J.;Khan, N. A.",2013,,,0,
283,Particular aspects in patients with coronary heart disease and vascular cognitive impairment,"Among the patients with cognitive vascular impairment, a particular group is represented by those who have concomitant cerebrovascular and coronary heart disease (CHD). The clinical evolution of some of these patients is dominated apparently by the progressive cognitive impairment and sometimes psychotic episodes and not by evident clinical stroke and/or symptoms of their heart disease, so that they receive the diagnosis of Alzheimer's disease or of a psychiatric disease. Most of these patients have a severe evolution, particularly if their cardiovascular disease is not recognized and die unexpectedly. In the author's clinical experience, the systematic cardiovascular examination in all patients hospitalized with the diagnosis of dementia or cognitive impairment, even if they did not have previously been diagnosed with cerebrovascular and/or coronary heart disease, disclosed in many instances the presence of severe but apparently silent cardiovascular disorders characterized always by concomitant severe CHD and significant large vessel disease of the brain. It is important to emphasize the particular situation in which the progressive cognitive impairment associated or not with psychiatric manifestations could mask severe cardio- and cerebrovascular disorders, which could further be worsened by symptomatic psychiatric treatment, and which evolution is to ""unexpected"" cardiovascular death.","Alzheimer Disease/complications/physiopathology/psychology;Cognition Disorders/*complications/physiopathology/psychology;Coronary Disease/*complications/physiopathology/psychology;Dementia, Vascular/*complications/physiopathology/psychology;Humans","Bajenaru, O.;Antochi, F.;Tiu, C.",2010,Dec 15,10.1016/j.jns.2010.08.049,0,
284,Heart failure re-admission: Measuring the ever shortening gap between repeat heart failure hospitalizations,"Many quality-of-care and risk prediction metrics rely on time to first rehospitalization even though heart failure (HF) patients may undergo several repeat hospitalizations. The aim of this study is to compare repeat hospitalization models. Using a population-based cohort of 40,667 patients, we examined both HF and all cause re-hospitalizations using up to five years of follow-up. Two models were examined: the gap-time model which estimates the adjusted time between hospitalizations and a multistate model which considered patients to be in one of four states; community-dwelling, in hospital for HF, in hospital for any reason, or dead. The transition probabilities and times were then modeled using patient characteristics and number of repeat hospitalizations. We found that during the five years of follow-up roughly half of the patients returned for a subsequent hospitalization for each repeat hospitalization. Additionally, we noted that the unadjusted time between hospitalizations was reduce0d ∼40% between each successive hospitalization. After adjustment each additional hospitalization was associated with a 28 day (95% Cl: 22-35) reduction in time spent out of hospital. A similar pattern was seen when considering the four state model. A large proportion of patients had multiple repeat hospitalizations. Extending the gap between hospitalizations should be an important goal of treatment evaluation.",age;aged;article;Canada;Charlson Comorbidity Index;chronic obstructive lung disease;cohort analysis;comorbidity;dementia;diabetes mellitus;emergency care;female;follow up;health status;atrial fibrillation;heart failure;hospital discharge;hospital readmission;human;hypertension;ischemic heart disease;length of stay;major clinical study;male;neoplasm;peripheral vascular disease;time series analysis,"Bakal, J. A.;McAlister, F. A.;Liu, W.;Ezekowitz, J. A.",2014,,,0,
285,"Memantine treatment in patients with mild to moderate Alzheimer's disease: Results of a randomised, double-blind, placebo-controlled 6-month study","Memantine is a moderate affinity, uncompetitive NMDA receptor antagonist currently approved for the treatment of moderate to severe Alzheimer's disease (AD). A 24-week, double-blind, placebo-controlled, study (Study 99679) conducted in Europe evaluated the efficacy and tolerability of 20mg/day memantine in patients with mild to moderate AD. Patients were randomised to either memantine or placebo in a 2:1 ratio. Efficacy was primarily assessed as change from baseline in ADAS-cog and CIBIC-plus score. Of 470 patients randomised and treated (memantine, n=318; placebo, n=152), 85% and 91% completed the study. Memantine-treated patients showed statistically significant improvement relative to placebo at weeks 12 and 18, and numerical superiority at week 24 on both efficacy scales. The lack of significance at week 24 was attributed to an unexpectedly high placebo response. Memantine was well tolerated with an adverse event profile similar to placebo. The data presented support the efficacy of memantine in mild to moderate AD. © 2007 - IOS Press and the authors. All rights reserved.",memantine;placebo;abdominal pain;accidental injury;adult;aged;agitation;Alzheimer disease;article;brain hemorrhage;clinical trial;controlled clinical trial;controlled study;depression;dizziness;double blind procedure;drug efficacy;drug tolerability;drug withdrawal;female;heart infarction;human;major clinical study;male;pneumonia;priority journal;randomized controlled trial;rhinitis;side effect;statistical significance,"Bakchine, S.;Loft, H.",2007,,,0,
286,"Current FDA-related drug information-New drugs approved by the FDA; New dosage forms and indications approved by the FDA; Agents pending FDA approval; Significant labeling changes or ""dear health professional"" letters related to safety",,alcaftadine;amlodipine;beta adrenergic receptor stimulating agent;botulinum toxin A;glycopyrronium bromide;docetaxel;donepezil;dutasteride;retigabine;heparin;hydrochlorothiazide;lamotrigine;lopinavir plus ritonavir;mitoxantrone;new drug;olmesartan;ribavirin;ticagrelor;topotecan;trebenzor;unclassified drug;acute coronary syndrome;Alzheimer disease;blepharospasm;cervical dystonia;constipation;drug approval;drug contraindication;drug dosage form;drug indication;drug information;drug labeling;drug mechanism;drug megadose;drug safety;dysphagia;eye burning;eye irritation;flushing;focal epilepsy;food and drug administration;headache;heart failure;human;hypertension;influenza;injection site pain;muscle weakness;musculoskeletal pain;neck pain;nose obstruction;ocular pruritus;rhinopharyngitis;short survey;side effect;toxic epidermal necrolysis;vomiting;xerostomia;aricept;avodart;brilinta;copegus;cuvposa;hycamtin;kaletra;lamictal;lastacaft;novantrone;potiga;taxotere;xeomin,"Baker, D.",2010,,,0,
287,New drugs approved by the FDA: Agents pending FDA approval - Supplemental applications filed by manufacturer. Significant labeling changes,,17 methylnaltrexone;adalimumab;ethinylestradiol plus levonorgestrel;amfebutamone;aripiprazole;atomoxetine;betamethasone dipropionate plus calcipotriol;certolizumab pegol;complement component C1s inhibitor;colesevelam;laropiprant plus nicotinic acid;estradiol;fospropofol;human growth hormone;laropiprant;lisdexamfetamine;lithium;loratadine;metformin plus sitagliptin;micafungin;montelukast;natalizumab;nicotinic acid;ora verse;phentolamine mesylate;quetiapine;recombinant blood clotting factor 7a;risedronic acid;rituximab;trastuzumab;unclassified drug;unindexed drug;valproic acid;abdominal pain;abnormal laboratory result;agitation;allergic rhinitis;allergy;anaphylaxis;anesthesia complication;angioneurotic edema;application site reaction;arthralgia;attention deficit disorder;bipolar disorder;bone disease;breast cancer;breast carcinoma;cardiomyopathy;constipation;Crohn disease;dementia;diarrhea;dizziness;drug approval;drug contraindication;drug dosage form;drug effect;drug fatality;drug indication;drug induced cancer;drug information;drug labeling;drug mechanism;drug safety;dyslipidemia;embryotoxicity;endometrium cancer;erythema;fetotoxicity;flatulence;fluid retention;folliculitis;food and drug administration;generalized anxiety disorder;genital tract cancer;glucose intolerance;headache;heart failure;human;allergic reaction;hypothyroidism;immune deficiency;infection;injection site reaction;insomnia;Internet;intracranial hypertension;ischemic heart disease;liver toxicity;lung toxicity;major depression;mania;migraine;mixed mania and depression;nausea;nose obstruction;note;ovary cancer;patient monitoring;practice guideline;progressive multifocal leukoencephalopathy;psoriasis;psoriasis vulgaris;side effect;skin burning sensation;skin exfoliation;Stevens Johnson syndrome;cerebrovascular accident;thromboembolism;tremor;unspecified side effect;upper respiratory tract infection;urinary tract infection;venous thromboembolism;vomiting;xerostomia;abilify;actonel;alesse 28;aplenzin;aquavan;cimzia;cinryze;cordaptive;estrogel;herceptin;humira;janumet;mycamine;novoseven;omnitrope;relistor;rituxan;seroquel xr;seroquel;strattera;taclonex scalp;tysabri;vyvanse;welchol,"Baker, D. E.",2008,,,0,
288,Effects of growth hormone-releasing hormone on cognitive function in adults with mild cognitive impairment and healthy older adults: Results of a controlled trial,"Background: Growth hormone-releasing hormone (GHRH), growth hormone, and insulinlike growth factor 1 have potent effects on brain function, their levels decrease with advancing age, and they likely play a role in the pathogenesis of Alzheimer disease. Previously, we reported favorable cognitive effects of short-term GHRH administration in healthy older adults and provided preliminary evidence to suggest a similar benefit in adults with mild cognitive impairment (MCI). Objective: To examine the effects of GHRH on cognitive function in healthy older adults and in adults with MCI. Design: Randomized,double-blind, placebo-controlledtrial. Setting: Clinical Research Center, University of Washington School of Medicine in Seattle. Participants: A total of 152 adults (66 with MCI) ranging in age from 55 to 87 years (mean age, 68 years); 137 adults (76 healthy participants and 61 participants with MCI) successfully completed the study. Intervention: Participants self-administered daily subcutaneous injections of tesamorelin (Theratechnologies Inc), a stabilized analog of human GHRH (1 mg/d), or placebo 30 minutes before bedtime for 20 weeks. At baseline, at weeks 10 and 20 of treatment, and after a 10-week washout (week 30), blood samples were collected, and parallel versions of a cognitive battery were administered. Before and after the 20-week intervention, participants completed an oral glucose tolerance test and a dual-energy x-ray absorptiometry scan to measure body composition. Main Outcome Measures: Primary cognitive outcomes wereanalyzedusinganalysis ofvarianceandincluded3composites reflecting executive function, verbal memory, and visualmemory. Executive function was assessed with Stroop Color-Word Interference, Task Switching, the Self-Ordered Pointing Test, and Word Fluency, verbal memory was assessed with Story Recall and the Hopkins Verbal Learning Test, andvisualmemorywasassessedwiththeVisual-Spatial Learning Test and Delayed Match-to-Sample. Results: The intent-to-treat analysis indicated a favorable effect of GHRH on cognition (P =.03), which was comparable in adults withMCIandhealthy older adults.Thecompleter analysis showed a similar pattern, with a more robustGHRHeffect (P =.002). Subsequent analyses indicated a positiveGHRHeffectonexecutive function (P =.005)and a trend showing a similar treatment-related benefit in verbalmemory( P =.08). Treatment withGHRHincreased insulinlike growth factor 1 levels by117%(P - .001), which remained within the physiological range, and reduced percentbodyfatby7.4%( P - .001). Treatment withGHRHincreased fasting insulin levelswithinthenormalrangeby35% in adults withMCI(P - .001) but not in healthy adults. Adverse eventsweremildandwerereportedby68%ofGHRHtreated adults and 36% of those who received placebo. Conclusions: Twenty weeks ofGHRHadministration had favorable effects on cognition in both adults with MCI and healthy older adults. Longer-duration treatment trials are needed to further examine the therapeutic potential of GHRH administration on brain health during normal aging and ""pathological aging."" Trial Registration: clinicaltrials.gov Identifier: NCT00257712. ©2012 American Medical Association. All rights reserved.",NCT00257712;growth hormone releasing factor;placebo;somatomedin C;tesamorelin;adult;aged;arthralgia;article;bedtime dosage;blood sampling;body composition;body fat;brain function;cognition;congestive heart failure;controlled study;coronary artery disease;double blind procedure;drug dose increase;drug dose reduction;dual energy X ray absorptiometry;effect size;episodic memory;executive function;female;fluid retention;gastrointestinal symptom;glucose tolerance;human;hypertension;injection site pruritus;injection site reaction;injection site stinging;insulin sensitivity;lean body weight;major clinical study;male;mild cognitive impairment;mood;obesity;paresthesia;patient compliance;priority journal;randomized controlled trial;side effect;skin redness;skin tingling;sleep;verbal memory;visual memory;weight gain,"Baker, L. D.;Barsness, S. M.;Borson, S.;Merriam, G. R.;Friedman, S. D.;Craft, S.;Vitiello, M. V.",2012,,,0,
289,"Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988-2007","Background: hip fractures result in a significant burden to the patient, their caregivers and the health care system. Patients with Alzheimer's disease (AD) have a higher incidence of hip fracture compared with other older people without AD, although it is not clear if AD is an independent risk factor for hip fracture. Methods: a retrospective cohort study was conducted using anonymised electronic medical records from primary care practices in the United Kingdom. Proportional hazards regression modelling with adjustment for potential confounders was used to evaluate AD as an independent risk factor for predicting hip fractures. Results: the incidence of hip fracture among patients with and without AD was 17.4 (95% CI, 15.7-19.2) and 6.6 (95% CI, 5.8-7.6) per 1,000 person years, respectively. Patients with AD had a hazard that was 3.2 (95% CI, 2.4-4.2) times that of non-AD patients after controlling for potential confounders. AD patients who experienced a hip fracture also had an increased mortality rate compared with non-AD patients who experienced a hip fracture (hazard ratio = 1.5; 95% CI, 1.1-1.9). Conclusion: patients with AD and their caregivers should be advised on how to prevent hip fractures and more attention should be given to AD patients who are undergoing rehabilitation following a hip fracture. © The Author 2010. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.",anticonvulsive agent;antidepressant agent;benzodiazepine;corticosteroid;neuroleptic agent;thiazide diuretic agent;vitamin D;Alzheimer disease;article;cohort analysis;comorbidity;controlled study;diabetes mellitus;electronic medical record;female;hazard assessment;heart failure;hip fracture;human;hyperthyroidism;incidence;major clinical study;male;mortality;onset age;osteoporosis;prediction;primary medical care;priority journal;retrospective study;risk factor;smoking;cerebrovascular accident;United Kingdom,"Baker, N. L.;Cook, M. N.;Arrighi, H. M.;Bullock, R.",2011,,,0,
290,"Ischemic stroke in young adults: Risk factors, subtypes, and prognosis","Background: Ischemic strokes occurring in patients younger than 47 years is a relatively rare event and accounts for less than 5% of all ischemic strokes in western countries. OBJECTIVE: The etiologic spectrum in younger patients and older patients differs considerably. Methods: In this hospital case series study, we enrolled 192 patients with ischemic stroke, aged 18 to 47 years, all of whom were submitted to a diagnostic protocol. The risk factors for stroke and the distribution of stroke subtype and prognosis were studied. Modified diagnostic criteria adopted from the Trial of ORG 10172 in Acute Stroke Treatment and the Baltimore-Washington Cooperative Young Stroke Study, were used for etiologic classification. Results: Hypertension was found to be the main risk factor (45%) followed by cigarette smoking (37%), hyperlipidemia (35.4%), diabetes mellitus (17%), and family history of stroke (18%). Hypertension, diabetes mellitus, hypercholesterolemia, and smoking were present either alone or in combination in the majority of our patients. Oral contraceptives were being taken by 25% of the women. The etiology of stroke was as follows: atherothrombosis 26.5%, cardioembolism 20%, nonatherosclerotic vasculopathies 13%, other determined causes 10%, lacunar stroke 6%, migraine 3.6%, and undetermined causes 21%. CONCLUSIONS: Hypertension, diabetes mellitus, hypercholesterolemia, and smoking were the most common risk factors in our ischemic stroke patients between 18-47 years of age. Health care programs targeting the prevention and treatment of these factors will reduce the associated morbidity and mortality of stroke among this socioeconomically active age group. Copyright © 2011 by Lippincott Williams & Wilkins.",lupus anticoagulant;oral contraceptive agent;phospholipid antibody;adult;alcohol consumption;antithrombin III deficiency;artery dissection;artery thrombosis;article;bacterial endocarditis;brain ischemia;CADASIL;cardiomyopathy;smoking;deep vein thrombosis;diabetes mellitus;disease classification;embolism;family history;female;health program;atrial fibrillation;heart atrium myxoma;heart infarction;human;hypercholesterolemia;hyperlipidemia;hypertension;idiopathic thrombocytopenic purpura;major clinical study;male;migraine;morbidity;mortality;patent foramen ovale;polycythemia vera;priority journal;prognosis;protein C deficiency;protein S deficiency;valvular heart disease;vascular disease;vasculitis,"Balci, K.;Utku, U.;Asil, T.;Celik, Y.",2011,,,0,
291,Dementia is a major predictor of death among the Italian elderly,"Background: Neurologic diseases are rarely listed on death certificates because death is more often attributed to cardiovascular and pneumonic events occurring during terminal stages. Objective: To evaluate the effect of major age-associated neurologic and non-neurologic diseases on survival in a cohort of Italian elderly. Methods: A population-based multicenter survey, carried out in eight Italian municipalities, with a sample of 5,632 individuals aged 65 to 84 years. The entire sample was screened for all the diseases under study, and all individuals were interviewed about risk factors. Those who screened positive underwent clinical assessments by specialists. Two years after the baseline survey, the study population was followed up to determine the vital status either directly from the individuals or from proxy respondents. A copy of the death certificate was obtained for each individual who had died. The risk of dying (mortality risk ratio [MRR]) was calculated using the Cox proportional hazards model in which we included all the diseases under study, age, gender, and years of education. Results: At follow-up (mean duration 26.7 ± 5.4 months) 444 individuals had died. The Cox proportional hazards model selected the following as significant predictors of death: age (for year of age MRR = 1.12; 95% confidence interval [CI], 1.08 to 1.15), male gender (MRR = 1.72; 95% CI, 1.27 to 2.34), institutionalization (MRR = 4.17; 95% CI, 2.20 to 7.94), dementia (MRR = 3.61; 95% CI, 2.55 to 5.11), neoplasm (MRR = 2.01; 95% CI, 1.20 to 3.38), heart failure (MRR = 1.87; 95% CI, 1.27 to 2.76), and diabetes (MRR = 1.62; 95% CI, 1.12 to 2.34). Conclusions: These data provide further evidence on the malignancy of dementia, which proved the major predictor of death in the elderly, with an MRR higher than neoplastic diseases and other severe age- associated conditions.",aged;article;death certificate;dementia;demography;follow up;geriatric patient;high risk population;human;Italy;mortality;prediction;priority journal;risk factor;survival rate,"Baldereschi, M.;Di Carlo, A.;Maggi, S.;Grigoletto, F.;Scarlato, G.;Amaducci, L.;Inzitari, D.",1999,,,0,
292,Risk of dementia among elderly nursing home patients using paroxetine and other selective serotonin reuptake inhibitors,"Objective: Selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment for depression. Among the SSRIs, paroxetine has strong anticholinergic properties and may lead to increased risk of adverse cognitive outcomes among elderly patients. This study evaluated the comparative risk of dementia associated with use of paroxetine and other SSRIs among elderly nursing home patients. Methods: A retrospective cohort study using propensity score matching was conducted with 2007-2010 Minimum Data Set-linked Medicare data. The study population included elderly nursing home patients with depression who were new users of SSRIs. Patients were followed for a maximum of two years after index SSRI use. The risk of dementia was modeled by using a robust Cox proportional hazards model to account for clustering within matched users of paroxetine and other SSRIs. Results: The unmatched cohort included 19,952 new users of SSRIs; 1,898 used paroxetine, and 18,054 used other SSRIs. In the propensity-matched cohort of 3,796 patients, the unadjusted incidence of dementia was 7.5% for users of paroxetine and 8.6% for users of other SSRIs. There was no difference in the risk of dementia for users of paroxetine or other SSRIs. These study findings remained robust in multiple sensitivity analyses involving various measures of dementia. Conclusions: Compared with use of other SSRIs, use of paroxetine was not associated with higher risk of dementia among elderly nursing home patients with depression. Future studies are needed to evaluate the impact of paroxetine on other cognition measures.",agents acting on the peripheral nervous and neuromuscular systems;analgesic agent;anorexigenic agent;anticonvulsive agent;antihistaminic agent;antiinfective agent;antiinflammatory agent;antilipemic agent;antineoplastic agent;antiobesity agent;antiparkinson agent;anxiolytic agent;cardiovascular agent;central stimulant agent;cholinesterase inhibitor;gastrointestinal agent;hematologic agent;hypnotic agent;neuroleptic agent;paroxetine;respiratory tract agent;serotonin uptake inhibitor;topical agent;acute heart infarction;age;aged;alcoholism;anemia;anxiety disorder;article;asthma;backache;bipolar disorder;cataract;Caucasian;cerebrovascular accident;chronic obstructive lung disease;cohort analysis;comparative study;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;drug dependence;drug use;dysphagia;endocarditis;extrapyramidal syndrome;falling;female;fibromyalgia;gender;glaucoma;gout;heart arrhythmia;hip fracture;human;hyperlipidemia;hypertension;hypothyroidism;insomnia;ischemia;kidney disease;kidney failure;liver disease;major clinical study;male;medical history;medicare;mental disease;migraine;mood disorder;neoplasm;nursing home patient;obesity;osteoarthritis;osteoporosis;Parkinson disease;peripheral occlusive artery disease;pneumonia;propensity score;prostate hypertrophy;race;retrospective study;rheumatoid arthritis;risk assessment;sample size;schizophrenia;stomach disease;thromboembolism;transient ischemic attack;treatment duration;ulcer,"Bali, V.;Chatterjee, S.;Carnahan, R. M.;Chen, H.;Johnson, M. L.;Aparasu, R. R.",2015,,,0,
293,Centenarian offspring: A model for understanding longevity,"A main objective of current medical research is to improve the life quality of elderly people as priority of the continuous increase of ageing population. This phenomenon implies several medical, economic and social problems because of dramatic increase in number of non autonomous individuals affected by various pathologies. Accordingly, the research interest is focused on understanding the biological mechanisms involved in determining (he positive ageing phenotype, i.e. the centenarian phenotype. In achieving this goal the choice of an appropriate study models is fundamental. Centenarians have been used as an optimal model for successful ageing. However, this model shows several limitations, i.e. the selection of appropriate controls and the use itself of the centenarians as a suitable model for healthy ageing. Thus, the interest has been centered on centenarian offspring, health) elderly people. They may represent a model for understanding exceptional longevity for the following reasons: they exhibit a protective genetic background, cardiovascular and immunological profile, as well as a reduced rate of cognitive decline than age-matched people without centenarian relatives. Several of these aspects are summarized in this review based on the literature and the results of our studies.",heat shock protein 70;high density lipoprotein cholesterol;immunoglobulin M;low density lipoprotein cholesterol;mitochondrial DNA;telomerase reverse transcriptase;acute heart infarction;aging;Alzheimer disease;article;B lymphocyte;cardiovascular risk;CD8+ T lymphocyte;cerebrovascular accident;dementia;gene mutation;genetic variability;genotyping technique;homozygosity;human;hypertension;immune deficiency;ischemic heart disease;longevity;memory;memory disorder;natural killer cell;non insulin dependent diabetes mellitus;phenotype;progeny;very elderly,"Balistreri, C. R.;Candore, G.;Accardi, G.;Buffa, S.;Bulati, M.;Martorana, A.;Colonna-Romano, G.;Lio, D.;Caruso, C.",2014,,,0,
294,Role of TLR4 polymorphisms in inflammatory responses: implications for unsuccessful aging,"The total burden of infection at various sites may affect the progression of atherosclerosis and Alzheimer's disease (AD), the risk being modulated by host genotype. The role of lipopolysaccharide (LPS) receptor TLR4 is paradigmatic. It initiates the innate immune response against gram-negative bacteria, and TLR4 single nucleotide polymorphisms (SNPs), such as +896A/G, known to attenuate receptor signaling, have been described. This SNP shows a significantly lower frequency in patients affected by myocardial infarction or AD. Thus, people genetically predisposed to developing lower inflammatory activity seem to have less chance of developing cardiovascular disease (CVD) or AD. In the present report, to validate this hypothesis, the levels of the eicosanoids, leukotriene B4 (LTB4) and prostaglandin E2 (PGE2), known to be involved as mediators in age-related diseases, were determined by an enzyme-linked immunosorbent assay in supernatants from a whole blood assay, after stimulation with subliminal doses of LPS from Escherichia coli. The samples, genotyped for the +896A/G SNP, were challenged with LPS for 4, 24, and 48 h. Both LTB4 and PGE2 values were significantly lower in carriers bearing the TLR4 mutation. Therefore, the pathogen burden, by interacting with the host genotype, determines the type and intensity of the inflammatory responses accountable for proinflammatory status, CVD, AD, and unsuccessful aging (i.e., age-related inflammatory diseases).","Adult;Aging/*genetics/*metabolism;Alzheimer Disease/*genetics/*metabolism;Blood Cells/metabolism;Cells, Cultured;Dinoprostone/biosynthesis;Escherichia coli;Escherichia coli Infections/genetics/metabolism;Female;Genotype;Humans;Immunity, Innate/genetics;Inflammation/genetics/metabolism;Leukotriene B4/biosynthesis;Lipopolysaccharides/pharmacology;Male;Middle Aged;Myocardial Infarction/*genetics/*metabolism;*Polymorphism, Single Nucleotide;Time Factors;Toll-Like Receptor 4/*genetics/*metabolism","Balistreri, C. R.;Candore, G.;Listi, F.;Fazio, T.;Gangi, S.;Incalcaterra, E.;Caruso, M.;Vecchi, M. L.;Lio, D.;Caruso, C.",2007,Nov,10.1196/annals.1404.003,0,
295,LPS-mediated production of pro/anti-inflammatory cytokines and eicosanoids in whole blood samples: biological effects of +896A/G TLR4 polymorphism in a Sicilian population of healthy subjects,"Toll-like receptors (TLRs) are the principal mediators of rapid microbial recognition: the lipopolysaccharide (LPS) receptor TLR4 seems to have a paradigmatic role. Single nucleotide polymorphisms (SNPs) in the TLR4 gene, such as +896A/G, known to attenuate receptor signaling, have been described. The +896A/G SNP is significantly less frequent in patients with myocardial infarction, Alzheimer's disease or prostate cancer, whereas it is overrepresented in centenarians. To clarify and confirm the biological effects of +896A/G SNP and its role in the pathophysiology of age-related diseases and longevity, we assessed the levels of IL-6, TNF-alpha, IL-10 and eicosanoids (LTB4 and PGE2) in LPS-stimulated whole blood samples in vitro of 50 young healthy Sicilians, screened for the presence of this SNP. To evaluate the possible influence of SNPs in PTGS2 and 5-Lo genes on eicosanoid production, the enrolled individuals were also genotyped for -765G/C PTGS2 and -1708G/A 5-Lo SNPs. Both pro-inflammatory cytokines and eicosanoids were significantly lower in carriers bearing the TLR4 mutation, whereas the anti-inflammatory IL-10 values were higher. On the basis of data reported herein, some suggestions can be drawn. First, pathogen load, by interacting with the host genotype, determines the type and intensity of inflammatory responses, according to the pro-inflammatory status and tissue injury, implicated in the pathophysiology of major age-related diseases. Second, adequate control of inflammatory response might reduce the risk of these diseases, and, reciprocally, might increase the chance of extended survival in an environment with reduced antigen (that is, pathogen) load.","Adult;Cytokines/*biosynthesis;Dinoprostone/*biosynthesis/genetics;Female;Humans;Italy;Leukotriene B4/*biosynthesis/genetics;Lipopolysaccharides/*pharmacology;Male;Middle Aged;*Polymorphism, Single Nucleotide;Toll-Like Receptor 4/*blood/genetics","Balistreri, C. R.;Caruso, C.;Listi, F.;Colonna-Romano, G.;Lio, D.;Candore, G.",2011,Mar,10.1016/j.mad.2010.12.005,0,
296,"Ischemic axonopathy: The missing link between cardiocerebral hypotension, white matter loss, and Alzheimer's disease",,amyloid beta protein;fibrinogen;thrombin;Alzheimer disease;brain ischemia;cerebrospinal fluid;disease association;heart infarction;heart muscle fibrosis;hypotension;ischemic axonopathy;letter;meningeal artery;neuropathy;priority journal;vascular amyloidosis;white matter injury,"Ball, M. J.",2012,,,0,
297,Women's use of hormone replacement therapy for disease prevention; Results of a community survey,"This study investigated whether an increased use of hormone replacement therapy (HRT) is attributable to a growing motivation among women to use the therapy for disease prevention. Compared with earlier studies, results from this community survey of women aged 51 to 57 years revealed an increased use of HRT; 60% of women had tried HRT, with a median of four years' duration of use. The most frequently cited primary use of HRT was symptom relief, although many women also took the therapy for the prevention of osteoporosis. While women generally commence HRT for symptom relief, the extended use of the therapy is, in part, likely to be attributable to an increased motivation among women to remain on HRT for its 'added' benefit of preventing osteoporosis.",sex hormone;adult;aged;aging;Alzheimer disease;article;community care;comparative study;controlled study;drug utilization;female;health survey;hormone substitution;hot flush;human;hysterectomy;ischemic heart disease;long term care;major clinical study;menopausal syndrome;motivation;postmenopause osteoporosis;preventive health service;questionnaire;symptomatology,"Ballard, K.",2002,,,0,
298,Intramedullary fixation of pertrochanteric fractures after hip resurfacing arthroplasty - Do we have the answer? Case report and literature review,"Objective: To report a case of a peri-prosthetic hip fracture fixed using a previously unreported technique of intramedullary nailing with dual proximal fixation. Case summary: An 81-year-old nursing home resident suffered a multi-fragmentary peri-prosthetic hip fracture around a Birmingham Hip Resurfacing arthroplasty (BHR), which was fixed using a novel technique. Discussion: Such fractures pose a significant surgical dilemma with regards to the optimal method of treatment. The increasing popularity of these implants suggests that these fractures will become increasingly common. Conclusion: We believe that our technique provides a practical and satisfactory solution to these fractures.",dalteparin;aged;article;aspiration pneumonia;blood transfusion;case report;cemented prosthesis;compression stocking;diffuse Lewy body disease;falling;fluoroscopy;follow up;general condition deterioration;Harris hip score;heart arrest;hip arthroplasty;hip fracture;hip osteoarthritis;hip radiography;hip resurfacing arthroplasty;hip resurfacing device;human;intramedullary nail;intramedullary nailing;male;mobilization;operative blood loss;Parkinson disease;patient satisfaction;postoperative pain;postoperative period;priority journal;respiratory failure;surgical approach;thrombosis;thrombosis prevention;treatment outcome;weight bearing;Birmingham Hip Resurfacing arthroplasty;TED;universal nailing system,"Banerjee, S.;Little, T.;Little, N.",2015,,,0,
299,2014 eighth joint national committee panel recommendation for blood pressure targets revisited: Results from the invest study,"BACKGROUND: The 2014 Eighth Joint National Committee panel recommendations for management of high blood pressure (BP) recommend a systolic BP threshold for initiation of drug therapy and a therapeutic target of <150 mm Hg in those ≥60 years of age, a departure from prior recommendations of <140 mm Hg. However, it is not known whether this is an optimal choice, especially for the large population with coronary artery disease (CAD). OBJECTIVES: This study sought to evaluate optimal BP in patients ≥60 years of age. METHODS: Patients 60 years of age or older with CAD and baseline systolic BP >150 mm Hg randomized to a treatment strategy on the basis of either atenolol/ hydrochlorothiazide or verapamil-SR (sustained release)/trandolapril in INVEST (INternational VErapamil SR Trandolapril STudy) were categorized into 3 groups on the basis of achieved on-treatment systolic BP: group 1, <140 mm Hg; group 2, 140 to <150 mm Hg; and group 3, ≥150 mm Hg. Primary outcome was first occurrence of all-cause death, nonfatal myocardial infarction (MI), or nonfatal stroke. Secondary outcomes were all-cause mortality, cardiovascular mortality, total MI, nonfatal MI, total stroke, nonfatal stroke, heart failure, or revascularization, tabulated separately. Outcomes for each group were compared in unadjusted and multiple propensity score-adjusted models. RESULTS: Among 8,354 patients included in this analysis with an accumulated 22,308 patient-years of follow-up, 4,787 (57%) achieved systolic BP of <140 mm Hg (group 1), 1,747 (21%) achieved systolic BP of 140 to <150 mm Hg (group 2), and 1,820 (22%) achieved systolic BP of ≥150 mm Hg (group 3). In unadjusted models, group 1 had the lowest rates of the primary outcome (9.36% vs. 12.71% vs. 21.32%; p < 0.0001), all-cause mortality (7.92% vs. 10.07% vs. 16.81%; p < 0.0001), cardiovascular mortality (3.26% vs. 4.58% vs. 7.80%; p < 0.0001), MI (1.07% vs. 1.03% vs. 2.91%; p < 0.0001), total stroke (1.19% vs. 2.63% vs. 3.85%; p <0.0001), and nonfatal stroke (0.86% vs 1.89% vs 2.86%; p<0.0001) compared with groups 2 and 3, respectively. In multiple propensity score-adjusted models, compared with the reference group of <140 mm Hg (group 1), the risk of cardiovascular mortality (adjusted hazard ratio [HR]: 1.34; 95% confidence interval [CI]: 1.01 to 1.77; p = 0.04), total stroke (adjusted HR: 1.89; 95% CI: 1.26 to 2.82; p = 0.002) and nonfatal stroke (adjusted HR: 1.70; 95% CI: 1.06 to 2.72; p = 0.03) was increased in the group with BP of 140 to <150 mm Hg, whereas the risk of primary outcome, all-cause mortality, cardiovascular mortality, total MI, nonfatal MI, total stroke, and nonfatal stroke was increased in the group with BP ≥150 mm Hg. CONCLUSIONS: In hypertensive patients with CAD who are ≥60 years of age, achieving a BP target of 140 to <150 mm Hg as recommended by the JNC-8 panel was associated with less benefit than the previously recommended target of <140 mm Hg. © 2014 by the American College of Cardiology Foundation.",atenolol;hydrochlorothiazide;trandolapril plus verapamil;adult;age distribution;aged;Alzheimer disease;angina pectoris;article;atrioventricular block;blood pressure measurement;blood pressure monitoring;blood pressure regulation;bradycardia;cardiovascular mortality;cerebrovascular accident;clinical evaluation;constipation;controlled study;coronary artery disease;coughing;diastolic blood pressure;dizziness;drug indication;drug response;dyspnea;female;follow up;gastrointestinal hemorrhage;geriatric care;gout;headache;heart failure;heart infarction;heart muscle revascularization;human;hyperkalemia;hypokalemia;kidney failure;major clinical study;male;malignant neoplastic disease;medical society;outcome assessment;Parkinson disease;peripheral edema;peripheral vascular disease;population research;practice guideline;priority journal;randomized controlled trial;reference value;systolic blood pressure;systolic hypertension;unstable angina pectoris;wheezing,"Bangalore, S.;Gong, Y.;Cooper-Dehoff, R. M.;Pepine, C. J.;Messerli, F. H.",2014,,,0,
300,Psychiatric comorbidity and mortality among veterans hospitalized for congestive heart failure,"A Behavioral Model of Health Services Utilization approach was used to examine the impact of comorbid mental illness on mortality of veterans admitted to Veterans Affairs medical centers in fiscal year 2001 with a primary diagnosis of congestive heart failure (n = 15,497). Thirty percent had a psychiatric diagnosis, 4.7% died during the index hospitalization, and 11.5% died during the year following discharge. Among those with mental illness, 23.6% had multiple psychiatric disorders. Multivariable logistic regression models found dementia to be positively associated with inpatient mortality. Depression alone (excluding other psychiatric disorders) was positively associated with one-year mortality. Primary care visits were associated with a reduced likelihood of both inpatient and one-year mortality. Excepting dementia, VA patients with a mental illness had comparable or higher levels of primary care visits than those having no mental illness. Patients with multiple psychiatric disorders had more outpatient care than those with one psychiatric disorder.",aged;article;dementia;depression;female;heart failure;hospitalization;human;male;mental disease;socioeconomics;United States;veteran,"Banta, J. E.;Andersen, R. M.;Young, A. S.;Kominski, G.;Cunningham, W. E.",2010,,,0,
301,Charlson comorbidity index adjustment in intracerebral hemorrhage,"Background and Purpose-Previous studies of intracerebral hemorrhage (ICH) outcome prediction models have not systematically included adjustment for comorbid conditions. The purpose of this study was to assess whether the Charlson Comorbidity Index (CCI) was associated with early mortality and long-term functional outcome in patients with intracerebral hemorrhage. Methods-We performed a retrospective analysis on a prospective observational cohort of patients with ICH admitted to 2 University of California San Francisco hospitals from June 1, 2001 to May 31, 2004. Components of the ICH score and use of early care limitations were recorded. Outcome was assessed using the modified Rankin Scale to 12 months. The CCI was derived using hospital discharge International Classification of Diseases, revision 9 codes and patient history obtained from standardized case report forms. RESULTS-: In this cohort of 243 ICH patients, comorbid conditions were common, with CCI scores ranging from 0 to 12. Only 29% of patients with high CCI scores (3) achieved a 12-month modified Rankin Scale score of 3 compared with 48% of patients with CCI scores of 0 (P=0.02). CCI score was independently predictive of 12-month functional outcome, with higher CCI having a greater impact (CCI=2: odds ratio, 2.3; P=0.06; CCI=3: odds ratio, 3.5; P=0.001). Conclusions-Comorbid medical conditions as measured by the CCI independently influence outcome after ICH. Future ICH outcome studies should account for the impact of comorbidities on patient outcome. © 2011 American Heart Association, Inc.",acquired immune deficiency syndrome;article;brain hemorrhage;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;heart infarction;hemiplegia;hospital discharge;human;International Classification of Diseases;kidney disease;leukemia;liver disease;lymphoma;major clinical study;medical history;mortality;outcome assessment;peripheral vascular disease;predictive value;priority journal;Rankin scale;rating scale;retrospective study;risk assessment;solid tumor;neoplasm;ulcer,"Bar, B.;Hemphill, J. C.",2011,,,0,
302,An adolescent on peritoneal dialysis with acute encephalopathy: Questions,,antibiotic agent;antinuclear antibody;corticosteroid;dopamine;double stranded DNA antibody;immunoglobulin;milrinone;steroid;acute brain disease;adolescent;alopecia;anamnesis;blood pressure;cardiomyopathy;case report;echocardiography;electrocardiography;encephalitis;female;fluid resuscitation;heart left ventricle function;hospital admission;human;intensive care unit;intubation;kidney failure;leukocyte count;lymphocyte;magnetic resonance angiography;mental deterioration;mouth mucosa;mouth temperature;muscle reflex;muscle tone;neutrophil;note;nuclear magnetic resonance imaging;oxygen saturation;peritoneal dialysis;priority journal,"Baracco, R.;Ku, L.;Adabala, M.;Jain, A.;Valentini, R. P.;Mattoo, T. K.;Kapur, G.",2013,,,0,
303,Cardiac and cerebrovascular morbidity and mortality associated with antipsychotic medications in elderly psychiatric inpatients,"OBJECTIVE: To evaluate the rate of adverse medical outcomes for elderly exposed to antipsychotic treatment. METHODS: This was a retrospective evaluation of psychiatric inpatients records. Age, gender, diagnosis, treatment with antipsychotics, and duration of treatment were analyzed. An acute cardiac or cerebrovascular event necessitating transfer to a general hospital or resulting in death was the outcome measure. RESULTS: During 15 years (1990 to 2005), 3,111 elderly were hospitalized. Their mean age was 73.5 +/- 6.1 years, 1,220 were male (39%), and 1,891 were female (61%). Most patients (2,583 [83%]) were exposed to antipsychotics, of which 1,402 (54%) were exposed to second-generation antipsychotics (SGAs). Antipsychotic-treated patients did not have a higher rate of adverse medical outcomes compared with patients who had not received antipsychotics. No significant differences were noted between patients exposed to typical antipsychotics or SGAs. CONCLUSION: Treatment of elderly psychiatric inpatients with antipsychotics did not increase their risk of adverse medical outcomes. Thus, regulating the use of conventional antipsychotics or SGAs for all elderly patients in all indications may be premature.","Aged;Aged, 80 and over;Alzheimer Disease/*drug therapy/*mortality;Antipsychotic Agents/*adverse effects/therapeutic use;Cause of Death;Cerebral Infarction/*chemically induced/*mortality;Female;Humans;Israel;Male;Myocardial Infarction/*chemically induced/*mortality;Outcome Assessment (Health Care)/statistics & numerical data;Psychotic Disorders/*drug therapy/*mortality;Retrospective Studies;Risk Factors","Barak, Y.;Baruch, Y.;Mazeh, D.;Paleacu, D.;Aizenberg, D.",2007,Apr,10.1097/JGP.0b013e318030253a,0,
304,Escitalopram versus risperidone for the treatment of behavioral and psychotic symptoms associated with Alzheimer's disease: A randomized double-blind pilot study,"Background: Antipsychotics are frequently used to treat psychosis, aggression and agitation in patients with Alzheimer's disease (AD), but safety warnings abound. Escitalopram was investigated since citalopram has demonstrated some effectiveness in AD. We compared escitalopram and risperidone for psychotic symptoms and agitation associated with AD. Methods: Inpatients with AD, who had been hospitalized because of behavioral symptoms, were recruited to a six-week randomized, double-blind, controlled trial. Participants (n = 40) were randomized to once daily risperidone 1 mg or escitalopram 10 mg. Results: The NPI total score improved in both groups. Onset was earlier in the risperidone-treated group, but improvement did not significantly differ between groups by study end. Completion rates differed for escitalopram (75%) and risperidone (55%), mainly due to adverse events. There were no adverse events in the escitalopram group, while in the risperidone group two patients suffered severe extrapyramidal symptoms and four patients suffered acute physical illness necessitating transfer to general hospital. Conclusion: Escitalopram and risperidone did not differ in efficacy in reducing psychotic symptoms and agitation in patients with AD. Completion rates were higher for escitalopram-treated patients. Replication in larger trials with ambulatory patients is needed. Copyright © 2011 International Psychogeriatric Association.",NCT01119638;cholinesterase inhibitor;escitalopram;memantine;risperidone;absence of side effects;aged;agitation;Alzheimer disease;article;behavior disorder;clinical article;controlled study;disease association;disease severity;double blind procedure;drug efficacy;extrapyramidal symptom;female;heart infarction;human;male;Mini Mental State Examination;pilot study;pneumonia;psychosis;randomized controlled trial;scoring system;treatment duration;urosepsis,"Barak, Y.;Plopski, I.;Tadger, S.;Paleacu, D.",2011,,,0,
305,"Effects of Various Kynurenine Metabolites on Respiratory Parameters of Rat Brain, Liver and Heart Mitochondria","Previously, we demonstrated that the endogenous glutamate receptor antagonist kynurenic acid dose-dependently and significantly affected rat heart mitochondria. Now we have investigated the effects of L-tryptophan, L-kynurenine, 3-hydroxykynurenine and kynurenic, anthranilic, 3-hydroxyanthranilic, xanthurenic and quinolinic acids on respiratory parameters (ie, state 2, state 3), respiratory control index (RC) and ADP/oxygen ratio in brain, liver and heart mitochondria of adult rats. Mitochondria were incubated with glutamate/malate (5 mM) or succinate (10 mM) and in the presence of L-tryptophan metabolites (1 mM) or in the absence, as control. Kynurenic and anthranilic acids significantly reduced RC values of heart mitochondria in the presence of glutamate/malate. Xanthurenic acid significantly reduced RC values of brain mitochondria in the presence of glutamate/malate. Furthermore, 3-hydroxykynurenine and 3-hydroxyanthranilic acid decreased RC values of brain, liver and heart mitochondria using glutamate/malate. In the presence of succinate, 3-hydroxykynurenine and 3-hydroxyanthranilic acid affected RC values of brain mitochondria, whereas in liver and heart mitochondria only 3-hydroxykynurenine lowered RC values significantly. Furthermore, lowered ADP/oxygen ratios were observed in brain mitochondria in the presence of succinate with 3-hydroxykynurenine and 3-hydroxyanthranilic acid, and to a lesser extent with glutamate/malate. In addition, 3-hydroxyanthranilic acid significantly lowered the ADP/oxygen ratio in heart mitochondria exposed to glutamate/malate, while in the liver mitochondria only a mild reduction was found. Tests of the influence of L-tryptophan and its metabolites on complex I in liver mitochondria showed that only 3-hydroxykynurenine, 3-hydroxyanthranilic acid and L-kynurenine led to a significant acceleration of NADH-driven complex I activities. The data indicate that L-tryptophan metabolites had different effects on brain, liver and heart mitochondria. Alterations of L-tryptophan metabolism might have an impact on the bioenergetic activities of brain, liver and/or heart mitochondria and might be involved in the development of clinical symptoms such as cardiomyopathy, hepatopathy and dementia.",brain;dementia;heart;kynurenine metabolites;liver;misfoldome;respiratory parameters of mitochondria;xanthurenic acid,"Baran, H.;Staniek, K.;Bertignol-Sporr, M.;Attam, M.;Kronsteiner, C.;Kepplinger, B.",2016,,10.4137/ijtr.s37973,0,
306,Epilepsy in a rural elderly population,"PURPOSE: The first goal of this study was to describe the characteristics of elderly patients with epilepsy and the antiepileptic drugs used to treat them. Next, the factors (such as epilepsy type, seizure frequency, medical comorbidities, etc.) influencing antiepileptic drug choice and living situation were explored. METHODS: Retrospective chart review of patients older than 70 with epilepsy seen in a rural health care system. This yielded 449 patients with epilepsy, 54 patients with isolated seizures and 38 patients with syncope as the primary diagnosis. RESULTS: The most commonly used antiepileptic drug was phenytoin. New generation AED's which had fewer side effects were used much less frequently than old generation AED's but the probability of using new generation AED's was increased in patients with renal failure and congestive heart failure as well as in patients that had seen a neurologist. Patients with acute symptomatic seizures, dementia, chronic obstructive pulmonary disease, frequent seizures and advanced age were less likely to be independent. Patients that had seen a neurologist as an outpatient were more likely to live independently. CONCLUSIONS: The elderly are a vulnerable population because of difficulty communicating their symptoms and their needs. This leads to the suboptimal use of AED's as well as poor outcomes. Careful attention to seizure control and medication side effects is critical in promoting good outcomes in this patient group. This retrospective study suggests that access of elderly patients with epilepsy to specialty care improves outcomes in terms of living status. This important information needs to be confirmed by prospective studies.",Activities of Daily Living;Aged/*statistics & numerical data;Anticonvulsants/administration & dosage/adverse effects/therapeutic use;Drug Utilization;Electroencephalography;Epilepsy/drug therapy/*epidemiology/physiopathology;Female;Humans;Logistic Models;Male;Medical Records/statistics & numerical data;Prognosis;Regression Analysis;Retrospective Studies;Rural Population;Seizures/drug therapy/etiology;Treatment Outcome,"Baran, M.;Stecker, M. M.",2007,Sep,10.1684/epd.2007.0113,0,
307,Hospitalizations and mortality in the United States for adults with Down syndrome and congenital heart disease,"Congenital heart disease (CHD) is common in patients with Down syndrome (DS), and these patients are living longer lives. The aim of this study was to describe the epidemiology of hospitalizations in adults with DS and CHD in the United States. Hospitalizations from 1998 to 2009 for adults aged 18 to 64 years with and without DS with CHD diagnoses associated with DS (atrioventricular canal defect, ventricular septal defect, tetralogy of Fallot, and patent ductus arteriosus) were analyzed using the Nationwide Inpatient Sample. Outcomes of interest were (1) in-hospital mortality, (2) common co-morbidities, (3) cardiac procedures, (4) hospital charges, and (5) length of stay. Multivariate modeling adjusted for age, gender, CHD diagnosis, and co-morbidities. There were 78,793 +/- 2,653 CHD admissions, 9,088 +/- 351 (11.5%) of which were associated with diagnoses of DS. The proportion of admissions associated with DS (DS/CHD) decreased from 15.2 +/- 1.3% to 8.5 +/- 0.9%. DS was associated with higher in-hospital mortality (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.4 to 2.4), especially in women (OR 2.4, 95% CI 1.7 to 3.4). DS/CHD admissions were more commonly associated with hypothyroidism (OR 7.7, 95% CI 6.6 to 9.0), dementia (OR 82.0, 95% CI 32 to 213), heart failure (OR 2.2, 95% CI 1.9 to 2.5), pulmonary hypertension (OR 2.5, 95% CI 2.2 to 2.9), and cyanosis or secondary polycythemia (OR 4.6, 95% CI 3.8 to 5.6). Conversely, DS/CHD hospitalizations were less likely to include cardiac procedures or surgery (OR 0.3, 95% CI 0.2 to 0.4) and were associated with lower charges ($23,789 +/- $1,177 vs $39,464 +/- $1,371, p <0.0001) compared to non-DS/CHD admissions. In conclusion, DS/CHD hospitalizations represent a decreasing proportion of admissions for adults with CHD typical of DS; patients with DS/CHD are more likely to die during hospitalization but less likely to undergo a cardiac procedure.","Adolescent;Adult;Comorbidity;Cross-Sectional Studies;Down Syndrome/*complications/economics/epidemiology;Female;Heart Defects, Congenital/*complications/economics/epidemiology/therapy;*Hospital Charges;Hospital Mortality;Hospitalization/economics/*statistics & numerical data;Humans;Length of Stay/statistics & numerical data;Male;Middle Aged;Prevalence;Retrospective Studies;Risk Factors;Sex Factors;United States/epidemiology","Baraona, F.;Gurvitz, M.;Landzberg, M. J.;Opotowsky, A. R.",2013,Apr 1,10.1016/j.amjcard.2012.12.025,0,
308,Rehabilitation modalities in palliative care,"Palliative care incorporates an interdisciplinary team approach to the continued care of patients with life-threatening illnesses and their families. Major palliative diagnoses include cancer, chronic obstructive pulmonary disease, congestive heart failure, and neurodegenerative disorders such as amyotrophic lateral sclerosis and end-stage dementia. When treating these patients with an interdisciplinary approach, rehabilitation medicine specialists and rehabilitative modalities are beneficial adjuvants. Like palliative medicine, rehabilitation medicine also incorporates an interdisciplinary approach to treating patients with chronic and even terminal illnesses. These rehabilitation modalities may include physical therapy, occupational therapy, speech therapy, transcutaneous electrical nerve stimulation units, heat pads, massage, prosthetics, orthotics, and medications and may be useful in improving function, mobility, activities of daily living, pain relief, endurance, and the psyche of a patient with a terminal illness. The modalities may also improve the patient's quality of life and ability to maintain as much independence as possible. In turn, this independence can decrease the burden on caregivers and family members. This review article focuses on rehabilitation modalities than can be used in patients with terminal illnesses in a palliative care setting. © 2013 by Begell House, Inc.",antineoplastic agent;baclofen;beta 2 adrenergic receptor blocking agent;botulinum toxin;buspirone;cholinergic receptor blocking agent;glucocorticoid;methylxanthine derivative;riluzole;sertraline;tricyclic antidepressant agent;Alzheimer disease;amyotrophic lateral sclerosis;analgesia;anxiety disorder;article;bereavement counseling;cancer chemotherapy;cancer palliative therapy;cancer patient;cancer rehabilitation;cardiac patient;cardiovascular disease;caregiver burden;chronic disease;chronic obstructive lung disease;cognitive therapy;coping behavior;daily life activity;delirium;depression;dyspnea;endurance;endurance training;exercise;heart failure;heart left ventricle ejection fraction;heart muscle oxygen consumption;human;hypersalivation;hyperthermic therapy;independence;kinesiotherapy;life sustaining treatment;low energy radiation;lung function test;massage;mobilization;mood disorder;myalgia;neoplasm;nutritional support;occupational therapy;orthotics;oxygen therapy;palliative therapy;patient care;physiotherapy;positive end expiratory pressure;priority journal;prosthesis;pulmonary rehabilitation;quality of life;range of motion;rehabilitation care;rehabilitation medicine;resistance training;resuscitation;sedation;self care;side effect;social psychology;speech therapy;terminal care;terminal disease;terminally ill patient;transcutaneous nerve stimulation,"Barawid, E. L.;Covarrubias, N.;Tribuzio, B.;Karimi, D. P.;Liao, S.",2013,,,0,
309,Poststroke dementia: Clinical features and risk factors,"Background and Purpose - The goal of the present study was to examine a series of putative risk factors of poststroke dementia (PSD), especially those factors usually associated with cerebrovascular disease and degenerative dementia, in a series of 251 consecutive unselected stroke patients. Methods - A standard protocol was prospectively applied at admission and 3 months after stroke; this protocol included clinical, functional, and cognitive assessments, hemogram and serum biochemistry, ECG and CT exams, apolipoprotein E and angiotensin-converting enzyme genotype, and neuropsychological examination. After a neuropsychological examination and an interview with a relative, the following diagnostic criteria were used: the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV for dementia after stroke, DSM-III-R for previous dementia and dementia stage, and Association Internationale pour la Recherche et l'Enseignement en Neurologie (NINDS-AIREN) for vascular dementia. Results - Seventy-five cases (30%) demonstrated dementia at 3-month follow up; 25 of them (10%) had demonstrated dementia before the stroke. Dementia was unrelated to type (ischemic/hemorrhagic) or location of stroke, vascular factors (hypertension, diabetes, ischemic heart disease, or hypercholesterolemia), apolipoprotein E or angiotensinconverting enzyme genotype, and serum homocysteine. Age (odds ratio [OR] 1.1, 95% CI 1.03 to 1.2), previous nephropathy (OR 6.1, 95% CI 1.5 to 24.3), atrial fibrillation (OR 4.4, 95% CI 1.4 to 13.9), low Canadian Neurological Scale score at discharge (OR 0.5, 95% CI 0.4 to 0.6), and previous mental decline assessed by the shortened Spanish version of the Informant Questionnaire on Cognitive Decline in the Elderly (SS-IQCODE; OR 1.2, 95% CI 1.1 to 1.4) were the correlates of dementia in logistic regression analyses. The same risks factors were found when cases with previous dementia and with hemorrhagic stroke were excluded. Conclusions - Dementia is frequent after ischemic or hemorrhagic stroke. Age, nephropathy, atrial fibrillation, previous mental decline, and stroke severity independently contribute to the risk.",apolipoprotein E;dipeptidyl carboxypeptidase;homocysteine;adult;age;aged;article;cerebrovascular disease;clinical feature;cognition;computer assisted tomography;controlled study;degenerative disease;dementia;electrocardiogram;female;atrial fibrillation;human;kidney disease;laboratory test;major clinical study;male;multiinfarct dementia;neuropsychological test;priority journal;questionnaire;risk factor;cerebrovascular accident,"Barba, R.;Martínez-Espinosa, S.;Rodríguez-García, E.;Pondal, M.;Vivancos, J.;Del Ser, T.",2000,,,0,
310,Admission of nursing home residents to a hospital internal medicine department,"Objective: Hospitalization of nursing home residents is costly and potentially exposes residents to iatrogenic disease and psychological harm. Design and Setting: In this study, we analyzed the data from the Basic Minimum Data Set of patients hospitalized from the nursing home who were discharged from all the internal medicine departments at the National Health Service hospitals in Spain between 2005 and 2008, according to the data provided by the Ministry of Health and Consumer Affairs. Results: Between January 2005 and December 2008, 2,134,363 patients were admitted to internal medicine departments in Spain, of whom 45,757 (2.1%) were nursing home residents. Overall, 7898 (17.3%) patients died during hospitalization, 2442 (30.91%) of them in the first 48 hours. The following variables were the significant predictors of in-hospital mortality in multivariate analysis: age (odds ratio [OR] 1.02, 95% confidence intervals [CI] 1.02-1.03), female gender (OR 1.13, 95% CI 1.13-1.17), dementia (OR 1.09, 95% CI 1.03-1.16), previous feeding tube (OR 1.34, 95% CI 1.09-1.79), malignant disease (OR 2.03, 95% CI 1.86-2.23), acute infectious disease (OR 1.18, 95% CI 1.12-1.25), pressure sores (OR 1.88, 95% CI 1.62-1.95), acute respiratory failure (OR 2.00, 95% CI 1.90-2.10), and nosocomial pneumonia (OR 2.5, 95% CI 2.23-2.72). Conclusions: Two of every 100 patients admitted to internalmedicine departments came from nursing homes. The rate of mortality is very high in these patients, with almost one third of patients dying in the first 48 hours, which suggests that many of these transfers were unnecessary. The cost of these admissions for 1 year was equivalent to the annual budget of a 300- to 400-bed public hospital in Spain. The mechanism of coordination between nursing homes and public hospitals must be reviewed with the aim of containing costs and facilitating the care of patients in the last days of life. © 2012 American Medical Directors Association, Inc.",acute heart infarction;acute kidney failure;acute respiratory failure;aged;article;cerebrovascular disease;chronic kidney failure;chronic liver disease;chronic lung disease;Clostridium difficile infection;congestive heart failure;decubitus;dementia;female;hip fracture;hospital acquired pneumonia;hospital admission;hospitalization cost;human;internal medicine;major clinical study;male;malnutrition;mortality;neoplasm;nursing home;nursing home patient;Spain;thromboembolism,"Barba, R.;Zapatero, A.;Marco, J.;Perez, A.;Canora, J.;Plaza, S.;Losa, J.",2012,,,0,
311,Magnesium homeostasis and aging,"Aging is very often associated with magnesium (Mg) deficit. Total plasma magnesium concentrations are remarkably constant in healthy subjects throughout life, while total body Mg and Mg in the intracellular compartment tend to decrease with age. Dietary Mg deficiencies are common in the elderly population. Other frequent causes of Mg deficits in the elderly include reduced Mg intestinal absorption, reduced Mg bone stores, and excess urinary loss. Secondary Mg deficit in aging may result from different conditions and diseases often observed in the elderly (i.e. insulin resistance and/or type 2 diabetes mellitus) and drugs (i.e. use of hypermagnesuric diuretics). Chronic Mg deficits have been linked to an increased risk of numerous preclinical and clinical outcomes, mostly observed in the elderly population, including hypertension, stroke, atherosclerosis, ischemic heart disease, cardiac arrhythmias, glucose intolerance, insulin resistance, type 2 diabetes mellitus, endothelial dysfunction, vascular remodeling, alterations in lipid metabolism, platelet aggregation/thrombosis, inflammation, oxidative stress, cardiovascular mortality, asthma, chronic fatigue, as well as depression and other neuropsychiatric disorders. Both aging and Mg deficiency have been associated to excessive production of oxygen-derived free radicals and lowgrade inflammation. Chronic inflammation and oxidative stress are also present in several age-related diseases, such as many vascular and metabolic conditions, as well as frailty, muscle loss and sarcopenia, and altered immune responses, among others. Mg deficit associated to aging may be at least one of the pathophysiological links that may help to explain the interactions between inflammation and oxidative stress with the aging process and many age-related diseases.",magnesium;adult;aged;aging;article;blood;diet;DNA damage;homeostasis;human;immunology;inflammation;magnesium deficiency;metabolism;middle aged;oxidative stress;pathophysiology;physiology;risk factor;urine,"Barbagallo, M.;Belvedere, M.;Dominguez, L. J.",2009,,,0,
312,Clinical course of cardiomyopathy in HIV-infected patients with or without encephalopathy related to the myocardial expression of tumour necrosis factor-alpha and nitric oxide synthase,"OBJECTIVE: To define whether the development of encephalopathy influences the clinical course of HIV-associated cardiomyopathy (HIV-DCM) in relation to the myocardial expression of tumour necrosis factor-alpha (TNF-alpha) and inducible nitric oxide synthase (iNOS). DESIGN: Prospective study. SETTING: University hospitals and AIDS centres. METHODS: 115 HIV-infected patients with echocardiographic diagnosis of HIV-associated cardiomyopathy (34 with encephalopathy and 81 without encephalopathy) were followed for a mean of 24 +/- 3.2 months. All patients underwent endomyocardial biopsy for determination of myocardial immunostaining intensity of TNF-alpha and iNOS. Cerebrospinal fluid (CSF) from patients with encephalopathy was examined for the presence of viruses. Patients underwent clinical examination every 3 months and echocardiographic examination every 6 months. The intensity of TNF-alpha and iNOS immunostaining was also evaluated on postmortem cerebral tissue of patients who died of congestive heart failure (CHF). RESULTS: A greater impairment of echocardiographic parameters was observed in patients with HIV-associated cardiomyopathy after development of encephalopathy. These parameters tended to worsen progressively during the follow-up period and were inversely correlated with HIV-1 viral load, CD4 cell count, mini mental status score and the intensity of myocardial and cerebral TNF-alpha and iNOS staining. CSF specimens were available in 29 patients with encephalopathy. HIV-1 sequences were detected in CSF of all these patients with cytomegalovirus sequences in two. The mortality rate for CHF was greater among patients with encephalopathy (73% versus 12%). CONCLUSIONS: The development of encephalopathy has an adverse effect on the clinical course of HIV-associated cardiomyopathy. In the relationship between cardiomyopathy and encephalopathy, the activation of iNOS by TNF-alpha may have a significant pathogenetic role in HIV disease.","AIDS Dementia Complex/*complications/metabolism/virology;Adult;Cardiomyopathy, Dilated/*complications/metabolism/mortality/virology;Cerebral Cortex/metabolism/virology;Cerebrospinal Fluid/virology;Echocardiography;Female;HIV Infections/*complications/metabolism/virology;HIV-1/physiology;Heart/virology;Humans;Male;Myocardium/*metabolism;Nitric Oxide Synthase/*biosynthesis;RNA, Viral/blood;Tumor Necrosis Factor-alpha/*biosynthesis;Viral Load","Barbaro, G.;Di Lorenzo, G.;Soldini, M.;Giancaspro, G.;Grisorio, B.;Pellicelli, A. M.;D'Amati, G.;Barbarini, G.",2000,May 5,,0,
313,Unrecognized cognitive impairment in cardiac rehabilitation patients,"To determine the prevalence of unrecognized brain dysfunction accompanying chronic severe cardiac disease, we examined 20 clinically stable consecutive admissions to a cardiac rehabilitation service who were free of known stroke or dementia. Age range was 47 to 85 years (mean +/- SEM, 72.5 +/- 2.1 years), the male: female ratio was 10:10. Multiple cognitive deficits including significant memory impairment and disorientation were present in eight patients (40%), and seven of these eight patients were unable to administer their own medications reliably. An additional six patients (30%) showed milder impairments. One patient was found to be normal after neurological examination, four showed evidence of a single brain lesion, and 15 of 20 (75%) had multiple neurological abnormalities suggesting multifocal brain disease. The mechanism of cognitive deficits in cardiac patients is unclear, and it may be related to multiple infarcts, or acute or chronic hypoxic damage secondary to arrhythmias, cardiac failure, or small vessel disease of the brain. The term ""circulatory dementia"" is proposed to describe patients with vascular disease and non-Alzheimer type dementia. Patients with cardiac disease should undergo cognitive screening, as early identification of patients at risk of progressive intellectual loss may allow early use of preventive therapy.",Aged;Cognition Disorders/diagnosis/*etiology;Female;Heart Diseases/*complications/rehabilitation;Humans;Intelligence Tests;Male;Middle Aged;Motor Skills;Neuropsychological Tests,"Barclay, L. L.;Weiss, E. M.;Mattis, S.;Bond, O.;Blass, J. P.",1988,Jan,,0,
314,Coronary artery disease and plasma apolipoprotein E4 in mild cognitive impairment,"BACKGROUND: Atherosclerosis and apolipoprotein E4 (APOE4) are known risks for Dementia. We sought to evaluate the relationship between coronary atherosclerosis and APOE4 with mild cognitive impairment (MCI). METHODS: In a case-control study, subjects with age more than 60 years and recent coronary angiography were evaluated by mini-mental state examination and neuropsychiatry unit cognitive assessment tool (NUCOG) to find the patients with MCI (n = 40) and the controls with normal cognition (n = 40). Coronary angiography records were re-assessed to find the severity of coronary artery disease by the Gensini scores. Plasma levels of APOE4 were measured. RESULTS: There were no-significant difference between the 2 groups regarding the plasma APOE4 levels (P = 0.706) and the Gensini scores (P = 0.236). Associations between the Gensini scores and the NUCOG scores in the MCI group (r = -0.196, P = 0.225) and the control group (r = 0.189, P = 0.243) were not significant. However, the interaction effect between the Gensini and the NUCOG scores based on allocation to the control or the patient groups showed statistically significant difference (F(1,67) = 4.84, P = 0.031). CONCLUSION: Although atherosclerosis has been considered as known risk factor for dementia and MCI, this study could not reveal that coronary atherosclerosis-related to declining in cognitive functioning. There was no significant association between plasma APOE4 levels and MCI.",Angiography;Apolipoprotein E4;Coronary Artery;Mild Cognitive Impairment,"Barekatain, M.;Zahedian, F.;Askarpour, H.;Maracy, M. R.;Hashemi-Jazi, M.;Aghaye-Ghazvini, M. R.",2014,Sep,,0,
315,"Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population","Objective: Acute lower extremity ischemia (ALI) is a common vascular surgery emergency associated with high rates of morbidity and mortality. The purpose of this study was to assess contemporary trends in the incidence of ALI, the methods of treatment, and the associated mortality and amputation rates in the U.S. Medicare population. Methods: This was an observational study using Medicare claims data between 1998 and 2009. Outcomes examined included trends in the incidence of ALI; trends in interventions for ALI; and trends in amputation, mortality, and amputation-free survival rates. Results: Between 1998 and 2009, the incidence of hospitalization for ALI decreased from 45.7 per 100,000 to 26.0 per 100,000 (P for trend <.001). The percentage of patients undergoing surgical intervention decreased from 57.1% to 51.6% (P for trend <.001), whereas the percentage of patients undergoing endovascular interventions increased from 15.0% to 33.1% (P for trend <.001). In-hospital mortality rates decreased from 12.0% to 9.0% (P for trend <.001), whereas 1-year mortality rates remained stable at 41.0% and 42.5% (P for trend not significant). In-hospital amputation rates remained stable at 8.1% and 6.4% (P for trend not significant), whereas 1-year amputation rates decreased from 14.8% to 11.0% (P for trend <.001). In-hospital amputation-free survival after hospitalization for ALI increased from 81.2% to 85.4% (P for trend <.001); however, 1-year amputation-free survival remained unchanged. Conclusions: Between 1998 and 2009, the incidence of ALI among the U.S. Medicare population declined significantly, and the percentage of patients treated with endovascular techniques markedly increased. During this time, 1-year amputation rates declined. Furthermore, although in-hospital mortality rates declined after presentation with ALI, 1-year mortality rates remained unchanged. Copyright © 2014 by the Society for Vascular Surgery.",age;aged;amputation free survival;article;cerebrovascular disease;chronic kidney failure;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;endovascular surgery;female;gender;atrial fibrillation;hospitalization;human;hyperlipidemia;hypertension;incidence;leg amputation;leg ischemia;limb salvage;liver disease;major clinical study;male;malignant neoplastic disease;medicare;mortality;observational study;outcome assessment;paralysis;priority journal;race;survival;survival rate;survival time;United States;very elderly,"Baril, D. T.;Ghosh, K.;Rosen, A. B.",2014,,,0,
316,Development and validation of a brief dementia screening indicator for primary care,"Background Detection of ""any cognitive impairment"" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives. Methods We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening. Results The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m2 (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78). Conclusions The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.",age distribution;aged;article;body mass;cerebrovascular accident;clinical assessment tool;cognitive defect;cohort analysis;daily life activity;dementia;dementia screening indicator;depression;diabetes mellitus;educational status;female;high risk patient;high risk population;human;hypertension;ischemic heart disease;low risk population;major clinical study;male;obesity;primary medical care;priority journal;risk factor;validation study,"Barnes, D. E.;Beiser, A. S.;Lee, A.;Langa, K. M.;Koyama, A.;Preis, S. R.;Neuhaus, J.;McCammon, R. J.;Yaffe, K.;Seshadri, S.;Haan, M. N.;Weir, D. R.",2014,,,0,
317,"Prediction of recovery, dependence or death in elders who become disabled during hospitalization","BACKGROUND: Many older adults become dependent in one or more activities of daily living (ADLs: dressing, bathing, transferring, eating, toileting) when hospitalized, and their prognosis after discharge is unclear. OBJECTIVE: To develop a prognostic index to estimate one-year probabilities of recovery, dependence or death in older hospitalized patients who are discharged with incident ADL dependence. DESIGN: Retrospective cohort study. PARTICIPANTS: 449 adults aged ≥ 70 years hospitalized for acute illness and discharged with incident ADL dependence. MAIN MEASURES: Potential predictors included demographics (age, sex, race, education, marital status), functional measures (ADL dependencies, instrumental activities of daily living [IADL] dependencies, walking ability), chronic conditions (e.g., congestive heart failure, dementia, cancer), reason for admission (e.g., neurologic, cardiovascular), and laboratory values (creatinine, albumin, hematocrit). Multinomial logistic regression was used to develop a prognostic index for estimating the probabilities of recovery, disability or death over 1 year. Discrimination of the index was assessed for each outcome based on the c statistic. KEY RESULTS: During the year following hospitalization, 36 % of patients recovered, 27 % remained dependent and 37 % died. Key predictors of recovery, dependence or death were age, sex, number of IADL dependencies 2 weeks prior to admission, number of ADL dependencies at discharge, dementia, cancer, number of other chronic conditions, reason for admission, and creatinine levels. The final prognostic index had good to excellent discrimination for all three outcomes based on the c statistic (recovery: 0.81, dependence: 0.72, death: 0.78). CONCLUSIONS: This index accurately estimated the probabilities of recovery, dependence or death in adults aged 70 years or older who were discharged with incident disability following hospitalization. This tool may be useful in clinical settings to guide care discussions and inform decision-making related to post-hospitalization care. © 2012 Society of General Internal Medicine.",albumin;creatinine;acute disease;ADL disability;aged;albumin blood level;article;bath;chronic disease;clinical decision making;congestive heart failure;controlled study;convalescence;creatinine blood level;daily life activity;death;dementia;eating;educational status;elderly care;female;hematocrit;hospital admission;hospital discharge;hospitalization;human;major clinical study;male;neoplasm;prediction;prognosis;race;retrospective study;walking difficulty,"Barnes, D. E.;Mehta, K. M.;Boscardin, W. J.;Fortinsky, R. H.;Palmer, R. M.;Kirby, K. A.;Landefeld, C. S.",2013,,,0,
318,Type and extent of myocardial injury related to brain damage and its significance in heart transplantation: a morphometric study,"BACKGROUND: Focal myocardial necrosis reported in patients who died of brain lesions and in donor hearts soon after insertion has been attributed to catecholamine-related injury induced before operation, or in the perioperative period. Interpretation of the morphofunctional type of myocardial injury observed and its quantification may help understand both its pathophysiology and clinical relevance. METHODS: In 27 patients without heart disease who died of intracranial brain hemorrhage after berry aneurysm rupture, terminal clinical signs were correlated with the presence of absence of myocardial injury. All hearts were systematically examined, and the total histologic area was measured in square millimeters, with both the number of foci and myocardial cells showing necrosis, normalized to 100 mm2. Forty-five cases of fatal head trauma (26 ""instantaneous"" and 19 ""rapid"" deaths) in normal subjects and 38 cases of acquired immunodeficiency syndrome with (14 cases) or without (24 cases) severe brain damage were used as control subjects. RESULTS: Contraction band necrosis was the only form of myocardial necrosis found in 89% of patients with acute brain hemorrhage. Its extent was 26 +/- 34 foci and 67 +/- 104 necrotic myocardial cells x 100 mm2. In patients with acquired immunodeficiency syndrome, its frequency was 58% in those without and 78.5% with severe brain lesions, with foci and myocardial cell values of 1 +/- 1.5 and 10 +/- 22 and 7 +/- 16 and 17 +/- 32, respectively. In head trauma cases with instantaneous death, the frequency was 4% (one case only with foci 0.5 and myocardial cells 35), whereas with a rapid death it was 40% (foci 12 +/- 18 and myocardial cells 21 +/- 33). CONCLUSIONS: The observed myocardial injury was present in all groups examined, being maximal in patients with intracranial brain hemorrhage with longer survival and minimal in patients with head trauma who died instantaneously. In this setting, this lesion is typical of catecholamine myotoxicity and may express a sympathetic overstimulation either in the agonal period and independent of therapy or be caused by brain injury, especially intracranial brain hemorrhage. However, the extent of myocardial injury observed was minimal and should not jeopardize cardiac function if hearts from such subjects are transplanted.","AIDS Dementia Complex/complications/physiopathology;Acquired Immunodeficiency Syndrome/complications/physiopathology;Adult;Age Factors;Aged;Aneurysm, Ruptured/complications/physiopathology;Brain Abscess/complications/physiopathology;Brain Diseases/*complications/physiopathology;Catecholamines/physiology;Cause of Death;Cerebral Hemorrhage/complications/physiopathology;Craniocerebral Trauma/complications/physiopathology;Female;Heart Transplantation/*pathology;Humans;Intracranial Aneurysm/complications/physiopathology;Male;Meningoencephalitis/complications/physiopathology;Middle Aged;Myocardial Infarction/etiology/pathology/physiopathology;Myocardial Ischemia/*etiology/pathology/physiopathology;Myocardium/pathology;Necrosis;Organ Size;Sex Factors;Sympathomimetics/pharmacology","Baroldi, G.;Di Pasquale, G.;Silver, M. D.;Pinelli, G.;Lusa, A. M.;Fineschi, V.",1997,Oct,,0,
319,Comorbidity and polypharmacy in chronic heart failure: A large cross-sectional study in primary care,"Background: Comorbidity is common in heart failure, but previous prevalence estimates have been based on a limited number of conditions using mainly non-primary care data sources. Aim: To compare prevalence rates of comorbidity and polypharmacy in those with and without chronic heart failure due to left ventricular systolic dysfunction (LVSD). Design and setting A cross-sectional study of 1.4 million patients in primary care in Scotland. Method: Data on the presence of LVSD, 31 other physical, and seven mental health comorbidities, and prescriptions were extracted from a database of 1 424 378 adults. Comorbidity prevalence was compared in patients with and without LVSD, standardised by age, sex, and deprivation. Pharmacology data were also compared between the two groups. Results: There were 17 285 patients (1.2%) who had a diagnosis of LVSD. Compared with standardised controls, the LVSD group had greater comorbidity, with the biggest difference found for seven or more conditions (odds ratio [OR] 4.10; 95% confidence interval (CI] = 3.90 to 4.32). Twenty-five physical conditions and six mental health conditions were significantly more prevalent in those with LVSD relative to standardised controls. Polypharmacy was higher in the LVSD group compared with controls, with the biggest difference found for ≥11 repeat prescriptions (OR 4.81; 95% CI = 4.60 to 5.04). However, these differences in polypharmacy were attenuated after controlling for the number of morbidities, indicating that much of the additional prescribing was accounted for by multimorbidity rather than LVSD per se. Conclusion: Extreme comorbidity and polypharmacy is significantly more common in patients with chronic heart failure due to LVSD. The efficient management of such complexity requires the integration of general and specialist expertise.",adult;age;aged;alcoholism;anorexia;anxiety disorder;article;asthma;atrial fibrillation;bipolar disorder;blindness;bronchiectasis;bulimia;cardiac patient;cerebrovascular accident;chronic kidney failure;chronic liver disease;chronic obstructive lung disease;chronic pain;chronic sinusitis;comorbidity;constipation;controlled study;cross-sectional study;dementia;depression;diabetes mellitus;diverticulosis;dyspepsia;eczema;epilepsy;female;gender;glaucoma;health;hearing impairment;heart failure;human;hypertension;inflammatory bowel disease;learning disorder;left ventricular systolic dysfunction;major clinical study;male;malignant neoplasm;mental health;middle aged;migraine;multiple sclerosis;Parkinson disease;polypharmacy;prescription;primary medical care;prostate disease;psoriasis;rheumatoid arthritis;schizophrenia;Scotland;thyroid disease;transient ischemic attack;virus hepatitis;young adult,"Baron-Franco, B.;McLean, G.;Mair, F. S.;Roger, V. L.;Guthrie, B.;Mercer, S. W.",2017,,10.3399/bjgp17X690533,0,
320,Transfusion associated circulatory overload (TACO) - Underestimated complication of transfusion: A case report,"Aim of the article is to emphasize the need for a multidisciplinary approach in identification, diagnosis and therapy of TACO, and differentiate it from the transfusion related acute lung injury (TRALI) A 85-year-old woman with the subacute calculous cholecystitis received four units of fresh frozen plasma (FFP) for the preoperative correction of prolonged prothrombin time. At the end of transfusion, clinical deterioration was observed with dyspnea, ortopnea, cold sweating, hypertension and bilateral auscultatory crackles. The patient was intubated and mechanical ventilation and diuretic therapy were initiated. After the stabilization she was operated. On the following day she received two doses of packed red blood cells (PRBC) in order to correct moderate anemia, and her clinical and respiratory status deteriorated again. Acute myocardial infarction, pulmonary embolism and pneumonia were excluded by appropriate examinations. Chest X-ray (CXR), hemodynamic monitoring and cardiac ultrasound showed parahillar bilateral infiltrates, increased preload parameters and reduced ejection fraction (EF). Although we initially suspected that the patient developed TRALI, the clinical symptoms, hemodynamic and cardiac status directed us to the diagnosis of TACO. Even relatively small volumes of blood components are sufficient to trigger TACO in high risk patients. Because of the prolonged Intensive care unit (ICU) and hospital stay and possible increased mortality, clinicians should identify high risk patients and consider the use of diuretics in a pretransfusion period. Adherence to evidence-based transfusion practice is of great importance as it could prevent TACO or minimize its consequences.",analgesic agent;antibiotic agent;D dimer;diuretic agent;fresh frozen plasma;furosemide;morphine;noradrenalin;prothrombin complex;troponin T;vitamin K group;warfarin;acute cholecystitis;adult respiratory distress syndrome;aged;anemia;antibiotic therapy;article;artificial ventilation;blood transfusion reaction;cardiologist;case report;central venous pressure;cholecystectomy;chronic kidney failure;continuous infusion;crackle;deterioration;diabetes mellitus;diuresis;diuretic therapy;dyspnea;echocardiography;empyema;erythrocyte;female;fever;atrial fibrillation;heart ejection fraction;heart preload;hemodynamic monitoring;human;hypertension;hypotension;hypoxia;kidney failure;low drug dose;mental deterioration;multiple organ failure;non ST segment elevation myocardial infarction;oliguria;oxygen saturation;oxygen therapy;pleura effusion;preoperative care;prothrombin time;respiratory tract intubation;sepsis;sweating;thorax radiography;transfusion associated circulatory overload;transfusion related acute lung injury;very elderly,"Baronica, R.;Funes, T.;Tonković, D.;Drvar, Ž;Pavlović, D. B.;Režek, K.;Divjak, L.",2013,,,0,
321,In vitro stimulation of tissue-type plasminogen activator by Alzheimer amyloid β-peptide analogues,"We have studied the effects of amyloid β-peptide analogues on the activity of tissue-type plasminogen activator (t-PA) in vitro. We have found that these peptides have a marked stimulatory effect upon plasminogen activation by t-PA, comparable to that of known stimulators of t-PA. This stimulatory activity appears to increase when β-peptides form aggregated fibrillar structures similar to those found in amyloid deposits. This finding is significant in that it may provide insights into the pathogenesis of hereditary cerebral haemorrhage with amyloidosis-Dutch type (HCHWA-D) and cerebral amyloid angiopathy-related cerebral haemorrhage. It may also provide an explanation for the deaths resulting from intracerebral haemorrhage that have occurred in patients undergoing t-PA treatment for acute myocardial infarction.",alteplase;amyloid beta protein;apoferritin;benzoylarginine 4 nitroanilide;bovine serum albumin;chromogenic substrate;corticotropin releasing factor;cyanogen bromide;fibrin;fibrinogen;growth hormone releasing factor;ovalbumin;plasmin;pyruvate kinase;tissue plasminogen activator;acute heart infarction;amyloidosis;article;brain hemorrhage;cause of death;controlled study;human;Michaelis Menten kinetics;plasminogen activation;priority journal;activase,"Barry Kingston, I.;Castro, M. J. M.;Anderson, S.",1995,,,0,
322,The views of older people and carers on participation in clinical trials: The PREDICT Study,"Concern over the inappropriate exclusion of older people from clinical trials is longstanding. The PREDICT study used mixed methods to investigate the extent of this exclusion and to explore the views of those directly involved. This paper reports findings from that aspect of the study investigating the views of older people and carers. Drawing on findings from earlier stages in the study, a structured interview schedule was developed to form the basis of focus group discussions. Groups were held across nine countries: the Czech Republic, Israel, Italy, Lithuania, Holland, Poland, Romania, Spain and the UK (n = 42). Discussants were those living with conditions commonly affecting older people: hypertension, cancer, dementia, heart failure, stroke and depression (n = 285). Data were analyzed for differences and commonalities within and between groups. Issues raised fell into four themes: ageism, both within society and amongst clinicians and researchers; advantages and disadvantages to participation; the relationship between the participant and their clinician/research team; and practical features to support participation. Findings confirm that older people and carers see chronological age as an insufficient reason for exclusion from trials and view such exclusion as age discrimination. They point to the complex relationship between healthcare professionals and trial participants and identify the need for cultural and generational sensitivity in trial design, as well as the importance of considering adaptations to meet special needs. Finally, they identify the need for quality of life to be included as an outcome measure in such research and emphasize the importance of including lay perspectives in health research design generally. © 2012 Future Science Ltd.",adult;aged;ageism;article;caregiver;clinical article;clinical trial (topic);controlled study;Czech Republic;data analysis;dementia;depression;female;group process;health care need;health care personnel;heart failure;human;hypertension;Israel;Italy;Lithuania;male;neoplasm;Netherlands;outcome assessment;patient participation;Poland;priority journal;quality of life;Romania;scientist;sensitivity analysis;Spain;cerebrovascular accident;structured interview;study design;United Kingdom,"Bartlam, B.;Crome, P.;Lally, F.;Beswick, A. D.;Cherubini, A.;Clarfield, A. M.;Edbrooke, D.;Farré, A.;Hertogh, C.;Lesauskaite, V.;Mills, G.;Muller, M.;Oristrell, J.;Prada, G. I.;Ruggiero, C.;Sinclair-Cohen, J.;Szczerbińska, K.;Topinkova, E.;Zalewski, Z.",2012,,,0,
323,Acute coronary syndrome in octogenarians: Association between percutaneous coronary intervention and long-term mortality,"Aim: Evidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS. Methods and results: We followed 353 consecutive patients aged $80 years hospitalized with ACS during 2006-2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P,0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5). In propensity-matched cohort, 5-year all-cause mortalit was 54.9% and 83.1% in the PCI and non-PCI groups, respectively. Kaplan-Meier survival curves and log rank test showed significantly improved mean survival rates (P=0.001): 48 months (95% CI 41-54) for PCI-treated patients versus 35 months (95% CI 29-42) for non-PCI-treated patients. Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction #45%, estimated glomerular filtration rate #35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins. Conclusion: In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.",clopidogrel;hydroxymethylglutaryl coenzyme A reductase inhibitor;acute coronary syndrome;age;aged;article;chronic obstructive lung disease;controlled study;daily life activity;diabetes mellitus;female;gender;glomerulus filtration rate;heart left ventricle ejection fraction;human;hypertension;major clinical study;male;mental deterioration;mitral valve regurgitation;mortality;percutaneous coronary intervention,"Barywani, S. B.;Li, S.;Lindh, M.;Ekelund, J.;Petzold, M.;Albertsson, P.;Lund, L. H.;Fu, M. L.",2015,,,0,
324,Genes for exceptional longevity,"Families with exceptional longevity may inherit biological factors that favorably modulate aging processes and disease susceptibility. This inheritance has been demonstrated across generations in families with exceptional long-lived individuals. However, the genetic/biological pathways responsible for such phenotypes are still under active investigation. When studying genes that may be associated with human longevity, one must consider several approaches: 1. Infer that genes that modulate lifespan in lower species are conserved and have similar role in human aging. Such aging associated systems might have originated from a very early common ancestor. An example of such a lineage associated with aging is the insulin/insulin-like growth factor (IGF1) signaling pathway, which involves in many functions that are necessary for metabolism, growth, and fertility in animal models including fl ies, nematodes, and mammals. Mutations in genes that are part of this pathway in lower species led to signifi cant increases in lifespan. This observation, coupled with the homology to the human pathway, raised special interest in studying genetic alterations in the insulin/IGF1 signaling that may contribute to human's longevity. 2. Study genetic factors associated or causative to age-related diseases, namely cardiovascular disease, diabetes mellitus, cancer, and Alzheimer's disease. Because those diseases account for most age-dependent mortality, it was proposed that the more ""perfect"" (the one depleted from genotypes associated with age-related disease), the longer and healthier one would live. However, extremely old individuals that have genetic factors for these diseases seem to be protected from such diseases. Discovering such genomic mechanisms may provide another avenue to discover genetic protective mechanisms against known disease genotypes. 3. Discover protective genes in centenarians and their families. Centenarians and their family members seem to share certain biological protective factors that could be more easily discerned when looking beyond the centenarian index case. The survival advantage of these families is highly heritable, with siblings and offspring of centenarians also living long lives. Identifying which genes confer this unique advantage is also critical in understanding what controls human lifespan.",adiponectin;apolipoprotein C3;biological factor;cholesterol ester transfer protein;growth hormone;insulin receptor;liothyronine;lipoprotein;microRNA;microsomal triglyceride transfer protein;somatomedin C;thyrotropin;thyrotropin receptor;transcription factor FKHRL1;aged;aging;allele;Alzheimer disease;atherosclerosis;cardiovascular disease;conceptual framework;diabetes mellitus;disease predisposition;epigenetics;exceptional longevity;exercise;family;gene;gene frequency;gene mutation;gene sequence;genetic association;genetic conservation;genotype;growth hormone deficiency;heart infarction;heredity;hormone release;human;hypertension;inheritance;insulin sensitivity;Laron syndrome;lifespan;longevity;malignant neoplastic disease;methylation;mortality;next generation sequencing;obesity;phenotype;premature aging;progeny;single nucleotide polymorphism;smoking;transient ischemic attack,"Barzilai, N.;Atzmon, G.",2014,,,0,
325,Pharmacological prevention and treatment of vascular dementia: Approaches and perspectives,"Vascular dementia (VaD) is a common dementing illness. There are no pharmacological agents with a regulatory approval for its treatment or prevention. Review of published clinical trial reports indicates that early treatment of hypertension, a risk factor for stroke, reduces VaD risk and slows progression. However, unlike stroke, treatment of hyperlipidemia with statin class drugs or treatment of blood clotting abnormalities with acetylsalicylic acid do not appear to have an effect on VaD incidence or progression. Pharmacological agents for treatment of Alzheimer's dementia (AD) such as memantine or acetylcholinesterase inhibitors have small positive effects on cognition in VaD, which are likely due to their action on co-existing AD-related neuropathology. Drug development efforts using novel approaches such as patient stratification by their genotype are needed in order to address the increasing need for effective VaD therapeutics. © 2012 Elsevier Inc.",acetylsalicylic acid;adrenergic receptor blocking agent;angiotensin receptor antagonist;calcium channel blocking agent;cholinesterase inhibitor;citicoline;dihydroergotoxine mesilate;dipeptidyl carboxypeptidase inhibitor;diuretic agent;donepezil;folic acid;galantamine;Ginkgo biloba extract;huperzine A;hydroxymethylglutaryl coenzyme A reductase inhibitor;memantine;nicergoline;nimodipine;placebo;rivastigmine;Alzheimer disease;Alzheimer disease Functional Assessment and Change Scale;Alzhemer Disease Assessment Scale cognitive;anorexia;antihypertensive therapy;anxiety disorder;article;bleeding;brain dysfunction;CADASIL;cerebrovascular accident;Clinical Dementia Rating scale;Clinical Global Impression scale;Clinician Interview Based Impression of Change with Caregiver Input;confusion;daily life activity;depression;diabetes mellitus;diarrhea;Disability Assessment for Dementia scale;disease association;dizziness;drug efficacy;drug fatality;drug mechanism;drug response;drug safety;drug targeting;drug treatment failure;drug withdrawal;dyslipidemia;early intervention;executive interview 25 scale;gene;gene mutation;genetic polymorphism;headache;atrial fibrillation;heart infarction;human;hyperlipidemia;hypertension;learning disorder;memory disorder;Mini Mental State Examination;MTHFR gene;multiinfarct dementia;nausea;neurologic examination;neuroprotection;neuropsychiatric inventory;Notch3 gene;Nurse Observational Scale for Geriatric Patient;outcome assessment;Parkinson disease;priority journal;risk factor;risk reduction;tinnitus;transient ischemic attack;unspecified side effect;vertigo;vomiting;egb 761,"Baskys, A.;Cheng, J. X.",2012,,,0,
326,A missed scalp laceration causing avoidable sequelae,"Introduction We present the case of an overlooked scalp laceration in an 81-year-old lady who presented with polytrauma following a fall down stairs. Complications that developed required more extensive treatment compared to what would have sufficed with early identification. Presentation of case Imaging on admission to hospital showed multiple vertebrae and rib fractures as well as a large cranial subcutaneous haematoma with no intracerebral bleed. Before the laceration was identified, the patient developed acute anaemia requiring transfusion. Continued reduction in haemoglobin levels called for a more thorough examination of the scalp. Investigation, following copious irrigation, revealed a large laceration. The presence of infection and necrotic tissue necessitated a general anaesthetic for debridement and closure. Disscussion Diagnostic errors are more common in patients presenting with multiple or severe injuries. Initial management in trauma cases should focus on more evident or life threatening injuries However, it is important that reflections and recommendations are continually made to reduce diagnostic errors, which are higher in polytraumatised patients. Various factors including haemodynamic instability and patient positioning added to the elusive nature of this wound. Adequate examination of lacerations requires thorough cleaning as coagulated blood and other material may obscure findings. This is particularly important in scalp lacerations where the overlying hair can form a barrier that is effective at hiding the wound edges. Conclusion This case highlights the importance of a thorough secondary survey; an effective examination technique would have avoided the need for extensive treatment to manage the sequelae of the missed scalp laceration.",amoxicillin plus clavulanic acid;corticosteroid;hemoglobin;nitrite;aged;anemia;angina pectoris;antibiotic sensitivity;antibiotic therapy;article;asthma;bandaging technique;bleeding;blood transfusion;case report;clinical examination;collapse;computer assisted tomography;congestive heart failure;corticosteroid therapy;dizziness;emergency ward;Escherichia coli;female;follow up;Glasgow coma scale;hemoglobin blood level;human;hypothyroidism;laceration;leukocyte;leukocyte count;mental health;multiinfarct dementia;neutrophil;outcome assessment;pain;priority journal;retrograde amnesia;rib fracture;scalp;scalp hematoma;scalp laceration;skin disease;social care;soft tissue injury;spine fracture;third lumbar vertebra;urinalysis;urinary tract infection;very elderly;wound closure,"Basyuni, S.;Panayi, A.;Sharma, V.;Santhanam, V.",2016,,,0,
327,Confusion and delirium,"Confusion and delirium are the most common behavioural disorders seen in an acute medical or surgical unit. Confusion can be regarded as a mild form of delirium and may give warning of the development of the more severe disorder. It causes an acute change of mental status, characterized by abnormal and fluctuating attention. It affects between 10 and 30% of medically ill patients, especially the elderly and often shortly after admission to hospital. It causes prolonged admission, increased morbidity and mortality, and delayed discharge, often culminating in long-term care. Its causation is reviewed and its prevention and management are described. © 2013 Elsevier B.V. All rights reserved.",donepezil;ondansetron;valproic acid;article;attention disturbance;behavior disorder;Behcet disease;brain vasculitis;cerebrovascular accident;clinical feature;cognitive defect;confusion;consciousness disorder;delirium;dementia;diagnostic procedure;differential diagnosis;disease course;drug abuse;DSM-IV;early diagnosis;electroencephalogram;epilepsy;heart failure;hypertension encephalopathy;infection;laboratory test;multiple organ failure;perception disorder;physical examination;postoperative complication;primary prevention;priority journal;prognosis;psychomotor disorder;sleep waking cycle;thought disorder;treatment indication;writing,"Bates, D.;Bates, C.",2013,,,0,
328,Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE (Action in Diabetes and Vascular Disease: preterax and Diamicron Modified-Release Controlled Evaluation) trial,"BACKGROUND: Although there are plausible mechanisms linking erectile dysfunction (ED) with coronary heart disease (CHD) and stroke, studies are scarce.METHODS: In a cohort analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial population, 6,304 men age 55 to 88 years with type 2 diabetes participated in a baseline medical examination when inquiries were made about ED. Over 5 years of follow-up, during which study members attended repeat clinical examinations, the presence of fatal and nonfatal CVD outcomes, cognitive decline, and dementia was ascertained.RESULTS: After adjusting for a range of covariates, including existing illness, psychological health, and classic CVD risk factors, relative to those who were free of the condition, baseline ED was associated with an elevated risk of all CVD events (hazard ratio: 1.19; 95% confidence interval: 1.08 to 1.32), CHD (hazard ratio: 1.35; 95% confidence interval: 1.16 to 1.56), and cerebrovascular disease (hazard ratio: 1.36; 95% confidence interval: 1.11 to 1.67). Men who experienced ED at baseline and at 2-year follow-up had the highest risk for these outcomes.CONCLUSIONS: In this cohort of men with type 2 diabetes, ED was associated with a range of CVD events.OBJECTIVES: The aim of this study was to examine the relationship between erectile problems in men and cardiovascular disease (CVD) mortality.","Antihypertensive Agents [administration & dosage] [therapeutic use];Blood Pressure [drug effects];Cardiovascular Diseases [epidemiology] [etiology] [prevention & control];Delayed-Action Preparations;Diabetes Mellitus, Type 2 [complications] [drug therapy] [epidemiology];Dose-Response Relationship, Drug;Drug Combinations;Drug Therapy, Combination;Erectile Dysfunction [epidemiology] [etiology] [prevention & control];Follow-Up Studies;Gliclazide [administration & dosage] [therapeutic use];Hypoglycemic Agents [administration & dosage] [therapeutic use];Indapamide [administration & dosage] [therapeutic use];Perindopril [administration & dosage] [therapeutic use];Prospective Studies;Risk Factors;Time Factors;Treatment Outcome;Aged[checkword];Aged, 80 and over[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-endoc: sr-stroke","Batty, Gd;Li, Q;Czernichow, S;Neal, B;Zoungas, S;Huxley, R;Patel, A;Galan, Be;Woodward, M;Hamet, P;Harrap, Sb;Poulter, N;Chalmers, J",2010,,10.1016/j.jacc.2010.04.067,0,
329,Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial,"OBJECTIVES: The aim of this study was to examine the relationship between erectile problems in men and cardiovascular disease (CVD) mortality. BACKGROUND: Although there are plausible mechanisms linking erectile dysfunction (ED) with coronary heart disease (CHD) and stroke, studies are scarce. METHODS: In a cohort analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial population, 6,304 men age 55 to 88 years with type 2 diabetes participated in a baseline medical examination when inquiries were made about ED. Over 5 years of follow-up, during which study members attended repeat clinical examinations, the presence of fatal and nonfatal CVD outcomes, cognitive decline, and dementia was ascertained. RESULTS: After adjusting for a range of covariates, including existing illness, psychological health, and classic CVD risk factors, relative to those who were free of the condition, baseline ED was associated with an elevated risk of all CVD events (hazard ratio: 1.19; 95% confidence interval: 1.08 to 1.32), CHD (hazard ratio: 1.35; 95% confidence interval: 1.16 to 1.56), and cerebrovascular disease (hazard ratio: 1.36; 95% confidence interval: 1.11 to 1.67). Men who experienced ED at baseline and at 2-year follow-up had the highest risk for these outcomes. CONCLUSIONS: In this cohort of men with type 2 diabetes, ED was associated with a range of CVD events.","Aged;Aged, 80 and over;Antihypertensive Agents/administration & dosage/therapeutic use;Blood Pressure/drug effects;Cardiovascular Diseases/epidemiology/*etiology/prevention & control;Delayed-Action Preparations;Diabetes Mellitus, Type 2/complications/*drug therapy/epidemiology;Dose-Response Relationship, Drug;Drug Combinations;Drug Therapy, Combination;Erectile Dysfunction/epidemiology/*etiology/prevention & control;Follow-Up Studies;Gliclazide/administration & dosage/*therapeutic use;Humans;Hypoglycemic Agents/administration & dosage/therapeutic use;Indapamide/administration & dosage/*therapeutic use;Male;Middle Aged;Perindopril/administration & dosage/*therapeutic use;Prospective Studies;Risk Factors;Time Factors;Treatment Outcome","Batty, G. D.;Li, Q.;Czernichow, S.;Neal, B.;Zoungas, S.;Huxley, R.;Patel, A.;de Galan, B. E.;Woodward, M.;Hamet, P.;Harrap, S. B.;Poulter, N.;Chalmers, J.",2010,Nov 30,10.1016/j.jacc.2010.04.067,0,
330,"Psychological distress and risk of peripheral vascular disease, abdominal aortic aneurysm, and heart failure: Pooling of sixteen cohort studies","Objectives: Examine the little-tested relation of psychological distress with peripheral vascular disease, abdominal aortic aneurysm, and heart failure. Methods: Pooling of raw data from 166,631 male and female participants in 16 UK-based cohort studies. Psychological distress was measured using the 12-item General Health Questionnaire. Peripheral vascular disease, abdominal aortic aneurysm, and heart failure events were based on death register linkage. Results: During a mean follow-up 9.5 years there were 17,368 deaths of which 8625 were cardiovascular disease-related. Relative to the asymptomatic group (0 score), the highly distressed group (score 7-12) experienced an elevated risk of peripheral vascular disease (adjusted hazard ratio; 95% confidence interval: 3.39; 1.97, 5.82) and heart failure (1.76; 1.37, 2.26). Psychological distress was weakly related to the risk of death from abdominal aortic aneurysm. As anticipated, distress was associated with cardiovascular disease, coronary heart disease, and all strokes combined. Conclusions: In the present study, we provide new evidence of mental health-related cardiovascular disease presentations.",abdominal aorta aneurysm;article;cardiovascular disease;cerebrovascular accident;cohort analysis;death;disease association;distress syndrome;follow up;General Health Questionnaire;hazard ratio;heart failure;human;ischemic heart disease;meta analysis;peripheral vascular disease;United Kingdom,"Batty, G. D.;Russ, T. C.;Stamatakis, E.;Kivima¨ki, M.",2014,,,0,
331,"Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study","Objectives The aims of this population based study were to describe mid- to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD). Methods This was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records. All patients who underwent revascularisation in Sweden between May 2008 and May 2013 for intermittent claudication (IC) or critical limb ischaemia (CLI), aged 50 years and older, were identified through the Swedvasc database. The mandatory national health care registries and medical records provided data on comorbidities, mortality, and major amputations. Results A total of 16,889 patients with PAD (IC, n = 6272; CLI, n = 10,617) were studied. The incidence of amputations in IC patients was 0.4% (range 0.3%–0.5%) per year. Among CLI patients, the amputation rate during the first 6 months following revascularisation was 12.0% (95% CI 11.3–12.6). Thereafter, the incidence declined to approximately 2% per year. The cumulative combined incidence of death or amputation 3 years after revascularisation was 12.9% (95% CI 12.0–13.9) in IC patients and 48.8% (95% CI 47.7–49.8) in CLI patients. Among CLI patients, compared with IC patients, the prevalence of diabetes, ischaemic stroke, heart failure, and atrial fibrillation was approximately doubled and renal failure was nearly tripled, even after age standardisation. Conclusion The risk of amputation is particularly high during the first 6 months following revascularisation for CLI. IC patients have a benign course in terms of limb loss. Mortality in both IC and CLI patients is substantial. Revascularised CLI patients have different comorbidities from IC patients.",adult;aged;amputation;angina pectoris;aortic aneurysm;artery embolism;artery thrombosis;article;atrial fibrillation;brain ischemia;chronic kidney failure;chronic obstructive lung disease;cohort analysis;comorbidity;critical limb ischemia;dementia;diabetes mellitus;endovascular surgery;female;follow up;heart failure;heart infarction;human;hypertension;intermittent claudication;kidney failure;major clinical study;male;malignant neoplasm;mortality;mortality rate;observational study;peripheral occlusive artery disease;preoperative period;priority journal;prospective study;sensitivity analysis;transient ischemic attack,"Baubeta Fridh, E.;Andersson, M.;Thuresson, M.;Sigvant, B.;Kragsterman, B.;Johansson, S.;Hasvold, P.;Falkenberg, M.;Nordanstig, J.",2017,,10.1016/j.ejvs.2017.07.005,0,
332,Sarcopenia and frailty: A clinician's controversial point of view,"Sarcopenia and frailty are both highly relevant entities with regard to functionality and independence in the elderly. The term sarcopenia has been introduced already in the late 80s and since then attracted the interest of many researchers, the majority being interested in its pathophysiology. Nevertheless there is still no consensus on the definition of sarcopenia and its diagnosis. Despite its relevance for functionality and autonomy most clinicians caring for the elderly are not familiar with sarcopenia and it has not become part of the routine geriatric evaluation. The concept of frailty has recently been supported by the introduction of two new working definitions. Since then clinical research on frailty has steeply increased. The influence of frailty on different age-associated diseases has been investigated and populations at risk for complications of medical or operative therapy are identified with the help of this concept. Simultaneously the pathophysiologic mechanisms involved in the development of frailty are explored. While sarcopenia may be regarded as a clinical sign that is not specific for the elderly, frailty may be seen as a multidimensional geriatric syndrome which implies a greater relevance for the clinician than the one dimensional approach of sarcopenia. © 2008 Elsevier Inc. All rights reserved.",alpha tocopherol;cyanocobalamin;growth hormone;somatomedin C;testosterone;vitamin D;aging;alpha tocopherol deficiency;Alzheimer disease;body composition;bradykinesia;breast disease;caloric intake;cerebrovascular disease;cognitive defect;congestive heart failure;cyanocobalamin deficiency;daily life activity;degenerative disease;delirium;depression;diabetes mellitus;elderly care;esophagitis;exhaustion;falling;fatigue;frailty;gait;geriatric disorder;gerontologist;head and neck disease;headache;heart arrhythmia;heart disease;heart infarction;human;hypertension;ischemic heart disease;long term memory;lung disease;memory disorder;mental disease;mood disorder;muscle atrophy;muscle tone;musculoskeletal disease;neoplasm;paranoia;Parkinson disease;pathophysiology;physical activity;priority journal;rectum disease;restlessness;risk;seizure;short survey;short term memory;skin disease;sleep disorder;cerebrovascular accident;faintness;thyroid disease;tremor;urine incontinence;venous thromboembolism;vitamin D deficiency;walking difficulty;weakness;weight reduction,"Bauer, J. M.;Sieber, C. C.",2008,,,0,
333,The partial code blue,,case report;complication;dementia;fatality;female;heart failure;human;procedures;resuscitation;very elderly,"Baumrucker, S. J.;Hutchinson, L.;Oertli, R. K.;Stolick, M.;Adkins, R. W.;VandeKieft, G.",2015,,10.1177/1049909114540790,0,
334,Risk of underlying chronic medical conditions for invasive pneumococcal disease in adults,"Purpose In the United States, the 13-valent pneumococcal conjugate vaccine is recommended in persons ⩾65 years of age, and persons ⩽65 years of age with immunocompromising (IC) conditions. For invasive pneumococcal disease (IPD) prevention in those ⩽65 with non-IC medical conditions, the 23-valent polysaccharide vaccine is recommended. This group is at higher risk of IPD than the general population, but the level of risk is not well-quantified. We estimated IPD risk by individual underlying medical conditions, and by total number of conditions, for persons ⩾18 years of age. We calculated the relative risks (RR) of various medical conditions, comparing the incident IPD cases to the general study population, and used Poisson regression models to estimate an IPD RR, adjusting for other conditions. We also examined IPD incidence by number of conditions diagnosed in each calendar year, using a risk-stacking model. Results Underlying medical conditions with the highest adjusted RR for IPD were chronic liver disease (RR 2.1, 95% CI 1.5–2.8) and chronic obstructive pulmonary disease (COPD; RR 2.1, 95% CI 1.8–2.5). IPD risk increased with increasing number of medical conditions: adjusted RR, 2.2 (95% CI 1.9–2.5) 1 condition, 2.9 (2.5–3.5) for 2 conditions, and 5.2 (4.4–6.1) for 3 conditions. Conclusions For persons with a single, non-IC medical condition, IPD risk was twice that for the general KPNC population. Persons with multiple, non-IC chronic conditions exhibited increased IPD risk with each additional condition. Such information may inform discussions on recommendations for adult pneumococcal immunization and prevention.",Pneumococcus vaccine;adult;aged;alcoholism;article;asplenia;asthma;cerebrovascular accident;chronic disease;chronic kidney disease;chronic liver disease;chronic obstructive lung disease;congestive heart failure;controlled study;dementia;diabetes mellitus;end stage renal disease;female;hemoglobinopathy;high risk population;human;Human immunodeficiency virus infection;incidence;leukemia;liquorrhea;lymphoma;major clinical study;male;multiple myeloma;myelofibrosis;nephrotic syndrome;observational study;pneumococcal infection;priority journal;risk factor;smoking,"Baxter, R.;Yee, A.;Aukes, L.;Snow, V.;Fireman, B.;Atkinson, B.;Klein, N. P.",2016,,,0,
335,The carotid plaque imaging in acute stroke (CAPIAS) study: Protocol and initial baseline data,"Background: In up to 30% of patients with ischemic stroke no definite etiology can be established. A significant proportion of cryptogenic stroke cases may be due to non-stenosing atherosclerotic plaques or low grade carotid artery stenosis not fulfilling common criteria for atherothrombotic stroke. The aim of the CAPIAS study is to determine the frequency, characteristics, clinical and radiological long-term consequences of ipsilateral complicated American Heart Association lesion type VI (AHA-LT VI) carotid artery plaques in patients with cryptogenic stroke. Methods/Design: 300 patients (age >49 years) with unilateral DWI-positive lesions in the anterior circulation and non- or moderately stenosing (<70% NASCET) internal carotid artery plaques will be enrolled in the prospective multicenter study CAPIAS. Carotid plaque characteristics will be determined by high-resolution black-blood carotid MRI at baseline and 12 month follow up. Primary outcome is the prevalence of complicated AHA-LT VI plaques in cryptogenic stroke patients ipsilateral to the ischemic stroke compared to the contralateral side and to patients with defined stroke etiology. Secondary outcomes include the association of AHA-LT VI plaques with the recurrence rates of ischemic events up to 36 months, rates of new ischemic lesions on cerebral MRI (including clinically silent lesions) after 12 months and the influence of specific AHA-LT VI plaque features on the progression of atherosclerotic disease burden, on specific infarct patterns, biomarkers and aortic arch plaques. Discussion: CAPIAS will provide important insights into the role of non-stenosing carotid artery plaques in cryptogenic stroke. The results might have implications for our understanding of stroke mechanism, offer new diagnostic options and provide the basis for the planning of targeted interventional studies. Trial Registration: NCT01284933. © 2013 Bayer-Karpinska et al.; licensee BioMed Central Ltd.",NCT01284933;fluorodeoxyglucose f 18;aged;article;atherosclerotic plaque;brain ischemia;carotid artery;carotid artery obstruction;carotid atherosclerosis;cerebrovascular accident;cohort analysis;contrast enhancement;diffusion weighted imaging;disease course;disease severity;echography;female;follow up;human;internal carotid artery;major clinical study;male;medical society;multicenter study;nuclear magnetic resonance imaging;observational study;outcome assessment;positron emission tomography;prospective study;recurrence risk,"Bayer-Karpinska, A.;Schwarz, F.;Wollenweber, F. A.;Poppert, H.;Boeckh-Behrens, T.;Becker, A.;Clevert, D. A.;Nikolaou, K.;Opherk, C.;Dichgans, M.;Saam, T.",2013,,,0,
336,Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis,"Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with stroke, cognitive impairment, and cardiovascular death. Some predisposing factors - as aging, diabetes, hypertension - induce and maintain electrophysiological and ultrastructural remodeling that usually includes fibrosis. Interatrial conduction disturbances play a crucial role in the initiation of atrial fibrosis and in its associated complications. The diagnosis of interatrial blocks (IABs) is easy to perform using the surface ECG. IAB is classified as partial when the P wave duration is >/=120 ms, and advanced if the P wave also presents a biphasic pattern in II, III and aVF. IAB is very frequent in the elderly and, particularly in the case of the advanced type, is associated with AF, AF recurrences, stroke, and dementia. The anticoagulation in elderly patients at high risk of AF without documented arrhythmias is an open issue but recent data suggest that it might have a role, particularly in elderly patients with structural heart disease, high CHA2DS2VASc (Congestive heart failure/left ventricular dysfunction, Hypertension, Age >/= 75 [doubled], Diabetes, Stroke [doubled] - Vascular disease, Age 65-74, and Sex category [female]), and advanced IAB. In this debate, we discuss the association of surface ECG IAB, a marker of atrial fibrosis, with AF and stroke. We also present the rationale that justifies further studies regarding anticoagulation in some of these patients.",Atrial fibrillation;Interatrial block;Risk;Stroke,"Bayes de Luna, A.;Martinez-Selles, M.;Bayes-Genis, A.;Elosua, R.;Baranchuk, A.",2017,Jul 31,,0,
337,Surface ECG interatrial block-guided treatment for stroke prevention: Rationale for an attractive hypothesis,"Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with stroke, cognitive impairment, and cardiovascular death. Some predisposing factors - as aging, diabetes, hypertension - induce and maintain electrophysiological and ultrastructural remodeling that usually includes fibrosis. Interatrial conduction disturbances play a crucial role in the initiation of atrial fibrosis and in its associated complications. The diagnosis of interatrial blocks (IABs) is easy to perform using the surface ECG. IAB is classified as partial when the P wave duration is ≥120ms, and advanced if the P wave also presents a biphasic pattern in II, III and aVF. IAB is very frequent in the elderly and, particularly in the case of the advanced type, is associated with AF, AF recurrences, stroke, and dementia. The anticoagulation in elderly patients at high risk of AF without documented arrhythmias is an open issue but recent data suggest that it might have a role, particularly in elderly patients with structural heart disease, high CHA2DS2VASc (Congestive heart failure/left ventricular dysfunction, Hypertension, Age≥75 [doubled], Diabetes, Stroke [doubled] - Vascular disease, Age 65-74, and Sex category [female]), and advanced IAB. In this debate, we discuss the association of surface ECG IAB, a marker of atrial fibrosis, with AF and stroke. We also present the rationale that justifies further studies regarding anticoagulation in some of these patients.",age distribution;anticoagulant therapy;article;atrial fibrillation;cardiovascular magnetic resonance;cardiovascular risk;cerebrovascular accident;CHADS2 score;cognitive defect;dementia;disease classification;disease severity;electrocardiography;heart muscle conduction disturbance;heart muscle fibrosis;human;interatrial block;P wave;priority journal;risk factor;sex difference;treatment planning,"Bayés de Luna, A.;Martínez-Sellés, M.;Bayés-Genís, A.;Elosua, R.;Baranchuk, A.",2017,,10.1186/s12872-017-0650-y,0,
338,Gateways to clinical trials,"Gateways to Clinical Trials are a guide to the most recent clinical trials in current literature and congresses. The data in the following tables has been retrieved from the Clinical Trials Knowledge Area of Prous Science Integrity®, the drug discovery and development portal, http://integrity. prous.com. This issue focuses on the following selection of drugs: 1-Octanol, 9vPnC-MnCc; Abiraterone acetate, Adalimumab, Adefovir dipivoxil, Alemtuzumab, Aliskiren fumarate, Aminolevulinic acid hexyl ester, Amlodipine besylatelatorvastatin calcium, Amrubicin hydrochloride, Anakinra, Aripiprazole, ARRY-520, AS-1404, Asimadoline, Atazanavir sulfate, AVE-0277, Azelnidipine; Bevacizumab, Bimatoprost, Boceprevir, Bortezomib, Bosentan, Botulinum toxin type B; Certolizumab pegol, Cetuximab, Clevudine, Contusugene ladenovec, CP-751871, Crofelemer, Cypher, CYT006-AngQb; Darbepoetin alfa, Desmopressin, Dexlansoprazole, DG-041; E-5555, Ecogramostim, Entecavir, Erlotinib hydrochloride, Escitalopram oxalate, Eszopiclone, Everolimus, Ezetimibe, Ezetimibe/simvastatin; Falecalcitriol, Fampridine, Fesoterodine fumarate, Fingolimod hydrochloride; Gefitinib, Ghrelin (human), GS-7904L, GV-1001; HT-1001; Insulin detemir, ISIS-112989, Istradefylline; Laquinimod sodium, Latanoprost/timolol maleate, Lenalidomide, Levobetaxolol hydrochloride, Liposomal doxorubicin, Liposomal morphine sulfate, Lubiprostone, Lumiracoxib, LY-518674; MEM-1003, Mesna disulfide, Mipomersen sodium, MM-093, Mycophenolic acid sodium salt; Naptumomab estafenatox, Natalizumab; Olmesartan medoxomil, Olmesartan medoxomil/hydrochlorothiazide; Paclitaxel nanoparticles, Paclitaxel poliglumex, Pasireotide, Pazufloxacin mesilate, Pegfilgrastim, Peginterferon alfa-2a, Peginterferon alfa-2b, Peginterferon alfa-2b/ribavirin, Pegvisomant, Pemetrexed disodium, Pimagedine, Pimecrolimus, Pramlintide acetate, Prasterone, Pregabalin, Prulifloxacin; QAE-397; Rec-15/2615, RFB4(dsFv)-PE38, rhGAD65, Roflumilast, Romiplostim, Rosuvastatin calcium, Rotigotine, Rupatadine fumarate; Safinamide mesilate, SIR-Spheres, Sitagliptin phosphate, Sodium phenylacetate, Sodium phenylacetate/Sodium benzoate, Sorafenib, SSR-244738; Taribavirin hydrochloride, Taxus, Teduglutide, Tegaserod maleate, Telaprevir, Telbivudine, Tenofovir disoproxil fumarate, Tigecycline, Tiotropium bromide, Trabectedin, Travoprost, Treprostinil sodium; Ustekinumab; Valsartan/ amlodipine besylate, Varenicline tartrate, Vildagliptin; Zofenopril calcium. © 2007 Prous Science. All rights reserved.","2 [4 [3 [4,5 dihydro 1 (4 methylbenzyl) 5 oxo 1h 1,2,4 triazol 3 yl]propyl]phenoxy] 2 methylpropionic acid;vadimezan;alfacalcidol;aliskiren;aluminum hydroxide;amlodipine;amlodipine plus benazepril;amlodipine plus valsartan;antineoplastic agent;antivirus agent;filanesib;atenolol;atorvastatin;ave 0277;bosentan;figitumumab;desmopressin;3 [1 (2,4 dichlorobenzyl) 5 fluoro 3 methyl 1h indol 7 yl] n [(4,5 dichloro 2 thienyl)sulfonyl]acrylamide;atopaxar;ezetimibe;falecalcitriol;felodipine;ghrelin;gs 7904l;tertomotide;ht 1001;hydrochlorothiazide;mem 1003;mm 093;monoclonal antibody;novel erythropoiesis stimulating protein;octreotide;custirsen;olmesartan;paclitaxel;pasireotide;pegvisomant;prasterone;qae 397;ramipril;rapamycin;rec 15 2615;ssr 244738;tumor necrosis factor alpha antibody;unclassified drug;unindexed drug;treprostinil;valsartan;acromegaly;acute lymphoblastic leukemia;adrenal insufficiency;Alzheimer disease;anemia;article;ataxia;bile duct cancer;bladder cancer;hematologic disease;bone cancer;breast cancer;cardiovascular disease;chronic lymphatic leukemia;chronic obstructive lung disease;clinical trial;colorectal cancer;coronary artery disease;coronary stent;Crohn disease;Cushing syndrome;depression;drug dose titration;dyslipidemia;dystonia;endocrine disease;glaucoma;heart infarction;hepatitis;hepatitis B;hepatitis C;human;hypercholesterolemia;hyperparathyroidism;hypertension;insomnia;kidney carcinoma;kidney disease;kidney failure;liver cancer;non small cell lung cancer;small cell lung cancer;lymphatic system disease;melanoma;mental disease;metabolic syndrome X;motor dysfunction;multiple myeloma;multiple sclerosis;neoplasm;neuroendocrine tumor;neurologic disease;neutropenia;nonhodgkin lymphoma;obesity;ovary cancer;overactive bladder;paclitaxel eluting stent;pancreas cancer;Parkinson disease;prostate cancer;pulmonary hypertension;respiratory tract disease;sirolimus eluting stent;skin disease;suicide;thorax disease;thrombocytopenic purpura;unspecified side effect;urinary tract disease;arry 520;as 1404;cdp 571;cp 751871;dg 041;e 5555;gv 1001;isis 112989;ly 518674","Bayés, M.;Rabasseda, X.;Prous, J. R.",2007,,,0,
339,Characteristics of Medicare Part D beneficiaries who reach the drug benefit threshold in both of the first two years of the Part D benefit,"Background: Medicare Part D beneficiaries who reach the drug benefit threshold (DBT) risk adverse health outcomes. Objectives: We explore clinical characteristics of beneficiaries who repeatedly reach the DBT during the first 2 years of Medicare Part D and may benefit from proactive identification for medication and care management. Research desing: Retrospective cohort. Subjects: 25,320 Medicare Advantage beneficiaries of whom 536 reached the DBT in 2006 only, (""2006 only""); 961 reached the DBT in 2006 and 2007 (""both years""); and 23,823 in neither year. Measures: We assessed repeatedly reaching the DBT (relative to 2006 only) as a function of demographics, morbidity (specific conditions and overall burden), medication use (specific classes and overall burden), utilization, and use of catastrophic and/or additional pharmacy benefits. Results: Those who reached the DBT in both years had higher morbidity and utilization. In multivariate analyses, they were more likely than the 2006 only group to have one or more of 5 conditions (chronic pulmonary disease, dementia, depression, incontinence, and Parkinson disease), and within these conditions were more likely to use categories of trade-name medications for which there are limited available generic alternatives. Conclusions: Repeatedly reaching the DBT is a function of the extent and chronicity of disease burden and is characterized by conditions for which there is limited availability of generic medications, and associated common comorbidities. If these findings are confirmed, strategies at practice and policy levels may help such Medicare beneficiaries avoid unnecessary out of pocket expenditures on medications from prematurely reaching the DBT. Copyright © 2010 by Lippincott Williams & Wilkins.",alpha adrenergic receptor blocking agent;antihypertensive agent;antiinfective agent;antiparkinson agent;psychotropic agent;aged;article;chronic lung disease;chronic obstructive lung disease;congestive heart failure;controlled study;dementia;depression;emergency ward;falling;female;health care planning;health care utilization;hospital admission;hospital patient;human;hypertension;incontinence;lung embolism;major clinical study;male;medical examination;medicare;migraine;morbidity;Parkinson disease;patient care;pneumonia;primary medical care;retrospective study;skin ulcer;cerebrovascular accident;faintness;test strip;urinary tract infection,"Bayliss, E. A.;Ellis, J. L.;Delate, T.;Steiner, J. F.;Raebel, M. A.",2010,,,0,
340,Controversies in hormone replacement therapy,"Deficiency of estrogen hormone will result in either long-term or short-term health problems which may reduce the quality of life. There are numerous methods by which the quality of female life can be enhanced. Since the problems occurring are due to the deficiency of estrogen hormone, the appropriate method to tackle the problem is by administration of estrogen hormone. The administration of hormone replacement therapy (HRT) with estrogen may eliminate climacteric complaints, prevent osteoporosis, coronary heart disease, dementia, and colon cancer. Although HRT has a great deal of advantage, its use is still low and may result in controversies. These controversies are due to fact that both doctor and patient still hold on to the old, outmoded views which are not supported by numerous studies. Currently, the use of HRT is not only based on experience, or temporary observation, but more on evidence based medicine.",article;bleeding;breast cancer;colon cancer;dementia;hormone deficiency;hormone substitution;human;ischemic heart disease;life expectancy;mammography;osteoporosis;quality of life;weight gain,"Baziad, A.",2001,,10.13181/mji.v10i3.557,0,
341,Apolipoprotein E polymorphism in Southern Iran: E4 allele in the lowest reported amounts,"Background: Apolipoprotein E (apoE) with three major alleles E2, E3 and E4 is one of the critical genes in lipid metabolism. Common apoE alleles are in association with an increase in risk for central nervous and cardiovascular diseases such as Alzheimer's disease, dementia, multiple sclerosis, atherosclerosis, coronary heart disease, hyperlipoproteinemia and stroke. ApoE3 is known as the most frequent allele in all populations, while association of apoE gene polymorphism with reported diseases have mostly been related to other two major alleles especially apoE4. Objective: To determine of apoE alleles frequencies in Southern Iran and comparison of those frequencies with other populations. Methods: DNA was extracted from the whole blood of 198 healthy unrelated candidates from population of Fars Province, Southern Iran, for apoE genotyping who were checked up by a physician. The frequencies of apoE alleles were compared with other populations by χ2 test. Results: The frequencies of E2, E3 and E4 were 0.063, 0.886 and 0.051 respectively. These values were similar to those reported from populations of Kuwait, Oman, Lebanon, India, Turkey, Greece, Spain, Sardinia Islands of Italy and two Iranian populations but were different from South of Italy and Caucasians in other Europe regions, American, American-Indian, African, East Asian and Saudi populations (P < 0.05). Conclusion: The frequency of E4 allele as a genetic risk factor for some multifactorial diseases in the population of Southern Iran is in the lowest reported amounts in the world. Iranian population has Caucasoid origin but differs from some Caucasian populations in Europe and America. The results of present study are in agreement with the historical evidences which show admixture of Iranian population with other populations and some studies based on genetic polymorphisms in the population of Southern Iran. © 2007 Springer Science+Business Media B.V.",apolipoprotein E;apolipoprotein E2;apolipoprotein E3;apolipoprotein E4;DNA;adult;African American;American Indian;article;Caucasian;chi square test;controlled study;DNA extraction;female;gene frequency;genetic polymorphism;genetic risk;genotype;Greece;human;India;Iran;Italy;Kuwait;Lebanon;male;normal human;Oman;Saudi Arabia;Spain;turkey (bird),"Bazrgar, M.;Karimi, M.;Fathzadeh, M.;Senemar, S.;Peiravian, F.;Shojaee, A.;Saadat, M.",2008,,,0,
342,Reduced clinical and postmortem measures of cardiac pathology in subjects with advanced Alzheimer's Disease,"Epidemiological studies indicate a statistical linkage between atherosclerotic vascular disease (ATH) and Alzheimer's disease (AD). Autopsy studies of cardiac disease in AD have been few and inconclusive. In this report, clinical and gross anatomic measures of cardiac disease were compared in deceased human subjects with and without AD. Clinically documented cardiovascular conditions from AD (n = 35) and elderly non-demented control subjects (n = 22) were obtained by review of medical records. Coronary artery stenosis and other gross anatomical measures, including heart weight, ventricular wall thickness, valvular circumferences, valvular calcifications and myocardial infarct number and volume were determined at autopsy. Compared to non-demented age-similar control subjects, those with AD had significantly fewer total diagnosed clinical conditions (2.91 vs 4.18), decreased coronary artery stenosis (70.8 vs 74.8%), heart weight (402 vs 489 g for males; 319 vs 412 g for females) and valvular circumferences. Carriage of the Apolipoprotein E-ε4 allele did not influence the degree of coronary stenosis. Group differences in heart weight remained significant after adjustment for age, gender, body mass index and apolipoprotein E genotype while differences in coronary artery stenosis were significantly associated with body mass index alone. The results are in agreement with an emerging understanding that, while midlife risk factors for ATH increase the risk for the later development of AD, once dementia begins, both risk factors and manifest disease diminish, possibly due to progressive weight loss with increasing dementia as well as disease involvement of the brain's vasomotor centers.",Alzheimer disease;article;atherosclerosis;coronary artery obstruction;coronary blood vessel;female;heart muscle;heart valve;heart ventricle;human;image processing;male;organ size;pathology;prevalence;statistical model,"Beach, T. G.;Maarouf, C. L.;Brooks, R. G.;Shirohi, S.;Daugs, I. D.;Sue, L. I.;Sabbagh, M. N.;Walker, D. G.;Lue, L.;Roher, A. E.",2011,,,0,
343,A metoprolol-terbinafine combination induced bradycardia,"To report a sinus bradycardia induced by metoprolol and terbinafine drug-drug interaction and its management. A 63 year-old Caucasian man on metoprolol 200 mg/day for stable coronary artery disease was prescribed a 90-day course of oral terbinafine 250 mg/day for onychomycosis. On the 49th day of terbinafine therapy, he was brought to the emergency room for a decrease of his global health status, confusion and falls. The electrocardiogram revealed a 37 beats/min sinus bradycardia. A score of 7 on the Naranjo adverse drug reaction probability scale indicates a probable relationship between the patient's sinus bradycardia and the drug interaction between metoprolol and terbinafine. The heart rate ameliorated first with a decrease in the dose of metoprolol. It was subsequently changed to bisoprolol and the heart rate remained normal. By inhibiting the cytochrome P450 2D6, terbinafine had decreased metoprolol's clearance, leading in metoprolol accumulation which has resulted in clinically significant sinus bradycardia.",bisoprolol;metoprolol;rivastigmine;terbinafine;acute coronary syndrome;adult;Alzheimer disease;anamnesis;article;case report;coronary artery disease;disease exacerbation;drug accumulation;drug clearance;drug dose increase;drug dose reduction;drug efficacy;drug potentiation;drug safety;dyslipidemia;electrocardiography;emergency ward;genotype;glomerulus filtration rate;health status;heart failure;heart left ventricle ejection fraction;human;liver function test;male;middle aged;onychomycosis;probability;sinus bradycardia,"Bebawi, E.;Jouni, S. S.;Tessier, A. A.;Frenette, A. J.;Brindamour, D.;Doré, M.",2015,,,0,
344,Stem cell therapies and ethical issues on human stem cell researches,"Stem cells are essential and magic cells which have been found in all animals. The stem cells of early embryological period are the most basic and extraordinary ones. These cells are able to transform to all cell types of the body. Embryonic germ cells and embryonic stem cells promise scientific and therapeutic hopes by obtaining both the early stage embryonic tissues and fetal cadaver tissues in an extraordinary level. The discussions of the usage of these cells have been continuing in all over the world. The world of medicine have not reached to a consensus between the ethical discussions about the rights of the people whose struggling for the fatal diseases and also the rights of the fetuses which will be aborted for a therapeutic aim after a programmed pregnancy. Hundred percent histocompatibility between cloned fetal EG cells and the transplanted tissues will yield miraculous therapeutic results for the treatments of Alzheimer's disease, diabetes, heart failure, AIDS etc. However a danger might be waiting for human being in the future if this technology will be used to compose human spare part factories by bringing the babies into the world by cloning.",acquired immune deficiency syndrome;Alzheimer disease;cadaver;cell clone;cell nucleus transplantation;cell transformation;cells by body anatomy;diabetes mellitus;embryo cell;fertilization in vitro;fetus cell;heart failure;histocompatibility;medical ethics;medical research;short survey;stem cell transplantation,"Bebitoǧlu, F. G.;Oǧuzhan, T.",2005,,,0,
345,Genetic testing and common disorders in a public health framework: How to assess relevance and possibilities,,Alzheimer disease;article;atherosclerosis;breast cancer;colon cancer;coronary artery disease;cost benefit analysis;Crohn disease;diagnostic value;emphysema;gene mutation;genetic association;genetic screening;genomics;health care policy;heart infarction;human;hypertension;liver cirrhosis;medical education;medicolegal aspect;non insulin dependent diabetes mellitus;obesity;population genetics;postmarketing surveillance;priority journal;prostate cancer;public health service;retina maculopathy;sensitivity and specificity,"Becker, F.;Van El, C. G.;Ibarreta, D.;Zika, E.;Hogarth, S.;Borry, P.;Cambon-Thomsen, A.;Cassiman, J. J.;Evers-Kiebooms, G.;Hodgson, S.;Janssens, A. C. J. W.;Kaariainen, H.;Krawczak, M.;Kristoffersson, U.;Lubinski, J.;Patch, C.;Penchaszadeh, V. B.;Read, A.;Rogowski, W.;Sequeiros, J.;Tranebjaerg, L.;Van Langen, I. M.;Wallace, H.;Zimmern, R.;Schmidtke, J.;Cornel, M. C.",2011,,,0,
346,The effect of the psychosocial working environment on cognition and dementia,,apolipoprotein E4;cognition;dementia;follow up;genotype;human;ischemic heart disease;major depression;mental deterioration;note;priority journal;psychosocial environment;risk factor;social determinants of health;social interaction;social status;socioeconomics;systematic review (topic);work environment,"Becker, T.",2014,,,0,
347,Dural sinus and internal jugular vein thrombosis complicating a blunt head injury in a pediatric patient,"Introduction: Cerebral venous sinus thrombosis (CVST) following a blunt head trauma is a rare condition, described in the literature along with the lack of consensus regarding diagnosis and management. Case summary: We present a case of a pediatric patient with a blunt head injury and epidural hematoma, who developed dural sinus and internal jugular vein thrombosis with fatal outcome. Discussion: Most of reports show good outcome and recovery, but CVST might be related to poor recovery and even lead to death. The diagnosis and management of this condition are discussed based on a literature review. Conclusion: It is important to keep a high degree of suspicion of CVST since early diagnosis may prevent potentially treatable catastrophic outcomes. © 2013 Springer-Verlag Berlin Heidelberg.",arousal;article;blunt trauma;brain infarction;cardiopulmonary insufficiency;case report;cerebral sinus thrombosis;child;death;decompressive craniectomy;endotracheal intubation;epidural hematoma;fatality;fracture;head injury;hemodynamics;human;internal jugular vein thrombosis;male;mental deterioration;miosis;mydriasis;neuroimaging;phlebography;preschool child;priority journal;sedation;surgical drainage;vein thrombosis,"Beer-Furlan, A.;De Almeida, C. C.;Noleto, G.;Paiva, W.;Ferreira, A. A.;Teixeira, M. J.",2013,,,0,
348,Relationship between body height and dementia,"Objective: Structural and functional brain reserves, thought to develop in childhood and adolescence, may be critical in determining the age at onset of cognitive impairment. Body height is affected by childhood conditions that promote growth. The authors examine the relationship of height in midlife and subsequent dementia, Alzheimer disease (AD), and vascular dementia. Methods: Dementia was evaluated from 1999 to 2001 in 1,892 men age 76 to 95. Height had been measured when these men participated in the Israeli Ischemic Heart Disease project in 1963. Age, socioeconomic status (SES), and area of birth were also assessed in 1963. Results: Older men and those with lower SES tended to be shorter. Relative to the shortest quartile, controlling for age, SES, and area of birth, the other quartiles had lesser respective odds ratios for dementia as a whole, AD, and vascular dementia. Conclusion: Height was inversely associated with dementia, AD, and vascular dementia in a male sample. Since height is associated with childhood nutrition and may be associated with other risk factors for dementia, efforts to improve early life conditions that maximize body growth may diminish or delay the onset of dementia in later life. © 2005 American Association for Geriatric Psychiatry.",adult;aged;Alzheimer disease;article;body growth;body height;child growth;child nutrition;cognitive defect;controlled study;correlation analysis;dementia;female;groups by age;human;major clinical study;male;multiinfarct dementia;nutritional status;onset age;risk assessment;social status,"Beeri, M. S.;Davidson, M.;Silverman, J. M.;Noy, S.;Schmeidler, J.;Goldbourt, U.",2005,,,0,
349,Religious education and midlife observance are associated with dementia three decades later in Israeli men,"Objective: The aim of the study was to examine the association of religious education and observance with dementia among participants in the Israeli Ischemic Heart Disease study. Study Design and Setting: We assessed dementia in 1,890 participants among 2,604 survivors of 10,059 participants in the Israeli Ischemic Heart Disease study, a longitudinal investigation of the incidence and risk factors for cardiovascular disease among Jewish male civil servants in Israel. Face-to-face interviews were conducted with 651 subjects identified as possibly demented by the Modified Telephone Interview for Cognitive Status. Results: Of 1,628 subjects included in this analysis (mean age 82 at assessment), 308 (18.9%) had dementia. The prevalence rates of dementia (and odds ratios (ORs) relative to those with exclusively religious education, adjusted for age, area of birth, and socioeconomic status) were 27.1% for those with exclusively religious education, 12.6% (OR = 0.49) for those with mixed education, and 16.1% (OR = 0.76) for those with secular education. For religious self-definition and practice, the prevalence rates were 9.7%, 17.7%, 14.1%, 19.3%, and 28.8% for categories from least to most religious (ORs relative to the most religious: 0.43, 0.67, 0.48, 0.55). Conclusions: Examining lifestyles associated with religiosity might shed light onto environmental risks for dementia. Mechanisms underlying these associations remain elusive. © 2008 Elsevier Inc. All rights reserved.",adult;aged;article;cardiovascular risk;cognition;dementia;education;human;incidence;Israel;Jew;longitudinal study;major clinical study;male;prevalence;priority journal;religion;social status;survivor;teleconsultation,"Beeri, M. S.;Davidson, M.;Silverman, J. M.;Schmeidler, J.;Springer, R. R.;Noy, S.;Goldbourt, U.",2008,,,0,
350,Late-life dementia predicts mortality beyond established midlife risk factors,"Objectives: To compare the mortality rates of elderly demented and nondemented subjects and the differential association of midlife risk factors with mortality according to dementia status. DESIGN:: Prospective historical study. SETTINGS:: Community based. Participants: From the 10,059 male Jewish civil servants who participated in the Israel Ischemic Heart Disease study in the 1960s, the 1,713 who were evaluated for dementia in 1999/2000 and who were unequivocally classified as demented or nondemented. Measurements: Midlife sociodemographic and cardiovascular risk factors, late-life dementia, and mortality. Results: Over a period of 6 years, 718 (42%) subjects died. Of the 307 demented subjects, 71.8% died and of the 1,407 nondemented subjects, 35.4% died. Multivariate survival analyses showed that compared with subjects without dementia, demented subjects had a hazard ratio [HR] for mortality of 2.27 (95% confidence interval [CI] 1.92-2.68). Other risk factors associated with mortality were socioeconomic status (HR 0.94 [0.88-1.00]), higher systolic (HR 1.16 per 20 mm Hg [1.06-1.28 mm Hg]) and diastolic blood pressure (HR 1.15 per 10 mm Hg [1.06-1.25 mm Hg]), and ever smoking (HR 1.38 [1.18-1.61]). Midlife total cholesterol was not associated with mortality (1.01 per 40 mg/dL [0.93-1.10 mg/dL]). None of the interactions of the risk factors with dementia was significant. Conclusions: Dementia was associated with more than double the risk of mortality, but this increased risk did not reflect exacerbation by midlife sociodemographic and cardiovascular risk factors. Our findings suggest that the dementing process itself or its consequences may go beyond well-established midlife risk factors for mortality. © 2010 American Association for Geriatric Psychiatry.",cholesterol;adult;aged;article;clinical trial;controlled study;dementia;diastolic blood pressure;human;major clinical study;male;Mini Mental State Examination;mortality;prediction;risk factor;smoking;systolic blood pressure,"Beeri, M. S.;Goldbourt, U.",2011,,,0,
351,Coronary artery disease is associated with Alzheimer disease neuropathology in APOE4 carriers,"OBJECTIVE: To examine the associations between postmortem Alzheimer disease (AD) neuropathology and autopsy-verified cardiovascular disease. METHODS: The authors examined 99 subjects (mean age at death = 87.6; SD = 8.7) from the Mount Sinai School of Medicine Department of Psychiatry Brain Bank who were devoid of cerebrovascular disease-associated lesions or of non-AD-related neuropathology. Density of neuritic plaques (NPs) and neurofibrillary tangles (NFTs) as well as coronary artery and aortic atherosclerosis, left ventricular wall thickness, and heart weight were measured. Partial correlations were used to assess the associations of the four cardiovascular variables with NPs and NFTs in the hippocampus, entorhinal cortex, and multiple regions of the cerebral cortex after controlling for age at death, sex, dementia severity, body mass index, and ApoE genotype. These analyses were also repeated separately for ApoE4 carriers and noncarriers. RESULTS: The extent of coronary artery disease and to a lesser extent atherosclerosis were significantly associated with the density of cardinal neuropathologic lesions of AD in this autopsy sample (significant correlations between 0.22 and 0.29). These associations were more pronounced for the ApoE4 allele carriers (n = 42; significant correlations between 0.34 and 0.47). CONCLUSIONS: The degree of coronary artery disease is independently associated with the cardinal neuropathological lesions of Alzheimer disease. These associations are primarily attributable to individuals with the ApoE4 allele.","Aged, 80 and over;Alleles;Alzheimer Disease/*complications/genetics/pathology;Aortic Diseases/complications/genetics;Apolipoprotein E4;Apolipoproteins E/*genetics;Atherosclerosis/complications/genetics;Brain/pathology;Cardiomegaly/complications/genetics/pathology;Comorbidity;Coronary Disease/*complications/genetics;Female;Genetic Predisposition to Disease;Genotype;Heart Ventricles/pathology;Humans;Male;Neurofibrillary Tangles;Organ Size;Plaque, Amyloid;Severity of Illness Index","Beeri, M. S.;Rapp, M.;Silverman, J. M.;Schmeidler, J.;Grossman, H. T.;Fallon, J. T.;Purohit, D. P.;Perl, D. P.;Siddiqui, A.;Lesser, G.;Rosendorff, C.;Haroutunian, V.",2006,May 9,10.1212/01.wnl.0000210447.19748.0b,0,
352,The Israel Diabetes and Cognitive Decline (IDCD) study: Design and baseline characteristics,"Background Type 2 diabetes (T2D) is associated with increased risk of dementia. The prospective longitudinal Israel Diabetes and Cognitive Decline study aims at identifying T2D-related characteristics associated with cognitive decline. Methods Subjects are population-based T2D 65+, initially cognitively intact. Medical conditions, blood examinations, and medication use data are since 1998; cognitive, functional, demographic, psychiatric, DNA, and inflammatory marker study assessments were conducted every 18 months. Because the duration of T2D reflects its chronicity and implications, we compared short (0-4.99 years), moderate (5-9.99), and long (10+) duration for the first 897 subjects. Results The long duration group used more T2D medications, had higher glucose, lower glomerular filtration rate, slower walking speed, and poorer cognitive functioning. Duration was not associated with most medical, blood, urine, and vital characteristics. Conclusions Tracking cognition, with face-to-face evaluations, exploiting 15 years of historical detailed computerized, easily accessible, and validated T2D-related characteristics may provide novel insights into T2D-related dementia.",apolipoprotein E;C reactive protein;glucose;high density lipoprotein;low density lipoprotein;thyrotropin;acute heart infarction;aged;angina pectoris;article;autopsy;blood examination;body mass;cataract;chronic kidney failure;chronicity;cognition;cognitive defect;daily life activity;diastolic blood pressure;disease association;drug use;female;functional assessment;glomerulus filtration rate;glucose blood level;heart arrhythmia;human;hyperlipidemia;hypertension;hypoglycemia;hypothyroidism;Israel;Israeli;major clinical study;male;Mini Mental State Examination;motor activity;non insulin dependent diabetes mellitus;oxygen saturation;peripheral vascular disease;priority journal;public health;retinopathy;study design;systolic blood pressure;walking speed,"Beeri, M. S.;Ravona-Springer, R.;Moshier, E.;Schmeidler, J.;Godbold, J.;Karpati, T.;Leroith, D.;Koifman, K.;Kravitz, E.;Price, R.;Hoffman, H.;Silverman, J. M.;Heymann, A.",2014,,,0,
353,Validation of the modified Telephone Interview for Cognitive Status (TICS-m) in Hebrew,"Introduction: The validity of the Hebrew version of the Telephone Interview for Cognitive Status-Modified (TICS-m) for Mild Cognitive Impairment (MCI), for dementia, and for cognitive impairment (either MCI or dementia) was investigated. Methods: Of the 10 059 who took part of the Israel Ischemic Heart Disease Cohort, 1902 of the 2901 survivors in 1999 had TICS-m interviews. Those with a score of 27 or below and a random sample with a score of 28 or 29 were invited to have a physician's examination for the diagnosis of dementia. The analysis was performed on the 576 who agreed. Results: Based on physician's diagnosis, 269 were diagnosed as suffering from dementia, 128 as suffering from MCI, and 179 were diagnosed with no cognitive impairment. The TICS-m Hebrew version's internal consistency was very high (Cronbach's alpha = 0.98) and showed a strong convergent validity with the MMSE (r = 0.82; p < 0.0005). The sensitivity was 100% for each of the conditions. Finally, after controlling for age, education and hearing impairment, TICS-m was a strong predictor of dementia, MCI and cognitive impairment. Conclusion: At a cut-off of 27/50 the Hebrew version of the TICS-m is a useful screening instrument to identify subjects suffering from mild cognitive impairment, dementia and cognitive impairment (MCI or dementia). Copyright © 2003 John Wiley & Sons, Ltd.",age;aged;article;cognitive defect;cohort analysis;controlled study;dementia;diagnostic accuracy;diagnostic test;disease severity;education;elderly care;hearing impairment;human;interview;Israel;language;major clinical study;male;outcomes research;population research;prediction;randomization;scoring system;screening;sensitivity analysis;telephone;validation process,"Beeri, M. S.;Werner, P.;Davidson, M.;Schmidler, J.;Silverman, J.",2003,,,0,
354,Referral to palliative care in COPD and other chronic diseases: A population-based study,"Aim To describe how patients with COPD, heart failure, dementia and cancer differ in frequency and timing of referral to palliative care services. Methods We performed a population-based study with the Sentinel Network of General Practitioners in Belgium. Of 2405 registered deaths respectively 5%, 4% and 28% were identified as from COPD, heart failure or cancer and 14% were diagnosed with severe dementia. GPs reported use and timing of palliative care services and treatment goals in the final three months of life. Results Patients with COPD (20%) were less likely than those with heart failure (34%), severe dementia (37%) or cancer (60%) to be referred to palliative care services (p < 0.001). The median days between referral and death was respectively 10, 12, 14 and 20. Patients with COPD who were not referred more often received treatment with a curative or life-prolonging goal and less often with a palliative or comfort goal than did the other patients who were not referred. Conclusion Patients with COPD are underserved in terms of palliative care compared to those with other chronic life-limiting diseases. Awareness of palliative care as an option for patients with COPD needs to increase in palliative care services, physicians and the general public. © 2013 Elsevier Ltd. All rights reserved.",adult;aged;article;Belgium;chronic disease;chronic obstructive lung disease;dementia;female;general practitioner;heart failure;human;male;malignant neoplastic disease;mortality;palliative therapy;patient referral;population;priority journal,"Beernaert, K.;Cohen, J.;Deliens, L.;Devroey, D.;Vanthomme, K.;Pardon, K.;Van Den Block, L.",2013,,,0,
355,Is There a Need for Early Palliative Care in Patients With Life-Limiting Illnesses? Interview Study With Patients About Experienced Care Needs From Diagnosis Onward,"The early integration of specialist palliative care has been shown to benefit the quality of life of patients with advanced cancer. In order to explore whether other seriously ill people and people at even earlier phases would also benefit from early palliative care, we conducted 18 qualitative interviews with people having cancer, chronic obstructive lung disease, heart failure, or dementia at different phases of the illness trajectory about how they experienced care needs related to their disease from diagnosis onward. Respondents experienced needs within the different domains of palliative care at different stages of the illness and different illness types or duration of the illness. This study contributes to the understanding of primary care needs of patients for whom palliative care (not necessarily specialized palliative care) could be beneficial.",cancer;chronic care;dementia;organ failure;palliative care;symptoms,"Beernaert, K.;Deliens, L.;De Vleminck, A.;Devroey, D.;Pardon, K.;Block, L. V.;Cohen, J.",2016,Jun,10.1177/1049909115577352,0,356
356,Is There a Need for Early Palliative Care in Patients With Life-Limiting Illnesses? Interview Study With Patients About Experienced Care Needs From Diagnosis Onward,"The early integration of specialist palliative care has been shown to benefit the quality of life of patients with advanced cancer. In order to explore whether other seriously ill people and people at even earlier phases would also benefit from early palliative care, we conducted 18 qualitative interviews with people having cancer, chronic obstructive lung disease, heart failure, or dementia at different phases of the illness trajectory about how they experienced care needs related to their disease from diagnosis onward. Respondents experienced needs within the different domains of palliative care at different stages of the illness and different illness types or duration of the illness. This study contributes to the understanding of primary care needs of patients for whom palliative care (not necessarily specialized palliative care) could be beneficial.",chronic obstructive lung disease;dementia;female;heart failure;human;human relation;interpersonal communication;male;neoplasm;organization and management;palliative therapy;patient care;patient education;psychology;qualitative research;quality of life;terminal care;time factor;time to treatment,"Beernaert, K.;Deliens, L.;De Vleminck, A.;Devroey, D.;Pardon, K.;Block, L. V.;Cohen, J.",2016,,10.1177/1049909115577352,0,
357,"Early identification of palliative care needs by family physicians: A qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients","Background: There is a growing recognition that a palliative care approach should be initiated early and not just in the terminal phase for patients with life-limiting diseases. Family physicians then play a central role in identifying and managing palliative care needs, but appear to not identify them accurately or in a timely manner. Aim: To explore the barriers to and facilitators of the early identification by family physicians of the palliative care needs. Design, setting, and participants: Six focus groups (four with family physicians, n = 20, and two with community nurses, n = 12) and 18 interviews with patients with cancer, chronic obstructive pulmonary disease, heart failure, and dementia were held. Thematic analysis was used to derive themes that covered barriers and facilitators. Results: Key barriers and facilitators found relate to communication styles, the perceived role of a family physician, and continuity of care. Family physicians do not systematically assess non-acute care needs, and patients do not mention them or try to mask them from the family physician. This is embedded within a predominant perception among patients, nurses, and family physicians of the family physician as the person to appeal to in acute and standard follow-up situations rather than for palliative care needs. Family physicians also seemed to pay more often attention to palliative care needs of patients in a terminal phase. Conclusion: The current practice of palliative care in Belgium is far from the presently considered ideal palliative care approaches. Facilitators such as proactive communication and communication tools could contribute to the development of guidelines for family physicians and policymakers in primary care.",adult;aged;article;chronic obstructive lung disease;clinical article;controlled study;dementia;female;follow up;general practitioner;health care need;heart failure;human;interpersonal communication;male;middle aged;neoplasm;palliative therapy;patient care;physician attitude;prognosis;qualitative research;thematic analysis;very elderly,"Beernaert, K.;Deliens, L.;De Vleminck, A.;Devroey, D.;Pardon, K.;Van Den Block, L.;Cohen, J.",2013,,,0,
358,Improving comfort around dying in elderly people: a cluster randomised controlled trial,"Background Over 50% of elderly people die in acute hospital settings, where the quality of end-of-life care is often suboptimum. We aimed to assess the effectiveness of the Care Programme for the Last Days of Life (CAREFuL) at improving comfort and quality of care in the dying phase in elderly people. Methods We did a cluster randomised controlled trial in acute geriatric wards in ten hospitals in Flemish Region, Belgium, between Oct 1, 2012, and March 31, 2015. Hospitals were randomly assigned to implementation of CAREFuL (CAREFuL group) or to standard care (control group) using a random number generator. Patients and families were masked to interventaion allocation; hospital staff were unmasked. CAREFuL comprised a care guide for the last days of life, training, supportive documentation, and an implementation guide. Primary outcomes were comfort around dying, measured with the End-of-Life in Dementia–Comfort Assessment in Dying (CAD-EOLD), and symptom management, measured with the End-of-Life in Dementia–Symptom Management (SM-EOLD), by nurses and family carers. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01890239. Findings 451 (11%) of 4241 beds in ten hospitals were included in the analyses. Five hospitals were randomly assigned to standard health care practice and five to the CAREFuL programme; 118 patients in the control group and 164 in the CAREFuL group were eligible for assessment. Assessments were done for 132 (80%) of 164 patients in the CAREFuL group and 109 (92%) of 118 in the control group by nurses, and 48 (29%) in the CAREFuL group and 23 (19%) in the control group by family carers. Implementation of CAREFuL compared with control significantly improved nurse-assessed comfort (CAD-EOLD baseline-adjusted mean difference 4·30, 95% CI 2·07–6·53; p<0·0001). No significant differences were noted for the CAD-EOLD assessed by family carers (baseline-adjusted mean difference −0·62, 95% CI −6·07 to 4·82; p=0·82) or the SM-EOLD assessed by nurses (−0·41, −1·86 to 1·05; p=0·58) or by family carers (−0·59, −3·75 to 2·57; p=0·71). Interpretation Although a continuous monitoring of the programme is warranted, these results suggest that implementation of CAREFuL might improve care during the last days of life for patients in acute geriatric hospital wards. Funding The Flemish Government Agency for Innovation by Science and Technology and the Belgian Cancer Society “Kom Op Tegen Kanker”.",NCT01890239;aged;anxiety;article;caregiver;cause of death;controlled study;crying;dying;dysphagia;dyspnea;End of Life in Dementia Comfort Assessment in Dying;fear;female;follow up;geriatric assessment;geriatric care;geriatric hospital;health care practice;health care quality;health program;heart failure;human;infection;major clinical study;male;multicenter study;nurse;outcome assessment;oxygen therapy;pain;patient comfort;pneumonia;priority journal;program effectiveness;randomized controlled trial;restlessness;symptom;terminal care;vomiting,"Beernaert, K.;Smets, T.;Cohen, J.;Verhofstede, R.;Costantini, M.;Eecloo, K.;Van Den Noortgate, N.;Deliens, L.",2017,,10.1016/s0140-6736(17)31265-5,0,
359,Atypical antipsychotics in dementia (multiple letters),,aripiprazole;atypical antipsychotic agent;olanzapine;quetiapine;risperidone;ziprasidone;behavior disorder;clinical trial;dementia;drug efficacy;drug indication;drug safety;drug tolerability;drug use;geriatric care;heart failure;human;letter;medical practice;pneumonia;practice guideline;psychosis;quality of life;risk factor;schizophrenia;sudden death,"Beers, M. H.;Keys, M.;Dewald, C.",2005,,,0,
360,"Comment on ""The predictive capacity of personal genome sequencing""",An alternative calculation of the predictive capacity of genomic sequencing and an analysis based on the occurrence of cancer in the second breast of breast cancer patients both offer a more optimistic view of the predictive value of genetic data than that presented by Roberts et al.,Alzheimer disease;article;bladder cancer;breast cancer;cancer incidence;cancer risk;cholelithiasis;chronic fatigue syndrome;colorectal cancer;death;dementia;dystocia;gastroesophageal reflux;gene sequence;genetic risk;genome analysis;human;insulin dependent diabetes mellitus;irritable colon;ischemic heart disease;leukemia;lung cancer;non insulin dependent diabetes mellitus;ovary cancer;pancreas cancer;Parkinson disease;pelvic organ prolapse;predictive value;priority journal;prostate cancer;second cancer;standardized incidence ratio;stomach cancer;stress incontinence;thyroid disease;twin discordance,"Begg, C. B.;Pike, M. C.",2012,,,0,
361,"Subjective memory impairment in older adults: Aetiology, salience and help seeking","Background Subjective memory impairment (SMI) is one of the key symptoms with which people with early cognitive impairment may present to health services. However, little research has investigated how older people view the symptom, its salience and how often help is sought. The objectives were to investigate (a) factors associated with SMI, (b) salience of SMI in comparison with other symptoms and (c) help seeking for SMI. Method A cross-sectional survey was based in two Primary Care services in south London in which registered people aged 65+ were interviewed blind to the study objectives. Measurements included systematic ascertainment of SMI and other common symptoms/disorders. In each of these, concern and interference were quantified, and participants were asked to rank all reported symptoms/disorders in order of importance. Results Of 126 participants, any SMI was reported in 66.7%, and 31.0% reported SMI to a significant degree. SMI occupied a middling rank in terms of salience, being ranked as more concerning than angina, asthma, hypertension or a previous heart attack in around half of participants in whom these co-occurred. However, only one participant with SMI had sought help from their GP, making it the least likely symptom to be reported. Conclusion Subjective memory impairment is common and appears to have functional and/or emotional significance for many older people. However, very few appear to seek medical attention for this symptom, which has implications for wider policy regarding prompt assessment and diagnosis of mild cognitive impairment or dementia. Copyright © 2011 John Wiley & Sons, Ltd.",aged;angina pectoris;article;asthma;cross-sectional study;depression;emotion;female;general practitioner;geriatric disorder;heart infarction;human;hypertension;interview;major clinical study;male;memory disorder;patient attitude;subjective memory impairment;symptom,"Begum, A.;Morgan, C.;Chiu, C. C.;Tylee, A.;Stewart, R.",2012,,,0,
362,A review of the literature on dehydration in the institutionalized elderly,"Background & aims: Dehydration is the most common fluid and electrolyte problem among the elderly. The purpose of this review is to summarize the literature on dehydration in the institutionalized elderly. Methods: To find relevant literature for this narrative review, a computerized search of articles published until June 2009 was performed in three databases: PubMed, Medline, and the Cochrane Library. Results: Dehydration is conceptualized and operationalized in many different ways in the literature. Yet, dehydration is reported to be widely prevalent and costly to individuals and to the health care system. It affects large numbers, contributes to or exacerbates other severe medical conditions, may cause acute confusion and disorientation, and severely impairs the elderly individual's quality of life. Various strategies to detect and address dehydration are reported in the literature and these are primarily based on practice, or small scale research projects. Conclusions: Detection and prevention of dehydration is critically important among the frail, institutionalized elderly. In the future, the efficacy, effectiveness and economics of these strategies need to be further evaluated through research. © 2009 European Society for Clinical Nutrition and Metabolism.",adrenalin;aldosterone;angiotensin II;bile pigment;natriuretic factor;nitric oxide synthase;noradrenalin;potassium;renin;sodium;urea;vasopressin;aged;alcohol consumption;Alzheimer disease;arteriole;bleeding;blood flow;body temperature;body water;body weight;Cochrane Library;cognitive defect;coma;confusion;constipation;creatinine clearance;death;decubitus;dehydration;delirium;dementia;diabetes mellitus;diarrhea;disorientation;dysphagia;elderly care;electrolyte balance;extracellular fluid;falling;fever;fluid intake;functional status;gastroenteritis;glomerulus filtration rate;health care cost;health care system;heart failure;heat exhaustion;homeostasis;human;hypernatremia;hypovolemia;hypovolemic shock;incontinence;information retrieval;institutional care;intracellular fluid;kidney;kidney disease;kidney failure;malnutrition;medical ethics;Medline;metabolic disorder;mitral valve prolapse;mortality;mucosal dryness;nausea and vomiting;nephrolithiasis;nephron;neurologic disease;oliguria;orthostatic hypotension;osmoreceptor;plasma volume;pneumonia;prevalence;quality of life;risk factor;seizure;sepsis;serum osmolality;serum osmolarity;short survey;skin turgor;social interaction;sodium appetite;sodium blood level;sodium urine level;sweating;tachycardia;terminally ill patient;thermal exposure;thirst;urea nitrogen blood level;uremia;urinalysis;urinary tract infection;urine;urine color;vomiting;walking difficulty;water loss,"Begum, M. N.;Johnson, C. S.",2010,,,0,
363,Clinical spectrum of Kufor-Rakeb syndrome in the Chilean kindred with ATP13A2 mutations,"We report the clinical features of the original Chilean family with Kufor-Rakeb syndrome (KRS) that led to the discovery of the ATP13A2 gene at the PARK9 locus. KRS is a rare juvenile-onset autosomal recessive disease characterized by progressive Parkinsonism, pyramidal signs, and cognitive decline in addition to vertical gaze palsy and facial-faucial-finger minimyoclonus. Neurological and neuropsychological examination during a 10-year period, videotaping, neuroimaging, and measurement of DNA methylation of the ATP13A2 promoter region were performed. The youngest 5 of 17 children of nonconsanguineous parents, carrying compound-heterozygous ATP13A2 mutations, had normal development until ages ∼10 to 12 years, when school performance deteriorated and slowness, rigidity, and frequent falls developed. Examination revealed bradykinesia, subtle postural/action tremor, cogwheel rigidity, spasticity, upward gaze palsy, smooth pursuit with saccadic intrusions, and dementia. Additional signs included facial-faucial-finger minimyoclonus, absent postural reflexes, visual/auditory hallucinations, and insomnia. Levodopa response could not be fully judged in this family. T2* magnetic resonance imaging sequences revealed marked diffuse hypointensity of the caudate (head and body) and lenticular nucleus bilaterally. Disease progression was slow including epilepsy, cachexia, and anarthria. Four affected members died after 28.5 ± 5.5 (mean ± SD) years of disease. Two heterozygous carriers, the mother and eldest sibling, showed jerky perioral muscle contractions and clumsiness of hand movements. There was no significant correlation between DNA methylation of the ATP13A2 promoter region and disease progression. The marked caudate and lenticular nucleus T2*-hypointensity suggests that KRS might belong to the family of neurodegenerative diseases associated with brain iron accumulation. © 2010 Movement Disorder Society.",benserazide;levodopa;thioridazine;trihexyphenidyl;academic achievement;adolescent;adult;aged;apraxia;article;auditory hallucination;autosomal recessive disorder;Babinski reflex;bradykinesia;brain atrophy;cachexia;caudate nucleus;child;child development;Chile;clinical article;clonus;dementia;disease course;DNA methylation;drug intermittent therapy;dystonia;epilepsy;extrapyramidal symptom;falling;fatigue;female;gait disorder;gaze paralysis;gene locus;gene mutation;hallucination;hand movement;heart infarction;hemiparesis;herpes zoster;heterozygosity;human;hyperreflexia;hypertension;hearing impairment;infant;insomnia;Kufor Rakeb syndrome;laziness;male;missense mutation;mortality;mother;muscle atrophy;muscle contraction;muscle rigidity;myoclonus;nausea;neuroimaging;neurologic examination;neuropsychological test;nuclear magnetic resonance imaging;onset age;pedigree analysis;pneumonia;priority journal;prolonged pregnancy;promoter region;quadriplegia;restless legs syndrome;saccadic eye movement;seizure;sibling;slurred speech;spasticity;speech disorder;spinocerebellar degeneration;treatment response;tremor;videooculography;visual hallucination;walking difficulty;weight reduction,"Behrens, M. I.;Brüggemann, N.;Chana, P.;Venegas, P.;Kägi, M.;Parrao, T.;Orellana, P.;Garrido, C.;Rojas, C. V.;Hauke, J.;Hahnen, E.;González, R.;Seleme, N.;Fernández, V.;Schmidt, A.;Binkofski, F.;Kömpf, D.;Kubisch, C.;Hagenah, J.;Klein, C.;Ramirez, A.",2010,,,0,
364,"Clinical presentation, etiology, and long-term prognosis in patients with nontraumatic convexal subarachnoid hemorrhage","BACKGROUND AND PURPOSE-: Nontraumatic subarachnoid hemorrhage at the convexity of the brain (cSAH) is an incompletely characterized subtype of nonaneurysmal subarachnoid bleeding. This study sought to systematically describe the clinical presentation, etiology, and long-term outcome in patients with cSAH. METHODS-: For a 6-year period, we searched our radiological database for patients with nontraumatic nonaneurysmal subarachnoid hemorrhages (n=131) seen on CT or MRI. By subsequent image review, we identified 24 patients with cSAH defined by intrasulcal bleeding restricted to the hemispheric convexities. We reviewed their medical records, analyzed the neuroimaging studies, and followed up patients by telephone or a clinical visit. RESULTS-: The 24 patients with cSAH had a mean age of 70 years (range, 37-88 years), 20 (83%) were >60 years, and 13 (54%) were women. Patients often presented with transient sensory and/or motor symptoms (n=10 [42%]) and seizures (n=5 [21%]), whereas headaches typical of subarachnoid hemorrhage were rare (n=4 [17%]). MRI provided evidence for prior bleedings in 11 patients (microbleeds in 10 and parenchymal bleeds in 5) with a bleeding pattern suggestive of cerebral amyloid angiopathy in 5 subjects. At follow-up (after a mean of 33 months), 14 patients (64%) had an unfavorable outcome (modified Rankin scale score 3-6), including 5 deaths. We did not observe recurrent cSAH. CONCLUSIONS-: Our data suggest that cSAH often presents with features not typical for subarachnoid bleeding. In the elderly, cSAH is frequently associated with bleeding-prone conditions such as cerebral amyloid angiopathy. Recurrence of cSAH is rare but the condition itself is a marker of poor prognosis. © 2011 American Heart Association, Inc.",acute heart failure;adult;aged;aphasia;article;brain disease;brain ischemia;cause of death;cerebral hyperperfusion syndrome;clinical article;clinical feature;computed tomographic angiography;computer assisted tomography;confusion;dementia;digital subtraction angiography;Doppler echography;electroencephalography;female;focal epilepsy;follow up;tonic clonic seizure;headache;hemisphere;human;magnetic resonance angiography;male;medical record review;mortality;motor dysfunction;nausea;neuroimaging;nuclear magnetic resonance imaging;outcome assessment;parenchyma;pneumonia;priority journal;prognosis;Rankin scale;sensory dysfunction;cerebrovascular accident;subarachnoid hemorrhage;subcortical intracerebral hemorrhage;surface electroencephalography;vertigo;vomiting,"Beitzke, M.;Gattringer, T.;Enzinger, C.;Wagner, G.;Niederkorn, K.;Fazekas, F.",2011,,,0,
365,Poststroke disposition and associated factors in a population-based study: The dijon stroke registry,"BACKGROUND AND PURPOSE-: The organization of poststroke care will be a major challenge in coming years. We aimed to assess hospital disposition after stroke and its associated factors in clinical practice. METHODS-: All cases of stroke from 2006 to 2010 were identified population-based Stroke Registry of Dijon, France. Demographic features, risk factors, and prestroke treatments were recorded. Admission stroke severity was assessed using the National Institutes of Health Stroke Scale score. At discharge, we collected dementia, disability using the modified Rankin Scale, length of stay, and hospital disposition (home, rehabilitation, convalescent home, and nursing home). Multivariate analyses were performed using logistic regression models to identify associated factors of postdischarge disposition. RESULTS-: Of the patients with 1069 stroke included, 913 survived acute care. Among them, 433 (47.4%) returned home, whereas 206 (22.6%) were discharged to rehabilitation, 134 (14.7%) were admitted to a convalescent home, and 140 (15.3%) to a nursing home. Old patients, those under anticoagulants before stroke, those with severe stroke on admission, severe disability at discharge, dementia, or prolonged length of stay were less likely to return home. Moreover, advanced age, severe initial stroke, severe disability at discharge, and dementia were associated with admission to convalescent and nursing homes rather than rehabilitation centers. CONCLUSION-: This population-based study demonstrated that postdischarge destinations are associated with several factors. Our findings may be useful to establish health policy concerning the organization of poststroke care. © 2012 American Heart Association, Inc.",adult;age distribution;aged;article;clinical practice;dementia;demography;disability;disease predisposition;disease severity;emergency care;female;atrial fibrillation;heart failure;home care;hospital discharge;human;hypertension;length of stay;long term care;major clinical study;male;National Institutes of Health Stroke Scale;nursing home;peripheral occlusive artery disease;population research;priority journal;Rankin scale;rehabilitation care;risk factor;cerebrovascular accident,"Béjot, Y.;Troisgros, O.;Gremeaux, V.;Lucas, B.;Jacquin, A.;Khoumri, C.;Aboa-Eboulé, C.;Benaïm, C.;Casillas, J. M.;Giroud, M.",2012,,,0,
366,Collaborative care to alleviate symptoms and adjust to illness (CASA): primary efficacy results from the casa randomized clinical trial of a palliative symptom and psychosocial care intervention in heart failure,"BACKGROUND: Palliative care provided by specialists shows promise in improving symptoms and quality of life in patients with chronic heart failure. However, there is limited high-quality data for what works in the outpatient setting. Furthermore, because there are relatively few palliative care specialists, scalable interventions that can be used in routine outpatient care are needed. The CASA trial determined whether a team-based intervention improved health status (i.e., symptoms, function, and quality of life) and other outcomes in outpatients with heart failure compared to usual care. METHODS: Patients with heart failure and poor self-reported health status were recruited from a VA, an academic health system, and an urban safety net health system. Patients with dementia, metastatic cancer, major mental illness, or active substance abuse were excluded. The CASA intervention included a nurse who addressed persistent symptoms (e.g., shortness of breath, fatigue, pain) and a social worker who provided psychosocial care. Patients were also reviewed with a study primary care provider, cardiologist, and palliative care physician who wrote orders for medications and tests for patients' primary providers to consider. The primary outcome was heart failure-specific health status at 6 months, measured using the Kansas City Cardiomyopathy Questionnaire (range, 0-100, higher is better; the study was designed to have 90% power to detect a clinically meaningful difference of 6). Secondary outcomes included depression (Patient Health Questionnaire-9), overall symptom distress (General Symptom Distress Scale), specific symptoms (PEG pain, PROMIS fatigue, shortness of breath), hospitalizations, and mortality. Data were analyzed using mixed models. RESULTS: 314 patients were randomized (157 intervention, 157 control). Participants were generally male (77%), white (63%), with a mean age of 65.5 years, and 57% had reduced ejection fraction. At 6 months, mean KCCQ score improved 5.5 points in the intervention arm and 2.9 points in the control arm (difference, 2.7; 95% confidence interval -1.3, 6.6; p = 0.19). Among secondary outcomes, depressive symptoms and fatigue improved at 6 months with CASA (effect sizes of -0.29 and -0.30, respectively, p = 0.02 for both). There were no changes in overall symptom distress, pain, shortness of breath, or hospitalizations. Mortality at 12months was similar (CASA, 10/157; usual care, 13/157; p=0.52). CONCLUSIONS: This randomized trial of the CASA intervention did not demonstrate a significant improvement in heart failure-specific health status. Secondary outcomes of depression and fatigue, which have been difficult symptoms to address in heart failure, did improve. Alternate or more intensive interventions should be evaluated to improve health status in the symptomatic heart failure population.",aged;cardiologist;cardiomyopathy;clinical trial;confidence interval;controlled clinical trial;controlled study;dementia;depression;distress syndrome;dyspnea;effect size;fatigue;health status;heart ejection fraction;heart failure;hospitalization;human;Kansas;major clinical study;male;metastasis;mortality;nurse;outpatient care;pain;palliative therapy;Patient Health Questionnaire 9;primary medical care;psychosocial care;quality of life;questionnaire;randomized controlled trial;safety;social worker;substance abuse;Symptom Distress Scale,"Bekelman, D;Allen, L;Hattler, B;Havranek, Ep;Fairclough, D;McBryde, Cf;Meek, P",2017,,,0,
367,The National Hospital Discharge Survey and Nationwide Inpatient Sample: The Databases Used Affect Results in THA Research,"Background: The National Hospital Discharge Survey (NHDS) and the Nationwide Inpatient Sample (NIS) collect sample data and publish annual estimates of inpatient care in the United States, and both are commonly used in orthopaedic research. However, there are important differences between the databases, and because of these differences, asking these two databases the same question may result in different answers. The degree to which this is true for arthroplasty-related research has, to our knowledge, not been characterized. Question/purposes: We tested the following null hypotheses: (1) there are no differences between the NHDS and NIS in patient characteristics, comorbidities, and adverse events in patients with hip osteoarthritis treated with THA, and (2) there are no differences between databases in factors associated with inpatient mortality, adverse events, and length of hospital stay after THA. Methods: The NHDS and NIS databases use different methods of data collection and weighting to provide data representative of all nonfederal hospital discharges in the United States. In 2006 the NHDS database contained 203,149 patients with hip arthritis treated with hip arthroplasty, and the NIS database included 193,879 patients. Multivariable analyses for factors associated with inpatient mortality, adverse events, and days of care were constructed for each database. Results: We found that 26 of 42 of the factors in demographics, comorbidities, and adverse events after THA in the NIS and NHDS databases differed more than 10%. Age and days of care were associated with inpatient mortality with the NHDS and the NIS although the effect rates differ more than 10%. The NIS identified seven other factors not identified by the NHDS: wound complications, congestive heart failure, new mental disorder, chronic pulmonary disease, dementia, geographic region Northeast, acute postoperative anemia, and sex, that were associated with inpatient mortality even after controlling for potentially confounding variables. For inpatient adverse events, atrial fibrillation, osteoporosis, and female sex were associated with the NHDS and the NIS although the effect rates differ more than 10%. There were different directions for sources of payment, dementia, congestive heart failure, and geographic region. For longer length of stay, common factors differing more than 10% in effect rate included chronic pulmonary disease, atrial fibrillation, complication not elsewhere classified, congestive heart failure, transfusion, discharge nonroutine compared with routine, acute postoperative anemia, hypertension, wound adverse events, and diabetes mellitus, whereas discrepant factors included geographic region, payment method, dementia, sex, and iatrogenic hypotension. Conclusions: Studies that use large databases intended to be representative of the entire United States population can produce different results, likely related to differences in the databases, such as the number of comorbidities and procedures that can be entered in the database. In other words, analyses of large databases can have limited reliability and should be interpreted with caution. Level of Evidence: Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.",acute heart infarction;acute kidney failure;adult;aged;anemia;article;artificial ventilation;chronic lung disease;comorbidity;coxitis;data base;deep vein thrombosis;dementia;diabetes mellitus;fat embolism;female;geography;atrial fibrillation;heart ventricle arrhythmia;hematoma;hip arthroplasty;hip osteoarthritis;hospital discharge;human;hypertension;induced hypotension;length of stay;lung congestion;lung embolism;lung insufficiency;major clinical study;male;mortality;osteoporosis;pneumonia;postoperative complication;postoperative infection;seroma;total hip prosthesis;transfusion;United States,"Bekkers, S.;Bot, A. G. J.;Makarawung, D.;Neuhaus, V.;Ring, D.",2014,,,0,
368,Drug therapies and presence of coronary artery disease may affect aortic stiffness in Alzheimer's disease,,Alzheimer Disease/*physiopathology;Aortic Diseases/*physiopathology;Diastole/*physiology;Female;Humans;Male;Vascular Stiffness/*physiology,"Bektas, O.;Gunaydin, Z. Y.;Karagoz, A.;Kaya, A.",2015,,10.2147/cia.s80096,0,
369,"Canadian Consensus Conference on Menopause, 2006 Update","Objective: To provide guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor symptoms, urogenital, sexual, and mood and memory concerns and on specific medical considerations, and cardiovascular and cancer issues. Outcomes: Prescription medications, complementary and alternative medicine (CAM), and lifestyle interventions are presented according to their efficacy in treating menopausal symptoms. Evidence: MEDLINE and the Cochrane database were searched for articles from March 2001 to April 2005 in English on subjects related to menopause, menopausal symptoms, urogenital and sexual health, mood and memory, hormone therapy, CAM, and on specific medical considerations that affect the decision of which intervention to choose. Values: The quality of evidence is rated using the criteria described in the report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this report (see Table 1). Sponsors: The development of this consensus guideline was supported by unrestricted educational grants from Berlex Canada Inc, Lilly Canada, Merck Frosst, Novartis, Novogen, Novo Nordisk, Proctor and Gamble, Schering Canada, and Wyeth Canada. RECOMMENDATIONS: I. General Recommendations. 1.Health care providers should discuss and encourage initiation of healthy lifestyle choices in menopausal women. (II-2A)2.The primary indication for hormone therapy (HT) should be for the management of moderate to severe menopausal symptoms. (IA)3.HT should not be prescribed for primary or secondary prevention of cardiovascular disease (CVD) or for primary prevention of dementia. (IA)4.Local estrogen therapy (ET) is recommended if HT is prescribed for vulvovaginal symptoms alone. (IA)5.HT should be prescribed for the appropriate duration to achieve treatment goals while taking into consideration risks and benefits and the woman's quality of life. (IIIB)6.HT should be prescribed at the lowest effective dose, although the long-term risk/benefit ratio of lower dose HT has not been demonstrated. (IIIC)7.The primary indication for progestin use should be endometrial protection in women using systemic estrogen therapy who have an intact uterus. (IA)8.HT may be prescribed for an extended period, following proper counselling, if the woman decides that for her the benefits outweigh the risks (II-2A). Periodic re-evaluation is strongly recommended (IIIC).9.Androgen therapy may be considered for selected women with acquired sexual desire/interest disorders after comprehensive assessment, systemic estrogen therapy and appropriate counselling (II-1B) Androgen therapy is still investigational and long-term safety data are lacking (IIIB).10.Health care providers may offer identified complementary and alternative medicine with demonstrated efficacy for mild menopausal symptoms. (IB). II. Specific Recommendations: Chapter 1: Introduction. No Recommendations. Chapter 2: Menopause and Age-Related Concerns. 1.Lifestyle modifications, including reducing core body temperature, regular exercise, weight management, smoking cessation, and controlled breathing may be recommended to reduce mild vasomotor symptoms. (IC)2.Health care providers should offer HT (ET/estrogen-progestin therapy) as the most effective therapy for the medical management of menopausal symptoms. (IA)3.Progestins alone or low-dose oral contraceptives can be offered as alternatives for the relief of menopausal symptoms especially during the transition phase. (IA)4.Non-hormonal prescription therapies, including antidepressant agents, gabapentine, clonidine, and bellergal, can be prescribed as alternatives to HT to reduce vasomotor symptoms. (IB)5.Complementary and alternative medicine, including black cohosh, red clover (derived isoflavone, and vitamin E) may be recommended for the reduction of mild vasomotor symptoms (IB). Long-term efficacy and safety data are still lacking.6.Any unexpected bleeding that occurs after 12 months of ameno rhea is considered postmenopausal bleeding and should be investigated. (IA)7.If prescribing HT to older postmenopausal women, low or ultra-low dose ET is preferred. (IB)Chapter 3: Urogenital Concerns. 1.Conjugated estrogen (CE) cream, an intravaginal sustained-release estradiol ring, or estradiol vaginal tablets are recommended as effective treatment for vulvovaginal atrophy. (IA)2.Routine progestin co-therapy is not required for endometrial protection in women receiving vaginal estrogen therapy in appropriate dose. (IIIC)3.Vaginal lubricants may be recommended for subjective symptom improvement of dyspareunia. (IIIC)4.Health care providers can offer polycarbophil gel (a vaginal moisturizer) as an effective treatment for symptoms of vulvovaginal atrophy including dryness and dyspareunia. (IA)5.Effective surgical treatment options, including Burch colposuspension and the TVT procedure, are recommended for the treatment of stress urinary incontinence. (IA)6.Effective non-surgical treatment options, such as weight loss (in obese women), pelvic floor physiotherapy with or without biofeedback, weighted vaginal cones, functional electrical stimulation, and/or intravaginal pessaries, can be recommended for the treatment of stress urinary incontinence. (II-1B)7.Lifestyle modification, bladder drill (II-1B), and antimuscarinic therapy (IA) are recommended for the treatment of urge urinary incontinence.8.ET should not be recommended for the treatment of postmenopausal urge or stress urinary incontinence. (IA)9.Vaginal estrogen therapy can be recommended for the prevention of recurrent urinary tract infections in postmenopausal women. (IA)Chapter 4: Sexual Concerns. 1.A biopsychosexual assessment of preferably both partners (when appropriate), identifying intrapersonal, contextual, interpersonal, and biological factors, is recommended prior to treatment of women's sexual problems. (IIIA)2.For women with vaginal atrophy, local estrogen should be prescribed to improve vulvovaginal atrophy-associated dyspareunia. (IA)3.Routine evaluation of sex hormone levels in postmenopausal women with sexual problems is not recommended. Available androgen assays neither reflect total androgen activity, nor correlate with sexual function. (IIIA)4.Any investigational testosterone therapy included in the management of selected women with acquired sexual desire/interest disorder, typically associated with an arousal disorder, should only be initiated by clinicians experienced in women's sexual dysfunction and with informed consent from the woman. The investigational nature, lack of long-term safety data, need for systemic estrogen therapy, and careful follow-up must be explained. (IC)Chapter 5: Mood and Memory. 1.Estrogen alone may be offered as an effective treatment for depressive disorders in perimenopausal women and may augment clinical response to antidepressant treatment, specifically SSRIs (IB). The use of antidepressant medication, however, is supported with the most research evidence (IA).2.Estrogen can be prescribed to enhance mood in women with depressive symptoms. The effect appears to be greater for perimenopausal symptomatic women than for postmenopausal women. (IA)3.Estrogen therapy is not currently recommended for reducing the risk of developing dementia in postmenopausal women or for retarding the progression or deterioration in women with diagnosed Alzheimer's disease. (IB)Chapter 6: Prescription Drugs. No Recommendations. Chapter 7: Complementary and Alternative Medicine. No Recommendations. Chapter 8: Specific Medical Considerations. 1.HT should be offered to women with premature ovarian failure (POF) or early menopause (IA), and its use can be recommended until the age of natural menopause (IIIC).2.ET can be offered to women who have undergone surgical menopause for the treatment of endometriosis. (IA)3.Menopausal women undergoing pelvic surgery should be given appropriate thromboembolic prophylaxis. (IA)4.Health care providers may prescribe HT to diabetic women for the relief of menopausal symptoms. (IA)Chapter 9: Cardiovascular D sease (CVD). 1.Health care providers should not initiate or continue HT for the sole purpose of preventing CVD (coronary artery disease and stroke). (IA)2.Health care providers should abstain from prescribing HT in women at high risk for venous thromboembolic disease. (IA)3.Health care providers should consider other evidence-based therapies and interventions to effectively reduce the risk of CVD events in women with or without vascular disease. (IA)Chapter 10: Cancer. 1.All unscheduled uterine bleeding should be investigated because no estrogen-progestin regimen is completely protective against endometrial carcinoma. (IA)2.Estrogen-progestin therapy may be offered to women with low-grade adenocarcinoma of the endometrium who have moderate to severe menopausal symptoms. (IB)3.Health care providers should periodically review the risks and benefits of prescribing HT to a menopausal woman in light of the association between duration of use and breast cancer risk. (IA)4.Health care providers may prescribe HT for menopausal symptoms in women at increased risk of breast cancer with appropriate counselling and surveillance (IA) (in women in the Women's Health Initiative [WHI] study with high Gael scores were at no greater risk of breast cancer than women with low risk scores).5.Health care providers should clearly discuss the uncertainty of risks associated with HT after a diagnosis of breast cancer in women seeking treatment for distressing symptoms. (IB).",alpha tocopherol;androgen;antidepressant agent;bellergal;clonidine;conjugated estrogen;estradiol;estrogen;gabapentin;gestagen;isoflavone;lubricating agent;muscarinic receptor blocking agent;polycarbophil;Actaea racemosa;alternative medicine;amenorrhea;androgen therapy;article;breast cancer;Canada;cardiovascular disease;colposuspension;consensus development;dementia;disease surveillance;dyspareunia;early menopause;endometriosis;estrogen therapy;feedback system;female sexual dysfunction;functional electrical stimulation;health care personnel;hormonal therapy;human;hypoactive sexual desire disorder;lifestyle modification;low drug dose;memory disorder;menopausal syndrome;menopause;mood disorder;patient counseling;physiotherapy;practice guideline;premature ovarian failure;prescription;primary prevention;quality of life;recurrent infection;red clover;secondary prevention;sexual behavior test;sexual dysfunction;stress incontinence;surgical drill;tension free vaginal tape;treatment duration;treatment indication;urge incontinence;urinary tract infection;urogenital tract disease;vagina atrophy;vaginal dryness;vasomotor disorder;vulvovaginal disease;weight reduction,"Bélisle, S.;Blake, J.;Basson, R.;Desindes, S.;Graves, G.;Grigoriadis, S.;Johnston, S.;Lalonde, A.;Mills, C.;Nash, L.;Reid, R.;Rowe, T.;Senikas, V.;Turek, M.;Henneberg, E.;Pothier, M.;Capistran, C.;Oman, J.",2006,,,0,
370,Factors associated with place of death for elderly Japanese-American men: The Honolulu heart program and Honolulu-Asia aging study,"Place of death is an indicator of health service utilization at the end of life and differs according to cause of death. Asian Americans may have a higher percentage of hospital deaths than Caucasian Americans, yet reasons for this finding are unclear. This study examined distribution of place of death and the associations between place and cause of death in elderly Japanese-American men in a longitudinal cohort: the Honolulu Heart Program and Honolulu-Asia Aging Study. Data collected between 1991 and 1999 on 1,352 men aged 73 to 99 at death were analyzed for associations between cause-of-death characteristics and hospital, home, or nursing home location of death. Fifty-nine percent of men died in hospitals, 23% died at home, and 18% died in nursing homes. Of the dementia-related deaths, 43% occurred in hospitals (vs 16% in a national study), 37% occurred in nursing homes (vs 67% in a national study), and 20% occurred at home. Of the stroke deaths, 53% occurred in hospitals, 40% were in nursing homes, and 7% occurred at home. Of the cancer deaths, 53% occurred in hospitals, 34% occurred at home, and 13% were in nursing homes. Traditional family obligation to care for elderly people at home and inability to access care for dementia may account for the greater rate of hospital death and lower rate of nursing home deaths in this cohort. Attitudes of elderly Japanese Americans and their families regarding place of care at the end of life, particularly in the setting of dementia, merit future study. © 2009 The American Geriatrics Society.",aged;aging;article;Asia;Asian American;attitude to aging;cancer mortality;cause of death;cohort analysis;dementia;elderly care;ethnicity;family;health program;heart;home;hospital;human;ischemic heart disease;lifespan;longitudinal study;major clinical study;male;mortality;neoplasm;nursing home;population distribution;respiratory tract disease;risk factor;cerebrovascular accident,"Bell, C. L.;Davis, J.;Harrigan, R. C.;Somogyi-Zalud, E.;Tanabe, M. K. G.;Masaki, K. H.",2009,,,0,
371,Coma after cardiac arrest,,"Adult;Age Factors;Aged;Blindness/etiology;Brain Damage, Chronic/*etiology;Cardiac Surgical Procedures;Child;Coma/*etiology;Coronary Disease/complications;Decerebrate State/etiology;Dementia/etiology;Female;Follow-Up Studies;Heart Arrest/*complications/etiology/therapy;Heart Diseases/complications;Hemiplegia/etiology;Humans;Infant;Male;Middle Aged;Muscle Spasticity/etiology;Postoperative Complications;Quadriplegia/etiology;Respiratory Insufficiency/complications;*Resuscitation;Surgical Procedures, Operative/adverse effects","Bell, J. A.;Hodgson, H. J.",1974,Jun,,0,
372,2004 SAE-P: Geriatric rehabilitation,,abuse;arterial oxygen saturation;arthritis;bone density;bone mineral;caregiver;chronic obstructive lung disease;congestive heart failure;constipation;crime;dementia;diabetes mellitus;driving ability;erectile dysfunction;falling;food industry;fracture;functional assessment;geriatric care;geriatric patient;geriatrics;health care facilities and services;health service;hemiparesis;hip fracture;hypertension;intestine transit time;kinesiotherapy;leukocyte;medicare;mental health;mobilization;muscle strength;note;nursing home;pain;patient care;physical medicine;physician;physiotherapist;polypharmacy;postoperative care;prospective payment;rehabilitation;retirement;risk assessment;risk factor;risk reduction;sensory neuropathy;sitting;skill;social support;cerebrovascular accident;traffic accident;urinalysis;urine incontinence;vagina atrophy;work,"Bell, K. R.;Gittler, M. S.;Prather, H.;Webster, J. B.",2004,,,0,
373,Action observation treatment improves recovery of postsurgical orthopedic patients: Evidence for a top-down effect?,"Objective To assess whether action observation treatment (AOT) may also improve motor recovery in postsurgical orthopedic patients, in addition to conventional physiotherapy. Design Randomized controlled trial. Setting Department of rehabilitation. Participants Patients (N=60) admitted to our department postorthopedic surgery were randomly assigned to either a case (n=30) or control (n=30) group. Exclusion criteria were age 18 years or younger and 90 years or older, Mini-Mental State Examination score of 21 of 30 or lower, no ambulating order, advanced vision impairment, malignancy, pneumonia, or heart failure. Interventions All participants underwent conventional physiotherapy. In addition, patients in the case group were asked to observe video clips showing daily actions and to imitate them afterward. Patients in the control group were asked to observe video clips with no motor content and to execute the same actions as patients in the case group afterward. Participants were scored on functional scales at baseline and after treatment by a physician blinded to group assignment. Main Outcomes Measures Changes in FIM and Tinetti scale scores, and dependence on walking aids. Results At baseline, groups did not differ in clinical and functional scale scores. After treatment, patients in the case group scored better than patients in the control group (FIM total score, P=.02; FIM motor subscore, P=.001; Tinetti scale score, P=.04); patients in the case group were assigned more frequently to 1 crutch (P=.01). Conclusions In addition to conventional physiotherapy, AOT is effective in the rehabilitation of postsurgical orthopedic patients. The present results strongly support top-down effects of this treatment in motor recovery, even in nonneurologic patients. © 2010 American Congress of Rehabilitation Medicine.",adult;article;case control study;clinical article;clinical trial;controlled clinical trial;controlled study;convalescence;female;functional assessment;Functional Independence Measure;gait;hip arthroplasty;hip fracture;human;knee arthroplasty;length of stay;male;motor performance;observation;orthopedic surgery;outcome assessment;physical activity;physiotherapy;postoperative care;rehabilitation care;scoring system;single blind procedure;surgical patient;videorecording;walking aid,"Bellelli, G.;Buccino, G.;Bernardini, B.;Padovani, A.;Trabucchi, M.",2010,,,0,
374,Patients with Alzheimer disease have altered transmitral flow: echocardiographic analysis of the vortex formation time,"OBJECTIVE: There is considerable epidemiologic evidence that Alzheimer disease (AD) is linked to cardiovascular risk factors and associated with an increased risk of symptomatic left ventricular (LV) dysfunction. Formation of a vortex alongside a diastolic jet signifies an efficient blood transport mechanism. The vortex formation time (VFT) is an index of optimal conditions for vortex formation. We hypothesized that AD and its associated cardiovascular risk factors impair diastolic transmitral flow efficiency and, therefore, shift the VFT value out of its optimal range. METHODS: Echocardiographic studies were performed on 45 participants in total: 22 patients with AD diagnosed according to the American Psychiatric Association's criteria and 23 age-matched individuals as a control group with cognitive function within normal limits. RESULTS: The echocardiographic ratio of the early to atrial phases of the LV filling velocities was significantly lower in the AD group (mean +/- SD, 0.67 +/- 14) when compared with the control individuals (0.79 +/- 0.14; P = .003). The interventricular septum diastolic thickness, left ventricular posterior wall diastolic thickness, and right ventricular end-diastolic diameter were significantly higher in the AD group (P <or= 0.04). The mitral annular diameters in the control and AD groups were nearly identical (P = .725). The time-velocity integral of the E wave had a lower value in the AD group than in the control group (P = .05), whereas the VFT was significantly lower in the AD group (P = .018). CONCLUSIONS: Our study suggests that patients with AD have impaired transmitral flow efficiency of diastolic filling, as measured by the VFT, compared with age-matched control individuals.","Aged;Alzheimer Disease/complications/*physiopathology/ultrasonography;*Blood Flow Velocity;Echocardiography/methods;Female;Humans;Male;Mitral Valve/*physiopathology;*Stroke Volume;Ventricular Dysfunction, Left/etiology/*physiopathology/ultrasonography","Belohlavek, M.;Jiamsripong, P.;Calleja, A. M.;McMahon, E. M.;Maarouf, C. L.;Kokjohn, T. A.;Chaffin, T. L.;Vedders, L. J.;Garami, Z.;Beach, T. G.;Sabbagh, M. N.;Roher, A. E.",2009,Nov,,0,
375,Hydrogen sulfide in pharmacology and medicine - An update,"Hydrogen sulfide (H2S) is the endogenously produced gasotransmitter involved in the regulation of nervous system, cardiovascular functions, inflammatory response, gastrointestinal system and renal function. Together with nitric oxide and carbon monoxide, H2S belongs to a family of gasotransmitters. H2S is synthesized from l-cysteine and/or l-homocysteine by cystathionine β-synthase, cystathionine γ-lyase and cysteine aminotransferase together with 3-mercaptopyruvate sulfurtransferase. Significant progress has been made in recent years in our understanding of H2S biochemistry, signaling mechanisms and physiological role. H2S-mediated signaling may be accounted for not only by the intact compound but also by its oxidized form, polysulfides. The most important signaling mechanisms include reaction with protein thiol groups to form persulfides (protein S-sulfhydration), reaction with nitric oxide and related species such as nitrosothiols to form thionitrous acid (HSNO), nitrosopersulfide (SSNO-) and nitroxyl (HNO), as well as reaction with hemoproteins. H2S is enzymatically oxidized in mitochondria to thiosulfate and sulfate by specific enzymes, sulfide:quinone oxidoreductase, persulfide dioxygenase, rhodanese and sulfite oxidase. H2S donors have therapeutic potential for diseases such as arterial and pulmonary hypertension, atherosclerosis, ischemia-reperfusion injury, heart failure, peptic ulcer disease, acute and chronic inflammatory diseases, Parkinson's and Alzheimer's disease and erectile dysfunction. The group of currently available H2S donors includes inorganic sulfide salts, synthetic organic slow-releasing H2S donors, H2S-releasing non-steroidal antiinflammatory drugs, cysteine analogs, nucleoside phosphorothioates and plant-derived polysulfides contained in garlic. H2S is also regulated by many currently used drugs but the mechanism of these effects and their clinical implications are only started to be understood.",Alzheimer disease;atherosclerosis;cardiovascular disease;cardiovascular function;diseases;donor;erectile dysfunction;garlic;gastrointestinal tract;heart failure;inflammation;inflammatory disease;kidney function;mitochondrion;nervous system;peptic ulcer;pharmacology;plant;pulmonary hypertension;reperfusion injury;species;3 mercaptopyruvic acid;acid;aminotransferase;carbon monoxide;cystathionine beta synthase;cystathionine gamma lyase;cysteine;dioxygenase;enzyme;gasotransmitter;homocysteine;hydrogen sulfide;nitric oxide;nonsteroid antiinflammatory agent;nucleoside;oxidoreductase;protein;protein S;quinone derivative;sulfate;sulfide;sulfite oxidase;sulfurtransferase;thiol group;thiosulfate;thiosulfate sulfurtransferase,"Bełtowski, J.",2015,,,0,
376,The public health burden of material deprivation: Excess mortality in leading causes of death in Spain,"Objective. The aim of the study is to investigate the burden of deprivation-associated excess of deaths by 10 leading causes of death in each gender and two age groups. Design. A small-area ecological study using two indices of material deprivation drawn from 1991 census and mortality data aggregated for 1987-1995 was undertaken. Setting. 2218 small areas in Spain. Data are presented by region. Main outcome measures The 10 leading causes of death in each gender and two age groups were determined. Results. The deprivation-associated excess mortality in the top 10 leading causes of death was 14.4 and 11% for males and females, respectively. Excess mortality in the 9-year period studied accounted for more than 222,000 deaths. A large proportion of excess deaths was found in causes related to smoking and alcohol consumption among males and diet-related causes of death among females. The most deprived regions within the country showed the highest mortality risk. Conclusions. Material deprivation appears to be manifested in high mortality rates differently by gender and region. It imposes a significant public health burden that demands urgently attention and action by health policy-makers. © 2003 American Health Foundation and Elsevier Science (USA). All rights reserved.",adolescent;adult;age;alcohol consumption;Alzheimer disease;article;atherosclerosis;breast cancer;cause of death;cerebrovascular disease;child;chronic obstructive lung disease;colon cancer;controlled study;dementia;diet;ecology;female;food deprivation;gender;human;ischemic heart disease;liver cirrhosis;lung cancer;major clinical study;male;mortality;population research;priority journal;prostate cancer;public health;respiratory tract infection;risk factor;smoking;Spain;stomach cancer;traffic accident,"Benach, J.;Yasui, Y.;Borrell, C.;Pasarín, M. I.;Martínez, J. M.;Daponte, A.",2003,,,0,
377,Involvement of vagal autonomic nuclei in multiple system atrophy and Lewy body disease,"Background: Multiple system atrophy (MSA) and Lewy body disorders (LBDs) are associated with impaired control of gastrointestinal and cardiac functions. The dorsal vagal nucleus (DMV) innervates enteric neurons, whereas the ventrolateral nucleus ambiguus (NAmb) innervates the heart. The relationship between DMV and NAmb involvement and the gastrointestinal or cardiovagal manifestations in MSA and LBD is unclear. Methods: The authors counted the cholinergic neurons in the DMV and NAmb in 15 cases of neuropathologically confirmed MSA, 14 of LBD (4 brainstem, 3 limbic, and 7 neocortical), and 12 control cases. All MSA and 8 of the 14 LBD cases had gastrointestinal symptoms; 8 of 12 MSA and 1 of 4 LBD cases had laboratory evidence of cardiovagal failure; 5 of the MSA and no LBD cases had laryngeal stridor. Results: There was loss of cholinergic DMV neurons in all MSA and LBD cases. The degree of DMV cell loss was similar in LBD patient with or without gastrointestinal symptoms. In MSA but not in LBD cases, there was neuronal loss in the ventrolateral NAmb, with lower counts in patients with cardiovagal failure. Conclusions: There is comparable involvement of the dorsal vagal nucleus (DMV) in multiple system atrophy (MSA) and different stages of Lewy body disorders (LBDs). The relationship of DMV involvement and gastrointestinal symptoms is uncertain. Loss of neurons in the ventrolateral nucleus ambiguus may explain the more consistent cardiovagal failure in MSA than in LBD. Copyright © 2006 by AAN Enterprises, Inc.",ambiguus nucleus;article;autonomic nervous system;brain stem;cholinergic nerve cell;controlled study;diffuse Lewy body disease;gastrointestinal tract function;heart failure;heart function;human;human tissue;intestine innervation;limbic cortex;neocortex;priority journal;Shy Drager syndrome;vagus nerve nucleus,"Benarroch, E. E.;Schmeichel, A. M.;Sandroni, P.;Low, P. A.;Parisi, J. E.",2006,,,0,
378,"Apolipoprotein E genotyping: accurate, simple, high throughput method using ABI Prism SNaPshot Multiplex System","Apolipoprotein E (apo E) is an essential constituent of several plasma lipoproteins, and plays an important role in lipoprotein metabolism. The apo E gene exhibits two common functional polymorphisms, producing 3 isoforms known to be associated with the risks of developing cardiovascular disease and susceptibility to Alzheimer's disease. Numerous different methods have been established for determining the three apo E isoforms, yet there are disadvantages and ambiguities associated with all of them. We used a method adapted for multiplex automated primer extension analysis by improving a commercially available protocol (SNaPshot) and simultaneously typing apo E single nucleotide polymorphisms (SNPs) encoding for isoforms at codon 112 and 158. This protocol relies on the extension with fluorescent dideoxyNTPs of a primer that ends one nucleotide 5' of a given SNP (minisequencing). Improvement of the method is achieved by incorporating into the minisequencing reaction two pooled primers corresponding to both apo E SNPs followed by analysis on an ABI PRISM 310 DNA sequencer. We found full concordance with genotypes determined using universal heteroduplex. This method is readily available for many laboratories and is a simple, unequivocal easy to use technique suitable for large amount of clinical samples that may provide a significant improvement over previously reported methods for apo E genotyping.","Alzheimer Disease/complications/*genetics;Apolipoproteins E/*genetics;Base Sequence;Codon/genetics;Coronary Artery Disease/complications;DNA Primers/genetics;Genotype;Humans;Polymerase Chain Reaction/*instrumentation;Polymorphism, Genetic/genetics;Protein Isoforms/genetics","Ben-Avi, L.;Durst, R.;Shpitzen, S.;Leitersdorf, E.;Meiner, V.",2004,Oct,,0,
379,Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding,"Background Use of mental indication in health outcomes research is of growing interest to researchers. This study, as part of a larger research program, quantified agreement between administrative International Classification of Disease (ICD-9) coding for, and ""gold standard"" clinician documentation of, mental health issues (MHIs) in hospitalized heart failure (HF) patients to determine the validity of mental health administrative data for use in HF outcomes research. Methods A 13% random sample (n = 504) was selected from all unique patients (n = 3,769) hospitalized with a primary HF diagnosis at 4 San Diego County community hospitals during 2009-2012. MHI was defined as ICD-9 discharge diagnostic coding 290-319. Records were audited for clinician documentation of MHI. Results A total of 43% (n = 216) had mental health clinician documentation; 33% (n = 164) had ICD-9 coding for MHI. ICD-9 code bundle 290-319 had 0.70 sensitivity, 0.97 specificity, and kappa 0.69 (95% confidence interval 0.61-0.79). More specific ICD-9 MHI code bundles had kappas ranging from 0.44 to 0.82 and sensitivities ranging from 42% to 82%. Conclusions Agreement between ICD-9 coding and clinician documentation for a broadly defined MHI is substantial, and can validly ""rule in"" MHI for hospitalized patients with heart failure. More specific MHI code bundles had fair to almost perfect agreement, with a wide range of sensitivities for identifying patients with an MHI.",aged;alcohol abuse;anxiety;anxiety disorder;article;community hospital;controlled study;dementia;depression;disease classification;drug abuse;female;heart failure;hospital patient;human;ICD-9;major clinical study;male;medical audit;medical documentation;mental health;outcomes research;priority journal;sensitivity and specificity;smoking,"Bender, M.;Smith, T. C.",2016,,,0,
380,Rectal bleeding and hemostatic disorders induced by dabigatran etexilate in 2 elderly patients,"OBJECTIVE: To report rectal bleeding associated with hemostatic disorders in 2 elderly patients treated with dabigatran etexilate. CASE SUMMARY: A 79-year-old woman (weight, 69 kg) was hospitalized in agastroenterology unit for severe rectal bleeding. She had been treated for 2 months with dabigatran etexilate 110 mg twice daily for chronic atrial fibrillation. On admission, her creatinine clearance (CrCl) was 20.7 mL/min/1.73 m2, prothrombin time (PT) less than 10% (reference range 70-130%), and international normalized ratio (INR) 14.5 (venous blood). Eleven days after admission, hematologic and renal function were normalized and rectal bleeding stopped. An 84-year-old man (weight, 71 kg) was admitted for rectal bleeding with acute renal failure and dehydration that began while he was treated with dabigatran etexilate 110 mg twice daily for atrial fibrillation. On admission, CrCl was 33.5 mL/min/1.73 m2, PT 13%, and INR 7.53 (venous blood). Dabigatran etexilate was stopped on admission. At the end of the hospitalization, CrCl was 66.5 mL/min/1.73 m2, PT 54%, and INR 1.53. In both cases, an objective causality assessment revealed that those adverse reactions were probably related to dabigatran etexilate. DISCUSSION: In these 2 cases of rectal bleeding during dabigatran etexilate therapy, coagulation monitoring showed elevated PT and INR; neither patient had been exposed to vitamin K antagonists. These cases indicate the importance of PT and INR monitoring when using dabigatran etexilate, mainly in patients with a high risk of overdose, such as elderly patients or those with renal function impairment. CONCLUSIONS: It is critical to identify and subsequently manage dabigatran etexilate toxicity because there is no specific antidote to reverse the drug's anticoagulant effects.",acetylsalicylic acid;amlodipine;antivitamin K;bisoprolol;bumetanide;creatinine;cyproterone;dabigatran etexilate;fluindione;fresh frozen plasma;gamma glutamyltransferase;hemoglobin;perindopril;rivastigmine;rosuvastatin;urea;vitamin K group;zopiclone;acute kidney failure;aged;alcohol consumption;Alzheimer disease;anemia;article;blood clotting;blood clotting disorder;case report;cognitive defect;computer assisted tomography;creatinine blood level;creatinine clearance;dehydration;drug exposure;drug induced disease;drug substitution;drug withdrawal;female;gamma glutamyl transferase blood level;atrial fibrillation;heart failure;hemoglobin blood level;hospital admission;human;hypertension;hypoalbuminemia;international normalized ratio;ischemic heart disease;kidney function;liver cirrhosis;male;partial thromboplastin time;priority journal;prostate hypertrophy;prothrombin time;rectum hemorrhage;thrombocyte count;treatment duration;urea blood level,"Béné, J.;Saïd, W.;Rannou, M.;Deheul, S.;Coupe, P.;Gautier, S.",2012,,,0,
381,Assessment of arterial stiffness in an older population: The interest of the cardio-ankle vascular index (CAVI),"The clinical complications of arterial aging, mainly heart failure and stroke, but also coronary and other arterial atherosclerotic disease, renal failure and dementia, are all major causes of loss of autonomy, morbidity, and mortality in older subjects. Arterial stiffness is a key arterial alteration during the aging process leading to cardiovascular morbidity and mortality. Assessment of arterial stiffness can identify the subjects who are at higher risk of developing cardiovascular complications and other age-related diseases. Several methods have been developed over the past few years in order to non-invasively measure arterial stiffness. The most common approach is the measurement of pulse wave velocity, which has shown promise over the last few years in detecting subjects at high risk of CV complications. However, PWV values depend on both the intrinsic elastic properties of the arterial wall and on distension pressure (blood pressure) levels. In this paper, we develop the topic of using methods that are much less dependent on BP levels, which especially in the very old, depend mainly on co-morbidities and frailty. In this respect, the use of the cardio-ankle vascular index (CAVI) in the assessment of age-related arterial stiffening is of major interest, since the dependency of CAVI on BP levels is much weaker. Therefore, CAVI can better assess the effects of ageing on intrinsic elastic properties.",aging;arterial stiffness;artery wall;article;atherosclerosis;blood pressure;cardio ankle vascular index;cardiovascular parameters;cardiovascular risk;comorbidity;diastolic blood pressure;human;metabolic disorder;predictive value;prevalence;priority journal;prognosis;pulse wave;risk assessment;risk factor;systolic blood pressure;systolic hypertension,"Benetos, A.",2017,,10.1093/eurheartj/suw059,0,
382,2012 SNM Highlights Lectures,,"Acetylcholine/metabolism;Animals;Cardiovascular System/pathology/physiopathology/radionuclide imaging;Dementia/diagnosis/metabolism/pathology/physiopathology;Humans;Mice;Molecular Imaging;Myocardial Infarction/pathology/physiopathology/radionuclide imaging;Myocardial Perfusion Imaging;Neurosciences;*Nuclear Medicine;Rats;*Societies, Scientific","Bengel, F. M.;Minoshima, S.",2012,Sep,,0,
383,Angiotensin II AT1 receptor blockade ameliorates brain inflammation,"Brain inflammation has a critical role in the pathophysiology of brain diseases of high prevalence and economic impact, such as major depression, schizophrenia, post-traumatic stress disorder, Parkinson's and Alzheimer's disease, and traumatic brain injury. Our results demonstrate that systemic administration of the centrally acting angiotensin II AT(1) receptor blocker (ARB) candesartan to normotensive rats decreases the acute brain inflammatory response to administration of the bacterial endotoxin lipopolysaccharide (LPS), a model of brain inflammation. The broad anti-inflammatory effects of candesartan were seen across the entire inflammatory cascade, including decreased production and release to the circulation of centrally acting proinflammatory cytokines, repression of nuclear transcription factors activation in the brain, reduction of gene expression of brain proinflammatory cytokines, cytokine and prostanoid receptors, adhesion molecules, proinflammatory inducible enzymes, and reduced microglia activation. These effects are widespread, occurring not only in well-known brain target areas for circulating proinflammatory factors and LPS, that is, hypothalamic paraventricular nucleus and the subfornical organ, but also in the prefrontal cortex, hippocampus, and amygdala. Candesartan reduced the associated anorexic effects, and ameliorated associated body weight loss and anxiety. Direct anti-inflammatory effects of candesartan were also documented in cultured rat microglia, cerebellar granule cells, and cerebral microvascular endothelial cells. ARBs are widely used in the treatment of hypertension and stroke, and their anti-inflammatory effects contribute to reduce renal and cardiac failure. Our results indicate that these compounds may offer a novel and safe therapeutic approach for the treatment of brain disorders.","Angiotensin II Type 1 Receptor Blockers/*therapeutic use;Animals;Animals, Newborn;Benzimidazoles/administration & dosage/pharmacology;Brain/drug effects/*metabolism/*pathology;Female;Inflammation/metabolism/pathology/prevention & control;Lipopolysaccharides/antagonists & inhibitors/toxicity;Male;Rats;Rats, Inbred SHR;Rats, Sprague-Dawley;Rats, Wistar;Receptor, Angiotensin, Type 1/*metabolism;Tetrazoles/administration & dosage/pharmacology","Benicky, J.;Sanchez-Lemus, E.;Honda, M.;Pang, T.;Orecna, M.;Wang, J.;Leng, Y.;Chuang, D. M.;Saavedra, J. M.",2011,Mar,10.1038/npp.2010.225,0,
384,"Symptomatic atherosclerotic disease and decreased risk of cancer-specific mortality: A prospective, population-based study (NEDICES)","The few studies that have assessed the association between symptomatic atherosclerotic disease and risk of cancer have had conflicting results. In addition, these studies ascertained participants either from treatment settings (ie, service-based studies) or by using a records linkage system (ie, medical records of patients evaluated at clinics or hospitals) and, therefore, were prone to selection bias. Our purpose was to estimate the risk of cancer mortality in a large population-based sample of elderly people, comparing participants with symptomatic atherosclerotic disease (atherosclerotic stroke and coronary disease) to their counterparts without symptomatic atherosclerotic disease (ie, controls) in the same population. In this population-based, prospective study (Neurological Disorders of Central Spain, NEDICES), 5262 elderly community-dwelling participants with and without symptomatic atherosclerotic disease were identified and followed for a median of 12.1 years, after which the death certificates of those who died were reviewed. A total of 2701 (53.3%) of 5262 participants died, including 314 (68.6%) of 458 participants with symptomatic atherosclerotic disease and 2387 (49.7%) of 4804 controls. Cancer mortality was reported significantly less often in those with symptomatic atherosclerotic disease (15.6%) than in controls (25.6%) (P < 0.001). In an unadjusted Cox model, risk of cancer-specific mortality was decreased in participants with symptomatic atherosclerotic disease (HR = 0.74, 95% confidence interval [CI], 0.55-0.98, P = 0.04) vs. those without symptomatic atherosclerotic disease (reference group). In an adjusted Cox model, HR = 0.58; 95% CI, 0.38-0.89; P = 0.01. This population-based, prospective study suggests that there is an inverse association between symptomatic atherosclerotic disease and risk of cancer mortality.",age;aged;alcoholism;angina pectoris;article;atherosclerosis;breast cancer;cancer mortality;cancer risk;cancer survival;comorbidity;controlled study;death certificate;dementia;digestive system cancer;female;gender;heart infarction;human;hypertension;major clinical study;male;Mini Mental State Examination;overall survival;peritoneum cancer;priority journal;prospective study;prostate cancer;secondary analysis;smoking;transient ischemic attack;waist circumference,"Benito-León, J.;De La Aleja, J. G.;Martínez-Salio, A.;Louis, E. D.;Lichtman, J. H.;Bermejo-Pareja, F.;Aykan, A.",2015,,,0,
385,Karyomapping: a single centre's experience from application of methodology to ongoing pregnancy and live-birth rates,"This study aimed to determine whether karyomapping can be applied to couples requiring preimplantation genetic diagnosis (PGD) for single gene disorder (SGD) and/or chromosomal rearrangement. 75/82 (91.5%) and 6/82 (7.3%) couples were referred for autosomal SGD and X-linked disease, respectively. One couple (1.2%) was referred for SGD and chromosomal rearrangement. Of 608 embryos, 146 (24%, 95% CI 21–28) day-3 and 462 (76%, 95% CI 72–79) blastocyst biopsies were performed. A total of 81 embryo transfers were performed; 16/81 (20%) were following day-3 embryo biopsy, 65/81 (80%) were following blastocyst biopsy and cryopreserved embryo transfer. Of 81 embryo transfers with known pregnancy outcome, 51 (63%, 95% CI 52–73) were on-going pregnancies, 6/81 (7%, 95% CI 3–15) resulted in first trimester miscarriages and 24/81 (30%, 95% CI 21–40) were failed implantations. Of the 51 on-going pregnancies, 15 (29%, 95% CI 19–43) couples had a singleton live birth at the time of write up. There have been no reports of abnormal prenatal, genetic testing or diagnosis of phenotype at birth. Karyomapping is reliable, efficient and accurate for couples requiring PGD for SGD and/or chromosomal rearrangement. Additionally, it provides aneuploidy screening, minimising risks of miscarriage and implantation failure.",adrenoleukodystrophy;agyria;aneuploidy;argininosuccinic aciduria;article;autosomal disorder;azoospermia;Beckwith Wiedemann syndrome;beta thalassemia;birth rate;blastocyst;cardiomyopathy;case study;catecholaminergic polymorphic ventricular tachycardia;chromosome disorder;chromosome rearrangement;cystic fibrosis;diagnostic accuracy;ectodermal dysplasia;embryo;embryo transfer;familial adenomatous polyposis;female;first trimester pregnancy;gene mapping;genetic disorder;genetic screening;hereditary motor sensory neuropathy;hereditary nonpolyposis colorectal cancer;hereditary tumor syndrome;human;Huntington chorea;incontinentia pigmenti;karyomapping;karyotyping;kidney polycystic disease;live birth;major clinical study;male;Marfan syndrome;Meckel syndrome;neurofibromatosis type 1;Noonan syndrome;Norrie disease;oocyte retrieval;ovarian reserve;paraganglioma;parity;pregnancy outcome;pregnancy rate;preimplantation genetic diagnosis;retinoblastoma;retinoschisis;retrospective study;sickle cell anemia;spinal muscular atrophy;spinocerebellar degeneration;spontaneous abortion;stomach cancer;twin pregnancy;Usher syndrome;von Hippel Lindau disease;Waardenburg syndrome;X chromosome linked disorder;X linked hypophosphatemic rickets,"Ben-Nagi, J.;Wells, D.;Doye, K.;Loutradi, K.;Exeter, H.;Drew, E.;Alfarawati, S.;Naja, R.;Serhal, P.",2017,,10.1016/j.rbmo.2017.06.004,0,
386,Long-term persistence in use of statin therapy in elderly patients,"Context: Knowledge of long-term persistence with 3-hydroxy-3-methylglutaryl co-enzyme A reductase inhibitor (statin) therapy is limited because previous studies have observed patients for short periods of time, in closely monitored clinical trials, or in other unrepresentative settings. Objective: To describe the patterns and predictors of long-term persistence with statin therapy in an elderly US population. Design, Setting, and Patients: Retrospective cohort study including 34501 enrollees in the New Jersey Medicaid and Pharmaceutical Assistance to the Aged and Disabled programs who were 65 years of age and older, initiated statin treatment between 1990 and 1998, and who were followed up until death, disenrollment, or December 31, 1999. Main Outcome Measures: Proportion of days covered (PDC) by a statin in each quarter during the first year of therapy and every 6 months thereafter; predictors of suboptimal persistence during each interval (PDC >80%) were identified using generalized linear models for repeated measures. Results: The mean PDC was 79% in the first 3 months of treatment, 56% in the second quarter, and 42% after 120 months. Only 1 patient in 4 maintained a PDC of at least 80% after 5 years. The proportion of patients with a PDC less than 80% increased in a log-linear manner, comprising 40%, 61%, and 68% of the cohort after 3, 12, and 120 months, respectively. Independent predictors of poor long-term persistence included nonwhite race, lower income, older age, less cardiovascular morbidity at initiation of therapy, depression, dementia, and occurrence of coronary heart disease events after starting treatment. Patients who initiated therapy between 1996-1998 were 21% to 25% more likely to have a PDC of at least 80% than those who started in 1990. Conclusions: Persistence with statin therapy in older patients declines substantially over time, with the greatest drop occurring in the first 6 months of treatment. Despite slightly better persistence among patients who began treatment in recent years, long-term use remains low. Interventions are needed early in treatment and among high-risk groups, including those who experience coronary heart disease events after initiating treatment.",hydroxymethylglutaryl coenzyme A reductase inhibitor;age;aged;article;dementia;depression;drug use;female;high risk population;human;ischemic heart disease;long term care;major clinical study;male;patient compliance;priority journal;race difference,"Benner, J. S.;Glynn, R. J.;Mogun, H.;Neumann, P. J.;Weinstein, M. C.;Avorn, J.",2002,,,0,
387,Recurrent syncope: Differential diagnosis and management,,pacemaker;beta adrenergic receptor blocking agent;fludrocortisone;midodrine;paroxetine;Addison disease;anemia;angiocardiography;aorta stenosis;article;atrial fibrillation;atrioventricular block;atrophy;autonomic dysfunction;bleeding;bradycardia;brain perfusion;cardiac syncope;carotid sinus massage;carotid sinus syndrome;cataplexy;cause of death;cerebrovascular accident;chronic obstructive lung disease;comorbidity;complete heart block;consciousness disorder;coronary artery bypass graft;diabetes mellitus;diastolic blood pressure;differential diagnosis;diffuse Lewy body disease;disease association;diuresis;down regulation;drug efficacy;electrocardiogram;electrophysiology;epilepsy;exercise test;faintness;fluid therapy;follow up;heart atrium myxoma;heart catheterization;heart infarction;heart output;heart pacing;Holter monitor;human;hypertension;hypertrophic cardiomyopathy;hypotension;implantable cardiac monitor;incidence;lung embolism;meta analysis (topic);metabolic disorder;Mobitz II;morbidity;neurocardiogenic syncope;orthostatic hypotension;orthostatic hypotensive syncope;Parkinson disease;plasma volume;presyncope;prevalence;priority journal;pseudosyncope;pulmonary hypertension;randomized controlled trial (topic);recurrent disease;reflex syncope;risk factor;risk reduction;salt intake;smoking;systolic blood pressure;tachycardia;tilt table test;vascular resistance,"Bennett, M. T.;Leader, N.;Krahn, A. D.",2015,,,0,
388,Molecular and clinical studies in SCA-7 define a broad clinical spectrum and the infantile phenotype,"OBJECTIVE: To screen for the SCA-7 mutation in autosomal dominant cerebellar ataxia (ADCA) families and study genotype/phenotype correlations. BACKGROUND: The association of cerebellar ataxia and progressive pigmentary macular dystrophy clinically defines a distinct form of ADCA classified as SCA-7. SCA-7 is caused by expansion of a highly unstable CAG repeat that lies in the coding region of a novel gene on chromosome 3p12-13. METHODS: We screened 51 ADCA kindreds, in which SCA-1, SCA-2, SCA-3, and SCA6 mutations had been excluded, for the SCA-7 mutation using primers that specifically amplify the SCA-7 CAG repeat. RESULTS: The SCA-7 mutation was identified in 10 independent families. Normal alleles ranged from 7 to 16 repeats; expanded alleles ranged from 41 to 306 repeats. One allele with 36 repeats was found in an asymptomatic individual carrying an at-risk haplotype. SCA-7 presents a wide spectrum of clinical features including visual loss, dementia, hypoacusia, severe hypotonia, and auditory hallucinations. Juvenile SCA-7 occurs on maternal and paternal transmission of the mutation, whereas the infantile form occurs only on paternal transmission. An infant of African American descent carried the largest SCA-7 expansion (306 CAG repeats) and had severe hypotonia, congestive heart failure, patent ductus arteriosus, cerebral and cerebellar atrophy, and visual loss. CONCLUSION: These data show a wide spectrum of phenotypic abnormalities in SCA-7 and define an infantile phenotype caused by the largest CAG repeat expansion described to date.",Adolescent;Adult;Age of Onset;Alleles;Ataxin-7;DNA Mutational Analysis;Family Health;Genotype;Humans;Infant;Magnetic Resonance Imaging;Nerve Tissue Proteins/*genetics;Pedigree;Phenotype;Spinocerebellar Degenerations/diagnosis/*genetics;*Trinucleotide Repeats,"Benton, C. S.;de Silva, R.;Rutledge, S. L.;Bohlega, S.;Ashizawa, T.;Zoghbi, H. Y.",1998,Oct,,0,
389,Mortality and risk factors after a hip fracture: Long-term follow-up,"We conducted an ambidirectional cohort study to document mortality and risk factors in patients who suffered a hip fracture during 2006. Patients admitted for a hip fracture during 2006 were identified. The cohort was followed from the date of the fracture until death or July 1, 2009. One hundred and twenty four patients were admitted for a hip fracture during the period. Mean age was 79.4±8.7 years, 78.5% female. Mean followup was 2.33±0.089 years and 1.6% of the cases were lost. During the first year of the study, 16.2% of the patients died; a total of 25.8% died in the study period. Mortality differed between sex, and it was higher in men (30.8%) compared with women (24.5%). In multivariate analysis, risks factors of mortality included age (HR 1.07 per each additional year, p=0.027), diagnosis of dementia (HR 2.34: p<0.001), and coronary heart disease (HR 2.94, p<0.001). The event ""hip fracture"" diminished the survival of the population under study.",age distribution;aged;article;cohort analysis;dementia;female;follow up;hip fracture;hospital admission;human;ischemic heart disease;major clinical study;male;mortality;risk assessment;sex difference;survival,"Beratarrechea, A.;Diehl, M.;Saimovici, J.;Pace, N.;Trossero, A.;Plantalech, L.",2011,,,0,
390,Heart surgery and the risk of cognitive decline,"Cognitive decline is being diagnosed with increasing frequency as a complication of cardiac surgery, in both selective coronary artery bypass and various other types of cardiac surgery. Although cognitive decline may occur after general surgical operations, its frequency is much higher following cardiac surgery. Although the etiology of cognitive dysfunction after cardiac surgery remains unclear, many risk factors are identified, such as advanced age that restricts cognitive reserve and affects the ability to overcome brain damage, a low presurgical level of cognitive function, extensive atherosclerotic disease, diabetes mellitus, and increased concentrations of the protein S100 and neuron specific enolase, that are indicators of brain damage. The absence of a common and clear understanding of the etiology and natural history of cognitive decline following cardiac surgery is the product, to a great extent, of methodological limitations in the reported studies. These limitations are due to (a) the absence of consensus concerning the diagnostic criteria used for the detection of cognitive impairment, (b) the selection of inadequate control groups, (c) the unsuccessful and frequently limited selection of neuropsychological tests for the evaluation of cognitive function, and (d) the inadequate investigation of preexisting cognitive decline. Recent advances which make possible the accurate diagnosis of mild cognitive impairment and of dementia in older individuals by applying clinical, imaging, and biochemical markers provide, to a great extent, the ability to conduct studies free of the above limitations. Thus, it is now feasible to conduct appropriately designed research projects with the capacity to expand knowledge on the prevention, prognosis, and treatment options of cognitive decline following cardiac surgery. © Athens Medical Society.",biochemical marker;neuron specific enolase;protein S 100;age;article;coronary artery atherosclerosis;brain damage;clinical feature;cognition;cognitive defect;cognitive reserve;consensus;dementia;diabetes mellitus;diagnostic accuracy;diagnostic imaging;heart surgery;human;meaningful use criteria;mild cognitive impairment;neuropsychological test;risk factor,"Beratis, I. N.;Papageorgiou, S. G.",2014,,,0,
391,Postmarketing surveillance of the safety of cimetidine: 15-Year mortality report,"The pattern of mortality after 15 years of observation is reported among almost 10,000 patients who were taking cimetidine when they were first recruited between 1977 and 1980. Many took the drug for a number of years, some switching to other antisecretory agents as the study progressed. The findings are reassuring and provide no evidence of any long-term adverse effects of cimetidine which might be detected by monitoring mortality rates. The data have also been used to examine the possible positive relationships between aluminium ingestion and Alzheimer's disease and H. pylori infection and ischaemic heart disease. No significant evidence was obtained in support of the existence of these relationships.",aluminum;cimetidine;histamine H2 receptor antagonist;adult;Alzheimer disease;article;disease association;drug safety;female;Gram negative infection;Helicobacter pylori;human;ischemic heart disease;major clinical study;male;mortality;postmarketing surveillance;priority journal,"Beresford, J.;Colin-Jones, D. G.;Flind, A. C.;Langman, M. J. S.;Lawson, D. H.;Logan, R. F. A.;Paterson, K. R.;Vessey, M. P.",1998,,,0,
392,Heart and Brain Interactions - the Akershus Cardiac Examination (ACE) 1950 Study Design,"Objectives. The aim of the Akershus Cardiac Examination (ACE) 1950 Study is to investigate the development and progression of cardiovascular and cerebrovascular disease (CVD/CeVD) in an extensively characterized age cohort of middle-aged subjects with longitudinal long-term follow-up. Design. The ACE 1950 Study is a prospective, population-based, age-cohort study of all men and women born in 1950 in Akershus County, Norway. The study involves a comprehensive baseline examination, especially for CVD/CeVD, including advanced ultrasound imaging and biobanking (""deep phenotyping""). We expect to obtain an inclusion rate of > 60% from the total study population of 5,827 eligible subjects. Enrollment will be completed during 2015. Conclusions. The ACE 1950 Study will have potential to generate new and relevant insight into identification of subclinical disease progression. Extensive phenotyping will enable identification of novel disease markers and mechanisms for subclinical disease, which can prove important for future disease prevention.",biochemical marker;adult;article;atherosclerosis;cardiovascular disease;cardiovascular system examination;cerebrovascular disease;cognitive defect;cohort analysis;dementia;disease course;echography;female;follow up;heart ventricle remodeling;human;longitudinal study;major clinical study;male;middle aged;prevalence;priority journal;prospective study,"Berge, T.;Vigen, T.;Pervez, M. O.;Ihle-Hansen, H.;Lyngbakken, M. N.;Omland, T.;Smith, P.;Steine, K.;Røsjø, H.;Tveit, A.;Aslam, Z.;Bakkelund, V.;Brynildsen, J.;Chandra, A.;Einvik, G.;Gjørven, A. M.;Gulati, G.;Jørgensen, M.;Kalstø, S. M.;Kvisvik, B. A.;Larsen, H. N.;Lorentzen, A.;Myhre, P. L.;Orstad, E. B.;Ottesen, A. H.;Repac, S.;Rønning, O. M.;Sandbu, R. A.;Søyseth, V.;Thommessen, B.;Aagaard, E. N.;Aarsland, D.;Bechensteen, K. M.;Christophersen, I. E.;Drægni, L.;Enger, S.;Haider, K.;Ihle-Hansen, H.;Ihle-Hansen, H.;Kaldestad, S. K.;Larhammer, H.;Olufsen, M. S.;Onarheim, S.;Semb, V. B.;Stolsmo, S. L. P.;Ulimoen, S. R.",2015,,,0,
393,Improving quality improvement for cardiopulmonary resuscitation,,angiocardiography;bronchoscopy;cancer patient;cardiopulmonary arrest;clinical assessment;communication skill;congestive heart failure;consultation;critically ill patient;defibrillation;dementia;health care quality;hospitalization;human;intensive care;invasive procedure;medical ethics;medical record;morbidity;mortality;palliative therapy;physician;priority journal;prognosis;resuscitation;risk factor;sepsis;short survey;sinus rhythm;survival rate;survivor;terminal care;total quality management,"Berger, J. T.",2013,,,0,
394,Asymptomatic pyuria in diabetic women: Commentary,,hemoglobin A1c;cerebrovascular disease;constipation;dementia;diabetic retinopathy;disease association;disease severity;hyperlipidemia;hypertension;ischemic heart disease;kidney disease;neuropathy;non insulin dependent diabetes mellitus;note;prevalence;priority journal;pyuria;risk factor,"Berger, R. E.",2006,,,0,
395,"Co-morbidities, complications and causes of death among people with femoral neck fracture - a three-year follow-up study","BACKGROUND: The poor outcome after a hip fracture is not fully understood. The aim of the study was to describe the prevalence of co-morbidities, complications and causes of death and to investigate factors that are able to predict mortality in old people with femoral neck fracture. METHODS: Data was obtained from a randomized, controlled trial with a 3-year follow-up at Umea University Hospital, Sweden, which included 199 consecutive patients with femoral neck fracture, aged >/=70 years. The participants were assessed during hospitalization and in their homes 4, 12 and 36 months after surgery. Medical records and death certificates were analysed. RESULTS: Multivariate analysis revealed that cancer, dependence in P-ADL (Personal Activities of Daily Living), cardiovascular disease, dementia at baseline or pulmonary emboli or cardiac failure during hospitalization were all independent predictors of 3-year mortality. Seventy-nine out of 199 participants (40 %) died within 3 years. Cardiovascular events (24 %), dementia (23 %), hip-fracture (19 %) and cancer (13 %) were the most common primary causes of death. In total, 136 participants suffered at least one urinary tract infection; 114 suffered 542 falls and 37 sustained 56 new fractures, including 13 hip fractures, during follow-up. CONCLUSION: Old people with femoral neck fracture have multiple co-morbidities and suffer numerous complications. Thus randomized intervention studies should focus on prevention of complications that might be avoidable such as infections, heart diseases, falls and fractures.",Cause of death;Complications;Hip fracture,"Berggren, M.;Stenvall, M.;Englund, U.;Olofsson, B.;Gustafson, Y.",2016,Jun 03,10.1186/s12877-016-0291-5,0,
396,Hormone therapy and risk of cardiovascular outcomes and mortality in women treated with statins,"Objective This work aims to study the effects of hormone therapy (HT) on the risk of cardiovascular outcomes and all-cause mortality in women treated with statins. Methods We included women aged 40 to 74 years and living in Sweden who filled a first statin prescription between 2006 and 2007. Women were categorized as HT users or as nonusers. Information on dispensed drugs, comorbidity, cardiovascular outcomes, and all-cause mortality was obtained from national health registers. Results A total of 40,958 statin users - 2,862 (7%) HT users and 38,096 nonusers - were followed for a mean of 4.0 years. In total, 70% of the women used statins as primary prevention. Among HT users, there were five cardiovascular deaths per 10,000 person-years. The corresponding rate among nonusers was 18, which yielded a hazard ratio of 0.38 (95% CI, 0.12-1.19). The all-cause mortality rates were 33 and 87, respectively, and the hazard ratio was 0.53 (95% CI, 0.34-0.81). There were no associations with cardiovascular events. A similar pattern was found for both primary and secondary prevention. Conclusions HT is associated with a reduced risk of all-cause mortality in women treated with statins. Although confounding factors, such as lifestyle and disease severity, might have influenced the results, HT does not seem to be detrimental to statin-treated women.",hydroxymethylglutaryl coenzyme A reductase inhibitor;adult;aged;article;brain ischemia;cardiovascular mortality;cardiovascular risk;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;dementia;diabetes mellitus;essential hypertension;female;follow up;atrial fibrillation;heart infarction;hormonal therapy;human;ischemic heart disease;kidney disease;liver disease;major clinical study;neoplasm;nicotine replacement therapy;obesity;outcome assessment;peptic ulcer;peripheral occlusive artery disease;pharmaceutical care;prescription;primary prevention;rheumatic disease;risk assessment;secondary prevention;solid tumor;Sweden;transient ischemic attack,"Berglind, I. A.;Andersen, M.;Citarella, A.;Linder, M.;Sundström, A.;Kieler, H.",2015,,,0,
397,Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL): A morphological study of a German family,"Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is characterized clinically by recurrent cerebral infarcts, subcortical dementia and pseudobulbar palsy, and morphologically by a granular degeneration of cerebral and, to a lesser degree, extracerebral blood vessels. We present morphological findings in a further German family affected by CADASIL. The index case showed the typical periodic acid-Schiff-positive granular degeneration of vascular smooth muscle cells (VSMC) in cerebral vessels, which did not react with antibodies against various immunoglobulins or complement factors. Ultrastructurally, granular osmiophilic material (GOM) covered the VSMC in different cerebral regions as well as in extracerebral organs (muscle, nerve, skin, small and large intestine, liver, kidney and heart). Skin biopsy samples from other family members of the last two generations also revealed GOM irrespective of the clinical symptomatology (CADASIL, migraine only or asymptomatic). Patients in the third generation had higher amounts of GOM in skin vessels than did asymptomatic or migraine patients in the fourth generation. We conclude that skin biopsy is a useful and less-invasive screening method for the differential diagnosis of CADASIL.",antibody;complement;immunoglobulin;adult;aged;artery disease;article;autosomal dominant disorder;brain blood vessel;brain infarction;cell ultrastructure;clinical article;controlled study;dementia;differential diagnosis;female;Germany;heart;human;human tissue;kidney;large intestine;leukoencephalopathy;liver;male;migraine;muscle;nerve;paralysis;priority journal;skin;skin biopsy;small intestine;symptomatology;vascular smooth muscle,"Bergmann, M.;Ebke, M.;Yuan, Y.;Brück, W.;Mugler, M.;Schwendemann, G.",1996,,,0,
398,Population based secondary preventive intervention after stroke and transient ischemic attack: Implementation and prognosis,"Background: Nurse-led, population based, long-term telephone follow-up after stroke/TIA with focus on reaching set treatment goals promptly, may be an effective secondary preventive method. In the present study we analyzed the implementation of the method, reasons for exclusion and prognosis in included versus excluded patients. Material and methods: Between January 1 2010 and December 31 2011, 890 patients were included in the hospital phase of the study. The reason for exclusion was documented for each patient who was not eligible for randomization into the secondary preventive follow-up. The occurrence of the combined endpoint of stroke/ TIA, myocardial infarction and death was recorded within the first year after discharge and compared between included and excluded patients. Results: 434 (48,8%) patients were randomized while 456 (51,2%) were excluded. Reasons for exclusion were aphasia (n = 52, 5,8%), impaired hearing (n = 6, 0,7%), dementia (n = 64, 7,2%), participation in another medical trial (n = 4, 0,4%), patient rejecting participation (n = 91, 10,2%), advanced disease (n = 162, 18,2%) and death (n = 77, 8,7%). The combined endpoint occurred in 14,1% (n = 61) and 29,2% (n = 133) of included and excluded patients, respectively. The corresponding rates of all-cause mortality were 3,9% (n = 17) and 23,7% (n = 108). Similarly, vascular mortality was 1,4 % and 8,3%, accounting for 35% of all cause mortality in both groups. Conclusion: A large proportion of stroke/TIA patients are unable to participate even in a simple secondary preventive follow-up. The most common causes of exclusion are advanced disease and non-willingness to participate. The one-year prognosis is substantially worse among excluded patients. (Table Presented).",population;cerebrovascular accident;transient ischemic attack;prognosis;human;patient;follow up;mortality;death;aphasia;heart infarction;nurse;randomization;hospital;clinical study;dementia;hearing impairment;telephone,"Bergstrom, L.;Joachimogren, J.;Mooe, T.",2013,,10.3109/14017431.2013.783674,0,399
399,Population based secondary preventive intervention after stroke and transient ischemic attack: implementation and prognosis,"Background: Nurse-led, population based, long-term telephone follow-up after stroke/TIA with focus on reaching set treatment goals promptly, may be an effective secondary preventive method. In the present study we analyzed the implementation of the method, reasons for exclusion and prognosis in included versus excluded patients. Material and methods: Between January 1 2010 and December 31 2011, 890 patients were included in the hospital phase of the study. The reason for exclusion was documented for each patient who was not eligible for randomization into the secondary preventive follow-up. The occurrence of the combined endpoint of stroke/ TIA, myocardial infarction and death was recorded within the first year after discharge and compared between included and excluded patients. Results: 434 (48,8%) patients were randomized while 456 (51,2%) were excluded. Reasons for exclusion were aphasia (n = 52, 5,8%), impaired hearing (n = 6, 0,7%), dementia (n = 64, 7,2%), participation in another medical trial (n = 4, 0,4%), patient rejecting participation (n = 91, 10,2%), advanced disease (n = 162, 18,2%) and death (n = 77, 8,7%). The combined endpoint occurred in 14,1% (n = 61) and 29,2% (n = 133) of included and excluded patients, respectively. The corresponding rates of all-cause mortality were 3,9% (n = 17) and 23,7% (n = 108). Similarly, vascular mortality was 1,4 % and 8,3%, accounting for 35% of all cause mortality in both groups. Conclusion: A large proportion of stroke/TIA patients are unable to participate even in a simple secondary preventive follow-up. The most common causes of exclusion are advanced disease and non-willingness to participate. The one-year prognosis is substantially worse among excluded patients. (Table Presented).",population;cerebrovascular accident;transient ischemic attack;prognosis;human;patient;follow up;mortality;death;aphasia;heart infarction;nurse;randomization;hospital;clinical study;dementia;hearing impairment;telephone,"Bergstrom, L;Joachimogren, J;Mooe, T",2013,,10.3109/14017431.2013.783674,0,
400,Conservative management in very elderly patients with severe aortic stenosis: Time to change?,"Background Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management. Methods Consecutive patients with severe aortic stenosis diagnosed at 48 centers during January 2014 were included. Baseline clinical characteristics, echocardiographic data, Charlson index, and EuroSCORE-II were registered, including vital status and performance of valve intervention during one-year follow-up. For the purpose of this substudy we assessed symptomatic patients undergoing conservative management, including them in 5 groups according to the reason for performing conservative management [I: comorbidity/frailty (128, 43.8%); II: dementia 18 (6.2%); III: advanced age 34 (11.6%); IV: patients’ refusal 62 (21.2%); and V: other reasons 50 (17.1%)]. Results We included 292 patients aged 81.5 ± 9 years. Patients from group I had higher Charlson index (4 ± 2.3), higher EuroSCORE-II (7.5 ± 6), and a higher overall (42.2%) and non-cardiac mortality (16.4%) than the other groups. In contrast, patients from group III had fewer comorbidities, lower EuroSCORE-II (4 ± 2.5), and low overall (20.6%) and non-cardiac mortality (5.9%). Conclusions Patients with severe symptomatic aortic stenosis managed conservatively have different baseline characteristics and clinical course according to the reason for performing conservative management. A prospective assessment of comorbidity and other geriatric syndromes might contribute to improve therapeutic strategy in this clinical setting.",age;aged;aortic valve stenosis;article;cerebrovascular accident;Charlson Comorbidity Index;comorbidity;conservative treatment;dementia;disease severity;echocardiography;EuroSCORE;female;follow up;frailty;functional status;geriatric patient;heart failure;heart infarction;human;infection;major clinical study;male;mortality;neoplasm;prognosis;retrospective study;sudden cardiac death;transcatheter aortic valve implantation;treatment refusal;very elderly,"Bernal, E.;Ariza-Solé, A.;Formiga, F.;Abu-Assi, E.;Carol, A.;Galián, L.;Bayés-Genís, A.;Saldivar, H. G.;Díez-Villanueva, P.;Sellés, M. M.",2017,,10.1016/j.jjcc.2016.08.009,0,
401,Postmenopausal hormone substitution--for many of for few? I. Effects of long-term hormone substitution,"Users of hormone replacement therapy (HRT) are characterised by a 20-50 per cent reduction in all-cause mortality, and a 50 per cent reduction in the risk of coronary disease and osteoporotic fracture. The risk of Alzheimer's dementia or of cerebrovascular disease has also been reported to be reduced, though published findings have been inconsistent. In contrast, the risk of breast cancer or venous thrombosis is probably increased. A number of minor side-effects are associated with HRT, though hitherto their impact has received little attention. Although randomised controlled studies have been conducted to assess relationship between HRT and risk factors for disease, no such studies of relationship between long-term HRT and myocardial infarction, osteoporotic fractures or mortality have been performed in large series. Selection bias may thus explain part of the reported beneficial effects of HRT on morbidity and mortality found in observational studies.",Aged;Breast Neoplasms/chemically induced/prevention & control;Decision Making;*Estrogen Replacement Therapy;Female;Humans;Middle Aged;Patient Selection;Risk Factors,"Berntsen, G. K.;Tollan, A.;Fonnebo, V.",1997,Oct,,0,
402,High sensitivity cardiac troponin t and cognitive function in the oldest old: The leiden 85-plus study,"Background: Impaired cardiac function has been related to accelerated cognitive decline in late-life. Objective: To investigate whether higher levels of high sensitivity cardiac troponin T (hs-cTnT), a sensitive marker for myocardial injury, are associated with worse cognitive function in the oldest old. Methods: In 455 participants of the population-based Leiden 85-plus Study, hs-cTnT was measured at 86 years. Cognitive function was measured annually during four years with the Mini-Mental State Examination (MMSE). Results: Participants in the highest gender-specific tertile of hs-cTnT had a 2.0-point lower baseline MMSE score than participants in the lowest tertile (95% confidence interval (CI) (95% CI 0.73-3.3), and had a 0.58-point steeper annual decline in MMSE during follow-up (95% CI 0.06-1.1). The associations remained after adjusting for sociodemographic and cardiovascular risk factors excluding those without a history of overt cardiac disease. Conclusion: In a population-based sample of the oldest old, higher levels of hs-cTnT were associated with worse cognitive function and faster cognitive decline, independently from cardiovascular risk factors and a history of overt cardiac disease.",biological marker;cholesterol;creatinine;troponin T;aged;article;body mass;cardiovascular risk;cholesterol blood level;cognition;cohort analysis;creatinine blood level;demography;diastolic blood pressure;female;follow up;heart muscle injury;human;major clinical study;male;mental deterioration;Mini Mental State Examination;Netherlands;population research;priority journal;prospective study;social status;systolic blood pressure;very elderly,"Bertens, A. S.;Sabayan, B.;De Craen, A. J. M.;Van der Mast, R. C.;Gussekloo, J.",2017,,10.3233/jad-170171,0,
403,Identifying emergency-sensitive conditions for the calculation of an emergency care inhospital standardized mortality ratio,"Study objective Hospital standardized mortality ratios are used for hospital performance assessment. As a first step to develop a ratio variant sensitive to the outcome of patients admitted from the emergency department (ED), we identified International Classification of Diseases, 10th Revision, Canada diagnosis groups in which high-quality ED care would be expected to reduce inhospital mortality (emergency-sensitive conditions). Methods To identify emergency-sensitive conditions, we assembled a multidisciplinary panel of emergency care providers and managers (n=14). Using a modified RAND/University of California, Los Angeles Appropriateness Method, 3 rounds of independent ratings including a teleconference were conducted from May to October 2012. Panelists serially rated diagnosis groups included in the Canadian hospital standardized mortality ratio (n=72) according to the extent ED management influences mortality. Results The panel rated ED care as potentially reducing patient mortality for 37 diagnosis groups (eg, sepsis) and morbidity for 43 diagnosis groups (eg, atrial fibrillation) and rated timely ED care as critical for 40 diagnosis groups (eg, stroke). Panelists also identified 47 diagnosis groups (eg, asthma) not included in the Canadian hospital standardized mortality ratio in which mortality could potentially be decreased by ED care. Conclusion We identified 37 diagnosis groups representing emergency-sensitive conditions that will enable the calculation of a hospital standardized mortality ratio relevant to emergency care. © 2013 by the American College of Emergency Physicians.",Alzheimer disease;article;asthma;cerebrovascular accident;emergency care;emergency ward;heart arrest;atrial fibrillation;human;ICD-10;lung embolism;malignant neoplastic disease;morbidity;mortality;priority journal;sepsis;standardized mortality ratio;teleconference,"Berthelot, S.;Lang, E. S.;Quan, H.;Stelfox, H. T.",2014,,,0,
404,Lipid-lowering drug therapy in elderly patients,"Coronary heart disease (CHD) is the leading cause of death among elderly patients and >80% of all coronary deaths occur inpatients >65 years. Cerebrovascular events are also associated with older age. Since elevated cholesterol concentrations are a risk factorfor cardiovascular disease, lipid-lowering drugs, especially statins, are in widespread use for prevention. There is substantial underutilization of statins in the elderly population although meta-analyses of randomized trials have shown that in elderly secondary prevention patientsthey reduce all-cause mortality by approximately 22%, CHD mortality by 30%, non-fatal myocardial infarction (MI) by 26% and stroke by 25% over a treatment period of 5 years. Relative risk reduction is greater or at least equal to the one in younger patients, but absolute risk reduction is greater in the elderly because the event rate is higher. The benefit from statin treatment seems to start beyond 1year of treatment. Data on primary prevention in the elderly are less clear. There is a significant reduction in CHD events, CHD deaths and all-cause mortality but numbers needed to treat (NNT) are higher than in secondary prevention. Treatment decisions have to considerthe individual patient's situation regarding multimorbidity, polypharmacy and patient wishes. Economic considerations have to be madein some health systems. Statins have no role in the prevention or the treatment of dementia. Statins are generally safe and safety is equalin younger and older age groups. Their prescription should not be denied to patients for reasons of age alone. Other lipid-lowering drugsplay only a minor role in cardiovascular disease (CVD) event prevention because convincing outcome studies are largely missing. A primaryprevention statin trial in the very elderly is urgently needed. © 2011 Bentham Science Publishers Ltd.",antihypertensive agent;antilipemic agent;atorvastatin;bezafibrate;C reactive protein;cerivastatin;cholesterol;clofibrate;colesevelam;colestipol;colestyramine;conjugated estrogen;cyclosporin;ezetimibe;fenofibrate;fibric acid derivative;fluindostatin;garlic extract;gemfibrozil;high density lipoprotein cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;mevinolin;nicotinic acid;pitavastatin;placebo;pravastatin;rosuvastatin;simvastatin;unindexed drug;verapamil;aging;Alzheimer disease;angina pectoris;article;cardiovascular disease;cardiovascular risk;cause of death;cerebrovascular accident;cholesterol blood level;cholesterol metabolism;clinical decision making;clinical trial;comorbidity;dementia;disease association;drug safety;drug withdrawal;dyslipidemia;economic aspect;garlic;geriatric care;health care system;atrial fibrillation;heart death;heart infarction;heart muscle ischemia;heart protection;human;hypercholesterolemia;hyperlipidemia;hypertension;hypertriglyceridemia;ischemic heart disease;lipid analysis;liver toxicity;medical decision making;medicare;mortality;myopathy;prescription;priority journal;quality of life;rhabdomyolysis;risk assessment;risk factor;secondary prevention;transient ischemic attack,"Berthold, H. K.;Gouni-Berthold, I.",2011,,,0,
405,"Physico-physical comorbidity, poor health behaviour and health promotion in South Verona patients with functional psychoses","Background/Objectives: Epidemiological studies investigating the mortality and physical health of mental patients have provided evidence of an excess mortality and of a substantially higher prevalence of physical co-morbidity as compared to the general population. These findings have been explained with a multi-causal model including a higher prevalence of risk factors like high blood pressure, high plasma cholesterol and obesity, tendency to self neglect, unhealthy lifestyles, and medication side-effects. In addition, the mentally ill share the problems of disadvantaged people at large, especially of people with low income, and tend to have poorer lifestyles in general. This project are addresses physical co-morbidity, health status and lifestyles of mental patients. These topics that are less covered in the international literature in comparison to mortality, and minimally studied in the Italian literature. Aims of the study are: (a) To examine the prevalence of physical co-morbidity in mental patients with an ICD-10 diagnosis of affective and non-affective functional psychotic disorder in contact with the South-Verona Community Mental Health Service (CMHS) (Phase 1); (b) Then implementing health promotion strategies related to dietary habits and physical exercise, and studying their efficacy with a randomised controlled study (Phase 2). Methods: Subjects with an ICD-10 diagnosis of affective and non-affective functional psychotic disorder in contact with the South-Verona CMHS are recruited in Phase 1 via a cross-sectional design. The assessment procedure consists of a physical health examination, laboratory tests and an interview on socio-demographic data, physical health status, risk factors, lifestyles and quality of life. The following Phase 2 is a randomised controlled trial of a health promotion intervention programme (experimental group) and treatment as usual (control group). The PHYSICO intervention program builds upon the experience previously acquired in an exploratory project on health education for diet followed by practical demonstrations and exercise and coupled with a group-walking program performed in the South-Verona CMHS in 2006, with the participation of both mental health workers and patients, designed and implemented in collaboration with the Department of Prevention of the local health authority (LSS 20 Verona). Results: This presentation will illustrate and discuss the Phase 1 results. Results show that the diseases of the circulatory system, including hypertension and coronary heart disease take the lions' share. Nervous systems disease including severe diseases like stroke or Alzheimer and less severe ailments like migraine follow. Metabolic diseases, including diabetes and thyroid dysfunctions, come as third, together with diseases of the musculoskeletal system/connective tissue. The comparison with the data of the Veneto population show that the patients in the PHYSICO sample present a higher percentage of overweight/obesity and of smoking habits and a lower percentage of adherence to WHO recommendations for diet and physical activity. Discussion/Conclusions: The PHYSICO study has successfully completed Phase 1 thus confirming the feasibility of this type of research. Phase 1 has already shown that it is possible to improve collaboration and has collected good quality data on health parameters and health-related lifestyles. The project has also witnessed an excellent cooperation of both the personnel and the patients of the South-Verona CMHS.",human;mental health service;health promotion;patient;psychosis;health status;health behavior;comorbidity;health;lifestyle;prevalence;morbidity;hypertension;diseases;mental patient;mortality;exercise;diagnosis;population;randomized controlled trial;risk factor;diet;thyroid disease;tissues;smoking habit;physical activity;cholesterol blood level;obesity;self neglect;drug therapy;side effect;mental disease;model;world health organization;lowest income group;parameters;personnel;habit;controlled study;cross-sectional study;procedures;medical examination;laboratory test;interview;quality of life;control group;health education;walking;prevention;cardiovascular system;ischemic heart disease;lion;nervous system;stroke;metabolic disorder;diabetes mellitus;migraine,"Berti, L.;Bonfioli, E.;Castellazzi, M.;Fiorini, I.;Mazzi, M.;Muraro, F.;Burti, L.",2011,,10.1055/s-0031-1277806,0,406
406,"Physico-physical comorbidity, poor health behaviour and health promotion in South Verona patients with functional psychoses","Background/Objectives: Epidemiological studies investigating the mortality and physical health of mental patients have provided evidence of an excess mortality and of a substantially higher prevalence of physical co-morbidity as compared to the general population. These findings have been explained with a multi-causal model including a higher prevalence of risk factors like high blood pressure, high plasma cholesterol and obesity, tendency to self neglect, unhealthy lifestyles, and medication side-effects. In addition, the mentally ill share the problems of disadvantaged people at large, especially of people with low income, and tend to have poorer lifestyles in general. This project are addresses physical co-morbidity, health status and lifestyles of mental patients. These topics that are less covered in the international literature in comparison to mortality, and minimally studied in the Italian literature. Aims of the study are: (a) To examine the prevalence of physical co-morbidity in mental patients with an ICD-10 diagnosis of affective and non-affective functional psychotic disorder in contact with the South-Verona Community Mental Health Service (CMHS) (Phase 1); (b) Then implementing health promotion strategies related to dietary habits and physical exercise, and studying their efficacy with a randomised controlled study (Phase 2). Methods: Subjects with an ICD-10 diagnosis of affective and non-affective functional psychotic disorder in contact with the South-Verona CMHS are recruited in Phase 1 via a cross-sectional design. The assessment procedure consists of a physical health examination, laboratory tests and an interview on socio-demographic data, physical health status, risk factors, lifestyles and quality of life. The following Phase 2 is a randomised controlled trial of a health promotion intervention programme (experimental group) and treatment as usual (control group). The PHYSICO intervention program builds upon the experience previously acquired in an exploratory project on health education for diet followed by practical demonstrations and exercise and coupled with a group-walking program performed in the South-Verona CMHS in 2006, with the participation of both mental health workers and patients, designed and implemented in collaboration with the Department of Prevention of the local health authority (LSS 20 Verona). Results: This presentation will illustrate and discuss the Phase 1 results. Results show that the diseases of the circulatory system, including hypertension and coronary heart disease take the lions' share. Nervous systems disease including severe diseases like stroke or Alzheimer and less severe ailments like migraine follow. Metabolic diseases, including diabetes and thyroid dysfunctions, come as third, together with diseases of the musculoskeletal system/connective tissue. The comparison with the data of the Veneto population show that the patients in the PHYSICO sample present a higher percentage of overweight/obesity and of smoking habits and a lower percentage of adherence to WHO recommendations for diet and physical activity. Discussion/Conclusions: The PHYSICO study has successfully completed Phase 1 thus confirming the feasibility of this type of research. Phase 1 has already shown that it is possible to improve collaboration and has collected good quality data on health parameters and health-related lifestyles. The project has also witnessed an excellent cooperation of both the personnel and the patients of the South-Verona CMHS.",human;mental health service;health promotion;patient;psychosis;health status;health behavior;comorbidity;health;lifestyle;prevalence;morbidity;hypertension;diseases;mental patient;mortality;exercise;diagnosis;population;randomized controlled trial;risk factor;diet;thyroid disease;tissues;smoking habit;physical activity;cholesterol blood level;obesity;self neglect;drug therapy;side effect;mental disease;model;world health organization;lowest income group;parameters;personnel;habit;controlled study;cross-sectional study;procedures;medical examination;laboratory test;interview;quality of life;control group;health education;walking;prevention;cardiovascular system;ischemic heart disease;lion;nervous system;stroke;metabolic disorder;diabetes mellitus;migraine,"Berti, L;Bonfioli, E;Castellazzi, M;Fiorini, I;Mazzi, M;Muraro, F;Burti, L",2011,,10.1055/s-0031-1277806,0,
407,PET/CT in diagnosis of movement disorders,"Molecular imaging with PET offers a broad variety of tools supporting the diagnosis of movement disorders. The more widely applied PET imaging techniques have focused on the assessment of neurotransmitter systems, predominantly the pre- and postsynaptic dopaminergic system. Additionally, PET imaging with [18F]fluorodeoxyglucose has been extensively used to assess local synaptic activity in the resting state and to highlight local changes in brain metabolism accompanying changes in neural activity in movement disorders. PET imaging has provided us with diagnostic agents as well as tools for evaluation of novel therapeutics, and has served as a powerful means for revealing in vivo changes at different stages of movement disorders and within the course of an individual patient's illness. © 2011 New York Academy of Sciences..",3 (2 fluoroethyl)spiperone f 18;4 aminobutyric acid receptor;benzodiazepine receptor;desmethoxyfallypride f 18;dihydrotetrabenazine;dihydrotetrabenazine c 11;diprenorphine;diprenorphine c 11;dopamine;dopamine 1 receptor;dopamine 2 receptor;dopamine f 18;dopamine receptor stimulating agent;dopamine transporter;flumazenil c 11;fluorodeoxyglucose f 18;fluoroethylspiperone f 18;glucose;levodopa;n sec butyl 1 (2 chlorophenyl) n methyl 3 isoquinolinecarboxamide;raclopride c 11;radiopharmaceutical agent;unclassified drug;vesicular monoamine transporter 2;Alzheimer disease;article;ataxia;basal ganglion;brain ischemia;brain metabolism;brain stem;caudate nucleus;cerebral metabolic rate of glucose;clinical practice;computer assisted emission tomography;corticobasal degeneration;cyclotron;cytoplasm;diagnosis;diagnostic value;disease course;disease duration;disease severity;dopamine metabolism;dopaminergic system;drug uptake;dystonia;essential tremor;genetic disorder;human;Huntington chorea;hypermetabolism;in vivo study;inflammation;Kearns Sayre syndrome;memory disorder;mesencephalon;molecular imaging;motor cortex;motor dysfunction;myoclonus epilepsy;nerve degeneration;nervous system parameters;neuroimaging;neuropathy;neurotransmission;Parkinson disease;prefrontal cortex;progressive supranuclear palsy;putamen;receptor binding;retinitis pigmentosa;Shy Drager syndrome;spinocerebellar degeneration;synapse;temporal cortex;temporal lobe;traumatic brain injury;treatment response;upregulation,"Berti, V.;Pupi, A.;Mosconi, L.",2011,,,0,
408,NMR study of human biological fluids for detection of pathologies,"The paper deals with the NMR spectra obtained using preparations of five different human biological body fluids. Characteristic metabolite signals of blood, urine, tears, saliva, and sweat spectra have been determined and classified. The biological body fluid samples were used for search and identification of biomarkers of cardiovascular disease. Absolute functional biomarkers for diseases such as coronary heart disease (CHD) have not been recognized even in the case acute myocardial infarction. A hypothesis explaining reasons of lack of such markers has been formulated. The results of comparative analysis of blood and urine samples from humans and some laboratory animals are given. Identify and analyze signals of metabolites of pathogenic microflora and their dynamics in the urine from patients with urogenital diseases have been determined and analyzed and characteristic biomarkers have been recognized. Publisher: V rabote predstavleny IaMR-spektry preparatov piati razlichnykh biologicheskikh zhidkostei cheloveka. Opredeleny i klassifitsirovany signaly metabolitov, kharakternye dlia spektrov krovi, mochi, slezy, sliuny i pota. Byla predpriniata popytka vydelit' biomarkery nekotorykh serdechnososudistykh zabolevanii v biozhidkostiakh patsientov. Absoliutnykh biomarkerov dlia funktsional'nykh zabolevanii, takikh kak ishemicheskaia bolezn' serdtsa (IBS), dazhe v sluchae ee ostroi formy - infarkta miokarda, ne vyiavleno. Sformulirovana gipoteza, ob""iasniaiushchaia prichinu etogo. Predstavleny rezul'taty sravnitel'nogo analiza obraztsov krovi i mochi cheloveka i nekotorykh laboratornykh zhivotnykh. Opredeleny i proanalizirovany signaly metabolitov patogennoi mikroflory i ikh dinamika v moche pri nekotorykh zabolevaniiakh mochepolovoi sistemy. Vyiavleny kharakternye biomarkery. Rus","Alzheimer Disease/diagnosis;Animals;Biomarkers/analysis;Body Fluids/*chemistry;Cardiovascular Diseases/diagnosis;Case-Control Studies;Humans;*Magnetic Resonance Spectroscopy;Male;Male Urogenital Diseases/diagnosis;Rats;Rats, Wistar;Sciuridae;Species Specificity;Nmr;biological fluids;biomarkers","Beskaravainy, P. M.;Molchanov, M. V.;Suslikov, A. V.;Paskevich, S. I.;Kutyshenko, V. P.;Vorob'ev, S. I.",2015,Jan-Feb,,0,
409,High ferritin levels have major effects on the morphology of erythrocytes in Alzheimer's disease,"Introduction: Unliganded iron both contributes to the pathology of Alzheimer's disease (AD) and also changes the morphology of erythrocytes (RBCs). We tested the hypothesis that these two facts might be linked, i.e., that the RBCs of AD individuals have a variant morphology, that might have diagnostic or prognostic value. Methods: We included a literature survey of AD and its relationships to the vascular system, followed by a laboratory study. Four different microscopy techniques were used and results statistically compared to analyze trends between high and normal serum ferritin (SF) AD individuals. Results: Light and scanning electron microscopies showed little difference between the morphologies of RBCs taken from healthy individuals and from normal SF AD individuals. By contrast, there were substantial changes in the morphology of RBCs taken from high SF AD individuals. These differences were also observed using confocal microscopy and as a significantly greater membrane stiffness (measured using force-distance curves). Conclusion: We argue that high ferritin levels may contribute to an accelerated pathology in AD. Our findings reinforce the importance of (unliganded) iron in AD, and suggest the possibility both of an early diagnosis and some means of treating or slowing down the progress of this disease. © 2013 Bester, Buys, Lipinski, Kell and Pretorius.",ferritin;adult;aged;Alzheimer disease;arterial stiffness;article;atomic force microscopy;brain ischemia;cerebrovascular accident;clinical article;cognitive defect;confocal microscopy;controlled study;diabetes mellitus;disease association;disease course;disease duration;early diagnosis;epilepsy;erythrocyte;erythrocyte structure;female;ferritin blood level;heart infarction;human;human cell;human tissue;hyperferritinemia;hypertension;hypothyroidism;iron overload;laboratory test;male;medical history;microscopy;middle aged;Mini Mental State Examination;onset age;osteoporosis;outer membrane;scanning electron microscopy;smoking;very elderly,"Bester, J.;Buys, A. V.;Lipinski, B.;Kell, D. B.;Pretorius, E.",2013,,,0,
410,"Nationwide Inpatient Prevalence, Predictors, and Outcomes of Alzheimer's Disease among Older Adults in the United States, 2002-2012","In the inpatient setting, prevalence, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of Alzheimer's disease (AD) are largely unknown. We used data on older adults (60+ y) from the Nationwide Inpatient Sample (NIS) 2002-2012. AD prevalence was approximately 3.12% in 2012 (total weighted discharges with AD +/- standard error: 474, 410 +/- 6,276). Co-morbidities prevailing more in AD inpatient admissions included depression (OR = 1.67, 95% CI: 1.63-1.71, p < 0.001), fluid/electrolyte disorders (OR = 1.25, 95% CI: 1.22-1.27, p < 0.001), weight loss (OR = 1.26, 95% CI: 1.22-1.30, p < 0.001), and psychosis (OR = 2.59, 95% CI: 2.47-2.71, p < 0.001), with mean total co-morbidities increasing over time. AD was linked to higher MR and longer LOS, but lower TC. TC rose in AD, while MR and LOS dropped markedly over time. In AD, co-morbidities predicting simultaneously higher MR, TC, and LOS (2012) included congestive heart failure, chronic pulmonary disease, coagulopathy, fluid/electrolyte disorders, metastatic cancer, paralysis, pulmonary circulatory disorders, and weight loss. In sum, co-morbidities and TC increased over time in AD, while MR and LOS dropped. Few co-morbidities predicted occurrence of AD or adverse outcomes in AD.","Aged;Aged, 80 and over;Alzheimer Disease/diagnosis/*epidemiology/therapy;Comorbidity;Depression/epidemiology;Female;Health Care Costs;Hospitals/statistics & numerical data;Humans;Inpatients/*statistics & numerical data;Length of Stay;Male;Middle Aged;Prevalence;Prognosis;Psychotic Disorders/epidemiology;Risk Factors;Treatment Outcome;United States/epidemiology;Weight Loss;Alzheimer's disease;co-morbidity;health care cost;inpatient sample;mortality;older adults","Beydoun, M. A.;Beydoun, H. A.;Gamaldo, A. A.;Rostant, O. S.;Dore, G. A.;Zonderman, A. B.;Eid, S. M.",2015,,10.3233/jad-150228,0,
411,Neuroleptic malignant syndrome: Uncommon postoperative diagnostic dilemma,"Neuroleptic malignant syndrome occurred in a 71-year-old man on haloperidol therapy for mild depressive dementia. After coronary artery bypass grafting, he developed hyperthermia, elevated creatine kinase without a corresponding rise in the MB-isoenzyme, leukocytosis, and raised liver enzymes, urea, and creatinine. His condition responded to bromocriptine therapy.",acetylsalicylic acid;antibiotic agent;antipyretic agent;atorvastatin;bromocriptine;creatine kinase;creatine kinase MB;creatinine;haloperidol;isosorbide dinitrate;liver enzyme;metoprolol;ramipril;urea;aged;article;case report;coronary artery bypass graft;coronary artery disease;creatine kinase blood level;creatinine blood level;diagnostic value;heart infarction;heart ventricle septum;hemodynamics;human;hyperthermia;hypokinesia;hypotension;laboratory test;leukocytosis;liver dysfunction;male;mixed depression and dementia;neuroleptic malignant syndrome,"Bhan, S.;Kulkarni, V.;Mehta, Y.;Sharma, K. K.;Trehan, N.;Suri, M. L.",2002,,,0,
412,"Vascular disease and risk factors, rate of progression, and survival in Alzheimer's disease","Two hundred forty-seven patients with early Alzheimer's disease were studied for the association of demographic, functional, and cognitive status and vascular comorbidities and risk factors present at index visit to rate of clinical disease progression over 3 years and to survival time. Patients who progressed to the moderate stage were designated fast progressors; those who remained in the early stage were designated slow progressors. At index visit, Mini-Mental State Exam score was significantly lower for the fast than the slow group; global impairment was significantly higher for the fast group. Cognitive scores showed greater annual decline in the fast group, and the fast group also had a greater annualized global change. The fast group had a shorter median survival time from onset, but age at onset, age at initial visit, history of heart problems, myocardial infarct, stroke, hypertension, diabetes, or past or current smoking did not differ between groups.",Aged;Alzheimer Disease/*epidemiology/*mortality;Cognition Disorders/*epidemiology;Comorbidity;Disease Progression;Female;Humans;Male;Mental Status Schedule;Risk Factors;Survival Rate;Texas;Vascular Diseases/*epidemiology,"Bhargava, D.;Weiner, M. F.;Hynan, L. S.;Diaz-Arrastia, R.;Lipton, A. M.",2006,Jun,10.1177/0891988706286505,0,
413,Congenital heart disease in the older adult: A scientific statement from the American heart association,,adulthood;aging;aorta coarctation;aorta valve regurgitation;article;atrial fibrillation;atrioventricular block;atrioventricular septal defect;bicuspid aortic valve;bradycardia;cancer risk;cancer screening;cardiac patient;cardiovascular magnetic resonance;cardiovascular risk;childhood;computer assisted tomography;congenital heart disease;coronary artery anomaly;dementia;diabetes mellitus;Ebstein anomaly;electrophysiological procedures;exercise test;Fallot tetralogy;genetic counseling;genetic risk;genetic screening;great vessels transposition;heart atrium septum defect;heart catheterization;heart failure;heart single ventricle;heart ventricle tachycardia;human;hyperlipidemia;hypertension;kidney disease;liver disease;lung function;lung vein drainage anomaly;medical society;meta analysis (topic);morbidity;multicenter study (topic);outcome assessment;pathogenesis;patient care;priority journal;pulmonary valve insufficiency;pulmonary valve stenosis;pulmonary vascular disease;randomized controlled trial (topic);recurrence risk;right ventricle to pulmonary artery conduit;sexual dysfunction;sinoatrial nodal reentry tachycardia;stress echocardiography;survival;transesophageal echocardiography;tricuspid valve regurgitation;Wolff Parkinson White syndrome,"Bhatt, A. B.;Foster, E.;Kuehl, K.;Alpert, J.;Brabeck, S.;Crumb, S.;Davidson, W. R.;Earing, M. G.;Ghoshhajra, B. B.;Karamlou, T.;Mital, S.;Ting, J.;Tseng, Z. H.",2015,,,0,
414,Recognition and evaluation of delirium,"Delirium (acute confusional state) is one of the most common mental disorders encountered in patients with medical illness, particularly among those who are older. It is associated with many complex underlying medical conditions and can be hard to recognise. Systematic studies and clinical trials are difficult to perform in patients with cognitive impairment; recommendations for evaluating and treating delirium are based primarily upon clinical observation and expert opinion. Our knowledge of the clinical epidemiology of delirium has substantially increased in the last decade, providing a basic framework for understanding and managing the disorder.",4 aminobutyric acid;acetylcholine;analgesic agent;anticonvulsive agent;antidepressant agent;antiemetic agent;antihistaminic agent;antiparkinson agent;cardiovascular agent;cholinergic receptor blocking agent;corticosteroid;cytokine;digoxin;endorphin;histamine H2 receptor antagonist;hypnotic sedative agent;interferon;narcotic agent;neuropeptide;neurotransmitter;non prescription drug;nonsteroid antiinflammatory agent;noradrenalin;psychotropic agent;serotonin;spasmolytic agent;article;brain cortex;brain electrophysiology;cerebrospinal fluid analysis;clinical evaluation;clinical feature;cognitive defect;consciousness disorder;critically ill patient;dehydration;delirium;dementia;Diagnostic and Statistical Manual of Mental Disorders;diagnostic procedure;differential diagnosis;drug toxicity;electroencephalogram;electrolyte disturbance;heart failure;human;hypercalcemia;hypoglycemia;immobilization;incidence;infection;liver failure;lumbar puncture;malnutrition;myoclonus;neuroimaging;neurologic examination;Parkinson disease;pathogenesis;point of care testing;polypharmacy;psychological aspect;respiratory tract infection;risk assessment;risk factor;shock;skin infection;soft tissue infection;cerebrovascular accident;subcortex;uremia;urinary catheter;urinary tract infection;withdrawal syndrome,"Bhattacharya, A.",2011,,,0,
415,The prevalence of dysphagia among adults in the United States,"Objective. To determine the prevalence of dysphagia, reported etiologies, and impact among adults in the United States. Study Design. Cross-sectional analysis of a national health care survey. Subjects and Methods. The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for swallowing problems, diagnoses given, and severity of the swallowing problem were analyzed. The relationship between swallowing problems and lost workdays was assessed. Results. An estimated 9.44 ± 0.33 million adults (raw N = 1554; mean age, 52.1 years; 60.2% ± 1.6% female) reported a swallowing problem (4.0% ± 0.1%). Overall, 22.7% ± 1.7% saw a health care professional for their swallowing problem, and 36.9% ± 0.1.7% were given a diagnosis. Women were more likely than men to report a swallowing problem (4.7% ± 0.2% versus 3.3% ± 0.2%, P <.001). Of the patients, 31.7% and 24.8% reported their swallowing problem to be a moderate or a big/very big problem, respectively. Stroke was the most commonly reported etiology (422,000 ± 77,000; 11.2% ± 1.9%), followed by other neurologic cause (269,000 ± 57,000; 7.2% ± 1.5%) and head and neck cancer (185,000 ± 40,000; 4.9% ± 1.1%). The mean number of days affected by the swallowing problem was 139 ± 7. Respondents with a swallowing problem reported 11.6 ± 2.0 lost workdays in the past year versus 3.4 ± 0.1 lost workdays for those without a swallowing problem (contrast, 18.1 lost workdays, P<.001). Conclusion. Swallowing problems affect 1 in 25 adults, annually. A relative minority seek health care for their swallowing problem, even though the subjective impact and associated workdays lost with the swallowing problem are significant.",absenteeism;adult;Alzheimer disease;arthritis;cerebrovascular accident;chronic obstructive lung disease;congestive heart failure;cross-sectional study;dysphagia;female;head and neck cancer;head and neck injury;human;major clinical study;male;Parkinson disease;prescription;prevalence;sex ratio;United States,"Bhattacharyya, N.",2014,,,0,
416,Big data and meaning: Methodological innovations,,age distribution;alcohol consumption;autism;bipolar disorder;cause of death;comorbidity;dementia;drug use;epilepsy;ethnic difference;health behavior;health care policy;human;intellectual impairment;ischemic heart disease;major depression;medical information system;mental disease;mental health care;methodology;neurologic disease;note;poverty;premature mortality;schizophrenia;sex difference;smoking cessation;substance abuse;suicide,"Bhui, K. S.",2015,,,0,
417,"Clinical profile and predictors of in-hospital outcome in patients with heart failure: the FADOI ""CONFINE"" Study","BACKGROUND: Heart failure (HF) is a major health and social problem. Internal Medicine (IM) wards admit a high proportion of patients with HF, frequently with advanced age and comorbidities. Few recent data are available in this setting, especially on predictors of in-hospital outcome. METHODS: In this observational study, we recruited patients admitted with diagnosis of HF and present in five index days, in 91 units of IM in Italy. Characteristics and management of HF, comorbidities, functional and cognitive status, and quality of life, were analyzed. RESULTS: We observed 1411 patients, with a mean age of 78.7 +/- 9.6 years. At admission, 81.7% of the patients were in NYHA classes III-IV. Ninety percent of the patients had at least one comorbidity. Dementia or severely impaired functional status were registered in 21.5% and 22.8% of the patients. In 89 patients (6,3%) a negative outcome (death or clinical worsening) occurred during hospitalization. A number of variables were significantly related to negative outcome by means of univariate analysis (systolic blood pressure <100 mm Hg, pulse pressure >/= 55 mm Hg, anaemia, brain deficit, permanent bed rest, Barthel Index </= 30). At multivariable analysis, significant correlation was retained by anaemia and Barthel Index </= 30, the latter being the strongest predictor. CONCLUSIONS: Real-world patients with HF and hospitalized in IM are frequently very old, frail and with multiple comorbidities. Functional and cognitive status significantly influence patients' outcome, and this could lead to a rethinking of the overall (in-hospital but also home-based) management of HF.","Adult;Aged;Aged, 80 and over;Comorbidity;Female;*Health Status;Heart Failure/*mortality/*physiopathology/therapy;Hospital Mortality;Humans;Inpatients/*statistics & numerical data;Internal Medicine/statistics & numerical data;Length of Stay/statistics & numerical data;Male;Middle Aged;Multivariate Analysis;Predictive Value of Tests;Prognosis;*Quality of Life;Recovery of Function;Severity of Illness Index","Biagi, P.;Gussoni, G.;Iori, I.;Nardi, R.;Mathieu, G.;Mazzone, A.;Panuccio, D.;Scanelli, G.;Cicatello, C.;Rinollo, C.;Muriago, M.;Galasso, D.;Bonizzoni, E.;Vescovo, G.",2011,Oct 6,10.1016/j.ijcard.2011.02.025,0,
418,Cerebral and extracerebral amyloidosis in senile dementia of the Alzheimer type,,Aged;Alzheimer Disease/*etiology;Amyloidosis/*complications;Brain Diseases/*complications;Cardiomyopathies/*complications;Cerebrovascular Disorders/*complications;Dementia/*etiology;Female;Humans;Male,"Bianchi, C.;Berti, N.;Grandi, G.",1980,Jan-Feb,,0,
419,Dilated cardiomyopathy and Creutzfeldt-Jakob disease: evidence for a role of cellular prion protein in the heart?,,"Cardiomyopathy, Dilated/*complications/metabolism;Creutzfeldt-Jakob Syndrome/*complications/metabolism;Humans;Myocardium/*metabolism/pathology;PrPSc Proteins/*metabolism","Bianchin, M. M.;Walz, R.;Brentani, R. R.;Martins, V. R.",2005,Jul 25,10.1001/archinte.165.14.1663-b,0,
420,The value of transcranial Doppler sonography in the differential diagnosis of Alzheimer disease vs multi-infarct dementia,"Primary degenerative dementia of the Alzheimer type and multi-infarct dementia exhibit differences in cerebrovascular blood flow velocity profiles, which were investigated by means of transcranial Doppler sonography. The pulsatility indices, as angle-independent parameters of peripheral vascular resistance, measured in middle cerebral and basilar arteries of patients with multi-infarct dementia (MID), were significantly increased (p < 0.005) with respect to cases of primary degenerative dementia of the Alzheimer type and to healthy age-matched controls. Approximately 75% of all MID patients exhibited small vessel disease rather than thromboembolism from the extracranial arteries and the heart, as judged by extracranial and transcranial Doppler sonographies, computerized cerebral tomographies, EEGs, and, if necessary, 2-D echocardiographies.","Aged;Alzheimer Disease/*diagnosis;Basilar Artery/ultrasonography;Blood Pressure/physiology;Cerebral Arteries/ultrasonography;Cerebrovascular Circulation/physiology;Dementia, Multi-Infarct/*diagnosis/etiology;Diagnosis, Differential;Echoencephalography;Female;Humans;Intracranial Embolism and Thrombosis/complications;Male;Middle Aged;Ultrasonics;Vascular Resistance/physiology","Biedert, S.;Forstl, H.;Hewer, W.",1993,May-Jun,,0,
421,Vascular brain damage in diabetes mellitus,,blood vessel injury;brain blood vessel;brain damage;cardiovascular risk;cognition;dementia;diabetes mellitus;heart infarction;human;risk reduction;short survey,"Biessels, G. J.;Kappelle, L. J.",2006,,,0,
422,Adult Comorbidity Evaluation 27 score as a predictor of survival in endometrial cancer patients,"Background The incidence of endometrial cancer increases with age and is associated with medical comorbidities such as obesity and diabetes. Although a few cohort studies of <500 patients showed an association between comorbidity and survival in patients with endometrial cancer, the degree of association must be better described. The Adult Comorbidity Evaluation 27 is a validated comorbidity instrument that provides a score of 0–3 based on the number of and severity of medical comorbidities. Objective This study was performed to explore the association between medical comorbidities and survival of patients with endometrial cancer. Study Design Patients who were diagnosed with endometrial cancer from 2000–2012 were identified from the prospectively maintained Siteman Cancer Center tumor registry. Patients who underwent primary surgical treatment for endometrioid, serous, and clear cell endometrial carcinoma were included. Patients who primarily were treated with radiation, chemotherapy, or hormone therapy were excluded. Patients with uterine sarcomas or neuroendocrine tumors were excluded. Patients with missing Adult Comorbidity Evaluation 27 scores were also excluded from analysis. Information that included patient demographics, Adult Comorbidity Evaluation 27 score, tumor characteristics, adjuvant treatment, and survival data were extracted from the database. The association of Adult Comorbidity Evaluation 27 and overall and recurrence-free survival was explored in a multivariable Cox regression analysis after being controlled for variables that have been found to be associated significantly with survival in univariable analysis. Results A total of 2073 patients with a median age of 61 years (range, 20–94 years) at diagnosis were identified. The Adult Comorbidity Evaluation 27 score was 0, 1, 2, and 3 in 22%, 38%, 28%, and 12% of patients, respectively. Stage distribution was I (73%), II (5%), III (15%), and IV (7%), and grade distribution was 1 (52%), 2 (23%), and 3 (25%). Most patients had endometrioid histologic condition (87%) followed by serous (11%) and clear cell (3%) endometrial carcinoma. The median overall survival time for the entire cohort was 54 months (95% confidence interval, 3–154 months), and the median recurrence-free survival was 50 months (95% confidence interval, 2–154 months). On univariable analysis, age, race, marital status, stage, grade, histologic condition, and treatment type were associated significantly with overall survival and recurrence-free survival. After adjustment for these covariates, patients with an Adult Comorbidity Evaluation 27 score of 2 had a 52% higher risk of death (95% confidence interval, 1.16–2.00); patients with an Adult Comorbidity Evaluation 27 score of 3 had a 2.35-fold increased risk of death (95% confidence interval, 1.73–3.21) compared with patients with an Adult Comorbidity Evaluation 27 score of 0. Similarly, patients with an Adult Comorbidity Evaluation 27 score of 2 had a 38% higher risk of recurrence (95% confidence interval, 1.07–1.78); patients with Adult Comorbidity Evaluation 27 score of 3 had a 2.05-fold increased risk of recurrence (95% confidence interval, 1.53–2.75) compared with patients with an Adult Comorbidity Evaluation 27 score of 0. We found no interaction between Adult Comorbidity Evaluation 27 score and age, stage, or treatment type. Conclusion Our findings demonstrate the importance of comorbidities in the estimation of the prognosis of patients with endometrial cancer, even after adjustment for age and known tumor-specific prognostic factors such as stage, grade, histologic condition, and adjuvant treatment.",illicit drug;acquired immune deficiency syndrome;adult;aged;alcohol abuse;angina pectoris;article;cancer adjuvant therapy;cancer patient;cancer prognosis;cancer survival;cerebrovascular accident;clear cell carcinoma;comorbidity assessment;congestive heart failure;dementia;diabetes mellitus;end stage renal disease;endometrium cancer;endometrium carcinoma;enteropathy;female;gastrointestinal tract;heart arrhythmia;heart infarction;human;hypertension;ischemic heart disease;Kaplan Meier method;leukemia;liver disease;lymphoma;major clinical study;mental disease;myeloma;neuromuscular disease;obesity;overall survival;pancreas disease;paralysis;peripheral occlusive artery disease;priority journal;recurrence free survival;respiratory tract disease;rheumatic disease;solid malignant neoplasm;stomach disease;vein disease,"Binder, P. S.;Peipert, J. F.;Kallogjeri, D.;Brooks, R. A.;Massad, L. S.;Mutch, D. G.;Powell, M. A.;Thaker, P. H.;McCourt, C. K.",2016,,10.1016/j.ajog.2016.07.035,0,
423,The 2015 european thyroid association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism,"Endogenous subclinical hyperthyroidism (SHyper) is caused by Graves' disease, autonomously functioning thyroid nodules and multinodular goitre. Its diagnosis is based on a persistently subnormal serum thyroid-stimulating hormone (TSH) level with free thyroid hormone levels within their respective reference intervals. In 2014 the European Thyroid Association Executive Committee, given the controversies regarding the treatment of Endo SHyper, formed a task force to develop clinical practice guidelines based on the principles of evidence-based medicine. The task force recognized that recent meta-analyses, including those based on large prospective cohort studies, indicate that SHyper is associated with increased risk of coronary heart disease mortality, incident atrial fibrillation, heart failure, fractures and excess mortality in patients with serum TSH levels <0.1 mIU/l (grade 2 SHyper). Therefore, despite the absence of randomized prospective trials, there is evidence that treatment is indicated in patients older than 65 years with grade 2 SHyper to potentially avoid these serious cardiovascular events, fractures and the risk of progression to overt hyperthyroidism. Treatment could be considered in patients older than 65 years with TSH levels 0.1-0.39 mIU/l (grade 1 SHyper) because of their increased risk of atrial fibrillation, and might also be reasonable in younger (<65 years) symptomatic patients with grade 2 SHyper because of the risk of progression, especially in the presence of symptoms and/or underlying risk factors or co-morbidity. Finally, the task force concluded that there are no data to support treating SHyper in younger asymptomatic patients with grade 1 SHyper. These patients should be followed without treatment due to the low risk of progression to overt hyperthyroidism and the weaker evidence for adverse health outcomes.",radioactive iodine;thyroid hormone;allergic reaction;article;atrial fibrillation;cardiovascular mortality;cardiovascular risk;cerebrovascular accident;cognitive defect;cohort analysis;comorbidity;dementia;disease association;disease course;Doppler echocardiography;endogenous subclinical hyperthyroidism;evidence based medicine;heart failure;Holter monitoring;human;hyperthyroidism;hypothyroidism;ischemic heart disease;osteoporosis;practice guideline;prevalence;priority journal;prospective study;quality of life;risk factor;subclinical hyperthyroidism;thyroid hormone blood level;thyrotropin blood level;treatment outcome,"Biondi, B.;Bartalena, L.;Cooper, D. S.;Hegedüs, L.;Laurberg, P.;Kahaly, G. J.",2015,,,0,
424,Minerva,,anticoagulant agent;clonidine;tamoxifen;vitamin;aging;alpha hemolytic Streptococcus;alternative medicine;Alzheimer disease;brain death;brain edema;breast cancer;condom;congenital heart disease;energy expenditure;hot flush;human;Human immunodeficiency virus infection;inguinal hernia;ischemic heart disease;Kenya;lung embolism;malaria;massage;note;prenatal care;priority journal;sexual behavior;smoking;splenectomy;Streptococcus infection;suicide;total hip prosthesis;visual impairment,"Birchall, W.;Ataullah, S.",2000,,,0,
425,Gamma camera positron emission tomography,,carbon;fluorine;fluorodeoxyglucose f 18;isotope;nitrogen;oxygen;sodium iodide;technetium 99m;tracer;Alzheimer disease;biomedical technology assessment;cardiology;collimator;cost effectiveness analysis;crystal;destruction;diagnostic imaging;human;lymphoma;malignant neoplastic disease;myocardial hibernation;neurology;note;nuclear magnetic resonance imaging;nuclear medicine;oncology;positron emission tomography;radiation attenuation;radiosensitivity;scintillation camera;sensitivity and specificity;single photon emission computer tomography;three dimensional imaging,"Bird, N. J.;Old, S. E.;Barber, R. W.",2001,,,0,
426,Molecular genetics in neurologic diseases,,cell nucleus DNA;mitochondrial DNA;Alzheimer disease;Friedreich ataxia;gene mutation;genetic analysis;genetic counseling;genetic linkage;hereditary motor sensory neuropathy;hereditary optic atrophy;hereditary spinal muscular atrophy;human;Huntington chorea;Kearns Sayre syndrome;molecular genetics;neurofibromatosis;neurologic disease;note;priority journal,"Bird, T. D.",1993,,,0,
427,Risks and benefits of DNA testing for neurogenetic disorders,"DNA testing for mutations in genes causing neurogenetic disorders is becoming a common practice in clinical neurology. The tests are highly sensitive and specific. They are especially valuable in establishing diagnoses in symptomatic patients. These DNA tests are also used in asymptomatic persons at risk for genetic diseases who wish to determine whether or not they have inherited an abnormal gene. There are risks and benefits to such asymptomatic, predictive testing. A number of complex issues need to be considered including precipitation of depression, prenatal diagnosis and testing of children, impact on insurance and employment, legal aspects, possible third-party coercion, and an understanding of each test's limitations. Therefore, these DNA tests need to be used with careful clinical judgment and in the context of each individual patient and family.",adoption;Alzheimer disease;amyloid neuropathy;article;Canavan disease;DNA determination;dystonia;fragile X syndrome;Friedreich ataxia;Gaucher disease;gene mutation;genetic association;hereditary motor sensory neuropathy;hereditary optic atrophy;Huntington chorea;inheritance;Kallmann syndrome;Kearns Sayre syndrome;Kennedy disease;legal aspect;Lesch Nyhan syndrome;medical decision making;MELAS syndrome;multiple endocrine neoplasia;muscular dystrophy;neurofibromatosis;neurologic disease;Pelizaeus Merzbacher disease;prenatal diagnosis;priority journal;risk benefit analysis;Tay Sachs disease;von Hippel Lindau disease,"Bird, T. D.",1999,,,0,
428,Nursing care study: secondary dementia,,"Anoxia/complications;Brain Damage, Chronic/etiology;Dementia/etiology;Humans;Myocardial Infarction/complications","Birkett, M.",1973,Jan 5,,0,
429,Hormone substitution therapy and carcinogenesis,"Background: A correct hormone replacement therapy (HRT) guarantees a successful treatment of subjective symptoms of oestrogen deficiency and an efficient prevention of postmenopausal osteoporosis, cardiovascular diseases and Morbus Alzheimer. In non-substituted postmenopausal women, the risk to die from a myocardial infarction is 10 times higher than the risk to die from a carcinoma of the breast or from the consequences of a fracture of the femoral neck. In spite of this observation, the acceptancy is still insufficient because of an unjustified fear of hormone-induced carcinomas. Methods: In a review the possible connections of HRT and carcinogenesis are analyzed. Results: A carcinoma of the endometrium is more frequent in women substituted by unopposed oestrogens, today an obsolete way of substitution in women having an intact uterus. In contrast, the relative risk of a carcinoma of the endometrium is not increased in women being correctly substituted by a natural oestrogen combined with a progestogen. The incidence of a carcinoma of the breast is not higher in women profiting of a HRT by a correct combination of an oestrogen and a progestogen administered up to 5 years than in untreated controls. Although some but not all authors suspect a slight increase of the relative risk of a carcinoma of the breast to approximately 1.5 after ≤ 10 years of HRT, the overall mortality of substituted women is clearly inferior to the one of a non-substituted population. However, the final goal of HRT is not prolongation of life, but amelioration of the quality of life. In past-users, the relative risk drops rapidly to values below 1 after a few years. The risk of a carcinoma of the breast should therefore not influence the decision in favour or against HRT, except in patients having personal risk factors. As HRT, hormonal contraception does most likely not influence the relative risk of a carcinoma of the breast in women without personal risk factors. However, the data available are contradictory. The incidence of a carcinoma of the vulva, the vagina, the cervix, the tubes and the ovary is not increased by hormonal contraception. In contrast, hormonal contraception, and to some extent probably also HRT, have a protective effect on the ovary and on the endometrium. Conclusions: In HRT, but also in hormonal contraception in young non-smokers, the benefits clearly outweigh the risks.",estrogen;Alzheimer disease;article;breast carcinoma;carcinogenesis;cardiovascular disease;endometrium carcinoma;estrogen deficiency;estrogen therapy;postmenopause osteoporosis,"Birkhäuser, M.",1996,,,0,
430,Hormone replacement therapy after treatment of breast cancer,"A correct Hormone Replacement Therapy (HRT) guarantees a successful treatment of subjective symptoms of oestrogen deficiency and an efficient prevention of postmenopausal osteoporosis, of cardiovascular diseases and of M. Alzheimer. In non-substituted postmenopausal women, the risk to die from a myocardial infarction is ten times higher than the risk to die from a carcinoma of the breast or the consequences of a fracture of the femoral neck. In spite of this observation, the acceptance is still insufficient because of an unjustified fear of hormone-induced carcinomas. The incidence of a carcinoma of the breast is not higher in women profiting of a HRT by a correct combination of an oestrogen and a progestogen administered up to 5 years than in untreated controls. Although some but not all authors suspect a slight increase of the relative risk of a carcinoma of the breast to approximately 1.5 after ≥10 years of HRT, the overall mortality of substituted women is clearly inferior to the one of a non-substituted population. However, the final goal of HRT is not prolongation of life, but a better quality of life. Quality of life is often miserable in women treated for breast cancer. The final answer to the question if women after treatment of breast cancer should be allowed to profit of HRT is still open because formal evidence is missing. However, a woman should not be denied HRT if she lived two years without relapse since her primary cancer and if she does not belong to the subgroup where adjuvant treatment by tamoxifen is appropriate. In the future, selective oestrogen receptor modulators may be used in women after breast cancer.",androgen;bisphosphonic acid derivative;calcitonin;calcitriol;calcium;colecalciferol;estriol;estrogen;fluoride;gestagen;medroxyprogesterone acetate;tamoxifen;article;breast cancer;cancer patient;cardiovascular disease;drug contraindication;estrogen deficiency;female;hip fracture;hormone substitution;human;menopause;oral drug administration;postmenopause osteoporosis;quality of life;risk assessment;topical drug administration,"Birkhäuser, M.",1998,,,0,
431,"Clinical, Sociodemographic, and Psychological Correlates of Health-Related Quality of Life in Chronic Hemodialysis Patients","Background: Physical comorbidities and depression are associated with poor health-related quality of life (HRQoL) in patients undergoing chronic hemodialysis, but little is known about the impact of psychological determinants such as coping strategies in this association. This study examined the relation between psychosocial factors, particularly health-related locus of control (HLOC) and quality of life (QoL) in chronic hemodialisys patients. Methods: Three hundred hemodialysis patients underwent assessment of QoL (SF-36), depression (Beck Depression Inventory score), anxiety (State-Trait Anxiety Inventory), and HLOC profile (Multidimensional Health Locus of Control scale). Comorbidities and sociodemographic factors were assessed. Results: All QoL scores were low. Depression and comorbidities were negatively correlated with physical QoL components and depression, anxiety, and comorbidities were negatively correlated with mental components. However, internal locus of control (LOC) and external LOC (influence of ""powerful others"") were positively correlated with mental QoL components. Multiple regression analysis showed internal LOC significantly and positively associated with mental QoL components, especially mental health score (P < 0.01). Conclusions: Altered QoL of patients undergoing chronic hemodialysis is associated with physical and psychiatric comorbidities, in particular depression and anxiety. However, internal and external LOC seem to have differential impact on QoL. Increasing awareness and empowerment of the internal and external components of the LOC could help patients improving QoL. © 2012 The Academy of Psychosomatic Medicine.",adult;aged;anxiety;article;Beck Depression Inventory;comorbidity;dementia;depression;diabetes mellitus;female;heart failure;hemodialysis;human;locus of control;male;Multidimensional Health Locus of Control scale;neurologic disease;quality of life;Short Form 36;social psychology;State Trait Anxiety Inventory;cerebrovascular accident;vascular disease,"Birmelé, B.;Le Gall, A.;Sautenet, B.;Aguerre, C.;Camus, V.",2012,,,0,
432,"Adverse effects of clozapine in older patients: Epidemiology, prevention and management","Research into the use of clozapine in older people is somewhat scarce. Clozapine is associated with serious adverse effects such as agranulocytosis, seizures, myocarditis and metabolic syndrome. Other common undesirable effects such as sedation, constipation (which can be fatal), urinary incontinence and hypersalivation further limit its use. These adverse effects are particularly important for the use of clozapine in older people, who are generally more susceptible to medication-related adverse effects. Whilst clozapine should be used with caution in elderly people, strict monitoring procedures can help to prevent harmful effects through early detection, and certain management techniques exist to minimise them. This review outlines the epidemiology of clozapine-related adverse effects in older people and discusses potential prevention and management strategies © Springer International Publishing Switzerland 2013.",atenolol;atropine;carbamazepine;clonidine;clozapine;cytochrome P450 1A2;desmopressin;fluconazole;fluoxetine;ipratropium bromide;itraconazole;laxative;lofexidine;norclozapine;pirenzepine;rifampicin;scopolamine;trihexyphenidyl;adverse drug reaction;aged;agranulocytosis;anamnesis;article;bipolar disorder;blurred vision;body temperature disorder;body weight disorder;cardiomyopathy;cognitive defect;confusion;constipation;coughing;dementia;diabetes mellitus;diarrhea;drug indication;drug monitoring;dry eye;dyspnea;feces impaction;fever;flu like syndrome;groups by age;headache;heart failure;human;hyperhidrosis;hypersalivation;hypotension;intestinal dysmotility;intestine obstruction;memory disorder;metabolic syndrome X;micturition disorder;myalgia;myocarditis;nausea;neuroleptic malignant syndrome;neutropenia;off label drug use;orthostatic hypotension;paralytic ileus;Parkinson disease;priority journal;psychosis;restlessness;schizoaffective psychosis;schizophrenia;screening;seizure;sinus tachycardia;sore throat;tachycardia;thorax pain;unspecified side effect;urine incontinence;urine retention;vomiting,"Bishara, D.;Taylor, D.",2014,,,0,
433,Warfarin persistence among stroke patients with atrial fibrillation,"INTRODUCTION: Warfarin treatment discontinuation is significant among patients with atrial fibrillation (AF). For AF patients with stroke a warfarin persistence rate of 0.45 after 2years has previously been reported. No consistent predictors for discontinuation have been established. AIMS: Evaluation of warfarin persistence and variables associated with discontinuation, in a large Swedish cohort with unselected stroke/TIA patients with AF treated with warfarin. MATERIALS AND METHODS: 4 583 patients with stroke/TIA and AF in the Swedish National Patient Register (NPR), from 1. Jan 2006 to 31. Dec 2011, were matched with the Swedish national quality register AuriculA. They were followed until treatment cessation, death or end of study. Baseline characteristics and CHA2DS2VASc score were retrieved from NPR. Treatment-time was retrieved from AuriculA. RESULTS: Overall proportion of warfarin persistence was 0.78 (95% confidence interval (CI) 0.76 to 0.80) after one year, 0.69 (95% CI 0.67 to 0.71) after 2years and 0.47 (95% CI 0.43 to 0.51) after 5years. Variables clearly associated with higher discontinuation were dementia (hazard ratio (HR) 2.22, CI 1.51-3.27) and alcohol abuse (HR 1.66, CI 1.19-2.33). Chronic obstructive pulmonary disease (COPD), cancer and chronic heart failure (CHF) were each associated with over 20% increased risk of treatment discontinuation. Higher CHA2DS2VASc score and start-age lead to lower persistence (p<0.001). CONCLUSIONS: Persistence to warfarin in unselected stroke/TIA patients with AF is in Sweden greater than previously reported. Lower persistence is found among patients with high treatment start-age, incidence of dementia, alcohol abuse, cancer, CHF, COPD and/or high CHA2DS2VASc score.",Aged;Anticoagulants/administration & dosage/*therapeutic use;Atrial Fibrillation/*drug therapy;Cohort Studies;Female;Humans;Male;Risk Factors;Stroke/*drug therapy;Warfarin/administration & dosage/*therapeutic use;Atrial fibrillation;Discontinuation;Persistence;Stroke;Treatment;Warfarin,"Bjorck, F.;Renlund, H.;Svensson, P. J.;Sjalander, A.",2015,Oct,10.1016/j.thromres.2015.07.028,0,
434,'Negative' results of autopsy and elusive cause of death,,aged;aging;article;case report;cause of death;coronary artery atherosclerosis;coronary artery thrombosis;dementia;heart arrhythmia;atrial fibrillation;human;human tissue;male;mitral valve regurgitation;nursing home;priority journal;sudden death,"Bjornsson, J.;Hanzlick, R.",1998,,,0,
435,A matrix method for the evaluation of therapeutic agents: A framework based on disease process-oriented mechanisms of drug action and their effectiveness,"A matrix method has been developed for the evaluation of therapeutic agents based on six categories of therapeutic specificities and three levels of therapeutic effectiveness. The therapeutic specificity categories are based on the relationship between a drug's therapeutic effect and the pathophysiologic process being treated or prevented. The therapeutic effectiveness levels are based on the drug's degree of effectiveness with respect to the underlying disease or disease process. By providing a framework for comparisons across different therapeutic agents, this matrix evaluation method may have applications in assessing different therapeutic options, choosing clinical trials endpoints, and selecting drug discovery targets.",amoxicillin;beta 2 adrenergic receptor stimulating agent;cholinergic receptor blocking agent;corticosteroid;cromoglycate disodium;digoxin;edrophonium;heparin;hepatitis B vaccine;hydrochlorothiazide;imipramine;ipratropium bromide;levodopa;mercaptopurine;methylxanthine;mevinolin;nedocromil;paracetamol;prednisolone;propranolol;salbutamol;tacrine;terfenadine;theophylline;thioridazine;triamcinolone;acute lymphoblastic leukemia;allergic rhinitis;Alzheimer disease;article;asthma;clinical trial;congestive heart failure;deep vein thrombosis;depression;drug classification;drug efficacy;drug indication;drug mechanism;drug research;drug screening;drug targeting;headache;hepatitis B;human;hypercholesterolemia;hypertension;inhalational drug administration;myasthenia gravis;Parkinson disease;priority journal;schizophrenia;upper respiratory tract infection;albuterol;lovastatin,"Bjornsson, T. D.",1997,,,0,
436,From epidemiological transition to modern cardiovascular epidemiology: hypertension in the 21st century,,"Antihypertensive Agents/*administration & dosage;Atrial Fibrillation/prevention & control;*Blood Pressure/drug effects;Blood Pressure Determination/standards;Cardiovascular Diseases/*epidemiology/etiology/physiopathology/*prevention &;control;Dementia, Vascular/prevention & control;Drug Therapy, Combination;Heart Failure/prevention & control;Humans;Hypertension/*complications/physiopathology/prevention & control;Hypertension, Renal/prevention & control;*Life Expectancy;Nephritis/prevention & control","Blacher, J.;Levy, B. I.;Mourad, J. J.;Safar, M. E.;Bakris, G.",2016,Jul 30,10.1016/s0140-6736(16)00002-7,0,
437,Excessive daytime sleepiness and vascular events: the Three City Study,"OBJECTIVE: We assessed whether excessive daytime sleepiness (EDS) at baseline was associated with subsequent coronary heart disease (CHD) and stroke events. METHODS: The Three City Study, a French population-based multicenter prospective study, included 7,007 subjects aged >/=65 years with no personal history of CHD, stroke, or dementia, and self-rated EDS as never, rare, regular, or frequent in response to a face-to-face questionnaire. Hazard ratios (HRs) for the first episode of stroke and CHD over 6 years were estimated using a Cox proportional hazards model with age as the time scale. RESULTS: The mean age of the cohort was 73.7 years (standard deviation, 5.37), 63% were women, and 13.3% and 4.3% reported regular and frequent EDS, respectively. After a median follow-up period of 5.1 years, 372 subjects experienced a first event, either stroke (122 subjects) or a CHD event (250 subjects). The increased risk of CHD and stroke was confined to the group with frequent EDS, and was 1.73x as much as in the group that reported never having EDS (HR, 1.73; 95% confidence interval [CI], 1.15-2.60), after adjustment for confounding and mediating factors. This association was seen in those without hypertension but not in those with hypertension at baseline (p for interaction = 0.01). Moreover, the association with frequent EDS was statistically significant for stroke (HR, 2.10; 95% CI, 1.13-3.89) but not for CHD (HR, 1.51; 95% CI, 0.87-2.61). INTERPRETATION: The current study suggests that frequent EDS is independently associated with future vascular events and stroke in particular in healthy community-dwelling elderly subjects.",Aged;Cohort Studies;Coronary Disease/*complications/epidemiology;Disorders of Excessive Somnolence/*complications/epidemiology;Female;Humans;Male;Middle Aged;Proportional Hazards Models;Stroke/*complications/epidemiology,"Blachier, M.;Dauvilliers, Y.;Jaussent, I.;Helmer, C.;Ritchie, K.;Jouven, X.;Tzourio, C.;Amouyel, P.;Besset, A.;Ducimetiere, P.;Empana, J. P.",2012,May,10.1002/ana.22656,0,
438,Advance care planning throughout the end-of-life: focusing the lens for social work practice,"Advance care planning throughout the end-of-life is an increasingly important aspect of professional practice with older adults and their families. As the nation's population continues to live longer, more and more people will experience years of functional and cognitive decline prior to death. This article discusses the growing importance of advance care planning using a long-range, holistic perspective of examining care needs throughout the end of life. End-of-life care is conceptualized by three trajectories of decline leading to death, with about two-thirds of all older adults succumbing to four key conditions: congestive heart failure, emphysema, frailty, and dementia. Research regarding the advance care planning needs of older adults with the key conditions is presented. Further research is needed to enhance social work practice in this area.",Advance Care Planning/*organization & administration;Chronic Disease;Humans;Social Work/*organization & administration;Terminal Care/*organization & administration,"Black, K.",2007,,10.1300/J457v03n02_04,0,
439,"Vascular cognitive impairment: Epidemiology, subtypes, diagnosis and management","Dementia occurs after stroke in 25% of patients but also can arise from covert cerebrovascular disease (CVD). 'Silent' lacunes occur in 25% of the elderly, often associated with focal or confluent hyperintensities on T2-weighted magnetic resonance imaging, which are detected in 95% of seniors. These covert infarcts predict future stroke and faster cognitive decline. Best practice guidelines advocate screening for cognitive impairment in all phases of overt stroke, when covert CVD is uncovered, when vascular risk factors are present and if patients present with cognitive complaints. Standardised testing is recommended, emphasising executive function and speed of processing. Cholinesterase inhibitors have cognitive enhancing effects in vascular dementia, but the major thrust is still aggressive management of vascular risk factors and healthy lifestyle choices. Given that mixed Alzheimer's dementia and CVD is likely the most common substrate for dementia and that they share common vascular risk factors, a major goal for vascular medicine is cerebrovascular protection, not just to prevent heart attack and stroke, but also to maintain brain health and delay dementia. © sandra.black@sunnybrook.ca.",cholinesterase inhibitor;donepezil;galantamine;memantine;placebo;Alzheimer disease;article;cerebrovascular disease;cognitive defect;drug efficacy;drug fatality;drug safety;executive function;heart infarction;human;lifestyle;multiinfarct dementia;neuroprotection;nuclear magnetic resonance imaging;practice guideline;risk factor;screening;cerebrovascular accident;vascular cognitive impairment,"Black, S. E.",2011,,,0,
440,The future of CV risk prediction: Multisite imaging to predict multiple outcomes,,atherogenesis;coronary artery atherosclerosis;cardiac imaging;cardiovascular mortality;cardiovascular risk;cerebrovascular accident;clinical decision making;computer assisted tomography;coronary artery calcium score;echography;Framingham risk score;groups by age;high risk patient;human;hypothesis;ischemic heart disease;lung nodule;morbidity;multiinfarct dementia;note;peripheral vascular disease;personalized medicine;prediction;risk assessment;three dimensional imaging,"Blaha, M. J.",2014,,,0,
441,Joseph Haydn's encephalopathy: New aspects,"With increasing age, Joseph Haydn complained of progressive forgetfulness preventing him from composing for about the last 8 years of his life. He spent his days more and more inactive and immobilized, suffering from a disabling gait disturbance. Still, most biographers consider diffuse atherosclerosis and congestive heart failure to be reasons for Haydn's medical condition and physical decline during the last years of his life. A more sophisticated and detailed inspection of documents and sources, however, leads to the diagnosis of subcortical vascular encephalopathy (SVE), caused by progressive cerebral small vessel disease. Important features of the disease are mood changes, urinary symptoms, and in particular a characteristic gait disturbance, while dementia is only mild and occurs later in the course. Haydn was severely disabled by the symptoms of SVE for several years and often reported difficulties in the completion of his last oratorio ""Die Jahreszeiten"" (The Seasons). Subsequently, the disease prevented him from composing another large oratorio, ""Das jüngste Gericht"" (The last judgement), which had been already drafted. Finally, the progress of SVE stopped his long career as a composer and conductor at the age of 73 years.",amnesia;apraxia;article;atherosclerosis;behavior change;brain disease;cerebrovascular accident;cerebrovascular disease;cognitive defect;congestive heart failure;coordination disorder;dementia;depression;gait disorder;human;male;mental instability;mood change;multiinfarct dementia;priority journal;subcortical vascular encephalopathy;urinary dysfunction,"Blahak, C.;Bäzner, H.;Hennerici, M. G.",2015,,,0,
442,A polymorphism in lipoprotein lipase affects the severity of Alzheimer's disease pathophysiology,"Emerging evidences indicate a role for lipoprotein lipase (LPL) in degenerative states. Genetic variations in the LPL gene were previously associated to lipid imbalance and coronary artery disease (CAD) risk and severity, a condition that shares pathological features with common Alzheimer's disease (AD). To evaluate whether these genetic variations associate with the risk and pathophysiology of common AD, autopsy-confirmed patients (242 controls, 153 AD) were genotyped for a PvuII single nucleotide polymorphism (SNP; rs285; referred to as the P+ allele) of LPL. Brain LPL mRNA levels, cholesterol levels, amyloid concentration, senile plaques and neurofibrillary tangles density counts were measured and contrasted with specific LPL genotypes. When adjusted for age and sex, homozygosity for the P+ allele resulted in an odds ratio of 2.3 for the risk of developing AD. More importantly, we report that the presence of the P+ allele of LPL significantly affects its mRNA expression level (n = 51; P = 0.026), brain tissue cholesterol levels (n = 55; P = 0.0013), neurofibrillary tangles (n = 52; P = 0.025) and senile plaque (n = 52; P = 0.022) densities. These results indicate that a common polymorphism in the lipoprotein lipase gene modulates the risk level for sporadic AD in the eastern Canadian population but more importantly, indirectly modulates the pathophysiology of the brain in autopsy-confirmed cases.","Aged;Aged, 80 and over;Alzheimer Disease/epidemiology/*genetics/pathology/*physiopathology;Amyloid beta-Peptides/genetics/metabolism;Analysis of Variance;Apolipoproteins E/genetics/metabolism;Brain Chemistry;Canada/epidemiology;Case-Control Studies;Cholesterol/metabolism;Female;Gene Frequency;Genotype;Humans;Lipoprotein Lipase/*genetics;Male;Neurofibrillary Tangles/pathology;Neuropsychological Tests;Odds Ratio;Plaque, Amyloid/pathology;*Polymorphism, Genetic;Polymorphism, Single Nucleotide/*genetics;RNA, Messenger/metabolism;Reverse Transcriptase Polymerase Chain Reaction/methods","Blain, J. F.;Aumont, N.;Theroux, L.;Dea, D.;Poirier, J.",2006,Sep,10.1111/j.1460-9568.2006.05007.x,0,
443,A nondegenerate code of deleterious variants in mendelian loci contributes to complex disease risk,"Summary Although countless highly penetrant variants have been associated with Mendelian disorders, the genetic etiologies underlying complex diseases remain largely unresolved. By mining the medical records of over 110 million patients, we examine the extent to which Mendelian variation contributes to complex disease risk. We detect thousands of associations between Mendelian and complex diseases, revealing a nondegenerate, phenotypic code that links each complex disorder to a unique collection of Mendelian loci. Using genome-wide association results, we demonstrate that common variants associated with complex diseases are enriched in the genes indicated by this ""Mendelian code."" Finally, we detect hundreds of comorbidity associations among Mendelian disorders, and we use probabilistic genetic modeling to demonstrate that Mendelian variants likely contribute nonadditively to the risk for a subset of complex diseases. Overall, this study illustrates a complementary approach for mapping complex disease loci and provides unique predictions concerning the etiologies of specific diseases. © 2013 Elsevier Inc.",acne;acute glomerulonephritis;acute heart infarction;Addison disease;alopecia areata;Alzheimer disease;anxiety disorder;article;asthma;autism;benign tumor;bipolar disorder;bladder cancer;brain cancer;brain infarction;brain tumor;breast cancer;bronchitis;Burkitt lymphoma;cardiovascular disease;cataract;celiac disease;colorectal cancer;Crohn disease;Cushing syndrome;deep vein thrombosis;depression;dermatitis herpetiformis;diabetes insipidus;eczema;emphysema;endocrine disease;endophthalmitis;epilepsy;eye disease;frontotemporal dementia;gene locus;genetic association;genetic code;genetic disorder;genetic risk;genetic variability;glaucoma;gout;human;hypothyroidism;immunopathology;insulin dependent diabetes mellitus;intellectual impairment;kidney cancer;lichen (disease);lung cancer;lung embolism;lung infarction;lupus vulgaris;lymphosarcoma;malignant neoplastic disease;medical record;melanoma;mendelian disorder;migraine;mucocutaneous lymph node syndrome;neurologic disease;non insulin dependent diabetes mellitus;obsessive compulsive disorder;osteoarthritis;parkinsonism;phenotype;phobia;Pick presenile dementia;priority journal;prostate cancer;prostate hypertrophy;psoriasis;reticulosarcoma;rheumatoid arthritis;rosacea;sarcoidosis;schizophrenia;skin cyst;sleep disorder;stomach cancer;uterus cancer;virus infection,"Blair, D. R.;Lyttle, C. S.;Mortensen, J. M.;Bearden, C. F.;Jensen, A. B.;Khiabanian, H.;Melamed, R.;Rabadan, R.;Bernstam, E. V.;Brunak, S.;Jensen, L. J.;Nicolae, D.;Shah, N. H.;Grossman, R. L.;Cox, N. J.;White, K. P.;Rzhetsky, A.",2013,,,0,
444,The continuing risk of transfusion-transmitted infections,,piroplasmosis;bacterial infection;blood analysis;blood component;blood donor;blood filtration;blood transfusion;Chagas disease;Creutzfeldt Jakob disease;cytomegalovirus infection;epidemic;Hepatitis B virus;Hepatitis C virus;human;Human herpesvirus 8;Human immunodeficiency virus;Human T-lymphotropic virus 1;Human T-lymphotropic virus 2;immune deficiency;infection risk;malaria;mosquito;parasite vector;posttransfusion hepatitis;priority journal;sepsis;short survey;virus detection;virus infection;virus transmission;West Nile virus,"Blajchman, M. A.;Vamvakas, E. C.",2006,,,0,
445,"Breaking the thought barrier: Chronic disease management, drugs, and risk/benefit",,alosetron;conjugated estrogen;cyclooxygenase 1;cyclooxygenase 2;cyclooxygenase 2 inhibitor;enzyme inhibitor;medroxyprogesterone acetate;new drug;prostacyclin;rofecoxib;troglitazone;valdecoxib;chronic disease;clinical trial;dementia;diabetes mellitus;drug approval;drug binding;drug cost;drug design;drug fatality;drug industry;drug marketing;drug potency;drug research;drug safety;drug screening;drug withdrawal;enzyme inhibition;food and drug administration;heart disease;heart infarction;human;inflammatory disease;irritable colon;malignant neoplastic disease;medical technology;note;osteoarthritis;pain;patent;prescription;reimbursement;risk benefit analysis;cerebrovascular accident;thrombocyte aggregation;thrombosis;tissue specificity;United States;vascular disease;bextra;depo provera;lotronex;premarin;rezulin;vioxx,"Bland, J. S.",2005,,,0,
446,"Efficacy and safety of ixekizumab for the treatment of moderate-to-severe plaque psoriasis: Results through 108 weeks of a randomized, controlled phase 3 clinical trial (UNCOVER-3)","Background Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin 17A, is efficacious in treating moderate-to-severe plaque psoriasis through 60 weeks. Objective To evaluate the efficacy and safety of ixekizumab through 108 weeks of treatment in UNCOVER-3. Methods Patients (N = 1346) were randomized 2:2:2:1 to 80 mg ixekizumab every 2 or 4 weeks, 50 mg etanercept twice weekly, or placebo. At week 12, patients switched to ixekizumab every 4 weeks during a long-term extension (LTE) period. Efficacy data were summarized using as-observed, multiple imputation (MI), and modified MI (mMI) methods. Results For patients (N = 385) receiving the recommended dose (ixekizumab every 2 weeks on weeks 0-12 and every 4 weeks during LTE), the 108-week as-observed, MI, and mMI response rates were 93.4%, 88.3%, and 83.6%, respectively, for patients achieving ≥75% improvement from baseline in the Psoriasis Area and Severity Index, and the 108-week as-observed, MI, and mMI response rates were 82.6%, 78.3%, and 74.1%, respectively, for patients with a static Physician's Global Assessment score of 0 or 1. During LTE, 1077 (84.5%) patients reported ≥1 treatment-emergent adverse event, and 85% were mild or moderate in severity. Discontinuation because of adverse events occurred in 6.4% of patients. Limitations There was no comparison treatment group after week 12. Conclusion Ixekizumab is well tolerated and demonstrates persistent efficacy through 108 weeks.",NCT01646177;etanercept;ixekizumab;placebo;accidental death;adult;adverse event;arthralgia;article;brain infarction;bronchitis;candidiasis;cardiopulmonary insufficiency;clinical evaluation;controlled study;Crohn disease;disease assessment;disease severity;double blind procedure;drug dose increase;drug efficacy;drug safety;drug withdrawal;female;headache;heart infarction;human;injection site reaction;long term care;major clinical study;male;middle aged;multicenter study;neutropenia;outcome assessment;phase 3 clinical trial;Physician Global Assessment score;priority journal;Psoriasis Area and Severity Index;psoriasis vulgaris;pustulosis palmoplantaris;randomized controlled trial;recommended drug dose;rhinopharyngitis;senile dementia;side effect;treatment duration;treatment response;ulcerative colitis;upper respiratory tract infection,"Blauvelt, A.;Gooderham, M.;Iversen, L.;Ball, S.;Zhang, L.;Agada, N. O.;Reich, K.",2017,,10.1016/j.jaad.2017.06.153,0,
447,Safety and Effectiveness of Statins for Prevention of Recurrent Myocardial Infarction in 12 156 Typical Older Patients: A Quasi-Experimental Study,"BACKGROUND: There is limited evidence on statin risk and effectiveness for patients aged 80+. We estimated risk of recurrent myocardial infarction, muscle-related and other adverse events, and statin-related incremental costs in ""real-world"" older patients treated with statins versus no statins. METHODS: We used primary care electronic medical records from the UK Clinical Practice Research Datalink. Subhazard ratios (competing risk of death) for myocardial infarction recurrence (primary end point), falls, fractures, ischemic stroke, and dementia, and hazard ratios (Cox) for all-cause mortality were used to compare older (60+) statin users and 1:1 propensity-score-matched controls (n = 12,156). Participants were followed-up for 10 years. RESULTS: Mean age was 76.5+/-9.2 years; 45.5% were women. Statins were associated with near significant reduction in myocardial infarction recurrence (subhazard ratio = 0.84, 0.69-1.02, p = .073), with protective effect in the 60-79 age group (0.73, 0.57-0.94) but a nonsignificant result in the 80+ group (1.06, 0.78-1.44; age interaction p = .094). No significant associations were found for stroke or dementia. Data suggest an increased risk of falls (1.36, 1.17-1.60) and fractures (1.33, 1.04-1.69) in the first 2 years of treatment, particularly in the 80+ group. Treatment was associated with lower all-cause mortality. Statin use was associated with health care cost savings in the 60-79 group but higher costs in the 80+ group. CONCLUSIONS: Estimates of statin effectiveness for the prevention of recurrent myocardial infarction in patients aged 60-79 years were similar to trial results, but more evidence is needed in the older group. There may be an excess of falls and fractures in very old patients, which deserves further investigation.",Falls;Fractures;Myocardial infarction;Older;Statins,"Ble, A.;Hughes, P. M.;Delgado, J.;Masoli, J. A.;Bowman, K.;Zirk-Sadowski, J.;Mujica Mota, R. E.;Henley, W. E.;Melzer, D.",2016,May 4,10.1093/gerona/glw082,0,448
448,Safety and Effectiveness of Statins for Prevention of Recurrent Myocardial Infarction in 12 156 Typical Older Patients: A Quasi-Experimental Study,"BACKGROUND: There is limited evidence on statin risk and effectiveness for patients aged 80+. We estimated risk of recurrent myocardial infarction, muscle-related and other adverse events, and statin-related incremental costs in ""real-world"" older patients treated with statins versus no statins. METHODS: We used primary care electronic medical records from the UK Clinical Practice Research Datalink. Subhazard ratios (competing risk of death) for myocardial infarction recurrence (primary end point), falls, fractures, ischemic stroke, and dementia, and hazard ratios (Cox) for all-cause mortality were used to compare older (60+) statin users and 1:1 propensity-score-matched controls (n = 12,156). Participants were followed-up for 10 years. RESULTS: Mean age was 76.5±9.2 years; 45.5% were women. Statins were associated with near significant reduction in myocardial infarction recurrence (subhazard ratio = 0.84, 0.69-1.02, p = .073), with protective effect in the 60-79 age group (0.73, 0.57-0.94) but a nonsignificant result in the 80+ group (1.06, 0.78-1.44; age interaction p = .094). No significant associations were found for stroke or dementia. Data suggest an increased risk of falls (1.36, 1.17-1.60) and fractures (1.33, 1.04-1.69) in the first 2 years of treatment, particularly in the 80+ group. Treatment was associated with lower all-cause mortality. Statin use was associated with health care cost savings in the 60-79 group but higher costs in the 80+ group. CONCLUSIONS: Estimates of statin effectiveness for the prevention of recurrent myocardial infarction in patients aged 60-79 years were similar to trial results, but more evidence is needed in the older group. There may be an excess of falls and fractures in very old patients, which deserves further investigation.",hydroxymethylglutaryl coenzyme A reductase inhibitor;aged;cohort analysis;controlled clinical trial (topic);female;human;male;middle aged;heart infarction;retrospective study;secondary prevention;treatment outcome;very elderly,"Ble, A.;Hughes, P. M.;Delgado, J.;Masoli, J. A.;Bowman, K.;Zirk-Sadowski, J.;Mujica Mota, R. E.;Henley, W. E.;Melzer, D.",2017,,10.1093/gerona/glw082,0,
449,Leukoaraiosis is associated with functional impairment in older patients with Alzheimer's disease but not vascular dementia,"BACKGROUND: Leukoaraiosis (LA) is a common finding in older persons, and might be associated with reduced cognitive performance, gait abnormalities, and functional impairment. Although LA is more frequent in persons affected by dementia, scant data are available about its clinical consequences in this group of patients. OBJECTIVE: To study the association between presence of LA and functional performance in basic activities of daily living in a sample of older persons affected by dementia. DESIGN: We conducted a cross-sectional study on 214 patients; 77 affected by late onset Alzheimer's disease (LOAD), and 137 by vascular dementia (VD). Functional status was assessed using Barthel Index (BI). LA was assessed using computed tomography. RESULTS: In LOAD patients, LA (OR: 7.87; 1.26-48.94), and MMSE score (OR: 0.83; 0.71-0.98) were associated with the risk of severe disability, independent of age, gender, diabetes, hypertension, coronary heart disease, left ventricular hypertrophy, atrial fibrillation, and brain atrophy. In VD patients, MMSE score (OR: 0.77; 0.64-0.93), and CHD (OR: 7.41; 1.09-50.21), but not LA (OR: 2.07; 0.45-9.45) were associated with a severe functional impairment after multivariate adjustment. CONCLUSIONS: Our study suggests that LA might be associated with a worse functional status in basic activities of daily living in patients affected by LOAD but not VD. LA might act synergistically with cognitive and behavioural disturbances to the onset and progression of disability of these patients.","Activities of Daily Living;Aged;Aged, 80 and over;Alzheimer Disease/*pathology;Analysis of Variance;Brain/radiography;Cross-Sectional Studies;Dementia, Vascular/*pathology;Female;Humans;Leukoaraiosis/*complications/*pathology/physiopathology;Logistic Models;Male;Severity of Illness Index;Tomography, X-Ray Computed","Ble, A.;Ranzini, M.;Zurlo, A.;Menozzi, L.;Atti, A. R.;Munari, M. R.;Volpato, S.;Scaramelli, G.;Fellin, R.;Zuliani, G.",2006,Jan-Feb,,0,
450,Impact of coronary heart disease on cognitive decline in Alzheimer's disease: a prospective longitudinal cohort study in primary care,"BACKGROUND: Arteriosclerotic disorders increase the risk of dementia. As they have common causes and risk factors, coronary heart disease (CHD) could influence the course of dementia. AIM: To determine whether CHD increases the speed of cognitive decline in Alzheimer's disease, and to discuss the potential for secondary cardiovascular prevention to modify this decline. DESIGN AND SETTING: Prospective multicentre cohort study in general practices in six cities in Germany. METHOD: Participants were patients with probable mild-to-moderate Alzheimer's dementia or mixed dementia (n = 118; mean age 85.6 [+/-3.4] years, range 80-96 years). The authors assessed the presence of CHD according to the family physicians' diagnosis. Cognitive performance was measured during home visits for up to 3 years in intervals of 6 months, using Mini Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SoB). The authors also recorded whether patients died in the observation period. RESULTS: At baseline, 65 patients (55%) had CHD and/or a heart condition following a myocardial infarction. The presence of CHD accelerated cognitive decline (MMSE, P<0.05) by about 66%, and reduced cognitive-functional ability (CDR-SoB, P<0.05) by about 83%, but had no impact on survival. CONCLUSION: The study shows that CHD has a significant influence on cognitive decline in older patients with late-onset dementia. The dementia process might therefore be positively influenced by cardiovascular prevention, and this possible effect should be further investigated.","Aged, 80 and over;Alzheimer Disease/epidemiology/ physiopathology/psychology;Cognitive Dysfunction/epidemiology/ physiopathology;Coronary Artery Disease/epidemiology/ physiopathology/psychology;Disease Progression;Female;Germany/epidemiology;Humans;Longitudinal Studies;Male;Neuropsychological Tests;Primary Health Care;Prospective Studies;Risk Factors;Alzheimer's disease;cardiovascular diseases;cardiovascular risk;cognitive decline;dementia;family practice","Bleckwenn, M.;Kleineidam, L.;Wagner, M.;Jessen, F.;Weyerer, S.;Werle, J.;Wiese, B.;Luhmann, D.;Posselt, T.;Konig, H. H.;Brettschneider, C.;Mosch, E.;Weeg, D.;Fuchs, A.;Pentzek, M.;Luck, T.;Riedel-Heller, S. G.;Maier, W.;Scherer, M.",2017,Feb,,0,
451,Confusional symptomatology distinguishes early- and late-onset Alzheimer's disease,"Symptoms of confusion were examined in 75 patients with Alzheimer's disease (AD). Mild confusion was found in 20, and moderate/severe confusion in 8 patients. Confusion was more frequent in the late-onset (26/44-59%) than in the early-onset AD group (2/31-6%) (P < 0.0001), and patients with confusion were older (p < 0.0001) than those without confusion. The frequency of confusion was higher in patients with ischemic heart disease (13/28-46%) than in patients without this vascular factor (10/47-21%) (p < 0.05). An inverse relation was found between confusional symptomatology and parietal-lobe symptoms. The findings in this study suggest that a subgroup of AD patients, fulfilling the NINCDS-ADRDA criteria for probable AD, is characterized by a clinical picture of mild confusional symptomatology together with no or mild parietal-lobe symptomatology, higher age and higher frequency of ischemic heart disease. This group contrasts with the other subgroup of pure AD, which is characterized by a clinical picture of marked parietal-lobe symptomatology, almost no confusional symptomatology, lower age and lower frequency of ischemic heart disease.",aged;Alzheimer disease;article;confusion;controlled study;female;human;major clinical study;male,"Blennow, K.;Wallin, A.;Gottfries, C. G.",1990,,,0,
452,The application of information theory for the estimation of old-age multimorbidity,"Elderly patients are commonly characterized by the presence of several chronic aging-related diseases at once, or old-age “multimorbidity,” with critical implications for diagnosis and therapy. However, at the present there is no agreed or formal method to diagnose or even define “multimorbidity.” There is also no formal quantitative method to evaluate the effects of individual or combined diagnostic parameters and therapeutic interventions on multimorbidity. The present work outlines a methodology to provide such a measurement and definition, using information theoretical measure of normalized mutual information. A cohort of geriatric patients, suffering from several age-related diseases (multimorbidity), including ischemic heart disease, COPD, and dementia, were evaluated by a variety of diagnostic parameters, including static as well as dynamic biochemical, functional-behavioral, immunological, and hematological parameters. Multimorbidity was formally coded and measured as a composite of several chronic age-related diseases. The normalized mutual information allowed establishing the exact informative value of particular parameters and their combinations about the multimorbidity value. With the currently intensifying attempts to reduce aging-related multimorbidity by therapeutic interventions into its underlying aging processes, the proposed method may outline a valuable direction toward the formal indication and evidence-based evaluation of effectiveness of such interventions.",adult;aging;chronic obstructive lung disease;cohort analysis;comparative effectiveness;dementia;frailty;geriatric patient;hematological parameters;human;information science;ischemic heart disease;multiple chronic conditions;theoretical study,"Blokh, D.;Stambler, I.;Lubart, E.;Mizrahi, E. H.",2017,,10.1007/s11357-017-9996-4,0,
453,The influence of vascular risk factors on cognitive decline in patients with Alzheimer's Disease,"Introduction The influence of vascular risk factors (VRFs) on the rate of cognitive decline in patients with established dementia is unclear. This study aims to examine the association between VRFs and the rate of cognitive decline in patients with Alzheimer's disease (AD). Methods Data were obtained from patients visiting a memory clinic between 2004 and 2012. VRFs were determined at baseline and included hypertension, hypercholesterolemia, diabetes mellitus, overweight and smoking. Continuous values of blood pressure, total cholesterol, glucose level and body mass index were also obtained. Mini-Mental State Exam (MMSE) scores were obtained at baseline and during follow-up visits. The association between VRFs and the annual change in MMSE scores was analysed with a multivariable linear mixed model adjusted for age, sex and the aforementioned VRFs. Results From 174 patients (mean age 78.3 years), with a follow-up time up to 5.8 years (mean 1.1 year), in total 447 MMSE scores were obtained. The multivariable analyses showed an association between age as well as systolic blood pressure and a decline in annual rates of change in MMSE scores of -0.05 (95% confidence interval (CI): -0.09 to 0.00) and -0.01 (CI: -0.03 to 0.00), respectively. For all other VRFs, including sex, patients did not show a significant difference. Conclusion This study did not find an association between preventable vascular risk factors and cognitive decline in patients with AD, except for systolic blood pressure. As the association between systolic blood pressure and decline in MMSE was small, clinical relevance may be limited. © 2014 Elsevier Ireland Ltd.",cholesterol;glucose;aged;Alzheimer disease;article;blood pressure;body mass;cerebrovascular disease;cholesterol blood level;cognitive defect;diabetes mellitus;diastolic blood pressure;female;human;hypercholesterolemia;hypertension;ischemic heart disease;major clinical study;male;Mini Mental State Examination;obesity;risk factor;smoking;systolic blood pressure,"Blom, K.;Vaartjes, I.;Peters, S. A. E.;Koek, H. L.",2014,,,0,
454,Stroke incidence and association with risk factors in women: A 32-year follow-up of the Prospective Population Study of Women in Gothenburg,"Objective: To study stroke incidence among women over 32 years of age with a focus on subdividing by stroke type, to consolidate end points and associations with risk factors. Design: Prospective population study initiated in 1968-1969 with follow-ups in 1974, 1980, 1992 and 2001. Setting: Gothenburg, Sweden. Participants: A sample of 1462 women from five age strata examined in 1968-1969, representative of women in the general population. Main outcome measures: Main types of first-ever stroke and fatal stroke during 1968-2001 identified and validated. Stroke incidence rates in different age strata. Association with baseline smoking, body mass index (BMI), waist-hip ratio, hypertension, serum lipids, physical inactivity, perceived mental stress and education. Associations with atrial fibrillation (AF), diabetes, baseline hypertension and myocardial infarction (MI). Blood pressure (BP) levels 1-3, corresponding to modern guidelines, in relation to stroke risk. Results: 184 (12.6%) cases of first-ever stroke, 33 (18%) of them fatal. Validation reduced unspecified stroke diagnoses from 37% to 11%. Age-standardised incidence rate per 100 000 person-years was 448. A multivariate model showed a significant association between ischaemic stroke and high BMI: HR 1.07 (95% CI 1.02 to 1.12), smoking 1.78 (1.23 to 2.57) and low education 1.17 (1.01 to 1.35). Significant association was seen between haemorrhagic stroke and, besides age, physical inactivity 2.18 (1.04 to 4.58) and for total stroke also hypertension 1.45 (1.02 to 2.08). Survival analysis showed a significantly increased risk of stroke in participants with diabetes (p<0.001), AF (p<0.001) and hypertension (p=0.001), but not MI. Stroke risk increased with increasing BP levels but was already seen for diastolic pressure grade 1 and particularly when combined with systolic BP grade 1; 1.62 (1.17 to 2.25). Conclusions: Hypertension, smoking, AF, diabetes and high BMI were associated with increased stroke risk. Low education was associated with stroke. Validation of National Patient Registry diagnoses to increase specified diagnoses improved data quality.",adult;article;body mass;brain hemorrhage;brain ischemia;cerebrovascular accident;controlled study;dementia;diabetes mellitus;diastolic blood pressure;education;epileptic state;female;follow up;atrial fibrillation;heart failure;heart infarction;human;incidence;lipid blood level;major clinical study;mental stress;mortality;physical inactivity;population research;practice guideline;prospective study;risk factor;smoking;Sweden;systolic blood pressure;systolic hypertension;transient ischemic attack;validation process;waist hip ratio,"Blomstrand, A.;Blomstrand, C.;Ariai, N.;Bengtsson, C.;Björkelund, C.",2014,,,0,
455,Association of direct-to-consumer genome-wide disease risk estimates and self-reported disease,"The ongoing controversy surrounding direct-to-consumer (DTC) personal genomic tests intensified last year when the U.S. Government Accountability Office released results of an undercover investigation of four companies that offer such testing. Among their findings, they reported that some of their donors received DNA-based predictions that conflicted with their actual medical histories. We aimed to more rigorously evaluate the relationship between DTC genomic risk estimates and self-reported disease by leveraging data from the Scripps Genomic Health Initiative. We prospectively collected selfreported personal and family health history data for 3,416 individuals, who went on to purchase a commercially available DTC genomic test. For 5 out of 15 total conditions studied, we found that risk estimates from the test were significantly associated with self-reported family and/or personal health history. The five conditions included Graves' disease, Type 2 Diabetes, Lupus, Alzheimer's disease, and Restless Leg Syndrome. To further investigate these findings, we ranked each of the 15 conditions based on published heritability estimates and conducted post hoc power analyses, based on the number of individuals in our sample who reported significant histories of each condition. We found that high heritability, coupled with high prevalence in our sample and thus adequate statistical power, explained the pattern of associations observed. Our study represents one of the first evaluations of the relationship between risk estimates from a commercially available DTC personal genomic test and self-reported health histories in the consumers of that test. © 2011 Wiley Periodicals, Inc.",Alzheimer disease;article;family history;genetic association;genetic risk;Graves disease;heart infarction;human;human genome;lupus vulgaris;non insulin dependent diabetes mellitus;prospective study;prostate cancer;restless legs syndrome;risk assessment,"Bloss, C. S.;Topol, E. J.;Schork, N. J.",2012,,,0,
456,"Anticipating the ""silver tsunami"": Prevalence trajectories and comorbidity burden among older cancer survivors in the United States","Background: Cancer survivors are a growing population, due in large part to the aging of the baby boomer generation and the related ""silver tsunami"" facing the U.S. health care system. Understanding the impact of a graying nation on cancer prevalence and comorbidity burden is critical in informing efforts to design and implement quality cancer care for this population. Methods: Incidence and survival data from 1975 to 2011 were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program to estimate current cancer prevalence. SEER-Medicare claims data were used to estimate comorbidity burden. Prevalence projections were made using U.S. Census Bureau data and the Prevalence Incidence Approach Model, assuming constant future incidence and survival trends but dynamic projections of the U.S. population. Results: In 2016, there were an estimated 15.5 million cancer survivors living in the United States, 62% of whom were 65 years or older. The prevalent population is projected to grow to 26.1 million by 2040, and include 73% of survivors who are 65 years and older. Comorbidity burden was highest in the oldest survivors (those ≥85 years) and worst among lung cancer survivors. Conclusions: Older adults, who often present with complex health needs, now constitute the majority of cancer survivors and will continue to dominate the survivor population over the next 24 years. Impact: The oldest adults (i.e., those >75 years) should be priority populations in a pressing cancer control and prevention research agenda that includes expanding criteria for clinical trials to recruit more elderly participants and developing relevant supportive care interventions.",acquired immune deficiency syndrome;acute heart infarction;adult;aged;aging;article;bladder cancer;breast cancer;cancer epidemiology;cancer incidence;cancer prognosis;cancer registry;cancer survival;cancer survivor;cerebrovascular disease;Charlson Comorbidity Index;chronic kidney failure;chronic obstructive lung disease;colorectal cancer;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;female;heart infarction;hemiplegia;human;kidney disease;leukemia;liver dysfunction;lung cancer;major clinical study;male;medicare;middle aged;mild hepatic impairment;moderate hepatic impairment;mouth cancer;neoplasm;paraplegia;peripheral vascular disease;prevalence;priority journal;prostate cancer;quality of life;rheumatic disease;severe hepatic impairment;ulcer;United States;very elderly,"Bluethmann, S. M.;Mariotto, A. B.;Rowland, J. H.",2016,,,0,
457,Multiple-modality exercise and mind-motor training to improve cardiovascular health and fitness in older adults at risk for cognitive impairment: A randomized controlled trial,"Background The effects of multiple-modality exercise on arterial stiffening and cardiovascular fitness has not been fully explored. Objectives To explore the influence of a 24-week multiple-modality exercise program associated with a mind-motor training in cardiovascular health and fitness in community-dwelling older adults, compared to multiple-modality exercise (M2) alone. Methods Participants (n = 127, aged 67.5 [7.3] years, 71% females) were randomized to either M4 or M2 groups. Both groups received multiple-modality exercise intervention (60 min/day, 3 days/week for 24-weeks); however, the M4 group underwent additional 15 min of mind-motor training, whereas the M2 group received 15 min of balance training. Participants were assessed at 24-weeks and after a 28-week non-contact follow-up (52-weeks). Results at 52-weeks, the M4 group demonstrated a greater VO2max (ml/kg/min) compared to the M2 group (mean difference: 2.39, 95% CI: 0. 61 to 4.16, p = 0.009). Within-group analysis indicated that the M4 group demonstrated a positive change in VO2max at 24-weeks (mean change: 1.93, 95% CI: 0.82 to 3.05, p = 0.001) and 52-weeks (4.02, 95% CI: 2.71 to 5.32, p = 0.001). Similarly, the M2 group increased VO2max at 24-weeks (2.28, 95% CI: 1.23 to 3.32, p < 0.001) and 52-weeks (1.63, 95% CI: 0.43 to 2.83, p = 0.008). Additionally, the M2 group decreased 24 h SBP (mmHg) at 24-weeks (−2.31, 95% CI: −4.61 to −0.01, p = 0.049); whereas the M4 group improved 24 h DBP (−1.6, 95% CI: −3.03 to −0.17, p = 0.028) at 52-weeks. Conclusion Mind-motor training associated with multiple-modality exercise can positively impact cardiovascular fitness to the same extent as multiple-modality exercise alone.",adult;aerobic exercise;aged;arterial stiffness;article;balance training;blood pressure monitoring;body equilibrium;body mass;cardiovascular disease;cognitive defect;congestive heart failure;controlled study;daily life activity;dementia;Doppler flowmetry;exercise;female;fitness;heart infarction;heart output;human;intermethod comparison;major clinical study;major depression;male;memory;mind motor training;Mini Mental State Examination;Montreal cognitive assessment;oxygen consumption;priority journal;randomized controlled trial;risk factor;risk reduction;self report;systolic blood pressure;training,"Boa Sorte Silva, N. C.;Gregory, M. A.;Gill, D. P.;Petrella, R. J.",2017,,10.1016/j.archger.2016.10.009,0,
458,Low-grade inflammation and arterial stiffness in the elderly,,advanced glycation end product;angiotensin II;C reactive protein;collagen;elastin;endothelin;interleukin 6;interleukin 8;nitric oxide;reactive oxygen metabolite;tumor necrosis factor alpha;aging;arterial stiffness;artery wall;atherosclerosis;cardiovascular risk;cell expansion;dementia;diabetes mellitus;disease association;endothelial dysfunction;heart failure;heart infarction;human;inflammation;kidney disease;low grade inflammation;macrophage;mononuclear cell;mortality;note;priority journal;signal transduction;smooth muscle fiber;cerebrovascular accident;vascular smooth muscle;Young modulus,"Bobik, A.;Grassi, G.",2012,,,0,
459,Vascular Cognitive Impairment: Most Useful Subtests of the Montreal Cognitive Assessment in Minor Stroke and Transient Ischemic Attack,"Background/Aims: Cognitive impairment is frequent in cerebrovascular disease but often remains undetected. The Montreal Cognitive Assessment (MoCA) has been proposed in this context. Our aim was to evaluate the MoCA and its subtests in cerebrovascular disease. Methods: We assessed 386 consecutive patients with minor stroke (National Institutes of Health Stroke Score <4) or transient ischemic attack at 3 months. The MoCA and the modified Rankin Scale (mRS) were administered. Computed tomography (CT) scans were assessed for stroke and white matter changes. An unfavorable functional outcome was defined as mRS >1. Results: The prevalence of cognitive impairment (cutoff of 26) was 55% using the MoCA and 13% using the MMSE. In a multivariate analysis, MoCA <26 was associated with the outcome (OR 3.00, CI 1.78-5.03), as were remote lacunar stroke on CT and white matter changes of at least moderate severity. Five subtests (5-word recall, word list generation, trail-making, abstract reasoning and cube copy) formed an optimal short MoCA with 6/10 or less showing a sensitivity of 91% and a specificity of 83%. Conclusion: This study extends the utility of the MoCA to milder forms of cerebrovascular disease. The MoCA is associated with the 3-month functional outcome. Five subtests may constitute an optimal brief tool in vascular cognitive impairment.",abstract reasoning test;acute coronary syndrome;aged;article;cerebrovascular accident;cognitive defect;computer assisted tomography;cube copy test;female;functional assessment;human;lacunar stroke;major clinical study;male;Mini Mental State Examination;Montreal cognitive assessment;National Institutes of Health Stroke Scale;neuroimaging;neuropsychological test;priority journal;psychologic test;Rankin scale;transient ischemic attack;verbal fluency test;white matter;word list recall;word recognition,"Bocti, C.;Legault, V.;Leblanc, N.;Berger, L.;Nasreddine, Z.;Beaulieu-Boire, I.;Yaneva, K.;Boulanger, J. M.",2013,,,0,
460,Influence of individual differences in disease perception on consumer response to direct-to-consumer genomic testing,"Individuals who undergo multiplex direct-to-consumer (DTC) genomic testing receive genetic risk results for multiple conditions. To date, research has not investigated the influence of individual differences in disease perceptions among consumers on testing outcomes. A total of 2037 participants received DTC genomic testing and completed baseline and follow-up surveys assessing disease perceptions and health behaviors. Participants were asked to indicate their most feared disease of those tested. Perceived seriousness and controllability of the disease via lifestyle or medical intervention were assessed. Participants most frequently reported heart attack (19.1%) and Alzheimer's disease (18.6%) as their most feared disease. Perceived seriousness and control over the feared disease both influenced response to DTC genomic testing. Greater perceived seriousness and diminished perceived control were associated with higher, but not clinically significant levels of anxiety and distress. In some cases these associations were modified by genetic risk. No significant associations were observed for diet, exercise and screening behaviors. Individual differences in disease perceptions influence psychological outcomes following DTC genomic testing. Higher perceived seriousness may make a consumer more psychologically sensitive to test results and greater perceived control may protect against adverse psychological outcomes. Findings may inform development of educational and counseling services.",adult;aged;Alzheimer disease;anxiety;article;cohort analysis;colon cancer;direct to consumer genomic testing;disease course;diseases;distress syndrome;female;follow up;genetic risk;genetic screening;health behavior;Health Belief Model;heart infarction;human;lifestyle;major clinical study;male;medical examination;middle aged;non insulin dependent diabetes mellitus;obesity;outcome assessment;priority journal,"Boeldt, D. L.;Schork, N. J.;Topol, E. J.;Bloss, C. S.",2015,,,0,
461,Biomarker snapshots,"The identification of novel biomarkers is a crucial step in advancing towards earlier detection of diseases, as well as more personalized treatment options. This snapshot summarizes some of the biochemical and genomic biomarkers reported recently in the literature and at leading industry conferences for a variety of disorders and conditions.","antithrombin III;biological marker;carnitine;CD163 antigen;cytochrome P450 3A5;dedicator of cytokinesis protein 6;delta like protein 3;exportin 1;glucocorticoid receptor;glucose regulated protein 94;hepatocyte nuclear factor 3alpha;indoleamine 2,3 dioxygenase;indoleamine 2,3 dioxygenase 1;interleukin 13 receptor alpha1;lung resistance protein;membrane antigen;methylated DNA protein cysteine methyltransferase;microRNA;mismatch repair protein PMS2;nicotinamide phosphoribosyltransferase;organic anion transporter B;protein homer 2;suppression of tumorigenicity 2;transcription factor;transcription factor Pitx2;transcription factor Sox11;transcription factor Sox17;transcription factor YY1;transforming growth factor beta2;unclassified drug;vasodilator stimulated phosphoprotein;acquired immune deficiency syndrome;alcohol liver disease;article;bladder cancer;brain atrophy;breast cancer;cancer growth;cancer patient;cancer prognosis;cancer survival;CD4 lymphocyte count;chronic fatigue syndrome;clinical feature;dermatomyositis;diffuse Lewy body disease;ectodermal dysplasia;endometrium cancer;endometrium carcinoma;esophageal adenocarcinoma;follow up;food allergy;gene mutation;genetic variability;glioblastoma;heart infarction;human;Human immunodeficiency virus;Human immunodeficiency virus infected patient;Human immunodeficiency virus infection;immunohistochemistry;immunoreactivity;kidney carcinoma;leiomyoma;leiomyosarcoma;lung carcinoma;macrophage;major depression;malignant neoplasm;milk allergy;multiple myeloma;myelodysplastic syndrome;nephroblastoma;overall survival;personalized medicine;phagocytosis;primary glaucoma;progression free survival;rheumatoid arthritis;solid pseudopapillary tumor;stomach cancer;thyroid medullary carcinoma;thyroid papillary carcinoma;tumor growth;ulcerative colitis;uterine cervix dysplasia","Bofill, X.;Cole, P.;Dulsat, C.",2017,,10.1358/dof.2017.042.03.2624086,0,
462,Early hospital readmission of nursing home residents and community-dwelling elderly adults discharged from the geriatrics service of an urban teaching hospital: patterns and risk factors,"OBJECTIVES: To compare rates and risk factors for early hospital readmission for nursing home residents and community-dwelling older adults. DESIGN: Retrospective cohort study. SETTING: Geriatric inpatient service at a large urban hospital. PARTICIPANTS: Nursing home residents (n=625) and community-dwelling individuals (n=413) aged 65 and older admitted over a 1-year period. MEASUREMENTS: Thirty-day readmissions. RESULTS: There were 1,706 hospital admissions within the 1-year study period involving 1,038 individuals. The 30-day readmission rate was higher for subjects discharged to a nursing home than those discharged to the community (34.4% vs 22.6%, P<.001). Chronic kidney disease and pressure ulcers were associated with greater risk of readmission in both groups. Chronic obstructive pulmonary disease was a risk factor for readmission only in community-dwelling individuals. Congestive heart failure and dementia were associated with greater risk of readmission only in nursing home residents. Readmission rates varied between individual nursing homes by more than a factor of 2. Risk of readmission was 30% lower in nursing home residents cared for by hospitalist than nonhospitalist geriatricians. CONCLUSION: Higher rates of hospital readmission for individuals discharged to nursing homes than to the community and differing patterns of risk factors for readmission indicate the importance of customized interventions to reduce readmission rates for two distinct elderly populations.","Aged, 80 and over;Cohort Studies;Female;Hospitals, Teaching;Hospitals, Urban;Humans;Male;Nursing Homes;Patient Discharge/*statistics & numerical data;Patient Readmission/*statistics & numerical data;Residence Characteristics;Retrospective Studies;Risk Factors;Time Factors;elderly;hospital readmission;nursing home resident","Bogaisky, M.;Dezieck, L.",2015,Mar,10.1111/jgs.13317,0,
463,Leukoencephalopathy in patients with ischemic stroke,"Thirty-one (16 women, 15 men; mean age 68 years) of 1,000 consecutive patients with an ischemic stroke investigated systematically with computed tomography (CT), Doppler, electrocardiography (ECG), and biological tests had a diffuse hypodensity of the cerebral hemispheric white matter on CT, a sign indicative of leukoencephalopathy. In 25 of the 31 patients, the acute infarct was deep. Leukoencephalopathy was more frequent in patients with a deep infarct (8%) than in patients in whom the cortex was involved (0.8%) (p < 0.01). A history of progressive intellectual impairment (23%) and the finding of a mild or moderate impairment, or severe dementia (84%) were more frequent in study patients (p < 0.05) than in 31 sex- and age-matched controls with acute infarct of same size and topography but without leukoencephalopathy. A history of hypertension (81%) and high blood pressure on admission (166 ± 19/96 ± 12 mm Hg) were the most common risk factors and were more frequent in study patients (p < 0.05) than in controls. On the other hand, study patients had a ≥ 50% stenosis or occlusion of the carotid artery (13%) less often than controls (35%) (p < 0.05). Diabetes (23%), elevated blood cholesterol (13%) , hematocrit > 45% (23%), smoking (32%), and myocardial ischemia by history or ECG (45%) did not differ. These findings suggest that hypertension may be more strongly associated with leukoencephalopathy than with deep infarcts. In acute stroke patients, leukoencephalopathy on CT should not be considered a fortuitous finding.",adult;aged;central nervous system;clinical article;computer assisted tomography;diagnosis;human;leukoencephalopathy;nervous system;peripheral vascular system;priority journal;cerebrovascular accident,"Bogousslavsky, J.;Regli, F.;Uske, A.",1987,,,0,
464,Adverse outcomes associated with elective knee arthroscopy: A population-based cohort study,"Purpose: The aims of this study were to quantify the frequency of adverse outcomes after elective knee arthroscopies in Victoria, Australia, and to identify risk factors associated with adverse outcomes. Methods: We performed a retrospective, longitudinal cohort study of elective orthopaedic admissions using the Victorian Admitted Episodes database, a routinely collected public and private hospital episodes database linked to death registry data, from July 1, 2000, to June 30, 2009. Adverse outcome measures included pulmonary embolism (PE), deep vein thrombosis (DVT), hemarthrosis, effusion and synovitis, cellulitis, wound infection, synovial fistula, acute renal failure, myocardial infarct, stroke, and death. Patients were excluded if they had an additional procedure performed during the arthroscopy admission. We identified complications during the admission and within readmissions up to 30 days after the procedure. PE, DVT, and death within 90 days of the arthroscopy episode were also examined. We used logistic regression analysis to identify risk factors associated with complications. Results: After we excluded 16,807 patients (8.5%) with an additional procedure during their admission, there were 180,717 episodes involving an elective arthroscopy during the period studied. The most common adverse outcomes within 30 days were DVT (579, 0.32%), effusion and synovitis (154, 0.09%), PE (147, 0.08%), and hemarthrosis (134, 0.07%). The 30-day orthopaedic readmission rate was 0.77%, and there were 55 deaths (0.03%). Within 90 days of arthroscopy, we identified 655 events of DVT (0.36%) and 179 PE events (0.10%). Logistic regression analysis identified that potential risk factors for complications were older age, presence of comorbidity, being married, major mechanical issues, and having the procedure performed in a public hospital. Conclusions: Our study found 6.4 adverse outcomes per 1,000 elective knee arthroscopy procedures (0.64%), with the 3 most common complications being DVT, effusion and synovitis, and PE. We have also identified risk factors for adverse outcomes, particularly chronic kidney disease, myocardial infarction, cerebrovascular accident, and cancer. Level of Evidence: Level III, retrospective cohort study. © 2013 by the Arthroscopy Association of North America.",acute kidney failure;adult;adverse outcome;article;Australia;cellulitis;cerebrovascular accident;chronic liver disease;chronic lung disease;cohort analysis;comorbidity;connective tissue disease;deep vein thrombosis;dementia;diabetes mellitus;effusion;female;heart failure;heart infarction;hemarthrosis;hemiplegia;hospital admission;hospital readmission;human;knee arthroscopy;length of stay;major clinical study;male;marriage;metastasis;neoplasm;obesity;peripheral vascular disease;private hospital;public hospital;retrospective study;risk factor;social status;synovitis;wound infection,"Bohensky, M. A.;Desteiger, R.;Kondogiannis, C.;Sundararajan, V.;Andrianopoulos, N.;Bucknill, A.;McColl, G.;Brand, C. A.",2013,,,0,
465,Continuous treatment with antidementia drugs in Germany 2003-2013: a retrospective database analysis,"BACKGROUND: Continuous treatment is an important indicator of medication adherence in dementia. However, long-term studies in larger clinical settings are lacking, and little is known about moderating effects of patient and service characteristics. METHODS: Data from 12,910 outpatients with dementia (mean age 79.2 years; SD = 7.6 years) treated between January 2003 and December 2013 in Germany were included. Continuous treatment was analysed using Kaplan-Meier curves and log-rank tests. In addition, multivariate Cox regression models were fitted with continuous treatment as dependent variable and the predictors antidementia agent, age, gender, medical comorbidities, physician specialty, and health insurance status. RESULTS: After one year of follow-up, nearly 60% of patients continued drug treatment. Donezepil (HR: 0.88; 95% CI: 0.82-0.95) and memantine (HR: 0.85; 0.79-0.91) patients were less likely to be discontinued treatment as compared to rivastigmine users. Patients were less likely to be discontinued if they were treated by specialist physicians as compared to general practitioners (HR: 0.44; 0.41-0.48). Younger male patients and patients who had private health insurance had a lower discontinuation risk. Regarding comorbidity, patients were more likely to be continuously treated with the index substance if a diagnosis of heart failure or hypertension had been diagnosed at baseline. CONCLUSIONS: Our results imply that besides type of antidementia agent, involvement of a specialist in the complex process of prescribing antidementia drugs can provide meaningful benefits to patients, in terms of more disease-specific and continuous treatment.","Age Factors;Aged;Aged, 80 and over;Databases, Factual;Dementia/*drug therapy;Female;Germany/epidemiology;Humans;Indans/therapeutic use;Kaplan-Meier Estimate;Male;Memantine/therapeutic use;Middle Aged;Nootropic Agents/*therapeutic use;Piperidines/therapeutic use;Practice Patterns, Physicians'/statistics & numerical data;Retrospective Studies;Alzheimer's disease;adherence;cholinesterase inhibitors;dementia;memantine;persistence;treatment continuation","Bohlken, J.;Weber, S.;Rapp, M. A.;Kostev, K.",2015,Aug,10.1017/s1041610215000654,0,
466,"Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke","AimsRecurrent stroke is a frequent and disabling event. A high heart rate is associated with cardiovascular outcomes. We investigated the effects of the resting heart rate on cardiovascular and neurological outcomes after recurrent stroke in the high-risk population of the PRoFESS study.Methods and resultsA total of 20 165 patients after ischaemic stroke (mean age 66.1, SD 8.6 years) assigned to the treatment arms of the PRoFESS trial were pooled divided by quintiles of the baseline heart rate and analysed according to cardiovascular and functional outcomes after stroke: recurrent stroke and major cardiovascular outcomes such as stroke, myocardial infarction, and worsening or new-onset heart failure as well as death from cardiovascular and non-cardiovascular causes. Pre-defined endpoints were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and the Barthel index at 3 months, and cognitive function, assessed with the Mini-Mental State Examination (MMSE) score at 4 weeks after randomization and at the penultimate visit. Patients in the two highest quintiles of heart rate (77-82 and >82 b.p.m.) were at a higher risk for total death [hazard ratio (HR) 1.42, 95 CI 1.19-1.69 and HR 1.74, 95 CI 1.48-2.06, P < 0.0001] compared with the lowest quintile. Similar results were observed for vascular death [71-≤76 b.p.m., HR 1.39 (1.11-1.74), P < 0.0001] and non-vascular death [from >82 b.p.m., HR 1.66 (1.29-2.13), P = 0.0016]. Myocardial infarction (P = 0.7084) and recurrent stroke (P = 0.1379) were not significantly associated with the baseline heart rate. Hazard ratios were adjusted to multiple confounders including the baseline blood pressure. In the group of patients with a recurrent stroke, an association of a lower heart rate to better outcomes was measured with the Barthel index across all heart rate groups. In addition, there was a significant association of the baseline heart rate to the occurrence of significant cognitive decline according to an MMSE score ≤24 points at 1 month and at the penultimate visit or a decline of <2 points between these two time periods. Better independence score at a low heart rate were observed.ConclusionThe heart rate is a risk indicator for mortality in patients with stroke and, importantly, a low heart rate is associated with a better functional outcome and less cognitive decline after an ischaemic stroke.Trial registration: ClinicalTrials.gov, number NTC00153062. © 2012 The Author.",NCT00153062;beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;adult;aged;article;Barthel index;blood pressure;brain ischemia;cardiovascular mortality;cardiovascular system;cerebrovascular accident;cognition;cognitive defect;disability;female;heart failure;heart infarction;heart rate;high risk population;human;major clinical study;male;Mini Mental State Examination;mortality;nervous system;outcome assessment;post hoc analysis;priority journal;Rankin scale;recurrent disease;rest;transient ischemic attack,"Böhm, M.;Cotton, D.;Foster, L.;Custodis, F.;Laufs, U.;Sacco, R.;Bath, P. M. W.;Yusuf, S.;Diener, H. C.",2012,,,0,
467,Systolic blood pressure variation and mean heart rate is associated with cognitive dysfunction in patients with high cardiovascular risk,"Elevated systolic blood pressure (SBP) correlates to cognitive decline and incident dementia. The effects of heart rate (HR), visit to visit HR variation, and visit to visit SBP variation are less well established. Patients without preexisting cognitive dysfunction (N=24 593) were evaluated according to mean SBP, SBP visit to visit variation (coefficient of variation [standard deviation/meanx100%], CV), mean HR, and visit to visit HR variation (HR-CV) in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease. Cognitive function was assessed with mini mental state examination. Cognitive dysfunction (fall in mini mental state examination </=24 points), important cognitive decline (drop of >/=5 points), and cognitive deterioration (drop of >1 point per year or decline to <24 points) were assessed. SBP and HR were measured over 10.7+/-2.2 (mean+/-SD) visits. Mean SBP, mean HR, and SBP-CV were associated with cognitive decline, dysfunction, and deterioration (all P<0.01, unadjusted). After adjustment, only SBP-CV (P=0.0030) and mean HR (P=0.0008) remained predictors for cognitive dysfunction (odds ratios [95% confidence intervals], 1.32 [1.10-1.58] for 5th versus 1st quintile of SBP-CV and 1.40 [1.18-1.66] for 5th versus 1st quintile of mean HR). Similar effects were observed for cognitive decline and deterioration. SBP-CV and mean HR showed additive effects. In conclusion, SBP-CV and mean HR are independent predictors of cognitive decline and cognitive dysfunction in patients at high CV risk. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT 00153101.","Aged;Aged, 80 and over;Angiotensin-Converting Enzyme Inhibitors/therapeutic use;Antihypertensive Agents/therapeutic use;Benzimidazoles/therapeutic use;Benzoates/therapeutic use;Blood Pressure/*physiology;Cardiovascular Diseases/*epidemiology;Cognition Disorders/*epidemiology;Drug Therapy, Combination;Female;Follow-Up Studies;Heart Rate/*physiology;Humans;Hypertension/*complications/drug therapy/*physiopathology;Incidence;Male;Middle Aged;Multivariate Analysis;Predictive Value of Tests;Ramipril/therapeutic use;Randomized Controlled Trials as Topic;Retrospective Studies;Risk Factors;heart rate;hypertension;myocardial infarction;stroke","Bohm, M.;Schumacher, H.;Leong, D.;Mancia, G.;Unger, T.;Schmieder, R.;Custodis, F.;Diener, H. C.;Laufs, U.;Lonn, E.;Sliwa, K.;Teo, K.;Fagard, R.;Redon, J.;Sleight, P.;Anderson, C.;O'Donnell, M.;Yusuf, S.",2015,Mar,10.1161/hypertensionaha.114.04568,0,
468,High-throughput method for determination of apolipoprotein E genotypes with use of restriction digestion analysis by microplate array diagonal gel electrophoresis,"Molecular epidemiological research has identified the association of a common apolipoprotein E (apo E) isoform (E4 as opposed to E3), with risk both of coronary artery disease and of Alzheimer dementia. In addition, the role of apo E genotype (usually E2/E2) in Type III hyperlipidemia is well known. However, both for diagnostic and research purposes, apo E genotyping is cumbersome. The preferred approach is electrophoretic sizing of restriction digestion fragments, enabling simultaneous analysis of the two codons (112 and 158) that represent the six common genotypes (E2/E2; E2/E3; E2/E4; E3/E3; E3/E4; E4/E4). However, the consequent demands of high-yield PCR, high-resolution, high-throughput electrophoresis, and sufficient detection sensitivity have left shortfalls in published protocols. In conjunction with a high-throughput electrophoresis system we described recently, microplate array diagonal gel electrophoresis (MADGE), we have constructed extensively optimized, simplified protocols for DNA isolation from mouthwash samples for PCR setup and high-yield PCR, for restriction digestion, and for subsequent MADGE gel image analysis. The integral system enables one worker to readily undertake apo E genotyping of as many as hundreds of DNA samples per day, without special equipment.","Apolipoproteins E/*genetics;Base Sequence;DNA/chemistry/isolation & purification;*Deoxyribonucleases, Type II Site-Specific;Electrophoresis/*methods;*Genotype;Humans;Molecular Sequence Data;Polymerase Chain Reaction;Saliva/chemistry;Templates, Genetic","Bolla, M. K.;Haddad, L.;Humphries, S. E.;Winder, A. F.;Day, I. N.",1995,Nov,,0,
469,Rapid determination of apolipoprotein E genotype using a heteroduplex generator,"The apoE gene exhibits two common polymorphisms that have been associated with both coronary artery disease and Alzheimer's disease. The polymorphisms create the three allelic isoforms E2, E3, and E4 which are encoded by Cys-Cys, Cys-Arg, and Arg-Arg at amino acid positions 112 and 158, respectively. Numerous methods have been described to identify these three apoE alleles although there are disadvantages and ambiguities associated with all of them. Here we describe a method by which the two common apoE polymorphisms can be identified simultaneously. The method involves PCR of the region containing the two polymorphic sites, followed by hybridization of this PCR product to a synthetic molecule called a universal heteroduplex generator (UHG). The UHG is used to induce heteroduplex formation which is visualized on a non-denaturing mini-gel using ethidium bromide staining. This technique which can also identify other rare mutations in the amplified region of DNA under investigation, is an unequivocal method of genotyping and is simpler and faster than many methods, including using restriction enzyme digestion. Bolla, M. K., N. Wood, and S. E. Humphries. Rapid determination of apolipoprotein E genotype using a heteroduplex generator.",apolipoprotein E;heteroduplex;Alzheimer disease;amino acid substitution;article;coronary artery disease;drug determination;enzyme analysis;enzyme modification;genetic variability;genotype;human;human cell;isoelectric focusing;lipid metabolism;priority journal;single strand conformation polymorphism,"Bolla, M. K.;Wood, N.;Humphries, S. E.",1999,,,0,
470,A novel allele of eNOS gene in the Italian population: The actual essence of intron 4 polymorphism,,nitric oxide synthase;acute coronary syndrome;African American;allele;Alzheimer disease;gene identification;genetic linkage;genetic polymorphism;genetic transcription;genetic variability;heterozygosity;human;intron;letter;polymerase chain reaction;population research;priority journal;substitution reaction,"Bolli, P.;Sticchi, E.;Abbate, R.;Fatini, C.",2007,,,0,
471,Kearns syndrome,"Two patients aged 17 and 25 years with Kearns syndrome are described. This condition is characterized by the triad of chronic progressive external ophthalmoplegia, pigmentary degenerations of the retina and cardiac conduction defects. A review of the literature reveals frequent association with other symptoms, mainly cerebellar atazia, neurosensory hearing loss, small stature muscle weakness mental retardation or dementia and endocrine disturbances. In skeletal and extraocular muscle biopsies, abnormalities of mitochondria, at present of unknown significance, have been found. CSF protein is almost always increased. The etiology of this multisystem disorder remains obscure. The 58 published cases have been sporadic, with no evidence of hereditary transmission. The prognosis seems mainly to depend on the progressive cardiac conduction defects, since several patients have already died in the second or third decade due to heart block. Patients with progressive external ophthal,oplegia should be investigated for Kearns syndrome. If appropriate, implantation of a cardiac pacemaker should be considered.",cerebellum;child;dementia;diagnosis;external ophthalmoplegia;heart muscle conduction system;histology;Kearns Sayre syndrome;mental deficiency;protein cerebrospinal fluid level;retina degeneration;weakness,"Boltshauser, E.;Jerusalem, F.;Niemeyer, G.;Huber, C.",1977,,,0,
472,Concurrent use of ECT and cholinesterase inhibitor medications 1,,acetylcholine;acetylcholinesterase;cholinergic receptor stimulating agent;cholinesterase inhibitor;donepezil;ecothiopate;galantamine;rivastigmine;suxamethonium;tacrine;Alzheimer disease;apnea;heart arrest;Australia;bradycardia;convulsion;death;drug half life;drug mechanism;drug potentiation;electroconvulsive therapy;enzyme inhibition;glaucoma;heart arrhythmia;human;letter;Medline;neuromuscular blocking;paralysis;patient education;risk benefit analysis;seizure threshold,"Boman, B.",2002,,,0,
473,Coenzyme Q10,"Coenzyme Q10 is a vitamin-like substance used in the treatment of a variety of disorders primarily related to suboptimal cellular energy metabolism and oxidative injury. Studies supporting the efficacy of coenzyme Q10 appear most promising for neurodegenerative disorders such as Parkinson's disease and certain encephalomyopathies for which coenzyme Q10 has gained orphan drug status. Results in other areas of research, including treatment of congestive heart failure and diabetes, appear to be contradictory or need further clarification before proceeding with recommendations. Coenzyme Q10 appears to be a safe supplement with minimal side effects and low drug interaction potential. Copyright © 2005 American Academy of Family Physicians.",hydroxymethylglutaryl coenzyme A reductase inhibitor;ubidecarenone;warfarin;article;cell energy;clinical trial;congestive heart failure;degenerative disease;diabetes mellitus;diet supplementation;drug efficacy;drug safety;encephalomyelitis;energy metabolism;gastrointestinal symptom;human;Huntington chorea;mitochondrial encephalomyopathy;Parkinson disease,"Bonakdar, R. A.;Guarneri, E.",2005,,,0,
474,"Alcohol, aging, and cognitive performance in a cohort of Japanese Americans aged 65 and older: The Kame Project","Objective: To investigate the effects of light to moderate alcohol consumption on cognitive performance. Design and Setting: A cross-sectional analysis including older Japanese Americans in King County, WA, enrolled in the Kame Project, a population-based study of cognition, dementia, and aging. Participants: 1,836 cognitively intact participants aged 65 and older who participated in the baseline (1992-1994) examination. Measurement: Cognitive performance was measured using the Cognitive Abilities Screening Instrument, reaction time (simple and choice), and a measure of vocabulary (North American Adult Reading Test). Results: Multivariate analyses were used to examine the relationship between cognitive performance and alcohol consumption at baseline with men and women together and then separately controlling for age, education, smoking, history of stroke, angina, hypertension, diabetes, and coronary heart disease. Findings showed lower cognitive test scores were observed for men who were either abstainers or in the heavy drinking group. For women, a linear relationship between alcohol consumption and cognitive performance was seen on two of the four measures of cognitive functioning. No significant difference in the association of drinking and cognitive function was identified within the different Japanese American subgroups. Conclusion: Results suggest a possible positive relationship between light to moderate drinking and cognitive performance in an aging Japanese American population. Additional long-term prospective and cross-cultural studies are needed to determine the generalizability of these findings to other aging cohorts.",adult;aged;aging;alcohol consumption;article;smoking;cognition;cohort analysis;cultural factor;drinking behavior;ethnic group;female;human;major clinical study;male;multivariate analysis;population research;reaction time;screening,"Bond, G. E.;Burr, R.;McCurry, S. M.;Graves, A. B.;Larson, E. B.",2001,,,0,
475,Molecular aspects of the histamine H3 receptor,"The cloning of the histamine H(3) receptor (H(3)R) cDNA in 1999 by Lovenberg et al. [10] allowed detailed studies of its molecular aspects and indicated that the H(3)R can activate several signal transduction pathways including G(i/o)-dependent inhibition of adenylyl cyclase, activation of phospholipase A(2), Akt and the mitogen activated kinase as well as the inhibition of the Na(+)/H(+) exchanger and inhibition of K(+)-induced Ca(2+) mobilization. Moreover, cloning of the H(3)R has led to the discovery several H(3)R isoforms generated through alternative splicing of the H(3)R mRNA. The H(3)R has gained the interest of many pharmaceutical companies as a potential drug target for the treatment of various important disorders like obesity, myocardial ischemia, migraine, inflammatory diseases and several CNS disorders like Alzheimer's disease, attention-deficit hyperactivity disorder and schizophrenia. In this paper, we review various molecular aspects of the hH(3)R including its signal transduction, dimerization and the occurrence of different H(3)R isoforms.","Adenylyl Cyclases/metabolism;*Alternative Splicing;Dimerization;Histamine Agonists/pharmacology;Histamine Antagonists/pharmacology;Humans;Protein Isoforms/metabolism;Receptors, Histamine H3/drug effects/genetics/*metabolism;Signal Transduction/*physiology","Bongers, G.;Bakker, R. A.;Leurs, R.",2007,Apr 15,10.1016/j.bcp.2007.01.008,0,
476,Antibiotics for acute bronchitis and COPD-exacerbation with comorbidity,,antibiotic agent;insulin;oral antidiabetic agent;prednisolone;aged;angina pectoris;antibiotic therapy;asthma;bronchitis;chronic obstructive lung disease;comorbidity;dementia;diabetes mellitus;disease exacerbation;emphysema;heart failure;heart infarction;human;major clinical study;neoplasm;note,"Bont, J.;Hak, E.;Birkhoff, C.;Hoes, A.;Verheij, T.",2009,,,0,
477,A prediction rule for elderly primary-care patients with lower respiratory tract infections,"Prognostic scores for lower respiratory tract infections (LRTI) have been mainly derived in a hospital setting. The current authors have developed and validated a prediction rule for the prognosis of acute LRTI in elderly primary-care patients. Data including demographics, medication use, healthcare use and comorbid conditions from 3,166 episodes of patients aged ≥65 yrs visiting the general practitioner (GP) with LRTI were collected. Multiple logistic regression analysis was used to construct a predictive model. The main outcome measure was 30-day hospitalisation or death. The Second Dutch Survey of GPs was used for validation. The following were independent predictors of 30-day hospitalisation or death: increasing age; previous hospitalisation; heart failure; diabetes; use of oral glucocorticoids; previous use of antibiotics; a diagnosis of pneumonia; and exacerbation of chronic obstructive pulmonary disease. A prediction rule based on these variables showed that the outcome increased directly with increasing scores: 3, 10 and 31% for scores of <2 points, 3-6 and ≥7 points, respectively. Corresponding figures for the validation cohort were 3, 11 and 26%, respectively. This simple prediction rule can help the primary-care physician to differentiate between high-and low-risk patients. As a possible consequence, low-risk patients may be suitable for home treatment, whereas high-risk patients might be monitored more closely in a homecare or hospital setting. Future studies should assess whether information on signs and symptoms can further improve this prediction rule. Copyright © ERS Journals Ltd 2007.",antibiotic agent;antidepressant agent;benzodiazepine derivative;glucocorticoid;age;aged;angina pectoris;article;bronchitis;chronic obstructive lung disease;comorbidity;congestive heart failure;consultation;controlled study;death;dementia;demography;diabetes mellitus;disease exacerbation;drug use;elderly care;female;general practitioner;health care utilization;heart failure;heart infarction;high risk patient;home care;hospital care;hospitalization;human;kidney disease;liver disease;logistic regression analysis;lower respiratory tract infection;major clinical study;male;malignant neoplastic disease;medical research;Netherlands;neurologic disease;outcome assessment;patient monitoring;physical examination;pneumonia;prediction;primary medical care;priority journal;prognosis;risk assessment;scoring system;cerebrovascular accident;thorax radiography,"Bont, J.;Hak, E.;Hoes, A. W.;Schipper, M.;Schellevis, F. G.;Verheij, T. J. M.",2007,,,0,
478,Risk factors for dementia diagnosis in German primary care practices,"BACKGROUND: Dementia is a psychiatric condition the development of which is associated with numerous aspects of life. Our aim was to estimate dementia risk factors in German primary care patients. METHODS: The case-control study included primary care patients (70-90 years) with first diagnosis of dementia (all-cause) during the index period (01/2010-12/2014) (Disease Analyzer, Germany), and controls without dementia matched (1:1) to cases on the basis of age, sex, type of health insurance, and physician. Practice visit records were used to verify that there had been 10 years of continuous follow-up prior to the index date. Multivariate logistic regression models were fitted with dementia as a dependent variable and the potential predictors. RESULTS: The mean age for the 11,956 cases and the 11,956 controls was 80.4 (SD: 5.3) years. 39.0% of them were male and 1.9% had private health insurance. In the multivariate regression model, the following variables were linked to a significant extent with an increased risk of dementia: diabetes (OR: 1.17; 95% CI: 1.10-1.24), lipid metabolism (1.07; 1.00-1.14), stroke incl. TIA (1.68; 1.57-1.80), Parkinson's disease (PD) (1.89; 1.64-2.19), intracranial injury (1.30; 1.00-1.70), coronary heart disease (1.06; 1.00-1.13), mild cognitive impairment (MCI) (2.12; 1.82-2.48), mental and behavioral disorders due to alcohol use (1.96; 1.50-2.57). The use of statins (OR: 0.94; 0.90-0.99), proton-pump inhibitors (PPI) (0.93; 0.90-0.97), and antihypertensive drugs (0.96, 0.94-0.99) were associated with a decreased risk of developing dementia. CONCLUSIONS: Risk factors for dementia found in this study are consistent with the literature. Nevertheless, the associations between statin, PPI and antihypertensive drug use, and decreased risk of dementia need further investigations.",Alzheimer;dementia;risk factors;statins,"Booker, A.;Jacob, L. E.;Rapp, M.;Bohlken, J.;Kostev, K.",2016,Jul,10.1017/s1041610215002082,0,
479,Dying with dignity 8,,neoplasm;cause of death;clinical practice;continuing education;dementia;drug industry;dying;elderly care;emotional attachment;heart failure;human;human dignity;letter;medical decision making;medical society;motor neuron disease;palliative therapy;pharmaceutical care;pharmacist;pharmacy;register;skill;cerebrovascular accident;teamwork;terminal disease;treatment planning;vocational guidance,"Boorman, S. M.",2006,,,0,
480,CE and cover story: New drug update 2003 - Part 1,,abarelix;alfuzosin;amiodarone;aprepitant;atazanavir;bortezomib;daptomycin;dihydroergotamine;docetaxel;efavirenz;emtricitabine;enfuvirtide;epinastine;ferric ferrocyanide;gefitinib;gemifloxacin;ibandronic acid;itraconazole;ketoconazole;lopinavir;memantine;midazolam;miglustat;ondansetron;orphan drug;palonosetron;pegvisomant;platinum derivative;ritonavir;rosuvastatin;serotonin 3 antagonist;sertaconazole;sildenafil;sotalol;tadalafil;tamsulosin;triazolam;vardenafil;abdominal pain;acne;acromegaly;allergic conjunctivitis;Alzheimer disease;angioneurotic edema;anorexia;antigen antibody complex;anxiety;appetite disorder;arthralgia;backache;bacterial pneumonia;body fat;bradycardia;breast augmentation;bronchitis;candidiasis;cellulitis;chemotherapy induced emesis;chill;chronic bronchitis;clinical pharmacy;confusion;constipation;coughing;Cushingoid syndrome;dehydration;depression;diarrhea;disorientation;dizziness;drowsiness;drug hypersensitivity;drug mechanism;dry skin;duodenum ulcer;dyspepsia;dyspnea;edema;erectile dysfunction;erythema multiforme;eye burning;eye pain;fatigue;fever;Gaucher disease;glomerulonephritis;Guillain Barre syndrome;headache;heart arrhythmia;heart failure;hematuria;human;Human immunodeficiency virus infection;hyperbilirubinemia;hypercholesterolemia;hyperglycemia;hyperlipidemia;hypersensitivity;hypoglycemia;hypokalemia;hyponatremia;hypotension;impotence;insomnia;jaundice;lactic acidosis;leukocyturia;liver dysfunction;non small cell lung cancer;multiple myeloma;nausea;obesity;orthostatic hypotension;osteoporosis;paresthesia;peripheral neuropathy;pharmaceutical care;pharyngitis;priapism;prostate cancer;prostate hypertrophy;pruritus,"Boothby, L. A.;Doering, P. L.",2004,,,0,
481,Association between chronic diseases and disability in elderly subjects with low and high income: The Leiden 85-plus Study,"Background: Disability in activities of daily living (ADL) might be more prevalent among elderly with low income due to higher prevalence of chronic diseases and impairments, as well as stronger associations of these factors with ADL-disability. Methods: In the Leiden 85-plus Study, we defined disability as being unable to perform one or more basic ADL activities. Presence of chronic diseases was obtained from medical records, impairments were assessed with performance-tests. Results: Elderly with low income had higher prevalence of ADL-disability (23% versus 12%; odds ratio 2.0; 95% confidence interval 1.3-3.2), higher prevalence of impairments and equal prevalence of chronic diseases, except for dementia and co-morbidity. Associations of these factors with ADL-disability were not stronger. Conclusions: We conclude that ADL-disability is more prevalent in elderly with low income. Neither prevalence of chronic diseases nor the association with disability could explain this. © The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.",aged;aging;arthritis;article;chronic disease;chronic obstructive lung disease;comorbidity;confidence interval;controlled study;daily life activity;dementia;diabetes mellitus;economic aspect;female;heart infarction;hip fracture;human;income;lowest income group;major clinical study;male;Parkinson disease;physical disability;prevalence;priority journal,"Bootsma-Van Der Wiel, A.;De Craen, A. J. M.;Van Exel, E.;Macfarlane, P. W.;Gussekloo, J.;Westendorp, R. G. J.",2005,,,0,
482,Palliative medicine - Much more than pain therapy,,acquired immune deficiency syndrome;cancer palliative therapy;dementia;doctor patient relation;heart failure;human;neoplasm;neuropsychiatry;peripheral neuropathy;psychosocial care;quality of life;religion;short survey;social psychology;spiritual care,"Borasio, G. D.;Volkenandt, M.",2008,,,0,
483,Polymorphism of the apolipoprotein E gene (APOE) in the populations of Russia and neighboring countries,"Allele and genotype frequencies for the locus encoding apolipoprotein E, involved in the regulation of lipid metabolism (APOE), were evaluated in 16 populations representing 12 ethnic groups (a total of 1103 subjects) from Russia and neighboring countries. In the populations examined, the frequencies of allele epsilon4, which is the risk factor of Alzheimer's disease and coronary heart disease, varied from less than 5 to more than 20%, while the variation of the major epsilon3 allele in these populations ranged from less than 75 to 95%. The frequencies of alleles epsilon3 and epsilon4 were 0.714 and 0.205 in Saami, 0.734 and 0.149 in Maris, 0.841 and 0.122 in Evenks, 0.788 and 0.163 in Buryats, 0.764 and 0.202 in Chukchi, 0.875 and 0.075 in Iranians, 0.956 and 0.044 in mountain-dwellers of the Pamirs, 0.771 and 0.094 in Ukrainians, and 0.795 and 0.091 in Belarussians, respectively. In Russians from different regions of the country, the frequencies of these alleles were 0.728 and 0.139 (Kostroma), 0.795 and 0.105 (Moscow), 0.857 and 0.092 (Rostov-on-Don), and 0.824 and 0.083 (Krasnodar), respectively. The latitudinal distribution of the APOE epsilon3 and epsilon4 allele frequencies in the populations examined was comparable to the frequency distribution pattern of these alleles in other populations of Eurasia.",apolipoprotein E;Alzheimer disease;article;Belarus;ethnology;female;gene frequency;genetic predisposition;genetics;heart muscle ischemia;human;male;population;Russian Federation;Ukraine,"Borinskaia, S. A.;Kal'ina, N. R.;Sanina, E. D.;Kozhekbaeva, Z. M.;Gupalo, E. I.;Garmash, I. V.;Ogurtsov, P. P.;Parshukova, O. N.;Boǐko, S. G.;Veselovskiǐ, E. M.;Vershubskaia, G. G.;Kozlov, A. I.;Rogaev, E. I.;Iankovskiǐ, N. K.",2007,,,0,
484,"Homocysteine, vitamin B6, and vascular disease in patients with AD 3 (multiple letters)",,homocysteine;pyridoxine;Alzheimer disease;angina pectoris;congestive heart failure;controlled study;coronary artery disease;dementia;diabetes mellitus;disease severity;female;heart infarction;human;hypertension;letter;major clinical study;male;peripheral vascular disease;priority journal;vascular disease,"Borroni, B.;Agosti, C.;Panzali, A. F.;Di Luca, M.;Padovani, A.",2002,,,0,
485,Education plays a different role in Frontotemporal Dementia and Alzheimer's disease,"Background: The role of modifiable and non-modifiable variables in Frontotemporal Dementia (FTD) as compared to Alzheimer's dDisease (AD) and to Progressive Supranuclear Palsy (PSP) or Corticobasal Degeneration Syndrome (CBDS) has not been extensively evaluated. In particular, low education levels have been reported to be a risk factor for AD, but their contribution in FTD is yet not known. Objective: To investigate the role of education, other modifiable and non-modifiable factors in FTD as compared to AD, PSP and CBDS patients. Methods: One hundred and seventeen FTD patients, 400 AD, 55 PSP, and 55 CBDS entered the study. Demographic and clinical characteristics were carefully recorded. Age, gender, family history for dementia and Apolipoprotein E (APOE) genotype were considered as non-modifiable factors; education and comorbidities were included as modifiable variables. Regression analyses were applied in order to identify differences among groups. Results: FTD differed from AD patients in terms of younger age, positive family history and gender status. In regard to APOE genotype, no differences between FTD and AD were found, but FTD showed higher prevalence of epsilon 4 allele compared to both CBDS and PSP patients (p < 0.05). When modifiable factors were considered, FTD were higher educated than AD patients (p < 0.001). Regression analysis identified younger age, positive family history, and education levels as independently associated variables to FTD diagnosis compared to AD (F = 21.27, R2 = 24.1, p = 0.036). Conclusion: Our results highlight that the contribution of education and non-modifiable factors is likely different in FTD and AD. Further work is needed to completely establish the role of this modifiable variable as a potential area of intervention for dementias. Copyright © 2008 John Wiley & Sons, Ltd.",apolipoprotein E;apolipoprotein E4;academic achievement;adult;age;aged;Alzheimer disease;article;behavior;cardiomyopathy;comorbidity;computer assisted tomography;controlled study;corticobasal degeneration;daily life activity;demography;diabetes mellitus;differential diagnosis;education;educational status;family history;female;frontotemporal dementia;genotype;geographic distribution;human;hypercholesterolemia;hypertension;major clinical study;male;medical assessment;Mini Mental State Examination;neuropsychological test;nuclear magnetic resonance imaging;progressive supranuclear palsy;sex difference,"Borroni, B.;Alberici, A.;Agosti, C.;Premi, E.;Padovani, A.",2008,,,0,
486,Cumulative effect of COMT and 5-HTTLPR polymorphisms and their interaction with disease severity and comorbidities on the risk of psychosis in Alzheimer disease,"OBJECTIVE: The objective of this study was to investigate the cumulative effect of the genes likely involved in Alzheimer disease (AD)-related psychosis and their interaction with disease stage and environmental factors. METHODS: Two hundred thirty-four patients with AD underwent clinical and neuropsychologic examination, behavioral and psychiatric disturbances evaluation, and were subsequently divided into two subgroups according to the presence (AD-P) or the absence (AD-nP) of psychotic symptoms. Cathecol-O-methyltransferase (COMT), serotonin gene-linked promoter region (5-HTTLPR), and Apolipoprotein E (ApoE) genotypes were performed. RESULTS: COMT*H (H/H or H/liter; odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.13-5.11) and 5-HTTLPR*S (S/S or S/liter, OR: 2.14; 95% CI: 1.13-4.07) were associated with AD-P. A gene dose effect was observed; in fact, carriers of both polymorphisms showed a fivefold risk for psychosis compared with patients bearing no polymorphisms. An interaction between these two genetic variations with disease stage and ischemic cardiomyopathy was found, the latter influencing AD-P risk only if ""at-risk"" genetic polymorphisms were present. The combined trend effect of COMT*H plus 5-HTTLPR*S and advance disease stage on AD-P risk was approximately 200% greater than that predicted by assuming additive effects, whereas the one obtained by COMT*H plus 5-HTTLPR*S and ischemic cardiomyopathy was 50% greater. ApoE genotype did not influence AD-P risk. CONCLUSIONS: These findings claim for a synergic effect of COMT*H and 5-HTTLPR*S polymorphisms on the risk of psychosis in AD and for their interaction with disease stage and ischemic cardiomyopathy. This study suggests that considering both the genetic background and the environmental correlates might provide new insight for understanding psychosis mechanisms related to AD.","Aged;Alzheimer Disease/diagnosis/*epidemiology/*genetics;Apolipoproteins E/genetics;Catechol O-Methyltransferase/*genetics;Cognition Disorders/diagnosis/epidemiology;Comorbidity;Demography;Environment;Female;Genotype;Humans;Hypotension/epidemiology;Male;Polymorphism, Genetic/*genetics;Promoter Regions, Genetic/*genetics;Psychotic Disorders/diagnosis/*epidemiology;Risk Factors;Serotonin/*genetics;Serotonin Plasma Membrane Transport Proteins/*genetics;Severity of Illness Index","Borroni, B.;Grassi, M.;Agosti, C.;Archetti, S.;Costanzi, C.;Cornali, C.;Caltagirone, C.;Caimi, L.;Di Luca, M.;Padovani, A.",2006,Apr,10.1097/01.JGP.0000192491.50802.c3,0,
487,Atherosclerotic calcification is related to a higher risk of dementia and cognitive decline,"Background: Longitudinal data on the role of atherosclerosis in different vessel beds in the etiology of cognitive impairment and dementia are scarce and inconsistent. Methods: Between 2003-2006, 2364 nondemented persons underwent computed tomography of the coronaries, aortic arch, extracranial, and intracranial carotid arteries to quantify atherosclerotic calcification. Participants were followed for incident dementia (n = 90) until April 2012. At baseline and follow-up participants also underwent a cognitive test battery. Results: Larger calcification volume in all vessels, except in the coronaries, was associated with a higher risk of dementia. After adjustment for relevant confounders, extracranial carotid artery calcification remained significantly associated with a higher risk of dementia [hazard ratio per standard deviation increase in calcification volume: 1.37 (1.05, 1.79)]. Additional analyses for Alzheimer's disease only or censoring for stroke showed similar results. Larger calcification volumes were also associated with cognitive decline. Conclusions: Atherosclerosis, in particular in the extracranial carotid arteries, is related to a higher risk of dementia and cognitive decline.",aged;Alzheimer disease;aorta arch;aorta atherosclerosis;artery calcification;article;atherosclerosis;carotid artery calcification;carotid atherosclerosis;cerebrovascular accident;cognition assessment;cognitive defect;computer assisted tomography;coronary artery atherosclerosis;coronary artery calcification;dementia;disease assessment;female;follow up;human;internal carotid artery;left coronary artery;major clinical study;male;priority journal;risk factor,"Bos, D.;Vernooij, M. W.;De Bruijn, R. F. A. G.;Koudstaal, P. J.;Hofman, A.;Franco, O. H.;Van Der Lugt, A.;Ikram, M. A.",2015,,,0,
488,Incidence and prognosis of transient neurological attacks,"CONTEXT: Transient neurological attacks (TNAs) are attacks with temporary (<24 hours) neurological symptoms. These symptoms can be focal, nonfocal, or a mixture of both. The prognostic significance of TNAs with focal symptoms (better known as transient ischemic attacks [TIAs]) is well understood. Conversely, hardly anything is known about the prognostic significance of TNAs with nonfocal or mixed symptoms. OBJECTIVE: To study the incidence and prognosis of focal TNAs (or TIAs), nonfocal TNAs, and mixed TNAs. DESIGN, SETTING, AND PARTICIPANTS: The study population comprised 6062 community-dwelling Rotterdam Study participants who were aged 55 years or older and free from stroke, myocardial infarction, and dementia at baseline (1990-1993). They were followed up for events until January 1, 2005. We analyzed the associations between incident TNAs and subsequent adverse events with age- and sex-adjusted Cox regression models. MAIN OUTCOME MEASURES: Stroke, ischemic heart disease, or dementia. RESULTS: During 60 535 person-years, 548 participants developed TNA (282 focal, 228 nonfocal, and 38 mixed). The incidence rate per 1000 person-years was 4.7 (95% confidence interval [CI], 4.1-5.2) for focal TNA, 3.8 (95% CI, 3.3-4.3) for nonfocal TNA, and 0.6 (95% CI, 0.4-0.9) for mixed TNA. Participants with focal TNA were at higher risk of subsequent stroke than participants without TNA (n = 46 vs 540; hazard ratio [HR], 2.14; 95% confidence interval [CI]; 1.57-2.91) but had an equal risk of ischemic heart disease and dementia. Nonfocal TNA patients were at higher risk of stroke (27 vs 540; HR, 1.56; 95% CI, 1.08-2.28) and dementia (30 vs 552; HR, 1.59; 95% CI, 1.11-2.26) than participants without TNA. Mixed TNA patients were at higher risk of stroke (6 vs 540; HR, 2.48; 95% CI, 1.11-5.56), ischemic heart disease (8 vs 779; HR, 2.26; 95% CI, 1.07-4.78), vascular death (8 vs 594; HR, 2.54; 95% CI, 1.31-4.91), and dementia (7 vs 552; HR, 3.46; 95% CI, 1.72-6.98) than participants without TNA. CONCLUSION: Patients who experience nonfocal TNAs, and especially those with mixed TNAs, have a higher risk of major vascular diseases and dementia than persons without TNA.","Aged;Dementia/epidemiology;Female;Humans;Incidence;Ischemic Attack, Transient/*epidemiology/physiopathology;Kaplan-Meier Estimate;Male;Middle Aged;Myocardial Ischemia/epidemiology;Prognosis;Proportional Hazards Models;Risk;Stroke/epidemiology","Bos, M. J.;van Rijn, M. J.;Witteman, J. C.;Hofman, A.;Koudstaal, P. J.;Breteler, M. M.",2007,Dec 26,10.1001/jama.298.24.2877,0,
489,Executive and visuospatial deficits in patients with chronic progressive external ophthalmoplegia and Kearns-Sayre syndrome,"Although neuropsychological deficits have been reported in mitochondrial cytopathies, patients with chronic progressive external ophthalmoplegia (CPEO) or Kearns-Sayre syndrome (KSS) have not been studied systematically using a comprehensive test battery. The aim of our study was to assess the range and extent of putative cognitive dysfunction in 22 patients with CPEO or KSS, and to compare cognitive performance of patients with healthy control subjects matched for age, sex and years of education. Genetic analysis of skeletal muscle tissue from 22 patients with CPEO or KSS included screening for mitochondrial DNA (mtDNA) point mutations (3243/8344) and mtDNA deletions. All patients were examined by a neuropsychological test battery covering verbal skills, verbal and visual memory, visuo-spatial perception, visual construction, attention, abstraction and flexibility, and Quality of Life. Molecular genetic analysis of mtDNA revealed single large-scale deletions in 15 out of 22 patients and the tRNA (Leu) A3243G point mutation in two out of 22 patients. In five out of 22 patients none of the frequently encountered mtDNA mutations could be detected. Neuropsychological testing did not reveal general intellectual deterioration, but specific cognitive deficits, particularly in visual construction, attention and abstraction/flexibility. Subgroup analysis of 15 patients with mtDNA deletions showed similar results when compared with the full group. In our series of patients with CPEO or KSS neuropsychological testing did not reveal signs that would suggest general intellectual decline or dementia, but provided evidence of specific focal neuropsychological deficits, suggesting particular impairment of visuospatial perception associated to parieto-occipital lobes and executive deficits associated to the prefrontal cortex.","Adult;Aged;Analysis of Variance;Case-Control Studies;Chi-Square Distribution;DNA, Mitochondrial;Female;Gene Deletion;Humans;Kearns-Sayre Syndrome/genetics/psychology;Language Tests;Male;Memory;Middle Aged;Neuropsychological Tests;Ophthalmoplegia, Chronic Progressive External/genetics/*psychology;Point Mutation;Quality of Life","Bosbach, S.;Kornblum, C.;Schroder, R.;Wagner, M.",2003,May,,0,
490,Withdrawal-induced delirium associated with a benzodiazepine switch: A case report,"Introduction. Introduced in the early 1960s, diazepam remains among the most frequently prescribed benzodiazepine-type sedatives and hypnotics. Patients with chronic use of short-acting benzodiazepines are frequently switched to diazepam because the accumulating, long-acting metabolite, N-desmethyl-diazepam, prevents benzodiazepine-associated withdrawal symptoms, which can occur during trough plasma levels of short-acting benzodiazepines. Although mild to moderate withdrawal symptoms are frequently observed during benzodiazepine switching to diazepam, severe medical complications associated with this treatment approach have thus far not been reported. Case presentation. A 64-year-old female Caucasian with major depression, alcohol dependence and benzodiazepine dependence was successfully treated for depression and, after lorazepam-assisted alcohol detoxification, was switched from lorazepam to diazepam to facilitate benzodiazepine discontinuation. Subsequent to the benzodiazepine switch, our patient unexpectedly developed an acute delirious state, which quickly remitted after re-administration of lorazepam. A newly diagnosed early form of mixed dementia, combining both vascular and Alzheimer-type lesions, was found as a likely contributing factor for the observed vulnerability to benzodiazepine-induced withdrawal symptoms. Conclusion: Chronic use of benzodiazepines is common in the elderly and a switch to diazepam often precedes benzodiazepine discontinuation trials. However, contrary to common clinical practice, benzodiazepine switching to diazepam may require cross-titration with slow tapering of the first benzodiazepine to allow for the build-up of N-desmethyl-diazepam, in order to safely prevent severe withdrawal symptoms. Alternatively, long-term treatment with low doses of benzodiazepines may be considered, especially in elderly patients with chronic use of benzodiazepines and proven vulnerability to benzodiazepine-associated withdrawal symptoms. © 2011 Bosshart; licensee BioMed Central Ltd.",atorvastatin;diazepam;dydrogesterone;estradiol;felodipine;gamma glutamyltransferase;haloperidol;levothyroxine;lisinopril;lorazepam;metoprolol;mianserin;mirtazapine;pantoprazole;salicylic acid;venlafaxine;adult;alcoholism;Alzheimer disease;amnesia;anxiety;article;attention disturbance;case report;Caucasian;cognitive defect;delirium;detoxification;disease association;disorientation;dissociative disorder;drug dependence;drug dependence treatment;drug substitution;drug tolerability;drug withdrawal;female;gamma glutamyl transferase blood level;heart infarction;human;hyperlipidemia;hypertension;hypothyroidism;maintenance drug dose;major depression;priority journal;restlessness;speech disorder;withdrawal syndrome,"Bosshart, H.",2011,,,0,
491,Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis,"OBJECTIVE: Intradialytic hypotension (IDH) is common in patients on chronic hemodialysis, but knowledge on determinants is still unclear. The present study aims at evaluating the association between IDH and dialytic age (DA) in patients on chronic hemodialysis. METHODS: Between January 2012 and January 2013, 82 patients on chronic hemodialysis for at least 1 year were screened for inclusion in the present study. Of these, 14 were excluded because of advanced heart failure (n.9), history of alcohol/substance abuse (n.1), diagnosis of dementia (n.2), actual instability of clinical conditions requiring hospitalization (n.2). IDH was defined as a decrease in systolic blood pressure >/=20 mmHg or a decrease in mean arterial pressure (MAP) by 10 mmHg associated with clinical events and need for nursing interventions. The number of IDH episodes in 10 consecutive hemodialysis sessions was recorded for each patient. Linear and logistic regressions were adopted to assess the adjusted association between IDH and DA. RESULTS: The mean DA was 92 +/- 81. Eleven patients (16%) experienced IDH. DA was associated with IDH (OR = 1.01; 95% CI = 1.01-1.02; p = 0.048), after adjusting for potential confounders. DA was associated with the numbers of IDH events in the unadjusted model (B = 0.02; 95% CI = 0.01-0.03; p = 0.042), after adjusting for age and sex (B = 0.01; 95% CI = 0.01-0.03; p = 0.042) as well as in the multivariable model (B = 0.02; 95% CI = 0.01-0.05; p = 0.045). CONCLUSION: DA is associated with an increased probability of IDH and with increased number of IHD events. Studies are needed to understand the underlying factors of such an association.","Adult;Aged;Female;Humans;Hypotension/*etiology;Kidney Failure, Chronic/therapy;Male;Middle Aged;Regression Analysis;Renal Dialysis/*adverse effects;Time Factors","Bossola, M.;Laudisio, A.;Antocicco, M.;Panocchia, N.;Tazza, L.;Colloca, G.;Tosato, M.;Zuccala, G.",2013,Oct,10.3109/0886022x.2013.820645,0,
492,Antidepressant use and mortality in very old people,"BACKGROUND: Antidepressant treatment may increase the risk of death. The association between antidepressants and mortality has been evaluated in community-dwelling older people, but not in representative samples of very old people, among whom dementia, multimorbidity, and disability are common. METHODS: Umea 85+/GERDA study participants (n = 992) aged 85, 90, and >/=95 years were followed for up to five years. Cox proportional hazard regression models were used to analyze mortality risk associated with baseline antidepressant treatment, adjusted for potential confounders. RESULTS: Mean age was 89 years; 27% of participants had dementia, 20% had stroke histories, 29% had heart failure, and 16% used antidepressants. In age- and sex-adjusted analyses, antidepressant use was associated with a 76% increased mortality risk (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.41-2.19). Adding adjustment for Geriatric Depression Scale score, HR was 1.62 (95% CI, 1.29-2.03). The association was not significant when adjusting for additional confounding factors (HR = 1.08; 95% CI, 0.85-1.38). Interaction analyses in the fully adjusted model revealed a significant interaction between sex and antidepressant use (HR: 1.76; 95% CI, 1.05-2.94). Among male and female antidepressant users, the HRs for death were 0.76 (95% CI, 0.47-1.24) and 1.28 (95% CI, 0.97-1.70), respectively. CONCLUSION: Among very old people, baseline antidepressant treatment does not seem to be independently associated with increased mortality risk. However, the risk may be different in men and women. This difference and the potential risk of initial treatment require further investigation in future cohort studies of very old people.",age 80 and over;antidepressants;dementia;depression;epidemiology;frail elderly;mortality;residential facilities,"Bostrom, G.;Hornsten, C.;Brannstrom, J.;Conradsson, M.;Nordstrom, P.;Allard, P.;Gustafson, Y.;Littbrand, H.",2016,Jul,10.1017/s104161021600048x,0,
493,"Diabetes mellitus in patients with Alzheimer's disease: Clinical description and correlation with the apoe genotype in a sample population from the province of Antioquia, Colombia","Introduction. Alzheimer's disease is a multifactorial disease affecting approximately twenty million people worldwide. Numerous variables are associated with increased risk of developing this severe neurological disorder. Among the risk factors, diabetes mellitus, and the e4 isoform of the APOE gene have been amply demonstrated as increasing the risk ofdeveloping this disease. Objective. To determine if a correlation exists between APOE genotype, diabetes mellitus and Alzheimer's disease. Materials and methods. Clinical studies were carried out by surveying the clinical histories in a group of patients in the province of Antioquia, Colombia. Forty-three Alzheimer's patients were compared with 43 control subjects, paired by age and gender. Commercially available methods were used to determine whether the patients had diabetes, and restriction enzyme-based genotyping was used to determine the APOE genotypes. Results. The most common non-neurological comorbidities were: arterial hypertension,acute myocardial infarction, chronic obstructive pulmonary disease and hypothyroidism. From the many variables investigated, two were conclusive:(1) the presence of Alzheimer's disease was higher in patients with diabetes mellitus, and (2) no correlation between late-onset sporadic Alzheimer's disease and APOEwas found in the target population. Conclusions. To detect any association with the APOE genotype, a study involving mucha larger population samples must be undertaken.Keywords: Alzheimer's disease, diabetes mellitus, apolipoprotein E, dementia; pulmonary disease, chronic obstructive.",apolipoprotein E;apolipoprotein E4;aged;Alzheimer disease;article;case control study;chronic obstructive lung disease;Colombia;comorbidity;diabetes mellitus;epilepsy;female;gene frequency;genetic predisposition;genetics;genotype;head injury;heart infarction;human;hypertension;hypothyroidism;male;neuropsychological test;non insulin dependent diabetes mellitus;risk;very elderly,"Botero, L. E.;Toro, A. E.;Patiño, A. J.;Salazar, G.;Rodríguez, J. C.;Suárez-Escudero, J. C.;Alarcán, G. A.;Corcimaru, A.;Osorio, C.;Jeong, J. S. Y.;Alzate, O.",2012,,,0,
494,Effect of the readmission primary diagnosis and time interval in heart failure patients: Analysis of English administrative data,"Aims To compare the predictors of unplanned readmission by primary diagnosis and time since discharge in heart failure (HF) patients. Methods and results We used national hospital administrative data for England to analyse unplanned readmission by primary diagnosis (HF and non-HF) at 7, 30, 90, 182, and 365 days after the index discharge. A total of 84 212 adult patients had their first HF admission between April 2008 and March 2010; 14 104 (16.8%) died during the index admission and were excluded. Of the remaining 70 108, half were readmitted and 28.7% died during 1 year from discharge (overall mortality rate of 40.6%). Patients had an average of three co-morbidities. Hierarchical logistic regression showed that arrhythmias [odds ratio (OR) = 1.13] and valvular disease (OR = 1.12) had significantly higher odds only for HF readmission; dementia (OR = 1.29), stroke (OR = 1.29), and mental health conditions (OR = 1.25) had higher odds only for non-HF. Ischaemic heart disease, renal disease, and chronic lung disease predicted both. Same-day discharge occurred for 6% of patients and was strongly associated with higher readmission for HF at 7 days, less so thereafter, and not for non-HF after 7 days. Other relationships changed little between 7 and 365 days. Prior outpatient non-attendance was associated with 5-10% higher odds of any readmission per appointment missed. Conclusion In HF patients, some predictors of readmission for HF, especially some common co-morbidities, differ from those for non-HF. In contrast, the time since discharge made little difference to the results. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.",adult;aged;article;cerebrovascular accident;chronic lung disease;dementia;female;heart arrhythmia;heart failure;hospital discharge;hospital readmission;human;major clinical study;male;medical record;morbidity;mortality;priority journal;time;United Kingdom;valvular heart disease;very elderly,"Bottle, A.;Aylin, P.;Bell, D.",2014,,,0,
495,The problems of vitamin d insufficiency in older people,"This report reviews evidence on disorders related to inadequate vitamin D repletion in older people. Vitamin D is as essential for bone health in adults as in children, preventing osteomalacia and muscle weakness and protecting against falls and low-impact fractures. Vitamin D is provided by skin synthesis by UVB-irradiation from summer sunshine and to a small extent by absorption from food. However, these processes become less efficient with age. Loss of mobility or residential care restricts solar exposure. Reduced appetite and financial problems often add to these problems. Thus, hypovitaminosis D is common world-wide, but is more common and more severe in older people. Non-classical effects of vitamin D, depending on serum circulating 25-hydroxyvitamin D concentrations, are present in most non-bony tissues; disorders associated with hypovitaminosis D include increased risks of sepsis [bacterial, mycobacterial and viral], cardiovascular and metabolic disorders [e.g. hyperlipidemia, type 2 diabetes mellitus, acute vascular events, dementia, stroke and heart failure]. Many cancer risks are associated with vitamin D inadequacy, though causality is accepted only for colo-rectal cancer. Maintenance of repletion in healthy older people requires intakes of >/=800IU/day [20mug], as advised by the Institute of Medicine [IOM], but achieving such intakes usually requires supplementation. Excessive intakes are dangerous, especially in undiagnosed primary hyperparathyroidism or sarcoidosis, but the IOM finds doses <4000 IU/day are safe. Many experts suggest that >/=1000-2000 IU [25-50mug] of vitamin D daily is necessary for older people, especially when independence is lost, or hypovitaminosis D could add to the clinical problem[s]. Much higher doses than these are needed for treatment of established deficiency or insufficiency.",aging;deficiency;elderly;pathology;supplementation;vitamin D,"Boucher, B. J.",2012,Aug,,0,
496,Are elderly patients with diabetes being overtreated in French long-term-care homes?,"Aim: In France, diabetes prevalence and ageing of the population are both on the increase, yet little information on diabetes in elderly patients living in geriatric institutions is available. Moreover, institutionalized diabetic patients are not included in the French recommendations for the management of diabetes in the elderly. For this reason, the aim of the present study was to evaluate diabetes management in older, institutionalized patients. Methods: The medical records of 100 diabetic patients, aged 65 years and over, and living in seven geriatric institutions in the Côte d'Or region of France, were studied from May 2008 to January 2009. Results: Prevalence of diabetes in these seven geriatric institutions was 15.46±4.9%, higher than in the general population. The diabetic patients had a mean age of 81.85±11.93 years, and 32% had glycated haemoglobin (HbA1c) less or equal to 6.5%, indicating a high risk of severe hypoglycaemia. A diet for diabetes was prescribed in 54% of the patients, but HbA1c levels did not differ between patients following and not following the diet (7.26±1.36% vs 7.11±1.10%, respectively; P=0.27). Creatinine was assessed in 87% of the patients, and 16% were ophthalmologically followed-up. Daily capillary blood glucose monitoring was performed in 100% of the patients taking insulin and in 17% of those taking oral antidiabetic treatment (P<0.0001). Conclusion: Our data show that, among older institutionalized patients, the prevalence of diabetes is high and the control of diabetes too tight, with a potential risk of hypoglycaemia. Antidiabetic treatment should be reduced when the HbA1c value is less than 7.5% in this frail and functionally dependent population. Furthermore, a diabetic diet, prescribed for more than half this population, is useless for glycaemic control and may even impinge on quality of life. © 2010 Elsevier Masson SAS.",alpha glucosidase inhibitor;angiotensin receptor antagonist;antidiabetic agent;antihypertensive agent;antilipemic agent;antithrombocytic agent;creatinine;dipeptidyl carboxypeptidase inhibitor;glinide derivative;glitazone derivative;glycosylated hemoglobin;hemoglobin A1c;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;isophane insulin;metformin;oral antidiabetic agent;sulfonylurea derivative;unclassified drug;aged;aging;article;blood glucose monitoring;capillary blood;clinical assessment;clinical evaluation;clinical trial;creatinine blood level;dementia;diabetes mellitus;diabetic diet;diabetic patient;diabetic retinopathy;disease severity;dyslipidemia;female;France;geriatric care;heart failure;hemoglobin blood level;high risk patient;home care;human;hypertension;hypoglycemia;institutional care;ischemic heart disease;long term care;major clinical study;male;medical record;multicenter study;ophthalmology;peripheral occlusive artery disease;prevalence;quality of life;cerebrovascular accident,"Bouillet, B.;Vaillant, G.;Petit, J. M.;Duclos, M.;Poussier, A.;Brindisi, M. C.;Vergès, B.",2010,,,0,
497,Heart failure and comorbidities,"Heart failure is a frequent disease in the elderly. Its clinical presentation is less typical and the prognosis more severe than in younger subjects because heart failure occurs in patients with multiple comorbidities. A comprehensive geriatric assessment should therefore be performed to detect the vulnerabilities and manage the comorbidities. The main diseases associated with heart failure are dementia, depression, malnutrition, atrial fibrillation, coronary artery disease, orthostatic hypotension, renal failure, anemia and iron deficiency. Comorbidities worsen heart failure and makes its treatment more difficult. The identification and treatment of comorbidities improve the prognosis in terms of mortality but especially in terms of quality of life. Caution with drugs is necessary because of pharmacokinetic or pharmacodynamic changes related to aging and the comorbidities. In this context, clinical and laboratory monitoring should be increased, mostly during an acute event (acute heart failure, infection, dehydration, fall, new therapy...). Therefore, the follow-up of elderly patients with heart failure requires a multidisciplinary approach that involves close cooperation between cardiologists, geriatricians, general practitioners, nurses, and pharmacists.",comorbidities;elderly;heart failure,"Boully, C.;Hanon, O.",2015,Mar,10.1684/pnv.2015.0544,0,
498,Disability in older people with diabetes: Issues for the clinician,"Diabetes may become a disabling disease due to diverse mechanisms. Many patients have evidence of physical or cognitive impairments that can markedly influence their ability to diabetes self manage and adversely affect possible outcomes of diabetes care. A screening process for impairment is therefore needed and in frail patients a comprehensive gerontological assessment should be used to improve the efficiency of care. A diabetes educational programme adapted to this population, which has involved the main care-giver has shown its efficacy to improve risk factor control and quality of life in a safer way. The experience of case-managers according to a model of heart failure may be promising for the future. © 2012 The Author(s).",creatinine;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;article;caregiver;cognition;cognitive defect;creatinine clearance;delirium;dementia;depression;diabetes mellitus;disability;disease course;education program;fall risk assessment;functional status;geriatric care;health care organization;human;insulin resistance;kidney function;Mini Mental State Examination;nutritional assessment;patient assessment;patient education;quality of life;risk factor;systolic hypertension;visual analog scale,"Bourdel-Marchasson, I.;Dugaret, E.;Regueme, S.",2012,,,0,
499,One-year incidence of hyperosmolar states and prognosis in a geriatric acute care unit,"Background: Hyperosmolar syndromes are associated with high mortality rates, yet little is known about their incidence and their prognosis. Objective: To determine the 1-year incidence of hyperosmolar states and the prognostic factors for in-hospital and 1-year mortality. Method: A 6-month prospective cohort study was conducted in a 40-bed acute care geriatric unit and included all patients who developed plasma osmolarity of 320 mosm/l or greater. Age, sex and known cognitive impairment as possible risk factors of hyperosmolarity were assessed. In-hospital and 1-year mortality were calculated and risk factors for death among baseline patient characteristics were sought. Results: 48 (11) of the 436 inpatients in the study were identified as hyperosmolar. Diabetic hyperosmolarity was found in 8 patients. Cognitive impairment was a risk factor for hyperosmolarity (relative risk 2.39, 95% confidence interval 2.18-3.33, p < 0.001), but not age or sex. Infections were accompanied by hyperosmolarity in 30 (62.5). Thirty-five patients (72.9) were bed- or chair-ridden. In-hospital mortality was higher in hyperosmolar patients (35.4) than in the others (16.7%, p = 0.003). Causes of death were infection in 5 (29.4), terminal cachexia in 5, thrombosis in 3, gastric bleeding in 1, renal failure in 2 and heart failure in 1. Functional dependency for mobility was a risk factor for in-hospital mortality but not the degree of hyperosmolarity. One-year mortality was 68.7%. Functional dependency and pressure ulcers were independent predictors of 1-year mortality (p = 0.005 and p = 0.044, respectively). Conclusion: Hyperosmolar states occurred in cognitively impaired and dependent patients and resulted in high mortality rates at short and at mid-term. Mortality was related to functional dependency rather than to hyperosmolarity. Copyright © 2004 S. Karger AG, Basel.",age;aged;article;cachexia;clinical article;cognitive defect;cohort analysis;controlled study;death;diabetes mellitus;female;gender;geriatric care;geriatric hospital;heart failure;hospital bed;hospital patient;human;hyperosmolarity;incidence;infection;kidney failure;male;mortality;patient mobility;physical capacity;plasma osmolarity;priority journal;prognosis;prospective study;risk factor;stomach hemorrhage;thrombosis;ulcer,"Bourdel-Marchasson, I.;Proux, S.;Dehail, P.;Muller, F.;Richard-Harston, S.;Traissac, T.;Rainfray, M.",2004,,,0,
500,Psychopharmacology for the clinician,The information in this column is not intended as a definitive treatment strategy but as a suggested approach for clinicians treating patients with similar histories. Individual cases may vary and should be evaluated carefully before treatment is provided. The patient described in this column is a composite with characteristics of several real patients. © 2012 Canadian Medical Association.,aripiprazole;citalopram;clozapine;haloperidol;olanzapine;quetiapine;risperidone;acute myeloblastic leukemia;adult;aggression;agranulocytosis;article;aspiration pneumonia;cardiomyopathy;case report;cholesterol blood level;cognition;defensiveness;delirium;delusional disorder;depression;drug dose reduction;firearm;health belief;heart disease;hostility;human;hypersalivation;impulsiveness;irritability;major depression;male;mental deterioration;mental disease;metabolic disorder;myocarditis;nocturnal enuresis;obsessive compulsive disorder;outcome assessment;paranoia;psychosis;quality of life;risk;schizoaffective psychosis;schizophrenia;sedation;seizure;side effect;suicide;weight gain,"Bourget, D.;Labelle, A.",2012,,,0,
501,Two patients with hypotension and respiratory distress,,antibiotic agent;prednisone;acute kidney failure;aged;air embolism;antibiotic therapy;atrial fibrillation;cardiac critical care ultrasonography;case report;chronic obstructive lung disease;computer assisted tomography;congestive heart failure;dementia;disease exacerbation;echocardiography;fat embolism;female;fluid resuscitation;health care associated pneumonia;hemodialysis;human;hypotension;hypoxemia;image analysis;inferior cava vein;intensive care unit;male;medical history;note;oxygen saturation;particulate matter;patient transport;physical examination;pneumonia;priority journal;respiratory distress;subclinical venous air embolism;very elderly,"Bourne, M. H.;Sekiguchi, H.",2016,,,0,
502,"Rationale and design of a randomized, double-blind, parallel-group study of terutroban 30 mg/day versus aspirin 100 mg/day in stroke patients: the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study","METHODS AND RESULTS: The PERFORM Study is a multicenter, randomized, double-blind, parallel-group study being carried out in 802 centers in 46 countries. The study population includes patients aged > or =55 years, having suffered an ischemic stroke (< or =3 months) or a transient ischemic attack (< or =8 days). Participants are randomly allocated to terutroban (30 mg/day) or aspirin (100 mg/day). The primary efficacy endpoint is a composite of ischemic stroke (fatal or nonfatal), myocardial infarction (fatal or nonfatal), or other vascular death (excluding hemorrhagic death of any origin). Safety is being evaluated by assessing hemorrhagic events. Follow-up is expected to last for 2-4 years. Assuming a relative risk reduction of 13%, the expected number of primary events is 2,340. To obtain statistical power of 90%, this requires inclusion of at least 18,000 patients in this event-driven trial. The first patient was randomized in February 2006.CONCLUSIONS: The PERFORM Study will explore the benefits and safety of terutroban in secondary cardiovascular prevention after a cerebral ischemic event.BACKGROUND: Ischemic stroke is the leading cause of mortality worldwide and a major contributor to neurological disability and dementia. Terutroban is a specific TP receptor antagonist with antithrombotic, antivasoconstrictive, and antiatherosclerotic properties, which may be of interest for the secondary prevention of ischemic stroke. This article describes the rationale and design of the Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic Attack (PERFORM) Study, which aims to demonstrate the superiority of the efficacy of terutroban versus aspirin in secondary prevention of cerebrovascular and cardiovascular events.","Aspirin [adverse effects] [therapeutic use];Cardiovascular Diseases [etiology] [prevention & control];Dose-Response Relationship, Drug;Double-Blind Method;Endpoint Determination;International Cooperation;Ischemic Attack, Transient [complications] [drug therapy];Naphthalenes [adverse effects] [therapeutic use];Platelet Aggregation Inhibitors [adverse effects] [therapeutic use];Propionates [adverse effects] [therapeutic use];Receptors, Thromboxane [antagonists & inhibitors];Stroke [complications] [drug therapy] [etiology] [prevention & control];Treatment Outcome;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-dementia: sr-stroke","Bousser, Mg;Amarenco, P;Chamorro, A;Fisher, M;Ford, I;Fox, K;Hennerici, Mg;Mattle, Hp;Rothwell, Pm",2009,,10.1159/000212671,0,503
503,"Rationale and design of a randomized, double-blind, parallel-group study of terutroban 30 mg/day versus aspirin 100 mg/day in stroke patients: the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study","BACKGROUND: Ischemic stroke is the leading cause of mortality worldwide and a major contributor to neurological disability and dementia. Terutroban is a specific TP receptor antagonist with antithrombotic, antivasoconstrictive, and antiatherosclerotic properties, which may be of interest for the secondary prevention of ischemic stroke. This article describes the rationale and design of the Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic Attack (PERFORM) Study, which aims to demonstrate the superiority of the efficacy of terutroban versus aspirin in secondary prevention of cerebrovascular and cardiovascular events. METHODS AND RESULTS: The PERFORM Study is a multicenter, randomized, double-blind, parallel-group study being carried out in 802 centers in 46 countries. The study population includes patients aged > or =55 years, having suffered an ischemic stroke (< or =3 months) or a transient ischemic attack (< or =8 days). Participants are randomly allocated to terutroban (30 mg/day) or aspirin (100 mg/day). The primary efficacy endpoint is a composite of ischemic stroke (fatal or nonfatal), myocardial infarction (fatal or nonfatal), or other vascular death (excluding hemorrhagic death of any origin). Safety is being evaluated by assessing hemorrhagic events. Follow-up is expected to last for 2-4 years. Assuming a relative risk reduction of 13%, the expected number of primary events is 2,340. To obtain statistical power of 90%, this requires inclusion of at least 18,000 patients in this event-driven trial. The first patient was randomized in February 2006. CONCLUSIONS: The PERFORM Study will explore the benefits and safety of terutroban in secondary cardiovascular prevention after a cerebral ischemic event.","Aspirin [adverse effects] [therapeutic use];Cardiovascular Diseases [etiology] [prevention & control];Dose-Response Relationship, Drug;Double-Blind Method;Endpoint Determination;International Cooperation;Ischemic Attack, Transient [complications] [drug therapy];Naphthalenes [adverse effects] [therapeutic use];Platelet Aggregation Inhibitors [adverse effects] [therapeutic use];Propionates [adverse effects] [therapeutic use];Receptors, Thromboxane [antagonists & inhibitors];Stroke [complications] [drug therapy] [etiology] [prevention & control];Treatment Outcome;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-dementia: sr-stroke","Bousser, M. G.;Amarenco, P.;Chamorro, A.;Fisher, M.;Ford, I.;Fox, K.;Hennerici, M. G.;Mattle, H. P.;Rothwell, P. M.",2009,,10.1159/000212671,0,
504,Association of Multimorbidity with Mortality and Healthcare Utilization in Chronic Kidney Disease,"Objectives: Chronic kidney disease (CKD) almost universally occurs in individuals with other medical problems. However, few studies have described CKD-related multimorbidity using a framework that identifies chronic conditions as concordant (having overlap in treatment goals) versus discordant (having opposing treatment recommendations) and unrelated (having no overlap, but contributing to complexity via different resource requirements). Design: Retrospective cohort. Setting: Veterans Affairs (VA) Medical Centers. Participants: VA patients (n = 821,334) ages 18–100 years with at least one outpatient visit and incident CKD defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 for at least 3 months between January 1, 2005 and December 31, 2008 after excluding prevalent CKD. Measurements: We determined the associations of number of chronic conditions (1, 2, 3, 4, 5, 6 or more) stratified by the presence of one or more discordant/unrelated conditions with mortality, hospitalizations and emergency department (ED) visits. Results: There were 381,187 deaths over 6.8 median years of follow-up. Higher risks of death, hospitalization and ED visits were associated with higher number of chronic conditions, among those with and without discordant/unrelated conditions. However, the magnitudes of the associations were consistently larger when at least one discordant/unrelated condition was present. For example, compared to patients with one concordant condition, patients with six or more concordant conditions had an age-, race- and sex-adjusted hazard ratio (HR) for mortality of 1.72 (95% CI 1.64–1.80) whereas those with six or more conditions, at least one of which was discordant/unrelated, had a HR of 2.05 (2.01–2.09) (P-interaction <0.001). Conclusions: The presence of one or more discordant/unrelated conditions was associated with increased risk for adverse health outcomes, beyond the effect of multimorbidity.",antithrombocytic agent;adult;aged;anemia;arthritis;article;asthma;atrial fibrillation;cerebrovascular disease;chronic kidney failure;chronic obstructive lung disease;comorbidity;dementia;depression;diabetes mellitus;disease association;emergency care;epilepsy;estimated glomerular filtration rate;female;follow up;gastroesophageal reflux;gout;health care utilization;heart failure;hospitalization;human;hyperlipidemia;hypertension;hypothyroidism;ischemic heart disease;major clinical study;male;mortality;osteoporosis;outpatient care;Parkinson disease;peptic ulcer;peripheral occlusive artery disease;practice guideline;prostate cancer;prostate hypertrophy;retrospective study,"Bowling, C. B.;Plantinga, L.;Phillips, L. S.;McClellan, W.;Echt, K.;Chumbler, N.;McGwin, G.;Vandenberg, A.;Allman, R. M.;Johnson, T. M.",2017,,10.1111/jgs.14662,0,
505,"Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants","Background: For older groups, being overweight [body mass index (BMI; in kg/m2): 25 to <30] is reportedly associated with a lower or similar risk of mortality than being normal weight (BMI: 18.5 to <25). However, this ""risk paradox"" is partly explained by smoking and disease-associated weight loss. This paradox may also arise from BMI failing to measure fat redistribution to a centralized position in later life.Objective: This study aimed to estimate associations between combined measurements of BMI and waist-to-hip ratio (WHR) with mortality and incident coronary artery disease (CAD).Design: This study followed 130,473 UK Biobank participants aged 60-69 y (baseline 2006-2010) for </=8.3 y (n = 2974 deaths). Current smokers and individuals with recent or disease-associated (e.g., from dementia, heart failure, or cancer) weight loss were excluded, yielding a ""healthier agers"" group. Survival models were adjusted for age, sex, alcohol intake, smoking history, and educational attainment. Population and sex-specific lower and higher WHR tertiles were <0.91 and >/=0.96 for men and <0.79 and >/=0.85 for women, respectively.Results: Ignoring WHR, the risk of mortality for overweight subjects was similar to that for normal-weight subjects (HR: 1.09; 95% CI: 0.99, 1.19; P = 0.066). However, among normal-weight subjects, mortality increased for those with a higher WHR (HR: 1.33; 95% CI: 1.08, 1.65) compared with a lower WHR. Being overweight with a higher WHR was associated with substantial excess mortality (HR: 1.41; 95% CI: 1.25, 1.61) and greatly increased CAD incidence (sub-HR: 1.64; 95% CI: 1.39, 1.93) compared with being normal weight with a lower WHR. There was no interaction between physical activity and BMI plus WHR groups with respect to mortality.Conclusions: For healthier agers (i.e., nonsmokers without disease-associated weight loss), having central adiposity and a BMI corresponding to normal weight or overweight is associated with substantial excess mortality. The claimed BMI-defined overweight risk paradox may result in part from failing to account for central adiposity, rather than reflecting a protective physiologic effect of higher body-fat content in later life.","Adipose Tissue/ metabolism;Adiposity;Aged;Aging;Biological Specimen Banks;Body Mass Index;Coronary Artery Disease/epidemiology;Female;Humans;Male;Middle Aged;Obesity/mortality;Obesity, Abdominal/ mortality;Overweight/mortality;Risk Factors;Smoking;United Kingdom/epidemiology;Waist-Hip Ratio;UK Biobank;coronary artery disease;mortality;older persons;overweight","Bowman, K.;Atkins, J. L.;Delgado, J.;Kos, K.;Kuchel, G. A.;Ble, A.;Ferrucci, L.;Melzer, D.",2017,Jul,,0,
506,Investigating patient-centered care,"This issue provides many articles reporting on research pertinent to patient-centered care, with great richness in the variety of methods and settings. Topics include disparities in the availability of care and the type of care provided (including a randomized trial), effecting elective hospitalizations on future patient satisfaction, the effect of the specific content of the after visit summary, 2 articles related to aspects of shared decision making, 2 articles considering the effects of practice culture, plus a report on divergent views on how to integrate behavioral and primary health care. Differences between academic and nonacademic family medicine practice are finally documented, with important dissimilarities in patient-centered care. Family physicians are highly involved with dementia care. An exciting report documents a high negative predictive value for a new genomic expression test for coronary artery disease in family medicine that uses combinations of gene expression instead of individual gene testing.",*Family Practice/methods/organization & administration;Humans;*Patient-Centered Care/methods/organization & administration;United States,"Bowman, M. A.;Neale, A. V.",2014,Mar-Apr,10.3122/jabfm.2014.02.140009,0,
507,Improved activity and mental function related to proper antiasthmatic treatment in elderly patients with Alzheimer's disease,"Alzheimer's disease (AD) and bronchial asthma are common diseases in elderly patients. Untreated chronic diseases, such as chronic obstructive pulmonary disorder, diabetes, heart failure, and asthma can be associated with declining cognitive function. The objective of this study was to evaluate the influence of asthma therapy performed according to Global Initiative for Asthma (GINA) guidelines (GINA. Global strategy for asthma management and prevention. Report. Available online at http://www.ginasthma.com/Guidelineitem.asp??l1=2&l2=1&intId=60 last accessed Oct. 2009) on cognitive function and functional status in patients diagnosed with AD. A total of 302 participants who were diagnosed with bronchial asthma and mild or moderate AD (138 women and 164 men) with a mean age of 68.2 +/- 5.1 years were included in the study. Cognitive function was assessed based on the Mini-Mental State Examination (MMSE) and the clock drawing test at the beginning of the study, after 6 months, and after 1 year. Results were compared with a control group of patients with AD but not asthma. Several patients (68.9%) had uncontrolled asthma (confirmed at the beginning of the study) and AD. After 1 year of antiasthmatic treatment, the mean MMSE score increased significantly from the baseline values of 17.2 +/- 3.2 to 19.5 +/- 2.1 (mean +/- SD; p < 0.05). This change was significant compared with the control group. Significant improvement in instrumental activity was observed after 1 year of treatment in patients with asthma. Finally, 63.6% of patients met the criteria of well-controlled asthma. Adequate treatment of chronic asthma could improve some cognitive and instrumental activities. Asthma in patients with AD is commonly underdiagnosed and undertreated.","*Activities of Daily Living;Aged;Aged, 80 and over;Alzheimer Disease/*complications/diagnosis;Anti-Asthmatic Agents/*therapeutic use;Asthma/complications/*drug therapy;Female;Humans;Male;Middle Aged;Neuropsychological Tests;Severity of Illness Index","Bozek, A.;Jarzab, J.",2011,Sep-Oct,10.2500/aap.2011.32.3459,0,
508,"Asthma, COPD and comorbidities in elderly people","Co-morbidities are a significant problem in the elderly population but are rarely presented and analyzed for interdependencies among the various coexisting chronic diseases. Objective: The aim of this study was to present a profile of comorbidities in elderly patients with and without asthma and COPD. Methods: Respondents were recruited at 20 sites in Poland. Stratified random sampling from patient databases resulted in 15,973 patients older than 60 years of age. A retrospective analysis of medical history and ICD-10 codes was performed. In addition, patients underwent a spirometry test with a bronchial reversibility test and were administered questionnaires on the prevalence of chronic diseases by doctors. Results: The study population consisted of 1023 asthmatic patients, 1084 patients with COPD and 1076 control subjects without any signs of bronchoconstriction and with correct spirometry. Patients with asthma exhibited a similar distribution of cardiovascular and metabolic co-morbidities as the control group. However, asthmatic patients had a higher prevalence of arterial hypertension and depression with an odds ratio (OR) = 1.48 (95% CI: 1.38–1.62) and OR = 1.52 (95% CI: 1.44–1.68), respectively. Coronary disease (OR = 2.12; 95% CI: 1.97–2.33), cor pulmonale (OR = 3.1; 95% CI: 2.87–3.22) and heart failure (OR = 2.71; 95% CI: 2.64–3.11) were predominantly observed in patients with COPD. Patients with severe asthma exhibited a greater predisposition to cardiovascular and neuropsychiatric diseases. Conclusion: Asthma coexisted frequently with arterial hypertension and depression in elderly patients. Patients with COPD have a more exaggerated profile of coexisting diseases, specifically cardiovascular problems.",adult;aged;anemia;anxiety;article;asthma;body mass;bronchial reversibility test;bronchoconstriction;bronchus examination;cerebrovascular accident;chronic obstructive lung disease;colitis;comorbidity;controlled study;cor pulmonale;coronary artery disease;delirium;dementia;depression;diabetes mellitus;dysphagia;female;gastritis;geriatric disorder;heart arrhythmia;heart failure;hospitalization;human;hyperlipidemia;hypertension;hyperuricemia;ICD-10;major clinical study;male;medical record review;mortality;neoplasm;obesity;osteoporosis;peptic ulcer;Poland;prevalence;retrospective study;spirometry,"Bozek, A.;Rogala, B.;Bednarski, P.",2016,,,0,
509,Patient-related risk factors for postoperative mortality and periprosthetic joint infection in medicare patients undergoing TKA,"BACKGROUND: The impact of specific baseline comorbid conditions on the relative risk of postoperative mortality and periprosthetic joint infection (PJI) in elderly patients undergoing TKA has not been well defined. QUESTIONS/PURPOSES: We calculated the relative risk of postoperative mortality and PJI associated with 29 comorbid conditions in Medicare patients undergoing TKA. PATIENTS AND METHODS: The Medicare 5% sample was used to calculate the relative risk of 90-day postoperative mortality and PJI as a function of 29 preexisting comorbid conditions in 83,011 patients who underwent primary TKA between 1998 and 2007. RESULTS: The independent risk factors for 90-day postoperative mortality (in decreasing order of significance) were congestive heart failure, metastatic cancer, renal disease, peripheral vascular disease, cerebrovascular disease, lymphoma, cardiac arrhythmia, dementia, pulmonary circulation disorders, and chronic liver disease. The independent risk factors for PJI (in decreasing order of significance) were congestive heart failure, chronic pulmonary disease, preoperative anemia, diabetes, depression, renal disease, pulmonary circulation disorders, obesity, rheumatologic disease, psychoses, metastatic tumor, peripheral vascular disease, and valvular disease. CONCLUSIONS: We believe this information important when counseling elderly patients regarding the risks of mortality and PJI after TKA and risk-adjusting publicly reported TKA patient outcomes.","Aged;Aged, 80 and over;Arthroplasty, Replacement, Knee/*mortality;*Cause of Death;Chi-Square Distribution;Cohort Studies;*Comorbidity;Confidence Intervals;Databases, Factual;Female;Follow-Up Studies;Hospital Mortality/trends;Humans;Knee Prosthesis;Male;Medicare/statistics & numerical data;Postoperative Complications/*mortality;Proportional Hazards Models;Prosthesis-Related Infections/diagnosis/*mortality;Retrospective Studies;Risk Factors;Survival Analysis;Time Factors;United States","Bozic, K. J.;Lau, E.;Kurtz, S.;Ong, K.;Berry, D. J.",2012,Jan,10.1007/s11999-011-2043-3,0,
510,Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in medicare patients,"Background: The patient-related risk factors for periprosthetic joint infection and postoperative mortality in elderly patients undergoing total hip arthroplasty are poorly understood. The purpose of this study was to identify the specific patient comorbidities that are associated with an increased risk of periprosthetic joint infection and of ninety-day postoperative mortality in U.S. Medicare patients undergoing total hip arthroplasty. Methods: The Medicare 5% sample claims database was used to calculate the relative risk of periprosthetic joint infection and of ninety-day postoperative mortality as a function of preexisting comorbidities in 40,919 patients who underwent primary total hip arthroplasty between 1998 and 2007. The impact of twenty-nine comorbid conditions on periprosthetic joint infection and on postoperative mortality was examined with use of Cox regression, controlling for age, sex, census region, public assistance, and all other baseline comorbidities. The adjusted hazard ratios for all comorbid conditions were evaluated, and the Wald chi-square statistic was used to rank the degree of association of each condition with periprosthetic joint infection and with postoperative mortality. The Bonferroni-Holm method was used to adjust for the multiple comparisons resulting from the number of comorbid conditions analyzed. Results: Comorbid conditions associated with an increased adjusted risk of periprosthetic joint infection (in decreasing order of significance, p < 0.05 for all comparisons) were rheumatologic disease (hazard ratio [HR] = 1.71), obesity (HR = 1.73), coagulopathy (HR = 1.58), and preoperative anemia (HR = 1.36). Comorbid conditions associated with an increased adjusted risk of ninety-day postoperative mortality (in decreasing order of significance, p < 0.05 for all comparisons) were congestive heart failure (HR = 2.11), metastatic cancer (HR = 3.14), psychosis (HR = 1.85), renal disease (HR = 1.98), dementia (HR = 2.04), hemiplegia or paraplegia (HR = 2.62), cerebrovascular disease (HR = 1.40), and chronic pulmonary disease (HR = 1.32). Conclusions: We identified specific patient comorbidities that were independently associated with an increased risk of periprosthetic joint infection and of ninety-day postoperative mortality in Medicare patients who had undergone total hip arthroplasty. This information is important when counseling elderly patients regarding the risks of periprosthetic joint infection and mortality following total hip arthroplasty, as well as for risk adjustment of publicly reported total hip arthroplasty outcomes. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated.",alcohol abuse;anemia;article;blood clotting disorder;cerebrovascular disease;chronic liver disease;chronic lung disease;comorbidity;congestive heart failure;dementia;depression;diabetes mellitus;disease association;hemiplegia;hip arthroplasty;human;hypercholesterolemia;hypertension;hypothyroidism;kidney disease;lymphoma;major clinical study;medicare;metastasis;obesity;paraplegia;peptic ulcer;priority journal;prosthesis infection;psychosis;rheumatic disease;risk factor;surgical mortality;urinary tract infection,"Bozic, K. J.;Lau, E.;Kurtz, S.;Ong, K.;Rubash, H.;Vail, T. P.;Berry, D. J.",2012,,,0,
511,Biomarkers: Indicators for diagnosis and therapy,,albumin;bilirubin;biological marker;calcium;cetuximab;chloride ion;chorionic gonadotropin;creatinine;dasatinib;electrolyte;erlotinib;gefitinib;hemoglobin A1c;imatinib;immunoglobulin G;insulin;irinotecan;ketone;lapatinib;liothyronine;low density lipoprotein;myelin;nilotinib;nucleic acid;panitumumab;phosphate;potassium ion;sodium ion;thyroxine;virus protein;Alzheimer disease;article;biopsy;blood clotting;blood sampling;breast cancer;cancer therapy;CD4+ T lymphocyte;chronic myeloid leukemia;creatinine clearance;degenerative disease;diabetes mellitus;diagnostic procedure;drug industry;gene expression;gene mutation;glucose blood level;health care system;heart infarction;hormonal therapy;Human immunodeficiency virus infection;kidney function;liver function;non small cell lung cancer;mortality;multiple sclerosis;national health organization;neoplasm;osteoporosis;pharmacy;pregnancy test;prognosis;qualitative analysis;quality of life;quantitative analysis;rheumatoid arthritis;sensitivity analysis;thyroid function;urinalysis,"Bracht, K.",2009,,,0,
512,Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population,"Background: Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. Aim: To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data. Design: Retrospective cohort study. Setting/participants: The cohort consisted of 23,852 people aged 20 years and over who died in Western Australia between 1 January 2009 and 31 December 2010 after excluding deaths related to pregnancy or trauma. Within this cohort, the number, proportion and characteristics of people who died from one or more of 10 medical conditions considered amenable to palliative care were identified using linked hospital records and death certificate data. Results: Depending on the information source(s) used, between 43% and 73% of the 23,852 people who died had a condition potentially amenable to palliative care identified. The median age at death and the sex distribution of the decedents by condition also varied with the information source. Conclusion: Health service planners and researchers need to be aware of the limitations when using hospital records and death certificate data to determine a potential palliative care population. The use of Emergency Department and other administrative data sources could further exacerbate this variation.",acquired immune deficiency syndrome;adult;aged;Alzheimer disease;article;Australia;chronic obstructive lung disease;cohort analysis;death certificate;female;heart failure;human;Human immunodeficiency virus infection;Huntington chorea;kidney failure;liver failure;major clinical study;male;medical record;middle aged;motor neuron disease;neoplasm;palliative therapy;Parkinson disease;retrospective study;sex ratio;very elderly,"Brameld, K.;Spilsbury, K.;Rosenwax, L.;Murray, K.;Semmens, J.",2017,,10.1177/0269216316673550,0,
513,The prevalence of potentially remediable urinary incontinence in frail older people: a study using the Minimum Data Set,"OBJECTIVES: To use the Minimum Data Set (MDS) to describe the frequency and correlates of potentially treatable causes of urinary incontinence among a representative sample of American nursing home residents. To describe current management practices of urinary incontinence in the same population. DESIGN: Cross-sectional study using the dataset that was part of the Health Care Financing Administration (HCFA) evaluation of the MDS. SETTING: 270 Medicaid-certified nursing homes in 10 states. PARTICIPANTS: A total of 2014 nursing home residents 60 years or older (mean = 84.3 +/- 8.7), 75.5% women, 81.9% white, who lived in a nursing home during the fall of 1990 were randomly selected to sample a fixed number of residents for each facility based on facility size. MEASUREMENTS: Incontinence was defined as the presence of at least two episodes of urinary leakage per week in the previous 2 weeks. Management techniques (toileting, pads/briefs, catheters) were those listed in the MDS. Potentially remediable causes of urinary incontinence available in the MDS were: medications (antipsychotics, antidepressants, and antianxiety/hypnotics); congestive heart failure; diabetes mellitus; pedal edema; delirium; depression; and impairments in activities of daily living (ADLs) (transferring, locomotion, dressing, toileting; bedrails; trunk restraints; and chair restraints). RESULTS: Forty-nine percent of residents were incontinent. Of these, 84.0% were managed by pads/briefs, 38.7% by scheduled toileting, 3.5% by indwelling catheter, and 1.2% by external catheter. Of the potentially reversible causes, bivariate analysis revealed associations (P < .1) with use of antidepressants, antipsychotics, and antianxiety/hypnotics; delirium; bedrails; trunk restraints; chair restraints; and ADL impairment. Dementia was also associated with incontinence (P < .1). Multivariate analysis revealed that urinary incontinence was independently associated with impairment in ADLs (OR = 4.2; CI = 3.2,5.6), dementia (OR = 2.3;CI = 1.8,3.0), restraints-trunk (OR = 1.7; CI = 1.5,2.0), chair (OR = 1.4; CI = 1.2,1.6), bedrails (OR = 1.3; CI = 1.1,1.5), and use of antianxiety/hypnotic medications (OR = .7;CI = .5,1.0) (all P < .04). CONCLUSIONS: Current management practices for urinary incontinence are inconsistent with advocated guidelines. These data also confirm the association between incontinence and several potentially remediable conditions and suggest that, even in the nursing home setting, urinary incontinence may respond to efforts to improve conditions not directly related to bladder function. This study underscores the need to examine the impact on urinary incontinence of strategies to address such conditions.","Activities of Daily Living;Aged;Aged, 80 and over;Antidepressive Agents/therapeutic use;Centers for Medicare and Medicaid Services (U.S.);Cross-Sectional Studies;Delirium/complications;Female;Frail Elderly/*statistics & numerical data;Humans;Male;Middle Aged;Nursing Homes/*statistics & numerical data;Prevalence;Risk Factors;United States/epidemiology;Urinary Incontinence/classification/*epidemiology/etiology/therapy","Brandeis, G. H.;Baumann, M. M.;Hossain, M.;Morris, J. N.;Resnick, N. M.",1997,Feb,,0,
514,Weight loss in the elderly: medications complicating the picture?,"An 81-year-old female presented with weight loss as a result of her multiple comorbidities, including a history of congestive heart failure (CHF), coronary artery disease, paroxysmal atrial fibrillation, myocardial infarction, pulmonary embolism, and stroke. She has experienced deep-venous thrombosis in her right leg, severe depression, and dementia and also has suffered a right tibial and fibular fracture. All of these comorbidites and her medication regimen complicated the issue of weight loss. A senior care pharmacist addressed the complexity of her situation with a goal of preventing potentially negative outcome of any prescribed medication. This case demonstrates the importance of a pharmacist taking a focused look at the addition of a new medication.",,"Brandt, N. J.;Lin, M.;Patel, P.",2005,Nov,,0,
515,Psychotropic drug use and mortality in old people with dementia: Investigating sex differences,"Background : Psychotropic drugs are common among old people with dementia, and have been associated with increased mortality. Previous studies have not investigated sex differences in this risk. This study was conducted to analyse associations between the use of antipsychotics, antidepressants, and benzodiazepines and 2-year mortality in old people with dementia, and to investigate sex differences therein. Methods: In total, 1037 participants (74% women; mean age, 89 years) with dementia were included from four cohort studies and followed for 2 years. Data were collected through home visits and medical records. Cox proportional hazard regression models were used to analyse associations between ongoing baseline drug use and mortality. Multiple possible confounders were evaluated and adjusted for. Results: In fully adjusted models including data from the whole population, no association between baseline psychotropic drug use and increased 2-year mortality was seen. Significant sex differences were found in mortality associated with antidepressant use, which was protective in men, but not in women (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40-0.92 and HR 1.09, 95% CI 0.87-1.38, respectively). The interaction term for sex was significant in analyses of benzodiazepine use, with a higher mortality risk among men than among women. Conclusions: Among old people with dementia, ongoing psychotropic drug use at baseline was not associated with increased mortality in analyses adjusted for multiple confounders. Sex differences in mortality risk associated with antidepressant and benzodiazepine use were seen, highlighting the need for further investigation of the impact of sex.",analgesic agent;antidepressant agent;benzodiazepine derivative;psychotropic agent;aged;Alzheimer disease;angina pectoris;article;cohort analysis;comorbidity;controlled study;delirium;dementia;depression;drug use;elderly care;female;human;major clinical study;male;Mini Mental State Examination;mortality;mortality risk;multiinfarct dementia;protection;sex difference,"Brännström, J.;Boström, G.;Rosendahl, E.;Nordström, P.;Littbrand, H.;Lövheim, H.;Gustafson, Y.",2017,,10.1186/s40360-017-0142-9,0,
516,Galantamine and QTc prolongation 4,,galantamine;placebo;Alzheimer disease;clinical trial;diabetes mellitus;drug dose titration;drug effect;drug formulation;drug release;drug response;drug withdrawal;electrocardiogram;Holter monitoring;human;hypertension;letter;priority journal,"Brashear, H. R.;Spivey, J. M.",2007,,,0,
517,An Assessment of Statin Safety by Neurologists,"The National Lipid Association's (NLA) Statin Safety Task Force charged the Neurology Expert Panel with the task of reviewing the scientific evidence related to adverse effects with statins and providing assessments and advice regarding the safety of statins. The evidence included key adverse reaction statin literature identified via a Medline search by the Task Force and Panel members and the commissioned reviews and research presented in this supplement. Panel members were asked to use this evidence to independently form explicit answers to a series of questions posed by the Task Force. Panelists were asked to grade the type of literature and the confidence they had in it in forming their answers using prescribed scales. Panelists were encouraged to seek the highest level of evidence available to answer their questions and to concentrate on literature involving humans. In addition, the Neurology Expert Panel was asked to propose recommendations to regulatory authorities, health professionals, patients, researchers, and the pharmaceutical industry to address statin safety issues. © 2006 Elsevier Inc. All rights reserved.",atorvastatin;hydroxymethylglutaryl coenzyme A reductase inhibitor;pravastatin;simvastatin;Alzheimer disease;article;brain hemorrhage;clinical trial;cognitive defect;data analysis;depression;drug safety;drug withdrawal;health care organization;health care personnel;heart infarction;human;medical research;Medline;memory disorder;mental function;neurologic disease;neurologic examination;neurology;neuropathy;neurotoxicity;peripheral neuropathy;practice guideline;priority journal;risk assessment;standard;statistical significance;cerebrovascular accident;suicide,"Brass, L. M.;Alberts, M. J.;Sparks, L.",2006,,,0,
518,Antipsychotic drugs and risks of myocardial infarction: A self-controlled case series study,"Aim: Antipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncertain because people prescribed and not prescribed antipsychotic drugs differ in their underlying vascular risk making between-person comparisons difficult to interpret. The aim of our study was to investigate this association using the self-controlled case series design that eliminates between-person confounding effects. Methods and results: All the patients with a first recorded myocardial infarction and prescription for an antipsychotic identified in the Clinical Practice Research Datalink linked to the Myocardial Ischaemia National Audit Project were selected for the self-controlled case series. The incidence ratio of myocardial infarction during risk periods following the initiation of antipsychotic use relative to unexposed periods was estimated within individuals. A classical case-control study was undertaken for comparative purposes comparing antipsychotic exposure among cases and matched controls. We identified 1546 exposed cases for the self-controlled case series and found evidence of an association during the first 30 days after the first prescription of an antipsychotic, for first-generation agents [incidence rate ratio (IRR) 2.82, 95% confidence interval (CI) 2.0-3.99] and second-generation agents (IRR: 2.5, 95% CI: 1.18-5.32). Similar results were found for the case-control study for new users of first- (OR: 3.19, 95% CI: 1.9-5.37) and second-generation agents (OR: 2.55, 95% CI: 0.93-7.01) within 30 days of their myocardial infarction. Conclusion: We found an increased risk of myocardial infarction in the period following the initiation of antipsychotics that was not attributable to differences between people prescribed and not prescribed antipsychotics.",neuroleptic agent;aged;alcohol consumption;article;atherosclerosis;body mass;cardiovascular risk;comorbidity;controlled study;dementia;diabetes mellitus;dyslipidemia;female;follow up;heart infarction;human;hypertension;major clinical study;male;obesity;outcome assessment;prescription;priority journal;secondary analysis;smoking,"Brauer, R.;Smeeth, L.;Anaya-Izquierdo, K.;Timmis, A.;Denaxas, S. C.;Farrington, C. P.;Whitaker, H.;Hemingway, H.;Douglas, I.",2015,,,0,
519,Staying well in the long term,,acetylsalicylic acid;docosahexaenoic acid;fish oil;green tea extract;icosapentaenoic acid;omega 3 fatty acid;phytosterol;aerobic exercise;Alzheimer disease;antioxidant activity;article;brain function;cardiovascular disease;cardiovascular risk;chemoprophylaxis;clinical trial;cognitive defect;cognitive therapy;diet therapy;emotional stability;fish meat;headache;health promotion;heart protection;human;incidence;ischemic heart disease;lifestyle modification;longevity;low drug dose;malignant neoplastic disease;Mediterranean diet;mental health;morbidity;mortality;patient counseling;pharmaceutical care;pharmacist;prescription;primary prevention;quality of life;recommended drug dose;risk reduction;secondary prevention;sitting,"Braun, L.",2009,,,0,
520,The risk for nursing home admission (NHA) did not change in ten years-A prospective cohort study with five-year follow-up,"In an aging population the burden on health care systems depends on the proportion of lifetime spent in good or poor health. The objective of this study was to examine the effect of a ten-year cohort difference on NHA, indicating changes in lifetime spent without severe disabilities. Additionally, important risk factors for NHA were identified. The data were obtained from two cohort studies of elderly people. Cohort A (1991-1993) comprised 74+ patients from 20 German general practices and cohort B (2002-2003) 70+ patients from 14 general practices. The merged sample consisted of 2301 community dwelling patients that contacted their general practitioner within a 12-month period during the respective enquiry period. After an initial assessment at study entry, participants were monitored over a five-year period respective NHA and death. The Cox proportional hazards model was used including socio-epidemic data, state of health, chronic diseases, dementia, health system usage, and social support. The ten-year cohort-difference was no predictor of NHA within a 5-year period. Significant influencing variables were: age (OR 1.10), living with others (OR 0.59), no auxiliary person (OR 1.69), mild forgetfulness (OR 2.12), clear cognitive impairment (OR 3.74), severe cognitive disturbance (3.61), loss of memory (11.83), walking difficulties (OR 1.53), impaired vision (OR 1.90), and cancer (OR 0.22). This study could not find a cohort effect on NHA. With regard to increased life expectancy the findings do not support the compression of morbidity hypothesis. The identified influencing variables contribute to the understanding of NHA risk factors. © 2011 Elsevier Ireland Ltd.",age;aged;angina pectoris;artery occlusion;article;cancer patient;chronic disease;chronic pain;cognitive defect;cohort analysis;community living;controlled study;dementia;diabetes mellitus;disease severity;dyspnea;falling;female;follow up;gender;general practice;health care utilization;health status;hearing impairment;hip fracture;hospitalization;human;incontinence;major clinical study;male;memory disorder;mental function;mild forgetfulness;mortality;muscle weakness;nursing home;nursing home admission;osteoarthritis;Parkinson disease;patient monitoring;priority journal;prospective study;risk assessment;risk factor;social support;speech disorder;cerebrovascular accident;visual impairment;walking difficulty,"Braunseis, F.;Deutsch, T.;Frese, T.;Sandholzer, H.",2012,,,0,
521,Vascular risks and incident dementia: Results from a cohort study of the very old,"The contribution of vascular pathology to the manifestation of dementia and the importance of vascular risk to measures of cognitive function is being increasingly recognized. In particular, confirmation of this risk points towards approaches for prevention in large sections of the population. Information on determinants of incident dementia is increasing, but still relatively few studies of risk have been based on incident cases of dementia in very elderly populations. In this study based on incident cases of dementia in a population aged 75 and over, vascular risks were obtained from informants of the respondents with incident dementia. When compared with controls the factors associated with incident dementia were history of heart attack (odds ratio 2.9), transient ischaemic attacks (4.8), cerebrovascular accidents (3.4), family history of first-degree relatives with dementia (4.0), and occupational exposure to vibrating instruments (1.4). If only Alzheimer's disease, clinically diagnosed, was included, diabetes (1.4) and a history of dementia in first-degree relatives (6.6) emerged. Thus, vascular risk continues to be of importance in the oldest age groups.",aged;anamnesis;article;cerebrovascular accident;cognition;controlled study;dementia;diabetes mellitus;family history;female;heart infarction;human;major clinical study;male;occupational exposure;priority journal;risk;transient ischemic attack;vascular disease;vibration,"Brayne, C.;Gill, C.;Huppert, F. A.;Barkley, C.;Gehlhaar, E.;Girling, D. M.;O'Connor, D. W.;Paykel, E. S.",1998,,,0,
522,Clinical pharmacology and therapeutics,,alteplase;apolipoprotein E4;captopril;cerebrolysin;dipeptidyl carboxypeptidase inhibitor;enalapril;indometacin;lisinopril;nitric oxide;ramipril;selegiline;streptokinase;tacrine;troglitazone;zidovudine;acquired immune deficiency syndrome;Alzheimer disease;article;clinical pharmacology;cost effectiveness analysis;degenerative disease;diabetes mellitus;good clinical practice;heart infarction;human;labor inhibition;liver toxicity;priority journal,"Breckenridge, A.",1995,,,0,
523,Psychoses in composers,"Summary -In this article, we have described the pathographies of fifty composers who were suffering from psychotic disorders. A few of them committed suicide in younger age because of schizophrenia. Others suffered from paranoid personality disorder, or were likely to have a bipolar affective disorder. The vast majority of composers who attempted to commit suicide suffered from severe depressive episodes. Progressive paralysis-neurosyphi-lis, as well as alcoholic psychosis were previously mentioned and published in this Journal.",alcohol;adult;aged;alcohol consumption;alcohol psychosis;alcoholism;article;auditory hallucination;bipolar disorder;cause of death;collapse;coma;cyclothymia;delusion;depression;drowning;dysuria;grandiose delusion;hallucination;heart failure;human;hypochondriasis;hypomania;impotence;incontinence;insomnia;kidney calcification;life expectancy;life history;medical history;melancholia;mental hospital;mental instability;middle aged;multiinfarct dementia;muscle weakness;neuropathy;neurosyphilis;painter;panic;paralysis;paranoid personality disorder;paranoid schizophrenia;persecutory delusion;personality disorder;pneumonia;psychosis;schizoaffective psychosis;schizophrenia;senescence;suicide attempt;tuberculosis;uremia;very elderly,"Breitenfeld, T.;Vodanović, M.;Ilić, B.;Breitenfeld, D.;Buljan, D.;Vuksanović, M.;Orešković, A.;Glavina, T.",2013,,,0,
524,Apathetic hyperthroidism,"Among the psychosyndromes least well known to be associated with an endocrinopathy is apathetic hyperthyroidism. This condition is characterized by apathy, lethargy, severe ""senile depression"" and often a high output cardiac failure occurring as the presenting problem.1,2,9 The depressive component of the clinical picture may occur without cardiac complications. Such depressions in the elderly, while refractory to treatment with antidepressant drugs, often respond dramatically to the correction of the underlying endocrine dysfunction.4 It is therefore important to consider ""thyroid melancholia"" in the differential diagnosis of such cases. Given this high index of suspicion, the diagnosis can be fairly easily made.",aged;article;case report;dementia;depression;female;human;hyperthyroidism;major depression;paranoid psychosis;psychological aspect;thyroid function test,"Brenner, I.",1978,,,0,
525,Incident Heart Failure and Cognitive Decline: The Atherosclerosis Risk in Communities Study,"Background Cognitive impairment is found in a significant proportion of patients with heart failure (HF). Although cognitive impairment may be a consequence of HF, early signs of cognitive impairment may also indicate subclinical vascular disease, and thus a risk factor for future cardiovascular events. Methods and Results The Atherosclerosis Risk in Communities Study is a prospective cohort study of the development of atherosclerosis. Cox proportional hazards regression was used to examine the association between mean 6-year change in cognitive function and incident HF in 7962 white and 1933 African-American men and women aged 46 to 70 years and free of clinical stroke. Scores were obtained for the Delayed Word Recall Test, the Digit Symbol Substitution Test (DSST), and the Word Fluency Test. There was a significantly increased risk of developing HF during the mean 12.6-year follow-up period after adjustment for age, gender, race, and education for those in the quartile with the greatest decline in DSST scores (hazard ratio [HR] = 1.17, P = .009), and in the quartile with the lowest baseline DSST scores (HR = 1.43, P < .001). Conclusions The results suggest that relatively low performance on a test of information processing speed may serve as an indicator of HF risk in middle age.",adult;aged;alcohol consumption;article;atherosclerosis;cardiac patient;cardiovascular risk;clinical examination;cognition assessment;cognitive defect;cohort analysis;comparative study;digit symbol substitution test;disease association;disease course;female;follow up;heart failure;human;ICD-9;laboratory test;major clinical study;male;medical record;mental deterioration;neuropsychological test;physical examination;priority journal;psychomotor performance;Wechsler adult intelligence scale;Word Fluency Test;word recognition,"Bressler, J.;Knopman, D. S.;Sharrett, A. R.;Gottesman, R. F.;Penman, A.;Chang, P. P.;Rosamond, W. D.;Boerwinkle, E.;Mosley, T. H.",2017,,10.1016/j.cardfail.2016.11.002,0,
526,Cardiovascular disease and distribution of cognitive function in elderly people: the Rotterdam Study,"OBJECTIVE: To investigate the distribution of cognitive function in elderly people and to assess the impact of clinical manifestations of atherosclerotic disease on this distribution. DESIGN: Single centre population based cross sectional door to door study. SETTING: Ommoord, a suburb of Rotterdam, the Netherlands. SUBJECTS: 4971 subjects aged 55 to 94 years. MAIN OUTCOME MEASURE: Cognitive function as measured by the mini mental state examination. RESULTS: The overall participation rate in the study was 80%. Cognitive test data were available for 90% of the participants. Increasing age and lower educational level were associated with poorer cognitive function. Previous vascular events, presence of plaques in the carotid arteries, and presence of peripheral arterial atherosclerotic disease were associated with worse cognitive performance independent of the effects of age and education. On average the differences were moderate; however, they reflected the net result of a shift of the total population distribution of cognitive function towards lower values. Thereby, they resulted in a considerable increase in the proportion of subjects with scores indicative of dementia. CONCLUSIONS: These findings are compatible with the view that atherosclerotic disease accounts for considerable cognitive impairment in the general population.","Age Distribution;Aged;Aged, 80 and over;Arteriosclerosis/psychology;Cardiovascular Diseases/*psychology;Cerebrovascular Disorders/psychology;Cognition;Cognition Disorders/*etiology;Educational Status;Female;Follow-Up Studies;Humans;Male;Mental Status Schedule;Middle Aged;Myocardial Infarction/psychology;Prospective Studies;Sex Distribution","Breteler, M. M.;Claus, J. J.;Grobbee, D. E.;Hofman, A.",1994,Jun 18,,0,
527,Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs,"OBJECTIVES: To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries. DESIGN: Observational, retrospective study using propensity-based matching. SETTING: A health system in southern California. PARTICIPANTS: Individuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia. All were known to be dead at the time of the retrospective study, were Medicare Advantage beneficiaries, and had 2 years of usage data before death. Median age at death for each disease group was older than 80. INTERVENTION: Home- and clinic-based palliative care (PC) services provided by a multidisciplinary team. MEASUREMENTS: Outcomes included hospital costs, other healthcare costs, readmission rates, hospital admissions and bed days, intensive care unit use in final 30 days of life, and death within 30 days of an admission. RESULTS: Intervention participants in all four disease groups had less hospital use and lower hospital costs nonintervention participants, which drove lower overall healthcare costs. In the final 6 months of life, healthcare costs for the intervention groups stayed largely the same from month to month, whereas costs for comparison participants increased dramatically. CONCLUSION: In the context of an alternative payment model in which the provider was ""at risk"" of bearing the costs of care, a proactive PC program helped to avoid the escalation in hospital use and costs commonly seen in the final months of life.",Medicare Advantage;costs;palliative care;serious illness;utilization,"Brian Cassel, J.;Kerr, K. M.;McClish, D. K.;Skoro, N.;Johnson, S.;Wanke, C.;Hoefer, D.",2016,Sep 2,10.1111/jgs.14354,0,
528,Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs,"Objectives: To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries. Design: Observational, retrospective study using propensity-based matching. Setting: A health system in southern California. Participants: Individuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia. All were known to be dead at the time of the retrospective study, were Medicare Advantage beneficiaries, and had 2 years of usage data before death. Median age at death for each disease group was older than 80. Intervention: Home- and clinic-based palliative care (PC) services provided by a multidisciplinary team. Measurements: Outcomes included hospital costs, other healthcare costs, readmission rates, hospital admissions and bed days, intensive care unit use in final 30 days of life, and death within 30 days of an admission. Results: Intervention participants in all four disease groups had less hospital use and lower hospital costs nonintervention participants, which drove lower overall healthcare costs. In the final 6 months of life, healthcare costs for the intervention groups stayed largely the same from month to month, whereas costs for comparison participants increased dramatically. Conclusion: In the context of an alternative payment model in which the provider was “at risk” of bearing the costs of care, a proactive PC program helped to avoid the escalation in hospital use and costs commonly seen in the final months of life.",aged;article;chronic obstructive lung disease;death;dementia;female;health care utilization;home care;hospice care;hospital admission;hospital charge;hospital cost;human;intensive care unit;life;major clinical study;male;medicare;observational study;outcome assessment;palliative therapy;personal experience;retrospective study;sex;very elderly,"Brian Cassel, J.;Kerr, K. M.;McClish, D. K.;Skoro, N.;Johnson, S.;Wanke, C.;Hoefer, D.",2016,,10.1111/jgs.14354,0,527
529,"Genetics, health and medicine","Advances in genetics are driving a revolution in health care, promising greater understanding of disease, superior tools for prevention and diagnosis, and novel treatments. No one can afford to ignore genetics. In this article, Philippa Brice and Simon Sanderson outline essential knowledge for pharmacists, and consider the immediate and possible long-term impact of genetics on health.",antibiotic agent;apolipoprotein E4;blood clotting factor 5 Leiden;BRCA1 protein;BRCA2 protein;chemokine receptor CCR5;epidermal growth factor receptor 2;trastuzumab;Alzheimer disease;article;asthma;breast cancer;neoplasm;cardiovascular disease;chromosome disorder;clinical genetics;cystic fibrosis;deep vein thrombosis;depression;diabetes mellitus;DNA microarray;Down syndrome;drug efficacy;drug response;gene deletion;gene duplication;gene expression;gene mutation;gene technology;genetic disorder;genetic susceptibility;genetic variability;haplotype;health promotion;heredity;human;human genome project;Human immunodeficiency virus infection;Huntington chorea;inheritance;ischemic heart disease;microbial genetics;molecular evolution;pharmacy;professional knowledge;regulatory DNA sequence;single nucleotide polymorphism;herceptin,"Brice, P.;Sanderson, S.",2006,,,0,
530,The brighter (and evolutionarily older) face of the metabolic syndrome: evidence from Trypanosoma cruzi infection in CD-1 mice,"BACKGROUND: Infection with Trypanosoma cruzi, the protozoan parasite that causes Chagas disease, results in chronic infection that leads to cardiomyopathy with increased mortality and morbidity in endemic regions. In a companion study, our group found that a high-fat diet (HFD) protected mice from T. cruzi-induced myocardial damage and significantly reduced post-infection mortality during acute T. cruzi infection. METHODS: In the present study metabolic syndrome was induced prior to T. cruzi infection by feeding a high fat diet. Also, mice were treated with anti-diabetic drug metformin. RESULTS: In the present study, the lethality of T. cruzi (Brazil strain) infection in CD-1 mice was reduced from 55% to 20% by an 8-week pre-feeding of an HFD to induce obesity and metabolic syndrome. The addition of metformin reduced mortality to 3%. CONCLUSIONS: It is an interesting observation that both the high fat diet and the metformin, which are known to differentially attenuate host metabolism, effectively modified mortality in T. cruzi-infected mice. In humans, the metabolic syndrome, as presently construed, produces immune activation and metabolic alterations that promote complications of obesity and diseases of later life, such as myocardial infarction, stroke, diabetes, Alzheimer's disease and cancer. Using an evolutionary approach, we hypothesized that for millions of years, the channeling of host resources into immune defences starting early in life ameliorated the effects of infectious diseases, especially chronic infections, such as tuberculosis and Chagas disease. In economically developed countries in recent times, with control of the common devastating infections, epidemic obesity and lengthening of lifespan, the dwindling benefits of the immune activation in the first half of life have been overshadowed by the explosion of the syndrome's negative effects in later life.","Adipose Tissue, White/drug effects/*immunology/metabolism/parasitology;Adiposity/drug effects;Animals;Cell Line;Chagas Disease/blood/*immunology/metabolism/parasitology;Cytokines/blood/metabolism;Energy Metabolism/*drug effects;Foreskin/drug effects/immunology/metabolism/parasitology;Heart Ventricles/drug effects/immunology/metabolism/parasitology;Humans;Hypoglycemic Agents/pharmacology/therapeutic use;Leptin/blood/metabolism;Male;Metabolic Syndrome X/drug therapy/etiology/*immunology/parasitology;Metformin/pharmacology/therapeutic use;Mice, Inbred Strains;*Models, Immunological;Obesity/blood/*immunology/metabolism/physiopathology;Random Allocation;Survival Analysis;Trypanosoma cruzi/drug effects/*immunology/isolation & purification/pathogenicity;Trypanosoma cruzi;high-fat diet;infectious disease;metabolic syndrome;metformin;mortality","Brima, W.;Eden, D. J.;Mehdi, S. F.;Bravo, M.;Wiese, M. M.;Stein, J.;Almonte, V.;Zhao, D.;Kurland, I.;Pessin, J. E.;Zima, T.;Tanowitz, H. B.;Weiss, L. M.;Roth, J.;Nagajyothi, F.",2015,May,10.1002/dmrr.2636,0,
531,The goals of patient care project: Implementing a proactive approach to patient-centred decision-making,"Background: Patients in the later stages of their lives risk being harmed by futile or unwanted interventions if realistic care goals and patient values are not recognised. Doctors have difficulty discussing and informing patients' healthcare goals. Aims: To review implementation of a Goals of Patient Care (GOPC) summary in medical inpatients and its applicability in emergency medical response (EMR) situations. Methods: Single-centre cross-sectional study of adult medical inpatients and adult inpatients requiring EMR at a Victorian general hospital. Measures: presence and content of GOPC summary, secondary review of decision-making and discussion documentation, patient characteristics; EMR precipitants and outcomes. Results: GOPC were documented for 82 of 101 patients. One had an existing advance directive, and six had records of a patient-appointed substitute decision-maker. For patients with GOPC, 80 had life-prolonging treatment aims, with a varying degree of treatment limitation in 48. Discussion with patient or substitute decision-maker was evident in 43 cases. GOPC were documented prior to nine of 23 EMR. The EMR triggered a GOPC modification in three instances. Conclusions: Introduction of a routine GOPC summary encourages consideration of goals of care for most medical inpatients. Few have pre-existing records of their wishes, and there are opportunities for improvement in this regard. Doctors may still have difficulty determining goals of care, and discussion of GOPC with patients and families may not be clearly documented. Most patients requiring EMR do not have prior GOPC review, and the role of the summary in these situations remains unclear.",adult;advanced cancer;aged;article;cerebrovascular accident;chronic obstructive lung disease;comorbidity;cross-sectional study;dementia;emergency care;female;heart failure;human;ischemic heart disease;life sustaining treatment;living will;major clinical study;male;observational study;patient decision making;peripheral vascular disease,"Brimblecombe, C.;Crosbie, D.;Lim, W. K.;Hayes, B.",2014,,,0,
532,Characteristics of use and quality of the antibiotic prescription in a general internal medicine ward. Study of pharmacological interactions,,alfuzosin;allopurinol;aminoglycoside;amiodarone;atenolol;captopril;clarithromycin;diltiazem;glipizide;haloperidol;ibuprofen;imipenem;indapamide;levofloxacin;midazolam;moxifloxacin;penicillin G;tazobactam;valproic acid;Acinetobacter baumannii;adult;aged;antimicrobial therapy;asthma;dementia;diabetes mellitus;Escherichia coli;female;Haemophilus influenzae;heart failure;hospital infection;human;hypertension;letter;male;microbial identification;neoplasm;Streptococcus pneumoniae,"Briongos-Figuero, L. S.;Bachiller-Luque, P.;Prada-Lobato, J.;Labajo-Molpeceres, A.;Palacios-Martín, T.",2010,,,0,
533,In-hospital mortality due to infectious disease in an Internal Medicine Department. Epidemiology and risk factors,"OBJECTIVE: Hospital mortality is a leading indicator of quality of healthcare and a valuable tool for planning and management. Infectious diseases represent a substantial part of the activity of internal medicine.Our aim was to describe the characteristics of in-hospital mortality due to infectious diseases and associated risk factors in our environment. MATERIALS AND METHODS: A retrospective case-control study was designed. We reviewed deaths during 2012 from an Internal Medicine Department. 187 cases (infectious disease related mortality) and 224 controls were found. Clinical and demographic information was obtained from medical records. Comorbidity was evaluated with Charlson index (CI). Data were analyzed using SPSS 15.0 (pvalue < 0.05). RESULTS: During 2012, of the 3193 discharge, 187 were exitus due to infectious disease (5.8%). Mean age was 85.7 ± 7.6, higher in women (88 ± 7 vs 83 ± 7.4, p < 0.001), and 55% were aged over 85 years. The CI mean was 4.2 ± 3, higher in younger than 85 years (5.3 ± 3.4 vs 3.6 ± 2.6, p < 0.001). Most frequent causes of death were respiratory sepsis (29%), severe pneumonia (23.5%) and urinary sepsis (16.6%) and risk factors were living in Nursing Home (55.6% vs 34%, p < 0.001), being dependent (73.8% vs. 44.6%, p < 0.001), dementia (59.4% vs 27.2%, p < 0.001) and cerebrovascular disease (25.7% vs 17.4%, p = 0.041). CONCLUSIONS: Dementia, cerebrovascular disease, living in Nursing Home and being dependent were risk factors for infectious disease in-hospital mortality in our study, but not comorbidity, age or length of stay. Our series, although limited by retrospective design, is the first qualitative study of in-hospital mortality due to infectious disease in an Internal Medicine Service in our environment. Most frequent cause of death in our setting was respiratory etiology.",acute heart failure;ADL disability;aged;antibiotic therapy;article;case control study;cause of death;cerebrovascular disease;cognitive defect;comorbidity;controlled study;dementia;female;fever;human;infection;Legionella;major clinical study;male;medical record review;mortality;nursing home;pneumonia;qualitative research;respiratory failure;respiratory tract disease;respiratory tract infection;retrospective study;risk factor;sepsis;Streptococcus pneumoniae;urinary tract infection,"Briongos-Figuero, L. S.;Hernanz-Román, L.;Pineda-Alonso, M.;Vega-Tejedor, G.;Gómez-Traveso, T.;Sañudo-García, S.;Dueñas-Laita, A.;Pérez-Castrillón, J. L.",2015,,,0,
534,The Evans’ Index revisited: New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly,"Background and purpose Assessment of ventricular enlargement is subjective and based on the radiologist's experience. Linear indices, such as the Evans Index (EI), have been proposed as markers of ventricular volume with an EI ≥ 0.3 indicating pathologic ventricular enlargement in any subject. However, normal range for EI measured on magnetic resonance imaging (MRI) scans are lacking in healthy elderly according to age and sex. We propose new age and sex specific cut-off values for ventricular enlargement in the elderly population. Materials and methods 534 participants (53% women) aged 65–84 years; 226 patients with Alzheimer's disease (AD), and 308 healthy elderly controls (CTR) from the AddNeuroMed and ADNI studies were included. The cut-off for pathological ventricular enlargement was estimated from healthy elderly categorized into age groups of 5 years range and defined as EI 97,5 percentile (mean + 2SD). Cut-off values were tested on patients with Alzheimer's disease and a small sample of patients with probable idiopathic normal pressure hydrocephalus (iNPH) to assess the sensitivity. Results The range of the EI in healthy elderly is wide and 29% of the CTR had an EI of 0.3 or greater. The EI increases with age in both CTR and AD, and the overall EI for women were lower than for men (p < 0.001). New EI cut off values for male/female: 65–69 years 0.34/0.32, 70–74 years 0.36/0.33, 75–79 years 0.37/0.34 and 80–84 years 0.37/0.36. When applying the proposed cut-offs for EI in men and women aged 65–84, they differentiated between iNPH and CTR with a sensitivity of 80% and for different age and sex categories of AD and CTR with a sensitivity and specificity of 0–27% and 91–98%, respectively. Conclusion The range of the EI measurements in healthy elderly is wide, and a cut-off value of 0.3 cannot be used to differentiate between normal and enlarged ventricles in individual cases. The proposed EI thresholds from the present study show good sensitivity for the iNPH diagnosis.",age distribution;aged;Alzheimer disease;article;cardiac imaging;cardiovascular disease assessment;clinical practice;controlled study;Evans Index;female;heart ventricle hypertrophy;heart volume;human;major clinical study;male;normotensive hydrocephalus;outcome assessment;priority journal;sensitivity and specificity;sex difference,"Brix, M. K.;Westman, E.;Simmons, A.;Ringstad, G. A.;Eide, P. K.;Wagner-Larsen, K.;Page, C. M.;Vitelli, V.;Beyer, M. K.",2017,,10.1016/j.ejrad.2017.07.013,0,
535,Age-associated diseases and conditions: Implications for decreasing late life morbidity,"We discuss two types of age-associated diseases; aging-dependent such as Alzheimer's disease and congestive heart failure which increase logarithmically with age, versus age-dependent such as multiple sclerosis and amyotrophic lateral sclerosis which occur at proscribed ages, and then occurrence of new cases ceases or diminishes with further aging. Prevention strategies with both types emphasize postponement or delay of onset. The non-fatal aging-dependent diseases and conditions are an accumulating burden as we age, and increase overall morbidity in late years. These include Alzheimer's disease and other dementias, Parkinson's disease, loss of vision and hearing, incontinence, osteoporosis and hip fracture, osteoarthritis and depression. With mortality postponed, we will be living for many years at old and vulnerable ages. Life's quality will be reasonable for most. Still, increasing the chance that all will experience this desirable outcome requires pursuing the means to delay the onset of the physical and social events which we categorize as the non-fatal aging dependent diseases and conditions. We must recognize that each added year occurs at the tip of an exponential curve where risk is maximal.",age;aged;aging;algorithm;Alzheimer disease;amyotrophic lateral sclerosis;article;congestive heart failure;controlled study;dementia;depression;experience;hearing impairment;hip fracture;human;incontinence;morbidity;mortality;multiple sclerosis;osteoarthritis;osteoporosis;outcomes research;Parkinson disease;quality of life;risk assessment;social aspect;visual impairment,"Brody, J. A.;Grant, M. D.",2001,,,0,
536,Referring patients to hospice or palliative care,"NPs care for patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, cancer, and dementia. As the disease progresses or patients age, disease-related symptoms may become increasingly burdensome, and these patients may benefit from hospice or palliative care. NPs can guide individuals in this process to optimize care and support at the end of life.",,"Broglio, K.;Walsh, A.",2017,Apr 16,,0,
537,Interaction between topical miconazole and coumarins,,acenocoumarol;bisacodyl;carvedilol;chlortalidone;flecainide;fosinopril;furosemide;glimepiride;losartan;metformin;metoprolol;miconazole;phenprocoumon;simvastatin;sotalol;valproic acid;vitamin K group;aged;blood clotting disorder;case report;cerebrovascular accident;congestive heart failure;dementia;dermatomycosis;diabetes mellitus;drug dose reduction;drug potentiation;drug withdrawal;female;heart arrhythmia;atrial fibrillation;human;international normalized ratio;intertrigo;letter;mycosis;perianal mycosis;priority journal;side effect;single drug dose,"Broos, N.;Van Puijenbroek, E. P.",2010,,,0,
538,Mortality after hip fracture: A three year follow-up study,"BACKGROUND AND OBJECTIVE: We designed this study to know the mortality rate of hip fractures after 3 years of follow-up. PATIENTS AND METHOD: We admitted 194 patients with hip fractures (cases) from our reference hospitals and 184 without hip fractures (control) who were selected from an ambulatory health centre. After 3 years, morbidity and mortality causes were analyzed using medical records. RESULTS: Mortality rate in cases was 40% compared with only 16.5% in patients without hip fracture (control group) (p = 0,000; non adjusted RR = 2.4; adjusted RR = 3.9). In the multivariant analysis, age (RR = 1.1), heart failure (RR = 2.5), neoplasia (RR = 3.5), dementia (RR = 5) and hip fracture were independently associated with mortality after 3 years of follow-up. CONCLUSIONS: Patients with hip fracture showed a higher mortality (24%) than those without hip fracture after 3 years of follow-up.",age distribution;aged;article;controlled study;dementia;disease activity;disease course;female;follow up;health center;heart failure;hip fracture;hospital admission;human;major clinical study;male;medical record;mortality;multivariate analysis;neoplasm,"Brossa Torruella, A.;Tobias Ferrer, J.;Zorrilla Ribeiro, J.;López Borras, E.;Alabart Teixidó, A.;Belmonte Garrido, M.",2005,,,0,
539,Dementia testing in the elderly,Cognitive testing with the Dementia Rating Scale was performed serially over an 18-month period in 410 nursing home patients. The principal findings were: deterioration in patients with congestive failure but not cerebrovascular accident: continuous deterioration in organic mental syndrome cases in relation to initial severity; specific impairment of memory in patients on neuroleptics; and no evidence that the nursing home environment alone induced cognitive decline.,"Aged;Aged, 80 and over;Antipsychotic Agents/adverse effects;Cerebrovascular Disorders/complications/psychology;Cognition Disorders/diagnosis/etiology/psychology;Dementia/*diagnosis/etiology/psychology;Female;*Geriatric Assessment;Heart Failure/complications/psychology;Humans;Male;Middle Aged;Neuropsychological Tests/*standards;Nursing Homes;Psychometrics;Severity of Illness Index;Social Environment","Brown, J. W.;Chobor, A.;Zinn, F.",1993,Nov,,0,
540,Molecular basis of mitochondrial DNA disease,"Mitochondrial ATP production via oxidative phosphorylation (OXPHOS) is essential for normal function and maintenance of human organ systems. Since OXPHOS biogenesis depends on both nuclear- and mitochondrial-encoded gene products, mutations in both genomes can result in impaired electron transport and ATP synthesis, thus causing tissue dysfunction and, ultimately, human disease. Over 30 mitochondrial DNA (mtDNA) point mutations and over 100 mtDNA rearrangements have now been identified as etiological factors in human disease. Because of the unique characteristics of mtDNA genetics, genotype/phenotype associations are often complex and disease expression can be influenced by a number of factors, including the presence of nuclear modifying or susceptibility alleles. Accordingly, these mutations result in an extraordinarily broad spectrum of clinical phenotypes ranging from systemic, lethal pediatric disease to late-onset, tissue-specific neurodegenerative disorders. In spite of its complexity, an understanding of the molecular basis of mitochondrial DNA disease will be essential as the first step toward rationale and permanent curative therapy.",mitochondrial DNA;Alzheimer disease;cardiomyopathy;diabetes mellitus;electron transport;gene rearrangement;hearing impairment;human;lactic acidosis;mitochondrial myopathy;myoclonus epilepsy;nonsense mutation;nucleic acid base substitution;oxidative phosphorylation;Parkinson disease;pathogenesis;point mutation;short survey,"Brown, M. D.;Wallace, D. C.",1994,,,0,
541,15-Site randomized trial of coordinated care in medicare FFS,"Medicare beneficiaries in fee-for-service (FFS) who had chronic illnesses and volunteered to participate in 15 care coordination programs were randomized to treatment or control status. Nurses provided patient education (mostly by telephone) to improve adherence and ability to communicate with physicians. Patients were contacted an average of two times per month. The findings after 2 years are not encouraging. Few programs improved patient behaviors, health, or quality of care. The treatment group had significantly fewer hospitalizations in only one program; no program reduced gross or net expenditures. However, effects may be observed when 4 years of followup are available and sample sizes increase.",adult;aged;article;chronic disease;clinical trial;congestive heart failure;controlled clinical trial;controlled study;coronary artery disease;dementia;diabetes mellitus;health care;health care availability;health care cost;health care quality;health insurance;health program;hospitalization;human;major clinical study;medical fee;medicare;nurse;patient care;patient compliance;patient education;physician;randomized controlled trial;telemonitoring,"Brown, R.;Peikes, D.;Chen, A.;Schore, J.",2008,,,0,
542,Variation in Do-Not-Resuscitate Orders and Implications for Heart Failure Risk-Adjusted Hospital Mortality Metrics,"Objectives This study evaluated the effect of patient do-not-resuscitate (DNR) status on hospital risk-adjusted heart failure mortality metrics. Background Do-not-resuscitate orders limit the use of life-sustaining therapies. Patients with DNR orders have increased in-hospital mortality, and DNR rates vary among hospitals. Variations in DNR rates could strongly confound risk-adjusted hospital mortality rates for heart failure. Methods We identified a cohort of adults with primary diagnosis of heart failure by using the 2011 California State Inpatient Database, a claims database that captures “early DNR,” within 24 h of admission. Hospital-level risk-standardized in-hospital mortality was determined using random effects logistic regression. We explored changes in outlier status in models with and without early DNR status. Results Among 55,865 patients from 290 hospitals hospitalized with heart failure, 12.1% (11.8% to 12.4%) had an early DNR order. Hospitals with higher risk-standardized DNR rates had higher risk-standardized mortality (ρ = 0.241; 95% confidence interval [CI]: 0.129 to 0.346; p < 0.001). Including DNR in models used to benchmark hospital mortality improved model performance (c-statistic from 0.821 [95% CI: 0.812 to 0.830] to 0.845 [95% CI: 0.837 to 0.853]; increased model explanatory power by 17%). Including DNR resulted in reclassification of 9.3% of hospitals’ outlier status. Agreement in hospital outlier designation between models with and without DNR was low to moderate (kappa coefficient: 0.492; 95% CI: 0.331 to 0.654). Conclusions Accounting for DNR status resulted in a change in estimated risk-standardized mortality rates and classification of hospitals as performance “outliers.” Given public reporting of heart failure mortality measurements and their influence on reimbursement, accounting for the presence of early DNR orders in quality measures should be considered.",acute coronary syndrome;age;aged;article;benchmarking;cohort analysis;comorbidity;controlled study;dementia;diabetes mellitus;do not resuscitate order;female;heart arrhythmia;heart failure;hospital admission;hospital mortality;human;intensive care;leukemia;major clinical study;male;metastasis;mortality rate;prediction;priority journal;reimbursement;sex,"Bruckel, J.;Mehta, A.;Bradley, S. M.;Thomas, S.;Lowenstein, C. J.;Nallamothu, B. K.;Walkey, A. J.",2017,,10.1016/j.jchf.2017.07.010,0,
543,Studying the effectiveness of palliative care 1,,acquired immune deficiency syndrome;chronic obstructive lung disease;congestive heart failure;dementia;home care;hospice care;human;letter;medical practice;motor neuron disease;neoplasm;outpatient department;palliative therapy;priority journal;teleconsultation,"Bruera, E.",2008,,,0,
544,"Glycohistochemical characterization of vascular muscle cell destruction in CADASIL subjects by lectins, neoglycoconjugates and galectin-specific antibodies","CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a type of small-artery stroke and vascular dementia-inducing pathology of the brain. In order to explain the molecular mechanisms behind the alterations to the blood vessels in CADASIL subjects, we scrutinized the expression of glycan and glycan-binding sites in the wall of vessels taken from five such subjects (vs. five control subjects matched for age and sex). Specimens were taken from the brain, heart, kidney, liver and lung. Although the main vessel lesions were observed in the tissues depending on the blood-brain barrier, alterations to systemic vessels were also observed despite the absence of any symptoms. The histochemical expression of a panel of 10 biotinylated neoglycoconjugates [Gal-β(1-4)-D-Glc, Galβ(1-3)GalNAc, α-D-GalNAc, β-D-GalNAc, GalNAcα(1-3)-D-GalNAcα, GalNAcα(1-3)-D-GalNAcβ, β-D-Glc, α-D-Man, L-Fucose and D-Glcα(1-4)-D-Glc], eight plant lectins (PNA, MAA, SNA, DBA, WGA, ConA, GNA and UEA-1) and two antigalectin antibodies was monitored by means of semiquantitative and quantitative computer-assisted microscopy. The data show the altered histochemical binding of plant lectins, such as UEA-1 and ConA, in the vessel walls of CADASIL subjects. The present work, based upon staining by a panel of neoglycoconjugates, provides a biochemical characterization of the alteration of vessel walls in the brain compared to other organs including the heart, kidney, lung and liver in CADASIL as opposed to control subjects. These glycohistochemical results suggest a functional relevance of protein-carbohydrate interactions in this disease.",antibody;fucose;galactose;galectin antibody;glycan;glycoconjugate;lectin;mannose;oligosaccharide;unclassified drug;age;antibody specificity;article;biotinylation;blood brain barrier;brain;CADASIL;cerebral artery disease;clinical article;computer analysis;controlled study;female;gender;heart;histochemistry;human;human tissue;kidney;liver;lung;male;microscopy;molecular biology;neuropathology;pathogenesis;priority journal;protein interaction;quantitative analysis;smooth muscle fiber;staining;symptom;vascular smooth muscle,"Brulin-Fardoux, P.;Godfrain, C.;Maurage, C. A.;De Reuck, J.;Hauw, J. J.;Kaltner, H.;Bovin, N. V.;Gabius, H. J.;Ruchoux, M. M.;Kiss, R.;Camby, I.",2003,,,0,
545,Neuropathology of late life,"In the oldest age group of dementia, patients dying after age 80, 38 cases were studied clinically and neuropathologically. In comparison with dementia cases dying at younger ages the disease panorama differed in important respects. In the older age group frontal lobe dementia of non-Alzheimer type was entirely absent but trauma was much more common as were also cerebrovascular diseases. Dementia of the Alzheimer type was in many cases milder than in younger age groups and a mild, subclinical Alzheimer encephalopathy often complicated the cerebrovascular disorders. In this context, it may be of interest that some of the patients died from diseases not directly connected with the dementing disorder such as heart failure, cancer and pulmonary embolism, suggesting that the dementing disorders did not necessarily represent an end stage. Contrary to our previous opinion Alzheimer disease in these aged patients was of a very long duration, in many cases lasting 7-13 years. Labile blood pressure and orthostatism presented further prominent problems. The mild Alzheimer changes, in 1 case precluding a distinct diagnosis, may be taken as a harbinger of the vague changes found in 3 centenarians, 2 of whom had dementia. They suffered from changes of an Alzheimer encephalopathy of a subclinical severity, mild frontal white matter degeneration and a loss of frontal cortical neurons, changes that would be difficult to diagnose in life and which may be the cause of the real dementia of the senium.",aged;aging;Alzheimer disease;article;controlled study;dementia;female;human;human tissue;major clinical study;male,"Brun, A.;Gustafson, L.;Samuelsson, S. M.;Ericsson, C.",1992,,,0,
546,Again a horror message: Analgesics increase Alzheimer's risk!?,,analgesic agent;celecoxib;prostaglandin synthase;rofecoxib;Alzheimer disease;comparative study;heart infarction;note;pain;risk,"Brune, K.",2009,,,0,
547,Erotomania Variants in Dementia,"Erotomania is a delusional syndrome in which an affected individual is convinced that another person loves him or her. Erotomania usually occurs in middle-aged female patients. Only 3 cases have been described in dementia so far. The authors report 2 cases, in Alzheimer's disease and vascular dementia, in which erotomania emerged in the early stage of the underlying disorder. In both cases, erotomania partially responded to antipsychotic treatment. Erotomania may be understood in evolutionary terms as a pathologic deviation of an evolved psychological mechanism relating to mate selection and may therefore account for the typical sex distribution of the syndrome in favor of women and the onset of the disorder, usually during the late reproductive phase. The association of erotomania with dementing disorders may tentatively be interpreted to suggest that such complex psychological mechanisms and behaviors as involved here in ""organic"" delusions may have distinct, ""hard-wired"" representations in the human brain.",donepezil;memantine;neuroleptic agent;quetiapine;risperidone;sertraline;aged;Alzheimer disease;anamnesis;article;case report;clinical examination;clinical feature;delusion;dementia;diet restriction;disease association;disease course;disorientation;drug response;erotomania;female;heart infarction;hospital admission;human;hypertension;ischemic heart disease;male;mate choice;medical record;Mini Mental State Examination;multiinfarct dementia;neurologic examination;onset age;paranoid psychosis;physical examination;priority journal;psychosis;reproduction;sex ratio;syndrome,"Brüne, M.;Schröder, S. G.",2003,,,0,
548,"Fish, human health and marine ecosystem health: Policies in collision","Background: Health recommendations advocating increased fish consumption need to be placed in the context of the potential collapse of global marine capture fisheries. Methods Literature overview. Results: In economically developed countries, official healthy eating advice is to eat more fish, particularly that rich in omega-3 oils. In many less economically developed countries, fish is a key human health asset, contributing ≥20% of animal protein intake for 2.6 billion people. Marine ecologists predict on current trends that fish stocks are set to collapse in 40 years, and propose increased restrictions on fishing, including no-take zones, in order to restore marine ecosystem health. Production of fishmeal for aquaculture and other non-food uses (22 MT in 2003) appears to be unsustainable. Differences in fish consumption probably contribute to within-country and international health inequalities. Such inequalities are likely to increase if fish stocks continue to decline, while increasing demand for fish will accelerate declines in fish stocks and the health of marine ecosystems. Conclusions: Urgent national and international action is necessary to address the tensions arising from increasing human demand for fish and seafood, and rapidly declining marine ecosystem health. © The Author 2008; all rights reserved.",fish oil;methylmercury;omega 3 fatty acid;polychlorinated biphenyl;aquaculture;article;asthma;atopy;cognitive defect;defibrillator;dementia;developed country;diet supplementation;environmental health;environmental management;environmental sustainability;fat intake;fish;fish stock;fishing;food intake;food security;government regulation;heart arrhythmia;heart protection;human;law;marine environment;primary prevention;priority journal;protein intake;risk benefit analysis;social justice;stable angina pectoris;water contamination,"Brunner, E. J.;Jones, P. J. S.;Friel, S.;Bartley, M.",2009,,,0,
549,Cause of death in patients with dementia disorders,"BACKGROUND: Investigations on cause of death may provide valuable information about life expectancy and on conditions of terminal dementia care, which perhaps can be ameliorated. METHODS: The autopsy reports were studied on all patients (n = 524; 55.3% females; median age 80 years) with a clinically and neuropathologically diagnosed dementia disorder who underwent a complete autopsy at the University Hospital in Lund, Sweden, during 1974-2004. RESULTS: The two most common causes of death were bronchopneumonia (38.4%) and ischaemic heart disease (23.1%), whilst neoplastic diseases were uncommon (3.8%). In a general population of elderly studied for comparison, bronchopneumonia accounted for 2.8%, ischaemic heart disease for 22.0%, and neoplasm for 21.3% of the deaths. Amongst the demented patients, circulatory and respiratory system diseases were the causes of death in 23.2% and 55.5% of the Alzheimer patients, respectively, whilst the corresponding figures were 54.8% and 33.1% for the patients with vascular dementia. CONCLUSIONS: In patients with dementia, pneumonia as the immediate cause of death may reflect a terminal stage in which patient care and feeding is difficult to manage well. Knowledge about what actually causes death is of value in the terminal care of patients with dementia disorders.","Adult;Aged;Aged, 80 and over;Alzheimer Disease/complications/mortality;Bronchopneumonia/complications/mortality;Cause of Death;Dementia/*complications/*mortality;Dementia, Vascular/complications/mortality;Female;Humans;Male;Middle Aged;Myocardial Ischemia/complications/mortality;Neoplasms/complications/mortality;Respiratory Tract Diseases/complications/mortality;Vascular Diseases/complications/mortality","Brunnstrom, H. R.;Englund, E. M.",2009,Apr,10.1111/j.1468-1331.2008.02503.x,0,
550,"Proinflammatory cytokines, antibodies to Chlamydia pneumoniae and age-associated diseases in Danish centenarians: Is there a link?","Plasma levels of tumour necrosis factor (TNF)-α levels increase with age. High levels are associated with dementia and atherosclerosis in centenarians. Chlamydia pneumoniae induces the production of proinflammatory cytokines and has been related to the pathogeneses of Alzheimer's disease and cardiovascular diseases. The purpose of this study was to test the hypothesis that circulating levels of TNF-α represent a link between C. pneumoniae, high prevalences of dementia and cardiovascular diseases in 126 Danish centenarians. IgA antibody titres against C. pneumoniae were linearly correlated with high plasma levels of TNF-α in centenarians. However, both parameters were also correlated with total IgA in the blood and the association between C. pneumoniae IgA and TNF-α was not significant when total IgA was included in a multiple linear regression model. Accordingly, the association between C. pneumoniae-specific IgA and TNF-α may reflect immune activation rather than a specific antibody response. No associations were found between antibodies to C. pneumoniae and dementia or cardiovascular diseases. Although TNF-α is likely to be involved in the pathogenesis of atherosclerosis and dementia, the present study does not support the hypothesis that TNF-α represents a link between chronic C. pneumoniae infection and these disorders.",bacterium antibody;cytokine;immunoglobulin A;tumor necrosis factor alpha;age;aged;Alzheimer disease;antibody response;antibody titer;article;cardiovascular disease;Chlamydia pneumoniae;controlled study;coronary artery atherosclerosis;correlation analysis;cytokine production;dementia;Denmark;disease association;elderly care;female;human;hypothesis;immune response;linear regression analysis;major clinical study;male;pathogenesis;prevalence,"Bruunsgaard, H.;Østergaard, L.;Andersen-Ranberg, K.;Jeune, B.;Pedersen, B. K.",2002,,,0,
551,Vitamin C in health and disease,"Vitamins are essential to maintain normal metabolic processes and homeostasis within the body. The amount of a specific vitamin required by an individual varies considerably and it is influenced by such factors as body size, growth rate, physical activity, and pregnancy. Most vitamins are stored minimally in human cells, but some are stored in liver cells to a greater extent. Vitamins A and D, for example, may be stored in sufficient amounts to maintain an individual without any intake for 5 to 10 months and 2 to 4 months, respectively. However, a deficiency of vitamin B compounds (except vitamin B12) may be noted within days, and the lack of vitamin C will manifest within weeks and may result in death in 5 to 6 months. The current recommended dietary allowance (RDA) of vitamin C is 75 mg for woman and 90 mg for men, based on the vitamin's role as an antioxidant as well as protection from deficiency. High intakes of the vitamin are generally well tolerated, however, a Tolerable Upper Level (TUL) was recently set at 2 g based on gastrointestinal upset that sometimes accompanies excessive dosages. Several populations warrant special attention with respect to vitamin C requirements. These include patients with periodontal disease, smokers, pregnant and lactating women, and the elderly.",ascorbic acid;retinol;vitamin B group;vitamin D;Alzheimer disease;antineoplastic activity;antioxidant activity;article;ascorbic acid deficiency;body size;cardiovascular disease;common cold;congestive heart failure;dental caries;dental health;dentin;diabetes mellitus;diarrhea;drug effect;drug efficacy;drug megadose;drug safety;drug tolerability;fracture healing;gastrointestinal disease;geriatric care;growth rate;herpes simplex;human;Human immunodeficiency virus infection;hypertension;iron deficiency anemia;ischemic heart disease;kidney transplantation;lactation;nausea;nephrolithiasis;nutritional requirement;periodontal disease;physical activity;pregnancy;protection;age related macular degeneration;scurvy;smoking;virus infection;vitamin metabolism;vitamin supplementation,"Bsoul, S. A.;Terezhalmy, G. T.",2004,,,0,
552,Analyses of male residents in community nursing facilities: Comparisons of Veterans Health Administration residents to other residents,"We compared Veterans Health Administration (VHA) residents in community nursing facilities to other residents. We used all admission assessments in the Minimum Data Set throughout the United States during 2000 to identify 7,296 male VHA residents and 159,203 other male residents in community nursing facilities. Male VHA residents were significantly more independent in the self-performance of activities of daily living and less physically disabled than other male residents, with minor differences in cognitive function as measured by a Cognitive Performance Scale. Male VHA residents were more likely to have comorbidities than other male residents. Significantly larger proportions of other male residents than VHA residents received special treatments and procedures, with especially large differences for various therapies (e.g., physical therapy). We found significant differences in the demographic and clinical characteristics of male VHA residents in community nursing facilities compared with other male residents. These differences in the delivery of services may have implications for the quality of care for veterans in this setting.",antidepressant agent;anxiolytic agent;diuretic agent;hypnotic sedative agent;neuroleptic agent;adult;aged;Alzheimer disease;anemia;article;behavior;cerebrovascular accident;chronic obstructive lung disease;cognition;community care;comorbidity;congestive heart failure;daily life activity;decubitus;dementia;depression;diabetes mellitus;disability;emphysema;functional assessment;health care facility;hospice care;human;hypertension;infection;major clinical study;male;medicaid;medicare;mental disease;mental health;nursing home;occupational therapy;oxygen therapy;pain assessment;patient coding;physical disability;physiotherapy;priority journal;private health insurance;psychotherapy;rating scale;soldier;speech therapy,"Buchanan, R. J.;Johnson, C.;Wang, S.;Cowper, D. C.;Myung, S. K.;Reker, D.",2004,,,0,
553,Novel mutation of the NOTCH3 gene in a Polish family with CADASIL,"Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited small blood vessels disease caused by mutations in the gene encoding the neurogenic locus notch homolog protein 3 (NOTCH 3). We present a Polish family with a previously unreported novel mutation in exon 12 c.1851C>C/G of the NOTCH3 gene and varying disease expression. One of the two family members with the confirmed mutation presented with all the main CADASIL symptoms; while, his affected father was nearly asymptomatic. Both family members had epilepsy, coronary artery disease, and abdominal aorta aneurysm. Our observation confirms there is phenotypic variability in CADASIL not only between, but also within, families carrying the same mutation.",cysteine;Notch3 receptor;tryptophan;abdominal aorta aneurysm;adult;aged;aneurysm rupture;article;atrial septal aneurysm;brain ischemia;CADASIL;clinical article;cognition;coronary artery disease;depression;disease severity;epilepsy;genetic screening;heart aneurysm;heart ejection fraction;heart failure;human;Huntington chorea;male;middle aged;missense mutation;neuroimaging;nuclear magnetic resonance imaging;Polish citizen;post infarction heart failure;skin blood vessel;very elderly;white matter,"Buczek, J.;Błażejewska-Hyżorek, B.;Cudna, A.;Lusawa, M.;Lewandowska, E.;Kurkowska-Jastrzębska, I.;Członkowska, A.",2016,,,0,
554,Trends in comorbidity in patients hospitalised for cardiovascular disease,"BACKGROUND: We determined trends over time in cardiovascular and non-cardiovascular comorbidity in patients hospitalised for cardiovascular disease (CVD). METHODS: The Dutch nationwide hospital register was used to identify patients hospitalised for CVD during 2000-2010. Comorbidity was defined as a previous hospital admission for CVD other than the index CVD, cancer, diabetes, musculoskeletal and connective tissue disorders, respiratory disorders, thyroid gland disorders, kidney disorders and dementia in the five years previous to hospital admittance for the index CVD. Trends were calculated in strata of age and sex and for different types of CVD: coronary heart disease (CHD), cerebrovascular disease (CVA), heart failure (HF) and peripheral arterial disease (PAD). RESULTS: We identified 2,397,773 admissions for CVD between 2000 and 2010. Comorbidity was present in 38%. In HF, PAD, CHD and CVA this was 54%, 46%, 40%, and 32%, respectively. Between 2000 and 2010, the percentage of patients with comorbidity increased (+1.1%), this increase was most pronounced in patients >/=75years (+3.0%). Cardiovascular disease was the most frequent comorbid condition, though became less prevalent over time (men -5%; women: -2%), whereas non-cardiovascular comorbidity increased in men (+4%), and remained similar in women (-1%). Cancer was the most common non-cardiovascular comorbid condition and increased in men and women (men: +5%; women: +4%). CONCLUSIONS: Comorbid conditions are highly prevalent in patients hospitalised for CVD, especially HF and PAD patients. In older patients, prevalences increased over time. Cardiovascular diseases were the most common comorbid condition, though the prevalence decreased over the study period whereas the prevalence of cancer increased.",Cardiovascular disease;Comorbidity;Epidemiology;Trends,"Buddeke, J.;Bots, M. L.;van Dis, I.;Liem, A.;Visseren, F. L. J.;Vaartjes, I.",2017,Dec 01,,0,
555,Occurrence of IgA subclasses (IgA1 and IgA2) in the human nervous system. Correlation with disease,"The occurrence of IgA subclasses in pathological conditions of the nervous system was studied by means of monoclonal antibodies and an indirect immunofluorescence technique. IgA1- and/or IgA2-positive lymphoid (plasma) cells were found in demyelinating diseases comprising multiple sclerosis, Guillain-Barre syndrome, and adrenoleukodystrophy, in various inflammatory diseases, and in tumors, some of which exhibited labeling of tumor cells. Demyelinating and inflammatory diseases with chronic course displayed some prevalence of IgA2-, and tumors some prevalence of IgA1-positive cells. This is the first demonstration of IgA1 and IgA2 in the nervous system.","Alzheimer Disease/immunology;Demyelinating Diseases/immunology;Humans;Immunoglobulin A/*classification;Intestinal Mucosa/cytology;Lymph Nodes/cytology;Myocardial Infarction/immunology;Neoplasms, Nerve Tissue/immunology;Nerve Tissue/*immunology;Nervous System Diseases/*immunology;Neuritis/immunology","Budka, H.;Bernheimer, H.;Haaijman, J. J.;Radl, J.",1985,,,0,
556,Haloperidol in states of psychomotor excitation and in anxiety states secondary to acute cardiocirculatory insufficiency,,Aged;Anxiety Disorders/*drug therapy;Coronary Disease/*complications;Dementia/*complications;Female;Haloperidol/*therapeutic use;Heart Diseases/*complications;Humans;Hypertension/*complications;Male;Schizophrenia/*complications,"Buffa, B.;Cotta Ramusino, M.;Muti, M.",1966,Dec 31,,0,
557,Exclusion of patients with concomitant chronic conditions in ongoing randomised controlled trials targeting 10 common chronic conditions and registered at ClinicalTrials.gov: a systematic review of registration details,"OBJECTIVES: To systematically assess registration details of ongoing randomised controlled trials (RCTs) targeting 10 common chronic conditions and registered at ClinicalTrials.gov and to determine the prevalence of (1) trial records excluding patients with concomitant chronic condition(s) and (2) those specifically targeting patients with concomitant chronic conditions. DESIGN: Systematic review of trial registration records. DATA SOURCES: ClinicalTrials.gov register. STUDY SELECTION: All ongoing RCTs registered from 1 January 2014 to 31 January 2015 that assessed an intervention targeting adults with coronary heart disease (CHD), hypertension, heart failure, stroke/transient ischaemic attack, atrial fibrillation, type 2 diabetes, chronic obstructive pulmonary disease, painful condition, depression and dementia with a target sample size >/=100. DATA EXTRACTION: From the trial registration records, 2 researchers independently recorded the trial characteristics and the number of exclusion criteria and determined whether patients with concomitant chronic conditions were excluded or specifically targeted. RESULTS: Among 319 ongoing RCTs, despite the high prevalence of the concomitant chronic conditions, patients with these conditions were excluded in 251 trials (79%). For example, although 91% of patients with CHD had a concomitant chronic condition, 69% of trials targeting such patients excluded patients with concomitant chronic condition(s). When considering the co-occurrence of 2 chronic conditions, 31% of patients with chronic pain also had depression, but 58% of the trials targeting patients with chronic pain excluded patients with depression. Only 37 trials (12%) assessed interventions specifically targeting patients with concomitant chronic conditions; 31 (84%) excluded patients with concomitant chronic condition(s). CONCLUSIONS: Despite widespread multimorbidity, more than three-quarters of ongoing trials assessing interventions for patients with chronic conditions excluded patients with concomitant chronic conditions.",Primary care;chronic condition;external validity;multimorbidity;randomized controlled trials,"Buffel du Vaure, C.;Dechartres, A.;Battin, C.;Ravaud, P.;Boutron, I.",2016,Sep 27,10.1136/bmjopen-2016-012265,0,
558,"Diagnostic certainty, co-morbidity and medication in a primary care population with presumed airway obstruction: The DIDASCO2 study","Study Objectives: To document the rate of diagnostic certainty, co-morbidity and use of medication in patients with presumed obstructive airway disease (OAD) in a primary care setting. Methods: Twenty-six general practitioners (GPs) were asked to select the last 50 contacts with patients older than 40 years of age who were taking bronchodilators and/or inhaled corticosteroids or who had known OAD. After reviewing their medical data on file, the GPs gave their diagnostic opinion and rated their certainty about the diagnosis using a Likert-type scale. Results: Analysis of 1126 files revealed that in at least 523 patients (46.4%), a diagnostic work-up was judged necessary. The GPs judged that 6% of the patients had no OAD. Less than 33% of the study population underwent spirometry during the two years preceding the survey. The number of co-morbid conditions was on average 2.2 for patients with asthma and 3.2 for patients with COPD. Patients with presumed COPD took significantly more drugs (mean, 5.1; 95% CI, 4.8-5.3) than did patients with other diagnostic labels (mean, 4.6 95%; CI, 4.4-4.8). Conclusions: We confirmed the underuse of spirometry as a diagnostic tool in presumed airway obstruction in primary care. Nearly half of the patients older than 40 years who were taking bronchodilators and/or inhaled corticosteroids needed a diagnostic work-up. This population had a high prevalence of co-morbidity and polypharmacy. © 2009 General Practice Airways Group. All rights reserved.",acetylcysteine;antihistaminic agent;beta adrenergic receptor stimulating agent;bronchodilating agent;cholinergic receptor blocking agent;corticosteroid;leukotriene receptor blocking agent;theophylline;aged;airway obstruction;alcoholism;article;asthma;chronic obstructive lung disease;comorbidity;dementia;depression;diabetes mellitus;female;general practitioner;atrial fibrillation;heart failure;human;hypertension;ischemic heart disease;likert type scale;major clinical study;male;medical record review;neoplasm;obesity;osteoporosis;peripheral vascular disease;primary medical care;rating scale;social problem;spirometry;cerebrovascular accident;transient ischemic attack,"Buffels, J.;Degryse, J.;Liistro, G.",2009,,,0,
559,Dementia treatment update,,alcohol;alpha tocopherol;amiodarone;antidepressant agent;antiinflammatory agent;anxiolytic agent;calcium;carbonate dehydratase inhibitor;cholinergic receptor blocking agent;diltiazem;donepezil;galantamine;Ginkgo biloba extract;hormone;hydrochlorothiazide;hydroxymethylglutaryl coenzyme A reductase inhibitor;ketoconazole;memantine;neuroleptic agent;neuroprotective agent;nonsteroid antiinflammatory agent;nootropic agent;piracetam;rifampicin;rivastigmine;selegiline;suxamethonium;tacrine;unindexed drug;vaccine;aged;Alzheimer disease;anorexia;article;body weight disorder;bradycardia;central nervous system disease;clinical trial;confusion;constipation;cost benefit analysis;diarrhea;digestive system ulcer;dizziness;drug absorption;drug antagonism;drug efficacy;drug induced headache;drug mechanism;drug potentiation;drug preference;drug safety;drug synthesis;drug withdrawal;fatigue;food drug interaction;gastrointestinal disease;gastrointestinal hemorrhage;heart infarction;human;incontinence;insomnia;muscle cramp;nausea;risk benefit analysis;faintness;unpleasant dream;vaccination;vomiting;weight reduction;aricept;cognex;exelon;namenda;reminyl,"Buffum, M. D.;Buffum, J. C.",2005,,,0,
560,New pharmacological strategies to increase cGMP,"The intracellular nucleotide cyclic guanosine monophosphate (cGMP) is found in many human organ tissues. Its concentration increases in response to the activation of receptor enzymes called guanylyl cyclases (GCs). Different ligands bind GCs, generating the second messenger cGMP, which in turn leads to a variety of biological actions. A deficit or dysfunction of this pathway at the cardiac, vascular, and renal levels manifests in cardiovascular diseases such as heart failure, arterial hypertension, and pulmonary arterial hypertension. An impairment of the cGMP pathway also may be involved in the pathogenesis of obesity as well as dementia. Therefore, agents enhancing the generation of cGMP for the treatment of these conditions have been intensively studied. Some have already been approved, and others are currently under investigation. This review discusses the potential of novel drugs directly or indirectly targeting cGMP as well as the progress of research to date.",angiotensin receptor;cyclic GMP;enkephalinase inhibitor;guanylate cyclase activator;natriuretic factor;phosphodiesterase inhibitor;phosphodiesterase V;article;cardiovascular disease;drug targeting;enzyme deficiency;human;metabolic disorder;priority journal;signal transduction,"Buglioni, A.;Burnett, J. C.",2016,,,0,
561,Recurrent Fat Embolic Strokes in a Patient With Duchenne Muscular Dystrophy With Long Bone Fractures and a Patent Foramen Ovale,"Background Individuals with Duchenne muscular dystrophy have an increased risk of long bone fractures. Such fractures are sometimes associated with brain dysfunction due to fat embolism syndrome, although this syndrome has seldom been documented in muscular dystrophy patients. Patient Description We describe a child with Duchenne muscular dystrophy who developed fat embolism syndrome with neurological dysfunction following multiple long bone fractures. He experienced recurrent cerebral infarctions that probably resulted from embolization through a patent foramen ovale. The patent foramen ovale was closed by an occluder device in the cardiac catheterization laboratory, and he did not experience further infarctions. Conclusions Fat embolism with ischemic cerebral infarction can occur in individuals with Duchenne muscular dystrophy following long bone fractures. In this setting it is important to identify and close atrial level shunts in order to prevent additional infarctions.",acetylsalicylic acid;naloxone;adolescent;airway pressure;article;atrial septal occluder;Babinski reflex;blood cell count;brain infarction;cardiovascular magnetic resonance;case report;cerebrovascular accident;clonus;differential diagnosis;distal femur fracture;Duchenne muscular dystrophy;echocardiography;fat embolism;frontal lobe;Glasgow coma scale;hemiparesis;human;leukocytosis;male;mental deterioration;neuroimaging;parietal lobe;patent foramen ovale;priority journal;proximal tibia fracture;recurrent disease;respiratory failure;seizure;somnolence;temporal lobe;transthoracic echocardiography;white matter,"Bugnitz, C. J.;Cripe, L. H.;Lo, W. D.;Flanigan, K. M.",2016,,,0,
562,Mental disorders: All specialties are needed,,article;bipolar depression;clinical practice;cooperation;dementia;depression;diabetes mellitus;health care quality;human;incidence;interdisciplinary communication;ischemic heart disease;medical specialist;mental disease;patient care;psychological aspect;psychosomatics;psychotherapy;risk factor;schizophrenia;social aspect;stress,"Bühren, A.;Voderholzer, U.;Schulte-Markwort, M.;Loew, T. H.;Neitscher, F.;Hohagen, F.;Berger, M.",2008,,,0,
563,Guidance when Applying the Canadian Triage and Acuity Scale (CTAS) to the Geriatric Patient: Executive Summary,,acute coronary syndrome;aged;arterial stiffness;article;breathing rate;Canadian Triage and Acuity Scale;cerebrovascular accident;cognitive defect;dementia;dyspnea;elderly care;emergency ward;falling;hospital information system;human;pain assessment;palliative therapy;polypharmacy;systolic blood pressure;temperature;transient ischemic attack,"Bullard, M. J.;Melady, D.;Emond, M.;Musgrave, E.;Unger, B.;Van Der Linde, E.;Grierson, R.;Skeldon, T.;Warren, D.;Swain, J.",2017,,10.1017/cem.2017.363,0,
564,The influence of psychiatric comorbidity on perioperative outcomes following primary total hip and knee arthroplasty; A 17-year analysis of the national hospital discharge survey database,"Studies conflict regarding the impact of psychiatric illnesses including depression, anxiety, dementia and schizophrenia on perioperative outcomes following total hip (THA) and knee arthroplasty (TKA). Psychiatric comorbidity incidence, in-hospital adverse events, discharge disposition, and mortality were assessed for THA or TKA patients between 1990 and 2007 using the US National Hospital Discharge Survey. A cohort representative of 8,379,490 patients was identified and analyzed using multivariable regression analysis. Diagnoses of depression, dementia and schizophrenia were associated with increased odds of adverse events (P < 0.001). Schizophrenia and depression were associated with higher odds of perioperative blood transfusion (P < 0.001). All psychiatric comorbidities were associated with higher odds of non-routine discharge (P < 0.001). Diagnosis of dementia was associated with higher in-hospital mortality (P < 0.001).",acute heart infarction;acute kidney failure;adult;aged;anemia;anxiety disorder;article;blood transfusion;controlled study;deep vein thrombosis;dementia;depression;female;hospital discharge;human;intubation;lung embolism;lung insufficiency;major clinical study;male;mental disease;pneumonia;postoperative complication;postoperative infection;postoperative thrombosis;schizophrenia;shock;surgical mortality;surgical risk;total hip prosthesis;total knee replacement;treatment outcome;wound complication,"Buller, L. T.;Best, M. J.;Klika, A. K.;Barsoum, W. K.",2015,,,0,
565,Comorbidity does not predict long-term mortality after total hip arthroplasty,"Background and purpose — In-hospital death following total hip arthroplasty (THA) is related to comorbidity. The long-term effect of comorbidity on all-cause mortality is, however, unknown for this group of patients and it was investigated in this study. Patients and methods — We used data from the Swedish Hip Arthroplasty Register, linked to the National Patient Register from the National Board of Health and Welfare, for patients operated on with THA in 1999–2012. We identified 120,836 THAs that could be included in the study. We evaluated the predictive power of the Charlson and Elixhauser comorbidity indices on mortality, using concordance indices calculated after 5, 8, and 14 years after THA. Results — All comorbidity indices performed poorly as predictors, in fact worse than a base model with age and sex only. Elixhauser was, however, the least bad choice and it predicted mortality with concordance indices 0.59, 0.58, and 0.56 for 5, 8, and 14 years after THA. Interpretation — Comorbidity indices are poor predictors of long-term mortality after THA.",acquired immune deficiency syndrome;aged;alcohol abuse;anemia;article;blood clotting disorder;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;congestive heart failure;dementia;depression;diabetes mellitus;diabetic complication;disease severity;diseases;drug abuse;electrolyte disturbance;Elixhauser comorbidity index;female;follow up;heart arrhythmia;heart infarction;hemiplegia;human;hypertension;hypothyroidism;kidney failure;liver disease;lymphoma;major clinical study;male;metastasis;neurologic disease;obesity;paralysis;paraplegia;peptic ulcer;peripheral vascular disease;psychosis;rheumatic disease;rheumatoid arthritis;solid malignant neoplasm;surgical mortality;survival prediction;Swedish citizen;total hip prosthesis;valvular heart disease;weight reduction,"Bülow, E.;Rolfson, O.;Cnudde, P.;Rogmark, C.;Garellick, G.;Nemes, S.",2017,,10.1080/17453674.2017.1341243,0,
566,"Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation","Outcomes in Patients With AF. Introduction: Atrial fibrillation (AF) adversely impacts mortality, stroke, heart failure, and dementia. AF ablation eliminates AF in most patients. We evaluated the long-term impact of AF ablation on mortality, heart failure (HF), stroke, and dementia in a large system-wide patient population. Methods: A total of 4,212 consecutive patients who underwent AF ablation were compared (1:4) to 16,848 age/gender matched controls with AF (no ablation) and 16,848 age/gender matched controls without AF. Patients were enrolled from the large ongoing prospective Intermountain AF study and were followed for at least 3 years. Results: Of the 37,908 patients, mean age 65.0 ± 13 years, 5,667 (14.9%) died, 1,296 (3.4%) had a stroke, and 1,096 (2.9%) were hospitalized for HF over >3 years of follow-up. AF ablation patients were less likely to have diabetes, but were more likely to have hypertension, HF, and significant valvular heart disease. AF ablation patients had a lower risk of death and stroke in comparison to AF patients without ablation. Alzheimer's dementia occurred in 0.2% of the AF ablation patients compared to 0.9% of the AF no ablation patients and 0.5% of the no AF patients (P < 0.0001). Other forms of dementia were also reduced significantly in those treated with ablation. Compared to patients with no AF, AF ablation patients had similar long-term rates of death, dementia, and stroke. Conclusions: AF ablation patients have a significantly lower risk of death, stroke, and dementia in comparison to AF patients without ablation. AF ablation may eliminate the increased risk of death and stroke associated with AF. © 2011 Wiley Periodicals, Inc.",adult;aged;Alzheimer disease;article;catheter ablation;controlled study;diabetes mellitus;female;follow up;atrial fibrillation;heart failure;human;hypertension;major clinical study;male;mortality;priority journal;cerebrovascular accident;treatment outcome;valvular heart disease,"Bunch, T. J.;Crandall, B. G.;Weiss, J. P.;May, H. T.;Bair, T. L.;Osborn, J. S.;Anderson, J. L.;Muhlestein, J. B.;Horne, B. D.;Lappe, D. L.;Day, J. D.",2011,,,0,
567,Atrial Fibrillation Patients Treated With Long-Term Warfarin Anticoagulation Have Higher Rates of All Dementia Types Compared With Patients Receiving Long-Term Warfarin for Other Indications,"BACKGROUND: The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. We previously found a significantly increased risk of dementia in AF patients taking warfarin with a low percentage of time in therapeutic range. The purpose of this study was to determine the extent to which AF itself increases dementia risk, in addition to long-term anticoagulation exposure. METHODS AND RESULTS: A total of 10 537 patients anticoagulated with warfarin (target INR 2-3), managed by the Clinical Pharmacist Anticoagulation Service with no history of dementia were included. Warfarin indication was for AF (n=4460), thromboembolism (n=5868), and mechanical heart valve(s) (n=209). Patients in the latter 2 categories were included only if they had no prior history of AF. The primary outcome was dementia. Patients with AF were older and had higher rates of hypertension, diabetes, heart failure, and stroke. AF patients experienced higher rates of total dementia (5.8% versus 1.6%, P<0.0001), Alzheimer disease (2.8% versus 0.9%, P<0.0001), and vascular dementia (1.0% versus 0.2%, P<0.0001). A propensity analysis of 6030 patients was performed to account for baseline demographics differences. Long-term risk of dementia remained significant in AF patients compared with matched non-AF patients (total dementia: hazard ratio [HR]=2.42 [1.85-3.18], P<0.0001; Alzheimer: HR=2.04 [1.40-2.98], P<0.0001; senile: HR=2.46 [1.58-3.86], P<0.0001). Low percent therapeutic range compared with a higher percent therapeutic range was associated with dementia risk in both AF (26-50% versus >75%: HR=2.51, P=0.005) and non-AF groups (</=25% versus >75%: HR=3.92, P<0.0001). CONCLUSIONS: The presence of AF significantly increases risk of dementia, including Alzheimer's disease, compared with matched patients receiving warfarin anticoagulation for other reasons. Quality of anticoagulation management remains an important risk factor for dementia in all patients.",Alzheimer disease;anticoagulant drugs;atrial fibrillation;cognition;dementia,"Bunch, T. J.;May, H. T.;Bair, T. L.;Crandall, B. G.;Cutler, M. J.;Day, J. D.;Jacobs, V.;Mallender, C.;Osborn, J. S.;Stevens, S. M.;Weiss, J. P.;Woller, S. C.",2016,Jul 11,10.1161/jaha.116.003932,0,
568,"Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia","BACKGROUND: The aging population has resulted in more patients living with cardiovascular disease, such as atrial fibrillation (AF). Recent focus has been placed on understanding the long-term consequences of chronic cardiovascular disease, such as a potential increased risk of dementia. OBJECTIVE: This study sought to determine whether there is an association between AF and dementia and whether their coexistence is an independent marker of risk. METHODS: A total of 37,025 consecutive patients from the large ongoing prospective Intermountain Heart Collaborative Study database were evaluated and followed up for a mean of 5 years for the development of AF and dementia. Dementia was sub-typed into vascular (VD), senile (SD), Alzheimer's (AD), and nonspecified (ND). RESULTS: Of the 37,025 patients with a mean age of 60.6 +/- 17.9 years, 10,161 (27%) developed AF and 1,535 (4.1%) developed dementia (179 VD, 321 SD, 347 AD, 688 ND) during the 5-year follow-up. Patients with dementia were older and had higher rates of hypertension, coronary artery disease, renal failure, heart failure, and prior strokes. In age-based analysis, AF independently was significantly associated with all dementia types. The highest risk was in the younger group (<70). After dementia diagnosis, the presence of AF was associated with a marked increased risk of mortality (VD: hazard ratio [HR] = 1.38, P = .01; SD: HR = 1.41, P = .001; AD: HR = 1.45; ND: HR = 1.38, P <.0001). CONCLUSION: AF was independently associated with all forms of dementia. Although dementia is strongly associated with aging, the highest risk of AD was in the younger group, in support of the observed association. The presence of AF also identified dementia patients at high risk of death.","Adult;Aged;Alzheimer Disease/*complications/mortality;Atrial Fibrillation/*complications/mortality;Dementia, Vascular/*complications/mortality;Female;Humans;Male;Middle Aged;Risk Factors","Bunch, T. J.;Weiss, J. P.;Crandall, B. G.;May, H. T.;Bair, T. L.;Osborn, J. S.;Anderson, J. L.;Muhlestein, J. B.;Horne, B. D.;Lappe, D. L.;Day, J. D.",2010,Apr,10.1016/j.hrthm.2009.12.004,0,
569,Right ventricular dysfunction in the R6/2 transgenic mouse model of Huntington's disease is unmasked by dobutamine,"BACKGROUND: Increasingly, evidence from studies in both animal models and patients suggests that cardiovascular dysfunction is important in HD. Previous studies measuring function of the left ventricle (LV) in the R6/2 model have found a clear cardiac abnormality, albeit with preserved LV systolic function. It was hypothesized that an impairment of RV function might play a role in this condition via mechanisms of ventricular interdependence. OBJECTIVE: To investigate RV function in the R6/2 mouse model of Huntington's disease (HD). METHODS: Cardiac cine-magnetic resonance imaging (MRI) was used to determine functional parameters in R6/2 mice. In a first experiment, these parameters were derived longitudinally to determine deterioration of cardiac function with disease progression. A second experiment compared the response to a stress test (using dobutamine) of wildtype and early-symptomatic R6/2 mice. RESULTS: There was progressive deterioration of RV systolic function with age in R6/2 mice. Furthermore, beta-adrenergic stimulation with dobutamine revealed RV dysfunction in R6/2 mice before any overt symptoms of the disease were apparent. CONCLUSIONS: This work adds to accumulating evidence of cardiovascular dysfunction in R6/2 mice, describing for the first time the involvement of the right ventricle. Cardiovascular dysfunction should be considered, both when treatment strategies are being designed, and when searching for biomarkers for HD.","Animals;*Cardiac Imaging Techniques;Disease Models, Animal;Disease Progression;Dobutamine;Huntington Disease/complications/*physiopathology;Longitudinal Studies;*Magnetic Resonance Imaging, Cine;Mice;Mice, Transgenic;Stroke Volume/physiology;Sympathomimetics;Ventricular Dysfunction, Right/etiology/*physiopathology;Huntington's Disease;Mri;cognitive function;heart failure;right ventricle","Buonincontri, G.;Wood, N. I.;Puttick, S. G.;Ward, A. O.;Carpenter, T. A.;Sawiak, S. J.;Morton, A. J.",2014,,10.3233/jhd-130083,0,
570,"Growth, disease and ageing: a unified approach",,"Adolescent;Adult;Aged;*Aging;Alopecia/epidemiology;Arcus Senilis/epidemiology;Arthritis, Rheumatoid/epidemiology;*Autoimmune Diseases;Breast Neoplasms/epidemiology;Child;Coronary Disease/epidemiology;Dementia/epidemiology;Diabetes Mellitus/epidemiology;Female;Femoral Neck Fractures/epidemiology;Geriatric Dentistry;*Growth;Humans;Male;Middle Aged;Mutation;Prostatic Neoplasms/epidemiology;Retinal Detachment/epidemiology;Spinal Diseases/epidemiology;Urinary Bladder Neoplasms/epidemiology","Burch, P. R.;Jackson, D.;Rowell, N. R.",1972,,,0,
571,Family practitioner and carbon monoxide poisoning,"Carbon monoxide poisoning is not easily identifiable. It is the first cause of death by accidental poisoning in Europe. The family practitioner, who has not been made aware of this problem, incurs the risk of diagnostic indecision or of involuntary personal poisoning. Since symptomatology is non specific, the general practitioner answering housecalls is sometimes confronted with an urgent medical problem linked to the complications of this intoxication (coronary, neurological problems...), without having ways of documenting its origin of the poisoning or any means to protect himself. Through direct contact with his patients' environment, the family practitioner, being made sensitive to this problem, can certainly contribute to care aid aftercare of the patient suffering from carbon monoxide poisoning, but also to the prevention of this public health problem often called ""the silent killer"".",aftercare;article;awareness;carbon monoxide intoxication;clinical feature;coma;consciousness disorder;death;dementia;diagnostic test;environmental factor;Europe;general practitioner;heart infarction;mental disease;Parkinson disease;patient care;risk factor;survival,"Burette, P.;Vanmeerbeek, M.;Boüüaert, C.;Giet, D.",2006,,,0,
572,Mendelian Randomization Implicates High-Density Lipoprotein Cholesterol-Associated Mechanisms in Etiology of Age-Related Macular Degeneration,"PURPOSE: Undertake a systematic investigation into associations between genetic predictors of lipid fractions and age-related macular degeneration (AMD) risk. DESIGN: Two-sample Mendelian randomization investigation using published data. PARTICIPANTS: A total of 33 526 individuals (16 144 cases, 17 832 controls) predominantly of European ancestry from the International Age-related Macular Degeneration Genomics Consortium. METHODS: We consider 185 variants previously demonstrated to be associated with at least 1 of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, or triglycerides at a genome-wide level of significance, and test their associations with AMD. We particularly focus on variants in gene regions that are proxies for specific pharmacologic agents for lipid therapy. We then conduct a 2-sample Mendelian randomization investigation to assess the causal roles of LDL-cholesterol, HDL-cholesterol, and triglycerides on AMD risk. We also conduct parallel investigations for coronary artery disease (CAD) (viewed as a positive control) and Alzheimer's disease (a negative control) for comparison. MAIN OUTCOME MEASURES: Diagnosis of AMD. RESULTS: We find evidence that HDL-cholesterol is a causal risk factor for AMD, with an odds ratio (OR) estimate of 1.22 (95% confidence interval [CI], 1.03-1.44) per 1 standard deviation increase in HDL-cholesterol. No causal effect of LDL-cholesterol or triglycerides was found. Variants in the CETP gene region associated with increased circulating HDL-cholesterol also associate with increased AMD risk, although variants in the LIPC gene region that increase circulating HDL-cholesterol have the opposite direction of association with AMD risk. Parallel analyses suggest that lipids have a greater role for AMD compared with Alzheimer's disease, but a lesser role than for CAD. CONCLUSIONS: Some genetic evidence suggests that HDL-cholesterol is a causal risk factor for AMD risk and that increasing HDL-cholesterol (particularly via CETP inhibition) will increase AMD risk.","0 (CETP protein, human);0 (Cholesterol Ester Transfer Proteins);0 (Cholesterol, HDL);0 (Cholesterol, LDL);0 (Triglycerides);Aged;Cholesterol Ester Transfer Proteins/genetics;Cholesterol, HDL/blood/ genetics;Cholesterol, LDL/blood/genetics;Female;Genetic Association Studies;Genetic Variation;Genotype;Humans;Macular Degeneration/ epidemiology/ genetics;Male;Mendelian Randomization Analysis;Middle Aged;Odds Ratio;Polymorphism, Single Nucleotide;Risk Factors;Triglycerides/blood/genetics","Burgess, S.;Davey Smith, G.",2017,Aug,,0,
573,Nocturnal enuresis in community-dwelling older adults,"OBJECTIVE: To investigate the prevalence and characteristics of nocturnal enuresis in community-dwelling older adults and to identify potential predisposing variables. DESIGN: Interview survey. SETTING: Five rural counties in northwestern Pennsylvania. PARTICIPANTS: Subjects were 3884 community-dwelling older adults aged 65 to 79 years who volunteered for a health promotion demonstration. MEASUREMENTS: The dependent variable was self-reported accidental loss of urine during sleep. Independent variables included demographic variables, self-reported disease history and symptomatology, and standardized screening instruments for depression (CES-D), dementia (MMSE), and functional status (ADLs). MAIN RESULTS: Prevalence of nocturnal enuresis was 2.1%, and was significantly higher among women (2.9%) compared with men (1.0%; P < .0001). Compared with subjects with daytime incontinence only, those with nocturnal enuresis reported greater severity and impact of incontinence on several parameters. Enuretics were more likely to have received treatment; treatment outcome, however, was significantly less successful. In univariate analyses, enuresis was significantly associated with symptoms of congestive heart failure (CHF), impairment in activities of daily living, depression, and use of sleep medications at least once per week. In stepwise logistic regression modeling, two symptoms of congestive heart failure and regular use of sleep medication entered the model. CONCLUSIONS: Nocturnal enuresis appears to be uncommon among older adults, but it may be associated with poorer therapeutic outcomes compared with the more common forms of daytime incontinence. The findings are consistent with the hypothesis that daytime fluid accumulation followed at night by mobilization of excess fluid is a contributor to enuresis in older adults.",Aged;Analysis of Variance;Causality;Enuresis/*epidemiology/*etiology/therapy;Female;Geriatric Assessment;Humans;Logistic Models;Male;Pennsylvania/epidemiology;Prevalence;Rural Health;*Sleep;Surveys and Questionnaires;Treatment Outcome,"Burgio, K. L.;Locher, J. L.;Ives, D. G.;Hardin, J. M.;Newman, A. B.;Kuller, L. H.",1996,Feb,,0,
574,Beta-1-Selective Beta-Blockers and Cognitive Functions in Patients With Coronary Artery Disease: A Cross-Sectional Study,"The association between current beta-1-selective beta-blocker use and cognitive function was evaluated in 722 patients with coronary artery disease without dementia. Beta-1-selective beta-blocker use was associated with worse incidental learning independently of sociodemographic characteristics, clinical coronary artery disease severity, and depression/anxiety.",,"Burkauskas, J.;Noreikaite, A.;Bunevicius, A.;Brozaitiene, J.;Neverauskas, J.;Mickuviene, N.;Bunevicius, R.",2016,Spring,10.1176/appi.neuropsych.15040088,0,
575,Determining strokeês rank as a cause of death using multicause mortality data,"BACKGROUND AND PURPOSE-: Stroke has fallen second to the fourth leading cause of death in the United States without large declines in stroke incidence or case fatality. We explored whether this decline may be attributable to changes in mortality attribution methodology. METHODS-: Multicause mortality files from 2000 to 2008 were used to compare changes in reporting of stroke as underlying cause of death (UCOD) with changes in death certificates reporting any mention (AMCOD) of stroke. In addition, the UCOD/AMCOD ratio was calculated for the 6 leading organ and disease-specific causes of death. If stroke mortality is underestimated by the system of mortality attribution, we hypothesized that we would find: (1) a greater decline in stroke as UCOD than as AMCOD; and (2) a decline in the UCOD/AMCOD ratio compared with other causes of death. RESULTS-: Age-adjusted death rates for stroke as UCOD (61 per 100 000 in 2000 versus 41 in 2008) and AMCOD (102 per 100 000 versus 68) both declined by 33%. The ratio of UCOD to AMCOD for stroke did not change over time (0.595 in 2000 versus 0.598 in 2008). Changes in UCOD/AMCOD ratio for the diagnoses that surpassed stroke as UCOD were too small (no change for lung cancer and a slight increase from 0.49 to 0.52 for chronic lower respiratory diseases) to explain stroke's decline as UCOD. CONCLUSION-: Changes in mortality attribution methodology are not likely responsible for stroke's decline as a leading cause of death. The discordant trends in incidence, case fatality, and mortality require further study. © 2012 American Heart Association, Inc.",age distribution;algorithm;Alzheimer disease;article;cardiovascular mortality;cause of death;comparative study;death certificate;human;incidence;information processing;ischemic heart disease;lower respiratory tract infection;lung cancer;population distribution;priority journal;cerebrovascular accident,"Burke, J. F.;Lisabeth, L. D.;Brown, D. L.;Reeves, M. J.;Morgenstern, L. B.",2012,,,0,
576,Traumatic brain injury may be an independent risk factor for stroke,"Objective: To explore whether traumatic brain injury (TBI) may be a risk factor for subsequent ischemic stroke. Methods: Patients with any emergency department visit or hospitalization for TBI (exposed group) or non-TBI trauma (control) based on statewide emergency department and inpatient databases in California from 2005 to 2009 were included in a retrospective cohort. TBI was defined using the Centers for Disease Control definition. Our primary outcome was subsequent hospitalization for acute ischemic stroke. The association between TBI and stroke was estimated using Cox proportional hazards modeling adjusting for demographics, vascular risk factors, comorbidities, trauma severity, and trauma mechanism. Results: The cohort included a total of 1,173,353 trauma subjects, 436,630 (37%) with TBI. The patients with TBI were slightly younger than the controls (mean age 49.2 vs 50.3 years), less likely to be female (46.8%vs 49.3%), and had a higher mean injury severity score (4.6 vs 4.1). Subsequent stroke was identified in 1.1%of the TBI group and 0.9%of the control group over a median followup period of 28 months (interquartile range 14-44). After adjustment, TBI was independently associated with subsequent ischemic stroke (hazard ratio 1.31, 95% confidence interval 1.25-1.36). Conclusions: In this large cohort, TBI is associated with ischemic stroke, independent of other major predictors. © 2013 American Academy of Neurology.",adult;article;brain hemorrhage;brain ischemia;chronic obstructive lung disease;comorbidity;concussion;congestive heart failure;controlled study;coronary artery disease;dementia;diabetes mellitus;disease association;emergency ward;female;follow up;atrial fibrillation;hospital patient;hospitalization;human;hyperlipidemia;hypertension;injury scale;injury severity;kidney disease;major clinical study;male;neoplasm;peptic ulcer;peripheral vascular disease;priority journal;rheumatology;risk;risk factor;skull fracture;stroke risk;traumatic brain injury;United States,"Burke, J. F.;Stulc, J. L.;Skolarus, L. E.;Sears, E. D.;Zahuranec, D. B.;Morgenstern, L. B.",2013,,,0,
577,Chronic Health Illnesses as Predictors of Mild Cognitive Impairment Among African American Older Adults,"Approximately 5.5 million individuals are diagnosed with Alzheimer's disease (AD) dementia, a number which includes those with mild cognitive impairment and asymptomatic individuals with biomarkers of AD. There is a higher incidence of mild cognitive impairment (MCI) in African American populations as compared to White populations, even when controlling for sociodemographic factors. The existing body of ethnically/racially targeted research on MCI has been limited by few studies with the ability to generalize to African Americans communities. This study sought to examine whether medical conditions which occur at a higher rate in African American individuals increase the hazard of subsequent MCI development.A secondary data analysis of the National Alzheimer's Coordinating Center Uniform Data Set was employed to examine the associations between health conditions (congestive heart failure, traumatic brain injury, diabetes, hypertension, hypercholesterolemia, B12 deficiency, thyroid disease) and their relationship to MCI. The analytic sample included 2847 participants with 9872 observations. Binary logistic generalized estimating equation modeling was used to examine repeated measures over the course of 1-11 observations. Education was associated with MCI development, specifically those with some college or college graduates (p < 0.001) and more than college (p = 0.002). Female sex was associated with development of MCI (p < 0.001). African Americans with traumatic brain injury (TBI) were more likely to develop MCI (p < 0.001) compared to those with no reports of a TBI. Inactive thyroid conditions decreased the risk of MCI development (p = 0.005) compared to those without thyroid disease.Though vascular factors are often attributed to higher mortality and neurodegeneration in African Americans, congestive heart failure, diabetes, high cholesterol, hypertension, diabetes, nor seizures were associated with an increased risk of MCI development. Findings from this study provide formative data to develop targeted interventions for subsets of the African American community, including those with higher educational levels, those with TBI, and those with a history of thyroid disease. While it may not be possible to prevent MCI development, it is possible to modify lifestyle behaviors contributing to these health conditions, such as falls that are often experienced by older adults. Practitioners can increase awareness, knowledge, and resources relevant to clients.",adult;African American;Alzheimer disease;awareness;congestive heart failure;controlled study;data analysis;diabetes mellitus;diagnosis;disease duration;education;female;human;human tissue;hypercholesterolemia;hypertension;lifestyle;major clinical study;mild cognitive impairment;mortality;nerve degeneration;nutritional deficiency;participant observation;physician;prevention;seizure;statistical model;thyroid disease;traumatic brain injury;cholesterol,"Burke, S. L.;Cadet, T.;Maddux, M.",2017,,10.1016/j.jnma.2017.06.007,0,
578,Diagnostic efficiency of cystatin C and serum creatinine as markers of reduced glomerular filtration rate in the elderly,"This is a secondary analysis of data from a cross-sectional study to evaluate the diagnostic efficiency of cystatin C as a marker of the glomerular filtration rate in the elderly. Thirty patients (15 male, 15 female, mean age 75.4 +/- 7.1 years) attending a geriatric ward were enrolled. Exclusion criteria were previously diagnosed renal disease, dementia and heart failure (NYHA III or IV). Cystatin C in serum was determined by a particle-enhanced turbidimetric assay. Inulin clearance was assessed using a single-shot method. Also, Cockcroft-Gault formula was calculated. Twelve patients had a reduced glomerular filtration rate (<70 ml/min/ 1.73 m2). The mean values were 88.4 micromol/l (+/- 27.7) for serum creatinine, 1.57 mg/l (+/- 0.34) for cystatin C and 88.7 ml/min/1.73 m2 (+/- 34.6) for inulin clearance. Maximum efficiency was 0.73 for serum creatinine (cut-off limit 82 micromol/l), 0.67 for cystatin C (cut-off limit 1.63 mg/l) and 0.8 for Cockcroft and Gault estimation (cut-off limit 54 ml/min/1.73 m2). A receiver operating characteristics (ROC) analysis did not show any differences between the various methods. Therefore, cystatin C in serum may not improve the diagnostic efficiency in detecting a reduced glomerular filtration rate in the elderly. Furthermore, normal ranges for serum creatinine in the elderly might need to be adjusted.",Age Factors;Aged;Biomarkers/blood;Creatinine/*blood;Cross-Sectional Studies;Cystatin C;Cystatins/*blood;Female;*Glomerular Filtration Rate;Humans;Inulin/blood;Male;Metabolic Clearance Rate;Nephelometry and Turbidimetry/methods;ROC Curve;Sensitivity and Specificity,"Burkhardt, H.;Bojarsky, G.;Gladisch, R.",2002,Nov,10.1515/cclm.2002.199,0,
579,"Creatinine clearance, Cockcroft-Gault formula and cystatin C: estimators of true glomerular filtration rate in the elderly?","BACKGROUND: The aim of this study was to assess the accuracy and precision of estimators of true glomerular filtration rate (GFR) (Cockcroft formula, measured creatinine clearance (CCR) and a cystatin-C-based estimation) in elderly patients attending a geriatric department. Additionally, parameters influencing GFR in the elderly were evaluated. METHODS: 30 patients aged 57-90 years treated in the Geriatric Department for pulmonary or cerebral diseases were included in the study. Nine patients were diabetic and 16 hypertensive. Exclusion criteria were advanced dementia, acute heart failure and primary renal disease. Inulin clearance (CINU), CCR and estimation by Cockcroft-Gault equation (CG) were performed on the same day. For comparison of the methods an analysis according to Bland and Altman was used, depicting the mean difference between the methods and the limits of agreement of the differences, representing their 95% interval of confidence. Furthermore, the influence of confounding variables on GFR estimation was analyzed by multiple regression. RESULTS: Baseline characteristics showed a median age of 74.5 years and a median body weight of 66.7 kg. Median values for serum creatinine 88.4 micromol/l, 5.74 mmol/l for urea and 1.57 mg/l for cystatin C. CCR (median: 51.6 ml/min) and CG (median: 63.0 ml/min) underestimated CINU (median: 83.3 ml/min). Both methods showed poor precision compared with CINU. The upper limit of agreement of the difference was 101.3 ml/min for CCR and 81.4 ml/min for CG, the lower limit was -33.8 ml/min for CCR and -24.6 ml/min for CG. Among frequently used variables to predict GFR, the reciprocal of serum creatinine and body weight revealed a significant influence but not age or gender. A cystatin-C-based estimation of GFR, derived from regression analysis, did not improve the precision of the estimation of GFR compared to CG. Additionally, the occurrence of diabetes mellitus disclosed a borderline influence on the estimation of GFR. CONCLUSION: CCR is not only inconvenient and time consuming, but also imprecise and inaccurate in the elderly, mainly due to reduced muscle mass and erroneous urine sampling. CG and a cystatin-C-based estimation are slightly more adequate, but overall there is no sufficiently precise formula for GFR estimation in the elderly.",*Aged;Creatinine/blood;Cystatin C;Cystatins/blood;Female;*Glomerular Filtration Rate;Humans;Kidney/*physiology/physiopathology;Male;Sensitivity and Specificity,"Burkhardt, H.;Bojarsky, G.;Gretz, N.;Gladisch, R.",2002,May-Jun,52832,0,
580,"Utility of the APACHE IV, PPI, and combined APACHE IV with PPI for predicting overall and disease-specific ICU and ACU mortality","BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) IV and Palliative Performance Index (PPI) are scales commonly used to assess prognosis in intensive care units (ICUs) and acute care units (ACUs). OBJECTIVE: To compare the utility of APACHE IV, PPI, and combined APACHE IV with PPI for predicting overall and disease-specific mortality. DESIGN: This is a prospective cohort study using admission data during the first 24 hours. Chi-square contingency tables were used to analyze mortality data for each scale. SETTING: This study was conducted at a community hospital. PATIENTS: Participants were admitted between December 24, 2008 and April 2, 2010. RESULTS: The APACHE IV, PPI, and APACHE IV plus PPI (n = 599) were significant for predicting overall mortality (P < .0001 each). The APACHE IV was also significant in predicting mortality in patients with congestive heart failure (CHF), pulmonary edema (PULEDEM), stroke (cerebrovascular accident [CVA]), terminal or metastatic cancer (CA), and dementia. The PPI was significant for predicting mortality in PULEDEM, CA, and dementia but not CVA or CHF, while the APACHE IV with PPI was significant for all diseases but CVA. The APACHE IV was the most robust in predicting ICU/ACU mortality. The combined APACHE IV and PPI improved the specificity of the PPI to predict mortality but caused a decline in sensitivity. LIMITATIONS: Limitations are due to the subjective nature of the PPI and Glasgow Coma scale (GCS), differences in illness trajectories, and a lack of reliable follow-up of all participants. CONCLUSION: The benefits of combining scales were best exemplified in participants with dementia. Inconsistencies in the predictive value of specific participant populations are likely due to difference in the illness trajectories of disease processes.",*Apache;Adult;Aged;Cohort Studies;Female;*Glasgow Coma Scale;*Hospital Mortality;Humans;Intensive Care Units;Male;Middle Aged;Outcome Assessment (Health Care);Palliative Care/*organization & administration;Predictive Value of Tests;Prognosis;Prospective Studies;Reproducibility of Results;Sensitivity and Specificity;*Severity of Illness Index;Surveys and Questionnaires/*standards;Young Adult,"Burkmar, J. A.;Iyengar, R.",2011,Aug,10.1177/1049909110396504,0,
581,"Efficacy and safety of donepezil over 3 years: An open-label, multicentre study in patients with Alzheimer's disease","Objective: This 132-week, open-label extension study assessed the long-term efficacy and safety of donepezil in 579 patients with mild to moderate Alzheimer's disease (AD) who had previously participated in a 24-week double-blind study of 5 or 10 mg/day donepezil vs placebo. Method: Patients enrolled in the present study had a 6-week single-blind placebo washout period followed by treatment with donepezil 5 mg/day for 6 weeks with an optional increase in dosage to 10 mg/day between weeks 6 and 32. Results: After 6 weeks of open-label treatment with donepezil 5 mg/day, mean Alzheimer's Disease Assessment Scale - cognitive subscale scores (ADAS-cog) improved by approximately two points, while after 12 weeks of open-label treatment (with a majority of patients receiving 10 mg/day), the mean ADAS-cog score was 1 point better than the score at the end of the placebo washout period. Scores then declined gradually over the remainder of the study. Mean changes in Clinical Dementia Rating-Sum of Boxes scores showed slight improvement over the first 12 weeks of open-label treatment and then slowly declined for the remainder of the study period. Donepezil was well tolerated over the entire 162-week study period. Overall, 85% of patients experienced at least one adverse event (AE). The most common included diarrhoea (12%), nausea (11%), infection (11%) and accidental injury (10%). Some patients discontinued the study due to AEs (15%). Conclusions: These results support the conclusion that donepezil is safe and effective for the long-term treatment of patients with mild to moderate AD. Copyright © 2007 John Wiley & Sons, Ltd.",donepezil;placebo;accidental injury;adult;aged;agitation;Alzheimer disease;article;bradycardia;brain hemorrhage;cerebrovascular accident;clinical trial;cognition;cohort analysis;confusion;controlled clinical trial;controlled study;depression;diarrhea;diastolic blood pressure;disease exacerbation;disease severity;drug dose increase;drug efficacy;drug fatality;drug safety;drug tolerability;drug withdrawal;female;heart infarction;heart rate;human;hypertension;hypotension;infection;long term care;major clinical study;male;multicenter study;nausea;open study;orthostatic hypotension;pneumonia;rating scale;scoring system;side effect;single blind procedure;systolic blood pressure;treatment duration,"Burns, A.;Gauthier, S.;Perdomo, C.",2007,,,0,
582,Use of alternative medicine by patients with stage 5 chronic kidney disease,"The use of complementary and alternative medicine (CAM) in the United States is growing at a remarkable speed. Herbal products and dietary supplements are CAM therapies that have grown faster than any other CAM treatments. Little information is available about herbs and dietary supplement use in the stage 5 chronic kidney disease population. These products contain a myriad of pharmacologically active compounds that, when used by people with kidney disease, may be hazardous. Members of the renal dietitian listserv were queried about herbs and dietary supplements reportedly used by dialysis patients. Up-to-date information on the use, safety, efficacy, adverse effects, and recommended dosages in the nondialysis population are presented for 24 products. In the dialysis population, Noni juice should be avoided because of its high potassium content. In addition, bulk-forming laxatives such as flaxseed should be used with caution because of the need for increased fluid intake. Dialysis practitioners should include specific questions about herbs and dietary supplement use in medical and nutrition histories, and they should increase their knowledge about these products to advise patients appropriately. A list of reliable sources of information for the health care provider on herbs and dietary supplements is also presented. © 2005 by the National Kidney Foundation, Inc.",acetylsalicylic acid;Aesculus hippocastanum extract;alpha tocopherol;angelica archangelica extract;Angelica sinensis extract;ascorbic acid;Borago officinalis extract;chondroitin sulfate;Cimicifuga racemosa extract;Cinchona calisaya extract;Eleutherococcus senticosus extract;fish oil;garlic extract;Ginkgo biloba extract;ginseng extract;Harpagophytum procumbens extract;Hypericum perforatum extract;linseed oil;melatonin;primrose oil;probiotic agent;red clover extract;retinol;Rhamnus frangula extract;Salvia bowleyana extract;ubiquinone;unclassified drug;unindexed drug;vinpocetine;vitamin K group;Vitis vinifera extract;warfarin;abdominal pain;abnormally high substrate concentration in blood;acquired immune deficiency syndrome;agitation;alcohol liver disease;alternative medicine;Alzheimer disease;anorexia;antihypertensive therapy;anxiety;artery disease;article;atherosclerosis;eructation;bleeding;bone injury;breast tenderness;breathing disorder;burning mouth syndrome;cataract;chondropathy;chronic hepatitis;chronic kidney disease;chronic liver disease;Actaea racemosa;clinical trial;congestive heart failure;convulsion;delirium;depression;diarrhea;diet supplementation;diuresis;dizziness;drug elimination;drug eruption;drug half life;drug hypersensitivity;drug induced disease;edema;epigastric pain;fatigue;flatulence;food drug interaction;gastritis;gastrointestinal disease;gastrointestinal symptom;halitosis;headache;heart disease;heart failure;heart infarction;heart palpitation;heart ventricle extrasystole;heartburn;hip osteoarthritis;hot flush;human;hypercholesterolemia;hyperglycemia;hyperlipidemia;hypertension;hypervitaminosis;hypoglycemia;hypokalemia;infection;insomnia;insulin resistance;intestine obstruction;intracranial hypertension;irritability;knee osteoarthritis;Lactobacillus acidophilus;lactose intolerance;lethargy;liver cirrhosis;liver injury;liver toxicity;menopausal syndrome;meta analysis;mouth ulcer;muscle cramp;muscle hypotonia;muscle weakness;myopathy;nausea;nephrotoxicity;nervousness;neurotoxicity;nocturia;non insulin dependent diabetes mellitus;paresthesia;periodontal disease;photosensitivity;priority journal;prostate cancer;prostate hypertrophy;pruritus;pyridoxine deficiency;respiratory tract infection;restlessness;age related macular degeneration;retinol deficiency;rhabdomyolysis;schizophrenia;side effect;skin allergy;sodium retention;tachycardia;toxicity;tremor;vomiting;water retention;weight gain;withdrawal syndrome;xerostomia;aspirin;remifemin,"Burrowes, J. D.;Van Houten, G.",2005,,,0,
583,Heart disease and dementia: a population-based study,"There are conflicting reports on the possible positive association between coronary disease and dementia. The objectives of this study were to examine the association between coronary disease, as measured by myocardial infarction and cardiac death, and dementia in a population-based study. By use of the record-linkage system of the Rochester Epidemiology Project, 916 cases of dementia and 916 age (+/-1 year)- and sex-matched controls were identified in Rochester, Minnesota, between 1985 and 1994. From the same population, the authors identified all subjects who experienced a myocardial infarction (defined using standardized criteria) during the period 1979-1998. For myocardial infarction occurring prior to the index year of dementia, the authors used conditional logistic regression (case-control analysis), while for myocardial infarction and death occurring after the index year, they used competing risk survival analysis to account for informative censoring (cohort analysis). Before the index year, the odds ratio for myocardial infarction among cases with dementia compared with controls was 1.00 (95% confidence interval (CI): 0.62, 1.62; p = 1.00). After the index year, patients with dementia had a 46% decreased risk of subsequent myocardial infarction (hazard ratio = 0.54, 95% CI: 0.36, 0.82; p = 0.004) and an 18% decreased risk of cardiac death (hazard ratio = 0.82, 95% CI: 0.70, 0.95; p = 0.010). There was no evidence of a positive association between dementia and preceding myocardial infarction, while there was a decreased risk of myocardial infarction and cardiac death following dementia.","Adult;Aged;Aged, 80 and over;Case-Control Studies;Dementia/*epidemiology;Female;Humans;Logistic Models;Male;Middle Aged;Minnesota/epidemiology;Myocardial Infarction/*epidemiology;Retrospective Studies;Risk Factors;Survival Analysis","Bursi, F.;Rocca, W. A.;Killian, J. M.;Weston, S. A.;Knopman, D. S.;Jacobsen, S. J.;Roger, V. L.",2006,Jan 15,10.1093/aje/kwj025,0,
584,The association of anxiety and depression with future dementia diagnosis: A case-control study in primary care,"Background.: Depression is identified as a risk factor for dementia. Little research has been carried out on the importance of anxiety, despite strong evidence of co-morbidity with depression. Objective.: To examine the association of anxiety and depression with future dementia diagnosis. Methods.: This case-control study was set in the Consultations in Primary Care Archive. Cases (n = 400), were patients aged >65 years old. About 1353 controls were matched to cases by gender, practice, age group and year of case diagnosis. Read codes of risk factors for dementia were searched in patient records. The associations of prior consultations for anxiety and depression, with future diagnosis of dementia were determined using multivariable logistic regression. Results.: A past anxiety diagnosis was associated with a future dementia diagnosis [odds ratio 2.76 (95% confidence interval 2.11-3.62)]. The association of depression with dementia was attenuated by the high prevalence of anxiety within those who have depression. Including an interaction of depression and anxiety showed that having only depression was associated with future dementia diagnosis but a diagnosis of depression alongside anxiety did not increase the likelihood of a dementia diagnosis compared to having just an anxiety diagnosis. Conclusion.: Prior diagnosis of anxiety was strongly associated with dementia diagnosis after adjustment for other risk factors. The independent effect of depression was weaker compared to anxiety. Given the higher prevalence of anxiety primary care physicians should consider anxiety as well as depression as premorbid risk factors of dementia to improve early recognition and facilitate greater access to services. © The Author 2012. Published by Oxford University Press.",aged;anxiety;article;case control study;cerebrovascular disease;comorbidity;consultation;controlled study;dementia;depression;diabetes mellitus;disease association;dyslipidemia;female;human;hypertension;hypotension;ischemic heart disease;major clinical study;male;medical record review;prevalence;primary medical care;risk factor,"Burton, C.;Campbell, P.;Jordan, K.;Strauss, V.;Mallen, C.",2013,,,0,
585,Oligogenic inheritance of optineurin (OPTN) and C9ORF72 mutations in ALS highlights localisation of OPTN in the TDP-43-negative inclusions of C9ORF72-ALS,"Amyotrophic lateral sclerosis (ALS) is characterized by motor neurone loss resulting in muscle weakness, spasticity and ultimately death. 5-10% are caused by inherited mutations, most commonly C9ORF72, SOD1, TARDBP and FUS. Rarer genetic causes of ALS include mutation of optineurin (mt OPTN). Furthermore, optineurin protein has been localized to the ubiquitylated aggregates in several neurodegenerative diseases, including ALS. This study: (i) investigated the frequency of mt OPTN in ALS patients in England, (ii) characterized the clinical and neuropathological features of ALS associated with a mt OPTN; and (iii) investigated optineurin neuropathology in C9ORF72-related ALS (C9ORF72-ALS). We identified a heterozygous p.E322K missense mutation in exon 10 of OPTN in one familial ALS patient who additionally had a C9ORF72 mutation. This patient had bulbar, limb and respiratory disease without cognitive problems. Neuropathology revealed motor neurone loss, trans-activation response DNA protein 43 (TDP-43)-positive neuronal and glial cytoplasmic inclusions together with TDP-43-negative neuronal cytoplasmic inclusions in extra motor regions that are characteristic of C9ORF72-ALS. We have demonstrated that both TDP-43-positive and negative inclusion types had positive staining for optineurin by immunohistochemistry. We went on to show that optineurin was present in TDP-43-negative cytoplasmic extra motor inclusions in C9ORF72-ALS cases that do not carry mt OPTN. We conclude that: (i) OPTN mutations are associated with ALS; (ii) optineurin protein is present in a subset of the extramotor inclusions of C9ORF72-ALS; (iii) It is not uncommon for multiple ALS-causing mutations to occur in the same patient; and (iv) studies of optineurin are likely to provide useful dataregarding the pathophysiology of ALS and neurodegeneration.",copper zinc superoxide dismutase;dipeptide;DNA;fused in sarcoma protein;glutamic acid;lysine;methionine;optineurin;Rab protein;Rab8 protein;TAR DNA binding protein;ubiquitin;unclassified drug;5' untranslated region;adult;African;aged;amino acid substitution;amyotrophic lateral sclerosis;arm weakness;article;binding site;bulbar paralysis;cardiopulmonary insufficiency;cause of death;cell inclusion;cell labeling;cell loss;cell vacuole;cerebellum;chromosome 9;chromosome 9 open reading frame 72;chromosome mutation;clinical feature;cognition;cohort analysis;computer model;controlled study;daily life activity;dementia;disease course;disease duration;disease severity;dysarthria;dysphagia;E322K gene;electromyography;ethnic difference;exon;family history;fasciculation;female;frontal cortex;gene;gene frequency;gene sequence;genetic association;genetic heterogeneity;genetic variability;genome;genome analysis;glia cell;heterozygote;hippocampus;history;human;human cell;human tissue;hysterectomy;immunohistochemistry;intron;limb disease;limb weakness;male;malnutrition;medical history;menorrhagia;mental instability;migraine;missense mutation;motoneuron;multifactorial inheritance;mutational analysis;neocortex;nerve degeneration;neuropathology;neuropil;oligogenic inheritance;onset age;ovary cyst;phenotype;population;priority journal;protein expression;protein localization;respiratory tract disease;single nucleotide polymorphism;spinal cord ventral horn;ubiquitination;United Kingdom;venous blood,"Bury, J. J.;Highley, J. R.;Cooper-Knock, J.;Goodall, E. F.;Higginbottom, A.;McDermott, C. J.;Ince, P. G.;Shaw, P. J.;Kirby, J.",2016,,,0,
586,Depressive symptom clusters are differentially associated with atherosclerotic disease,"BACKGROUND: Depression increases the risk of subsequent vascular events in both cardiac and non-cardiac patients. Atherosclerosis, the underlying process leading to vascular events, has been associated with depression. This association, however, may be confounded by the somatic-affective symptoms being a consequence of cardiovascular disease. While taking into account the differentiation between somatic-affective and cognitive-affective symptoms of depression, we examined the association between depression and atherosclerosis in a community-based sample. METHOD: In 1261 participants of the Nijmegen Biomedical Study (NBS), aged 50-70 years and free of stroke and dementia, we measured the intima-media thickness (IMT) of the carotid artery as a measure of atherosclerosis and we assessed depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis (PCA) of the BDI items yielded two factors, representing a cognitive-affective and a somatic-affective symptom cluster. While correcting for confounders, we used separate multiple regression analyses to test the BDI sum score and both depression symptom clusters. RESULTS: We found a significant correlation between the BDI sum score and the IMT. Cognitive-affective, but not somatic-affective, symptoms were also associated with the IMT. When we stratified for coronary artery disease (CAD), the somatic-affective symptom cluster correlated significantly with depression in both patients with and patients without CAD. CONCLUSIONS: The association between depressive symptoms and atherosclerosis is explained by the somatic-affective symptom cluster of depression. Subclinical vascular disease thus may inflate depressive symptom scores and may explain why treatment of depression in cardiac patients hardly affects vascular outcome.",Aged;Carotid Artery Diseases/*complications/*psychology;Depressive Disorder/*complications/*psychology;Female;Humans;Male;Middle Aged;Netherlands;Principal Component Analysis/methods;Psychiatric Status Rating Scales/statistics & numerical data,"Bus, B. A.;Marijnissen, R. M.;Holewijn, S.;Franke, B.;Purandare, N.;de Graaf, J.;den Heijer, M.;Buitelaar, J. K.;Voshaar, R. C.",2011,Jul,10.1017/s0033291710002151,0,
587,Assessing the overuse of medicines,"The use of medicines has increased markedly in many countries over recent years, providing clear evidence of the increasing 'pharmacaeuticalisation' of society. This paper contributes to the sociological analysis of pharmaceuticalisation by starting to explore how we can begin to make judgements as to when and to what extent some medicines are being overused - an important aspect that, rather surprisingly, has not so far been the focus of attention those analysing the process. It considers the World Health Organisation's criteria for the 'rational' use of medicines, pointing to some of the issues they raise. It then develops a typology of over and underuse derived from these criteria. This provides a framework for the discussion of assessing overuse that focuses in particular on the widespread and increasing use of medicines that are not very effective for the conditions for which they are prescribed, and their use where the issue of clinical need is in doubt. Some of the factors that encourage overuse are also considered.",antibiotic agent;antidepressant agent;antihypertensive agent;neuroleptic agent;placebo;psychostimulant agent;serotonin uptake inhibitor;anxiety;article;attention deficit disorder;bacterial infection;cerebrovascular accident;common cold;dementia;depression;diabetes mellitus;drowsiness;drug abuse;drug cost;drug efficacy;drug indication;drug industry;drug misuse;drug safety;drug use;headache;heart infarction;human;hyperactivity;insomnia;nausea;patient care;patient compliance;pharmaceutical care;practice guideline;prescription;psychosis;respiratory tract infection;risk benefit analysis;risk reduction;self medication;sexual dysfunction;side effect;social interaction;suicidal ideation;suicide;world health organization,"Busfield, J.",2015,,,0,
588,Statins and the trajectory of cognitive decline,,high density lipoprotein cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;Alzheimer disease;chronic obstructive lung disease;Clinical Dementia Rating;cognition;cognitive defect;congestive heart failure;drug use;dyslipidemia;heart infarction;human;letter;mental deterioration,"Buslovich, S.;Salbu, R.;Ramaswamy, R.",2014,,,0,
589,Objective cardiac markers in dementia: Results from the Kerala-Einstein study,,Alzheimer disease;aorta valve regurgitation;calcification;cognition;disease association;echocardiography;electrocardiography;atrial fibrillation;heart block;heart bundle branch block;heart ejection fraction;heart electrophysiology;heart infarction;heart left ventricle hypertrophy;human;letter;medical research;multiinfarct dementia;priority journal;Q wave,"Buss, S.;Noone, M. L.;Tsai, R.;Johnson, B.;Pradeep, V. G.;Salam, K. A.;Mathuranath, P. S.;Verghese, J.",2013,,,0,
590,Cardiovascular disease and psychopathology in the elderly,,"Aged;Arrhythmias, Cardiac/psychology;Brain Ischemia/psychology;Cardiovascular Diseases/*psychology;Cerebrovascular Disorders/psychology;Cognition Disorders/psychology;Coronary Disease/psychology;Dementia/psychology;Humans;Hypertension/psychology;Intracranial Arteriosclerosis/psychology;Life Style;Neurocognitive Disorders/*psychology;Personality;Sex Factors;Sleep Wake Disorders/psychology;Smoking","Busse, E. W.",1982,Apr,,0,
591,The effect of nurse-led intensive vascular care on cardiovascular disease risk in older people,"Background: Recently, in the preDIVA trial (Prevention of Dementia by Intensive Vascular care) nurse-led intensive vascular care offered to older community dwelling people did not sort significant effects on cardiovascular morbidity or mortality over 6.7 years. The follow-up time may have been too short for an effect on cardiovascular mortality, but may have sorted an effect on intermediate biological risk factors in this population of older people. Design: Secondary analysis of the preDIVA trial, a cluster randomized controlled trail to investigate the effect of nurse-led intensive vascular care on the occurrence of all-cause dementia. Methods: PreDIVA participants without a history of myocardial infarction, stroke or transient ischemic attack were included in the analysis (n=2254; 63.9% ). To assess the overall effect of the intervention on SCORE-OP, a repeated measurements linear mixed model was used including random effects at the participant level nested within the GP level nested within HCC level to account for potential dependencies between the observations. Results: Also in this primary prevention setting, there was no effect of the intervention on incident cardiovascular disease. At baseline, the 10-year risk of CVD-mortality was 12.2% in the intervention and 12.0% in the control group. During a median follow-up of 5.4 years, the mean risk increased to 18.8% in the control group and to 17.4% in the intervention group (adjusted mean difference -0.98 (95%CI -1.61 to -0.35)). The lower increment in risk in the intervention group was observed for both CHD mortality risk and non-CHD mortality. The effect of the intervention was most pronounced in the group with the highest risk at baseline. Conclusion: In this secondary analysis of the preDIVA trial, nurse-led intensive vascular care during on average 5.4 years resulted in a healthier risk factor profile, though not in lower CVD mortality rates in older people in a primary prevention setting. Possibly, interventions in an elderly population are potent to improve risk profiles, but too late to prevent cardiovascular events or death since vascular damage and atherosclerosis have built up already for many years before.",aged;atherosclerosis;control group;controlled clinical trial;controlled study;dementia;female;follow up;heart infarction;human;major clinical study;male;mortality rate;mortality risk;nurse;participant observation;prevention;primary prevention;randomized controlled trial;risk factor;secondary analysis;statistical model;transient ischemic attack,"Bussel, Ef;Hoevenaar, Blom Mp;Busschers, Wb;Richard, E;Gool, Wa;Moll, Van Charante Ep",2017,,,0,
592,Etanercept in Alzheimer disease,"Objectives: To determine whether the tumor necrosis factor α inhibitor etanercept is well tolerated and obtain preliminary data on its safety in Alzheimer disease dementia. Methods: In a double-blind study, patients with mild to moderate Alzheimer disease dementia were randomized (1:1) to subcutaneous etanercept (50 mg) once weekly or identical placebo over a 24-week period. Tolerability and safety of this medication was recorded including secondary outcomes of cognition, global function, behavior, and systemic cytokine levels at baseline, 12 weeks, 24 weeks, and following a 4-week washout period. This trial is registered with EudraCT (2009-013400-31) and ClinicalTrials.gov (NCT01068353). Results: Forty-one participants (mean age 72.4 years; 61% men) were randomized to etanercept (n 20) or placebo (n 21). Etanercept was well tolerated; 90% of participants (18/20) completed the study compared with 71% (15/21) in the placebo group. Although infections were more common in the etanercept group, there were no serious adverse events or new safety concerns. While there were some interesting trends that favored etanercept, there were no statistically significant changes in cognition, behavior, or global function. Conclusions: This study showed that subcutaneous etanercept (50 mg/wk) was well tolerated in this small group of patients with Alzheimer disease dementia, but a larger more heterogeneous group needs to be tested before recommending its use for broader groups of patients. Classification of evidence: This study shows Class I evidence that weekly subcutaneous etanercept is well tolerated in Alzheimer disease dementia.",eudract(2009-013400-31);NCT01068353;aminotransferase;C reactive protein;creatinine;DNA antibody;etanercept;placebo;aged;Alzheimer disease;aminotransferase blood level;angina pectoris;antibody blood level;article;atrial fibrillation;backache;balance disorder;cellulitis;cerumen impaction;clinical article;colon polyp;colonoscopy;confusion;constipation;controlled study;creatinine blood level;dehydration;delusion;diarrhea;double blind procedure;drug safety;drug tolerability;drug withdrawal;eczema;epigastric discomfort;eye pain;fatigue;female;gastroenteritis;hallucination;headache;hearing impairment;heart rate;heart sound;human;hyperhidrosis;hyperkalemia;hypertension;injection site reaction;joint stiffness;keratitis;lymphedema;male;malignant neoplastic disease;muscle weakness;nausea and vomiting;osteoarthritis;outcome assessment;parkinsonism;parosmia;pharyngitis;phase 2 clinical trial;priority journal;protein blood level;psychometry;randomized controlled trial;rectum hemorrhage;respiratory tract infection;sciatica;seborrheic dermatitis;seborrheic keratitis;side effect;spine fracture;urinary frequency;urinary tract infection;urine incontinence;varicose eczema;yawning,"Butchart, J.;Brook, L.;Hopkins, V.;Teeling, J.;Püntener, U.;Culliford, D.;Sharples, R.;Sharif, S.;McFarlane, B.;Raybould, R.;Thomas, R.;Passmore, P.;Perry, V. H.;Holmes, C.",2015,,,0,
593,The health of elderly residents in long term care institutions in New Zealand,"AIMS: To estimate the morbidity of residents in long term care institutions in Hamilton, New Zealand and examine the prescribing practice within these institutions. METHODS: One hundred residents were selected at random from the total population of residents in long-term institutions in Hamilton. Residents were examined by a physician to arrive at ICD-9 diagnoses and details were recorded about prescribing practice. RESULTS: Eighty residents were examined. Of these, 73% had dementia. Forty-five per cent were diagnosed as having heart failure and 44% cerebrovascular disease. The most common previously undiagnosed disorder was postural hypotension (24%). Residents were prescribed an average of 4.5 non-psychotropic medications. Seventy-seven per cent of residents were prescribed three or more medications. CONCLUSION: Elderly residents in long term care institutions in Hamilton have complex health care needs which offer particular challenges for doctors and other health care workers. Regular health care reviews could lead to more accurate diagnosis and better prescribing practice.",aged;article;female;geriatric assessment;health status;human;long term care;male;middle aged;morbidity,"Butler, R.;Fonseka, S.;Barclay, L.;Sembhi, S.;Wells, S.",1999,,,0,
594,The role of phosphodiesterase inhibitors in the management of pulmonary vascular diseases,"Phosphodiesterase inhibitors (PDE) can be used as therapeutic agents for various diseases such as dementia, depression, schizophrenia and erectile dysfunction in men, as well as congestive heart failure, chronic obstructive pulmonary disease, rheumatoid arthritis, other inflammatory diseases, diabetes and various other conditions. In this review we will concentrate on one type of PDE, mainly PDE5 and its role in pulmonary vascular diseases.",pulmonary hypertension;pulmonary phosphodiesterase inhibitors;pulmonary vascular disease,"Butrous, G.",2014,,10.5339/gcsp.2014.42,0,
595,Genetic Markers: Not Yet Ready for Prime Time 6 (multiple letters),,neoplasm;gene expression;genetic counseling;genetic marker;genomics;genotype;heart infarction;human;human genome;Huntington chorea;letter;neurologic disease;perioperative period;priority journal;prognosis;risk;risk assessment;severe acute respiratory syndrome;single nucleotide polymorphism,"Butterworth, J.;Ziegeler, S.;Tsusaki, B. E.;Collard, C. D.",2004,,,0,
596,Acute and chronic diseases as part of multimorbidity in acutely hospitalized older patients,"Background To describe the prevalence of multimorbidity and to study the association between acute and chronic diseases in acutely hospitalized older patients Methods Prospective cohort study conducted between 2006 and 2008 in three teaching hospitals in the Netherlands. 639 patients aged 65 years and older, hospitalized for > 48 h were included. Two physicians scored diseases, using ICD-9 codes. Chronic multimorbidity was defined as the presence of ≥ 2 chronic diseases, and acute multimorbidity as ≥ 1 acute diseases upon pre-existent chronic diseases. Logistic regression analyses were conducted to analyse cluster associations between a chronic index disease and the concurrent chronic or acute disease, corrected for age and sex. Results The mean age of patients was 78 years, over 50% had ADL impairments. Prevalence of chronic multimorbidity was 69%, and acute multimorbidity was present in 88%. Hypertension (OR 1.16; 95% CI 1.08-1.24), diabetes (type I or type 2) (OR 1.12; 95% CI 1.04-1.21), heart failure (OR 1.25; 95% CI 1.14-1.38) and COPD (OR 1.19; 95% CI 1.05-1.34) were associated with acute renal failure. Hypertension (OR 1.10; 95% CI 1.04-1.17) and atrial fibrillation (OR 1.17; 95% CI 1.08-1.27) were associated with an adverse drug event. Gastro-intestinal bleeding was clustered with atrial fibrillation (OR 1.11; 95% CI 1.04-1.19) and gastric ulcer (OR 1.16; 95% CI 1.07-1.25). Conclusion Both acute and chronic multimorbidity was frequently present in hospitalized older patients. We identified specific associations between acute and chronic diseases. There is a need for strategies addressing multimorbidity during the exacerbation of chronic diseases.",acute disease;acute kidney failure;ADL disability;adverse drug reaction;aged;anemia;article;atrial fibrillation;cerebrovascular accident;chronic disease;chronic obstructive lung disease;cohort analysis;dehydration;dementia;depression;diarrhea;dyslipidemia;female;gastrointestinal hemorrhage;hearing impairment;heart failure;heart infarction;hospital patient;human;hypertension;ICD-9;insulin dependent diabetes mellitus;investigative procedures;kidney failure;major clinical study;male;multicenter study;Netherlands;non insulin dependent diabetes mellitus;obesity;osteoporosis;prevalence;prospective study;solid tumor;stomach ulcer;teaching hospital;visual impairment,"Buurman, B. M.;Frenkel, W. J.;Abu-Hanna, A.;Parlevliet, J. L.;De Rooij, S. E.",2016,,,0,
597,The intern experience: Facing death,,article;attitude to death;congestive heart failure;dementia;human;intensive care;medical education;medical practice;patient advocacy;patient care;patient transport;resuscitation;social isolation;work experience,"Buxton, D.",2011,,,0,
598,Sleeping Accidents in the Elderly,"Abstract: Two cases of dangerous sleeping environments in the elderly are reported to demonstrate similarities and differences of these ""sleeping accidents"" to similar episodes that occur in infants and children. Case reports: An 87-year-old wheelchair-bound man with a history of dementia was found in his nursing home room hanging off the side of the bed from a vertical metal bar, and an 87-year-old woman with epilepsy, ischemic heart disease, and insulin-dependent diabetes mellitus was found in hospital wedged between an inflatable mattress and the bars of her bed. These cases demonstrate that, as in the very young, relatively poor coordination and strength in the elderly often with limited comprehension and ability to deal with dangerous environments may predispose to sleeping accidents. Significant underlying organic disease may, however, make determination of the precise lethal mechanisms difficult. Modification of beds should only be undertaken when safety issues have been carefully evaluated. © 2011 American Academy of Forensic Sciences.",accident;aged;article;asphyxia;bed;body posture;case report;dementia;equipment design;female;forensic medicine;frail elderly;human;male;nursing home;risk factor;sleep,"Byard, R. W.;Gilbert, J. D.",2011,,,0,
599,Outcomes in Older Adults with Multimorbidity Associated with Predominant Provider of Care Specialty,"Objectives: To determine whether receiving the predominance of ambulatory visits from a primary care provider compared to a specialty provider is associated with better outcomes in older adults with multi morbidity. Design: Observational study using propensity score matching. Setting: Medicare fee-for-service, 2011–12. Participants: Beneficiaries aged 65 and older with multimorbidity. Measurements: The independent variable was an indicator for having a specialty (versus primary care) as the predominant provider of care (PPC). Main outcomes were 1-year mortality, hospitalization, standardized expenditures, and ambulatory visit patterns. RESULTS: Two-thirds of 3,934,942 beneficiaries with multimorbidity had a primary care provider as their PPC. Individuals with a specialty PPC had more hospitalizations (40.3 more per 1,000) and higher spending ($1,781 more per beneficiary) than those with a primary care PPC, but there was little difference in mortality (0.2% higher) or preventable hospitalizations. Spending differences were largest for professional fees ($769 higher per beneficiary), inpatient stays ($572 higher per beneficiary), and outpatient facilities ($510 higher per beneficiary) (all P <.001). In addition, people with a specialist PPC had lower continuity of care and saw more providers. Conclusions: Older adults with multimorbidity with a specialist as their main ambulatory care provider had higher spending and lower continuity of care than those whose PPC was in primary care but similar clinical outcomes.",aged;aged hospital patient;ambulatory care;angina pectoris;appendix perforation;article;asthma;bacterial pneumonia;chronic obstructive lung disease;clinical outcome;congestive heart failure;controlled study;coronary artery disease;dehydration;dementia;diabetes mellitus;disease association;female;health care cost;health care personnel;heart failure;hospital discharge;hospitalization;human;hypertension;independent variable;length of stay;major clinical study;male;medical fee;medical specialist;medicare;mortality;multiple chronic conditions;observational study;outpatient department;patient care;primary medical care;propensity score;secondary analysis;sensitivity analysis;urinary tract infection;very elderly,"Bynum, J. P. W.;Chang, C. H.;Austin, A.;Carmichael, D.;Meara, E.",2017,,10.1111/jgs.14882,0,
600,"Evaluating patterns in retention, continuation, gaps, and re-engagement in HIV care in a medicaid-insured population, 2006-2012, United States","We used the US-based MarketScan® Medicaid Multi-state Databases to determine the un-weighted proportion of publically insured persons with HIV that were retained, continued, and re-engaged in care. Persons were followed for up to 84 months. Cox proportional hazards models were conducted to determine factors associated with gaps in care. Of the 6463 HIV cases identified in 2006, 61% were retained during the first 24 months, and 53% continued in care through 78 months. Between 8% and 30% experienced a gap in care, and 59% of persons who experienced a gap in care later reengaged in care. Persons with one or more Charlson co-morbidities (HR 0.72, 95% CI 0.64-0.81), ages 40-59 (0.79, 0.71-0.88), mental illness diagnosis (0.79, 0.72-0.87), hepatitis C co-infection (0.83, 0.75- 0.93), and female sex (0.86, 0.78-0.94) were less likely to experience a gap in care. Between 27% and 38% of those not retained in care continued to receive HIV-related laboratory services. This Medicaid claims database combines features of both clinic visits-based and surveillance lab-based surrogate measures to give a more complete picture of engagement in care than single-facility-based studies.",adult;alcoholism;anxiety disorder;article;bipolar disorder;CD4 lymphocyte count;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;congestive heart failure;dementia;diabetes mellitus;drug dependence;female;follow up;groups by age;heart infarction;hemiplegia;hepatitis B;hepatitis C;human;Human immunodeficiency virus infection;kidney disease;laboratory test;liver disease;major clinical study;major depression;male;medicaid;mixed infection;paraplegia;patient participation;peptic ulcer;peripheral vascular disease;priority journal;rheumatic disease;schizophrenia;sex difference;solid tumor;United States;virus load,"Byrd, K. K.;Furtado, M.;Bush, T.;Gardner, L.",2015,,,0,
601,Homocysteine and cognition: From Galenic dogmatism to genetic relativism,"To test the hypothesis that lowering plasma homocysteine concentration improves cognition in elderly subjects, a 2-year, double-blind, placebo-controlled, randomized clinical trial has been conducted in 276 healthy participants (>65 years of age) with plasma homocysteine concentrations of at least 13 μmol/l. The subjects were supplemented daily with 1000 μg of folate, 500 μg of vitamin B12 and 10 mg of vitamin B6. Different tests of cognition were conducted at baseline and after 1 and 2 years of treatment. During the course of the study, plasma homocysteine levels were significantly lower in the vitamin group than in the placebo group; however, no significant differences were observed between the vitamin and placebo groups in cognitive performance, demonstrating that homocysteine lowering with vitamin supplementation does not improve cognition in elderly people. © 2006 Future Medicine Ltd.","5,10 methylenetetrahydrofolate reductase (FADH2);amyloid beta protein;apolipoprotein E;apolipoprotein E4;cholesterol;creatinine;cyanocobalamin;folic acid;histamine H2 receptor antagonist;homocysteine;metformin;methionine;nitrous oxide;phenformin;placebo;presenilin 1;proton pump inhibitor;pyridoxine;s adenosylmethionine;Alzheimer disease;amino acid blood level;article;blood viscosity;cardiovascular risk;clinical trial;cognition;cognitive defect;dementia;diet restriction;diet supplementation;disease association;dose response;folic acid deficiency;gene mutation;genetic polymorphism;genetic variability;genotype phenotype correlation;homozygosity;human;hypothesis;insulin dependent diabetes mellitus;ischemic heart disease;learning;mental test;Mini Mental State Examination;neuropsychological test;New Zealand;psychomotor activity;risk reduction;task performance;thyroid disease;treatment duration;treatment outcome;vitamin deficiency;vitamin supplementation;Wechsler memory scale","Cacabelos, R.",2006,,,0,
602,Serum tumor necrosis factor (TNF) in Alzheimer's disease and multi-infarct dementia,"Changes in neuroimmune parameters and cytokine production have been reported in patients with Alzheimer's disease, including increased levels of interleukin-1 (IL-1) and histamine in brain tissue, cerebrospinal fluid and serum. Specific neuroimmune reactions may be responsible in part for astrogliosis and neuronal death in particular circumstances. Since IL-1 and tumor necrosis factor (TNF) tend to act synergistically in physiological conditions and in some pathological processes, we have studied the concentration of TNF-alpha in patients with Alzheimer's disease (AD) or multi-infarct dementia (MID) and in age-matched control subjects (CS) in order to evaluate possible changes in the levels of this cytokine with potential influence on the pathogenesis of AD. Serum TNF-alpha levels were significantly lower in AD (2.5 +/- 1.25 pg/ml, p < 0.01) and MID (1.64 +/- 1.17 pg/ml, p < 0.001) than in CS (10.66 +/- 8.92 pg/ml). A negative correlation between serum TNF-alpha levels and age in AD was found (r = -0.645, p < 0.01); however, no significant correlations were detected between serum TNF-alpha levels and mental performance, cerebrovascular risk, heart rate and blood pressure in either AD or MID. In conclusion, there is a marked reduction in the concentration of serum TNF-alpha in both AD and MID which seems to be poorly related to cognitive dysfunction and/or neurovascular damage, probably reflecting an endogenous immune dysregulation and/or an inhibitory reactive process in demented patients.","Adult;Aged;Alzheimer Disease/*blood;Blood Pressure;Dementia, Multi-Infarct/*blood;Female;Humans;Intelligence Tests;Male;Middle Aged;Risk Factors;Tumor Necrosis Factor-alpha/*metabolism","Cacabelos, R.;Alvarez, X. A.;Franco-Maside, A.;Fernandez-Novoa, L.;Caamano, J.",1994,Jan-Feb,,0,
603,"Lowering homocysteine levels with folic acid and B-vitamins do not reduce early atherosclerosis, but could interfere with cognitive decline and Alzheimer's disease","Inheired or acquired hyperhomocysteinemia (HHcy) is associated with several impairments, as certain tumors, deep venous thrombosis, tube neural defects, osteoporosis, early atherosclerosis and vascular acute events (IMA, stroke, PVD), mild cognitive impairments till Alzheimer's disease (AD). But, vascular and neuronal derangements are the most frequent HHcy-manifestations. As far as early atherosclerosis, some clinical trials demonstrated that folates and B 6-12 vitamins SUPPL.ementation is unable to reduce atherosclerotic lesions and cardiovascular events, even if it lowers HHcy levels. Thus, for atherosclerosis and its acute events (IMA, stroke, PVD) HHcy acts as a powerful biomarker rather than a risk factor. For that, the SUPPL.ementation with folates and B vitamins to lower atherosclerotic lesions-events in hyperhomocysteinemic patients is not recommended. On the contrary, several clinical investigations demonstrated that folates and vitamins administration is able to reduce Hcy serum levels and antagonize some mechanisms favouring neurodegenerative impairments, as mild cognitive impairment, AD and dementia. Thus, contrarily to the atherosclerotic manifestations in hyperhomocysteinemic patients, preventive treatment with folates and B6-12 vitamins reduces Hcy concentration and could prevent or delay cognitive decline and AD. © 2012 Springer Science+Business Media New York.",amyloid beta protein;apolipoprotein E;apolipoprotein E2;apolipoprotein E3;apolipoprotein E4;cysteine;folic acid;homocysteine;methionine;presenilin 1;s adenosylmethionine;vitamin B group;aging;Alzheimer disease;article;atherosclerosis;cerebrovascular accident;cognitive defect;degenerative disease;desulfurization;heart infarction;hyperhomocysteinemia;methylation;mild cognitive impairment;neurofibrillary tangle;oxidative stress;priority journal;protein function;vascular disease;vitamin supplementation,"Cacciapuoti, F.",2013,,,0,
604,Role of ventricular rate response on dementia in cognitively impaired elderly subjects with atrial fibrillation: A 10-year study,"Background: The role of ventricular rate response (VRr) on the incidence of dementia in elderly subjects with cognitive impairment and atrial fibrillation (AF) is not known. Thus, we examined the ability of VRr to predict dementia in cognitively impaired elderly subjects with and without AF. Methods: A total of 358 cognitively impaired elderly subjects (MMSE <24) with and without AF were stratified in low/high (<50/>90) and moderate (>50/<90 bpm) VRr. A 10-year follow-up was performed. Results: Cognitively impaired subjects with dementia at the end of the follow-up were 135 (37.7%): 33 in the presence (75.0%) and 102 (32.5%) in the absence of AF (p < 0.001). Multivariate analysis shows that AF is a strong predictor of dementia (hazard ratio, HR = 4.10; 95% confidence interval, CI = 1.80-9.30, p < 0.001). More importantly, low/high VRr (<50/>90 bpm) is predictive of dementia in the presence (HR = 7.70, 95% CI = 1.10-14.20, p = 0.03) but not in the absence (HR = 1.85; 95% CI = 0.78-4.47; p = 0.152) of AF. Conclusions: This study demonstrates that AF predicts dementia in elderly subjects with cognitive impairment. Moreover, VRr seems to play a key role in the incidence of dementia in cognitively impaired elderly subjects with AF. © 2012 S. Karger AG, Basel.",acetylsalicylic acid;warfarin;aged;article;cardiovascular parameters;cognitive defect;comorbidity;controlled study;coronary artery disease;dementia;depression;elderly care;female;follow up;atrial fibrillation;heart failure;heart rate;Holter monitoring;human;major clinical study;male;Mini Mental State Examination;multiinfarct dementia;outpatient care;physical examination;predictive value;priority journal;pulse pressure;ventricular rate response,"Cacciatore, F.;Testa, G.;Langellotto, A.;Galizia, G.;Della-Morte, D.;Gargiulo, G.;Bevilacqua, A.;Del Genio, M. T.;Canonico, V.;Rengo, F.;Abete, P.",2012,,,0,
605,APOE and MS4A6A interact with GnRH signaling in Alzheimer's disease: Enrichment of epistatic effects,"INTRODUCTION: It is unknown if risk loci, identified by genome-wide association studies of late-onset Alzheimer's disease (LOAD), are linked to common molecular mechanisms through epistatic effects. METHODS: We performed genome-wide interaction studies of five risk variants for LOAD followed by enrichment analyses to find if there are pathways that simultaneously interact with more than one variant. This novel approach was applied to four independent cohorts (5393 cases and 3746 controls). RESULTS: We found enrichment of epistasis in gonadotropin-releasing hormone signaling with risk single-nucleotide polymorphisms in APOE and MS4A6A (P value = 3.7 x 10-5, P value = 5.6 x 10-6); vascular smooth muscle contraction pathway was also enriched in epistasis with these loci (P value = 9.6 x 10-5, P value = 2.4 x 10-7). MS4A6A risk variant also interacted with dilated cardiomyopathy pathway (P value = 3.1 x 10-7). DISCUSSION: In addition to APOE, MS4A6A polymorphisms should be considered in hormone trials targeting gonadotropins. Interactions of risk variants with neurovascular pathways may also be important in LOAD pathology.",Apoe;Alzheimer's disease;Epistasis;Gwas;GnRH signaling;Gonadotropin;Ms4a6a;Picalm;Pathway analysis;Snp,"Caceres, A.;Vargas, J. E.;Gonzalez, J. R.",2016,Jun 20,10.1016/j.jalz.2016.05.009,0,
606,APOE and MS4A6A interact with GnRH signaling in Alzheimer's disease: Enrichment of epistatic effects,"Introduction It is unknown if risk loci, identified by genome-wide association studies of late-onset Alzheimer's disease (LOAD), are linked to common molecular mechanisms through epistatic effects. Methods We performed genome-wide interaction studies of five risk variants for LOAD followed by enrichment analyses to find if there are pathways that simultaneously interact with more than one variant. This novel approach was applied to four independent cohorts (5393 cases and 3746 controls). Results We found enrichment of epistasis in gonadotropin-releasing hormone signaling with risk single-nucleotide polymorphisms in APOE and MS4A6A (P value = 3.7 × 10−5, P value = 5.6 × 10−6); vascular smooth muscle contraction pathway was also enriched in epistasis with these loci (P value = 9.6 × 10−5, P value = 2.4 × 10−7). MS4A6A risk variant also interacted with dilated cardiomyopathy pathway (P value = 3.1 × 10−7). Discussion In addition to APOE, MS4A6A polymorphisms should be considered in hormone trials targeting gonadotropins. Interactions of risk variants with neurovascular pathways may also be important in LOAD pathology.",apolipoprotein E;gonadorelin;gonadotropin;MS4A6A protein;neurotrophin;protein;T lymphocyte receptor;unclassified drug;Wnt protein;Alzheimer disease;article;cohort analysis;congestive cardiomyopathy;controlled study;epistasis;gene frequency;gene linkage disequilibrium;genome-wide association study;human;major clinical study;priority journal;signal transduction;single nucleotide polymorphism;smooth muscle contraction;vascular smooth muscle;Wnt signaling,"Cáceres, A.;Vargas, J. E.;González, J. R.",2017,,10.1016/j.jalz.2016.05.009,0,
607,"Clinical, pathological, and genetic mutation analysis of sporadic inclusion body myositis in Japanese people","Previous studies have identified several genetic loci associated with the development of familial inclusion body myopathy. However, there have been few genetic analyses of sporadic inclusion body myositis (sIBM). In order to explore the molecular basis of sIBM and to investigate genotype-phenotype correlations, we performed a clinicopathological analysis of 21 sIBM patients and screened for mutations in the Desmin, GNE, MYHC2A, VCP, and ZASP genes. All coding exons of the five genes were sequenced directly. Definite IBM was confirmed in 14 cases, probable IBM in three cases, and possible IBM in four cases. No cases showed missense mutations in the Desmin, GNE, or VCP genes. Three patients carried the missense mutation c.2542T[C (p.V805A) in the MYHC2A gene; immunohistochemical staining for MYHC isoforms in these three cases showed atrophy or loss of muscle fibers expressing MYHC IIa or IIx. One patient harbored the missense mutation c.1719G[A (p.V566M) in the ZASP gene; immunohistochemical studies of Z-band-associated proteins revealed Z-band abnormalities. Both of the novel heterogeneous mutations were located in highly evolutionarily conserved domains of their respective genes. Cumulatively, these findings have expanded our understanding of the molecular background of sIBM. However, we advocate further clinicopathology and investigation of additional candidate genes in a larger cohort. © Springer-Verlag 2012.",desmin;myosin heavy chain;uridine diphosphate n acetylglucosamine 2 epimerase;adult;aged;article;cardiomyopathy;clinical article;clinical feature;controlled study;desmin gene;exon;female;frontotemporal dementia;gene;gene expression;gene mutation;gene sequence;genetic conservation;genotype;gne gene;histopathology;human;human tissue;immunohistochemistry;inclusion body myositis;Japanese (people);joint contracture;male;missense mutation;muscle atrophy;muscle cell;muscle weakness;mutational analysis;myhc iia gene;myhc iix gene;myhc2a gene;ophthalmoplegia;Paget bone disease;pathogenesis;phenotype;priority journal;vcp gene;zasp gene,"Cai, H.;Yabe, I.;Sato, K.;Kano, T.;Nakamura, M.;Hozen, H.;Sasaki, H.",2012,,,0,
608,Mortality of bullous pemphigoid in Singapore: Risk factors and causes of death in 359 patients seen at the National Skin Centre,"Background Bullous pemphigoid (BP) is the most common autoimmune-mediated subepidermal blistering skin disease and is associated with significant morbidity and mortality. Objectives To determine the 3-year mortality rate, risk factors and causes of death in patients with BP in Singapore, compared with the general population. Methods We conducted a retrospective cohort study of all newly diagnosed patients with BP seen at the National Skin Centre from 1 April 2004 to 31 December 2009. Demographic and clinical data on comorbidities and treatment were recorded. Mortality information was obtained from the National Registry of Diseases. Results In total 359 patients were included in our study. The 1-, 2-, 3-year mortality rates were 26·7%, 38·4% and 45·7%, respectively. The 3-year standardized mortality risk for patients with BP was 2·74 (95% confidence interval 2·34-3·19) times higher than for the age- and sex-matched general population. Parkinson disease, heart failure and chronic renal disease were associated with increased mortality, while combination treatment with low-to-moderate-dose corticoste-roids and immunomodulatory agents such as doxycycline and/or nicotinamide was associated with lower mortality. Overall, infections were the most common cause of death (59·8%), with the main causes of death being pneumonia (42·7%), cardiovascular disease (14·6%) and stroke (11·6%). Conclusions This study confirms an increased 3-year mortality rate for patients with BP in Singapore. Risk factors for increased mortality include medical comorbidities, especially neurological, cardiac and renal diseases. Treatment with combination therapy, including the use of low-to-moderate-dose corticosteroid, appeared to decrease mortality risk in patients with BP. What's already known about this topic? Bullous pemphigoid (BP) is the most common subepidermal blistering skin disease and is associated with significant morbidity. Patients with BP have an increased mortality rate compared with the general population in Western cohorts. What does this study add? This is the first comprehensive study to demonstrate increased mortality risk in Asian patients with BP. Mortality risk factors include Parkinson disease, heart failure and chronic renal disease. Combination treatment with low-to-moderate-dose corticosteroids and immunomodulatory agents, such as doxycycline and/or nicotinamide, was associated with lower mortality. © 2013 British Association of Dermatologists.",azathioprine;corticosteroid;dapsone;doxycycline;nicotinamide;prednisolone;adult;aged;article;bullous pemphigoid;cause of death;cerebrovascular accident;chronic kidney disease;chronic lung disease;clinical study;cohort analysis;comorbidity;comparative study;congestive heart failure;dementia;diabetes mellitus;female;follow up;gastrointestinal disease;heart failure;heart infarction;human;hypertension;ischemic heart disease;liver disease;major clinical study;male;morbidity;mortality;Parkinson disease;pneumonia;population research;priority journal;pyelonephritis;retrospective study;risk factor;septicemia;Singapore;skin infection;soft tissue infection;systemic therapy;thyroid disease;urinary tract infection,"Cai, S. C. S.;Allen, J. C.;Lim, Y. L.;Chua, S. H.;Tan, S. H.;Tang, M. B. Y.",2014,,,0,
609,Mutations in presenilin 2 and its implications in Alzheimer’s disease and other dementia-associated disorders,"Alzheimer’s disease (AD) is the most common form of dementia. Mutations in the genes encoding presenilin 1 (PSEN1), presenilin 2 (PSEN2), and amyloid precursor protein have been identified as the main genetic causes of familial AD. To date, more than 200 mutations have been described worldwide in PSEN1, which is highly homologous with PSEN2, while mutations in PSEN2 have been rarely reported. We performed a systematic review of studies describing the mutations identified in PSEN2. Most PSEN2 mutations were detected in European and in African populations. Only two were found in Korean populations. Interestingly, PSEN2 mutations appeared not only in AD patients but also in patients with other disorders, including frontotemporal dementia, dementia with Lewy bodies, breast cancer, dilated cardiomyopathy, and Parkinson’s disease with dementia. Here, we have summarized the PSEN2 mutations and the potential implications of these mutations in dementia-associated disorders.",presenilin 2;African;Alzheimer disease;amino acid substitution;article;brain region;breast cancer;congestive cardiomyopathy;dementia;disease association;European;exon;frontotemporal dementia;gene frequency;gene function;gene mutation;genetic variability;haplotype;human;Korean (people);Lewy body;missense mutation;Parkinson disease;pathogenesis;phylogeny;population research;prevalence;protein cleavage;protein function;protein structure;PSEN2 gene;stop codon;transcription regulation;upregulation,"Cai, Y.;An, S. S. A.;Kim, S.",2015,,,0,
610,"Total and cancer mortality in a cohort of ulcerative colitis and Crohn's disease patients: The Florence inflammatory bowel disease study, 1978–2010","Background There is no consensus on the leading causes of death among inflammatory bowel diseases (IBD) patients. Aim We present the results of an extended follow-up of the population-based Florence IBD cohort, including 689 ulcerative colitis and 231 Crohn's disease patients. Methods The causes of death of cohort members were determined through linkage with the local mortality registry. We calculated standardized mortality ratios (SMR) and 95% confidence intervals (95%CI) by applying gender-, age- and calendar time–death rates to person-years at risk. Results Ulcerative colitis patients had overall mortality comparable to the general population (SMR 0.99, 95%CI 0.85–1.14), though being at increased risk of dying from Hodgkin's disease (SMR 11.74, 95%CI 2.94–46.94), rectal cancer (SMR 3.69, 95%CI 1.66–8.22) and Alzheimer's disease (2.40, 95%CI 1.00–5.76). Crohn's disease patients had an increased overall mortality (SMR 1.79, 95%CI 1.39–2.27) and were at higher risk of dying from cancer (SMR 2.57, 95%CI 1.28–5.13) and non-cancer diseases of the respiratory system (SMR 2.51, 95%CI 1.05–6.04), brain cancer (SMR 6.26, 95%CI 1.57–25.02) and non-cancer diseases of the genitourinary system (SMR 4.38, 95%CI 1.10–17.52). Conclusions IBD patients should be offered counselling on risk reduction strategies, as much of their mortality excess is potentially avoidable.",acute heart infarction;adolescent;adult;Alzheimer disease;article;bile duct cancer;bladder cancer;brain cancer;brain degeneration;breast cancer;bronchus cancer;cancer mortality;cause of death;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;colitis;colon cancer;Crohn disease;diabetes mellitus;enteritis;female;follow up;gastrointestinal disease;Hodgkin disease;human;injury;intoxication;ischemic heart disease;Italy;liver cancer;lung cancer;lymphosarcoma;major clinical study;male;mortality;mortality risk;Parkinson disease;patient counseling;peritoneum cancer;population;priority journal;prostate cancer;rectum cancer;respiratory tract disease;reticulosarcoma;risk reduction;sex difference;standardized mortality ratio;stomach cancer;trachea cancer;ulcerative colitis;urogenital tract disease;vascular disease,"Caini, S.;Bagnoli, S.;Palli, D.;Saieva, C.;Ceroti, M.;Bendinelli, B.;Assedi, M.;Masala, G.",2016,,10.1016/j.dld.2016.07.008,0,
611,Absence of MRI exams in epidemiological studies can leads to clinical overdiagnosis of Alzheimer's disease and underdiagnosis of vascular dementia,,Alzheimer disease;clinical protocol;cognitive defect;computer assisted tomography;congestive heart failure;dementia;diagnostic accuracy;diagnostic error;diagnostic value;human;incidence;letter;multiinfarct dementia;neuroimaging;neurologic examination;neuropathology;nuclear magnetic resonance imaging;prevalence,"Caixeta, L.;Soares, V. L.;Soares, C. D.",2009,,,0,
612,Memantine (Ebixa®) in clinical practice - Results of an observational study,"Background/Aims: In a post-marketing observational study, the efficacy and tolerability of memantine were examined in patients with moderate to severe Alzheimer's disease. Methods: The patients were treated with 20 mg/day of memantine for a 6-month period. The efficacy of memantine was evaluated using the Mini-Mental State Examination, the Nurses' Observation Scale for Geriatric Patients (NOSGER) and the Explorationsmodul Demenz (EMD) scale. In addition, a global assessment was made by the physician. Results: After 6 months of open-label treatment with memantine, the patients' cognitive function, ability to perform daily activities and global performance all showed a marked improvement. In the overall evaluation by the physician, improvement or stabilisation had been achieved by 78.8% of patients after 6 months of therapy. Memantine also demonstrated an excellent tolerability profile. Conclusion: The results of this naturalistic study support the significant efficacy and tolerability of memantine that has been previously demonstrated in randomised, controlled clinical Alzheimer's disease trials. Copyright © 2007 S. Karger AG.",Ginkgo biloba extract;memantine;piracetam;aged;aggression;agitation;Alzheimer disease;article;cerebrovascular accident;clinical practice;cognition;confusion;controlled study;daily life activity;dehydration;dizziness;drug efficacy;drug tolerability;drug withdrawal;female;geriatric patient;heart failure;human;male;Mini Mental State Examination;nausea;observational study;paranoia;physician;pneumonia;priority journal;restlessness;side effect;urinary tract infection;ebixa,"Calabrese, P.;Essner, U.;Förstl, H.",2007,,,0,
613,Global health care use by patients with type-2 diabetes: Does the type of comorbidity matter?,"To identify patterns of health care use among diabetic patients with multimorbidity across primary, specialised, hospital and emergency care, depending on their type of chronic comorbidity. Methods Longitudinal study of a population-based retrospective cohort conformed by adult patients with type-2 diabetes assigned to any of the primary care centres in Aragon during 2010 and 2011 (n = 65,716). Negative binomial regressions were run to model the effect of the type of comorbidity on the number of visits to each level of care. Comorbidities were classified as concordant, discordant or mental based on expert consensus and depending on whether they shared the same overall pathophysiologic risk profile and disease management plan designed for type-2 diabetes. Results Mental comorbidity was independently associated with total and unplanned admissions (incidence rate ratio [IRR]:1.25; 95% confidence interval [CI]:1.12-1.39, IRR:1.21; 95% CI:1.06-1.39), average length of stay (IRR:1.47; 95% CI:1.25-1.73), and total and priority emergency room visits (IRR:1.26; 95% CI:1.17-1.35, IRR:1.30; 95% CI:1.18-1.42). Patients with discordant comorbidities showed the strongest associations with the number of visits to specialists (IRR:1.38; 95% CI:1.33-1.43) and to different specialties (IRR:1.36; 95% CI:1.32-1.39). Differences regarding GP visits were lower but still significant for patients with discordant comorbidity (IRR:1.08; 95% CI:1.06-1.11), but especially for those with mental comorbidity (IRR:1.17; 95% CI:1.14-1.21). Conclusion In patients with type-2 diabetes, the coexistence of mental comorbidity significantly increases the use of unplanned hospital services, and discordant comorbidities have an important effect on specialised care use. Differences with respect to primary care use are not as prominent.",acquired immune deficiency syndrome;acute heart infarction;acute leukemia;adult;affective psychosis;anxiety disorder;aorta aneurysm;aphakia;aplastic anemia;arthropathy;article;asthma;atherosclerosis;attention deficit disorder;autoimmune disease;behavior disorder;bladder cancer;blindness;blood clotting disorder;breast cancer;cardiomyopathy;cardiovascular disease;cataract;cerebral palsy;cerebrovascular disease;chromosome aberration;chronic kidney failure;chronic liver disease;chronic obstructive lung disease;chronic pancreatitis;cleft lip;clinical assessment;colorectal cancer;comorbidity;congenital heart disease;congenital hip dislocation;congenital malformation;congestive heart failure;connective tissue disease;cystic fibrosis;deep vein thrombosis;delirium;dementia;depression;dermatitis;developmental disorder;diabetic patient;diabetic retinopathy;disorders of lipid metabolism;diverticulosis;eczema;emergency ward;emphysema;endocrine disease;endometriosis;esophagus cancer;female;gallstone formation;gastroesophageal reflux;glaucoma;gout;hair disease;health care utilization;hearing impairment;heart arrhythmia;hematologic disease;hemolytic anemia;hemophilia;hospital service;human;Human immunodeficiency virus infection;hypertension;hypospadias;hypothyroidism;immunopathology;iron deficiency anemia;irritable colon;ischemic heart disease;kidney disease;kyphoscoliosis;lactose intolerance;leg varicosis;length of stay;longitudinal study;low back pain;lung embolism;lymphoma;major clinical study;male;malignant neoplastic disease;medical specialist;metabolic disorder;multiple sclerosis;muscular dystrophy;nephritis;neuritis;neurologic disease;neurosis;non insulin dependent diabetes mellitus;obesity;organ transplantation;osteoarthritis;osteoporosis;ovary cancer;paralysis;Parkinson disease;peripheral neuropathy;peripheral vascular disease;personality disorder;primary medical care;prostate hypertrophy;prostatitis;psoriasis;quadriplegia;respiratory tract disease;retina disease;schizophrenia;seizure;skin cancer;skin ulcer;sleep disordered breathing;spinal cord injury;stomach cancer;substance use;thrombophlebitis;tracheostomy;tuberculosis;uterus prolapse;valvular heart disease,"Calderón-Larrañaga, A.;Abad-Díez, J. M.;Gimeno-Feliu, L. A.;Marta-Moreno, J.;González-Rubio, F.;Clerencia-Sierra, M.;Poblador-Plou, B.;Poncel-Falcó, A.;Prados-Torres, A.",2015,,,0,
614,Multimorbidity and weight loss in obese primary care patients: Longitudinal study based on electronic healthcare records,"Objective: To analyse the association between cardiovascular and mental comorbidities of obesity and weight loss registered in the electronic primary healthcare records. Design and setting: Longitudinal study of a cohort of adult patients assigned to any of the public primary care centres in Aragon, Spain, during 2010 and 2011. Participants: Adult obese patients for whom data on their weight were available for 2010 (n=62 901), and for both 2010 and 2011 (n=42 428). Outcomes: Weight loss (yes/no) was calculated based on the weight difference between the first value registered in 2010 and the last value registered in 2011. Multivariate logistic regression models were adjusted for individuals' age, sex, total number of chronic comorbidities, type of obesity and length of time between both weight measurements. Results: According to the recorded clinical information, 9 of 10 obese patients showed at least one chronic comorbidity. After adjusting for covariates, weight loss seemed to be more likely among obese patients with a diagnosis of diabetes and/or dementia and less likely among those with hypertension, anxiety and/or substance use problems (p<0.05). The probability of weight loss was also significantly higher in male patients with more severe obesity and older age. Conclusions: An increased probability of weight loss over 1 year was observed in older obese male patients, especially among those already manifesting high levels of obesity and severe comorbidities such as diabetes and/or dementia. Yet patients with certain psychological problems showed lower rates of weight reduction. Future research should clarify if these differences persist beyond potential selective weight documentation in primary care, to better understand the trends in weight reduction among obese patients and the underlying role of general practitioners regarding such trends.",acute heart infarction;adolescent;adult;affective psychosis;aged;anxiety disorder;article;attention deficit disorder;behavior disorder;cardiovascular disease;cerebrovascular disease;cohort analysis;comparative study;congestive heart failure;dementia;depression;diabetes mellitus;dyslipidemia;electronic medical record;female;heart arrhythmia;human;hypertension;ischemic heart disease;longitudinal study;major clinical study;male;mental disease;middle aged;mitral valve disease;morbidity;obesity;patient care;personality disorder;primary medical care;schizophrenia;Spain;substance use;weight reduction,"Calderón-Larrañaga, A.;Hernández-Olivan, P.;González-Rubio, F.;Gimeno-Feliu, L. A.;Poblador-Plou, B.;Prados-Torres, A.",2015,,,0,
615,"Butyrylcholinesterase activity, cardiovascular risk factors, and mortality in middle-aged and elderly men and women in Jerusalem","Background: The association of butyrylcholinesterase (BuChE) with Alzheimer disease and the association of this disease with cardiovascular risk factors raise interest in the association of BuChE activity with cardiovascular risk factors and mortality. Methods: A baseline cross-sectional study was conducted between 1985 and 1987, encompassing residents ≥50 years of age living in a Jewish neighborhood in western Jerusalem. Interviews were followed by examinations and nonfasting blood sampling (available for 1807 participants). Follow-up data to April 1996 on mortality and causes of death were obtained through record linkage with the Israeli Population Registry. Results: BuChE activity was inversely related to age and was positively associated with serum concentrations of albumin (r = 0.35; P <0.001), cholesterol (r = 0.31; P <0.001), and triglycerides (r = 0.30; P <0.001). Enzyme activity was associated with measures of overweight, obesity, and body fat distribution (e.g., body mass index, r = 0.20; P <0.001). In multivariate analysis, the associations of enzyme activity with serum cholesterol, triglycerides, and albumin persisted strongly. After adjustment by Cox proportional hazards regression for other predictors of mortality in this population, individuals in the lowest quintile of BuChE activity had significantly higher mortality than those in the highest quintile [hazard ratios (95% confidence intervals): all-cause mortality, 1.62 (1.15-2.30); cardiovascular deaths, 1.79 (1.05-3.05)]. The association was attenuated by introduction of serum albumin into the models. Conclusions: This is the first study to report on the association between BuChE and mortality. The relatively strong association of BuChE with serum lipid and albumin concentrations requires elucidation. Our results suggest that low BuChE activity may be a nonspecific risk factor for mortality in the elderly. © 2006 American Association for Clinical Chemistry.",cholesterol;cholinesterase;serum albumin;triacylglycerol;adult;aged;article;basal metabolic rate;blood sampling;body mass;cardiovascular risk;enzyme activity;female;follow up;glucose metabolism;human;ischemic heart disease;Israel;Jew;lipid blood level;major clinical study;male;mortality;obesity;population research;risk factor,"Calderon-Margalit, R.;Adler, B.;Abramson, J. H.;Gofin, J.;Kark, J. D.",2006,,,0,
616,Use of Medicare claims to identify US hospitals with a high rate of surgical site infection after hip arthroplasty,"Objective. To assess the ability of Medicare claims to identify US hospitals with high rates of surgical site infection (SSI) after hip arthroplasty. design. Retrospective cohort study. setting. Acute care US hospitals. participants. Fee-for-serviceMedicarepatients65yearsofageandolderwhounderwenthiparthroplastyinUShospitalsfrom2005 through 2007. methods. Hospital rankings were derived from claims codes suggestive of SSI, adjusted for age, sex, and comorbidities, while using generalized linear mixed models to account for hospital volume. Medical records were obtained for validation of infection on a random sample of patients from hospitals ranked in the best and worst deciles of performance. We then calculated the risk-adjusted odds of developing a chart-confirmed SSI after hip arthroplasty in hospitals ranked by claims into worst versus best-performing deciles. results. Among 524,892 eligible Medicare patients who underwent hip arthroplasty at 3,296 US hospitals, a patient who underwent surgery in a hospital ranked in the worst-performing decile based on claims-based evidence of SSI had 2.9-fold higher odds of developing a chart-confirmed SSI relative to a patient with the same age, sex, and comorbidities in a hospital ranked in the best-performing decile (95% confidence interval, 2.2-3.7). conclusions. Medicare claims successfully distinguished between hospitals with high and low SSI rates following hip arthroplasty. These claims can identify potential outlier hospitals that merit further evaluation. This strategy can also be used to validate the completeness of public reporting of SSI. © 2012 by The Society for Healthcare Epidemiology of America.",acquired immune deficiency syndrome;aged;article;cardiovascular disease;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;dementia;diabetes mellitus;female;hemiplegia;hip arthroplasty;hospitalization;human;Human immunodeficiency virus infection;infection rate;kidney disease;liver disease;major clinical study;male;medicare;postoperative infection;retrospective study;solid tumor;surgical infection;United States,"Calderwood, M. S.;Kleinman, K.;Bratzler, D. W.;Ma, A.;Bruce, C. B.;Kaganov, R. E.;Canning, C.;Platt, R.;Huang, S. S.",2013,,,0,
617,"Apolipoprotein E genotyping method by Real Time PCR, a fast and cost-effective alternative to the TaqMan® and FRET assays","The apolipoprotein E gene (APOE) polymorphism genotyping has an allegedly important predictive value for coronary heart disorders and Alzheimer's disease. We developed a simple, fast, cost-effective and suited for high-throughput protocol for determining APOE genotypes by Real Time PCR monitored by SYBR® Green. The method is based on differential amplification by allele-specific primers. These primers have variations in their 3′-end nucleotides such that are specific for one of the two variants in each polymorphic position. By this protocol, we obtained a 100% concordance with the APOE genotypes determined by sequencing analysis. The main advantages of this method are its relative simplicity and the reduced cost compared to other methodologies, such as the TaqMan® and FRET assays. © 2009 Elsevier B.V. All rights reserved.",apolipoprotein E;DNA;fluorescent dye;allele;Alzheimer disease;article;controlled study;diagnostic value;DNA isolation;fluorescence resonance energy transfer;gene amplification;genetic polymorphism;genetic variability;genotype;high throughput screening;human;human tissue;intermethod comparison;ischemic heart disease;major clinical study;nucleotide sequence;prediction;priority journal;real time polymerase chain reaction;risk assessment;sequence analysis,"Calero, O.;Hortigüela, R.;Bullido, M. J.;Calero, M.",2009,,,0,
618,Evaluation of diagnostic imaging technologies and therapeutics devices: better information for better decisions: proceedings of a multidisciplinary workshop,"We are entering an era in which the success of biomedical science and the increasing understanding of the value of evidence for practice are in a state of tension. This tension is especially notable in the device arena, in which the short life cycles and iterative nature of development are at odds with current design constructs of the types of clinical trials that provide evidence for medical decision making. The financial pressure arising from strained budgets and expanding costs from the aging of the population and the continued development of new technology heightens the need for a focus on new approaches. Given this background, a group of experts representing constituencies with different perspectives were convened for a day and a half to discuss key issues and their potential solutions. Because of the complex and heterogeneous nature of the environments in which devices are used, the meeting focused on 3 broad, general uses of devices: imaging, risk stratification, and therapeutics. The goal of the meeting was to develop a preliminary list of ideas that could be framed as researchable questions or constructs for consideration by policy makers that ultimately might lead to improvements in the current system. Across diagnostic imaging, risk stratification devices, and therapeutic devices, the crosscutting issues can be identified: We need better methods of collaborative funding and priority setting, improved and more flexible methods, and new approaches to the integration of federal agencies in overseeing the system.","Alzheimer Disease/diagnosis;Biomedical Technology/economics/*organization & administration;Centers for Medicare and Medicaid Services (U.S.);Cooperative Behavior;Death, Sudden, Cardiac/epidemiology;Decision Making;Defibrillators, Implantable;*Device Approval;Diagnostic Imaging/economics/*instrumentation/methods;Equipment Safety;Health Services Research/manpower;Humans;Interinstitutional Relations;Male;Prostatic Hyperplasia/therapy;Randomized Controlled Trials as Topic;*Technology Assessment, Biomedical;Transurethral Resection of Prostate;United States;United States Food and Drug Administration;Ventricular Dysfunction, Left/diagnosis/therapy","Califf, R. M.",2006,Jul,10.1016/j.ahj.2005.10.001,0,
619,Altered diastolic function and aortic stiffness in Alzheimer's disease,"Background: Alzheimer's disease (AD) is closely linked to cardiovascular risk factors. Methods: Echocardiographic studies were performed, including left ventricular diastolic functions, left and right atrial conduction times, and arterial stiffness parameters, namely stiffness index, pressure-strain elastic modulus, and distensibility, on 29 patients with AD and 24 age-matched individuals with normal cognitive function. Results: The peak mitral flow velocity of the early rapid filling wave (E) was lower, and the peak velocity of the late filling wave caused by atrial contraction (A), deceleration time of peak E velocity, and isovolumetric relaxation time were higher in the AD group. The early myocardial peak (Ea) velocity was significantly lower in AD patients, whereas the late diastolic (Aa) velocity and E/Ea ratio were similar between the two groups. In Alzheimer patients, stiffness index and pressure-strain elastic modulus were higher, and distensibility was significantly lower in the AD group compared to the control. Interatrial electromechanical delay was significantly longer in the AD group. Conclusion: Our findings suggest that patients with AD are more likely to have diastolic dysfunction, higher atrial conduction times, and increased arterial stiffness compared to the controls of same sex and similar age. © 2014 Çalik et al.",age distribution;aged;Alzheimer disease;arterial stiffness;artery compliance;article;blood flow velocity;cardiovascular parameters;cardiovascular risk;clinical article;controlled study;deceleration;diastolic dysfunction;disease association;echocardiography;excitation contraction coupling;female;heart atrium conduction;heart atrium contraction;heart left ventricle function;heart muscle relaxation;heart ventricle filling;human;male;relaxation time;stiffness index;Young modulus,"Çalik, A. N.;Özcan, K. S.;Yüksel, G.;Güngör, B.;Arugarslan, E.;Varlibas, F.;Ekmekci, A.;Osmonov, D.;Tatlisu, M. A.;Karaca, M.;Bolca, O.;Erdinler, I.",2014,,,0,
620,Targeting functional decline in Alzheimer disease: A randomized trial,"Background: Alzheimer disease results in progressive functional decline, leading to loss of independence. Objective: To determine whether collaborative care plus 2 years of home-based occupational therapy delays functional decline. Design: Randomized, controlled clinical trial. (ClinicalTrials.gov: NCT01314950) Setting: Urban public health system. Patients: 180 community-dwelling participants with Alzheimer disease and their informal caregivers. Intervention: All participants received collaborative care for dementia. Patients in the intervention group also received in-home occupational therapy delivered in 24 sessions over 2 years. Measurements: The primary outcome measure was the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Scale (ADCS ADL); performance-based measures included the Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM). Results: At baseline, clinical characteristics did not differ significantly between groups; the mean Mini-Mental State Examination score for both groups was 19 (SD, 7). The intervention group received a median of 18 home visits from the study occupational therapists. In both groups, ADCS ADL scores declined over 24 months. At the primary end point of 24 months, ADCS ADL scores did not differ between groups (mean difference, 2.34 [95% CI, - 5.27 to 9.96]). We also could not definitively demonstrate between-group differences in mean SPPB or SPSM values. Limitation: The results of this trial are indeterminate and do not rule out potential clinically important effects of the intervention. Conclusion: The authors could not definitively demonstrate whether the addition of 2 years of in-home occupational therapy to a collaborative care management model slowed the rate of functional decline among persons with Alzheimer disease. This trial underscores the burden undertaken by caregivers as they provide care for family members with Alzheimer disease and the difficulty in slowing functional decline. Primary Funding Source: National Institute on Aging.",NCT01314950;adult;aged;Alzheimer disease;article;caregiver;cerebrovascular accident;cognitive defect;congestive heart failure;controlled study;coronary artery disease;daily life activity;depression;diabetes mellitus;female;functional disease;home rehabilitation;home visit;human;Indiana;major clinical study;male;Mini Mental State Examination;occupational therapist;occupational therapy;outcome assessment;parallel design;primary medical care;priority journal;problem behavior;public health;randomized controlled trial;single blind procedure;social welfare;urban area,"Callahan, C. M.;Boustani, M. A.;Schmid, A. A.;La Mantia, M. A.;Austrom, M. G.;Miller, D. K.;Gao, S.;Ferguson, D. Y.;Lane, K. A.;Hendrie, H. C.",2017,,10.7326/m16-0830,0,
621,Childhood intelligence in relation to major causes of death in 68 year follow-up: Prospective population study,"Objectives To examine the association between intelligence measured in childhood and leading causes of death in men and women over the life course. Design Prospective cohort study based on a whole population of participants born in Scotland in 1936 and linked to mortality data across 68 years of follow-up. Setting Scotland. Participants 33 536 men and 32 229 women who were participants in the Scottish Mental Survey of 1947 (SMS1947) and who could be linked to cause of death data up to December 2015. Main outcome measures Cause specific mortality, including from coronary heart disease, stroke, specific cancer types, respiratory disease, digestive disease, external causes, and dementia. Results Childhood intelligence was inversely associated with all major causes of death. The age and sex adjusted hazard ratios (and 95% confidence intervals) per 1 SD (about 15 points) advantage in intelligence test score were strongest for respiratory disease (0.72, 0.70 to 0.74), coronary heart disease (0.75, 0.73 to 0.77), and stroke (0.76, 0.73 to 0.79). Other notable associations (all P<0.001) were observed for deaths from injury (0.81, 0.75 to 0.86), smoking related cancers (0.82, 0.80 to 0.84), digestive disease (0.82, 0.79 to 0.86), and dementia (0.84, 0.78 to 0.90). Weak associations were apparent for suicide (0.87, 0.74 to 1.02) and deaths from cancer not related to smoking (0.96, 0.93 to 1.00), and their confidence intervals included unity. There was a suggestion that childhood intelligence was somewhat more strongly related to coronary heart disease, smoking related cancers, respiratory disease, and dementia in women than men (P value for interactions <0.001, 0.02, <0.001, and 0.02, respectively).Childhood intelligence was related to selected cancer presentations, including lung (0.75, 0.72 to 0.77), stomach (0.77, 0.69 to 0.85), bladder (0.81, 0.71 to 0.91), oesophageal (0.85, 0.78 to 0.94), liver (0.85, 0.74 to 0.97), colorectal (0.89, 0.83 to 0.95), and haematopoietic (0.91, 0.83 to 0.98). Sensitivity analyses on a representative subsample of the cohort observed only small attenuation of the estimated effect of intelligence (by 10-26%) after adjustment for potential confounders, including three indicators of childhood socioeconomic status. In a replication sample from Scotland, in a similar birth year cohort and follow-up period, smoking and adult socioeconomic status partially attenuated (by 16-58%) the association of intelligence with outcome rates. Conclusions In a whole national population year of birth cohort followed over the life course from age 11 to age 79, higher scores on a well validated childhood intelligence test were associated with lower risk of mortality ascribed to coronary heart disease and stroke, cancers related to smoking (particularly lung and stomach), respiratory diseases, digestive diseases, injury, and dementia.",adolescent;adult;aged;article;cause of death;cerebrovascular accident;child;childhood;cohort analysis;colorectal cancer;dementia;disease association;esophagus cancer;female;follow up;gastrointestinal disease;health survey;hematologic malignancy;human;intelligence;intelligence test;ischemic heart disease;lifespan;liver cancer;lung cancer;major clinical study;male;malignant neoplasm;population research;priority journal;prospective study;respiratory tract disease;Scotland;sensitivity analysis;sex difference;smoking;socioeconomics;suicide,"Calvin, C. M.;Batty, G. D.;Der, G.;Brett, C. E.;Taylor, A.;Pattie, A.;Cukic, I.;Deary, I. J.",2017,,10.1136/bmj.j2708,0,
622,Symptomatic sinus bradycardia associated with donepezil,"Introduction. Donepezil is a drug which is being used more and more widely in mild-moderate Alzheimer's disease. In general, it is well tolerated and the side-effects are basically cholinergic-dependent. Symptomatic disorders of cardiac rhythm associated with the use of donepezil are extremely unusual. Clinical case. We describe the case of an 81 year old patient with hypertensive cardiopathy, who developed sinus bradycardia, fainting and left cardiac failure three weeks after starting treatment with donepezil. When donepezil was stopped the sinus bradycardia disappeared, a 24 hour electrocardiographic holter showed no signs of sinus node disease and no episodes of this type occurred during the following six months. Conclusion. Symptomatic sinus bradycardia is a possible adverse effect of treatment with donepezil in Alzheimer's disease.",donepezil;aged;Alzheimer disease;article;case report;clinical feature;disease course;drug withdrawal;electrocardiography monitoring;female;human;sinus bradycardia;treatment outcome,"Calvo-Romero, J. M.",1999,,,0,
623,Myocardial ischemia: Cost-effectiveness and epidemiologic data,,abdominal obesity;accident;Alzheimer disease;cerebrovascular disease;cost effectiveness analysis;diabetes mellitus;environmental exposure;health care cost;heart infarction;heart muscle ischemia;human;hyperglycemia;incidence;mortality;neoplasm;pollution;prevalence;primary prevention;risk factor;short survey;smoking;suicide,"Cambou, J. P.",2008,,,0,
624,Context-driven automatic subgraph creation for literature-based discovery,"Background: Literature-based discovery (LBD) is characterized by uncovering hidden associations in non-interacting scientific literature. Prior approaches to LBD include use of: (1) domain expertise and structured background knowledge to manually filter and explore the literature, (2) distributional statistics and graph-theoretic measures to rank interesting connections, and (3) heuristics to help eliminate spurious connections. However, manual approaches to LBD are not scalable and purely distributional approaches may not be sufficient to obtain insights into the meaning of poorly understood associations. While several graph-based approaches have the potential to elucidate associations, their effectiveness has not been fully demonstrated. A considerable degree of a priori knowledge, heuristics, and manual filtering is still required. Objectives: In this paper we implement and evaluate a context-driven, automatic subgraph creation method that captures multifaceted complex associations between biomedical concepts to facilitate LBD. Given a pair of concepts, our method automatically generates a ranked list of subgraphs, which provide informative and potentially unknown associations between such concepts. Methods: To generate subgraphs, the set of all MEDLINE articles that contain either of the two specified concepts (A, C) are first collected. Then binary relationships or assertions, which are automatically extracted from the MEDLINE articles, called semantic predications, are used to create a labeled directed predications graph. In this predications graph, a path is represented as a sequence of semantic predications. The hierarchical agglomerative clustering (HAC) algorithm is then applied to cluster paths that are bounded by the two concepts (A, C). HAC relies on implicit semantics captured through Medical Subject Heading (MeSH) descriptors, and explicit semantics from the MeSH hierarchy, for clustering. Paths that exceed a threshold of semantic relatedness are clustered into subgraphs based on their shared context. Finally, the automatically generated clusters are provided as a ranked list of subgraphs. Results: The subgraphs generated using this approach facilitated the rediscovery of 8 out of 9 existing scientific discoveries. In particular, they directly (or indirectly) led to the recovery of several intermediates (or B-concepts) between A- and C-terms, while also providing insights into the meaning of the associations. Such meaning is derived from predicates between the concepts, as well as the provenance of the semantic predications in MEDLINE. Additionally, by generating subgraphs on different thematic dimensions (such as Cellular Activity, Pharmaceutical Treatment and Tissue Function), the approach may enable a broader understanding of the nature of complex associations between concepts. Finally, in a statistical evaluation to determine the interestingness of the subgraphs, it was observed that an arbitrary association is mentioned in only approximately 4 articles in MEDLINE on average. Conclusion: These results suggest that leveraging the implicit and explicit semantics provided by manually assigned MeSH descriptors is an effective representation for capturing the underlying context of complex associations, along multiple thematic dimensions in LBD situations.",arginine;calcium independent phospholipase A2;chlorpromazine;estrogen;fish oil;indometacin;magnesium;phthalic acid bis(2 ethylhexyl) ester;somatomedin C;testosterone;algorithm;Alzheimer disease;article;cluster analysis;evidence based practice;heart ventricle hypertrophy;human;information retrieval;Medical Subject Headings;migraine;priority journal;Raynaud phenomenon;schizophrenia;semantics;sepsis;sleep;thrombocyte aggregation,"Cameron, D.;Kavuluru, R.;Rindflesch, T. C.;Sheth, A. P.;Thirunarayan, K.;Bodenreider, O.",2015,,,0,
625,Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation,"OBJECTIVE: We studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and >/=1 additional stroke risk factor between 2010 and 2015. METHODS: 39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010-2011), n=5500; C2 (2011-2013), n=11 662; C3 (2013-2014), n=11 462; C4 (2014-2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort. RESULTS: Baseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age >/=75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)+/-antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)+/-AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc >/=2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities. CONCLUSIONS: Since NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA+/-AP or AP alone. TRIAL REGISTRATION NUMBER: NCT01090362; Pre-results.",Stroke,"Camm, A. J.;Accetta, G.;Ambrosio, G.;Atar, D.;Bassand, J. P.;Berge, E.;Cools, F.;Fitzmaurice, D. A.;Goldhaber, S. Z.;Goto, S.;Haas, S.;Kayani, G.;Koretsune, Y.;Mantovani, L. G.;Misselwitz, F.;Oh, S.;Turpie, A. G.;Verheugt, F. W.;Kakkar, A. K.",2016,Sep 19,10.1136/heartjnl-2016-309832,0,
626,Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation,"Objective We studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ?1 additional stroke risk factor between 2010 and 2015. Methods 39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010'2011), n=5500; C2 (20112013), n=11 662; C3 (2013-2014), n=11 462; C4 (2014- 2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort. Results Baseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ?75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ?2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal antiinflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities. Conclusions Since NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.",anticoagulant agent;antivitamin K;aged;article;Asian;atrial fibrillation;cerebrovascular accident;CHADS2 score;cohort analysis;controlled study;dementia;diabetes mellitus;ethnicity;female;geriatric patient;heart failure;human;hypertension;major clinical study;male;monotherapy;prospective study;risk assessment;risk factor;scoring system;visual analog scale,"Camm, A. J.;Accetta, G.;Ambrosio, G.;Atar, D.;Bassand, J. P.;Berge, E.;Cools, F.;Fitzmaurice, D. A.;Goldhaber, S. Z.;Goto, S.;Haas, S.;Kayani, G.;Koretsune, Y.;Mantovani, L. G.;Misselwitz, F.;Oh, S.;Turpie, A. G. G.;Verheugt, F. W. A.;Kakkar, A. K.",2017,,10.1136/heartjnl-2016-309832,0,
627,"Disease, impairment, disability and social handicap: a community based study of people aged 70 years and over","The aim of this research was to investigate the prevalence of disability in a total population-based sample aged 70 years and over, the social handicap resulting from the disability and the diseases and impairments contributing to disability in the most disabled subjects. From the initial sample of 856 subjects, 782 (91.4%) participated. Disability in the tasks examined varied from 1.3% of subjects unable to feed themselves to 24.4% unable to carry out housework. In the 74 most disabled subjects comorbidity was common. The major clinical disorders that contributed to impairment and disability were heart failure, osteoarthritis, stroke and dementia. Those who were disabled were considerably more likely to be handicapped than those not disabled (odds ratio 6.65, 95% confidence interval 4.73-9.36). When social support was considered, the estimated risk of handicap associated with disability ranged from 3.19 (95% CI 1.92-5.30) for the subset of subjects who had a spouse, to 52.00 (95% CI 4.03-670.6) for subjects without emotional support.","Activities of Daily Living;Aged;Aged, 80 and over;Comorbidity;Cross-Sectional Studies;*Disability Evaluation;*Disabled Persons/statistics & numerical data;*Disease;Female;Humans;Male;New Zealand;Population Surveillance;Prevalence;Prospective Studies;Research Design;Self Care","Campbell, A. J.;Busby, W. J.;Robertson, M. C.;Lum, C. L.;Langlois, J. A.;Morgan, F. C.",1994,Apr-Jun,,0,
628,Medicare Program Expenditures Associated with Hospice Use,"Background: Hospice providers contend that enrollment reduces the cost of the Medicare programs, but estimates of effects are dated, methodologically limited, and focused on persons with cancer. Objective: To estimate the effects of hospice care on Medicare program payments during the last year of life from 1996 to 1999 within cohorts defined by age and diagnosis. Design: Retrospective cohort. Setting: Deceased Medicare enrollees. Participants: Elderly Medicare fee-for-service beneficiaries who received 36 months of continuous Part A and B coverage before death during 1996 to 1999 (n = 245 326). Age- and condition-specific (cancer or noncancer and principal condition) cohorts were defined. Measurements: Medicare expenditures in the last year of life, as a total figure and by service type. The cost effects of hospice were estimated by using linear regression within the cohorts for hospice enrollees compared with nonenrollees after adjustment for propensity to use hospice, gender, race, enrollment in Medicaid, urban setting, duration of illness, comorbid conditions, low use of Medicare, nursing home residence, and year of death. Results: Adjusted mean expenditures were 4.0% higher overall among hospice enrollees than among nonenrollees. Adjusted mean expenditures were 1% lower for hospice enrollees with cancer than for patients with cancer who did not use hospice. Savings were highest (7% to 17%) among enrollees with lung cancer and other very aggressive types of cancer diagnosed in the last year of life. Expenditures for hospice enrollees without cancer were 11% higher than for nonenrollees, ranging from 20% to 44% for patients with dementia and 0% to 16% for those with chronic heart failure or failure of most other organ systems. Hospice-related savings decreased and relative costs increased with age. Conclusion: Hospice enrollment correlates with reduced Medicare expenditures among younger decedents with cancer but increased expenditures among decedents without cancer and those older than 84 years of age. Future studies should assess the effects of hospice on quality and on expenditures from all payment sources.",adult;aged;aging;article;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;dementia;diabetes mellitus;female;health care cost;health care quality;heart disease;heart failure;hospice;hospice care;human;kidney disease;lung cancer;major clinical study;male;medicaid;medicare;patient care;priority journal,"Campbell, D. E.;Lynn, J.;Louis, T. A.;Shugarman, L. R.",2004,,,0,
629,Acute myocardial infarction in a young man with dilated cardiomyopathy: Clinicopathological correlation,"Cardiac involvement is commonly described in autopsy examinations of patients infected with human immunodeficiency virus (HIV). However, only a small percentage have clinically significant cardiac disease. Dilated cardiomyopathy is one of the most common HIV-related heart diseases. Cardiovascular complications of HIV infection are likely to become more common with improvements in treatment and survival. Coronary thromboembolism has rarely been reported in the setting of dilated cardiomyopathy. Coronary thromboembolism should be suspected in a patient presenting with acute myocardial infarction, normal coronary arteries at subsequent angiography and a potential source of embolus. A patient presenting with acute myocardial infarction subsequently diagnosed as a coronary artery embolism due to HIV cardiomyopathy is reported. Coronary artery embolism and HIV cardiomyopathy are briefly discussed.",acetylsalicylic acid;amiodarone;atorvastatin;cefazolin;ciprofloxacin;clopidogrel;cotrimoxazole;creatine kinase;dexamethasone;efavirenz;enalapril;fibrinolytic agent;furosemide;glyceryl trinitrate;hemoglobin;heparin;lamivudine;lidocaine;metoprolol;metronidazole;milrinone;nitric acid;pyrimethamine;sulfadiazine;zidovudine;acute heart infarction;adult;akinesia;angina pectoris;angiocardiography;artery embolism;article;atrioventricular block;autopsy;blood cell count;blood pressure measurement;cardiovascular parameters;case report;clinical article;clinical examination;clinical feature;congestive heart failure;coughing;creatine kinase blood level;diagnostic imaging;diaphoresis;disease association;disease course;disease severity;dyspnea;electrocardiogram;heart dilatation;heart muscle ischemia;heart rate;heart ventricle failure;heart ventricle tachycardia;human;Human immunodeficiency virus infection;hypokinesia;lipoatrophy;lung auscultation;lung edema;male;mental deterioration;muscle weakness;pericardial effusion;pleura effusion;Q wave;serology;sinus tachycardia,"Campbell, J. A. L. J.;Higginson, L. A. J.;Chan, K. L.;Woulfe, J. M.;Veinot, J. P.",2003,,,0,
630,Trajectory of Dyspnea and Respiratory Distress among Patients in the Last Month of Life,"BACKGROUND: The trajectory of dyspnea has been reported among patients approaching the end of life. However, patients near death have been dropped from longitudinal studies or excluded altogether because of an inability to self-report; proxy estimates have been reported. It is not known whether dyspnea or respiratory distress remains stable, escalates, or abates as patients reach last days. OBJECTIVE: Determine trajectory of dyspnea (self-reported) and respiratory distress (observed) among patients who were approaching death. DESIGN: A prospective, repeated-measures study of dyspnea/respiratory distress among a sample of hospice patients was done. Measures were collected at each patient encounter from hospice enrollment until patient death. MEASUREMENTS: Dyspnea was measured in response to ""Are you short of breath?"" and using the numeric rating scale anchored at 0 and 10. Nurses measured respiratory distress with the Respiratory Distress Observation Scale (RDOS). Patient consciousness (Reaction Level Scale), nearness to death (Palliative Performance Scale), diagnoses, and demographics were recorded. Data for the 30-day interval before death were analyzed. RESULTS: The sample was 91 patients who were female (58%) and Caucasian (83%) with dementia (32%), heart failure (26%), and cancer (13%). RDOS increased significantly from mild distress 30 days before death to moderate/severe distress on the day of death (F = 10.8, p < 0.0001). Distress was strongly correlated with nearness to death (r = -0.97, p < 0.0001) and consciousness (r = 0.97, p < 0.0001). CONCLUSIONS: Respiratory distress escalated in the last days. Inability to self-report raises care concerns about under-recognition and under-treatment of respiratory distress.",dyspnea;respiratory distress;symptom assessment,"Campbell, M. L.;Kiernan, J. M.;Strandmark, J.;Yarandi, H. N.",2017,Aug 17,,0,
631,Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care,"DESIGNRandomised controlled trial.SETTINGA random sample of 19 general practices in northeast Scotland.PATIENTS1173 patients (685 men and 488 women) under 80 years with working diagnoses of coronary heart disease, but without terminal illness or dementia and not housebound.INTERVENTIONNurse run clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow up.MAIN OUTCOME MEASURESComponents of secondary prevention assessed at baseline and one year were: aspirin use; blood pressure management; lipid management; physical activity; dietary fat; and smoking status. A cumulative score was generated by counting the number of appropriate components of secondary prevention for each patient.RESULTSThere were significant improvements in aspirin management (odds ratio 3.22, 95% confidence interval 2.15 to 4.80), blood pressure management (5.32, 3.01 to 9.41), lipid management (3.19, 2.39 to 4.26), physical activity (1.67, 1.23 to 2.26) and diet (1.47, 1.10 to 1.96). There was no effect on smoking cessation (0.78, 0.47 to 1.28). Of six possible components of secondary prevention, the baseline mean was 3.27. The adjusted mean improvement attributable to intervention was 0.55 of a component (0.44 to 0.67). Improvement was found regardless of practice baseline performance.CONCLUSIONSNurse run clinics proved practical to implement in general practice and effectively increased secondary prevention in coronary heart disease. Most patients gained at least one effective component of secondary prevention and, for them, future cardiovascular events and mortality could be reduced by up to a third.OBJECTIVETo evaluate whether nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease.","Ambulatory Care Facilities [organization & administration];Anti-Inflammatory Agents, Non-Steroidal [therapeutic use];Aspirin [therapeutic use];Coronary Disease [blood] [nursing] [prevention & control];Dietary Fats [administration & dosage];Hypertension [drug therapy];Lipids [blood];Nurse Clinicians;Odds Ratio;Patient Compliance;Patient Education as Topic;Smoking Cessation;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-anaesth: sr-behavmed: sr-epoc: sr-htn: sr-rehab: sr-tobacco: sr-vasc","Campbell, Nc;Ritchie, Ld;Thain, J;Deans, Hg;Rawles, Jm;Squair, Jl",1998,,,0,634
632,Secondary prevention clinics for coronary heart disease: randomised trial of effect on health,"DESIGNRandomised controlled trial of clinics over one year with assessment by self completed postal questionnaires and audit of medical records at the start and end of the trial.SETTINGRandom sample of 19 general practices in northeast Scotland.SUBJECTS1173 patients (685 men and 488 women) under 80 years with working diagnoses of coronary heart disease who did not have terminal illness or dementia and were not housebound.INTERVENTIONClinic staff promoted medical and lifestyle aspects of secondary prevention and offered regular follow up.MAIN OUTCOME MEASURESHealth status measured by the SF-36 questionnaire, chest pain by the angina type specification, and anxiety and depression by the hospital anxiety and depression scale. Use of health services before and during the study.RESULTSThere were significant improvements in six of eight health status domains (all functioning scales, pain, and general health) among patients attending the clinic. Role limitations attributed to physical problems improved most (adjusted difference 8.52, 95% confidence interval 4.16 to 12. 9). Fewer patients reported worsening chest pain (odds ratio 0.59, 95% confidence interval 0.37 to 0.94). There were no significant effects on anxiety or depression. Fewer intervention group patients required hospital admissions (0.64, 0.48 to 0.86), but general practitioner consultation rates did not alter.CONCLUSIONSWithin their first year secondary prevention clinics improved patients' health and reduced hospital admissions.OBJECTIVETo evaluate the effects of secondary prevention clinics run by nurses in general practice on the health of patients with coronary heart disease.",Ambulatory Care [organization & administration];Anxiety [etiology];Chest Pain [prevention & control];Coronary Disease [nursing] [prevention & control];Depression [etiology];Family Practice;Health Promotion [methods] [organization & administration];Health Status;Length of Stay;Patient Acceptance of Health Care;Scotland [epidemiology];Treatment Failure;Adult[checkword];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Hs-handsrch: sr-epoc: sr-rehab: sr-sympt: sr-tobacco: sr-vasc,"Campbell, Nc;Thain, J;Deans, Hg;Ritchie, Ld;Rawles, Jm;Squair, Jl",1998,,,0,635
633,"A Framework for Discussion on How to Improve Prevention, Management, and Control of Hypertension in Canada","Increased blood pressure is a leading risk for premature death and disability. The causes of increased blood pressure are intuitive and well known. However, the fundamental basis and means for improving blood pressure control are highly integrated into our complex societal structure both inside and outside our health system and hence require a comprehensive discussion of the pathway forward. A group of Canadian experts was appointed by Hypertension Canada with funding from Public Health Agency of Canada and the Heart and Stroke Foundation of Canada, Canadian Institute for Health Research (HSFC-CIHR) Chair in Hypertension Prevention and Control to draft a discussion Framework for prevention and control of hypertension. The report includes an environmental scan of past and current activities, proposals for key indicators, and targets to be achieved by 2020, and what changes are likely to be required in Canada to achieve the proposed targets. The key targets are to reduce the prevalence of hypertension to 13% of adults and improve control to 78% of those with hypertension. Broad changes in government policy, research, and health services delivery are required for these changes to occur. The Hypertension Framework process is designed to have 3 phases. The first includes the experts' report which is summarized in this report. The second phase is to gather input and priorities for action from individuals and organizations for revision of the Framework. It is hoped the Framework will stimulate discussion and input for its full intended lifespan 2011-2020. The third phase is to work with individuals and organizations on the priorities set in phase 2. © 2012 Canadian Cardiovascular Society.",antihypertensive agent;indigenous people;article;awareness;blood pressure;Canada;community;conceptual framework;dementia;disease control;government;health care delivery;health care policy;health care system;health service;heart failure;heart infarction;human;hypertension;kidney failure;lifestyle;prevalence;society;cerebrovascular accident;support group,"Campbell, N.;Young, E. R.;Drouin, D.;Legowski, B.;Adams, M. A.;Farrell, J.;Kaczorowski, J.;Lewanczuk, R.;Lum-Kwong, M. M.;Tobe, S.",2012,,,0,
634,Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care,"OBJECTIVE: To evaluate whether nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease. DESIGN: Randomised controlled trial. SETTING: A random sample of 19 general practices in northeast Scotland. PATIENTS: 1173 patients (685 men and 488 women) under 80 years with working diagnoses of coronary heart disease, but without terminal illness or dementia and not housebound. INTERVENTION: Nurse run clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow up. MAIN OUTCOME MEASURES: Components of secondary prevention assessed at baseline and one year were: aspirin use; blood pressure management; lipid management; physical activity; dietary fat; and smoking status. A cumulative score was generated by counting the number of appropriate components of secondary prevention for each patient. RESULTS: There were significant improvements in aspirin management (odds ratio 3.22, 95% confidence interval 2.15 to 4.80), blood pressure management (5.32, 3.01 to 9.41), lipid management (3.19, 2.39 to 4.26), physical activity (1.67, 1.23 to 2.26) and diet (1.47, 1.10 to 1.96). There was no effect on smoking cessation (0.78, 0.47 to 1.28). Of six possible components of secondary prevention, the baseline mean was 3.27. The adjusted mean improvement attributable to intervention was 0.55 of a component (0.44 to 0.67). Improvement was found regardless of practice baseline performance. CONCLUSIONS: Nurse run clinics proved practical to implement in general practice and effectively increased secondary prevention in coronary heart disease. Most patients gained at least one effective component of secondary prevention and, for them, future cardiovascular events and mortality could be reduced by up to a third.","Ambulatory Care Facilities [organization & administration];Anti-Inflammatory Agents, Non-Steroidal [therapeutic use];Aspirin [therapeutic use];Coronary Disease [blood] [nursing] [prevention & control];Dietary Fats [administration & dosage];Hypertension [drug therapy];Lipids [blood];Nurse Clinicians;Odds Ratio;Patient Compliance;Patient Education as Topic;Smoking Cessation;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-anaesth: sr-behavmed: sr-epoc: sr-htn: sr-rehab: sr-tobacco: sr-vasc","Campbell, N. C.;Ritchie, L. D.;Thain, J.;Deans, H. G.;Rawles, J. M.;Squair, J. L.",1998,,,0,
635,Secondary prevention clinics for coronary heart disease: randomised trial of effect on health,"OBJECTIVE: To evaluate the effects of secondary prevention clinics run by nurses in general practice on the health of patients with coronary heart disease. DESIGN: Randomised controlled trial of clinics over one year with assessment by self completed postal questionnaires and audit of medical records at the start and end of the trial. SETTING: Random sample of 19 general practices in northeast Scotland. SUBJECTS: 1173 patients (685 men and 488 women) under 80 years with working diagnoses of coronary heart disease who did not have terminal illness or dementia and were not housebound. INTERVENTION: Clinic staff promoted medical and lifestyle aspects of secondary prevention and offered regular follow up. MAIN OUTCOME MEASURES: Health status measured by the SF-36 questionnaire, chest pain by the angina type specification, and anxiety and depression by the hospital anxiety and depression scale. Use of health services before and during the study. RESULTS: There were significant improvements in six of eight health status domains (all functioning scales, pain, and general health) among patients attending the clinic. Role limitations attributed to physical problems improved most (adjusted difference 8.52, 95% confidence interval 4.16 to 12. 9). Fewer patients reported worsening chest pain (odds ratio 0.59, 95% confidence interval 0.37 to 0.94). There were no significant effects on anxiety or depression. Fewer intervention group patients required hospital admissions (0.64, 0.48 to 0.86), but general practitioner consultation rates did not alter. CONCLUSIONS: Within their first year secondary prevention clinics improved patients' health and reduced hospital admissions.",Ambulatory Care [organization & administration];Anxiety [etiology];Chest Pain [prevention & control];Coronary Disease [nursing] [prevention & control];Depression [etiology];Family Practice;Health Promotion [methods] [organization & administration];Health Status;Length of Stay;Patient Acceptance of Health Care;Scotland [epidemiology];Treatment Failure;Adult[checkword];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Hs-handsrch: sr-epoc: sr-rehab: sr-sympt: sr-tobacco: sr-vasc,"Campbell, N. C.;Thain, J.;Deans, H. G.;Ritchie, L. D.;Rawles, J. M.;Squair, J. L.",1998,,,0,
636,"High Blood Pressure in Sub-Saharan Africa: Why Prevention, Detection, and Control are Urgent and Important",,water;Africa south of the Sahara;alcohol consumption;article;cause of death;cerebrovascular accident;cost control;cost effectiveness analysis;dementia;diabetes mellitus;dyslipidemia;evidence based practice;fetus death;food processing;fruit;fruit juice;government;grain;health care policy;health practitioner;health service;heart disease;heart failure;human;hypertension;incidence;kidney failure;lifestyle modification;long term care;maternal mortality;non communicable disease;obesity;outcome assessment;physical inactivity;potassium intake;practice guideline;pregnancy;prevalence;priority journal;public health;risk factor;salt intake;sodium intake;tobacco use;vegetable;wellbeing;world health organization,"Campbell, N. R. C.;Bovet, P.;Schutte, A. E.;Lemogoum, D.;Nkwescheu, A. S.",2015,,,0,
637,A novel clinical entity: The Campbell-Trachter syndrome,,acute heart failure;Alzheimer disease;anhedonia;Campbell Trachter syndrome;depression;human;incidence;medical student;neurologic disease;note;postgraduate education;symptomatology;syndrome;thorax pain,"Campbell, T. G.;Trachter, R.",2014,,,0,
638,Contribution Of Alzheimer disease to mortality in the United States,,Alzheimer disease;autopsy;cardiopulmonary arrest;cause of death;chronic obstructive lung disease;congestive heart failure;death certificate;dementia;diagnostic error;human;mortality;note;physician;pneumonia;priority journal;risk;United States,"Campbell-Taylor, I.",2014,,,0,
639,Specific interaction of heterogeneous nuclear ribonucleoprotein A1 with the -219T allelic form modulates APOE promoter activity,"The polymorphic -219T/G variant in the APOE promoter has been associated with variations in basal transcriptional activity as well as with the risk of developing Alzheimer's disease, myocardial infarction and early-onset coronary heart disease. The molecular mechanisms underlying these effects are presently unknown. In this report, we show that nuclear extracts from Jurkat cells form a T-specific complex with a motif including the -219 site within the APOE promoter. By DNA-affinity chromatography and mass spectrometry, the human heterogeneous nuclear ribonucleoprotein hnRNPA1(A1) was identified as one component of the complex. In vitro binding analysis indicated that a fragment of A1 had a marked binding specificity for the T form. Interaction of A1 with this region is driven by an adjacent telomeric-like sequence; however, the presence of G, but not T, at -219 position inhibited this interaction. The differences in transcriptional activity between the -219T and -219G promoter allelic forms correlated with the expression levels of A1 in several cell lines; also, over-expression of A1 increased the activity of the T form relative to that of the G form. These results indicate that A1 transactivates APOE promoter activity by direct and specific interaction with the -219T site.","Alleles;Apolipoproteins E/*genetics;Binding Sites;DNA Helicases/metabolism;Heterogeneous-Nuclear Ribonucleoprotein Group A-B/genetics/*metabolism;Humans;Jurkat Cells;Nuclear Proteins/metabolism;*Polymorphism, Genetic;*Promoter Regions, Genetic;Recombinant Proteins/metabolism;Regulatory Sequences, Nucleic Acid;*Ribonucleoproteins;Thymus Hormones/metabolism;*Transcriptional Activation;Tumor Cells, Cultured","Campillos, M.;Lamas, J. R.;Garcia, M. A.;Bullido, M. J.;Valdivieso, F.;Vazquez, J.",2003,Jun 15,,0,
640,Attitudes to outcomes measured in clinical trials of cardiovascular prevention,"BACKGROUND: Selecting outcome measures in cardiovascular prevention trials should be informed by their importance to selected populations. Major vascular event outcomes are usually prioritized in these trials with considerably less attention paid to cognitive and functional outcomes. AIM: To examine views on importance of outcome measures used in clinical trials. DESIGN: Cross-sectional survey. METHODS: Of 367 individuals approached, 280 (76%) participated: outpatients attending cardiovascular prevention clinics (n = 97), active retirement groups members (n = 75), medical students (n = 108). Participants were asked to rank, in order of importance, outcome measures, which may be included in cardiovascular prevention trials. Results were compared between two groups: <65s (n = 157) and >/=65s (n = 104). RESULTS: When asked what outcomes were most important to measure in cardiovascular prevention trials, respondents reported: death (31.6%) stroke (28.5%), dementia (26.9%), myocardial infarction (MI) (7.9%) and requiring nursing home (NH) care (5.1%). When asked the most relevant outcomes regarding successful ageing respondents reported; maintaining independence (32.4%), avoiding major illness (24.3%), good family life (23.6%), living as long as possible (15.8%), avoiding NH care (3.1%) and contributing to society (0.8%) as most important. When asked what outcome concerned them most about the future, respondents reported: dementia (32.6%), dependence (30.4%), death (12.8%), stroke (12.5%), cancer (6.2%) requiring NH care (4.8%) and MI (0.7%). Maintaining independence was considered most important in younger and older cohorts. CONCLUSION: Cognitive and functional outcomes are important patient-relevant outcomes, sometimes more important than major vascular events. Incorporating these outcomes into trials may encourage patient participation and adherence to preventative regimens.",,"Canavan, M.;Smyth, A.;Robinson, S. M.;Gibson, I.;Costello, C.;O'Keeffe, S. T.;Walsh, T.;Mulkerrin, E. C.;O'Donnell, M. J.",2016,Jun,10.1093/qjmed/hcv132,0,
641,The care for chronic heart failure by general practitioners. Results from a clinical audit in Italy,"BACKGROUND: In Italian primary care, chronic heart failure (CHF) patients are mainly managed by general practitioners (GPs). However, there are few studies analysing CHF management challenges in primary care and identifying opportunities for improvement. OBJECTIVES: To describe CHF care as implemented by GPs in the Veneto Region and to identify opportunities for improvement. METHODS: In 2008, using an audit process, 114 Venetian GPs analysed their electronic health records, identified CHF patients and collected clinical and care related information: prevalence, co-morbidity, caring conditions, diagnostic and therapeutic management, and hospitalization. After two training sessions, data on pharmacotherapy were analysed again in 2009. RESULTS: The prevalence of CHF was 1.2% (95% CI: 1.1-1.3%). Diagnostic echocardiography was used in 57% of cases. At baseline, the proportions of patients that used specific medication were: diuretics 88%; angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) 77%, beta-blockers 46% and anti-aldosterone agents 32%. After two training sessions, the use of ACE inhibitors/ARB and beta-blockers increased to 80% and 56%, respectively. Renal failure, chronic obstructive pulmonary disease (COPD), diabetes mellitus and dementia were the most prevalent concomitant diseases, posing specific management problems. Half of the patients were generally visited at home; they were dependent on some kind of care given. CONCLUSION: In Veneto a large number of CHF patients are mainly managed by GPs. Further improvements are necessary to meet standards of care with regard to diagnosis, medication, follow-up and home care. The care situation affected hospitalization and the quality of follow-up visits.","Adrenergic beta-Antagonists/therapeutic use;Aged;Aged, 80 and over;Angiotensin Receptor Antagonists/therapeutic use;Angiotensin-Converting Enzyme Inhibitors/therapeutic use;Chronic Disease;Comorbidity;Coronary Disease/epidemiology;Dementia/epidemiology;Diabetes Mellitus/epidemiology;Diuretics/therapeutic use;Echocardiography/utilization;Female;General Practice/education/*methods;Heart Failure/diagnosis/*drug therapy/epidemiology;House Calls/utilization;Humans;Hypertension/epidemiology;Italy/epidemiology;Male;Medical Audit;Middle Aged;Pulmonary Disease, Chronic Obstructive/epidemiology;Renal Insufficiency/epidemiology","Cancian, M.;Battaggia, A.;Celebrano, M.;Del Zotti, F.;Novelletto, B. F.;Michieli, R.;Saugo, M.;Pellizzari, M.;Toffanin, R.",2013,Mar,10.3109/13814788.2012.717925,0,
642,Association between the HFE mutations and unsuccessful ageing: a study in Alzheimer's disease patients from Northern Italy,"Mutations in the class I-like Major Histocompatibility Complex gene HFE are associated with hereditary hemochromatosis (HH), a disorder caused by excessive iron uptake. Three common mutations have been found: C282Y, H63D, and S65C. Moreover, several studies have suggested that HFE mutations may be involved in several age-related chronic diseases such as Alzheimer's disease (AD) and coronary heart disease, but apparently paradoxically also with longevity. In particular, in AD, patients carrying the H63D allele have been suggested to have a mean age at onset of 72 vs. 77 years for those who were homozygous for the wild-type allele. Thus, it seems that H63D mutations may anticipate sporadic AD clinical presentation in susceptible individuals. In the present study, we analysed the HFE genotype in 123 patients with sporadic AD and 152 age-matched controls from Northern Italy. Samples were typed for C282Y, H63D and S65C alleles using the polymerase chain reaction and sequence specific primers. No significant differences were observed in frequencies of the different alleles between controls and AD both for the whole group and when the data were analysed according to gender. In addition, we failed to observe any difference in the age at onset between patients carrying the mutant HFE-H63D allele and those homozygous for the wild-type allele, either in men or women. Also taking into account the presence or absence of the APOE-epsilon 4 allele, no significant differences were observed between carriers of the mutant HFE-H63D allele and those homozygous for the wild-type allele. Thus, our study does not support the suggestion that H63D mutations may anticipate sporadic AD clinical presentation in susceptible individuals.",Aged;Aging/*genetics/*immunology;Alzheimer Disease/*genetics/*immunology;Female;Gene Frequency;Heterozygote;Histocompatibility Antigens Class I/*genetics;Homozygote;Humans;Italy;Male;Membrane Proteins/*genetics;Middle Aged;Point Mutation,"Candore, G.;Licastro, F.;Chiappelli, M.;Franceschi, C.;Lio, D.;Rita Balistreri, C.;Piazza, G.;Colonna-Romano, G.;Grimaldi, L. M.;Caruso, C.",2003,Apr,,0,
643,Depression and concomitant diseases in a Turkish geriatric outpatient setting,"Depression is an important but inadequately diagnosed mood disorder in elderly. Depressed elderly patients often have chronic concomitant diseases. This paper intended to determine the prevalence of depression and its relation with concomitant disorders and social status among the patients admitted to our geriatric unit. Seven hundred and eighty-nine females and 466 males admitted to our unit were examined for the presence of depression by using the geriatric depression scale (GDS) test. The presence of concomitant diseases was assessed. Depression was diagnosed in 273 patients (21.8%), 193 (70.7%) females and 80 (29.3%) males. Depressed patients suffered from a wide range of other diseases the number and prevalence of which were as follows: Alzheimer's disease (AD) (34; 12.5%), vascular dementia (27; 9.9%), hypertension (HT) (211; 77.3%), diabetes mellitus (DM) (64; 23.4%), osteoporosis (182; 66.7%), atherosclerotic coronary artery disease (CAD) (89; 32.6%), cardiac failure (23; 8.5%), bronchial asthma (8; 2.9%), chronic obstructive pulmonary disease (COPD) (25; 9.2%) and osteoarthritis (133; 48.8%). The correlation between depression and concomitant diseases was statistically significant in hypertensive, demented and osteoporotic patients, as determined in a large elderly population. Previous studies examined the correlation of depression with only one concomitant disease, while we performed the analysis on multiple correlations. © 2004 Elsevier Ireland Ltd. All rights reserved.",adult;aged;Alzheimer disease;article;asthma;atherosclerosis;chronic obstructive lung disease;correlation analysis;depression;diabetes mellitus;disease association;female;geriatric care;heart failure;human;hypertension;ischemic heart disease;major clinical study;male;multiinfarct dementia;osteoarthritis;osteoporosis;outpatient;population research;prevalence;priority journal;rating scale;statistical significance;turkey (bird),"Cankurtaran, M.;Halil, M.;Yavuz, B. B.;Dagli, N.;Cankurtaran, E. S.;Ariogul, S.",2005,,,0,
644,Dementia-related adverse effects in the prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial (PARADIGM-HF),"Background: Inhibition of neprilysin, an enzyme degrading natriuretic and other vasoactive peptides, is beneficial in heart failure with reduced ejection fraction, as shown in PARADIGM-HF which compared the angiotensin receptor neprilysin inhibitor (ARNI) LCZ696 (sacubitril-valsartan) to enalapril. As neprilysin is also one of many enzymes clearing amyloid-beta peptides from the brain, there is theoretical concern about the long-term effects of LCZ696 on cognition. Therefore, we examined dementia-related adverse effects in PARADIGM-HF. Methods: Patients with NYHA class II-IV heart failure (HF), a LVEF <40% and a mildly elevated BNP/NT proBNP were randomized to LCZ696 200mg bid or enalapril 10mg bid in a 1:1 ratio. We searched adverse event reports (AERs) coded using the Medical Dictionary for Regulatory Activities (MedRA) using Standardized MedRA Queries (SMQs) with ""broad"" and ""narrow"" preferred terms (PTs) related to cognition, memory, dementia-like and related events. Results: 8399 patients aged 18-96 yrs were randomized and followed for a median of 2.25 yrs (up to 4.3 yrs). The narrow SMQ search identified 27 relevant AERs: 15 (0.35%) on enalapril and 12 (0.29%) on LCZ696 (HR 0.79, 0.37-1.70). The numbers using the broad search were: 83 (1.96%) and 86 (2.05%), respectively, HR 1.03 (0.76, 1.39). The most common PTs in each treatment group are shown in the Table. Conclusion: We found no evidence that LCZ696, compared with enalapril, increased dementia-related adverse events in PARADIGM-HF. (Table presented) .",heart failure;adverse drug reaction;mortality;morbidity;dementia;acute heart failure;patient;human;cognition;heart ejection fraction;memory;Medical Dictionary for Regulatory Activities;brain;New York Heart Association class;sacubitril plus valsartan;enalapril;peptide;membrane metalloendopeptidase;enzyme;angiotensin receptor;valsartan;sacubitril;amyloid;enkephalinase inhibitor,"Cannon, J;Boytsov, S;Senni, M;Rouleau, Jl;Solomon, Sd;Swedberg, K;Zile, M;Chen, F;McMurray, Jjv;Packer, M",2015,,10.1002/ejhf.277,0,645
645,Dementia-related adverse effects in the prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial (PARADIGM-HF),"Background: Inhibition of neprilysin, an enzyme degrading natriuretic and other vasoactive peptides, is beneficial in heart failure with reduced ejection fraction, as shown in PARADIGM-HF which compared the angiotensin receptor neprilysin inhibitor (ARNI) LCZ696 (sacubitril-valsartan) to enalapril. As neprilysin is also one of many enzymes clearing amyloid-beta peptides from the brain, there is theoretical concern about the long-term effects of LCZ696 on cognition. Therefore, we examined dementia-related adverse effects in PARADIGM-HF. Methods: Patients with NYHA class II-IV heart failure (HF), a LVEF <40% and a mildly elevated BNP/NT proBNP were randomized to LCZ696 200mg bid or enalapril 10mg bid in a 1:1 ratio. We searched adverse event reports (AERs) coded using the Medical Dictionary for Regulatory Activities (MedRA) using Standardized MedRA Queries (SMQs) with ""broad"" and ""narrow"" preferred terms (PTs) related to cognition, memory, dementia-like and related events. Results: 8399 patients aged 18-96 yrs were randomized and followed for a median of 2.25 yrs (up to 4.3 yrs). The narrow SMQ search identified 27 relevant AERs: 15 (0.35%) on enalapril and 12 (0.29%) on LCZ696 (HR 0.79, 0.37-1.70). The numbers using the broad search were: 83 (1.96%) and 86 (2.05%), respectively, HR 1.03 (0.76, 1.39). The most common PTs in each treatment group are shown in the Table. Conclusion: We found no evidence that LCZ696, compared with enalapril, increased dementia-related adverse events in PARADIGM-HF. (Table presented) .",heart failure;adverse drug reaction;mortality;morbidity;dementia;acute heart failure;patient;human;cognition;heart ejection fraction;memory;Medical Dictionary for Regulatory Activities;brain;New York Heart Association class;sacubitril plus valsartan;enalapril;peptide;membrane metalloendopeptidase;enzyme;angiotensin receptor;valsartan;sacubitril;amyloid;enkephalinase inhibitor,"Cannon, J.;Boytsov, S.;Senni, M.;Rouleau, J. L.;Solomon, S. D.;Swedberg, K.;Zile, M.;Chen, F.;McMurray, J. J. V.;Packer, M.",2015,,10.1002/ejhf.277,0,
646,Dementia-related adverse events in PARADIGM-HF and other trials in heart failure with reduced ejection fraction,"Aims: Inhibition of neprilysin, an enzyme degrading natriuretic and other vasoactive peptides, is beneficial in heart failure with reduced ejection fraction (HFrEF), as shown in PARADIGM-HF which compared the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan with enalapril. As neprilysin is also one of many enzymes clearing amyloid-beta peptides from the brain, there is a theoretical concern about the long-term effects of sacubitril/valsartan on cognition. Therefore, we have examined dementia-related adverse effects (AEs) in PARADIGM-HF and placed these findings in the context of other recently conducted HFrEF trials. Methods and results: In PARADIGM-HF, patients with symptomatic HFrEF were randomized to sacubitril/valsartan 97/103mg b.i.d. or enalapril 10mg b.i.d. in a 1:1 ratio. We systematically searched AE reports, coded using the Medical Dictionary for Regulatory Activities (MedDRA), using Standardized MedDRA Queries (SMQs) with 'broad' and 'narrow' preferred terms related to dementia. In PARADIGM-HF, 8399 patients aged 18-96 years were randomized and followed for a median of 2.25years (up to 4.3years). The narrow SMQ search identified 27 dementia-related AEs: 15 (0.36%) on enalapril and 12 (0.29%) on sacubitril/valsartan [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.33-1.59]. The broad search identified 97 (2.30%) and 104 (2.48%) AEs (HR 1.01, 95% CI 0.75-1.37), respectively. The rates of dementia-related AEs in both treatment groups in PARADIGM-HF were similar to those in three other recent trials in HFrEF. Conclusion: We found no evidence that sacubitril/valsartan, compared with enalapril, increased dementia-related AEs, although longer follow-up may be necessary to detect such a signal and more sensitive tools are needed to detect lesser degrees of cognitive impairment. Further studies to address this question are warranted. Copyright © 2016 European Society of Cardiology.",adult;adverse drug reaction;cognitive defect;confidence interval;controlled clinical trial;controlled study;follow up;hazard ratio;heart ejection fraction;heart failure;human;major clinical study;Medical Dictionary for Regulatory Activities;randomized controlled trial;side effect;young adult;angiotensin receptor;common acute lymphoblastic leukemia antigen;enalapril;sacubitril plus valsartan,"Cannon, Ja;Shen, L;Jhund, Ps;Kristensen, Sl;Kober, L;Chen, F;Gong, J;Lefkowitz, Mp;Rouleau, Jl;Shi, Vc;Swedberg, K;Zile, Mr;Solomon, Sd;Packer, M;McMurray, Jj",2016,,10.1002/ejhf.687,0,
647,Dementia-related adverse events in PARADIGM-HF and other trials in heart failure with reduced ejection fraction,"Aims: Inhibition of neprilysin, an enzyme degrading natriuretic and other vasoactive peptides, is beneficial in heart failure with reduced ejection fraction (HFrEF), as shown in PARADIGM-HF which compared the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan with enalapril. As neprilysin is also one of many enzymes clearing amyloid-beta peptides from the brain, there is a theoretical concern about the long-term effects of sacubitril/valsartan on cognition. Therefore, we have examined dementia-related adverse effects (AEs) in PARADIGM-HF and placed these findings in the context of other recently conducted HFrEF trials. Methods and results: In PARADIGM-HF, patients with symptomatic HFrEF were randomized to sacubitril/valsartan 97/103 mg b.i.d. or enalapril 10 mg b.i.d. in a 1:1 ratio. We systematically searched AE reports, coded using the Medical Dictionary for Regulatory Activities (MedDRA), using Standardized MedDRA Queries (SMQs) with 'broad' and 'narrow' preferred terms related to dementia. In PARADIGM-HF, 8399 patients aged 18-96 years were randomized and followed for a median of 2.25 years (up to 4.3 years). The narrow SMQ search identified 27 dementia-related AEs: 15 (0.36%) on enalapril and 12 (0.29%) on sacubitril/valsartan [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.33-1.59]. The broad search identified 97 (2.30%) and 104 (2.48%) AEs (HR 1.01, 95% CI 0.75-1.37), respectively. The rates of dementia-related AEs in both treatment groups in PARADIGM-HF were similar to those in three other recent trials in HFrEF. Conclusion: We found no evidence that sacubitril/valsartan, compared with enalapril, increased dementia-related AEs, although longer follow-up may be necessary to detect such a signal and more sensitive tools are needed to detect lesser degrees of cognitive impairment. Further studies to address this question are warranted. Copyright © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.",abnormal behavior/si [Side Effect];abnormal sensation/si [Side Effect];aggression;agitation;Alzheimer disease/si [Side Effect];amnesia/si [Side Effect];apathy;aphasia/si [Side Effect];apraxia/si [Side Effect];article;behavior disorder/si [Side Effect];brain atrophy/si [Side Effect];cognitive defect/si [Side Effect];combination chemotherapy;confusion/si [Side Effect];delirium/si [Side Effect];delusion/si [Side Effect];dementia/si [Side Effect];dementia/si [Side Effect];disorientation/si [Side Effect];frontotemporal dementia/si [Side Effect];hallucination/si [Side Effect];heart failure/dt [Drug Therapy];heart failure with reduced ejection fraction/dt [Drug Therapy];heart failure with reduced ejection fraction/dt [Drug Therapy];hippocampal sclerosis/si [Side Effect];human;illusion/si [Side Effect];insomnia/si [Side Effect];memory disorder/si [Side Effect];mental disease/si [Side Effect];mental instability/si [Side Effect];monotherapy;mood change;multiinfarct dementia/si [Side Effect];personality disorder/si [Side Effect];presenile dementia/si [Side Effect];priority journal;psychosis/si [Side Effect];restlessness/si [Side Effect];senile dementia/si [Side Effect];side effect/si [Side Effect];sleep walking/si [Side Effect];somnolence/si [Side Effect];speech disorder/si [Side Effect];systematic review;aliskiren/ae [Adverse Drug Reaction];aliskiren/ct [Clinical Trial];aliskiren/cb [Drug Combination];aliskiren/dt [Drug Therapy];enalapril/ae [Adverse Drug Reaction];enalapril/ct [Clinical Trial];enalapril/cb [Drug Combination];enalapril/cm [Drug Comparison];enalapril/dt [Drug Therapy];placebo;rosuvastatin/ae [Adverse Drug Reaction];rosuvastatin/ct [Clinical Trial];rosuvastatin/cm [Drug Comparison];rosuvastatin/dt [Drug Therapy];sacubitril plus valsartan/ae [Adverse Drug Reaction];sacubitril plus valsartan/ct [Clinical Trial];sacubitril plus valsartan/cm [Drug Comparison];sacubitril plus valsartan/dt [Drug Therapy];valsartan/ae [Adverse Drug Reaction];valsartan/ct [Clinical Trial];valsartan/cm [Drug Comparison];valsartan/dt [Drug Therapy];adult;adverse drug reaction;cognitive defect;confidence interval;controlled clinical trial;controlled study;follow up;hazard ratio;heart ejection fraction;heart failure;major clinical study;Medical Dictionary for Regulatory Activities;randomized controlled trial;side effect;young adult;angiotensin receptor;common acute lymphoblastic leukemia antigen;enalapril;sacubitril plus valsartan;Sr-dementia,"Cannon, Ja;Shen, L;Jhund, Ps;Kristensen, Sl;Kober, L;Chen, F;Gong, J;Lefkowitz, Mp;Rouleau, Jl;Shi, Vc;Swedberg, K;Zile, Mr;Solomon, Sd;Packer, M;McMurray, Jjv",2017,,10.1002/ejhf.687,0,
648,"'Hearts and minds': association, causation and implication of cognitive impairment in heart failure","The clinical syndrome of heart failure is one of the leading causes of hospitalisation and mortality in older adults. An association between cognitive impairment and heart failure is well described but our understanding of the relationship between the two conditions remains limited. In this review we provide a synthesis of available evidence, focussing on epidemiology, the potential pathogenesis, and treatment implications of cognitive decline in heart failure. Most evidence available relates to heart failure with reduced ejection fraction and the syndromes of chronic cognitive decline or dementia. These conditions are only part of a complex heart failure-cognition paradigm. Associations between cognition and heart failure with preserved ejection fraction and between acute delirium and heart failure also seem evident and where data are available we will discuss these syndromes. Many questions remain unanswered regarding heart failure and cognition. Much of the observational evidence on the association is confounded by study design, comorbidity and insensitive cognitive assessment tools. If a causal link exists, there are several potential pathophysiological explanations. Plausible underlying mechanisms relating to cerebral hypoperfusion or occult cerebrovascular disease have been described and it seems likely that these may coexist and exert synergistic effects. Despite the prevalence of the two conditions, when cognitive impairment coexists with heart failure there is no specific guidance on treatment. Institution of evidence-based heart failure therapies that reduce mortality and hospitalisations seems intuitive and there is no signal that these interventions have an adverse effect on cognition. However, cognitive impairment will present a further barrier to the often complex medication self-management that is required in contemporary heart failure treatment.",,"Cannon, J. A.;McMurray, J. J.;Quinn, T. J.",2015,,10.1186/s13195-015-0106-5,0,
649,Risk and prognostic factors of status epilepticus in the elderly: a case-control study,"PURPOSE: The aim of this study was to assess the risk and prognostic factors of status epilepticus (SE) among elderly inpatients. METHODS: From May 2003 to April 2005, 63 consecutive patients aged 70 years or older with SE were included. Each patient was matched to three controls without SE seen during the same period. Matching variables were age (+/-3 years), gender, and comorbidity index (+/-3). Multivariate logistic regression model were used to compare cases to controls and, among the cases, nonsurvivors to survivors. KEY FINDINGS: By multivariate analysis, factors independently associated with SE were acute decompensation (cardiac, respiratory, or hepatic) [adjusted odds ratio (OR(a) ) 2.57, 95% confidence interval (95% CI) 1.05-6.25] history of epilepsy (OR(a) 3.93, 95% CI 1.27-12.14), chronic cerebrovascular disease (OR(a) 7.96, 95% CI 3.31-19.15), nonvascular dementia (OR(a) 4.16, 95% CI 1.86-9.29), and dysnatremia (OR(a) 5.08, 95% CI 2.34-11.04). In-hospital 1-month mortality was 2.3 times higher among cases than controls (14/63, 22.0%; 95% CI 12.7-34.5%; vs. 18/189, 9.5%; 95% CI 5.7-14.7%; p = 0.01). Among the cases, factors independently associated with in-hospital death within 1 month were younger age (OR(a) per 1-year increase 0.87, 95% CI 0.76-0.98), higher comorbidity index (OR(a) per 1-point increase 1.27, 95% CI 1.07-1.55), and de novo SE (OR(a) 14.95, 95% CI 2.24-192.8). SIGNIFICANCE: Independent predictors of SE in hospitalized patients aged 70 years or older were acute decompensation (cardiac, respiratory, or hepatic), history of epilepsy, chronic cerebrovascular disease, nonvascular dementia, and dysnatremia. Factors that independently predicted death in patients with SE were younger age, higher comorbidity index, and de novo SE.","Age Factors;Aged;Aged, 80 and over;Case-Control Studies;Cerebrovascular Disorders/complications;Chi-Square Distribution;Electroencephalography;Female;Heart Failure/complications;Humans;Logistic Models;Male;Multivariate Analysis;Odds Ratio;Prognosis;Risk Factors;Sex Factors;Statistics, Nonparametric;Status Epilepticus/diagnosis/*etiology/genetics","Canoui-Poitrine, F.;Bastuji-Garin, S.;Alonso, E.;Darcel, G.;Verstichel, P.;Caillet, P.;Paillaud, E.",2011,Oct,10.1111/j.1528-1167.2011.03168.x,0,
650,Atypical presentations among Medicare beneficiaries with unstable angina pectoris,"Chest pain is a hallmark symptom in patients with unstable angina pectoris (UAP). However, little is known regarding the prevalence of an atypical presentation among these patients and its relation to subsequent care. We examined the medical records of 4,167 randomly sampled Medicare patients hospitalized with unstable angina at 22 Alabama hospitals between 1993 and 1999. We defined typical presentation as (1) chest pain located substernally in the left or right chest, or (2) chest pain characterized as squeezing, tightness, aching, crushing, arm discomfort, dullness, fullness, heaviness, pressure, or pain aggravated by exercise or relieved with rest or nitroglycerin. Atypical presentation was defined as confirmed UAP without typical presentation. Among patients with confirmed UAP, 51.7% had atypical presentations. The most frequent symptoms associated with atypical presentation were dyspnea (69.4%), nausea (37.7%), diaphoresis (25.2%), syncope (10.6%), or pain in the arms (11.5%), epigastrium (8.1%), shoulder (7.4%), or neck (5.9%). Independent predictors of atypical presentation for patients with UAP were older age (odds ratio 1.09, 95% confidence interval 1.01 to 1.17/decade), history of dementia (odds ratio 1.49, 95% confidence interval 1.10 to 2.03), and absence of prior myocardial infarction, hypercholesterolemia, or family history of heart disease. Patients with atypical presentation received aspirin, heparin, and beta-blocker therapy less aggressively, but there was no difference in mortality. Thus, over half of Medicare patients with confirmed UAP had ""atypical"" presentations. National educational initiatives may need to redefine the classic presentation of UAP to include atypical presentations to ensure appropriate quality of care.","Aged;Aged, 80 and over;Angina, Unstable/*diagnosis/drug therapy/physiopathology;Female;Humans;Male;Medicare;United States","Canto, J. G.;Fincher, C.;Kiefe, C. I.;Allison, J. J.;Li, Q.;Funkhouser, E.;Centor, R. M.;Selker, H. P.;Weissman, N. W.",2002,Aug 1,,0,
651,Funny turns: They do mean something,,adverse outcome;brain dysfunction;dementia;disease association;disease severity;follow up;human;ischemic heart disease;morbidity;note;priority journal;prognosis;risk assessment;cerebrovascular accident;structured interview;structured questionnaire;transient ischemic attack;vascular disease,"Caplan, L. R.",2008,,,0,
652,The safety and efficacy of percutaneous endoscopic gastrostomy after recent myocardial infarction: A study of 28 patients and 40 controls at four university teaching hospitals,"Objectives: To analyze the risks versus benefits of percutaneous endoscopic gastrostomy (PEG) performed soon after myocardial infarction. Methods: Retrospective review of 28 patients undergoing PEG within 30 days after myocardial infarction at four university teaching hospitals for study periods of up to 10 yr. Forty controls undergoing PEG were matched for age and sex and had no myocardial infarction during the prior 6 months. Results: Indications for PEG were inability to eat because of stroke in 13, chronic dependency on mechanically assisted ventilation in seven, anoxic encephalopathy in five, dementia in two, and other in one. The mean patient age was 72.5 ± 9.2 (SD) yr. PEG was performed on average 22.3 ± 6.2 days after myocardial infarction. Seventeen patients were intubated and were receiving mechanically assisted ventilation at the time of PEG. PEG was successfully performed in all patients. Study patients suffered two insignificant complications, and one significant complication from PEG of bleeding at the gastrostomy site that required transfusion of 4 U of packed erythrocytes. Of note, no study patient suffered a cardiovascular complication due to PEG. The control complication rate was not significantly different (three insignificant and one significant complications, NS, Fisher's exact test). PEG feedings in study patients resulted in stabilization of body weight and significant improvement of the serum albumin level (from 2.2 ± 0.3 gm/dl to 2.5 ± 0.5 gm/dl, p < 0.03, Student's t test). Also the absolute lymphocyte count, hematocrit, and serum total protein level tended to improve after PEG. PEG contributed to transfer to a rehabilitation center, skilled nursing facility, or home in 19 study patients (70%; control rate = 78%, NS, χ2). Conclusion: Recent myocardial infarction is not an absolute contraindication to PEG. In this study, the benefits exceeded the risks of PEG in medically stable patients. PEG should be performed with monitoring by electrocardiography and pulse oximetry in medically stable patients. PEG is an elective procedure that should not be performed in highly unstable patients.",adult;aged;article;artificial feeding;artificial ventilation;bleeding;brain disease;brain hypoxia;clinical article;controlled study;dementia;endoscopic surgery;erythrocyte transfusion;female;heart infarction;human;male;patient monitoring;percutaneous endoscopic gastrostomy;priority journal;cerebrovascular accident,"Cappell, M. S.;Iacovone Jr, F. M.",1996,,,0,
653,Intravenous thrombolysis on early recurrent cardioembolic stroke: 'Dr Jekyll' or 'Mr Hyde'?,"Early recurrent cardioembolic stroke on the previously unaffected side has very rarely been reported during or after intravenous recombinant tissue plasminogen activator for acute ischemic stroke. For these cases, thrombolysis guidelines lack any clear recommendation. We report two cases of thrombolysed stroke patients, with paroxysmal atrial fibrillation but normal sinus rhythm on admission, who respectively developed recurrent ischemic stroke within few hours after complete improvement and during intravenous recombinant tissue plasminogen activator infusion. Intravenous thrombolysis was successfully repeated after echocardiographic evidence of left appendage thrombus in the first case and discontinued before complete administration in the second. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.",alteplase;heparin;aphasia;article;atherosclerotic plaque;atrioventricular block;blood clot lysis;brain ischemia;cardiomyopathy;case report;coronary artery thrombosis;dysarthria;female;hemianopia;hemiparesis;hemiplegia;human;hypertension;hypesthesia;mental deterioration;paresis;priority journal;recurrent disease;sinus node;stupor;thrombosis,"Cappellari, M.;Tomelleri, G.;Carletti, M.;Bovi, P.;Moretto, G.",2012,,,0,
654,Caffeine: Cognitive and physical performance enhancer or psychoactive drug?,"Caffeine use is increasing worldwide. The underlying motivations are mainly concentration and memory enhancement and physical performance improvement. Coffee and caffeine-containing products affect the cardiovascular system, with their positive inotropic and chronotropic effects, and the central nervous system, with their locomotor activity stimulation and anxiogenic-like effects. Thus, it is of interest to examine whether these effects could be detrimental for health. Furthermore, caffeine abuse and dependence are becoming more and more common and can lead to caffeine intoxication, which puts individuals at risk for premature and unnatural death. The present review summarizes the main findings concerning caffeine’s mechanisms of action (focusing on adenosine antagonism, intracellular calcium mobilization, and phosphodiesterases inhibition), use, abuse, dependence, intoxication, and lethal effects. It also suggests that the concepts of toxic and lethal doses are relative, since doses below the toxic and/or lethal range may play a causal role in intoxication or death. This could be due to caffeine’s interaction with other substances or to the individuals' preexisting metabolism alterations or diseases.",5 acetamido 6 formylamino 3 methyluracil;adenosine A1 receptor;adenosine A2a receptor;adenosine A2b receptor;adenosine receptor blocking agent;caffeine;calcium;cyclic GMP;cyclooxygenase 2;cytochrome P450 1A2;endothelial nitric oxide synthase;hormone sensitive lipase;paraxanthine;phosphodiesterase;psychotropic agent;Alzheimer disease;anxiety;article;cacao;calcium mobilization;coffee;cognition;drug abuse;drug blood level;drug dependence;drug half life;drug intoxication;drug mechanism;drug metabolism;drug safety;drug tolerance;DSM-5;DSM-IV-TR;energy drink;enzyme inhibition;fatty acid oxidation;glycogen muscle level;heart ventricle extrasystole;human;meta analysis (topic);Parkinson disease;pharmacodynamics;physical performance;QRS complex,"Cappelletti, S.;Piacentino, D.;Sani, G.;Aromatario, M.",2015,,,0,
655,Thyroid function in the euthyroid range and adverse outcomes in older adults,"CONTEXT: The appropriateness of current reference ranges for thyroid function testing in older adults has been questioned. OBJECTIVE: This study aimed to determine the relationship between thyroid function tests within the euthyroid range and adverse outcomes in older adults not taking thyroid medication. DESIGN, SETTING, AND PARTICIPANTS: US community-dwelling adults years of older (n = 2843) enrolled onto the Cardiovascular Health Study with TSH, free T4 (FT4), and total T3 concentrations in the euthyroid range. MAIN OUTCOME MEASURES: Incidence of atrial fibrillation, coronary heart disease, heart failure, hip fracture, dementia, and all-cause death were measured. RESULTS: No departures from linearity were detected. Higher TSH was negatively associated (P = .03) and higher FT4 was positively associated (P = .007) with mortality. Higher FT4 was associated with atrial fibrillation (P < .001) and heart failure (P = .004). Compared with the first quartile, individuals with TSH in the fourth quartile had a 9.6 per 1000 person-year lower incidence of dementia (P < .05) and those with FT4 in the fourth quartile had higher incidences of atrial fibrillation, coronary heart disease, heart failure, and mortality (11.0, 8.0, 7.8, and 14.3 per 1000 person-years, respectively, all P < .05). Total T3 was not associated with any outcome. CONCLUSIONS: Higher TSH and lower FT4 concentrations within the euthyroid range are associated with lower risk of multiple adverse events in older people, including mortality. This suggests tolerance for lower thyroid hormone levels in this age group. Clinical trials are needed to evaluate the risk-benefit profile of new thresholds for initiating treatment and optimal target concentrations for thyroid hormone replacement in older people.","Aged;Aged, 80 and over;Aging/*physiology;Atrial Fibrillation/diagnosis/*epidemiology;Cause of Death;Coronary Disease/diagnosis/*epidemiology;Dementia/diagnosis/*epidemiology;Female;Heart Failure/diagnosis/*epidemiology;Hip Fractures/diagnosis/*epidemiology;Humans;Incidence;Male;Prognosis;Reference Values;Survival Analysis;Thyroid Function Tests/*standards;Thyroid Gland/*physiology","Cappola, A. R.;Arnold, A. M.;Wulczyn, K.;Carlson, M.;Robbins, J.;Psaty, B. M.",2015,Mar,10.1210/jc.2014-3586,0,
656,Disability in the elderly: Epidemiology and risk factors,"The ""frail elderly"" is the sum of several risk factors for disability. In older persons there are different kind of disability: motor frailty, cerebrovascular frailty, cognitive frailty, environmental frailty, and metabolic frailty. In older individuals disability coming from motor frailty is more frequent, with increased risk for falls and fractures. The loss of muscular and nervous strenght increased the risk for hip fractures, while vertebral fractures are the result of osteoporosis. Stroke risk factors (atrial fibrillation, coronary artery disease, diabetes, hypertension, and cigarette smoking) are risk factors for cerebrovascular frailty too. Recent studies have confirmed in the elderly the important role of hypercholesterolemia, and therefore the efficacy of lipid-lowering treatments in secondary prevention. Age-related cognitive decline is expression of cognitive frailty and, at present, Mild cognitive impairment (MCI) is the most widely used term to classify nondemented aged persons with a mild memory or cognitive impairment that cannot be accounted for by any recognized medical or psychiatric condition. Whether MCI is expression of a normal aging process, or represents a distinct clinical entity, or is in continuum with dementia is still difficult to establish. MCI may be a prodromal phase of dementia, and identification and subsequent management of possible risk factors for MCI or for the conversion of MCI to dementia may be crucial for prevention. Recent findings suggest a possible role of diet in age-related cognitive decline, and cognitive impairment of both degenerative or vascular origin. In particular, in an older population of Southern Italy with a typical Mediterranean diet, high monounsaturated fatty acids energy intake appeared to be associated with a high protection against cognitive decline. Dietary anti-oxidants and supplements and specific macronutrients of the diet may act synergistically with other protective factors (estrogens, NSAIDs) opening new possibilities of intervention for cognitive decline.",antilipemic agent;antioxidant;estrogen;monounsaturated fatty acid;nonsteroid antiinflammatory agent;aged;aging;article;caloric intake;cerebrovascular disease;smoking;cognitive defect;coronary artery disease;dementia;diabetes mellitus;disability;disease severity;drug efficacy;drug potentiation;environmental disease;falling;food drug interaction;geriatric care;groups by age;atrial fibrillation;hip fracture;human;hypercholesterolemia;hypertension;Italy;lipid diet;macronutrient;Mediterranean diet;memory disorder;mental disease;metabolic disorder;motor dysfunction;muscle strength;nervous system function;osteoporosis;patient coding;risk factor;secondary prevention;cerebrovascular accident;spine fracture,"Capurso, A.;Panza, F.;Capurso, C.;Torres, F.;D'Introno, A.;Capurso, S.;Colacicco, A. M.;Solfrizzi, V.",2004,,,0,
657,Cerebrovascular disease in the elderly: Lipoprotein metabolism and cognitive decline,"Data concerning the treatment of lipid abnormalities in patients with cerebrovascular disease (CVD) are less robust than for coronary heart disease (CHD), raising clinical questions as to which is the appropriate therapeutic approach to stroke patients. Although observational cohort studies have failed to demonstrate an association between lipid disorders and stroke incidence, recently completed trials of subjects at risk for CHD have shown that statins reduce not only the risk of myocardial infarction and death, but also that of brain infarction and transient ischemic attacks. At present, it seems reasonable to conclude that the stroke patient with an undesirable lipid profile who has a history of CHD should receive specific treatment for the lipid disorder. Recommendations are more problematic for stroke patients with lipid disorder but no history of CHD. Furthermore, many of the risk factors for CVD and vascular dementia (VaD), including serum total cholesterol (TC), lipoprotein(a), diabetes mellitus, atrial fibrillation, hypertension, apolipoprotein E levels, and atherosclerosis, have also been shown to increase the risk of AD. In a recent study, we estimated prevalence, incidence, and rate of progression of MCI to dementia and correlated vascular risk factors with incident MCI and its progression to dementia. We evaluated 2,963 individuals from the population-based sample of 5,632 subjects 65-84 year old of the Italian Longitudinal Study on Aging, with a 3.5-year follow-up. We found a progression rate to dementia (all causes) of 3.8/100 person-years. Furthermore, age was a risk factor for incident MCI, while education was protective, and serum TC evidenced a borderline non-significant trend for a protective effect. There was a non-significant trend for stroke as a risk factor of progression of MCI to dementia. In conclusions, in our population, among those who progressed to dementia, 60% progressed to Alzheimer's disease and 33% to VaD. Vascular risk factors influence incident MCI and the rate of progression to dementia.",apolipoprotein E;cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;lipoprotein;age;aged;aging;Alzheimer disease;anamnesis;article;brain infarction;brain protection;cerebrovascular disease;cholesterol blood level;clinical observation;clinical trial;cognitive defect;coronary risk;death;dementia;diabetes mellitus;disease association;disorders of lipid and lipoprotein metabolism;education;follow up;atrial fibrillation;heart infarction;human;hypertension;incidence;ischemic heart disease;Italy;lipid blood level;lipoprotein blood level;lipoprotein metabolism;longitudinal study;major clinical study;meta analysis;multiinfarct dementia;population structure;prevalence;risk factor;risk reduction;cerebrovascular accident;transient ischemic attack,"Capurso, A.;Solfrizzi, V.;Colacicco, A. M.;D'Introno, A.;Capurso, C.;Argentieri, G.;Capurso, S.;Panza, F.",2005,,,0,
658,Beyond coronary artery disease: rosuvastatin in older patients with ischemic systolic heart failure,,"Aged;Cholesterol/*blood;Coronary Disease/complications;Dementia/*blood;Fluorobenzenes/*therapeutic use;*Geriatrics;Heart Failure/complications/*drug therapy;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use;Middle Aged;Pyrimidines/*therapeutic use;Randomized Controlled Trials as Topic;Rosuvastatin Calcium;Sulfonamides/*therapeutic use;Ventricular Dysfunction, Left/complications","Capurso, C.;Solfrizzi, V.;D'Introno, A.;Colacicco, A. M.;Gadaleta, A.;Frisardi, V.;Santamato, A.;Capurso, A.;Panza, F.",2008,Jul,10.1111/j.1532-5415.2008.01727.x,0,
659,Medical profiles of patients admitted to a geriatric assessment and rehabilitation unit,"A prospective prognostic study of all admissions to a geriatric assessment and rehabilitation unit was carried out which analysed the medical profiles of 205 patients admitted for the first time during a four month period. All patients were followed up for at least six months after discharge. Particularly poor prognosis was noted among patients with renal failure, ischaemic heart disease, depression, pneumonia, congestive cardiac failure, trauma, mental disorder and dementia. Good prognosis was reported in patients with Parkinson's disease, faecal impaction, stroke and adverse drug reactions. Multiple diagnoses were common, and only nine patients had no active medical problems during their admission. The implications for adequate training of geriatricians in medicine are discussed.",Aged;Cerebrovascular Disorders;*Disease;Drug-Related Side Effects and Adverse Reactions;Follow-Up Studies;Geriatrics;Heart Diseases;Hospital Units;*Hospitalization;Humans;Mental Disorders;Prognosis;Prospective Studies;Rehabilitation;Wounds and Injuries,"Caradoc-Davies, T. H.",1987,Sep 9,,0,
660,Omega-3: from cod-liver oil to nutrigenomics,"The leading role of cod-liver oil on rickets was a relevant factor in the knowledge of this disease. In 1922 the preventive and therapeutic value of cod-liver oil and sunlight against rickets in young infants was confirmed. The seasonal variation in the incidence of rickets, the role of skin pigmentation, of diet and the fact that breast milk was not an adequate source of vitamin D were understood. The discovery of essential fatty acids omega-6 and omega-3 have shown that deficiencies, mainly of omega-3 long chain polyunsaturated fatty acids, result in visual and cognitive impairment and disturbances in mental functions in infants and also in cognitive function in adults, as fatty acids are beneficial to vascular health and may forestall cerebrovascular disease and thus dementia. An adequate ratio of n-6 and n-3 fatty acids may promote a healthier balance of eicosanoids, which would protect membrane function with a nutraceutical function. Dietary lipids not only influence the biophysical state of the cell membranes but, via direct and indirect routes, they also act on multiple pathways including signalling, gene and protein activities, protein modifications and they probably play important role in modulating protein aggregation. Significant advances have been made in understanding the relation between dietary factors and inflammation, which is a central component of many chronic diseases, including coronary artery disease, rheumatoid arthritis, cancer prevention. However, the identification of those who will or will not benefit from dietary intervention strategies remains a major obstacle. Adequate knowledge about how the responses depend on an individual's genetic background (nutrigenetic effects), the cumulative effects of food components on genetic expression profiles through nutrigenomics mechanism, may assist in identifying responders and non-responders. Thus, fish and fish oil consumption might encourage brain development and gene expression to brain maintenance during aging through nutrigenomic mechanism.","Cod Liver Oil/*history/*therapeutic use;Fatty Acids, Omega-3/*therapeutic use;Global Health;Health Services/*history;History, 15th Century;History, 16th Century;History, 17th Century;History, 18th Century;History, 19th Century;History, 20th Century;History, Medieval;Humans;Nutrigenomics/*methods;Rickets/prevention & control/*therapy","Caramia, G.",2008,Aug,,0,
661,Neuro-Psychological Pattern in Patients Suffering from Primitive Dilated Cardiomyopathy with Impairment in Executive Function,"According to the American Heart Association (AHA), primitive dilated cardiomyopathy (PDCM) is a ""progressive dilation of the left or both ventricles and a depressed contractility in the absence of abnormal load conditions"". It evolves in progressive heart-failure. The term ""cardiogenic dementia"" expresses the intimate connection between heart diseases and cognitive functions. The association between PDCM and the neuropsychological functions is unclear: the main pathophysiological hypotheses are cerebral hypoperfusion and cardiogenic emboli. The aim of this study is to evaluate the impact that the PDCM has on neuropsychological decline and to detect early echocardiographic markers of cognitive impairment. We enrolled 235 patients: 168 suffering from PDCM as sample group and 67 suffering from hypertensive dilated cardiomyopathy (HTCM) as control group. They underwent a cardiology examination and a neuropsychological assessment. A p<0.05 was considered significant. The two groups showed no differences in risk factors, demographic and cardiovascular parameters (except for dimensions of aortic root, left atrium and ventricle which appeared greater in PDCM and left ventricle ejection fraction that appeared lower in PDCM). Among administered neuropsychological tests, only the Stroop Test (which explores executive and attentive functions) appeared significantly lower in PDCM (p = 0.029). Moreover left ventricle end-diastolic diameter was inversely related to the Stroop Test Score (r= -0.32). PDCM doesn't appear to be at the basis of a generalized cognitive and neuropsychological decline. Only the executive functions seem impaired in PDCM. Left ventricle dilation seems to be associated to attentive and executive functions decline.","Adult;Aged;Cardiomyopathy, Dilated/ physiopathology;Cognition/physiology;Executive Function/ physiology;Female;Heart Failure/physiopathology;Humans;Male;Middle Aged;Risk Factors;Ventricular Function, Left/physiology;Primitive dilated cardiomyopathy;Stroop Test;cardiogenic dementia;cognitive impairment;hypertensive cardiomyopathy;neuropsychology","Carbonara, R.;Giardinelli, F.;Zito, A.;Scicchitano, P.;Dentamaro, I.;Cortese, F.;Armenise, A.;Manca, F.;De Caro, M. F.;Nazzaro, P.;Federico, F.;Guaricci, A. I.;Laudadio, F.;Iacoviello, M.;Ciccone, M. M.",2017,,,0,
662,Elevated plasma fibrin D-dimer as a risk factor for vascular dementia: the Three-City cohort study,"BACKGROUND: Hemostatic biomarkers have been associated with coronary heart disease (CHD) and stroke. However, few studies have investigated these associations in the elderly. Moreover, vascular factors may be involved in dementia. Data on the relationship between hemostatic biomarkers and dementia remain scarce. OBJECTIVES: Our study aimed to investigate the relationship between hemostatic biomarkers and the risk of CHD, stroke and dementia in an elderly population. PATIENTS/METHODS: In the Three-City cohort study including men and women aged > or = 65, we investigated the association of fibrinogen, D-dimer and von Willebrand factor with the 4-year incidence of arterial disease (CHD, n = 199; and stroke, n = 111) and dementia (n = 218). Measurements were performed for all cases and for a random sample of the entire cohort (n = 1254). Hazards ratios (HR) compared the last quintile with the first of each parameter's distribution and P-values refer to the test for linear trend across quintiles. RESULTS: Elevated fibrinogen was associated with the risk of CHD and myocardial infarction (HR = 2.20, P < 0.05 and 2.45 P < 0.05, respectively). Moreover, high D-dimer was associated with the risk of CHD among younger subjects (aged < 75, HR = 3.64, P < 0.01) but not older subjects (P for interaction = 0.01). Furthermore, the risk of vascular dementia (VaD) increased with D-dimer level (HR = 3.05, P < 0.01). CONCLUSIONS: In the elderly, elevated fibrinogen and D-dimer levels were associated with incident arterial disease. In addition, high D-dimer level could represent a new risk factor for VaD.","Age Factors;Aged;Biomarkers/blood;Cohort Studies;Dementia, Vascular/*blood/diagnosis/etiology;Female;Fibrin Fibrinogen Degradation Products/*analysis;Fibrinogen/analysis;Hemostasis;Humans;Incidence;Male;Peripheral Vascular Diseases/blood/diagnosis/etiology;Prospective Studies;Risk Factors;Stroke/blood/diagnosis/etiology;von Willebrand Factor/analysis","Carcaillon, L.;Gaussem, P.;Ducimetiere, P.;Giroud, M.;Ritchie, K.;Dartigues, J. F.;Scarabin, P. Y.",2009,Dec,10.1111/j.1538-7836.2009.03603.x,0,
663,"Associations among vascular risk factors, carotid atherosclerosis, and cortical volume and thickness in older adults","BACKGROUND AND PURPOSE: The purpose of this study was to investigate whether the Framingham Cardiovascular Risk Profile and carotid artery intima-media thickness are associated with cortical volume and thickness. METHODS: Consecutive subjects participating in a prospective cohort study of aging and mild cognitive impairment enriched for vascular risk factors for atherosclerosis underwent structural MRI scans at 3-T and 4-T MRI at 3 sites. Freesurfer (Version 5.1) was used to obtain regional measures of neocortical volumes (mm3) and thickness (mm). Multiple linear regression was used to determine the association of Framingham Cardiovascular Risk Profile and carotid artery intima-media thickness with cortical volume and thickness. RESULTS: One hundred fifty-two subjects (82 men) were aged 78 (+/-7) years, 94 had a clinical dementia rating of 0, 58 had a clinical dementia rating of 0.5, and the mean Mini-Mental State Examination was 28+/-2. Framingham Cardiovascular Risk Profile score was inversely associated with total gray matter volume and parietal and temporal gray matter volume (adjusted P<0.04). Framingham Cardiovascular Risk Profile was inversely associated with parietal and total cerebral gray matter thickness (adjusted P<0.03). Carotid artery intima-media thickness was inversely associated with thickness of parietal gray matter only (adjusted P=0.04). Including history of myocardial infarction or stroke and radiological evidence of brain infarction, or apolipoprotein E genotype did not alter relationships with Framingham Cardiovascular Risk Profile or carotid artery intima-media thickness. CONCLUSIONS: Increased cardiovascular risk was associated with reduced gray matter volume and thickness in regions also affected by Alzheimer disease independent of infarcts and apolipoprotein E genotype. These results suggest a ""double hit"" toward developing dementia when someone with incipient Alzheimer disease also has high cardiovascular risk.","Aged;Aged, 80 and over;Cardiovascular Diseases/*complications/pathology;Carotid Artery Diseases/*complications/pathology;*Carotid Intima-Media Thickness;Cerebral Cortex/*pathology;Female;Humans;Magnetic Resonance Imaging;Male;Middle Aged;Risk Factors","Cardenas, V. A.;Reed, B.;Chao, L. L.;Chui, H.;Sanossian, N.;DeCarli, C. C.;Mack, W.;Kramer, J.;Hodis, H. N.;Yan, M.;Buonocore, M. H.;Carmichael, O.;Jagust, W. J.;Weiner, M. W.",2012,Nov,10.1161/strokeaha.112.659722,0,
664,Health characteristics and consultation patterns of people with intellectual disability: a cross-sectional database study in English general practice,"BACKGROUND: People with intellectual disability (ID) are a group with high levels of healthcare needs; however, comprehensive information on these needs and service use is very limited. AIM: To describe chronic disease, comorbidity, disability, and general practice use among people with ID compared with the general population. DESIGN AND SETTING: This study is a cross-sectional analysis of a primary care database including 408 English general practices in 2012. METHOD: A total of 14 751 adults with ID, aged 18-84 years, were compared with 86 221 age-, sex- and practice-matched controls. Depending on the outcome, prevalence (PR), risk (RR), or odds (OR) ratios comparing patients with ID with matched controls are shown. RESULTS: Patients with ID had a markedly higher prevalence of recorded epilepsy (18.5%, PR 25.33, 95% confidence interval [CI] = 23.29 to 27.57), severe mental illness (8.6%, PR 9.10, 95% CI = 8.34 to 9.92), and dementia (1.1%, PR 7.52, 95% CI = 5.95 to 9.49), as well as moderately increased rates of hypothyroidism and heart failure (PR>2.0). However, recorded prevalence of ischaemic heart disease and cancer was approximately 30% lower than the general population. The average annual number of primary care consultations was 6.29 for patients with ID, compared with 3.89 for matched controls. Patients with ID were less likely to have longer doctor consultations (OR 0.73, 95% CI = 0.69 to 0.77), and had lower continuity of care with the same doctor (OR 0.77, 95% CI = 0.73 to 0.82). CONCLUSION: Compared with the general population, people with ID have generally higher overall levels of chronic disease and greater primary care use. Ensuring access to high-quality chronic disease management, especially for epilepsy and mental illness, will help address these greater healthcare needs. Continuity of care and longer appointment times are important potential improvements in primary care.",chronic disease;continuity of care;intellectual disability;learning disabilities;primary care,"Carey, I. M.;Shah, S. M.;Hosking, F. J.;DeWilde, S.;Harris, T.;Beighton, C.;Cook, D. G.",2016,Apr,10.3399/bjgp16X684301,0,665
665,Health characteristics and consultation patterns of people with intellectual disability: A crosssectional database study in English general practice,"Background People with intellectual disability (ID) are a group with high levels of healthcare needs; however, comprehensive information on these needs and service use is very limited. Aim To describe chronic disease, comorbidity, disability, and general practice use among people with ID compared with the general population. Design and setting This study is a cross-sectional analysis of a primary care database including 408 English general practices in 2012. Method A total of 14 751 adults with ID, aged 18-84 years, were compared with 86 221 age-, sex- and practice-matched controls. Depending on the outcome, prevalence (PR), risk (RR), or odds (OR) ratios comparing patients with ID with matched controls are shown. Results Patients with ID had a markedly higher prevalence of recorded epilepsy (18.5%, PR 25.33, 95% confidence interval [CI] = 23.29 to 27.57), severe mental illness (8.6%, PR 9.10, 95% CI = 8.34 to 9.92), and dementia (1.1%, PR 7.52, 95% CI = 5.95 to 9.49), as well as moderately increased rates of hypothyroidism and heart failure (PR>2.0). However, recorded prevalence of ischaemic heart disease and cancer was approximately 30% lower than the general population. The average annual number of primary care consultations was 6.29 for patients with ID, compared with 3.89 for matched controls. Patients with ID were less likely to have longer doctor consultations (OR 0.73, 95% CI = 0.69 to 0.77), and had lower continuity of care with the same doctor (OR 0.77, 95% CI = 0.73 to 0.82). Conclusion Compared with the general population, people with ID have generally higher overall levels of chronic disease and greater primary care use. Ensuring access to high-quality chronic disease management, especially for epilepsy and mental illness, will help address these greater healthcare needs. Continuity of care and longer appointment times are important potential improvements in primary care.",adult;aged;anxiety disorder;article;asthma;atrial fibrillation;autism;cerebrovascular accident;chronic disease;chronic kidney disease;chronic obstructive lung disease;comorbidity;comparative study;constipation;consultation;controlled study;cross-sectional study;dementia;depression;diabetes mellitus;disability;disease severity;Down syndrome;epilepsy;feces incontinence;female;general practice;health care utilization;heart failure;human;hypertension;hypothyroidism;ischemic heart disease;low vision;major clinical study;male;mood disorder;neoplasm;osteoporosis;patient care;peripheral vascular disease;population;prevalence;primary medical care;problem behavior;reference database;rheumatoid arthritis;schizophrenia;teleconsultation;transient ischemic attack;urine incontinence;visual impairment,"Carey, I. M.;Shah, S. M.;Hosking, F. J.;DeWilde, S.;Harris, T.;Beighton, C.;Cook, D. G.",2016,,,0,
666,"Xenon-enhanced cerebral blood flow at 28% xenon provides uniquely safe access to quantitative, clinically useful cerebral blood flow information: A multicenter study","BACKGROUND AND PURPOSE: Xe-CT measures CBF and can be used to make clinical treatment decisions. Availability has been limited, in part due to safety concerns. Due to improvements in CT technology, the concentration of inhaled xenon gas has been decreased from 32% to 28%. To our knowledge, no data exist regarding the safety profile of this concentration. We sought to better determine the safety profile of this lower concentration through a multicenter evaluation of adverse events reported by all centers currently performing xenon/CT studies in the US. MATERIALS AND METHODS: Patients were prospectively recruited at 7 centers to obtain safety and efficacy information. All studies were performed to answer a clinical question. All centers used the same xenon delivery system. CT imaging was used during a 4.3-minute inhalation of 28% xenon gas. Vital signs were monitored on all patients throughout each procedure. Occurrence and severity of adverse events were recorded by the principal investigator at each site. RESULTS: At 7 centers, 2003 studies were performed, 1486 (74.2%) in nonventilated patients. The most common indications were occlusive vascular disease and ischemic stroke; 93% of studies were considered clinically useful. Thirty-nine studies (1.9%) caused respiratory suppression of >20 seconds, all of which resolved spontaneously. Shorter respiratory pauses occurred in 119 (5.9%), and hyperventilation, in 34 (1.7%). There were 53 additional adverse events (2.9%), 7 of which were classified as severe. No adverse event resulted in any persistent neurologic change or other sequelae. CONCLUSIONS: Xe-CT CBF can be performed safely, with a very low risk of adverse events and, to date, no risk of permanent morbidity or sequelae. On the basis of the importance of the clinical information gained, Xe-CT should be made widely available.",xenon;anxiety disorder;article;heart arrest;blurred vision;bradycardia;brain artery aneurysm;brain blood flow;brain hemorrhage;brain ischemia;brain tumor;chest tightness;claustrophobia;clinical effectiveness;computer assisted tomography;concentration (parameters);consciousness disorder;dementia;disease severity;drug safety;dyspnea;epilepsy;headache;human;hydrocephalus;hypertension;hyperventilation;major clinical study;multicenter study;nausea;nausea and vomiting;neurologic disease;paresthesia;patient monitoring;peripheral occlusive artery disease;prospective study;respiratory failure;respiratory tract disease;restlessness;risk assessment;seizure;skin tingling;skull base tumor;taste disorder;transient ischemic attack;traumatic brain injury;tremor;vasospasm;vital sign;vomiting,"Carlson, A. P.;Brown, A. M.;Zager, E.;Uchino, K.;Marks, M. P.;Robertson, C.;Sinson, G. P.;Marmarou, A.;Yonas, H.",2011,,,0,
667,Exposure-adjusted analysis of treatment-emergent adverse events from expedition and expedition2 trials of solanezumab for the treatment of Alzheimer's disease,"Background: Solanezumab, a humanized monoclonal antibody that binds to the mid-domain of soluble amyloid beta is being developed for the treatment of Alzheimer's disease (AD). EXPEDITION and EXPEDITION2 were Phase 3, 18-month, placebo-controlled studies that investigated intravenous solanezumab (400 mg/4 weeks) in patients with mild to moderate AD. In Phase 1 and 2 trials in AD patients, solanezumab was well tolerated with dosing up to 400 mg weekly for 12 weeks. Exposure adjusted incidence of treatment- emergent adverse events (TEAEs) were determined to detect any events occurring earlier or later in treatment. Methods: This analysis included pooled data from 1022 and 1020 solanezumaband placebo-treated-patients over 18 months in EXPEDITION and EXPEDITION2. Exposure-adjusted incidence of TEAEs and relative risks are presented. Results: Patients were aged 55-94 years; 65% had mild AD (Mini-Mental State Examination [MMSE] score 20-26) and 35% had moderate AD (MMSE score 16-19) at baseline. There were a total of 1379.7 and 1378.8 patient- years of exposure to solanezumab and placebo, respectively. For both solanezumab and placebo, the mean and median exposure durations were 1.34 years and 1.54 years, respectively. Approximately 75% of patients in both treatment groups completed the studies. There was a significantly lower relative risk in the Medical Dictionary for Regulatory Activities (MedDRA) Nervous System Disorders System Organ Class (SOC) in solanezumab-treated patients (Table 1). Solanezumab-treated patients experienced no greater incidence of combined TEAEs at the SOC level compared with placebo-treated patients. In addition, there was no significantly different relative risk for patients with > 1 TEAE or for the Cardiac Ischemic or Arrhythmia MedDRA Standard Medical Queries in solanezumab- compared with placebo-treated patients (Table 1). In solanezumab-treated patients, there were greater relative risks for MedDRA Preferred Terms Angina Pectoris and Sinus Bradycardia and a lower relative risks for Preferred Terms Procedural Pain, Upper Respiratory Tract Infection and Behavioral and Psychiatric Symptoms of Dementia compared with the placebo-treated patients, respectively (Table 1). Conclusions: Exposure-adjusted safety results are consistent with safety findings from the EXPEDITION studies reported previously using the traditional unadjusted measure, indicating solanezumab is generally well-tolerated with a favorable risk-benefit ratio. (Table Presented).",adult;adverse drug reaction;Alzheimer disease;angina pectoris;behavior;clinical trial;controlled clinical trial;controlled study;drug combination;drug therapy;exposure;heart arrhythmia;human;major clinical study;Medical Dictionary for Regulatory Activities;middle aged;Mini Mental State Examination;organ;pain;pharmacokinetics;phase 1 clinical trial;phase 3 clinical trial;risk factor;safety;side effect;sinus bradycardia;upper respiratory tract infection;placebo;solanezumab;Sr-dementia,"Carlson, Cd;Hake, Am;Sethuraman, G;Khanna, R;Salinas, Ca;Siemers, Er",2016,,,0,
668,Safety of solanezumab in the EXPEDITION-EXT study up to 2 years in a mild to moderate Alzheimer's disease population,"Background: Solanezumab, a humanized monoclonal antibody that binds to the mid-domain of soluble amyloid beta (Abeta) peptide was developed for the treatment of Alzheimer's disease (AD). EXPEDITION and EXPEDITION2 (the ""feeder studies"") were Phase 3, 18-month, placebo-controlled studies investigating solanezumab (400mg/4 weeks) in patients with mild-to-moderate AD. EXPEDITION-EXT is an extension study in patients who completed EXPEDITION or EXPEDITION2. Methods: In EXPEDITION- EXT, all patients receive solanezumab (400mg/4 weeks) intravenously, but patients and site personnel remain blinded to original treatment assignment in the feeder studies. Safety endpoints were summarized for patients assigned to placebo in the feeder studies (PBOF) and solanezumab in the feeder studies (SLZF); statistical comparisons were not conducted. The data cut for this safety analysis occurred after all patients had completed 2 years or had discontinued in EXPEDITION-EXT, but all available data were included in the analyses; therefore some patients have more than 2 years of follow-up. Results: A total of 1457 patients enrolled in EXPEDITION-EXT. This represents a total of 2879 person-years of exposure to solanezumab, with 70% of patients having at least 18 months' exposure, and maximum exposure of almost 3.5 years in EXPEDITION-EXT. Patients were age 54-93 years; 67% had mild AD (Mini-Mental Status Examination [MMSE] 20-26) and 33% had moderate AD (MMSE 16-19) at baseline in the feeder studies. Deaths, serious adverse events, discontinuations due to an adverse event, treatment-emergent adverse events, and categorical increases in amyloid-related imaging abnormality-hemosiderin deposition (ARIA-H) were evenly distributed across feeder study treatment groups. Four patients in the PBOF group and 3 patients in the SLZF group experienced ARIA-edema/effusion (ARIA-E) during EXPEDITIONEXT; however, ARIA-E was not clearly related to symptoms in any patient. Overall, cardiac disorders were observed in similar proportions across groups, but among ischemic-related events, myocardial infarction and arteriosclerosis coronary artery occurred with greater frequency in the PBOF or SLZF group, respectively (Table 1). Conclusions: These results are consistent with previous safety findings from the EXPEDITION studies, indicating that solanezumab is generally well tolerated. ARIA and cardiovascular events will continue to be evaluated in ongoing studies to further characterize these potential risks. (Table Presented).",safety;population;Alzheimer disease;human;patient;exposure;imaging;death;mental health;follow up;coronary artery;examination;heart infarction;personnel;arteriosclerosis;diseases;controlled study;risk;Mini Mental State Examination;solanezumab;amyloid;placebo;hemosiderin;peptide;monoclonal antibody,"Carlson, Cd;Sethuraman, G;Andersen, Sw;Holdridge, Kc;Hoog, Sl;Hayduk, R;Siemers, Er",2015,,,0,671
669,Efficacy of solanezumab in patients with mild or moderate Alzheimer's disease: Pooled analyses findings from two phase iii studies,"Background: Solanezumab, a humanized monoclonal antibody that binds the mid-domain of soluble amyloid beta (A b) peptide, was developed for treatment of Alzheimer's disease (AD). Two identicallydesigned Phase 3 trials were conducted. Methods: Pooled analyses findings from two double-blind, placebo-controlled Phase 3 trials are presented Participants with mild (baseline Mini-Mental State Examination [MMSE] score 20-26) to moderate (MMSE score 16-19) AD were randomized 1:1 to 400 mg solanezumab or placebo infusion every 4 weeks for 80 weeks. Primary outcomes of cognition and daily functioning were assessed using several Alzheimer's Disease Assessment Scale- Cognitive subscales (ADAS-Cog) and the Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) inventory, respectively. Additional measures of efficacy and safety were also assessed. Mixed model repeated measures (MMRM) analyses were conducted for each of the efficacy measures. Results: In the mild population, approximately 34 % less cognitive decline (ADAS-Cog 11, ADAS-Cog 14 and MMSE) was observed in the solanezumab versus placebo group (Table). In this population, there was no significant difference in overall functional decline between solanezumab versus placebo, but using a subset of instrumental ADLs (ADCS-iADL), the difference reached statistical significance (Table). In the moderate population, there were no between-treatment group differences in any cognitive or functional measure. In both mild and moderate populations, there were no significant treatment group-differences for Clinical Dementia Rating Scale-Sum of Boxes, Neuropsychiatric Inventory or quality of life measures. No individual serious adverse event was common, but significant treatment group differences were observed for Angina Pectoris, Congestive Heart Failure and Syncope (more common with solanezumab), and for Behavioral and Psychiatric Symptoms of Dementia and Mental Status Change (more common with placebo). Frequencies of treatment-emergent amyloid-related imaging abnormalities-edema/effusions (1.1% vs. 0.5%) and -hemosiderin deposition (9.1% vs. 7.3%) were greater with solanezumab, but not significantly different from placebo. There were no significant treatment-group differences in treatment-emergent changes in vital signs or laboratory measures. Conclusions: In a pooled analysis of solanezumab trial data, solanezumab reduced cognitive and functional decline in the mild but not the moderate AD population. Safety findings supported a favorable risk/benefit ratio.",human;patient;phase 3 clinical trial;Alzheimer disease;population;Mini Mental State Examination;safety;angina pectoris;quality of life;rating scale;Clinical Dementia Rating;statistical significance;model;congestive heart failure;laboratory;daily life activity;imaging;mental health;cognition;vital sign;dementia;mental disease;faintness;infusion;Alzheimer Disease Assessment Scale;solanezumab;placebo;amyloid;peptide;monoclonal antibody;hemosiderin,"Carlson, C.;Sundell, K.;Estergard, W.;Raskin, J.;Liu-Seifert, H.;Case, M.;Sethuraman, G.;Chen, Y. F.;Henley, D.;Mattos, R.;Siemers, E.",2013,,10.1016/j.jalz.2013.04.082,0,670
670,Efficacy of solanezumab in patients with mild or moderate Alzheimer's disease: pooled analyses findings from two phase iii studies,"Background: Solanezumab, a humanized monoclonal antibody that binds the mid-domain of soluble amyloid beta (A b) peptide, was developed for treatment of Alzheimer's disease (AD). Two identicallydesigned Phase 3 trials were conducted. Methods: Pooled analyses findings from two double-blind, placebo-controlled Phase 3 trials are presented Participants with mild (baseline Mini-Mental State Examination [MMSE] score 20-26) to moderate (MMSE score 16-19) AD were randomized 1:1 to 400 mg solanezumab or placebo infusion every 4 weeks for 80 weeks. Primary outcomes of cognition and daily functioning were assessed using several Alzheimer's Disease Assessment Scale- Cognitive subscales (ADAS-Cog) and the Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) inventory, respectively. Additional measures of efficacy and safety were also assessed. Mixed model repeated measures (MMRM) analyses were conducted for each of the efficacy measures. Results: In the mild population, approximately 34 % less cognitive decline (ADAS-Cog 11, ADAS-Cog 14 and MMSE) was observed in the solanezumab versus placebo group (Table). In this population, there was no significant difference in overall functional decline between solanezumab versus placebo, but using a subset of instrumental ADLs (ADCS-iADL), the difference reached statistical significance (Table). In the moderate population, there were no between-treatment group differences in any cognitive or functional measure. In both mild and moderate populations, there were no significant treatment group-differences for Clinical Dementia Rating Scale-Sum of Boxes, Neuropsychiatric Inventory or quality of life measures. No individual serious adverse event was common, but significant treatment group differences were observed for Angina Pectoris, Congestive Heart Failure and Syncope (more common with solanezumab), and for Behavioral and Psychiatric Symptoms of Dementia and Mental Status Change (more common with placebo). Frequencies of treatment-emergent amyloid-related imaging abnormalities-edema/effusions (1.1% vs. 0.5%) and -hemosiderin deposition (9.1% vs. 7.3%) were greater with solanezumab, but not significantly different from placebo. There were no significant treatment-group differences in treatment-emergent changes in vital signs or laboratory measures. Conclusions: In a pooled analysis of solanezumab trial data, solanezumab reduced cognitive and functional decline in the mild but not the moderate AD population. Safety findings supported a favorable risk/benefit ratio.",human;patient;phase 3 clinical trial;Alzheimer disease;population;Mini Mental State Examination;safety;angina pectoris;quality of life;rating scale;Clinical Dementia Rating;statistical significance;model;congestive heart failure;laboratory;daily life activity;imaging;mental health;cognition;vital sign;dementia;mental disease;faintness;infusion;Alzheimer Disease Assessment Scale;solanezumab;placebo;amyloid;peptide;monoclonal antibody;hemosiderin,"Carlson, C;Sundell, K;Estergard, W;Raskin, J;Liu-Seifert, H;Case, M;Sethuraman, G;Chen, Y-F;Henley, D;Mattos, R;Siemers, E",2013,,10.1016/j.jalz.2013.04.082,0,
671,Safety of solanezumab in the EXPEDITION-EXT study up to 2 years in a mild to moderate Alzheimer's disease population,"Background: Solanezumab, a humanized monoclonal antibody that binds to the mid-domain of soluble amyloid beta (Abeta) peptide was developed for the treatment of Alzheimer's disease (AD). EXPEDITION and EXPEDITION2 (the ""feeder studies"") were Phase 3, 18-month, placebo-controlled studies investigating solanezumab (400mg/4 weeks) in patients with mild-to-moderate AD. EXPEDITION-EXT is an extension study in patients who completed EXPEDITION or EXPEDITION2. Methods: In EXPEDITION- EXT, all patients receive solanezumab (400mg/4 weeks) intravenously, but patients and site personnel remain blinded to original treatment assignment in the feeder studies. Safety endpoints were summarized for patients assigned to placebo in the feeder studies (PBOF) and solanezumab in the feeder studies (SLZF); statistical comparisons were not conducted. The data cut for this safety analysis occurred after all patients had completed 2 years or had discontinued in EXPEDITION-EXT, but all available data were included in the analyses; therefore some patients have more than 2 years of follow-up. Results: A total of 1457 patients enrolled in EXPEDITION-EXT. This represents a total of 2879 person-years of exposure to solanezumab, with 70% of patients having at least 18 months' exposure, and maximum exposure of almost 3.5 years in EXPEDITION-EXT. Patients were age 54-93 years; 67% had mild AD (Mini-Mental Status Examination [MMSE] 20-26) and 33% had moderate AD (MMSE 16-19) at baseline in the feeder studies. Deaths, serious adverse events, discontinuations due to an adverse event, treatment-emergent adverse events, and categorical increases in amyloid-related imaging abnormality-hemosiderin deposition (ARIA-H) were evenly distributed across feeder study treatment groups. Four patients in the PBOF group and 3 patients in the SLZF group experienced ARIA-edema/effusion (ARIA-E) during EXPEDITIONEXT; however, ARIA-E was not clearly related to symptoms in any patient. Overall, cardiac disorders were observed in similar proportions across groups, but among ischemic-related events, myocardial infarction and arteriosclerosis coronary artery occurred with greater frequency in the PBOF or SLZF group, respectively (Table 1). Conclusions: These results are consistent with previous safety findings from the EXPEDITION studies, indicating that solanezumab is generally well tolerated. ARIA and cardiovascular events will continue to be evaluated in ongoing studies to further characterize these potential risks. (Table Presented).",safety;population;Alzheimer disease;human;patient;exposure;imaging;death;mental health;follow up;coronary artery;examination;heart infarction;personnel;arteriosclerosis;diseases;controlled study;risk;Mini Mental State Examination;solanezumab;amyloid;placebo;hemosiderin;peptide;monoclonal antibody,"Carlson, C. D.;Sethuraman, G.;Andersen, S. W.;Holdridge, K. C.;Hoog, S. L.;Hayduk, R.;Siemers, E. R.",2015,,,0,
672,Health-related quality of life and long-term therapy with pravastatin and tocopherol (vitamin E) in older adults,"Introduction: Concerns about the effects of HMG-CoA reductase inhibitors ('statins') on health-related quality of life may contribute to their underuse in older adults with and at risk for cardiovascular disease. These concerns also may prevent clinicians from enrolling older patients in clinical trials assessing the efficacy of statins as a preventive therapy for Alzheimer's disease. Objective: To determine the effects of pravastatin and tocopherol (vitamin E), alone and in combination, on health-related quality of life in older adults. Study design: Double-blind, randomised, placebo-controlled, crossover study. Participants: Forty-one community-dwelling men and women aged ≥70 years with low-density lipoprotein-cholesterol (LDL-C) ≥3.62 mmol/L (140 mg/dl) participated. Methods: Subjects received pravastatin for 6 months then pravastatin plus tocopherol for an additional 6 months (group 1), or tocopherol for 6 months then pravastatin plus tocopherol for an additional 6 months (group 2). Dosages were pravastatin 20mg daily and tocopherol 400IU daily. Main outcome measures: The following health-related quality-of-life measures were assessed at baseline, after 6 months and after 1 year: health perception, depression, physical function, cognitive function and sleep behaviour. In addition, data on adverse effects and laboratory abnormalities were obtained. Results: Pravastatin reduced levels of total cholesterol (-21%, p < 0.001) and LDL-C (-29%, p < 0.001). Health-related quality-of-life scores, physical adverse effects, muscle enzyme levels and liver function tests did not change after 12 months of therapy with pravastatin, tocopherol or their combination. Conclusion: Both pravastatin and tocopherol have a good safety profile, are well tolerated and do not adversely affect health-related quality of life in older patients with hypercholesterolaemia. Given the significant beneficial cardiovascular effects of statin therapy in older adults and the potential role of statins in prevention of Alzheimer's disease, concerns about adverse effects on quality of life should not deter use of these medications in this population.",alpha tocopherol;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;muscle enzyme;placebo;pravastatin;statin (protein);abdominal pain;aged;Alzheimer disease;appetite disorder;article;cardiovascular disease;cardiovascular risk;cholesterol blood level;clinical article;clinical trial;cognition;constipation;controlled clinical trial;controlled study;coughing;crossover procedure;depression;diarrhea;double blind procedure;drug efficacy;drug safety;dysphagia;enzyme blood level;fatigue;female;flu like syndrome;functional assessment;hair loss;headache;heart infarction;heartburn;human;hypercholesterolemia;jaundice;leg pain;liver function test;male;myalgia;nausea;priority journal;pruritus;quality of life;randomized controlled trial;rash;respiratory tract disease;sleep pattern;cerebrovascular accident;thorax pain;transient ischemic attack;vertigo;visual impairment;vomiting,"Carlsson, C. M.;Papcke-Benson, K.;Carnes, M.;McBride, P. E.;Stein, J. H.",2002,,,0,
673,"Physical activity, body functions and disability among middle-aged and older Spanish adults","BACKGROUND: Physical activity (PA) is a health determinant among middle-aged and older adults. In contrast, poor health is expected to have a negative impact on PA. This study sought to assess to what extent specific International Classification of Functioning, Disability and Health (ICF) health components were associated with PA among older adults. METHODS: We used a sample of 864 persons aged >/=50 years, positively screened for disability or cognition in a cross-sectional community survey in Spain. Weekly energy expenditure during PA was measured with the Yale Physical Activity Survey (YPAS) scale. The associations between body function impairment, health conditions or World Health Organization Disability Assessment Schedule (WHODAS 2.0) disability scores and energy expenditure were quantified using negative-binomial regression, and expressed in terms of adjusted mean ratios (aMRs). RESULTS: Mean energy expenditure was 4542 Kcal/week. A lower weekly energy expenditure was associated with: severe/extreme impairment of mental functions, aMR 0.38, 95% confidence interval, CI (0.21-0.68), and neuromusculoskeletal and movement functions, aMR 0.50 (0.35-0.72); WHODAS 2.0 disability, aMR 0.55 (0.34-0.91); dementia, aMR 0.45 (0.31-0.66); and heart failure, aMR 0.54 (0.34-0.87). In contrast, people with arthritis/osteoarthritis had a higher energy expenditure, aMR 1.27 (1.07-1.51). CONCLUSION: Our results suggest that there is a strong relationship between selected body function impairments, mainly mental, and PA. Although more research is needed to fully understand causal relationships, strategies to improve PA among the elderly may require targeting mental, neuromusculoskeletal and movement functions, disability determinants (including barriers), and specific approaches for persons with dementia or heart failure.","Disability evaluation;International classification of functioning, disability and health;Middle-aged and older adults;Physical activity","Caron, A.;Ayala, A.;Damian, J.;Rodriguez-Blazquez, C.;Almazan, J.;Castellote, J. M.;Comin, M.;Forjaz, M. J.;de Pedro, J.;group, Discap-Aragon research",2017,Jul 18,,0,
674,Late and early onset dementia: what is the role of vascular factors? A retrospective study,"BACKGROUND: Neuropathology of Alzheimer's disease (AD) demonstrates that the common occurrence of vascular lesions and vascular factors is suggested to contribute significantly to the clinical progression of the disease. This study has assessed the presence of vascular brain lesions and risk factors in subjects with diagnosis of AD and their influence on the disease course both in Late Onset Dementia (LOD) and in Early Onset Dementia (EOD). METHODS: MRI scans of 374 LOD and of 67 EOD patients were evaluated for the presence of vascular associated lesions and rated according to the age-related white matter changes (ARWMC) scale as ""pure degenerative"", ""mixed"" and ""vascular"" cases of dementia. Vascular risk factors burden (hypertension, diabetes, dyslipidemia, myocardial infarction) and disease progression were also assessed. RESULTS: 44% of LOD cases and 46% of EOD were classified as ""mixed dementia cases"". The vascular risk factors burden showed an increase from the pure degenerative to the pure vascular forms. Disease progression, calculated in two years using the Mini Mental State Evaluation (MMSE), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores, did not reveal differences among the three different classes of dementias. CONCLUSIONS: Vascular lesions are found in the majority of LOD cases and in about one half of EOD. This observation is consistent with the hypothesis of a synergistic effect of the degenerative and vascular factors on the development of cognitive dysfunction. The linear increase of the vascular burden supports the idea of a continuum spectrum between the pure degenerative and the pure vascular forms of adult-onset dementia disorders.","Activities of Daily Living;Age of Onset;Aged;Aged, 80 and over;Analysis of Variance;Brain/*pathology;Cerebrovascular Disorders/diagnosis/*epidemiology;Dementia/classification/*diagnosis/*epidemiology/psychology;Disease Progression;Female;Humans;Male;Mental Status Schedule;Retrospective Studies;Risk Factors;Time Factors","Carotenuto, A.;Rea, R.;Colucci, L.;Ziello, A. R.;Molino, I.;Carpi, S.;Traini, E.;Amenta, F.;Fasanaro, A. M.",2012,Nov 15,10.1016/j.jns.2012.07.066,0,
675,The Effect of the Association between Donepezil and Choline Alphoscerate on Behavioral Disturbances in Alzheimer's Disease: Interim Results of the ASCOMALVA Trial,"Background: Behavioral and psychological symptoms of dementia (BPSD) are a group of psychological reactions, psychiatric symptoms, and behaviors commonly found in Alzheimer's disease (AD). Four clusters of BPSD have been described: mood disorders (depression, anxiety, and apathy), psychotic symptoms (delusions and hallucinations), aberrant motor behaviors (pacing, wandering, and other purposeless behaviors), and inappropriate behaviors (agitation, disinhibition, and euphoria). Most of them are attributed to acetylcholine deficiency. Objective: To evaluate if a higher amount of acetylcholine obtained by associating donepezil and choline alphoscerate might have a favorable effect on BPSD. Methods: BPSD were measured at baseline and after 24 months in 113 mild/moderate AD patients, included in the double-blind randomized trial ASCOMALVA, by the Neuropsychiatric Inventory (NPI). Two matched groups were compared: group A treated with donepezil (10mg/day) plus choline alphoscerate (1200mg/day), and group B treated with donepezil (10mg/day) plus placebo. Results: Data of NPI revealed a significant decrease of BPSD severity and distress of the caregiver in patients of group A compared with group B. Mood disorders (depression, anxiety and apathy) were significantly decreased in subjects treated with donepezil and choline alphoscerate, while their severity and frequency was increased in the other group. Conclusions: Patients treated with donepezil plus choline alphoscerate showed a lower level of behavioral disturbances than subjects treated with donepezil only, suggesting that the association can have beneficial effects.",acetylcholine;choline alfoscerate;citalopram;donepezil;duloxetine;lorazepam;prazepam;quetiapine;risperidone;aged;Alzheimer disease;anxiety;apathy;article;behavior disorder;behavioral and psychological symptom of dementia;brain ischemia;cerebrovascular disease;comparative study;controlled study;dementia;depression;diabetes mellitus;disease severity;distress syndrome;drug effect;family history;female;human;hypercholesterolemia;hyperhomocysteinemia;hypertension;hypertriglyceridemia;irritability;ischemic heart disease;major clinical study;male;Mini Mental State Examination;neuropsychiatric inventory;obesity;priority journal;randomized controlled trial;smoking;transient ischemic attack,"Carotenuto, A.;Rea, R.;Traini, E.;Fasanaro, A. M.;Ricci, G.;Manzo, V.;Amenta, F.",2017,,10.3233/jad-160675,0,
676,Association between type-2 diabetes mellitus and post-discharge outcomes in heart failure patients: findings from the RICA registry,"AIMS: Heart failure (HF) and diabetes are common clinical conditions that may coexist. The main objective was to analyze the association of type-2 diabetes mellitus (T2DM) on prognosis in hospitalized patients with HF. METHODS: We evaluated the association between T2DM with all-cause mortality and readmissions in the Spanish National Registry on Heart Failure-""Registro Nacional de Insuficiencia Cardiaca"" (RICA). This is a multi-center and prospective cohort study that includes patients admitted for decompensated HF from 2008 to 2011. Study endpoints were all-cause mortality and hospital readmission. We determined the adjusted hazard ratio (HR) by a multivariable Cox regression model. RESULTS: A total of 1082 patients (mean age 77.6+/-8.5) were included of whom 490 (45.3%) had diabetes and 592 patients (54.7%) had preserved left ventricular ejection fraction (LVEF). During one-year follow-up, 287 patients died (151 patients with diabetes) and 383 patients were readmitted (197 patients with diabetes). After adjusting for baseline characteristics T2DM was significantly associated with all-cause mortality (HR 1.54; 95%CI 1.20-1.97, p=0.001) and readmissions (HR 1.46; 95%CI 1.18-1.80, p<0.001). Age, dementia, peripheral vascular disease, NYHA class, renal insufficiency, hyponatremia and anemia were also independently associated with outcomes. There were no differences in mortality (p=0.415) and readmissions (p=0.514) according to preserved or reduced LVEF. CONCLUSION: T2DM is very common in patients hospitalized for HF. This condition is a strong and independent co-morbidity of all-cause mortality and readmission for both HF with preserved and reduced LVEF.","Aged;Anemia/*epidemiology/mortality;Comorbidity;Diabetes Mellitus, Type 2/*physiopathology;Female;Follow-Up Studies;Heart Failure/*mortality/pathology;Hospitalization/*statistics & numerical data;Humans;Incidence;Male;Patient Discharge/*statistics & numerical data;Prognosis;Prospective Studies;Registries;Risk Factors;Spain/epidemiology;Stroke Volume/physiology;Survival Rate;Ventricular Function, Left/*physiology;Diabetes;Heart failure;Mortality","Carrasco-Sanchez, F. J.;Gomez-Huelgas, R.;Formiga, F.;Conde-Martel, A.;Trullas, J. C.;Bettencourt, P.;Arevalo-Lorido, J. C.;Perez-Barquero, M. M.",2014,Jun,10.1016/j.diabres.2014.03.015,0,
677,Mortality in the mentally handicapped: A 50 year survey at the Stoke Park group of hospitals (1930-1980),"Mortality trends during the past 50 years in the population of a hospital group for the mentally handicapped are reported. There has been a marked change in the causes of death during this period. Whilst tuberculosis is no longer a major cause, other terminal respiratory tract infections are still prevalent. Deaths due to status epilepticus have decreased, with a concomitant increase in those due to carcinoma, myocardial infarction and cerebrovascular accident. Similarly, the mortality rate has altered significantly. Fifty years ago the patients' mortality was considerably higher at all age groups in comparison with the general population, whereas the difference is now relatively small. These changes have been most marked during the past 25 years, with the introduction of new drug therapy, better diet, care and environment for the mentally handicapped. The result of this is increased longevity in the mentally handicapped, in particular in those with Down's syndrome whose longevity has increased by 40 years, and over 30 years in others. These findings have important implications for the planning of future services for the ageing mentally handicapped population, in hospital and in the community alike, with associated geriatric ailments, and pre-senile and senile dementias.",aged;central nervous system;clinical article;dementia;Down syndrome;epidemiology;human;mental deficiency;mortality,"Carter, G.;Jancar, J.",1983,,,0,
678,The impact of psychiatric comorbidities on the length of hospital stay in patients with heart failure,"BACKGROUND: Heart failure (HF) is a major healthcare problem contributing significantly to hospital admission stays and National Health Service (NHS) spending. Reducing length of hospital stay (LoS) in HF is paramount in reducing this burden and is influenced by factors relating to the condition, sociodemographics and comorbidities. Psychiatric comorbidities are being increasingly identified amongst HF patients but their impact on LoS has not been studied in the UK. METHODS: We investigated the impact of psychiatric comorbidities on LoS amongst 31,760 HF patients admitted to hospitals in North England between 1st January 2000 and 31st March 2013 from the ACALM (Algorithm for Comorbidities, Associations, Length of stay and Mortality) study. The ACALM protocol uses ICD-10 and OPCS-4 coding to trace HF patients, psychiatric comorbidities and demographics including LoS. RESULTS: Amongst 31,760 HF patients mean LoS in the absence of psychiatric comorbidities was 11.2days. The presence of a psychiatric comorbidity increased LoS by 3.3days. Logistic regression accounting for age, gender and ethnicity showed that LoS was significantly longer in patients suffering from depression (3.4days, p<0.001), bipolar disorder (8.8days, p<0.001) and all types of dementia (4.2days, p<0.001). CONCLUSIONS: Our results demonstrate that psychiatric comorbidities have a significant and clinically important impact on LoS in HF patients in the UK. Clinicians should be actively aware of psychiatric conditions amongst HF patients and manage them to reduce LoS and ultimately the risk for patients and financial burden for the NHS.",Heart failure;Length of hospital stay;Psychiatric comorbidities,"Carter, P.;Reynolds, J.;Carter, A.;Potluri, S.;Uppal, H.;Chandran, S.;Potluri, R.",2016,Mar 15,10.1016/j.ijcard.2016.01.132,0,
679,Lower Serum 25-Hydroxyvitamin D Is Associated with Obesity but Not Common Chronic Conditions: An Observational Study of African American and Caucasian Male Veterans,"OBJECTIVE: The study examined whether vitamin D insufficiency is a predictor of prevalent and/or incident common chronic conditions in African American men (AAM) and Caucasian American men (CAM). METHODS: A total of 1,017 men were recruited at an urban VA medical center and followed prospectively for a mean of 5.4 years. Prevalent and incident chronic conditions evaluated were: obesity, type 2 diabetes, cancer, depression, dementia, and cardiovascular disease (CVD, including coronary artery disease [CAD], cerebrovascular accident [CVA], and congestive heart failure [CHF]). Univariate and multivariate regressions were performed to examine the association between 25-hydroxyvitamin D (25[OH]D) and these chronic illnesses. RESULTS: This analysis was limited to 955 men (65.5% AAM, 27.2% CAM, 6.4% Hispanic) who had at least 1 year of follow-up (range, 1.0 to 7.1 years). Univariate analysis of the entire group showed that 25(OH)D correlated negatively with body mass index (BMI). There was no correlation between 25(OH)D and prevalent CVD (including separate analyses for CAD, CVA, and CHF), cancer, depression, dementia, all-cause mortality, or incident cancer, CAD, or CVA. Independent predictors of prevalent common conditions included increasing age, BMI, smoking, alcohol and polysubstance use, but not 25(OH)D levels. CONCLUSION: The study does not support previously suggested associations of low vitamin D levels with prevalent common chronic conditions or increased risk for cancer, CAD, and CVA in a population of men with high burden of chronic disease. The finding that smoking and alcohol and polysubstance use are predictors of chronic conditions is an important reminder for addressing these risks during patient encounters. ABBREVIATIONS: AAM = African American men BMI = body mass index CAD = coronary artery disease CAM = Caucasian American men CHF = congestive heart failure CI = confidence interval CVA = cerebrovascular accident CVD = cardiovascular disease HTN = hypertension OR = odds ratio T2DM = type 2 diabetes mellitus VAMC = Veteran Administration Medical Center 25(OH)D = 25-hydroxyvitamin D.","0 (Hydroxycholecalciferols);Adult;African Continental Ancestry Group/statistics & numerical data;Aged;Body Mass Index;Cardiovascular Diseases/epidemiology;Chronic Disease;Diabetes Mellitus, Type 2/epidemiology;European Continental Ancestry Group/statistics & numerical data;Follow-Up Studies;Humans;Hydroxycholecalciferols/ blood;Male;Middle Aged;Neoplasms/epidemiology;Nutritional Status;Obesity/ blood/ epidemiology;Prospective Studies;United States/epidemiology;United States Department of Veterans Affairs;Veterans/ statistics & numerical data","Cartier, J. L.;Kukreja, S. C.;Barengolts, E.",2017,Mar,,0,
680,Specific cyclooxygenase-2 inhibitor analgesics: therapeutic advances.,"BACKGROUND AND OBJECTIVES: Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are among the most widely prescribed drugs, including for Anesthesiology. This review aimed at discussing some current cycloxygenase biochemical aspects, which have provided the basis for the development of new analgesic and anti-inflammatory drugs. CONTENTS: These drugs primarily act by inhibiting cycloxygenase (COX), which is the key-enzyme catalyzing the conversion of arachidonic acid into prostaglandins and thromboxane. At least two COX isoforms have already been identified: COX-1, which is constitutively expressed in most tissues, and the inducible enzyme COX-2, which is primarily found in inflammatory cells and tissues. The discovery of COX-2 has enabled the development of more selective drugs to decrease inflammation without affecting COX-1 that protects stomach and kidneys and giving origin to a new generation of anti-inflammatory compounds called specific COX-2 inhibitors. CONCLUSIONS: Although there is significantly lower gastrointestinal toxicity in patients treated with selective COX-2 inhibitors, other severe adverse effects have been observed, including renal failure and cardiovascular effects, such as myocardial infarction acute and thrombosis. Despite these potential side effects, these new drugs are being tested in different clinical conditions, especially in cancer prevention and Alzheimer's disease.",,"Carvalho, W. A.;Carvalho, R. D.;Rios-Santos, F.",2004,Jun,,0,
681,System of renewal of driving licences for elderly people needs overhauling 3,,aged;dementia;disability;driver licence;driving ability;heart infarction;letter;practice guideline;priority journal;reaction time;spatial orientation;United Kingdom;visual acuity,"Carvel, D.",2002,,,0,
682,The immune protective effect of the mediterranean diet against chronic low-grade inflammatory diseases,"Dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, poor in natural antioxidants and fiber from fruits, vegetables, and whole grains, and poor in omega-3 fatty acids may cause an activation of the innate immune system, most likely by excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines. The Mediterranean Diet (MedDiet) is a nutritional model inspired by the traditional dietary pattern of some of the countries of the Mediterranean basin. This dietary pattern is characterized by the abundant consumption of olive oil, high consumption of plant foods (fruits, vegetables, pulses, cereals, nuts and seeds); frequent and moderate intake of wine (mainly with meals); moderate consumption of fish, seafood, yogurt, cheese, poultry and eggs; and low consumption of red meat, processed meat products and seeds. Several epidemiological studies have evaluated the effects of a Mediterranean pattern as protective against several diseases associated with chronic low-grade inflammation such as cancer, diabetes, obesity, atherosclerosis, metabolic syndrome and cognition disorders. The adoption of this dietary pattern could counter the effects of several inflammatory markers, decreasing, for example, the secretion of circulating and cellular biomarkers involved in the atherosclerotic process. Thus, the aim of this review was to consider the current evidence about the effectiveness of the MedDiet in these chronic inflammatory diseases due to its antioxidant and anti-inflammatory properties, which may not only act on classical risk factors but also on inflammatory biomarkers such as adhesion molecules, cytokines or molecules related to the stability of atheromatic plaque.",adiponectin;alpha4 integrin;C reactive protein;CD11b antigen;CD40 antigen;cell adhesion molecule;cyclooxygenase 2;endothelial leukocyte adhesion molecule 1;gelatinase B;intercellular adhesion molecule 1;interleukin 1;interleukin 10;interleukin 18;interleukin 6;interleukin 7;low density lipoprotein;lymphocyte function associated antigen 1;monocyte chemotactic protein 1;monounsaturated fatty acid;olive oil;omega 3 fatty acid;PADGEM protein;saturated fatty acid;tissue inhibitor of metalloproteinase 1;transforming growth factor beta1;tumor necrosis factor alpha;tumor necrosis factor receptor;unindexed drug;vascular cell adhesion molecule 1;very late activation antigen 4;Alzheimer disease;antiinflammatory activity;article;breast cancer;cancer mortality;carotid atherosclerosis;chronic inflammation;cognitive defect;colorectal cancer;cytokine production;dietary intake;disease association;endothelial dysfunction;human;immunomodulation;innate immunity;ischemic heart disease;macrophage activation;Mediterranean diet;meta analysis (topic);metabolic syndrome X;mild cognitive impairment;monocyte;multiinfarct dementia;non insulin dependent diabetes mellitus;obesity;oxidative stress;Parkinson disease;prostate cancer;protein expression;protein synthesis regulation;randomized controlled trial (topic),"Casas, R.;Sacanella, E.;Estruch, R.",2014,,,0,
683,Association between bullous pemphigoid and neurologic diseases: A case-control study,"Introduction In the past 10 years, bullous pemphigoid has been associated with other comorbidities and neurologic and psychiatric conditions in particular. Case series, small case-control studies, and large population-based studies in different Asian populations, mainland Europe, and the United Kingdom have confirmed this association. However, no data are available for the Spanish population. Material and methods This was an observational, retrospective, case-control study with 1:2 matching. Fifty-four patients with bullous pemphigoid were selected. We compared the percentage of patients in each group with concurrent neurologic conditions, ischemic heart disease, diabetes, chronic obstructive pulmonary disease, and solid tumors using univariate logistic regression. An association model was constructed with conditional multiple logistic regression. Results The case group had a significantly higher percentage of patients with cerebrovascular accident and/or transient ischemic attack (odds ratio [OR], 3.06; 95% CI, 1.19-7.87], dementia (OR, 5.52; 95% CI, 2.19-13.93), and Parkinson disease (OR, 5; 95% CI, 1.57-15.94). A significantly higher percentage of cases had neurologic conditions (OR, 6.34; 95% CI, 2.89-13.91). Dementia and Parkinson disease were independently associated with bullous pemphigoid in the multivariate analysis. Conclusions Patients with bullous pemphigoid have a higher frequency of neurologic conditions.",article;bullous pemphigoid;case control study;cerebrovascular accident;chronic obstructive lung disease;controlled study;dementia;diabetes mellitus;disease association;human;ischemic heart disease;major clinical study;neurologic disease;observational study;Parkinson disease;retrospective study;solid tumor,"Casas-De-La-Asunción, E.;Ruano-Ruiz, J.;Rodríguez-Martín, A. M.;Vélez García-Nieto, A.;Moreno-Giménez, J. C.",2014,,,0,
684,Transthyretin suppresses the toxicity of oligomers formed by misfolded proteins in vitro,"Although human transthyretin (TTR) is associated with systemic amyloidoses, an anti-amyloidogenic effect that prevents Abeta fibril formation in vitro and in animal models has been observed. Here we studied the ability of three different types of TTR, namely human tetramers (hTTR), mouse tetramers (muTTR) and an engineered monomer of the human protein (M-TTR), to suppress the toxicity of oligomers formed by two different amyloidogenic peptides/proteins (HypF-N and Abeta42). muTTR is the most stable homotetramer, hTTR can dissociate into partially unfolded monomers, whereas M-TTR maintains a monomeric state. Preformed toxic HypF-N and Abeta42 oligomers were incubated in the presence of each TTR then added to cell culture media. hTTR, and to a greater extent M-TTR, were found to protect human neuroblastoma cells and rat primary neurons against oligomer-induced toxicity, whereas muTTR had no protective effect. The thioflavin T assay and site-directed labeling experiments using pyrene ruled out disaggregation and structural reorganization within the discrete oligomers following incubation with TTRs, while confocal microscopy, SDS-PAGE, and intrinsic fluorescence measurements indicated tight binding between oligomers and hTTR, particularly M-TTR. Moreover, atomic force microscopy (AFM), light scattering and turbidimetry analyses indicated that larger assemblies of oligomers are formed in the presence of M-TTR and, to a lesser extent, with hTTR. Overall, the data suggest a generic capacity of TTR to efficiently neutralize the toxicity of oligomers formed by misfolded proteins and reveal that such neutralization occurs through a mechanism of TTR-mediated assembly of protein oligomers into larger species, with an efficiency that correlates inversely with TTR tetramer stability.","Amyloid beta-Peptides/*adverse effects;Amyloidogenic Proteins/*adverse effects;Animals;Calcium/metabolism;Carboxyl and Carbamoyl Transferases/*adverse effects;Cells, Cultured;Escherichia coli Proteins/*adverse effects;Humans;In Vitro Techniques;Mice;Microscopy, Atomic Force;Models, Molecular;Neuroblastoma/*drug therapy/metabolism/pathology;Neurons/*drug effects/metabolism/pathology;Prealbumin/*pharmacology;Protein Conformation;Protein Folding/*drug effects;Protein Multimerization;Rats;2',7'-dichlorodihydrofluorescein diacetate;3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide;Ad;Alzheimer's disease;Abeta;Bsa;Cm-h(2)dcfda;Csf;D-pbs;Dmso;Dtt;Dulbecco's phosphate-buffered saline;Ed;Fac;Fbs;HypF-N;Mtt;Molecular chaperone;N-terminal domain of the HypF protein from Escherichia coli;Nbm;Pmsf;Psd-95;Rbp;Sds-page;Ssa;T4;Ttr;TTR protective effect;TTR-mediated oligomer clustering;ThT;amyloid-beta peptide;bovine serum albumin;cerebrospinal fluid;dimethylsulfoxide;dithiothreitol;embryonic day;familial amyloid cardiomyopathy;fetal bovine serum;neurobasal medium;phenylmethylsulfonyl fluoride;postsynaptic density protein 95;retinol binding protein charged with retinol;senile systemic amyloidosis;sodium dodecylsulfate polyacrylamide gel electrophoresis;thioflavin T;thyroxine;transthyretin","Cascella, R.;Conti, S.;Mannini, B.;Li, X.;Buxbaum, J. N.;Tiribilli, B.;Chiti, F.;Cecchi, C.",2013,Dec,10.1016/j.bbadis.2013.09.011,0,
685,Transforming the delivery of health and social care: The case for fundamental change,,birth;death;dementia;diabetes mellitus;health care delivery;heart failure;human;letter;maternal care;social care,"Casey, D.",2013,,,0,
686,Total cholesterol and mortality in the elderly,"Objective. To evaluate, at a population level, whether total cholesterol (TC) is a risk factor of mortality. To verify whether or not this is true for both genders: Design. Population-based, long-lasting, prospective study. Setting. Institutional epidemiology in primary care. Subjects. A total of 3257 subjects aged 65-95 years, recruited from Italian general population. Intervention. None. Main outcome measures. Total cholesterol was measured, analysed as a continuous variable and then divided into quintiles and re-analysed. For each quintile, the multivariate relative risk (RR) of mortality adjusted for confounders was calculated in both genders. Stratification of mortality risk by TC quintiles, body mass index and cigarette smoking was also performed in both genders. Results. Total cholesterol levels directly predicted coronary mortality in men [RR being in the fifth rather than in the first quintile: 2.40 (1.40-4.14)] and any other mortality in women. It also inversely predicted miscellaneous mortality in both genders. This trend was more evident when low cholesterol was associated with malnutrition or smoking. Conclusions. High TC remains a strong risk factor for coronary mortality in elderly men. On the other hand, having a very low cholesterol level does not prolong survival in the elderly; on the contrary, low cholesterol predicts neoplastic mortality in women and any other noncardiovascular mortality in both genders.",cholesterol;accident;aged;article;body mass;neoplasm;cholesterol blood level;smoking;clinical trial;coronary risk;dementia;enteropathy;female;heart failure;hemorrhagic shock;homicide;human;infection;ischemic heart disease;Italy;kidney disease;liver cirrhosis;lung embolism;major clinical study;male;malnutrition;mathematical computing;mortality;multivariate analysis;Parkinson disease;priority journal;respiratory tract disease;risk factor;sex difference;cerebrovascular accident;suicide;survival rate,"Casiglia, E.;Mazza, A.;Tikhonoff, V.;Scarpa, R.;Schiavon, L.;Pessina, A. C.",2003,,,0,
687,Adult genetic risk screening,"Recent advances in genetic analysis especially DNA sequencing technology open a new strategy for adult disease prevention by genetic screening. Physicians presently treat disease pathology with less emphasis on disease risk prevention-reduction. Genetic screening has reduced the incidence of untreatable childhood genetic diseases and improved the care of newborns. The opportunity exists to expand screening programs and reduce the incidence of adult onset diseases via genetic risk identification and disease intervention. This article outlines the approach, challenges, and benefits of such screening for adult genetic disease risks. © 2014 by Annual Reviews. All rights reserved.",ATM protein;BRCA1 protein;BRCA2 protein;checkpoint kinase 2;epidermal growth factor receptor 2;fizzy related protein;protein;protein kinase LKB1;protein p53;Rad50 protein;Rad51 protein;unclassified drug;xrcc2 protein;XRCC3 protein;adult;Alzheimer disease;aneurysm;article;ataxia;bioinformatics;brain ischemia;breast cancer;cancer risk;cardiomyopathy;cardiovascular disease;colon cancer;DNA sequence;electronic medical record;familial hypercholesterolemia;frontotemporal dementia;gene mutation;genetic disorder;genetic risk;genetic screening;human;Huntington chorea;interpersonal communication;Marfan syndrome;medical care;medical history;non insulin dependent diabetes mellitus;obesity;ovary cancer;pancreas cancer;Parkinson disease;pedigree;priority journal,"Caskey, C. T.;Gonzalez-Garay, M. L.;Pereira, S.;McGuire, A. L.",2014,,,0,
688,Cause of death in patients with chronic visceral and chronic neurovisceral acid sphingomyelinase deficiency (Niemann-Pick disease type B and B variant): Literature review and report of new cases,"Background: Acid sphingomyelinase deficiency (ASMD), [Niemann-Pick Disease Types A and B (NPD A and B)], is an inherited metabolic disorder resulting from deficiency of the lysosomal enzyme acid sphingomyelinase. Accumulation of sphingomyelin in hepatocytes, reticuloendothelial cells, and in some cases neurons, results in a progressive multisystem disease that encompasses a broad clinical spectrum of neurological and visceral involvement, including: infantile neurovisceral ASMD (NPD A) that is uniformly fatal by 3 years of age; chronic neurovisceral ASMD (intermediate NPD A/B; NPD B variant) that has later symptom onset and slower neurological and visceral disease progression; and chronic visceral ASMD (NPD B) that lacks neurological symptoms but has significant disease-related morbidities in multiple organ systems. The purpose of this study was to characterize disease-related morbidities and causes of death in patients with the chronic visceral and chronic neurovisceral forms of ASMD. Methods: Data for 85 patients who had died or received liver transplant were collected by treating physicians (n = 27), or abstracted from previously published case studies (n = 58). Ages at symptom onset, diagnosis, and death; cause of death; organ involvement, and morbidity were analyzed. Results: Common disease-related morbidities included splenomegaly (96.6%), hepatomegaly (91.4%), liver dysfunction (82.6%), and pulmonary disease (75.0%). The overall leading causes of death were respiratory failure and liver failure (27.7% each) irrespective of age. For patients with chronic neurovisceral ASMD (31.8%), progression of neurodegenerative disease was a leading cause of death along with respiratory disease (both 23.1%) and liver disease (19.2%). Patients with chronic neurovisceral disease died at younger ages than those with chronic visceral disease (median age at death 8 vs. 23.5 years). Conclusions: The analysis emphasizes that treatment goals for patients with chronic visceral and chronic neurovisceral ASMD should include reducing splenomegaly and improving liver function and respiratory status, with the ultimate goal of decreasing serious morbidity and mortality.",adolescent;adult;anemia;article;ataxia;bleeding;cancer mortality;cause of death;chondrosarcoma;controlled study;degenerative disease;dementia;enzyme assay;female;genotype;heart failure;hepatomegaly;human;interstitial lung disease;liver cancer;liver cirrhosis;liver disease;liver dysfunction;liver failure;liver transplantation;lung disease;lung embolism;major clinical study;male;morbidity;multiple myeloma;multiple organ failure;neurologic disease;Niemann Pick disease;phenotype;physician;pneumonia;postoperative hemorrhage;priority journal;psychomotor retardation;respiratory failure;respiratory tract disease;spasticity;splenomegaly;subdural hematoma;thrombocytopenia;time of death;varicosis;young adult,"Cassiman, D.;Packman, S.;Bembi, B.;Turkia, H. B.;Al-Sayed, M.;Schiff, M.;Imrie, J.;Mabe, P.;Takahashi, T.;Mengel, K. E.;Giugliani, R.;Cox, G. F.",2016,,,0,
689,Old and new applications of non-anticoagulant heparin,"The aim of this chapter is to provide an overview of non-anticoagulant effects of heparins and their potential use in new therapeutic applications. Heparin and heparin derivatives have been tested in inflammatory, pulmonary and reproductive diseases, in cardiovascular, nephro- and neuro-tissue protection and repair, but also as agents against angiogenesis, atheroschlerosis, metastasis, protozoa and viruses. Targeting and inhibition of specific mediators involved in the inflammatory process, promoting some of the above mentioned pathologies, are reported along with recent studies of heparin conjugates and oral delivery systems. Some reports from the institute of the authors, such as those devoted to glycol-split heparins are also included. Among the members and derivatives of this class, several are undergoing clinical trials as antimetastatic and antimalarial agents and for the treatment of labour pain and severe hereditary anaemia. Other heparins, whose therapeutic targets are non-anticoagulant such as nephropathies, retinopathies and cystic fibrosis are also under investigation.",dalteparin;dfx 232;enoxaparin;fondaparinux;glycosaminoglycan polysulfate;heparanase;heparin;ivx 0142;low molecular weight heparin;nadroparin;necuparanib;neuroparin;oligosaccharide;org 31733;roneparstat;sevuparin;sr 80258;st 1514;sulodexide;unclassified drug;vasoflux;acute heart infarction;adult respiratory distress syndrome;allergic encephalomyelitis;allergic rhinitis;Alzheimer disease;amyloidosis;anemia;antiinflammatory activity;antineoplastic activity;antiphospholipid syndrome;article;asthma;atherosclerosis;atrial fibrillation;autoimmune disease;blood vessel occlusion;bone development;bronchospasm;chronic obstructive lung disease;cystic fibrosis;diabetic nephropathy;drug conjugation;drug delivery system;emphysema;enzyme inhibition;experimental amyloidosis;glomerulonephritis;heart disease;heart protection;human;hyperlipidemia;inflammatory bowel disease;iron restricted anemia;myeloma;neuroprotection;pancreas cancer;Parkinson disease;periodontal disease;prion disease;priority journal;rheumatoid arthritis;sarcoma;sepsis;sulfation;tissue repair;ulcerative colitis;virus inhibition;wound healing;df 01;lh 17;m 402;sst 0001,"Cassinelli, G.;Naggi, A.",2016,,,0,
690,"Hypertension in the very old: To treat or not to treat?, that is not yet the question",,aged;cerebrovascular accident;clinical practice;dementia;geriatric care;heart failure;human;hypertension;letter;mortality;very elderly,"Castilla Guerra, L.;Fernández Moreno, M. D. C.;Álvarez Suero, J.;Martín Pérez, E.",2009,,,0,
691,Excitation properties of the right cervical vagus nerve in adult dogs,"Vagus nerve stimulation (VNS) is an approved treatment for epilepsy and depression, and it is currently under investigation for applications in Alzheimer's disease, anxiety, heart failure, and obesity. However, the mechanism(s) by which VNS has its effects are not clear, and the stimulation parameters for obtaining therapeutic outcomes appear highly variable. The purpose of this study was to quantify the excitation properties of the right cervical vagus nerve in adult dogs anesthetized with propofol and fentanyl. Input-output curves of the right cervical vagus nerve compound action potential and laryngeal muscle electromyogram were measured in response to VNS across a range of stimulation parameters: amplitudes of 0.02-50mA, pulsewidths of 10, 50, 100, 200, 300, 500, and 1,000mus, frequencies of 1-2Hz, and train lengths of 20 pulses with 3 different electrode configurations: monopolar cathode, proximal anode/distal cathode, and proximal cathode/distal anode. Electrode configuration and stimulation waveform (monophasic vs. asymmetric charge-balanced biphasic) did not affect the threshold or recruitment of the vagal nerve fibers that were activated. The rheobase currents of A- and B-fibers were 0.4mA and 0.7mA, respectively, and the chronaxie of both components was 180mus. Pulsewidth had little effect on the normalized threshold difference between activation of A- and B-fibers. The results provide insight into the complement of nerve fibers activated by VNS and guidance to clinicians for the selection of optimal stimulation parameters.",Action Potentials/*physiology;Analysis of Variance;Animals;Biophysics/methods;Dogs;Electric Stimulation;Electrodes;Electromyography;Female;Functional Laterality/*physiology;Laryngeal Muscles/innervation;Male;Nerve Fibers/physiology;Vagus Nerve/cytology/*physiology,"Castoro, M. A.;Yoo, P. B.;Hincapie, J. G.;Hamann, J. J.;Ruble, S. B.;Wolf, P. D.;Grill, W. M.",2011,Jan,10.1016/j.expneurol.2010.09.011,0,
692,"Burden of disease assessment with summary measures of population health for the Region of Valencia, Spain: A population-based study","Background and objective: An important input to decision-making and health planning is a consistent and comparative description of the population health status. The purpose of this study was to describe the burden of disease in the Region of Valencia (Spain). Material and methods: Disability-adjusted life years (DALYs) were calculated and divided into years of life lost (YLLs) and years lived with disability (YLDs). Using death registry data and Valencian population estimates in 2008, we calculated the number of deaths and YLLs. YLDs were based on age- and sex-specific data for countries of the EURO-A subregional level (which includes the Region of Valencia) from the Global Burden of Disease study. The results were stratified by age group, sex and underlying cause of death. The DALY values were used to rank the leading conditions of disease burden. Results: In 2008, the total number of DALYs lost was about 551 thousands (53% in men). The main categories of DALYs lost were neuropsychiatric conditions (30%; 167 thousands), malignant tumors (15%; 85 thousands), cardiovascular diseases (13%; 72 thousands) and sense organ diseases (8%; 46 thousands). Depression (8% of DALYs; 47 thousands), dementias (8%; 42 thousands), ischaemic heart disease (5%; 27 thousands), hearing loss (4%; 22 thousands), stroke (4%; 20 thousands) and lung cancer (3%; 19 thousands) were the leading specific causes of disease burden. Conclusions: We provide for the first time ever information on the burden of disease in the Valencian population. At this local level, the use of DALYs can help to monitor the population health status and guide the debates on rational priority-setting. © 2012 Elsevier España, S.L. Todos los derechos reservados.",article;cause of death;cerebrovascular accident;chronic obstructive lung disease;clinical article;clinical assessment;colorectal cancer;dementia;depression;disability adjusted life year;disease classification;female;health status;hearing impairment;human;ischemic heart disease;lung cancer;major depression;male;mortality;population research;quality of life;Spain,"Catalá-López, F.;Gènova-Maleras, R.;Ridao, M.;Álvarez, E.;Sanfélix-Gimeno, G.;Morant, C.;Peiró, S.",2013,,,0,
693,The women's health initiative: Hormone therapy and calcium/vitamin D supplementation trials,"The Women's Health Initiative (WHI) was a large and complex study focused on strategies for the prevention and control of common chronic diseases of postmenopausal women. The WHI included 3 randomized controlled trials: the Hormone Therapy (HT) Trials, the Diet Modification Trial, and the Calcium/Vitamin D (CaD) Trial. Conjugated equine estrogen with or without a progestin significantly decreased hip, clinical vertebral, and all fractures. Once the intervention was stopped, the fracture benefit dissipated. However, estrogen plus progestin was associated with more risks than benefits and use of hormone therapy solely for the prevention of osteoporosis is not recommended. The CaD trial found no overall benefit for fracture reduction except in adherent women and women taking supplements for 5 or more years. Overall, the common practice of taking calcium and vitamin D supplementation with possible benefits on hip and positive evidence on bone mineral density and few risks is reasonable. © 2013 Springer Science+Business Media New York.",25 hydroxyvitamin D;bisphosphonic acid derivative;calcitonin;calcium;calcium carbonate;colecalciferol;conjugated estrogen;estrogen;estrogen plus gestagen;gestagen;hormone;medroxyprogesterone acetate;placebo;unclassified drug;vitamin D;age distribution;article;atherosclerosis;bleeding;body mass;bone density;breast cancer;cardiovascular mortality;cerebrovascular accident;chronic disease;climacterium;colorectal cancer;coronary risk;deep vein thrombosis;dementia;diabetes mellitus;diet supplementation;disease course;drug absorption;drug choice;drug contraindication;drug withdrawal;falling;family history;follow up;fragility fracture;global index;health hazard;heart infarction;hip fracture;hormonal therapy;human;ischemic heart disease;lung embolism;menopause;Black person;nephrolithiasis;obesity;osteoporosis;outcome assessment;patient attitude;patient compliance;postmenopause;rating scale;risk assessment;risk benefit analysis;risk factor;risk reduction;side effect;spine fracture;tablet;treatment duration;treatment outcome;tumor invasion;vitamin blood level;women's health;wrist fracture,"Cauley, J. A.",2013,,,0,
694,Therapeutic switching: A new strategic approach to enhance R&D productivity,"New chemical entity discovery and development is a long, expensive and risky way of producing new therapeutics. An alternative approach, namely finding new uses for existing drugs, offers substantial advantages in terms of cost, time and risk, and represents a highly attractive strategy to drug discovery. Patents protecting the new use may also be obtained. There are multiple different classes of such R&D programs, depending on whether the original development is still protected by composition of matter patents, and whether the compound was ever fully developed/marketed for its original indication. There are also shortened R&D programs for new uses for stereoisomers and metabolites of existing drugs. Case histories in all areas are presented. © The Thomson Corporation.",alendronic acid;amfebutamone;apomorphine;atomoxetine;carboplatin;cymbaltan;doxycycline;duloxetine;etodolac;fluoxetine;gabapentin;galantamine;glycopyrronium bromide;memantine;milnacipran;minoxidil;paclitaxel;paroxetine;raloxifene;ropinirole;sildenafil;tadalafil;thalidomide;tofisopam;topiramate;unclassified drug;Alzheimer disease;article;bacterial infection;breast cancer;cardiovascular disease;chronic obstructive lung disease;clinical trial;depression;drug indication;drug marketing;drug research;drug use;epilepsy;erectile dysfunction;face pain;fibromyalgia;heart failure;human;hypertension;insomnia;leprosy;male type alopecia;multiple myeloma;osteoporosis;paralysis;Parkinson disease;patent;periodontitis;poliomyelitis;side effect;wasting syndrome;evista;fosamax;namenda;nva 237;paraplatin;paxil;prozac;reminyl;sarafem;strattera;taxol;viagra;wellbutrin;yentreve;zyban,"Cavalla, D.",2005,,,0,
695,MtDNA mutations in maternally inherited diabetes: presence of the 3397 ND1 mutation previously associated with Alzheimer's and Parkinson's disease,"Mutations in the mitochondrial tRNA(leu) (UUR) gene have been associated with diabetes mellitus and deafness. We screened for the presence of mtDNA mutations in the tRNA(leu) (UUR) gene and adjacent ND1 sequences in 12 diabetes mellitus pedigrees with a possible maternal inheritance of the disease. One patient carried a G to A substitution at nt 3243 (tRNA(leu) (UUR) gene) in heteroplasmic state. In a second pedigree a patient had an A to G substitution at nt 3397 in the ND1 gene. All maternal relatives of the proband had the 3397 substitution in homoplasmic state. This substitution was not present in 246 nonsymptomatic Caucasian controls. The 3397 substitution changes a highly conserved methionine to a valine at aa 31 and has previously been found in Alzheimer's (AD) and Parkinson's (PD) disease patients. Substitutions in the mitochondrial ND1 gene at aa 30 and 31 have associated with a number of different diseases (e.g. AD/PD, MELAS, cardiomyopathy and diabetes mellitus, LHON, Wolfram-syndrome and maternal inherited diabetes) suggesting that changes at these two codons may be associated with very diverse pathogenic processes. In a further attempt to search for mtDNA mutations outside the tRNAleu gene associated with diabetes, the whole mtDNA genome sequence was determined for two patients with maternally inherited diabetes and deafness. Except for substitutions previously reported as polymorphisms, none of the two patients showed any non-synonymous substitutions either in homoplasmic or heteroplasmic state. These results imply that the maternal inherited diabetes and deafness in these patients must result from alterations of nuclear genes and/or environmental factors.","Alzheimer Disease/*genetics;*DNA, Mitochondrial;Diabetes Mellitus/*genetics;Female;Humans;Insect Proteins/*genetics;Male;Mothers;*Mutation;*NADH Dehydrogenase;Parkinson Disease/*genetics;Pedigree;RNA, Transfer, Leu/metabolism","Cavelier, L.;Erikson, I.;Tammi, M.;Jalonen, P.;Lindholm, E.;Jazin, E.;Smith, P.;Luthman, H.;Gyllensten, U.",2001,,,0,
696,"Coffee: A beverage rich in substances with important clinical effects, especially caffeine","Coffee is one of the most popular beverages in the world, with an approximate consumption of 6.7 million tons per year. Some of the physiological effects of a variety of substances found in the beverage are being widely studied. Some research highlights caffeine as a substance crucial to coffee’s biological effects. The aim of this study was to discern and highlight some of the relevant clinical effects of caffeine. To this end, we made a search for studies related to the clinical properties of coffee, which highlighted some of its main substances, and studies specifically about caffeine, which followed a clinical approach. The authors defined some positive and negative features of the clinical effects provoked by caffeine. Thus, the prospects of using caffeine, in food, as a medicine or in clinical parameter studies of type 2 diabetes, arrhythmia, cardiac arrest, nonfatal acute myocardial infarction, Parkinson and Alzheimer’s disease, were well discussed. In this context, it is very important to give responsible consideration to the use of caffeine, keeping in mind the vulnerability of the individual and the clinical manifestations of this substance.",caffeine;acute heart infarction;Alzheimer disease;article;clinical feature;coffee;heart arrest;heart arrhythmia;human;non insulin dependent diabetes mellitus;Parkinson disease;risk factor,"Cazarim, M. S.;Ueta, J.",2014,,,0,
697,Topical imiquimod in the treatment of large facial keratoacanthomas,,imiquimod;apoptosis;cell maturation;cream;dementia;facial keratoacanthoma;atrial fibrillation;heart infarction;innate immunity;keratoacanthoma;Langerhans cell;letter;lymphocyte proliferation;macrophage;natural killer cell;scar;treatment duration;tumor localization;tumor recurrence;tumor volume,"Cecchi, R.;Bartoli, L.;Brunetti, L.;Pavesi, M.",2012,,,0,
698,Cardiovascular and neurological function in elderly patients sustaining a fracture of the neck of the femur,"Cardiac and neurological functions were evaluated at the time of operation in 81 randomly selected elderly patients who had sustained a fracture of the neck of the femur. Although only one-fifth of the patients had clinical signs of senile dementia or cerebrovascular disease on admission to hospital, more than half had seriously abnormal EEGs including 12 of the 15 patients who died within six months. ECGs before operation showed that patients with signs of arrhythmia or previous myocardial infarction had a much lower survival rate than those with normal or other pathological ECG signs. Nerve conduction velocity findings proved inconclusive when correlated with survival or return home. Routine EEG and ECG examinations are of value in detecting underlying dysfunctions which may not be observable clinically on admission but are important prognostic indicators for survival or return home, and may be implicated as causative factors of fracture in the elderly.",aged;bone;cardiovascular system;central nervous system;diagnosis;electrocardiography;electroencephalography;femur neck fracture;heart;hip fracture;injury;joint;major clinical study;nerve conduction;nervous system,"Ceder, L.;Elmqvist, D.;Svensson, S. E.",1981,,,0,
699,Treatment of protein-energy malnutrition in chronic disorders in the elderly,"Protein-energy malnutrition (PEM) is a complication to chronic disease and is associated with increased morbidity and mortality. The causal connections between malnutrition and a poorer prognosis are complex. It cannot automatically be inferred that nutritional support will improve the clinical course of elderly patients with wasting disorders, such as chronic obstructive pulmonary disease, chronic heart failure, stroke, dementia and multiple disorders or after hip fracture. The execution of nutrition treatment studies in chronically ill patients is linked to several methodological problems, including no generally accepted definition of PEM, uncertain patient compliance with supplementation, and a wide range of outcome variables. However, treatment studies indicate that dietary supplements, either alone or in combination with hormonal treatment, may have positive effects. Nutritional therapy given to patients at nutritional risk in conjunction with chronic obstructive pulmonary disease may improve respiratory function. When administered to elderly patients with multiple disorders, diet therapy may improve their functional capacity and given to elderly women after hip fractures nutritional therapy may speed up the rehabilitation process. Nevertheless, there is still a great need for randomised, controlled long-term studies of the effects of nutritional intervention programs for the chronically ill and frail elderly with a focus on determining clinically relevant outcomes.",,"Cederholm, T.",2002,Sep,,0,
700,The medicare hospice benefit: A changing philosophy of care?,,abuse;Alzheimer disease;article;bladder cancer;breast cancer;chronic kidney disease;chronic liver disease;colorectal cancer;congestive heart failure;dementia;failure to thrive;fraud;government;heart disease;hematologic malignancy;hospice care;human;length of stay;liver cancer;lung cancer;medical history;medicare;oligophrenia;pancreas cancer;Parkinson disease;patient care;pneumonia;prostate cancer;respiratory tract disease;cerebrovascular accident,"Cefalu, C. A.;Ruiz, M.",2011,,,0,
701,Stercoral perforation of the rectosigmoid colon due to chronic constipation: A case report,"Introduction Chronic constipation is very common in elderly patients. As a result of this situation fecaloma is also frequently seen at these ages. However, the stercoral perforation caused by fecaloma is a rare situation to occur. The rectosigmoid colon is the most affected colonic segment. It is seen in older patients with concomitant diseases and a low quality of life. Presentation of case Here in this case, we have to report an 83 – year-old male patient who came to the emergency room with complaints of abdominal pain and constipation for two days. He had Type II Diabetes Mellitus, had a cardiac stent and also Alzheimer's disease. We diagnosed a rectosigmoid perforation due to a large fecaloma. This case presentation was prepared in accordance with the scare checklist guidelines (Agha et al., 2016 [1]). Discussion Constipation and faecal impaction are common entities, particularly in elderly and bedridden patients. Fecalomas are collections of dehydrated, hardened stool. They rarely can cause colonic ischemia and/or stercoral perforation. Stercoral perforation is the perforation or rupture of the intestine walls by a stercoraceous mass. Stercoral perforation is a very dangerous, life-threatening situation, as well as a surgical emergency, because the spillage of contaminated intestinal contents into the abdominal cavity leads to peritonitis, a rapid bacteremia with many complications. Conclusion Fecalomas can cause stercoral perforations. This situation can be confused with other causes of acuteabdomen in these patients. Early surgery can be life saving.",C reactive protein;enema;glucose;hemoglobin;imipenem;laxative;sodium ion;abdominal pain;abdominal tenderness;aged;Alzheimer disease;antibiotic prophylaxis;article;case report;chronic constipation;clinical article;colon perforation;computer assisted tomography;defecation;digital rectal examination;echocardiography;general anesthesia;heart ejection fraction;heart infarction;human;incision;laparotomy;left ventricular diastolic dysfunction;male;non insulin dependent diabetes mellitus;physical examination;pneumoperitoneum;priority journal;sigmoid;stercoral perforation;thorax radiography;very elderly,"Celayir, M. F.;Köksal, H. M.;Uludag, M.",2017,,10.1016/j.ijscr.2017.09.002,0,
702,Pitfalls of thrombolytic therapy for myocardial infarction,,plasminogen activator;recombinant protein;tissue plasminogen activator;article;brain hemorrhage;case report;chemically induced disorder;computer assisted tomography;dementia;diagnostic error;drug contraindication;fibrinolytic therapy;heart infarction;hematoma;human;male;middle aged;radiography,"Ceola, W. M.;Harik, S. I.",1998,,,0,
703,"Cardiovascular Diseases in ~30,000 Patients in the Swedish Dementia Registry","BACKGROUND: Cardiovascular diseases are leading causes of death and patients with dementia are often affected by them. OBJECTIVE: Investigate associations of cardiovascular diseases with different dementia disorders and determine their impact on mortality. METHODS: This study included 29,630 patients from the Swedish Dementia Registry (mean age 79 years, 59% women) diagnosed with Alzheimer's disease (AD), mixed dementia, vascular dementia, dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), frontotemporal dementia (FTD), or unspecified dementia. Records of cardiovascular diseases come from the Swedish National Patient Register. Multinomial logistic regression and cox proportional hazard models were applied. RESULTS: Compared to AD, we found a higher burden of all cardiovascular diseases in mixed and vascular dementia. Cerebrovascular diseases were more associated with DLB than with AD. Diabetes mellitus was less associated with PDD and DLB than with AD. Ischemic heart disease was less associated with PDD and FTD than AD. All cardiovascular diseases predicted death in patients with AD, mixed, and vascular dementia. Only ischemic heart disease significantly predicted death in DLB patients (HR = 1.72; 95% CI = 1.16-2.55). In PDD patients, heart failure and diabetes mellitus were associated with a higher risk of death (HR = 3.06; 95% CI = 1.74-5.41 and HR = 3.44; 95% CI = 1.31-9.03). In FTD patients, ischemic heart disease and atrial fibrillation or flutter significantly predicted death (HR = 2.11; 95% CI = 1.08-4.14 and HR = 3.15; 95% CI = 1.60-6.22, respectively). CONCLUSION: Our study highlights differences in the occurrence and prognostic significance of cardiovascular diseases in several dementia disorders. This has implications for the care and treatment of the different dementia disorders.","Aged;Aged, 80 and over;Cardiovascular Diseases/*complications/*mortality;Cohort Studies;Dementia/*complications/*mortality;Female;Humans;Logistic Models;Male;Proportional Hazards Models;Registries;Sweden/epidemiology;Alzheimer's disease;cardiovascular diseases;dementia;mortality","Cermakova, P.;Johnell, K.;Fastbom, J.;Garcia-Ptacek, S.;Lund, L. H.;Winblad, B.;Eriksdotter, M.;Religa, D.",2015,,10.3233/jad-150499,0,
704,Heart failure and dementia: Survival in relation to types of heart failure and different dementia disorders,"Aims Heart failure (HF) and dementia frequently coexist, but little is known about their types, relationships to each other and prognosis. The aims were to (i) describe patients with HF and dementia, assess (ii) the proportion of specific dementia disorders in types of HF based on ejection fraction and (iii) the prognostic role of types of HF and dementia disorders. Methods and results The Swedish Heart Failure Registry (RiksSvikt) and The Swedish Dementia Registry (SveDem) were record-linked. Associations between dementia disorders and HF types were assessed with multinomial logistic regression and survival was investigated with Kaplan-Meier analysis and multivariable Cox regression. We studied 775 patients found in both registries (55% men, mean age 82years). Ejection fraction was preserved in 38% of patients, reduced in 34%, and missing in 28%. The proportions of dementia disorders were similar across HF types. Vascular dementia was the most common dementia disorder (36%), followed by other dementias (28%), mixed dementia (20%), and Alzheimer disease (16%). Over a mean follow-up of 1.5years, 76% of patients survived 1year. We observed no significant differences in survival with regard to HF type (P=0.2) or dementia disorder (P=0.5). After adjustment for baseline covariates, neither HF types nor dementia disorders were independently associated with survival. Conclusions Heart failure with preserved ejection fraction was the most common HF type and vascular dementia was the most common dementia disorder. The proportions of dementia disorders were similar across HF types. Neither HF types nor specific dementia disorders were associated with survival.",adult;aged;Alzheimer disease;article;controlled study;dementia;disease classification;disease registry;female;follow up;heart ejection fraction;heart failure;heart failure with preserved ejection fraction;human;major clinical study;male;multiinfarct dementia;priority journal;prognosis;survival;survival rate,"Cermakova, P.;Lund, L. H.;Fereshtehnejad, S. M.;Johnell, K.;Winblad, B.;Dahlström, U.;Eriksdotter, M.;Religa, D.",2015,,,0,
705,"Management of Acute Myocardial Infarction in Patients With Dementia: Data From SveDem, the Swedish Dementia Registry","OBJECTIVES: We aimed to (1) study factors that determine the use of invasive procedures in the management of acute myocardial infarction (AMI) in patients with dementia and (2) determine whether the use of invasive procedures was associated with their better survival. DESIGN: Cohort study based on patients registered in the Swedish Dementia Registry (SveDem), 2007-2012. Median follow-up time was 228 days. SETTING: Patients diagnosed with dementia in specialist memory clinics and primary care units in Sweden. PARTICIPANTS: A total of 525 patients with dementia who suffered AMI (mean age 89 years, 54% women). MEASUREMENTS: Information on AMI and use of invasive procedures (coronary angiography and percutaneous coronary intervention) was obtained from Swedish national health registers. Binary logistic regression was applied to study associations of patients' characteristics with the use of invasive procedures; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Survival was analyzed with Kaplan-Meier curves; log-rank test was used to compare survival of patients who received an invasive procedure versus those who did not receive it. Cox regression was applied to study association of the invasive procedures with all-cause mortality; hazard ratios (HRs) with 95% CIs were calculated. RESULTS: One hundred ten patients (21%) with dementia received an invasive procedure in the management of AMI. After multivariate adjustment, lower age and higher global cognitive status were associated with the use of invasive procedures. The invasively managed patients survived longer (P = .001). The use of invasive procedures was associated with a lower risk of all-cause mortality, adjusting for type of AMI and dementia disorder, age, gender, registration unit, history of AMI and comorbidity score (HR 0.35, 95% CI 0.21-0.59), or total number of drugs (HR 0.34, 95% CI 0.20-0.58). CONCLUSION: Age and cognitive status determine the use of invasive procedures in patients with dementia. This study suggests that the invasive management of AMI has a benefit for survival of patients with dementia.",Acute myocardial infarction;coronary angiography;dementia;percutaneous coronary intervention;survival,"Cermakova, P.;Szummer, K.;Johnell, K.;Fastbom, J.;Winblad, B.;Eriksdotter, M.;Religa, D.",2016,Sep 14,10.1016/j.jamda.2016.07.026,0,
706,"Management of Acute Myocardial Infarction in Patients With Dementia: Data From SveDem, the Swedish Dementia Registry","Objectives We aimed to (1) study factors that determine the use of invasive procedures in the management of acute myocardial infarction (AMI) in patients with dementia and (2) determine whether the use of invasive procedures was associated with their better survival. Design Cohort study based on patients registered in the Swedish Dementia Registry (SveDem), 2007–2012. Median follow-up time was 228 days. Setting Patients diagnosed with dementia in specialist memory clinics and primary care units in Sweden. Participants A total of 525 patients with dementia who suffered AMI (mean age 89 years, 54% women). Measurements Information on AMI and use of invasive procedures (coronary angiography and percutaneous coronary intervention) was obtained from Swedish national health registers. Binary logistic regression was applied to study associations of patients’ characteristics with the use of invasive procedures; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Survival was analyzed with Kaplan-Meier curves; log-rank test was used to compare survival of patients who received an invasive procedure versus those who did not receive it. Cox regression was applied to study association of the invasive procedures with all-cause mortality; hazard ratios (HRs) with 95% CIs were calculated. Results One hundred ten patients (21%) with dementia received an invasive procedure in the management of AMI. After multivariate adjustment, lower age and higher global cognitive status were associated with the use of invasive procedures. The invasively managed patients survived longer (P = .001). The use of invasive procedures was associated with a lower risk of all-cause mortality, adjusting for type of AMI and dementia disorder, age, gender, registration unit, history of AMI and comorbidity score (HR 0.35, 95% CI 0.21–0.59), or total number of drugs (HR 0.34, 95% CI 0.20–0.58). Conclusion Age and cognitive status determine the use of invasive procedures in patients with dementia. This study suggests that the invasive management of AMI has a benefit for survival of patients with dementia.",acute heart infarction;age;aged;article;cardiovascular mortality;cognition;cohort analysis;coronary angiography;dementia;disease registry;female;follow up;human;invasive procedure;major clinical study;male;mortality risk;percutaneous coronary intervention;risk reduction;sex difference;survival;survival time;Sweden;very elderly,"Cermakova, P.;Szummer, K.;Johnell, K.;Fastbom, J.;Winblad, B.;Eriksdotter, M.;Religa, D.",2017,,10.1016/j.jamda.2016.07.026,0,705
707,"Characteristics, in-hospital management and outcome of late acute ST-elevation myocardial infarction presenters","Background: Patients with delayed presentation of acute myocardial infarction with ST-segment elevation (STEMI) frequently have a poor prognosis but literature about acute complications in intensive cardiac care unit (ICCU) and in-hospital outcome are still limited. Methods: All STEMI patients admitted to our institution between June 2007 and December 2013 were divided into patients presenting more than 12 h after symptom onset (lateSTEMI) and within 12 h (STEMI). Baselines clinical features including details about treatment of choice were collected. Major acute complications in ICCU and in-hospital mortality were the main end-points. Results: A total of 1372 patients were included, 147 (10.8%) were lateSTEMI. In ICCU lateSTEMI patients compared with STEMI patients experienced more frequently heart failure (75, 51.2% vs. 298, 24.3%; P < 0.001), atrial fibrillation (26, 17.7% vs. 130, 10.6%; P = 0.011), complete atrioventricular block (16, 10.9% vs. 63, 5.1%; P = 0.005), stroke (5, 3.4% vs. 5, 0.4%; P < 0.001), myocardial rupture (6, 4.1% vs. 3, 0.2%; P < 0.001), with higher administration of noninvasive ventilation support therapy (13, 9.8% vs. 44, 3.6%; P = 0.001) and the intra-aortic balloon counter-pulsation use (14, 10.3% vs. 102, 8.3%; P = 0.038). Intrahospital mortality was significantly higher in the lateSTEMI group (19, 13.4% vs. 69, 5.6%; P = 0.001). At the multiple regression analysis age [odds ratio (OR) 2.2 (1.46-2.92.; P = 0.01)], diabetes [OR 2.37 (1.38-4.07); P = 0.002] intra-aortic balloon counter-pulsation implantation [OR 2.78 (1.30-5.9); P = 0.03] and late presentation more than 12 h [2.52 (1.35-4.69); P = 0.001] resulted independently correlated with in-hospital mortality while a successful percutaneous coronary intervention procedure was protective [OR 0.15 (0.08-0.27); P = 0.003; all 95% confidence interval). Conclusion: Late presenters STEMI patients present a worse risk profile and prognosis compared with patients who arrive less than 12 h from onset of symptoms. Because of the presence of serious complications such as heart rupture or stroke a careful clinic and echocardiographic monitoring is strongly advisable in these population.",acetylsalicylic acid;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;fibrinogen receptor;inotropic agent;thienopyridine derivative;acute disease;adult;age;aged;aortic balloon;article;atrial fibrillation;atrioventricular block;balloon pump;cerebrovascular accident;clinical effectiveness;clinical feature;comorbidity;controlled study;counterpulsation;dementia;diabetes mellitus;disease duration;dual antiplatelet therapy;echocardiography;female;heart failure;heart left ventricle ejection fraction;heart rupture;heart ventricle septum rupture;hospital management;hospital mortality;hospital patient;human;hypertension;in-hospital management;incidence;intensive cardiac care unit;intensive care unit;late ST segment elevation myocardial infarction;major clinical study;male;malignant neoplasm;noninvasive ventilation;onset age;percutaneous coronary intervention;pericarditis;prognosis;regression analysis;risk factor;ST segment elevation myocardial infarction;symptomatology;treatment indication;treatment outcome;treatment refusal;very elderly,"Cerrato, E.;Forno, D.;Ferro, S.;Chinaglia, A.",2017,,10.2459/jcm.0000000000000527,0,
708,Takotsubo Cardiomyopathy in an Elderly Patient With Severe Alzheimer's Disease: A Case Report,"We report on an 80-year-old woman with Alzheimer's disease who presented with Takotsubo cardiomyopathy. As usual for this condition, our patient showed clinical symptoms of chest pain, electrocardiographic changes, elevated myocardial markers, and transient left ventricular apical ballooning in the absence of significant coronary artery disease. Because Takotsubo cardiomyopathy is frequently associated with emotional stress, which triggers an increase in circulating catecholamines, our case suggests that this event should not be neglected in Alzheimer's disease patients and promotes the adoption of a "" prosthetic"" approach for individuals with dementia. © 2012 American Medical Directors Association, Inc.",acetylsalicylic acid;beta adrenergic receptor blocking agent;catecholamine;chlortalidone;creatine kinase MB;dipeptidyl carboxypeptidase inhibitor;memantine;troponin T;aged;Alzheimer disease;article;balloon catheter;bladder distension;case report;disease severity;dyspnea;electrocardiography;emotional stress;female;geriatric patient;human,"Cerri, A. P.;Teruzzi, F.;Gregorio, M.;Bellelli, G.;Annoni, G.",2012,,,0,
709,Prediction of mortality in patients undergoing maintenance hemodialysis by Charlson Comorbidity Index using ICD-10 database,"Background/Aims: Many patients with end-stage renal disease have additional comorbidities that are important to clinical study and impact the patient's outcome. The Charlson Comorbidity Index (CCI) is a popular tool and a strong predictor of outcome in end-stage renal disease patients. We obtained comorbidity data from the hospital discharge database using the International Classification of Disease, 10th revision (ICD-10) and analyzed the mortality rate in incident patients undergoing maintenance hemodialysis (HD). Methods: We evaluated the medical records of a total of 456 patients on HD (58 ± 14 years of age, 56% males). We calculated CCI scores at the start of HD with information from the hospital discharge summary according to the ICD-10 code. We then analyzed patient mortality according to these CCI scores. Results: The percentages of patients that had diabetes with end-organ damage (51.1%), congestive heart failure (9.9%), coronary artery disease (8.1%) and stroke (6.8%) were identified. CCI scores were 5.09 ± 2.01 (range 2-11). Four comorbidity groups were established by quartile ranking of the CCI scores: low, moderate, high and very high. The mortality rates were: 0.83, 7.70, 14.09 and 18.69 deaths/100 patient-years, respectively (p = 0.001). Compared with the low comorbidity group, the hazard ratios for mortality were 9.22 (95% CI 3.29-25.84) for the moderate group, 16.77 (95% CI 5.97-47.11) for the high group, and 22.37 (95% CI 8.08-61.93) for the very high group. Conclusions: The CCI scores using the ICD-10 database information were significant predictors of mortality in incident patients undergoing maintenance HD. Copyright © 2010 S. Karger AG.",adult;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;congestive heart failure;connective tissue disease;coronary artery disease;dementia;diabetes mellitus;female;hemodialysis;hemodialysis patient;human;kidney disease;kidney failure;liver disease;major clinical study;male;paraplegia;peptic ulcer;peripheral vascular disease;priority journal;rating scale;cerebrovascular accident,"Chae, J. W.;Song, C. S.;Kim, H.;Lee, K. B.;Seo, B. S.;Kim, D. I.",2011,,,0,
710,Patient and physician determinants of implantable cardioverter defibrillator use in the heart failure population,"Recent studies report surprisingly low rates of implantable cardioverter defibrillator (ICD) placement for primary prevention against sudden cardiac death among patients with heart failure and left ventricular systolic dysfunction. Reasons for the low rates of utilization are not well understood. The authors examined ICD implantation rates at a university-based tertiary care center and used multivariable analysis to identify independent factors associated with ICD utilization. The ICD implantation rate for 850 eligible patients was 70%. Forty-seven (18%) patients refused implantation; women were twice as likely to refuse compared to men (8% vs 4%, P=.013). Race was not associated with utilization. On multivariable analysis, independent predictors of implantation included having a heart failure specialist (odds ratio [OR], 8.13; P<.001) or general cardiologist (OR, 2.23; P=.13) managing care, age range 70 to 79 (OR, 0.55; P<.001) or 80 and older (OR, 0.26; P<.001), female sex (OR, 0.49; P<.001), QRS interval (OR, 1.016; P<.001), diastolic blood pressure (OR, 0.979; P=.011), cerebrovascular disease (OR, 0.44; P=.007), and dementia (OR, 0.13; P=.002). Our registry of patients with cardiomyopathy and heart failure reveals that high rates of utilization are possible. Factors closely associated with ICD utilization include type of physician coordinating care, age, and comorbidities.","Aged;Aged, 80 and over;*Attitude of Health Personnel;Confidence Intervals;Death, Sudden, Cardiac/prevention & control;Defibrillators, Implantable/*utilization;Female;Heart Failure/*therapy;Humans;Logistic Models;Male;Middle Aged;Multivariate Analysis;Odds Ratio;Patient Acceptance of Health Care;*Patient Satisfaction;Physicians/*psychology;Primary Prevention;Regression Analysis;Systole;Ventricular Dysfunction, Left/*therapy","Chae, S. H.;Koelling, T. M.",2010,Jul-Aug,10.1111/j.1751-7133.2009.00139.x,0,
711,Progress in transthyretin fibrillogenesis research strengthens the amyloid hypothesis,,amyloid;levothyroxine;prealbumin;retinol;retinol binding protein;Alzheimer disease;amyloidosis;cardiomyopathy;crystal structure;denaturation;fiber;gene mutation;note;priority journal,"Chakrabartty, A.",2001,,,0,
712,Drugs that made headlines in 2015,,aducanumab;alirocumab;brodalumab;daclatasvir;empagliflozin;etiracetam;evolocumab;filgrastim;flibanserin;ivacaftor plus lumacaftor;nivolumab;ombitasvir;paritaprevir;ritonavir;sacubitril plus valsartan;secukinumab;talimogene laherparepvec;Alzheimer disease;cystic fibrosis;drug approval;fatigue;female sexual dysfunction;food and drug administration;heart failure;hepatitis C;human;macular degeneration;metastatic melanoma;non insulin dependent diabetes mellitus;non small cell lung cancer;pain;pluripotent stem cell;priority journal;psoriasis;psoriasis vulgaris;short survey;addyi;cosentyx;daklinza;entresto;imlygic;jardiance;neupogen;opdivo;orkambi;praluent;repatha;spritam;zarxio,"Chakradhar, S.",2015,,,0,
713,A randomised controlled trial to assess the clinical effectiveness and cost-effectiveness of alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularisation (IVAN),,ISRCTN92166560;bevacizumab;ranibizumab;abdominal discomfort;abdominal distension;abdominal infection;abdominal pain;abdominal wall hernia;abnormal sensation;acute pancreatitis;age related macular degeneration;aged;allergic conjunctivitis;angina pectoris;ankle fracture;anorectal disease;anus fissure;aorta thrombosis;arthralgia;article;atrial fibrillation;backache;benign tumor;bladder tumor;bleeding;blepharitis;blepharospasm;blindness;blood vessel injury;blood vessel occlusion;blurred vision;bradycardia;breast cancer;breast disease;burn;cartilage injury;cataract;cellulitis;cerebrovascular accident;chalazion;cholecystitis;cholelithiasis;chronic obstructive lung disease;chronic pancreatitis;clavicle fracture;clinical effectiveness;colitis;colon cancer;color blindness;conjunctival hemorrhage;conjunctival hyperemia;conjunctivitis;connective tissue disease;constipation;contrast sensitivity;controlled study;contusion;cor pulmonale;cornea disease;cornea dystrophy;cornea erosion;cornea perforation;cost effectiveness analysis;cost minimization analysis;cost utility analysis;Crohn disease;dacryocystitis;deep vein thrombosis;diarrhea;diplopia;dosage schedule comparison;drug cost;drug efficacy;drug hypersensitivity;drug intermittent therapy;drug safety;drug treatment failure;drug withdrawal;dry eye;duodenum ulcer;dyspepsia;dysphagia;dyspnea;ear disease;endocrine disease;endophthalmitis;epicondylitis;episcleritis;esophagitis;esophagus carcinoma;European Quality of Life 5 dimensions;exophthalmos;eye discharge;eye infection;eye inflammation;eye injury;eye irritation;eye pain;eye swelling;eyelid edema;eyelid pain;face injury;facial nerve paralysis;factorial design;falling;feces impaction;feces incontinence;female;femur fracture;fibrosis;follow up;foot fracture;foreign body;fracture;frontotemporal dementia;gallbladder cancer;gastritis;gastroenteritis;gastroesophageal reflux;gastrointestinal carcinoma;gastrointestinal disease;gastrointestinal symptom;geographic atrophy;gingiva disease;gingiva pain;glaucoma;glossitis;hand fracture;Health Utilities Index version 3;heart arrest;heart arrhythmia;heart disease;heart failure;heart infarction;heart left ventricle failure;heart palpitation;hematologic disease;hematoma;hematuria;hemopericardium;hemorrhoid;herpes zoster;hiatus hernia;hip fracture;hordeolum;hospitalization;human;hypersensitivity;hypoglycemia;hyponatremia;infection;injury;inner ear disease;intestine obstruction;intestine perforation;intraocular foreign body;intraocular hemorrhage;intraocular pressure;iridocyclitis;irritable colon;jaundice;joint dislocation;keratitis;kidney disease;kidney failure;laceration;limb fracture;limb injury;liver cancer;lower respiratory tract infection;lung cancer;lung edema;lung embolism;lung emphysema;lymphatic system disease;macular degeneration;Macular Disease Dependent Quality of Life;Macular disease Treatment Satisfaction Questionnaire;macular edema;major clinical study;male;malignant neoplastic disease;mantle cell lymphoma;mediastinum disease;Meniere disease;mental disease;mesothelioma;metabolic disorder;metamorphopsia;metastasis;microcytic anemia;mitral valve regurgitation;mouth edema;mouth injury;mouth ulcer;multicenter study;multiple organ failure;muscle strain;musculoskeletal disease;musculoskeletal pain;mydriasis;nausea;neovascular age related macular degeneration;nephrolithiasis;neurologic disease;nose polyp;nutritional disorder;ocular pruritus;optical coherence tomography;orthostatic hypotension;ovary cancer;ovary cyst;pancreas carcinoma;pancreas cyst;pancreatitis;pelvis fracture;photophobia;pneumonia;postmenopause bleeding;presyncope;prostate cancer;ptosis;punctate keratitis;quality adjusted life year;quality of life;quality of life assessment;randomized controlled trial;rectum disease;rectum hemorrhage;rectum prolapse;respiratory tract disease;retina artery occlusion;retina detachment;retina edema;retina hemorrhage;retina maculopathy;retina tear;retina vein occlusion;retinal thickness;rib fracture;shock;side effect;skin disease;sprain;stomach disease;subdural hematoma;subretinal neovascularization;sudden deafness;supraventricular tachycardia;swelling;tachycardia;thorax disease;thrombocytopenia;tooth disease;tooth pain;transient ischemic attack;transitional blindness;transitional cell carcinoma;traumatic cataract;triple blind procedure;ulcerative colitis;United Kingdom;upper abdominal pain;upper respiratory tract infection;urinary tract disease;urinary tract infection;uveitis;valvular heart disease;vascular disease;vasculitis;visual acuity;visual field defect;visual hallucination;visual impairment;vitreous body detachment;vitreous disease;vitreous floaters;vitreous hemorrhage;vomiting;wrist fracture;xerostomia;avastin;lucentis,"Chakravarthy, U.;Harding, S. P.;Rogers, C. A.;Downes, S.;Lotery, A. J.;Dakin, H. A.;Culliford, L.;Scott, L. J.;Nash, R. L.;Taylor, J.;Muldrew, A.;Sahni, J.;Wordsworth, S.;Raftery, J.;Peto, T.;Reeves, B. C.",2015,,,0,
714,Some unusual features of Paget's disease of bone,"The usual features of Paget's disease of bone, e.g. large head, deafness due to involvement of the 8th cranial nerve and bowing of the legs are well described in text books of medicine. However, some features such as platybasia with neurological deficit, involvement of the 2nd, 5th and 7th cranial nerves, hydrocephalus, dementia, dyphasia, corrugation of the skull, bone pain (with or without associated osteo-arthrosis of hips and knees), heart failure, triradiate deformity of the pelvis have either had an inadequate or no description in books. These features are unusual, but it is important to recognise them, as the advances made since the introduction of the very promising new drugs in recent years have not only provided increasing insight into the disease, but also have improved management of patients with Paget's disease of bone.",arthritis;basilar impression;bone;central nervous system;cranial nerve;dementia;heart failure;hydrocephalus;major clinical study;musculoskeletal system;Paget bone disease,"Chakravorty, N. K.",1978,,,0,
715,NGF-ome: Its metabotrophic expression homage to Rita Levi-Montalcini,"Nowadays, in the postgenome time, many ""-ome"" studies have emerged including proteome, transcriptome, interactome, metabolome, adipokinome, connectome. In this vein, the catchall term NGF-ome embodies all the actions of NGF in health and disease. Accordingly, the present Festschrift, also tabula gratulatoria, is to honor and acknowledge the contributions of the distinguished neuroscientist and magistra Rita Levi-Montalcini, the Nobel Prize winner-1986 for the discoverer of NGF. Today, NGF and another neurotrophin, brain-derived neuroptrophic factor (BDNF), are well recognized to mediate multiple biological phenomena, ranging from the neurotrophic through immunotrophic and epitheliotrophic to metabotrophic effects. These latter effects are involved in the maintenance of cardiometabolic homeostasis (glucose and lipid metabolism as well as energy balance, and cardioprotection). Circulating and/or tissue levels of NGF and BDNF are altered in cardiometabolic diseases (atherosclerosis, obesity, type 2 diabetes, metabolic syndrome, and type 3 diabetes/Alzheimer's disease). A hypothesis thus emerged that a metabotrophic deficit due to the reduction of NGF/BDNF availability and/or utilization may be implicated in the pathogenesis of cariometabolic and neurodegenerative diseases. The present challenge is therefore to cultivate a metabotrophic thinking about how we can modulate NGF/BDNF secretion and signaling for the benefit of human cardiometabolic and mood health. © Bulgarian Society for Cell Biology.",brain derived neurotrophic factor;nerve growth factor;neurotrophin;proteome;transcriptome;article;cell activity;cell survival;coronary artery atherosclerosis;diabetes mellitus;disease association;energy balance;glucose homeostasis;human;metabolic syndrome X;nerve growth;obesity;protein expression;protein function,"Chaldakov, G. N.;Aloe, L.;Hristova, M. G.;Tonchev, A. B.;Nikolova, V.;Panayotov, P.;Ghenev, P. I.",2010,,,0,
716,Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS): interpretation and implementation,"OBJECTIVES: To determine the effects of a perindopril-based blood pressure lowering regimen in hypertensive and non-hypertensive patients with a history of stroke or transient ischaemic attack (TIA). DESIGN AND METHODS: 6105 subjects from 172 centres in Asia, Australasia, and Europe were randomised to receive active treatment (n = 3051) or placebo (n = 3054). Active treatment consisted of a flexible regimen based on the angiotensin-converting enzyme inhibitor perindopril (4 mg daily), with the addition of the diuretic indapamide, at the discretion of treating physicians. The primary outcome was total stroke (fatal or non-fatal). Analysis was by intention to treat. RESULTS: Active treatment reduced blood pressure by 9/4 mmHg over 4 years of follow-up. 307 (10%) individuals assigned active treatment suffered a stroke, compared with 420 (14%) assigned placebo [relative risk reduction 28% (95% confidence interval 17-38), P < 0.0001]. Active treatment also reduced the risks of total major vascular events [26% (16-34)] including non-fatal myocardial infarction [38% (14-55)], severe cognitive decline [19% (4-32)], stroke-related dementia [34% (3-55)] and disability [18% (8-28)]. There were similar reductions in the risk of stroke in hypertensive and non-hypertensive subgroups (P < 0.01). Combination therapy with perindopril plus indapamide lowered blood pressure by 12/5 mmHg and stroke risk by 43%. Single-drug therapy lowered blood pressure by 5/3 mmHg and produced no significant fall in the risk of stroke. CONCLUSIONS: The blood-pressure lowering regimen used in Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) reduced the risks of stroke and other serious events in hypertensive and non-hypertensive subjects with a history of stroke (whatever the subtype) or transient ischaemic attack. Combination therapy with perindopril and indapamide produced larger blood pressure reductions and larger stroke reductions than monotherapy with perindopril alone. Treatment with these two agents should be considered routinely for all patients with a history of previous stroke or TIA, whether hypertensive or normotensive.","Angiotensin-Converting Enzyme Inhibitors [therapeutic use];Antihypertensive Agents [therapeutic use];Data Interpretation, Statistical;Hypertension [drug therapy] [epidemiology] [etiology];Incidence;Perindopril [therapeutic use];Risk Reduction Behavior;Secondary Prevention;Stroke [epidemiology] [etiology] [prevention & control];Humans[checkword];Sr-htn: sr-stroke","Chalmers, J.;MacMahon, S.",2003,,,0,717
717,Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS): interpretation and implementation,"DESIGN AND METHODS6105 subjects from 172 centres in Asia, Australasia, and Europe were randomised to receive active treatment (n = 3051) or placebo (n = 3054). Active treatment consisted of a flexible regimen based on the angiotensin-converting enzyme inhibitor perindopril (4 mg daily), with the addition of the diuretic indapamide, at the discretion of treating physicians. The primary outcome was total stroke (fatal or non-fatal). Analysis was by intention to treat.RESULTSActive treatment reduced blood pressure by 9/4 mmHg over 4 years of follow-up. 307 (10%) individuals assigned active treatment suffered a stroke, compared with 420 (14%) assigned placebo [relative risk reduction 28% (95% confidence interval 17-38), P < 0.0001]. Active treatment also reduced the risks of total major vascular events [26% (16-34)] including non-fatal myocardial infarction [38% (14-55)], severe cognitive decline [19% (4-32)], stroke-related dementia [34% (3-55)] and disability [18% (8-28)]. There were similar reductions in the risk of stroke in hypertensive and non-hypertensive subgroups (P < 0.01). Combination therapy with perindopril plus indapamide lowered blood pressure by 12/5 mmHg and stroke risk by 43%. Single-drug therapy lowered blood pressure by 5/3 mmHg and produced no significant fall in the risk of stroke.CONCLUSIONSThe blood-pressure lowering regimen used in Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) reduced the risks of stroke and other serious events in hypertensive and non-hypertensive subjects with a history of stroke (whatever the subtype) or transient ischaemic attack. Combination therapy with perindopril and indapamide produced larger blood pressure reductions and larger stroke reductions than monotherapy with perindopril alone. Treatment with these two agents should be considered routinely for all patients with a history of previous stroke or TIA, whether hypertensive or normotensive.OBJECTIVESTo determine the effects of a perindopril-based blood pressure lowering regimen in hypertensive and non-hypertensive patients with a history of stroke or transient ischaemic attack (TIA).","Angiotensin-Converting Enzyme Inhibitors [therapeutic use];Antihypertensive Agents [therapeutic use];Data Interpretation, Statistical;Hypertension [drug therapy] [epidemiology] [etiology];Incidence;Perindopril [therapeutic use];Risk Reduction Behavior;Secondary Prevention;Stroke [epidemiology] [etiology] [prevention & control];Humans[checkword];Sr-htn: sr-stroke","Chalmers, J;MacMahon, S",2003,,,0,
718,PROGRESS (Perindopril Protection Against Recurrent Stroke Study): regional characteristics of the study population at baseline. PROGRESS Management Committee,"OBJECTIVE: To determine the effects of an angiotensin-converting enzyme (ACE) inhibitor-based blood pressure lowering regimen on the risk of stroke among patients with a history of cerebrovascular disease. Secondary aims include investigation of the effects of treatment on other cardiovascular events, dementia, and disability. DESIGN AND METHODS: PROGRESS (Perindopril Protection Against Recurrent Stroke Study) is a double-blind, placebo-controlled, randomized trial being conducted in 172 centres in 10 countries (Australia, Belgium, China, France, Italy, Ireland, Japan, New Zealand, Sweden, and the United Kingdom). Patients were randomly assigned to treatment with the ACE inhibitor perindopril (and the diuretic indapamide for those with no definite indication for or contraindication to treatment with a diuretic) or matching placebo(s). Both hypertensive and normotensive patients were eligible for inclusion. Follow-up is scheduled for completion in 2001. RESULTS: Of 6105 patients randomly allocated to study groups on completion of recruitment in November 1997, 1110 were recruited from Australia and New Zealand, 1520 from China, 713 from France and Belgium, 557 from Italy, 815 from Japan, 675 from Sweden, and 715 from the UK and Ireland. Regional differences in the baseline characteristics included a greater rate of diabetes, lacunar infarction, and cerebral haemorrhage in patients from China and Japan, and a more frequent history of myocardial infarction in Australia and New Zealand. Previous treatment with calcium antagonists was very frequent in Japan and China, whereas diuretic treatment was most often documented in the UK and Ireland. CONCLUSIONS: Analysis of baseline characteristics of patients recruited from seven distinct geographic regions revealed some interesting differences, but more striking was the consistency of characteristics of patients recruited from many different countries across the world.","Angiotensin-Converting Enzyme Inhibitors [administration & dosage] [therapeutic use];Blood Pressure [drug effects];Diuretics [administration & dosage] [therapeutic use];Double-Blind Method;Drug Therapy, Combination;Indapamide [administration & dosage] [therapeutic use];Perindopril [administration & dosage] [therapeutic use];Recurrence;Stroke [drug therapy] [prevention & control];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-dementia","Chalmers, J.;Neal, B.;MacMahon, S.",2000,,,0,720
719,PROGRESS (Perindopril Protection Against Recurrent Stroke Study): Regional characteristics of the study population at baseline,"Objective: To determine the effects of an angiotensin-converting enzyme (ACE) inhibitor-based blood pressure lowering regimen on the risk of stroke among patients with a history of cerebrovascular disease. Secondary aims include investigation of the effects of treatment on other cardiovascular events, dementia, and disability. Design and Methods: PROGRESS (Perindopril Protection Against Recurrent Stroke Study) is a double-blind, placebo-controlled, randomized trial being conducted in 172 centres in 10 countries (Australia, Belgium, China, France, Italy, Ireland, Japan, New Zealand, Sweden, and the United Kingdom). Patients were randomly assigned to treatment with the ACE inhibitor perindopril (and the diuretic indapamide for those with no definite indication for or contraindication to treatment with a diuretic) or matching placebo(s). Both hypertensive and normotensive patients were eligible for inclusion. Follow-up is scheduled for completion in 2001. Results: Of 6105 patients randomly allocated to study groups on completion of recruitment in November 1997 1110 were recruited from Australia and New Zealand, 1520 from China, 713 from France and Belgium, 557 from Italy, 815 from Japan, 675 from Sweden, and 715 from the UK and Ireland. Regional differences in the baseline characteristics included a greater rate of diabetes, lacunar infarction, and cerebral haemorrhage in patients from China and Japan, and a more frequent history of myocardial infarction in Australia and New Zealand. Previous treatment with calcium antagonists was very frequent in Japan and China, whereas diuretic treatment was most often documented in the UK and Ireland. Conclusions: Analysis of baseline characteristics of patients recruited from seven distinct geographic regions revealed some interesting differences, but more striking was the consistency of characteristics of patients recruited from many different countries across the world. (C) 2000 Lippincott Williams and Wilkins.",calcium antagonist;dipeptidyl carboxypeptidase inhibitor;diuretic agent;indapamide;perindopril;placebo;adult;aged;article;Australia;Belgium;blood pressure;brain hemorrhage;cardiovascular disease;China;clinical trial;controlled clinical trial;controlled study;dementia;diabetes mellitus;disability;double blind procedure;female;France;geographic distribution;heart infarction;history;human;hypertension;infarction;Ireland;Italy;Japan;major clinical study;male;multicenter study;New Zealand;priority journal;randomized controlled trial;recurrent disease;risk;cerebrovascular accident;Sweden;United Kingdom,"Chalmers, J.;Neal, B.;MacMahon, S.",2000,,,0,
720,PROGRESS (Perindopril Protection Against Recurrent Stroke Study): regional characteristics of the study population at baseline. PROGRESS Management Committee,"DESIGN AND METHODSPROGRESS (Perindopril Protection Against Recurrent Stroke Study) is a double-blind, placebo-controlled, randomized trial being conducted in 172 centres in 10 countries (Australia, Belgium, China, France, Italy, Ireland, Japan, New Zealand, Sweden, and the United Kingdom). Patients were randomly assigned to treatment with the ACE inhibitor perindopril (and the diuretic indapamide for those with no definite indication for or contraindication to treatment with a diuretic) or matching placebo(s). Both hypertensive and normotensive patients were eligible for inclusion. Follow-up is scheduled for completion in 2001.RESULTSOf 6105 patients randomly allocated to study groups on completion of recruitment in November 1997, 1110 were recruited from Australia and New Zealand, 1520 from China, 713 from France and Belgium, 557 from Italy, 815 from Japan, 675 from Sweden, and 715 from the UK and Ireland. Regional differences in the baseline characteristics included a greater rate of diabetes, lacunar infarction, and cerebral haemorrhage in patients from China and Japan, and a more frequent history of myocardial infarction in Australia and New Zealand. Previous treatment with calcium antagonists was very frequent in Japan and China, whereas diuretic treatment was most often documented in the UK and Ireland.CONCLUSIONSAnalysis of baseline characteristics of patients recruited from seven distinct geographic regions revealed some interesting differences, but more striking was the consistency of characteristics of patients recruited from many different countries across the world.OBJECTIVETo determine the effects of an angiotensin-converting enzyme (ACE) inhibitor-based blood pressure lowering regimen on the risk of stroke among patients with a history of cerebrovascular disease. Secondary aims include investigation of the effects of treatment on other cardiovascular events, dementia, and disability.","Angiotensin-Converting Enzyme Inhibitors [administration & dosage] [therapeutic use];Blood Pressure [drug effects];Diuretics [administration & dosage] [therapeutic use];Double-Blind Method;Drug Therapy, Combination;Indapamide [administration & dosage] [therapeutic use];Perindopril [administration & dosage] [therapeutic use];Recurrence;Stroke [drug therapy] [prevention & control];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-dementia","Chalmers, J;Neal, B;MacMahon, S",2000,,,0,
721,Multimorbidity and the risk of hospitalization and death in atrial fibrillation: A population-based study,"Patients with atrial fibrillation (AF) have many comorbidities and excess risks of hospitalization and death. Whether the impact of comorbidities on outcomes is greater in AF than the general population is unknown. METHODS: One thousand four hundred thirty patients with AF and community controls matched 1:1 on age and sex were obtained from Olmsted County, Minnesota. Andersen-Gill and Cox regression estimated associations of 19 comorbidities with hospitalization and death, respectively. RESULTS: AF cases had a higher prevalence of most comorbidities. Hypertension (25.4%), coronary artery disease (17.7%), and heart failure (13.3%) had the largest attributable risk of AF; these along with obesity and smoking explained 51.4% of AF. Over a mean follow-up of 6.3 years, patients with AF experienced higher rates of hospitalization and death than did population controls. However, the impact of comorbidities on hospitalization and death was generally not greater in patients with AF compared with controls, with the exception of smoking. Ever smokers with AF experienced higher-than-expected risks of hospitalization and death, with observed vs expected (assuming additivity of effects) hazard ratios compared with never smokers without AF of 1.78 (1.56-2.02) vs 1.52 for hospitalization and 2.41 (2.02-2.87) vs 1.84 for death. CONCLUSIONS: Patients with AF have a higher prevalence of most comorbidities; however, the impact of comorbidities on hospitalization and death is generally similar in AF and controls. Smoking is a notable exception; ever smokers with AF experienced higher-than-expected risks of hospitalization and death. Thus, interventions targeting modifiable behaviors may benefit patients with AF by reducing their risk of adverse outcomes.","Aged;Aged, 80 and over;Arthritis/epidemiology;Asthma/epidemiology;Atrial Fibrillation/ epidemiology;Cause of Death;Comorbidity;Coronary Artery Disease/epidemiology;Dementia/epidemiology;Diabetes Mellitus/epidemiology;Female;Heart Failure/epidemiology;Hospitalization;Humans;Hyperlipidemias/epidemiology;Hypertension/epidemiology;Incidence;Kaplan-Meier Estimate;Logistic Models;Male;Mental Disorders/epidemiology;Middle Aged;Minnesota/epidemiology;Mortality;Multivariate Analysis;Neoplasms/epidemiology;Obesity/epidemiology;Odds Ratio;Osteoporosis/epidemiology;Proportional Hazards Models;Pulmonary Disease, Chronic Obstructive/epidemiology;Renal Insufficiency, Chronic/epidemiology;Risk Factors;Smoking/epidemiology;Stroke/epidemiology","Chamberlain, A. M.;Alonso, A.;Gersh, B. J.;Manemann, S. M.;Killian, J. M.;Weston, S. A.;Byrne, M.;Roger, V. L.",2017,Mar,,0,
722,Decade-long trends in atrial fibrillation incidence and survival: A community study,"Background Contemporary data on temporal trends in incidence and survival after atrial fibrillation are scarce. Methods Residents of Olmsted County, Minn., with a first-ever atrial fibrillation or atrial flutter event between 2000 and 2010 were identified. Age- and sex-adjusted incidence rates were standardized to the 2010 US population, and the relative risk of atrial fibrillation in 2010 versus 2000 was calculated using Poisson regression. Standardized mortality ratios of observed versus expected survival were calculated, and time trends in survival were examined using Cox regression. Results We identified 3344 patients with incident atrial fibrillation/atrial flutter events (52% were male, mean age 72.6 years, 95.7% were white). Incidence did not change over time (age- and sex-adjusted rate ratio, 1.01; 95% confidence interval [CI], 0.91-1.13 for 2010 vs 2000). Within the first 90 days, the risk of all-cause mortality was greatly elevated compared with individuals of a similar age and sex distribution in the general population (standardized mortality ratios 19.4 [95% CI, 17.3-21.7] and 4.2 [95% CI, 3.5-5.0] for the first 30 days and 31 to 90 days after diagnosis, respectively). Survival within the first 90 days did not improve over the study period (adjusted hazard ratio, 0.96; 95% CI, 0.71-1.32 for 2010 vs 2000); likewise, no difference in mortality between 2010 and 2000 was observed among 90-day survivors (hazard ratio, 1.05; 95% CI, 0.85-1.31). Conclusions In the community, atrial fibrillation incidence and survival have remained constant over the last decade. A dramatic and persistent excess risk of death was observed in the 90 days after atrial fibrillation diagnosis, underscoring the importance of early risk stratification.",adult;age distribution;aged;article;body mass;brain ischemia;cerebrovascular disease;chronic lung disease;controlled study;dementia;diabetes mellitus;disease severity;female;follow up;hazard ratio;atrial fibrillation;heart atrium flutter;heart failure;heart infarction;hemiplegia;human;hypertension;incidence;kidney disease;liver disease;major clinical study;male;mortality;paraplegia;peripheral vascular disease;prevalence;priority journal;sex difference;sex ratio;smoking;standardized mortality ratio;survival rate;underweight,"Chamberlain, A. M.;Gersh, B. J.;Alonso, A.;Chen, L. Y.;Berardi, C.;Manemann, S. M.;Killian, J. M.;Weston, S. A.;Roger, V. L.",2015,,,0,
723,The association of corneal arcus with coronary heart disease and cardiovascular disease mortality in the Lipid Research Clinics Mortality Follow-up Study,"The relationship between corneal arcus (arcus senilis) and mortality from coronary heart disease (CHD) and cardiovascular disease (CVD) is examined in a prospective study of White men (n = 3,930) and women non-hormone users (n = 2,139), ages 30-69, followed for an average of 8.4 years as part of the Lipid Research Clinics Mortality Follow-up Study. After excluding those with clinically manifest CHD at baseline, corneal arcus was strongly associated with CHD and CVD mortality only in hyperlipidemic men ages 30-49 years, for whom the relative risk for CHD and CVD death was 3.7 and 4.0, respectively, after adjusting for age, total cholesterol, HDL cholesterol, and smoking status using a Cox proportional hazards model. Among 30-49 year old males, corneal arcus appears to be a prognostic factor for CHD, independent of its association with hyperlipidemia in this age-group, of about the same magnitude as other common risk factors, underscoring the usefulness of corneal arcus as a prognostic factor to the practicing clinician.",high density lipoprotein cholesterol;adult;age;article;cholesterol blood level;cornea;female;human;ischemic heart disease;male;methodology;normal human;priority journal;senility;smoking,"Chambless, L. E.;Fuchs, F. D.;Linn, S.;Kritchevsky, S. B.;Larosa, J. C.;Segal, P.;Rifkind, B. M.",1990,,,0,
724,Agitated dementia (multiple letters),,anticonvulsive agent;baclofen;benzodiazepine derivative;beta adrenergic receptor blocking agent;botulinum toxin;calcium channel blocking agent;cholinergic receptor blocking agent;cisapride;clonidine;dantrolene;diazepam;dipeptidyl carboxypeptidase inhibitor;donepezil;histamine H2 receptor antagonist;metoclopramide;metrifonate;narcotic agent;nonsteroid antiinflammatory agent;paracetamol;paroxetine;phenol;prochlorperazine;psychotropic agent;rivastigmine;serotonin uptake inhibitor;tacrine;tizanidine;tricyclic antidepressant agent;unclassified drug;agitation;behavior disorder;congestive heart failure;dementia;depression;gastritis;human;hypertension;letter;nausea;neurotoxicity;pain;psychopharmacotherapy;spasticity;tardive dyskinesia,"Chan, A. S.;Geller, A. S.;Franco, K.;Palmer, R. M.;Pozuelo, L.",1998,,,0,
725,Nursing home applications--reasons and possible interventions,"BACKGROUND: With a rapidly ageing population like Singapore, the need for nursing homes will increase. Admission to a nursing home may be for medical and/or social reasons. We carried out case studies with the Care Liaison Service (CLS) of the Ministry of Health to determine reasons why the elderly applied for nursing home admission, and whether it was possible to prevent an admission. PATIENTS: During the 6-month study period, 331 applications were received, of which 280 (84.6%) were > or = 60 years. There was an equal distribution of male (50.4%) and female (49.6%) applicants. Applicants were predominantly Chinese (86.0%), followed by Indians (8.0%), Malays and other races (3.0% each). Most of the applicants were semi-ambulant (50.0%), fully ambulant (31.4%) and non-ambulant (18.6%). The most common medical problems of the applicants were neurological (e.g. stroke, normal pressure hydrocephalus, epilepsy), heart diseases (e.g. hypertension, ischaemic heart disease, heart failure), orthopaedic conditions (e.g. osteoarthritis, fractures neck of femur and other fractures), and psychiatric problems (e.g. dementia, depression and history of schizophrenia/paranoid psychosis). METHOD: Fifty-seven applicants (20.4%) were selected for intervention. They were 'non-psychiatric' patients whose caregivers were willing but unable to look after them. About half (28, 49.1%) of these applicants required nursing home care. The remaining 29 patients (50.9%) had the potential of improving or able to remain at home with appropriate community services. These 29 patients were contacted by the CLS nurse and the following recommendations were made: 1) inpatient rehabilitation in a community hospital (7 patients); 2) rehabilitation and day care in a community-based day care centre (17 patients); 3) domiciliary medical care (4 patients), and 4) reassessment by psychiatrist to control psychotic symptoms (1 patient). Only 6 patients were willing to accept the new recommendations. This poor result may imply that attempts at intervention at this stage may be too late. CONCLUSION: We need to identify the group at risk for nursing home admissions early, take a proactive stance towards them, increase support to their caregivers to prevent burnt-out and continue to develop and publicize community-based services. More studies need to be done in this area.",aged;article;female;health care delivery;health service;human;male;middle aged;nursing home;patient referral;Singapore,"Chan, K. M.;Wong, S. F.;Yoong, T.",1998,,,0,
726,Validation study of Charlson Comorbidity Index in predicting mortality in Chinese older adults,"Aim: The Charlson Comorbidity Index (CCI) is commonly studied for predicting mortality, but there is no validation study of it in Chinese older adults. The objective of the present study was to validate the use of CCI in Chinese older adults for predicting mortality. Method: We carried out a retrospective cohort study from 2004 to 2013 for patients discharged from a geriatric day hospital in Hong Kong. Comorbidity was quantified using CCI, and patients were divided into six groups according to their score of CCI: CCI-0, CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5. Other data collected included demographics, and functional, nutritional, cognitive and social assessment. The outcome measure was 1-year mortality. Results: At 1-year follow up, 3.8% (n=17), 5.9% (n=37), 9.2% (n=35), 12.9% (n=20), 16.9% (n=23) and 19.3% (n=60) of CCI-0, CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5 died, respectively (P<0.001). Multivariate analysis showed that CCI-1, CCI-2, CCI-3, CCI-4 and CCI≥5 have a hazard ratio (HR) of 1.34 (confidence interval [CI] 1.04-2.12), 2.18 (CI 1.03-4.61), 3.44 (CI 1.52-7.81), 3.74 (CI 1.35-10.39) and 4.63 (CI 2.28-9.43), respectively, compared with CCI-0. The area under the curve of the receiver operating characteristic curves of CCI in predicting 1-year mortality for older adults was 0.68 (CI 0.64-0.72). Conclusion: There is a significant dose-response relationship in the hazard ratio between CCI and 1-year mortality in Chinese older adults, but involvements of functional, nutritional and social assessments are important for comprehensive quantification of health status in older adults. © 2013 Japan Geriatrics Society.",aged;article;cerebrovascular accident;Charlson Comorbidity Index;Chinese;chronic obstructive lung disease;cognition;cohort analysis;community living;congestive heart failure;dementia;diabetes mellitus;female;follow up;functional status;geriatric hospital;health status;hospital discharge;human;hypertension;ischemic heart disease;kidney disease;liver disease;major clinical study;male;mortality;nursing home;nutritional status;outcome assessment;peripheral vascular disease;priority journal;risk assessment;social status;solid tumor;validation study;very elderly,"Chan, T. C.;Luk, J. K. H.;Chu, L. W.;Chan, F. H. W.",2014,,,0,
727,Atrial Fibrillation is Independently Associated with Cognitive Impairment after Ischemic Stroke,"Background: While atrial fibrillation (AF) is an important risk factor for ischemic strokes and mild cognitive impairment (MCI) in Alzheimers disease, the association between AF and post-stroke cognitive impairment (PSCI), and the factors mediating this association, is unclear. Objective: To investigate the role of AF in PSCI, especially in relation to other markers of cerebrovascular disease. Methods: 445 subjects with mild ischemic stroke without pre-stroke cognitive decline were assessed 3-6 months post-stroke for cognitive deficits. MRIs were reviewed by trained raters for acute infarct characteristics, global cortical atrophy, white matter hyperintensities, cerebral microbleeds, and intracranial stenosis. Logistic regression analysis was used to identify factors independently associated with PSCI. Subjects were also categorized according to paroxysmal (pAF) or persistent/chronic AF (p/cAF), and presence or absence of AF or large cortical infarcts (LCI) to study cognitive trends. Results: 80 (18.0%) subjects had AF. 76.3% of AF subjects and 42.7% of subjects without AF had PSCI. The odds ratio (OR) of AF in developing PSCI was 2.31 (95% CI: 1.12-4.75; p = 0.035), after correcting for other risk factors. pAF subjects and AF subjects with LCIs had higher ORs for PSCI. AF subjects performed worse in neuropsychological tasks associated with global cognition, episodic memory, and executive function. Conclusion: AF is a significant risk factor for PSCI, even after correcting for AF-related infarcts. Other mechanisms, such as hypoperfusion, microhemorrhages, and neuroinflammation, may be at play. All stroke patients with AF, regardless of the type of infarction, should be closely monitored for PSCI.",adult;article;atrial fibrillation;brain atrophy;brain hemorrhage;brain infarction;brain infarction size;brain ischemia;cognition;cognitive defect;disease severity;episodic memory;executive function;female;global cortical atrophy;human;intracranial stenosis;ischemic heart disease;major clinical study;male;Mini Mental State Examination;Montreal cognitive assessment;neuroimaging;nuclear magnetic resonance imaging;prevalence;priority journal;risk factor;stenosis;white matter lesion,"Chander, R. J.;Lim, L.;Handa, S.;Hiu, S.;Choong, A.;Lin, X.;Singh, R.;Oh, D.;Kandiah, N.",2017,,10.3233/jad-170313,0,
728,Emergencies related to HIV infection and treatment (part 1),"HIV is a leading cause of mortality in resource limited settings and HIV associated medical emergencies are common emergency centre presentations in high-prevalence settings. HIV attacks the body's immune system, making infected individuals susceptible to severe infections of multiple organ systems including the respiratory tract, ocular structures, and central nervous system. HIV infected individuals also suffer from unique patterns of cardiac disease, gastrointestinal disturbances, and haematologic and oncologic conditions. Anti-retroviral therapy itself is also associated with numerous side effects, many of which can be life-threatening. Diagnosis and management of HIV infected patients require knowledge of the disease's pathology and the life threatening complications associated with it. Part 1 of this review discusses the pathophysiology of the disease and respiratory, cardiac, psychiatric, and neurologic complications.© 2013 Production and hosting by Elsevier on behalf of African Federation for Emergency Medicine.",amphotericin B;beta lactam;cephalosporin;cloxacillin;cotrimoxazole;dapsone;doxycycline;fluconazole;flucytosine;folic acid;macrolide;pentamidine;proteinase inhibitor;pyrimethamine;quinolone derivative;sulfadiazine;vancomycin;Africa;alcohol abuse;anxiety;article;asthma;bacterial meningitis;bacterial pneumonia;blood clot lysis;cardiomyopathy;central nervous system infection;chronic lung disease;coronary artery disease;cryptococcal meningitis;dementia;depression;drug megadose;highly active antiretroviral therapy;hospital infection;human;Human immunodeficiency virus infected patient;Human immunodeficiency virus infection;low drug dose;lung tuberculosis;methicillin resistant Staphylococcus aureus infection;neurological complication;pathophysiology;percutaneous coronary intervention;pericardial disease;Pneumocystis pneumonia;steroid therapy;substance abuse;toxoplasmosis;tuberculous meningitis,"Chandra, A.;Firth, J.;Sheikh, A.;Patel, P.",2013,,,0,
729,Vascular disease burden in indian subjects with vascular dementia,"Background Vascular disease factors like hypertension, diabetes mellitus, dyslipidaemia, and ischaemic heart disease contribute to the development of vascular dementia. As comorbidity of vascular disease factors in vascular dementia is common, we investigated the vascular disease burden in subjects with vascular dementia. Aims To investigate the vascular disease burden due to four vascular disease factors: hypertension, diabetes mellitus, dyslipidaemia, and ischaemic heart disease in Indian subjects with vascular dementia. Methods In this study, 159 subjects with probable vascular dementia (as per NINDS-AIREN criteria) attending the memory clinic at a tertiary care hospital were assessed for the presence of hypertension, diabetes mellitus, dyslipidaemia, and ischaemic heart disease using standardised operational definitions and for severity of dementia on the Clinical Dementia Rating (CDR) scale. The data obtained was subjected to appropriate statistical analysis. Results Dyslipidaemia (79.25 per cent) was the most common vascular disease factor followed by hypertension (73.58 per cent), ischaemic heart disease (58.49 per cent), and diabetes mellitus (40.80 per cent). Most subjects (81.1 per cent) had two or more vascular disease factors. Subjects with more severe dementia had more vascular disease factors (sig 0.001). Conclusion People with moderate to severe dementia have a significantly higher vascular disease burden; therefore, higher vascular disease burden may be considered as a poor prognostic marker in vascular dementia. Subjects with vascular dementia and their caregivers must manage cognitive impairment and ADL alongside managing serious comorbid vascular diseases that may worsen the dementia.",adult;aged;article;Clinical Dementia Rating;diabetes mellitus;disease association;disease severity;dyslipidemia;female;human;hypertension;image analysis;ischemic heart disease;major clinical study;male;multiinfarct dementia;nuclear magnetic resonance imaging;oral glucose tolerance test;prevalence;risk assessment;scoring system;validation process,"Chandra, M.;Anand, K. S.",2015,,,0,
730,The Impact of Admission Diagnosis on Recurrent or Frequent Hospitalizations in 3 Dementia Subtypes: A Hospital-Based Cohort in Taiwan with 4 Years Longitudinal Follow-Ups,"Increasing numbers of patients with different types of dementia have resulted in the increasing medical care loads. It is not known whether explanatory factors for recurrent or prolong hospitalization were driven by the subtypes of dementia. We analyzed 203 dementia patients aged >65-year-old with a clinical diagnosis of Alzheimer disease (AD), vascular dementia (VaD), or Parkinsonism-related dementia (PRD). With a 4-year follow-up period, logistic regression analyses were used to identify predictors of dementia diagnosis, cerebrovascular risk factors, chronic systemic diseases, and the etiology for admission for recurrent (>4 times/4 years) or prolonged hospitalization stay (>14 days per hospitalization). There were 48 AD, 96 VaD, and 59 PRD patients that completed the 4-year study. The average length of hospital stay was significant, the shortest in AD and the longest in PRD (P = 0.01), whereas the frequency of hospitalization was not different among 3 dementia subtypes. Although delirium is the most common etiology for admission in the patients, diabetes mellitus (Odds ratio, OR = 2.79, P = 0.02), pneumonia (OR = 11.21, P < 0.001), and fall-related hip fracture (OR = 4.762, P = 0.029) were significantly associated with prolong hospitalization. Patients with coronary artery disease (OR = 9.87, P = 0.02), pneumonia (OR = 84.48, P < 0.001), urinary tract infection (OR = 55.09, P < 0.001), and fall-related fracture (OR = 141.7, P < 0.001) predict recurrent hospitalization. Dementia subtypes did not influence directly on the hospitalization courses. The etiologies for admission carried higher clinical significance, compared with the coexisted systemic diseases.","Aged;Aged, 80 and over;Alzheimer Disease/complications;Dementia/*complications;Dementia, Vascular/complications;Female;Follow-Up Studies;Hospitalization/*statistics & numerical data;Humans;Length of Stay/statistics & numerical data;Male;Parkinson Disease/complications;Patient Readmission/statistics & numerical data","Chang, C. C.;Lin, P. H.;Chang, Y. T.;Chen, N. C.;Huang, C. W.;Lui, C. C.;Huang, S. H.;Chang, Y. H.;Lee, C. C.;Lai, W. A.",2015,Nov,10.1097/md.0000000000002091,0,
731,Adjusted age-adjusted charlson comorbidity index score as a risk measure of perioperative mortality before cancer surgery,"Background Identification of patients at risk of death from cancer surgery should aid in preoperative preparation. The purpose of this study is to assess and adjust the age-adjusted Charlson comorbidity index (ACCI) to identify cancer patients with increased risk of perioperative mortality. Methods We identified 156,151 patients undergoing surgery for one of the ten common cancers between 2007 and 2011 in the Taiwan National Health Insurance Research Database. Half of the patients were randomly selected, and a multivariate logistic regression analysis was used to develop an adjusted-ACCI score for estimating the risk of 90-day mortality by variables from the original ACCI. The score was validated. The association between the score and perioperative mortality was analyzed. Results The adjusted-ACCI score yield a better discrimination on mortality after cancer surgery than the original ACCI score, with c-statics of 0.75 versus 0.71. Over 80 years of age, 70â€""80 years, and renal disease had the strongest impact on mortality, hazard ratios 8.40, 3.63, and 3.09 (P < 0.001), respectively. The overall 90-day mortality rates in the entire cohort varied from 0.9%, 2.9%, 7.0%, and 13.2%in four risk groups stratifying by the adjusted-ACCI score; the adjusted hazard ratio for score 4â€""7, 8â€""11, and 12 was 2.84, 6.07, and 11.17 (P < 0.001), respectively, in 90-day mortality compared to score 0â€""3. Conclusions The adjusted-ACCI score helps to identify patients with a higher risk of 90-day mortality after cancer surgery. It might be particularly helpful for preoperative evaluation of patients over 80 years of age.",acquired immune deficiency syndrome;adult;age adjusted Charlson Comorbidity Index Score;age distribution;aged;article;bile duct cancer;breast cancer;bronchus cancer;cancer mortality;cancer surgery;cancer survival;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;colorectal cancer;comorbidity;congestive heart failure;controlled study;correlation analysis;dementia;diabetes mellitus;esophagus cancer;female;health insurance;health status;heart infarction;hemiplegia;human;ICD-9;kidney disease;leukemia;liver cancer;liver disease;lung cancer;lymphoma;major clinical study;male;mouth cancer;national health insurance;outcome assessment;outpatient;pancreas cancer;peptic ulcer;perioperative period;peripheral vascular disease;pharynx cancer;prostate cancer;rheumatic disease;risk assessment;stomach cancer;surgical mortality;Taiwan;uterine cervix cancer,"Chang, C. M.;Yin, W. Y.;Wei, C. K.;Wu, C. C.;Su, Y. C.;Yu, C. H.;Lee, C. C.",2016,,,0,
732,Lingering questions concerning intensive care unit utilization-Reply,,cerebrovascular accident;Charlson Comorbidity Index;chronic obstructive lung disease;comorbidity;congestive heart failure;dementia;diabetes mellitus;diabetic ketoacidosis;emergency care;heart infarction;high risk patient;hospital admission;hospital cost;hospital discharge;hospital mortality;hospital utilization;hospitalization;human;ICD-9;intensive care;intensive care unit;invasive procedure;letter;lung embolism;mortality rate;multiple organ failure;priority journal;risk assessment;upper gastrointestinal bleeding;workload,"Chang, D. W.;Shapiro, M. F.",2017,,10.1001/jamainternmed.2016.8761,0,
733,Trends of Do-Not-Resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A Hospital-based observational study,"Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital. Data on patients aged 20 years old or more who died of major terminal noncancer diseases, including brain diseases, amyotrophic lateral sclerosis, dementia, chronic obstructive pulmonary disease (COPD) and other lung diseases, heart failure, chronic liver diseases and cirrhosis, and renal failure between 2010 and 2014 were extracted for analysis. A total of 1416 patients aged 20 years or more died of major noncancer diseases in Taipei Veterans General Hospital during the study period. The most common diagnosis was brain diseases, amyotrophic lateral sclerosis, and dementias (n = 510, 36%) followed by chronic obstructive pulmonary disease and other lung diseases (n = 322, 22.7%). Among these noncancer decedents, 1045 (73.8%) had DNR consents, while 134 (9.5%) received hospice care. Patients diagnosed with renal failure had the highest percentage of DNR consent (80%), followed by chronic liver diseases and cirrhosis (77.7%). Patients diagnosed with chronic liver diseases and cirrhosis had the highest percentage of hospice utilization (17.4%), followed by renal failure (15.8%). The percentages of DNR consent and hospice utilization were significantly different across different disease diagnosis, hospitalization department, and year of death. There were increased trends of DNR consent in patients with major noncancer diagnoses, and increased hospice care utilization in patients diagnosed with lung diseases and renal failure from 2010 to 2014. However, the hospice care utilization could be improved. Further study to evaluate factors associated hospice care to improve the utilization is suggested.",aged;chronic disease;classification;cross-sectional study;epidemiology;female;hospice care;hospitalization;human;male;middle aged;mortality;patient care;procedures;resuscitation;standards;statistics and numerical data;Taiwan;total quality management;trends;utilization,"Chang, H. T.;Lin, M. H.;Chen, C. K.;Chou, P.;Chen, T. J.;Hwang, S. J.",2016,,,0,
734,Evaluation of the development of vascular dementia following lacunar infarctions: New vascular events may speed up the deterioration of vascular cognitive disorder,"Aim: To evaluate the cognitive and behavioral course in patients with probable VaD-L, and the affection when they suffered new vascular events during follow-up. Methods: Totally 72 patients with vascular dementia after lacunae cerebral infarction were selected from Neurological Department of Shanghai Huadong Hospital from January 1999 to June 2004. Among them, there were 54 males and 18 females with the average age of (73±7) years. All patients were given aspirin (75 mg/time, once per day), huperzine A (0.05 mg/pill, 2 pillsonce, twice per day) and piracetam (0.4 g/pill, 2 pills/time, 3 times per day).The follow-up was lasted from 1999 to 2001 with 4 months as a cycle and the average time was (24.25±6.01) months. The vascular events included the new vascular episode of brain and heart during the follow up. All patients were tested with CT or MRI, MMSE, NPI and ADL. And according to who did or did not undergo additional vascular episodes, all patients were randomized into 2 groups. Results: Totally 72 cases entered the final analysis. 1 Scores of MMSE were decreased as compared with those before follow up, but those of NPI and ADL were increased after the follow up [(22.3±4.6, 32.1±18.3, 43.7±9.6); (25.3±5.2, 19.4±13.9, 32.6±8.3), (t=5.67-14.86, P < 0.01)]. 2 Scores of MMSE, NPI and ADL in vascular-event occurrence group were deteriorated obviously as compared with those in vascular-event unoccurrence group [(-2.24±1.4, 11.60±14.3, 9.88±12.5); (-1.03±1.7, 2.35±15.6, 2.04±7.3), (t=2.94-7.38, P < 0.01)]. 3 Cognition and behavior deterioration were related with the level of vascular-event occurrence (r=0.920, P <0.01), and cognitive changes were obviously positive related with behavior changes (r=0.793, P < 0.01). Conclusion: VaD-L is characterized by cognitive and behavioral decline. The rate of decline is determined mainly by the occurrence of new vascular episodes. The underlying pathological processes affecting the brain and the severity of the cognitive and the behavioral impairments.",acetylsalicylic acid;huperzine A;piracetam;aged;article;behavior;behavior disorder;brain infarction;brain ventricle;cognition;cognitive defect;computer assisted tomography;controlled study;disease course;disease severity;drug dose regimen;female;follow up;human;major clinical study;male;Mini Mental State Examination;multiinfarct dementia;nuclear magnetic resonance imaging;aspirin,"Chang, J.;Wei, W. S.;Li, Y. J.",2005,,,0,
735,"7-Ketocholesterol induces ATM/ATR, Chk1/Chk2, PI3K/Akt signalings, cytotoxicity and IL-8 production in endothelial cells","Cardiovascular diseases (atherosclerosis, stroke, myocardiac infarction etc.) are the major systemic diseases of elder peoples in the world. This is possibly due to increased levels of oxidized low-density lipoproteins (oxLDLs) such as 7-ketocholesterol (7-KC) and lysophosphatidylcholine (LPC) that damage vascular endothelial cells, induce inflammatory responses, to elevate the risk of cardiovascular diseases, Alzheimer's disease, and age-related macular degeneration. However the toxic effects of 7-KC on endothelial cells are not known. In this study, 7-KC showed cytotoxicity to endothelial cells at concentrations higher than 10 microg/ml. 7-KC stimulated ATM/Chk2, ATR-Chk1 and p53 signaling pathways in endothelial cells. 7-KC also induced G0/G1 cell cycle arrest and apoptosis with an inhibition of Cyclin dependent kinase 1 (Cdk1) and cyclin B1 expression. Secretion and expression of IL-8 in endothelial cells were stimulated by 7-KC. 7-KC further induced intracellular ROS production as shown by increase in DCF fluorescence and Akt phosphorylation. LY294002 attenuated the 7-KC-induced apoptosis and IL-8 mRNA expression of endothelial cells. These results indicate that oxLDLs such as 7-KC may contribute to the pathogenesis of atherosclerosis, thrombosis and cardiovascular diseases by induction of endothelial damage, apoptosis and inflammatory responses. These events are associated with ROS production, activation of ATM/Chk2, ATR/Chk1, p53 and PI3K/Akt signaling pathways.",Gerotarget;apoptosis;atherosclerosis;cytotoxicity;endothelial cells;inflammation,"Chang, M. C.;Chen, Y. J.;Liou, E. J.;Tseng, W. Y.;Chan, C. P.;Lin, H. J.;Liao, W. C.;Chang, Y. C.;Jeng, P. Y.;Jeng, J. H.",2016,Oct 11,10.18632/oncotarget.12578,0,736
736,"7-Ketocholesterol induces ATM/ATR, Chk1/Chk2, PI3K/Akt signalings, cytotoxicity and IL-8 production in endothelial cells","Cardiovascular diseases (atherosclerosis, stroke, myocardiac infarction etc.) are the major systemic diseases of elder peoples in the world. This is possibly due to increased levels of oxidized low-density lipoproteins (oxLDLs) such as 7-ketocholesterol (7-KC) and lysophosphatidylcholine (LPC) that damage vascular endothelial cells, induce inflammatory responses, to elevate the risk of cardiovascular diseases, Alzheimer's disease, and age-related macular degeneration. However the toxic effects of 7-KC on endothelial cells are not known. In this study, 7-KC showed cytotoxicity to endothelial cells at concentrations higher than 10 microg/ml. 7-KC stimulated ATM/Chk2, ATR-Chk1 and p53 signaling pathways in endothelial cells. 7-KC also induced G0/G1 cell cycle arrest and apoptosis with an inhibition of Cyclin dependent kinase 1 (Cdk1) and cyclin B1 expression. Secretion and expression of IL-8 in endothelial cells were stimulated by 7-KC. 7-KC further induced intracellular ROS production as shown by increase in DCF fluorescence and Akt phosphorylation. LY294002 attenuated the 7-KC-induced apoptosis and IL-8 mRNA expression of endothelial cells. These results indicate that oxLDLs such as 7-KC may contribute to the pathogenesis of atherosclerosis, thrombosis and cardiovascular diseases by induction of endothelial damage, apoptosis and inflammatory responses. These events are associated with ROS production, activation of ATM/Chk2, ATR/Chk1, p53 and PI3K/Akt signaling pathways.",Gerotarget;apoptosis;atherosclerosis;cytotoxicity;endothelial cells;inflammation,"Chang, M. C.;Chen, Y. J.;Liou, E. J.;Tseng, W. Y.;Chan, C. P.;Lin, H. J.;Liao, W. C.;Chang, Y. C.;Jeng, P. Y.;Jeng, J. H.",2016,Nov 15,,0,
737,"Visit-to-visit variability of blood pressure and death, end-stage renal disease, and cardiovascular events in patients with chronic kidney disease","Objectives: Visit-to-visit variability of blood pressure (VVV of BP) is an important independent risk factor for premature death and cardiovascular events, but relatively little is known about this phenomenon in patients with chronic kidney disease (CKD) not yet on dialysis. Methods: We conducted a retrospective study in a community-based cohort of 114 900 adults with CKD stages 3-4 (estimated glomerular filtration rate 15-59 ml/min per 1.73 m 2). We hypothesized that VVV of BP would be independently associated with higher risks of death, incident treated end-stage renal disease, and cardiovascular events. We defined systolic VVV of BP using three metrics: coefficient of variation, standard deviation of the mean SBP, and average real variability. Results: The highest versus the lowest quintile of the coefficient of variation was associated with higher adjusted rates of death (hazard ratio 1.22; 95% confidence interval 1.11-1.34) and hemorrhagic stroke (hazard ratio 1.91; confidence interval 1.36-2.68). VVV of BP was inconsistently associated with heart failure, and was not significantly associated with acute coronary syndrome and ischemic stroke. Results were similar when using the other two metrics of VVV of BP. VVV of BP had inconsistent associations with end-stage renal disease, perhaps because of the relatively low incidences of this outcome. Conclusion: Higher VVV of BP is independently associated with higher rates of death and hemorrhagic stroke in patients with moderate to advanced CKD not yet on dialysis.",aldosterone antagonist;angiotensin receptor antagonist;antilipemic agent;antithrombocytic agent;calcium channel blocking agent;creatinine;digoxin;diuretic agent;hemoglobin;high density lipoprotein cholesterol;hydralazine;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein;minoxidil;nitric acid derivative;acute coronary syndrome;acute heart infarction;aged;aorta valve disease;article;atrial fibrillation;blood pressure monitoring;brain hemorrhage;brain ischemia;cardiovascular disease;chronic kidney disease;chronic liver disease;chronic lung disease;cohort analysis;controlled study;creatinine blood level;death;dementia;depression;diabetes mellitus;end stage renal disease;female;follow up;glomerulus filtration rate;heart atrium flutter;heart failure;heart fibrillation;heart infarction;heart ventricle tachycardia;hemoglobin blood level;human;hypertension;incidence;major clinical study;male;outcome assessment;peripheral occlusive artery disease;priority journal;retrospective study;systolic blood pressure;transient ischemic attack;visit to visit variability of blood pressure,"Chang, T. I.;Tabada, G. H.;Yang, J.;Tan, T. C.;Go, A. S.",2016,,,0,
738,Ischemic colitis following colonoscopy in an elder patient with cardiovascular disease,"This case is an 85 year-old female with hypertension, diabetes mellitus, cardiovascular disease, congestive heart failure and dementia. She was admitted for hematuria and low gastrointestinal bleeding, the computed tomography scan of the abdomen and pelvis revealed a transverse colon tumor. She received a colonoscopy that found the tumor made transverse colon almost completely obstruction. The pathology of tumor biopsy showed adenocarcinoma. Unfortunately, abdominal fullness, fever, severe leukocytosis developed one day after the colonoscopy and then hypotension was detected. There was no evidence of arrhythmia or acute coronary syndrome. A follow-up abdominal computed tomography revealed pneumatosis intestinalis at the distal transverse colon, splenic flexure and sigmoid colon, compatible with ischemic colitis. Despite intensive treatment including hydration, inotropic agent infusion, antibiotics therapy and ventilatory support, she died of soon multi-organ failure. Literatures were reviewed for discussion. Ischemic colitis is a rare complication of colonoscopy. The predisposing factors for developing ischemic colitis following colonoscopy include connective tissue disease, advanced age and cardiovascular disease. Ischemic colitis may rarely occur following a colonoscopy without these predisposing factors. For patients with risk factors, we should supply adequate fluids for them, do careful bowel preparation, avoid hyperinflation during the procedure and shorten the procedure time. Be aware of the possible complications including ischemic colitis after colonoscopy and do the proper management.",bisacodyl;C reactive protein;castor oil;inotropic agent;abdominal infection;abdominal tenderness;aged;antibiotic therapy;article;blood pressure measurement;body height;body weight;cardiovascular disease;case report;cause of death;colon adenocarcinoma;colon ischemia;colon tumor;colonoscopy;computer assisted tomography;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;disease severity;electrocardiography;female;fever;follow up;gastrointestinal hemorrhage;hematuria;histopathology;hospital admission;human;human tissue;hydration;hypertension;hypotension;ischemic colitis;leukocyte count;leukocytosis;medical history;multiple organ failure;neoplasm;pneumatosis intestinalis;sinus tachycardia;transverse colon;tumor biopsy;very elderly,"Chang, Y. L.;Tsai, M. S.",2015,,,0,
739,Eradication of Helicobacter pylori Is Associated with the Progression of Dementia: A Population-Based Study,"Objective. To evaluate the effect of eradication of Helicobacter pylori (H. pylori) on the progression of dementia in Alzheimer's disease (AD) patients with peptic ulcer. Methods. Participants with the diagnosis of AD and peptic ulcer were recruited between 2001 and 2008. We examined the association between eradication of H. pylori and the progression of AD using the multiple regression models. Medication shift from Donepezil, Rivastgmine, and Galantamine to Mematine is defined as progression of dementia according to the insurance of National Health Insurance (NHI) under expert review. Results. Among the 30142 AD patients with peptic ulcers, the ratio of medication shift in AD patients with peptic ulcers is 79.95%. There were significant lower incidence comorbidities (diabetes mellitus, hypertension, cerebrovascular disease, coronary artery disease, congestive heart failure and hyperlipidemia) in patients with H. pylori eradication as compared with no H. pylori eradication. Eradication of H. pylori was associated with a decreased risk of AD progression (odds ratio [OR] 0.35 [0.23-0.52]) as compared with no H. pylori eradication, which was not modified by comorbidities. Conclusions. Eradication of H. pylori was associated with a decreased progression of dementia as compared to no eradication of H. pylori in AD patients with peptic ulcers.",,"Chang, Y. P.;Chiu, G. F.;Kuo, F. C.;Lai, C. L.;Yang, Y. H.;Hu, H. M.;Chang, P. Y.;Chen, C. Y.;Wu, D. C.;Yu, F. J.",2013,,10.1155/2013/175729,0,
740,Dementia: A barrier to receiving percutaneous coronary intervention for elderly patients with ST-elevated myocardial infarction,"Objective Percutaneous coronary intervention (PCI) is the first line of treatment for ST-elevated myocardial infarction (STEMI). This study evaluates the role of dementia in diagnostic cardiac catheterization (to receive PCI) in STEMI patients ≥65 years old admitted to high annual volume PCI hospitals. Methods Participants were registered in Florida's comprehensive inpatient surveillance system for the years 2006-2007 with principal diagnosis of STEMI. Dementia was defined using ICD-9 codes for presenile, senile, and Alzheimer's type dementia. Results Data from 8331 STEMI patients were used. Of these, 77.2% were catheterized, 67.2% received PCI, and 9.3% had coronary artery bypass graft (CABG). The mean age of the cohort was 76.3 years (SD 7.8 years.); with 43.3% female, 83.4% white, 4.6% black, and 12% Hispanic/other. Of the 248 (3%) patients with dementia, 42% were catheterized. After adjustment for age, gender, and race/ethnicity, patients with dementia were less likely to be catheterized (RR 0.30, 95% CI 0.30-0.50) than non-demented patients. However, among patients who were catheterized, there was no difference in the use of PCI or CABG for patients with versus without dementia (p = 0.56). Of those with dementia, being older and arriving to the hospital in the afternoon were associated with lower likelihood of being catheterized (RR 0.08, 95% CI 0.02-0.28, and RR 0.30, 95% CI 0.10-0.88, respectively). However, having hyperlipidemia increased the probability of catheterization (RR 3.60, 95% CI 1.86-6.98). Conclusion ST-elevated myocardial infarction patients with dementia were much less likely to receive diagnostic cardiac catheterization, thereby limiting the possibility for receiving optimal care including PCI or CABG. Copyright © 2014 John Wiley & Sons, Ltd.",aged;aged hospital patient;alcohol abuse;article;cerebrovascular accident;chronic kidney disease;chronic obstructive lung disease;cohort analysis;congestive heart failure;coronary artery bypass graft;dementia;depression;diabetes mellitus;elderly care;end stage renal disease;female;heart catheterization;human;hyperlipidemia;hypertension;ICD-9;length of stay;major clinical study;male;non insulin dependent diabetes mellitus;obesity;percutaneous coronary intervention;practice guideline;retrospective study;smoking,"Chanti-Ketterl, M.;Pathak, E. B.;Andel, R.;Mortimer, J. A.",2014,,,0,
741,Functional decline among elderly patients admitted for different illnesses: A cohort study,"Background: Elderly who survive after acute insults are frequently left with intractable complications and multimorbidity. Episodes of hospitalization frequently cause physical limitations among these patients, but illness-specific estimates of functional decline are unclear. Methods: We utilized a prospectively collected cohort of elderly patients (≥ 65) admitted to the general medical wards between January 2014 and August 2014, for analysis. All participants completed questionnaires about clinical features, comorbidity profiles, and pre-morbid functional status, estimated by Barthel Index (BI) on admission. Dedicated nurse practitioners assessed BI on admission and at discharge for enrollees, and the results were analyzed according to their main admission diagnostic categories. Results: We recruited one hundred and fifty-two elderly patients (mean, 80.4 years; 51% male), among whom 55% had hypertension and 39% had diabetes. They were admitted mainly for pulmonary disorders (46%), followed by sepsis of unknown origin (11%), gastrointestinal (10%) and renal (10%) disorders, hepatobiliary (7%) and oncology disorders (7%). Elderly patients admitted for renal and pulmonary disorders had significantly lower pre-morbid BI scores, while those admitted for oncology, gastrointestinal, and neuropsychiatric disorders demonstrated more significant functional decline compared with patients admitted for other disorders (BI scores for oncology, 48.3 ± 23.6; for gastrointestinal, 48.3 ± 28.4; for neuropsychiatric, 57.5 ± 29). Conclusion: We discovered that elderly suffered from different types of illnesses might display variable degrees of functional decline on admission compared to their premorbid status. Rehabilitation programs focusing on those with neuropsychiatric disorders on admission might improve functional outcomes.",aged;article;asthma;Barthel index;chronic kidney disease;chronic obstructive lung disease;comorbidity assessment;coronary artery disease;dementia;diabetes mellitus;elderly care;female;functional status;functional status assessment;gastrointestinal hemorrhage;glomerulus filtration rate;heart failure;human;hypertension;liver cirrhosis;lung disease;major clinical study;male;neoplasm;neuropsychiatry;parkinsonism;peripheral occlusive artery disease;pneumonia;public health;questionnaire;respiratory failure;sepsis;very elderly,"Chao, C. T.;Tsai, H. B.",2016,,,0,
742,Cumulative cardiovascular polypharmacy is associated with the risk of acute kidney injury in elderly patients,"Polypharmacy is common in the elderly due to multi-morbidity and interventions. However, the temporal association between polypharmacy and renal outcomes is rarely addressed and recognized. We investigated the association between cardiovascular (CV) polypharmacy and the risk of acute kidney injury (AKI) in elderly patients. We used the Taiwan National Health Insurance PharmaCloud system to investigate the relationship between cumulative CV medications in the 3 months before admission and risk of AKI in the elderly at their admission to general medical wards in a single center. Community-dwelling elderly patients (>60 years) were prospectively enrolled and classified according to the number of preadmission CV medications. CV polypharmacy was defined as use of 2 or more CV medications. We enrolled 152 patients, 48% with AKI (based upon Kidney Disease Improving Global Outcomes [KDIGO] classification) and 64% with CV polypharmacy. The incidence of AKI was higher in patients taking more CV medications (0 drugs: 33%; 1 drug: 50%; 2 drugs: 57%; 3 or more drugs: 60%; P=0.05) before admission. Patients with higher KDIGO grades also took more preadmission CV medications (P =0.04). Multiple regression analysis showed that patients who used 1 or more CV medications before admission had increased risk of AKI at admission (1 drug: odds ratio [OR]= 1.63, P=0.2; 2 drugs: OR=4.74, P=0.03; 3 or more drugs: OR= 5.92, P =0.02), and that CV polypharmacy is associated with higher risk of AKI (OR 2.58; P = 0.02). Each additional CV medication increased the risk for AKI by 30%. We found that elderly patients taking more CV medications are associated with risk of adverse renal events. Further study to evaluate whether interventions that reduce polypharmacy could reduce the incidence of geriatric AKI is urgently needed.",acetylsalicylic acid;angiotensin receptor antagonist;antibiotic agent;antiinfective agent;atypical antipsychotic agent;calcineurin inhibitor;cardiovascular agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;nonsteroid antiinflammatory agent;acute kidney failure;aged;article;body mass;cerebrovascular disease;chronic kidney disease;chronic obstructive lung disease;comorbidity;coronary artery disease;dementia;diabetes mellitus;drug use;female;geriatric patient;heart failure;hospital admission;hospitalization;human;hypertension;liver cirrhosis;major clinical study;male;mortality;nephrotoxicity;parkinsonism;peptic ulcer;peripheral occlusive artery disease;polypharmacy;prescription;priority journal;Taiwan;very elderly,"Chao, C. T.;Tsai, H. B.;Wu, C. Y.;Lin, Y. F.;Hsu, N. C.;Chen, J. S.;Hung, K. Y.;Agarwal, S.",2015,,,0,
743,"Lifetime Risks, Projected Numbers, and Adverse Outcomes in Asian Patients With Atrial Fibrillation: A Report From the Taiwan Nationwide AF Cohort Study","BACKGROUND: Most data on the clinical epidemiology of atrial fibrillation (AF) come from Western populations, and data for Asians are limited. We investigated the lifetime risk and projected number of AF among Asians. The annual risks of adverse events among patients with AF, time trends, and the risks compared with patients without AF were analyzed. METHODS: Between 2000 and 2011, 289,559 patients aged >/= 20 years experienced new-onset AF in Taiwan. The incidence, prevalence, and lifetime risk of AF were calculated. The risk of adverse events among patients with AF were analyzed and compared with that of age- and sex-matched patients without AF. RESULTS: The incidence of AF in year 2011 was 1.51 per 1,000 person-years, with a lifetime risk of AF being appropriately 1 in 7 for subjects aged > 20 years. The prevalence of AF is estimated to be 4.01% in 2050. Compared with patients without AF, AF was associated with an increased risk of mortality (adjusted hazard ratio [aHR], 2.61), heart failure (aHR, 3.31), ischemic stroke (aHR, 3.34), dementia (aHR, 1.56), sudden cardiac death (aHR, 1.83), and myocardial infarction (aHR, 1.62); all P < .01. The risks of ischemic stroke, heart failure, and mortality were especially higher compared with patients without AF in the initial period (approximately 6 months) after AF was first diagnosed. CONCLUSIONS: The burden of AF among Asian patients is increasing, with a lifetime risk of AF being 1 in 7. Optimized management of any associated comorbidities should be part of the holistic management approach for AF.",adverse events;atrial fibrillation;incidence;lifetime risk;prevalence,"Chao, T. F.;Liu, C. J.;Tuan, T. C.;Chen, T. J.;Hsieh, M. H.;Lip, G. Y. H.;Chen, S. A.",2017,Oct 07,,0,
744,Discussion,,acetylsalicylic acid;clopidogrel;acute coronary syndrome;bleeding;cardiovascular disease;dementia;drug efficacy;drug overdose;drug safety;epistaxis;genotype;heterozygosity;human;loading drug dose;low drug dose;monotherapy;note;percutaneous coronary intervention;peripheral occlusive artery disease;randomized controlled trial (topic);cerebrovascular accident;aspirin,"Chaplin, S.",2010,,,0,
745,Predictors of adherence with antihypertensive and lipid-lowering therapy,"Background: Patients with comorbid hypertension and dyslipidemia are at high risk for cardiovascular disease, which can be considerably mitigated by treatment. Adherence with prescribed drug therapy is, therefore, especially important in these patients. This study was undertaken to describe the patterns and predictors of adherence with concomitant antihypertensive (AH) and lipid-lowering (LL) therapy. Methods: This retrospective cohort study examined 8406 enrollees in a US managed care plan who initiated treatment with AH and LL therapy within a 90-day period. Adherence was measured as the proportion of days covered in each 3-month interval following initiation of concomitant therapy (mean follow-up, 12.9 months). Patients were considered adherent if they had filled prescriptions sufficient to cover at least 80% of days with both classes of medications. A multivariate regression model evaluated potential predictors of adherence. Results: The percentage of patients adherent with both AH and LL therapy declined sharply following treatment initiation, with 44.7%, 35.9%, and 35.8% of patients adherent at 3, 6, and 12 months, respectively. After adjustment for age, sex, and other potential predictors, patients were more likely to be adherent if they initiated AH and LL therapy together, had a history of coronary heart disease or congestive heart failure, or took fewer other medications. Conclusions: Adherence with concomitant AH and LL therapy is poor, with only 1 in 3 patients adherent with both medications at 6 months. Physicians may be able to significantly improve adherence by initiating AH and LL therapy concomitantly and by reducing pill burden.",antihypertensive agent;antilipemic agent;adult;aged;article;cardiovascular risk;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;dyslipidemia;female;human;hypertension;major clinical study;male;managed care organization;prediction;priority journal;cerebrovascular accident;United States,"Chapman, R. H.;Benner, J. S.;Petrilla, A. A.;Tierce, J. C.;Collins, S. R.;Battleman, D. S.;Schwartz, J. S.",2005,,,0,
746,Hallucinations treated with rivastigmine in Creutzfeldt-Jakob disease,"Clinical features at onset of Creutzfeldt-Jakob disease (CJD) may mimic symptoms of Lewy bodies dementia. Clinical evolution, neuroimaging, metabolism exploration, and cerebrospinal fluid investigations may help establishing the diagnosis. However, CJD definite diagnosis requires postmortem autopsy. This symptom overlap led us to successfully prescribe an anticholinesterasic treatment, rivastigmine, to a patient for whom a probable CJD disease was finally diagnosed. © 2011 The Authors Fundamental and Clinical Pharmacology © 2011 Société Française de Pharmacologie et de Thérapeutique.",fructose bisphosphate aldolase;neopterin;risperidone;rivastigmine;aged;aphasia;apraxia;article;case report;cerebellar ataxia;cerebrospinal fluid;cognitive defect;Creutzfeldt Jakob disease;diarrhea;diffuse Lewy body disease;diffusion weighted imaging;disease severity;drug dose increase;drug efficacy;electroencephalogram;extrapyramidal syndrome;female;headache;heart infarction;human;memory disorder;Mini Mental State Examination;neurologic examination;parkinsonism;priority journal;visual hallucination,"Chapuis, C.;Casez, O.;Lagrange, E.;Bedouch, P.;Besson, G.",2012,,,0,
747,Objective cardiac markers and cerebrovascular lesions in Indian seniors,"Cardiovascular risk factors are implicated in cerebrovascular disease, resulting in cognitive impairment. This study investigated the relationship between objective cardiac markers and cerebral changes in older Indian adults with and without dementia. Dementia patients with major electrocardiographic (EKG) abnormalities were 8.19 times more likely to have evidence of stroke on magnetic resonance imaging (MRI) compared with patients with no EKG abnormalities (p<. .05). The relationship between major EKG abnormalities and stroke on MRI was not significant for patients without dementia. Objective cardiac markers may identify MRI cerebrovascular lesions in patients with dementia, and thus guide neuroimaging allocation in resource-poor areas. © 2014 Ministry of Health, Saudi Arabia.",aged;article;cardiovascular risk;cerebrovascular accident;cerebrovascular disease;controlled study;cross-sectional study;dementia;disease association;ECG abnormality;female;atrial fibrillation;heart atrium flutter;heart bundle branch block;heart left ventricle hypertrophy;human;Indian;leukoaraiosis;major clinical study;male;nuclear magnetic resonance imaging;priority journal;Wolff Parkinson White syndrome,"Charles, S. H.;Tow, A. C.;Verghese, J.",2014,,,0,
748,The Charlson comorbidity index can be used prospectively to identify patients who will incur high future costs,"Background: Reducing health care costs requires the ability to identify patients most likely to incur high costs. Our objective was to evaluate the ability of the Charlson comorbidity score to predict the individuals who would incur high costs in the subsequent year and to contrast its predictive ability with other commonly used predictors. Methods: We contrasted the prior year Charlson comorbidity index, costs, Diagnostic Cost Group (DCG) and hospitalization as predictors of subsequent year costs from claims data of fund that provides comprehensive health benefits to a large union of health care workers. Total costs in the subsequent year was the principal outcome. Results: Of the 181,764 predominantly Black and Latino beneficiaries, 70% were adults (mean age 45.7 years; 62% women). As the comorbidity index increased, total yearly costs increased significantly (P<.001). At lower comorbidity, the costs were similar across different chronic diseases. Using regression to predict total costs, top 5th and 10th percentile of costs, the comorbidity index, prior costs and DCG achieved almost identical explained variance in both adults and children. Conclusions and Relevance: The comorbidity index predicted health costs in the subsequent year, performing as well as prior cost and DCG in identifying those in the top 5% or 10%. The comorbidity index can be used prospectively to identify patients who are likely to incur high costs.",NCT01761253;acquired immune deficiency syndrome;adolescent;adult;African American;article;asthma;cellulitis;cerebrovascular disease;Charlson Comorbidity Index;child;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;cost;dementia;depression;diabetes mellitus;diagnostic cost group;female;health care cost;heart infarction;hemiplegia;Hispanic;hospitalization;human;hypertension;infant;leukemia;lymphoma;male;mild hepatic impairment;moderate renal impairment;peripheral vascular disease;predictor variable;preschool child;rheumatic disease;school child;severe hepatic impairment;severe renal impairment;skin ulcer;solid tumor;ulcer,"Charlson, M.;Wells, M. T.;Ullman, R.;King, F.;Shmukler, C.",2014,,,0,
749,General medicine consultation. Lessons from a clinical service,"The 564 consultations performed by a general medicine consultation service during its first year were analyzed in order to provide a concrete definition of this new academic domain. Of the consultations, 52 percent were for patients on the surgical service. Among these patients, the most common reason for consultation was the preoperative management of chronic illness, specifically, hypertension, diabetes, and angina; 47 percent of such patients had two or more chronic illnesses. The service recommended cancellation of planned surgery in 2 percent and postponement in 9 percent of the 210 patients seen preoperatively. Patients on the psychiatric service accounted for 47 percent of the consultations. In this group, diagnostic issues were the most common reasons for consultation, that is, abdominal pain, dementia, and the suspicion of thyroid disease. Only 12 percent of the patients were seen for prognostic reasons, usually related to the planned use of electroconvulsive therapy or tricyclic antidepressants. The service was evaluated by the referring physicians who rated the service favorably on its 'mechanics', as well as on its qualitative performance. However, complaints of triviality were voiced when the average length of the list of recommendations seemed disproportionate to the complexity of the problems. The service was also evaluated by the residents who had provided consultations. From their perspective, the service was more successful in teaching the 'art' of consultation than the 'science'. This experience provides an operational definition of the work facing a general medicine consultation service as well as data useful in focusing future educational programs and research efforts.",angina pectoris;cardiovascular system;clinical article;consultation;diabetes mellitus;diagnosis;endocrine system;general practice;human;hypertension;mental health service;organization and management;preoperative evaluation;surgery,"Charlson, M. E.;Cohen, R. P.;Sears, C. L.",1983,,,0,
750,Meta-analysis and meta-modelling for diagnostic problems,"BACKGROUND: A proportional hazards measure is suggested in the context of analyzing SROC curves that arise in the meta-analysis of diagnostic studies. The measure can be motivated as a special model: the Lehmann model for ROC curves. The Lehmann model involves study-specific sensitivities and specificities and a diagnostic accuracy parameter which connects the two. METHODS: A study-specific model is estimated for each study, and the resulting study-specific estimate of diagnostic accuracy is taken as an outcome measure for a mixed model with a random study effect and other study-level covariates as fixed effects. The variance component model becomes estimable by deriving within-study variances, depending on the outcome measure of choice. In contrast to existing approaches - usually of bivariate nature for the outcome measures - the suggested approach is univariate and, hence, allows easily the application of conventional mixed modelling. RESULTS: Some simple modifications in the SAS procedure proc mixed allow the fitting of mixed models for meta-analytic data from diagnostic studies. The methodology is illustrated with several meta-analytic diagnostic data sets, including a meta-analysis of the Mini-Mental State Examination as a diagnostic device for dementia and mild cognitive impairment. CONCLUSIONS: The proposed methodology allows us to embed the meta-analysis of diagnostic studies into the well-developed area of mixed modelling. Different outcome measures, specifically from the perspective of whether a local or a global measure of diagnostic accuracy should be applied, are discussed as well. In particular, variation in cut-off value is discussed together with recommendations on choosing the best cut-off value. We also show how this problem can be addressed with the proposed methodology.",brain natriuretic peptide;algorithm;dementia;depression;diagnostic error;diagnostic test;heart failure;human;mental health;mild cognitive impairment;outcome assessment;procedures;proportional hazards model;receiver operating characteristic;sensitivity and specificity;statistical model,"Charoensawat, S.;Böhning, W.;Böhning, D.;Holling, H.",2014,,,0,
751,Cause of death and factors associated with early in-hospital mortality after hip fracture,"The aims of this study were to identify the early in-hospital mortality rate after hip fracture, identify factors associated with this mortality, and identify the cause of death in these patients. A retrospective cohort study was performed on 4426 patients admitted to our institution between the 1 January 2006 and 31 December 2013 with a hip fracture (1128 male (26%), mean age 82.0 years (60 to 105)). Admissions increased annually, but despite this 30-day mortality decreased from 12.1% to 6.5%; 77% of these were in-hospital deaths. Male gender (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.3 to 3.0), increasing age (age ? 91; OR 4.1, 95% CI 1.4 to 12.2) and comorbidity (American Society of Anesthesiologists grades 3 to 5; OR 4.2, 95% CI 2.0 to 8.7) were independently and significantly associated with increased odds of in-hospital mortality. From 220 post-mortem reports, the most common causes of death were respiratory infections (35%), ischaemic heart disease (21%), and cardiac failure (13%). A subgroup of hip fracture patients at highest risk of early death can be identified with these risk factors, and the knowledge of the causes of death can be used to inform service improvements and the development of a more didactic care pathway, so that multidisciplinary intervention can be focused for this sub-group in order to improve their outcome.",bone cement device;acute kidney failure;adult;aged;American Society of Anesthesiologist Grade;article;behavior disorder;bone cement implantation syndrome;bronchopneumonia;cause of death;cerebrovascular accident;chronic respiratory tract disease;cohort analysis;comorbidity;dementia;digestive system perforation;enterocolitis;female;femur neck fracture;gastrointestinal hemorrhage;heart failure;high risk patient;hip fracture;human;intestine ischemia;ischemic heart disease;lung edema;major clinical study;male;malignant neoplastic disease;medical device complication;mental disease;middle aged;mortality;parasitosis;peritonitis;priority journal;respiratory failure;respiratory tract infection;retrospective study;scoring system;sepsis;sex difference;urinary tract infection;very elderly;virus infection,"Chatterton, B. D.;Moores, T. S.;Ahmad, S.;Cattell, A.;Roberts, P. J.",2015,,,0,
752,Clinico-radiological predictors of vascular cognitive impairment (VCI) in patients with stroke: A prospective observational study,"Background and purpose Cognitive dysfunction occurs commonly following stroke and varies in severity. This study was aimed to determine the clinical, neuro-imaging, laboratory predictors of post stroke cognitive impairment and factors related to poor functional outcome in patients with post-stroke vascular cognitive impairment (VCI). Material and methods We prospectively evaluated 102 of 240 consecutive stroke patients for 6 months after incident stroke for development of VCI. Patients with VCI comprised of those with VCI-no dementia (VCIND) and vascular dementia (VaD). Functional outcome was assessed by modified Barthel index (MBI). Results Frequency of post-stroke VCI was 45.1% (46/102): 26.5% (27/102) having VCI-ND and 18.6% (19/102) having VaD. Patients with VCI were more likely to have lower educational and socioeconomic status, diabetes, hypertension, prior stroke, multiple risk factors, urinary incontinence, gait abnormality, peripheral signs of atherosclerosis, higher blood sugar level on admission and LDL levels, strategic site lesion, higher ARWMC (age related white matter changes) score, worse stroke severity (NIHSS) and functional outcome scores. On logistic regression analysis, lower educational status, strategic site lesion, higher ARWMC score and baseline stroke severity score were found to independently predict the risk of developing VCI. Worse stroke severity (NIHSS) scores and functional status scores at baseline predicted poor outcome in patients with VCI. Conclusion Post-stroke cognitive impairment is frequent and is associated with poor functional outcome. Predictors like lower educational status, strategic site lesion, greater severity of age related white matter changes and baseline stroke severity independently contributed to the risk of developing VCI in stroke patients. © 2014 Elsevier B.V. All rights reserved.",alcohol;cholesterol;glucose;high density lipoprotein;low density lipoprotein;triacylglycerol;adult;age related white matter change score;article;atherosclerosis;Barthel index;cerebrovascular accident;cholesterol blood level;cognitive defect;dementia;diabetes mellitus;disorders of higher cerebral function;dyslipidemia;educational status;family history;female;functional status;gait disorder;glucose blood level;human;hypertension;ischemic heart disease;major clinical study;male;multiinfarct dementia;assessment of humans;National Institutes of Health Stroke Scale;nuclear magnetic resonance imaging;observational study;outcome assessment;priority journal;prospective study;risk factor;smoking;social status;stroke patient;tobacco;urine incontinence;vascular cognitive impairment;vascular cognitive impairment no dementia,"Chaudhari, T. S.;Verma, R.;Garg, R. K.;Singh, M. K.;Malhotra, H. S.;Sharma, P. K.",2014,,,0,
753,Restricting symptoms in the last year of life: A prospective cohort study,"IMPORTANCE: Freedom from symptoms is an important determinant of a good death, but little is known about symptom occurrence during the last year of life. OBJECTIVE: To evaluate the monthly occurrence of physical and psychological symptoms leading to restrictions in daily activities (ie, restricting symptoms) among older persons during the last year of life and to determine the associations of demographic and clinical factors with symptom occurrence. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study. Comprehensive assessments were completed every 18 months, and monthly interviews were conducted to assess the presence of restricting symptoms. Of 1002 nondisabled community-dwelling individuals 70 years or older in greater New Haven, Connecticut, eligible to participate, 754 agreed and were enrolled between 1998 and 1999. MAIN OUTCOMES AND MEASURES: The primary outcome was the monthly occurrence of restricting symptoms as a dichotomous outcome. The monthly mean count of restricting symptoms was a secondary outcome. RESULTS: Among the 491 participants who died after their first interview and before June 30, 2011, mean age at death was 85.8 years, 61.9%were women, and 9.0% were nonwhite. The mean number of comorbid conditions was 2.4, and 73.1% had multimorbidity. The monthly occurrence of restricting symptoms was fairly constant from 12 months before death (20.4%) until 5 months before death (27.4%), when it began to increase rapidly, reaching 57.2% in the month before death. In multivariable analysis, age younger than 85 years (odds ratio [OR], 1.30 [95% CI, 1.07-1.57]), multimorbidity (OR, 1.38 [95% CI, 1.09-1.75]), and proximity to time of death (OR, 1.14 per month [95% CI, 1.11-1.16]) were significantly associated with the monthly occurrence of restricting symptoms. Participants who died of cancer had higher monthly symptom occurrence (OR, 1.80 [95% CI, 1.03-3.14]) than participants who died of sudden death, although this difference was only marginally significant (P = .04). Symptom burden did not otherwise differ substantially according to condition leading to death. CONCLUSIONS AND RELEVANCE: Restricting symptoms are common during the last year of life, increasing substantially approximately 5 months before death. Our results highlight the importance of assessing and managing symptoms in older patients, particularly those with multimorbidity.",aged;arthritis;article;cerebrovascular accident;cohort analysis;dementia;diabetes mellitus;dizziness;dyspnea;fatigue;female;heart failure;heart infarction;hip fracture;human;hypertension;interview;lung disease;major clinical study;male;morbidity;musculoskeletal pain;neoplasm;outcome assessment;priority journal;prospective study;sudden death;symptom;time of death;unsteadiness,"Chaudhry, S. I.;Murphy, T. E.;Gahbauer, E.;Sussman, L. S.;Allore, H. G.;Gill, T. M.",2013,,,0,
754,Geriatric conditions and subsequent mortality in older patients with heart failure,"OBJECTIVES: This study was designed to develop models for short- (30-day) and long- (5-year) term mortality after heart failure (HF) hospitalization that include geriatric conditions, specifically mobility disability and dementia, to determine whether these conditions emerge as strong and independent risk factors. BACKGROUND: Although 80% of patients with HF are 65 years of age or older, no large studies have focused on the prognostic importance of geriatric conditions. METHODS: We analyzed medical record data from a national sample of Medicare beneficiaries hospitalized for HF. To identify independent predictors of mortality, we performed stepwise selection in multivariable logistic regression models. We used net reclassification improvement to assess the incremental benefit of adding geriatric conditions to a model containing traditional risk factors for mortality. RESULTS: The mean age of patients included in the analysis was 80 years; 59% were women, 13% were nonwhite, 10% had dementia, and 39% had mobility disability. Mortality rates were 9.8% at 30 days and 74.7% at 5 years. Twenty-one variables were considered for inclusion in the final multivariable model. Dementia and mobility disability were among the top predictors of short- and long-term mortality, with among the top 6 largest absolute standardized estimates in the final model for 30-day mortality, and among the top 7 largest standardized estimates for 5-year mortality. The net reclassification improvement when geriatric conditions were added to traditional factors was 5.1% at 30 days and 4.2% at 5 years. CONCLUSIONS: Geriatric conditions are strongly and independently associated with short- and long-term mortality among older patients with HF.","Aged;Aged, 80 and over;Aging/physiology;Alzheimer Disease/complications;Female;Heart Failure/complications/*mortality/physiopathology;Humans;Male;Mobility Limitation;Models, Theoretical;Prognosis;Risk Factors","Chaudhry, S. I.;Wang, Y.;Gill, T. M.;Krumholz, H. M.",2010,Jan 26,10.1016/j.jacc.2009.07.066,0,
755,Head drops are also observed in McLeod syndrome,,phenobarbital;valproic acid;aged;apraxia;axonal neuropathy;brain depth stimulation;case report;chorea;chorea-acanthocytosis;disease severity;dysarthria;dystonia;electromyogram;gait disorder;gene mutation;grand mal epilepsy;head drop;head twitch;human;Huntington chorea;hypertrophic cardiomyopathy;laboratory test;letter;McLeod syndrome;motor dysfunction;muscle hypotonia;neck;neuropathy;priority journal;prognosis;screening test;X chromosome linked disorder,"Chauveau, M.;Damon-Perriere, N.;Latxague, C.;Spampinato, U.;Jung, H.;Burbaud, P.;Tison, F.",2011,,,0,
756,Prevalence and Risk Factors of Atrial Fibrillation in Chinese Elderly: Results from the Chinese Longitudinal Healthy Longevity Survey,"BACKGROUND: Prevalence of atrial fibrillation (AF) is increasing as the world ages. AF is associated with higher risk of mortality and disease, including stroke, hypertension, heart failure, and dementia. Prevalence of AF differs with each population studied, and research on non-Western populations and the oldest old is scarce. METHODS: We used data from the 2012 wave of the Chinese Longitudinal Healthy Longevity Survey, a community-based study in eight longevity areas in China, to estimate AF prevalence in an elderly Chinese population (n = 1418, mean age = 85.6 years) and to identify risk factors. We determined the presence of AF in our participants using single-lead electrocardiograms. The weighted prevalence of AF was estimated in subjects stratified according to age groups (65-74, 75-84, 85-94, 95 years and above) and gender. We used logistic regressions to determine the potential risk factors of AF. RESULTS: The overall prevalence of AF was 3.5%; 2.4% of men and 4.5% of women had AF (P < 0.05). AF was associated with weight extremes of being underweight or overweight/obese. Finally, advanced age (85-94 years), history of stroke or heart disease, low high-density lipoprotein levels, low triglyceride levels, and lack of regular physical activity were associated with AF. CONCLUSIONS: In urban elderly, AF prevalence increased with age (P < 0.05), and in rural elderly, women had higher AF prevalence (P < 0.05). Further exploration of population-specific risk factors is needed to address the AF epidemic.","Aged;Aged, 80 and over;Atrial Fibrillation/*epidemiology;China/epidemiology;Female;Humans;Longitudinal Studies;Male;Prevalence;Risk Factors","Chei, C. L.;Raman, P.;Ching, C. K.;Yin, Z. X.;Shi, X. M.;Zeng, Y.;Matchar, D. B.",2015,Sep 20,10.4103/0366-6999.164918,0,
757,A study on the risk factors of Binswanger's leukoencephalopathy (BE),"A matched case-control study (1:1) was carried out among 122 hospitalized patients with Binswanger's leukoencephalopathy to explore the possible risk factors of BE. Data collected were processed with conditional logistic regression analysis. Individual logistic analysis showed that family history of vascular dementia, history of hypertension, diabetes, coronary heart disease, transient cerebral ischemic attacks (TIAs), cerebral ischemia, cerebral hemorrhage, renal disfunction, alcohol intake smoking were risk factors while healthy life style played protective effect. Body weight index, average family income, education level and type A behavior scores did not show close relations with BE. Multiple regression analysis showed that hypertension, TIAs, coronary heart disease, diabetes and family history of vascular dementia were independent risk factors.","Aged;China/epidemiology;Coronary Disease/complications;Dementia, Vascular/*epidemiology/etiology;Diabetes Complications;Female;Humans;Hypertension/complications;Ischemic Attack, Transient/complications;Logistic Models;Male;Middle Aged;Risk Factors","Chen, C. F.;Chen, T. H.;Jia, H. Y.",1997,Aug,,0,
758,Irritable Bowel Syndrome Is Associated with an Increased Risk of Dementia: A Nationwide Population-Based Study,"PURPOSE: Abnormal interaction in the brain-gut axis has emerged as one of the relevant pathophysiological mechanisms for the development of irritable bowel syndrome (IBS). Moreover, the brain-gut axis has recently been demonstrated to be crucial for the maintenance of cognitive performance. Therefore, we assessed the risk of dementia following diagnosis of IBS. METHODS: Using the Taiwan National Health Insurance Research Database (NHIRD) to obtain medical claims data from 2000 to 2011, we employed a random sampling method to enroll32 298 adult patients with IBS and frequency-matched them according to sex, age, and baseline year with 129 192 patients without IBS. RESULTS: The patients with IBS exhibited an increased risk of dementia [adjusted hazard ratio (aHR) = 1.26, 95% confidence interval (CI) = 1.17-1.35]after adjustment for age, sex, diabetes, hypertension, stroke, coronary artery disease (CAD), head injury, depression, and epilepsy, and the overall incidence of dementia for the cohorts with and without IBS was 4.86 and 3.41 per 1000 person-years, respectively. IBS was associated with an increased risk of dementia in patients older than 50 years in both male and female, and in those with comorbidity or without comorbidity. After adjustment for age, sex, and comorbidity, patients with IBS were also more likely to develop either non- Alzheimer's disease (AD) dementia (aHR = 1.24, 95% CI = 1.15-1.33) or AD (aHR = 1.76, 95% CI = 1.28-2.43). CONCLUSIONS: IBS is associated with an increased risk of dementia, and this effect is obvious only in patients who are >/=50 years old.","Adult;Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/epidemiology;Cardiovascular Diseases/epidemiology;Cohort Studies;Comorbidity;Craniocerebral Trauma/epidemiology;Dementia/*epidemiology;Depression/epidemiology;Diabetes Mellitus/epidemiology;Epilepsy/epidemiology;Female;Humans;Irritable Bowel Syndrome/*epidemiology/psychology;Male;Microbiota;Middle Aged;Proportional Hazards Models;Risk;Risk Factors;Sampling Studies;Taiwan/epidemiology;Young Adult","Chen, C. H.;Lin, C. L.;Kao, C. H.",2016,,10.1371/journal.pone.0144589,0,
759,Health care outcomes and advance care planning in older adults who receive home-based palliative care: A pilot cohort study,"Background: Approximately 20% of seniors live with five or more chronic medical illnesses. Terminal stages of their lives are often characterized by repeated burdensome hospitalizations and advance care directives are insufficiently addressed. This study reports on the preliminary results of a Palliative Care Homebound Program (PCHP) at the Mayo Clinic in Rochester, Minnesota to service these vulnerable populations. Objective: The study objective was to evaluate inpatient hospital utilization and the adequacy of advance care planning in patients who receive home-based palliative care. © 2015, Mary Ann Liebert, Inc. Methods: This is a retrospective pilot cohort study of patients enrolled in the PCHP between September 2012 and March 2013. Two control patients were matched to each intervention patient by propensity scoring methods that factor in risk and prognosis. Primary outcomes were six-month hospital utilization including ER visits. Secondary outcomes evaluated advance care directive completion and overall mortality. Results: Patients enrolled in the PCHP group (n=54) were matched to 108 controls with an average age of 87 years. Ninety-two percent of controls and 33% of PCHP patients were admitted to the hospital at least once. The average number of hospital admissions was 1.36 per patient for controls versus 0.35 in the PCHP (p<0.001). Total hospital days were reduced by 5.13 days. There was no difference between rates of ER visits. Advanced care directive were completed more often in the intervention group (98%) as compared to controls (31%), with p<0.001. Goals of care discussions were held at least once for all patients in the PCHP group, compared to 41% in the controls.",aged;article;chronic obstructive lung disease;cohort analysis;comparative study;congestive heart failure;controlled study;day hospital;dementia;female;health care;home care;hospital admission;hospital utilization;hospitalization;human;major clinical study;male;mortality;outcome assessment;palliative therapy;patient care;pilot study;primary medical care;prognosis;retrospective study;United States;very elderly;vulnerable population,"Chen, C. Y.;Thorsteinsdottir, B.;Cha, S. S.;Hanson, G. J.;Peterson, S. M.;Rahman, P. A.;Naessens, J. M.;Takahashi, P. Y.",2015,,,0,
760,Systematic tracking of disrupted modules identifies altered pathways associated with congenital heart defects in down syndrome,"Background: This work aimed to identify altered pathways in congenital heart defects (CHD) in Down syndrome (DS) by systematically tracking the dysregulated modules of reweighted protein-protein interaction (PPI) networks. Material/Methods: We performed systematic identification and comparison of modules across normal and disease conditions by integrating PPI and gene-expression data. Based on Pearson correlation coefficient (PCC), normal and disease PPI networks were inferred and reweighted. Then, modules in the PPI network were explored by clique-merging algorithm; altered modules were identified via maximum weight bipartite matching and ranked in non-increasing order. Finally, pathways enrichment analysis of genes in altered modules was carried out based on Database for Annotation, Visualization, and Integrated Discovery (DAVID) to study the biological pathways in CHD in DS. Results: Our analyses revealed that 348 altered modules were identified by comparing modules in normal and disease PPI networks. Pathway functional enrichment analysis of disrupted module genes showed that the 4 most significantly altered pathways were: ECM-receptor interaction, purine metabolism, focal adhesion, and dilated cardiomyopathy. Conclusions: We successfully identified 4 altered pathways and we predicted that these pathways would be good indicators for CHD in DS.",Alzheimer disease;article;comparative study;congenital heart malformation;congestive cardiomyopathy;controlled study;disrupted module;Down syndrome;enrichment culture;focal adhesion;gene expression;genetic analysis;human;Huntington chorea;mathematical model;mathematical phenomena;oxidative phosphorylation;Parkinson disease;protein protein interaction;purine metabolism;signal transduction,"Chen, D.;Zhang, Z.;Meng, Y.",2015,,,0,
761,APO A-V -1131T → C polymorphism frequency and its association with morbidity in a Brazilian elderly population,"Identification of genetic polymorphisms as risk factors for complex diseases affecting older people can be relevant for their prevention, diagnosis and management. The -1131T → C polymorphism of the apolipoprotein A-V gene (APO A-V) is tightly linked to lipid metabolism and has been associated with increased triglyceride levels and familial dyslipidemia. The aims of this study were to analyze the allele and genotype frequencies of this polymorphism in a Brazilian elderly population and to investigate any association between the polymorphism and major morbidities affecting elderly people. This polymorphism was investigated in 371 individuals, aged 66-97 years, in a Brazilian Elderly Longitudinal Population Study. Major morbidities investigated were: cerebrovascular diseases (CVD); myocardial infarction (MI); type 2 diabetes; hypertension; obesity; dementia; depression; and neoplasia. DNA was isolated and amplified by PCR and its products were digested with restriction enzyme Tru1l. T and C allele frequencies were 0.842 and 0.158, respectively. Our population showed allele frequencies that were similar to European and Afro-American and different from Asiatic populations. Genotype distributions were not within Hardy-Weinberg equilibrium only for the obesity subject sample. On the other hand, a significant association between the C allele and obesity in the presence of CVDX depression interaction was observed. Logistic analysis showed no association of the polymorphism with each morbidity group. Therefore, the C allele in elderly Brazilian subjects may represent a risk factor for these morbidity interactions, which may lead to better comprehension of their pathophysiology. © 2006 by Walter de Gruyter.",apolipoprotein A5;restriction endonuclease;African American;aged;allele;article;Asian;Brazil;cerebrovascular disease;controlled study;dementia;depression;DNA isolation;European American;female;gene amplification;gene frequency;genetic association;genetic polymorphism;genetic risk;genotype;heart infarction;human;hypertension;longitudinal study;major clinical study;male;morbidity;neoplasm;non insulin dependent diabetes mellitus;obesity;pathophysiology;polymerase chain reaction;population genetics;priority journal;risk factor,"Chen, E. S.;Cendoroglo, M. S.;Ramos, L. R.;Araujo, L. M. Q.;Carvalheira, G. M. G.;De Lábio, R. W.;Burbano, R. R.;Payão, S. L. M.;Smith, M. D. A. C.",2006,,,0,
762,Influence of using different databases and 'look back' intervals to define comorbidity profiles for patients with newly diagnosed hypertension: Implications for health services researchers,"Objective To determine the data sources and 'look back' intervals to define comorbidities. Data Sources Hospital discharge abstracts database (DAD), physician claims, population registry and death registry from April 1, 1994 to March 31, 2010 in Alberta, Canada. Study Design Newly-diagnosed hypertension cases from 1997 to 2008 fiscal years were identified and followed up to 12 years. We defined comorbidities using data sources and duration of retrospective observation (6 months, 1 year, 2 years, and 3 years). The C-statistics for logistic regression and concordance index (CI) for Cox model of mortality and cardiovascular disease hospitalization were used to evaluate discrimination performance for each approach of defining comorbidities. Principal Findings The comorbidities prevalence became higher with a longer duration. Using DAD alone underestimated the prevalence by about 75%, compared to using both DAD and physician claims. The C-statistic and CI were highest when both DAD and physician claims were used, and model performance improved when observation duration increased from 6 months to one year or longer. Conclusion The comorbidities prevalence is greatly impacted by the data source and duration of retrospective observation. A combination of DAD and physicians claims with at least one year observation duration improves predictions for cardiovascular disease and one-year mortality outcome model performance.",acquired immune deficiency syndrome;adult;aged;article;cerebrovascular accident;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;disease duration;disease registry;female;heart infarction;hemiplegia;human;Human immunodeficiency virus infection;hypertension;kidney disease;liver disease;major clinical study;male;malignant neoplastic disease;mortality rate;paraplegia;peptic ulcer;peripheral vascular disease;reference database;retrospective study;rheumatic disease;survival time,"Chen, G.;Lix, L.;Tu, K.;Hemmelgarn, B. R.;Campbell, N. R. C.;McAlister, F. A.;Quan, H.",2016,,,0,
763,The relationship between dizziness and cervical artery stenosis,"Dizziness is a common complaint in neurology departments. We sought to identify the relationship between dizziness and cervical artery stenosis, as assessed using cervical computed tomographic angiography. From 1 January 2012 to 20 April 2014, we prospectively and continuously collected the demographic characteristics, clinical data, and chief complaints of all hospitalized patients aged between 20 and 80 years who underwent computed tomographic angiography at our medical center. Altogether, 5796 hospitalized patients were enrolled in this study. After propensity-score matching, a matched cohort of 1139 patients in a dizziness group and 1139 patients in a nondizziness group was created. The proportion of patients with vertebrobasilar artery stenosis was larger in the dizziness group than in the nondizziness group (13.3 vs. 7.6% in the matched cohort) and was especially larger among patients with stroke histories (19.4 vs. 11.2% in the matched cohort). In the logistic regression, dizziness did not significantly predict carotid artery stenosis (P>0.01). Age, male sex, and hypertension, diabetes, myocardial infarction, cerebral infarction, or demyelinating diseases were the predictors of carotid artery stenosis that remained after adjustment (P<0.01). Patients with dizziness faced nearly twice the risk for vertebrobasilar artery stenosis than did those without dizziness (P<0.01). The other independent predictors of vertebrobasilar artery stenosis were age, male sex, hypertension, coronary artery disease, cerebral infarction, and hemorrhage (P<0.01). Patients with dizziness faced nearly twice the risk for vertebrobasilar artery stenosis than did those without dizziness, whereas dizziness did not significantly predict carotid artery stenosis. NeuroReport 26:1112-1118",adult;anemia;artery occlusion;article;atrial fibrillation;brain hemorrhage;brain infarction;carotid artery obstruction;cervical artery stenosis;chronic obstructive lung disease;computed tomographic angiography;controlled study;coronary artery disease;demyelinating disease;diabetes mellitus;disease association;dizziness;female;heart failure;heart infarction;hospital patient;human;hyperlipidemia;hypertension;hypotension;major clinical study;male;middle aged;multiinfarct dementia;priority journal;valvular heart disease;vertebral artery;vertebral artery stenosis;virus hepatitis,"Chen, H.;Shi, Z.;Feng, H.;Wang, R.;Zhang, Y.;Xie, J.;Yao, S.;Zhou, H.",2015,,,0,
764,National trends in heart failure hospitalization after acute myocardial infarction for medicare beneficiaries 1998-2010,"Background-Previous studies have reported conflicting findings regarding how the incidence of heart failure (HF) after acute myocardial infarction (AMI) has changed over time, and data on contemporary national trends are sparse. Methods and Results-Using a complete national sample of 2 789 943 AMI hospitalizations of Medicare fee-for-service beneficiaries from 1998 through 2010, we evaluated annual changes in the incidence of subsequent HF hospitalization and mortality using Poisson and survival analysis models. The number of patients hospitalized for HF within 1 year after AMI declined modestly from 16.1 per 100 person-years in 1998 to 14.2 per 100 person years in 2010 (P<0.001). After adjusting for demographic factors, a relative 14.6% decline for HF hospitalizations after AMI was observed over the study period (incidence risk ratio, 0.854; 95% confidence interval, 0.809-0.901). Unadjusted 1-year mortality following HF hospitalization after AMI was 44.4% in 1998, which decreased to 43.2% in 2004 to 2005, but then increased to 45.5% by 2010. After adjusting for demographic factors and clinical comorbidities, this represented a 2.4% relative annual decline (hazard ratio, 0.976; 95% confidence interval, 0.974-0.978) from 1998 to 2007, but a 5.1% relative annual increase from 2007 to 2010 (hazard ratio, 1.051; 95% confidence interval, 1.039-1.064). Conclusions-In a national sample of Medicare beneficiaries, HF hospitalization after AMI decreased from 1998 to 2010, which may indicate improvements in the management of AMI. In contrast, survival after HF following AMI remains poor, and has worsened from 2007 to 2010, demonstrating that challenges still remain for the treatment of this high-risk condition after AMI. © 2013 American Heart Association, Inc.",acute coronary syndrome;acute heart infarction;acute leukemia;aged;anemia;angina pectoris;article;asthma;brain disease;cardiovascular mortality;cerebrovascular accident;cerebrovascular disease;chronic obstructive lung disease;comorbidity;congestive heart failure;coronary artery atherosclerosis;decubitus;dementia;diabetes mellitus;disorders of acid base balance;electrolyte disturbance;end stage renal disease;female;follow up;functional disease;heart arrhythmia;heart failure;heart infarction;hematologic disease;hemiplegia;hemodialysis;hospitalization;human;ICD-9-CM;infection;iron deficiency anemia;kidney failure;major clinical study;male;malignant neoplastic disease;medicaid;medical fee;medical history;medicare;metastasis;microangiopathy;outcome assessment;paralysis;paraplegia;pneumonia;priority journal;protein calorie malnutrition;rheumatic heart disease;skin ulcer;survival;urinary tract disease;valvular heart disease;vascular disease;very elderly,"Chen, J.;Hsieh, A. F. C.;Dharmarajan, K.;Masoudi, F. A.;Krumholz, H. M.",2013,,,0,
765,Terminal trajectories of functional decline in the long-term care setting,"BACKGROUND: Little is known about the terminal trajectories of functional decline among long-term care (LTC) residents dying with different diseases. METHODS: A retrospective cohort study was performed on 747 individuals aged 65 or older who died between January 1994 and December 2004 in a 675-bed LTC facility in Massachusetts. Three study groups were created: advanced dementia, n = 314 (42%); terminal cancer, n = 63 (8%); and organ failure (congestive heart failure and chronic obstructive pulmonary disease), n = 370 (50%). Quarterly scores of 7 activities of daily living (ADLs) during the last year of life derived from the Minimum Data Set were compared among the three groups. Each activity was rated from 0 to 4 (higher scores indicate more dependence; total range, 0-28). RESULTS: The mean age of all individuals at death was 91 +/- 6 (standard deviation) years. Functional decline was greatest during the last 3 months of life, but this decline was most precipitous in the terminal cancer and organ failure groups compared to the advanced dementia group. The mean change in ADL scores during the last year of life differed among the three groups (p <.001), with the greatest decline in the terminal cancer group (from initial score 13 to final score 25), followed by the organ failure group (13 to 22), and finally, the advanced dementia group (24 to 27). CONCLUSIONS: The terminal trajectories of functional decline among LTC residents vary by underlying diseases. An understanding of these trajectories may be useful to clinicians and families caring for LTC residents near the end of life.","Activities of Daily Living;Aged;Aged, 80 and over;Analysis of Variance;*Death;*Disability Evaluation;Female;Geriatric Assessment;Humans;*Long-Term Care;Male;Retrospective Studies;*Terminally Ill","Chen, J. H.;Chan, D. C.;Kiely, D. K.;Morris, J. N.;Mitchell, S. L.",2007,May,,0,
766,Mitochondrial dynamic changes in health and genetic diseases,"Mitochondria are highly specialized in function, but mitochondrial and, therefore, cellular integrity is maintained through their dynamic nature. Through the frequent processes of fusion and fission, mitochondria continuously change in shape and adjust function to meet cellular requirements. Abnormalities in fusion/fission dynamics generate cellular dysfunction that may lead to diseases. Mutations in the genes encoding mitochondrial fusion/fission proteins, such as MFN2 and OPA1, have been associated with an increasing number of genetic disorders, including Charcot-Marie-Tooth disease type 2A (CMT2A) and autosomal dominant optic atrophy. In this review, we address the mitochondrial dynamic changes in several important genetic diseases, which will bring the new insight of clinical relevance of mitochondrial genetics.",alpha synuclein,"Chen, L.;Winger, A. J.;Knowlton, A. A.",2014,,,0,
767,Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: The atherosclerosis risk in communities study,"BACKGROUND AND PURPOSE-: The mechanism underlying the association of atrial fibrillation (AF) with cognitive decline in stroke-free individuals is unclear. We examined the association of incident AF with cognitive decline in stroke-free individuals, stratified by subclinical cerebral infarcts (SCIs) on brain MRI scans. METHODS-: We analyzed data from 935 stroke-free participants (mean age±SD, 61.5±4.3 years; 62% women; and 51% black) from 1993 to 1995 through 2004 to 2006 in the Atherosclerosis Risk in Communities Study, a biracial community-based prospective cohort study. Cognitive testing (including the digit symbol substitution and the word fluency tests) was performed in 1993 to 1995, 1996 to 1998, and 2004 to 2006 and brain MRI scans in 1993 to 1995 and 2004 to 2006. RESULTS-: During follow-up, there were 48 incident AF events. Incident AF was associated with greater annual average rate of decline in digit symbol substitution (-0.77; 95% confidence interval,-1.55 to 0.01; P=0.054) and word fluency (-0.80; 95% confidence interval,-1.60 to-0.01; P=0.048). Among participants without SCIs on brain MRI scans, incident AF was not associated with cognitive decline. In contrast, incident AF was associated with greater annual average rate of decline in word fluency (-2.65; 95% confidence interval,-4.26 to-1.03; P=0.002) among participants with prevalent SCIs in 1993 to 1995. Among participants who developed SCIs during follow-up, incident AF was associated with a greater annual average rate of decline in digit symbol substitution (-1.51; 95% confidence interval,-3.02 to-0.01; P=0.049). CONCLUSIONS-: The association of incident AF with cognitive decline in stroke-free individuals can be explained by the presence or development of SCIs, raising the possibility of anticoagulation as a strategy to prevent cognitive decline in AF. © 2014 American Heart Association, Inc.",anticoagulant agent;adult;article;brain infarction;brain ischemia;cardiovascular risk;cohort analysis;confidence interval;electrocardiogram;female;follow up;atrial fibrillation;human;major clinical study;male;mental deterioration;middle aged;multiracial person;nuclear magnetic resonance imaging;priority journal;prospective study,"Chen, L. Y.;Lopez, F. L.;Gottesman, R. F.;Huxley, R. R.;Agarwal, S. K.;Loehr, L.;Mosley, T.;Alonso, A.",2014,,,0,
768,Influencing factors of outcome after lower-limb amputation: a five-year review in a plastic surgical department,"The crude major lower limb amputation procedure rate is 8.8 per 100,000 of the population per year in Taiwan. From January 2002 to October 2006, patients that received major lower limb amputation in our department were enrolled in this study. Retrospective chart reviews concerning different factors that can affect the eventual postoperative functional status were investigated. Factors that affected the length of hospital stay included duration before amputation (P < 0.001) and renal function (P = 0.045). Phantom limb pain was affected by wound healing time (P = 0.006). Factors that affected the daily prosthesis usage time were initial infection status (P = 0.021), renal function (P = 0.01), patient educational level (P = 0.016), and pretraining waiting time (P = 0.003). The duration of prosthetic training was affected by patient educational level (P = 0.004) and marital status (P = 0.024). In addition, subjective satisfaction about the usage of prosthesis was affected by pretraining waiting time (P = 0.001) and daily prosthesis usage time (P < 0.001). The daily prosthesis usage time was closely related to life quality improvement (P < 0.001) and subjective satisfaction of prosthesis usage (P < 0.001). Despite reported unchangeable factors like age, end-stage renal disease, dementia, coronary artery disease, and level of amputation, preprosthesis training waiting time significantly affected the satisfaction and daily usage time of the prosthesis. Surgeons can make some contribution to accelerate amputation wound healing and stump maturation by choosing the correct operating procedure, delicately managing the soft tissue, and ascertaining proper wound care to improve the outcome.","Adult;Aged;Aged, 80 and over;Amputation/*rehabilitation/*statistics & numerical data;Amputation Stumps/surgery;Artificial Limbs/*utilization;Debridement;Diabetic Foot/surgery;Family;Female;Humans;Leg/surgery;Length of Stay;Male;Marital Status;Middle Aged;Patient Education as Topic;Patient Satisfaction;Phantom Limb/epidemiology/rehabilitation;Retrospective Studies;Social Support;Thrombophlebitis/surgery;Treatment Outcome;Wound Healing","Chen, M. C.;Lee, S. S.;Hsieh, Y. L.;Wu, S. J.;Lai, C. S.;Lin, S. D.",2008,Sep,10.1097/SAP.0b013e3181571379,0,
769,"Depression in veterans with Parkinson's disease: frequency, co-morbidity, and healthcare utilization","OBJECTIVE: To determine the frequency of depression in Parkinson's disease (PD) in routine clinical care, and to examine its association with co-morbid psychiatric and medical conditions and healthcare utilization. METHODS: Depression diagnoses and healthcare utilization data for all male veterans with PD age 55 or older seen in fiscal year 2002 (n = 41,162) were analyzed using Department of Veterans Affairs (VA) national databases. Frequencies of co-morbid disorders and healthcare utilization were determined for depressed and non-depressed patients; associations with depression were examined using multivariate logistic regression models. RESULTS: A depression diagnosis was recorded for 18.5% of PD patients, including major depression in 3.9%. Depression decreased in frequency and severity with increasing age. In multivariate logistic regression models, depressed patients had significantly greater psychiatric and medical co-morbidity, including dementia, psychosis, stroke, congestive heart failure, diabetes, and chronic obstructive pulmonary disease than non-depressed patients (all p < 0.01). Depressed PD patients were also significantly more likely to have medical (OR = 1.34, 95% CI = 1.25-1.44) and psychiatric hospitalizations (OR = 2.14, 95% CI = 1.83-2.51), and had more outpatient visits (p < 0.01), than non-depressed PD patients in adjusted models. CONCLUSION: Depression in PD in non-tertiary care settings may not be as common or as severe as that seen in specialty care, though these findings also may reflect under-recognition or diagnostic imprecision. The occurrence of depression in PD is associated with greater psychiatric and medical co-morbidity, and greater healthcare utilization. These findings suggest that screening for depression in PD is important and should be embedded in a comprehensive psychiatric, neuropsychological, and medical evaluation.","Age Factors;Aged;Aged, 80 and over;Comorbidity;Cross-Sectional Studies;Depressive Disorder/*epidemiology/psychology;Depressive Disorder, Major/*epidemiology/psychology;Health Services/*utilization;Humans;Male;Mental Health Services/utilization;Middle Aged;Parkinson Disease/*epidemiology/psychology;Patient Admission/statistics & numerical data;United States;Utilization Review/statistics & numerical data;Veterans/psychology/*statistics & numerical data","Chen, P.;Kales, H. C.;Weintraub, D.;Blow, F. C.;Jiang, L.;Ignacio, R. V.;Mellow, A. M.",2007,Jun,10.1002/gps.1712,0,
770,Clinical risk factors in regional brain ischemia using single photon emission computed tomography,,albumin;glucose;hemoglobin;hemoglobin A1c;lactate dehydrogenase;age distribution;aged;albumin blood level;Alzheimer disease;anemia;brain atrophy;brain hemorrhage;brain infarction;brain ischemia;carotid artery obstruction;cervicobrachial neuralgia;clinical trial;controlled clinical trial;controlled study;depression;diet restriction;erythrocyte count;female;heart arrhythmia;heart failure;human;hypertension;insomnia;ischemic heart disease;letter;major clinical study;male;non insulin dependent diabetes mellitus;perfusion;photon emission tomography;randomized controlled trial;reflux esophagitis;risk factor;sex difference;cerebrovascular accident,"Chen, R.;Liang, F.;Ishigami, K. I.;Kanda, T.;Zeng, L.;Saito, A.;Hasegawa, M.;Yamashita, N.;Itoh, T.;Kigoshi, T.;Izumi, Y.;Takekoshi, N.;Morimoto, S.",2010,,,0,
771,Behind the monitor - The trouble with telemetry: A teachable moment,,lorazepam;atrial fibrillation;delirium;dementia;drug dose titration;hip fracture;hospitalization;human;intensive care unit;ischemic heart disease;physical examination;priority journal;retrospective study;short survey;telemetry,"Chen, S.;Zakaria, S.",2015,,,0,
772,Molecular imaging of amyloidosis: Will the heart be the next target after the brain?,"Amyloidosis is a heterogeneous group of diseases with a common feature of extracellular deposition and infiltration of different types of amyloid fibrils in various organs. For example, Alzheimer's disease is characterized by deposition of amyloid β in the brain. Radiolabeled positron emission tomography (PET) tracers, mainly derivatives of thioflavin-T, were recently introduced for identification of amyloid β plaques in Alzheimer's patients. Such advances of amyloid β plaque imaging of the brain may shed light into imaging of other organs in amyloidosis patients, such as the heart. Cardiac infiltration of amyloid confers poor clinical outcomes, which renders early diagnosis for appropriate clinical management. At present, nuclear imaging of cardiac amyloidosis is predominantly accomplished with bone-seeking radiotracers, such as 99m-technetiumlabeled pyrophosphate ( 99mTc-PYP), 99m-technetiummethylene diphosphonate ( 99mTc-MDP), and 99m-technetium- 3,3,-diphosphono-1,2- propanodicarboxylic acid (99mTc-DPD), with conflicting results in terms of diagnostic performance, with the exception for 99mTc-DPD, which may differentiate light-chain amyloidosis from transthyretin-related cardiac amyloidosis. Although other non-bone-seeking radiotracers such as iodine-123-labeled amyloid P component (123I-SAP), 123-iodine-Meta-iodobenzylguanidine (123I-mIBG), 99mtechnetium- labeled protease inhibitor, and indium-111-labeled amyloid antibodies have also shown some success in identifying cardiac amyloidosis, the future, however, may lie in labeling derivatives of thioflavin-T. With the recent success of visualizing deposition of amyloid β in the brain, the US Food and Drug Administration-approved PET imaging agent 18F-florbetapir may be used to target cardiac amyloidosis next. © Springer Science+Business Media, LLC 2012.",(3 iodobenzyl)guanidine i 123;amyloid beta protein;aprotinin tc 99m;butedronate technetium tc 99m;florbetaben;florbetapir f 18;flutemetamol f 18;imciromab pentetate;medronate technetium tc 99m;Pittsburgh compound B;pyrophosphate technetium tc 99m;thioflavine;tracer;unclassified drug;Alzheimer disease;amyloid plaque;amyloidosis;article;bone marrow transplantation;congestive cardiomyopathy;early diagnosis;echocardiography;familial amyloidosis;heart amyloidosis;heart innervation;heart muscle biopsy;human;isotope labeling;molecular imaging;neuroimaging;positron emission tomography;single photon emission computer tomography,"Chen, W.;Dilsizian, V.",2012,,,0,
773,Acute cholecystitis in end-stage renal disease patients: A nation-wide longitudinal study,"Background: The objective of this study was to evaluate the risks of acute cholecystitis among end-stage renal disease patients and compare the incidence between two dialysis modality. Study design: In this retrospective cohort study, records of fifty thousand end-stage renal disease patients older than 20 years of age from 1998 to 2007 and an age, gender, Charlson's score, diabetes, and dyslipidemia matched control cohort were retrieved from Taiwan National Health Insurance Research Database. Hospitalizations for acute cholecystitis were retrieved using ICD-9-CM diagnosis codes and ICD-9-CM operation codes from in-patient claims. Results: The incidence rates were 5.8 per 1000 patient-years in the end-stage renal disease patients and 0.92 per 1000 patient-years in the control group. End-stage renal disease was an independent risk factor for acute cholecystitis. In the end-stage renal disease patients, independent risk factors were old age, higher Charlson's score, diabetes, severe liver disease, atrial fibrillation, and haemodialysis (all p< 0.05). However, the peritoneal dialysis patients had a higher mortality rate after developing acute cholecystitis. Conclusion: Acute cholecystitis is not uncommon in end-stage renal disease patients. The independent risk factors were older age, higher Charlson's score, atrial fibrillation, severe liver disease, diabetes, and dialysis modality. Haemodialysis patients had a higher risk of acute cholecystitis than PD patients. © 2012.",acute cholecystitis;adult;article;Charlson Comorbidity Index;cohort analysis;connective tissue disease;dementia;diabetes mellitus;dyslipidemia;female;follow up;atrial fibrillation;heart failure;heart infarction;hemodialysis;human;hypertension;incidence;kidney failure;liver disease;longitudinal study;major clinical study;male;peripheral vascular disease;peritoneal dialysis;priority journal;renal replacement therapy;retrospective study;risk factor,"Chen, Y. T.;Ou, S. M.;Chao, P. W.;Li, S. Y.;Chen, T. J.;Tsai, L. W.;Chen, T. W.",2013,,,0,
774,Excess mortality and hospitalized morbidity in newly treated epilepsy patients,"Objective: To assess the burden of mortality and hospitalized morbidity in newly treated epilepsy patients. Methods: We extracted relevant data of patients with newly treated epilepsy between September 16, 2005, and September 15, 2010, from the data repository covering all public hospitals in Hong Kong. Patients were followed up until September 15, 2011. Mortality and hospitalized morbidity were assessed, stratified by baseline comorbidities, number of antiepileptic drugs (AEDs) used, and treatment with enzyme-inducing AEDs (EIAEDs). Mortality was compared to the age-and sex-specific general population in Hong Kong. Results: Of the 7,461 newly treated epilepsy patients (55% male; median age 60 years), 2,166 (29%) died during the study period. The standardized mortality ratio was 5.09 (95% confidence interval [CI] 4.88-5.31), and was higher among those with physical or psychiatric baseline comorbidity (5.46; 95% CI 5.22-5.71) than those without (3.28; 95% CI 2.87-3.73). Standardized hospitalization ratio was 6.76 (95% CI 6.70-6.82). Baseline physical comorbidity-free patients (n 3,514) exhibited higher risk of developing stroke (standardized incidence ratio [SIR] 4.96; 95% CI 4.19-5.84) and ischemic heart disease (SIR 4.18; 95% CI 3.54-4.91), and male patients had elevated risk of developing cancer (SIR 2.30; 95% CI 1.75-2.97). Patients treated with EIAEDs had higher risk of being subsequently recorded with new physical comorbidities than those with non-EIAEDs (relative risk [RR] 1.48; 95% CI 1.19-1.85), especially for cerebrovascular disease (RR 1.78; 95% CI 1.14-2.77). Conclusions: Newly treated epilepsy patients bear excess mortality and hospitalization risks. They have higher risk of developing stroke, ischemic heart disease, and cancer. Treatment with EIAEDs was associated with increased overall morbidity.",anticonvulsive agent;enzyme inducing antiepileptic drug;unclassified drug;adult;alcoholism;article;cerebrovascular accident;Charlson Comorbidity Index;chronic lung disease;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;drug dependence;epilepsy;female;follow up;heart infarction;hemiplegia;Hong Kong;human;ischemic heart disease;kidney disease;major clinical study;male;mental disease;metastasis;monotherapy;mood disorder;morbidity;mortality;neoplasm;paraplegia;peptic ulcer;peripheral vascular disease;priority journal;public hospital,"Chen, Z.;Liew, D.;Kwan, P.",2016,,,0,
775,Involvement of the Warburg effect in non-tumor diseases processes,"Warburg effect, as an energy shift from mitochondrial oxidative phosphorylation to aerobic glycolysis, is extensively found in various cancers. Interestingly, increasing researchers show that Warburg effect plays a crucial role in non-tumor diseases. For instance, inhibition of Warburg effect can alleviate pulmonary vascular remodeling in the process of pulmonary hypertension (PH). Interference of Warburg effect improves mitochondrial function and cardiac function in the process of cardiac hypertrophy and heart failure. Additionally, the Warburg effect induces vascular smooth muscle cell proliferation and contributes to atherosclerosis. Warburg effect may also involve in axonal damage and neuronal death, which are related with multiple sclerosis. Furthermore, Warburg effect significantly promotes cell proliferation and cyst expansion in polycystic kidney disease (PKD). Besides, Warburg effect relieves amyloid β-mediated cell death in Alzheimer's disease. And Warburg effect also improves the mycobacterium tuberculosis infection. Finally, we also introduce some glycolytic agonists. This review focuses on the newest researches about the role of Warburg effect in non-tumor diseases, including PH, tuberculosis, idiopathic pulmonary fibrosis (IPF), failing heart, cardiac hypertrophy, atherosclerosis, Alzheimer's diseases, multiple sclerosis, and PKD. Obviously, Warburg effect may be a potential therapeutic target for those non-tumor diseases.",aerobic glycolysis;agonist;Alzheimer disease;atherosclerosis;axon;cell death;cell proliferation;fibrosing alveolitis;gene inactivation;heart failure;heart function;heart hypertrophy;human;kidney polycystic disease;malignant neoplasm;mitochondrion;multiple sclerosis;oxidative phosphorylation;pulmonary hypertension;scientist;tuberculosis;vascular remodeling;vascular smooth muscle cell;amyloid beta protein;endogenous compound,"Chen, Z.;Liu, M.;Li, L.;Chen, L.",2017,,10.1002/jcp.25998,0,
776,Examining pediatric resuscitation education using simulation and scripted debriefing: A multicenter randomized trial,"Importance: Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings. Objective: To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. Design: Prospective, randomized, factorial study design. Setting: The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing. Participants: Werandomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. Intervention: Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators. Main Outcomes and Measures: Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC). Results: There was no significant difference at baseline in nonscripted vs scripted groups for MCQ(P =.87), BAT (P =.99), and CPT (P =.95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P =.04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P =.03). Their improvement in clinical performance during simulated cardio-pulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P =.18). Level of physical realism of the simulator had no independent effect on these outcomes. Conclusions and Relevance: The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors. ©2013 American Medical Association. All rights reserved.",article;behavioral assessment tool;cardiopulmonary arrest;clinical assessment tool;clinical performance tool;health care personnel;human;major clinical study;medical education;priority journal;professional knowledge;prospective study;psychomotor performance;randomized controlled trial;resuscitation;simulation;simulator,"Cheng, A.;Hunt, E. A.;Donoghue, A.;Nelson-McMillan, K.;Nishisaki, A.;LeFlore, J.;Eppich, W.;Moyer, M.;Brett-Fleegler, M.;Kleinman, M.;Anderson, J.;Adler, M.;Braga, M.;Kost, S.;Stryjewski, G.;Min, S.;Podraza, J.;Lopreiato, J.;Hamilton, M. F.;Stone, K.;Reid, J.;Hopkins, J.;Manos, J.;Duff, J.;Richard, M.;Nadkarni, V. M.",2013,,,0,
777,Risk of developing Parkinson's disease among patients with asthma: A nationwide longitudinal study,"Background A cross-sectional retrospective study suggested a link between allergic diseases and Parkinson's disease. However, the temporal association between asthma and Parkinson's disease remains unknown. Methods From the Taiwan National Health Insurance Research Database, 10 455 patients who were diagnosed with asthma between 1998 and 2008 and aged ≥45 years and 41 820 age- and sex-matched controls were selected for our study and observed until the end of 2011. Those who developed Parkinson's disease during the follow-up period were identified. We also examined the asthma severity, as indicated by the frequency of admission (times per year) for asthma exacerbation, and the risk of subsequent Parkinson's disease. Results Patients with asthma had an increased risk of developing Parkinson's disease (hazard ratio [HR]: 3.10, 95% confidence interval [CI]: 2.20-4.36) after we adjusted for demographic data, health system use, medical comorbidities, and medication use. Sensitivity tests yielded consistent findings after we excluded observations on the first year (HR: 2.90, 95% CI: 2.04-4.13) and first 3 years (HR: 2.46, 95% CI: 1.64-3.69). Patients with asthma who had more frequent admissions (times per year) during the follow-up period exhibited a greater risk of subsequent Parkinson's disease (>2: HR: 16.42, 95% CI: 5.88-45.91; 1-2: 12.69, 95% CI: 5.03-31.71; 0-1: HR: 2.92, 95% CI: 1.91-4.49). Conclusion Patients with asthma had an elevated risk of developing Parkinson's disease later in life, and we observed a dose-dependent relationship between greater asthma severity and a higher risk of subsequent Parkinson's disease.",antihistaminic agent;beta adrenergic receptor stimulating agent;steroid;xanthine derivative;adult;aged;alcoholism;allergic rhinitis;article;asthma;atopic dermatitis;cerebrovascular disease;chronic respiratory tract disease;comorbidity;controlled study;dementia;demography;depression;diabetes mellitus;disease association;disease exacerbation;dyslipidemia;female;follow up;head injury;health care system;human;hypertension;ischemic heart disease;kidney disease;longitudinal study;major clinical study;male;Parkinson disease;priority journal;substance abuse,"Cheng, C. M.;Wu, Y. H.;Tsai, S. J.;Bai, Y. M.;Hsu, J. W.;Huang, K. L.;Su, T. P.;Li, C. T.;Tsai, C. F.;Yang, A. C.;Lin, W. C.;Pan, T. L.;Chang, W. H.;Chen, T. J.;Chen, M. H.",2015,,,0,
778,A novel pathway identification analysis based on attractor of within-pathway effects and crosstalk inter-pathways on effects of sevoflurane and propofol,"The gas sevoflurane and the intravenous propofol are widely used inhalation anesthetic for surgery. A novel pipeline reinforcing of attractor and crosstalk was introduced to identify dysregulated pathways associated with effects of sevoflurane and propofol. Patients scheduled for off-pump coronary artery bypass graft (CABG) surgery were grouped in the anesthetic gas sevoflurane (n = 10) and the intravenous anesthetic propofol (n = 10), which were collected from E-GEOD-4386. 300 pathways were obtained from Kyoto Encyclopedia of Genes and Genomes (KEGG) database and 787896 protein-protein interaction sets were gathered from the Retrieval of Interacting Genes. Then, attract was used to screen differentially expressed pathways. The pathway crosstalk networks were constructed to assess interactions inter-pathways. We used impact factor to assess the interactions inter-pathways and RP-value to evaluate the comprehensive identified ability. Then 7 significantly dysfunctional pathways with strong interactions which were related to effects of anesthetics were found. Among them, Cytokine-cytokine receptor interaction (KEGG ID: 04060) was the most significantly different pathway. The effect of propofol on patients undergoing CABG surgery was better than that of sevoflurane. A novel process was constructed that identified the dysregulated pathways on effects of two anesthetics, which was based on attractor of within-pathway effects and crosstalk inter-pathways. We hope the new method will become more prevalent in the identification of candidate pathways in the future.",phosphatidylinositol 3 kinase;propofol;protein kinase B;sevoflurane;adrenergic activity;article;clinical article;congestive cardiomyopathy;controlled study;cytokine production;drug efficacy;gene expression;gene regulatory network;human;Huntington chorea;hypertrophic cardiomyopathy;off pump coronary surgery;protein protein interaction;signal transduction;spliceosome,"Cheng, H.;Zhang, K.;Cheng, L.;Zhou, X.",2016,,,0,
779,Can Combination Drug Therapy Potentially Reduce Multiple Medications and Polypharmacy in Nursing Homes?,,acetylsalicylic acid;alendronic acid;alpha tocopherol;aminoglutethimide;antihypertensive agent;aromatase inhibitor;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;folic acid;glibenclamide plus metformin;hydroxymethylglutaryl coenzyme A reductase inhibitor;parathyroid hormone;selective estrogen receptor modulator;selegiline;tamoxifen;thiazide diuretic agent;Alzheimer disease;comorbidity;drug indication;drug mechanism;frail elderly;heart infarction;human;letter;nursing home;osteoporosis;patient care;polypharmacy;postmenopause osteoporosis;practice guideline;cerebrovascular accident;glucovance,"Cheng, H. y",2006,,,0,
780,Cardiogenic dementia 4,,aged;dementia;heart disease;heart infarction;human;letter,"Cheng, T. O.",1992,,,0,
781,Microvascular network alterations in the retina of patients with Alzheimer's disease,"BACKGROUND: Although cerebral small-vessel disease has been implicated in the development of Alzheimer's disease (AD), the cerebral microcirculation is difficult to visualize directly in vivo. Because the retina provides a noninvasive window to assess the microcirculation, we determined whether quantitatively measured retinal microvascular parameters are associated with AD. METHODS: We conducted a case-control study (case:control matching approximately 1:2). Retinal photographs were analyzed using a computer program, and a spectrum of quantitative retinal microvascular parameters (caliber, fractal dimension, tortuosity, and bifurcation) were measured. Logistic regression models were used to compute the odds ratio (OR) and 95% confidence interval for AD adjusting for age, gender, ethnicity, smoking, hypertension, diabetes, hypercholesterolemia, and history of myocardial infarction. RESULTS: We included 136 demented patients with AD and 290 age-gender-race-matched controls. Persons with narrower venular caliber (OR per standard deviation [SD] decrease, 2.01 [1.27-3.19]), decreased arteriolar and venular fractal dimension (OR per SD decrease 1.35 [1.08-1.68], 1.47 [1.17-1.84], respectively) and increased arteriolar and venular tortuosity (OR per SD increase, 1.84 [1.40-2.31], 1.94 [1.48-2.53], respectively) were more likely to have AD. These associations still persisted when only AD cases without a history of cerebrovascular disease were included. CONCLUSIONS: Patients with AD have altered microvascular network in the retina (narrower retinal venules and a sparser and more tortuous retinal vessels) compared with matched nondemented controls. These changes in retinal microvasculature may reflect similar pathophysiological processes in cerebral microvasculature in the brains of patients with AD.",Aged;Alzheimer Disease/*pathology;Case-Control Studies;Female;Humans;Male;Microvessels/*pathology;Retina/*pathology;Retinal Vessels/*pathology;Retinoscopy;Retrospective Studies;Alzheimer's disease;Microcirculation;Retina;Retinal vasculature;Small-vessel disease,"Cheung, C. Y.;Ong, Y. T.;Ikram, M. K.;Ong, S. Y.;Li, X.;Hilal, S.;Catindig, J. A.;Venketasubramanian, N.;Yap, P.;Seow, D.;Chen, C. P.;Wong, T. Y.",2014,Mar,10.1016/j.jalz.2013.06.009,0,
782,Comparative adherence to oral hormonal agents in older women with breast cancer,"We aim to (1) compare compliance of anastrozole, letrozole, exemestane, and tamoxifen in women and (2) identify clinical factors associated with medication non-adherence and non-persistence. Female Medicare beneficiaries who were new users of anastrozole, letrozole, exemestane, or tamoxifen between 2007 and 2010 were analyzed. Multivariate-modified Poisson and Cox regression models were constructed to compare non-adherence and non-persistence, respectively, across the different oral agents. A total of 5,150 women were included: mean age was 76.4 years, 2352 initiated anastrozole, 1401 letrozole, 248 exemestane, and 1149 tamoxifen. Non-adherence and non-persistence were 41 and 49 % respectively, with exemestane being associated with the worst non-adherence and non-persistence (RR 1.57, 95 % CI 1.37–1.80, p < 0.001; HR 1.93, 95 % CI 1.63–2.30, respectively, p < 0.001), followed by letrozole (RR 1.39, 95 % CI 1.26–1.53, p < 0.001; HR 1.47, 95 % CI 1.32–1.64, respectively, p < 0.001), and anastrozole (RR 1.16, 95 % CI 1.05–1.27, p = 0.003; HR 1.14, 95 %CI 1.03–1.27, respectively, p = 0.011), whereas tamoxifen was associated with the best compliance. Use of statins and osteoporosis medications was correlated with improved adherence (RR 0.89, 95 % CI 0.82–0.96, p = 0.002 and RR 0.84, 95 % CI 0.76–0.92, p < 0.001, respectively, for non-adherence) and persistence (HR 0.86, 95 % CI 0.79–0.94, p < 0.001 and HR 0.86, 95 % CI 0.78–0.96, p = 0.005, respectively, for non-persistence), but chronic kidney disease was correlated with worse non-persistence (HR 1.15, 95 % CI 1.04–1.33, p = 0.04). Age ≥ 70 years was also associated with worse compliance. Compliance to oral hormonal therapy varied depending on the type of agent, age, and concurrent medications, highlighting specific opportunities to improve adherence and persistence in older women with breast cancer.",anastrozole;angiotensin receptor antagonist;antidepressant agent;antidiabetic agent;antilipemic agent;antithrombocytic agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;capecitabine;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;exemestane;hydroxymethylglutaryl coenzyme A reductase inhibitor;letrozole;neuroleptic agent;spironolactone;tamoxifen citrate;thiazide diuretic agent;age;aged;anxiety disorder;article;breast cancer;cardiomyopathy;Caucasian;cerebrovascular disease;chronic kidney disease;chronic obstructive lung disease;comorbidity;correlation analysis;delirium;dementia;depression;diabetes mellitus;drug substitution;drug use;drug withdrawal;female;human;ischemic heart disease;major clinical study;medicare;mood disorder;osteoporosis;patient compliance;priority journal;regression analysis;valvular heart disease,"Cheung, W. Y.;Lai, E. C. C.;Ruan, J. Y.;Chang, J. T.;Setoguchi, S.",2015,,,0,
783,Incremental burden of congestive heart failure among elderly with Alzheimer's,"Objective: A complex relationship exists between Alzheimer's disease (AD) and other co-existing co-morbidities such as congestive heart failure (CHF) with implications for health resource utilization (HRU) and cost of care. Study objective was to assess HRU and cost of care in elderly with AD and with or without concomitant CHF. Methods: All elderly (65 years) from an academic healthcare system diagnosed with AD in 1999 (n = 904) and matched AD-free controls (n = 3616). Each group was subdivided into those with and without a CHF diagnosis. Costs and HRU were obtained from Medicare databases for 1999 and 2000. Costs and HRU were compared using ANOVA and Wilcoxon rank sum tests. Regressions were used to model the effect of AD and CHF on outcomes. Results: Mean annual cost were $20,888 for AD + CHF group, $5473 for only AD group, $17,700 for only CHF group and $4578 for the control group (no-AD and no-CHF). After adjusting for covariates, AD + CHF group had an eight-fold increase in total cost, while only CHF group had five-fold increase in total cost, compared to the control group. Regressions for inpatient costs, outpatient costs and inpatient pharmacy costs exhibited comparable trends. Conclusions: For elderly AD patients, a co-occurring diagnosis of CHF can result in a substantial increase in cost and HRU. This necessitates additional considerations if health care expenditures are to be reduced, particularly inpatient expenditure.",aged;Alzheimer disease;ambulatory care;article;case control study;comorbidity;congestive heart failure;controlled study;female;geriatric patient;health care cost;health care system;health care utilization;hospital cost;human;major clinical study;male;medicare;priority journal;retrospective study,"Chhatre, S.;Weiner, M. G.;Jayadevappa, R.;Johnson, J. C.",2009,,,0,
784,Prevalence and incidence of comorbidities in elderly women with ovarian cancer,"Objective: Studies suggest comorbidity plays an important role in ovarian cancer. We characterized the epidemiology of comorbid conditions in elderly U.S. women with ovarian cancer. Methods: Women with ovarian cancer age ≥ 66 years, and matched cancer-free women, were identified using the National Cancer Institute's Surveillance, Epidemiology, and End Results registry linked to Medicare claims. Prevalence before diagnosis/index date and 3- and 12-month incidence rates (per 1000 person-years) after diagnosis/index date were estimated for 34 chronic and acute conditions across a broad range of diagnostic categories. Results: There were 5087 each of women with ovarian cancer and cancer-free women. The prevalence of most conditions was similar between cancer and cancer-free patients, but exceptions included hypertension (51.8% and 43.5%, respectively), osteoarthritis (13.4% and 17.3%, respectively), and cerebrovascular disease (8.0% and 9.8%, respectively). In contrast, 3- and 12-month incidence rates (per 1000 person years) of most conditions were significantly higher in cancer than in cancer-free patients: hypertension (177.3 and 47.4, respectively); thromboembolic event (145.3 and 5.5, respectively); congestive heart failure (113.3 and 28.6, respectively); infection (664.4 and 55.2, respectively); and anemia (408.3 and 33.1, respectively) at 12 months. Conclusions: Comorbidities were common among elderly women. After cancer diagnosis, women with ovarian cancer had a much higher incidence of comorbidities than cancer-free women. The high incidence of some of these comorbidities may be related to the cancer or its treatment, but others may have been prevalent but undiagnosed until the cancer diagnosis. The presence of comorbidities may affect treatment decisions. © 2013 Elsevier Inc. All rights reserved.",acute disease;aged;Alzheimer disease;anemia;artery thrombosis;article;atherosclerosis;bronchitis;cancer diagnosis;cancer incidence;cerebrovascular disease;cholecystitis;chronic disease;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;coronary artery disease;depression;diabetes mellitus;diarrhea;electrolyte disturbance;emphysema;female;geriatric patient;heart arrest;heart arrhythmia;atrial fibrillation;heart atrium flutter;heart infarction;hemiplegia;human;hyperglycemia;hypertension;infection;kidney disease;liver disease;major clinical study;nephrotic syndrome;neutropenia;oral mucositis;osteoarthritis;ovary cancer;peripheral vascular disease;prevalence;priority journal;rash;rheumatic disease;skin defect;stomach ulcer;thrombocytopenia;thromboembolism,"Chia, V. M.;O'Malley, C. D.;Danese, M. D.;Lindquist, K. J.;Gleeson, M. L.;Kelsh, M. A.;Griffiths, R. I.",2013,,,0,
785,Systematic evaluation of drug-disease relationships to identify leads for novel drug uses,"Drug repositioning refers to the discovery of alternative uses for drugsuses that are different from that for which the drugs were originally intended. One challenge in this effort lies in choosing the indication for which a drug of interest could be prospectively tested. We systematically evaluated a drug treatment-based view of diseases in order to address this challenge. Suggestions for novel drug uses were generated using a guilt by association approach. When compared with a control group of drug uses, the suggested novel drug uses generated by this approach were significantly enriched with respect to previous and ongoing clinical trials. © 2009 American Society for Clinical Pharmacology and Therapeutics.",atorvastatin;bevacizumab;doxycycline;magnesium;rituximab;rivastigmine;acquired immune deficiency syndrome;acute coronary syndrome;alcohol withdrawal;Alzheimer disease;anemia;article;asthma;breast cancer;cataract;chronic obstructive lung disease;clinical evaluation;clinical trial;colorectal cancer;comparative study;control group;Crohn disease;drug use;endometritis;glaucoma;heart infarction;Hodgkin disease;human;non small cell lung cancer;lupus erythematosus;mantle cell lymphoma;multiple myeloma;multiple sclerosis;mycosis;nephroblastoma;nonhodgkin lymphoma;osteosarcoma;Parkinson disease;priority journal;rheumatoid arthritis;sarcoidosis;stomach cancer;stomach ulcer,"Chiang, A. P.;Butte, A. J.",2009,,,0,
786,"The effects and safety of Shen zhi ling oral liquid for the treatment of amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD) (heart qi deficiency syndrome),: randomized, double-blind, placebo-controlled, multi-center clinical trial study","Inclusion criteria: 1. Aged 50 to 85; 2. Memory loss >=6 months duration, confirmed by others; 3. MMSE score 22-26; 4. Meet the amnestic mild cognitive impairment (MCI) or Alzheimer's disease (AD) diagnostic criteria; 5. TCM syndrome differentiation is qi deficiency Syndrome 6. MRI findings in line with the requirements of the subject; 7. sufficient visual and auditory resolution acceptable neuropsychological tests; 8. There is a certain level of education, read simple texts and write simple sentences; 9. A stable caregiver; 10. Signed the inform consent. Exclusion criteria: 1. suffering from vascular dementia or other causes of dementia, including VaD, Parkinson's disease, Huntington's disease, normal pressure hydrocephalus, brain tumor, progressive supranuclear palsy, epilepsy, chronic subdural hematoma and multiple sclerosis, severe head trauma with persistent neurological deficits or abnormal brain structure known; 2. cerebrovascular disease, thyroid disease, vitamin B12 or folate deficiency, anemia or severe malnutrition, severe heart, liver, lung, kidney and other organ disease affecting the central nervous system dysfunction; cerebral vascular disease where the evidence in single or multiple vascular territories, and cognitive decline associated with brain infarction important parts, including the angular gyrus, thalamus, basal forebrain, the anterior cerebral artery territory back to the brain, multiple basal ganglia infarcts, white matter ischemic changes involving extensive white matter region least a full 25% or more; 3. allergies ,Aricept or hydrochloric acid piperidine derivatives allergy; 4. taking cholinergic or anticholinergic drugs and drugs that affect cognitive function at the same period; 5. depression, schizophrenia and other mental illness; 6. alcohol, long-term use of antipsychotics; 7. can not coordinate with cognitive function tests. aMCI treatment group:Shen zhi ling oral liquid;aMCI control group:Shen zhi ling oral liquid Mimetics;AD treatment group:Donepezil hydrochloride+Shen zhi ling oral liquid;AD control group:Donepezil hydrochloride+Shen zhi ling oral liquid Mimetics; MMSE;ADAS-Cog; Alzheimer's disease (AD) conversions;CIBIC-Plus;TCM symptom score;MRI;",Sr-dementia,"ChiCtr, Ipr",2015,,,0,
787,Intervention study of DHA and its metabolite on mild cognitive impairment among community-based elderly population,"Inclusion criteria: 1. Community-based elderly subjects aged between 65 years old and 75 years old; 2. Memory complaints reported by the patient, family, or physician, of at least a 6-month duration and preferably corroborated by an informant; 3. Mild quantitative impairments in cognitive function were assessed by the Chinese version of the 30-point Mini Mental State Examination (MMSE) using age- and education-based norms (cutoff point was set at 1.5 SD below the mean age- and education-adjusted MMSE scores); 4. Decreased daily living ability and social function, as measured by the daily living scale, score is below 18; 5. Absence of dementia (according to DSM-IV criteria), psychiatric disorder, cerebral damage, or any active neuropsychiatric condition producing disability. Subjects conforming to five items above can be determined as MCI and included in our study. Exclusion criteria: 1. Neurological examination found the sign of local central nerve obstruction such as obvious paralysis,unilateral sensory disturbance and aphasia etc, history of cerebrovascular diseases (hemorrhagic and ischemic stroke), brain injury or bone fracture; 2. Medical diseases such as asthmatic bronchitis,severe hypertension,angina pectoris and severe infection; 3. Psychotic patients with evident anxiety and depressed emotion and subjects with endocrine system history of disease(hyperthyroidism,thyroid hypofunction, systemic lupus eythematosus,rheumatoid arthritis); 4. Newly discovered or advanced tumor; 5. Visual perception,auditory perceptual disorders or languages communication difficulties,all of which may influence measurement of cognitive function; 6. Alcohol dependence and other psychoactive substance abuse such as antipsychotic drug,benzodiazepines or taking medicine influencing cognitive function.MCI intervention group:DHA 2g /day (1tablet/day), oral, six month;control group:placebo; Intelligence Quotient;autophagy related biomarkers;Expression level of MCI related genes, proteins;",Sr-dementia,"ChiCtr, Ior",2015,,,0,
788,Effects of folic acid and DHA on elders with mild cognitive impairment: a randomized controlled trial,"Inclusion criteria: 1. Community-based elderly subjects aged 60 or older; 2. Memory complaints reported by the patient, family, or physician, of at least a 6-month duration and preferably corroborated by an informant; 3. Mild quantitative impairments in cognitive function were assessed by the Chinese version of the 30-point Mini Mental State Examination (MMSE) using age- and education-based norms (cutoff point was set at 1.5 SD below the mean age- and education-adjusted MMSE scores); 4. Decreased daily living ability and social function, as measured by the daily living scale, score is below 18; 5. Absence of dementia (according to DSM-IV criteria), psychiatric disorder, cerebral damage, or any active neuropsychiatric condition producing disability; Subjects conforming to five items above can be determined as MCI and included in our study. Exclusion criteria: 1. Neurological examination found the sign of local central nerve obstruction such as obvious paralysisunilateral sensory disturbance and aphasia etc, history of cerebrovascular diseases (hemorrhagic and ischemic stroke), brain injury or bone fracture; 2. Medical diseases such as asthmatic bronchitis, severe hypertension, angina pectoris and severe infection; 3. Psychotic patients with evident anxiety and depressed emotion and subjects with endocrine system history of disease(hyperthyroidism, thyroid hypofunction, systemic lupus eythematosus, rheumatoid arthritis); 4. Newly discovered or advanced tumor; 5. Visual perception,auditory perceptual disorders or languages communication difficulties, all of which may influence measurement of cognitive function; 6. Alcohol dependence and other psychoactive substance abuse such as antipsychotic drug,benzodiazepines or taking medicine influencing cognitive function. <Condition>Mild Cognitive Impairment (MCI);ICD:F06.7</Condition> placebo:placebo, oral, six months;folic acid:folic acid, 0.8mg/day, oral, six months;DHA:DHA 800mg/day, oral, six months;folic acid+DHA:folic acid (0.8mg/day) + DHA (800mg/day), oral, six months; Cognitive function (total intelligence quotient) ; Folate and methionine circulating metabolites;DHA and NPD1;AD-related genes expression;Inflammatory factors;DNA methyltransferases; <Secondary_ID ></Secondary_ID>",Sr-dementia,"ChiCtr, Ior",2016,,,0,
789,Multimorbidity is associated with increased rates of depression in patients hospitalized with diabetes mellitus in the United States,"Aims Information on the burden and risk factors for diabetes-depression comorbidity in the US is sparse. We used data from the largest all-payer, nationally-representative inpatient database in the US to estimate the prevalence, temporal trends, and risk factors for comorbid depression among adult diabetic inpatients. Methods We conducted a retrospective analysis using the 2002–2014 Nationwide Inpatient Sample databases. Depression and other comorbidities were identified using ICD-9-CM codes. Logistic regression was used to investigate the association between patient characteristics and depression. Results The rate of depression among patients with type 2 diabetes increased from 7.6% in 2002 to 15.4% in 2014, while for type 1 diabetes the rate increased from 8.7% in 2002 to 19.6% in 2014. The highest rates of depression were observed among females, non-Hispanic whites, younger patients, and patients with five or more chronic comorbidities. Conclusions The prevalence of comorbid depression among diabetic inpatients in the US is increasing rapidly. Although some portion of this increase could be explained by the rising prevalence of multimorbidity, increased awareness and likelihood of diagnosis of comorbid depression by physicians and better documentation as a result of the increased adoption of electronic health records likely contributed to this trend.",adult;aged;alcoholism;Alzheimer disease;arthritis;article;asthma;autism;cerebrovascular accident;chronic disease;chronic kidney failure;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;coronary artery disease;cross-sectional study;depression;diabetes mellitus;disease association;drug dependence;female;heart arrhythmia;hepatitis;hospital patient;human;Human immunodeficiency virus infection;hyperlipidemia;hypertension;ICD-9-CM;insulin dependent diabetes mellitus;major clinical study;male;malignant neoplasm;middle aged;multiple chronic conditions;non insulin dependent diabetes mellitus;osteoporosis;prevalence;priority journal;retrospective study;risk factor;schizophrenia;senile dementia;United States;very elderly,"Chima, C. C.;Salemi, J. L.;Wang, M.;Mejia de Grubb, M. C.;Gonzalez, S. J.;Zoorob, R. J.",2017,,10.1016/j.jdiacomp.2017.08.001,0,
790,"Atrial fibrillation, stroke, and quality of life","Contemporary management of atrial fibrillation imposes many challenges, particularly in the setting of our aging population. In addition to well-recognized consequences, such as stroke and mortality, emerging evidence relates atrial fibrillation to elevated risk of dementia, posing further therapeutic challenges. As the incidence of atrial fibrillation rises with age, the balance of controlling stroke risk and limiting major hemorrhage on anticoagulation has become increasingly critical in elderly patients. Appreciation of more extensive risk factors has made it possible to identify patients at very low risk of thromboembolism and higher risk of bleeding. However, practice guidelines in the United States and abroad have occasionally divergent viewpoints regarding how to best manage patients in various risk strata. Options for stroke prevention have expanded with novel antithrombotics and promising mechanical alternatives to anticoagulation, which may be at least as effective in preventing stroke without increasing bleeding risk. Catheter ablation has demonstrated impressive success at preventing atrial fibrillation recurrence in selected patients, and has the potential to further improve outcomes. In addition, the role of antiplatelet medications in patients deemed unsuitable for anticoagulation has been better clarified, although novel agents require further study to assess their impact on thromboembolism. High-bleeding risks associated with the concomitant use of multiple antithrombotics remains a major obstacle in patients with indications for both antiplatelet and anticoagulant therapy. © 2012 New York Academy of Sciences.",acetylsalicylic acid;antivitamin K;apixaban;atopaxar;clopidogrel;dabigatran etexilate;irbesartan;purinergic P2Y12 receptor;rivaroxaban;ticagrelor;vorapaxar;warfarin;acute coronary syndrome;add on therapy;Alzheimer disease;anticoagulant therapy;article;bare metal stent;bleeding;brain hemorrhage;brain perfusion;catheter ablation;clinical practice;comorbidity;congestive heart failure;diabetes mellitus;disease severity;drug efficacy;drug eluting stent;drug megadose;drug safety;dyspepsia;follow up;gastrointestinal hemorrhage;heart atrium appendage;atrial fibrillation;heart left ventricle failure;heart rate variability;human;hypertension;international normalized ratio;liver function test;low drug dose;meta analysis (topic);mortality;multicenter study (topic);patient monitoring;percutaneous coronary intervention;phase 2 clinical trial (topic),"Chinitz, J. S.;Castellano, J. M.;Kovacic, J. C.;Fuster, V.",2012,,,0,
791,Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): clinical and Therapeutic Considerations,"Multiple phase III trials over the last few decades have failed to demonstrate a clear benefit of various pharmacologic interventions in heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF). Therefore, a better understanding of its pathophysiology is important. An accompanying review describes key technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. This review deals with the potential of this approach to enhance our clinical, translational, and therapeutic approach to HFpEF. Specifically, the role of arterial hemodynamics is discussed in relation to (1) the pathophysiology of left ventricular diastolic dysfunction, remodeling, and fibrosis, (2) impaired oxygen delivery to peripheral skeletal muscle, which affects peripheral oxygen extraction, (3) the frequent presence of comorbidities, such as renal failure and dementia in this population, and (4) the potential to enhance precision medicine approaches. A therapeutic approach to target arterial hemodynamic abnormalities that are prevalent in this population (particularly, with inorganic nitrate/nitrite) is also discussed. Copyright © 2017 Springer Science+Business Media New York",artery blood flow;comorbidity;congenital malformation;controlled clinical trial;controlled study;dementia;exercise;extraction;fibrosis;heart afterload;heart failure with preserved ejection fraction;heart left ventricle ejection fraction;human;kidney failure;left ventricular diastolic dysfunction;personalized medicine;phase 3 clinical trial;phenotype;skeletal muscle;tissue oxygenation;nitrite;oxygen,"Chirinos, Ja",2017,,10.1007/s12265-017-9736-2,0,792
792,Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): Clinical and Therapeutic Considerations,"Multiple phase III trials over the last few decades have failed to demonstrate a clear benefit of various pharmacologic interventions in heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF). Therefore, a better understanding of its pathophysiology is important. An accompanying review describes key technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. This review deals with the potential of this approach to enhance our clinical, translational, and therapeutic approach to HFpEF. Specifically, the role of arterial hemodynamics is discussed in relation to (1) the pathophysiology of left ventricular diastolic dysfunction, remodeling, and fibrosis, (2) impaired oxygen delivery to peripheral skeletal muscle, which affects peripheral oxygen extraction, (3) the frequent presence of comorbidities, such as renal failure and dementia in this population, and (4) the potential to enhance precision medicine approaches. A therapeutic approach to target arterial hemodynamic abnormalities that are prevalent in this population (particularly, with inorganic nitrate/nitrite) is also discussed.",Afterload;Arterial hemodynamics;Comorbidities;Dementia;Exercise intolerance;Heart failure with preserved ejection fraction;Pulsatile load;Renal disease;Wave reflections,"Chirinos, J. A.",2017,Jun,,0,
793,Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 1): Physiologic and Technical Considerations,"A better understanding of the pathophysiology of heart failure with a preserved left ventricular ejection fraction (HFpEF) is important. Detailed phenotyping of pulsatile hemodynamics has provided important insights into the pathophysiology of left ventricular remodeling and fibrosis, diastolic dysfunction, microvascular disease, and impaired oxygen delivery to peripheral skeletal muscle, all of which contribute to exercise intolerance, the cardinal feature of HFpEF. Furthermore, arterial pulsatile hemodynamic mechanisms likely contribute to the frequent presence of comorbidities, such as renal failure and dementia, in this population. Our therapeutic approach to HFpEF can be enhanced by clinical phenotyping tools with the potential to “segment” this population into relevant pathophysiologic categories or to identify individuals exhibiting prominent specific abnormalities that can be targeted by pharmacologic interventions. This review describes relevant technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. In an accompanying review, the potential of this approach to enhance our clinical and therapeutic approach to HFpEF is discussed.",artery blood flow;comorbidity;congenital malformation;dementia;diastolic dysfunction;exercise;fibrosis;heart afterload;heart failure with preserved ejection fraction;heart left ventricle ejection fraction;heart ventricle remodeling;kidney failure;microangiopathy;phenotype;skeletal muscle;tissue oxygenation;oxygen,"Chirinos, J. A.",2017,,10.1007/s12265-017-9735-3,0,
794,Evaluation of comorbidity scores to predict all-cause mortality in patients with established coronary artery disease,"Background: To assess the value of scores based on the presence of comorbid conditions for mortality risk-stratification in patients with coronary artery disease (CAD). Methods: We prospectively followed 305 males with CAD undergoing coronary angiography for 58 months. We correlated the modified Charlson Index (MCI) and the recently proposed CAD-specific index (CSI) with the risk of all-cause mortality. Results: The odds ratio (OR) for death increased by 31% per point increase in the MCI (95% CI = 17-46%; p < 0.0001). The OR for death increased by 16% per point increase in the CSI (95% CI = 8.5-25%; p < 0.0001). In logistic regression models that adjusted for age, left ventricular ejection fraction, and the number of vessels involved with CAD, both the MCI and the CSI were the strongest predictors of mortality according to the χ2 value for each term, with the MCI having the highest value. The adjusted OR per point increase in the MCI was 1.32 (95% CI = 1.17-1.48; p < 0.0001); the corresponding adjusted OR per point increase in the CSI was 1.17 (95% CI = 1.09-1.26; p < 0.0001). The model including the MCI had a slightly higher χ2 value (45.1 vs. 39.1) and area under the receiver operator characteristic curve (0.742 vs. 0.727) than the model including the CSI. Conclusion: The MCI and the newly proposed CSI are powerful tools to predict all-cause mortality in patients with established CAD. Although the CSI was not superior to the MCI, its simplicity might make it useful in populations with a low prevalence of comorbidities not included in this score. © 2006 Elsevier B.V. All rights reserved.",acquired immune deficiency syndrome;adult;angiocardiography;article;cause of death;cerebrovascular disease;comorbidity;connective tissue disease;controlled study;coronary artery disease;correlation analysis;dementia;diabetes mellitus;heart left ventricle ejection fraction;hemiplegia;human;hypertension;kidney disease;leukemia;liver disease;logistic regression analysis;lymphoma;major clinical study;male;metastasis;mortality;peripheral vascular disease;prediction;prevalence;priority journal;prospective study;risk assessment;scoring system;smoking;solid tumor;neoplasm,"Chirinos, J. A.;Veerani, A.;Zambrano, J. P.;Schob, A.;Perez, G.;Mendez, A. J.;Chakko, S.",2007,,,0,
795,Use of Statins and Risk of Dementia in Heart Failure: A Retrospective Cohort Study,"OBJECTIVE: Heart failure (HF) is associated with an increased risk of dementia, and studies show that dyslipidemia may be involved in the pathogenesis of dementia. However, it is unclear whether 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are associated with a lower risk of dementia in HF patients. The present study examines the effectiveness of statins to prevent dementia in HF patients. METHODS: This retrospective longitudinal study used a cohort of patients with HF identified from a local US Medicare Advantage Prescription Drug plan to examine the incidence of dementia with up to 3 years of follow-up. A multivariable time-dependent Cox model and inverse-probability-of-treatment weighting (IPTW) of the marginal structural model were used to estimate the risk of developing dementia. Adjusted dementia rate ratios were estimated among current and former statin users, as compared with nonusers. RESULTS: The study included a total of 8062 HF patients (mean age 74.47 +/- 9.21 years), of whom 1135 (14.08%) were diagnosed with dementia during a median follow-up of 22 months. Using the time-dependent Cox model, the adjusted dementia rate ratios among current and former users were 0.93 (95% confidence interval [CI] 0.71-1.21) and 0.99 (95% CI 0.79-1.25), respectively. Use of IPTW resulted in similar findings of 1.24 (95% conservative CI 0.89-1.72) among current users and 0.94 (95% conservative CI 0.67-1.31) among former users as compared with nonusers. CONCLUSION: This study found no difference in the risk of dementia among current and former users of statins as compared with nonusers in an already at-risk HF population.","Aged;Aged, 80 and over;Cohort Studies;Dementia/*epidemiology/etiology;Dyslipidemias/*drug therapy;Female;Heart Failure/*drug therapy;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use;Incidence;Longitudinal Studies;Male;Middle Aged;Retrospective Studies;Risk","Chitnis, A. S.;Aparasu, R. R.;Chen, H.;Kunik, M. E.;Schulz, P. E.;Johnson, M. L.",2015,Sep,10.1007/s40266-015-0295-4,0,
796,"Use of Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Risk of Dementia in Heart Failure","OBJECTIVE: To test the effect of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) on reducing the risk of dementia in patients with heart failure (HF). METHODS: This retrospective, longitudinal study used a cohort of HF patients identified from a local Medicare advantage prescription drug plan. Multivariable time-dependent Cox model and marginal structural model using inverse-probability-oftreatment weighting were used to estimate the risk of developing dementia. Adjusted dementia rate ratios were estimated among current and former ACEI/ARB users, as compared with nonusers. RESULTS: Using the time-dependent Cox model, the adjusted dementia rate ratios (95% confidence-interval) among current and former users were 0.90(0.70-1.16) and 0.89 (0.71-1.10), respectively. Use of marginal structural model resulted in similar effect estimates for current and former users as compared with the nonusers. CONCLUSION: This study found no difference in risk of dementia among the current and former users of ACEI/ARB as compared with the nonusers in an already at-risk HF population.",angiotensin receptor blockers;angiotensin-converting enzyme inhibitors;dementia;heart failure,"Chitnis, A. S.;Aparasu, R. R.;Chen, H.;Kunik, M. E.;Schulz, P. E.;Johnson, M. L.",2016,Aug,10.1177/1533317515618799,0,
797,Causes of death in Huntington's disease,,Adult;Australia;Heart Failure/complications;Humans;Huntington Disease/complications/*mortality;Myocardial Infarction/complications;Pneumonia/complications,"Chiu, E.;Alexander, L.",1982,Feb 20,,0,
798,Angiotension receptor blockers reduce the risk of dementia,"OBJECTIVE:: Recent studies implied that angiotension receptor blockers (ARBs) not only have an antihypertensive effect but also have beneficial effects on dementia. The purpose of this study was to investigate the effects of ARBs on dementia and the subtypes. METHODS:: We conducted a population-based cohort study with data from the Taiwan National Health Insurance Research Database. A total of 24 531 matching pairs (1 : 1) of ARB-exposed and non-ARB-exposed patients were included. Each patient was individually tracked from 1997 to 2009 to identify incident cases of dementia (onset in 1999 or later). Cox proportional hazard regressions were employed to calculate the hazard ratios and 95% confidence intervals (CIs) for the association between ARBs and dementia, Alzheimer's disease and vascular dementia, conditional for matching pairs. RESULTS:: There were 1322 cases (5.4%) of dementia in the ARB cohort and 2181 cases (8.9%) in the non-ARB cohort identified during the 11-year follow-up period. The multivariate-adjusted hazard ratios for dementia, Alzheimer's disease and vascular dementia were 0.54 (95% CI 0.51-0.59), 0.53 (95% CI 0.43-0.64) and 0.63 (95% CI 0.54-0.73) for patients with ARB treatments, respectively. In terms of cumulative dosage, patients with more than 1460 defined daily dose of ARBs had less risk than those patients with less than 1460 defined daily dose (hazard ratio 0.37 vs. 0.61; P < 0.05). CONCLUSION:: These results suggest that ARB may be associated with a reduced risk of dementia in high vascular-risk individuals. Patients exposed to ARBs for higher cumulative doses experienced more protection from dementia and the subtypes. Copyright © Lippincott Williams & Wilkins.",angiotensin receptor antagonist;beta adrenergic receptor blocking agent;calcium channel blocking agent;cholinesterase inhibitor;dipeptidyl carboxypeptidase inhibitor;diuretic agent;memantine;adult;aged;Alzheimer disease;ambulatory care;antihypertensive therapy;article;cerebrovascular accident;chronic kidney disease;cohort analysis;comorbidity;controlled study;dementia;depression;diabetes mellitus;drug effect;drug use;DSM-IV;female;follow up;hazard ratio;heart failure;high risk population;human;hypercholesterolemia;hypertension;ICD-9;incidence;income;ischemic heart disease;major clinical study;male;middle aged;monotherapy;multiinfarct dementia;population research;prescription;priority journal;proportional hazards model;reimbursement;risk reduction;Taiwan;treatment duration;urbanization;very elderly,"Chiu, W. C.;Ho, W. C.;Lin, M. H.;Lee, H. H.;Yeh, Y. C.;Wang, J. D.;Chen, P. C.",2014,,,0,
799,Menopausal hormone therapy after breast cancer,,estrogen;gestagen;hormone;breast cancer;breast tumor;cancer recurrence;cancer risk;clinical trial;controlled clinical trial;dementia;drug safety;estrogen therapy;female;follow up;gene mutation;heart protection;hormone substitution;human;iatrogenic disease;ischemic heart disease;lung embolism;mammography;menopausal syndrome;menopause;note;ovary cancer;pathology;physiology;priority journal;quality of life;randomized controlled trial;risk assessment;risk factor;cerebrovascular accident;tumor recurrence,"Chlebowski, R. T.;Col, N.",2004,,,0,
800,Comorbidity-Adjusted life expectancy: A new tool to inform recommendations for optimal screening strategies,"Background: Many guidelines recommend considering health status and life expectancy when making cancer screening decisions for elderly persons. Objective: To estimate life expectancy for elderly persons without a history of cancer, taking into account comorbid conditions. Design: Population-based cohort study. Setting: A 5% sample of Medicare beneficiaries in selected geographic areas, including their claims and vital status information. Participants: Medicare beneficiaries aged 66 years or older between 1992 and 2005 without a history of cancer (n = 407 749). Measurements: Medicare claims were used to identify comorbid conditions included in the Charlson index. Survival probabilities were estimated by comorbidity group (no, low/medium, and high) and for the 3 most prevalent conditions (diabetes, chronic obstructivepulmonary disease, and congestive heart failure) by using the Cox proportional hazards model. Comorbidity-adjusted life expectancy was calculated based on comparisons of survival models with U.S. life tables. Survival probabilities from the U.S. life tables providing the most similar survival experience to the cohort of interest were used.Results: Persons with higher levels of comorbidity had shorter life expectancies, whereas those with no comorbid conditions, including very elderly persons, had favorable life expectancies relative to an average person of the same chronological age. The estimated life expectancy at age 75 years was approximately 3 years longer for persons with no comorbid conditions and approximately 3 years shorter for those with high comorbidity relative to the average U.S. population. Limitations: The cohort was limited to Medicare fee-for-service beneficiaries aged 66 years or older living in selected geographic areas. Data from the Surveillance, Epidemiology, and End Results cancer registry and Medicare claims lack information on functional status and severity of comorbidity, which might influence life expectancy in elderly persons. Conclusion: Life expectancy varies considerably by comorbidity status in elderly persons. Comorbidity-adjusted life expectancy may help physicians tailor recommendations for stopping or continuing cancer screening for individual patients. Primary Funding Source: None. © 2013 American College of Physicians.",acquired immune deficiency syndrome;acute heart infarction;adult;age;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic hepatitis;chronic kidney failure;chronic obstructive lung disease;clinical decision making;cohort analysis;comorbidity;congestive heart failure;dementia;diabetes mellitus;disease severity;female;functional status;geography;heart infarction;human;life expectancy;life table;liver cirrhosis;major clinical study;male;medical fee;medical history;medicare;paralysis;peripheral vascular disease;population research;priority journal;rheumatoid arthritis;screening;survival rate;ulcer;United States;very elderly,"Cho Dr, H.;Klabunde Dr, C. N.;Yabroff Dr, K. R.;Wang Dr, Z.;Meekins Dr, A.;Lansdorp-Vogelaar Dr, I.;Mariotto Dr, A. B.",2013,,,0,
801,Development and validation of the modified charlson comorbidity index in incident peritoneal dialysis patients: A national population-based approach,"♦ Background: The utility of applying the Charlson comorbidity index (CCI) to peritoneal dialysis (PD) patients is disputed because the relative weight of each comorbidity in PD patients may be different from those in other chronic diseases. We aimed to develop and validate a modified CCI in incident PD patients (mCCI-IPD) for better risk stratification and prediction of mortality. ♦ Methods: The mCCI-IPD was developed using data from all Korean adult incident PD patients between 2005 and 2008 (n = 7,606). Multivariate Cox regression was used to determine new weights for the individual comorbidities in the CCI. The prognostic performance of the mCCI-IPD was validated in an independent cohort (n = 664) through c-statistics and continuous net reclassification improvement (cNRI). ♦ Results: A total of 75.5% of the patients in the development cohort had 1 or more comorbidities. The Cox proportional hazards model provided reassigned severity weights for the 11 comorbidities that significantly predicted mortality. In the validation cohort, the CCI and mCCI-IPD scores were both correlated with survival and showed no differences in their c-statistics. However, multivariate analyses using cNRI revealed that the mCCI-IPD provided a 38.2% improvement in mortality risk assessment compared with the CCI (95% confidence interval [CI], 15.3 – 61.0; p < 0.001). These significant reclassification improvements were observed consistently in subjects with events (cNRIEvent, 28.2% [95% CI, 6.9 – 49.5; p = 0.009]) and without events (cNRINon-event, 10.0% [95% CI, 1.7 – 18.2; p = 0.019]). ♦ Conclusions: Compared with the CCI, the mCCI-IPD showed better performance in mortality prediction for incident PD patients. Therefore, this tool may be used as a preferred index for statistical analysis and clinical decision-making.",adult;article;Charlson Comorbidity Index;chronic lung disease;comorbidity assessment;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;female;human;information processing;major clinical study;male;middle aged;mortality rate;peptic ulcer;peripheral vascular disease;peritoneal dialysis;priority journal;risk assessment;solid malignant neoplasm;validation study,"Cho, H.;Kim, M. H.;Kim, H. J.;Park, J. Y.;Ryu, D. R.;Lee, H.;Lee, J. P.;Lim, C. S.;Kim, K. H.;Oh, K. H.;Joo, K. W.;Kim, Y. S.;Kim, D. K.",2017,,10.3747/pdi.2015.00201,0,
802,Protective and Risk Factors for 5-Year Survival in the Oldest Veterans: Data from the Veterans Health Administration,"OBJECTIVES: To characterize physical and mental diseases and use of healthcare services and identify factors associated with mortality in the oldest individuals using the Veterans Health Administration (VHA). DESIGN: Retrospective study with 5-year survival follow-up. SETTING: VHA, system-wide. PARTICIPANTS: Veterans using the VHA aged 80 and older as of October 2008 (N = 721,588: n = 665,249 aged 80-89, n = 56,118 aged 90-99, n = 221 aged 100-115). MEASUREMENTS: Demographic characteristics, physical and mental diseases, healthcare services, and 5-year survival were measured. RESULTS: Accelerated failure time models identified protective and risk factors associated with mortality according to age group. During 5 years of follow-up, 44% of participants died (survival rate: 59% aged 80-89, 32% aged 90-99, 15% aged >/=100). In the multivariable model, protective effects for veterans aged 80-99 were female sex, minority race or ethnicity, being married, having certain physical and mental diagnoses (hypertension, cataract, dyslipidemia, posttraumatic stress disorder, bipolar disorder), having urgent care visits, having invasive surgery, and having few (1-3) prescriptions. Risk factors were lower VHA priority status, physical and mental conditions (diabetes mellitus, anemia, congestive heart failure, dementia, anxiety, depression, smoking, substance abuse disorder), hospital admission, and nursing home care. For those aged 100 and older, being married, smoking, hospital admission, nursing home care, invasive surgery, and prescription use were significant risk factors; only emergency department (ED) use was protective. CONCLUSION: Although the data are limited to VHA care (thus missing Medicare services), this study shows that many veterans served by the VHA live to advanced old age despite multiple chronic conditions. Further study is needed to determine whether a comprehensive, coordinated care system like VHA is associated with greater longevity for very old persons.",health services;oldest;survival;veterans,"Cho, J.;Copeland, L. A.;Stock, E. M.;Zeber, J. E.;Restrepo, M. I.;MacCarthy, A. A.;Ory, M. G.;Smith, P. A.;Stevens, A. B.",2016,Jun,10.1111/jgs.14161,0,
803,Importance of symptomatic cerebral infarcts on cognitive performance in patients with Alzheimer's disease,"The coexistence of cerebral infarcts and Alzheimer's disease (AD) is common, but the influence of symptomatic cerebral infarcts on cognition is uncertain in AD. We hypothesize that symptomatic cerebral infarcts may provide an additive cognitive factor contributing to dementia in the AD population. We studied 1,001 clinically probable or possible AD patients in the Alzheimer Disease Research Center (ADRC) database. Linear regression was used to evaluate for an association between symptomatic cerebral infarcts and memory, language, executive function, abstract reasoning, and visuospatial performance, separately. Models were adjusted for covariates including age, gender, education, ethnicity, hypertension, diabetes mellitus, heart disease, clinical dementia rating, the presence of silent cerebral infarcts, and multiplicity or location of infarcts. Clinical history of stroke was present in 107 patients, radiological infarcts in 308 patients, and 68 patients with both were considered to have symptomatic infarcts. Adjusting for all covariates, AD patients with symptomatic infarcts had more impairment of executive function (P < 0.05). The influence of cerebral infarcts is neither general nor diffuse, and the presence of clinical history may have a more important influence on executive performance in AD.","Aged;Aged, 80 and over;Alzheimer Disease/*physiopathology;Cerebral Infarction/*physiopathology;Cognition Disorders/*physiopathology;Executive Function;Female;Humans;Male;Middle Aged;Neuropsychological Tests;Stroke;Alzheimer Disease;Cerebral Infarction;Cognitive;Neuroimaging","Cho, S. J.;Scarmeas, N.;Jang, T. W.;Marder, K.;Tang, M. X.;Honig, L. S.",2011,Mar,10.3346/jkms.2011.26.3.412,0,
804,Post-stroke memory impairment among patients with vascular mild cognitive impairment,"BACKGROUND: The American Stroke Association/American Heart Association recommended the criteria for diagnosis of vascular cognitive impairment and memory impairment (MI) is a feature in the classification of vascular mild cognitive impairment (VaMCI). VaMCI patients with MI may differ in terms of infarct location or demographic features, so we evaluated the clinical characteristics associated with MI in patients with VaMCI. METHODS: A prospective multicenter study enrolled 353 acute ischemic stroke patients who underwent evaluation using the Korean Vascular Cognitive Impairment Harmonization Standard Neuropsychological Protocol at three months after onset. The association between MI and demographic features, stroke risk factors, and infarct location was assessed. RESULTS: VaMCI was diagnosed in 141 patients, and 58 (41.1%) exhibited MI. Proportions of men and of left side infarcts were higher in VaMCI with MI than those without (75.9 vs. 57.8%, P = 0.03, 66.7 vs. 47%, P = 0.02). Multiple logistic analyses revealed that male sex (odds ratio [OR] 3.07, 95% confidence interval [95% CI] 1.12-8.42), left-side infarcts (OR 3.14, 95% CI 1.37-7.20), and basal ganglia/internal capsule infarcts (OR 4.53, 95% CI 1.55-13.22) were associated with MI after adjusting other demographic variables, vascular risk factors, and subtypes of stroke. CONCLUSIONS: MI is associated with sex and infarct location in VaMCI patients.",aged;basal ganglion hemorrhage;brain infarction;cerebrovascular accident;cognitive defect;cohort analysis;complication;multiinfarct dementia;female;human;male;memory disorder;middle aged;neuropsychological test;odds ratio;prospective study;psychology;risk factor;sex difference;statistical model;United States,"Cho, S. J.;Yu, K. H.;Oh, M. S.;Jung, S.;Lee, J. H.;Koh, I. S.;Bae, H. J.;Kang, Y.;Lee, B. C.",2014,,10.1186/s12883-014-0244-6,0,
805,Depressive symptoms as a predictor of cognitive decline: Macarthur studies of successful aging,"OBJECTIVE:: The prevalence of dementia continues to rise, and yet, there are few known modifiable risk factors. Depression, as a treatable condition, may be important in the development of dementia. Our objective was to examine the association between depressive symptoms and longitudinal cognitive changes in older adults who were high-functioning at baseline. METHODS:: The authors analyzed data from a community-based cohort (aged 70 - 79 at baseline), who, at study entry, scored 7 or more (out of 9) on the Short Portable Mental Status Questionnaire (SPMSQ). Depressive symptoms were assessed at baseline using the depression subscale of the Hopkins Symptom Check List. Cognitive performance was measured at baseline and at seven-year follow up by the SPMSQ and by summary scores from standard tests of naming, construction, spatial recognition, abstraction, and delayed recall. RESULTS:: After adjusting for potential confounders, including age, education, and chronic health conditions such as diabetes, heart attack, stroke, and hypertension, a higher number of baseline depressive symptoms were strongly associated with greater seven-year decline in cognitive performance and with higher odds of incident cognitive impairment, i.e., decline in SPMSQ score to ≤6 (adjusted odds ratio per quartile of depressive symptoms score: 1.34, 95% confidence interval: 1.10 - 1.68). CONCLUSIONS:: Depressive symptomatology independently predicts cognitive decline and incident cognitive impairment in previously high-functioning older persons. © 2007 American Association for Geriatric Psychiatry.",aged;aging;article;clinical assessment;cognition;cognitive defect;cohort analysis;dementia;depression;diabetes mellitus;disease association;educational status;female;heart infarction;Hopkins Symptom Check List;human;hypertension;major clinical study;male;mental health;neuropsychological test;prevalence;questionnaire;recall;recognition;scoring system;Short Portable Mental Status Questionnaire;cerebrovascular accident;symptomatology,"Chodosh, J.;Kado, D. M.;Seeman, T. E.;Karlamangla, A. S.",2007,,,0,
806,Physician recognition of cognitive impairment: evaluating the need for improvement,"OBJECTIVES: To assess physician recognition of dementia and cognitive impairment, compare recognition with documentation, and identify physician and patient factors associated with recognition. DESIGN: Survey of physicians and review of medical records. SETTING: Health maintenance organization in southern California. PARTICIPANTS: Seven hundred twenty-nine physicians who provided care for women participating in a cohort study of memory (Women's Memory Study). MEASUREMENTS: Percentage of patients with dementia or cognitive impairment (using the Telephone Interview of Cognitive Status supplemented by the Telephone Dementia Questionnaire) recognized by physicians. Relationship between physician recognition and patient characteristics and physician demographics, practice characteristics, training, knowledge, and attitudes about dementia. RESULTS: Physicians (n=365) correctly identified 81% of patients with dementia and 44% of patients with cognitive impairment without definite dementia. Medical records documented cognitive impairment in 83% of patients with dementia and 26% of patients with cognitive impairment without definite dementia. In a multivariable model, physicians with geriatric credentials (defined as geriatric fellowship experience and/or the certificate of added qualifications) recognized cognitive impairment more often than did those without (risk ratio (RR)=1.56, 95% confidence interval (CI)=1.04-1.66). Physicians were more likely to recognize cognitive impairment in patients with a history of depression treatment (RR=1.3, 95% CI=1.03-1.45) or stroke (RR=1.37, 95% CI=1.04-1.45) and less likely to recognize impairment in patients with cognitive impairment without definite dementia than in those with dementia (RR=0.46, 95% CI=0.23-0.72) and in patients with a prior hospitalization for myocardial infarction (RR=0.37, 95% CI=0.09-0.88) or cancer (RR=0.49, 95% CI=0.18-0.90). CONCLUSION: Medical record documentation reflects physician recognition of dementia, yet physicians are aware of, but have not documented, many patients with milder cognitive impairment. Physicians are unaware of cognitive impairment in more than 40% of their cognitively impaired patients. Additional geriatrics training may promote recognition, but systems solutions are needed to improve recognition critical to provision of emerging therapies for early dementia.","Aged;Aged, 80 and over;Clinical Competence;Cognition Disorders/*diagnosis/epidemiology;Dementia/*diagnosis/epidemiology;Documentation/standards;Female;Geriatric Assessment;Humans;Logistic Models;Practice Patterns, Physicians'/*statistics & numerical data;Risk Factors","Chodosh, J.;Petitti, D. B.;Elliott, M.;Hays, R. D.;Crooks, V. C.;Reuben, D. B.;Galen Buckwalter, J.;Wenger, N.",2004,Jul,10.1111/j.1532-5415.2004.52301.x,0,
807,Troponin I and NT-proBNP (N-terminal pro-brain natriuretic peptide) do not predict 6-month mortality in frail older patients undergoing orthopedic surgery,"OBJECTIVES: To determine if troponin I and NT-proBNP were predictors of 6-month mortality after emergency orthopedic-geriatric surgery in a frail population. DESIGN: Prospective observational study. SETTING: Orthopedic-geriatric unit of a metropolitan hospital in Australia. PARTICIPANTS: A total of 383 patients were screened; 44 were eligible for this study of which 33 patients consented who were receiving high-level care or had severe dementia or an illness with a prognosis of less than 12 months. MEASUREMENTS: Troponin I and NT-proBNP were tested on one preoperative sample and at least one postoperative blood sample. Cardiac events were defined as acute myocardial infarction, congestive cardiac failure, new onset or rapid atrial fibrillation, major arrhythmia, or cardiac arrest. RESULTS: The mean age of the patients was 85.8 +/- 9.6 years and 93.9% had a fractured neck of femur. Premorbid cardiac conditions were common (24.2% had ischemic heart disease and 21.2% congestive cardiac failure). A third of patients had a preoperative troponin elevation and 60.6% had a postoperative elevation. The mortality within 30 days of surgery was 15.2% (5/33 patients), rising to 39.4% (13/33) at 6 months with 46.2% (6/13) dying of a cardiac cause. The Kaplan-Meier survival curve was not significantly different between patients with and without a troponin elevation. A third of patients sustained a cardiac event at 6 months. The median preoperative NT-proBNP was 1651.50 pg/L, range 25 to 31,227, and median postoperative NT-proBNP was 3038.50pg/L, range 44 to 27,348. Troponin I and NT pro-BNP did not predict 6-month mortality or cardiac complications. Predictors of 6-month mortality using univariate analysis were number of comorbidities OR 2.0 (95% CI 1.1-3.8, P = .033) and premorbid atrial fibrillation OR 7.7 (95% CI 1.2-47.8, P = .028). CONCLUSION: Troponin I and NT-proBNP were not predictors of 6-month mortality or cardiac events in an older frailer population of patients undergoing orthopedic surgery. These patients sustained substantial cardiac morbidity and mortality at 6 months after surgery. The control of symptoms, rather than prolongation of life with cardiological intervention, may be more appropriate for this patient group.","Aged;Aged, 80 and over;Cardiovascular Diseases;Female;Fractures, Bone/surgery;Frail Elderly;Hospitals, Urban;Humans;Male;Mortality/*trends;Natriuretic Peptide, Brain/*blood;Observation;*Orthopedics;Peptide Fragments/blood;*Predictive Value of Tests;Prognosis;Prospective Studies;Risk Assessment;Troponin I/*blood;Victoria/epidemiology","Chong, C. P.;van Gaal, W. J.;Ryan, J. E.;Burrell, L. M.;Savige, J.;Lim, W. K.",2010,Jul,10.1016/j.jamda.2010.01.003,0,
808,The Case for Stage-Specific Frailty Interventions Spanning Community Aging to Cognitive Impairment,"Objectives: To explore factors associated with frailty across the continuum of healthy aging to cognitive impairment (mild cognitive impairment [MCI], mild and moderate Alzheimer disease [AD]). Design: Cross-sectional study. Setting: Senior activity centers and the outpatient memory clinic of a tertiary hospital. Participants: Community-dwelling and functionally independent adults aged 50 years and older and older adults attending the memory clinic with MCI, and mild and moderate AD diagnoses. Methods: We recruited 299 participants comprising 200 cognitively healthy individuals, 16 with MCI, 68 with mild AD, and 15 with moderate AD. We collected measures of comorbidities, cognitive and functional performance, physical activity level, and anthropometric and nutritional status. Frailty was defined using Buchmann criteria, and sarcopenic obesity (SO) was defined using the Asian Working Group for Sarcopenia criteria and the revised National Cholesterol and Education Panel-obesity definition of waist circumference. Multiple logistic regression was performed to identify factors associated with frailty as a whole group and separately based on cognitive subgroups. Results: There were 16.7% of patients who met frailty criteria. Frailty prevalence was lowest in the well elderly (3.5%) and subsequently followed a U-shaped prevalence from MCI to mild and moderate AD, respectively. Specific univariate differences were noted in age, hypertension, ischemic heart disease, depressive symptoms, social differences, and functional scores. Multivariable logistic regression showed age, cognitive status, and SO to be significantly associated with frailty status. Subgroup analysis showed only SO to be significant (odds ratio [OR] 15.55, 95% confidence interval [CI] 1.63-148.42) in well elderly and only cognition to be associated with frailty (OR 0.89, 95% CI 0.80-0.99) among the cognitively impaired. Conclusion: Our findings lend initial support to the case for stage-specific interventions for physical frailty with the focus on SO in healthy community-dwelling older persons and cognitive-based measures in older adults with cognitive impairment. The accurate clinical phenotyping would then set the stage for future potential investigative therapies along these specific lines, rather than an undifferentiated approach.",aged;aging;Alzheimer disease;article;cognitive defect;community care;comorbidity;controlled study;depression;female;frail elderly;human;hypertension;ischemic heart disease;major clinical study;male;mild cognitive impairment;nutritional status;prevalence;sarcopenic obesity;tertiary care center;waist circumference,"Chong, M. S.;Tay, L.;Ismail, N. H.;Tan, C. H.;Yew, S.;Yeo, A.;Ye, R.;Leung, B.;Ding, Y. Y.",2015,,,0,
809,mTOR: A novel therapeutic target for diseases of multiple systems,"Significant progress in the research of mammalian target of rapamycin (mTOR) in recent years, has greatly enhanced our understanding of the role and cellular pathways through which mTOR control cellular processes, such as translational initiation, actin organization, cell proliferation, and cell survival. mTOR is activated by phosphorylation and functions mainly through mTOR complex 1 or mTOR complex 2. mTORC1 is activated through tuberous sclerosis complex 1/2 dependent and independent mechanisms following the stimulation by growth factors, nutrient, amino acids, and other signaling pathways. The activity of mTOR is closely associated with cell proliferation and differentiation, apoptosis, and autophagy. Activation of mTOR prevents the induction of both apoptosis and autophagy through regulating its multiple targets. Given that the activity of mTOR has been involved in the pathogenesis of neurodegenerative disorders, cardiovascular abnormalities, metabolic diseases, renal transplantation, autoimmune abnormalities, and cancer, manipulating mTOR activation may represent as an innovative therapeutic strategy for these diseases. Yet, the role of mTOR in the body is complicated and therefore, its activity needs to be tightly regulated to achieve beneficial outcome in a specific pathological condition.",cell cycle protein;cyclin D1;cyclin dependent kinase 4;DDB1 CUL4;deptor;glycogen synthase kinase 3beta;hypoxia inducible factor 1alpha;initiation factor 4E binding protein 1;mammalian target of rapamycin;mitogen activated protein kinase 1;mLST8;p70S6K;peroxisome proliferator activated receptor gamma coactivator 1alpha;PRAS40;protein kinase B;protor 1;PRR5L;Rac1 protein;raptor protein;Rheb protein;Rho guanine nucleotide binding protein;S6 kinase;serum and glucocorticoid regulated kinase 1;STAT3 protein;sterol regulatory element binding protein 1;transcription factor FKHRL1;transcription factor Maf;transcription factor YY1;tuberin;unclassified drug;unindexed drug;aging;Alzheimer disease;angiogenesis;apoptosis;article;autoimmune disease;autophagy;biology;brain function;brain ischemia;cardiac allograft vasculopathy;cell metabolism;central nervous system disease;degenerative disease;diabetes mellitus;drug targeting;enzyme activity;epilepsy;fragile X syndrome;heart ventricle hypertrophy;Huntington chorea;immunoregulation;inflammation;insulin sensitivity;ischemic heart disease;Lhermitte Duclos disease;lipid metabolism;neurofibromatosis type 1;neurovascular biology;Parkinson disease;protein function;protein phosphorylation;protein protein interaction;stem cell;subarachnoid hemorrhage;tuberous sclerosis,"Chong, Z. Z.",2015,,,0,
810,Hospital length of stay and all-cause 30-day readmissions among high-risk medicaid beneficiaries,"This study examined the association between index hospitalization characteristics and the risk of all-cause 30-day readmission among high-risk Medicaid beneficiaries using multilevel analyses. A retrospective cohort with a baseline and a follow-up period was used. The study population consisted of Medicaid beneficiaries (21-64 years old) with selected chronic conditions, continuous fee-for-service enrollment through the observation period, and at least 1 inpatient encounter during the follow-up period (N = 15,806). The outcome of 30-day readmission was measured using inpatient admissions within 30-days from the discharge date of the first observed hospitalization. Key independent variables included length of stay, reason for admission, and month of index hospitalization (seasonality). Multilevel logistic regression that accounted for beneficiaries nested within counties was used to examine this association, after controlling for patient-level and county-level characteristics. In this study population, 16.7% had all-cause 30-day readmissions. Adults with greater lengths of stay during the index hospitalization were more likely to have 30-day readmissions (adjusted odds ratio [AOR]: 1.03, 95% confidence interval [CI]: 1.02-1.04). Adults who were hospitalized for cardiovascular conditions (AOR: 1.20, 95% CI: 1.08-1.33), diabetes (AOR: 1.23, 95% CI: 1.10-1.39), cancer (AOR: 1.55, 95% CI: 1.26-1.90), and mental health conditions (AOR: 2.17, 95% CI: 1.98-2.38) were more likely to have 30-day readmissions compared to those without these conditions.",adult;arthritis;article;asthma;cardiovascular disease;cerebrovascular accident;chronic kidney disease;chronic obstructive lung disease;cohort analysis;congestive heart failure;controlled study;coronary artery disease;dementia;depression;diabetes mellitus;female;follow up;health care access;health insurance;health service;heart arrhythmia;hepatitis;high risk population;hospital discharge;hospital readmission;human;hyperlipidemia;hypertension;length of stay;major clinical study;male;malignant neoplastic disease;medicaid;mental disease;osteoporosis;outcome assessment;priority journal;retrospective study;schizophrenia;substance abuse,"Chopra, I.;Wilkins, T. L.;Sambamoorthi, U.",2016,,,0,
811,Subcutaneous emphysema and pneumothorax secondary to subclavian vein catheterization via supraclavicular approach,,acute pyelonephritis;aged;artificial ventilation;cardiomegaly;case report;cause of death;central venous catheterization;chest tube;chronic hepatitis C;crackle;dementia;disease course;disease severity;extubation;female;follow up;fungemia;heart arrhythmia;human;hypertension;immobility;internal jugular vein;letter;liver cirrhosis;non insulin dependent diabetes mellitus;pacemaker implantation;pneumonia;pneumothorax;right subclavian vein;scoliosis;septic shock;subclavian vein catheter;subclavian vein catheterization;subcutaneous emphysema;supraclavicular approach;thorax radiography;treatment failure;treatment indication;treatment outcome;treatment response;very elderly,"Chou, C. D.;Tsung, Y. C.;Yang, F. L.",2016,,,0,
812,Treatment for Rheumatoid Arthritis and Risk of Alzheimer's Disease: A Nested Case-Control Analysis,"INTRODUCTION: It is increasingly becoming accepted that inflammation may play an important role in the pathogenesis of Alzheimer's disease (AD), as several immune-related genes have been associated with AD. Among these is tumor necrosis factor (TNF)-alpha, a proinflammatory cytokine known to play an important role in autoimmune disorders, including rheumatoid arthritis (RA). Although AD and RA appear to involve similar pathological mechanisms through the production of TNF-alpha, the relationship between AD and RA remains unknown. OBJECTIVE: To determine the relative risk of AD among RA patients and non-RA patients, and whether anti-TNF therapy for RA was associated with a lower risk of AD in RA patients. METHODS: We performed a nested case-control study of more than 8.5 million commercially insured adults (aged >/=18 years) in all 50 US states, Puerto Rico, and US Virgin Islands in the Verisk Health claims database. We derived a sub-cohort of subjects with a diagnosis of RA (controls), or RA and AD (cases), matching cases and controls based on age, sex, exposure assessment period, and methotrexate treatment. We also assessed relative risk of AD following exposure to standard RA therapies, including anti-TNF agents (infliximab, adalimumab, etanercept), methotrexate, prednisone, sulfasalazine, and rituximab. Odds ratios were adjusted for comorbidities, including coronary artery disease, diabetes mellitus, and peripheral vascular disease. RESULTS: AD was more prevalent (p < 0.0001) among RA patients (0.79 %) than among those without RA (0.11 %). Chronic conditions such as coronary artery disease (odds ratio [OR] 1.48; 95 % confidence interval [CI] 1.04-2.05; p = 0.03), diabetes (OR 1.86; 95 % CI 1.32-2.62; p = 0.0004), and peripheral vascular disease (OR 1.61; 95 % CI 1.06-2.43; p = 0.02) significantly increased the relative risk of AD among RA patients. Exposure to anti-TNF agents as a class, but not other immunosuppressive drugs studied, was associated with lowered risk of AD among RA patients (unadjusted OR 0.44; 95 % CI 0.22-0.87; p = 0.02; adjusted OR 0.45; 95 % CI 0.23-0.90; p = 0.02). Sub-group analysis demonstrated that of the three anti-TNF agents studied, only etanercept (unadjusted OR, 0.33; 95 % CI 0.08-0.94; p = 0.03; adjusted OR 0.30; 95 % CI 0.08-0.89; p = 0.02) was associated with a decreased risk of AD in RA patients. CONCLUSION: There is an increased risk of AD in the studied RA population. The relative risk of AD among RA subjects was lowered in those exposed to etanercept. Anti-TNF therapy with etanercept shows promise as a potential treatment for AD.",,"Chou, R. C.;Kane, M.;Ghimire, S.;Gautam, S.;Gui, J.",2016,Nov,10.1007/s40263-016-0374-z,0,813
813,Treatment for Rheumatoid Arthritis and Risk of Alzheimer’s Disease: A Nested Case-Control Analysis,"Introduction: It is increasingly becoming accepted that inflammation may play an important role in the pathogenesis of Alzheimer’s disease (AD), as several immune-related genes have been associated with AD. Among these is tumor necrosis factor (TNF)-α, a proinflammatory cytokine known to play an important role in autoimmune disorders, including rheumatoid arthritis (RA). Although AD and RA appear to involve similar pathological mechanisms through the production of TNF-α, the relationship between AD and RA remains unknown. Objective: To determine the relative risk of AD among RA patients and non-RA patients, and whether anti-TNF therapy for RA was associated with a lower risk of AD in RA patients. Methods: We performed a nested case-control study of more than 8.5 million commercially insured adults (aged ≥18 years) in all 50 US states, Puerto Rico, and US Virgin Islands in the Verisk Health claims database. We derived a sub-cohort of subjects with a diagnosis of RA (controls), or RA and AD (cases), matching cases and controls based on age, sex, exposure assessment period, and methotrexate treatment. We also assessed relative risk of AD following exposure to standard RA therapies, including anti-TNF agents (infliximab, adalimumab, etanercept), methotrexate, prednisone, sulfasalazine, and rituximab. Odds ratios were adjusted for comorbidities, including coronary artery disease, diabetes mellitus, and peripheral vascular disease. Results: AD was more prevalent (p < 0.0001) among RA patients (0.79 %) than among those without RA (0.11 %). Chronic conditions such as coronary artery disease (odds ratio [OR] 1.48; 95 % confidence interval [CI] 1.04–2.05; p = 0.03), diabetes (OR 1.86; 95 % CI 1.32–2.62; p = 0.0004), and peripheral vascular disease (OR 1.61; 95 % CI 1.06–2.43; p = 0.02) significantly increased the relative risk of AD among RA patients. Exposure to anti-TNF agents as a class, but not other immunosuppressive drugs studied, was associated with lowered risk of AD among RA patients (unadjusted OR 0.44; 95 % CI 0.22–0.87; p = 0.02; adjusted OR 0.45; 95 % CI 0.23–0.90; p = 0.02). Sub-group analysis demonstrated that of the three anti-TNF agents studied, only etanercept (unadjusted OR, 0.33; 95 % CI 0.08–0.94; p = 0.03; adjusted OR 0.30; 95 % CI 0.08–0.89; p = 0.02) was associated with a decreased risk of AD in RA patients. Conclusion: There is an increased risk of AD in the studied RA population. The relative risk of AD among RA subjects was lowered in those exposed to etanercept. Anti-TNF therapy with etanercept shows promise as a potential treatment for AD.",adalimumab;etanercept;immunosuppressive agent;infliximab;methotrexate;prednisone;rituximab;salazosulfapyridine;adult;age;aged;Alzheimer disease;article;clinical assessment;comorbidity;controlled study;coronary artery disease;coronary risk;diabetes mellitus;disease association;drug exposure;female;human;low risk patient;major clinical study;male;middle aged;peripheral vascular disease;prevalence;priority journal;Puerto Rico;rheumatoid arthritis;risk assessment;risk factor;sex;United States,"Chou, R. C.;Kane, M.;Ghimire, S.;Gautam, S.;Gui, J.",2016,,10.1007/s40263-016-0374-z,0,
814,Prediction of vascular dementia and Alzheimer's disease in patients with atrial fibrillation or atrial flutter using CHADS2 score,"Background Atrial fibrillation (AF) is associated with an increased risk of dementia. However, limited data are available on the predictors of dementia in patients with AF. This study aimed to evaluate whether the CHADS2 score could be a useful tool for risk stratification with regard to dementia occurrence among patients with AF. Methods AF patients were identified from the National Health Insurance sampling database, which has accumulated a total of 1,000,000 participants since 2000. After excluding patients diagnosed with dementia prior to the index day of enrollment, CHADS2 score was measured to investigate its association with the occurrence of dementia, including vascular dementia and Alzheimer's disease. Results During the mean follow-up period of 3.71 ± 2.78 years, 1135 dementia cases (7.36%) were identified, including 241 cases of vascular dementia and 894 cases of Alzheimer's disease. In multivariate analysis, an increase of 1 point in the CHADS2 score was independently associated with a 54% increase in the risk of vascular dementia (hazard ratio = 1.54; 95% confidence interval, 1.41–1.69; p < 0.001) and a 40% increase in Alzheimer's disease (hazard ratio = 1.40; 95% confidence interval, 1.34–1.46; p < 0.001). Conclusion CHADS2 score is a useful predictor for the development of vascular dementia as well as Alzheimer's disease in patients with AF.",acetylsalicylic acid;angiotensin receptor antagonist;calcium channel blocking agent;clopidogrel;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;thiazide diuretic agent;ticlopidine;warfarin;adult;aged;Alzheimer disease;article;atrial fibrillation;cerebrovascular accident;CHADS2 score;chronic kidney disease;chronic obstructive lung disease;comorbidity;computer assisted tomography;congestive heart failure;coronary artery disease;diabetes mellitus;female;follow up;heart atrium flutter;human;hypertension;ICD-9;major clinical study;male;medical history;multiinfarct dementia;national health insurance;neuroimaging;nuclear magnetic resonance imaging;peripheral occlusive artery disease;prediction;risk factor;valvular heart disease,"Chou, R. H.;Chiu, C. C.;Huang, C. C.;Chan, W. L.;Huang, P. H.;Chen, Y. C.;Chen, T. J.;Chung, C. M.;Lin, S. J.;Chen, J. W.;Leu, H. B.",2016,,,0,
815,Comorbidity in very old adults with type 2 diabetes mellitus,,aged;aging;cataract;chronic disease;cognitive defect;comorbidity;congestive heart failure;coronary artery disease;dementia;depression;dyslipidemia;electronic medical record;female;gastroesophageal reflux;glaucoma;atrial fibrillation;human;hypertension;hypothyroidism;intervertebral disk degeneration;kidney failure;letter;major clinical study;male;non insulin dependent diabetes mellitus;osteoarthritis;osteoporosis;peripheral vascular disease;primary medical care;prostate hypertrophy;transient ischemic attack,"Chow, J. Y.;Nie, J. X.;Shawn Tracy, C.;Wang, L.;Upshur, R. E. G.",2013,,,0,
816,The role of antioxidants in dementia and other diseases: A review,"A lot of research had been done to investigate the preventive and treatment roles of antioxidants in different diseases. A review of recently published papers was done. Well-known antioxidants are Vitamins A, C and E. They are rich in fruits and vegetables. Vitamin E is postulated to be beneficial in treatment of dementia, while the use of ginkgo biloba is still controversial. Epidemiological evidence has shown protective role of antioxidants in coronary heart disease and cancer, but clinical trials did not. Some other substances in fruits and vegetables might play a more important role. Therefore, further investigations may be needed. It might be beneficial to advise public to increase the consumption of fruits and vegetables in this context.",alpha tocopherol;alpha tocopherylquinone;antioxidant;ascorbic acid;beta carotene;cholinesterase inhibitor;estrogen;flavanoid;Ginkgo biloba extract;indometacin;mineral;placebo;protective agent;retinol;selegiline;selenium;terpenoid;vitamin;vitamin K group;zinc;adverse drug reaction;Alzheimer disease;article;neoplasm;clinical trial;controlled study;dementia;drug research;epidemiology;food intake;fruit;Ginkgo biloba;headache;human;ischemic heart disease;Parkinson disease;publication;vegetable,"Chow, V. S. F.",2001,,,0,
817,Beyond comorbidity: expanding the definition and measurement of complexity among older adults using administrative claims data,"BACKGROUND: Studies of patients with multiple chronic conditions using claims data are often missing important determinants of treatments and outcomes, such as function status and disease severity. We sought to identify and evaluate a class of function-related indicators (FRIs) from administrative claims data. POPULATION: The study cohort comprised US Medicare beneficiaries aged 65 years or older with Parts A and B fee-for-service and Part D coverage, with a hospitalization for acute myocardial infarction during 2007. METHODS: Measures during the year before admission included the FRIs, demographics, conventional comorbidity measures, and prior hospitalization. Outcomes were receipt of cardiac catheterization during the index hospitalization and 12-month mortality. Model development used a random sample (n=72,056) with an equal sample for validation. RESULTS: In addition to prior cardiovascular conditions (85%), 40% had >/=1 comorbid condition, 30% were hospitalized in the prior 6 months, and 65% had >/=1 FRI [eg, delirium/dementia (22.7%), depression (16.7%), mobility limitation (16.1%), and chronic skin ulcers (12.6%)]. Including the FRIs improved mortality and cardiac catheterization prediction models (C-statistics 0.71 and 0.77, respectively). Patients with more cardiovascular conditions received less cardiac catheterization [minimally adjusted odds ratio (OR) 0.83; 95% confidence interval (CI), 0.82-0.83], as did patients with more comorbidities (minimally adjusted OR 0.70; 95% CI, 0.69-0.71), but this was attenuated by adjusting for functional status (fully adjusted OR for cardiovascular conditions 0.95; 95% CI, 0.94-0.96 and for comorbid conditions 0.94; 95% CI, 0.92-0.95). CONCLUSIONS: Claims data studies that include indicators of potentially diminished patient functional status better capture heterogeneity of patients with multiple chronic conditions.","Aged;Cardiovascular Diseases/epidemiology/therapy;Chronic Disease/*classification/epidemiology/*therapy;Cohort Studies;Comorbidity;Confidence Intervals;Diabetes Mellitus, Type 2/epidemiology/therapy;Female;Humans;Insurance Claim Review/*statistics & numerical data;Kidney Diseases/epidemiology/therapy;Logistic Models;Male;Medicare/*utilization;Mental Disorders/epidemiology/therapy;Middle Aged;Multivariate Analysis;Odds Ratio;*Severity of Illness Index;United States/epidemiology","Chrischilles, E.;Schneider, K.;Wilwert, J.;Lessman, G.;O'Donnell, B.;Gryzlak, B.;Wright, K.;Wallace, R.",2014,Mar,10.1097/mlr.0000000000000026,0,
818,Mortality after the hospitalization of a spouse,"BACKGROUND: The illness of a spouse can affect the health of a caregiving partner. We examined the association between the hospitalization of a spouse and a partner's risk of death among elderly people. METHODS: We studied 518,240 couples who were enrolled in Medicare in 1993. We used Cox regression analysis and fixed-effects (case-time-control) methods to assess hospitalizations and deaths during nine years of follow-up. RESULTS: Overall, 383,480 husbands (74 percent) and 347,269 wives (67 percent) were hospitalized at least once, and 252,557 husbands (49 percent) and 156,004 wives (30 percent) died. Mortality after the hospitalization of a spouse varied according to the spouse's diagnosis. Among men, 6.4 percent died within a year after a spouse's hospitalization for colon cancer, 6.9 percent after a spouse's hospitalization for stroke, 7.5 percent after a spouse's hospitalization for psychiatric disease, and 8.6 percent after a spouse's hospitalization for dementia. Among women, 3.0 percent died within a year after a spouse's hospitalization for colon cancer, 3.7 percent after a spouse's hospitalization for stroke, 5.7 percent after a spouse's hospitalization for psychiatric disease, and 5.0 percent after a spouse's hospitalization for dementia. After adjustment for measured covariates, the risk of death for men was not significantly higher after a spouse's hospitalization for colon cancer (hazard ratio, 1.02; 95 percent confidence interval, 0.95 to 1.09) but was higher after hospitalization for stroke (hazard ratio, 1.06; 95 percent confidence interval, 1.03 to 1.09), congestive heart failure (hazard ratio, 1.12; 95 percent confidence interval, 1.07 to 1.16), hip fracture (hazard ratio, 1.15; 95 percent confidence interval, 1.11 to 1.18), psychiatric disease (hazard ratio, 1.19; 95 percent confidence interval, 1.12 to 1.26), or dementia (hazard ratio, 1.22; 95 percent confidence interval, 1.12 to 1.32). For women, the various risks of death after a spouse's hospitalization were similar. Overall, for men, the risk of death associated with a spouse's hospitalization was 22 percent of that associated with a spouse's death (95 percent confidence interval, 17 to 27 percent); for women, the risk was 16 percent of that associated with death (95 percent confidence interval, 8 to 24 percent). CONCLUSIONS: Among elderly people hospitalization of a spouse is associated with an increased risk of death, and the effect of the illness of a spouse varies among diagnoses. Such interpersonal health effects have clinical and policy implications for the care of patients and their families.",Aged;Bereavement;Caregivers/psychology/*statistics & numerical data;Case-Control Studies;Female;Follow-Up Studies;*Hospitalization;Humans;Male;Medicare;*Mortality;Odds Ratio;Proportional Hazards Models;Risk;Spouses/psychology/*statistics & numerical data;United States/epidemiology,"Christakis, N. A.;Allison, P. D.",2006,Feb 16,10.1056/NEJMsa050196,0,
819,"Genetics: Healthy ageing, the genome and the environment",,aging;arthritis;atrial fibrillation;clinical examination;cognition;dementia;diabetes mellitus;environment;gene sequence;genetic variability;genome;genetic association;human;hypertension;insulin dependent diabetes mellitus;ischemic heart disease;longevity;lung cancer;non insulin dependent diabetes mellitus;note;osteoporosis;priority journal;quality of life,"Christensen, K.;McGue, M.",2016,,,0,
820,Disclosing Pleiotropic Effects During Genetic Risk Assessment for Alzheimer Disease: a Randomized Trial,"OBJECTIVE: To determine the safety and behavioral effect of disclosing modest associations between apolipoprotein E (APOE) genotype and coronary artery disease (CAD) risk during APOE-based genetic risk assessments for Alzheimer disease (AD).DESIGN: Randomized, multicenter equivalence clinical trial. (ClinicalTrials.gov: NCT00462917).SETTING: 4 teaching hospitals.PARTICIPANTS: 257 asymptomatic adults were enrolled, 69% of whom had 1 AD-affected first-degree relative.INTERVENTION: Disclosure of genetic risk information about AD and CAD (AD+CAD) or AD only (AD-only).MEASUREMENTS: Primary outcomes were Beck Anxiety Inventory (BAI) and Center for Epidemiologic Studies Depression Scale (CES-D) scores at 12 months. Secondary outcomes were all measures at 6 weeks and 6 months and test-related distress and health behavior changes at 12 months.RESULTS: At 12 months, mean BAI scores were 3.5 in both the AD-only and AD+CAD groups (difference, 0.0 [95% CI, -1.0 to 1.0]), and mean CES-D scores were 6.4 and 7.1 in the AD-only and AD+CAD groups, respectively (difference, 0.7 [CI, -1.0 to 2.4]). Both confidence bounds fell within the equivalence margin of ±5 points. Among carriers of the APOE ?4 allele, distress was lower in the AD+CAD groups (difference, -4.8 [CI, -8.6 to -1.0]) (P = 0.031 for the interaction between group and APOE genotype). Participants in the AD+CAD groups also reported more health behavior changes, regardless of APOE genotype.LIMITATIONS: Outcomes were self-reported by volunteers without severe anxiety, severe depression, or cognitive problems. Analyses omitted 33 randomly assigned participants.CONCLUSION: Disclosure of pleiotropic information did not increase anxiety or depression and may have decreased distress among persons at increased risk for 2 conditions. Providing risk modification information about CAD improved health behaviors. Findings highlight the potential benefits of disclosure of secondary genetic findings when options exist for decreasing risk.PRIMARY FUNDING SOURCE: National Human Genome Research Institute.BACKGROUND: Increasing use of genetic testing raises questions about disclosing secondary findings, including pleiotropic information.","Alzheimer Disease [genetics] [psychology];Anxiety [etiology];Apolipoprotein E4 [genetics];Coronary Artery Disease [genetics] [psychology];Depression [etiology];Genetic Predisposition to Disease;Genotype;Health Behavior;Risk Assessment;Stress, Psychological [etiology];Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword];Sr-dementia","Christensen, Kd;Roberts, Js;Whitehouse, Pj;Royal, Cd;Obisesan, To;Cupples, La;Vernarelli, Ja;Bhatt, Dl;Linnenbringer, E;Butson, Mb;Fasaye, Ga;Uhlmann, Wr;Hiraki, S;Wang, N;Cook-Deegan, R;Green, Rc",2016,,10.7326/M15-0187,0,821
821,Disclosing Pleiotropic Effects During Genetic Risk Assessment for Alzheimer Disease: A Randomized Trial,"BACKGROUND: Increasing use of genetic testing raises questions about disclosing secondary findings, including pleiotropic information. OBJECTIVE: To determine the safety and behavioral effect of disclosing modest associations between apolipoprotein E (APOE) genotype and coronary artery disease (CAD) risk during APOE-based genetic risk assessments for Alzheimer disease (AD). DESIGN: Randomized, multicenter equivalence clinical trial. (ClinicalTrials.gov: NCT00462917). SETTING: 4 teaching hospitals. PARTICIPANTS: 257 asymptomatic adults were enrolled, 69% of whom had 1 AD-affected first-degree relative. INTERVENTION: Disclosure of genetic risk information about AD and CAD (AD+CAD) or AD only (AD-only). MEASUREMENTS: Primary outcomes were Beck Anxiety Inventory (BAI) and Center for Epidemiologic Studies Depression Scale (CES-D) scores at 12 months. Secondary outcomes were all measures at 6 weeks and 6 months and test-related distress and health behavior changes at 12 months. RESULTS: At 12 months, mean BAI scores were 3.5 in both the AD-only and AD+CAD groups (difference, 0.0 [95% CI, -1.0 to 1.0]), and mean CES-D scores were 6.4 and 7.1 in the AD-only and AD+CAD groups, respectively (difference, 0.7 [CI, -1.0 to 2.4]). Both confidence bounds fell within the equivalence margin of ±5 points. Among carriers of the APOE ?4 allele, distress was lower in the AD+CAD groups (difference, -4.8 [CI, -8.6 to -1.0]) (P = 0.031 for the interaction between group and APOE genotype). Participants in the AD+CAD groups also reported more health behavior changes, regardless of APOE genotype. LIMITATIONS: Outcomes were self-reported by volunteers without severe anxiety, severe depression, or cognitive problems. Analyses omitted 33 randomly assigned participants. CONCLUSION: Disclosure of pleiotropic information did not increase anxiety or depression and may have decreased distress among persons at increased risk for 2 conditions. Providing risk modification information about CAD improved health behaviors. Findings highlight the potential benefits of disclosure of secondary genetic findings when options exist for decreasing risk. PRIMARY FUNDING SOURCE: National Human Genome Research Institute.","Alzheimer Disease [genetics] [psychology];Anxiety [etiology];Apolipoprotein E4 [genetics];Coronary Artery Disease [genetics] [psychology];Depression [etiology];Genetic Predisposition to Disease;Genotype;Health Behavior;Risk Assessment;Stress, Psychological [etiology];Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword]","Christensen, K. D.;Roberts, J. S.;Whitehouse, P. J.;Royal, C. D.;Obisesan, T. O.;Cupples, L. A.;Vernarelli, J. A.;Bhatt, D. L.;Linnenbringer, E.;Butson, M. B.;Fasaye, G. A.;Uhlmann, W. R.;Hiraki, S.;Wang, N.;Cook-Deegan, R.;Green, R. C.",2016,,10.7326/m15-0187,0,
822,Catecholamines and psychological stress,"Recent results concerning the interaction between catecholamines, psychological stress and disease are reviewed. The importance of cognitive assessment of the experience of stress and choice of coping strategy are emphasized. These fall into two groups: direct action and amelioration. In psychological stress, plasma adrenaline is increased. Metabolism of catecholamines in the brain is increased, in any case, during acute stress. Sex differences exist in the physiological stress reaction. In psychological stress, plasma adrenaline increases more in men than in wome. Plasma noradrenaline which reflects muscle sympathetic activity is not altered in pure psychological stress but is influenced primarily by alterations in position and increased motor activity, and increases considerably with age. It is difficult, by means of physiological measurements, to differentiate between increased emotional activation (arousal) in the form of exertion and performance on the one hand and psychological distress on the other. Experience of the situation is of significance for possible choice of coping strategies. Psychological stress scarcely plays any part in the development of blood-pressure disease while clear evidence exists for a connection between psychological stress and ischaemic heart disease. Both increased physiological reaction to stress (Type A behaviour) and psychosocial stress, which is again connected with a modest educational level, probably contribute to development of arteriosclerosis or the chance of surviving after myocardial infarction. In certain patients, including patients who have or have had duodenal ulcer and in patients with Alzheimer's disease, the increase with age in the noradrenaline content of plasma and in the cerebrospinal fluid, respectively, is greater than in normal subjects. The hypothesis is propounded that both increased physiological stress reactions (Type A behaviour or increased psychosocial stress) and coping strategies (increased tobacco consumption, massive alcohol consumption or massive intake of medicine) may result in damage to organs. This may result in greater increase in plasma noradrenaline with age than in healthy individuals. There are probably certain disease entitites in which the physiological stress reaction is reduced. Controlled intervention studies should be employed to a greater extent in future to investigate the extent to which it is possible, in our present state of knowledge, to reduce possible injurious effects of stress.",adrenalin;catecholamine;noradrenalin;cardiovascular system;central nervous system;endocrine system;etiology;human;hypertension;ischemic heart disease;pancreas;personality;psychological aspect;short survey;stress,"Christensen, N. J.",1986,,,0,
823,Migraine and risk of dementia: a nationwide retrospective cohort study,"OBJECTIVE: Migraines are one of the most common neurological disorders. Dementia is a neurodegenerative disease characterized by slow progressive memory loss and cognitive dysfunction. This retrospective cohort study investigates the association between migraines and dementia using a nationwide population-based database in Taiwan. METHODS: We retrieved the data analyzed in this study from the National Health Insurance Research database (NHIRD) in Taiwan. We used multivariate Cox proportion-hazards regression models to assess the effects of migraines on the risk of dementia after adjusting for sociodemographic characteristics and comorbidities. RESULTS: The migraine cohort had a higher prevalence of diabetes, hypertension, coronary artery disease, head injury and depression at baseline (p < 0.0001). After adjusting the covariates, migraine patients had a 1.33-fold higher risk of developing dementia [hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.22-1.46]. The sex-specific incidence rate of dementia was higher in men than in women in both cohorts, with an HR of 1.09 (95% CI 1.00-1.18) for men compared to women. Kaplan-Meier analysis shows that the cumulative incidence of dementia was 1.48% greater in the migraine cohort than in the nonmigraine cohort (log-rank test, p < 0.0001). CONCLUSIONS: This study shows that migraines are associated with a future higher risk of dementia after adjusting for comorbidities. Specifically, the association between migraine and dementia is greater in young adults than in older adults.",Adult;Aged;Cohort Studies;Comorbidity;Dementia/*epidemiology;Female;Humans;Male;Middle Aged;Migraine Disorders/*epidemiology;Retrospective Studies;Risk Factors;Taiwan/epidemiology,"Chuang, C. S.;Lin, C. L.;Lin, M. C.;Sung, F. C.;Kao, C. H.",2013,,10.1159/000353559,0,
824,Do formulation switches exacerbate existing medical illness? Results of an open-label transition to orally disintegrating risperidone tablets,"Background: Orally disintegrating risperidone tablets (Risperdal* M-TABs*) present an alternative method of drug delivery that may benefit physicians struggling to treat non-compliant patients, since it begins to dissolve within 5s, preventing tablet cheeking or spitting. Objectives: To evaluate safety and maintenance of effect in symptomatically stable patients transitioned from compressed risperidone tablets to orally disintegrating risperidone tablets. Methods: This open-label, multi-centre study enrolled 82 adults from four diagnostic groups (major depressive disorder (MDD), n = 25; bipolar disorder (BP), n = 21; dementia (DE), n = 20; schizophrenia (SZ), n = 16). Patients were switched from their previous dosage of compressed tablets (0.5, 1.0, 2.0, 3.0, or 4.0mg/day) to an equivalent dosage of orally disintegrating risperidone and followed for 4 weeks. The primary effectiveness parameter evaluated was the Clinical Global Impression - Severity (CGI-S) scale. Results: Most patients (24/25 MDD; 20/21 BP; 17/18 DE; 14/15 SZ) improved by 1 point on CGI-S from baseline or experienced no change at endpoint. Adverse events (AEs) occurring in any group at a ≥ 10% incidence included headache (19%) and pharyngolaryngeal pain (10%), reported in the BP group only. Conclusions: Patients stabilized on compressed risperidone tablets transitioned to the equivalent dose of orally disintegrating risperidone tablets with continued maintenance of effect, no decompensation and with minimal side effects. Copyright © 2007 John Wiley & Sons, Ltd.",antidepressant agent;anxiolytic agent;mood stabilizer;neuroleptic agent;psychotropic agent;risperdal m tabs;risperidone;unclassified drug;abnormal behavior;adult;aged;agitation;anxiety;arthralgia;article;bipolar disorder;Clinical Global Impression scale;clinical trial;congestive heart failure;conjunctivitis;dementia;diarrhea;diastolic blood pressure;disease exacerbation;drug efficacy;drug formulation;drug induced headache;drug safety;drug solubility;drug withdrawal;dyspepsia;dyspnea;female;fever;follow up;atrial fibrillation;heart infarction;human;insomnia;joint swelling;kidney carcinoma;major clinical study;major depression;male;multicenter study;nose obstruction;open study;outcome assessment;pain;patient compliance;priority journal;pulse rate;reference value;respiratory tract infection;schizophrenia;side effect;sleep disorder;sore throat;systolic blood pressure;tablet compression;tablet disintegration;thorax pain;weight change,"Chue, P.;Prinzo, R. S.;Binder, C. E.",2007,,,0,
825,Advances in vascular cognitive impairment 2005,,antioxidant;calcium antagonist;donepezil;nimodipine;atherosclerosis;CADASIL;clinical trial;cognitive defect;coronary artery atherosclerosis;diagnostic imaging;disease severity;drug effect;drug efficacy;gene mutation;human;image analysis;infection;inflammation;memory disorder;multiinfarct dementia;neuroimaging;nuclear magnetic resonance imaging;prevalence;priority journal;risk assessment;risk factor;short survey;vascular cognitive impairment;white matter,"Chui, H.;Skoog, I.",2006,,,0,
826,Association between neovascular age-related macular degeneration and dementia: A population-based case-control study in Taiwan,"Most available studies focusing on the association between neovascular age-related macular degeneration (AMD) and dementia have conflicting results. This study aimed to investigate the association between previously diagnosed AMD and dementia using a populationbased dataset in Taiwan. Methods Data for this case-control study were retrospectively collected from the Taiwan National Health Insurance Research Database. We identified 13,402 subjects who had a diagnosis of dementia as cases, and 40,206 subjects without dementia as controls. A conditional logistic regression was used to examine the association of dementia with previously diagnosed neovascular AMD. Results We found that of the study sample of 53,608 subjects, 1.01% had previously diagnosed neovascular AMD, 1.35%and 0.90% for cases and the controls, respectively (p<0.001). The conditional logistic regression analysis suggested that the odds ratio of prior neovascular AMD for cases was 1.37 (95% confidence interval: 1.14∼1.65) compared to the controls after adjusting for subjects' age, monthly income, geographic location, urbanization level, and hyperlipidemia, diabetes, hypertension, stroke, ischemic heart disease, and whether or not a subjects underwent cataract surgery prior to index date than controls. Conclusions Dementia subjects were associated with a higher proportion of prior neovascular AMD than were the controls.",adult;age;age related macular degeneration;aged;article;cataract extraction;cerebrovascular accident;controlled study;dementia;diabetes mellitus;disease association;female;geography;human;hyperlipidemia;hypertension;income;ischemic heart disease;logistic regression analysis;major clinical study;male;middle aged;population based case control study;retrospective study;risk assessment;Taiwan;urbanization;very elderly,"Chung, S. D.;Lee, C. Z.;Kao, L. T.;Lin, H. C.;Tsai, M. C.;Sheu, J. J.",2015,,,0,
827,Increased risk of pemphigoid following scabies: a population-based matched-cohort study,"BACKGROUND: No prior study has investigated the possibility that scabies patients may be at an increased risk for developing pemphigoid. OBJECTIVE: To evaluate the risk of pemphigoid following scabies during a 3-year follow-up period using a Taiwanese population-based claims database and taking clinical and demographic characteristics into consideration. METHODS: This investigation consisted of a study group of 6793 subjects with a diagnosis of scabies and 33 965 randomly selected subjects used as a comparison group. Each patient was tracked for 3 years following their index dates to identify those who received a subsequent diagnosis of pemphigoid. Stratified Cox proportional hazards regressions were used to compute the hazard ratio (HR) of pemphigoid during the 3-year follow-up period. RESULTS: Of the 40 758 subjects, 52 (0.13%) had received a diagnosis of pemphigoid during the 3-year follow-up period; 33 (0.49% of the study group) were from the study group and 19 (0.06% of the comparison group) were from the comparison group. Compared to subjects without scabies, the HR for pemphigoid for subjects with scabies was 5.93 within the 3-year follow-up period following the index date after adjusting for monthly income, hypertension, diabetes, obesity, psoriasis, stroke, dementia, Parkinson's disease, coronary heart disease, schizophrenia or bipolar disorder, and after censoring those that died during the follow-up period. CONCLUSIONS: This study detected an increased risk for pemphigoid among patients suffering from scabies. Physicians treating elderly patients with a history of scabies should be alert to the development of pemphigoid.","Adolescent;Adult;Aged;Cohort Studies;Female;Humans;Male;Middle Aged;Pemphigoid, Bullous/complications/*epidemiology;Population Surveillance;Proportional Hazards Models;Risk Factors;Scabies/*complications;Young Adult","Chung, S. D.;Lin, H. C.;Wang, K. H.",2014,May,10.1111/jdv.12132,0,
828,Serum amyloid A in Alzheimer's disease brain is predominantly localized to myelin sheaths and axonal membrane,"Immunohistochemical localization of the injury specific apolipoprotein, acute phase serum amyloid A (A-apoSAA), was compared in brains of patients with neuropathologically confirmed Alzheimer's disease (AD), multiple sclerosis (MS), Parkinson's disease (PD); Pick's disease (Pick's), dementia with Lewy bodies (DLB), coronary artery disease (CAD), and schizophrenia. Affected regions of both AD and MS brains showed intense staining for A-apoSAA in comparison to an unaffected region and non-AD/MS brains. The major site of A-apoSAA staining in both diseases was the myelin sheaths of axons in layers V and VI of affected cortex. A-apoSAA contains a cholesterol binding site near its amino terminus and is likely to have a high affinity for cholesterol-rich myelin. These findings, along with our recent evidence that A-apoSAA can inhibit lipid synthesis in vascular smooth muscle cells suggest that A-apoSAA plays a role in the neuronal loss and white matter damage occurring in AD and MS.","Aged;Aged, 80 and over;Alzheimer Disease/*metabolism/pathology;Apolipoproteins/*metabolism;Brain/*metabolism/pathology;Cell Membrane/metabolism;Humans;Male;Middle Aged;Myelin Sheath/*metabolism;Presynaptic Terminals/*metabolism;Protein Precursors/metabolism;Serum Amyloid A Protein/*metabolism","Chung, T. F.;Sipe, J. D.;McKee, A.;Fine, R. E.;Schreiber, B. M.;Liang, J. S.;Johnson, R. J.",2000,Jun,,0,
829,Adverse respiratory events associated with hypnotics use in patients of chronic obstructive pulmonary disease,"Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD). We conducted a population-based case-control study to evaluate the effects of hypnotics on the risk of adverse respiratory events in patients with COPD. The case-control study was investigated using data retrieved from the Taiwan National Health Insurance Research Database. Patients with newly diagnosed adverse respiratory events (pneumonia, COPD with acute exacerbation, acute respiratory failure, and cardiopulmonary arrest) were included in the case group. Patients with COPD and no history of adverse respiratory events were randomly selected for the control group, which was frequency-matched with the case group according to index date, age (per 10 years), and sex. Patients who had used hypnotics within 1 month meant active users. The odds ratios (ORs) and 95% confidence intervals (CIs) of were calculated using univariable and multivariable logistic regression models. Most of the study participants were male (71.6%), and the mean ages of the participants in the case and control groups were 69.2 (±12.4) and 67.5 (±12.3) years, respectively. After potential confounding factors were adjusting for, the adjusted ORs of adverse respiratory events were 12.0 for active users of benzodiazepines (95% CI, 8.11-17.6) and 10.5 for active users of nonbenzodiazepines (95% CI, 7.68-14.2) compared with the adjusted ORs of those who never used hypnotics. The results of this epidemiological study suggested that hypnotics increased the risk of adverse respiratory events in patients with COPD.",benzodiazepine derivative;hypnotic agent;aged;alcohol related disease;article;cardiopulmonary arrest;case control study;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;coronary artery disease;dementia;disease exacerbation;diseases;female;human;insomnia;major clinical study;male;pneumonia;population based case control study;priority journal;randomized controlled trial;respiratory tract disease;risk assessment,"Chung, W. S.;Lai, C. Y.;Lin, C. L.;Kao, C. H.",2015,,,0,
830,White matter disease as a biomarker for long-term cerebrovascular disease and dementia topical collection on cerebrovascular disease and stroke,,article;basal ganglion;brain ischemia;central nervous system disease;cerebrovascular disease;cognitive defect;computer assisted tomography;dementia;diagnostic accuracy;diagnostic value;disease severity;executive function;heart infarction;hematoma;high risk population;human;lacunar stroke;leukoaraiosis;mortality;nuclear magnetic resonance imaging;rating scale;white matter;white matter hyperintensity;white matter lesion,"Chutinet, A.;Rost, N. S.",2014,,,0,
831,Length of stay in hospital is longer in ethnic minority patients after coronary artery bypass surgery,,adult;African Caribbean;aged;breast cancer;Caucasian;cerebrovascular disease;chronic kidney disease;chronic obstructive lung disease;comorbidity;coronary artery bypass surgery;dementia;emergency patient;ethnic difference;ethnic group;ethnicity;female;heart failure;hospital admission;hospitalization;human;ICD-10;ischemic heart disease;length of stay;letter;lung cancer;major clinical study;male;middle aged;Oriental;priority journal;South Asian;United Kingdom,"Ciputra, R. N.;Sembiring, Y. E.;Prawoto, O. L.;Khouw, N.;Baig, M.;Uppal, H.;Chandran, S.;Potluri, R.",2014,,,0,
832,Correspondences from 10th to 9th Revision of the International Classification of Diseases in the causes of death lists of the National Institute of Statistics and the Regional Health Authority of Murcia in Spain,"BACKGROUND: Different countries have conducted comparability studies between Revisions 10 and 9 of the International Classification of Diseases for aggregate lists of causes of death. In Spain, the COMPARA project was aimed at evaluating the impact of the revision change. METHODS: Descriptive cross-sectional epidemiological study of 88,048 deaths recorded in Spain in 1999 with the underlying cause of death doubled coded in ICD-9 and ICD-10. The theoretical correspondences between the ICD on the lists of the National Institute of Statistics and Murcia are established. The comparability rates and their confidence intervals, and the total kappa index were calculated. RESULTS: A decline in infectious diseases (-1.7%) and viral hepatitis, (-12.3%) declined under Tenth revision, while AIDS showed an increase (5.7%). Neoplasms increased a little (0.3%) with the inclusion of the Mielodisplasic Syndrome (55.2%). Diabetes mellitus is increased (2.1%). Mental disorders declined on dementia being shifted to Alzheimer's disease (28.6%). Cardiovascular diseases dropped slightly (-1.4%), without any impact on cerebrovascular diseases, although acute myocardial infarct decreased (-0.6%) while ischemic heart disease increased (0.3%). Pneumonia decreased (-12.5%) and hepatic cirrhosis grows (4.3%). Ill-defined conditions increased due to cardiorespiratory insufficiencies. The external causes show no change without including the accuracy of ICD-9. The National Institute of Statistics 102 groups list obtained a total kappa index of 95.4%, similar to the Murcia variants. CONCLUSIONS: Although ICD-10 has a lesser overall impact, the significant comparability rates of the causes of death groups between the revisions with important absolute differences should be taken into account.",*Cause of Death;Cross-Sectional Studies;Humans;International Classification of Diseases/*statistics & numerical data;Spain,"Cirera Suarez, L.;Rodriguez Barranco, M.;Madrigal de Torres, E.;Carrillo Prieto, J.;Hasiak Santo, A.;Augusto Becker, R.;Tobias Garces, A.;Sanchez Carmen, N.",2006,Mar-Apr,,0,
833,Pathophysiological role of mitochondrial potassium channels and their modulation by drugs,"Mitochondria play a central role in ATP-generating processes. Indeed, in mammalian tissues, up to 90% of ATP is generated by mitochondria through the process of oxidative phosphorylation; furthermore, mitochondria are involved in multiple signal transduction pathways. A rapidly expanding body of literature has con fi rmed that mitochondria play a pivotal role in apoptosis, cardio- and neuro-protection, and various neurodegenerative disorders, ranging from Parkinson's to Alzheimer's disease. It is evident that mitochondria are also the targets of multiple drugs; some of these are exactly designed to influence mitochondrial function, while others have primary targets in other cellular locations but may interact with mitochondria because of the presence of numerous targets on this organelle. In this regard, mitochondrial potassium (mitoK) channels play a critical role in mitochondrial function and, consequently, in the metabolism of the whole cell. Indeed, they play a decisive role in cardiovascular diseases, particularly in myocardial infarction and neurodegenerative diseases, and they are emerging as promising oncological targets. This review aims to describe mitoK channels from a structural point of view and investigate their pathophysiological roles, focusing on possible specific modulators that might be useful as pharmacological tools in the treatment of various pathologies characterized by mitoK involvement.",Mitochondrial potassium channels;cardiovascular diseases;neurological diseases;oncological diseases.,"Citi, V.;Calderone, V.;Martelli, A.;Breschi, M. C.;Testai, L.",2017,Oct 12,,0,
834,"Comorbidity and polypharmacy in people with dementia: Insights from a large, population-based cross-sectional analysis of primary care data","Background: the care of older people with dementia is often complicated by physical comorbidity and polypharmacy, but the extent and patterns of these have not been well described. This paper reports analysis of these factors within a large, cross-sectional primary care data set. Methods: data were extracted for 291,169 people aged 65 years or older registered with 314 general practices in the UK, of whom 10,258 had an electronically recorded dementia diagnosis. Differences in the number and type of 32 physical conditions and the number of repeat prescriptions in those with and without dementia were examined. Age-gender standardised rates were used to calculate odds ratios (ORs) of physical comorbidity and polypharmacy. Results: people with dementia, after controlling for age and sex, had on average more physical conditions than controls (mean number of conditions 2.9 versus 2.4; P < 0.001) and were on more repeat medication (mean number of repeats 5.4 versus 4.2; P < 0.001). Those with dementia were more likely to have 5 or more physical conditions (age-sex standardised OR [sOR] 1.42, 95% confidence interval (CI) 1.35-1.50; P < 0.001) and were also more likely to be on 5 or more (sOR 1.46; 95% CI 1.40-1.52; P < 0.001) or 10 or more repeat prescriptions (sOR 2.01; 95% CI 1.90-2.12; P < 0.001). Conclusions: people with dementia have a higher burden of comorbid physical disease and polypharmacy than those without dementia, even after accounting for age and sex differences. Such complex needs require an integrated response from general health professionals and multidisciplinary dementia specialists.",aged;article;asthma;cerebrovascular accident;comorbidity;constipation;controlled study;dementia;female;human;hypertension;ischemic heart disease;male;pain;polypharmacy;prevalence;primary medical care;priority journal;sex difference;very elderly,"Clague, F.;Mercer, S. W.;McLean, G.;Reynish, E.;Guthrie, B.",2017,,10.1093/ageing/afw176,0,
835,Non-invasive vagus nerve stimulation in healthy humans reduces sympathetic nerve activity,"OBJECTIVEWe investigated a non-invasive method of VNS through electrical stimulation of the auricular branch of the vagus nerve distributed to the skin of the ear--transcutaneous VNS (tVNS) and measured the autonomic effects.METHODSThe effects of tVNS parameters on autonomic function in 48 healthy participants were investigated using heart rate variability (HRV) and microneurography. tVNS was performed using a transcutaneous electrical nerve stimulation (TENS) machine and modified surface electrodes. Participants visited the laboratory once and received either active (200 ?s, 30 Hz; n = 34) or sham (n = 14) stimulation.RESULTSActive tVNS significantly increased HRV in healthy participants (P = 0.026) indicating a shift in cardiac autonomic function toward parasympathetic predominance. Microneurographic recordings revealed a significant decrease in frequency (P = 0.0001) and incidence (P = 0.0002) of muscle sympathetic nerve activity during tVNS.CONCLUSIONtVNS can increase HRV and reduce sympathetic nerve outflow, which is desirable in conditions characterized by enhanced sympathetic nerve activity, such as heart failure. tVNS can therefore influence human physiology and provide a simple and inexpensive alternative to invasive VNS.BACKGROUNDVagus nerve stimulation (VNS) is currently used to treat refractory epilepsy and is being investigated as a potential therapy for a range of conditions, including heart failure, tinnitus, obesity and Alzheimer's disease. However, the invasive nature and expense limits the use of VNS in patient populations and hinders the exploration of the mechanisms involved.",Healthy Volunteers;Heart Rate [physiology];Respiratory Rate [physiology];Sympathetic Nervous System [physiology];Transcutaneous Electric Nerve Stimulation;Vagus Nerve [physiology];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword],"Clancy, Ja;Mary, Da;Witte, Kk;Greenwood, Jp;Deuchars, Sa;Deuchars, J",2014,,10.1016/j.brs.2014.07.031,0,836
836,Non-invasive vagus nerve stimulation in healthy humans reduces sympathetic nerve activity,"BACKGROUND: Vagus nerve stimulation (VNS) is currently used to treat refractory epilepsy and is being investigated as a potential therapy for a range of conditions, including heart failure, tinnitus, obesity and Alzheimer's disease. However, the invasive nature and expense limits the use of VNS in patient populations and hinders the exploration of the mechanisms involved. OBJECTIVE: We investigated a non-invasive method of VNS through electrical stimulation of the auricular branch of the vagus nerve distributed to the skin of the ear--transcutaneous VNS (tVNS) and measured the autonomic effects. METHODS: The effects of tVNS parameters on autonomic function in 48 healthy participants were investigated using heart rate variability (HRV) and microneurography. tVNS was performed using a transcutaneous electrical nerve stimulation (TENS) machine and modified surface electrodes. Participants visited the laboratory once and received either active (200 ?s, 30 Hz; n = 34) or sham (n = 14) stimulation. RESULTS: Active tVNS significantly increased HRV in healthy participants (P = 0.026) indicating a shift in cardiac autonomic function toward parasympathetic predominance. Microneurographic recordings revealed a significant decrease in frequency (P = 0.0001) and incidence (P = 0.0002) of muscle sympathetic nerve activity during tVNS. CONCLUSION: tVNS can increase HRV and reduce sympathetic nerve outflow, which is desirable in conditions characterized by enhanced sympathetic nerve activity, such as heart failure. tVNS can therefore influence human physiology and provide a simple and inexpensive alternative to invasive VNS.",Healthy Volunteers;Heart Rate [physiology];Respiratory Rate [physiology];Sympathetic Nervous System [physiology];Transcutaneous Electric Nerve Stimulation;Vagus Nerve [physiology];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Young Adult[checkword],"Clancy, J. A.;Mary, D. A.;Witte, K. K.;Greenwood, J. P.;Deuchars, S. A.;Deuchars, J.",2014,,10.1016/j.brs.2014.07.031,0,
837,Characteristics and outcomes for acute heart failure in elderly patients presenting to the ED,"Introduction The first aim of this study was to investigate the characteristics for elderly patients with acute heart failure presenting to the emergency department (ED). The second aim was to determine the characteristics of these elderly patients associated with serious adverse events. Methods The population was divided into 2 age groups, <80 and ≥80 years. The primary outcome was the occurrence of a serious adverse event, defined as either death from any cause within 30 days of the index ED visit or any of the following events within 14 days of the index ED visit: admission to a monitored unit, intubation, need for noninvasive ventilation, myocardial infarction, major procedure, or, for patients who were discharged after the initial visit, return to the ED resulting in admission to hospital. Results This prospective cohort study included 1658 visits. Older patients had a lower heart rate and higher diastolic blood pressure. The older patients were more likely to experience hospital admission (56% vs 46%, P <.001). For patients 80 years or older, 109 (14%) experienced a serious adverse event. In this ≥80-year group, history of heart failure, current medication with antiarrhythmic, acute infarction on the arrival electrocardiography, chest x-ray with pleural effusion, and urea greater than 12 mmol/L were independently associated with short-term serious adverse events. Conclusions Elderly patients with heart failure are a high-risk group. Careful assessment of these factors could help physicians identify those patients most at risk for adverse outcomes and, therefore, most in need of hospital admission.",antiarrhythmic agent;antibiotic agent;anticoagulant agent;antithrombocytic agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;cholinergic receptor blocking agent;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;nitrate;nitric acid derivative;steroid;urea;vasodilator agent;acute heart failure;acute heart infarction;adverse outcome;aged;article;atrial fibrillation;clinical outcome;cohort analysis;dementia;diabetes mellitus;diastolic blood pressure;electrocardiography;emergency ward;female;groups by age;heart rate;high risk population;hospital admission;hospital discharge;human;intubation;major clinical study;male;noninvasive ventilation;patient monitoring;pleura effusion;population;priority journal;prospective study;thorax radiography;very elderly,"Claret, P. G.;Stiell, I. G.;Yan, J. W.;Clement, C. M.;Rowe, B. H.;Calder, L. A.;Perry, J. J.",2016,,10.1016/j.ajem.2016.08.015,0,
838,Medical meanings,,amnesia;angina pectoris;bezoar;cataract;claudication;decubitus;delirium;dementia;geriatrics;gerontology;heart muscle ischemia;human;iatrogenic disease;leishmaniasis;medical literature;note;penis;polypharmacy,"Clarfield, A. M.",2005,,,0,
839,Diogenes syndrome. A clinical study of gross neglect in old age,"A study of elderly patients (fourteen men, sixteen women) who were admitted to hospital with acute illness and extreme self-neglect revealed common features which might be called Diogenes syndrome. All had dirty, untidy homes and a filthy personal appearance about which they showed no shame. Hoarding of rubbish (syllogomania) was sometimes seen. All except two lived alone, but poverty and poor housing standards were not a serious problem. All were known to the social-services departments and a third had persistently refused offers of help. An acute presentation with falls or collapse was common, and several physical diagnoses could be made. Multiple deficiency states were found--including iron, folate, vitamin B12, vitamin C, calcium and vitamin D, serum proteins and albumin, water, and potassium. The mortality, especially for women, was high (46%); most of the survivors responded well and were discharged. Half showed no evidence of psychiatric disorder and possessed higher than average intelligence. Many had led successful professional and business lives, with good family backgrounds and upbringing. Personality characteristics showed them to tend to be aloff, suspicious, emotionally labile, aggressive, group-dependent, and reality-distorting individuals. It is suggested that this syndrome may be a reaction late in life to stress in a certain type of personality.",Age Factors;*Aged;Ascorbic Acid Deficiency/complications;Blood Protein Disorders/complications;Bronchopneumonia/complications;Cerebrovascular Disorders/complications;Deficiency Diseases/*complications;Dementia/complications/diagnosis;Female;Folic Acid Deficiency/complications;Heart Failure/complications;Housing;Humans;Intelligence;Intelligence Tests;*Life Style;Male;Neoplasms/complications;Osteoarthritis/complications;Parkinson Disease/complications;Social Conditions;Social Isolation;Syndrome;Vitamin B 12 Deficiency/complications;Vitamin D Deficiency/complications,"Clark, A. N.;Mankikar, G. D.;Gray, I.",1975,Feb 15,,0,
840,Cerebral PET with florbetapir compared with neuropathology at autopsy for detection of neuritic amyloid-β plaques: A prospective cohort study,"Background: Results of previous studies have shown associations between PET imaging of amyloid plaques and amyloid-β pathology measured at autopsy. However, these studies were small and not designed to prospectively measure sensitivity or specificity of amyloid PET imaging against a reference standard. We therefore prospectively compared the sensitivity and specificity of amyloid PET imaging with neuropathology at autopsy. Methods: This study was an extension of our previous imaging-to-autopsy study of participants recruited at 22 centres in the USA who had a life expectancy of less than 6 months at enrolment. Participants had autopsy within 2 years of PET imaging with florbetapir (18F). For one of the primary analyses, the interpretation of the florbetapir scans (majority interpretation of five nuclear medicine physicians, who classified each scan as amyloid positive or amyloid negative) was compared with amyloid pathology (assessed according to the Consortium to Establish a Registry for Alzheimer's Disease standards, and classed as amyloid positive for moderate or frequent plaques or amyloid negative for no or sparse plaques); correlation of the image analysis results with amyloid burden was tested as a coprimary endpoint. Correlation, sensitivity, and specificity analyses were also done in the subset of participants who had autopsy within 1 year of imaging as secondary endpoints. The study is registered with ClinicalTrials.gov, number NCT 01447719 (original study NCT 00857415). Findings: We included 59 participants (aged 47-103 years; cognitive status ranging from normal to advanced dementia). The sensitivity and specificity of florbetapir PET imaging for detection of moderate to frequent plaques were 92% (36 of 39; 95% CI 78-98) and 100% (20 of 20; 80-100%), respectively, in people who had autopsy within 2 years of PET imaging, and 96% (27 of 28; 80-100%) and 100% (18 of 18; 78-100%), respectively, for those who had autopsy within 1 year. Amyloid assessed semiquantitatively with florbetapir PET was correlated with the post-mortem amyloid burden in the participants who had an autopsy within 2 years (Spearman ρ=0·76; p<0·0001) and within 12 months between imaging and autopsy (0·79; p<0·0001). Interpretation: The results of this study validate the binary visual reading method approved in the USA for clinical use with florbetapir and suggest that florbetapir could be used to distinguish individuals with no or sparse amyloid plaques from those with moderate to frequent plaques. Additional research is needed to understand the prognostic implications of moderate to frequent plaque density. Funding: Avid Radiopharmaceuticals. © 2012 Elsevier Ltd.",NCT00857415;NCT01447719;amyloid beta protein;florbetapir f 18;absence of side effects;adult;aged;Alzheimer disease;article;autopsy;brain region;cause of death;chronic obstructive lung disease;cognition;cohort analysis;controlled study;correlation analysis;dementia;density;drug tolerability;female;gray matter;heart failure;human;image analysis;image reconstruction;immunohistochemistry;life expectancy;male;neuroimaging;neuropathology;physician;positron emission tomography;priority journal;prognosis;prospective study;protein blood level;qualitative analysis;quantitative analysis;senile plaque;sensitivity and specificity,"Clark, C. M.;Pontecorvo, M. J.;Beach, T. G.;Bedell, B. J.;Coleman, R. E.;Doraiswamy, P. M.;Fleisher, A. S.;Reiman, E. M.;Sabbagh, M. N.;Sadowsky, C. H.;Schneider, J. A.;Arora, A.;Carpenter, A. P.;Flitter, M. L.;Joshi, A. D.;Krautkramer, M. J.;Lu, M.;Mintun, M. A.;Skovronsky, D. M.",2012,,,0,
841,Changes in the world of palliative care,"The last quarter of the 20th century produced considerable advances in hospice and palliative care. In many countries, specialist services developed, education programmes got underway and in some cases palliative care ideas began to infiltrate national health policies. Globally, however, palliative care still faces many challenges: lack of recognition and understanding on the part of the health professions and the public; limited expression in health policy; insufficient funding; few accredited training programmes; and a paucity of evidence to demonstrate efficacy and cost benefits. We describe what is known about the development of palliative care around the world, how its clinical focus is changing and what prospects there are for further development.",acquired immune deficiency syndrome;aging;article;capacity building;cerebrovascular accident;community care;dementia;dying;health care policy;health insurance;heart failure;home care;hospice;human;motor neuron disease;multiple sclerosis;palliative therapy;population growth;primary medical care;priority journal;terminal care;United Kingdom,"Clark, D.;Graham, F.;Centeno, C.",2015,,,0,
842,What has virtual screening ever done for drug discovery?,"Background: Although virtual screening is now widely applied as a hit-finding methodology within drug discovery programmes, there are relatively few reports of its contributing to compounds on the market or in the clinic. Objective: To assess the impact of virtual screening on drug discovery. Method: Such cases as can be found in the public domain at the current time are reviewed. Additionally, some of the current challenges in structure- and ligand-based virtual screening are discussed. Conclusion: It is concluded that virtual screening has contributed to the discovery of several compounds that have either reached the market or entered clinical trials. In terms of praxis, there is 'no free lunch' in virtual screening and as many methods as possible should be applied to maximise the likelihood of success. © 2008 Informa UK Ltd.",antilipemic agent;cevoglitazar;dihydroorotate dehydrogenase inhibitor;donepezil;fibrinogen receptor antagonist;mozenavir;naluzotan;placebo;prx 03140;prx 07034;prx 08066;prx 93009;sc 12267;serotonin 1A agonist;serotonin 2 antagonist;serotonin 4 agonist;tirofiban;water;Alzheimer disease;article;clinical trial;cognitive defect;computer aided design;computer program;conformational transition;drug binding;drug design;drug dose increase;drug efficacy;drug marketing;drug potency;drug research;drug screening;drug selectivity;dyslipidemia;heart infarction;human;Human immunodeficiency virus infection;IC50;inhibition kinetics;machine learning;major depression;molecular docking;molecular model;obesity;patent;priority journal;protein structure;pulmonary hypertension;rheumatoid arthritis;scoring system;structure activity relation;virtual reality;aggrastat;aricept;dmp 450;l 700462;lbm 642;prx 00023,"Clark, D. E.",2008,,,0,
843,Genetic testing for hypertrophic cardiomyopathy 4,,child;gene mutation;genetic screening;human;Huntington chorea;hypertrophic cardiomyopathy;letter;medical ethics;priority journal;survival;treatment planning,"Clarke, A.;Harper, P.;Watkins, H.;Seidman, J. G.;Seidman, C. E.",1992,,,0,
844,The effect of comorbidity on the competing risk of sudden and nonsudden death in an ambulatory heart failure population,"Background: Sudden death (SD) and non-sudden cardiac death are responsible for the majority of deaths in patients with heart failure. We sought to identify the influence of comorbid illness (Charlson Comorbidity Index [CCI]) on competing modes of death in heart failure. Methods: A retrospective analysis of 824 patients followed in a tertiary care heart failure clinic was performed. We analyzed the cumulative incidence of sudden and nonsudden death. Competing risk regression was used to examine the association between medical comorbidities and mode of death. The outcomes of interest were overall mortality, SD, SD and/or appropriate implantable cardioverterdefibrillator therapy (ICD), and non-SD. Results: Mean age of the study population was 64.1 ± 14.7 years, 68.6% were male, and mean ejection fraction was 32.8% ± 13.5%. Over a mean follow-up of 4.4 years, 229 patients (27.8%) died. SD accounted for 33 deaths (14.4%), whereas SD/appropriate ICD therapy occurred in 56 patients (24.5%). The risk of non-SD and total mortality increased (P <.0001) as the CCI increased, whereas the risk of SD decreased (P =.03). The cumulative incidence of SD, SD and/or ventricular tachycardia/fibrillation, and non-SD at 5 years was 5.6%, 9.1%, and 27.8%, respectively. In multivariate competing risk analysis, advancing age, New York Heart Association class, and a CCI >4 were significantly associated with non-SD, Conclusion: Patients with heart failure with significant comorbidities are much more likely to sustain non-SD. These findings may have implications in optimal selection of patients with heart failure for interventions such as prophylactic ICD therapy. © 2011 Canadian Cardiovascular Society.",beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;spironolactone;statin (protein);acquired immune deficiency syndrome;adult;age;aged;article;cerebrovascular disease;chronic obstructive lung disease;clinical assessment tool;comorbidity;congestive heart failure;connective tissue disease;defibrillator;dementia;diabetes mellitus;disease classification;female;follow up;heart ejection fraction;heart failure;heart infarction;heart ventricle fibrillation;heart ventricle tachycardia;hemiplegia;human;incidence;leukemia;liver disease;lymphoma;major clinical study;male;medical record review;metastasis;mortality;patient selection;peptic ulcer;peripheral vascular disease;prophylaxis;retrospective study;sudden death;tertiary health care,"Clarke, B.;Howlett, J.;Sapp, J.;Andreou, P.;Parkash, R.",2011,,,0,
845,How to estimate the health benefits of additional research and changing clinical practice,"A simple extension of standard metaanalysis can provide quantitative estimates of the potential health benefits of further research and of implementing the findings of existing research, which can help inform research prioritisation and efforts to change clinical practice.",cholinesterase inhibitor;streptokinase;Alzheimer disease;article;blood clot lysis;clinical practice;drug efficacy;drug use;follow up;health care policy;heart infarction;human;medical research;morbidity;mortality;national health service;outcome assessment;priority journal,"Claxton, K.;Griffin, S.;Koffijberg, H.;McKenna, C.",2015,,,0,
846,Morbidity and mortality following fractures of the femoral neck and trochanteric region: analysis of risk factors,"A retrospective review of casenotes with patient review at 3 years was carried out of 405 patients who had surgery for fracture of the femoral neck (including the trochanteric region). The operative management consisted of either internal fixation (61%), hemiarthroplasty (38%), or total arthroplasty (1%). Medical complications developed in 30% of patients; surgical complications developed in 14%. The mortality rate was greater for the first 9 months after operation, but thereafter approached the rate found in the general population (matched for age and sex). Followup 3 years postoperatively recorded 50% of patients still alive. Factors associated with death within the first postoperative year included increasing age, male sex, and the presence of dementia or congestive cardiac failure. Of the survivors, 55% described unlimited range of mobility but 32% reported only poor mobility (progressive dementia being the most common cause). Factors associated with poor mobility were increasing age, female sex, placement in an institution, and the presence of dementia or cerebrovascular insufficiency. Transfer to the specialist rehabilitation ward postoperatively was associated with significantly improved survival and mobility.","Adult;Age Factors;Aged;Aged, 80 and over;Dementia/complications;Epidemiologic Methods;Female;Femoral Fractures/complications/epidemiology/mortality/surgery;Femoral Neck Fractures/complications/epidemiology/*mortality/surgery;Heart Failure/complications;Humans;Hypertension/complications;Male;Middle Aged;Movement;Postoperative Period;Retrospective Studies;Risk Factors;Sex Factors;South Australia","Clayer, M. T.;Bauze, R. J.",1989,Dec,,0,
847,Trends in antihyperglycemic medication prescriptions and hypoglycemia in older adults: 2002-2013,"Background: Over the last decade, several new antihyperglycemic medications have been introduced including those associated with a lower hypoglycemia risk. We aimed to investigate how these medications are being prescribed to older adults in our region. Methods: We conducted population-based cross-sectional analyses of older adults (mean age 75 years) with treated diabetes in Ontario, Canada from 2002 until 2013, to examine the percentage prescribed insulin, sulphonylureas, alpha-glucosidase inhibitors, metformin, thiazolidinediones, meglitinides, and dipeptidyl peptidase-4 inhibitors. Over the study period, we also examined their hospital encounters for hypoglycemia (emergency room or inpatient encounter). Results: The mean age of treated patients increased slightly over the study quarters and the proportion that were women declined. With the exception of chronic kidney disease, cancer, dementia, and neuropathy, the percentage with a comorbidity appeared to decline. The percentage of treated patients prescribed metformin, gliclazide and dipeptidyl peptidase-4 inhibitors increased as did combination therapy. Glyburide and thiazolidinedione prescriptions declined, and insulin use remained stable. In those with newly treated diabetes, the majority were prescribed metformin, with smaller percentages prescribed insulin and other oral agents. Although the absolute number of treated patients with a hypoglycemia encounter increased until mid-2006 and then decreased, the overall percentage with an encounter declined over the study period (0.8% with an event in the first quarter, 0.4% with an event in the last quarter). Conclusions: Antihyperglycemic medications with safer profiles are being increasingly prescribed to older adults. In this setting there has been a decrease in the percentage of treated patients with a hospital encounter for hypoglycemia.",alpha glucosidase inhibitor;antidiabetic agent;cholesterol;dipeptidyl peptidase IV inhibitor;glibenclamide;gliclazide;glitazone derivative;hemoglobin A1c;insulin;meglitinide;metformin;pioglitazone;rosiglitazone;saxagliptin;sitagliptin;sulfonylurea derivative;adult;age distribution;aged;article;Canada;cerebrovascular accident;chronic kidney disease;chronic liver disease;combination chemotherapy;comorbidity;congestive heart failure;controlled study;coronary artery disease;cross-sectional study;dementia;diabetes mellitus;drug use;female;human;hyperglycemia;hypoglycemia;major clinical study;male;monotherapy;neoplasm;neuropathy;outcome assessment;peripheral vascular disease;population research;prescription;retinopathy;transient ischemic attack;trend study;very elderly,"Clemens, K. K.;Shariff, S.;Liu, K.;Hramiak, I.;Mahon, J. L.;McArthur, E.;Garg, A. X.",2015,,,0,
848,Long-term efficacy of nebivolol monotherapy in patients with hypertension,"Background: The antihypertensive activity of beta-blockers generally increases during the first 6 to 8 weeks of treatment; however, no study has systematically assessed whether blood pressure continues to decrease with prolonged treatment. Nebivolol is a third-generation beta-blocker that combines beta-blocking activity with nitric oxide-mediated vasodilatory properties. It is not known whether this combination of properties provides better long-term control of blood pressure than other monotherapies. Objectives: The purpose of this study was to determine whether the antihypertensive activity of nebivolol continues to increase over a 6-month period and to assess the efficacy and safety of nebivolol monotherapy over 6 months in previously untreated and treated hypertensive patients. Methods: Patients who had not been treated previously for hypertension took nebivolol 5 mg once daily. Those who had been treated previously replaced their monotherapy with nebivolol 5 mg once daily starting the day after the first evaluation. Patients were evaluated at baseline and 1/2;, 2 1/2;, and 6 months after nebivolol treatment and were defined as responders if their diastolic blood pressure (DBP) was <90 mm Hg or the decrease in DBP versus baseline was >10 mm Hg. Patients answered a self-administered questionnaire about general feelings of well-being, compliance with treatment, and side effects. Results: A total of 3741 patients were enrolled; 1656 patients had been treated previously for hypertension. A total of 461 (12.3%) patients did not complete the study. In previously untreated patients, nebivolol reduced blood pressure by 19/11 mm Hg after 1/2; month and by 24/14 mm Hg after 6 months. In previously treated patients, mean blood pressure reductions were 9/7 mm Hg after 1/2; month and 14/8 mm Hg after 6 months (P < 0.001 for all differences from baseline). After 2 1/2 months of treatment, blood pressures were not significantly different from those obtained at 1/2 month; however, blood pressures at 6 months were significantly different from those measured at 1/2 month (P < 0.05). After 1/2 month, 61% of previously untreated patients and 52% of treated patients were responders; after 6 months 86% and 74%, respectively, were responders (P < 0.01, 1/2 vs 6 months for both treated and untreated patients). Serious adverse effects considered unrelated to the study drug were dementia, malignancy, myocardial infarction, and septic shock. Minor adverse effects were mild and included transient headache (1.9%), dizziness (1.3%), and fatigue (1.3%) and were not considered reasons for withdrawal; 97 patients (2.6%) preferred not to continue the trial because of side effects. After 6 months, 73% of patients (95% CI, 60%-82%) reported that their general feeling of well-being had improved during the past 6 months, whereas only 5% reported that it had deteriorated. Among previously treated patients, 67% (95% CI, 54%-76%) reported at 6 months that they tolerated nebivolol better than their previous treatment, whereas only 2.4% reported that the previous treatment was better tolerated (P < 0.001 for both comparisons). Conclusion: In this study nebivolol was effective and well tolerated in the long term, and its antihypertensive activity continued to increase during the first 6 months of treatment.",angiotensin receptor antagonist;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;nebivolol;adult;aged;antihypertensive activity;antihypertensive therapy;article;beta adrenergic receptor blocking;clinical trial;controlled study;coughing;depression;diarrhea;drug efficacy;drug safety;edema;fatigue;female;headache;heart palpitation;human;hypertension;impotence;insomnia;major clinical study;male;multicenter study;patient compliance;priority journal;thorax pain;vertigo;wellbeing,"Cleophas, T. J.;Grabowsky, I.;Niemeyer, M. G.;Mäkel, W. N.;Van Der Wall, E. E.",2001,,,0,
849,Clinical trials in chronic diseases,"In spite of rather negative publicity on the crossover/self-controlled design for clinical trials in the early 1980s, a fair number of these studies were published in that period. Using these studies as examples, we try to give an overview of major advantages and disadvantages of crossover and parallel group studies. Strengths of the crossover versus the parallel design include: (1) elimination of between-subject variability of symptoms; (2) no need for large samples; (3) fewer ethical problems; and (4) subjects are able to express their preference for one of the compounds being given. Weaknesses include: (1) carryover effect from one treatment period into the other; and (2) time effect due to spontaneously evolving symptoms in a lengthy trial. Although routinely used for all types of therapies in phase I/II studies, the crossover/self-controlled design cannot be used in phase III/IV studies other than for symptomatic treatments of stable disease. Treatments of chronic diseases are directly primarily to the relief of persistent symptoms rather than the cure of a rapidly evolving symptomatology. These very aspects make them particularly suitable for crossover/self-controlled studies. Awareness of the weaknesses of clinical trials is especially important to clinical practitioners, who depend on reported clinical trials when making clinical decisions.",antihypertensive agent;placebo;vasodilator agent;allergic rhinitis;Alzheimer disease;angina pectoris;article;atopy;chronic disease;chronic obstructive lung disease;clinical trial;controlled clinical trial;controlled study;crossover procedure;diabetes mellitus;dysmenorrhea;heart failure;heartburn;human;hyperlipidemia;hypertension;hypogonadism;malabsorption;medical decision making;medical ethics;obesity;osteoporosis;pain;phase 1 clinical trial;phase 2 clinical trial;phase 3 clinical trial;phase 4 clinical trial;Raynaud phenomenon;statistical analysis;tardive dyskinesia,"Cleophas, T. J. M.;Tavenier, P.",1995,,,0,
850,Pneumonia or pulmonary thromboembolism? Report of a case,,anticoagulant agent;diuretic agent;enalapril plus hydrochlorothiazide;mirtazapine;paroxetine;aged;article;bronchitis;case report;clinical feature;consultation;dyslipidemia;dyspnea;female;heart arrhythmia;heart failure;human;hypertension;laboratory test;lung embolism;lung surgery;mental deterioration;pneumonia,"Clos, M. M. L.;Alunes, C. C.;Batlle, C. S.;Jerez, F. R.",2007,,,0,
851,Low cancer prevalence in polyglutamine expansion diseases,"Objective: Polyglutamine (PolyQ) diseases are dominantly transmitted neurologic disorders, caused by coding and expanded CAG trinucleotide repeats. Cancer was reported retrospectively to be rare in patients with PolyQ diseases and we aimed to investigate its prevalence in France. Methods: Consecutive patients with Huntington disease (HD) and spinocerebellar ataxia (SCA) were questioned about cancer, cardiovascular diseases, and related risk factors in 4 university hospitals in Paris, Toulouse, Strasbourg, and Montpellier. Standardized incidence ratios (SIR), based on age- and sex-adjusted rate of the French population, were assessed for different types of cancer. Results: We questioned 372 patients with HD and 134 patients with SCA. SIR showed significantly reduced risk of cancer in HD: 23 observed cases vs 111.05 expected ones (SIR 0.21, 95% confidence interval [CI] 0.13-0.31), as well as in SCA: 7 observed cases vs 34.73 expected (SIR 0.23, 95% CI 0.08-0.42). This was surprising since risk behavior for cancer was increased in these patients, with significantly greater tobacco and alcohol consumption in patients with HD vs patients with SCA (p < 0.0056). There was no association between CAG repeat size and cancer or cardiovascular disease. However, in patients with HD, skin cancers were more frequent than expected (5 vs 0.98, SIR 5.11, 95% CI 1.65-11.95). Conclusions: There was a decreased cancer rate in PolyQ diseases despite high incidence of risk factors. Intriguingly, skin cancer incidence was higher, suggesting a crosstalk between neurodegeneration and skin tumorigenesis.",adult;alcohol consumption;angina pectoris;article;bladder cancer;brain cancer;breast cancer;CAG repeat;cancer incidence;cancer risk;cardiovascular risk;cerebrovascular accident;controlled study;female;France;heart arrhythmia;heart disease;heart infarction;human;Huntington chorea;hypertension;leukemia;lung cancer;lymphoma;major clinical study;male;malignant neoplasm;melanoma;middle aged;nasopharynx cancer;neurologic disease;ovary cancer;pancreas cancer;peripheral occlusive artery disease;polyglutamine expansion disease;prevalence;priority journal;prostate cancer;questionnaire;retrospective study;risk factor;skin cancer;spinocerebellar degeneration;standardized incidence ratio;thyroid cancer;tobacco consumption;university hospital;uterine cervix cancer,"Coarelli, G.;Diallo, A.;Thion, M. S.;Rinaldi, D.;Calvas, F.;Boukbiza, O. L.;Tataru, A.;Charles, P.;Tranchant, C.;Marelli, C.;Ewenczyk, C.;Tchikviladzé, M.;Monin, M. L.;Carlander, B.;Anheim, M.;Brice, A.;Mochel, F.;Tezenas Du Montcel, S.;Humbert, S.;Durr, A.",2017,,10.1212/wnl.0000000000003725,0,
852,Translating the WHO 25×25 goals into a UK context: The PROMISE modelling study,"ObjectiveModel the impact of targets for obesity, diabetes, raised blood pressure, tobacco use, salt intake, physical inactivity and harmful alcohol use, as outlined in the Global Non-Communicable Disease Action Plan 2013-2020, on mortality and morbidity in the UK population. DesignDynamic population modelling study. SettingUK population. ParticipantsNot available. Main outcome measuresMortality and morbidity (years lived with disability) from non-communicable diseases (NCDs) that are averted or delayed. Probability of achieving a 25% reduction in premature mortality from NCDs by 2025 (current WHO target) and a 33% reduction by 2030 (proposed target). ResultsThe largest improvements in mortality would be achieved by meeting the obesity target and the largest improvements in morbidity would be achieved by meeting the diabetes target. The UK could achieve the 2025 and 2030 targets for reducing premature mortality with only a little additional preventive effort compared with current practice. Achieving all 7 risk targets could avert a total of 300 000 deaths (95% uncertainty interval 250 000 to 350 000) and 1.3 million years lived with disability (1.2-1.4 million) from NCDs by 2025, with the majority of health gains due to reduced mortality and morbidity from heart disease and stroke, and reduced morbidity from diabetes. Potential reductions in morbidity from depression and in morbidity and mortality from dementia at older ages are also substantial. ConclusionsThe global premature mortality targets are a potentially achievable goal for countries such as the UK that can capitalise on many decades of effort in prevention and treatment. High morbidity diseases and diseases in later life are not addressed in the Global NCD Action Plan and targets, but must also be considered a priority for prevention in the UK where the population is ageing and the costs of health and social care are rising.",aging;alcohol consumption;article;body mass;cerebrovascular accident;counseling;dementia;depression;diabetes mellitus;health care cost;health survey;human;hypertension;ischemic heart disease;morbidity;mortality;non communicable disease;obesity;physical activity;physical inactivity;premature mortality;prevalence;risk factor;risk reduction;salt intake;smoking;social care;tobacco use;United Kingdom;world health organization,"Cobiac, L. J.;Scarborough, P.",2017,,10.1136/bmjopen-2016-012805,0,
853,Anti-thromboembolic strategies in atrial fibrillation,"Oral anticoagulation (OAC) is highly effective for stroke prevention in high-risk-patients with atrial fibrillation (AF). AF is also a risk for dementia, and effective OAC reduces the risk of dementia. Up to 30% of patients with AF have a coronary artery disease and antiplatelets are used to avoid thrombotic complications. Patients with AF often have an acute coronary syndrome (ACS) and undergo a percutaneous intervention with stent-implantation. These patients require a triple therapy, i.e. the combination of OAC with dual-antiplatelet therapy. It is obvious that OAC may induce bleeding with potentially deleterious effects on mortality. Even the occurrence of minor bleeding is problematic. The review describes available data on used anti-thromboembolic regimens in patients treated with OAC (vitamin K antagonists and non-vitamin K antagonists) who need a triple therapy (i.e. anticoagulation and antiplatelets). Most data are from patients who were treated for an ACS and cannot be directly extrapolated for patients with AF. The impact of used stents and novel P2Y12 antagonist-antiplatelets and duration of triple therapy is discussed. Often some high-risk patients with AF would need anticoagulation but cannot be given this therapy be-cause of excessive bleeding risks or contraindicating comorbidities: in these patients left atrial appendage closure with an occluding device can be used as an alternative to anti-thromboem-bolic therapy. The unavoidable anti-thromboembolic triple therapy carries a strong potential for bleeding events, which increase mortality. We have many data and several recommendations are offered. Nonetheless, we lack solid data on the best anti-thromboembolic regimen in patients with AF who need anticoagulation and antiplatelets.",anti-thromboembolic regimens;atrial fibrillation,"Cocco, G.;Amiet, P.;Jerie, P.",2016,,10.5603/CJ.a2016.0004,0,
854,Coronary revascularisation in the elderly,,NCT01813435;NCT02086019;acetylsalicylic acid;antithrombocytic agent;clopidogrel;prasugrel;ticagrelor;acute coronary syndrome;article;bare metal stent;cerebrovascular accident;chronic kidney failure;clinical feature;coronary artery bypass graft;coronary artery calcification;dementia;diabetes mellitus;drug eluting stent;evidence based medicine;frail elderly;geriatric care;heart infarction;heart muscle revascularization;high risk patient;human;mental deterioration;percutaneous coronary intervention;practice guideline;quality of life;risk assessment;risk factor;silent myocardial ischemia;ST segment elevation myocardial infarction;stable angina pectoris,"Cockburn, J.;Hildick-Smith, D.;Trivedi, U.;De Belder, A.",2017,,10.1136/heartjnl-2015-308999,0,
855,Coding for dementia,,allopurinol;gabapentin;levothyroxine;metformin;rivastigmine;simvastatin;aged;Alzheimer disease;article;bladder cancer;brain tumor;cancer surgery;case report;coding;cognition assessment;cognitive defect;confusion;dementia;diagnosis coding;differential diagnosis;emotional disorder;evaluation and management coding;female;follow up;gout;heart infarction;human;hypercholesterolemia;hypothyroidism;ICD-10-CM;language delay;male;medical information;memory disorder;Mini Mental State Examination;neuropathy;non insulin dependent diabetes mellitus;non invasive procedure;nuclear magnetic resonance imaging;obesity;procedure coding;speech delay;vitamin deficiency;wandering behavior,"Cohen, B. H.;Donofrio, P. D.",2016,,,0,
856,"Cognitive function, mental health, and health-related quality of life after lung transplantation","Rationale: Cognitive and psychiatric impairments are threats to functional independence, general health, and quality of life. Evidence regarding these outcomes after lung transplantation is limited. Objectives: Determine the frequency of cognitive and psychiatric impairment after lung transplantation and identify potential factors associated with cognitive impairment after lung transplantation. Methods: In a retrospective cohort study, we assessed cognitive function, mental health, and health-related quality of life using a validated battery of standardized tests in 42 subjects posttransplantation. The battery assessed cognition, depression, anxiety, resilience, and post-traumatic stress disorder (PTSD). Cognitive function was assessed using the Montreal Cognitive Assessment, a validated screening test with a range of 0 to 30. We hypothesized that cognitive function post-transplantation would be associated with type of transplant, cardiopulmonary bypass, primary graft dysfunction, allograft ischemic time, and physical therapy posttransplantation. We used multivariable linear regression to examine the relationship between candidate risk factors and cognitive function post-transplantation. Measurements and Main Results: Mild cognitive impairment (score, 18-25) was observed in 67% of post-transplant subjects (95% confidence interval [CI]: 50-80%) and moderate cognitive impairment (score, 10-17) was observed in 5% (95% CI, 1-16%) of post-transplant subjects. Symptoms of moderate to severe anxiety and depression were observed in 21 and 3% of post-transplant subjects, respectively. No transplant recipients reported symptoms of PTSD. Higher resilience correlated with less psychological distress in the domains of depression (P < 0.001) and PTSD (P = 0.02). Prolonged graft ischemic time was independently associated with worse cognitive performance after lung transplantation (P = 0.001). The functional gain in 6-minute-walk distance achieved at the end of post-transplant physical rehabilitation (P = 0.04) was independently associated with improved cognitive performance post-transplantation. Conclusions: Mild cognitive impairment was present in the majority of patients after lung transplantation. Prolonged allograft ischemic time may be associated with cognitive impairment. Poor physical performance and cognitive impairment are linked, and physical rehabilitation post-transplant and psychological resilience may be protective against the development of long-term impairment. Further study is warranted to confirm these potential associations and to examine the trajectory of cognitive function after lung transplantation. Copyright © 2014 by the American Thoracic Society.",adult;age;aged;allograft;anxiety disorder;article;cardiopulmonary bypass;cerebrovascular disease;Charlson Comorbidity Index;chronic kidney disease;clinical article;cognition;cognitive defect;cohort analysis;comorbidity;congestive heart failure;coronary artery disease;dementia;depression;diabetes mellitus;disease severity;distress syndrome;female;functional status;gender;graft recipient;heart muscle ischemia;human;hyperlipidemia;hypertension;ischemia;lung transplantation;male;mental health;mild cognitive impairment;Montreal cognitive assessment;physiotherapy;posttraumatic stress disorder;primary graft dysfunction;pulmonary hypertension;quality of life;rehabilitation care;retrospective study;risk factor;visual analog scale,"Cohen, D. G.;Christie, J. D.;Anderson, B. J.;Diamond, J. M.;Judy, R. P.;Shah, R. J.;Cantu, E.;Bellamy, S. L.;Blumenthal, N. P.;Demissie, E.;Hopkins, R. O.;Mikkelsen, M. E.",2014,,,0,
857,Doctors are less likely than patients to have stopped eating beef 16,,brain spongiosis;Creutzfeldt Jakob disease;dietary intake;disease association;human;ischemic heart disease;letter;mass medium;meat;priority journal;sex difference;social class,"Cohen, H.",1996,,,0,
858,Does preventive care save money? Health economics and the presidential candidates,,antiretrovirus agent;influenza vaccine;Alzheimer disease;cancer screening;colorectal cancer;cost effectiveness analysis;health care cost;health care quality;human;Human immunodeficiency virus infection;infection prevention;influenza;ischemic heart disease;physical activity;preventive medicine;priority journal;quality adjusted life year;risk factor;short survey;smoking habit;socioeconomics,"Cohen, J. T.;Neumann, P. J.;Weinstein, M. C.",2008,,,0,
859,Epidemiology of systemic mastocytosis in Denmark,"Mastocytosis is a heterogeneous group of diseases characterized by abnormal proliferation of mast cells. Systemic mastocytosis (SM), in which abnormal mast cells are present in tissues beyond the skin, is divided into seven subcategories with varying degrees of severity and prognosis. Very little is known about the epidemiology of SM and its subcategories. This retrospective cohort study of 548 adults with SM diagnosed 1997-2010 was constructed using linked Danish national health registries. The most common subtype of mastocytosis was indolent SM (including urticaria pigmentosa) (n = 450; 82%), followed by SM with subtype unknown (n = 61; 11%), SM with associated clonal haematological non-mast cell lineage disease (n = 24; 4%), aggressive SM (n = 8; 2%), and mast cell leukaemia (n = 5; 1%). The incidence rate for SM (all subtypes including urticaria pigmentosa) was 0·89 per 100 000 per year. Cumulative incidence was 12·46 per 100 000, and the 14-year limited-duration prevalence as of 1 January, 2011 was 9·59 per 100 000. This nationwide cohort from Denmark is the first population-based epidemiological study of mastocytosis. In this cohort of patients aged 15 years and older, SM was found to be overall relatively rare with notable variation by subtype for patient characteristics, survival and epidemiological measures. © 2014 John Wiley & Sons Ltd.",acquired immune deficiency syndrome;adolescent;adult;aged;aggressive systemic mastocytosis;article;cerebrovascular disease;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;Denmark;disease classification;female;follow up;heart infarction;hemiplegia;human;incidence;indolent systemic mastocytosis;insulin dependent diabetes mellitus;kidney disease;liver disease;major clinical study;male;mast cell leukemia;metastasis;middle aged;non insulin dependent diabetes mellitus;peripheral vascular disease;prevalence;priority journal;register;retrospective study;survival time;systemic mastocytosis;systemic mastocytosis with associated clonal haematological non-mast cell lineage disease;ulcer;urticaria pigmentosa,"Cohen, S. S.;Skovbo, S.;Vestergaard, H.;Kristensen, T.;Møller, M.;Bindslev-Jensen, C.;Fryzek, J. P.;Broesby-Olsen, S.",2014,,,0,
860,Predicting heart failure survival: Value of a mortality risk score,,coronary artery disease;dementia;follow up;heart failure;human;mortality;note;peripheral vascular disease;prevalence;survival;United States,"Cohn, P. F.",2007,,,0,
861,Postmenopausal hormone therapy and subclinical cerebrovascular disease: The WHIMS-MRI Study,"Objective:: The Womens Health Initiative Memory Study (WHIMS) hormone therapy (HT) trials reported that conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA) increases risk for all-cause dementia and global cognitive decline. WHIMS MRI measured subclinical cerebrovascular disease as a possible mechanism to explain cognitive decline reported in WHIMS. METHODS:: We contacted 2,345 women at 14 WHIMS sites; scans were completed on 1,424 (61%) and 1,403 were accepted for analysis. The primary outcome measure was total ischemic lesion volume on brain MRI. Mean duration of on-trial HT or placebo was 4 (CEE+MPA) or 5.6 years (CEE-Alone) and scans were conducted an average of 3 (CEE+MPA) or 1.4 years (CEE-Alone) post-trial termination. Cross-sectional analysis of MRI lesions was conducted; general linear models were fitted to assess treatment group differences using analysis of covariance. A (two-tailed) critical value of α = 0.05 was used. RESULTS:: In women evenly matched within trials at baseline, increased lesion volumes were significantly related to age, smoking, history of cardiovascular disease, hypertension, lower post-trial global cognition scores, and increased incident cases of on- or post-trial mild cognitive impairment or probable dementia. Mean ischemic lesion volumes were slightly larger for the CEE+MPA group vs placebo, except for the basal ganglia, but the differences were not significant. Women assigned to CEE-Alone had similar mean ischemic lesion volumes compared to placebo. CONCLUSIONS:: Conjugated equine estrogen-based hormone therapy was not associated with a significant increase in ischemic brain lesion volume relative to placebo. This finding was consistent within each trial and in pooled analyses across trials. Copyright © 2009 by AAN Enterprises, Inc.",BMI1 protein;conjugated estrogen;medroxyprogesterone acetate;placebo;adult;aged;article;cerebrovascular disease;cognition;cognitive defect;demography;educational status;ethnic group;female;follow up;hormonal therapy;human;ischemic heart disease;lifestyle;major clinical study;mental deterioration;nuclear magnetic resonance imaging;outcome assessment;patient selection;postmenopause;priority journal;smoking habit;social status,"Coker, L. H.;Hogan, P. E.;Bryan, N. R.;Kuller, L. H.;Margolis, K. L.;Bettermann, K.;Wallace, R. B.;Lao, Z.;Freeman, R.;Stefanick, M. L.;Shumaker, S. A.",2009,,,0,
862,Integrated Left Ventricular Global Transcriptome and Proteome Profiling in Human End-Stage Dilated Cardiomyopathy,"AIMS: The disease pathways leading to idiopathic dilated cardiomyopathy (DCM) are still elusive. The present study investigated integrated global transcriptional and translational changes in human DCM for disease biomarker discovery. METHODS: We used identical myocardial tissues from five DCM hearts compared to five non-failing (NF) donor hearts for both transcriptome profiling using the ABI high-density oligonucleotide microarrays and proteome expression with One-Dimensional Nano Acquity liquid chromatography coupled with tandem mass spectrometry on the Synapt G2 system. RESULTS: We identified 1262 differentially expressed genes (DEGs) and 269 proteins (DEPs) between DCM cases and healthy controls. Among the most significantly upregulated (>5-fold) proteins were GRK5, APOA2, IGHG3, ANXA6, HSP90AA1, and ATP5C1 (p< 0.01). On the other hand, the most significantly downregulated proteins were GSTM5, COX17, CAV1 and ANXA3. At least ten entities were concomitantly upregulated on the two analysis platforms: GOT1, ALDH4A1, PDHB, BDH1, SLC2A11, HSP90AA1, HSP90AB1, H2AFV, HSPA5 and NDUFV1. Gene ontology analyses of DEGs and DEPs revealed significant overlap with enrichment of genes/proteins related to metabolic process, biosynthetic process, cellular component organization, oxidative phosphorylation, alterations in glycolysis and ATP synthesis, Alzheimer's disease, chemokine-mediated inflammation and cytokine signalling pathways. CONCLUSION: The concomitant use of transcriptome and proteome expression to evaluate global changes in DCM has led to the identification of sixteen commonly altered entities as well as novel genes, proteins and pathways whose cardiac functions have yet to be deciphered. This data should contribute towards better management of the disease.",,"Colak, D.;Alaiya, A. A.;Kaya, N.;Muiya, N. P.;AlHarazi, O.;Shinwari, Z.;Andres, E.;Dzimiri, N.",2016,,10.1371/journal.pone.0162669,0,
863,Left ventricular global transcriptional profiling in human end-stage dilated cardiomyopathy,"We employed ABI high-density oligonucleotide microarrays containing 31,700 sixty-mer probes (representing 27,868 annotated human genes) to determine differential gene expression in idiopathic dilated cardiomyopathy (DCM). We identified 626 up-regulated and 636 down-regulated genes in DCM compared to controls. Most significant changes occurred in the tricarboxylic acid cycle, angiogenesis, and apoptotic signaling pathways, among which 32 apoptosis- and 13 MAPK activity-related genes were altered. Inorganic cation transporter, catalytic activities, energy metabolism and electron transport-related processes were among the most critically influenced pathways. Among the up-regulated genes were HTRA1 (6.9-fold), PDCD8(AIFM1) (5.2) and PRDX2 (4.4) and the down-regulated genes were NR4A2 (4.8), MX1 (4.3), LGALS9 (4), IFNA13 (4), UNC5D (3.6) and HDAC2 (3) (p<0.05), all of which have no clearly defined cardiac-related function yet. Gene ontology and enrichment analysis also revealed significant alterations in mitochondrial oxidative phosphorylation, metabolism and Alzheimer's disease pathways. Concordance was also confirmed for a significant number of genes and pathways in an independent validation microarray dataset. Furthermore, verification by real-time RT-PCR showed a high degree of consistency with the microarray results. Our data demonstrate an association of DCM with alterations in various cellular events and multiple yet undeciphered genes that may contribute to heart muscle disease pathways.","Apoptosis/genetics;Cardiomyopathy, Dilated/*genetics;Case-Control Studies;Citric Acid Cycle/genetics;Down-Regulation;Gene Expression Profiling/*methods;*Heart Ventricles;Humans;Neovascularization, Physiologic/genetics;Oligonucleotide Array Sequence Analysis;Signal Transduction/genetics;Up-Regulation","Colak, D.;Kaya, N.;Al-Zahrani, J.;Al Bakheet, A.;Muiya, P.;Andres, E.;Quackenbush, J.;Dzimiri, N.",2009,Jul,10.1016/j.ygeno.2009.03.003,0,
864,Positron tomography: the case for reimbursement,"Positron emission tomography (PET) is now being used clinically in several institutions. It makes available unique information, which is important in managing patients with brain tumors, epilepsy, and dementia. PET provides information that is important in patients being considered for myocardial revascularization because it can differentiate ischemic, viable myocardium from infarcted myocardium. Third-party payers, including Medicare, are presently reviewing PET for reimbursement. Clinical PET centers are increasing in number, and they will continue to provide data to document the clinical information available from PET.","Brain Neoplasms/radiography;Cardiomyopathies/radiography;Dementia/radiography;Epilepsy/radiography;Humans;*Insurance, Health, Reimbursement;Medicare;*Technology Assessment, Biomedical;Tomography, Emission-Computed/*economics;United States","Coleman, R. E.",1989,Sep,,0,
865,Health and disease in 85 year olds: Baseline findings from the Newcastle 85+ cohort study,"Objectives The Newcastle 85+ Study aims to systematically study the clinical, biological, and psychosocial attributes of an unselected cohort of 85 year olds and to examine subsequent health trajectories as the cohort ages; health at baseline is reported. Design Cross sectional analysis of baseline data from a cohort study. Setting Newcastle upon Tyne and North Tyneside primary care trusts, United Kingdom. Participants 1042 people born in 1921 and registered with the participating general practices. Main outcome measures Detailed health assessment and review of general practice records (disease, medication, and use of general practice services); participants could decline elements of the protocol. Results Of the 1453 eligible people, 851 (58.6%) were recruited to health assessment plus record review, 188 (12.9%) to record review only, and 3 (0.2%) to health assessment only. Data from record review are reported on a maximum of 1030 and from health assessment on a maximum of 853; individual denominators differ owing to withdrawal and missing values. Of the health assessment sample (n=853), 62.1% (n=530) were women and 10.4% (n=89) were in institutional care. The most prevalent diseases were hypertension (57.5%, 592/1030) and osteoarthritis (51.8%, 534/1030). Moderate or severe cognitive impairment was present in 11.7% (96/824) of participants, severe or profound urinary incontinence in 21.3% (173/813), hearing impairment in 59.6% (505/ 848), and visual impairment in 37.2% (309/831). Health assessment identified participants with possible disease but without a previous diagnosis in their medical record for hypertension (25.1%, 206/821), ischaemic heart disease (12.6%, 99/788), depression (6.9%, 53/772), dementia (6.7%, 56/840), and atrial fibrillation (3.8%, 30/788). Undiagnosed diabetes mellitus and thyroid disease were rare (1%, 7/717 and 6/762, respectively). A median of 3 (interquartile range 1-8) activities of daily living were undertaken with difficulty. Overall, 77.6% (646/832) of participants rated their health compared with others of the same age as good, very good, or excellent. High contact rates in the previous year with general practitioners (93.8%, 960/1024) were recorded. Womenhad significantly higher disease counts (medians: women 5, men 4; P=0.033) and disability scores (medians: women 4, men 2; P=0.0006) than men, but were less likely to have attended outpatient clinics in the previous three months (women 29% (150/524), men 37% (118/320), odds ratio 0.7, 95% confidence interval 0.5 to 0.9). Conclusions This large cohort of 85 year olds showed good levels of both self rated health and functional ability despite significant levels of disease and impairment. Hypertension, ischaemic heart disease, atrial fibrillation, depression, and dementia may be underdiagnosed. Notable differences were found between the sexes: women outnumbered men and had more disease and disability.",aged;article;cognitive defect;cohort analysis;cross-sectional study;daily life activity;dementia;depression;diabetes mellitus;disability;elderly care;female;functional status;general practice;general practitioner;geriatric disorder;Health Assessment Questionnaire;health service;health status;hearing impairment;atrial fibrillation;human;hypertension;institutional care;ischemic heart disease;major clinical study;male;medical record review;osteoarthritis;outpatient;prevalence;priority journal;self concept;sex difference;social psychology;thyroid disease;United Kingdom;urine incontinence;visual impairment,"Collerton, J.;Davies, K.;Jagger, C.;Kingston, A.;Bond, J.;Eccles, M. P.;Robinson, L. A.;Martin-Ruiz, C.;Von Zglinicki, T.;James, O. F. W.;Kirkwood, T. B. L.",2010,,,0,
866,Five Common Clinical Presentations in the Elderly: An Anatomical Review,"Elderly patients face distinct health challenges and have an increased demand for specific medical procedures. As the aging population continues to increase, age-associated conditions such as congestive heart failure, hip fractures, spine degeneration, dementia and airway compromise will increase in prevalence and procedures to correct these conditions will be increasingly performed. A clear understanding of the clinical anatomy of these diseases and procedures is imperative for anatomists and clinicians alike in order to best treat patients and continue to advance aging research and better teach future medical practitioners about the specific anatomy often involved in this group. The aging process mirrors in a variety of ways the common pathologies of the elderly, but it is key to draw the distinction between normal aging and pathology, particularly for congestive heart failure and dementia, in the clinical setting. This article aims to review the common presentations or procedures of the elderly and how the normal aging process is associated with the anatomy of these conditions or complications. This article is protected by copyright. All rights reserved.",ageing;airway;anatomy;congestive heart failure;dementia;fractures;geriatrics;spine,"Collin, P. G.;Oskouian, R. J.;Loukas, M.;D'Antoni, A. V.;Tubbs, R. S.",2016,Aug 25,10.1002/ca.22771,0,867
867,Five common clinical presentations in the elderly: An anatomical review,"Elderly patients face distinct health challenges and have an increased demand for specific medical procedures. As the aging population continues to increase, age-associated conditions such as congestive heart failure, hip fractures, spine degeneration, dementia, and airway compromise will increase in prevalence and procedures to correct these conditions will be increasingly performed. A clear understanding of the clinical anatomy of these diseases and procedures is imperative for anatomists and clinicians alike in order to best treat patients and continue to advance aging research and better teach future medical practitioners about the specific anatomy often involved in this group. The aging process mirrors in a variety of ways the common pathologies of the elderly, but it is key to draw the distinction between normal aging and pathology, particularly for congestive heart failure and dementia, in the clinical setting. This article aims to review the common presentations or procedures of the elderly and how the normal aging process is associated with the anatomy of these conditions or complications. Clin. Anat. 30:168-174, 2017. (c) 2017 Wiley Periodicals, Inc.",ageing;airway;anatomy;congestive heart failure;dementia;fractures;geriatrics;spine,"Collin, P. G.;Oskouian, R. J.;Loukas, M.;D'Antoni, A. V.;Tubbs, R. S.",2017,Mar,,0,
868,Caregiver care,"In 2009, nearly 66 million Americans (three in 10 U.S. households) reported at least one person providing unpaid care as a family caregiver. More adults with chronic conditions and disabilities are living at home than ever before, and family caregivers have an even higher level of responsibility. Caring for loved ones is associated with several benefits, including personal fulfillment. However, caregiving is also associated with physical, psychological, and financial burdens. Primary care physicians can aid in the identification, support, and treatment of caregivers by offering caregiver assessments-interviews directed at identifying high levels of burden-as soon as caregivers are identified. Repeat assessments may be considered when there is a change in the status of caregiver or care recipient. Caregivers should be directed to appropriate resources for support, including national caregiving organizations, local area agencies on aging, Web sites, and respite care. Psychoeducational, skills-training, and therapeutic counseling interventions for caregivers of patients with chronic conditions such as dementia, cancer, stroke, and heart failure have shown small to moderate success in decreasing caregiver burden and increasing caregiver quality of life. Further research is needed to further identify strategies to offset caregiver stress, depression, and poor health outcomes. Additional support and anticipatory guidance for the care recipient and caregiver are particularly helpful during care transitions and at the care recipient's end of life.","Adaptation, Psychological;Adult;Caregivers/*psychology;Chronic Disease/economics/*psychology;Cost of Illness;Disabled Persons/psychology;Family Relations;Home Nursing/*psychology;Humans;Needs Assessment/economics;*Physicians, Primary Care;*Quality of Life;Respite Care;Social Support;Stress, Psychological;Surveys and Questionnaires","Collins, L. G.;Swartz, K.",2011,Jun 1,,0,
869,The Safety Profile of Infliximab in Patients with Crohn's Disease: The Mayo Clinic Experience in 500 Patients,"Background & Aims: The aim of this study was to evaluate the short- and long-term safety of infliximab in patients with Crohn's disease in clinical practice. Methods: The medical records of 500 consecutive patients treated with infliximab at the Mayo Clinic were reviewed and abstracted for demographic features and adverse events. The likelihood of a causal relationship to infliximab for each adverse event was determined by calculating an intrinsic likelihood (imputability) score. Results: The 500 patients received a median of 3 infusions and had a median follow-up of 17 months. Forty-three patients (8.6%) experienced a serious adverse event, of which 30 (6%) were related to infliximab. Acute infusion reactions occurred in 19 of 500 patients (3.8%). Serum sickness-like disease occurred in 19 of 500 patients and was attributed to infliximab in 14 (2.8%). Three patients developed drug-induced lupus. One patient developed a new demyelination disorder. Forty-eight patients had an infectious event, of which 41 (8.2%) were attributed to infliximab. Twenty patients had a serious infection: 2 had fatal sepsis, 8 had pneumonia (of which 2 cases were fatal), 6 had viral infections, 2 had abdominal abscesses requiring surgery, one had arm cellulitis, and one had histoplasmosis. Nine patients had a malignant disorder, 3 of which were possibly related to infliximab. A total of 10 deaths were observed. For 5 of these patients (1%), the events leading to death were possibly related to infliximab. Conclusions: Short- and long-term infliximab therapy is generally well tolerated. However, clinicians must be vigilant for the occurrence of infrequent but serious events, including serum sickness-like reaction, opportunistic infection and sepsis, and autoimmune disorders.",adrenalin;antinuclear antibody;azathioprine;corticosteroid;diphenhydramine;immunosuppressive agent;infliximab;mercaptopurine;methotrexate;methylprednisolone;morphine;paracetamol;prednisone;abdominal abscess;abdominal cancer;abscess drainage;adolescent;adult;aged;amnesia;ankle edema;arthralgia;article;autoimmune disease;B cell lymphoma;basal cell carcinoma;bronchitis;calculation;neoplasm;Candida albicans;candidiasis;carcinomatosis;cardiopulmonary insufficiency;cardiotoxicity;cardiovascular disease;cellulitis;chickenpox;child;clinical practice;Peptoclostridium difficile;Crohn disease;dehydration;dementia;demography;demyelinating disease;diabetes mellitus;diarrhea;diffuse Lewy body disease;disease exacerbation;disease severity;drug eruption;drug fatality;drug fever;drug safety;edema;enteritis;Enterococcus;Epstein Barr virus;esophagitis;esophagus disease;face edema;fatality;fatigue;female;fistula;flu like syndrome;follow up;gastritis;gastrointestinal infection;genital herpes;growth disorder;Haemophilus;heart failure;Herpes simplex virus;herpes zoster;Ajellomyces capsulatus;histoplasmosis;Hodgkin disease;human;infection;mononucleosis;inflammatory disease;jaw disease;joint stiffness;kidney failure;leg disease;liver cirrhosis;liver failure;liver metastasis;long term care;lung adenocarcinoma;lung cancer;lupus like syndrome;lymphadenopathy;male;malignant neoplastic disease;medical record;metastasis;motor dysfunction;mouth disease;multiple sclerosis;myalgia;nonhodgkin lymphoma;onchocerciasis;opportunistic infection;pancreatitis;paresthesia;peptic ulcer;perianal abscess;pharyngitis;pneumonia;postoperative infection;premedication;priority journal;pruritus;pustule;pyuria;respiratory distress;respiratory failure;sensory dysfunction;sepsis;septicemia;Serratia marcescens;serum sickness like disease;short course therapy;side effect;sinusitis;skin infection;skin ulcer;solid tumor;squamous cell carcinoma;Staphylococcus;Streptococcus pneumonia;Streptococcus pneumoniae;temporomandibular joint disorder;treatment outcome;upper respiratory tract infection;Varicella zoster virus;virus infection;remicade,"Colombel, J. F.;Loftus Jr, E. V.;Tremaine, W. J.;Egan, L. J.;Harmsen, W. S.;Schleck, C. D.;Zinsmeister, A. R.;Sandborn, W. J.",2004,,,0,
870,The risks and benefits of HRT,"For many years hormone replacement therapy (HRT) was regarded as the gold standard for treatment of osteoporosis. In recent years this status has been challenged, because of the lack of a robust evidence base for anti-fracture efficacy, emerging evidence of adverse extraskeletal effects and the demonstrated efficacy of a number of alternative options in the prevention of osteoporotic fractures. The current consensus is that HRT is no longer regarded as a front-line option for prevention of osteoporotic fractures and that its use for this purpose should be restricted to women with osteoporosis who have menopausal symptoms and to older women who are intolerant of other therapies and /or express a strong preference for HRT despite being informed about potential adverse effects. Nevertheless, the mechanisms by which estrogen exerts its beneficial skeletal effects remain a major area of research that has important implications for the development of novel therapies.",conjugated estrogen;estrogen;gestagen;medroxyprogesterone;placebo;article;breast cancer;breast tenderness;cardiovascular disease;cause of death;clinical trial;cognition;colorectal cancer;dementia;dose response;drug efficacy;drug indication;drug mechanism;drug surveillance program;endometrium cancer;evidence based medicine;female;fracture;gastrointestinal symptom;headache;hip fracture;hormone substitution;human;ischemic heart disease;lung embolism;menopause;mortality;ovary cancer;postmenopause osteoporosis;risk assessment;risk benefit analysis;risk reduction;cerebrovascular accident;vagina bleeding;spine fracture,"Compston, J. E.",2004,,,0,
871,"Novel associations for coronary artery disease derived from genome wide association studies are not associated with increased carotid intima-media thickness, suggesting they do not act via early atherosclerosis or vessel remodeling","Background: Recent genome-wide association studies (GWAS) have identified associations with myocardial infarction and coronary artery disease (CAD), but the mechanisms underlying these associations remain largely unclear. Carotid intima-media thickness (IMT) is a measure of early arterial remodeling and arteriosclerosis. Therefore, if CAD associated SNPs are also associated with carotid IMT; it suggests that they are acting via the early stages of the atherosclerotic process. Methods: In three large community based independent populations (CAPS, KORA and Young Finns) of European ancestry in which common carotid IMT had been measured (total 4961 individuals), we determined whether SNPs that have been associated with CAD in GWAS studies are also associated with carotid IMT. Associations with plaque were not examined. Results: We identified 11 SNPs and one haplotype previously associated with CAD. None of these were associated with common carotid IMT. Conclusions: We found no evidence that SNPs associated with CAD on GWAS are also associated with carotid IMT. This suggests these genetic associations are not acting via early vessel remodeling or early arteriosclerosis. © 2011 Elsevier Ireland Ltd.",arterial wall thickness;artery intima;artery media;article;atherogenesis;carotid artery;carotid atherosclerosis;coronary artery disease;Europe;genetic association;genome analysis;haplotype;human;meta analysis;nucleotide sequence;priority journal;single nucleotide polymorphism,"Conde, L.;Bevan, S.;Sitzer, M.;Klopp, N.;Illig, T.;Thiery, J.;Seissler, J.;Baumert, J.;Raitakari, O.;Kähönen, M.;Lyytikäinen, L. P.;Laaksonen, R.;Viikari, J.;Lehtimäki, T.;Koernig, W.;Halperin, E.;Markus, H. S.",2011,,,0,
872,Design of the Swiss Atrial Fibrillation Cohort Study (Swiss-AF): structural brain damage and cognitive decline among patients with atrial fibrillation,"BACKGROUND: Several studies found that patients with atrial fibrillation (AF) have an increased risk of cognitive decline and dementia over time. However, the magnitude of the problem, associated risk factors and underlying mechanisms remain unclear. METHODS: This article describes the design and methodology of the Swiss Atrial Fibrillation (Swiss-AF) Cohort Study, a prospective multicentre national cohort study of 2400 patients across 13 sites in Switzerland. Eligible patients must have documented AF. Main exclusion criteria are the inability to provide informed consent and the presence of exclusively short episodes of reversible forms of AF. All patients undergo extensive phenotyping and genotyping, including repeated assessment of cognitive functions, quality of life, disability, electrocardiography and cerebral magnetic resonance imaging. We also collect information on health related costs, and we assemble a large biobank. Key clinical outcomes in Swiss-AF are death, stroke, systemic embolism, bleeding, hospitalisation for heart failure and myocardial infarction. Information on outcomes and updates on other characteristics are being collected during yearly follow-up visits. RESULTS: Up to 7 April 2017, we have enrolled 2133 patients into Swiss-AF. With the current recruitment rate of 15 to 20 patients per week, we expect that the target sample size of 2400 patients will be reached by summer 2017. CONCLUSION: Swiss-AF is a large national prospective cohort of patients with AF in Switzerland. This study will provide important new information on structural and functional brain damage in patients with AF and on other AF related complications, using a large variety of genetic, phenotypic and health economic parameters.",,"Conen, D.;Rodondi, N.;Mueller, A.;Beer, J.;Auricchio, A.;Ammann, P.;Hayoz, D.;Kobza, R.;Moschovitis, G.;Shah, D.;Schlaepfer, J.;Novak, J.;di Valentino, M.;Erne, P.;Sticherling, C.;Bonati, L.;Ehret, G.;Roten, L.;Fischer, U.;Monsch, A.;Stippich, C.;Wuerfel, J.;Schwenkglenks, M.;Kuehne, M.;Osswald, S.",2017,Jul 11,,0,
873,Design of the Swiss Atrial Fibrillation Cohort Study (Swiss-AF): Structural brain damage and cognitive decline among patients with atrial fibrillation,"BACKGROUND: Several studies found that patients with atrial fibrillation (AF) have an increased risk of cognitive decline and dementia over time. However, the magnitude of the problem, associated risk factors and underlying mechanisms remain unclear. METHODS: This article describes the design and methodology of the Swiss Atrial Fibrillation (Swiss-AF) Cohort Study, a prospective multicentre national cohort study of 2400 patients across 13 sites in Switzerland. Eligible patients must have documented AF. Main exclusion criteria are the inability to provide informed consent and the presence of exclusively short episodes of reversible forms of AF. All patients undergo extensive phenotyping and genotyping, including repeated assessment of cognitive functions, quality of life, disability, electrocardiography and cerebral magnetic resonance imaging. We also collect information on health related costs, and we assemble a large biobank. Key clinical outcomes in Swiss-AF are death, stroke, systemic embolism, bleeding, hospitalisation for heart failure and myocardial infarction. Information on outcomes and updates on other characteristics are being collected during yearly follow-up visits. RESULTS: Up to 7 April 2017, we have enrolled 2133 patients into Swiss-AF. With the current recruitment rate of 15 to 20 patients per week, we expect that the target sample size of 2400 patients will be reached by summer 2017. CONCLUSION: Swiss-AF is a large national prospective cohort of patients with AF in Switzerland. This study will provide important new information on structural and functional brain damage in patients with AF and on other AF related complications, using a large variety of genetic, phenotypic and health economic parameters.",adult;aged;article;atrial fibrillation;bleeding;cause of death;cerebrovascular accident;cognition;cognitive decline;cohort analysis;computer assisted tomography;controlled study;disability;disease association;electrocardiography;embolism;follow up;genotype;heart failure;heart infarction;hospitalization;human;informed consent;major clinical study;nuclear magnetic resonance imaging;observational study;phenotype;prospective study;quality of life;Switzerland,"Conen, D.;Rodondi, N.;Müller, A.;Beer, J. H.;Auricchio, A.;Ammann, P.;Hayoz, D.;Kobza, R.;Moschovitis, G.;Shah, D.;Schläpfer, J.;Novak, J.;Di Valentino, M.;Erne, P.;Sticherling, C.;Bonati, L. H.;Ehret, G.;Roten, L.;Fischer, U.;Monsch, A.;Stippich, C.;Wuerfel, J.;Schwenkglenks, M.;Kühne, M.;Osswald, S.",2017,,10.4414/smw.2017.14467,0,
874,Pattern of use of antidepressants in long-term care facilities for the elderly,"Despite some evidence that neuroleptic medication is overused or misused in long-term care facilities for the elderly, there has been virtually no attention paid to the pattern of use of antidepressants in these facilities. All patients in longterm care in a geriatric hospital and a home for the aged who were receiving antidepressants were identified; 10.5% of the patients in the hospital and 12.7% in the home for the aged were receiving an antidepressant. The rate of use of antidepressants on the different units ranged from 0% to 26.8%. The most commonly prescribed antidepressant was doxepin followed by nortriptyline. The mean dose of antidepressant was 34.8 mg. Although depression was the most common reason for the prescription of an antidepressant (69% of patients receiving one), other reasons included pain, agitation, aggression, and insomnia. Patients had been receiving antidepressants for up to 10 years, with a mean duration of 32 months. The majority of patients (60%) had a history of depression predating their institutional admission. Patients receiving antidepressants were compared to a group not receiving antidepressants, who were matched for age, sex, unit, and attending physician. Patients receiving antidepressants were more likely to have a history of stroke (33.8% versus 16.9%). There was no significant difference between the two groups regarding the prevalence of dementia, Parkinson's disease, thyroid disease, malignant tumor, congestive heart failure, or diabetes mellitus. Prospective studies are required to determine the efficacy of antidepressants in this population and to identify factors that can predict a positive response to treatment.",amitriptyline;antidepressant agent;clomipramine;desipramine;doxepin;imipramine;nortriptyline;trazodone;aged;aging;article;controlled study;depression;female;home for the aged;human;major clinical study;male;priority journal,"Conn, D. K.;Goldman, Z.",1992,,,0,
875,Diagnosing and managing delirium in the elderly,"OBJECTIVE: To outline current approaches to diagnosing and managing delirium in the elderly. QUALITY OF EVIDENCE: A literature review was based on a MEDLINE search (1966 to 1998). Selected articles were reviewed and used as the basis for discussion of diagnosis and etiology. We planned to include all published randomized controlled trials regarding management but found only two. Consequently, we also used review articles and recent practice guidelines for delirium published by the American Psychiatric Association. MAIN FINDINGS: Clinical diagnosis of delirium can be aided by using DSM-IV criteria, the Delirium Symptom Interview, or the confusion assessment method. Management must include investigation and treatment of underlying causes and general supportive measures. Providing optimal levels of stimulation, reorienting patients, education, and supporting families are important. Pharmacologic management of delirium should be considered only for specific symptoms or behaviours, eg, aggression, severe agitation, or psychosis. Only one randomized controlled trial of tranquilizer use for delirium in medically ill people has been published. Findings support the current belief that neuroleptics are superior to benzodiazepines in most cases of delirium. Most authorities still consider haloperidol the neuroleptic of choice. Controlled trials of the new atypical neuroleptics for treating delirium are not yet available. Benzodiazepines with relatively short half-lives, such as lorazepam, are the drugs of choice for withdrawal symptoms. CONCLUSION: Delirium is frequently underdiagnosed in clinical practice. It should be suspected with acute changes in behaviour. Careful investigation of the underlying cause permits appropriate management.",analgesic agent;anticonvulsive agent;benzodiazepine;chlorpromazine;cholinergic receptor blocking agent;cotrimoxazole;digoxin;glyceryl trinitrate;haloperidol;histamine H2 receptor antagonist;hypnotic sedative agent;lorazepam;olanzapine;paracetamol;physostigmine;quetiapine;risperidone;sertraline;steroid;aged;aging;article;behavior disorder;case report;cognitive defect;congestive heart failure;delirium;dementia;differential diagnosis;drug abuse;female;heart ventricle fibrillation;human;infection;pneumonia;prognosis;respiration depression;symptomatology;withdrawal syndrome,"Conn, D. K.;Lieff, S.",2001,,,0,
876,Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review,"BACKGROUND: Vascular diseases contribute to the causation and progression of clinical dementia. AIM: To evaluate the quality of medical care for vascular diseases provided to people with dementia, the patient and practice characteristics that influence quality, and to compare care with that provided to those without dementia. DESIGN AND SETTING: Observational, cross-sectional review of primary care records of people with dementia from 52 general practices from five primary care trusts in the UK, and comparison with publicly available summary data on patients without dementia. METHOD: A total of 700 patients with >/=1 diagnosed vascular disease or risk factor were identified from dementia registers. Quality of care was measured on 30 indicators from the UK Quality and Outcomes Framework (QOF) for hypertension, coronary heart disease, stroke, diabetes mellitus, atrial fibrillation, heart failure, and smoking. Overall quality of vascular care was calculated for each patient with dementia. RESULT: Level of care received by people with dementia was significantly lower compared with those without dementia for 22 of 30 (73%) indicators; most notably for measurement processes such as peripheral pulses check and neuropathy testing for diabetes, and cholesterol measures for stroke. Among people with dementia, women, those in care homes, and those with fewer comorbid physical conditions and medications were associated with lower scores for overall quality of vascular care. CONCLUSION: The quality of medical care provided to people with dementia with regard to vascular diseases is not concordant with quality, as defined by the QOF. Research is needed to improve access to high-quality care.","Aged, 80 and over;Cardiovascular Diseases/complications/*therapy;Cross-Sectional Studies;Dementia/*etiology;England;Female;General Practice/standards;*Healthcare Disparities;Humans;Male;Multivariate Analysis;Quality of Health Care;Risk Factors","Connolly, A.;Campbell, S.;Gaehl, E.;Iliffe, S.;Drake, R.;Morris, J.;Martin, H.;Purandare, N.",2013,Feb,10.3399/bjgp13X663046,0,
877,Thiazolidinediones and Parkinson disease: A cohort study,"Thiazolidinediones, a class of medications indicated for the treatment of type 2 diabetes mellitus, reduce inflammation and have been shown to provide a therapeutic benefit in animal models of Parkinson disease.We examined the association between treatment with thiazolidinediones and the onset of Parkinson disease in older individuals. We performed a cohort study of 29,397 Medicare patients enrolled in state pharmaceutical benefits programs who initiated treatment with thiazolidinediones or sulfonylureas during the years 1997 through 2005 and had no prior diagnosis of Parkinson disease. New users of thiazolidinediones were propensity score matched to new users of sulfonylureas and followed to determine whether they were diagnosed with Parkinson disease. We used Cox proportional hazards models to compare time to diagnosis of Parkinson disease in the propensity score-matched populations. To assess the association with duration of use, we performed several analyses that required longer continuous use of medications. In the primary analysis, thiazolidinedione users had a hazard ratio for a diagnosis of Parkinson disease of 1.09 (95% confidence interval: 0.71, 1.66) when compared with sulfonylurea users. Increasing the duration-of-use requirements to 10 months did not substantially change the association; the hazard ratios ranged from 1.00 (95% confidence interval: 0.49, 2.05) to 1.17 (95% confidence interval: 0.60, 2.25). Thiazolidinedione use was not associated with a longer time to diagnosis of Parkinson disease than was sulfonylurea use, regardless of duration of exposure.","2,4 thiazolidinedione derivative;acetohexamide;chlorpropamide;glibenclamide;glimepiride;glipizide;illicit drug;pioglitazone;rosiglitazone;sulfonylurea;tolazamide;tolbutamide;troglitazone;acquired immune deficiency syndrome;aged;alcohol abuse;Alzheimer disease;ambulatory care;angina pectoris;angiography;article;atrial fibrillation;cerebrovascular accident;chronic kidney disease;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;controlled study;coronary artery disease;delayed diagnosis;depression;diabetes mellitus;dialysis;end stage renal disease;female;gout;heart palpitation;hospitalization;human;Human immunodeficiency virus infection;hyperlipidemia;hypertension;hypothyroidism;kidney disease;liver disease;major clinical study;male;medicare;neoplasm;neuropathy;nursing home;obesity;Parkinson disease;peptic ulcer;peripheral vascular disease;propensity score;retinopathy;rheumatoid arthritis;stent;stomach paresis;transient ischemic attack;treatment duration","Connolly, J. G.;Bykov, K.;Gagne, J. J.",2015,,,0,
878,Sigmoid volvulus: A 10-year-audit,"Background. Chronic constipation in elderly, institutionalised patients is the leading cause of sigmoid volvulus in the developed world. Endoscopic deflation is associated with a 90% recurrence rate and a 35% mortality rate. Aims. To review a 10-year experience of sigmoid volvulus and encourage more aggressive primary treatment. Methods. A retrospective study was performed on 16 patients with sigmoid volvulus from 1992 to 1999. Patients were identified using the hospital inpatient enquiry (HIPE) data system. Demographics, clinical course, intervention, complications and outcome were recorded. Results. The male:female ratio was 5:3 and mean age was 78 years (range 39-92). Fifty per cent had at least one risk factor: Parkinson's disease (n=3); multiple sclerosis (n=1); Alzheimer's disease (n=1); and hypokalaemia (n=3). Thirty-seven per cent were managed conservatively and 63% required surgical intervention. Mean time to surgery was 2.4 days. Operations performed were sigmoid colectomy (45%), Hartmann's procedure (33%) and total colectomy (22%). There was one post-operative death from myocardial ischaemia. Mean duration of admission was 21 days. Conclusions. Endoscopic deflation of a sigmoid volvulus facilitates optimisation of cardiopulmonary co-morbidity in a high-risk group of patients. It converts an emergent to an elective procedure and minimises operative morbidity as a result.",antibiotic agent;adult;aged;Alzheimer disease;article;cause of death;clinical article;colon resection;comorbidity;conservative treatment;controlled study;demography;disease course;elective surgery;endoscopic therapy;female;heart muscle ischemia;high risk population;hospital information system;human;hypokalemia;length of stay;male;medical audit;multiple sclerosis;Parkinson disease;risk factor;sex ratio;sigmoid volvulus;surgical mortality,"Connolly, S.;Brannigan, A. E.;Heffernan, E.;Hyland, J. M. P.",2002,,,0,
879,"Noninvasive ventilation in patients with hypoxemic, nonhypercapnic acute respiratory failure","Patients with hypoxemic acute respiratory failure are commonly admitted to the intensive care unit for a large spectrum of clinical conditions including pneumonia, acute pulmonary edema, acute lung injury, acute respiratory distress syndrome, postoperative respiratory failure, and trauma. To reduce the rate of endotracheal intubation and related complications, these patients are commonly treated with noninvasive ventilation to increase oxygenation, reduce dyspnea, and unload respiratory muscles. However, a very prudent approach is needed, limiting the application of noninvasive ventilation to hemodynamically stable patients who can be closely monitored in the intensive care unit where endotracheal intubation is promptly available. Copyright © 2011 by Lippincott Williams & Wilkins.",acute lung injury;acute respiratory failure;adult respiratory distress syndrome;arterial oxygen saturation;article;assisted ventilation;burn;chronic obstructive lung disease;claustrophobia;coma;community acquired pneumonia;disease exacerbation;disease severity;dyspnea;endotracheal intubation;face injury;face surgery;heart muscle ischemia;heart ventricle arrhythmia;human;hypercapnia;hypoxemia;hypoxemic acute respiratory failure;immunocompromized patient;infection risk;informed consent;intensive care unit;length of stay;lung edema;lung gas exchange;mental deterioration;mortality;multicenter study (topic);noninvasive positive pressure ventilation;noninvasive ventilation;oxygen therapy;oxygenation;pain;pneumonia;positive end expiratory pressure;postoperative complication;randomized controlled trial (topic);seizure;shock;sinusitis;survival rate;treatment contraindication;treatment indication;treatment withdrawal;upper gastrointestinal bleeding;ventilator associated pneumonia;vomiting,"Conti, G.;Costa, R.",2011,,,0,
880,"The underlying molecular mechanism of apolipoprotein E polymorphism: Relationships to lipid disorders, cardiovascular disease, and Alzheimer's disease","Apolipoprotein E (apo E) polymorphism has important clinical correlates, including disorders of lipoprotein metabolism and atherosclerosis. This article provides a detailed methodology for apo E genotyping and discusses the link between apo E genotype and type III hyperlipoproteinemia, coronary heart disease (CHD), stroke, and Alzheimer's disease (AD). Although apo E genotype appears to provide significant information concerning the genetic component of CHD and AD risk, more research is needed before genotyping can be recommended as a routine screening tool. The data so far, however, implicate apo E as a major component of the genetic basis of cardiovascular disease and AD.",apolipoprotein A;Alzheimer disease;article;cardiovascular disease;diagnostic value;genetic analysis;genetic susceptibility;genetic variability;human;hyperlipoproteinemia type 3;lipoprotein blood level;pathogenesis;priority journal;protein lipid interaction;protein processing;receptor binding;risk assessment;screening,"Contois, J. H.;Anamani, D. E.;Tsongalis, G. J.",1996,,,0,
881,Encephalopathy and progression of human immunodeficiency virus disease in a cohort of children with perinatally acquired human immunodeficiency virus infection. Women and Infants Transmission Study Group,"OBJECTIVE: To describe the incidence, predictors, and survival of children with human immunodeficiency virus (HIV) encephalopathy followed in the Women and Infants Transmission Study cohort. STUDY DESIGN: Retrospective review of clinical and immunologic staging of perinatally HIV-infected infants, based on the 1994 Centers for Disease Control and Prevention Classification System. RESULTS: Data were available for 128 HIV-infected children, with a median follow-up of 24 months. HIV encephalopathy was diagnosed in 27 (21%) of children. Median survival after diagnosis was 14 months. Of children with encephalopathy, 74% had at least moderate immunosuppression by the time of diagnosis. Encephalopathy represented the first acquired immunodeficiency syndrome-defining condition in 67%, and the only one in 26% of children. Hepatosplenomegaly or lymphadenopathy during the first 3 months of life was diagnosed in 63%, in contrast to 29% of those without encephalopathy (p value = 0.001). Cardiomyopathy was present in 30% of the children with encephalopathy versus 2% of those without encephalopathy. High viral load in infancy was associated with increased risk of encephalopathy but was not predictive of age at onset. CONCLUSIONS: Encephalopathy in children with HIV is common and is associated with high viral load, immunodeficiency, and shortened survival. Encephalopathy was more likely to develop in infants with early signs and symptoms of HIV, although age at onset could not be predicted.","AIDS Dementia Complex/epidemiology/immunology/*mortality;Cohort Studies;Disease Progression;Female;HIV Infections/complications/mortality/*transmission;Humans;Incidence;Infant;Infant, Newborn;*Infectious Disease Transmission, Vertical;Probability;Retrospective Studies;Survival Analysis","Cooper, E. R.;Hanson, C.;Diaz, C.;Mendez, H.;Abboud, R.;Nugent, R.;Pitt, J.;Rich, K.;Rodriguez, E. M.;Smeriglio, V.",1998,May,,0,
882,Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: Description of the problem and elements of a solution,"Objective: To provide a description of communication breakdowns and to identify interventions to improve surgical decision making for elderly patients with serious illness and acute, life-threatening surgical conditions. Background: Communication between surgeons, patients, and surrogates about goals of treatment plays an important and understudied role in determining the surgical interventions elderly patients with serious illness receive. Communication breakdowns may lead to nonbeneficial procedures in acute events near the end of life. Methods: We review the available literature on factors that lead to communication challenges and nonbeneficial surgery at the end of life. We use this review to identify solutions for navigating surgical decision making for seriously ill elderly patients with acute surgical conditions. Results: Surgeon, patient, surrogate, and systemic factors-including time constraints, inadequate provider communication skills and training, uncertainty about prognosis, patient and surrogate anxiety and fear of inaction, and limitations in advance care planning-contribute to communication challenges and nonbeneficial surgery at the end of life. Surgeons could accomplish more effective communication with seriously ill elderly patients if they had a structured, standardized approach to exploring patients' preferences and to integrating those preferences into surgical decisions in the acute setting. Conclusions: Improved communication among surgeons, patients, and surrogates is necessary to ensure that patients receive the care that they want and to avoid nonbeneficial treatment. Further research is needed to learn how to best structure these conversations in the emergency surgical setting.",acute disease;anxiety;apparent life threatening event;article;brain hemorrhage;communication skill;conversation;critical illness;critical limb ischemia;dementia;emergency surgery;fragility fracture;heart disease;heart muscle ischemia;human;intestine perforation;kidney disease;liver disease;medical decision making;medical education;mesenteric ischemia;motivation;neoplasm;neurologic disease;patient care;patient preference;priority journal;prognosis;respiratory tract disease;small intestine obstruction;spinal cord compression;surgeon;training;treatment planning,"Cooper, Z.;Courtwright, A.;Karlage, A.;Gawande, A.;Block, S.",2014,,,0,
883,Predictors of Mortality Up to 1 Year After Emergency Major Abdominal Surgery in Older Adults,"OBJECTIVES: To identify factors associated with mortality in older adults 30, 180, and 365 days after emergency major abdominal surgery. DESIGN: A retrospective study linked to Medicare claims from 2000 to 2010. SETTING: Health and Retirement Study (HRS). PARTICIPANTS: Medicare beneficiaries aged 65.5 enrolled in the HRS from 2000 to 2010 with at least one urgent or emergency major abdominal surgery and a core interview from the HRS within 3 years before surgery. MEASUREMENTS: Survival analysis was used to describe all-cause mortality 30, 180, and 365 days after surgery. Complementary log-log regression was used to identify participant characteristics and postoperative events associated with poorer survival. RESULTS: Four hundred individuals had one of the urgent or emergency surgeries of interest, 24% of whom were aged 85 and older, 50% had coronary artery disease, 48% had cancer, 33% had congestive heart failure, and 37% experienced a postoperative complication. Postoperative mortality was 20% at 30 days, 31% at 180 days, and 34% at 365 days. Of those aged 85 and older, 50% were dead 1 year after surgery. After multivariate adjustment including postoperative complications, dementia (hazard ratio (HR) = 2.02, 95% confidence interval (CI) = 1.24-3.31), hospitalization within 6 months before surgery (HR = 1.63, 95% CI = 1.12-2.28), and complications (HR = 3.45, 95% CI = 2.32-5.13) were independently associated with worse 1-year survival. CONCLUSION: Overall mortality is high in many older adults up to 1 year after undergoing emergency major abdominal surgery. The occurrence of a complication is the clinical factor most strongly associated with worse survival.",1-year mortality;emergency surgery;geriatric surgery;major abdominal surgery;surgical complications,"Cooper, Z.;Mitchell, S. L.;Gorges, R. J.;Rosenthal, R. A.;Lipsitz, S. R.;Kelley, A. S.",2015,Dec,10.1111/jgs.13785,0,
884,A case of necrotising fasciitis caused by serratia marsescens: Extreme age as functional immunosuppression?,"We report the case of a 97-year-old woman who had a prolonged hospital admission for the treatment of right-sided heart failure. During her stay she experienced a rapid deterioration, characterised by shortness of breath, cardiovascular compromise and a hot, red, swollen calf. Post-mortem examination demonstrated that this was caused by necrotising fasciitis due to Serratia marcescens as a single pathogen. This is only the second reported case of this condition in the absence of diabetes or immunosuppression, and clinical deterioration was much more rapid. The case underlines the importance of circumspection and regular review in the diagnosis of the elderly patient. It reminds us that these patients should be viewed as functionally immunosuppressed, and that some or all of the haematological markers of infection can be absent even in severe disease. © The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.",amoxicillin;biological marker;C reactive protein;flucloxacillin;furosemide;low molecular weight heparin;metolazone;aged;article;case report;cause of death;central venous pressure;chronic kidney disease;clinical assessment;clinical evaluation;deep vein thrombosis;disease association;DNA sequence;dyspnea;female;geriatric care;geriatric patient;glomerulus filtration rate;heart arrest;atrial fibrillation;heart failure;hospital admission;human;hypotension;immunosuppressive treatment;leg pain;leg swelling;length of stay;lung angiography;lung embolism;multiinfarct dementia;necrotizing fasciitis;neutrophil count;oxygen saturation;peripheral edema;pleura effusion;priority journal;prothrombin time;Serratia infection;Serratia marcescens;tachypnea,"Cope, T. E.;Cope, W.;Beaumont, D. M.",2013,,,0,
885,"Repetitive Transcranial Magnetic Stimulation (rTMS) applied with H-coil in Alzheimer's disease: a placebo-controlled, double-blind, pilot study","Focal rTMS in Alzheimer's disease (AD) revealed cognitive benefits. H-coil can depolarize deeper and wider structures compared with focal coils, thus targeting widespread networks involved in neurodegenerative disorders. We aimed to evaluate H-coil rTMS safety and efficacy in AD. Thirty AD subjects (70.21 +/- 8.66 y.o.), randomized in real or sham groups, underwent 16 rTMS sessions (3 weekly for 4 weeks, 1 weekly for other 4 weeks), over frontoparieto- temporal lobes at 10 Hz. Neuropsychological assessment was performed at baseline, after 4 weeks (4w), at the end of treatment (8w). Primary outcome was an improvement in Alzheimer's disease scale-cognitive (ADAS-cog). No serious side effects were reported. Four subjects were excluded (1 acute myocardial infarction in the sham group, 1 misdiagnosis, 2 missing data), thus statistical analysis included 26 subjects. At 4w, percent ADAS-cog improvement from baseline (4 w%) was greater in the real compared with the sham group (p = 0.042). The relationship between baseline ADAS-cog and 4 w% differed between the two groups (p = 0.009), with higher improvement for less cognitively impaired subjects at baseline only in the real. These findings suggest that H-coil may be safe and effective in AD and that deep rTMS may better impact the course of the disease when administered at earlier stages.",Sr-dementia,"Coppi, E;Ferrari, L;Nuara, A;Chieffo, R;Houdayer, E;Ambrosi, A;Bernasconi, Mp;Falautano, M;Zangen, A;Comi, G;Magnani, G;Leocani, L",2016,,10.1016/j.clinph.2015.09.079,0,
886,"Deep repetitive transcranial magnetic stimulation with H-coil in Alzheimer's disease: a double-blind, placebo-controlled pilot study","Background and aims: Repetitive transcranial magnetic stimulation (rTMS) applied with focal coils in Alzheimer's disease (AD) revealed positive effects on cognition. The Hcoil is able to depolarize deeper and wider neuronal structures compared with focal coils. Our aim was to evaluate feasibility, safety and efficacy of excitatory rTMS with Hcoil in AD. Methods: 30 AD subjects (age 70.21+/-8.66; MMSE 17.31+/-5.77), randomized in real and sham group, underwent 12 rTMS sessions within 4 weeks, then a 4-week maintenance (1/week), over the fronto-parieto-temporal lobes (10Hz; 120%RMT). Neuropsychological assessment (Alzheimer's Disease Assessment Scale cognitive - ADAS-cog, Mini-Mental State Examination-MMSE, Beck Depression Inventory-II, Clinical Global Impression- Improvement, a word recognition task) were performed at baseline, 4 weeks from start of treatment (4w), end of treatment (8w), follow-up (8 weeks after 8w). Results: No serious side effects were reported and no patient dropped due to side effects. Four subjects were excluded from the analyses (1 acute myocardial infarction in the sham group, 1 misdiagnosis, 2 missing data). Comparing percent ADAS-cog change at 4w with a null hypothesis of 0 change, only the real group significantly improved (-7.22+/-10.49 %, p=0.046). To achieve 3-4 points group difference change ADAS-cog with 80% power, we calculated a sample size 16-22 per arm. Conclusion: Our preliminary findings suggest that rTMS with H-coil is a safe and feasible procedure in AD, with good patients' adherence. Our neuropsychological data will be used to plan phase II trials on a larger sample. Future studies should explore earlier disease phases and the combination with cognitive training.",pilot study;transcranial magnetic stimulation;European;neurology;Alzheimer disease;human;side effect;Mini Mental State Examination;patient;acute heart infarction;disease assessment;follow up;safety;word recognition;sample size;Clinical Global Impression scale;cognition;diagnostic error;Beck Depression Inventory;null hypothesis;temporal lobe;arm;procedures;phase 2 clinical trial;placebo;Sr-compmed,"Coppi, E;Ferrari, L;Nuara, A;Chieffo, R;Houdayer, E;Bianco, M;Bernasconi, Mp;Falautano, M;Zangen, A;Comi, G;Magnani, G;Leocani, L",2015,,10.1111/ene.12807,0,887
887,"Deep repetitive transcranial magnetic stimulation with H-coil in Alzheimer's disease: A double-blind, placebo-controlled pilot study","Background and aims: Repetitive transcranial magnetic stimulation (rTMS) applied with focal coils in Alzheimer's disease (AD) revealed positive effects on cognition. The Hcoil is able to depolarize deeper and wider neuronal structures compared with focal coils. Our aim was to evaluate feasibility, safety and efficacy of excitatory rTMS with Hcoil in AD. Methods: 30 AD subjects (age 70.21+/-8.66; MMSE 17.31+/-5.77), randomized in real and sham group, underwent 12 rTMS sessions within 4 weeks, then a 4-week maintenance (1/week), over the fronto-parieto-temporal lobes (10Hz; 120%RMT). Neuropsychological assessment (Alzheimer's Disease Assessment Scale cognitive - ADAS-cog, Mini-Mental State Examination-MMSE, Beck Depression Inventory-II, Clinical Global Impression- Improvement, a word recognition task) were performed at baseline, 4 weeks from start of treatment (4w), end of treatment (8w), follow-up (8 weeks after 8w). Results: No serious side effects were reported and no patient dropped due to side effects. Four subjects were excluded from the analyses (1 acute myocardial infarction in the sham group, 1 misdiagnosis, 2 missing data). Comparing percent ADAS-cog change at 4w with a null hypothesis of 0 change, only the real group significantly improved (-7.22+/-10.49 %, p=0.046). To achieve 3-4 points group difference change ADAS-cog with 80% power, we calculated a sample size 16-22 per arm. Conclusion: Our preliminary findings suggest that rTMS with H-coil is a safe and feasible procedure in AD, with good patients' adherence. Our neuropsychological data will be used to plan phase II trials on a larger sample. Future studies should explore earlier disease phases and the combination with cognitive training.",pilot study;transcranial magnetic stimulation;European;neurology;Alzheimer disease;human;side effect;Mini Mental State Examination;patient;acute heart infarction;disease assessment;follow up;safety;word recognition;sample size;Clinical Global Impression scale;cognition;diagnostic error;Beck Depression Inventory;null hypothesis;temporal lobe;arm;procedures;phase 2 clinical trial;placebo;Sr-compmed,"Coppi, E.;Ferrari, L.;Nuara, A.;Chieffo, R.;Houdayer, E.;Bianco, M.;Bernasconi, M. P.;Falautano, M.;Zangen, A.;Comi, G.;Magnani, G.;Leocani, L.",2015,,10.1111/ene.12807,0,
888,Structural and phylogenetic approaches to assess the significance of human Apolipoprotein E variation,"Apolipoprotein E (APOE) is an important gene whose common polymorphism, and precisely the e *4 allele, has been reportedly associated with some disorders, including Alzheimer's disease (AD) and coronary artery disease. In the course of previous surveys on AD patients and healthy individuals some rare variants were detected by means of Isoelectric focusing and denaturing high-performance liquid chromatography techniques. After a mutation in a gene is identified, the problem arises to understand its effective significance. Structure modelling and phylogenetic analysis methods are widely used to establish the possible deleterious effect of mutations. In this study their usefulness in the analysis of APOE variants was evaluated. The two combined methods provided helpful indications for distinguishing between mutations possibly involved in AD susceptibility and not deleterious mutations.","Amino Acid Sequence;Apolipoproteins E/*chemistry/*genetics;Chromatography, High Pressure Liquid;Exons/genetics;Humans;Molecular Sequence Data;Mutation/genetics;Nucleic Acid Denaturation;*Phylogeny;*Polymorphism, Genetic;Sequence Alignment","Corbo, R. M.;Prevost, M.;Raussens, V.;Gambina, G.;Moretto, G.;Scacchi, R.",2006,Nov,10.1016/j.ymgme.2006.02.015,0,
889,Apolipoprotein E (APOE) allele distribution in the world. Is APOE*4 a 'thrifty' allele?,"Apolipoprotein E (APOE = gene, apoE = protein) plays a central role in plasma lipoprotein metabolism and in lipid transport within tissues. The APOE shows a genetic polymorphism determined by three common alleles, APOE*2, APOE*3, APOE*4 and the product of the three alleles differs in several functional properties. APOE is involved in the development of certain pathological conditions. In particular, the APOE*4 allele is a risk factor for susceptibility to coronary artery disease (CAD) and Alzheimer's Disease (AD). In the present study we analyzed the APOE allele distribution in the world. The APOE*3 is the most frequent in all the human groups, especially in populations with a long-established agricultural economy like those of the Mediterranean basin (0.849-0.898). The frequency of APOE*4, the ancestral allele, remains higher in populations like Pygmies (0.407) and Khoi San (0.370), aborigines of Malaysia (0.240) and Australia (0.260), Papuans (0.368), some Native Americans (0.280), and Lapps (0.310) where an economy of foraging still exists, or food supply is (or was until the recent past) scarce and sporadically available. The APOE*2 frequency fluctuates with no apparent trend (0.145-0.02) and is absent in Native Americans. We suggest that the APOE*4, based on some functional properties it has and on its distribution among human populations, could be identified as a 'thrifty' allele. The exposure of APOE*4 to the contemporary environmental conditions (Western diet, longer lifespans) could have rendered it a susceptibility allele for CAD and AD. The absence of the association of APOE*4 with CAD and AD in Sub-Saharan Africans, and its presence in African Americans, seems to confirm this hypothesis.","Africa/epidemiology;*Alleles;Alzheimer Disease/genetics;Apolipoprotein E4;Apolipoproteins E/*genetics;Asia/epidemiology;Coronary Disease/genetics;Europe/epidemiology;Gene Frequency;Humans;Indians, North American;Polymorphism, Genetic;Risk Factors","Corbo, R. M.;Scacchi, R.",1999,Jul,,0,
890,Polymorphisms in the apolipoprotein E gene regulatory region in relation to coronary heart disease and their effect on plasma apolipoprotein E,"In a previous study which examined the distribution of apolipoprotein E genotypes and plasma levels in a sample of male coronary heart disease (CHD) patients and controls, we found a significant excess of the genotypes carrying APOE*4 allele in CHD men (18.2%) vs. controls (9.6%) and an association between the APOE*4 allele and the lowest concentrations of apoE. In the present investigation, we re-examined in the same samples two recently identified polymorphisms in the promoter region of APOE, -491A/T and -427T/C, which may alter the level of apoE expression. No differences in the distributions of the -491A/T genotypes and alleles were observed between cases and controls (-491*A = 0.760 and 0.757 respectively). Polymorphism -427T/C showed in CHD patients an excess of -427*C allele (patients vs. controls = 0.123 vs. 0.074) and corresponding genotypes that was marginally significant. Stratification of the samples according to the presence/absence of APOE*4 showed that the excess of the -427*C allele concerned only CHD patients not carrying APOE*4 allele (patients vs. controls = 0.133 vs. 0.061; p=0.017). This result suggests that the presence of -427*C allele could represent a risk for developing CHD in subjects with E2/E2, E3/E2, and E3/E3 genotypes. Studies carried out on patients with Alzheimer's disease demonstrated that -491A/T and -427T/C polymorphisms affect the level of plasma apoE. In the present study, carried out on CHD patients and controls, the genetic variation at -427 and -491 sites of the APOE regulatory region had no apparent effect on apoE plasma concentration.","Age Factors;Aged;Alleles;Angina Pectoris/blood/genetics;Apolipoproteins E/*blood/*genetics;Case-Control Studies;Cholesterol/blood;Cholesterol, HDL/blood;Coronary Disease/*blood/*genetics;Genotype;Haplotypes;Humans;Male;Middle Aged;Myocardial Infarction/blood/genetics;*Polymorphism, Genetic;Promoter Regions, Genetic;Risk Factors;Triglycerides/blood","Corbo, R. M.;Scacchi, R.;Vilardo, T.;Ruggeri, M.",2001,Jan,10.1515/cclm.2001.002,0,
891,Lack of implementation of clinical Guidelines in a geriatric rehabilitation ward,"Aim: Evaluation of the causes of not-implementation of Clinical Guidelines (CGs) in patients admitted in a Geriatric Rehabilitation Unit (GRU). Methods: Between 2002 and 2004 the physicians of the GRU elaborated internal CGs on the basis of the international diagnostic and therapeutical CGs, adapting them on their own geriatric setting. Among the diseases most present in the elderly, diabetes mellitus, heart failure, atrial fibrillation, hypertension, chronic pain, urinary infections, pneumonia, chronic obstructive pulmonary disease were considered. The respect of CGs or the reasons of not-implementation were registered in the clinical chart and on discharge the staff discussed single cases. Setting and patients: 692 patients were observed (79.2 ± 7.5 years old, M 25.3%), consecutively admitted for a mean of 31.1 ± 12.2 days. Results: Totally the CGs were implemented in 65.3% of the cases. The physiscians applied more the CGs of the chronic pain (92.9%), hypertension (89.5%) and pneumonia (87.3%). The CGs less used were those of the heart failure (51.4%) and atrial fibrillation (38.5%). The main reason of not-implementation (20.8%) was determined by the physician's judgment based on the particular patient's clinical-prognostical-social conditions. In fact, in comparison of those cured with the CGs, patients without implementation were older (78.8 ± 7.2 vs. 81.1 ± 6.9 years respectively, p 0.000), with more cognitive impairment (Mini-Mental State Examination- MMSE 21.5 ± 8.7 vs. 18.7 ± 7.5, p 0.000), more disability (Basic Activities of Daily Living - BADL, functions lost on admission 2.6 ± 2.0 vs. 3.6 ± 1.9, p 0.000), higher comorbidity (number of total diseases 6.0 ± 2.0 vs. 6.6 ± 1.8, p 0.000; Burden of Disease - BOD 10.8 ± 3.9 vs. 12.9 ± 4.1, p 0.000; number of drugs 5.5 ± 2.8 vs. 6.1 ± 2.9, p 0.007), biological frailty (serum albumin 3.5 ± 0.4 vs. 3.4 ± 0.5 g/dl, p 0.003; total cholesterol 182.0 ± 44.9 vs. 174.5 ± 44.2 mg/dl, p 0.037), and elevated prevalence of intercurrent acute events (46.7% vs. 56.2%, p 0.022). In a multivariate logistic regression analysis, adjusting for age, gender, number of drugs, and serum albumin, determinants of not-implementation were cognitive impairment (MMSE HR 0.97, 95% CI 0.94-0.99, p 0.026), functional impairment (BADL lost HR 1.15, 95% CI 1.04-1.27, p 0.007), and comorbidity (BOD HR 1.11, 95% CI 1.06-1.16, p 0.000). Conclusions: Although the CGs were implemented in their own setting by the clinical staff, the percentage of not-implementation exceeded 30%. The main reason because geriatricians decided not to apply CGs are based on the patient's prognosis: in disabled and demented subjects they prefer symptomatic and less complicated therapies.",cholesterol;human albumin;aged;albumin blood level;article;cholesterol blood level;chronic obstructive lung disease;chronic pain;cognitive defect;comorbidity;controlled study;daily life activity;diabetes mellitus;elderly care;female;frail elderly;functional disease;functional status;geriatric rehabilitation;atrial fibrillation;heart failure;human;hypertension;major clinical study;male;medical decision making;Mini Mental State Examination;multivariate logistic regression analysis;pneumonia;practice guideline;prevalence;urinary tract infection,"Cornali, C.;Franzoni, S.;Di Fazio, I.;Trabucchi, M.",2007,,,0,
892,Implementation of guidelines for type 2 diabetes mellitus in a post-acute geriatric setting,"BACKGROUND AND AIMS: Several health organizations have developed guidelines for type 2 diabetes mellitus, but it is known that population aging poses challenges to their application. We evaluated the reasons for not implementing guidelines for type 2 diabetes mellitus (DM) in patients admitted to a post-acute geriatric ward. METHODS: 209 patients (78.8+/-6.9 years old, female 72.7%) affected by DM, consecutively admitted in a Geriatric Evaluation and Rehabilitation Unit (GERU) between 2003 and 2005 for 32.2+/-11.5 days. The GERU geriatricians generated an algorithm for DM management following the guidelines proposed by the American Diabetes Association (2001) and the California Healthcare Foundation/American Geriatric Society (2003). The fit between medical choices and the guideline or the reasons for non-implementation were recorded on clinical charts. RESULTS: Guidelines were implemented in 82.3% of cases. The main reason for non-application was the physician's judgment of the patient's clinical condition. Subjects in the non-implementation group had worse functional status, their somatic comorbidity was more severe, and their clinical condition more unstable. They were also affected by more serious psychological and behavioral symptoms associated with dementia. In a multivariate logistic regression analysis, adjusting for age, gender, cognitive, functional status, and number of drugs, the burden of comorbidity was the only independent determinant for not implementing the guidelines (OR 2.27, 95% CI 1.36-3.81, p=0.002). CONCLUSIONS: although the guidelines for DM have previously been adapted to a geriatric setting, they are not applied in a significant percentage of old frail patients. Severe comorbidity is the main limitation for applying guidelines, but also polypharmacy, disability, cognitive impairment, and behavioral disturbances are factors taken into consideration before starting treatment of a very old patient affected by diabetes.","Activities of Daily Living;Aged;Aged, 80 and over;Algorithms;Arthritis/complications/epidemiology;Arthroplasty, Replacement, Hip/statistics & numerical data;Comorbidity;Dementia/complications/epidemiology;Diabetes Mellitus, Type 2/complications/drug therapy/*therapy;Female;Fractures, Bone/complications/epidemiology;Geriatrics/*organization & administration/statistics & numerical data;Heart Failure/complications/epidemiology;Humans;Hypoglycemic Agents/therapeutic use;Knee Prosthesis/statistics & numerical data;Male;Middle Aged;Practice Guidelines as Topic/*standards;Stroke/complications/epidemiology;Treatment Outcome","Cornali, C.;Franzoni, S.;Di Fazio, I.;Trabucchi, M.",2009,Aug-Oct,,0,
893,Senile cardiac amyloid: evidence that fibrils contain a protein immunologically related to prealbumin,"Antiserum specific for human prealbumin (HPA) was studied by indirect immunofluorescence on tissue sections of cardiac ventricles containing senile cardiac amyloid. The pattern of reactivity was identical to that previously reported for an antiserum specific for protein ASc1 (formerly designated ASCA present in these tissues. Anti-HPA failed to react with isolated atrial amyloid (IAA), primary amyloid (A lambda I, A lambda IV, A lambda VI), secondary amyloid (AA), amyloid associated with medullary carcinoma of the thyroid (AEt), pancreatic amyloid associated with adult onset diabetes, cerebral amyloid present in Alzheimer's disease or lichen amyloid. THe reaction of anti-HPA was completely blocked by purified human prealbumin but was not influenced by absorption with purified human albumin or proteins extracted from any amyloid types tested. The anti-HPA reaction was also completely blocked by purified protein ASc1, and the reaction of anti-ASc1 was similarly blocked by purified HPA. These studies suggest that senile cardiac amyloid of the ASc1 type contains prealbumin or a protein antigenically closely related to this molecule.",Aged;Amyloidosis/*metabolism;Cardiomyopathies/*metabolism;Fluorescent Antibody Technique;Heart Ventricles/analysis;Humans;Immune Sera/immunology;Prealbumin/*immunology;Proteins/analysis;Serum Albumin/*immunology,"Cornwell, G. G., 3rd;Westermark, P.;Natvig, J. B.;Murdoch, W.",1981,Nov,,0,
894,"Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study","BACKGROUND: It is well known that atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with a higher risk of stroke, and new evidence links AF to cognitive impairment, independently from an overt stroke (CI). Our aim was to investigate, assuming an underlying role of atrial microembolism, the impact of CI and CKD in elderly hospitalized patients with AF. METHODS: We retrospectively analyzed the data collected on elderly patients in 66 Italian hospitals, in the frame of the REPOSI project. We analyzed the clinical characteristics of patients with AF and different degrees of CI. Multivariate logistic analysis was used to explore the relationship between variables and mortality. RESULTS: Among the 1384 patients enrolled, 321 had AF. Patients with AF were older, had worse CI and disability and higher rates of stroke, hypertension, heart failure, and CKD, and less than 50% were on anticoagulant therapy. Among patients with AF, those with worse CI and those with lower estimated glomerular filtration rate (eGFR) had a higher mortality risk (odds ratio 1.13, p=0.006). Higher disability levels, older age, higher systolic blood pressure, and higher eGFR were related to lower probability of oral anticoagulant prescription. Lower mortality rates were found in patients on oral anticoagulant therapy. CONCLUSIONS: Elderly hospitalized patients with AF are more likely affected by CI and CKD, two conditions that expose them to a higher mortality risk. Oral anticoagulant therapy, still underused and not optimally enforced, may afford protection from thromboembolic episodes that probably concur to the high mortality.","Aged;Aged, 80 and over;Anticoagulants/*administration & dosage;Atrial Fibrillation/*complications/*drug therapy/*mortality;Brain/physiopathology;Cognition Disorders/drug therapy;Dementia/drug therapy;Disability Evaluation;Female;Glomerular Filtration Rate;Heart Atria;Humans;Kidney/physiopathology;Male;Multivariate Analysis;Odds Ratio;Renal Insufficiency, Chronic/*complications;Retrospective Studies;Risk Factors;Stroke/prevention & control;Thromboembolism/*prevention & control;Anticoagulants;Atrial fibrillation;Dementia;Renal insufficiency, chronic;Stroke","Corrao, S.;Argano, C.;Nobili, A.;Marcucci, M.;Djade, C. D.;Tettamanti, M.;Pasina, L.;Franchi, C.;Marengoni, A.;Salerno, F.;Violi, F.;Mannucci, P. M.;Perticone, F.",2015,May,10.1016/j.ejim.2015.02.018,0,
895,Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs,"Objective: To examine the relationship between presence of metabolic syndrome and the risk of coronary heart disease (CHD) events (angina pectoris, myocardial infarction, and sudden cardiac death) in patients treated with second-generation antipsychotic medications. Method: 367 adults treated with second-generation antipsychotics randomly selected from consecutive psychiatric admissions to a single hospital between August 1, 2004, and March 1, 2005, underwent assessments evaluating the presence of metabolic syndrome. The 10-year risk of CHD events was calculated according to the Framingham scoring system for age, smoking, total cholesterol, high-density lipoprotein (HDL)-cholesterol, blood pressure, and history of diabetes and was compared in patients with and without the metabolic syndrome. Results: Metabolic syndrome, present in 137 patients (37.3%), was associated with a significantly greater age- and race-adjusted 10-year risk of CHD events, i.e., 11.5% vs. 5.3% for men (risk ratio = 2.18, 95% CI = 1.88 to 2.48, p < .0001) and 4.5% vs. 2.3% for women (risk ratio = 1.94, 95% CI = 1.65 to 2.23, p = .0005). The increased risk of CHD events in patients with metabolic syndrome remained significant after the exclusion of diabetic patients. In a logistic regression analysis of variables independent of the Framingham scoring system, triglyceride levels (p < .0001), waist circumference (p = .035), and white race (p = .047) were significantly associated with the 10-year risk of CHD events (R2 = 0.134; p < .0001). Conclusions: These data confirm the high prevalence of metabolic syndrome in patients receiving second-generation antipsychotics, indicate that metabolic syndrome doubles the 10-year risk of CHD events in this population, and emphasize the importance of the ""hypertriglyceridemic waist"" for the identification of psychiatric patients at high risk of CHD.",anxiolytic agent;aripiprazole;cholesterol;clozapine;high density lipoprotein;hypnotic agent;mood stabilizer;neuroleptic agent;olanzapine;quetiapine;risperidone;triacylglycerol;ziprasidone;adult;angina pectoris;article;bipolar disorder;blood pressure;Caucasian;cholesterol blood level;controlled study;dementia;depression;diabetes mellitus;disease association;female;groups by age;heart death;heart infarction;hospital admission;human;ischemic heart disease;logistic regression analysis;major clinical study;male;metabolic syndrome X;priority journal;schizoaffective psychosis;schizophrenia;scoring system;smoking;waist circumference,"Correll, C. U.;Frederickson, A. M.;Kane, J. M.;Manu, P.",2006,,,0,
896,Low-density lipoprotein cholesterol in patients treated with atypical antipsychotics: Missed targets and lost opportunities,"Background: The treatment of psychotic disorders with second-generation antipsychotics (SGAs) has been linked to an increased risk of coronary heart disease (CHD). Lowering low-density lipoprotein-cholesterol (LDL-C) to individualized targets of 100, 130 or 160 mg/dl reduces the risk of CHD. We determined the prevalence of above-target LDL-C and its management during psychiatric hospitalization. Methods: 364 hospitalized adults receiving SGAs underwent LDL-C target assessments. Records of patients with above-target LDL-C were searched for dietary or pharmacologic treatments and referrals for medical consultation. Results: Above-target LDL-C levels were present in 100 (27.5%) patients and were associated with higher total cholesterol, lower high-density lipoprotein cholesterol, older age, higher systolic blood pressure, smoking and male gender (r2: 0.53; p < 0.0001). Only 32.0% of these patients received appropriate interventions during hospital stays of 27.6 ± 23.3 days. Conclusions: A substantial number of SGA-treated patients have above-target LDL-C, but do not receive interventions to reduce the risk of CHD. © 2007 Elsevier B.V. All rights reserved.",antidepressant agent;antidiabetic agent;antihypertensive agent;anxiolytic agent;aripiprazole;cholesterol;clozapine;high density lipoprotein cholesterol;hypnotic agent;low density lipoprotein cholesterol;mood stabilizer;neuroleptic agent;olanzapine;quetiapine;risperidone;ziprasidone;adult;aged;article;bipolar disorder;body mass;coronary risk;dementia;demography;diabetes mellitus;dyslipidemia;female;human;ischemic heart disease;major clinical study;major depression;male;priority journal;psychosis;risk reduction;schizophrenia;smoking;statistical analysis;substance abuse,"Correll, C. U.;Harris, J. L.;Pantaleon Moya, R. A.;Frederickson, A. M.;Kane, J. M.;Manu, P.",2007,,,0,
897,Cardiovascular and cerebrovascular risk factors and events associated with second-generation antipsychotic compared to antidepressant use in a non-elderly adult sample: results from a claims-based inception cohort study,"This is a study of the metabolic and distal cardiovascular/cerebrovascular outcomes associated with the use of second-generation antipsychotics (SGAs) compared to antidepressants (ADs) in adults aged 18-65 years, based on data from Thomson Reuters MarketScan(R) Research Databases 2006-2010, a commercial U.S. claims database. Interventions included clinicians' choice treatment with SGAs (allowing any comedications) versus ADs (not allowing SGAs). The primary outcomes of interest were time to inpatient or outpatient claims for the following diagnoses within one year of SGA or AD discontinuation: hypertension, ischemic and hypertensive heart disease, cerebrovascular disease, diabetes mellitus, hyperlipidemia, and obesity. Secondary outcomes included the same diagnoses at last follow-up time point, i.e., not censoring observations at 365 days after SGA or AD discontinuation. Cox regression models, adjusted for age, gender, diagnosis of schizophrenia and mood disorders, and number of medical comorbidities, were run. Among 284,234 individuals, those within one year of exposure to SGAs versus ADs showed a higher risk of essential hypertension (adjusted hazard ratio, AHR=1.16, 95% CI: 1.12-1.21, p<0.0001), diabetes mellitus (AHR=1.43, CI: 1.33-1.53, p<0.0001), hypertensive heart disease (AHR=1.34, CI: 1.10-1.63, p<0.01), stroke (AHR=1.46, CI: 1.22-1.75, p<0.0001), coronary artery disease (AHR=1.17, CI: 1.05-1.30, p<0.01), and hyperlipidemia (AHR=1.12, CI: 1.07-1.17, p<0.0001). Unrestricted follow-up results were consistent with within one-year post-exposure results. Increased risk for stroke with SGAs has previously only been demonstrated in elderly patients, usually with dementia. This study documents, for the first time, a significantly increased risk for stroke and coronary artery disease in a non-elderly adult sample with SGA use. We also confirm a significant risk for adverse metabolic outcomes. These findings raise concerns about the longer-term safety of SGAs, given their widespread and chronic use.",Second-generation antipsychotics;coronary heart disease;diabetes mellitus;essential hypertension;hyperlipidemia;hypertensive heart disease;stroke,"Correll, C. U.;Joffe, B. I.;Rosen, L. M.;Sullivan, T. B.;Joffe, R. T.",2015,Feb,10.1002/wps.20187,0,
898,Obesity and coronary risk in patients treated with second-generation antipsychotics,"Weight gain leading to obesity is a frequent adverse effect of treatment with atypical antipsychotics. However, the degree of its independent contribution to the risk of coronary heart disease events in patients treated with these drugs has not been elucidated. The aim of this study is to determine whether obesity is an independent risk factor for the 10-year risk of coronary heart disease events in psychiatric patients treated with atypical antipsychotics. We used the Framingham method, which is based on age, gender, blood pressure, smoking, and plasma levels of total and high-density lipoprotein cholesterol, to estimate the 10-year risk of coronary heart disease events in patients treated with second-generation antipsychotics who were obese (N = 44; mean age 38.1 years, 54.5% men) or normal weight (N = 83; mean age 39.9 years, 47.0% men). Excluded were patients with metabolic syndrome and those taking antihypertensive, hypoglycemic, and lipid-lowering drugs. The 10-year risk of coronary artery disease events was very low and virtually identical in the obese and normal weight patients (2.3 ± 3.5 vs. 2.6 ± 4.6, P = 0.68), despite excess of 12 BMI units (P < 0.0001) and 15.7 cm waist circumference (P < 0.0001) in the obese. The risk was similar in obese and normal weight men (3.8 ± 5.9 vs. 2.8 ± 3.4, P = 0.45) and women (1.7 ± 3.7 vs. 1.5 ± 2.5, P = 0.83). The validity of the 10-year prediction for risk of coronary heart disease events in the mentally ill based on the Framingham score system requires prospective confirmation. Obesity does not appear to be an independent predictor for the 10-year risk of coronary heart disease events in patients without metabolic syndrome treated with second-generation antipsychotics. © 2010 Springer-Verlag.",antidepressant agent;antidiabetic agent;antihypertensive agent;antilipemic agent;anxiolytic agent;aripiprazole;atypical antipsychotic agent;cholinergic receptor blocking agent;clozapine;glucose;high density lipoprotein cholesterol;hypnotic agent;low density lipoprotein cholesterol;mood stabilizer;olanzapine;quetiapine;risperidone;triacylglycerol;ziprasidone;adult;antihypertensive therapy;article;bipolar disorder;blood pressure;cardiovascular risk;cholesterol blood level;clinical article;controlled study;dementia;depression;female;gender;glucose blood level;human;ischemic heart disease;male;mental patient;obesity;priority journal;schizophrenia;smoking;triacylglycerol blood level;waist circumference,"Correll, C. U.;Kane, J. M.;Manu, P.",2011,,,0,
899,Epidemiology of diabetes and diabetes complications in the elderly: An emerging public health burden,"Diabetes in the elderly is a growing public health burden. Persons with diabetes are living longer and are vulnerable to the traditional microvascular and macrovascular complications of diabetes but also at increased risk for geriatric syndromes. Peripheral vascular disease, heart disease, and stroke all have a high prevalence among older adults with diabetes. Traditional microvascular complications such as retinopathy, nephropathy, and neuropathy also frequently occur. Unique to this older population is the effect of diabetes on functional status. Older adults with diabetes are also more likely to experience geriatric syndromes such as falls, dementia, depression, and incontinence. Further studies are needed to better characterize those elderly individuals who may be at the highest risk of adverse complications from diabetes. © 2013 Springer Science+Business Media New York.",antidepressant agent;insulin;metformin;oral antidiabetic agent;sulfonylurea derivative;ADL disability;aged;article;cerebrovascular disease;chronic kidney disease;cognitive defect;dementia;depression;diabetes mellitus;diabetic nephropathy;diabetic neuropathy;diabetic retinopathy;falling;frail elderly;geriatric patient;hearing impairment;human;ischemic heart disease;life expectancy;mortality;non insulin dependent diabetes mellitus;nursing home patient;peripheral vascular disease;prevalence;public health problem;urine incontinence;visual impairment,"Corriere, M.;Rooparinesingh, N.;Kalyani, R. R.",2013,,,0,
900,Four cases of takotsubo cardiomyopathy linked with exacerbations of psychiatric illness,"Objective. Takotsubo cardiomyopathy is a rare cardiac syndrome most often occurring in post-menopausal women after an acute episode of severe emotional or physical stress. Prior literature suggests a higher prevalence of anxiety and depression among patients with Takotsubo cardiomyopathy. We observed four cases of Takotsubo cardiomyopathy at one tertiary care center preceded by and concurrent with exacerbations of psychiatric illness rather than after acute episodes of stress. We examined each to further understand Takotsubo cardiomyopathy's pathogenesis and relationship to psychiatric illness.Methods. We retrospectively reviewed four consecutive cases of Takotsubo cardiomyopathy at one tertiary center from August 2009 to October 2009. The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision criteria were used to diagnose psychiatric illness. Each patient was diagnosed with Takotsubo cardiomyopathy via cardiac catheterization.Results. Each woman (age range 53-67 years) was previously diagnosed with psychiatric illness. Psychiatric illnesses were as follows: Alzheimer's dementia with psychotic features, adjustment disorder, major depressive disorder, and bipolar affective disorder type 1. All four cases demonstrated exacerbations of their psychiatric illness just prior to and concurrent with their diagnosis of Takotsubo cardiomyopathy. They showed improved left ventricular ejection fraction within 1 to 3 weeks after diagnosis with supportive care.Conclusions. Differing from the traditional cases of Takotsubo cardiomyopathy, which follow acute events of stress, our four cases indicate exacerbations of underlying psychiatric illness can lead to Takotsubo cardiomyopathy. In addition to anxiety and depression, psychosis and mania may predispose an individual to Takotsubo cardiomyopathy. We suggest that cardiologists and psychiatrists be aware of this association and screen patients. We suggest further studies that may help better understand the connection between the heart and mind.",Acute coronary syndrome;patient safety;psychiatric illness;psychosomatic;takotsubo cardiomyopathy,"Corrigan, F. E., 3rd;Kimmel, M. C.;Jayaram, G.",2011,Jul,,0,
901,Observations on the neuropathology of dementia,,"Aged;Alzheimer Disease/pathology;Brain/*pathology;Cell Count/instrumentation;Cerebral Cortex/pathology;Cerebrovascular Circulation;Circle of Willis/pathology;Coronary Disease/pathology;Dementia/*pathology;Humans;Intracranial Arteriosclerosis/pathology;Ischemic Attack, Transient/pathology;Nerve Degeneration;Neurons/pathology","Corsellis, J. A.",1977,,,0,
902,Sarcopenia is predictive of nosocomial infection in care of the elderly,"Protein-energy malnutrition and nosocomial infection (NI) are frequent in elderly patients, and a causal link between the two has often been suggested. The aim of the present study was to identify the nutritional parameters predictive of NI in elderly patients. We assessed on admission 101 patients (sixty-six women, thirty-five men, aged over 65 years) admitted to an acute care of the elderly department. Sarcopenia was detected by dual-energy X-ray absorptiometry, with appendicular skeletal muscle mass expressed with respect to body area. Weight, BMI, albuminaemia, serum transthyretin and C-reactive protein values were also determined on admission, and known risk factors, such as functional dependence and invasive biomedical material, were also evaluated. After up to 3 weeks of hospitalisation, patients were classified according to whether they had developed an NI. After 3 weeks of hospitalisation, we found that twenty-nine patients had suffered an NI, occurring after a mean of 16.1 d. Patients who were sarcopenic on admission had a significantly higher risk of contracting an NI (relative risk 2.1, 95% CI 1.1, 3.8). None of the other morphometric or biological parameters differed significantly between the two groups of patients on admission. Patients who experienced an NI were also more likely, on admission, to have a medical device (P≡0.02 to P≡0.001 depending on the device), to have swallowing problems (P≡0.002) or to have restricted autonomy (P<0.01). Sarcopenia on admission to an acute care of the elderly unit, as measured by X-ray absorptiometry, was therefore associated with a doubled risk of NI during the first 3 weeks of hospitalisation. © The Authors 2006.",albumin;C reactive protein;prealbumin;aged;albumin blood level;article;body mass;body weight;controlled study;dementia;disease association;dual energy X ray absorptiometry;dysphagia;elderly care;female;heart failure;hospital admission;hospital infection;hospitalization;human;independence;intravenous catheter;kidney failure;length of stay;major clinical study;male;medical assessment;medical device;morphometrics;muscle atrophy;muscle mass;nasogastric tube;nutritional parameters;prediction;protein calorie malnutrition;risk assessment;risk factor;skeletal muscle;suprapubic catheter,"Cosquëric, G.;Sebag, A.;Ducolombier, C.;Thomas, C.;Piette, F.;Weill-Engerer, S.",2006,,,0,
903,Observation versus intervention in the evaluation of drugs: the story of hormone replacement therapy,"Hormone replacement therapy, which was approved for menopausal symptoms, offers an opportunity to compare clinical trials and observational studies when evaluating the risks and benefits of drugs. The differences between randomized and observational evidence relate mainly to the risks of coronary heart diseases and dementia, higher or not elevated in users in trials, and decreased in observational studies. The most likely explanation for these discrepancies is bad accounting for confounders, in particular, time-dependent confounders in classical multivariate analyses and use of prevalent user design. Marginal structural models and new user design should help to diminish strongly indication bias in future observational studies aiming at the evaluation of the risks and benefits of drugs. To cite this article: D. Costagliola, C. R. Biologies 330 (2007). © 2007 Académie des sciences.",estrogen;gestagen;testosterone derivative;article;breast cancer;cerebrovascular accident;clinical trial;combination chemotherapy;deep vein thrombosis;dementia;drug screening;hormone substitution;human;intervention study;ischemic heart disease;lung embolism;menopausal syndrome;monotherapy;multivariate analysis;observational study;risk benefit analysis,"Costagliola, D.",2007,,,0,
904,The burden of diabetes mellitus for medicare beneficiaries,"The objective was to estimate health care costs and utilization for Medicare beneficiaries with type 1 (T1DM) or type 2 (T2DM) diabetes and their respective matched control cohorts. A retrospective claims cohort analysis was used to assess direct health care cost and utilization of health services in 2009 for patients aged 65-89 who were enrolled in a Medicare Advantage Plus prescription drug plan. Patients were matched 1:1 with patients without diabetes. All-cause health care costs for 2009 were calculated as the sum of all medical and pharmacy claims. The analysis included 6562 patients with T1DM and an equal number of matched controls, and 194,775 patients with T2DM and an equal number of matched controls. There were no significant demographic differences between cohorts for matched variables. Patients with T2DM had significantly higher mean Deyo/Charlson Comorbidity Index scores compared with their controls (2.47 versus 0.77; P<0.001), although all groups reported a high rate of costly comorbidities such as hypertension and heart disease. Mean all-cause health care costs per patient per year were significantly higher for patients with T1DM and T2DM versus controls for inpatient hospitalizations; outpatient, office, and emergency room visits; pharmacy expenditures; and total health care costs for 2009 (T1DM group: $20,701±$30,201; T1DM-matched control group: $6,537±$10,441; T2DM group: $10,437±$18,518; T2DM-matched control group: $6,505±$11,140). Diabetes escalates health care costs for Medicare Advantage Plus patients compared with patients in the same plan without diabetes, regardless of comorbidities. (Population Health Management 2014;17:272-278)",antidiabetic agent;glitazone derivative;insulin;metformin;acute heart infarction;aged;article;asthma;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;controlled study;dementia;dyslipidemia;emergency ward;female;health care cost;health care utilization;heart disease;hospitalization;human;hypertension;insulin dependent diabetes mellitus;insulin treatment;ischemic heart disease;kidney disease;major clinical study;male;medicare;neuropathy;non insulin dependent diabetes mellitus;obesity;osteoarthritis;osteoporosis;outpatient;outpatient department;peripheral vascular disease;pharmacy;retinopathy;retrospective study;rheumatic disease,"Costantino, M. E.;Stacy, J. N.;Song, F.;Xu, Y.;Bouchard, J. R.",2014,,,0,
905,Apolipoprotein ε4 allele is associated with psoriasis severity: Reply,,apolipoprotein E4;allele;Alzheimer disease;cardiovascular risk;disease severity;gene frequency;genetic association;genotype;human;ischemic heart disease;letter;onset age;priority journal;psoriasis,"Coto-Segura, P.;Coto, E.;Alvarez, V.;Santos-Juanes, J.",2010,,,0,
906,The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) - a randomised control trial protocol,"BACKGROUND: There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers. Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population.METHODS/DESIGN: The study design is a pragmatic prospective multi-centre two arm randomised controlled trial. The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation. Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility. The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions.DISCUSSION: The paper presents a protocol for the first pragmatic randomised controlled trial evaluating the effectiveness and cost-effectiveness of stepped care interventions for older hazardous alcohol users in primary care.TRIAL REGISTRATION: ISRCTN52557360.",Alcoholism [diagnosis] [economics] [therapy];Cost-Benefit Analysis;Mass Screening [economics] [methods];Prevalence;Primary Health Care [economics];Therapeutics [economics];Treatment Outcome;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult;aged;alcohol consumption;article;clinical protocol;clinical trial;cognitive defect;controlled clinical trial;controlled study;cost effectiveness analysis;dementia;economic aspect;falling;health care delivery;human;hypertension;ischemic heart disease;multicenter study;neoplasm;primary medical care;randomized controlled trial;screening;stroke;Sr-addictn: sr-behavmed: sr-dementia: sr-healthp: sr-htn: sr-epoc,"Coulton, S.;Watson, J.;Bland, M.;Drummond, C.;Kaner, E.;Godfrey, C.;Hassey, A.;Morton, V.;Parrott, S.;Phillips, T.;Raistrick, D.;Rumball, D.;Tober, G.",2008,,10.1186/1472-6963-8-129,0,907
907,The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) - a randomised control trial protocol,"METHODS/DESIGN: The study design is a pragmatic prospective multi-centre two arm randomised controlled trial. The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation. Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility. The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions.DISCUSSION: The paper presents a protocol for the first pragmatic randomised controlled trial evaluating the effectiveness and cost-effectiveness of stepped care interventions for older hazardous alcohol users in primary care.TRIAL REGISTRATION: ISRCTN52557360.BACKGROUND: There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers. Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population.",Alcoholism [diagnosis] [economics] [therapy];Cost-Benefit Analysis;Mass Screening [economics] [methods];Prevalence;Primary Health Care [economics];Therapeutics [economics];Treatment Outcome;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult;aged;alcohol consumption;article;clinical protocol;clinical trial;cognitive defect;controlled clinical trial;controlled study;cost effectiveness analysis;dementia;economic aspect;falling;health care delivery;human;hypertension;ischemic heart disease;multicenter study;neoplasm;primary medical care;randomized controlled trial;screening;stroke;Sr-addictn: sr-behavmed: sr-dementia: sr-healthp: sr-htn: sr-epoc,"Coulton, S;Watson, J;Bland, M;Drummond, C;Kaner, E;Godfrey, C;Hassey, A;Morton, V;Parrott, S;Phillips, T;Raistrick, D;Rumball, D;Tober, G",2008,,10.1186/1472-6963-8-129,0,
908,Estrogen receptors: Therapeutic implications in clinical practice (2nd part),,antiestrogen;clomifene citrate;cytostatic agent;estradiol;estrogen receptor;estrogen receptor alpha;estrogen receptor beta;follitropin;homocysteine;lipoprotein A;low density lipoprotein cholesterol;placebo;progesterone;progesterone receptor;raloxifene;selective estrogen receptor modulator;tamoxifen;Alzheimer disease;bone demineralization;bone mineral;bone turnover;breast cancer;breast carcinogenesis;cancer risk;cardiovascular system;clinical practice;clinical trial;drug efficacy;female infertility;heart infarction;heart protection;human;menopause;mortality;osteoporosis;ovulation;Parkinson disease;prostate cancer;short survey;thromboembolism;uterus cancer;spine fracture;clomid,"Courtillot, C.;Touraine, P.",2004,,,0,
909,Polymorphic cytochromes P450 and drugs used in psychiatry,"1. The cytochrome P450 monooxygenases, CYP2D6, CYP2C19, and CYP2C9, display polymorphism. CYP2D6 and CYP2C19 have been studied extensively, and despite their low abundance in the liver, they catalyze the metabolism of many drugs. 2. CYP2D6 has numerous allelic variants, whereas CYP2C19 has only two. Most variants are translated into inactive, truncated protein or fail to express protein. 3. CYP2C9 is expressed as the wild-type enzyme and has two variants, in each of which one amino acid residue has been replaced. 4. The nucleotide base sequences of the cDNAs of the three polymorphic genes and their variants have been determined, and the proteins derived from these genes have been characterized. 5. An absence of CYP2D6 and/or CYP2C19 in an individual produces a poor metabolizer (PM) of drugs that are substrates of these enzymes. 6. When two drugs that are substrates for a polymorphic CYP enzyme are administered concomitantly, each will compete for that enzyme and competitively inhibit the metabolism of the other substrate. This can result in toxicity. 7. Patients can be readily phenotyped or genotyped to determine their CYP2D6 or CYP2C19 enzymatic status. Poor metabolizers (PMs), extensive metabolizers (EMs), and ultrarapid metabolizers (URMs) can be identified. 8. Numerous substrates and inhibitors of CYP2D6, CYP2C19, and CYP2C9 are identified. 9. An individual's diet and age can influence CYP enzyme activity. 10. CYP2D6 polymorphism has been associated with the risk of onset of various illnesses, including cancer, schizophrenia, Parkinson's disease, Alzheimer's disease, and epilepsy.",amiflamine;amino acid;amitriptyline;antidepressant agent;brofaromine;citalopram;clomipramine;clozapine;complementary DNA;cytochrome P450;debrisoquine 4 hydroxylase;desipramine;drug;fluoxetine;haloperidol;imipramine;maprotiline;methylphenobarbital;mianserin;neuroleptic agent;nucleotide;omeprazole;oxidoreductase;oxygenase;phenytoin;serotonin uptake inhibitor;tolbutamide;tranylcypromine;unindexed drug;unspecific monooxygenase;age;Alzheimer disease;amino acid sequence;article;brain;neoplasm;dealkylation;demethylation;diet;disease predisposition;drug metabolism;enzyme activity;enzyme inhibition;enzyme substrate;epilepsy;extrapyramidal symptom;gene;genetic polymorphism;genotype;heart muscle ischemia;human;hydroxylation;liver;oral drug administration;Parkinson disease;phenotype;polymerase chain reaction;priority journal;restriction fragment length polymorphism;schizophrenia,"Coutts, R. T.;Urichuk, L. J.",1999,,,0,
910,"Clinical trials. Halt of Celebrex study threatens drug's future, other trials",,celecoxib;prostaglandin synthase inhibitor;pyrazole derivative;sulfonamide;Alzheimer disease;article;cerebrovascular accident;chemically induced disorder;clinical trial;colon polyp;drug industry;health care organization;heart infarction;human;United States,"Couzin, J.",2004,,,0,
911,Nail-biting time for trials of COX-2 drugs,,celecoxib;cyclooxygenase 2 inhibitor;naproxen;nonsteroid antiinflammatory agent;placebo;rofecoxib;valdecoxib;Alzheimer disease;neoplasm;cardiovascular risk;clinical trial;colon polyp;drug efficacy;drug indication;drug marketing;drug monitoring;drug screening;heart infarction;human;note;priority journal;cerebrovascular accident;bextra;celebrex;vioxx,"Couzin, J.",2004,,,0,
912,Withdrawal of Vioxx casts a shadow over COX-2 inhibitors,,acetylsalicylic acid;celecoxib;cyclooxygenase 1 inhibitor;cyclooxygenase 2 inhibitor;etoricoxib;lumiracoxib;naproxen;placebo;prostacyclin;rofecoxib;thromboxane;valdecoxib;Alzheimer disease;arthritis;cancer inhibition;clinical trial;colon polyp;drug safety;food and drug administration;gastrointestinal symptom;heart failure;heart infarction;human;hypertension;note;pain;priority journal;cerebrovascular accident;thrombosis;aleve;arcoxia;bextra;celebrex;prexige;vioxx,"Couzin, J.",2004,,,0,
913,To what extent are genetic variation and personal health linked,,antileukemic agent;DNA;nicotine;suxamethonium;Alzheimer disease;asthma;breast cancer;cystic fibrosis;decision making;depression;DNA microarray;DNA sequence;drug metabolism;genetic disorder;genetic risk;genetic variability;haplotype;heart infarction;hemophilia;heritability;human;leukemia;lung cancer;lupus erythematosus;note;priority journal;schizophrenia,"Couzin, J.",2005,,,0,
914,Gaps in the safety net,,antidepressant agent;celecoxib;dexfenfluramine;naproxen;rofecoxib;thalidomide;Alzheimer disease;arthritis;cardiovascular risk;clinical trial;drug monitoring;drug safety;drug screening;drug tolerance;European Union;food and drug administration;heart infarction;human;note;postmarketing surveillance;priority journal;cerebrovascular accident;suicide attempt;United States,"Couzin, J.",2005,,,0,
915,Impact of the Orthopaedic Nurse Practitioner role on acute hospital length of stay and cost-savings for patients with hip fracture: A retrospective cohort study,"AIMS: To compare acute hospital length of stay and cost-savings for patients with hip fracture before and after commencement of the Orthopaedic Nurse Practitioner and identify variables that increase length of stay in hospital. BACKGROUND: Globally, hip fractures are associated with significant morbidity and mortality. Whilst the practical benefits of the Orthopaedic Nurse Practitioner have been anecdotally shown, an analysis showing the cost-saving benefits has yet to be published. DESIGN: A retrospective cohort study. METHODS: Data from two population-based cohorts (2010, 2013) of hip fracture patients aged >/=65 years were extracted from the electronic hospital database at a large Western Australian tertiary metropolitan hospital. Multivariate linear regression was used to model factors affecting length of stay in hospital. A simple economic analysis was undertaken and cost-savings were estimated. RESULTS: For comparison (n = 354) and intervention (n = 301) groups, average age was 84 years and over 70% were female. Analyses showed length of stay was shorter in 2013 compared with 2010 (4.4-5.3 days). Shorter length of stay was associated with type of procedure and surgery within 24-hr and longer length of stay was associated with co-morbid conditions of pulmonary disease, congestive heart failure, dementia, anaemia on admission and complications of delirium, urinary tract infection, myocardial infarction and pneumonia. The cost-savings to the hospital over one year was $354,483 and the net annual cost-savings per patient was $1,178. CONCLUSION: Implementation of the Orthopaedic Nurse Practitioner role for care of hip fracture patients can reduce acute hospital length of stay resulting in important cost-savings.",cost-savings;hip fractures;length of stay;multivariate statistics;nurse practitioner;nursing,"Coventry, L. L.;Pickles, S.;Sin, M.;Towell, A.;Giles, M.;Murray, K.;Twigg, D. E.",2017,Nov,,0,
916,Enhancing Braden pressure ulcer risk assessment in acutely ill adult veterans,"This study sought to determine if a parsimonious pressure ulcer (PU) predictive model could be identified specific to acute care to enhance the current PU risk assessment tool (Braden Scale) utilized within veteran facilities. Factors investigated include: diagnosis of gangrene, anemia, diabetes, malnutrition, osteomyelitis, pneumonia/pneumonitis, septicemia, candidiasis, bacterial skin infection, device/implant/graft complications, urinary tract infection, paralysis, senility, respiratory failure, acute renal failure, cerebrovascular accident, or congestive heart failure during hospitalization; patient's age, race, smoking status, history of previous PU, surgery, hours in surgery; length of hospitalization, and intensive care unit days. Retrospective chart review and logistic regression analyses were used to examine Braden scores and other risk factors in 213 acutely ill veterans in North Florida with (n=100) and without (n=113) incident PU from January-July 2008. Findings indicate four medical factors (malnutrition, pneumonia/ pneumonitis, candidiasis, and surgery) have stronger predictive value (sensitivity 83%, specificity 72%, area under receiver operating characteristic [ROC] curve 0.82) for predicting PUs in acutely ill veterans than Braden Scale total scores alone (sensitivity 65%, specificity 70%, area under ROC curve 0.70). In addition, accounting for four medical factors plus two Braden subscores (activity and friction) demonstrates better overall model performance (sensitivity 80%, specificity 76%, area under ROC curve 0.88). © 2012 by the Wound Healing Society.",acute disease;acute kidney failure;adult;age distribution;aged;anemia;area under the curve;article;bacterial skin disease;Braden Scale;candidiasis;cerebrovascular accident;congestive heart failure;controlled study;decubitus;diabetes mellitus;female;gangrene;hospitalization;human;intensive care unit;length of stay;logistic regression analysis;major clinical study;male;malnutrition;osteomyelitis;paralysis;pneumonia;priority journal;receiver operating characteristic;respiratory failure;retrospective study;risk assessment;risk factor;scoring system;senility;sensitivity and specificity;septicemia;smoking;urinary tract infection;veteran,"Cowan, L. J.;Stechmiller, J. K.;Rowe, M.;Kairalla, J. A.",2012,,,0,
917,Trends in Operative and Nonoperative Hip Fracture Management 1990–2014: A Longitudinal Analysis of Manitoba Administrative Data,"Objectives: To evaluate longitudinal trends in the use of total hip arthroplasty (THA), hemiarthroplasty (HA), internal fixation (IF), and nonoperative management and to identify individual-level factors associated with nonoperative treatment of hip fracture (HF). Design: Longitudinal analysis of administrative data. Setting: Manitoba, Canada. Participants: All adults who experienced nontraumatic hip fractures between 1990 and 2014 (N = 19,626; mean age 80.6, 72.3% female). Measurements: Billing codes were used to identify surgical treatment, and trends in treatment over time were examined. Regression models were developed to identify individual factors associated with receiving nonoperative management. Results: Use of THA increased from 0.6% for all HFs in 1990–94 to 5.3% in 2010–14, use of HA increased from 19.3% to 29.7%, and use of IF declined from 71.8% to 59.9% (P <.001 for all); increase in THA and HA were largest in individuals with femoral neck fracture. Nonoperative management declined from 8.3% in 1990–94 to 5.1% in 2010–14 (P <.001). Factors associated with nonoperative management included aged 90 and older, male sex, residing in a care facility before fracture, and rural residence. Conclusion: HF is increasingly treated with THA and HA, whereas rates of nonoperative management and IF are declining. Future efforts should focus on ensuring that all individuals are optimally triaged to the best procedure for them, with nonoperative management considered for individuals with extremely poor prefracture health.",adult;age;aged;article;chronic kidney failure;comorbidity;congestive heart failure;conservative treatment;controlled study;death;dementia;female;femoral neck fracture;femur subtrochanteric fracture;follow up;hemiarthroplasty;hip fracture;hip surgery;home;hospital mortality;hospital patient;human;ICD-9-CM;income;long term care;longitudinal study;major clinical study;male;Manitoba;metastasis;middle aged;nursing home;osteoporosis;osteosynthesis;sex;surgical patient;total hip prosthesis;very elderly,"Cram, P.;Yan, L.;Bohm, E.;Kuzyk, P.;Lix, L. M.;Morin, S. N.;Majumdar, S. R.;Leslie, W. D.",2017,,10.1111/jgs.14538,0,
918,A case report of chronic subdural haematomas in two elderly patients,The authors present two elderly patients with chronic subdural haematomas following minor trauma. The difficulty associated with making the diagnosis is discussed. A high index of suspicion and routine follow-up of such patients is recommended in order to promote early diagnosis and prompt treatment of this reversible cause of dementia.,ADL disability;aged;article;case report;clinical feature;closed drainage;computer assisted tomography;diagnostic accuracy;differential diagnosis;drowsiness;dyspnea;falling;female;general condition deterioration;head injury;heart infarction;human;lung embolism;male;seizure;skull fracture;subdural hematoma;surgical drainage,"Crandon, I. W.;Eldemire-Shearer, D.;Fearon-Boothe, D.;Morris, C.;James, K.",2007,,,0,
919,An investigation of the impact of the Force Sensing Array pressure mapping system on the clinical judgement of occupational therapists,"Objectives: To examine the impact of pressure mapping technology on the clinical decisions of occupational therapists and to examine the role of the Braden Scale in assisting with the selection of pressure-reducing cushions. Design: Case studies. Setting: Community. Subjects: Forty clients. Interventions: Clients were pressure mapped on their current seating surface and on four pre-selected cushions by the principal researcher. An occupational therapist completed the Braden Scale and a decision tree to assist in recommending a suitable pressure-reducing cushion. Main outcome measures: Interface pressure maps, Braden Scale, and the cushion recommended, using a decision tree to guide clinical judgement. Results: Thirty per cent (12) of the 40 cushions recommended were changed when the pressure maps from the Force Sensing Array (FSA) system were viewed. In 70% (26) of cases, the maps supported the cushion recommended. In 25% (10) of the cases, the maps showed that the client's current seating surface was unsuitable. After viewing the pressure maps, a surface other than the client's current surface was recommended in 47% (19) of the cases. There was a lack of agreement between the risk level of the clients as identified by the Braden Scale score, and the risk level of the clients as identified by the occupational therapist using a decision tree and the FSA maps. Conclusion: Pressure mapping technology has a positive impact on clinical decisions regarding the provision of pressure-reducing cushions. Future research should examine the predictive validity of this technology. The Braden Scale may underpredict the risk level of the clients. © 2005 Edward Arnold (Publishers) Ltd.",adult;aged;arthritis;article;body surface;clinical article;clinical practice;controlled study;decubitus;dementia;female;femur neck fracture;heart failure;human;leg amputation;male;medical decision making;medical profession;medical technology;multiple sclerosis;muscular dystrophy;occupational therapy;pressure measurement;professional practice;rating scale;risk assessment;scoring system;sitting;cerebrovascular accident,"Crawford, S. A.;Strain, B.;Gregg, B.;Walsh, D. M.;Porter-Armstrong, A. P.",2005,,,0,
920,Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding,"Background & Aims: The incidence of upper gastrointestinal bleeding (GIB) has not been reduced despite the decreasing incidence of peptic ulcers, strategies to eradicate Helicobacter pylori infection, and prophylaxis against ulceration from nonsteroidal anti-inflammatory drugs. Other factors might therefore be involved in the pathogenesis of GIB. Patients with GIB have increasing nongastrointestinal comorbidity, so we investigated whether comorbidity itself increased the risk of GIB. Methods: We conducted a matched case-control study using linked primary and secondary care data collected in England from April 1, 1997 through August 31, 2010. Patients older than 15 years with nonvariceal GIB (n = 16,355) were matched to 5 controls by age, sex, year, and practice (n = 81,636). All available risk factors for GIB were extracted and modeled using conditional logistic regression. Adjusted associations with nongastrointestinal comorbidity, defined using the Charlson Index, were then tested and sequential population attributable fractions calculated. Results: Comorbidity had a strong graded association with GIB; the adjusted odds ratio for a single comorbidity was 1.43 (95% confidence interval [CI]: 1.35-1.52) and for multiple or severe comorbidity was 2.26 (95% CI: 2.14%-2.38%). The additional population attributable fraction for comorbidity (19.8%; 95% CI: 18.4%-21.2%) was considerably larger than that for any other measured risk factor, including aspirin or nonsteroidal anti-inflammatory drug use (3.0% and 3.1%, respectively). Conclusions: Nongastrointestinal comorbidity is an independent risk factor for GIB, and contributes to a greater proportion of patients with bleeding in the population than other recognized risk factors. These findings could help in the assessment of potential causes of GIB, and also explain why the incidence of GIB remains high in an aging population. © 2013 AGA Institute.",acetylsalicylic acid;nonsteroid antiinflammatory agent;alcohol consumption;article;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;congestive heart failure;dementia;diabetes mellitus;disease association;heart infarction;hemiplegia;human;kidney disease;liver cirrhosis;lymphoproliferative disease;mortality;peptic ulcer;peripheral vascular disease;priority journal;rheumatic disease;risk factor;scoring system;smoking;solid tumor;upper gastrointestinal bleeding,"Crooks, C. J.;West, J.;Card, T. R.",2013,,,0,
921,Triflusal versus aspirin for the prevention of stroke,"Antiplatelet agents represent an important part of the therapeutic armamentarium in the prevention of stroke. Triflusal is an antiplatelet agent structurally related to salicylates but not derived from acetylsalicylic acid. Like aspirin, triflusal irreversibly acetylates cyclo-oxygenase isoform 1 (COX-1) and therefore inhibits thromboxane biosynthesis. Triflusal is rapidly absorbed after oral administration, with an absorption half life of 0.44 hours. Evidence of the efficacy and safety of triflusal is derived from clinical trials performed in patients with unstable angina, acute myocardial infarction, stroke, aortocoronary by-pass, atrial fibrillation, valve replacement, and asthmatic patients intolerant to aspirin and/or non-steroidal antiinflamatory drugs (NSAID). The Triflusal versus Aspirin for the Prevention of Infarction: A Randomized Stroke Study (TAPIRSS) study was performed to explore the efficacy and safety of triflusal versus aspirin in the prevention of vascular complications in patients with a previous TIA or ischemic stroke in a Latin American population. In this pilot study differences between triflusal and aspirin in the prevention of vascular complications after TIA or ischemic stroke were not observed. Hemorrhagic risk was lower with triflusal than with aspirin. The TAPIRSS study contributed evidence on the efficacy and safety of triflusal as a valid alternative to aspirin in the prevention of vascular events in patients with ischemic stroke or TIA. © 2008 Cambridge Univeristy Press.",acenocoumarol;acetylsalicylic acid;analgesic agent;antithrombocytic agent;cardiovascular agent;clopidogrel;dipyridamole;drug metabolite;nonsteroid antiinflammatory agent;placebo;thromboxane;ticlopidine;triflusal;warfarin;acute heart infarction;Alzheimer disease;angina pectoris;area under the curve;article;asthma;bleeding;brain hemorrhage;brain ischemia;cerebrovascular accident;cerebrovascular disease;clinical trial;coronary artery bypass graft;drug absorption;drug clearance;drug distribution;drug efficacy;drug elimination;drug half life;drug mechanism;drug metabolism;drug safety;drug tolerability;drug transformation;drug withdrawal;dyspepsia;gastrointestinal hemorrhage;gastrointestinal toxicity;graft occlusion;atrial fibrillation;heart valve replacement;hematoma;hematuria;human;intraocular hemorrhage;low drug dose;maximum plasma concentration;nephrotoxicity;neurotoxicity;outcome assessment;peptic ulcer;pilot study;priority journal;repeated drug dose;respiratory tract hemorrhage;single drug dose;skin manifestation;skin toxicity;stomach ulcer;time to maximum plasma concentration;transient ischemic attack;treatment duration;unstable angina pectoris;upper gastrointestinal bleeding,"Culebras, A.;Borja, J.;García-Rafanell, J.",2008,,,0,
922,Effect of dextromethorphan-quinidine on agitation in patients with Alzheimer disease dementia a randomized clinical trial,"IMPORTANCE Agitation is common among patients with Alzheimer disease; safe, effective treatments are lacking. OBJECTIVE To assess the efficacy, safety, and tolerability of dextromethorphan hydrobromide-quinidine sulfate for Alzheimer disease-related agitation. DESIGN, SETTING, AND PARTICIPANTS Phase 2 randomized, multicenter, double-blind, placebo-controlled trial using a sequential parallel comparison design with 2 consecutive 5-week treatment stages conducted August 2012-August 2014. Patients with probable Alzheimer disease, clinically significant agitation (Clinical Global Impressions-Severity agitation score≥4), and a Mini-Mental State Examination score of 8 to 28 participated at 42 US study sites. Stable dosages of antidepressants, antipsychotics, hypnotics, and antidementia medications were allowed. INTERVENTIONS In stage 1, 220 patients were randomized in a 3:4 ratio to receive dextromethorphan-quinidine (n = 93) or placebo (n = 127). In stage 2, patients receiving dextromethorphan-quinidine continued; those receiving placebo were stratified by response and rerandomized in a 1:1 ratio to dextromethorphan-quinidine (n = 59) or placebo (n = 60). MAIN OUTCOMES AND MEASURES The primary end pointwas change from baseline on the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain (scale range, 0 [absence of symptoms] to 12 [symptoms occur daily and with marked severity]). RESULTS Atotal of 194 patients (88.2%) completed the study. With the sequential parallel comparison design, 152 patients received dextromethorphan-quinidine and 127 received placebo during the study. Analysis combining stages 1 (all patients) and 2 (rerandomized placebo nonresponders)showedsignificantlyreducedNPIAgitation/Aggressionscoresfordextromethorphanquinidinevsplacebo( ordinaryleastsquareszstatistic,-3.95;P < .001).Instage1,meanNPIAgitation/ Aggression scoreswere reduced from 7.1 to 3.8 with dextromethorphan-quinidine and from 7.0to 5.3withplacebo.Between-grouptreatmentdifferencesweresignificantinstage1(leastsquaresmean, -1.5; 95%CI, -2.3 to -0.7; P<.001). In stage 2, NPI Agitation/Aggression scoreswere reduced from 5.8 to 3.8 with dextromethorphan-quinidine and from 6.7 to 5.8 with placebo. Between-group treatmentdifferenceswere also significant in stage2(leastsquaresmean,-1.6;95%CI,-2.9to-0.3; P=.02).Adverseevents included falls (8.6%fordextromethorphan-quinidine vs3.9%for placebo), diarrhea (5.9%vs 3.1%respectively), and urinary tract infection (5.3%vs 3.9%respectively). Serious adverse events occurred in 7.9%with dextromethorphan-quinidine vs 4.7%with placebo. Dextromethorphan-quinidinewas not associated with cognitiveimpairment, sedation, or clinically significantQTc prolongation. CONCLUSIONS AND RELEVANCE In this preliminary 10-week phase 2 randomized clinical trial of patients with probable Alzheimer disease, combination dextromethorphan-quinidine demonstrated clinically relevant efficacy for agitation and was generally well tolerated. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01584440",antidepressant agent;benzodiazepine derivative;cholinesterase inhibitor;dextromethorphan plus quinidine;hypnotic agent;lorazepam;memantine;neuroleptic agent;nootropic agent;placebo;acute heart infarction;adult;aged;aggression;agitation;Alzheimer disease;anemia;article;bradycardia;cerebrovascular accident;Clinical Global Impression scale;cognitive defect;colon cancer;controlled study;dehydration;diarrhea;dizziness;double blind procedure;drug efficacy;drug response;drug safety;drug tolerability;drug withdrawal;falling;female;femur fracture;hematuria;human;kidney infection;major clinical study;male;Mini Mental State Examination;multicenter study;phase 2 clinical trial;priority journal;psychomotor disorder,"Cummings, J. L.;Lyketsos, C. G.;Peskind, E. R.;Porsteinsson, A. P.;Mintzer, J. E.;Scharre, D. W.;De La Gandara, J. E.;Agronin, M.;Davis, C. S.;Nguyen, U.;Shin, P.;Tariot, P. N.;Siffert, J.",2015,,,0,
923,Electrocardiogram in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy patients without any clinical evidence of coronary artery disease: a case-control study,"BACKGROUND AND PURPOSE: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited systemic arteriopathy caused by highly stereotyped mutations in NOTCH3. The clinical expression of CADASIL is confined to the central nervous system with characteristic recurrent subcortical infarcts and vascular dementia. However, cases have been reported with associated circulatory small vessel abnormalities in the retina or the myocardium and with myocardial infarction. Classical cardiovascular risk factors may influence such circulatory abnormalities. Thus, we conducted a case control study to determine the frequency of electrical abnormalities on a 12-lead resting ECG in CADASIL patients without classical atherosclerotic risk factors. METHODS: Twenty-three CADASIL patients (mean age+/-SD; 55.1+/-11 years) free of any classical cardiovascular risk factors except for hypercholesterolemia were recruited from 1 neurology department and compared with 23 sex- and age-matched healthy controls (mean age+/-SD; 54.7+/-9.5 years). A resting supine 12-lead ECG was recorded at inclusion and analyzed later by 2 reviewers. Signs of myocardial infarction or ischemia, conduction, and rhythm disturbances were looked for. RESULTS: We found no ECG sign evoking myocardial infarction or myocardial ischemia. CADASIL patients had, compared with healthy controls, a significantly higher heart rate and a significantly lower Sokolow index, but these values remained in the normal ranges. CONCLUSIONS: In this case-control study, we found no ECG evidence for myocardial infarction or ischemia, conduction disturbances, or arrhythmias in CADASIL patients compared with healthy controls.","Adult;Animals;Arrhythmias, Cardiac/complications/diagnosis;CADASIL/*complications;Case-Control Studies;*Electrocardiography;Female;Heart Conduction System/physiopathology;Heart Diseases/*complications/*diagnosis/physiopathology;Heart Rate;Humans;Hypercholesterolemia/complications;Male;Medical Records;Middle Aged;Myocardial Infarction/complications/diagnosis;Myocardial Ischemia/complications/diagnosis;Risk Factors","Cumurciuc, R.;Henry, P.;Gobron, C.;Vicaut, E.;Bousser, M. G.;Chabriat, H.;Vahedi, K.",2006,Apr,10.1161/01.str.0000209242.68844.20,0,
924,Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group,"OBJECTIVE: To assess the effect of low-dose, diuretic-based antihypertensive treatment on major cardiovascular disease (CVD) event rates in older, non-insulin-treated diabetic patients with isolated systolic hypertension (ISH), compared with nondiabetic patients. DESIGN: Double-blind, randomized, placebo-controlled trial: the Systolic Hypertension in the Elderly Program (SHEP). SETTING: Multiple clinical and support centers in the United States. PARTICIPANTS: A total of 4736 men and women aged 60 years and older at baseline with ISH (systolic blood pressure [BP], > or = 160 mm Hg; diastolic BP, <90 mm Hg) at baseline, 583 non-insulin-dependent diabetic patients and 4149 nondiabetic patients (4 additional patients not so classifiable were randomized but not included in these analyses). Diabetes mellitus defined as physician diagnosis, taking oral hypoglycemic drugs, fasting glucose level of 7.8 mmol/L or more (> or = 140 mg/dL), or any combination of these characteristics. INTERVENTION: The active treatment group received a low dose of chlorthalidone (12.5-25.0 mg/d) with a step-up to atenolol (25.0-50.0 mg/d) or reserpine (0.05-0.10 mg/d) if needed. The placebo group received placebo and any active antihypertensive drugs prescribed by patient's private physician for persistently high BP. MAIN OUTCOME MEASURES: The 5-year rates of major CVD events, nonfatal plus fatal stroke, nonfatal myocardial infarction (MI) and fatal coronary heart disease (CHD), major CHD events, and all-cause mortality. RESULTS: The SHEP antihypertensive drug regimen lowered BP of both diabetic and nondiabetic patients, with few adverse effects. For both diabetic and nondiabetic patients, all outcome rates were lower for participants randomized to the active treatment group than for those randomized to the placebo group. Thus, 5-year major CVD rate was lower by 34% for active treatment compared with placebo, both for diabetic patients (95% confidence interval [CI], 6%-54%) and nondiabetic patients (95% CI, 21%-45%). Absolute risk reduction with active treatment compared with placebo was twice as great for diabetic vs nondiabetic patients (101/1000 vs 51/1000 randomized participants at the 5-year follow-up), reflecting the higher risk of diabetic patients. CONCLUSION: Low-dose diuretic-based (chlorthalidone) treatment is effective in preventing major CVD events, cerebral and cardiac, in both non-insulin-treated diabetic and nondiabetic older patients with ISH.","Adrenergic beta-Antagonists/therapeutic use;Aged;Antihypertensive Agents/*therapeutic use;Atenolol/therapeutic use;Cardiovascular Diseases/epidemiology/*prevention & control;Chlorthalidone/*therapeutic use;Dementia;Depression;Diabetes Mellitus, Type 2/*complications;Diuretics/*therapeutic use;Double-Blind Method;Female;Follow-Up Studies;Humans;Hypertension/*complications/*drug therapy;Male;Middle Aged;Proportional Hazards Models;Risk","Curb, J. D.;Pressel, S. L.;Cutler, J. A.;Savage, P. J.;Applegate, W. B.;Black, H.;Camel, G.;Davis, B. R.;Frost, P. H.;Gonzalez, N.;Guthrie, G.;Oberman, A.;Rutan, G. H.;Stamler, J.",1996,Dec 18,,0,
925,Vascular risk as a predictor of cognitive decline in a cohort of elderly patients with mild to moderate dementia,"BACKGROUND/AIMS: The purpose of our study was to evaluate vascular risk factors and other clinical variables as predictors of cognitive and functional decline in elderly patients with mild to moderate dementia. METHODS: The clinical characteristics of 82 elderly patients (mean age 79.0 +/- 5.9 years; 67.1% females) with mild to moderate dementia were obtained at baseline, including years of education, Framingham Coronary Heart Disease Risk score, Hachinski Ischemic Score (HIS), Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE) score, Functional Activities Questionnaire (FAQ) score, Burden Interview Scale score, and Neuropsychiatric Inventory (NPI) score. Changes in MMSE and FAQ scores over time were assessed annually. The association between baseline clinical variables and cognitive and functional decline was investigated during 3 years of follow-up through the use of generalized linear mixed effects models. RESULTS: A trend was found towards steeper cognitive decline in patients with less vascular burden according to the HIS (beta = 0.056, p = 0.09), better cognitive performance according to the CDR score (beta = 0.313, p = 0.06) and worse caregiver burden according to the Burden Interview Scale score (beta = -0.012, p = 0.07) at baseline. CONCLUSION: Further studies with larger samples are necessary to confirm and expand our findings.",Aging;Aging and cognition;Alzheimer's disease;Dementia;Prognosis,"Curiati, P. K.;Magaldi, R. M.;Suemoto, C. K.;Bottino, C. M.;Nitrini, R.;Farfel, J. M.;Jacob-Filho, W.",2014,Sep,10.1159/000368190,0,
926,Brain structural variability due to aging and gender in cognitively healthy elders: Results from the São Paulo ageing and health study,"BACKGROUND AND PURPOSE: Several morphometric MR imaging studies have investigated age- and sex-related cerebral volume changes in healthy human brains, most often by using samples spanning several decades of life and linear correlation methods. This study aimed to map the normal pattern of regional age-related volumetric reductions specifically in the elderly population. MATERIALS AND METHODS: One hundred thirty-two eligible individuals (67-75 years of age) were selected from a community-based sample recruited for the São Paulo Ageing and Health (SPAH) study, and a cross-sectional MR imaging investigation was performed concurrently with the second SPAH wave. We used voxel-based morphometry (VBM) to conduct a voxelwise search for significant linear correlations between gray matter (GM) volumes and age. In addition, region-of-interest masks were used to investigate whether the relationship between regional GM (rGM) volumes and age would be best predicted by a nonlinear model. RESULTS: VBM and region-of-interest analyses revealed selective foci of accelerated rGM loss exclusively in men, involving the temporal neocortex, prefrontal cortex, and medial temporal region. The only structure in which GM volumetric changes were best predicted by a nonlinear model was the left parahippocampal gyrus. CONCLUSIONS: The variable patterns of age-related GM loss across separate neocortical and temporolimbic regions highlight the complexity of degenerative processes that affect the healthy human brain across the life span. The detection of age-related limbic GM decrease in men supports the view that atrophy in such regions should be seen as compatible with normal aging.",aged;aging;amygdaloid nucleus;article;brain;brain atrophy;brain size;Brazil;cardiovascular risk;community sample;cross-sectional study;dementia;female;gray matter;Hamilton Depression Rating Scale;human;imaging system;ischemic heart disease;lifespan;limbic system;major clinical study;male;mental disease;morphometrics;multiple regression;neocortex;neuroimaging;nuclear magnetic resonance imaging;population research;prefrontal cortex;sex difference;subiculum;temporal lobe;Signa LX CVi scanner,"Curiati, P. K.;Tamashiro, J. H.;Squarzoni, P.;Duran, F. L. S.;Santos, L. C.;Wajngarten, M.;Leite, C. C.;Vallada, H.;Menezes, P. R.;Scazufca, M.;Busatto, G. F.;Alves, T. C. T. F.",2009,,,0,
927,"Early and long-term outcomes of heart failure in elderly persons, 2001-2005","Background: The treatment of chronic heart failure has improved during the past 2 decades, but little is known about whether the improvements are reflected in trends in early and long-term mortality and hospital readmission. Methods: In a retrospective cohort study of 2 540 838 elderly Medicare beneficiaries hospitalized with heart failure between January 1, 2001, and December 31, 2005, we examined early and long-term all-cause mortality and hospital readmission and patient- and hospital-level predictors of these outcomes. Results: Unadjusted in-hospital mortality declined from 5.1% to 4.2% during the study (P<.001), but 30-day, 180-day, and 1-year all-cause mortality remained fairly constant at 11%, 26%, and 37%, respectively. Nearly 1 in 4 patients were readmitted within 30 days of the index hospitalization, and two-thirds were readmitted within 1 year. Controlling for patient- and hospital-level covariates, the hazard of all-cause mortality at 1 year was slightly lower in 2005 than in 2001 (hazard ratio, 0.98; 95% confidence interval, 0.97-0.99). The hazard of readmission did not decline significantly from 2001 to 2005 (hazard ratio, 0.99; 95% confidence interval, 0.98-1.00). Conclusions: Early and long-term all-cause mortality and hospital readmission rates remain high and have improved little with time. The need to identify optimal management strategies for these clinically complex patients is urgent. ©2008 American Medical Association. All rights reserved.",acute heart infarction;aged;article;atherosclerosis;cardiovascular disease;cardiovascular risk;chronic liver disease;chronic obstructive lung disease;cohort analysis;comorbidity;dementia;deterioration;diabetes mellitus;female;heart arrhythmia;heart failure;hemiplegia;hospital readmission;hospitalization;human;hypertension;ischemic heart disease;kidney failure;long term care;major clinical study;male;medicare;mental disease;metastasis;mortality;outcome assessment;paraplegia;patient care;peripheral vascular disease;pneumonia;priority journal;protein calorie malnutrition;rheumatic heart disease;cerebrovascular accident;unstable angina pectoris,"Curtis, L. H.;Greiner, M. A.;Hammill, B. G.;Kramer, J. M.;Whellan, D. J.;Schulman, K. A.;Hernandez, A. F.",2008,,,0,
928,Treatment patterns for neovascular age-related macular degeneration: Analysis of 284 380 medicare beneficiaries,"Purpose: To examine trends in the treatment of newly diagnosed neovascular age-related macular degeneration (AMD). Design: Retrospective cohort study. Methods: Among 284 380 Medicare beneficiaries with a new diagnosis between 2006 and 2008, we used the cumulative incidence function to estimate procedure rates and the mean frequency function to estimate the cumulative mean number of intravitreous injections. We used Cox log-binomial regression to estimate predictors of the use of vascular endothelial growth factor (VEGF) antagonists within 1 year after diagnosis. Discontinuation of anti-VEGF therapy was defined by absence of treatment for 12 months. Discontinuation rates were calculated using the Kaplan-Meier method. Results: The proportion of patients receiving anti-VEGF therapy increased from 60.3% to 72.7%, photodynamic therapy decreased from 12.8% to 5.3%, and thermal laser treatment decreased from 5.5% to 3.2%. Black patients (hazard ratio, 0.77; 95% confidence interval, 0.75-0.79) and patients of other/unknown race (0.83; 0.81-0.84) were less likely than white patients to receive anti-VEGF therapy. Patients with dementia were less likely to receive anti-VEGF therapy (0.88; 0.88-0.89). Among patients who received anti-VEGF therapy, the mean number of injections within 1 year of the first injection was 4.3 per treated eye. Anti-VEGF therapy was discontinued in 53.6% of eyes within 1 year, and in 61.7% of eyes within 18 months. Conclusions: Treatment of new neovascular AMD changed significantly between 2006 and 2008, most notably in the increasing use of anti-VEGF therapies. However, few patients treated with anti-VEGF medications received monthly injections, and discontinuation rates were high. © 2012 Elsevier Inc. All rights reserved.",bevacizumab;pegaptanib;ranibizumab;acute heart infarction;African American;aged;article;cataract;chronic kidney disease;chronic obstructive lung disease;cohort analysis;dementia;diabetes mellitus;drug use;European American;female;fluorescence angiography;glaucoma;atrial fibrillation;heart failure;human;ischemic heart disease;low level laser therapy;major clinical study;male;medicare;neoplasm;optical coherence tomography;photodynamic therapy;prediction;priority journal;race;age related macular degeneration;retrospective study;cerebrovascular accident;transient ischemic attack;treatment withdrawal;trend study;avastin;lucentis;macugen,"Curtis, L. H.;Hammill, B. G.;Qualls, L. G.;Dimartino, L. D.;Wang, F.;Schulman, K. A.;Cousins, S. W.",2012,,,0,
929,Research on family caregivers: understanding levels of burden and how to provide assistance,This article focuses on issues and research related to informal caregivers. The first 2 profiled studies looked at caregiver burden with 1 study conducted in the United States and the other in Thailand. Caregiver burden refers to the physical and emotional risks facing caregivers who are taking care of a relative or friend. Both found that the level of caregiver burden was related more to caregiver perception and attitude than to patient disease or other patient characteristic. Other important findings can be found in the summaries in this research brief. The third article profiles an investigation that was part of the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) initiative. Amanda Elliott and colleagues provide evidence of an intervention that was successful in improving caregiver health. The fourth write-up summarizes an important meta-analysis recently published on evaluating the effectiveness of family caregiver interventions on reducing behavioral and psychological symptoms in people with dementia and reducing caregiver negative reactions to these symptoms. Interested readers are encouraged to read the original articles for more details.,adaptive behavior;Alzheimer disease;behavior;caregiver;chronic disease;chronic obstructive lung disease;dementia;etiology;family health;female;frail elderly;heart failure;human;male;mental stress;neoplasm;nursing;psychology;psychotherapy;statistics and numerical data,"Cutrino, A.;Santamaria, J.",2013,,,0,
930,Hormone replacement therapy and the risk of breast cancer,"Hormone replacement therapy (HRT) has had a chequered history ever since its initial use to manage menopausal symptoms. It is clear that it has many other effects and here we review its impact on the risk of breast cancer. A clear risk is seen for current uses of combined oestrogen/progestagen pills, but this returns to normal shortly after treatment cessation. The role of oestrogen only replacement therapy is less clear, but most studies find a weaker, but still positive, association in current users. Recent sharp reductions in HRT use have been correlated with declines in breast cancer incidence in the USA, but not so clearly elsewhere. © 2008 Elsevier Ltd. All rights reserved.",calcium;conjugated estrogen;estrogen;gestagen;medroxyprogesterone acetate;tibolone;vitamin D;article;breast cancer;cancer risk;colorectal cancer;dementia;endometrium cancer;hip fracture;hormone substitution;human;ischemic heart disease;lung embolism;menopausal syndrome;pill;priority journal;cerebrovascular accident;United States,"Cuzick, J.",2008,,,0,
931,Vascular risk factors in demented elderly: analysis of Alzheimer Clinic materials,"In recent years evidence is increasing that vascular disease is associated with cognitive impairment and dementia. Moreover, presence of cerebrovascular disease may intensify the clinical symptoms of Alzheimer's disease (AD). The aim of the study was to determine the prevalence of vascular risk factors in age and sex matched patients with dementia. We studied 109 patients with AD and 37 patients vascular dementia (VD). DSM-III-R test for dementia, NINCDS-ADRDA guidelines for AD and NINDS-ARIEN for VD were applied. RESULTS: Mean age of dementia onset in AD and VD was 65.8 SD 7.8 and 67.4 SD 7.0 years (p > 0.05), the duration of dementia, MMS and GDS for patients with AD and VD was not significantly different. Arterial hypertension was associated in 51.3% VD and 30.3% AD (p < 0.05), hypotension in 11.1 and 23.6% respectively (p > 0.05), atrial fibrillation was similar in AD and VD, coronary artery disease was presents 64.8% AD and 46.8 VD (p > 0.05) and type 2 diabetes in 21.6% and 10.1% (p > 0.05) respectively. No significant differences in serum lipid profile were found in both groups, except two times higher incidence of normal HDL-cholesterol concentration in AD compare to VD. The relation between alcohol consumption, cigarette smoking and head trauma was similar in both types of dementia. CONCLUSION: Vascular disease and AD have to some extent a shared aetiology, and risk factors that they have in common increase the risk of both disorders independently and vascular disease is perhaps involved in the aetiology of AD.","Adult;Aged;Aged, 80 and over;Alzheimer Disease/epidemiology/*etiology/psychology;Arrhythmias, Cardiac/complications/diagnosis/epidemiology;Atrial Fibrillation/complications/diagnosis/epidemiology;Cerebrovascular Disorders/*complications/diagnosis/epidemiology;Cholesterol/blood;Coronary Artery Disease/*complications/diagnosis/epidemiology;Dementia, Vascular/epidemiology/*etiology/psychology;Depressive Disorder, Major/epidemiology/etiology;Diabetes Mellitus, Type 2/complications;Female;Humans;Hypertension/complications/diagnosis;Hypotension/complications/diagnosis;Male;Middle Aged;Risk Factors","Czyzewski, K.;Pfeffer, A.;Wasiak, B.;Luczywek, E.;Golebiowski, M.;Styczynska, M.;Barcikowska, M.",2001,Mar-Apr,,0,
932,Retrospective study on agitation provoked by memantine in dementia,"The authors retrospectively reviewed the clinical records of 196 patients with dementia treated with memantine for at least 6 months. Eleven (5.6%) developed treatment-induced agitation. At chi-square analysis, they were significantly more likely to have a history of similar side effects from other medications acting on the central nervous system in comparison with the group without agitation, suggesting neurochemical susceptibility. A trend toward a significantly greater prevalence was also present for ischemic cardiopathy and neuroimaging evidence of chronic small vessel disease. Ischemic brain and heart disease might contribute through anatomical and functional alterations within the glutamatergic system.",memantine;aged;agitation;anesthesia complication;article;asthenia;behavior disorder;chronic cough;clinical feature;confusion;constipation;controlled study;corticobasal degeneration;delusion;dementia;diffuse Lewy body disease;dizziness;drug dose increase;drug dose titration;drug withdrawal;female;follow up;frontotemporal dementia;human;hypertension;ischemic heart disease;major clinical study;malaise;male;mental disease;Mini Mental State Examination;multiinfarct dementia;neuroimaging;prevalence;priority journal;retrospective study;treatment duration;visual hallucination,"Da Re, F.;Rucci, F.;Isella, V.",2015,,,0,
933,Prevalence of different comorbidities in COPD patients by gender and GOLD stage,"BACKGROUND: Several comorbidities frequently affect COPD progression. Aim of the study was to assess the prevalence of main comorbidities by gender and disease severity in a cohort of COPD patients referring for the first time to a specialist institution. METHODS: The study was a non-interventional, cross-sectional investigation carried out via automatic and anonymous selection from the institutional data base over the period 2012-2015. Inclusion criteria were: subjects of both sex aged >/=40 years; diagnosis of COPD according to GOLD guidelines 2014; the availability of a complete clinical record file. Variables collected were: lung function; smoking history; BMI; the Charlson Comorbidity Index (CCI); number and kind of comorbidities for each patient. RESULTS: At least one comorbidity of clinical relevance was found in 78.6 % of patients, but at least two in 68.8 %, and three or more were found in 47.9 % of subjects. Mean CCI was 3.4 +/- 1.6sd. The overall prevalence was 2.6 comorbidities per patient, but 2.5 in males, and 3.0 in females, respectively (p < 0.05). Cardio-vascular disorders were the most frequent, but significantly more frequent in males (44.7 vs 30.7 %, respectively), while the metabolic, the digestive and the osteo-articular disorders were prevailing in females (12.4 vs 9.2; 14.2 vs 4.8, and 6.0 vs 3.8, respectively). In particular, chronic cor pumonale and arrhythmias mainly prevailed in men and congestive heart failure in females, while arterial hypertension resulted equally distributed. As concerning respiratory disorders, pneumonia, pleural effusions and chronic respiratory failure were more frequently found in men, while bronchiectasis and asthma-COPD overlap syndrome (ACOS) in females. Anaemia, gall bladder stones, osteoporosis and spontaneous fractures mostly prevailed in females, while gastric disorders of inflammatory origin and arthrosis were more frequent in males. Cognition disorders, dementia and signs of degenerative brain disorders were more frequently found in men, while depression in females. Finally, lung cancer was at the first place in men, but at the second in females. CONCLUSIONS: All comorbidities increased their prevalence progressively up to the last stage of COPD severity, except the cardio-vascular and the metabolic ones which dropped in the IV GOLD stage, presumably due to the high mortality rate in this severe COPD stage. The gender-dependency of comorbidities was confirmed in general terms, even if lung cancer proved a dramatic increase almost independently of sex.",Copd;Comorbidities;GOLD severity;Gender,"Dal Negro, R. W.;Bonadiman, L.;Turco, P.",2015,,10.1186/s40248-015-0023-2,0,
934,Effect of Long-Term Vascular Care on Progression of Cerebrovascular Lesions,"Background and Purpose - This study aimed to evaluate the effect of a nurse-led multidomain cardiovascular intervention on white matter hyperintensity (WMH) progression and incident lacunar infarcts in community-dwelling elderly with hypertension. Methods - The preDIVA trial (Prevention of Dementia by Intensive Vascular Care) was an open-label, cluster-randomized controlled trial in community-dwelling individuals aged 70 to 78 years. General practices were assigned by computer-generated randomization to 6-year nurse-led, multidomain intensive vascular care or standard care. Of 3526 preDIVA participants, 195 nondemented participants with a systolic blood pressure >=140 mm Hg were consecutively recruited to undergo magnetic resonance imaging at 2 to 3 and 5 to 6 years after baseline. WMH volumes were measured automatically, lacunar infarcts assessed visually, blinded to treatment allocation. Results - One hundred and twenty-six participants were available for longitudinal analysis (64 intervention and 62 control). Annual WMH volume increase in milliliter was similar for intervention (mean=0.73, SD=0.84) and control (mean=0.70, SD=0.59) participants (adjusted mean difference, -0.08 mL; 95% confidence interval, -0.30 to 0.15; P=0.50). Analyses suggested greater intervention effects with increasing baseline WMH volumes (P for interaction=0.03). New lacunar infarcts developed in 6 (9%) intervention and 2 (3%) control participants (odds ratio, 2.2; 95% confidence interval, 0.4-12.1; P=0.36). Conclusions - Nurse-led vascular care in hypertensive community-dwelling older persons did not diminish WMH accumulation over 3 years. However, our results do suggest this type of intervention could be effective in persons with high WMH volumes. There was no effect on lacunar infarcts incidence but numbers were low. Copyright © 2017 American Heart Association, Inc.",aged;article;cerebrovascular disease;controlled study;dementia;disease course;female;human;hypertension;lacunar stroke;longitudinal study;major clinical study;male;neuroimaging;neurologic disease assessment;nuclear magnetic resonance imaging;priority journal;randomization;randomized controlled trial;systolic blood pressure;white matter;white matter lesion,"Dalen, Jw;Moll, Van Charante Ep;Caan, Mwa;Scheltens, P;Majoie, Cblm;Nederveen, Aj;Gool, Wa;Richard, E",2017,,10.1161/STROKEAHA.117.017207,0,
935,Novel (ovario) leukodystrophy related to AARS2 mutations,"Objectives: The study was focused on leukoencephalopathies of unknown cause in order to define a novel, homogeneous phenotype suggestive of a common genetic defect, based on clinical and MRI findings, and to identify the causal genetic defect shared by patients with this phenotype. Methods: Independent next-generation exome-sequencing studies were performed in 2 unrelated patients with a leukoencephalopathy. MRI findings in these patients were compared with available MRIs in a database of unclassified leukoencephalopathies; 11 patients with similar MRI abnormalities were selected. Clinical and MRI findings were investigated. Results: Next-generation sequencing revealed compound heterozygous mutations in AARS2 encoding mitochondrial alanyl-tRNA synthetase in both patients. Functional studies in yeast confirmed the pathogenicity of the mutations in one patient. Sanger sequencing revealed AARS2 mutations in 4 of the 11 selected patients. The 6 patients with AARS2 mutations had childhoodto adulthood-onset signs of neurologic deterioration consisting of ataxia, spasticity, and cognitive decline with features of frontal lobe dysfunction. MRIs showed a leukoencephalopathy with striking involvement of left-right connections, descending tracts, and cerebellar atrophy. All female patients had ovarian failure. None of the patients had signs of a cardiomyopathy. Conclusions: Mutations in AARS2 have been found in a severe form of infantile cardiomyopathy in 2 families. We present 6 patients with a new phenotype caused by AARS2 mutations, characterized by leukoencephalopathy and, in female patients, ovarian failure, indicating that the phenotypic spectrum associated with AARS2 variants is much wider than previously reported. © 2014 American Academy of Neurology.",alanine transfer RNA ligase;alanyl trna synthetase 2;genomic DNA;mitochondrial DNA;unclassified drug;adolescent;adult;article;ataxia;cerebellum atrophy;clinical article;controlled study;female;frontal lobe;gene mutation;gene sequence;heterozygote;human;human tissue;leukodystrophy;leukoencephalopathy;male;mental deterioration;middle aged;missense mutation;muscle biopsy;mutation;neuroimaging;nuclear magnetic resonance imaging;nucleotide sequence;ovary insufficiency;oxidative phosphorylation;pathogenicity;priority journal;single nucleotide polymorphism;spasticity,"Dallabona, C.;Diodato, D.;Kevelam, S. H.;Haack, T. B.;Wong, L. J.;Salomons, G. S.;Baruffini, E.;Melchionda, L.;Mariotti, C.;Strom, T. M.;Meitinger, T.;Prokisch, H.;Chapman, K.;Colley, A.;Rocha, H.;Ounap, K.;Schiffmann, R.;Salsano, E.;Savoiardo, M.;Hamilton, E. M.;Abbink, T. E. M.;Wolf, N. I.;Ferrero, I.;Lamperti, C.;Zeviani, M.;Vanderver, A.;Ghezzi, D.;Van Der Knaap, M. S.",2014,,,0,
936,2012 updated beers criteria: Greater applicability to Europe?,,acetylsalicylic acid;antihistaminic agent;benzodiazepine;calcium channel blocking agent;cholinergic receptor blocking agent;fluoxetine;laxative;opiate;proton pump inhibitor;sulfonylurea;warfarin;cardiovascular disease;constipation;delirium;dementia;Europe;evidence based medicine;falling;fracture;frail elderly;heart failure;human;inappropriate prescribing;letter;medical literature;medical research;medical society;prescription;primary prevention,"Dalleur, O.;Boland, B.;Spinewine, A.",2012,,,0,
937,Depressive symptoms and associated factors in an older Spanish population positively screened for disability,"Objectives To measure the prevalence of depressive symptoms and its association with a comprehensive set of variables and to study the potential modifying effects of sex and age. Methods In a cross-sectional study, subjects who tested positive to the 12-item World Health Organization disability screening tool were selected from a probabilistic sample of persons aged 65 years or older in a rural area of Spain. Measurements included EURO-D depression scale, socio-demographics, habits, anthropometrics, medical history, cognition, disability, functional dependence, self-rated health and pain. Logistic regression models were used to obtain adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for the association between depression and variables. The modifying effects of age and sex were assessed. Results Prevalence (95% CI) of current depressive symptoms among the 438 participants was 35.8% (31.3-40.3%). Depressive symptomatology was higher among women (aOR = 2.98). An inverse association was observed with alcohol (aORs of 0.52 and 0.27 for consumption of 1-2 and >2 standard units/day, respectively, versus abstainers). Depressive symptomatology was associated with heart failure (aOR = 4.24), urinary incontinence (aOR = 2.68), ischemic heart disease (aOR = 1.87), poor self-rated health and pain. Sex and age modified the effect of several variables. Conclusion Prevalence of depressive symptoms, albeit high, was less than expected. The consistently strong negative association between depressive symptoms and alcohol consumption warrants further in-depth research. Awareness of effect modification by key variables, such as sex and age, may enable the probability of suffering depression to be more accurately assessed, with a view to performing a potential diagnostic work-up. Copyright © 2012 John Wiley & Sons, Ltd.",aged;alcohol consumption;article;body mass;chronic liver disease;cognitive defect;cross-sectional study;dementia;depression;disability;disease association;female;heart failure;human;ischemic heart disease;major clinical study;male;medical history;prevalence;rural area;urine incontinence,"Damian, J.;De Pedro-Cuesta, J.;Almazán, J.;Comín-Comín, M.;Quintanilla, M. A.;Lobo, A.",2013,,,0,
938,Weight loss and coronary heart disease: Sensitivity analysis for unmeasured confounding by undiagnosed disease,"Background: Evidence for the effect of weight loss on coronary heart disease (CHD) or mortality has been mixed. The effect estimates can be confounded due to undiagnosed diseases that may affect weight loss. Methods: We used data from the Nurses' Health Study to estimate the 26-year risk of CHD under several hypothetical weight loss strategies. We applied the parametric g-formula and implemented a novel sensitivity analysis for unmeasured confounding due to undiagnosed disease by imposing a lag time for the effect of weight loss on chronic disease. Several sensitivity analyses were conducted. Results: The estimated 26-year risk of CHD did not change under weight loss strategies using lag times from 0 to 18 years. For a 6-year lag time, the risk ratios of CHD for weight loss compared with no weight loss ranged from 1.00 (0.99, 1.02) to 1.02 (0.99, 1.05) for different degrees of weight loss with and without restricting the weight loss strategy to participants with no major chronic disease. Similarly, no protective effect of weight loss was estimated for mortality risk. In contrast, we estimated a protective effect of weight loss on risk of type 2 diabetes. Conclusion: We estimated that maintaining or losing weight after becoming overweight or obese does not reduce the risk of CHD or death in this cohort of middle-age US women. Unmeasured confounding, measurement error, and model misspecification are possible explanations but these did not prevent us from estimating a beneficial effect of weight loss on diabetes.",acetylsalicylic acid;hydroxymethylglutaryl coenzyme A reductase inhibitor;multivitamin;adult;alcohol consumption;Alzheimer disease;amyotrophic lateral sclerosis;angina pectoris;article;atrial fibrillation;cardiovascular risk;cerebrovascular accident;chronic disease;chronic kidney disease;depression;diabetes mellitus;emphysema;exercise;female;follow up;gout;heart failure;heart infarction;human;ischemic heart disease;lung embolism;major clinical study;male;multiple sclerosis;neoplasm;non insulin dependent diabetes mellitus;Parkinson disease;peripheral vascular disease;priority journal;rheumatoid arthritis;smoking;systemic lupus erythematosus;ulcerative colitis;weight reduction,"Danaei, G.;Robins, J. M.;Young, J. G.;Hu, F. B.;Manson, J. E.;Hernán, M. A.",2016,,,0,
939,Antibiotic use in long-term care facilities,"Objectives: Evaluation and optimization of antibiotic use (antibiotic stewardship) is being increasingly promoted as a means to reduce antibiotic resistance, adverse events, treatment complications and costs within institutions. Our goal was to examine the prevalence of antibiotic use among long-term care facility residents and the extent of variability across these institutions. Methods: We conducted a population-based, point-prevalence study of antibiotic use among elderly individuals (n=37371) residing in long-term care facilities (n=363 institutions) in Ontario between April and June 2009, using linked healthcare databases from Canada's largest province. Facilities were grouped into quintiles according to their mean antibiotic dispensing rates and variation was compared across quintiles. Results: There were 2190 (5.9%) long-term care residents receiving antibiotic prescriptions on the study date. The three most prevalent antibiotics were agents most commonly used for the treatment of urinary tract infections, including nitrofurantoin (365, 15.4%), trimethoprim/sulfamethoxazole (338, 14.3%) and ciprofloxacin (304, 12.8%). The majority of treatment courses were at least 10 days in duration (1482, 62.6%), and many exceeded 90 days (495, 20.9%), suggesting chronic prophylaxis. There was substantial variability in antibiotic use across facilities, with a 5-fold variation from the highest-use quintile (10.8%) to the lowest-use quintile (2.2%). This variation persisted after adjustment for multiple facility-level and resident-level factors, including demographic characteristics, healthcare utilization statistics, co-morbidity prevalence, functional status and device dependence. Conclusions: Antibiotic use is common among long-term care residents, variable across institutions, and may benefit from focused antimicrobial stewardship interventions to standardize treatment indications and duration. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.",amoxicillin;ampicillin;azithromycin;cefaclor;cefalexin;cefixime;cefprozil;ceftriaxone;cefuroxime;cephalosporin derivative;ciprofloxacin;clarithromycin;clindamycin;cloxacillin;cotrimoxazole;erythromycin;levofloxacin;lincosamide;macrolide;metronidazole;moxifloxacin;nitrofurantoin;norfloxacin;penicillin derivative;penicillin G;quinoline derived antiinfective agent;sulfonamide;tetracycline;tetracycline derivative;vancomycin;aged;antibiotic therapy;article;coronary artery atherosclerosis;Canada;chronic obstructive lung disease;comorbidity;congestive heart failure;dementia;diabetes mellitus;drug use;elderly care;female;functional status;health care facility;health care utilization;human;infection prevention;kidney disease;liver disease;long term care;major clinical study;male;medical device;paralysis;Parkinson disease;peripheral vascular disease;population research;prescription;cerebrovascular accident;treatment duration;urinary tract infection,"Daneman, N.;Gruneir, A.;Newman, A.;Fischer, H. D.;Bronskill, S. E.;Rochon, P. A.;Anderson, G. M.;Bell, C. M.",2011,,,0,
940,Lipoprotein (a) and plasminogen in atherosclerosis,"The aim of this study was to evaluate plasma levels of lipoprotein (a) [LP(a)] and plasminogen in patients affected with atherosclerotic disease and to understand the mutual relationships. Eighty-four patients affected with atherosclerosis were examined and divided as follows: group I, 24 patients with peripheral arteriopathy; group II, 40 patients with ischemic heart disease (myocardial infarction and/or angina pectoris); group III, 20 patients with multi-infarct dementia; group IV (control group) with 20 healthy young subjects. The results show that Lp(a) plasma levels, in atherosclerotic patients, are higher than 30 mg/dl, while the plasminogen levels are lower than 80 mg/dl. There is an inverse correlation between these two data. Moreover, a different behaviour of Lp(a) and plasminogen rate related to age of patients, to number of atherosclerotic lesions or to acuteness of ischemic heart disease, was observed.","Age Factors;Aged;Aged, 80 and over;Angina Pectoris/blood;Arterial Occlusive Diseases/blood;Arteriosclerosis/*blood;Colorimetry;Coronary Disease/blood;Data Interpretation, Statistical;Dementia, Multi-Infarct/blood;Humans;Immunoenzyme Techniques;Lipoprotein(a)/*blood;Middle Aged;Myocardial Infarction/blood;Plasminogen/*analysis","Danese, C.;Borgia, M. C.;Ferranti, E.;Zavattaro, E.;Epiceno, A. N.;Marciano, F.",1996,Nov,,0,
941,Identifying potential differences in cause-of-death coding practices across Russian regions,"Background: Reliable and comparable data on causes of death are crucial for public health analysis, but the usefulness of these data can be markedly diminished when the approach to coding is not standardized across territories and/or over time. Because the Russian system of producing information on causes of death is highly decentralized, there may be discrepancies in the coding practices employed across the country. In this study, we evaluate the uniformity of cause-of-death coding practices across Russian regions using an indirect method. Methods: Based on 2002-2012 mortality data, we estimate the prevalence of the major causes of death (70 causes) in the mortality structures of 52 Russian regions. For each region-cause combination we measured the degree to which the share of a certain cause in the mortality structure of a certain region deviates from the respective inter-regional average share. We use heat map visualization and a regression model to determine whether there is regularity in the causes and the regions that is more likely to deviate from the average level across all regions. In addition to analyzing the comparability of cause-specific mortality structures in a spatial dimension, we examine the regional cause-of-death time series to identify the causes with temporal trends that vary greatly across regions. Results: A high level of consistency was found both across regions and over time for transport accidents, most of the neoplasms, congenital malformations, and perinatal conditions. However, a high degree of inconsistency was found for mental and behavioral disorders, diseases of the nervous system, endocrine disorders, ill-defined causes of death, and certain cardiovascular diseases. This finding suggests that the coding practices for these causes of death are not uniform across regions. The level of consistency improves when causes of death can be grouped into broader diagnostic categories. Conclusion: This systematic analysis allows us to present a broader picture of the quality of cause-of-death coding at the regional level. For some causes of death, there is a high degree of variance across regions in the likelihood that these causes will be chosen as the underlying causes. In addition, for some causes of death the mortality statistics reflect the coding practices, rather than the real epidemiological situation.",accident;acquired immune deficiency syndrome;alcohol liver disease;article;atherosclerosis;behavior disorder;brain hemorrhage;cause of death;chronic obstructive lung disease;coding;controlled study;cor pulmonale;heart infarction;human;hypertension;ICD-10;mental disease;mortality;prevalence;priority journal;scoring system;senility;stomach cancer,"Danilova, I.;Shkolnikov, V. M.;Jdanov, D. A.;Meslé, F.;Vallin, J.",2016,,,0,
942,Paraoxonase 1 192/55 gene polymorphisms in Alzheimer's disease,"An esterase, paraoxonase 1 (PON1), protects against organophosphate neurotoxicity and decreases lipoprotein oxidation. Two polymorphisms of PON1 [192 (R or Q) and 55 (M or L)] exist and are associated with coronary artery disease. We have previously shown that serum PON1 activity (PON1a) is lower in vascular dementia (VaD) than in Alzheimer's disease (AD), suggesting that PON1a may distinguish VaD from AD. As PON1 polymorphism modifies PON1a, we determined 192 and 55 PON1 polymorphisms by sequence-specific primer PCR in 64 healthy subjects (HS; mean age: 79.5 +/- 6.3 years; 38 women) and in 72 patients (mean age: 80.2 +/- 6.8 years; 51 women) undergoing cognitive evaluations. According to DSM-IV/NINCDS/ADRDA/NINDS/AIREN criteria, 45 patients (mean age: 80.0 +/- 7.2 years, 34 women) had AD and 27 patients (mean age: 79.8 +/- 6.6 years, 16 women) had VaD. We also measured serum PON1a by spectrophotometry. No significant differences in phenotype distributions among the three study groups were detected by chi(2) test. Among the variables, age, sex, and phenotypes 192 and 55, logistic regression selected only polymorphism 192, but not 55, as a discriminating factor between AD and VaD (p < 0.05). Substitution of serum PON1a for genotype yielded a similar result. PON1 polymorphism 192 appears to be a reliable marker to distinguish patients with AD from patients with VaD and from healthy subjects. Changes in 192 polymorphism distributions in AD and in VaD may at least partially explain the significant difference in PON1a in these two types of dementia.","Aged;Aged, 80 and over;Alzheimer Disease/enzymology/*genetics;Aryldialkylphosphatase;Base Sequence;DNA Primers;Esterases/blood/*genetics;Female;Genotype;Humans;Male;*Polymorphism, Genetic;Sex Characteristics","Dantoine, T. F.;Drouet, M.;Debord, J.;Merle, L.;Cogne, M.;Charmes, J. P.",2002,Nov,,0,
943,Twenty years of research on cytokine-induced sickness behavior,"Cytokine-induced sickness behavior was recognized within a few years of the cloning and expression of interferon-alpha, IL-1 and IL-2, which occurred around the time that the first issue of Brain, Behavior, and Immunity was published in 1987. Phase I clinical trials established that injection of recombinant cytokines into cancer patients led to a variety of psychological disturbances. It was subsequently shown that physiological concentrations of proinflammatory cytokines that occur after infection act in the brain to induce common symptoms of sickness, such as loss of appetite, sleepiness, withdrawal from normal social activities, fever, aching joints and fatigue. This syndrome was defined as sickness behavior and is now recognized to be part of a motivational system that reorganizes the organism's priorities to facilitate recovery from the infection. Cytokines convey to the brain that an infection has occurred in the periphery, and this action of cytokines can occur via the traditional endocrine route via the blood or by direct neural transmission via the afferent vagus nerve. The finding that sickness behavior occurs in all mammals and birds indicates that communication between the immune system and brain has been evolutionarily conserved and forms an important physiological adaptive response that favors survival of the organism during infections. The fact that cytokines act in the brain to induce physiological adaptations that promote survival has led to the hypothesis that inappropriate, prolonged activation of the innate immune system may be involved in a number of pathological disturbances in the brain, ranging from Alzheimer's disease to stroke. Conversely, the newly-defined role of cytokines in a wide variety of systemic co-morbid conditions, ranging from chronic heart failure to obesity, may begin to explain changes in the mental state of these subjects. Indeed, the newest findings of cytokine actions in the brain offer some of the first clues about the pathophysiology of certain mental health disorders, including depression. The time is ripe to begin to move these fundamental discoveries in mice to man and some of the pharmacological tools are already available to antagonize the detrimental actions of cytokines.","Adaptation, Physiological/immunology;Adaptation, Psychological;Animals;Behavior, Animal/physiology;Behavioral Research/*history;Brain/immunology;Cytokines/*immunology;History, 20th Century;History, 21st Century;Humans;Neuroimmunomodulation/*physiology;*Sick Role","Dantzer, R.;Kelley, K. W.",2007,Feb,10.1016/j.bbi.2006.09.006,0,
944,"Mortality rates, life expectancy, and causes of death in people with hemophilia A or B in the United Kingdom who were not infected with HIV","Since the 1970s, mortality in the hemophilia population has been dominated by human immunodeficiency virus (HIV) and few reports have described mortality in uninfected individuals. This study presents mortality in 6018 people with hemophilia A or B in the United Kingdom during 1977 to 1998 who were not infected with HIV, with follow-up until January 1, 2000. Given disease severity and factor inhibitor status, all-cause mortality did not differ significantly between hemophilia A and hemophilia B. In severe hemophilia, all-cause mortality did not change significantly during 1977 to 1999. During this period, it exceeded mortality in the general population by a factor of 2.69 (95% confidence interval [CI]: 2.37-3.05), and median life expectancy in severe hemophilia was 63 years. In moderate/mild hemophilia, all-cause mortality did not change significantly during 1985 to 1999, and median life expectancy was 75 years. Compared with mortality in the general population, mortality from bleeding and its consequences, and from liver diseases and Hodgkin disease, was increased, but for ischemic heart disease it was lower, at only 62% (95% CI: 51%-76%) of general population rates, and for 14 other specific causes it did not differ significantly from general population rates. There was no evidence of any death from variant Creutzfeldt-Jakob disease or from conditions that could be confused with it. © 2007 by The American Society of Hematology.",adolescent;adult;aged;article;cause of death;child;comparative study;Creutzfeldt Jakob disease;follow up;hemophilia A;hemophilia B;Hodgkin disease;human;Human immunodeficiency virus infection;infant;ischemic heart disease;life expectancy;liver disease;major clinical study;male;mortality;priority journal;United Kingdom,"Darby, S. C.;Sau, W. K.;Spooner, R. J.;Giangrande, P. L. F.;Hill, F. G. H.;Hay, C. R. M.;Lee, C. A.;Ludlam, C. A.;Williams, M.",2007,,,0,
945,Cognitive impairment in heart failure,"Cognitive impairment (CI) is increasingly recognized as a common adverse consequence of heart failure (HF). Although the exact mechanisms remain unclear, microembolism, chronic or intermittent cerebral hypoperfusion, and/or impaired cerebral vessel reactivity that lead to cerebral hypoxia and ischemic brain damage seem to underlie the development of CI in HF. Cognitive decline in HF is characterized by deficits in one or more cognition domains, including attention, memory, executive function, and psychomotor speed. These deficits may affect patients' decision-making capacity and interfere with their ability to comply with treatment requirements, recognize and self-manage disease worsening symptoms. CI may have fluctuations in severity over time, improve with effective HF treatment or progress to dementia. CI is independently associated with disability, mortality, and decreased quality of life of HF patients. It is essential therefore for health professionals in their routine evaluations of HF patients to become familiar with assessment of cognitive performance using standardized screening instruments. Future studies should focus on elucidating the mechanisms that underlie CI in HF and establishing preventive strategies and treatment approaches.",,"Dardiotis, E.;Giamouzis, G.;Mastrogiannis, D.;Vogiatzi, C.;Skoularigis, J.;Triposkiadis, F.;Hadjigeorgiou, G. M.",2012,,10.1155/2012/595821,0,
946,"Beneficial effect(s) of n-3 fatty acids in cardiovascular diseases: But, why and how?","Low rates of coronary heart disease was found in Greenland Eskimos and Japanese who are exposed to a diet rich in fish oil. Suggested mechanisms for this cardio-protective effect focused on the effects of n-3 fatty acids on eicosanoid metabolism, inflammation, β oxidation, endothelial dysfunction, cytokine growth factors, and gene expression of adhesion molecules; But, none of these mechanisms could adequately explain the beneficial actions of n-3 fatty acids. One attractive suggestion is a direct cardiac effect of n-3 fatty acids on arrhythmogenesis. N-3 fatty acids can modify Na+ channels by directly binding to the channel proteins and thus, prevent ischemia-induced ventricular fibrillation and sudden cardiac death. Though this is an attractive explanation, there could be other actions as well. N-3 fatty acids can inhibit the synthesis and release of pro-inflammatory cytokines such as tumor necrosis factorα (TNFα) and interleukin-1 (IL-1) and IL-2 that are released during the early course of ischemic heart disease. These cytokines decrease myocardial contractility and induce myocardial damage, enhance the production of free radicals, which can also suppress myocardial function. Further, n-3 fatty acids can increase parasympathetic tone leading to an increase in heart rate variability and thus, protect the myocardium against ventricular arrhythmias. Increased parasympathetic tone and acetylcholine, the principle vagal neurotransmitter, significantly attenuate the release of TNF, IL-1 β, IL-6 and IL-18. Exercise enhances parasympathetic tone, and the production of anti-inflammatory cytokine IL-10 which may explain the beneficial action of exercise in the prevention of cardiovascular diseases and diabetes mellitus. TNFα has neurotoxic actions, where as n-3 fatty acids are potent neuroprotectors and brain is rich in these fatty acids. Based on this, it is suggested that the principle mechanism of cardioprotective and neuroprotective action(s) of n-3 fatty acids can be due to the suppression of TNFα and IL synthesis and release, modulation of hypothalamic-pituitary-adrenal anti-inflammatory responses, and an increase in acetylcholine release, the vagal neurotransmitter. Thus, there appears to be a close interaction between the central nervous system, endocrine organs, cytokines, exercise, and dietary n-3 fatty acids. This may explain why these fatty acids could be of benefit in the management of conditions such as septicemia and septic shock, Alzheimer's disease, Parkinson's disease, inflammatory bowel diseases, diabetes mellitus, essential hypertension and atherosclerosis. © 2000 Harcourt Publishers Ltd.",cell adhesion molecule;fish oil;interleukin 1;omega 3 fatty acid;sodium channel;tumor necrosis factor alpha;article;cardiovascular disease;cardiovascular effect;controlled study;cytokine production;diabetes mellitus;fatty acid oxidation;heart muscle injury;heart protection;heart ventricle fibrillation;human;ischemic heart disease;neuroprotection;neurotransmitter release;parasympathetic innervation;priority journal;protein binding;sudden death,"Das, U. N.",2000,,,0,
947,Can essential fatty acids reduce the burden of disease(s)?,"Coronary heart disease, stroke, diabetes mellitus, hypertension, cancer, depression schizophrenia, Alzheimer's disease, and collagen vascular diseases are low-grade systemic inflammatory conditions that are a severe burden on health care resources. Essential fatty acids (EFAs) and their metabolites: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), gamma-linolenic acid (GLA), dihomo-gamma-linolenic acid (DGLA), and arachidonic acid (AA) and their products: prostaglandin E1, prostacyclin, lipoxins, resolvins, and protectins suppress inflammation, augment healing, and are of benefit in the prevention and management of these conditions. Hence, supplementation of EFAs could reduce burden of these disease(s).","Animals;Anti-Infective Agents/pharmacology;Chronic Disease;*Disease;Fatty Acids, Essential/deficiency/*metabolism;Fatty Acids, Unsaturated/pharmacology;Humans;Inflammation;Models, Biological","Das, U. N.",2008,Mar 18,10.1186/1476-511x-7-9,0,
948,Acetylcholinesterase and butyrylcholinesterase as markers of low-grade systemic inflammation,,acetylcholine;acetylcholinesterase;C reactive protein;cholinesterase;Alzheimer disease;diabetic retinopathy;disease marker;disease severity;enzyme activity;enzyme analysis;human;hyperlipidemia;hypertension;inflammation;insulin resistance;insulin sensitivity;ischemic heart disease;kidney disease;letter;non insulin dependent diabetes mellitus;pathogenesis;prognosis;protein blood level;age related macular degeneration;rheumatic disease;signal transduction;systemic inflammation,"Das, U. N.",2012,,,0,
949,"Improved prediction of long-term, other cause mortality in men with prostate cancer","Purpose: Comorbidity assessment is essential to triage of care for men with prostate cancer. We identified long-term risks of other cause mortality associated with comorbidities in the Charlson index and applied these to the creation of a prostate cancer specific comorbidity index. Materials and Methods: We sampled 1,598 cases of prostate cancer diagnosed in 1997 to 2004 at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers. We used Cox proportional hazards modeling to determine the risks of other cause mortality associated with comorbidities and used these hazard ratios to re-weight the Charlson index. We then compared the ability of each index to predict other cause mortality. Results: Cox modeling showed that moderate to severe liver disease, metastatic solid tumor, lymphoma and leukemia carried the highest risk (HR greater than 5) for other cause mortality, followed by moderate to severe chronic obstructive pulmonary disease, moderate to severe renal disease, dementia, hemiplegia and congestive heart failure (HR 2.5 to less than 3.5). The revised and original Charlson indices performed similarly in predicting other cause mortality across all patients (c-index 0.816 vs 0.802). However, in survival analysis our revised index identified 137 men with a greater than 90% probability of other cause mortality within 10 years while the original Charlson identified only 51. In multivariate modeling the odds of 5-year other cause mortality for men with original Charlson scores 1, 2, 3 and 4+ were 2.9, 6.0, 9.2 and 29.8, respectively, compared with 3.9, 6.2, 12.8 and 84.2 for the revised index. Conclusions: Re-weighting the Charlson index allowed for more accurate identification of men at highest risk for other cause mortality. Our revised index may be used to aid medical decision making for men with prostate cancer. © 2011 American Urological Association Education and Research, Inc.",accuracy;acquired immune deficiency syndrome;angina pectoris;article;blood clotting disorder;cancer diagnosis;cancer mortality;cancer patient;cancer survival;cerebrovascular disease;Charlson Comorbidity Index;chronic obstructive lung disease;clinical assessment tool;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;disease severity;endocrine disease;enteritis;gastrointestinal hemorrhage;heart arrhythmia;heart infarction;hemiplegia;high risk patient;human;Human immunodeficiency virus infection;hypertension;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;metastasis;neurologic disease;peptic ulcer;peripheral vascular disease;prediction;priority journal;probability;prostate cancer;risk assessment;valvular heart disease,"Daskivich, T. J.;Chamie, K.;Kwan, L.;Labo, J.;Dash, A.;Greenfield, S.;Litwin, M. S.",2011,,,0,
950,Comorbidity and competing risks for mortality in men with prostate cancer,"BACKGROUND: Accurate estimation of life expectancy is essential for men deciding between aggressive and conservative treatment of prostate cancer. The authors sought to assess the competing risks of nonprostate cancer and prostate cancer mortality among men with differing Charlson comorbidity index scores and tumor risks. METHODS: The authors conducted a retrospective study of 1482 men with nonmetastatic prostate cancer diagnosed from 1997 to 2004 at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers. They performed Kaplan-Meier and competing risks regression analyses to assess survival outcomes. RESULTS: After a mean follow-up of 6.0 years, 370 (25%) men died from other causes, whereas 44 (3%) died of prostate cancer. At 10 years after diagnosis, men with Charlson scores 0, 1, 2, and 3+ had nonprostate cancer mortality rates of 17%, 34%, 52%, and 74%, respectively. In competing risks regression analysis, each point increase in Charlson score was associated with a 2-fold increase in hazard of nonprostate mortality. Men with Charlson 3+ had 8.5× the hazard of death from other causes, compared with men with the lowest scores (subhazard ratio, 8.5; 95% confidence interval, 6.2-11.7). After stratification by tumor risk, nonprostate mortality rates remained markedly elevated among men with higher Charlson scores, whereas prostate cancer mortality was rare, especially among low-risk and intermediate-risk groups (0.4%, 3%, and 8% for low, intermediate, and high risk, respectively). CONCLUSIONS: Men with the highest Charlson scores should consider conservative management of low-risk and intermediate-risk tumors, given their exceedingly high risk of death from other causes and low risk of prostate cancer mortality. Cancer 2011;. © 2011 American Cancer Society. Comorbidity is a key component in prostate cancer decision making but is poorly integrated because of lack of a standardized comorbidity assessment tool. The authors found that men with Charlson scores 3+ and low-risk to intermediate-risk tumors had an exceedingly high risk of death from other causes and a low risk of prostate cancer mortality, suggesting that such men should strongly consider conservative over aggressive treatment for their prostate cancer. Copyright © 2011 American Cancer Society.",antiandrogen;antineoplastic agent;prostate specific antigen;acquired immune deficiency syndrome;adult;aged;article;cancer mortality;cancer staging;cancer survival;Caucasian;cerebrovascular disease;Charlson comorbidity index score;chronic obstructive lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;follow up;Gleason score;heart infarction;hemiplegia;Hispanic;human;Human immunodeficiency virus infection;Kaplan Meier method;kidney disease;leukemia;life expectancy;liver disease;lymphoma;major clinical study;male;medical decision making;metastasis;mortality;assessment of humans;Black person;outcome assessment;overall survival;peptic ulcer;peripheral vascular disease;priority journal;prostate cancer;race difference;regression analysis;retrospective study;risk assessment;United States;watchful waiting,"Daskivich, T. J.;Chamie, K.;Kwan, L.;Labo, J.;Dash, A.;Greenfield, S.;Litwin, M. S.",2011,,,0,
951,Acute ST-segment elevation myocardial infarction in patients 89 years of age or older: Description of a series with 96 cases,"Objetives. To evaluate the clinical profile and management of very old patients with acute myocardial infarction (AMI), and to describe their outcomes and the factors that influence them. Methods. All consecutive patients ≥89 old admitted to our institution with an ST-segment elevation / complete left bundle-branch block AMI, from 1998 to 2003. Results. We found 96 AMIs in 92 patients, with a mean age of 91.4 years (DS = 2.1), 65% women. Thirty five percent were unable to walk and 20% had dementia. Reperfusion therapies were only employed in 27 patients, primary angioplasty in 18 (18.8%) and thrombolysis in 9 (9.8%). Cardiac rupture occurred in 3 patients (33.3%) treated with thrombolytic therapy, in 2.8% among those who did not received reperfusion therapy and in none of those who underwent primary angioplasty (p = 0.0003 for the three groups comparison). Thirty-two patients (33%) died during hospitalization. The overall mortality was 53% at 3 months, and 60% at 6 months. Independent predictors of death were older age, higher Killip class, and depressed left ventricular ejection fraction, whereas heparin use was associated with a lower mortality rate. Admission to the coronary care unit showed no effect on mortality (OR 1.5; 95% CI, 0.5-5.0; p = 0.5). Conclusions. We found no evidence of benefit in the admission to the CCU in nonagenarian patients with AMI or in the use of thrombolytic therapy. On the contrary, heparin use may have beneficial effect on prognosis in these patients.",heparin;aged;angioplasty;article;female;fibrinolytic therapy;geriatric care;heart infarction;heart left ventricle ejection fraction;heart muscle reperfusion;hospitalization;human;major clinical study;male;mortality;prediction;prognosis,"Datino, T.;Martínez-Sellés, M.;Puchol, A.;Bueno, H.",2005,,,0,
952,Thrombolytic therapy for elderly patients with myocardial infarction 1 (multiple letters),,fibrinolytic agent;age;comorbidity;confusion;dementia;fibrinolytic therapy;functional assessment;geriatric care;health care cost;heart infarction;human;letter;priority journal;quality of life,"Dave, S.;Bernabei, R.;Zuccala, G.;Carbonin, P.;Krumholz, H. M.;Gurwitz, J. H.",1997,,,0,
953,Menopause and HRT - Keeping perspective,,conjugated estrogen plus medroxyprogesterone acetate;estradiol;estrogen;gestagen;Alzheimer disease;article;breast cancer;cancer risk;cardiovascular disease;cardiovascular risk;cerebrovascular disease;clinical practice;clinical trial;controlled clinical trial;data analysis;female;hormone substitution;hot flush;human;ischemic heart disease;medical research;menopausal syndrome;night sweat;osteoporosis;postmenopause;primary prevention;publication;randomized controlled trial;recurrence risk;risk benefit analysis;risk reduction;secondary prevention;cerebrovascular accident;venous thromboembolism,"Davey, D. A.",2004,,,0,
954,Recoverable cognitive dysfunction in older persons 1,,adaptation;cognition;cognitive defect;dementia;geriatrics;heart infarction;hospitalization;human;letter;medical specialist;social psychology;cerebrovascular accident,"Davidovic, M.;Erceg, P.;Despotovic, N.;Milosevic, D. P.",2007,,,0,
955,"The Oxygen Paradox, oxidative stress, and ageing","Professor Helmut Sies is being lauded in this special issue of Archives of Biochemistry & Biophysics, on the occasion of his retirement as Editor-in-Chief. There is no doubt that Helmut has exerted an enormously positive influence on this journal, the fields of Biochemistry & Biophysics in general, and the areas of free radical and redox biology & medicine in particular. Helmut Sies' many discoveries about peroxide metabolism, glutathione, glutathione peroxidases, singlet oxygen, carotenoids in general and lycopene in particular, and flavonoids, fill the pages of his more than 600 publications. In addition, he will forever be remembered for coining the term 'oxidative stress' that is so widely used (and sometimes abused) by most of his colleagues.",carotenoid;flavonoid;glutathione;glutathione peroxidase;lycopene;nitric oxide;oxygen;peroxynitrite;selenium;singlet oxygen;aging;Alzheimer disease;article;cerebrovascular accident;cutaneous parameters;glutathione metabolism;heart failure;human;light damage;oxidation;oxidative stress;priority journal;ultraviolet radiation,"Davies, K. J. A.",2016,,,0,
956,"Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly","In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). At 1 year following surgery, the mortality was 20.4%. Increasing age, ischaemic heart disease, cardiac failure, preoperative arrhythmias and poor ASA status were all associated with increases in early and long term mortality. A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.","Anesthesia, General [mortality];Anesthesia, Spinal [mortality];Clinical Trials as Topic;Emergencies;Hip Fractures [surgery];Postoperative Complications [mortality];Prospective Studies;Random Allocation;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Sr-anaesth: sr-muskinj","Davis, Fm;Woolner, Df;Frampton, C;Wilkinson, A;Grant, A;Harrison, Rt;Roberts, Mt;Thadaka, R",1987,,,0,957
957,"Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly","In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). At 1 year following surgery, the mortality was 20.4%. Increasing age, ischaemic heart disease, cardiac failure, preoperative arrhythmias and poor ASA status were all associated with increases in early and long term mortality. A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.","Anesthesia, General [mortality];Anesthesia, Spinal [mortality];Clinical Trials as Topic;Emergencies;Hip Fractures [surgery];Postoperative Complications [mortality];Prospective Studies;Random Allocation;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Sr-anaesth: sr-muskinj","Davis, F. M.;Woolner, D. F.;Frampton, C.;Wilkinson, A.;Grant, A.;Harrison, R. T.;Roberts, M. T.;Thadaka, R.",1987,,,0,
958,Novel mutations in ataxia telangiectasia and AOA2 associated with prolonged survival,"Ataxia telangiectasia (AT) and ataxia oculomotor apraxia type 2 (AOA2) are autosomal recessive ataxias caused by mutations in genes involved in maintaining DNA integrity. Lifespan in AT is greatly shortened (20s-30s) due to increased susceptibility to malignancies (leukemia/lymphoma). Lifespan in AOA2 is uncertain. We describe a woman with variant AT with two novel mutations in ATM (IVS14 + 2 T > G and 5825C > T, p.A1942V) who died at age 48 with pancreatic adenocarcinoma. Her mutations are associated with an unusually long life for AT and with a cancer rarely associated with that disease. We also describe two siblings with AOA2, heterozygous for two novel mutations in senataxin (3 bp deletion c.343-345 and 1398 T > G, p.I466M) who have survived into their 70s, allowing us to characterize the longitudinal course of AOA2. In contrast to AT, we show that persons with AOA2 can experience a prolonged lifespan with considerable motor disability. © 2013 Elsevier B.V. All rights reserved.",acetylsalicylic acid;antihypertensive agent;ataxia oculomotor apraxia type 2 protein;ATM protein;DNA;hydroxymethylglutaryl coenzyme A reductase inhibitor;protein p53;protein serine threonine kinase;senataxin;unclassified drug;aged;article;assisted living facility;ataxia;ataxia telangiectasia;case report;cerebellum atrophy;choreoathetosis;consanguinity;daily life activity;disease severity;dysarthria;electronystagmography;female;gene mutation;genetic association;genetic screening;heart disease;heart failure;heterozygote;human;human tissue;lifespan;longevity;male;mental deterioration;missense mutation;motor dysfunction;nuclear magnetic resonance imaging;nystagmus;pancreas adenocarcinoma;peripheral neuropathy;priority journal;social interaction;special education;spinocerebellar degeneration;survival,"Davis, M. Y.;Keene, C. D.;Swanson, P. D.;Sheehy, C.;Bird, T. D.",2013,,,0,
959,Ruptured splenic artery aneurysm: Rare cause of shock diagnosed with bedside ultrasound,"Splenic artery aneurysm rupture is rare and potentially fatal. It has largely been reported in pregnant patients and typically not diagnosed until laparotomy. This case reports a constellation of clinical and sonographic findings that may lead clinicians to rapidly diagnose ruptured splenic artery aneurysm at the bedside. We also propose a rapid, but systematic sonographic approach to patients with atraumatic hemoperitoneum causing shock. It is yet another demonstration of the utility of bedside ultrasound in critically ill patients, specifically with undifferentiated shock.",fresh frozen plasma;abdominal pain;abdominal tenderness;adult;aneurysm rupture;article;artificial embolism;blood clotting;blood transfusion;case report;computed tomographic angiography;cryoprecipitate;differential diagnosis;echography;ectopic pregnancy;epigastric pain;erythrocyte transfusion;female;fluid resuscitation;heart infarction;heart left ventricle function;hematoma;hemoperitoneum;hemorrhagic pancreatitis;human;interventional radiology;mental deterioration;pancreas resection;physical examination;plasma transfusion;sepsis;shock;spleen artery aneurysm;spleen artery aneurysm rupture;splenectomy;upper abdominal pain;upper gastrointestinal bleeding,"Davis, T.;Minardi, J.;Knight, J.;Larrabee, H.;Schaefer, G.",2015,,,0,
960,Cohort profile: The fremantle diabetes study,,acetylsalicylic acid;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;hemoglobin A1c;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;abdominal aorta aneurysm;article;Australia;cardiovascular mortality;cardiovascular risk;carotid artery bruit;cerebrovascular accident;cerebrovascular disease;cohort analysis;dementia;diabetes mellitus;diabetic patient;disease association;follow up;heart infarction;hemoglobin blood level;hepatobiliary disease;hospital;human;insulin dependent diabetes mellitus;insulin treatment;low drug dose;non insulin dependent diabetes mellitus;observational study;osteoporosis;peripheral neuropathy;peripheral occlusive artery disease;phase 1 clinical trial (topic);phase 2 clinical trial (topic);prevalence;priority journal;prognosis;questionnaire;risk factor;sex ratio;silent myocardial infarction;Southern Europe;weakness;aspirin,"Davis, T. M. E.;Bruce, D. G.;Davis, W. A.",2013,,,0,
961,The effect of transplantation on dialysis dementia,"Seven patients with dialysis dementia are described. Three patients, symptomatic from dementia at the time of transplantation, had a rapid exacerbation of their symptoms with deterioration to death. Four patients, asymptomatic at the time of transplantation, developed symptoms of dementia after surgery. Two of these had a rapidly fatal illness while the remaining two had a mild illness. One subsequently died from a myocardial infarction while the other gradually improved sufficiently for her to return to work. This experience indicates that transplantation is to be avoided in patients with dialysis dementia.",aluminum;adult;article;case report;female;human;male;middle aged;renal replacement therapy;schizophrenia;transplantation,"Davison, A. M.;Giles, G. R.",1979,,,0,
962,"The association of depression, cognitive impairment without dementia, and dementia with risk of ischemic stroke: A cohort study","Objective: To determine if depression, cognitive impairment without dementia (CIND), and/or dementia are each independently associated with risk of ischemic stroke and to identify characteristics that could modify these associations. Methods: This retrospective-cohort study examined a population-based sample of 7031 Americans older than 50 years participating in the Health and Retirement Study (1998-2008) who consented to have their interviews linked to theirMedicare claims. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Hospitalizations for ischemic stroke were identified via ICD-9-CM diagnoses. Results: After adjusting for demographics, medical comorbidities, and health-risk behaviors, CIND alone (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.11-1.69) and co-occurring depression and CIND (OR = 1.65, 95% CI = 1.24-2.18) were independently associated with increased odds of ischemic stroke. Depression alone was not associated with odds of ischemic stroke (OR = 1.11, 95% CI = 0.88-1.40) in unadjusted analyses. Neither dementia alone (OR = 1.09, 95% CI = 0.82-1.45) nor co-occurring depression and dementia (OR = 1.25, 95% CI = 0.89-1.76) were associated with odds of ischemic stroke after adjusting for demographics. Conclusions: CIND and co-occurring depression and CIND are independently associated with increased risk of ischemic stroke. Individuals with co-occurring depression and CIND represent a high-risk group that may benefit from targeted interventions to prevent stroke.",aged;alcohol consumption;article;blood clotting disorder;brain ischemia;cerebrovascular disease;cognitive defect;cohort analysis;congestive heart failure;dementia;depression;diabetes mellitus;disease association;female;follow up;health behavior;health hazard;heart infarction;hospitalization;human;hypertension;interview;major clinical study;male;peripheral vascular disease;priority journal;retrospective study;sensitivity analysis;smoking;very elderly,"Davydow, D. S.;Levine, D. A.;Zivin, K.;Katon, W. J.;Langa, K. M.",2015,,,0,
963,Neuropsychiatric disorders and potentially preventable hospitalizations in a prospective cohort study of older Americans,"BACKGROUND: The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood. OBJECTIVE(S): To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI). DESIGN: Prospective cohort study. PARTICIPANTS: Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008). MAIN MEASURES: The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI. KEY RESULTS: All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95% Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI. CONCLUSIONS: Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.","Aged;Aged, 80 and over;Cognition Disorders/diagnosis/*epidemiology/psychology;Cohort Studies;Dementia/diagnosis/*epidemiology/psychology;Depression/diagnosis/*epidemiology/psychology;Female;Hospitalization/*trends;Humans;Male;Mental Disorders/diagnosis/epidemiology/psychology;Prospective Studies;Risk Factors;United States/epidemiology","Davydow, D. S.;Zivin, K.;Katon, W. J.;Pontone, G. M.;Chwastiak, L.;Langa, K. M.;Iwashyna, T. J.",2014,Oct,10.1007/s11606-014-2916-8,0,
964,Never too old for modern infarct-treatment,"In 4 elderly patients, two women aged 94 and 92 and two men aged 98 and 95 years, respectively, acute symptoms were found to be caused by acute myocardial infarction (AMI). The first woman and the two men were treated by stenting and/or percutaneous intervention and recovered fully, but in the second woman, who was hemiplegic following a CVA and had progressive dementia, a palliative treatment course was chosen after extensive consultation with the general practitioner and the next of kin. In elderly patients the outcome after AMI is often worse than in their younger counterparts. On the other hand, treatment decisions in elderly patients are often automatically considered to be difficult, which may result in under-treatment or no treatment at all. This has been referred to as discrimination towards the elderly. Primary angioplasty should not be withheld on the basis of age alone.",acute disease;aged;article;case report;female;frail elderly;heart infarction;human;male;stent;transluminal coronary angioplasty;treatment outcome,"de Boer, M. J.;Zijlstra, F.",2010,,,0,
965,"The potential for prevention of dementia across two decades: the prospective, population-based Rotterdam Study","BACKGROUND: Cardiovascular factors and low education are important risk factors of dementia. We provide contemporary estimates of the proportion of dementia cases that could be prevented if modifiable risk factors were eliminated, i.e., population attributable risk (PAR). Furthermore, we studied whether the PAR has changed across the last two decades. METHODS: We included 7,003 participants of the original cohort (starting in 1990) and 2,953 participants of the extended cohort (starting in 2000) of the Rotterdam Study. Both cohorts were followed for dementia until ten years after baseline. We calculated the PAR of overweight, hypertension, diabetes mellitus, cholesterol, smoking, and education. Additionally, we assessed the PAR of stroke, coronary heart disease, heart failure, and atrial fibrillation. We calculated the PAR for each risk factor separately and the combined PAR taking into account the interaction of risk factors. RESULTS: During 57,996 person-years, 624 participants of the original cohort developed dementia, and during 26,177 person-years, 145 participants of the extended cohort developed dementia. The combined PAR in the original cohort was 0.23 (95 % CI, 0.05-0.62). The PAR in the extended cohort was slightly higher at 0.30 (95 % CI, 0.06-0.76). The combined PAR including cardiovascular diseases was 0.25 (95 % CI, 0.07-0.62) in the original cohort and 0.33 (95 % CI, 0.07-0.77) in the extended cohort. CONCLUSIONS: A substantial part of dementia cases could be prevented if modifiable risk factors would be eliminated. Although prevention and treatment options of cardiovascular risk factors and diseases have improved, the preventive potential for dementia has not declined over the last two decades.","Aged;*Cardiovascular Diseases/epidemiology/prevention & control;Causality;*Dementia/diagnosis/epidemiology/prevention & control;Diabetes Mellitus/*epidemiology;Effect Modifier, Epidemiologic;Female;*Health Education/methods/organization & administration;Humans;Hypercholesterolemia/*epidemiology;Hypertension/*epidemiology;Longitudinal Studies;Male;Middle Aged;Netherlands/epidemiology;Overweight/epidemiology;Preventive Medicine/methods;Prospective Studies;Risk Factors;Risk Reduction Behavior;Smoking/*epidemiology","de Bruijn, R. F.;Bos, M. J.;Portegies, M. L.;Hofman, A.;Franco, O. H.;Koudstaal, P. J.;Ikram, M. A.",2015,Jul 21,10.1186/s12916-015-0377-5,0,
966,Subclinical cardiac dysfunction increases the risk of stroke and dementia: the Rotterdam Study,"OBJECTIVE: To investigate the association between cardiac function and the risk of stroke and dementia in elderly free of clinical cardiac disease. Additionally, we investigated the relation between cardiac function and MRI markers of subclinical cerebrovascular disease. METHODS: This study was conducted within the population-based Rotterdam Study. A total of 3,291 participants (60.8% female, age-range 58-98 years) free of coronary heart disease, heart failure, atrial fibrillation, stroke, and dementia underwent echocardiography in 2002-2005 to measure cardiac function. Follow-up finished in 2012. In 2005-2006, a random subset of 577 stroke-free people without dementia underwent brain MRI on which infarcts and white matter lesion volume were assessed. RESULTS: During 21,785 person-years of follow-up, 164 people had a stroke and during 19,462 person-years of follow-up, 208 people developed dementia. Measures of better diastolic function, such as higher E/A ratio, were associated with a lower risk of stroke (hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.69; 0.98) and dementia (HR 0.82; 95% CI 0.70; 0.96). Better systolic function, measured as higher fractional shortening, was only associated with a lower risk of stroke (HR 0.84; 95% CI 0.72; 0.98). Better diastolic function was related to a lower prevalence of silent infarcts on MRI, especially lacunar infarcts. CONCLUSIONS: In elderly free of clinical cardiac disease, worse diastolic function is associated with clinical stroke, dementia, and silent infarcts on MRI, whereas worse systolic function is related only to clinical stroke. These findings can form the basis for future research on the utility of cardiac function as potential intervention target for prevention of neurologic diseases.","Aged;Aged, 80 and over;Cardiovascular Diseases/*diagnosis/*epidemiology;Cohort Studies;Dementia/*diagnosis/*epidemiology;Female;Follow-Up Studies;Humans;Male;Middle Aged;Netherlands/epidemiology;Population Surveillance/methods;Prospective Studies;Risk Factors;Stroke/*diagnosis/*epidemiology","de Bruijn, R. F.;Portegies, M. L.;Leening, M. J.;Bos, M. J.;Hofman, A.;van der Lugt, A.;Niessen, W. J.;Vernooij, M. W.;Franco, O. H.;Koudstaal, P. J.;Ikram, M. A.",2015,Feb 24,10.1212/wnl.0000000000001289,0,
967,Cardiovascular risk factors and future risk of Alzheimer's disease,"Alzheimer's disease (AD) is the most common neurodegenerative disorder in elderly people, but there are still no curative options. Senile plaques and neurofibrillary tangles are considered hallmarks of AD, but cerebrovascular pathology is also common. In this review, we summarize findings on cardiovascular disease (CVD) and risk factors in the etiology of AD. Firstly, we discuss the association of clinical CVD (such as stroke and heart disease) and AD. Secondly, we summarize the relation between imaging makers of pre-clinical vascular disease and AD. Lastly, we discuss the association of cardiovascular risk factors and AD. We discuss both established cardiovascular risk factors and emerging putative risk factors, which exert their effect partly via CVD.",homocysteine;thyroid hormone;Alzheimer disease;arterial stiffness;article;blood pressure;brain atrophy;brain hemorrhage;cardiovascular disease;cardiovascular risk;cerebrovascular accident;cerebrovascular disease;chronic kidney disease;cognitive defect;dementia;diffusion tensor imaging;disease association;disease marker;functional magnetic resonance imaging;glucose metabolism;atrial fibrillation;heart disease;heart failure;human;hypercholesterolemia;hypertension;inflammation;ischemic heart disease;Mediterranean diet;non insulin dependent diabetes mellitus;obesity;physical activity;pulse wave;risk assessment;smoking;thyroid function;white matter lesion,"de Bruijn, R. F. A. G.;Ikram, M. A.",2014,,,0,
968,"Health surveillance, biosafety and emergence and re-emergence of infectious diseases in Brazil","The present paper presents compulsory notifi cation data for infectious diseases and epidemiologic ones recorded at the Center for Strategic Information and Health Surveillance (CIEVS) for the period of March 2006 to April 2007. Data is presented in accordance with geographic distribution, time and risk classifi cation of the etiologic agents found, according to Ministry of Health regulations. The importance of this epidemiologic surveillance system is presented, debating the main topics required for quality improvement and information analysis. It is concluded, from the analysis of epidemiologic events and their relation to risk management, that the compulsory notifi cation system in Brazil is incomplete, irregular, delayed and, in a large percentage of cases, notifi cation cannot be completed and the agent may not be identifi ed. Quality of data varies from one region to another and from county to county within the same region. There is a high proportion of cases in which the etiologic agent is unknown and, in such cases, a high lethality is expected, establishing a high risk exposure condition for those health professionals involved in health surveillance. From these data, the study points out the need to improve the surveillance system and strengthens the idea of building maximum containment laboratories. © Elsevier Editora Ltda.",article;biosafety;botulism;Brazil;Chagas disease;chickenpox;cholera;Creutzfeldt Jakob disease;dengue;diarrhea;disease transmission;epidemic;epidemic meningitis;epidemiological data;geographic distribution;Hantavirus infection;health practitioner;health program;health survey;hemolytic uremic syndrome;hepatitis A;high risk population;human;infection;influenza;leishmaniasis;lethality;malaria;measles;medical information;meningitis;mycobacteriosis;prion disease;rabies;risk assessment;risk management;Rocky Mountain spotted fever;rubella;St. Louis encephalitis;tetanus;yellow fever,"de Cardoso, T. A. O.;de Navarro, M. B. M. A.;Neto, C. C.;Moreira, J. C.",2010,,,0,
969,"Homocysteine, B vitamins, and cardiovascular disease 4",,folic acid;homocysteine;vitamin B group;amino acid blood level;cardiovascular disease;cardiovascular risk;clinical trial;cognitive defect;dementia;drug blood level;familial disease;genetic association;genetic variability;human;hyperhomocysteinemia;ischemic heart disease;letter;observational study;outcome assessment;priority journal;risk factor,"De Craen, A. J. M.;Stott, D. J.;Westendorp, R. G. J.",2006,,,0,
970,"Management of agitation, aggression, and psychosis associated with dementia: A pooled analysis including three randomized, placebo-controlled double-blind trials in nursing home residents treated with risperidone","This analysis used pooled data from three randomized, placebo-controlled trials that examined the efficacy and safety of risperidone for the treatment of agitation, aggression, and psychosis associated with dementia in elderly nursing home residents to assess the risk-benefit of the use of risperidone in this population. The efficacy data (risperidone n = 722, placebo n = 428) were obtained from the Cohen-Mansfield agitation inventory (CMAI) and behavioral pathology in Alzheimer's disease (BEHAVE-AD) total and subscales. Additionally, clinical global impression (CGI) assessments were performed. Subgroup analyses were performed by type of dementia, severity of dementia, presence or absence of somnolence as an adverse event, and presence or absence of psychosis at baseline. Safety assessments included evaluation of treatment emergent adverse events, Extrapyramidal Symptom Rating Scale, ECG and vital signs, and Mini-Mental State Examination (MMSE). The mean dose of risperidone at end point was 1.0 mg/day (0.02 S.E.). The observed mean change at end point was significantly higher for risperidone than for placebo on CMAI total score (-11.8 versus -6.4, respectively; p < 0.001), total aggression score (-5.0 versus -1.8, respectively; p < 0.001), BEHAVE-AD total score (-6.1 and -3.6, respectively; p < 0.001), and psychotic symptoms score (-2.1 and -1.3, respectively; p = 0.003). The main treatment effects of risperidone were similar in all subgroup analyses. Additionally, risperidone-treated patients scored significantly better than placebo-treated patients on the CGI scales at end point. The incidence of treatment-emergent adverse events was comparable between risperidone (84.3%) and placebo (83.9%). More patients discontinued due to adverse events in the risperidone-treated group (17.2%) than in the placebo group (11.2%). Differences in adverse event incidences between placebo and risperidone were observed for extrapyramidal symptoms (EPS), mild somnolence and the less common cerebrovascular adverse events (CAE). Risperidone induced neither orthostatic, nor anticholinergic side effects nor falls nor cognitive decline. Of all atypical antipsychotics, risperidone has the largest database of double-blind controlled trials to support its efficacy and safety in the treatment of agitation, aggression, and psychosis associated with dementia. At the recommended doses, risperidone displayed a favorable risk-benefit profile. Risperidone was well tolerated with respect to EPS, somnolence, and anticholinergic side effects in this elderly population. In view of the risk for CAEs, risperidone, should be targeted towards the treatment of those patients in whom psychotic and behavioral symptoms of dementia are prominent and associated with significant distress, functional impairment or danger to the patient. © 2005 Elsevier B.V. All rights reserved.",neuroleptic agent;placebo;risperidone;aggression;agitation;Alzheimer disease;analysis;anticholinergic effect;article;behavior;blood pressure;cardiovascular disease;central nervous system disease;cerebrovascular disease;clinical trial;cognitive defect;conjunctivitis;constipation;coughing;dementia;diarrhea;disability;disease association;disease severity;distress syndrome;dizziness;drug efficacy;drug fatality;drug safety;drug tolerability;edema;electrocardiogram;erythema;evaluation study;extrapyramidal symptom;falling;fever;functional disease;gait disorder;gastrointestinal disease;headache;health hazard;heart arrest;heart failure;human;hypotension;injury;mental disease;Mini Mental State Examination;muscle weakness;nursing home;pain;pathology;peripheral edema;pneumonia;psychosis;purpura;rash;respiratory tract disease;rhinitis;risk benefit analysis;side effect;skin disease;skin ulcer;somnolence;statistical significance;cerebrovascular accident;faintness;tardive dyskinesia;treatment outcome;upper respiratory tract;urinary tract infection;vomiting,"De Deyn, P. P.;Katz, I. R.;Brodaty, H.;Lyons, B.;Greenspan, A.;Burns, A.",2005,,,0,
971,Subclinical myocardial dysfunction in Rett syndrome,"Aims: Rett syndrome (RTT) is a rare neurodevelopmental disorder frequently linked to methyl-CpG-binding protein 2 (MeCP2) gene mutations. RTT is associated with a 300-fold increased risk of sudden cardiac death. Rhythm abnormalities and cardiac dysautonomia do not to fully account for cardiac mortality. Conversely, heart function in RTT has not been explored to date. Recent data indicate a previously unrecognized role of MeCP2 in cardiomyocytes development. Besides, increased oxidative stress markers (OS) have been found in RTT. We hypothesized that (i) RTT patients present a subclinical biventricular dysfunction and (ii) the myocardial dysfunction correlate with OS. Methods and results: We evaluated typical (n = 72) and atypical (n = 20) RTT female and healthy controls (n = 92). Main outcome measurements were (i) echocardiographic biventricular systo-diastolic parameters; (ii) correlation between echocardiographic measures and OS levels, i.e. plasma and intra-erythrocyte non-protein-bound iron (NPBI) and plasma F2-Isoprostanes (F2-IsoPs). A significant reduction in longitudinal biventricular function (tricuspid annular plane systolic excursion, mitral annular plane systolic excursion, S′ of lateral and septal mitral annulus, S′ of tricuspidal annulus) was evidenced in RTT patients vs. controls. No significant changes in the LV ejection fraction were found. Peak-early filling parameters (E, E′ of lateral mitral annulus, E′ of tricuspidal annulus) and right ventricular systolic pressure were reduced. A-wave, E/A, and E/E′ were normal. OS markers were increased, but only F2-IsoPs correlated to LV systolic dysfunction. Conclusion: These data indicate a previously unrecognized subclinical systo-diastolic biventricular myocardial dysfunction in typical and atypical RTT patients. A reduced preload is evidenced. The biventricular dysfunction is partially related to OS damage. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011.",iron;isoprostane derivative;methyl CpG binding protein 2;adolescent;article;cardiovascular parameters;child;clinical article;controlled study;correlation analysis;disease association;echocardiography;female;heart disease;heart function;heart left ventricle ejection fraction;heart ventricle function;human;left ventricular systolic dysfunction;myocardial disease;oxidative stress;priority journal;Rett syndrome;school child;systolic blood pressure,"De Felice, C.;Maffei, S.;Signorini, C.;Leoncini, S.;Lunghetti, S.;Valacchi, G.;D'Esposito, M.;Filosa, S.;Ragione, F. D.;Butera, G.;Favilli, R.;Ciccoli, L.;Hayek, J.",2012,,,0,
972,Importance of HDL-c for the occurrence of cardiovascular disease in the elderly,"Background: Studies on the impact of HDL-c and the occurrence of cardiovascular disease (CV) in the elderly are scarce. Objective: To evaluate the clinical and laboratory variables and the occurrence of CV events in elderly patients stratified according to the behavior of HDL-c during an eight-year follow up. Methods: We evaluated 81 elderly patients, mean age of 68.51 ± 6.32 years (38.2% male), in two stages (A1 and A2), with a minimum interval of five years. The subjects were divided into 3 groups according to HDL-c levels: normal HDL-c in both assessments (NG) (n = 31), low HDL-c in both assessments (LG) (n = 21) and variable HDL-c in A1 and A2 (VG) (n = 29). Main CV events were recorded: coronary heart disease (angina, myocardial infarction, percutaneous / surgical myocardial revascularization), stroke, transient ischemic attack, carotid disease, dementia and heart failure. Results: The groups did not differ in gender and age in A1 and A2. Mean triglyceride levels were lower in the NG in A1 (p = 0.027) and A2 (p = 0.016) than in the LG. The distribution of CV events was as follows: 13 events in the NG (41.9%), 16 (76.2%) in the LG, and 12 (41.4%) in the VG (χ2 = 7.149, p = 0.024). The logistic regression analysis showed that the older the patient (OR = 1.187, p = 0.0230) and the lower the HDL-c (OR = 0.9372, p = 0.0102), the greater the occurrence of events CV. Conclusion: Permanently low HDL-c during eight years of monitoring is a risk factor for the development of CV events in the elderly.",cholesterol;high density lipoprotein cholesterol;low density lipoprotein cholesterol;triacylglycerol;aged;angina pectoris;article;body height;body mass;body weight;cardiovascular disease;carotid artery disease;cholesterol blood level;clinical assessment;clinical evaluation;controlled study;dementia;diastolic blood pressure;female;follow up;geriatric patient;heart failure;heart infarction;heart muscle revascularization;human;major clinical study;male;percutaneous coronary intervention;cerebrovascular accident;systolic blood pressure;transient ischemic attack;triacylglycerol blood level,"De Freitas, E. V.;Brandão, A. A.;Pozzan, R.;Magalhães, M. E.;Fonseca, F.;Pizzi, O.;Campana, É;Brandão, A. P.",2009,,,0,
973,"Advance care planning and dying in nursing homes in Flanders, Belgium: A nationwide survey","Context: In Belgium, data on actual advance care planning (ACP) in nursing homes (NHs) are scarce. Objectives: To investigate the prevalence and characteristics of documented advance directives and physicians' orders for end-of-life care in NHs, and the authorization of a legal representative in relation to the residents' demographic and clinical characteristics and care received. Methods: This was a retrospective cross-sectional study, including all NH residents deceased during September and October 2006 in all 594 NHs in Flanders, Belgium. Structured mail questionnaires about the resident's characteristics, hospital transfers, palliative care delivery, ACPs, and authorization of legal representatives were completed via the NH administrators and nurses involved in the care of the resident. Results: Administrators of 318 NHs (53.5%) reported 1303 deaths. Nurses provided information about 1240 (95.2%) of these deaths. At the end of life, NH residents often had dementia (65.2%) and were severely dependent (76.1%). Almost half (43.1%) had at least one hospital transfer during the last three months of life and two-thirds received palliative care. Half had an ACP, predominantly a physician's order and less often an advance directive. Having advance directives or physician's orders was associated with receiving palliative care. Residents with a physician's order more often died in the NH. Nine percent had an authorized legal representative. Conclusion: Prevalence of ACPs and formal authorization of a legal representative was low among the deceased NH residents in Flanders, Belgium. There was a higher prevalence of physicians' orders, often established after the resident had lost capacity. Initiatives should be developed to stimulate more advance discussion on care options and making end-of-life decision with the residents while they retain capacity. © 2013 U.S. Cancer Pain Relief Committee.",aged;article;Belgium;cardiopulmonary arrest;cross-sectional study;dementia;female;follow up;human;length of stay;living will;major clinical study;male;nursing home;palliative therapy;patient care;patient transport;resident;retrospective study;terminal care,"De Gendt, C.;Bilsen, J.;Stichele, R. V.;Deliens, L.",2013,,,0,
974,Biventricular thrombosis in biventricular stress(takotsubo)-cardiomyopathy,"Endo-ventricular thrombosis represents a possible clinical complication of stress(takotsubo)-cardiomyopathy (SC). Depressed ventricular systolic ventricular function, localized left ventricular (LV) dyskinesis, but also an increased pro-thrombotic state induced by catecholamine surge may facilitate the occurrence of endovascular thrombosis in SC. SC, however, may also present as right ventricular (RV) dysfunction or even as biventricular ballooning. Ventricular thrombosis may therefore theoretically occur in either ventricles or both. We report the case of an 88-year old woman, with vascular dementia and depression, admitted for abdominal pain, diarrhea, and rectal bleeding. Unexpectedly, electrocardiogram showed induced QT-prolongation with diffuse negative T-waves, while echocardiogram severe LV dysfunction (ejection fraction 35%), but also RV dysfunction and biventricular thrombosis. The diagnosis was therefore biventricular SC complicated by biventricular thrombosis; LV recovered after 10 days. When SC presents with a biventricular involvement, a careful assessment of either ventricular cavities should be therefore recommended to exclude the presence of (bi)ventricular thrombosis. It remains unresolved whether biventricular SC may represent a condition at higher risk of ventricular thrombosis.",Biventricular dyskinesis;Biventricular thrombosis;Stress cardiomyopathy,"De Gennaro, L.;Ruggiero, M.;Musci, S.;Tota, F.;De Laura, D.;Resta, M.;Locuratolo, N.;Santoro, F.;Brunetti, N. D.;Caldarola, P.",2017,Aug,,0,
975,Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data,,cerebrovascular accident;chronic obstructive lung disease;comorbidity;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;disease course;electronic medical record;emergency ward;follow up;high risk patient;hospital admission;hospital mortality;hospital readmission;hospitalization;human;laboratory;letter;medical history;neoplasm;priority journal;risk assessment;risk factor,"De Giorgi, A.;Fabbian, F.",2017,,10.1097/mlr.0000000000000793,0,
976,Performing Survival Analyses in the Presence of Competing Risks: A Clinical Example in Older Breast Cancer Patients,"An important consideration in studies that use cause-specific endpoints such as cancer-specific survival or disease recurrence is that risk of dying from another cause before experiencing the event of interest is generally much higher in older patients. Such competing events are of major importance in the design and analysis of studies with older patients, as a patient who dies from another cause before the event of interest cannot reach the endpoint. In this Commentary, we present several clinical examples of research questions in a population-based cohort of older breast cancer patients with a high frequency of competing events and discuss implications of choosing models that deal with competing risks in different ways. We show that in populations with high frequency of competing events, it is important to consider which method is most appropriate to estimate cause-specific endpoints. We demonstrate that when calculating absolute cause-specific risks the Kaplan-Meier method overestimates risk of the event of interest and that the cumulative incidence competing risks (CICR) method, which takes competing risks into account, should be used instead. Two approaches are commonly used to model the association between prognostic factors and cause-specific survival: the Cox proportional hazards model and the Fine and Gray model. We discuss both models and show that in etiologic research the Cox Proportional Hazards model is recommended, while in predictive research the Fine and Gray model is often more appropriate. In conclusion, in studies with cause-specific endpoints in populations with a high frequency of competing events, researchers should carefully choose the most appropriate statistical method to prevent incorrect interpretation of results.",breast cancer;cancer incidence;cancer patient;cancer prognosis;cancer risk;cancer staging;cancer survival;cardiovascular disease;cause specific survival;conceptual framework;dementia;distant metastasis;groups by age;heart infarction;human;Kaplan Meier method;lymph node metastasis;mental disease;note;priority journal;proportional hazards model;risk assessment;statistical analysis;survival time,"De Glas, N. A.;Kiderlen, M.;Vandenbroucke, J. P.;De Craen, A. J. M.;Portielje, J. E. A.;Van De Velde, C. J. H.;Liefers, G. J.;Bastiaannet, E.;Le Cessie, S.",2016,,,0,
977,Non-communicable disease clinical practice guidelines in Brazil: A systematic assessment of methodological quality and transparency,"Background Annually, non-communicable diseases (NCDs) kill 38 million people worldwide, with low and middle-income countries accounting for three-quarters of these deaths. High-quality clinical practice guidelines (CPGs) are fundamental to improving NCD management. The present study evaluated the methodological rigor and transparency of Brazilian CPGs that recommend pharmacological treatment for the most prevalent NCDs. Methods We conducted a systematic search for CPGs of the following NCDs: asthma, atrial fibrillation, benign prostatic hyperplasia, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease and/or stable angina, dementia, depression, diabetes, gastroesophageal reflux disease, hypercholesterolemia, hypertension, osteoarthritis, and osteoporosis. CPGs comprising pharmacological treatment recommendations were included. No language or year restrictions were applied. CPGs were excluded if they were merely for local use and referred to NCDs not listed above. CPG quality was independently assessed by two reviewers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II). Main Findings ""Scope and purpose"" and ""clarity and presentation"" domains received the highest scores. Sixteen of 26 CPGs were classified as low quality, and none were classified as high overall quality. No CPG was recommended without modification (77% were not recommended at all). After 2009, 2 domain scores (""rigor of development"" and ""clarity and presentation"") increased (61% and 73%, respectively). However, ""rigor of development"" was still rated < 30%. Conclusion Brazilian healthcare professionals should be concerned with CPG quality for the treatment of selected NCDs. Features that undermined AGREE II scores included the lack of a multidisciplinary team for the development group, no consideration of patients' preferences, insufficient information regarding literature searches, lack of selection criteria, formulating recommendations, authors' conflict of interest disclosures, and funding body influence.",article;asthma;atrial fibrillation;Brazil;chronic obstructive lung disease;congestive heart failure;controlled study;coronary artery disease;dementia;depression;diabetes mellitus;gastroesophageal reflux;health care personnel;health care quality;human;hypercholesterolemia;hypertension;non communicable disease;osteoarthritis;osteoporosis;practice guideline;prostate hypertrophy;stable angina pectoris,"De Godoi Rezende Costa Molino, C.;Romano-Lieber, N. S.;Ribeiro, E.;De Melo, D. O.",2016,,10.1371/journal.pone.0166367,0,
978,Relationship between kidney function and risk of asymptomatic peripheral arterial disease in elderly subjects,"Background: Limited data exist regarding the relationship between kidney function and incident asymptomatic peripheral arterial disease (PAD).Methods. The study population consisted of 2881 participants of the Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg, Bavaria, a community-based cohort of elderly individuals. Kidney function was calculated as creatinine clearance (Ccr) estimated by the CockcroftGault formula. Incident PAD was defined as a new onset of ankle-brachial index < 0.9 assessed at regular examinations among those with an ankle brachial pressure index (ABPI) ≥ 0.9 at baseline. Relative risks (RR) for PAD were compared across declining kidney function quartiles.Results. Mean serum concentration of creatinine and Ccr were 0.82 ± 0.31 mg/dL and 78 ± 21 mL/min/1.73 m2. After 6 years of follow-up, 478 (17%) participants developed incident asymptomatic PAD. After adjustment for demographic factors and cardiovascular risk factors, lower Ccr quartiles were directly associated with a higher risk of PAD. Compared with participants in quartile 1 (> 89 mL/min/1.73 m 2), the adjusted RR (95% CI) for PAD were 1.01 (0.88-1.19) for quartile 2 (75-89 mL/min/1.73 m2), 1.05 (0.93-1.23) for quartile 3 (64-75 mL/min/1.73 m2) and 1.10 (1.01-1.44) for quartile 4 (< 64 mL/min/1.73 m2; P = 0.009 for trend). Cardiovascular events as a function of baseline Ccr and incident PAD showed that most vascular events occurred in participants with Ccr < 60 mL/min/1.73 m2 at baseline and incident PAD (log-rank test, P = 0.0018).Conclusions. Lower kidney function is associated with incident asymptomatic PAD. In addition, the combination of impaired kidney function and incident PAD better predicts cardiovascular outcomes. © The Author 2011. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.",C reactive protein;creatinine;glucose;hemoglobin A1c;high density lipoprotein cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;triacylglycerol;adult;aged;ankle brachial index;article;blood pressure;cardiovascular disease;cardiovascular risk;cholesterol blood level;chronic kidney disease;controlled study;creatinine blood level;creatinine clearance;demography;disease association;female;follow up;glucose blood level;hemoglobin blood level;human;hypertension;ischemic heart disease;kidney function;major clinical study;male;peripheral occlusive artery disease;priority journal;risk assessment;smoking;cerebrovascular accident;triacylglycerol blood level,"De Graauw, J.;Chonchol, M.;Poppert, H.;Etgen, T.;Sander, D.",2011,,,0,
979,Loss of venous integrity in cerebral small vessel disease: A 7-T MRI study in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL),"BACKGROUND AND PURPOSE - : Previous pathological studies in humans or in animal models have shown alterations of small arteries and veins within white matter lesions in cerebral small vessel disease. We aimed to evaluate in vivo, the integrity of the cerebral venous network using high-resolution MRI both within and outside white matter hyperintensities in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). METHODS - : High-resolution T2*-weighted images were obtained at 7-T in 13 CADASIL patients with no or only mild symptoms and 13 age- and sex-matched controls. Macroscopic veins were automatically counted in the centrum semiovale and compared between patients and controls. In addition, T2* was compared between groups in the normal-appearing white matter. RESULTS - : Vein density was found lower in CADASIL patients compared with that in controls (-14.6% in patients, P<0.001). This was detected both within and outside white matter hyperintensities. Mean T2*, that is presumably inversely related to the venous density, was also found increased in normal-appearing white matter of patients (+7.2%, P=0.006). All results were independent from the extent of white matter hyperintensities. CONCLUSIONS - : A significant reduction in the number of visible veins was observed in the centrum semiovale of CADASIL patients both within and outside white matter hyperintensities, together with an increase of T2* in the normal-appearing white matter. Additional studies are needed to decipher the exact implication of such vasculature changes in the appearance of white matter lesions. © 2014 American Heart Association, Inc.",adult;aged;article;blood vessel parameters;brain size;CADASIL;cerebrovascular disease;clinical article;clinical study;controlled study;density;female;human;in vivo study;male;Mini Mental State Examination;nuclear magnetic resonance imaging;priority journal;symptom;vascularization;vein density;white matter lesion,"De Guio, F.;Vignaud, A.;Ropele, S.;Duering, M.;Duchesnay, E.;Chabriat, H.;Jouvent, E.",2014,,,0,
980,Decision-making concerning the very old person living at home with deteriorating health,"A woman aged 87 and three man aged 87, 86 and 83, respectively, lived at home or in an old-people's home, in poor physical condition due to old age and diseases such as COPD and heart failure. One man was demented, the others did not wish hospital admission in case of further deterioriation. When the condition worsened due to infections and fractures, the GP to a limited extent performed diagnostics and treatment. The four patients died, three of them after admission and intensive treatment because the restricted policy had not been communicated clearly. In decision-making about the management of geriatric patients, it is important that the GP knows the patient's wishes, correctly assesses his physical condition and prognosis and communicates well with the patient's next of kin and other care-givers.",aged;article;caregiver;chronic obstructive lung disease;decision making;deterioration;female;fracture;general practitioner;geriatric care;health care policy;heart failure;home for the aged;hospital admission;human;infection;intensive care;male;patient guidance;physical disability;prognosis;relative;senile dementia,"De Haan, J.;Hutter, A. W.",2000,,,0,
981,Rofecoxib: The second COX-2 specific inhibitor,,acetylsalicylic acid;antihypertensive agent;antiinflammatory agent;celecoxib;cyclooxygenase 2 inhibitor;diclofenac;dipeptidyl carboxypeptidase inhibitor;ibuprofen;methotrexate;naproxen;nonsteroid antiinflammatory agent;placebo;rofecoxib;sulfone derivative;warfarin;Alzheimer disease;anticoagulant therapy;antihypertensive therapy;article;bleeding;blood pressure regulation;clinical trial;colon carcinoma;congestive heart failure;controlled study;coxitis;dose response;drug contraindication;drug efficacy;drug hypersensitivity;drug indication;drug monitoring;drug safety;drug specificity;drug tolerability;dysmenorrhea;fluid retention;peptic ulcer;heart protection;human;hypertension;kidney disease;knee osteoarthritis;leg edema;pain;prescription;rheumatoid arthritis;tooth pain;aspirin;celebrex;vioxx,"De Jager, J. P.",2001,,,0,
982,Assessment of adverse effects of Alzheimer's disease medications: Analysis of notifications to Regional Pharmacovigilance Centers in Northwest France,"The population ageing results in an increase of the incidence of dementia, in particularly the Alzheimer's disease. Currently, four drugs are indicated in this affection: donepezil, rivastigmine and galantamine which are three acetylcholinesterase inhibitors and memantine, a non competitive antagonist of N-methyl D-aspartate receptors of glutamate. We tried to assess the reported side effects of these medications next to four Regional Pharmacovigilance Centers in Northwest France since they have been introduced in the French market. We identified 71 observations of adverse drug events in which one of the Alzheimer's disease medications was suspected. More than a half of these side effects were serious, concerned in one third of cases the cardiac function, and in another one third the central nervous system. In most of cases, there has been a good outcome after drug interruption. In 21% of cases, the adverse events occurred at the start of the treatment or when increasing the dosage. Most of the reported side effects were common for drugs of the same class. Older patients seemed to be more likely to develop side effects with acetylcholinesterase inhibitors. Adverse drug events may have heavy consequences in old people with dementia, so it would be of interest to conduct further studies in order to compare the efficiency of these medications with their adverse effects incidence in long term prescriptions.",donepezil;galantamine;memantine;rivastigmine;adult;age distribution;aging;agitation;Alzheimer disease;angioneurotic edema;anorexia;article;bradycardia;bronchospasm;confusion;controlled study;convulsion;dehydration;dementia;disease severity;drug efficacy;drug safety;drug tolerability;female;France;human;insomnia;major clinical study;malaise;male;prescription;side effect;somnolence;treatment outcome;visual hallucination;vomiting,"De La Gastine, B.;Mosquet, B.;Coquerel, A.",2007,,,0,
983,Cerebromicrovascular pathology in Alzheimer's disease compared to normal aging,"A growing amount of data using light and electron microscopy, immunocytochemistry, uptake of brain markers and metabolic studies suggest that the pathogenesis of Alzheimer's disease may be due to impaired vascular delivery of nutrients to the brain. The bulk of this evidence indicates that cerebral capillary transport of glucose, oxygen and other vital nutrients is dysfunctional in Alzheimer brains due to abnormal hemodynamic flow patterns caused by structural deformities of the capillaries. Clinical disorders which can worsen cerebral blood flow, such as head injury, coronary artery disease, cerebrovascular ischemia or the presence of apolipoprotein E4 allele will increase the risk of Alzheimer's dementia. By contrast, activities that increase cerebral blood flow during aging such as complex thinking patterns or the use of drugs to reduce vascular resistance, such as aspirin or NSAIDs, will reduce the risk or improve the status of Alzheimer's disease. The production of neuritic plaques and neurofibrillary tangles may develop from the hypometabolic abnormalities caused by the impaired cerebromicrovasculature in Alzheimer brains. Such metabolic and cerebral blood flow changes are considerably less significant in age-matched control subjects. The major physiological, pathological and cognitive changes reported for Alzheimer's disease appear to have a common denominator which is reflected by the physically distorted cerebromicrovessels and their inability to optimally deliver nutrients to the brain, a condition which ultimately disturbs neurono-glial homeostasis.",acetylsalicylic acid;apolipoprotein E4;glucose;nonsteroid antiinflammatory agent;oxygen;aging;allele;Alzheimer disease;article;brain blood flow;brain capillary;brain ischemia;brain metabolism;brain vascular resistance;cognitive defect;comparative study;coronary artery disease;drug use;electron microscopy;glucose transport;head injury;hemodynamics;homeostasis;human;immunocytochemistry;neurofibrillary tangle;nutrient;oxygen transport;pathogenesis;pathology;priority journal;risk;senile plaque,"De La Torre, J. C.",1997,,,0,
984,Cardiovascular risk factors promote brain hypoperfusion leading to cognitive decline and dementia,"Heart disease is the major leading cause of death and disability in the world. Mainly affecting the elderly population, heart disease and its main outcome, cardiovascular disease, have become an important risk factor in the development of cognitive decline and Alzheimer's disease (AD). This paper examines the evidence linking chronic brain hypoperfusion induced by a variety of cardiovascular deficits in the development of cognitive impairment preceding AD. The evidence indicates a strong association between AD and cardiovascular risk factors, including ApoE(4), atrial fibrillation, thrombotic events, hypertension, hypotension, heart failure, high serum markers of inflammation, coronary artery disease, low cardiac index, and valvular pathology. In elderly people whose cerebral perfusion is already diminished by their advanced age, additional reduction of cerebral blood flow stemming from abnormalities in the heart-brain vascular loop ostensibly increases the probability of developing AD. Evidence also suggests that a neuronal energy crisis brought on by relentless brain hypoperfusion may be responsible for protein synthesis abnormalities that later result in the classic neurodegenerative lesions involving the formation of amyloid-beta plaques and neurofibrillary tangles. Insight into how cardiovascular risk factors can induce progressive cognitive impairment offers an enhanced understanding of the multifactorial pathophysiology characterizing AD and ways at preventing or managing the cardiovascular precursors of this dementia.",,"de la Torre, J. C.",2012,,10.1155/2012/367516,0,
985,Cerebral Perfusion Enhancing Interventions: A New Strategy for the Prevention of Alzheimer Dementia,"Cardiovascular and cerebrovascular diseases are major risk factors in the development of cognitive impairment and Alzheimer's disease (AD). These cardio-cerebral disorders promote a variety of vascular risk factors which in the presence of advancing age are prone to markedly reduce cerebral perfusion and create a neuronal energy crisis. Long-term hypoperfusion of the brain evolves mainly from cardiac structural pathology and brain vascular insufficiency. Brain hypoperfusion in the elderly is strongly associated with the development of mild cognitive impairment (MCI) and both conditions are presumed to be precursors of Alzheimer dementia. A therapeutic target to prevent or treat MCI and consequently reduce the incidence of AD aims to elevate cerebral perfusion using novel pharmacological agents. As reviewed here, the experimental pharmaca include the use of Rho kinase inhibitors, neurometabolic energy boosters, sirtuins and vascular growth factors. In addition, a compelling new technique in laser medicine called photobiomodulation is reviewed. Photobiomodulation is based on the use of low level laser therapy to stimulate mitochondrial energy production non-invasively in nerve cells. The use of novel pharmaca and photobiomodulation may become important tools in the treatment or prevention of cognitive decline that can lead to dementia.",dimethyl sulfoxide;growth factor;nitric oxide;Rho kinase inhibitor;sirtuin;unclassified drug;vascular growth factor;Alzheimer disease;angiogenesis;aorta;article;atrial fibrillation;brain blood flow;brain perfusion;cardiovascular risk;cerebrovascular disease;cognition;coronary artery disease;heart failure;human;hypertension;hypotension;low level laser therapy;mild cognitive impairment;mitral valve,"de la Torre, J. C.",2016,,,0,
986,Cerebral white matter lesions and lacunar infarcts contribute to the presence of mild parkinsonian signs,"BACKGROUND AND PURPOSE-: Mild parkinsonian signs (MPS) are common in elderly people and may be an early stage of parkinson(ism). They might be related to cerebral small-vessel disease, although this association remains incompletely understood. To identify subjects at early stages of the disease, we investigated whether the presence of MPS was dependent on the severity and location of small-vessel disease, including white matter lesions and lacunar infarcts. METHODS-: Four hundred thirty individuals, with small-vessel disease, aged between 50 and 85 years, without dementia or parkinsonism, were included in this analysis and underwent MRI scanning. The number and location of lacunar infarcts were rated. White matter lesion volume was assessed by manual segmentation with automated delineating of different regions. Presence of MPS was based on the motor section of the Unified Parkinson's Disease Rating Scale. Associations were determined using logistic regression analysis adjusted for age, sex, and total brain volume. RESULTS-: Severe white matter lesions and the presence of lacunar infarcts were independently associated with the presence of MPS (OR, 2.6; 95% CI, 1.3-4.9 and OR, 1.8; 95% CI, 1.0-3.0). Frontal and parietal white matter lesions and, to a lesser extent, lacunar infarcts in the thalamus were associated with a higher risk of MPS. The presence of lacunar infarcts was independently related to the bradykinesia category of parkinsonian signs. CONCLUSIONS-: This study shows that severe small-vessel disease, especially at certain locations, is associated with MPS signs in older adults. Our findings suggest that small-vessel disease interrupts basal ganglia-thalamocortical circuits involving both the frontal and parietal lobes and hence may result in MPS. © 2012 American Heart Association, Inc.",adult;aged;article;bradykinesia;brain damage;brain region;brain size;disease association;disease severity;female;frontal lobe;gait disorder;high risk patient;human;lacunar stroke;major clinical study;male;mild parkinsonian sign;muscle rigidity;nuclear magnetic resonance imaging;parietal lobe;parkinsonism;priority journal;thalamus;tremor;Unified Parkinson Disease Rating Scale;white matter,"De Laat, K. F.;Van Norden, A. G. W.;Gons, R. A. R.;Van Uden, I. W. M.;Zwiers, M. P.;Bloem, B. R.;Van Dijk, E. J.;De Leeuw, F. E.",2012,,,0,
987,A follow-up study of blood pressure and cerebral white matter lesions,"White matter lesions are often observed on cerebral magnetic resonance imaging scans of elderly people and may play a role in the pathogenesis of dementia. Cross-sectional studies have shown an association between elevated blood pressure and white matter lesions. We prospectively studied the relation between blood pressure and white matter lesions in 1,077 subjects aged 60 to 90 years who were randomly sampled from two prospective population-based studies. One study had blood pressure measurements 20 years before, the other 5 years before. Overall response for the magnetic resonance imaging study was 63%, and declined from 73% among 60- to 70-year-olds to 48% for 80- to 90-year-olds. Diastolic and systolic blood pressure levels assessed 20 years before were significantly associated with subcortical and periventricular white matter lesions. The association between 20-year change in diastolic blood pressure and subcortical white matter lesions was J-shaped (relative risk, 2.2; 95% confidence interval, 1.0-5.2; and relative risk, 3.2; 95% confidence interval, 1.4-7.4, for decrease or increase of more than 10 mm Hg, respectively). The association between concurrent diastolic blood pressure level and white matter lesions was linear in subjects without, and J-shaped in subjects with, a history of myocardial infarction. Our results indicate that the J-shape relationship of diastolic blood pressure is not restricted to cardiovascular disease, but is also manifest in cerebrovascular disease.",adult;aged;article;blood pressure regulation;brain injury;cardiovascular autoregulation;cerebrovascular disease;dementia;diastolic blood pressure;female;heart infarction;human;male;priority journal;systolic blood pressure;white matter,"De Leeuw, F. E.;De Groot, J. C.;Oudkerk, M.;Witteman, J. C. M.;Hofman, A.;Van Gijn, J.;Breteler, M. M. B.",1999,,,0,
988,Frailty: An emerging concept for general practice,"Ageing of the population in western societies and the rising costs of health and social care are refocusing health policy on health promotion and disability prevention among older people. However, efforts to identify at-risk groups of older people and to alter the trajectory of avoidable problems associated with ageing by early intervention or multidisciplinary case management have been largely unsuccessful. This paper argues that this failure arises from the dominance in primary care of a managerial perspective on health care for older people, and proposes instead the adoption of a clinical paradigm based on the concept of frailty. Frailty, in its simplest definition, is vulnerability to adverse outcomes. It is a dynamic concept that is different from disability and easy to overlook, but also easy to identify using heuristics (rules of thumb) and to measure using simple scales. Conceptually, frailty fits well with the biopsychosocial model of general practice, offers practitioners useful tools for patient care, and provides commissioners of health care with a clinical focus for targeting resources at an ageing population. ©British Journal of General Practice.",growth hormone;prasterone;testosterone;adverse outcome;aged;amnesia;androgen therapy;caloric intake;cancer chemotherapy;cancer radiotherapy;clinical assessment;comorbidity;daily life activity;death;dementia;diabetes mellitus;disability;drug utilization;emergency care;emotion;exercise;falling;fatigue;frail elderly;functional assessment;general practice;general practitioner;geriatric care;health behavior;health care management;heart disease;heart failure;hospital admission;human;institutionalization;kinesiotherapy;leg ulcer;mobilization;mood;morbidity;muscle exercise;muscle mass;muscle training;note;nursing home;palliative therapy;physical activity;physical performance;primary medical care;quality of life;social psychology;social support;wellbeing,"De Lepeleire, J.;Iliffe, S.;Mann, E.;Degryse, J. M.",2009,,,0,
989,Comorbidity and mortality following hip fracture: a population-based cohort study,"BACKGROUND AND AIMS: Identifying predictors for mortality following hip fracture is essential in order to improve survival, especially among the elderly. We compared mortality after hip fracture to controls without hip fracture, and assessed the impact of comorbidity on mortality following hip fracture in a population-based cohort study. METHODS: The health care databases in Western Denmark (1.4 million inhabitants) were used to identify all persons > or = 40 years of age with first-time hospitalization for hip fracture between 1/1/1998 and 1/31/2003. Five population controls without hip fracture were matched to hip fracture patients on age and gender. Prior hospitalization for selected comorbidities among hip fracture subjects was assessed from hospital discharge registries. Cox regression analysis was used to compute crude and adjusted relative risks and 95% confidence intervals for 30-day, 90-day, and 1-year mortality associated with hip fracture, and with prior hospital history of selected comorbidities. RESULTS: The cohort was followed for an average of 22 months. Females comprised 71% of the cohort and 90% was aged 65 years or older. Compared to persons without hip fracture, persons with hip fracture had from 2 to >3-fold higher risk of death at 1 year. History of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), dementia, tumor, and malignancy increased adjusted 1-year mortality from 50% to 3-fold among persons with hip fracture. CONCLUSIONS: Hip fracture increased 1-year mortality more than 3-fold compared with mortality without hip fracture. Among hip fracture subjects, the presence of selected comorbidities further increased the risk of mortality after hip fracture.","Adult;Aged;Aged, 80 and over;*Comorbidity;Female;*Hip Fractures/mortality/physiopathology;Humans;Male;Middle Aged;Regression Analysis;Risk Factors;Survival Rate","de Luise, C.;Brimacombe, M.;Pedersen, L.;Sorensen, H. T.",2008,Oct,,0,
990,Trends in hospitalizations for community-acquired pneumonia in Spain: 2004 to 2013,"Aim To describe trends in the incidence and outcomes of community-acquired pneumonia (CAP) hospitalizations in Spain (2004–2013). Methods We used national hospital discharge data to select all hospital admissions for CAP as primary diagnosis. We analyzed incidence, Charlson comorbidity index (CCI), diagnostic and therapeutic procedures, pathogens, length of hospital stay (LOHS), in-hospital mortality (IHM) and readmission. Results We identified 959,465 admissions for CAP. Incidence rates of CAP increased significantly over time (from 142.4 in 2004 to 163.87 cases per 100,000 inhabitants in 2013). Time trend analyses showed significant increases in the number of comorbidities and the use of CAT of thorax, red cell transfusion, non-invasive mechanical ventilation and readmissions (all p values < 0.05). S. pneumoniae was the most frequent causative agent, but its isolation decreased over time. Overall median of LOHS was 7 days and it did not change significantly during the study period. Time trend analyses also showed significant decreases in mortality during admission for CAP. Factor associated with higher IHM included: older age, higher CCI, S. aureus isolated, use of red cell transfusion or mechanical ventilation and readmission. Conclusions The incidence and mortality of CAP have changed in Spain from 2004 to 2013. Although there was an increased incidence of hospitalization for this disease over time, we saw a significant reduction in IHM.",acute heart infarction;adult;aged;article;artificial ventilation;cerebrovascular disease;Charlson Comorbidity Index;chronic obstructive lung disease;community acquired pneumonia;comorbidity;congestive heart failure;dementia;erythrocyte transfusion;female;hemiplegia;hospital admission;hospital discharge;hospital mortality;hospital readmission;hospitalization;human;incidence;major clinical study;male;malignant neoplasm;non insulin dependent diabetes mellitus;obesity;observational study;paraplegia;peripheral vascular disease;retrospective study;Spain;Streptococcus pneumonia;very elderly,"de Miguel-Díez, J.;Jiménez-García, R.;Hernández-Barrera, V.;Jiménez-Trujillo, I.;de Miguel-Yanes, J. M.;Méndez-Bailón, M.;López-de-Andrés, A.",2017,,10.1016/j.ejim.2016.12.010,0,
991,Pharmacogenetics of cerebrovascular metabolism modulators in dementia due to Alzheimer’s disease,"The aims of this study were to investigate risk factors for cognitive and functional decline among 193 patients with Alzheimer’s disease dementia (AD), and to conduct pharmacogenetic analysis on cerebrovascular metabolism modulators, taking into account APOE haplotypes and the genotypes of ACE, CETP, LDLR and the LXR-β gene. For all patients, later age at AD onset was the most important risk factor for faster cognitive and functional decline, while the late-life coronary heart disease risk was inversely related to cognitive decline only for carriers of APOE4+ haplotypes. Schooling was protective against cognitive decline only for women and carriers of APOE4+ haplotypes, while higher body mass index in late life was protective against cognitive decline only for men. Carriers of the APOE-ε4/ε4 haplotype had earlier AD onset, whereas genotypes of CETP and LDLR that had traditionally been associated with higher risk of AD were associated with later onset of dementia. Angiotensin-converting enzyme inhibitors caused a 50% reduction in Mini-Mental State Examination score changes, and had better disease-modifying properties than did centrally-acting angiotensin-converting enzyme inhibitors alone. Angiotensin receptor blockers had genetically mediated effects that led to faster cognitive and functional decline, while patients with genetic tendencies towards faster cognitive and functional decline had maximum benefits when they used lipophilic statins, and vice versa.",dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;Alzheimer disease;article;body mass;cognition;dementia;haplotype;human;ischemic heart disease;major clinical study;Mini Mental State Examination;pharmacogenetics;risk factor;school,"de Oliveira, F. F.",2015,,,0,
992,Assessment of risk factors for earlier onset of sporadic Alzheimer's disease dementia,"BACKGROUND: Pharmacological treatment has mild effects for patients with Alzheimer's disease dementia (AD); therefore, the search for modifiable risk factors is an important challenge. Though risk factors for AD are widely recognized, elements that influence the time of dementia onset have not been comprehensively reported. We aimed to investigate which risk factors might be related to the age of onset of AD in a sample of patients with highly variable educational levels, taking into account the Framingham risk scoring as the sole measure of vascular risk. SUBJECTS AND METHODS: We included 209 consecutive late-onset AD patients to find out which factors among educational levels, coronary heart disease risk estimated by way of Framingham risk scores, history of head trauma or depression, surgical procedures under general anesthesia, family history of neurodegenerative diseases, gender, marital status and APOE haplotypes might be related to the age of dementia onset in this sample of patients with low mean schooling. RESULTS: Mean age of AD onset was 73.38+/-6.5 years old, unaffected by schooling or family history of neurodegenerative diseases. Patients who were APOE-epsilon4 carriers, married, or with history of depression, had earlier onset of AD, particularly when they were women. Coronary heart disease risk was marginally significant for later onset of AD. CONCLUSIONS: APOE haplotypes, marital status and history of depression were the most important factors to influence the age of AD onset in this sample. While midlife cerebrovascular risk factors may increase incidence of AD, they may lead to later dementia onset when present in late life.","Age of Onset;Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology/*genetics;Apolipoprotein E4/*genetics;Dementia/epidemiology/genetics;Educational Status;Female;Haplotypes;Humans;Male;Middle Aged;Risk Factors","de Oliveira, F. F.;Bertolucci, P. H.;Chen, E. S.;Smith, M. C.",2014,Nov-Dec,10.4103/0028-3886.149384,0,
993,Increased susceptibility to amyloid-beta-induced neurotoxicity in mice lacking the low-density lipoprotein receptor,"Familial hypercholesterolemia is caused by inherited genetic abnormalities that directly or indirectly affect the function of the low-density lipoprotein (LDL) receptor. This condition is characterized by defective catabolism of LDL which results in increased plasma cholesterol concentrations and premature coronary artery disease. Nevertheless, there is increasing preclinical and clinical evidence indicating that familial hypercholesterolemia subjects show a particularly high incidence of mild cognitive impairment. Moreover, the LDL receptor (LDLr) has been implicated as the main central nervous system apolipoprotein E receptor that regulates amyloid deposition in distinct mouse models of beta-amyloidosis. In this regard, herein we hypothesized that the lack of LDLr would enhance the susceptibility to amyloid-beta-(Abeta)-induced neurotoxicity in mice. Using the acute intracerebroventricular injection of aggregated Abeta(1-40) peptide (400 pmol/mouse), a useful approach for the investigation of molecular mechanisms involved in Abeta toxicity, we observed oxidative stress, neuroinflammation, and neuronal membrane damage within the hippocampus of C57BL/6 wild-type mice, which were associated with spatial reference memory and working memory impairments. In addition, our data show that LDLr knockout (LDLr(-/-)) mice, regardless of Abeta treatment, displayed memory deficits and increased blood-brain barrier permeability. Nonetheless, LDLr(-/-) mice treated with Abeta(1-40) peptide presented increased acetylcholinesterase activity, astrogliosis, oxidative imbalance, and cell permeability within the hippocampus in comparison with Abeta(1-40)-treated C57BL/6 wild-type mice. Overall, the present study shows that the lack of LDLr increases the susceptibility to Abeta-induced neurotoxicity in mice providing new evidence about the crosslink between familial hypercholesterolemia and cognitive impairment.","Acetylcholinesterase/metabolism;Amyloid beta-Peptides;Amyloidosis/complications/pathology/*physiopathology;Animals;Antioxidants/metabolism;Astrocytes/pathology/physiology;Blood-Brain Barrier/physiopathology;Capillary Permeability/physiology;Cell Membrane Permeability/physiology;Disease Models, Animal;Gliosis/pathology/physiopathology;Hippocampus/pathology/*physiopathology;Memory Disorders/etiology/pathology/*physiopathology;Memory, Short-Term/physiology;Mice, Inbred C57BL;Mice, Knockout;Neuroimmunomodulation/physiology;Oxidative Stress/physiology;Peptide Fragments;Prefrontal Cortex/pathology/*physiopathology;Receptors, LDL/genetics/*metabolism;Spatial Memory/physiology;Superoxide Dismutase/metabolism;Alzheimer's disease;LDL receptor;amyloid-beta peptide;hypercholesterolemia;learning and memory;oxidative stress","de Oliveira, J.;Moreira, E. L.;dos Santos, D. B.;Piermartiri, T. C.;Dutra, R. C.;Pinton, S.;Tasca, C. I.;Farina, M.;Prediger, R. D.;de Bem, A. F.",2014,,10.3233/jad-132228,0,
994,Pathogenesis of Binswanger chronic progressive subcortical encephalopathy,"We studied the clinicopathologic findings in four hypertensive patients with multiple leukomalacia, demyelinated lesions, and lacunar state. Only one patient had clinical evidence of dementia. The preventricular watershed infarcts were attributed to transient episodes of cardiac failure in brains with a compromised circulation in the territory of the deep perforating branches. These observations suggest that Binswanger encephalopathy does not differ from multi-infarct dementia.",autopsy;Binswanger encephalopathy;case report;central nervous system;electron microscopy;etiology;histology;pathogenesis,"De Reuck, J.;Crevits, L.;De Coster, W.",1980,,,0,
995,Magnetic resonance imaging of cardiovascular function and the brain: Is dementia a cardiovascular-driven disease?,"The proximal aorta acts as a coupling device between heart and brain perfusion, modulating the amount of pressure and flow pulsatility transmitted into the cerebral microcirculation. Stiffening of the proximal aorta is strongly associated with age and hypertension. The detrimental effects of aortic stiffening may result in brain damage as well as heart failure. The resulting cerebral small vessel disease and heart failure may contribute to early cognitive decline and (vascular) dementia. This pathophysiological sequence of events underscores the role of cardiovascular disease as a contributory mechanism in causing cognitive decline and dementia and potentially may provide a starting point for prevention and treatment. Magnetic resonance imaging is well suited to assess the function of the proximal aorta and the left ventricle (eg, aortic arch pulse wave velocity and distensibility) as well as the various early and late manifestations of cerebral small vessel disease (eg, microbleeds and white matter hyperintensities in strategically important regions of the brain). Specialized magnetic resonance imaging techniques are explored for diagnosing preclinical changes in white matter integrity or brain microvascular pulsatility.",aging;aorta;aortic arch;aortic root;arterial stiffness;artery compliance;article;ascending aorta;brain blood flow;brain damage;brain function;brain microcirculation;brain perfusion;cardiovascular disease;cardiovascular function;cardiovascular risk;cerebrovascular disease;cognitive defect;dementia;heart cycle;heart failure;heart function;heart left ventricle;human;mental deterioration;neuroimaging;nuclear magnetic resonance imaging;pathophysiology;priority journal;pulse pressure;pulse wave;systolic blood pressure;white matter,"De Roos, A.;Van Der Grond, J.;Mitchell, G.;Westenberg, J.",2017,,10.1161/circulationaha.116.021978,0,
996,Prevalence and Associations of the Use of Proton-Pump Inhibitors in Nursing Homes: A Cross-Sectional Study,"Objectives: Very scarce information is available about the use of proton-pump inhibitors (PPI) in nursing homes (NH). This study investigated the factors associated with PPI use among NH residents. Design: Cross-sectional. Setting: One hundred seventy-five NHs in Midi-Pyrénées region, South-Western France. Participants: Data was collected for 6275 NH residents. Participants (73.7% women) were aged 86 years (±8.2). Measurements: NH staff sent participants' drug prescriptions to research team; they also recorded information on residents' health characteristics. A binary logistic regression was performed on PPI use. Results: PPI use was highly prevalent (n = 2 370, ie, 37.8%). Whilst peptic ulcer (OR 4.741; 95% CI 3.647-6.163) and nonsteroidal anti-inflammatory drugs (OR 2.124; 95% CI 1.528-2.951) were important indicators of PPI use, they explained just a small fraction of PPI prescriptions; most prescriptions were probably inappropriately related to a general condition of health vulnerability, reflected by polypharmacy and comorbidities. Conclusions: Vulnerable people take PPIs more often in NHs. Physicians must be aware about the health risks possibly induced by inappropriate PPI use when prescribing these drugs for NH residents. © 2013.",nonsteroid antiinflammatory agent;proton pump inhibitor;ADL disability;aged;article;behavior disorder;cerebrovascular accident;comorbidity;congestive heart failure;cross-sectional study;dementia;depression;drug use;female;France;general condition;health hazard;heart infarction;hemiplegia;hospitalization;human;inappropriate prescribing;length of stay;major clinical study;male;mental disease;nursing home;nursing home patient;nursing home personnel;pain;peptic ulcer;peripheral vascular disease;polypharmacy;prescription;prevalence;vulnerable population,"De Souto Barreto, P.;Lapeyre-Mestre, M.;Mathieu, C.;Piau, C.;Bouget, C.;Cayla, F.;Vellas, B.;Rolland, Y.",2013,,,0,
997,A multicentric individually-tailored controlled trial of education and professional support to nursing home staff: Research protocol and baseline data of the IQUARE study,"Background: Whilst the number of people living in nursing homes (NH) is expected to rise, research on NH quality is scarce. The purpose of this article is to describe the research protocol of the IQUARE study and to present its baseline data. Methods and design: IQUARE is a 18-month multicentric individually-tailored controlled trial of education and professional support to NH staff. The main purposes of IQUARE are to improve the quality of the health care provided in NHs and to reduce the risk of functional decline among residents. Data on internal organisation and residents' health for the 175 participating NHs were recorded by NH staff at baseline. NHs were allocated to either a light intervention group (LIG, n = 90 NHs, totalising 3 258 participants) or a strong intervention group (SIG, n = 85 NHs, totalising 3 017 participants). Intervention for LIG consisted at delivering to NH staff descriptive statistics on indicators of quality regarding their NH and the NHs from their sub-region of health and region; whereas for SIG, NH staff received the same information that LIG, but quality indicators were discussed by a cooperative work (two half-day meetings) between a hospital geriatrician and NH staff. Strategies for overcoming NH's weaknesses were then traced; the efficacy of strategies is evaluated at a 6-month period. Results: Baseline data showed high levels of dependence, comorbidities, psychological disturbances and medication's consumption among NH residents. Large discrepancies among NHs were observed. Conclusions: IQUARE is one of the largest controlled trials in NHs developed in France. Results from IQUARE may constitute the basis for the development of new work modalities within the French health system, and serve as a model of a feasible research approach in NHs. © 2013 Serdi and Springer-Verlag France.",article;caregiver support;cerebrovascular accident;chronic lung disease;clinical protocol;comorbidity;congestive heart failure;dementia;depression;descriptive research;diabetes mellitus;epilepsy;female;follow up;health care organization;health care quality;heart infarction;hemiplegia;human;hypertension;kidney disease;major clinical study;male;medical education;neoplasm;nursing home;nursing home personnel;outcome assessment;peripheral vascular disease;priority journal;sample size,"De Souto Barreto, P.;Lapeyre-Mestre, M.;Mathieu, C.;Piau, C.;Bouget, C.;Cayla, F.;Vellas, B.;Rolland, Y.",2013,,,0,
998,"Multimorbidity type, hospitalizations and emergency department visits among nursing home residents: A preliminary study","Conclusions: Mental diseases in very old and multimorbid NH residents probably moderate the associations between physical diseases and hospitalizations. To what extent this represents either a mirror of better clinical practice in NHs or the under-recognition from the NH staff of symptoms leading to justifiable hospitalizations remains unclear. Methods: This is a cross-sectional study among NH residents. Information on residents’ health, number of hospitalizations in the last 12 months and hospital department of admission (having been seen in ED vs. non) was recorded by NH staff of 175 French NHs (data was collected in 2011). Participants were screened for the presence of several mental (e.g., dementia) and physical conditions (e.g., diabetes). Results: Data on hospitalization was available for 6076 NH residents. Compared to having no diseases, the concomitant presence of ≥ 2 physical conditions was the multimorbidity type more strongly associated with both the number of hospitalizations (incidence rate ratio (IRR) =1.93; 95% confidence interval (CI) =1.57 − 2.37) and ED visits (odds ratio (OR)= 1.79; 95% CI=1.24 − 2.58). The presence of a mental condition appeared to moderate the associations between physical conditions and hospitalizations, since the estimate effects were lower among people who had both physical and mental conditions, compared to those with only physical conditions. For example, compared to people with ≥ 2 physical conditions, those with multiple physical and mental conditions had lower IRR (IRR = 0.84; 95% CI=0.75 − 0.95) for the number of hospitalizations. Background: The burden of multimorbidity in institutionalized elderly is poorly investigated. We examined the associations of the type of multimorbidity (i.e., physical, mental or both) with the number of hospitalizations and emergency department (ED) visits in nursing home (NH) residents.",NCT01703689;aged;article;cerebrovascular accident;Charlson Comorbidity Index;chronic lung disease;comorbidity;congestive heart failure;controlled clinical trial (topic);controlled study;cross-sectional study;dementia;depression;diabetes mellitus;disease association;emergency care;emergency ward;female;follow up;heart infarction;hospitalization;human;major clinical study;male;malignant neoplastic disease;mental disease;mental health;multicenter study (topic);nursing home;nursing home patient;pain;peripheral vascular disease,"de Souto Barreto, P.;Lapeyre-Mestre, M.;Vellas, B.;Rolland, Y.",2014,,,0,
999,Subtle gray matter changes in temporo-parietal cortex associated with cardiovascular risk factors,"Vascular risk factors may play an important role in the pathophysiology of Alzheimer's disease (AD). While there is consistent evidence of gray matter (GM) abnormalities in earlier stages of AD, the presence of more subtle GM changes associated with vascular risk factors in the absence of clinically significant vascular events has been scarcely investigated. This study aimed to examine GM changes in elderly subjects with cardiovascular risk factors. We predicted that the presence of cardiovascular risk would be associated with GM abnormalities involving the temporal-parietal cortices and limbic structures. We recruited 248 dementia-free subjects, age range 66-75 years, from the population-based ""Sao Paulo Ageing and Health Study"", classified in accordance to their Framingham Coronary Heart Disease Risk (FCHDR) score to undergo an MRI scan. We performed an overall analysis of covariance, controlled to total GM and APOE4 status, to investigate the presence of regional GM abnormalities in association with FCHDR subgroups (high-risk, medium-risk, and low-risk), and followed by post hoc t-test. We also applied a co-relational design in order to investigate the presence of linear progression of the GM vulnerability in association with cardiovascular risk factor. Voxel-based morphometry showed that the presence of cardiovascular risk factors were associated with regional GM loss involving the temporal cortices bilaterally. Those results retained statistical significance after including APOE4 as a covariate of interest. We also observed that there was a negative correlation between FCHDR scores and rGM distribution in the parietal cortex. Subclinical cerebrovascular abnormalities involving GM loss may provide an important link between cardiovascular risk factors and AD.",Aged;Cardiovascular Diseases/*epidemiology/*pathology;Cerebral Cortex/pathology;Female;Follow-Up Studies;Humans;Magnetic Resonance Imaging/methods;Male;Parietal Lobe/*pathology;Risk Factors;Temporal Lobe/*pathology,"de Toledo Ferraz Alves, T. C.;Scazufca, M.;Squarzoni, P.;de Souza Duran, F. L.;Tamashiro-Duran, J. H.;Vallada, H. P.;Andrei, A.;Wajngarten, M.;Menezes, P. R.;Busatto, G. F.",2011,,10.3233/jad-2011-110827,0,
1000,South African Menopause Society Council consensus statement on menopausal hormone therapy,,estrogen;gestagen;tibolone;adrenergic system;Alzheimer disease;article;breast cancer;cancer risk;colorectal cancer;disease association;early menopause;female;fragility fracture;hormone substitution;human;ischemic heart disease;medical society;menopausal syndrome;postmenopause osteoporosis;quality of life;risk benefit analysis;sleep disorder;South Africa;vagina atrophy;venous thromboembolism,"de Villiers, T. J.",2004,,,0,
1001,"Barriers to advance care planning in cancer, heart failure and dementia patients: a focus group study on general practitioners' views and experiences","BACKGROUND: The long-term and often lifelong relationship of general practitioners (GPs) with their patients is considered to make them the ideal initiators of advance care planning (ACP). However, in general the incidence of ACP discussions is low and ACP seems to occur more often for cancer patients than for those with dementia or heart failure. OBJECTIVE: To identify the barriers, from GPs' perspective, to initiating ACP and to gain insight into any differences in barriers between the trajectories of patients with cancer, heart failure and dementia. METHOD: Five focus groups were held with GPs (n = 36) in Flanders, Belgium. The focus group discussions were transcribed verbatim and analyzed using the method of constant comparative analysis. RESULTS: THREE TYPES OF BARRIERS WERE DISTINGUISHED: barriers relating to the GP, to the patient and family and to the health care system. In cancer patients, a GP's lack of knowledge about treatment options and the lack of structural collaboration between the GP and specialist were expressed as barriers. Barriers that occured more often with heart failure and dementia were the lack of GP familiarity with the terminal phase, the lack of key moments to initiate ACP, the patient's lack of awareness of their diagnosis and prognosis and the fact that patients did not often initiate such discussions themselves. The future lack of decision-making capacity of dementia patients was reported by the GPs as a specific barrier for the initiation of ACP. CONCLUSION: The results of our study contribute to a better understanding of the factors hindering GPs in initiating ACP. Multiple barriers need to be overcome, of which many can be addressed through the development of practical guidelines and educational interventions.","Adult;Advance Care Planning/*organization & administration;Aged;Attitude of Health Personnel;Belgium;Dementia/psychology/therapy;Female;*Focus Groups;General Practitioners/organization & administration/*psychology;Guidelines as Topic;Health Knowledge, Attitudes, Practice;Heart Failure/psychology/therapy;Humans;Male;Middle Aged;Neoplasms/psychology/therapy;*Physician-Patient Relations;*Practice Patterns, Physicians'","De Vleminck, A.;Pardon, K.;Beernaert, K.;Deschepper, R.;Houttekier, D.;Van Audenhove, C.;Deliens, L.;Vander Stichele, R.",2014,,10.1371/journal.pone.0084905,0,
1002,A practical diagnostic approach to patients with erectile dysfuncton in the oral drug therapy era,,androgen;antiandrogen;antidepressant agent;atypical antipsychotic agent;cholinergic receptor blocking agent;gonadorelin agonist;neuroleptic agent;phosphodiesterase V inhibitor;quetiapine;serotonin uptake inhibitor;sildenafil;tricyclic antidepressant agent;anamnesis;androgen deficiency;arteriography;article;behavior modification;cavernosography;cognitive defect;color ultrasound flowmetry;comorbidity;dementia;depression;diabetes mellitus;diagnostic procedure;erectile dysfunction;health education;human;hyperprolactinemia;hypertension;ischemic heart disease;libido;libido disorder;lifestyle;male;medical examination;neurologic disease;penis disease;penis erection;penis injury;penis nocturnal tumescence;Peyronie disease;prostate cancer;prostate hypertrophy;psychosis;questionnaire;schizophrenia;scoring system;sexual behavior;sexual dysfunction;sexual intercourse;sexuality;social aspect;symptomatology;treatment outcome,"Dean, J.",2004,,,0,
1003,"Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality: The framingham offspring study","BACKGROUND AND PURPOSE-: White matter hyperintensities and MRI-defined brain infarcts (BIs) have individually been related to stroke, dementia, and mortality in population-based studies, mainly in older people. Their significance in middle-aged community-dwelling persons and the relative importance of these associations remain unclear. We simultaneously assessed the relation of white matter hyperintensities and BI with incident stroke, mild cognitive impairment, dementia, and mortality in a middle-aged community-based cohort. METHODS-: A total of 2229 Framingham Offspring Study participants aged 62±9 years underwent volumetric brain MRI and neuropsychological testing (1999 to 2005). Incident stroke, dementia, and mortality were prospectively ascertained and for 1694 participants in whom a second neuropsychological assessment was performed (2005 to 2007), incident mild cognitive impairment was evaluated. All outcomes were related to white matter hyperintensities volume (WMHV), age-specific extensive WMHV and BI adjusting for age and gender. RESULTS-: Extensive WMHV and BI were associated with an increased risk of stroke (hazard ratio [HR]=2.28, 95% CI: 1.02 to 5.13; HR=2.84, 95% CI: 1.32 to 6.10). WMHV, extensive WMHV, and BI were associated with an increased risk of dementia (HR=2.22, 95% CI: 1.32 to 3.72; HR=3.97, 95% CI: 1.10 to 14.30; HR=6.12, 95% CI: 1.82 to 20.54) independently of vascular risk factors and interim stroke. WMHV and extensive WMHV were associated with incident amnestic mild cognitive impairment in participants aged ≥60 years only (OR=2.47, 95% CI: 1.31 to 4.66 and OR=1.49, 95% CI: 1.14 to 1.97). WMHV and extensive WMHV were associated with an increased risk of death (HR=1.38, 95% CI: 1.13 to 1.69; HR=2.27, 95% CI: 1.41 to 3.65) independent of vascular risk factors and of interim stroke and dementia. CONCLUSIONS-: In a large community-based sample of middle-aged adults, BI predicted an increased risk of stroke and dementia independent of vascular risk factors. White matter hyperintensities portended an increased risk of stroke, amnestic mild cognitive impairment, dementia, and death independent of vascular risk factors and interim vascular events. © 2010 American Heart Association, Inc.",adolescent;adult;age distribution;article;brain infarction;brain injury;brain size;cardiovascular risk;cerebrovascular disease;cohort analysis;community sample;controlled study;dementia;disease association;female;human;major clinical study;male;middle aged;mild cognitive impairment;mortality;neuropsychological test;nuclear magnetic resonance imaging;outcome assessment;priority journal;prospective study;psychologic assessment;quantitative analysis;sex difference;cerebrovascular accident;white matter;white matter hyperintensity,"Debette, S.;Beiser, A.;Decarli, C.;Au, R.;Himali, J. J.;Kelly-Hayes, M.;Romero, J. R.;Kase, C. S.;Wolf, P. A.;Seshadri, S.",2010,,,0,
1004,Common variation in PHACTR1 is associated with susceptibility to cervical artery dissection,"Cervical artery dissection (CeAD), a mural hematoma in a carotid or vertebral artery, is a major cause of ischemic stroke in young adults although relatively uncommon in the general population (incidence of 2.6/100,000 per year)<sup>1</sup>. Minor cervical traumas, infection, migraine and hypertension are putative risk factors<sup>1-3</sup>, and inverse associations with obesity and hypercholesterolemia are described<sup>3</sup>,<sup>4</sup>. No confirmed genetic susceptibility factors have been identified using candidate gene approaches5. We performed genome-wide association studies (GWAS) in 1,393 CeAD cases and 14,416 controls. The rs9349379[G] allele (PHACTR1) was associated with lower CeAD risk (odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.69-0.82; P = 4.46 × 10<sup>-10</sup>), with confirmation in independent follow-up samples (659 CeAD cases and 2,648 controls; P = 3.91 × 10<sup>-3</sup>; combined P = 1.00 × 10<sup>-11</sup>). The rs9349379[G] allele was previously shown to be associated with lower risk of migraine and increased risk of myocardial infarction6-9. Deciphering the mechanisms underlying this pleiotropy might provide important information on the.",NCT00657969;adult;allele;artery dissection;article;brain ischemia;carotid artery;cervical artery dissection;female;follow up;gene;gene frequency;genetic association;genetic risk;genetic susceptibility;heart infarction;human;major clinical study;male;migraine;PHACTR1 gene;priority journal;risk assessment;single nucleotide polymorphism;transient ischemic attack;vertebral artery,"Debette, S.;Kamatani, Y.;Metso, T. M.;Kloss, M.;Chauhan, G.;Engelter, S. T.;Pezzini, A.;Thijs, V.;Markus, H. S.;Dichgans, M.;Wolf, C.;Dittrich, R.;Touzé, E.;Southerland, A. M.;Samson, Y.;Abboud, S.;Béjot, Y.;Caso, V.;Bersano, A.;Gschwendtner, A.;Sessa, M.;Cole, J.;Lamy, C.;Medeiros, E.;Beretta, S.;Bonati, L. H.;Grau, A. J.;Michel, P.;Majersik, J. J.;Sharma, P.;Kalashnikova, L.;Nazarova, M.;Dobrynina, L.;Bartels, E.;Guillon, B.;Van Den Herik, E. G.;Fernandez-Cadenas, I.;Jood, K.;Nalls, M. A.;De Leeuw, F. E.;Jern, C.;Cheng, Y. C.;Werner, I.;Metso, A. J.;Lichy, C.;Lyrer, P. A.;Brandt, T.;Boncoraglio, G. B.;Wichmann, H. E.;Gieger, C.;Johnson, A. D.;Böttcher, T.;Castellano, M.;Arveiler, D.;Ikram, M. A.;Breteler, M. M. B.;Padovani, A.;Meschia, J. F.;Kuhlenbäumer, G.;Rolfs, A.;Worrall, B. B.;Ringelstein, E. B.;Zelenika, D.;Tatlisumak, T.;Lathrop, M.;Leys, D.;Amouyel, P.;Dallongeville, J.",2014,,,0,
1005,Insight for impairment in independent living skills in Alzheimer's disease and multi-infarct dementia,"Dementing diseases cause a deterioration in the capacity for independent living skills (ILS). The present study investigated the level of insight in ILS impairment in 12 Alzheimer's disease (AD) patients, 12 multi-infarct dementia (MID) patients, and 12 normal elderly controls, using two different measurement techniques: informant report and patient self-report. Pairwise comparisons at the .05 level revealed a significantly greater loss of insight for ILS impairment in AD patients as compared to both controls and MID patients. Additional analyses revealed that loss of insight, operationally defined as the discrepancy between informant report and patient self-report, was not significantly related to age, education, mental status, or level of depression, but was significantly related to degree of caregiver burden. These results indicate that intervention strategies are needed that take into consideration the level of patient insight for ILS impairment, as well as the caregiver's perception of the patient's capabilities and the degree of burden experienced by the caregiver.",aged;Alzheimer disease;article;controlled study;daily life activity;dementia;heart infarction;human,"DeBettignies, B. H.;Mahurin, R. K.;Pirozzolo, F. J.",1990,,,0,
1006,Aneurysm of the left ventricle: A two-decade silent history 4,,amiodarone;abdominal mass;aged;Alzheimer disease;case report;computer assisted tomography;congestive heart failure;echocardiography;electrocardiogram;female;atrial fibrillation;heart left ventricle aneurysm;human;letter;pneumonia;thorax radiography,"Debray, M.;Pautas, E.;Dulou, L.;Laurent, M.;Blanche, A. F. L.",2001,,,0,
1007,"Cerebrovascular and brain morphologic correlates of mild cognitive impairment in the National Heart, Lung, and Blood Institute Twin Study","OBJECTIVE: To evaluate the relative risk (RR) of mild cognitive impairment (MCI) associated with cerebrovascular risk factors and cerebrovascular-related brain changes. DESIGN: Mild cognitive impairment was determined for the subjects of the prospective National Heart, Lung, and Blood Institute Twin Study. Quantitative measures of brain, white matter hyperintensity, cerebral infarction, apolipoprotein E genotype, and psychometric testing were obtained. RESULTS: Subjects with MCI were older (73.5 +/- 3.0 vs 72.1 +/- 2.8 years), consumed less alcohol (3.7 +/- 5.8 vs 7.0 +/- 10.7 drinks per week), had greater white matter hyperintensity volumes (0.56% +/- 0.82% vs 0.25% +/- 0.34% of cranial volume), and had an increased prevalence of apolipoprotein E4 genotype (31.4% vs 19.2%) than normal subjects. White matter hyperintensity and the presence of the apolipoprotein E4 genotype were associated with a significantly increased risk for MCI. When all subjects were included in the analysis, alcohol consumption was associated with a reduced risk for MCI (RR = 0.93, P<.05). When subjects with a history of symptomatic cerebrovascular disease were excluded from the analysis, elevated midlife diastolic blood pressure was associated with an increased risk for MCI (RR = 1.70, P<.05). CONCLUSIONS: Elevated midlife blood pressures, and the resulting increased white matter hyperintensities, increase the risk for MCI in a group of community-dwelling older men to at least the same degree as apolipoprotein E4 genotype. Given the common occurrence of elevations in midlife blood pressure, early and effective treatment may be warranted to prevent late-life brain abnormalities and MCI. Moreover, since many individuals with MCI progress to clinical dementia, longitudinal evaluations of this cohort will be important.",Aged;Apolipoproteins E/genetics;Blood Vessels/pathology;Brain/*pathology;Cerebral Infarction/psychology;*Cerebrovascular Circulation;Cognition Disorders/diagnosis/*etiology/*genetics/psychology;Cohort Studies;Diseases in Twins/diagnosis/*etiology/*genetics;Genetic Predisposition to Disease;Genotype;Humans;Hypertension/complications;Longitudinal Studies;*Magnetic Resonance Imaging;Male;Mental Recall;National Institutes of Health (U.S.);Prospective Studies;Risk Factors;United States,"DeCarli, C.;Miller, B. L.;Swan, G. E.;Reed, T.;Wolf, P. A.;Carmelli, D.",2001,Apr,,0,
1008,Recognizing temporal lobe epilepsy in adults,,antidepressant agent;carbamazepine;etiracetam;lamotrigine;valproic acid;adult;aged;amnesia;artificial heart pacemaker;heart arrest;auditory hallucination;brain;cardiology;case report;complex partial seizure;deja vu;dementia;depersonalization;electroencephalogram;epileptic aura;epileptic discharge;grand mal epilepsy;gustatory hallucination;human;letter;male;medical psychology;neurology;nuclear magnetic resonance imaging;olfactory hallucination;psychiatric department;sinus bradycardia;sinus tachycardia;speech disorder;temporal lobe epilepsy;tonic clonic seizure;visual hallucination,"Deckers, C. L. P.;Stapert, J. R. L. H.;De Weerd, A. W.",2009,,,0,
1009,Assessment of endothelial function in Alzheimer's disease: is Alzheimer's disease a vascular disease?,"OBJECTIVES: To compare endothelial function of people with Alzheimer's disease (AD) with that of people without. DESIGN: Case-control study. SETTING: Geriatric medicine outpatient clinic of a university hospital. PARTICIPANTS: Twenty-five patients with AD who were free of vascular risk factors and 24 healthy elderly controls were enrolled. Exclusion criteria were diabetes mellitus, hypertension, dyslipidemia, evident stroke, smoking, documented coronary artery disease, history of myocardial infarction, heart failure, acute or chronic infection, malignancy, peripheral artery disease, renal disease, rheumatologic diseases, alcohol abuse, and certain drugs that may affect endothelial function. Both groups underwent comprehensive geriatric assessment and neuropsychiatric assessment. MEASUREMENTS: Endothelial function was evaluated according to flow-mediated dilation (FMD) from the brachial artery. RESULTS: Mean age +/- standard deviation was 78 +/- 5.9 in the group with AD (11 female and 14 male) and 72.1 +/- 5.8 in the control group (9 female and 11 male). Multiple linear regression analysis revealed that FMD was significantly lower in patients with AD (median 3.45, range 0-7) than controls (median 8.41, range 1-14) (P < .001), independent of age. It was also found that FMD values were inversely correlated with the stage of the disease as determined according to the Clinical Dementia Rating scale (r=-0.603, P < .001). CONCLUSION: Endothelial function is impaired in patients with AD. Endothelial function was worse in patients with severe AD. These findings provide evidence that vascular factors have a role in the pathogenesis of AD.","Aged;Alzheimer Disease/*physiopathology;Blood Flow Velocity;Brachial Artery;Case-Control Studies;Cognition;Endothelium, Vascular/*pathology;Female;Geriatric Assessment/*methods;Humans;Male","Dede, D. S.;Yavuz, B.;Yavuz, B. B.;Cankurtaran, M.;Halil, M.;Ulger, Z.;Cankurtaran, E. S.;Aytemir, K.;Kabakci, G.;Ariogul, S.",2007,Oct,10.1111/j.1532-5415.2007.01378.x,0,
1010,A comparison of cardiovascular disease risk factor biomarkers in African Americans and Yoruba Nigerians,"Objective: Classical risk factors for coronary artery disease are changing in the developing world while rates of cardiovascular disease are increasing in these populations. Newer risk factors have been identified for cardiovascular disease, but these have been rarely examined in elderly populations and not those of developing countries. Methods: This study was a cross-sectional comparison from a longitudinal, observational, epidemiologic study in which participants are interviewed at three-year intervals. The sample included 1510 African Americans from Indianapolis, Indiana, and 1254 Yoruba from Ibadan, Nigeria. We compared anthropomorphic measurements; biomarkers of endothelial dysfunction (plasminogen activator inhibitor type 1 [PAI-1] and E-selectin), inflammation (C-reactive protein), and lipid oxidation (8-isoprostane); and levels of lipids, homocysteine, folate, and vitamin B12. Results: Cholesterol, triglycerides, and low-density lipoprotein cholesterol levels were higher in African Americans. For markers of endothelial dysfunction, E-selectin and homocysteine differed between men, and PAI-1 was higher in the Yoruba. C-reactive protein differed only in women, but 8-isoprostane was higher in the Yoruba. Conclusion: Higher lipid levels in African Americans are consistent with their Western diet and lifestyle. Oxidative stress appears to be higher in the Yoruba than in African Americans, which may be secondary to dietary differences. Whether these differences in classical and emerging risk factors account for the different rates of cardiovascular disease, dementia, or other morbidities in these two populations remains to be determined.",8 isoprostane;biological marker;C reactive protein;cholesterol;cyanocobalamin;endothelial leukocyte adhesion molecule 1;folic acid;homocysteine;low density lipoprotein;plasminogen activator inhibitor 1;triacylglycerol;adult;African American;article;cardiovascular disease;cardiovascular risk;controlled study;endothelial dysfunction;female;human;inflammation;lipid oxidation;major clinical study;male;Nigeria,"Deeg, M.;Baiyewu, O.;Gao, S.;Ogunniyi, A.;Shen, J.;Gureje, O.;Taylor, S.;Murrell, J.;Unverzagt, F.;Smith-Gamble, V.;Evans, R.;Dickens, J.;Hendrie, H.;Hall, K. S.",2008,,,0,
1011,Informational and emotional elements in online support groups: A Bayesian approach to large-scale content analysis,"Objective This research examines the extent to which informational and emotional elements are employed in online support forums for 14 purposively sampled chronic medical conditions and the factors that influence whether posts are of a more informational or emotional nature. Methods Large-scale qualitative data were obtained from Dailystrength.org. Based on a hand-coded training dataset, all posts were classified into informational or emotional using a Bayesian classification algorithm to generalize the findings. Posts that could not be classified with a probability of at least 75% were excluded. Results The overall tendency toward emotional posts differs by condition: mental health (depression, schizophrenia) and Alzheimer's disease consist of more emotional posts, while informational posts relate more to nonterminal physical conditions (irritable bowel syndrome, diabetes, asthma). There is no gender difference across conditions, although prostate cancer forums are oriented toward informational support, whereas breast cancer forums rather feature emotional support. Across diseases, the best predictors for emotional content are lower age and a higher number of overall posts by the support group member. Discussion The results are in line with previous empirical research and unify empirical findings from single/2-condition research. Limitations include the analytical restriction to predefined categories (informational, emotional) through the chosen machine-learning approach. Conclusion Our findings provide an empirical foundation for building theory on informational versus emotional support across conditions, give insights for practitioners to better understand the role of online support groups for different patients, and show the usefulness of machine-learning approaches to analyze large-scale qualitative health data from online settings.",aged;Alzheimer disease;article;asthma;Bayes theorem;breast cancer;chronic obstructive lung disease;classification algorithm;content analysis;cystic fibrosis;depression;diabetes mellitus;emotion;female;fibromyalgia;heart failure;human;information;irritable colon;lung cancer;major clinical study;male;mental health;multiple sclerosis;non insulin dependent diabetes mellitus;online support group;prostate cancer;schizophrenia;sex difference;support group,"Deetjen, U.;Powell, J. A.",2016,,,0,
1012,Severity of depression impacts imminent conversion from mild cognitive impairment to Alzheimer's disease,"Background: Mild cognitive impairment (MCI) has been suggested to represent a prodromal stage of dementia and to confer a high risk for conversion to dementia Alzheimer's type (DAT). Objectives: In this study, we examined the predictive value of depressive symptoms and neuropsychological variables on conversion of MCI to DAT. Methods: Neuropsychological and clinical follow-up data of 260 MCI patients seen at the Psychiatric Memory Clinic of the Medical University of Innsbruck between 2005 and 2015 were analyzed retrospectively. Depression was assessed using the Geriatric Depression Scale (GDS). Potential predictors of conversion from MCI to DAT were analyzed by logistic regression analyses and additional survival-analytic methods. Results: Of the 260 patients (mean age 71.5±7.7 years), 83 (32%) converted toDATwithin a mean follow-up time of 3.2±2.2 years and estimated one-year conversion rate of 10.1%. The univariate analysis showed with few exceptions (gender, use of antidepressants, low GDS score) group differences at baseline in patients converted to DAT compared to stable MCI patients. Logistic regression analysis as well as survival analysis revealed moderate to severe depression together with higher age and specific cognitive deficits as predictors of conversion from MCI to DAT. Conclusion: Our results support the predictive value of different neuropsychological measures on the progression of DAT. In addition, we found a strong negative influence of depression on conversion to DAT in MCI patients. These results emphasize the importance of assessing depressive symptoms in the early stages of DAT when evaluating the conversion from MCI to DAT.",antidepressant agent;apolipoprotein E4;neuroleptic agent;sedative agent;aged;Alzheimer disease;article;Boston naming test;Clinical Dementia Rating;diabetes mellitus;disease course;disease severity;education;female;follow up;Geriatric Depression Scale;heart infarction;human;late life depression;major clinical study;male;mild cognitive impairment;Mini Mental State Examination;neuropsychological test;observational study;predictive value;priority journal;retrospective study;survival analysis;visual memory;word list recall,"Defrancesco, M.;Marksteiner, J.;Kemmler, G.;Fleischhacker, W. W.;Blasko, I.;Deisenhammer, E. A.",2017,,10.3233/jad-161135,0,
1013,High tau levels in cerebrospinal fluid predict rapid decline and increased dementia mortality in alzheimer's disease,"Objective: Cerebrospinal fluid (CSF) amyloid β<inf>42</inf> (Aβ<inf>42</inf>), total tau (t-tau) and phosphorylated tau (p-tau) are useful as predictors of conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia. However, results are contradictory as to whether these biomarkers reflect the future rate of clinical decline. Methods: This is a retrospective study on 196 patients with AD [mild/moderate AD (n = 72) or AD-MCI (n = 124) at baseline] with a follow-up period of 2-9 years' duration (median 6 years). Lumbar punctures were performed at baseline as a part of the diagnostic procedure. Results: We found an increased risk of rapid cognitive decline defined as a drop in the Mini-Mental State Examination score of ≥4 points/year in patients with CSF t-tau concentrations above the median (OR 3.31, 95% CI 1.53-7.16) and CSF p-tau above the median (OR 2.53, 95% CI 1.21-5.26). Patients with CSF t-tau in the highest quartile had a higher risk of dying in severe dementia (HR 4.67, 95% CI 1.16-18.82). Conclusions: In this large AD cohort, we found an association between high levels of CSF t-tau and p-tau and a more aggressive course of the disease, measured as a rapid cognitive decline and a higher risk of dying in severe dementia.",amyloid beta protein[1-42];apolipoprotein E;cholinesterase inhibitor;memantine;tau protein;adult;aged;Alzheimer disease;article;cause of death;cerebrospinal fluid analysis;disease course;disease severity;female;follow up;genotype;heart failure;human;major clinical study;male;mental deterioration;Mini Mental State Examination;mortality;pneumonia;premature mortality;priority journal;protein cerebrospinal fluid level;protein phosphorylation;retrospective study;risk factor,"Degerman Gunnarsson, M.;Lannfelt, L.;Ingelsson, M.;Basun, H.;Kilander, L.",2014,,,0,
1014,Predictors of osteoporosis screening completion rates in a primary care practice,"The United States Preventive Services Task Force and the National Osteoporosis Foundation recommend routine osteoporosis screening for women aged 65 years or older. Previous studies have shown that the use of a clinical decision-support tool significantly improves screening rates. In a recently published study, a statistically significant improvement was found in the screening rates for eligible women with use of the tool. To evaluate whether a clinical decision-support tool independently predicts completion of osteoporosis screening tests and to identify predictors of screening completion, we examined the records of 2462 female patients who were eligible for osteoporosis screening but had no prior baseline screening and who were seen in our primary care practices in 2007 and 2008. Patient and provider characteristics and clinic visit type were identified, and their association with screening test completion was statistically analyzed using both univariate and multivariate models. Screening completion rates increased significantly from 2007 to 2008. Factors associated with increased likelihood of screening completion included race, marital status, residence, presence of comorbidity (cancer, rheumatologic disease), and the year and type of visit. Screening was less likely for women aged 80 years or older. The use of a point-of-care decision-support tool not only improved osteoporosis screening rates significantly but appeared to be an independent predictor of screening completion. It potentially can facilitate the systematic and effective delivery of preventive health services to patients in the primary care setting. © 2011 Mary Ann Liebert, Inc.",acquired immune deficiency syndrome;age distribution;aged;article;chronic obstructive lung disease;congestive heart failure;dementia;demography;diabetes mellitus;disease association;disease severity;female;heart infarction;hemiplegia;human;ischemic heart disease;liver disease;major clinical study;marriage;medical practice;medical record;neoplasm;osteoporosis;point of care testing;primary medical care;race difference;rheumatoid arthritis;screening test;ulcer,"Dejesus, R. S.;Chaudhry, R.;Angstman, K. B.;Cha, S. S.;Tulledge-Scheitel, S. M.;Kesman, R. L.;Bernard, M. E.;Stroebel, R. J.",2011,,,0,
1015,The Ginkgo Evaluation of Memory (GEM) study: Design and baseline data of a randomized trial of Ginkgo biloba extract in prevention of dementia,"The epidemic of late life dementia, prominence of use of alternative medications and supplements, and initiation of efforts to determine how to prevent dementia have led to efforts to conduct studies aimed at prevention of dementia. The GEM (Ginkgo Evaluation of Memory) study was initially designed as a 5-year, randomized double-blind, placebo-controlled trial of Ginkgo biloba, administered in a dose of 120 mg twice per day as EGb761, in the prevention of dementia (and especially Alzheimer's disease) in normal elderly or those with mild cognitive impairment. The study anticipates 8.5 years of participant follow-up. Initial power calculations based on estimates of incidence rates of dementia in the target population (age 75+) led to a 3000-person study, which was successfully recruited at four clinical sites around the United States from September 2000 to June 2002. Primary outcome is incidence of all-cause dementia; secondary outcomes include rate of cognitive and functional decline, the incidence of cardiovascular and cerebrovascular events, and mortality. Following screening to exclude participants with incident dementia at baseline, an extensive neuropsychological assessment was performed and participants were randomly assigned to treatment groups. All participants are required to have a proxy who agreed to provide an independent assessment of the functional and cognitive abilities of the participant. Assessments are repeated every 6 months. Significant decline at any visit, defined by specific changes in cognitive screening scores, leads to a repeat detailed neuropsychological battery, neurological and medical evaluation and MRI scan of the brain. The final diagnosis of dementia is achieved by a consensus panel of experts. Side effects and adverse events are tracked by computer at the central data coordinating center and unblinded data are reviewed by an independent safety monitoring board. Studies such as these are necessary for this and a variety of other potential protective agents to evaluate their effectiveness in preventing or slowing the emergence of dementia in the elderly population. © 2006 Elsevier Inc. All rights reserved.",Ginkgo biloba extract;Alzheimer disease;angina pectoris;artery disease;article;cardiovascular disease;cerebrovascular disease;clinical trial;cognitive defect;congestive heart failure;coronary artery disease;dementia;follow up;Ginkgo biloba;heart infarction;human;incidence;mathematical analysis;memory disorder;methodology;mortality;neuropsychological test;nuclear magnetic resonance imaging;outcome assessment;randomization;screening;cerebrovascular accident;transient ischemic attack;United States;egb 761,"DeKosky, S. T.;Fitzpatrick, A.;Ives, D. G.;Saxton, J.;Williamson, J.;Lopez, O. L.;Burke, G.;Fried, L.;Kuller, L. H.;Robbins, J.;Tracy, R.;Woolard, N.;Dunn, L.;Kronmal, R.;Nahin, R.;Furberg, C.",2006,,,0,
1016,Ginkgo biloba for prevention of dementia: A randomized controlled trial,"Context: Ginkgo biloba is widely used for its potential effects on memory and cognition. To date, adequately powered clinical trials testing the effect of G biloba on dementia incidence are lacking. Objective: To determine effectiveness of G biloba vs placebo in reducing the incidence of all-cause dementia and Alzheimer disease (AD) in elderly individuals with normal cognition and those with mild cognitive impairment (MCI). Design, Setting, and Participants: Randomized, double-blind, placebo-controlled clinical trial conducted in 5 academic medical centers in the United States between 2000 and 2008 with a median follow-up of 6.1 years. Three thousand sixty-nine community volunteers aged 75 years or older with normal cognition (n=2587) or MCI (n=482) at study entry were assessed every 6 months for incident dementia. Intervention: Twice-daily dose of 120-mg extract of G biloba (n=1545) or placebo (n=1524). Main Outcome Measures: Incident dementia and AD determined by expert panel consensus. Results: Five hundred twenty-three individuals developed dementia (246 receiving placebo and 277 receiving G biloba) with 92% of the dementia cases classified as possible or probable AD, or AD with evidence of vascular disease of the brain. Rates of dropout and loss to follow-up were low (6.3%), and the adverse effect profiles were similar for both groups. The overall dementia rate was 3.3 per 100 person-years in participants assigned to G biloba and 2.9 per 100 person-years in the placebo group. The hazard ratio (HR) for G biloba compared with placebo for all-cause dementia was 1.12 (95% confidence interval [CI], 0.94-1.33; P=.21) and for AD, 1.16 (95% CI, 0.97-1.39; P=.11). G biloba also had no effect on the rate of progression to dementia in participants with MCI (HR, 1.13; 95% CI, 0.85-1.50; P=.39). Conclusions: In this study, G biloba at 120 mg twice a day was not effective in reducing either the overall incidence rate of dementia or AD incidence in elderly individuals with normal cognition or those with MCI. Trial Registration: clinicaltrials.gov Identifier: NCT00010803. ©2008 American Medical Association. All rights reserved.",NCT00010803;Ginkgo biloba extract;placebo;aged;Alzheimer disease;angina pectoris;article;bleeding;cerebrovascular accident;clinical trial;cognition;cognitive defect;controlled clinical trial;controlled study;dementia;disease course;drug effect;drug efficacy;female;follow up;gastrointestinal hemorrhage;Ginkgo biloba;hazard ratio;heart infarction;human;ischemic heart disease;major clinical study;male;morbidity;priority journal;randomized controlled trial;vascular disease;egb 761,"DeKosky, S. T.;Williamson, J. D.;Fitzpatrick, A. L.;Kronmal, R. A.;Ives, D. G.;Saxton, J. A.;Lopez, O. L.;Burke, G.;Carlson, M. C.;Fried, L. P.;Kuller, L. H.;Robbins, J. A.;Tracy, R. P.;Woolard, N. F.;Dunn, L.;Snitz, B. E.;Nahin, R. L.;Furberg, C. D.",2008,,,0,
1017,A clinical pattern predictive of dementia in subjects with brain ischemia,,adult;aged;angiography;brain ischemia;cardiomyopathy;female;human;hypertension;major clinical study;male;methodology;priority journal;risk factor,"Del Re, M. L.;Di Gregorio, C.;Pennese, F.;Abate, G.;Bonelli, G.;Mattafirri, R.;Battistini, N.",1988,,,0,
1018,Does femoral nerve analgesia impact the development of postoperative delirium in the elderly? A retrospective investigation,"Background: The potential effects of femoral nerve analgesia on postoperative delirium and length of stay remains poorly investigated. After detecting several cases of delirium in postoperative patients, we sought to find out if femoral nerve analgesia would prove superior in the prevention of postoperative delirium when compared to a conventional analgesia regimen. Methods: Ninety-nine (99) patients were retrospectively investigated for delirium following hip fracture repair in 1 year (October 2004-October 2005). Patients were divided in two groups: Group 1 (n = 49) received patient-controlled femoral nerve analgesia (PCAF), Group 2 (n = 50) were treated with intravenous analgesia. All patients were studied for the following variables: age, gender, previous dementia, length of hospitalisation, blood transfusion, haemoglobin level at discharge, delirium, respiratory failure or oxygen therapy, heart failure or acute coronary disease, renal failure, stroke, rescue opioid analgesia, sitting and walking times, patients discharge to rehabilitation centre and patients discharge without walking recovery. Results: Patients in Group 1 showed significantly less occurrence of postoperative delirium than those treated with conventional analgesia (8.2% and 42%, respectively). Patients in PCAF group did not receive any morphine rescue medication in contrast to 28% of those of Group 2 (p < 0.001). Peripheral nerve analgesia substantially reduced the time when patients could first sit at their bedside (1.6 ± 0.6 and 2.0 ± 0.8, respectively). Conclusions: The incidence of postoperative delirium was lower in the PCAF group. The PCAF technique in hip fracture repair improves the quality of postoperative analgesia, without needing rescue opioid analgesia. © 2008 Elsevier B.V. All rights reserved.",bupivacaine;dipyrone;morphine;paracetamol;aged;article;blood transfusion;controlled study;coronary artery disease;delirium;dementia;female;femoral nerve;heart failure;hemoglobin blood level;hip fracture;human;kidney failure;length of stay;major clinical study;male;oxygen therapy;patient controlled analgesia;postoperative analgesia;postoperative pain;postoperative period;priority journal;respiratory failure;retrospective study;sex difference;cerebrovascular accident,"Del Rosario, E.;Esteve, N.;Sernandez, M. J.;Batet, C.;Aguilar, J. L.",2008,,,0,
1019,Vascular dementia. A clinicopathological study,"We have reviewed the clinical and pathological records of 40 aged patients who showed only vascular lesions on histological examination. They were followed up for 3.5 +/- 6.3 years before death, and in 28 cases the diagnosis of dementia was done during life. Demographic data, vascular and systemic illnesses, psychiatric neurological and neuropsychological disturbances, and pathological findings were compared between demented and non-demented patients. The number of strokes, several neurological and almost all neuropsychological disturbances, the volume of macroscopic cerebral infarct, especially in frontal, occipital and basal regions, the lacunar state and the white matter lesions, were significantly greater in demented patients. However most of them had less than 100 ml3 of brain infarct. The relative influence of each type of cerebral vascular lesion upon the dementia syndrome was determined by means of multivariate analysis. The volume of macroscopic cerebral infarct, the white matter lesion and the lacunar state showed quite similar contributions to mental deterioration.","Aged;Aged, 80 and over;Coronary Disease/complications;Dementia, Vascular/complications/epidemiology/*physiopathology;Female;Humans;Hypertension/complications;Male;Middle Aged;Neuropsychological Tests;Regression Analysis;Retrospective Studies;Risk Factors","del Ser, T.;Bermejo, F.;Portera, A.;Arredondo, J. M.;Bouras, C.;Constantinidis, J.",1990,Apr,,0,
1020,Innate inflammation as the common pathway of risk factors leading to TIAs and stroke,"In the early moments of ischemic stroke, the processes of thrombosis, ischemia, and inflammation are intimately interrelated, setting in motion an injury that leads to infarction and permanent damage. Of these, the potential roles that innate inflammation can play in the evolution of brain tissue damage in response to the ischemic injury are not well understood. Observations in the settings of atherosclerotic cardiovascular disease and cerebral ischemia have much to teach each other. The following provides an introductory overview of the conference ""Innate Inflammation as the Common Pathway of Risk Factors Leading to Transient Ischemic Attacks and Stroke: Pathophysiology and Potential Interventions,"" which took place May 9-10, 2010 at the New York Academy of Sciences. This meeting was convened to explore aspects of the cellular and tissue responses to innate inflammation. A faculty of leading experts was assembled to discuss the role of inflammation in laboratory models of stroke and myocardial infarction, define possible novel means from laboratory evidence to alleviate or prevent inflammation underlying stroke and cardiovascular disease, and present information on current examples of clinical translation of these understandings in relation to human stroke and myocardial infarction. © 2010 New York Academy of Sciences.",apolipoprotein E;C reactive protein;integrin receptor;interleukin 6;membrane receptor;nonsteroid antiinflammatory agent;tumor necrosis factor alpha;Alzheimer disease;article;astrocyte;basement membrane;cardiovascular disease;cardiovascular risk;carotid endarterectomy;cell activation;central nervous system;cognition;dementia;disease course;edema;extracellular matrix;gingivitis;heart infarction;human;immunotherapy;infection prevention;infection risk;inflammation;laboratory;mast cell;microglia;neuropathology;pericyte;cerebrovascular accident;T lymphocyte;tissue reaction;transient ischemic attack;vascular disease,"del Zoppo, G. J.;Gorelick, P. B.",2010,,,0,
1021,The blood brain barrier: Insights from development and ageing,"The blood brain barrier is a necessity for cerebral homeostasis and response to environmental insult, thus loss in functionality with age creates opportunities for disease to arise in the aged brain. Understanding how the barrier is developed and maintained throughout the earlier years of adult life can identify key processes that may have beneficial applications in the restoration of the aged brain. With an unprecedented increasing global aged population, the prevention and treatment of age-associated disorders has become a rising healthcare priority demanding novel approaches for the development of therapeutic strategies. The aging cardiovascular system has long been recognised to be a major factor in age-associated diseases such as stroke, atherosclerosis and cardiac arrest. Changes in the highly specialised cerebral vasculature may similarly drive neurodegenerative and neuropsychiatric disease.",aging;atherosclerosis;blood brain barrier;brain blood vessel;cerebrovascular accident;degenerative disease;dementia;heart arrest;homeostasis;human;tight junction,"Delaney, C.;Campbell, M.",2017,,10.1080/21688370.2017.1373897,0,
1022,Secondary prevention clinics for coronary heart disease: a 10-year follow-up of a randomised controlled trial in primary care,"Objectives: To evaluate the effects of nurse-led secondary prevention clinics for coronary heart disease (CHD) in primary care on total mortality and coronary event rates after 10 years. Design: Follow-up of a randomised controlled trial by review of national datasets. Setting: Stratified random sample of 19 general practices in northeast Scotland. Participants: Original study cohort of 1343 patients, aged <80 years, with a working diagnosis of CHD, but without dementia or terminal illness and not housebound. Intervention: Nurse-led secondary prevention clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow-up for 1 year, Main outcome measures: Total mortality and coronary events (non-fatal myocardial infarctions (MIs) and coronary deaths). Results: Mean (SD) follow-up was at 10.2 (0.19) years. No significant differences in total mortality or coronary events were found at 10 years. 254 patients in the intervention group and 277 patients in the control group had died: cumulative death rates were 38% and 41%, respectively (p = 0.177). 196 coronary events occurred in the intervention group and 195 in the control group: cumulative event rates were 29.1% and 29.1%, respectively (p = 0.994). When Kaplan-Meier survival analysis, adjusted for age, sex and general practice, was used, proportional hazard ratios were 0.88 (0.74 to 1.04) for total mortality and 0.96 (0.79 to 1.18) for coronary death or non-fatal MI. No significant differences in the distribution of cause of death classifications was found at either 4 or 10 years. Conclusions: After 10 years, differences between groups were no longer significant. Total mortality survival curves for the intervention and control groups had not converged, but the coronary event survival curves had. Possibly, therefore, the earlier that secondary prevention is optimised, the less likely a subsequent coronary event is to prove fatal.",adult;aged;article;clinical trial;cohort analysis;controlled clinical trial;controlled study;follow up;general practice;health center;heart death/co [Complication];heart infarction/co [Complication];human;ischemic heart disease/pc [Prevention];Kaplan Meier method;lifestyle;major clinical study;mortality;preventive medicine;primary medical care;priority journal;randomized controlled trial;secondary prevention;survival rate;Sr-epoc: sr-sympt: sr-vasc,"Delaney, Ek;Murchie, P;Lee, Aj;Ritchie, Ld;Campbell, Nc",2008,,10.1136/hrt.2007.126144,0,1023
1023,Secondary prevention clinics for coronary heart disease: a 10-year follow-up of a randomised controlled trial in primary care,"Objectives: To evaluate the effects of nurse-led secondary prevention clinics for coronary heart disease (CHD) in primary care on total mortality and coronary event rates after 10 years. Design: Follow-up of a randomised controlled trial by review of national datasets. Setting: Stratified random sample of 19 general practices in northeast Scotland. Participants: Original study cohort of 1343 patients, aged <80 years, with a working diagnosis of CHD, but without dementia or terminal illness and not housebound. Intervention: Nurse-led secondary prevention clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow-up for 1 year, Main outcome measures: Total mortality and coronary events (non-fatal myocardial infarctions (MIs) and coronary deaths). Results: Mean (SD) follow-up was at 10.2 (0.19) years. No significant differences in total mortality or coronary events were found at 10 years. 254 patients in the intervention group and 277 patients in the control group had died: cumulative death rates were 38% and 41%, respectively (p = 0.177). 196 coronary events occurred in the intervention group and 195 in the control group: cumulative event rates were 29.1% and 29.1%, respectively (p = 0.994). When Kaplan-Meier survival analysis, adjusted for age, sex and general practice, was used, proportional hazard ratios were 0.88 (0.74 to 1.04) for total mortality and 0.96 (0.79 to 1.18) for coronary death or non-fatal MI. No significant differences in the distribution of cause of death classifications was found at either 4 or 10 years. Conclusions: After 10 years, differences between groups were no longer significant. Total mortality survival curves for the intervention and control groups had not converged, but the coronary event survival curves had. Possibly, therefore, the earlier that secondary prevention is optimised, the less likely a subsequent coronary event is to prove fatal. Copyright © 2011 Elsevier B. V., Amsterdam. All Rights Reserved.",Adult;Aged;Article;Clinical Trial;Cohort Analysis;Controlled Clinical Trial;Controlled Study;Follow up;General Practice;Health Center;Heart Death;Co [Complication];Heart Infarction;Co [Complication];Human;Ischemic Heart Disease;Pc [Prevention];Kaplan Meier Method;Lifestyle;Major Clinical Study;Mortality;Preventive Medicine;Primary Medical Care;Priority Journal;Randomized Controlled Trial;Secondary Prevention;Survival Rate;Sr-epoc: sr-sympt: sr-vasc,"Delaney, E. K.;Murchie, P.;Lee, A. J.;Ritchie, L. D.;Campbell, N. C.",2008,,,0,
1024,Comorbidity and survival of Danish lung cancer patients from 2000-2011: A population-based cohort study,"Objective: To examine lung cancer survival and the impact of comorbidity in the Central Denmark Region from 2000 to 2011. Methods: We performed a population-based cohort study of lung cancer patients diagnosed during four 3-year calendar periods (2000-2002, 2003-2005, 2006-2008, and 2009-2011) in the Central Denmark Region. The Danish National Registry of Patients was used to identify 9,369 incident lung cancer patients, and to obtain data on their Charlson comorbidity index score, categorized as no (score = 0), medium (score = 1-2), or high (score ≥3) level comorbidity. We calculated 1- and 5-year survival in different calendar time periods overall, and by age, sex, and level of comorbidity, and used Cox regression to compute mortality rate ratios (MRR) for each level of comorbidity versus no comorbidity in different calendar time periods. Results: Overall 1-year survival increased from 31% in 2000-2002 to 37% in 2009-2011, while the 5-year survival increased from 10% in 2000-2002 to predicted 13% in 2009-2011 with the largest improvement observed for women and patients less than 80 years. The adjusted 1-year MRR in patients with high comorbidity compared with those without comorbidity was 1.23 (95% confidence interval [CI]: 1.05-1.46) in 2000-2002 and 1.35 (95% CI: 1.17-1.56) in 2009-2011. The corresponding adjusted 5-year MRRs were 1.21 (95% CI: 1.04-1.40) in 2000-2002 and 1.26 (95% CI: 1.11-1.42) in 2009-2011. Conclusion: Lung cancer patients' survival increased from 2000 to 2011 in the Central Denmark Region, most prominently for women under 80 years and patients with no, or medium level of comorbidity. Their prognosis remained nonetheless dismal with overall 5-year survival of 13%, and comorbidity remained a negative prognostic factor. © 2013 Deleuran et al, publisher and licensee Dove Medical Press Ltd.",adolescent;adult;age;aged;article;cancer prognosis;cancer survival;cerebrovascular disease;chronic lung disease;cohort analysis;comorbidity;confidence interval;congestive heart failure;connective tissue disease;dementia;Denmark;female;heart infarction;hematologic malignancy;hemiplegia;human;Human immunodeficiency virus infection;kidney disease;liver disease;lung cancer;male;mortality;non insulin dependent diabetes mellitus;overall survival;peptic ulcer;peripheral vascular disease;proportional hazards model;sex difference,"Deleuran, T.;Thomsen, R. W.;Nørgaard, M.;Jacobsen, J. B.;Rasmussen, T. R.;Søgaard, M.",2013,,,0,
1025,"Outcomes of Treated Hypertension at Age 80 and Older: Cohort Analysis of 79,376 Individuals","OBJECTIVES: To estimate outcomes according to attained blood pressure (BP) in the oldest adults treated for hypertension in routine family practice. DESIGN: Cohort analysis of primary care inpatient and death certificate data for individuals with hypertension. SETTING: Primary care practices in England (Clinical Practice Research Datalink). PARTICIPANTS: Individuals aged 80 and older taking antihypertensive medication and free of dementia, cancer, coronary heart disease, stroke, heart failure, and end-stage renal failure at baseline. MEASUREMENTS: Outcomes were mortality, cardiovascular events, and fragility fractures. Systolic BP (SBP) was grouped in 10-mmHg increments from less than 125 to 185 mmHg or more (reference 145-154 mmHg). RESULTS: Myocardial infarction hazards increased linearly with increasing SBP, and stroke hazards increased for SBP of 145 mmHg or greater, although lowest mortality was in individuals with SBP of 135 to 154 mmHg. Mortality of the 13.1% of patients with SBP less than 135 mmHg was higher than that of the reference group (Cox hazard ratio=1.25, 95% confidence interval=1.19-1.31; equating to one extra death per 12.6 participants). This difference in mortality was consistent over short- and long-term follow-up; adjusting for diastolic BP did not change the risk. Incident heart failure rates were higher in those with SBP less than 125 mmHg than in the reference group. CONCLUSION: In routine primary care, SBP less than 135 mmHg was associated with greater mortality in the oldest adults with hypertension and free of selected potentially confounding comorbidities. Although important confounders were accounted for, observational studies cannot exclude residual confounding. More work is needed to establish whether unplanned SBPs less than 135 mmHg in older adults with hypertension may be a useful clinical sign of poor prognosis, perhaps requiring clinical review of overall care.","0 (Antihypertensive Agents);Aged, 80 and over;Antihypertensive Agents/ therapeutic use;Blood Pressure;Cardiovascular Diseases/prevention & control;Cohort Studies;England/epidemiology;Female;Humans;Hypertension/ drug therapy/epidemiology;Male;Mortality;Risk Factors;hypertension;oldest old;outcomes;primary care","Delgado, J.;Masoli, J. A. H.;Bowman, K.;Strain, W. D.;Kuchel, G. A.;Walters, K.;Lafortune, L.;Brayne, C.;Melzer, D.;Ble, A.;As part of the Ageing Well Programme of the Nihr School for Public Health Research, England",2017,May,,0,
1026,Prevalence and associated factors of silent brain infarcts in a Mediterranean cohort of hypertensives,"Silent brain infarcts (SBIs) are detected by neuroimaging in approximately 20% of elderly patients in population-based studies. Limited evidence is available for hypertensives at low cardiovascular risk countries. Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study (ISSYS) is aimed to assess the prevalence and risk factors of SBIs in a hypertensive Mediterranean population. This is a cohort study in randomly selected hypertensives, aged 50 to 70 years old, and free of clinical stroke and dementia. On baseline, all participants underwent a brain magnetic resonance imaging to assess prevalence and location of silent infarcts, and data on vascular risk factors, comorbidities, and the presence of subclinical cardiorenal damage (left ventricular hypertrophy and microalbuminuria) were collected. Multivariate analyses were performed to determine SBIs associated factors. A total of 976 patients (49.4% men, mean age 64 years) were enrolled, and 163 SBIs were detected in 99 participants (prevalence 10.1%; 95% CI, 8.4%-12.2%), most of them (64.4%) located in the basal ganglia and subcortical white matter. After adjustment, besides age and sex, microalbuminuria and increasing total cardiovascular risk (assessed by the Framingham-calibrated for Spanish population risk function) were independently associated with SBIs. Male sex increased the odds of having SBIs in 2.5 as compared with females. Our results highlight the importance of considering both global risk assessment and sex differences in hypertension and may be useful to design future preventive interventions of stroke and dementia.","Aged;Albuminuria/*epidemiology;Brain Infarction/*epidemiology;Cohort Studies;Comorbidity;Cross-Sectional Studies;Female;Humans;Hypertension/complications/*epidemiology;Hypertrophy, Left Ventricular/*epidemiology;Longitudinal Studies;Male;Mediterranean Region/epidemiology;Middle Aged;Multivariate Analysis;Neuroimaging;Prevalence;Risk Factors;Sex Factors;Spain/epidemiology;hypertension;stroke","Delgado, P.;Riba-Llena, I.;Tovar, J. L.;Jarca, C. I.;Mundet, X.;Lopez-Rueda, A.;Orfila, F.;Llussa, J.;Manresa, J. M.;Alvarez-Sabin, J.;Nafria, C.;Fernandez, J. L.;Maisterra, O.;Montaner, J.",2014,Sep,10.1161/hypertensionaha.114.03563,0,
1027,"Efficacy and safety of Ginkgo biloba standardized extract in the treatment of vascular cognitive impairment: A randomized, double-blind, placebo-controlled clinical trial","Objectives: The aim of this randomized, double-blind, placebo-controlled trial was to determine the efficacy and safety of Ginkgo biloba extract in patients diagnosed with vascular cognitive impairment (VCI). Methods: A total of 90 patients (aged 67.1±8.0 years; 59 women) were randomly allocated (1:1:1) to receive G. biloba 120 mg, G. biloba 60 mg, or placebo during a 6-month period. Assessment was made for efficacy indicators, including neuropsychological tests scores (Sandoz Clinical Assessment Geriatric Scale, Folstein Mini-Mental State Examination, Mattis Dementia Rating Scale, and Clinical Global Impression) and transcranial Doppler ultrasound findings. Safety indicators included laboratory findings, reported adverse reactions, and clinical examination. Results: At the end of 6-month study period, G. biloba 120 and 60 mg showed a statistically significant positive effect in comparison with placebo only on the Clinical Global Impression score (2.6±0.8 vs 3.1±0.7 vs 2.8±0.7, respectively; P=0.038). The Clinical Global Impression score showed a significant deterioration from the baseline values in the placebo group (-0.3±0.5; P=0.021) as opposed to G. biloba groups. No significant differences were found in the transcranial Doppler ultrasound findings. Adverse reactions were significantly more common and serious in the placebo group (16 subjects) than in either of the two G. biloba extract groups (eight and nine subjects, respectively), whereas laboratory findings and clinical examinations revealed no differences between the groups receiving G. biloba extract and placebo. Conclusion: According to our results, G. biloba seemed to slow down the cognitive deterioration in patients with VCI, but the effect was shown in only one of the four neuropsychological tests administered. However, because of this mild effect in combination with a few adverse reactions, we cannot say that it is ineffective or unsafe either. Further studies are still needed to provide unambiguous evidence on the efficacy and safety of G. biloba extract.",NCT00446485;alanine aminotransferase;aminotransferase;aspartate aminotransferase;bilirubin;cardiovascular agent;central nervous system agents;chloride;creatinine;flavonoid glycoside;Ginkgo biloba extract;glucose;hemoglobin;high density lipoprotein cholesterol;low density lipoprotein cholesterol;nonsteroid antiinflammatory agent;placebo;potassium;sodium;terpene derivative;triacylglycerol;urea;abdominal pain;abnormal sensation;adult;aged;anterior cerebral artery;article;basilar artery;blood cell count;blood pressure;body temperature;breathing rate;cerebrovascular accident;chemical composition;chronic obstructive lung disease;Clinical Global Impression scale;cognitive defect;combination chemotherapy;concentration loss;controlled study;double blind procedure;drug contraindication;drug efficacy;drug safety;erythrocyte count;erythrocyte sedimentation rate;female;follow up;Folstein Mini Mental State Examination;headache;heart infarction;hematocrit;human;hypertension;insomnia;left anterior cerebral artery;leg varicosis;leukocyte count;major clinical study;male;Mattis Dementia Rating Scale;mood disorder;nausea;neuropsychological test;Parkinson disease;partial thromboplastin time;patient compliance;prothrombin time;pulse rate;randomized controlled trial;rash;retching;Sandoz Clinical Assessment Geriatric Scale;scoring system;sedimentation rate;side effect;tachycardia;thrombocyte count;tinnitus;transcranial Doppler ultrasonography;transient ischemic attack;treatment duration;treatment withdrawal;varicosis;vascular cognitive impairment;vertigo;vomiting,"Demarin, V.;Kes, V. B.;Trkanjec, Z.;Budišić, M.;Pašić, M. B.;Črnac, P.;Budinčević, H.",2017,,10.2147/ndt.s120790,0,
1028,HRT & menopause. A clinician's guide to understanding the dilemma,,"Alzheimer Disease/epidemiology/prevention & control;Coronary Disease/epidemiology/prevention & control;Estrogen Replacement Therapy/*contraindications;Female;Humans;*Menopause;Middle Aged;Osteoporosis, Postmenopausal/epidemiology/prevention & control;Risk Factors","DeMasters, J.",2000,Apr-May,,0,
1029,A simple multi-component intervention improves self management in heart failure,"BACKGROUND: Heart failure (HF) is the most frequent reason for hospitalization of older individuals inNorth America. Despite the availability of evidence-based therapy and comprehensive disease management programs, readmission rates for recurrentHF remain high, particularly within the first 3 months. Frequentmonitoring, adequate health care resources, social support and accessibility to care, may be limited for older HF patients. Engagement in selfcare, including adherence to prescribed therapies and recognition of HF symptoms, is key to HF management. Despite the known importance of self-care, HF patients do not consistently engage in appropriate behaviours. Many factors may affect the older HF patient's ability to self-care, including health literacy, cognitive impairment and the absence of an informal caregiver (Carepartner/ CP). Previous studies demonstrate that up to 80% of older HF patients without dementia, show evidence of mild cognitive deficits (as measured by the Montreal Cognitive Assessment-MoCA) at hospital discharge, and poor self-care ability (as measured by Self-Care HF Index/SCHFI, 0-100). Cognitive deficits may lead to difficulties in selfmanagement ofHF symptoms after discharge, potentially increasing the risk of hospital readmission. Involvement of a CP can provide important support to patients with HF. Randomized controlled trials have demonstrated that the involvement of CPs can significantly improve clinical outcomes in patients with stroke and dementia. METHODOLOGY: We have completed a pilot RCT evaluating a multi-component intervention to enhance HF care after discharge, with or without the support of a CP for the patient. The 3-month intervention included: (a) a talking scale, (b) a diuretic decision support tool, (c) literacy sensitive HF home based education sessions and (d) a HF specific hospital discharge summary sent immediately to the primary care physician. Selfcare was assessed using the SCHFI for the patient and CP; HF knowledge explored with the Knowledge Assessment questionnaire; CP burden measured with the modified Oberst scale; medication adherence with the Medication Possession Ratio. RESULTS: Patient enrolment started in October 2012 with last follow up visit planned for July 2014. From 3 hospital sites in Hamilton, ON, we recruited 85 patients, mean age 76 years (SD 9), 49% male, mean left ventricular ejection fraction 46% (SD 16). Preliminary results show improvement in the management subscale of SCHFI, for patients and CPs (Table 1). CONCLUSION: Preliminary results demonstrate that a simple multi-component intervention after hospital discharge, significantly improves self-care. Final results will be reported. (Table Presented).",self care;heart failure;society;human;patient;cognitive defect;hospital discharge;dementia;therapy;hospital readmission;health care;evidence based practice;Western Hemisphere;risk;follow up;disease management;hospitalization;hospital;heart left ventricle ejection fraction;randomized controlled trial(topic);cerebrovascular accident;medication compliance;questionnaire;general practitioner;caregiver;education;reading;health literacy;decision support system;drug therapy;male;social support;diuretic agent,"Demers, C.;Patterson, C.;Archer, N.;Coallier, J.;Strachan, P.;Keshavjee, K.;Thabane, L.;Spencer, F.;Cockhill, C.;Foster, G.;Gwadry-Shridar, F.",2014,,,0,1030
1030,A simple multi-component intervention improves self management in heart failure,"BACKGROUND: Heart failure (HF) is the most frequent reason for hospitalization of older individuals inNorth America. Despite the availability of evidence-based therapy and comprehensive disease management programs, readmission rates for recurrentHF remain high, particularly within the first 3 months. Frequentmonitoring, adequate health care resources, social support and accessibility to care, may be limited for older HF patients. Engagement in selfcare, including adherence to prescribed therapies and recognition of HF symptoms, is key to HF management. Despite the known importance of self-care, HF patients do not consistently engage in appropriate behaviours. Many factors may affect the older HF patient's ability to self-care, including health literacy, cognitive impairment and the absence of an informal caregiver (Carepartner/ CP). Previous studies demonstrate that up to 80% of older HF patients without dementia, show evidence of mild cognitive deficits (as measured by the Montreal Cognitive Assessment-MoCA) at hospital discharge, and poor self-care ability (as measured by Self-Care HF Index/SCHFI, 0-100). Cognitive deficits may lead to difficulties in selfmanagement ofHF symptoms after discharge, potentially increasing the risk of hospital readmission. Involvement of a CP can provide important support to patients with HF. Randomized controlled trials have demonstrated that the involvement of CPs can significantly improve clinical outcomes in patients with stroke and dementia. METHODOLOGY: We have completed a pilot RCT evaluating a multi-component intervention to enhance HF care after discharge, with or without the support of a CP for the patient. The 3-month intervention included: (a) a talking scale, (b) a diuretic decision support tool, (c) literacy sensitive HF home based education sessions and (d) a HF specific hospital discharge summary sent immediately to the primary care physician. Selfcare was assessed using the SCHFI for the patient and CP; HF knowledge explored with the Knowledge Assessment questionnaire; CP burden measured with the modified Oberst scale; medication adherence with the Medication Possession Ratio. RESULTS: Patient enrolment started in October 2012 with last follow up visit planned for July 2014. From 3 hospital sites in Hamilton, ON, we recruited 85 patients, mean age 76 years (SD 9), 49% male, mean left ventricular ejection fraction 46% (SD 16). Preliminary results show improvement in the management subscale of SCHFI, for patients and CPs (Table 1). CONCLUSION: Preliminary results demonstrate that a simple multi-component intervention after hospital discharge, significantly improves self-care. Final results will be reported. (Table Presented).",self care;heart failure;society;human;patient;cognitive defect;hospital discharge;dementia;therapy;hospital readmission;health care;evidence based practice;Western Hemisphere;risk;follow up;disease management;hospitalization;hospital;heart left ventricle ejection fraction;randomized controlled trial (topic);cerebrovascular accident;medication compliance;questionnaire;general practitioner;caregiver;education;reading;health literacy;decision support system;drug therapy;male;social support;diuretic agent,"Demers, C;Patterson, C;Archer, N;Coallier, J;Strachan, P;Keshavjee, K;Thabane, L;Spencer, F;Cockhill, C;Foster, G;Gwadry-Shridar, F",2014,,,0,
1031,Slow release vincamine in geriatrics,"The author has treated 77 very old people, 59 of them women, average age 83.4 yr, with Pervincamine Forte Retard in a daily dosage of 4 gelules, 2 in the morning and 2 at night, though 2 patients who were highly cachectic were given only 3 gelules. Their tolerance was excellent, even with prolonged treatment, except in one case (who developed digestive disorders and hot flushes) after having previously shown a poor tolerance to Pervincamine Simple. It seemed that the dominant factor was the age of the lesions and of the clinical state. Very advanced age does not interfere with the favorable action in cases where the deterioration treated is recent.",pervincamine forte retard;unclassified drug;vincamine;adverse drug reaction;aged;brain blood flow;brain dysfunction;cerebrovascular disease;dementia;flushing;gastrointestinal symptom;heart failure;hypertension;ischemic heart disease;oral drug administration;Parkinson disease;polyneuropathy;therapy,"Denceux, P.",1976,,,0,
1032,Evaluation and follow-up of cognitive functions in patients with minor stroke and transient ischemic attack,"Background and purpose: We aimed to examine the incidence of cognitive impairment among patients with stroke, the associated risk factors, progression of the cognitive impairment, and the association between the localization of the lesion(s) as detected by magnetic resonance imaging and the affected areas of cognitive function. Methods: A total of 40 patients over 18 years of age enduring a transient ischemic stroke or minor stroke within the past 3 months who had a minimum life expectancy of 1 year were included in this study. Same number, age-, and sex-matched individuals were included as controls. Patients were inquired on the presence of risk factors for stroke. A series of neuropsychological test batteries were administered in patient and control subjects for assessing cognitive functions. These tests were readministered at 6 and 12 months of follow-up to assess the progression of cognitive functions. Results: In this study among the patients with stroke, a significant impairment was seen in multiple cognitive functional tests following ischemic stroke as compared to control groups. The most common risk factors for stroke included hypertension (72.5%), hyperlipidemia, and cigarette smoking. The number of cognitive domains with an impairment was highest (in four cognitive tests) among those with coronary artery disease and atrial fibrillation, followed by those who had a >50% stenosis in Doppler (three cognitive tests). These findings suggest that the frequency of risk factors associated with stroke does not correlate with the frequency of risk factors associated with cognitive dysfunction. The stroke localizations were classified among the patients with stroke and reviewed in accordance with cognitive impairment. Conclusion: Neuropsychological tests, clinical findings, and imaging studies should be used to document the poststroke cognitive dysfunction.",adult;article;atrial fibrillation;cerebrovascular accident;clinical article;cognition;cognitive function test;controlled study;coronary artery disease;female;follow up;human;hyperlipidemia;hypertension;male;neuropsychological test;nuclear magnetic resonance imaging;prospective study;risk factor;smoking;transient ischemic attack,"Deniz, Ç;Çelik, Y.;Gültekin, T. Ö;Baran, G. E.;Deniz, Ç;Asil, T.",2016,,,0,
1033,Risk of Adverse Outcomes for Older People with Dementia Prescribed Antipsychotic Medication: A Population Based e-Cohort Study,"Introduction: Over recent years there has been growing evidence of increased risk of mortality associated with antipsychotic use in older people with dementia. Although this concern combined with limited evidence of efficacy has informed guidelines restricting antipsychotic prescription in this population, the use of antipsycotics remains common. Many published studies only report short-term outcomes, are restricted to examining mortality and stroke risk or have other limitations. The aim of this study was to assess adverse outcomes associated with the use of antipsychotics in older people living with dementia in Wales (UK). Methods: This was a retrospective study of a population-based dementia cohort using the Welsh Secure Anonymised Information Linkage databank. The prior event rate ratio (PERR) was used to estimate the influence of exposure to antipsychotic medication on acute cardiac events, venous thromboembolism, stroke and hip fracture, and adjusted Cox proportional hazard models were used to compare all-cause mortality. Results: A total of 10,339 people aged ≥65 years were identified with newly diagnosed dementia. After excluding those who did not meet the inclusion criteria, 9674 people remained in the main cohort of whom 3735 were exposed to antipsychotic medication. An increased risk of a venous thromboembolic episode [PERR 1.95, 95% confidence interval (CI) 1.83–2.0], stroke (PERR 1.41, 95% CI 1.4–1.46) and hip fracture (PERR 1.62, 95% CI 1.59–1.65) was associated with antipsychotic use. However, there was no long-term increased mortality in people exposed to antipsychotics (adjusted hazard ratio 1.06, 95% CI 0.99–1.13). Conclusions: The increase in adverse medical events supports guidelines restricting antipsychotic use in this population.",neuroleptic agent;aged;Alzheimer disease;article;atrial fibrillation;bipolar disorder;cerebrovascular accident;cerebrovascular disease;comorbidity;deep vein thrombosis;dementia;female;follow up;heart muscle ischemia;hip fracture;human;ischemic heart disease;lung embolism;major clinical study;male;mortality;mortality risk;primary medical care;priority journal;thromboembolism;venous thromboembolism;very elderly,"Dennis, M.;Shine, L.;John, A.;Marchant, A.;McGregor, J.;Lyons, R. A.;Brophy, S.",2017,,10.1007/s40120-016-0060-6,0,
1034,Systematic comparison of phenome-wide association study of electronic medical record data and genome-wide association study data,"Candidate gene and genome-wide association studies (GWAS) have identified genetic variants that modulate risk for human disease; many of these associations require further study to replicate the results. Here we report the first large-scale application of the phenome-wide association study (PheWAS) paradigm within electronic medical records (EMRs), an unbiased approach to replication and discovery that interrogates relationships between targeted genotypes and multiple phenotypes. We scanned for associations between 3,144 single-nucleotide polymorphisms (previously implicated by GWAS as mediators of human traits) and 1,358 EMR-derived phenotypes in 13,835 individuals of European ancestry. This PheWAS replicated 66% (51/77) of sufficiently powered prior GWAS associations and revealed 63 potentially pleiotropic associations with P < 4.6 × 10 -6 (false discovery rate < 0.1); the strongest of these novel associations were replicated in an independent cohort (n = 7,406). These findings validate PheWAS as a tool to allow unbiased interrogation across multiple phenotypes in EMR-based cohorts and to enhance analysis of the genomic basis of human disease. © 2013 Nature America, Inc. All rights reserved.",blood clotting factor 5 Leiden;breast cancer resistance protein;D dimer;HLA DQB1 antigen;actinic keratosis;acute heart infarction;Alzheimer disease;article;basal cell carcinoma;comparative study;coronary artery atherosclerosis;disease association;electronic medical record;eye color;gene linkage disequilibrium;genetic association;genetic parameters;genetic variability;genotype;genotype phenotype correlation;gout;heredity;human;hypercholesterolemia;hypothyroidism;insulin dependent diabetes mellitus;iron metabolism disorder;natural language processing;non insulin dependent diabetes mellitus;non melanoma skin cancer;obesity;phenome wide association study;phenotype;pleiotropy;predictive value;priority journal;psoriasis;rheumatoid arthritis;seborrheic keratosis;single nucleotide polymorphism;squamous cell carcinoma,"Denny, J. C.;Bastarache, L.;Ritchie, M. D.;Carroll, R. J.;Zink, R.;Mosley, J. D.;Field, J. R.;Pulley, J. M.;Ramirez, A. H.;Bowton, E.;Basford, M. A.;Carrell, D. S.;Peissig, P. L.;Kho, A. N.;Pacheco, J. A.;Rasmussen, L. V.;Crosslin, D. R.;Crane, P. K.;Pathak, J.;Bielinski, S. J.;Pendergrass, S. A.;Xu, H.;Hindorff, L. A.;Li, R.;Manolio, T. A.;Chute, C. G.;Chisholm, R. L.;Larson, E. B.;Jarvik, G. P.;Brilliant, M. H.;McCarty, C. A.;Kullo, I. J.;Haines, J. L.;Crawford, D. C.;Masys, D. R.;Roden, D. M.",2013,,,0,
1035,Risk prediction models: A framework for assessment,"Background: Medical risk prediction models estimate the likelihood of future health-related events. Many make use of information derived from analysis of the genome. Models predict health outcomes such as cardiovascular disease, stroke and cancer, and for some conditions several models exist. Although risk models can help decision-making in clinical medicine and public health, they can also be harmful, for example, by misdirecting clinical effort away from those who are most likely to benefit towards people with less need, thus exacerbating health inequalities. Discussion: Risk prediction models need careful assessment before implementation, but the current approach to their development, evaluation and implementation is inappropriate. As a result, some models are pressed into use before it is clear whether they are suitable, while in other cases there is confusion about which model to use. This paper proposes an approach to the appraisal of risk-scoring models, based on a conference of UK experts. Summary: By specifying what needs to be known before a model can be judged suitable for translation from research into practice, we can ensure that useful models are taken up promptly, that less well-proven ones undergo further evaluation and that resources are not wasted on ineffective ones. © 2011 S. Karger AG, Basel.",biological marker;article;breast cancer;cardiovascular disease;clinical decision making;clinical practice;colorectal cancer;conceptual framework;dementia;family history;genetic marker;genetic risk;genomics;health care planning;human;intensive care;ischemic heart disease;lifestyle;non insulin dependent diabetes mellitus;prediction;primary medical care;priority journal;prostate cancer;psychometry;quality control;risk assessment;cerebrovascular accident;translational research,"Dent, T. H. S.;Wright, C. F.;Stephan, B. C. M.;Brayne, C.;Janssens, A. C. J. W.",2012,,,0,
1036,Validity of the modified charlson comorbidity index as predictor of short-term outcome in older stroke patients,"The modified Charlson Comorbidity Index (MCCI) has been proposed as a tool for adjusting the outcomes of stroke for comorbidity, but its validity in such a context has been evaluated in only a few studies and needs to be further explored, especially in elderly patients. We aimed to retrospectively assess the validity of the MCCI as a predictor of the short-term outcomes in a cohort of 297 patients with first-ever ischemic stroke, older than 60 years, and managed according to a clinical pathway. The poor outcome (PO) at 1 month, defined as a modified Rankin Scale score of 3-6, was the primary end point. Furthermore, a new comorbidity index has been developed, specific to our cohort, according to the same statistical approach used for the original CCI. The MCCI showed a positive association with PO (odds ratio [OR] 1.62; 95% confidence interval [CI].98-2.68) and mortality (hazard ratio [HR] 1.85; 95% CI.94-3.61), not statistically significant and totally dependent on its association with the severity of neurologic impairment at onset. The new comorbidity index showed, as expected, a significant association with the PO and mortality with higher point estimates of OR (2.74; 95% CI 1.64-4.59) and HR (2.73; 95% CI 1.51-4.94), but this association was also dependent on stroke severity and premorbid disability. Our results do not support the validity of the MCCI as a predictor of the short-term outcomes in elderly stroke patients nor could we develop a more valid index from the available data. This suggests the need for development of disease- and age-specific indexes, possibly according to a prospective design. In any case, initial stroke severity, a strong predictor of outcome, is associated with the degree of comorbidity.",acquired immune deficiency syndrome;aged;article;brain ischemia;Charlson Comorbidity Index;chronic lung disease;clinical pathway;cohort analysis;comorbidity;congestive heart failure;dementia;diabetes mellitus;disease severity;female;heart failure;heart infarction;human;ischemic heart disease;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;Modified Charlson Comorbidity Index;mortality;outcome assessment;peripheral occlusive artery disease;peripheral vascular disease;priority journal;Rankin scale;retrospective study;solid tumor;stroke patient;ulcer;very elderly,"Denti, L.;Artoni, A.;Casella, M.;Giambanco, F.;Scoditti, U.;Ceda, G. P.",2015,,,0,
1037,Trends in Dementia Incidence in a Birth Cohort Analysis of the Einstein Aging Study,"Importance: Trends in dementia incidence rates have important implications for planning and prevention. To better understand incidence trends over time requires separation of age and cohort effects, and few prior studies have used this approach. Objectives: To examine trends in dementia incidence and concomitant trends in cardiovascular comorbidities among individuals aged 70 years or older who were enrolled in the Einstein Aging Study between 1993 and 2015. Design, Setting, and Participants: In this birth cohort analysis of all-cause dementia incidence in persons enrolled in the Einstein Aging Study from October 20, 1993, through November 17, 2015, a systematically recruited, population-based sample of 1348 participants from Bronx County, New York, who were 70 years or older without dementia at enrollment and at least one annual follow-up was studied. Poisson regression was used to model dementia incidence as a function of age, sex, educational level, race, and birth cohort, with profile likelihood used to identify the timing of significant increases or decreases in incidence. Exposures: Birth year and age. Main Outcomes and Measures: Incident dementia defined by consensus case conference based on annual, standardized neuropsychological and neurologic examination findings, using criteria from the DSM-IV. Results: Among 1348 individuals (mean [SD] baseline age, 78.5 [5.4] years; 830 [61.6%] female; 915 [67.9%] non-Hispanic white), 150 incident dementia cases developed during 5932 person-years (mean [SD] follow-up, 4.4 [3.4] years). Dementia incidence decreased in successive birth cohorts. Incidence per 100 person-years was 5.09 in birth cohorts before 1920, 3.11 in the 1920 through 1924 birth cohorts, 1.73 in the 1925 through 1929 birth cohorts, and 0.23 in cohorts born after 1929. Change point analyses identified a significant decrease in dementia incidence among those born after July 1929 (95% CI, June 1929 to January 1930). The relative rate for birth cohorts before July 1929 vs after was 0.13 (95% CI, 0.04-0.41). Prevalence of stroke and myocardial infarction decreased across successive birth cohorts, whereas diabetes prevalence increased. Adjustment for these cardiovascular comorbidities did not explain the decreased dementia incidence rates for more recent birth cohorts. Conclusions and Relevance: Analyses confirm decreasing dementia incidence in this population-based sample. Whether decreasing incidence will contribute to reduced burden of dementia given the aging of the population is not known.",,"Derby, C. A.;Katz, M. J.;Lipton, R. B.;Hall, C. B.",2017,Nov 01,,0,
1038,Patterns and preexisting risk factors of 30-day mortality after a primary discharge diagnosis of syncope or near syncope,"OBJECTIVES: The risk of short-term mortality after an emergency department (ED) visit for syncope is poorly understood, resulting in prognostic uncertainty and frequent hospital admission. The authors determined patterns and risk factors for short-term mortality after a diagnosis of syncope or near syncope to aid in medical decision-making. METHODS: A retrospective cohort study was performed of adult members of Kaiser Permanente Southern California seen at 11 EDs from 2002 to 2006 with a primary discharge diagnosis of syncope or near syncope (International Classification of Diseases, Ninth Revision [ICD-9] 780.2). The outcome was 30-day mortality. Proportional hazards time-to-event regression models were used to identify risk factors. RESULTS: There were 22,189 participants with 23,951 ED visits, resulting in 307 deaths by 30 days. A relatively lower risk of death was reached within 2 weeks for ages 18 to 59 years, but not until 3 months or more for ages 60 and older. Preexisting comorbidities associated with increased mortality included heart failure (hazard ratio [HR] = 14.3 in ages 18 to 59 years, HR = 3.09 in ages 60 to 79 years, HR = 2.34 in ages 80 years plus; all p < 0.001), diabetes (HR = 1.49, p = 0.002), seizure (HR = 1.65, p = 0.016), and dementia (HR = 1.41, p = 0.034). If the index visit followed one or more visits for syncope in the previous 30 days, it was associated with increased mortality (HR = 1.86, p = 0.024). Absolute risk of death at 30 days was under 0.2% in those under 60 years without heart failure and more than 2.5% across all ages in those with heart failure. CONCLUSIONS: The low risk of death after an ED visit for syncope or near syncope in patients younger than 60 years old without heart failure may be helpful when deciding who to admit for inpatient evaluation. The presence of one or more comorbidities that predict death and a prior visit for syncope should be considered in clinical decisions and risk stratification tools for patients with syncope. Close clinical follow-up seems advisable in patients 60 years and older due to a prolonged risk of death.","Adolescent;Adult;Aged;Aged, 80 and over;California/epidemiology;Cohort Studies;Comorbidity;Dementia/epidemiology;Emergency Service, Hospital;Female;Follow-Up Studies;Heart Failure/epidemiology;Humans;Logistic Models;Male;Middle Aged;Patient Discharge;Retrospective Studies;Risk Factors;Survival Rate;Syncope/*diagnosis/*mortality;Time Factors;Young Adult","Derose, S. F.;Gabayan, G. Z.;Chiu, V. Y.;Sun, B. C.",2012,May,10.1111/j.1553-2712.2012.01336.x,0,
1039,Sex-related trends inmortality after elective abdominal aortic aneurysmsurgery between 2002 and 2013 at National Health Service hospitals in England: Less benefit for women compared with men,"Aims To quantify the difference in long-term survival and cardiovascular morbidity between women and men undergoing elective abdominal aortic aneurysm (AAA) repair at National Health Service hospitals in England. Methods and results Patients having elective repair of AAA were reviewed using the Hospital Episode Statistics and Office for National Statistics (ONS) datasets. The primary outcome measure was 30-day mortality and the secondary outcomes were 1-year, 5-year, and aortic-related mortality and post-operative complication rates. We used logistic regression and survival models to assess risk factors on the primary and secondary outcomes. Between 1 April 2002 and 31 March 2013, a total of 31 090 patients (4795 women and 26 295 men) underwent open AAA repair. Between 1 January 2006 and 31 March 2013, a total of 16 777 patients (2036 women and 14 741 men) underwent endovascular aneurysm repair (EVAR). All-cause and aortic-related mortalities at 30 days, 1 year, and 5 years were all higher in women, despite a lower prevalence of pre-operative cardiovascular risk factors. Female sex was a significant independent risk factor for 30-day mortality in both open repair [odds ratio (OR) 1.39; 95% confidence interval (CI) 1.25-1.56; P<0.001] and EVAR (OR 1.57; 95% CI 1.23-2.00; P<0.001) groups. Based on an all-cause long-term survival model, conditional on 30-day survival, the estimated hazard for women in the open repair group was significantly (P = 0.006) higher than men, but the sex difference was not significant in the EVAR group (P = 0.356). In the open repair group, women had significantly (P<0.001) higher cumulative incidence probabilities for both aortic-related mortality and other-cause mortality. In the EVAR group, women had significantly (P<0.001) higher mean cumulative incidence probabilities for the aortic-related mortality compared with men, but not for the other-cause mortality (P = 0.235). Conclusion Women undergoing elective AAA repair at National Health Service hospitals in England had increased short-and long-term mortality and post-operative morbidity compared with men. These findings can be used to improve preoperative counselling for women undergoing AAA repair, and highlight the need for female-specific pre-, peri-, and post-operative management strategies.",abdominal aortic aneurysm;acquired immune deficiency syndrome;acute kidney failure;article;blood transfusion reaction;cardiovascular disease;cardiovascular risk;cerebrovascular accident;cerebrovascular disease;chronic lung disease;congestive heart failure;deep vein thrombosis;dementia;diabetes mellitus;disseminated intravascular clotting;elective surgery;endovascular aneurysm repair;England;female;graft failure;heart infarction;hemiplegia;human;Human immunodeficiency virus infection;ICD-10;kidney disease;long term survival;lung embolism;major clinical study;male;mortality;observational study;paraplegia;peripheral vascular disease;postoperative complication;preoperative evaluation;priority journal;risk factor;sex difference;shock;systemic disease;wound dehiscence,"Desai, M.;Choke, E.;Sayers, R. D.;Nath, M.;Bown, M. J.",2016,,10.1093/eurheartj/ehw335,0,
1040,Intensive care unit delirium,"Intensive care unit (ICU) delirium is widespread and occurs in 20% to 80% of patients. It can be assessed with ICU-validated scoring tools. The most commonly used tools include the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist. Since ICU delirium is associated with increased morbidity and mortality, it is imperative that risk factors are identified and prevented. Risk factors include predisposing factors such as history of alcohol abuse, dementia, or hypertension and precipitating factors such as immobilization, oversedation, higher severity of illness, and use of certain psychoactive medications such as benzodiazepines. Pharmacologic treatment with atypical antipsychotics may be used to reduce the duration of delirium if prevention is not successful. However, because of the adverse effects associated with these treatments, close monitoring for side effects is warranted. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.",benzodiazepine derivative;dexmedetomidine;haloperidol;lorazepam;midazolam;olanzapine;opiate;placebo;propofol;quetiapine;risperidone;rivastigmine;ziprasidone;alcohol abuse;article;artificial ventilation;bradycardia;cognitive defect;coma;comparative study;constipation;critically ill patient;delirium;drug dose comparison;extrapyramidal symptom;hospital patient;human;hypotension;intensive care psychosis;intensive care unit;length of stay;metabolic acidosis;mortality;neuroleptic malignant syndrome;occupational therapy;prolactin blood level;propofol infusion syndrome,"Desai, S.;Chau, T.;George, L.",2013,,,0,
1041,Kidney function and progression of carotid intima-media thickness in a community study,"BACKGROUND: Limited data exist regarding the relationship between decreased kidney function, carotid intima-media thickness (IMT) progression, and vascular events. STUDY DESIGN: A community-based cohort study. SETTING & PARTICIPANTS: 3,364 participants in the Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg, Bavaria Study. PREDICTOR: Quartiles of kidney function level estimated by means of creatinine clearance (Ccr) using the Cockcroft-Gault equation (Ccr <64, 64 to 75, 75 to 89, and >89 mL/min/1.73 m(2)). OUTCOMES & MEASUREMENTS: Change in carotid IMT during 2 years. Composite clinical study end point is the occurrence of major adverse cardiovascular events, a composite of myocardial infarction, stroke, and vascular death after 2 years. RESULTS: Baseline mean carotid IMT was 0.79 +/- 0.19 (SD) mm. Mean change in carotid IMT was 0.02 +/- 0.11 mm/y. Lower Ccr quartile at baseline was associated with a greater change in adjusted mean values: 0.024 (95% confidence interval [CI], 0.020 to 0.027); 0.019 (95% CI, 0.015 to 0.023); 0.012 (95% CI, 0.009 to 0.016); and 0.0077 (95% CI, 0.005 to 0.011), respectively (P < 0.01). After evaluation of change in carotid IMT, 36 patients (1.1%) experienced a fatal and nonfatal vascular event. Subjects with baseline Ccr less than the median (75 mL/min/1.73 m(2)) and change in carotid IMT greater than the median (0.008 mm/y) had the worst prognosis (log-rank test, P = 0.04). By means of multivariable analysis with the Cox proportional hazard model, lower baseline Ccr (hazard ratio, 1.04; 95% CI, 1.02 to 1.23; P = 0.03 per 1-mL/min/1.73 m(2) decrease) and faster change in carotid IMT (hazard ratio, 1.15; 95% CI, 1.11 to 1.93; P = 0.01 per 0.1-mm increase) were associated with fatal and nonfatal vascular events. LIMITATIONS: Microalbuminuria, associated with carotid atherosclerosis, was not available. CONCLUSION: Decreased kidney function is associated strongly with faster change in carotid IMT. In addition, decreased kidney function and faster change in carotid IMT are associated with cardiovascular events.",Aged;Carotid Arteries/*pathology;Chronic Disease;Cohort Studies;Disease Progression;Female;Humans;Kidney/*physiopathology;Kidney Diseases/*physiopathology;Kidney Function Tests;Male;Tunica Intima/*pathology;Tunica Media/*pathology,"Desbien, A. M.;Chonchol, M.;Gnahn, H.;Sander, D.",2008,Apr,10.1053/j.ajkd.2007.11.026,0,
1042,"Spanish registry for adverse events of biological therapy in rheumatic diseases (BIOBADASER): State report, January 26th, 2006","Objective: BIOBADASER is a prospective registry of rheumatic patients treated with biological therapies, which aim is the analysis of long-term survival and safety of these agents. Patients and methods: As of January 26th 2006, 6,969 patients from 100 centers were included in BIOBADASER. In total, 8,321 treatments with biological therapies have been registered. Results: Treatment was discontinued in 2,351 (28%) occasions, mostly as a result of an adverse event (960;41%) or inefficacy (942;40%). A total of 2,503 adverse events were notified. Of these, the most frequent ones were infections (909;36%), followed by post-infusion reactions (500;20%), skin lesions (255;10%) and cardiovascular events (165;7%). Conclusions: The analysis reassures us in the increased rate of infections with biological therapies. Neither the rates of neoplasm nor of cardiac failure are significantly increased with these therapies. Specific measures have proved useful in preventing the occurrence of defined events.",adalimumab;antirheumatic agent;etanercept;infliximab;recombinant interleukin 1 receptor blocking agent;rituximab;abdominal pain;accident;acne;adenocarcinoma;agoraphobia;alopecia;amnesia;amyloidosis;amyotrophic lateral sclerosis;anaphylaxis;anemia;angina pectoris;angioneurotic edema;ankylosing spondylitis;anus fistula;aorta aneurysm;aorta arch syndrome;aorta rupture;appendicitis;arthropathy;article;asthenia;atlantoaxial dislocation;avascular necrosis;bacterial endocarditis;basal cell carcinoma;Behcet disease;biliary colic;hematologic disease;brain hemorrhage;brain infarction;brain infection;breast carcinoma;bronchiolitis obliterans;bronchospasm;cardiovascular disease;cerebrovascular disease;cervicobrachial neuralgia;colon carcinoma;colon polyp;combination chemotherapy;confusion;convulsion;cor pulmonale;cornea ulcer;Crohn disease;dementia;depression;dermatitis;diabetes mellitus;diarrhea;digestive system disease;digestive system hemorrhage;diplopia;disease registry;diskitis;diverticulitis;drug efficacy;drug eruption;drug hypersensitivity;drug induced cancer;drug infusion;drug safety;drug surveillance program;drug withdrawal;duodenitis;Dupuytren contracture;dyspepsia;dyspnea;dysuria;endocrine disease;endometriosis;eosinophilia;epistaxis;erythema;erythema multiforme;erythema nodosum;esophagitis;essential tremor;eye disease;eye pain;Felty syndrome;gastritis;gingiva bleeding;gingiva tumor;glaucoma;glioblastoma;granuloma annulare;gynecologic disease;heart arrhythmia;heart disease;heart failure;heart infarction;hematoma;hematuria;hemoptysis;hemorrhagic cystitis;hernia;human;hyperbilirubinemia;hypercholesterolemia;hyperparathyroidism;hypertension;hyperthyroidism;hypertrichosis;hypocalcemia;hypothyroidism;hysteria;impotence;infection;infection rate;injection site inflammation;insomnia;intestine ischemia;intestine obstruction;intraocular hemorrhage;iritis;ischialgia;juvenile rheumatoid arthritis;keratoacanthoma;kidney disease;kidney failure;kidney function;kidney pain;larynx tumor;leukopenia;libido disorder;lichen planus;lichen striatus;lipoma;liver dysfunction;long term care;lung carcinoma;lung disease;lung embolism;lung fibrosis;lung tuberculosis;lupus erythematosus;lupus like syndrome;lymphoma;melanoma;meningioma;menstruation disorder;mental disease;miliary tuberculosis;monoclonal immunoglobulinemia;monotherapy;mouth ulcer;Muckle Wells syndrome;myasthenia gravis;nephrolithiasis;neuritis;neurologic disease;obesity;occlusive cerebrovascular disease;odynophagia;ovary carcinoma;pain;pancreas carcinoma;pancreatitis;pancytopenia;pathologic fracture;peptic ulcer;pericarditis;peripheral edema;peripheral ischemia;peritoneum cancer;phlebitis;pleura disease;pneumonia;pneumothorax;polyarteritis nodosa;polyarthritis;polychondritis;polymyositis;polyneuropathy;posttraumatic arthropathy;preventive medicine;prostate carcinoma;prostatism;pruritus;psoriasis;psoriatic arthritis;psychosis;ptosis;pyoderma gangrenosum;rectum hemorrhage;Reiter syndrome;respiratory failure;rheumatic disease;rheumatoid arthritis;rhinitis;SAPHO syndrome;sarcoidosis;scleritis;scleroderma;seborrhea;sepsis;septic shock;side effect;Sjoegren syndrome;skin defect;skin disease;skin lupus erythematosus;skin ulcer;Spain;squamous cell carcinoma;stomach perforation;survival;faintness;systemic lupus erythematosus;tendon rupture;thorax pain;thorax radiography;thrombocytopenia;toxic hepatitis;treatment duration;trigeminus neuralgia;tuberculosis;ulcerative colitis;urinary tract disease;urticaria;uveitis;valvular heart disease;vasculitis;vein thrombosis;vertigo;visual disorder;vitiligo;vitreous disease;Wegener granulomatosis;xanthoma,"Descalzo, M. Á;Montero, D.;Erra, A.;Marsal, S.;Fernández Castro, M.;Mulero, J.;Luis Andréu, J.;Rodríguez Gómez, M.;Larrosa Pardo, M.;Casado, E.;Sirvent, E. L.;Reina, D.;García Gómez, C.;Joven, B.;Carreira, P.;Hernández, M. V.;Loza, E.;Alonso, A.;Uriarte, E.;Pantoja, L.;Valvanera Pinillos, M.;Mariné, T.;García de Vicuña, R.;Ortiz, A. M.;González Álvaro, I.;Laffón, A.;Álvaro-Gracia, J. M.;Díaz López, C.;Rodríguez de La Serna, A.;Loza, E.;Irigoyen, M. V.;Ureña, I.;Coret, V.;Vela, P.;Pascual Gómez, E.;Belmonte, M. A.;Beltrán, J.;Lerma, J. J.;Liz, M.;Gelman, S. M.;Ciruelo, E.;Tomero, E.;Amengual, O.;Cobeta, J. C.;Saiz, E.;Gálvez, J.;Iglesias de La Torre, G.;Roselló, R.;Vźquez, C.;Valdazo, J. P.;Tena, X.;Ortiz, V.;Fernández Prada, M.;Piqueras, J. A.;Tornero Molina, J.;Cebrián, L.;Carreño, L.;García Borras, J. J.;Javier Manero, F.;Pujol, M.;Granados, J.;Cuadra, J. L.;Javier Paulino, F.;Paulino, M.;Maiz, O.;Barastay, E.;Figueroa, M.;Torres, C.;Corteguera, M.;Rodríguez Lozano, C.;Francisco Hernńadez, F.;Rua Figueroa, I.;Illera, O.;Zea, A. C.;García de La Peña, P.;Valero, M.;Aznar, E.;Gutiérrez, R.;Cruz Valenciano, A.;Crespo, M.;Cabero, F.;Ruiz Jimeno, M. T.;Fiter, J.;Espadaler, L.;Vesga, J. C.;Cuende, E.;Sánchez Andrada, S.;Rodríguez Valverde, V.;Ferraz, I.;González, T.;Marenco, J. L.;Rejón, E.;Collantes, E.;Castro, M. C.;Montes de Oca, J. V.;Navarro, F.;Javier Toyos, F.;Marras, C.;Linares, L. F.",2007,,,0,
1043,Induction of the C-terminal proteolytic cleavage of AβPP by statins,"Statins are drugs commonly used to inhibit cholesterol synthesis, with the goal of reducing vascular diseases such as myocardial infarction and stroke. Statins have also been suggested as a therapeutic option for Alzheimer's disease (AD), although their benefit in AD remains controversial. We have previously shown that the intracellular C-terminal cleavage of the amyloid-β protein precursor (AβPP) is a major contributor to the neuronal toxicity seen in AD, and that this cleavage can be induced by amyloid-β. We now report that certain brain permeable statins are also able to induce the C-terminal cleavage of AβPP and associated cell death, whereas other statins do not. This statin effect on AβPP exceeded the effects of all other FDA-approved drugs in a library composed of these compounds, suggesting that this effect on AβPP cleavage is unique to a subset of the statins. Furthermore, the greatest effect occurred with cerivastatin, which has previously been shown to be the statin associated with the greatest risk of rhabdomyolysis. These results may have implications for the choice of which statins to evaluate in AD therapeutic trials; furthermore, the results may inform statin choice in individuals who are at high risk for the development of AD, such as those with an apolipoprotein E ε4 allele. © 2011 - IOS Press and the authors. All rights reserved.",amyloid precursor protein;atorvastatin;cerivastatin;compactin;hydroxymethylglutaryl coenzyme A reductase inhibitor;pravastatin;simvastatin;article;carboxy terminal sequence;cell death;CHO cell line;controlled study;drug penetration;priority journal;protein cleavage,"Descamps, O.;Zhang, Q.;John, V.;Bredesen, D. E.",2011,,,0,
1044,What to do when facing with atrial thrombus: Surgical treatment of five cases,"Although atrial thrombuses are not very common, may represent as tumors. Urgent surgery is indicated in patients to prevent pulmonary embolism, acute valve obstruction or heart failure. We review here the clinical features, epidemiology, diagnosis and treatment of five interesting cases with atrial thrombuses.",antibiotic agent;warfarin;adult;aged;Alzheimer disease;antibiotic therapy;anticoagulant therapy;article;artificial heart pacemaker;atrial fibrillation;bioprosthesis;case report;cerebrovascular disease;clinical article;clinical feature;deterioration;diabetes mellitus;disease severity;dyspnea;echocardiography;emergency surgery;excision;external pacemaker;female;heart atrium thrombosis;heart left atrium;human;hypertension;leg swelling;medical history;middle aged;mitral valve regurgitation;mitral valve replacement;open heart surgery;respiratory tract infection;rheumatic fever;sepsis;surgical technique;transthoracic echocardiography;tricuspid valve;tricuspid valve prosthesis;tricuspid valve regurgitation;tricuspid valve replacement,"Deser, S. B.;Demirag, M. K.",2017,,10.5835/jecm.omu.34.02.012,0,
1045,Mortality in patients with dementia after ischemic stroke,"Objective: Although dementia is typically considered to be a consequence of a variety of neurologic diseases, it can also serve as a risk factor for other adverse outcomes. The authors investigated dementia as a predictor of long-term survival among patients with ischemic stroke. Methods: Neurologic, neuropsychological, and functional assessments were administered to 453 patients (mean age ± SD, 72.0 ± 8.3 years) 3 months after ischemic stroke. The authors diagnosed dementia in 119 (26.3%) of the patients using modified Diagnostic and Statistical Manual of Mental Disorders, Revised 3rd Edition, criteria requiring deficits in memory and two or more additional cognitive domains as well as functional impairment. Dementia as a predictor of long-term survival during up to 10 years of follow-up was then investigated. Results: The mortality rate was 15.90 deaths per 100 person-years among patients with dementia and 5.37 deaths per 100 person-years among nondemented patients. A Cox proportional hazards analysis found that the relative risk (RR) of death was increased in association with dementia (RR = 2.4; 95% CI = 1.6 to 3.4), adjusting for the following: a major hemispheral stroke syndrome (RR = 1.4); a middle cerebral artery territory index stroke (RR = 1.7); a Stroke Severity Scale score of ≥4, representing more severe stroke (RR = 1.8); atrial fibrillation (RR = 1.8); congestive heart failure (RR = 2.2); recurrent stroke occurring during follow-up (RR = 3.9); and demographic variables. The risk of death increased in association with the severity of dementia, but it did not differ by dementia subtype. Conclusions: Dementia is a significant independent risk factor for reduced survival after ischemic stroke, adjusting for other recognized predictors of mortality. The authors hypothesize that patients with dementia are at an elevated risk of mortality because of their increased burden of cerebrovascular disease, a tendency toward undertreatment for stroke prophylaxis among clinicians, or patient noncompliance with treatment regimens.",amnesia;article;cerebrovascular accident;cognitive defect;congestive heart failure;dementia;demography;disease severity;follow up;functional assessment;atrial fibrillation;human;major clinical study;middle cerebral artery occlusion;mortality;neurologic examination;neuropsychological test;prediction;priority journal;psychiatric diagnosis;rating scale;recurrent disease;risk assessment;risk factor;scoring system;survival;United States,"Desmond, D. W.;Moroney, J. T.;Sano, M.;Stern, Y.",2002,,,0,
1046,Bacteriological and clinical profile of community acquired pneumonia in hospitalized patients,"The aim of our study was to determine the bacteriological and clinical profile of community acquired pneumonia patients requiring hospital admission. CAP was defined as per BTS guidelines. 65/104 cases of study group turned out to be culture positive for definitive bacterial etiology. The Commonest cause for CAP was Streptococcus pneumoniae (19/65) followed by, Klebsiella pneumoniae (17/65), Staphylococcus aureus (13/65), Pseudomonas aeruginosa (8/65), Escherichia coli (4/65), Acinetobactor spp. (3/65). Smoking (52%) and chronic alcoholism (28%) were major risk factors and COPD (23%) and Diabetes mellitus (19%) were major co-morbidities associated with CAP in the study group. The mortality was 8% cases after therapy and Pseudomonas aeruginosa was commonest cause of it. Death occurred exclusively in elderly people, all of whom were suffering from co- morbidities and had an initial CURB-65 a score of three. Limitation of our study was the inability to isolate atypical micro organisms. This emphasizes the need for further studies.",Acinetobacter;addiction;adult;alcoholism;article;asthma;bacterium culture;bacterium isolate;bronchiectasis;cause of death;cerebrovascular disease;chronic kidney disease;chronic obstructive lung disease;community acquired pneumonia;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;disease severity;Escherichia coli;female;hospital admission;hospital patient;human;interstitial lung disease;Klebsiella pneumoniae;lung lavage;major clinical study;male;mortality;multiple organ failure;pancreas carcinoma;pleura fluid;Pseudomonas aeruginosa;risk factor;smoking;sputum analysis;Staphylococcus aureus;Streptococcus pneumoniae,"Dharmadhikari, V.;Joseph, T.;Kulkarni, A.",2013,,,0,
1047,"Hypertension management: Implications to patients, providers, and payers",,antihypertensive agent;beta adrenergic receptor blocking agent;diuretic agent;artery disease;blood pressure regulation;cerebrovascular disease;chronic kidney disease;disease course;drug cost;health care cost;health care personnel;health insurance;heart failure;heart infarction;human;hypertension;lifestyle modification;multiinfarct dementia;patient attitude;physician attitude;prophylaxis;risk assessment;risk factor;short survey;treatment indication;treatment outcome,"Dharmarajan, L.",2010,,,0,
1048,Managing complex long-term conditions and multimorbidity,,"Chronic Disease/ epidemiology/ therapy;Comorbidity;Dementia;Heart Failure;Humans;Mental Disorders;Parkinson Disease;Primary Health Care;Pulmonary Disease, Chronic Obstructive;Renal Insufficiency, Chronic;United Kingdom","Dhere, A.",2016,Dec,,0,
1049,Playing it safe: exercise and cardiovascular health,"Regular physical activity controls acquired cardiovascular risk factors such as obesity, diabetes mellitus, hypertension and hyperlipidaemia. Exercise is generally associated with a 50% reduction in adverse events from coronary artery disease (CAD). The benefits of exercise extend well beyond the cardiovascular system. Recent evidence suggests that exercise prevents cell senescence, and active individuals are at lower risk of developing certain malignancies including cancer of the prostate and the colon, osteoporosis, depression and dementia. Individuals who exercise regularly extend their life expectancy by three to seven years. Healthy individuals should engage in 150 minutes of moderate-intensity, aerobic exercise per week. Recent studies have demonstrated that even lower volumes of exercise below these recommendations confer health benefits, which is highly relevant to individuals with established cardiac disease including heart failure. Sudden cardiac death in athletes under 35 is rare with.estimates ranging from 1 in 50,000 to 1 in 200,000. Hereditary and congenital abnormalities of the heart are the most common cause of nontraumatic death during sport in young athletes. In middle-aged recreational athletes more than 90% of sudden cardiac deaths occur in males and more than 90% are caused by atherosclerotic CAD. The AHA and the ESC advocate pre-participation screening of young athletes. The ECG has the ability to detect congenital accessory pathways and ion channelopathies, and is frequently abnormal in individuals with cardiomyopathy. Screening with a 12-lead ECG in older athletes is of limited value given the overwhelming contribution of atherosclerotic CAD to sudden cardiac death.",*Activities of Daily Living;*Cardiovascular Diseases/epidemiology/physiopathology/prevention & control;Global Health;*Health Status;Humans;*Mass Screening;Morbidity/trends;*Physical Fitness;Risk Factors,"Dhutia, H.;Sharma, S.",2015,Oct,,0,
1050,"Cognitive impairment without dementia in older people: prevalence, vascular risk factors, impact on disability. The Italian Longitudinal Study on Aging","OBJECTIVES: To investigate prevalence of ""cognitive impairment, no dementia"" (CIND) in the Italian older population, evaluating the association with cardiovascular disease and the impact on activities of daily living (ADL). CIND may provide pathogenic clues to dementia and independently affect ADL. DESIGN: Cross-sectional examination in the context of the Italian Longitudinal Study on Aging. SETTING: Random population sample from eight Italian municipalities. PARTICIPANTS: A total of 3,425 individuals aged 65-84 years, residing in the community or institutionalized. MEASUREMENTS: Study participants were screened for cognitive impairment by using the Mini-Mental State Examination. Trained neurologists examined those scoring <24. CIND diagnosis relied on clinical and neuropsychological examination, informant interview, and assessment of functional activities. Age-related cognitive decline (ARCD) was diagnosed in CIND cases without neuropsychiatric disorders responsible for the cognitive impairment. RESULTS: Prevalence was 10.7% for CIND and 7.5% for ARCD, increased with age, and was higher in women. Age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.06-1.12), stroke (OR, 2.05; 95% CI, 1.26-3.35) and heart failure (OR, 1.73; 95% CI, 1.11-2.68) were significantly and positively associated with CIND at multivariate analysis. Education (OR, 0.61; 95% CI, 0.56-0.65) and smoking (OR, 0.72; 95% CI, 0.54-0.98) showed a negative correlation. Age and myocardial infarction were positively associated with ARCD, whereas a negative correlation was found for education and smoking. The effect of smoking was no more significant either on CIND or ARCD considering current habits or ""pack year"" exposure. CIND showed an independent impact on ADL (OR, 1.88; 95% CI, 1.41-2.49). CONCLUSIONS: CIND is very frequent in older people. The effect of demographic variables and vascular conditions offers opportunities for prevention. The association with functional impairment is useful to evaluate the burden of disability and healthcare demands.","Activities of Daily Living/classification;Aged;Aged, 80 and over;Cognition Disorders/diagnosis/*epidemiology;Cross-Sectional Studies;Dementia/diagnosis/*epidemiology;Dementia, Vascular/diagnosis/*epidemiology;*Disability Evaluation;Female;Geriatric Assessment;Humans;Italy/epidemiology;Longitudinal Studies;Male;Mental Status Schedule;Risk Factors","Di Carlo, A.;Baldereschi, M.;Amaducci, L.;Maggi, S.;Grigoletto, F.;Scarlato, G.;Inzitari, D.",2000,Jul,,0,
1051,Transdermal/transmucosal drug delivery: New technologies and outsourcing opportunities,,clonidine;cyanocobalamin;desmopressin;diclofenac;estradiol;estradiol plus norethisterone acetate;fentanyl;fentanyl citrate;fluticasone propionate;glyceryl trinitrate;influenza vaccine;lidocaine;miconazole;methylphenidate;nabiximols;nicotine;nicotine gum;ondansetron;oxybutynin;oxytocin;piroxicam;prochlorperazine maleate;rivastigmine;rotigotine;salcatonin;scopolamine;selegiline;striant sr;testosterone;tiloket;trinitrate;unclassified drug;zolpidem tartrate;Alzheimer disease;analgesia;androgen therapy;angina pectoris;article;attention deficit disorder;cream;dehydration;diabetes mellitus;drug delivery system;drug industry;drug manufacture;drug uptake;gel;hypertension;insomnia;major depression;membrane permeability;menopausal syndrome;motion sickness;mouth;mucosal drug administration;multiple sclerosis;nausea and vomiting;nose;osteoarthritis;osteoporosis;overactive bladder;Parkinson disease;sclerosis;skin;smoking cessation;tobacco dependence;transdermal patch;vitamin deficiency;actiq;androgel;buccastem;Catapres-TTS;combipatch;daytrana;desmospray;duragesic;emsam;estraderm;estrogel;exelon;feldene;fentora;flonase;flumist;fortical;lazanda;lidoderm;loramyc;miacalcin;nascobal;neupro;nicorette;nicotinell;nicotrol;nitromist;nitrostat;onsolis;oxytrol;pennsaid;sativex;suscard;syntocinon;transderm nitro;transderm scop;voltaren;zofran;zolpimist,"Di Filippo, P.",2013,,,0,
1052,Chitotriosidase: A New Inflammatory Marker in Diabetic Complications,"Chitotriosidase (CHIT1) belongs to chitinase family. So far this enzyme has been the best investigated human chitinase regarding its biological activity and association with various disorders. In a healthy population, CHIT1 activity is very low and originates in the circulating polymorphonuclear cells. Conversely, during the development of acute/chronic inflammatory disorders, the enzymatic activity of CHIT1 increases significantly. Recently, CHIT1 has also been involved in the pathogenesis of diabetes mellitus (DM). Mounting evidence from experimental studies revealing the increase of CHIT1 levels in pathological conditions, such as atherosclerosis, coronary artery disease, acute ischemic stroke, cerebrovascular dementia, nonalcoholic fatty liver disease, and osteolytic processes suggest its critical role in the evolutions and complications of DM. This review is addressed to provide mechanistic insights by highlighting the relationship between CHIT1 and diabetes, and their contribution in the exacerbation of this disease.",,"Di Rosa, M.;Malaguarnera, L.",2016,,10.1159/000443932,0,
1053,Atrial fibrillation and comorbidities in very elderly patients,"Background: Atrial fibrillation is the most common arrhythmia encountered in clinical practice. It is associated with increased morbidity and mortality, due to the risk of thromboembolic events and associated risk factors. Methods: The purpose of the study was to analyze the clinical characteristics of very elderly patients (> 80 yo) with permanent atrial fibrillation admitted to the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest over a period of one year. Results: The distribution by sex in the study group: 81 men (41.53%) and 114 women (58.46%). The mean age was 84.5 yo. 42.56% of the patients were institutionalized in nursing homes. The main comorbidities were: arterial hypertension 78.46%, coronary artery disease 61.02%, heart failure 47.17%, chronic obstructive pulmonary disease 44.61%, peripheral artery disease 42.05%, cerebrovascular disease 40.51%, valvular heart disease 39.48%, diabetes 31.79%, dementia 14.35%, chronic kidney disease (eGFR< 60 ml/min/1.73 m2) (MDRD) 9.74%. As compared to non-institutionalized patients, those residing in nursing homes were older and had higher comorbidity score. 173 patients (88.71%) received anticoagulants: 129 patients (74.56%) received cumarinic oral anticoagulants and 44 patients (25.43%) new anticoagulants (dabigatran). The mean CHA2DS2-VASc score was 5.2. In-hospital mortality rate in very elderly patients with atrial fibrillation was 10.76%. Rates of mortality, heart failure, coronary artery disease and stroke increased with older age and higher CHA2DS2-VASc scores. Conclusions: Atrial fibrillation is a frequent arrhythmia in very elderly patients. Very elderly patients with atrial fibrillation have many comorbidities, arterial hypertension, coronary artery disease, heart failure and chronic obstructive pulmonary disease being the most frequent. In-hospital mortality rate of very elderly patients with atrial fibrillation is high. Adequate control of arterial hypertension and management of heart failure in patients with atrial fibrillation, alongside with stroke prevention are key priorities for the management of very elderly patients with atrial fibrillation and improving quality of their life.",anticoagulant agent;dabigatran;aged;anticoagulant therapy;article;cardiovascular mortality;cerebrovascular disease;chronic kidney failure;chronic obstructive lung disease;clinical assessment;comorbidity;controlled study;coronary artery disease;dementia;diabetes mellitus;female;heart failure;hospital;hospital mortality;human;hypertension;major clinical study;male;nursing home;peripheral occlusive artery disease;permanent atrial fibrillation;sex ratio;valvular heart disease;very elderly,"Diaconu, C. C.;Balaceanu, A.",2015,,,0,
1054,Mitochondrial DNA has a pro-inflammatory role in AMD,"Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the elderly of industrialized nations, and there is increasing evidence to support a role for chronic inflammation in its pathogenesis. Mitochondrial DNA (mtDNA) has been recently reported to be pro-inflammatory in various diseases such as Alzheimer's and heart failure. Here, we report that intracellular mtDNA induces ARPE-19 cells to secrete inflammatory cytokines IL-6 and IL-8, which have been consistently associated with AMD onset and progression. The induction was dependent on the size of mtDNA, but not on specific sequence. Oxidative stress plays a major role in the development of AMD, and our findings indicate that mtDNA induces IL-6 and IL-8 more potently when oxidized. Cytokine induction was mediated by STING (Stimulator of Interferon Genes) and NF-kappaB as evidenced by abrogation of the cytokine response with the use of specific inhibitors (siRNA and BAY 11-7082, respectively). Finally, mtDNA primed the NLRP3 inflammasome. This study contributes to our understanding of the potential pro-inflammatory role of mtDNA in the pathogenesis of AMD.","Carrier Proteins/metabolism;Cell Line;DNA, Mitochondrial/*metabolism;Humans;Inflammasomes/*metabolism;Interleukin-6/*metabolism;Interleukin-8/*metabolism;Macular Degeneration/*metabolism/pathology;*Oxidative Stress;Age-related macular degeneration;Inflammation;Mitochondrial DNA;NLRP3 inflammasome;Retinal pigment epithelium","Dib, B.;Lin, H.;Maidana, D. E.;Tian, B.;Miller, J. B.;Bouzika, P.;Miller, J. W.;Vavvas, D. G.",2015,Nov,10.1016/j.bbamcr.2015.08.012,0,
1055,The relationship between patient-reported tolerability issues with oral antidiabetic agents and work productivity among patients having type 2 diabetes,"OBJECTIVE: To investigate the association between reported oral antidiabetic tolerability issues and work productivity, activity impairment, and indirect costs. METHODS: Data were collected from the 2006 to 2008 US National Health and Wellness Survey and the Lightspeed Research, using an Internet-based questionnaire (N = 2074). RESULTS: Absenteeism, presenteeism, overall work impairment, and activity impairment increased as the number of tolerability issues increased. Similar results were observed using a diabetes-specific productively measure. Total annual adjusted indirect costs (absenteeism and presenteeism costs summed) were $2759, $5533, $7537, and $8405 for patients with 1, 2, 3, and 4 or more tolerability issues, respectively. CONCLUSIONS: The consideration of tolerability profiles of oral antidiabetic agents may lead to improved productivity among treated patients. Furthermore, targeted educational programs regarding risks and management of these issues to employees with type 2 diabetes mellitus may benefit both employers and patients. © 2011 The American College of Occupational and Environmental Medicine.",hemoglobin A1c;oral antidiabetic agent;absenteeism;acquired immune deficiency syndrome;adult;Alzheimer disease;anxiety;article;bipolar disorder;chronic bronchitis;chronic kidney disease;chronic obstructive lung disease;congestive heart failure;constipation;dementia;depression;diarrhea;disease duration;drug tolerability;educational status;emphysema;ethnicity;female;headache;heart infarction;hemiplegia;hepatitis A;hepatitis B;hepatitis C;human;Human immunodeficiency virus infection;hypertension;hypoglycemia;income;kidney failure;leukemia;liver cirrhosis;major clinical study;male;marriage;non insulin dependent diabetes mellitus;osteoporosis;outcome assessment;peripheral vascular disease;productivity;rheumatoid arthritis;side effect;treatment duration;neoplasm;ulcerative colitis;water retention;weight gain,"DiBonaventura, M.;Link, C.;Pollack, M. F.;Wagner, J. S.;Williams, S. A.",2011,,,0,
1056,"Letter by Dichgans et al regarding article, ""peripheral Artery Disease as a Manifestation of Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) and practical implications""",,artery disease;brain damage;CADASIL;cerebrovascular disease;diabetes mellitus;disease severity;heart failure;human;hypotension;letter;nuclear magnetic resonance imaging;peripheral occlusive artery disease;priority journal;risk factor,"Dichgans, M.;Joutel, A.;Chabriat, H.",2013,,,0,
1057,Shared genetic susceptibility to ischemic stroke and coronary artery disease : A genome-wide analysis of common variants,"Background and Purpose-Ischemic stroke (IS) and coronary artery disease (CAD) share several risk factors and each has a substantial heritability. We conducted a genome-wide analysis to evaluate the extent of shared genetic determination of the two diseases. Methods-Genome-wide association data were obtained from the METASTROKE, Coronary Artery Disease Genomewide Replication and Meta-analysis (CARDIoGRAM), and Coronary Artery Disease (C4D) Genetics consortia. We first analyzed common variants reaching a nominal threshold of significance (P<0.01) for CAD for their association with IS and vice versa. We then examined specific overlap across phenotypes for variants that reached a high threshold of significance. Finally, we conducted a joint meta-analysis on the combined phenotype of IS or CAD. Corresponding analyses were performed restricted to the 2167 individuals with the ischemic large artery stroke (LAS) subtype. Results-Common variants associated with CAD at P<0.01 were associated with a significant excess risk for IS and for LAS and vice versa. Among the 42 known genome-wide significant loci for CAD, 3 and 5 loci were significantly associated with IS and LAS, respectively. In the joint meta-analyses, 15 loci passed genome-wide significance (P<5×10-8) for the combined phenotype of IS or CAD and 17 loci passed genome-wide significance for LAS or CAD. Because these loci had prior evidence for genome-wide significance for CAD, we specifically analyzed the respective signals for IS and LAS and found evidence for association at chr12q24/SH2B3 (PIS=1.62×10-7) and ABO (PIS=2.6×10-4), as well as at HDAC9 (PLAS=2.32×10-12), 9p21 (PLAS=3.70×10-6), RAI1-PEMT-RASD1 (PLAS=2.69×10-5), EDNRA (PLAS=7.29×10-4), and CYP17A1-CNNM2-NT5C2 (PLAS=4.9×10-4). Conclusions-Our results demonstrate substantial overlap in the genetic risk of IS and particularly the LAS subtype with CAD. © 2013 American Heart Association, Inc.",ISRCTN48489393;article;brain ischemia;coronary artery disease;gene locus;genetic association;genetic risk;genetic susceptibility;genetic variability;human;large artery stroke;meta analysis (topic);phenotype;priority journal,"Dichgans, M.;Malik, R.;König, I. R.;Rosand, J.;Clarke, R.;Gretarsdottir, S.;Thorleifsson, G.;Mitchell, B. D.;Assimes, T. L.;Levi, C.;Ódonnell, C. J.;Fornage, M.;Thorsteinsdottir, U.;Psaty, B. M.;Hengstenberg, C.;Seshadri, S.;Erdmann, J.;Bis, J. C.;Peters, A.;Boncoraglio, G. B.;März, W.;Meschia, J. F.;Kathiresan, S.;Ikram, M. A.;McPherson, R.;Stefansson, K.;Sudlow, C.;Reilly, M. P.;Thompson, J. R.;Sharma, P.;Hopewell, J. C.;Chambers, J. C.;Watkins, H.;Rothwell, P. M.;Roberts, R.;Markus, H. S.;Samani, N. J.;Farrall, M.;Schunkert, H.",2014,,,0,
1058,"Atrial fibrillation and heart failure: Intersecting populations, morbidities, and mortality","Heart failure (HF) and atrial fibrillation (AF) are the only two cardiovascular disorders that continue to increase in magnitude in the United States. The purpose of this brief overview is to provide a description of these two cardiovascular epidemics of HF and AF as they interact, and to provide additional information regarding the emerging influence of genetics and environment in the development of AF in the HF setting. These two modern epidemics are highly interactive and highly age-dependent. The development of new AF in a patient with either HF with preserved ejection fraction or HF with reduced ejection fraction possesses challenging management issues for practicing physicians. Control of heart rate is always prudent though still not precisely defined. The need to restore normal sinus rhythm is highly patient-dependent and strategies will vary. Elderly patients derive the most benefit from anticoagulation, but are also more prone to falls and bleeding complications. Today, we know much more about AF and HF and how they interact. The extent of AF/HF challenge is now widely recognized. It is inevitable that as people age, they will develop structural and functional changes in the cardiovascular system, some of which will predispose to the development of HF and AF. Not every case of HF or AF is preventable. Nevertheless, it is only throughout careful observations and further studies that we will be able to better manage these two Goliaths. © 2013 Springer Science+Business Media New York.",implantable cardioverter defibrillator;anticoagulant agent;enalapril;ibopamine;vasodilator agent;acute heart failure;African American;age distribution;Alzheimer disease;article;Asian;bleeding;cardiac resynchronization therapy;Caucasian;cerebrovascular accident;congestive heart failure;coronary artery disease;coronary risk;diastolic dysfunction;disease classification;disease exacerbation;disease predisposition;disease severity;elderly care;ethnic difference;gene locus;genetic association;genetic heterogeneity;genetic risk;genetic susceptibility;genetic variability;genotype environment interaction;health care cost;heart atrium arrhythmia;heart atrium enlargement;atrial fibrillation;heart failure;heart failure with preserved ejection fraction;heart failure with reduced ejection fraction;heart left ventricle ejection fraction;heart left ventricle hypertrophy;heart rate;heart supraventricular arrhythmia;heart ventricle pacing;heritability;home monitoring;hospitalization;human;hypertension;incidence;intermethod comparison;ischemic cardiomyopathy;mitral valve regurgitation;morbidity;mortality;pathophysiology;prevalence;prophylaxis;rehabilitation care;risk assessment;risk factor;scoring system;sex difference;single nucleotide polymorphism;sudden cardiac death;survival;systolic dysfunction;transient ischemic attack,"Dickinson, O.;Chen, L. Y.;Francis, G. S.",2014,,,0,
1059,Hippocampal sclerosis: A common pathological feature of dementia in very old (≥80 years of age) humans,"In a neuropathological study of 81 brains of prospectively studied subjects of 80 years of age or older at the time of death, 13 cases (16%), including 4 men and 9 women, had hippocampal sclerosis (HpScl) affecting the vulnerable region of the hippocampus. In demented subjects of 80 years of age or older, the frequency of HpScl was even higher, 26%. Cases with HpScl had significantly fewer hippocampal senile plaques (SP) and neurofibrillary tangles (NFT) and parahippocampal NFT than cases without HpScl, but did not differ significantly in any of the other measured pathological parameters. Enzyme-linked analysis of synaptic protein immunoreactivity in a subset of 33 cases demonstrated significant decreases in the hippocampus, but not in frontal, temporal, parietal or parahippocampal cortices. All but 4 of the cases with HpScl had Blessed information, memory and concentration scores (BIMC) of 8 or more, and all were considered to be demented. In some patients memory disturbance was disproportionate to deficits in other cognitive areas. All but 4 of the cases with HpScl had many non-neuritic, amyloid plaques in the neocortex meeting NIA criteria for Alzheimer's disease (AD); however, given the advanced age of the subjects, amyloid plaques were considered to represent age-related cerebral amyloid deposition ('pathological aging') in most cases. Only 3 cases had both many SP and NFT in multiple cortical regions consistent with AD. Another case had brain stem and cortical Lewy bodies consistent with diffuse Lewy body disease (DLBD). A few ballooned neurons were present in the limbic cortices in 3 cases, including one case of dementia with argyrophilic grains (DAG) in limbic and orbital frontal and temporal cortices. The 8 cases without AD, DLBD or DAG included 4 cases in which no other obvious cause of dementia was detected and 4 cases in which HpScl was accompanied by either multiple cerebral infarcts or leukoencephalopathy, or both, that could have contributed to dementia. Patients with HpScl had risk factors, clinical signs and post-mortem pathological findings of cardiovascular disease, but due to the high prevalence of these conditions in very old humans, no significant correlation with HpScl was detected. This study demonstrates that HpScl is a common post-mortem finding in demented, but not normal, elderly subjects. It may contribute to, or be a marker for, the increased risk of dementia in subjects with documented cardiovascular disease or a history of myocardial infarction.",amyloid;aged;amnesia;article;brain infarction;clinical article;dementia;enzyme analysis;female;hippocampus;human;human tissue;leukoencephalopathy;Lewy body;male;memory;neocortex;neurofibrillary tangle;neuropathology;priority journal;prospective study;senile plaque,"Dickson, D. W.;Davies, P.;Bevona, C.;Van Hoeven, K. H.;Factor, S. M.;Grober, E.;Aronson, M. K.;Crystal, H. A.",1994,,,0,
1060,Medical risk factors in frontotemporal lobar degeneration,"Frontotemporal lobar degenerations (FTLD) are the cause of 30 to 50% of presenile dementias. A positive family history of dementia is present in approximately 40% of FTLD patients. Evidence of autosomal dominant transmission, however, is only found in less than 10% of cases. This suggests that non-genetic factors have a role in the aetiology of these neurodegenerative disorders. In the present case-control study we assessed the personal history of 82 German patients with FTLD (frontotemporal dementia - FTD, semantic dementia - SD, and primary progressive aphasia - PPA) and compared it with data of 82 cognitively healthy individuals matched for age and sex. The case-control study focused on diseases for which a possible association with cognitive impairment has been demonstrated: hypertension, hypercholesterolaemia, myocardial infarction, stroke, diabetes, thyroid disorders, head trauma with loss of consciousness, and depression. We included information on nicotine and alcohol use as well as on alcohol dependence. None of the somatic conditions investigated was significantly more frequent in patients with FTD than in age-matched cognitively healthy individuals. The number of smokers was almost identical in both groups. Regular intake of alcohol was less common among FTLD patients than among healthy subjects. Due to the relatively low prevalence of FTLD the search for risk factors is difficult. However, research in this area must be pushed ahead since the identification of risk factors can reveal new insights into pathophysiological mechanisms and may ultimately pave the way for therapeutic and preventive strategies. © Georg Thieme Verlag KG Stuttgart.",nicotine;alcohol consumption;alcoholism;article;autosomal dominant inheritance;brain degeneration;case control study;cognitive defect;consciousness disorder;controlled study;degenerative disease;dementia;depression;diabetes mellitus;family history;frontotemporal dementia;head injury;heart infarction;human;hypercholesterolemia;hypertension;major clinical study;primary progressive aphasia;risk assessment;smoking;cerebrovascular accident;thyroid disease,"Diehl, J.;Bornschein, S.;Krapp, S.;Hartmann, J.;Cramer, B.;Pohl, C.;Belcredi, P.;Kurz, A.",2005,,,0,
1061,The PRoFESS trial: Future impact on secondary stroke prevention,"Patients with transient ischemic attack and ischemic stroke have a high risk of recurrent stroke and death. While aspirin is accepted as standard therapy in these patients, recent trials demonstrate that a combination of aspirin and extended-release dipyridamole or clopidogrel is superior to aspirin monotherapy. Blockade of the renin-angiotensin system with angiotensin- converting enzyme inhibitors or angiotensin-receptor blockers may also reduce recurrent stroke. The ongoing Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial is designed to evaluate whether extended-release dipyridamole plus aspirin compared with clopidogrel, and whether telmisartan in addition to usual care, in individuals after a stroke, will reduce the risk of further strokes. PRoFESS is a multicenter, randomized, double-blind trial involving 695 sites from 35 countries or regions. The primary outcome for the trial is recurrent stroke, using a time-to-event analysis. Safety is evaluated by assessing the risk of major hemorrhagic and other serious adverse events. With over 20,000 patients randomized, and utilizing a 2 x 2 factorial design, PRoFESS is the largest stroke trial to investigate the prevention of recurrent stroke. © 2007 Future Drugs Ltd.",acetylsalicylic acid;acetylsalicylic acid plus dipyridamole;clopidogrel;dipeptidyl carboxypeptidase inhibitor;telmisartan;adult;aged;article;bleeding;brain hemorrhage;cerebrovascular accident;clinical trial;combination chemotherapy;congestive heart failure;controlled clinical trial;controlled study;deep vein thrombosis;double blind procedure;drug safety;epistaxis;female;gastrointestinal hemorrhage;gynecologic disease;heart infarction;hematemesis;hematuria;human;intraocular hemorrhage;lung embolism;major clinical study;male;monotherapy;multicenter study;neutropenia;occlusive cerebrovascular disease;peripheral occlusive artery disease;purpura;randomized controlled trial;recurrent disease;renin angiotensin aldosterone system;risk assessment;risk factor;secondary prevention;thrombotic thrombocytopenic purpura;transient ischemic attack;treatment outcome;unspecified side effect;aspirin,"Diener, H. C.",2007,,,0,
1062,"Rationale, design and baseline data of a randomized, double-blind, controlled trial comparing two antithrombotic regimens (a fixed-dose combination of extended-release dipyridamole plus ASA with clopidogrel) and telmisartan versus placebo in patients with strokes: The Prevention Regimen for Effectively Avoiding Second Strokes trial (PRoFESS)","Background: Individuals with transient ischemic attack and ischemic stroke have a high risk of recurrent stroke and death. While acetylsalicylic acid (ASA, aspirin) is proven and accepted as standard therapy in these patients, recent trials demonstrate that a combination of ASA and dipyridamole (DP) or clopidogrel may be superior to ASA. Blocking the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may also reduce recurrent stroke. The ongoing PRoFESS (Prevention Regimen for Effectively Avoiding Second Strokes) trial is designed to evaluate whether ASA + extended-release DP compared to clopidogrel, and whether telmisartan in addition to usual care in individuals after a stroke, will reduce the risk of further strokes. Methods: PRoFESS is a multicenter, randomized, double-blind trial involving 695 sites from 35 countries or regions. Patients ≥50 years presenting with an ischemic stroke <120 days who were stable were randomized. The primary outcome for the trial is recurrent stroke, using a time-to-event analysis. The most important secondary outcome is the composite of stroke, myocardial infarction or vascular death. Other secondary outcomes include this composite + congestive heart failure, new-onset diabetes, other designated occlusive vascular events (pulmonary embolism, deep-vein thrombosis, peripheral arterial occlusion, transient ischemic attack, cerebral venous thrombosis or retinal vascular accident not classified as stroke), any death, stroke subtype by TOAST criteria and Mini Mental State Examination score. Safety is evaluated by assessing the risk of major hemorrhagic events. The comparison between ASA + DP and clopidogrel is based on an initial assessment of noninferiority, followed by evaluation of superiority, while for telmisartan, we will assess its superiority over placebo. Results: With over 20,000 patients randomized, and utilizing a 2 x 2 factorial design, PRoFESS is the largest stroke trial to investigate the prevention of recurrent stroke. The mean age was 66.1 ± 8.6 years, and 36.0% of the patients were females. The median time from qualifying event to randomization was 15 days with 39.9% of patients randomized within 10 days. According to the TOAST criteria, 28.5% of the strokes were due to large-vessel disease, 52.1% to small-vessel disease, 1.8% to cardioembolism, and 2.0% to other determined etiologies and 15.5% were of undetermined etiology. Conclusions: PRoFESS is the largest secondary stroke prevention trial to date and will directly compare two antiplatelet regimens as well as the benefit of telmisartan versus placebo. Copyright © 2007 S. Karger AG.",acetylsalicylic acid plus dipyridamole;angiotensin receptor antagonist;anticoagulant agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;clopidogrel;dipeptidyl carboxypeptidase inhibitor;fibric acid derivative;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;loop diuretic agent;oral antidiabetic agent;placebo;potassium sparing diuretic agent;telmisartan;thiazide diuretic agent;adult;aged;anticoagulant therapy;article;bleeding;brain embolism;capillary;cerebrovascular accident;chemoprophylaxis;clinical trial;congestive heart failure;controlled clinical trial;controlled study;death;deep vein thrombosis;diabetes mellitus;double blind procedure;drug efficacy;drug safety;female;great blood vessel;heart death;heart infarction;human;low drug dose;lung embolism;major clinical study;male;methodology;Mini Mental State Examination;multicenter study;occlusive cerebrovascular disease;outcome assessment;peripheral occlusive artery disease;priority journal;randomization;randomized controlled trial;recurrence risk;recurrent disease;retina blood vessel occlusion;risk reduction;secondary prevention;sustained drug release;transient ischemic attack,"Diener, H. C.;Sacco, R.;Yusuf, S.",2007,,,0,
1063,"Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study","Background: The treatment of ischaemic stroke with neuroprotective drugs has been unsuccessful, and whether these compounds can be used to reduce disability after recurrent stroke is unknown. The putative neuroprotective effects of antiplatelet compounds and the angiotensin II receptor antagonist telmisartan were investigated in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. Methods: Patients who had had an ischaemic stroke were randomly assigned in a two by two factorial design to receive either 25 mg aspirin (ASA) and 200 mg extended-release dipyridamole (ER-DP) twice a day or 75 mg clopidogrel once a day, and either 80 mg telmisartan or placebo once per day. The predefined endpoints for this substudy were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and Barthel index at 3 months, and cognitive function, assessed with the mini-mental state examination (MMSE) score at 4 weeks after randomisation and at the penultimate visit. Analysis was by intention to treat. The study was registered with ClinicalTrials.gov, number NTC00153062. Findings: 20 332 patients (mean age 66 years) were randomised and followed-up for a median of 2·4 years. Recurrent strokes occurred in 916 (9%) patients randomly assigned to ASA with ER-DP and 898 (9%) patients randomly assigned to clopidogrel; 880 (9%) patients randomly assigned to telmisartan and 934 (9%) patients given placebo had recurrent strokes. mRS scores were not statistically different in patients with recurrent stroke who were treated with ASA and ER-DP versus clopidogrel (p=0·38), or with telmisartan versus placebo (p=0·61). There was no significant difference in the proportion of patients with recurrent stroke with a good outcome, as measured with the Barthel index, across all treatment groups. Additionally, there was no significant difference in the median MMSE scores, the percentage of patients with an MMSE score of 24 points or less, the percentage of patients with a drop in MMSE score of 3 points or more between 1 month and the penultimate visit, and the number of patients with dementia among the treatment groups. There were no significant differences in the proportion of patients with cognitive impairment or dementia among the treatment groups. Interpretation: Disability due to recurrent stroke and cognitive decline in patients with ischaemic stroke were not different between the two antiplatelet regimens and were not affected by the preventive use of telmisartan. Funding: Boehringer Ingelheim; Bayer-Schering Pharma (in selected countries); GlaxoSmithKline (in selected countries). © 2008 Elsevier Ltd. All rights reserved.",NCT00153062;acetylsalicylic acid;clopidogrel;dipyridamole;placebo;telmisartan;adult;aged;article;Barthel index;cerebrovascular accident;clinical trial;cognition;cognitive defect;connective tissue disease;controlled clinical trial;controlled study;dementia;disability;double blind procedure;falling;female;gastrointestinal disease;atrial fibrillation;hepatobiliary disease;human;kidney disease;major clinical study;male;mental disease;metabolic disorder;Mini Mental State Examination;multicenter study;musculoskeletal disease;neurologic disease;neuroprotection;nutritional disorder;pneumonia;priority journal;randomized controlled trial;Rankin scale;recurrent disease;respiratory tract disease;side effect;sustained release formulation;thorax pain;unstable angina pectoris;urinary tract disease;urinary tract infection;vascular disease;aspirin,"Diener, H. C.;Sacco, R. L.;Yusuf, S.;Cotton, D.;Ôunpuu, S.;Lawton, W. A.;Palesch, Y.;Martin, R. H.;Albers, G. W.;Bath, P.;Bornstein, N.;Chan, B. P.;Chen, S. T.;Cunha, L.;Dahlöf, B.;De Keyser, J.;Donnan, G. A.;Estol, C.;Gorelick, P.;Gu, V.;Hermansson, K.;Hilbrich, L.;Kaste, M.;Lu, C.;Machnig, T.;Pais, P.;Roberts, R.;Skvortsova, V.;Teal, P.;Toni, D.;VanderMaelen, C.;Voigt, T.;Weber, M.;Yoon, B. W.",2008,,,0,
1064,Advance care planning and severe chronic diseases,"INTRODUCTION: Advanced care planning (ACP) helps in make decisions on the health problems of people who have lost the capacity for informed consent. It has proven particularly useful in addressing the end of life. The aim of this study was to determine the prevalence of ACP in patients with severe chronic diseases. MATERIAL AND METHODS: Review of medical records of patients with dementia, amyotrophic lateral sclerosis, Parkinson's disease, chronic obstructive pulmonary disease or interstitial lung disease, heart failure, chronic kidney disease on dialysis and cancer, all in advanced stages. We collected data on living wills or registered prior decisions by the physician according to clinical planned. RESULTS: A total of 135 patients were studied. There was a record of ACP in 22 patients (16.3%). In most of them it was planned not to start any vital treatment in the event of high risk of imminent death and lacking the ability to make decisions. Only two patients were had a legal living will. CONCLUSION: The registration of ACP is relatively low, and this can affect decision-making in accordance with the personal values of patients when they do not have the capacity to exercise informed consent.",Advance Care Planning/*statistics & numerical data;Aged;*Chronic Disease;Female;Humans;Male;Retrospective Studies;Severity of Illness Index;Advance care planning;Bioethics;Bioetica;Cuidados paliativos;Palliative care;Planificacion anticipada de decisiones,"Diestre Ortin, G.;Gonzalez Sequero, V.;Collell Domenech, N.;Perez Lopez, F.;Hernando Robles, P.",2013,Sep-Oct,10.1016/j.regg.2013.01.001,0,
1065,Drug expenditures resulting from the implementation of clinical practice guidelines in Germany,"Due to the increasing demand for more quality in drug therapy, German statutory health insurance physicians intensified their efforts to put clinical practice guidelines into action. Regarding limited health care resources, the evaluation of the financial effects of a nationwide, high-quality, guideline based drug therapy seems worthwhile. In this study, drug expenditures of a guideline-based therapy of seven diseases were determined and compared with real drug expenses. With regard to the seven selected diseases pain, depression, coronary heart disease, asthma, osteoporosis, Alzheimer's disease and mucopolysaccharidosis there is an increased demand of 2.7 billion € on the basis of the prescriptions in 2003.",angiotensin II antagonist;antithrombocytic agent;beta adrenergic receptor blocking agent;beta adrenergic receptor stimulating agent;bisphosphonic acid derivative;buprenorphine;calcium;calcium antagonist;cholinesterase inhibitor;dipeptidyl carboxypeptidase inhibitor;diuretic agent;fentanyl;fibric acid derivative;fluoride;Ginkgo biloba extract;hydromorphone;lithium;monoamine oxidase inhibitor;montelukast;morphine;n methyl dextro aspartic acid receptor blocking agent;nitrate;oxycodone;pimecrolimus;serotonin uptake inhibitor;statine;tacrolimus;theophylline;unindexed drug;vitamin D;Alzheimer disease;article;asthma;atopic dermatitis;cancer pain;clinical practice;depression;drug cost;evidence based medicine;financial management;Germany;health care;health care cost;health care quality;health insurance;ischemic heart disease;mucopolysaccharidosis;osteoporosis;practice guideline;prescription,"Dietrich, E. S.;Jopp, R.;Schreier, U.;Gilge, R.;Bartmann, P.;Berthold, H.",2005,,,0,
1066,Associations between apolipoprotein E genotype and circulating F2-isoprostane levels in humans,"Apolipoprotein E (apoE), an important determinant of plasma lipoprotein metabolism, has three common alleles (epsilon2, epsilon3, and epsilon4). Population studies have shown that the risk of diseases characterized by oxidative damage, such as coronary heart disease and Alzheimer's disease, is significantly higher in epsilon4 carriers. We evaluated the association between apoE genotypes and plasma F2-isoprostane levels, an index of lipid peroxidation, in humans. Two hundred seventy-four healthy subjects (104 males, 170 females; 46.9 +/- 13.0 yr; 200 whites, 74 blacks; 81 nonsmokers, 64 passive smokers, and 129 active smokers) recruited for a randomized clinical antioxidant intervention trial were included in this analysis. ApoE genotype was determined by PCR and restriction enzyme digestion. Free plasma F2-isoprostane was measured by GC-MS. Genotype groups were compared using multiple regression analysis with adjustment for sex, age, race, smoking status, body mass index, plasma ascorbic acid, and beta-carotene. Subjects with epsilon3/epsilon4 and epsilon4/epsilon4 genotype (epsilon4-carriers) and with epsilon2/epsilon3 and epsilon3/epsilon3 (non-epsilon4-carriers) were pooled for analysis. In subjects with high cholesterol levels (total cholesterol above 200 mg/dl), plasma F2-isoprostane levels were 29% higher in epsilon4 carriers than in non-epsilon4-carriers (P= 0.0056). High-cholesterol subjects that are epsilon4 carriers have significantly higher levels of lipid peroxidation as assessed by circulating F2-isoprostane levels.",Apolipoproteins E/*genetics/physiology;Cholesterol/blood;F2-Isoprostanes/*blood;Female;Genotype;Humans;Lipid Peroxidation/genetics/physiology;Male;Middle Aged,"Dietrich, M.;Hu, Y.;Block, G.;Olano, E.;Packer, L.;Morrow, J. D.;Hudes, M.;Abdukeyum, G.;Rimbach, G.;Minihane, A. M.",2005,Apr,,0,
1067,Severe sinus node dysfunction in a patient with juvenile neuronal ceroid lipofuscinosis,,adult;blood smear;case report;cell vacuole;disease severity;dual chamber pacemaker;ECG abnormality;echocardiography;electrocardiogram;electrocardiography monitoring;female;genetic screening;heart atrium pacing;heart left ventricle ejection fraction;heart repolarization;heart ventricle hypertrophy;hemodynamics;human;human cell;human tissue;immobility;implanted heart pacemaker;left ventricular systolic dysfunction;letter;lymphocyte;medical examination;microscopy;neuronal ceroid lipofuscinosis;postoperative period;priority journal;sinus arrest;sinus bradycardia;sinus node disease;skin biopsy;symptomatology;T wave inversion,"Dilaveris, P.;Koutagiar, I.;Aggeli, C.;Sideris, S.;Gatzoulis, K.;Stefanadis, C.",2014,,,0,
1068,Enteroliths and multiple neuroendocrine tumours in a Meckel's diverticulum,,albumin;C reactive protein;creatinine;lactic acid;urea;abdominal distension;abdominal pain;abdominal radiography;abdominal tenderness;aged;albumin blood level;artificial heart pacemaker;bradycardia;cardiomyopathy;case report;computer assisted tomography;confusion;creatinine blood level;dehydration;dementia;disease severity;end to end anastomosis;enterolith;heart atrium flutter;human;hypertension;intestine obstruction;kidney failure;lactate blood level;letter;male;Meckel diverticulum;neuroendocrine tumor;neutrophil;small intestine obstruction;urea blood level;very elderly;virus myocarditis;vomiting,"Dill, T.;Sugo, E.;McManus, B.",2017,,10.1016/j.pathol.2016.10.016,0,
1069,Geographic variation of the incidence rate of lower limb amputation in Australia from 2007-12,"In Australia, little is known about how the incidence rate (IR) of lower limb amputation (LLA) varies across the country. While studies in other economically developed countries have shown considerable geographic variation in the IR-LLA, mostly these have not considered whether the effect of common risk factors are the same across regions. Mapping variation of the IR-LLA, and the effect of common risk factors, is an important first step to focus research into areas of greatest need and support the development of regional specific hypotheses for in-depth examination. The aim of this study was to describe the geographic variation in the IR-LLA across Australia and understand whether the effect of common risk factors was the same across regions. Using hospital episode data from the Australian National Hospital Morbidity database and Australian Bureau of Statistics, the all-cause crude and age-standardised IR-LLA in males and females were calculated for the nation and each state and territory. Generalised Linear Models were developed to understand which factors influenced geographic variation in the crude IR-LLA. While the crude and age-standardised IR-LLA in males and females were similar in most states and territories, they were higher in the Northern Territory. The effect of older age, being male and the presence of type 2 diabetes was associated with an increase of IR-LLA in most states and territories. In the Northern Territory, the younger age at amputation confounded the effect of sex and type 2 diabetes. There are likely to be many factors not included in this investigation, such as Indigenous status, that may explain part of the variation in the IR-LLA not captured in our models. Further research is needed to identify regional- and population-specific factors that could be modified to reduce the IR-LLA in all states and territories of Australia.",adult;aging;article;Australia;chronic obstructive lung disease;congestive heart failure;controlled study;dementia;female;foot amputation;geographic distribution;geography;human;hypertension;incidence;insulin dependent diabetes mellitus;kidney disease;leg amputation;major clinical study;male;morbidity;non insulin dependent diabetes mellitus;Northern Territory;race difference;risk factor;sex,"Dillon, M. P.;Fortington, L. V.;Akram, M.;Erbas, B.;Kohler, F.",2017,,10.1371/journal.pone.0170705,0,
1070,Decubitus ulcers: When to suspect osteomyelitis,"Six nursing home patients developed pressure sores of the foot and ankle, complicated by osteomyelitis of the underlying bone. All patients had advanced multi-infarct dementia with multiple contractures, and were bedridden, debilitated, and nutritionally deficient. All had arteriosclerotic heart and peripheral vascular disease, and other chronic illnesses. The pressure sores progressed rapidly and did not respond to medical and surgical therapy. Cultures yielded organisms usually associated with pressure sores. Diagnosis of osteomyelitis was initially made by radiography and eventually confirmed surgically. Patients with osteomyelitis of the metatarsal bones responded well to intravenous antibiotics and local amputation; all survived. The two patients with osteomyelitis of the calcaneal bone died after a short course. The diagnosis of osteomyelitis of the foot associated with pressure ulcers requires a high index of suspicion when a pressure sore does not respond to medical and surgical therapy in the appropriate clinical setting.",aged;article;bone;case report;decubitus;etiology;inhalational drug administration;multiinfarct dementia;nursing home;osteomyelitis;priority journal;therapy,"Dimant, J.;Tanael, L.",1987,,,0,
1071,An unusual treatment for cardiac ischemia,,acetylsalicylic acid;amiloride;amlodipine;carbon dioxide;chloride;hydrochlorothiazide;hydromorphone;levothyroxine;macrogol;metoprolol;morphine;olanzapine;omeprazole;ondansetron;oxycodone;oxygen;paracetamol;perphenazine;potassium;sennoside;simvastatin;troponin;verapamil;abdominal drainage;abdominal pain;acute coronary syndrome;aged;article;body temperature;cancer surgery;case report;chronic kidney disease;chronic pain;constipation;coronary artery obstruction;dementia;diabetes mellitus;disease duration;drug hypersensitivity;dyspnea;electrocardiography;emergency ward;gastroesophageal reflux;geriatric patient;heart catheterization;heart infarction;heart muscle ischemia;hematocrit;human;hypercholesterolemia;hypertension;hypothyroidism;intestine distension;leukocyte count;leukocyte differential count;lymphocyte;male;monocyte;nasogastric tube;neuroendocrine tumor;neutrophil;nursing home;oxygen therapy;priority journal;schizophrenia;small intestine obstruction,"Dinh, K. T.;Golden, K. E.;Morrison Ponce, D. P.;Raja, A. S.;Miller, E. S.",2016,,,0,
1072,Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomized trials,"Background: Research has shown that following a Mediterranean diet is associated with a reduced risk of major chronic disease; however, the existing literature led to debates for different issues. Aim: To summarize the evidence and evaluate the validity of the association between adherence to Mediterranean diet and multiple health outcomes Design: Umbrella review of the evidence across meta-analyses of observational studies and randomized clinical trials (RCTs) reporting adherence to Mediterranean diet and health outcomes Data sources: Medline, Embase, Scopus, Cochrane database of systematic reviews, Google Scholar, and screening of citations and references Eligibility criteria: Meta-analyses of observational studies (cohort, crosssectional, and case-control design) and RCTs that examined the association between adherence to Mediterranean diet and health outcomes Results: 12 meta-analyses of observational studies and 14 meta-analyses of RCTs investigating the association between adherence to Mediterranean diet and 32 different health outcomes, for a total population of over than 12 700 000 subjects, were identified. A robust evidence, identified by a p value < 0.001, a large simple size, and not a considerable heterogeneity between studies, for a greater adherence to Mediterranean diet and a reduced the risk of overall mortality, cardiovascular diseases, coronary heart disease, myocardial infarction, overall cancer, neurodegenerative disease, dementia and diabetes was found. On the basis of the available literature, for most of the sitespecific cancers, as well as for inflammatory and metabolic parameters, the evidence was only suggestive or weak and further studies are needed to draw firmer conclusions. No significant evidence, on the other hand, was reported for bladder, endometrial and ovarian cancers, as well as for LDL-cholesterol levels. Conclusions: The present umbrella review of meta-analyses investigating the possible association between adherence to Mediterranean diet and clinical outcomes reported a robust evidence for the beneficial role of Mediterranean diet versus some relevant clinical outcomes such as overall mortality, cardiovascular disease, cancer, neurodegenerative disease and diabetes.",bladder cancer;cancer epidemiology;cancer size;cancer susceptibility;clinical outcome;Cochrane Library;controlled clinical trial;controlled study;degenerative disease;dementia;diabetes mellitus;Embase;endometrium cancer;female;heart infarction;human;Mediterranean diet;Medline;meta analysis;metabolic parameters;mortality;observational study;ovary cancer;population based case control study;randomized controlled trial;Scopus;screening;statistical significance;validity;low density lipoprotein cholesterol,"Dinu, M;Pagliai, G;Casini, A;Sofi, F",2017,,10.1016/j.numecd.2016.11.055,0,
1073,Assessing fracture risk in people with ms: A service development study comparing three fracture risk scoring systems,"Objectives: Suboptimal bone health is increasingly recognised as an important cause of morbidity. Multiple sclerosis (MS) has been consistently associated with an increased risk of osteoporosis and fracture. Various fracture risk screening tools have been developed, two of which are in routine use and a further one is MS-specific. We set out to compare the results obtained by these in the MS clinic population. Design: This was a service development study. The 10-year risk estimates of any fracture and hip fracture generated by each of the algorithms were compared. Setting: The MS clinic at the Royal London Hospital. Participants: 88 patients with a confirmed diagnosis of MS. Outcome measures: Mean 10-year overall fracture risk and hip fracture risk were calculated using each of the three fracture risk calculators. The number of interventions that would be required as a result of using each of these tools was also compared. Results: Mean 10-year fracture risk was 4.7%, 2.3% and 7.6% using FRAX, QFracture and the MS-specific calculator, respectively (p<0.0001 for difference). The agreement between risk scoring tools was poor at all levels of fracture risk. Conclusions: The agreement between these three fracture risk scoring tools is poor in the MS population. Further work is required to develop and validate an accurate fracture risk scoring system for use in MS. Trial registration: This service development study was approved by the Clinical Effectiveness Department at Barts Health NHS Trust ( project registration number 156/12).",anticonvulsive agent;antidepressant agent;estrogen;glucocorticoid;adult;age;aged;alcohol consumption;algorithm;angina pectoris;article;asthma;body mass;body weight;cerebrovascular accident;chronic kidney disease;chronic liver disease;chronic obstructive lung disease;comparative study;controlled study;Crohn disease;dementia;diabetes mellitus;disease duration;drug exposure;dual energy X ray absorptiometry;endocrine disease;epilepsy;ethnicity;falling;fatigue;female;femur neck;fragility fracture;gender;heart infarction;hip fracture;hormone substitution;human;major clinical study;malabsorption;male;medical history;multiple sclerosis;neoplasm;nursing home patient;Parkinson disease;patient mobility;rheumatoid arthritis;risk assessment;scoring system;smoking;thyroid disease,"Dobson, R.;Leddy, S. G.;Gangadharan, S.;Giovannoni, G.",2013,,,0,
1074,Low-impact pelvic fractures in the emergency department,"Objective: We examined the records of patients presenting to the emergency department (ED) with low-impact pelvic fractures. We describe frequency, demographics, management and patient outcomes in terms of ambulatory ability, living independence and mortality. Methods: Patients treated for a pelvic fracture over a 2-year period in Kingston, Ont., were identified. We performed a retrospective hospital record review to distinguish high- versus low-impact injury mechanisms, and to characterize the injury event, ED management and outcomes for patients with low-impact fractures. Results: Of 132 pelvic fractures identified, 77 were low-impact fractures. Patients were predominantly women (82%) with a mean age of 81 years; 96% had some pre-existing medical comorbidity. The pubic rami were most commonly involved (86%). The median length of stay in the ED was 9.4 hours. Twenty-five patients (32%) were admitted to hospital. Ten patients had surgical stabilization, mostly of the acetabulum. Five patients died in hospital, 4 from pneumonia and 1 from myocardial infarction. Eight additional patients died within 1 year of injury. At discharge, only 18% lived independently and 16% walked without aids versus 42% and 38%, respectively, before injury. Conclusion: Low-impact pelvic fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of time and resources in the ED are used during the workup of these patients and while awaiting their disposition from the ED. These injuries are important because they affect independence and seem associated with an increased risk of death.",acetabulum;adult;aged;arthritis;article;Canada;cardiovascular disease;comorbidity;dementia;diabetes mellitus;emergency care;emergency ward;female;fracture;fracture fixation;heart arrhythmia;heart infarction;hospitalization;human;hypertension;independence;low impact pelvic fracture;major clinical study;male;medical history;medical record review;mortality;osteoporosis;pelvis fracture;physical capacity;pneumonia;retrospective study;sex difference;cerebrovascular accident;transient ischemic attack;treatment outcome;walking,"Dodge, G.;Brison, R.",2010,,,0,
1075,Developments in transdermal delivery open the pores to a new range of drugs,,adhesive agent;estradiol;fentanyl;glyceryl trinitrate;methylphenidate;nicotine;rivastigmine;rotigotine;scopolamine;aerosol;angina pectoris;attention deficit disorder;chronic pain;controlled drug release;dementia;drug design;drug marketing;food and drug administration;gastrointestinal symptom;gel;human;intestine bypass;liver metabolism;membrane permeability;menopausal syndrome;motion sickness;Parkinson disease;patient compliance;short survey;smoking cessation;tablet matrix;transdermal patch,"Dodou, K.",2012,,,0,
1076,Incidence and Determinants of Traumatic Intracranial Bleeding Among Older Veterans Receiving Warfarin for Atrial Fibrillation,"IMPORTANCE: Traumatic intracranial bleeding, which is most commonly attributable to falls, is a common concern among health care professionals, who are hesitant to prescribe oral anticoagulants to older adults with atrial fibrillation. OBJECTIVE: To describe the incidence of and risk factors for traumatic intracranial bleeding in a large cohort of older adults who were newly prescribed warfarin sodium. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study at the US Department of Veterans Affairs (VA). Participants included 31951 veterans with atrial fibrillation 75 years or older who were new referrals to VA anticoagulation clinics (for warfarin therapy) between January 1, 2002, and December 31, 2012. The dates of the core analysis were March 2014 through May 2015, and subsequent ad hoc analyses were performed through December 2015. Patients with comorbid conditions requiring warfarin were excluded. MAIN OUTCOMES AND MEASURES: The primary outcome was hospitalization for traumatic intracranial bleeding. Secondary outcomes included hospitalization for any intracranial bleeding or ischemic stroke. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify the incidence rates of these outcomes after warfarin initiation using VA administrative data (in-system hospitalizations) and Medicare fee-for-service claims data (out-of-system hospitalizations). Clinical characteristics, laboratory results, and pharmacy data were extracted from the VA electronic medical record. For traumatic intracranial bleeding, Cox proportional hazards regression was used to determine predictors of interest selected a priori based on prior known associations. RESULTS: The study population comprised 31951 participants. The mean (SD) patient age was 81.1 (4.1) years, and 98.1% were male. Comorbidities were common, including hypertension (82.5%), coronary artery disease (42.6%), and diabetes mellitus (33.8%). During the study period, the incidence rate of hospitalization for traumatic intracranial bleeding was 4.80 per 1000 person-years. In unadjusted models, significant predictors of traumatic intracranial bleeding included dementia, fall within the past year, anemia, depression, abnormal renal or liver function, anticonvulsant use, labile international normalized ratio, and antihypertensive use. After adjusting for potential confounders, the remaining significant predictors for traumatic intracranial bleeding were dementia (hazard ratio [HR], 1.76; 95% CI, 1.26-2.46), anemia (HR, 1.23; 95% CI, 1.00-1.52), depression (HR, 1.30; 95% CI, 1.05-1.61), anticonvulsant use (HR, 1.35; 95% CI, 1.04-1.75), and labile international normalized ratio (HR, 1.33; 95% CI, 1.04-1.72). The incidence rates of hospitalization for any intracranial bleeding and ischemic stroke were 14.58 and 13.44, respectively, per 1000 person-years. CONCLUSIONS AND RELEVANCE: Among patients 75 years or older with atrial fibrillation initiating warfarin therapy, the risk factors for traumatic intracranial bleeding are unique from those for ischemic stroke. The high overall rate of intracranial bleeding in our sample supports the need to more systematically evaluate the benefits and harms of warfarin therapy in older adults.",,"Dodson, J. A.;Petrone, A.;Gagnon, D. R.;Tinetti, M. E.;Krumholz, H. M.;Gaziano, J. M.",2016,Apr 1,10.1001/jamacardio.2015.0345,0,
1077,Incidence and determinants of traumatic intracranial bleeding among older veterans receiving warfarin for atrial fibrillation,"IMPORTANCE: Traumatic intracranial bleeding, which is most commonly attributable to falls, is a common concern among health care professionals, who are hesitant to prescribe oral anticoagulants to older adults with atrial fibrillation. OBJECTIVE: To describe the incidence of and risk factors for traumatic intracranial bleeding in a large cohort of older adults who were newly prescribed warfarin sodium. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study at the US Department of Veterans Affairs (VA). Participants included 31951 veterans with atrial fibrillation 75 years or older who were new referrals to VA anticoagulation clinics (for warfarin therapy) between January 1, 2002, and December 31,2012. The dates of the core analysis were March 2014 through May 2015, and subsequent ad hoc analyses were performed through December 2015. Patients with comorbid conditions requiring warfarin were excluded. MAIN OUTCOMES AND MEASURES: The primary outcome was hospitalization for traumatic intracranial bleeding. Secondary outcomes included hospitalization for any intracranial bleeding or ischemic stroke. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify the incidence rates of these outcomes after warfarin initiation using VA administrative data (in-system hospitalizations) and Medicare fee-for-service claims data (out-of-system hospitalizations). Clinical characteristics, laboratory results, and pharmacy data were extracted from the VA electronic medical record. For traumatic intracranial bleeding, Cox proportional hazards regression was used to determine predictors of interest selected a priori based on prior known associations. RESULTS: The study population comprised 31951 participants. The mean (SD) patient age was 81.1 (4.1) years, and 98.1% were male. Comorbidities were common, including hypertension (82.5%), coronary artery disease (42.6%), and diabetes mellitus (33.8%). During the study period, the incidence rate of hospitalization for traumatic intracranial bleeding was 4.80 per 1000 person-years. In unadjusted models, significant predictors of traumatic intracranial bleeding included dementia, fall within the past year, anemia, depression, abnormal renal or liver function, anticonvulsant use, labile international normalized ratio, and antihypertensive use. After adjusting for potential confounders, the remaining significant predictors for traumatic intracranial bleeding were dementia (hazard ratio [HR], 1.76; 95% CI, 1.26-2.46), anemia (HR, 1.23; 95% CI, 1.00-1.52), depression (HR, 1.30; 95% CI, 1.05-1.61), anticonvulsant use (HR, 1.35; 95% CI, 1.04-1.75), and labile international normalized ratio (HR, 1.33; 95% CI, 1.04-1.72). The incidence rates of hospitalization for any intracranial bleeding and ischemic stroke were 14.58 and 13.44, respectively, per 1000 person-years. CONCLUSIONS AND RELEVANCE: Among patients 75 years or older with atrial fibrillation initiating warfarin therapy, the risk factors for traumatic intracranial bleeding are unique from those for ischemic stroke. The high overall rate of intracranial bleeding in our sample supports the need to more systematically evaluate the benefits and harms of warfarin therapy in older adults.",warfarin;adverse outcome;aged;anemia;article;atrial fibrillation;brain hemorrhage;brain ischemia;CHADS2 score;clinical feature;cohort analysis;comorbidity;controlled study;coronary artery disease;dementia;depression;diabetes mellitus;drug safety;electronic medical record;fall risk assessment;female;hospitalization;human;hypertension;ICD-9-CM;incidence;international normalized ratio;kidney disease;liver disease;major clinical study;male;medicare;outcome assessment;retrospective study;risk assessment;risk factor;veteran;visual analog scale,"Dodson, J. A.;Petrone, A.;Gagnon, D. R.;Tinetti, M. E.;Krumholz, H. M.;Gaziano, J. M.",2016,,10.1001/jamacardio.2015.0345,0,1076
1078,Psychotic disorder and extrapyramidal symptoms associated with vitamin B12 and folate deficiency,"Vitamin B12 and folate deficiency causing neuropsychiatric and thrombotic manifestations, such as peripheral neuropathy, subacute combined degeneration of cord, dementia, ataxia, optic atrophy, catatonia, psychosis, mood disturbances, myocardial infarction and portal vein thrombosis are well known. This present report highlights an unusual presentation of vitamin B12 deficiency - psychotic disorder, extrapyramidal symptoms in a 12-year-old boy. His symptoms responded to parenteral vitamin B12 therapy. So with this report we emphasized that serum vitamin B12 and folate levels should be measured, especially in those patients who present with other known neuropsychiatric features of vitamin B12 and folate deficiency. © The Author [2008]. Published by Oxford University Press. All rights reserved.",cyanocobalamin;folinic acid;anamnesis;aphasia;article;behavior disorder;case report;child;clinical feature;clonus;cyanocobalamin deficiency;disease association;extrapyramidal symptom;facial expression;folic acid blood level;folic acid deficiency;human;hyporeflexia;male;muscle rigidity;nervousness;psychosis;saccadic eye movement;self care;sleep disorder;treatment response;tremor;vitamin blood level;vitamin supplementation,"Dogan, M.;Ozdemir, O.;Sal, E. A.;Dogan, S. Z.;Ozdemir, P.;Cesur, Y.;Caksen, H.",2009,,,0,
1079,There was something about Mary,,adrenalin;anamnesis;death;dementia;dying;elderly care;emergency health service;euthanasia;general practice;heart arrest;heart ventricle fibrillation;human;intensive care;medical decision making;note;paramedical disciplines;patient attitude;patient transport,"Doherty, S. R.",2001,,,0,
1080,"Atherosclerosis, dementia, and Alzheimer disease in the Baltimore Longitudinal Study of Aging cohort","OBJECTIVE: Although it is now accepted that asymptomatic cerebral infarcts are an important cause of dementia in the elderly, the relationship between atherosclerosis per se and dementia is controversial. Specifically, it is unclear whether atherosclerosis can cause the neuritic plaques and neurofibrillary tangles that define Alzheimer neuropathology and whether atherosclerosis, a potentially reversible risk factor, can influence cognition independent of brain infarcts. METHODS: We examined the relationship between systemic atherosclerosis, Alzheimer type pathology, and dementia in autopsies from 200 participants in the Baltimore Longitudinal Study of Aging, a prospective study of the effect of aging on cognition, 175 of whom had complete body autopsies. RESULTS: Using a quantitative analysis of atherosclerosis in the aorta, heart, and intracranial vessels, we found no relationship between the degree of atherosclerosis in any of these systems and the degree of Alzheimer type brain pathology. However, we found that the presence of intracranial but not coronary or aortic atherosclerosis significantly increased the odds of dementia, independent of cerebral infarction. Given the large number of individuals with intracranial atherosclerosis in this cohort (136/200), the population attributable risk of dementia related to intracranial atherosclerosis (independent of infarction) is substantial and potentially reversible. INTERPRETATION: Atherosclerosis of the intracranial arteries is an independent and important risk factor for dementia, suggesting potentially reversible pathways unrelated to Alzheimer pathology and stroke through which vascular changes may influence dementia risk.","Aged;Aged, 80 and over;Aging/metabolism/pathology;Alzheimer Disease/diagnosis/epidemiology/*pathology;Atherosclerosis/diagnosis/epidemiology/*pathology;Baltimore/epidemiology;Dementia/diagnosis/epidemiology/*pathology;Female;Humans;Intracranial Arteriosclerosis/diagnosis/epidemiology/pathology;Longitudinal Studies;Male;Neuropsychological Tests;Prevalence;Risk Factors","Dolan, H.;Crain, B.;Troncoso, J.;Resnick, S. M.;Zonderman, A. B.;Obrien, R. J.",2010,Aug,10.1002/ana.22055,0,
1081,Association Between Poorer Cognitive Function and Reduced Objectively Monitored Medication Adherence in Patients With Heart Failure,"BACKGROUND: Subclinical cognitive impairment is prevalent in heart failure (HF); however, its role in important clinical outcomes, such as HF treatment adherence, is unclear. Given the complex polypharmacy in HF treatment, cognitive deficits may be important in predicting medication management. Thus, the objective of the current study was to examine the impact of cognitive function on medication adherence among community-dwelling patients with HF using objective assessments. METHODS AND RESULTS: A prospective observational cohort design of 309 community-dwelling patients with HF (59.7% male, 68.7+/-9.7 years) and no history of dementia or neurological disease. Cognition was assessed using a neuropsychological battery at baseline. Medication adherence was objectively measured for 21 days using an electronic pillbox. Regression analyses tested whether attention, executive function, or memory predicted 21-day medication adherence. In unadjusted analyses, lower scores on all 3 cognitive domains predicted poorer medication adherence (beta=0.52-85; P=0.001-0.009). After adjusting for demographic, clinical, and psychosocial variables, memory continued to predict medication adherence (beta=0.51; P=0.008), whereas executive function (beta=0.24; P=0.075) and attention were no longer a predictor (beta=0.34; P=0.131). CONCLUSIONS: Poorer cognitive function, especially in regard to memory, predicted reduced medication adherence among patients with HF and no history of dementia. This effect remained after adjustment for factors known to predict adherence, such as depressed mood, social support, and disease severity level. Future studies should examine the link from cognitive impairment and medication nonadherence to clinical outcomes (eg, hospitalization and mortality). CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01461629.",Aged;Attention;Cognition Disorders/complications/ psychology;Executive Function;Female;Heart Failure/drug therapy/ psychology;Humans;Male;Medication Adherence;Memory;Middle Aged;Prospective Studies;Residence Characteristics;Risk Factors;cognitive function;dementia;depression;heart failure,"Dolansky, M. A.;Hawkins, M. A.;Schaefer, J. T.;Sattar, A.;Gunstad, J.;Redle, J. D.;Josephson, R.;Moore, S. M.;Hughes, J. W.",2016,Dec,,0,
1082,Cardiovascular medication prescribing in older adults with psychiatric disorders,"Objectives: To examine the appropriateness of cardiovascular (CV) medication prescribing of patients admitted to a geriatric psychiatry ward. Secondary aims included examining: 1) if differences in CV medication prescribing existed between admission and discharge and 2) if differences in CV medication prescribing existed between patients with and without dementia. Design: Cross-sectional study. Setting: Inpatient geriatric psychiatry unit within a regional medical center. Patients: 197 patients admitted between June 2005 and May 2006. Interventions: Changes in CV medication prescribing from admission to discharge. Measures and Results: On admission, the percent of patients receiving appropriate CV medications for general CV prevention, atrial fibrillation, coronary-artery disease, and heart failure ranged from 33% to 56%. With the exception of the treatment of heart failure, no significant improvements in appropriate CV medication prescribing were noted at the time of discharge. No differences in CV medication prescribing were found between patients with and without dementia. Conclusion: Despite the known benefits of numerous CV medications in older adults, many patients admitted to a geriatric psychiatry ward were not prescribed optimal pharmacotherapeutic regimens on admission or had their medications changed by the time of discharge. © 2007, American Society of Consultant Pharmacists, Inc. All rights reserved.",acetylsalicylic acid;angiotensin receptor antagonist;beta adrenergic receptor blocking agent;bisoprolol;cardiovascular agent;carvedilol;clopidogrel;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;metoprolol;perindopril;placebo;pravastatin;simvastatin;warfarin;adult;aged;article;cardiovascular disease;comorbidity;coronary artery disease;dementia;drug efficacy;drug safety;drug use;female;gerontopsychiatry;atrial fibrillation;heart failure;hospital admission;hospital discharge;hospital patient;human;major clinical study;male;mental disease;practice guideline;prescription;aspirin,"Dolder, C. R.;Veverka, A.;Nuzum, D. S.;McKinsey, J.",2007,,,0,
1083,Improvement of the prescription in polymedicated elderly,"Objective: We selected the START/STOPP criteria in order to detect and analyze Inappropriate Medication Prescriptions (IMP) in over 65 years old patients who were admitted in the Traumatology service and measured the impact of submitted suggestions to the primary care physicians. Method: We followed up the patients, who were admitted in Traumatology service during three months, we reviewed their home therapy and performed a personal interview. After detecting some IMP, we informed their primary care physician. Six weeks after submitting the notifications, we checked their treatment again by a telephone interview. Results: Of 268 patients; 92 were over 65 years old. We detected 44 IMP in 25 patients: 19 IMP regarding the START criteria and 25 IMP regarding the STOPP criteria. We detected a single IMP in 13 patients, two IMP in seven patients, three IMP in three patients, one patient had four and another five. Six were modified. Conclusion: Using the STOPP/START criteria in elderly patients who were admitted at the hospital is a reliable tool for detecting IMP. It would be necessary to apply a different method of intervention.",antithrombocytic agent;benzodiazepine;bisphosphonic acid derivative;calcium;calcium channel blocking agent;corticosteroid;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;muscarinic receptor blocking agent;nonsteroid antiinflammatory agent;opiate;vitamin D;ADL disability;aged;article;constipation;dementia;dietary fiber;diverticulitis;elderly care;female;follow up;general practitioner;geriatric patient;heart failure;home care;human;hypertension;inappropriate prescribing;independence;interview;major clinical study;male;mild cognitive impairment;non insulin dependent diabetes mellitus;osteoporosis;polypharmacy;telephone interview;traumatology,"Domínguez Senín, L.;Barón Franco, B.;De Sousa Baena, M.",2013,,,0,
1084,Advanced intimal hyperplasia without luminal narrowing of leptomeningeal arteries in CADASIL,"BACKGROUND AND PURPOSE-: Leptomeningeal artery abnormalities in Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) have not been extensively characterized. We quantified substructure and diameter of leptomeningeal arteries in CADASIL compared with age-matched controls and the very old; in addition, we characterized intimal thickening in CADASIL using immunohistochemistry. METHODS-: Frontal and temporal cortex of 6 genetically proven CADASIL brains (average age, 66 years), 6 controls without symptoms of cerebrovascular disease, and 6 very old brains (average age, 89 years) were examined for leptomeningeal artery intimal, medial, and adventitial thickness; inner diameter; and sclerotic index and for smooth muscle markers. RESULTS-: The intima of CADASIL arteries was thickened 5-fold compared with controls and the very aged (P<0.0001). Medial thickness was lower in CADASIL compared with controls and the very old (P<0.01). The adventitia was not significantly increased in CADASIL compared with age-matched controls. Arterial diameters were not smaller in CADASIL compared with controls. Sclerotic index was significantly increased in CADASIL compared with other groups (P<0.00001). Intimal cells in CADASIL expressed smooth muscle actin, S100A4, and vimentin but not desmin. CONCLUSIONS-: Principle changes of leptomeningeal arteries in CADASIL include intimal thickening and medial thinning, but not luminal narrowing. Smooth muscle-like cells participate in neointimal thickening of CADASIL arteries. © 2013 American Heart Association, Inc.",calvasculin;Notch3 receptor;smooth muscle actin;vimentin;adult;adventitia;aged;antigen expression;arterial wall thickness;artery diameter;artery intima proliferation;article;autopsy;brain artery;brain blood vessel;CADASIL;cerebral artery disease;clinical article;controlled study;frontal cortex;gene mutation;human;human tissue;immunohistochemistry;leptomeninx artery;neointima;phenotype;priority journal;temporal cortex;tunica media;very elderly,"Dong, H.;Ding, H.;Young, K.;Blaivas, M.;Christensen, P. J.;Wang, M. M.",2013,,,0,
1085,Association between reported elder abuse and rates of admission to skilled nursing facilities: Findings from a longitudinal population-based cohort study,"Background: Elder abuse is common and is a frank violation of an older adult's fundamental rights to be safe and free of violence. Our prior study indicates elder abuse is independently associated with mortality. This study aims to quantify the relationship between overall elder abuse and specific subtypes of elder abuse and rate of admission to skilled nursing facilities (SNF). Methods: A prospective population-based study conducted in Chicago of community-dwelling older adults who participated in the Chicago Health and Aging Project (CHAP). Of the 6,674 participants in the CHAP study, 106 participants were reported to the social services agency for elder abuse. The primary predictor was elder abuse reported to the social services agency. The outcome of interest was the annual rate of admission to SNF obtained from the Center for Medicare and Medicaid Services. Poisson regression models were used to assess these longitudinal relationships. Results: The average annual rate of SNF for those without elder abuse was 0.14 (0.58) and for those with elder abuse was 0.66 (1.63). After adjusting for sociodemographic and socioeconomic variables, medical comorbidities, cognitive and physical function, and psychosocial wellbeing, older adults who have been abused had higher rates of SNF admission (RR 4.60 (2.85-7.42)). Psychological abuse (RR 2.31 (1.17-4.56)), physical abuse (RR 2.36 (1.19-4.66)), financial exploitation (RR 2.81 (1.53-5.17)) and caregiver neglect (RR 4.73 (3.03-7.40)) were associated with increased rates of admission to SNF, after considering the same confounders. Elder abuse is associated with a higher rate of SNF stay longer than 30 days (RR 6.27 (3.68-10.69)). Conclusion: Elder abuse was associated with increased rates of admission to SNF in this community population. Specific subtypes of elder abuse had a differential association with an increased rate of admission to SNF. Copyright © 2013 S. Karger AG, Basel.",aged;Alzheimer disease;article;caregiver;cerebrovascular accident;cognition;cognitive defect;cohort analysis;comorbidity;coronary artery disease;depression;diabetes mellitus;elder abuse;female;health care utilization;heart infarction;hip fracture;hospital admission;human;hypertension;Katz index;length of stay;longitudinal study;male;medicaid;medical care;medicare;neglect;neoplasm;nursing home;outcome assessment;physical abuse;physical disability;population research;priority journal;prospective study;sex difference;social network;social psychology;social work;social worker;thyroid disease;United States,"Dong, X.;Simon, M. A.",2013,,,0,
1086,"Effect of dimebon on cognition, activities of daily living, behaviour, and global function in patients with mild-to-moderate Alzheimer's disease: a randomised, double-blind, placebo-controlled study","Background: Although treatments for Alzheimer's disease sometimes improve cognition, functional ability, or behaviour compared with baseline levels, such improvements are inconsistent across studies and measures, and effects diminish over time. More effective treatments are needed. We assessed the safety, tolerability, and efficacy of dimebon in the treatment of patients with mild-to-moderate Alzheimer's disease. Methods: We enrolled 183 patients with mild-to-moderate Alzheimer's disease (mini-mental state examination [MMSE] scores 10-24) at 11 sites in Russia. Patients were randomly assigned by a computer-generated randomisation scheme to receive oral dimebon, 20 mg three times a day (60 mg/day [n=89]), or matched placebo (n=94). Other antidementia drugs were not allowed. The primary outcome measure assessed cognition, the difference in mean change from baseline to week 26, or last completed observation on the cognitive subscale of the Alzheimer's disease assessment scale (ADAS-cog). All patients and study personnel were blinded throughout the study. We compared dimebon with placebo with an intention-to-treat analysis, with last observation carried forward (ITT-LOCF) imputation. Analyses were repeated on the fully evaluable population, defined as all patients in the intention-to-treat population who had an ADAS-cog at week 26 and at least 80% compliance. 134 patients (68 in dimebon group, 66 in placebo group) enrolled in the 6-month blinded extension phase of the study. This trial is registered with Clinicaltrials.gov, number NCT00377715. Findings: 155 (85%) patients completed the trial (78 [88%] in dimebon group, 77 [82%] in placebo group). Treatment with dimebon resulted in significant benefits in ADAS-cog compared with placebo (ITT-LOCF) at week 26 (mean drug-placebo difference -4·0 [95% CI -5·73 to -2·28]; p<0·0001). Results of the ITT-LOCF and the evaluable population analyses were much the same for all measures. Patients given dimebon were significantly improved over baseline for ADAS-cog (mean difference -1·9 [-2·92 to -0·85]; p=0·0005). Dimebon was well tolerated: dry mouth and depressed mood or depression were the most common adverse events associated with dimebon (12 [14%] patients for each symptom by week 26). The percentage of patients who had adverse events in the two groups did not differ. Interpretation: Dimebon was safe, well tolerated, and significantly improved the clinical course of patients with mild-to-moderate Alzheimer's disease. Funding: Medivation (USA). © 2008 Elsevier Ltd. All rights reserved.",NCT00377715;antidepressant agent;antihypertensive agent;antithrombocytic agent;anxiolytic agent;dimebon;hypnotic agent;phenobarbital;placebo;psychotropic agent;sedative agent;adult;aged;Alzheimer disease;angina pectoris;article;asthenia;behavior;bilirubin blood level;clinical trial;cognition;controlled clinical trial;controlled study;daily life activity;depression;disease severity;double blind procedure;drug effect;drug tolerability;dyspnea;female;heart atrium flutter;human;hyperhidrosis;hyperkalemia;insomnia;major clinical study;male;Mini Mental State Examination;motor dysfunction;multicenter study;musculoskeletal pain;patient compliance;polyuria;priority journal;randomized controlled trial;Russian Federation;side effect;treatment outcome;xerostomia,"Doody, R. S.;Gavrilova, S. I.;Sano, M.;Thomas, R. G.;Aisen, P. S.;Bachurin, S. O.;Seely, L.;Hung, D.",2008,,,0,
1087,Phase 3 trials of solanezumab for mild-to-moderate alzheimer's disease,"Background: Alzheimer's disease is characterized by amyloid-beta plaques, neurofibrillary tangles, gliosis, and neuronal loss. Solanezumab, a humanized monoclonal antibody, preferentially binds soluble forms of amyloid and in preclinical studies promoted its clearance from the brain. Methods: In two phase 3, double-blind trials (EXPEDITION 1 and EXPEDITION 2), we randomly assigned 1012 and 1040 patients, respectively, with mild-to-moderate Alzheimer's disease to receive placebo or solanezumab (administered intravenously at a dose of 400 mg) every 4 weeks for 18 months. The primary outcomes were the changes from baseline to week 80 in scores on the 11-item cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog11; range, 0 to 70, with higher scores indicating greater cognitive impairment) and the Alzheimer's Disease Cooperative Study-Activities of Daily Living scale (ADCS-ADL; range, 0 to 78, with lower scores indicating worse functioning). After analysis of data from EXPEDITION 1, the primary outcome for EXPEDITION 2 was revised to the change in scores on the 14-item cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog14; range, 0 to 90, with higher scores indicating greater impairment), in patients with mild Alzheimer's disease. Results: Neither study showed significant improvement in the primary outcomes. The modeled difference between groups (solanezumab group minus placebo group) in the change from baseline was -0.8 points for the ADAS-cog11 score (95% confidence interval [CI], -2.1 to 0.5; P = 0.24) and -0.4 points for the ADCS-ADL score (95% CI, -2.3 to 1.4; P = 0.64) in EXPEDITION 1 and -1.3 points (95% CI, -2.5 to 0.3; P = 0.06) and 1.6 points (95% CI, -0.2 to 3.3; P = 0.08), respectively, in EXPEDITION 2. Between-group differences in the changes in the ADAS-cog14 score were -1.7 points in patients with mild Alzheimer's disease (95% CI, -3.5 to 0.1; P = 0.06) and -1.5 in patients with moderate Alzheimer's disease (95% CI, -4.1 to 1.1; P = 0.26). In the combined safety data set, the incidence of amyloid-related imaging abnormalities with edema or hemorrhage was 0.9% with solanezumab and 0.4% with placebo for edema (P = 0.27) and 4.9% and 5.6%, respectively, for hemorrhage (P = 0.49). Conclusions: Solanezumab, a humanized monoclonal antibody that binds amyloid, failed to improve cognition or functional ability. (Funded by Eli Lilly; EXPEDITION 1 and 2 ClinicalTrials.gov numbers, NCT00905372 and NCT00904683.) Copyright © 2014 Massachusetts Medical Society.",NCT00904683;NCT00905372;placebo;solanezumab;adult;aged;Alzheimer disease;Alzheimer Disease Assessment Scale;Alzheimer Disease Cooperative Study Activities of Daily Living scale;article;bleeding;controlled study;disease severity;double blind procedure;drug efficacy;drug fatality;drug safety;edema;female;heart arrhythmia;heart muscle ischemia;human;intention to treat analysis;major clinical study;male;middle aged;assessment of humans;phase 3 clinical trial;priority journal;randomized controlled trial;treatment outcome,"Doody, R. S.;Thomas, R. G.;Farlow, M.;Iwatsubo, T.;Vellas, B.;Joffe, S.;Kieburtz, K.;Raman, R.;Sun, X.;Aisen, P. S.;Siemers, E.;Liu-Seifert, H.;Mohs, R.",2014,,,0,
1088,Therapeutic applications of mesenchymal stromal cells: Paracrine effects and potential improvements,"Among the various types of cell-to-cell signaling, paracrine signaling comprises those signals that are transmitted over short distances between different cell types. In the human body, secreted growth factors and cytokines instruct, among others, proliferation, differentiation, and migration. In the hematopoietic stem cell (HSC) niche, stromal cells provide instructive cues to stem cells via paracrine signaling and one of these cell types, known to secrete a broad panel of growth factors and cytokines, is mesenchymal stromal cells (MSCs). The factors secreted by MSCs have trophic, immunomodulatory, antiapoptotic, and proangiogenic properties, and their paracrine profile varies according to their initial activation by various stimuli. MSCs are currently studied as treatment for inflammatory diseases such as graft-versus-host disease and Crohn's disease, but also as treatment for myocardial infarct and solid organ transplantation. In addition, MSCs are investigated for their use in tissue engineering applications, in which their differentiation plays an important role, but as we have recently demonstrated, their trophic factors may also be involved. Furthermore, a functional improvement of MSCs might be obtained after preconditioning or tailoring the cells themselves. Also, the way the cells are clinically administered may be specialized for specific therapeutic scenarios. In this review we will first discuss the HSC niche, in which MSCs were recently identified and are thought to play an instructive and supportive role. We will then evaluate therapeutic applications that currently try to utilize the trophic and/or immunomodulatory properties of MSCs, and we will also discuss new options to enhance their therapeutic effects. © 2012, Mary Ann Liebert, Inc.","5' nucleotidase;colony stimulating factor 1;endoglin;galectin 1;hypocalcin;indoleamine 2,3 dioxygenase;leukemia inhibitory factor;stromal cell derived factor 1;thrombopoietin;Thy 1 antigen;vasculotropin;Alzheimer disease;amyotrophic lateral sclerosis;article;cell activation;cell differentiation;cell migration;cell proliferation;clinical trial (topic);Crohn disease;graft versus host reaction;heart infarction;hematopoietic stem cell;human;Huntington chorea;immunomodulation;mesenchymal stroma cell;neuroprotection;organ transplantation;paracrine signaling;Parkinson disease;phase 2 clinical trial (topic);priority journal;stem cell niche;cerebrovascular accident;tissue engineering;wound healing","Doorn, J.;Moll, G.;Le Blanc, K.;Van Blitterswijk, C.;De Boer, J.",2012,,,0,
1089,267 Spanish Exomes Reveal Population-Specific Differences in Disease-Related Genetic Variation,"Recent results from large-scale genomic projects suggest that allele frequencies, which are highly relevant for medical purposes, differ considerably across different populations. The need for a detailed catalog of local variability motivated the whole-exome sequencing of 267 unrelated individuals, representative of the healthy Spanish population. Like in other studies, a considerable number of rare variants were found (almost one-third of the described variants). There were also relevant differences in allelic frequencies in polymorphic variants, including ∼10,000 polymorphisms private to the Spanish population. The allelic frequencies of variants conferring susceptibility to complex diseases (including cancer, schizophrenia, Alzheimer disease, type 2 diabetes, and other pathologies) were overall similar to those of other populations. However, the trend is the opposite for variants linked to Mendelian and rare diseases (including several retinal degenerative dystrophies and cardiomyopathies) that show marked frequency differences between populations. Interestingly, a correspondence between differences in allelic frequencies and disease prevalence was found, highlighting the relevance of frequency differences in disease risk. These differences are also observed in variants that disrupt known drug binding sites, suggesting an important role for local variability in population-specific drug resistances or adverse effects. We have made the Spanish population variant server web page that contains population frequency information for the complete list of 170,888 variant positions we found publicly available (http://spv.babelomics.org/), We show that it if fundamental to determine population-specific variant frequencies to distinguish real disease associations from population-specific polymorphisms.",Alzheimer disease;aorta dissection;article;attention deficit disorder;cardiomyopathy;complex I deficiency;congenital heart malformation;disease association;diseases;DNA library;drug binding site;Ellis van Creveld syndrome;exome;gene frequency;gene sequence;genetic variability;geography;heart right ventricle dysplasia;hereditary motor sensory neuropathy;heterozygote;homozygote;human;hypertriglyceridemia;major clinical study;Marfan syndrome;muscular dystrophy;nephrotic syndrome;non insulin dependent diabetes mellitus;ovary cancer;Pendred syndrome;prevalence;psoriasis;retina degeneration;schizophrenia;single nucleotide polymorphism;stain;Wilson disease,"Dopazo, J.;Amadoz, A.;Bleda, M.;Garcia-Alonso, L.;Alemán, A.;García-García, F.;Rodriguez, J. A.;Daub, J. T.;Muntané, G.;Rueda, A.;Vela-Boza, A.;López-Domingo, F. J.;Florido, J. P.;Arce, P.;Ruiz-Ferrer, M.;Méndez-Vidal, C.;Arnold, T. E.;Spleiss, O.;Alvarez-Tejado, M.;Navarro, A.;Bhattacharya, S. S.;Borrego, S.;Santoyo-López, J.;Antiñolo, G.",2016,,,0,
1090,"Down Syndrome, Partial Trisomy 21, and Absence of Alzheimer's Disease: The Role of APP","Overexpression of the amyloid precursor protein (APP) gene on chromosome 21 in Down syndrome (DS) has been linked to increased brain amyloid levels and early-onset Alzheimer's disease (AD). An elderly man with phenotypic DS and partial trisomy of chromosome 21 (PT21) lacked triplication of APP affording an opportunity to study the role of this gene in the pathogenesis of dementia. Multidisciplinary studies between ages 66-72 years comprised neuropsychological testing, independent neurological exams, amyloid PET imaging with 11C-Pittsburgh compound-B (PiB), plasma amyloid-β (Aβ) measurements, and a brain autopsy examination. The clinical phenotype was typical for DS and his intellectual disability was mild in severity. His serial neuropsychological test scores showed less than a 3 decline as compared to high functioning individuals with DS who developed dementia wherein the scores declined 17-28 per year. No dementia was detected on neurological examinations. On PiB-PET scans, the patient with PT21 had lower PiB standard uptake values than controls with typical DS or sporadic AD. Plasma Aβ42 was lower than values for demented or non-demented adults with DS. Neuropathological findings showed only a single neuritic plaque and neurofibrillary degeneration consistent with normal aging but not AD. Taken together the findings in this rare patient with PT21 confirm the obligatory role of APP in the clinical, biochemical, and neuropathological findings of AD in DS.",amyloid precursor protein;psychotropic agent;aged;Alzheimer disease;anteverted nostril;arthritis;article;behavior disorder;brachycephaly;case report;chromosome 21;delusion;Down syndrome;dysarthria;first degree atrioventricular block;genetic analysis;hallucination;hearing aid;heart infarction;human;hypertension;hypoplasia;male;mitral valve regurgitation;neuroimaging;neuropathology;partial trisomy;partial trisomy 21;pathogenesis;perception deafness;prevalence;priority journal;psychopharmacotherapy;tongue disease,"Doran, E.;Keator, D.;Head, E.;Phelan, M. J.;Kim, R.;Totoiu, M.;Barrio, J. R.;Small, G. W.;Potkin, S. G.;Lott, I. T.",2017,,10.3233/jad-160836,0,
1091,Why the Million Women Study is important for European women,,Cimicifuga racemosa extract;estrogen;gestagen;hormone;isoflavone;phytoestrogen;plant extract;tibolone;breast cancer;breast tumor;cancer mortality;cancer risk;cardiovascular disease;Actaea racemosa;dementia;drug efficacy;drug safety;drug synthesis;drug use;drug withdrawal;estrogen therapy;Europe;female;hormonal therapy;hot flush;human;iatrogenic disease;ischemic heart disease;lifestyle;medicinal plant;note;osteoporosis;population;prospective study;study;vasomotor disorder,"Dören, M.",2003,,,0,
1092,Benefit of reducing whole blood viscosity for patients with angina and dementia symptoms,,aged;angina pectoris;article;blood;blood viscosity;case report;dementia;female;human;male;methodology;middle aged;patient satisfaction;phlebotomy;treatment outcome,"Dorman, T. A.;Kensey, K.;Cho, Y.",2008,,,0,
1093,"The relationship between body mass index and incidental mild cognitive impairment, Alzheimer's disease, and Vascular Dementia in elderly","Objective: To examine the association between body mass index (BMI) and cognitive decline (CD) due to Mild Cognitive Impairment (MCI), Alzheimer's Disease (AD), and Vascular Dementia (VaD). Design and setting: The subjects aged ≥ 65 years were recruited prospectively from the Geriatrics Clinic of Gulhane Medical School, between 2004 and 2008 years. Participants: 1302 patients were included in the study. Measurements: Cognitive status, clinical diagnosis of CD (MCI, AD, and VaD) and clinical and environmental risk factors were evaluated by comprehensive geriatric assesment. Finally, the subjects were categorized into two groups according to having CD or not. Results: 905 (69.5%) subjects were not having CD whereas 397 (30.5%) patients with CD. Of the patients with CD, 140 (10.4%) had MCI, 227 (16.9%) AD, and 30 (2.2%) VaD. After adjustment for confounding with a model for multiple regression analysis, age (OR=1.054; CI:1.027-1.083; p<0.001) and family history of dementia (OR=1.662; CI:1.038-2.660; p=0.034) were found to be independent risk factors for CD. Also, overweight (OR=0.594; CI:0.370-0.952; p=0.03) and obese (OR=0.396; CI:0.242-0.649; p<0.001), and high education level (OR=0.640; CI:0.451-0.908; p=0.012) were found to be independent protective factors for CD. Conclusions: We found the risk of CD decreases in overweight and obese elderly. The results indicate that the primary prevention should not only consider risk factors, but must also take anthropometric data into consideration in order to identify persons at high risk for CD. © 2010 Serdi and Springer Verlag France.",aged;alcohol consumption;Alzheimer disease;article;body mass;cognition;congestive heart failure;controlled study;dementia;demography;diabetes mellitus;disease association;educational status;environmental factor;family history;female;geriatric assessment;geriatric patient;heart muscle ischemia;human;hypertension;major clinical study;male;marriage;mild cognitive impairment;multiinfarct dementia;nutritional assessment;obesity;priority journal;prospective study;smoking;cerebrovascular accident,"Doruk, H.;Naharci, M. I.;Bozoglu, E.;Isik, A. T.;Kilic, S.",2010,,,0,
1094,Risk factors and management of diabetes in elderly French patients,"AIMS: The aim of this study was to assess the characteristics of elderly diabetic patients, evaluate the relationship between glycaemic control and diabetes complications, and compare the day-to-day management of such patients with the published recommendations. METHODS: The study included 238 elderly diabetic patients, for whom data for the past six months' medical history, clinical examination (including ocular fundus) and standard biological tests were collected. RESULTS: The patients' mean age was 82.2+/-7.2, HbA(1c) value was > or =8.5% in 24% of patients and the mean number of cardiovascular risk factors (CVRF) was 4.1+/-0.7 per patient. Dementia or cognitive impairment was present in 68% of patients. Estimated glomerular filtration rate was 30 mL/min or lesser than 16%. Retinopathy was present in 37% of patients, and 64% had a history of infection in the past six months; more than 50% of patients took insulin. The prevalence of retinopathy, cognitive dysfunction and infections were significantly less frequent in patients with HbA(1c) < or =6.5%. There was a positive correlation between the number of CVRF and the number of cardiovascular anomalies (r=0.19, P<0.001). With the exception of HbA(1c), standard paraclinical tests were performed in less than 50% of patients. There was positive agreement between day-to-day HbA(1c) and HbA(1c) target values in 36% of patients. CONCLUSION: Complications and/or associated diseases were more frequent in this cohort of elderly diabetic patients compared with those in studies not based on clinical examinations. Our results highlight the inadequate management, given the frequent discrepancy between day-to-day HbA(1c) and HbA(1c) targets, of such patients.","Aged;Aged, 80 and over;Albuminuria/epidemiology;Arteries/ultrasonography;Blood Glucose/metabolism;Body Mass Index;Cholesterol/blood;Cholesterol, LDL/blood;Coronary Disease/genetics;Diabetes Complications/*epidemiology;Diabetes Mellitus/*blood/epidemiology;Female;France/epidemiology;Humans;Male;Medical Records;Obesity/epidemiology;Prospective Studies;Proteinuria/epidemiology;Risk Factors;Ultrasonography, Doppler","Doucet, J.;Druesne, L.;Capet, C.;Greboval, E.;Landrin, I.;Moirot, P.;Micaud, G.",2008,Dec,10.1016/j.diabet.2008.05.007,0,
1095,"First-line gefitinib in Caucasian EGFR mutation-positive NSCLC patients: A phase-IV, open-label, single-arm study","Background:Phase-IV, open-label, single-arm study (NCT01203917) to assess efficacy and safety/tolerability of first-line gefitinib in Caucasian patients with stage IIIA/B/IV, epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC).Methods:Treatment: gefitinib 250 mg day-1 until progression. Primary endpoint: objective response rate (ORR). Secondary endpoints: disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and safety/tolerability. Pre-planned exploratory objective: EGFR mutation analysis in matched tumour and plasma samples.Results:Of 1060 screened patients with NSCLC (859 known mutation status; 118 positive, mutation frequency 14%), 106 with EGFR sensitising mutations were enrolled (female 70.8%; adenocarcinoma 97.2%; never-smoker 64.2%). At data cutoff: ORR 69.8% (95% confidence interval (CI) 60.5-77.7), DCR 90.6% (95% CI 83.5-94.8), median PFS 9.7 months (95% CI 8.5-11.0), median OS 19.2 months (95% CI 17.0-NC; 27% maturity). Most common adverse events (AEs; any grade): rash (44.9%), diarrhoea (30.8%); CTC (Common Toxicity Criteria) grade 3/4 AEs: 15%; SAEs: 19%. Baseline plasma 1 samples were available in 803 patients (784 known mutation status; 82 positive; mutation frequency 10%). Plasma 1 EGFR mutation test sensitivity: 65.7% (95% CI 55.8-74.7).Conclusion:First-line gefitinib was effective and well tolerated in Caucasian patients with EGFR mutation-positive NSCLC. Plasma samples could be considered for mutation analysis if tumour tissue is unavailable. © 2014 Cancer Research UK.",NCT01203917;epidermal growth factor receptor;gefitinib;adult;aged;Alzheimer disease;article;asthenia;blood sampling;cancer chemotherapy;cancer palliative therapy;cancer patient;cancer radiotherapy;cancer screening;Caucasian;chemotherapy induced emesis;clinical assessment;controlled study;coughing;diagnostic test accuracy study;diarrhea;disease control;disease severity;drug efficacy;drug eruption;drug safety;drug tolerability;dry skin;female;gene expression;gene mutation;heart failure;human;interstitial lung disease;lung adenocarcinoma;non small cell lung cancer;lung surgery;major clinical study;male;middle aged;mutation rate;nausea;objective response rate;open study;overall survival;phase 4 clinical trial;pneumonia;predictive value;priority journal;progression free survival;sensitivity and specificity;treatment response;young adult,"Douillard, J. Y.;Ostoros, G.;Cobo, M.;Ciuleanu, T.;McCormack, R.;Webster, A.;Milenkova, T.",2014,,,0,
1096,Sinking incidence of dementia,,aged;atrial fibrillation;comorbidity;dementia;educational status;female;heart failure;human;incidence;longitudinal study;Massachusetts;middle aged;proportional hazards model;risk factor;cerebrovascular accident;very elderly,"Dovjak, P.",2016,,10.1007/s00391-016-1076-3,0,
1097,The Effect of Undiagnosed Diabetes on the Association between Self-Reported Diabetes and Cognitive Impairment among Older Mexican Adults,"Purpose: To study the effect of undiagnosed diabetes on the relationship between self-reported diabetes and cognitive impairment. Methods: Data were from 1033 participants aged ≥60 from Wave III (2012) of the Mexican Health and Aging Study. Participants were classified as nondiabetic (n = 589), undiagnosed diabetic (n = 201), and self-reported diabetic (n = 243). Multivariate logistic regression models were used to estimate the relationship between self-reported diabetes and severity of cognitive impairment (nonimpaired, moderate impaired, severe impaired). Results: Self-reported diabetes was associated with significantly higher odds for severe, but not moderate, cognitive impairment (odds ratio [OR] = 2.70, 95% confidence interval [CI] = 1.39-5.32). The association between self-reported diabetes and severe cognitive impairment decreased by 6.3% when undiagnosed diabetics were included in the nondiabetic category and by 30.4% when undiagnosed diabetics were included in the self-reported diabetes category. Discussion: The association between self-reported diabetes and severe cognitive impairment is underestimated when undiagnosed diabetics are not differentiated from self-reported diabetics and nondiabetics.",hemoglobin A1c;adult;alcohol consumption;article;body mass;cerebrovascular accident;cognitive defect;cross-sectional study;depression;diabetes mellitus;disease association;disease severity;exercise;female;glucose blood level;heart infarction;hemoglobin determination;human;hypertension;major clinical study;male;Mexican;smoking,"Downer, B.;Kumar, A.;Mehta, H.;Al Snih, S.;Wong, R.",2016,,,0,
1098,Relationship between metabolic and vascular conditions and cognitive decline among older Mexican Americans,"Objective Metabolic and vascular conditions have been independently associated with dementia and cognitive decline among older adults, but research on the combined effects that these conditions have on cognitive decline, especially among older Mexican Americans, is lacking. The purpose of this study was to examine the relationship between metabolic and vascular conditions and cognitive decline among older Mexican Americans. Methods The final sample included 2767 participants of the Hispanic Established Populations for the Epidemiologic Study of the Elderly. Linear mixed-effects regression was used to model cognitive decline across six examinations (1993-2007) according to the number (zero, one, two, and three to four) of metabolic and vascular conditions (hypertension, diabetes, stroke, and heart attack). Results Of the 2767 participants included in the final sample, 777 had zero conditions, 1314 had one condition, 553 had two conditions, and 123 had three to four conditions. Participants with two or three to four conditions had significantly greater cognitive decline compared with participants with zero or one condition. Stroke had the largest effect size on cognitive decline based on the proportion of variance that stroke accounted for in the linear mixed-effects model. Conclusion Mexican American older adults with multiple metabolic and vascular conditions exhibit greater cognitive decline than those with zero or one condition. Public health interventions designed to reduce the prevalence of chronic metabolic and vascular conditions, in particular stroke, may limit the severity of cognitive decline among older Mexican Americans.",alcohol;aged;alcohol consumption;article;cerebrovascular accident;cognitive defect;controlled study;depression;diabetes mellitus;disease association;educational status;female;heart infarction;human;hypertension;interview;major clinical study;male;Mexican American;Mini Mental State Examination;sex difference;smoking,"Downer, B.;Raji, M. A.;Markides, K. S.",2016,,,0,
1099,"Geriatric psychiatry review: Differential diagnosis and treatment of the 3 D's - Delirium, dementia, and depression","The three D's of Geriatric Psychiatry - delirium, dementia, and depression - represent some of the most common and challenging diagnoses for older adults. Delirium is often difficult to diagnose and treatment is sometimes controversial with the use of antipsychotic medications, but it is common in a variety of patient care settings and remains an independent risk factor for morbidity and mortality in older adults. Dementia may affect a significant number of older adults and is associated with delirium, depression, frailty, and failure to thrive. Treatment of dementia is challenging and while medication interventions are common, environmental and problem solving therapies may have some of the greatest benefits. Finally, depression increases with age and is more likely to present with somatic complaints or insomnia and is more likely to be reported to a primary care physician than any other healthcare provider by older adults. Depression carries an increased risk for suicide in older adults and proven therapies should be initiated immediately. These three syndromes have great overlap, can exist simultaneously in the same patient, and often confer increased risk for each other. The primary care provider will undoubtedly benefit from a solid foundation in the identification, classification, and treatment of these common problems of older adulthood. © 2013 Springer Science+Business Media New York.",antioxidant;donepezil;fish oil;galantamine;hypnotic sedative agent;memantine;neuroleptic agent;nonsteroid antiinflammatory agent;rivastigmine;serotonin uptake inhibitor;vitamin;acute heart infarction;adult failure to thrive;Alzheimer disease;article;behavior therapy;cataract;cerebrovascular accident;delirium;dementia;depression;diabetes mellitus;diet supplementation;differential diagnosis;drug dose increase;drug dose titration;dystonia;exercise;failure to thrive;falling;frail elderly;hip fracture;human;insomnia;mild cognitive impairment;obesity;parkinsonism;quality of life;side effect;social support;suicidal ideation;tardive dyskinesia;terminal care;unspecified side effect,"Downing, L. J.;Caprio, T. V.;Lyness, J. M.",2013,,,0,
1100,Emotional well-being in spouses of patients with advanced heart failure,"BACKGROUND: The physical demands and psychological stressors of caregiving negatively impact the emotional well-being of spouses in many chronically ill populations such as patients with Alzheimer's disease and end-stage renal failure. Heart failure (HF) is a chronic illness with a poor prognosis that is increasing in prevalence and incidence, yet little is know about its effect on the family, particularly the spouse. OBJECTIVE: We conducted this study to describe the emotional well-being of spouses of patients with HF, to identify factors associated with spouses' decreased emotional well-being, and to compare emotional well-being between spouses with higher and lower levels of perceived control. We proposed a model that included age, sex, employment status, perceived control, and caregiver burden to explain the emotional well-being of spouses. METHODS: Data were collected from 69 spouses of patients with advanced HF (mean age 54 years and predominantly female) using 2 subscales of the SF-36, control attitudes scale-family version and caregiver appraisal tool. Descriptive statistics, Pearson correlations, and stepwise multiple regression were used to analyze data. RESULTS: The model explained 40% of the variance in the emotional well-being of spouses (P = 0.001). Perceived control (P = 0.001) and age (P = 0.046) were associated with emotional well-being. In spouses with higher levels of control, emotional well-being was significantly higher than in spouses with lower levels of control (P = 0.003). Older spouses had higher levels of emotional well-being compared with younger spouses (P = 0.01). CONCLUSIONS: Health care professionals must assess the level of control perceived by spouses of patients with advanced HF and provide information and counseling directed toward increasing their sense of control. Younger spouses are particularly at risk for decreased emotional well-being and may require special intervention.",Adult;Age Factors;Aged;Caregivers/*psychology;Cross-Sectional Studies;*Emotions;Family Health;Female;Heart Failure/psychology/therapy;Humans;*Internal-External Control;Interpersonal Relations;Male;Mental Health;Middle Aged;Spouses/*psychology,"Dracup, K.;Evangelista, L. S.;Doering, L.;Tullman, D.;Moser, D. K.;Hamilton, M.",2004,Nov-Dec,,0,
1101,Should we now abandon the low-salt diet?,,aldosterone;angiotensin;antihypertensive agent;renin;sodium ion;adrenergic system;Alzheimer disease;arterial pressure;body mass;brain damage;heart failure;heart infarction;human;hypertension;hyponatremia;insulin resistance;intracellular signaling;mortality;muscle contraction;nerve conduction;note;primary prevention;priority journal;salt intake;sodium excretion;sodium restriction;sodium urine level;cerebrovascular accident;sympathetic nerve;unspecified side effect,"Drake-Holland, A. J.;Noble, M. I. M.",2011,,,0,
1102,Results of a phase II multicenter trial of pentostatin and rituximab in patients with low-grade B-cell non-Hodgkin's lymphoma: An effective and minimally toxic regimen,"This study explored the efficacy and toxicity of the combinatino of pentostatin and rituximab, effective single agents in low-grade non-Hodgkin's lymphoma (NHL). Sixty patients with previously treated low-grade NHL were enrolled. Except for day 1, both drugs were administered weekly for 4 weeks, with week 5 off. During week 1 (day 1) only rituximab was given; subsequent weekly treatments included both drugs. Patients received a minimum of 2 five-week cycles in order to be evaluable for efficacy. Responses were evaluated on week 5 of cycle 2. If partial response (PR) or stable disease (SD) responses were noted, 2 additional cycles were administered. Final evaluations were done on week 5 of cycle 4. Of 60 patients, 58.3% had an Eastern Cooperative Oncology Group performance status (PS) of 0, and 41.7% had PS of 1; 31.7% and 51.7% had stage III or stage IV disease, respectively. Histology included follicular center, follicular, grade I (45%), II (21.7%), III (1.7%), and small lymphocytic (31.7%). Seventeen patients had prior chemotherapy, but no patients had received prior pentostatin or rituximab. Median age was 60.3 years (range, 32.5-84.7 years). Among 57 evaluable patients, 77% responded (22.3% complete response [CR], 3.5% unconfirmed CR, 35.1% PR, and 10.5% unconfirmed PR); 19.3% had SD, and 8.8% progressive disease (PD). Response rate among previously untreated patients was 83% versus 63% in previously treated patients. Median duration of response was 11 months (range, 2.3-22.2 months); median time to progression was 15 months (range, < 1-25 months). Neutropenia was the only adverse event experienced by ≥ 10% of patients. Six deaths were causedy by PD, and one death each was caused by acute respiratory distress, possibly related respiratory failure, and cardiac toxicity. These results suggest the combination of pentostatin/rituximab is well tolerated and active in low-grade lymphoma.",anthracycline;doxorubicin;pentostatin;rituximab;adult;aged;anaphylaxis;anemia;anorexia;anxiety disorder;article;asthenia;B cell lymphoma;bronchospasm;cancer chemotherapy;cancer grading;cancer growth;cancer staging;cardiotoxicity;cause of death;chill;clinical trial;congestive heart failure;controlled clinical trial;controlled study;dehydration;dementia;drug efficacy;drug eruption;drug response;drug tolerability;drug toxicity;dyspnea;electrolyte disturbance;febrile neutropenia;feces incontinence;female;follicular lymphoma;granuloma;headache;atrial fibrillation;herpes zoster;histopathology;human;hyperglycemia;hyperkalemia;hypokalemia;hypotension;insomnia;kidney failure;lactate dehydrogenase blood level;leukopenia;liver dysfunction;lymphocytoma;major clinical study;male;mucosa inflammation;multicenter study;nausea and vomiting;nephrotoxicity;neutropenia;nonhodgkin lymphoma;phase 2 clinical trial;pneumonia;respiratory distress;respiratory failure;sepsis;skin defect;spine disease;tachycardia;thrombotic thrombocytopenic purpura;upper respiratory tract infection;vertigo;wheezing,"Drapkin, R.;Di Bella, N. J.;Faragher, D. C.;Harden, E.;Matei, C.;Hyman, W.;Mirabel, M.;Boehm, K. A.;Asmar, L.",2003,,,0,
1103,Medical utility of apoe allele determination in assessing the need for antioxidant therapy,"The APOE varepsilon4 allele is associated with a variety of conditions such as Alzheimer's disease, coronary artery disease, stroke and postoperative cognitive dysfunction. The common pathophysiological feature that appears to explain these positive clinical associations with APOE varepsilon4 allele may relate to the decreased endogenous anti-oxidant capability of an individual. A significant body of existing clinical data supports the assumption that diseases associated with the varepsilon4 allele can be alleviated by antioxidant therapies, such as vitamin E. Therefore, we hypothesize that determination of an individual's APOE allele status has medical utility as an efficient method to identify patient subgroups susceptible to oxidative damage. We suggest that prospective studies are needed to determine if individuals at high risk for diseases characterized by oxidative damage and/or who have an APOE varepsilon4 allele might benefit significantly from available antioxidant intervention at a relatively early and asymptomatic age.","Alleles;Alzheimer Disease/drug therapy/*genetics;Antioxidants/*therapeutic use;Apolipoprotein E4;Apolipoproteins E/*genetics;Cognition Disorders/drug therapy/etiology/genetics;Coronary Disease/drug therapy/*genetics;Genetic Predisposition to Disease;Humans;*Models, Biological;Models, Genetic;Postoperative Complications/psychology;Stroke/drug therapy/*genetics;Vitamin E/therapeutic use","Dreon, D. M.;Peroutkal, S. J.",2001,Mar,10.1054/mehy.2000.1213,0,
1104,Cognitive function and all-cause mortality in maintenance hemodialysis patients,"BACKGROUND: Cognitive impairment is common in hemodialysis patients and is associated with significant morbidity. Limited information exists about whether cognitive impairment is associated with survival and whether the type of cognitive impairment is important. STUDY DESIGN: Longitudinal cohort. SETTING & PARTICIPANTS: Cognitive function was assessed at baseline and yearly using a comprehensive battery of cognitive tests in 292 prevalent hemodialysis patients. PREDICTOR: Using principal component analysis, individual test results were reduced into 2 domain scores, representing memory and executive function. By definition, each score carried a mean of 0 and SD of 1. OUTCOMES: Association of each score with all-cause mortality was assessed using Cox proportional hazards models adjusted for demographics and dialysis and cardiovascular (CV) risk factors. RESULTS: Mean age of participants was 63 years, 53% were men, 23% were African American, and 90% had at least a high school education. During a median follow-up of 2.1 (IQR, 1.1-3.7) years, 145 deaths occurred. Each 1-SD better executive function score was associated with a 35% lower hazard of mortality (HR, 0.65; 95% CI, 0.55-0.76). In models adjusting for demographics and dialysis-related factors, this relationship was partially attenuated but remained significant (HR, 0.81; 95% CI, 0.67-0.98), whereas adjustment for CV disease and heart failure resulted in further attenuation (HR, 0.87; 95% CI, 0.72-1.06). Use of time-dependent models showed a similar unadjusted association (HR, 0.62; 95% CI, 0.54-0.72), with the relationship remaining significant after adjustment for demographics and dialysis and CV risk factors (HR, 0.79; 95% CI, 0.66-0.94). Better memory was associated with lower mortality in univariate analysis (HR per 1 SD, 0.82; 95% CI, 0.69-0.96), but not when adjusting for demographics (HR, 1.00; 95% CI, 0.83-1.19). LIMITATIONS: Patients with dementia were excluded from the full battery, perhaps underestimating the strength of the association. CONCLUSIONS: Worse executive function and memory are associated with increased risk of mortality. For memory, this association is explained by patient demographics, whereas for executive function, this relationship may be explained in part by CV disease burden.","Adult;Aged;Aged, 80 and over;Cognition Disorders/*diagnosis/*mortality;Cohort Studies;Executive Function/*physiology;Female;Follow-Up Studies;Humans;Longitudinal Studies;Male;Memory/physiology;Middle Aged;Mortality/trends;Renal Dialysis/*mortality/trends;Cognition;cardiovascular disease;cognitive impairment;end-stage renal disease (ESRD);executive function;hemodialysis;memory;mortality;neurocognitive testing","Drew, D. A.;Weiner, D. E.;Tighiouart, H.;Scott, T.;Lou, K.;Kantor, A.;Fan, L.;Strom, J. A.;Singh, A. K.;Sarnak, M. J.",2015,Feb,10.1053/j.ajkd.2014.07.009,0,
1105,Analysis of the prevalence of dementia and the diseases that cause dementia syndromes in the population of Lower Silesia,"Background. Dementia is a gradually developing mentally deteriorating illness. The intellectual structures involved affect the human ability to act, work and properly interact in the society. It is an organic illness. Material and methods. Lower Silesia Public Health Center in Wroclaw is responsible for collecting and analyzing data on causes of therapy and death in Lower Silesia population. A literature search was performed to determine the main conditions and illnesses leading to dementia, then the collected data on hospital treatment in 2002-2006 were analyzed to find the most important region's population health threats that may lead to dementia. Results. The illnesses causing primary dementia, such as Alzheimer disease, are rarely encountered in the Lower Silesia population, but there are many illnesses common that lead to secondary dementia, such as hypertension and atherosclerosis, with their brain and renal complications, as well as chronic heart insufficiency causing brain ischaemia, that is caused also by pulmonary obturative diseases and lung neoplasms. The hepatic failure, brain tumors and neoplasms are also quite common. Conclusions. The results of the study confirmed that in the Polish population, as well as the Lower Silesia, there are more vascular dementia causes than caused by Alzheimer disease. The number of patients that were diagnosed with dementia is very low in the region and it suggests that many patients could not be diagnosed properly. There is a large number of patients in the Lower Silesia region who were treated in hospitals because of dementia risk factors that could be modified. On one hand it indicates high risk of increase in the count of dementia patients the following years, on the other hand it shows that the basic illnesses, such as hypertension and atheromatosis, should be treated more intensively and the prevention of risk factors, especially smoking, should be stressed. © Copyright by Wydawnictwo Continuo.",Alzheimer disease;article;atherosclerosis;brain ischemia;brain tumor;dementia;heart failure;human;hypertension;liver failure;lung tumor;mortality;population research;prevalence;public health;risk factor;smoking;threat,"Drobnik, J.;Susło, R.;Krzesińska-Nowacka, A.;Kurpas, D.;Muszyńska, A.;Mastalerz-Migas, A.;Pirogowicz, I.",2010,,,0,
1106,Occurrence analysis of dementia and diseases causing dementia syndromes in Lower Silesia region population,"Background. Dementia is a gradually developing mentally deteriorating illness. The intellectual structures involved affect the human ability to act, work and properly interact in the society. It is an organic illness. Material and methods. Lower Silesia Public Health Center in Wroclaw is responsible for collecting and analyzing data on causes of therapy and death in Lower Silesia population. A literature search was performed to determine the main conditions and illnesses leading to dementia, then the collected data on hospital treatment in 2002-2006 were analyzed to find most important region's population health threats that may lead to dementia. Results. The illnesses causing primary dementia, like Alzheimer disease, are rarely encountered in the Lower Silesia population, but there are many illnesses common that lead to secondary dementia, like hypertension and atherosclerosis, with their brain and renal complications, as well as chronic heart insufficiency causing brain ischaemia, that is caused also by pulmonary obturative diseases and lung neoplasms. The hepatic failure and brain tumors and neoplasms are also quite common. Conclusions. The results of the study confirmed that in the Polish, as well as the Lower Silesia, population, there are more vascular dementia causes than caused by Alzheimer disease. The number of the patients that received a diagnosis of dementia is very low in the region and it suggests that many patients could be not diagnosed properly. There is a big number of patients in the Lower Silesia region that were treated in hospitals because of dementia risk factors that could be modified. On one hand it indicates high risk of increase in the number of dementia patients in forthcoming years, on the second hand it shows that the basic illnesses, such as hypertension and atheromatosis, should be treated more intensively and the prevention of risk factors, especially smoking, should be stressed. © Copyright by Wydawnictwo Continuo.",Alzheimer disease;article;atherosclerosis;brain ischemia;brain tumor;cause of death;chronic obstructive lung disease;data analysis;data collection method;dementia;disease association;health hazard;heart failure;human;hypertension;liver failure;lung tumor;multiinfarct dementia;Poland;risk factor,"Drobnik, J.;Susło, R.;Kurpas, D.;Muszyńska, A.;Mastalerz-Migas, A.;Pirogowicz, I.",2009,,,0,
1107,Vitamins in the prevention or delay of cognitive disability of aging,"During the 20th century, the average lifespan in the industrialized societies has enormously increased and it is still rising. With the increase in the number of old people, a parallel increase in the number of the disabled elderly is postulated. Thus, the whole society might suffer from an imbalance between the productive segment of the society and a huge segment of helpless people. Moderation of the physiological processes, which enhance disability in aging, turns out to be a major concern in health research and clinical practice. Preservation of brain integrity, which is partly influenced by nutrition, presumably is the main target in the attempt to delay the development of disability of aging. Optimal micronutrient status would moderate the deterioration in brain integrity. The human brain is probably the most vulnerable tissue affected by a long-term unbalanced nutrition and is particularly vulnerable to reactive oxygen species and to oxidative stress, because of its high oxygen requirement, its iron storage capacity and its elevated polyunsaturated fatty acid content, and because of its low synthesis capacity of endogenous antioxidants. The capability of central nervous system (CNS) cells to regenerate is most limited, because their repair is inhibited by anti-apoptotic molecules. Efficient autophagy is the major mechanism that moderates accumulation of aggregating compounds. Autophagy is probably a crucial and a major process in the preservation of brain integrity. Micronutrients (vitamins, trace-elements and also antioxidants) most likely affect brain integrity by normalizing efficient autophagy. Brain sensitivity to metabolic disorders is demonstrated by the effect of homocysteine on metabolic pathways, on brain integrity and on the cognitive capacity. Brain imaging might be used as a surrogate for detecting long-lasting low status of micronutrients. Comprehensive evaluation of brain scans concomitantly with blood micronutrient examinations may provide reliable criteria for the estimation of the optimal micronutrient intakes or blood concentrations. Recommended dietary intakes for micronutrients are based on a list of biomarkers, but have not been suggested a safe range for their intake or blood concentration. According to many studies, a U-shaped curve prevails for the effect of serum calcidiol concentration on the relative risk of morbidity and mortality. An increased relative risk of morbidity and mortality with lower serum calcidiol has been shown in almost all the studies. A safe range of 20-40 ng/mL was identified for serum calcidiol. A significant detrimental effect of serum calcidiol on the hazard ratio for the combined data of all-cause mortality and acute coronary syndrome morbidity was shown at a concentration higher than 36 ng/ml. Most of the tolerable upper intake levels for the micronutrients, published by authorized institutions, were set without considering the long-term effects of overdosing. Excessive intake of almost all the micromutrients, particularly for a long period of time, produces adverse effects. In most of the elderly people prevail an insufficient intake of one or more micronutruients. Therefore, until an efficient laboratory system for evaluating blood levels is established, a moderate 'multivitamin' supplementation at an amount of about half the American RDA for most of the micronutrients is suggested.",homocysteine;mineral;selenium;trace element;vitamin;vitamin D;aged;aging;amino acid blood level;article;autophagy;blood vessel function;brain;brain damage;brain function;cognition;cognitive defect;drug tolerability;geriatric care;human;lifestyle;mineral blood level;morbidity;mortality;nutrition;nutritional deficiency;outcome assessment;priority journal;selenium blood level;vitamin blood level;vitamin intake;vitamin supplementation,"Dror, Y.;Stern, F.;Gomori, M. J.",2014,,,0,
1108,Depression risk in patients with late-onset rheumatoid arthritis in Germany,"Goal: The goal of this study was to determine the prevalence of depression and its risk factors in patients with late-onset rheumatoid arthritis (RA) treated in German primary care practices. Methods: Longitudinal data from general practices (n=1072) throughout Germany were analyzed. Individuals initially diagnosed with RA (2009–2013) were identified, and 7301 patients were included and matched (1:1) to 7301 controls. The primary outcome measure was the initial diagnosis of depression within 5 years after the index date in patients with and without RA. Cox proportional hazards models were used to adjust for confounders. Results: The mean age was 72.2 years (SD: 7.6 years). A total of 34.9 % of patients were men. Depression diagnoses were present in 22.0 % of the RA group and 14.3 % of the control group after a 5-year follow-up period (p < 0.001). In the multivariate regression model, RA was a strong risk factor for the development of depression (HR: 1.55, p < 0.001). There was significant interaction of RA and diagnosed inflammatory polyarthropathies (IP) (RA*IP interaction: p < 0.001). Furthermore, dementia, cancer, osteoporosis, hypertension, and diabetes were associated with a higher risk of developing depression (p values <0.001). Conclusion: The risk of depression is significantly higher in patients with late-onset RA than in patients without RA for subjects treated in primary care practices in Germany. RA patients should be screened routinely for depression in order to ensure improved treatment and management.",aged;article;clinical outcome;controlled study;dementia;depression;diabetes mellitus;female;follow up;Germany;heart failure;human;hypertension;ischemic heart disease;late onset disorder;longitudinal study;major clinical study;male;malignant neoplasm;osteoarthritis;osteoporosis;polyarthritis;priority journal;rheumatoid arthritis;risk assessment,"Drosselmeyer, J.;Jacob, L.;Rathmann, W.;Rapp, M. A.;Kostev, K.",2017,,10.1007/s11136-016-1387-2,0,
1109,Depression risk in female patients with osteoporosis in primary care practices in Germany,"Thirty-five thousand four hundred eighty-three female osteoporosis patients were compared with 35,483 patients without osteoporosis regarding the incidence of depression. The risk of depression is significantly increased for patients with osteoporosis compared with patients without osteoporosis in primary care practices within Germany. INTRODUCTION: The objectives of the present study were to analyze the incidence of depression in German female patients with osteoporosis and to evaluate the risk factors for depression diagnosis within this patient population. METHODS: This study was a retrospective database analysis conducted in Germany utilizing the Disease Analyzer(R) Database (IMS Health, Germany). The study population included 70,966 patients between 40 and 80 years of age from 1072 primary care practices. The observation period was between 2004 and 2013. Follow-up duration was 5 years and was completed in April 2015. A total of 35,483 osteoporosis patients were selected after applying exclusion criteria, and 35,483 controls were chosen and then matched (1:1) to osteoporosis patients based on age, sex, health insurance coverage, depression diagnosis in the past, and follow-up duration after index date. The analyses of depression-free survival were carried out using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models (dependent variable: depression) were used to adjust for confounders. RESULTS: Depression diagnoses were presented in 33.0 % of the osteoporosis group and 22.7 % of the control group after the 5-year follow-up (p < 0.001). Dementia, cancer, heart failure, coronary heart disease, and diabetes were associated with a higher risk of developing depression (p < 0.001). Private health insurance was associated with a lower risk of depression. There was no significant effect of fractures on depression risk. CONCLUSION: The risk of depression is significantly increased for patients with osteoporosis in primary care practices within Germany.",Comorbidity;Depression risk;Osteoporosis;Primary care practice,"Drosselmeyer, J.;Rapp, M. A.;Hadji, P.;Kostev, K.",2016,Sep,10.1007/s00198-016-3584-9,0,
1110,SHI Xue-min's idea of acupuncture treatment on acute syndromes and intractable diseases,"Under the guidance of traditional acupuncture theory and modern medical knowledge, with long-term clinical practice, professor SHI Xue-min, academician of the Chinese Academy of Engineering, has made new recognitions on the concept of Shen (mind or vitality, a general term for life processes of the human body, referring to mentality, consciousness and thinking) and the brain, established the ideas of ""Xingshen"" (to cause resuscitation), ""Tiaoshen"" (to regulate the function of mental activity) and ""Anshen"" (to tranquilize the mind), promoted the application of the above ideas into acupuncture treatment on acute syndromes and intractable diseases, which is approved to have significant effect. The article dedicats to introduce professor SHI's experiences of using his idea of mental regulation with the combination of standard quantitative manipulations to treat acute, severe and intractable diseases such as stroke, central respiratory failure, angina pectoris, temporary syncope, pseudobular palsy, vascular dementia and dysuria.",*Acupuncture Therapy;Brain Diseases/psychology/*therapy;Consciousness;Humans,"Du, Y. Z.",2010,Dec,,0,
1111,Depression,"Major depressive disorder (MDD) is a global public health concern, with high prevalence among patients seeking medical services in primary care. In 2020, it is estimated to be among the leading causes of disability worldwide, and still remains underdiagnosed or undertreated, which compromises the clinical outcome of affected individuals. The etiology of MDD is multifactorial, involving alostatic mechanisms, which predisposes to the appearance of other clinical and chronic degenerative conditions such as diabetes mellitus, acute myocardial infarction, stroke and Alzheimer's dementia. This article for primary care, talks about the importance of their role in reducing the impact of morbidity and mortality and improving the quality of life of patients with depression through day to day data for the diagnosis and management of the disease.",acute heart infarction;Alzheimer disease;article;cerebrovascular accident;dementia;diabetes mellitus;disability severity;help seeking behavior;human;major depression;managed care;medical service;morbidity;mortality;outcome assessment;prevalence;primary medical care;public health;quality of life,"Duailibi, K.;Da Silva, A. S. M.;Bonifácio Jubara, C. F.",2014,,,0,1112
1112,Depression,"Major Depressive Disorder (MDD) is a global public health concern, with high prevalence among patients seeking medical services in primary care. In 2020, it is estimated to be among the leading causes of disability worldwide, and still remains underdiagnosed or undertreated, which compromises the clinical outcome of affected individuals. The etiology of MDD is multifactorial, involving alostatic mechanisms, which predisposes to the appearance of other clinical and chronic degenerative conditions such as Diabetes Mellitus, Acute Myocardial Infarction, Stroke and Alzheimer's dementia. This article for primary care, talks about the importance of their role in reducing the impact of morbidity and mortality and improving the quality of life of patients with depression through day to day data for the diagnosis and management of the disease.",acute heart infarction;Alzheimer disease;article;cerebrovascular accident;degenerative disease;diabetes mellitus;diagnostic error;disability;disease predisposition;human;major depression;medical service;morbidity;mortality;prevalence;primary medical care;public health problem;quality of life;treatment outcome,"Duailibi, K.;Da Silva, A. S. M.;Bonifácio Jubara, C. F.",2015,,,0,
1113,Neuroprotective effects of estradiol in middle-aged female rats,"Estrogen replacement therapy in postmenopausal women ameliorates cognitive dysfunction and decreases the risk and/or severity of neurodegenerative conditions such as Alzheimer's disease and stroke. Furthermore, estradiol exerts neuroprotective effects in a variety of in vitro and in vivo models of brain injury. We have previously shown that physiological levels of estradiol attenuate ischemic brain injury in young female rats. However, neurodegenerative events occur more frequently in elderly women who are chronically hypoestrogenic. Therefore, we investigated whether aging rats remain responsive to the neuroprotective actions of estradiol. Young (3-4 months) and middle-aged (9-12 months) rats were ovariectomized and treated for 1 week with estradiol before middle cerebral artery occlusion (MCAO). Regional cerebral blood flow was monitored in some animals at the time of injury. Brains were collected 24 h after MCAO and infarct volume was analyzed. Our data demonstrate that in both young and aging rats, low and high physiological doses of estradiol decrease ischemic injury by almost 50%, compared with oil-treated controls. Additionally, our data suggest that estradiol acts in both age groups via blood flow-independent mechanisms, as basal and postinjury blood flow was equivalent between estradiol- and oil-treated young and aging rats. These data demonstrate that replacement with physiological levels of estradiol protects against stroke-related injury in young and aging female rats and strongly suggest that older animals remain responsive to the protective actions of estradiol.","Aging/*physiology;Animals;Brain/drug effects/growth & development/*pathology;Cerebrovascular Circulation/drug effects/*physiology;Estradiol/*pharmacology;Estrogen Replacement Therapy;Female;Humans;Ischemic Attack, Transient/*physiopathology/prevention & control;Models, Animal;Myocardial Infarction/pathology/*physiopathology/*prevention & control;*Neuroprotective Agents;Ovariectomy;Postmenopause;Rats;Rats, Sprague-Dawley","Dubal, D. B.;Wise, P. M.",2001,Jan,10.1210/endo.142.1.7911,0,
1114,Oxidative phosphorylation defect in the brains of carriers of the tRNA(leu(UUR)) A3243G mutation in a MELAS pedigree,"MELAS is a mitochondrial encephalomyopathy characterized clinically by recurrent stroke-like episodes, seizures, sensorineural deafness, dementia, hypertrophic cardiomyopathy, and short stature. The majority of patients are heteroplasmic for a mutation (A3243G) in the tRNA(leu(UUR)) gene in mitochondrial DNA (mtDNA). In cells cultured in vitro, the mutation produces a severe mitochondrial translation defect only when the proportion of mutant mtDNAs exceeds 95% of total mtDNAs. However, most patients are symptomatic well below this threshold, a paradox that remains unexplained. We studied the relationship between the level of heteroplasmy for the mutant mtDNA and the clinical and biochemical abnormalities in a large pedigree that included 8 individuals carrying the A3243G mutation, 4 of whom were asymptomatic. Unexpectedly, we found that brain lactate, a sensitive indicator of oxidative phosphorylation dysfunction, was linearly related to the proportion of mutant mtDNAs in all individuals carrying the mutation, whether they were symptomatic or not. There was no evidence for threshold expression of the metabolic defect. These results suggest that marked tissue-specific differences may exist in the pathogenic expression of the A3243G mutation and explain why a neurological phenotype can be observed at relatively low levels of heteroplasmy.",adult;aged;article;clinical article;DNA determination;female;gene mutation;genotype;human;male;MELAS syndrome;oxidative phosphorylation;phenotype;priority journal;RNA analysis,"Dubeau, F.;De Stefano, N.;Zifkin, B. G.;Arnold, D. L.;Shoubridge, E. A.",2000,,,0,
1115,Superficial siderosis of the central nervous system: A rare cause of dementia with therapeutic consequences,"A 75-year-old patient was evaluated for dementia. His past medical history included an ischaemic cardiomyopathy treated with aspirin daily. His neurological examination showed mild ataxia syndrome and central deafness. The neuropsychological examination did not suggest Alzheimer's disease. No specific aetiology was found from biological investigations, but MRI scans revealed a superficial siderosis, which was further confirmed with CSF exams. This case highlights the interest of MRI with echo-gradient-T2 weighted sequences in patients investigated for memory disorders. Once the diagnosis is known, specific preventive measures have to be taken: searching for a treatable source of bleeding and the interruption of antiplatelet aggregation or anticoagulant treatments. © The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.",acetylsalicylic acid;hydroxymethylglutaryl coenzyme A reductase inhibitor;aged;Alzheimer disease;article;ataxia;case report;central nervous system disease;cerebrospinal fluid analysis;clinical feature;dementia;disease course;head injury;hearing impairment;human;hypertension;language disability;male;memory disorder;non insulin dependent diabetes mellitus;priority journal;protein blood level;superficial siderosis,"Dubessy, A.;Ursu, R.;Maillet, D.;Augier, A.;Le Guilloux, J.;Carpentier, A. F.;Belin, C.",2012,,,0,
1116,Effect of six months of treatment with V0191 in patients with suspected prodromal alzheimer's disease,"New criteria related to prodromal Alzheimer's disease (AD) have been proposed to overcome the issue of heterogeneity of patients with mild cognitive impairment (MCI) and to better define patients in early stage AD. Only few therapeutic trials, if any, have been reported using this newly defined population. The objective of this study was to assess the clinical efficacy and safety of a novel pro-cholinergic drug (V0191) in patients with prodromal AD. Two hundred forty two (242) patients with a diagnosis of prodromal AD were randomized in an approximately 1: 1 ratio to receive either 1500 mg V0191 or matching placebo once daily for 24 weeks. Changes in global cognitive functioning were assessed using the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog; responder rate as primary efficacy measure). Standardized measures of memory, executive function, attention, functional capacity, and apathy were also obtained. Despite some interesting trends at week 12 and conversion rates favoring V0191, no statistically significant differences in cognitive function between V0191 and placebo were noted. In addition to the absence of drug efficacy on this population, several design features may have hindered this study, including insufficient powering to assess changes in cognition over time, a relatively short duration of treatment, and the lack of validated clinical trial measures designed to assess the prodromal AD population. Lessons learned in AD study design optimization, including those presented in this paper, could be valuable for further investigation with pro-cholinergic drugs such as V0191. © 2012-IOS Press and the authors. All rights reserved.",cholinergic receptor stimulating agent;unclassified drug;v0191;adult;aged;Alzheimer disease;Alzheimer Disease Assessment Scale Cognitive Subscale;apathy;article;attention;bronchitis;cognition;connective tissue disease;controlled study;diarrhea;double blind procedure;drug efficacy;drug fatality;drug safety;drug tolerability;drug withdrawal;female;functional assessment;gastrointestinal disease;headache;heart arrest;heart failure;human;hypertension;infection;infestation;major clinical study;male;memory;metabolic disorder;mild cognitive impairment;morning dosage;multicenter study;musculoskeletal disease;neurologic disease;nutritional disorder;patient compliance;priority journal;randomized controlled trial;rating scale;respiratory arrest;treatment duration;urinary tract infection;vascular disease,"Dubois, B.;Zaim, M.;Touchon, J.;Vellas, B.;Robert, P.;Murphy, M. F.;Pujadas-Navinés, F.;Rainer, M.;Soininen, H.;Riordan, H. J.;Kanony-Truc, C.",2012,,,0,
1117,Air medical repatriation: Compassionate and palliative care consideration during transport,"As the world's population ages, the number of elderly and very elderly international travelers continues to increases. Many of these travelers are afflicted with multiple, often severe, medical conditions; in fact, a significant portion of these elderly travelers are considered end stage with respect to their disease state. While traveling, they are exposed to travel hazards and deterioration of their already compromised health. Once acute illness or injury occurs, medically appropriate, compassionate repatriation of these elderly patients is associated with a range of complex challenges. In this series, we present 4 cases that demonstrate these challenges. © 2012 Air Medical Journal Associates.",aged;air medical transport;article;case report;consciousness disorder;dementia;general condition deterioration;geriatric patient;Glasgow coma scale;heart failure;hemiparesis;hemiplegia;human;hypothyroidism;intensive care nursing;kidney failure;male;medical history;Ogilvie syndrome;palliative therapy;Parkinson disease;pneumonia;priority journal;prostate adenocarcinoma;prostate cancer;cerebrovascular accident;travel;urine retention,"Duchateau, F. X.;Verner, L.;Gauss, T.;Brady, W. J.",2012,,,0,
1118,Efficacy of atorvastatin after LDL-cholesterol-based dose selection in high risk dyslipidaemic patients: Results of the target dose study,"Background: Hypercholesterolaemia is one of the major risk factors for the development of coronary heart disease (CHD). European guidelines emphasize the importance of reducing low-density lipoprotein cholesterol (LDL-C) levels below 115 mg/ dL (3.0 mmol/L) in patients with high CHD risk. Objective: The present study evaluates whether selection of the atorvastatin starting dose based on baseline LDL-C levels and previous statin treatment status would result in an achievement of LDL-C targets without the need for up-titration. Methods: A multicentre, prospective, open-label study conducted in Belgium. Patients were at high risk defined as either a history of CHD, another atherosclerotic disease, diabetes mellitus Type 2 or an estimated 10-year CHD risk > 20%. The primary endpoint was the proportion of patients achieving the LDL-C goal after 12 weeks of treatment. Results: Overall, 96.4% of the 195 statin-naïve patients reached the LDL-C target after 12 weeks of treatment. The majority of the patients (95.4%) already reached LDL-C control at Week 6. Mean (SD) LDL-C levels decreased from 159 (25) mg/dL[(4.1 (0.6) mmol/L] to 86 (14)mg/dL [2.2 (0.4) mmol/L] after 12 weeks of treatment. Only 4.6% of the patients needed an up-titration at Week 6. Conclusions: Taken together, the results demonstrate that LDL-C based dose selection of atorvastatin is highly efficacious for rapid achievement of target LDL-C levels with a low need for up-titration. Application of this flexible first dosing strategy in general practice will, based on available evidence, increase adherence to atorvastatin treatment in patients with high CHD risk. © 2007 Librapharm Limited.",acetylsalicylic acid;atorvastatin;beta adrenergic receptor blocking agent;bisoprolol fumarate;calcium antagonist;dipeptidyl carboxypeptidase inhibitor;low density lipoprotein cholesterol;abdominal pain;adult;aged;article;atherosclerosis;bronchitis;cholesterol blood level;clinical trial;constipation;controlled study;dementia;diarrhea;drug dose titration;drug efficacy;drug intoxication;drug withdrawal;dyslipidemia;falling;female;gastritis;headache;high risk patient;human;humeroscapular periarthritis;ischemic heart disease;major clinical study;male;multicenter study;non insulin dependent diabetes mellitus;prostate adenocarcinoma;sepsis;side effect;transient ischemic attack;treatment duration;treatment outcome;upper respiratory tract infection;aspirin,"Ducobu, J.;Claeys, M.;Commers, K.;Van Mieghem, W.;Nachtergaele, H.;Vandenbroucke, M.;Deforce, J.",2007,,,0,
1119,Characteristics of Older Adults in Primary Care Who May Benefit From Primary Palliative Care in the U.S,"CONTEXT: Older adults with advanced illness and associated symptoms may benefit from primary palliative care, but limited data exist to identify older adults in U.S. primary care to benefit from this care. OBJECTIVES: To describe U.S. primary care visits among adults aged 65 years and older with advanced illness. METHODS: Cross-sectional analysis of the National Ambulatory and Hospital Ambulatory Medical Care Surveys (2009-2011) was conducted using Chi-squared tests to compare visits without and with advanced illness with U.S. primary care defined by National Committee for Quality Assurance Palliative and End-of-Life Care Physician Performance Measurement Set International Classification of Diseases, Ninth Revision (ICD-9) codes for end-stage illness. RESULTS: Among visits by older adults to primary care, 7.9% visits were related to advanced illness. A higher proportion of advanced illness visits was among men vs. women (8.9% vs. 7.2%; P = 0.03) and adults aged 75 years and older, non-Hispanic whites (8.3%) and blacks (8.2%) vs. Hispanic (6.7%) and non-Hispanic other (2.5%) (P = 0.02), dually eligible for Medicare and Medicaid, and from patient ZIP Codes with lower median household incomes (below $32,793). A higher percentage of visits with advanced illness conditions to primary care was chronic obstructive pulmonary disease, congestive heart failure, dementia, and cancer, and symptoms reported with these visits were mostly pain, depression, anxiety, fatigue, and insomnia. CONCLUSION: In the U.S., approximately 8% primary care visits among older adults was related to advanced illness conditions. Advanced illness visits were most common among those most likely to be socioeconomically vulnerable and highlight the need to focus efforts for high-quality palliative care for these populations.",Geriatrics;advanced illness;primary care;primary palliative care;socioeconomically vulnerable;symptoms,"Dudley, N.;Ritchie, C. S.;Wallhagen, M. I.;Covinsky, K. E.;Cooper, B. A.;Patel, K.;Stijacic Cenzer, I.;Chapman, S. A.",2017,Sep 13,,0,
1120,The continuing challenge of turning promising observational evidence about risk for dementia to evidence supporting prevention,,amyloid beta protein;biological marker;glucose;lipid;blood pressure;brain function;brain size;cardiovascular disease;cardiovascular risk;cerebrovascular accident;cognition;cognitive defect;dementia;depression;diabetic patient;disease marker;dose response;follow up;heart infarction;human;hyperlipidemia;hypertension;intensive care;intention to treat analysis;kidney disease;metabolic disorder;mortality;multiinfarct dementia;non insulin dependent diabetes mellitus;note;nuclear magnetic resonance imaging;observational study;primary prevention;priority journal;risk factor;secondary prevention,"Dufouil, C.;Brayne, C.",2014,,,0,
1121,Refractory hypoxemia due to sodium polystyrene sulfonate (Kayexalate) aspiration,,ciprofloxacin;cisatracurium;oxygen;polystyrenesulfonate sodium;adult respiratory distress syndrome;aged;antibiotic therapy;artificial ventilation;aspiration;autopsy;blood gas analysis;case report;chronic obstructive lung disease;coronary artery disease;dehydration;dementia;extracorporeal oxygenation;female;heart arrest;human;hyperkalemia;hypoxemia;laboratory test;lethargy;letter;lung auscultation;mental disease;mental health;multiple organ failure;oxygen saturation;oxygen therapy;physical examination;positive end expiratory pressure;pulse oximetry;resuscitation;shock;thorax radiography;urinary tract infection;very elderly;vital sign;weakness,"Duggal, A.;Salam, S.;Mehta, A.",2014,,,0,
1122,Oxybutynin - Kentera®: Transdermal administration,,acetylcholine;clarithromycin;enzyme inhibitor;erythromycin;itraconazole;ketoconazole;miconazole;muscarinic M3 receptor;neuroleptic agent;oxybutynin;abdominal pain;aging;application site erythema;application site pruritus;application site reaction;article;autonomic neuropathy;breast feeding;cardiovascular disease;closed angle glaucoma;constipation;dementia;diarrhea;dizziness;drug contraindication;drug hypersensitivity;drug induced headache;drug mechanism;gastrointestinal obstruction;heart failure;heart muscle conduction disturbance;human;hypertension;hyperthermia;hyperthyroidism;kidney failure;liver failure;myasthenia;nausea;pregnancy;prostate hypertrophy;somnolence;toxic megacolon;treatment indication;ulcerative colitis;urinary tract obstruction;urine incontinence;urine retention;xerostomia;kentera,"Duh, D.;Vandevijver, A.",2007,,,0,
1123,Cognitive disorders in Parkinson's disease: Confirmation of a spectrum of severity,"Introduction: Clinical presentation and progression of cognitive disorders in Parkinson's disease (PD) is heterogeneous. Our objective was to confirm prospectively a previous exploratory cluster analysis based on retrospective data that identified five cognitive phenotypes in PD. Methods: A model-based confirmatory cluster analysis was conducted on the results of neuropsychological tests administered in 156 PD patients from two European movement disorder centers (Lille, n = 81; Maastricht, n = 75). The number of clusters was determined on the basis of statistical criteria as well as clinical plausibility. A factorial discriminant analysis assessed the quality of the clusters' separation. Results: A five-cluster model was statistically superior and clinically the most relevant. These clusters can be described as follows: 1) cognitively intact patients with high level of performance in all cognitive domains (25.64%), 2) cognitively intact patients slightly slower than those in cluster 1 (26.92%), 3) patients with deficits in executive functions (37.18%), 4) patients with severe deficits in all cognitive domains, particularly executive functions (3.20%), 5) patients with severe deficits in all cognitive domains, particularly working memory and recall in verbal episodic memory (7.05%). The groups differed in terms of age, apathy and frequency of hallucinations that were all higher in the clusters with cognitive deficits, and the duration of formal education was lower in those groups. Conclusion: We confirm our previous exploratory analysis. Cognitive disorders in PD patients are heterogeneous and can be separated in five clusters ranging from patients with performance in the normal range to patients with severe disorders in all cognitive domains.",NCT01792843;antidepressant agent;benzodiazepine;dopamine receptor stimulating agent;levodopa;aged;article;cluster analysis;cognitive defect;controlled study;daily life activity;diabetes mellitus;diastolic blood pressure;discriminant analysis;disease severity;episodic memory;executive function;female;heart infarction;human;hypercholesterolemia;hypertension;major clinical study;male;medical society;Mini Mental State Examination;neuropsychological test;Parkinson disease;peripheral vascular disease;phenotype;priority journal;prospective study;risk assessment;risk factor;sleep disordered breathing;systolic blood pressure;Unified Parkinson Disease Rating Scale;verbal memory;working memory,"Dujardin, K.;Moonen, A. J. H.;Behal, H.;Defebvre, L.;Duhamel, A.;Duits, A. A.;Plomhause, L.;Tard, C.;Leentjens, A. F. G.",2015,,,0,
1124,Expected death and unwanted resuscitation in the prehospital setting,"Study objective: To determine the outcome, location, preexisting conditions, and resuscitation wishes of prehospital cardiac arrest patients. Design: Retrospective review of paramedic and emergency medical technician run reports. Setting: Urban area with a two-tiered emergency medical services response system covering an area of 2,128 square miles and serving a population of 1,413,900 (in 1988). Participants: All prehospital cardiac arrest patients to which the King County, Washington, Emergency Medical Services (KCEMS) system responded to during a 12-month period. Unless decapitation, decomposition, or dependent lividity existed, all cardiac arrest patients in the KCEMS system received full resuscitative efforts. Measurements: We analyzed run reports from 694 cardiac arrest patients, excluding all cardiac arrests from trauma, overdose, or drowning, or obvious signs of extended downtime such as decomposition or dependent lividity. We defined an unwanted resuscitation as a resuscitation attempt despite written or verbal requests by the patient, family, or private physician. We defined a patient as having severe, chronic disease if the run report listed one or more conditions associated with poor survival rates after inpatient CPR. These included cancer, cerebral vascular accident, dementia, renal failure, dialysis, AIDS, thoracic or abdominal aneurysms, cirrhosis, or if the patient was bedridden or was receiving chronic home nursing care. Main results: Overall 16% (103 of 633) of all cardiac arrest patients survived to hospital discharge. Seven percent (47 of 633) of all cardiac arrest patients fit the unwanted resuscitation definition; 2% (one of 47) survived to hospital discharge. Twenty-five percent (158 of 633) of cardiac arrest patients fit the definition of severe chronic disease; 8% (12 of 158) survived to hospital discharge. Conclusion: Severe chronic disease and unwanted resuscitation patients comprised one-third of all resuscitation attempts by KCEMS during a 12-month period. Both groups had lower survival rates compared to cardiac arrest patients who did not have severe chronic disease or indications of unwanted resuscitation.",abdominal aorta aneurysm;acquired immune deficiency syndrome;article;neoplasm;cerebrovascular accident;chronic disease;death;dementia;dialysis;emergency health service;heart arrest;hospital discharge;human;kidney failure;liver cirrhosis;living will;major clinical study;priority journal;rescue personnel;resuscitation;survival rate;thoracic aorta aneurysm,"Dull, S. M.;Graves, J. R.;Larsen, M. P.;Cummins, R. O.",1994,,,0,
1125,Clinical variability of neuroacanthocytosis syndromes - A series of six patients with long follow-up,"Objective To provide clinical clues to differential diagnosis in patients with chorea and other movement disorders with blood acanthocytes. Methods We present a long-term video accompanied follow-up of six Caucasian patients with neuroacanthocytosis from several centers, three diagnosed with chorea-acanthocytosis (ChAc): 34-y.o.(no.1), 36-y.o.(no.2), 43-y.o.(no.3), two diagnosed with McLeod Syndrome (MLS): 52-y.o.(no.4), 61-y.o.(no.5) and one 63-y.o.(no.6), a brother of no.5, with clinical suspicion of MLS. Additionally we report pathological findings of the mother of two brothers with MLS reported in our series with acanthocytes on peripheral blood smear Results The patients had an unremarkable family history and were asymptomatic until adulthood. Patients no. 1,2,4,5,6 developed generalized chorea and patient no. 3 had predominant bradykinesia. Patients no. 1,2,3 had phonic and motor tics, additionally patients no. 1 and 2 exhibited peculiar oromandibular dystonia with tongue thrusting. In patients no. 2 and 3 dystonic supination of feet was observed, patient no. 3 subsequently developed bilateral foot drop. Patients no. 2 and 4 had signs of muscle atrophy. Tendon reflexes were decreased or absent and electroneurography demonstrated sensorimotor neuropathy in patients no. 1,2,3,4,5, except no. 6. Generalized seizures were seen in patients no. 2,3,5,6 and myoclonic jerks in patient no. 1. Cognitive deterioration was reported in patients no. 1,2,3,5,6. Serum creatine kinase levels were elevated in all six patients. Conclusion We highlight the variability of clinical presentation of neuroacanthocytosis syndromes and the long time from the onset to diagnosis with the need to screen the blood smears in uncertain cases, however, as in one of our cases acanthocytes may even be not found. Based on our observations and data from the literature we propose several red flags that should raise the suspicion of an NA syndrome in a patient with a movement disorder: severe orofacial dyskinesia with tongue and lip-biting (typical of ChAc), feeding dystonia, psychiatric and cognitive disturbances, seizures, peripheral neuropathy, elevation of creatine kinase, elevation of transaminases, hepatosplenomegaly, cardiomyopathy and arrhythmias, and an X-linked pattern of inheritance (McLeod Syndrome, MLS).",alanine aminotransferase;aspartate aminotransferase;creatine kinase;gamma glutamyltransferase;adult;alanine aminotransferase blood level;article;aspartate aminotransferase blood level;blood smear;bradykinesia;brain atrophy;Caucasian;chorea-acanthocytosis;clinical article;computer assisted tomography;creatine kinase blood level;electroneurography;follow up;gamma glutamyl transferase blood level;human;male;McLeod syndrome;mental deterioration;muscle atrophy;neuroacanthocytosis;neuroimaging;nuclear magnetic resonance imaging;onset age;oromandibular dystonia;peroneus nerve paralysis;sensorimotor neuropathy;tendon reflex;tic;tonic clonic seizure,"Dulski, J.;Sołtan, W.;Schinwelski, M.;Rudzińska, M.;Wójcik-Pȩdziwiatr, M.;Wictor, L.;Schön, F.;Puschmann, A.;Klempíř, J.;Tilley, L.;Roth, J.;Tacik, P.;Fujioka, S.;Drozdowski, W.;Sitek, E. J.;Wszolek, Z.;Sławek, J.",2016,,,0,
1126,"Ethics and care for older people approaching the end of life - Symptoms, Choices and dilemmas",,anticipation;decision making;dementia;functional status;health care quality;heart failure;human;medical ethics;note;nutritional status;palliative therapy;patient safety;patient selection;prediction;symptom;terminal care;vulnerable population,"Duncan, G. W.",2014,,,0,
1127,Atrial fibrillation as a cause of death increased steeply in England between 1995 and 2010,"Aims: To report trends in mortality rates for atrial fibrillation/flutter (AF), using all the certified causes of death mentioned on death certificates (conventionally known as 'mentions') as well as the underlying cause of death, in the national population of England (1995-2010) and in a regional population with longer coverage of all-mentions mortality (1979-2010). Methods and results: Analysis of death registration data in England and in the Oxford record linkage study. In England between 1995 and 2010, AF was mentioned as a cause of death (either as an underlying cause or as a contributory cause) in 192 770 registered deaths in people aged 45 years of age and over (representing 0.254 of all registered deaths in this age group). Atrial fibrillation was given as the underlying cause of death in 21.4 of all deaths in which it was mentioned (41 298 of 192 770). In England, age-standardized death rates for mentions of AF increased almost three-fold between 1995 and 2010, from 202.5 deaths per million (1995) to 554.1 deaths per million (2010), with an average annual percentage change of 6.6 (95 confidence interval: 6.3, 7.0). Mortality rates for AF did not increase substantially until the mid-1990s: rates in Oxford were 145.4 deaths per million in 1979, 178.1 in 1995, and 505.1 in 2010. Conclusion: Atrial fibrillation has become much more common as a certified cause of death. The reasons for this are likely to be multifactorial, with changes in demographics, lifestyle, advances in therapeutics, and altered perception of the importance of the condition by certifying doctors all likely to be contributing factors. All rights reserved. © The Author 2013.",adult;aged;article;cause of death;cerebrovascular accident;death certificate;demography;disease association;female;atrial fibrillation;heart failure;heart infarction;human;lifestyle modification;major clinical study;male;mortality;perception;pneumonia;population;priority journal;senility;United Kingdom,"Duncan, M. E.;Pitcher, A.;Goldacre, M. J.",2014,,,0,
1128,Care in the Last Year of Life for Community Patients with Heart Failure,"Background-Healthcare utilization peaks at the end of life (EOL) in patients with heart failure. However, it is unclear what factors affect end of life utilization in patients with heart failure and if utilization has changed over time. Methods and Results-Southeastern Minnesota residents with heart failure were prospectively enrolled into a longitudinal cohort study from 2003 to 2011. Patients who died before December 31, 2012, were included in the analysis. Information on hospitalizations and outpatient visits in the last year of life was obtained using administrative sources. Negative binomial regression was used to assess the association between patient characteristics and utilization. The 698 decedents (47.3% men; 53.4% preserved ejection fraction) experienced 1528 hospitalizations (median 2 per person; range, 0-12; 37.6% because of cardiovascular causes) and 12 927 outpatient visits (median 14 per person; range, 0-119) in their last year of life. Most patients (81.5%) were hospitalized at least once and 28.4% died in the hospital. Patients who were older and those with dementia had lower utilization. Patients who were married, resided in a skilled nursing facility, and had more comorbidities had higher utilization. Patients with preserved ejection fraction had higher rates of noncardiovascular hospitalizations although other utilization was similar. Over time, rates of hospitalizations and outpatient visits decreased, whereas palliative care consults and enrollment in hospice increased. Conclusions-Although patient factors remain associated with differential healthcare utilization at the end of life, utilization declined over time and use of palliative care services increased. These results are encouraging given the high resource use in patients with heart failure.",aged;article;cardiovascular mortality;Charlson Comorbidity Index;chronic obstructive lung disease;cohort analysis;comorbidity;dementia;female;health care utilization;heart arrhythmia;heart ejection fraction;heart failure;hospice;hospice care;hospitalization;human;incidence;male;mortality;outpatient;palliative therapy;peripheral vascular disease;pneumonia;priority journal;sepsis;terminal care;very elderly,"Dunlay, S. M.;Redfield, M. M.;Jiang, R.;Weston, S. A.;Roger, V. L.",2015,,,0,
1129,Amyloidosis: Localization and consequences,"The symptoms of amyloidosis depend on the type of precursor, the amount of deposits and their location. In systemic amyloidosis almost every organ may be involved. Cardiac involvement is severe, especially in AL amyloidosis, responsible for restrictive cardiomyopathy with right ventricular failure, leading rapidly to death. Renal amyloid-deposition causes nephrotic syndrome with hypertension and renal failure. Neurological complications include peripheral neuropathy with dysautonomia cerebral involvement (dementia, cerebral haemorrhages). Arterial deposits are common in systemic senile amyloidosis, and map cause ischaemia. Osteo-articular damage is mainly seen in patients on long-term haemodialysis. Liver enlargement is often the only manifestation of hepatic amyloidosis. Digestive tract involvement includes macroglossia deposits in salivary glands and disturbances in gastrointestinal motility. Pulmonary amyloidosis causes nodular or interstitial infiltrates. Cutaneous lesions are various. Localized amyloidoses include goiter, breast and vesical involvement which can be difficult to differentiate from neoplasm, as well as ocular amyloidosis mimicking posterior uveitis.",amyloidosis;dysautonomia;gastrointestinal motility;heart right ventricle failure;hemodialysis;hepatomegaly;human;hypertension;kidney failure;neurological complication;peripheral neuropathy;restrictive cardiomyopathy;salivary gland;short survey;symptom,"Dupond, J. L.;Gil, H.",1997,,,0,
1130,Prevalence of diabetes mellitus in geriatric patients in nursing homes of Cadiz. Diagerca study,"OBJECTIVE: To determine prevalence and clinical characteristics of elderly diabetic patients in nursing homes. MATERIAL AND METHOD: Observational and multicentre study in 14 nursing homes in Cadiz (Spain). STUDY VARIABLES: age, sex, prevalence of diabetes, duration of diabetes, complications, macrovascular complications, retinopathy, nephropathy, and neuropathy. Metabolic control: frequency of baseline blood glucose and HbA1c determinations. Metabolic complications suffered. TREATMENT: oral and type of antidiabetics, insulinisation. Diabetes education. Functional and mental assessment using Barthel index and MMT. Data was analysed using SPSS v17.0. RESULTS: A total of 1952 elderly institutionalised patients were studied, with a diabetes prevalence of 26.44%. The study included 312 patients with a mean age of 79.7 years, of whom 57.4% were women, and 66.9% knew of their diagnosis of diabetes for over 10 years. Vascular events were suffered by 55.1%, with the most common being ischaemic stroke (55.2%), followed by myocardial infarction (18%) and 14.5% with peripheral arterial disease. There were 29.6% with retinopathy, 21.3% diabetic nephropathy, and 25.6% suffering from distal symmetric polyneuropathy. HbA1c analysis was performed in 90.1% of patients, with 50% levels between 7 and 9%, with a six-monthly assessment rate of 63.4%. Metabolic complications: diabetic ketoacidosis 7.1%, hyperosmolar syndrome 2.9%, and 15.7% symptomatic hypoglycaemia. Oral hypoglycaemic agents were being taken by 66% of patients, with the most frequently used being metformin (55.3%) followed by gliclazide and repaglinide (10.2%, 3.4%, respectively). 50.2% were insulinised. 45.6% functional dependence. Barthel Index average of 48.4 points, with 46.1% diagnosed with dementia, moderate state, 36.7%. CONCLUSIONS: Diabetic prevalence in nursing homes is high, and institutionalised patients are elderly, long-standing diabetics, with both macro- and microvascular complications, and have a significant level of mental and functional disabilities.",Aged;Diabetes Complications/epidemiology;Diabetes Mellitus/*epidemiology;Female;Homes for the Aged;Humans;Male;Nursing Homes;Prevalence;Spain,"Duran Alonso, J. C.",2012,May-Jun,10.1016/j.regg.2011.11.003,0,
1131,"Colistin and rifampicin compared with colistin alone for the treatment of serious infections due to extensively drug-resistant Acinetobacter baumannii: A multicenter, randomized clinical trial","Background. Extensively drug-resistant (XDR) Acinetobacter baumannii may cause serious infections in critically ill patients. Colistin often remains the only therapeutic option. Addition of rifampicin to colistin may be synergistic in vitro. In this study, we assessed whether the combination of colistin and rifampicin reduced the mortality of XDR A. baumannii infections compared to colistin alone. Methods. This multicenter, parallel, randomized, open-label clinical trial enrolled 210 patients with life-threatening infections due to XDR A. baumannii from intensive care units of 5 tertiary care hospitals. Patients were randomly allocated (1:1) to either colistin alone, 2 MU every 8 hours intravenously, or colistin (as above), plus rifampicin 600 mg every 12 hours intravenously. The primary end point was overall 30-day mortality. Secondary end points were infection-related death, microbiologic eradication, and hospitalization length. Results. Death within 30 days from randomization occurred in 90 (43%) subjects, without difference between treatment arms (P = .95). This was confirmed by multivariable analysis (odds ratio, 0.88 [95% confidence interval, .46-1.69], P = .71). A significant increase of microbiologic eradication rate was observed in the colistin plus rifampicin arm (P = .034). No difference was observed for infection-related death and length of hospitalization. Conclusions. In serious XDR A. baumannii infections, 30-day mortality is not reduced by addition of rifampicin to colistin. These results indicate that, at present, rifampicin should not be routinely combined with colistin in clinical practice. The increased rate of A. baumannii eradication with combination treatment could still imply a clinical benefit. © The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.",NCT01577862;colimicina;colistin;meropenem;rifampicin;tigecycline;unclassified drug;abdominal infection;Acinetobacter infection;adult;age;aged;antibiotic therapy;article;bloodstream infection;cause of death;cerebrovascular disease;chronic kidney disease;chronic obstructive lung disease;combination chemotherapy;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;drug dose reduction;drug fatality;drug safety;drug withdrawal;female;hospital acquired pneumonia;hospital admission;human;hyperbilirubinemia;intensive care unit;ischemic heart disease;kidney disease;kidney failure;kidney function;length of stay;liver dysfunction;major clinical study;male;minimum inhibitory concentration;mixed infection;monotherapy;mortality;multicenter study;neurotoxicity;obesity;open study;parallel design;priority journal;Pseudomonas infection;randomized controlled trial;renal replacement therapy;sex;side effect;Simplified Acute Physiology Score;Staphylococcus infection;treatment outcome;treatment withdrawal;ventilator associated pneumonia,"Durante-Mangoni, E.;Signoriello, G.;Andini, R.;Mattei, A.;De Cristoforo, M.;Murino, P.;Bassetti, M.;Malacarne, P.;Petrosillo, N.;Galdieri, N.;Mocavero, P.;Corcione, A.;Viscoli, C.;Zarrilli, R.;Gallo, C.;Utili, R.",2013,,,0,
1132,Clinical pathologic correlations of Lyme disease,"The multisystem effects caused by Borrelia burgdorferi in Lyme disease are multiple, varied, and unpredictable. In some patients, the full extent of the infection consists of a stage I acute systemic viral-like illness. Stage II primarily involves the cardiovascular system (myocarditis) and/or the central nervous system (CNS) (meningoencephalitis, polyradiculitis). More inflammatory cells are found in the heart and nervous system structures during this intermediate stage than are found in any tissues involved during stage I. Stage III is characterized by peripheral neuropathy and CNS disorders such as dementia or transverse myelitis and arthritis and synovitis of large joints such as the knee. Chronic Lyme disease is also associated with multiple and seemingly unrelated cutaneous manifestations such as acrodermatitis chronica atrophicans, sclerodermoid-like reactions, lichen sclerosus et atrophicus, subcuticular fibrous nodules, eosinophilic fasciitis-like lesions of the extremities, and, possibly, granuloma annulare. With care, spirochetes can be recovered or demonstrated by silver staining in most of the above lesions. Spirochetes have yet to be seen in the tissues of autonomic ganglia or peripheral nerves.","Acute Disease;Animals;Arthritis, Infectious/pathology;Central Nervous System Diseases/pathology;Chronic Disease;Erythema Chronicum Migrans/pathology;Female;Humans;Lyme Disease/*pathology;Muscles/pathology;Myocarditis/pathology;Myocardium/pathology;Myositis/pathology;Nervous System/pathology;Retrospective Studies;Skin/pathology;Synovial Membrane/pathology;Ticks","Duray, P. H.",1989,Sep-Oct,,0,
1133,Effects of antihypertensive therapy on cognitive decline in Alzheimer's disease,"BACKGROUND: Therapeutic trials concerning the effect of antihypertensive therapy on cognition have produced controversial findings. Our objective was to evaluate the impact of antihypertensive therapy on the cognitive function in subjects already diagnosed with Alzheimer's disease (AD). METHODS: We conducted an observational study in a memory clinic assessing outpatients suffering from AD. A total of 321 patients were included. Cognitive function was assessed yearly by the Mini-Mental State Examination (MMSE; score/30). RESULTS: The mean age of patients was 78.1 +/- 6 years, 54% of them received antihypertensive therapy and the mean MMSE scores were similar in both groups (patients taking antihypertensive therapy and patient without antihypertensive therapy). The mean follow-up was 34.1 +/- 6 months. MMSE means were significantly higher among patients using antihypertensive therapy compared to those without antihypertensive therapy (MMSE scores = 21.9 +/- 4.9 vs. 21.2 +/- 5.1 at 1 year (P = 0.001); 20.8 +/- 5.5 vs. 19.4 +/- 5.7 at 2 years (P < 0.001); 19.0 +/- 6.7 vs. 17.5 +/- 6.4 at 3 years (P < 0.001)), after adjustment for age, gender, education level, systolic blood pressure (SBP), and diastolic blood pressure (DBP) at baseline, MMSE at baseline, coronary heart disease, statins, and antiplatelet agents' consumption. Furthermore, the use of antihypertensive therapy was associated with a lower estimated risk of cognitive decline (as defined by a decrease of at least one point in MMSE score over time) (hazard ratio = 0.61; 95% confidence interval = 0.45-0.81) after adjustment for the same factors. CONCLUSIONS: These results suggest an association between antihypertensive therapy, a lower decrease in mean MMSE and a lower cognitive decline over time in AD.","Aged;Aged, 80 and over;Alzheimer Disease/complications/*drug therapy;Antihypertensive Agents/*therapeutic use;Cognition/*drug effects;Cognition Disorders/complications/drug therapy;Female;Humans;Male;Neuropsychological Tests","Duron, E.;Rigaud, A. S.;Dubail, D.;Mehrabian, S.;Latour, F.;Seux, M. L.;Hanon, O.",2009,Sep,10.1038/ajh.2009.119,0,
1134,"Relationships between personality traits, medial temporal lobe atrophy and white matter lesion in subjects suffering from mild cognitive impairment","Mild Cognitive Impairment (MCI) is a heterogeneous cognitive status that can be a prodromal stage of Alzheimer's disease (AD). It is particularly relevant to focus on prodromal stages of AD such as MCI, because pathophysiological abnormalities of AD start years before the dementia stage. Medial temporal lobe atrophy (MTL) resulting from AD lesions and cerebrovascular lesions (i.e. white matter lesions (WML), lacunar strokes and strokes) are often revealed concurrently on Magnetic Resonance Imaging (MRI) in MCI subjects. Personality changes have been reported to be associated with MCI status and early AD. More specifically, an increase in neuroticism and a decrease in conscientiousness have been reported, suggesting that higher and lower scores, respectively in neuroticism and conscientiousness are associated with an increased risk of developing the disease. However, personality changes have not been studied concomitantly with pathological structural brain alterations detected on MRI in patients suffering from MCI. Therefore, the objective of the present study was to assess the relationship between MTL atrophy, WML, lacunar strokes and personality traits in such patients. The severity of WML was strongly associated with lower levels of conscientiousness and higher levels of neuroticism. Conversely, no association was detected between personality traits and the presence of lacunar strokes or MTL atrophy. Altogether, these results strongly suggest that personality changes occurring in a MCI population, at high risk of AD, are associated with WML, which can induce executive dysfunctions, rather than with MTL atrophy. © 2014 Duron, Vidal, Bounatiro, Ben_ahmed, Seux, Rigaud, Hanon, Viollet, Epelbaum and Martel.",cholesterol;aged;alcohol consumption;Alzheimer disease;article;Big Five Inventory;brain atrophy;cardiovascular risk;cholesterol blood level;cognition;comparative study;conscience;controlled study;diabetes mellitus;disease association;disease severity;educational status;extraversion;female;atrial fibrillation;heart failure;high risk population;human;hypercholesterolemia;hypertension;internal consistency;ischemic heart disease;lacunar stroke;Likert scale;major clinical study;male;medial temporal lobe atrophy;migraine;mild cognitive impairment;Mini Mental State Examination;assessment of humans;neuroimaging;neurosis;nuclear magnetic resonance imaging;personality;personality disorder;smoking;temporal lobe;white matter lesion,"Duron, E.;Vidal, J. S.;Bounatiro, S.;Ahmed, S. B.;Seux, M. L.;Rigaud, A. S.;Hanon, O.;Viollet, C.;Epelbaum, J.;Martel, G.",2014,,,0,
1135,Risk factors for mortality in major digestive surgery in the elderly: A multicenter prospective study,"Objective: To identify the mortality risk factors of elderly patients (≥65 years old) during major digestive surgery, as defined according to the complexity of the operation. Background: In the aging populations of developed countries, the incidence rate of major digestive surgery is currently on the rise and is associated with a high mortality rate. Consequently, validated indicators must be developed to improve elderly patients' surgical care and outcomes. Methods: We acquired data from a multicenter prospective cohort that included 3322 consecutive patients undergoing major digestive surgery across 47 different facilities. We assessed 27 pre-, intra-, and postoperative demographic and clinical variables. A multivariate analysis was used to identify the independent risk factors of mortality in elderly patients (n = 1796). Young patients were used as a control group, and the end-point was defined as 30-day postoperative mortality. Results: In the entire cohort, postoperative mortality increased significantly among patients aged 65-74 years, and an age ≥65 years was by itself an independent risk factor for mortality (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.36-3.59; P = 0.001). The mortality rate among elderly patients was 10.6%. Six independent risk factors of mortality were characteristic of the elderly patients: age ≥85 years (OR, 2.62; 95% CI, 1.08-6.31; P = 0.032), emergency (OR, 3.42; 95% CI, 1.67-6.99; P = 0.001), anemia (OR, 1.80; 95% CI, 1.02-3.17; P = 0.041), white cell count > 10,000/mm (OR, 1.90; 95% CI, 1.08-3.35; P = 0.024), ASA class IV (OR, 9.86; 95% CI, 1.77-54.7; P = 0.009) and a palliative cancer operation (OR, 4.03; 95% CI, 1.99-8.19; P < 0.001). Conclusion: Characterization of independent validated risk indicators for mortality in elderly patients undergoing major digestive surgery is essential and may lead to an efficient specific workup, which constitutes a necessary step to developing a dedicated score for elderly patients. Copyright © 2011 by Lippincott Williams & Wilkins.",abdominal surgery;abscess;aged;anastomosis leakage;anemia;article;bleeding;blood transfusion;body mass;cancer palliative therapy;cancer surgery;cardiomyopathy;chronic obstructive lung disease;clinical assessment;congestive heart failure;controlled study;dementia;diabetes mellitus;disease classification;emergency care;female;geriatric patient;heart arrhythmia;heart infarction;hematoma;human;hypertension;incisional hernia;kidney failure;laparoscopy;leukocyte count;liver cirrhosis;major clinical study;male;mortality;multivariate analysis;operation duration;Parkinson disease;peritonitis;postoperative complication;priority journal;prospective study;risk assessment;cerebrovascular accident,"Duron, J. J.;Duron, E.;Dugue, T.;Pujol, J.;Muscari, F.;Collet, D.;Pessaux, P.;Hay, J. M.",2011,,,0,
1136,Undiagnosed medical comorbidities in the uninsured: A significant predictor of mortality following trauma,"BACKGROUND: Lack of health care insurance has been correlated with increased mortality after trauma. Medical comorbidities significantly affect trauma outcomes. Access to health care and thereby being diagnosed with a pretrauma comorbidity is highly dependent on insurance status. The objective of this study was to determine whether rates of diagnosed or undiagnosed preexisting comorbidities significantly contribute to disparities in mortality rates observed between insured and uninsured trauma patients. METHODS: Review of trauma patients admitted to a Level I trauma center during a 5-year period. Data extracted from the registry included age, sex, Injury Severity Score (ISS), comorbidities, mortality, and insurance status. Multivariate logistic regression analysis was performed using age, sex, and insurance status to predict comorbidities and age, sex, ISS, and insurance status to predict mortality. RESULTS: Insured patients were older (54 years vs. 38, p < 0.001) and more likely female (41.3% vs. 22.5%, p < 0.001). When adjusting for age and sex, insured patients were more likely to have a pretrauma diagnosis of coronary artery disease (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.54-2.83), diabetes mellitus (OR, 2.09; 95% CI, 1.61-2.72), hypertension (OR, 1.97; 95% CI, 1.65-2.35), asthma/emphysema (OR, 1.64; 95% CI, 1.32-2.04), neurologic problems (OR, 1.79; 95% CI, 1.31-2.44), and gastroesophageal reflux disease (OR, 2.03; 95% CI, 1.33-3.11), compared with patients without insurance. In the analysis to predict mortality, having insurance was protective (OR, 0.57; 95% CI, 0.45-0.71). Among patients with no diagnosed comorbidities, insured patients had the lowest mortality risk (OR, 0.5; 95% CI, 0.38-0.67). When analyzing only patients with diagnosed comorbidities, insurance status had no impact on mortality risk (OR, 0.81; 95% CI, 0.53-1.22). CONCLUSION: Undiagnosed preexisting comorbidities play a crucial role in determining outcomes following trauma. Diagnosis of medical comorbidities may be a marker of access to health care and may be associated with treatment, which may explain the gap in mortality rates between insured and uninsured trauma patients. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III. © 2012 Lippincott Williams & Wilkins.",adult;alcohol abuse;Alzheimer disease;arthritis;article;asthma;cerebrovascular accident;chronic obstructive lung disease;comorbidity;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;drug abuse;emphysema;female;gastroesophageal reflux;health care;health insurance;heart infarction;heart surgery;human;hypertension;injury;insulin dependent diabetes mellitus;male;medicaid;medicare;mental disease;mortality;non insulin dependent diabetes mellitus;osteoarthritis;outcome assessment;Parkinson disease;peptic ulcer;priority journal;retrospective study;rheumatoid arthritis;scoring system;seizure;stomach function disorder,"Duron, V. P.;Monaghan, S. F.;Connolly, M. D.;Gregg, S. C.;Stephen, A. H.;Adams, C. A.;Cioffi, W. G.;Heffernan, D. S.",2012,,,0,
1137,Does better disease management in primary care reduce hospital costs? Evidence from English primary care,"We apply cross-sectional and panel data methods to a database of 5 million patients in 8000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions. © 2011 Elsevier B.V.",adolescent;adult;aftercare;aged;ambulatory care;article;asthma;child;chronic disease;chronic kidney disease;chronic obstructive lung disease;cost control;dementia;diabetes mellitus;disease management;female;general practice;health care cost;hospital cost;hospital running cost;human;hypertension;hypothyroidism;infant;ischemic heart disease;male;mental health;morbidity;outpatient department;preschool child;primary medical care;school child;cerebrovascular accident,"Dusheiko, M.;Gravelle, H.;Martin, S.;Rice, N.;Smith, P. C.",2011,,,0,
1138,The pathologic anatomy of Alzheimer's disease,,Adenofibroma/complications;Aged;Aortic Diseases/complications;Arteriosclerosis/complications;Brain/*pathology;Breast Neoplasms/complications;Cerebral Cortex/pathology;Coronary Disease/complications;Dementia/complications/*pathology;Diabetes Complications;Erectile Dysfunction/complications;Female;Graves Disease/complications;Humans;Hydrocephalus/etiology;Hypertension/complications;Intracranial Arteriosclerosis/complications;Leiomyoma/complications;Male;Menstruation Disturbances/complications;Middle Aged;Myocardial Infarction/complications;Myxedema/complications;Neurofibrils;Organ Size;Ovarian Cysts/complications;Seizures/complications;Uterine Neoplasms/complications,"Dusheiko, S. D.",1973,,,0,
1139,Injury severity and comorbidities alone do not predict futility of care after geriatric trauma,"Background: When counseling surrogates of massively injured elderly trauma patients, the prognostic information they desire is rarely evidence based. Objective: We sought to objectively predict futility of care in the massively injured elderly trauma patient using easily available parameters: age, Injury Severity Score (ISS), and preinjury comorbidities. Methods: Two cohorts (70-79 years and ≥80 years) were constructed from The National Trauma Data Bank (NTDB) for years 2007-2011. Comorbidities were tabulated for each patient. Mortality rates at every ISS score were tabulated for subjects with 0, 1, or ≥2 comorbidities. Futility was defined a priori as an in-hospital mortality rate of ≥95% in a cell with ≥5 subjects. Results: A total of 570,442 subjects were identified (age 70-79 years, n=217,384; age ≥80 years, n=352,608). Overall mortality was 5.3% for ages 70-79 and 6.6% for ≥80 years. No individual ISS score was found to have a mortality rate of ≥95% for any number of comorbidities in either age cohort. The highest mortality rate seen in any cell was for an ISS of 66 in the ≥80 year-old cohort with no listed comorbidities (93.3%). When upper extremes of ISS were aggregated into deciles, mortality for both cohorts across all number of comorbidities was 45.5%-60.9% for ISS 40-49, 56.6%-81.4% for ISS 50-59, and 73.9%-93.3% for ISS ≥60. Conclusions: ISS and preinjury comorbidities alone cannot be used to predict futility in massively injured elderly trauma patients. Future attempts to predict futility in these age groups may benefit from incorporating measures of physiologic distress.",steroid;age;aged;alcoholism;angina pectoris;article;ascites;bleeding disorder;cerebrovascular accident;chronic kidney failure;comorbidity;congestive heart failure;dementia;diabetes mellitus;disseminated cancer;drug abuse;drug dependence;esophagus varices;geriatric care;health status;heart arrest;heart infarction;human;injury scale;injury severity;liver cirrhosis;major clinical study;mental disease;mortality;multiple trauma;obesity;peripheral vascular disease;respiratory tract disease;treatment outcome;very elderly,"Duvall, D. B.;Zhu, X.;Elliott, A. C.;Wolf, S. E.;Rhodes, R. L.;Paulk, M. E.;Phelan, H. A.",2015,,,0,
1140,Apolipoprotein E polymorphism and stroke in a population from Eastern Turkey,"Human apolipoprotein E (apo E) alleles are polymorphic with significantly different frequencies among different ethnic groups and have been associated with increased risk of coronary heart disease, and postulated as a major genetic susceptibility locus for Alzheimer's disease. Studies undertaken in different populations have shown different association patterns between apo E genotype and stroke. The aim of this study was to determine the risk of apo E genotype in stroke patients living in the eastern part of Turkey. The apo E genotypes and allele frequencies of 229 individuals from the same geographic area were determined by polymerase chain reaction and restriction fragment length polymorphism, of which 103 were patients with a documented history of stroke without other apparent dementia and 126 age-matched healthy subjects as a control group. A reduced E3/4 genotype frequency was found in subjects with stroke and the E2/3 genotype frequency was elevated in patients with previous stroke. There was no association between apo E ε4 allele and stroke. The APOE alleles had divergent effects in this population. Association between APOE (the gene) alleles and stroke in this population may be altered due to interaction with other genetic effects. The effects of APOE alleles and genotypes require further study in different populations.",apolipoprotein E;apolipoprotein E2;apolipoprotein E4;DNA;adult;aged;Alzheimer disease;article;cardiovascular disease;cerebrovascular accident;controlled study;dementia;diabetes mellitus;DNA polymorphism;female;gene frequency;genetic susceptibility;genotype;geographic distribution;human;ischemic heart disease;major clinical study;male;polymerase chain reaction;priority journal;restriction fragment length polymorphism;Turkey (republic),"Duzenli, S.;Pirim, I.;Gepdiremen, A.;Deniz, O.",2004,,,0,
1141,Getting services right for those sick enough to die,,acquired immune deficiency syndrome;chronic disease;dementia;emphysema;health care delivery;health care need;health care planning;health care system;health program;health service;heart failure;human;kidney failure;liver cirrhosis;medical practice;patient care;patient right;priority journal;short survey;cerebrovascular accident;sudden death,"Dy, S.;Lynn, J.",2007,,,0,
1142,Concise Review: Fat and Furious: Harnessing the Full Potential of Adipose-Derived Stromal Vascular Fraction,"Due to their capacity to self-renew, proliferate and generate multi-lineage cells, adult-derived stem cells offer great potential for use in regenerative therapies to stop and/or reverse degenerative diseases such as diabetes, heart failure, Alzheimer's disease and others. However, these subsets of cells can be isolated from different niches, each with differing potential for therapeutic applications. The stromal vascular fraction (SVF), a stem cell enriched and adipose-derived cell population, has garnered interest as a therapeutic in regenerative medicine due to its ability to secrete paracrine factors that accelerate endogenous repair, ease of accessibility and lack of identified major adverse effects. Thus, one can easily understand the rush to employ adipose-derived SVF to treat human disease. Perhaps faster than any other cell preparation, SVF is making its way to clinics worldwide, while critical preclinical research needed to establish SVF safety, efficacy and optimal, standardized clinical procedures are underway. Here, we will provide an overview of the current knowledge driving this phenomenon, its regulatory issues and existing studies, and propose potential unmapped applications. Stem Cells Translational Medicine 2017;6:1096-1108.",Adipose;Adult stem cells;Autologous stem cell transplantation;Cellular therapy;Clinical trials;Mesenchymal stem cells,"Dykstra, J. A.;Facile, T.;Patrick, R. J.;Francis, K. R.;Milanovich, S.;Weimer, J. M.;Kota, D. J.",2017,Apr,,0,
1143,Changes in vitamin E prescribing for Alzheimer patients,"OBJECTIVE: At the end of 2006, a survey was sent to members of the American Association of Geriatric Psychiatry (AAGP) to assess possible changes in prescribing Vitamin E to patients with Alzheimer disease that followed two published reports in early 2005 suggesting increased mortality and an increased incidence of heart failure with Vitamin E supplements. METHOD: A three-item questionnaire was mailed to all AAGP members who had prescription privileges to assess changes in prescribing Vitamin E after January, 2005. RESULTS: A total of 572 completed surveys were returned for a response rate of 35%. Nearly 60% of respondents reported a change over the 2 years that followed the 2005 reports. The greatest change was in the group not prescribing Vitamin E, which increased from 6.6% before 2005 to 60.6% afterward. CONCLUSIONS: AAGP members significantly reduced prescribing Vitamin E to patients with Alzheimer disease after 2005. The two reports are discussed with an emphasis on their methodological limitations and the potential for additional information on Vitamin E side effects from ongoing research.",Aged;Alzheimer Disease/*drug therapy/mortality;Cognition Disorders/drug therapy/mortality;Data Collection;Geriatric Psychiatry/*trends;Guideline Adherence/*trends;Heart Failure/chemically induced/mortality;Hospitalization/trends;Humans;Incidence;Survival Rate;United States;Vitamin E/*adverse effects/*therapeutic use,"Dysken, M. W.;Kirk, L. N.;Kuskowski, M.",2009,Jul,10.1097/JGP.0b013e3181a31fcf,0,
1144,Effect of vitamin E and memantine on functional decline in Alzheimer disease: The TEAM-AD VA cooperative randomized trial,"IMPORTANCE: Although vitamin E and memantine have been shown to have beneficial effects in moderately severe Alzheimer disease (AD), evidence is limited in mild to moderate AD. OBJECTIVE: To determine if vitamin E (alpha tocopherol), memantine, or both slow progression of mild to moderate AD in patients taking an acetylcholinesterase inhibitor. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, placebo-controlled, parallel-group, randomized clinical trial involving 613 patients with mild to moderate AD initiated in August 2007 and concluded in September 2012 at 14 Veterans Affairs medical centers. INTERVENTIONS: Participants received either 2000 IU/d of alpha tocopherol (n = 152), 20 mg/d of memantine (n = 155), the combination (n = 154), or placebo (n = 152). MAIN OUTCOMES AND MEASURES: Alzheimer's Disease Cooperative Study/Activities of Daily Living (ADCS-ADL) Inventory score (range, 0-78). Secondary outcomes included cognitive, neuropsychiatric, functional, and caregiver measures. RESULTS: Over the mean (SD) follow-up of 2.27 (1.22) years, participants receiving alpha tocopherol had slower decline than those receiving placebo as measured by the ADCS-ADL. The change translates into a delay in clinical progression of 19% per year compared with placebo (approximately 6.2 months over the follow-up period). Caregiver time increased least in the alpha tocopherol group. All-cause mortality and safety analyses showed a difference only on the serious adverse event of ""infections or infestations"" with greater frequencies in the memantine (31 events in 23 participants) and combination groups (44 events in 31 participants) compared with placebo (13 events in 11 participants). (Table Presented) CONCLUSIONS AND RELEVANCE: Among patients with mild to moderate AD, 2000 IU/d of alpha tocopherol compared with placebo resulted in slower functional decline. There were no significant differences in the groups receiving memantine alone or memantine plus alpha tocopherol. These findings suggest benefit of alpha tocopherol in mild to moderate AD by slowing functional decline and decreasing caregiver burden. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00235716 Copyright 2014 American Medical Association. All rights reserved.",NCT00235716;alpha tocopherol;apolipoprotein E;cholinesterase inhibitor;donepezil;galantamine;memantine;placebo;rivastigmine;adult;aged;Alzheimer disease;article;bleeding;caregiver burden;cause of death;Charlson Comorbidity Index;cognition;comorbidity;controlled study;daily life activity;disease course;double blind procedure;drug dose reduction;drug dose titration;drug efficacy;drug safety;drug withdrawal;faintness;female;gene frequency;genotype;heart failure;human;infection;infestation;major clinical study;male;mortality;outcome assessment;patient compliance;pneumonia;priority journal;randomized controlled trial;urinary tract infection;very elderly;namenda,"Dysken, M. W.;Sano, M.;Asthana, S.;Vertrees, J. E.;Pallaki, M.;Llorente, M.;Love, S.;Schellenberg, G. D.;McCarten, J. R.;Malphurs, J.;Prieto, S.;Chen, P.;Loreck, D. J.;Trapp, G.;Bakshi, R. S.;Mintzer, J. E.;Heidebrink, J. L.;Vidal-Cardona, A.;Arroyo, L. M.;Cruz, A. R.;Zachariah, S.;Kowall, N. W.;Chopra, M. P.;Craft, S.;Thielke, S.;Turvey, C. L.;Woodman, C.;Monnell, K. A.;Gordon, K.;Tomaska, J.;Segal, Y.;Peduzzi, P. N.;Guarino, P. D.",2014,,,0,
1145,Carcinoid syndrome,,5 hydroxyindoleacetic acid;angiotensin;chromogranin A;epinephrine;everolimus;noradrenalin;ondansetron;remifentanil;somatostatin;telotristat;tryptophan hydroxylase;vasopressin;abdominal pain;article;blood pressure;bronchospasm;capsule endoscopy;carcinoid;carcinoid syndrome;computer assisted tomography;dementia;dermatitis;electron microscopy;flushing;heart failure;human;hypovolemia;liver metabolism;nausea;nuclear magnetic resonance imaging;pellagra;positron emission tomography;vomiting,"Eagar, M. A.",2017,,10.1080/22201181.2017.1287835,0,
1146,Variation of blunt traumatic injury with age in older adults: Statewide analysis 2011-14,"Introduction: Traumatic injury is a leading cause of death and disability in adults ≥ 65 years old, but there are few epidemiological studies addressing this issue. The aim of this study was to assess how characteristics of blunt traumatic injuries in adults ≥ 65 vary by age. Methods: Using data from the a single-state trauma registry, this retrospective cohort study examined injured patients ≥ 65 admitted to all Level I and Level II trauma centers in Pennsylvania between 2011 and 2014 (n=38,562). Patients were stratified by age into three subgroups (age 65-74; 75-84; ≥85). We compared demographics, injury, and system-level across groups. Results: We found significant increases in the proportion of female gender, (48.6% vs. 58.7% vs. 67.7%), white race (89.1% vs. 92.6% vs. 94.6%), and non-Hispanic ethnicity (97.5% vs. 98.6% vs. 99.4%) across advancing age across age groups, respectively. As age increased, the proportion of falls (69.9% vs. 82.1% vs. 90.3%), in-hospital mortality (4.6% vs. 6.2% vs. 6.8%), and proportion of patients arriving to the hospital via ambulance also increased (73.6% vs. 75.8% vs. 81.1%), while median injury severity plateaued (9.0% all groups) and the proportion of Level I trauma alerts (10.6% vs. 8.2% vs. 6.7%) decreased. We found no trend between age and patient transfer status. The five most common diagnoses were vertebral fracture, rib fracture, head contusion, open head wound, and intracranial hemorrhage, with vertebral fracture and head contusion increasing with age, and rib fracture decreasing with age. Conclusion: In a large cohort of older adults with trauma (n= 38,000), we found, with advancing age, a decrease in trauma alert level, despite an increase in mortality and a decrease in demographic diversity. This descriptive study provides a framework for future research on the relationship between age and blunt traumatic injury in older adults.",anticoagulant agent;aged;arthritis;article;Asian;Black person;blunt trauma;brain hemorrhage;Caucasian;cerebrovascular disease;cohort analysis;congestive heart failure;contusion;coronary artery disease;dementia;demography;female;human;hypertension;injury scale;injury severity;major clinical study;male;mental disease;patient transport;Pennsylvania;retrospective study;rib fracture;spinal cord injury;spine fracture;thyroid disease;traumatic brain injury,"Earl-Royal, E.;Shofer, F.;Ruggieri, D.;Frasso, R.;Holena, D.",2016,,10.5811/westjem.2016.9.31003,0,
1147,Preventive guidelines,,cancer patient;dementia;diabetes mellitus;emergency ward;general practitioner;heart failure;home care;hospital care;hospital readmission;letter;osteoporosis;patient counseling;physician;practice guideline;professional practice;prostate cancer;society;symptom;terminal disease,"Eaton, B.",2008,,,0,
1148,Survival after in-hospital cardiopulmonary resuscitation: A meta- analysis,"OBJECTIVE: To determine the rates of immediate survival and survival to discharge for adult patients undergoing in-hospital cardiopulmonary resuscitation, and to identify demographic and clinical variables associated with these outcomes. MEASUREMENTS AND MAIN RESULTS: The MEDLARS database of the National Library of Medicine was searched. In addition, the authors' extensive personal files and the bibliography of each identified study were searched for further studies. Two sets of inclusion criteria were used, minimal (any study of adults undergoing in-hospital cardiopulmonary resuscitation) and strict (included only patients from general ward and intensive care units, and adequately defined cardiopulmonary arrest and resuscitation). Each study was independently reviewed and abstracted in a nonblinded fashion by two reviewers. The data abstracted were compared, and any discrepancies were resolved by consensus discussion. For the subset of studies meeting the strict criteria, the overall rate of immediate survival was 40.7% and the rate of survival to discharge was 13.4%. The following variables were associated with failure to survive to discharge: sepsis on the day prior to resuscitation (odds ratio [OR] 31.3; 95% confidence interval [CI] 1.9, 515), metastatic cancer (OR 3.9; 95% CI 1.2, 12.6), dementia (OR 3.1; 95% CI 1.1, 8.8), African-American race (OR 2.8; 95% CI 1.4, 5.6), serum creatinine level at a cutpoint of 1.5 mg/dL (OR 2.2; 95% CI 1.2, 3.8), cancer (OR 1.9; 95% CI 1.2, 3.0), coronary artery disease (OR 0.55; 95% CI 0.4, 0.8), and location of resuscitation in the intensive care unit (OR 0.51; 950/0 CI 0.4, 0.8). CONCLUSIONS: When talking with patients, physicians can describe the overall likelihood of surviving discharge as I in 8 for patients who undergo cardiopulmonary resuscitation and 1 in 3 for patients who survive cardiopulmonary resuscitation.",creatinine;adult;aged;article;neoplasm;coronary artery disease;dementia;hospital admission;hospital discharge;human;intensive care unit;meta analysis;metastasis;Black person;resuscitation;sepsis;survival,"Ebell, M. H.;Becker, L. A.;Barry, H. C.;Hagen, M.",1998,,,0,
1149,Sleepiness or Excessive Daytime Somnolence,"Excessive daytime somnolence (EDS) is associated with age-related changes, environment, circadian rhythm or sleep pattern disorder, insomnia, medications, lifestyle factors, depression, pain, and illness. The notion of ""sleep architecture"" connotes a structure that describes the sleep cycle (i.e., stages) and wakefulness during a single sleep period-that is, rapid eye movement (REM) and non-REM sleep. Circadian rhythms perform a variety of functions including regulation of the quality and distribution of the stages of sleep. Insomnia includes delayed sleep onset as well as premature wakening; sleep is nonrestorative. Comorbidities associated with insomnia are Alzheimer's disease and other dementias, delirium, depression, congestive heart failure, chronic obstructive pulmonary disease, gastroesophageal reflux disease, pain, degenerative diseases of the neurological system, and sleep apnea. Continuous inadequate sleep affects cognitive function, physical performance, overall well-being, and quality of life. There is a greater risk of falls from insomnia than is the use of hypnotics to manage it. Sleep disruption among older adults is underrecognized and undertreated. Assessment using valid tools can be performed rapidly. There are a variety of treatment options, including sleep hygiene and pharmacological and alternative modalities. © 2009 Mosby, Inc. All rights reserved.",article;circadian rhythm;fatigue;human;pathophysiology;REM sleep;restless legs syndrome;sleep;sleep disordered breathing,"EdD, E. M.;Flores, S.",2009,,,0,
1150,The future of nuclear medicine,,"Alzheimer Disease/radionuclide imaging;Brain Diseases/radionuclide imaging;Cardiomyopathies/radionuclide imaging;Coronary Disease/radionuclide imaging;Forecasting;Humans;Nuclear Medicine/*trends;*Tomography, Emission-Computed, Single-Photon","Edell, S. L.",1990,Jun,,0,
1151,"Multimorbidity among people with HIV in regional New South Wales, Australia","Background Multimorbidity is the co-occurrence of more than one chronic health condition in addition to HIV. Higher multimorbidity increases mortality, complexity of care and healthcare costs while decreasing quality of life. The prevalence of and factors associated with multimorbidity among HIV positive patients attending a regional sexual health service are described. Methods: A record review of all HIV positive patients attending the service between 1 July 2011 and 30 June 2012 was conducted. Two medical officers reviewed records for chronic health conditions and to rate multimorbidity using the Cumulative Illness Rating Scale (CIRS). Univariate and multivariate linear regression analyses were used to determine factors associated with a higher CIRS score. Results: One hundred and eighty-nine individuals were included in the study; the mean age was 51.8 years and 92.6% were men. One-quarter (25.4%) had ever been diagnosed with AIDS. Multimorbidity was extremely common, with 54.5% of individuals having two or more chronic health conditions in addition to HIV; the most common being a mental health diagnosis, followed by vascular disease. In multivariate analysis, older age, having ever been diagnosed with AIDS and being on an antiretroviral regimen other than two nucleosides and a non-nucleoside reverse transcriptase inhibitor or protease inhibitor were associated with a higher CIRS score. Conclusion: To the best of our knowledge, this is the first study looking at associations with multimorbidity in the Australian setting. Care models for HIV positive patients should include assessing and managing multimorbidity, particularly in older people and those that have ever been diagnosed with AIDS.Journal compilation",Human immunodeficiency virus proteinase inhibitor;nonnucleoside reverse transcriptase inhibitor;raltegravir;RNA directed DNA polymerase inhibitor;acquired immune deficiency syndrome;adult;alcoholism;article;assessment of humans;Australia;CD4 lymphocyte count;cerebrovascular accident;Cumulative Illness Rating Scale;diabetes mellitus;drug dependence;female;heart infarction;hepatitis B;hepatitis C;HIV associated dementia;human;Human immunodeficiency virus infected patient;Human immunodeficiency virus infection;hypertension;kidney disease;major clinical study;male;medical record review;mental disease;middle aged;morbidity;obesity;osteoporosis;prevalence;sexual health,"Edmiston, N.;Passmore, E.;Smith, D. J.;Petoumenos, K.",2015,,,0,
1152,"Statins, neuromuscular degenerative disease and an amyotrophic lateral sclerosis-like syndrome: An analysis of individual case safety reports from vigibase","Background: The WHO Foundation Collaborating Centre for International Drug Monitoring (Uppsala Monitoring Centre [UMC]) has received many individual case safety reports (ICSRs) associating HMG-CoA reductase inhibitor drug (statin) use with the occurrence of muscle damage, including rhabdomyolysis, and also peripheral neuropathy. A new signal has now appeared of disproportionally high reporting of upper motor neurone lesions. Aim and Scope: The aim of this paper is to present the upper motor neurone lesion cases, with other evidence, as a signal of a relationship between statins and an amyotrophic lateral sclerosis (ALS)-like syndrome. The paper also presents some arguments for considering that a spectrum of severe neuromuscular damage may be associated with statin use, albeit rarely. The paper does not do more than raise the signal for further work and analysis of what must be regarded as a potentially very serious and perhaps avoidable or reversible adverse reaction, though it also suggests action to be taken if an ALS-like syndrome should occur in a patient using statins. Methods: The 43 reports accounting for the disproportional reports in Vigibase (the database of the WHO Programme for International Drug Monitoring) are summarised and analysed for the diagnosis of an ALS-like syndrome. The issues of data quality and potential reporting bias are considered. Results: 'Upper motor neurone lesion' is a rare adverse event reported in relationship to drugs in Vigibase (a database containing nearly 4 million ICSRs). Of the total of 172 ICSRs on this reported term, 43 were related to statins, of which 40 were considered further: all but one case was reported as ALS. In 34/40 reports a statin was the sole reported suspected drug. The diagnostic criteria were variable, and seven of the statin cases also had features of peripheral neuropathy. Of a total of 5534 ICSRs of peripheral neuropathy related to any drug in Vigibase, 547 were on statins. The disproportional reporting of statins and upper motor neurone lesion persisted after age stratification, and such disproportionality was not seen for statins and Parkinson's disease, Alzheimer's disease, extrapyramidal disorders, or multiple sclerosis-like syndromes. Discussion: Because the cases were sometimes atypical we propose the use of the term 'ALS-like syndrome' and speculate whether this is part of a spectrum of rare neuromuscular damage. The diagnosis of ALS is often problematic, and the insidiousness and chronicity of the disease make causality with a drug difficult to assess. The disproportionally high reporting makes this an important signal nevertheless, since ALS is serious clinically and statins are so widely used. Wide use of the statins also makes a chance finding more probable, but is unlikely to cause disproportional reporting when there are no obvious biases identified. Conclusion: We emphasise the rarity of this possible association, and also the need for further study to establish whether a causal relationship exists. We do advocate that trial discontinuation of a statin should be considered in patients with serious neuromuscular disease such as the ALS-like syndrome, given the poor prognosis and a possibility that progression of the disease may be halted or even reversed. © 2007 Adis Data Information BV. All rights reserved.",atorvastatin;cerivastatin;doxycycline;fenofibrate;gemfibrozil;losartan;mevinolin;nicotinic acid;rosuvastatin;simvastatin;sotalol;warfarin;adult;aged;amyotrophic lateral sclerosis;anemia;anxiety;arthropathy;article;asthenia;backache;balance impairment;blister;bursitis;cachexia;cervical myelopathy;chronic bronchitis;clinical article;clinical feature;confusion;contact dermatitis;coordination disorder;coughing;degenerative disease;demyelination;diabetes mellitus;disease association;drug fatality;drug safety;dry skin;dysarthria;dyskinesia;dysphagia;electromyogram;erectile dysfunction;falling;fatigue;female;gait disorder;heart infarction;heel spur;human;hyperreflexia;hypesthesia;inflammation;insomnia;joint stiffness;leg pain;limb pain;liver atrophy;Lyme disease;lymphadenopathy;male;mouth disease;muscle atrophy;muscle cramp;muscle spasm;muscle weakness;myalgia;myopathy;myositis;nerve root compression;neuromuscular disease;neuropathy;osteoarthritis;pain;paraneoplastic syndrome;paresthesia;penis disease;peripheral neuropathy;peroneus nerve paralysis;priority journal;prostate hypertrophy;quadriplegia;respiratory tract disease;rhabdomyolysis;rheumatic polymyalgia;self care;side effect;speech disorder;spondylosis;tension;thorax pain;throat irritation;thrombosis;tongue disease;tongue edema;toxic myopathy;vertebral canal stenosis;walking difficulty;weight,"Edwards, I. R.;Star, K.;Kiuru, A.",2007,,,0,
1153,Efficacy and safety of galantamine in patients with dementia with Lewy bodies: A 24-week open-label study,"Background: Dementia with Lewy bodies (DLB) is a common dementia of the elderly. A significant cholinergic deficit has been demonstrated that may be responsive to treatment by cholinesterase inhibitors (ChEIs). Methods: A 24-week, open-label study was designed to assess the efficacy and safety of a ChEI, galantamine, in 50 patients with DLB. Results: This study showed beneficial effects with galantamine in 2 of the 3 primary efficacy parameters. The scores on the Neuropsychiatric Inventory (NPI-12) improved by 8.24 points from baseline (p = 0.01) especially in visual hallucinations and nighttime behaviors (p = 0.004). The scores on the Clinician's Global Impression of Change improved by 0.5 points from baseline (p = 0.01). The third primary efficacy parameter, the Cognitive Drug Research Computerized Cognitive Assessment System, was unchanged from baseline. Adverse events were generally mild and transient. Conclusion: Galantamine appears to be an effective and safe therapy for patients with DLB. Copyright © 2007 S. Karger AG.",galantamine;adult;adverse outcome;aged;agitation;anorexia;article;clinical article;clinical trial;dementia;disease severity;dose response;drug dose reduction;drug effect;drug efficacy;drug research;drug safety;drug withdrawal;electrocardiogram;fatigue;female;heart infarction;human;laboratory test;Lewy body;male;motor dysfunction;multicenter study;nausea;neuropsychiatry;open study;physical examination;priority journal;side effect;somnolence;statistical analysis;visual hallucination;vital sign;vomiting,"Edwards, K.;Royall, D.;Hershey, L.;Lichter, D.;Hake, A.;Farlow, M.;Pasquier, F.;Johnson, S.",2007,,,0,
1154,Efficacy and safety of galantamine in patients with dementia with Lewy bodies: A 12-week interim analysis,"Observations on the neurochemistry of dementia with Lewy bodies (DLB) have suggested that cholinesterase inhibitors (ChEIs) might be beneficial in treating some clinical symptoms of DLB. A 24-week, multicenter open-label study was designed to assess the safety and efficacy of the ChEI galantamine in patients with DLB, and an interim analysis of results was performed at 12 weeks. Efficacy analyses were performed on data from 25 patients. Scores on the Neuropsychiatric Inventory (NPI-12) improved (decreased) by 7.52 points over the 12 weeks (marginally significant, p = 0.061). NPI-12 scores decreased by half in 12 of the 25 patients. Highly significant improvement was observed in scores on the NPI-4 subscale (delusions, hallucinations, apathy, and depression: p = 0.003). Scores on the Clinician's Global Impression of Change (CGIC) improved by 0.95 points (significant, p = 0.02). Improvements also were found in secondary efficacy variables, including cognitive, functional, activities of daily living, sleep and confusion assessments. Motor scores, as measured by the UPDRS motor subscale, showed mild improvement, which demonstrates that galantamine has no adverse effect on parkinsonian symptoms. Adverse events generally were transient and of mild-to-moderate intensity. Two of the 25 patients discontinued galantamine because of nausea and anorexia. One serious adverse event was recorded, but it was judged to be unrelated to the study medication. Copyright © 2004 S. Karger AG, Basel.",cholinesterase inhibitor;galantamine;adult;aged;anorexia;apathy;article;attention deficit disorder;auditory hallucination;clinical article;clinical trial;cognition;confusion;controlled clinical trial;controlled study;daily life activity;delusion;dementia;depression;diarrhea;drug efficacy;drug safety;dyspepsia;fatigue;female;gastrointestinal disease;hallucination;heart infarction;human;Lewy body;male;Mini Mental State Examination;motor performance;multicenter study;nausea;neuropsychological test;outcomes research;parkinsonism;polydipsia;priority journal;scoring system;side effect;sleep disorder;sleep pattern;somnolence;statistical significance;tremor;vertigo;visual hallucination,"Edwards, K. R.;Hershey, L.;Wray, L.;Bednarczyk, E. M.;Lichter, D.;Farlow, M.;Johnson, S.",2004,,,0,
1155,Plasmapheresis as a steroid saving procedure in bullous pemphigoid,"Background: Bullous pemphigoid is an immunobullous disease affecting predominantly older patients. In severe cases, high-dose corticosteroids and/or other immunosuppressants are often needed long term to control the disease. These can be associated with serious side-effects in this patient population. Objective: To evaluate the benefit of plasmapheresis as a steroid saving agent in a cohort of 10 patients. Results: Plasmapheresis was effective as a steroid saving therapy. All patients went into remission with a lower daily dosage of oral prednisone at 3 and 6 months postplasmapheresis. Two patients had side-effects from therapy that, while significant, did not interfere with long-term improvement in their disease. Eight patients had circulating immunoglobulin G (IgG) antibodies reactive with bullous pemphigoid antigen 1, and three of these had circulating antibodies reactive with bullous pemphigoid antigen 2 on Western immunoblot. Conclusions: Plasmapheresis was an effective steroid sparing therapy in these patients. Due to its high cost and potential morbidity, plasmapheresis should not be recommended as routine therapy for bullous pemphigoid, but it is a useful adjunct in resistant cases.",azathioprine;corticosterone;cyclophosphamide;methylprednisolone sodium succinate;prednisone;triamcinolone;adjuvant therapy;adult;aged;article;clinical article;congestive heart failure;dementia;dose response;health care cost;human;hypertension;insulin dependent diabetes mellitus;non insulin dependent diabetes mellitus;pemphigoid;plasmapheresis;pneumothorax;prognosis;septicemia;Staphylococcus;Staphylococcus infection;steroid therapy,"Egan, C. A.;Meadows, K. P.;Zone, J. J.",2000,,,0,
1156,Myocardial ischemia in a patient treated with donepezil,,donepezil;aged;Alzheimer disease;case report;clinical examination;drug safety;electrocardiogram;female;heart muscle ischemia;human;letter,"Egido, A.;Sena, F.;Lechuga, I.;Gutierrez, L.",2000,,,0,
1157,Increased prevalence of cardiovascular disease in idiopathic normal pressure hydrocephalus patients compared to a population-based cohort from the HUNT3 survey,"BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is one of few types of dementia that can be treated with shunt surgery and cerebrospinal fluid (CSF) diversion. It is frequently present with cerebral vasculopathy; however, how the prevalence of cardiovascular disease compares between iNPH patients and the general population has not yet been established. Therefore, a case-control study was performed to examine whether the prevalence of cardiovascular disease (arterial hypertension, angina pectoris, cardiac infarction, and diabetes) was different in 440 iNPH patients, when compared to 43,387 participants of the Nord-Trondelag Health 3 Survey (The HUNT3 Survey), which was considered as the general control population. FINDINGS: In iNPH patients aged 35-70 years, we found increased prevalence for arterial hypertension (males), angina pectoris (females and males), and cardiac infarction (males), as compared with the HUNT3 control group with significant odds ratio estimates. In addition, the prevalence of diabetes was increased in both age groups 35-70 years (males) and 70-90 years (females and males). CONCLUSIONS: The data show significantly increased prevalence of cardiovascular disease iNPH patients, which provide evidence that cardiovascular disease is involved as an exposure in the development of iNPH.",Angina pectoris;Arterial hypertension;Cardiac infarction;Cardiovascular disease;Diabetes;General population;Idiopathic normal pressure hydrocephalus;The HUNT3 Survey,"Eide, P. K.;Pripp, A. H.",2014,,10.1186/2045-8118-11-19,0,
1158,Trajectories of the Framingham general cardiovascular risk profile in midlife and poor motor function later in life: the Whitehall II study,"BACKGROUND: Vascular risk factors are associated with increased risk of cognitive impairment and dementia, but their association with motor function, another key feature of aging, has received little research attention. We examined the association between trajectories of the Framingham general cardiovascular disease risk score (FRS) over midlife and motor function later in life. METHODS: A total of 5376 participants of the Whitehall II cohort study (29% women) who had up to four repeat measures of FRS between 1991-1993 (mean age=48.6 years) and 2007-2009 (mean age=65.4 years) and without history of stroke or coronary heart disease in 2007-2009 were included. Motor function was assessed in 2007-2009 through objective tests (walking speed, chair rises, balance, finger tapping, grip strength). We used age- and sex-adjusted linear mixed models. RESULTS: Participants with poorer performances for walking speed, chair rises, and balance in 2007-2009 had higher FRS concurrently and also in 1991-1993, on average 16 years earlier. These associations were robust to adjustment for cognition, socio-economic status, height, and BMI, and not explained by incident mobility limitation prior to motor assessment. No association was found with finger tapping and grip strength. CONCLUSIONS: Cardiovascular risk early in midlife is associated with poor motor performances later in life. Vascular risk factors play an important and under-recognized role in motor function, independently of their impact on cognition, and suggest that better control of vascular risk factors in midlife may prevent physical impairment and disability in the elderly.",Adult;Age Distribution;Aged;*Aging;Cardiovascular Diseases/*epidemiology/prevention & control;Cognition Disorders/epidemiology/prevention & control;Coronary Disease/epidemiology/prevention & control;*Disability Evaluation;Female;Fingers;Hand Strength;Humans;Male;Middle Aged;*Mobility Limitation;*Motor Skills;Myocardial Infarction/epidemiology/prevention & control;Psychomotor Performance;Risk Factors;Stroke/epidemiology/prevention & control;Aging;Cardiovascular risk score;Cohort study;Motor function;Stroke,"Elbaz, A.;Shipley, M. J.;Nabi, H.;Brunner, E. J.;Kivimaki, M.;Singh-Manoux, A.",2014,Mar 1,10.1016/j.ijcard.2013.12.051,0,
1159,Causes of death and predictors of survival after aortic valve replacement in low flow vs. normal flowsevere aortic stenosiswith preserved ejection fraction,"Aims Reduced stroke volume index (SVI) in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) is associated with adverse outcomes even after aortic valve replacement (AVR), although specific reasons for impaired survival in this group are unknown.We investigated predictors of post-AVR survival and specific cause of death in patients with AS according to SVI. Methods and results Among 1120 consecutive patients with severe AS (aortic valve area <1.0 cm2) and preserved EF (≥50%) using 2-D and Doppler echocardiography who hadAVR, 61 (5%) patients had reduced SVI [≥35 mL/m2 (lowflow, LF)] and 1059 (95%) had normal SVI [≥35 mL/m2 (normal flow, NF)]. Survival post-AVR was lower in patients with LF compared with NF [3-year survival in LF group 76% (95% CI 70.82) vs. 89% (95% CI 88.90%), P = 0.03] primarily due to higher cardiac mortality [3-year event rate 13% (95% CI 8.18%) in LF vs. 5%(95% CI 5.7%) inNF, P = 0.02].Congestive heart failure (CHF) was the most common cause of cardiac death in the LF group (57% of post-AVR cardiac deaths) andwas a more frequent cause of death in LF compared with NF (3-year risk 7 vs. 2%, P = 0.008). Multivariable predictors of post-AVR mortality included age, creatinine, haemoglobin, right ventricular systolic pressure, SVI, and cognitive impairment. Conclusion Reduced SVI is associated with higher cardiac mortality afterAVR.CHFis the predominant cause of cardiac mortality after AVR in patients with LF, suggesting the presence of persistent myocardial impairment in this population.",creatinine;hemoglobin;age;aged;aorta stenosis;aorta valve replacement;article;cause of death;cerebrovascular accident;chronic lung disease;cognitive defect;congestive heart failure;controlled study;creatinine blood level;dementia;Doppler echocardiography;female;follow up;heart death;heart ejection fraction;heart right ventricle pressure;heart stroke volume;hemoglobin blood level;human;infection;injury;lung embolism;major clinical study;male;malignant neoplastic disease;post treatment survival;priority journal;stroke volume index;survival prediction;systolic blood pressure,"Eleid, M. F.;Michelena, H. I.;Nkomo, V. T.;Nishimura, R. A.;Malouf, J. F.;Scott, C. G.;Pellikka, P. A.",2015,,,0,
1160,The Women's Health Initiative trial (WHI) in the right perspective,,conjugated estrogen plus medroxyprogesterone acetate;age;Alzheimer disease;breast cancer;cancer risk;cardiovascular disease;cardiovascular risk;climacterium;clinical practice;clinical trial;colon cancer;drug withdrawal;health;hormone substitution;human;hypercholesterolemia;hypertension;hysterectomy;ischemic heart disease;letter;menopausal syndrome;obesity;patient compliance;postmenopause osteoporosis,"Elhelw, B.",2003,,,0,
1161,Outcomes After Stroke: Risk of Recurrent Ischemic Stroke and Other Events,"Stroke is a common and debilitating disease, and much is known about the incidence and risk factors for first stroke. Much less is known, however, about outcomes after stroke. The epidemiology of outcomes after stroke has been relatively less studied for several reasons, including the traditional study of populations in which rates of cardiac disease are higher than those of stroke, the heterogeneity of stroke, and the absence until recently of effective therapies. The importance of recurrent stroke, cardiac events, dementia, depression, and other vascular and nonvascular events will increase as the population ages and as more patients survive a first stroke. This article discusses the relative importance of recurrent stroke and other events after initial ischemic stroke or transient ischemic attack, and proven and potential risk factors for recurrent stroke. Based on growing evidence regarding the high rates of cardiovascular events after stroke, and the efficacy of statin therapy in reducing the risk of stroke as well as cardiac disease, it may be time to consider expanding the ""coronary risk equivalent"" category to include patients with stroke. Patients who have had a stroke are likely at high enough risk for subsequent events to warrant the same aggressive treatment, including statins and antihypertensive drugs, as would be given to patients with other forms of cardiovascular disease. Future clinical trials will better define the optimal management of patients after stroke. © 2009 Elsevier Inc. All rights reserved.",antihypertensive agent;enoxaparin;heparin;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;perindopril;antihypertensive therapy;article;cardiovascular risk;cerebrovascular accident;deep vein thrombosis;dementia;depression;heart infarction;human;hypercholesterolemia;hypertension;mortality;outcome assessment;practice guideline;priority journal;recurrence risk;recurrent disease;risk reduction;secondary prevention,"Elkind, M. S. V.",2009,,,0,
1162,"Analytical, practical and regulatory issues in prevention studies","Prevention studies, as distinguished from studies investigating treatments for established disease, present some distinct challenges. Perhaps the most extensive experience with preventive agents is in the area of infectious diseases; vaccines have been extremely effective in preventing many such diseases. Vaccines have been, and continue to be, studied in other disease areas such as certain cancers, but as yet have not achieved success outside of infectious disease prevention. One obvious and important feature of prevention studies is that they enrol healthy individuals; thus such studies require particularly high standards for the safety of those enrolled (and those who might ultimately receive the product being tested). Prevention studies often need to be quite large, as the types of diseases most important to prevent tend to be uncommon. Large studies usually require simplified approaches; to ensure high quality of data on the key variables it may be necessary to compromise on the amount of data collected, frequency of data collection, and other aspects of trial design. The reliability of randomization and blinding may be especially important in these large studies, as bias could easily overwhelm the small effects that are usually sought. Often, biomarkers thought to indicate developing but as yet subclinical disease, will be important to evaluate; whether such markers can serve as primary endpoints in prevention studies has been a contentious issue in many contexts. Studies in older populations, such as those at risk for Alzheimer's Disease, raise challenges such as accounting for competing risks, and considering potential interactions of preventive agents with multiple medications often used by the elderly. Published in 2004 by John Wiley & Sons, Ltd.",acetylsalicylic acid;bacterial vaccine;beta carotene;biological marker;cancer vaccine;diphtheria pertussis tetanus vaccine;poliomyelitis vaccine;retinol;smallpox vaccine;virus vaccine;Alzheimer disease;article;bacterial infection;clinical study;clinical trial;controlled clinical trial;controlled study;data analysis;diphtheria;drug safety;drug surveillance program;elderly care;frequency analysis;health status;heart infarction;high risk patient;human;infection prevention;information processing;malignant neoplastic disease;methodology;outcomes research;pertussis;poliomyelitis;preventive medicine;quality control;randomized controlled trial;reliability;risk assessment;safety;sample size;smallpox;statistical analysis;tetanus;treatment outcome;uterine cervix cancer;virus infection;Wart virus;aspirin,"Ellenberg, S. S.",2004,,,0,
1163,Group discussion,,anti human immunodeficiency virus agent;antidepressant agent;antihistaminic agent;cyclosporin;fluorouracil;fluoxetine;levamisole;methotrexate;steroid;Alzheimer disease;article;Bayes theorem;clinical research;clinical trial;colon cancer;congestive heart failure;data analysis;depression;drug approval;drug efficacy;drug industry;drug information;drug research;drug safety;drug withdrawal;effect size;financial management;human;institutional review;maximum likelihood method;methodology;off label drug use;patient selection;professional standard;randomization;research ethics;sample size;sequential analysis;statistical analysis;statistical parameters;statistical significance;systematic error;treatment response;prozac,"Ellenberg, S. S.",2006,,,0,
1164,Introduction to Symposium,,high density lipoprotein cholesterol;alcohol abuse;alcohol consumption;alcoholic beverage;alcoholism;article;blood clotting;cardiovascular disease;cardiovascular risk;congestive heart failure;coronary artery disease;correlation analysis;dementia;diabetes mellitus;disease association;fibrinolysis;glucose metabolism;health hazard;heart ventricle function;human;inflammation;ischemic heart disease;lipid oxidation;metabolic syndrome X;mortality;priority journal;risk assessment;social aspect;cerebrovascular accident,"Ellison, R. C.",2007,,,0,
1165,The Impact of Cholecystectomy after Endoscopic Sphincterotomy for Complicated Gallstone Disease,"Objectives:Cholecystectomy after endoscopic sphincterotomy (ES) is associated with improved outcomes compared to ES alone, however randomized trials have included mainly fit surgical candidates. Our objective was to assess the impact of cholecystectomy after ES among elderly patients, in whom the perceived risks of surgery may be increased and the prevailing bias may be to defer cholecystectomy.Methods:We performed adjusted analyses comparing clinical outcomes in patients ≥65 years of age who did and did not undergo follow-up cholecystectomy after endoscopic sphincterotomy for choledocholithiasis, ascending cholangitis, or gallstone pancreatitis. We also compared adverse events between the two groups.Results:In the ES alone group, 39.3% of patients experienced a recurrent complication compared with 18.0% in the ES and cholecystectomy group. After adjusting for comorbidities using multivariable regression, cholecystectomy in addition to ES was associated with a reduced risk of recurrent choledocholithiasis (OR 0.38, 95%CI 0.34-0.42, P<0.001), ascending cholangitis (OR 0.28, 95%CI 0.23-0.34, P<0.001), and gallstone pancreatitis (OR 0.35, 95%CI 0.24-0.49, P<0.001) compared to ES alone. This benefit was preserved after propensity score adjustment, in patients ≥75 years of age, and in those with major comorbidities including cancer, heart failure, and liver disease. Serious post-operative complications such as myocardial infarction, pulmonary embolism, and pneumonia were not more common in the cholecystectomy group.Conclusions:Among older patients, including those with serious comorbidities, cholecystectomy after endoscopic sphincterotomy was associated with a significant and clinically important reduction in recurrent complications compared to sphincterotomy alone. This benefit did not appear to be outweighed by surgical complications, highlighting the importance of cholecystectomy, even in elderly patients whose lifespans may be limited by unrelated conditions.",acquired immune deficiency syndrome;aged;article;cerebrovascular disease;cholangitis;cholecystectomy;cholecystitis;clinical outcome;cohort analysis;common bile duct stone;comorbidity;congestive heart failure;controlled study;deep vein thrombosis;dementia;diabetes mellitus;endoscopic sphincterotomy;female;gallstone;gastrointestinal symptom;heart infarction;hematoma;hemiplegia;human;liver disease;lung embolism;major clinical study;male;malignant neoplasm;metastasis;pancreatitis;paraplegia;peptic ulcer;peripheral vascular disease;pneumonia;postoperative complication;postoperative ileus;postoperative thrombosis;priority journal;retrospective study;seroma;surgical infection;surgical risk;urinary tract infection;very elderly,"Elmunzer, B. J.;Noureldin, M.;Morgan, K. A.;Adams, D. B.;Coté, G. A.;Waljee, A. K.",2017,,10.1038/ajg.2017.247,0,
1166,Physical activity guidelines for older adults,"Few older adults in the United States achieve the minimum recommended amount of physical activity. Lack of physical activity contributes to many chronic diseases that occur in older adults, including heart disease, stroke, diabetes mellitus, lung disease, Alzheimer disease, hypertension, and cancer. Lack of physical activity, combined with poor dietary habits, has also contributed to increased obesity in older persons. Regular exercise and increased aerobic fitness are associated with a decrease in all-cause mortality and morbidity, and are proven to reduce disease and disability, and improve quality of life in older persons. In 2008, The U.S. Department of Health and Human Services released guidelines to provide information and guidance on the amount of physical activity recommended to maintain health and fitness. For substantial health benefits, the guidelines recommend that most older adults participate in at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination of each per week. Older adults should also engage in strengthening activities that involve all major muscle groups at least two days a week. Those at risk of falling should add exercises that help maintain or improve balance. Generally healthy adults without chronic health conditions do not need to consult with a physician before starting an exercise regimen.",Aged;Coronary Disease/*prevention & control;Exercise/*physiology;*Health Promotion;Humans;Patient Education as Topic;Practice Guidelines as Topic,"Elsawy, B.;Higgins, K. E.",2010,Jan 1,,0,
1167,Quality of prescribing in belgian nursing homes: An electronic assessment of the medication chart,"Objectives: To develop a computerized assessment tool for monitoring the quality of prescribing in Belgian nursing homes. Design: In a observational cross-sectional study of the medication charts of nursing home residents, potentially inappropriate medication (PIM) was investigated using three scoring systems for the elderly (Beers, ACOVE, BEDNURS) complemented with a list of drug-drug interactions. Setting: A representative stratified sample of Belgian nursing homes (n = 76). Participants: A random sample of nursing home residents with a complete data set (n = 1730) excluding palliative care patients. Main Outcome Measure: A combination of PIM scores to assess inappropriate, under- and overprescribing. Results: Included residents had a mean age of 85, 78% were female. They used a mean of 7.1 chronic medications. Most PIMs were detected by the application of the ACOVE criteria for underprescribing with 58% of patients having at least one PIM. Using the BEDNURS and the Beers criteria, at least one PIM was noticed in 56 and 27% of patients, respectively. Patients' characteristics showing a positive relationship with the PIM score were age, female gender, amount of clinical and nursing care problems, number of prescriptions and the use of psychotropic drugs (multiple regression analysis R2 = 0.332). Conclusions: In Belgian nursing homes, the observed high level of drug utilization was associated with potentially inappropriate prescribing. The development of a combined assessment tool and the implementation of a computerized monitoring system of PIMs is highly recommended to improve the quality of prescribing. © The Author 2013. Published by Oxford University Press in association with the International Society for Quality in Health Care; All rights reserved.",amiodarone;digoxin;oxybutynin;adult;aged;article;automation;Belgium;computerized assessment tool;constipation;cross-sectional study;dementia;depression;drug use;drug utilization;fall risk;female;health care quality;heart failure;heart infarction;human;hypertension;inappropriate prescribing;insomnia;major clinical study;male;middle aged;nursing home;nursing home patient;osteoporosis;prescription;prevalence;priority journal;scoring system;very elderly,"Elseviers, M. M.;Vander stichele, R. R.;Van bortel, L.",2014,,,0,
1168,Audiologic findings in a family with mitochondrial disorder,"Mitochondrial disorder is an inborn error of metabolism affecting the cellular respiratory chain. Defective energy production leads to a wide variety of clinical manifestations (ataxia, epilepsy, dementia, myopathy, polyneuropathy, retinal pigment anomalies, and cardiomyopathy with conduction anomalies). Hearing loss is a regular feature and is often the first clinical symptom. Audiologic data from 26 members of a family in three generations is presented. One of these patients was examined for the biochemical error. Respiratory study of muscle biopsy revealed a mild defect in the NADH-ubiquinone oxidoreductase step of the oxidative phosphorylation (complex I). The content of cytochrome aa3 (complex IV) was also reduced. Adult onset sensorineural hearing loss starting in the high frequency region progresses with a fairly constant speed in this family. A cochlear type of hearing loss is found in the less pronounced cases. Advanced cases present features of retrocochlear affection with decreasing speech recognition, elevated acoustic reflex thresholds, and increased ABR latency with derangement of potentials. Caloric sensitivity was unaffected.","Adolescent;Adult;Aged;Audiometry, Pure-Tone;Child;Evoked Potentials, Auditory, Brain Stem;Hearing Loss, Sensorineural/*etiology/genetics/physiopathology;Humans;Metabolism, Inborn Errors/*complications/genetics/physiopathology;Middle Aged;Mitochondria/metabolism;Pedigree;Reflex, Acoustic;Speech Perception","Elverland, H. H.;Torbergsen, T.",1991,Nov,,0,
1169,"Aspirin: past, present and future","Many folk remedies used since pre-historic times have depended upon salicylates for their effect. One hundred years ago aspirin was formulated from salicylic and acetic acids. It was the first drug to be synthesised and its formulation is regarded as the foundation of the modern pharmaceutical industry. The benefit of low-dose aspirin as a prophylactic after a thrombotic event was first reported 25 years ago. Its use after coronary or cerebral thrombosis is virtually mandatory, unless there are signs of intolerance. A 'loading dose' of soluble aspirin should be given on first contact with a patient who may be suffering from myocardial infarction. Patients considered to be at increased risk of a vascular event should also be advised to carry their own aspirin and, if they experience sudden severe chest pain, to chew and swallow a 300 mg tablet or a soluble preparation immediately. The current phase of the aspirin story is, however, not over, and its possible value in a variety of conditions, including dementia and certain cancers, seems likely to ensure that it will long continue to play a remarkable part in clinical practice.","Anti-Inflammatory Agents, Non-Steroidal/*history/therapeutic use;Aspirin/*history/therapeutic use;Cost-Benefit Analysis;Female;History, 19th Century;History, 20th Century;Humans;Male;Preventive Medicine","Elwood, P. C.",2001,Mar-Apr,,0,
1170,"Reducing the risk: Heart disease, stroke and aspirin","Aspirin used in cardiovascular disease is probably the best evaluated and the most highly cost effective prophylactic available in clinical practice today. It has been evaluated in over 150 randomised controlled trials and a small daily dose of around 100 mg has been shown to reduce the risk of myocardial infarction and stroke by about 30 per cent. The saving of lives and prevention of vascular events in patients judged to be at increased risk of a vascular event for any reason is large. In healthy subjects, however, the risk of a vascular event is so low that prophylaxis by any drug is inappropriate. The earlier aspirin is given in the acute phase of a myocardial infarction the greater the saving of lives. Patients judged to be at increased risk of a vascular event, for any reason, should therefore be advised to carry aspirin and to chew and swallow one or two tablets immediately, if they experience sudden severe chest pain. Aspirin is derived from a salicylate, and salicylates are widely distributed in nature, with many functions in plants. Its use in cardiovascular disease derives from an effect on blood platelets, but other possible effects have led to suggestions that it may be of benefit in conditions other than heart disease and stroke. Current research is now focussing on the possible reduction by aspirin in the risk of dementia, certain cancers, retarded foetal growth and cataract.",acetylsalicylic acid;article;cardiovascular risk;cataract;dementia;heart disease;heart infarction;human;intrauterine growth retardation;prophylaxis;risk management;cerebrovascular accident;thorax pain,"Elwood, P. C.",2001,,,0,
1171,"Platelets, aspirin, and cardiovascular disease","Aspirin was first synthesised 100 years ago and its preparation and marketing is generally reckoned to have been the foundation of the pharmaceutical industry. For most of the time since then it has been used for the relief of pain and fever. The modern phase of aspirin use commenced with the reporting in 1974 of a randomised controlled trial in the secondary prevention of death by low-dose aspirin given to patients who had suffered a myocardial infarct. Reports of other trials followed and an overview of the first six trials was presented to the inaugural meeting of the Society for Clinical Trials in Philadelphia in 1980. There have been two further major overviews and the most recent, based on 145 trials, established that low-dose aspirin reduces vascular events by around one third. It has been estimated that, used appropriately, aspirin could prevent 100,000 premature deaths each year worldwide, at a cost of about 250 Pounds ($400) per life saved, and about 80 Pounds ($130) per cardiovascular event prevented. The evidence indicates that it is seriously underused at present. The aspirin story continues and trials are in progress to test other possible uses of aspirin, in vascular dementia, colorectal cancer, and cataract. OTHER PUBLICATIONS OF THIS RESEARCH: Elwood PC, Hughes C. A short history of aspirin [abstract]. Journal of Epidemiology and Community Health 1998;52:683.",CMR: Evaluation methodology - history and epidemiology of evaluations;CMRA3;CMRA4,"Elwood, P. C.;Hughes, C.;O'Brien, J. R.",1998,,,0,
1172,Use of aspirin in cardiovascular prophylaxis,"The value of prophylatic low-dose aspirin in patients who have experienced a myocardial infarction (MI), stroke or transient ischaemic attack (TIA) has been established beyond all reasonable doubt in a number of major overviews of randomised controlled trials. The value of aspirin in so-called 'primary prevention' is debated, but discussions are based on a misunderstanding. The terms 'primary' and 'secondary' relate to past vascular events and the occurrence of a prior event is only one factor in the estimation of the risk of a future event. Trials have confirmed that patients at high risk, who have not already had a clinical event, do benefit from aspirin. The estimation of risk, and the balancing of this against the chance of undesirable side-effects from aspirin, constitutes a clinical judgement. Although there is only limited evidence from trials, it is reasonable to assume that the earlier aspirin is given in infarction, the greater the benefit is likely to be. This assumption underlies advice from a number of bodies that aspirin should be given by a doctor, nurse or paramedic on first contact with a patient experiencing sudden severe chest pain. Again, although there is no direct evidence from trials, it would seem reasonable to advise patients who have been judged to be at increased risk of infarction to carry aspirin tablets and to chew and swallow one or two immediately if they experience sudden severe chest pain. Aspirin has a fascinating history. The new uses now being suggested, namely in the management of dementia, cancer and other conditions, make it likely that it will have an even more fascinating future.",,"Elwood, P. C.;Stillings, M. R.",2000,Jun,,0,
1173,Preliminary evidence of a genetic association between chromosome 9p21.3 and human longevity,"BACKGROUND: Emerging evidence suggests that there is a significant genetic component to human longevity. One or more genetic variants located on chromosome 9p21.3 and tagged by the single-nucleotide polymorphism (SNP) rs1333049 (G/C) are major risk factors for age-related disorders, including acute myocardial infarction (AMI), stroke, and dementia. We hypothesized that this locus may have widespread effects on aging phenotypes and, as such, influences the ability to achieve a long and healthy life. AIM: The aim of this study was to assess whether the rs1333049 polymorphism is associated with human longevity. METHODS: We tested the rs1333049 polymorphism in a sample of 80 healthy centenarians (39 men and 41 women, aged 100-104), 218 patients younger than 40 who experienced an AMI, and a control group of 258 healthy young volunteers matched to AMI patients for age and sex. RESULTS: The frequency of the C allele of rs1333049 was significantly lower in centenarians compared to young controls, whereas AMI patients showed a higher frequency. After adjustment for gender and traditional vascular risk factors, the C allele of rs1333049 remained significantly associated with a reduced likelihood to reach longevity: Odds ratio (OR) 0.64, 95% confidence interval (CI) 0.39-0.89, p < 0.01. CONCLUSIONS: Our data suggest that the rs1333049 polymorphism at 9p21.3 may influence successful human longevity, possibly by modulating the risk of age-related disorders.","Adult;Aged, 80 and over;Case-Control Studies;Chromosomes, Human, Pair 9/*genetics;Female;Gene Frequency/genetics;Genotype;Humans;Longevity/*genetics;Male;Young Adult","Emanuele, E.;Fontana, J. M.;Minoretti, P.;Geroldi, D.",2010,Feb,10.1089/rej.2009.0970,0,
1174,Linking atherosclerosis to Alzheimer's disease: Focus on biomarkers,"Alzheimer's disease (AD) is a progressive neurodegenerative disorder with an important vascular component, ultimately resulting in dementia. Recent years have witnessed an enormous interest in the field of biomarkers in medicine both in the field of atherosclerosis and neurodegeneration. Numerous studies have recently reported altered levels of biomarkers of atherosclerotic vascular disease in patients with AD. This review provides an overview of clinical studies assessing biomarkers of atherosclerosis/vascular disease in the serum/plasma of patients with AD and highlights future directions in the field. The study of specific biomarkers of atherosclerosis in AD can contribute to identify different components of the pathophysiology and the complex mechanisms underlying the progression of the disease.",advanced glycation end product;amine oxidase (copper containing);apolipoprotein A;biological marker;C reactive protein;cystatin C;homocysteine;lipoprotein A;osteoprotegerin;Alzheimer disease;arterial wall thickness;article;atherosclerosis;blood vessel injury;cerebrovascular disease;cognitive defect;concentration (parameters);diabetes mellitus;disease association;disease course;disease severity;heart failure;human;pathophysiology;positron emission tomography;risk assessment;single photon emission computer tomography,"Emanuele, E.;Martinelli, V.;Abbiati, V.;Ricevuti, G.",2012,,,0,
1175,Plasma osteoprotegerin as a biochemical marker for vascular dementia and Alzheimer's disease,"Elevated level of osteoprotegerin (OPG), a pleiotropic cytokine involved in bone metabolism, has been associated with coronary heart disease and higher cardiovascular mortality. Because cardiovascular disorders are recognized risk factors for dementia, the study of OPG as a disease marker in vascular dementia (VaD) and Alzheimer's disease (AD) seemed worthy of investigation. OPG concentration was determined by ELISA in an Italian cohort consisting of 39 VaD patients, 36 AD patients, and 39 non-demented controls strictly matched for age and gender. Plasma OPG levels were positively related to age in both demented and non-demented persons. OPG concentrations were significantly higher in both VaD (median: 4.75 pmol/l; interquartile range: 3.42-6.85 pmol/l; P<0.0001) and AD (median: 4.02 pmol/l; interquartile range: 3.07-4.77 pmol/l; P=0.0278) compared to non-demented controls (median: 3.24 pmol/l, interquartile range: 2.70-3.98 pmol/l). After allowance for confounding factors (age, gender and APOE epsilon4 allele), plasma OPG levels remained independently associated with the presence of VaD (OR = 2.51; 95% CI 1.46-4.32; P=0.0009) and AD (OR = 2.17; 95% CI 1.18-3.99; P=0.0126). Our study demonstrates that OPG may be regarded as a novel biomarker of dementia in the Italian population. These results further support the hypothesis that vascular factors may not only play a role in the pathogenesis of VaD but also in the pathogenesis of AD.","Aged;Alzheimer Disease/diagnosis/*metabolism;Dementia, Vascular/diagnosis/*metabolism;Female;Glycoproteins/blood/*chemistry;Humans;Italy;Male;Osteoprotegerin;Receptors, Cytoplasmic and Nuclear/blood/*chemistry;Receptors, Tumor Necrosis Factor","Emanuele, E.;Peros, E.;Scioli, G. A.;D'Angelo, A.;Olivieri, C.;Montagna, L.;Geroldi, D.",2004,Jun,,0,
1176,"Usual blood pressure, atrial fibrillation and vascular risk: evidence from 4.3 million adults","BACKGROUND: Although elevated blood pressure is associated with an increased risk of atrial fibrillation (AF), it is unclear if this association varies by individual characteristics. Furthermore, the associations between AF and a range of different vascular events are yet to be reliably quantified. METHODS: Using linked electronic health records, we examined the time to first diagnosis of AF and time to first diagnosis of nine vascular events in a cohort of 4.3 million adults, aged 30 to 90 years, in the UK. RESULTS: A 20-mmHg higher usual systolic blood pressure was associated with a higher risk of AF [hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.19, 1.22]. The strength of the association declined with increasing age, from an HR of 1.91 (CI 1.75, 2.09) at age 30-40 to an HR of 1.01 (CI 0.97, 1.04) at age 80-90 years. AF without antithrombotic use at baseline was associated with a greater risk of any vascular event than AF with antithrombotic usage (P interaction < 0.0001). AF without baseline antithrombotic usage was associated with an increased risk of ischaemic heart disease (HR 2.52, CI 2.23, 2.84), heart failure (HR 3.80, CI 3.50, 4.12), ischaemic stroke (HR 2.72, CI 2.19, 3.38), unspecified stroke (HR 2.59, CI 2.25, 2.99), haemorrhagic stroke, chronic kidney disease, peripheral arterial disease and vascular dementia, but not aortic aneurysm. CONCLUSIONS: The association between elevated blood pressure and AF attenuates with increasing age. AF without antithrombotic usage is associated with an increased risk of eight vascular events.",Atrial fibrillation;blood pressure;cardiovascular disease;epidemiology,"Emdin, C. A.;Anderson, S. G.;Salimi-Khorshidi, G.;Woodward, M.;MacMahon, S.;Dwyer, T.;Rahimi, K.",2016,May 3,10.1093/ije/dyw053,0,
1177,"Usual blood pressure, atrial fibrillation and vascular risk: evidence from 4.3 million adults","Background: Although elevated blood pressure is associated with an increased risk of atrial fibrillation (AF), it is unclear if this association varies by individual characteristics. Furthermore, the associations between AF and a range of different vascular events are yet to be reliably quantified. Methods: Using linked electronic health records, we examined the time to first diagnosis of AF and time to first diagnosis of nine vascular events in a cohort of 4.3 million adults, aged 30 to 90 years, in the UK. Results: : A 20-mmHg higher usual systolic blood pressure was associated with a higher risk of AF [hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.19, 1.22]. The strength of the association declined with increasing age, from an HR of 1.91 (CI 1.75, 2.09) at age 30-40 to an HR of 1.01 (CI 0.97, 1.04) at age 80-90 years. AF without antithrombotic use at baseline was associated with a greater risk of any vascular event than AF with antithrombotic usage ( P interaction < 0.0001). AF without baseline antithrombotic usage was associated with an increased risk of ischaemic heart disease (HR 2.52, CI 2.23, 2.84), heart failure (HR 3.80, CI 3.50, 4.12), ischaemic stroke (HR 2.72, CI 2.19, 3.38), unspecified stroke (HR 2.59, CI 2.25, 2.99), haemorrhagic stroke, chronic kidney disease, peripheral arterial disease and vascular dementia, but not aortic aneurysm. Conclusions: The association between elevated blood pressure and AF attenuates with increasing age. AF without antithrombotic usage is associated with an increased risk of eight vascular events.",Atrial fibrillation;blood pressure;cardiovascular disease;epidemiology,"Emdin, C. A.;Anderson, S. G.;Salimi-Khorshidi, G.;Woodward, M.;MacMahon, S.;Dwyer, T.;Rahimi, K.",2017,Feb 01,,0,1176
1178,Cardiogenic dementia - a myth?,"Evidence of cardiac abnormalities (obtained from electrocardiogram, heart size, bloodpressure, and the presence of heart failure and arrhythmias) was compared between 51 elderly patients with dementia and 48 non-demented elderly mentally ill patients. No significant difference was found in the number of abnormalities between the two groups of patients. None had an abnormality which warranted further investigation with a view to pacing. The results do not support the suggestion that cardiac disease is an important cause of dementia.",central nervous system;dementia;diagnosis;heart;heart disease;major clinical study,"Emerson, T. R.;Milne, J. R.;Gardner, A. J.",1981,,,0,
1179,Neuropathological findings after cardiac surgery - Retrospective study over 6 years,"Neuropathological studies may contribute to the discovery of central nervous system complications after heart surgery and thus help to reduce the incidence of postoperative neurological or cognitive disturbances. We examined the brains of 262 such patients operated for coronary bypass, valve replacement, or heart transplantation. Circulatory disturbances (macro- and microhemorrhages, infarcts, subarachnoid hemorrhages, and hypoxemic brain damage) were present in 128 cases (49%), as the cause of death in 33 cases (12.6%). The infarcts were caused by local arteriosclerosis of brain arteries, arterial emboli originating from the operative sites or myocardial infarctions, or by fat emboli, foreign body emboli or megakaryocytic capillary emboli in rare cases. Inflammatory disturbances were present in 17 cases and consisted of fungal or bacterial septicopyemic changes (12) or of glial nodules (5) as the substrate of a viral or autoimmunencephalitis (Bickerstaff). An incidental finding was Alzheimer's disease in 37 cases (14% of the material) of elderly patients, often associated with cerebral amyloid angiopathy but not as cause of death or cause of macroscopic brain hemorrhage. Since we have conducted an autopsy study, there is a limitation to transfer the documented changes to the total group of post-cardiac surgery patients with neurologic and cognitive deficits. Contrary to some previous reports, histologically overt microembolic phenomena do not seem to play a major role in our material. On the other hand, careful scrutiny revealed non-fatal white matter microhemorrhages of varying frequency in the different groups, especially after valve operations. These as well as the occasional glial nodules, after resorption and microscarring, could well be the cause of slight neurologic and cognitive impairments.",adult;aged;Alzheimer disease;arteriosclerosis;artery embolism;article;autopsy;brain hemorrhage;brain infarction;brain injury;cause of death;central nervous system disease;cognitive defect;controlled study;coronary artery bypass graft;encephalitis;heart surgery;heart transplantation;heart valve replacement;histology;human;hypoxemia;inflammation;major clinical study;neuropathology;postoperative complication;subarachnoid hemorrhage;treatment indication;vascular amyloidosis,"Emmrich, P.;Hahn, J.;Ogunlade, V.;Geiger, K.;Schober, R.;Mohr, F. W.",2003,,,0,
1180,Risk factors for 30-day readmission following hypoglycemia-related emergency room and inpatient admissions,"Objective: Hypoglycemia is a serious complication of diabetes treatment. This retrospective observational study characterized hypoglycemia-related hospital emergency room (ER) and inpatient (in-pt) admissions and identified risk factors for 30-day all-cause and hypoglycemia-related readmission. Research design and methods: 4476 hypoglycemia-related ER and in-pt encounters with discharge dates from 1/1/2009 to 3/31/2014 were identified in a large, multicenter electronic health record database. Outcomes were 30-day all-cause ER/ hospital readmission and hypoglycemia-related readmission. Multivariable logistic regression methods identified risk factors for both outcomes. Results: 1095 (24.5%) encounters had ER/hospital all-cause readmission within 30 days and 158 (14.4%) of these were hypoglycemia-related. Predictors of allcause 30-day readmission included recent exposure to a hospital/nursing home (NH)/skilled nursing facility (SNF; OR 1.985, p<0.001); age 25-34 and 35-44 (OR 2.334 and 1.996, respectively, compared with age 65-74, both p<0.001); and African-American (AA) race versus all other race categories (OR 1.427, p=0.011). Other factors positively associated with readmission include chronic obstructive pulmonary disease, cerebrovascular disease, cardiac dysrhythmias, congestive heart disease, hypertension, and mood disorders. Predictors of readmissions attributable to hypoglycemia included recent exposure to a hospital/ NH/SNF (OR 2.299, p<0.001), AA race (OR 1.722, p=0.002), age 35-44 (OR 3.484, compared with age 65-74, p<0.001), hypertension (OR 1.891, p=0.019), and delirium/dementia and other cognitive disorders (OR 1.794, p=0.038). Obesity was protective against 30-day hypoglycemia-related readmission (OR 0.505, p=0.017). Conclusions: Factors associated with 30-day all-cause and hypoglycemia-related readmission among patients with diabetic hypoglycemia include recent exposure to hospital/SNF/NH, adults <45 years, AAs, and several cardiovascular and respiratory-related comorbid conditions.",adolescent;adult;age;aged;article;cerebrovascular disease;child;chronic obstructive lung disease;congestive cardiomyopathy;delirium;dementia;diabetes mellitus;emergency ward;ethnicity;female;heart arrhythmia;hospital discharge;hospital patient;hospital readmission;human;hypertension;hypoglycemia;major clinical study;male;middle aged;mood disorder;obesity;observational study;outcome assessment;preschool child;priority journal;retrospective study;risk factor;school child,"Emons, M. F.;Bae, J. P.;Hoogwerf, B. J.;Kindermann, S. L.;Taylor, R. J.;Nathanson, B. H.",2016,,,0,
1181,Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three city study,"BACKGROUND AND PURPOSE: Excessive daytime sleepiness, one of the most frequent sleep complaints in the elderly, may affect survival, but inconsistent results have been observed in that population so far. We therefore estimated the risk of mortality for excessive daytime sleepiness (EDS) in community-dwelling elderly participating in the Three City Study. METHODS: The Three City Study is a French population-based multicenter prospective study including 9294 subjects (60% women) aged >or=65 years at recruitment between 1999 to 2001. At baseline, 8269 subjects rated EDS and nocturnal sleep complaints as never, rare, regular, and frequent in response to an administered questionnaire and provided information on medication use for sleep or anxiety. Hazard ratios (HR) of EDS (regular or frequent) for mortality over 6 years were estimated by a Cox proportional hazard model. RESULTS: At baseline, 18.7% of the study participants had regular or frequent EDS. After 6 years of follow-up, 762 subjects had died including 260 from cancer and 196 from cardiovascular disease. EDS was associated with a significant 33% increased risk of mortality (95% CI: 1.13 to 1.61) after adjustment for age, gender, study center, body mass index, previous cardiovascular disease, Mini Mental State Examination score, and cardiovascular risk factors. Further adjustment for current use of medication for sleep and for depressive symptoms slightly diminished the HRs. EDS was equally predictive of mortality in those who snored loudly and in those who did not. EDS was related to cardiovascular mortality but not to mortality attributable to cancer. CONCLUSIONS: EDS might be independently associated with total and cardiovascular mortality in community-dwelling elderly.",Aged;Coronary Disease/*mortality;Dementia/*mortality;Disorders of Excessive Somnolence/*mortality;Female;Follow-Up Studies;France/epidemiology;Humans;Male;Multivariate Analysis;Proportional Hazards Models;Prospective Studies;Residence Characteristics;Risk Factors;Stroke/*epidemiology,"Empana, J. P.;Dauvilliers, Y.;Dartigues, J. F.;Ritchie, K.;Gariepy, J.;Jouven, X.;Tzourio, C.;Amouyel, P.;Besset, A.;Ducimetiere, P.",2009,Apr,10.1161/strokeaha.108.530824,0,
1182,"Long-term safety of rivastigmine in parkinson disease dementia: An open-label, randomized study","OBJECTIVE: This study investigated the long-term safety of rivastigmine (12 mg/d capsules, 9.5 mg/24 h patch) and effects on motor symptoms in patients with mild-to-moderately severe Parkinson disease dementia. METHODS: This was a 76-week, prospective, open-label, randomized study in patients aged 50 to 85 years. Primary outcomes included incidence of, and discontinuation due to, predefined adverse events (AEs) potentially arising from worsening of Parkinson disease motor symptoms with capsules. Secondary outcomes included frequency of AEs/serious AEs. Efficacy outcomes included Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL), Neuropsychiatric Inventory (NPI-10), and Mattis Dementia Rating Scale (MDRS). RESULTS: Five hundred eighty-three patients were randomized to rivastigmine capsules (n = 295) or patch (n = 288). Incidence of predefined AEs was 36.1% for capsules, 31.9% for patch; discontinuation due to worsening of motor symptoms was 4.4% and 2.4%, respectively. Most common AEs were nausea (capsules, 40.5%; patch, 8.3%), tremor (24.5%; 9.7%), fall (17.0%; 20.1%), vomiting (15.3%; 2.8%), and application site erythema (0%; 13.9%). Significant efficacy in favor of capsules was observed at weeks 24 to 76 on MDRS; 24 and 76 on NPI-10; weeks 52 and 76 on ADCS-ADL. In patients with Mini-Mental State Examination (MMSE) greater than 21, no differences in efficacy on MDRS and ADCS-ADL were observed at any time point; significant differences in favor of capsules were maintained in patients with MMSE less than or equal to 21. CONCLUSIONS: This study supports the long-term safety of rivastigmine in Parkinson disease dementia. The rate of worsening of motor symptoms was in the range expected due to the natural progression of Parkinson disease, no new or unexpected safety issues emerged in the long-term. [-] [-] [-] [-] [-] [-] [-] [-] [-].",antiparkinson agent;levodopa;rivastigmine;adult;aged;anxiety disorder;application site erythema;article;backache;bradykinesia;cholinergic stimulation;confusion;controlled study;daily life activity;decreased appetite;dementia;depression;diarrhea;disease course;dizziness;drug dosage form comparison;drug dose titration;drug effect;drug efficacy;drug safety;drug tolerability;drug withdrawal;faintness;female;headache;heart disease;heart infarction;human;hypertension;hypotension;insomnia;long term care;major clinical study;male;Mattis Dementia Rating Scale;microcapsule;Mini Mental State Examination;morbidity;multicenter study;muscle rigidity;assessment of humans;nausea;neuropsychiatric inventory;open study;orthostatic hypotension;Parkinson disease;Parkinson disease dementia;pneumonia;priority journal;prospective study;randomized controlled trial;risk assessment;somnolence;transdermal patch;treatment outcome;tremor;unspecified side effect;urinary tract infection;very elderly;visual hallucination;vomiting,"Emre, M.;Poewe, W.;De Deyn, P. P.;Barone, P.;Kulisevsky, J.;Pourcher, E.;Van Laar, T.;Storch, A.;Micheli, F.;Burn, D.;Durif, F.;Pahwa, R.;Callegari, F.;Tenenbaum, N.;Strohmaier, C.",2014,,,0,
1183,"Comprehensive evaluation of medical conditions associated with risk of non-Hodgkin lymphoma using medicare claims (""MedWAS"")","Background: Certain medical conditions affect risk of non- Hodgkin lymphoma (NHL), but the full range of associations is unknown. We implemented a novel method (""medical condition- wide association study,"" MedWAS) to comprehensively evaluate medical risk factors for NHL documented in administrative health claims. Methods: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we conducted a case-control study comparing NHL cases [N = 52,691, age 66+ years, with five subtypes: chronic lymphocytic leukemia/small lymphocytic lymphoma, diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, marginal zone lymphoma (MZL), T-cell lymphoma (TCL)] to controls (N = 200,000). We systematically screened for associations with 5,926 medical conditions documented in Medicare claims more than 1 year before selection. Results: Fifty-five conditions were variously associated with NHL. Examples include well-established associations of human immunodeficiency virus, solid organ transplantation, and hepatitis C virus with increased DLBCL risk (ORs 3.83, 4.27, and 1.74, respectively), and autoimmune conditions with DLBCL and MZL (e.g., ORs of 2.10 and 4.74, respectively, for Sjogren syndrome). Risks for all NHL subtypes were increased after diagnoses of nonmelanoma skin cancer (ORs 1.19-1.55), actinic keratosis (1.12-1.25), or hemolytic anemia (1.64-4.07). Nine additional skin conditions increased only TCL risk (ORs 2.20-4.12). Diabetes mellitus was associated with increased DLBCL risk (OR 1.09). Associations varied significantly across NHL subtypes for 49 conditions (89%). Conclusion: Using an exploratory method, we found numerous medical conditions associated with NHL risk, and many associations varied across NHL subtypes. Impact: These results point to etiologic heterogeneity among NHL subtypes. MedWAS is a new method for assessing the etiology of cancer and other diseases.",abdominal aorta aneurysm;actinic keratosis;adult;aged;alcoholism;anemia;aplastic anemia;article;asphyxia;atopic dermatitis;autoimmune disease;bronchitis;bullous skin disease;cancer epidemiology;celiac disease;cerebrovascular accident;chronic bronchitis;chronic lymphatic leukemia;contact dermatitis;controlled study;cryoglobulinemia;decubitus;depression;diabetes mellitus;discoid lupus erythematosus;disease association;female;follicular lymphoma;folliculitis;hemolytic anemia;hepatitis C;herpes zoster;hip fracture;human;Human immunodeficiency virus infection;hypertension;large cell lymphoma;lupus vulgaris;lymphocytoma;major clinical study;male;marginal zone lymphoma;medicare;mental disease;neutropenia;non melanoma skin cancer;nonhodgkin lymphoma;organ transplantation;paraproteinemia;Parkinson disease;priority journal;prostate hypertrophy;psoriasis;randomized controlled trial;rheumatoid arthritis;risk assessment;sarcoidosis;seborrheic keratosis;senile dementia;sinusitis;Sjoegren syndrome;spinal cord malformation;stomach ulcer;systolic heart failure;T cell lymphoma;thrombocytopenia;urinary tract infection;urticaria;uveitis,"Engels, E. A.;Parsons, R.;Besson, C.;Morton, L. M.;Enewold, L.;Ricker, W.;Yanik, E. L.;Arem, H.;Austin, A. A.;Pfeiffer, R. M.",2016,,,0,
1184,Changes in mortality and causes of death in the Swedish Down syndrome population,"During the past few decades age at death for individuals with Down syndrome (DS) has increased dramatically. The birth frequency of infants with DS has long been constant in Sweden. Thus, the prevalence of DS in the population is increasing. The aim of the present study was to analyze mortality and causes of death in individuals with DS during the period 1969-2003. All individuals with DS that died between 1969 and 2003 in Sweden, and all individuals born with DS in Sweden between 1974 and 2003 were included. Data were obtained from the Swedish Medical Birth Register, the Swedish Birth Defects Register, and the National Cause of Death Register. Median age at death has increased by 1.8 years per year. The main cause of death was pneumonia. Death from congenital heart defects decreased. Death from atherosclerosis was rare but more frequent than reported previously. Dementia was not reported in any subjects with DS before 40 years of age, but was a main or contributing cause of death in 30% of the older subjects. Except for childhood leukemia, cancer as a cause of death was rare in all age groups. Mortality in DS, particularly infant mortality, has decreased markedly during the past decades. Median age at death is increasing and is now almost 60 years. Death from cancer is rare in DS, but death from dementia is common. © 2013 Wiley Periodicals, Inc.",adolescent;adult;article;atherosclerosis;cause of death;central nervous system disease;child;childhood leukemia;congenital heart disease;dementia;Down syndrome;epilepsy;female;gastrointestinal disease;human;infant;ischemic heart disease;male;mortality;pneumonia;preschool child;priority journal;register;school child;solid tumor;Sweden,"Englund, A.;Jonsson, B.;Zander, C. S.;Gustafsson, J.;Annerén, G.",2013,,,0,
1185,Risk factors associated with 30-day readmission and length of stay in patients with type 2 diabetes,"Aims Patients with type 2 diabetes mellitus (type 2 DM) are at greater risk of poor hospital outcomes. The purpose of this study was to determine the impact of type 2 DM on 30-day hospital readmission and length of stay (LOS). Methods We studied all inpatient admissions in Pennsylvania during 2011 using data from the Pennsylvania Health Care Cost Containment Council. Outcomes included 30-day readmission and inpatient LOS. We estimated the impact of type 2 DM on readmission and LOS, and identified risk factors for readmission and prolonged LOS. Results Among inpatient admissions, patients with diabetes were more likely to be readmitted (AOR = 1.17, P < 0.001) and have longer LOS (0.19 days, P < 0.001) compared to patients without diabetes. Among those with diabetes, several factors were associated with readmission, including demographics, source of admission, and comorbidities. Patients with diabetes were more likely to be readmitted for infectious complications (9.4% vs. 7.7%), heart failure (6.0% vs. 3.1%), and chest pain/MI (5.5% vs. 3.3%) than patients without diabetes. Conclusions Diabetes is associated with risk of 30-day readmission and LOS, and several patient-specific factors are associated with outcomes for patients with diabetes. Future studies may target risk factors to develop strategies to reduce readmissions and LOS.",acute kidney failure;adult;aged;article;atrial fibrillation;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;controlled study;dementia;diabetic patient;disease association;female;heart failure;heart infarction;hemiplegia;hospital readmission;human;infectious complication;kidney disease;length of stay;liver disease;major clinical study;male;malignant neoplasm;non insulin dependent diabetes mellitus;paraplegia;peptic ulcer;peripheral vascular disease;priority journal;respiratory failure;retrospective study;rheumatic disease;risk factor;thorax pain;very elderly,"Enomoto, L. M.;Shrestha, D. P.;Rosenthal, M. B.;Hollenbeak, C. S.;Gabbay, R. A.",2017,,10.1016/j.jdiacomp.2016.10.021,0,
1186,"Cholesterol ester transfer protein, interleukin-8, peroxisome proliferator activator receptor alpha, and Toll-like receptor 4 genetic variations and risk of incident nonfatal myocardial infarction and ischemic stroke","Variations in candidate genes participating in oxidative stress, inflammation, and their interactions are potentially associated with diseases of atherosclerotic origin. We investigated independent and joint associations of variations in cholesterol ester transfer protein (CETP), interleukin-8 (IL8), peroxisome proliferator activator receptor-alpha (PPARA), and Toll-like receptor 4 (TLR4) genes with incident nonfatal myocardial infarction (MI) or ischemic stroke. In a population-based case-control study, patients (848 with MI and 368 with ischemic stroke) and controls (2,682) were recruited from postmenopausal women and hypertensive men/women who were members of Group Health in western Washington State. Common tag single-nucleotide polymorphisms (SNPs; n=34) representing gene-wide variations were selected from gene sequencing data using pairwise linkage disequilibrium. Haplotypes were inferred using a modified expectation maximization algorithm. Multivariate logistic regression evaluated individual haplotype and SNP-disease associations in log-additive models. Global haplotype tests assessed overall gene-disease associations. Logic regression was used to evaluate gene-gene interactions. False discovery rates and permutation tests were used for multiple testing adjustment in evaluating independent associations and interactions, respectively. Overall, gene-wide variations in PPARA and TLR4 genes were associated with MI. The minor allele of the PPARA SNP, rs4253623, was associated with a higher risk of MI (odds ratio 1.25, 95% confidence interval 1.08 to 1.46), whereas the minor allele of the TLR4 SNP, rs1927911, was associated with a lower risk of MI (odds ratio 0.88, 95% confidence interval 0.77 to 0.99). No within-gene or gene-gene interaction was associated with MI or ischemic stroke risk. In conclusion, potential SNP-disease associations identified in the present study are novel and need further investigation.","Adult;Aged;Alleles;Brain Ischemia/blood/epidemiology/*genetics;Cholesterol Ester Transfer Proteins/blood/*genetics;Confidence Intervals;DNA/genetics;Dementia;Female;Follow-Up Studies;Genetic Predisposition to Disease;*Genetic Variation;Haplotypes;Humans;Incidence;Interleukin-8/*genetics;Male;Middle Aged;Myocardial Infarction/blood/epidemiology/*genetics;Odds Ratio;PPAR alpha/blood/*genetics;Polymorphism, Single Nucleotide;Prognosis;Retrospective Studies;Risk Factors;Survival Rate;Toll-Like Receptor 4/blood/*genetics;Washington/epidemiology","Enquobahrie, D. A.;Smith, N. L.;Bis, J. C.;Carty, C. L.;Rice, K. M.;Lumley, T.;Hindorff, L. A.;Lemaitre, R. N.;Williams, M. A.;Siscovick, D. S.;Heckbert, S. R.;Psaty, B. M.",2008,Jun 15,10.1016/j.amjcard.2008.02.052,0,
1187,Vascular risk factors and cardiovascular outcomes in the Alzheimer's disease neuroimaging initiative,"Background: Vascular disease and medical factors are associated with cognitive decline and cardiovascular events. We examined the association between vascular risk factors and events in the Alzheimer's Disease Neuroimaging Initiative cohort. Methods: The association between vascular risk factors and cardiovascular events in a cohort of 810 participants, including 400 with mild cognitive impairment, 184 with Alzheimer's, and 226 controls was investigated using a longitudinal hazard model. Results: There were 31 events including 11 strokes, 7 myocardial infarctions, 5 revascularizations, and 8 deaths during an average follow-up of 31 months. Longitudinal cardiovascular event rates were low and similar between diagnostic groups. Conclusions: All baseline vascular risk factors that were expected to be associated with longitudinal cardiovascular events were, or were trending toward, associating with cardiovascular events except atrial fibrillation, depression, and apolipoprotein E genotype. Despite differences in baseline vascular risk factors, longitudinal cardiovascular event rates were similar between diagnostic groups. © The Author(s) 2012.",adult;aged;Alzheimer disease;article;cardiovascular disease;cardiovascular risk;cohort analysis;controlled study;disease association;female;heart infarction;human;longitudinal study;major clinical study;male;mild cognitive impairment;revascularization;cerebrovascular accident,"Epstein, N. U.;Xie, H.;Ruland, S. D.;Pandey, D. K.",2012,,,0,
1188,Prevalence of chronic conditions among Medicare Part A beneficiaries in 2008 and 2010: are Medicare beneficiaries getting sicker?,"INTRODUCTION: Medicare beneficiaries who have chronic conditions are responsible for a disproportionate share of Medicare fee-for-service expenditures. The objective of this study was to analyze the change in the health of Medicare beneficiaries enrolled in Part A (hospital insurance) between 2008 and 2010 by comparing the prevalence of 11 chronic conditions. METHODS: We conducted descriptive analyses using the 2008 and 2010 Chronic Conditions Public Use Files, which are newly available from the Centers for Medicare and Medicaid Services and have administrative (claims) data on 100% of the Medicare fee-for-service population. We examined the data by age, sex, and dual eligibility (eligibility for both Medicare and Medicaid). RESULTS: Medicare Part A beneficiaries had more chronic conditions on average in 2010 than in 2008. The percentage increase in the average number of chronic conditions was larger for dual-eligible beneficiaries (2.8%) than for nondual-eligible beneficiaries (1.2%). The prevalence of some chronic conditions, such as congestive heart failure, ischemic heart disease, and stroke/transient ischemic attack, decreased. The deterioration of average health was due to other chronic conditions: chronic kidney disease, depression, diabetes, osteoporosis, rheumatoid arthritis/osteoarthritis. Trends in Alzheimer's disease, cancer, and chronic obstructive pulmonary disease showed differences by sex or dual eligibility or both. CONCLUSION: Analyzing the prevalence of 11 chronic conditions by using Medicare claims data provides a monitoring tool that can guide health care providers and policy makers in devising strategies to address chronic conditions and rising health care costs.",aged;chronic disease;epidemiology;female;health services research;human;insurance;male;medicare;middle aged;prevalence;time;United States;very elderly,"Erdem, E.",2014,,,0,
1189,[Nutrition in elderly patients with cardiovascular diseases] Kardiyovaskuler hastaligi olan yaslida beslenme,"Elderly population is rapidly increasing in Turkey as well as in the world. There are a number of factors that affect the nutritional status of elderly. Factors such as physiological changes that occur with aging, socioeconomic factors, dementia, depression, large number of chronic illnesses and excessive use of drugs, and low intake of food on the grounds of illness affect the feeding of elderly. Cardiovascular diseases such as hypertension, ischemic heart disease and heart failure are more common in elderly and nutrition in these diseases is important in terms of mortality and morbidity.",,"Erdincler, D. S.;Avci, S.",2017,Sep,,0,
1190,"Prevalence, associated factors and impact on mortality of chronic kidney disease in nursing home residents: A single-center experience","Aim: We carried out the present study to determine the prevalence, associated comorbidities and impact on mortality of chronic kidney disease (CKD) in nursing home residents. Methods: This was an 8-year prospective single-center, longitudinal cohort study consisting of 612 patients living in a nursing home from 2005-2013. The glomerular filtration rate (GFR) was estimated from a prediction equation, the Chronic Kidney Disease Epidemiology Collaboration equation, based on the serum creatinine concentration, age, race, sex and body size. The demographic and clinical characteristics of the residents were collected. Results: CKD, defined as abnormalities of kidney structure or function, present for >3 months, with implications for health, was present in 197 (39.9%) residents. Specifically, 109 (21.5%) residents had an estimated GFR of 45-59mL/min, and 64 (12.6%) had an estimated GFR of 30-44mL/min. Multivariate logistic regression identified older age (OR 0.97, 95% CI 0.95-0.99), female sex (OR 2.99, 95% CI 1.99-4.49) and hypertension (OR 1.55, 95%, CI 1.00-2.40) as the only independent predictors of CKD. After a follow up of 8 years, 208 (41.1%) of the 506 residents died. Of these residents, 104 (52.8%) had CKD and 104 (33.4%) did not have CKD. The Kaplan-Meier survival curves showed that residents with CKD had a significantly higher mortality than those without CKD. Conclusion: CKD is prevalent in nursing home residents. A decline in renal function is associated with cardiovascular disease and mortality. Early recognition of CKD might improve drug dosage, renal management and outcomes in this particular group of patients.",age distribution;aged;article;atrial fibrillation;body mass;cerebrovascular accident;chronic kidney disease;cohort analysis;comorbidity;congestive cardiomyopathy;controlled study;coronary artery disease;creatinine blood level;dementia;depression;disease association;female;gender;glomerulus filtration rate;human;hypertension;longitudinal study;major clinical study;male;mortality;nursing home patient;prevalence;priority journal;prospective study;survival rate;Turkey (republic),"Eren, Z.;Küçükardali, Y.;Öztürk, M. A.;Küçükardali, B.;Kaspar, E. C.;Kantarci, G.",2015,,,0,
1191,Encapsulated cell biodelivery of nerve growth factor to the basal forebrain in patients with Alzheimer's disease,"Background/Aims: Degeneration of cholinergic neurons in the basal forebrain correlates with cognitive decline in patients with Alzheimer's disease (AD). Targeted delivery of exogenous nerve growth factor (NGF) has emerged as a potential AD therapy due to its regenerative effects on the basal forebrain cholinergic neurons in AD animal models. Here we report the results of a first-in-man study of encapsulated cell (EC) biodelivery of NGF to the basal forebrain of AD patients with the primary objective to explore safety and tolerability. Methods: This was an open-label, 12-month study in 6 AD patients. Patients were implanted stereotactically with EC-NGF biodelivery devices targeting the basal forebrain. Patients were monitored with respect to safety, tolerability, disease progression and implant functionality. Results: All patients were implanted successfully with bilateral single or double implants without complications or signs of toxicity. No adverse events were related to NGF or the device. All patients completed the study, including removal of implants at 12 months. Positive findings in cognition, EEG and nicotinic receptor binding in 2 of 6 patients were detected. Conclusions: This study demonstrates that surgical implantation and removal of EC-NGF biodelivery to the basal forebrain in AD patients is safe, well tolerated and feasible. Copyright © 2012 S. Karger AG.",cholinesterase inhibitor;glucose;nerve growth factor;nicotinic receptor;adult;aged;Alzheimer disease;article;backache;body mass;brain biopsy;cell encapsulation;cognition;computer assisted tomography;confusion;contusion;delirium;device removal;device safety;devices;disease course;dizziness;drug delivery system;drug dose escalation;drug induced headache;drug safety;drug tolerability;electroencephalography;enzyme linked immunosorbent assay;female;follow up;forebrain;genetic transfection;glaucoma;glucose metabolism;hair loss;atrial fibrillation;heart failure;hematuria;hip pain;histopathology;human;human cell;human tissue;hyperglycemia;hypertension;hypokalemia;implantation;major clinical study;male;memory;migraine;Mini Mental State Examination;nausea;neuroanatomy;nuclear magnetic resonance imaging;open study;paresthesia;patient monitoring;phase 1 clinical trial;pigment epithelium;pneumonia;priority journal;protein expression;protein phosphorylation;pruritus;receptor binding;rhinopharyngitis;side effect;stomatitis;subdural hematoma;thorax pain;treatment duration;urinary tract infection;urticaria;visual acuity;visual analog scale;white matter,"Eriksdotter-Jönhagen, M.;Linderoth, B.;Lind, G.;Aladellie, L.;Almkvist, O.;Andreasen, N.;Blennow, K.;Bogdanovic, N.;Jelic, V.;Kadir, A.;Nordberg, A.;Sundström, E.;Wahlund, L. O.;Wall, A.;Wiberg, M.;Winblad, B.;Seiger, Å;Almqvist, P.;Wahlberg, L.",2012,,,0,
1192,Whole-Genome Sequencing of a Healthy Aging Cohort,"Studies of long-lived individuals have revealed few genetic mechanisms for protection against age-associated disease. Therefore, we pursued genome sequencing of a related phenotype-healthy aging-to understand the genetics of disease-free aging without medical intervention. In contrast with studies of exceptional longevity, usually focused on centenarians, healthy aging is not associated with known longevity variants, but is associated with reduced genetic susceptibility to Alzheimer and coronary artery disease. Additionally, healthy aging is not associated with a decreased rate of rare pathogenic variants, potentially indicating the presence of disease-resistance factors. In keeping with this possibility, we identify suggestive common and rare variant genetic associations implying that protection against cognitive decline is a genetic component of healthy aging. These findings, based on a relatively small cohort, require independent replication. Overall, our results suggest healthy aging is an overlapping but distinct phenotype from exceptional longevity that may be enriched with disease-protective genetic factors. VIDEO ABSTRACT.",,"Erikson, G. A.;Bodian, D. L.;Rueda, M.;Molparia, B.;Scott, E. R.;Scott-Van Zeeland, A. A.;Topol, S. E.;Wineinger, N. E.;Niederhuber, J. E.;Topol, E. J.;Torkamani, A.",2016,May 5,10.1016/j.cell.2016.03.022,0,
1193,Urinary tract infection in very old women is associated with delirium,"BACKGROUND: The aim of the study was to investigate whether urinary tract infection (UTI) in a representative sample of 85-, 90- and >/=95-year-old women is associated with delirium. METHODS: In 504 out of 643 women (78.4%) it was possible to evaluate UTI and delirium. Assessments such as the Organic Brain Syndrome (OBS) Scale, the Geriatric Depression Scale-15 (GDS-15) and the Mini-mental State Examination (MMSE) were performed during home visits. Delirium, dementia and depression were diagnosed according to the DSM-IV criteria. A diagnosed, symptomatic UTI with or without ongoing treatment, documented in medical records or detected in association with the assessments, was registered. RESULTS: Eighty-seven of 504 women (17.2%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half of them (44.8%) were diagnosed to be delirious or having had episodes of delirium during the past month. One hundred and thirty-seven of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed to have a UTI. In a multivariate logistic regression model, delirium was significantly associated with Alzheimer's disease (OR = 5.8), multi-infarct dementia (OR = 5.4), depression (OR = 3.1), heart failure (OR = 2.3) and urinary tract infection (OR = 1.9). CONCLUSIONS: A large proportion of very old women with UTI suffered from delirium which might indicate that UTI is a common cause of delirium. There should be more focus on detecting, preventing and treating UTI to avoid unnecessary suffering among old women.","Activities of Daily Living/psychology;Aged, 80 and over;Chi-Square Distribution;Delirium/*etiology/prevention & control/psychology;Female;Humans;Logistic Models;Neuropsychological Tests;Urinary Tract Infections/complications/*psychology","Eriksson, I.;Gustafson, Y.;Fagerstrom, L.;Olofsson, B.",2011,Apr,10.1017/s1041610210001456,0,
1194,Low levels of antibodies against phosphorylcholine in Alzheimer's disease,"Phosphorylcholine (PC) may play an important role in the atherogenic and pro-inflammatory effects of oxidized low density lipoproteins. We recently demonstrated that low levels of IgM antibodies against PC (anti-PC) are associated with development of myocardial infarction and stroke. We here evaluate the association between anti-PC and dementia and Alzheimer's disease (AD). We conducted a nested case-control study of 182 incident dementia cases (serum collected before onset of dementia) matched to 366 controls and a case-control study of 97 prevalent dementia cases (serum collected after dementia onset) matched to 205 controls. Controls were matched on gender and age at blood draw (+/- 1 year). Participants were from the Swedish Twin Registry. Anti-PC levels were measured by ELISA. The odds ratio (OR) of dementia was modeled using conditional logistic regression. Patients with dementia had significantly lower mean anti-PC levels than controls (39.1 versus 49.5 U/ml). The likelihood of having dementia or AD was doubled for individuals with the lowest 25% anti-PC levels (OR=2.04 and 2.70, respectively). The results were similar after adjustments for potential confounders. There was no association between anti-PC levels and incident dementia. Low levels of atheroprotective anti-PC could play a role in AD and dementia. Potential mechanisms include decreased anti-inflammatory potential and effects on the vasculature. Further attention is merited to elucidate the role of anti-PC in AD development and the usefulness of anti-PC as a part of risk prediction, prognosis, diagnosis, or treatment.","Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology/*immunology;Autoantibodies/*blood;Case-Control Studies;Dementia/epidemiology/immunology;Female;Humans;Lipoproteins, LDL/blood;Male;Middle Aged;Phosphorylcholine/*immunology;Predictive Value of Tests;Risk Factors;Seroepidemiologic Studies","Eriksson, U. K.;Sjoberg, B. G.;Bennet, A. M.;de Faire, U.;Pedersen, N. L.;Frostegard, J.",2010,,10.3233/jad-2010-091705,0,
1195,Primary antiphospholipid syndrome: Functional outcome after 10 years,"Objective. To analyze the 10 year functional outcome of primary antiphospholipid syndrome (APS). Methods. We identified 39 patients with primary APS (35 female, 4 male) who developed a first thrombotic or pregnancy event before 1990. Patients meeting American College of Rheumatology criteria for systemic lupus erythematosus or other connective tissue disorders (secondary APS) were excluded. Medical records were reviewed for detailed histories and functional outcomes. Results. At 10 years' followup, 15 patients (38.4%) had organ damage in the form of hemiparesis (n = 8), dementia (n = 3), quadriplegia (n = 1), dilated cardiomyopathy-myocardial infarction (n = 1), vascular insufficiency-massive pulmonary infarction (n = 1), and endstage renal disease (n = 1). Eight patients (20.5%) with organ damage were unable to perform everyday activities important to their quality of life (functionally impaired). Causes of functional impairment were cognitive dysfunction (n = 3), cardiovascular disease (New York Heart Association Functional Classification Class IV) (n = 2), aphasia (n = 1), expressive aphasia (n = 1), and locked-in syndrome (n = 1). Conclusion. Functional prognosis is poor in an important minority of primary APS patients with > 10 years of disease. One-third of primary APS patients had organ damage and one-fifth were functionally impaired.",phospholipid antibody;adolescent;adult;antiphospholipid syndrome;aphasia;article;cardiovascular disease;clinical article;cognitive defect;daily life activity;dementia;disease association;female;follow up;functional assessment;heart dilatation;heart infarction;hemiparesis;human;kidney failure;locked in syndrome;lung infarction;male;priority journal;prognosis;quadriplegia;quality of life;cerebrovascular accident;transient ischemic attack,"Erkan, D.;Yazici, Y.;Sobel, R.;Lockshin, M. D.",2000,,,0,
1196,Is determination of plasma lipids useful in the differentiation of multi-infarct dementia from Alzheimer's disease?,"Plasma triglycerides, total cholesterol and high-density lipoprotein cholesterol were studied in patients with Alzheimer's disease (AD, n = 57, mean age 70 years) and multi-infarct dementia (MID, n = 69, mean age 73 years) when the patients were admitted for assessment. Both total cholesterol and high-density lipoprotein cholesterol but not triglycerides were lower in MID than in AD even though there was a considerable overlap. Especially in younger patients and in patients living at home the difference was not statistically significant. Further, the plasma lipid values in neuropathologically confirmed cases with AD (n = 5) and MID (n = 16) were similar at admission. Low total cholesterol and high-density lipoprotein cholesterol were related to cardio- and cerebrovascular disorders, living in institutions, and negatively correlated to age and severity of dementia. Our results suggest that determination of total cholesterol and high-density lipoprotein cholesterol is of minor value in the differential diagnosis between AD and MID and that associated diseases, such as coronary heart disease, cardiac failure and arterial hypertension, are more important in this respect.","Adult;Aged;Aged, 80 and over;Alzheimer Disease/*blood/diagnosis;Cholesterol/blood;Cholesterol, HDL/blood;Dementia, Multi-Infarct/*blood/diagnosis;Diagnosis, Differential;Female;Humans;Lipids/*blood;Male;Middle Aged;Triglycerides/blood","Erkinjuntti, T.;Sulkava, R.;Tilvis, R.",1988,Feb,,0,
1197,Polymorphisms in the PON gene cluster are associated with Alzheimer disease,"Paraoxonase is an arylesterase enzyme that is expressed in the liver and found in the circulation in association with apoA1 and the high-density lipoprotein, and prevents the accumulation of oxidized lipids in low-density lipoproteins in vitro. Common polymorphisms in genes encoding paraoxonase are established risk factors in a variety of vascular disorders including coronary artery disease and carotid artery stenosis, but their association with Alzheimer disease (AD) is controversial. We tested the association of 29 SNPs in PON1, PON2 and PON3 with AD in 730 Caucasian and 467 African American participants of the MIRAGE Study, an ongoing multi-center family-based genetic epidemiology study of AD. Eight SNPs were associated with AD in the African American families (0.0001< or =P< or =0.04) and two SNPs were associated with AD in Caucasian families (0.01< or =P< or =0.04). Of note, the pattern of association for the PON1 promoter SNP -161[C/T] was the same in both ethnic groups (P=0.006). Haplotype analysis using sliding windows revealed 11 contiguous SNP combinations spanning the three PON genes with significant global test scores (0.006< or =P< or =0.04) in the two ethnic groups combined. The most significantly associated haplotype comprised SNPs in the region spanning the -161[C/T] SNP (P=0.00009). Our results demonstrate association between AD and variants in the PON gene cluster in Caucasians and African Americans.","African Americans/genetics;Alzheimer Disease/*epidemiology/*genetics;Aryldialkylphosphatase/*genetics;European Continental Ancestry Group/genetics;Gene Frequency;Humans;Linkage Disequilibrium;Multigene Family/*genetics;Polymorphism, Single Nucleotide/genetics;Promoter Regions, Genetic/genetics;United States/epidemiology","Erlich, P. M.;Lunetta, K. L.;Cupples, L. A.;Huyck, M.;Green, R. C.;Baldwin, C. T.;Farrer, L. A.",2006,Jan 1,10.1093/hmg/ddi428,0,
1198,Herbal medicinal products,,Aesculus hippocastanum extract;anticoagulant agent;antihypertensive agent;cardiac glycoside;central depressant agent;Crataegus extract;Echinacea extract;Ginkgo biloba extract;Harpagophytum extract;herbaceous agent;hormone;Hypericum perforatum extract;immunosuppressive agent;nitrate;oral contraceptive agent;peppermint;plant extract;Sabal extract;Tanacetum parthenium extract;awareness;bone pain;chronic vein insufficiency;clinical trial;common cold;congestive heart failure;dementia;depression;diet supplementation;disease severity;doctor patient relation;drug antagonism;drug control;drug efficacy;drug hypersensitivity;drug marketing;drug potentiation;drug use;evidence based medicine;gastrointestinal disease;general practitioner;good clinical practice;herbal medicine;hormone substitution;human;Hypericum perforatum;intermittent claudication;interpersonal communication;irritable colon;letter;medical information;migraine;nausea;photosensitivity disorder;physician attitude;prescription;prostate hypertrophy;Sabal;stomatitis;United Kingdom,"Ernst, E.",2002,,,0,
1199,Complementary treatments on the NHS,,Aesculus hippocastanum extract;Arnica montana extract;chitosan;chondroitin;Crataegus extract;Ginkgo biloba extract;glucosamine;Hypericum perforatum extract;primrose oil;red clover extract;Sabal extract;Viscum album extract;acupuncture;alternative medicine;article;chelation therapy;chronic vein insufficiency;congestive heart failure;cost control;dementia;depression;eczema;evidence based medicine;general practitioner;government;health care access;health care delivery;health care organization;health care system;homeopathy;human;ischemia;malignant neoplastic disease;manipulative medicine;medical decision making;menopausal syndrome;national health service;nausea and vomiting;neck pain;osteoarthritis;patient referral;politics;primary medical care;prostate hypertrophy;public health service;responsibility;risk benefit analysis;safety;smoking cessation;stress;treatment failure;United Kingdom;weight reduction;wound healing impairment,"Ernst, E.",2005,,,0,
1200,Complementary and alternative medicine: What the NHS should be funding?,,Aesculus hippocastanum extract;Crataegus extract;Ginkgo biloba extract;guar gum;herbaceous agent;Hypericum perforatum extract;kava extract;melatonin;padma 28;phytodolor;Pygeum africanum extract;red clover extract;s adenosylmethionine;Sabal extract;ubidecarenone;unclassified drug;acupuncture;alternative medicine;Alzheimer disease;anxiety disorder;aromatherapy;artery disease;article;cancer palliative therapy;chronic vein insufficiency;clinical effectiveness;congestive heart failure;consensus development;cost effectiveness analysis;depression;diabetes mellitus;evidence based practice;financial management;homeopathy;human;hypercholesterolemia;hypertension;hypnosis;insomnia;intermethod comparison;labor pain;massage;medical decision making;medical research;menopausal syndrome;music therapy;national health service;nausea and vomiting;osteoarthritis;patient safety;practice guideline;prostate hypertrophy;relaxation training;rheumatic disease;risk benefit analysis;soybean;treatment contraindication;United Kingdom,"Ernst, E.",2008,,,0,
1201,How to assess frailty and the need for care? Report from the Study of Health and Drugs in the Elderly (SHADES) in community dwellings in Sweden,"Knowledge about the need for care of elderly individuals in community dwellings and the factors affecting their needs and support is limited. The aim of this study was to characterize the frailty of a population of elderly individuals living in community dwellings in Sweden in relation to co-morbidity, use of drugs, and risk of severe conditions such as malnutrition, pressure ulcers, and falls. In 2008, 315 elderly individuals living in community dwellings were interviewed and examined as part of the SHADES-study. The elderly demonstrated co-morbidity (a mean of three diseases) and polypharmacy (an average of seven drugs). More than half the sample was at risk for malnutrition, one third was at risk for developing pressure ulcers, and nearly all (93%) had an increased risk of falling and a great majority had cognitive problems. Age, pulse pressure, body mass index, and specific items from the modified Norton scale (MNS), the Downton fall risk index (DFRI), and the mini nutritional assessment (MNA-SF) were related to different outcomes, defining the need for care and frailty. Based on the results of this study, we suggest a single set of items useful for understanding the need for care and to improve individual based care in community dwellings. © 2010 Elsevier Ireland Ltd.",acetylsalicylic acid;antidepressant agent;beta adrenergic receptor blocking agent;cyanocobalamin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;folic acid;hemoglobin;hypnotic agent;laxative;neuroleptic agent;opiate;paracetamol;proton pump inhibitor;sedative agent;age;aged;article;body mass;cognitive defect;community living;comorbidity;decubitus;dementia;diastolic blood pressure;Downton fall risk index;elderly care;fall risk assessment;falling;female;frail elderly;heart failure;hemoglobin blood level;human;hypertension;major clinical study;male;malnutrition;nutritional assessment;nutritional status;physical capacity;polypharmacy;priority journal;pulse pressure;risk assessment;cerebrovascular accident;Sweden;symptom;systolic blood pressure,"Ernsth Bravell, M.;Westerlind, B.;Midlöv, P.;Östgren, C. J.;Borgquist, L.;Lannering, C.;Mölstad, S.",2011,,,0,
1202,Costs of dementia in Hungary,"OBJECTIVE: The main aim of this paper is to give an overview on the quality of life, health care utilisation and costs of dementia in Hungary. METHOD: A cross-sectional non-population based study of 88 consecutive dementia patients and their caregivers was conducted in three GP practices and one outpatient setting in 2008. Resource Utilization in Dementia (RUD), Mini Mental State Examination (MMSE) and quality of life (EQ-5D) were surveyed and cost calculations were performed. Costs of patients living at home were estimated by the current bottom-up cost-of-illness calculations, while costs of nursing home patients were considered by official reimbursement to determine the disease burden from a societal viewpoint. RESULTS: The mean age of the patients was 77.4 years (SD=9.2), 59% of them were female. The mean MMSE score was 16.70 (SD=7.24), and the mean EQ-5D score was 0.40 (SD=0.34). The average annual cost of dementia was 6,432 Euros per patient living at home and 6,086 Euros per patient living in nursing homes. For the whole demented population (based on EuroCoDe data) we estimated total annual costs of 846.8 million Euros; of which 55% are direct costs, 9% indirect costs and 36% informal care cost. Compared to acute myocardial infarction the total disease burden of dementia is 26.3 times greater. CONCLUSIONS: This is the first study investigating resource utilisation, costs, and quality of life of dementia patients in the Central and Eastern European region. Compared to the general population of Hungary EQ-5D values of the demented patients are lower in all age groups. Dementia related costs are much lower in Hungary compared to Western European countries. There is no remarkable difference between the costs of demented patients living at home and in nursing homes, from the societal point of view.","Aged;Aged, 80 and over;Caregivers;*Cost of Illness;Cross-Sectional Studies;Dementia/drug therapy/*economics/physiopathology/*therapy;Drug Costs/statistics & numerical data;Female;Health Care Costs/*statistics & numerical data;Health Care Surveys;Health Services/utilization;Home Nursing/economics;Humans;Hungary;Male;Nursing Homes/economics;Quality of Life;Severity of Illness Index","Ersek, K.;Kovacs, T.;Wimo, A.;Karpati, K.;Brodszky, V.;Pentek, M.;Jonsson, L.;Gustavsson, A.;McDaid, D.;Kenigsberg, P. A.;Valtonen, H.;Gulacsi, L.",2010,Oct,,0,
1203,Switch-like genes populate cell communication pathways and are enriched for extracellular proteins,"BACKGROUND: Recent studies have placed gene expression in the context of distribution profiles including housekeeping, graded, and bimodal (switch-like). Single-gene studies have shown bimodal expression results from healthy cell signaling and complex diseases such as cancer, however developing a comprehensive list of human bimodal genes has remained a major challenge due to inherent noise in human microarray data. This study presents a two-component mixture analysis of mouse gene expression data for genes on the Affymetrix MG-U74Av2 array for the detection and annotation of switch-like genes. Two-component normal mixtures were fit to the data to identify bimodal genes and their potential roles in cell signaling and disease progression. RESULTS: Seventeen percent of the genes on the MG-U74Av2 array (1519 out of 9091) were identified as bimodal or switch-like. KEGG pathways significantly enriched for bimodal genes included ECM-receptor interaction, cell communication, and focal adhesion. Similarly, the GO biological process ""cell adhesion"" and cellular component ""extracellular matrix"" were significantly enriched. Switch-like genes were found to be associated with such diseases as congestive heart failure, Alzheimer's disease, arteriosclerosis, breast neoplasms, hypertension, myocardial infarction, obesity, rheumatoid arthritis, and type I and type II diabetes. In diabetes alone, over two hundred bimodal genes were in a different mode of expression compared to normal tissue. CONCLUSION: This research identified and annotated bimodal or switch-like genes in the mouse genome using a large collection of microarray data. Genes with bimodal expression were enriched within the cell membrane and extracellular environment. Hundreds of bimodal genes demonstrated alternate modes of expression in diabetic muscle, pancreas, liver, heart, and adipose tissue. Bimodal genes comprise a candidate set of biomarkers for a large number of disease states because their expressions are tightly regulated at the transcription level.","Animals;Cell Communication/*genetics;Extracellular Matrix/metabolism;Extracellular Matrix Proteins/genetics/*metabolism;*Genes, Switch;Genome;Mice;Oligonucleotide Array Sequence Analysis;Phenotype;Signal Transduction/genetics;Transcription Factors/genetics/metabolism","Ertel, A.;Tozeren, A.",2008,Jan 04,10.1186/1471-2164-9-3,0,
1204,Competence Network Heart Failure (CNHF). Together against heart failure,,clinical competence;clinical trial (topic);dementia;Germany;government;health care quality;human;medical research;nonbiological model;organization and management;program evaluation;public relations,"Ertl, G.;Störk, S.;Börste, R.",2016,,10.1007/s00103-016-2322-y,0,
1205,Diagnostic value of cardiac 123I-metaiodobenzylguanidine ( 123I-MIBG) scintigraphy in Lewy body disorders,"Introduction. Lewy body disorders such as Parkinson's disease (PD) and Lewy body dementia (LBD) are associated with cardiac sympathetic denervation, which can be visualized on 123I-MIBG scintigraphy. Our objectives were to study the diagnostic value of this technique in Lewy body disorders and its relationship with PD clinical variables. Patients and methods. We studied 90 patients: 51 with PD, 19 with LBD, 9 with multiple system atrophy (MSA) and 11 controls. Scintigraphy images were qualitatively evaluated and early and delayed heart-to-mediastinum ratios (HMR) were calculated. The main confounding factors (ischemic heart disease, diabetes, hypertension and drugs) were controlled by multivariate linear regression analysis. We investigated correlations between scintigraphy variables and PD variables. Results. The delayed HMR, which showed better discriminative ability was 2.03 ± 0.32 in controls, 1.37 ± 0.30 in PD (p < 0.001 vs controls), 1.47 ± 0.45 in LBD (p = 0.001 vs controls) and 1.69 ± 0.28 in MSA (p = 0.02 vs controls; p = 0.004 vs PD). This ratio was influenced by PD/LBD diagnosis (β = -0.638; p < 0.001) and to a lesser degree, by ischemic heart disease (β = -0.244; p = 0.028). Optimal cut-off value between PD/LBD and controls was 1.71 (83% sensitivity and 82% specificity). Within the PD group, those with a family history of PD/LB showed higher delayed HMR values (1.65 ± 0.34 vs 1.30 ± 0.24 without history; p < 0.001) and proportion with normal scintigraphy (56% vs 5%; p = 0.001). Conclusions. Cardiac 123I-MIBG scintigraphy is useful in the diagnosis of Lewy body disorders, although its value in PD is conditioned by having a family history of PD.",(3 iodobenzyl)guanidine i 123;adrenergic receptor stimulating agent;beta adrenergic receptor blocking agent;levodopa;monoamine oxidase B inhibitor;pergolide;pramipexole;rasagiline;ropinirole;selegiline;serotonin uptake inhibitor;trazodone;tricyclic antidepressant agent;adult;aged;article;clinical trial;controlled clinical trial;controlled study;diabetes mellitus;diagnostic value;diffuse Lewy body disease;family history;female;heart;heart scintiscanning;human;hypertension;image analysis;ischemic heart disease;major clinical study;male;mediastinum;Parkinson disease;sensitivity and specificity;Shy Drager syndrome,"Escamilla-Sevilla, F.;Pérez-Navarro, M. J.;Muñoz-Pasadas, M.;Ortega-León, T.;Gallego-Peinado, M.;Cabello-García, D.;Gómez-Río, M.;Ortega-Moreno, A.;Carnero-Pardo, C.;Rebollo-Aguirre, A. C.;Mínguez-Castellanos, A.",2009,,,0,
1206,Access to palliative care: Which barriers for which patients?,"Palliative care was shown to be beneficial but too few patients have access to it. Barriers are a bad identification of patients, and a lack of knowledge as to their needs and the way palliative care can provide for them. There are communication difficulties. Patient and family representations were associated with a delay in referral to palliative care. Non cancer patients are referred even later as the evolution of the underlying disease is unpredictable. Expertise in palliative care was acquired with cancer patients and is not always suited to other patients' needs. Patients themselves are sometimes reluctant to turn to palliative care because it reminds them of cancer and an impending death. Doctors' education is warranted to improve access to and quality of palliative care.",cancer patient;chronic obstructive lung disease;clinical practice;dementia;health care quality;health service;heart failure;hospitalization;human;medical education;medical research;neoplasm;palliative therapy;patient identification;patient satisfaction;short survey,"Escher-Imhof, M.;Mazzocato, C.;Pautex, S.",2008,,,0,
1207,A one-year mortality clinical prediction rule for patients with heart failure,"AIMS: To create and validate a clinical prediction rule which is easy to manage, reproducible and that allows classifying patients admitted for heart failure according to their one-year mortality risk. METHODS: A prospective cohort study carried out with 2565 consecutive patients admitted with heart failure in 13 hospitals in Spain. The derivation cohort was made up of 1283 patients and 1282 formed the validation cohort. In the derivation cohort, we carried out a multivariate logistic model to predict one-year mortality. The performance of the derived predictive risk score was externally validated in the validation cohort, and internally validated by K-fold cross-validation. The risk score was categorized into four risk levels. RESULTS: The mean age was 77.2years, 49.7% were female and there were 611 (23.8%) deaths in the follow-up period. The variables included in the predictive model were: age>/=75, systolic blood pressure<135, New York Heart Association class III-IV, heart valve disease, dementia, prior hospitalization, haemoglobin<13, sodium<136, urea>/=86, length of stay>/=14 and Physical dimension of Minnesota Living with Heart Failure questionnaire. The AUC for the risk score were 0.73 and 0.70 in the derivation and validation cohorts, respectively, and 0.73 in the K-fold cross-validation. The percentage of mortality ranged from 8.08% in the low-risk to 58.20% in the high-risk groups (p<0.0001; AUC, 0.72). CONCLUSIONS: This model based on routinely available data, for admitted patients and with a follow-up at one year is a simple and easy-to-use tool for improving management of patients with heart failure.",Clinical prediction rule;Heart failure;One-year mortality risk,"Escobar, A.;Garcia-Perez, L.;Navarro, G.;Bilbao, A.;Quiros, R.;group, Cace-Hf Score",2017,Oct,,0,
1208,Previous medical problems in 326 consecutive hip fracture patients,"Pre-existing medical problems of elderly patients with hip fracture are seldom considered in orthopaedic literature, although they are indisputably the most important determinants for mortality, morbidity and final outcome. It is the purpose of this study to determine these problems in our hip fracture patients. Previous medical disorders and treatments, age, sex and type of fracture were prospectively recorded from all patients over 65 years old, diagnosed with hip fracture in a tertiary university general hospital during 2004. There were 326 patients who fractured their hip (81.04 hip fractures/100,000 people/year) (83.67.3 years old) (85.3% female). The patients existing medical conditions included hypertension (53% of patients), diabetes (19%), dementia (18%), cerebrovascular disease (11%), cataracts and/or blindness (10%), cardiac arrhythmia (9%), chronic obstructive pulmonary disease (9%), heart failure (8%), ischaemic heart disease (7%), psychiatric disorders other than dementia (7%), peptic ulcer (7%), and Parkinson's disease (5%); only 7% had no known significant medical problem beyond their fracture. Cardiovascular and neurological disorders, the most frequent, were also the most dangerous as potential sources for complications and difficulties during anaesthesia, surgery, immediate postoperative period and rehabilitation. Diabetes, the second most frequent diagnosis, complicated any other existing condition.",,"Escobar, L.;Escobar, R.;Cordero-Ampuero, J.",2006,Jan-Mar,,0,
1209,Visuo-spatial memory deficits following medial temporal lobe damage: A comparison of three patient groups,"The contributions of the hippocampal formation and adjacent regions of the medial temporal lobe (MTL) to memory are still a matter of debate. It is currently unclear, to what extent discrepancies between previous human lesion studies may have been caused by the choice of distinct patient models of MTL dysfunction, as disorders affecting this region differ in selectivity, laterality and mechanisms of post-lesional compensation. Here, we investigated the performance of three distinct patient groups with lesions to the MTL with a battery of visuo-spatial short-term memory tasks. Thirty-one subjects with either unilateral damage to the MTL (postsurgical lesions following resection of a benign brain tumor, 6 right-sided lesions, 5 left) or bilateral damage (10 post-encephalitic lesions, 10 post-anoxic lesions) performed a series of tasks requiring short-term memory of colors, locations or color-location associations. We have shown previously that performance in the association task critically depends on hippocampal integrity. Patients with postsurgical damage of the MTL showed deficient performance in the association task, but performed normally in color and location tasks. Patients with left-sided lesions were almost as impaired as patients with right-sided lesions. Patients with bilateral post-encephalitic lesions showed comparable damage to MTL sub-regions and performed similarly to patients with postsurgical lesions in the association task. However, post-encephalitic patients showed additional impairments in the non-associative color and location tasks. A strikingly similar pattern of deficits was observed in post-anoxic patients. These results suggest a distinct cerebral organization of associative and non-associative short-term memory that was differentially affected in the three patient groups. Thus, while all patient groups may provide appropriate models of medial temporal lobe dysfunction in associative visuo-spatial short-term memory, additional deficits in non-associative memory tasks likely reflect damage of regions outside the MTL. Importantly, the choice of a patient model in human lesion studies of the MTL significantly influences overall performance patterns in visuo-spatial memory tasks.",carbamazepine;citalopram;doxepin;escitalopram;etiracetam;gabapentin;lamotrigine;lorazepam;opipramol;oxcarbazepine;phenytoin;adult;aged;article;associative memory;astrocytoma;benign tumor;brain cortex;brain hypoxia;brain tumor;cavernous hemangioma;clinical article;controlled study;entorhinal cortex;epidermoid tumor;female;glioma;heart arrest;herpes simplex encephalitis;hippocampus;histopathology;human;male;medial temporal lobe;memory assessment;memory disorder;neuroepithelioma;nuclear magnetic resonance imaging;parahippocampal cortex;perirhinal cortex;pilocytic astrocytoma;preoperative period;resuscitation;short term memory;spatial memory;task performance;temporal lobe epilepsy;visual memory;visuo spatial memory disorder;working memory,"Esfahani-Bayerl, N. E.;Finke, C.;Braun, M.;Düzel, E.;Heekeren, H. R.;Holtkamp, M.;Hasper, D.;Storm, C.;Ploner, C. J.",2016,,,0,
1210,Impact of the most frequent chronic health conditions on the quality of life among people aged >15 years in Madrid,"BACKGROUND: This study sought to ascertain to what degree health-related quality of life (HRQL) in the City of Madrid was affected by each of the most frequent chronic health conditions, and the specific quality-of-life (QL) domains on which such health conditions had the greatest impact, taking co-morbidity and socio-demographic variables into account. METHODS: A descriptive, analytical, cross-sectional study was conducted covering 7341 subjects aged >or=16 years in the City of Madrid. Data were collected on self-reported diagnosed morbidity, including hypertension, hypercholesterolaemia, varicose veins, diabetes, chronic asthma/bronchitis, myocardial infarction/angina pectoris, stomach problems, allergy, arthrosis/arthritis or rheumatism, depression/anxiety, cataracts, cerebrovascular accidents (CVACs), chronic constipation, osteoporosis and Alzheimer's disease or dementia. HRQL was measured using the COOP/WONCA questionnaire. The effects of diagnosis, age, social class, gender and the co-morbidity were analysed using a multivariate analysis of covariance (ANCOVA). RESULTS: The chronic health conditions that registered the worst overall mean scores on the COOP/WONCA questionnaire were Alzheimer's disease or dementia, Parkinson's disease, fibromyalgia, CVACs and depression, with scores of over 26 points in all cases. After the introduction of socio-demographic variables in the model, the highest values of Snedecor's F-test corresponds to depression (F = 461.63), 'arthrosis/arthritis or rheumatism' (F = 175.41), Alzheimer's disease or dementia (F = 65.70), gastric disorders (F = 65.17), cancer (F = 43.08) and CVACs (F = 41.65). CONCLUSIONS: Depression and 'arthrosis/arthritis or rheumatism' are the two chronic health conditions, which have the greatest impact on HRQL in Madrid's citizens, therefore is mandatory to propose and implement public health strategies that would reduce the prevalence and morbidity of such disorders.",Adolescent;Adult;Aged;*Chronic Disease;Cross-Sectional Studies;Female;Humans;Male;Middle Aged;*Quality of Life;*Sickness Impact Profile;Spain;Young Adult,"Esteban y Pena, M.;Garcia, R. J.;Olalla, J. M.;Llanos, E. V.;de Miguel, A. G.;Cordero, X. F.",2010,Feb,10.1093/eurpub/ckp098,0,
1211,Statin use and risk of epilepsy: A nested case-control study,"Objective: To examine the potential efficacy of hydroxymethyl-glutaryl- coenzyme A reductase inhibitors (statins) in the prevention of epilepsy. Methods: This study was a population-based, nested case-control study among older adults in the province of Quebec, Canada. The primary cohort consisted of cardiovascular patients who had received a revascularization procedure. Within the cohort, those with the primary hospital diagnosis of epilepsy were identified (cases). Each case was matched to 10 controls by age and cohort entry time. Potential confounders were adjusted using a conditional logistic regression model. A sensitivity analysis was performed using propensity score matching. Results: The initial cohort consisted of 150,555 subjects. Within the cohort, 217 hospital-diagnosed cases of epilepsy and 2,170 corresponding controls were identified. The adjusted rate ratio (ARR) for epilepsy among current statin users was 0.65 (95% confidence interval [CI] 0.46-0.92). The ARR for past users of statins was 0.72 (95% CI 0.39-1.30). No benefit was found for the control drug groups, including nonstatin cholesterol-lowering drugs, β-blockers, and angiotensin-converting enzyme inhibitors (1.00 [95% CI 0.45-2.20], 1.04 [95% CI 0.74-1.47], and 0.94 [95% CI 0.66-1.33]). Conclusions: These results suggest that statin use decreases the risk of hospitalization for epilepsy. Because of its observational nature, this study requires future research to confirm these intriguing findings. Copyright © 2010 by AAN Enterprises, Inc.",anticonvulsive agent;atorvastatin;benzodiazepine;cerivastatin;fluindostatin;mevinolin;neuroleptic agent;pravastatin;rosuvastatin;serotonin uptake inhibitor;simvastatin;tricyclic antidepressant agent;adult;article;brain tumor;Canada;cardiac patient;case control study;cerebrovascular disease;comorbidity;controlled study;dementia;diabetes mellitus;dose response;drug efficacy;drug use;epilepsy;female;head injury;heart infarction;hospitalization;human;hypertension;logistic regression analysis;major clinical study;male;population research;priority journal;revascularization;risk assessment;sensitivity analysis,"Etminan, M.;Samii, A.;Brophy, J. M.",2010,,,0,
1212,A study of gantenerumab in patients with mild Alzheimer disease,"Inclusion criteria: - Adult patients, 50 to 90 years of age, inclusive - Clinical diagnosis of probable mild Alzheimer disease based on NINCDS/ADRDA criteria or major NCD due to AD of mild severity, whether or not receiving AD approved medication - Availability of a person ('caregiver') who in the investigator's judgment has frequent and sufficient contact with the patient, and is able to provide accurate information regarding the patient's cognitive and functional abilities - Fluency in the language of the tests used at the study site - Willingness and ability to complete all aspects of the study - Adequate visual and auditory acuity, in the investigator's judgment, sufficient to perform the neuropsychological testing (eye glasses and hearing aids are permitted) - If currently receiving approved medications for AD, doses must have been stable for at least 3 months prior to screening - Agreement not to participate in other research studies for the duration of this trial and its associated substudies Are the trial subjects under 18? no Number of subjects for this age range: 0 F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range 100 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 900 Exclusion criteria: - Dementia or NCD due to a condition other than AD, including, but not limited to, frontotemporal dementia, Parkinson disease, dementia with Lewy bodies, Huntington disease, or vascular dementia - History or presence of clinically evident vascular disease potentially affecting the brain that in the opinion of the investigator has the potential to affect cognitive function - History or presence of stroke within the past 2 years or documented history of transient ischemic attack within the last 12 months - History or presence of systemic autoimmune disorders potentially causing progressive neurologic disease with associated cognitive deficits - History of schizophrenia, schizoaffective disorder, or bipolar disorder - Alcohol and/or substance use disorder (according to the DSM-5) within the past 2 years (nicotine use is allowed) - History or presence of atrial fibrillation - Within the last 2 years, unstable or clinically significant cardiovascular disease (e.g., myocardial infarction, angina pectoris, cardiac failure New York Heart Association Class II or higher) - Uncontrolled hypertension - Chronic kidney disease - Impaired hepatic function <Condition>MILD ALZHEIMER?S DISEASE MedDRA version: 18.1 Level: HLT Classification code 10001897 Term: Alzheimer's disease (incl subtypes) System Organ Class: 100000004852 ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Name: Gantenerumab Product Code: Ro 490-9832/F12 Pharmaceutical Form: Solution for injection in pre-filled syringe INN or Proposed INN: gantenerumab CAS Number: n/a Current Sponsor code: RO4909832 Other descriptive name: human anti-Aß antibody Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 105- Pharmaceutical form of the placebo: Solution for injection in pre-filled syringe Route of administration of the placebo: Subcutaneous use Product Name: Gantenerumab Product Code: Ro 490-9832/F14 Pharmaceutical Form: Solution for injection in pre-filled syringe INN or Proposed INN: gantenerumab CAS Number: n/a Current Sponsor code: RO4909832 Other descriptive name: human anti-Aß antibody Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 225- Pharmaceutical form of the placebo: Solution for injection in pre-filled syringe Route of administration of the placebo: Subcutaneous use Product Name: Gantenerumab Product Code: Ro 490-9832/F10 Pharmaceutical Form: Solution for injection INN or Proposed INN: gantenerumab CAS Number: n/a Current Sponsor code: RO4909832 Other descriptive name: human anti-Aß antibody Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 300- Main Objective: Double-blind treatment period (Part 1): To evaluate the efficacy of gantenerumab administered to patients by",Sr-dementia,eudract_number,2013,,,0,
1213,"A study to see how effective and safe two doses of the study drug, LND101001 are compared to a placebo when given to patients with Mild to Moderate Alzheimer?s Disease. A placebo is a dummy medication - looks like the study drug but has no active ingredient","Inclusion criteria: 1. Male and female outpatients. 2. Patients with a diagnosis of dementia of the Alzheimer's type according to the Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM-IV TR?) criteria and a clinical diagnosis of probable AD according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer?s Disease and Related Disorders Association (NINCDS-ADRDA) criteria, 2011 Edition17, of AD and DSM-IV criteria of dementia. 3. Age of 50 to 85 years. 4. Brain MRI study to support the clinical diagnosis of AD within the last 12 months prior to the screening visit or during the screening period. 5. Mild to moderate stage of AD according to a MMSE score of 12 to 22 (inclusive) at the screening visit. 6. Clinical evidence of cognitive decline in the past 6 months (based on clinical assessments and patient history data, including reports from caregivers). 7. Patients who are treatment-naïve, have received treatment for AD in the past or currently receiving treatment for AD (in the latter case, Investigators should find it clinically justifiable to switch treatment, and patients should undergo a minimum adequate washout period of 14 days prior to randomization). 8. The patient, if a female, should: ? Have a FSH value indicating menopause with high reliability, AND ? Have had her last natural menstruation = 12 (or a different period, depending on region) months prior to the screening visit, OR ? Have been surgically sterilized prior to the screening visit, OR ? Have had a hysterectomy with oophorectomy prior to the screening visit. 9. The patient, if a male, should: ? Use two methods of contraception in combination; if his female partner is of childbearing potential; e.g., barrier methods such as condom or occlusive cap (diaphragm or cervical/vault cap) with spermicidal foam/gel/film/cream/suppository. (Failure rates indicate that, when used alone, the diaphragm and condom are not highly effective forms of contraception. Therefore, the use of additional spermicides does confer additional theoretical contraceptive protection. However, spermicides alone are inefficient at preventing pregnancy when the whole ejaculate is spilled. Therefore, spermicides are not a barrier method of contraception and should not be used alone.). This combination of contraceptive methods should be used from the baseline visit to = 3 months after the last dose of study medication, OR ? Have been surgically sterilized prior to the screening visit. ? Should not perform or plan to perform sperm donation from the baseline visit to = 3 months after the last dose of study medication. 10. Have good general health, hydration and nutrition status for participating in this clinical study, as assessed by the Investigator. 11. Ability to swallow capsules. 12. Patient living at home or in long-stay residential or care settings not requiring continuous and extensive nursing care; able to walk independently with or without a walking aid (e.g., cane or walker). 13. Patient has an identified, reliable caregiver (at least every day for a minimum of 1 to 2 hours) who is willing to provide support, ensure compliance, correct storage, preparation and administration of the study medication and ready to accompany the patient to study visits whenever required, as well as to provide information about the patient?s physical and behavioral symptoms and changes. 14. The patient and the caregiver are fluent in the language Exclusion criteria: 1. Clinical, laboratory or neuro-imaging findings consistent with: ? Other primary degenerative dementia, (dementia with Lewy bodies, Parkinson?s disease with dementia, frontotemporal dementia, Huntington?s disease, Jakob Creutzfeldt disease, Down?s syndrome, etc.) and/or vascular dementia. ? Other central nervous system lesions (hydrocephalus, severe head trauma, tumors, subdural hematomas or other relevant space occupying processes, etc.). ? Other relevant infectious, metabolic or systemic diseases (syphilis, juvenile onset diabetes mellitus, clinically signific nt vitamin B1 , folate or thyroid deficiency, clinically significant serum electrolyte disturbances, etc.) affecting central nervous system. ? Any other significant brain pathology/condition (hypoxia, brain infection, mental retardation) that can compromise the safety of the patient as determined by the Investigator. 2. Any current DSM-IV axis I diagnosis other than dementia of the Alzheimer?s type, specifically schizophrenia, schizoaffective disorder, bipolar disorders or major depressive disorder. 3. Patients with major risk of suicidal tendencies and suicide-related behavior, in particular, non-fatal suicide attempt, interrupted attempt, aborted attempt, and preparatory acts or behavior. 4. The patient has experienced/experiences hallucinations, delusions or any psychotic symptomatology. 5. The patient has one or more clinical laboratory test values outside the reference range, based on the blood and urine samples taken at the screening visit, that are of potential risk to the patient?s safety or the patient has, at the screening visit: ? A serum total bilirubin value > 1.5 times the upper limit of normal (ULN). ? A serum alanine aminotransferase (ALAT) or aspartate aminotransferase (ASAT) value > 2 times the ULN. ? A serum creatinine > 2 mg/dL and creatinine clearance = 60 mL/min according to Cockcroft-Gault formula. 6. The patient has, at the screening visit: ? An abnormal ECG that is, in the Investigator?s opinion, clinically significant. ? A PR interval > 250 ms. ? A QRS interval > 130 ms (if not caused by a bundle branch block). ? A QTcF interval > 450 ms (for males and females) (based on the Fridericia correction where QTcF = QT/RR0.33). ? A history of additional risk factors for Torsade de Points (e.g., heart failure, hypokalemia, family history of long QT syndrome). 7. Any clinically significant, advanced or unstable disease or history of that may interfere with primary or secondary variable evaluations, may bias the assessment of the clinical or mental status of the patient or put the patient at special risk. see protocol for more detail 8. In the judgment of the Investigator, the patient is not considered to be euthyroid. If the patient has a TSH level outside the laboratory established reference range, reflex test from TSH will be utilized to test for T4 to support the diagnosis whether the patient is clinically euthyroid. Patients who were previously diagnosed with hyperthyroidism or hypothyroidism and are receiving treatment should have been treated with a stable dose of thyroid supplement for at least the past 3 months. 9. The patient takes or has taken disallowed recent or concomitant medication within the period specified, or it is anticipated that the patient will require treatment during the study with at least one of the disallowed concomitant medications/treatments during the study. 10. The patient has clinic <Condition>Mild to Moderate Alzheimer?s Disease MedDRA version: 14.1 Level: LLT Classification code 10001896 Term: Alzheimer's disease System Organ Class: 100000004852 ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Code: LND101001 Pharmaceutical Form: Capsule, soft INN or Proposed INN: Not Assigned Current Sponsor code: LND101001 Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 2.5- Pharmaceutical form of the placebo: Capsule, soft Route of administration of the placebo: Oral use Product Code: LND101001 Pharmaceutical Form: Capsule, soft INN or Proposed INN: Not assigned Current Sponsor code: LND101001 Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 25- Pharmaceutical form of the placebo: Capsule, soft Route of administration of the placebo: Oral use Main Objective: To evaluate the efficacy of two different doses of LND101001 in improving cognitive function in patients with dementia of the Alzheimer's type in comparison with placebo, using the Alzheimer's Disease Assessment Scale - Cognitive Subscale - 13 (ADAS Cog-13) total score.;Secondary Objective: To evalua e the safety and tolerability of two di ferent doses of LND101001.;Primary end point(s): Primary Efficacy Endpoint: ? Mean change from baseline in the ADAS-Cog-13 total score at 90 days. ;Timepoint(s) of evaluation of this end point: At day 90 Secondary end point(s): Secondary Efficacy Endpoints: ? Mean change from baseline in the following: - ADCS-CGIC at 30, 60 and 90 days. - ADAS-Cog-13 total score at 30 and 60 days. - MMSE at 90 days. - ADCS-ADL at 30, 60 and 90 days. - NPI at 90 days. ;Timepoint(s) of evaluation of this end point: Various timepoints during the study",Sr-dementia,eudract_number,2013,,,0,
1214,A study of PQ912 in patients with Alzheimer's Disease,"Inclusion criteria: 1. Signed and dated written informed consent obtained from the subject in accordance with local regulations. 2. Male or surgically sterile or postmenopausal female, aged =50 to =89 years. Male subjects with childbearing potential partners are willing to and should use condoms during study medication treatment and until 28 days after the last dose of study medication. 3. Diagnosis of MCI due to AD or mild dementia due to AD with amnestic presentation, according to Alzheimer Association ? National Institute on Aging (AA-NIA) criteria [Albert et al 2011; McKhann et al 2011]. 4. MMSE score of 21 to 30 inclusive at screening. 5. Screening visit brain MRI scan consistent with the diagnosis of MCI due to AD or mild dementia due to AD, as judged by central rater. 6. A positive AD signature showing one of the following (either a, b, c, OR d): a. Screening CSF sample with an A-beta 42 concentration of less than 638 ng/L AND total tau >375 ng/L, as assessed by central laboratory. b. Screening CSF sample with an A-beta 42 concentration of less than 638 ng/L AND p-tau > 52 ng/L, as assessed by central laboratory. c. Tau/A-beta ratio > 0.52, as assessed by central laboratory. d. Positive amyloid PET if available prior to screening. 7. Treatment naïve, this means not having received any prior established specific treatment for MCI due to AD or mild dementia due to AD including no (prior) use of an acetylcholinesterase inhibitor, or memantine. A maximum of two months of prior cumulative treatment with an acetylcholinesterase inhibitor or memantine is allowed if the acetylcholinesterase inhibitor or memantine was discontinued due to intolerance and if this was done at least two months prior to baseline. Use of Souvenaid will be allowed if Souvenaid was discontinued at least two months prior to baseline, or if the subject is on stable dose for at least six months prior to baseline and is willing to continue during the study on the same dose and frequency. 8. Fluency in local language and evidence of adequate premorbid intellectual functioning in the opinion of the investigator. 9. Adequate visual and auditory abilities to perform the cognitive and functional assessments in the opinion of the investigator. 10. Outpatient with study partner (age 18 years or older) capable of accompanying the subject on all clinic visits. In accordance to Swedish regulations the availability of a study partner is not applicable for Sweden. 11. The subject and study partner are likely to be able to participate in all scheduled evaluations. In accordance to Swedish regulations the availability of a study partner is not applicable for Sweden. 12. In the opinion of the investigator, the subject and study partner can be compliant and have a high probability of completing the study. In accordance to Swedish regulations the availability of a study partner is not applicable for Sweden. Are the trial subjects under 18? no Number of subjects for this age range: F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range 55 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 55 Exclusion criteria: 1. Significant neurologic disease, other than AD, that may affect cognition. 2. Atypical clinical presentations of MCI due to AD or mild dementia due to AD, such as the visual variant of AD (including posterior cortical atrophy) or the language variant (including logopenic aphasia). Concomitant disorders: 3. History of or screening visit brain MRI scan indicative of any other significant abnormality, including but not limited to multiple microhaemorrhages (4 or more, defined as 10 mm or less at the greatest diameter), severe white matter hyper intensities (Fazekas score 3), history or evidence of a single prior haemorrhage >1 cm3, multiple lacunar infarcts or evidence of a single prior infarct >1 cm3, evidence of a cerebral contusion, encephalomalacia, aneurysms, vascular malformations, subdural hematoma, or space-occupying lesions (e.g. brain tumours). 4. Current presence of a clinically important major psych atric disorder (e.g. major depressive disorder) as defined by DSM-5 criteria, or symptom(s) (e.g. hallucinations) that could affect the subject?s ability to complete the study. 5. Current clinically important systemic illness that is likely to result in clinically relevant deterioration of the subject?s condition or might affect the subject?s safety during the study. 6. History of clinically evident stroke or history of clinically important and symptomatic carotid or vertebrobasilar stenosis or plaque. 7. History of seizures within the last two years prior to the screening visit. 8. Weight > 120 kg (264 lb) at screening. 9. Myocardial infarction within the last six months prior to screening. 10. History of cancer within the last two years prior to screening, with the exception of any of the following conditions: non-metastatic basal cell carcinoma, and squamous cell carcinoma of the skin or any other cancer if evidence of no residual cancer has been clinically confirmed within the last six months before baseline. 11. History of uncontrolled hypertension (in the opinion of the investigator) within six months prior to screening. 12. Other clinically important diseases or conditions or abnormalities of vital signs, physical examination, neurologic examination, laboratory results, or ECG examination (e.g. atrial fibrillation) that could compromise the study or the safety of the subject. 13. Haemoglobin level less than 11 g/dL (6.8 mmol/L) at screening. 14. Clinically important infection within 30 days prior to screening (e.g. chronic persistent or acute infection, such as bronchitis or urinary tract infection. 15. Any known hypersensitivity to any of the excipients contained in the test article formulation. 16. Severe hepatic failure (Child-Pugh C) or kidney failure (creatinine clearance (eGFR) = 30 ml/min/1.73m2) or serum creatinine above 1.5 fold of ULN or AST or ALT above 3 fold of ULN at screening. 17. The following therapies are not permitted for the given intervals prior to baseline and until V5/EOT: ? Anticoagulants (e.g. heparin and vitamin K antagonists) within 30 days ? Use of experimental medications for AD or any other investigational medications or devices for treatment of indications other than AD within 60 days. ? Treatment with an acetylcholinesterase inhibitor or memantine or Souvenaid, except for an acetylcholinesterase inhibitor or memantine in case of clinically relevant worsening of cognitive performance during the double blind study period, and for Souvenaid if only on stable dose for at <Condition>Early Stage Alzheimer's Disease MedDRA version: 19.0 Level: LLT Classification code 10001896 Term: Alzheimer's disease System Organ Class: 10029205 - Nervous system disorders MedDRA version: 19.0 Level: PT Classification code 10074616 Term: Prodromal Alzheimer's disease System Organ Class: 10029205 - Nervous system disorders ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Name: PQ912 Product Code: PQ912 Pharmaceutical Form: Tablet INN or Proposed INN: PQ912 Other descriptive name: PQ912 Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 200- Pharmaceutical form of the placebo: Tablet Route of administration of the placebo: Oral use Main Objective: The primary objective of this study is to assess the safety and tolerability of multiple doses of PQ912 compared with placebo in subjects with early stage AD. ;Secondary Objective: ? To explore the efficacy of PQ912 from baseline to week 12 on cognitive function, as measured by a neuropsychological test battery. ? To assess the pharmacodynamics of PQ912 and to identify therapeutic markers as measured by a panel of concept- and AD-related biomarkers in CSF. ? To investigate the effect of PQ912 on brain functional connectivity as assessed by RSfMRI. ? To provide biological support for the hypothesized PQ912 efficacy in counter-acting disruption of the functional network organization in MCI due to AD or mild dementia due to AD, using functional connectivity and n twork analysis in EEG. ;Primary end po nt(s): Three primary safety endpoints are defined: time to dose adjustment (as an indication of tolerability), number of (S)AEs (as an indication of safety) and compliance as measured by adherence to prescribed investigational product compared to placebo (as an indication of feasibility). ;Timepoint(s) of evaluation of this end point: V5/EOT Timepoint(s) of evaluation of this end point: V5/EOT;Secondary end point(s): Additionally the following safety endpoints will be assessed throughout the study: spontaneously reported adverse events (AEs), vital signs (heart rate, blood pressure), ECG measurements, clinical laboratory tests, changes on brain MRI scans as judged by central rating (ARIA-E, ARIA-H, infarcts etc.), physical and neurologic examinations. Secondary study endpoints are: Neuropsychological endpoints: An exploratory endpoint is efficacy of PQ912 versus placebo on cognitive function as measured by a neuropsychological test battery between baseline (V2) and End-of-treatment visit (V5/EOT). CSF endpoints: The levels of and correlation between at least a choice of the following biomarkers will be assessed in CSF at screening (V1) and End-of-treatment visit (V5/EOT): 1. Individual tests for diagnosis: ? A-beta 1-42. ? Tau. ? P- tau. 2. Exploratory biomarkers as clusters: ? QC enzyme. ? Panel of A-beta peptide versions of various length (X-40/42). ? Panel measuring pGluAbeta and its substrates A-beta 3-40/42 and 11-40/42. ? Panel of A-beta oligomer assays using different technologies, each likely detecting A-beta-Oligomers of different a length. ? Panel of inflammatory markers. Neuronal network endpoints: The functional connectivity of the neuronal network will be evaluated with EEG and resting-state fMRI. The following endpoints will be calculated from the EEG: ? Mean peak frequency in the parieto-occipital region. ? Mean global Phase Lag Index in the alpha band. ? Minimum Spanning Tree analyses: o Leaf fraction in the alpha band. o Tree hierarchy in the alpha band. The following endpoints will be calculated from the RSfMRI: ? Eigenvector centrality values. ? Average path length and clustering.",Sr-dementia,eudract_number,2014,,,0,
1215,Study to find out whether AADvac1 is safe and efficient for patient with mild Alzheimer's disease,"Inclusion criteria: 1. Patient has a diagnosis of probable Alzheimer?s disease according to the revised NIA-AA criteria (McKhann 2011). 2. Patient has a MMSE total score = 20 and = 26 at Screening. 3. Patient has a brain MRI finding consistent with the diagnosis of Alzheimer?s disease at Screening. 4. Patient has a medial temporal lobe atrophy as assessed on brain MRI and according to a Scheltens score of = 2 (rated on a scale of 0-4 on the more atrophied side) at Screening. 5. Patient had completed 6 years of formal elementary education. 6. Patients aged 50-85 years inclusive at Screening. 7. Patient is fluent in the local language and possesses sufficient auditory and visual capacities to allow neuropsychological testing. 8. Patient is able to read and understand the informed consent. 9. Patient is on a stable therapy with an acetylcholinesterase inhibitor for at least 3 months prior to screening visit. 10. If the patient is on memantine treatment, the dose regimen must be stable for at least 3 months prior to Screening (V01). 11. Patient has a Hachinski Ischemia Scale score = 4 at Screening. 12. Availability of a caregiver who sufficiently knows the patient and will be able to accompany the patient on the study visits and to participate in study assessments of the patient where required. 13. Female patients are only eligible for the study if they are either surgically sterile or at least 2 years postmenopausal. 14. Male patients must either be surgically sterile, or he and his female spouse/partner who is of childbearing potential must be using highly effective contraception consisting of 2 forms of birth control (1 of which must be a barrier method) starting at screening and continuing throughout the study period. 15. Patient provides written informed consent. Are the trial subjects under 18? no Number of subjects for this age range: F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range 77 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 108 Exclusion criteria: 1. Patient has been participating in another clinical study within 3 months prior to Screening. 2. Female patient who is pregnant or breastfeeding. 3. Patient is not expected to complete the clinical study. 4. Patient has known allergy to components of the vaccine currently or in the past, if considered relevant by the investigator. 5. Patient has known contraindication for MRI imaging such as MRI-incompatible metallic endoprosthesis or MRI-incompatible stent implantation or other as judged by the Investigator. 6. Any of the following detected by brain MRI: a) Infarction in the territory of large vessels b) More than one lacunar infarct defined as a focal lesion of CSF signal intensity with a diameter of less than 1.5 cm in any dimension. c) Any lacunar infarct in a strategically important location such as the thalamus, hippocampus of either hemisphere, head of the left caudate nucleus. d) Confluent hemispheric deep white matter lesions (Fazekas grade 3). e) Other focal lesions which may be responsible for the cognitive status of the patient such as infectious disease, space-occupying lesions, normal pressure hydrocephalus or any other abnormalities associated with significant central nervous disease other than Alzheimer?s disease. 7. Patient underwent surgery (under general anaesthesia) within 3 months prior to screening and/or has scheduled surgery (under general anaesthesia) during the whole study period. 8. Patient has a history and/or currently suffers from a clinically significant autoimmune disease, or is expected to receive immunosuppressive or immunomodulatory treatment at the present or in the future. 9. Patient has a recent history of cancer (last specific treatment = 5 years prior to Screening) (Exceptions: basal cell carcinoma, intraepithelial cervical neoplasia). 10. Patient had myocardial infarction within the last 2 years prior to Screening. 11. Patient has Hepatitis B, C, HIV or Syphilis confirmed by serology. 12. Patient suffers from an active infectious disease. 13. Presence a d/or histo y of immunodeficiency. 14. Patient currently suffering from a clinically important systemic illness that is likely to result in deterioration of the patient?s condition or affect the patient?s safety during the study: *poorly controlled congestive heart failure (NYHA = 3) *BMI > 40 *poorly controlled diabetes (HbA1c > 7.5%) *severe renal insufficiency (eGFR < 30 mL/min) *chronic liver disease ? ALT (alanine aminotransferase) > 66 U/L in females or > 80 U/L in males, AST (aspartate aminotransferase) > 82 U/L *QTc interval prolongation in ECG (> 450 ms) *other clinically significant systemic illness, if considered relevant by the investigator 15. Patient suffers from hypothyroidism, defined as TSH (thyroid-stimulating hormone) elevation > 5.000 mcIU/mL, and/or FT4 levels < 0.7 ng/dL. Patients with corrected hypothyroidism are eligible for the study provided that treatment has been stable for 3 months before study entry. 16. Patient has valid diagnosis of a significant psychiatric illness such as schizophrenia, any type of psychotic disorder or bipolar affective disorder. 17. Patient has a current depressive episode (Geriatric Depression Scale GDS = 6 at Visit 01) or had a major depressive episode within the last 1 year. 18. Patient has a metabolic or toxic encephalopathy or dementia due to a general medical condition. 19. Patient has a history of alcohol or drug abuse or dependence within the past 2 yea Product Name: AADvac1 Product Code: AADvac1 Pharmaceutical Form: Suspension for injection INN or Proposed INN: AADvac1 Current Sponsor code: Axon peptide 108 (coupled to KLH) Other descriptive name: AADVAC1 Concentration unit: µg microgram(s) Concentration type: equal Concentration number: 40- Pharmaceutical form of the placebo: Suspension for injection Route of administration of the placebo: Subcutaneous use Main Objective: To evaluate safety and tolerability of long-term AADvac1 treatment of patients with mild Alzheimer?s disease.;Secondary Objective: ? To evaluate efficacy of AADvac1 treatment in slowing or cessation of cognitive and functional decline in patients with mild Alzheimer?s disease, as measured by Clinical Dementia Rating Scale Sum of Boxes (CDR-SB). ? To evaluate efficacy of AADvac1 treatment in slowing or cessation of cognitive decline in patients with mild Alzheimer?s disease, as measured by a composite score of a battery of cognitive tests assessing multiple domains of cognition. ? To evaluate the effect of AADvac1 treatment on patient functioning as measured by the ADCS-MCI-ADL questionnaire ? To evaluate immunogenicity of AADvac1 by measuring antibody titres and antibody isotype profiles.;Primary end point(s): The safety assessment is based on the number, type and severity of adverse events. - The incidence of adverse events for each group will be summarized by organ class, severity and duration. - Descriptive statistics for laboratory values, imaging and clinical observations, and their change from baseline will be prepared for each group. - Safety will be statistically analysed. Statistical analysis will only be used to draw attention to areas of concern. ;Timepoint(s) of evaluation of this end point: - for active patients at every visit V01-V17 Secondary end point(s): ? Mean change in CDR-SB score from Baseline to Visit 16 (week 104) ? Mean change in standard (composite z-score) score of Custom Cognitive Battery from Baseline to Visit 16 (week 104). The composite Z score is calculated from the results of the following tests: o Cogstate International Shopping List Task (immediate and delayed recall, recognition): verbal episodic memory o Cogstate One Card Learning and One Card Back tasks: visual episodic memory o Letter Fluency Test & Category Fluency Test: executive function o Digit-Symbol Coding test: processing speed, working memory, executive function ? Mean change in ADCS-MCI-ADL score from Baseline to Visit 16 (week 104). ? Percentage of AADvac1-treated patients who develop an immune response against the ?Axon peptide 108? component of AADvac1. ? Geometric mean titre of AADvac1-induced antibodi s (total, IgM, and IgG) ;Timepoint(s) of evaluation of this end point: * Cognition (CDR-SB, Custom Cognitive Battery, and ADCS-MCI-ADL): V02, V05, V08, V09, V11, V12, V14, V15 and V16 * Percentage of AADvac1-treated patients who develop an immune response against the ?Axon peptide 108? component of AADvac1 (at any point in the study) * Geometric mean titre of AADvac1-induced antibodies (total, IgM, and IgG): V02-V16",Sr-dementia,eudract_number,2015,,,0,
1216,"A 12 week, multicentre, study investigating the efficacy of ORM-12741 on agitation/aggression symptoms in patients with Alzheimer's Disease","Inclusion criteria: 1. Written informed consent (IC) for participation in the study (co-signed by the subject?s next of kin or caregiver, or other legally acceptable representative, if required by the local regulations/guidelines/ethics committee [EC]) obtained from the subject. 2. Written IC obtained from a consistently available caregiver informant who is knowledgeable of the subject?s condition and its progression and is willing to accompany the subject to all visits and supervise the administration of the study medication. The caregiver should be in contact with the subject on most days, as the contact is necessary to ensure accurate reporting of the subject?s behaviour on rating scales. 3. Age of 55-90 years (inclusive). Inclusion of subjects above the age of 80 years will need the medical monitor?s approval before enrolment. 4. Male or female subjects with diagnosis of probable AD according to the recommendations from the National Institute on Aging-Alzheimer?s Association workgroups on diagnostic guidelines for Alzheimer?s disease 5. History of progressive cognitive deterioration prior to baseline (via caregiver or medical record review). 6. Brain imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) consistent with a diagnosis of AD (within 18 months or at screening). In case the medical history suggests a neurological event between the previous scan and the screening, the scan should be repeated. 7. Mini-mental state examination (MMSE) score between 10-24 (inclusive) at screening visit. 8. Clinically significant agitation meeting the IPA Provisional Criteria for Agitation in Cognitive Impairment (Appendix 3), both at screening and baseline visits. The agitation symptoms need to have been present for at least 4 weeks before the screening visit and also have to be sustained up to the baseline visit. 9. NPI agitation/aggression item score ?4 at screening visit (on original NPI scale, as derived from the NPI-C). Are the trial subjects under 18? no Number of subjects for this age range: F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range 50 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 250 Exclusion criteria: 1. Any other type of dementia than AD. 2. Modified Hachinski Ischemia Score (MHIS) > 4. 3. Changes in AChE inhibitor (donepezil, rivastigmine or galantamine) dosing within 2 months prior to screening. 4. Changes in memantine dosing within 2 months prior to the screening. 5. Changes in antidepressant dosing or addition of another antidepressant medication within 2 months prior to the screening. 6. Use of antipsychotics at any dose within 1 month prior to screening (even for sleep). In the event of previous use of long-acting injectable antipsychotics the duration of required wash-out (at least 5 times the elimination half-life) needs to be agreed with the medical monitor before enrollment. 7. Use of benzodiazepines, other than short-acting sleep medications, for night at a maximum of 3 nights/week, within 2 months prior to screening. 8. Use of any anticholinergic medication within 2 months prior to screening (including those used to treat overactive bladder and tricyclic antidepressants). 9. Current use (within the 30 days prior to screening) of medications with known relevant alpha-2C AR affinity (e.g. mirtazapine, mianserine, clonidine, guanfacine or tizanidine) or with high noradrenaline transporter affinity (reboxetine, venlafaxine or duloxetine). 10. Current use of other psychotropic agents, unless the dosing has been stable during the last 2 months prior to the screening and is expected to remain stable during the study, and permission has been obtained from the medical monitor before enrolment. 11. Myocardial infarction or other clinically significant ischemic cardiac disease, heart failure, or arrhythmia tendency within the past 2 years. 12. Poorly controlled diabetes mellitus 13. Current or history of malignancy within 5 years before screening (some exceptions) 14. Suicidal ideation in the 6 months before scr ening or current su cide risk. 15. Known or suspected history of alcoholism or drug abuse. 16. Any other clinically significant cardiovascular, pulmonary, gastrointestinal, hepatic, renal, neurological (e.g. epilepsy) or psychiatric disorder (e.g. lifetime schizophrenia, or bipolar disorder within last 5 years) or any other major concurrent illness that in the opinion of the investigator may interfere with the interpretation of the study results or constitute a health risk for the subject 17. Specific findings in MRI or CT that could in the opinion of the investigator affect cognitive function 18. Supine HR < 48 bpm or > 100 bpm after a 5-minute rest at screening visit. 19. Systolic blood pressure (SBP) > 160 mmHg or diastolic blood pressure (DBP) > 100 mmHg after a 5-minute rest at screening visit. 20. Symptomatic orthostatic hypotension at screening visit. 21. QTc-Fridericia (QTcF) repeatedly > 450 ms in males or > 470 ms in females at screening visit. 22. Clinically significantly abnormal thyroid-stimulating hormone (TSH), vitamin B12 or folate serum levels at screening. 23. Any other abnormal value in laboratory tests, vital signs or ECG which may in the opinion of the investigator interfere with the interpretation of the study results (e.g. affect cognition) or cause a health risk for the patient 24. Female patients of childbearing potential 25. Pre-planned elective surgery for the study period 26. Known hypersensitivity to the active substance. 27. Blood donation or loss of significant amount of blood within 60 days prior to the scree <Condition>The agitation/aggression symptoms in patients with Alzheimer?s disease MedDRA version: 17.1 Level: LLT Classification code 10001896 Term: Alzheimer's disease System Organ Class: 100000004852 ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Name: ORM-12741 Pharmaceutical Form: Capsule, hard INN or Proposed INN: ORM-12741 Other descriptive name: ORM-12741 (Immediate Release) Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 60- Pharmaceutical form of the placebo: Capsule, hard Route of administration of the placebo: Oral use Product Name: ORM-12741 Pharmaceutical Form: Modified-release capsule, hard INN or Proposed INN: ORM-12741 Other descriptive name: ORM-12741 (Modified Release A) Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 60- Product Name: ORM-12741 Pharmaceutical Form: Modified-release capsule, hard INN or Proposed INN: ORM-12741 Other descriptive name: ORM-12741 (Modified Release B) Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 60- Main Objective: The primary objective of the study is to evaluate efficacy of ORM-12741 on agitation/aggression symptoms in patients with mild to moderate Alzheimer?s disease. The efficacy of ORM-12741 administered both as immediate release (IR) and modified release (MR) formulations will be evaluated and compared to placebo. ;Secondary Objective: The secondary objectives of the study are to evaluate the efficacy of ORM-12741 on cognition and psychotic and depressive symptoms, as well as to evaluate the safety of ORM-12741.;Primary end point(s): The primary efficacy evaluation will be done for the sum of the NPI-C agitation and aggression domains (NPI-C-A+A).;Timepoint(s) of evaluation of this end point: Will be assessed at screening, baseline (day 1 predose) and at the week 4, 8 and 12 visits by a trained clinician rater Secondary end point(s): The key secondary evaluation will be done for the CDR System Quality of Memory. In addition, special priority will be put to preplanned analyses of CGIC-A/A (agitation), CGIC-O (overall clinical condition), CMAI-C total score, NPI-C-D+H and NPI-C dysphoria/depression domains.;Timepoint(s) of evaluation of this end point: The CDR System computerised cognitive test battery will be assessed at screening and baseline (day 1 predose). At week 4, week 8 and week 12 visits. The CDR Assessment System cognitive test battery will be assessed 1 our after study treatment administration a d at week 8 visit additionally 4h after study treatment. CMAI-C will be assessed based on the caregiver interview at baseline (day 1) and at the week 4, 8 and 12 visits after NPI-C mADCS-CGIC - will be assessed at week 4, 8 and 12 visits by mADCS-CGIC scale based on both caregiver and subject interviews. The following variables will be derived from the NPI/NPI-C rating: - Sum of the NPI-C delusion and hallucination domain scores - Individual NPI-C domain scores",Sr-dementia,eudract_number,2015,,,0,
1217,221AD302 Phase 3 Study of Aducanumab in Early Alzheimer's Disease,"Inclusion criteria: Key Inclusion Criteria: - Must meet all of the following clinical criteria for MCI due to AD or mild AD and must have: - A Clinical Dementia Rating (CDR)-Global Score of 0.5. - A Repeatable Battery for Assessment of Neuropsychological Status (RBANS) score of 85 or lower indicative of objective cognitive impairment - An MMSE score between 24 and 30 (inclusive) - Must have a positive amyloid Positron Emission Tomography (PET) scan - Must consent to apolipoprotein E (ApoE) genotyping - Must have stable symptomatic AD medications - Must have a reliable informant or caregiver LTE specific Criteria at week 78: - Must have completed the placebo-controlled period of the study. - MMSE score > 15 at the Week 78 Visit. - Must (or the subject's legally authorized representative) understand the purpose and risks of the study and provide signed consent (or assent) - Apart from a clinical diagnosis of AD, subject must be in good health as determined by the Investigator, based on medical history. - Must have the ability to comply with procedures for protocol-related tests. - Must have reliable informant or caregiver NOTE: Other protocol defined Inclusion criteria may apply Are the trial subjects under 18? no Number of subjects for this age range: F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range 600 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 750 Exclusion criteria: Key Exclusion Criteria: - Any medical or neurological condition (other than Alzheimer's Disease) that might be a contributing cause of the subject's cognitive impairment - Have had a stroke or Transient Ischemic Attack (TIA) or unexplained loss of consciousness in the past 1 year - Clinically significant psychiatric illness in past 6 months - History of unstable angina, myocardial infarction, chronic heart failure, or clinical significant conduction abnormalities within 1 year prior to Screening - Indication of impaired renal or liver function - Have human immunodeficiency virus (HIV) infection - Have a significant systematic illness or infection in past 30 days - Relevant brain hemorrhage, bleeding disorder and cardiovascular abnormalities - Any contraindications to brain magnetic resonance imaging (MRI) or PET scans - Alcohol or substance abuse in past 1 year - Taking blood thinners (except for aspirin at a prophylactic dose or less) - Use of AD medications at doses that have not been stable for at least 8 weeks prior to Screening Visit 1 Subjects will be excluded from entering the LTE if at Week 78 they have: any medical or psychiatric contraindication or clinically significant abnormality that will substantially increase the risk associated with the subject's participation in and completion of the study. NOTE: Other protocol defined Exclusion criteria may apply <Condition>Early Alzheimer's Disease MedDRA version: 19.0 Level: LLT Classification code 10001896 Term: Alzheimer's disease System Organ Class: 100000004852 ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Name: Aducanumab Product Code: BIIB037 Pharmaceutical Form: Concentrate for solution for infusion INN or Proposed INN: Aducanumab CAS Number: N/A Current Sponsor code: BIIB037 Concentration unit: mg/ml milligram(s)/millilitre Concentration type: equal Concentration number: 50- Pharmaceutical form of the placebo: Solution for injection/infusion Route of administration of the placebo: Intravenous use Main Objective: Placebo-controlled period: To evaluate the efficacy of monthly doses of aducanumab in slowing cognitive and functional impairment as measured by changes in the CDR-SB score as compared with placebo in subjects with early AD. Long-term Extension: To evaluate the long-term safety and tolerability profile of aducanumab in subjects with early AD. ? To evaluate the long-term efficacy of aducanumab treatment as measured by clinical, radiological, and additional assessments reported by the subject and informant/care partner.;Secondary Objective: To assess the effect of monthly doses o aducanu ab as compared with placebo on clinical progression as measured by the MMSE. To assess the effect of monthly doses of aducanumab as compared with placebo on clinical progression as measured by ADAS-Cog 13. To assess the effect of monthly doses of aducanumab as compared with placebo on clinical progression as measured by ADCS-ADL-MCI. ;Primary end point(s): Primary endpoint: Change from baseline in CDR-SB score at Week 78. LTE period endpoints: The incidence of AEs and/SAEs; brain MRI findings (including the incidence of ARIA-E and ARIA-H); and the incidence of anti-aducanumab antibodies in serum over the placebo-controlled and LTE periods of the study. Change in the following measures over the placebo-controlled and LTE periods of the study: CDR-SB score. MMSE score. ADAS-Cog 13 score. ADCS-ADL-MCI score. Amyloid PET signal (in a subset of subjects). Whole brain volume, hippocampal volume, ventricular volume, and cortical gray matter volume measured by MRI. Functional connectivity as measured by tf-fMRI (where available). Cerebral blood flow as measured by ASL-MRI (where available). Disease-related biomarker levels in CSF which will include, but are not limited to, amyloid and tau proteins (in a subset of subjects). Disease-related biomarker levels in blood which may include, but are not limited to, amyloid and tau proteins. NPI-10 total score. Informant-rated EQ-5D index score. Informant/care partner?s own self-reported EQ-5D index score. Caregiver burden measures.;Timepoint(s) of evaluation of this end point: Primary endpoint: Week 78 LTE endpoints: On-going over the course of the study Secondary end point(s): Change from baseline in MMSE score at Week 78. Change from baseline in ADAS-Cog 13 score at Week 78. Change from baseline in ADCS-ADL-MCI score at Week 78.;Timepoint(s) of evaluation of this end point: Week 78",Sr-dementia,eudract_number,2015,,,0,
1218,"This is a multicenter, double-blind, randomized, placebo-controlled, parallel-group study: the efficacy and safety of investigated drug RVT-101 at a dose of 35 mg daily when used as an adjunct treatment to stable donepezil therapy will be evaluated over a 24-week treatment period for mild to moderate Alzheimer?s disease in patients on stable therapy with donepezil","Inclusion criteria: Subjects eligible for enrollment in the study must meet all of the following criteria: -Male or female subject with a clinical diagnosis of AD in accordance the recommendations from the National Institute on Aging-Alzheimer?s Association workgroups on diagnostic guidelines for AD. - Subject has a documented history of at least 4 months of ongoing donepezil therapy for AD, with stable dosing of 5 or 10 mg/day for at least the last 2 months and with no intent to change for the duration of the study. - Subject has an MMSE score 12 to 24 inclusive at Screening and a Baseline MMSE score 10 to 26 inclusive. The difference between the Screening and Baseline MMSE score is less than or equal to 3 points. If a greater than 3-point difference between the Screening and Baseline MMSE score is in the opinion of the investigator due to recent changes in AD medication, Screening may be extended for an additional 3 weeks after discussion with the Medical Monitor, during which time MMSE stability, defined as less than or equal to 3-point change over 3 weeks, must be observed. - Subject has a Hachinski Ischaemia score less than or equal to 4 at Screening. - Magnetic resonance imaging (MRI) or computed tomography (CT) scan performed within 12 months before screening with findings consistent with the diagnosis of dementia due to AD without any other clinically significant pathologies. If an MRI (preferred) or CT scan is unavailable or was performed longer than 12 months prior to Screening, one must be performed during the Screening Period (prior to Run-In). - Age greater than or equal to 50 years to less than or equal to 85 years at the time of Screening. - If female, subject must be: a. Of non-childbearing potential (i.e., any female who is post-menopausal [greater than 1 year without menstrual period in the absence of hormone replacement therapy]) or surgically sterile; or, b. If pre-menopausal or menopausal for 1 year or less, must have a negative pregnancy test and must not be lactating at the Screening and Baseline Visits. Female subjects of childbearing potential and who are sexually active are required to practice adequate methods of birth control. Female subjects for whom menopausal status is in doubt in the opinion of the investigator will be required to use an adequate form of birth control. Acceptable, adequate form of birth control is defined as consistent use of combined effective methods of contraception including at least 1 barrier method. Male subjects who are sexually active will also be required to use an adequate form of birth control as described above. - Subject has the ability to comply with procedures for cognitive and other testing in the opinion of the investigator. - Subject must be able to ingest pills (in tablet form) whole. - Subject lives with (or has substantial periods of contact with) a regular caregiver who is willing to attend visits, oversee the subject?s compliance with protocol-specified procedures and study medication, and report on subject?s status, and who has substantial contact with the subject. If the caregiver does not cohabitate with the subject, he/she ideally should have a minimum of 10 hours total and at least 3 days contact with the subject per week. Prior to randomization, study representatives will review eligibility of non-cohabitating caregivers. Every effort should be made to have the same caregiver throughout the study. - Subject has provided full written informed consent prior to the p Exclusion criteria: A subject will not be eligible for inclusion in this study if any of the following criteria apply: Other Causes for Dementia - Diagnosis of possible, probable, or definite vascular dementia - History and/or evidence of any other CNS disorder that could be interpreted as a cause of dementia - Evidence of the following disorders where this is thought to be the cause of, or to contribute to the severity of, the subject?s dementia: current vitamin B12 deficiency, hypothyroidism, neurosyphilis, or Wernicke?s encephalopathy. - Focal findings on the neurol gical exam hat are inconsistent with a primary diagnosis of AD. - History of existing negative amyloid positron emission tomography scan or similar brain amyloid imaging, or Screen Failure from research trial due to negative amyloid imaging within 5 years. - Atypical clinical features or clinical course of dementia that conclude symptoms are more likely due to an alternate dementia diagnosis. Confounding Medical Conditions - History of significant psychiatric illness such as schizophrenia or bipolar affective disorder, or significant suicide risk. Current psychosis that in the opinion of the investigator would interfere with the subject?s ability to participate in this study. History of epilepsy or unexplained seizure in the past 5 years. History of alcohol use disorder or other substance abuse disorder in the past 10 years. History of Down syndrome or mental retardation. - Any clinically relevant concomitant disease including progressive liver or kidney dysfunction, history of myocardial infarction or unstable angina within 6 months of Screening. - Concomitant Medications: Participation in another investigational drug or device study in AD during the 60 days prior to the Screening Visit or Treatment with any concomitant medications as detailed in Table 1 of protocol. Unacceptable Test/Laboratory Values such as: -Postural hypotension at the time of screening. - Persistent or recurrent liver enzyme elevations. - Total bilirubin over 1.5 x ULN - Calculated creatinine clearance less than 40 mL/min - Positive hepatitis B surface antigen or hepatitis C antibody test. - QT interval (QTc) value =450 msec for males or =470 msec for females Other Previous exposure to RVT-101 or SB742457. Subject non-compliance in taking study medication as prescribed throughout the study Subject or caregiver is an immediate family member or employee of the participating investigator, any of the participating site staff, or of the sponsor study staff. Subject was prescribed cognitive tasks for cognitive rehabilitation performed under medical supervision in the 3 months prior to Screening and/or during the study. Subject has participated in a program of neurostimulation in the past 3 months or plans to participate during the study. <Condition>Alzheimer?s Disease MedDRA version: 18.1 Level: LLT Classification code 10001896 Term: Alzheimer's disease System Organ Class: 100000004852 ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Name: RVT-101 Product Code: RVT-101 Pharmaceutical Form: Film-coated tablet INN or Proposed INN: N/A CAS Number: 607742-69-8 Current Sponsor code: RVT-101 Other descriptive name: 3-Phenylsulfonyl-8-(piperazin-1-yl)quinoline Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 35- Pharmaceutical form of the placebo: Film-coated tablet Route of administration of the placebo: Oral use Main Objective: To assess the effects of RVT-101 versus placebo as adjuncts to stable donepezil therapy: - on cognitive function as measured by the ADAS-Cog-11 after 24 weeks of treatment. - on activities of daily living as measured by ADCS-ADL scale after 24 weeks of treatment;Secondary Objective: To assess the effects of RVT-101 versus placebo as adjuncts to stable donepezil therapy; - on cognition as measured by the ADAS-Cog-13 after 24 weeks of treatment - on global clinical assessment of change as measured by CIBIC+ after 24 weeks of treatment - on neuropsychiatric symptoms as measured by the Neuropsychiatric Inventory (NPI) after 24 weeks of treatment - on an analysis of responders based on prespecified efficacy evaluations - on subject dependency as measured by the Dependence Scale (DS) To assess: - how baseline MMSE score affects efficacy outcome measures after 24 weeks of treatment - the safety and tolerability of RVT-101 as an adjunct therapy to stable donepezil treatment To measure RVT-101 plasma concentrations and donepezil plasma concentrations in study subjects To estimate the PK parameters of RVT-101 and explore relationships to efficacy or safety endpoints, as a propriate;Prima y end point(s): - ADAS-Cog-11 score change from baseline to Week 24 - ADCS-ADL score change from baseline to Week 24;Timepoint(s) of evaluation of this end point: Week 24 Secondary end point(s): - ADAS-Cog-13 score change from baseline to Week 24 - CIBIC+ score at Week 24 - ADAS-Cog score change from baseline - ADCS-ADL score change from baseline; - CIBIC+ score; all assessed by MMSE baseline score - NPI score change from baseline to Week 24 - Analysis of responders defined as improvement of at least 3 points on ADAS-Cog-11 from baseline AND at least no worsening on ADCS-ADL from baseline AND no worsening on CIBIC+ at 24 weeks - DS score change from baseline to Week 24 - Measurement of concentrations of RVT-101 and donepezil in plasma - Steady state area under the concentration-time curve (AUCtss), peak concentration (Cmax-ss), and minimum concentration (Cmin-ss) of RVT-101 in plasma - Occurrence of adverse events (AEs) and changes in physical examinations, vital signs measurements, electrocardiograms (ECGs), routine laboratory assessments, and Columbia Suicide Severity Rating Scale (C-SSRS);Timepoint(s) of evaluation of this end point: Baseline to Week 24",Sr-dementia,eudract_number,2015,,,0,
1219,221AD301 Phase 3 Study of Aducanumab in Early Alzheimer's Disease,"Inclusion criteria: Key Inclusion Criteria: - Must meet all of the following clinical criteria for MCI due to AD or mild AD and must have: - A Clinical Dementia Rating (CDR)-Global Score of 0.5. - A Repeatable Battery for Assessment of Neuropsychological Status (RBANS) score of 85 or lower indicative of objective cognitive impairment - An MMSE score between 24 and 30 (inclusive) - Must have a positive amyloid Positron Emission Tomography (PET) scan - Must consent to apolipoprotein E (ApoE) genotyping - Must have stable symptomatic AD medications - Must have a reliable informant or caregiver LTE specific Criteria at week 78: - Must have completed the placebo-controlled period of the study. - MMSE score > 15 at the Week 78 Visit. - Must (or the subject?s legally authorized representative) understand the purpose and risks of the study and provide signed consent (or assent) - Apart from a clinical diagnosis of AD, subject must be in good health as determined by the Investigator, based on medical history. - Must have the ability to comply with procedures for protocol-related tests. - Must have reliable informant or caregiver NOTE: Other protocol defined Inclusion criteria may apply Are the trial subjects under 18? no Number of subjects for this age range: F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range 600 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 750 Exclusion criteria: Key Exclusion Criteria: - Any medical or neurological condition (other than Alzheimer's Disease) that might be a contributing cause of the subject's cognitive impairment - Have had a stroke or Transient Ischemic Attack (TIA) or unexplained loss of consciousness in the past 1 year - Clinically significant psychiatric illness in past 6 months - History of unstable angina, myocardial infarction, chronic heart failure, or clinical significant conduction abnormalities within 1 year prior to Screening - Indication of impaired renal or liver function - Have human immunodeficiency virus (HIV) infection - Have a significant systematic illness or infection in past 30 days - Relevant brain haemorrhage, bleeding disorder and cardiovascular abnormalities - Any contraindications to brain magnetic resonance imaging (MRI) or PET scans - Alcohol or substance abuse in past 1 year - Taking blood thinners (except for aspirin at a prophylactic dose or less) - Use of AD medications at doses that have not been stable for at least 8 weeks prior to Screening Visit 1 Subjects will be excluded from entering the LTE if at Week 78 they have: - any medical or psychiatric contraindication or clinically significant abnormality that, in the opinion of the Investigator, will substantially increase the risk associated with the subject's participation in the study. NOTE: Other protocol defined Exclusion criteria may apply Product Name: Aducanumab Product Code: BIIB037 Pharmaceutical Form: Concentrate for solution for infusion INN or Proposed INN: Aducanumab CAS Number: N/A Current Sponsor code: BIIB037 Concentration unit: mg/ml milligram(s)/millilitre Concentration type: equal Concentration number: 50- Pharmaceutical form of the placebo: Solution for injection/infusion Route of administration of the placebo: Intravenous use Main Objective: Placebo-controlled period: To evaluate the efficacy of monthly doses of aducanumab in slowing cognitive and functional impairment as measured by changes in the CDR-SB score as compared with placebo in subjects with early AD. Long-term Extension: To evaluate the long-term safety and tolerability profile of aducanumab in subjects with early AD. ? To evaluate the long-term efficacy of aducanumab treatment as measured by clinical, radiological, and additional assessments reported by the subject and informant/care partner.;Secondary Objective: To assess the e fect of monthly doses of aducanumab as compared with placebo on clinical progression as measured by the MMSE. To assess the effect of monthly doses of aducanumab as compared with placebo on clinical progression as measured by ADAS-Cog 13. To ssess the effect of monthly doses of aducanumab as compared with placebo on clinical progression as measured by ADCS-ADL-MCI. ;Primary end point(s): Primary endpoint: Change from baseline in CDR-SB score at Week 78. LTE period endpoints: The incidence of AEs and/SAEs; brain MRI findings (including the incidence of ARIA-E and ARIA-H); and the incidence of anti-aducanumab antibodies in serum over the placebo-controlled and LTE periods of the study. Change in the following measures over the placebo-controlled and LTE periods of the study: CDR-SB score. MMSE score. ADAS-Cog 13 score. ADCS-ADL-MCI score. Amyloid PET signal (in a subset of subjects). Whole brain volume, hippocampal volume, ventricular volume, and cortical gray matter volume measured by MRI. Functional connectivity as measured by tf-fMRI (where available). Cerebral blood flow as measured by ASL-MRI (where available). Disease-related biomarker levels in CSF which will include, but are not limited to, amyloid and tau proteins (in a subset of subjects). Disease-related biomarker levels in blood which may include, but are not limited to, amyloid and tau proteins. NPI-10 total score. Informant-rated EQ-5D index score. Informant/care partner?s own self-reported EQ-5D index score. Caregiver burden measures.;Timepoint(s) of evaluation of this end point: Primary endpoint: Week 78 LTE endpoints: On-going over the course of the study Secondary end point(s): Change from baseline in MMSE score at Week 78. Change from baseline in ADAS-Cog 13 score at Week 78. Change from baseline in ADCS-ADL-MCI score at Week 78.;Timepoint(s) of evaluation of this end point: Week 78",Sr-dementia,eudract_number,2015,,,0,
1220,"A clinical study performed at several sites with a treatment duration of 6 months, with 3 treatment arms (2 different dosages LM11A-31-BHS and 1 placebo), which are randomly distributed in a double-blind manner (neither physician nor patient will know which treatment arm) between the patients to evaluate safety, tolerability and other questions of research of the two different oral dosages of LM11A-31-BHS in comparison with placebo in patients with mild to moderate probable Alzheimer?s disease","Inclusion criteria: 1. Men and women (non-childbearing potential) with a diagnosis of Alzheimer?s disease according to McKhann (2011) criteria 2. Age 50 - 85 years 3. MRI or CT assessment within six months before baseline, corroborating the clinical diagnosis of AD and excluding other potential causes of dementia, especially cerebrovascular lesions (see exclusion criteria, number 3) 4. CSF AD specific biomarker profile; positive, defined as CSF Aß42 <530 ng l-1 together with either of T-tau>350 ng l-1 or p-tau >60 ng? -1 5. Mild to moderate stage of Alzheimer?s disease according to MMSE =18 and =26 6. Absence of major depressive disease according to GDS of < 5 7. Modified Hachinski Ischemic Scale =4 8. Formal education for eight or more years 9. Previous decline in cognition for more than six months as documented in patient medical records 10. A caregiver available and living in the same household or interacting with the patient a sufficient time each week and available if necessary to assure administration of drug 11. Patients living at home or nursing home setting without continuous nursing care 12. General health status acceptable for a participation in a 6-month clinical trial 13. Ability to swallow capsules 14. Stable pharmacological treatment of any other chronic condition for at least one month prior to screening 15. Stable treatment with one of the acetylcholinesterase inhibitors donepezil (Aricept ®), galantamine (Razadyne®), or rivastigmine (Exelon) or the partial NMDA receptor antagonist with memantine (Namenda®) at least 3-months before baseline Visit or Combination of both treatments mentioned above 16. No regular intake of prohibited medications as noted in Section 11.8. of the protocol 17. Signed informed consent by caregiver and patient prior to the initiation of any study specific procedure. Are the trial subjects under 18? no Number of subjects for this age range: F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range 40 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 80 Exclusion criteria: 1. Failure to perform screening or baseline examinations 2. Hospitalization or change of chronic concomitant medication one month prior to screening or during screening period 3. Clinical, laboratory or neuro-imaging findings consistent with: ? Other primary degenerative dementia, (dementia with Lewy bodies, fronto-temporal dementia, Huntington?s disease, Creutzfeldt-Jakob Disease, Down's syndrome, etc.) ? Other neurodegenerative condition (Parkinson?s disease, amyotrophic lateral sclerosis, etc.) ? Cerebrovascular disease (major infarct, one strategic or multiple lacunar infarcts, extensive white matter lesions > one quarter of the total white matter) ? Other central nervous system diseases (severe head trauma, tumors, subdural hematoma or other space occupying processes, etc.) ? Seizure disorder ? Other infectious, metabolic or systemic diseases affecting central nervous system (syphilis, present hypothyroidism, present vitamin B12 or folate deficiency, serum electrolytes out of normal range, juvenile onset diabetes mellitus, etc.) 4. A current DSM-IV diagnosis of active major depression, schizophrenia or bipolar disorder 5. Clinically significant, advanced or unstable disease that may interfere with primary or secondary variable evaluations, and which may bias the assessment of the clinical or mental status of the patient or put the patient at special risk, such as: ? Chronic liver disease, liver function test abnormalities or other signs of hepatic insufficiency (ALT, AST, Gamma GT, alkaline phosphatase > 2.5 ULN) ? Respiratory insufficiency ? Renal insufficiency (serum creatinine >2mg/dl) or creatinine clearance = 30 mL/min according to Cockcroft-Gault formula. In case of creatinine clearance =30mL/min, an alternative verification of the renal function must be completed using Cystatin C analysis. In case of normal level of Cystatin C, the patient can be included ? Heart disease (myocardial infarction, unstable angina, heart failure, Cardiomyopathy within six months before screening) ? Bradycardia (heart beat <50/min.) or tachycardia (heart beat >95/min.) ? Hypertension (>180/95) or hypotension requiring treatment with more than three drugs ? AV block (type II / Mobitz II and type III), congenital long QT syndrome, sinus node dysfunction or prolonged QTcB-interval (males >450 and females >470 msec) ?.Uncontrolled diabetes defined by HbA1c >8.5 ? Malignant tumors within the last five years except skin malignancies (other than melanoma) or indolent prostate cancer ? Metastases 6. Disability that may prevent the patient from completing all study requirements (e.g. blindness, deafness, severe language difficulty, etc.) 7. Women who are fertile and of childbearing potential 8. Chronic daily drug intake of = 14 days or expected for = 14 days: ? Benzodiazepines, neuroleptics or major sedatives ? Antiepileptics ? Centrally active anti-hypertensive drugs (clonidine, l-methyl DOPA, guanidine, guanfacine, etc.) ? Opioid containing analgesics 9. Nootropic drugs 10. Suspected or known drug or alcohol abuse, i.e. more than approximately 60 g alcohol (approximately 1 liter of beer or 0.5 liter of wine) per day indicated by elevated MCV significantly above normal value at screening 11. Suspected or known allergy to any components of the study treatments 12. Enrollment in another investigational study or intake of investigational drug within the previous three months 13. Any condition, which, in the opinion of the investigator, makes the patien <Condition>Mild to moderate Alzheimer's disease MedDRA version: 19.0 Level: LLT Classification code 10001896 Term: Alzheimer's disease System Organ Class: 100000004852 MedDRA version: 19.0 Level: LLT Classification code 10066571 Term: Progression of Alzheimer's disease System Organ Class: 100000004852 ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Name: LM11A-31-BHS Product Code: LM11A-31-BHS Pharmaceutical Form: Capsule, hard INN or Proposed INN: LM11A-31-BHS Current Sponsor code: LM11A-31-BHS Other descriptive name: LM11A-31-BHS Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 200- Pharmaceutical form of the placebo: Capsule, hard Route of administration of the placebo: Oral use Main Objective: To investigate the safety and tolerability of 200mg bid and 400mg bid doses of LM11A-31-BHS (free base) administered for a period of 26 weeks in comparison to placebo. Safety will be assessed through adverse event reporting, clinical laboratory, ECG and a standard range of patient physical evaluations including a suicide severity rating scale (C-SSRS). ;Secondary Objective: Exploratory investigation of relevant biomarkers for AD and drug mechanism including regional brain glucose metabolism (18F-FDG-PET) and CSF measures. The assessment of exploratory clinical endpoints including a composite of the specific cognitive tests performed (the NTB composite standardized Z score). The investigation of the pharmacokinetics of 200mg bid and 400mg bid doses of LM11A-31-BHS (free base) administered for a period of 26 weeks. PK parameters for LM11A-31 and its aminoethyl morpholine metabolite will be estimated using noncompartmental analysis (NCA). ;Primary end point(s): All safety evaluations will be summarized as interval or categorical summaries as appropriate. The overall incidence of adverse events, together with the top three most frequently reported adverse events, will be analyzed using a binary logistic model to demonstrate differences between the treatment groups and placebo. The end points include alls Adverse events (AEs), Serious adverse events (SAEs), Clinical Diagnostics, Vital signs (blood pressure, heart rate, respiratory rate, body temperature), ECG, Laboratory assessment (hematology, biochemistry, coagulation, serology and urinalysis), Columbia-Suicide Severity Rating Scale (C-SSRS), MRI scans (analyzed by a central reader);Timepoint(s) of evaluation of this end point: Changes between base ine and end of study visit (26 weeks) Secondary end point(s): All exploratory efficacy vari bles will be analyzed at the endpoint (Final visit). The analyses will involve the change from baseline in the NTB composite summary Z score calculated after 6 months (26 weeks) of treatment. This will involve an Analysis Of Covariance Variance (ANCOVA) model incorporating the baseline score and country as covariates. Additional analyses will involve evaluation of the time course of treatment response over the treatment period, using a repeated measures mixed model Analysis of Covariance (ANCOVA) for evaluation. 18F-Pet Scan variables will be analyzed in a descriptive and exploratory manner. Categorical endpoints will be analyzed using a Cochran Mantel-Haenszel (CMH-row mean scores difference), chi-squared test or Logistic regression models (as appropriate). Exploratory/ Candidate Efficacy variables ? CSF-Biomarkers (tau, ptau, Aß40, Aß42, AchE activity) ? Regional brain glucose metabolism (18FDG-PET) ? NTB: o Digit Span Test o Category Fluency Test o COWAT o Digit Symbol Substitution Test (DSST) ? ADAS-cog 13 items ? SPATIAL ORIENTATION AND LEARNING (Amunet) ? Geriatric Depression Scale (GDS) ? Clinical Global Impression Scale ? Severity/Improvement (CGI-I/CGI-S) ;Timepoint(s) of evaluation of this end point: Changes between baseline and end of study visit (26 weeks)",Sr-dementia,eudract_number,2016,,,0,
1221,"Double-blind, placebo-controlled, parallel-group, efficacy and safety study of Crenezumab in patients with prodromal- to-mild Alzheimer?s disease","Inclusion criteria: ? Must meet all of the following clinical criteria for MCI due to AD or mild AD and must have: ? A Clinical Dementia Rating (CDR)-Global Score of 0.5 or 1.0 ? Objective evidence of cognitive impairment at screening ? An MMSE score between 22 and 30 (inclusive) ? Must have confirmed amyloid pathology consistent with AD (by PET scan or CSF measurement) ? Must consent genotyping for apolipoprotein E (ApoE) ? If using drugs to treat symptoms related to AD, doses must be stable for at least 3 months prior to screening ? Must have a reliable study partner or caregiver Are the trial subjects under 18? no Number of subjects for this age range: F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range 150 F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range 600 Exclusion criteria: ? Any medical or neurological condition (other than Alzheimer's Disease) that might result in cognitive impairment. ? Have had a stroke resulting in clinical symptoms within 2 years or Transient Ischemic Attack (TIA) within 6 months ? History of serious psychiatric illness or untreated major depressive disorder ? History of unstable angina, myocardial infarction, advanced chronic heart failure within 2 years prior to screening ? Have human immunodeficiency virus (HIV) infection ? Relevant brain hemorrhage or cerebrovascular abnormalities ? Any contraindications to brain magnetic resonance imaging (MRI) scans ? Alcohol or substance abuse in past 2 years ? Anti-coagulation medications within 3 months of screening ? antiplatelet therapies including clopidogrel are permitted. <Condition>Alzheimer?s Disease MedDRA version: 19.0 Level: LLT Classification code 10001896 Term: Alzheimer's disease System Organ Class: 100000004852 ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Name: crenezumab Product Code: Ro 549-0245/F05 Pharmaceutical Form: Concentrate for solution for infusion INN or Proposed INN: crenezumab CAS Number: 1095207-05-8 Current Sponsor code: RO5490245 Other descriptive name: Crenezumab, Anti Abeta, MABT5102A Concentration unit: mg/ml milligram(s)/millilitre Concentration type: equal Concentration number: 180- Pharmaceutical form of the placebo: Concentrate for solution for infusion Route of administration of the placebo: Intravenous use Main Objective: Efficacy:evaluate crenezumab 60 mg/kg compared with placebo when admin. by IV infusion q4w over 100 wks as measured(final outcome assessment at Wk 105,4 wks after the final dose)Change from baseline on CDR-sum of boxes Safety:evaluate the safety of crenezumab compared with placebo in patients with prodromal to mild AD on the basis of the follow. endpoints ?Nature,frequency,severity and timing of adverse events and serious adverse events ?Physical and neurologic examinations,vital signs,blood tests,ECGs,Columbia Suicide Severity Rating Scale,Non-serious adverse events of special interest, specific. pneumonia ?Adverse events,as assessed by magnetic resonance imaging:amyloid related imaging abnormalities edema/effusion,amyloid related imaging abnormalities hemosiderin deposition ?The immunogenic potential of crenezumab through measurement of antibodies directed against crenezumab and other components of the drug product,assessment of their relationship with other outcome measures ;Secondary Objective: Efficacy: secondary efficacy objective for this study is to evaluate the benefits of crenezumab versus placebo administered to patients by IV infusion over 100 weeks through assessment of the following endpoints ?Cognition, as measured by the ADAS-Cog (subscale) 13 (ADAS Cog 13) ?Effect on severity of dementia, assessed using the CDR-Global Score (CDR GS) ?Effect on cognition, assessed using the MMSE, ADAS-COG12 ?Effect on function, assessed using the ADCS-ADL instrumental subscale (ADCS iADL) and ADCS-ADL total score ?Effect on behavioral and neuropsychological symptoms of AD, assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q ?Effect of crenezumab on health-related quality of life (QoL , assessed using the Quality of Life-Alzheimer?s Disease scale, caregiver burden, assessed using the Zarit Caregiver Interview for Alzheimer?s Disease scale and on health outcomes in patient and caregiver as measured by EQ-5D ;Primary end point(s): To evaluate crenezumab 60 mg/kg compared with placebo when administered by IV infusion q4w over 100 weeks as measured by the following primary endpoint (final outcome assessment at Week 105, 4 weeks after the final dose): Global outcomes, as assessed by the CDR SB ;Timepoint(s) of evaluation of this end point: Change from baseline at week 105 Secondary end point(s): To evaluate the benefits of crenezumab versus placebo administered to patients by IV infusion q4w over 100 weeks through assessment of the following endpoints: Effect on cognition, as measured by the ADAS-Cog (subscale) 13 (ADAS Cog 13) ;Timepoint(s) of evaluation of this end point: Change from baseline at week 105",Sr-dementia,eudract_number,2016,,,0,
1222,To evaluate the efficacy of CAD106 and CNP520 in participants at risk for the onset of Alzheimer?s disease,"Inclusion criteria: Pre-screening Epoch and Genetic Disclosure Follow-up inclusion criteria: 1. Written informed consent (Informed consent #1) obtained before any assessment is performed, including consent to receive disclosure of their APOE genotype. 2. Male or female, age 60 to 75 years inclusive, before signing the prescreening informed consent. a. When approximately 20% of the participants expected to be randomized are 60-64 years old, a restriction to this age group will apply. 3. Females must be considered post-menopausal and not of child bearing potential. Confirmation will be obtained for those who continue on to the Screening Epoch. 4. Fluency in, and ability to read, the language in which study assessments are administered. 5. Mini-Mental State Examination (MMSE) total score =24. 6. For those without prior genotype information, deemed capable of receiving their genotype information based on pre-disclosure rating scales, specifically: a. Geriatric Depression Scale (GDS short form) total score <6. If the score is between 6 and 10 (inclusive), the participant can only be included based on investigator?s judgment assessing in particular the scores of the questions: i. Item 3: ?Do you feel your life is empty?? ii. Item 6: ?Are you afraid that something bad is going to happen to you?? iii. Item 12: ?Do you feel pretty worthless the way you are now?? iv. Item 14: ?Do you feel your situation is hopeless?? b. Six Item Subset Inventory of the STAI-AD total score <17. If the score is between 17 and 19 (inclusive), the participant can only be included based on the investigator?s judgment. 7. Participant has evidence of adequate functioning (e.g. intellectual, visual and auditory) (e.g. completion of at least 6 years of regular schooling or sustained employment). 8. Participant?s willingness to have a study partner for the Screening and Treatment Epoch. Screening and Treatment Epoch inclusion criteria: Participants eligible for inclusion must fulfill all of the following criteria prior to randomization: 1. Written informed consent (Informed consent #2) for participation to the Screening and Treatment Epochs. 2. Continue to meet all eligibility criteria from Pre-screening Epoch and Genetic Disclosure Follow-up, as confirmed by the review of the medical records by the Investigator. 3. Homozygous APOE4 genotype. 4. Cognitively unimpaired as defined by: - Score of 85 or greater on the RBANS delayed memory index score AND CDR global score of 0. With two exceptions: - If the RBANS delayed memory index score is between 70 and 84 (inclusive) AND the global CDR = 0, the participant may be allowed to continue ONLY if the Investigator judges that cognition is unimpaired following review of the MCI/dementia criteria. - If the global CDR score = 0.5 AND the RBANS delayed memory index score is 85 or greater, the participant may be allowed to continue ONLY if the Investigator judges that cognition is unimpaired following review of the MCI/dementia criteria. 5. Females must be considered post-menopausal and not of child bearing potential, i.e. they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy), total hysterectomy, or tubal ligation at least six weeks before the amyloid test. - In the case of bilateral oophorectomy alone (without hysterectomy or tubal ligation), the reprodu Exclusion criteria: Pre-screening Epoch and Genetic Disclosure Follow-up exclusion criteria: 1. Any disability that may prevent the participants from completing all study requirements. 2. Current medical or neurological condition that might impact cognition or performance on cognitive assessments e.g., MCI, dementia, Huntington?s disease, Parkinson?s disease, Lyme disease, schizophrenia, bipolar disorder, major depression, active seizure disorder, history of multiple traumatic brain injuries, alcohol/drug abuse or dependence currently, or dependence within the l st two years. 3. Advanced, severe progressive or unstable disease that may interfere with the safety, tolerability and study assessments, or put the participant at special risk, e.g. active hepatitis, HIV infection, severe renal impairment, severe hepatic impairment, uncontrolled or significant cardiac disease including recent myocardial infarction, congestive heart failure. 4. History of malignancy of any organ system, treated or untreated, within the past 60 months, regardless of whether there is evidence of local recurrence or metastases. However, localized nonmalignant tumors not requiring systemic chemo- or radio-therapy, localized basal or squamous cell carcinoma of the skin, or in-situ cervical cancer are permitted. 5. History of hypersensitivity to any of the investigational drugs or their excipients/adjuvant, or to drugs of similar chemical classes. 6. Indication for or current treatment with ChEIs and/or another AD treatment. 7. Contraindication or intolerance to MRI or PET investigations. Screening and Treatment Epoch exclusion criteria: Participants fulfilling any of the following criteria prior to randomization will be excluded. Participants, who fulfill one or more exclusion criteria due to a temporary condition, or the use of treatment requiring a specific time window prior to randomization, can be re-screened at a later stage: 1. Brain MRI results showing findings unrelated to AD that, in the opinion of the Investigator might be a leading cause of cognitive decline, might pose a risk to the participant, or might prevent a satisfactory MRI assessment for safety monitoring. For Cohort I (CAD 106) only, in addition, evidence of ARIAH as demonstrated by: - More than four cerebral microhemorrhages regardless of their anatomical location; - Single area of superficial siderosis of the CNS or evidence of a prior cerebral macrohemorrhage. 2. Score ?yes? on item four or item five of the Suicidal Ideation Section of the C-SSRS if this ideation occurred in the past six months, or ?yes? on any item of the Suicidal Behavior Section, except for the ?Non-Suicidal Self-Injurious Behavior? if this behavior occurred in the past two years prior to screening. 3. A positive drug screen at Screening, if, in the Investigator?s opinion, this is due to drug abuse. Participants with a positive drug screen not believed to be related to drug abuse, can be re-screened once. 4. Significantly abnormal laboratory results at Screening, meeting the exclusionary alert values specified in the Laboratory Manual. If, in the opinion of the Investigator, an abnormal finding is the result of a temporary condition, the laboratory test can be repeated once. 5. Current clinically significant ECG findings. 6. Use of other investigational drugs until: - Blood concentration has returned to Baseline for biologics, e.g. monoclonal antibodies or antibodies induced by active immunotherapy; or - Within 30 days or <Condition>Alzheimer's disease MedDRA version: 18.1 Level: LLT Classification code 10001896 Term: Alzheimer's disease System Organ Class: 100000004852 ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Code: CAD106 Pharmaceutical Form: Powder for solution for injection INN or Proposed INN: Not established Current Sponsor code: CAD106 Other descriptive name: Q? VLP COUPLED VIA A CHEMICAL LINKER (SMPH) TO A?1-6 PEPTIDE Concentration unit: µg microgram(s) Concentration type: equal Concentration number: 450- Pharmaceutical form of the placebo: Powder for solution for injection Route of administration of the placebo: Intramuscular use Timepoint(s) of evaluation of this end point: - Baseline to Month 60. - Baseline to Month 60.;Main Objective: - To assess the effects of CAD106 and CNP520, respectively, vs. placebo on Time-to-event, with event defined as a diagnosis of MCI due to AD or dementia due to AD, whichever occurs first during the course of the study. - To assess the effects of CAD106 and CNP520, respectively, vs. placebo on cognition as measured by the change from Baseline to Month 60 in the APCC te t score.;Secondary Objective: - To assess the e fects of CAD106 / CNP520, respectively vs. placebo on global clinical status as measured by the change from Baseline to Month 60 in Clinical Dementia Rating Scale Sum of Boxes score. - To assess the safety and tolerability of CAD106 / CNP520, respectively vs. placebo by measured AEs, changes in MRI, lab tests, vital signs, ECG, C-SSRS and injection-related reactions from Cohort I. - To assess the effects of CAD106 / CNP520, respectively vs. placebo on cognition as measured by changes from Baseline to Month 60 on the Total Scale score and individual neurocognitive domain index scores of the RBANS. - To assess the effects of CAD106 / CNP520, respectively vs. placebo on function as measured by the change from Baseline to Month 60 in the ECog total scores reported by the participant and study partner, respectively. - To assess the effects of CAD106 / CNP520, respectively vs. placebo on AD-related biomarkers as measured by change from Baseline to Months 24 and 60.;Primary end point(s): - Time-to-event (MCI or dementia due to AD) measured by the MCI/dementia criteria check list that includes measurements of cognitive function (RBANS, MMSE), function/cognition (CDR-SOB), daily function and subjective/observer memory concerns (ECog), plus Neuropsychiatric Inventory Questionnaire (NPI-Q), Geriatric Depression Scale, and safety MRI. - API Preclinical Composite Cognitive Battery (APCC) derived from tests performed as part of the cognitive scales (MMSE, RBANS, and a subset of Raven?s Progressive Matrices) administered during the study. Secondary end point(s): - Global clinical status as measured by the change in Clinical Dementia Rating Scale Sum of Boxes score.;Timepoint(s) of evaluation of this end point: - Baseline to Month 60.",Sr-dementia,eudract_number,2016,,,0,
1223,Study of RVT-101 in patients with dementia with Lewy Bodies ( DLB),"Inclusion criteria: 1) Male or female subject with a clinical diagnosis of DLB established for a minimum of 2 months prior to Visit 1 and who currently meet consensus criteria as determined by the PI by having dementia and either a) or b) below: a) At least two of the following three Core Criteria: i) Fluctuating cognition, ii) Recurrent visual hallucinations, or iii) Spontaneous features of parkinsonism. b) One of the Core Criteria above and as least one of the following three Suggestive Criteria: i) REM Sleep Behavior Disorder, ii) Severe Neuroleptic Sensitivity, or iii) Low dopamine transporter uptake in basal ganglia on single photon emission computed tomography (SPECT) or positron emission tomography (PET) scan as determined by the investigator (SPECT or PET must have been performed in the 12 months prior to the Screening Visit otherwise it must be repeated prior to the Run-In Period). 2) Subject has an MMSE score of 14 to 26, inclusive, at Screening. In addition, the MMSE score at Baseline (V3) must not have declined by 4 points or more from the Visit 2 MMSE score. For subjects with an MMSE score at Baseline (V3) of 4 or more points lower than their Visit 2 MMSE score or an MMSE <14 at V3, the Run-In period may be extended for 1 to 10 days. If, after the first extension to the Run-In Period, the subject still does not meet the MMSE stability criterion, the Run-In period may again be extended for an additional 1 to 10 days. No more than 2 extensions to the Run-In Period will be allowed. If this MMSE stability requirement is not met after 2 extensions of the Run-In Period, the subject will be discontinued from the study. 3) If the subject is currently receiving any of the following medications, the treatment regimen has been stable (i.e., no changes in the type of drug, dose or frequency of dosing) for at least 30 days prior to the Screening Visit and there is no intent to change this treatment regimen for the duration of the study. Acetylcholinesterase inhibitors (i.e., donepezil, galantamine, rivastigmine, tacrine) Memantine Axona® (caprylidene) Antidepressants (other than MAO inhibitors) Thyroid hormones, Atypical antipsychotics (e.g., quetiapine),Benzodiazepines and other sedatives/hypnotics 4) Subject is 50 to 85 years of age, inclusive, at the time of the Screening Visit. 5) Female subjects must be: a) Of non-childbearing potential (i.e., any female who is post-menopausal [greater than 1 year without menstrual period in the absence of hormone replacement therapy]) or surgically sterile; or, b) If pre-menopausal or menopausal for 1 year or less, must have a negative pregnancy test and must not be lactating at Screening. Female subjects of childbearing potential and who are sexually active are required to practice highly effective methods of birth control. Female subjects for whom menopausal status is in doubt, in the opinion of the investigator, will be required to use a highly form of birth control. Highly effective forms of birth control are defined as methods that have a failure rate of less than 1% per year when used correctly and consistently and include: ? combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation; oral, intravaginal, or transdermal ? progestogen-only hormonal contraception associated with inhibition of ovulation; oral, injectable, or implantable ? intrauterine device (IUD) ? intrauterine hormone-releasing system ( IUS) ? bilateral tubal occlusion ? vasectomised Exclusion criteria: Other Causes for Dementia : 1) Parkinson?s disease dementia, vascular dementia, frontotemporal dementia, or Alzheimer?s disease dementia. 2) A CT or MRI scan performed within the past 12 months or at Screening could be interpreted as the primary cause of dementia (e.g., cerebrovascular disease [transient ischemic attack, stroke, hemorrhage]; structural or developmental abnormality; epilepsy; infectious, or degenerative or inflammatory/demyelinating CNS conditions) or any other history and/or evidence to suggest the same. 3) Current vitamin B12 deficien y, h pothyroidism, neurosyphilis, HIV dementia, or Korsakoff?s encephalopathy. 4) Focal findings on the neruological exam Confounding Medical Conditions: 5) History of schizophrenia, major depressive episode in the past 6 months bipolar affective disorder that in the opinion of the investigator would interfere with participation in the study or could affect performance on outcome measures. 6) Significant suicide risk as defined by (1) suicidal ideation as endorsed on items 4 or 5 on the C-SSRS within the past year, at Screening or at Baseline or; (2) suicidal behaviors within the past year or; (3) clinical assessment of significant suicidal risk during subject interview. 7) History of epilepsy, unexplained seizure or history of significant head trauma with loss of consciousness in the past 5 years. 8) History of malignancy during the 5 years before Screening. History of basal cell carcinoma and melanoma in situ are permitted. History of other cancers currently in a non-active state may be acceptable after review with the Medical Monitor. 9) Any clinically relevant concomitant disease including unregulated diabetes, progressive liver or kidney dysfunction, history of myocardial infarction or unstable angina within 6 months of Screening, history of more than one myocardial infarction within 5 years of Screening, history of clinically significant stroke, or any other medical or psychiatric condition, which, in the opinion of the investigator, makes the subject unsuitable for inclusion in the study. 10) History of alcohol use disorder or other substance abuse disorder (excluding tobacco use). Concomintant Medications: 11) Participation in another investigational drug or device study during the 30 days prior to the Screening Visit (Visit 1), or within 5 half-lives of use of the investigational drug prior to the Screening Visit, whichever is longer. 12) Treatment with any concomitant medications : Butyrophenones, phenothiazines, and other ?conventional? antipsychotics, Barbiturates, MAO inhibitors, Any investigational drug, warfarin, phenytoin and (R)-acenocoumarol, ketoconazole, itraconazole, erythromycin, rifampicin, phenytoin and carbamazepine, itraconazole, ketoconazole, cyclosporin, diltiazem, verapamil, quinidine, and carvedilol. Unacceptable Tests/Laboratory values: 13) Alanine transaminase (ALT) and/or aspartate aminotransferase (AST) ?2.0 times upper limit of normal (ULN) at Screening. 14) Total bilirubin over 1.5 x ULN at Screening except due to documented Gilbert?s disease or evidence of Gilbert?s disease on Screening laboratory assessments. 15) Calculated creatinine clearance <40 mL/min (Cockroft-Gault formula) at Screening: 16) Positive hepatitis B surface antigen or hepatitis C antibody test at Screening. 17) Confirmed corrected QT interval (QTc) value greater than or equal to 450 msec for males or greater than or equal to 470 msec for females at Screening. <Condition>Dementia with Lewy Bodies MedDRA version: 19.0 Level: PT Classification code 10067889 Term: Dementia with Lewy bodies System Organ Class: 10029205 - Nervous system disorders ;Therapeutic area: Diseases [C] - Nervous System Diseases [C10]</Condition> Product Name: RVT-101 Product Code: RVT-101 Pharmaceutical Form: Tablet INN or Proposed INN: 3-(Phenylsulfonyl)-8-(1-piperazinyl) quinoline CAS Number: 607742-69-8 Current Sponsor code: RVT-101 Other descriptive name: SB742457 Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 35- Pharmaceutical form of the placebo: Tablet Route of administration of the placebo: Oral use Secondary Objective: To assess the effects of RVT-101 versus placebo after 24 wks of treatment : 1.On attention, as measured by the z-score of the PoA domain of the CDR computerized assessment system 2.On instrumental activities of daily living as measured by the instrumental subscale of the ADCS-ADL scale 3.On cognition, including amnestic aspects of cognition, as measured by the ADAS-Cog-13 4. On working memory as a measure of executive func as assessed by the COWAT 5.On cognitive function as measure by a co posite z-score combining the 7 domains for the CDR computerized assessment system and the COWAT 6.on hallucinations and delusions as measured by a 2-item subscore on the NPI which is the sum of the scores for the hallucinations and delusions domains 7.on visual hallucinations as measured by the NEVHI 8.On fluctuations in cognition using the CAF 9.On subject dependence using the DS 10.On an analysis of responders based on pre-specified efficacy evaluations 11. Assess the safety and tolerability;Main Objective: ? To assess the effects of RVT-101 versus placebo on global function as measured by the Clinician?s Interview-Based Impression of Change Plus Caregiver Input (CIBIC+) after 24 weeks of treatment ? To assess the effects of RVT-101 versus placebo on cognition as measured by the composite z-score of the 7 domains of the Cognitive Drug Research (CDR) computerized assessment system after 24 weeks of treatment (CDR domains include Power of Attention, Continuity of Attention, Quality of Working Memory, Quality of Episodic Memory, Speed of Memory, Cognitive Reaction Time and Reaction Time Variability);Primary end point(s): The primary efficacy endpoints will be an assessment of cognition and global function at Week 24. Change from baseline to Week 24 in cognition will be measured by a composite z-score of 7 domains of the CDR computerized assessment system (Power of Attention, Continuity of Attention, Quality of Working Memory, Quality of Episodic Memory, Speed of Memory, Cognitive Reaction Time and Reaction Time Variability). Global function at Week 24 will be measured by the CIBIC+.;Timepoint(s) of evaluation of this end point: The primary endpoints will be measured after 24 weeks of treatment. Study participation will last approximately 32 weeks: 0 to 4 weeks for Screening, a 2-week Single-Blind Run-In Period to evaluate baseline status, a 24-week randomized, double-blind, placebo-controlled Treatment Period and a 2-week Safety Follow-up Period for subjects who do not enter the extension study. There will be weekly clinical assessments for the first two weeks of double-blind treatment, bi-weekly assessments thereafter until 12 weeks post-randomization and every six weeks thereafter. For certain visits (Visits 5, 7 and 9), subjects may have the option of whether to have assessments performed at the clinical study site or by a trained, visiting nurse in their own home Secondary end point(s): Secondary efficacy endpoints: Instrumental activities of daily living will be measured by the instrumental subscale of the ADCS-ADL as a key secondary endpoint. Safety evaluation: Safety will be evaluated based on adverse events (AEs), physical examinations, vital signs (including measurements of orthostatic changes in blood pressure [BP] and heart rate [HR]), a questionnaire evaluating the occurrence of symptoms potentially associated with orthostasis, the Unified Parkinson's Disease Rating Scale - Part III (UPDRS-III) after 24 weeks of treatment, electrocardiograms (ECGs), the Columbia-Suicide Severity Rating Scale (C-SSRS) and routine clinical laboratory assessments.;Timepoint(s) of evaluation of this end point: The primary endpoints will be measured after 24 weeks of treatment. Study participation will last approximately 32 weeks: 0 to 4 weeks for Screening, a 2-week Single-Blind Run-In Period to evaluate baseline status, a 24-week randomized, double-blind, placebo-controlled Treatment Period and a 2-week Safety Follow-up Period for subjects who do not enter the extension study. There will be weekly clinical assessments for the first two weeks of double-blind treatment, bi-weekly assessments thereafter until 12 weeks post-randomization and every six weeks thereafter. For certain visits (Visits 5, 7 and 9), subjects may have the option of whether to have assessments performed at the clinical study site or by a trained, visiting nurse in their own home",Sr-dementia,eudract_number,2016,,,0,
1224,"Place and Cause of Death in Centenarians: A Population-Based Observational Study in England, 2001 to 2010","Background:Centenarians are a rapidly growing demographic group worldwide, yet their health and social care needs are seldom considered. This study aims to examine trends in place of death and associations for centenarians in England over 10 years to consider policy implications of extreme longevity.Methods and Findings:This is a population-based observational study using death registration data linked with area-level indices of multiple deprivations for people aged ≥100 years who died 2001 to 2010 in England, compared with those dying at ages 80-99. We used linear regression to examine the time trends in number of deaths and place of death, and Poisson regression to evaluate factors associated with centenarians' place of death. The cohort totalled 35,867 people with a median age at death of 101 years (range: 100-115 years). Centenarian deaths increased 56% (95% CI 53.8%-57.4%) in 10 years. Most died in a care home with (26.7%, 95% CI 26.3%-27.2%) or without nursing (34.5%, 95% CI 34.0%-35.0%) or in hospital (27.2%, 95% CI 26.7%-27.6%). The proportion of deaths in nursing homes decreased over 10 years (-0.36% annually, 95% CI -0.63% to -0.09%, p = 0.014), while hospital deaths changed little (0.25% annually, 95% CI -0.06% to 0.57%, p = 0.09). Dying with frailty was common with ""old age"" stated in 75.6% of death certifications. Centenarians were more likely to die of pneumonia (e.g., 17.7% [95% CI 17.3%-18.1%] versus 6.0% [5.9%-6.0%] for those aged 80-84 years) and old age/frailty (28.1% [27.6%-28.5%] versus 0.9% [0.9%-0.9%] for those aged 80-84 years) and less likely to die of cancer (4.4% [4.2%-4.6%] versus 24.5% [24.6%-25.4%] for those aged 80-84 years) and ischemic heart disease (8.6% [8.3%-8.9%] versus 19.0% [18.9%-19.0%] for those aged 80-84 years) than were younger elderly patients. More care home beds available per 1,000 population were associated with fewer deaths in hospital (PR 0.98, 95% CI 0.98-0.99, p<0.001).Conclusions:Centenarians are more likely to have causes of death certified as pneumonia and frailty and less likely to have causes of death of cancer or ischemic heart disease, compared with younger elderly patients. To reduce reliance on hospital care at the end of life requires recognition of centenarians' increased likelihood to ""acute"" decline, notably from pneumonia, and wider provision of anticipatory care to enable people to remain in their usual residence, and increasing care home bed capacity.Please see later in the article for the Editors' Summary. © 2014 Evans et al.",aged;article;cancer mortality;cause of death;death certificate;dementia;female;home care;hospital care;human;ischemic heart disease;longevity;major clinical study;male;nursing home;observational study;pneumonia;primary health care;residential care;social care;terminal care;very elderly,"Evans, C. J.;Ho, Y.;Daveson, B. A.;Hall, S.;Higginson, I. J.;Gao, W.",2014,,,0,
1225,Salpingo-oophorectomy at the Time of Benign Hysterectomy: A Systematic Review,"OBJECTIVE: To compare the long-term risks associated with salpingo-oophorectomy with ovarian conservation at the time of benign hysterectomy. DATA SOURCES: MEDLINE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials were searched from inception to January 30, 2015. We included prospective and retrospective comparative studies of women with benign hysterectomy who had either bilateral salpingo-oophorectomy (BSO) or conservation of one or both ovaries. METHODS OF STUDY SELECTION: Reviewers double-screened 5,568 citations and extracted eligible studies into customized forms. Twenty-six comparative studies met inclusion criteria. Studies were assessed for results, quality, and strength of evidence. TABULATION, INTEGRATION, AND RESULTS: Studies were extracted for participant, intervention, comparator, and outcomes data. When compared with hysterectomy with BSO, prevalence of reoperation and ovarian cancer was higher in women with ovarian conservation (ovarian cancer risk of 0.14-0.7% compared with 0.02-0.04% among those with BSO). Hysterectomy with BSO was associated with a lower incidence of breast and total cancer, but no difference in the incidence of cancer mortality was found when compared with ovarian conservation. All-cause mortality was higher in women younger than age 45 years at the time of BSO who were not treated with estrogen replacement therapy (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.04-1.92). Coronary heart disease (HR 1.26, 95% CI 1.04-1.54) and cardiovascular death were higher among women with BSO (HR 1.84, 95% CI 1.27-2.68), especially women younger than 45 years who were not treated with estrogen. Finally, there was an increase in the prevalence of dementia and Parkinson disease among women with BSO compared with conservation, especially in women younger than age 50 years. Clinical practice guidelines were devised based on these results. CONCLUSION: Bilateral salpingo-oophorectomy offers the advantage of effectively eliminating the risk of ovarian cancer and reoperation but can be detrimental to other aspects of health, especially among women younger than age 45 years.",,"Evans, E. C.;Matteson, K. A.;Orejuela, F. J.;Alperin, M.;Balk, E. M.;El-Nashar, S.;Gleason, J. L.;Grimes, C.;Jeppson, P.;Mathews, C.;Wheeler, T. L.;Murphy, M.",2016,Sep,10.1097/aog.0000000000001592,0,
1226,"End-of-life care in general practice: A cross-sectional, retrospective survey of 'cancer', 'organ failure' and 'old-age/dementia' patients","BACKGROUND: End-of-life care is often provided in primary care settings. AIM: To describe and compare general-practitioner end-of-life care for Dutch patients who died from 'cancer', 'organ failure' and 'old-age or dementia'. DESIGN: A cross-sectional, retrospective survey was conducted within a sentinel network of general practitioners. General practitioners recorded the end-of-life care of all patients who died (1 January 2009 to 31 December 2011). Differences in care between patient groups were analysed using multivariate logistic regressions performed with generalised linear mixed models. SETTING/PARTICIPANTS: Up to 63 general practitioners, covering 0.8% of the population, recorded the care of 1491 patients. RESULTS: General practitioners personally provided palliative care for 75% of cancer, 38% of organ failure and 64% of old-age/dementia patients (adjusted odds ratio (confidence interval): cancer (reference category); organ failure: 0.28 (0.17, 0.47); old-age/dementia: 0.31 (0.15, 0.63)). In the week before death, 89% of cancer, 77% of organ failure and 86% of old-age/dementia patients received palliative treatments: (adjusted odds ratio (confidence interval): cancer (reference category); old-age/dementia: 0.54 (0.29, 1.00); organ failure: 0.38 (0.16, 0.92)). Options for palliative care were discussed with 81% of cancer, 44% of organ failure and 39% of old-age/dementia patients (adjusted odds ratio (confidence interval): cancer (reference category); old-age/dementia: 0.34 (0.21, 0.57); organ failure: 0.17 (0.08, 0.36)). CONCLUSION: The results highlight the need to integrate palliative care with optimal disease management in primary practice and to initiate advance care planning early in the chronic disease trajectory to enable all patients to live as well as possible with progressive illness and die with dignity and comfort.",Palliative care;cancer;chronic obstructive airways disease;frail elderly;heart failure;primary health care,"Evans, N.;Pasman, H. R.;Donker, G. A.;Deliens, L.;Van den Block, L.;Onwuteaka-Philipsen, B.",2014,Mar 18,10.1177/0269216314526271,0,
1227,Plasma Amyloid β42 and Amyloid β40 Levels Are Associated With Early Cognitive Dysfunction After Cardiac Surgery,"Background: Decreased cognitive function associated with coronary artery bypass graft surgery is common. These deficits may be similar to the cognitive dysfunction seen in the spectrum of mild cognitive impairment to Alzheimer's disease, which are believed to result from the accumulation of amyloid beta (Aβ) peptide in the brain. We measured cognition both before and after coronary artery bypass graft surgery and assayed Aβ levels to investigate whether the cognitive dysfunction of cardiac surgery was associated with Aβ levels. Methods: The plasma of 332 patients, who had undergone neuropsychological testing before and 3 and 12 months after coronary artery bypass graft surgery, was analyzed for Aβ42 and Aβ40. Patients were classified as having preexisting cognitive impairment if cognitive function was decreased in two or more tests compared with a healthy control group, and postoperative cognitive dysfunction was defined as a decline in two or more tests compared with the group mean baseline score. Results: Preexisting cognitive impairment was present in 117 patients (35.2%), and postoperative cognitive dysfunction was present in 40 (12%) at 3 months and 41 (13%) at 12 months after surgery. Both plasma Aβ42 and Aβ40 levels assessed before the surgery were significantly lower in patients who later had postoperative cognitive dysfunction at 3 months. Conclusions: Decreased preoperative plasma levels of Aβ42 and Aβ40 in patients who exhibit postoperative cognitive dysfunction at 3 months suggest that postoperative cognitive dysfunction at this time may share a common mechanism with mild cognitive impairment and Alzheimer's disease. This process may be exacerbated by anesthesia. © 2009 The Society of Thoracic Surgeons.",amyloid beta protein[1-40];amyloid beta protein[1-42];antihypertensive agent;adult;aged;article;cognition;cognitive defect;controlled study;coronary artery bypass graft;disease association;female;heart infarction;human;hypertension;intelligence quotient;major clinical study;male;neuropsychological test;postoperative period;preoperative evaluation;priority journal;protein blood level;scoring system,"Evered, L. A.;Silbert, B. S.;Scott, D. A.;Maruff, P.;Laughton, K. M.;Volitakis, I.;Cowie, T.;Cherny, R. A.;Masters, C. L.;Li, Q. X.",2009,,,0,
1228,Mortality differences by APOE genotype estimated from demographic synthesis,"The 4 allele of apolipoprotein E (APOE) is associated with increased risk of two major causes of death in low-mortality populations: ischemic heart disease and Alzheimer's disease. It is less common among centenarians than at younger ages. Therefore, it is likely that it is associated with excess risk of death. This article extends demographic models that estimate relative mortality risks from changes in gene frequencies with age. The resulting demographic synthesis combines gene frequencies with data on mortality by genotype from cohort studies. The model was applied to data from Denmark, Finland, France, Italy, Sweden, and the United States. Near age 50, the 3/4 genotype is associated with a risk of death of 1.34 times that of the 3/3 (95% CI 1.18-1.67). The relative risk for 4/4 is the square of the relative risk for 3/4, 1.81. The 2/3 genotype is protective with a relative risk of 0.84 (0.68-0.93) near age 50. These relative risks move toward 1.0 at the oldest ages and APOE genotype is associated with little variation in mortality over age 100. There are no significant differences in the relative risks by sex. There is little evidence of differences within Europe in the effects of APOE. This approach can be generalized to combine data on genetic risk factors for disease from a wide variety of study designs and sample characteristics.","Age Factors;Aged;Aged, 80 and over;Alleles;Alzheimer Disease/*genetics/*mortality;Apolipoproteins E/*genetics;Cause of Death;Cross-Sectional Studies;Female;Gene Frequency;Genotype;Humans;Male;Middle Aged;Models, Genetic;Models, Statistical;Myocardial Ischemia/*genetics/*mortality;Risk","Ewbank, D. C.",2002,Feb,10.1002/gepi.0164,0,
1229,The APOE Gene and Differences in Life Expectancy in Europe,"Common alleles of the apolipoprotein-E gene (APOE) are associated with different risks of ischemic heart disease, Alzheimer's disease, and other chronic conditions in European populations. Also, the APOE allele frequencies vary widely among European countries. We estimated the proportion of differences in mortality and differences in life span that are attributable to differences in APOE allele frequencies in Europe. Mortality rates by age, sex, and APOE genotype for six countries (Denmark, Finland, France, Italy, the Netherlands, and Sweden) were used to standardize mortality rates to the allele frequencies in Italy. Differences in APOE allele frequencies explain 12%-17% of the variation among these countries in mortality in people older than 65 years and 1%-2% of the variation in life span in those older than 65 years. Differences by genotype in mortality in people older than 15 years account for about 3.5% of the genetic contribution to the variation in life span in Denmark.",apolipoprotein E;age;aged;Alzheimer disease;article;chronic disease;Denmark;disease association;Europe;female;Finland;France;gender;gene frequency;genotype;heredity;human;ischemic heart disease;Italy;life expectancy;lifespan;male;mortality;Netherlands;priority journal;risk;standardization;Sweden,"Ewbank, D. C.",2004,,,0,
1230,"A review of the diagnostic scope of biomarker techniques, genetic screening and virtual scanning","The purpose of this article is to compare and evaluate the advantages and benefits of the cognitive screening technique Virtual Scanning with contemporary diagnostic and screening techniques, in particular genetic screening and biomarkers. In the last 50 years biomarker techniques and more recently genetic screening have been developed to characterise the onset, progression and regression of pathologies. Nevertheless the scientific picture is not yet complete. It does not yet include an understanding of relationship between genotype and phenotype; the regulatory function of the autonomic nervous system; or the rate or level of the expressed protein, protein conformation, the rate at which proteins react, and the reaction conditions such as pH, levels of minerals and cofactors, and temperature. By contrast, Virtual Scanning is based upon the light absorbing and emitting properties of proteins and how this bioluminescence influences colour perception. It provides a measure of the level of expressed protein and the rate at which such expressed protein subsequently reacts with its reactive substrate. The article highlights the limitations of genetic screening and biomarkers and the perceived advantages which Virtual Scanning may have for routine mass screening e.g. of diabetes, cardiovascular disease, cancers, depression, migraine, etc. © 2013 Bentham Science Publishers.",biological marker;hemoglobin A1c;Alzheimer disease;angina pectoris;article;autonomic nervous system;cell structure;color vision;cystic fibrosis;diabetes mellitus;Gaucher disease;genetic predisposition;genetic screening;hemophilia;histopathology;mass screening;medical procedures;prevalence;protein conformation;protein expression;virtual scanning,"Ewing, G. W.",2013,,,0,
1231,"Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patients: A rebuttal",,autopsy;cardiovascular mortality;cerebrovascular accident;chronic kidney disease;comorbidity;dementia;diabetes mellitus;heart infarction;hemodialysis;hemodialysis patient;hospitalization;human;hypertension;kidney dysfunction;kidney failure;letter;lung embolism;mortality;peripheral vascular disease;priority journal;sex;sudden death,"Fabbian, F.;Dentali, F.;Ageno, W.;Manfredini, R.",2013,,,0,
1232,In-hospital mortality for pulmonary embolism: relationship with chronic kidney disease and end-stage renal disease. The hospital admission and discharge database of the Emilia Romagna region of Italy,"The impact of chronic kidney disease (CKD) on the outcome of acute pulmonary embolism (PE) is uncertain. We aimed to evaluate the effect of renal dysfunction (defined by ICD-9-CM codification) on in-hospital mortality for PE. We considered all cases of PE (first event) recorded in the database of hospital admissions for the Emilia-Romagna region, Italy, from 1999 to 2009. The inclusion criterion was the presence, as a main discharge diagnosis, of acute PE codes according to ICD-9-CM. Diagnoses of immobilization, dementia, sepsis, skeletal fractures, hypertension, heart failure, myocardial infarction, diabetes mellitus, peripheral vascular disease, cerebrovascular disease, chronic pulmonary disease, pneumonia, malignancy, CKD and end-stage renal disease (ESRD) were also considered to evaluate comorbidity. The outcome was in-hospital mortality for PE, and multivariate logistic regression analyses was performed. We considered 24,690 cases of first episode of PE. In-hospital mortality for PE was not different in patients without renal dysfunction, with CKD, or ESRD (23.6 vs. 24 vs. 18 % p = ns). In-hospital mortality for PE was independently associated with age (OR 1.045, 95 % CI 1.042-1.048, p < 0.001), female sex (OR 1.322, 95 % CI 1.242-1.406, p < 0.001), hypertension (OR 1.096, 95 % CI 1.019-1.178, p = 0.013), diabetes mellitus (OR 1.120, 95 % CI 1.001-1.253, p = 0.049), dementia (OR 1.171, 95 % CI 1.020-1.346, p = 0.025), peripheral vascular disease (OR 1.349, 95 % CI 1.057-1.720, p = 0.016) and malignancy (OR 1.065, 95 % CI 1.016-1.116, p = 0.008). Age and comorbidity are associated with in-hospital mortality for PE, whereas CKD does not appear to be an independent predictor of adverse outcomes in patients hospitalized for PE.","Aged;Cross-Sectional Studies;Databases, Factual;Female;*Hospital Mortality;Humans;Italy;Kidney Failure, Chronic/complications;Male;Patient Admission/statistics & numerical data;Patient Discharge/statistics & numerical data;Pulmonary Embolism/*etiology/*mortality;Renal Insufficiency, Chronic/*complications;Retrospective Studies","Fabbian, F.;Gallerani, M.;Pala, M.;De Giorgi, A.;Salmi, R.;Manfredini, F.;Portaluppi, F.;Dentali, F.;Ageno, W.;Mikhailidis, D. P.;Manfredini, R.",2013,Dec,10.1007/s11739-012-0892-8,0,
1233,Association Between Accelerated Multimorbidity and Age-Related Cognitive Decline in Older Baltimore Longitudinal Study of Aging Participants without Dementia,"Objectives: To explore the association between rate of physical health deterioration, operationalized as rising multimorbidity overtime, and longitudinal decline in cognitive function in older adults without dementia. Design: Longitudinal (Baltimore Longitudinal Study of Aging (BLSA)). Setting: Community. Participants: BLSA participants aged 65 and older followed for an average of 3 years and free of dementia or mild cognitive impairment (MCI) at baseline and follow-up (N = 756). Measurements: Standardized neurocognitive tests evaluating mental status, memory, executive function, processing speed, and verbal fluency were administered. Multimorbidity was assessed at each visit as number of diagnosed chronic diseases from a predefined list. Faster accumulation of chronic diseases was defined as upper quartile of rate of change in number of diseases over time (≥0.25 diseases/year). Results: Faster accumulation of chronic diseases was significantly associated with greater rate of decline on the Category (P =.01) and Letter (P =.01) Fluency Tests. Similar trends were also found for the Trail-Making Test Parts A (P =.08) and B (P =.07); no association was found with rate of change in visual and verbal memory. Conclusion: Although further investigations are required to validate the results and fully understand the underlying mechanisms, these findings suggest that accelerated deterioration of physical health is associated with accelerated decline with aging in specific cognitive domains in older adults without dementia.",aged;arthropathy;article;attention;Benton visual retention test;cerebrovascular accident;chronic disease;chronic obstructive lung disease;cognitive defect;comorbidity;congestive heart failure;coronary artery disease;correlational study;diabetes mellitus;executive function;female;follow up;hip fracture;human;hypertension;major clinical study;male;memory assessment;mental deterioration;mental health;mild cognitive impairment;Mini Mental State Examination;neoplasm;Parkinson disease;trail making test;verbal communication;verbal memory;working memory,"Fabbri, E.;An, Y.;Zoli, M.;Tanaka, T.;Simonsick, E. M.;Kitner-Triolo, M. H.;Studenski, S. A.;Resnick, S. M.;Ferrucci, L.",2016,,,0,
1234,Characteristics and mortality of type 2 diabetic patients hospitalized for severe iatrogenic hypoglycemia,"Aims: Severe hypoglycemia can be dramatic in diabetic patients, but its long-term outcome is unknown. We aimed to describe clinical characteristics of type 2 diabetic patients hospitalized for iatrogenic hypoglycemia, and find predictors of long-term mortality, with a special regard to anti-hyperglycemic regimens. Methods: We retrospectively analyzed 126 episodes of severe hypoglycemia in type 2 diabetic patients. We collected data on the event (coma, pre-hospital fall, glucose level, duration of hypoglycemia), concomitant risk factors, diabetic complications and chronic comorbidities. We divided patients according to the use of insulin or oral agents (OHAs). In-hospital outcomes were acute coronary syndrome (ACS) and duration of hospitalization. We finally assessed long-term mortality. Results: Hypoglycemia due to OHA was associated with higher prevalence of coma and longer duration than hypoglycemia due to insulin. OHA use was also associated with a longer hospital stay, but no increase in the incidence of ACS. Overall mortality after a 2-year median follow-up was 42.1%. Despite the apparent worse presentation of hypoglycemic episodes associated with OHA use, this did not lead to an increased long-term mortality. Conclusions: Severe iatrogenic hypoglycemia in OHA-treated patients has a worse presentation, but is not associated with a higher long-term mortality than in insulin-treated patients. © 2009 Elsevier Ireland Ltd. All rights reserved.",acetylsalicylic acid;beta adrenergic receptor blocking agent;central depressant agent;cimetidine;dipeptidyl carboxypeptidase inhibitor;glibenclamide;gliclazide;glimepiride;glucose;insulin;insulin derivative;metformin;nonsteroid antiinflammatory agent;oral antidiabetic agent;repaglinide;acute coronary syndrome;adult;aged;artery disease;article;blood sampling;chronic obstructive lung disease;comorbidity;coronary artery disease;dementia;diabetic neuropathy;diabetic retinopathy;disease duration;drug use;dyslipidemia;falling;female;follow up;glucose blood level;hospital patient;human;human tissue;hypertension;hypoglycemia;hypoglycemic coma;iatrogenic disease;insulin treatment;length of stay;liver disease;major clinical study;male;medical record review;mortality;neoplasm;non insulin dependent diabetes mellitus;obesity;prognosis;retrospective study;rheumatoid arthritis;risk factor;aspirin,"Fadini, G. P.;Rigato, M.;Tiengo, A.;Avogaro, A.",2009,,,0,
1235,Magnetic resonance of metabolic and degenerative diseases in children,"Cerebral magnetic resonance imaging and spectroscopy form an integral part in the diagnosis and management of the vast spectrum of metabolic and degenerative disorders in children. These varied disorders have been classified in many different ways, according to anatomic location, head size, enzyme disorder, or cellular morphology and function. The clinical features and magnetic resonance imaging appearances of the most common disorders are discussed.",adrenoleukodystrophy;Alexander disease;alper disease;article;Canavan disease;cell function;cell structure;cephalometry;child;childhood disease;clinical feature;Cockayne syndrome;degenerative disease;diagnostic value;disease classification;Fahr disease;gangliosidosis;neurodegeneration with brain iron accumulation;hereditary optic atrophy;human;Huntington chorea;image analysis;inborn error of metabolism;Kearns Sayre syndrome;Leigh disease;lipidosis;MELAS syndrome;Menkes syndrome;MERFF syndrome;metabolic disorder;mucopolysaccharidosis;neuroanatomy;neuronal ceroid lipofuscinosis;nuclear magnetic resonance imaging;nuclear magnetic resonance spectroscopy;Pelizaeus Merzbacher disease;priority journal;Zellweger syndrome,"Faerber, E. N.;Poussaint, T. Y.",2002,,,0,
1236,"Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice","The purpose of the study was to assess the prognostic significance of out-of-the-office blood pressure (BP) measurement in older patients in general practice, and to compare the results for BP measured in the office, at home and during 24-h ambulatory monitoring. All registerd patients who were 60 years or older were eligible for the study, except when bedridden, demented or admitted in a home for sick elderly people, or when they had suffered a myocardial infarction or stroke. After baseline measurements in 1990 -1993, incidence of major cardiovascular events (cardiovascular death, myocardial infarction and stroke) was ascertained in 2002 -2003 and related to the BPs by use of multivariate Cox regression analysis. Age of the 391 patients averaged 71±9 years; 40% were men. During median follow-up of 10.9 years, 86 patients (22%) suffered a cardiovascular event. The adjusted relative hazard rate, associated with a 1 s.d. increment in systolic BP was 1.13 for office BP (NS), and, respectively, 1.32, 1.33 and 1.42, for home, daytime and night time BP (P≤0.01 for all). Results were similar for diastolic BP. The prognostic significance of all out-of-the-office BPs was independent of office BP. The prognostic value of home BP was equal to (systolic) or even better (diastolic) than that of daytime BP. Night time BP predicted cardiovascular events independent of all other BPs. Prognosis of white-coat hypertension was similar to that of true normotension, but better than in sustained hypertension. In conclusion, the prognostic value of home BP is better than that of office BP in older patients in primary care, and is at least equal to that of daytime ambulatory BP. The prognosis of patients with white-coat hypertension is similar to that of true normotensives. © 2005 Nature Publishing Group All rights reserved.",adult;aged;ambulatory monitoring;article;blood pressure monitoring;cardiovascular disease;circadian rhythm;controlled study;dementia;diastolic blood pressure;female;follow up;general practice;geriatric care;heart death;heart infarction;home care;home for the aged;human;incidence;major clinical study;male;multivariate logistic regression analysis;outpatient department;prediction;primary medical care;prognosis;risk assessment;cerebrovascular accident;systolic blood pressure;white coat hypertension,"Fagard, R. H.;Van Den Broeke, C.;De Cort, P.",2005,,,0,
1237,Active rehabilitation of senile patients,"781 patients with an average age of 78 yr were rehabilitated after a stay of 221 days in a geriatric hospital and could be released to their own or into old people's homes. The course of 600 patients was followed up. 80 patients were able to stay outside the hospital for up to only 6 mth. But, for instance, a new myocardial infarction cannot be looked at as a failure of rehabilitation in the case of an 83 yr old patient.",age;aged;classification;hospital;nursing home;rehabilitation;senility;therapy,"Falck, I.",1976,,,0,
1238,Hospitalization for pneumonia is associated with decreased 1-year survival in patients with type 2 diabetes results from a prospective cohort study,"Diabetes mellitus is a frequent comorbid conditions among patients with pneumonia living in the community. The aim of our study is to evaluate the impact of hospitalization for pneumonia on early (30 day) and late mortality (1 year) in patients with type 2 diabetes mellitus. Prospective comparative cohort study of 203 patients with type 2 diabetes hospitalized for pneumonia versus 206 patients with diabetes hospitalized for other noninfectious causes from January 2012 to December 2013 at Policlinico Umberto I (Rome). Enrolled patients were followed up to discharge and up to 1 year after initial hospital admission or death. Overall, 203 patients with type 2 diabetes admitted to hospital for pneumonia were compared to 206 patients with type 2 diabetes admitted for other causes (39.3% decompensated diabetes, 21.4% cerebrovascular diseases, 9.2% renal failure, 8.3% acute myocardial infarction, and 21.8% other causes). Compared to control patients, those admitted for pneumonia showed a higher 30-day (10.8% vs 1%, P<0.001) and 1-year mortality rate (30.3% vs 16.8%, P<0.001). Compared to survivors, nonsurvivor patients with pneumonia had a higher incidence of moderate to severe chronic kidney disease, hemodialysis, and malnutrition were more likely to present with a mental status deterioration, and had a higher number of cardiovascular events during the follow-up period. Cox regression analysis found age, Charlson comorbidity index, pH<7.35 at admission, hemodialysis, and hospitalization for pneumonia as variables independently associated with mortality. Hospitalization for pneumonia is associated with decreased 1-year survival in patients with type 2 diabetes, and appears to be a major determinant of long-term outcome in these patients.",beta lactamase inhibitor;carbapenem;cephalosporin;macrolide;metformin;polypeptide antibiotic agent;quinolone derivative;acute heart infarction;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic obstructive lung disease;clinical evaluation;clinical feature;cohort analysis;controlled study;diabetic patient;disease association;Escherichia coli pneumonia;female;follow up;Haemophilus influenzae;health care associated pneumonia;heart failure;hemodialysis;hospital admission;hospitalization;human;kidney failure;Klebsiella pneumoniae;Klebsiella pneumoniae infection;major clinical study;male;malnutrition;mental deterioration;mental health;metabolic acidosis;mortality rate;Mycoplasma pneumonia;Mycoplasma pneumoniae;non insulin dependent diabetes mellitus;pneumonia;priority journal;prospective study;Pseudomonas aeruginosa;Pseudomonas pneumonia;septic shock;staphylococcal pneumonia;Staphylococcus aureus;Streptococcus pneumonia;Streptococcus pneumoniae;survival time;survivor;very elderly,"Falcone, M.;Tiseo, G.;Russo, A.;Giordo, L.;Manzini, E.;Bertazzoni, G.;Palange, P.;Taliani, G.;Cangemi, R.;Farcomeni, A.;Vullo, V.;Violi, F.;Venditti, M.",2016,,,0,
1239,Competing-risk analysis of death and dialysis initiation among elderly (>/=80 years) newly referred to nephrologists: a French prospective study,"BACKGROUND: Reasons underlying dialysis decision-making in Octogenarians and Nonagenarians have not been further explored in prospective studies. METHODS: This regional, multicentre, non-interventional and prospective study was aimed to describe characteristics and quality of life (QoL) of elderly (>/=80 years of age) with advanced chronic kidney disease (stage 3b-5 CKD) newly referred to nephrologists. Predictive factors of death and dialysis initiation were also assessed using competing-risk analyses. RESULTS: All 155 included patients had an estimated glomerular filtration rate (eGFR) below 45 ml/min/1.73 m2. Most patients had a non anaemic haemoglobin level (Hb) with no iron deficiency, and normal calcium and phosphate levels. They were well-fed and had a normal cognitive function and a good QoL. The 3-year probabilities of death and dialysis initiation reached 27% and 11%, respectively. The leading causes of death were cardiovascular (32%), cachexia (18%), cancer (9%), infection (3%), trauma (3%), dementia (3%), and unknown (32%). The reasons for dialysis initiation were based on uncontrolled biological abnormalities, such as hyperkalemia or acidosis (71%), uncontrolled digestive disorders (35%), uncontrolled pulmonary or peripheral oedema (29%), and uncontrolled malnutrition (12%). No patients with acute congestive heart failure or cancer initiated dialysis. Predictors of death found in both multivariate regression models (Cox and Fine & Gray) included acute congestive heart failure, age, any walking impairment and Hb<10 g/dL. Regarding dialysis initiation, eGFR <23 mL/min/1.73 m2 was the only predictor found in the Cox multivariate regression model whereas eGFR<23 mL/min/1.73 m2 and diastolic blood pressure were both independently associated with dialysis initiation in the Fine & Gray analysis. Such findings suggested that death and dialysis were independent events. CONCLUSIONS: Octogenarians and Nonagenarians newly referred to nephrologists by general practitioners were highly selected patients, without any symptoms of the common geriatric syndrome. In this population, nephrologists' dialysis decision was based exclusively on uremic criteria.","Aged, 80 and over;Female;Follow-Up Studies;France/epidemiology;Humans;Male;*Physicians;Prospective Studies;*Referral and Consultation;Renal Dialysis/*adverse effects/*mortality;Renal Insufficiency, Chronic/*mortality/*therapy;Risk Assessment","Faller, B.;Beuscart, J. B.;Frimat, L.",2013,May 07,10.1186/1471-2369-14-103,0,1240
1240,Competing-risk analysis of death and dialysis initiation among elderly (≥80 years) newly referred to nephrologists: A French prospective study,"Background: Reasons underlying dialysis decision-making in Octogenarians and Nonagenarians have not been further explored in prospective studies. Methods. This regional, multicentre, non-interventional and prospective study was aimed to describe characteristics and quality of life (QoL) of elderly (≥80 years of age) with advanced chronic kidney disease (stage 3b-5 CKD) newly referred to nephrologists. Predictive factors of death and dialysis initiation were also assessed using competing-risk analyses. Results: All 155 included patients had an estimated glomerular filtration rate (eGFR) below 45 ml/min/1.73 m2. Most patients had a non anaemic haemoglobin level (Hb) with no iron deficiency, and normal calcium and phosphate levels. They were well-fed and had a normal cognitive function and a good QoL. The 3-year probabilities of death and dialysis initiation reached 27% and 11%, respectively. The leading causes of death were cardiovascular (32%), cachexia (18%), cancer (9%), infection (3%), trauma (3%), dementia (3%), and unknown (32%). The reasons for dialysis initiation were based on uncontrolled biological abnormalities, such as hyperkalemia or acidosis (71%), uncontrolled digestive disorders (35%), uncontrolled pulmonary or peripheral oedema (29%), and uncontrolled malnutrition (12%). No patients with acute congestive heart failure or cancer initiated dialysis. Predictors of death found in both multivariate regression models (Cox and Fine & Gray) included acute congestive heart failure, age, any walking impairment and Hb <10 g/dL. Regarding dialysis initiation, eGFR <23 mL/min/1.73 m2 was the only predictor found in the Cox multivariate regression model whereas eGFR <23 mL/min/1.73 m 2 and diastolic blood pressure were both independently associated with dialysis initiation in the Fine & Gray analysis. Such findings suggested that death and dialysis were independent events. Conclusions: Octogenarians and Nonagenarians newly referred to nephrologists by general practitioners were highly selected patients, without any symptoms of the common geriatric syndrome. In this population, nephrologists' dialysis decision was based exclusively on uremic criteria. © 2013 Faller et al.; licensee BioMed Central Ltd.",C reactive protein;calcium;hemoglobin;phosphate;transferrin;acidosis;aged;article;blood pressure measurement;calcium blood level;cause of death;chronic kidney disease;cognition;congestive heart failure;dementia;diabetic nephropathy;dialysis;diastolic blood pressure;disease association;disease course;elderly care;female;glomerulonephritis;glomerulus filtration rate;hearing impairment;hemiplegia;hemoglobin blood level;human;hyperkalemia;interstitial nephritis;lung edema;major clinical study;male;malnutrition;multicenter study;nephrologist;peripheral edema;phosphate blood level;practice guideline;predictive value;prospective study;quality of life;risk assessment;systolic blood pressure;very elderly;visual impairment;walking difficulty,"Faller, B.;Beuscart, J. B.;Frimat, L.",2013,,,0,
1241,The Rate of Magnetic Resonance Imaging in Patients with Deep Brain Stimulation,"Background: For Parkinson's disease (PD), essential tremor (ET), and dystonia patients with deep brain stimulation (DBS) implants, magnetic resonance imaging (MRI) requires additional safety considerations due to potentially hazardous interactions. Objective: A propensity-matched cohort of DBS-implanted patients was analyzed to determine the likelihood of needing MRI. Methods: Patients with new DBS full-system implants (n = 576) were identified in the Truven Health MarketScan® Commercial Claims and Medicare Supplemental Databases (2009-2012). Patients diagnosed with PD, ET, or dystonia and no DBS implant were identified (DBS-indicated patients: n = 11,216). The DBS-indicated patients were continuously enrolled for 4 years and matched for age, gender, and propensity score based on comorbid conditions to DBS-implanted patients (n = 4,878 and 543, respectively). A Kaplan-Meier survival curve of time to first MRI was extrapolated to 10 years. Results: An estimated 56-57% of DBS-indicated patients need an MRI within 5 years and 66-75% within 10 years after implantation. While 92% of DBS-implanted patients' MRI after implantation was of the head, for DBS-indicated patients, 62% of MRIs were of the body, potentially unrelated to the primary diagnosis. Conclusions: This analysis highlights the projected utilization of MRI in the DBS population for head and full-body images.",acquired immune deficiency syndrome;adult;age;aged;article;brain depth stimulation;cerebrovascular disease;chronic lung disease;cohort analysis;congestive heart failure;diabetes mellitus;dystonia;essential tremor;female;gender;heart infarction;hemiplegia;human;Human immunodeficiency virus infection;kidney disease;liver disease;major clinical study;male;malignant neoplastic disease;metastasis;middle aged;nuclear magnetic resonance imaging;paraplegia;Parkinson disease;peptic ulcer;peripheral vascular disease;rheumatic disease;senility;very elderly,"Falowski, S.;Safriel, Y.;Ryan, M. P.;Hargens, L.",2016,,,0,
1242,Charlson comorbidity index as a predictor of in-hospital death in acute ischemic stroke among very old patients: a single-cohort perspective study,"Chronic diseases are increasing worldwide. Association of two or more chronic conditions is related with poor health status and reduced life expectancy, particularly among elderly patients. Comorbidities represent a risk factor for adverse events in several critical illnesses. We aimed to evaluate if elderly patients are affected by multiple chronic pathologies, assessed by Charlson comorbidity index (CCI), showed a reduced in-hospital survival after ischemic stroke. In a 3-year period, we evaluated all the subjects admitted to our internal medicine department for ischemic stroke. Age, sex, NIHSS score and all the comorbidities were recorded. Days of hospitalization, hospital-related infections and in-hospital mortality were also assessed. For each patient, we evaluated CCI, obtaining four classes: group 1 (CCI: 2–3), group 2 (CCI: 4–5), group 3 (CCI: 6–7) and group 4 (CCI: ≥8). Survival was evaluated with Kaplan–Meier and Cox regression analyses. The complete model considered in-hospital death as the main outcome, days of hospitalization as the time variable and CCI as the main predictor, adjusting for NIHSS, sex and nosocomial infections. Patients in CCI group 3 and 4 had an increased risk of in-hospital mortality, independently of NIHSS, sex and nosocomial infections. Elderly patients with multiple comorbidities have higher risk of in-hospital death when affected by ischemic stroke.",acquired immune deficiency syndrome;acute leukemia;adult;aged;aging;article;artificial ventilation;atrial fibrillation;brain ischemia;cerebrovascular disease;Charlson Comorbidity Index;chronic disease;chronic hepatitis;chronic leukemia;chronic lung disease;chronic obstructive lung disease;clinical assessment;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;diabetic nephropathy;diabetic neuropathy;diabetic retinopathy;dyslipidemia;female;heart infarction;high risk patient;hospital infection;mortality;hospitalization;human;hypertension;Kaplan Meier method;kidney disease;liver disease;lymphoma;major clinical study;male;middle aged;National Institutes of Health Stroke Scale;neoplasm;outcome assessment;peptic ulcer;pneumonia;proportional hazards model;risk factor;stroke patient;survival rate;urinary tract infection;very elderly,"Falsetti, L.;Viticchi, G.;Tarquinio, N.;Silvestrini, M.;Capeci, W.;Catozzo, V.;Fioranelli, A.;Buratti, L.;Pellegrini, F.",2016,,,0,
1243,Related risk factors of vascular dementia in stroke patients: Grouping controlled comparison,"Aim: Vascular dementia (VD) is the only dementia that can be prevented by controlling its risk factors, so it is very significant to explore the risk factors of VD. Methods: Totally 226 patients with cerebrovascular diseases, who were diagnosed in the Department of Neurology, First and Second Affiliated Hospitals of China Medical University, were divided into VD group (n = 59) and non-VD group (n = 167). The related factors of dementia were compared in the two groups. Results: There were 52 cases in the VD group and 83 cases in the non-VD group respectively. The number of patients with age of episode ≥65 years old, course of disease ≥ 5 years, educational levels ≤ junior middle school, frequency of stroke ≥ 2, amount of focus ≥ 2 were 52, 50, 49, 47 and 48 in the VD group, while 83, 69, 103, 74 and 70 in the non-VD group respectively. Cerebral infarction and cerebral hemorrhage occupied 48/101 and 7/48 respectively in the VD group; the basal ganglion and the thalamus occupied 22/43 and 18/33 respectively in focus position. The risk factors of hypertension, diabetes, hyperlipidemia, coronary heart disease (CHD) and smoking addiction occurred in 53, 23, 34, 16 and 44 cases of the VD group, and 107, 37, 69, 25 and 96 cases of the non-VD group respectively, and the differences were significant. Conclusion: VD is the consequence of multiple factors. Patients with advanced age, long course of disease, low educational level, repeated stroke, multi-focal lesion, ischemic cerebral infarction, the basal ganglion and the thalamus focus were easy to get VD. Hypertension, diabetes, hyperlipidemia, CHD, smoking addiction are the high risk factors of VD, which should be supervised and treated.",adult;aged;article;basal ganglion;brain hemorrhage;brain infarction;cerebrovascular disease;comparative study;controlled study;dementia;diabetes mellitus;disease course;female;human;hyperlipidemia;hypertension;ischemic heart disease;major clinical study;male;morbidity;multiinfarct dementia;patient education;risk assessment;risk factor;cerebrovascular accident;thalamus;tobacco dependence,"Fan, H. J.;Yu, W. D.",2004,,,0,
1244,Cardiovascular and Cognitive Health Study in Middle-Aged and Elderly Residents of Beijing(CCHS-Beijing): Design and Rationale,"The Cardiovascular and Cognitive Health Study (CCHS-Beijing) is a population-based study of cardiovascular disease (CVD) and cognitive impairment in adults aged 55 and older in Beijing. The main aims of the study are to investigate the prevalence rates of CVD, asymptomatic atherosclerosis, and cognitive impairment, as well as validate the risk factors related to the onset and development of CVD, Alzheimer's disease (AD) and mild cognitive impairment (MCI). The study was designed to detect the traditional and new risk factors in this age group. Participants were recruited randomly from residential regions in the greater Beijing municipality area based on the average levels of development in Beijing, China in 2012 (based on socioeconomic, demographic, and geographical characteristics). Thorough physical and laboratory examination were performed at baseline (also the cross-sectional survey) to identify the risk factors such as hypertension, dyslipidemia, diabetes, as well as newly defined risk factors like elevated homocysteine, high sensitivity C-reactive protein, and urine micro-albumin. Subclinical disease of the cerebral vasculature included atherosclerosis of carotid arteries, intracranial arteries, and retinal vessels. Subclinical cardiac diseases included left ventricular enlargement, arrhythmias, chamber hypertrophy and myocardial ischemia. Blood pressure was documented using the ankle-arm method. In addition, neuropsychological assessments were performed for all subjects aged 65 and above. Baseline evaluation began during the period August 2013 to December 2014. Follow-up examination will occur in 5 years. The initial and recurrent CVD, AD and MCI events will be verified and validated during the follow-up period.",,"Fang, X.;Wang, Z.;Wang, C.;Wu, J.;Yang, Y.;Li, F.;Hua, Y.;Liu, D.;Cai, Y.;Wang, R.;Guan, S.",2016,,10.1159/000443707,0,
1245,Prediction of Mortality in Nonagenarians Following the Surgical Repair of Hip Fractures,"BACKGROUND: The purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality. METHODS: Thirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery. RESULTS: Deyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036). CONCLUSIONS: Nonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients.",Femur neck fractures;Hip fractures;Nonagenarians;Trochanteric fractures,"Fansa, A.;Huff, S.;Ebraheim, N.",2016,Jun,10.4055/cios.2016.8.2.140,0,
1246,Carotid Endarterectomy or Stenting in Octogenarians in a Monocentric Experience,"Background Carotid artery stenting (CAS) has emerged as an alternative to carotid endarterectomy (CEA) in patients at high risk for complications from surgery. The very elderly (≥80-year-old) are 1 subgroup of patients identified as being at increased risk for carotid surgery. However, there is concern that the very elderly are also at increased risk for complications of CAS. A stroke and death rate of 12% were reported in very elderly patients during the roll-in phase of Carotid Revascularization Endarterectomy versus Stent Trial. We are reporting on a clinical series of CAS and CEA with independent neurologic assessment in the very elderly. The aim of this article is to evaluate early and mild-term results obtained in the treatment of the carotid artery stenosis in symptomatic and asymptomatic octogenarians, comparing the data of CEA and CAS in academic hospital. Methods Between 2002 and 2013, a consecutive series of 129 CAS and 45 CEA patients (≥80-year-old) were treated in our academic hospital, a center with extensive carotid revascularization experience. Independent neurologic assessment was performed before and after procedures. Exclusion criteria were cerebral hemorrhage diagnosed within 6 months, cerebral tumors and dementia. Hostile aortic arches were nevertheless treated with alternative approaches like cervical or radial access. All the procedures have been performed by the senior authors. Results The average age was 86.9 years. Most patients were male (56%), and the target lesion carotid stenosis was asymptomatic in 80% of patients. No significant differences were obtained regarding gender, symptoms, risk factors or comorbidities, and evident CT lesions among the 2 groups of different treatments. Embolic protection devices were used in all cases with the CAS procedure. The overall 30-day incidence of stroke and death was 2.3% (3 of 129) in CAS group and 4.4% (2 of 45) in CEA group. Conclusions Exclusion of high-risk patients from CAS, based on age alone, seems to be unjustified. Octogenarians are not at increased risk of periprocedural adverse events after CAS compared with younger patients. The key to obtain satisfactory results is CAS to be performed by an experienced team able to use not only standard filter protected CAS but also familiar with all the other types of access and protection techniques.",aged;aortic arch;article;atrial fibrillation;cardiovascular mortality;cardiovascular risk;carotid artery bifurcation;carotid artery obstruction;carotid artery stenting;carotid endarterectomy;cerebrovascular accident;comorbidity;embolic protection device;endovascular surgery;female;heart muscle ischemia;high risk patient;human;incidence;intermethod comparison;lingual artery;major clinical study;male;morbidity;mortality rate;non ST segment elevation myocardial infarction;nuclear magnetic resonance imaging;postoperative care;postoperative complication;postoperative hemorrhage;preoperative care;priority journal;regional anesthesia;ST segment depression;transient ischemic attack;treatment outcome;very elderly,"Fantozzi, C.;Taurino, M.;Rizzo, L.;Stella, N.;Persiani, F.",2016,,10.1016/j.avsg.2015.10.039,0,
1247,Management of thrombotic and cardiovascular disorders in the new millenium,"Anticoagulants and antithrombotic drugs have played a key role in the prophylaxis, treatment and surgical/interventional management of thrombotic and cardiovascular disorders. There are several newer drugs which are currently developed for the anticoagulant management of cardiovascular diseases in both the medical and surgical indications. These include the low molecular weight heparins (LMWHs), antithrombin agents such as the Hirudin, Hirulog and Argatroban and indirect and direct anti-Xa drugs, represented by Pentasaccharide (Arixtra®) and DX 9065a, respectively. Several other agents such as the natural and recombinant anti-Xa drugs and anti-tissue factor agents are also developed. The antiplatelet agents include Clopidogrel, Cilostazol, Anplag and GP IIb/IIIa inhibitors. For the subcutaneous indications, unfractionated heparin is gradually replaced by the low molecular weight heparins (LMWHs). LMWHs such as the Enoxaparin and Dalteparin are commonly used for the management of acute coronary syndrome. These drugs have been approved for the treatment of unstable angina and are currently undergoing rigorous trials for interventional indications. Arixtra® is also developed for various subcutaneous indications. However, it exhibits lower anticoagulant effects and may not be optimal for intravenous and interventional purposes. At a higher dosage when administered intravenously the LMWHs produce varying degrees of anticoagulation at relatively lower activated clotting times (150-200). Several studies in vascular and cardiovascular interventions have shown that even at a relatively lower anticoagulant level the LMWHs are as effective as unfractionated heparin at the recommended dosages which produce a relatively higher level of anticoagulation (ACT > 200 secs.). Thus, these agents are currently developed for interventional and surgical indications. It should be emphasized that different LMWHs produce different degrees of anticoagulation and should therefore be individually optimized for a given interventional or surgical purposes. At a relatively high dosage the levels of LMWHs can be measured by using the ACT and APTT. When administered with such GP IIb/IIIa inhibitors as the Abciximab, Aggrastat or Eptifibratide, these drugs may require dosage adjustment. However, since the introduction of the front loading of Clopidogrel, the unqualified use of GP IIb/IIIa is debated. LMWHs will find expanded indications in both the medical and surgical management of patients with cardiovascular disorders including atrial fibrillation and congestive heart failure. The only approved anti-Xa drug is represented by a synthetic heparinomimetic, namely, Arixtra®. This drug is given for the prophylaxis of post orthopedic indications. This agent is undergoing additional clinical trials in the management of coronary artery diseases. Because of the dependence on antithrombin III (AT) and the sole and-Xa effects, it has a narrow therapeutic index and its efficacy in this indication may be limited. Additional clinical trials are needed at this time to validate the clinical potential of this drug. The antithrombin agents (Hirudin, Hirulog and Argatroban) were initially developed for arterial indications. However, these agents are approved as a substitute anticoagulant in patients with heparin induced thrombocytopenia (HIT) and PCI. Currently all of these agents are being developed for surgical and interventional use. However, since there is no available antidote at this time, the development is somewhat limited. The antithrombin agents may be useful in patients with HIT which require further clinical validaton. Many other anti-Xa agents are also developed. Most of these can be given parenterally. However, the clinical data is somewhat limited. Similarly, several of the new antiplatelet drugs can be administered parenterally and may be useful in CAD. Since most of these newer anticoagulant and antithrombotic drugs are mono-therapeutic their therapeutic index is rather limited. Only in combination these agents can mimic heparins. At this time i is safe to state that heparin and its LMW derivatives will remain the anticoagulant of choice for cardiovascular indications until these newer agents have been validated in extended clinical trials in polytherapeutic settings.",2 [4 [(1 acetimidoyl 3 pyrrolidinyl)oxy]phenyl] 3 (7 amidino 2 naphthyl)propionic acid;abciximab;activated protein C;anticoagulant agent;antithrombin;antithrombocytic agent;argatroban;biovalirudin;blood clotting factor 10a inhibitor;cilostazol;clopidogrel;dalteparin;drotrecogin;enoxaparin;eptifibatide;fibrinogen receptor antagonist;fibrinolytic agent;fondaparinux;heparin;hirudin;hirulog;lepirudin;low molecular weight heparin;mc 977;melagatran;nadroparin;sarpogrelate;ticlopidine;tirofiban;unindexed drug;ximelagatran;tadocizumab;article;bleeding;blood clotting time;cardiovascular disease;clinical trial;drug cost;drug efficacy;drug safety;heart infarction;heart muscle ischemia;human;multiinfarct dementia;partial thromboplastin time;priority journal;thrombocytopenia;thrombosis;unstable angina pectoris;angiomax;arixtra;dx 9065a;novastan;refludan;reopro;xigris;ym 337,"Fareed, J.;Hoppensteadt, D. A.;Bick, R. L.",2003,,,0,
1248,Use of beta-blockers and risk of dementia in elderly patients,,beta adrenergic receptor;beta adrenergic receptor blocking agent;melatonin;metoprolol;serotonin receptor;acute coronary syndrome;Alzheimer disease;cognitive defect;delirium;dementia;drug withdrawal;human;letter;liver metabolism;long term care;mild cognitive impairment;priority journal;urinary excretion;visual hallucination,"Fares, A.",2012,,,0,
1249,Low-Level Laser Therapy Ameliorates Disease Progression in a Mouse Model of Alzheimer's Disease,"Low-level laser therapy (LLLT) has been used to treat inflammation, tissue healing, and repair processes. We recently reported that LLLT to the bone marrow (BM) led to proliferation of mesenchymal stem cells (MSCs) and their homing in the ischemic heart suggesting its role in regenerative medicine. The aim of the present study was to investigate the ability of LLLT to stimulate MSCs of autologous BM in order to affect neurological behavior and β-amyloid burden in progressive stages of Alzheimer's disease (AD) mouse model. MSCs from wild-type mice stimulated with LLLT showed to increase their ability to maturate towards a monocyte lineage and to increase phagocytosis activity towards soluble amyloid beta (Aβ). Furthermore, weekly LLLT to BM of AD mice for 2 months, starting at 4 months of age (progressive stage of AD), improved cognitive capacity and spatial learning, as compared to sham-treated AD mice. Histology revealed a significant reduction in Aβ brain burden. Our results suggest the use of LLLT as a therapeutic application in progressive stages of AD and imply its role in mediating MSC therapy in brain amyloidogenic diseases. © 2014 Springer Science+Business Media New York.",amyloid;low level laser therapy;bone marrow;mesenchymal stem cell;disease course;mouse;mouse model;Alzheimer disease;brain;monocyte;wild type;regenerative medicine;heart muscle ischemia;commercial phenomena;animal behavior;therapy;histology;healing;spatial learning;diseases;phagocytosis;United States;tissues;inflammation,"Farfara, D.;Tuby, H.;Trudler, D.;Doron-Mandel, E.;Maltz, L.;Vassar, R. J.;Frenkel, D.;Oron, U.",2014,,,0,
1250,A look into amyloid formation by transthyretin: aggregation pathway and a novel kinetic model,"The aggregation of proteins into insoluble amyloid fibrils is the hallmark of many, highly debilitating, human pathologies such as Alzheimer's or Parkinson's disease. Transthyretin (TTR) is a homotetrameric protein implicated in several amyloidoses like Senile Systemic Amyloidosis (SSA), Familial Amyloid Polyneuropathy (FAP), Familial Amyloid Cardiomyopathy (FAC), and the rare Central Nervous System selective Amyloidosis (CNSA). In this work, we have investigated the kinetics of TTR aggregation into amyloid fibrils produced by the addition of NaCl to acid-unfolded TTR monomers and we propose a mathematically simple kinetic mechanism to analyse the aggregation kinetics of TTR. We have conducted circular dichroism, intrinsic tryptophan fluorescence and thioflavin-T emission experiments to follow the conformational changes accompanying amyloid formation at different TTR concentrations. Kinetic traces were adjusted to a two-step model with the first step being second-order and the second being unimolecular. The molecular species present in the pathway of TTR oligomerization were characterized by size exclusion chromatography coupled to multi-angle light scattering and by transmission electron microscopy. The results show the transient accumulation of oligomers composed of 6 to 10 monomers in agreement with reports suggesting that these oligomers may be the causative agent of cell toxicity. The results obtained may prove to be useful in understanding the mode of action of different compounds in preventing fibril formation and, therefore, in designing new drugs against TTR amyloidosis.","Amyloid/*chemistry;Humans;Hydrochloric Acid/pharmacology;Kinetics;*Models, Molecular;Prealbumin/*chemistry;*Protein Multimerization;Protein Structure, Secondary;Protein Unfolding/drug effects","Faria, T. Q.;Almeida, Z. L.;Cruz, P. F.;Jesus, C. S.;Castanheira, P.;Brito, R. M.",2015,Mar 21,10.1039/c4cp04549a,0,
1251,"A 25-week, open-label trial investigating rivastigmine transdermal patches with concomitant memantine in mild-to-moderate Alzheimers disease: A post hoc analysis","Objective: To investigate the tolerability and efficacy of the rivastigmine transdermal patch in patients with mild-to-moderate Alzheimers disease receiving concomitant memantine. Research design and methods: Post hoc analysis of a 25-week, randomized, prospective, open-label, parallel-group study. Patients receiving donepezil were switched to rivastigmine patches (4.6mg/24h) immediately or following a 7-day withdrawal for 4 weeks (core phase), before titrating up to 9.5mg/24h for a further 20-week extension phase. Prior memantine therapy was continued throughout. Clinical trial registration: clinicaltrials.gov. NCT00428389. Main outcome measures: Tolerability (adverse events [AEs], serious AEs [SAEs] and discontinuations) and efficacy (cognition, global functioning and activities of daily living [ADLs]) were assessed for the rivastigmine transdermal patch, with or without concomitant memantine. Results: Overall, 135 and 126 patients received rivastigmine with and without memantine, respectively. Of these, 122 (90.4) and 118 (93.7) patients with and without memantine, respectively, completed the core phase; 120 and 114 patients, respectively, entered the extension phase, and 90 (75.0) and 86 (75.4) completed the study. The incidences of AEs (73.3 vs. 67.5) and SAEs (10.4 vs. 7.1) were both slightly larger in patients receiving concomitant memantine, but the differences were not statistically significant (95 CIs:-5.2, 16.9 and-3.6, 10.1 for AEs and SEAs, respectively). The incidence of gastrointestinal AEs was low in both groups. Discontinuation due to AEs was higher in patients who received memantine (17.0 vs. 11.9). Changes in cognitive and global function were similar between groups. ADL scores worsened in both groups; significantly more in those treated with memantine. Conclusion: Use of the rivastigmine transdermal patch in patients on established memantine appears to be well-tolerated, with only modest, non-significant increases in AEs compared with monotherapy, and did not seem to affect cognition or global functioning adversely. © 2010 Informa UK Ltd All rights reserved.",NCT00428389;donepezil;memantine;rivastigmine;aged;agitation;Alzheimer disease;anemia;anxiety;application site reaction;article;asthenia;benign tumor;bradycardia;cerebrovascular accident;clinical trial;cognition;confusion;controlled clinical trial;controlled study;coronary artery disease;daily life activity;dehydration;diarrhea;disease severity;drug dose titration;drug efficacy;drug substitution;drug tolerability;drug withdrawal;dyspnea;falling;female;heart infarction;hip fracture;human;hyperglycemia;hyponatremia;lethargy;limb abscess;limb disease;major clinical study;major depression;male;mental health;nausea;post hoc analysis;psychosis;randomized controlled trial;sepsis;side effect;faintness;treatment duration;treatment outcome;urinary tract infection;vomiting,"Farlow, M. R.;Alva, G.;Meng, X.;Olin, J. T.",2010,,,0,
1252,Long-term treatment with active Aβ immunotherapy with CAD106 in mild Alzheimer's disease,"Abstract Introduction: CAD106 is designed to stimulate amyloid-β (Aβ)-specific antibody responses while avoiding T-cell autoimmune responses. The CAD106 first-in-human study demonstrated a favorable safety profile and promising antibody response. We investigated long-term safety, tolerability and antibody response after repeated CAD106 injections. Methods: Two phase IIa, 52-week, multicenter, randomized, double-blind, placebo-controlled core studies (2201; 2202) and two 66-week open-label extension studies (2201E; 2202E) were conducted in patients with mild Alzheimer's disease (AD) aged 40 to 85 years. Patients were randomized to receive 150μg CAD106 or placebo given as three subcutaneous (2201) or subcutaneous/intramuscular (2202) injections, followed by four injections (150 μg CAD106; subcutaneous, 2201E1; intramuscular, 2202E1). Our primary objective was to evaluate the safety and tolerability of repeated injections, including monitoring cerebral magnetic resonance imaging scans, adverse events (AEs) and serious AEs (SAEs). Further objectives were to assess Aβ-specific antibody response in serum and Aβ-specific T-cell response (core only). Comparable Aβ-immunoglobulin G (IgG) exposure across studies supported pooled immune response assessments. Results: Fifty-eight patients were randomized (CAD106, n = 47; placebo, n = 11). Baseline demographics and characteristics were balanced. Forty-five patients entered extension studies. AEs occurred in 74.5% of CAD106-treated patients versus 63.6% of placebo-treated patients (core), and 82.2% experienced AEs during extension studies. Most AEs were mild to moderate in severity, were not study medication-related and did not require discontinuation. SAEs occurred in 19.1% of CAD106-treated patients and 36.4% of placebo-treated patients (core). One patient (CAD106-treated; 2201) reported a possibly study drug-related SAE of intracerebral hemorrhage. Four patients met criteria for amyloid-related imaging abnormalities (ARIA) corresponding to microhemorrhages: one was CAD106-treated (2201), one placebo-treated (2202) and two open-label CAD106-treated. No ARIA corresponded to vasogenic edema. Two patients discontinued extension studies because of SAEs (rectal neoplasm and rapid AD progression, respectively). Thirty CAD106-treated patients (63.8%) were serological responders. Sustained Aβ-IgG titers and prolonged time to decline were observed in extensions versus core studies. Neither Aβ<inf>1-6</inf> nor Aβ<inf>1-42</inf> induced specific T-cell responses; however, positive control responses were consistently detected with the CAD106 carrier. Conclusions: No unexpected safety findings or Aβ-specific T-cell responses support the CAD106 favorable tolerability profile. Long-term treatment-induced Aβ-specific antibody titers and prolonged time to decline indicate antibody exposure may increase with additional injections. CAD106 may be a valuable therapeutic option in AD. Trial registration: ClinicalTrials.gov identifiers: NCT00733863, registered 8 August 2008; NCT00795418, registered 10 November 2008; NCT00956410, registered 10 August 2009; NCT01023685, registered 1 December 2009.",NCT00733863;Alzheimer disease vaccine;amyloid beta protein;amyloid beta protein[1-42];antibody;immunoglobulin G;placebo;adult;aged;Alzheimer disease;angina pectoris;antibody response;antibody titer;arthralgia;article;brain edema;chill;demography;disease exacerbation;disease severity;double blind procedure;drug fatality;drug induced headache;drug response;drug safety;drug tolerability;fatigue;female;heart left ventricle hypertrophy;heart muscle ischemia;heart ventricle extrasystole;human;immune response;immunotherapy;intoxication;kidney disease;major clinical study;malaise;male;meningoencephalitis;mental disease;multicenter study;myalgia;nervous system inflammation;neuroimaging;neurologic disease;nuclear magnetic resonance imaging;phase 2 clinical trial;priority journal;protein blood level;rectum cancer;rhinopharyngitis;serology;skin disease;T lymphocyte;tachycardia;treatment duration;cad 106,"Farlow, M. R.;Andreasen, N.;Riviere, M. E.;Vostiar, I.;Vitaliti, A.;Sovago, J.;Caputo, A.;Winblad, B.;Graf, A.",2015,,,0,
1253,"Response to letter regarding article, ""quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial: Validation of the residual SYNTAX score""",,acute heart infarction;Clinical Dementia Rating;comorbidity;coronary artery bypass graft;creatinine clearance;heart left ventricle ejection fraction;heart muscle revascularization;heart surgery;human;letter;mortality;percutaneous coronary intervention;peroperative complication;priority journal;prognosis;SYNTAX score;treatment outcome,"Farooq, V.;Serruys, P. W.;Bourantas, C. V.;Zhang, Y.;Muramatsu, T.;Feldman, T.;Holmes, D. R.;Mack, M.;Morice, M. C.;Ståhle, E.;Colombo, A.;De Vries, T.;Morel, M. A.;Dawkins, K. D.;Kappetein, A. P.;Mohr, F. W.",2014,,,0,
1254,"Long-term outcome of transitory ""reversible"" complete atrio-ventricular block unrelated to myocardial ischemia",,creatinine;isoprenaline;acute coronary syndrome;age;aged;comorbidity;complete heart block;controlled study;coronary artery disease;creatinine blood level;dementia;disease association;faintness;female;follow up;heart disease;heart electrophysiology;heart failure;heart left bundle branch block;heart muscle conduction disturbance;heart muscle ischemia;heart ventricle conduction;heart ventricle pacing;hospitalization;human;hyperkalemia;implanted heart pacemaker;incidence;infection;letter;lung embolism;major clinical study;male;mortality;prevalence;priority journal;recurrent disease;retrospective study,"Farre, N.;Bazan, V.;Garcia-Garcia, C.;Recasens, L.;Marti-Almor, J.;Ascoeta, S.;Valles, E.;Meroño-Dueñas, O.;Ribas, N.;Bruguera-Cortada, J.",2014,,,0,
1255,Risk of being undernourished in a cohort of community-dwelling 85-year-olds: The Octabaix study,"Objectives: To describe the prevalence of the risk of being undernourished in a community-dwelling population of 85-year-olds, and to study associated factors. Methods: A cross-sectional community-based survey of 328 inhabitants assigned to seven primary healthcare teams was carried out. Geriatric assessment was based on sociodemographic variables, the Barthel Index (BI), the Lawton Index (LI), the Spanish version of the Mini-Mental State Examination, the Charlson Comorbidity Index, chronic diseases, social risk measured by Gijon's Social-Familial Evaluation Scale, prescriptions and blood tests. Nutritional status was assessed using the Mini Nutritional Assessment (MNA). Participants were defined as being at risk of undernourishment when they had a MNA score above or equal to 23.5. A comparative analysis was carried out between patients with and without risk of being undernourished, and a multiple logistic regression analysis was carried out. Results: The prevalence risk of being undernourished was 34.5%. A statistically significant association was found with being female (OR 2.44, 95% CI 1.28-4.54), LI (OR 1.47, 95% CI 1.29-1.66), social risk (OR 1.15, 95% CI 1.02-1.29) and prescription drugs taken (OR 5.58, 95% CI 2.09-14.92). Cardiovascular prescription showed a protective association (OR 4.34, 95% CI 1.78-10.0). No statistical differences between the risks of being undernourished were found in the laboratory analysis. Conclusions: There is a high risk of being undernourished in 85-year-old subjects. This nutritional status was positively associated with being female, disability, increased social risk and a high number of prescription drugs, whereas there was a protective relationship with cardiovascular prescription. In evaluations of nutritional status in the community, a multidisciplinary assessment is more valid than analytical findings. Geriatr Gerontol Int 2014; 14: 702-709. © 2013 Japan Geriatrics Society.",antiinflammatory agent;cardiovascular agent;central nervous system agents;psychotropic agent;adult;age;anemia;article;Barthel index;cardiovascular risk;cerebrovascular accident;Charlson Comorbidity Index;community assessment;controlled study;cross-sectional study;daily life activity;dementia;diabetes mellitus;dyslipidemia;female;geriatric assessment;Gijons Social Familial Evaluation Scale;atrial fibrillation;heart failure;human;hypertension;ischemic cardiomyopathy;Lawton Index;major clinical study;male;malnutrition;Mini Mental State Examination;Mini Nutritional Assessment;assessment of humans;nutritional status;Parkinson disease;prevalence;priority journal;quality of life;risk factor;thyroid disease,"Farre, T. B.;Formiga, F.;Ferrer, A.;Plana-Ripoll, O.;Almeda, J.;Pujol, R.",2014,,,0,
1256,What are the benefits and risks of HRT?,Opinions concerning the benefits and risks of HRT have varied over the past decade. Maintaining and regularly updating one's knowledge about HRT is paramount so accurate information can be given to patients. © Istockphoto/Diane Diederich.,estrogen;progesterone;tibolone;bone density;breast cancer;cancer risk;coronary artery disease;dementia;early menopause;endometrium cancer;estrogen deficiency;estrogen therapy;hip fracture;hormone substitution;hot flush;ischemic heart disease;lung cancer;menopausal syndrome;mood disorder;osteoporosis;ovary cancer;patient monitoring;prescription;quality of life;risk benefit analysis;risk factor;risk reduction;screening;short survey;spine fracture;cerebrovascular accident;sweating;treatment duration;treatment indication;vaginal dryness;venous thromboembolism,"Farrell, E.",2012,,,0,
1257,Factors associated with initiation of chronic renal replacement therapy for patients with kidney failure,"Background and objectives Patients with kidney failure sometimes do not receive chronic renal replacement therapy (RRT), even though thismay reduce their life expectancy. This study aimed to identify factors associated with initiation of chronic RRT. Design, setting, participants, & measurements This cohort study was conducted with Albertans aged >18 years between May 2002 and March 2009, using linked data from the provincial renal programs, clinical laboratories, and provincial health ministry. This study focused on those who developed kidney failure, defined by an estimated GFR (eGFR)< 15 ml/min per 1.73 m2 at last measurement during follow-up, together with prior CKD (eGFR < 60 ml/min per 1.73 m2 at least 90 days earlier). Multivariable Cox proportional hazards models were used to determine factors significantly associated with initiation of chronic RRT. Results In total, 7901 participants had eGFR < 15 ml/min per 1.73m2 at last measurement. After adjustment, older participants were less likely to initiate chronic RRT. Remote residence location, dementia, and metastatic cancer also decreased the likelihood of initiating RRT. The cumulative probability of initiating RRT during follow-up was 76.8% for urban-dwelling men aged < 50 years without comorbidity, but was only 3.2% among remotedwelling women aged ≥ 70 years with dementia and metastatic cancer. In contrast, patients with diabetes and heavy/severe proteinuria were more likely to initiate chronic RRT. Conclusions There is substantial variability in the likelihood of RRT initiation for patients with eGFR < 15 ml/min per 1.73 m2. Further studies are needed to delineate factors that influence this outcome. © 2013 by the American Society of Nephrology.",adult;aged;article;cerebrovascular disease;chronic kidney disease;chronic lung disease;cohort analysis;comorbidity;death;dementia;diabetes mellitus;female;follow up;glomerulus filtration rate;heart failure;heart infarction;human;kidney failure;liver disease;major clinical study;male;metastasis;proteinuria;renal replacement therapy;sensitivity analysis;urban area,"Faruque, L. I.;Hemmelgarn, B. R.;Wiebe, N.;Manns, B. J.;Ravani, P.;Klarenbach, S.;Pelletier, R.;Tonelli, M.",2013,,,0,
1258,Motor and cognitive outcome in patients with Parkinson's disease 8 years after subthalamic implants,"Deep brain stimulation of the subthalamic nucleus represents the most important innovation for treatment of advanced Parkinson's disease. Prospective studies have shown that although the beneficial effects of this procedure are maintained at 5 years, axial motor features and cognitive decline may occur in the long term after the implants. In order to address some unsolved questions raised by previous studies, we evaluated a series of 20 consecutive patients who received continuous stimulation for 8 years. The overall motor improvement reported at 5 years (55.5 at Unified Parkinson's Disease Rating Scale-motor part, P < 0.001 compared with baseline) was only partly retained 3 years later (39, P < 0.001, compared with baseline;-16.5, P < 0.01, compared with 5 years), with differential effects on motor features: speech did not improve and postural stability worsened (P < 0.05). The preoperative levodopa equivalent daily dose was reduced by 58.2 at 5 years and by 60.3 at 8 years. In spite of subtle worsening of motor features, a dramatic impairment in functional state (-56.6 at Unified Parkinson's Disease Rating Scale-Activities of Daily Living, P < 0.01) emerged after the fifth year of stimulation. The present study did not reveal a predictive value of preoperative levodopa response, whereas few single features at baseline (such as gait and postural stability motor scores and the preoperative levodopa equivalent daily dose) could predict long-term motor outcome. A decline in verbal fluency (slightly more pronounced than after 5 years) was detected after 8 years. A significant but slight decline in tasks of abstract reasoning, episodic memory and executive function was also found. One patient had developed dementia at 5 years with further progression at 8 years. Executive dysfunction correlated significantly with postural stability, suggesting interplay between axial motor deterioration and cognition. Eight years after surgery, no significant change was observed on scales assessing depression or anxiety when compared with baseline. At 8 years, there was no significant increase of side-effects when compared with 5-year follow-up. In conclusion, deep brain stimulation of the subthalamic nucleus is a safe procedure with regard to cognitive and behavioural morbidity over long-term follow-up. However, the global benefit partly decreases later in the course of the disease, due to progression of Parkinson's disease and the appearance of medication-and stimulation-resistant symptoms. © (2010) The Author.",antiparkinson agent;levodopa;adult;anxiety;apathy;apraxia;article;blepharospasm;body posture;brain depth stimulation;clinical article;cognition;death;dementia;depression;disease course;dysarthria;dysphagia;dystonia;episodic memory;female;gait;headache;heart arrhythmia;heart failure;heart muscle ischemia;hemiparesis;human;hypopyon;implant;lung embolism;male;manic psychosis;motor performance;Parkinson disease;physical performance;postoperative infection;preoperative evaluation;priority journal;seizure;sexuality;speech;spondylosis;task performance;transient ischemic attack;treatment outcome;treatment response;Unified Parkinson Disease Rating Scale;verbal behavior;weight reduction;wound dehiscence,"Fasano, A.;Romito, L. M.;Daniele, A.;Piano, C.;Zinno, M.;Bentivoglio, A. R.;Albanese, A.",2010,,,0,
1259,Cost Trajectories at the End of Life: The Canadian Experience,"A significant proportion of health care resources are consumed at end of life. As a result, decision and policy makers seek cost savings to enhance program planning. Most literature, however, combines the cost of all dying patients and, subsequently, fails to recognize the variation between trajectories of functional decline and utilization of health care services. In this article, we classified dying Albertans by categories of functional decline and assessed their utilization and costs. We used data from two years of health care utilization and costs for three annual cohorts of permanent residents of Alberta, Canada (April 1999 to March 2002). Literature, expert opinion, and cluster analysis were used to categorize the deceased according to sudden death, terminal illness, organ failure, frailty, and other causes of death. Expenditures were decomposed into constituent quantities and prices. We found that nearly 18,000 die per year in Alberta: sudden death (7.1%), terminal illness (29.8%), organ failure (30.5%), frailty (30.2%), and other causes (2.3%). Inpatient care remains the primary cost driver for all trajectories. Significant and predictable health care services are required by noncancer patients. Trajectories of costs are significantly different for the four categories of dying Albertans. Trajectories of dying are a useful classification for analyzing health care use and costs. © 2009 U.S. Cancer Pain Relief Committee.",accidental death;amyotrophic lateral sclerosis;article;Canada;cancer mortality;cause of death;chronic obstructive lung disease;cluster analysis;congestive heart failure;cost control;cost utility analysis;dementia;dying;health care cost;health care planning;health care policy;health care utilization;health program;health service;hospital patient;human;Human immunodeficiency virus infection;infection;International Classification of Diseases;kidney failure;medical decision making;mental disease;mortality;multiple organ failure;newborn death;osteoporosis;Parkinson disease;patient care;resource allocation;sudden death;terminal care;terminal disease;weakness;weight reduction,"Fassbender, K.;Fainsinger, R. L.;Carson, M.;Finegan, B. A.",2009,,,0,
1260,The effect of lipoic acid therapy on cognitive functioning in patients with alzheimer's disease,"Diabetes mellitus (DM) is an important risk factor for Alzheimer's disease (AD). Most diabetic patients have insulin resistance (IR) that is associated with compensatory hyperinsulinemia, one of the mechanisms suggested for increased AD risk in patients with DM. Alpha-lipoic acid (ALA) is a disulfide molecule with antioxidant properties that has positive effects on glucose metabolism and IR. This study evaluated the effect of ALA treatment (600 mg/day) on cognitive performances in AD patients with and without DM. One hundred and twenty-six patients with AD were divided into two groups, according to DM presence (group A) or absence (group B). Cognitive functions were assessed by MMSE, Alzheimer's Disease Assessment Scale-cognitive (ADAS-Cog), Clinician's Interview-Based Impression of Severity (CIBIC), Clinical Dementia Rating (CDR), and Alzheimer's Disease Functional and Change Scale (ADFACS). IR was assessed by HOMA index. At the end of the study, MMSE scores showed a significant improvement in 43% patients of group A (26 subjects) and 23% of group B (15 subjects), compared to baseline (P =.001). Also ADAS-Cog, CIBIC, and ADFACS scores showed a significant improvement in group A versus group B. IR was higher in group A. Our study suggests that ALA therapy could be effective in slowing cognitive decline in patients with AD and IR. © 2013 Antonietta Fava et al.",donepezil;galantamine;glucose;insulin;memantine;oral antidiabetic agent;rivastigmine;thioctic acid;triacylglycerol;aged;Alzheimer disease;article;body mass;Clinical Dementia Rating;cognition;cognitive defect;daily life activity;diarrhea;disease duration;female;gastrointestinal symptom;glucose blood level;human;hypercholesterolemia;hypertension;insulin blood level;insulin resistance;insulin treatment;ischemic heart disease;major clinical study;male;medication compliance;mental deterioration;Mini Mental State Examination;Montgomery Asberg Depression Rating Scale;muscle cramp;neuropsychological test;non insulin dependent diabetes mellitus;sleep disorder;smoking;smoking habit;somnolence;triacylglycerol blood level;unspecified side effect,"Fava, A.;Pirritano, D.;Plastino, M.;Cristiano, D.;Puccio, G.;Colica, C.;Ermio, C.;De Bartolo, M.;Mauro, G.;Bosco, D.",2013,,,0,
1261,Glycaemic Control: A Balancing Act or A Different Approach?,"The prevalence of diabetes is increasing world-wide. Tight glycaemic control has been shown to reduce diabetes complications in a number of landmark trials. Apart from increasing the risk of microvascular and macrovascular disease, poor glycaemic control is also associated with cognitive and memory impairment as well as with mood disturbance. However, tighter glycaemic control with conventional anti-hyperglycaemic medication is also associated with increased risk of hypoglycaemia. There is increasing evidence that hypoglycaemia is much more than a troublesome inconvenience. Indeed it is associated with acute cognitive impairment, dementia, increased risk of falls, rebound hyperglycaemia with consequent loss of glycaemic control, acute coronary syndrome and increased mortality. Hence, a very difficult balance needs to be achieved so as to achieve the best glycaemic control possible, whilst avoiding hypoglycaemia. This paper will briefly discuss the potential benefits of tight glycemic control and reviews the risks associated with hypoglycaemia. A paradigm shift in diabetes care may be needed; use of newer anti-hyperglycemic agents with low hypoglycaemia risk may allow us to achieve good control in most patients whilst avoiding the serious consequences of hypoglycaemia. This may be especially important in those at significant risk of hypoglycaemia (e.g. those with brittle diabetes) or of its consequences such as elderly patients, those in certain occupations or those with cardiovascular disease or epilepsy.",acute coronary syndrome;article;cardiovascular disease;cardiovascular risk;cognitive defect;dementia;diabetes mellitus;falling;geriatric patient;glycemic control;human;hyperglycemia;hypoglycemia;memory disorder;microangiopathy;mood disorder;mortality;priority journal;risk assessment,"Fava, S.",2014,,,0,
1262,Association between body mass index and quality of split bowel preparation,"Background & Aims: Little is known about the association between obesity and bowel preparation. We investigated whether body mass index (BMI) is an independent risk factor for inadequate bowel preparation in patients who receive split preparation regimens. Methods: We performed a retrospective study of data from 2163 consecutive patients (mean age, 60.6 ± 10.5 y; 93.8% male) who received outpatient colonoscopies in 2009 at the Veterans Affairs Medical Center in Indianapolis, Indiana. All patients received a split preparation, categorized as adequate (excellent or good, based on the Aronchick scale) or inadequate. We performed a multivariable analysis to identify factors independently associated with inadequate preparation. Results: Bowel preparation quality was inadequate for 44.2% of patients; these patients had significantly higher mean BMIs than patients with adequate preparation (31.2 ± 6.5 vs 29.8 ± 5.9, respectively; P <.0001) and Charlson comorbidity scores (1.5 ± 1.6 vs 1.1 ± 1.4; P <.0001). Independent risk factors for inadequate preparation were a BMI of 30 kg/m2 or greater (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.21-1.75; P <.0001), use of tobacco (OR, 1.28; 95% CI, 1.07-1.54; P=.0084) or narcotics (OR, 1.28; 95% CI, 1.04-1.57; P=.0179), hypertension (OR, 1.30; 95% CI, 1.07-1.57; P=.0085), diabetes (OR, 1.38; 95% CI, 1.12-1.69; P=.0021), and dementia (OR, 3.02; 95% CI, 1.22-7.49; P=.0169). Conclusions: BMI is an independent factor associated with inadequate split bowel preparation for colonoscopy. Additional factors associated with quality of bowel preparation include diabetes, hypertension, dementia, and use of tobacco and narcotics. Patients with BMIs of 30 kg/m2 or greater should be considered for more intensive preparation regimens. © 2013 AGA Institute.",anticonvulsive agent;calcium channel blocking agent;cholinergic receptor blocking agent;narcotic agent;adult;article;body mass;cerebrovascular accident;Charlson Comorbidity Index;cohort analysis;colonoscopy;congestive heart failure;coronary artery disease;cross-sectional study;dementia;diabetes mellitus;drug use;female;follow up;human;hypertension;intestine preparation;iron therapy;liver cirrhosis;major clinical study;male;outpatient care;retrospective study;risk factor;smoking;split bowel preparation;United States,"Fayad, N. F.;Kahi, C. J.;Abd El-Jawad, K. H.;Shin, A. S.;Shah, S.;Lane, K. A.;Imperiale, T. F.",2013,,,0,
1263,Neuronal ceroid lipofuscinosis in a 31-year-old woman presenting as biventricular heart failure with restrictive features,"A 31-year-old woman presented with dyspnea and left-sided chest discomfort and was found to have biventricular heart failure with impaired ventricular filling. Clinically, she was thought to have restrictive cardiomyopathy or constrictive pericarditis. Transmission electron microscopy of myocardial tissue unexpectedly revealed crosshatched, curvilinear, and fingerprint depositions, which were characteristic for neuronal ceroid lipofuscinosis. Cardiac involvement by this inherited disorder is discussed in light of the findings in this patient and in 15 other reported cases. © 2009 Elsevier Inc. All rights reserved.",adult;article;case report;constrictive pericarditis;dyspnea;female;heart;heart disease;heart failure;heart ventricle filling impairment;human;human tissue;neuronal ceroid lipofuscinosis;pericarditis;priority journal;restrictive cardiomyopathy;thorax pain;transmission electron microscopy,"Fealey, M. E.;Edwards, W. D.;Grogan, M.;Orszulak, T. A.",2009,,,0,
1264,Increase in Parkinson's disease-related mortality among males in Northern Italy,"Background According to standard mortality statistics based on the underlying cause of death (UCOD), mortality from Parkinson's disease (PD) is increasing in most European countries. However, mortality trends are better investigated taking into account all the diseases reported in the death certificate (multiple causes of death approach, MCOD). Methods All deaths of residents in the Veneto Region (Northern Italy) aged≥45 years with any mention of PD were extracted from 2008 to 2015. The Annual Percent Change (APC) in age-standardized mortality rates was computed both for PD as the UCOD, and by MCOD. The association with common chronic comorbidities and acute complications was investigated by log-binomial regression. The frequency of the mention of PD in death certificates was investigated through linkage with an archive of patients with a previous clinical diagnosis of the disease. Results PD was reported in 2.1% of all deaths, rising from 1.9% in 2008 to 2.4% in 2015. Among males, age-standardized rates increased over time both in analyses based on the UCOD (APC +4.1%; Confidence Interval +1.5%,+6.7%), and on MCOD (APC +2.2%; +0.2,+4.2%). Among females time trends were not significant. Mention of PD was associated with that of dementia/Alzheimer and acute infectious diseases. Among known PD patients, the disease was reported only in 60.2% of death certificates. Conclusions Mortality associated to PD is steeply increasing among males in Northern Italy; further investigations on time trends for PD, both through all available electronic health archives and clinical studies, should be set as a priority for epidemiological research.",adult;aged;Alzheimer disease;article;cause of death;cerebrovascular disease;chronic obstructive lung disease;comorbidity;dementia;diabetes mellitus;female;human;hypertension;influenza;ischemic heart disease;Italy;male;mortality rate;neoplasm;Parkinson disease;pneumonia;priority journal;sepsis;survival rate;very elderly,"Fedeli, U.;Schievano, E.",2017,,10.1016/j.parkreldis.2017.04.008,0,
1265,Prevalence and contents of advance directives of patients with ESRD receiving dialysis,"Background and objectives ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life.Advance directives are intended to give providers and surrogates instruction onmanagingmedical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives. Design, setting, participants, & measurements We retrospectively reviewed the medical records of all patients receivingmaintenance in-center hemodialysis at a tertiary academicmedical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis. ResultsAmong 808 patients (mean age of 68.6 years old;men =61.2%), 49%had advance directives, ofwhich only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; P<0.001) and have died during the study period (64.4% versus 46.6%; P<0.001) than patients who did not have advance directives. Notably, for patients receiving dialysis who had advance directives, more of the advance directives addressed cardiopulmonary resuscitation (44.2%),mechanical ventilation (37.1%), artificial nutrition and hydration (34.3%), and pain management (43.4%) than dialysis (10.6%). Conclusions Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients.",aged;analgesia;article;artificial ventilation;cerebrovascular accident;chronic obstructive lung disease;congestive heart failure;coronary artery disease;decision making;dementia;diabetes mellitus;dialysis;end stage renal disease;female;health care system;home care;human;hydration;major clinical study;male;medical record;nutrition;palliative therapy;prevalence;resuscitation;retrospective study,"Feely, M. A.;Hildebrandt, D.;Varayil, J. E.;Mueller, P. S.",2016,,10.2215/cjn.12131115,0,
1266,New developments in dementia,,age distribution;Alzheimer disease;atherosclerosis;smoking;cognition;diabetes mellitus;disease association;disease course;atrial fibrillation;hypertension;ischemic heart disease;letter;risk factor,"Feigin, V.",2003,,,0,
1267,Minor thalassemia may be a protective factor against Alzheimer?,,low density lipoprotein;Alzheimer disease;beta thalassemia;cholesterol blood level;disease association;heart infarction;hemoglobin blood level;histiocyte;human;hypertension;letter;thalassemia minor,"Feily, A.",2009,,,0,
1268,Clinical and subclinical macrovascular disease as predictors of cognitive decline in older patients with type 2 diabetes: The Edinburgh type 2 diabetes study,"OBJECTIVE-Macrovascular disease may contribute to increased risk of accelerated cognitive decline in patients with type 2 diabetes. We aimed to determine associations of measures of macrovascular disease with cognitive change in a cognitively healthy older population with type 2 diabetes. RESEARCH DESIGN AND METHODS-Eight hundred thirty-one men and women (aged 60-75 years) attended two waves of the prospective Edinburgh Type 2 Diabetes Study (ET2DS). At baseline, clinical and subclinical macrovascular disease was measured, including cardiovascular event history, carotid intima-media thickness (cIMT), ankle brachial index (ABI), and serum N-terminal probrain natriuretic peptide (NT-proBNP). Seven neuropsychological tests were administered at baseline and after 4 years; scores were combined to a standardized general ability factor (g). Adjustment of follow-up g for baseline g assessed 4-year cognitive change. Adjustment for vocabulary (estimated premorbid ability) was used to estimate lifetime cognitive change. RESULTS-Measures of cognitive decline were significantly associated with stroke, NT-proBNP, ABI, and cIMT, but not with nonstroke vascular events. The association of stroke with increased estimated lifetime cognitive decline (standardized β, -0.12) and of subclinical markers with actual 4-year decline (standardized β,-0.12, 0.12, and -0.15 for NT-proBNP, ABI, and cIMT, respectively) reached the Bonferroni-adjusted level of statistical significance (P < 0.006). Results altered only slightly on adjustment for vascular risk factors. CONCLUSIONS-Stroke and subclinical markers of cardiac stress and generalized atherosclerosis are associated with cognitive decline in older patientswith type 2 diabetes. Further investigation into the potential use of subclinical vascular disease markers in predicting cognitive decline is warranted. © 2013 by the American Diabetes Association.",amino terminal pro brain natriuretic peptide;adult;age;aged;angina pectoris;ankle brachial index;arterial wall thickness;article;atherosclerosis;cerebrovascular accident;cognitive defect;dementia;disease association;disease marker;female;heart infarction;heart stress;Hospital Anxiety and Depression Scale;human;Letter Number Sequencing;macrovascular disease;major clinical study;male;Matrix Reasoning;Mill Hill Vocabulary Scale;Mini Mental State Examination;neuropsychological test;non insulin dependent diabetes mellitus;peripheral occlusive artery disease;predictive value;protein blood level;risk assessment;Scottish Index of Multiple Deprivation;Trail Making Test B;transient ischemic attack;vascular disease,"Feinkohl, I.;Keller, M.;Robertson, C. M.;Morling, J. R.;Williamson, R. M.;Nee, L. D.;McLachlan, S.;Sattar, N.;Welsh, P.;Reynolds, R. M.;Russ, T. C.;Deary, I. J.;Strachan, M. W. J.;Price, J. F.",2013,,,0,
1269,Valsartan/Sacubitril for Heart Failure: Reconciling Disparities Between Preclinical and Clinical Investigations,,"Alzheimer Disease/etiology/metabolism;Aminobutyrates/*pharmacology;Amyloid beta-Peptides/metabolism;Angiotensin Receptor Antagonists/*pharmacology;Animals;Brain/metabolism;*Disease Models, Animal;Drug Combinations;Drug Evaluation, Preclinical;Haplorhini;Heart Failure/*drug therapy;Humans;Mice;Neprilysin/antagonists & inhibitors/*physiology;Retinal Degeneration/drug therapy/etiology;Tetrazoles/*pharmacology","Feldman, A. M.;Haller, J. A.;DeKosky, S. T.",2016,Jan 5,10.1001/jama.2015.17632,0,
1270,Randomized controlled trial of atorvastatin in mild to moderate Alzheimer disease: LEADe,"Background: There is some evidence that statins may have a protective and symptomatic benefit in Alzheimer disease (AD). The LEADe study is a randomized controlled trial (RCT) evaluating the efficacy and safety of atorvastatin in patients with mild to moderate AD. Methods: This was an international, multicenter, double-blind, randomized, parallel-group study. Subjects had mild to moderate probable AD (Mini-Mental State Examination score 13-25), were aged 50-90 years, and were taking donepezil 10 mg daily for ≥3 months prior to screening. Entry low-density lipoprotein cholesterol levels (LDL-C) were >95 and <195 mg/dL. Patients were randomized to atorvastatin 80 mg/day or placebo for 72 weeks followed by a double-blind, 8-week atorvastatin withdrawal phase. Coprimary endpoints were changes in cognition (Alzheimer's Disease Assessment Scale-Cognitive Subscale [ADAS-Cog]) and global function (Alzheimer's Disease Cooperative Study Clinical Global Impression of Change [ADCS-CGIC]) at 72 weeks. Results: A total of 640 patients were randomized in the study. There were no significant differences in the coprimary endpoints of ADAS-cog or ADCS-CGIC or the secondary endpoints. Atorvastatin was generally well-tolerated. Conclusions: In this large-scale randomized controlled trial evaluating statin therapy as a treatment for mild to moderate Alzheimer disease, atorvastatin was not associated with significant clinical benefit over 72 weeks. This treatment was generally well-tolerated without unexpected adverse events. Classification of evidence: This study provides Class II evidence that intensive lipid lowering with atorvastatin 80 mg/day in patients with mild to moderate probable Alzheimer disease (aged 50-90), taking donepezil, with low-density lipoprotein cholesterol levels between 95 and 195 mg/dL over 72 weeks does not benefit cognition (as measured by Alzheimer's Disease Assessment Scale-Cognitive Subscale) (p = 0.26) or global function (as measured by Alzheimer's Disease Cooperative Study Clinical Global Impression of Change) (p = 0.73) compared with placebo. © 2010 by AAN Enterprises, Inc.",NCT00053599;atorvastatin;donepezil;high density lipoprotein cholesterol;low density lipoprotein cholesterol;placebo;triacylglycerol;abdominal pain;acute kidney failure;adult;aged;Alzheimer disease;aminotransferase blood level;analysis of covariance;article;atrioventricular block;Australia;Austria;Canada;cause of death;cholesterol blood level;clinical evaluation;clinical trial;computer assisted tomography;concentration (parameters);congestive heart failure;controlled clinical trial;controlled study;death;Denmark;Diagnostic and Statistical Manual of Mental Disorders;double blind procedure;drug efficacy;drug safety;drug tolerability;falling;female;gastrointestinal hemorrhage;Germany;heart infarction;hepatitis;human;liver disease;major clinical study;male;methodology;Mini Mental State Examination;multicenter study;nausea;nuclear magnetic resonance imaging;outcome assessment;pancreatitis;pneumonia;priority journal;randomized controlled trial;rhabdomyolysis;sample size;screening;side effect;South Africa;Spain;stomach perforation;sudden death;Sweden;thorax pain;treatment duration;triacylglycerol blood level;United Kingdom;United States,"Feldman, H. H.;Doody, R. S.;Kivipelto, M.;Sparks, D. L.;Waters, D. D.;Jones, R. W.;Schwam, E.;Schindler, R.;Hey-Hadavi, J.;Demicco, D. A.;Breazna, A.",2010,,,0,
1271,Economic and comorbidity burden among patients with moderate-to-severe psoriasis,"BACKGROUND: Previous studies demonstrated substantial economic and comorbidity burden associated with psoriasis (PsO) before biologics were available. Biologics have changed PsO treatment paradigms and potentially improved patient outcomes. There is a need to reassess the economic and comorbidity burden of PsO in the biologic era. OBJECTIVE: To compare the prevalence of comorbidities, health care resource utilization, and costs between moderate-to-severe PsO patients and demographically matched controls. METHODS: Adults aged 18-64 years with at least 2 PsO diagnoses (ICD-9-CM code 696.1) were identified in the OptumHealth Reporting and Insights claims database from January 2007 to March 2012. Moderate-to-severe PsO patients were identified as those receiving = 1 systemic therapy or phototherapy during the 12-month study period following the index date (randomly selected date after the first PsO diagnosis). Controls were free of PsO and psoriatic arthritis (PsA) and were matched 1:1 with PsO patients on age, gender, and geographic region. All patients had at least 12 months of continuous enrollment after the index date. Selected comorbidities, medication use, all-cause health care utilization, and costs were compared between PsO patients and controls. Multivariate regression models were performed to examine the association between PsO and selected comorbidities, medication use, and health care costs and utilization, adjusting for demographics, index year, insurance type, and other comorbidities. Odds ratios (ORs) were reported for any medication use, hospitalization, emergency room visit, and outpatient visit, and incidence rate ratios (IRRs) were reported for the number of medications filled. Adjusted cost differences between PsO patient and controls were also estimated. RESULTS: A total of 5,492 matched pairs of moderate-to-severe PsO patients and controls were selected, with a mean age of 47.6 years and 55.5[%] of patients being male. PsO patients were significantly more likely to have most of the comorbidities examined, with the top 3 most common in both groups being hyperlipidemia (33.3[%] vs. 27.3[%]), hypertension (32.8[%] vs. 23.5[%]), and diabetes (15.8[%] vs. 9.7[%]). Compared with controls, PsO patients were more likely to have any medication filled (OR = 27.5) and had more distinct number of prescription medications (IRR = 2.1; both P &lt; 0.01). PsO patients were more likely to have any inpatient admission (OR = 1.3), emergency room visit (OR = 1.3), and outpatient visit (OR = 29.3; all P &lt; 0.01). PsO patients also incurred significantly higher total, pharmacy, and medical costs (adjusted annual costs differences: $18,960, $13,990, and $3,895 per patient, respectively; all P &lt; 0.01) than controls. CONCLUSIONS: Compared with PsO- and PsA-free controls, moderate-to-severe PsO patients were more likely to have selected comorbidities and higher health care utilization and costs.",acquired immune deficiency syndrome;acute heart infarction;adult;anxiety;article;autoimmune disease;cerebrovascular disease;comorbidity;controlled study;Crohn disease;data base;dementia;depression;diabetes mellitus;disease association;disease severity;female;health care cost;health care utilization;health insurance;hemiplegia;hospitalization;human;hyperlipidemia;hypertension;ischemic heart disease;kidney disease;liver disease;lung disease;lymphoma;major clinical study;male;middle aged;multiple sclerosis;obesity;outpatient;peptic ulcer;peripheral vascular disease;phototherapy;prescription;prevalence;psoriasis;psoriatic arthritis;retrospective study;rheumatoid arthritis;skin cancer;systemic therapy;ulcerative colitis,"Feldman, S. R.;Zhao, Y.;Shi, L.;Tran, M. H.",2015,,,0,
1272,Ischemic stroke mortality tendency (2000-2009) and prognostic factors. ICTUS Study-Extremadura (Spain),"BACKGROUND AND OBJECTIVES: Mortality due to stroke is high in our setting. However, we do not know its magnitude and course in a recent decade. Thus, we have assessed the global inhospital mortality and that at 1 year of stroke in patients seen in a regional hospital as well as its prognostic factors. MATERIAL AND METHODS: A one-year follow-up historical cohort study was performed of patients admitted at Don Benito-Villanueva de la Serena Regional Hospital (Badajoz) with diagnosis of ischemic stroke (1 January 2000 to 31 December 2009). Epidemiological, clinical data all cause death information were collected. RESULTS: A total of 2.228 patients (50.8% male), mean age 71 (SD 10) years were recruited. In-hospital mortality rate was 15.3% and mortality rate at 1 year was 16.9%, with no significant changes during the 10-year study period. Risk factors for greater in-hospital mortality were age, previous renal and heart failure and not performing diagnostic tests. Factors associated with 1-year all-cause mortality were age, dementia, chronic obstructive pulmonary disease, myocardial infarction, atrial fibrillation and also not performing diagnostic tests. During the study, use of diagnostic tests and treatment with statin, heparin and antihypertensive medication on discharge increased. CONCLUSIONS: Patients admitted due to ischemic stroke, in a regional hospital presented a 1 year mortality rate of 29.6%. This tendency did not improve during the 10-year study period. Mortality was associated to greater age, comorbidities and not performing diagnostic tests.",Aged;Brain Ischemia/complications/*mortality;Cohort Studies;Female;Follow-Up Studies;Humans;Male;Mortality/trends;Prognosis;Retrospective Studies;Spain/epidemiology;Stroke/etiology/*mortality;Time Factors,"Felix-Redondo, F. J.;Consuegra-Sanchez, L.;Ramirez-Moreno, J. M.;Lozano, L.;Escudero, V.;Fernandez-Berges, D.",2013,May,10.1016/j.rce.2013.01.005,0,
1273,Cognitive function and heart failure: the role of the adrenergic system,"BACKGROUND: Heart Failure (HF) and cognitive impairment (CI) represent two high incident diseases worldwide, with extremely elevated mortality and morbidity rates. Their prevalence is expected to further increase in the next years due to the aging population, thus they pose enormous clinical, social and economic challenges. Sympathetic nervous system hyperactivity is known to play a pivotal role in HF pathophysiology and progression. In fact, increased cardiac and circulating catecholamine levels are responsible of several molecular and structural abnormalities with detrimental effects on the failing heart. The poof of this latter concept is represented by the clinical success of beta-blocker therapy that is able to attenuate HF-related morbidity and mortality. Recently, adrenergic system alterations have been implied also in the pathogenesis of CI and dementia opening the window for new fascinating and promising therapeutic opportunities. OBJECTIVE: Assess the state of the art on the relationship between cognitive impairment and heart failure. METHOD: In the present manuscript, we propose an updated review of literature and patent on the role of sympathetic nervous system derangement in the pathogenesis of HF and CI. CONCLUSION: We have discussed recent findings allowing the identification of new molecular targets that hopefully will contribute to the generation of effective therapeutic strategies for HF and dementia. In this article the patents Us20100048479, Us7060871, Wo2006052857, Us7351401, Us5721243, Wo1994009155, Us5449604, Wo1999058981, Us5985581, EP2319511, EP2377534, EP2650303, WO2006004939, WO2010132128 and EP1779858 are summarized.",,"Femminella, G. D.;Candido, C.;Conte, M.;Provenzano, S.;Rengo, C.;Coscioni, E.;Ferrara, N.",2016,May 13,,0,
1274,Cognitive Function and Heart Failure: The Role of the Adrenergic System,"BACKGROUND: Heart Failure (HF) and cognitive impairment (CI) represent two high incident diseases worldwide, with extremely elevated mortality and morbidity rates. Their prevalence is expected to further increase in the next years due to the aging population, thus they pose enormous clinical, social and economic challenges. Sympathetic nervous system hyperactivity is known to play a pivotal role in HF pathophysiology and progression. In fact, increased cardiac and circulating catecholamine levels are responsible for several molecular and structural abnormalities with detrimental effects on the failing heart. The proof of this latter concept is represented by the clinical success of .-Blocker therapy that is able to attenuate HF-related morbidity and mortality. Recently, adrenergic system alterations have been implied also in the pathogenesis of CI and dementia opening the window for new fascinating and promising therapeutic opportunities. OBJECTIVE: Assess the state of the art on the relationship between cognitive impairment and heart failure. METHOD: In the present manuscript, we propose an updated review of literature and patent on the role of sympathetic nervous system derangement in the pathogenesis of HF and CI. CONCLUSION: We have discussed recent findings allowing the identification of new molecular targets that hopefully will contribute to the generation of effective therapeutic strategies for HF and dementia. In this article, the patents US20100048479, US7060871, WO2006052857, US7351401, US5721243, WO1994009155, US5449604, WO1999058981, US5985581, EP2319511, EP2377534, EP2650303, WO2006004939, WO2010132128 and EP1779858 are summarized.",beta adrenergic receptor blocking agent;cardiovascular agent;epinephrine;neuroprotective agent;noradrenalin;adrenergic nerve cell;adrenergic system;age;animal;brain;cognition;cognitive defect;complication;drug development;drug effects;heart;heart failure;human;innervation;metabolism;molecularly targeted therapy;nerve degeneration;patent;pathophysiology;risk factor,"Femminella, G. D.;Candido, C.;Conte, M.;Provenzano, S.;Rengo, C.;Coscioni, E.;Ferrara, N.",2016,,,0,1273
1275,More than just aging societies: The demographic change has an impact on actual numbers of patients,"Objective: The purpose of this paper is to estimate the number of patients resulting from the aging of the population for selected diseases (colon cancer, myocardial infarction, diabetes mellitus and dementia) in 2012 and 2020 compared to 2002 based on the Federal State of Mecklenburg-West Pomerania as a model for Germany. Data sources: The population projection considers fertility, migration and age-specific mortality in Mecklenburg-West Pomerania. The calculation of patient number is based on age-specific incidence or prevalence from population-based epidemiological studies and/or registers. Study design: The population for 2012 and 2020 is projected for 1-year gender-specific age-cohorts. The demographic projection is then used for the estimation of age- and gender-specific numbers of patients. Results: While the total population will decrease by 10.5% in Mecklenburg-West Pomerania by 2012, both the proportion and the absolute number of people older than 64 years will increase (2002: 294,000; 2012: 349,000; 2020: 382,000). Asa consequence, the incident number of patients with colon cancer will increase by 24.4% by 2012 (+30.9% in 2020) and with myocardial infarction by 27.5% by 2012 (+40.9% in 2020). Conclusion: The demographic change will lead to an absolute increase of patients with colon cancer, myocardial infarction, diabetes mellitus and dementia. At the same time the age-spectrum of patients with these diseases will shift towards older ages. © 2007 Springer-Verlag.",adult;aged;aging;article;calculation;colon cancer;controlled study;dementia;demography;diabetes mellitus;female;fertility;Germany;heart infarction;human;incidence;male;migration;mortality;prevalence;register;sex difference;sex ratio;society,"Fendrich, K.;Hoffmann, W.",2007,,,0,
1276,Metabolic syndrome and amnestic mild cognitive impairment: Singapore longitudinal ageing study-2 findings,"Metabolic syndrome (MetS) is reported to be associated with cognitive decline and dementia, in particular vascular dementia. However, the evidence linking MetS to Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI), a precursor of AD, is inconsistent and limited. This study examined the association of MetS and its components with aMCI and how APOE-εe4 and younger age influenced this association. Participants with aMCI (n = 98) and cognitively normal controls (n = 802) were identified from baseline data in a second wave cohort of older subjects aged 55 and over in the Singapore Longitudinal Ageing Study-2 (SLAS-2) in 2009/2010. The associations of MetS and its individual components with aMCI were analyzed using logistic regression controlling for age, gender, education, current smoking, alcohol drink, leisure time activities score, Geriatric Depression Scale score, APOE-ε4, and heart disease or stroke. The analysis was repeated for associations stratified by age and APOE-ε4 status. In multivariate analysis, MetS was associated with an elevated risk of aMCI (OR = 1.79; 95% CI 1.15-2.77). Among MetS components, central obesity showed a significant association with aMCI (OR = 1.77; 95% CI 1.11-2.82). The association between MetS and aMCI remained significant on repeated analysis among subjects free of heart disease and stroke. This association was particularly stronger among participants with APOE-ε4 allele (OR = 3.35; 95% CI, 1.03-10.85) and younger (<65 years) participants with APOE-ε4 (OR = 6.57; 95% CI, 1.03-41.74). MetS was found to be associated with aMCI, especially in individuals with APOE-ε4 at younger age in this middle-aged and older cohort. © 2013 - IOS Press and the authors. All rights reserved.",adult;aged;aging;article;cerebrovascular accident;congestive heart failure;controlled study;disease association;drinking behavior;education;female;gender;Geriatric Depression Scale;atrial fibrillation;heart infarction;human;leisure;logistic regression analysis;longitudinal study;major clinical study;male;metabolic syndrome X;mild cognitive impairment;multivariate analysis;obesity;priority journal;Singapore;smoking,"Feng, L.;Chong, M. S.;Lim, W. S.;Lee, T. S.;Collinson, S. L.;Yap, P.;Ng, T. P.",2013,,,0,
1277,Neuropsychological impact of implantable cardioverter defibrillator in congestive heart failure patients,,brain natriuretic peptide;aged;anxiety;clinical assessment;clinical evaluation;cognitive defect;congestive heart failure;controlled study;disease severity;echocardiography;emotional disorder;exercise test;female;Geriatric Depression Scale;atrial fibrillation;heart left ventricle ejection fraction;heart output;Hospital Anxiety and Depression Scale;human;implantable cardioverter defibrillator;letter;major clinical study;male;mental deterioration;Mini Mental State Examination;neuropsychological test;neuropsychology;New York Heart Association class;observational study;prevalence;priority journal;protein blood level;psychological well being;self report;sensitivity analysis,"Feola, M.;Vallauri, P.;Salvatico, L.;Vado, A.;Testa, M.",2013,,,0,
1278,Predictors of mortality among nursing home residents with a diagnosis of Parkinson's disease,"Background: Little is known about predictors of mortality among Parkinson patients living in long term care. Material/Methods: We conducted a 3-year follow-up study on 15,237 I'D residents aged 65 years and older using the Systematic Assessment in Geriatric drug use via Epidemiology (SAGE) database, The SAGE database consists of the Minimum Data Set (MDS) data collected on over 400,000 nursing home residents in 5 U.S. states, including demographic characteristics, dementia severity, comorbidity and other clinical variables. Information on death was derived through linkage to Medicare files. Baseline characteristics were used to predict survival using univariate and multivariate Cox proportional hazard models. Results: The overall 3-year mortality rate was 50%. Advanced age (relative rate (RR) 2.22; 95% confidence interval (CI) 1.99-2.47, for patients 85+ years), male gender (RR 1.73; 95% CI 1.60-1.87), severe functional (RR 1.81; 95% CI 1.53-2.13) and cognitive (RR 1.54; 95% CI 1.38-1.72) impairment, the presence of vision problems (RR 1.25; 95% CI 1.20-1.57), pressure ulcers (RR 1.25; 95% 1.14-1.37), and a diagnosis of congestive heart failure (RR 1.49; 95% CI 1.35-1.65), diabetes mellitus (RR 1.22; 95% 1.11-1.35) and pneumonia (RR 1.39; 95% Cl 1.09-1.77) were independent predictors of death. The specific presence of aspiration pneumonia had the highest mortality risk ratio among all comorbidities (RR 1.58; CI 0.97-2.56). African-Americans and other minority groups were less likely to die relative to white PD residents. Conclusion: Age, sex, functional and cognitive impairment and the diagnosis of pneumonia or congestive heart failure were the strongest predictors of death. Minority groups have a reduced risk of death relative to white PD nursing home residents.",aged;aging;article;aspiration pneumonia;clinical examination;cognition;comorbidity;congestive heart failure;data base;demography;diabetes mellitus;disease severity;elderly care;ethnic group;female;follow up;human;long term care;major clinical study;male;medicare;mortality;multivariate analysis;nursing home;Parkinson disease;prediction;resident;risk assessment;sex difference;ulcer,"Fernandez, H. H.;Lapane, K. L.",2002,,,0,
1279,The ability of self-rated health to predict mortality among community-dwelling elderly individuals differs according to the specific cause of death: Data from the NEDICES cohort,"Background: The biomedical and psychosocial mechanisms underlying the relationship between self-rated health (SRH) and mortality in elderly individuals remain unclear. Objective: To assess the association between different measurements of subjective health (global, age-comparative, and time-comparative SRH) and cause-specific mortality. Methods: Neurological Disorders in Central Spain (NEDICES) is a prospective population-based survey of the prevalence and incidence of major age-associated conditions. Data on demographic and health-related variables were collected from 5,278 subjects (≥65 years) in the baseline questionnaire. Thirteen-year mortality and cause of death were obtained from the National Death Registry. Adjusted hazard ratios (aHR) for SRH and all-cause and cause-specific mortality were estimated by Cox proportional hazard models. Results: At baseline, 4,958 participants (93.9%) answered the SRH questionnaire. At the end of follow-up, 2,468 (49.8%) participants had died, of whom 723 (29.2%) died from cardiovascular diseases, 609 (24.7%) from cancer, and 359 (14.5%) from respiratory diseases. Global SRH independently predicted all-cause mortality (aHR for 'poor or very poor' vs. 'very good' category: 1.39; 95% confidence interval (CI): 1.15-1.69). Analysis of cause-specific mortality revealed that global SRH was an independent predictor for death due to respiratory diseases (aHR for 'poor or very poor' vs. 'very good' category: 2.61; 95% CI: 1.55-4.39), whereas age-comparative SRH exhibited a gradient effect on the risk of death due to stroke. Time-comparative SRH provided small additional predictive value. Conclusions: The predictive ability of SRH for mortality largely differs according to the specific cause of death, with the strongest associations found for respiratory disease and stroke mortality.",age;aged;article;cardiovascular disease;cause of death;cerebrovascular accident;community living;dementia;demography;disease registry;female;follow up;hazard ratio;health;health survey;heart infarction;human;incidence;major clinical study;male;mortality;neoplasm;neurologic disease;predictive value;prevalence;priority journal;proportional hazards model;questionnaire;respiratory tract disease;risk assessment;self rated health;self report;time,"Fernández-Ruiz, M.;Guerra-Vales, J. M.;Trincado, R.;Fernández, R.;Medrano, M. J.;Villarejo, A.;Benito-León, J.;Bermejo-Pareja, F.",2013,,,0,
1280,Death certification: Do consultant pathologists do it better?,"The completion of the medical certificate of cause of death is required for registration of a death, and this data helps plan healthcare services for the country. Many audits have shown them to be inaccurately completed by junior doctors, but the authors examined whether advice from consultant pathologists could improve this. Using the Office for National Statistics guidelines, the authors found that only 56% of the certificates were appropriately completed. The planned introduction of medical examiners to England and Wales is aimed at improving this situation, but consultant pathologists will still issue causes of death following postmortems, and it would seem prudent to train pathologists as well.",article;autopsy;blood culture;cause of death;death certificate;dementia;diabetes mellitus;heart failure;heart infarction;human;immobilization;ischemic heart disease;kidney failure;leukemia;lung cancer;metastasis;pathologist;pneumonia;priority journal;respiratory failure;sepsis;septicemia;United Kingdom,"Fernando, D.;Oxley, J. D.;Nottingham, J.",2012,,,0,
1281,C.P.C.: An unusual case of dementia associated with long standing hypertension,"A young adult is presented who becomes hypertensive and demented over a long period. Essential hypertension was probably the initial lesion. With time, renal hypertension developed, as did marked cerebral atrophy. There was no heart failure or cardiac insufficiency, and extensive investigations over the course of six yr could not account for the dementia or demonstrate any medical disease other than renal hypertension. The main gross and microscopic autopsy findings were all explicable as sequelae of hypertension and there was no structural evidence of any other underlying disease.",Alzheimer disease;brain atrophy;dementia;diagnosis;essential hypertension;etiology;histology;hydrocephalus;hypertension;lipidosis;major clinical study;Marchiafava Bignami disease;Pick presenile dementia;pseudobulbar palsy;renovascular hypertension,"Fernbach, J. C.",1975,,,0,
1282,Development and validation of a new patient experience tool in patients with serious illness,"BACKGROUND: Patients with serious chronic illnesses face increasingly complex care and are at risk of poor experience due to a fragmented health system. Most current patient experience tools are not designed to address the unique care aspects of this population and the few that exist are delivered too late in the disease trajectory and are not administered longitudinally which makes them less useful across settings. METHODS: We developed a new tool designed to address these gaps. The 25 item scale was tested and refined using randomly cross-validated exploratory and confirmatory factor analyses. Participants were not yet hospice eligible but sick enough to receive benefits of a supportive care approach in the last 2 to 3 years of life. Full information maximum likelihood models were run to confirm the factor structure developed in exploratory analyses. Goodness-of-fit was assessed with the Comparative Fit Index, the Tucker-Lewis Index, and the Root Mean Square Error of Approximation. Test-retest reliability was assessed with the intraclass correlation coefficient and internal consistency of the final scale was examined using Cronbach's alpha. RESULTS: Exploratory factor analysis revealed three domains - Care Team, Communication, and Care Goals - after removing weak loading and cross loading items. The initial three domain measurement model suggested in the development cohort was tested in the validation cohort and exhibited poor fit X 2 (206) = 565.37, p < 0.001; CFI = 0.879; TLI = 0.864; RMSEA = 0.076. After model respecification, including removing one additional item and allowing paths between theoretically plausible error terms, the final 21 item tool exhibited good fit X 2 (173) = 295.63, p < 0.001; CFI = 0.958; TLI = 0.949; RMSEA = 0.048. Cronbach's alpha revealed high reliability of each domain (Care Team = 0.92, Communication = 0.83, Care Goals = 0.77) and the entire scale (alpha = 0.91). ICC showed adequate test-retest validity (ICC = 0.58; 95% CI: 0.52-0.65) of the full scale. CONCLUSIONS: When administered earlier in the chronic illness trajectory, a new patient experience scale focused on care teams across settings, communication, and care goals, displayed strong reliability and performed well psychometrically. TRIAL REGISTRATIONS: This trial ( NCT01746446 ) was registered at ClinicalTrials.gov on November 27, 2012 (retrospectively registered).","Aged;Chronic Disease;Delivery of Health Care/standards;Dementia/psychology/ therapy;Female;Heart Failure/psychology/ therapy;Humans;Male;Minnesota;Neoplasms/psychology/ therapy;Patient Care Planning;Patient Care Team/standards;Patient Comfort/standards;Patient Satisfaction;Professional-Patient Relations;Psychometrics;Quality Indicators, Health Care/ standards;Surveys and Questionnaires/standards;Wisconsin;Health care surveys;Patient experience;Patient-centered care;Patient-reported outcome measures","Fernstrom, K. M.;Shippee, N. D.;Jones, A. L.;Britt, H. R.",2016,Dec 30,,0,
1283,PCR detection of JC virus DNA in brain tissue from patients with and without progressive multifocal leukoencephalopathy,"Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system, which is thought to be a result of the reactivation of JC virus (JCV), a human polyomavirus. The disease occurs in individuals with immunosuppression and in recent years there has been an increase in PML cases due to AIDS. A nested polymerase chain reaction (n-PCR) was employed to detect JCV and BK virus (BKV) DNA in brain tissue collected postmortem from 28 AIDS patients with PML and from 13 patients without PML, but with other diagnoses, including solid tumors, Alzheimer's disease, thromboembolism, myocardial infarction and acute cerebrovascular diseases. All 28 brain specimens from the patients with PML were positive for JCV DNA when tested by n-PCR and three of the latter were also positive for BKV DNA. These results were confirmed by an enzyme restriction analysis and a DNA hybridization assay. interestingly, in this study, JCV DNA was also found in 6 brain tissue specimens from 4 subjects with diseases unrelated to PML or AIDS. All the brain specimens from the control group were negative for BKV DNA. The results confirm that the n-PCR is a useful tool for PML diagnosis. The presence of JCV DNA in the brain tissue of patients without PML is particularly important since it indicates that JCV could be latent in the brains of immunocompetent individuals. Moreover, detection of simultaneous presence of JCV and BKV in the brain tissue of the patients with PML demonstrates that BKV may also infect the human brain without causing any apparent neurological disease.",adult;article,"Ferrante, P.;Caldarelli-Stefano, R.;Omodeo-Zorini, E.;Vago, L.;Boldorini, R.;Costanzi, G.",1995,,,0,
1284,Memantine-induced hepatitis with cholestasis in a very elderly patient,,alanine aminotransferase;alkaline phosphatase;alprazolam;aspartate aminotransferase;bilirubin;digoxin;gamma glutamyltransferase;hepatitis A antibody;hepatitis B antibody;hepatitis C antibody;lisinopril;memantine;promazine;tiapride;virus antibody;abdominal pain;aged;alanine aminotransferase blood level;alkaline phosphatase blood level;ascites;aspartate aminotransferase blood level;behavior disorder;bilirubin blood level;case report;cholestasis;cholestatic hepatitis;dementia;drug withdrawal;echography;female;fever;follow up;gamma glutamyl transferase blood level;heart failure;hepatitis;hepatitis A;hepatosplenomegaly;home care;human;hypertension;immunoglobulin blood level;jaundice;laboratory test;letter;liver toxicity;nausea;priority journal;side effect;vomiting,"Ferrara, N.;Corbi, G.;Capuano, A.;Filippelli, A.;Rossi, F.",2008,,,0,
1285,Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease,"Objective: To summarize the 2010 EFNS/MDS-ES evidence-based treatment recommendations for the management of Parkinson's disease (PD). This summary includes the treatment recommendations for early and late PD. Methods: For the 2010 publication, a literature search was undertaken for articles published up to September 2009. For this summary, an additional literature search was undertaken up to December 2010. Classification of scientific evidence and the rating of recommendations were made according to the EFNS guidance. In cases where there was insufficient scientific evidence, a consensus statement ('good practice point') is made. Results and Conclusions: For each clinical indication, a list of therapeutic interventions is provided, including classification of evidence. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.",alpha tocopherol;amantadine;apomorphine;benzatropine;biperiden;bornaprine;botulinum toxin;bromocriptine;cabergoline;catechol methyltransferase inhibitor;clozapine;dihydroergocryptine;dopamine receptor stimulating agent;entacapone;etilevodopa;levodopa;lisuride;monoamine oxidase inhibitor;pergolide;piribedil;pramipexole;propranolol;rasagiline;riluzole;ropinirole;rotigotine;selegiline;sildenafil;tolcapone;unindexed drug;add on therapy;agranulocytosis;anorexia;anticholinergic effect;anxiety;apathy;article;ataxia;brain depth stimulation;cardiovascular disease;confusion;constipation;daytime somnolence;dementia;depression;diarrhea;dizziness;drug efficacy;drug induced headache;drug safety;dyskinesia;dysphagia;dystonia;edema;erectile dysfunction;evidence based practice;gastrointestinal motility;gastrointestinal symptom;good clinical practice;heart arrest;human;hypertension;hypomania;hypotension;insomnia;livedo reticularis;liver toxicity;medical society;mental disease;monotherapy;motor dysfunction;myocarditis;nightmare;orthostatic hypotension;pallidotomy;Parkinson disease;postoperative complication;practice guideline;priapism;priority journal;psychosis;serotonin syndrome;side effect;sleep disorder;suicide;suicide attempt;thalamotomy;treatment indication;tremor;urogenital tract disease;visual disorder;vomiting;xerostomia,"Ferreira, J. J.;Katzenschlager, R.;Bloem, B. R.;Bonuccelli, U.;Burn, D.;Deuschl, G.;Dietrichs, E.;Fabbrini, G.;Friedman, A.;Kanovsky, P.;Kostic, V.;Nieuwboer, A.;Odin, P.;Poewe, W.;Rascol, O.;Sampaio, C.;Schüpbach, M.;Tolosa, E.;Trenkwalder, C.;Schapira, A.;Berardelli, A.;Oertel, W. H.",2013,,,0,
1286,Does rosmarinic acid underestimate as an experimental cardiovascular drug?,"PURPOSE: The rationale of the present review is to analize the activity of Rosmarinus officinalis in the the cardiovascular system METHODS: A MEDLINE database search (from January 1970 to December 2011) using only rosmarinic acid as searched term. RESULTS: The references search revealed 509 references about rosmarinic acid in 40 years (the first reference is from 1970). There is a powerful prevalence of antioxidant and cancer studies. Other diseases are few cited, as inflammation, brain (Alzheimer and Parkinson disease) and, memory; allergy; diabetes; atherosclerosis, and; hypertension. It is necessary to consider the complete absence of studies on coronary artery disease, myocardial ischemia, heart failure or ischemia/reperfusion injury. CONCLUSION: Rosmarinic acid is underestimated as an experimental cardiovascular drug and deserves more attention.",rosmarinic acid;Alzheimer disease;antioxidant activity;article;atherosclerosis;cardiovascular system;diabetes mellitus;human;hypertension;inflammation;memory disorder;neoplasm;Parkinson disease;prevalence;rosemary;sepsis,"Ferreira, L. G.;Celotto, A. C.;Capellini, V. K.;Albuquerque, A. A. S.;de Nadai, T.;de Carvalho, M. T. M.;Evora, P. R. B.",2013,,,0,
1287,Risk of falls in 85-year-olds is associated with functional and cognitive status: The Octabaix study,"Falls are a source of morbidity and mortality in the oldest old. The purpose of this study was to describe the prevalence of falls among community-dwelling 85-year-olds and to study the factors associated with falling. A cross-sectional study, including geriatric assessment, was conducted within the framework of the Octabaix Study. Functional status was measured with Barthel Index (BI) and Lawton Index (LI), cognitive impairment was assessed with the Mini-Mental State Examination (MMSE), the Spanish version of which is called MEC, Comorbidity by Charlson Index (CCI), and data were gathered on nutritional risk, social risk, falls, and drugs. The fall prevalence among the 328 octogenarians studied was 28.4%. A bivariate analysis revealed an association with being female (p= 0.017) and poorer functional status according to BI (p= 0.027). Logistic analysis showed an association with female gender (OR = 1.96; 95%CI = 1.15-3.33; p= 0.014), BI (OR = 0.98; 95%CI = 0.97-0.99; p= 0.007) and MEC (OR = 1.05; 95%CI = 1.01-1.09; p= 0.027). The prevalence of falls among 85-year-olds is high and similar to that described in those aged 65 or over. The analyses show that being female, a degree of disability and a good score on cognitive status were independent risk factors for falls among these community-dwelling. © 2011 Elsevier Ireland Ltd.",calcium;psychotropic agent;aged;aging;article;Barthel index;Charlson Comorbidity Index;chronic drug administration;cognition;cognitive defect;community;comorbidity;cross-sectional study;dementia;dyslipidemia;fall risk;fall risk assessment;falling;female;functional status;gait;gender;geriatric assessment;geriatric nutrition;hearing impairment;atrial fibrillation;heart failure;human;hypertension;ischemic cardiomyopathy;Lawton instrumental activities of daily living scale;major clinical study;male;Mini Mental State Examination;Parkinson disease;polypharmacy;prescription;prevalence;priority journal;quality of life;risk factor;scoring system;social aspect;cerebrovascular accident;visual impairment,"Ferrer, A.;Formiga, F.;Plana-Ripoll, O.;Tobella, M. A.;Gil, A.;Pujol, R.",2012,,,0,
1288,"Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: The Octabaix study","Background: The population is aging and multimorbidity is becoming a common problem in the elderly. Objective: To explore the effect of multimorbidity patterns on mortality for all causes at 3- and 5-year follow-up periods. Materials and methods: A prospective community-based cohort (2009-2014) embedded within a randomized clinical trial was conducted in seven primary health care centers, including 328 subjects aged 85 years at baseline. Sociodemographic variables, sensory status, cardiovascular risk factors, comorbidity, and geriatric tests were analyzed. Multimorbidity patterns were defined as combinations of two or three of 16 specific chronic conditions in the same individual. Results: Of the total sample, the median and interquartile range value of conditions was 4 (3-5). The individual morbidities significantly associated with death were chronic obstructive pulmonary disease (COPD; hazard ratio [HR]: 2.47; 95% confidence interval [CI]: 1.3; 4.7), atrial fibrillation (AF; HR: 2.41; 95% CI: 1.3; 4.3), and malignancy (HR: 1.9; 95% CI: 1.0; 3.6) at 3-year follow-up; whereas dementia (HR: 2.04; 95% CI: 1.3; 3.2), malignancy (HR: 1.84; 95% CI: 1.2; 2.8), and COPD (HR: 1.77; 95% CI: 1.1; 2.8) were the most associated with mortality at 5-year follow-up, after adjusting using Barthel functional index (BI). The two multimorbidity patterns most associated with death were AF, chronic kidney disease (CKD), and visual impairment (HR: 4.19; 95% CI: 2.2; 8.2) at 3-year follow-up as well as hypertension, CKD, and malignancy (HR: 3.24; 95% CI: 1.8; 5.8) at 5 years, after adjusting using BI. Conclusion: Multimorbidity as specific combinations of chronic conditions showed an effect on mortality, which would be higher than the risk attributable to individual morbidities. The most important predicting pattern for mortality was the combination of AF, CKD, and visual impairment after 3 years. These findings suggest that a new approach is required to target multimorbidity in octogenarians.",aged;anemia;article;atrial fibrillation;Barthel index;cardiovascular risk;cerebrovascular accident;chronic kidney failure;chronic obstructive lung disease;cohort analysis;comorbidity;controlled study;dementia;demography;diabetes mellitus;dyslipidemia;female;follow up;geriatric patient;heart failure;human;hypertension;ischemic cardiomyopathy;major clinical study;male;malignant neoplasm;mortality rate;neurologic examination;Parkinson disease;peripheral occlusive artery disease;population research;primary health care;prospective study;randomized controlled trial;social status;survival rate;very elderly;visual impairment,"Ferrer, A.;Formiga, F.;Sanz, H.;Almeda, J.;Padrós, G.",2017,,10.2147/cia.s123173,0,
1289,Intensity of Integrated Primary and Specialist Home-Based Palliative Care for Chronic Diseases in Northeast Italy and Its Impact on End-of-Life Hospital Access,"Background: Hospital admissions at the end of life (EOL) represent an established indicator of poor quality of care. Objective: To examine the impact of intensity of integrated primary and specialist home-based palliative care for chronic diseases (HPCCD) plans of care on EOL hospital access. Methods: Retrospective population-based study using linked mortality, hospitalization, and home care data. Intensity of HPCCD was measured 90-31 days before death; outcomes were hospital death and prolonged hospital stay for medical reasons in the last month of life. Outcomes were modeled through Poisson and quartile regressions. Adults aged 65-84 years with at least an ordinary hospitalization and a drug treatment in the year before death, who died from nononcological chronic diseases in the Veneto Region, January 2012-December 2013, were included. Results: Among 2087 patients, 1016 (48.7%) did not receive any HPCCD homecare visit; 860 (41.2%), 152 (7.3%), and 59 (2.8%) had <2, 2-4, and 4-7 homecare visits/week, respectively. Hospital death occurred for 1310 patients (62.8%) and the median hospital stay in the last month of life was five days (interquartile range 0-14). In multivariate analysis, a higher intensity of HPCCD was associated with lower rates of prolonged (≥14 days) EOL hospitalization and hospital death with a dose-response relationship. When no access to HPCCD was compared with 2-4 visits/week, adjusted percentage of hospital death decreased by -18.4% (95% confidence interval [CI] -5.4% to -29.7%) and the length of hospital stay decreased by 37.9% (95% CI 16.7%-56.0%). Conclusions: The intensity of integrated HPCCD plans of care was associated with a reduction in EOL hospital stay and in hospital death.",aged;Alzheimer disease;article;cardiomyopathy;cerebrovascular disease;chronic disease;chronic kidney failure;chronic liver disease;chronic obstructive lung disease;clinical outcome;controlled study;death;diabetes mellitus;dose response;female;health care access;heart arrhythmia;heart failure;home care;hospitalization;human;hypertension;ischemic heart disease;Italy;length of stay;major clinical study;male;medical specialist;neurologic disease;palliative therapy;primary medical care;respiratory distress;retrospective study;terminal care;very elderly,"Ferroni, E.;Avossa, F.;Figoli, F.;Cancian, M.;De Chirico, C.;Pinato, E.;Pellizzari, M.;Fedeli, U.;Saugo, M.;Mantoan, D.",2016,,10.1089/jpm.2016.0158,0,
1290,Nightmare-induced atypical midventricular tako-tsubo cardiomyopathy,"Tako-Tsubo cardiomyopathy (TTC) is a reversible cardiomyopathy characterized by acute left ventricular segmental dysfunction, whose clinical presentation resembles that of acute myocardial infarction. The syndrome often follows a psychophysical stressful event and is characterized by echocardiographic evidence of akinesia of the left ventricular mid-apical segments. Atypical echocardiographic patterns of TTC have recently been described, often triggered by emotional stressors, rather than physical. In this report, we describe a case of atypical TTC triggered by an unusual stressor (recurrent nightmare) in a 45-year-old woman, with peculiar clinical presentation and evolution characterized by persistent loss of consciousness, neurological deterioration, absence of typical symptoms of TTC, and features suggestive of a hysterical crisis.",acetylsalicylic acid;atorvastatin;benzodiazepine derivative;C reactive protein;clopidogrel;diazepam;fondaparinux;metoprolol;pantoprazole;troponin I;acute coronary syndrome;adult;anxiety;article;atypical midventricular takotsubo cardiomyopathy;case report;female;human;hyperlactatemia;hypersalivation;hypokinesia;hyporeflexia;leukocytosis;low drug dose;mental deterioration;metabolic acidosis;middle aged;neurologic examination;nightmare;priority journal;retrograde amnesia;seizure,"Fibbi, V.;Ballo, P.;Nannini, M.;Consoli, L.;Chechi, T.;Bribani, A.;Fiorentino, F.;Chiodi, L.;Zuppiroli, A.",2015,,,0,
1291,Remodeling of mitochondrial interior in cardiac lipofuscinosis,"Ultrastructural analysis was performed in cardiac ceroidlipofuscinosis to confirm the presence and the nature of storage material. Granular osmophilic deposits characteristic of GROD structures coincidented with particularly aberrant mitochondria. Remodeling of mitochondrial interior with the appearance of several form of abnormal inclusions was never observed in cardiac ceroidlipofuscinosis. The presence of dense osmophilic bodies, glycogen conglomerates, balloon-like and onion-like structures in mitochondrial interior seem to be early events of this storage process. © 2013 Informa Healthcare USA, Inc.",article;biopsy;cardiomyopathy;cell inclusion;electron microscopy;heart mitochondrion;heart muscle;human;neuronal ceroid lipofuscinosis;pathology;ultrastructure,"Fidziańska, A.;Walczak, E.;Szwoch, M.",2013,,,0,
1292,"Hypothermia-related deaths - Virginia, November 1996-April 1997",,adult;aging;alcohol abuse;Alzheimer disease;clinical article;cold exposure;congestive heart failure;emergency health service;female;high risk patient;human;hypothermia;male;mortality;Parkinson disease;priority journal;prognosis;short survey;United States;winter,"Fierro, M.",1998,,,0,
1293,Impact of baseline adjustment for vascular risk factors on sample size for atrophy outcomes in Alzheimer's disease clinical trials,"Background: Whole-brain and hippocampal atrophy rate measures are used as outcomes measures in trials of putative therapies for Alzheimer's disease (AD). Since atrophy rates may be influenced by vascular risk factors or vascular brain injury, we investigated whether baseline adjustment for these characteristics may also reduce sample size estimates. Methods: Participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI) 1 study were included where they had useable 1.5T MRI imaging at baseline and 1 year follow-up. Boundary shift integral (BSI) was used to assess MRI whole-brain and hippocampal atrophy rates. Sample sizes per arm were estimated for a placebo controlled clinical trial in AD or MCI to have 80% power to detect a 25% reduction in atrophy rate and for 25% reduction relative to atrophy rates in controls. Sample sizes were calculated with adjustment for baseline age, diastolic and systolic blood pressure, fasting glucose, serum cholesterol, body mass index (BMI), smoking status, hypertension, diabetes, hyperlipidaemia, central and coronary heart disease, MRI infarcts, stroke-related events, and white matter hyperintensities. Results: Participants included 177 controls, 297 participants with MCI and 122 participants with AD at baseline. The mean whole-brain atrophy rates were: controls 5.9 ml/yr (SD 5.9); MCI 10.9 (8.3); AD 14.9 (7.7). Sample sizes per arm for a 25% reduction in whole-brain atrophy rate were 719 MCI and 186 AD.With adjustment for all vascular risk factors and vascular brain injury variables sample size were reduced by 3% in MCI and 10% in AD (Table 1). Hippocampal atrophy rates were: controls 0.06 ml/yr (SD 0.09); MCI 0.14 (0.12); AD 0.20 (0.12). Sample sizes per arm for 25% reduction in hippocampal atrophy were 544 MCI and 179 AD. Adjustment for all vascular risk factors reduced sample size estimates by 2.6% in MCI but there was no reduction in AD (Table 1). Conclusions: Adjustment for 14 vascular risk factors provided a modest reduction in sample size estimates of up to 10%. AD treatment trials which exclude patients with overt cerebrovascular disease, much like ADNI1, may still benefit from adjustment of whole-brain atrophy rate outcome measures by vascular risk factors and event.",atrophy;risk factor;sample size;clinical trial (topic);Alzheimer disease;human;brain atrophy;arm;brain injury;brain;controlled clinical trial (topic);nuclear magnetic resonance imaging;systolic blood pressure;patient;white matter;cerebrovascular disease;diet restriction;cerebrovascular accident;infarction;controlled clinical trial;ischemic heart disease;hyperlipidemia;follow up;diabetes mellitus;hypertension;smoking;body mass;cholesterol blood level;imaging;neuroimaging;therapy;placebo;glucose,"Fiford, C;Frost, C;Manning, En;Nicholas, J;Barnes, J;Leung, Kk;Carmichael, Ot;Meade, T",2014,,,0,1294
1294,Impact of baseline adjustment for vascular risk factors on sample size for atrophy outcomes in Alzheimer's disease clinical trials,"Background: Whole-brain and hippocampal atrophy rate measures are used as outcomes measures in trials of putative therapies for Alzheimer's disease (AD). Since atrophy rates may be influenced by vascular risk factors or vascular brain injury, we investigated whether baseline adjustment for these characteristics may also reduce sample size estimates. Methods: Participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI) 1 study were included where they had useable 1.5T MRI imaging at baseline and 1 year follow-up. Boundary shift integral (BSI) was used to assess MRI whole-brain and hippocampal atrophy rates. Sample sizes per arm were estimated for a placebo controlled clinical trial in AD or MCI to have 80% power to detect a 25% reduction in atrophy rate and for 25% reduction relative to atrophy rates in controls. Sample sizes were calculated with adjustment for baseline age, diastolic and systolic blood pressure, fasting glucose, serum cholesterol, body mass index (BMI), smoking status, hypertension, diabetes, hyperlipidaemia, central and coronary heart disease, MRI infarcts, stroke-related events, and white matter hyperintensities. Results: Participants included 177 controls, 297 participants with MCI and 122 participants with AD at baseline. The mean whole-brain atrophy rates were: controls 5.9 ml/yr (SD 5.9); MCI 10.9 (8.3); AD 14.9 (7.7). Sample sizes per arm for a 25% reduction in whole-brain atrophy rate were 719 MCI and 186 AD.With adjustment for all vascular risk factors and vascular brain injury variables sample size were reduced by 3% in MCI and 10% in AD (Table 1). Hippocampal atrophy rates were: controls 0.06 ml/yr (SD 0.09); MCI 0.14 (0.12); AD 0.20 (0.12). Sample sizes per arm for 25% reduction in hippocampal atrophy were 544 MCI and 179 AD. Adjustment for all vascular risk factors reduced sample size estimates by 2.6% in MCI but there was no reduction in AD (Table 1). Conclusions: Adjustment for 14 vascular risk factors provided a modest reduction in sample size estimates of up to 10%. AD treatment trials which exclude patients with overt cerebrovascular disease, much like ADNI1, may still benefit from adjustment of whole-brain atrophy rate outcome measures by vascular risk factors and event.",atrophy;risk factor;sample size;clinical trial (topic);Alzheimer disease;human;brain atrophy;arm;brain injury;brain;controlled clinical trial (topic);nuclear magnetic resonance imaging;systolic blood pressure;patient;white matter;cerebrovascular disease;diet restriction;cerebrovascular accident;infarction;controlled clinical trial;ischemic heart disease;hyperlipidemia;follow up;diabetes mellitus;hypertension;smoking;body mass;cholesterol blood level;imaging;neuroimaging;therapy;placebo;glucose,"Fiford, C.;Frost, C.;Manning, E. N.;Nicholas, J.;Barnes, J.;Leung, K. K.;Carmichael, O. T.;Meade, T.",2014,,,0,
1295,Restless Legs Syndrome/Willis-Ekbom Disease and Periodic Limb Movements in Sleep in the Elderly with and without Dementia,"There is great interest in the study of sleep in healthy and cognitively impaired elderly. Sleep disorders have been related to quality of aging. Sleep-related movements are a frequent cause of disordered sleep and daytime sleepiness. Restless legs syndrome/Willis-Ekbom disease (RLS/WED) is often unrecognized in the elderly. This review explores RLS/WED in the elderly population. The elderly population may be subdivided into 3 groups: healthy, dependent, and frail. The RLS/WED could be a predictor for lower physical function; its burden on quality of life and health care-related costs, in the elderly, should be an important clinical and public health concern.",alkaline phosphatase;aminotransferase;amitriptyline;aripiprazole;citalopram;clonazepam;clozapine;dopamine receptor stimulating agent;duloxetine;escitalopram;fluoxetine;gabapentin;imipramine;lithium;loxapine;mianserin;mirtazapine;olanzapine;opiate;oxycodone;paroxetine;pramipexole;pregabalin;risperidone;rotigotine;sertraline;thioridazine;tramadol;unindexed drug;venlafaxine;abdominal pain;addiction;age distribution;akathisia;alcohol abstinence;amnesia;anemia;anxiety disorder;arthralgia;article;ataxia;attention disturbance;balance impairment;blurred vision;body weight disorder;breathing disorder;chronic kidney failure;claudication;clinical feature;cognitive defect;comorbidity;concentration loss;confusion;congestive heart failure;constipation;delayed hypersensitivity;delirium;dementia;depression;differential diagnosis;diplopia;disease association;disease classification;disorientation;dizziness;dysarthria;dyskinesia;dyspepsia;dyspnea;eosinophilia;epigastric pain;exercise;faintness;fatigue;first degree atrioventricular block;gastritis;genetic predisposition;geriatric patient;hallucination;headache;heart arrhythmia;hepatomegaly;human;hyperactivity;hyperhidrosis;hypersalivation;hypertension;hypotension;impulse control disorder;incontinence;increased appetite;insomnia;iron deficiency;kidney failure;language disability;leg cramp;leg edema;leg injury;leukopenia;lung edema;memory disorder;mental disease;mood disorder;myoclonus;myopathy;nausea;neurologic disease;nightmare;nystagmus;onset age;orthostatic hypotension;panic;paradoxical drug reaction;paresthesia;patient education;periodic limb movement disorder;peripheral edema;peripheral neuropathy;physical examination;polysomnography;priority journal;pruritus,"Figorilli, M.;Puligheddu, M.;Ferri, R.",2015,,,0,
1296,"Health status of populations living in French overseas territories in 2012, compared with metropolitan France: An analysis of the national health insurance database","BACKGROUND: This study uses healthcare consumption to compare the health status of beneficiaries of the French national health insurance general scheme between individuals living in French overseas territories (FOT) and those living in metropolitan France. METHODS: Data were extracted from the French national health insurance database (Sniiram) for 2012, using algorithms, 56 groups of diseases and 27 groups of hospital activity were isolated. Standardized morbidity ratio for age and sex (SMR) were used to compare FOT to mainland France. RESULTS: Compared with mainland France, people living in the four FOT had high SMR for diabetes care (Guadeloupe 1.9; Martinique 1.7; Guyane 1.9; La Reunion 2.3), dialysis (2.7; 2.4; 3.8; 4.4), stroke (1.2; 1.1; 2.0; 1.5), and hospitalization for infectious diseases (1.9; 2.5; 2.4; 1.4) and obstetrics (1.4; 1.2; 1.9; 1.2). Care for inflammatory bowel disease or cancer were less frequent except for prostate in Martinique and Guadeloupe (2.3). People living in Martinique, Guadeloupe and la Reunion had more frequently care for psychotic disorders (2.0; 1.7; 1.2), dementia (1.1; 1.3; 11), epileptic seizures (1.4; 1.4; 16) and hospitalizations for burns (2.6; 1.7; 2.9). In la Reunion, people had more frequently coronary syndrome (1.3), cardiac heart failure (1.6), chronic respiratory diseases except cystic fibrosis (1.5), drug addiction (1.4) and hospitalizations for cardiovascular catheterization (1.4) and toxicology, poisoning, alcohol (1.7). Other differences were observed by gender: HIV infection, peripheral arterial disease, some chronic inflammatory disease (lupus) were more frequent in women living in Martinique or Guadeloupe, compared to women from mainland France and psychotic disorders for men. From la Reunion, men had more frequently liver and pancreatic diseases and hospitalisation for toxicology, poisoning, alcohol than men from mainland France. CONCLUSION: This study highlights the utility of administrative database to compare and follow population health status considering healthcare use. Specific Public Health policies are justified for FOT, taking into account the specific context of each FOT, the necessity of prevention initiatives and screening to reduce the frequency of the chronic diseases.",Assures;Consommation de soins;Departements d'outre-mer;French overseas territories;Healthcare use;Hospital;Hopital;Insured people;Morbidity;Morbidite,"Filipovic-Pierucci, A.;Rigault, A.;Fagot-Campagna, A.;Tuppin, P.",2016,Jun,10.1016/j.respe.2016.01.099,0,
1297,Acute care of dementia patients: Specialized programs needed,,Alzheimer disease;aspiration pneumonia;congestive heart failure;decubitus;diabetes mellitus;feeding disorder;geriatric care;hospitalization;human;malnutrition;senile dementia;sepsis;short survey;urinary tract infection,"Fillit, H.",1994,,,0,
1298,Telethon Network of Genetic Biobanks: A key service for diagnosis and research on rare diseases,"Several examples have always illustrated how access to large numbers of biospecimens and associated data plays a pivotal role in the identification of disease genes and the development of pharmaceuticals. Hence, allowing researchers to access to significant numbers of quality samples and data, genetic biobanks are a powerful tool in basic, translational and clinical research into rare diseases. Recently demand for well-annotated and properly-preserved specimens is growing at a high rate, and is expected to grow for years to come. The best effective solution to this issue is to enhance the potentialities of well-managed biobanks by building a network.Here we report a 5-year experience of the Telethon Network of Genetic Biobanks (TNGB), a non-profit association of Italian repositories created in 2008 to form a virtually unique catalogue of biospecimens and associated data, which presently lists more than 750 rare genetic defects. The process of TNGB harmonisation has been mainly achieved through the adoption of a unique, centrally coordinated, IT infrastructure, which has enabled (i) standardisation of all the TNGB procedures and activities; (ii) creation of an updated TNGB online catalogue, based on minimal data set and controlled terminologies; (iii) sample access policy managed via a shared request control panel at web portal. TNGB has been engaged in disseminating information on its services into both scientific/biomedical - national and international - contexts, as well as associations of patients and families. Indeed, during the last 5-years national and international scientists extensively used the TNGB with different purposes resulting in more than 250 scientific publications. In addition, since its inception the TNGB is an associated member of the Biobanking and Biomolecular Resources Research Infrastructure and recently joined the EuroBioBank network. Moreover, the involvement of patients and families, leading to the formalization of various agreements between TNGB and Patients' Associations, has demonstrated how promoting Biobank services can be instrumental in gaining a critical mass of samples essential for research, as well as, raising awareness, trust and interest of the general public in Biobanks. This article focuses on some fundamental aspects of networking and demonstrates how the translational research benefits from a sustained infrastructure. © 2013 Filocamo et al.; licensee BioMed Central Ltd.",article;bone dysplasia;cardiomyopathy;cardiovascular disease;cataloging database;chromosome aberration;clinical data repository;endocrine disease;genetic database;hearing impairment;hematologic disease;human;human genetics;information dissemination;intellectual impairment;kidney disease;metabolic disorder;motor dysfunction;neurologic disease;neuromuscular disease;nomenclature;non profit organization;publication;rare disease;Rett syndrome;telethon network of genetic biobank;translational research,"Filocamo, M.;Baldo, C.;Goldwurm, S.;Renieri, A.;Angelini, C.;Moggio, M.;Mora, M.;Merla, G.;Politano, L.;Garavaglia, B.;Casareto, L.;Bricarelli, F. D.",2013,,,0,
1299,"Statins - A major success in cardiovascular therapeutics, but more safety data needed",,antilipemic agent;cerivastatin;fibric acid derivative;high density lipoprotein cholesterol;low density lipoprotein cholesterol;artery disease;cardiovascular disease;clinical practice;clinical trial;dementia;diabetes mellitus;disease severity;drug efficacy;drug safety;drug withdrawal;experience;financial management;heart protection;human;incidence;ischemic heart disease;letter;medical research;medical society;myopathy;national health service;physician;physician attitude;prescription;primary medical care;rhabdomyolysis;cerebrovascular accident;United Kingdom,"Findlay, S.",2001,,,0,
1300,Chronic Pain Management in Older Adults: Special Considerations,"The rising prevalence of neuropathic pain and the multifaceted sequelae of pain particularly within older adults are part of the increasing challenges in providing good geriatric pain management. Aging can lead to a higher sensitivity to pain within older adults, whereas physiological changes modify the absorption, bioavailability, and transit time of pharmaceutical agents. Ultimately, these differences within older adults require clinicians treating them to provide individually tailored analgesic approaches. Progressive age increases the variance in physiology among people; thus, the management approach should reflect an individual's unique requirements and limitations based on findings at the time of assessment. © 2009 U.S. Cancer Pain Relief Committee.",amitriptyline;analgesic agent;anticonvulsive agent;buprenorphine;cannabinoid derivative;capsaicin;carbamazepine;clonidine;duloxetine;fentanyl;gabapentin;hydrocodone;hydromorphone;ketamine;lamotrigine;lidocaine;memantine;mexiletine;mirtazapine;nortriptyline;opiate;pregabalin;serotonin noradrenalin reuptake inhibitor;tapentadol;tizanidine;tramadol;tricyclic antidepressant agent;unindexed drug;valproic acid;venlafaxine;age distribution;allodynia;anxiety;application site reaction;article;Australia;caudate nucleus;central nervous system;chronic kidney failure;chronic pain;Cochrane Library;cognitive defect;consensus;constipation;coping behavior;daily life activity;degenerative disease;delayed diagnosis;delirium;dementia;depression;diagnostic error;dizziness;drowsiness;drug absorption;drug accumulation;drug bioavailability;drug formulation;drug indication;drug withdrawal;fracture;functional assessment;gastrointestinal tract;geriatric care;glaucoma;glomerulus filtration rate;heart infarction;human;hyperalgesia;hypertension;hypesthesia;inflammation;intestine absorption;intestine blood flow;intestine motility;intestinal secretion;intestine transit time;renal clearance;kidney function;length of stay;liver blood flow;liver function;medical education;nausea;neuropathic pain;nociception;nursing home;pain assessment;pain threshold;patient compliance;perceptive threshold;peripheral neuropathy;personality;physical examination;polypharmacy;postherpetic neuralgia;practice guideline;prescription;putamen;quality of life;rash;respiration depression;scar formation;senescence;sensory dysfunction;sleep disorder;small intestine disease;social behavior;spine;spinothalamic tract;treatment contraindication;trigeminus neuralgia;United States;vomiting,"Fine, P. G.",2009,,,0,
1301,Diagnostic approach to restricted-diffusion patterns on MR imaging,"The vast majority of restricted-diffusion abnormalities result from acute stroke, and as such, the diagnosis may be problematic when this MRI feature results from other causes. Distinct patterns of restricted diffusion seen with various disease conditions can play an important diagnostic role. The association of certain diseases with a given restricted-diffusion pattern allows for a focused assessment to determine a specific etiology. Copyright © 2012 American Academy of Neurology.",carboxyhemoglobin;oligoclonal band;opiate;protein 14 3 3;tissue plasminogen activator;abscess drainage;adolescent;adult;aged;alcohol liver disease;article;autopsy;balance disorder;brain abscess;brain disease;brain infarction;carbon monoxide intoxication;cardiopulmonary insufficiency;cardioversion;caudate nucleus;cerebellum injury;cerebral palsy;child;clinical article;cognitive defect;comatose patient;Creutzfeldt Jakob disease;delta rhythm;diagnostic approach route;diffusion weighted imaging;dizziness;electrocardiogram;electroencephalogram;esophagogastroduodenoscopy;esophagus varices bleeding;female;follow up;gait disorder;headache;atrial fibrillation;hematemesis;hemiparesis;hemoglobin blood level;heroin dependence;His bundle electrogram;human;hyperammonemic encephalopathy;hypertension;hypoxic ischemic encephalopathy;image analysis;lung embolism;male;memory disorder;muscle rigidity;myoclonus;neuroimaging;Pelizaeus Merzbacher disease;portal hypertension;priority journal;protein cerebrospinal fluid level;radiological parameters;restricted diffusion;resuscitation;school child;seizure;stomach disease;weakness,"Finelli, P. F.",2012,,,0,
1302,Outcomes after rectal cancer surgery in elderly nursing home residents,"BACKGROUND: As the population ages, an increasing number of elderly persons will undergo surgery for rectal cancer. The use of sphincter-sparing surgery in frail older adults is controversial. OBJECTIVE: The aim of this study was to examine mortality and bowel function after proctectomy in nursing home residents. DESIGN: This is a retrospective cohort study. SETTING: This investigation was conducted in nursing homes in the United States contracted with the Center for Medicare and Medicaid Services. PATIENTS: Nursing home residents age 65 and older undergoing proctectomy for rectal cancer (2000-2005) were included. MAIN OUTCOME MEASURES: The primary outcomes measured were fecal incontinence and the 1-year mortality rate. RESULTS: Operative mortality was 18% after proctectomy with permanent colostomy and 13% after sphincter-sparing proctectomy (adjusted relative risk, 1.25 (95% CI 0.90-1.73), p = 0.188). One-year mortality was high: 40% after sphincter-sparing proctectomy and 51% after proctectomy with permanent colostomy (adjusted hazard ratio 1.32 (95% CI 1.09-1.60), p = 0.004). After sphincter-sparing proctectomy, 37% of residents were incontinent of feces. Residents with the poorest functional status (Minimum Data Set-Activities of Daily Living quartile 4) were significantly more likely to be incontinent of feces than residents with the best functional status (Minimum Data Set-Activities of Daily Living quartile 1) (76% vs 13%, adjusted relative risk 3.28 (95% CI 1.74-6.18), p = 0.0002). Fecal incontinence was also associated with dementia (adjusted relative risk 1.55 (95% CI 1.15-2.09), p = 0.004) and renal failure (adjusted relative risk 1.93 (95% CI 1.10-3.38), p = 0.022). LIMITATIONS: Measures of fecal incontinence in nursing home registries are not as well studied as those commonly used in clinical practice. CONCLUSIONS: Sphincter-sparing proctectomy in nursing home residents is frequently associated with postoperative fecal incontinence and should be considered only for continent patients with good functional status. © The ASCRS 2012.",aged;article;cancer patient;cancer surgery;cerebrovascular disease;cohort analysis;colostomy;comorbidity;congestive heart failure;controlled study;coronary artery disease;daily life activity;dementia;enteric feeding;feces incontinence;female;functional status;geriatric patient;geriatric surgery;hospital admission;human;intestine function;kidney failure;length of stay;liver disease;major clinical study;male;medical decision making;nursing home patient;peripheral vascular disease;rectum cancer;rectum resection;retrospective study;sphincter sparing proctectomy;surgical mortality;treatment outcome;urine incontinence,"Finlayson, E.;Zhao, S.;Varma, M. G.",2012,,,0,
1303,Neuromuscular implications in CADASIL,"Objectives: Recent studies indicate that Notch3 gene mutations not only manifest as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) but also in the peripheral nerves and skeletal muscles. Methods: A MEDLINE search with appropriate terms was carried out. Six articles, dealing with neuromuscular involvement in CADASIL, were selected and reviewed. Results: Several case studies presented CADASIL patients with clinical features of myopathy. Neurological diagnostic workup in these patients revealed weakness, wasting, reduced/exaggerated tendon reflexes, abnormal nerve conduction and electromyography, muscle biopsy with ragged red muscle fibers, reduced COX staining, decreased complex I respiratory chain activity, abnormally structured mitochondria, or mitochondrial DNA (mtDNA) mutations, such as G5650A in the tRNAAla gene, or various other mtDNA substitutions. Additionally, fibroblasts in skin biopsy may show reduced complex V respiratory chain activity. Conclusions: These findings suggest Notch3 mutations to be associated with mitochondrial disease, particularly affecting the skeletal muscle. Whether mtDNA mutations were induced by Notch3 mutations, by oxidative stress due to chronic hypoxia, resulting from arteriopathy, or occurred spontaneously remains elusive. Patients carrying Notch3 mutations should be systematically investigated for neuromuscular involvement, which may have therapeutic and prognostic implications for these patients. Copyright © 2007 S. Karger AG.",complex 5;enzyme;mitochondrial DNA;prostaglandin synthase;reduced nicotinamide adenine dinucleotide dehydrogenase (ubiquinone);unclassified drug;article;CADASIL;clinical feature;electromyography;fibroblast;human;Medline;mitochondrion;muscle atrophy;muscle biopsy;muscle cell;mutation;myopathy;nerve conduction disorder;neuromuscular disease;priority journal;reflex disorder;respiratory chain;skin biopsy;staining;tendon reflex;weakness,"Finsterer, J.",2007,,,0,
1304,"Mitochondrial disorders, cognitive impairment and dementia","The organ most frequently affected in mitochondrial disorders, particularly respiratory chain diseases (RCDs), in addition to the skeletal muscle, is the central nervous system (CNS). CNS manifestations of RCDs comprise stroke-like episodes, epilepsy, migraine, ataxia, spasticity, movement disorders, psychiatric disorders, cognitive decline, or even dementia (mitochondrial dementia). So far mitochondrial dementia has been reported in MELAS, MERRF, LHON, CPEO, KSS, MNGIE, NARP, Leigh syndrome, and Alpers-Huttenlocher disease. Mitochondrial dementia not only results from mutations in the mitochondrial genome but also from mutations in nuclear genes, such as POLG, thymidine kinase 2, or DDP1. Often mitochondrial dementia starts with specific cognitive deficits, particularly in visual construction, attention, abstraction, or flexibility but without a general intellectual deterioration. Cognitive impairment in RCDs is diagnosed upon neuropsychological testing, imaging studies, such as MRI, PET, or MR-spectroscopy, CSF-investigations, or electroencephalography. Therapy of mitochondrial dementia relies on symptomatic measures. Only single patients profit from cholinesterase inhibitors or memantine, antioxidants, vitamins, coenzyme-Q, or other substitutes. Overall, mitochondrial dementia is an important differential of dementias and should be considered in patients with multi-system disease. © 2009 Elsevier B.V. All rights reserved.",mitochondrial DNA;Alpers disease;article;chronic progressive external ophthalmoplegia;clinical feature;cognitive defect;dementia;disease association;disease classification;disorders of mitochondrial functions;human;Kearns Sayre syndrome;Leber hereditary optic neuropathy;Leigh disease;MELAS syndrome;MERRF syndrome;MNGIE syndrome;NARP syndrome;neuropsychological test;pathophysiology;priority journal;syndrome delineation,"Finsterer, J.",2009,,,0,
1305,Apical hypertrophic cardiomyopathy in encephalomyopathy,"Apical hypertrophic cardiomyopathy (AHC) is associated with neurological abnormalities such as transient ischemic attack, stroke, limb-girdle muscular dystrophy, or eosinophilic myositis in single cases. The association of AHC and metabolic myopathy has not been reported. In an 84-year-old woman with long-standing gait disturbance, dementia, Parkinson syndrome, ptosis, ophthalmoparesis, tetraparesis, polyneuropathy, lactacidosis, polyarthralgia, dorsalgia, and osteoporosis, cardiac examination for long-standing anginal chest pain and palpitations, revealed supraventricular and monomorphic ventricular ectopic beats, hypertrophic signs, ST-depression and negative T waves on electrocardiogram (ECG), diastolic dysfunction with impaired relaxation, and AHC on transthoracic echocardiography. AHC was confirmed by cardiac magnetic resonance imaging, which additionally showed a small left ventricular apical aneurysm with a wall-thickness of only 3 mm. The patient was suspected to additionally have a multisystem disease, most likely due to impaired oxidative metabolism. This case shows that AHC may take a mild course and be associated with a number of extracardiac abnormalities. © 2007 Italian Federation of Cardiology.",aged;article;atrophy;case report;computer assisted tomography;Doppler echography;encephalomyopathy;female;human;hypertrophic cardiomyopathy;nuclear magnetic resonance imaging;osteochondrosis;osteoporosis,"Finsterer, J.;Kopsa, W.;Stöllberger, C.",2007,,,0,
1306,Stroke due to Chagas' cardiomyopathy or noncompaction,,ablation therapy;acute disease;anticoagulant therapy;cerebrospinal fluid analysis;Chagas disease;chronic disease;computer assisted tomography;confusion;dementia;genetic disorder;heart atrium flutter;human;letter;meningoencephalitis;mitral valve regurgitation;myocarditis;neuritis;nuclear magnetic resonance imaging;sensory dysfunction;cerebrovascular accident;transthoracic echocardiography;ventricular noncompaction,"Finsterer, J.;Stöllberger, C.",2011,,,0,
1307,Left ventricular hypertrabeculation/noncompaction in juvenile neuronal ceroid lipofuscinosis,,muscle enzyme;adolescent;aspiration pneumonia;case report;chromosome disorder;disease association;echocardiography;electromyography;female;heart arrhythmia;heart failure;hospitalization;human;left ventricular hypertrabeculation;letter;nerve conduction;neuromuscular disease;neuronal ceroid lipofuscinosis;ventricular noncompaction,"Finsterer, J.;Stöllberger, C.;Yoshida, T.",2015,,,0,
1308,Re: Feuer et al.: Gene therapy for Leber hereditary optic neuropathy: Initial results (Ophthalmology 2016;123:558-70),,adenovirus vector;anemia;angina pectoris;arterial stiffness;chorea;congestive cardiomyopathy;dementia;diabetes mellitus;dyspnea;faintness;gene mutation;gene therapy;hearing impairment;heart palpitation;human;hyperthyroidism;hypophysis adenoma;hypothyroidism;Leber hereditary optic neuropathy;letter;migraine with aura;migraine without aura;muscle cramp;myoclonus epilepsy;posterior reversible encephalopathy syndrome;priority journal;visual acuity,"Finsterer, J.;Zarrouk-Mahjoub, S.",2016,,,0,
1309,"Psychological morbidity in leber’s hereditary optic neuropathy depends on phenotypic, social, economic, and genetic factors","We have read with interest the article by Garcia et al1 about the effect of visual impairment on psychological well-being with regard to mood, interpersonal interactions, and career-related goals.1 Among the 103 Leber’s hereditary optic neuropathy (LHON) patients, half became depressed with negative impacts on interpersonal relations and career goals. At diagnosis, older age corresponded to higher depression prevalence than young age. We have the following comments and concerns.",idebenone;mitochondrial DNA;anemia;arterial stiffness;ataxia;cardiomyopathy;chorea;dementia;depression;diabetes mellitus;epilepsy;gene mutation;genetic association;genetic risk;hearing impairment;heart arrhythmia;heart failure;human;hypophysis adenoma;Leber hereditary optic neuropathy;letter;leukoencephalopathy;migraine;morbidity;pathogenesis;phenotype;polyneuropathy;posterior reversible encephalopathy syndrome;psychological well-being;socioeconomics;sudden cardiac death;thyroid disease,"Finsterer, J.;Zarrouk-Mahjoub, S.",2017,,10.2147/opth.s136761,0,
1310,Organic brain syndrome potentially treatable,"Certain psychiatric disabilities are especially common in elderly people. Among the behavioral abnormalities generally classified under the term 'senile dementia' there are some organic brain illneses or acute confusional states often treatable and reversible, or the combintion of organic confusional conditions. A reliable history is essential in diagnosis: the account of a reliable informant is indispensable. Relatives might report the mode of the onset of the mental condition: acute or gradual and progressive, the behaviour of the patient, a recent organic illness, frequently as influenza or urinary infection. It is very important to know the nature of drugs the patient has taken: barbiturates and other hypnotics and sedatives, some anti Parkinsonian drug, digitalis and other certainly cause acute confusion. Alcoholism in the elderly is very common. Painless myocardial infarction and silent pneumonia are examples of how physical conditions can cause acute confusional states. It is also important to exclude other illnesses as mixoedema, vitamin B12 and folate deficiency, hypochromic anemia, subdural haematoma, symptomatic occult normal pressure hydrocephalus, brain tumor, infarction or hemorrhage, hypoparatiroidism. Low perfusion syndrome, diabetes and hypoglycemia can also often cause acute confusional states. The environment and patient's social circumstances and role are also very important. Last but not least we remember depressive pseudodementia that is particularly common in old age. If a reliable history is the first essential in the diagnostic process, it must always be followed by careful clinical assessment one aspect of which are standard routine screening procedures. Fox and coworkers established a 'dementia protocol': a group of laboratory blood tests, electroencephalogram, skull and chest roentgenograms, electrocardiogram, directional Doppler's ultrasonography, isotope brain scan, computerized axial tomography study of cerebral transit time. Spcial studies as RISA cisternography, pneumoencephalograpy and cranial arteriography are performed only in patients with a picture suggestive of surgical illness as normal pressure hydrocephalus. Simple psychometric tests of memory, general knowledge and orientation all of which are often impaired are useful.",aged;brain dysfunction;central nervous system;chronic brain disease;dementia;diagnosis;pseudodementia;psychological aspect;therapy,"Finzi, B.",1979,,,0,
1311,Plasma F2-isoprostane level and cognitive function over eight years in non-demented older adults: Findings from the Health ABC Study,"F2-isoprostanes (F2-IsoP) are reportedly increased in dementia patients, and are considered a reliable biomarker of oxidation. However, few studies have examined the predictive value of peripheral F2-IsoP levels in non-demented older adults. This study assesses the association between plasma F2-IsoP and change in cognitive function in non-demented elderly over eight years. Plasma F2-IsoP was measured by gas chromatography-mass spectrometry in a biracial cohort of 726 elderly men and women. Digit Symbol Substitution test and the Modified Mini-Mental State Exam were administered over time. No association was found between F2-IsoP tertile and baseline or change (slope) in cognitive function over eight years. Plasma F2-IsoP is not a valuable biomarker in predicting cognitive change over years in non-demented older adults. © 2010 Elsevier Ltd.",apolipoprotein E4;isoprostane derivative;aged;aging;article;body mass;cognition;cohort analysis;diabetes mellitus;education;female;genotype;heart infarction;human;hypertension;male;mass fragmentography;Mini Mental State Examination;prediction;priority journal;race difference;sex difference;cerebrovascular accident,"Fiocco, A. J.;Kanaya, A. M.;Lindquist, K. M.;Harris, T. B.;Satterfield, S.;Simonsick, E. M.;Kuller, L.;Rosano, C.;Yaffe, K.",2011,,,0,
1312,Five things physicians and patients should question in hospice and palliative medicine,"Overuse or misuse of tests and treatments exposes patients to potential harm. The American Board of Internal Medicine Foundation's Choosing Wisely® campaign is a multiyear effort to encourage physician leadership in reducing harmful or inappropriate resource utilization. Via the campaign, medical societies are asked to identify five tests or procedures commonly used in their field, the routine use of which in specific clinical scenarios should be questioned by both physicians and patients based on the evidence that the test or procedure is ineffective or even harmful. The American Academy of Hospice and Palliative Medicine (AAHPM) was invited, and it agreed to participate in the campaign. The AAHPM Choosing Wisely Task Force, with input from the AAHPM membership, developed the following five recommendations: 1) Don't recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral-assisted feeding; 2) Don't delay palliative care for a patient with serious illness who has physical, psychological, social, or spiritual distress because they are pursuing disease-directed treatment; 3) Don't leave an implantable cardioverter-defibrillator activated when it is inconsistent with the patient/family goals of care; 4) Don't recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis; and 5) Don't use topical lorazepam (Ativan®), diphenhydramine (Benadryl®), and haloperidol (Haldol®) (ABH) gel for nausea. These recommendations and their supporting rationale should be considered by physicians, patients, and their caregivers as they collaborate in choosing those treatments that do the most good and avoid the most harm for those living with serious illness. © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.",antiinflammatory agent;diphenhydramine;haloperidol;lorazepam;article;artificial feeding;bone metastasis;comparative effectiveness;dementia;feeding apparatus;hospice;hydration;implantable cardioverter defibrillator;malnutrition;medical society;nausea;palliative therapy;patient;percutaneous endoscopic gastrostomy;physician;recurrent infection;terminal care;ativan;benadryl;haldol,"Fischberg, D.;Bull, J.;Casarett, D.;Hanson, L. C.;Klein, S. M.;Rotella, J.;Smith, T.;Storey Jr, C. P.;Teno, J. M.;Widera, E.",2013,,,0,
1313,Impact of comorbidity on ischemic stroke outcome,"OBJECTIVE: To evaluate the impact of comorbidity on stroke outcome of patients admitted to a general ward (GW) and a stroke unit (SU). METHODS: Data of 266 patients with acute ischemic stroke (GW: 103, SU: 163) were collected prospectively for 13 months. Clinical and radiological findings, and the Charlson Comorbidity Index (CCI) were recorded. Predictors of outcome 4 months after stroke were analyzed. Favorable outcome was defined as modified Rankin Scale (mRS) score of < or = 2, unfavorable as mRS >2. RESULTS: The mean age of the patients was 67.2 years (SD = 14.4), the mean CCI 1.2 (SD = 1.4). In univariate analysis, small artery disease predicted favorable outcome (P < 0.001) and age (P = 0.022), high National Institutes of Health Stroke Scale (NIHSS) score (P < 0.001), high CCI (P < 0.001), treatment in a GW (P = 0.004), coronary artery disease (P = 0.02), dementia (P = 0.009), diabetes (P = 0.005) and atrial fibrillation (P < 0.001) unfavorable outcome after 4 months. In multivariate analysis, high NIHSS score (P < 0.001), atrial fibrillation (P = 0.004), coronary artery disease (P = 0.012) and diabetes (P = 0.031) were predictors of unfavorable outcome. CONCLUSIONS: Comorbidity has a significant impact on stroke outcome. In addition to stroke severity, atrial fibrillation, coronary artery disease and diabetes were predictors of outcome after stroke, but not the sum of the CCI.","Adult;Aged;Aged, 80 and over;Brain Ischemia/*complications/diagnosis/therapy;Female;Follow-Up Studies;Hospital Units;Hospitals, General;Hospitals, University;Humans;Male;Middle Aged;Patients' Rooms;Prospective Studies;Severity of Illness Index;Stroke/*complications/diagnosis/therapy;Treatment Outcome","Fischer, U.;Arnold, M.;Nedeltchev, K.;Schoenenberger, R. A.;Kappeler, L.;Hollinger, P.;Schroth, G.;Ballinari, P.;Mattle, H. P.",2006,Feb,10.1111/j.1600-0404.2005.00551.x,0,
1314,A Delirium Unit in an Acute Geriatric Hospital,,"Aged;Barbiturates/*toxicity;*Delirium;*Dementia;*Geriatrics;*Heart Failure;*Homes for the Aged;*Hospitals;*Hospitals, Psychiatric;Humans;*Intracranial Arteriosclerosis;*Myocardial Infarction;*Psychotic Disorders;*Respiratory Tract Infections;*Toxicology;*Urinary Tract Infections;*Barbiturate toxicology;*Cerebral arteriosclerosis;*Heart failure, congestive;*Myocardial infarct;*Psychoses, senile;*Toxicologic report","Fish, F.;Williamson, J.",1964,,,0,
1315,"Poststroke hip fracture: prevalence, clinical characteristics, mineral-bone metabolism, outcomes, and gaps in prevention","Objective. To assess the prevalence, clinical and laboratory characteristics, and short-term outcomes of poststroke hip fracture (HF). Methods. A cross-sectional study of 761 consecutive patients aged >/=60 years (82.3 +/- 8.8 years; 75% females) with osteoporotic HF. Results. The prevalence of poststroke HF was 13.1% occurring on average 2.4 years after the stroke. The poststroke group compared to the rest of the cohort had a higher proportion of women, subjects with dementia, history of TIA, hypertension, coronary artery disease, secondary hyperparathyroidism, higher serum vitamin B12 levels (>350 pmol/L), walking aid users, and living in residential care facilities. The majority of poststroke HF patients had vitamin D insufficiency (68%) and excess bone resorption (90%). This group had a 3-fold higher incidence of postoperative myocardial injury and need for institutionalisation. In multivariate analysis, independent indicators of poststroke HF were female sex (OR 3.6), history of TIA (OR 5.2), dementia (OR 4.1), hypertension (OR 3.2), use of walking aid (OR 2.5), and higher vitamin B12 level (OR 2.3). Only 15% of poststroke patients received antiosteoporotic therapy prior to HF. Conclusions. Approximately one in seven HFs occurs in older stroke survivors and are associated with poorer outcomes. Early implementation of fracture prevention strategies is needed.",,"Fisher, A.;Srikusalanukul, W.;Davis, M.;Smith, P.",2013,,10.1155/2013/641943,0,
1316,"Prolonged QT interval, syncope, and delirium with galantamine","OBJECTIVE: To describe a case of QT interval prolongation, syncope, and delirium associated with galantamine use and to analyze similar cases related to acetylcholinesterase inhibitors (AChIs) reported to the Australian Adverse Drug Reaction Advisory Committee (ADRAC). CASE SUMMARY: An 85-year-old man with dementia was treated with prolonged release galantamine 8 mg daily for 1.5 years. Three months prior to the current admission, he had a syncopal episode with low blood pressure and bradycardia. Two months later, galantamine was withdrawn, but within 2 weeks, the man developed marked cognitive, behavioral, and functional deterioration and galantamine was restarted. Three weeks later, he developed syncope, delirium, hypotension, and prolonged QT interval with serious cardiac arrhythmias, in addition to vomiting and diarrhea. A complete blood cell count and biochemistry panel performed on admission wore normal. No infection was detected. Galantamine and irbesartan were ceased. The delirium fully resolved in 6 days, and the QT interval shortened from 503 to 443 msec (corrected by Bazett's formula) 4 days after discontinuation of galantamine and remained normal. DISCUSSION: In the ADRAC reports, galantamine was associated with 18 cases of delirium/confusion, 8 of syncope, 13 of bradycardia, 6 of other arrhythmias or conduction abnormalities, and 6 of hypotension. Donepezil was associated with 56, 15, 26, 15, and 5, and rivastigmine with 21, 8, 6, 2, and 2, respectively, of these reactions. Five fatal outcomes were reported in association with galantamine, 11 with donepezil, and 3 with rivastigmine, including 3, 6, and 0 sudden deaths, respectively. This case, along with previously published reports and cases identified from the ADRAC database, illustrates that AChIs may lead to delirium, syncope, hypotension, and life-threatening arrhythmias. The Naranjo probability scale indicated that galantamine was the probable cause of QT interval prolongation, syncope, and delirium in this patient. CONCLUSIONS: Administration of galantamine and other AChIs requires vigilance and assessment of risk factors that may precipitate QT interval prolongation, syncope, and delirium.",donepezil;enoxaparin;galantamine;haloperidol;irbesartan;rivastigmine;aged;agitation;Alzheimer disease;article;atrioventricular block;blood cell count;bradycardia;case report;computer assisted tomography;confusion;delirium;diarrhea;dizziness;drug effect;drug withdrawal;electrocardiography;heart arrest;heart arrhythmia;heart bundle branch block;heart infarction;heart muscle conduction disturbance;human;hypotension;male;nausea;priority journal,"Fisher, A. A.;Davis, M. W.",2008,,,0,
1317,Serum leptin levels in older patients with hip fracture--impact on peri-operative myocardial injury,"To evaluate whether there is a relationship between admission serum leptin concentrations and peri-operative myocardial injury, 238 consecutive older patients (mean age 81.9+/-7.9 years; 172 women) with low-trauma hip fracture were assessed. Myocardial injury as defined by elevated serum cardiac troponin I was associated with lower leptin levels analyzed as continuous or categorical variables. Patients with serum leptin concentrations <12ng/ml (medium value) had a two-fold greater increased risk for such complications compared with those with higher leptin levels (odd ratio 2.13, 95% confidence interval 1.06-4.28; p=0.033). This association remained significant after adjustments for age, gender, clinical (history of coronary artery disease [CAD], stroke, hypertension, diabetes, dementia), hematological (red, white, and lymphocyte count, hemoglobin, hematocrit), metabolic (parathyroid hormone [PTH], albumin), renal(creatinine, urea, glomerular filtration rate [GFR]), and inflammatory (C-reactive protein [CRP], ferritin) factors. The predictive value of lower leptin levels increased significantly when used in combination with traditional risk factors for myocardial injury.","Aged, 80 and over;Biomarkers/blood;Female;Hip Fractures/*blood/surgery;Humans;Leptin/*blood;Male;Myocardium/*metabolism;Prognosis;Risk Factors;Troponin I/*blood","Fisher, A. A.;Goh, S. L.;Srikusalankul, W.;Southcott, E. N.;Davis, M. W.",2009,Summer,,0,1318
1318,Serum leptin levels in older patients with hip fracture-impact on peri-operative myocardial injury,"To evaluate whether there is a relationship between admission serum leptin concentrations and peri-operative myocardial injury, 238 consecutive older patients (mean age 81.9±7.9 years; 172 women) with low-trauma hip fracture were assessed. Myocardial injury as defined by elevated serum cardiac troponin I was associated with lower leptin levels analyzed as continuous or categorical variables. Patients with serum leptin concentrations < 12ng/ml (medium value) had a two-fold greater increased risk for such complications compared with those with higher leptin levels (odd ratio 2.13, 95% confidence interval 1.06-4.28; p=0.033).This association remained significant after adjustments for age, gender, clinical (history of coronary artery disease [CAD], stroke, hypertension, diabetes, dementia), hematological (red, white, and lymphocyte count, hemoglobin, hematocrit), metabolic (parathyroid hormone [PTH], albumin), renal (creatinine, urea, glomerular filtration rate [GFR]), and inflammatory (C-reactive protein [CRP], ferritin) factors.The predictive value of lower leptin levels increased significantly when used in combination with traditional risk factors for myocardial injury.",C reactive protein;ferritin;hemoglobin;leptin;troponin I;age distribution;aged;albumin blood level;anemia;article;cardiovascular risk;comorbidity;controlled study;coronary artery disease;dementia;diabetes mellitus;disease marker;female;heart muscle injury;hematocrit;hip fracture;hormone blood level;human;hyperparathyroidism;hypertension;lymphocyte count;major clinical study;male;malnutrition;perioperative period;priority journal;prognosis;protein blood level;risk assessment;risk factor;sex difference;smoking;very elderly;vitamin D deficiency,"Fisher, A. A.;Goh, S. L.;Srikusalankul, W.;Southcott, E. N.;Davis, M. W.",2009,,,0,
1319,Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences,"BACKGROUND: Data on clinical characteristics and outcomes in regard to hip fracture (HF) type are controversial. This study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type. METHODS: Prospective evaluation of 761 consecutively admitted patients (mean age 82.3 +/- 8.8 years; 74.9% women) with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded. Haematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH) vitamin D, PTH, leptin, adiponectin and resistin were determined. RESULTS: The cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin, albumin, adiponectin and resistin and lower PTH levels (all P < 0.05). In-hospital mortality, length of hospital stay (LOS), incidence of post-operative myocardial injury and need of institutionalisation were similar in both groups. Multivariate analysis revealed as independent predictors for in-hospital death in patient with cervical HF male sex, hyperparathyroidism and lower leptin levels, while in patients with trochanteric HF only hyperparathyroidism; for post-operative myocardial injury dementia, smoking and renal impairment in the former group and coronary artery disease (CAD), hyperparathyroidism and hypoleptinaemia in the latter; for LOS > 20 days CAD, and age > 75 years and hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia in both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF. CONCLUSIONS: Clinical characteristics and incidence of poorer short-term outcomes in the two main HF types are rather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms.",,"Fisher, A. A.;Srikusalanukul, W.;Davis, M. W.;Smith, P. N.",2012,Feb 15,10.1186/1752-2897-6-2,0,
1320,"Liver function parameters in hip fracture patients: Relations to age, adipokines, comorbidities and outcomes","Aim: To asses liver markers in older patients with hip fracture (HF) in relation to age, comorbidities, metabolic characteristics and short-term outcomes. Methods: In 294 patients with HF (mean age 82.0±7.9 years, 72.1% women) serum alanine aminotransferase (ALT), gammaglutamyltransferase (GGT), alkaline phosphatase (ALP), albumin, bilirubin, 25(OH)vitaminD, PTH, calcium, phosphate, magnesium, adiponectin, leptin, resistin, thyroid function and cardiac troponin I were measured. Results: Elevated ALT, GGT, ALP or bilirubin levels on admission were observed in 1.7% - 9.9% of patients. With age GGT, ALT and leptin decrease, while PTH and adiponectin concentrations increase. Higher GGT (>30U/L, median level) was associated with coronary artery disease (CAD), diabetes mellitus (DM), and alcohol overuse; lower ALT (≤20U/L, median level) with dementia; total bilirubin >20μmol/L with CAD and alcohol overuse; and albumin >33g/L with CAD. Multivariate adjusted regression analyses revealed ALT, ALP, adiponectin, alcohol overuse and DM as independent and significant determinants of GGT (as continuous or categorical variable); GGT for each other liver marker; and PTH for adiponectin. The risk of prolonged hospital stay (>20 days) was about two times higher in patients with GGT>30U/L or adiponectin >17.14 ng/L (median level) and 4.7 times higher if both conditions coexisted. The risk of in-hospital death was 3 times higher if albumin was <33g/L. Conclusions: In older HF patients liver markers even within the normal range are associated with age-related disorders and outcomes. Adiponectin (but not 25(OH)vitaminD, PTH, leptin or resistin) is an independent contributor to higher GGT. Serum GGT and albumin predict prolonged hospital stay and in-hospital death, respectively. A unifying hypothesis of the findings presented.",25 hydroxyvitamin D;adipocytokine;adiponectin;alanine aminotransferase;albumin;alkaline phosphatase;bilirubin;C reactive protein;calcium;gamma glutamyltransferase;hemoglobin;hemoglobin A1c;leptin;magnesium;parathyroid hormone;phosphate;resistin;thyroxine;age;aged;aging;alanine aminotransferase blood level;albumin blood level;alcohol abuse;alcohol consumption;alkaline phosphatase blood level;article;calcium blood level;cerebrovascular accident;chronic kidney disease;chronic obstructive lung disease;cohort analysis;comorbidity;controlled study;coronary artery disease;dementia;diabetes mellitus;diagnostic accuracy;diagnostic test accuracy study;disease association;disease severity;enzyme activity;female;gamma glutamyl transferase blood level;glomerulus filtration rate;heart failure;heart muscle injury;hip fracture;hospital admission;hospitalization;human;inflammation;liver function test;magnesium blood level;major clinical study;male;medical history;metabolism;mortality;multivariate analysis;non insulin dependent diabetes mellitus;observational study;outcome assessment;parathyroid hormone blood level;Parkinson disease;phosphate blood level;predictive value;prevalence;prognosis;prospective study;protein blood level;regression analysis;sensitivity and specificity;sex difference;smoking;transient ischemic attack;very elderly;vitamin blood level,"Fisher, L.;Srikusalanukul, W.;Fisher, A.;Smith, P.",2015,,,0,
1321,Cocoa flavanols and brain perfusion,"Foods and beverages rich in flavonoids are being heralded as potential preventive agents for a range of pathologic conditions, ranging from hypertension to coronary heart disease to stroke and dementia. We and others have demonstrated that short-term ingestion of cocoa, particularly rich in the subclass of flavonoids known as flavanols, induced a consistent and striking peripheral vasodilation in healthy people, improving endothelial function in a nitric oxide-dependent manner. The vasodilator response was reversed by N-nitro-L-arginine methyl ester, an arginine analog that blocks nitric oxide synthesis. Flavanol-poor cocoa induced much smaller responses. Because impairment of endothelial function is a nearly universal accompaniment of the aging process, we examined the peripheral vasodilator response to flavanol-rich cocoa in healthy older subjects. Observations point to a favorable response among the older. Together with peripheral vascular disease, cerebrovascular disease is responsible for significant mortality with advancing age. An association of decreased cerebral perfusion with dementia has been recently highlighted. The prospect of increasing cerebral perfusion with cocoa flavanols is extremely promising. Our still preliminary data hold out the promise that the cerebral blood supply in the elderly participates in the vasodilator response. With the modalities of transcranial Doppler and MRI, we have the capabilities of analyzing the potential benefits of flavanols on brain perfusion and, subsequently, on cognition.","Aged;Aging;Beverages;Cacao/*chemistry;Cerebrovascular Circulation/*drug effects;Dementia, Vascular/physiopathology;Endothelium, Vascular/physiopathology;Flavonoids/*pharmacology;Humans;Magnetic Resonance Imaging;Middle Aged","Fisher, N. D.;Sorond, F. A.;Hollenberg, N. K.",2006,,,0,
1322,Automatic summarization of MEDLINE citations for evidence-based medical treatment: A topic-oriented evaluation,"As the number of electronic biomedical textual resources increases, it becomes harder for physicians to find useful answers at the point of care. Information retrieval applications provide access to databases; however, little research has been done on using automatic summarization to help navigate the documents returned by these systems. After presenting a semantic abstraction automatic summarization system for MEDLINE citations, we concentrate on evaluating its ability to identify useful drug interventions for 53 diseases. The evaluation methodology uses existing sources of evidence-based medicine as surrogates for a physician-annotated reference standard. Mean average precision (MAP) and a clinical usefulness score developed for this study were computed as performance metrics. The automatic summarization system significantly outperformed the baseline in both metrics. The MAP gain was 0.17 (p < 0.01) and the increase in the overall score of clinical usefulness was 0.39 (p < 0.05).",acetylsalicylic acid;alprazolam;alteplase;ancrod;anticoagulant agent;benzodiazepine;buspirone;captopril;clonazepam;digoxin;diltiazem;dipeptidyl carboxypeptidase inhibitor;donepezil;fibrinolytic agent;fluoxetine;Ginkgo biloba extract;heparin;imipramine;lisinopril;low molecular weight heparin;metoprolol;monoamine oxidase inhibitor;ramipril;serotonin uptake inhibitor;sertraline;streptokinase;thrombin;tricyclic antidepressant agent;unindexed drug;verapamil;accuracy;acute heart infarction;article;automation;cerebrovascular accident;citation analysis;data synthesis;dementia;drug information;evidence based medicine;atrial fibrillation;heart failure;information system;language processing;Medline;panic;physician;priority journal;reference database;scoring system;semantics;standard;unstable angina pectoris;aspirin,"Fiszman, M.;Demner-Fushman, D.;Kilicoglu, H.;Rindflesch, T. C.",2009,,,0,
1323,A myocardial infarction during intravenous recombinant tissue plasminogen activator infusion for evolving ischemic stroke,"Introduction: There are reports of an ischemic stroke during intravenous recombinant tissue-type plasminogen activator (rtPA) for evolving myocardial infarction (MI), and the risk of stroke shortly after an acute MI seems to be higher than in the control population, attributed to intracardiac thrombus formation. Case Report: We report a case of fatal MI developing immediately after the start of rtPA infusion for middle cerebral artery stroke in an 88-year-old woman. We assume that the systemic thrombolysis with rtPA led to the fragmentation of an underlying cardiac thrombus, which embolized and occluded the coronary artery and caused MI. This hypothesis is discussed with respect to a short review of the related literature. Conclusions: An embolic MI seems to be a rare but serious complication in thrombolysis therapy with rtPA.",alteplase;aged;angiocardiography;article;atrial fibrillation;blood clot lysis;brain ischemia;case report;computer assisted tomography;dementia;diabetes mellitus;disease duration;electrocardiography monitoring;female;gaze;heart infarction;hemiparesis;human;hypertension;middle cerebral artery;National Institutes of Health Stroke Scale;oxygen saturation;pneumonia;priority journal,"Fitzek, S.;Fitzek, C.",2015,,,0,
1324,Leukocyte telomere length and mortality in the Cardiovascular Health Study,"BACKGROUND: Leukocyte telomere length (LTL) is related to diseases of aging, but studies of mortality have been inconsistent. METHODS: We evaluated LTL in relation to total mortality and specific cause of death in 1,136 participants of the Cardiovascular Health Study who provided blood samples in 1992-1993 and survived through 1997-1998. LTL was measured by Southern blots of the terminal restriction fragments. Cause of death was classified by a committee of physicians reviewing death certificates, medical records, and informant interviews. RESULTS: A total of 468 (41.2%) deaths occurred over 6.1 years of follow-up in participants with mean age of 73.9 years (SD 4.7), 65.4% female, and 14.8% African American. Although increased age and male gender were associated with shorter LTLs, African Americans had significantly longer LTLs independent of age and sex (p < .001). Adjusted for age, sex, and race, persons with the shortest quartile of LTL were 60% more likely to die during follow-up than those within the longest quartile (hazard ratio: 1.61, 95% confidence interval: 1.22-2.12, p = .001). The association remained after adjustment for cardiovascular disease risk factors. Evaluations of cause of death found LTL to be related to deaths due to an infectious disease etiology (hazard ratio: 2.80, 95% confidence interval: 1.32-5.94, p = .007), whereas a borderline association was found for cardiac deaths (hazard ratio: 1.82, 95% confidence interval: 0.95-3.49, p = .07) in adjusted models. Risk estimates for deaths due to cancer, dementia, and ischemic stroke were not significant. CONCLUSION: These data weakly corroborate prior findings of associations between LTL and mortality in the elderly.","Aged;Aged, 80 and over;Aging/*genetics;Body Mass Index;Cardiovascular Diseases/*mortality;*Cause of Death;Comorbidity;Coronary Disease/mortality;Diabetes Mellitus/epidemiology;Female;Humans;Hypertension/epidemiology;Leukocytes/metabolism;Longitudinal Studies;Male;Prospective Studies;Smoking/epidemiology;Stroke/mortality;Telomere/*genetics","Fitzpatrick, A. L.;Kronmal, R. A.;Kimura, M.;Gardner, J. P.;Psaty, B. M.;Jenny, N. S.;Tracy, R. P.;Hardikar, S.;Aviv, A.",2011,Apr,10.1093/gerona/glq224,0,
1325,What is a geriatric syndrome anyway?,,angina pectoris;decubitus;delirium;dementia;dependent personality disorder;depression;disease severity;falling;gait disorder;geriatric disorder;geriatric syndrome;hearing impairment;insomnia;language disability;malnutrition;nomenclature;note;osteoporosis;pain;sexual dysfunction;faintness;urine incontinence;vertigo;visual impairment;vomiting,"Flacker, J. M.",2003,,,0,
1326,Role of carnitine in disease,"Carnitine is a conditionally essential nutrient that plays a vital role in energy production and fatty acid metabolism. Vegetarians possess a greater bioavailability than meat eaters. Distinct deficiencies arise either from genetic mutation of carnitine transporters or in association with other disorders such as liver or kidney disease. Carnitine deficiency occurs in aberrations of carnitine regulation in disorders such as diabetes, sepsis, cardiomyopathy, malnutrition, cirrhosis, endocrine disorders and with aging. Nutritional supplementation of L-carnitine, the biologically active form of carnitine, is ameliorative for uremic patients, and can improve nerve conduction, neuropathic pain and immune function in diabetes patients while it is life-saving for patients suffering primary carnitine deficiency. Clinical application of carnitine holds much promise in a range of neural disorders such as Alzheimer's disease, hepatic encephalopathy and other painful neuropathies. Topical application in dry eye offers osmoprotection and modulates immune and inflammatory responses. Carnitine has been recognized as a nutritional supplement in cardiovascular disease and there is increasing evidence that carnitine supplementation may be beneficial in treating obesity, improving glucose intolerance and total energy expenditure.",,"Flanagan, J. L.;Simmons, P. A.;Vehige, J.;Willcox, M. D.;Garrett, Q.",2010,Apr 16,10.1186/1743-7075-7-30,0,
1327,Risk factors for 90-day and 180-day mortality in hospitalised patients with pressure ulcers,"An understanding of risk factors associated with mortality among pressure ulcer patients can inform prognostic counselling and treatment plans. This retrospective cohort study examined associations of comorbid illness, demographic characteristics and laboratory values with 90-day and 90- to 180-day mortality in adult hospitalised patients with pressure ulcers. Data were extracted from hospital databases at two academic urban hospitals. Covariates included mortality risk factors identified in other populations, including demographic and laboratory variables, DRG weight, 'systemic infection or fever' and comorbidity categories from the Charlson comorbidity index. In adjusted Cox proportional hazards models, diabetes, chronic renal failure, congestive heart failure and metastatic cancer were significantly associated with mortality in both time frames. There was no significant effect on mortality from dementia, hemiplegia/paraplegia, rheumatic disease, chronic pulmonary disease or peripheral vascular disease. Myocardial infarction, cerebrovascular disease, liver disease and human immunodeficiency virus/AIDS were associated with mortality in the 90-day time frame only. 'Systemic infection or fever' was associated with mortality in the 90-day time frame but did not show a confounding effect on other variables, and the only significant interaction term was with metastatic cancer. Albumin was the only studied laboratory value that was strongly associated with mortality. Understanding the context of comorbid illness in pressure ulcer patients sets the groundwork for more robust studies of patient- and population-level outcomes, as well as study of heterogeneity within this group. © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.",albumin;acquired immune deficiency syndrome;adult;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic kidney failure;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;correlation analysis;decubitus;dementia;demography;diabetes mellitus;female;fever;heart infarction;hemiplegia;hospital patient;human;Human immunodeficiency virus;infection;laboratory test;liver disease;major clinical study;male;metastasis;middle aged;mortality;paraplegia;peripheral vascular disease;priority journal;proportional hazards model;retrospective study;rheumatic disease;risk factor;urban area;very elderly;young adult,"Flattau, A.;Blank, A. E.",2014,,,0,
1328,"Pharmacogenomics and personalized medicine: Wicked problems, ragged edges and ethical precipices","In the age of genomic medicine we can often now do the genetic testing that will permit more accurate personal tailoring of medications to obtain the best therapeutic results. This is certainly a medically and morally desirable result. However, in other areas of medicine pharmacogenomics is generating consequences that are much less ethically benign and much less amenable to a satisfactory ethical resolution. More specifically, we will often find ourselves left with 'wicked problems,' 'ragged edges,' and well-disguised ethical precipices. This will be especially true with regard to these extraordinarily expensive cancer drugs that generally yield only extra weeks or extra months of life. Our key ethical question is this: Does every individual faced with cancer have a just claim to receive treatment with one of more of these targeted cancer therapies at social expense? If any of these drugs literally made the difference between an unlimited life expectancy (a cure) and a premature death, that would be a powerful moral consideration in favor of saying that such individuals had a strong just claim to that drug. However, what we are beginning to discover is that different individuals with different genotypes respond more or less positively to these targeted drugs with some in a cohort gaining a couple extra years of life while others gain only extra weeks or months. Should only the strongest responders have a just claim to these drugs at social expense when there is no bright line that separates strong responders from modest responders from marginal responders? This is the key ethical issue we address. We argue that no ethical theory yields a satisfactory answer to this question, that we need instead fair and respectful processes of rational democratic deliberation. © 2012 Elsevier B.V.",bevacizumab;cetuximab;Alzheimer disease;arthritis;article;artificial heart;breast cancer;cardiovascular mortality;chronic disease;chronic obstructive lung disease;health care cost;health care need;health care organization;heart disease;heart failure;kidney failure;left ventricular assist device;life expectancy;non small cell lung cancer;medical technology;medicare;national health insurance;neoplasm;overall survival;personalized medicine;pessimism;pharmacogenomics;priority journal;quality of life;cerebrovascular accident;United States,"Fleck, L. M.",2012,,,0,
1329,Changes in practice morbidity between the 1970 and 1981 national morbidity surveys,"The primary aim of the study was to evaluate practice differences in reported morbidity in the second and third national morbidity surveys (1970/71, 1981/82) and to discuss their cause. A secondary aim concerned the validation of trends identified from analysis of the data from the total populations in the practices. Altogether 19 practices participated in both surveys. Annual prevalences (that is, the number of patients attending the general practitioner with a condition per 1000 persons at risk) were examined for: all conditions; each of three categories of seriousness of disease; diseases aggregated by chapter of the International classification of diseases; and each of 130 rubrics of the disease classification. Annual prevalence for 'all conditions' was approximately the same for males in both surveys, whereas for females there was an increase. In both sexes, annual prevalence for 'serious conditions' increased slightly and for 'trivial conditions' increased substantially. For 'intermediate conditions', there was a modest decrease in males. In the analysis at ICD chapter level, substantial increases in prevalence occurred in infectious diseases, nervous system diseases, circulatory diseases, genitourinary diseases, musculoskeletal diseases, symptoms, signs and ill-defined conditions, injuries and poisonings. Decreases were found in blood diseases, mental disorders and digestive diseases. Among 130 individual conditions examined, increased annual prevalence was found for mumps, fungal infections, hypothyroidism, diabetes, gout, senile dementia, angina, left heart failure, catarrh, hay fever and asthma, orchitis, acne, osteoarthritis and for some symptoms. Decreases were found for iron deficiency anaemia, anxiety state, refractive errors, haemorrhoids, chronic bronchitis, functional disorders of the stomach, carbuncle and skin infections.(ABSTRACT TRUNCATED AT 250 WORDS)","Adolescent;Adult;Aged;Child;Child, Preschool;England/epidemiology;Family Practice/statistics & numerical data/*trends;Female;Humans;Infant;Infant, Newborn;Male;Middle Aged;*Morbidity;Prevalence;Wales/epidemiology","Fleming, D. M.;Cross, K. W.;Olmos, L. G.;Crombie, D. L.",1991,May,,0,
1330,Improving patient outcomes with better care transitions: the role for home health,"Patients, particularly the old and frail, are especially vulnerable at the time of hospital discharge. Fragmentation of care, characterized by miscommunications and lack of follow-up, can lead to oversights in diagnosis and management. The frequent result is avoidable rehospitalization. Amedisys, a home health and hospice organization, created and tested a care transitions initiative for its impact on patients' quality of life and avoidable rehospitalizations. The initiative was carried out in three academic institutions with 12 months of observation. The results suggested reduced hospital readmissions and a critical role for the home health industry in improving patient outcomes and reducing costs.",aged;article;case report;dementia;economics;emergency health service;female;frail elderly;heart failure;home care;hospital discharge;hospital readmission;human;life expectancy;medicare;methodology;patient care;patient education;population dynamics;public relations;standard;statistics;United States;very elderly,"Fleming, M. O.;Haney, T. T.",2013,,,0,
1331,"Clinical, sociodemographic, and service provider determinants of guideline concordant colorectal cancer care for Appalachian residents","BACKGROUND: Colorectal cancer represents a significant cause of morbidity and mortality, particularly in Appalachia where high mortality from colorectal cancer is more prevalent. Adherence to treatment guidelines leads to improved survival. This paper examines determinants of guideline concordance for colorectal cancer. METHODS: Colorectal cancer patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009). Final sample size after exclusions was 2,932 stage I-III colon, and 184 stage III rectal cancer patients. The 3 measures of guideline concordance include adjuvant chemotherapy (stage III colon cancer, <80 years), >/=12 lymph nodes assessed (resected stage I-III colon cancer), and radiation therapy (stage III rectal cancer, <80 years). Bivariate and multivariate analyses with clinical, sociodemographic, and service provider covariates were estimated for each of the measures. RESULTS: Rates of chemotherapy, lymph node assessment, and radiation were 62.9%, 66.3%, and 56.0%, respectively. Older patients had lower rates of chemotherapy and radiation. Five comorbidities were significantly associated with lower concordance in the bivariate analyses: myocardial infarction, congestive heart failure, respiratory diseases, dementia with chemotherapy, and diabetes with adequate lymph node assessment. Patients treated by hospitals with no Commission on Cancer (COC) designation or lower surgical volumes had lower odds of adequate lymph node assessment. CONCLUSIONS: Clinical, sociodemographic, and service provider characteristics are significant determinants of the variation in guideline concordance rates of 3 colorectal cancer measures.","Aged;Aged, 80 and over;Appalachian Region/epidemiology;Colorectal Neoplasms/epidemiology/*therapy;Female;*Guideline Adherence;Humans;Kentucky/epidemiology;Male;Medicare;North Carolina/epidemiology;Ohio/epidemiology;Pennsylvania/epidemiology;Socioeconomic Factors;United States;cancer;demography;epidemiology;health disparities","Fleming, S. T.;Mackley, H. B.;Camacho, F.;Seiber, E. E.;Gusani, N. J.;Matthews, S. A.;Liao, J.;Yang, T. C.;Hwang, W.;Yao, N.",2014,Winter,10.1111/jrh.12033,0,
1332,"Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants","BACKGROUND: Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. METHODS: CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-III patients with metachronous or synchronous metastases. We estimate bivariate and multivariate analyses for several surgical and chemotherapeutic strategies of care using clinical, sociodemographic, and contextual determinants. RESULTS: Among 1,445 CRC patients, 84% had primary tumor resection and 44% received chemotherapy. Of the chemotherapy patients, 44% received newer systemic agents for at least 75% of the cycles. One year survivors with liver or lung metastases were more likely to have their primary tumor resected immediately (86.1% vs 69.5% for liver, and 78.2% vs 64.9% for lung) and have their metastases resected/ablated (15.7% vs 2.6% for liver and 15.0% vs 0.5% for lung). Patients with stages I-III primary tumors (versus IV) were much more likely to be resected, but they were less likely to receive chemotherapy. Patients with comorbidities (congestive heart failure, dementia, or respiratory disease) had lower odds of chemotherapy. Smaller hospital size and surgical volume had higher odds of immediate versus delayed surgery. The newer chemotherapeutic agents were more common with higher surgical volume. CONCLUSIONS: Metastatic colorectal cancer has clinical, sociodemographic, and service provider determinants.",access to care;colorectal cancer;medical care;metastatic cancer;utilization of health services,"Fleming, S. T.;Mackley, H. B.;Camacho, F.;Yao, N.;Gusani, N. J.;Seiber, E. E.;Matthews, S. A.;Yang, T. C.;Hwang, W.",2016,Spring,10.1111/jrh.12132,0,
1333,"Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants","BACKGROUND: Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. METHODS: CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-III patients with metachronous or synchronous metastases. We estimate bivariate and multivariate analyses for several surgical and chemotherapeutic strategies of care using clinical, sociodemographic, and contextual determinants. RESULTS: Among 1,445 CRC patients, 84% had primary tumor resection and 44% received chemotherapy. Of the chemotherapy patients, 44% received newer systemic agents for at least 75% of the cycles. One year survivors with liver or lung metastases were more likely to have their primary tumor resected immediately (86.1% vs 69.5% for liver, and 78.2% vs 64.9% for lung) and have their metastases resected/ablated (15.7% vs 2.6% for liver and 15.0% vs 0.5% for lung). Patients with stages I-III primary tumors (versus IV) were much more likely to be resected, but they were less likely to receive chemotherapy. Patients with comorbidities (congestive heart failure, dementia, or respiratory disease) had lower odds of chemotherapy. Smaller hospital size and surgical volume had higher odds of immediate versus delayed surgery. The newer chemotherapeutic agents were more common with higher surgical volume. CONCLUSIONS: Metastatic colorectal cancer has clinical, sociodemographic, and service provider determinants.",antineoplastic agent;aged;cancer staging;colon;colorectal tumor;comorbidity;epidemiology;female;hospital bed capacity;human;liver tumor;lung tumor;male;mortality;pathology;secondary;socioeconomics;surgery;time to treatment;United States;very elderly,"Fleming, S. T.;Mackley, H. B.;Camacho, F.;Yao, N.;Gusani, N. J.;Seiber, E. E.;Matthews, S. A.;Yang, T. C.;Hwang, W.",2016,,10.1111/jrh.12132,0,1332
1334,Pharmacoeconomic evaluation of risk factors for cardiovascular disease: an epidemiological perspective,"Over the past 30 years the identification of high blood pressure and hypercholesterolaemia as major predictors of cardiovascular disease has led to an increasing expenditure on healthcare costs in pharmacological treatment of these risk factors. Most of the cost has been due to antihypertensive treatment, but evidence from randomised trials of the benefits of cholesterol-lowering drugs, along with the introduction of therapies with fewer side effects, suggests that expenditure on cholesterol treatment will rise dramatically. Cost-effectiveness analyses can aid decision making in the use of these treatments. For both hypertension and hypercholesterolaemia, the most favourable cost-effectiveness ratios were found in late middle age, in men compared to women, at the highest level of the risk factor, and in subjects with multiple risk factors. The most cost-effective treatments appear to be those which were the cheapest and which also produced the largest reductions in the risk factor. However, certain findings were based on assumptions which may be invalid. The most important of these in hypertension, and to a lesser extent in hypercholesterolaemia, is that different treatments have similar effects on morbidity and mortality for a given level of risk reduction. Experimental evidence that might confirm or refute this is not available for most treatments of hypertension. Moreover there are no trials in women or in the elderly of cholesterol-lowering treatments. The burden of disease due to these risk factors has been underestimated, and further research is required to establish the benefits of treatment on prevention of conditions such as heart failure, peripheral vascular disease, and vascular dementia.","Adult;Aged;Cardiovascular Diseases/drug therapy/economics/*epidemiology;*Economics, Pharmaceutical;Female;Health Care Costs;Humans;Hypercholesterolemia/drug therapy/*economics/epidemiology;Male;Middle Aged;*Risk Factors","Fletcher, A. E.;Bulpitt, C. J.",1992,Jan,,0,
1335,Index of suspicion: Case 2: Altered mental status in 4-month-old boy,,phenobarbital;abdominal tuberculosis;adolescent;adult;article;case report;child abuse;congestive cardiomyopathy;coughing;differential diagnosis;drug overdose;dysentery;faintness;female;fever;Hispanic;human;infant;long QT syndrome;male;mental deterioration;Munchausen syndrome by proxy;recurrent disease;sudden cardiac death;symptomatology,"Fletcher, C.;Jones, A.",2014,,,0,
1336,The Supporting Patient Activation in Transition to Home (sPATH) intervention: a study protocol of a randomised controlled trial using motivational interviewing to decrease re-hospitalisation for patients with COPD or heart failure,"INTRODUCTION: Deficient hospital discharging and patients struggling to handle postdischarge self-management have been identified as potential causes of re-hospitalisation rates. Despite an increased interest in interventions aiming to reduce re-hospitalisation rates, there is yet no best evidence on how to support patients in being active participants in their self-management postdischarge. The aim of this paper is to describe the study protocol for an upcoming randomised controlled trial (RCT) of the Supporting Patient in Activation to Home (sPATH) intervention. METHODS/ANALYSIS: The described study is a randomised, controlled, analysis-blinded, two-site trial, with primary outcome re-hospitalisation within 90 days. In total, 290 participants aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure who are admitted to hospital and who are living in an own home will be eligible for inclusion into an intervention (n=145) or control group (n=145). Patients who need an interpreter to communicate in Swedish, or who have a diagnosis of dementia or cognitive impairment, will be excluded from inclusion. The sPATH intervention, developed with a theoretical base in the self-determination theory, consists of five postdischarge motivational interviewing sessions (face to face or by phone). The intervention covers the self-management areas medication management, follow-up/care plan, symptoms/signs of worsening condition and relations/contacts with healthcare providers. This RCT will add to the literature on evidence to support patient activation in postdischarge self-management. ETHICS AND DISSEMINATION: The study is approved by the Regional Research Ethics Committee (No. 2014/1498-31/2) in Stockholm, Sweden. The results of the study will be published in peer-reviewed journals and presented at international and national scientific conferences. TRIAL REGISTRATION NUMBER: NCT02823795; Pre-results.",Chronic airways disease;Heart failure;Protocols & guidelines;motivational interviewing;re-hospitalization,"Flink, M.;Lindblad, M.;Frykholm, O.;Kneck, A.;Nilsen, P.;Arestedt, K.;Ekstedt, M.",2017,Jul 10,,0,
1337,The Supporting Patient Activation in Transition to Home (sPATH) intervention: A study protocol of a randomised controlled trial using motivational interviewing to decrease re-hospitalisation for patients with COPD or heart failure,"Introduction Deficient hospital discharging and patients struggling to handle postdischarge self-management have been identified as potential causes of re-hospitalisation rates. Despite an increased interest in interventions aiming to reduce re-hospitalisation rates, there is yet no best evidence on how to support patients in being active participants in their self-management postdischarge. The aim of this paper is to describe the study protocol for an upcoming randomised controlled trial (RCT) of the Supporting Patient in Activation to Home (sPATH) intervention. Methods/analysis The described study is a randomised, controlled, analysis-blinded, two-site trial, with primary outcome re-hospitalisation within 90 days. In total, 290 participants aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure who are admitted to hospital and who are living in an own home will be eligible for inclusion into an intervention (n=145) or control group (n=145). Patients who need an interpreter to communicate in Swedish, or who have a diagnosis of dementia or cognitive impairment, will be excluded from inclusion. The sPATH intervention, developed with a theoretical base in the self-determination theory, consists of five postdischarge motivational interviewing sessions (face to face or by phone). The intervention covers the self-management areas medication management, follow-up/care plan, symptoms/signs of worsening condition and relations/contacts with healthcare providers. This RCT will add to the literature on evidence to support patient activation in postdischarge self-management. Ethics and dissemination The study is approved by the Regional Research Ethics Committee (No. 2014/1498-31/2) in Stockholm, Sweden. The results of the study will be published in peer-reviewed journals and presented at international and national scientific conferences. Trial registration number NCT02823795; Pre-results.",NCT02823795;adult;article;chronic obstructive lung disease;congestive heart failure;controlled study;cost effectiveness analysis;follow up;home care;hospital readmission;human;major clinical study;medication compliance;medication therapy management;motivational interviewing;quality of life;randomized controlled trial;self care;transitional care,"Flink, M.;Lindblad, M.;Frykholm, O.;Kneck, A.;Nilsen, P.;Årestedt, K.;Ekstedt, M.",2017,,10.1136/bmjopen-2016-014178,0,
1338,Long-chain omega-3 fatty acids: Time to establish a dietary reference intake,"The beneficial effects of consuming omega-3 polyunsaturated fatty acids (n-3 PUFAs), specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on cardiovascular health have been studied extensively. To date, there is no dietary reference intake (DRI) for EPA and DHA, although many international authorities and expert groups have issued dietary recommendations for them. Given the substantial new evidence published since the last Institute of Medicine (IOM) report on energy and macronutrients, released in 2002, there is a pressing need to establish a DRI for EPA and DHA. In order to set a DRI, however, more information is needed to define the intakes of EPA and DHA required to reduce the burden of chronic disease. Information about potential gender- or race-based differences in requirements is also needed. Given the many health benefits of EPA and DHA that have been described since the 2002 IOM report, there is now a strong justification for establishing a DRI for these fatty acids. © 2013 International Life Sciences Institute.",calcium;carbohydrate;cytochrome P450;docosahexaenoic acid;essential fatty acid;fish oil;G protein coupled receptor;high density lipoprotein;icosanoid;icosapentaenoic acid;long chain fatty acid;low density lipoprotein;omega 3 fatty acid;triacylglycerol;vitamin D;acute coronary syndrome;Alzheimer disease;antiinflammatory activity;article;brain development;chronic disease;cognition;diet supplementation;dietary fiber;dietary intake;dietary reference intake;energy;executive function;heart arrhythmia;atrial fibrillation;heart death;heart failure;human;ischemic heart disease;macronutrient;membrane fluidity;meta analysis (topic);mild cognitive impairment;phospholipid bilayer;pregnant woman;primary prevention;race difference;randomized controlled trial (topic);risk factor;safety;sea food;secondary prevention;sex difference;sudden cardiac death;systematic review (topic);triacylglycerol blood level;working memory,"Flock, M. R.;Harris, W. S.;Kris-Etherton, P. M.",2013,,,0,
1339,Anticonvulsants for Creutzfeldt-Jakob disease?,,anticonvulsive agent;phenytoin;topiramate;aged;angina pectoris;aphasia;article;breathing disorder;case report;cerebrospinal fluid examination;clinical feature;clinical trial;computer assisted tomography;controlled clinical trial;controlled study;Creutzfeldt Jakob disease;disease course;dose calculation;drug effect;drug megadose;electroencephalogram;epileptic discharge;hemiparesis;hospital admission;human;hypermetabolism;interpersonal communication;lumbar puncture;male;microangiography;myoclonus;pacemaker;positron emission tomography;priority journal;protein determination;rigidity;time;walking,"Flöel, A.;Reilmann, R.;Frese, A.;Lüdemann, P.",2003,,,0,
1340,"Diagnostic data for neurological conditions in interRAI assessments in home care, nursing home and mental health care settings: a validity study","The interRAI suite of assessment instruments can provide valuable information to support person-specific care planning across the continuum of care. Comprehensive clinical information is collected with these instruments, including disease diagnoses. In Canada, interRAI data holdings represent some of the largest repositories of clinical information in the country for persons with neurological conditions. This study examined the accuracy of the diagnostic information captured by interRAI instruments designed for use in the home care, long-term care and mental health care settings as compared with national administrative databases. The interRAI assessments were matched with an inpatient hospital record and emergency department (ED) visit record in the preceding 90 days. Diagnoses captured on the interRAI instruments were compared to those recorded in either administrative record for each individual. Diagnostic validity was examined through sensitivity, specificity and positive predictive value analysis for the following conditions: multiple sclerosis, epilepsy, Alzheimer's disease and other dementias, Parkinson's disease, traumatic brain injury, stroke, diabetes mellitus, heart failure and reactive airway disease. In the three large study samples (home care: n = 128,448; long-term care: n = 26,644; mental health: n = 13,812), interRAI diagnoses demonstrated high specificity when compared to administrative records, for both neurological conditions (range 0.80-1.00) and comparative chronic diseases (range 0.83-1.00). Sensitivity and positive predictive values (PPV) were more varied by specific diagnosis, with sensitivities and PPV for neurological conditions ranging from 0.23 to 0.94 and 0.14 to 0.77, respectively. The interRAI assessments routinely captured more cases of the diagnoses of interest than the administrative records. The interRAI assessment collected accurate information about disease diagnoses when compared to administrative records within three months. Such information is likely relevant to day-to-day care in these three environments and can be used to inform care planning and resource allocation decisions.",aged;article;Canada;emergency health service;female;health care quality;home care;human;long term care;male;mental health service;middle aged;neurologic disease;nursing home;patient care;reproducibility;sensitivity and specificity;standard;statistics;very elderly,"Foebel, A. D.;Hirdes, J. P.;Heckman, G. A.;Kergoat, M. J.;Patten, S.;Marrie, R. A.;ideas, P. N. C. r t",2013,,,0,
1341,Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment,"Summary: To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care. Introduction: The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors. Methods: This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008. Results: The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p < 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4–5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1–2 OR 1.46, CCI 3–4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96). Conclusion: After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to the historical control patients who were treated with standard care. The most important risk factors for 1-year mortality were male gender, increasing age, malnutrition, physical limitations, increasing BI, and medical conditions. Awareness of risk factors that affect the 1-year mortality can be useful in optimizing care and outcomes. Orthogeriatric treatment should be standard for elderly patients with hip fractures due to the multidimensional needs of these patients.",age;age distribution;aged;American Society of Anesthesiologists score;anemia;article;Barthel index;benchmarking;Charlson Comorbidity Index;cohort analysis;comorbidity;comparative effectiveness;conservative treatment;controlled study;cost control;daily life activity;delirium;dementia;endoprosthesis;female;femoral neck fracture;femur intertrochanteric fracture;femur trochanteric fracture;fragility fracture;frail elderly;geriatric care;geriatric patient;geriatric surgery;geriatrician;health care cost;health care quality;heart failure;hip fracture;hospital discharge;hospitalization;human;incidence;length of stay;male;malnutrition;mortality rate;mortality risk;osteoporosis;osteosynthesis;physical disability;pneumonia;postoperative complication;practice guideline;priority journal;prospective study;quality of life;risk assessment;risk factor;scoring system;sex difference;survival rate;urinary tract infection,"Folbert, E. C.;Hegeman, J. H.;Vermeer, M.;Regtuijt, E. M.;van der Velde, D.;ten Duis, H. J.;Slaets, J. P.",2017,,10.1007/s00198-016-3711-7,0,
1342,Sleep-disordered breathing and cognitive impairment in elderly Japanese-American men,"Study Objective: To assess the association between sleep-disordered breathing and cognitive functioning in an elderly cohort of Japanese-American men Design: Cross-sectional study Setting: The Honolulu-Asia Aging Study of Sleep Apnea, Oahu, Hawaii Participants: 718 men between 79 and 97 years of age examined in 1999 and 2000 Measurements: Apnea-hypopnea index from in-home overnight polysomnography, performance on the Cognitive Abilities Screening Instrument, body mass index, neck circumference, Epworth Sleepiness Scale, snoring, Center for Epidemiologic Studies Depression 11-item depression scale, physical disability, and history of heart disease, stroke, hypertension, diabetes, and dementia. Results: Less than 30% of the men had no sleep-disordered breathing (apnea-hypopnea index < 5) and nearly one-fifth (19%) had severe sleep-disordered breathing (apnea-hypopnea index ≥ 30). Severe sleep-disordered breathing was associated with higher body mass index, habitual snoring, and daytime drowsiness. No association was found between sleep-disordered breathing and cognitive functioning, including measures of memory function, concentration, and attention. Conclusions: Sleep-disordered breathing was associated with more drowsiness but not with poor performance on standardized cognitive tests used to screen for Alzheimer disease and other dementias in older persons. Because a healthy-participant effect may have contributed to this finding, more extensive cognitive testing may be necessary to reveal more subtle deficits from sleep-disordered breathing.",anamnesis;anthropometry;article;attention;body mass;cognitive defect;cohort analysis;controlled study;dementia;disease association;disease severity;geriatric patient;human;hypertension;ischemic heart disease;major clinical study;male;medical assessment;memory consolidation;non insulin dependent diabetes mellitus;physical disability;polysomnography;priority journal;psychologic assessment;rating scale;sample size;screening test;sleep disordered breathing;snoring;somnolence;cerebrovascular accident,"Foley, D. J.;Masaki, K.;White, L.;Larkin, E. K.;Monjan, A.;Redline, S.",2003,,,0,
1343,A double-blind comparison of olanzapine versus risperidone in the acute treatment of dementia-related behavioral disturbances in extended care facilities,"Background: In addition to demonstrating their superiority to placebo, there is a need to compare the relative efficacy and side effects of atypical neuroleptics for the acute treatment of dementia-related behavioral disturbances in residents of long-term care facilities. Method: In a double-blind parallel study allowing dose titration over 14 days, 39 agitated persons with DSM-IV dementia who were residing in long-term care facilities were administered olanzapine (N = 20) or risperidone (N = 19) as acute treatment. Drug was administered once a day at bedtime. The initial dosages were olanzapine, 2.5 mg/day, and risperidone, 0.5 mg/day. Titration was allowed to maximum doses of olanzapine, 10 mg/day, and risperidone, 2.0 mg/day. The primary outcome measures were the Clinical Global Impressions scale (CGI) and the Neuropsychiatric Inventory (NPI). Data were gathered from 2000 to 2002. Results: Both drugs produced significant reductions in CGI and NPI scores (p < .0001), but there was no significant difference between drugs. The mean olanzapine dose was 6.65 mg/day; for risperidone, the dose was 1.47 mg/day. The positive drug effect was not accompanied by decreased mobility, and there was improvement on a quality-of-life measure. The chief adverse events were drowsiness and falls. At baseline, 42% (16/38) of subjects in both groups had extrapyramidal symptoms that increased slightly, but not significantly, by the end of the study. Conclusion: Low-dose, once-a-day olanzapine and risperidone appear to be equally safe and equally effective in the treatment of dementia-related behavioral disturbances in residents of extended care facilities.",chloral hydrate;lorazepam;olanzapine;risperidone;aged;article;heart arrest;behavior disorder;clinical article;clinical trial;controlled clinical trial;controlled study;dementia;diaphoresis;disease severity;dose response;double blind procedure;drowsiness;drug dose reduction;drug effect;drug efficacy;drug safety;dystonia;extrapyramidal symptom;falling;female;fever;human;hypertension;leukocytosis;long term care;male;neuropsychiatry;nursing home;priority journal;psychopharmacotherapy;quality of life;randomized controlled trial;rash;scoring system;faintness;treatment outcome,"Fontaine, C. S.;Hynan, L. S.;Koch, K.;Martin-Cook, K.;Svetlik, D.;Weiner, M. F.",2003,,,0,
1344,Predictors of cardiologist care for older patients hospitalized for heart failure,"Background: Studies have suggested that cardiologists may provide higher quality heart failure care than generalists. However, national rates of specialty care during hospitalization for heart failure and factors associated with care by a cardiologist are unknown. Methods: We assessed specialty care in a sample of Medicare patients hospitalized nationwide with heart failure between 1998 and 1999 (n = 25,869). Multivariable hierarchical logistic regression models were used to identify factors independently associated with treatment by a cardiologist. Results: One-quarter (25.5%) of patients had a cardiologist as their attending physician, 31.3% of patients received a cardiology consult, and 43.2% of patients were not treated by a cardiologist during hospitalization. Older patients (age <75 years: referent; age 75-84 years: risk ratio [RR], 0.92; 95% CI, 0.86-0.98; age ≥85 years: RR, 0.81; 95% CI, 0.74-0.88) and women (RR, 0.87; 95% CI, 0.83-0.93) were less likely to have an attending cardiologist. Patients with a history of heart failure (RR, 1.13; 95% CI, 1.06-1.20), coronary disease (RR, 1.23; 95% CI, 1.14-1.32), coronary artery bypass grafting (RR, 1.42; 95% CI, 1.32-1.42), or percutaneous transluminal coronary angioplasty (RR, 1.30; 95% CI, 1.19-1.42) were more likely to be treated by a cardiologist, whereas patients with chronic obstructive pulmonary disease (RR, 0.74; 95% CI, 0.70-0.79) and dementia (RR, 0.61; 95% CI, 0.54-0.70) were less likely to be treated by a cardiologist. Patient race was not associated with treatment by a cardiologist. The strongest predictors of attending cardiology care were hospital factors, including large volume (>300 beds; RR, 1.45; 95% CI, 1.32-1.42) and geographic location (RR, 1.00 Northeast (referent) vs RR, 0.55; 95% CI 0.46-0.65 Midwest). Conclusions: Slightly more than half of older patients with heart failure received care from a cardiologist. Several patient characteristics, including age and sex, were associated with the use of specialty care, suggesting that factors other than clinical presentation may independently influence the use of specialty care.",age;aged;anamnesis;article;cardiologist;cardiovascular risk;chronic obstructive lung disease;clinical practice;comorbidity;consultation;controlled study;coronary artery bypass graft;coronary artery disease;dementia;demography;female;geography;health care access;health care quality;health care utilization;heart failure;hospital;hospitalization;human;major clinical study;male;medical specialist;medicare;multivariate logistic regression analysis;patient care;percutaneous transluminal angioplasty;physician;prediction;priority journal;race;sex;socioeconomics,"Foody, J. M.;Rathore, S. S.;Wang, Y.;Herrin, J.;Masoudi, F. A.;Havranek, E. P.;Radford, M. J.;Krumholz, H. M.",2004,,,0,
1345,Health and function in the old and very old,"This report advocates conceptual separation and parallel assessment of medically diagnosed health conditions and functional disability in clinical and epidemiological studies of the aged. Data from a study of urban elderly are presented to demonstrate how this can be done and to reexamine the meaning of self-reported illness and disability. One hundred thirteen subjects 74 to 95 years old, recruited from a longitudinal study of a representative sample of the elderly population of Cleveland, Ohio, participated in structured interviews and epidemiologically based medical examinations, conducted by a physician-nurse team at the place of residence. The presence or absence of 11 common chronic conditions was determined according to preestablished criteria, by self-report and, separately, by medical diagnostic evaluation. Functional disability was estimated by self-report and by physician-nurse assessment, using established measures of mobility and activities of daily living. Results indicate that interview self-report can provide useful estimates of the prevalence of medical conditions and functional disabilities in elderly populations, although self-report alone is not a sufficiently sensitive measure to be used for case-finding or diagnosis. When functional disabilities are matched against the specific medical conditions that cause them and disease-specific mortality is also taken into account, a three-dimensional classification results that has implications for future clinical and survey work with the elderly.",age;aged;arthritis;dementia;depression;diabetes mellitus;disability;epidemiology;health;heart failure;human;hypertension;lung;major clinical study;psychological aspect,"Ford, A. B.;Folmar, S. J.;Salmon, R. B.;Medalie, J. H.;Roy, A. W.;Galazka, S. S.",1988,,,0,
1346,Plasma homocysteine and MTHFRC677T polymorphism as risk factors for incident dementia,"Background: Elevated total plasma homocysteine (tHcy) has been associated with increased risk of dementia. The C677T polymorphism of the 5,10-methylenetetrahydrofolate reductase gene (MTHFR) increases tHcy and provides a means of studying the association between tHcy and dementia while not being as susceptible to the common biases and confounding of observational studies. The authors designed this longitudinal study to determine if high tHcy and the MTHFR C677T polymorphism increase the risk of incident dementia among older men. Methods: The authors studied 4227 men aged 70-89 years from the Health in Men Study cohort and established the diagnosis of dementia (International Classification of Diseases - 10th edition) using morbidity and mortality records. Information on tHcy, MTHFR gene status, lifestyle and clinical variables were obtained using postal and face-to-face assessments. Results: 230 men (5.4%) developed dementia during the mean follow-up period of 5.8±1.6 years (range 0.1-8.2 years). The hazard of dementia increased with a doubling of tHcy concentration (adjusted HR 1.48, 95% CI 1.10 to 2.00) and was higher in men with tHcy >15 μmol/l (adjusted HR 1.36 95% CI 1.03 to 1.81, p=0.032). Men with the TT genotype had a HR of dementia of 1.25 (95% CI 0.81 to 1.92). Conclusions: The results of this prospective study are consistent with a causal link between high tHcy and incident dementia, but the study lacked power to determine an effect of the MTHFR genotype.",high density lipoprotein;homocysteine;low density lipoprotein;methylenetetrahydrofolate reductase (NADPH2);aged;article;body mass;cohort analysis;comorbidity;dementia;DNA polymorphism;genotype;glomerulus filtration rate;human;hypertension;incidence;incident dementia;ischemic heart disease;lifestyle;longitudinal study;major clinical study;male;outcome assessment;prevalence;priority journal;prospective study;risk factor;smoking;cerebrovascular accident,"Ford, A. H.;Flicker, L.;Alfonso, H.;Hankey, G. J.;Norman, P. E.;Van Bockxmeer, F. M.;Almeida, O. P.",2012,,,0,
1347,Weekend opening in primary care: Analysis of the General Practice Patient Survey,"Background Seven-day opening in primary care is a key policy for the UK government. However, it is unclear if weekend opening will meet patients' needs or lead to additional demand. Aim To identify patient groups most likely to use weekend opening in primary care. Design and setting The General Practice Patient Survey 2014, which sampled from all general practices in England, was used. Method Logistic regression was used to measure the associations between perceived benefit from seeing or speaking to someone at the weekend and age, sex, deprivation, health conditions, functioning, work status, rurality, and quality of life. Results Out of 881 183 participants who responded to the questionnaire, 712 776 (80.9%) did not report any problems with opening times. Of the 168 407 responders (19.1%) who reported inconvenient opening times, 73.9% stated that Saturday opening, and 35.8% Sunday opening, would make it easier for them to see or speak to someone. Only 2.2% of responders reported that Sunday, but not Saturday, opening would make it easier for them. Younger people, those who work full time, and those who could not get time off work were more likely to report that weekend opening would help. People with Alzheimer's disease, learning difficulties, or problems with walking, washing, or dressing were less likely to report that weekend opening would help. Conclusion Most people do not think they need weekend opening, but it may benefit certain patient groups, such as younger people in full-time work. Sunday opening, in addition to Saturday, is unlikely to improve access.",aged;Alzheimer disease;angina pectoris;arthritis;article;asthma;diabetes mellitus;disease association;employment;ethnicity;female;functional disease;general practice;health survey;human;hypertension;kidney cancer;learning disorder;liver disease;logistic regression analysis;major clinical study;male;primary medical care;quality of life;rural area;social care;United Kingdom,"Ford, J. A.;Jones, A. P.;Wong, G.;Steel, N.",2015,,,0,
1348,Problems of cardiovascular toxicity of coxibs and non-selective NSA,"Non-steroidal antirheumatics (NSA) belong to the most often prescribed drugs. Certain observation studies indicate that they are used by 20 to 30% of population of developed countries. The most common NSA's adverse effects are gastrointestinal complications. Coxibs have been developed as an alternative to conventional non-selective NSA; with similar efficacy, they should reduce the risk of development of gastrointestinal complications. In the few last years, possible toxicity of coxibs and other non-steroidal antirheumatics has been widely discussed. The VIGOR study, which was performed 6 years ago, showed five times higher incidence of nonfatal myocardial infarction in patients with rofecoxib therapy as compared with naproxen. Afterwards, there was much debate about rofecoxib, and coxibs in general, whose cardiotoxicity was supported and confuted at the same time. Possible cardioprotective effect of naproxen was discussed too. Later on, results of the APPROVE study (Adenoma Polyp Prevention on Vioxx) made Merck & Co., Inc. withdraw rofecoxib from all markets voluntarily. In the end of 2004, three controversial studies on celecoxib were published. Although the first study (Adenoma Prevention with Celecoxib study, APC) showed higher cardiovascular risk of celecoxib, the second study (Prevention of Adenomatosus Polyps, PreSAP) did not verify these results. Surprisingly, the third study (Alzheimer Disease and Prevention Trial, ADAPT) proved 50% increase of the risk of cardiovascular (CV) toxicity of naproxen. In the last year, researchers have tried to decide whether CV toxicity is a class effect of coxib group or a class effect of all NSA. Many observation studies proved higher CV risk both of coxibs (particularly rofecoxib) and non-selective NSA including naproxen. These new findings moved the American FDA (Food and Drug Administration) to publish guidance concerning higher CV risk of all coxibs and NSA. For the time being, the EMEA (European Agency for Evaluation of Medicinal Products) does not change its attitude to NSA; coxibs are contraindicated in patients with ischemic heart disease, cerebrovascular disease and peripheral artery disease; they should be used with caution in high-risk patients. Final assessment of the problems of CV toxicity of NSA and coxibs will be a case of a long-term randomized study focused on the incidence of cardiovascular adverse effects.",antirheumatic agent;cyclooxygenase 2 inhibitor;naproxen;nonsteroid antiinflammatory agent;rofecoxib;article;cardiotoxicity;drug approval;food and drug administration;gastrointestinal symptom;heart infarction;heart protection;high risk patient;human;rheumatic disease;risk assessment;treatment contraindication,"Forejtová, Š",2006,,,0,
1349,Vascular health and cognitive function in older adults with cardiovascular disease,"Background: We hypothesized that changes in vascular flow dynamics resulting from age and cardiovascular disease (CVD) would correlate to neurocognitive capacities, even in adults screened to exclude dementia and neurological disease. We studied endothelial-dependent as well as endothelial-independent brachial responses in older adults with CVD to study the associations of vascular responses with cognition. Comprehensive neurocognitive testing was used to discern which specific cognitive domain(s) correlated with the vascular responses. Methods: Eighty-eight independent, community-dwelling older adults (70.02 ± 7.67 years) with mild to severe CVD were recruited. Enrollees were thoroughly screened to exclude neurological disease and dementia. Flow-mediated (endothelial-dependent) and nitroglycerin-mediated (endothelial-independent) brachial artery responses were assessed using 2-D ultrasound. Cognitive functioning was assessed using comprehensive neuropsychological testing. Linear regression analyses were used to evaluate the relationships between the endothelial-dependent and endothelial-independent vascular flow dynamics and specific domains of neurocognitive function. Results: Endothelial-dependent and endothelial-independent brachial artery responses both correlated with neurocognitive testing indices. The strongest independent relationship was between endothelial function and measures of attention-executive functioning. Conclusions: Endothelial-dependent and endothelial-independent vascular responsiveness correlate with neurocognitive performance among older CVD patients, particularly in the attention-executive domain. While further study is needed to substantiate causal relationships, our data demonstrate that brachial responses serve as important markers of risk for common neurocognitive changes. Learning and behavior-modifying therapeutic strategies that compensate for such common, insidious neurocognitive limitations will likely improve caregiving efficacy. © 2008 Association for Research into Arterial Structure and Physiology.",age distribution;aged;aging;article;atherosclerosis;attention;blood flow;brachial artery;cardiovascular disease;cardiovascular risk;cardiovascular system;cognition;controlled study;correlation analysis;dementia;disease severity;endothelium;female;heart arrhythmia;heart failure;human;hypertension;linear regression analysis;major clinical study;male;motor performance;neurologic disease;neuropsychological test;priority journal,"Forman, D. E.;Cohen, R. A.;Hoth, K. F.;Haley, A. P.;Poppas, A.;Moser, D. J.;Gunstad, J.;Paul, R. H.;Jefferson, A. L.;Tate, D. F.;Ono, M.;Wake, N.;Gerhard-Herman, M.",2008,,,0,
1350,Predictors of cognitive decline in 85-year-old patients without cognitive impairment at baseline: 2-year follow-up of the Octabaix study,"Background/Rationale: To determine how many 85-year-old community-dwelling patients with good cognitive performance at baseline maintain this level at 2-year follow-up. Methods: We realized a longitudinal community-based study including 169 inhabitants. Patients who maintained scores >23 on the Spanish version of the Mini-Mental State Examination (MEC) were compared with the rest. Results: A total of 144 individuals (85.2%) were found maintaining a MEC score >23. Under the combined criteria 110 (65%) presented no new cognitive decline. Multiple logistic regression analysis showed that maintaining a MEC score >23 was significantly associated with having a higher MEC score at baseline (P <.001, odds ratio 1.280, 95% confidence interval 1.104-1.484). Conclusion: Most oldest-old patients with good cognitive function at baseline maintain this level at 2-year follow-up. © The Author(s) 2013.",cholesterol;cyanocobalamin;folic acid;thyrotropin;aged;anemia;article;cardiovascular risk;cerebrovascular accident;cholesterol blood level;cognition;cognitive defect;comorbidity;comparative study;controlled study;diabetes mellitus;dyslipidemia;falling;female;follow up;geriatric assessment;geriatric patient;atrial fibrillation;heart failure;human;hypertension;ischemic cardiomyopathy;longitudinal study;major clinical study;male;mental deterioration;mental performance;Mini Mental State Examination;prediction;prospective study;thyrotropin blood level,"Formiga, F.;Ferrer, A.;Chivite, D.;Alburquerque, J.;Olmedo, C.;Mora, J. M.;Labori, M.;Pujol, R.",2013,,,0,
1351,High rate of anticoagulation therapy in oldest old subjects with atrial fibrillation: The octabaix study,"Objective: To assess the prevalence of permanent atrial fibrillation (AF) in community-dwelling subjects aged 85 and to determine the anticoagulation therapy rate. Design: Community-based survey of inhabitants aged 85 years. Participants: Participants were 328 people born in 1924 and assigned to 7 primary health care teams. Measurements: Sociodemographic variables, Barthel Index, the Spanish version of the Mini-Mental State Examination, Mini Nutritional Assessment, Charlson Index, social risk, quality of life, and prevalent chronic diseases were assessed. Permanent AF was determined by patient interview, treatment prescriptions, and clinical records. Results: The sample included 202 women (61.6%) and 126 men. In 41 (12.5%) participants permanent AF was diagnosed; 25 (60.9%) were on anticoagulant oral therapy and 9 (21.9%) were receiving antiplatelet therapy. Using multiple logistic regression analysis, previous diagnosis of heart failure (P < .001, OR 4.170, 95% CI 1.927-9.024) and stroke history (P < .03, OR 2.439, 95% CI 1.101-5.401) were significantly associated with the diagnosis of permanent AF. Conclusion: AF is quite prevalent in 85-year-old subjects. A large percentage of patients with AF were receiving chronic anticoagulant therapy. The percentage of patients who were not receiving prophylactic treatment was low. © 2012 American Medical Directors Association, Inc.",acetylsalicylic acid;anticoagulant agent;clopidogrel;ticlopidine;warfarin;aged;anticoagulant therapy;article;controlled study;dementia;fall risk;female;atrial fibrillation;heart failure;human;hypertension;major clinical study;male;Mini Mental State Examination;outcome assessment;primary health care;quality of life;cerebrovascular accident;treatment contraindication;treatment response,"Formiga, F.;Ferrer, A.;Mimbrera, D.;Badia, T.;Fernández, C.;Pujol, R.;Almeda, J.;Badia, T.;Lobato, A.;Fernández, C.;Ferrer, A.;Formiga, F.;Gil, A.;Megido, M. J.;Padrós, G.;Sarró, M.;Tobella, A.",2012,,,0,
1352,Patterns of comorbidity and multimorbidity in the oldest old: the Octabaix study,"BACKGROUND: Multimorbidity is associated with higher mortality, increased disability, a decline in functional status and a lower quality of life. The objective of the study is to explore patterns of multimorbidity in an elderly population. METHODS: 328 community inhabitants aged 85 years were included. Socio-demographic variables and data from the global geriatric assessment were evaluated. Information on the presence of sixteen common chronic conditions was collected: hypertension, diabetes mellitus, dyslipidemia, ischemic cardiomyopathy, heart failure, stroke, chronic obstructive pulmonary disease, (COPD), atrial fibrillation, peripheral arterial disease, Parkinson's disease, cancer, dementia, anemia, chronic kidney disease (CKD), visual impairment and deafness. Hierarchical cluster analysis was performed. RESULTS: The rate of multimorbidity (>1 disease) was 95.1%. Men had a higher percentage of COPD and malignancy. Four main clusters were identified. The highest value of the bivariate correlation matrix was that between heart failure and visual impairment. These two diseases were included in a cluster with atrial fibrillation, CKD, heart failure, stroke, high blood pressure and diabetes mellitus. CONCLUSIONS: The large majority of oldest old subjects had multimorbidity. The results confirm the non-random co-occurrence of certain diseases in this age group.","Aged, 80 and over;Comorbidity;Female;*Geriatrics;Humans;Male;Prospective Studies","Formiga, F.;Ferrer, A.;Sanz, H.;Marengoni, A.;Alburquerque, J.;Pujol, R.",2013,Jan,10.1016/j.ejim.2012.11.003,0,
1353,Medical comorbidity in elderly patients with dementia. Differences according age and gender,"BACKGROUND: Prevalence of dementia in elderly patients is high. The goal of the study was to assess some aspects of comorbidity in the patients with dementia. We also analyzed comorbidity differences according to age and gender. PATIENTS AND METHODS: A total of 311 patients older than 64 years old with dementia were prospectively evaluated. Data were collected on sociodemographic endpoints, type of dementia, Barthel Index (BI), Lawton Index (LO), Mini-Mental State Examination (MMSE), Charlson Index, total number of drugs, history of high blood pressure (HT), diabetes (DM), dyslipidemia (DL), heart failure (HF), chronic obstructive pulmonary disease (COPD) and cancer. RESULTS: The sample consisted of 222 women (71.4%) and 89 men. Mean age (standard deviation [SD]) was 80.6 (6) years. Patients were taking an average of 5.8 (2.6) drugs. The mean of Charlson Index was of 2.1 (1.3). Fifty-one percent had HT, 24% DM, 24% DL, 13% HF, 11% COPD and 8% cancer. We found better scores in the MMSE, higher comorbidity and percentage of married people and prevalence of vascular dementia in men with respect to women, who had higher percentage of Alzheimer disease, and widowers. When differences were analyzed according to age, we found a higher percentage of widowers and HF diagnosis, a lower LI values and DL percentage in the patients older than 84 years with respect to younger subjects. CONCLUSIONS: Our results showed the presence of high comorbidity and chronic drugs prescription in elderly people with dementia. There are some differences in comorbidity according to age and gender that must be taken into account.","Age Factors;Aged;Aged, 80 and over;Dementia/*complications;Female;Humans;Male;Prospective Studies;Sex Factors","Formiga, F.;Fort, I.;Robles, M. J.;Barranco, E.;Espinosa, M. C.;Riu, S.",2007,Nov,,0,
1354,Features differentiating comorbidity in elderly patients with Alzheimer-type dementia or with vascular dementia,"INTRODUCTION: Alzheimer's disease (AD) and vascular dementia (VD) are the two most common forms of dementia. In the elderly subjects with dementia, there is a significant comorbidity associated and often cause greater morbidity and mortality. AIM: To investigate some aspects of comorbidity in the patients with these two types of dementia in order to analyze possible differences. PATIENTS AND METHODS: A total of 365 patients > 64 years old were prospectively evaluated. Of them 289 patients (79.1%) had probable AD, and 76 patients probable VD. Data were collected on sociodemographic variables, Barthel index, Lawton index), Minimental State Examination, total number of drugs, history of high blood pressure (HBP), diabetes mellitus (DM), dyslipidemia (DL), heart failure (HF), chronic obstructive pulmonary disease (COPD) and cancer. RESULTS: The sample consisted of 264 women (72.3%) and 101 men. Mean age was 81.1 +/- 6 years. Patients were taken an average of 5.5 +/- 2.5 drugs. 54% had HBP, 26.6% DM, 25.8% DL, 12.1% HF, 13.7% COPD and 8.2% cancer. When in multivariate analysis differences were analyzed according the type of dementia, we found a higher percentage of men, taken more than three drugs and lower percentage of taken specific dementia therapy in the VD group. CONCLUSIONS: Our results showed the presence of high comorbidity and chronic drugs prescription in elderly people with dementia. There are some differences according the type of dementia, highlighting a higher percentage of polypharmacy in patients with vascular dementia group.","Aged;Aged, 80 and over;Alzheimer Disease/*complications;Dementia, Vascular/*complications;Female;Humans;Male;Prospective Studies","Formiga, F.;Fort, I.;Robles, M. J.;Riu, S.;Rodriguez, D.;Sabartes, O.",2008,Jan 16-31,,0,
1355,Hospital deaths of people aged 90 and over: end-of-life palliative care management,"BACKGROUND: In developed countries, hospital deaths at very advanced age are increasingly common. Few studies have addressed end-of-life care in very elderly patients with non-cancer chronic diseases. OBJECTIVE: To evaluate the circumstances related to end-stage death of non-cancer nonagenarians in an acute care hospital. The results were compared with those from a sample of younger patients. METHODS: We conducted a prospective assessment in two teaching hospitals of the written instructions for the following actions: do not resuscitate (DNR) orders, the graduation of therapeutic decisions, information provided to relatives about prognosis, total withdrawal of normal drug therapy and provision of palliative care. RESULTS: 80 patients over 89 years of age with end-stage congestive heart failure (57.5%) or dementia (42.5%) were included. The control group comprised 52 younger patients (65-74 years). DNR orders were specified in 56% of cases, graduation of therapeutic decisions in 35%, and knowledge of relatives regarding the prognosis in 61%. Drug therapy was withdrawn in 66% of cases and terminal palliative care was initiated in 69%. In the nonagenarians who died, we detected a predominance of females (p = 0.001), a higher percentage of DNR orders (p = 0.02) and a higher percentage of graduation of therapeutic measures (p = 0.02) in comparison with younger patients. CONCLUSION: Our results indicate that there are marked differences according the palliative care provided to oldest-old patients with end-stage non-cancer chronic diseases admitted to an acute care hospital. In any case, care should be improved for both age groups.","Age Factors;Aged;Aged, 80 and over;Case-Control Studies;Chronic Disease;Dementia/*mortality/*therapy;Female;Heart Failure/*mortality/*therapy;Hospital Mortality;Humans;Length of Stay;Male;Palliative Care/*organization & administration;Prospective Studies;Terminal Care/*organization & administration","Formiga, F.;Lopez-Soto, A.;Navarro, M.;Riera-Mestre, A.;Bosch, X.;Pujol, R.",2008,,10.1159/000135201,0,
1356,Dying in hospital of terminal heart failure or severe dementia: the circumstances associated with death and the opinions of caregivers,"BACKGROUND: Improving the care provided to elderly patients affected by end-stage chronic diseases dying in acute hospitals is a health priority. We evaluated the circumstances related to death in end-stage non-cancer patients dying in two acute care hospitals, and their caregiver's opinions about the death. METHODS: Some 102 patients, over 64 years of age, with end-stage dementia (37%) or congestive heart failure (64%), were included in the study. Caregiver's opinions on the circumstances of death were obtained using a questionnaire. In addition, we collected data regarding written instructions on several items, including do not resuscitate (DNR) orders, decisions about care in terms of the level or intensity of interventions, information provided to relatives about the prognosis, total withdrawal of normal drug therapy, and provision of palliative care. RESULTS: Caregivers stated that the clinical information was accurate in 67.6% of cases, and the control of symptoms was good in 55%. However, the perception of pain persisted in 14% and uncontrolled dyspnoea in 45%. The end-of-life care was assessed as: excellent 30.5%, good 36%, fairly good 25.5%, bad 6%, and very bad 2%. DNR orders were specified in 89% of patients, decisions concerning the intensity of care in 64%, and 80% of relatives were aware of the prognosis. Drug therapy was withdrawn in 64% of cases, and terminal palliative care was initiated in 79.5%. CONCLUSION: Our results suggest that some aspects of the palliative care provided to elderly patients with end-stage chronic diseases, admitted to acute care hospitals, could be improved. Such aspects include the clinical information provided and the successful control of specific symptoms.","Aged, 80 and over;Attitude to Death;Caregivers/*psychology;Chronic Disease;Decision Making;Dementia/*psychology;Female;Heart Failure/*psychology;Hospitalization;Humans;Male;Perception;*Terminally Ill","Formiga, F.;Olmedo, C.;Lopez-Soto, A.;Navarro, M.;Culla, A.;Pujol, R.",2007,Jan,10.1177/0269216306073256,0,
1357,Differences in end of life care in patients who died with dementia during acute hospital admissions 9,,aged;chronic obstructive lung disease;controlled study;disease association;dying;health care delivery;health care quality;heart failure;hospice care;hospital admission;human;letter;major clinical study;medical decision making;mortality;palliative therapy;priority journal;prognosis;senile dementia;statistical analysis;statistical significance,"Formiga, F.;Pujol, R.",2006,,,0,
1358,Dying in the hospital from an end-stage non-oncologic disease: A decision making analysis,"Background and objective: The aim of the study was to evaluate palliative decision-making in non- oncological patients who died in an acute care hospital. Patients and method: 293 patients > 64 years old were analyzed. These patients suffered from dementia (46%), end-stage congestive heart failure (31%) and end-stage chronic obstructive pulmonary disease (23%). We evaluated written information about: do not resuscitate (DNR) orders, graduation of therapeutic decisions, information provided to relatives about prognosis, total withdrawal of other drug therapy and provision of terminal care. Results: DNR orders were specified in 37% of cases, graduation of therapeutic decisions in 18% and knowledge of the prognosis by relatives in 57%. Drug withdrawal was carried out in 56% and palliative care in 65% patients. Conclusions: Identification and provision of palliative care, in an acute care hospital, of elderly patients at their last admission prior to death because of non-oncological end-stage diseases must be improved.",adult;aged;article;chronic obstructive lung disease;congestive heart failure;controlled study;dementia;drug withdrawal;dying;female;hospital admission;hospital care;human;major clinical study;male;medical decision making;medical information;palliative therapy;prognosis;relative;terminal care;terminal disease,"Formiga, F.;Vivanco, V.;Cuapio, Y.;Porta, J.;Gómez-Batiste, X.;Pujol, R.",2003,,,0,
1359,Risks for stroke and bleeding with warfarin or aspirin treatment in patients with atrial fibrillation at different CHA<inf>2</inf>DS<inf>2</inf>VASc scores: Experience from the Stockholm region,"Purpose: This study evaluated the benefits of and possible contraindications to warfarin treatment in patients with atrial fibrillation (AF) prior to the introduction of new oral anticoagulants using health registry data from inpatient care, specialist ambulatory care, and primary care. Methods: This is a cohort study including all patients in the region of Stockholm, Sweden (2.1 million inhabitants) with a diagnosis of non-valvular AF (n=41 810) recorded during 2005-2009. The risks of suffering ischemic stroke, bleeding, or death with warfarin, aspirin, or no antithrombotic treatment during 2010 were related to CHA2DS2VASc scores, age, and complicating co-morbidities. Results: One-year risks for ischemic stroke were 1.0-1.2 % with aspirin, 0-0.3 % with warfarin, and 0.1-0.2 % without treatment at CHA<inf>2</inf>DS<inf>2</inf>VASc scores 0-1. Among the aspirin-treated patients with CHA<inf>2</inf>DS<inf>2</inf>VASc scores ≥2, half had possible contraindications and high risks for ischemic stroke (5.2 %), bleeding (5.0 %), and death (19.3 %). The other half of the patients with no identified contraindications had a high risk for ischemic stroke (4.0%) but a low bleeding risk (1.8 %) and a moderate mortality rate (8.4 %). Conclusions: The present observations confirm earlier findings of undertreatment with warfarin and half of the highrisk patients treated with aspirin were obvious candidates for anticoagulant treatment. However, the other half of the patients had complicating co-morbidities, high bleeding risk, and poor prognosis. This and possible overtreatment of lowrisk patients should be taken into account when considering more aggressive use of anticoagulant treatment.",acetylsalicylic acid;clopidogrel;warfarin;aged;alcoholism;ambulatory care;anemia;anticoagulant therapy;article;bleeding;brain hemorrhage;brain ischemia;cardiac patient;cerebrovascular accident;CHADS2 score;cohort analysis;death;dementia;diabetes mellitus;drug contraindication;falling;female;geriatric patient;atrial fibrillation;heart failure;high risk patient;human;hypertension;kidney disease;major clinical study;male;malignant neoplastic disease;medical history;medical specialist;population research;prescription;primary medical care;risk assessment;Sweden;thromboembolism;thrombosis prevention;transient ischemic attack;vascular disease;very elderly;aspirin,"Forslund, T.;Wettermark, B.;Wändell, P.;Von Euler, M.;Hasselström, J.;Hjemdahl, P.",2014,,,0,
1360,High prevalence of neuroleptic drug use in elderly people with dementia,"BACKGROUND AND OBJECTIVES: The management of psychological and behavioural symptoms associated with dementia frequently requires the use of neuroleptic drugs. The objective of this study was to determine the prevalence, characteristics and possible differential factors of people aged > or = 65 years with dementia who take or not neuroleptic drugs. The subgroup with Alzheimer disease was analysed. PATIENTS AND METHODS: Five-hundred and fifteen patients aged > or = 65 years with dementia were prospectively evaluated. Data were collected on sociodemographic variables, type of dementia, Barthel Index (BI), Lawton Index (LI), Mini Mental State Exam (MMSE), Charlson Index, treatment with neuroleptic, antidepressants, benzodiazepines and non-benzodiazepine hypnotic-sedatives drugs, specific dementia treatments, vascular risk factors and comorbidities. The stage and severity of dementia were evaluated by the Global Deterioration Scale (GDS), creating two groups: Mild-moderate (GDS 3, 4 and 5) and severe (GDS 6 and 7) disease. RESULTS: There were 364 women (70%) and 151 men, with a mean age of 81+/-6 years, of whom 10.1% were institutionalized. Two hundred and seventy patients (52.5%) had mild-moderate disease and 245 had severe disease (47.5%). Neuroleptic drugs were being taken by 233 (45.2%) patients. In the multivariate analysis, neuroleptic drug use was associated with male gender, institutionalization, worse LI scores, more severe dementia and not having heart failure. The subgroup with Alzheimer disease was associated with worse IB and not having arterial hypertension. CONCLUSION: A high percentage of elderly patients with dementia are treated with neuroleptic drugs. There are significant differences in the prescription of neuroleptic drugs according to patient sociodemographic characteristics, severity of dementia and comorbidities.","Aged, 80 and over;Alzheimer Disease/*drug therapy;Antipsychotic Agents/*therapeutic use;Cross-Sectional Studies;Dementia/*drug therapy;Drug Prescriptions/statistics & numerical data;Female;Humans;Male","Fort, I.;Formiga, F.;Robles, M. J.;Regalado, P.;Rodriguez, D.;Barranco, E.",2010,Feb 6,10.1016/j.medcli.2009.07.046,0,
1361,Apolipoprotein E genotypic frequencies among Down syndrome patients imply early unsuccessful aging for ApoE4 carriers,"Down syndrome (DS) might be considered a model for unsuccessful and early aging, possibly accelerated for those who carry the APOE4 allele associated with common age-related diseases, e.g., Alzheimer's disease and a poor prognosis after acute myocardial infarction, causing lower ApoE4 frequencies among the very old in general populations. We compared ApoE genotypic frequencies found for healthy adults (n = 211, age < 40; n = 79, ages 70-79; n = 71, ages > 90) to those found for DS patients (n = 106, mean age 9 years), all living in western Sicily. We found that the frequency of the ApoE23 genotype increased with age among the healthy adults (8.5%, 6.4%, 19.7%; p = 0.024) while ApoE34 frequency decreased (16.1%, 12.6%, 4.1%; p = 0.012). DS patients had APOE34 genotypic frequencies very similar to those found in septuagenarians (9%; p = 0.005). Analyzing results according to surviving rate of persons with DS, an age-related reduction of ApoE3/4 genotype frequency was found comparing =5 years old to >5 years old DS subjects. These results highlight DS as a model to understand the role of APOE4 allele in unsuccessful ageing considering that a number of proinflammatory supernumerary genes (Cu/Zn superoxide dismutase, Ets-2 transcription factors, Down syndrome critical region 1, stress-inducible factor, interferon-alpha receptor and the amyloid precursor protein) are located on chromosome 21 and are implied in the pathologic processes of DS.","Adolescent;Adult;Aging/*genetics;Apolipoprotein E4/*genetics/*physiology;Child;Child, Preschool;Chromosomes, Human, Pair 21;Down Syndrome/*genetics;Female;Genotype;Humans;Infant;Male;Prognosis;Sequence Analysis, DNA","Forte, G. I.;Piccione, M.;Scola, L.;Crivello, A.;Galfano, C.;Corsi, M. M.;Chiappelli, M.;Candore, G.;Giuffre, M.;Verna, R.;Licastro, F.;Corsello, G.;Caruso, C.;Lio, D.",2007,Sep,10.1089/rej.2006.0525,0,
1362,Genome-Wide Scan Informed by Age-Related Disease Identifies Loci for Exceptional Human Longevity,"We developed a new statistical framework to find genetic variants associated with extreme longevity. The method, informed GWAS (iGWAS), takes advantage of knowledge from large studies of age-related disease in order to narrow the search for SNPs associated with longevity. To gain support for our approach, we first show there is an overlap between loci involved in disease and loci associated with extreme longevity. These results indicate that several disease variants may be depleted in centenarians versus the general population. Next, we used iGWAS to harness information from 14 meta-analyses of disease and trait GWAS to identify longevity loci in two studies of long-lived humans. In a standard GWAS analysis, only one locus in these studies is significant (APOE/TOMM40) when controlling the false discovery rate (FDR) at 10%. With iGWAS, we identify eight genetic loci to associate significantly with exceptional human longevity at FDR < 10%. We followed up the eight lead SNPs in independent cohorts, and found replication evidence of four loci and suggestive evidence for one more with exceptional longevity. The loci that replicated (FDR < 5%) included APOE/TOMM40 (associated with Alzheimer’s disease), CDKN2B/ANRIL (implicated in the regulation of cellular senescence), ABO (tags the O blood group), and SH2B3/ATXN2 (a signaling gene that extends lifespan in Drosophila and a gene involved in neurological disease). Our results implicate new loci in longevity and reveal a genetic overlap between longevity and age-related diseases and traits, including coronary artery disease and Alzheimer’s disease. iGWAS provides a new analytical strategy for uncovering SNPs that influence extreme longevity, and can be applied more broadly to boost power in other studies of complex phenotypes.",apolipoprotein E;ataxin 2;cyclin dependent kinase inhibitor 2B;adult;age;aged;algorithm;Alzheimer disease;article;controlled study;coronary artery disease;diseases;Drosophila;gene locus;gene replication;genetic variability;human;information;informed genome wide association study;lifespan;longevity;major clinical study;neurologic disease;overlapping gene;phenotype;quantitative trait;senescence;single nucleotide polymorphism;statistical analysis,"Fortney, K.;Dobriban, E.;Garagnani, P.;Pirazzini, C.;Monti, D.;Mari, D.;Atzmon, G.;Barzilai, N.;Franceschi, C.;Owen, A. B.;Kim, S. K.",2015,,,0,
1363,Comparative cardiovascular safety of dementia medications: A cross-national study,"Objectives To compare the cardiovascular safety of currently marketed dementia medications in new users in the United States and Denmark. Design Retrospective cohort study. Setting Nationally representative sample of Medicare beneficiaries from 2006 through 2009 and nationwide Danish administrative registries from 1997 through 2007. Participants Individuals treated with a dementia medication aged 65 and older. Measurements Hospitalizations for myocardial infarction (MI), heart failure, and syncope or atrioventricular block in both cohorts; fatal or nonfatal MI and cardiac death in the Danish cohort; and all-cause mortality in sensitivity analyses. Results In 46,737 Medicare beneficiaries and 29,496 Danish participants, donepezil was the most frequently used medication. There were no substantial differences in the risk of MI or heart failure between participants using donepezil and those using other cholinesterase inhibitors (all hazard ratios (HR) crossing 1). In the Danish cohort, memantine was associated with fatal or nonfatal MI (HR = 1.33, 95% confidence interval (CI) = 1.08-1.63), cardiac death (HR = 1.31, 95% CI = 1.12-1.53), and a trend toward higher rates of hospitalization for MI (HR = 1.31, 95% CI = 0.98-1.76). Memantine was also associated with greater risk of all-cause mortality in the Medicare (HR = 1.20, 95% CI = 1.13-1.28) and Danish (HR = 1.83, 95% CI = 1.73-1.94) cohorts, suggesting that sicker individuals were selected for memantine therapy. Conclusion Cholinesterase inhibitors have similar cardiovascular risk profiles. Associations between memantine and fatal outcomes in Denmark may be related, in part, to selection of sicker individuals for memantine therapy. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.",cholinesterase inhibitor;donepezil;galantamine;memantine;rivastigmine;aged;article;atrioventricular block;cardiovascular risk;cohort analysis;comparative study;controlled study;dementia;Denmark;drug safety;faintness;female;heart failure;heart infarction;human;major clinical study;male;medicare;mortality;retrospective study;side effect;United States,"Fosbøl, E. L.;Peterson, E. D.;Holm, E.;Gislason, G. H.;Zhang, Y.;Curtis, L. H.;Kober, L.;Iwata, I.;Torp-Pedersen, C.;Setoguchi, S.",2012,,,0,
1364,Anoxic-ischemic alpha coma: Prognostic significance of the incomplete variant,"The prognostic significance of post-anoxic-ischemic alpha coma (AC) is controversial. We recorded somatosensory evoked potentials (SEPs) and performed serial electroencephalography (EEG) in a 60-year-old woman in coma after cardiac arrest. The first EEG was recorded after 48 hours (GCS=5; E1-V1-M3); brain-stem reflexes were preserved. The EEG pattern showed monotonous alpha frequencies (10-11 Hz) with posterior predominance; acoustic and noxious stimuli evoked EEG reactivity. Early cortical SEPs (72 h) were normal. On the fifth day (GCS=8; E4-V1-M3), the EEG alpha pattern was replaced by a diffuse delta activity; rhythmic theta changes appeared spontaneously or in response to stimuli. The patient regained consciousness on the tenth day and EEG showed posterior theta activity (6-7 c/s) partially reactive to stimuli. At the 6-month follow-up, cognitive evaluation showed mild dementia. Recent studies identified two forms of AC. Patients with complete AC have an outcome that is almost invariably poor. Conversely, incomplete AC (posteriorly accentuated alpha frequency, reactive and with SEPs mostly normal) reflects a less severe degree of anoxic-ischemic encephalopathy. The case we report should be classified, according to the SEPs and EEG features, as incomplete AC. The fact that the patient has regained consciousness, even if with residual cognitive impairment, confirms the need to distinguish this variant from complete AC.",adult;alpha rhythm;article;brain hypoxia;brain ischemia;brain stem;case report;cognition;cognitive defect;coma;consciousness;delta rhythm;dementia;disease classification;disease severity;electroencephalography;evoked somatosensory response;female;follow up;heart arrest;human;medical assessment;outcomes research;prognosis;reflex;resuscitation;stimulus response;theta rhythm;time,"Fossi, S.;Amanti, A.;Grippo, A.;Cossu, C.;Boni, N.;Pinto, F.",2004,,,0,
1365,How HIV-1 causes AIDS: implications for prevention and treatment,"HIV-1 encodes for one of the human glutathione peroxidases. As a consequence, as it is replicated, its genetic needs cause it to deprive HIV-1 seropositive individuals not only of glutathione peroxidase, but also of the four basic components of this selenoenzyme, namely selenium, cysteine, glutamine, and tryptophan. Eventually this depletion process causes severe deficiencies of all these substances. These, in turn, are responsible for the major symptoms of AIDS which include immune system collapse, greater susceptibility to cancer and myocardial infarction, muscle wasting, depression, diarrhea, psychosis and dementia. As the immune system fails, associated pathogenic cofactors become responsible for a variety of their own unique symptoms. Any treatment for HIV/AIDS must, therefore, include normalization of body levels of glutathione, glutathione peroxidase, selenium, cysteine, glutamine, and tryptophan. Although various clinical trials have improved the health of AIDS patients by correcting one or more of these nutritional deficiencies, they have not, until the present, been addressed together. Physicians involved in a selenium and amino-acid field trial in Botswana, however, are reporting that this nutritional protocol reverses AIDS in 99% of patients receiving it, usually within three weeks.",Acquired Immunodeficiency Syndrome/blood/diet;therapy/enzymology/*etiology/*metabolism/prevention & control;Cysteine/blood/deficiency;Glutamine/blood/deficiency;Glutathione/blood/deficiency;Glutathione Peroxidase/blood/deficiency;HIV Infections/blood/diet therapy/*metabolism;HIV Seropositivity;*Hiv-1;Humans;Nutrition Disorders/blood/diet therapy/*etiology/metabolism;Selenium/blood/deficiency;Tryptophan/blood/deficiency,"Foster, H. D.",2004,,10.1016/j.mehy.2003.12.009,0,
1366,"IXth Medical days at Principal Hospital in Dakar, Senegal",,iodine;iron;retinol;trace element;zinc;Alzheimer disease;cardiovascular disease;degenerative disease;dementia;diet supplementation;environmental factor;heart failure;heredity;human;hypertension;infant mortality;infant nutrition;infection risk;macronutrient;malnutrition;maternal care;mental development;obesity;prevalence;psychomotor development;short survey;socioeconomics;vitamin supplementation,"Fourcade, L.;Mbaye, P. S.",2008,,,0,
1367,Normal pressure hydrocephalus,"Normal pressure hydrocephalus (NPH) is characterized by a classic triad of symptoms including gait disturbance, urinary incontinence, and dementia. NPH is associated with a radiological verifiable ventnculomegaly in the absence of elevated cerebrospinal fluid (CSF) pressure. Because many patients do not present with classical clinical and radiological findings, its diagnosis and management represents a challenge for the treating doctor. Various supplemental preoperative tests, including lumbar CSF tap test or CSF outflow resistance determination, can improve the accuracy of predicting a response to surgical intervention. CSF shunt results in significant reduction of the symptoms in the majority of appropriately evaluated patients.",accuracy;article;brain hemorrhage;catheter occlusion;cerebrospinal fluid flow;cerebrospinal fluid pressure;cerebrospinal fluid shunting;clinical feature;disease association;epilepsy;heart ventricle hypertrophy;hematoma;human;infection;lumbar puncture;normotensive hydrocephalus;patient care;prediction;preoperative evaluation;radiodiagnosis;reduction;treatment response,"Fournier, J. Y.;Gautschi, O. P.;Hildebrandt, G.",2010,,,0,
1368,Coronary artery disease in patients with dementia,"Our population is ageing. The prevalence of dementia is increasing as the population ages. Dementia is known to share many common risk factors with coronary artery disease including age, genetics, smoking, the components of the metabolic syndrome and inflammation. Despite the growing ageing population with dementia, there is underutilization of optimal care (pharmacotherapy and interventional procedures) in this cohort. Given common risk factors and potential benefit, patients with cognitive impairment and dementia should be offered contemporary care. However, further research evaluating optimal care in this patient cohort is warranted.",,"Fowkes, R.;Byrne, M.;Sinclair, H.;Tang, E.;Kunadian, V.",2016,Sep,10.1097/mca.0000000000000377,0,
1369,Effect of dementia on the use of drugs for secondary prevention of ischemic heart disease,"Background. Dementia and cardiovascular disease (CVD) are frequently comorbid. The presence of dementia may have an effect on how CVD is treated. Objective. To examine the effect of dementia on the use of four medications recommended for secondary prevention of ischemic heart disease (IHD): angiotensin-converting enzyme inhibitors, beta-blockers, lipid-lowering medications, and antiplatelet medications. Design. Retrospective analysis of data from the Cardiovascular Health Study: Cognition Study. Setting and Subjects. 1,087 older adults in four US states who had or developed IHD between 1989 and 1998. Methods. Generalized estimating equations to explore the association between dementia and the use of guideline-recommended medications for the secondary prevention of IHD. Results. The length of follow-up for the cohort was 8.7 years and 265 (24%) had or developed dementia during the study. Use of medications for the secondary prevention of IHD for patients with and without dementia increased during the study period. In models, subjects with dementia were not less likely to use any one particular class of medication but were less likely to use two or more classes of medications as a group (OR, 0.60; 95% CI, 0.36-0.99). Conclusions. Subjects with dementia used fewer guideline-recommended medications for the secondary prevention of IHD than those without dementia. © 2014 Nicole R. Fowler et al.",acetylsalicylic acid;adenosine diphosphate receptor inhibitor;antilipemic agent;antithrombocytic agent;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;prostaglandin synthase inhibitor;unclassified drug;aged;article;cohort analysis;controlled study;dementia;drug use;drug utilization;female;follow up;human;ischemic heart disease;major clinical study;male;priority journal;retrospective study;very elderly,"Fowler, N. R.;Barnato, A. E.;Degenholtz, H. B.;Curcio, A. M.;Becker, J. T.;Kuller, L. H.;Lopez, O. L.",2014,,,0,
1370,The importance of detecting and managing comorbidities in people with dementia?,,Alzheimer disease;chronic obstructive lung disease;comorbidity;delirium;dementia;diabetes mellitus;disease severity;early diagnosis;epilepsy;falling;frail elderly;health care cost;health promotion;heart failure;human;incontinence;malnutrition;mouth disease;musculoskeletal disease;note;pneumonia;practice guideline;prevalence;quality of life;sleep disorder;urinary tract infection;visual disorder;wellbeing,"Fox, C.;Smith, T.;Maidment, I.;Hebding, J.;Madzima, T.;Cheater, F.;Cross, J.;Poland, F.;White, J.;Young, J.",2014,,,0,
1371,Atrial fibrillation: Current status and challenges,"Atrial fibrillation is a sinister often silent rhythm disturbance and a key cause of stroke and death, especially in older age and when combined with other risk factors. Worldwide, it is the silent epidemic of the elderly. In the minority of patients, interventional approaches are possible to restore sinus rhythm, including electrophysiological ablation of pulmonary veins. However, although they relieve symptoms they do not abrogate future stroke risk. Anticoagulation is highly effective in reducing the risk of stroke and systemic embolism, but controlling vitamin K antagonists is challenging. Many patients are untreated because of real or perceived bleeding risks and many patients discontinue treatment. The newer anticoagulants present a revolutionary change (oral direct thrombin inhibitors: dabigatran; factor-Xa inhibitors rivaroxaban, apixaban, endoxaban). They do not require monitoring and their management is not confounded by the many food and drug interactions of warfarin. Importantly, the newer agents are at least as effective as warfarin in preventing stroke (some are more effective) and have similar or lower risks of bleeding. The newer agents all reduce a key complication of vitamin K anticoagulation, intracranial hemorrhage. Widespread application of the newer agents presents challenges, but also major opportunities to improve outcome and quality of life. © 2012 LLS SAS. All rights reserved.",acetylsalicylic acid;amiodarone;antiarrhythmic agent;antibiotic agent;anticoagulant agent;antiinflammatory agent;antithrombocytic agent;antivitamin K;apixaban;beta adrenergic receptor blocking agent;blood clotting factor 10a inhibitor;calcium antagonist;clopidogrel;dabigatran;dronedarone;edoxaban;flecainide;hydroxymethylglutaryl coenzyme A reductase inhibitor;propafenone;rivaroxaban;thrombin inhibitor;warfarin;ximelagatran;acute coronary syndrome;anticoagulant therapy;article;atrioventricular conduction;bleeding;blood clot lysis;blood pressure regulation;bradycardia;brain hemorrhage;Brugada syndrome;cardiovascular mortality;cardioversion;catheter ablation;cerebrovascular accident;cognitive defect;disease classification;drug efficacy;dyspnea;electrosurgery;extrasystole;eye disease;faintness;fibrosing alveolitis;food drug interaction;gastrointestinal hemorrhage;genetic screening;atrial fibrillation;heart atrium flutter;heart failure;heart infarction;heart muscle refractory period;heart muscle revascularization;heart palpitation;heart rate and rhythm;heart ventricle compliance;heart ventricle overload;human;hypertrophic cardiomyopathy;life expectancy;lung complication;multiinfarct dementia;obesity;pulmonary vein isolation;Purkinje fiber;quality of life;randomized controlled trial (topic);sinus rhythm;systematic review (topic);thromboembolism;thyroid disease;transesophageal echocardiography;transthoracic echocardiography,"Fox, K. A. A.",2012,,,0,
1372,'Heart Team' decision-making for cardiac interventional procedures should take into account patients' cognitive function and frailty,,aortic valve stenosis;brain blood vessel;cardiac patient;cerebrovascular accident;clinical decision making;clinical evaluation;cognition;cognitive defect;cultural factor;dementia;frail elderly;health care cost;heart failure;heart rehabilitation;human;interventional cardiovascular procedure;letter;neurologist;palliative therapy;practice guideline;prognosis;quality of life;stroke patient;surgical risk;transcatheter aortic valve implantation;transcranial Doppler ultrasonography;valvular heart disease,"Fragasso, G.",2016,,10.2459/jcm.0000000000000413,0,
1373,Cardiac arrest outside of hospital. A retrospective study in Odense,"During the period 1.10.1986-30.9.1987, all patients with cardiac arrest outside hospital brought to the casualty department in Odense Hospital were registered. Out of 160 patients, 133 (83%) could be primarily resuscitated, 19 (12%) were resuscitated but died later in hospital and eight patients (5%) were resuscitated and could be discharged alive from hospital. Out of the eight patients who were discharged alive, only two (1%) had retained reasonable cerebral function as assessed by dementia testing. Treatment of the cardiac arrest prior to the arrival of the ambulance, duration of the cardiac arrest for less than six minutes and staffing of the ambulance with three first-aid men were factors of decisive importance for survival of the patients. The results of this investigation demonstrate that treatment of cardiac arrest outside hospital is unsatisfactory. Proposals for improvement of treatment include: 1. Information to the population. 2. Training of first-aid staff in treatment of cardiac arrest. 3. Quicker arrival of ambulances and 4. Better staffing and training of ambulance staff in the use of a defibrillator possibly with participation of a doctor.",article;Denmark;female;heart arrest;hospital admission;human;male;mortality;resuscitation;retrospective study,"Frandsen, F.;Nielsen, J. R.;Gram, L.;Larsen, C. F.;Jørgensen, H. R.;Haghfelt, T.",1989,,,0,
1374,Evaluation of intensified prehospital treatment in out-of-hospital cardiac arrest: survival and cerebral prognosis. The Odense ambulance study,"During a period of 3 years three different types of emergency medical service (EMS) systems were evaluated in a city with about 238,000 inhabitants/population density of 570/km2. Included were 393 out-of-hospital cardiac arrest patients in whom prehospital cardiopulmonary resuscitation was provided by personnel on basic, intermediate, or advanced care training. When ordinary ambulances (basic EMS) were used, 8 (5%) patients were discharged alive. When ambulances with specially trained paramedics (intermediate EMS) were used, 2 (1%) patients were discharged. Finally medically staffed ambulances with doctors collaborating (advanced EMS) were used, and 11 (13%) patients were discharged. The intermediate EMS system was used in another area with 45,000 inhabitants/population density of 340/km2, and in this area 20 (18%) patients were discharged. Among the survivors a psychological assessment in form of a test for dementia was assessed in long-term survivors (n = 30) together with 28 patients surviving acute myocardial infarction and 11 control persons. The results of the investigation demonstrate that the more intensive the prehospital treatment of out-of-hospital cardiac arrest, the more patients survive and the more patients survive with good cerebral function. However, the ambulances with specially trained paramedics were only effective in the area with 340 inhabitants/km2.","Brain Ischemia/epidemiology/*etiology;Denmark/epidemiology;Emergency Medical Services/*standards;Evaluation Studies as Topic;Female;Heart Arrest/complications/mortality/*therapy;Hospitals, University;Humans;Male;Middle Aged;Prognosis;Risk Factors;Survival Rate;Treatment Outcome","Frandsen, F.;Nielsen, J. R.;Gram, L.;Larsen, C. F.;Jorgensen, H. R.;Hole, P.;Haghfelt, T.",1991,,,0,
1375,Cognitive Impairment: A New Predictor of Exercise Trainability and Outcomes in Cardiac Rehabilitation?,,Alzheimer disease;cognition;cognitive defect;correlation analysis;disease severity;exercise;exercise tolerance;functional assessment;heart muscle ischemia;heart rehabilitation;high risk patient;human;ischemic heart disease;mortality;note;oxygen consumption;physical capacity;predictor variable;priority journal;psychological aspect;quality of life;treadmill;vascular disease,"Franklin, B. A.",2010,,,0,
1376,Causal inference in obesity research,"Obesity is a risk factor for a plethora of severe morbidities and premature death. Most supporting evidence comes from observational studies that are prone to chance, bias and confounding. Even data on the protective effects of weight loss from randomized controlled trials will be susceptible to confounding and bias if treatment assignment cannot be masked, which is usually the case with lifestyle and surgical interventions. Thus, whilst obesity is widely considered the major modifiable risk factor for many chronic diseases, its causes and consequences are often difficult to determine. Addressing this is important, as the prevention and treatment of any disease requires that interventions focus on causal risk factors. Disease prediction, although not dependent on knowing the causes, is nevertheless enhanced by such knowledge. Here, we provide an overview of some of the barriers to causal inference in obesity research and discuss analytical approaches, such as Mendelian randomization, that can help to overcome these obstacles. In a systematic review of the literature in this field, we found: (i) probable causal relationships between adiposity and bone health/disease, cancers (colorectal, lung and kidney cancers), cardiometabolic traits (blood pressure, fasting insulin, inflammatory markers and lipids), uric acid concentrations, coronary heart disease and venous thrombosis (in the presence of pulmonary embolism), (ii) possible causal relationships between adiposity and gray matter volume, depression and common mental disorders, oesophageal cancer, macroalbuminuria, end-stage renal disease, diabetic kidney disease, nuclear cataract and gall stone disease, and (iii) no evidence for causal relationships between adiposity and Alzheimer's disease, pancreatic cancer, venous thrombosis (in the absence of pulmonary embolism), liver function and periodontitis. Copyright © 2016 The Association for the Publication of the Journal of Internal Medicine.",Alzheimer disease;bile;blood pressure;bone;cancer size;cataract;chronic disease;colorectal cancer;controlled clinical trial;controlled study;depression;diabetic nephropathy;diet restriction;end stage renal disease;esophagus cancer;genetics;gray matter;human;ischemic heart disease;kidney cancer;lifestyle;liver function;lung cancer;lung embolism;macroalbuminuria;Mendelian randomization analysis;obesity;pancreas cancer;periodontitis;prediction;randomized controlled trial;risk factor;systematic review;vein thrombosis;insulin;lipid;uric acid,"Franks, Pw;Atabaki-Pasdar, N",2016,,10.1111/joim.12577,0,1377
1377,Causal inference in obesity research,"Obesity is a risk factor for a plethora of severe morbidities and premature death. Most supporting evidence comes from observational studies that are prone to chance, bias and confounding. Even data on the protective effects of weight loss from randomized controlled trials will be susceptible to confounding and bias if treatment assignment cannot be masked, which is usually the case with lifestyle and surgical interventions. Thus, whilst obesity is widely considered the major modifiable risk factor for many chronic diseases, its causes and consequences are often difficult to determine. Addressing this is important, as the prevention and treatment of any disease requires that interventions focus on causal risk factors. Disease prediction, although not dependent on knowing the causes, is nevertheless enhanced by such knowledge. Here, we provide an overview of some of the barriers to causal inference in obesity research and discuss analytical approaches, such as Mendelian randomization, that can help to overcome these obstacles. In a systematic review of the literature in this field, we found: (i) probable causal relationships between adiposity and bone health/disease, cancers (colorectal, lung and kidney cancers), cardiometabolic traits (blood pressure, fasting insulin, inflammatory markers and lipids), uric acid concentrations, coronary heart disease and venous thrombosis (in the presence of pulmonary embolism), (ii) possible causal relationships between adiposity and gray matter volume, depression and common mental disorders, oesophageal cancer, macroalbuminuria, end-stage renal disease, diabetic kidney disease, nuclear cataract and gall stone disease, and (iii) no evidence for causal relationships between adiposity and Alzheimer's disease, pancreatic cancer, venous thrombosis (in the absence of pulmonary embolism), liver function and periodontitis. Copyright © 2016 The Association for the Publication of the Journal of Internal Medicine",Bayes theorem;bone disease;cardiometabolic risk;cardiovascular parameters;cataract;causal attribution;cholelithiasis;clinical research;depression;gray matter;human;ischemic heart disease;kidney disease;malignant neoplasm;Mendelian randomization analysis;mental disease;obesity/et [Etiology];priority journal;propensity score;review;risk factor;systematic review;vein thrombosis;insulin/ec [Endogenous Compound];lipid/ec [Endogenous Compound];uric acid/ec [Endogenous Compound];Alzheimer disease;bile;blood pressure;bone;cancer size;chronic disease;colorectal cancer;controlled clinical trial;controlled study;diabetic nephropathy;diet restriction;end stage renal disease;esophagus cancer;genetics;kidney cancer;lifestyle;liver function;lung cancer;lung embolism;macroalbuminuria;Mendelian randomization analysis;obesity;pancreas cancer;periodontitis;prediction;randomized controlled trial;insulin;lipid;uric acid,"Franks, Pw;Atabaki-Pasdar, N",2017,,10.1111/joim.12577,0,
1378,Dose adjustment in patients with liver cirrhosis: Impact on adverse drug reactions and hospitalizations,"Aim and background: To assess drug-related problems in patients with liver cirrhosis by investigating the prevalence of inadequately dosed drugs and their association with adverse drug reactions (ADRs) and hospitalizations. Methods: This was a cross-sectional retrospective study assessing the dose adequacy of drug treatment of 400 cirrhotic patients at hospital admission based on the authors' own previous studies and standard literature. The prevalence of total and preventable ADRs and of hospitalizations due to preventable ADRs was determined. Results: Of all 1653 drugs prescribed (median 4 per patient), 336 (20 %) drugs were inadequately dosed in 184 patients. Overall, 210 ADRs (78 % preventable) occurred in 120 patients. Sixty-nine ADRs (33 % of all ADRs) were associated with inadequate drug dosing in 46 patients, of which 68 % were preventable. Nonsteroidal anti-inflammatory drugs and psycholeptics in particular frequently caused preventable ADRs associated with inadequate drug dosing. Inadequate drug dosing was more frequently associated with ADRs than adequate drug dosing, and patients receiving inadequately dosed drugs were more frequently admitted to the hospital due to ADRs. Hospitalization of patients receiving inadequately dosed drugs that caused preventable ADRs resulted in 94 additional hospital days. Conclusion: In this retrospective study, inadequate drug dosing was associated with an increased frequency of ADRs, hospital admissions and hospital days in cirrhotic patients. We therefore conclude that the careful dosing of critical drugs is important in patients with liver cirrhosis. © 2013 Springer-Verlag Berlin Heidelberg.",acetylsalicylic acid;amlodipine;diazepam;diclofenac;doxorubicin;esomeprazole;ibuprofen;lansoprazole;losartan;mefenamic acid;metformin;methadone;midazolam;omeprazole;pantoprazole;phenprocoumon;pipamperone;piroxicam;ramipril;rosiglitazone;spironolactone;torasemide;zolpidem;anemia;anorexia;article;ascites;bacterial peritonitis;Clostridium difficile infection;confusion;creatinine clearance;cross-sectional study;diarrhea;digestive system ulcer;dose adjustment;drug contraindication;dyspnea;edema;eosinophilia;epistaxis;faintness;falling;febrile neutropenia;gait disorder;gastrointestinal hemorrhage;heart failure;hospital admission;hospitalization;human;hyperbilirubinemia;hyperkalemia;hyponatremia;hypotension;international normalized ratio;length of stay;leukopenia;liver cirrhosis;major clinical study;mental deterioration;pharmacological parameters;prescription;priority journal;restlessness;retrospective study;side effect;sleep walking;somnolence;thrombocytopenia;torsade des pointes,"Franz, C. C.;Hildbrand, C.;Born, C.;Egger, S.;Rätz Bravo, A. E.;Krähenbühl, S.",2013,,,0,
1379,Psychostimulants for older adults,,alpha interferon;amfebutamone;amphetamine derivative;citalopram;dexamphetamine;donepezil;lisdexamfetamine;methylphenidate;monoamine oxidase inhibitor;placebo;psychostimulant agent;tricyclic antidepressant agent;warfarin;Alzheimer disease;anorexia;anxiety;apathy;article;attention deficit disorder;controlled clinical trial (topic);decreased appetite;delirium;depression;drug dose increase;drug dose titration;drug induced headache;drug potentiation;drug safety;emotional disorder;fall risk;fatigue;geriatric patient;gerontopsychiatry;glaucoma;hallucination;heart arrhythmia;heart infarction;heart palpitation;heart rate;hepatitis C;human;insomnia;randomized controlled trial (topic);side effect;sleep disorder;cerebrovascular accident;sudden death;systolic blood pressure;treatment response,"Franzen, J. D.;Padala, P. R.;Wetzel, M. W.;Burke, W. J.",2012,,,0,
1380,Discussion,,apolipoprotein E2;allele;Alzheimer disease;Bayley II Scale of Infant Development;brain blood flow;brain development;brain maturation;brain perfusion;brain protection;cardiopulmonary bypass;clinical trial (topic);cohort analysis;deep hypothermic circulatory arrest;genotype;heart arrest;heart single ventricle;heart surgery;human;hypoplastic left heart syndrome;lung blood flow;Mental Developmental Index;mental disease;mental disease assessment;nerve cell lesion;neuroimaging;note;nuclear magnetic resonance imaging;oxidative stress;pediatric surgery;priority journal;Psychomotor Developmental Index;statistical significance;systemic circulation;white matter,"Fraser, C. D.;Laks, H.",2014,,,0,
1381,Infection as cause of immobility and occurrence of venous thromboembolism: analysis of 1635 medical cases from the RIETE registry,"Several risk assessment models include infection and immobility among the items to be considered for venous thromboembolism (VTE) prevention. However, information on patients with infection leading to immobility and developing VTE are limited, as well as on the role of specific types of infection. Data were collected from the worldwide RIETE registry, including patients with symptomatic objectively confirmed VTE, and followed-up for at least 3 months. The overall population of RIETE at June 2013 (n = 47,390) was considered. Acute infection leading to immobility was reported in 3.9 % of non-surgical patients. Compared with patients immobilized due to dementia, patients with infection had a shorter duration of immobilization prior to VTE (less than 4 weeks in 94.2 vs. 25.9 % of cases; p < 0.001). During the 3-month follow-up, VTE patients with infection versus those with dementia had a lower rate of fatal bleeding (0.5 vs. 1.1 %; p < 0.05) or fatal PE (1.7 vs. 3.5 %; p < 0.01). Patients with respiratory tract infections had more likely PE as initial VTE presentation than other types of infection (62.3 vs. 37.7 %; p < 0.001). Significantly more patients with pneumonia than those with other respiratory infections had received VTE prophylaxis (50.2 vs. 30.6 %; p < 0.001). Following VTE, patients with sepsis showed a significantly higher risk of fatal bleeding. Based on our real-world data, infection seems to contribute to the pathogenesis of VTE by accelerating the effects of immobility. Its role as VTE risk factor probably deserves further attention and specific assessment in order to optimize VTE prophylaxis and treatment.",anticoagulant agent;antivitamin K;fondaparinux;low molecular weight heparin;age;aged;article;bleeding;chronic lung disease;comparative study;controlled study;dementia;disease duration;female;heart failure;high risk patient;human;immobility;infection;long term care;lung embolism;major clinical study;male;mortality;neoplasm;pneumonia;priority journal;recurrent disease;respiratory tract infection;risk factor;sepsis;thrombosis;thrombosis prevention;urinary tract infection;venous thromboembolism,"Frasson, S.;Gussoni, G.;Di Micco, P.;Barba, R.;Bertoletti, L.;Nuñez, M. J.;Valero, B.;Samperiz, A. L.;Rivas, A.;Monreal, M.",2016,,,0,
1382,Prevention of Alzheimer's disease and dementia. Major findings from the Kungsholmen Project,"The aging of the population is a worldwide phenomenon, and studying age-related diseases has become a relevant issue from both a scientific and a public health perspective. This review summarises the major findings concerning prevention of Alzheimer's disease (AD) and other dementias from a population-based study, the Kungsholmen Project. The study addresses risk- and protective factors for AD and dementia from a lifetime perspective: at birth, during childhood, in adult life, and in old age. Although many aspects of the dementias are still unclear, some risk factors have been identified and interesting hypotheses have been suggested for other putative risk or protective factors. At the moment it is also possible to delineate some preventative strategies for dementia. © 2007 Elsevier Inc. All rights reserved.",apolipoprotein E;aging;alcohol consumption;Alzheimer disease;anemia;article;blood pressure;dementia;diabetes mellitus;drug use;education;environmental factor;family history;genotype;heart failure;heredity;human;lifestyle;occupation;population research;primary prevention;priority journal;rehabilitation;risk factor;secondary prevention;smoking;social aspect;socioeconomics,"Fratiglioni, L.;Winblad, B.;von Strauss, E.",2007,,,0,
1383,Primary chronic traumatic encephalopathy in an older patient with late-onset AD phenotype,"First described as dementia pugilistica in boxers, chronic traumatic encephalopathy (CTE) is associated with repeated head injury and has received much attention after several high-profile National Football League cases.1 Recent work suggests that both the nature of potential predisposing trauma and the clinical spectrum of CTE may be broader than previously recognized.1-3 We report a case of CTE presenting as Alzheimerlike dementia in a war reporter with a history of prolonged proximity to shelling but no acute head trauma.",apolipoprotein E2;apolipoprotein E4;bapineuzumab;donepezil;escitalopram;leuprorelin;memantine;TAR DNA binding protein;tau protein;aged;alcohol consumption;Alzheimer disease;amnesia;amygdaloid nucleus;anxiety;apathy;article;bradykinesia;brain disease;case report;chronic traumatic encephalopathy;cognitive defect;diffuse axonal injury;disorientation;executive function;genetic screening;hearing impairment;heart infarction;hippocampus;human;impulsiveness;inferior temporal gyrus;insula;male;memory disorder;neurologic examination;neuropsychological test;priority journal;prostate cancer;senile plaque;short term memory;tinnitus;verbal memory,"Fredericks, C. A.;Koestler, M.;Seeley, W.;Miller, B.;Boxer, A.;Grinberg, L. T.",2015,,,0,
1384,Does confounding explain the association between PPIs and Clostridium difficile-related diarrhea?,,clopidogrel;proton pump inhibitor;chronic kidney disease;chronic obstructive lung disease;Clostridium difficile infection;dementia;diabetes mellitus;disease association;heart failure;human;ischemic heart disease;letter;liver disease;priority journal;recurrent infection,"Freedberg, D. E.;Abrams, J. A.",2013,,,0,
1385,Harnessing the HGP for public health,,apolipoprotein E;apolipoprotein E4;cyclosporin;cytochrome P450 2C9;DNA;low density lipoprotein cholesterol;tacrolimus;warfarin;advertizing;Alzheimer disease;bleeding;cell activity;smoking;DNA repair;drug monitoring;drug research;drug sensitivity;environmental change;environmental exposure;environmental factor;financial management;gene function;gene interaction;genetic analysis;genetic linkage;genetic polymorphism;genetic recombination;genetic risk;genetic susceptibility;genetic variability;health care organization;heart disease;heart infarction;human;kidney disease;kidney failure;medical genetics;medical research;motivation;note;priority journal;public health service;risk assessment;single nucleotide polymorphism;smoking cessation;symposium;thromboembolism;United Kingdom,"Freeman, K.",2004,,,0,
1386,Prevalence and risk factors of silent brain infarcts in the population,,Age Factors;Angina Pectoris/epidemiology;Atrial Fibrillation/epidemiology;Brain Infarction/*epidemiology;Comorbidity;Dementia/epidemiology;Denmark/epidemiology;Female;Humans;Hypertension/epidemiology;Japan/epidemiology;Male;Netherlands/epidemiology;Odds Ratio;Prevalence;Risk Factors;United States/epidemiology,"Freestone, B.;Lip, G. Y.",2002,May,,0,
1387,Sequencing of 42kb of the APO E-C2 gene cluster reveals a new gene: PEREC1,"Through the sequencing of a 42kb cosmid clone we describe a new gene, designated PEREC1, located approximately 1.5kb centromeric of the human apolipoprotein (APO) E-C2 cluster. The combination of dotplot analysis, predicted coding potential and interrogation of the Expressed Sequence Tag (EST) database determined the genomic organisation of PEREC1. Sequence alignment with multiple overlapping ESTs confirmed the predicted splice sites. The predicted cDNA and amino acid sequences of PEREC1 have extensive similarity to the Caenorhabditis elegans protein, C18E9.6. Conserved structural and functional motifs have been defined by combining nucleotide and amino acid analyses to identify third base degeneracy and therefore selection at the protein level. The Poliovirus Receptor Related Protein2 gene (PRR2), previously mapped to chromosome 19q13.2 by Fluorescent In-Situ Hybridisation, has also been located approximately 17kb centromeric of APO E.","Alzheimer Disease/genetics;Amino Acid Motifs;Amino Acid Sequence;Animals;Apolipoproteins E/*chemistry/*genetics;Base Sequence;Caenorhabditis elegans/genetics;Cell Adhesion Molecules;Chromosome Mapping;Chromosomes, Human, Pair 19/genetics;Coronary Disease/genetics;Cosmids/genetics;Databases, Factual;Expressed Sequence Tags;Helminth Proteins/chemistry/genetics;Humans;Membrane Glycoproteins/chemistry/genetics;*Membrane Transport Proteins;Molecular Sequence Data;*Multigene Family;Proteins/chemistry/*genetics/metabolism;*Receptors, Tumor Necrosis Factor;Receptors, Tumor Necrosis Factor, Member 14;*Receptors, Virus;Sequence Analysis, DNA;Sequence Analysis, Protein","Freitas, E. M.;Zhang, W. J.;Lalonde, J. P.;Tay, G. K.;Gaudieri, S.;Ashworth, L. K.;Van Bockxmeer, F. M.;Dawkins, R. L.",1998,,,0,
1388,Patterns of multimorbidity in primary care patients at high risk of future hospitalization,"Care management is seen as a promising approach to address the complex care needs of patients with multimorbidity. Predictive modeling based on insurance claims data is an emerging concept to identify patients likely to benefit from care management interventions. We aimed to identify and explore patterns of multimorbidity in primary care patients with high predicted risk of future hospitalizations in order to develop a primary care-based care management intervention. We conducted a retrospective cohort study to assess insurance claims data of 6026 patients from 10 primary care practices in Germany. We stratified the population by the predicted likelihood of hospitalization (LOH) using a diagnostic cost group-based case-finding software. Co-occurrence of chronic conditions in multimorbid patients with an upper-quartile LOH score was explored by extraction of mutually exclusive patterns. Predictive modeling identified multimorbid elderly patients with a high number of co-occurring chronic conditions (mean number 7.8 [SD 3.1]). Assessing co-occurrence of highly prevalent chronic conditions in 1407 multimorbid patients with upper-quartile LOH revealed 471 mutually exclusive patterns with low single frequencies. The observed prevalence significantly exceeded expected prevalence for patterns with causal comorbidity. Additionally, chronic pain (related to osteoarthritis) or depression could be identified as discordant co-occurring conditions in 80% (12/15) of the most common multimorbidity patterns. High-risk primary care patients suffer from heterogeneous individual patterns of co-occurring chronic conditions. Care management interventions will have to account for discordant co-occurring conditions such as osteoarthritis and depression. © 2012 Mary Ann Liebert, Inc.",acquired immune deficiency syndrome;adult;alcohol abuse;anemia;anxiety disorder;article;asthma;cerebrovascular disease;chronic disease;chronic hepatitis;chronic obstructive lung disease;cohort analysis;computer analysis;controlled study;dementia;depression;drug abuse;female;general practice;Germany;health insurance;hearing impairment;atrial fibrillation;heart failure;high risk patient;hospitalization;human;hypertension;insulin dependent diabetes mellitus;ischemic heart disease;kidney failure;major clinical study;male;malignant neoplastic disease;morbidity;multicenter study;multimorbidity;neuropathy;non insulin dependent diabetes mellitus;osteoarthritis;osteoporosis;Parkinson disease;peripheral vascular disease;primary medical care;psoriasis;retrospective study;rheumatoid arthritis;schizophrenia;somatoform disorder;statistical model;thyroid disease;urine incontinence;valvular heart disease;visual impairment,"Freund, T.;Kunz, C. U.;Ose, D.;Szecsenyi, J.;Peters-Klimm, F.",2012,,,0,
1389,Assessment of female sex as a risk factor in atrial fibrillation in Sweden: Nationwide retrospective cohort study,"Objective: To determine whether women with atrial fibrillation have a higher risk of stroke than men. Design: Nationwide retrospective cohort study. Setting: Patients with a diagnosis of atrial fibrillation in the Swedish hospital discharge register between 1 July 2005 and 31 December 2008. Information about drug treatment taken from the Swedish drug register. Participants: 100 802 patients with atrial fibrillation at any Swedish hospital or hospital affiliated outpatient clinic with a total follow-up of 139 504 years at risk (median 1.2 years). We excluded patients with warfarin at baseline, mitral stenosis, previous valvular surgery, or who died within 14 days from baseline. Main outcome measure: Incidence of ischaemic stroke. Results: Ischaemic strokes were more common in women than in men (6.2% v 4.2% per year, P<0.0001). The univariable hazard ratio for women compared with men was 1.47 (95% confidence 1.40 to 1.54), indicating a 47% higher incidence of ischaemic stroke in women than in men. Stratification according to the CHADS2 scheme showed increased stroke rates for women in all strata. After multivariable adjustment for 35 cofactors for stroke, an increased risk of stroke in women remained (1.18, 1.12 to 1.24). Among patients with ""lone atrial fibrillation"" (age <65 years and no vascular disease), the annual stroke rate tended to be higher in women than in men, although this difference was not significant (0.7% v 0.5%, P=0.09). When low risk patients with CHADS2scores of 0-1 were stratified according to their CHA 2DS2-VASc scores, women did not have higher stroke incidence than men at CHA2DS2-VASc scores of 2 or less. Conclusion: Women with atrial fibrillation have a moderately increased risk of stroke compared with men, and thus, female sex should be considered when making decisions about anticoagulation treatment. However, women younger than 65 years and without other risk factors have a low risk for stroke, and do not need anticoagulant treatment.",acetylsalicylic acid;antiarrhythmic agent;beta adrenergic receptor blocking agent;clopidogrel;digoxin;warfarin;age;aged;alcohol abuse;article;brain ischemia;cohort analysis;comorbidity;controlled study;dementia;diabetes mellitus;falling;female;gender;atrial fibrillation;heart infarction;hospital admission;human;hypertension;incidence;kidney disease;liver disease;major clinical study;male;outcome assessment;predictive value;priority journal;retrospective study;risk assessment;risk factor;sex difference;cerebrovascular accident;Sweden;thromboembolism;validity;vascular disease,"Friberg, L.;Benson, L.;Rosenqvist, M.;Lip, G. Y. H.",2012,,,0,
1390,One is the deadliest number: the detrimental effects of social isolation on cerebrovascular diseases and cognition,"The deleterious effects of chronic social isolation (SI) have been recognized for several decades. Isolation is a major source of psychosocial stress and is associated with an increased prevalence of vascular and neurological diseases. In addition, isolation exacerbates morbidity and mortality following acute injuries such as stroke or myocardial infarction. In contrast, affiliative social interactions can improve organismal function and health. The molecular mechanisms underlying these effects are unknown. Recently, results from large epidemiological trials and pre-clinical studies have revealed several potential mediators of the detrimental effects of isolation. At least three major biological systems have been implicated: the neuroendocrine (HPA) axis, the immune system, and the autonomic nervous system. This review summarizes studies examining the relationship between isolation and mortality and the pathophysiological mechanisms underlying SI. Cardiovascular, cerebrovascular, and neurological diseases including atherosclerosis, myocardial infarction, ischemic stroke and Alzheimer’s disease are given special emphasis in the context of SI. Sex differences are highlighted and studies are separated into clinical and basic science for clarity.",atherosclerosis;autonomic nervous system;biology;brain ischemia;cerebrovascular accident;cerebrovascular disease;clinical study;cognition;health;heart infarction;human;immune system;inflammation;injury;mental stress;morbidity;mortality;neurologic disease;prevalence;sex difference;social interaction;social isolation;vascular disease,"Friedler, B.;Crapser, J.;McCullough, L.",2014,,,0,
1391,Neurobiology of atypical presentations among medicare beneficiaries with unstable angina pectoris,,age;behavior;blood pressure regulation;brain function;brain stem;clinical feature;cognition;coping behavior;coronary artery disease;dementia;elderly care;environmental factor;family history;health;health care quality;heart arrhythmia;heart disease;hemispheric dominance;human;hypercholesterolemia;immunity;mental health;mental stress;microvasculature;mood;neurobiology;neuromodulation;note;priority journal;respiratory tract disease;rumination;sex difference;speech;symptom;unstable angina pectoris;vasoconstriction;vasospasm;working memory,"Friedman, E. H.",2003,,,0,
1392,Reduced plasma levels of asymmetric Di-Methylarginine (ADMA) in patients with alcohol dependence normalize during withdrawal,"Asymmetric Di-Methylarginine, an endogenous inhibitor of nitric oxide synthase, is increasingly recognized as vascular risk factor. Elevated ADMA levels have been described not only in 'typical' vascular diseases like congestive heart failure, artherosclerosis and diabetes but also for major depression and Alzheimer's disease. As homocysteine increases ADMA levels and elevated homocysteine serum levels are present in patients with alcohol dependence, the aim of the present study was to examine plasma ADMA levels in patients with alcohol dependence during withdrawal. ADMA and homocysteine levels were measured in the plasma from 42 patients drawn at baseline, on day 1, day 3 and day 7-10 of inpatient detoxification treatment. Measurements were compared against 32 healthy controls. We found significantly lower levels of ADMA in patients at baseline and on day 1 and 3, while no differences were present at the end of treatment. Plasma ADMA levels significantly increased during withdrawal. We found no association between homocysteine and ADMA levels. Our finding of reduced ADMA levels in actively drinking alcohol dependent patients is in apparent contrast to other findings regarding cardiovascular risk factors in alcoholism. However an influence of alcohol on arginine metabolism may help explain the so called 'French paradox'. © 2012 Elsevier B.V. and ECNP.","homocysteine;n(g),n(g) dimethylarginine;adult;alcohol withdrawal;alcoholism;amino acid blood level;article;cardiovascular risk;clinical article;controlled study;drinking behavior;hospital patient;human;male;priority journal","Frieling, H.;Leitmeier, V.;Haschemi-Nassab, M.;Kornhuber, J.;Rhein, M.;Bleich, S.;Hillemacher, T.",2012,,,0,
1393,Twenty-four-hour ambulatory electrocardiography in elderly subjects: prevalence of various arrhythmias and prognostic implications (report from the Bronx Longitudinal Aging Study),"Functional, ambulatory, community-dwelling subjects (n = 423, aged 75 to 85 years) underwent baseline 24-hour ambulatory electrocardiography (ECG) examinations as part of the Bronx Aging Study, a 10-year prospective cohort study designed to identify risk factors and disease markers for cardiovascular, cerebrovascular, and dementia illnesses in old people. Premature ventricular contractions were the most commonly observed arrhythmia noted (93% of subjects), with a low prevalence of nonsustained ventricular tachycardia (5%), paroxysmal atrial tachycardia (13%), atrial fibrillation (4%), and atrioventricular blocks (4%). A 24-hour sinus rate of < 60 beats/min was noted in 13% of subjects, and 11% of subjects were noted to have transient episodes of severe bradycardia (< 40 beats/min). In a multivariate analysis, nonsustained ventricular tachycardia was an independent predictor of death (p = 0.015; relative risk [RR] 2.8; 95% confidence interval [CI] 1.4 to 5.8) and myocardial infarction (p = 0.031; RR 3.2; CI 1.2 to 9.4). Transient atrioventricular block was an independent predictor of stroke (p - 0.0006; RR 9.7; CI 3.3 to 28.9), as was sinus bradycardia over a 24-hour period (p = 0.033; RR 2.7; CI 1.2 to 6.4). Ventricular tachycardia approached significance as an independent predictor of multiinfarct dementia (p = 0.052; RR 6.3; CI 1.4 to 28.7). Episodes of paroxysmal atrial fibrillation, a trial tachycardia, and severe bradycardia were not associated with adverse outcomes. Some arrhythmias found on the ambulatory ECG in very old subjects can predict an increased risk for subsequent death, myocardial infarction, stroke, and multiinfarct dementia.","Aged;Aged, 80 and over;Arrhythmias, Cardiac/*epidemiology/physiopathology;*Electrocardiography, Ambulatory;Female;Humans;Longitudinal Studies;Male;Multivariate Analysis;New York City/epidemiology;Prognosis","Frishman, W. H.;Heiman, M.;Karpenos, A.;Ooi, W. L.;Mitzner, A.;Goldkorn, R.;Greenberg, S.",1996,Aug,,0,
1394,Primary or secondary prevention for AD: Who cares?,,amyloid beta protein;crenezumab;hypocholesterolemic agent;tau protein;Alzheimer disease;amyloidosis;brain amyloidosis;coronary artery atherosclerosis;disease course;human;letter;nerve degeneration;neuropathology;primary prevention;priority journal;secondary prevention,"Frisoni, G. B.;Trojanowski, J. Q.",2012,,,0,
1395,Which comorbidity classification best fits elderly candidates for radical prostatectomy?,"Objectives:Comorbidity assessment may assist in the treatment choice for elderly men with prostate cancer. There is, however, no consensus on the best comorbidity classification for this purpose. In this study, we used a heuristic approach to identify an optimal comorbidity classification in elderly men selected for radical prostatectomy. Methods and materials:A total of 1,106 men aged 65 years or older who underwent radical prostatectomy for clinically localized prostate cancer were stratified by 11 3-sided comorbidity classifications. Overall survival was the study endpoint. The comorbidity classifications were evaluated considering 4 statistical (height of hazard ratios and P values, survival difference between high and low risk patients, dose-response relationship) and 4 clinical demands (survival rates in low and high risk group, balance of the proportion of the risk groups). The 3 best classifications in each category received 3, 2, or 1 point. After adding all points, the classification with the highest score was considered best. Results:With one exception, all comorbidity classifications were significant predictors of overall survival. Comparing the highest with the lowest risk group, the hazard ratios ranged between 1.67 and 3.93. Concerning the fulfillment of clinical and statistical demands, the American Society of Anesthesiologists (ASA) physical status classification and 1 derivative of it that included further more clearly defined diseases were the most promising candidates. Conclusions:Stratifying candidates for radical prostatectomy according to their mortality risk using the ASA classification as a backbone supplemented by a list of more clearly defined concomitant diseases could be useful in clinical practice and outcome studies. © 2013 Elsevier Inc.",aged;angina pectoris;article;body mass;cancer classification;cancer surgery;cancer survival;cerebrovascular disease;comorbidity;connective tissue disease;dementia;diabetes mellitus;heart failure;heart infarction;hemiplegia;high risk population;human;hypertension;kidney disease;leukemia;liver disease;lung disease;lymphoma;major clinical study;male;overall survival;peripheral occlusive artery disease;priority journal;prostate cancer;prostatectomy;surgical risk;thromboembolism;ulcer,"Froehner, M.;Hentschel, C.;Koch, R.;Litz, R. J.;Hakenberg, O. W.;Wirth, M. P.",2013,,,0,
1396,Comorbidity and survival of patients selected for radical prostatectomy at an age of 75 years or older,"Radical prostatectomy in elderly patients is controversial. To identify very old candidates for radical prostatectomy with the highest probability of long-term survival, we studied 47 consecutive men who underwent radical prostatectomy between 1992 and 2005 at an age of 75 years or older. A heuristic approach was used to search for subgroups with particularly high long-term survival. Several two-sided comorbidity measures and combinations of these measures were investigated to find classifications best identifying healthy, long-living elderly candidates for radical prostatectomy. Four of the 25 two-sided comorbidity classifications or combinations reached the significance level with hazard ratios between 4.00 and 4.80. After 10 years, patients identified as healthy patients according to these comorbidity measurements had exhibited relative survival rates between 129%and 137%and overall survival rates between 86%and 95%, whereas those with comorbidities had exhibited relative survival rates of only 66%-84%and overall survival rates of 44%-58%. In conclusion, classifying comorbidity may identify a meaningful proportion of men selected for radical prostatectomy at an age of 75 years or older with an excellent long-term survival probability superseding that of the general population. © 2013 AJA, SIMM & SJTU. All rights reserved.",aged;angina pectoris;article;cerebrovascular disease;clinical article;comorbidity;connective tissue disease;dementia;diabetes mellitus;follow up;geriatric patient;Gleason score;groups by age;heart failure;heart infarction;hemiplegia;human;hypertension;kidney disease;leukemia;liver disease;long term survival;lung disease;lymphoma;male;metastasis;overall survival;peripheral occlusive artery disease;prostatectomy;risk assessment;solid tumor;survival rate;thromboembolism;ulcer,"Froehner, M.;Koch, R.;Wirth, M. P.",2013,,,0,
1397,Long-term treatment of patients with Alzheimer's disease in primary and secondary care: Results from an international survey,"Objective: The International Outcomes Survey in Dementia (IOSID) was initiated to observe the effects of current standard of care for Alzheimer's disease (AD) on patient outcomes and caregiver burden in a real-life setting. Research design and methods: This 2-year, international, prospective, longitudinal and observational cohort survey involved patients with mild-to-moderate AD (Mini-Mental State Examination [MMSE] scores of 10-26 points) living in an ordinary household at baseline. There was no intervention with regard to patient management. Primary informal caregivers were also included in the survey. Main outcome measures: Patient parameters assessed included the MMSE, Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI), and Clinical Global Impression (CGI). Caregiver burden was evaluated with the Zarit Burden Interview and caregiver distress was assessed as part of the NPI. Adverse events (AEs) were monitored. Results: Of 2288 patients recruited, 1382 (60.4%) completed the survey. At baseline, the majority (79.3%) of patients were receiving treatment with acetylcholinesterase inhibitors (AChEIs) or/and memantine. MMSE, DAD, NPI and CGI scores all showed that patients experienced deterioration of AD symptoms during the survey. MMSE scores declined less steeply than might have been expected based on historical data. Scores on the four outcome scales were significantly correlated at all time points. Mean caregivers' feeling of strain and caregiver distress increased during the survey. AEs occurring in more than 2% of patients were nausea (3.0%), injury (2.6%), fall (2.4%), depression (2.2%) and urinary tract infection (2.2%). Conclusions: Community patients with AD experience progressive and interconnected decline in cognition, behaviour and functioning over time, placing increased burden on caregivers. However, improved care in recent years, including AChEI use, might be reflected in slower rates of patient decline than were evident in the past. Overall, relatively low rates of AEs were apparent during the survey. Limitations of this survey included a smaller than anticipated number of recruited patients confounding the possibility of performing comprehensive subgroup analyses, and the lack of randomisation inherent in the survey methodology. © 2009 Informa UK Ltd.",alpha tocopherol;cholinesterase inhibitor;donepezil;galantamine;Ginkgo biloba extract;memantine;rivastigmine;tacrine;adult;aged;Alzheimer disease;article;behavior;caregiver burden;cerebrovascular accident;Clinical Global Impression scale;cognition;cohort analysis;community living;dementia;depression;deterioration;disability;disease severity;distress syndrome;falling;female;health care quality;health care utilization;health survey;heart infarction;household;human;injury;long term care;major clinical study;male;Mini Mental State Examination;nausea;patient care;primary health care;side effect;symptom;treatment outcome;urinary tract infection,"Froelich, L.;Andreasen, N.;Tsolaki, M.;Foucher, A.;Kavanagh, S.;Van Baelen, B.;Schwalen, S.",2009,,,0,
1398,The terminal phase of life as a team-based clinical global judgment: Prevalence and associations in an acute geriatric unit,"Background: In most elderly people, the final-terminal-phase of life is characterized by permanent dependency and a complete inability to perform activities of daily living. Treatment targets usually switch from rehabilitation to palliation. However, the prevalence of the clinical judgment ""last phase of life"" and its association with in-hospital death is unknown in geriatric patients. Patients and methods: We retrospectively analyzed GEMIDAS data from two geriatric units. Patients without cancer and an in-hospital stay of at least 1 week were included in our study. Prevalence of the terminal phase of life was clinically assessed according to the proposals made by M. Gillick. This clinical judgment was pronounced by the geriatric team after a stay in the hospital of at least 1 week. The clinical judgment took into account all available assessment parameters, as well as the impact of a geriatric treatment trial. In addition, the association between the clinical judgment and the risk of in-hospital mortality was analyzed. Results: Records from 2,433 (56%) patients in hospital A and from 1,912 (44%) patients in hospital B were analyzed. The frequency of a terminal phase of life was 30% and 9% (p<0.01), respectively. The frequency depended on the manner of admission to the hospital. In both hospitals, mortality was significantly higher in terminal patients (27% and 37%) than in other patients (0-8% and 0-6%). In both hospitals, the risk of in-hospital mortality was significantly associated with the clinical judgment (OR 3.1 and 2.7), heart failure (OR 2.2 and 2.1), and dementia (OR 2.0 and 1.8). Age, residency in a nursing home, and the Barthel Index on admission were all without relevant impact. Conclusion: The frequency of the clinical construct ""terminal phase of life"" varies in geriatric units between 9% and 30%. This clinical construct is significantly associated with increased in-hospital mortality. Therefore, this construct possesses external validity. Further studies are needed in order to assess the significance of such a clinical judgment, the associations with clinical burdens of symptoms, and the supply structure required to cover the needs of patients and their families. © 2011 Springer-Verlag.",aged;Alzheimer disease;article;cooperation;cross-sectional study;decision making;decision support system;elderly care;female;Germany;heart failure;home for the aged;hospital subdivisions and components;human;interdisciplinary communication;male;mortality;nursing home;palliative therapy;patient care;risk;risk factor;statistics;terminal care,"Frohnhofen, H.;Hagen, O.;Heuer, H. C.;Falkenhahn, C.;Willschrei, P.;Nehen, H. G.",2011,,,0,
1399,Feasibility of the Epworth Sleepiness Scale in a sample of geriatric in-hospital patients,"Excessive daytime sleepiness (EDS) is a major health concern in geriatric patients. EDS affects quality of life, daytime function, and mortality. The Epworth Sleepiness Scale (ESS) is a standard tool for the assessment daytime sleepiness, but the feasibility of the ESS has never been investigated in elderly subjects. We applied the ESS to a random sample of geriatric in-hospital patients. The aim of the study was to reveal the frequency and the risk factors for processing failure of the ESS in geriatric patients. 458 patients with a mean age of 82+/-8 years were included. One hundred sixty six (36%) completed the ESS, 118 (28%) patients had omissions of items, and 174 (38%) patients were unable to respond to any item. Completion of the ESS correlated significantly with age, disability, dementia, impairment of vision, and hearing. Omitted items were related to mobility and activities outside the house. Logistic regression analysis with completed ESS as a dependent variable revealed that dementia, disability, heart failure, and COPD were independent and significant risk factors for processing failure. The majority of patients of a geriatric unit are unable to complete the ESS. Since EDS is a frequent finding with a negative impact on health, the development of a reliable and valid tool for the assessment of EDS in elderly subjects is needed.","Disorders of Excessive Somnolence [diagnosis] [physiopathology];Feasibility Studies;Geriatric Assessment [methods];Hospitalization;Risk Factors;Severity of Illness Index;Sleep Stages [physiology];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]","Frohnhofen, H;Popp, R;Willmann, V;Heuer, Hc;Firat, A",2009,,,0,1400
1400,Feasibility of the Epworth Sleepiness Scale in a sample of geriatric in-hospital patients,"Excessive daytime sleepiness (EDS) is a major health concern in geriatric patients. EDS affects quality of life, daytime function, and mortality. The Epworth Sleepiness Scale (ESS) is a standard tool for the assessment daytime sleepiness, but the feasibility of the ESS has never been investigated in elderly subjects. We applied the ESS to a random sample of geriatric in-hospital patients. The aim of the study was to reveal the frequency and the risk factors for processing failure of the ESS in geriatric patients. 458 patients with a mean age of 82+/-8 years were included. One hundred sixty six (36%) completed the ESS, 118 (28%) patients had omissions of items, and 174 (38%) patients were unable to respond to any item. Completion of the ESS correlated significantly with age, disability, dementia, impairment of vision, and hearing. Omitted items were related to mobility and activities outside the house. Logistic regression analysis with completed ESS as a dependent variable revealed that dementia, disability, heart failure, and COPD were independent and significant risk factors for processing failure. The majority of patients of a geriatric unit are unable to complete the ESS. Since EDS is a frequent finding with a negative impact on health, the development of a reliable and valid tool for the assessment of EDS in elderly subjects is needed.","Disorders of Excessive Somnolence [diagnosis] [physiopathology];Feasibility Studies;Geriatric Assessment [methods];Hospitalization;Risk Factors;Severity of Illness Index;Sleep Stages [physiology];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]","Frohnhofen, H.;Popp, R.;Willmann, V.;Heuer, H. C.;Firat, A.",2009,,,0,
1401,Inspector Wallander’s clinical history: Metabolic syndrome with type 2 diabetes mellitus,"Background: Literature can make a contribution to curing diseases. In Anglo-Saxon countries medical analyses of literary texts (humanities) are an integral component of the curricular training of medical students. Henning Mankell’s Wallander: In Henning Mankell’s (1948–2015) novels with the Swedish Police Inspector Kurt Wallander, the reader experiences not only something about his investigative skills but is also witness to his clinical history. From the very beginning his regular consumption of alcohol and his battle against overweight are constantly highlighted and later also an episode of depression. The first symptoms of diabetes mellitus are described in Vol. 7 and in the last book the Inspector suffers from progressive mental and cognitive impairments due to Alzheimer’s disease. Kurt Wallander’s diabetes: The type of diabetes is not specified in the books. Based on the course of the disease, the description of the comorbidities and the treatment, type 2 diabetes mellitus can be deduced. In accordance with the lack of compliance, the plasma glucose levels mentioned in the books are unsatisfactory resulting in several episodes of hypoglycemia. Kurt Wallander suffers from metabolic syndrome but too few data are given in the novels for the diagnosis of additional comorbidities: coronary artery disease, initial stages of peripheral neuropathy and diabetic retinopathy are all possible. Conclusion: Overall, the story of Kurt Wallander reflects a typical at risk patient who is unable to cope with his disease. The examination of literary figures with specific diseases could school physicians in anamnestic and diagnostic skills and also lead to a return to a holistic approach to patients.",article;comorbidity;coronary artery disease;diabetic retinopathy;human;metabolic syndrome X;neuropathy;non insulin dependent diabetes mellitus,"Frommhold, B.;Wolf, G.",2017,,10.1007/s11428-017-0192-z,0,
1402,Lysoplex: An efficient toolkit to detect DNA sequence variations in the autophagy-lysosomal pathway,"The autophagy-lysosomal pathway (ALP) regulates cell homeostasis and plays a crucial role in human diseases, such as lysosomal storage disorders (LSDs) and common neurodegenerative diseases. Therefore, the identification of DNA sequence variations in genes involved in this pathway and their association with human diseases would have a significant impact on health. To this aim, we developed Lysoplex, a targeted next-generation sequencing (NGS) approach, which allowed us to obtain a uniform and accurate coding sequence coverage of a comprehensive set of 891 genes involved in lysosomal, endocytic, and autophagic pathways. Lysoplex was successfully validated on 14 different types of LSDs and then used to analyze 48 mutation-unknown patients with a clinical phenotype of neuronal ceroid lipofuscinosis (NCL), a genetically heterogeneous subtype of LSD. Lysoplex allowed us to identify pathogenic mutations in 67% of patients, most of whom had been unsuccessfully analyzed by several sequencing approaches. In addition, in 3 patients, we found potential disease-causing variants in novel NCL candidate genes. We then compared the variant detection power of Lysoplex with data derived from public whole exome sequencing (WES) efforts. On average, a 50% higher number of validated amino acid changes and truncating variations per gene were identified. Overall, we identified 61 truncating sequence variations and 488 missense variations with a high probability to cause loss of function in a total of 316 genes. Interestingly, some loss-of-function variations of genes involved in the ALP pathway were found in homozygosity in the normal population, suggesting that their role is not essential. Thus, Lysoplex provided a comprehensive catalog of sequence variants in ALP genes and allows the assessment of their relevance in cell biology as well as their contribution to human disease.",genomic DNA;article;autophagy;autophagy lysosomal pathway;clinical article;controlled study;copy number variation;Danon disease;diagnostic test accuracy study;DNA determination;DNA sequence;enzyme activity;Fabry disease;fibroblast;Gaucher disease;gene expression;gene identification;gene mutation;genetic code;genetic variability;genotype phenotype correlation;glycogen storage disease type 2;GM1 gangliosidosis;homozygosity;human;human cell;Hurler syndrome;loss of function mutation;lysosome;lysosome storage disease;metachromatic leukodystrophy;molecular diagnosis;molecular diagnostics;mucopolysaccharidosis;multiple sulfatase deficiency;neuronal ceroid lipofuscinosis;next generation sequencing;nonsense mutation;Pick presenile dementia;Sanfilippo syndrome;sensitivity and specificity;signal transduction;Lysoplex,"Fruscio, G. D.;Schulz, A.;Cegli, R. D.;Savarese, M.;Mutarelli, M.;Parenti, G.;Banfi, S.;Braulke, T.;Nigro, V.;Ballabio, A.",2015,,,0,
1403,Deaths and complications from hypertension,"In a long term follow-up over 25 years in a general practice the observed courses of complications and deaths in a group of 704 hypertensives were recorded and compared with those that occurred in the practice as a whole over the same period. The risks to the hypertensives were calculated as ratios of the observed: expected (O/E) complications and mortalities.Of the total number of complications and deaths (418), one half were cardiovascular and one-third were strokes.The O/E rates for coronary artery diseases as a whole showed no extra risks for the hypertensives, but the risks for young female hypertensives were appreciably higher. The O/E rates were nearly three times higher for females. The risks of hypertensives suffering from coronary artery diseases fell with age in both sexes.The observed rates for strokes were nearly four times greater than those expected. The O/E rates were similar in males and females. There was a decline with age.An unexpected finding was the higher O/E rate for dementia in elderly female hypertensives.The findings confirm the higher risks of complications and deaths for hypertensives, but within the whole spectrum of hypertension are some groups who are more vulnerable than others. These are males and those under 60 years of age. These vulnerables probably account for less than one half of all hypertensives diagnosed. It is suggested that a much more discriminating policy for the management of hypertension is accepted in order to make diagnosis and treatment of those hypertensives who really need intensive care practical, feasible, and possible.",Adult;Aged;Cerebrovascular Disorders/etiology;Coronary Disease/etiology;Dementia/etiology;Female;Follow-Up Studies;Heart Failure/etiology;Humans;Hypertension/*complications/mortality;Kidney Diseases/etiology;Male;Middle Aged,"Fry, J.",1975,Jul,,0,
1404,Vitamin E Status and Neurodegenerative Disease,"Vitamin E (alpha-and gamma-tocopherol) may slow the progression of a number of major degenerative diseases of the nervous system that appear to be significantly worsened by oxidative stress. The effects of vitamin E on excitoxicity in cultured neurones is considered, together with ataxia due to vitamin E deficiency (AVED) arising from abetalipoproteinaemia, cholestatic liver disease, cystic fibrosis, short bowel syndrome, total parenteral nutrition, diabetic peripheral neuropathy and familial isolated vitamin E (FIVE) deficiency. Selenium deficiency in Keshan disease is also described in relation to the cardiomyopathy seen in Friedreich's ataxia. Evidence for any beneficial effects of vitamin E upon the course of Friedreich's ataxia, tardive dyskinesia, amyotrophic lateral sclerosis (motor neurone disease), Parkinson's disease, Alzheimer's disease, and Huntington's disease is examined. The application of vitamin E derivatives as protective agents in posttraumatic injury to the nervous system (stroke, head and spinal cord injury and haemorrhage) is discussed.",Antioxidant;Neurodegeneration;Vitamin E;alpha-Tocopherol;gamma-Tocopherol,"Fryer, M. J.",1998,,10.1080/1028415x.1998.11747243,0,
1405,Health service utilization among Alzheimer's disease patients: Evidence from managed care,"Background: The objective of this study was to assess the disease burden of Alzheimer's disease (AD) in a commercial managed care setting by comparing direct health care costs and adverse event outcomes between patients with AD and without AD. Methods: The study design used eligibility, medical, and pharmacy claims data from a large, national, geographically diverse, fee-for-service U.S. managed health plan. Commercially insured patients aged 65 years and older with a pharmacy benefit with evidence of AD (n = 4,450) and a control group without AD (n = 13,650) were matched by age, gender, plan location, and length of enrollment. Adverse event outcomes, comorbid conditions, and annualized health care costs were compared. Incremental costs were calculated by using a two-part model to estimate the burden of illness; incremental cost confidence intervals were estimated by bootstrap analysis. Results: Patients with AD had generally higher health care costs and higher risk of acute adverse outcomes than the control cohort. Annual adjusted total health care costs per patient were approximately $1,418 greater for the AD cohort. Patients with AD had an unadjusted fracture risk of 14.6% versus 6.2% in the matched cohort and accidental injury/falls risk of 27.4% versus 11.4%. Conclusions: Few studies have examined the disease burden of AD in commercial managed care settings. Similar to results of comparative studies with Medicare data, the disease burden is greater for patients with AD compared with a matched control cohort, with a different mix and a greater number of comorbid health care conditions partially accounting for this difference. As membership in commercial and Medicare managed care plans increases, plans will need to develop effective mechanisms to manage the health care of high-risk, high-cost patients with AD. © 2008 The Alzheimer's Association.",cholinesterase inhibitor;donepezil;galantamine;nootropic agent;rivastigmine;tacrine;accidental injury;age;aged;alcohol abuse;Alzheimer disease;anxiety disorder;arthritis;article;atherosclerosis;bipolar disorder;cohort analysis;comorbidity;confidence interval;controlled study;depression;diabetes mellitus;drug abuse;falling;female;fracture;health care cost;health care utilization;health insurance;heart infarction;high risk patient;human;hyperlipidemia;ischemic heart disease;kidney failure;liver disease;major clinical study;male;malignant neoplastic disease;managed care;medical research;medicare;outcome assessment;Parkinson disease;patient care;priority journal;psychosis;respiratory tract disease;risk assessment;sex difference;cerebrovascular accident;United States,"Frytak, J. R.;Henk, H. J.;Zhao, Y.;Bowman, L.;Flynn, J. A.;Nelson, M.",2008,,,0,
1406,Comorbidity in Dementia: An Autopsy Study,"Context.-There is a paucity of accurate postmortem data pertinent to comorbid medical conditions in patients with dementia, including Alzheimer disease. Objectives.-The purposes of this study were (a) to examine general autopsy findings in patients with a dementia syndrome and (b) to establish patterns of central nervous system comorbidity in these patients. Design. -Review of autopsy reports and selected case material from 202 demented patients who had ""brainonly"" autopsies during a 17-year period (1984-2000) and from 52 demented patients who had general autopsies during a 6-year period (1995-2000). Setting.-Large academic medical center performing approximately 200 autopsies per year. Results.-Among the 52 patients who underwent complete autopsy, the most common cause of death was bronchopneumonia, which was found in 24 cases (46.1%). Other respiratory problems included emphysema, found in 19 (36.5%) of 52 patients, and pulmonary thromboembolism, found in 9 (17.3%) of 52 patients. In 6 cases, pulmonary thromboembolism was the proximate cause of death. Twenty-one (40.3%) of the 52 patients had evidence of a myocardial infarct (varying ages) and 38 (73.1%) had atherosclerotic cardiovascular disease, 27 of a moderate to severe degree. Four clinically unsuspected malignancies were found: I each of glioblastoma multiforme, diffusely infiltrative central nervous system lymphoma, pancreatic adenocarcinoma, and adenocarcinoma of the lung. One patient with frontotemporal dementia and amyotrophic lateral sclerosis died of severe meningoencephalitis/ventriculitis, probably secondary to seeding of the central nervous system by an infected cardiac valve. Of the 202 demented patients who underwent brain-only autopsies, the following types of dementia were found: 129 (63.8%) cases showed changes of severe Alzheimer disease, 21 (10.4%) showed combined neuropathologic abnormalities (Alzheimer disease plus another type of lesion, such as significant ischemic infarcts or diffuse Lewy body disease), 12 (5.9%) cases of relatively pure ischemic vascular dementia, 13 (6.4%) cases of diffuse Lewy body disease, and 8 (4.0%) cases of frontotemporal dementia. The remaining 19 (9.4%) patients showed miscellaneous neuropathologic diagnoses, including normal pressure hydrocephalus and progressive supranuclear palsy. Among the demented patients, 92 (45.5%) had cerebral atherosclerosis, which was moderate to severe in 65 patients (32.2%). Conclusions.-Some of the conditions found at autopsy, had they been known antemortem, would likely have affected clinical management of the patients. Autopsy findings may be used as a quality-of-care measure in patients who have been hospitalized in chronic care facilities for a neurodegenerative disorder.",accuracy;adult;aged;Alzheimer disease;amyotrophic lateral sclerosis;article;atherosclerosis;autopsy;brain ischemia;brain lymphoma;brain ventriculitis;bronchopneumonia;cadaver;cardiovascular disease;cause of death;central nervous system;dementia;disease severity;female;frontotemporal dementia;glioblastoma;health care quality;heart infarction;human;human tissue;hydrocephalus;Lewy body;lung adenocarcinoma;lung embolism;lung emphysema;male;meningoencephalitis;neuropathology;pancreas adenocarcinoma;progressive supranuclear palsy,"Fu, C.;Chute, D. J.;Farag, E. S.;Garakian, J.;Cummings, J. L.;Vinters, H. V.",2004,,,0,
1407,Morbidity risk in HFE associated hereditary hemochromatosis C282Y heterozygotes,"Hereditary hemochromatosis (HHC) is a late-onset, autosomal recessive disorder leading to a chronic iron overload syndrome, finally causing diabetes, cardiomyopathy and liver disease. HHC is the most common single gene disorder in northern Europeans that occurs with a frequency of approximately 0.5%, and most of these patients carry the C282Y and H63D mutation in the HFE gene on chromosome 6p21.3. The vast majority of HHC patients are homozygous for the C282Y mutation, but HHC phenotypes are observed in other genotypes. Expression of the disease, in those homozygous for the C282Y mutation, is highly variable depending on the various features of the population studied. C282Y heterozygotes have slightly increased iron stores and in absence of other genetic and/or environmental factors do usually not develop the HHC phenotype. It is currently a matter of debate whether C282Y heterozygotes may have an increased risk for morbidity. Different studies investigating the association of C282Y heterozygocity with morbidity have given conflicting results, as is exemplified by extrahepatic cancers, cardiovascular diseases, alcoholic liver disease, and diabetes. However, there are examples of clear and unambiguous disease associations, such as with sporadic pophyria cutanea tarda. It remains to be seen whether a strong correlation between the C282Y heterozygous state and distinct pathological conditions will exist and large-scale genotyping studies will help to identify such potential risk groups in the future. © 2002 Elsevier Science Ireland Ltd. All rights reserved.",alcohol liver cirrhosis;Alzheimer disease;article;autosomal recessive disorder;neoplasm;cardiomyopathy;cardiovascular disease;clinical feature;diabetes mellitus;disease association;environmental factor;Europe;gene mutation;genetic heterogeneity;genetic predisposition;genotype phenotype correlation;hemochromatosis;hepatitis;heterozygote;human;infection sensitivity;iron overload;liver cell carcinoma;liver disease;liver transplantation;morbidity;population genetics;porphyria cutanea tarda;priority journal;radiosensitivity;risk assessment,"Fuchs, J.;Podda, M.;Packer, L.;Kaufmann, R.",2002,,,0,
1408,Macrophage inhibitory cytokine-1 is associated with cognitive impairment and predicts cognitive decline - the Sydney Memory and Aging Study,"Higher levels of macrophage inhibitory cytokine-1, also known as growth differentiation factor 15 (MIC-1/GDF15), are associated with adverse health outcomes and all-cause mortality. The aim of this study was to examine the relationships between MIC-1/GDF15 serum levels and global cognition, five cognitive domains, and mild cognitive impairment (MCI), at baseline (Wave 1) and prospectively at 2 years (Wave 2), in nondemented participants aged 70-90 years. Analyses were controlled for age, sex, education, Framingham risk score, history of cerebrovascular accident, acute myocardial infarction, angina, cancer, depression, C-reactive protein, tumor necrosis factor-alpha, interleukins 6 and 12, and apolipoprotein epsilon4 genotype. Higher MIC-1/GDF15 levels were significantly associated with lower global cognition at both waves. Cross-sectional associations were found between MIC-1/GDF15 and all cognitive domains in Wave 1 (all P < 0.001) and between processing speed, memory, and executive function in Wave 2 (all P < 0.001). Only a trend was found for the prospective analyses, individuals with high MIC-1/GDF15 at baseline declined in global cognition, executive function, memory, and processing speed. However, when categorizing MIC-1/GDF15 by tertiles, prospective analyses revealed statistically significant lower memory and executive function in Wave 2 in those in the upper tertile compared with the lower tertile. Receiver operating characteristics (ROC) analysis was used to determine MIC-1/GDF15 cutoff values associated with cognitive decline and showed that a MIC-1/GDF15 level exceeding 2764 pg/ml was associated with a 20% chance of decline from normal to MCI or dementia. In summary, MIC-1/GDF15 levels are associated with cognitive performance and cognitive decline. Further research is required to determine the pathophysiology of this relationship.","Aged;Aged, 80 and over;Aging/*blood;Cognition/*physiology;Cognition Disorders/*blood/psychology;Female;Growth Differentiation Factor 15/*blood/genetics;Humans;Male;Memory/*physiology;aging;cognitive decline;dementia;growth differentiation factor-15;inflammation;macrophage inhibitory cytokine-1;mild cognitive impairment","Fuchs, T.;Trollor, J. N.;Crawford, J.;Brown, D. A.;Baune, B. T.;Samaras, K.;Campbell, L.;Breit, S. N.;Brodaty, H.;Sachdev, P.;Smith, E.",2013,Oct,10.1111/acel.12116,0,
1409,Prevention of age-induced N(epsilon)-(carboxymethyl)lysine accumulation in the microvasculature,"OBJECTIVE: N(epsilon)-(carboxymethyl)lysine (CML) is one of the major advanced glycation end products in both diabetics and nondiabetics. CML depositions in the microvasculature have recently been linked to the aetiology of acute myocardial infarction and cognitive impairment in Alzheimer's disease, possibly related to local enhancement of inflammation and oxidative processes. We hypothesized that CML deposition in the microvasculature of the heart and brain is age-induced and that it could be inhibited by a diet intervention with docosahexaenoic acid (DHA), an omega-3 fatty acid known for its anti-inflammatory and antioxidative actions. MATERIALS AND METHODS: ApoE(-/-) mice (n = 50) were fed a Western diet and were sacrificed after 40, 70 and 90 weeks. Part of these mice (n = 20) were fed a Western diet enriched with DHA from 40 weeks on. CML in cardiac and cerebral microvessels was quantified using immunohistochemistry. RESULTS: Cardiac microvascular depositions of CML significantly increased with an immunohistochemical score of 11.85 [5.92-14.60] at 40 weeks, to 33.17 [17.60-47.15] at 70 weeks (P = 0.005). At the same time points, cerebral microvascular CML increased from 6.45; [4.78-7.30] to 12.99; [9.85-20.122] (P = 0.003). DHA decreased CML in the intramyocardial vasculature at both 70 and 90 weeks, significant at 70 weeks [33.17; (17.60-47.15) vs. 14.73; (4.44-28.16) P = 0.037]. No such effects were found in the brain. CONCLUSIONS: Accumulation of N(epsilon)-(carboxymethyl)lysine in the cerebral and cardiac microvasculature is age-induced and is prevented by DHA in the intramyocardial vessels of ApoE(-/-) mice.",Advanced glycation end products;N(epsilon)-(carboxymethyl)lysine (CML);age-related pathology;docosahexaenoic acid;microvasculature,"Fuijkschot, W. W.;de Graaff, H. J.;Berishvili, E.;Kakabadze, Z.;Kupreishvili, K.;Meinster, E.;Houtman, M.;van Broekhoven, A.;Schalkwijk, C. G.;Vonk, A. B.;Krijnen, P. A.;Smulders, Y. M.;Niessen, H. W.",2016,Apr,10.1111/eci.12599,0,
1410,"A randomized, open-label trial of edoxaban in Japanese patients with severe renal impairment undergoing lower-limb orthopedic surgery","Background: Edoxaban is an oral, direct, factor Xa inhibitor approved in Japan for thromboembolic prophylaxis after lower-limb orthopedic surgery (LLOS), but contraindicated in patients with severe renal impairment (SRI; creatinine clearance [CLCR] ≥15 to <30 mL/min). Methods: This open-label study compared the safety of edoxaban 15 mg once daily in Japanese patients with SRI to that of edoxaban 30 mg in patients with mild renal impairment (MiRI; CLCR ≥50 to ≤80 mL/min; N = 30) undergoing LLOS. Patients with CLCR ≥20 to <30 mL/min were randomized to receive edoxaban 15 mg (N = 22) or subcutaneous fondaparinux 1.5 mg once daily (N = 21). All patients with CLCR ≥15 to <20 mL/min received edoxaban 15 mg (N = 7). Treatment was administered for 11 to 14 days. Results: Major or clinically relevant non-major bleeding occurred in 6.7%, 3.4%, and 5.0% of patients in the MiRI edoxaban 30-mg, SRI edoxaban 15-mg, and SRI fondaparinux groups, respectively; there were no major bleeding events. No thromboembolic events occurred. At all time points assessed, edoxaban plasma concentrations and changes in coagulation biomarkers were similar between the SRI and MiRI groups. Conclusions: These results suggest edoxaban 15 mg once daily is well tolerated in Japanese patients with SRI undergoing LLOS.",NCT01857583;alanine aminotransferase;alkaline phosphatase;aspartate aminotransferase;edoxaban;fondaparinux;gamma glutamyltransferase;acute heart failure;aged;alanine aminotransferase blood level;alkaline phosphatase blood level;article;aspartate aminotransferase blood level;brain infarction;controlled study;creatinine clearance;cystitis;dementia;drug blood level;drug safety;female;femur fracture;gamma glutamyl transferase blood level;hematuria;human;Japanese (people);joint dislocation;male;mild renal impairment;open study;orthopedic surgery;phase 3 clinical trial;pyelonephritis;randomized controlled trial;sepsis;severe renal impairment;side effect;subcutaneous hemorrhage;thromboembolism;thrombosis prevention;total hip prosthesis;total knee replacement,"Fuji, T.;Fujita, S.;Kawai, Y.;Abe, Y.;Kimura, T.;Fukuzawa, M.;Abe, K.;Tachibana, S.",2015,,,0,
1411,Small group teaching in a psychiatric hospital for dementia patients,,neuroleptic agent;nootropic agent;accident;acupuncture;aging;aromatherapy;aspiration pneumonia;behavior disorder;cancer patient;cerebrovascular accident;coffee;constipation;dementia;falling;frail elderly;heart infarction;hip fracture;human;ileus;Japan;letter;lung edema;massage;medical education;medical student;mental disease;mental hospital;neuroleptic malignant syndrome;priority journal;psychotherapy;small group teaching;student attitude;television viewing;terminal care;visual deprivation;vomiting,"Fujii, M.;Ishizuka, S.;Sasaki, H.",2015,,,0,
1412,Effect of oral cilostazol on acute neurological deterioration and outcome of noncardioembolic minor stroke,"Background/Purpose Stroke recurrence in the acute phase is not rare, even in minor stroke patients. We investigated whether combined antithrombotic therapy with early oral cilostazol prevents progressive stroke and improves outcomes in ischemic stroke patients. Methods For the present study, 311 first-time stroke patients who were admitted within 48 hours after the onset and were diagnosed as having a noncardioembolic stroke with National Institutes of Health Stroke Scale (NIHSS) scores of ≤ 7 were prospectively included. All patients were classified into two groups according to oral cilostazol. In Group A, 154 patients were treated with conventional antithrombotic agents with or without oral aspirin (100-200 mg/d), during the first 7 hospital days. In Group C, 157 patients were treated with oral cilostazol 200 mg/d (100 mg twice daily) plus conventional antithrombotic agents during the first 7 hospital days. Neurological deterioration during the first 21 days, stroke recurrence, cardiovascular events, and any deaths during a 3-month follow-up period were compared between Groups A and C. Results The frequencies of neurological deterioration, stroke recurrence, acute myocardial infarction, or death from all causes did not differ between Groups A and C. A good outcome at 3 months after admission was observed more frequently in Group C than in Group A patients (68% vs. 56%, p = 0.0253). In the multivariate analysis, age [odds ratio (OR), 0.94; 95% confidence interval (CI), 0.91-0.97; p < 0.0001] and initial NIHSS score (OR, 0.65; 95% CI, 0.56-0.76; p < 0.0001) were negatively associated, and cilostazol (OR, 1.99; 95% CI, 1.05-3.77; p = 0.0353) was positively associated with a good outcome. Conclusion In noncardioembolic stroke, combined antithrombotic therapy with early oral cilostazol in the acute phase appears to be associated with a good outcome in patients with progressive stroke.",acetylsalicylic acid;argatroban;cilostazol;ozagrel;acute heart infarction;aged;article;brain ischemia;cause of death;controlled study;drug efficacy;drug safety;drug withdrawal;female;follow up;headache;heart palpitation;hospital admission;human;major clinical study;male;mental deterioration;National Institutes of Health Stroke Scale;paroxysmal atrial fibrillation;priority journal;recurrent disease;tachycardia;treatment outcome,"Fujimoto, S.;Osaki, M.;Kanazawa, M.;Tagawa, N.;Kumamoto, M.;Ohya, Y.;Kitazono, T.",2016,,,0,
1413,Perioperative Management of Elderly Patients Over 90 Years of Age with Femoral Neck/Trochanteric Fracture,"BACKGROUND: The use of anesthesia in patients older than 90 years has been increasing. We examined the perioperative management of these patients. METHODS: The perioperative complications, waiting period for surgery, method of anesthesia, and prognosis in patients older than 90 years undergoing operations for femoral neck/trochanteric fractures were retrospectively examined in our anesthesia database. RESULTS: The average age of patients was 94.0+/-2.8 years. All patients had preoperative complications, including hypertensive disease (91.7%), renal dysfunction, anemia, or dementia. The average waiting period for surgery was 3.7+/-2.1 days; 92.6% of the patients underwent surgery within 7 days and 40.7% within 2 days. The main reason for waiting was withdrawal of antiplatelet and anticoagulant drugs. Local anesthesia, including spinal and epidural anesthesia, was used in 77.8% of patients. General anesthesia was selected for those patients on hemodialysis and continuous antiplatelets/anticoagulants. Hypotension was observed in 63.0% of the patients. The postoperative course was satisfactory, with the exception of 2 patients who died within 3 months from pneumonia and heart failure, respectively. CONCLUSIONS: Anesthetic management of the patients was without major complications. Anesthesia, either general or local, was performed safely. Further study of the relative advantages of anesthetic methods is required.","Aged;Aged, 80 and over;Anesthesia/adverse effects/methods;Female;Femoral Neck Fractures/*surgery;Hip Fractures/*surgery;Humans;Male;*Perioperative Care;Retrospective Studies","Fujimoto-Ibusuki, K.;Yamada, Y.;Hirai, T.;Morikawa-Kubota, K.",2015,Oct,,0,
1414,"Efficacy and Blood Plasmalogen Changes by Oral Administration of Plasmalogen in Patients with Mild Alzheimer's Disease and Mild Cognitive Impairment: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial","Background Plasmalogens (Pls) reportedly decreased in postmortem brain and in the blood of patients with Alzheimer's disease (AD). Recently we showed that intraperitoneal administration of Pls improved cognitive function in experimental animals. In the present trial, we tested the efficacy of oral administration of scallop-derived purified Pls with respect to cognitive function and blood Pls changes in patients with mild AD and mild cognitive impairment (MCI). Methods The study was a multicenter, randomized, double-blind, placebo-controlled trial of 24 weeks. Participants were 328 patients aged 60 to 85 years who had 20 to 27 points in Mini Mental State Examination-Japanese (MMSE-J) score and five or less points in Geriatric Depression Scale-Short Version-Japanese (GDS-S-J). They were randomized to receive either 1 mg/day of Pls purified from scallop or placebo. The patients and study physicians were masked to the assignment. The primary outcome was MMSE-J. The secondary outcomes included Wechsler Memory Scale-Revised (WMS-R), GDS-S-J and concentration of phosphatidyl ethanolamine plasmalogens (PlsPE) in erythrocyte membrane and plasma. This trial is registered with the University Hospital Medical Information Network, number UMIN000014945. Findings Of 328 patients enrolled, 276 patients completed the trial (140 in the treatment group and 136 in the placebo group). In an intention-to-treat analysis including both mild AD (20 ≤ MMSE-J ≤ 23) and MCI (24 ≤ MMSE-J ≤ 27), no significant difference was shown between the treatment and placebo groups in the primary and secondary outcomes, with no severe adverse events in either group. In mild AD patients, WMS-R improved significantly in the treatment group, and the between group difference was nearly significant (P = 0.067). In a subgroup analysis of mild AD patients, WMS-R significantly improved among females and those aged below 77 years in the treatment group, and the between-group differences were statistically significant in females (P = 0.017) and in those aged below 77 years (P = 0.029). Patients with mild AD showed a significantly greater decrease in plasma PlsPE in the placebo group than in the treatment group. Interpretation Oral administration of scallop-derived purified Pls may improve cognitive functions of mild AD. Funding.",UMIN000014945;phosphatidylethanolamine;placebo;plasmalogen;adult;aged;akathisia;Alzheimer disease;article;aspiration pneumonia;bladder cancer;cerebrovascular accident;cholelithiasis;clinical trial;cognition;cognitive defect;constipation;controlled clinical trial;controlled study;contusion;coughing;diarrhea;dizziness;double blind procedure;drug efficacy;edema;esophagus cancer;female;fracture;Geriatric Depression Scale;gout;hand paresthesia;heart muscle ischemia;heart ventricle extrasystole;herpes zoster;herpetic stomatitis;human;hypertension;intention to treat analysis;intestine obstruction;kidney failure;knee meniscus rupture;knee pain;liver disease;liver hemangioma;major clinical study;male;Mini Mental State Examination;multicenter study;myalgia;otalgia;ovary cancer;parkinsonism;priority journal;prurigo;randomized controlled trial;rash;scallop;shoulder pain;sore throat;stomach pain;stomach ulcer;stomatitis;subarachnoid hemorrhage;vomiting;Wechsler memory scale,"Fujino, T.;Yamada, T.;Asada, T.;Tsuboi, Y.;Wakana, C.;Mawatari, S.;Kono, S.",2017,,10.1016/j.ebiom.2017.02.012,0,
1415,Chronic Hyponatremia Causes Neurologic and Psychologic Impairments,"Hyponatremia is the most common clinical electrolyte disorder. Once thought to be asymptomatic in response to adaptation by the brain, recent evidence suggests that chronic hyponatremia may be linked to attention deficits, gait disturbances, risk of falls, and cognitive impairments. Such neurologic defects are associated with a reduction in quality of life and may be a significant cause of mortality. However, because underlying diseases such as adrenal insufficiency, heart failure, liver cirrhosis, and cancer may also affect brain function, the contribution of hyponatremia alone to neurologic manifestations and the underlying mechanisms remain unclear. Using a syndrome of inappropriate secretion of antidiuretic hormone rat model, we show here that sustained reduction of serum sodium ion concentration induced gait disturbances; facilitated the extinction of a contextual fear memory; caused cognitive impairment in a novel object recognition test; and impaired long-term potentiation at hippocampal CA3-CA1 synapses. In vivo microdialysis revealed an elevated extracellular glutamate concentration in the hippocampus of chronically hyponatremic rats. A sustained low extracellular sodium ion concentration also decreased glutamate uptake by primary astrocyte cultures, suggesting an underlying mechanism of impaired long-term potentiation. Furthermore, gait and memory performances of corrected hyponatremic rats were equivalent to those of control rats. Thus, these results suggest chronic hyponatremia in humans may cause gait disturbance and cognitive impairment, but these abnormalities are reversible and careful correction of this condition may improve quality of life and reduce mortality.","Animals;Astrocytes/drug effects/metabolism;CA1 Region, Hippocampal/physiopathology;CA3 Region, Hippocampal/physiopathology;Cells, Cultured;Chronic Disease;Cognition Disorders/blood/etiology;Disease Models, Animal;Fear/physiology;Gait Disorders, Neurologic/blood/*etiology;Glutamic Acid/metabolism;Hyponatremia/blood/*complications/psychology;Inappropriate ADH Syndrome/complications/*physiopathology/psychology;Male;Memory Disorders/blood/*etiology;Microdialysis;Neuronal Plasticity;Rats;Rats, Sprague-Dawley;Sodium/blood/pharmacology;Synapses/physiology;dementia;electrolytes;hyponatremia;osmolality;vasopressin;water-electrolyte balance","Fujisawa, H.;Sugimura, Y.;Takagi, H.;Mizoguchi, H.;Takeuchi, H.;Izumida, H.;Nakashima, K.;Ochiai, H.;Takeuchi, S.;Kiyota, A.;Fukumoto, K.;Iwama, S.;Takagishi, Y.;Hayashi, Y.;Arima, H.;Komatsu, Y.;Murata, Y.;Oiso, Y.",2016,Mar,10.1681/asn.2014121196,0,
1416,Delirium prior to dementia as a clinical phenotype of Lewy body disease: An autopsied case report,"Although delirium shares clinical characteristics with dementia with Lewy bodies (DLB), there is limited information regarding the relationship between delirium and Lewy body pathology. Here, we report an 89-year-old Japanese woman with an episode of delirium who was pathologically confirmed to have limbic-type Lewy body disease (LBD). Although she exhibited transient visual hallucinations during the delirium, she had no overt dementia. She developed no core clinical features of DLB and died of pneumonia at the age of 90 years. This autopsied case suggests that delirium may be one of the clinical phenotypes of LBD prior to the onset of dementia.",bromperidol;absence of side effects;aged;article;atrial fibrillation;autopsy;brain atrophy;case report;delirium;dementia;diffuse Lewy body disease;disease classification;disease duration;female;heart failure;hepatic encephalopathy;hospital admission;human;human tissue;hyperammonemia;liver cancer;Mini Mental State Examination;neurofibrillary tangle;nocturnal delirium;pneumonia;psychomotor delirium;psychomotor disorder;senile plaque;very elderly;visual hallucination;x-ray computed tomography,"Fujishiro, H.;Kawakami, I.;Oshima, K.;Niizato, K.;Iritani, S.",2017,,10.1017/s1041610216001265,0,
1417,Coronary Artery Calcium and Risk of Dementia in MESA (Multi-Ethnic Study of Atherosclerosis),"BACKGROUND: Studies suggest a link between vascular injuries and dementia. Only a few studies, however, examined a longitudinal relation of subclinical vascular disease with dementia. We tested whether baseline coronary artery calcium (CAC), a biomarker of subclinical vascular disease, is associated with incident dementia independent of vascular risk factors and APOE-epsilon4 genotype in a community-based sample. METHODS AND RESULTS: We analyzed 6293 participants of MESA (Multi-Ethnic Study of Atherosclerosis), aged 45 to 84 years at baseline (2000-2002), initially free of cardiovascular disease and noticeable cognitive deficit. Dementia cases were identified using hospital and death certificate International Statistical Classification of Diseases and Related Health Problems codes. Cox models were used to obtain hazard ratios according to CAC category, or per 1 SD log2[CAC+1], adjusted for vascular risk factor, APOE-epsilon4, with or without exclusion of interim stroke or cardiovascular disease. We observed 271 dementia cases in a median follow-up of 12.2 years. Baseline CAC had a graded positive association with dementia risk. Compared with no CAC, CAC score of 1 to 400, 401 to 1000, and >/=1001 had increased risk of dementia by 23%, 35%, and 71%, respectively, (Ptrend=0.026) after adjustment. 1 SD higher log2[CAC+1] was associated with 24% (95% confidence interval, 8%-41%; P=0.002) increase in dementia risk. Although the association was partially explained by interim stroke/cardiovascular disease, it remained significant even after excluding the interim events, or regardless of baseline age. CONCLUSIONS: Higher baseline CAC was significantly associated with increased risk of dementia independent of vascular risk factor, APOE-epsilon4, and incident stroke. This is consistent with a hypothesis that vascular injuries play a role in the development of dementia.","0 (Biomarkers);SY7Q814VUP (Calcium);Aged;Aged, 80 and over;Atherosclerosis/ complications/metabolism;Biomarkers/metabolism;Calcium/ metabolism;Coronary Artery Disease/ complications/metabolism;Coronary Vessels/ metabolism;Dementia/ complications/metabolism;Ethnic Groups/statistics & numerical data;Female;Humans;Male;Middle Aged;Risk Factors;atherosclerosis;cohort;coronary artery calcium;dementia;epidemiology;stroke","Fujiyoshi, A.;Jacobs, D. R., Jr.;Fitzpatrick, A. L.;Alonso, A.;Duprez, D. A.;Sharrett, A. R.;Seeman, T.;Blaha, M. J.;Luchsinger, J. A.;Rapp, S. R.",2017,May,,0,
1418,Striatonigral degeneration combined with Olivopontocerebellar atrophy with subcortical dementia and hallucinatory state,"We present an autopsied case of striatonigral degeneration (SND) combined with olivopontocerebellar atrophy (OPCA) with subcortical dementia and hallucinatory state. A Japanese woman without a remarkable family history showed hand tremor at the age of 35 years, followed by bradykinesia, muscle rigidity, orthostatic hypotension, neurogenic bladder and pyramidal signs. No obvious cerebellar symptoms were found. Various antiparkinsonian drugs were administered, but were not markedly effective for the parkinsonism. She developed a mild dementia characterized by mild memory disturbance with preservation of orientation, slowing of thought processes, emotional lability toward sadness, impaired ability to manipulate acquired knowledge and poor calculating, and by the absence of aphasia, apraxia and agnosia. The features in this patient were consistent with those seen in subcortical dementia. She also had auditory hallucinations. MRI revealed hypointense T2 signals in the putamina and substantia nigra. T1-weighted MRI demonstrated atrophy of both the pens and cerebellum in addition to atrophy of the putamina and substantia nigra. EEG showed slowing of background activity. She died of cardiac failure at the age of 47. Autopsy disclosed brain stem tegmental atrophy, SND, OPCA and many glial cytoplasmic inclusions in the central nervous system, but well-preseved cerebrum. We discuss the relationship between the psychiatric symptoms and pathologic findings of brain stem tegmentum.",adult;amnesia;article;autopsy;bradykinesia;brain degeneration;case report;cerebellum;cognitive defect;dementia;female;hallucination;heart failure;human;human tissue;muscle rigidity;neurogenic bladder;neuropathology;neuroradiology;nigroneostriatal system;nuclear magnetic resonance imaging;olivopontocerebellar atrophy;orthostatic hypotension;pons;priority journal;putamen;substantia nigra;tremor,"Fukitani, Y.;Takeuchi, N.;Kobayashi, K.;Miyazu, K.;Yamaguchi, N.;Terada, T.;Nakamurs, I.;Isaki, K.",1995,,,0,
1419,A case of acquired hemophilia A with massive hemothorax,"Acquired hemophilia A (AHA) is an uncommon but potentially life-threatening hemorrhagic disorder caused by the development of an inhibitor against coagulation factor VIII (FVIII). AHA is very rare, affecting approximately 1 in 1 million individuals. However, the incidence may actually be higher, because diagnosis is difficult and the disease can be overlooked. We report a case of an 80-year-old man who presented with sudden onset of severe hemothorax. The patient was diagnosed with presumed AHA based on acute onset of bleeding symptoms and unexplained isolated prolonged activated partial thromboplastin time. Diagnosis was definitely established by demonstrating a decrease in FVIII activity, presence of FVIII inhibitor activity, and normal von Willebrand factor. The patient was successfully treated with recombinant activated coagulation factor VII and transcatheter artery embolization of the intercostal arteries. © 2011 Japanese Society of Anesthesiologists.",blood clotting factor 8;cefepime;cefmetazole;fresh frozen plasma;gabexate mesilate;hemoglobin;prednisolone;recombinant blood clotting factor 7a;von Willebrand factor;aged;angiography;article;artificial embolism;artificial ventilation;aspiration pneumonia;bleeding;brain contusion;brain infarction;case report;chronic kidney failure;dementia;disease severity;disseminated intravascular clotting;heart failure;hematothorax;hemophilia A;human;hypotension;intubation;laboratory test;male;partial thromboplastin time;pleura effusion;protein function;prothrombin time;rib fracture;tachycardia;thoracic aorta aneurysm;thorax drainage;thorax radiography;thrombocyte count;thrombocytopenia,"Fukushima, T.;Oku, S.;Iwasaki, E.;Mikane, T.;Kobayashi, H.;Ishii, M.;Ono, D.;Watanabe, Y.;Tokioka, H.",2012,,,0,
1420,An autopsy case of familial juvenile Alzheimer's disease with extensive involvement of the subcortical gray and white matters,"An autopsy case of familial juvenile Alzheimer's disease with extensive involvement of the subcortical gray and white matters is reported. A 33-year-old woman showed a progressive dementia and died of cardiac failure at the age of 45. Neurological examination disclosed choreatic movements, myoclonus, rigidity, and generalized convulsion. Gross inspection of the brain showed a diffuse cerebral atrophy and marked degenerations of both the subcortical gray and white matters. Microscopically, numerous and extensive argyrophilic changes such as senile plaques, neurofibrillary tangles, and granulovacuolar degenerations were observed in the brain. The present case was characterized by a severe neuronal loss in the basal ganglia, substantia nigra, dentate nucleus, and thalamus as well as a marked myelin loss and axonal damage in the cerebral white matter. This case suggested a combination of multisystemic degeneration and primary degeneration of the cerebral white matter. The pathological similarity of this case to Creutzfeldt-Jakob disease and Pick's disease is discussed.",Alzheimer disease;autopsy;case report;familial disease;histology;human;priority journal;white matter,"Fukutani, Y.;Nakamura, I.;Kobayashi, K.;Yamaguchi, N.;Matsubara, R.",1989,,,0,
1421,The Role of IL-33 in the Inflammation Process of Asthma and Atherosclerosis,"Interleukin-33 (IL-33) is a newly found cytokine of the interleukin-1 (IL-1) family. It's mainly expressed by epithelial and endothelial cells. This expression is upregulated by pro-inflammatory stimulation, thus has an important role in inflammatory responses, such as hypersensitive diseases (asthma), autoimmune diseases (rheumatoid arthritis), cardiovascular diseases (heart failure) and neurodegenerative diseases (Alzheimer). Several studies explored the complicated mechanism of IL-33 action in asthma and atherosclerosis, as this IL is significantly increased in these pathologies, and suggested its potential use in the therapeutic procedures.",,"Fulgheri, G.;Malinowski, B.",2011,Oct,,0,
1422,Arterial stiffness and atrial fibrillation: A new and intriguing relationship,"Atrial fibrillation (AF) and arterial stiffness (AS) greatly increase with age. In elderly patients, AF is often a marker of frailty and is frequently associated with important diseases and complications, such as stroke, heart failure, dementia, chronic obstructive pulmonary disease, pneumonia, acute myocardial infarction and urinary infections. Little is known about the influence of vascular properties on AF. In a first experiment, to verify the existence of a possible association between arrhythmia and vascular properties, we evaluated the Cardio-Ankle Vascular Index (CAVI), a measure of AS, in 33 patients (age: 73 ± 12 years) at 5 h from effective external cardioversion (ECV) of persistent AF. We found that CAVI was a direct independent predictor of left atrial diameter. This association did not exist in a healthy control population (N = 18). In a second experiment, conducted in 31 patients (age: 78 ± 7 years), we studied the possible association between AS and AF after ECV of the arrhythmia. At follow-up (on average at 6 months), we observed the arrhythmia in 48% of cases and found that its presence was directly related to CAVI values and CHA2DS2-VASc score. These findings support the hypothesis that AS could exert a significant role in promoting arrhythmia development and its relapses. If our results are confirmed, CAVI could become a key component in the medical assessment of older, comorbid, AF patients.",amiodarone;beta adrenergic receptor blocking agent;interleukin 6;age distribution;aged;arterial pressure;arterial stiffness;article;atrial fibrillation;body mass;Cardio Ankle Vascular Index;cardiovascular parameters;clinical article;coronary artery disease;diabetes mellitus;disease duration;drug efficacy;drug response;heart failure;human;hypertension;mitral valve regurgitation;prevalence;priority journal;scoring system;sinus rhythm;very elderly,"Fumagalli, S.;Boni, S.;Pupo, S.;Giannini, I.;Roberts, A. T.;Di Serio, C.;Scardia, A.;Fumagalli, C.;Tarantini, F.;Marchionni, N.",2017,,10.1093/eurheartj/suw063,0,
1423,Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey,"The age of patients presenting with complex arrhythmias is increasing. Frailty is a multifaceted syndrome characterized by an increased vulnerability to stressors and a decreased ability to maintain homeostasis. The prevalence of frailty is associated with age. The aims of this European Heart Rhythm Association (EHRA) EP Wire survey were to evaluate the proportion of patients with frailty and its influence on the clinical management of arrhythmias. A total of 41 centres-members of the EHRA Electrophysiology Research Network-in 14 European countries completed the web-based questionnaire in June 2017. Patients over 70 years represented 53% of the total treated population, with the proportion of frail elderly individuals reaching approximately 10%; 91.7% of the responding centres reported treating frail subjects in the previous year. The respondents usually recognized frailty based on the presence of problems of mobility, nutrition, and cognition and inappropriate loss of body weight and muscle mass. Renal failure, dementia, disability, atrial fibrillation, heart failure, falls, and cancer were reported to characterize the elderly frail individuals. Atrial fibrillation was considered the prevalent arrhythmia associated with frailty by 72% of the responding centres, and for stroke prevention, non-vitamin K antagonist oral anticoagulants were preferred. None of the respondents considered withholding the prevention of thrombo-embolic events in subjects with a history of falls. All participants have agreed that cardiac resynchronization therapy exerts positive effects including improvement in cardiac, physical, and cognitive performance and quality of life. The majority of respondents preferred an Arrhythmia Team to manage this special population of elderly patients, and many would like having a simple tool to quickly assess the presence of frailty to guide their decisions, particularly on the use of complex cardiac implantable electrical devices (CIEDs). In conclusion, the complex clinical condition in frail patients presenting with arrhythmias warrants an integrated multidisciplinary approach both for the management of rhythm disturbances and for the decision on using CIEDs.",Anticoagulants;Arrhythmia team;Atrial fibrillation;Cardiac implantable electrical devices;EHRA survey;EP wire;Elderly;Frailty,"Fumagalli, S.;Potpara, T. S.;Bjerregaard Larsen, T.;Haugaa, K. H.;Dobreanu, D.;Proclemer, A.;Dagres, N.",2017,Nov 01,,0,
1424,Atrial fibrillation is a possible marker of frailty in hospitalized patients: Results of the GIFA Study,"Background and aims: Atrial fibrillation (AF) is the most common arrhythmia in elderly people, who are particularly exposed to its most severe complications, such as stroke, worsening heart failure and dementia. Some studies demonstrate that AF is associated with increased mortality in home-dwelling subjects, but little is known about the clinical impact of the arrhythmia in hospitalized patients. We studied the clinical associations and effects of AF on the 23,174 hospitalized patients enrolled in the GIFA (Gruppo Italiano di Farmacoepidemiologia nell''Anziano) Study. Methods: Patients were divided into three groups according to the absence or presence of AF (sinus rhythm, non-AF; AF as main diagnosis, AF-main; AF as comorbid condition, AF-associated) and stratified into four age-groups (≤60, 61-70, 71-80 and >80 yrs). Results: AF-associated patients were older, more frequently disabled, and characterized by greater comorbidity and longer in-hospital length of stay. Urea nitrogen concentration was higher, and total cholesterol was lower in AF-associated patients, compared with the other two groups. Overall mortality was 6.0%. Mortality was higher in AF-associated patients (non-AF: 6.0% vs AF-associated: 7.1% vs AF-main: 0%, p<0.001). Conclusions: Our results suggest that, in hospitalized patients, AF as a comorbid condition is associated with worse metabolic profile and clinical outcomes, and thus, may represent a marker of frailty. ©2010, Editrice Kurtis.",adult;aged;article;comorbidity;controlled study;female;atrial fibrillation;heart rate;hospitalization;human;length of stay;major clinical study;male;mortality;prevalence;sinus rhythm,"Fumagalli, S.;Tarantini, F.;Guarducci, L.;Pozzi, C.;Pepe, G.;Boncinelli, L.;Valoti, P.;Baldasseroni, S.;Masotti, G.;Marchionni, N.",2010,,,0,
1425,Atrial fibrillation: Still a benign condition in the elderly?,"A recent study demonstrated that the presence of an atrial arrhythmia, mainly atrial fibrillation, in a hospitalized elderly population (mean age: 85 years) was an independent predictor of all-cause mortality during follow-up. This association persisted in multivariable analyses, even after adjustment for several social, clinical and laboratory variables. The great complexity of a 'real-world geriatric population, which is the result of the coexistence of comorbidities, mood disorders, poor social networks and reduced homeostasis, may explain these results. New age-oriented guidelines are necessary in order to effectively manage atrial fibrillation in elderly individuals who are most exposed to the severe complications of arrhythmia. © 2010 Future Medicine Ltd.",aged;aged hospital patient;aging;cardioversion;cerebrovascular accident;comorbidity;congestive heart failure;dementia;depression;disease association;frail elderly;atrial fibrillation;human;incidence;inflammation;mood disorder;mortality;note;prevalence;quality of life;social network,"Fumagalli, S.;Tarantini, F.;Marchionni, N.",2010,,,0,
1426,Receipt of Nephrology Care and Clinical Outcomes Among Veterans With Advanced CKD,"BACKGROUND: Clinical practice guidelines recommend referral to nephrology when estimated glomerular filtration rate (eGFR) decreases to <30mL/min/1.73m2; however, evidence for benefits of nephrology care are mixed. STUDY DESIGN: Observational cohort using landmark analysis. SETTINGS & PARTICIPANTS: A national cohort of veterans with advanced chronic kidney disease, defined as an outpatient eGFR</=30mL/min/1.73m2 for January 1, 2010, through December 31, 2010, and a prior eGFR<60mL/min/1.73m2, using administrative and laboratory data from the Department of Veterans Affairs and the US Renal Data System. PREDICTOR: Receipt and frequency of outpatient nephrology care over 12 months. OUTCOMES: Survival and progression to end-stage renal disease (ESRD; receipt of dialysis or kidney transplantation) were the primary outcomes. In addition, control of associated clinical parameters over 12 months were intermediate outcomes. RESULTS: Of 39,669 patients included in the cohort, 14,983 (37.8%) received nephrology care. Older age, heart failure, dementia, depression, and rapidly declining kidney function were independently associated with the absence of nephrology care. During a mean follow-up of 2.9 years, 14,719 (37.1%) patients died and 4,310 (10.9%) progressed to ESRD. In models adjusting for demographics, comorbid conditions, and trajectory of kidney function, nephrology care was associated with lower risk for death (HR, 0.88; 95% CI, 0.85-0.91), but higher risk for ESRD (HR, 1.48; 95% CI, 1.38-1.58). Among patients with clinical parameters outside guideline recommendations at cohort entry, a significantly higher adjusted proportion of patients who received nephrology care had improvement in control of hemoglobin, potassium, albumin, calcium, and phosphorus concentrations compared with those who did not receive nephrology care. LIMITATIONS: May not be generalizable to nonveterans. CONCLUSIONS: Among patients with advanced chronic kidney disease, nephrology care was associated with lower mortality, but was not associated with lower risk for progression to ESRD.","Adult;Age Factors;Aged;Cohort Studies;Comorbidity;Dementia/epidemiology;Depression/epidemiology;Disease Progression;Female;Glomerular Filtration Rate;Heart Failure/epidemiology;Humans;Kidney Failure, Chronic/ epidemiology/mortality/therapy;Kidney Transplantation;Male;Middle Aged;Nephrology;Practice Guidelines as Topic;Proportional Hazards Models;Referral and Consultation;Renal Dialysis;Renal Insufficiency, Chronic/mortality/ therapy;Risk Factors;Severity of Illness Index;Survival Rate;United States;United States Department of Veterans Affairs;Veterans;Young Adult;CKD progression;Chronic kidney disease (CKD);delivery of health care;disease trajectory;end-stage renal disease (ESRD);guideline-concordant care;immortal time bias;intensity of care;landmark analysis;nephrology care;nephrology referral","Fung, E.;Chang, T. I.;Chertow, G. M.;Thomas, I. C.;Asch, S. M.;Kurella Tamura, M.",2017,Nov,,0,
1427,White blood cell count is an independent predictor of outcomes after acute ischaemic stroke,"Background and purpose: In patients with ischaemic stroke, elevated white blood cell count (WBC) has been associated with stroke severity on admission and poor functional outcome. However, previous studies did not control for confounding factors. We hypothesized that higher WBC is an independent predictor of stroke severity, greater degree of disability and 30-day mortality after acute ischaemic stroke. Methods: Data from the Registry of the Canadian Stroke Network on consecutive patients with acute ischaemic stroke admitted between July 2003 and March 2008 were used. Patients were divided into groups as follows: low WBC (0.1-4 × 10-9/l), normal WBC (4.1-10 × 10-9/l) and high WBC (10.1-40 × 10-9/l). Primary outcome measures were the frequency of moderate/severe strokes on admission (Canadian Neurological Scale ≤ 8), greater degree of disability at discharge (modified Rankin score 3-6) and 30-day mortality. Regression analyses were performed adjusting for confounders. Results: In total, 8829 patients were included. After adjustment for major potential confounders, every 1 × 10-9/l increase in WBC was associated with stroke severity on admission [odds ratio (OR) 1.09; 95%CI 1.07-1.10; P < 0.0001), disability at discharge (OR 1.04; 95%CI 1.02-1.06; P = 0.0005) and 30-day mortality (hazard ratio 1.07; 95%CI 1.05-1.08; P < 0.0001). The Kaplan-Meier curves indicate that elevated WBC is associated with higher mortality after acute ischaemic stroke (P = 0.001). Conclusions: In patients with acute ischaemic stroke, higher WBC on admission is an independent predictor of stroke severity on admission, greater degree of disability at discharge and 30-day mortality. These results reinforce the need for further studies focused on immunomodulation therapy targeting inflammatory response following acute ischaemic stroke. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.",aged;alcohol consumption;Alzheimer disease;angina pectoris;article;asthma;brain ischemia;cerebrovascular accident;congestive heart failure;controlled study;coronary artery disease;deep vein thrombosis;dementia;diabetes mellitus;disability severity;disease severity;atrial fibrillation;heart atrium flutter;hospital admission;hospital discharge;hospital infection;human;hyperlipidemia;hypertension;leukocyte count;lung disease;major clinical study;mortality;outcome assessment;peripheral vascular disease;pneumonia;prediction;priority journal;Rankin scale;sepsis;smoking;stroke patient;systemic inflammatory response syndrome;urinary tract infection;valvular heart disease,"Furlan, J. C.;Vergouwen, M. D. I.;Fang, J.;Silver, F. L.",2014,,,0,
1428,Coming back to oneself: a case of anoxic brain damage from a phenomenological perspective,"Struck by a cardiac arrest that lasted 3/4 of an hour, a 53-year-old man suddenly collapsed one day at work. The result was a serious anoxic brain damage that developed into dementia. This essay presents the process of 'coming back to himself' while it questions what this concept might imply. The descriptions and analyses rest upon an ethnographic study of his life, at hospitals and then at home, assisted by his wife, who is also the author of this article. Theoretically, the analysis depends on Merleau-Ponty's phenomenology of perception and is also based on the therapeutic use of music in treating people with dementia championed by Oliver Sachs. It is argued that the field of medicine has much to learn from the anthropological method of long-term observation, as well as theories of embodiment that see the body as simultaneously being an object and a subject.",case report;complication;cultural anthropology;dementia;heart arrest;human;brain hypoxia;learning;life event;male;middle aged;music therapy;physiology;procedures;psychology;self concept,"Fürst, E. L.",2015,,,0,
1429,Sigma-1 receptor agonist fluvoxamine for delirium in patients with Alzheimer's disease,"Background: Delirium in older adults is a common and serious acute neuropsychiatric syndrome, with core features of inattention and global cognitive impairment. Although antipsychotic drugs are the medications most frequently used to treat this syndrome, these drugs are associated with a variety of adverse events, including sedation, extrapyramidal side effects, and cardiac arrhythmias.Methods: We report on two cases in which monotherapy of the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the delirium of patients with Alzheimer's disease.Results: Delirium Rating Scale (DRS) scores in the two patients with Alzheimer's disease decreased after fluvoxamine monotherapy.Conclusion: Doctors should consider that fluvoxamine could be an alternative approach in treating delirium in patients with Alzheimer's disease because of the risk of extrapyramidal side effects by antipsychotic drugs. © 2010 Furuse and Hashimoto; licensee BioMed Central Ltd.",benzodiazepine;fluvoxamine;olanzapine;aged;Alzheimer disease;article;brain atrophy;brain infarction;case report;computer assisted tomography;delirium;Delirium Rating Scale;Diagnostic and Statistical Manual of Mental Disorders;drug dose increase;female;gastrointestinal symptom;heart left ventricle hypertrophy;human;International Classification of Diseases;lung congestion;Mini Mental State Examination;monotherapy;rating scale;single photon emission computer tomography;sleep disorder;visual hallucination,"Furuse, T.;Hashimoto, K.",2010,,,0,
1430,ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation),,2' (4 methoxyphenylacetamidomethyl) n [2 (3 pyridyl)ethyl] 2 biphenylcarboxamide;acetylsalicylic acid;amiodarone;angiotensin receptor antagonist;antiarrhythmic agent;anticoagulant agent;antivitamin K;beta adrenergic receptor blocking agent;calcium channel blocking agent;digitalis;digitalis glycoside;digoxin;diltiazem;dipeptidyl carboxypeptidase inhibitor;disopyramide;dofetilide;esmolol;flecainide;hydroxymethylglutaryl coenzyme A reductase inhibitor;ibutilide;irbesartan;metoprolol;nip 142;potassium channel blocking agent;procainamide;propafenone;propranolol derivative;quinidine;vernakalant;sotalol;unindexed drug;verapamil;warfarin;acute heart infarction;algorithm;anamnesis;anticoagulation;anxiety;article;asthma;atrioventricular block;atrioventricular conduction;autonomic nervous system;bleeding;blood clot lysis;bradycardia;brain hemorrhage;bronchospasm;cardiology;cardiovascular risk;cardioversion;catheter ablation;catheter complication;cerebrovascular accident;clinical assessment;clinical classification;clinical feature;clinical medicine;clinical trial;comorbidity;constipation;cornea disease;coronary artery disease;defibrillator;diagnostic procedure;diarrhea;disease activity;disease association;disease predisposition;drug contraindication;drug effect;drug efficacy;drug fatality;drug fever;drug indication;drug mechanism;drug potentiation;drug withdrawal;electric current;electroencephalogram;electrophysiology;embolism;epidemiological data;Europe;exercise test;familial disease;gastrointestinal symptom;genetic association;heart arrhythmia;heart atrioventricular node;atrial fibrillation;heart atrium flutter;heart atrium pacemaker;heart atrium pacing;heart block;heart disease;heart failure;heart left ventricle contractility;heart left ventricle failure;heart muscle conduction disturbance;heart preexcitation;heart rate;heart rhythm;heart ventricle arrhythmia;heart ventricle conduction;heart ventricle extrasystole;heart ventricle fibrillation;heart ventricle overload;heart ventricle tachycardia;hemodynamics;hemolytic anemia;hospitalization;human;hypertension;hyperthyroidism;hypertrophic cardiomyopathy;hypothyroidism;implantation;incidence;injection site pain;inotropism;liver dysfunction;liver injury;long term care;low drug dose;lung disease;lung fibrosis;lung toxicity;medical society;mental deterioration;mortality;mucosal disease;myocardial disease;nausea;neutropenia;nomenclature;optic nerve disease;outpatient;pathology;pathophysiology;patient assessment;patient care;patient monitoring;patient selection;phlebitis;physical examination;postoperative complication;practice guideline;predictor variable;pregnancy;prevalence;priority journal;prognosis;prophylaxis,"Fuster, V.;Rydén, L. E.;Cannom, D. S.;Crijns, H. J.;Curtis, A. B.;Ellenbogen, K. A.;Halperin, J. L.;Le Heuzey, J. Y.;Kay, G. N.;Lowe, J. E.;Olsson, S. B.;Prystowsky, E. N.;Tamargo, J. L.;Wann, S.;Smith Jr, S. C.;Jacobs, A. K.;Adams, C. D.;Anderson, J. L.;Antman, E. M.;Halperin, J. L.;Hunt, S. A.;Nishimura, R.;Ornato, J. P.;Page, R. L.;Riegel, B.;Priori, S. G.;Blanc, J. J.;Budaj, A.;Camm, A. J.;Dean, V.;Deckers, J. W.;Despres, C.;Dickstein, K.;Lekakis, J.;McGregor, K.;Metra, M.;Morais, J.;Osterspey, A.;Tamargo, J. L.;Zamorano, J. L.",2006,,,0,
1431,Predictors of short-term (seven-day) cardiac outcomes after emergency department visit for syncope,"Syncope is a common reason for emergency department (ED) visits, and patients are often admitted to exclude syncope of cardiovascular origin. Population-based data on patterns and predictors of cardiac outcomes may improve decision-making. Our objective was to identify patterns and predictors of short-term cardiac outcomes in ED patients with syncope. Administrative data from an integrated health system of 11 Southern California EDs were used to identify cardiac outcomes after ED presentation for syncope from January 1, 2002, to December 31, 2005. Syncope and cause of death were identified by codes from the International Classification of Disease, Ninth Revision. Cardiac outcomes included cardiac death and hospitalization or procedure consistent with ischemic heart disease, valvular disease, or arrhythmia. Predictors of cardiac outcomes were identified through multivariate logistic regression. There were 35,330 adult subjects who accounted for 39,943 ED visits for syncope. Risk of cardiac outcome sharply decreased following the 7 days after syncope. A 7-day cardiac outcome occurred in 893 cases (3%). Positive predictors of 7-day cardiac outcomes included age > or =60 years, male gender, congestive heart failure, ischemic heart disease, cardiac arrhythmia, and valvular heart disease. Negative predictors included dementia, pacemaker, coronary revascularization, and cerebrovascular disease. There was an age-dependent relation between 7-day cardiac outcomes and arrhythmia and valvular disease, with younger patients (<60 years of age) having greater risk of an event compared to their same-age counterparts. In conclusion, ED decision-making should focus on risk of cardiac event in the first 7 days after syncope and special attention should be given to younger patients with cardiac co-morbidities.","Adolescent;Adult;Death, Sudden, Cardiac/*epidemiology/etiology;*Emergency Service, Hospital;Female;Follow-Up Studies;Hospitalization/*statistics & numerical data;Humans;Incidence;Male;Middle Aged;Population Surveillance/*methods;Prognosis;Syncope/*epidemiology/therapy;Time Factors;United States/epidemiology;Young Adult","Gabayan, G. Z.;Derose, S. F.;Asch, S. M.;Chiu, V. Y.;Glenn, S. C.;Mangione, C. M.;Sun, B. C.",2010,Jan 1,10.1016/j.amjcard.2009.08.654,0,
1432,Selective loss of oxytocin and vasopressin in the hypothalamus in early Huntington disease: A case study,,oxytocin;vasopressin;acute heart infarction;adult;anxiety disorder;autopsy;brain;case report;caudate nucleus;gene loss;genetic screening;gliosis;heart arrest;histopathology;human;Huntington chorea;hyperkinesia;hypothalamus;immunohistochemistry;informed consent;letter;male;middle aged;neurologic examination;neurologist;neuropathology;priority journal;resuscitation;sleep disorder;tissue section,"Gabery, S.;Halliday, G.;Kirik, D.;Englund, E.;Petersén, A.",2015,,,0,
1433,"Comorbidities with chronic physical conditions and gender profiles of illness in schizophrenia. Results from PREST, a new health dataset","Objective Using data from a large health dataset, the objectives are to describe the epidemiology of comorbidities with chronic physical conditions in schizophrenia, to identify gender profiles of illness and to discuss findings in the light of previous research. Methods The PREST health database was used which combines high quality and complementary data from numerous public health care resources in the Basque Country (Spain). Results A total number of 2,255,406 patients were included in this study and 7331 had a diagnosis of schizophrenia. 55.6% of them had one comorbid condition and 29.3% had 2 or more (e.g. multiple comorbidities). Hypertension (16.8%) was the most prevalent diagnosed comorbid condition in these patients. The risk of having neuropsychiatric disorders including Parkinson (OR up to 47.89), infectious diseases (OR up to 3.31) or diabetes (OR2.23) was increased, while the risk of having cancer (OR down to 0.76) or some cardiovascular conditions (OR down to 0.63) was reduced. Women (both with and without schizophrenia) showed higher percentages of comorbidities than men. A cluster of respiratory diseases was found only in women with schizophrenia (not in men). Conclusions Results confirm partially previous findings and call for a more proactive and comprehensive approach to the health care of patients with schizophrenia. Specific profiles of risks for concrete disorders were identified which could be explained by selective underdiagnoses or higher exposition to risk factors in this group of patients. Results also suggest the need of a more gender oriented approach to health care in schizophrenia.",article;asthma;atrial fibrillation;autoimmune disease;blindness;bronchiectasis;cardiovascular disease;cerebrovascular disease;chromosome aberration;chronic bronchitis;chronic constipation;chronic disease;chronic kidney failure;chronic lung disease;chronic obstructive lung disease;chronic sinusitis;comorbidity;connective tissue disease;controlled study;data base;dementia;diabetes mellitus;dyspepsia;eczema;emphysema;epilepsy;female;glaucoma;gout;hearing impairment;heart disease;heart failure;hematologic disease;human;Human immunodeficiency virus infection;hypertension;hypothyroidism;immunopathology;inflammatory bowel disease;intestine diverticulosis;irritable colon;ischemic heart disease;liver disease;low back pain;low vision;major clinical study;male;malignant neoplasm;metabolic disorder;migraine;multiple sclerosis;muscular dystrophy;osteoarthritis;osteoporosis;pancreas disease;paralysis;Parkinson disease;peripheral neuropathy;peripheral vascular disease;physical disease;prevalence;prostate hypertrophy;psoriasis;respiratory tract disease;rheumatoid arthritis;risk factor;schizophrenia;sex difference;Spain;transplant status;virus hepatitis,"Gabilondo, A.;Alonso-Moran, E.;Nuño-Solinis, R.;Orueta, J. F.;Iruin, A.",2017,,10.1016/j.jpsychores.2016.12.011,0,
1434,Paternalism and autonomy - No contradiction,"Patient autonomy became increasingly important during the last decades. It is often described to be an antagonist to medical paternalism. Like for patients with full decisional capacity, autonomy should also be protected for incapacitated patients. To enable this, the Austrian legislator recently regulated advance directives and durable powers of attorney. These tools should be combined with a process of communication with the patient's loved ones and consultation by a caring physician according to the integrative model. This can enhance and supplement the patient's autonomy. This article demonstrates surrogate decision making in theory and by the example of a case report. © 2008 Springer-Verlag.",antibiotic agent;catecholamine;aged;antibiotic therapy;arteriosclerosis;artery disease;article;heart arrest;cardiogenic shock;case report;consultation;dementia;disability;ethical decision making;health care planning;heart failure;hemofiltration;human;intensive care;interpersonal communication;ischemic heart disease;male;medical decision making;medical ethics;multiple organ failure;palliative therapy;paternalism;patient autonomy;power of attorney;sepsis;social psychology,"Gabl, C.;Jox, R. J.",2008,,,0,
1435,Comorbidity in arthritis,"OBJECTIVE: To describe the relative frequency of selected comorbidities in 2 population based prevalence cohorts of patients with rheumatoid arthritis (RA) and osteoarthritis (OA) compared to age and sex matched community controls. METHODS: Using the population based data resources of the Rochester Epidemiology Project, we assembled 3 prevalence cohorts of all residents of Olmsted County, Minnesota, with RA (1987 American College of Rheumatology criteria) and age and sex matched controls without arthritis on January 1, 1965, January 1, 1975, and January 1, 1985. Cases and controls were followed longitudinally through their complete (inpatient and outpatient) medical records beginning 10 years prior to the prevalence (or index) date until death, migration from the county, or January 1, 1995. Comorbidity was assessed yearly using the Charlson Comorbidity Index and the Index of Co-existent Diseases (ICED). Descriptive statistics were used to illustrate the baseline characteristics of the study population and the frequency of individual comorbidities in each of the 3 groups over the followup period. Cox proportional hazards modeling was used to assess the risk for each individual comorbidity among patients with arthritis compared to controls and to identify significant predictors of an increase in comorbidity level over time. RESULTS: Our study population included 450 RA, 441 OA, and 891 control subjects. The age and sex distributions of cases and their controls were similar. Over the followup period, patients with RA had a higher likelihood of developing congestive heart failure, chronic pulmonary disease, dementia, and peptic ulcer disease, while cases with OA had a significantly higher risk of developing peptic ulcer disease and renal disease. Among patients with either RA or OA, age, male sex, and baseline comorbidity were significant predictors of a rise in comorbidity. The presence of RA was a highly significant predictor of a rise in comorbidity from one year to the next, even after controlling for the effects of age, sex, and baseline comorbidity (p = 0.0004 for the Charlson and p = 0.006 for the ICED). CONCLUSION: These data indicate that the burden of illness among people with arthritis is higher than for nonarthritics and that this burden appears to be increasing over time, particularly in RA. These results suggest that specialized chronic disease care will be increasingly important for the future health care needs of people with RA.","Arthritis, Rheumatoid/*epidemiology;Cohort Studies;Comorbidity;Female;Humans;Male;Osteoarthritis/*epidemiology;Prevalence","Gabriel, S. E.;Crowson, C. S.;O'Fallon, W. M.",1999,Nov,,0,
1436,Percutaneous endoscopic gastrostomy (PEG) feeding in elderly people with diabetes resident in nursing homes,"Aim: To investigate the level of Percutaneous Endoscopic Gastrostomy (PEG) feeding in elderly people with diabetes resident in Nursing homes in one area of the UK, to describe their degree of disability, comorbidities and to estimate medication costs of these residents. Methods: The data was collected from a retrospective case notes review of the 75 people with known diabetes who were resident in the 11 Nursing homes in the Coventry Teaching PCT in early 2010. Results: 14 residents (19% of the total sample) had PEG feeds in situ and one (1.3%) had a nasogastric feeding tube in situ. The 14 residents were taking a total of 80 daily medications, a mean of 5.7 daily medications per resident (range 3-10). The total medication costs for the regular medications for these 14 residents was 2410 euros per month giving a mean of 172 euros/month (range 14-935 euros per month). All of the 14 were recorded as being bedbound, having no speech and being doubly incontinent. Conclusion: All 14 residents being PEG fed have severe levels of disability. Cerebro Vascular Accident and Dementia are the main recorded co-morbidities. The most expensive monthly medication costs were for special order liquid medications, many for cardio vascular disease prevention, which may be considered as inappropriate in such severely disabled residents. © 2013 Serdi and Springer Verlag France.",adult;aged;article;brain injury;cardiovascular disease;cerebrovascular accident;comorbidity;dementia;diabetes mellitus;drug cost;heart arrest;atrial fibrillation;human;hypertension;injury;kidney failure;learning disorder;major clinical study;medical record review;multicenter study;nasogastric tube;nose feeding;nursing home patient;orthostatic hypotension;Parkinson disease;percutaneous endoscopic gastrostomy;physical disability;priority journal;prostate cancer;pseudobulbar palsy;retrospective study;schizophrenia;spasticity;United Kingdom,"Gadsby, R.",2013,,,0,
1437,"Aortic valve stenosis: What do people know? A heart valve disease awareness survey of over 8,800 people aged 60 or over","Aims: Little is known about the level of public knowledge and concern towards aortic valve disease. Therefore, a survey was conducted to evaluate the awareness of the general population regarding different diseases with special emphasis on aortic stenosis (AS). Methods and results: A total of 8,860 people aged 60 years or older in nine European countries took part in the survey. Cancer was the disease that respondents were most concerned about (27.5%), while only 1.7% were most concerned about heart valve disease. Seventeen percent (17%) of survey participants claimed to be familiar with heart valve disease, yet only 7% could correctly identify AS; 44.3% of respondents knew the correct number of valves in the human heart. After providing some general information about AS, 41.1% of respondents then said they were more concerned about the condition; 4.5% even recognised the symptoms in themselves. Over half of the respondents (54.2%) claimed that their general practitioners only rarely or never use the stethoscope to check their heart, which may eventually lead to an underdiagnosis of AS. Conclusions: Despite its high prevalence, high morbidity and mortality, as well as good treatment options, the vast majority of respondents were neither concerned nor fully aware of AS.",adult;age distribution;aged;Alzheimer disease;aorta valve stenosis;arthritis;article;attitude to illness;Central Europe;cerebrovascular accident;controlled study;diabetes mellitus;Europe;female;general practitioner;geographic distribution;health literacy;health survey;heart infarction;human;major clinical study;male;middle aged;neoplasm;Northern Europe;respiratory tract disease;sex difference;Southern Europe;stethoscope;symptom;valvular heart disease;very elderly,"Gaede, L.;Di Bartolomeo, R.;Van Der Kley, F.;Elsässer, A.;Iung, B.;Möllmann, H.",2016,,,0,
1438,A combined comorbidity score predicted mortality in elderly patients better than existing scores,"Objective: To develop and validate a single numerical comorbidity score for predicting short- and long-term mortality, by combining conditions in the Charlson and Elixhauser measures. Study Design and Setting: In a cohort of 120,679 Pennsylvania Medicare enrollees with drug coverage through a pharmacy assistance program, we developed a single numerical comorbidity score for predicting 1-year mortality, by combining the conditions in the Charlson and Elixhauser measures. We externally validated the combined score in a cohort of New Jersey Medicare enrollees, by comparing its performance to that of both component scores in predicting 1-year mortality, as well as 180-, 90-, and 30-day mortality. Results: C-statistics from logistic regression models including the combined score were higher than corresponding c-statistics from models including either the Romano implementation of the Charlson Index or the single numerical version of the Elixhauser system; c-statistics were 0.860 (95% confidence interval [CI]: 0.854, 0.866), 0.839 (95% CI: 0.836, 0.849), and 0.836 (95% CI: 0.834, 0.847), respectively, for the 30-day mortality outcome. The combined comorbidity score also yielded positive values for two recently proposed measures of reclassification. Conclusion: In similar populations and data settings, the combined score may offer improvements in comorbidity summarization over existing scores. © 2011 Elsevier Inc. All rights reserved.",acquired immune deficiency syndrome;aged;alcohol abuse;anemia;article;blood clotting disorder;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;clinical classification;comorbidity;congestive heart failure;degenerative disease;dementia;depression;diabetes mellitus;drug abuse;electrolyte disturbance;Elixhauser classification system;female;health program;heart arrhythmia;heart infarction;hemiplegia;human;Human immunodeficiency virus;hypertension;hypothyroidism;kidney failure;leukemia;liver disease;lung disease;lymphoma;male;medicare;metastasis;mortality;obesity;outcome assessment;paralysis;peripheral vascular disease;pharmacy;prediction;priority journal;psychosis;rheumatoid arthritis;scoring system;neoplasm;ulcer;United States;valvular heart disease;vascular disease;weight reduction,"Gagne, J. J.;Glynn, R. J.;Avorn, J.;Levin, R.;Schneeweiss, S.",2011,,,0,
1439,An overview on management of the traumatised elderly patient,"The elderly are predisposed to injuries due to consequences of ageing and presence of disease process commonly seen in the old people. Age-related deterioration of senses such as decrease in hearing capacity, presbyopia, changes in coordination, balance, motor strength and postural stability render the elderly vulnerable to environmental hazards. Diseases such as dementia, congestive cardiac failure, postural hypotension, osteoporosis and arthritis further contribute to compound problems of the elderly. Age and chronic factors further blunt the reserves to enable an elderly individual meet the demands of trauma. The challenge to the clinician is to be aware of the subtle changes and deviation from the norm that may suggest development of complications. With careful attention and appropriate physiological support the elderly patient has a good chance of survival. The primary condition must be assessed, necrotic tissues must be debrided by thorough surgical toileting, pus must be drained, wounds sutured and fractures must be set while cardiopulmonary activity must be monitored accurately. The patient should be re-assured, kept warm and adequate analgesia given to relieve pain. Intravascular volume and composition of extracelular fluid must be maintained. Nutritional support should be provided in amounts needed to meet the higher demands of trauma and preferably by oral feeding. Above all multidisciplinary approach to the traumatized elderly is mandatory involving surgeons, physicians, physiotherapists and other paramedical staff and relatives.",analgesia;article;debridement;dietary intake;elderly care;high risk population;human;injury;surgical technique;wound care,"Gakuu, L. N.;Kabetu, C. E.",1997,,,0,
1440,Inflammation and oxidative damage in Alzheimer's disease: Friend or foe?,"The two major neuropathologic hallmarks of AD are extracellular Amyloid beta plaques and intracellular neurofibrillary tangles. A number of additional pathogenic mechanisms have been described, including inflammation and oxidative damage. Regarding inflammation, several cytokines and chemokines have been detected both immunohistochemically and in Cerebrospinal Fluid from patients. Some of them, including Tumor Necrosis Factoralpha, Interferon-gamma-inducible Protein-10, Monocyte Chemotactic Protein-1 and Interleukin-8, are increased in AD and in Mild Cognitive Impairment, considered the prodromal stage of AD, suggesting that these modifications occur very early during the development of the disease, possibly explaining the failure of trials with antiinflammatory agents in patients with severe AD. Further evidence suggests that cytokines and chemokines could play a role in other neurodegenerative disorders. These disorders are considered multifactorial diseases, and genetic factors influence pathological events and contribute to change the disease phenotype from patient to patient. Gene polymorphisms in crucial molecules, including cytokines, chemokines and molecules related to oxidative stress, may act as susceptibility factors, or may operate as regulatory factors, modulating the severity of pathogenic processes.",acute phase protein;alpha 1 antichymotrypsin;amyloid precursor protein;apolipoprotein E;apolipoprotein E4;celecoxib;chemokine receptor CCR2;chemokine receptor CCR5;dapsone;diclofenac;endothelial nitric oxide synthase;gamma interferon inducible protein 10;hydroxychloroquine;indometacin;interleukin 1;interleukin 11;interleukin 1alpha;interleukin 1beta;interleukin 6;interleukin 8;monocyte chemotactic protein 1;monocyte chemotactic protein 2;naproxen;neuronal nitric oxide synthase;nimesulide;progranulin;RANTES;rofecoxib;rosiglitazone;tau protein;allele;Alzheimer disease;article;cerebrovascular accident;gastrointestinal toxicity;gene linkage disequilibrium;gene locus;gene mutation;genetic association;genetic risk;genetic variability;heart infarction;human;innate immunity;multigene family;nervous system inflammation;oxidative stress;pathogenesis;protein blood level;protein expression;regulatory mechanism;single nucleotide polymorphism;upregulation;avandia,"Galimberti, D.;Scarpini, E.",2011,,,0,
1441,"Sex differences in presentation, severity, and management of stroke in a population-based study","OBJECTIVES: Women may have poorer outcomes after stroke than men because of differences in their acute management. We examined sex differences in presentation, severity, in-hospital treatment, and early mortality in a cohort of first-ever-in-a-lifetime stroke patients. METHODS: Data were collected from May 1, 1996, to April 30, 1999, in the North East Melbourne Stroke Incidence Study. Stroke symptoms, prestroke medical history, in-hospital investigations, admission and discharge medications, initial stroke severity, and 28-day mortality were recorded. Multivariable regression was used to estimate sex differences in treatment, investigations, and 28-day mortality. RESULTS: A total of 1,316 patients were included. Women were older (mean age 76 +/- 0.6 vs 72 +/- 0.6, p < 0.01), had more severe strokes (median NIH Stroke Scale score 6 vs 5, p < 0.01), and more likely to experience loss of consciousness (31% vs 23%, p = 0.003) and incontinence (22% vs 11%, p = 0.01) than men. Women were less often on lipid-lowering therapy on admission. Echocardiography and carotid investigations were less frequently performed in women due to greater age and stroke severity. Women had greater 28-day mortality (32% vs 21%, p < 0.001) and stroke severity (44% vs 36%, p = 0.01) than men, but adjustment for age, comorbidities, and stroke severity (for mortality only) completely attenuated these associations. CONCLUSION: Sex differences seen in this study were mostly explained by women's older age, greater comorbidity, and stroke severity. The reasons for differences according to age may need further examination.","Age of Onset;Aged;Alcohol Drinking/epidemiology;Australia/epidemiology;Cardiovascular Diseases/epidemiology;Comorbidity;Confounding Factors (Epidemiology);Dementia/epidemiology;Diabetes Mellitus/epidemiology;Female;Health Status Disparities;Humans;Hypertension/epidemiology;Incidence;Male;Models, Statistical;Myocardial Infarction/epidemiology;Regression Analysis;Sex Distribution;Sex Factors;Smoking/epidemiology;Stroke/*epidemiology;Survival Rate","Gall, S. L.;Donnan, G.;Dewey, H. M.;Macdonell, R.;Sturm, J.;Gilligan, A.;Srikanth, V.;Thrift, A. G.",2010,Mar 23,10.1212/WNL.0b013e3181d5a48f,0,
1442,STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): Application to acutely ill elderly patients and comparison with Beers' criteria,"Introduction: STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers' criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. Methods: We prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers' criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. Results: Median patient age (interquartile range) was 77 (72-82) years. Median number of prescription medicines was 6 (range 0-21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers' criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers' criteria-related PIMs contributed to significantly fewer admissions (6%). Conclusion: STOPP criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers' criteria. This finding has significant implications for hospital geriatric practice. © The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.",acetylsalicylic acid;amitriptyline;antihistaminic agent;benzodiazepine;beta adrenergic receptor blocking agent;cholinergic receptor blocking agent;colchicine;corticosteroid;digoxin;diltiazem;doxazosin;morphine;muscarinic receptor blocking agent;neuroleptic agent;nonsteroid antiinflammatory agent;opiate;psychotropic agent;serotonin uptake inhibitor;thiazide diuretic agent;tricyclic antidepressant agent;vasodilator agent;verapamil;warfarin;acute disease;aged;article;Beer's criteria;chronic obstructive lung disease;clinical assessment tool;congestive heart failure;criterion variable;delirium;drug induced disease;drug megadose;falling;female;femur fracture;fracture;gastrointestinal hemorrhage;geriatric patient;hospital admission;human;hyponatremia;hypotension;intermethod comparison;kidney failure;major clinical study;male;medication error;mental deterioration;nephrotoxicity;orthostatic hypotension;osteoporosis;peptic ulcer;prescription;priority journal;prospective study;Screening Tool of Older Person's potentially inappropriate Prescription;side effect;upper gastrointestinal bleeding;spine fracture,"Gallagher, P.;O'Mahony, D.",2008,,,0,
1443,"Case presentation: Demise by decision, dementia, or depression?",,digoxin;dipeptidyl carboxypeptidase inhibitor;morphine;aged;case report;cause of death;congestive heart failure;dementia;depression;dyspnea;atrial fibrillation;human;male;note;palliative therapy,"Gallagher, R.",2000,,,0,
1444,Killing the symptom without killing the patient,,antibiotic agent;bronchodilating agent;fentanyl;hemoglobin;hydromorphone;naloxone;opiate;oxygen;prednisolone;steroid;ADL disability;adult respiratory distress syndrome;aged;agitation;article;bedtime dosage;blood pressure;blood transfusion;breathing rate;case report;chronic kidney failure;chronic obstructive lung disease;computer assisted tomography;confusion;congestive heart failure;coughing;depression;diuresis;dyspnea;erythrocyte concentrate;female;forced expiratory volume;forced vital capacity;heart arrhythmia;hemoglobin blood level;human;hypertension;lung fibrosis;male;multiinfarct dementia;oxygen saturation;patient positioning;pneumonia;respiration depression;smoking;thorax radiography,"Gallagher, R.",2010,,,0,
1445,"Mild cognitive impairment, screening, and patient perceptions in heart failure patients","OBJECTIVE: Cognitive impairments are prevalent in heart failure (HF) patients, worsening outcomes but often undetected.The aim of this study was to screen HF outpatients for mild cognitive impairment (MCI), determine the areas of cognition affected, patient awareness of cognitive change, and associated factors. METHOD AND RESULTS: HF patients (n = 128) newly registered for the Management of Cardiac Function program, free from neurocognitive disorder, and with sufficient visual acuity were assessed with the use of the Montreal Cognitive Assessment tool (MoCA). MCI was classified as MoCA score </=22. The sample was elderly (mean, 80.65 years; SD, 11.52). Mean MoCA score was 24.58 (SD 3.45), 22% were classified as impaired, 45% had noticed a change in cognition, and 15% reported that they were affected in their daily lives. Patients noticing this impact had lower MoCA scores (22.74, SD 3.0) than those who did not (25.17, SD 2.96; P </= .02). Most impairments occurred for delayed recall, visuospatial/executive function, and abstraction. The odds of impairment increased by the presence of ischemic heart disease (odds ratio, 4.18; 95% confidence interval, 1.15-15.69). CONCLUSIONS: In HF outpatients without a dementia diagnosis, MCI is prevalent. Screening for MCI and incorporation of compensatory strategies are essential.","Aged;Aged, 80 and over;Female;Heart Failure/diagnosis/epidemiology/*psychology;Humans;Male;Mild Cognitive Impairment/diagnosis/epidemiology/*psychology;*Neuropsychological Tests;Patient Participation/methods/*psychology;Pilot Projects;*Self Report;Cognitive impairment;awareness;comorbidity;heart failure;screening","Gallagher, R.;Sullivan, A.;Burke, R.;Hales, S.;Gillies, G.;Cameron, J.;Saliba, B.;Tofler, G.",2013,Sep,10.1016/j.cardfail.2013.08.001,0,
1446,"Quality of life, social support and cognitive impairment in heart failure patients without diagnosed dementia","Improving health-related quality of life (HRQL) is an important goal for heart failure (HF) patients, and understanding the factors that influence HRQL is essential to this process. We investigated the influence of social support and cognitive impairment on HRQL in community dwelling HF patients (n = 104) without diagnosed dementia. Patients were aged mean 80.93 years (SD 11.01) and were classified as New York Heart Association Class 1/II (45%) or III/IV (53%). Age, social support and cognition had important independent effects. Younger people had the most negative effects of HF in all areas of HRQL: emotional (B = -0.32), physical (B = -0.44) and overall (B = -1). Well-supported patients (general social support) had the least negative effect from HF on HRQL: emotional domain (B = -4.62) and overall (B = -11.72). Patients with normal cognition had more negative impact of HF on HRQL: physical domain (B = 5.51) and overall HRQL (B = 10.42). A clearer understanding of the relationships between age, social support and cognition and the effect on the impact of HF on HRQL is needed before interventions can be appropriately developed.",age;cognitive impairment;health-related quality of life;heart failure;social support,"Gallagher, R.;Sullivan, A.;Burke, R.;Hales, S.;Sharpe, P.;Tofler, G.",2016,Apr,10.1111/ijn.12402,0,1447
1447,"Quality of life, social support and cognitive impairment in heart failure patients without diagnosed dementia","Improving health-related quality of life (HRQL) is an important goal for heart failure (HF) patients, and understanding the factors that influence HRQL is essential to this process. We investigated the influence of social support and cognitive impairment on HRQL in community dwelling HF patients (n = 104) without diagnosed dementia. Patients were aged mean 80.93 years (SD 11.01) and were classified as New York Heart Association Class 1/II (45%) or III/IV (53%). Age, social support and cognition had important independent effects. Younger people had the most negative effects of HF in all areas of HRQL: emotional (B = -0.32), physical (B = -0.44) and overall (B = -1). Well-supported patients (general social support) had the least negative effect from HF on HRQL: emotional domain (B = -4.62) and overall (B = -11.72). Patients with normal cognition had more negative impact of HF on HRQL: physical domain (B = 5.51) and overall HRQL (B = 10.42). A clearer understanding of the relationships between age, social support and cognition and the effect on the impact of HF on HRQL is needed before interventions can be appropriately developed.",cognition;cognitive defect;female;heart failure;human;male;mental health;physiology;psychology;quality of life;questionnaire;social support;very elderly,"Gallagher, R.;Sullivan, A.;Burke, R.;Hales, S.;Sharpe, P.;Tofler, G.",2016,,10.1111/ijn.12402,0,
1448,Does Memantine induce bradycardia? A study in the French Pharmaco Vigilance Database,"Objective: To review the cardiovascular adverse drug reactions (ADRs) with memantine reported to the French PharmacoVigilance Database. Methods: We reviewed all the observations of cardiovascular ADRs with memantine reported to the French PharmacoVigilance Database up to May 2007. We recorded the characteristics of patients (age, sex and underlying disease) and of ADRs (nature, seriousness, delay in occurrence, evolution, imputability). Results: After exclusion of 16 cases, the cardiac origin of which was not clearly assessed, 36 cardiac ADRs with memantine were recorded between its commercialisation in France (July 2003) and May 2007. These ADRs consisted of 18 reports of bradycardia and 18 reports of various cardiovascular ADRs (orthostatic hypotension with fall[6] electrocardiogram perturbations[4] fainting[2] malaise with arterial hypotension[2] arterial hypoterision and acute renal failure[1] fatal heart failure[1] sudden death[2]). Among the 18 reports of bradycardia, 7 cases occurred with memantine as the sole suspected drug and all but one resolved after memantine's discontinuation. Conclusion: Cardiovascular properties of memantine seem to be complex and remain quite unclear. Despite its drawbacks and its descriptive design, our study suggests that memantine could determine some cardiac ADRs, especially bradycardia; the mechanism of which remains unexplained. Copyright © 2008 John Wiley & Sons, Ltd.",beta adrenergic receptor blocking agent;digoxin;donepezil;galantamine;memantine;rivastigmine;acute kidney failure;adult;aged;Alzheimer disease;article;bradycardia;cardiovascular disease;cardiovascular effect;cardiovascular risk;clinical article;data base;descriptive research;drug response;drug safety;drug surveillance program;drug withdrawal;ECG abnormality;female;heart failure;heart rate;human;hypotension;malaise;male;observational study;orthostatic hypotension;priority journal;side effect;sudden death;faintness;ebixa,"Gallini, A.;Sommet, A.;Montastruc, J. L.",2008,,,0,
1449,Statins and their pleiotropic effects,"Statins are well-established and effective drugs in the treatment of hyperlipidemias and coronary heart disease. However the effects of statins extend beyond their lipid-lowering actions, due to their capacity to inhibit prenylation of some intracellular regulatory proteins. Recent studies have shown that statins could modulate inflammantory response, improve endothelial function, exert antiarrhytmic properties, have beneficial effects on renal function and bone tissue. Statins may exert effect in the treament and prevention of dementia and some autoimmune disorders. Although statins therapy is generally well-tolerated, sometimes they lead to objective adverse effects, mainly in muscular system. Combination therapy with fibrates, coenzyme Q and other substances may increase and even extend therapeutic effects of statins. Further studies will help to clarify the clinical role of statins.",hydroxymethylglutaryl coenzyme A reductase inhibitor;article;autoimmune disease;chemically induced disorder;coronary artery disease;dementia;human;hyperlipidemia;musculoskeletal disease,"Galus, R.;Zandecki, Ł;Jóźwiak, J.;Włodarski, K.",2008,,,0,
1450,Mystery case responses,,adult;brain hemorrhage;case report;computed tomographic angiography;computer assisted tomography;female;headache;heart failure;human;hydrocephalus;middle aged;neuroimaging;note;pregnancy;priority journal;vein of Galen malformation;vomiting,"Ganesh, A.",2015,,,0,
1451,Loci influencing blood pressure identified using a cardiovascular gene-centric array,"Blood pressure (BP) is a heritable determinant of risk for cardiovascular disease (CVD). To investigate genetic associations with systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP), we genotyped ~50 000 single-nucleotide polymorphisms (SNPs) that capture variation in ~2100 candidate genes for cardiovascular phenotypes in 61 619 individuals of European ancestry from cohort studies in the USA and Europe. We identified novel associations between rs347591 and SBP (chromosome 3p25.3, in an intron of HRH1) and between rs2169137 and DBP (chromosome1q32.1 in an intron of MDM4) and between rs2014408 and SBP (chromosome 11p15 in an intron of SOX6), previously reported to be associated with MAP. We also confirmed 10 previously known loci associated with SBP, DBP, MAP or PP (ADRB1, ATP2B1, SH2B3/ATXN2, CSK, CYP17A1, FURIN, HFE, LSP1, MTHFR, SOX6) at array-wide significance (P < 2.4 × 10-6). We then replicated these associations in an independent set of 65 886 individuals of European ancestry. The findings from expression QTL (eQTL) analysis showed associations of SNPs in the MDM4 region with MDM4 expression. We did not find any evidence of association of the two novel SNPs in MDM4 and HRH1 with sequelae of high BP including coronary artery disease (CAD), left ventricular hypertrophy (LVH) or stroke. In summary, we identified two novel loci associated with BP and confirmed multiple previously reported associations. Our findings extend our understanding of genes involved in BP regulation, some of which may eventually provide new targets for therapeutic intervention. © The Author 2013. Published by Oxford University Press. All rights reserved.",furin;protein MDMX;transcription factor Sox6;adult;article;blood pressure;blood pressure regulation;cardiovascular disease;cerebrovascular accident;chromosome 11p;chromosome 19;chromosome 1q;chromosome 3p;coronary artery disease;diastolic blood pressure;Europe;female;gene locus;gene replication;genetic association;genetic variability;genotype;heart left ventricle hypertrophy;human;intron;major clinical study;male;mean arterial pressure;phenotype;pleiotropy;priority journal;pulse pressure;quantitative trait locus;single nucleotide polymorphism;systolic blood pressure;United States,"Ganesh, S. K.;Tragante, V.;Guo, W.;Guo, Y.;Lanktree, M. B.;Smith, E. N.;Johnson, T.;Castillo, B. A.;Barnard, J.;Baumert, J.;Chang, Y. P. C.;Elbers, C. C.;Farrall, M.;Fischer, M. E.;Franceschini, N.;Gaunt, T. R.;Gho, J. M. I. H.;Gieger, C.;Gong, Y.;Isaacs, A.;Kleber, M. E.;Leach, I. M.;McDonough, C. W.;Meijs, M. F.;Mellander, O.;Molony, C. M.;Nolte, I. M.;Padmanabhan, S.;Price, T. S.;Rajagopalan, R.;Shaffer, J.;Shah, S.;Shen, H.;Soranzo, N.;van der Most, P. J.;Van Iperen, E. P. A.;Van Setten, J. A.;Vonk, J. M.;Zhang, L.;Beitelshees, A. L.;Berenson, G. S.;Bhatt, D. L.;Boer, J. M. A.;Boerwinkle, E.;Burkley, B.;Burt, A.;Chakravarti, A.;Chen, W.;Cooper-DeHoff, R. M.;Curtis, S. P.;Dreisbach, A.;Duggan, D.;Ehret, G. B.;Fabsitz, R. R.;Fornage, M.;Fox, E.;Furlong, C. E.;Gansevoort, R. T.;Hofker, M. H.;Hovingh, G. K.;Kirkland, S. A.;Kottke-Marchant, K.;Kutlar, A.;LaCroix, A. Z.;Langaee, T. Y.;Li, Y. R.;Lin, H.;Liu, K.;Maiwald, S.;Malik, R.;Murugesan, G.;Newton-Cheh, C.;O'Connell, J. R.;Onland-Moret, N. C.;Ouwehand, W. H.;Palmas, W.;Penninx, B. W.;Pepine, C. J.;Pettinger, M.;Polak, J. F.;Ramachandran, V. S.;Ranchalis, J.;Redline, S.;Ridker, P. M.;Rose, L. M.;Scharnag, H.;Schork, N. J.;Shimbo, D.;Shuldiner, A. R.;Srinivasan, S. R.;Stolk, R. P.;Taylor, H. A.;Thorand, B.;Trip, M. D.;van Duijn, C. M.;Verschuren, W. M.;Wijmenga, C.;Winkelmann, B. R.;Wyatt, S.;Young, J. H.;Boehm, B. O.;Caulfield, M. J.;Chasman, D. I.;Davidson, K. W.;Doevendans, P. A.;FitzGerald, G. A.;Gums, J. G.;Hakonarson, H.;Hillege, H. L.;Illig, T.;Jarvik, G. P.;Johnson, J. A.;Kastelein, J. J.;Koenig, W.;Study, L. C.;März, W.;Mitchell, B. D.;Murray, S. S.;Oldehinkel, A. J.;Rader, D. J.;Reilly, M. P.;Reiner, A. P.;Schadt, E. E.;Silverstein, R. L.;Snieder, H.;Stanton, A. V.;Uitterlinden, A. G.;van der Harst, P.;van der Schouw, Y. T.;Samani, N. J.;Johnson, A. D.;Munroe, P. B.;de Bakker, P. I. W.;Zhu, X.;Levy, D.;Keating, B. J.;Asselbergs, F. W.",2013,,,0,
1452,Small heat shock protein alphaB-crystallin is part of cell cycle-dependent Golgi reorganization,"AlphaB-crystallin is a developmentally regulated small heat shock protein known for its binding to a variety of denatured polypeptides and suppression of protein aggregation in vitro. Elevated levels of alphaB-crystallin are known to be associated with a number of neurodegenerative pathologies such as Alzheimer disease and multiple sclerosis. Mutations in alphaB-crystallin gene have been linked to desmin related cardiomyopathy and cataractogenesis. The physiological function of this protein, however, is unknown. Using discontinuous sucrose density gradient fractionation of post-nuclear supernatants, prepared from rat tissues and human glioblastoma cell line U373MG, we have identified discrete membrane-bound fractions of alphaB-crystallin, which co-sediment with the Golgi matrix protein, GM130. Confocal microscopy reveals co-localization of alphaB-crystallin with BODIPY TR ceramide and the Golgi matrix protein, GM130, in the perinuclear Golgi in human glioblastoma U373MG cells. Examination of synchronized cultures indicated that alphaB-crystallin follows disassembly of the Golgi at prometaphase and its reassembly at the completion of cytokinesis, suggesting that this small heat shock protein, with its chaperone-like activity, may have an important role in the Golgi reorganization during cell division.","Amino Acid Sequence;Animals;Cell Cycle/*physiology;Cell Division/physiology;Cell Line;Conserved Sequence;Golgi Apparatus/physiology/*ultrastructure;Microscopy, Confocal;Peptide Fragments;Rats;Rats, Sprague-Dawley;alpha-Crystallin B Chain/*physiology","Gangalum, R. K.;Schibler, M. J.;Bhat, S. P.",2004,Oct 15,10.1074/jbc.C400371200,0,
1453,A theoretical model based upon mast cells and histamine to explain the recently proclaimed sensitivity to electric and/or magnetic fields in humans,"The relationship between exposure to electromagnetic fields (EMFs) and human health is more and more in focus. This is mainly because of the rapid increasing use of such EMFs within our modern society. Exposure to EMFs has been linked to different cancer forms, e.g. leukemia, brain tumors, neurological diseases, such as Alzheimer's disease, asthma and allergy, and recently to the phenomena of 'electrosupersensitivity' and 'screen dermatitis'. There is an increasing number of reports about cutaneous problems as well as symptoms from internal organs, such as the heart, in people exposed to video display terminals (VDTs). These people suffer from subjective and objective skin and mucosa-related symptoms, such as itch, heat sensation, pain, erythema, papules and pustules. In severe cases, people can not, for instance, use VDTs or artificial light at all, or be close to mobile telephones. Mast cells (MCs), when activated, release a spectrum of mediators, among them histamine, which is involved in a variety of biological effects with clinical relevance, e.g. allergic hypersensitivity, itch, edema, local erythema and many types of dermatoses. From the results of recent studies, it is clear that EMFs affect the MC, and also the dendritic cell, population and may degranulate these cells. The release of inflammatory substances, such as histamine, from MCs in the skin results in a local erythema, edema and sensation of itch and pain, and the release of somatostatin from the dendritic cells may give rise to subjective sensations of on-going inflammation and sensitivity to ordinary light. These are, as mentioned, the common symptoms reported from patients suffering from 'electrosupersensitivity'/'screen dermatitis'. MCs are also present in the heart tissue and their localization is of particular relevance to their function. Data from studies made on interactions of EMFs with the cardiac function have demonstrated that highly interesting changes are present in the heart after exposure to EMFs. One could speculate that the cardiac MCs are responsible for these changes due to degranulation after exposure to EMFs. However, it is still not known how, and through which mechanisms, all these different cells are affected by EMFs. In this article, we present a theoretical model, based upon observations on EMFs and their cellular effects, to explain the proclaimed sensitivity to electric and/or magnetic fields in humans.","*Electromagnetic Fields;Histamine/*physiology;Humans;Mast Cells/*physiology/radiation effects;*Models, Biological","Gangi, S.;Johansson, O.",2000,Apr,10.1054/mehy.1999.0923,0,
1454,"Hyponatremia: Incidence, risk factors, and consequences in the elderly in a home-based primary care program","Aims: To determine the incidence, risk factors, etiology, and associations of hyponatremia in community-dwelling elderly with geriatric morbidity and mortality. Materials: Elderly participants of a single center home-based primary care program were included. Method: Retrospective chart review was conducted on demographic and clinical variables, comorbid diseases, frailty by Fried criteria and biochemical tests over a 1-year period. Primary outcome measure was a composite of falls, fractures due to falls, and hospitalization witnessed within the first year of enrollment into the program. Secondary outcome was all-cause mortality. Results: The study population (n = 608) had a mean age of 84.3 ± 9.3 years and was largely female (77.1%) and African-American (89.5%). Mean follow-up was 41.5 months. Frailty was seen in 44.4%. Incidence of allcause mortality was 26.9%. Initial hyponatremia occurred in 8.71% (n = 53), and persistent hyponatremia (> 6 months of low serum sodium) in 4.1% (n = 25) of the study population. The major causes of hyponatremia included multiple potential causes, idiopathic syndrome of inappropriate antidiuretic hormone (SIADH) and medications (thiazides and selective serotonin reuptake inhibitor (SSRI)). Primary outcome was independently associated with frailty (Odds ratio (OR) of 2.33) and persistent but not initial hyponatremia (OR 3.52). Secondary outcome was independently associated with age > 75 years (OR 2.88) and Afro-American race (OR 2.09) only but not to frailty or hyponatremia. Conclusions: Hyponatremia is common in home-bound elderly patients and its persistence independently contributes to falls, fractures, and hospitalization but not mortality. Our study highlights a new association of hyponatremia with frailty and underscores the need to study time-dependent association of hyponatremia with epidemiological outcomes.",neuroleptic agent;serotonin uptake inhibitor;sodium;thiazide diuretic agent;African American;aged;Alzheimer disease;article;Asian;Caucasian;cerebrovascular disease;Charlson Comorbidity Index;chronic kidney disease;congestive heart failure;creatinine blood level;diabetes mellitus;disease association;falling;female;follow up;frail elderly;geriatric patient;health program;heart failure;Hispanic;home care;human;hypertension;hypervolemia;hyponatremia;hypothyroidism;inappropriate vasopressin secretion;incidence;major clinical study;male;medical record review;mental disease;morbidity;mortality;multiinfarct dementia;outcome assessment;physical activity;polydipsia;primary medical care;retrospective study;risk factor;self report;serum osmolarity;sodium blood level;sodium urine level;terminal disease;urine osmolality;very elderly;walking speed;weight reduction,"Ganguli, A.;Mascarenhas, R. C.;Jamshed, N.;Tefera, E.;Veis, J. H.",2015,,,0,
1455,Mild cognitive impairment: incidence and vascular risk factors in a population-based cohort,"OBJECTIVE: We examined the incidence of mild cognitive impairment (MCI) and its potential vascular risk factors in a prospective population-based study. METHODS: An age-stratified random population-based cohort (baseline n = 1,982), followed for up to 4 years, was annually assessed for cognitive and everyday functioning. Incidence rates were calculated for both cognitive (neuropsychological [NP]-MCI) and functional (Clinical Dementia Rating [CDR] = 0.5) definitions of MCI. Several measures of vascular, metabolic, and inflammatory risk were assessed at baseline. Risk factor analyses used interval censoring survival models, followed by joint modeling of both MCI and attrition due to mortality and illness. RESULTS: Incidence rates for NP-MCI and CDR = 0.5 were 95 and 55 per 1,000 person-years. In individual joint models, risk factors for NP-MCI were diabetes and adiposity (waist: hip ratio), while APOE epsilon4 genotype and heart failure increased risk of attrition. Adiposity, stroke, heart failure, and diabetes were risk factors for nonamnestic MCI. For CDR = 0.5, risk factors were stroke and heart failure; heart failure and adiposity increased risk of attrition. In multivariable joint models combining all risk factors, adiposity increased risk of NP-MCI, while stroke and heart failure increased risk for CDR = 0.5. Current alcohol use appeared protective against all subtypes. CONCLUSION: Incidence of MCI increased with age regardless of definition and did not vary by sex or education. Several vascular risk factors elevated the risk of incident MCI, whether defined cognitively or functionally, but most were associated with nonamnestic MCI and CDR = 0.5. Controlling vascular risk may potentially reduce risk of MCI.","Age Factors;Aged;Aged, 80 and over;Female;Follow-Up Studies;Humans;Incidence;Male;Mild Cognitive Impairment/*epidemiology/mortality/physiopathology;Models, Statistical;Neuropsychological Tests;Pennsylvania/epidemiology;Psychiatric Status Rating Scales;Risk Factors;Time Factors","Ganguli, M.;Fu, B.;Snitz, B. E.;Hughes, T. F.;Chang, C. C.",2013,Jun 4,10.1212/WNL.0b013e318295d776,0,
1456,Genetic determinants of mortality. Can findings from genome-wide association studies explain variation in human mortality?,"Twin studies have estimated the heritability of longevity to be approximately 20-30 %. Genome-wide association studies (GWAS) have revealed a large number of determinants of morbidity, but so far, no new polymorphisms have been discovered to be associated with longevity per se in GWAS. We aim to determine whether the genetic architecture of mortality can be explained by single nucleotide polymorphisms (SNPs) associated with common traits and diseases related to mortality. By extensive quality control of published GWAS we created a genetic score from 707 common SNPs associated with 125 diseases or risk factors related with overall mortality. We prospectively studied the association of the genetic score with: (1) time-to-death; (2) incidence of the first of nine major diseases (coronary heart disease, stroke, heart failure, diabetes, dementia, lung, breast, colon and prostate cancers) in two population-based cohorts of Dutch and Swedish individuals (N = 15,039; age range 47-99 years). During a median follow-up of 6.3 years (max 22.2 years), we observed 4,318 deaths and 2,132 incident disease events. The genetic score was significantly associated with time-to-death [hazard ratio (HR) per added risk allele = 1.003, P value = 0.006; HR 4th vs. 1st quartile = 1.103]. The association between the genetic score and incidence of major diseases was stronger (HR per added risk allele = 1.004, P value = 0.002; HR 4th vs. 1st quartile = 1.160). Associations were stronger for individuals dying at older ages. Our findings are compatible with the view of mortality as a complex and highly polygenetic trait, not easily explainable by common genetic variants related to diseases and physiological traits.","Aged;Aged, 80 and over;Cohort Studies;Dementia/genetics/mortality;Diabetes Mellitus/genetics/mortality;Female;Follow-Up Studies;Genetic Predisposition to Disease/*genetics;*Genome-Wide Association Study;Genotype;Heart Diseases/genetics/mortality;Humans;Incidence;Longevity/*genetics/physiology;Longitudinal Studies;Male;Middle Aged;Multifactorial Inheritance/*genetics;Neoplasms/genetics/mortality;Netherlands/epidemiology;Phenotype;Polymorphism, Single Nucleotide/*genetics;Prospective Studies;Risk Factors;Stroke/genetics/mortality;Sweden/epidemiology","Ganna, A.;Rivadeneira, F.;Hofman, A.;Uitterlinden, A. G.;Magnusson, P. K.;Pedersen, N. L.;Ingelsson, E.;Tiemeier, H.",2013,May,10.1007/s00439-013-1267-6,0,
1457,Nurse practitioner comanagement for patients in an academic geriatric practice,"OBJECTIVE: To determine whether nurse practitioner (NP) comanagement can improve the quality of care for 5 chronic conditions in an academic geriatrics practice. STUDY DESIGN AND METHODS: From September 2006 to September 2007, 18 primary care geriatricians were divided into an intervention group that could refer patients to an NP for comanagement of dementia, depression, falls, heart failure, and/or urinary incontinence, or a control group that indicated which patients would have been referred to the NP for these conditions. The NP used structured visit notes to guide care delivery for the 5 conditions concordant with Assessing Care of Vulnerable Elders-3 (ACOVE-3) quality indicators. We reviewed charts to determine adherence to recommended processes of care. RESULTS: A total of 200 patients (108 intervention, 92 control) were eligible for at least 1 process of care recommended by ACOVE-3 for the 5 conditions. Patients' mean (SD) age was 85 years (7 years), 67% were women, and patients were eligible for a mean (SD) of 6.9 (4.4) processes of care. Intervention patients were eligible for more care processes than controls (7.8 vs 5.9 processes per patient; P = .002). Quality of care was higher for patients in the intervention group compared with the control group (54% vs 34% of care processes completed; P <.001). The adjusted absolute difference between intervention and control groups in care processes completed was 20% (95% confidence interval = 13%, 27%). CONCLUSION: NP comanagement of 5 chronic conditions was associated with higher quality of care, even in a practice of geriatricians.","*Accidental Falls;Aged, 80 and over;Chronic Disease;Dementia/*nursing/psychology;Depression/*nursing/psychology;Female;Geriatric Nursing;Heart Failure/*nursing/psychology;Hospitals, Teaching/organization & administration;Humans;Male;*Nurse Practitioners;Patient Care Team/organization & administration;Program Evaluation;Quality of Health Care;Statistics as Topic;Urinary Incontinence/*nursing/psychology","Ganz, D. A.;Koretz, B. K.;Bail, J. K.;McCreath, H. E.;Wenger, N. S.;Roth, C. P.;Reuben, D. B.",2010,Dec 01,,0,
1458,Advancement of hormone replacement therapy on peri- and post - menopausal symptoms,"Although the hormone replacement therapy (HRT) is widely used and more and more studies on HRT are carried out, the debate about the effect and side effect of HRT remains. This state summarized the benefits and risks of HRT on postmenopausal osteoporosis, Alzheimer's disease, coronary heart disease and malignant tumors of postmenopausal women, the programs and the rules of HRT.",conjugated estrogen;conjugated estrogen plus medroxyprogesterone acetate;medroxyprogesterone acetate;Alzheimer disease;article;clinical trial;hormone substitution;human;ischemic heart disease;malignant neoplastic disease;menopausal syndrome;postmenopause osteoporosis;risk benefit analysis,"Gao, N.;Shi, H.",2009,,,0,
1459,Accelerated weight loss and incident dementia in an elderly african-american cohort,"OBJECTIVES: To examine the association between changes in body mass index (BMI), dementia, and mild cognitive impairment (MCI). DESIGN: Prospective observational study. SETTING: Urban community in Indianapolis, Indiana. PARTICIPANTS: Participants were African Americans aged 65 and older enrolled in the Indianapolis Dementia Project and followed through 2007. This analysis included 1,331 participants who did not have dementia at their first BMI measurement. MEASUREMENTS: Cognitive assessment and clinical evaluations were conducted every other year to identify participants with dementia or MCI during 12 years of follow-up (mean follow-up 6.4 years). BMI measures; alcohol and smoking history; and medical conditions including history of cancer, hypertension, diabetes mellitus, heart attack, stroke; and depression were collected at each follow-up evaluation. Mixed-effect models were used to examine the differences in BMI between participants who developed dementia or MCI and those who did not, adjusting for covariates. RESULTS: Mean BMI at baseline was 29.8 ± 5.7 for women and 28.3 ± 4.8 for men. Participants with incident dementia or MCI had greater decline in BMI than those without (P=.02 for dementia, P=.04 for MCI). BMI in participants with incident dementia, MCI, and normal cognition did not differ 12 or 9 years before diagnosis, but 6 years before diagnosis, participants with incident dementia had significantly lower BMI than participants with normal cognition (P=.03), as did participants with MCI (P=.006). CONCLUSION: Decline in BMI appears to be an early marker for dementia. There is a need for the close monitoring of weight loss in older adults. © 2010, The American Geriatrics Society.",African American;aged;aging;alcohol consumption;Alzheimer disease;article;body mass;clinical assessment;clinical evaluation;clinical feature;cognition;cohort analysis;controlled study;dementia;depression;diabetes mellitus;disease association;female;follow up;heart infarction;human;hypertension;major clinical study;male;mild cognitive impairment;neoplasm;observational study;prospective study;smoking;cerebrovascular accident;United States;urban population;weight reduction,"Gao, S.;Nguyen, J. T.;Hendrie, H. C.;Unverzagt, F. W.;Hake, A.;Smith-Gamble, V.;Hall, K.",2011,,,0,
1460,Adverse effects of propafenone after long-term therapy with the addition of citalopram,"Background: Propafenone, a class IC antiarrhythmic, and citalopram, a selective serotonin reuptake inhibitor (SSRI), are widely used in older patients. Although a potential interaction between propafenone and SSRIs has been noted, a MEDLINE search revealed no published reports of an interaction between propafenone and citalopram. Objective: The goal of this article was to describe a potential drug-drug interaction between propafenone and citalopram, which caused symptoms of propafenone adverse effects. Case summary: An 80-year-old white female, followed up at the Memory Clinic for mild cognitive impairment, had been taking propafenone 900 mg/d for >10 years for paroxysmal atrial fibrillation without adverse effects. Three months after starting citalopram, she experienced episodes of chest tightness and dizziness. The episodes became more frequent in the following months, causing several falls and requiring visits to the emergency department, but no acute coronary event was diagnosed. She was started on amlodipine 2.5 mg orally once daily, a nitroglycerin patch (0.4 mg/h), and warfarin 5 mg orally once daily. After one fall, the patient became delirious. Amlodipine and the nitroglycerin patch were discontinued and propafenone decreased to 450 mg/d; citalopram was continued at 20 mg/d. The patient recovered well, both cognitively and physically, and did not have any further symptoms in 1 year of follow-up. Results of coronary investigations were negative. Conclusions: This is the first report of a possible interaction between propafenone and citalopram, which caused propafenone adverse effects (eg, dizziness, falls) and mimicked coronary artery disease. © 2008 Excerpta Medica Inc. All rights reserved.",acetylsalicylic acid;amlodipine;citalopram;creatinine;cytochrome P450 2D6;digoxin;diuretic agent;glyceryl trinitrate;hydrochlorothiazide plus spironolactone;isosorbide dinitrate;propafenone;simvastatin;warfarin;aged;anamnesis;anemia;anxiety disorder;article;Canada;case report;chest tightness;cognitive defect;coronary artery disease;creatinine blood level;delirium;dementia;differential diagnosis;disease severity;dizziness;drug antagonism;drug blood level;drug dependence;drug dose increase;drug dose reduction;drug response;drug withdrawal;emergency care;falling;female;follow up;genetic polymorphism;glomerulus filtration rate;atrial fibrillation;heterozygosity;human;hypercholesterolemia;long term care;priority journal;promoter region;scoring system;side effect;stress,"Garcia, A.",2008,,,0,
1461,"Platelet clinical proteomics: Facts, challenges, and future perspectives","In recent years, proteomics has been applied to platelet clinical research. Platelets are small enucleated cells that play a fundamental role in hemostasis. In a pathological context, unwanted platelet activation is related to various diseases, primarily thrombosis, but also cancer metastasis, inflammation, immunity, and neurodegenerative diseases. The absence of a nucleus is one of the reasons why proteomics can be considered an ideal analytical tool for platelet research. Indeed, platelet proteomics has allowed the identification of many novel signaling proteins and receptors, several of which are being pursued as potential therapeutic targets. Encouraged by this success, several research groups have recently initiated clinical proteomics studies covering diseases where platelets are involved in some way, such as coronary artery disease, storage pool diseases, uremia, cystic fibrosis, and Alzheimer disease. The goal was to identify platelet biomarkers and drug targets that can help to improve the treatment/diagnosis of the disease and provide further mechanistic evidences of the role platelets play in the pathology. The present article will comment on the recent progress of clinical proteomics in the context of platelet research, challenges, and perspectives for the future ahead.",Clinical proteomics;Platelets,"Garcia, A.",2016,Aug,10.1002/prca.201500125,0,
1462,Use of diagnostic and therapeutic resources in patients hospitalized for heart failure: influence of admission ward type (INCARGAL Study),"BACKGROUND: Heart failure (HF) is the most rapidly growing cardiac pathology in industrialized countries, and already the primary cause of hospital admissions of elderly people. Outside the field of clinical trials, there have not been many studies in Spain of the influence of the admission department on diagnostic and therapeutic management, whether this affects short-term and long-term prognosis, and the factors that determine the department the patient is admitted to. OBJECTIVE: . To analyze whether management and prognosis of patients admitted with heart failure differ depending on the admission ward (cardiology versus internal medicine-geriatrics). PATIENTS AND METHODS: Cross-sectional study of 951 patients (505 men and 446 women) consecutively hospitalized for HF in the cardiology (n = 363) and internal medicine-geriatrics (n = 588) wards of 12 hospitals of Galicia and recruited over a maximum period of 6 months. The main epidemiological and clinical variables were recorded at admission, and the complications, treatments, and clinical status were recorded at release.Results. HF patients had a mean age of 75.5 12 years (women 78.5 years and men 72.6 years). The average hospitalization time was 11 8 days and 50.8% were first admissions. Total hospital mortality was 6.8%. Fifty-nine percent (58.9%) of patients had arterial hypertension, 31.9% ischemic heart disease, 27.6% cardiac valve disease, 28.5% diabetes mellitus, and 32.5% chronic obstructive pulmonary disease (COPD). The patients admitted to cardiology ward were younger (72.5 13 vs 77.4 11 years; p < 0.005), more frequently men (51.9 vs 43.7%; p < 0.005), more often first hospitalizations (54.8 vs 48.4%; p < 0.005), and acute pulmonary edema was more common (22.8 vs 9.2%; p < 0.005). The odds ratio (and 95% CI) for therapeutic and diagnostic procedures in relation to admission ward (reference group internal medicine-geriatrics), adjusted for age, sex, systolic function, number of hospitalizations, and history of dementia, hypertension, COPD, AMI, valve disease and ischemic heart disease, are: echocardiogram, 3.49 (2.58-4.73); catheterization, 6.42 (3.29-12.55), admission to intensive care, 3.94 (2.15-7.25), revascularization, 2.15 (0.57-8.08), and beta-blocker treatment, 3.39 (1.93-5.97). No differences in hospital mortality (6.6% in cardiology vs 7% in internal medicine-geriatrics) or average hospitalization time were found between departments. CONCLUSIONS: The admission ward was related with a clear difference in HF management, with better adherence to guidelines and more use of resources by cardiologists. This was unrelated with differences in hospital mortality so a longer follow-up of these patients is required to evaluate the impact of these therapeutic measures on the prognosis and evolution of HF, as well as the cost-benefit relation in an elderly patient population.","Aged;Aged, 80 and over;Cardiology Service, Hospital/statistics & numerical data;Cross-Sectional Studies;Female;Health Resources/*utilization;Heart Failure/epidemiology/*therapy;Hospitalization/statistics & numerical data;Humans;Internal Medicine/statistics & numerical data;Length of Stay/statistics & numerical data;Male;Middle Aged;Patient Admission/statistics & numerical data;Practice Patterns, Physicians';Prognosis;Spain/epidemiology","Garcia Castelo, A.;Muniz Garcia, J.;Sesma Sanchez, P.;Castro Beiras, A.",2003,Jan,,0,
1463,Case report: Evidence of Autochthonous chagas disease in Southeastern Texas,"Autochthonous transmission of Trypanosoma cruzi in the United States is rarely reported. Here, we describe five newly identified patients with autochthonously acquired infections from a small pilot study of positive blood donors in southeast Texas. Case-patients 1-4 were possibly infected near their residences, which were all in the same region ∼100 miles west of Houston. Case-patient 5 was a young male with considerable exposure from routine outdoor and camping activities associated with a youth civic organization. Only one of the five autochthonous case-patients received anti-parasitic treatment. Our findings suggest an unrecognized risk of human vector-borne transmission in southeast Texas. Education of physicians and public health officials is crucial for identifying the true disease burden and source of infection in Texas.",adult;aged;Alzheimer disease;article;blood analysis;blood bank;blood donor;blood sampling;blood transfusion;bradycardia;camping;Chagas disease;clinical article;electrocardiography;enzyme linked immunosorbent assay;female;first degree atrioventricular block;heart atrium pacing;heart right bundle branch block;human;hypertension;male;middle aged;occupational exposure;pilot study;polymerase chain reaction;residential area;screening test;Triatoma;Triatoma gerstaeckeri;Trypanosoma cruzi;United States;young adult,"Garcia, M. N.;Aguilar, D.;Gorchakov, R.;Rossmann, S. N.;Montgomery, S. P.;Rivera, H.;Woc-Colburn, L.;Hotez, P. J.;Murray, K. O.",2015,,,0,
1464,Gallstone-related disease in the elderly: is there room for improvement?,"BACKGROUND AND AIM: Elderly patients are frequently affected by gallstone-related disease. Current guidelines support cholecystectomy after a first acute biliary complication. In the aging, these recommendations are irregularly followed. METHODS: We analyzed data from patients 65 or older admitted between June 30, 2004 and June 30, 2013 with a diagnosis of acute pancreatitis, cholangitis, or cholecystitis. Diagnosis and severity assessment were defined according to current guidelines. Harms, mortality, and cholecystectomy rates were evaluated. Baseline factors independently predicting cholecystectomy were identified. RESULTS: A total of 491 patients were included. The median age was 78.8 years, and 51.7 % were women. Acute cholecystitis was present in 51.7 %, acute pancreatitis in 36.5 %, and acute cholangitis in 11.8 %. Cholecystectomy was performed in 47.1 %. Age, myocardial infarct, dementia, diabetes, nonmetastatic tumor, and severe liver disease were risk factors for not undergoing surgery. Complications related to hospital stay appeared in 33 % of patients. Surgery, cholecystostomy, and ERCP presented harms in 21-25 %. Overall mortality rate was 5.4 %: 10.4 % in acute cholangitis, 6.8 % in acute cholecystitis, and 2.2 % in acute pancreatitis. Mild cases presented a 1.3 % mortality, while 28.6 % of severe cases died. After discharge, 24.7 % of patients presented a new biliary complication, 9.7 % of them severe. Relapse was more frequent in patients managed without invasive procedures, 42.3 % than in cholecystectomy patients, 9.9 % (p < 0.001) and than in ERCP patients, 19.4 % (p = 0.01). CONCLUSIONS: Cholecystectomy should be recommended to elderly patients after a first acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused.","Acute Disease;Aged;Aged, 80 and over;Cholangitis/epidemiology/surgery;*Cholecystectomy;Cholecystitis, Acute/epidemiology/*surgery;Female;Guideline Adherence;Hospital Mortality;Humans;Male;Pancreatitis/epidemiology/surgery;Postoperative Complications/mortality;Retrospective Studies;Severity of Illness Index;Treatment Outcome","Garcia-Alonso, F. J.;de Lucas Gallego, M.;Bonillo Cambrodon, D.;Algaba, A.;de la Poza, G.;Martin-Mateos, R. M.;Bermejo, F.",2015,Jun,10.1007/s10620-014-3497-4,0,
1465,Risk factors for postoperative infections in patients with hip fracture treated by means of Thompson arthroplasty,"Specific conditions associated with surgery may predispose elderly people to septic complications after hip fracture surgery. This study investigated the risk factors predisposing infection in aged patients with subcapital hip fracture. We performed a prospective study of 290 patients with displaced subcapital hip fracture, operated by means of Thompson hip hemi-arthroplasty (83.5% fractures in women). The mean age was 85.42 ± 6.06 years (ranging from 69 to 104). Follow-up was realized until death or at least for 2 years. The χ2 test, analysis of variance, Kruskal-Wallis test, correlation analysis and the Spearman test were applied. Odds ratios (OR) were calculated. During the hospital stay, there were diagnosed 94 urinary tract infections, 25 pneumonias, 50 superficial wound infections, 11 deep wound infections. Transfusions were made in 120 patients (in average: 2.54 ± 1.45 units of red cell concentrate/transfused patient). Transfusion appeared to be correlated with superficial wound infection (OR = 1.96), urinary infection (OR = 1.76) and pneumonia (OR = 2.85). Higher number of days waiting for surgery were related significantly with pneumonia (9.8 ± 7.44 days vs. 6.39 ± 3.75), or urinary tract infection (7.76 ± 4.39 days vs. 6.17 ± 4.14). We concluded that the transfusion and longer waiting time for surgery have been associated with the septic complications in elderly patients treated surgically for hip fracture. © 2009 Elsevier Ireland Ltd. All rights reserved.",albumin;anticoagulant agent;age distribution;aged;albumin blood level;anticoagulant therapy;arthroplasty;article;bacterium culture;bladder catheterization;clinical trial;dementia;diabetes mellitus;disease association;disease predisposition;erythrocyte transfusion;female;fever;follow up;heart infarction;hip fracture;human;hypertension;length of stay;leukocyte count;leukopenia;major clinical study;male;operation duration;pneumonia;postoperative infection;prediction;preoperative evaluation;preoperative period;priority journal;risk factor;sex difference;Thompson arthroplasty;urinary tract infection;wound infection,"García-Alvarez, F.;Al-Ghanem, R.;García-Alvarez, I.;López-Baisson, A.;Bernal, M.",2010,,,0,
1466,One-year and long-term mortality in patients hospitalized for chronic obstructive pulmonary disease,"Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Identifying potentially-modifiable predictors of mortality could help optimize COPD patient management. The aim of this study is to determine long-term mortality following hospitalization due to acute exacerbations of COPD (AECOPD), as well as AECOPD mortality predictors. Methods: We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD in the University Hospital Complex of Santiago de Compostela in 2007 and 2008. In order to identify variables independently associated with mortality, we conducted a multivariate Cox proportional hazard regression analysis including those variables which proved to be significant in the univariate analysis. Results: Seven hundred and fifty seven patients were assessed. Patient mean age was 74.8 years and males accounted for 77% of all patients. Mean stay was 12.2 days. Three point six percent of all patients required intensive care. As for mortality rates, 1-year mortality was 26.2%, and 5-year mortality was 64.3%. In both scenarios, the most frequent causes of death were respiratory and cardiovascular disorders. Factors independently associated with mortality were older age, hospitalization by internal medicine (IMU), length of stay, the need for mechanical ventilation (MV) or noninvasive mechanical ventilation (NIV), early readmission, and history of atrial fibrillation (AF) and dementia. Conclusions: In patients with COPD, age, exacerbation severity and comorbidity have long-term prognostic significance.",acute coronary syndrome;age;aged;article;artificial ventilation;aspiration;atrial fibrillation;cause of death;chronic obstructive lung disease;comorbidity;dementia;disease exacerbation;disease severity;female;follow up;heart failure;home oxygen therapy;hospital mortality;hospital readmission;human;length of stay;long term survival;lower respiratory tract infection;lung embolism;major clinical study;male;malignant neoplasm;medical history;mortality rate;mortality risk;prognosis;respiratory failure;retrospective study;risk assessment;risk factor;septic shock,"García-Sanz, M. T.;Cánive-Gómez, J. C.;Senín-Rial, L.;Aboal-Viñas, J.;Barreiro-García, A.;López-Val, E.;González-Barcala, F. J.",2017,,10.21037/jtd.2017.03.34,0,
1467,Implications of the angiotensin converting enzyme gene insertion/deletion polymorphism in health and disease: a snapshot review,"This review considers the 250+ papers concerning the association of the angiotensin converting enzyme (ACE) gene insertion/deletion polymorphism (rs1799752) and various disease conditions published in 2009. The deletion allele occurs in approximately 55% of the population and is associated with increased activity of the ACE enzyme. It might be predicted that the D allele, therefore, might be associated with pathologies involving increased activity of the renin-angiotensin system. The D allele was seen to be associated with an increased risk of hypertension, pre-eclampsia, heart failure, cerebral infarct, diabetic nephropathy, encephalopathy, asthma, severe hypoglycaemia in diabetes, gastric cancer (in Caucasians) and poor prognosis following kidney transplant. On the positive side, the D allele appears to offer protection against schizophrenia and chronic periodontitis and confers greater up-per-body strength in old age. The I allele, meanwhile, offers improved endurance/athletic performance and aerobic capacity as determined by lung function tests, although it does increase the risk of oral squamous cell carcinoma and obstructive sleep apnoea in hypertensives.",ACE gene polymorphism;Angiotensin converting enzyme;dementia;depression;heart failure;hypertension;renin-angiotensin system,"Gard, P. R.",2010,Mar 20,,0,
1468,Economic impact of hospitalisations among patients in the last year of life: An observational study,"Background: Hospital admissions among patients at the end of life have a significant economic impact. Avoiding unnecessary hospitalisations has the potential for significant cost savings and is often in line with patient preference. Objective: To determine the extent of potentially avoidable hospital admissions among patients admitted to hospital in the last year of life and to cost these accordingly. Design: An observational retrospective case note review with economic impact assessment. Setting: Two large acute hospitals in the North of England, serving contrasting socio-demographic populations. Patients: A total of 483 patients who died within 1 year of admission to hospital. Measurements: Data were collected across a range of clinical, demographic, economic and service use variables and were collected from hospital case notes and routinely collected sources. Palliative medicine consultants identified admissions that were potentially avoidable. Results: Of 483 admissions, 35 were classified as potentially avoidable. Avoiding these admissions and caring for the patients in alternative locations would save the two hospitals £5.9 million per year. Reducing length of stay in all 483 patients by 14% has the potential to save the two hospitals £47.5 million per year; however, this cost would have to be offset against increased community care costs. Limitations: A lack of accurate cost data on alternative care provision in the community limits the accuracy of economic estimates. Conclusions: Reducing length of hospital stay in palliative care patients may offer the potential to achieve higher hospital cost savings than preventing avoidable admissions. Further research is required to determine both the feasibility of reducing length of hospital stay for patients with palliative care needs and the economic impact of doing so. © The Author(s) 2013.",article;bronchitis;Clostridium difficile infection;congestive heart failure;dementia;demography;female;heart arrest;home care;hospice care;hospital admission;hospital cost;hospitalization;human;kidney failure;length of stay;major clinical study;male;medical record review;multiple organ failure;neoplasm;nursing home;observational study;palliative therapy;patient preference;pneumonia;retrospective study;terminal care;upper respiratory tract obstruction,"Gardiner, C.;Ward, S.;Gott, M.;Ingleton, C.",2014,,,0,
1469,Sertraline-induced rhabdomyolysis in an elderly patient with dementia and comorbidities,"OBJECTIVE: To describe a case of sertraline-induced rhabdomyolysis in an elderly patient with dementia and comorbidities. CASE SUMMARY: A 71-year-old woman visited a psychiatrist in September 2007 for her depressed mood. Her medical history included vascular dementia accompanied by depression, arterial hypertension, and heart failure, as well as cardiac pacemaker implantation several years earlier for severe bradyarrythmia. She had begun taking amisulpride 50 mg/day and diazepam 2 mg at bedtime 6 months prior to the psychiatrist appointment, with poor relief of her depressed mood. Her drug therapy also included nicergoline 30 mg/day, amlodipine 5 mg/day, aspirin 100 mg/day, candesartan 16 mg/day, and atenolol 25 mg/day. At this psychiatrist visit, sertraline 50 mg/day was added for her depression, and was continued after a geriatrician visit in October. Her mood improved significantly. On December 18, 2007, she was admitted to the cardiology unit to undergo a pacemaker replacement. Laboratory tests revealed creatine kinase (CK) 7952 IU/L, lactate dehydrogenase 1021 IU/L, myoglobin 2322 U/L, and aspartate aminotransferase 362 IU/L, resulting in a diagnosis of iatrogenic rhabdomyolysis. Amisulpride and sertraline were discontinued. On December 24, serum CK was 839 IU/L and myoglobin was 91 U/L and the patient was discharged. On January 22, laboratory tests showed normal values of CK, CK-MB, and myoglobin. Sertraline 50 mg/day was again prescribed for the patient's persistent depressed mood. Fifteen days later, blood tests showed CK 1327 IU/L and myoglobin 324 U/L; therefore, the drug was discontinued. CK and myoglobin levels normalized a week later. On April 2, escitalopram was started. At time of writing, there was no evidence of any increase in CK, myoglobin, or other markers of rhabdomyolysis. DISCUSSION: The Naranjo probability scale indicated a probable relationship between sertraline treatment and the onset of rhabdomyolysis. No relationship between amisulpride and rhabdomyolysis was found. Furthermore, rechallenge with sertraline caused CK and myoglobin to again increase, which was reversed following a discontinuation of sertraline. The patient's other comorbidities and medications have not been suggested as possible interactions with sertraline that can cause rhabdomyolysis. Genetic defects of sertraline demethylation and/or Pglycoprotein binding or concurrent circumstances may explain the onset of rhabdomyolysis in this particular patient. CONCLUSIONS: This patient's rhabdomyolysis was probably induced by sertraline therapy.",acetylsalicylic acid;amisulpride;amlodipine;atenolol;candesartan;diazepam;escitalopram;nicergoline;sertraline;aged;anamnesis;article;bedtime dosage;case report;clinical feature;comorbidity;dementia;depression;drug withdrawal;female;heart failure;human;hypertension;priority journal;rhabdomyolysis;aspirin,"Gareri, P.;Segura-Garcia, C.;De Fazio, P.;De Fazio, S.;De Sarro, G.",2009,,,0,
1470,The war against polypharmacy: A new cost-effective geriatric-positive approach for improving drug therapy in disabled elderly people,"Background: The extent of medical and financial problems of polypharmacy in the elderly is disturbing, particularly in nursing homes and nursing departments. Objectives: To improve drug therapy and minimize drug intake in nursing departments. Methods: We introduced a geriatric-palliative approach and methodology to combat the problem of polypharmacy. The study group comprised 119 disabled patients in six geriatric nursing departments; the control group included 71 patients of comparable age, gender and co-morbidities in the same wards. After 12 months, we assessed whether any change in medications affected the death rate, referrals to acute care facility, and costs. Results: A total of 332 different drugs were discontinued in 119 patients (average of 2.8 drugs per patient) and was not associated with significant adverse effects. The overall rate of drug discontinuation failure was 18% of all patients and 10% of all drugs. The 1 year mortality rate was 45% in the control group but only 21% in the study group (P< 0.001, chi-square test). The patients annual referral rate to acute care facilities was 30% in the control group but only 11.8% in the study group (P< 0.002). The intervention was associated with a substantial decrease in the cost of drugs. Conclusions: Application of the geriatric-palliative methodology in the disabled elderly enables simultaneous discontinuation of several medications and yields a number of benefits: reduction in mortality rates and referrals to acute care facilities, lower costs, and improved quality of living.",amantadine;analgesic agent;antidepressant agent;antidiabetic agent;antihypertensive agent;carbamazepine;digoxin;histamine H2 receptor antagonist;hydroxymethylglutaryl coenzyme A reductase inhibitor;neuroleptic agent;nitrate;nonsteroid antiinflammatory agent;pentoxifylline;potassium;sedative agent;tranquilizer;absence of side effects;aged;article;chi square test;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;cost effectiveness analysis;dementia;diabetes mellitus;disabled person;drug cost;drug dose reduction;drug treatment failure;drug withdrawal;dyspepsia;ECG abnormality;emergency care;female;gastrointestinal hemorrhage;gastrointestinal symptom;geriatric care;health care quality;atrial fibrillation;heart infarction;human;hypertension;hypoalbuminemia;iron therapy;major clinical study;male;mortality;patient referral;peptic ulcer;polypharmacy;cerebrovascular accident;urine incontinence,"Garfinkel, D.;Zur-Gil, S.;Ben-Israel, J.",2007,,,0,
1471,Contribution of modeling and simulation in the regulatory review and decision-making: U.S. FDA perspective,"The Division of Pharmacometrics at the U.S. FDA engages in regulatory reviews, research and policy development. During 2000-2008, over 50% of pharmacometric reviews of 198 NDA and BLA applications influenced approval and safety decisions. During this time, pharmacometric analyses were used in pediatric dose selection, and approval of doses not directly studied in effectiveness trials. Additionally, pharmacometrics has been used in FDA advice on protocol design to optimize dosing regimens based on benefit-risk for clinical testing, and to provide confirmatory evidence of effectiveness. Current research projects aim to solve drug development challenges and develop policies grounded in pharmacometric principles and methodologies. © American Association of Pharmaceutical Scientists 2011.",adalimumab;apomorphine;argatroban;argatroban injection;busulfan;canakinumab;celecoxib;certolizumab pegol;clevidipine;digoxin;everolimus;fenoldopam mesilate;levocetirizine;levofloxacin;lovaquin;micafungin;nesiritide;oxcarbazepine;paricalcitol;piperacillin plus tazobactam;sotalol;tetrabenazine;unclassified drug;varenicline;zoledronic acid;abdominal infection;article;bone metastasis;chronic myeloid leukemia;clinical protocol;clinical trial (topic);Crohn disease;decision making;drug approval;drug development;drug dose;drug dose increase;drug dose reduction;drug dose titration;drug indication;drug labeling;drug research;drug safety;epilepsy;esophagus candidiasis;food and drug administration;graft rejection;heart arrhythmia;heart failure;human;Huntington chorea;hypercalcemia;hyperparathyroidism;hypertension;juvenile rheumatoid arthritis;loading drug dose;mathematical model;Parkinson disease;pediatrics;pharmaceutics;pharmacometrics;priority journal;recommended drug dose;rheumatoid arthritis;risk benefit analysis;simulation;study design;United States;unspecified side effect;apokyn;betapace;busulfex;celebrex;chantix;cimzia;cleviprex;corlopam;humira;mycamine;natrecor;trileptal;xenazine;xyzal;zemplar;zometa;zosyn,"Garnett, C. E.;Lee, J. Y.;Gobburu, J. V. S.",2011,,,0,
1472,"Silent aspiration: results of 2,000 video fluoroscopic evaluations","The purpose of this retrospective study of aspiration and the lack of a protective cough reflex at the vocal folds (silent aspiration) was to increase the awareness of nursing staffs of the diagnostic pathology groups associated with silent aspiration. Of the 2,000 patients evaluated in this study, 51% aspirated on the video fluoroscopic evaluation. Of the patients who aspirated, 55% had no protective cough reflex (silent aspiration). The diagnostic pathology groups with the highest rates of silent aspiration were brain cancer, brainstem stroke, head-neck cancer, pneumonia, dementia/Alzheimer, chronic obstructive lung disease, seizures, myocardial infarcts, neurodegenerative pathologies, right hemisphere stroke, closed head injury, and left hemisphere stroke. It is of high concern that the diagnostic groups identified in this research as having the highest risk of silent aspiration be viewed as ""red-flag"" patients by the nursing staff caring for them. Early nursing dysphagia screens, with close attention to the clinical symptoms associated with silent aspiration, and early referral for formal dysphagia evaluation are stressed.","Adolescent;Adult;Aged;Aged, 80 and over;Cough;Deglutition;Deglutition Disorders/*nursing/*radiography;Education, Nursing, Continuing;Female;*Fluoroscopy;Humans;Male;Mass Screening;Middle Aged;Pneumonia, Aspiration/*nursing/*radiography;Retrospective Studies;Young Adult","Garon, B. R.;Sierzant, T.;Ormiston, C.",2009,Aug,,0,
1473,Poorly managed anticoagulation may contribute to risk of dementia,,acetylsalicylic acid;warfarin;anticoagulation;bleeding;brain ischemia;cerebrovascular accident;CHADS2 score;dementia;follow up;atrial fibrillation;heart infarction;heart surgery;human;international normalized ratio;microembolism;note;peroperative complication,"Garrett, A. D.",2014,,,0,
1474,Thoracic tuberculosis (TB) in 75 to 100 year-old patients,"In developed countries, the incidence of TB is decreasing and the age of onset is delayed relying more on the reactivation of old infection. In 2014, the age-group >64 had the highest incidence in our area (21.4/100,000). The immunosenescence and comorbidities appear to play an important role. Aim: To analyse the clinical aspects and treatment outcome of TB in our elderly patients. Methods: Retrospective study. All patients with TB >75 years in the urban area of Bilbao between 2009- 2013 were included. Controls were randomly selected from patients <65 years with TB from the same metropolitan area and period. VIH-positive patients were excluded. Variables collected were sociodemographic data, comorbidities, clinico-radiological and microbiologic features, toxicity and mortality. Results: 50 patients with TB >75 years, mean age 82+/-5, with a Charlson index 2.9: COPD (38%), heart failure (36%), diabetes (24%), dementia (24%), neoplasms (20%). 19% were institutionalized. Previous history of TB was present in 44% of patients. Main results are shown in the table below. CONCLUSIONS: TB in very elderly patients represents a major challenge for the future: -Miliary presentations are more frequent -Mortality and liver toxicity are higher -Difficult and delayed diagnosis due to unespecific clinico-radiological features -Institutionalized patients present a great epidemiological risk. -More hospital admissions.",aged;Charlson Comorbidity Index;chronic obstructive lung disease;clinical article;clinical feature;controlled clinical trial;controlled study;delayed diagnosis;dementia;diabetes mellitus;heart failure;hospital admission;human;liver toxicity;mortality;neoplasm;randomized controlled trial;retrospective study;thorax;tuberculosis;urban area;very elderly,"Garrido, Is;Huguet, Et;Garay, Jg;Alana, Pg;Ayuso, Ec;Aranaga, Il;Basanez, Ra",2016,,10.1183/13993003.congress-2016.PA2654,0,
1475,Coenzyme Q10 therapy,"For a number of years, coenzyme Q10 (CoQ10) was known for its key role in mitochondrial bioenergetics; later studies demonstrated its presence in other subcellular fractions and in blood plasma, and extensively investigated its antioxidant role. These 2 functions constitute the basis for supporting the clinical use of CoQ10. Also, at the inner mitochondrial membrane level, CoQ10 is recognized as an obligatory cofactor for the function of uncoupling proteins and a modulator of the mitochondrial transition pore. Furthermore, recent data indicate that CoQ 10 affects the expression of genes involved in human cell signaling, metabolism and transport, and some of the effects of CoQ10 supplementation may be due to this property. CoQ10 deficiencies are due to autosomal recessive mutations, mitochondrial diseases, aging-related oxidative stress and carcinogenesis processes, and also statin treatment. Many neurodegenerative disorders, diabetes, cancer, and muscular and cardiovascular diseases have been associated with low CoQ10 levels as well as different ataxias and encephalomyopathies. CoQ10 treatment does not cause serious adverse effects in humans and new formulations have been developed that increase CoQ10 absorption and tissue distribution. Oral administration of CoQ10 is a frequent antioxidant strategy in many diseases that may provide a significant symptomatic benefit. © 2014 S. Karger AG, Basel.",hydroxymethylglutaryl coenzyme A reductase inhibitor;metoprolol;mevinolin;phenothiazine derivative;pravastatin;propranolol;tricyclic antidepressant agent;ubidecarenone;ubiquinone;warfarin;abdominal discomfort;aging;Alzheimer disease;anorexia;article;asthenospermia;ataxia;atherosclerosis;bioenergy;carcinogenesis;cardiovascular disease;cell fractionation;cell metabolism;cell transport;chemotherapy induced nausea and vomiting;concentration (parameters);diabetes mellitus;diarrhea;diet supplementation;disorders of mitochondrial functions;DNA damage;Down syndrome;drug absorption;drug distribution;drug eruption;drug induced headache;drug mechanism;drug uptake;dyslipidemia;encephalomyopathy;fibromyalgia;Friedreich ataxia;gene mutation;heart failure;human;Huntington chorea;hypertension;ischemic heart disease;male infertility;metabolic disorder;migraine;mitochondrial membrane;muscle disease;neoplasm;oxidative stress;Parkinson disease;periodontal disease;preeclampsia;priority journal;recessive inheritance;signal transduction;tissue distribution;treatment indication;ubidecarenone deficiency,"Garrido-Maraver, J.;Cordero, M. D.;Oropesa-Ávila, M.;Fernández Vega, A.;De La Mata, M.;Delgado Pavón, A.;De Miguel, M.;Pérez Calero, C.;Villanueva Paz, M.;Cotán, D.;Sánchez-Alcázar, J. A.",2014,,,0,
1476,Thoracic and hematogenous tuberculosis in patients aged 75 to 100 years,"Summary: Authors have reported differences between tuberculosis in the elderly and younger adults. This situation is increased as senescence progresses. Therefore, we decided to study tuberculosis patients aged 75 and over. Methods: Retrospective study of 50 patients with thoracic tuberculosis or hematogenous between 75 and 100 years diagnosed in Bilbao between 2009 and 2013. Results: History of previous tuberculosis was present in 44% of patients. The most frequent comorbidities were COPD (38%), heart failure (36%), diabetes mellitus (24%), dementia (24%) and malignant neoplasms (20%). Main clinical presentations were pulmonary (60%), pleural (20%) and miliary (12%). The most common symptoms were cough (66%), sputum production (38%), fever (34%) and dyspnea (34%), being uncommon hemoptysis (10%). 42% of patients had old healed lesions ( in 54% of them was the only finding). Unilateral infiltrate was the most common lesion, slightly more prevalent in the upper lobes. Cavitation (6%) was rare. In 64% of cases the Zhiel / Auramine was negative. Resistant strains rate was very low. 40% of the patients died before the end of treatment, Death was directly attributed to tuberculosis in 50% of them. Hepatotoxicity was common resulting in death in one patient. We did not observe any bacteriological failure. Conclusion: Elderly patients showed differences in clinical features, radiology presentation and microbiological aspects compared to what is reported in younger patients, although treatment effectiveness remained satisfactory.",aged;article;chronic obstructive lung disease;clinical article;clinical feature;comorbidity;coughing;dementia;diabetes mellitus;dyspnea;fever;heart failure;hemoptysis;human;liver toxicity;lung tuberculosis;malignant neoplasm;medical history;miliary tuberculosis;mortality;retrospective study;Spain;sputum;thoracic tuberculosis,"Garrós-Garay, J.;Tabernero-Huget, E.;Gil-Alaña, P.;Alkiza-Basáñez, R.;Toja-Uriarte, B.;Guerediaga-Urrucha, A.",2016,,,0,
1477,The aging population: The increasing effects on health care,,aged;ambulatory care;arthritis;baby boomer;cause of death;cerebrovascular accident;chronic disease;congestive heart failure;dementia;developing country;diabetes mellitus;disability;falling;geriatrics;health care cost;health care system;heart disease;hospital admission;human;hypercholesterolemia;hypertension;incidence;infection;life expectancy;neoplasm;non communicable disease;note;obesity;population size;world health organization,"Garza, A.",2016,,,0,
1478,"Cognitive impairment in common, noncentral nervous system medical conditions of adults and the elderly","Common, noncentral nervous system medical conditions linked with cognitive impairment in adults and the elderly include: acute respiratory distress syndrome; cancer; chronic kidney disease; chronic obstructive pulmonary disease; coronary heart disease; hypertension; obesity (bariatric surgical candidates); obstructive sleep apnea; and type 2 diabetes. Cross-condition comparison of the nature and frequency of cognitive impairment is difficult as these conditions often coexist, and there exists no consensus as to the definition of cognitive impairment, nor the optimal number and type of neuropsychological tests required for evaluation. There is as yet no clear evidence for condition-specific profiles of cognitive impairment. Rather, a generalized profile consisting of subclinical levels of impairment in attention, processing speed, executive, and memory functions from bilateral frontal-subcortical ischemia fits across all conditions. This profile: occurs only in subgroups of patients; is inconsistently related to measures of illness severity; is unrelated to patient self-report or level of functional independence; is exacerbated by very high levels of emotional distress; and is reversible in some cases but can also progress to frank neurological disease (dementia) in others, especially the elderly, when multiple conditions coexist, and/or when medical condition severity progresses.","Anxiety/diagnosis/etiology;Cognition Disorders/*diagnosis/etiology/*psychology;Cross-Sectional Studies;Databases, Bibliographic/statistics & numerical data;Depression/diagnosis/etiology;Female;Humans;Male;Motor Skills/physiology;Neuropsychological Tests;Psychiatric Status Rating Scales;Severity of Illness Index","Gasquoine, P. G.",2011,Apr,10.1080/13803395.2010.536759,0,
1479,Deferasirox in iron-overloaded patients with transfusion-dependent myelodysplastic syndromes: Results from the large 1-year EPIC study,"The prospective 1-year EPIC study enrolled 341 patients with myelodysplastic syndromes (MDS); although baseline iron burden was >2500. ng/mL, ∼50% were chelation-naïve. Overall median serum ferritin decreased significantly at 1 year (p=0.002). Decreases occurred irrespective of whether patients were chelation-naïve or previously chelated; changes were dependent on dose adjustments and ongoing iron intake. Sustained reductions in labile plasma iron were observed. Discontinuation rate (48.7%) and adverse event profile were consistent with previously reported deferasirox data in MDS. Alanine aminotransferase levels decreased significantly; change correlated significantly with reduction in serum ferritin (p<0.0001). This large dataset prospectively confirms the efficacy and well characterizes the safety profile of deferasirox in MDS. © 2010 Elsevier Ltd.",alanine aminotransferase;deferasirox;ferritin;iron;abdominal pain;adolescent;adult;aged;anemia;article;chelation therapy;child;clinical trial;colitis;constipation;creatinine blood level;cytopenia;dementia;diarrhea;dose response;drug dose increase;drug dose reduction;drug efficacy;drug fatality;drug induced headache;drug safety;drug withdrawal;duodenitis;erythrocyte transfusion;esophagitis;female;ferritin blood level;fever;gastritis;gastrointestinal symptom;hearing impairment;heart failure;human;hyperthermia;iron blood level;iron intake;iron overload;leukocyte count;major clinical study;male;multicenter study;myelodysplastic syndrome;neutropenia;pancytopenia;preschool child;priority journal;prospective study;rash;school child;side effect;thrombocytopenia;upper abdominal pain;vomiting;weight reduction;exjade,"Gattermann, N.;Finelli, C.;Porta, M. D.;Fenaux, P.;Ganser, A.;Guerci-Bresler, A.;Schmid, M.;Taylor, K.;Vassilieff, D.;Habr, D.;Domokos, G.;Roubert, B.;Rose, C.",2010,,,0,
1480,"Efficacy and safety of tau-aggregation inhibitor therapy in patients with mild or moderate Alzheimer's disease: a randomised, controlled, double-blind, parallel-arm, phase 3 trial","Background Leuco-methylthioninium bis(hydromethanesulfonate; LMTM), a stable reduced form of the methylthioninium moiety, acts as a selective inhibitor of tau protein aggregation both in vitro and in transgenic mouse models. Methylthioninium chloride has previously shown potential efficacy as monotherapy in patients with Alzheimer's disease. We aimed to determine whether LMTM was safe and effective in modifying disease progression in patients with mild to moderate Alzheimer's disease. Methods We did a 15-month, randomised, controlled double-blind, parallel-group trial at 115 academic centres and private research clinics in 16 countries in Europe, North America, Asia, and Russia with patients younger than 90 years with mild to moderate Alzheimer's disease. Patients concomitantly using other medicines for Alzheimer's disease were permitted to be included because we considered it infeasible not to allow their inclusion; however, patients using medicines carrying warnings of methaemoglobinaemia were excluded because the oxidised form of methylthioninium in high doses has been shown to induce this condition. We randomly assigned participants (3:3:4) to 75 mg LMTM twice a day, 125 mg LMTM twice a day, or control (4 mg LMTM twice a day to maintain blinding with respect to urine or faecal discolouration) administered as oral tablets. We did the randomisation with an interactive web response system using 600 blocks of length ten, and stratified patients by severity of disease, global region, whether they were concomitantly using Alzheimer's disease-labelled medications, and site PET capability. Participants, their study partners (generally carers), and all assessors were masked to treatment assignment throughout the study. The coprimary outcomes were progression on the Alzheimer's Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) and the Alzheimer's Disease Co-operative Study–Activities of Daily Living Inventory (ADCS-ADL) scales from baseline assessed at week 65 in the modified intention-to-treat population. This trial is registered with Clinicaltrials.gov (NCT01689246) and the European Union Clinical Trials Registry (2012-002866-11). Findings Between Jan 29, 2013, and June 26, 2014, we recruited and randomly assigned 891 participants to treatment (357 to control, 268 to 75 mg LMTM twice a day, and 266 to 125 mg LMTM twice a day). The prespecified primary analyses did not show any treatment benefit at either of the doses tested for the coprimary outcomes (change in ADAS-Cog score compared with control [n=354, 6·32, 95% CI 5·31−7·34]: 75 mg LMTM twice a day [n=257] −0·02, −1·60 to 1·56, p=0·9834, 125 mg LMTM twice a day [n=250] −0·43, −2·06 to 1·20, p=0·9323; change in ADCS-ADL score compared with control [−8·22, 95% CI −9·63 to −6·82]: 75 mg LMTM twice a day −0·93, −3·12 to 1·26, p=0·8659; 125 mg LMTM twice a day −0·34, −2·61 to 1·93, p=0·9479). Gastrointestinal and urinary effects were the most common adverse events with both high doses of LMTM, and the most common causes for discontinuation. Non-clinically significant dose-dependent reductions in haemoglobin concentrations were the most common laboratory abnormality. Amyloid-related imaging abnormalities were noted in less than 1% (8/885) of participants. Interpretation The primary analysis for this study was negative, and the results do not suggest benefit of LMTM as an add-on treatment for patients with mild to moderate Alzheimer's disease. Findings from a recently completed 18-month trial of patients with mild Alzheimer's disease will be reported soon. Funding TauRx Therapeutics.",2012-002866-11;NCT01689246;amyloid;antidepressant agent;cholinesterase inhibitor;leuco methylthioninium bis(hydromethanesulfonate;memantine;methylene blue;neuroleptic agent;protein inhibitor;sedative agent;serotonin uptake inhibitor;tau protein;unclassified drug;abnormal laboratory result;activity of daily living assessment;adverse outcome;aged;Alzheimer disease;Alzheimer Disease Assessment Scale;Alzheimer Disease Assessment Scale Cognitive Subscale;Alzheimer Disease Co operative Study Activities of Daily Living Inventory scale;article;clinical effectiveness;controlled study;convulsion;daily life activity;disease course;disease severity;double blind procedure;drug efficacy;drug megadose;drug safety;drug withdrawal;feces color;female;heart infarction;hemoglobin determination;hemolytic anemia;human;intention to treat analysis;low drug dose;major clinical study;male;outcome assessment;phase 1 clinical trial (topic);phase 3 clinical trial;positron emission tomography;priority journal;protein aggregation;randomized controlled trial;serotonin syndrome;side effect;treatment duration;treatment response;urinalysis,"Gauthier, S.;Feldman, H. H.;Schneider, L. S.;Wilcock, G. K.;Frisoni, G. B.;Hardlund, J. H.;Moebius, H. J.;Bentham, P.;Kook, K. A.;Wischik, D. J.;Schelter, B. O.;Davis, C. S.;Staff, R. T.;Bracoud, L.;Shamsi, K.;Storey, J. M. D.;Harrington, C. R.;Wischik, C. M.",2016,,10.1016/s0140-6736(16)31275-2,0,
1481,Anthropometric reference data for elderly Swedes and its disease-related pattern,"BACKGROUND/OBJECTIVES: Anthropometric measurement is a noninvasive and cost-efficient method for nutritional assessment. The study aims to present age- and gender-specific anthropometric reference data for Swedish elderly in relation to common medical conditions, and also formulate prediction equations for such anthropometric measurements. SUBJECTS/METHODS: A cross-sectional study among random heterogeneous sample of 3360 subjects, aged 60-99 years, from a population study 'Good Aging in Scania. Means (+/-s.d.) and percentiles for height, weight, waist-, hip-, arm-, calf circumferences, triceps- (TST) and subscapular skinfold thickness (SST), body mass index (BMI), waist-hip ratio (WHR) and arm muscle circumference (AMC) were presented. The values were estimated based on the prevalence of myocardial infarction (MI), cardiac failure (CHF), stroke, cognitive impairment, dementia and dependence in daily living activities (ADL). Linear regression analysis was used to formulate the prediction equations. RESULTS: Mean BMI was 27.5+/-5.8 kg/m(2) (men) and 27.2+/-8.1 kg/m(2) (women). WHR was higher among men (Men: 0.98+/-0.3, women: 0.87+/-0.2), except at age 85+ (women: 0.91+/-0.6). TST was 6.7+/-0.4 mm higher among women. Men with MI had BMI: 28.6+/-4.8 kg/m(2) and SST: 21+/-9.2 mm, whereas subjects with dementia had lower weight (by 9.5+/-2.9 kg) compared with the non-demented. ADL-dependent women had BMI= 29.0+/-3.9 kg/m(2), TST=19.2+/-1.3 mm. CONCLUSION: New normative data on gender- and age-specific anthropometrics on the general elderly population are presented. Cardiovascular diseases are associated with subcutaneous and central adiposity opposed to fat loss with dementia. ADL dependence indicates inadequate physical activity. The prediction models could be used as possible indicators monitoring physical activity and adiposity among the general elderly population hence potential health indicators in health promotion.","Activities of Daily Living;Age Distribution;Aged;Aged, 80 and over;Aging/*physiology;Anthropometry/*methods;*Body Composition;Body Mass Index;Cognition Disorders/epidemiology;Cross-Sectional Studies;Dementia/epidemiology;Female;Heart Failure/epidemiology;Humans;Linear Models;Male;Middle Aged;Myocardial Infarction/epidemiology;Reference Values;Sex Distribution;Stroke/epidemiology;Sweden/epidemiology","Gavriilidou, N. N.;Pihlsgard, M.;Elmstahl, S.",2015,Sep,10.1038/ejcn.2015.73,0,
1482,Potential of preventive treatment of Alzheimer's disease: Results of a three-year prospective open comparative trial of the efficacy and safety of courses of treatment with cerebrolysin and Cavinton in elderly patients with mild cognitive impairment syndrome,"Studies were performed in three Russian centers (Moscow, St. Petersburg, Nizhnii Novgorod). The cohort consisted of 110 patients whose mental state corresponded to the concept of ""mild cognitive impairment"" (MCI). Patient status was assessed using widely accepted scales (MMSE, GDS, CDR, etc.) and a battery of neuropsychological tests. ApoE genotypes were also identified. Patients were divided into two comparable groups depending on treatment: 55 patients received cerebrolysin and 55 received Cavinton. The data provided evidence that treatment with cerebrolysin was more effective than treatment with Cavinton in terms of slowing the progression of cognitive deficit and delaying the time at which the patients qualified for the diagnosis of Alzheimer's disease. Cerebrolysin was more effective in patients with MCI and the ApoE4+ genotype, i.e., patients in the high risk group for Alzheimer's disease. Adverse events were rare in both groups. © 2011 Springer Science+Business Media, Inc.",apolipoprotein E;cerebrolysin;vinpocetine;acute respiratory tract disease;adult;aged;Alzheimer disease;angina pectoris;aptitude test;article;breast tumor;chronic pancreatitis;Clinical Dementia Rating Scale;cognition;cohort analysis;controlled clinical trial;controlled study;diarrhea;disease association;drug efficacy;drug induced headache;drug safety;extirpation of uterus;female;femur neck fracture;genotype;geriatrics;Global Deterioration Scale;high risk population;hip osteoarthritis;human;leg thrombophlebitis;major clinical study;male;mental health;mild cognitive impairment;Mini Mental State Examination;multiple cycle treatment;neuropsychological test;outcome assessment;ovary tumor;prostate tumor;respiratory tract infection;Russian Federation;stomach ulcer;treatment duration;uterus disease;cavinton,"Gavrilova, S. I.;Kolykhalov, I. V.;Fedorova, Y. B.;Selezneva, N. D.;Kalyn, Y. B.;Roshchina, I. F.;Odinak, M. M.;Emelin, A. Y.;Kashin, A. V.;Gustov, A. V.;Antipenko, E. A.;Korshunova, Y. A.;Davydova, T. A.;Messler, G.",2011,,,0,
1483,Complications of Minimally Invasive Lumbar Spine Surgery,"Compared with open procedures, minimally invasive spine surgery allows spinal abnormalities to be addressed through smaller incisions with less soft-tissue damage and postoperative pain, which may lead to shorter hospitalizations and earlier mobility for the patient. However, minimally invasive spine procedures require advanced techniques, mandate specialized equipment, provide decreased visualization, and are associated with a steep learning curve. Although studies have shown similar complication rates for the 2 approaches, minimally invasive surgery may be associated with decreased fusion rates, increased dural injury rates, and inadequate decompression compared with conventional surgical techniques. This review addresses the complications associated with minimally invasive spine procedures and provides tips for prevention. © 2011 Elsevier Inc.",antibiotic agent;bone morphogenetic protein 2;poly(methyl methacrylate);article;axial lumbar interbody fusion surgery;bacteremia;central nervous system disease;compression fracture;computer assisted tomography;congestive heart failure;dementia;device malposition;direct lateral interbody fusion surgery;dural injury;endoscopic decompression;endoscopic surgery;enteritis;extreme lateral interbody fusion surgery;fever;fluoroscopy;guide wire;heart infarction;hematoma;human;hypotension;implant related pain;incidence;incision pain;intermethod comparison;interspinous spacers;intervertebral disk disease;intervertebral disk hernia;kyphoplasty;lumbar spine;lung edema;lung embolism;malaise;meralgia paresthetica;minimally invasive surgery;motor radiculopathy;muscle spasm;nausea;nerve injury;nerve stimulation;neuromonitoring;obesity;open surgery;osteoporosis;patient satisfaction;pedicle screw;percutaneous cement augmentation;percutaneous transforaminal surgery;percutaneous vertebroplasty;pneumonia;posterior lumbar interbody fusion surgery;postoperative complication;presacral surgery;priority journal;radiculopathy;rectum disease;rectum perforation;revision surgery;scoliosis;sensory radiculopathy;spine surgery;spinous process fracture;spondylolisthesis;spondylosis;stenosis;surgical infection;surgical technique;swelling;tachycardia;three dimensional imaging;urine retention;vertebral canal stenosis;wound healing,"Gebauer, G.;Anderson, D. G.",2011,,,0,
1484,Dual or mono antiplatelet therapy for patients with acute ischemic stroke or transient ischemic attack: Systematic review and meta-analysis of randomized controlled trials,"Background and Purpose-Antiplatelets are recommended for patients with acute noncardioembolic stroke or transient ischemic attack. We compared the safety and efficacy of dual versus mono antiplatelet therapy in patients with acute ischemic stroke or transient ischemic attack. Methods-Completed randomized controlled trials of dual versus mono antiplatelet therapy in patients with acute (≤3 days) ischemic stroke/transient ischemic attack were identified using electronic bibliographic searches. The primary outcome was recurrent stroke (ischemic, hemorrhagic, unknown; fatal, nonfatal). Comparison of binary outcomes between treatment groups was analyzed with random effect models and described using risk ratios (95% CI). Results-Twelve completed randomized trials involving 3766 patients were included. In comparison with mono antiplatelet therapy, dual therapy (aspirin+dipyridamole and aspirin+clopidogrel) significantly reduced stroke recurrence, dual 58 (3.3%) versus mono 91 (5.0%; risk ratio, 0.67; 95% CI, 0.49-0.93); composite vascular event (stroke, myocardial infarction, vascular death), dual 74 (4.4%) versus mono 106 (6%; risk ratio, 0.75; 95% CI, 0.56-0.99); and the combination of stroke, transient ischemic attack, acute coronary syndrome, and all death, dual 100 (1.7%) versus mono 136 (9.1%; risk ratio, 0.71; 95% CI, 0.56-0.91); dual therapy was also associated with a nonsignificant trend to increase major bleeding, dual 15 (0.9%) versus mono 6 (0.4%; risk ratio, 2.09; 95% CI, 0.86-5.06). Conclusions-Dual antiplatelet therapy appears to be safe and effective in reducing stroke recurrence and combined vascular events in patients with acute ischemic stroke or transient ischemic attack as compared with mono therapy. These results need to be tested in prospective studies. © 2012 2012 American Heart Association, Inc.",acetylsalicylic acid;clopidogrel;dipyridamole;article;bleeding;brain ischemia;comparative study;heart muscle ischemia;human;intermethod comparison;monotherapy;mortality;outcome assessment;priority journal;recurrent disease;risk reduction;cerebrovascular accident;transient ischemic attack;treatment outcome;aspirin,"Geeganage, C. M.;Diener, H. C.;Algra, A.;Chen, C.;Topol, E. J.;Dengler, R.;Markus, H. S.;Bath, M. W.;Bath, P. M. W.",2012,,,0,
1485,"Effects of n-3 fatty acids on cognitive decline: a randomized, double-blind, placebo-controlled trial in stable myocardial infarction patients","METHODSThe analysis included 2911 coronary patients (78% men) aged 60 to 80 years who participated in a double-blind placebo-controlled trial of n-3 fatty acids and cardiovascular diseases (Alpha Omega Trial). By using a 2 × 2 factorial design, patients were randomly assigned to margarines that provided 400 mg/d of EPA-DHA, 2 g/d of ALA, both EPA-DHA and ALA, or placebo for 40 months. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) at baseline and after 40 months. The effect of n-3 fatty acids on change in MMSE score was assessed using analysis of variance. Logistic regression analysis was used to examine the effects on risk of cognitive decline, defined as a decrease of 3 or more points in MMSE score or incidence of dementia.RESULTSPatients in the active treatment groups had an additional intake of 384 mg of EPA-DHA, 1.9 g of ALA, or both. The overall MMSE score in this cohort was 28.3 ± 1.6 points, which decreased by 0.67 ± 2.25 points during follow-up. Changes in MMSE score during intervention did not differ significantly between EPA-DHA and placebo (-0.65 vs -0.69 points, P = .44) or between ALA and placebo (-0.60 vs -0.74 points, P = .12). The risk of cognitive decline was 1.03 (95% confidence interval: 0.84-1.26, P = .80) for EPA-DHA (vs placebo) and 0.90 (0.74-1.10, P = .31) for ALA (vs placebo).CONCLUSIONThis large intervention study showed no effect of dietary doses of n-3 fatty acids on global cognitive decline in coronary heart disease patients.BACKGROUNDEpidemiological studies suggest a protective effect of n-3 fatty acids derived from fish (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) against cognitive decline. For ?-linolenic acid (ALA) obtained from vegetable sources, the effect on cognitive decline is unknown. We examined the effect of n-3 fatty acid supplementation on cognitive decline in coronary heart disease patients.","Cognition Disorders [diet therapy] [etiology];Double-Blind Method;Fatty Acids, Omega-3 [administration & dosage];Logistic Models;Longitudinal Studies;Mental Status Schedule;Myocardial Infarction [complications];Neuropsychological Tests;Treatment Outcome;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-compmed","Geleijnse, Jm;Giltay, Ej;Kromhout, D",2012,,10.1016/j.jalz.2011.06.002,0,1486
1486,"Effects of n-3 fatty acids on cognitive decline: A randomized, double-blind, placebo-controlled trial in stable myocardial infarction patients","Background: Epidemiological studies suggest a protective effect of n-3 fatty acids derived from fish (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) against cognitive decline. For alpha-linolenic acid (ALA) obtained from vegetable sources, the effect on cognitive decline is unknown. We examined the effect of n-3 fatty acid supplementation on cognitive decline in coronary heart disease patients. Methods: The analysis included 2911 coronary patients (78% men) aged 60 to 80 years who participated in a double-blind placebo-controlled trial of n-3 fatty acids and cardiovascular diseases (Alpha Omega Trial). By using a 2 x 2 factorial design, patients were randomly assigned to margarines that provided 400 mg/d of EPA-DHA, 2 g/d of ALA, both EPA-DHA and ALA, or placebo for 40 months. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) at baseline and after 40 months. The effect of n-3 fatty acids on change in MMSE score was assessed using analysis of variance. Logistic regression analysis was used to examine the effects on risk of cognitive decline, defined as a decrease of 3 or more points in MMSE score or incidence of dementia. Results: Patients in the active treatment groups had an additional intake of 384 mg of EPA-DHA, 1.9 g of ALA, or both. The overall MMSE score in this cohort was 28.3 +/- 1.6 points, which decreased by 0.67 +/- 2.25 points during follow-up. Changes in MMSE score during intervention did not differ significantly between EPA-DHA and placebo (-0.65 vs -0.69 points, P =.44) or between ALA and placebo (-0.60 vs -0.74 points, P =.12). The risk of cognitive decline was 1.03 (95% confidence interval: 0.84-1.26, P =.80) for EPA-DHA (vs placebo) and 0.90 (0.74-1.10, P =.31) for ALA (vs placebo). Conclusion: This large intervention study showed no effect of dietary doses of n-3 fatty acids on global cognitive decline in coronary heart disease patients. 2012 The Alzheimer's Association. All rights reserved.",adult // aged // article // cognition // cognitive defect/th [Therapy] // controlled study // dementia // diet supplementation // double blind procedure // female // follow up // heart infarction // human // major clinical study // male // Mini Mental S,"Geleijnse, J. M.;Giltay, E. J.;Kromhout, D.",2012,,http://dx.doi.org/10.1016/j.jalz.2011.06.002,0,
1487,Polypharmacy and the Role of Physical Medicine and Rehabilitation,"Polypharmacy and inappropriate prescribing practices lead to higher rates of mortality and morbidity, particularly in vulnerable populations, such as the elderly and those with complex medical conditions. Physical medicine and physiatrists face particular challenges given the array of symptoms treated across a spectrum of conditions. This clinical review focuses on polypharmacy and the associated issue of potentially inappropriate prescribing. The article begins with a review of polypharmacy along with relevant aspects of pharmacokinetics and pharmacodynamics in the elderly. The adverse effects and potential hazards of selected medications commonly initiated and managed by rehabilitation specialists are then discussed with specific attention to pain medications, neurostimulants, antipsychotics, antidepressants, antispasmodics, sleep medications, and antiepileptics. Of particular concern is the notion that an adverse effect of one medication can mimic an indication for another and lead to a prescribing cascade and further adverse medication events. Appropriate prescribing practices mandate an accurate, current medication list, yet errors and inaccuracies often plague such lists. The evidence to support explicit (medications to avoid) and implicit (how to evaluate) criteria is presented along with the role of physicians and patients in prescribing medications. A brief discussion of ""medication debridement"" or de-prescribing strategies follows. In the last section, we draw on the essence of physiatry as a team-based endeavor to discuss the potential benefits of collaboration. In working to optimize medication prescribing, efforts should be made to collaborate not only with pharmacists and other medical specialties but with members of inpatient rehabilitation teams as well. © 2012 American Academy of Physical Medicine and Rehabilitation.",amantadine;amiodarone;bromocriptine;carbamazepine;desvenlafaxine;diazepam;donepezil;duloxetine;fluoxetine;gabapentin;ketoconazole;ketorolac;methylphenidate;milnacipran;mirtazapine;modafinil;morphine;naproxen;nonsteroid antiinflammatory agent;olanzapine;opiate;oxycodone;paracetamol;pregabalin;rifampicin;risperidone;ritonavir;tramadol;unindexed drug;warfarin;age;agitation;Alzheimer disease;analgesia;anaphylaxis;anterograde amnesia;anxiety;article;balance disorder;bleeding;body composition;bronchospasm;caregiver support;clinical practice;confusion;congestive heart failure;constipation;cooperation;decision support system;delusion;diarrhea;dizziness;drowsiness;drug abuse;drug binding;drug dependence;drug hypersensitivity;drug safety;drug tolerability;dyspepsia;electrolyte disturbance;eosinophilia;fatigue;fracture;fracture nonunion;gastrointestinal hemorrhage;gastrointestinal symptom;gastrointestinal tract function;glaucoma;hallucination;headache;health care cost;health hazard;health literacy;heart infarction;hospital patient;human;hyperalgesia;hypercalcemia;hypertension;hypogonadism;hypomania;hyponatremia;hypotension;immune deficiency;insomnia;irritability;kidney failure;kidney function;liver failure;liver function;liver toxicity;medical error;medical history;motor dysfunction;muscle rigidity;muscle weakness;nausea;nausea and vomiting;nervousness;neuropathic pain;neutropenia;opiate addiction;orthostatic hypotension;osteoporosis;pain;patient care;peptic ulcer;peripheral edema;pharmacist;physical medicine;physician;polypharmacy;postoperative pain;prescription;priority journal;pruritus;psychosis;rehabilitation;restlessness;rhabdomyolysis;sedation;seizure;sexual dysfunction;side effect;skin manifestation;sleep;sleep disorder;stomach emptying;cerebrovascular accident;sudden death;sweating;faintness;technology;tension headache;tremor;urine retention;visual disorder;weight gain;weight reduction;withdrawal syndrome;xerostomia,"Geller, A. I.;Nopkhun, W.;Dows-Martinez, M. N.;Strasser, D. C.",2012,,,0,
1488,"Demonstration of safety of intravenous immunoglobulin in geriatric patients in a long-term, placebo-controlled study of Alzheimer's disease","Introduction We present safety results from a study of Gammagard Liquid intravenous immunoglobulin (IGIV) in patients with probable Alzheimer's disease. Methods This was a placebo-controlled double-blind study. Subjects were randomized to 400 mg/kg (n = 127), 200 mg/kg (n = 135) IGIV, or to 0.25% human albumin (n = 121) administered every 2 weeks ± 7 days for 18 months. Results Elevated risk ratios of IGIV versus placebo included chills (3.85) in 9.5% of IGIV-treated subjects (all doses), compared to 2.5% of placebo-treated subjects, and rash (3.08) in 15.3% of IGIV-treated subjects versus 5.0% of subjects treated with placebo. Subjects in the highest IGIV dose group had the lowest proportion of SAEs considered related to product (2 of 127 [1.6%]). Subjects treated with IGIV experienced a lower rate of respiratory and all other infections compared to placebo. Discussion IGIV-treated subjects did not experience higher rates of renal failure, lung injury, or thrombotic events than the placebo group. There were no unexpected safety findings. IGIV was well tolerated throughout 18 months of treatment in subjects aged 50–89 years.",NCT00818662;albumin;cetirizine;cholinesterase inhibitor;cortisone;dexamethasone;diphenhydramine;hemoglobin;immunoglobulin;loratadine;memantine;methylprednisolone;placebo;prednisone;adult;aged;Alzheimer disease;anaphylaxis;anemia;artery thrombosis;arthralgia;article;bradycardia;brain edema;brain hemorrhage;brain infarction;cerebrovascular accident;chill;clinical assessment;cohort analysis;confusion;congestive heart failure;controlled study;contusion;diarrhea;dizziness;dose response;double blind procedure;drug efficacy;drug megadose;drug safety;drug tolerability;drug withdrawal;epistaxis;extravasation;female;focal epilepsy;geriatric patient;headache;heart infarction;human;hypertension;infection;insomnia;kidney failure;laceration;low drug dose;lung embolism;lung injury;major clinical study;male;mental disease;nausea;nuclear magnetic resonance imaging;outcome assessment;phase 3 clinical trial;priority journal;randomized controlled trial;rash;respiratory tract disease;risk assessment;side effect;statistical analysis;thromboembolism;thrombosis;upper respiratory tract infection;urinary tract infection;vomiting;gammagard liquid,"Gelmont, D.;Thomas, R. G.;Britt, J.;Dyck-Jones, J. A.;Doralt, J.;Fritsch, S.;Brewer, J. B.;Rissman, R. A.;Aisen, P.",2016,,,0,
1489,Early and long-term outcomes of older adults after acute care encounters for chronic obstructive pulmonary disease exacerbation,"Rationale: Older patients are at high risk of death and rehospitalization after hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AE-COPD). Emergency department visits comprise a substantial portion of acute care encounters in this patient population. The risks of mortality and repeat acute care encounters, including both hospital readmission and repeat emergency department visits, after AE-COPD among older adults are not well understood. Objectives: To examine early and long-term rates of death and repeat acute care encounters after hospitalization or emergency department visit for AE-COPD in Medicare fee-for-service beneficiaries and to identify patient characteristics, including medical comorbid conditions, associated with these outcomes. Methods:Aretrospective analysis was conducted using a nationally representative 5% sample of Medicare fee-for-service claims data from the U.S. Centers for Medicare and Medicaid Services to identify Medicare beneficiaries 65 years or older who had an acute care episode for an AE-COPD between January 1, 2006, and December 31, 2010 (n = 52,741). Outcomes of interest were all-cause mortality, repeat acute care encounters for any cause, and repeat acute care encounters for AE-COPD at 30 days, 1 year, and 3 years. Measurements and Main Results: Acute care encounters, including hospitalizations and emergency department visits for AE-COPD, were associated with substantial subsequent mortality risk, with 4.6, 24.4, and 48.2% dying by 30 days, 1 year, and 3 years, respectively. The risk of repeat hospitalization or emergency department visit was similarly high, with 1 in 4 patients having a repeat acute care encounter within 30 days of discharge, increasing to 9 in 10 in the next 3 years. Several comorbid conditions and other patient factors, including heart failure, malnutrition, dual eligibility for Medicare and Medicaid, and prior supplemental oxygen use, were independently associated with increased risk of repeat acute care encounter. Conclusions: Repeat hospitalizations and emergency department visits and death are common in older fee-for-service Medicare beneficiaries seen in acute care for AE-COPD. Our results suggest that addressing important comorbid conditions, such as heart failure or malnutrition, and targeting resources to oxygen-dependent or dual Medicareand Medicaid-eligible patients may help modify these outcomes.",aged;article;asthma;atrial fibrillation;chronic liver disease;chronic obstructive lung disease;dementia;diabetes mellitus;disease exacerbation;emergency care;emergency ward;female;follow up;gastroesophageal reflux;geriatric disorder;heart failure;heart infarction;hospitalization;human;incidence;kidney disease;long term care;lung cancer;lung fibrosis;major clinical study;male;malnutrition;medicaid;medicare;mortality;outcome assessment;oxygen therapy;pneumonia;respiratory failure;respiratory tract disease;retrospective study;risk factor;sleep disordered breathing;very elderly,"Genao, L.;Durheim, M. T.;Mi, X.;Todd, J. L.;Whitson, H. E.;Curtis, L. H.",2015,,,0,
1490,APOE genotype-function relationship: evidence of -491 A/T promoter polymorphism modifying transcription control but not type 2 diabetes risk,"BACKGROUND: The apolipoprotein E gene (APOE) coding polymorphism modifies the risks of Alzheimer's disease, type 2 diabetes, and coronary heart disease. Aside from the coding variants, single nucleotide polymorphism (SNP) of the APOE promoter has also been shown to modify the risk of Alzheimer's disease. METHODOLOGY/PRINCIPAL FINDINGS: In this study we investigate the genotype-function relationship of APOE promoter polymorphism at molecular level and at physiological level: i.e., in transcription control of the gene and in the risk of type 2 diabetes. In molecular studies, the effect of the APOE -491A/T (rs449647) polymorphism on gene transcription was accessed by dual-luciferase reporter gene assays. The -491 A to T substitution decreased the activity (p<0.05) of the cloned APOE promoter (-1017 to +406). Using the -501 to -481 nucleotide sequence of the APOE promoter as a 'bait' to screen the human brain cDNA library by yeast one-hybrid system yielded ATF4, an endoplasmic reticulum stress response gene, as one of the interacting factors. Electrophoretic-mobility-shift assays (EMSA) and chromatin immuno-precipitation (ChIP) analyses further substantiated the physical interaction between ATF4 and the APOE promoter. Over-expression of ATF4 stimulated APOE expression whereas siRNA against ATF4 suppressed the expression of the gene. However, interaction between APOE promoter and ATF4 was not -491A/T-specific. At physiological level, the genotype-function relationship of APOE promoter polymorphism was studied in type 2 diabetes. In 630 cases and 595 controls, three APOE promoter SNPs -491A/T, -219G/T (rs405509), and +113G/C (rs440446) were genotyped and tested for association with type 2 diabetes in Hong Kong Chinese. No SNP or haplotype association with type 2 diabetes was detected. CONCLUSIONS/SIGNIFICANCE: At molecular level, polymorphism -491A/T and ATF4 elicit independent control of APOE gene expression. At physiological level, no genotype-risk association was detected between the studied APOE promoter SNPs and type 2 diabetes in Hong Kong Chinese.","Activating Transcription Factor 4/metabolism;Adult;Apolipoproteins E/*genetics/*metabolism;Diabetes Mellitus, Type 2/genetics;Endoplasmic Reticulum Stress/genetics;Female;Gene Expression Regulation/*genetics;Genetic Predisposition to Disease/genetics;*Genotype;Glucose/metabolism;HEK293 Cells;Homeostasis/genetics;Humans;Lipid Metabolism/genetics;Male;Polymorphism, Single Nucleotide/*genetics;Promoter Regions, Genetic/*genetics;Transcription, Genetic/*genetics","Geng, H.;Law, P. P.;Ng, M. C.;Li, T.;Liang, L. Y.;Ge, T. F.;Wong, K. B.;Liang, C.;Ma, R. C.;So, W. Y.;Chan, J. C.;Ho, Y. Y.",2011,,10.1371/journal.pone.0024669,0,
1491,Burden of disease in the elderly population in Spain,"Objective: We analyzed the burden of disease in the elderly population in Spain in 2008. Methods: A population-based cross-sectional study was performed to calculate the disability-adjusted life years (DALYs) of the Spanish population aged ≥ 60 years old. DALYs are the sum of the number of years of life lost (YLLs) and the number of years lived with disability (YLDs). Data sources included the national mortality register for YLLs, and inference of Euro-A subregion (including Spain) estimates for YLDs. Results: In the elderly population, DALYs lost due to all diseases were estimated at 2.1 million. The main causes of DALYs were malignancies (21.3%), neuropsychiatric disorders (21.1%) and cardiovascular diseases (20.4%). The main specific subcategories were dementias, ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, hearing loss and osteoarthritis. Conclusions: Burden of disease analysis allows distinct health problems to be reassessed in relation to classical mortality analysis. © 2011 SESPAS.",age distribution;aged;article;cardiovascular disease;chronic disease;cross-sectional study;dementia;disabled person;female;human;life expectancy;male;mental disease;middle aged;mortality;neoplasm;quality adjusted life year;Spain;statistics,"Gènova-Maleras, R.;Álvarez-Martín, E.;Catalá-López, F.;Fernández de Larrea-Baz, N.;Morant-Ginestar, C.",2011,,,0,
1492,Measuring the burden of disease and injury in Spain using disability-adjusted life years: An updated and policy-oriented overview,"Objective: To provide a comprehensive and detailed overview of the burden of disease in Spain for 2008. Implications for public health policies are discussed. Study design: Cross-sectional population-based study. Methods: Disability-adjusted life years (DALYs) were calculated at country level using the methodology developed in the Global Burden of Disease study. DALYs were divided into years of life lost and years of life lived with disability. Results were obtained using Spanish mortality data for 2008 and morbidity data estimated previously by the World Health Organization for Euro-A. Results: In 2008, DALYs lost due to all diseases and injuries were estimated at 5.1 million. Non-communicable diseases accounted for 89.2% of the total DALYs. The leading causes of DALYs were neurological and mental disorders (29.9%), malignant neoplasms (15.8%) and cardiovascular diseases (12.5%). The main specific causes included depression (5.5%), ischaemic heart disease (5.5%), lung cancer (5.3%) and alcohol abuse (4.7%) among males; and depression (11.7%), dementias (10.0%), hearing loss (4.2%) and cerebrovascular disease (3.5%) among females. Conclusions: Measuring DALYs specifically for Spain represents a systematic analysis of population health losses, and also provides an important measure to track the outcomes of future health interventions. © 2012 The Royal Society for Public Health.",disability;Spain;cost of illness;population;injury;health;policy;public health;study design;malignant neoplastic disease;health care policy;ischemic heart disease;lung cancer;methodology;communicable disease;society;world health organization;diseases;morbidity;mental disease;hearing impairment;cardiovascular disease;dementia;male;alcohol abuse;mortality;cerebrovascular disease;female,"Gènova-Maleras, R.;Álvarez-Martín, E.;Morant-Ginestar, C.;Fernández de Larrea-Baz, N.;Catalá-López, F.",2012,,,0,
1493,Use of anticoagulant treatments in the elderly,"Purpose. - The frequency of pathologies requiring anticoagulant treatment (thromboembolic disease, atrial fibrillation) is particulary high in people above 75. The risk of haemorrhagic complications is also highest in this population of patients.Therefore, the assessment of the risk/benefit ratio of an anticoagulant treatment may overestimate the haemorrhagic risk and lead to the under-using of anticoagulant treatment in such pathologies as atrial fibrillation. Current knowledge and key-points. - However, the use of ""classical"" anticoagulant treatments such as non-fractionated heparin, low-molecular-weight heparin, and above all, antivitamin K requires special precautions. Several haemorraghic risk factors are well known and should be spotted out. Finally, the risk/benefit ratio of an anticoagulant treatment in the elderly patients must rely on a comprehensive geriatric assessment. Prospects and projects. - In the era of ""new anticoagulant treatments"", and particularly of per-os antithrombin, it may seem anachronical to issue a statement over the use of ""classical anticoagulant treatments"", but in the present state of knowledge, the evaluation of these new molecules is not sufficient in the elderly population of patients. © 2005 Elsevier SAS. All rights reserved.",acenocoumarol;acetylsalicylic acid;amiodarone;antibiotic agent;anticoagulant agent;antithrombin;antivitamin K;coumarin derivative;creatinine;cytochrome P450 2C9;dalteparin;enoxaparin;fluindione;fondaparinux;Ginkgo biloba extract;heparin;heparin calcium;low molecular weight heparin;nadroparin;paracetamol;tinzaparin;warfarin;ximelagatran;aging;Alzheimer disease;bleeding disorder;bolus injection;cardiovascular risk;clinical trial;cognition;comorbidity;creatinine clearance;diabetes mellitus;dose calculation;drug contraindication;drug elimination;drug indication;drug use;evaluation study;extracorporeal circulation;functional assessment;genetic polymorphism;geriatrics;atrial fibrillation;heart failure;high risk population;hospitalization;human;hypertension;renal clearance;kidney failure;kidney function;knowledge;lung embolism;pathology;patient education;pharmacogenetics;risk assessment;risk benefit analysis;short survey;thrombocytopenia;thromboembolism;vein thrombosis;venous thromboembolism;aspirin;coumadin;lovenox;previscan;sintrom,"Gentric, A.;Estivin, S.",2006,,,0,
1494,Development and validation of the medication-based disease burden index,"BACKGROUND: Medication lists offer an alternative source of data on comorbidities and disease burden. OBJECTIVE: To develop and validate the Medication-Based Disease Burden Index (MDBI). METHODS: A list of medication corresponding to the leading causes of global death was pilot tested and finalized by an expert panel. The resulting index was tested on drug regimens of patients at risk of medication misadventure. Criterion validity of the index was established against Charlsons's Index and Chronic Disease Score (CDS). Sensitivity, specificity, predictive validity, convergent and discriminant validity, and interrater and test-retest reliabilities of the index were also assessed. RESULTS: The MDBI consisting of specific medication for 20 chronic medical conditions and corresponding disability weightings was developed. The MDBI was tested on 317 patients with mean ± SD Charlson's index scores of 2.8 ± 2.2 and CDS scores of 7.3 ± 2.8. Mean MDBI scores (0.33 ± 0.28) demonstrated significant correlations with Charlson's index scores (r = 0.30; p < 0.001) and CDS (r = 0.53; p < 0.001). MDBI had satisfactory sensitivity and high specificity. Age of the patients and number of medications had significant correlation with the MDBI scores, but the MDBI scores were not significantly different in males and females. MDBI scores could successfully predict death and planned or unplanned readmissions (OR = 4.7, 95% CI 1.4 to 15.5; p = 0.01). MDBI demonstrated high inter-rater (intraclass correlation coefficient [ICC] = 0.99) and test-retest reliabilities (ICC = 0.98). CONCLUSIONS: Initial testing suggests that MDBI could offer an alternative low-cost and convenient method for quantifying disease burden and predicting health outcomes.",abciximab;acetylsalicylic acid;alpha interferon;anticonvulsive agent;antineoplastic agent;antivirus agent;benzathine penicillin;cholinergic receptor blocking agent;cholinesterase inhibitor;corticosteroid;dipeptidyl carboxypeptidase inhibitor;dipyridamole;donepezil;eptifibatide;finasteride;insulin;isoniazid;levodopa;nedocromil;nitrate;novel erythropoiesis stimulating protein;oral antidiabetic agent;proteinase inhibitor;proton pump inhibitor;pyrazinamide;RNA directed DNA polymerase inhibitor;spironolactone;tirofiban;unindexed drug;xanthine derivative;acquired immune deficiency syndrome;adult;aged;Alzheimer disease;article;asthma;neoplasm;cerebrovascular disease;chronic disease;chronic obstructive lung disease;comorbidity;dementia;diabetes mellitus;disease severity;epilepsy;female;health service;hepatitis B;hepatitis C;human;Human immunodeficiency virus infection;hypertension;ischemic heart disease;liver cirrhosis;major clinical study;male;Medication Based Disease Burden Index;nephritis;nephrosis;outcomes research;Parkinson disease;peptic ulcer;pharmacist;prediction;priority journal;prostate hypertrophy;rheumatic heart disease;risk factor;scoring system;skin disease;treatment outcome;tuberculosis,"George, J.;Vuong, T.;Bailey, M. J.;Kong, D. C. M.;Marriott, J. L.;Stewart, K.",2006,,,0,
1495,Heart Failure Increases the Risk of Adverse Renal Outcomes in Patients With Normal Kidney Function,"BACKGROUND: Heart failure (HF) is associated with poor cardiac outcomes and mortality. It is not known whether HF leads to poor renal outcomes in patients with normal kidney function. We hypothesized that HF is associated with worse long-term renal outcomes. METHODS AND RESULTS: Among 3 570 865 US veterans with estimated glomerular filtration rate (eGFR) >/=60 mL min-1 1.73 m-2 during October 1, 2004 to September 30, 2006, we identified 156 743 with an International Classification of Diseases, Ninth Revision, diagnosis of HF. We examined the association of HF with incident chronic kidney disease (CKD), the composite of incident CKD or mortality, and rapid rate of eGFR decline (slopes steeper than -5 mL min-1 1.73 m-2 y-1) using Cox proportional hazard analyses and logistic regression. Adjustments were made for various confounders. The mean+/-standard deviation baseline age and eGFR of HF patients were 68+/-11 years and 78+/-14 mL min-1 1.73 m-2 and in patients without HF were 59+/-14 years and 84+/-16 mL min-1 1.73 m-2, respectively. HF patients had higher prevalence of hypertension, diabetes mellitus, cardiac, peripheral vascular and chronic lung diseases, stroke, and dementia. Incidence of CKD was 69.0/1000 patient-years in HF patients versus 14.5/1000 patient-years in patients without HF, and 22% of patients with HF had rapid decline in eGFR compared with 8.5% in patients without HF. HF patients had a 2.12-, 2.06-, and 2.13-fold higher multivariable-adjusted risk of incident CKD, composite of CKD or mortality, and rapid eGFR decline, respectively. CONCLUSIONS: HF is associated with significantly higher risk of incident CKD, incident CKD or mortality, and rapid eGFR decline. Early diagnosis and management of HF could help reduce the risk of long-term renal complications.","Aged;Female;Follow-Up Studies;Glomerular Filtration Rate/ physiology;Heart Failure/ complications/physiopathology;Humans;Incidence;Kidney/ physiopathology;Male;Middle Aged;Renal Insufficiency, Chronic/ epidemiology/etiology/physiopathology;Retrospective Studies;Risk Assessment;Risk Factors;Survival Rate/trends;United States/epidemiology;glomerular filtration rate;heart failure;kidney diseases;mortality;renal insufficiency;veterans","George, L. K.;Koshy, S. K. G.;Molnar, M. Z.;Thomas, F.;Lu, J. L.;Kalantar-Zadeh, K.;Kovesdy, C. P.",2017,Aug,,0,
1496,A family with diabetes and heart failure,"The case of a middle-aged woman with early-onset diabetes mellitus, hypertrophic cardiomyopathy, premature sensorineural hearing loss and neuropsychiatric symptoms is described. The patient's family history revealed the classical pattern of maternally inherited diabetes and deafness (MIDD) and isolation of mitochondrial DNA from peripheral blood leucocytes showed an A3243G transition in the gene encoding for the tRNA(Leu(UUR)). Thus, the suspected diagnosis of a mitochondrial disorder was confirmed. Cardiac involvement turned out to be the dominating clinical feature in the patient. She died of cardiogenic shock and multiple organ failure within 1 year of diagnosis. Three out of nine affected family members had hypertrophic cardiomyopathy.",leucine transfer RNA;article;cardiogenic shock;case report;dementia;disorders of mitochondrial functions;echocardiography;fatality;female;genetic counseling;genetics;hearing impairment;heart failure;human;hypertrophic cardiomyopathy;insulin dependent diabetes mellitus;middle aged;multiple organ failure;nucleotide sequence;pedigree;sex chromosome aberration;X chromosome,"Gerber, B.;Manser, C.;Wiesli, P.;Meier, C. A.",2010,,,0,
1497,Cardiovascular and noncardiovascular disease associations with hip fractures,"Background: There is growing awareness of an association between cardiovascular disease and fractures, and a temporal increase in fracture risk after myocardial infarction has been identified. To further explore the nature of this relationship, we systematically examined the association of hip fracture with all disease categories and assessed related secular trends. Methods: By using resources of the Rochester Epidemiology Project, a population-based incident case-control study was conducted. Disease history was compared among all Olmsted County, Minnesota, residents aged 50 years or more with a first radiographically confirmed hip fracture in 1985-2006 and community control subjects individually matched (1:1) to cases on age, sex, and index year (n = 3808; mean age, 82 years; standard deviation, 9 years; 76% were women). Results: All cardiovascular and numerous non-cardiovascular disease categories (eg, infectious diseases, nutritional and metabolic diseases, mental disorders, diseases of the nervous system and sense organs, and diseases of the respiratory system) were associated with fracture risk. However, increasing temporal trends were detected almost exclusively in cardiovascular disease categories. The largest increases in association were observed for ischemic heart disease, other forms of heart disease (including heart failure), hypertension, and diabetes, and were more pronounced among elderly women than other demographic subgroups. Conclusions: Although the association with hip fracture was not specific to cardiovascular disease, temporal increases were mainly detected in cardiometabolic diseases, all of which have been linked previously to frailty. This mechanism and others warrant further investigation. © 2013 Elsevier Inc.",abdominal wall hernia;adult;age;aged;arm fracture;arthropathy;article;asthma;bacterial infection;breast disease;bronchitis;cardiac patient;cardiovascular disease;case control study;cerebrovascular disease;chronic lung disease;comorbidity;congenital malformation;controlled study;contusion;dementia;dermatitis;diabetes mellitus;disease association;duodenum disease;emphysema;endocrine disease;enteropathy;esophagus disease;eye inflammation;female;frail elderly;gallbladder disease;gender;geriatric patient;gynecologic disease;head injury;heart failure;heart infarction;hip fracture;hip radiography;human;hypertension;intestine infection;ischemic heart disease;jaw disease;laceration;liver disease;major clinical study;malabsorption;male;medical history;mouth disease;mycosis;neck injury;neoplasm;nephritis;nephrosis;neurosis;nutritional deficiency;organic brain syndrome;osteomyelitis;pancreas disease;peripheral vascular disease;peritoneal disease;personality disorder;pneumonia;population research;prevalence;priority journal;psychosis;risk assessment;salivary gland disease;secularism;skin infection;skull fracture;spine fracture;stomach disease;thyroid disease;trend study;ulcer;urinary tract disease;virus infection;vitamin deficiency,"Gerber, Y.;Melton Iii, L. J.;McNallan, S. M.;Jiang, R.;Weston, S. A.;Roger, V. L.",2013,,,0,
1498,"Estimation of apolipoprotein E genotype-specific relative mortality risks from the distribution of genotypes in centenarians and middle-aged men: Apolipoprotein E gene is a 'frailty gene,' not a 'longevity gene'","We developed a method to estimate genotype-specific average relative mortality risk, R, from genotype distributions in cross-sectional studies of people belonging to different age-groups, and applied the method to new data from a study of apolipoprotein E genotypes (apoE) in 177 Danish centenarians and data from a study of 40-year-old Danish men. Twenty-one percent of the centenarians were ε2-carriers (genotypes ε2ε2 and ε3ε2) and 15% were ε4-carriers (genotypes ε4ε4 and ε4ε3) compared to 13 and 29%, respectively, of the young men. The R-values were 0.95 (95% CI 0.88 to 1.02) for ε2-carriers and 1.13 (95% CI 1.05 to 1.22) for ε4-carriers, using ε3ε3- and ε4ε2 genotypes as reference. Corresponding values for ε4-carriers were obtained by using published data from a French and a Finnish study of centenarians, whereas the values for ε2-carriers were about 0.90 with these data. The method to estimate mortality risk and the results associate with the view that the apoE gene is a 'frailty gene.' On the other hand, if odds ratios are used to summarize data from studies of this kind, they are more impressive and may propagate the misconception that apoE is a 'longevity gene'. (C) 2000 Wiley-Liss, Inc.",apolipoprotein E;adult;aged;allele;Alzheimer disease;article;chromosome 19q;controlled study;female;gene frequency;genotype;high risk population;human;ischemic heart disease;lipoprotein metabolism;longevity;male;mortality;normal human;risk factor,"Gerdes, L. U.;Jeune, B.;Ranberg, K. A.;Nybo, H.;Vaupel, J. W.",2000,,,0,
1499,Spectrum of neurodevelopmental disabilities: A cohort study in hungary,"The spectrum of neurodevelopmental disabilities was studied in a cohort of patients in Hungary. A search for etiologies and assessment of the degree of intellectual disability were carried out. The study included 241 (131 boys) patients. Disability occurred without any prenatal, perinatal, and/or neonatal adverse events in 167 patients. They were classified into the following subgroups: genetic syndromes with recognized etiology, global developmental delay/intellectual disability in association with dysmorphic features but unknown etiology, global developmental delay/intellectual disability without dysmorphic features and recognized etiology, brain malformations, inborn errors of metabolism, leukoencephalopathies, epileptic syndromes, developmental language impairment, and neuromuscular disorders. Adverse events occurred in 74 children classified into subgroups such as cerebral palsy after delivery preterm or at term, and disabilities without cerebral palsy. The etiology was identified in 66.4%, and genetic diagnosis was found in 19.5%. Classification of neurodevelopmental disorders contribute to etiological diagnosis, proper rehabilitation, and genetic counseling.","49,XXXXY syndrome;adolescent;adrenoleukodystrophy;adult;Alexander disease;article;blepharophimosis;brain malformation;centronuclear myopathy;cerebral palsy;child;chromosome aberration;clinical feature;cohort analysis;de Lange syndrome;delivery;developmental disorder;DiGeorge syndrome;disease association;Duchenne muscular dystrophy;epilepsy;female;fragile X syndrome;genetic counseling;genetic disorder;globoid cell leukodystrophy;happy puppet syndrome;hemiplegia;human;Hungary;inborn error of metabolism;infant;intellectual impairment;intelligence;intrauterine growth retardation;Kearns Sayre syndrome;language disability;Leigh disease;leukoencephalopathy;major clinical study;male;mental retardation malformation syndrome;myotonic dystrophy;neuromuscular disease;Prader Willi syndrome;premature labor;priority journal;quadriplegia;retrospective study;Rett syndrome;ring chromosome;tuberous sclerosis;Waardenburg syndrome;white matter injury;Williams Beuren syndrome","Gergev, G.;Máté, A.;Zimmermann, A.;Rárosi, F.;Sztriha, L.",2015,,,0,
1500,When enough is enough: The nephrologist's responsibility in ordering dialysis treatments,"For more than 20 years, nephrologists have been reporting that they are increasingly being expected to dialyze patients whom they believe may receive little benefit from dialysis therapy. During this time, there has been substantial research about the outcomes of patients of differing ages and comorbid conditions requiring dialysis and the development of clinical practice guidelines for dialysis decision making based on research evidence, ethics, and the law. The importance of palliative medicine to the care of the patient throughout the continuum of kidney disease also has been recognized, and its application has been described. This article summarizes these advances and provides an approach for decision making and treatment for patients who are not likely to benefit from dialysis therapy. © 2011 National Kidney Foundation, Inc.",albumin;aged;albumin blood level;article;case report;Chinese;chronic kidney disease;clinical decision making;comorbidity;dementia;diabetes mellitus;dialysis;glomerulus filtration rate;health status;human;ischemic heart disease;Karnofsky Performance Status;kidney failure;male;nephrologist;palliative therapy;patient care;peripheral vascular disease;practice guideline;prediction;prognosis;responsibility;survival time;treatment outcome,"Germain, M. J.;Davison, S. N.;Moss, A. H.",2011,,,0,
1501,The aging electrocardiogram: Retrospective study in the elderly patient in geriatrics,"Context: Electrocardiographic abnormalities are often found in older patient. Objective: Define the prevalence of major electrocardiographic abnormalities in geriatrics. Methods: Retrospective study about electrocardiogram of 151 patients, 48 men of an average age of 75 years and 103 women of an average age of 83 years, hospitalised in gerontology unit. More than 60% of the patients were older than 80 years of age, 58% had a dementia, 4% a pacemaker. Results: The main results were the following: 12% of patients had atrial fibrillation, 3% had first degree atrioventricular block and 11% sinusal tachycardia. A left deviation of electrical axis was present in 50% of subjects and 30% presented a left anteriot hemiblock. Finally, a left hypertrophy ventricle was present in 6%, a prolongation of the QT interval in 40%, ST-T wave alterations in 25% and signs of myocardial necrosis in 7% of the population.",antiangina pectoris agent;antiarrhythmic agent;antihypertensive agent;antithrombocytic agent;cardiovascular agent;aged;aging;article;artificial heart pacemaker;atrioventricular block;cardiovascular disease;dementia;electrocardiogram;female;geriatric patient;heart arrhythmia;heart atrium arrhythmia;atrial fibrillation;heart left ventricle hypertrophy;heart muscle conduction disturbance;human;major clinical study;male;QRS complex,"Gervais-Veysseyre, A. M.;Palisson, M.;Maury, S.;Perilliat, J. G.",2002,,,0,
1502,Cognitive impairment and outcomes in older adult survivors of acute myocardial infarction: findings from the translational research investigating underlying disparities in acute myocardial infarction patients' health status registry,"BACKGROUND: Cognitive impairment without dementia (CIND) and acute myocardial infarction (AMI) are prevalent in older adults; however, the association of CIND with outcomes after AMI is unknown. METHODS: We used a multicenter registry to study 772 patients >/=65 years with AMI, enrolled between April 2005 and December 2008, who underwent cognitive function assessment with the Telephone Interview for Cognitive Status-modified (TICS-m) 1 month after AMI. Patients were categorized by cognitive status to describe characteristics and in-hospital treatment, including quality of life and survival 1 year after AMI. RESULTS: Mean age was 73.2 +/- 6.3 years; 58.5% were men, and 78.2% were white. Normal cognitive function (TICS-m >22) was present in 44.4%; mild CIND (TICS-m 19-22) in 29.8%; and moderate/severe CIND (TICS-m <19) in 25.8% of patients. Rates of hypertension (72.6%, 77.4%, and 81.9%), cerebrovascular accidents (3.5%, 7.0%, and 9.0%), and myocardial infarction (20.1%, 22.2%, and 29.6%) were higher in those with lower TICS-m scores (P < .05 for comparisons). AMI medications were similar by cognitive status; however, CIND was associated with lower cardiac catheterization rates (P = .002) and cardiac rehabilitation referrals (P < .001). Patients with moderate/severe CIND had higher risk-adjusted 1-year mortality that was nonstatistically significant (adjusted hazard ratio 1.97, 95% CI 0.99-3.94, P = .054; referent normal, TICS-m >22). Quality of life across cognitive status was similar at 1 year. CONCLUSIONS: Most older patients surviving AMI have measurable CIND. Cognitive impairment without dementia was associated with less invasive care, less referral and participation in cardiac rehabilitation, and worse risk-adjusted 1-year survival in those with moderate/severe CIND, making it an important condition to consider in optimizing AMI care.","Aged;Aged, 80 and over;Cognition Disorders/*complications/pathology;Female;*Health Services for the Aged;*Health Status Disparities;Humans;Male;Myocardial Infarction/complications/*epidemiology/mortality/therapy;Prospective Studies;Registries;Risk Factors;Severity of Illness Index;Surveys and Questionnaires;Telephone;Treatment Outcome;United States/epidemiology","Gharacholou, S. M.;Reid, K. J.;Arnold, S. V.;Spertus, J.;Rich, M. W.;Pellikka, P. A.;Singh, M.;Holsinger, T.;Krumholz, H. M.;Peterson, E. D.;Alexander, K. P.",2011,Nov,10.1016/j.ahj.2011.08.005,0,
1503,A brief report on the efficacy of donepezil in pain management in alzheimer's disease,"Alzheimer's disease is an advanced dementia. In this disease, little by little the brain loses most of its functions. Pain is a prevalent complaint. It seems easing the pain had the better recovery to antipsychotic drug in controlling agitation in dementia patients. Donepezil is a drug that is used to treat Alzheimer's disease. This brief report describes an 83-year-old woman with Alzheimer's disease who experienced boredom and changes in attitude for about 1 year and complained about general pain in her extremity. Starting donepezil controlled the patient's symptoms. As soon as the treatment started, all pain was dramatically eliminated and her behavior improved. Donepezil may be effective in controlling the pain and improve the outcome of these patients. © 2014 Informa Healthcare USA, Inc.",donepezil;indometacin;levothyroxine;losartan;triamcinolone acetonide;absence of side effects;aged;Alzheimer disease;article;attitude;boredom;brain atrophy;brain scintiscanning;case report;computer assisted tomography;congestive heart failure;disease severity;drug dose increase;drug efficacy;evening dosage;family history;female;human;hypertension;joint prosthesis;knee pain;limb pain;massage;medical history;multiple myeloma;neurologic examination;skull radiography;very elderly;warming,"Gharaei, H.;Shadlou, H.",2014,,,0,
1504,Clinical phenome scanning,"Large population-based cohorts are ideal for the study of common, complex disorders because they allow characterization of gene-gene and gene-environment interactions. We propose a clinical phenome scanning approach to genotype-phenotype association studies, as this approach acknowledges the heterogeneous nature of common diseases and takes advantage of the unprecedented density of phenotypic data available in population-based DNA biobanks. By analogy to genome-wide scanning, the construction of a clinical phenome scan includes a complete scan of all clinically available information (housed in electronic medical records). This is done on a subject-by-subject basis and the resulting phenomes can subsequently be interrogated for association with a single allele for any given gene. By prioritizing phenotype (rather than genotype), this approach allows investigators to ask the question ""Which disease is associated with a given gene?"" rather than ""Which gene is associated with a given disease?"". © 2007 Future Medicine Ltd.",apolipoprotein E;dipeptidyl carboxypeptidase;leukocyte antigen;transforming growth factor beta1;algorithm;allele;Alzheimer disease;article;clinical effectiveness;clinical genetics;cohort analysis;disease classification;disease course;DNA polymorphism;effect size;electronic medical record;gene frequency;gene locus;genetic association;genetic database;genetic variability;genotype environment interaction;genotype phenotype correlation;haplotype map;health service;heart infarction;human;hypertension;informed consent;linkage analysis;non insulin dependent diabetes mellitus;outcome assessment;pleiotropy;population genetics;priority journal;sample size;sensitivity and specificity;single nucleotide polymorphism,"Ghebranious, N.;McCarty, C. A.;Wilke, R. A.",2007,,,0,
1505,Delirium in the elderly patient,"Delirium (hypoalert-hypoactive variant) or a confusional state (hyperactive variant) is found in 15-55% of elderly in-patients. Age and underlying dementia are the major risk factors for a confusional state to occur, often following the intake of a drug (sedatives, antibiotics, corticoids...), infectious disease (urinary tract infection, pneumonia...), surgery, an hydroelectrolytic or glycaemic abnormality, a gastrointestinal or vesical obstruction, cardiac ischaemia, a pulmonary condition (embolism, respiratory failure...) a stroke, a neoplasm, or an anemia. Early and rapid discovery and correction of the causal factors are the first diagnostic and therapeutic step, before the prescription of neuroleptics, benzodiazepines, beta-blockers or anticonvulsant medication.",age;aged;anemia;delirium;dementia;diagnostic accuracy;drug use;good clinical practice;heart muscle ischemia;human;hypoglycemia;infection;neoplasm;risk factor;short survey;cerebrovascular accident;surgery,"Ghika, J.",1997,,,0,
1506,Effects of a Community-Based Fall Management Program on Medicare Cost Savings,"Introduction Fall-related injuries and health risks associated with reduced mobility or physical inactivity account for significant costs to the U.S. healthcare system. The widely disseminated lay-led A Matter of Balance (MOB) program aims to help older adults reduce their risk of falling and associated activity limitations. This study examined effects of MOB participation on health service utilization and costs for Medicare beneficiaries, as a part of a larger effort to understand the value of community-based prevention and wellness programs for Medicare. Methods A controlled retrospective cohort study was conducted in 2012-2013, using 2007-2011 MOB program data and 2006-2013 Medicare data. It investigated program effects on falls and fall-related fractures, and health service utilization and costs (standardized to 2012 dollars), of 6,136 Medicare beneficiaries enrolled in MOB from 2007 through 2011. A difference-in-differences analysis was employed to compare outcomes of MOB participants with matched controls. Results MOB participation was associated with total medical cost savings of $938 per person (95% CI=$379, $1,498) at 1 year. Savings per person amounted to $517 (95% CI=$265, $769) for unplanned hospitalizations; $81 for home health care (95% CI=$20, $141); and $234 (95% CI=$55, $413) for skilled nursing facility care. Changes in the incidence of falls or fall-related fractures were not detected, suggesting that cost savings accrue through other mechanisms. Conclusions This study suggests that MOB and similar prevention programs have the potential to reduce Medicare costs. Further research accounting for program delivery costs would help inform the development of Medicare-covered preventive benefits.",aged;arthritis;article;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;congestive heart failure;cost control;dementia;depression;diabetes mellitus;emergency care;falling;female;fracture;health care cost;health care utilization;hip fracture;home care;hospitalization;human;hypertension;ischemic heart disease;major clinical study;male;medicare;peripheral vascular disease;physiotherapy;retrospective study;spine fracture,"Ghimire, E.;Colligan, E. M.;Howell, B.;Perlroth, D.;Marrufo, G.;Rusev, E.;Packard, M.",2015,,,0,
1507,Does gender affect outcome of cardiac surgery in octogenarians?,"The long-term results of cardiac surgery in 212 consecutive octogenarians (116 men, 96 women) were reviewed retrospectively. Preoperative functional status, Euroscore, and the incidences of hypertension and chronic obstructive pulmonary disease were similar in both sexes. Women had more diabetes mellitus (45% versus 25%; p < 0.05) but less renal dysfunction (16% versus 29%; p < 0.05). Men required emergency procedures more frequently (p < 0.05). Women underwent complete revascularization more often and had more arterial grafts. Hospital mortality was similar (11.5% in women versus 12.9% in men), but women had more complications (76% versus 64%), longer convalescence (24.3 versus 18.5 days), fewer psychiatric disorders (14% versus 23%) and less heart block (9% versus 19%). Men had a slightly better outcome in terms of functional class and Euroqol score during follow-up of up to 114 months. Median survival was longer in women (3.15 versus 2.96 years) but 1-, 3-, and 5-year survival rates and late deaths were similar. Outcomes appear to be equitable for both sexes among octogenarians.",aged;artery graft;article;bioprosthesis;chronic obstructive lung disease;controlled study;convalescence;death;dementia;diabetes mellitus;elderly care;emergency surgery;female;follow up;gastrointestinal hemorrhage;heart block;heart death;heart disease;heart failure;heart function;heart infarction;heart muscle revascularization;heart surgery;hemodialysis;high risk population;human;hypertension;kidney dysfunction;kidney failure;lung infection;major clinical study;male;mental disease;multiple organ failure;peroperative complication;postoperative complication;preoperative period;quality of life;retrospective study;sex difference;surgical mortality;survival;treatment outcome;Biocor;Carbomedics;Hancock;Intact;Mosaic;SJM;Sorin Pericarbon,"Ghosh, P.;Djordjevic, M.;Schistek, R.;Baier, R.;Unger, F.",2003,,,0,
1508,Acute health events in adult patients with genetic disorders: The Marshfield Epidemiologic Study Area,"PURPOSE: We ascertained and reviewed acute health events occurring in 2003 among patients age 18 and greater with well-defined single gene, chromosomal, and selected multifactorial conditions within the Marshfield Epidemiologic Study Area. METHODS: Of 47,077 adult Marshfield Epidemiologic Study Area Central cohort members, 1831 (3.9%) had been given at least one of 71 ICD-9 codes appropriate for genetic diagnoses of interest. Physician review narrowed this to 591 (1.3%) validated patients for the study. Of the 591, 527 (89.2%) patients registered 6,849 visits, which were manually reviewed to delineate acute, relevant health events in the urgent care and primary care provider setting. RESULTS: A total of 244 acute relevant health events among 126 patients corresponding to 58 different genetic conditions were observed. Acute relevant health events corresponded to 3.4% of the total health events in patients identified with genetic problems. Categories of genetic conditions with the highest frequencies of acute relevant health events included chromosomal and microdeletion syndromes (21.3%), hematologic disorders (11.5%), muscular dystrophies (8.6%), and connective tissue disorders (10.2%). CONCLUSIONS: These data have multiple applications and implications in addressing the natural history, long-term medical needs and financial impact of adult patients with genetic conditions. Copyright © American College of Medical Genetics.",achondroplasia;Alport syndrome;Alstrom syndrome;angioosteohypertrophy syndrome;Arnold Chiari malformation;article;basal cell nevus syndrome;bile duct atresia;chromosome deletion;cohort analysis;connective tissue disease;cutis laxa;Down syndrome;Dupuytren contracture;Ehlers Danlos syndrome;genetic disorder;genodermatosis;happy puppet syndrome;health care financing;health care need;health status;hematologic disease;hemochromatosis;hereditary motor sensory neuropathy;Hirschsprung disease;Holt Oram syndrome;human;Huntington chorea;incontinentia pigmenti;Kearns Sayre syndrome;kidney polycystic disease;Klinefelter syndrome;Klippel Feil syndrome;limb girdle muscular dystrophy;long QT syndrome;Marfan syndrome;muscular dystrophy;ossifying myositis;patient care;Pendred syndrome;physician;Prader Willi syndrome;primary medical care;pseudoxanthoma elasticum;spinal dysraphism;syringomyelia;Thomsen disease;Turner syndrome;validation process;velocardiofacial syndrome;von Hippel Lindau disease;Williams Beuren syndrome,"Giampietro, P. F.;Greenlee, R. T.;McPherson, E.;Benetti, L. L.;Berg, R. L.;Wagner, S. F.",2006,,,0,
1509,Protein aggregates and novel presenilin gene variants in idiopathic dilated cardiomyopathy,"BACKGROUND: Heart failure is a debilitating condition resulting in severe disability and death. In a subset of cases, clustered as idiopathic dilated cardiomyopathy (iDCM), the origin of heart failure is unknown. In the brain of patients with dementia, proteinaceous aggregates and abnormal oligomeric assemblies of beta-amyloid impair cell function and lead to cell death. METHODS AND RESULTS: We have similarly characterized fibrillar and oligomeric assemblies in the hearts of iDCM patients, pointing to abnormal protein aggregation as a determinant of iDCM. We also showed that oligomers alter myocyte Ca(2+) homeostasis. Additionally, we have identified 2 new sequence variants in the presenilin-1 (PSEN1) gene promoter leading to reduced gene and protein expression. We also show that presenilin-1 coimmunoprecipitates with SERCA2a. CONCLUSIONS: On the basis of these findings, we propose that 2 mechanisms may link protein aggregation and cardiac function: oligomer-induced changes on Ca(2+) handling and a direct effect of PSEN1 sequence variants on excitation-contraction coupling protein function.","Adult;Aged;Amyloid/analysis;Amyloid beta-Peptides/analysis;Calcium/metabolism;Cardiomyopathy, Dilated/*genetics/*metabolism;Female;Humans;Immunohistochemistry;Male;Middle Aged;Mutation;Polymorphism, Single Nucleotide;Presenilin-1/*genetics;Presenilin-2/genetics;Proteins/*chemistry","Gianni, D.;Li, A.;Tesco, G.;McKay, K. M.;Moore, J.;Raygor, K.;Rota, M.;Gwathmey, J. K.;Dec, G. W.;Aretz, T.;Leri, A.;Semigran, M. J.;Anversa, P.;Macgillivray, T. E.;Tanzi, R. E.;del Monte, F.",2010,Mar 16,10.1161/circulationaha.109.879510,0,
1510,Long-term overall and disease-specific mortality associated with benign gynecologic surgery performed at different ages,"OBJECTIVE: As bilateral salpingo-oophorectomy is frequently performed with hysterectomy for nonmalignant conditions, defining health outcomes associated with benign bilateral salpingo-oophorectomy performed at different ages is critical. METHODS: We assessed mortality risk associated with benign total abdominal hysterectomy or bilateral salpingo-oophorectomy among 52,846 Breast Cancer Detection Demonstration Project follow-up study participants. Surgery and risk factor data were ascertained via baseline interview (1979-1986) and three questionnaires (1987-1998). During follow-up through December 2005 (mean, 22.1 y), 13,734 deaths were identified. We estimated hazard ratios (HRs) and 95% CIs for overall and disease-specific mortality for total abdominal hysterectomy or bilateral salpingo-oophorectomy performed by age 35, 40, 45, 50, or 55 years, compared with not having surgery, using landmark analyses and multivariable Cox regression. RESULTS: Undergoing bilateral salpingo-oophorectomy by age 35 years was associated with increased mortality risk (HR35 y, 1.20; 95% CI, 1.08-1.34), which decreased with age (HR40 y, 1.12; 95% CI, 1.04-1.21; HR45 y, 1.10; 95% CI, 1.03-1.17). Total abdominal hysterectomy alone performed by age 40 years was associated with increased mortality risk to a lesser extent (HR40 y, 1.08; 95% CI, 1.01-1.15). Analyses based on matched propensity scores related to having gynecologic surgery yielded similar results. Elevated mortality risks were largely attributable to noncancer causes. CONCLUSIONS: Benign gynecologic surgeries among young women are associated with increased mortality risk, which attenuates with age.","Adult;Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/mortality;Coronary Disease/mortality;Diabetes Mellitus/mortality;Female;Genital Diseases, Female/surgery;Humans;Hysterectomy/*mortality;Middle Aged;Neoplasms/*mortality;Ovariectomy/*mortality;Prospective Studies;Pulmonary Disease, Chronic Obstructive/mortality;Salpingectomy/*mortality;Stroke/mortality;Time Factors;United States/epidemiology","Gierach, G. L.;Pfeiffer, R. M.;Patel, D. A.;Black, A.;Schairer, C.;Gill, A.;Brinton, L. A.;Sherman, M. E.",2014,Jun,10.1097/gme.0000000000000118,0,
1511,"Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome mimicking herpes simplex encephalitis on imaging studies","We present a case in which mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome mimicked the clinical and radiological signs of herpes simplex encephalitis. In a patient with subacute encephalopathy, on computed tomography and magnetic resonance imaging, lesions were present in both temporal lobes extending to both insular regions with sparing of the lentiform nuclei and in both posterior straight and cingulate gyri. Final diagnosis of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome was based on biochemical investigations on cerebrospinal fluid, electromyogram, muscle biopsy, and genetic analysis. On diffusion-weighted imaging, diffusion restriction was present in some parts of the lesions but not throughout the entire lesions. We suggest that this could be an important sign in the differential diagnosis with herpes simplex encephalitis. Copyright © 2013 by Lippincott Williams & Wilkins.",aciclovir;albumin;gadolinium;lactic acid;methionine;mitochondrial DNA;protein;adult;amnesia;aphasia;article;case report;cerebrospinal fluid;cerebrospinal fluid level;cingulate gyrus;clinical evaluation;comprehension;computer assisted tomography;contrast enhancement;Creutzfeldt Jakob disease;differential diagnosis;diffusion weighted imaging;disease duration;disease free interval;echography;electroencephalogram;electromyogram;genetic analysis;gliosis;hearing impairment;heart left ventricle hypertrophy;heart right ventricle hypertrophy;herpes simplex encephalitis;human;human tissue;hypertension;hypertrophic cardiomyopathy;insula;laboratory test;lactic acidosis;logorrhea;lymphoma;male;MELAS syndrome;migraine;mitochondrial encephalomyopathy;motor unit potential;muscle biopsy;myopathy;neuroimaging;nuclear magnetic resonance imaging;polymerase chain reaction;positron emission tomography;priority journal;protein cerebrospinal fluid level;quadriceps femoris muscle;repeat procedure;short term memory;stuttering;subacute sclerosing panencephalitis;temporal lobe;tonic clonic seizure,"Gieraerts, C.;Demaerel, P.;Van Damme, P.;Wilms, G.",2013,,,0,
1512,Quantitative rotating frame relaxometry methods in MRI,"Macromolecular degeneration and biochemical changes in tissue can be quantified using rotating frame relaxometry in MRI. It has been shown in several studies that the rotating frame longitudinal relaxation rate constant (R1ρ) and the rotating frame transverse relaxation rate constant (R2ρ) are sensitive biomarkers of phenomena at the cellular level. In this comprehensive review, existing MRI methods for probing the biophysical mechanisms that affect the rotating frame relaxation rates of the tissue (i.e. R1ρ and R2ρ) are presented. Long acquisition times and high radiofrequency (RF) energy deposition into tissue during the process of spin-locking in rotating frame relaxometry are the major barriers to the establishment of these relaxation contrasts at high magnetic fields. Therefore, clinical applications of R1ρ and R2ρ MRI using on- or off-resonance RF excitation methods remain challenging. Accordingly, this review describes the theoretical and experimental approaches to the design of hard RF pulse cluster- and adiabatic RF pulse-based excitation schemes for accurate and precise measurements of R1ρ and R2ρ. The merits and drawbacks of different MRI acquisition strategies for quantitative relaxation rate measurement in the rotating frame regime are reviewed. In addition, this review summarizes current clinical applications of rotating frame MRI sequences.",biological marker;water;adiabaticity;aging;Alzheimer disease;analytic method;article;articular cartilage;BOLD signal;brain cortex lesion;dipole;dispersion;echo planar imaging;epiphyseal cartilage;Fourier transformation;human;hypertrophic cardiomyopathy;imaging phantom;macromolecule;magnetic field;mathematical analysis;measurement accuracy;mild cognitive impairment;molecular dynamics;multiple sclerosis;nuclear magnetic resonance imaging;Parkinson disease;priority journal;quantitative analysis;quantum chemistry;rate constant;rotating frame relaxometry;signal noise ratio;soft tissue;steady state,"Gilani, I. A.;Sepponen, R.",2016,,,0,
1513,Quinidine dementia,"Used primarily in the treatment of atrial fibrillation and certain other cardiac arrhythmias, quinidine is well recognized to be a dangerous as well as an effective drug. Occasionally the introduction of even small doses may cause tinnitus, vertigo, visual disturbance, headache, and confusion. A new and treatable cause of progressive dementia was found in a woman receiving quinidine for 14 years after an acute myocardial infarction; moreover, the discontinuation of quinidine led to a remarkable and progressive recovery of intellectual faculties.",quinidine;adverse drug reaction;clinical study;dementia;drug therapy;heart arrhythmia;heart infarction;major clinical study;oral drug administration;therapy,"Gilbert, G. J.",1977,,,0,
1514,Cerebral amyloid angiopathy: Incidence and complications in the aging brain. I. Cerebral hemorrhage,"The clinical and pathologic findings in eleven patients with fatal cerebral hemorrhages related to cerebral amyloid angiopathy (CAA) are described. The hemorrhages were bihemispheric, though not necessarily of simultaneous onset in four patients, and favoured the fronto-parietal cortex and white matter in ten patients. Dissection into the subarachnoid space was common. Cerebrovascular lesions or cardiomegaly related to hypertension coexisted with those of CAA in three cases. Seven patients were not demented prior to the ictus. Ten of eleven brains contained abundant senile plaques and/or neurofibrillary tangles, whether or not the patient had been clinically demented. In the elderly, CAA is an important etiologic consideration for cerebral hemorrhage, especially if the hemorrhage occurs in a peripheral location in the brain and is superimposed on a history of dementia.",aged;aging;amyloidosis;autopsy;brain angiography;brain hemorrhage;central nervous system;clinical article;dementia;diagnosis;great blood vessel;human;psychological aspect;vascular amyloidosis,"Gilbert, J. J.;Vinters, H. V.",1983,,,0,
1515,OSCE: Experience as a simulated candidate 4,,anxiety;automutilation;clinical examination;clinical practice;dementia;depression;health care quality;heart infarction;human;letter;medical education;medical school;mental health care;paranoia;process model;psychologic assessment;schizophrenia;work experience,"Gilder, Z.",2007,,,0,
1516,Short-term results with a constrained acetabular liner in patients at high risk of dislocation after primary total hip arthroplasty,"Background: Dislocation following primary total hip arthroplasty (THA) is a complication with an incidence of 2%-5%. This study examines the clinical and radiological outcome of a constrained acetabular implant used in primary THA in high-risk patients to prevent dislocation. Methods: 54 patients with 55 constrained implants for primary THA were reviewed clinically and radiologically. Oxford, Harris Hip and Charlson scores were recorded. Results: 54 patients, with an average age of 83.2 years, were followed up at a mean of 44.9 (20-74) months. 38 had an hydroxyapatite-(HA) coated acetabular shell with a constrained insert and 17 had a cemented constrained implant. The median Charlson score at surgery was 5 (4-10). There were significant improvements in Oxford, Harris hip pain and function scores and Charnley pain after surgery. 2 patients had radiolucent lines on the most recent radiograph. Neither was symptomatic and the acetabular components had not migrated. 3 patients developed postoperative infection, 1 deep requiring a 2-stage revision. Of the 29 patients who died, 1 required revision 2 months following surgery for dislocation of the constrained liner. This patient died 26 months later from unrelated causes having had no further complications from her surgery. There have been no further revisions or reoperations for dislocation in any of the other cases. Conclusions: The use of a constrained acetabular liner at primary THA in high risk patients for dislocation can successfully prevent this complication without increasing component loosening. In this series of 55 constrained implants we have a postoperative dislocation rate of 1.8%.",hydroxyapatite;acute motor axonal neuropathy;adult;aged;Alzheimer disease;article;cardiopulmonary arrest;Charlson score;cognition assessment;controlled study;evaluation and follow up;female;femur trochanteric fracture;Harris hip pain and function score;hip dislocation;hip hemiarthroplasty;human;incidence;major clinical study;male;middle aged;mild cognitive impairment;outcome assessment;paraplegia;postoperative infection;radiography;range of motion;risk factor;scoring system;total hip prosthesis;very elderly;young adult,"Gill, K.;Whitehouse, S. L.;Hubble, M. J. W.;Wilson, M. J.",2016,,10.5301/hipint.5000396,0,
1517,Improving prescribing in the elderly: A study in the long term care setting,"OBJECTIVES: To determine the prevalence and predictors of potentially inappropriate prescribing of medications in the long term care setting, and to determine the effectiveness of follow-up pharmacist letters to the prescribing physicians in improving prescribing. PATIENTS AND METHODS: The Improving Prescribing in the Elderly Tool was applied to the charts of all long term care patients aged 65 years and over at Parkwood Hospital, a rehabilitation hospital/long term care facility in London, Ontario. All potentially inappropriate prescriptions were verified by a consensus panel consisting of a family physician, a geriatric medicine specialist and a geriatric pharmacist. Follow-up letters to the prescribing physicians were developed that briefly described the concerns with the potentially inappropriate prescriptions and suggested safer alternatives. These letters were sent to the prescribing physicians, accompanied by a brief survey. Patient charts in which a potentially inappropriate prescription had been noted were reviewed for prescription changes two months after the prescribing physicians had received the follow-up letters. RESULTS: A total of 69 potentially inappropriate prescriptions were found in 65 of 355 long term care patients (18.3%). The most common types of potentially inappropriate prescriptions were anticholinergic drugs to manage antipsychotic side effects (17 cases), tricyclic antidepressants with active metabolites (16 cases), and long-acting benzodiazepines (14 cases). The total number of prescription medications (P<0.001), a history of mental illness (P=0.002) and a high minimum data set (MDS) score for depression (P=0.002) were all highly associated with potentially inappropriate prescribing. Variables that were not correlated with increased rates of potentially inappropriate prescribing included age, sex, code status, a diagnosis of dementia (as documented explicitly in the chart), high MDS scores for delirium or cognitive impairment, the date of the prescribing physician's graduation and the total Charlson comorbidity index score. Potentially inappropriate prescriptions were significantly less common in patients seen by a geriatric medicine specialist (P<0.001). In response to the follow-up letter suggesting safer alternatives, 37.9% of potentially inappropriate prescriptions were changed by the prescribing physician. Ninety-two per cent of responding physicians rated the follow-up letter as a 'somewhat' or 'very' helpful method for improving prescribing in elderly patients. CONCLUSIONS: Potentially inappropriate prescribing in the long term care setting is common and can be improved by the provision of a follow-up letter suggesting safer alternatives.",benzodiazepine derivative;beta adrenergic receptor blocking agent;calcium channel blocking agent;cholinergic receptor blocking agent;diphenoxylate;neuroleptic agent;nonsteroid antiinflammatory agent;thiazide diuretic agent;tricyclic antidepressant agent;age;aged;article;Canada;chronic obstructive lung disease;cognitive defect;comorbidity;congestive heart failure;controlled study;delirium;dementia;depression;diarrhea;drug safety;elderly care;female;follow up;general practitioner;geriatrics;gout;human;hypertension;kidney failure;long term care;major clinical study;male;osteoarthritis;peptic ulcer;pharmacist;prediction;prescription;sex difference;side effect,"Gill, S. S.;Misiaszek, B. C.;Brymer, C.",2001,,,0,
1518,"From association to mechanism: comment on ""antipsychotic use and myocardial infarction in older patients with treated dementia""",,,"Gill, S. S.;Seitz, D. P.",2012,Apr 23,10.1001/archinternmed.2012.682,0,
1519,Rhabdomyolysis in an elderly multitreated patient: Multiple drug interactions after statin withdrawal,"Rhabdomyolysis precipitated by multitherapy is most frequently described during statin treatment, due to impairment of statin clearance by drugs sharing cytochrome P450 biotransformation pathway. Modulation of membrane transporters for drug efflux, operated by substrates, can also affect drugs' tissue levels. We report rhabdomyolysis in an elderly patient, in multitreatment with different potentially myotoxic medications, taking place seven months after atorvastatin discontinuation. Affected by ischaemic heart disease, arterial hypertension and dementia-related behaviour disturbances, the patient was receiving angiotensin 2-receptor inhibitors, beta-blockers, vasodilators, diuretics, salycilates, allopurinol, proton pump inhibitors, antipsychotics and antidepressants. He had taken atorvastatin for 14 years, with constantly normal creatine-kinase plasma levels. Two months after addition of the antianginal drug ranolazine, creatine-kinase mildly increased and atorvastatin was withdrawn. Nonetheless, creatine-kinase progressively rose, with severe weakness and rhabdomyolysis developing seven months later. Muscle biopsy showed a necrotizing myopathy with no inflammation or autoimmune changes. After ranolazine withdrawal, creatine-kinase and myoglobin returned to normal levels and strength was restored. Several psychotropic and cardiovascular medications prescribed to the patient share either cytochrome P450 biotransformation and permeability- glycoprotein efflux transport. In the event of cardiovascular/neuropsychiatric polypharmacy in geriatric patients, the risk of muscle severe adverse effects from pharmacokinetic drug-drug interaction should be considered beyond the direct myotoxicity of statins. © 2013 Elsevier B.V. All rights reserved.",atorvastatin;creatine kinase;creatinine;major histocompatibility antigen class 1;myoglobin;potassium;ranolazine;rosuvastatin;sodium chloride;triacylglycerol;aged;angina pectoris;article;case report;cholesterol blood level;creatine kinase blood level;creatinine blood level;drug induced disease;drug withdrawal;electromyogram;falling;follow up;hospital admission;human;intravenous drug administration;malaise;male;muscle necrosis;muscle strength;muscle weakness;myalgia;nausea;patient history of therapy;periodic medical examination;potassium blood level;priority journal;protein blood level;recurrent disease;rhabdomyolysis;triacylglycerol blood level;vastus lateralis muscle;vomiting,"Ginanneschi, F.;Volpi, N.;Giannini, F.;Rocchi, R.;Donati, D.;Aglianò, M.;Lorenzoni, P.;Rossi, A.",2014,,,0,
1520,"Mortality, hospital days and expenditures attributable to ambient air pollution from particulate matter in Israel","Background: Worldwide, ambient air pollution accounts for around 3.7 million deaths annually. Measuring the burden of disease is important not just for advocacy but also is a first step towards carrying out a full cost-utility analysis in order to prioritise technological interventions that are available to reduce air pollution (and subsequent morbidity and mortality) from industrial, power generating and vehicular sources. Methods: We calculated the average national exposure to particulate matter particles less than 2.5 μm (PM2.5) in diameter by weighting readings from 52 (non-roadside) monitoring stations by the population of the catchment area around the station. The PM2.5 exposure level was then multiplied by the gender and cause specific (Acute Lower Respiratory Infections, Asthma, Circulatory Diseases, Coronary Heart Failure, Chronic Obstructive Pulmonary Disease, Diabetes, Ischemic Heart Disease, Lung Cancer, Low Birth Weight, Respiratory Diseases and Stroke) relative risks and the national age, cause and gender specific mortality (and hospital utilisation which included neuro-degenerative disorders) rates to arrive at the estimated mortality and hospital days attributable to ambient PM2.5 pollution in Israel in 2015. We utilised a WHO spread-sheet model, which was expanded to include relative risks (based on more recent meta-analyses) of sub-sets of other diagnoses in two additional models. Results: Mortality estimates from the three models were 1609, 1908 and 2253 respectively in addition to 184,000, 348,000 and 542,000 days hospitalisation in general hospitals. Total costs from PM2.5 pollution (including premature burial costs) amounted to $544 million, $1030 million and $1749 million respectively (or 0.18 %, 0.35 % and 0.59 % of GNP). Conclusions: Subject to the caveat that our estimates were based on a limited number of non-randomly sited stations exposure data. The mortality, morbidity and monetary burden of disease attributable to air pollution from particulate matter in Israel is of sufficient magnitude to warrant the consideration of and prioritisation of technological interventions that are available to reduce air pollution from industrial, power generating and vehicular sources. The accuracy of our burden estimates would be improved if more precise estimates of population exposure were to become available in the future.",air pollution;Alzheimer disease;article;asthma;birth weight;brain ischemia;chronic obstructive lung disease;cost effectiveness analysis;dementia;environmental exposure;exhaust gas;health care cost;heart disease;heart failure;hospitalization;human;ischemic heart disease;Israel;life expectancy;lung cancer;meta analysis;morbidity;mortality;non insulin dependent diabetes mellitus;parkinsonism;population;priority journal;respiratory tract infection;risk;sensitivity analysis,"Ginsberg, G. M.;Kaliner, E.;Grotto, I.",2016,,10.1186/s13584-016-0110-7,0,
1521,Primary idiopathic cerebrovascular amyloidosis,"A 67 yr old patient is described with slight, but clearly evident, syptoms of mental deterioration. The patient died suddenly about 12 months after his neurological symptoms started. Macroscopic examination disclosed a slight brain atrophy, recent myocardial infarction and diffuse atheroclerosis. Microscopic examination showed amorphous deposits in the walls of the small cortical vessels which enlarged their media and adventitia extended into the perivascular areas with a brushlike aspect. Senile plaques were also observed, while neurofibrillary tangles were absent. The deposits were PAS positive, congophilic birefrengent and fluorescent with Thioflavine T, and were identified as amyloid. Small amyloid deposits were observed also in the vessels of the white matter and of the molecular layer of the molecular layer of the cerebellum. Significant amyloid deposits were not found outside the brain. The case was diagnosed as primary cerebrovascular amyloidosis, and distinguished from Alzheimer's dementia (in which congophilic angiopathy is often present) by the lack of neurofibrillary tangles. Furthermore, the extent and the characteristic aspects of the vascular and prevascular amyloid deposits, together with the distribution of lesions (cerebellar and white matter involvement), makes such cases clearly distinguishable on histological grounds from typical Alzheimer's disease.",amyloidosis;autopsy;case report;central nervous system;cerebrovascular disease;histology;peripheral vascular system,"Giordano, R.;Licandro, A.;Tavolato, B.",1981,,,0,
1522,Large middle cerebral artery and panhemispheric infarction,"Large middle cerebral artery (MCA) and panhemispheric stroke represent a minority of cerebral ischemic events, yet they are responsible for a disproportionate share of morbidity and mortality. Malignant infarction with formation of cerebral edema is a common cause for secondary neurologic deterioration. Despite intensive medical and surgical care, prognosis is often poor and mortality may be as high as 60-80%. Surgical intervention can reduce that mortality compared to medical therapy alone, but necessitates a careful exploration of patient characteristics for acceptable outcomes. Copyright © 2012 S. Karger AG, Basel.",barbituric acid derivative;furosemide;glycerol;indometacin;mannitol;sodium chloride;steroid;trometamol;age;article;basal ganglion;brain edema;brain hernia;brain infarction;brain surgery;cardiovascular risk;cerebral artery disease;clinical feature;congestive heart failure;consciousness disorder;craniectomy;hemiplegia;human;hypertension;induced hypothermia;intracranial pressure;mental deterioration;morbidity;mortality;nausea and vomiting;neuroprotection;panhemispheric stroke;priority journal;prognosis;sex difference;systolic blood pressure;therapeutic hyperventilation;treatment outcome;white matter,"Giossi, A.;Volonghi, I.;Del Zotto, E.;Costa, P.;Padovani, A.;Pezzini, A.",2012,,,0,
1523,Creating systemic oral transmucosal drug delivery strategies: Case study of APL-130277,"This article addresses the strategic application of systemic oral transmucosal&z.ast; (i.e., sublingual and buccal) drug delivery. Circumvention of first-pass hepatic metabolism in the gut, rapid onset of action, easy access via the oral cavity, easy administration for patients with dysphagia and a high level of patient acceptance are the principal advantages of the oral transmucosal route. Key clinical and commercial strategies driving the development of oral transmucosal formulations are addressed. A case study of Cynapsus Therapeutics' APL-130277, a sublingual apomorphine formulation in clinical development for Parkinson's disease exemplifies the scientific, clinical and commercial considerations for systemic oral transmucosal drug delivery.",ago 178;agomelatine;alks 5461;alprazolam;antiparkinson agent;apl 130277;apomorphine;asenapine;bema;btl tml hsv;buprenorphine;buprenorphine plus naloxone;cannabidiol;commit;donepezil;duromist;emetic agent;fentanyl;fentanyl citrate;flumazenil;flumup;gas x;glyceryl trinitrate;granisetron;imatinib;insulin;intermezzo;kappa opiate receptor antagonist;misoprostol;nabiximols;naloxone;nanotab;nicotine gum;nicotine lozenge;olanzapine;ramelteon;recombinant human insulin;selegiline;sildenafil;sublinox;sufentanil;sumatriptan succinate;testosterone;tetrahydrocannabinol;triazolam;uish 00;unclassified drug;unindexed drug;x excite;zolmitriptan;zolpidem;zolpidem tartrate;Alzheimer disease;angina pectoris;anxiety;anxiety disorder;article;bipolar disorder;buccal drug administration;cancer pain;chronic pain;dizziness;drug delivery system;drug formulation;erectile dysfunction;hematologic malignancy;human;inflammation;injection site pain;insomnia;insulin dependent diabetes mellitus;low drug dose;lozenge;major depression;migraine;nausea;nausea and vomiting;non insulin dependent diabetes mellitus;opiate addiction;panniculitis;Parkinson disease;phase 1 clinical trial (topic);phase 2 clinical trial (topic);phase 3 clinical trial (topic);postoperative pain;pregnancy disorder;scar formation;schizophrenia;sedation;sleep disorder;smoking cessation;sublingual drug administration;urine incontinence;abstral;actiq;aricept;edluar;fentora;gleevec;imigran;imitrex;nicorette;niravam;nitromist;nitrostat;onsolis;oral lyn;saphris;sativex;striant;suboxone;subsys;subutex;sycrest;valdoxan;viagra;zelapar;zolpimist;zomig;zydis;zyprexa,"Giovinazzo, A.;Bryson, N.;Tankosic, T.",2012,,,0,
1524,Neutralization of Inflammation by Inhibiting In vitro and In vivo Secretory Phospholipase A2 by Ethanol Extract of Boerhaavia diffusa L,"BACKGROUND: Inflammation is a normal and necessary prerequisite to healing of the injured tissues. Inflammation contributes to all disease process including immunity, vascular pathology, trauma, sepsis, chemical, and metabolic injuries. The secretory phospholipase A2 (sPLA2) is a key enzyme in the production of pro-inflammatory mediators in chronic inflammatory disorders such as rheumatoid arthritis, coronary heart disease, diabetes, and asthma. The sPLA2 also contribute to neuroinflammatory disorders such as Parkinson's, Alzheimer's, and Crohn's disease. AIMS: The present study aims to investigate the inhibition of human sPLA2 by a popular medicinal herb Boerhaavia diffusa Linn. as a function of anti-inflammatory activity. MATERIALS AND METHODS: The aqueous and different organic solvents extracts of B. diffusa were prepared and evaluated for human synovial fluid, human pleural fluid, as well as Vipera russelli and Naja naja venom sPLA2 enzyme inhibition. RESULTS: Among the extracts, the ethanol extract of B. diffusa (EEBD) showed the highest sPLA2 inhibition and IC50 values ranging from 17.8 to 27.5 mug. Further, antioxidant and lipid peroxidation activities of B. diffusa extract were checked using 2,2-diphenyl-1-picrylhydrazyl radical, thiobarbituric acid, and rat liver homogenate. The antioxidant activity of EEBD was more or less directly proportional to in vitro sPLA2 inhibition. Eventually, the extract was subjected to neutralize sPLA2-induced mouse paw edema and indirect hemolytic activity. The EEBD showed similar potency in both the cases. CONCLUSIONS: The findings suggest that the bioactive molecule/s from the EEBD is/are potentially responsible for the observed in vitro and in vivo sPLA2 inhibition and antioxidant activity. SUMMARY: The present study aims to investigate the inhibition of human sPLA2 by a popular medicinal herb Boerhaavia diffusa Linn. as a function of anti inflammatory activity. Abbreviation Used: EEBD: Ethanolic extract of boerhaavia diffusa, sPLA2: Secretory phospholipase A2, HSF: Human synovial fluid, HPF: Human pleural fluid, VRV-PLA2-V: Vipera russelli phospholipase A2, NN-PLA2-I: Naja naja phospholipase A2.",Ethanolic extract of Boerhaavia diffusa L.;Naja naja phospholipase A2;Vipera russelli phospholipase A2;human pleural fluid;human synovial fluid,"Giresha, A. S.;Pramod, S. N.;Sathisha, A. D.;Dharmappa, K. K.",2017,Apr-Jun,,0,
1525,The appropriateness of drug use in an older nondemented and demented population,"OBJECTIVE: To assess the extent of inappropriateness of drug use in an older nondemented and demented population. DESIGN: Descriptive analysis based on data from a sample of older subjects age 81 years and older. Data were collected from the second follow-up conducted in 1994-1996. SETTING: A population-based study of the Kungsholmen project in Stockholm, Sweden. PARTICIPANTS: Drug information was obtained from 681 subjects with a mean age of 86.9 years. The subjects were predominantly women (78%). Thirteen percent resided in institutions and 27.6% were diagnosed with dementia. MEASUREMENTS: Dementia diagnosis based on DSM III-R. Criteria for inappropriateness of drug use: use of drugs with potent anticholinergic properties, drug duplication, potential drug-drug and drug-disease interactions, and inappropriate drug dosage. RESULTS: The mean number of drugs used was 4.6: 4.5 drugs for nondemented and 4.8 for demented subjects. Nondemented subjects more commonly used cardiovascular-system drugs and demented subjects used nervous-system drugs. Demented subjects were more commonly exposed to drug duplication and to drugs with potent anticholinergic properties, both involving the use of psychotropic drugs. Nondemented subjects were more commonly exposed to potential drug-disease interactions, mostly with the use of cardiovascular drugs. The most common drug combination leading to a potential interaction was the use of digoxin with furosemide, occurring more frequently among nondemented subjects. The most common drug-disease interaction was the use of beta-blockers and calcium antagonists in subjects with congestive heart failure. The doses of drugs taken by both nondemented and demented subjects were mostly lower than the defined daily dose. CONCLUSION: There was substantial exposure to presumptive inappropriateness of drug use in this very old nondemented and demented population. The exposure of demented subjects to psychotropic drugs and nondemented subjects to cardiovascular drugs reflect the high frequency of prescribing these drugs in this population.","Age Factors;*Aged;Aged, 80 and over;Chi-Square Distribution;Dementia/drug therapy/*epidemiology/psychology;Dose-Response Relationship, Drug;Drug Interactions;Drug Therapy/contraindications/*statistics & numerical data;Drug Utilization/statistics & numerical data;Female;Humans;Longitudinal Studies;Male;Mental Competency;*Polypharmacy;Population Surveillance;Risk Assessment;Safety;Sensitivity and Specificity;Sweden/epidemiology","Giron, M. S.;Wang, H. X.;Bernsten, C.;Thorslund, M.;Winblad, B.;Fastbom, J.",2001,Mar,,0,
1526,Factors associated with beta-blocker initiation and discontinuation in a population-based cohort of seniors newly diagnosed with heart failure,"PURPOSE: beta-Blockers (bisoprolol, carvedilol, and metoprolol) are the cornerstone of heart failure (HF) management. The incidence rate of beta-blocker initiation and discontinuation and their associated factors among seniors with a first HF diagnosis were assessed. METHODS: A population-based inception cohort study that included all individuals aged >/=65 years with a first HF diagnosis in Quebec was conducted. beta-Blockers initiation among 91,131 patients who were not using beta-blockers at the time of HF diagnosis and discontinuation among those who initiated a beta-blocker after HF diagnosis were assessed. Stepwise Cox regression analyses were used to calculate hazard ratios (HR) and to identify factors associated with beta-blocker initiation and discontinuation. RESULTS: After HF diagnosis, 32,989 (36.2%) individuals initiated a beta-blocker. Of these, 15,408 (46.7%) discontinued their beta-blocker during the follow-up. Individuals more likely to initiate a beta-blocker were those diagnosed in a recent calendar year (2009: HR, 2.11; 95% confidence interval [CI], 2.00-2.23) and diagnosed by a cardiologist (HR, 1.38; 95% CI, 1.34-1.42). Individuals less likely to initiate were those aged >/=90 years (HR, 0.65; 95% CI, 0.61-0.68) and those with chronic obstructive pulmonary disease (HR, 0.66; 95% CI, 0.64-0.68). Individuals more likely to discontinue were those with more than nine medical consultations (HR, 1.14; 95% CI, 1.10-1.18) and those with dementia (HR, 1.13; 95% CI, 1.01-1.27). Individuals less likely to discontinue were those diagnosed in a recent calendar year (2009: HR 0.74; 95% CI, 0.65-0.82) and those exposed to another beta-blocker before HF diagnosis (HR, 0.88; 95% CI, 0.85-0.91). CONCLUSION: Quebec seniors seem to be underexposed to beta-blocker following HF diagnosis. Among those who initiate beta-blocker use, discontinuation is high. Better understanding of the underlying causes is needed to help target interventions to improve the management of HF.",cohort study;drug use;heart failure;beta-blocker discontinuation;beta-blocker initiation,"Girouard, C.;Gregoire, J. P.;Poirier, P.;Moisan, J.",2016,,10.2147/ppa.s109054,0,
1527,The Food and Drug Administration,,acetylsalicylic acid;antiaging drug;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;hormone;terfenadine;trastuzumab;troglitazone;unclassified drug;aging;Alzheimer disease;drug approval;drug safety;food and drug administration;hormone substitution;human;hypercholesterolemia;ischemic heart disease;liver toxicity;note;osteoporosis;priority journal;prophylaxis;aspirin;herceptin,"Glaser, V.",2000,,,0,
1528,"How does the number and scatter of trials vary by discipline? Poster presentation at the 19th Cochrane Colloquium; 2011 Oct 19-22; Madrid, Spain abstract","Background: Bradford's law of scatter suggests that if the journals in a field are sorted by number of articles and divided into 3 equal sized groups the number of journals will be in the proportions 1:n:n2. Bradford's Law has been shown to apply to trials overall but little work has been done for specialties of diseases. Objectives: To assess whether and how Bradford's law applies to trials and reviews overall and in different specialty areas. Methods: We downloaded all trials (using publication type) in MEDLINE for 2009, and classified trials in each of 14 clinical areas and specific disorders that are major contributors to the global burden of disease: mental disorders, depression, alcohol related disorders, heart disease, myocardial ischemia, nervous system diseases, cerebrovascular, dementia, otorhinolaryngologic, hearing loss, endocrine disorders, diabetes, cancer and lung cancer. Results: The number of journals covering all trials in an area was highly correlated with the number of trials (r = 0.97), but varied by clinical area. Depression had most with 318 trials in 214 journals ? 1.5 trials per journal. Cardiology had least scatter with 1,459 trials in 374 journals ? 3.9 trials per journal. The number of journals to identify half the trials in a condition ranged from 9 for lung cancer trials to 79 for stroke trials. The journal with the highest number of trials in each area was generally a journal within that speciality, e.g. Stroke for cerebrovascular disease and Diabetes Care for diabetes. However, general medical journals and journals in related subspecialties often occurred in the top 10. Conclusions: Trials are widely scattered in the medical literature and for specialty areas and diseases the scatter follows the pattern predicted by Bradford's law. The scatter has implications for both clinicians trying to keep up to date and for those performing systematic reviews.",CMR: Evaluation methodology - history and epidemiology of evaluations;CMRA3,"Glasziou, P.;Thorning, S.;Erueti, C.;Hoffman, T.",2011,,,0,
1529,Effect of delirium and other major complications on outcomes after elective surgery in older adults,"IMPORTANCE: Major postoperative complications and delirium contribute independently to adverse outcomes and high resource use in patients who undergo major surgery; however, their interrelationship is not well examined. OBJECTIVE: To evaluate the association of major postoperative complications and delirium, alone and combined, with adverse outcomes after surgery. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in 2 large academic medical centers of 566 patients who were 70 years or older without recognized dementia or a history of delirium and underwent elective major orthopedic, vascular, or abdominal surgical procedures with aminimum 3-day hospitalization between June 18, 2010, and August 8, 2013. Data analysis took place from December 13, 2013, through May 1, 2015. MAIN OUTCOMES AND MEASURES: Major postoperative complications, defined as life-altering or life-threatening events (Accordion Severity grade 2 or higher), were identified by expert-panel adjudication. Delirium was measured daily with the Confusion Assessment Method and avalidated medical record review method. The following 4 subgroups were analyzed: (1) no complications or delirium; (2) complications only; (3) delirium only; and (4) complications and delirium. Adverse outcomes included a length of stay (LOS) of more than 5 days, institutional discharge, and rehospitalization within 30 days of discharge. RESULTS: In the 566 participants, the mean (SD) age was 76.7 (5.2) years, 236 (41.7%) were male, and 523 (92.4%) were white. Forty-seven patients (8.3%) developed major complications and 135 (23.9%) developed delirium. Compared with no complications or delirium as the reference group, major complications only contributed to prolonged LOS only (relative risk [RR], 2.8; 95% CI, 1.9-4.0); by contrast, delirium only significantly increased all adverse outcomes, including prolonged LOS (RR, 1.9; 95% CI, 1.4-2.7), institutional discharge (RR, 1.5; 95% CI, 1.3-1.7), and 30-day readmission (RR, 2.3; 95% CI, 1.4-3.7). The subgroup with complications and delirium had the highest rates of all adverse outcomes, including prolonged LOS (RR, 3.4; 95% CI, 2.3-4.8), institutional discharge (RR, 1.8; 95% CI, 1.4-2.5), and 30-day readmission (RR, 3.0; 95% CI, 1.3-6.8). Delirium exerted the highest attributable risk at the population level (5.8%; 95% CI, 4.7-6.8) compared with all other adverse events (prolonged LOS, institutional discharge, or readmission). CONCLUSIONS AND RELEVANCE: Major postoperative complications and delirium are separately associated with adverse events and demonstrate a combined effect. Delirium occurs more frequently and has a greater effect at the population level than other major complications.",abdominal surgery;adverse outcome;aged;article;attributable risk;cerebrovascular accident;clinical assessment tool;cohort analysis;confidence interval;Confusion Assessment Method;delirium;dementia;elective surgery;female;heart arrhythmia;heart block;hospital discharge;hospital readmission;hospitalization;human;kidney failure;length of stay;lung embolism;major clinical study;male;medical record review;non ST segment elevation myocardial infarction;orthopedic surgery;pneumonia;postoperative complication;priority journal;prognosis;prospective study;respiratory failure;risk factor;sepsis;statistical analysis;treatment outcome;university hospital;vascular surgery,"Gleason, L. J.;Schmitt, E. M.;Kosar, C. M.;Tabloski, P.;Saczynski, J. S.;Robinson, T.;Cooper, Z.;Rogers, S. O.;Jones, R. N.;Marcantonio, E. R.;Inouye, S. K.",2015,,,0,
1530,Medical Research Council: annual report 1974-75: A brief guide to the report,,bile acid;carbon disulfide;carcinogen;catecholamine;noradrenalin;anaerobic metabolism;bacterial flora;neoplasm;climate;colon carcinoma;epidemiology;fetus growth;growth retardation;health council;health service;hearing impairment;heart disease;Huntington chorea;immunology;ischemic heart disease;medical research;mental deficiency;mental disease;microorganism;pain;Human respiratory syncytial virus;spinal cord;temperature;tuberculosis;virus infection;weather,"Gloag, D.",1975,,,0,
1531,Clinical types of GM1 gangliosidosis - Presentation of 3 patients,"Background: Gangliosidoses belong to the group of genetic lipid metabolism disorders, caused by defects of lisosome enzymes, inherited by an autosomal recessive trait. Gangliosidosis GM1 is caused by the deficiency of the acid beta-galactosidase(GLB11) resulting in the storage of the substrate - GM1 ganglioside in brain and visceral organs. GM 1 gangliosidosis comprises of three phenotypes, depending on the age of onset: an infantile, juvenile and an adult type. In the infantile type dismorphic features severe psychomotor retardation, hepatosplenomegaly, bone changes and a cherry-red spot in the macular region are seen. The juvenile GM1 gangliosidosis has no such external distinguishing features. In the adult type behavioral problems, dementia, extrapiramidal movements are especially prominent. The authors present symptoms, clinical course and laboratory findings at three children with diagnosed GM1 gangliosidosis. Case Report: The authors present three patients with the GM1 gangliosidosis - a 10-month-old boy with the infantile type, a 5-month-old girl, with the enzyme activity at the level characteristic for the juvenile type and a 16-year-old boy with the adult type. Conclusions: Although the GM1 gangliosidosis is not exceedingly rare disorder and has been already relatively precisely described, the diagnosis can be sometimes very difficult. In spite of that the cases 1 and 3 represent typical clinical features of the disease, the diagnosis was established relatively late. The case 2 is unusual because of its early beginning and the enzyme activity at the level characteristic for the juvenile type. That is why we believe that such case reports are important for improving our knowledge and understanding of the disease.",adolescent;anamnesis;Apgar score;article;cardiomyopathy;case report;clinical feature;echocardiography;female;GM1 gangliosidosis;hepatosplenomegaly;human;infant;laboratory test;male;neurologic examination;nuclear magnetic resonance imaging;ophthalmoscopy;physical examination;psychomotor development,"Głuszkiewicz, E.;Jamroz, E.;Marszał, E.;Czartoryska, B.;Kopyta, I.;Ługowska, A.",2006,,,0,
1532,Contemporary rates and correlates of statin use and adherence in nondiabetic adults with cardiovascular risk factors: The KP CHAMP study,"Background Statin therapy is highly efficacious in the prevention of fatal and nonfatal atherosclerotic events in persons at increased cardiovascular risk. However, its long-term effectiveness in practice depends on a high level of medication adherence by patients. Methods We identified nondiabetic adults with cardiovascular risk factors between 2008 and 2010 within a large integrated health care delivery system in Northern California. Through 2013, we examined the use and adherence of newly initiated statin therapy based on data from dispensed prescriptions from outpatient pharmacy databases. Results Among 209,704 eligible adults, 68,085 (32.5%) initiated statin therapy during the follow-up period, with 90.4% receiving low-potency statins. At 12 and 24 months after initiating statins, 84.3% and 80.2%, respectively, were actively receiving statin therapy, but only 42% and 30%, respectively, had no gaps in treatment during those time periods. There was also minimal switching between statins or use of other lipid-lowering therapies for augmentation during follow-up. Age ≥ 50 years, Asian/Pacific Islander race, Hispanic ethnicity, prior myocardial infarction, prior ischemic stroke, hypertension, and baseline low-density lipoprotein cholesterol > 100 mg/dL were associated with higher adjusted odds, whereas female gender, black race, current smoking, dementia were associated with lower adjusted odds, of active statin treatment at 12 months after initiation. Conclusions There remain opportunities for improving prevention in patients at risk for cardiovascular events. Our study identified certain patient subgroups that may benefit from interventions to enhance medication adherence, particularly by minimizing treatment gaps and discontinuation of statin therapy within the first year of treatment.",atorvastatin;cholesterol;fluindostatin;high density lipoprotein cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;mevinolin;pitavastatin;pravastatin;rosuvastatin;simvastatin;adult;aged;article;Black person;brain ischemia;cardiovascular risk;dementia;disease association;drug potency;ethnicity;female;follow up;heart infarction;Hispanic;human;hypertension;integrated health care system;major clinical study;male;medication compliance;multicenter study;patient compliance;prescription;primary prevention;priority journal;race;secondary prevention;smoking,"Go, A. S.;Fan, D.;Sung, S. H.;Inveiss, A. I.;Romo-LeTourneau, V.;Mallya, U. G.;Boklage, S.;Lo, J. C.",2017,,10.1016/j.ahj.2017.08.013,0,
1533,Economic Burden of Disease-Associated Malnutrition at the State Level,"BACKGROUND: Disease-associated malnutrition has been identified as a prevalent condition, particularly for the elderly, which has often been overlooked in the U.S. healthcare system. The state-level burden of community-based disease-associated malnutrition is unknown and there have been limited efforts by state policy makers to identify, quantify, and address malnutrition. The objective of this study was to examine and quantify the state-level economic burden of disease-associated malnutrition. METHODS: Direct medical costs of disease-associated malnutrition were calculated for 8 diseases: Stroke, Chronic Obstructive Pulmonary Disease, Coronary Heart Failure, Breast Cancer, Dementia, Musculoskeletal Disorders, Depression, and Colorectal Cancer. National disease and malnutrition prevalence rates were estimated for subgroups defined by age, race, and sex using the National Health and Nutrition Examination Survey and the National Health Interview Survey. State prevalence of disease-associated malnutrition was estimated by combining national prevalence estimates with states' demographic data from the U.S. Census. Direct medical cost for each state was estimated as the increased expenditures incurred as a result of malnutrition. PRINCIPAL FINDINGS: Direct medical costs attributable to disease-associated malnutrition vary among states from an annual cost of $36 per capita in Utah to $65 per capita in Washington, D.C. Nationally the annual cost of disease-associated malnutrition is over $15.5 billion. The elderly bear a disproportionate share of this cost on both the state and national level. CONCLUSIONS: Additional action is needed to reduce the economic impact of disease-associated malnutrition, particularly at the state level. Nutrition may be a cost-effective way to help address high health care costs.",,"Goates, S.;Du, K.;Braunschweig, C. A.;Arensberg, M. B.",2016,,10.1371/journal.pone.0161833,0,1534
1534,Economic burden of disease-associated malnutrition at the state level,"Background: Disease-associated malnutrition has been identified as a prevalent condition, particularly for the elderly, which has often been overlooked in the U.S. healthcare system. The state-level burden of community-based disease-associated malnutrition is unknown and there have been limited efforts by state policy makers to identify, quantify, and address malnutrition. The objective of this study was to examine and quantify the state-level economic burden of disease-associated malnutrition. Methods: Direct medical costs of disease-associated malnutrition were calculated for 8 diseases: Stroke, Chronic Obstructive Pulmonary Disease, Coronary Heart Failure, Breast Cancer, Dementia, Musculoskeletal Disorders, Depression, and Colorectal Cancer. National disease and malnutrition prevalence rates were estimated for subgroups defined by age, race, and sex using the National Health and Nutrition Examination Survey and the National Health Interview Survey. State prevalence of disease-associated malnutrition was estimated by combining national prevalence estimates with states' demographic data from the U.S. Census. Direct medical cost for each state was estimated as the increased expenditures incurred as a result of malnutrition. Principal Findings: Direct medical costs attributable to disease-associated malnutrition vary among states from an annual cost of $36 per capita in Utah to $65 per capita in Washington, D.C. Nationally the annual cost of disease-associated malnutrition is over $15.5 billion. The elderly bear a disproportionate share of this cost on both the state and national level. Conclusions: Additional action is needed to reduce the economic impact of disease-associated malnutrition, particularly at the state level. Nutrition may be a cost-effective way to help address high health care costs.",age;article;breast cancer;cerebrovascular accident;chronic obstructive lung disease;colorectal cancer;cost control;cost effectiveness analysis;dementia;demography;depression;disease association;health care cost;health survey;human;ischemic heart disease;malnutrition;musculoskeletal disease;nutritional support;population research;prevalence;quantitative analysis;race difference;sex difference;United States,"Goates, S.;Du, K.;Braunschweig, C. A.;Arensberg, M. B.",2016,,10.1371/journal.pone.0161833,0,
1535,Laminar cortical necrosis,,adult;article;brain cortex;brain hypoxia;case report;caudate nucleus;cerebellum cortex;chronic brain disease;dementia;epileptic state;fatality;female;generalized epilepsy;heart arrest;human;intensive care;ketoacidosis;male;necrosis;neurologic examination;nuclear magnetic resonance imaging;pathology,"Gobert, D.;Cumurciuc, R.;Hénin, D.;de Broucker, T.",2008,,,0,
1536,Is the montreal cognitive assessment superior to the mini-mental state examination to detect poststroke cognitive impairment?: A study with neuropsychological evaluation,"Background And Purpose- A screening test is required to improve the diagnosis of poststroke cognitive impairment. The Montreal Cognitive Assessment (MoCA), a newly designed screening test, has been found to be more sensitive than Mini-Mental State Examination (MMSE), but its clinical value has not been established by means of a comprehensive neuropsychological battery. This study was designed to assess the value of MoCA and MMSE to detect poststroke cognitive impairment determined by a neuropsychological battery. Methods- Both screening tests and a neuropsychological battery were administered during the acute phase in 95 patients referred for recent infarct or hemorrhage. Raw MMSE and MoCA scores were used with published cutoffs and new cutoff scores for MMSE and MoCA were also computed after adjustment for age and education. Results- Using raw scores, MoCA was more frequently impaired (P=0.0001) than MMSE. MoCA showed good sensitivity (sensitivity, 0.94) but moderate specificity (specificity, 0.42; positive predictive value, 0.77; negative predictive value, 0.76), whereas an inverse profile was observed for MMSE (sensitivity, 0.66; specificity, 0.97; positive predictive value, 0.98; negative predictive value, 0.58). Adjusted scores with new cutoffs (MMSEadj ≤24, MoCAadj ≤20) provided good sensitivity and very good specificity for both tests (MMSEadj: sensitivity, 0.7, specificity, 0.97, positive predictive value, 0.98, negative predictive value, 0.61; MoCAadj: sensitivity, 0.67, specificity, 0.9, positive predictive value, 0.93, negative predictive value, 0.57). On receiver operating characteristic curve analysis, areas under the curve of all scores were >0.88. Conclusions- The previously reported high sensitivity of MoCA is associated with low specificity. Both screening tests are moderately sensitive to acute poststroke cognitive impairment. This study provides indications for the diagnosis of poststroke cognitive impairment. © 2011 American Heart Association, Inc.",adult;aged;aptitude test;area under the curve;article;bleeding;cognition;cognitive defect;controlled study;education;female;human;infarction;major clinical study;male;Mini Mental State Examination;Montreal cognitive assessment;neuropsychological test;poststroke cognitive impairment;predictive value;priority journal;receiver operating characteristic;scoring system;sensitivity and specificity;cerebrovascular accident,"Godefroy, O.;Fickl, A.;Roussel, M.;Auribault, C.;Bugnicourt, J. M.;Lamy, C.;Canaple, S.;Petitnicolas, G.",2011,,,0,
1537,Factors associated with Prolonged Inaction in the hypoglycaemic treatment in people with non-insulin dependent Type 2 Diabetes and elevated glycated haemoglobin: A registry-based cohort study,"Aims To assess factors associated with Prolonged Inaction (PI) in insulin-naïve patients with Type 2 Diabetes Mellitus (T2DM). PI was defined as the absence of treatment initiation or intensification for ≥12 months despite HbA1c >7% (53 mmol/mol). Methods A retrospective cohort study was conducted based on data from Intego, a Flemish General Practice registry. The study period ranged from January 1, 2006 to December 31, 2013. Patients with insulin therapy before the start of the study period were excluded from the analysis. A mixed effects logistic regression was used to assess the association of PI with the presence of co-morbidities, co-medications, process parameters and bio-clinical parameters. Results In a population of 2265 patients with T2DM, 578 insulin-naive patients presented with an HbA1c >7% (53 mmol/mol) for ≥12 months. Median follow-up was 1.2 years, median age 67 years, 55% were male. PI was present in 340 patients (59%) and associated with moderate to severe Chronic Kidney Disease, absence of a mental health disorder, less frequent HbA1c measurements, lower HbA1c values and a smaller number of co-medications. Conclusions PI is highly prevalent in primary care, particularly in patients with less complex disease status and with less intensive follow-up.",acetylsalicylic acid;antidiabetic agent;antihypertensive agent;corticosteroid;hemoglobin A1c;nonsteroid antiinflammatory agent;statin (protein);aged;alcoholism;anemia;article;atrial fibrillation;Charlson Comorbidity Index;chronic kidney failure;chronic obstructive lung disease;cohort analysis;dementia;depression;diabetic neuropathy;diabetic patient;diabetic retinopathy;disease severity;female;follow up;general practice;gout;heart failure;heart infarction;hemiplegia;hemoglobin blood level;human;hypercholesterolemia;hypertension;ICD-10;insulin treatment;leukemia;liver failure;lymphoma;major clinical study;male;microangiopathy;non insulin dependent diabetes mellitus;osteoarthritis;peripheral occlusive artery disease;personality disorder;pharmaceutical care;priority journal;prolonged inaction;register;retrospective study;rheumatoid arthritis;risk factor;transient ischemic attack,"Goderis, G.;Vaes, B.;Van den Akker, M.;Elli, S.;Mathieu, C.;Buntinx, F.;Henrard, S.",2017,,10.1016/j.pcd.2017.05.008,0,
1538,Angiotensin receptor blockers and risk of dementia: Cohort study in UK Clinical Practice Research Datalink,"Aims This was a cohort study to evaluate whether individuals exposed to angiotensin receptor blockers have a reduced risk of dementia compared with those exposed to angiotensin-converting enzyme inhibitors. Methods The study included new users of angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (from 1995 to 2010) from UK primary care practices contributing to the Clinical Research Practice Datalink. The association between exposure to angiotensin receptor blockers and the risk of incident dementia was analysed using a Cox model, adjusting for age, sex, body mass index, diabetes, hypertension, heart failure, statin use, socioeconomic status, alcohol, smoking, number of consultations and calendar year. Results A total of 426 089 persons were included in the primary analysis, with 45 541 persons exposed to angiotensin receptor blockers and the remainder to angiotensin-converting enzyme inhibitors. The total number of new diagnoses of dementia was 6517. There was weak evidence of a decreased risk of dementia with exposure to angiotensin receptor blockers, with follow-up beginning at 1 year after the start of treatment (adjusted hazard ratio 0.92, 95% confidence interval 0.85-1.00). An analysis restricted to the first 12 months after the index date showed a larger effect on dementia risk (adjusted hazard ratio 0.60, 95% confidence interval 0.50-0.72). Conclusions A small reduction in dementia risk was seen with angiotensin receptor blockers in comparison to angiotensin-converting enzyme inhibitors. However, the strongest association was seen in early follow-up, suggesting that the inverse association is unlikely to be causal, but instead reflects other important but unmeasured differences between angiotensin receptor blocker and angiotensin-converting enzyme inhibitor users.",alcohol;angiotensin receptor antagonist;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;metformin;adult;aged;article;body mass;clinical assessment;clinical practice;cohort analysis;confidence interval;consultation;controlled study;dementia;diabetes mellitus;diagnostic accuracy;diagnostic test accuracy study;drug exposure;drug use;female;follow up;hazard ratio;heart failure;human;hypertension;insulin treatment;major clinical study;male;middle aged;prescription;primary medical care;priority journal;proportional hazards model;risk factor;risk reduction;smoking;socioeconomics;treatment duration;United Kingdom;very elderly,"Goh, K. L.;Bhaskaran, K.;Minassian, C.;Evans, S. J. W.;Smeeth, L.;Douglas, I. J.",2015,,,0,
1539,"Recommendations of the project group prevention of the German Cardiac Society (DGK) on risk adjusted prevention of cardiovascular diseases: Part 3: Dyslipidemia, arterial hypertension and glucose metabolism","Dyslipidemia: There is a strong correlation between low-density lipoproteins (LDL) cholesterol level and cardiovascular risk. Risk adjusted treatment, predominantly with statins, improves prognosis (Class I recommendation, evidence level A). The LDL targets depend on the individual risk. For HDL und triglycerides no target levels but only levels below (for HDL-C) or above which an increased cardiovascular risk is documented are defined. The guideline conforming LDL lowering with the defined LDL target levels requires the availability of highly effective statins for all patients. Arterial hypertension: Arterial hypertension is one of the major cardiovascular risk factors leading to myocardial infarction, stroke or dementia. Repeated blood pressure readings of 140/90 mmHg or more confirm the diagnosis hypertension and should lead to further investigations to exclude secondary forms of hypertension or already established end organ damage. Antihypertensive drugs are prescribed according to the individual cardiovascular risk and additional diseases. Life style modifications markedly reduce blood pressure even in patients receiving blood pressure lowering drugs. A combination of drugs is needed in most cases and fixed combinations are recommended. Follow-up has to be performed regularly to control blood pressure response, possible side effects and patient adherence to therapy. Glucosemetabolism and diabetes: The stages in the manifestation of type 2 diabetes mellitus develop over several years ranging from impaired fasting glucose to impaired glucose metabolism and manifest diabetes mellitus. Cardiovascular complications can occur early and the earlier the diagnosis is confirmed with subsequent near normal blood glucose adjustment, the more favorable the prognosis. The glycated hemoglobin (HbA1c) target for patients with established type 2 diabetes is less than 7% (53 mmol/mol). In individual cases particularly with new onset diabetes lower values can be attempted. Particular care should be taken to avoid hypoglycemic episodes because of the high associated risk. Statins should be prescribed to reach the LDL-C target of <70 mg/dl (1.8 mmol/l). Additional cardiovascular risk factors increase cardiovascular risk and are to be treated according to the evidence-based therapy recommendations. © 2013 Springer-Verlag Berlin Heidelberg.",antihypertensive agent;glucose;hemoglobin A1c;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;triacylglycerol;article;blood pressure measurement;blood pressure regulation;cardiovascular risk;cerebrovascular accident;dementia;disease association;drug efficacy;dyslipidemia;glucose metabolism;heart infarction;heart protection;human;hypertension;lifestyle modification;non insulin dependent diabetes mellitus;practice guideline;prognosis;risk assessment,"Gohlke, H.;Albus, C.;Bönner, G.;Darius, H.;Eckert, S.;Gohlke-Bärwolf, C.;Gysan, D.;Hahmann, H.;Halle, M.;Hambrecht, R.;Mathes, P.;Predel, H. G.;Sauer, G.;Von Schacky, C.;Schuler, G.;Siegrist, J.;Thiery, J.;Tschöpe, D.;Völler, H.;Wirth, A.",2013,,,0,
1540,How I treat older patients with ALL,"The treatment of older patients with acute lymphoblastic leukemia (ALL) is an unmet medical need. In Western countries, the population is aging, which means there will be an increasing number of older patients. However, in the past few decades, there has been little improvement in treating them, and few clinical trials specifically designed for older patients with ALL have been reported. Older patients with ALL have a significantly lower complete response rate, higher early mortality, higher relapse rate, and poorer survival compared with younger patients. This is partly explained by a higher incidence of poor prognostic factors. Most importantly, intensive chemotherapy with or without stem cell transplantation, both of which are successful in younger patients, is less well tolerated in older patients. For the future, the most promising approaches are optimized supportive care, targeted therapies, moderately intensified consolidation, and reduced-intensity stem cell transplantation. One of the most important challenges for physicians is to differentiate between fit and unfit older patients in order to offer both groups optimal treatment regarding toxicity and mortality risks, quality of life, and long-term outcome. Prospective trials for older patients with ALL are urgently needed. © 2013 by The American Society of Hematology.",anthracycline derivative;antifungal agent;asparaginase;bendamustine;blinatumomab;cyclophosphamide;cytarabine;dasatinib;daunorubicin;dexamethasone;doxorubicin;fibrinogen;granulocyte colony stimulating factor;hemoglobin;hydroxyurea;idarubicin;imatinib;lactate dehydrogenase;mercaptopurine;methotrexate;nelarabine;nilotinib;non prescription drug;prednisone;purine derivative;pyrrole derivative;rituximab;steroid;vincristine;vindesine;acute lymphoblastic leukemia;acute myeloblastic leukemia;age;alternative medicine;antibiotic prophylaxis;antigen expression;article;autologous stem cell transplantation;blood toxicity;bone marrow toxicity;cancer chemotherapy;cancer mortality;cancer palliative therapy;cancer prognosis;cancer survival;cardiotoxicity;Charlson Comorbidity Index;chronic lung disease;clinical decision making;clinical feature;comorbidity;consolidation chemotherapy;continuous infusion;cytogenetics;cytopenia;daily life activity;dementia;depression;diabetes mellitus;diet supplementation;disease free survival;drug dose reduction;drug efficacy;drug megadose;drug substitution;drug tolerability;drug withdrawal;geriatric assessment;geriatric disorder;heart disease;heart failure;hemoglobin blood level;human;hyperglycemia;immunophenotyping;induction chemotherapy;infection;kidney failure;lactate blood level;leukemia relapse;leukocyte count;life expectancy;liver toxicity;long term survival;low drug dose;molecular diagnostics;multiple cycle treatment;myelodysplastic syndrome;neurotoxicity;osteoporosis;overall survival;phase 1 clinical trial (topic);phase 2 clinical trial (topic);polyneuropathy;priority journal;quality of life;randomized controlled trial (topic);recurrence free survival;recurrence risk;reduced intensity conditioning;self medication;subdural hematoma;thrombocyte count;vascular disease,"Gökbuget, N.",2013,,,0,
1541,Measuring missing heritability: Inferring the contribution of common variants,"Genome-wide association studies (GWASs), also called common variant association studies (CVASs), have uncovered thousands of genetic variants associated with hundreds of diseases. However, the variants that reach statistical significance typically explain only a small fraction of the heritability. One explanation for the ""missing heritability"" is that there are many additional disease-associated common variants whose effects are too small to detect with current sample sizes. It therefore is useful to have methods to quantify the heritability due to common variation, without having to identify all causal variants. Recent studies applied restricted maximum likelihood (REML) estimation to case-control studies for diseases. Here, we show that REML considerably underestimates the fraction of heritability due to common variation in this setting. The degree of underestimation increases with the rarity of disease, the heritability of the disease, and the size of the sample. Instead, we develop a general framework for heritability estimation, called phenotype correlation-genotype correlation (PCGC) regression, which generalizes the well-known Haseman-Elston regression method. We show that PCGC regression yields unbiased estimates. Applying PCGC regression to six diseases, we estimate the proportion of the phenotypic variance due to common variants to range from 25%to 56%and the proportion of heritability due to common variants from 41% to 68% (mean 60%). These results suggest that common variants may explain at least half the heritability for many diseases. PCGC regression also is readily applicable to other settings, including analyzing extreme-phenotype studies and adjusting for covariates such as sex, age, and population structure.",Alzheimer disease;article;bipolar disorder;case control study;controlled study;Crohn disease;disease association;female;gene frequency;gene linkage disequilibrium;gene locus;gene mapping;genetic association;genetic correlation;genetic linkage;genetic variability;genotype environment interaction;genotype phenotype correlation;heart infarction;heritability;human;insulin dependent diabetes mellitus;male;maximum likelihood method;multiple sclerosis;phenotype;population structure;quantitative trait;restricted maximum likelihood;schizophrenia;single nucleotide polymorphism,"Golan, D.;Lander, E. S.;Rosset, S.",2014,,,0,
1542,Phenotyping of apolipoprotein E using immobilized pH gradient gels for one-dimensional and two-dimensional separations,"Apolipoprotein E (apo E) is a normal component of several classes of plasma lipoproteins. Apo E phenotypes are closely related to total cholesterol, low density lipoprotein (LDL)-cholesterol and apo B concentration. The apo E 2/2 phenotype is related to the type III hyperlipoproteinemia due to the defective binding of apo E-2 to the hepatic receptors. The apo E 4/4 phenotype has been reported to be present in most elderly people suffering from the Alzheimer disease, and is associated with increased risk of coronary heart disease and Creutzfeld-Jakob disease. Therefore, apo E phenotyping is essential. The method described here uses a precast immobilized pH gradient, avoids time-consuming separation of lipoproteins from plasma, needs no pretreatment with neuraminidase and involves highly sensitive enhanced chemiluminescence for visualization. Therefore it has many advantages over previously published methods.","Apolipoproteins E/*genetics/isolation & purification;Electrophoresis, Gel, Two-Dimensional/*instrumentation;Electrophoresis, Polyacrylamide Gel/*instrumentation;Humans;Hydrogen-Ion Concentration;Phenotype","Golaz, O.;Sanchez, J. C.;James, R. W.;Hochstrasser, D. F.",1995,Jul,,0,
1543,"Cognitive consequences of thalamic, basal ganglia, and deep white matter lacunes in brain aging and dementia","Background and Purpose - Most previous studies addressed the cognitive impact of lacunar infarcts using radiologic correlations that are known to correlate poorly with neuropathological data. Moreover, absence of systematic bilateral assessment of vascular lesions and masking effects of Alzheimer disease pathology and macrovascular lesions may explain discrepancies among previous reports. To define the relative contribution of silent lacunes to cognitive decline, we performed a detailed analysis of lacunar and microvascular pathology in both cortical and subcortical areas of 72 elderly individuals without significant neurofibrillary tangle pathology or macrovascular lesions. Methods - Cognitive status was assessed prospectively using the Clinical Dementia Rating (CDR) scale; neuropathological evaluation included Aβ-protein deposition staging and bilateral assessment of microvascular ischemic pathology and lacunes; statistical analysis included multivariate models controlling for age, amyloid deposits, and microvascular pathology. Results - Thalamic and basal ganglia lacunes were negatively associated with CDR scores; cortical microinfarcts, periventricular and diffuse white matter demyelination also significantly affected cognition. In a multivariate model, cortical microinfarcts and thalamic and basal ganglia lacunes explained 22% of CDR variability; amyloid deposits and microvascular pathology explained 12%, and the assessment of thalamic and basal ganglia lacunes added an extra 17%. Deep white matter lacunes were not related to cognitive status in univariate and multivariate models. Conclusions - In agreement with the recently proposed concept of subcortical ischemic vascular dementia, our autopsy series provides important evidence that gray matter lacunes are independent predictors of cognitive decline in elderly individuals without concomitant dementing processes such as Alzheimer disease. © 2005 American Heart Association, Inc.",amyloid beta protein;adult;aged;aging;Alzheimer disease;amyloidosis;article;basal ganglion;brain cortex;brain infarction;brain infarction size;brain ischemia;clinical dementia rating scale;cognition;cortical microinfarct;dementia;demyelination;female;gray matter;human;human tissue;lacunar stroke;major clinical study;male;microvasculature;multiinfarct dementia;multivariate analysis;neurofibrillary tangle;neuropathology;priority journal;rating scale;thalamus;vascular disease;white matter,"Gold, G.;Kövari, E.;Herrmann, F. R.;Canuto, A.;Hof, P. R.;Michel, J. P.;Bouras, C.;Giannakopoulos, P.",2005,,,0,
1544,"Rosiglitazone monotherapy in mild-to-moderate alzheimer's disease: Results from a randomized, double-blind, placebo-controlled phase III study","Background/Aims: A phase II study of the peroxisome proliferator-activated receptor-γ agonist rosiglitazone extended release (RSG XR) in mild-to-moderate Alzheimer's disease (AD) detected a treatment benefit to cognition in apolipoprotein E(APOE)-ε4-negative subjects. The current phase III study with prospective stratification by APOE genotype was conducted to confirm the efficacy and safety of RSG XR in mild-to-moderate AD. An open-label extension study assessed the long-term safety and tolerability of 8 mg RSG XR. Methods: This double-blind, randomized, placebo-controlled study enrolled 693 subjects. Within 2 APOE allelic strata (ε4-positive, ε4-negative), subjects were randomized (2:2:2:1) to once-daily placebo, 2 mg RSG XR, 8 mg RSG XR or 10 mg donepezil (control). Coprimary endpoints were change from baseline to week 24 in the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog) score, and week 24 Clinician's Interview-Based Impression of Change plus caregiver input (CIBIC+). Results: At week 24, no significant differences from placebo in change from baseline in coprimary endpoints were detected with either the RSG XR dose in APOE-ε4-negative subjects or overall. For donepezil, no significant treatment difference was detected in ADAS-Cog; however, a significant difference was detected (p = 0.009) on the CIBIC+. Peripheral edema was the most common adverse event for 8 mg RSG XR (15%) and placebo (5%), and nasopharyngitis for 2 mg RSG XR (7%). Conclusion: No evidence of efficacy of 2 mg or 8 mg RSG XR monotherapy in cognition or global function was detected in the APOE-ε4-negative or other analysis populations. The safety and tolerability of RSG XR was consistent with its known pharmacology. Copyright © 2010 S. Karger AG.",NCT00428090;NCT00550420;apolipoprotein E;donepezil;placebo;rosiglitazone;adult;aged;Alzheimer disease;anemia;article;cerebrovascular disease;clinical trial;congestive heart failure;controlled clinical trial;controlled study;diarrhea;disease severity;double blind procedure;drug dose comparison;drug efficacy;drug safety;drug tolerability;drug withdrawal;dyslipidemia;edema;female;fracture;gastroesophageal reflux;genotype;headache;heart failure;heart muscle ischemia;human;hyperlipidemia;insomnia;liver disease;major clinical study;male;malignant neoplastic disease;monotherapy;multicenter study;nausea;neoplasm;open study;peripheral edema;peripheral vascular disease;phase 3 clinical trial;priority journal;randomized controlled trial;rhinopharyngitis;scoring system;side effect;treatment duration;weight gain;avandia,"Gold, M.;Alderton, C.;Zvartau-Hind, M.;Egginton, S.;Saunders, A. M.;Irizarry, M.;Craft, S.;Landreth, G.;Linnamägi, U.;Sawchak, S.",2010,,,0,
1545,Trends in mortality rates comparing underlying-cause and multiple-cause coding in an English population 1979-1998,"Until recently, national coding and analysis of routine mortality statistics in most countries included only underlying cause of death. There were changes in the rules for selection and coding of underlying cause in England in 1984 and 1993. We report on trends in mortality rates in an English region from 1979 to 1998, comparing multiple-cause and underlying-cause coded rates, for individual diseases that were affected by coding changes. Among many others, these include pneumonia, venous thromboembolism, heart failure, respiratory distress syndrome, tuberculosis, diabetes, dementia, alcohol and drug abuse, epilepsy, multiple sclerosis, stroke, asthma, peptic ulcer, appendicitis, and cancers of the breast, colon and prostate. Comparisons over time of mortality rates based on underlying cause alone will be misleading when the time-period crosses years in which rules changed for selecting underlying cause.",Cause of Death/*trends;Chi-Square Distribution;*Death Certificates;England/epidemiology;Humans;*Mortality,"Goldacre, M. J.;Duncan, M. E.;Cook-Mozaffari, P.;Griffith, M.",2003,Sep,,0,
1546,"Identifying subgroups of the general population that may be susceptible to short-term increases in particulate air pollution: a time-series study in Montreal, Quebec","This study was undertaken in order to shed light on which groups of the general population may be susceptible to the effects of ambient particles. The objectives of the study were (1) to determine whether concentrations of particles in the ambient air of Montreal, Quebec, were associated with daily all-cause and cause-specific mortality in the period 1984 to 1993, and (2) to determine whether groups of the population had higher than average risks of death from exposure to particles. From the network of fixed-site air pollution monitors in Montreal we obtained daily mean levels of various measures of particles, gaseous pollutants, and weather variables measured at Dorval International Airport. We also used measurements of sulfate from an acid rain monitoring station 150 km southeast of the city (Sutton, Quebec). We estimated associations for particulate matter (PM) with an aerodynamic diameter of 10 microns or smaller (PM10), or 2.5 microns or smaller (PM2.5), total suspended particles (TSP), coefficient of haze (COH), an extinction coefficient, and sulfate. Because substantial data for fine particles were missing, we developed a regression model to predict PM2.5 and to predict sulfate from PM2.5. In the main body of the report, we present results for COH, predicted PM2.5, and sulfate. Detailed results for all pollutants are included in Appendices H through O, which are available on request from Health Effects Institute and from the HEI web site at www.healtheffects.org. To address the first objective, we made use of the underlying causes of death among all 140,939 residents of Montreal who died between 1984 and 1993. We regressed the logarithm of daily counts of cause-specific mortality on the daily mean levels for a variety of measures of particles, accounting for seasonal and subseasonal fluctuations in the mortality time series, overdispersion, and weather factors. To address the second objective, we developed algorithms to define conditions that subjects had prior to death, with the focus on cardiopulmonary diseases. These algorithms were based on information retained on the databases of the universal Quebec Health Insurance Plan (QHIP). The databases include records of all procedures (e.g., type of surgery), physician visits, and consultations carried out by all physicians in Quebec. For persons > or = 65 years and for all recipients of social assistance the prescription database contains records of all pharmaceuticals dispensed (type of medication, dose, quantity). For each group of conditions defined, we used the same statistical model that was used in the analyses of all nonaccidental causes of death. In the analyses of cause-specific mortality, we found evidence of associations for all nonaccidental causes of death and specific causes of death--cancer, coronary artery disease, respiratory diseases, and diabetes--that were consistent across most metrics of ambient air particle concentrations, evaluated as the 3-day mean of particle concentrations measured on the day of death (lag 0) and on each of the two days before death (lag 1, lag 2). Associations for all cardiovascular diseases combined were found only with sulfate. As well, we generally found increased daily mortality for persons 65 years of age and over. The results for all nonaccidental causes of death are similar to findings from other studies; the mean percent increase in mortality for a 100 micrograms/m3 increase in daily TSP at lag 0 was 6.7%. In the analyses of the groups defined from the QHIP data, there was little evidence of associations with air pollutants among persons who before death were classified as having acute or chronic upper respiratory diseases, airways diseases, hypertension, acute coronary artery diseases, and cerebrovascular diseases. On the other hand, we found consistent increases across most types of ambient particles for persons who had cancer, acute lower respiratory diseases, any form of cardiovascular disease, chronic coronary artery diseases, and congestive heart failure. As well, we found an association for individual who did not have any cardiovascular disease, lower respiratory diseases, and cancer. This latter group consisted of persons who had no interactions with the health care system one year before death (12%) and individuals with a wide variety of potentially fatal diseases (52%), including neurological conditions (12%), diabetes (8%), cardiac dysrhythmias (8%), dementia (6%), organic psychotic disorders (6%), and anemias (4%). As statistical power was reduced in the analyses presented above, differences between groups (e.g., < 65 and > or = 65 year age groups) were not usually statistically significant. The association with diabetes has not been reported previously, and this needs to be replicated in other studies. (ABSTRACT TRUNCATED)",age;aged;air pollutant;air pollution;article;Canada;cause of death;congestive heart failure;cor pulmonale;coronary artery disease;diabetes mellitus;female;human;lung disease;male;maximum allowable concentration;mortality;neoplasm;statistics;task performance;weather,"Goldberg, M. S.;Bailar 3rd, J. C.;Burnett, R. T.;Brook, J. R.;Tamblyn, R.;Bonvalot, Y.;Ernst, P.;Flegel, K. M.;Singh, R. K.;Valois, M. F.",2000,,,0,
1547,Must physicians respect an incompetent patient's refusal of treatment?,,aged;article;beneficence;case report;decision making;dementia;ethics;heart catheterization;heart infarction;human;male;mental capacity;paternalism;personal autonomy;physician attitude;human relation;treatment refusal,"Goldblatt, D.",2006,,,0,
1548,Socioeconomic status in relationship to death of vascular disease and late-life dementia,"It is unclear to what extent coronary heart disease (CHD) and ischemic stroke share several biochemicals clinical and other risk factors with dementia and Alzheimer Disease. Socioeconomic status (SES) has been linked to vascular disease in some investigations and to dementia in a few others. We followed 10,000 Jewish male civil servants in Israel, initially examined in 1963, for mortality. Close to 2000 Survivors of this cohort were assessed between 1999 and 2001 for dementia and AD, yielding 309 cases of dementia. A 5-scale Socioeconomic status (SES) rank, defined during working years, on the basis of education and occupation, was directly but weakly related to CHD mortality but exhibited a clear inverse association with stroke mortality: hazard ratio (HR) 0.89 (95% CI, 0.81-0.97) per ""1 step"" of SES rank. A similar but more profound association was found for the prevalence of dementia, years later, among long-term survivors. Those at the lowest SES ranks exhibited estimated 3-fold and 6-fold dementia rates. The results are consistent with a ""protective"" mechanism associated with high education, but survival bias could affect these results and long-term incidence studies of dementia should clarify the SES-dementia association. © 2007 Elsevier B.V. All rights reserved.",adult;aged;Alzheimer disease;article;cerebrovascular accident;dementia;human;incidence;ischemic heart disease;Israel;Jew;major clinical study;mortality;prevalence;priority journal;socioeconomics;survival;survival time;vascular disease,"Goldbourt, U.;Schnaider-Beeri, M.;Davidson, M.",2007,,,0,
1549,Health insurance status and the care of nursing home residents with advanced dementia,"IMPORTANCE Nursing home residents with advanced dementia commonly experience burdensome and costly hospitalizations that may not extend survival or improve the quality of life. Fragmentation in health care has contributed to poor coordination of care for acutely ill nursing home residents. OBJECTIVE To compare patterns of care and quality outcomes for nursing home residents with advanced dementia covered by managed care with those covered by traditional fee-for-service Medicare. DESIGN, SETTING, AND PARTICIPANTS Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life (CASCADE) was a prospective cohort study including 22 nursing homes in the Boston, Massachusetts, area that monitored 323 nursing home residents for 18 months to better understand the course of advanced dementia at or near the end of life. Data from CASCADE and Medicare were linked to determine the health insurance status of study participants. EXPOSURES The health insurance status of the resident, either managed care or traditional fee for service. MAIN OUTCOMES AND MEASURES The outcomes included survival, symptoms related to comfort, treatment of pain and dyspnea, presence of pressure ulcers, presence of a do-not-hospitalize order, treatment of pneumonia, hospital transfer (admission or emergency department visit) for an acute illness, hospice referral, primary care visits, and family satisfaction with care. RESULTS Residents enrolled in managed care (n = 133) were more likely to have do-not-hospitalize orders compared with those in traditional Medicare fee for service (n = 158) (63.7%vs 50.9%; adjusted odds ratio, 1.9; 95%CI, 1.1-3.4), were less likely to be transferred to the hospital for acute illness (3.8% vs 15.7%; adjusted odds ratio, 0.2; 95%CI, 0.1-0.5), had more primary care visits per 90 days (mean [SD], 4.8 [2.6] vs 4.2 [5.0]; adjusted rate ratio, 1.3; 95%CI, 1.1-1.6), and had more nurse practitioner visits (3.0 [2.1] vs 0.8 [2.6]; adjusted rate ratio, 3.0; 95%CI, 2.2-4.1). Survival, comfort, and other treatment outcomes did not differ significantly across groups. CONCLUSIONS AND RELEVANCE Medicare managed-care programs may offer a promising approach to ensure that nursing homes are able to provide appropriate, less burdensome, and affordable care, especially at the end of life. Copyright © 2013 American Medical Association. All rights reserved.",acute disease;aged;article;chronic obstructive lung disease;congestive heart failure;decubitus;dementia;dyspnea;emergency care;emergency ward;female;health care delivery;health insurance;hospice;hospital admission;human;intensive care unit;major clinical study;male;managed care;medicare;neoplasm;nurse practitioner;nursing home;nursing home patient;pain;patient comfort;patient referral;patient satisfaction;percutaneous endoscopic gastrostomy;pneumonia;primary medical care;priority journal;survival;treatment outcome;United States,"Goldfeld, K. S.;Grabowski, D. C.;Caudry, D. J.;Mitchell, S. L.",2013,,,0,
1550,IMI2 to simplify procedures and increase participation,,alopecia;autoimmune disease;cardiovascular disease;dementia;drug industry;European Union;funding;health care cost;health care need;heart failure;human;investment;mental disease;multiple sclerosis;osteoarthritis;public-private partnership;rare disease;respiratory tract disease;short survey;vitiligo,"Goldman, M.",2013,,,0,
1551,Improving the estimation of influenza-related mortality over a seasonal baseline,"BACKGROUND: Existing methods for estimation of mortality attributable to influenza are limited by methodological and data uncertainty. We have used proxies for disease incidence of the three influenza cocirculating subtypes (A/H3N2, A/H1N1, and B) that combine data on influenza-like illness consultations and respiratory specimen testing to estimate influenza-associated mortality in the United States between 1997 and 2007. METHODS: Weekly mortality rate for several mortality causes potentially affected by influenza was regressed linearly against subtype-specific influenza incidence proxies, adjusting for temporal trend and seasonal baseline, modeled by periodic cubic splines. RESULTS: Average annual influenza-associated mortality rates per 100,000 individuals were estimated for the following underlying causes of death: for pneumonia and influenza, 1.73 (95% confidence interval = 1.53-1.93); for chronic lower respiratory disease, 1.70 (1.48-1.93); for all respiratory causes, 3.58 (3.04-4.14); for myocardial infarctions, 1.02 (0.85-1.2); for ischemic heart disease, 2.7 (2.23-3.16); for heart disease, 3.82 (3.21-4.4); for cerebrovascular deaths, 0.65 (0.51-0.78); for all circulatory causes, 4.6 (3.79-5.39); for cancer, 0.87 (0.68-1.05); for diabetes, 0.33 (0.26-0.39); for renal disease, 0.19 (0.14-0.24); for Alzheimer disease, 0.41 (0.3-0.52); and for all causes, 11.92 (10.17-13.67). For several underlying causes of death, baseline mortality rates changed after the introduction of the pneumococcal conjugate vaccine. CONCLUSIONS: The proposed methodology establishes a linear relation between influenza incidence proxies and excess mortality, rendering temporally consistent model fits, and allowing for the assessment of related epidemiologic phenomena such as changes in mortality baselines.","Alzheimer Disease/epidemiology;Cardiovascular Diseases/epidemiology;*Cause of Death;Comorbidity;Diabetes Mellitus/epidemiology;Humans;Incidence;Influenza Vaccines;Influenza, Human/classification/*mortality/prevention & control;Kidney Diseases/epidemiology;Middle Aged;Pneumonia/epidemiology;Regression Analysis;Respiratory Tract Diseases/epidemiology;*Seasons;United States/epidemiology","Goldstein, E.;Viboud, C.;Charu, V.;Lipsitch, M.",2012,Nov,10.1097/EDE.0b013e31826c2dda,0,
1552,The Role of Omega-3 Fatty Acids in Diets,"The article is a summary of Dra. Carmen Gómez Candela's presentation at the Science in Nutrition 3rd International Congress in Milan, March 2014. The article covers omega-3 fatty acids use in different medical areas and several institutions' opinions in relation to the topic. Omega-3 acids are essential fatty acids. A certain amount of omega-3 is needed in our daily diet; however, the usual consumption is generally less than the recommended amount. Changes in dietary patterns in the course of history have led to deficit levels of omega-3 in the human body. Currently, there is increasing evidence of the benefits of omega-3 in different medical specialities. There are still some gaps regarding its role in illnesses such as dementia, psychiatric disorders, and inflammatory diseases. Nevertheless, stronger evidence is being proved in cardiovascular diseases and cancer. This article provides a reflection on possible ways to increase omega-3 daily consumption and the constraints associated with food with high contents of heavy metals, which, in turn, are also rich in omega-3s.",linolenic acid;omega 3 fatty acid;triacylglycerol;article;breast cancer;cardiovascular disease;clinical trial (topic);fish;heart reinfarction;human;incidence;inflammation;insulin sensitivity;maternal welfare;mental disease;neoplasm;pregnancy;risk factor;scoring system,"Gomez-Candela, C.;Roldan Puchalt, M. C.;Palma Milla, S.;Lopez Plaza, B.;Bermejo, L.",2015,,,0,
1553,Dementia associated with the antiphospholipid syndrome: Clinical and radiological characteristics of 30 patients,"Objective. To analyse the clinical and radiological characteristics of patients with dementia associated with the antiphospholipid syndrome (APS). Methods. Twenty-five patients were identified by a computer-assisted (MEDLINE, National Library of Medicine, Bethesda, MD) search of the literature to locate all cases of dementia associated with APS published in English, Spanish and French from 1983 to 2003. Additionally, we included five patients from our clinics. Results. There were 21 (70%) females and 9 (30%) males. The mean age of patients was 49±15 yr (range 16-79 yr). Fourteen (47%) of the patients suffered from primary APS, 9 (30%) had systemic lupus erythematosus and 7 (23%) had 'lupus-like' syndrome. Ten (33%) patients had Sneddon's syndrome and 2 (7%) had cerebral lesions described as Binswanger's disease. Other APS-related manifestations included thrombocytopenia in 12 (40%) patients, cerebrovascular accidents in 11 (37%), heart valve lesions in 8 (27%), deep vein thrombosis in 7 (28%), migraine in 7 (23%), seizures in 4 (13%); five of the 21 (24%) female patients had nine spontaneous abortions. Lupus anticoagulant was present in 21/29 (72%) patients and anticardiolipin antibodies were present in 24/29 (83%) patients. Cortical infarcts were found in 19 (63%) patients, subcortical infarcts in 9 (30%), basal ganglia infarcts in 7 (23%) and signs of cerebral atrophy in 11 (37%). Anticoagulation was used in 14/25 (56%) patients, steroids in 12/25 (48%), aspirin in 6/25 (24%) and dypiridamole in 5/25 (20%). Conclusions. Dementia is an unusual manifestation of APS but one which has a high disability impact in a patient's daily life. In order to prevent these consequences, an echocardiographic and cerebral CT or MRI evaluation are recommended in all patients with APS. Furthermore, ruling out APS should be recommended in the clinical approach to dementia, especially in young patients. © British Society for Rheumatology 2004; all rights reserved.",acetylsalicylic acid;cardiolipin antibody;dipyridamole;lupus anticoagulant;steroid;adolescent;adult;aged;anticoagulant therapy;antiphospholipid syndrome;article;basal ganglion;Binswanger encephalopathy;brain atrophy;brain infarction;cerebrovascular accident;clinical article;clinical feature;computer analysis;computer assisted tomography;controlled study;daily life activity;deep vein thrombosis;dementia;disability;echocardiography;female;human;lupus erythematosus;male;medical literature;Medline;migraine;nuclear magnetic resonance imaging;priority journal;publication;radiodiagnosis;seizure;Sneddon syndrome;spontaneous abortion;systemic lupus erythematosus;thrombocytopenia;valvular heart disease;aspirin,"Gómez-Puerta, J. A.;Cervera, R.;Calvo, L. M.;Gómez-Ansón, B.;Espinosa, G.;Claver, G.;Bucciarelli, S.;Bové, A.;Ramos-Casals, M.;Ingelmo, M.;Font, J.",2005,,,0,
1554,Consultation between specialists in Internal Medicine and Family Medicine improves management and prognosis of heart failure,"Background and objective: To evaluate if consultation between specialists in Internal Medicine and family doctors (CIMFD) improves the clinical management and prognosis of patients with heart failure (HF). Methods: Design: prospective case-control study (5 years of follow-up). Setting: community-based sample within the area of a university teaching hospital. Subjects: 1857 patients (>= 14 years) diagnosed for the first time with HF (1stDxHF), in the CIMFD. Control group: 1981 patients (from health centres not covered by the CIMFD), 1stDxHF, in the external consultations of the hospital. Main outcome measures: mortality rate (MR). Admissions (HA). Emergency services visits (ESV). Delays in receiving specialist attention (DRSA), and the resolution of the process (DRP). Number (NTP) and delays in reporting (DTP) tests performed. Proportion (PRC) and delay (DRC) in resolving cases. Results: We observed a reduction of: MR (by 10.8%, CI 95%, 8.6-13.0, p < 0.005); HA, per patient per year (ppy) (by 1.8, 1.3-2.3, p < 0.01); ESV, ppy (by 1.9, 1.2-2.6, p < 0.01); DRSA (by 26.5 days, 21.8-31.2, p < 0.001); DRP (by 21.0 days, 18.3-23.7, p < 0.001), and DRC (by 25.8 days, 20.3-31.4, p < 0.01). The PRC (17.2%, CI 95%, 15.5-18.9, p < 0.01) was higher for the CIMFD. Conclusion: The CIMFD approach improves prognosis and efficacy in the clinical management of patients with HF because it reduces mortality and morbidity (HA and ESV), shortens the delays in receiving care and in resolving the diagnostic and therapeutic process (DRSA, DRP, DRC), and increases the proportion of diagnosed and treated patients. © 2008 European Federation of Internal Medicine.",acute heart infarction;aged;angina pectoris;article;chronic hepatitis;chronic kidney failure;chronic obstructive lung disease;comorbidity;computer assisted tomography;consultation;controlled study;dementia;diabetes mellitus;diagnostic test;electrocardiogram;emergency health service;exercise test;family medicine;female;heart failure;heart left ventricle ejection fraction;hospital admission;human;hypertension;internal medicine;major clinical study;male;medical specialist;mortality;nuclear magnetic resonance;patient care;peripheral ischemia;prognosis;spirometry;thorax radiography,"Gomez-Soto, F. M.;Puerto, J. L.;Andrey, J. L.;Fernandez, F. J.;Escobar, M. A.;Garcia-Egido, A. A.;Romero, S. P.;Bernal, J. A.;Gomez, F.",2008,,,0,
1555,Drug-induced sleepiness and insomnia: An update,"Medical practice of sleep medicine requires an extensive pharmacological knowledge, especially when you need to make decisions about the drug scheme already adopted by a given patient. The care of patients with multiple diseases and using of multiple drugs has become common. The great challenge facing the physician is to what extent one or more drugs may be contributing to the complaint of sleepiness or insomnia. Any drug with activity in the central nervous system has the potential to affect sleep-wake cycle. The pharmacokinetic drug knowledge's will be useful in determining the likelihood of adverse effects on sleep-wake functioning. In this article we describe the potential sedative or in generating insomnia by drugs used in the major chronic diseases in the population.",acetylsalicylic acid;angipress;atenolol;becarve;beta adrenergic receptor blocking agent;calcium channel blocking agent;captopril;cardilol;carvedilat;carvedilol;chlorpropamide;clonidine;clopidogrel;corus;dipeptidyl carboxypeptidase inhibitor;diuretic agent;doxazosin;ecator;enalapril maleate;eupressin;glibenclamide;glimepiride;glipizide;hydralazine;ictus;insulin;isosorbide;karvil;labetalol;losartan;losartec;methyldopa;metoprolol tartrate;naprix;prazosin;propranolol;ramipril;terazosin;tolazamide;tolbutamide;unclassified drug;unindexed drug;vasodilator agent;Alzheimer disease;analgesia;article;cardiovascular disease;coronary artery disease;deep sedation;depression;diabetes mellitus;drug induced disease;epilepsy;fatigue;human;hypertension;insomnia;ischemic heart disease;nightmare;posttraumatic stress disorder;side effect;sleep waking cycle;somnolence;vivid dream;ablok;amaryl;apresolina;atenol;carduran;coreg;daonil;diabinese;hytrin;inderal;lisaglucon;lopressor;minidiab;minipress;normodyne;orinase;renitec;seloken;tolinase;trandate;triatec,"Gonçalves, R.;Togeiro, S. M. G.",2013,,,0,
1556,Knowledge enrichment analysis for human tissue-specific genes uncover new biological insights,"The expression and regulation of genes in different tissues are fundamental questions to be answered in biology. Knowledge enrichment analysis for tissue specific (TS) and housekeeping (HK) genes may help identify their roles in biological process or diseases and gain new biological insights. In this paper, we performed the knowledge enrichment analysis for 17,343 genes in 84 human tissues using Gene Set Enrichment Analysis (GSEA) and Hypergeometric Analysis (HA) against three biological ontologies: Gene Ontology (GO), KEGG pathways and Disease Ontology (DO) respectively. The analyses results demonstrated that the functions of most gene groups are consistent with their tissue origins. Meanwhile three interesting new associations for HK genes and the skeletal muscle tissue genes are found. Firstly, Hypergeometric analysis against KEGG database for HK genes disclosed that three disease terms (Parkinson's disease, Huntington's disease, Alzheimer's disease) are intensively enriched. Secondly, Hypergeometric analysis against the KEGG database for Skeletal Muscle tissue genes shows that two cardiac diseases of ""Hypertrophic cardiomyopathy (HCM)"" and ""Arrhythmogenic right ventricular cardiomyopathy (ARVC)"" are heavily enriched, which are also considered as no relationship with skeletal functions. Thirdly, ""Prostate cancer"" is intensively enriched in Hypergeometric analysis against the disease ontology (DO) for the Skeletal Muscle tissue genes, which is a much unexpected phenomenon.","Databases, Genetic;*Gene Expression Profiling;Gene Frequency;*Genes, Essential;Humans;Information Storage and Retrieval/methods;*Knowledge Bases","Gong, X. J.;Yu, H.;Yang, C. B.;Li, Y. F.",2012,Jul 09,10.2390/biecoll-jib-2012-194,0,
1557,Central effects of humanin on hepatic triglyceride secretion,"Humanin (HN) is an endogenous mitochondria-associated peptide that has been shown to protect against various Alzheimer's disease-associated insults, myocardial ischemia-reperfusion injury, and reactive oxygen species-induced cell death. We have shown previously that HN improves whole body glucose homeostasis by improving insulin sensitivity and increasing glucose-stimulated insulin secretion (GSIS) from the beta-cells. Here, we report that intraperitoneal treatment with one of HN analogs, HNG, decreases body weight gain, visceral fat, and hepatic triglyceride (TG) accumulation in high-fat diet-fed mice. The decrease in hepatic TG accumulation is due to increased activity of hepatic microsomal triglyceride transfer protein (MTTP) and increased hepatic TG secretion. Both intravenous (iv) and intracerebroventricular (icv) infusion of HNG acutely increase TG secretion from the liver. Vagotomy blocks the effect on both iv and icv HNG on TG secretion, suggesting that the effects of HNG on hepatic TG flux are centrally mediated. Our data suggest that HN is a new player in central regulation of peripheral lipid metabolism.","Adiposity/drug effects;Animals;Anti-Obesity Agents/administration & dosage/pharmacology/therapeutic use;Carrier Proteins/agonists/genetics/metabolism;Cells, Cultured;Central Nervous System Agents/administration & dosage/pharmacology/therapeutic;use;Diet, High-Fat/adverse effects;Hepatocytes/cytology/drug effects/metabolism;Infusions, Intravenous;Infusions, Intraventricular;Intra-Abdominal Fat/drug effects/pathology;Intracellular Signaling Peptides and Proteins/administration &;dosage/chemistry/*metabolism/pharmacology/therapeutic use;Liver/drug effects/metabolism/pathology/*secretion;Male;Mice, Inbred C57BL;*Models, Biological;Obesity/drug therapy/etiology/*metabolism/pathology;Peptides/administration & dosage/pharmacology/therapeutic use;Rats, Sprague-Dawley;Reproducibility of Results;Triglycerides/blood/metabolism/*secretion;Vagotomy, Truncal;hepatic microsomal triglyceride transfer protein;humanin;hypothalamus;triglyceride secretion","Gong, Z.;Su, K.;Cui, L.;Tas, E.;Zhang, T.;Dong, H. H.;Yakar, S.;Muzumdar, R. H.",2015,Aug 1,10.1152/ajpendo.00043.2015,0,
1558,A pilot single-institution predictive model to guide rib fracture management in elderly patients,"BACKGROUND Rib fractures (RFx) remain the most prevalent injury in an elderly population that will increase from 40 to 81 million for the next 30 years. We sought to create an accurate cost-effective algorithm to triage elderly patients with RFx that accounted for both frailty and trauma burden. METHODS Retrospective analysis evaluated 400 patients older than 55 years with RFx admitted to a level 1 trauma center from 2007 to 2012. Comorbidities included chronic obstructive pulmonary disease, congestive heart failure, tobacco use, obesity, and nutrition and functional status. Trauma burden included RFx, tube thoracostomy, pulmonary contusions, and spine and extremity fractures. Patients with Glasgow Coma Scale scores lower than 13, thoracoabdominal surgery, or deaths from other causes were excluded. Comparative analysis used bivariate and logistic regression. Variables contributing to intubation (INT) and pneumonia (PNA) were then used to create a scoring system to predict the need for intensive care unit (ICU) admission. RESULTS Six variables increased the risk for INT or PNA: chronic obstructive pulmonary disease, low albumin, assisted status, tube thoracostomy, Injury Severity Score, and RFx (p < 0.05). These six variables and congestive heart failure (odds ratio, 1.9; p = 0.06) were used to create a predictive model with the following scores assigned respectively: 1.4, 1.1, 1, 0.9, 0.1(n), 0.1(n), and 0.6. A score lower than 3.7 had a sensitivity and specificity of 78.5% and 78.9%. The negative predictive value was 94.5% for INT or PNA, suggesting a low risk for ICU requirement. Ninety-two ICU admissions had a score lower than 3.7. Forty had no other indication for ICU admission aside from RFx. These patients had an average ICU length of stay of 1.7 days, resulting in an increased cost of $2,200 per patient. CONCLUSION A scoring system combining frailty and trauma burden may provide more accurate and cost-effective triage of the elderly trauma patient with RFx. Further prospective studies are required to verify our scoring system. LEVEL OF EVIDENCE Prognostic and epidemiologic study, level III.",albumin;adult;aged;albumin blood level;analgesia;article;chronic obstructive lung disease;comparative study;congestive heart failure;controlled study;cost control;dementia;dysphagia;dyspnea;emergency health service;falling;frail elderly;functional status;geriatric patient;Glasgow coma scale;health care cost;heart arrhythmia;human;injury scale;intubation;leg fracture;length of stay;limb fracture;lung contusion;major clinical study;mental health;middle aged;mortality;nutritional status;obesity;pelvis fracture;pneumonia;predictive value;priority journal;protein calorie malnutrition;receiver operating characteristic;retrospective study;rib fracture;risk;scoring system;sensitivity and specificity;septic shock;spine fracture;thorax drainage;tobacco use;traffic accident,"Gonzalez, K. W.;Ghneim, M. H.;Kang, F.;Jupiter, D. C.;Davis, M. L.;Regner, J. L.",2015,,,0,
1559,Mortality in internal medicine. Importance of patients in terminal condition,"Background and objectives: many patients with end-stage chronic illnesses are cared for in medical services, outside specific palliative care resources. This encouraged us to review the patients that had died in our department during 2006, describing their characteristics and the care they were given. Patients and methods: a retrospective descriptive study of the clinical records of patients who died during 2006 at Internal Medicine Service, Virgen de la Torre Hospital, Madrid, Spain. We analyzed their sociodemographic and clinical information, end-stage disease criteria, causes of death, type of care and treatments, degree of instrumentalization, and presence of a living will. The results were analyzed with the statistical program SPSS 14.0. Results: we obtained 172 clinical records of 188 deceased patients during this period (64.5% women, 35.5% males, mean age 85.76 ±7.0);69% of patients had end-stage disease, and diseases included dementia in 52%, cancer in 14%, COPD in 10%, and heart failure in 9%. Death was most commonly of respiratory (70%), neurological (52%), cardiovascular (35%), or septic (31%) cause. No patient had a living will;81% of terminal patients were included in a palliative protocol. Conclusions: a high percentage of the patients that had died in our service had a terminal chronic disease. Patient type was a woman of advanced age, with multiple chronic diseases, with a high level of dependency, cared after by her family, and with end-stage dementia. No patient had a living will. Copyright © 2009 Arán Ediciones, S.L.",chronic disease;death;dementia;diseases;female;heart failure;hospital;human;internal medicine;living will;male;medical service;mortality;neoplasm;palliative therapy;patient;Spain;terminal care;terminally ill patient,"González-Ruano Pérez, P.;Serralta San Martín, G.;Sáez Vaquero, T.;Pacheco Cuadros, R.;Ulla Anes, M.;Marco Mur, A.;Pascual Cuesta, T.;Viña Carregal, B.",2009,,,0,
1560,Blood management: Transfusion medicine comes of age,,alloimmunization;blood safety;blood transfusion;blood transfusion reaction;brucellosis;Chagas disease;Creutzfeldt Jakob disease;cytomegalovirus infection;dengue;hepatitis A;Hepatitis B virus;hepatitis C;human;Human immunodeficiency virus infection;immunomodulation;iron overload;leishmaniasis;malaria;note;parvovirus infection;posttransfusion hepatitis;priority journal;syphilis;Torque teno virus infection,"Goodnough, L. T.",2013,,,0,
1561,Evaluation and management of anemia in the elderly,"Anemia is now recognized as a risk factor for a number of adverse outcomes in the elderly, including hospitalization, morbidity, and mortality. What constitutes appropriate evaluation and management for an elderly patient with anemia, and when to initiate a referral to a hematologist, are significant issues. Attempts to identify suggested hemoglobin levels for blood transfusion therapy have been confounded for elderly patients with their co-morbidities. Since no specific recommended hemoglobin threshold has stood the test of time, prudent transfusion practices to maintain hemoglobin thresholds of 9-10 g/dL in the elderly are indicated, unless or until evidence emerges to indicate otherwise. © 2013 Wiley Periodicals, Inc.",antianemic agent;anticoagulant agent;C reactive protein;creatinine;cyanocobalamin;erythropoietin;ferritin;fibrinogen;folic acid;hemoglobin;hepcidin;homocysteine;interleukin 6;iron;methylmalonic acid;recombinant erythropoietin;transferrin;abnormal laboratory result;acute coronary syndrome;acute heart infarction;anemia;article;bleeding;blood flow;blood transfusion;blood viscosity;cardiovascular disease;cardiovascular response;cardiovascular risk;chronic inflammation;chronic kidney disease;clinical evaluation;clinical practice;clinical trial (topic);cognition;comorbidity;coronary artery disease;creatinine blood level;cyanocobalamin deficiency;dementia;elective surgery;end stage renal disease;erythrocyte sedimentation rate;erythrocyte transfusion;folic acid deficiency;geriatric disorder;glomerulus filtration rate;heart catheterization;heart output;heart stroke volume;hematocrit;hemoglobin blood level;hemoglobin determination;high risk patient;hip fracture;hospitalization;human;inflammation;intensive care unit;iron deficiency;iron deficiency anemia;iron storage;iron therapy;Jehovah's witness;mean corpuscular volume;megalocytosis;mortality;myelodysplastic syndrome;nutritional deficiency;oxygen transport;plasma volume;population;practice guideline;prevalence;priority journal;prostatectomy;reticulocyte;retrospective study;spine surgery;stable angina pectoris;tachycardia;thorax surgery;vitamin blood level;vitamin supplementation,"Goodnough, L. T.;Schrier, S. L.",2014,,,0,
1562,Functional outcomes of excessive daytime sleepiness in older adults,"OBJECTIVES: To describe the effect of self-reported excessive daytime sleepiness (EDS) on functional outcomes. DESIGN: Case-control study designed to examine differences in functional status between cases (with daytime sleepiness) and controls (no daytime sleepiness) with regard to demographic factors, general health, sleep history, and medications. SETTING: Retirement communities in southeastern Pennsylvania, Delaware, and New Jersey. PARTICIPANTS: Seventy-six nondepressed, nondemented adults, aged 65 and older, were cases (had daytime sleepiness) and 38 were controls (had no daytime sleepiness). MEASUREMENTS: Standardized questionnaires to assess disease-specific functional status (Functional Outcomes of Sleepiness Questionnaire (FOSQ) and Epworth Sleepiness Scale (ESS)), depression (Geriatric Depression Scale-Short Form and the Center for Epidemiologic Studies-Depression Scale), dementia (Short Blessed Test), demographic factors, current medical history, and sleep complaints. RESULTS: There was a significant difference in functional status between sleepy cases and nonsleepy controls. Sleepiness had a moderate to large negative effect (effect size range from 0.59 to 0.83, P < .005) on the following functional domains of the FOSQ: social outcome, general productivity, vigilance, activity level, and global assessment of functional status. Correlation between ESS and FOSQ subscales were -0.31 to -0.67, P < .05. Examination of cases with daytime sleepiness revealed increased functional impairment in individuals with more than three medical conditions or those taking more than four medications (P < .001 and P = .03, respectively). CONCLUSION: Daytime sleepiness is associated with functional impairments in a broad range of activities. The decrease in daily functioning noted in the sleepy subjects has implications for deconditioning and related comorbidity. These findings suggest that exploration of daytime sleepiness should be part of the ongoing assessment of the elderly, particularly those with multiple medical conditions.",calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;nonsteroid antiinflammatory agent;thyroid hormone;vitamin;aged;alertness;angina pectoris;arthritis;article;neoplasm;comorbidity;controlled study;dementia;demography;depression;female;functional assessment;functional disease;general condition;geriatric disorder;geriatric patient;human;hypertension;lung disease;major clinical study;male;outcomes research;patient information;quality of life;questionnaire;rating scale;retirement;self report;social aspect;somnolence;spine disease;standardization;statistical significance;thyroid disease;United States,"Gooneratne, N. S.;Weaver, T. E.;Cater, J. R.;Pack, F. M.;Arner, H. M.;Greenberg, A. S.;Pack, A. I.",2003,,,0,
1563,Risk factors for dementia associated with multiple cerebral infarcts. A case-control analysis in predominantly African-American hospital-based patients,"OBJECTIVE: To clarify risk factors for dementia associated with cerebral infarction. DESIGN: Case-control study. SETTING: The study was conducted in a hospital setting. PATIENTS: The subjects were consecutive patients with acute stroke with multiple cerebral infarctions who were admitted to the hospital between November 1, 1987, and December 1, 1990. They were predominantly elderly African Americans. Index cases met criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, for multi-infarct dementia, whereas control subjects were patients with multiple infarcts who did not have dementia. There were 61 multi-infarct disease index cases and 86 controls without cognitive impairment. MAIN OUTCOME MEASURES: Demographic and cardiovascular disease risk factor variables. RESULTS: Index cases were older (mean [+/- SD] age, 75.5 +/- 9.7 vs 69.6 +/- 9.1 years), were less well educated (odds ratio, 4.37; confidence interval, 2.12 to 9.04), had lower annual incomes (odds ratio, 8.82; confidence interval, 2.38 to 32.70), more frequently had a family history of dementia (odds ratio, 3.61; confidence interval, 1.09 to 11.96) and laboratory evidence of proteinuria (odds ratio, 3.66; confidence interval, 1.54 to 8.71), had lower scores on neuropsychological tests, had more neurologic signs and symptoms, and were more functionally impaired in activities of daily living. Multiple logistic regression analysis showed that advanced age, lower educational attainment, history of myocardial infarction, and recent cigarette smoking were positively associated with case status and systolic blood pressure level was negatively associated with case status. CONCLUSIONS: Cardiovascular disease risk factors may be modifiable predictors of dementia associated with cerebral infarction. Additional well-designed epidemiologic studies are needed to clarify these associations.",African Americans;African Continental Ancestry Group;Age Factors;Aged;Case-Control Studies;Cerebral Infarction/*complications/epidemiology/ethnology;Cerebrovascular Disorders/complications/epidemiology/ethnology;Dementia/epidemiology/ethnology/*etiology;Educational Status;Female;Humans;Hypertension/complications;Male;Multivariate Analysis;Neuropsychological Tests;Obesity/complications;Risk Factors;Smoking/adverse effects,"Gorelick, P. B.;Brody, J.;Cohen, D.;Freels, S.;Levy, P.;Dollear, W.;Forman, H.;Harris, Y.",1993,Jul,,0,
1564,Frequency of use of oral vitamin K antagonists in patients with atrial fibrillation and cognitive function disturbances,"UNLABELLED: The incidence of atrial fibrillation (AF) and of thromboembolic complications increases along with age. This is also the case for cognitive function disturbances; therefore their occurrence in patients (pts) with AF may hamper control of anticoagulant therapy and maintenance of therapeutic INR values. The aim of the study was to evaluate the effect of cognitive function disturbances on implementation and monitoring of the treatment with oral vitamin K antagonists (VKA) in patients with AF. The relationship between the level of cognitive function disturbances and the severity of experienced AF symptoms was defined. MATERIAL AND METHODS: The analysis included a group of 93 pts (41 males, 52 females, mean age: 76.8) with a diagnosis of AF and with indications for anticoagulation treatment with VKAs (CHA2DS2VASc > or = 2, HAS-BLED < 3), referred to the Clinic of Internal Diseases and Clinical Pharmacology of the Medical University of Lodz. In a group of pts (n = 46) treated chronically with VKAs, mean INR values at admission to the hospital were calculated and the number of results falling within the therapeutic range of 2-3, by the severity of cognitive disturbances, was analyzed. Cognitive abilities were assessed with the Mini Mental State Examination Scale (MMSE) (MMSE-Mini-mental state examination). The EHRA (European Heart Rhythm Association) classification was used to assess AF-related complaints. RESULTS: The 93 studied subjects were divided into 3 groups: group I with normal cognitive function (MMSE = 24-27) - n = 35; group II with disturbances of cognitive function without dementia (MMSE = 24-26) - n = 35 and group III with dementia (MMSE < 24) - n = 23.66% of pts with normal MMSE result were referred to the hospital because AF-related symptoms and in the group of patients with MMSE < 24 these symptoms were the cause of hospitalization in 23% of pts. Despite the fact that all patients had indications for VKAs, this treatment was not started in 40%, 51.4% and 65% of pts in group I, II and III, respectively. At admission to the hospital, therapeutic level INR values were found only in 34.8% of AF pts. 49% of pts were treated with VKAs in total. In group II, a high percentage of patients (43%) treated with aspirin was found in spite of high thromboembolic risk and no contraindications to VKAs. About 23% of pts with a normal MMSE result and 14% of pts in group II experienced AF-related symptoms preventing them from normal functioning and performing daily activities (EHRA IV). Nobody in group III reported severe AF-related symptoms. CONCLUSIONS: Along with the advancing age, there is an increase of the incidence of persistent and fixed atrial fibrillation, of the risk of thromboembolic complications and of the severity of cognitive function disturbances. Treatment with oral vitamin K antagonists was implemented much less frequently among patients with atrial fibrillation and cognitive function disturbances, as compared to the patients with normal cognitive function. The MMSE test should be routinely performed in patients with atrial fibrillation to monitor the efficacy and safety of the treatment with oral vitamin K antagonists properly. In patients with disturbances of cognitive function, significantly lower reportability of AF-related complaints was shown, as compared to individuals without these disturbances. Patients with normal MMSE result were referred to the hospital because AF-related symptoms, in the group of patients with MMSE < 23 the main reason for hospitalization was the severity of the symptoms heart failure. ECG should be a routine test performed in elderly patients with cognitive function disturbances or with dementia to detect atrial fibrillation.","Anticoagulants [therapeutic use];Atrial Fibrillation [diagnosis] [drug therapy] [epidemiology];Cognition Disorders [drug therapy] [epidemiology];Comorbidity;Dementia [epidemiology];Drug Monitoring;Drug Utilization;Electrocardiography;Incidence;Thromboembolism [epidemiology];Vitamin K [antagonists & inhibitors];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];aged;article;cognitive defect/dt [Drug Therapy];cognitive defect/ep [Epidemiology];comorbidity;controlled clinical trial;controlled study;dementia/ep [Epidemiology];drug antagonism;drug monitoring;drug utilization;electrocardiography;female;heart atrium fibrillation/di [Diagnosis];heart atrium fibrillation/dt [Drug Therapy];heart atrium fibrillation/ep [Epidemiology];human;incidence;male;middle aged;thromboembolism/ep [Epidemiology];very elderly;anticoagulant agent/dt [Drug Therapy];vitamin K group","Gorzelak, P.;Zyzak, S.;Krewko;Mozdzan, M.;Broncel, M.",2014,,,0,1565
1565,Frequency of use of oral vitamin K antagonists in patients with atrial fibrillation and cognitive function disturbances,"MATERIAL AND METHODS: The analysis included a group of 93 pts (41 males, 52 females, mean age: 76.8) with a diagnosis of AF and with indications for anticoagulation treatment with VKAs (CHA2DS2VASc > or = 2, HAS-BLED < 3), referred to the Clinic of Internal Diseases and Clinical Pharmacology of the Medical University of Lodz. In a group of pts (n = 46) treated chronically with VKAs, mean INR values at admission to the hospital were calculated and the number of results falling within the therapeutic range of 2-3, by the severity of cognitive disturbances, was analyzed. Cognitive abilities were assessed with the Mini Mental State Examination Scale (MMSE) (MMSE-Mini-mental state examination). The EHRA (European Heart Rhythm Association) classification was used to assess AF-related complaints.RESULTS: The 93 studied subjects were divided into 3 groups: group I with normal cognitive function (MMSE = 24-27) - n = 35; group II with disturbances of cognitive function without dementia (MMSE = 24-26) - n = 35 and group III with dementia (MMSE < 24) - n = 23.66% of pts with normal MMSE result were referred to the hospital because AF-related symptoms and in the group of patients with MMSE < 24 these symptoms were the cause of hospitalization in 23% of pts. Despite the fact that all patients had indications for VKAs, this treatment was not started in 40%, 51.4% and 65% of pts in group I, II and III, respectively. At admission to the hospital, therapeutic level INR values were found only in 34.8% of AF pts. 49% of pts were treated with VKAs in total. In group II, a high percentage of patients (43%) treated with aspirin was found in spite of high thromboembolic risk and no contraindications to VKAs. About 23% of pts with a normal MMSE result and 14% of pts in group II experienced AF-related symptoms preventing them from normal functioning and performing daily activities (EHRA IV). Nobody in group III reported severe AF-related symptoms.CONCLUSIONS: Along with the advancing age, there is an increase of the incidence of persistent and fixed atrial fibrillation, of the risk of thromboembolic complications and of the severity of cognitive function disturbances. Treatment with oral vitamin K antagonists was implemented much less frequently among patients with atrial fibrillation and cognitive function disturbances, as compared to the patients with normal cognitive function. The MMSE test should be routinely performed in patients with atrial fibrillation to monitor the efficacy and safety of the treatment with oral vitamin K antagonists properly. In patients with disturbances of cognitive function, significantly lower reportability of AF-related complaints was shown, as compared to individuals without these disturbances. Patients with normal MMSE result were referred to the hospital because AF-related symptoms, in the group of patients with MMSE < 23 the main reason for hospitalization was the severity of the symptoms heart failure. ECG should be a routine test performed in elderly patients with cognitive function disturbances or with dementia to detect atrial fibrillation.The incidence of atrial fibrillation (AF) and of thromboembolic complications increases along with age. This is also the case for cognitive function disturbances; therefore their occurrence in patients (pts) with AF may hamper control of anticoagulant therapy and maintenance of therapeutic INR values. The aim of the study was to evaluate the effect of cognitive function disturbances on implementation and monitoring of the treatment with oral vitamin K antagonists (VKA) in patients with AF. The relationship between the level of cognitive function disturbances and the severity of experienced AF symptoms was defined.","Anticoagulants [therapeutic use];Atrial Fibrillation [diagnosis] [drug therapy] [epidemiology];Cognition Disorders [drug therapy] [epidemiology];Comorbidity;Dementia [epidemiology];Drug Monitoring;Drug Utilization;Electrocardiography;Incidence;Thromboembolism [epidemiology];Vitamin K [antagonists & inhibitors];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];aged;article;cognitive defect/dt [Drug Therapy];cognitive defect/ep [Epidemiology];comorbidity;controlled clinical trial;controlled study;dementia/ep [Epidemiology];drug antagonism;drug monitoring;drug utilization;electrocardiography;female;heart atrium fibrillation/di [Diagnosis];heart atrium fibrillation/dt [Drug Therapy];heart atrium fibrillation/ep [Epidemiology];human;incidence;male;middle aged;thromboembolism/ep [Epidemiology];very elderly;anticoagulant agent/dt [Drug Therapy];vitamin K group","Gorzelak, P;Zyzak, S;Krewko;Mozdzan, M;Broncel, M",2014,,,0,
1566,Inappropriate prescribing as a predictor for long-term mortality after hip fracture,"Background: Hip fracture patients are at a higher risk for death compared to age-matched controls. While the reasons for this increased mortality risk are incompletely understood, medical comorbidities and associated medication prescribing likely play an important role in patient outcomes. Altered drug metabolism, polypharmacy and diminished physiologic reserve may all lead to adverse drug reactions and adverse outcomes. Additionally, underprescribing of efficacious medications may deprive older patients of potential therapeutic benefits. Objective: The aim of our trial was to estimate the impact of inappropriate medication prescribing on the long-term outcome of older hip fracture patients. Methods: The present study is a retrospective cohort study. We included all hip fracture patients who were consecutively admitted to our department from 2000 to 2004. We used the previously published STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria to assess the appropriateness of medication prescribing with an additional focus on osteoporosis medications and the total number of prescriptions. Prescriptions meeting STOPP and START criteria were considered 'positive items' and correlated with outcomes. Mortality was assessed by cross-referencing with the national death registry of the Tyrolean Institute of Epidemiology. Results: During the study period, a total of 457 patients with hip fracture (mean age 80.61 ± 7.07 years; range 65-98) were evaluated. The mean number of positive combined STOPP and START items per patient was 2 ± 1.3, with ranges from 0 to 6 (STOPP items), 0 to 4 (START items) and 0 to 7 (combined STOPP/START items). Only 44 (9.6%) of patients had no positive STOPP or START items. The mean number of positive items (STOPP, START and combined) was significantly higher in non-survivors than survivors. The all-cause mortality rate at 3 years was lowest in the subjects with 1 or 0 positive items (20.5%; n = 35) and highest among those with >3 positive items (44.4%; n = 63). Inappropriate medication prescribing remained an independent risk factor with an odds ratio of 1.28 (1.07-1.52) after adjustment for sex, age, activities of daily living, comorbidities and nutrition status. Conclusion: Inappropriate medication prescribing is an independent predictor of long-term mortality in older hip fracture patients. It increases the relative risk of mortality in older hip fracture patients by 28%.",acetylsalicylic acid;benzodiazepine derivative;beta adrenergic receptor blocking agent;calcium;clopidogrel;long acting drug;neuroleptic agent;prescription drug;proton pump inhibitor;theophylline;vasodilator agent;vitamin D;warfarin;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;chronic obstructive lung disease;cohort analysis;comorbidity;controlled study;daily life activity;dementia;female;functional status;atrial fibrillation;heart failure;hip fracture;human;inappropriate prescribing;kidney failure;long term care;major clinical study;male;medical record review;Mini Mental State Examination;monotherapy;mortality;nutritional status;orthostatic hypotension;osteoporosis;outcome assessment;peripheral occlusive artery disease;priority journal;program appropriateness;retrospective study;sex difference;stable angina pectoris,"Gosch, M.;Wörtz, M.;Nicholas, J. A.;Doshi, H. K.;Kammerlander, C.;Lechleitner, M.",2014,,,0,
1567,Impact of Non-Adherence on Renal and Cardiovascular Outcomes in US Veterans,"Background: Adherence is paramount in treating hypertension; however, no gold standard method is available for non-adherence screening, delineating high-risk patients. An International Classification of Diseases 9th Edition non-adherence diagnostic code (V15.81) has been available for decades; but, its utility is poorly studied. We examined the association between the V15.81 code assigned prior to the initiation of anti-hypertensive drugs (AHDs) and renal and cardiovascular outcomes. Methods: This was a historical prospective cohort study involving 312,489 newly treated hypertensive individuals (mean age 53.8 years, 90.9% males, 20.3% black, median follow-up 8.0 years). We used crude and Cox models adjusted for baseline socio-demographic characteristics, estimated glomerular filtration rate (eGFR), body mass index, blood pressure, comorbidities, and prospective AHD adherence (measured as proportion of days covered, PDC). Results: In the unadjusted analysis, the V15.81 code was associated with higher risks for faster eGFR decline (hazard ratio, HR 1.22, 95% CI 1.11-1.33), incident CKD (HR 1.17, 95% CI 1.09-1.27), end-stage renal disease (ESRD) (HR 2.53, 95% CI 1.72-3.72), incident coronary artery disease (CAD) (HR 1.26, 95% CI 1.15-1.38), and stroke (HR 1.55, 95% CI 1.38-1.73). In the adjusted model, the V15.81 code remained predictive of increased risk of CKD (HR 1.33, 95% CI 1.22-1.45), ESRD (HR 1.81, 95% CI 1.18-2.78), incident CAD (HR 1.26, 95% CI 1.14-1.40), and stroke (HR 1.46, 95% CI 1.29-1.65). Additional adjustment for PDC did not alter adverse associations between V15.81 code and studied outcomes. Conclusions: Assignment of V15.81 code prior to AHD therapy was associated with higher risks of renal and cardiovascular outcomes in incident hypertensive US veterans. Previous history of non-adherence is a poor prognostic marker in hypertensive individuals; therefore, patients with V15.81 code may require close monitoring. The observational nature of this study limits our ability to make firm recommendations for clinical practice.",antihyperkalemic agent;adult;African American;antihypertensive therapy;article;body mass;cardiovascular function;cerebrovascular accident;cerebrovascular disease;chronic liver disease;chronic lung disease;cohort analysis;comorbidity;coronary artery disease;correlational study;dementia;depression;diabetes mellitus;diastolic blood pressure;end stage renal disease;female;follow up;glomerulus filtration rate;high risk patient;human;Human immunodeficiency virus infection;hypertension;ICD-9-CM;kidney function;major clinical study;male;medication compliance;neoplasm;outcome assessment;patient compliance;peripheral vascular disease;priority journal;race;risk assessment;systolic blood pressure;veteran,"Gosmanova, E. O.;Molnar, M. Z.;Alrifai, A.;Lu, J. L.;Streja, E.;Cushman, W. C.;Kalantar-Zadeh, K.;Kovesdy, C. P.",2015,,,0,
1568,What is the extent of potentially avoidable admissions amongst hospital inpatients with palliative care needs?,"Background: There is clear evidence that the full range of services required to support people dying at home are far from being implemented, either in England or elsewhere. No studies to date have attempted to identify the proportion of hospital admissions that could have been avoided amongst patients with palliative care needs, given existing and current local services. This study aimed to examine the extent of potentially avoidable admissions amongst hospital patients with palliative care needs. Methods. A cross sectional survey of palliative care needs was undertaken in two acute hospitals in England. Appropriateness of admission was assessed by two Palliative Medicine Consultants using the following data collected from case notes: reasons for admission; diagnosis and co-morbidities; age and living arrangements; time and route of admission; medical and nursing plan on admission; specialist palliative care involvement; and evidence of cognitive impairment. Results: A total of 1359 inpatients were present in the two hospitals at the time of the census. Of the 654 consenting patients/consultees, complete case note data were collected for 580 patients; the analysis in this paper relates to these 580 patients. Amongst 208 patients meeting diagnostic and prognostic criteria for palliative care need in two acute settings in England, only 6.7% were identified as potentially avoidable hospitalisations. These patients had a median age of 84. Half of the patients lived in residential or nursing homes and it was concluded that most could have received care in this setting in place of hospital. Conclusion: Our findings challenge assumptions that, within the existing configuration of palliative and end of life health and social care services, patients with palliative care needs experience a high level of potentially avoidable hospitalisations. © 2013 Gott et al; licensee BioMed Central Ltd.",article;cerebrovascular accident;chronic obstructive lung disease;cognitive defect;comorbidity;cross-sectional study;dementia;female;frail elderly;heart disease;heart infarction;heart surgery;hospital admission;hospital patient;human;kidney failure;major clinical study;male;medical staff;neoplasm;nursing home;palliative therapy;transient ischemic attack;United Kingdom,"Gott, M.;Gardiner, C.;Ingleton, C.;Cobb, M.;Noble, B.;Bennett, M. I.;Seymour, J.",2013,,,0,
1569,Late life depression,"Depression has an overall prevalence of 5-8%. The prevalence of late life depression is estimated among people 65 years of age to be 15%. There is a great under-diagnosis and under-treatment of late life depression with the most serious consequence being premature death. Depression is also an important and independent risk factor for mortality following myocardial infarction, while patients with stroke associated with depression also have a higher death rate. The suicide rate is increased in elderly especially elderly men with depression. The aetiology of depression is more heterogeneous than depression in younger adults. Obviously age-related changes in the brain increase the risk for depression. Patients with neurodegenerative disorders also run a higher risk for being depressed. In Alzheimer's disease the frequency is around 50%. Deficiency of essential nutrients like folic acid and vitamin B12 is an obvious risk factor for both disorders with cognitive impairment and depression. Treatment of depression in the elderly follows the same lines as treatment of depression in younger patients. Many different drugs may be prescribed; however, the risk of adverse events is greater in the elderly. The drugs of choice are the selective serotonin re-uptake inhibitors (SSRIs), which have a response rate of around 65%. Of interest is that emotional disturbances like irritability, aggressiveness and anxiety also respond to treatment with SSRIs. A comprehensive treatment of late life depression, which includes social and psychological support, has a response rate of 80-90%.","Age of Onset;Aged;Brain/metabolism;Depressive Disorder, Major/*epidemiology/etiology/metabolism;Folic Acid/metabolism;Humans;Prevalence;Vitamin B 12/metabolism","Gottfries, C. G.",2001,,,0,
1570,Comorbidity profiles and their effect on treatment selection and survival among patients with lung cancer,"Rationale: Prior work has shown that the comorbidity burden is high among patients with lung cancer, but patterns of comorbid conditions have not been systematically identified. Objectives: We aimed to identify distinct comorbidity profiles in a large sample of patients with lung cancer and to examine the effect of comorbidity profiles on treatment and survival. Methods: In this retrospective cohort study, we used latent class analysis to identify comorbidity profiles (or classes) in a population-based sample of 6,662 patients with bronchogenic carcinoma diagnosed between 2008 and 2013. We included specific comorbid conditions from the Charlson comorbidity index. We used Cox proportional hazards analysis to examine the effect of comorbidity class on survival. Results: The mean age of the patients was 70 years, and 50% were female, 34% were nonwhite, and 17% were never-smokers. Most patients had stage III (21%) or IV (53%) disease. Over half (51%) had at least one comorbid condition, whereas 18% had at least four comorbidities. Latent class analysis identified five distinct comorbidity classes. Classes were defined by progressively greater Charlson comorbidity index scores and were further distinguished by the presence or absence of specific types of vascular disease and diabetes. Comorbidity class was independently associated with treatment selection (P, 0.001) and survival (P, 0.0001), especially among patients with stages 0–II disease (P, 0.0001). Conclusions: Patients with lung cancer can be described by distinct comorbidity profiles that are independent predictors of treatment and survival. These profiles provide a more nuanced understanding of how comorbidities cluster within patients with lung cancer and how they can be applied for descriptive purposes or in research.",antineoplastic agent;acquired immune deficiency syndrome;aged;article;cancer chemotherapy;cancer radiotherapy;cancer staging;cancer surgery;cancer survival;cancer therapy;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;female;heart failure;heart infarction;hemiplegia;human;Human immunodeficiency virus infection;kidney disease;large cell lung carcinoma;latent class analysis;liver disease;lung adenocarcinoma;lung cancer;lung carcinoma;major clinical study;male;malignant neoplasm;metastasis;paraplegia;peptic ulcer;peripheral vascular disease;retrospective study;rheumatic disease;small cell lung cancer;squamous cell lung carcinoma;vascular disease,"Gould, M. K.;Munoz-Plaza, C. E.;Hahn, E. E.;Lee, J. S.;Parry, C.;Shen, E.",2017,,10.1513/AnnalsATS.201701-030OC,0,
1571,Perioperative complications and mortality after spinal fusions: Analysis of trends and risk factors,"Study Design: Retrospective review. Objective: To analyze the trends in complications and mortality after spinal fusions. Summary of Background Data: Utilization of spinal fusions has been increasing during the past decade. It is essential to evaluate surgical outcomes to better identify patients who benefit most from surgical intervention. Integration of empiric evidence from large administrative databases into clinical decision making is instrumental in providing higher-quality, evidence-based, patient-centered care. Methods: This study used Nationwide Inpatient Sample data from 2001 through 2010. Patients who underwent spinal fusions were identified using the CCS (Clinical Classifications Software) and ICD-9 (International Classification of Diseases, 9th Revision) codes. Data on patient comorbidities, primary diagnosis, and postoperative complications were obtained via ICD-9 diagnosis codes and via CCS categories. National estimates were calculated using weights provided as part of the database. Time trend analysis for average length of stay, total charges, mortality, and comorbidity burden was performed. Univariate and multivariate models were constructed to identify predictors of mortality and postoperative complications. Results: An estimated 3,552,873 spinal fusions were performed in the United States between 2001 and 2010. The national bill for spinal fusions increased from $10 billion to $46.8 billion. Today, patients are older and have a greater comorbidity burden than 10 years ago. Mortality remained relatively constant at 0.46%, 1.2%, and 0.14% for cervical, thoracic, and lumbar fusions, respectively. Morbidity rates showed an increasing trend at all levels. Multivariate analysis of 19 procedures and patient-related risk factors and 9 perioperative complications identified 85 statistically significant (P< 0.01) interactions. Conclusion: The data on perioperative risks and risk factors for postoperative complications of spinal fusions presented in this study is pivotal to appropriate surgical patient selection and well-informed risk-benefit evaluation of surgical intervention. © 2013 Lippincott Williams & Wilkins.",adult respiratory distress syndrome;anemia;article;Charlson Comorbidity Index;comorbidity;congestive heart failure;dementia;diabetes mellitus;health care cost;heart infarction;human;ICD-9;kidney failure;length of stay;liver disease;lymphoma;metastasis;neurologic disease;peripheral vascular disease;peroperative complication;postoperative complication;priority journal;retrospective study;spine fusion;spine injury;spine malformation;surgical mortality;valvular heart disease;weight reduction,"Goz, V.;Weinreb, J. H.;McCarthy, I.;Schwab, F.;Lafage, V.;Errico, T. J.",2013,,,0,
1572,End-of-life transitions among nursing home residents with cognitive issues,"BACKGROUND: Health care transitions in the last months of life can be burdensome and potentially of limited clinical benefit for patients with advanced cognitive and functional impairment. METHODS: To examine health care transitions among Medicare decedents with advanced cognitive and functional impairment who were nursing home residents 120 days before death, we linked nationwide data from the Medicare Minimum Data Set and claims files from 2000 through 2007. We defined patterns of transition as burdensome if they occurred in the last 3 days of life, if there was a lack of continuity in nursing homes after hospitalization in the last 90 days of life, or if there were multiple hospitalizations in the last 90 days of life. We also considered various factors explaining variation in these rates of burdensome transition. We examined whether there was an association between regional rates of burdensome transition and the likelihood of feeding-tube insertion, hospitalization in an intensive care unit (ICU) in the last month of life, the presence of a stage IV decubitus ulcer, and hospice enrollment in the last 3 days of life. RESULTS: Among 474,829 nursing home decedents, 19.0% had at least one burdensome transition (range, 2.1% in Alaska to 37.5% in Louisiana). In adjusted analyses, blacks, Hispanics, and those without an advance directive were at increased risk. Nursing home residents in regions in the highest quintile of burdensome transitions (as compared with those in the lowest quintile) were significantly more likely to have a feeding tube (adjusted risk ratio, 3.38), have spent time in an ICU in the last month of life (adjusted risk ratio, 2.10), have a stage IV decubitus ulcer (adjusted risk ratio, 2.28), or have had a late enrollment in hospice (adjusted risk ratio, 1.17). CONCLUSIONS: Burdensome transitions are common, vary according to state, and are associated with markers of poor quality in end-of-life care. (Funded by the National Institute on Aging.). Copyright © 2011 Massachusetts Medical Society. All rights reserved.",age distribution;aged;Alzheimer disease;article;caregiver burden;chronic obstructive lung disease;cognitive defect;congestive heart failure;controlled study;daily life activity;diabetes mellitus;feeding apparatus;female;functional disease;geographic distribution;health care delivery;health care quality;health care utilization;health status;hip fracture;hospitalization;human;intensive care unit;major clinical study;male;nursing home patient;outcome assessment;pneumonia;priority journal;risk assessment;risk factor;cerebrovascular accident;terminal care,"Gozalo, P.;Teno, J. M.;Mitchell, S. L.;Skinner, J.;Bynum, J.;Tyler, D.;Mor, V.",2011,,,0,
1573,Vascular and biochemical risk factors of vascular dementia after lacunar strokes (S-VaD) and after multiinfarcts in strategic areas (M-VaD),"Vascular cognitive impairment is an important cause of cognitive decline in the elderly. Ischemic lesions in the brain have an influence on the natural history of dementia. Vascular dementia can be caused by small-vessels disease (S-VaD) or by large-artery atherosclerosis with vascular lesions in strategic areas of the brain (M-VaD). In both cases changes in white matter are observed. In 60 patients with S-VaD and in 34 with M-VaD the presence of vascular and biochemical risk factors was evaluated and compared to age and sex matched 126 controls without dementia. Coronary artery disease, atrial fibrillation, hypertension and strokes were observed more frequently in both investigated groups. Of biochemical risk factors, hyperhomocysteinemia (associated with low levels of folic acid and vitamin B 12) and low HDL cholesterol levels were found in both forms of VaD. © 2009 Elsevier B.V. All rights reserved.",cyanocobalamin;folic acid;high density lipoprotein cholesterol;homocysteine;adult;aged;article;atherosclerosis;controlled study;coronary artery disease;female;atrial fibrillation;human;hyperhomocysteinemia;hypertension;lacunar stroke;major clinical study;male;multiinfarct dementia;priority journal;risk assessment;risk factor;cerebrovascular accident;white matter,"Graban, A.;Bednarska-Makaruk, M.;Bochyńska, A.;Lipczyńska- Łojkowska, W.;Ryglewicz, D.;Wehr, H.",2009,,,0,
1574,"Safety of tacrine: Clinical trials, treatment IND, and postmarketing experience","The safety of tacrine (Cognex®), a centrally active, reversible acetylcholinesterase inhibitor approved in 1993 for the treatment of mild to moderate dementia of the Alzheimer type, was evaluated in 2706 patients with Alzheimer disease (AD) in clinical trials and in 9861 patients with AD in a treatment investigational new drug (TIND) program. More than 190,000 patients in the United States received tacrine during the first 2 years following marketing approval. The most common tacrine-associated adverse events were elevated liver transaminase levels [alanine aminotransferase (ALT) and, to a lesser degree, aspartate aminotransferase] and peripheral cholinergic events involving primarily the digestive system (nausea, vomiting, diarrhea, dyspepsia, anorexia, and weight loss). Based on clinical trial experience, potentially clinically significant (> 3 x upper limit of normal) ALT elevations occurred in 25% of patients, requiring routine monitoring early in treatment. The elevations were almost always asymptomatic, rarely accompanied by significant increases in bilirubin, and related to time on drug rather than to dose (90% occurred within the first 12 weeks of treatment). Gastrointestinal events were related to dose and generally of mild to moderate intensity. Tacrine-associated events, including ALT elevations, were reversible. Cholinergic events were manageable with dosage adjustment. Tacrine was not associated with permanent liver injury in clinical trials or a TIND setting.",alanine aminotransferase;aminotransferase;aspartate aminotransferase;bilirubin;cholinesterase inhibitor;tacrine;abdominal pain;adult;aged;agitation;Alzheimer disease;anorexia;article;ataxia;cerebrovascular accident;clinical trial;confusion;controlled clinical trial;controlled study;convulsion;dehydration;diarrhea;digestive system;digestive system ulcer;drug safety;dyspepsia;female;flatulence;fracture;gastrointestinal hemorrhage;heart arrest;heart infarction;human;liver function;liver injury;major clinical study;male;pneumonia;priority journal;prostate carcinoma;rash;faintness;thorax pain;tremor;United States;vomiting;weight reduction;cognex,"Gracon, S. I.;Knapp, M. J.;Berghoff, W. G.;Pierce, M.;DeJong, R.;Lobbestael, S. J.;Symons, J.;Dombey, S. L.;Luscombe, F. A.;Kraemer, D.",1998,,,0,
1575,Diurnal variation of the serum cortisol level of geriatric subjects,,Aged;*Aging;*Circadian Rhythm;Coronary Disease/blood;Dementia/blood;Diabetes Mellitus/blood;Female;Heart Failure/blood;Humans;Hydrocortisone/*blood;Intracranial Arteriosclerosis/blood;Male;Statistics as Topic,"Grad, B.;Rosenberg, G. M.;Liberman, H.;Trachtenberg, J.;Kral, V. A.",1971,Jul,,0,
1576,"End-of-life medications draw more attention, greater scrutiny",,bisphosphonic acid derivative;cholinesterase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;memantine;advanced cancer;Alzheimer disease;cardiovascular disease;cerebrovascular accident;dementia;drug efficacy;drug use;drug withdrawal;heart infarction;human;life expectancy;myalgia;palliative therapy;patient decision making;polypharmacy;prescription;randomized controlled trial (topic);short survey;terminal care;terminal disease,"Graham, J.",2015,,,0,
1577,Disability-adjusted life years: An instrument for defining public health priorities?,"Background: The objective of this paper is the study of a health indicator allowing surveillance and evaluation of the overall health of the Paris population, and providing information to help prioritize possible choices among preventive and curative actions. Moreover, comparison between results obtained for Paris with a global health indicator, ""Disability-adjusted life years"" (DALYs) and available bibliographical data will enable clarifying some points about summary measures of health. Methods: The method used is that of the Global Burden of Disease. It allows a ranking of diseases using an indicator called DALYs. This indicator integrates mortality and morbidity components by summing expected years of life lost due to premature mortality and calculated years of healthy life lost. DALYs were calculated using local mortality data and published regional disabilities tables from the World Health Organisation (WHO). Results: There were a total of 242 061 DALYs for Paris for the year 1999. The six leading specific causes are: alcoholic psychosis and dependence (accounting for 6.5% of the total), lung cancers (5.7%), ischaemic hearth disease (4.8%), depression (4.4%), dementias (4.2%), and arthritis (3.9%). Men contributed the majority of DALYs for the first three. For four of the six leading causes, the majority of DALYs came from years lived with disability, rather than mortality. Only for lung cancer and ischaemic hearth disease was the majority of DALYs from years of life lost by mortality. Conclusion: The results for Paris are used to illustrate how DALYs can illuminate debates about public health priorities. Such data can inform the population about health condition and provide decision makers with global health indicators. The next step will be to estimate the DALYs from local morbidity data when available, and compare these results to those based on the World Health Organisation tables, which are not sensitive to local results other than those due to mortality. Future steps include further evaluation and development of this method for surveillance, assessment and evaluation of public health actions. However, some of the results obtained with this indicator underline the limits of this kind of analysis. © Masson, 2005.",alcohol psychosis;alcoholism;arthritis;article;decision making;dementia;depression;disability;health survey;human;ischemic heart disease;lung cancer;mortality;public health;quality adjusted life year;world health organization,"Granados, D.;Lefranc, A.;Reiter, R.;Grémy, I.;Spira, A.",2005,,,0,
1578,Reversible Mild Cognitive Impairment: The Role of Comorbidities at Baseline Evaluation,"The prognostic value of mild cognitive impairment (MCI) is being questioned, with some MCI subjects reverting to normal cognition (NC). The reversion rate varies mostly depending on the study design, the setting, and both MCI and NC definitions. Previous studies have focused on the profile of subjects who revert to NC, but the role of comorbidities has not been entirely investigated. We aimed to evaluate the proportion of MCI subjects who revert to NC in a memory clinic context, focusing on the role of comorbidities. Between 2004 and 2013, 374 MCI subjects were recruited. During a mean time of 32 ± 25.5 months, 21 subjects (5.6) reverted to NC. Subjects who reverted to NC were younger (p = 0.0001), more educated (p = 0.0001), had a better global cognition (p = 0.0001), as assessed by the Mini-Mental State Examination (MMSE) and suffered from more comorbidities (p = 0.002), as assessed by Cumulative Illness Rating Scale (CIRS) than those who developed dementia. The Cox Regression Model, constructed to adjust for the confounders, showed that the higher were the MMSE (HR = 1.83, CI 95: 1.07-3.11) and the CIRS score (HR = 1.3, CI 95 0.88-1.92) at baseline, the higher was the probability of returning to NC than developing dementia, though the last association was not significant. Subjects who reverted to NC were more frequently affected by respiratory (p = 0.002), urologic (p = 0.012), and psychiatric (p = 0.012) diseases. The cognitive performance of subjects with medical comorbidities could benefit from preventive strategies aimed at treating the underlying diseases.",aged;angina pectoris;article;assessment of humans;atrial fibrillation;cerebrovascular disease;clinical evaluation;cognition;cohort analysis;comorbidity;cumulative illness rating scale;dementia;diabetes mellitus;diffuse Lewy body disease;educational status;female;follow up;frontotemporal dementia;genotype;heart infarction;human;hypertension;major clinical study;male;mental disease;mental performance;mild cognitive impairment;Mini Mental State Examination;multiinfarct dementia;Parkinson disease;priority journal;prospective study;respiratory tract disease;urinary tract disease,"Grande, G.;Cucumo, V.;Cova, I.;Ghiretti, R.;Maggiore, L.;Lacorte, E.;Galimberti, D.;Scarpini, E.;Clerici, F.;Pomati, S.;Vanacore, N.;Mariani, C.",2016,,,0,
1579,Food for thought ... and health: Making a case for plant-based nutrition,,calcium;estrogen;glucose;insulin;protein;vitamin D;Alzheimer disease;breast cancer;cancer risk;cardiovascular risk;cholelithiasis;colorectal cancer;coronary artery disease;dementia;diabetic neuropathy;dietary intake;diverticulosis;egg;fish;gallstone;general practitioner;glycemic control;health care access;health status;hypercholesterolemia;hyperlipidemia;hypertension;information dissemination;insulin resistance;ischemic heart disease;kidney cancer;microalbuminuria;milk;mortality;non insulin dependent diabetes mellitus;note;nutrition education;nutritional assessment;nutritional health;obesity;osteoporosis;poultry;prostate cancer;red meat;age related macular degeneration;skinfold thickness;testis cancer;vegetarian diet,"Grant, J. D.",2012,,,0,
1580,Sufficient knowledge of the health benefits of vitamin D exists to modify public health recommendations now,,calcium;vitamin D;cancer incidence;cancer risk;dementia;heart failure;human;influenza;ischemic heart disease;letter;melanoma;priority journal;public health;respiratory tract disease;skin cancer;ultraviolet B radiation;vitamin supplementation,"Grant, W. B.",2009,,,0,
1581,Health benefits of higher serum 25-hydroxyvitamin D levels in The Netherlands,"A large and rapidly expanding body of scientific literature exists on the roles of vitamin D in maintaining optimal health and reducing the risk of chronic and infectious diseases. Serum 25-hydroxyvitamin D [25(OH)D] levels for optimal health are in the range of 100-150 nmol/L; mean population values in The Netherlands are around 50-63 nmol/L. Health problems for which there exists good observational evidence and some randomized controlled trial evidence that vitamin D reduces risk include many types of cancer, cardiovascular disease, diabetes mellitus, bacterial and viral infections, autoimmune diseases, osteoporosis, falls and fractures, dementia, congestive heart failure, and adverse pregnancy outcomes. Reductions in incidence and mortality rates for various diseases and all-cause mortality rates can be determined from ecological, observational and cross-sectional studies and randomized controlled trials. For The Netherlands, raising mean serum 25(OH)D levels to 105 nmol/L is estimated to reduce specific disease rates by 10-50% and all-cause mortality rates by 18%. To raise serum 25(OH)D levels by this amount, inhabitants in The Netherlands would have to increase vitamin D production or oral intake by 2500-4000 IU/day. Doing so would pose only minimal increased risks of melanoma or skin cancer or hypercalcemia.",Adult;Antimicrobial Cationic Peptides/*therapeutic use;Cardiovascular Diseases/*prevention & control;Communicable Disease Control;Communicable Diseases/metabolism;Diet Therapy/methods;Dietary Supplements;Disease/genetics;Humans;Middle Aged;Netherlands;Risk;Ultraviolet Rays;Vitamin D/*analogs & derivatives/blood/metabolism,"Grant, W. B.;Schuitemaker, G. E.",2010,Jul,10.1016/j.jsbmb.2010.03.089,0,
1582,Choroid plexus transcytosis and exosome shuttling deliver folate into brain parenchyma,"Loss of folate receptor-α function is associated with cerebral folate transport deficiency and childhood-onset neurodegeneration. To clarify the mechanism of cerebral folate transport at the blood-cerebrospinal fluid barrier, we investigate the transport of 5-methyltetrahydrofolate in polarized cells. Here we identify folate receptor-α-positive intralumenal vesicles within multivesicular bodies and demonstrate the directional cotransport of human folate receptor-α, and labelled folate from the basolateral to the apical membrane in rat choroid plexus cells. Both the apical medium of folate receptor-α-transfected rat choroid plexus cells and human cerebrospinal fluid contain folate receptor-α-positive exosomes. Loss of folate receptor-α-expressing cerebrospinal fluid exosomes correlates with severely reduced 5-methyltetrahydrofolate concentration, corroborating the importance of the folate receptor-α-mediated folate transport in the cerebrospinal fluid. Intraventricular injections of folate receptor-α- positive and-negative exosomes into mouse brains demonstrate folate receptor-α-dependent delivery of exosomes into the brain parenchyma. Our results unravel a new pathway of folate receptor-α-dependent exosome-mediated folate delivery into the brain parenchyma and opens new avenues for cerebral drug targeting. © 2013 Macmillan Publishers Limited. All rights reserved.",5 methyltetrahydrofolic acid;CD63 antigen;flotillin 1;flotillin 2;folate receptor 1;folic acid;glyceraldehyde 3 phosphate dehydrogenase;methotrexate;multidrug resistance protein 1;multidrug resistance protein 4;phospholipase C;taurocholic acid;transferrin receptor;adolescent;apical membrane;article;astrocyte;blood cerebrospinal fluid barrier;cellular distribution;cerebrospinal fluid;child;choroid plexus;controlled study;drug targeting;electron microscopy;exosome;female;human;human cell;immunofluorescence microscopy;immunohistochemistry;Kearns Sayre syndrome;male;mass spectrometry;multivesicular body;mutational analysis;parenchyma;preschool child;protein analysis;protein expression;protein localization;protein transport;transcytosis;Western blotting,"Grapp, M.;Wrede, A.;Schweizer, M.;Hüwel, S.;Galla, H. J.;Snaidero, N.;Simons, M.;Bückers, J.;Low, P. S.;Urlaub, H.;Gärtner, J.;Steinfeld, R.",2013,,,0,
1583,Achievements of developmental biology and the resultant ethical and social dilemmas. Lecture in the Academy of Athens,"Looking at the frontiers of developmental biology, there is justifiable excitement and optimism as investigators are unraveling the secrets of how a single fertilized egg goes through the complex and beautifully orchestrated series of changes that create an entire organism. The great majority of one hundred leading developmental biologists who were recently asked what they thought were the most important questions in their field, listed the following: how the body's specialized organs and tissues are formed, how patterns form in the embryo that tell different parts what to become, how cells receive and respond to signals during development, and how individual cells become committed to particular developmental fates. Although morphogenesis is not by any means the first stage of the embryo's development, it was nevertheless chosen by these scientists as the most important field, as developmental biology enters its second century. Thus, if the early steps of development take place in the control room, then morphogenesis is what happens on the factory floor, the actual assembly of the tissues and organs, such as the finished heart, brain and kidneys of the organism. To understand morphogenesis, one needs to go from the molecule to the cell behavior, to the mechanics. Although cell movements are an essential part of morphogenesis, cells also need to know when to stop growing and when to die, in order to sculpt the tissues and give them their final form. During the formation of hands and feet, for instance, cells must die to produce the spaces between the fingers and toes. A prime example, is the heart's foresight during embryonic development regarding the morphogenesis of one of its important structures, namely the conduction system, the heart's signal superhighway. This system, although essential for fetal survival, does not reach its final form until early adult life. Although the exact stimulus for this housekeeping morphogenetic process is not clear, the question remains how the heart accomplishes this important task of getting rid of the excess fetal tissues when they are no longer necessary. Nature makes available an alternative form of cell death that does not excite any noticeable reaction which may disturb the order of structures the heart wants to preserve. This is, in biological terms, a form of death without concomitant inflammation, notorious for creating havoc. This alternative manner of death has been called programmed cell death, perhaps a form of cell suicide, an altruistic suicide, also known among scientists as apoptosis, an obvious Greek term meaning dropping-off. Experts in developmental biology predict that the next ten years will be 'a decade outside the nucleus', as more and more attention is shifted to another class of molecules: those that carry signals betwen cells and then within the cell. Understandably, communication between cells is crucial throughout development. For example, in the early frog embryo, a protein called Noggin is produced by a group of cells called the organizer and causes neighboring cells to become the precursors of the nervous system. Nature's conservative ways are also apparent in the use of the same signal transduction pathways to accomplish many tasks. For example, a protein called Ras controls developmental tasks ranging from the making of a fruit fly eye to the formation of sex organs in a certain worm. The question, how to incorporate developmental research into clinical practice, has been answered by cell biologists and the biomedical industry, who are exploring a variety of approaches to harnessing the embryo's generative powers in order to provide new therapies for disorders as diverse as blindness, heart failure, diabetes, Alzheimer's disease, Parkinson's disease, hard to heal wounds, and bone fractures. We need to recognize that the adult does not possess the same full range of biological skills, but if similar capacities could be bestowed at will upon the adult human, many diseases could be cured simply by growing new tissues to replace damaged ones.",Ras protein;apoptosis;cell death;cell differentiation;developmental biology;embryo development;ethics;heart development;heart muscle conduction system;morphogenesis;short survey;signal transduction;social aspect,"Gravanis, M. B.",1995,,,0,
1584,Atrial fibrillation incrementally increases dementia risk across all CHADS2 and CHA2DS2VASc strata in patients receiving long-term warfarin,"BACKGROUND: Patients with atrial fibrillation (AF) are at higher risk for developing dementia. Warfarin is a common therapy for the prevention of thromboembolism in AF, valve replacement, and thrombosis patients. The extent to which AF itself increases dementia risk remains unknown. METHODS: A total 6030 patients with no history of dementia and chronically anticoagulated with warfarin were studied. Warfarin management was provided through a Clinical Pharmacy Anticoagulation Service. Patients were stratified by warfarin indication of AF (n=3015) and non-AF (n=3015) and matched by propensity score (+/-0.01). Patients were stratified by the congestive heart failure, hypertension, age >75 years, diabetes, stroke (CHADS2) score calculated at the time of warfarin initiation and followed for incident dementia. RESULTS: The average age of the AF cohort was 69.3+/-11.2 years, and 52.7% were male; average age of non-AF cohort was 69.3+/-10.9 years, and 51.5% were male. Increasing CHADS2 score was associated with increased dementia incidence, P trend=.004. When stratified by warfarin indication, AF patients had an increased risk of dementia incidence. After multivariable adjustment, AF patients continued to display a significantly increased risk of dementia when compared with non-AF patients across all CHADS2 scores strata. CONCLUSIONS: In patients receiving long-term warfarin therapy, dementia risk increased with increasing CHADS2 scores. However, the presence of AF was associated with higher rates of dementia across all CHADS2 score strata. These data suggest that AF contributes to the risk of dementia and that this risk is not solely attributable to anticoagulant use. Dementia may be an end manifestation of a systemic disease state, and AF likely contributes to its progression.",0 (Anticoagulants);5Q7ZVV76EI (Warfarin);Aged;Anticoagulants/administration & dosage;Atrial Fibrillation/complications/ drug therapy;Dementia/epidemiology/ etiology;Female;Follow-Up Studies;Humans;Incidence;Male;Retrospective Studies;Risk Assessment;Risk Factors;Thromboembolism/etiology/ prevention & control;Time Factors;United States/epidemiology;Warfarin/ administration & dosage,"Graves, K. G.;May, H. T.;Jacobs, V.;Bair, T. L.;Stevens, S. M.;Woller, S. C.;Crandall, B. G.;Cutler, M. J.;Day, J. D.;Mallender, C.;Osborn, J. S.;Peter Weiss, J.;Jared Bunch, T.",2017,Jun,,0,
1585,Benzodiazepine use and risk of incident dementia or cognitive decline: Prospective population based study,"OBJECTIVE: To determine whether higher cumulative use of benzodiazepines is associated with a higher risk of dementia or more rapid cognitive decline. DESIGN: Prospective population based cohort. SETTING: Integrated healthcare delivery system, Seattle, Washington. PARTICIPANTS: 3434 participants aged ≥65 without dementia at study entry. There were two rounds of recruitment (1994-96 and 2000-03) followed by continuous enrollment beginning in 2004. MAIN OUTCOMES MEASURES: The cognitive abilities screening instrument (CASI) was administered every two years to screen for dementia and was used to examine cognitive trajectory. Incident dementia and Alzheimer's disease were determined with standard diagnostic criteria. Benzodiazepine exposure was defined from computerized pharmacy data and consisted of the total standardized daily doses (TSDDs) dispensed over a 10 year period (a rolling window that moved forward in time during follow-up). The most recent year was excluded because of possible use for prodromal symptoms. Multivariable Cox proportional hazard models were used to examine time varying use of benzodiazepine and dementia risk. Analyses of cognitive trajectory used linear regression models with generalized estimating equations. RESULTS: Over a mean follow-up of 7.3 years, 797 participants (23.2%) developed dementia, of whom 637 developed Alzheimer's disease. For dementia, the adjusted hazard ratios associated with cumulative benzodiazepine use compared with non-use were 1.25 (95% confidence interval 1.03 to 1.51) for 1-30 TSDDs; 1.31 (1.00 to 1.71) for 31-120 TSDDs; and 1.07 (0.82 to 1.39) for ≥121 TSDDs. Results were similar for Alzheimer's disease. Higher benzodiazepine use was not associated with more rapid cognitive decline. CONCLUSION: The risk of dementia is slightly higher in people with minimal exposure to benzodiazepines but not with the highest level of exposure. These results do not support a causal association between benzodiazepine use and dementia.",alprazolam;benzodiazepine;chlordiazepoxide;clonazepam;clorazepate;diazepam;eszopiclone;flurazepam;lorazepam;oxazepam;temazepam;triazolam;zaleplon;zolpidem;age distribution;aged;Alzheimer disease;article;cerebrovascular accident;cognitive abilities screening instrument;cognitive defect;cognitive function test;cohort analysis;controlled study;dementia;depression;drug exposure;female;follow up;high risk population;human;hypertension;incidence;integrated health care system;ischemic heart disease;major clinical study;male;population research;prescription;priority journal;prodromal symptom;prospective study;United States,"Gray, S. L.;Dublin, S.;Yu, O.;Walker, R.;Anderson, M.;Hubbard, R. A.;Crane, P. K.;Larson, E. B.",2016,,,0,
1586,Increased BACE1-AS long noncoding RNA and beta-amyloid levels in heart failure,"Aims: Antisense long noncoding RNAs (ncRNAs) are transcripts emerging from the opposite strand of a coding-RNA region and their role in heart failure (HF) is largely unknown. Additionally, HF and Alzheimer's disease (AD) share several non-genetic effectors and risk factors. We investigated the regulation of the beta-secretase-1 (BACE1) gene and of its antisense transcript BACE1-AS in ischaemic HF. Methods and results: BACE1 and BACE1-AS expression was measured in left ventricle biopsies from 18 patients affected by non-end stage ischaemic HF and 17 matched controls. The levels of both transcripts were increased in HF patients. Likewise, both transcripts increased also in a mouse model of ischaemic HF, and their expression was directly correlated. BACE1-AS was expressed by all cardiac cell types and BACE1-AS up- or down-modulation in cultured cardiomyocytes and endothelial cells induced a concordant regulation of the cognate BACE1 transcript. Interestingly, BACE1 increase also induced the intracellular accumulation of its product beta-amyloid. In keeping with these findings, higher BACE1 protein and beta-amyloid peptide levels were also observed in HF. Moreover, increased beta-amyloid 1-40 was also found in the plasma of HF patients. Transcriptomic changes of BACE1-AS overexpressing and beta-amyloid 1-40 treated cells were largely overlapping and indicated changes of relevant biological process such as 'cell cycle and proliferation', 'apoptosis', and 'DNA repair' as well as 'TGFbeta-, TNFalpha-, p38-, EGFR-signalling', suggesting a potential maladaptive role of the BACE1-AS/BACE1/beta-amyloid axis. Accordingly, the administration of beta-amyloid peptides decreased the cell viability in endothelial cells and in both human IPS-derived and mouse cardiomyocytes. Moreover, both beta-amyloid treatment and BACE1-AS overexpression increased endothelial cell apoptosis, and this effect was prevented by BACE1 silencing. Conclusion: Given the neurotoxic role of beta-amyloid in AD, dysregulation of the BACE1/BACE1-AS/beta-amyloid axis might be relevant in HF pathogenesis, further implicating ncRNAs in the complex scenario of proteotoxicity in cardiac dysfunction.","0 (Amyloid beta-Peptides);0 (BACE1-AS long non-coding RNA, human);0 (RNA, Long Noncoding);0 (RNA, Messenger);0 (long non-coding RNA BACE1-AS, mouse);EC 3.4.- (Amyloid Precursor Protein Secretases);EC 3.4.23.- (Aspartic Acid Endopeptidases);EC 3.4.23.46 (BACE1 protein, human);EC 3.4.23.46 (Bace1 protein, mouse);Aged;Amyloid Precursor Protein Secretases/genetics/metabolism;Amyloid beta-Peptides/blood/genetics/ metabolism;Animals;Apoptosis;Aspartic Acid Endopeptidases/genetics/metabolism;Case-Control Studies;Cell Survival;Cells, Cultured;Disease Models, Animal;Endothelial Cells/ metabolism/pathology;Female;Heart Failure/genetics/ metabolism/pathology;Humans;Induced Pluripotent Stem Cells/metabolism/pathology;Male;Mice;Middle Aged;Myocytes, Cardiac/ metabolism/pathology;RNA Interference;RNA, Long Noncoding/genetics/ metabolism;RNA, Messenger/genetics/metabolism;Transcriptome;Transfection;Up-Regulation;Amyloid;Bace1;Bace1-as;Heart failure;Long noncoding RNA","Greco, S.;Zaccagnini, G.;Fuschi, P.;Voellenkle, C.;Carrara, M.;Sadeghi, I.;Bearzi, C.;Maimone, B.;Castelvecchio, S.;Stellos, K.;Gaetano, C.;Menicanti, L.;Martelli, F.",2017,Apr 01,,0,
1587,Decision-Making Experiences of Patients with Implantable Cardioverter Defibrillators,"Background: When patients are not adequately engaged in decision making, they may be at risk of decision regret. Our objective was to explore patients’ perceptions of their decision-making experiences related to implantable cardioverter defibrillators (ICDs). Methods: Cross-sectional, mailed survey of 412 patients who received an ICD without cardiac resynchronization therapy for any indication between 2006 and 2009. Patients were asked about decision participation and decision regret. Results: A total of 295 patients with ICDs responded (72% response rate). Overall, 79% reported that they were as involved in the decision as they wanted. However, 28% reported that they were not told of the option of not getting an ICD and 37% did not remember being asked if they wanted an ICD. In total, 19% reported not wanting their ICD at the time of implantation. Those who did not want the ICD were younger (<65 years; 74% vs 43%, P < 0.001), had higher decision regret (31/100 vs 11/100, P < 0.001), and reported less participation in decision making (the doctor “totally” made the decision, 9% vs 3%; P < 0.001). Conclusions: A considerable number of ICD recipients recalled not wanting their ICD at the time of implantation. While these findings may be prone to recall bias, they likely identify opportunities to improve ICD decision making.",adult;age;aged;anxiety;article;cardiac resynchronization therapy;cerebrovascular accident;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;coronary artery disease;cross-sectional study;defibrillation;dementia;depression;doctor patient relation;female;heart failure;human;hypertension;implantable cardioverter defibrillator;insulin dependent diabetes mellitus;interpersonal communication;kidney failure;lifespan;liver disease;major clinical study;male;malignant neoplastic disease;medical decision making;middle aged;non insulin dependent diabetes mellitus;patient decision making;physician attitude;quality of life;recall bias;shared decision making;treatment indication;United States;very elderly,"Green, A. R.;Jenkins, A.;Masoudi, F. A.;Magid, D. J.;Kutner, J. S.;Leff, B.;Matlock, D. D.",2016,,,0,
1588,Geriatric Conditions in Patients Undergoing Defibrillator Implantation for Prevention of Sudden Cardiac Death: Prevalence and Impact on Mortality,"Background - Geriatric conditions may influence outcomes among patients receiving implantable cardioverter-defibrillators (ICDs). We sought to determine the prevalence of frailty and dementia among older adults receiving primary prevention ICDs and to determine the impact of multimorbidity on mortality within 1 year of ICD implantation. Methods and Results - The cohort included 83 792 Medicare patients from the National Cardiovascular Data Registry ICD Registry who underwent first primary prevention ICD implantation between 2006 and 2009. These data were merged with Medicare analytic files to determine the prevalence of frailty, dementia, and other conditions before ICD implantation, as well as 1-year mortality. A validated claim-based algorithm was used to identify frail patients. Mutually exclusive patterns of chronic conditions were examined. The association of each pattern with 1-year mortality was assessed using logistic regression models adjusted for selected patient characteristics. Approximately 1 in 10 Medicare patients with heart failure receiving a primary prevention ICD had frailty (10%) or dementia (1%). One-year mortality was 22% for patients with frailty, 27% for patients with dementia, and 12% in the overall cohort. Several multimorbidity patterns were associated with high 1-year mortality rates: dementia with frailty (29%), frailty with chronic obstructive pulmonary disease (25%), and frailty with diabetes mellitus (23%). These patterns were present in 8% of the cohort. Conclusions - More than 10% of Medicare beneficiaries with heart failure receiving primary prevention ICDs have frailty or dementia. These patients had significantly higher 1-year mortality than those with other common chronic conditions. Frailty and dementia should be considered in clinical decision-making and guideline development.",aged;article;cardiovascular mortality;chronic obstructive lung disease;cohort analysis;dementia;diabetes mellitus;female;frail elderly;heart failure;heart left ventricle ejection fraction;human;implantable cardioverter defibrillator;major clinical study;male;medicare;pacemaker implantation;prevalence;primary prevention;priority journal;register;sudden cardiac death,"Green, A. R.;Leff, B.;Wang, Y.;Spatz, E. S.;Masoudi, F. A.;Peterson, P. N.;Daugherty, S. L.;Matlock, D. D.",2016,,,0,
1589,"Effects of Exercise on Vascular Function, Structure, and Health in Humans","Physical activity has profound impacts on the vasculature in humans. Acute exercise induces immediate changes in artery function, whereas repeated episodic bouts of exercise induce chronic functional adaptation and, ultimately, structural arterial remodeling. The nature of these changes in function and structure are dependent on the characteristics of the training load and may be modulated by other factors such as exercise-induced inflammation and oxidative stress. The clinical implications of these physiological adaptations are profound. Exercise impacts on the development of atherosclerosis and on the incidence of primary and secondary cardiovascular events, including myocardial infarction and stroke. Exercise also plays a role in the amelioration of other chronic diseases that possess a vascular etiology, including diabetes and dementia. The mechanisms responsible for these effects of exercise on the vasculature are both primary and secondary in nature, in that the benefits conferred by changes in cardiovascular risk factors such as lipid profiles and blood pressure occur in concert with direct effects of arterial shear stress and mechanotransduction. From an evolutionary perspective, exercise is an essential stimulus for the maintenance of vascular health: exercise is vascular medicine.",,"Green, D. J.;Smith, K. J.",2017,Apr 21,,0,
1590,Emergency laparotomy in octogenarians: A 5-year study of morbidity and mortality,"AIM: To determine the morbidity and mortality associated with emergency laparotomy for a clinically acute abdomen in patients aged >/= 80 years. METHODS: In this retrospective audit, octogenarians undergoing emergency laparotomy between 1st January 2005 and 1(st) January 2010 were identified using the Galaxy Theatre System. Patients undergoing abdominal surgery through groin crease incisions or Lanz or Gridiron incisions were excluded. Also simple appendectomies were excluded. All patients were aged 80 years or more at the time of their surgery. Data were obtained using casenote review with a standardised proforma to determine patient age, American Society of Anesthesiologists (ASA) grade, indications for surgery, early (within 30 d) and late (after 30 d) complications, mortality and length of stay. Data were inserted into a Microsoft Excel spreadsheet and analysed. RESULTS: One hundred patients were identified from the database (Galaxy) as having undergone emergency laparotomy. Of those, 55 underwent the procedure for intestinal procedures and 37 for secondary peritonitis. There was a 2:1 female predominance; average age 85 and ASA grade 3. Bowel resection was required in 51 out of the 100 patients and 22 (43%) died. Other procedures included appendicectomy, adhesiolysis, repair of AAA graft leak and colostomies for the pathological process resulting in an acute abdomen. Twelve of 100 patients (12%) suffered intra-operative complications, including splenic and bowel-serosal tears. Seventy patients (70%) had postoperative complications including myocardial infarction, wound infection, haematoma and sepsis. Overall mortality was 45/100 patients (45%). The major causes of death were sepsis (19/45 patients, 42%), underlying cancer (13/45 patients, 29%); with others including bowel obstruction (2/45 patients, 4%), myocardial and intestinal ischaemia and dementia. CONCLUSION: Emergency laparotomy in octogenarians carries a significant morbidity and mortality. In particular, surgery requiring bowel resection has higher mortality than without resection.",Aged;Laparotomy;Morbidity;Mortality;Perioperative care,"Green, G.;Shaikh, I.;Fernandes, R.;Wegstapel, H.",2013,Jul 27,10.4240/wjgs.v5.i7.216,0,
1591,Huntington's disease - Making connections,,huntingtin;peroxisome proliferator activated receptor gamma coactivator 1alpha;article;biogenesis;cardiomyopathy;disorders of mitochondrial functions;exon;gene mutation;gene overexpression;genetic transcription;human;Huntington chorea;nerve degeneration;nuclear magnetic resonance;oxidative phosphorylation;pathogenesis;priority journal;protein expression,"Greenamyre, J. T.",2007,,,0,
1592,Alzheimer disease and nonfluent progressive aphasia,"Objective: To describe a patient with pathologically proven Alzheimer disease (AD) who presented with a nonfluent progressive aphasic syndrome. Designs: Longitudinal neuropsychological assessment, structural (magnetic resonance imaging) and functional (single photon emission computed tomography) imaging, and postmortem brain examination. Setting: Memory and cognitive disorders clinic in a tertiary referral hospital. Patient: A 66- year-old man presented with a 5-year history of progressive nonfluent aphasia characterized by marked deficits in phonology and syntax with preservation of everyday abilities. His condition deteriorated rapidly and he died suddenly of a myocardial infarction 12 months later. Results: Neuropsychological testing revealed mild global intellectual impairment with marked impairment of auditory verbal short-term memory, syntactic, and phonological abilities. His naming errors were predominantly phonological paraphasias. Magnetic resonance imaging scans showed left perisylvian atrophy and results of a Tc 99m hexamethyl-propyleneamine-oxime single photon emission computed tomographic scan were normal. Postmortem pathological examination revealed typical AD pathological features with atypical distribution, involving predominantly perisylvian language areas, but sparing the medial temporal lobe. Conclusions: The language deficits in AD, which have received considerable attention, are thought to involve predominantly lexicosemantic processes. When AD presents as a relatively isolated language disturbance, the aphasia is usually of the fluent anomic type. To our knowledge, our patient represents the first fully documented case of progressive nonfluent aphasia with pathologically verified AD.",aged;Alzheimer disease;amnesia;aphasia;article;case report;clinical feature;cognitive defect;disease association;heart infarction;human;male;neuropsychological test;nuclear magnetic resonance imaging;priority journal;single photon emission computer tomography,"Greene, J. D. W.;Patterson, K.;Xuereb, J.;Hodges, J. R.",1996,,,0,
1593,Palliative care referral among patients hospitalized with advanced heart failure,"BACKGROUND: Many heart failure (HF) patients experience high symptom burden, but palliative care (PC) services have been used infrequently in this population. OBJECTIVE: The specific aim of this study was to identify individual-level factors associated with PC referral. METHODS: The study sample included adult patients hospitalized at an academic medical center with a primary diagnosis of HF between January 2005 and June 2010. Inpatient records were merged with the PC database to identify HF patients who received PC consultations. The analytical sample included 2647 HF admissions. We used descriptive statistics to characterize HF patients who received and did not receive PC services. Logistic regression analyses were used to identify patient characteristics that predict PC referral. RESULTS: Just over 6% of patients with HF were referred to PC during their hospitalization. We identified the following statistically significant determinants of PC referral: secondary diagnosis of Alzheimer's disease, receipt of thoracentesis, intensive care unit (ICU) stay, and prior HF-related hospitalizations. CONCLUSIONS: Currently, only a fraction of HF patients who are at high risk for morbidity and mortality receive PC services. Additional research is needed to identify factors associated with PC referral that can be prospectively identified, and to develop better prediction models to identify HF patients who may benefit from PC referral.","Academic Medical Centers;Aged;Databases, Factual;Female;Heart Failure/complications/mortality/*therapy;Hospitalization;Humans;Male;Middle Aged;*Palliative Care;*Referral and Consultation","Greener, D. T.;Quill, T.;Amir, O.;Szydlowski, J.;Gramling, R. E.",2014,Oct,10.1089/jpm.2013.0658,0,
1594,The impact of comorbidity on mortality in multiple myeloma: a Danish nationwide population-based study,"To describe the prevalence of comorbidity and its impact on survival in newly diagnosed multiple myeloma patients compared with population controls. Cases of newly diagnosed symptomatic multiple myeloma during the 2005–2012 period were identified in the Danish National Multiple Myeloma Registry. For each myeloma patient, 10 members of the general population matched by age and sex were chosen from the national Civil Registration System. Data on comorbidity in the myeloma patients and the general population comparison cohort were collected by linkage to the Danish National Patient Registry (DNPR). Cox proportional hazards regression models were used to evaluate the prognostic significance of comorbidity. The study included 2190 cases of multiple myeloma and 21,900 population controls. The comorbidity was increased in multiple myeloma patients compared with population controls, odds ratio (OR) 1.4 (1.1–1.7). The registration of comorbidity was highly increased within the year preceding diagnosis of multiple myeloma (OR 3.0 [2.5–3.5]), which was attributable to an increased registration of various diseases, in particular, renal disease with OR 11.0 (8.1–14.9). The median follow-up time from diagnosis of multiple myeloma for patients alive was 4.3 years (interquartile range 2.4–6.3). Patients with registered comorbidity had increased mortality compared with patients without comorbidity, hazard ratio 1.6 (1.5–1.8). Multiple myeloma patients have increased comorbidity compared with the background population, in particular during the year preceding the diagnosis of myeloma.",C reactive protein;creatinine;immunoglobulin A;lactate dehydrogenase;melphalan;adult;aged;article;cancer mortality;cancer staging;cancer survival;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;controlled study;Danish citizen;dementia;Denmark;diabetes mellitus;drug megadose;female;frailty;hazard ratio;heart infarction;hematopoietic stem cell transplantation;hemiplegia;human;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;multiple myeloma;peripheral vascular disease;population dynamics;population research;prevalence;priority journal;risk factor;solid malignant neoplasm;survival time;ulcer;very elderly,"Gregersen, H.;Vangsted, A. J.;Abildgaard, N.;Andersen, N. F.;Pedersen, R. S.;Frølund, U. C.;Helleberg, C.;Broch, B.;Pedersen, P. T.;Gimsing, P.;Klausen, T. W.",2017,,10.1002/cam4.1128,0,
1595,Copeptin and Long-Term Risk of Recurrent Vascular Events after Transient Ischemic Attack and Ischemic Stroke: Population-Based Study,"Background and Purpose-Copeptin, the c-terminal portion of provasopressin, is a useful prognostic marker in patients after myocardial infarction and heart failure. More recently, high levels of copeptin have also been associated with worse functional outcome and increased mortality within the first year after ischemic stroke and transient ischemic attack (TIA). However, to date, there are no published data on whether copeptin predicts long-term risk of vascular events after TIA and stroke. Methods-We measured copeptin levels in consecutive patients with TIA or ischemic stroke in a population-based study (Oxford Vascular Study) recruited from 2002 to 2007 and followed up to 2014. Associations with risk of recurrent vascular events were determined by Cox-regression. Results-During ≈6000 patient-years in 1076 patients, there were 357 recurrent vascular events, including 174 ischemic strokes. After adjustment for age, sex, and risk factors, copeptin was predictive of recurrent vascular events (adjusted hazard ratio per SD, 1.47; 95% confidence interval, 1.31-1.64; P=0.0001), vascular death (1.85; 1.60-2.14; P<0.0001), all-cause death (1.75; 1.58-1.93; P<0.0001), and recurrent ischemic stroke (1.22; 1.04-1.44; P=0.017); and improved model-discrimination significantly: net reclassification improvement for recurrent vascular events (32%; P<0.0001), vascular death (55%; P<0.0001), death (66%; P<0.0001), and recurrent stroke (16%; P=0.044). The predictive value of copeptin was largest in patients with cardioembolic index events (adjusted hazard ratio, 1.84; 95% confidence interval, 1.53-2.20 versus 1.31, 1.14-1.50 in noncardioembolic stroke; P=0.0025). In patients with cardioembolic stroke, high copeptin levels were associated with a 4-fold increased risk of vascular events within the first year of follow-up (adjusted hazard ratio, 4.02; 95% confidence interval, 2.13-7.70). Conclusions-In patients with TIA and ischemic stroke, copeptin predicted recurrent vascular events and death, particularly after cardioembolic TIA/stroke. Further validation is required, in particular, in studies using more extensive cardiac evaluation.",copeptin;age;aged;article;brain ischemia;cardioembolic stroke;cardiovascular mortality;concentration (parameters);controlled study;female;follow up;gender;human;hypertension;major clinical study;male;population research;predictive value;priority journal;recurrent disease;risk assessment;risk factor;transient ischemic attack,"Greisenegger, S.;Segal, H. C.;Burgess, A. I.;Poole, D. L.;Mehta, Z.;Rothwell, P. M.",2015,,,0,
1596,Drugs in the hospital sector (excluding temporary use authorization),,abatacept;adalimumab;aminolevulinic acid methyl ester;bevacizumab;blood clotting factor 8;budesonide;cetuximab;clofarabine;clopidogrel;darunavir;dasatinib;docetaxel;entecavir;erlotinib;etiracetam;exemestane;blood clotting factor 8 concentrate;flisint;fondaparinux;hydrochlorothiazide plus losartan;imatinib;immunoglobulin;infliximab;interferon beta serine;ivabradine;lanthanum carbonate;letrozole;leuprorelin;losartan;natalizumab;oxybate sodium;pemetrexed;posaconazole;pramipexole;pregabalin;recombinant alpha2b interferon;recombinant erythropoietin;ribavirin;rimonabant;rituximab;rivastigmine;sertindole;sitagliptin;sitaxsentan;sunitinib;Temerit;topotecan;trastuzumab;triamcinolone hexacetonide;unindexed drug;valaciclovir;varenicline;Wart virus vaccine;zonisamide;ankylosing spondylitis;Crohn disease;dementia;diabetes mellitus;drug indication;drug research;epilepsy;female genital tract cancer;heart failure;heart infarction;hepatitis B;hypertension;infection;juvenile rheumatoid arthritis;kidney disease;leukemia;lymphoma;metastasis;multiple sclerosis;neuropathy;obesity;pancreas cancer;parasitosis;Parkinson disease;peritoneum mesothelioma;prostate cancer;psoriasis;rheumatic fever;schizophrenia;short survey;skin disease;systemic disease;thrombosis;acomplia;alimta;arixtra;aromasin;avastin;baraclude;betaferon;champix;dynepo;enantone;entocort;erbitux;evoltra;exelon;factane;femara;fosrenol;gardasil;glivec;herceptin;hexatrione;humira;hycamtin;hyzaar;introna;januvia;keppra;lyrica;mabthera;metvixia;noxafil;orencia;prezista;procoralan;rebetol;remicade;serdolect;sifrol;sprycel;sutent;tarceva;taxotere;tegeline;tysabri;viraferon;xyrem;zelitrex;zonegran,"Grellet, J.;Gerbouin, O.",2008,,,0,
1597,Angiosarcoma associated with a Kasabach-Merritt syndrome: Report of two cases treated with paclitaxel,"Angiosarcomas are rare, aggressive vascular malignancies of endothelial cell differentiation. Kasabach-Merritt syndrome is a rare condition defined by the association of thrombocytopenia and consumption coagulopathy with specific vascular tumors, such as tufted angioma or kaposiform hemangioendothelioma. We report here two cases of angiosarcomas complicated by a Kasabach-Merritt syndrome and their outcome after treatment with paclitaxel. © 2013 Future Medicine Ltd.",CD31 antigen;CD34 antigen;D dimer;epidermal growth factor receptor 2;fibrin degradation product;letrozole;navelbine;paclitaxel;aged;anemia;angiosarcoma;article;axillary lymph node;bone marrow biopsy;breast carcinoma;cancer chemotherapy;cancer hormone therapy;cancer recurrence;case report;clinical examination;computer assisted tomography;dementia;disease association;disease severity;epithelioid cell;erysipelas;female;atrial fibrillation;heart infarction;histopathology;human;immunohistochemistry;Kasabach Merritt syndrome;leukocyte count;lymph node dissection;male;mitosis rate;priority journal;thrombocyte transfusion;thrombocytopenia;treatment outcome;treatment response;tumor bleeding,"Grellety, T.;Italiano, A.",2013,,,0,
1598,Cognitive changes after Carotid Endarterectomy,"The aim of this study was to investigate changes in cognitive function following carotid endarterectomy (CEA). In 74 asymptomatic CEA patients cognitive function, depression, laterality and severity of stenosis, cerebral Computer Tomography results, and ischemic heart diseases were measured preoperatively. The sample included 31 patients with dementia and 43 patients without any symptom of dementia. Cognitive function was measured again at 3 months postoperatively using a brief standardised test. After controlling for cognitive function and depression at baseline, cognitive function improved significantly at 3 months after CEA in both patients with and without dementia. CEA may offer more than reduced stroke risk to patients, independent of cognitive function.",aged;article;carotid artery obstruction;carotid endarterectomy;cognition;computer assisted tomography;controlled study;dementia;depression;disease course;disease severity;female;follow up;human;ischemic heart disease;major clinical study;male;Mini Mental State Examination;postoperative period;preoperative evaluation;risk assessment;cerebrovascular accident;symptom,"Gremigni, P.;Sciarroni, L.;Pedrini, L.",2009,,,0,
1599,Successful treatment of agitation and aggression with prazosin in an elderly patient with dementia and comorbid heart disease,"An elderly male with dementia was admitted for increasing aggression and agitation. He was initially treated with risperidone, citalopram, and memantine, as well as nonpharmacological interventions such as behavioral approaches, environmental modifications, and maintaining sleep routines without improvement. He was treated with the addition of the alpha-1 adrenoreceptor antagonist prazosin, with a subsequent reduction in the number of doses of antipsychotic medication needed to maintain appropriate behavior. Prazosin was well tolerated in this patient who had a significant history of heart disease and poor systolic function. Prazosin may represent a relatively safe and effective medication for the treatment of agitation and aggression in patients with dementia, including patients with comorbid cardiac conditions. In this patient, prazosin was better tolerated than the other medications utilized.",citalopram;haloperidol;memantine;olanzapine;prazosin;risperidone;aged;aggression;agitation;article;bedtime dosage;behavior disorder;bradycardia;chronic kidney failure;comorbidity;congestive heart failure;dementia;disorientation;disruptive behavior;dizziness;drug dose increase;drug dose reduction;drug substitution;drug withdrawal;evening dosage;exercise;extrapyramidal symptom;faintness;hearing impairment;human;hypertension;hypotension;male;memory disorder;mental instability;motor dysfunction;normal human;nursing home patient;orthostatic hypotension;parkinsonism;perseveration;physical violence;priority journal;restlessness;social interaction;tardive dyskinesia;verbal hostility,"Greve, M. J.;DesJarlais, D.;Ahmed, I.",2016,,10.1016/j.jcgg.2015.06.001,0,
1600,Proceedings: Consideration of genetics in the design of induced pluripotent stem cell-based models of complex disease,"The goal of exploiting induced pluripotent stem cell (iPSC) technology for the discovery of new mechanisms and treatments of disease is being pursued by many laboratories, and analyses of rare monogenic diseases have already provided ample evidence that this approach has merit. Considering the enormous medical burden imposed by common chronic diseases, successful implementation of iPSC-based models has the potential for major impact on these diseases as well. Since common diseases represent complex traits with varying genetic and environmental contributions to disease manifestation, the use of iPSC technology poses unique challenges. In this perspective, we will consider how the genetics of complex disease and mechanisms underlying phenotypic variation affect experimental design.",amyloid precursor protein;sodium channel Nav1.1;age related macular degeneration;Alzheimer disease;article;autism;developmental disorder;diabetic retinopathy;experimental design;familial hypertrophic cardiomyopathy;fibrosing alveolitis;gene mutation;genetic association;genetic risk;hepatitis C;human;nonalcoholic fatty liver;open angle glaucoma;Parkinson disease;phenotypic variation;pluripotent stem cell;quantitative trait locus;schizophrenia;single nucleotide polymorphism,"Grieshammer, U.;Shepard, K. A.",2014,,,0,
1601,Knowledge and experience with Alzheimer's disease. Relationship to resuscitation preference,"BACKGROUND: Previous studies suggest that 20% to 67% of patients would desire cardiopulmonary resuscitation (CPR) even if they had advanced Alzheimer's disease. These preferences were not affected by education about CPR. We hypothesized that CPR preferences in scenarios involving Alzheimer's disease are influenced more by knowledge of or experience with Alzheimer's disease than by knowledge of CPR and its outcomes. METHODS: We performed a random digit-dialing telephone survey of adult Kentuckians in June 1993. A total of 661 persons responded. We asked respondents whether they have had a friend or family member with Alzheimer's disease and whether they had cared for that person at home. We then assessed basic knowledge of Alzheimer's disease and CPR. We read to one half of respondents an educational paragraph describing CPR and its outcomes. Finally, we asked respondents their CPR preference if they were to develop Alzheimer's disease. RESULTS: Overall, 22% of respondents would probably or definitely want CPR if they had Alzheimer's disease. With the use of simultaneous multiple linear regression, predictors of refusing CPR in scenarios involving Alzheimer's disease included knowledge of or experience with Alzheimer's disease (P < .001), older age (P < .001), greater income (P < .004), female sex (P < .01), and nonwhite race (P < .04). Baseline knowledge of CPR did not affect CPR preferences, nor did being read the educational paragraph. CONCLUSIONS: Cardiopulmonary resuscitation preferences in scenarios involving Alzheimer's disease are strongly associated with knowledge of or experience with Alzheimer's disease more so than with knowledge of CPR. These findings suggest that in eliciting patients' CPR preferences in an advanced directive, care must be taken that patients understand the condition presented in the scenario (eg, Alzheimer's disease).",adult;aged;Alzheimer disease;article;attitude to health;clinical trial;comprehension;controlled clinical trial;controlled study;Death and Euthanasia;Empirical Approach;female;health education;heart arrest;human;male;Mental Health Therapies;middle aged;patient care;psychological aspect;questionnaire;randomized controlled trial;resuscitation,"Griffith 3rd, C. H.;Wilson, J. F.;Emmett, K. R.;Ramsbottom-Lucier, M.;Rich, E. C.",1995,,,0,
1602,Is information from Cochrane systematic reviews of effects of interventions useful for health policies? abstract,"Objective: To assess availability and usefulness of information about the efficacy of health interventions obtainable from systematic reviews (SRs). Methods: Cochrane Library's (CDSR Issue 2-2002) SRs in the following areas: stroke, cardiovascular diseases (myocardial infarction, heart failure, prevention), childhood asthma, pneumonia, back pain, hip replacement, depressive disorders, schizophrenia, dementia, Parkinson's disease, labour and delivery, and breast, colorectal and prostate cancers. Results: 414 SRs analysed so far. The number of SRs varies by area - very few in oncology (21) vs. stroke care (67) or schizophrenia (66) - reflecting the still incomplete coverage of Cochrane reviews and the imbalance between drugs over non-drugs interventions. 230 SRs (56%) looked at drugs and 9% surgical treatments. 68% dealt with treatment and 15% preventative interventions. Reporting of outcomes is problematic quantitatively and qualitatively. We found a total of 11,619 outcomes (range 1-60) without often being able to distinguish between primary and secondary outcomes. Eligibility thresholds were often high: in 21% SRs no study was included and in 39% only one was. Conclusions: Our preliminary results - DARE SRs will also be analysed - suggest that more thoughts should be given to conceptualisation and format of SRs to make them more useful for evidence-based policies.",CMR: Review methodology - presentation of reviews - dissemination - guidelines;CMRA3,"Grilli, R.;Liberati, A.;Buzzetti, R.;Casati, M.;Ronfani, L.;Mario, S.;Gagliotti, C.;Macaluso, A.",2003,,,0,
1603,Characteristics of carotid atherosclerotic plaques of chronic lipid apheresis patients as assessed by in Vivo High-Resolution CMR - A comparative analysis,"Background: Components of carotid atherosclerotic plaques can reliably be identified and quantified using high resolution in vivo 3-Tesla CMR. It is suspected that lipid apheresis therapy in addition to lowering serum lipid levels also has an influence on development and progression of atherosclerotic plaques. The purpose of this study was to evaluate the influence of chronic lipid apheresis (LA) on the composition of atherosclerotic carotid plaques. Methods. 32 arteries of 16 patients during chronic LA-therapy with carotid plaques and stenosis of 1-80% were matched according to degree of stenosis with 32 patients, who had recently suffered an ischemic stroke. Of these patients only the asymptomatic carotid artery was analyzed. All patients underwent black-blood 3T CMR of the carotids using parallel imaging and dedicated surface coils. Cardiovascular risk factors were recorded. Morphology and composition of carotid plaques were evaluated. For statistical evaluation Fishers Exact and unpaired t-test were used. A p-value <0.05 was considered statistically significant. Results: Patients in the LA-group were younger (63.5 vs. 73.9. years, p<0.05), had a higher prevalence of hypercholesterolemia and of established coronary heart disease in patients and in first-degree relatives (p<0.05, respectively). LA-patients had smaller maximum wall areas (49.7 vs. 59.6mm2, p<0.05), showed lower prevalence of lipid cores (28.1% vs. 56.3%, p<0.05) and the lipid content was smaller than in the control group (5.0 vs. 11.6%, p<0.05). Minimum lumen areas and maximum total vessel areas did not differ significantly between both groups. Conclusion: Results of this study suggest that, despite a severer risk profile for cardiovascular complications in LA-patients, chronic LA is associated with significantly lower lipid content in carotid plaques compared to plaques of patients without LA with similar degrees of stenosis, which is characteristic of clinically stable plaques. © 2012 Grimm et al.; licensee BioMed Central Ltd.",gadobutrol;high density lipoprotein;lipid;low density lipoprotein;adult;aged;apheresis;article;asymptomatic disease;atherosclerotic plaque;brain ischemia;cardiovascular magnetic resonance;cardiovascular risk;carotid artery obstruction;carotid atherosclerosis;clinical article;comparative study;controlled study;female;groups by age;human;hypercholesterolemia;image quality;in vivo study;ischemic heart disease;lipid apheresis;lipid composition;long term care;male;morphology;nuclear magnetic resonance scanner;priority journal;prospective study;qualitative analysis;quantitative analysis;relative;gadovist;Siemens Verio Scanner,"Grimm, J. M.;Nikolaou, K.;Schindler, A.;Hettich, R.;Heigl, F.;Cyran, C. C.;Schwarz, F.;Klingel, R.;Karpinska, A.;Yuan, C.;Dichgans, M.;Reiser, M. F.;Saam, T.",2012,,,0,
1604,Hospital crossover increases utilization for people with epilepsy: A retrospective cohort study,"Summary Objectives ""Hospital crossover"" occurs when people visit multiple hospitals for care, which may cause gaps in electronic health records. Although crossover is common among people with epilepsy, the effect on subsequent use of health services is unknown. Understanding this effect will help prioritize health care delivery innovations targeted for this population. Methods We collected de-identified information from a health information exchange network describing 7,836 people with epilepsy who visited any of seven hospitals in New York, NY from 2009-2012. Data included demographics, comorbidities, and 2 years of visit information from ambulatory, inpatient, emergency department (ED), and radiology settings. We performed two complementary retrospective cohort analyses, in order to (1) illustrate the effect on a carefully selected subgroup, and (2) confirm the effect across the study population. First, we performed a matched cohort analysis on 410 pairs of individuals with and without hospital crossover in the baseline year. Second, we performed a propensity score odds weighted ordinal logistic regression analysis to estimate the effect across all 7,836 individuals. The outcomes were the use of six health services in the follow-up year. Results In the matched pair analysis, baseline hospital crossover increased the odds of more visits in the ED (odds ratio 1.42, 95% confidence interval [CI] 1.05-1.95) and radiology settings (1.7, 1.22-2.38). The regression analysis confirmed the ED and radiology findings, and also suggested that crossover led to more inpatient admissions (1.35, 1.11-1.63), head CTs (1.44, 1.04-2), and brain MRIs (2.32, 1.59-3.37). Significance Baseline hospital crossover is an independent marker for subsequent increased health service use in multiple settings among people with epilepsy. Health care delivery innovations targeted for people with epilepsy who engage in hospital crossover should prioritize (1) sharing radiology images and reports (to reduce unnecessary radiology use, particularly head CTs), and (2) improving coordination of care (to reduce unnecessary ED and inpatient use).",adolescent;adult;aged;alcohol abuse;article;aspiration pneumonia;brain disease;brain injury;brain tumor;central nervous system infection;cerebral palsy;cerebrovascular disease;child;chronic lung disease;cohort analysis;comorbidity;computer assisted tomography;congestive heart failure;dementia;depression;diabetes mellitus;drug abuse;emergency ward;epilepsy;female;follow up;fracture;health care delivery;health care utilization;health service;heart arrhythmia;heart infarction;hemiplegia;hospital admission;hospital crossover;hospital patient;human;hypertension;infant;kidney disease;liver disease;lung circulation;major clinical study;male;medical information;medical information system;metastasis;multihospital system;multiple sclerosis;neuroimaging;newborn;nuclear magnetic resonance imaging;paraplegia;patient care;peptic ulcer;peripheral vascular disease;priority journal;propensity score;psychosis;radiodiagnosis;retrospective study;rheumatoid arthritis;solid tumor;traumatic brain injury;United States;valvular heart disease;vascular disease,"Grinspan, Z. M.;Shapiro, J. S.;Abramson, E. L.;Jung, H. Y.;Kaushal, R.;Kern, L. M.",2015,,,0,
1605,Nutritional status of patients in the cardiac ward of a regional hospital,"Aim of study: To assess the nutritional status of patients in the cardiac ward of the Regional Hospital in Zlín, and to analyze the association between nutritional status and selected characteristics of hospitalized cardiac patients. Patients and methods: A group of 236 patients was created by collecting of data of all currently hospitalized patients at randomly selected time points at approximately 3-week intervals (August through December 2012). Nutritional status was assessed using a screening questionnaire developed by the Nutrition and Dietetic Center of the Prague-based Thomayer Hospital. The data were used to determine any association between the risk of malnutrition with sex, age, diagnosis of a heart disease, left ventricular function, associated conditions, length of hospitalization, social background, treatment with some drugs, insomnia, chronic pain, patient mobility, and other factors. Results: The criteria of impending malnutrition were met by 67 patients (28.4%) while 3 patients (1.3%) already suffered from malnutrition. Significant risk factors for malnutrition included female sex (malnutrition risk 22% males vs. 37.8% females; p=0.009), age above 76 years (median 70 vs. 78 years; p<0.001), some comorbidities (diabetes mellitus, history of stroke, gastrointestinal tract-related disease, alcohol abuse, malignancy) (p<0.001), long-term immobility (p<0.001), length of hospitalization over 6 days (median 4 vs. 7 days; p<0,001), polypharmacy, and treatment with some drug classes. An association between malnutrition risk and the type of cardiac disease has been established (p=0.016). No association has been demonstrated between nutritional status and left ventricular ejection fraction, body mass index, co-existing psychiatric disorder and/or dementia, and socio-economic status of the patient. Conclusions: Our study has shown that impending malnutrition or current malnutrition poses a major problem in a significant proportion of hospitalized cardiac patients. Thorough screening and nutritional intervention should make an integral and/or essential part of care of patients hospitalized in a standard cardiac ward. © 2013 The Czech Society of Cardiology. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.",analgesic agent;digoxin;psychotropic agent;serum albumin;theophylline derivative;adult;age distribution;aged;alcohol abuse;angina pectoris;article;body mass;bradycardia;cardiac patient;cerebrovascular accident;chronic pain;comorbidity;controlled study;coronary care unit;dementia;diabetes mellitus;disease association;endocarditis;faintness;fatigue;female;heart disease;heart failure;heart infarction;heart left ventricle ejection fraction;heart surgery;hospitalization;human;hypertension;immobility;insomnia;intensive care unit;length of stay;loss of appetite;lung embolism;major clinical study;male;malnutrition;mental disease;myocarditis;noncardiac chest pain;nutritional status;patient mobility;pericarditis;polypharmacy;postoperative period;quality of life;questionnaire;resuscitation;risk factor;sex difference;sleep waking cycle;social background;social status;tachycardia;vein thrombosis,"Gřiva, M.;Jarkovský, J.;Brázdilová, P.",2013,,,0,
1606,"Omega-3 fatty acids (EPA, DHA)",,antioxidant;C reactive protein;carnitine;docosahexaenoic acid;fibrinogen;high density lipoprotein cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;icosapentaenoic acid;leukotriene B4;leukotriene B5;low density lipoprotein cholesterol;magnesium;nitric oxide synthase;omega 3 fatty acid;prostacyclin;pyridoxine;retinol;taurine;thromboxane A2;triacylglycerol;zinc;Alzheimer disease;asthma;bronchitis;cachexia;cardiovascular disease;cardiovascular risk;chronic obstructive lung disease;colon ulcer;Crohn disease;dementia;depression;diabetes mellitus;drug efficacy;drug mechanism;dyslipoproteinemia;heart arrhythmia;human;hypertriglyceridemia;immunoglobulin A nephropathy;lipid metabolism;mental disease;muscle hypertonia;neurodermatitis;premenstrual syndrome;psoriasis;retinitis pigmentosa;rheumatoid arthritis;rhinitis;risk factor;risk reduction;short survey;syndrome X;thrombocyte aggregation;vascular endothelium,"Gröber, U.",2007,,,0,
1607,Perioperative genomics and neurologic outcome: We can't change who we are,,apolipoprotein E;C reactive protein;acute coronary syndrome;Alzheimer disease;aorta atherosclerosis;brain injury;cognitive defect;comorbidity;coronary artery bypass graft;coronary artery disease;demography;gene frequency;genetic analysis;genetic predisposition;genetic variability;genomics;head injury;heart surgery;human;incidence;letter;Mini Mental State Examination;neurologic disease;neurology;outcome assessment;pathophysiology;percutaneous coronary intervention;perioperative period;phenotype;postoperative complication;priority journal;protein interaction;risk assessment;risk factor;single nucleotide polymorphism;cerebrovascular accident;subarachnoid hemorrhage;surgical technique,"Grocott, H. P.",2009,,,0,
1608,Hormone therapy in younger women and cognitive health,,estrogen;placebo;progesterone;age;atherosclerosis;brain size;cardiovascular disease;cardiovascular risk;chronic disease;cognition;coronary artery calcification;dementia;estrogen therapy;health care cost;heart infarction;hormonal therapy;human;hysterectomy;ischemic heart disease;low drug dose;memory;menopausal syndrome;menopause;note;osteoporosis;outcome assessment;postmenopause;priority journal;women's health,"Grodstein, F.",2013,,,0,
1609,Trans-catheter closure of the native aortic valve with an Amplatzer® Occluder to treat progressive aortic regurgitation after implantation of a left-ventricular assist device,"We report on a patient with ischaemic dilated cardiomyopathy, who developed progressive regurgitation of his native aortic valve after implantation of a left-ventricular assist device (LVAD, HeartMate II). Increasing regurgitant volume led to reduced effective cardiac output and worsening of symptoms. To overcome aortic regurgitation, we successfully closed his aortic valve minimally invasively using the Amplatzer® P.I. Muscular VSD Occluder. This led to instant haemodynamic stabilisation. We observed significant residual regurgitation through the Occluder during the initial phase, which led temporarily to increased haemolysis and subsequently to worsening of kidney function; once the haemolysis ceased, we noted a very good interventional and clinical result at short-term follow-up. © 2011 European Association for Cardio-Thoracic Surgery.",acetylsalicylic acid;clopidogrel;heparin;warfarin;aged;aorta valve regurgitation;article;case report;dementia;devices;dyspnea;forward heart failure;heart output;hemodynamics;hemolysis;human;ischemic cardiomyopathy;kidney function;left ventricular assist device;lung edema;male;priority journal;transesophageal echocardiography;Amplatzer P.I. Muscular VSD Occluder;HeartMate II,"Grohmann, J.;Blanke, P.;Benk, C.;Schlensak, C.",2011,,,0,
1610,Measurement of ECG abnormalities and cardiovascular risk classification: A cohort study of primary care patients in the Netherlands,"Background: GPs need accurate tools for cardiovascular (CV) risk assessment. Abnormalities in resting electrocardiograms (ECGs) relate to increased CV risk. Aim: To determine whether measurement of ECG abnormalities on top of established risk estimation (SCORE) improves CV risk classification in a primary care population. Design and setting: A cohort study of patients enlisted with academic general practices in the Netherlands (the Utrecht Health Project [UHP]). Method: Incident CV events were extracted from the GP records. MEANS algorithm was used to assess ECG abnormalities. Cox proportional hazards modelling was applied to relate ECG abnormalities to CV events. For a prediction model only with SCORE variables, and a model with SCORE+ECG abnormalities, the discriminative value (area under the receiver operator curve [AUC]) and the net reclassification improvement (NRI) were estimated. Results: A total of 2370 participants aged 38-74 years were included, all eligible for CV risk assessment. During a mean follow-up of 7.8 years, 172 CV events occurred. In 19% of the participants at least one ECG abnormality was found (Lausanne criteria). Presence of atrial fibrillation/flutter (AF) and myocardial infarction (MI) were significantly related to CV events. The AUC of the SCORE risk factors was 0.75 (95% CI = 0.71 to 0.79). Addition of MI or AF resulted in an AUC of 0.76 (95% CI = 0.72 to 0.79) and 0.75 (95% CI = 0.72 to 0.79), respectively. The NRI with the addition of ECG abnormalities was small (MI 1.0%; 95% CI = -3.2% to 6.9%; AF 0.5%; 95% CI = -3.5% to 3.3%). Conclusion: Performing a resting ECG in a primary care population does not seem to improve risk classification when SCORE information - age, sex, smoking, systolic blood pressure, and total cholesterol/HDL ratio - is already available.",adult;aged;angina pectoris;aorta aneurysm;article;atherosclerosis;cardiac patient;cardiovascular risk;cause of death;cerebrovascular accident;cohort analysis;controlled study;disease classification;ECG abnormality;electrocardiography;female;follow up;atrial fibrillation;heart atrium flutter;heart failure;heart infarction;human;major clinical study;male;multiinfarct dementia;Netherlands;peripheral occlusive artery disease;primary medical care;risk assessment;transient ischemic attack,"Groot, A.;Bots, M. L.;Rutten, F. H.;Den Ruijter, H. M.;Numans, M. E.;Vaartjes, I.",2015,,,0,
1611,Variation in comorbidity and clinical management in patients newly diagnosed with lung cancer in four Scottish centers,"Background: Treatment and survival rates within Scotland for patients with lung cancer seem lower than in many other European countries. No study of lung cancer has attempted to specifically investigate the association between variation in investigation, comorbidity, and treatment and outcome between different centers. Methods: Patient demographics, World Health Organization/Eastern Cooperative Oncology Group performance status, and primary treatment modality were recorded. In addition to recording the comorbidities present in each patient, the severity of each comorbidity was graded on a 4-point scale (0-3) using validated severity scales. Data were collected as the patient was investigated and entered in an anonymized format into a database designed for the study. Results: Prospectively collected data from 882 patients diagnosed with lung cancer in four Scottish centers. A number of statistically significant differences were identified between centers. These included investigation, treatment between centers (i.e., surgical rates), age, tumor histology, smoking history, socioeconomic profile, ventilatory function, and performance status. Predictors of declining performance status included increasing severity of a number of comorbidities, age, lower socioeconomic status, and specific centers. Conclusions: This study has identified many significant intercenter differences within Scotland. We believe this to be the first study to identify nontumor factors independent of performance status that together limit the ability to deliver radical, possibly curative, therapy to our lung cancer population. It is only by identifying such factors that we can hope to improve on the relatively poor outlook for the majority of Scottish patients with lung cancer. Copyright © 2011 The International Association for the Study of Lung Cancer.",alcohol;aged;alcohol consumption;article;cancer center;cerebrovascular disease;chronic obstructive lung disease;comorbidity;data base;data collection method;dementia;demography;diabetes mellitus;disease severity;female;heart failure;heart muscle ischemia;histopathology;human;kidney function;lung cancer;major clinical study;male;multicenter study;performance;peripheral vascular disease;priority journal;prospective study;respiratory function;smoking;socioeconomics;study design;United Kingdom;world health organization,"Grose, D.;Devereux, G.;Brown, L.;Jones, R.;Sharma, D.;Selby, C.;Morrison, D. S.;Docherty, K.;McIntosh, D.;Louden, G.;Downer, P.;Nicolson, M.;Milroy, R.",2011,,,0,
1612,The cognitive impact of atrial fibrillation: Lessons learned at the interface of medicine and psychiatry,"The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. © 2013 Physicians Postgraduate Press, Inc.",beta adrenergic receptor blocking agent;calcium channel blocking agent;digoxin;age distribution;Alzheimer disease;article;cardioversion;causal attribution;cerebrovascular accident;cerebrovascular disease;cognitive defect;dementia;disease association;heart arrhythmia;atrial fibrillation;heart failure;human;mild cognitive impairment;pathogenesis;prevalence;risk factor;treatment indication;treatment response,"Gross, A. F.;Stern, T. A.",2013,,,0,
1613,Safety and tolerability of the rivastigmine patch: Results of a 28-week open-label extension,"The primary objective of the open-label extension was to evaluate the long-term safety and tolerability of a transdermal rivastigmine patch up to 1 year, as a novel approach to treatment in Alzheimer disease. This was a 28-week extension to a 24-week, double-blind, double-dummy, placebo-controlled, and active-controlled study evaluating rivastigmine patches [9.5 mg/24 h (10 cm) and 17.4 mg/24 h (20 cm)] and oral capsules (3 to 6 mg twice-daily). Patients entering the extension were switched directly to 9.5 mg/24 h rivastigmine patch and increased to 17.4 mg/24 h patch, irrespective of their double-blind study treatment. Primary measures included safety and tolerability assessments, including adverse events and serious adverse events. Of 1195 patients randomized to treatment, 870 (72.8%) completed the double-blind study and entered the open-label extension. During weeks 1 to 4 of the extension, 9.5 mg/24 h rivastigmine patch was well tolerated overall by patients formerly randomized to rivastigmine capsule or patch groups: ≤2.5% reported nausea and ≤1.9% reported vomiting. No unexpected safety issues arose, and skin tolerability was good; similar to the double-blind study. During the 28-week, open-label extension phase, the patch seemed to be well tolerated with a favorable safety profile. © 2009 Lippincott Williams & Wilkins, Inc.",placebo;rivastigmine;adult;aged;Alzheimer disease;article;cerebrovascular accident;clinical assessment;clinical trial;controlled clinical trial;controlled study;double blind procedure;drug administration route;drug capsule;drug dose increase;drug efficacy;drug safety;drug substitution;drug tolerability;drug withdrawal;female;gastrointestinal disease;heart disease;heart failure;human;infection;infestation;major clinical study;male;morning dosage;nausea;priority journal;randomized controlled trial;skin irritation;transdermal patch;unspecified side effect;vomiting,"Grossberg, G.;Sadowsky, C.;Förstl, H.;Frölich, L.;Nagel, J.;Tekin, S.;Zechner, S.;Ros, J.;Orgogozo, J. M.",2009,,,0,
1614,Functional outcomes in octogenarian trauma,"Background: Outcome data on geriatric trauma patients (GTPs) (age ≥ 65) focus on mortality and resource use. We examined mortality and outcome in GTPs and octogenarian trauma patients (OTPs) (age ≥ 80). We hypothesized that OTPs would have worse functional outcomes than GTPs as defined by functional independence measurement (FIM) scales. Methods. Our study was a 13-year retrospective analysis of a statewide trauma database. Isolated hip fractures and intubation with Glasgow Coma Scale scores of 3 at admission were excluded. Demographic data, preexisting conditions, complications, discharge destination, mortality, and FIM were analyzed. Results: OTPs constituted 17,742 (40.9%) of 43,297 GTPs admitted to trauma centers. Falls (64.4%) and motor vehicle collisions (24.5%) were predominant. Average Injury Severity Score (ISS) was higher in GTPs (11.5 ± 9.2 vs. 10.8 ± 8.3, p = 0.001). Cardiac disease was the most common preexisting condition. Diabetes, obesity, and pulmonary disease were more common in GTPs than in OTPs (p = 0.001). Dementia, congestive heart failure, and hematologic disease were more common in OTPs than in GTPs (p = 0.001). Pulmonary and infectious complications were most common and occurred with equal frequency in OTPs and GTPs. Mortality rates were higher (10.0% vs. 6.6%, p = 0.001) for OTPs overall and when stratified into low (<10), moderate (11-20), and high (>20) ISS subgroups (p = 0.001). Discharge destination was most often home (53.3% vs. 28.8%,p = 0.001) or a rehabilitation facility (20.0% vs. 17.4%, p = 0.001) for GTPs versus OTPs. OTPs were discharged to skilled nursing facilities (37.2% vs. 14.9%, p = 0.001) far more often than GTPs. FIM at discharge was lower in all categories for OTPs. Modified dependence in locomotion and transfer was seen for OTPs but not GTPs overall and when stratified by ISS subgroups (p = 0.001). Some dependence in feeding was seen for OTPs but not GTPs with high injury severity (p = 0.001). Otherwise, feeding, expression, and social independence were preserved for both OTPs and GTPs. Conclusion: Functional outcomes after blunt trauma are worse for OTPs; however, functional independence in feeding and social interaction are preserved in OTPs even with moderate injury severity.",aged;article;comorbidity;congestive heart failure;data base;dementia;demography;diabetes mellitus;disease severity;emergency health service;falling;feeding;geriatric care;Glasgow coma scale;heart disease;hematologic disease;hospital admission;hospital discharge;human;hypothesis;independence;infection;injury;locomotion;lung disease;major clinical study;mortality;nursing home;obesity;priority journal;rating scale;resource allocation;retrospective study;scoring system;social aspect;traffic accident;traumatology;treatment outcome;United States,"Grossman, M.;Scaff, D. W.;Miller, D.;Reed Iii, J.;Hoey, B.;Anderson Iii, H. L.;Morris Jr, J. A.;Udekwu, P.",2003,,,0,
1615,"Palliative care needs of seriously ill, older adults presenting to the emergency department","OBJECTIVES: The objective was to identify the palliative care needs of seriously ill, older adults in the emergency department (ED). METHODS: The authors conducted a cross-sectional structured survey. A convenience sample of 50 functionally impaired adults 65 years or older with coexisting cancer, congestive heart failure, end-stage liver or renal disease, stroke, oxygen-dependent pulmonary disease, or dementia was recruited from an urban academic tertiary care ED. Face-to-face interviews were conducted using the Needs Near the End-of-Life Screening Tool (NEST), McGill Quality of Life Index (MQOL), and Edmonton Symptom Assessment Survey (ESAS) to assess 1) range and severity of symptoms, 2) goals of care, 3) psychological well-being, 4) health care utilization, 5) spirituality, 6) social connectedness, 7) financial burden, 8) the patient-clinician relationship, and 9) overall quality of life (QOL). RESULTS: Mean (+/-SD) age was 74.3 (+/-6.5) years and cancer was the most common diagnosis. Mean (+/-SD) QOL on the MQOL was 3.6 (+/-2.9). Over half of the patients exceeded intratest severity-of-needs cutoffs in four categories of the NEST: physical symptoms (47/50, 94%), finances (36/50, 72%), mental health (31/50, 62%), and access to care (29/50, 58%). The majority of patients reported moderate to severe fatigue, pain, dyspnea, and depression on the ESAS. CONCLUSIONS: Seriously ill, older adults in an urban ED have substantial palliative care needs. Future work should focus on the role of emergency medicine and the new specialty of palliative care in addressing these needs.","Aged;Aged, 80 and over;Chronic Disease/*therapy;Comorbidity;Cross-Sectional Studies;Emergency Service, Hospital;Female;*Health Services Needs and Demand;Humans;Male;Palliative Care/*statistics & numerical data;Quality of Life;Surveys and Questionnaires","Grudzen, C. R.;Richardson, L. D.;Morrison, M.;Cho, E.;Morrison, R. S.",2010,Nov,10.1111/j.1553-2712.2010.00907.x,0,
1616,Prestige rankings of chronic diseases and disabilities. A survey among professionals in the disability field,"Disabled people constitute the world's largest minority; too little is known about the internal structure and valuations of that minority. We investigate whether prestige rankings of different chronic diseases and disabilities can be elicited from a community of disability non-governmental organizations (NGOs). A survey was performed in a sample of NGO professionals in Norway in late 2013 and early 2014. Two copies of a questionnaire was sent to 92 national and regional offices of disability NGOs requesting a response from either senior employees or elected officials, preferably one of each. Outcome measures were ratings on a 1-9 scale of the prestige these respondents believed most professionals in their field would accord to a sample of 38 different conditions. We find that there is a prestige hierarchy of chronic diseases and disabilities in the disability field. In this hierarchy, somatic conditions that are strongly associated with medical treatment were placed higher than either conditions that are characterized by permanence, or conditions are associated with psychosomatic etiologies. The elicited prestige hierarchy is at odds with prevalent normative positions in the disability field; there is a lack of fit between some of the field's central political goals and its internal evaluations. We propose that its structure can be explained through a) influence from the medical field, b) organization history, size, and prominence, and c) issues of credibility, shame and blame. Further research should be conducted into the structure and valuations of the disability field in general and people with disabilities and chronic diseases in particular.",acquired immune deficiency syndrome;adult;ankylosing spondylitis;anorexia;anxiety;aphasia;arthritis;article;asthma;attention deficit disorder;autism;blindness;brain tumor;cataract;cerebral palsy;chronic disease;chronic fatigue syndrome;colon cancer;depression;disability;Down syndrome;epilepsy;female;fibromyalgia;hearing impairment;heart infarction;human;Huntington chorea;leukemia;liver cirrhosis;lung cancer;lung embolism;male;multiple sclerosis;muscle disease;non profit organization;Norway;outcome assessment;ovary cancer;pancreas cancer;psoriasis;psychosomatics;questionnaire;schizophrenia;sciatica;scoring system;shame;social dominance;spinal dysraphism,"Grue, J.;Johannessen, L. E. F.;Rasmussen, E. F.",2015,,,0,
1617,Serum uric acid: A marker of development of subclinical atherosclerosis in patients with inflammatory joint diseases,"The association between gout and hypertension, diabetes, renal and cardiovascular diseases had been known since 19th century. But in the 50-60-ies of the 20th century this correlation had been rediscovered. Since then, a number of epidemiological surveys has proved the association between the levels of serum uric acid (SUA) and large number of cardiovascular diseases, such as hypertension, metabolic syndrome, coronary artery disease, cerebrovascular disease, vascular dementia, preeclampsia and renal diseases. Despite of that, the role of SUA as an independent cardiovascular risk factor has still been questioned. The aim of our study was to search for a correlation between the presence of subclinical atherosclerosis (defined as carotid intima- media thickness above 0.9 mm or presence of plaque) and traditional (hypertension, diabetes, dyslipidemia and smoking) and also nontraditional (SUA and inflammatory markers - CRP and SR) risk factors. 105 patients with inflammatory rheumatic diseases (IRD) - 80 with rheumatoid arthritis, 18 with psoriatic arthritis and 7 with ankylosing spondylitis, and a control group of 72 hypertensive patients were investigated. The traditional and nontraditional (CRP, SR and SUA) risk factors were measured in all the patients. Also a carotid sonography of both common carotid arteries was performed. A vascular transduser 3-12 MHz of Philips Envisor HD machine was used. Our results showed that in patients with IRD, the increased levels of SUA were associated with increased risk of development of atherosclerosis. Our conclusion fully corresponds with the conclusion made by Panoulas et al. in 2007, that SUA is an independent predictor of cardiovascular diseases in patients with rheumatoid arthritis.",uric acid;ankylosing spondylitis;arterial wall thickness;arthritis;article;atherosclerosis;atherosclerotic plaque;cardiovascular risk;carotid artery;diabetes mellitus;dyslipidemia;human;hypertension;major clinical study;psoriatic arthritis;rheumatoid arthritis;risk assessment;smoking;uric acid blood level,"Gruev, I.;Toncheva, A.",2010,,,0,
1618,Personal experiences with the preparation K.H.3-Geriatricum Schwarzhaupt in the therapy of geriatric diseases,,Age Factors;Aged;Arteriosclerosis/drug therapy;Cerebrovascular Disorders/drug therapy;Coronary Disease/drug therapy;Dementia/drug therapy;Drug Combinations;*Geriatrics;Hematoporphyrins/therapeutic use;Humans;Hypertension/drug therapy;Magnesium/*therapeutic use;Nutrition Disorders/drug therapy;Porphyrins/*therapeutic use;Procaine/*therapeutic use;Trace Elements/therapeutic use,"Grujic, M.;Perinovic, M.",1973,May 10,,0,
1619,Increasing comorbidity and health services utilization in older adults with prior stroke,"Objective: To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. Methods: This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons. Results: A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and dementia). Use of all health services doubled with increasing comorbidity and was largely attributed to non-stroke-related reasons. Total and per-patient costs increased with comorbidity. Main cost drivers shifted from physician and home care visits to hospital admissions with greater comorbidity. Conclusions: Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.",aged;arthritis;article;cerebrovascular accident;chronic obstructive lung disease;cohort analysis;community;comorbidity;dementia;diabetes mellitus;emergency ward;female;health care cost;health care utilization;heart muscle ischemia;home care;hospital admission;human;hypertension;inflammatory bowel disease;major clinical study;male;Ontario;physician;prevalence;priority journal;retrospective study,"Gruneir, A.;Griffith, L. E.;Fisher, K.;Panjwani, D.;Gandhi, S.;Sheng, L.;Patterson, C.;Gafni, A.;Ploeg, J.;Markle-Reid, M.",2016,,10.1212/wnl.0000000000003329,0,
1620,[Profile and evolution of chronic complex patients in a subacute unit] Perfil y evolucion de pacientes cronicos complejos en una unidad de subagudos,"OBJECTIVE: To improve the management of geriatric pluripathologic patients in Catalonia, the identification of chronic complex patient (PCC) or patients with advanced chronic disease (MACA) has been promoted. Patients with exacerbated chronic diseases are promoted to be admitted in subacute units (SG) located in intermediate hospitals and specialized in geriatric care, as an alternative to acute hospital. The results of the care process in patients identified as PCC/MACA in SG have not been evaluated. DESIGN: Descriptive-comparative, cross-sectional, and quantitative study. LOCATION: SG located in intermediate care hospital. PARTICIPANTS: Consecutive patients admitted in the SG during 6months. MAIN MEASUREMENTS: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30days post-discharge between PCC/MACA patients versus other patients. RESULTS: Of 244 patients (mean age+/-SD=85,6+/-7,5; 65.6%women), 91 (37,3%) were PCC/MACA (PCC=79,1%, MACA=20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson index=3,2+/-1,8 vs 2,0; p=0,001) and polypharmacy (9,5+/-3,7 drugs vs 8,1+/-3,8; p=0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30day post-discharge (15,4% vs 8%; p=0,010). In a multi-variable analysis, PCC/MACA identification (p=0,006), as well as a history of dementia (p=0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30day (18,7% vs 10,5%; p=0,014), in the multivariable analyses, only male, polypharmacy, and heart failure were independently associated to readmission. CONCLUSIONS: Despite having more comorbidity and polypharmacy, the outcomes of patients identified as PCC/MACA at discharge of SG, were comparable with other patients, although they experienced more readmissions within 30days, possibly due to comorbidity and polypharmacy.",Atencion intermedia;Chronicity;Cronicidad;Intermediate care;Mortalidad;Mortality;Multimorbidity;Multimorbilidad;Readmissions;Reingresos;Subacute care unit;Subagudos,"Gual, N.;Yuste Font, A.;Enfedaque Montes, B.;Blay Pueyo, C.;Martin Alvarez, R.;Inzitari, M.",2017,Nov,,0,
1621,,"Objective: To improve the management of geriatric pluripathologic patients in Catalonia, the identification of chronic complex patient (PCC) or patients with advanced chronic disease (MACA) has been promoted. Patients with exacerbated chronic diseases are promoted to be admitted in subacute units (SG) located in intermediate hospitals and specialized in geriatric care, as an alternative to acute hospital. The results of the care process in patients identified as PCC/MACA in SG have not been evaluated. Design: Descriptive-comparative, cross-sectional, and quantitative study. Location: SG located in intermediate care hospital. Participants: Consecutive patients admitted in the SG during 6. months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30. days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean age. ±. SD. =85,6. ±. 7,5; 65.6%. women), 91 (37,3%) were PCC/MACA (PCC = 79,1%, MACA = 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson index = 3,2. ±. 1,8 vs 2,0; p = 0,001) and polypharmacy (9,5. ±. 3,7 drugs vs 8,1. ±. 3,8; p = 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30. day post-discharge (15,4% vs 8%; p = 0,010). In a multi-variable analysis, PCC/MACA identification (p = 0,006), as well as a history of dementia (p = 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30. day (18,7% vs 10,5%; p = 0,014), in the multivariable analyses, only male, polypharmacy, and heart failure were independently associated to readmission. Conclusions: Despite having more comorbidity and polypharmacy, the outcomes of patients identified as PCC/MACA at discharge of SG, were comparable with other patients, although they experienced more readmissions within 30. days, possibly due to comorbidity and polypharmacy.",Charlson Comorbidity Index;chronicity;clinical trial;controlled study;dementia;female;geriatric assessment;heart failure;hospital readmission;human;major clinical study;male;mortality;polypharmacy;quantitative study;statistical model;subacute care,"Gual, N.;Yuste Font, A.;Enfedaque Montes, B.;Blay Pueyo, C.;Martín Álvarez, R.;Inzitari, M.",2017,,10.1016/j.aprim.2016.11.010,0,
1622,The application of acupuncture in military medicine in China,"Used for more than 2000 years in China, acupuncture is a mature but still-advancing field. The Chinese military trains its doctors to use acupuncture to prevent and treat illness as well as to treat injuries. Non-medical soldiers are trained too, to use acupuncture and related techniques in the prevention and treatment of illness within their barracks. In addition, the Chinese have trained military personnel from other countries to use acupuncture. The Chinese military also is involved in acupuncture research and academic exchanges that advance the use of acupuncture. Chinese medicine generally and acupuncture specifically also are important components of illness prevention programs for Chinese military veterans. © 2011, Mary Ann Liebert, Inc.",acupuncture;article;China;dementia;health care;human;hypertension;ischemic heart disease;joint degeneration;low back pain;massage;medical research;military medicine;moxibustion;muscle fatigue;myofascial pain;osteoarthritis;priority journal;soft tissue injury;swelling;wound healing,"Guan, L.",2011,,,0,
1623,Investigation of the incidence of mild cognitive impairment and its risk factors in an elderly population sample in Beijing area,"Objective: To investigate the incidence of mild cognitive impairment (MCI) and its risk factors in an elderly population sample in Beijing area. Methods: A sampling survey in 1865 aged subjects (≥ 65 years old) was established in Beijing area in 2004. The diagnosis of MCI was established according to the questionnaires and clinicians' examinations. 1750 subjects with complete data about MCI were selected in this study and the risk factors were analysis. Results: 1 Of the 1750 subjects, 203 had MCI, and the overall prevalence was 11.6%. Among them, the prevalence in ≥75 years old subjects (15.7%) was higher than that in <75 years old subjects (8.3%); the prevalence in the illiterate subjects (17.5%) was high than that in the literate subjects (7.2%); and the prevalence in the rural subjects (7.2%) was higher than that in the urban subjects (8.7%). There were significant differences among them (P = 0.000 all). Although the incidence in females (12.3%) was higher than that in males (10.8%), and the aged people without spouses (13.7%) was higher than that who had spouses (10.6%), but there were no significant differences. 2 Only stroke had effect on the incidence of MCI in patients with the history of hypertension, diabetes mellitus, coronary artery disease and stroke (χ2 = 18.853, P = 0.000). Hypertension, coronary artery disease and diabetes mellitus had no significant effects on the incidence of MCI in the different age and sex groups (P >0.05); While that stroke increased the incidence of MCI in the populations of old male (χ2 = 16.858, P = 0.000), female (χ2 = 4.531, P = 0.045) and <75 years old subjects (χ2 = 33.024, P = 0.000). 3 With the increased coexistent diseases such as hypertension, diabetes mellitus, coronary artery disease and stroke (0, 1 and ≥ 2 diseases), the incidence of MCI was also increased in the populations of male (χ2 = 11.119, P = 0.004) and <75 years old persons(χ2 = 6.117, P = 0.047). 4 The multiple logistic regression analysis showed that stroke (OR:2. 134,95% CI, 1.459 - 3.120), living in countryside (OR: 2.084,95% CI, 1.502 - 2.893), ≥75 years old (OR:1.853, 95% CI, 1.342 - 2.559) and illiterate (OR: 2.178,95% CI, 1.517 - 3.128) were the independent risk factors for MCI. Conclusion: Stroke is an independent risk factor for MCI in old populations. Prevention of stroke is more significant for preventing dementia in the < 75-year-old population and the aged males.",adult;aged;article;cerebrovascular accident;China;cognitive defect;controlled study;coronary artery disease;dementia;diabetes mellitus;disease severity;female;human;hypertension;incidence;major clinical study;male;prevalence;reading;risk factor;rural area;sex difference;spouse;urban area,"Guan, S. C.;Tang, Z.;Wu, X. G.;Diao, L. J.;Liu, H. J.;Sun, F.;Fang, X. H.",2008,,,0,
1624,Geriatric pharmacotherapy updates,,acetylsalicylic acid;alendronic acid;angiotensin receptor antagonist;antibiotic agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;candesartan;chondroitin;conjugated estrogen plus medroxyprogesterone acetate;corticosteroid;digoxin;dipeptidyl carboxypeptidase inhibitor;estrogen;finasteride;gemfibrozil;gestagen;glucosamine;itraconazole;naproxen;nonsteroid antiinflammatory agent;parathyroid hormone;placebo;repaglinide;rofecoxib;spironolactone;thiazide diuretic agent;topiramate;vitamin D;warfarin;aged;Alzheimer disease;area under the curve;article;blood pressure regulation;bone density;bone mineral;bone turnover;breast cancer;cardiovascular disease;chronic obstructive lung disease;colorectal cancer;disease severity;dizziness;drug concentration;drug fatality;drug half life;drug potentiation;drug withdrawal;ejaculation disorder;endometrium cancer;erectile dysfunction;fatigue;female;fragility fracture;atrial fibrillation;heart failure;hip fracture;hormone substitution;human;hyperkalemia;hypertension;hyperthermia;ischemic heart disease;kidney disease;libido disorder;lung embolism;male;mammography;medical research;monotherapy;mortality;osteoarthritis;osteoporosis;ovary cancer;priority journal;prophylaxis;prostate cancer;proteinuria;risk benefit analysis;sexual dysfunction;cerebrovascular accident;sweat gland disease;treatment outcome,"Guay, D. R. P.",2004,,,0,
1625,Geriatric pharmacotherapy updates,,acetylsalicylic acid;anastrozole;antidiabetic agent;aripiprazole;atypical antipsychotic agent;C reactive protein;carbamazepine;celiprolol;citalopram;conjugated estrogen;estrogen;fluoxetine;folic acid;homocysteine;hydroxymethylglutaryl coenzyme A reductase inhibitor;letrozole;mecobalamin;medroxyprogesterone;memantine;metoprolol;neuroleptic agent;nonsteroid antiinflammatory agent;olanzapine;propranolol;quetiapine;risperidone;tamoxifen;unindexed drug;valproic acid;zoledronic acid;aged;anticoagulant therapy;article;behavior disorder;bone metastasis;breast cancer;cancer chemotherapy;cardiovascular disease;cerebrovascular accident;cholestasis;chronic obstructive lung disease;clinical trial;dementia;diabetes mellitus;digestive system perforation;digestive system ulcer;disease exacerbation;drug efficacy;drug fatality;drug induced disease;drug information;drug safety;drug use;fatty liver;gastrointestinal disease;gastrointestinal hemorrhage;geriatric care;heart failure;heart protection;hip fracture;human;hypercholesterolemia;hyperhomocysteinemia;infection;infectious pneumonia;influenza vaccination;kidney dysfunction;liver disease;medication error;mortality;multiple myeloma;muscle disease;myopathy;nonalcoholic fatty liver;priority journal;public health service;rhabdomyolysis;sudden death;urine incontinence;venous thromboembolism;aspirin,"Guay, D. R. P.",2005,,,0,1624
1626,Geriatric pharmacotherapy updates,,acetylsalicylic acid;alendronic acid;alfacalcidol;anticoagulant agent;antiinfective agent;antineoplastic agent;antivitamin K;atorvastatin;bisphosphonic acid derivative;cholinesterase inhibitor;clopidogrel;cyanocobalamin;dipyridamole;donepezil;folic acid;galantamine;hemagglutination inhibiting antibody;homocysteine;hydroxymethylglutaryl coenzyme A reductase inhibitor;influenza vaccine;irbesartan;iron;memantine;placebo;prednisone;pyridoxine;raloxifene;rivastigmine;simvastatin;tamoxifen;tirofiban;unindexed drug;abdominal discomfort;acute coronary syndrome;adjuvant therapy;aggression;antibody titer;antioxidant activity;arthralgia;article;bacterial endocarditis;bone pain;brain ischemia;breast cancer;cancer risk;cataract;cerebrovascular accident;clinical trial;cognition;combination chemotherapy;constipation;corticosteroid induced osteoporosis;creatine kinase blood level;delusion;dementia;depression;drug dose comparison;drug efficacy;drug induced headache;drug megadose;drug tolerability;drug withdrawal;feces;fragility fracture;gastrointestinal hemorrhage;gastrointestinal symptom;geriatric care;hallucination;atrial fibrillation;heart infarction;heart protection;hemagglutination inhibition;human;influenza;influenza vaccination;injection site reaction;intestinal dysmotility;iron deficiency anemia;ischemic heart disease;low drug dose;major depression;medication error;melena;metabolic syndrome X;monotherapy;muscle disease;myalgia;nausea;neuromuscular disease;neuropsychology;non insulin dependent diabetes mellitus;nursing home patient;orthostatic hypotension;Parkinson disease;postmenopause;priority journal;psychotherapy;quality of life;rhabdomyolysis;risk reduction;secondary prevention;side effect;single drug dose;tablet;thromboembolism;tremor;unspecified side effect;uterus cancer;valvular heart disease;venous thromboembolism;vomiting;aggrastat;aspirin;zocor,"Guay, D. R. P.",2006,,,0,1624
1627,Protein cross-linkage induced by formaldehyde derived from semicarbazide-sensitive amine oxidase-mediated deamination of methylamine,"Semicarbazide-sensitive amine oxidase (SSAO) catalyzes the conversion of methylamine to formaldehyde. This enzyme is located on the surface of the cytoplasmic membrane and in the cytosol of vascular endothelial cells, smooth muscle cells, and adipocytes. Increased SSAO activity has been found in patients with diabetes mellitus, chronic heart failure, and multiple types of cerebral infarcts and is associated with obesity. Increased SSAO-mediated deamination may contribute to protein deposition, the formation of plaques, and inflammation, and thus may be involved in the pathophysiology of chronic vascular and neurological disorders, such as diabetic complications, atherosclerosis, and Alzheimer's disease. In the present study, we demonstrate the induction of cross-linkage of formaldehyde with the lysine moiety of peptides and proteins. Formaldehyde-protein adducts were reduced with sodium cyanoborohydride, hydrolyzed in hydrochloric acid, and the amino acids in the hydrolysates were derivatized with fluorenylmethyl chloroformate and then identified with high-performance liquid chromatography. We further demonstrate that incubation of methylamine in the presence of SSAO-rich tissues, e.g., human brain meninges, results in formaldehyde-protein cross-linkage of particulate bound proteins as well as of soluble proteins. This cross-linkage can be completely blocked by a selective inhibitor of SSAO. Our data support the hypothesis that the SSAO-induced production of formaldehyde may be involved in the alteration of protein structure, which may subsequently cause protein deposition associated with chronic pathological disorders.","Amine Oxidase (Copper-Containing)/*metabolism;Animals;Brain/cytology/metabolism;Cross-Linking Reagents/*metabolism;Deamination;Formaldehyde/*metabolism;Humans;Lysine/metabolism;Male;Methylamines/*metabolism;Mice;Proteins/*metabolism;Rats;Serum Albumin, Bovine/metabolism","Gubisne-Haberle, D.;Hill, W.;Kazachkov, M.;Richardson, J. S.;Yu, P. H.",2004,Sep,10.1124/jpet.104.068601,0,
1628,G-Protein-Coupled Receptor Kinase 2 (GRK2) Inhibitors: Current Trends and Future Perspectives,"G-protein-coupled receptor kinase 2 (GRK2) is a G-protein-coupled receptor kinase that is ubiquitously expressed in many tissues and regulates various intracellular mechanisms. The up- or down-regulation of GRK2 correlates with several pathological disorders. GRK2 plays an important role in the maintenance of heart structure and function; thus, this kinase is involved in many cardiovascular diseases. GRK2 up-regulation can worsen cardiac ischemia; furthermore, increased kinase levels occur during the early stages of heart failure and in hypertensive subjects. GRK2 up-regulation can lead to changes in the insulin signaling cascade, which can translate to insulin resistance. Increased GRK2 levels also correlate with the degree of cognitive impairment that is typically observed in Alzheimer's disease. This article reviews the most potent and selective GRK2 inhibitors that have been developed. We focus on their mechanism of action, inhibition profile, and structure-activity relationships to provide insight into the further development of GRK2 inhibitors as drug candidates.",,"Guccione, M.;Ettari, R.;Taliani, S.;Da Settimo, F.;Zappala, M.;Grasso, S.",2016,Jul 8,10.1021/acs.jmedchem.5b01939,0,
1629,Chronic Conditions and Self-Reported Health in a Medicare Advantage Plan Population,"Self-reported changes in physical and mental health by members are an important dimension by which the quality of a Medicare Advantage (MA) plan is rated by the Centers for Medicare & Medicaid Services. To better target their interventions, MA plans need a better understanding of what observed characteristics-including clinical health conditions-predict self-reported changes in physical and mental health. This study explored how one MA plan's survey of participants' responses regarding changes in physical and mental health is associated with a set of chronic conditions as well as sociodemographic characteristics. Multinomial logistic regressions were used to examine the influence of 9 chronic conditions and age, sex, race, education, dual eligibility status (Medicare/Medicaid eligible), marital and living status, and assistance with survey completion on changes in patient-reported physical and mental health. Six conditions-dementia (P < 0.001), diabetes (P = 0.003), congestive heart failure (P = 0.002), cerebrovascular disease (P = 0.001), coronary artery disease (CAD) (P < 0.001), and rheumatoid arthritis (P < 0.001)-were associated with self-reported worsening of overall physical health. Four conditions-dementia (P < 0.002), diabetes (P = 0.047), CAD (P = 0.001), and decubitus ulcers (P = 0.033)-were associated with self-reported worsening of overall mental health. Females, married respondents, and those needing assistance with survey completion were more likely to report worsening of their mental health. Enrollees older than age 65 actually were less likely to report worsening of overall mental health. Findings provide insight into which members may be more susceptible to reporting that their physical or mental health is worsening. (Population Health Management 2016;XX:XXX-XXX).",,"Guerard, B.;Omachonu, V.;Hernandez, S. R.;Sen, B.",2016,Jul 15,10.1089/pop.2016.0013,0,1630
1630,Chronic Conditions and Self-Reported Health in a Medicare Advantage Plan Population,"Self-reported changes in physical and mental health by members are an important dimension by which the quality of a Medicare Advantage (MA) plan is rated by the Centers for Medicare & Medicaid Services. To better target their interventions, MA plans need a better understanding of what observed characteristics - including clinical health conditions - predict self-reported changes in physical and mental health. This study explored how one MA plan's survey of participants' responses regarding changes in physical and mental health is associated with a set of chronic conditions as well as sociodemographic characteristics. Multinomial logistic regressions were used to examine the influence of 9 chronic conditions and age, sex, race, education, dual eligibility status (Medicare/Medicaid eligible), marital and living status, and assistance with survey completion on changes in patient-reported physical and mental health. Six conditions - dementia (P < 0.001), diabetes (P = 0.003), congestive heart failure (P = 0.002), cerebrovascular disease (P = 0.001), coronary artery disease (CAD) (P < 0.001), and rheumatoid arthritis (P < 0.001) - were associated with self-reported worsening of overall physical health. Four conditions - dementia (P < 0.002), diabetes (P = 0.047), CAD (P = 0.001), and decubitus ulcers (P = 0.033) - were associated with self-reported worsening of overall mental health. Females, married respondents, and those needing assistance with survey completion were more likely to report worsening of their mental health. Enrollees older than age 65 actually were less likely to report worsening of overall mental health. Findings provide insight into which members may be more susceptible to reporting that their physical or mental health is worsening.",aged;arthritis;article;cerebrovascular disease;chronic disease;chronic kidney failure;chronic obstructive lung disease;congestive heart failure;coronary artery disease;decubitus;dementia;diabetes mellitus;female;health;human;medicaid;medicare;mental health;rheumatoid arthritis;self report,"Guerard, B.;Omachonu, V.;Hernandez, S. R.;Sen, B.",2017,,10.1089/pop.2016.0013,0,
1631,Tako tsubo and ischemic stroke in a patient with Alzheimer’s disease,"Background Tako-tsubo cardiomyopathy (TTC), also known as ‘‘stress induced cardiomyopathy’’, is an acute cardiac condition characterized by transient myocardial dysfunction associated with a peculiar pattern of reversibile left ventricular ballooning that mimics myocardial infarction, but with normal coronary arteries. Tako-tsubo cardiomyopathy typically occurs in postmenopausal women and it is often triggered by physical or emotional stressful events. We report on a patient with Alzheimer’s disease, who presented with TTC and an ischemic stroke.",brain ischemia;cardiomyopathy;coronary artery;female;heart infarction;human;imaging software;patient;postmenopause;takotsubo cardiomyopathy,"Guidoni, S. V.;Pellicano, C.;La Starza, S.;Spalloni, A.;Rasura, M.",2014,,,0,
1632,"South African Menopause Society revised consensus position statement on menopausal hormone therapy, 2014","The South African Menopause Society (SAMS) consensus position statement on menopausal hormone therapy (HT) 2014 is a revision of the SAMS Council consensus statement on menopausal HT published in the SAMJin May 2007. Information presented in the previous statement has been re-evaluated and new evidence has been incorporated. While the recommendations pertaining to HT remain similar to those in the previous statement, the 2014 revision includes a wider range of clinical benefits for HT, the inclusion of non-hormonal alternatives such as selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors for the management of vasomotor symptoms, and an appraisal of bioidentical hormones and complementary medicines used for treatment of menopausal symptoms. New preparations that are likely to be more commonly used in the future are also mentioned. The revised statement emphasises that commencing HT during the 'therapeutic window of opportunity' maximises the benefit-to-risk profile of therapy in symptomatic menopausal women.",bazedoxifene;calcium;gabapentin;ospemifene;serotonin noradrenalin reuptake inhibitor;serotonin uptake inhibitor;vitamin D;Alzheimer disease;androgen therapy;article;breast cancer;cancer survivor;cerebrovascular accident;colorectal cancer;detrusor dyssynergia;diabetes mellitus;endometrium cancer;estrogen therapy;hormonal therapy;hot flush;human;insulin resistance;ischemic heart disease;lung cancer;menopausal syndrome;ovary carcinoma;premature ovarian failure;sleep disorder;vagina atrophy;vasomotor disorder;venous thromboembolism,"Guidozzi, F.;Alperstein, A.;Bagratee, J. S.;Dalmeyer, P.;Davey, M.;de Villiers, T. J.;Hirschowitz, S.;Kopenhager, T.;Moodley, S. P.;Roos, P.;Shaw, A.;Shimange, O.;Smith, T.;Thomas, C.;Titus, J.;van der Spuy, Z.;van Waart, J.",2014,,,0,
1633,"Short-stay Medical Unit, an alternative to conventional hospitalization","Background. The Short-stay Medical Unit (SSMU) is an alternative to conventional hospitalization. This study has aimed to analyze the evolution of admissions and duration of stay in a SSMU, to outline the characteristics of the patients while studying their relationship to length of time spent in the unit and their destination on discharge as well as to assess how appropriately their cases were resolved. Material and methods. A descriptive study was carried out (2000-2005), analyzing their age, sex, destination on discharge and main diagnosis as well as the evolution of admissions and length of stay over this period. In order to determine how appropriately each case was resolved, length of stay and destination on discharge were considered. The data were analyzed using the SPSS program. Results. During the study period there was an increase in the number of admissions and in length of stay. The average age of the 7,618 patients was 70.6 ± 16.9 years and the average stay 2.7 ± 1.4 days. One of the most frequent diagnoses was chronic obstructive pulmonary disease (COPD) (15.9%). On discharge, 85.9% of patients were sent home. A total of 76.4% of cases were resolved satisfactorily, with significant statistical differences related to age, diagnosis and number of diagnoses. Conclusions. A progressive increase in admissions and length of stay was observed. Ninety percent of the cases of the younger patients were resolved satisfactorily, this decreasing to 72% for older patients. The number of diagnoses, specific diagnoses and age caused some difficulty in reaching an appropriate resolution.",adult;age distribution;aged;anemia;article;asthma;cardiomyopathy;chronic obstructive lung disease;dementia;descriptive research;diabetes mellitus;female;gastroenteritis;gastrointestinal hemorrhage;atrial fibrillation;heart failure;hospital discharge;hospitalization;human;ischemic heart disease;length of stay;major clinical study;male;patient satisfaction;pneumonia;pyelonephritis;respiratory failure;respiratory tract infection;sex ratio;statistical significance;urinary tract infection,"Guirao Martínez, R.;Sempere Selva, M. T.;López Aguilera, I.;Sendra Pina, M. P.;Sánchez Payá, J.",2008,,,0,
1634,Hormone therapy for the prevention of chronic conditions in postmenopausal women,,bisphosphonic acid derivative;calcitonin;estrogen;gestagen;article;breast cancer;cardiovascular disease;cognitive defect;dementia;dual energy X ray absorptiometry;fragility fracture;hormonal therapy;hysterectomy;ischemic heart disease;menopausal syndrome;postmenopause osteoporosis;screening;cerebrovascular accident;thromboembolism,"Guirguis-Blake, J.",2005,,,0,
1635,Effects of gender on the phenotype of CADASIL,"Background and Purpose-: In the general population, migraine, cerebrovascular diseases, and vascular dementia differ in many aspects between men and women. CADASIL is considered a unique model to investigate migraine with aura, stroke, and dementia related to ischemic small vessel disease. This study aims to evaluate the effect of gender on the main clinical and neuroimaging characteristics of CADASIL. Methods-: Cross-sectional data from 313 CADASIL patients including various clinical and cognitive scores and MRI parameters were compared between men and women, and between those younger and older than the median age of the population corresponding to the usual age of menopause (51 years). Results-: At younger than 51 years, migraine with aura was 50% more prevalent in women and stroke was 75% more prevalent in men. After the fifth decade, men had higher National Institutes of Health Stroke Scale and Rankin scores than women and more severe executive dysfunction, although global cognitive scores were similar. Age at first stroke, the number of stroke events, and the prevalence of dementia and psychiatric symptoms did not differ between men and women. Brain volume was lower in men with a trend for a larger volume of lacunar infarcts. Conclusions-: In CADASIL, migraine with aura is more frequent in women and stroke is more frequent in men before the age of menopause. This difference seems to vanish after this age limit but may result in a higher degree of cognitive impairment and cerebral atrophy in men at the late stage of the disease. The presumable role of ovarian hormones in these gender-related differences remains to be explored. © 2011 American Heart Association. All rights reserved.",adult;article;brain infarction;brain size;CADASIL;female;human;major clinical study;male;mental disease;migraine with aura;neuroimaging;nuclear magnetic resonance imaging;onset age;phenotype;prevalence;priority journal;sex difference;cerebrovascular accident,"Gunda, B.;Hervé, D.;Godin, O.;Bruno, M.;Reyes, S.;Alili, N.;Opherk, C.;Jouvent, E.;Düring, M.;Bousser, M. G.;Dichgans, M.;Chabriat, H.",2012,,,0,
1636,Network-based in silico drug efficacy screening,"The increasing cost of drug development together with a significant drop in the number of new drug approvals raises the need for innovative approaches for target identification and efficacy prediction. Here, we take advantage of our increasing understanding of the network-based origins of diseases to introduce a drug-disease proximity measure that quantifies the interplay between drugs targets and diseases. By correcting for the known biases of the interactome, proximity helps us uncover the therapeutic effect of drugs, as well as to distinguish palliative from effective treatments. Our analysis of 238 drugs used in 78 diseases indicates that the therapeutic effect of drugs is localized in a small network neighborhood of the disease genes and highlights efficacy issues for drugs used in Parkinson and several inflammatory disorders. Finally, network-based proximity allows us to predict novel drug-disease associations that offer unprecedented opportunities for drug repurposing and the detection of adverse effects.",allopurinol;bentiromide;chlorpropamide;disopyramide;dofetilide;enalapril;fenofibrate;flecainide;furosemide;glimepiride;hydrochlorothiazide;insulin aspart;insulin lispro;irbesartan;isoprenaline;ketoprofen;liraglutide;losartan;miglitol;moracizine;nateglinide;propafenone;retinol;sitagliptin;sotalol;spironolactone;tolazamide;tolbutamide;tolvaptan;unindexed drug;acute myeloblastic leukemia;Alzheimer disease;amyotrophic lateral sclerosis;anemia;arthropathy;article;asthma;autoimmune disease;bacterial infection;biliary cirrhosis;blood clotting disorder;bone disease;breast tumor;collagen disease;colorectal tumor;congestive cardiomyopathy;coronary artery disease;Crohn disease;degeneration;disease association;diseases;drug efficacy;drug induced disease;drug repositioning;drug screening;endocrine disease;epilepsy;eye disease;gastroenteritis;head and neck tumor;heart arrhythmia;hematologic disease;human;hyperinsulinism;hypersensitivity;hypopigmentation;inborn error of metabolism;inflammatory bowel disease;inflammatory disease;insulin dependent diabetes mellitus;insulin resistance;intestine tumor;keratosis;kidney tumor;lung disease;lymphatic leukemia;lymphoma;malabsorption;metabolic bone disease;motor neuron disease;multiple sclerosis;mycobacteriosis;neuroendocrine tumor;non insulin dependent diabetes mellitus;palliative therapy;Parkinson disease;parkinsonism;peripheral occlusive artery disease;prostate tumor;protein protein interaction;retina maculopathy;rheumatic disease;rheumatoid arthritis;systemic lupus erythematosus;thyroid disease;varicosis,"Guney, E.;Menche, J.;Vidal, M.;Barábasi, A. L.",2016,,,0,
1637,Relation of brain natriuretic peptide levels to cognitive dysfunction in adults > 55 years of age with cardiovascular disease,"Cardiovascular disease (CVD) is associated with cognitive deficits long before the onset of stroke or dementia. Recent work has extended these findings and shown that patients with congestive heart failure also exhibit reduced cognitive performance. Brain natriuretic peptide (BNP) is used to help diagnose heart failure, but no study has examined whether BNP predicts cognitive dysfunction in older patients with CVD. BNP values and performance on the Dementia Rating Scale were assessed in 56 older adults with documented CVD. Forty-eight percent of the participants were women, and their average age was 70 +/- 8 years. All participants had Mini-Mental State Examination scores greater than the cutoff for dementia and no histories of neurologic or severe psychiatric disorders. The average BNP level was 122 +/- 202 pg/ml. Hierarchical regression analyses showed that log-transformed BNP levels predicted Dementia Rating Scale total score after adjusting for possible demographic and medical confounders (DeltaR2 = 0.09, F[1, 44] = 6.14, p = 0.017). Partial correlation analysis adjusting for these possible confounders showed a particularly strong relation to the conceptualization subtest (r = -0.44, p = 0.002), a measure of verbal and nonverbal abstraction abilities. In conclusion, the results of the present study provide the first evidence for an independent relation between BNP and cognitive dysfunction in older adults with CVD.","Age Factors;Aged;Biomarkers/blood;Cognition Disorders/*blood/epidemiology/etiology;Disease Progression;Female;Heart Failure/*blood/complications;Humans;Male;Middle Aged;Natriuretic Peptide, Brain/*blood;Prevalence;Prognosis;Risk Factors;Severity of Illness Index","Gunstad, J.;Poppas, A.;Smeal, S.;Paul, R. H.;Tate, D. F.;Jefferson, A. L.;Forman, D. E.;Cohen, R. A.",2006,Aug 15,10.1016/j.amjcard.2006.02.062,0,
1638,Around PediHeart: What should be done for fetal rhabdomyomata,,autosomal dominant disorder;congenital disorder;dementia;disease course;disease severity;echocardiography;fetus;fetus echography;heart arrhythmia;heart failure;heart surgery;human;prematurity;radiofrequency ablation;rhabdomyoma;short survey;tachycardia;tuberous sclerosis,"Guntheroth, W.",2005,,,0,
1639,Advancement of study on matrix metalloproteinase 3 and significance of its application in forensic medicine,"Matrix metalloproteinase 3 is one of matrix metalloproteinase family members, which degrades a wide range of components of the extracellular matrix and participates in tissue morphogenesis, wound healing and inflammation. In addition, matrix metalloproteinase 3 is involved in pathogenesis and progress of a spectrum of diseases and malignant tumors, such as rheumatic arthritis, arteriosclerosis, breast cancer, and so on. Recent studies have demonstrated that matrix metalloproteinase 3 may be a novel signaling proteinase from apoptotic neuronal cells to microglia, which results in degeneration of neurons in Alzheimer's disease and Parkinson's disease by activating microglia. There is also an association between genetic polymorphisms of matrix metalloproteinase 3 at promoter region 5A/6A and susceptibility of myocardial infarction. Decrease in serum concentration of matrix metalloproteinase 3 after myocardial infarction may be a useful parameter for diagnosing sudden death due to myocardial infarction in forensic practice. Expression of matrix metalloproteinase 3 varies with different types of brain injuries, suggesting that it may contribute to synaptic plasticity during functional recovery. To elucidate the time-dependent expression of matrix metalloproteinase 3 may provide a new way for wound age determination in the brain.",stromelysin;Alzheimer disease;arteriosclerosis;article;brain injury;breast cancer;convalescence;extracellular matrix;forensic medicine;forensic pathology;genetic polymorphism;genetic susceptibility;heart death;heart infarction;human;inflammation;malignant neoplastic disease;microglia;morphogenesis;nerve cell;nerve cell plasticity;Parkinson disease;pathogenesis;protein expression;rheumatoid arthritis;signal transduction;sudden death;wound healing,"Guo, X. C.;Li, R. B.;Liang, H. X.",2008,,,0,
1640,Medical management of hip fractures and the role of the orthogeriatrician,"Published literature shows that evidence-based medical care can improve hip fracture outcomes. The orthogeriatrician plays a key role in providing this care, in collaboration with surgical and multidisciplinary professionals, managing pre-operative conditions and post-operative complications that may affect functional recovery, and ensuring co-ordinated effective management of hip fractures right from admission to discharge. Several management guidelines are available for this vulnerable group of elderly patients. Recent UK guidelines recommend that, from time of admission, hip fracture patients should be offered a formal acute orthogeriatric or orthopaedic ward-based 'Hip Fracture Programme', which includes orthogeriatric assessment as an essential key component. © Copyright 2012 Cambridge University Press.",acetylsalicylic acid;antiinflammatory agent;cephalosporin derivative;clindamycin;clopidogrel;codeine;dipyridamole;fondaparinux;heparin;laxative;low molecular weight heparin;paracetamol;vancomycin;vitamin K group;warfarin;zoledronic acid;aged;analgesia;anemia;antibiotic prophylaxis;article;bladder function;blood transfusion;cerebrovascular accident;comorbidity;compression stocking;constipation;decubitus;deep vein thrombosis;delirium;dementia;electrolyte balance;fall risk assessment;fluid balance;gastrointestinal hemorrhage;gerontologist;heart infarction;hip fracture;hip surgery;human;intestine function;low drug dose;lung embolism;malnutrition;medical audit;orthogeriatrician;orthopedic specialist;osteoporosis;pain;palliative therapy;postoperative care;postoperative complication;practice guideline;surgical infection;thrombocytopenia;thrombosis prevention;United Kingdom;urinary tract infection;urine retention;venous thromboembolism;aspirin,"Gupta, A.",2012,,,0,
1641,Incidence and 1-year outcomes of perioperative atrial arrhythmia in elderly adults after hip fracture surgery,"Objectives To determine the incidence and 1-year outcomes of an elderly population with perioperative atrial arrhythmia (PAA) within 7 days of hip fracture surgery. Design Retrospective cohort study. Setting The Rochester Epidemiology Project (REP). Participants Elderly adults consecutive undergoing hip fracture repair from 1988 to 2002 in Olmsted County, Minnesota (N = 1,088, mean age 84.0 ± 7.4, 80.2% female). Measurements Baseline clinical variables were analyzed in relation to survival using Cox proportional hazards methods for comparison. Results Sixty-one participants (5.6%) developed PAA within the first 7 days. During 1 year of follow-up, 239 (22%) participants died. PAA was associated with greater mortality (45% vs 21%; hazard ratio (HR) = 2.8, 95% confidence interval (CI) = 1.9-4.2). Other mortality risk factors were male sex (HR = 2.0, 95% CI = 1.5-2.6), congestive heart failure (HR = 2.1, 95% CI = 1.7-2.8), chronic renal insufficiency (HR = 2.0, 95% CI = 1.5-2.8), dementia (HR = 2.9, 95% CI = 2.2-3.7), and American Society of Anesthesiologists risk Class III, IV, or V (HR = 3.3, 95% CI = 1.9-5.9). Conclusion Elderly adults undergoing hip fracture surgery who develop PAA within 7 days have significantly higher 1-year mortality than those who do not. Further studies are indicated to determine whether prevention of PAA will reduce mortality in this population.",aged;anesthesist;article;chronic kidney failure;cohort analysis;congestive heart failure;dementia;female;follow up;heart atrium arrhythmia;hip fracture;hip surgery;human;major clinical study;male;medical society;mortality;peroperative complication;retrospective study;risk factor;survival;treatment outcome;United States,"Gupta, B. P.;Steckelberg, R. C.;Gullerud, R. E.;Huddleston, P. M.;Kirkland, L. L.;Wright, R. S.;Huddleston, J. M.",2015,,,0,
1642,Shades of gray,,vasoactive agent;aged;agricultural worker;Alzheimer disease;aorta stenosis;blood analysis;case report;confusion;dementia;disease course;disease severity;doctor patient relation;dyspnea;echocardiography;electrocardiogram;emergency ward;evidence based medicine;fatigue;heart ejection fraction;heart failure;heart pacing;heart valve surgery;hospital admission;human;hypotension;intensive care unit;male;note;operating room;oxygen supply;priority journal;prognosis;sleep;surgical risk;thorax radiography;treatment response,"Gupta, D.",2012,,,0,
1643,Sequencing and analysis of a South Asian-Indian personal genome,"Background: With over 1.3 billion people, India is estimated to contain three times more genetic diversity than does Europe. Next-generation sequencing technologies have facilitated the understanding of diversity by enabling whole genome sequencing at greater speed and lower cost. While genomes from people of European and Asian descent have been sequenced, only recently has a single male genome from the Indian subcontinent been published at sufficient depth and coverage. In this study we have sequenced and analyzed the genome of a South Asian Indian female (SAIF) from the Indian state of Kerala.Results: We identified over 3.4 million SNPs in this genome including over 89,873 private variations. Comparison of the SAIF genome with several published personal genomes revealed that this individual shared ~50% of the SNPs with each of these genomes. Analysis of the SAIF mitochondrial genome showed that it was closely related to the U1 haplogroup which has been previously observed in Kerala. We assessed the SAIF genome for SNPs with health and disease consequences and found that the individual was at a higher risk for multiple sclerosis and a few other diseases. In analyzing SNPs that modulate drug response, we found a variation that predicts a favorable response to metformin, a drug used to treat diabetes. SNPs predictive of adverse reaction to warfarin indicated that the SAIF individual is not at risk for bleeding if treated with typical doses of warfarin. In addition, we report the presence of several additional SNPs of medical relevance.Conclusions: This is the first study to report the complete whole genome sequence of a female from the state of Kerala in India. The availability of this complete genome and variants will further aid studies aimed at understanding genetic diversity, identifying clinically relevant changes and assessing disease burden in the Indian population. © 2012 Gupta et al.; licensee BioMed Central Ltd.",metformin;warfarin;abdominal aorta aneurysm;Alzheimer disease;article;asthma;basal cell carcinoma;bipolar depression;bladder cancer;bleeding;breast cancer;cerebrovascular accident;colorectal cancer;congestive cardiomyopathy;controlled study;coronary artery disease;depression;esophagus cancer;essential tremor;female;follicular lymphoma;frontotemporal dementia;gene sequence;genetic risk;genetic susceptibility;genetic variability;genome analysis;gout;Graves disease;atrial fibrillation;heart infarction;human;human experiment;human genome;hypertension;hypertriglyceridemia;India;Indian;insulin dependent diabetes mellitus;intracranial aneurysm;lung cancer;melanoma;migraine;mitochondrial genome;multiple sclerosis;myeloproliferative disorder;narcolepsy;non insulin dependent diabetes mellitus;normal human;nucleotide sequence;obesity;osteoarthritis;ovary polycystic disease;Parkinson disease;primary sclerosing cholangitis;psoriasis;psoriatic arthritis;age related macular degeneration;rheumatoid arthritis;schizophrenia;single nucleotide polymorphism;stomach cancer;systemic lupus erythematosus;systemic sclerosis;thyroid cancer;ulcerative colitis;uterus myoma;vitiligo,"Gupta, R.;Ratan, A.;Rajesh, C.;Chen, R.;Kim, H. L.;Burhans, R.;Miller, W.;Santhosh, S.;Davuluri, R. V.;Butte, A. J.;Schuster, S. C.;Seshagiri, S.;Thomas, G.",2012,,,0,
1644,Acquired long QT syndrome and Torsades de Pointes related to donepezil use in a patient with Alzheimer disease,"Acetylcholinesterase inhibitors are group of drugs commonly used in Alzheimer disease and have beneficial effects on treatment. Although they have many known side effects, cardiovascular side effects are rarely seen. We present a 84 year old female who was admitted to emergency service due to repetitive syncope episodes while taking donepezil. Her electrocardiogram showed QT prolongation and on follow-up a Torsades de Pointes episode occurred. Patient was discharged with normal corrected QT time after removal of donepezil.",donepezil;magnesium;potassium;aged;Alzheimer disease;article;atrial fibrillation;case report;computer assisted tomography;coronary artery disease;drug withdrawal;electrocardiography;electrophysiology parameters;emergency health service;faintness;family history;female;follow up;heart palpitation;heart rate;human;long QT syndrome;mean arterial pressure;oxygen saturation;QT interval;QT prolongation;sudden cardiac death;T wave inversion;telemetry;thorax pain;torsade des pointes;tricuspid valve regurgitation;very elderly,"Gurbuz, A. S.;Ozturk, S.;Acar, E.;Efe, S. Ç;Akgun, T.;Kilicgedik, A.;Guler, A.;Kirma, C.",2016,,10.1016/j.ehj.2015.07.004,0,
1645,Prevalence of cognitive impairment in older adults with heart failure,"OBJECTIVES: To determine the prevalence of cognitive impairment in older adults with heart failure (HF). DESIGN: Cross-sectional analysis of the 2004 wave of the nationally representative Health and Retirement Study linked to 2002 to 2004 Medicare administrative claims. SETTING: United States, community. PARTICIPANTS: Six thousand one hundred eighty-nine individuals aged 67 and older. MEASUREMENTS: An algorithm was developed using a combination of self- and proxy report of a heart problem and the presence of one or more Medicare claims in administrative files using standard HF diagnostic codes. On the basis of the algorithm, three categories were created to characterize the likelihood of a HF diagnosis: high or moderate probability of HF, low probability of HF, and no HF. Cognitive function was assessed using a screening measure of cognitive function or according to proxy rating. Age-adjusted prevalence estimates of cognitive impairment were calculated for the three groups. RESULTS: The prevalence of cognitive impairment consistent with dementia in older adults with HF was 15%, and the prevalence of mild cognitive impairment was 24%. The odds of dementia in those with HF were significantly higher, even after adjustment for age, education level, net worth, and prior stroke (odds ratio = 1.52, 95% confidence interval = 1.14-2.02). CONCLUSION: Cognitive impairment is common in older adults with HF and is independently associated with risk of dementia. A cognitive assessment should be routinely incorporated into HF-focused models of care.","Aged;Aged, 80 and over;Algorithms;Chi-Square Distribution;Cognition Disorders/*epidemiology;Cross-Sectional Studies;Demography;Female;Heart Failure/*complications;Humans;Logistic Models;Male;Medicare;Prevalence;United States/epidemiology","Gure, T. R.;Blaum, C. S.;Giordani, B.;Koelling, T. M.;Galecki, A.;Pressler, S. J.;Hummel, S. L.;Langa, K. M.",2012,Sep,10.1111/j.1532-5415.2012.04097.x,0,
1646,"The Heart Protection Study: high-risk patients benefit from statins, regardless of LDL-C level","The landmark Heart Protection Study (Lancet 2002; 360:7-22) found benefit in treating subjects at high risk of a coronary event with simvastatin 40 mg daily, regardless of baseline low-density lipoprotein cholesterol level and in all subgroups, including women and the elderly. The study found no benefit of simvastatin therapy in preventing noncardiac events (eg, dementia, osteoporotic fractures), and no negative effects, such as an increase in cancer, respiratory disease, or suicide.","Cholesterol, HDL/blood;Coronary Disease/*prevention & control;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use;Simvastatin/therapeutic use;Treatment Outcome","Gurm, H. S.;Hoogwerf, B.",2003,Nov,,0,
1647,Management of the hopelessly ill patient: To stop or not to start?,"The paper discusses the subject of futile treatment in the case of a hopelessly ill patient. The topic has many facets, among them the ethical precepts of preventing futile treatment, but also the economic and logistic impact of treating patients who do not have a fair chance of benefitting from managing their medical condition. A 75-year old patient, suffering from an advanced stage of Alzheimer’s disease and a clinical picture of acute surgical abdomen, is presented and two approaches are discussed. The first scenario is the aggressive management, including immediate laparotomy and admission to an intensive care unit, a solution without a fair chance of saving the patient’s life. The most favorable, but theoretical, output in this case would be the patient’s return to his previous mental condition, without any connection with the reality and surroundings and in permanent need for help, supervision and assistance. The second option is letting the patient die in dignity, alleviating pain and surrounded by family. The role of the primary care physician and family is discussed and some ethical principles are presented in order to emphasize the importance of preventing futile treatment in a case of a terminally ill patient.",bicarbonate;creatinine;diuretic agent;enalapril;hemoglobin;potassium;sodium;abdominal radiography;abdominal surgery;abdominal tenderness;aged;Alzheimer disease;ambulance;analgesia;article;auscultation;brain death;case report;chronic kidney failure;chronic obstructive lung disease;crystalloid;death;dehydration;emergency ward;fever;general hospital;heart failure;hopelessness;hospital admission;human;human dignity;hypertension;immobility;intensive care unit;intestine sound;ischemic heart disease;laparotomy;managed care;medical ethics;medical history;mental health;oliguria;oxygen mask;physical examination;retirement;shared decision making;smoking;terminally ill patient;unconsciousness;vomiting,"Gurman, G. M.",2016,,10.21454/rjaic.7518.231.hps,0,
1648,Impact of tyrosine nitration at positions Tyr307 and Tyr335 on structural dynamics of Lipoprotein-associated phospholipase A2-A therapeutically important cardiovascular biomarker for atherosclerosis,"Protein tyrosine nitration (PTN) is a post translational event which results in the generation of 3-Nitrotyrosine (3-NT). High levels of 3-NT were reported in several human diseases such as Parkinson's disease, Alzheimer's disease, amylotrophic lateral sclerosis and coronary artery disease. It was reported that PTN at positions 307 and 335 of Lipoprotein-associated phospholipase A2 (Lp-PLA2) curtails its enzymatic activity but the mechanism of inhibition at the structure level is still incomprehensible. The present study is an in silico endeavor to understand nitrative stress induced structural changes in Lp-PLA2. Molecular docking studies revealed a decreased binding affinity of substrate, Platelet Activating Factor (PAF) with the nitrated forms of Lp-PLA2 (NT-Tyr307 and NT-Tyr335) compared to the wild type, due to differences in the hydrogen bond interaction patterns. Molecular dynamics (MD) simulation studies suggests higher flexibility of nitrated forms compared to wild type, disorientation of the catalytic triad and decreased molecular interactions of NT-Tyr307 and NT-Tyr335 with other residues of the protein. Essential dynamics (ED) further confirmed the enhanced structural flexibility of nitrated forms of Lp-PLA2. Our findings would help understand the molecular mechanism of nitrative stress induced inhibition of Lp-PLA2 which may further assist in designing of therapeutics having protective functions against PTN.",3-Nitrotyrosine (3-NT);Atherosclerosis;Cardiovascular biomarker;Lipoprotein-associated phospholipase A(2) (Lp-PLA(2));Platelet activating factor (PAF);Protein tyrosine nitration (PTN),"Gurung, A. B.;Bhattacharjee, A.",2017,Oct 16,,0,
1649,Oestrogen replacement therapy in postmenopausal women,,"Aged;Alzheimer Disease/prevention & control;Cerebrovascular Disorders/prevention & control;Coronary Disease/prevention & control;Endometrial Neoplasms/blood supply/chemically induced;Endothelium, Vascular/drug effects/enzymology;*Estrogen Replacement Therapy/adverse effects;Female;Humans;Myocardial Infarction/prevention & control;Nitric Oxide/metabolism;Nitric Oxide Synthase/metabolism;Postmenopause/*drug effects;Risk Factors;Vasodilator Agents/metabolism","Gurwitz, D.",1999,Feb 20,10.1016/s0140-6736(05)75472-6,0,
1650,Statins for primary prevention in older adults: Uncertainty and the need for more evidence,,NCT02099123;atorvastatin;hydroxymethylglutaryl coenzyme A reductase inhibitor;placebo;pravastatin;rosuvastatin;aged;cardiovascular mortality;cerebrovascular accident;coronary artery atherosclerosis;dementia;disability;drug withdrawal;geriatric patient;heart infarction;human;mortality;myalgia;note;primary prevention;priority journal;risk reduction;unstable angina pectoris,"Gurwitz, J. H.;Go, A. S.;Fortmann, S. P.",2016,,10.1001/jama.2016.15212,0,
1651,Contemporary prevalence and correlates of incident heart failure with preserved ejection fraction,"BACKGROUND: We assessed the prevalence of preserved left ventricular ejection fraction in patients with incident heart failure and differences in the demographic and clinical characteristics that may differentiate patients presenting with heart failure with preserved versus reduced left ventricular ejection fraction. METHODS: We identified all patients with newly diagnosed heart failure between 2005 and 2008 from 4 sites in the Cardiovascular Research Network on the basis of hospital discharge and ambulatory visit diagnoses, and assigned a category of preserved, borderline, or reduced left ventricular ejection fraction using data from electronic databases and chart review. RESULTS: We identified 11,994 patients with incident heart failure; of these, 6210 (51.8%) had preserved left ventricular ejection fraction, 1870 (15.6%) had borderline systolic dysfunction, and 3914 (32.6%) had reduced left ventricular ejection fraction. For those with heart failure with preserved left ventricular ejection fraction, the mean age was 74.7 years and 57.1% were women; for those with borderline systolic dysfunction, the mean age was 71.6 years and 38.4% were women; and for those with reduced left ventricular ejection fraction, the mean age was 69.1 years and 32.6% were women. Compared with white patients, black patients were less likely to have heart failure with preserved systolic function. Those with a history of coronary artery bypass surgery, mitral or aortic valvular disease, atrial fibrillation or flutter, or a diagnosis of hypertension were more likely to have heart failure with preserved systolic function, as were those with a diverse range of noncardiac comorbid conditions, including chronic lung disease, chronic liver disease, a history of a hospitalized bleed, a history of a mechanical fall, a diagnosis of depression, and a diagnosis of dementia. Patients with a history of acute myocardial infarction and a history of ventricular fibrillation or ventricular tachycardia were less likely to have heart failure with preserved left ventricular ejection fraction. Patients with higher systolic blood pressures at baseline and lower low-density lipoprotein levels were more likely to have heart failure with preserved left ventricular ejection fraction, as were those with lower hemoglobin levels and the lowest glomerular filtration rates. CONCLUSIONS: Heart failure with preserved left ventricular ejection fraction is the most common form of the heart failure syndrome among patients newly presenting with this condition, and women and older adults are especially affected. Evidence-based treatment strategies apply to less than one third of patients with newly diagnosed heart failure.","Aged;Aged, 80 and over;Female;Heart Failure/drug therapy/*epidemiology/physiopathology;Humans;Incidence;Male;Middle Aged;Prevalence;Stroke Volume/*physiology;Ventricular Dysfunction, Left/*diagnosis/epidemiology;Ventricular Function, Left/*physiology","Gurwitz, J. H.;Magid, D. J.;Smith, D. H.;Goldberg, R. J.;McManus, D. D.;Allen, L. A.;Saczynski, J. S.;Thorp, M. L.;Hsu, G.;Sung, S. H.;Go, A. S.",2013,May,10.1016/j.amjmed.2012.10.022,0,
1652,Insulinoma clinically misdiagnosed as vertebrobasilar insufficiency in an obese patient with recurrent episodes of loss of consciousness,,adenosine triphosphate sensitive potassium channel;glucose;trimetazidine;aged;amnesia;anxiety;arousal;autopsy;bariatric surgery;blurred vision;body mass;case report;central nervous system;computer assisted tomography;confusion;consciousness;dementia;diabetes mellitus;diagnostic error;differential diagnosis;diplopia;dizziness;dumping syndrome;dysarthria;emergency ward;epilepsy;exercise;follow up;glucose blood level;headache;hospitalization;human;hyperphagia;hypoglycemia;hypoglycemic coma;insulinoma;ischemic heart disease;lethargy;letter;male;nausea;obesity;pancreas duct;pancreas islet disease;pancreas resection;paresthesia;personality disorder;polyneuropathy;priority journal;seizure;somnolence;sweating;tachycardia;university hospital;vertebral artery;vertebrobasilar insufficiency;walking;weakness;weight gain,"Gurzu, S.;Jung, I.;Turdean, S.;Dee, E.;Ciomos, D.;Borz, C.",2014,,,0,
1653,Recurrent concussion and risk of depression in retired professional football players,"PURPOSE: The purpose of our study was to investigate the association between prior head injury and the likelihood of being diagnosed with clinical depression among retired professional football players with prior head injury exposure. METHODS: A general health questionnaire, including information about prior injuries, the SF-36 (Short Form 36), and other markers for depression, was completed by 2552 retired professional football players with an average age of 53.8 (± 13.4) yr and an average professional football-playing career of 6.6 (± 3.6) yr. A second questionnaire focusing on mild cognitive impairment (MCI)-related issues was completed by a subset of 758 retired professional football players (50 yr and older). RESULTS: Two hundred sixty-nine (11.1%) of all respondents reported having prior or current diagnosis of clinical depression. There was an association between recurrent concussion and diagnosis of lifetime depression (χ = 71.21, df = 2, P < 0.005), suggesting that the prevalence increases with increasing concussion history. Compared with retired players with no history of concussion, retired players reporting three or more previous concussions (24.4%) were three times more likely to be diagnosed with depression; those with a history of one or two previous concussions (36.3%) were 1.5 times more likely to be diagnosed with depression. The analyses controlled for age, number of years since retirement, number of years played, physical component score on the SF-36, and diagnosed comorbidities such as osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. CONCLUSION: Our findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression. The findings emphasize the importance of understanding potential neurological consequences of recurrent concussion. ©2007The American College of Sports Medicine.",adult;aged;article;neoplasm;cognitive defect;comorbidity;comparative study;concussion;depression;diabetes mellitus;football;General Health Questionnaire;head injury;human;ischemic heart disease;major clinical study;osteoarthritis;prevalence;risk assessment;Short Form 36;cerebrovascular accident,"Guskiewicz, K. M.;Marshall, S. W.;Bailes, J.;McCrea, M.;Harding Jr, H. P.;Matthews, A.;Mihalik, J. R.;Cantu, R. C.",2007,,,0,
1654,Impact of vitamin D receptor polymorphisms in centenarians,"Vitamin D is a seco-sterol produced endogenously in the skin or obtained from certain foods. It exerts its action through binding to intracellular vitamin D receptor (VDR). Lately, the role of vitamin D has been revised regarding its potential advantage on delaying the process of aging. The aim of this study was to assess the contribution of VDR gene polymorphisms in healthy aging and longevity. We evaluated the frequency of four polymorphisms of the VDR gene (FokI, BsmI, ApaI, and TaqI) in centenarians (102 subjects, mean age: 102.3 +/- 0.3 years), compared to septuagenarians (163 subjects, mean age: 73.0 +/- 0.6 years) and we analyzed a variety of pathophysiologically relevant functions in centenarians. BsmI and ApaI provided a significant association with longevity: there was a highly significant difference in the frequency of BsmI genotypes (p = 0.037), ApaI genotypes (p = 0.022), and ApaI alleles (p = 0.050) in centenarians versus septuagenarians. Furthermore, we found a significant correlation of all the VDR gene polymorphisms in centenarians with some measured variables such as hand grip strength, body mass index, blood pressure, HDL cholesterol, and mini-mental state examination. We also found a correlation with the prevalence of medical history of hypertension, acute myocardial infarction, angina, venous insufficiency, dementia, chronic obstructive pulmonary disease, and arthrosis. In conclusion, this study proposes a new scenario in which the variability of the VDR gene is relevant in the aging process and emphasizes the role of VDR genetic background in determining healthy aging.",Biology of aging;Centenarian;Co-morbidity;Longevity,"Gussago, C.;Arosio, B.;Guerini, F. R.;Ferri, E.;Costa, A. S.;Casati, M.;Bollini, E. M.;Ronchetti, F.;Colombo, E.;Bernardelli, G.;Clerici, M.;Mari, D.",2016,Aug,10.1007/s12020-016-0908-7,0,
1655,"Body mass index, cognition, disability, APOE genotype, and mortality: The ""treviso longeva"" study","Objectives: The concurrent contributions of dynamic, interrelated late-life parameters, such as body mass index (BMI), cognition, and physical functioning on mortality in the elderly are unclear, as is the influence of APOE genotype. We explored these measures in relation to 7-year mortality in long-lived Italian elderly. Design: A representative, age-stratified, population sample. Setting: The Treviso Longeva (TRELONG) Study, in Treviso, Italy. Participants: Three hundred eleven men and 357 women, aged 70 years and older (mean age 84 ± 8 years). Measurements: Seven-year mortality, BMI, Mini-Mental State Examination (MMSE) score, Activities of Daily Living (ADL), APOE genotype, and a variety of clinical and survey data. Results: In separate age-and sex-adjusted analyses, BMI <18.5 kg/m, MMSE ≤24, and ADL <6, were associated with greater 7-year mortality among adults aged 70 years and older. In a multivariate model including all factors, MMSE ≤24, and ADL <6 were associated with greater mortality; BMI ≥30 kg/m was protective. There were no interactions between BMI, MMSE, or ADL. When excluding those dying within 3 years of baseline, only an MMSE ≤24 was related to mortality. APOEε4 was not related to mortality. CONCLUSION:: Higher MMSE score, higher ADL score, and higher BMI, independent of age, sex, and other factors, are markers for longer life among northern Italian adults aged 70 years or older. Global cognition, BMI, and physical functioning, assessed by short, simple tests are profound indicators of death within less than a decade. © 2012 American Association for Geriatric Psychiatry.",apolipoprotein E;apolipoprotein E epsilon 2;apolipoprotein E epsilon 3;apolipoprotein e epsilon 4;unclassified drug;ADL disability;aged;article;body mass;cognition;congestive heart failure;daily life activity;diabetes mellitus;female;gene frequency;genotype;groups by age;heart muscle ischemia;human;Italy;longevity;major clinical study;male;Mini Mental State Examination;mortality;peripheral vascular disease;cerebrovascular accident,"Gustafson, D. R.;Mazzuco, S.;Ongaro, F.;Antuono, P.;Forloni, G.;Albani, D.;Gajo, G. B.;Durante, E.;Caberlotto, L.;Zanardo, A.;Siculi, M.;Gallucci, M.",2012,,,0,
1656,Outcomes of hip fractures: Rehabilitation programmes: Comprehensive Geriatric Assessment and Rehabilitation-a prerequisite for successful treatment of people who have suffered a hip-fracture,"One hundred and ninety-nine patients were randomized to either regular Orthopaedic care or to a Geriatric rehabilitation ward immediately postoperative. A geriatric team applying Comprehensive Geriatric Assessment (CGA) including the use of the Delirium-Check-list was used in the intervention group. CGA is probably the best way of taking care of the old patient with a hip-fracture and is a prerequisite for successful rehabilitation. Delirium can be successfully prevented by protecting the brain from hypoxemia and hypercortisolism by preventing complications endangering the metabolism of the brain. In a patient who develops delirium there is an urgent need to detect and treat any underlying complications and the treatment of the delirious patient should have the focus of creating the best prerequisites for the recovery of the brain which includes an active prevention, early detection and treatment of any new complications. Fewer patients randomized to the geriatric ward suffered from postoperative delirium. Those who developed delirium had a shorter duration of their delirium. The intervention group suffered fewer decubital ulcers, fewer urinary tract infections, less malnutrition and fewer falls and fewer new fractures occurred during hospitalisation. Length of stay was 25% shorter in the Geriatric ward and the Odds Ratio of being an independent walker one year later was 3.0 in the patients randomized to the Geriatric department. The patients in the above mentioned study was followed up for post-discharge complications during three years. Complications were numerous in both the control and intervention group: 480 infections (272 UTI in 136 participants), 542 falls resulting in 40 new fractures, 29 myocardial infarctions and 23 new strokes. There were 235 new admissions to hospital in 97 of the participants and the tree year mortality rate was 40%. Geriatric interventions are also needed after discharge from hospital. People who suffer from hip-fracture become older and frailer - e.g. the proportion with dementia and stroke has more than doubled in 20 years. The number of patients 90 years and older who have suffered hip-fractures has increased by 150% in ten years at Umea University Hospital and pre- per- and postoperative complications also seem to increase. Post-discharge complications are numerous and the one-year-mortality is still very high. The above mentioned rehabilitation program did not exclude patients with dementia and surprisingly the best effect was seen in patients with dementia. An old person with a hip-fracture should primarily be regarded as a patient in need of a Geriatric team applying CGA including active rehabilitation but geriatric medicine also has to take the responsibility for patients with hip-fractures after discharge from hospital.",hip fracture;rehabilitation;society;geriatrics;European Union;human;geriatric assessment;patient;delirium;hospital;ward;brain;dementia;stroke;fracture;mortality;hypercortisolism;tree;heart infarction;hypoxemia;infection;geriatric hospital;risk;length of stay;checklist;malnutrition;urinary tract infection;decubitus;postoperative delirium;postoperative complication;university hospital;prevention;metabolism;responsibility;geriatric rehabilitation,"Gustafson, Y.",2012,,10.1016/j.eurger.2012.07.413,0,
1657,Outcomes of hip fractures: rehabilitation programmes: comprehensive Geriatric Assessment and Rehabilitation-a prerequisite for successful treatment of people who have suffered a hip-fracture,"One hundred and ninety-nine patients were randomized to either regular Orthopaedic care or to a Geriatric rehabilitation ward immediately postoperative. A geriatric team applying Comprehensive Geriatric Assessment (CGA) including the use of the Delirium-Check-list was used in the intervention group. CGA is probably the best way of taking care of the old patient with a hip-fracture and is a prerequisite for successful rehabilitation. Delirium can be successfully prevented by protecting the brain from hypoxemia and hypercortisolism by preventing complications endangering the metabolism of the brain. In a patient who develops delirium there is an urgent need to detect and treat any underlying complications and the treatment of the delirious patient should have the focus of creating the best prerequisites for the recovery of the brain which includes an active prevention, early detection and treatment of any new complications. Fewer patients randomized to the geriatric ward suffered from postoperative delirium. Those who developed delirium had a shorter duration of their delirium. The intervention group suffered fewer decubital ulcers, fewer urinary tract infections, less malnutrition and fewer falls and fewer new fractures occurred during hospitalisation. Length of stay was 25% shorter in the Geriatric ward and the Odds Ratio of being an independent walker one year later was 3.0 in the patients randomized to the Geriatric department. The patients in the above mentioned study was followed up for post-discharge complications during three years. Complications were numerous in both the control and intervention group: 480 infections (272 UTI in 136 participants), 542 falls resulting in 40 new fractures, 29 myocardial infarctions and 23 new strokes. There were 235 new admissions to hospital in 97 of the participants and the tree year mortality rate was 40%. Geriatric interventions are also needed after discharge from hospital. People who suffer from hip-fracture become older and frailer - e.g. the proportion with dementia and stroke has more than doubled in 20 years. The number of patients 90 years and older who have suffered hip-fractures has increased by 150% in ten years at Umea University Hospital and pre- per- and postoperative complications also seem to increase. Post-discharge complications are numerous and the one-year-mortality is still very high. The above mentioned rehabilitation program did not exclude patients with dementia and surprisingly the best effect was seen in patients with dementia. An old person with a hip-fracture should primarily be regarded as a patient in need of a Geriatric team applying CGA including active rehabilitation but geriatric medicine also has to take the responsibility for patients with hip-fractures after discharge from hospital.",hip fracture;rehabilitation;society;geriatrics;European Union;human;geriatric assessment;patient;delirium;hospital;ward;brain;dementia;stroke;fracture;mortality;hypercortisolism;tree;heart infarction;hypoxemia;infection;geriatric hospital;risk;length of stay;checklist;malnutrition;urinary tract infection;decubitus;postoperative delirium;postoperative complication;university hospital;prevention;metabolism;responsibility;geriatric rehabilitation,"Gustafson, Y",2012,,10.1016/j.eurger.2012.07.413,0,1656
1658,Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial,"PURPOSE: To assess whether comprehensive medication reviews conducted by clinical pharmacists as part of a healthcare team reduce drug-related hospital readmission rates among people with dementia or cognitive impairment. METHODS: This randomized controlled trial was carried out between January 9, 2012, and December 2, 2014. Patients aged >/=65 years with dementia or cognitive impairment admitted to three wards at two hospitals located in Northern Sweden were included. RESULTS: Of the 473 deemed eligible for participation, 230 were randomized to intervention and 230 to control group by block randomization. The primary outcome, risk of drug-related hospital readmissions, was assessed at 180 days of follow-up by intention-to-treat analysis. During the 180 days of follow-up, 18.9% (40/212) of patients in the intervention group and 23.0% (50/217) of those in the control group were readmitted for drug-related reasons (HR = 0.80, 95% CI = 0.53-1.21, p = 0.28, univariable Cox regression). Heart failure was significantly more common in the intervention group. After adjustment for heart failure as a potential confounder and an interaction term, multiple Cox regression analysis indicated that pharmacist participation significantly reduced the risk of drug-related readmissions (HR = 0.49, 95% CI = 0.27-0.90, p = 0.02). A post-hoc analysis showed a significantly reduced risk of 30-day readmissions due to drug-related problems in the total sample (without adjustment for heart failure). CONCLUSION: Participation of clinical pharmacists in healthcare team conducting comprehensive medication reviews did not significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment; however, post-hoc and subgroup analyses indicated significant effects favoring the intervention. More research is needed. TRIAL REGISTRATION: Clinical trials NCT01504672.",Clinical pharmacists;Dementia;Drug-related readmissions;Medication reviews;Old people,"Gustafsson, M.;Sjolander, M.;Pfister, B.;Jonsson, J.;Schneede, J.;Lovheim, H.",2017,Jul,,0,
1659,High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice,"OBJECTIVE: To examine the prevalence and patterns of high risk prescribing, defined as potentially inappropriate prescribing of drugs to primary care patients particularly vulnerable to adverse drug events. DESIGN: Cross sectional population database analysis. SETTING: General practices in Scotland. PARTICIPANTS: 315 Scottish general practices with 1.76 million registered patients, 139 404 (7.9%) of whom were defined as particularly vulnerable to adverse drug events because of age, comorbidity, or co-prescription. MAIN OUTCOME MEASURES: How reliably each of 15 indicators-four each for non-steroidal anti-inflammatory drugs, co-prescription with warfarin, and prescribing in heart failure, two for dose instructions for methotrexate, and one for antipsychotic prescribing in dementia-and a composite of all 15 could distinguish practices in terms of their rates of high risk prescribing; and characteristics of patients and practices associated with high risk prescribing in a multilevel model. RESULTS: 19 308 of 139 404 (13.9%, 95% confidence interval 13.7% to 14.0%) patients had received at least one high risk prescription in the past year. This composite indicator was a reasonably reliable measure of practice rates of high risk prescribing (reliability >0.7 for 95.6% of practices, >0.8 for 88.2%). The patient characteristic most strongly associated with high risk prescribing was the number of drugs prescribed (>11 long term prescribed drugs v 0; odds ratio 7.90, 95% confidence interval 7.19 to 8.68). After adjustment for patient characteristics, rates of high risk prescribing varied by fourfold between practices, which was not explained by structural characteristics of the practices. CONCLUSIONS: Almost 14% of patients defined as particularly vulnerable to adverse drug events were prescribed one or more high risk drugs. The composite indicator of high risk prescribing used could identify practices as having above average or below average high risk prescribing rates with reasonable confidence. After adjustment, only the number of drugs prescribed long term to patients was strongly associated with high risk prescribing, and considerable unexplained variation existed between practices. High risk prescribing will often be appropriate, but the large variation between practices suggests opportunities for improvement.","Cross-Sectional Studies;*Databases, Factual;*Drug Prescriptions;*Drug-Related Side Effects and Adverse Reactions;General Practice/*organization & administration;Humans;*Primary Health Care;Risk Factors;Scotland","Guthrie, B.;McCowan, C.;Davey, P.;Simpson, C. R.;Dreischulte, T.;Barnett, K.",2011,Jun 21,10.1136/bmj.d3514,0,
1660,The Danubian Biobank Initiative: synchronizing the biobanking activities of the Danube universities,"Aging disorders pose an increasing challenge for the public health care systems in Europe. An important approach to cope with this task is the identification of relevant novel disease genes and the control of risk factors using new technological capabilities. A key element in this process is the availability of well classified, large enough patient cohorts and the establishment of quality-controlled central banks for DNA, serum, plasma, and cells/tissues/RNA/proteins together with the development of an IT based infrastructure to provide samples and data required for biomedical studies. The Danubian Biobank initiative connects universities, associated teaching hospitals and endpoint-related rehabilitation clinics along the Danube river and in neighbouring regions. The scientific network focuses on diabetes-related endpoints, vascular disease (e.g. myocardial infarction, stroke, arterial thrombosis, kidney failure), metabolic disease (e.g. obesity, diabetes, metabolic syndrome), and neurodegenerative disorders (e.g. dementia syndromes, Parkinsonism). Task forces are set up for the relevant topics of the biobank project including patient recruitment, sample and data management, public health, epidemiology and genetics, enabling technologies, and research strategies. The project aims to select the most relevant and promising scientific targets utilizing the core competences developed in the individual partner institutions. For this purpose a series of dedicated workshops and conferences are organized as well as joint research grant proposals are submitted.","Ethics, Institutional;*European Union;Humans;Internet;*Tissue Banks/ethics/organization & administration/trends;*Universities","Gyorffy, B.;Rosivall, L.;Prohaszka, Z.;Falus, A.;Fust, G.;Munkacsy, G.;Tulassay, T.",2007,Oct 21,10.1556/oh.2007.28066,0,
1661,Drug interactions: A current selection,,acenocoumarol;acetylsalicylic acid;amantadine;amantadine sulfate;anticoagulant agent;candesartan hexetil;carbidopa plus levodopa;celecoxib;clozapine;cotrimoxazole;diclofenac;dipeptidyl carboxypeptidase inhibitor;duloxetine;fluvoxamine maleate;ibuprofen;kinzal;lumiracoxib;memantine;naproxen;nonsteroid antiinflammatory agent;olanzapine;paracetamol;placebo;ramipril;rofecoxib;serotonin uptake inhibitor;telmisartan;tizanidine;trimethoprim;unclassified drug;unindexed drug;valsartan;vitamin K group;warfarin;Alzheimer disease;anticoagulation;cardiovascular effect;cardiovascular risk;cerebrovascular disease;clinical trial;coronary artery disease;drug interaction;drug safety;gastrointestinal hemorrhage;heart failure;heart left ventricle failure;human;liver toxicity;neurologic disease;short survey;aspirin;atacand;axura;bactrim;blopress;brufen;celebrex;cymbalta;dafalgan;diovan;ebixa;floxyfral;leponex;micardis;pk merz;prexige;proxen;sinemet;sintrom;sirdalud;symetrel;triatec;vioxx;voltaren;zyprexa,"Gysling, E.",2008,,,0,
1662,Homozygous missense mutation in BOLA3 causes multiple mitochondrial dysfunctions syndrome in two siblings,"Defects of mitochondrial oxidative phosphorylation constitute a clinical and genetic heterogeneous group of disorders affecting multiple organ systems at varying age. Biochemical analysis of biopsy material demonstrates isolated or combined deficiency of mitochondrial respiratory chain enzyme complexes. Co-occurrence of impaired activity of the pyruvate dehydrogenase complex has been rarely reported so far and is not yet fully understood. We investigated two siblings presenting with severe neonatal lactic acidosis, hypotonia, and intractable cardiomyopathy; both died within the first months of life. Muscle biopsy revealed a peculiar biochemical defect consisting of a combined deficiency of respiratory chain complexes I, II, and II+III accompanied by a defect of the pyruvate dehydrogenase complex. Joint exome analysis of both affected siblings uncovered a homozygous missense mutation in BOLA3. The causal role of the mutation was validated by lentiviral-mediated expression of the mitochondrial isoform of wildtype BOLA3 in patient fibroblasts, which lead to an increase of both residual enzyme activities and lipoic acid levels. Our results suggest that BOLA3 plays a crucial role in the biogenesis of iron-sulfur clusters necessary for proper function of respiratory chain and 2-oxoacid dehydrogenase complexes. We conclude that broad sequencing approaches combined with appropriate prioritization filters and experimental validation enable efficient molecular diagnosis and have the potential to discover new disease loci. © 2012 SSIEM and Springer.",2 oxoacid dehydrogenase;aconitic acid;bicarbonate;carnitine;citric acid;fumaric acid;glucose;glycine;lactic acid;malic acid;pyruvate dehydrogenase;pyruvic acid;riboflavin;succinic acid;thiamine;thioctic acid;trometamol;ubiquinone;abnormal laboratory result;amino acid blood level;article;BOLA3 gene;case report;cause of death;citric acid cycle;clinical feature;controlled study;disorders of mitochondrial functions;echocardiography;female;fibroblast;gene;gene sequence;glucose blood level;homozygosity;human;human cell;human tissue;hypertrophic cardiomyopathy;lactic acidosis;male;mental deterioration;missense mutation;multiple mitochondrial dysfunstion syndrome;multiple organ failure;muscle biopsy;muscle hypotonia;myelin deficiency;newborn;nuclear magnetic resonance imaging;nucleotide sequence;outcome assessment;parenteral nutrition;pyruvate dehydrogenase complex deficiency;respiratory chain;respiratory failure;seizure;urine level,"Haack, T. B.;Rolinski, B.;Haberberger, B.;Zimmermann, F.;Schum, J.;Strecker, V.;Graf, E.;Athing, U.;Hoppen, T.;Wittig, I.;Sperl, W.;Freisinger, P.;Mayr, J. A.;Strom, T. M.;Meitinger, T.;Prokisch, H.",2013,,,0,
1663,Reply from the authors,,atorvastatin;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;aging;cerebrovascular disease;cholesterol blood level;cognitive defect;dementia;follow up;health care;hospitalization;human;ischemic heart disease;letter;priority journal;cerebrovascular accident,"Haan, M. N.;Cramer, C.;Galea, S.;Langa, K. M.;Kalbfleisch, J. D.",2009,,,0,
1664,Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study,,cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;cholesterol blood level;cognitive defect;dementia;disease association;ischemic heart disease;letter;memory;priority journal,"Haan, M. N.;Cramer, C.;Kalbfleisch, J.;Langa, K.;Galea, S.",2009,,,0,
1665,"Cortical cathepsin D activity and immunolocalization in Alzheimer disease, critical coronary artery disease, and aging","The activity and immunocytochemical localization of cathepsin D in the frontal cortex were investigated in patients with Alzheimer disease (AD) and two groups of nondemented subjects; individuals with critical coronary artery disease (cCAD; > 75% stenosis) and non-heart disease controls (non-HD). The cathepsin D activity significantly increased with age in the non-HD population. No such age-related increase was observed in either AD or cCAD. Enzymatic activity was significantly increased in only the midaged, but not the older AD and cCAD subjects compared to controls. Immunocytochemical reactivity paralleled cathepsin D enzymatic activity. Frontal cortex neurons displayed an increased accumulation of cathepsin D immunoreactivity in aging (non-HD controls) with a further increase in cCAD, especially in the midaged group. Such immunoreactivity was markedly increased in AD. There was also an apparent age-related increase in the number of cathepsin D immunoreactive neurons in the non-HD population and a disease-related increase in only the mid-aged AD and cCAD subjects compared to controls. Senile plaques (SP) occurred in all AD patients, many cCAD, and a few of the oldest non-HD subjects, and they were immunoreactive to cathepsin D in each group. The data suggest a possible relationship between activation of cathepsin D and SP formation in AD, cCAD, and aging.",Adult;Aged;Aging/*metabolism;Alzheimer Disease/*enzymology/pathology;Autopsy;Cathepsin D/analysis/*metabolism;Coronary Disease/*enzymology/pathology;Frontal Lobe/*enzymology/growth & development/pathology;Humans;Immunohistochemistry;Infant;Middle Aged;Neurons/*enzymology/pathology/physiology;Postmortem Changes;Reference Values,"Haas, U.;Sparks, D. L.",1996,Sep,10.1007/bf02815189,0,
1666,"A health survey of the very aged in Tampere, Finland","The population aged 85 years or over (n = 674) living in Tampere, Finland, was surveyed in 1977-78. Altogether, 561 persons (83%)--99 men and 462 women--were examined. The study comprised questionnaire, medical examination, laboratory tests, ECG and chest X-ray examination. Of the subjects, 24% were hospitalized, 22% were in old people's homes and 54% lived at home. The most common symptoms were aches and pains (24%), vertigo (22%), defective vision (15%) and defective hearing (12%). Congestive heart failure (49%), dementia or confusional state (28%) and urinary tract infection (22%) were the most common diseases.",Aged;Blood Physiological Phenomena;Blood Pressure;Clinical Laboratory Techniques;Drug Therapy;Female;Finland;*Health Surveys;Humans;Male;Morbidity,"Haavisto, M.;Geiger, U.;Mattila, K.;Rajala, S.",1984,Sep,,0,
1667,Comorbid Medical Conditions in Vascular Dementia: A Matched Case-Control Study,"The objective of the study was to compare the presence of comorbid medical conditions between patients with a vascular dementia (VaD) and a control group, from the Integrated Healthcare Information Services (IHCIS) database. VaD was defined by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 290.40, 290.4, 290.41, 290.42, and, 290.43. An individual matching method was used to select the controls, which were matched to cases on a 15:1 ratio by age, gender, type of health plan, and pharmacy benefits. Alzheimer's disease, any other dementia or cognitive deficits associated were considered exclusion criteria. Among the IHCIS patients 60 years of age or older and full year of eligibility during 2010, there were 898 VaD patients, from which 63.6% were women. Concurrent presence of cerebrovascular disease, atherosclerosis, heart failure, and atrial fibrillation were found at 12.6, 4.6, 2.8, and 1.7 times higher in VaD patients, respectively. Compared to controls, VaD patients had more septicemia, injuries, lung diseases including chronic obstructive pulmonary disease, and urinary diseases (all with df = 897,1; p < 0.0001). The present study confirms that these four medical comorbidities are frequent complications of VaD and physicians should be alert to the presence ofthem in patients with VaD.",age;aged;article;atherosclerosis;atrial fibrillation;case control study;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;comorbidity;controlled study;female;heart failure;human;ICD-9-CM;major clinical study;male;multiinfarct dementia;physician,"Habeych, M. E.;Castilla-Puentes, R.",2015,,,0,
1668,Neurobehavioral changes and hypertension: The 'athymhormic syndrome',"In 3 hypertensive patients, aged 57 to 66, profound behavioral and personality changes occurred rather abruptly, characterized by total loss of spontaneous activity and initiative, apathetic behavior, passivity, lack of drive and motivation, loss of interest for any of previous occupations and hobbies, and total flatness of affect. Neurological examination was normal or only showed mild extrapyramidal signs. Neuropsychological evaluation was only remarkable for mild intellectual impairment suggestive of frontal lobe dysfunction. None of the 3 patients fulfilled criteria for dementia or severe depression. This neurobehavioral syndrome has been coined 'athymhormic syndrome' (Habib and Poncet, 1988) a term emphasizing the specific defect in drive ('horme') and affect ('thumos'). Electrical and clinical heart examination was unremarkable. Blood pressure was always found within normal limits during hospitalization, including 24-hour monitoring in one case. However, all patients were known as hypertensive in the past, with repeated bouts of high blood pressure (up to 270 mmHg systolic in one case). X-ray CT-scan was usually normal or showed non-specific white matter changes (so-called 'leukoaraiosis'). In all 3 cases, a brain MRI scan showed multiple small infarcts mainly involving deep subcortical structures (caudate nuclei and/or adjacent periventricular white matter) of both hemispheres, consistent with the definition of lacunes. This clinico-radiological syndrome appears as a specific entity whose pathophysiology may be discussed by reference to anatomical patterns of vasculature of the periventricular deep cerebral structures: the specific location of lacunes in the 3 patients indicates ischemic damage affecting the most distal territory of the long perforating arteries of the brain, suggesting reduced blood flow rather than arteriolar occlusions or dilatation of perivascular spaces, as usually invoked for the production of lacunes. It is proposed that bouts of HBP, beside their specific effect on the wall of small arteries, may have resulted in disruption of autoregulation processes, mainly expressing itself as ischemia in the most distal arteriolar territories. For the neurologist, recognizing this syndrome should prompt to search for bouts of HBP and to perform a brain MRI, even though CT-scan is normal. For cardiologists or internal medicine physicians, this syndrome is also worth knowing to evaluate the potential risk of certain forms of hypertension and for accurate appreciation of the neurological handicap. Finally, it may be the case that such cerebral lesions have a 'therapeutic' effect on the hypertensive disease as well as on the development of the lacunar lesions, as a result of changes in affective reactivity to the environment.",adult;aged;apathy;article;brain infarction;case report;human;hypertension;priority journal,"Habib, M.;Royere, M. L.;Habib, G.;Bonnefoi, B.;Milandre, L.;Poncet, M.;Luccioni, R.;Khalil, R.",1991,,,0,
1669,Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery,"Objective: To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS). Study Design: An observational study. Place and Duration of Study: The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009. Methodology: Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. Results: One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 ± 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. Conclusion: Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time.",creatinine;adult;article;cognition;cognitive defect;controlled study;coronary artery bypass graft;creatinine blood level;demography;depression;female;follow up;Hamilton Depression Rating Scale;human;intensive care unit;major clinical study;male;medical history;mental deterioration;middle aged;Mini Mental State Examination;observational study;postoperative complication;prevalence;surgical technique,"Habib, S.;Khan, A. R.;Iqbal Afridi, M.;Saeed, A.;Jan, A. F.;Amjad, N.",2014,,,0,
1670,Heightened Brain Syndromes as Precursors of Severe Physical Illness in Geriatric Patients,,"*Blood-Brain Barrier;*Brain Damage, Chronic;*Breast Neoplasms;*Cardiac Tamponade;*Coronary Disease;*Dementia;*Diagnosis, Differential;*Geriatrics;*Glomerulonephritis;*Heart Failure;*Homosexuality;Humans;*Lung Neoplasms;*Myocardial Infarction;*Pathology;*Psychotic Disorders;*Syndrome;*Heart failure, congestive;*Myocardial infarct;*Psychoses, senile","Hader, M.;Schulman, P. M.;Faigman, I.",1965,May,10.1176/ajp.121.11.1124,0,
1671,Risk of dementia in elderly patients with the use of proton pump inhibitors,"Drugs that modify the risk of dementia in the elderly are of potential interest for dementia prevention. Proton pump inhibitors (PPIs) are widely used to reduce gastric acid production, but information on the risk of dementia is lacking. We assessed association between the use of PPIs and the risk of dementia in elderly people. Data were derived from a longitudinal, multicenter cohort study in elderly primary care patients, the German Study on Aging, Cognition and Dementia in Primary Care Patients (AgeCoDe), including 3,327 community-dwelling persons aged ≥75 years. From follow-up 1 to follow-up 4 (follow-up interval 18 months), we identified a total of 431 patients with incident any dementia, including 260 patients with Alzheimer’s disease. We used time-dependent Cox regression to estimate hazard ratios of incident any dementia and Alzheimer’s disease. Potential confounders included in the analysis comprised age, sex, education, the Apolipoprotein E4 (ApoE4) allele status, polypharmacy, and the comorbidities depression, diabetes, ischemic heart disease, and stroke. Patients receiving PPI medication had a significantly increased risk of any dementia [Hazard ratio (HR) 1.38, 95 % confidence interval (CI) 1.04–1.83] and Alzheimer’s disease (HR 1.44, 95 % CI 1.01–2.06) compared with nonusers. Due to the major burden of dementia on public health and the lack of curative medication, this finding is of high interest to research on dementia and provides indication for dementia prevention.",apolipoprotein E4;cholinergic receptor blocking agent;proton pump inhibitor;age;aged;Alzheimer disease;article;assessment of humans;cerebrovascular accident;cohort analysis;depression;diabetes mellitus;drug use;DSM-IV;education;female;follow up;gender;gene frequency;Geriatric Depression Scale;Global Deterioration Scale;Hachinski Rosen Scale;human;ICD-10;ischemic heart disease;longitudinal study;major clinical study;Mini Mental State Examination;multicenter study;polypharmacy;primary medical care;priority journal;risk factor;senescence;sex;stomach acid secretion,"Haenisch, B.;von Holt, K.;Wiese, B.;Prokein, J.;Lange, C.;Ernst, A.;Brettschneider, C.;König, H. H.;Werle, J.;Weyerer, S.;Luppa, M.;Riedel-Heller, S. G.;Fuchs, A.;Pentzek, M.;Weeg, D.;Bickel, H.;Broich, K.;Jessen, F.;Maier, W.;Scherer, M.",2015,,,0,
1672,Polygenic risk for coronary artery disease is associated with cognitive ability in older adults,"Background: Coronary artery disease (CAD) is associated with cognitive decrements and risk of later dementia, but it is not known if shared genetic factors underlie this association. We tested whether polygenic risk for CAD was associated with cognitive ability in community-dwelling cohorts of middle-aged and older adults. Methods: Individuals from Generation Scotland: Scottish Family Health Study (GS:SFHS, N = 9865) and from the Lothian Birth Cohorts of 1921 (LBC1921, N = 517) and 1936 (LBC1936, N = 1005) provided cognitive data and genome-wide genotype data. Polygenic risk profile scores for CAD were calculated for all of the cohorts using the largest available genome-wide association studies (GWAS) data set, the CARDIoGRAM consortium (22 233 cases and 64 762 controls). Polygenic risk profile scores for CAD were then tested for their association with cognitive abilities in the presence and absence of manifest cardiovascular disease. Results: A meta-analysis of all three cohorts showed a negative association between CAD polygenic risk and fluid cognitive ability (β = -0.022, P = 0.016), verbal intelligence (β = -0.024, P = 0.011) and memory (β = -0.021, P = 0.028). Conclusions: Increased polygenic risk for CAD is associated with lower cognitive ability in older adults. Common genetic variants may underlie some of the association between age-related cognitive decrements and the risk for CAD.",adult;allele;article;cognition;cohort analysis;controlled study;coronary artery disease;electrocardiogram;female;gene linkage disequilibrium;genetic load;genetic risk;genetic variability;genetic association;genotype;human;intelligence;major clinical study;male;memory;phenotype;priority journal;Scotsman;senescence;single nucleotide polymorphism,"Hagenaars, S. P.;Harris, S. E.;Clarke, T. K.;Hall, L.;Luciano, M.;Fernandez-Pujals, A. M.;Davies, G.;Hayward, C.;Generation, S.;Starr, J. M.;Porteous, D. J.;McIntosh, A. M.;Deary, I. J.",2016,,,0,
1673,Shared genetic aetiology between cognitive functions and physical and mental health in UK Biobank (N=112 151) and 24 GWAS consortia,"Causes of the well-documented association between low levels of cognitive functioning and many adverse neuropsychiatric outcomes, poorer physical health and earlier death remain unknown. We used linkage disequilibrium regression and polygenic profile scoring to test for shared genetic aetiology between cognitive functions and neuropsychiatric disorders and physical health. Using information provided by many published genome-wide association study consortia, we created polygenic profile scores for 24 vascular-metabolic, neuropsychiatric, physiological-anthropometric and cognitive traits in the participants of UK Biobank, a very large population-based sample (N=112 151). Pleiotropy between cognitive and health traits was quantified by deriving genetic correlations using summary genome-wide association study statistics and to the method of linkage disequilibrium score regression. Substantial and significant genetic correlations were observed between cognitive test scores in the UK Biobank sample and many of the mental and physical health-related traits and disorders assessed here. In addition, highly significant associations were observed between the cognitive test scores in the UK Biobank sample and many polygenic profile scores, including coronary artery disease, stroke, Alzheimer's disease, schizophrenia, autism, major depressive disorder, body mass index, intracranial volume, infant head circumference and childhood cognitive ability. Where disease diagnosis was available for UK Biobank participants, we were able to show that these results were not confounded by those who had the relevant disease. These findings indicate that a substantial level of pleiotropy exists between cognitive abilities and many human mental and physical health disorders and traits and that it can be used to predict phenotypic variance across samples.",,"Hagenaars, S. P.;Harris, S. E.;Davies, G.;Hill, W. D.;Liewald, D. C.;Ritchie, S. J.;Marioni, R. E.;Fawns-Ritchie, C.;Cullen, B.;Malik, R.;Worrall, B. B.;Sudlow, C. L.;Wardlaw, J. M.;Gallacher, J.;Pell, J.;McIntosh, A. M.;Smith, D. J.;Gale, C. R.;Deary, I. J.",2016,Nov,10.1038/mp.2015.225,0,
1674,Shared genetic aetiology between cognitive functions and physical and mental health in UK Biobank (N=112 151) and 24 GWAS consortia,"Causes of the well-documented association between low levels of cognitive functioning and many adverse neuropsychiatric outcomes, poorer physical health and earlier death remain unknown. We used linkage disequilibrium regression and polygenic profile scoring to test for shared genetic aetiology between cognitive functions and neuropsychiatric disorders and physical health. Using information provided by many published genome-wide association study consortia, we created polygenic profile scores for 24 vascular-metabolic, neuropsychiatric, physiological-anthropometric and cognitive traits in the participants of UK Biobank, a very large population-based sample (N=112 151). Pleiotropy between cognitive and health traits was quantified by deriving genetic correlations using summary genome-wide association study statistics and to the method of linkage disequilibrium score regression. Substantial and significant genetic correlations were observed between cognitive test scores in the UK Biobank sample and many of the mental and physical health-related traits and disorders assessed here. In addition, highly significant associations were observed between the cognitive test scores in the UK Biobank sample and many polygenic profile scores, including coronary artery disease, stroke, Alzheimer's disease, schizophrenia, autism, major depressive disorder, body mass index, intracranial volume, infant head circumference and childhood cognitive ability. Where disease diagnosis was available for UK Biobank participants, we were able to show that these results were not confounded by those who had the relevant disease. These findings indicate that a substantial level of pleiotropy exists between cognitive abilities and many human mental and physical health disorders and traits and that it can be used to predict phenotypic variance across samples.",adult;aged;Alzheimer disease;anthropometry;article;autism;biobank;body mass;cerebrovascular accident;cognition;controlled study;coronary artery disease;female;gene linkage disequilibrium;genetic correlation;genetic predisposition;genome-wide association study;head circumference;human;major clinical study;major depression;male;mental health;pleiotropy;priority journal;schizophrenia;United Kingdom,"Hagenaars, S. P.;Harris, S. E.;Davies, G.;Hill, W. D.;Liewald, D. C. M.;Ritchie, S. J.;Marioni, R. E.;Fawns-Ritchie, C.;Cullen, B.;Malik, R.;Worrall, B. B.;Sudlow, C. L. M.;Wardlaw, J. M.;Gallacher, J.;Pell, J.;McIntosh, A. M.;Smith, D. J.;Gale, C. R.;Deary, I. J.",2016,,10.1038/mp.2015.225,0,
1675,"Effects of galantamine in a 2-year, randomized, placebo-controlled study in Alzheimer's disease","Background: Currently available treatments for Alzheimer's disease (AD) can produce mild improvements in cognitive function, behavior, and activities of daily living in patients, but their influence on long-term survival is not well established. This study was designed to assess patient survival and drug efficacy following a 2-year galantamine treatment in patients with mild to moderately severe AD. Methods: In this multicenter, double-blind study, patients were randomized 1:1 to receive galantamine or placebo. One primary end point was safety; mortality was assessed. An independent Data Safety Monitoring Board monitored mortality for the total deaths reaching prespecified numbers, using a time-to-event method and a Cox-regression model. The primary efficacy end point was cognitive change from baseline to month 24, as measured by the Mini-Mental State Examination (MMSE) score, analyzed using intent-to-treat analysis with the 'last observation carried forward' approach, in an analysis of covariance model. Results: In all, 1,024 galantamine- and 1,021 placebo-treated patients received study drug, with mean age ~73 years, and mean (standard deviation [SD]) baseline MMSE score of 19 (4.08). A total of 32% of patients (661/2,045) completed the study, 27% (554/2,045) withdrew, and 41% (830/2,045) did not complete the study and were discontinued due to a Data Safety Monitoring Board-recommended early study termination. The mortality rate was significantly lower in the galantamine group versus placebo (hazard ratio [HR] =0.58; 95% confidence interval [CI]: 0.37; 0.89) (P=0.011). Cognitive impairment, based on the mean (SD) change in MMSE scores from baseline to month 24, significantly worsened in the placebo (-2.14 [4.34]) compared with the galantamine group (-1.41 [4.05]) (P<0.001). Functional impairment, based on mean (SD) change in the Disability Assessment in Dementia score (secondary end point), at month 24 significantly worsened in the placebo (-10.81 [18.27]) versus the galantamine group (-8.16 [17.25]) (P=0.002). Incidences of treatment-emergent adverse events were 54.0% for the galantamine and 48.6% for the placebo group. Conclusion: Long-term treatment with galantamine significantly reduced mortality and the decline in cognition and daily living activities, in mild to moderate AD patients. Identification: This study is registered at ClinicalTrials.gov (NCT00679627). © 2014 Hager et al.",NCT00679627;cholinesterase inhibitor;galantamine;memantine;placebo;adult;aged;agitation;Alzheimer disease;anxiety;article;behavior disorder;body weight disorder;cardiopulmonary insufficiency;cardiovascular disease;cognitive defect;controlled study;daily life activity;decreased appetite;diarrhea;disease exacerbation;double blind procedure;drug effect;drug efficacy;drug fatality;drug safety;drug tolerability;drug withdrawal;fatigue;female;functional disease;headache;heart failure;human;hypertension;insomnia;long term care;lung disease;major clinical study;male;Mini Mental State Examination;mortality;multicenter study;nausea;parallel design;pneumonia;randomized controlled trial;rhinopharyngitis;survival rate;unspecified side effect;vertigo;vomiting;weight reduction,"Hager, K.;Baseman, A. S.;Nye, J. S.;Brashear, H. R.;Han, J.;Sano, M.;Davis, B.;Richards, H. M.",2014,,,0,
1676,Neurosyphilis is a long-forgotten disease but still a possible etiology for dementia,"We herein report a heterosexual Japanese man in his forties who had been suffering from advanced dementia and personality change for 4 years. Positive results of a serological test for syphilis, Treponema pallidum hemagglutination assay, and fluorescent treponemal antibody-absorption test of both serum and cerebral spinal fluid led to the diagnosis of neurosyphilis. Jarisch-Herxheimer reaction was seen shortly after the first dose of penicillin was administered to the patient. His cognitive function did not recover after treatment. The incidence of syphilis has been reported to be increasing. Neurosyphilis should not be overlooked as an etiology for progressive dementia even in this post-antibiotic era.",ceftriaxone;penicillin G;adult;article;attention deficit disorder;brain atrophy;case report;cerebrospinal fluid analysis;cognition;computer assisted tomography;dementia;disease assessment;drug substitution;drug withdrawal;fluorescent treponema antibody test;heart left ventricle hypertrophy;Herxheimer reaction;heterosexual male;human;magnetic resonance angiography;male;Mini Mental State Examination;neurosyphilis;nuclear magnetic resonance imaging;personality disorder;protein cerebrospinal fluid level;rash;revised Hasegawa dementia scale;serology;spastic gait;syphilis;Treponema pallidum hemagglutination test,"Hagiya, H.;Deguchi, K.;Kawada, K.;Otsuka, F.",2015,,,0,
1677,Occurrence and risk factors of mild cognitive impairment in the older Chinese population: a 3-year follow-up study,"OBJECTIVE: To investigate the occurrence and risk factors of mild cognitive impairment (MCI) and the conversion rates to dementia in Chinese people over 80 years of age. METHODS: Two hundred and two participants (>80 years old) without dementia were assessed clinically using neuropsychological tests; they were re-assessed at 1, 2, and 3 years. RESULTS: The results revealed that 30.2% of the study population was classified as having MCI at baseline. Multivariate linear regression analysis showed that coronary heart disease, hypertension, and stroke were risk factors of MCI. During the 3 years follow-up, the occurrence of MCI increased, and 21.8% of the participants with MCI progressed to dementia. CONCLUSIONS: These results suggest that in the older elderly, prevention and early treatment of cardiovascular and cerebrovascular diseases may be effective in lowering the risk of MCI. MCI is a high risk factor for dementia.","Aged, 80 and over;Alcohol Drinking;China/epidemiology;Coronary Disease/complications;Dementia/*epidemiology;Disease Progression;Educational Status;Female;Follow-Up Studies;Humans;Hypertension/complications;Logistic Models;Male;Mild Cognitive Impairment/*epidemiology/etiology;Prevalence;Risk Factors;Stroke/complications","Hai, S.;Dong, B.;Liu, Y.;Zou, Y.",2012,Jul,10.1002/gps.2768,0,
1678,Self-assessment of vulnerability to illness by the Austrian population,"Results of a Cross-Sectional Study in 1995: The self-perceived threat of cancer, myocardial infarction, stroke, traffic accidents, diabetes mellitus, AIDS, Alzheimer's Disease and drug abuse was investigated in a survey among a representative sample of Austrians (aged > or = 15 years) in 1995. The most feared disease was cancer (41%), followed by traffic accidents (38%) and myocardial infarction (36%). The disease feared least was drug abuse (6%). Females feared cancer, stroke, diabetes mellitus and Alzheimer's disease significantly more than males. A cluster analysis reveals that respondents who perceive a higher threat by the diseases have low levels of education and live in rural areas. The age distribution of persons who responded with ""very threatening"" corresponds well with the age-specific prevalence of the disease. Smoking habits, alcohol consumption and body-mass index have no influence on the self-perceived threat of the investigated diseases.",Adolescent;Adult;Aged;*Attitude to Health;Austria/epidemiology;Chronic Disease/*psychology;Cross-Sectional Studies;Female;Health Behavior;Health Surveys;Humans;Male;Middle Aged;Risk Factors,"Haidinger, G.;Waldhor, T.;Janda, M.;Potter, M.;Vutuc, C.",1998,Mar,,0,
1679,Prognostic factors for serious morbidity and mortality from community-acquired lower respiratory tract infections among the elderly in primary care,"BACKGROUND: Uncertainty about the prognosis of lower respiratory tract infections (LRTI) hinders optimal management in primary care. OBJECTIVE: We determined prognostic factors for a severe complicated course of LRTI among elderly patients in primary care. METHODS: In a retrospective clinical database study we examined 455 patients with a first LRTI episode; 226 with physician-diagnosed acute bronchitis or lung exacerbations and 229 with pneumonia. Multivariate logistic regression analysis was used to assess independent associations of the potential predictors with the endpoint. RESULTS: Occurrence of the combined endpoint 30-day home-treated complications from LRTI (4.4%) or hospitalisation (4.6%), or all-cause mortality (5.3%) was 14.3%. In a logistic regression model, increasing age [odds ratio (OR) 1.04; 95% confidence interval (95% CI) 1.00-1.08], male sex (OR 3.12; 95% CI 1.66-5.87), heart failure (OR 5.14; 95% CI 2.33-11.34), stroke or dementia (OR 3.36; 95% CI 1.18-9.58), use of antidepressants or benzodiazepines (OR 1.89; 95% CI 1.02-3.52) and a diagnosis of pneumonia (OR 4.24; 95% CI 2.17-8.28) were independent predictors. CONCLUSION: GPs need to be aware of readily available prognostic factors that can be used in primary care to complement physical examination and laboratory data in LRTI to guide preventive and therapeutic management decisions.","Aged;Aged, 80 and over;Community-Acquired Infections/epidemiology/*mortality/*physiopathology;Female;Humans;Male;Multivariate Analysis;Netherlands/epidemiology;*Primary Health Care;Prognosis;Respiratory Tract;Infections/complications/epidemiology/*mortality/*physiopathology;Retrospective Studies","Hak, E.;Bont, J.;Hoes, A. W.;Verheij, T. J.",2005,Aug,10.1093/fampra/cmi020,0,
1680,Subclinical atherosclerosis is related to lower neuronal viability in middle-aged adults: A 1H MRS study,"Background: Increased carotid artery intima-media thickness (IMT) is a noninvasive marker of systemic arterial disease, associated with atherosclerosis, abnormal arterial mechanics, myocardial infarction, and stroke. In the elderly, clinically elevated IMT is related to diminished attention-executive function. In this context, previous work involving paper-and-pencil measures of cognition has demonstrated that a threshold of pathology (i.e., IMT ≥ 0.9 mm) is needed before IMT consistently relates to poor neuropsychological test performance. Given the critical role of arterial health in the development of cognitive dysfunction, the goal of this study was to investigate early markers of brain vulnerability by examining subclinical levels of IMT in relation to a sensitive marker of neuronal integrity, cerebral N-acetyl-aspartate/creatine (NAA/Cr) ratio, in midlife. Methods: A total of 40 participants aged 50 ± 6 years, underwent neuropsychological assessment, proton magnetic resonance spectroscopy (1H MRS) examination of occipitoparietal grey matter and B-mode ultrasound of the common carotid artery. IMT was defined as the distance between the luminal-endothelial interface and the junction between the media and the adventitia. The relation between IMT and cerebral metabolite ratios was modeled using a single multivariate multiple regression analysis adjusted for age and current systolic blood pressure. Results: Increased IMT was associated with significantly lower NAA/Cr ratios (IMT beta = -0.62, p = 0.001), independent of age and systolic blood pressure (F(3,36) = 4.928, p = 0.006). Conclusions: Our study extends previous findings by demonstrating a significant relationship between IMT and NAA concentration, suggesting compromised neuronal viability even at IMT levels below thresholds for clinical end-organ damage. © 2010 Elsevier B.V. All rights reserved.",creatine;n acetylaspartic acid;adult;arterial wall thickness;article;atherosclerosis;brain metabolism;clinical article;common carotid artery;controlled study;female;human;male;mental deterioration;neuropsychological test;priority journal;proton nuclear magnetic resonance;systolic blood pressure,"Haley, A. P.;Tarumi, T.;Gonzales, M. M.;Sugawara, J.;Tanaka, H.",2010,,,0,
1681,Acute consequences of hypoglycaemia in diabetic patients,"Strict glycaemic control is a major concern in many people with diabetes, hypoglycaemia being the most limiting factor in the daily management of patients with diabetes. Acute consequences of hypoglycaemic attacks are not precisely evaluated. Acute cardiovascular (CV) complications as myocardial ischaemia or stroke seem to be rare, but possibly ignored mainly in older frail patients. Recent large trials in type 2 diabetic patients have not shown the anticipated mortality benefits of strict glycaemic control, and reported a higher frequency of severe hypoglycaemia in the intensive treatment arms with an excess of CV deaths. The authors of these trials persist to deny a direct link between CV deaths and hypoglycaemia. In young type 1 diabetics ""dead in bed"" syndrome represents a rare but devastating consequence probably due to arrhythmia and prolonged QTc interval. Driving mishaps represent another complication but with a controversial frequency. Neurologic syndromes are frequent during severe hypoglycaemia but usually reversible. Major brain damages are scarce, but cognitive defects or dementia should be underestimated in older and frail type 2 diabetics. Thus, iatrogenic hypoglycaemia due to insulin or sulphonylureas may cause recurrent morbidity in type 1 and type 2 diabetic subjects, and should be prevented by a reevaluation of glycaemic targets in some patients, patient education and the use of new antidiabetic drugs without hypoglycaemic risk. Un contrôle glycémique strict est une préoccupation majeure chez beaucoup de diabétiques dont l'hypoglycémie est le principal facteur limitant au quotidien. Les conséquences aiguës et graves des hypoglycémies ne sont pas précisément évaluées. Les conséquences cardiovasculaires (CV), ischémie myocardique ou accidents vasculaires cérébraux semblent rares, mais peut-être ignorées surtout chez des patients âgés fragiles. De récents essais menés chez des diabétiques de type 2 n'ont pas montré les bénéfices anticipés du contrôle glycémique strict sur mortalité et rapporté une fréquence plus élevée d'hypoglycémies sévères dans le groupe de traitement intensif avec un excès de décès CV. Leurs auteurs ne retiennent aucun lien direct entre décès CV et hypoglycémies. Chez les jeunes diabétiques de type 1, le syndrome ""du décès dans son sommeil"" est une conséquence rare mais dramatique, sans doute due à des arythmies par allongement de l'intervalle QTc. Des accidents automobiles sont une autre complication, mais de fréquence controversée. Des syndromes neurologiques déficitaires sont fréquents au cours de l'hypoglycémie sévère, généralement réversibles. Les lésions cérébrales majeures sont rares mais les défauts cognitifs ou les démences restent sous-estimés chez les plus âgés. Ainsi, l'hypoglycémie iatrogène due à l'insuline ou aux sulfamides hypoglycémiants peut causer une morbidité significative chez des diabétiques de type 1 et 2. Elle devrait être évitée par une réévaluation des objectifs glycémiques chez certains patients, l'éducation thérapeutique et l'utilisation de nouveaux antidiabétiques sans risque d'hypoglycémie. © 2010 Elsevier Masson SAS.",glucose;insulin;sulfonylurea derivative;article;brain damage;cardiovascular disease;cognitive defect;diabetic patient;disease severity;glycemic control;heart arrhythmia;heart muscle ischemia;human;hypoglycemia;iatrogenic disease;insulin dependent diabetes mellitus;mortality;neurological complication;non insulin dependent diabetes mellitus;patient education,"Halimi, S.",2010,,,0,
1682,Long-term follow-up after an initial episode of diverticulitis: What are the predictors of recurrence?,"PURPOSE: The purpose of our study was to determine the clinical and CT predictors of recurrent disease after a first episode of diverticulitis that was successfully managed nonoperatively. METHODS: We retrospectively analyzed 954 consecutive patients who presented to our institution with diverticulitis from 2002 to 2008. Patients were identified with International Classification of Diseases, 9th Revision/ Current Procedural Terminology codes. Patients were excluded if they had subsequent colectomy based on the first attack (n = 81), or if the attack they had between 2002 and 2008 was not their first attack (n = 201). We evaluated CT variables chosen by a panel of expert gastrointestinal radiologists. These radiologists reviewed the available published literature for CT imaging characteristics thought to predict diverticulitis severity. CT variables (n = 20) were determined by prospective reevaluation of scans by blinded study radiologists. Clinical variables (n = 43) were coded based on a retrospective chart review. Univariate analysis of variables in relation to recurrent disease was performed by a log-rank test of Kaplan-Meier estimates. Multivariate analysis was performed using Cox proportional hazards modeling. Variables with P < .2 on univariate analysis were included in a stepwise selection algorithm. RESULTS: The study population included 672 patients; mean age, 61 ± 15 years; mean follow-up, 42.8 ± 24 months. The index presentation of diverticulitis was most commonly located in the sigmoid colon (72%), followed by descending colon (33%), right colon (5%), and transverse colon (3%). Overall recurrence at 5 years was 36% by (95% CI 31.4%-40.6%) Kaplan-Meier estimate. Complicated recurrence (fistula, abscess, free perforation) occurred in 3.9% (95% CI 2.2%-5.6%) of patients at 5 years by Kaplan-Meier estimate. Family history of diverticulitis (HR 2.2, 95% CI 1.4 -3.2), length of involved colon >5 cm (HR 1.7, 95% CI 1.3-2.3), and retroperitoneal abscess (HR 4.5, 95% CI 1.1-18.4) were associated with diverticulitis recurrence. Right colon disease (HR 0.27, 95% CI 0.09-0.86) was associated with freedom from recurrence. CONCLUSION: Although diverticulitis recurrence is common following an initial attack that has been managed medically, complicated recurrence is uncommon. Patients who present with a family history of diverticulitis, long segment of involved colon, and/or retroperitoneal abscess are at higher risk for recurrent disease. Patients who present with right-sided diverticulitis are at low risk for recurrent disease. These findings should be taken into consideration when counseling patients regarding the potential benefits of prophylactic colectomy. ©The ASCRS 2011.",contrast medium;immunosuppressive agent;nonsteroid antiinflammatory agent;abscess;adult;age distribution;appendectomy;article;body mass;cholecystectomy;chronic obstructive lung disease;colitis;colon disease;colon diverticulosis;colon fistula;colon perforation;colon polyp;colon resection;colonoscopy;computer assisted tomography;congestive heart failure;connective tissue disease;coronary artery disease;dementia;descending colon;diet supplementation;dietary fiber;disease severity;family history;female;fever;follow up;heart infarction;hemiplegia;human;hysterectomy;insulin dependent diabetes mellitus;International Classification of Diseases;intestine resection;irritable colon;kidney disease;leukemia;leukocyte count;liver disease;long term care;lymphoma;major clinical study;male;malignant neoplastic disease;medical record review;metastasis;non insulin dependent diabetes mellitus;pelvis abscess;peptic ulcer;pericolic abscess;peripheral vascular disease;peritoneal disease;peritonitis;predictive value;prostatectomy;recurrent disease;retroperitoneal abscess;retrospective study;sigmoid;sigmoidoscopy;smoking;stomach bypass;transverse colon,"Hall, J. F.;Roberts, P. L.;Ricciardi, R.;Read, T.;Scheirey, C.;Wald, C.;Marcello, P. W.;Schoetz, D. J.",2011,,,0,
1683,Comorbidity and outcomes of concurrent chemo- and radiotherapy in limited disease small cell lung cancer,"Background: Many patients with limited disease small cell lung cancer (LD SCLC) suffer from comorbidity. Not all patients with comorbidity are offered standard treatment, though there is little evidence for such a policy. The aim of this study was to investigate whether patients with comorbidity had inferior outcomes in a LD SCLC cohort. Material and methods: We analyzed patients from a randomized study comparing two three-week schedules of thoracic radiotherapy (TRT) plus standard chemotherapy in LD SCLC. Patients were to receive four courses of cisplatin/etoposide and TRT of 45 Gy/30 fractions (twice daily) or 42 Gy/15 fractions (once daily). Responders received prophylactic cranial irradiation (PCI). Comorbidity was assessed using the Charlson Comorbidity Index (CCI), which rates conditions with increased one-year mortality. Results: In total 157 patients were enrolled between May 2005 and January 2011. Median age was 63 years, 52% were men, 16% had performance status 2, and 72% stage III disease. Forty percent had no comorbidity; 34% had CCI-score 1; 15% CCI 2; and 11% CCI 3–5. There were no significant differences in completion rates of chemotherapy, TRT or PCI across CCI-scores; or any significant differences in the frequency of grade 3–5 toxicity (p = 0.49), treatment-related deaths (p = 0.36), response rates (p = 0.20), progression-free survival (p = 0.18) or overall survival (p = 0.09) between the CCI categories. Conclusion: Patients with comorbidity completed and tolerated chemo-radiotherapy as well as other patients. There were no significant differences in response rates, progression-free survival or overall survival – suggesting that comorbidity alone is not a reason to withhold standard therapy in LD SCLC.",cisplatin;etoposide;acquired immune deficiency syndrome;adult;aged;anemia;article;cancer combination chemotherapy;cancer mortality;cancer patient;cancer prognosis;cancer radiotherapy;cancer staging;cancer survival;cerebrovascular disease;Charlson Comorbidity Index;chemoradiotherapy;chronic obstructive lung disease;cohort analysis;comorbidity;comparative effectiveness;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;esophagitis;female;heart infarction;hemiplegia;hemoptysis;human;ischemic heart disease;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;middle aged;multicenter study (topic);multiple cycle treatment;multiple organ failure;neoplasm;neutropenia;overall survival;peptic ulcer;peripheral vascular disease;phase 2 clinical trial (topic);pneumonia;priority journal;progression free survival;quality of life;radiation dose fractionation;radiation esophagitis;radiation injury;radiation pneumonia;randomized controlled trial (topic);respiratory failure;retrospective study;skull irradiation;small cell lung cancer;solid tumor;survival rate;survival time;thrombocytopenia;treatment outcome;treatment response,"Halvorsen, T. O.;Sundstrøm, S.;Fløtten, Ø;Brustugun, O. T.;Brunsvig, P.;Aasebø, U.;Bremnes, R. M.;Kaasa, S.;Grønberg, B. H.",2016,,,0,
1684,N-terminal pro-brain natriuretic peptide is a useful marker to identify latent heart failure patients in older adults in a rural outpatient clinic,"Aim: Although measurement of natriuretic peptides including N-terminal pro-brain natriuretic peptide (NT-proBNP) has been recommended for identifying heart failure (HF) patients, the prevalence of elderly patients with latent HF who are attending an outpatient clinic is unknown. Methods: We measured NT-proBNP levels in 393 patients (aged 75 ± 9 years) in a rural outpatient clinic. Patients with a diagnosis of heart disease were excluded. The patients were divided into two groups by the values of NT-proBNP: high NT-proBNP group (>400 pg/mL) and low NT-proBNP group (≤400 pg/mL) according to Japanese guidelines. Patients with a high NT-proBNP value underwent echocardiography including tissue Doppler examination. Results: A total of 43 (11%) patients had high NT-proBNP values. Those patients were older, and larger percentages of those patients were male, had atrial fibrillation, history of stroke and dementia. Echocardiography was carried out in 39 of the 43 patients with high NT-proBNP values, and there were four patients with left ventricular systolic dysfunction, two with hypertrophic cardiomyopathy and one with aortic regurgitation. In the remaining 32 patients, 27 patients had diastolic HF in accordance with Japanese guidelines. A diagnosis of HF according to the guidelines was finally made in 34 (87 %) of the 39 patients. Conclusions: A large number of elderly patients without a diagnosis of HF who were attending an outpatient clinic showed high levels of NT-proBNP, and measurement of NT-proBNP is useful to identify patients with latent HF. Geriatr Gerontol Int 2016; ••: ••-••.",adult;aged;aortic regurgitation;atrial fibrillation;cerebrovascular accident;consensus development;controlled study;dementia;diagnosis;diastolic heart failure;human;hypertrophic cardiomyopathy;left ventricular systolic dysfunction;major clinical study;male;outpatient department;prevalence;tissue Doppler imaging;amino terminal pro brain natriuretic peptide;endogenous compound,"Hamagawa, K.;Kubo, T.;Nishimura, K.;Baba, Y.;Hirota, T.;Yamasaki, N.;Kitaoka, H.",2016,,10.1111/ggi.12951,0,1685
1685,N-terminal pro-brain natriuretic peptide is a useful marker to identify latent heart failure patients in older adults in a rural outpatient clinic,"AIM: Although measurement of natriuretic peptides including N-terminal pro-brain natriuretic peptide (NT-proBNP) has been recommended for identifying heart failure (HF) patients, the prevalence of elderly patients with latent HF who are attending an outpatient clinic is unknown. METHODS: We measured NT-proBNP levels in 393 patients (aged 75 +/- 9 years) in a rural outpatient clinic. Patients with a diagnosis of heart disease were excluded. The patients were divided into two groups by the values of NT-proBNP: high NT-proBNP group (>400 pg/mL) and low NT-proBNP group (</=400 pg/mL) according to Japanese guidelines. Patients with a high NT-proBNP value underwent echocardiography including tissue Doppler examination. RESULTS: A total of 43 (11%) patients had high NT-proBNP values. Those patients were older, and larger percentages of those patients were male, had atrial fibrillation, history of stroke and dementia. Echocardiography was carried out in 39 of the 43 patients with high NT-proBNP values, and there were four patients with left ventricular systolic dysfunction, two with hypertrophic cardiomyopathy and one with aortic regurgitation. In the remaining 32 patients, 27 patients had diastolic HF in accordance with Japanese guidelines. A diagnosis of HF according to the guidelines was finally made in 34 (87 %) of the 39 patients. CONCLUSIONS: A large number of elderly patients without a diagnosis of HF who were attending an outpatient clinic showed high levels of NT-proBNP, and measurement of NT-proBNP is useful to identify patients with latent HF. Geriatr Gerontol Int 2017; 17: 1648-1653.",N-terminal pro-brain natriuretic peptide;biomarkers;echocardiography;elderly;heart failure,"Hamagawa, K.;Kubo, T.;Nishimura, K.;Baba, Y.;Hirota, T.;Yamasaki, N.;Kitaoka, H.",2017,Oct,,0,
1686,The effect of docosahexaenoic acid on aggression in young adults. A placebo-controlled double-blind study,"41 students took either docosahexaenoic acid (DHA)-rich oil capsules containing 1.5-1.8 grams DHA/day (17 females and 5 males) or control oil capsules containing 97% soybean oil plus 3% fish oil (12 females and 7 males) for 3 mo in a double-blind fashion. They took a psychological test (P-F Study) and Stroop and dementia-detecting tests at the start and end of the study. The present study started at the end of summer vacation and ended in the middle of mental stress such as final exams. In the control group extraggression (aggression against others) in P-F Study was significantly increased at the end of the study as compared with that measured at the start (delta = +8.9%, P = 0.0022), whereas it was not significantly changed in the DHA group (delta = -1.0%). The 95% CI of differences between the DHA and control groups were -16.8 to -3.0%. DHA supplementation did not affect the Stroop and dementia-detecting tests. Thus, DHA intake prevented extraggression from increasing at times of mental stress. This finding might help understand how fish oils prevent disease like coronary heart disease.","Aggression [physiology];Dementia [physiopathology];Dietary Fats [metabolism];Docosahexaenoic Acids [pharmacology];Double-Blind Method;Fatty Acids, Nonesterified [metabolism];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Hs-handsrch: sr-behav: sr-compmed","Hamazaki, T.;Sawazaki, S.;Itomura, M.;Asaoka, E.;Nagao, Y.;Nishimura, N.;Yazawa, K.;Kuwamori, T.;Kobayashi, M.",1996,,10.1172/jci118507,0,1687
1687,The effect of docosahexaenoic acid on aggression in young adults. A placebo-controlled double-blind study,"41 students took either docosahexaenoic acid (DHA)-rich oil capsules containing 1.5-1.8 grams DHA/day (17 females and 5 males) or control oil capsules containing 97% soybean oil plus 3% fish oil (12 females and 7 males) for 3 mo in a double-blind fashion. They took a psychological test (P-F Study) and Stroop and dementia-detecting tests at the start and end of the study. The present study started at the end of summer vacation and ended in the middle of mental stress such as final exams. In the control group extraggression (aggression against others) in P-F Study was significantly increased at the end of the study as compared with that measured at the start (delta = +8.9%, P = 0.0022), whereas it was not significantly changed in the DHA group (delta = -1.0%). The 95% CI of differences between the DHA and control groups were -16.8 to -3.0%. DHA supplementation did not affect the Stroop and dementia-detecting tests. Thus, DHA intake prevented extraggression from increasing at times of mental stress. This finding might help understand how fish oils prevent disease like coronary heart disease.","Aggression [physiology];Dementia [physiopathology];Dietary Fats [metabolism];Docosahexaenoic Acids [pharmacology];Double-Blind Method;Fatty Acids, Nonesterified [metabolism];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Hs-handsrch: sr-behav: sr-compmed","Hamazaki, T;Sawazaki, S;Itomura, M;Asaoka, E;Nagao, Y;Nishimura, N;Yazawa, K;Kuwamori, T;Kobayashi, M",1996,,10.1172/JCI118507,0,
1688,Elevated levels of the Kearns-Sayre syndrome mitochondrial DNA deletion in temporal cortex of Alzheimer's patients,"A mitochondrial hypothesis of Alzheimer's disease (AD) has been proposed based on a number of studies which establish altered oxidative phosphorylation (OXPHOS) and ATP synthesis in AD tissue. Four out of five complexes in the OXPHOS pathway are partly encoded by mitochondrial DNA (mtDNA); thus, this may be a crucial site of lesions that alter brain activity. We examined temporal cortex autopsy tissue for deleted mtDNA by PCR-based methods and Southern analysis. AD tissue was obtained from autopsy-confirmed cases that had a postmortem delay ranging from 5 to 27 h. Using a rat brain model system to examine postmortem effects by Southern analysis, no evidence of mtDNA degradation after 30 h of postmortem delay at room temperature was found. Nine tissue samples taken from AD autopsy brain (average age 68 years) and nine age-matched controls (average age 66 years) were assessed by serial dilution PCR for the 5 kb deletion (mtDNA delta 4977) previously associated with Kearns-Sayre syndrome. Using this method we determined that AD temporal cortex had a 6.5-fold greater frequency of mtDNA delta 4977 than controls (0.0593% vs. 0.0092%, p = 0.0269, one-tailed; p = 0.0530, two-tailed), indicating that damaged mtDNA preferentially accumulates in AD compared to aged brain.","Age Factors;Aged;Alzheimer Disease/*genetics;Animals;DNA, Mitochondrial/*analysis/genetics/metabolism;Humans;Kearns-Sayre Syndrome/*genetics;Middle Aged;Oxidative Phosphorylation;Polymerase Chain Reaction/methods;Postmortem Changes;Rats;Rats, Sprague-Dawley;Sequence Deletion/*genetics;Temporal Lobe/*chemistry;Time Factors","Hamblet, N. S.;Castora, F. J.",1997,Oct 6,,0,
1689,Apolipoprotein E alleles and hypertension: Controversy or lack of understanding?,,angiotensin receptor antagonist;apolipoprotein E;calcium channel blocking agent;chylomicron;dipeptidyl carboxypeptidase inhibitor;very low density lipoprotein;allele;Alzheimer disease;amino acid sequence;atherosclerosis;binding affinity;cell proliferation;cognitive defect;environmental factor;heart infarction;hemodynamics;heredity;hyperlipoproteinemia type 3;hypertension;isoelectric focusing;lipid metabolism;note;phenotype;priority journal;cerebrovascular accident,"Hamet, P.",2002,,,0,
1690,Treating-to-risk: An approach to managing absolute CVD risk and hypertension,"· The use of absolute risk calculations allows us to identify patients at high cardiovascular disease (CVD) risk who will benefit most from antihypertensive treatment. · Identify and treat all risk factors; the combined risk from multiple risk factors is greater than would be expected from simply adding them up, even if each risk factor is relatively minor. · Recent trial evidence shows that intensive blood pressure control is beneficial, especially for groups at high CVD risk. · Absolute risk charts are a useful source of information to help patients understand their CVD risk profile. · Remember nonpharmacological approaches to reducing CVD risk: a structured plan may involve referral to other health professionals, with therapy tailored to the individual patient's needs.",antihypertensive agent;adult;age;aged;antihypertensive therapy;article;blood pressure measurement;cardiovascular disease;cardiovascular risk;cholesterol blood level;cognitive defect;controlled study;dementia;diabetes mellitus;drug use;elderly care;female;gender;health behavior;heart failure;heart infarction;high risk patient;human;hypertension;lifestyle;male;medical decision making;patient compliance;risk assessment;side effect;smoking;unstable angina pectoris,"Hamilton-Craig, C. R.;Tonkin, A. L.",2001,,,0,
1691,Overcoming barriers to diabetes control in geriatrics,"INTRODUCTION: Diabetes mellitus is approaching epidemic proportions in most countries and has captured the attention of physicians at local, national and global levels. The elderly population remains at a higher risk for diabetes mellitus (1), and the disease poses unique concerns for geriatricians, primary care physicians, nurses and specialised pharmacists who provide care to the elderly. Glycaemic control, geriatric-related syndromes and cardiovascular risk factors considerably affect the elderly patient's functional status and life expectancy (2). Geriatric syndromes may include polypharmacy, chronic pain, injurious falls, cognitive impairment, urinary incontinence and depression. Higher rates of premature death; functional disability; and chronic illnesses, such as hypertension, cerebrovascular accidents, dementia and coronary artery disease, often affect elderly diabetic patients. DISCUSSION: Collaborative efforts are continually needed to allocate and maximise utilisation of resources to help empower older adults with diabetes to overcome barriers to disease management. Healthcare providers are increasingly challenged by the complexity of problems that face old patients, and must therefore be prepared to assess and treat diabetes mellitus within the milieu of many geriatric-related chronic illnesses. Healthcare providers must tailor individualised treatment methods, with the ultimate goal of not only achieving laboratory norms but also improving the quality of life for this vulnerable population. CONCLUSION: There is a need for extra care and overcoming barriers to diabetes control in old patients as a dynamic and a continuous task that needs coordination of healthcare systems and professionals at all levels of care.",Aged;Delivery of Health Care/*organization & administration;Diabetes Complications/prevention & control;Diabetes Mellitus/*prevention & control;Diet;Health Behavior;Health Services for the Aged/organization & administration;Humans;Motivation;Needs Assessment;Patient Acceptance of Health Care,"Hammouda, E. I.",2011,Apr,10.1111/j.1742-1241.2010.02599.x,0,
1692,"Comorbid conditions are associated with healthcare utilization, medical charges and mortality of patients with rheumatoid arthritis","This study aims to examine the associations between comorbid conditions and healthcare utilization, medical charges, or mortality of patients with rheumatoid arthritis (RA). Nebraska state emergency department (ED) discharge, hospital discharge, and death certificate data from 2007 to 2012 were used to study the comorbid conditions of patients with RA. RA was defined using the standard International Classification of Diseases (ICD-9-CM 714 or ICD-10-CM M05, M06, and M08). There were more comorbid conditions in patients with RA than in patients without RA. Comorbid conditions were majorly related to healthcare utilization and mortality of patients with RA. In addition to injury, fracture, sprains, and strains, symptoms of cardiovascular and digestive systems, respiratory infection, and chronic obstructive pulmonary disease (COPD) were common comorbid conditions for ED visits. In addition to joint replacement and fracture, infections, COPD and cardiovascular comorbidities were common comorbid conditions for hospitalizations. Cardiovascular, cerebrovascular, and respiratory comorbidities, dementia, malignant neoplasm, and diabetes mellitus were common comorbid conditions for deaths of patients with RA. In addition, the numbers of comorbid conditions were significantly associated with the length of hospital stay and hospital charges for patients with RA. The findings in this study indicated that comorbid conditions are associated with healthcare utilization, medical charges, and mortality of patients with RA.",abdominal pain;adolescent;adult;article;cardiovascular disease;cerebrovascular disease;child;chronic obstructive lung disease;comorbidity;controlled study;cross-sectional study;dementia;diabetes mellitus;digestive system disease;disease association;emergency ward;female;health care utilization;heart arrhythmia;heart failure;heart infarction;heart muscle conduction disturbance;hospital charge;hospital discharge;human;hypertension;ICD-10-CM;ICD-9-CM;infant;injury;ischemic heart disease;length of stay;major clinical study;male;malignant neoplastic disease;mortality;United States;newborn;pneumonia;priority journal;respiratory tract infection;rheumatoid arthritis;septicemia;thorax pain,"Han, G. M.;Han, X. F.",2016,,,0,
1693,Factors affecting cardiac catheterization rates in elders with acute coronary syndromes,"BACKGROUND: Elder patients with acute coronary syndromes (ACS) are less likely to receive cardiac catheterization. The reasons for this are unclear. OBJECTIVES: To assess whether elder patients who had a documented history of dementia, lived in extended care facilities, or had do not intubate-do not resuscitate (DNR-DNI) advance directives were less likely to receive cardiac catheterization, despite having ACS with high-risk features. METHODS: This was a medical record review conducted at an urban teaching hospital. DNR-DNI status before hospitalization, extended care facility (nursing home or assisted living) residence, and a previous diagnosis of dementia were obtained from the medical record. Patients 65 years and older who presented to the emergency department with acute myocardial infarction or with unstable angina with ST segment deviation were included. Univariate and multivariate logistic regression were performed, and odds ratios (ORs) were reported with their 95% confidence intervals (CIs). RESULTS: Of the 201 eligible patients, 66 (32.8%) patients did not undergo cardiac catheterization. In the univariate analysis, patients who had dementia, resided in extended care facilities, or were DNR-DNI were less likely to receive cardiac catheterization. Only extended care facility residence (OR, 0.18; 95% CI = 0.04 to 0.83) and DNR-DNI status (OR, 0.19; 95% CI = 0.04 to 0.92) remained significantly associated with decreased cardiac catheterization in the multivariate analysis. CONCLUSIONS: Elder patients with ACS residing in extended care facilities or who are DNR-DNI are less likely to receive cardiac catheterization. Future studies concerning the quality of ACS care for elders should take these variables into account.","Age Distribution;Aged;Aged, 80 and over;Cardiac Catheterization/*utilization;Chest Pain/epidemiology;Cohort Studies;Comorbidity;Dementia/epidemiology;Female;Humans;Logistic Models;Male;Multivariate Analysis;Myocardial Ischemia/diagnosis/epidemiology/*therapy;Nursing Homes/statistics & numerical data;Odds Ratio;Resuscitation Orders;Retrospective Studies;Tachycardia/diagnosis/epidemiology;Tennessee/epidemiology","Han, J. H.;Miller, K. F.;Storrow, A. B.",2007,Mar,10.1197/j.aem.2006.09.054,0,
1694,The impact of medication use on symptom burden in older patients with multiple medical morbidities,"Background On average, older adults have more medical morbidities and consume a greater number of prescribed medications than their younger counterparts. However, the independent impact of greater medication use on symptom burden is not clear. Objective To determine to what extent there is: (1) an association between medical morbidity and symptom burden; and/or (2) an association between medication use and symptom burden. Materials and methods We performed a cross-sectional study, including one-on-one surveys of patients and medical record reviews, at a Veterans' Affairs primary care clinic in Connecticut, involving 159 community-dwelling males age >65 years, who were seen at routine appointments during the 5-month study period. The most commonly reported symptoms associated with adverse drug events were considered, and severity of symptoms was reported according to a Likert scale. Symptom burden was calculated as the sum of ""severe and very severe"" symptoms across all symptom categories. Linear regression and Chi-square analyses were performed to assess the bivariate associations between symptom burden and medications and between symptom burden and medical morbidities. Results On average, participants had 2.6 ± 1.4 medical morbidities, were prescribed 7.9 ± 2.8 medications, and reported 0.70 ± 1.2 severe or very severe symptoms. Linear regression analysis demonstrated a direct association between medical morbidities and symptom burden (slope = 0.38, r2 = 0.17, p < 0.0001) and a weaker association between medication use and symptom burden (slope = 0.11, r2 = 0.06, p = 0.002). When considered in a multiple regression model, medical morbidity continued to be a significant predictor of symptom burden (p < 0.0001), but the number of medications was no longer predictive (p = 0.52). Conclusion Medical morbidity contributes significantly to symptom burden, and use of additional medications does not allay or contribute to this effect. © 2013, Asia Pacific League of Clinical Gerontology and Geriatrics. Published by Elsevier Taiwan LLC. All rights reserved.",beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;aged;arthritis;article;cerebrovascular accident;chronic obstructive lung disease;cross-sectional study;dementia;depression;diabetes mellitus;disease severity;drug use;electronic medical record;health survey;heart failure;heart infarction;human;hypertension;kidney disease;Likert scale;liver cirrhosis;liver disease;lymphoma;male;morbidity;neoplasm;peptic ulcer;peripheral vascular disease;priority journal;symptom;United States,"Han, M. A.;Tinetti, M. E.;Agostini, J. V.;Han, L.;Lee, H.;Walke, L. M.",2013,,,0,
1695,Geographic Variation in Use of Ambulance Transport to the Emergency Department,"Study objective Evidence on variability in emergency medical services use is limited. We obtain national evidence on geographic variation in the use of ambulance transport to the emergency department (ED) among Medicare enrollees and assess the role of health status, socioeconomic status, and provider availability. Methods We used 2010 Medicare claims data for a random sample of 999,999 enrollees aged 66 years and older, and identified ambulance transport and ED use. The main outcome measures were number of ambulance transports to the ED per 100 person-years (ambulance transport rate) and proportion (percentage) of ED visits by ambulance transport by hospital referral regions. Results The national ambulance transport rate was 22.2 and the overall proportion of ED visits by ambulance was 36.7%. Relative to hospital referral regions in the lowest rate quartile, those in the highest quartile had a 75% higher ambulance transport rate (incidence rate ratio [IRR] 1.75; 95% confidence interval [CI] 1.69 to 1.81) and a 15.5% higher proportion of ED visits by ambulance (IRR 1.155; 95% CI 1.146 to 1.164). Adjusting for health status, socioeconomic status, and provider availability reduced quartile 1 versus quartile 4 difference in ambulance transport rate by 43% (IRR 1.43; 95% CI 1.38 to 1.48) and proportion of ED visits by ambulance by 7% (IRR 1.145; 95% CI 1.135 to 1.155). Among the 3 covariate domains, health status was associated with the largest variability in ambulance transport rate (30.1%), followed by socioeconomic status (12.8%) and provider availability (2.9%). Conclusion Geographic variability in ambulance use is large and associated with variation in patient health status and socioeconomic status.",aged;Alabama;Alaska;Alzheimer disease;ambulance;ambulance transportation;anemia;Arizona;Arkansas;article;Asian;asthma;atrial fibrillation;Black person;breast cancer;California;cataract;cerebrovascular accident;chronic kidney failure;chronic obstructive lung disease;cohort analysis;Colombia;Colorado;colorectal cancer;Connecticut;Delaware;depression;diabetes mellitus;emergency health service;emergency patient;emergency ward;endometrium cancer;evidence based emergency medicine;female;Florida;Georgia (U.S.);Hawaii;health care availability;health care utilization;health status;heart failure;highest income group;hip fracture;Hispanic;human;hyperlipidemia;hypertension;hypothyroidism;Idaho;Illinois;Indiana;Iowa;ischemic heart disease;Kansas;Kentucky;Louisiana;lowest income group;lung cancer;Maine;major clinical study;male;Maryland;Massachusetts;medical geography;medicare;Michigan;Minnesota;Mississippi;Missouri;Montana;Nebraska;Nevada;New Hampshire;New Jersey;New Mexico;New York;North Carolina;North Dakota;Ohio;Oklahoma;Oregon;osteoarthritis;osteoporosis;outcome assessment;patient referral;pelvis fracture;Pennsylvania;priority journal;prostate cancer;prostate hypertrophy;retrospective study;rheumatoid arthritis;Rhode Island;social status;South Carolina;South Dakota;Tennessee;Texas;transient ischemic attack;Utah;Vermont;very elderly;Virginia;Washington;West Virginia;Wisconsin;Wyoming,"Hanchate, A. D.;Paasche-Orlow, M. K.;Dyer, K. S.;Baker, W. E.;Feng, C.;Feldman, J.",2017,,10.1016/j.annemergmed.2017.03.029,0,
1696,"Anti-Alzheimer's drug, donepezil, markedly improves long-term survival after chronic heart failure in mice","BACKGROUND: We previously reported that chronic vagal nerve stimulation markedly improved long-term survival after chronic heart failure (CHF) in rats through cardioprotective effects of acetylcholine, independent of the heart rate-slowing mechanism. However, such an approach is invasive and its safety is unknown in clinical settings. To develop an alternative therapy with a clinically available drug, we examined the chronic effect of oral donepezil, an acetylcholinesterase inhibitor against Alzheimer's disease, on cardiac remodeling and survival with a murine model of volume-overloaded CHF. METHODS AND RESULTS: Four weeks after surgery of aortocaval shunt, CHF mice were randomized into untreated and donepezil-treated groups. Donepezil was orally given at a dosage of 5 mgxkg(-1)xday(-1). After 4 weeks of treatment, we evaluated in situ left ventricular (LV) pressure, ex vivo LV pressure-volume relationships, and LV expression of brain natriuretic peptides (BNP). We also observed survival for 50 days. When compared with the untreated group, the donepezil-treated group had significantly low LV end-diastolic pressure, high LV contractility, and low LV expression of BNP. Donepezil significantly reduced the heart weight and markedly improved the survival rate during the 50-day treatment period (54% versus 81%, P < .05). CONCLUSIONS: Oral donepezil improves survival of CHF mice through prevention of pumping failure and cardiac remodeling.","*Alzheimer Disease/drug therapy;Animals;Disease Models, Animal;Heart Failure/*drug therapy/*mortality;Indans/*therapeutic use;Male;Mice;Piperidines/*therapeutic use;Survival Rate/trends;Time Factors;Treatment Outcome","Handa, T.;Katare, R. G.;Kakinuma, Y.;Arikawa, M.;Ando, M.;Sasaguri, S.;Yamasaki, F.;Sato, T.",2009,Nov,10.1016/j.cardfail.2009.05.008,0,
1697,The Association of Coronary Artery Calcium With Noncardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis,"OBJECTIVES: This study sought to determine if coronary artery calcium (CAC) is associated with incident noncardiovascular disease. BACKGROUND: CAC is considered a measure of vascular aging, associated with increased risk of cardiovascular and all-cause mortality. The relationship with noncardiovascular disease is not well defined. METHODS: A total of 6,814 participants from 6 MESA (Multi-Ethnic Study of Atherosclerosis) field centers were followed for a median of 10.2 years. Modified Cox proportional hazards ratios accounting for the competing risk of fatal coronary heart disease were calculated for new diagnoses of cancer, pneumonia, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), deep vein thrombosis/pulmonary embolism, hip fracture, and dementia. Analyses were adjusted for age; sex; race; socioeconomic status; health insurance status; body mass index; physical activity; diet; tobacco use; number of medications used; systolic and diastolic blood pressure; total and high-density lipoprotein cholesterol; antihypertensive, aspirin, and cholesterol medication; and diabetes. The outcome was first incident noncardiovascular disease diagnosis. RESULTS: Compared with those with CAC = 0, those with CAC >400 had an increased hazard of cancer (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.18 to 1.99), CKD (HR: 1.70; 95% CI: 1.21 to 2.39), pneumonia (HR: 1.97; 95% CI: 1.37 to 2.82), COPD (HR: 2.71; 95% CI: 1.60 to 4.57), and hip fracture (HR: 4.29; 95% CI: 1.47 to 12.50). CAC >400 was not associated with dementia or deep vein thrombosis/pulmonary embolism. Those with CAC = 0 had decreased risk of cancer (HR: 0.76; 95% CI: 0.63 to 0.92), CKD (HR: 0.77; 95% CI: 0.60 to 0.98), COPD (HR: 0.61; 95% CI: 0.40 to 0.91), and hip fracture (HR: 0.31; 95% CI: 0.14 to 0.70) compared to those with CAC >0. CAC = 0 was not associated with less pneumonia, dementia, or deep vein thrombosis/pulmonary embolism. The results were attenuated, but remained significant, after removing participants developing interim nonfatal coronary heart disease. CONCLUSIONS: Participants with elevated CAC were at increased risk of cancer, CKD, COPD, and hip fractures. Those with CAC = 0 are less likely to develop common age-related comorbid conditions, and represent a unique population of ""healthy agers.""",aging;biologic aging;cancer;coronary artery calcium;coronary artery disease,"Handy, C. E.;Desai, C. S.;Dardari, Z. A.;Al-Mallah, M. H.;Miedema, M. D.;Ouyang, P.;Budoff, M. J.;Blumenthal, R. S.;Nasir, K.;Blaha, M. J.",2016,May,10.1016/j.jcmg.2015.09.020,0,
1698,"VITATOPS, the VITAmins TO prevent stroke trial: rationale and design of a randomised trial of B-vitamin therapy in patients with recent transient ischaemic attack or stroke (NCT00097669) (ISRCTN74743444)","AIM: To determine whether the addition of B-vitamin supplements (folic acid 2 mg, B(6) 25 mg, B(12) 500 microg) to best medical and surgical management will reduce the combined incidence of stroke, myocardial infarction (MI) and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye.DESIGN: A prospective, international, multicentre, randomised, double blind, placebo-controlled clinical trial.SETTING: One hundred and four medical centres in 20 countries on five continents.SUBJECTS: Eight thousand (6600 recruited as of 5 January, 2006) patients with recent (<7 months) stroke (ischaemic or haemorrhagic) or TIA (brain or eye). RANDOMISATION: Randomisation and data collection are performed by means of a central telephone service or secure internet site.INTERVENTION: One tablet daily of either placebo or B vitamins (folic acid 2 mg, B(6) 25 mg, B(12) 500 mug). PRIMARY OUTCOME: The composite of stroke, MI or death from any vascular cause, whichever occurs first. Outcome and serious adverse events are adjudicated blinded to treatment allocation. SECONDARY OUTCOMES: TIA, unstable angina, revascularisation procedures, dementia, depression. STATISTICAL POWER: With 8000 patients followed up for a median of 2 years and an annual incidence of the primary outcome of 8% among patients assigned placebo, the study will have at least 80% power to detect a relative reduction of 15% in the incidence of the primary outcome among patients assigned B vitamins (to 6.8%/year), applying a two-tailed level of significance of 5%.CONCLUSION: VITATOPS aims to recruit and follow-up 8000 patients between 1998 and 2008, and provide a reliable estimate of the safety and effectiveness of folic acid, vitamin B(12), and vitamin B(6) supplementation in reducing recurrent serious vascular events among a wide range of patients with TIA and stroke throughout the world.BACKGROUND: Epidemiological studies suggest that raised plasma concentrations of total homocysteine (tHcy) may be a common, causal and treatable risk factor for atherothromboembolic ischaemic stroke, dementia and depression. Although tHcy can be lowered effectively with small doses of folic acid, vitamin B(12) and vitamin B(6), it is not known whether lowering tHcy, by means of B vitamin therapy, can prevent stroke and other major atherothromboembolic vascular events.","Ischemic Attack, Transient [prevention & control];Research Design;Secondary Prevention;Stroke [prevention & control];Vitamin B Complex [therapeutic use];Humans[checkword];Sr-stroke: sr-vasc: sr-compmed","Hankey, Gj;Algra, A;Chen, C;Wong, Mc;Cheung, R;Wong, L;Divjak, I;Ferro, J;Freitas, G;Gommans, J;Groppa, S;Hill, M;Spence, D;Lees, K;Lisheng, L;Navarro, J;Ranawaka, U;Ricci, S;Schmidt, R;Slivka, A;Tan, K;Tsiskaridze, A;Uddin, W;Vanhooren, G;Xavier, D;Armitage, J;Hobbs, M;Le, M;Sudlow, C;Wheatley, K;Yi, Q;Bulder, M;Eikelboom, Jw;Hankey, Gj;Ho, Wk;Jamrozik, K;Klijn, K;Koedam, E;Langton, P;Nijboer, E;Tuch, P;Pizzi, J;Tang, M;Antenucci, M;Chew, Y;Chinnery, D;Cockayne, C;Loh, K;McMullin, L;Smith, F;Schmidt, R;Chen, C;Wong, Mc;Freitas, G;Hankey, Gj;Loh, K;Song, S",2007,,10.1111/j.1747-4949.2007.00111.x,0,1699
1699,"VITATOPS, the VITAmins TO prevent stroke trial: rationale and design of a randomised trial of B-vitamin therapy in patients with recent transient ischaemic attack or stroke (NCT00097669) (ISRCTN74743444)","BACKGROUND: Epidemiological studies suggest that raised plasma concentrations of total homocysteine (tHcy) may be a common, causal and treatable risk factor for atherothromboembolic ischaemic stroke, dementia and depression. Although tHcy can be lowered effectively with small doses of folic acid, vitamin B(12) and vitamin B(6), it is not known whether lowering tHcy, by means of B vitamin therapy, can prevent stroke and other major atherothromboembolic vascular events. AIM: To determine whether the addition of B-vitamin supplements (folic acid 2 mg, B(6) 25 mg, B(12) 500 microg) to best medical and surgical management will reduce the combined incidence of stroke, myocardial infarction (MI) and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. DESIGN: A prospective, international, multicentre, randomised, double blind, placebo-controlled clinical trial. SETTING: One hundred and four medical centres in 20 countries on five continents. SUBJECTS: Eight thousand (6600 recruited as of 5 January, 2006) patients with recent (<7 months) stroke (ischaemic or haemorrhagic) or TIA (brain or eye). RANDOMISATION: Randomisation and data collection are performed by means of a central telephone service or secure internet site. INTERVENTION: One tablet daily of either placebo or B vitamins (folic acid 2 mg, B(6) 25 mg, B(12) 500 mug). PRIMARY OUTCOME: The composite of stroke, MI or death from any vascular cause, whichever occurs first. Outcome and serious adverse events are adjudicated blinded to treatment allocation. SECONDARY OUTCOMES: TIA, unstable angina, revascularisation procedures, dementia, depression. STATISTICAL POWER: With 8000 patients followed up for a median of 2 years and an annual incidence of the primary outcome of 8% among patients assigned placebo, the study will have at least 80% power to detect a relative reduction of 15% in the incidence of the primary outcome among patients assigned B vitamins (to 6.8%/year), applying a two-tailed level of significance of 5%. CONCLUSION: VITATOPS aims to recruit and follow-up 8000 patients between 1998 and 2008, and provide a reliable estimate of the safety and effectiveness of folic acid, vitamin B(12), and vitamin B(6) supplementation in reducing recurrent serious vascular events among a wide range of patients with TIA and stroke throughout the world.","Ischemic Attack, Transient [prevention & control];Research Design;Secondary Prevention;Stroke [prevention & control];Vitamin B Complex [therapeutic use];Humans[checkword];Sr-stroke: sr-vasc: sr-compmed","Hankey, G. J.;Algra, A.;Chen, C.;Wong, M. C.;Cheung, R.;Wong, L.;Divjak, I.;Ferro, J.;Freitas, G.;Gommans, J.;Groppa, S.;Hill, M.;Spence, D.;Lees, K.;Lisheng, L.;Navarro, J.;Ranawaka, U.;Ricci, S.;Schmidt, R.;Slivka, A.;Tan, K.;Tsiskaridze, A.;Uddin, W.;Vanhooren, G.;Xavier, D.;Armitage, J.;Hobbs, M.;Le, M.;Sudlow, C.;Wheatley, K.;Yi, Q.;Bulder, M.;Eikelboom, J. W.;Hankey, G. J.;Ho, W. K.;Jamrozik, K.;Klijn, K.;Koedam, E.;Langton, P.;Nijboer, E.;Tuch, P.;Pizzi, J.;Tang, M.;Antenucci, M.;Chew, Y.;Chinnery, D.;Cockayne, C.;Loh, K.;McMullin, L.;Smith, F.;Schmidt, R.;Chen, C.;Wong, M. C.;Freitas, G.;Hankey, G. J.;Loh, K.;Song, S.",2007,,10.1111/j.1747-4949.2007.00111.x,0,
1700,Hypertension treatment strategies for older adults,,acetylsalicylic acid;atenolol;chlortalidone;hemoglobin A1c;hydrochlorothiazide;aged;antihypertensive therapy;article;body mass;case report;chronic kidney failure;clinical article;cognitive defect;comorbidity;creatinine blood level;daily life activity;dementia;depression;diabetes mellitus;dyspnea;evidence based practice;female;follow up;frailty;heart failure;heart rate;human;hypertension;leg edema;male;multiple chronic conditions;polypharmacy;thorax pain;very elderly,"Hansell, M. W.;Mann, E. M.;Kirk, J. K.",2017,,,0,
1701,Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics,"The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multi-centre, prospective, randomized, double-blind, parallel-group study. The primary objective of SCOPE is to assess the effect of the angiotensin II type 1 (AT1) receptor blocker, candesartan cilexetil 8-16 mg once daily, on major cardiovascular events in elderly patients (70-89 years of age) with mild hypertension (DBP 90-99 and/or SBP 160-179 mmHg). The secondary objectives of the study are to test the hypothesis that antihypertensive therapy can prevent cognitive decline (as measured by the Mini Mental State Examination, MMSE) and dementia, and to assess the effect of therapy on total mortality, myocardial infarction (MI), stroke, renal function, and hospitalization. A total of 4964 patients from 15 participating countries were recruited during the randomization phase of SCOPE, exceeding the target population of 4000. The mean age of the patients at enrolment was 76 years, the ratio of male to female patients was approximately 1:2, and 52% of patients were already being treated with an antihypertensive agent at enrolment. The majority of patients (88%) were educated to at least primary school level. At randomization, mean sitting blood pressure values were SBP 166 mmHg and DBP 90 mmHg, and the mean MMSE score was 28. Previous cardiovascular disease in the study population included myocardial infarction (4%), stroke (4%) and atrial fibrillation (4%). Men, more often than women, had a history of previous MI, stroke and atrial fibrillation. A greater percentage of men were smokers (13% vs 6% in women) and had attended university (11% vs 3% of women). Of the randomized patients, 21% were 80 years of age. In this age group smoking was less common (4% vs 10% for 70-79-year-olds) and fewer had attended university (4% vs 7% for 70-79-year-olds). The incidence of MI was similar in both age groups. However, stroke and atrial fibrillation had occurred approximately twice as frequently in the older patients. The patients' mean age at baseline was similar in the participating countries, and most countries showed the approximate 1:2 ratio for male to female patients. There was also little inter-country variation in terms of mean SBP, DBP or MMSE score. However, there was considerable regional variation in the percentage of patients on therapy prior to enrolment.","Aging [psychology];Angiotensin Receptor Antagonists;Antihypertensive Agents [therapeutic use];Benzimidazoles [therapeutic use];Biphenyl Compounds [therapeutic use];Cardiovascular Diseases [epidemiology] [etiology] [prevention & control];Cognition [physiology];Cognition Disorders [prevention & control];Dementia [prevention & control];Double-Blind Method;Incidence;Prognosis;Receptor, Angiotensin, Type 1;Receptor, Angiotensin, Type 2;Risk Factors;Sex Characteristics;Tetrazoles;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Hs-handsrch: sr-htn: sr-renal: sr-stroke","Hansson, L;Lithell, H;Skoog, I;Baro, F;Bánki, Cm;Breteler, M;Castaigne, A;Correia, M;Degaute, Jp;Elmfeldt, D;Engedal, K;Farsang, C;Ferro, J;Hachinski, V;Hofman, A;James, Of;Krisin, E;Leeman, M;Leeuw, Pw;Leys, D;Lobo, A;Nordby, G;Olofsson, B;Opolski, G;Prince, M;Reischies, Fm",2000,,,0,
1702,Study on COgnition and Prognosis in the Elderly (SCOPE),"The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multicentre, prospective, randomized, double-blind, parallel-group study designed to compare the effects of candesartan cilexetil and placebo in elderly patients with mild hypertension. The primary objective of the study is to assess the effect of candesartan cilexetil on major cardiovascular events. The secondary objectives of the study are to assess the effect of candesartan cilexetil on cognitive function and on total mortality, cardiovascular mortality, myocardial infarction, stroke, renal function, hospitalization, quality of life and health economics. Male and female patients aged between 70 and 89 years, with a sitting systolic blood pressure (SBP) of 160-179 mmHg and/or diastolic blood pressure (DBP) of 90-99 mmHg, and a Mini-Mental State Examination (MMSE) score of 24 or above, are eligible for the study. The overall target study population is 4000 patients, at least 1000 of whom are also to be assessed for quality of life and health economics data. After an open run-in period lasting 1-3 months, during which patients are assessed for eligibility and those who are already on antihypertensive therapy at enrolment are switched to hydrochlorothiazide 12.5 mg o.d., patients are randomized to receive either candesartan cilexetil 8 mg once daily (o.d.) or matching placebo o.d. At subsequent study visits, if SBP remains >160 mmHg, or has decreased by <10 mmHg since the randomization visit, or DBP is >85 mmHg, study treatment is doubled to candesartan cilexetil 16 mg o.d. or two placebo tablets o.d. Recruitment was completed in January 1999. At that time 4964 patients had been randomized. All randomized patients will be followed for an additional 2 years. If the event rate is lower than anticipated, the follow-up will be prolonged.",candesartan hexetil;hydrochlorothiazide;aged;article;borderline hypertension;clinical trial;cognition;controlled clinical trial;controlled study;dementia;dose response;double blind procedure;drug efficacy;female;health economics;heart infarction;hospitalization;human;kidney function;major clinical study;male;mortality;multicenter study;oral drug administration;priority journal;prognosis;quality of life;randomized controlled trial;cerebrovascular accident,"Hansson, L.;Lithell, H.;Skoog, I.;Baro, F.;Bánki, C. M.;Breteler, M.;Carbonin, P. U.;Castaigne, A.;Correia, M.;Degaute, J. P.;Elmfeldt, D.;Engedal, K.;Farsang, C.;Ferro, J.;Hachinski, V.;Hofman, A.;James, O. F. W.;Krisin, E.;Leeman, M.;De Leeuw, P. W.;Leys, D.;Lobo, A.;Nordby, G.;Olofsson, B.;Opolski, G.;Prince, M.;Reischies, F. M.;Rosenfeld, J. B.;Ruilope, L.;Salerno, J.;Tilvis, R.;Trenkwalder, P.;Zanchetti, A.",1999,,,0,
1703,Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics,"The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multi-centre, prospective, randomized, double-blind, parallel-group study. The primary objective of SCOPE is to assess the effect of the angiotensin II type 1 (AT1) receptor blocker, candesartan cilexetil 8-16 mg once daily, on major cardiovascular events in elderly patients (70-89 years of age) with mild hypertension (DBP 90-99 and/or SBP 160-179 mmHg). The secondary objectives of the study are to test the hypothesis that antihypertensive therapy can prevent cognitive decline (as measured by the Mini Mental State Examination, MMSE) and dementia, and to assess the effect of therapy on total mortality, myocardial infarction (MI), stroke, renal function, and hospitalization. A total of 4964 patients from 15 participating countries were recruited during the randomization phase of SCOPE, exceeding the target population of 4000. The mean age of the patients at enrolment was 76 years, the ratio of male to female patients was approximately 1:2, and 52% of patients were already being treated with an antihypertensive agent at enrolment. The majority of patients (88%) were educated to at least primary school level. At randomization, mean sitting blood pressure values were SBP 166 mmHg and DBP 90 mmHg, and the mean MMSE score was 28. Previous cardiovascular disease in the study population included myocardial infarction (4%), stroke (4%) and atrial fibrillation (4%). Men, more often than women, had a history of previous MI, stroke and atrial fibrillation. A greater percentage of men were smokers (13% vs 6% in women) and had attended university (11% vs 3% of women). Of the randomized patients, 21% were 80 years of age. In this age group smoking was less common (4% vs 10% for 70-79-year-olds) and fewer had attended university (4% vs 7% for 70-79-year-olds). The incidence of MI was similar in both age groups. However, stroke and atrial fibrillation had occurred approximately twice as frequently in the older patients. The patients' mean age at baseline was similar in the participating countries, and most countries showed the approximate 1:2 ratio for male to female patients. There was also little inter-country variation in terms of mean SBP, DBP or MMSE score. However, there was considerable regional variation in the percentage of patients on therapy prior to enrolment.","Aged;Aged, 80 and over;Aging/*psychology;*Angiotensin Receptor Antagonists;Antihypertensive Agents/*therapeutic use;Benzimidazoles/*therapeutic use;Biphenyl Compounds/*therapeutic use;Cardiovascular Diseases/epidemiology/etiology/*prevention & control;Cognition/*physiology;Cognition Disorders/prevention & control;Dementia/prevention & control;Double-Blind Method;Female;Humans;Incidence;Male;Prognosis;Receptor, Angiotensin, Type 1;Receptor, Angiotensin, Type 2;Risk Factors;Sex Characteristics;*Tetrazoles","Hansson, L.;Lithell, H.;Skoog, I.;Baro, F.;Banki, C. M.;Breteler, M.;Castaigne, A.;Correia, M.;Degaute, J. P.;Elmfeldt, D.;Engedal, K.;Farsang, C.;Ferro, J.;Hachinski, V.;Hofman, A.;James, O. F.;Krisin, E.;Leeman, M.;de Leeuw, P. W.;Leys, D.;Lobo, A.;Nordby, G.;Olofsson, B.;Opolski, G.;Prince, M.;Reischies, F. M.",2000,,,0,
1704,Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients,"Introduction The aim of every patient with hip fracture is to regain previous function but we know little about the outcome, especially patient-reported outcome. We wanted to investigate what factors influence the result one year after hip fracture, including fast-track for hip fracture patients, as well as investigating the patients' satisfaction with their rehabilitation and to what degree they regained their pre-fracture function. Methods All patients (>20 years, non-pathological fracture, residents in the catchment area, n = 664) having surgery for hip fracture at our hospital during 2011 were included in a retrospective cohort study. From medical records, information was gathered about pre-fracture condition as well as fracture type, surgical details, length of stay and whether the patient entered the hospital through the fast-track system. Medical records were scrutinised for general complications up to six months and for local complications up to one year after surgery. A postal questionnaire was sent one year after surgery inquiring about health status, pain and satisfaction along with multiple-choice questions regarding mobility and rehabilitation. Variables were analysed with linear regression or the proportional odds model. Results The most common general complications were new falls, pneumonia and new fractures. Deep infection was the most frequent local complication. The only significant effect of the fast-track system was shorter time to surgery (78 vs. 62% had surgery within 24 h, p < 0.001). A total of 29% reported to have regained their previous mobility and 30% considered the rehabilitation to be adequate. Mean value for pain VAS was 24 (SD 22) and for satisfaction 28 (SD 25). Absence of general and local complications correlated to satisfaction and hip pain. General complications correlated to loss of function. Higher age correlated to inadequate rehabilitation. Conclusion General complications seem to be the major risk factor, being the only factor affecting functional outcome and together with local complications affecting pain and satisfaction. To avoid general complications, co-operation between orthopaedic surgeons and internists may be crucial in the aftercare of hip fracture patients. A majority did not receive adequate rehabilitation and efforts need to be made to improve the rehabilitation process.",adult;age;aged;anxiety disorder;article;avascular necrosis;cerebrovascular accident;cognitive defect;cohort analysis;convalescence;deep vein thrombosis;dementia;depression;falling;female;follow up;health status;heart infarction;hip arthroplasty;hip dislocation;hip fracture;hip pain;human;injury severity;length of stay;lung embolism;major clinical study;male;osteosynthesis;outcome assessment;patient satisfaction;periprosthetic fracture;pneumonia;posttraumatic complication;priority journal;pseudarthrosis;reoperation;retrospective study;wound infection,"Hansson, S.;Rolfson, O.;Åkesson, K.;Nemes, S.;Leonardsson, O.;Rogmark, C.",2015,,,0,
1705,Do elderly patients benefit from recent advances in the treatment of ischemic heart disease?,"Percutaneous coronary intervention (PCI) with a transradial approach can be performed in very elderly patients with ischemic heart disease. In our hospital, 20% of elderly patients, who did not undergo emergency PCI for acute coronary syndrome (ACS), died. In contrast, only 7.3% of the elderly patients with ACS (80-98 yrs old, mean age 85 ± 4 years) died, and 4.6% of those (66-79 yrs old, mean age 73 ± 4 years) died after successful emergency PCI. In-hospital major adverse cardiovascular events were associated with anemia, CRP levels at admission, max CK-MB, and the number of involved vessels. The long-term prognosis of the elderly patients after emergency PCI was good with optimum medication, and it was associated with max CK-MB and renal function. Therefore, the indications for emergency PCI for elderly patients with ACS should be identical to that for young patients. However, elderly patients with ACS often show ambiguous symptoms, which make it difficult for them to undergo emergency PCI. Dementia and renal dysfunction are also problematic. On the other hand, improvement in the long-term prognosis of chronic ischemic heart disease by PCI has been shown in elderly patients, but not in younger patients. Observational monitoring showed a better mid-term prognosis after PCI with drug-eluting stent, but bare metal stents are preferable in cases of elderly patients with ACS.",aged;article;heart muscle ischemia;human;mortality;percutaneous coronary intervention;stent;very elderly,"Harada, K.",2012,,,0,
1706,A geriatric patient with hyponatremia diagnosed as having SIADH (syndrome of inappropriate secretion of ADH) after undergoing general anesthesia,"The serum sodium level is closely regulated between 135-145 mEq/l, and levels of less than 135 mEq/l are diagnosed as hyponatremia. If hyponatremia becomes severe, it can cause a disturbance of consciousness, which requires a differential diagnosis to determine whether a brain disorder is present Here, we report a case with syndrome of inappropriate secretion of ADH (SIADH) in a geriatric patient who was diagnosed as having hyponatremia based on a postoperative examination. The patient was a 98-year-old woman with a height of 140 cm and a weight of 33 kg. She had a chronic heart illness, but her cardiac function was well controlled. In addition, she had Alzheimer's dementia, and she required partial assistance with her activities of daily living. She had broken her left mandibular bone and was scheduled to undergo surgery for reposition fixation. During the operation, her serum sodium level was maintained at between 119.2 and 122.4 mEq/l, but it fell to 114.4mEq/l after the operation. Initially, we thought that the preoperative hyponatremia was an adverse effect of a diuretic and that the high ADH level had been brought on by surgical stress, causing the hyponatremia to progress after the operation. However, additional examinations revealed a serum osmolality of 513 mOsm/kgH20, a TSH level of 2.82 μIU/ml, an fT3 level of 1.64 pg/ml, an fT4 level of 1.57 pg/ml, and a serum ADH level of 1.2 pg/ml. These findings led to a diagnosis of SIADH. Therefore, we restricted the patient's water intake (20ml/kg) and started sodium revision with a salt dosage of 200 mEq/day; as a result of this treatment, her serum sodium level returned to the preoperative value on the next day. Because hyponatremia is not uncommon in geriatric patients, the serum sodium level should be evaluated preoperatively.",liothyronine;sodium;thyrotropin;thyroxine;vasopressin;aged;article;case report;female;fluid intake;free liothyronine index;free thyroxine index;general anesthesia;geriatric care;geriatric patient;human;hyponatremia;inappropriate vasopressin secretion;mandible fracture;serum osmolality;sodium blood level;surgical stress;very elderly,"Harano, N.;Ogawa, M.;Kametani, A.;Kuno, A.;Maeda, S.;Shigeyama, S.;Sago, T.;Shiiba, S.;Watanabe, S.",2017,,,0,
1707,Impaired Cerebral Hemodynamics and Cognitive Performance in Patients with Atherothrombotic Disease,"BACKGROUND AND OBJECTIVE: Patients with pre-existing atherothrombotic disease are prone to cognitive impairment. We tested whether impaired cerebrovascular reactivity (CVR), a marker of cerebral microvascular hemodynamic dysfunction, is associated with poorer cognitive scores among patients with and without carotid large-vessel disease. METHODS: A subgroup of non-demented patients with chronic coronary heart disease followed-up for 15 +/- 3 years was assessed for cognitive function (Neurotrax Computerized Cognitive Battery; scaled to an IQ style scale with a mean of 100 and SD of 15) and for CVR using the breath-holding index (BHI) with transcranial Doppler and for carotid plaques using ultrasound. We assessed cognitive scores in specific domains in patients with and without impaired CVR (BHI <0.47; bottom quartile). RESULTS: Among 415 patients (mean age 71.7 +/- 6.2 y) median BHI was 0.73 (25% 0.47, 75% 1.04). Impaired CVR was associated with diabetes and peripheral artery disease. Adjusting for potential confounders, impaired CVR was associated with lower executive function (p = 0.02) and global cognitive scores (p = 0.04). There was an interaction with carotid large-vessel disease for executive function (p < 0.001), memory (p = 0.03), and global cognitive scores (p = 0.02). In the carotid large-vessel disease group there were pronounced differences by CVR status in executive function (p < 0.001), memory (p = 0.02), attention (p < 0.001), and global cognitive scores (p = 0.001). CONCLUSION: Impaired CVR, a marker of cerebral microvascular dysfunction, is associated with poorer cognitive functions and in particular executive dysfunction among non-demented patients with concomitant carotid large-vessel disease. These findings emphasize the importance of cerebral hemodynamics in cognitive performance.",Aged;Bezafibrate/pharmacology/therapeutic use;Blood Pressure/drug effects;Cerebrovascular Circulation/drug effects;Cerebrovascular Disorders/*complications/drug therapy;Cognition Disorders/*etiology;Female;Humans;Hypolipidemic Agents/pharmacology/therapeutic use;Longitudinal Studies;Male;Middle Aged;Neuropsychological Tests;Neurovascular Coupling/*physiology;Ultrasonography;Cerebrovascular disorders;dementia;hemodynamics;transcranial Doppler sonography;vascular dementia,"Haratz, S.;Weinstein, G.;Molshazki, N.;Beeri, M. S.;Ravona-Springer, R.;Marzeliak, O.;Goldbourt, U.;Tanne, D.",2015,,10.3233/jad-150052,0,
1708,"Impact of hip fracture, heart failure and weight loss on the risk of institutionalization of community-dwelling patients with dementia","OBJECTIVES: This study sought to identify the influence of medical symptoms and diseases on the risk of nursing home placement in a prospective cohort of newly diagnosed community-dwelling patients with dementia. STUDY DESIGN AND SETTING: This study included 348 patients with dementia, consecutively diagnosed, recruited and followed at a geriatric outpatient center (mean age: 81 years, 65.5% with Alzheimer's disease, mean baseline MMSE score: 20.5, mean follow-up: 20.5 months). RESULTS: After adjustment for factors commonly associated with institutionalization in this population, hip fracture in the 3 years preceding diagnosis, acute congestive heart failure during follow-up and weight loss of more than 5% in any year during follow-up were independently associated with nursing home placement. CONCLUSION: This study confirms the independent contribution of specific medical symptoms and diseases to earlier institutionalization of patients with dementia. These results stress the importance of better knowledge of the specific characteristics of hip fracture, weight loss and congestive heart failure in the context of dementia, to make more effective prevention possible in this patient population.","Aged, 80 and over;Comorbidity;Dementia/*epidemiology;Female;Geriatric Assessment;Hip Fractures/*epidemiology;Humans;Institutionalization/*statistics & numerical data;Male;*Nursing Homes;Paris;Prospective Studies;Psychiatric Status Rating Scales;Risk Assessment;*Weight Loss","Harboun, M.;Dorenlot, P.;Cohen, N.;Steinhagen-Thiessen, E.;Ankri, J.",2008,Dec,10.1002/gps.2058,0,
1709,The current state of postmenopausal hormone therapy: update for neurologists and epileptologists,"Appropriate and safe use of hormone replacement therapy (HRT) in postmenopausal women is an evolving saga, triggered by the unexpected results from the first publication of the Women's Health Initiative (WHI) Trial in 2002. These results showed a slight but significantly increased risk of breast cancer, stroke, and dementia with standard HRT compared with placebo. A reanalysis of these results shows that use of HRT within the first few years after the onset of menopause may be associated with decreased risk of dementia and coronary artery disease. However, HRT in its commonly used form of conjugated equine estrogen and medroxyprogesterone acetate can increase seizure frequency in menopausal women with epilepsy; this outcome may be an adverse effect of these neuroactive steroids on the epileptic female brain, which is already in a hormonally deprived state. To explore this possibility, more information about the neurophysiologic activity of medroxyprogesterone acetate is needed and alternatives to this specific HRT regimen should be considered for women with epilepsy.",,"Harden, C. L.",2007,Sep-Oct,10.1111/j.1535-7511.2007.00196.x,0,
1710,Experience with dedicated geriatric surgical consult services: meeting the need for surgery in the frail elderly,"BACKGROUND: Surgeons are increasingly faced with consultation for intervention in residents of geriatric centers or in patients who suffer from end stage medical disease. We review our experience with consult services dedicated to the needs of these frail patients. STUDY DESIGN: Patients were prospectively followed after being evaluated by three different geriatric surgical consult services: Group 1 was based at a geriatric center associated with a tertiary medical center, Group 2 was based at a community geriatric center, and Group 3 was based with an hospital-based service for ambulatory patients with end stage congestive heart failure. RESULTS: A total of 256 frail elderly patients underwent of 311 general surgical procedures ranging from major abdominal and vascular procedures to minor procedures such as debridement of decubitus ulcers, long-term intravenous access, enterostomy and enteral tube placement. Almost half of the surgical volume in Group 1 and 3 were 'maintenance' (decubitus debridement, long term intravenous or stomal or tube care); all of Group 2 were for treatment of decubiti. There was minimal morbidity and mortality from surgery itself, and overall one year survival for Groups 1, 2, and 3 was 46%, 60%, and 79%, respectively. Multivariate analysis showed that each group had its own unique indicators of decreased survival: Group 1 dementia and coronary artery disease, in Group 2 gender and coronary artery disease, and Group 3, gender alone. Age, number of comorbid illnesses, and type of surgery (major vs minor) were not significant indicators. CONCLUSIONS: This is the first review of the role of dedicated surgical consult services which focused on residents of geriatric centers and frail elderly. Conditions routinely encountered in this population such as dementia, end stage disease, multiple comorbidities, polypharmacy, decreased functional and nutritional status are not frequently encountered by general surgeons. But the surgery is safe, and survival data is comparable to those in geriatric centers who did not undergo surgery. A multidisciplinary team approach gives the most effective care, with a primary goal of palliation.",Aged;Coronary Artery Disease/epidemiology/surgery;Female;*Frail Elderly;*General Surgery;*Health Services Needs and Demand;Heart Failure/epidemiology/surgery;Humans;Male;Nursing Homes;Palliative Care;*Physician's Role;Prospective Studies;*Referral and Consultation;Survival;United States/epidemiology;congestive heart failure;coronary artery disease;dementia;frailty;geriatrics;nursing home residents;surgery in the elderly;surgical consultations,"Hardin, R. E.;Le Jemtel, T.;Zenilman, M. E.",2009,,,0,
1711,The cost of hypertension-related ill-health attributable to environmental noise,"Hypertension (HT) is associated with environmental noise exposure and is a risk factor for a range of health outcomes. The study aims were to identify key HT related health outcomes and to quantify and monetize the impact on health outcomes attributable to environmental noise-related HT. A reiterative literature review identified key HT related health outcomes and their quantitative links with HT. The health impact of increases in environmental noise above recommended daytime noise levels (55 dB[A]) were quantified in terms of quality adjusted life years and then monetized. A case study evaluated the cost of environmental noise, using published data on health risks and the number of people exposed to various bands of environmental noise levels in the United Kingdom (UK). Three health outcomes were selected based on the strength of evidence linking them with HT and their current impact on society: Acute myocardial infarction (AMI), stroke and dementia. In the UK population, an additional 542 cases of HT-related AMI, 788 cases of stroke and 1169 cases of dementia were expected per year due to daytime noise levels >/=55 dB(A). The cost of these additional cases was valued at around pound1.09 billion, with dementia accounting for 44%. The methodology is dependent on the availability and quality of published data and the resulting valuations reflect these limitations. The estimated intangible cost provides an insight into the scale of the health impacts and conversely the benefits that the implementation of policies to manage environmental noise may confer.","Adult;Aged;Aged, 80 and over;Cardiovascular Diseases/*economics/epidemiology;*Cost of Illness;Dementia/economics/epidemiology/etiology;Environmental Exposure/*adverse effects/*economics;Female;Great Britain/epidemiology;Humans;Hypertension/economics/epidemiology/etiology;Male;Middle Aged;Models, Econometric;Myocardial Infarction/economics/epidemiology/etiology;Noise/*adverse effects;Quality-Adjusted Life Years;Risk;Stroke/economics/epidemiology/etiology","Harding, A. H.;Frost, G. A.;Tan, E.;Tsuchiya, A.;Mason, H. M.",2013,Nov-Dec,10.4103/1463-1741.121253,0,
1712,Chemotherapy-associated toxicity in a large cohort of elderly patients with non-small cell lung cancer,"BACKGROUND: The objective of this study was to examine the risks for short-term (≤3 months) and long-term (>3 months) chemotherapy-associated toxicities in a large population-based cohort of patients with non-small cell lung cancer from 1991 to 2002. METHODS: The population consisted of 41,361 men and 30,804 women ≥65 years identified from the Surveillance, Epidemiology, and End Results-Medicare-linked database. The incidence of 50 toxicity-associated end points was calculated for 14 chemotherapy agents. Short- and long-term toxicities with a ≥2-fold increase in incidence compared with the no-chemotherapy group were defined as chemotherapy-associated toxicities. Hazard ratios and 95% confidence intervals for the risk of toxicity were calculated for the four most common chemotherapy agents for non-small cell lung cancer: cisplatin/carboplatin, paclitaxel, vinorelbine/vinblastine, and gemcitabine. RESULTS: The most common short-term toxicities (9.2-60%) included acute anemia, nausea, and neutropenia. The most common long-term toxicities (15-37%) included acute anemia, respiratory failure, pulmonary fibrosis, dehydration, neutropenia, nausea, and fever. Multivariate analysis for selected chemotherapies demonstrated that after adjusting for other risk factors and confounders, some short-term toxicities became nonsignificant; however, almost all long-term toxicities remained significant. Long-term toxicity increased over time and was more likely in women, minority populations, those with fewer baseline comorbidities, and across disease stages. CONCLUSIONS: The administration of various chemotherapy agents for non-small cell lung was associated with a number of short- and long-term toxicities. The projected survival benefits of chemotherapy must be weighed against the risk of long-term toxicities. Copyright © 2009 by the International Association for the Study of Lung Cancer.",bevacizumab;carboplatin;cisplatin;cyclophosphamide;docetaxel;doxorubicin;etoposide;fluorouracil;folinic acid;gemcitabine;ifosfamide;mitomycin;navelbine;paclitaxel;vinblastine;acute kidney failure;aged;anorexia;article;atrioventricular junction arrhythmia;bladder cancer;brain disease;cardiogenic shock;cardiomyopathy;chronic kidney failure;cognitive defect;colitis;controlled study;deep vein thrombosis;dehydration;delirium;dementia;dermatitis;diarrhea;drug fatality;drug fever;fatigue;female;gastroenteritis;heart failure;heart infarction;heart muscle conduction disturbance;hematuria;hemolytic anemia;human;hypertension;inappropriate vasopressin secretion;induced hypotension;infection;leukemia;liver dysfunction;lung edema;lung embolism;lung fibrosis;non small cell lung cancer;lung toxicity;major clinical study;male;myocarditis;nausea;neutropenia;ototoxicity;paroxysmal tachycardia;peripheral neuropathy;priority journal;proteinuria;psychosis;Raynaud phenomenon;respiratory failure;risk factor;seizure;side effect;stomatitis;stupor;sudden death;thorax pain;thrombocytopenia,"Hardy, D.;Cormier, J. N.;Xing, Y.;Liu, C. C.;Xia, R.;Du, X. L.",2010,,,0,
1713,Cardiovascular disease and cognitive decline in postmenopausal women: results from the Women's Health Initiative Memory Study,"BACKGROUND: Data on cardiovascular diseases (CVD) and cognitive decline are conflicting. Our objective was to investigate if CVD is associated with an increased risk for cognitive decline and to examine whether hypertension, diabetes, or adiposity modify the effect of CVD on cognitive functioning. METHODS AND RESULTS: Prospective follow-up of 6455 cognitively intact, postmenopausal women aged 65 to 79 years old enrolled in the Women's Health Initiative Memory Study (WHIMS). CVD was determined by self-report. For cognitive decline, we assessed the incidence of mild cognitive impairment (MCI) or probable dementia (PD) via modified mini-mental state examination (3 MS) score, neurocognitive, and neuropsychiatric examinations. The median follow-up was 8.4 years. Women with CVD tended to be at increased risk for cognitive decline compared with those free of CVD (hazard ratio [HR], 1.29; 95% CI: 1.00, 1.67). Women with myocardial infarction or other vascular disease were at highest risk (HR, 2.10; 95% CI: 1.40, 3.15 or HR, 1.97; 95% CI: 1.34, 2.87). Angina pectoris was moderately associated with cognitive decline (HR 1.45; 95% CI: 1.05, 2.01) whereas no significant relationships were found for atrial fibrillation or heart failure. Hypertension and diabetes increased the risk for cognitive decline in women without CVD. Diabetes tended to elevate the risk for MCI/PD in women with CVD. No significant trend was seen for adiposity. CONCLUSIONS: CVD is associated with cognitive decline in elderly postmenopausal women. Hypertension and diabetes, but not adiposity, are associated with a higher risk for cognitive decline. More research is warranted on the potential of CVD prevention for preserving cognitive functioning.",aged;cardiovascular disease;dementia;diabetes mellitus;female;human;hypertension;mild cognitive impairment;heart infarction;obesity;postmenopause;proportional hazards model;prospective study;risk factor;vascular disease,"Haring, B.;Leng, X.;Robinson, J.;Johnson, K. C.;Jackson, R. D.;Beyth, R.;Wactawski-Wende, J.;von Ballmoos, M. W.;Goveas, J. S.;Kuller, L. H.;Wassertheil-Smoller, S.",2013,,,1,
1714,"Hypertension, Dietary Sodium, and Cognitive Decline: Results from the Women's Health Initiative Memory Study","BACKGROUND To investigate the relationships of hypertension, antihypertensive treatment, and sodium intake on cognitive decline in older women. METHODS Prospective follow-up of 6,426 cognitively intact women aged 65-79 years enrolled in the Women's Health Initiative Memory Study (WHIMS) with a median follow-up of 9.1 years. Dietary sodium intake was determined by food frequency questionnaires. Hypertension was defined as self-report of current drug therapy for hypertension. Blood pressure (BP) control was assessed by treatment for hypertension and clinic measurement of systolic BP ≥ 140mm Hg or diastolic BP ≥ 90mm Hg at baseline. Cognitive functioning was assessed annually by global cognitive screening, neurocognitive, and neuropsychiatric evaluations. Cognitive decline was identified by the incidence of mild cognitive impairment (MCI) or probable dementia (PD). Cox proportional hazards analyses were used to calculate hazard ratios (HRs). RESULTS Hypertension was associated with an increased risk for cognitive decline (HR 1.20; 95% confidence interval (CI) 1.04, 1.39; P = 0.02). Among women with antihypertensive medication, those with BP ≥140/90mm Hg (uncontrolled BP) were at highest risk for developing cognitive decline (HR 1.30; 95% CI 1.05, 1.60) compared to women without treatment and BP <140/90mm Hg (controlled BP). Sodium intake >1,500mg/day did not alter the risk for cognitive decline in hypertensive women or women with antihypertensive treatment (P for interaction = 0.96 or 0.97). CONCLUSIONS Women with antihypertensive treatment and uncontrolled BP showed highest risk estimates for developing cognitive decline compared to non-hypertensive women. Sodium intake did not modify the risk for cognitive decline in women with hypertension or receiving antihypertensive medication.",NCT00685009;antihypertensive agent;estrogen;gestagen;placebo;sodium;aged;antihypertensive therapy;article;blood pressure measurement;cognitive defect;cognitive function test;confidence interval;controlled study;dementia;diastolic blood pressure;female;follow up;food frequency questionnaire;hazard ratio;high risk patient;hormonal therapy;human;hypertension;major clinical study;memory;menopausal syndrome;mild cognitive impairment;outcome assessment;postmenopause;priority journal;proportional hazards model;prospective study;psychologic assessment;randomized controlled trial;risk assessment;screening;sodium intake;systolic blood pressure;women's health,"Haring, B.;Wu, C.;Coker, L. H.;Seth, A.;Snetselaar, L.;Manson, J. E.;Rossouw, J. E.;Wassertheil-Smoller, S.",2016,,,0,
1715,What is best for the patient? 10,,acetylsalicylic acid;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;fluoxetine;hydroxymethylglutaryl coenzyme A reductase inhibitor;noradrenalin;serotonin uptake inhibitor;angina pectoris;anxiety disorder;dementia;evidence based medicine;geriatrics;heart muscle ischemia;human;letter;mental patient;Mini Mental State Examination;practice guideline;priority journal;aspirin,"Harper, A.",2003,,,0,
1716,Rosiglitazone does not improve cognition or global function when used as adjunctive therapy to AChE inhibitors in mild-to-moderate alzheimer's disease: Two phase 3 studies,"Two phase 3 studies evaluated the efficacy and safety of rosiglitazone (RSG), a type 2 diabetes treatment, in an extended release (RSG XR) form as adjunctive therapy to ongoing acetylcholine esterase inhibitor (AChEI) treatment in AD (REFLECT-2, adjunctive to donepezil; REFLECT-3, to any AChEI). An open-label extension study (REFLECT-4) assessed RSG XR long-term safety. Methods: In these two double-blind, placebo-controlled studies, subjects with mild-to-moderate probable AD were randomized within 2 apolipoprotein E (APOE) allelic strata (APOE e4-positive, APOE e4-negative) to once daily placebo, 2 mg RSG XR, or 8 mg RSG XR for 48 weeks (REFLECT-2, N=1,496; REFLECT-3, N=1,485). Co-primary efficacy endpoints were change from baseline in Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) and Clinical Dementia Rating scale - Sum of Boxes (CDR-SB) scores at week 48. Three populations were analyzed: APOE4-negative, all subjects except APOE e4 homozygotes, and the full intent-to-treat population. Results: No statistically or clinically relevant differences between treatment groups were observed on the a priori primary endpoints in REFLECT-2 or REFLECT-3. Edema was the most frequent adverse event with RSG in each study (14% and 19%, respectively, at 8 mg RSG XR). Conclusions: No evidence of statistically or clinically significant efficacy in cognition or global function was detected for 2 mg or 8 mg RSG XR as adjunctive therapy to ongoing AChEIs. There was no evidence of an interaction between treatment and APOE status. Safety and tolerability of RSG XR was consistent with the known profile of rosiglitazone. © 2011 Bentham Science Publishers Ltd.",NCT00348140;NCT00348309;NCT00490568;apolipoprotein E2;apolipoprotein E4;creatine kinase;creatinine;donepezil;hemoglobin A1c;lactate dehydrogenase;low density lipoprotein cholesterol;nitrogen;placebo;rosiglitazone;urea;acute heart failure;adjuvant therapy;adult;aged;Alzheimer disease;anemia;aorta dissection;article;cardiopulmonary arrest;cerebrovascular disease;clinical assessment;cognition;comparative effectiveness;congestive heart failure;controlled study;creatine kinase blood level;creatinine blood level;diastolic blood pressure;drug dose titration;drug efficacy;drug safety;drug tolerability;drug withdrawal;dyslipidemia;edema;erythrocyte count;female;fracture;heart infarction;heart muscle ischemia;hematocrit;human;hypoglycemia;lactate dehydrogenase blood level;leukocyte count;lipoprotein blood level;liver disease;lung edema;major clinical study;male;mental performance;Mini Mental State Examination;neoplasm;parotid gland disease;peripheral edema;peripheral vascular disease;phase 3 clinical trial;priority journal;randomized controlled trial;red blood cell distribution width;retina macula cystoid edema;macular edema;retinopathy;rhinopharyngitis;salivary gland disease;side effect;single blind procedure;systolic blood pressure;treatment duration;treatment outcome;urea nitrogen blood level;weight gain,"Harrington, C.;Sawchak, S.;Chiang, C.;Davies, J.;Donovan, C.;Saunders, A. M.;Irizarry, M.;Jeter, B.;Zvartau-Hind, M.;van Dyck, C. H.;Gold, M.",2011,,,0,
1717,Why evidence-based practice matters,,Aged;Dementia/*therapy;Evidence-Based Practice/*standards;Geriatrics/*standards;Heart Failure/*therapy;Humans;Nurse Practitioners/*standards;Physician Assistants/*standards,"Harrington, C. C.",2012,Apr,,0,
1718,Cardiac pacing for elderly patients,"During the past 10 years 770 patients have been treated with permanent pacemakers in the Pacing Unit at St. George's Hospital, London. Of these patients, 192 were 75 yr old or older. The age factor and the presence of additional chronic disease initially raised doubts as to the value of artificial pacing, particularly when the insertion of the pacing electrode required a thoracotomy. During the past 6 years all patients have been paced with a transvenous right ventricular electrode wire. The pacing wire is usually inserted via a cephalic vein or an external or internal jugular vein. The majority of patients have clearly benefited from treatment with artificial pacemakers. Many were able to return to a full and independent life, and in those whose condition necessitated continued hospital or nursing home care, control of Adams Stokes attacks and heart failure made their management easier. A low cardiac output secondary to a slow heart rate led to dementia and stupor in 6 patients. Drug therapy alone was ineffective, but temporary cardiac pacing reversed the clinical situation rapidly in 4 patients, indicating the need for permanent pacing. The other 2 patients showed no improvement and pacing was not continued. The annual mortality of paced patients is 10% (the general population mortality of a matched normal group being 6%). Untreated, the annual mortality of these patients is between 30 an 40%.",adrenalin;diamorphine;digitalis;ephedrine;perphenazine;isoprenaline;lidocaine;propantheline bromide;unclassified drug;Adams Stokes attack;age;aged;artificial heart pacemaker;atrioventricular block;axilla;cephalic vein;dementia;diagnosis;etiology;fatality;heart failure;heart output;heart pacing;heart surgery;heart ventricle;intravenous drug administration;jugular vein;major clinical study;subcutaneous drug administration;therapy;thoracotomy;fentazin;probanthine;saventrine,"Harris, A.",1974,,,0,
1719,Which Comorbid Conditions Should We Be Analyzing as Risk Factors for Healthcare-Associated Infections?,"OBJECTIVE To determine which comorbid conditions are considered causally related to central-line associated bloodstream infection (CLABSI) and surgical-site infection (SSI) based on expert consensus. DESIGN Using the Delphi method, we administered an iterative, 2-round survey to 9 infectious disease and infection control experts from the United States. METHODS Based on our selection of components from the Charlson and Elixhauser comorbidity indices, 35 different comorbid conditions were rated from 1 (not at all related) to 5 (strongly related) by each expert separately for CLABSI and SSI, based on perceived relatedness to the outcome. To assign expert consensus on causal relatedness for each comorbid condition, all 3 of the following criteria had to be met at the end of the second round: (1) a majority (>50%) of experts rating the condition at 3 (somewhat related) or higher, (2) interquartile range (IQR)≤1, and (3) standard deviation (SD)≤1. RESULTS From round 1 to round 2, the IQR and SD, respectively, decreased for ratings of 21 of 35 (60%) and 33 of 35 (94%) comorbid conditions for CLABSI, and for 17 of 35 (49%) and 32 of 35 (91%) comorbid conditions for SSI, suggesting improvement in consensus among this group of experts. At the end of round 2, 13 of 35 (37%) and 17 of 35 (49%) comorbid conditions were perceived as causally related to CLABSI and SSI, respectively. CONCLUSIONS Our results have produced a list of comorbid conditions that should be analyzed as risk factors for and further explored for risk adjustment of CLABSI and SSI.",catheter;acquired immune deficiency syndrome;alcohol abuse;anemia;article;blood clotting disorder;catheter infection;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;congestive heart failure;consensus development;Delphi study;dementia;depression;diabetes mellitus;electrolyte disturbance;Elixhauser comorbidity index;healthcare associated infection;heart arrhythmia;heart infarction;hemiplegia;human;hypertension;hypothyroidism;infection risk;kidney disease;liver disease;lymphoma;malnutrition;medical expert;metastasis;obesity;paraplegia;peptic ulcer;peripheral vascular disease;psychosis;rheumatic disease;solid malignant neoplasm;surgical infection;United States;valvular heart disease;weight reduction,"Harris, A. D.;Pineles, L.;Anderson, D.;Woeltje, K. F.;Trick, W. E.;Kaye, K. S.;Yokoe, D. S.;Nyquist, A. C.;Calfee, D. P.;Leekha, S.",2017,,10.1017/ice.2016.314,0,
1720,The relationship of obesity to hospice use and expenditures: A cohort study,"Background: Obesity complicates medical, nursing, and informal care in severe illness, but its effect on hospice use and Medicare expenditures is unknown. Objective: To describe the associations between body mass index (BMI) and hospice use and Medicare expenditures in the last 6 months of life. Design: Retrospective cohort. Setting: The HRS (Health and Retirement Study). Participants: 5677 community-dwelling Medicare fee-forservice beneficiaries who died between 1998 and 2012. Measurements: Hospice enrollment, days enrolled in hospice, in-home death, and total Medicare expenditures in the 6 months before death. Body mass index was modeled as a continuous variable with a quadratic functional form. Results: For decedents with BMI of 20 kg/m2, the predicted probability of hospice enrollment was 38.3% (95% CI, 36.5% to 40.2%), hospice duration was 42.8 days (CI, 42.3 to 43.2 days), probability of in-home death was 61.3% (CI, 59.4% to 63.2%), and total Medicare expenditures were $42 803 (CI, $41 085 to $44 521). When BMI increased to 30 kg/m2, the predicted probability of hospice enrollment decreased by 6.7 percentage points (CI, -9.3 to -4.0 percentage points), hospice duration decreased by 3.8 days (CI, -4.4 to -3.1 days), probability of in-home death decreased by 3.2 percentage points (CI, -6.0 to -0.4 percentage points), and total Medicare expenditures increased by $3471 (CI, $955 to $5988). For morbidly obese decedents (BMI =40 kg/m2), the predicted probability of hospice enrollment decreased by 15.2 percentage points (CI, -19.6 to -10.9 percentage points), hospice duration decreased by 4.3 days (CI, -5.7 to -2.9 days), and in-home death decreased by 6.3 percentage points (CI, -11.2 to -1.5 percentage points) versus decedents with BMI of 20 kg/m2. Limitation: Baseline data were self-reported, and the interval between reported BMI and time of death varied. Conclusion: Among community-dwelling decedents in the HRS, increasing obesity was associated with reduced hospice use and in-home death and higher Medicare expenditures in the last 6 months of life.",aged;article;body mass;cause of death;chronic lung disease;cognition;cohort analysis;comorbidity;congestive heart failure;daily life activity;dementia;diabetes mellitus;female;follow up;health care cost;health care utilization;hospice care;human;hypertension;incidence;major clinical study;male;medicare;metastasis;mild cognitive impairment;nursing home patient;obesity;priority journal;probability;proxy;retrospective study;time of death;underweight;very elderly;weight reduction,"Harris, J. A.;Byhoff, E.;Perumalswami, C. R.;Langa, K. M.;Wright, A. A.;Griggs, J. J.",2017,,10.7326/m16-0749,0,
1721,Relative mortality in U.S. medicare beneficiaries with parkinson disease and hip and pelvic fractures,"Background: Parkinson disease is a neurodegenerative disease that affects gait and postural stability, resulting in an increased risk of falling. The purpose of this study was to estimate mortality associated with demographic factors after hip or pelvic (hip/pelvic) fracture in people with Parkinson disease. A secondary goal was to compare the mortality associated with Parkinson disease to that associated with other common medical conditions in patients with hip/pelvic fracture. Methods: This was a retrospective observational cohort study of 1,980,401 elderly Medicare beneficiaries diagnosed with hip/pelvic fracture from 2000 to 2005 who were identified with use of the Beneficiary Annual Summary File. The race/ ethnicity distribution of the sample was white (93.2%), black (3.8%), Hispanic (1.2%), and Asian (0.6%). Individuals with Parkinson disease (131,215) were identified with use of outpatient and carrier claims. Cox proportional hazards models were used to estimate the risk of death associated with demographic and clinical variables and to compare mortality after hip/pelvic fracture between patients with Parkinson disease and those with other medical conditions associated with high mortality after hip/pelvic fracture, after adjustment for race/ethnicity, sex, age, and modified Charlson comorbidity score. Results: Among those with Parkinson disease, women had lower mortality after hip/pelvic fracture than men (adjusted hazard ratio [HR] = 0.63, 95% confidence interval [CI]) = 0.62 to 0.64), after adjustment for covariates. Compared with whites, blacks had a higher (HR = 1.12, 95% CI = 1.09 to 1.16) and Hispanics had a lower (HR = 0.87, 95% CI = 0.81 to 0.95) mortality, after adjustment for covariates. Overall, the adjusted mortality rate after hip/pelvic fracture in individuals with Parkinson disease (HR = 2.41, 95% CI = 2.37 to 2.46) was substantially elevated compared with those without the disease, a finding similar to the increased mortality associated with a diagnosis of dementia (HR = 2.73, 95% CI = 2.68 to 2.79), kidney disease (HR = 2.66, 95% CI = 2.60 to 2.72), and chronic obstructive pulmonary disease (HR = 2.48, 95% CI = 2.43 to 2.53). Conclusions: Mortality after hip/pelvic fracture in Parkinson disease varies according to demographic factors. Mortality after hip/pelvic fracture is substantially increased among those with Parkinson disease. Copyright © 2014 By The Journal of Bone and Joint Surgery, Incorporated.",aged;article;Asian;Caucasian;cerebrovascular accident;Charlson Comorbidity Index;chronic obstructive lung disease;cohort analysis;controlled study;dementia;diabetes mellitus;disease association;ethnicity;female;heart failure;hip fracture;Hispanic;human;ischemic heart disease;kidney disease;major clinical study;male;medicare;mortality;Black person;observational study;osteoporosis;Parkinson disease;pelvis fracture;priority journal;race difference;risk factor;United States,"Harris-Hayes, M.;Willis, A. W.;Klein, S. E.;Czuppon, S.;Crowner, B.;Racette, B. A.",2014,,,0,
1722,Are UK primary care teams formally identifying patients for palliative care before they die?,"Background: The palliative care approach has the potential to improve care for patients with progressive life-threatening illnesses from the time of diagnosis. Policy and clinical directives in the UK advocate early identification. Aim: To determine the extent to which practices identify patients for palliative care, including factors influencing early identification and possible effects on place of death. Design and setting: Qualitative and quantitative data were collected fromsix general practices from three Scottish NHS boards and analysed. Method: Records of patients who had died in the previous 6months were analysed and interviews with practice staff (n = 21) and with patients currently on the practice palliative care register and bereaved relatives (n = 14) were conducted. In addition, a practice meeting was observed. Results: In total, 29%of patients who died were recorded as being on the practice palliative care register before death. Two-thirds of patients with cancer were recorded on the register, but for those with non-malignant conditions only around 20%had any palliative care documented. This was a result of GPs not finding the current guidelines useful and being reluctant to discuss palliative care overtly with patients early in their illness. Palliative care services and documentation were geared towards patients with cancer. More district nurses than GPs saw the benefits of inclusion on the palliative care register. Only 25% of patients on the register died in hospital. Conclusion: Most patients with advanced progressive illnesses, especially those with non-malignant disease, are not being formally identified for a palliative care approach before they die. Those identified aremore likely to benefit from coordinated care andmay bemore likely to die at home. ©British Journal of General Practice.",article;cancer patient;cancer registry;chronic disease;community hospital;dementia;disease registry;doctor patient relation;frail elderly;general practice;health care personnel;heart failure;home care;hospice care;hospital;interpersonal communication;kidney failure;liver failure;mortality;palliative therapy;primary medical care;respiratory failure;semi structured interview;terminal care;United Kingdom,"Harrison, N.;Cavers, D.;Campbell, C.;Murray, S. A.",2012,,,0,
1723,Occupational class differences in later life hospital use by women who survived to age 80: the Renfrew and Paisley prospective cohort study,"BACKGROUND: population ageing challenges the sustainability of healthcare provision. OBJECTIVE: to investigate occupational class differences in hospital use in women aged 80+ years. METHODS: a total of 8,353 female residents, aged 45-64, took part in the Renfrew and Paisley prospective cohort study in 1972-76. Information on general and mental health hospital discharges was provided from computerised linkage with the Scottish Morbidity Records data to 31 December 2012. Numbers of admissions and bed-days after the 80th birthday were calculated for all and specific causes. Rate ratios by occupational class were calculated using negative binomial regression analysis, adjusting for age and a range of risk factors. RESULTS: four thousand and four hundred and seven (56%) women survived to age 80 and had 17,563 general admissions thereafter, with a mean stay of 19.4 days. There were no apparent relationships with occupational class for all general admissions, but lower occupational class was associated with higher rate ratios for coronary heart disease and stroke and lower rate ratios for cancer. Adjustment for risk factors could not fully explain the raised rate ratios. Bed-day use was higher in lower occupational classes, especially for stroke. There were strong associations with mental health admissions, especially dementia. Compared with the highest occupational class, admission rate ratios for dementia were higher for the lowest occupational class (adjusted rate ratio = 2.60, 95% confidence interval 1.79-3.77). CONCLUSION: in this population, there were no socio-economic gradients seen in hospital utilisation for general admissions in old age. However, occupational class was associated with mental health admissions, coronary heart disease, stroke and cancer.","Aged;Aged, 80 and over;Coronary Disease/epidemiology;Female;Hospitalization/*statistics & numerical data;Humans;Length of Stay/statistics & numerical data;Middle Aged;Neoplasms/epidemiology;Occupations/*statistics & numerical data;Prospective Studies;Risk Factors;Scotland/epidemiology;Social Class;Stroke/epidemiology;80 and over;length of stay;older people;patient admission;socio-economic factors;women","Hart, C. L.;McCartney, G.;Watt, G. C.",2015,May,10.1093/ageing/afu184,0,
1724,Minireview series on the thirtieth anniversary of research on O-GlcNAcylation of nuclear and cytoplasmic proteins: Nutrient regulation of cellular metabolism and physiology by O-GlcNAcylation,"The dynamic cycling of N-acetylglucosamine (termed O-GlcNAcylation) on serine or threonine residues of nuclear or cytoplasmic proteins serves as a nutrient sensor, both independently and also via its interplay with other post-translational modifications, to regulate signaling, transcription, and cellular physiology. Emerging evidence suggests that dysregulation of this ubiquitous post-translational modification contributes to the etiology of some the most important human chronic diseases.",cytoplasm protein;histone;n acetylglucosamine;nuclear protein;RNA polymerase II;Alzheimer disease;carcinogenesis;cell metabolism;chronic disease;diabetes mellitus;diabetic cardiomyopathy;glucose metabolism;glucotoxicity;heart protection;human;hyperglycemia;O GlcNAcylation;protein processing;short survey;signal transduction;transcription regulation,"Hart, G. W.",2014,,,0,
1725,The incidence of acute stroke emergency admissions in an Irish teaching hospital,"Background: Approximately 2,500 people die from stroke each year yet there is a lack of Irish services provision. Aims: The aims of this study were to investigate the incidence of acute stroke emergency admissions in a large teaching hospital and present an analysis of this cohort. Methods: All patients presenting acutely to the Emergency Department in 2005 meeting the WHO definition of stroke were included in our study. A chart review of the identified patients was conducted to obtain the necessary information. Results: A total of 273 patients experienced an acute stroke, representing 1.6% of all acute admissions. 81.7% (223) of patients survived to discharge from the acute hospital. At 1 year, 65.2% (178) patients were still alive post-stroke. The mean length of stay in our acute hospital was 21.1 days following stroke. Conclusion: Stroke represents a considerable burden on health resources within the hospital. © 2009 Royal Academy of Medicine in Ireland.",adult;aged;article;cerebrovascular accident;controlled study;dementia;diabetes mellitus;disease severity;emergency care;female;functional status;health care utilization;atrial fibrillation;heart failure;hospital admission;human;hypercholesterolemia;hypertension;incidence;Ireland;ischemic heart disease;kidney dysfunction;length of stay;long term care;major clinical study;male;malignant neoplastic disease;prognosis;rehabilitation care;smoking;survival rate;teaching hospital,"Hartigan, I.;Cooke, J.;Barry, P.;O'Connor, M.;O'Mahony, D.",2010,,,0,
1726,What is the “L” in LPDs? Localized as well as lateralized,"Background: Periodic discharges (PDs) are well established as either periodic lateralized epileptiform discharges (LPDs) or generalized discharges. However, PDs in the midline can currently not be adequately classified as they are not generalized and not lateralized. Aims of the study: To propose a modification of the current LPD classification. Methods: We here present a paradigmatic case series of three adult patients with midline LPDs. Results: In our patients, ictal electroencephalography (EEG) recordings revealed periodic epileptiform discharges in the midline region. All three patients were non-lesional. Conclusion: We, thus, suggest to include periodic localized non-lateralized epileptiform discharges into the term LPDs (in addition to periodic lateralized epileptiform discharges), as they can also be recorded as localized EEG phenomenon in the midline region.",adult;aged;case report;case study;cerebrospinal fluid;computer assisted tomography;cortical dysplasia;dementia;disease classification;disease duration;epileptic discharge;epileptic focus;epileptic state;female;frontal lobe;frontal lobe epilepsy;heart infarction;hospital admission;human;intensive care unit;intestine obstruction;lateralized epileptiform discharge;male;medical history;neuroimaging;note;nuclear magnetic resonance imaging;paralytic ileus;patient referral;patient transport;respiratory tract intubation;seizure;stereoelectroencephalography;tachycardia;tonic clonic seizure;tonic seizure;very elderly;young adult,"Hartl, E.;Rémi, J.;Stoyke, C.;Noachtar, S.",2017,,10.1111/ane.12730,0,
1727,Comparative randomized study of cerebral blood flow after long-term administration of pentoxifylline and co-dergocrine mesylate in patients with chronic cerebrovascular disease,"The behaviour of regional cerebral blood flow was studied in 90 patients with vascular type dementia. Patients were divided at random into three groups of 30 and treated 3-times daily over a period of 8 weeks with either 400 mg pentoxifylline ('Trental' 400) or 2 mg co-dergocrine mesylate, or remained untreated (control group). Measurements of regional cerebral blood flow were made before and after 4 and 8 weeks of the study using an atraumatic inhalative 133Xenon clearance technique and assessments made in 16 regions of interest per hemisphere (grey matter perfusion). A statistically significant increase over baseline in mean regional cerebral blood flow was found in patients on pentoxifylline medication at Weeks 4 and 8. At Week 8, the change from baseline was +16.4% in the pentoxyfylline group whereas the respective values for the other two groups were +0.4% for co-dergocrine mesylate, -2.4% for the controls. Hypoemic regions showed the most pronounced regional cerebral blood flow changes with pentoxifylline (+40%), the corresponding values for the co-dergocrine mesylate and control group being +10.8% and +0.4%, respectively.",dihydroergotoxine;dihydroergotoxine mesilate;pentoxifylline;unclassified drug;xenon 133;xenon 133 clearance;adverse drug reaction;aged;angina pectoris;article;brain blood flow;cardiotoxicity;cardiovascular system;central nervous system;cerebrovascular disease;clinical article;clinical trial;controlled study;dementia;drug comparison;drug therapy;gastrointestinal toxicity;heart;human;hypotension;intoxication;nervous system;neurotoxicity;oral drug administration;peripheral vascular system;priority journal;randomized controlled trial;therapy;vertigo;trental,"Hartmann, A.",1985,,,0,
1728,A demented male patient with strangulation marks: Was it a crime?,,acetylsalicylic acid;insulin;prednisone;aged;article;case report;crime;dementia;differential diagnosis;heart infarction;hematoma;human;insulin treatment;international normalized ratio;male;partial thromboplastin time;polyarthritis;strangulation,"Hartung, B.;Graß, H.",2009,,,0,
1729,Race and ethnicity in the era of emerging pharmacogenomics,"Race and ethnicity are terms that are commonly used to categorize subjects in medical research. Advances in genetics and the emerging discipline of pharmacogenomics have brought these terms under scrutiny, with arguments either for the continued use or for the abandonment of these terms generating strong views. As pharmacogenomics research develops, we may find that more accurate and specific descriptions of relevant variation in genes will reduce the value that these imprecise descriptors have in predicting how people will respond to drug therapies. ©2006 the American College of Clinical Pharmacology.",abacavir;apolipoprotein E4;endothelial nitric oxide synthase;HLA antibody;hydralazine plus isosorbide dinitrate;Alzheimer disease;clinical trial;cultural factor;drug approval;drug hypersensitivity;drug response;environmental factor;ethnic difference;gene cluster;gene linkage disequilibrium;genetic analysis;genetic risk;genetic variability;genotype;health care utilization;health status;heart failure;human;income;pharmacogenomics;race difference;short survey,"Harty, L.;Johnson, K.;Power, A.",2006,,,0,
1730,No association between subjective memory complaints and apolipoprotein E genotype in cognitively intact elderly,"Objective. This cross-sectional study examined the relationship between subjective memory complaints and the apolipoprotein epsilon 4 allele (E4), a genetic risk factor for Alzheimer's disease (AD), among cognitively normal subjects identified from a community memory screening. Design. The sample comprised 232 consecutive white non-Hispanic older adults who presented to a free community-based memory-screening program at a University affiliated memory disorders center. Participants were classified as cognitively normal based on scores on the age and educated adjusted Folstein Mini-Mental Status Exam (MMSAdj) and a brief Delayed Verbal Recall Test (DRT). Subjects were assessed for APOE genotype, subjective memory complaints (Memory Questionnaire, MQ), depressive symptoms (Hamilton Depression Rating Scale, HDRS), and history of four major medical conditions that have been associated with memory loss (stroke/transient ischemic attack [TIA], atherosclerotic heart disease, hypertension, and diabetes). A hierarchical regression analysis was performed to examine the association between APOE genotype and memory complaints after controlling for a host of potential confounding factors. Results. The APOE E4 allele frequency for cognitively normal subjects was 0.13. Subjective memory complaints were predicted by depressive symptoms and a history of stroke/TIA. They were not associated with APOE genotype, MMSAdj score, DRT score, age, education, gender, and reported history of atherosclerotic heart disease, hypertension, or diabetes. Conclusions. The results did not suggest an association between subjective memory complaints and the APOE E4 allele in this sample of cognitively intact subjects. This indicates that memory complaints may confer risk for future dementia through pathways independent of APOE genotype. The results also show that older adults with memory complaints are at increased risk for underlying depression. Copyright © 2004 John Wiley & Sons, Ltd.",apolipoprotein E;adult;aged;allele;Alzheimer disease;amnesia;article;cognition;coronary artery atherosclerosis;dementia;depression;diabetes mellitus;disease association;female;gene frequency;genetic risk;genotype;Hamilton Depression Rating Scale;human;hypertension;major clinical study;male;mass screening;memory disorder;Mini Mental State Examination;questionnaire;regression analysis;cerebrovascular accident;transient ischemic attack,"Harwood, D. G.;Barker, W. W.;Ownby, R. L.;Mullan, M.;Duara, R.",2004,,,0,
1731,Place and cause of death in community-dwelling disabled elderly people,"AIM: To examine the place and cause of death in community-dwelling disabled elderly people. METHODS: The baseline data of 1,875 participants and their caregivers in the Nagoya Longitudinal Study for Frail Elderly were used for the analysis. Cox proportional hazard models were used to assess the associations between the variables and the place of death during the 3-year follow-up period. RESULTS: During the observation period of three years, 454 died (hospital death: 347, home death: 107). In total, the rates of pneumonia-, cancer- and heart failure-related death were 22.7%, 14.5%, and 13.2%, respectively. Among the home deaths, 22.4% were age-related deaths and 18.7% were heart failure-related deaths. Females, older, and participants with dementia were more likely to die at home, while those with cancer or a spouse caregiver were more likely to die in the hospital. There were no differences in the levels of caregiver burden or formal service use between the cases of home and hospital death. Multivariate Cox hazard models revealed that home death was associated with an older age and the absence of diabetes mellitus and cancer at baseline. CONCLUSIONS: We demonstrated that death at home among community-dwelling disabled elderly is associated with an older age, and the absence of diabetes mellitus and cancer. Due to the lack of important factors that should be addressed, a further study is required in the future.","Aged;Aged, 80 and over;*Cause of Death;Cohort Studies;*Disabled Persons;Female;Hospitalization;Humans;*Independent Living;Male;Prospective Studies;Sex Factors","Hasegawa, J.;Enoki, H.;Izawa, S.;Hirose, T.;Kuzuya, M.",2013,,,0,
1732,"Urinary incontinence and behavioral symptoms are independent risk factors for recurrent and injurious falls, respectively, among residents in long-term care facilities","Numerous risk factors of falls, including urinary incontinence and behavioral symptoms have been identified among elderly people in long-term care settings. However, it remains uncertain whether incontinence or behavioral symptoms are associated with recurrent falls and injurious falls. The purpose of this research was to examine the association between various types of falls and urinary incontinence or behavioral symptoms among the residents of long-term care facilities using the Cox proportional hazards models. The participants were 1082 older people (327 men and 755 women) who were admitted to facilities between 1 April 2003 and 31 March 2004. Fall experience, urinary incontinence, and behavioral symptoms were followed for up to 6 months or until death or discharge. The functional status, comorbidity, and prescribed medications were determined at the baseline. Multivariate analysis revealed that urinary incontinence and behavioral symptoms were independent risk factors of falls during the follow-up period. However, urinary incontinence was a risk factor for recurrent falls but not for injurious falls. In contrast, behavioral symptoms were an independent risk factor for injurious but not for recurrent falls. The results suggested that treatment or management of urinary incontinence and behavioral symptoms should be considered to prevent falls in long-term care settings. © 2009 Elsevier Ireland Ltd. All rights reserved.",antidepressant agent;antihypertensive agent;antithrombocytic agent;anxiolytic agent;benzodiazepine derivative;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hypnotic agent;neuroleptic agent;nitrate;psychotropic agent;aged;agitation;arthritis;article;behavior;cerebrovascular accident;chronic disease;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;falling;female;follow up;fracture;functional status;human;hypertension;injurious fall;ischemic heart disease;long term care;major clinical study;male;prescription;priority journal;recurrent fall;residential home;risk factor;symptom;urine incontinence,"Hasegawa, J.;Kuzuya, M.;Iguchi, A.",2010,,,0,
1733,Small intestine perforation due to accidental press-through package ingestion in an elderly patient with Lewy body dementia and recurrent cardiopulmonary arrest,"An octogenarian with Lewy body dementia presented to our hospital in cardiac arrest and was successfully resuscitated. Although he had abdominal pain the previous day, small bowel wall oedema and ascites were the only abnormalities noted on abdominal CT. Despite treatment with catecholamines and antimicrobials, he died of recurrent cardiopulmonary arrest later the same day. An autopsy showed that the patient's death was the result of a small bowel perforation caused by accidental ingestion of a press-through package (PTP). Precautions regarding PTP use and improved packaging design are necessary to prevent PTP ingestion, especially in elderly patients with dementia.",antiinfective agent;catecholamine;donepezil;levodopa;omeprazole;abdominal pain;aged;article;autopsy;cardiopulmonary arrest;case report;dementia;diffuse Lewy body disease;echocardiography;ego development;endotracheal intubation;foreign body;heart right bundle branch block;human;human tissue;hypotension;ingestion;male;Mini Mental State Examination;parkinsonism;peritonitis;priority journal;resuscitation;sinus tachycardia;small intestine perforation;very elderly;visual hallucination,"Hashizume, T.;Tokumaru, A. M.;Harada, K.",2015,,,0,
1734,Heidenhain variant of Creutzfeldt-Jakob disease in a patient who had bovine bioprosthetic valve implantation,"Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disorder characterized by rapidly progressing dementia, general neurologic deterioration, and death. When the leading symptoms are visual disturbances, it is termed as the Heidenhain variant of CJD (HvCJD). CJD was reported following prion-contaminated pericardium transplants but never after bovine bioprosthetic cardiac valve. In this case report, we describe HvCJD in a patient who had a bovine bioprosthetic cardiac valve implant. An 82-year-old-woman was referred to neuro-ophthalmology clinic for unexplained visual loss that started 1 month previously. Medical history included aortic valve replacement with bovine bioprosthetic valve. On examination, best-corrected visual acuity was 20/120 in the right eye and 20/200 in the left eye; otherwise, the eye examination was normal. Humphrey visual fields revealed complete right homonymous hemianopsia. Magnetic resonance imaging (MRI) demonstrated nonspecific white matter changes. A week later, she was hospitalized due to memory impairment; repeated MRI and total body computed tomography scan showed no significant findings. Electroencephalography recordings and extremely elevated cerebrospinal fluid tau protein were compatible with CJD. The patient died 3 weeks later; autopsy was not performed. The patient had HvCJD. Ophthalmologists being first to see these patients should be aware of this diagnosis. Contaminated bovine bioprosthetic valve might be another source for prion disease. Further research is required to establish this issue.",adverse effects;animal;aortic valve;bioprosthesis;bovine;brain;case report;Creutzfeldt Jakob disease;electroencephalography;female;valvular heart disease;heart valve prosthesis;human;nuclear magnetic resonance imaging;pathology;pathophysiology;very elderly;visual disorder;x-ray computed tomography,"Hashoul, J.;Saliba, W.;Bloch, I.;Jabaly-Habib, H.",2016,,10.4103/0301-4738.195003,0,
1735,Pharmacological Management of Psychosis in Elderly Patients with Parkinsonism,"Parkinsonism is a characteristic feature of Parkinson's disease and dementia with Lewy bodies and is commonly seen in Alzheimer's disease. Psychosis commonly appears during the course of these illnesses. Treatment of parkinsonism with antiparkinsonian medications constitutes an additional risk factor for the appearance or worsening of psychosis. Conversely, treatment of psychosis with antipsychotic drugs in patients with parkinsonism might worsen the underlying movement disorder, especially in the elderly. In this article, we review parkinsonian conditions in the elderly and offer guidelines to assess and manage comorbid psychosis. We focus on the pharmacologic management of psychosis with atypical antipsychotic medications and briefly review the role of acetylcholinesterase inhibitors. © 2009 Elsevier Inc. All rights reserved.",antiparkinson agent;apomorphine;aripiprazole;atypical antipsychotic agent;benzatropine mesilate;carbidopa plus levodopa;cholinesterase inhibitor;clozapine;donepezil;entacapone;galantamine;haloperidol;memantine;nemanda;neuroleptic agent;olanzapine;paliperidone;pergolide;perimax;pramipexole;quetiapine;rasagiline;risperidone;rivastigmine;rotigotine;selegiline;tolcapone;trihexyphenidyl;unclassified drug;zelepar;ziprasidone;aging;Alzheimer disease;article;behavior disorder;cardiomyopathy;clinical trial;comorbidity;diffuse Lewy body disease;disease association;dizziness;dopaminergic activity;dose response;drowsiness;drug activity;drug efficacy;drug formulation;drug safety;drug tolerability;dyslipidemia;extrapyramidal symptom;gastrointestinal symptom;geriatric care;human;hyperglycemia;low drug dose;motor dysfunction;motor performance;myocarditis;orthostatic hypotension;Parkinson disease;parkinsonism;pathophysiology;practice guideline;prevalence;priority journal;psychosis;risk factor;schizophrenia;side effect;tremor;weight gain;abilify;aricept;artane;azilect;clozaril;cogentin;comtan;eldepryl;emsam;exelon;geodon;haldol;invega;mirapex;neupro;razadyne;risperdal;seroquel;sinemet;tasmar;zyprexa,"Hasnain, M.;Vieweg, W. V. R.;Baron, M. S.;Beatty-Brooks, M.;Fernandez, A.;Pandurangi, A. K.",2009,,,0,
1736,Methemoglobinemia in an elderly patient with glucose-6-phosphate dehydrogenase deficiency: A case report,"Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked genetic disorder characterized by low levels of the G6PD enzyme. It is present worldwide but with more prevalence in the Middle East and the Mediterranean areas. We report a case of severe hemolysis due to G6PD deficiency manifesting as methemoglobinemia in a 70 year old Omani male never known to have any previous hemolytic episodes or previously diagnosed of G6PD deficiency. © OMSB, 2014.",alanine aminotransferase;alkaline phosphatase;aspartate aminotransferase;bilirubin;creatinine;diuretic agent;hemoglobin;infusion fluid;lactate dehydrogenase;meropenem;methylene blue;oxygen;urea;aged;arterial gas;article;blood analysis;blood gas analysis;case report;dementia;erythrocyte transfusion;glucose 6 phosphate dehydrogenase deficiency;heart arrest;hemodialysis;hemolysis;high performance liquid chromatography;human;jaundice;lethargy;leukocyte count;lung edema;male;methemoglobinemia;neutrophilia;noninvasive ventilation;Oman;oxygen saturation;reticulocyte count;thrombocyte count;X chromosome linked disorder,"Hassan, K. S.;Al-Riyami, A. Z.;Al-Huneini, M.;Al-Farsi, K.;Al-Khabori, M.",2014,,,0,
1737,Is C-reactive protein level a marker of advanced motor and neuropsychiatric complications in Parkinson's disease?,"C-reactive protein (CRP) is a plasma protein involved in inflammation. While its levels have been associated with stroke, cognitive impairment and depression, the association with clinical characteristics of Parkinson's disease (PD) is unknown. A total of 73 consecutive patients with PD (46 males, age 68.8 ± 11.5 years) were evaluated regarding motor as well as cognitive and psychiatric features of PD. Plasma CRP levels were determined and tests for associations with disease parameters were performed. The average level of CRP was 3.9 ± 4.1 μmol/L, and 45.2% of the patients (n = 33) had a level above 3.0 μmol/L. Patients in the high CRP group tended to be older (71.4 ± 9.2 vs. 66.7 ± 12.9 years; p = 0.08) and coronary artery disease (CAD) was more common (36 vs. 10%, p < 0.05) in the high CRP group, but no differences were found between the groups regarding gender, disease duration, levodopa dose, motor scores or most of the neuropsychiatric complications such as severity of depression, psychosis, dementia, cognitive decline or frontal lobe dysfunction. Reported depression (at present or in the past) was more common in the high CRP group (54.5 vs. 25%, p = 0.01). CRP levels in patients with PD are associated with a higher prevalence of CAD, but are not associated with PD duration or severity, or with neuropsychiatric complications other than reported depression. © 2010 Springer-Verlag.",C reactive protein;levodopa;adolescent;adult;article;cognition;cognitive defect;dementia;depression;disease duration;disease severity;female;frontal lobe;human;major clinical study;male;motor dysfunction;neurologic disease;Parkinson disease;priority journal;protein blood level;psychosis;sex difference,"Hassin-Baer, S.;Cohen, O. S.;Vakil, E.;Molshazki, N.;Sela, B. A.;Nitsan, Z.;Chapman, J.;Tanne, D.",2011,,,0,
1738,"Diabetes mellitus is a risk factor for vascular dementia, but not for Alzheimer's disease: A population-based study of the oldest old","Background: The purpose of this study was to examine if Type 2 diabetes mellitus is a risk factor for dementia in very old age, specifically for Alzheimer's disease (AD) and vascular dementia (Val)). Methods: We evaluated the risk of dementia in relation to Type 2 diabetes using a population-based sample of 702 individuals aged 80 years and older (mean age 83 years). A total of 187 persons received a dementia diagnosis. Thirty-one individuals had a diabetes diagnosis prior to onset of the dementia. Results: Cox proportional hazard analyses, adjusted for age, gender, education, smoking habits, and circulatory diseases, indicated an elevated risk to develop VaD (relative risk = 2.54, 95% confidence interval 1.35-4.78) in individuals with diabetes mellitus. No association was found between diabetes and AD. Conclusion: Type 2 diabetes is selectively related to the different subtypes of dementia. There is no increased risk of AD but more than a twofold risk of VaD in persons with diabetes.",age;aged;aging;Alzheimer disease;angina pectoris;article;congestive heart failure;controlled study;covariance;education;female;gender;heart infarction;human;hypertension;hypotension;major clinical study;male;multiinfarct dementia;non insulin dependent diabetes mellitus;nonbiological model;onset age;population research;risk factor;smoking;Sweden;transient ischemic attack;twins,"Hassing, L. B.;Johansson, B.;Nilsson, S. E.;Berg, S.;Pedersen, N. L.;Gatz, M.;McClearn, G.",2002,,,0,
1739,Efficacy of a newly modified technique for distal limited open stenting in octogenarians with aortic arch aneurysm,"Objective We assessed the efficacy of distal limited open stenting procedure in octogenarians with distal aortic arch aneurysm. Methods During the last 5 years, 24 patients underwent distal limited open stenting. Mean patient age was 81.6 ± 2.5 years, ranging from 80 to 90 years. The hemicircumference of the anterior surface of the arch around the left common carotid artery was obliquely incised, and a J-Graft Open Stent (Japan Lifeline Co, Ltd, Tokyo, Japan) was inserted into the descending aorta. During open stenting, circulatory arrest was induced at a rectal temperature of 28°C without any cerebral perfusion. As soon as the proximal side of the stent graft and aortic incision were concomitantly sutured, rapid rewarming was initiated through heated blood perfusion. Results The durations of circulatory arrest, aortic crossclamping, cardiopulmonary bypass, the overall operation, postoperative mechanical ventilation, and hospital stay were 17.0 minutes, 27.8 minutes, 106.1 minutes, 167.6 minutes, 11.0 hours, and 13.9 days, respectively. The in-hospital mortality was 0%. There were no incidences of brain damage, renal failure, or respiratory failure. At the time of this study, 21 patients were doing well and visiting the outpatient clinic, and 19 scored more than 20 points on the Mini-Mental State Examination, indicating no development of dementia. The actuarial survival at 5 years was 82.4%. Conclusions This unique technique is safe and effective. It is a very attractive procedure that can contribute to maintaining a good long-term quality of life for octogenarians with distal aortic arch aneurysm.",aged;aortic aneurysm;aortic arch;article;artificial ventilation;cardiopulmonary bypass;clinical article;coronary artery bypass graft;descending aorta;disease duration;female;heart arrest;hospital mortality;hospitalization;human;incision;male;Mini Mental State Examination;priority journal;rectum temperature;survival time;vascular stent;very elderly;J-Graft Open Stent,"Hata, M.;Orime, Y.;Wakui, S.;Nakamura, T.;Hinoura, R.;Harada, A.;Akiyama, K.",2017,,10.1016/j.jtcvs.2016.09.049,0,
1740,Should emergency surgical intervention be performed for an octogenarian with type A acute aortic dissection?,"OBJECTIVE: The number of octogenarians undergoing emergency surgery is increasing and may negate the impact of the beneficial advances. The aim of this study was to review octogenarians with type A acute aortic dissection and assess the prognosis. METHODS: Fifty-eight patients with acute aortic dissection, whose average age was 83.2 years, were divided into 2 groups: Group I comprised 30 patients who underwent emergency surgery, and group II comprised 28 patients who were treated conservatively. We compared the 2 groups in terms of mortality and morbidity. RESULTS: In group I, postoperative hospital mortality was 13.3% (4 patients). In group II, 17 patients (60.7%) died in the hospital. In group I, although emergency aortic replacement was successfully completed, 5 patients became bedridden after surgery and 2 patients died of pneumonia or stroke in the early stages of institutional care. Thirteen patients in group I died of malignancies, abdominal aortic rupture, traffic accident, heart failure, or late-stage senility in later phase. There was no difference in actuarial survivals at 5 years, which were 48.5% in group I and 35.4% in group II. CONCLUSION: Emergency surgery for octogenarians with acute aortic dissection showed acceptable mortality. However, families had to take responsibility for patients who experienced unconsciousness, had dementia, or became bedridden. It is important to have consensus between the family and surgeons about emergency surgical treatment for octogenarians.","Aged, 80 and over;Aneurysm, Dissecting/*surgery;Aortic Aneurysm/*surgery;*Blood Vessel Prosthesis Implantation;Emergencies;Female;Humans;Male;Prognosis;*Quality of Life","Hata, M.;Sezai, A.;Niino, T.;Yoda, M.;Unosawa, S.;Furukawa, N.;Osaka, S.;Murakami, T.;Minami, K.",2008,May,10.1016/j.jtcvs.2007.08.078,0,
1741,"Midterm Outcomes of Rapid, Minimally Invasive Resection of Acute Type A Aortic Dissection in Octogenarians","Background: We previously reported the development of a new surgical technique, called the ""less invasive quick replacement"" technique, for treating type A acute aortic dissection. This study examines the midterm outcome and postoperative quality of life of octogenarian patients who underwent less invasive quick replacement. Methods: During the last 3 years, 27 patients underwent less invasive quick replacement. The average age of the patients at the time of onset was 81.7 years old. During open distal anastomosis with a rectal temperature of 28°C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass circuit was warmed to 40°C. As soon as the distal anastomosis was completed, rapid rewarming was initiated by 40°C blood perfusion. We assessed the midterm outcomes in terms of survival and cardiovascular event-free rates, patency of the distal false lumen, aortic regurgitation, and cognitive disorders. Results: The durations of circulatory arrest, cardiopulmonary bypass, overall operation, postoperative mechanical ventilation, and hospital stay were 18.7 minutes, 82.8 minutes, 143.4 minutes, 13.0 hours, and 12.2 days, respectively. Hospital mortality rate was 3.7% (1 patient). There were no incidences of brain damage, renal failure, or respiratory failure. At the time of this study, 25 of the patients were doing well and visiting the outpatient clinic, and 22 of them scored more than 20 points on the Mini-Mental State Examination, indicating no development of dementia. Midterm computed tomography scans detected the patent false lumen in 11.5%. No aortic regurgitation was found in the echocardiography. Actuarial survival and cardiovascular event-free rates at 3 years were 96.2% and 83.0%, respectively. Conclusions: The less invasive quick replacement technique is safe and effective. It is a very attractive option that can contribute to maintaining a long-term good quality of life for octogenarians with type A acute aortic dissection. © 2010 The Society of Thoracic Surgeons.",aged;aorta dissection;aorta reconstruction;aorta valve regurgitation;article;artificial ventilation;brain perfusion;cardiopulmonary bypass;clinical article;cognitive defect;computer assisted tomography;disease classification;electrocardiogram;female;geriatric surgery;heart arrest;hospitalization;human;long term care;male;Mini Mental State Examination;minimally invasive cardiac surgery;mortality;outpatient care;postoperative period;priority journal;quality of life;rectum temperature;surgical technique;survival,"Hata, M.;Sezai, A.;Yoshitake, I.;Wakui, S.;Minami, K.;Shiono, M.",2010,,,0,
1742,"A 91 year old man with a stroke, hypertension, and renal failure","We report a 91 year old man who had a stroke and died of renal failure. He had been treated for hypertension since 20 years before the onset of the present illness. In addition, he was operated on a gastric cancer 17 years previously. Otherwise he was doing well until May 29, 1991 (when he was 87 year old) when he had sudden onset of dysarthria and right facial weakness. He was admitted to our hospital. On admission, general physical examination was unremarkable, and neurologic examination revealed a mentally sound man with slight dysarthria, right facial weakness, orolingual dyskinesia, and disequilibrium in which he showed difficulty in tandem gait; however, no cerebellar ataxia was noted. A cranial CT scan revealed leukoaraiosis with multiple low density areas in the cerebral white matter. His BUN was 37 mg/dl and Cr 2.2 mg/dl. His neurologic symptoms cleared within the next few weeks and he was discharged with ticlopidine 100 mg q.d.. He had been doing well after the discharge except for gradual worsening of his renal function; his BUN was 65 mg/dl and Cr 3.27 mg/dl in April of 1994. On March 10, 1995, he fell down and hit his back; he became unable to walk because of pain, and he was admitted again on March 16, 1995. On admission, his blood pressure was 170/80 mmHg. There was an 1 + pitting pretibial edema; otherwise general physical examination was unremarkable. Neurologic examination revealed an alert and oriented man, however, Hasegawa's dementia scale was 23/30. Higher cerebral functions as well as cranial nerves were intact. He showed some unsteadiness of gait, however, no motor weakness or ataxia was noted. Deep tendon reflexes were diminished, but Chaddock sign was positive bilaterally. Vibration was diminished in the feet, however, pain and touch sensations were intact. Laboratory examination revealed a compression fracture of the twelfth thoracic vertebra. Blood count and chemistries were as follows: Hb 7.6 g/dl, Hct 23.3%, TP 6.0 g/dl, Alb 3.6 g/dl, BUN 87 mg/dl, Cr 4.53 mg/dl, T Chol 174 mg/dl, HDL Chol 49 mg/dl, Glu 156 mg/dl, Na 142 mEq/L, K 5.4 mEq/L, Cl 115 MEq/L. A urine specimen contained 1 + protein and 1 + glucose and the sediments contained hyaline casts. A cranial CT scan was essentially same as that taken four years ago. His hospital course was complicated with pneumonia, congestive heart failure, and progressive renal failure. He was treated with intravenous fluid, chemotherapy, and other supportive measures, however, he expired from respiratory failure on April 30, 1995. He was discussed in a neurologic CPC, and the chief discussant arrived at the conclusion that the patient had Binswanger's disease in the brain, benign nephrosclerosis from arteriosclerosis due to hypertension, congestive heart failure, and pneumonia. Opinions were divided regarding the question as to whether or not this patient had Binswanger's disease. Although his cranial CT scan revealed leukoaraiosis, his dementia and gait disturbance was only mild until his fall on March, 1995. Clinical features did not conform to those of Binswanger's disease. Postmortem examination of the right hemisphere revealed wide spread atherosclerosis and arteriolosclerosis. The kidney showed benign nephrosclerosis due to arteriolosclerosis. Sclerotic changes were also seen in the coronary arteries and the left middle cerebral artery with 70% stenosis. Myelin stain showed diffuse myelin pallor of the cerebral white matters with scattered small infarcts. Arterioles in the white matter showed arteriolosclerosis. Small infarcts were also seen in the putamen and in the thalamus. This patient appeared to have had circulatory disturbance of the white matter which is the basic abnormality causing the Binswanger's disease. However, white matter changes in this patient were not quite severe enough to make a pathologic diagnosis of Binswanger's disease.",ticlopidine;aged;arteriosclerosis;article;Binswanger encephalopathy;case report;computer assisted tomography;congestive heart failure;dysarthria;dyskinesia;edema;facial nerve paralysis;gait disorder;human;hypertension;kidney failure;male;nephrosclerosis;pneumonia;stomach cancer;cerebrovascular accident;spine fracture;white matter,"Hattori, Y.;Motoi, Y.;Mori, H.;Takase, S.;Suda, K.;Imai, H.;Mizuno, Y.",1996,,,0,
1743,History of the Cretan cohort of the Seven Countries Study,,cholesterol;saturated fatty acid;blood pressure;body mass;body weight;cancer mortality;cardiovascular mortality;cardiovascular risk;cholesterol blood level;cohort analysis;dementia;evidence based medicine;fat intake;Finland;follow up;Greece;human;ischemic heart disease;Italy;Japan;letter;life expectancy;lipid composition;Mediterranean diet;Netherlands;physical activity;smoking;United States;Yugoslavia,"Hatzis, C. M.;Sifaki-Pistolla, D.;Kafatos, A. G.",2015,,,0,
1744,The influence of cerebrovascular risk factors on incident dementia in patients with Parkinson's disease,"OBJECTIVE: To examine if risk factors for cerebrovascular disease would increase the risk for dementia in patients with Parkinson's disease (PD). METHODS: Non-demented patients were recruited from an epidemiological study of PD in the county of Rogaland, Norway. PD and dementia were diagnosed according to strict diagnostic criteria. Established cerebrovascular risk factors were recorded at baseline, and their influence on incident dementia was assessed 4 years later using logistic regression analysis. RESULTS: A total of 171 non-demented PD patients constituted the at-risk population. Seventy-two (55%) had at least one cerebrovascular risk factor. A total of 130 subjects (96% of survivors) completed the follow-up examination. Forty-three (33%) new cases of dementia were found. Twenty-five of the 72 (35%) patients with and 18 of the 58 (31%) subjects without any risk factor developed dementia (ns). A significant association with dementia was found for a diagnosis of heart failure in the univariate analyses. However, in the logistic regression analysis none of the cerebrovascular risk factors were significantly associated with incident dementia. CONCLUSIONS: In this large and representative cohort of patients with PD cerebrovascular risk factors were not associated with incident dementia, indicating that the disease-related degenerative brain changes are the main causes of dementia in PD.","Aged;Aged, 80 and over;Cardiovascular Diseases/*diagnosis/epidemiology;Cohort Studies;Comorbidity;Female;Follow-Up Studies;Heart Failure/diagnosis/epidemiology;Humans;Lewy Body Disease/*diagnosis/epidemiology;Male;Mental Status Schedule;Middle Aged;Neurologic Examination;Neuropsychological Tests;Norway;Parkinson Disease/*diagnosis/epidemiology;Risk Factors;Statistics as Topic","Haugarvoll, K.;Aarsland, D.;Wentzel-Larsen, T.;Larsen, J. P.",2005,Dec,10.1111/j.1600-0404.2005.00389.x,1,
1745,Down the Drain: The Cost of Medications Wasted in Hospice,,benzodiazepine derivative;diazepam;fentanyl;haloperidol;hydrocodone;hydrocodone bitartrate plus paracetamol;hydromorphone;lorazepam;morphine;morphine sulfate;opiate;oxycodone;psychotropic agent;analgesia;neoplasm;congestive heart failure;death;dementia;demography;dose response;drug cost;drug formulation;drug industry;health care policy;health care system;home care;hospice care;human;length of stay;letter;palliative therapy;retrospective study;ativan;dilaudid;duragesic;haldol;ms contin;oxycontin;oxydose;roxanol;valium;vicodin,"Hauser, J. M.;Chen, L.;Paice, J.",2006,,,0,
1746,Refer to hospice when goals are focused on quality of life rather than intervention,,Alzheimer disease;amyotrophic lateral sclerosis;chronic obstructive lung disease;coma;congestive heart failure;dementia;evidence based medicine;health care policy;heart disease;hospice care;Human immunodeficiency virus infection;kidney disease;law;life expectancy;liver disease;liver failure;lung disease;medical decision making;medicare;note;prognosis;reimbursement;cerebrovascular accident;terminal disease;United States,"Havas, N.",2006,,,0,
1747,Independent association of cognitive dysfunction with cardiac hypertrophy irrespective of 24-h or sleep blood pressure in older hypertensives,"BACKGROUND: Our aim was to assess whether cardiac hypertrophy is associated with cognitive function independently of office, 24-h, or sleep blood pressure (BP) levels in older hypertensive patients treated with antihypertensive medications. METHODS: In this cross-sectional study, we recruited 443 hypertensive patients aged over 60 years (mean age: 73.0 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. They underwent measurements of 24-h BP monitoring, echocardiographic left ventricular mass index (LVMI), and cognitive function (mini-mental state examination, MMSE). RESULTS: MMSE score was inversely associated with office, 24-h, awake, and sleep systolic BP (SBP) (each, P < 0.05). There was a close association between MMSE score and LVMI (rho = -0.32; P < 0.001). Using multiple logistic regression analysis including numerous covariates (i.e., age, sex, obesity, current smoking, educational level, duration of antihypertensive medications, renal dysfunction, statin use, and previous history of cardiovascular disease), the odds ratio (OR) for the presence of cognitive dysfunction, defined as the lowest quartile of MMSE score (median MMSE score: 23 points; n = 115), was estimated; the presence of cardiac hypertrophy (LVMI >/=125 kg/m(2) in men and >/=110 kg/m(2) in women) as well as uncontrolled 24-h BP (mean 24-h SBP/diastolic BP (DBP) >/=130/80 mm Hg) or sleep BP (mean sleep SBP/DBP >/=120/70 mm Hg), but not uncontrolled office BP (mean office SBP/DBP >/=140/90 mm Hg), were independently associated with cognitive dysfunction (all P < 0.05). CONCLUSIONS: Among older hypertensive patients with antihypertensive medications, those who had echocardiographically determined cardiac hypertrophy may be at high risk for cognitive dysfunction, irrespective of their office BP and 24-h BP levels.","Aged;Aging/*physiology;Antihypertensive Agents/therapeutic use;Blood Pressure/*physiology;Blood Pressure Monitoring, Ambulatory;Cardiomegaly/*complications/ultrasonography;Circadian Rhythm/*physiology;Cognition Disorders/diagnosis/*epidemiology;Cross-Sectional Studies;Echocardiography;Female;Heart Ventricles/ultrasonography;Humans;Hypertension/complications/drug therapy/*physiopathology;Intelligence Tests;Logistic Models;Male;Office Visits;Risk Factors;Sleep/*physiology","Hayakawa, M.;Yano, Y.;Kuroki, K.;Inoue, R.;Nakanishi, C.;Sagara, S.;Koga, M.;Kubo, H.;Imakiire, S.;Aoyagi, Z.;Kitani, M.;Kanemaru, K.;Hidehito, S.;Shimada, K.;Kario, K.",2012,Jun,10.1038/ajh.2012.27,0,
1748,Right atrial obstruction due to cardiac extension of hepatocellular carcinoma,"Hepatocellular carcinoma is fatal and has a marked propensity for vascular invasion. However, tumor thrombi rarely occur in the right atrium. A 72-year-old man was admitted with dyspnea and disturbed consciousness. Abdominal computed tomography and echocardiography showed a huge tumor thrombus in the inferior vena cava and the right atrium. The tumor thrombus was surgically removed to treat the hemodynamic compromise. The patient underwent transcatheter arterial chemoembolization postoperatively and survived for 6 months. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.",alpha fetoprotein;miriplatin;abdominal distension;abdominal radiography;aged;article;cancer chemotherapy;cardiopulmonary bypass;case report;cause of death;chemoembolization;cold sweat;computer assisted tomography;consciousness disorder;cyanosis;diffuse Lewy body disease;dyspnea;echocardiography;heart arrest;heart right atrium;human;inferior cava vein;leg edema;liver cell carcinoma;liver tumor;male;myocardial disease;physical examination;right atrial obstruction;speech disorder;sudden death;superior cava vein;tachypnea;treatment duration;tricuspid valve;tumor thrombus,"Hayashida, K.;Okumura, S.;Kawase, T.",2014,,,0,
1749,Differences in end-of-life preferences between congestive heart failure and dementia in a medical house calls program,"OBJECTIVES: To compare end-of-life preferences in elderly individuals with dementia and congestive heart failure (CHF). DESIGN: Retrospective case-control study. SETTING: Geriatrician-led interdisciplinary house-call program using an electronic medical record. PARTICIPANTS: Homebound individuals who died while under the care of the house-call program from October 1996 to April 2001. MEASUREMENTS: Medical records review for demographics, functional status, advance medical planning, hospice use, and place of death. RESULTS: Of 172 patients who died in the program, 29 had CHF, 79 had dementia, 34 had both, and 30 had neither. Patients with CHF were younger (82.6 vs 87.0, P=.011) and less functionally dependent (activities of daily living score 9.1 vs 11.5, P=.001). Time from enrollment to death was not significantly different (mean+/-standard deviation=444+/-375 days for CHF vs 325+/-330 days for dementia, P=.113). A do-not-resuscitate (DNR) directive was given in 62% of patients with CHF and 91% with dementia (P<.001). Advance medical planning discussions were not significantly different (2.10 in CHF vs 1.65 in dementia, P=.100). More patients with CHF participated in their advance medical planning than those with dementia (86% vs 17%, P<.001). Hospice was used in 24% of CHF and 61% of dementia cases (P<.001). Finally, 45% of patients with CHF and 18% of patients with dementia died in the acute hospital (P=.006). Multivariate analysis showed that the fact that more patients with CHF were involved in their medical planning was not significant in predicting end-of-life preferences. Alternatively, Caucasian ethnicity was an independent predictor of having a documented DNR and death outside of the acute hospital. CONCLUSION: In the months before death, patients with CHF were more likely to have care plans directed at disease modification and treatment, whereas dementia patients were more likely to have care plans that focused on symptom relief and anticipation of dying. Several factors may contribute to this difference.","Activities of Daily Living;*Advance Directives;Age Factors;Aged;Aged, 80 and over;Case-Control Studies;Chronic Disease;*Dementia/diagnosis/mortality;Female;*Heart Failure/mortality;*Hospices;House Calls;Humans;Male;Medical Records;*Palliative Care;Resuscitation Orders;Retrospective Studies;Sex Factors;Baylor University Medical Center;Death and Euthanasia;Empirical Approach","Haydar, Z. R.;Lowe, A. J.;Kahveci, K. L.;Weatherford, W.;Finucane, T.",2004,May,10.1111/j.1532-5415.2004.52210.x,0,
1750,Vascular risk factors for incident Alzheimer disease and vascular dementia: the Cache County study,"Vascular risk factors for Alzheimer disease (AD) and vascular dementia (VaD) have been evaluated; however, few studies have compared risks by dementia subtypes and sex. We evaluated relationships between cardiovascular risk factors (hypertension, high cholesterol, diabetes mellitus, and obesity), events (stroke, coronary artery bypass graft surgery, and myocardial infarction), and subsequent risk of AD and VaD by sex in a community-based cohort of 3264 Cache County residents aged 65 or older. Cardiovascular history was ascertained by self-report or proxy-report in detailed interviews. AD and VaD were diagnosed using standard criteria. Estimates from discrete-time survival models showed no association between self-reported history of hypertension and high cholesterol and AD after adjustments. Hypertension increased the risk of VaD [adjusted hazard ratio (aHR) 2.42, 95% confidence interval (CI) 0.95-7.44]. Obesity increased the risk of AD in females (aHR 2.23, 95% CI 1.09-4.30) but not males. Diabetes increased the risk of VaD in females after adjustments (aHR 3.33, 95% CI 1.03-9.78) but not males. The risk of VaD after stroke was increased in females (aHR 16.90, 95% CI 5.58-49.03) and males (aHR 10.95, 95% CI 2.48-44.78). The results indicate that vascular factors increase risks for AD and VaD differentially by sex. Future studies should focus on specific causal pathways for each of these factors with regard to sex to determine if sex differences in the prevalence of vascular factors have an influence on sex differences in dementia risk.","Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology/etiology;Cardiovascular Diseases/complications/*epidemiology;Causality;Cerebrovascular Disorders/complications/*epidemiology;Dementia, Vascular/*epidemiology/etiology;Female;Humans;Male;Proportional Hazards Models;Risk;Risk Factors;Sex Factors;Statistics as Topic","Hayden, K. M.;Zandi, P. P.;Lyketsos, C. G.;Khachaturian, A. S.;Bastian, L. A.;Charoonruk, G.;Tschanz, J. T.;Norton, M. C.;Pieper, C. F.;Munger, R. G.;Breitner, J. C.;Welsh-Bohmer, K. A.",2006,Apr-Jun,10.1097/01.wad.0000213814.43047.86,1,
1751,Cardiorenal metabolic syndrome and diabetic cognopathy,"The prevalence of the cardiorenal metabolic syndrome (CRS) is increasing in parallel with obesity, type 2 diabetes mellitus, Alzheimer's disease, and other forms of dementia. Along with metabolic, inflammatory, and immunological abnormalities, there is maladaptive structural remodeling of the heart, kidney, and brain. The term 'diabetic cognopathy' (DC) may be used when discussing functional and structural changes in the brain of the diabetic patient. DC likely represents an advanced form of these changes in the brain that evolve with increasing duration of the CRS and subsequent clinical diabetes. We posit that DC develops due to a convergence of aging, genetic and lifestyle abnormalities (overnutrition and lack of exercise), which result in multiple injurious metabolic and immunologic toxicities such as dysfunctional immune responses, oxidative stress, inflammation, insulin resistance, and dysglycemia (systemically and in the brain). These converging abnormalities may lead to endothelial blood-brain barrier tight junction/adherens junction (TJ/AJ) complex remodeling and microglia activation, which may result in neurodegeneration, impaired cognition, and dementia. Herein, we describe the brain ultrastructural changes evolving from a normal state to maladaptive remodeling in rodent models of CRS including microglia activation/polarization and attenuation and/or loss of the TJ/AJ complexes, pericytes and astrocytes of the neurovascular unit. Further, we discuss the potential relationship between these structural changes and the development of DC, potential therapeutic strategies, and future directions.",aging;article;astrocyte;blood brain barrier;cardiorenal syndrome;cell junction;cognitive defect;dementia;diabetic cognopathy;diabetic patient;dysglycemia;human;hyperinsulinemia;immune response;inflammation;insulin resistance;lifestyle;metabolic syndrome X;microglia;nerve degeneration;non insulin dependent diabetes mellitus;overnutrition;oxidative stress;pericyte;priority journal;tight junction,"Hayden, M. R.;Banks, W. A.;Shah, G. N.;Gu, Z.;Sowers, J. R.",2013,,,0,
1752,Differences in health at age 100 according to sex: Population-based cohort study of centenarians using electronic health records,"Objectives To use primary care electronic health records (EHRs) to evaluate the health of men and women at age 100. Design Population-based cohort study. Setting Primary care database in the United Kingdom, 1990-2013. Participants Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084, n = 8,982 women, n = 2,102 men). Measurements Main categories of morbidity and an index of multiple morbidities, geriatric syndromes and an index of multiple impairments, cardiovascular risk factors. Results The number of new female centenarians per year increased from 16 per 100,000 in 1990-94 to 25 per 100,000 in 2010-13 (P <.001) and of male centenarians from four per 100,000 to six per 100,000 (P =.06). The most prevalent morbidities at the age of 100 were musculoskeletal diseases, disorders of the senses, and digestive diseases. Women had greater multiple morbidity than men (odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.42-1.89, P <.001). Geriatric syndromes, including falls, fractures, hearing and vision impairment, and dementia, were frequent; 30% of women and 49% of men had no recorded geriatric syndromes. Women had greater likelihood of having multiple geriatric syndromes (OR = 2.14, 95% CI = 1.90-2.41, P <.001). Conclusion Fewer men than women reach the age of 100, but male centenarians have lower morbidity and fewer geriatric syndromes than women. Research using EHRs offers opportunities to understand the epidemiology of aging and improve care of the oldest old.",aged;article;cardiovascular risk;cataract;cerebrovascular accident;chronic obstructive lung disease;cognitive defect;cohort analysis;confusion;connective tissue disease;decubitus;delirium;dementia;depression;diabetes mellitus;diseases;ear disease;electronic medical record;falling;female;fracture;gait disorder;gastrointestinal disease;geriatric disorder;health status;hearing disorder;hearing impairment;human;hypertension;incontinence;ischemic heart disease;macular degeneration;major clinical study;male;memory disorder;morbidity;musculoskeletal disease;neoplasm;neurologic disease;oligophrenia;primary medical care;sensory dysfunction;sex difference;spine disease;United Kingdom;very elderly;visual impairment;weakness,"Hazra, N. C.;Dregan, A.;Jackson, S.;Gulliford, M. C.",2015,,,0,
1753,"Evolution of the ""fourth stage"" of epidemiologic transition in people aged 80 years and over: population-based cohort study using electronic health records","BACKGROUND: In the ""fourth stage"" of epidemiological transition, the distribution of non-communicable diseases is expected to shift to more advanced ages, but age-specific changes beyond 80 years of age have not been reported. METHODS: This study aimed to evaluate demographic and health transitions in a population aged 80 years and over in the United Kingdom from 1990 to 2014, using primary care electronic health records. Epidemiological analysis of chronic morbidities and age-related impairments included a cohort of 299,495 participants, with stratified sampling by five-year age group up to 100 years and over. Cause-specific proportional hazards models were used to estimate hazard ratios for incidence rates over time. RESULTS: Between 1990 and 2014, nonagenarians and centenarians increased as a proportion of the over-80 population, as did the male-to-female ratio among individuals aged 80 to 95 years. A lower risk of coronary heart disease (HR 0.54, 95% confidence interval [CI]: 0.50-0.58), stroke (0.83, 0.76-0.90) and chronic obstructive pulmonary disease (0.59, 0.54-0.64) was observed among 80-84 year-olds in 2010-2014 compared to 1995-1999. By contrast, the risk of type II diabetes (2.18, 1.96-2.42), cancer (1.52, 1.43-1.61), dementia (2.94, 2.70-3.21), cognitive impairment (5.57, 5.01-6.20), and musculoskeletal pain (1.26, 1.21-1.32) was greater in 2010-2014 compared to 1995-1999. CONCLUSIONS: Redistribution of the over-80 population to older ages, and declining age-specific incidence of cardiovascular and respiratory diseases in over-80s, are consistent with the ""fourth stage"" of epidemiologic transition, but increases in diabetes, cancer, and age-related impairment show new emerging epidemiological patterns in the senior elderly.",Chronic disease;Epidemiological transition;Epidemiology;Incidence;Morbidity;Primary care;Senior elderly;Uk;Very old,"Hazra, N. C.;Gulliford, M.",2017,May 12,,0,
1754,Biomedical engineering in China: Some interesting research ventures,,liquid nitrogen;Alzheimer disease;bioluminescence;biomedical engineering;brain computer interface;breast cancer;China;computer assisted impedance tomography;cooling;electric conductivity;fluorescence;health care system;heart muscle ischemia;heart rate variability;heating;medical device;molecular imaging;near infrared spectroscopy;nervous system function;nuclear magnetic resonance imaging;public health;short survey;tomography;visual prosthesis,"He, B.",2008,,,0,
1755,Vascular comorbidities in younger people with dementia: A cross-sectional population-based study of 616 245 middle-aged people in Scotland,"Introduction: There is growing evidence of an aetiological relationship between vascular risk factors and the development of dementia in later life. Dementia in the under-65s has historically been considered to be more driven by genetic factors, but previous epidemiological studies in the young have been relatively small. This study aims to determine the prevalence of vascular comorbidity in people aged <65 with dementia in comparison to the general population. Methods: Analysis of routine clinical data from 314 (30%) general medical practices in Scotland. Results: From an overall population of 616 245 individuals, 1061 cases of 'all-cause' dementia were identified (prevalence 172/100 000 population, 95% CI 161 to 182). The prevalence of dementia was higher in people with vascular morbidities, and prevalence progressively increased from 129/100 000 in people with no vascular comorbidity to 999/100 000 in people with four or more (p=0.01). The strength of association was greatest with a previous transient ischaemic attack (TIA) or stroke and chronic kidney disease (adjusted OR=3.1 and 2.9, respectively). Statistically significant, but smaller associations were seen with the presence of hypertension, diabetes, ischaemic heart disease and peripheral vascular disease (adjusted OR=1.4, 2.0, 1.9 and 2.2, respectively). Discussions: Vascular comorbid diseases were more commonly recorded in people aged 40-64 with dementia than those without. This finding indicates that vascular disease may be more important in the aetiology of young-onset dementia than previously believed, and is of concern given the continuing rise in obesity and diabetes internationally.",adult;article;cerebrovascular accident;chronic kidney disease;comorbidity;controlled study;cross-sectional study;dementia;diabetes mellitus;disease association;female;general practice;human;hypertension;ischemic heart disease;major clinical study;male;middle aged;peripheral vascular disease;population research;prevalence;priority journal;transient ischemic attack;United Kingdom;vascular disease,"Heath, C. A.;Mercer, S. W.;Guthrie, B.",2015,,,0,
1756,Time until incident dementia among Medicare beneficiaries using centrally acting or non-centrally acting ACE inhibitors,"Background: Centrally active (CA) angiotensin-converting enzyme inhibitors (ACEIs) are able to cross the blood-brain barrier. Small observational studies and mouse models suggest that use of CA versus non-CA ACEIs is associated with a reduced incidence of Alzheimer's disease and related dementias (ADRD). Objective: The aim of this research was to assess the effect of CA versus non-CA ACEI use on incident ADRD. Design: This is a retrospective cohort study with a non-equivalent control group. Setting and patients: This study used a national random sample of Medicare beneficiaries enrolled in Part D with an ACEI prescription. A prevalent ACEI user cohort included beneficiaries (n=107179) with an ACEI prescription prior to 30 April 2007; beneficiaries without an ACEI prescription before this date were defined as incident ACEI users (n=9840). Measurements: The main outcome was time until first diagnosis of ADRD in Medicare claims. Results: The unadjusted, propensity-matched and instrumental variable analyses of both the prevalent and incident ACEI user cohorts consistently showed similar time until incident ADRD in those taking CA ACEIs compared with those who took non-CA ACEIs. Limitations: The limitations of this study include the use of observational data, relatively short follow-up time and claims-based measure of cognitive decline. Conclusions: In this analysis of Medicare beneficiaries who were prevalent or incident users of ACEIs in 2007-2009, the use of CA ACEIs was unrelated to cognitive decline within 3years of index prescription. Continued follow-up of these patients and more sensitive measures of cognitive decline are necessary to determine whether a cognitive benefit of CA ACEIs is realized in the long term. © 2013 John Wiley & Sons, Ltd.",dipeptidyl carboxypeptidase inhibitor;aged;Alzheimer disease;Alzheimer disease and related dementia;article;cohort analysis;congestive heart failure;controlled study;female;follow up;heart infarction;human;incidence;major clinical study;male;medical history;medicare;prescription;priority journal;retrospective study;senile dementia;time,"Hebert, P. L.;McBean, A. M.;O'Connor, H.;Frank, B.;Good, C.;Maciejewski, M. L.",2013,,,0,
1757,Clinical Complexity and Use of Antipsychotics and Restraints in Long-Term Care Residents with Parkinson's Disease,"BACKGROUND: Patients with Parkinson's disease (PD) and/or Parkinsonism are affected by a complex burden of comorbidity. Many ultimately require institutional care, where they may be subject to the application of physical restraints or the prescription of antipsychotic medications, making them more vulnerable to adverse outcomes. OBJECTIVES: The objectives of this paper are to: 1) describe the clinical complexity of older institutionalized persons with PD; and 2) examine patterns and predictors of restraint use and prescription of antipsychotics in this population. METHODS: Population-based cross-sectional cohort study. Residents with PD and/or Parkinsonism living in long-term care (LTC) facilities in 6 Canadian provinces and 1 Northern Territory and Complex Continuing Care (CCC) facilities in Manitoba and Ontario, Canada. The RAI MDS 2.0 instrument was used to assess all LTC residents and CCC residents. Clinical characteristics and the prevalence of major comorbidities were examined. Multivariate modeling was used to identify the characteristics of PD residents most associated with the prescription of antipsychotics and the use of restraints in LTC and CCC facilities. RESULTS: Residents with PD in LTC and CCC exhibit a high prevalence of dementia, major psychiatric disorders, stroke, heart failure, chronic obstructive pulmonary disease and diabetes mellitus. More than 90% of LTC and CCC residents with PD had cognitive impairment; with more than half having moderate to severe impairment. Residents with PD were more likely to receive antipsychotics than those without PD. Antipsychotic use was associated with psychosis and aggressive behaviours, but also with unsteady gait and higher comorbidity and medication count. Similarly, although more common in CCC than LTC facilities, both psychosis and aggressive behaviours were associated with restraint use, as was greater cognitive and functional impairment, and urinary incontinence. Younger age, male gender, and lower physician access were all associated with greater antipsychotic and restraint use. CONCLUSIONS: LTC and CCC residents with PD are very complex medically. Use of antipsychotics and restraints is common, and their use is often associated with factors other than psychosis or aggression.",Parkinson's disease;Resident Assessment Instrument;antipsychotics;minimum data set;nursing home;restraints,"Heckman, G. A.;Crizzle, A. M.;Chen, J.;Pringsheim, T.;Jette, N.;Kergoat, M. J.;Eckel, L.;Hirdes, J. P.",2016,Sep 29,10.3233/jpd-160931,0,1758
1758,Clinical Complexity and Use of Antipsychotics and Restraints in Long-Term Care Residents with Parkinson's Disease,"Background: Patients with Parkinson's disease (PD) and/or Parkinsonism are affected by a complex burden of comorbidity. Many ultimately require institutional care, where they may be subject to the application of physical restraints or the prescription of antipsychotic medications, making them more vulnerable to adverse outcomes. Objectives: The objectives of this paper are to: 1) describe the clinical complexity of older institutionalized persons with PD; and 2) examine patterns and predictors of restraint use and prescription of antipsychotics in this population. Methods: Population-based cross-sectional cohort study. Residents with PD and/or Parkinsonism living in long-term care (LTC) facilities in 6 Canadian provinces and 1 Northern Territory and Complex Continuing Care (CCC) facilities in Manitoba and Ontario, Canada. The RAI MDS 2.0 instrument was used to assess all LTC residents and CCC residents. Clinical characteristics and the prevalence of major comorbidities were examined. Multivariate modeling was used to identify the characteristics of PD residents most associated with the prescription of antipsychotics and the use of restraints in LTC and CCC facilities. Results: Residents with PD in LTC and CCC exhibit a high prevalence of dementia, major psychiatric disorders, stroke, heart failure, chronic obstructive pulmonary disease and diabetes mellitus. More than 90 of LTC and CCC residents with PD had cognitive impairment; with more than half having moderate to severe impairment. Residents with PD were more likely to receive antipsychotics than those without PD. Antipsychotic use was associated with psychosis and aggressive behaviours, but also with unsteady gait and higher comorbidity and medication count. Similarly, although more common in CCC than LTC facilities, both psychosis and aggressive behaviours were associated with restraint use, as was greater cognitive and functional impairment, and urinary incontinence. Younger age, male gender, and lower physician access were all associated with greater antipsychotic and restraint use. Conclusions: LTC and CCC residents with PD are very complex medically. Use of antipsychotics and restraints is common, and their use is often associated with factors other than psychosis or aggression.",neuroleptic agent;adolescent;adult;aged;aggression;article;Canada;cerebrovascular accident;child;chronic obstructive lung disease;cohort analysis;comorbidity;controlled study;cross-sectional study;dementia;diabetes mellitus;disease association;doctor patient relation;female;health care facility;heart failure;human;infant;major clinical study;male;mental disease;middle aged;newborn;Parkinson disease;patient care;population research;practice guideline;preschool child;prescription;prevalence;protective equipment;psychosis;restraint;school child;unsteady gait;very elderly;young adult,"Heckman, G. A.;Crizzle, A. M.;Chen, J.;Pringsheim, T.;Jette, N.;Kergoat, M. J.;Eckel, L.;Hirdes, J. P.",2017,,10.3233/jpd-160931,0,
1759,In reply To Drs. Parashar and Varma 2,,dipeptidyl carboxypeptidase inhibitor;lisinopril;clinical feature;comorbidity;cross-sectional study;daily life activity;dementia;depression;heart failure;hospitalization;human;letter;long term care,"Heckman, G. A.;Misiaszek, B.;Harkness, K.;Turpie, I. D.;Patterson, C. J.;McKelvie, R. S.",2007,,,0,
1760,Radical prostatectomy in Denmark: Survival analysis and temporal trends in clinicopathological parameters with up to 20 years of follow-up,"Objectives To describe mortality, cause of death, and temporal trends in clinicopathological parameters with up to 20 years of follow-up in a nationwide cohort of prostate cancer (PCa) patients who underwent radical prostatectomy (RP). Materials and methods A total of 6857 patients with PCa treated with RP at six different hospitals in Denmark between 1995 and 2011. Data were extracted from the nationwide DaPCa database. Histopathology reports from the RP specimens were manually reviewed. Date and cause of death were obtained from national registries and cross-checked in patient files. The cumulative incidence of PCa specific mortality (PCSM) was analysed with the Aalen-Johansen method for competing risks with non-PCa death as a competing event. Risk of PCSM was analysed in a multivariate Cox regression model using age, preoperative PSA level, surgical margin status, RP Gleason score (GS), pathological T-category, and N-category as explanatory variables. Results The median follow-up was 6.4 years. Significant temporal changes in clinicopathological parameters were observed. During the study period, median age at surgery increased from 61.4 to 64.8 years and median preoperative PSA declined from 12.0 to 8.0 ng/ml. The proportion of men with pT2 PCa increased from 65% to 75% whereas the proportion of pT3 cancers decreased from 28% to 25%. The percentage of men with positive surgical margins decreased from 37% to 20%. During follow-up, 644 patients died, whereof 189 (29.3%) died from PCa. The cumulative incidence of PCSM and other-cause mortality after 15 years was 10.3% (95% CI 8.0–12.7) and 18.2% (95% CI 15.4–20.9), respectively. In a multivariate analysis, RP GS (P ≤ 0.001) and pT-category (P ≤ 0.001) were significantly associated with the risk of PCSM. Compared with GS ≤6, both GS +4 (HR 1.47), GS 4 + 3 (HR 2.32), GS 8 (HR 4.8) and GS 9 or 10 (HR 5.26) significantly increased the risk of PCa death. T3a PCa and T3b/T4 was also a significant predictor of PCSM with an increased risk of PCa death compared with pT2 of 2.24 and 4.5, respectively. Conclusions In a complete national cohort of men treated with RP during a 17-year period, we described the incidence of mortality after RP and predictors of PCSM. We demonstrated that RP GS and pT-category are the most significant predictors of PCa mortality. We found that an increasing proportion of men undergo RP for low-risk PCa suggesting that early detection of PCa is indeed undergoing in Denmark despite national recommendations. The Danish national results seem to concur with findings from international single- and multi-institutional reports.",fibrinolytic agent;prostate specific antigen;acute heart infarction;acute kidney failure;acute lymphoblastic leukemia;acute myeloid leukemia;acute pancreatitis;acute respiratory failure;adult;aged;Alzheimer disease;amyotrophic lateral sclerosis;aortic aneurysm;aortic dissection;article;aspiration pneumonia;atrial fibrillation;bile duct carcinoma;bladder cancer;bleeding;brain cancer;brain infarction;cancer mortality;cancer of unknown primary site;cancer staging;cancer surgery;cancer survival;carbon monoxide intoxication;cardiomyopathy;cause of death;cerebrovascular accident;choroid cancer;chronic kidney failure;chronic lymphatic leukemia;chronic obstructive lung disease;colorectal cancer;combustion;Creutzfeldt Jakob disease;Denmark;drowning;duodenum cancer;esophagus cancer;fibrinolytic therapy;follow up;Gleason score;hanging;head and neck cancer;heart failure;hepatitis C;hepatobiliary system cancer;histopathology;human;human tissue;ileus;ischemic heart disease;kidney carcinoma;leptospirosis;liver cell carcinoma;lung cancer;lung disease;lung embolism;lymph node metastasis;lymphoma;major clinical study;male;melanoma;multiple myeloma;multiple sclerosis;myelodysplastic syndrome;neuroendocrine tumor;pancreas cancer;Parkinson disease;plasma cell leukemia;pleura mesothelioma;pneumonia;practice guideline;preoperative evaluation;priority journal;prostate cancer;prostatectomy;retroperitoneal sarcoma;sepsis;stomach cancer;subarachnoid hemorrhage;subdural hematoma;sudden cardiac death;survival analysis;thyroid cancer;toxic epidermal necrolysis;transitional cell carcinoma,"Heering, M.;Berg, K. D.;Brasso, K.;Iversen, P.;Røder, M. A.",2017,,10.1016/j.suronc.2016.12.002,0,
1761,The potential antigoitrogenic effect of HMG-CoA reductase inhibitors (statins) in man,,hydroxymethylglutaryl coenzyme A reductase inhibitor;levothyroxine;mevinolin;radioactive iodine;Alzheimer disease;anticoagulation;antiinflammatory activity;fine needle aspiration biopsy;atherosclerosis;body composition;breast cancer;smoking;colorectal cancer;consensus;DNA synthesis;endothelium cell;environmental factor;goiter;heart infarction;human;iodine deficiency;laser thermotherapy;melanoma;nodular goiter;note;osteoporosis;physician;priority journal;prostate cancer;quality of life;questionnaire;risk assessment;risk factor;skin cancer;smoking habit;smooth muscle fiber;cerebrovascular accident;thyroidectomy,"Hegedüs, L.",2008,,,0,
1762,Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration: Year 1 results of the FOCUS study,"Objective: : To investigate the safety and efficacy of intravitreal ranibizumab treatment combined with verteporfin photodynamic therapy (PDT) in patients with predominantly classic choroidal neovascularization secondary to age-related macular degeneration. Methods: In this 2-year, phase I/II, multicenter, randomized, single-masked, controlled study, patients received monthly ranibizumab (0.5 mg) (n = 106) or sham (n = 56) injections. The PDT was performed 7 days before initial ranibizumab or sham treatment and then quarterly as needed. Main Outcomes Measures: Proportion of patients losing fewer than 15 letters from baseline visual acuity at 12 months (primary efficacy outcome) and the incidence and severity of adverse events. Results: At 12 months, 90.5% of the ranibizumab treated patients and 67.9% of the control patients had lost fewer than 15 letters (P<.001). The most frequent ranibizumab-associated serious ocular adverse events were intraocular inflammation (11.4%) and endophthalmitis (1.9%; 4.8% if including presumed cases). On average, patients with serious inflammation had better visual acuity outcomes at 12 months than did controls. Key serious nonocular adverse events included myocardial infarctions in the PDT-alone group (3.6%) and cerebrovascular accidents in the ranibizumab-treated group (3.8%). Conclusion/Application to Clinical Practice: Ranibizumab + PDT was more efficacious than PDT alone for treating neovascular age-related macular degeneration. Although ranibizumab treatment increased the risk of serious intraocular inflammation, affected patients, on average, still experienced visual acuity benefit. ©2006 American Medical Association. All rights reserved.",benzoporphyrin derivative;ranibizumab;abdominal pain;acute kidney failure;adult;anxiety;article;bleeding;blepharitis;blurred vision;cerebrovascular accident;chickenpox;cholelithiasis;chronic kidney failure;clinical trial;compression fracture;conjunctival hemorrhage;controlled clinical trial;controlled study;coronary artery obstruction;dehydration;dementia;depression;disease severity;drug dose regimen;drug efficacy;drug safety;drug tolerability;endophthalmitis;eye inflammation;eye irritation;eye pain;female;foreign body reaction;gastroenteritis;atrial fibrillation;heart infarction;hip fracture;human;hypertension;incidence;intestine obstruction;intraocular pressure abnormality;iridocyclitis;iritis;limb pain;lung tumor;male;multicenter study;ocular fibrosis;osteoarthritis;phase 2 clinical trial;photodynamic therapy;pneumonia;postoperative infection;priority journal;proteinuria;randomized controlled trial;retina detachment;retina hemorrhage;age related macular degeneration;macular degeneration;retina tear;rotator cuff rupture;side effect;sinusitis;subretinal neovascularization;thrombosis;thyroid cancer;transient ischemic attack;unstable angina pectoris;urinary tract infection;uveitis;viral respiratory tract infection;visual acuity;visual disorder;vitreous body detachment;vitreous disease;vitreous floaters;lucentis;visudyne,"Heier, J. S.;Boyer, D. S.;Ciulla, T. A.;Ferrone, P. J.;Jumper, J. M.;Gentile, R. C.;Kotlovker, D.;Chung, C. Y.;Kim, R. Y.",2006,,,0,
1763,Morbidity differences according to nursing stage and nursing setting in long-term care patients: Results of a claims data based study,,age distribution;aged;chronic disease;community care;comorbidity;dementia;elderly care;female;Germany;heart failure;home for the aged;human;insurance;long term care;male;needs assessment;nursing;nursing care;nursing home;prevalence;public health;risk assessment;statistics and numerical data;urine incontinence;utilization;very elderly,"Heinen, I.;van den Bussche, H.;Koller, D.;Wiese, B.;Hansen, H.;Schäfer, I.;Scherer, M.;Schön, G.;Kaduszkiewicz, H.",2015,,,0,
1764,30-Day Mortality after Cardiovascular Events in Persons with or without Alzheimer's Disease,"BACKGROUND AND OBJECTIVES: Persons with Alzheimer's disease (AD) have been suggested to receive suboptimal treatment. We studied the 30-day mortality after ischemic stroke, hemorrhagic stroke, or myocardial infarction in individuals with or without AD. METHODS: An exposure matched cohort of all Finnish community-dwellers diagnosed with clinically verified AD in 2005-2012 (n = 73,005) and 1-4 matched comparison persons/AD-affected person (n = 215,449). Data on 30-day mortality after ischemic stroke (n = 16,419; deaths: n = 2,748), hemorrhagic stroke (n = 3,570; deaths: n = 1,224), and myocardial infarction (n = 15,304; deaths: n = 3,804) were obtained from the National Hospital Discharge register. The main analyses were restricted to first-ever events. RESULTS: Persons with AD had slightly higher 30-day mortality after ischemic stroke (adjusted HR 1.36, 95% Confidence interval (CI) 1.24,1.49), hemorrhagic stroke (adjusted HR 1.11, 95% CI 0.98,1.25), or myocardial infarction (adjusted HR, 1.40, 9% CI 1.30,1.51). The associations were not affected by age, gender, or co-morbidities and remained similar when patients with previous ischemic strokes or infarctions were included. The absolute risk increase in 30-day mortality after ischemic or hemorrhagic stroke and myocardial infarction were 4.9% (95% CI 3.3,6.5), 3.3% (95% CI - 1.6,8.2), and 7.5% (95% CI 5.0,10.0), respectively. CONCLUSIONS: Although the 30-day mortality was somewhat higher in the AD cohort, the absolute differences were small indicating that acute treatment was not notably inferior in AD patients. The slightly higher mortality was not explained by co-morbidities but may reflect the higher mortality of AD persons in general, or treatment practice of patients with severe cognitive impairment.","Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology/*mortality;Cardiovascular Diseases/*epidemiology/*mortality;Cohort Studies;Female;Finland/epidemiology;Hemorrhagic Disorders;Humans;Male;Morbidity;Myocardial Infarction;Outcome Assessment (Health Care);Proportional Hazards Models;Residence Characteristics;Stroke;Alzheimer's disease;mortality","Heiskanen, J.;Hartikainen, S.;Roine, R. P.;Tolppanen, A. M.",2015,,10.3233/jad-150259,0,
1765,Effect of additional reconstructive surgery on perioperative and postoperative morbidity in women undergoing vaginal hysterectomy,"OBJECTIVE: To estimate the risk of perioperative and postoperative morbidity among women undergoing vaginal hysterectomy with and without reconstructive pelvic surgery. METHODS: We collected patient demographics, baseline medical status, perioperative and postoperative findings, and surgical procedures for women aged 18 years or older who had vaginal hysterectomy for a benign indication at Mayo Clinic, Rochester, Minnesota, between January 2004 and December 2005. The main outcome measure was any complication, defined by intensive care unit (ICU) admission, reoperation, readmission, or medical intervention within 9 weeks after surgery. RESULTS: Of 736 patients who met the study criteria, 712 had complete follow-up information. Overall, more women undergoing vaginal hysterectomy with reconstructive pelvic surgery had complications than did those without reconstructive pelvic surgery (147 of 336 [43.8%] compared with 77 of 376 [20.5%], odds ratio [OR] 3.0, 95% confidence interval [CI] 2.2-4.2, P<.001). This association was significant (OR 3.0, 95% CI 1.5-6.2, P=.003) even after adjusting for factors that were significantly different between groups (age, surgical indication, and change in hemoglobin). Specifically, urinary tract infection, pulmonary edema, and unplanned ICU admissions were more common among those undergoing reconstructive pelvic surgery. Disregarding urinary tract infections, the overall complication rate was still higher among the women with concomitant reconstructive pelvic surgery (22.9% compared with 16.5%, OR 1.5, 95% CI 1.04-2.2, P=.03). CONCLUSION: Women having vaginal hysterectomy with additional reconstructive pelvic surgery were more likely to have a perioperative complication than were women undergoing vaginal hysterectomy alone. © 2009 by The American College of Obstetricians and Gynecologists.",acetylsalicylic acid;antibiotic agent;corticosteroid;adult;anemia;antibiotic therapy;article;asthma;bleeding;blood transfusion;cardiovascular disease;cerebrovascular accident;chronic obstructive lung disease;congestive heart failure;controlled study;delirium;dementia;demography;diabetes mellitus;diuretic therapy;emphysema;enteropathy;female;fever;follow up;heart arrest;heart infarction;hematoma;hospital readmission;human;hypertension;intensive care unit;kidney failure;liver disease;lung edema;lung embolism;major clinical study;medical care;medical record review;morbidity;neuropathy;pelvic organ prolapse;pelvis surgery;perioperative period;peripheral vascular disease;plastic surgery;postoperative period;priority journal;reoperation;respiratory arrest;retrospective study;small intestine obstruction;thrombosis;thyroid disease;ureter obstruction;urinary tract infection;vagina bleeding;vaginal hysterectomy,"Heisler, C. A.;Weaver, A. L.;Melton, L. J.;Gebhart, J. B.",2009,,,0,
1766,Bradykinin B2 receptor as a potential therapeutic target,"Kinins are peptide hormones that exert pathophysiological as well as pronounced beneficial physiological effects, mainly by stimulation of bradykinin (BK) B(2) receptors. Owing to the strong proinflammatory properties of kinins resulting from vasodilation, plasma extravasation, activation of mast cells, fibroblasts and macrophages, stimulation of sensory neurons, and the release of nitric oxide, prostaglandins, leukotrienes and cytokines, kinins are believed to play an important role in a variety of inflammatory diseases and pain. Beneficial effects of BK B(2) receptor antagonists in perennial rhinitis, asthma and brain edema have already been shown in clinical trials. Recently, the potential therapeutic utility of BK B(2) receptor antagonists has been extended by the discovery of orally active, nonpeptide BK B(2) receptor antagonists and the identification of novel indications for their use. On the other hand, kinins also have been identified as potent antihypertensive and organ-protective peptides. They have been shown to have vasodilatory, antihypertrophic, antiaggregatory and fibrinolytic effects due to the BK B(2) receptor-mediated release of the autacoids nitric oxide, prostacyclin and tissue plasminogen activator. A recent finding is that kinins are also involved in ischemic preconditioning. Orally active, nonpeptide BK B(2) receptor agonists as potential novel therapeutic agents in cardiovascular medicine have also been identified. In conclusion, interaction with the BK B(2) receptor by either its blockade or its stimulation offers promising therapeutic approaches. BK B(2) receptor antagonists may prove to be useful in the treatment of asthma, rhinitis, arthritis, colitis, pancreatitis, sepsis, edema, tissue injury, pain and possibly infections, hepatorenal syndrome, Alzheimer's disease and lung cancer. BK B(2) receptor agonists have potential in the treatment of cardiovascular diseases like hypertension, cardiac hypertrophy, restenosis and myocardial infarction and diabetic disorders.",,"Heitsch, H.",2000,May,,0,
1767,Apolipoprotein(a) genetic sequence variants associated with systemic atherosclerosis and coronary atherosclerotic burden but not with venous thromboembolism,"The purpose of this study is investigate the effects of variants in the apolipoprotein(a) gene (LPA) on vascular diseases with different atherosclerotic and thrombotic components. It is unclear whether the LPA variants rs10455872 and rs3798220, which correlate with lipoprotein(a) levels and coronary artery disease (CAD), confer susceptibility predominantly via atherosclerosis or thrombosis. The 2 LPA variants were combined and examined as LPA scores for the association with ischemic stroke (and TOAST [Trial of Org 10172 in Acute Stroke Treatment] subtypes) (effective sample size [ne] = 9,396); peripheral arterial disease (ne = 5,215); abdominal aortic aneurysm (n e = 4,572); venous thromboembolism (ne = 4,607); intracranial aneurysm (ne = 1,328); CAD (ne = 12,716), carotid intima-media thickness (n = 3,714), and angiographic CAD severity (n = 5,588). LPA score was associated with ischemic stroke subtype large artery atherosclerosis (odds ratio [OR]: 1.27; p = 6.7 × 104), peripheral artery disease (OR: 1.47; p = 2.9 × 1014), and abdominal aortic aneurysm (OR: 1.23; p = 6.0 × 105), but not with the ischemic stroke subtypes cardioembolism (OR: 1.03; p = 0.69) or small vessel disease (OR: 1.06; p = 0.52). Although the LPA variants were not associated with carotid intima-media thickness, they were associated with the number of obstructed coronary vessels (p = 4.8 × 1012). Furthermore, CAD cases carrying LPA risk variants had increased susceptibility to atherosclerotic manifestations outside of the coronary tree (OR: 1.26; p = 0.0010) and had earlier onset of CAD (1.58 years/allele; p = 8.2 × 10 8) than CAD cases not carrying the risk variants. There was no association of LPA score with venous thromboembolism (OR: 0.97; p = 0.63) or intracranial aneurysm (OR: 0.85; p = 0.15). LPA sequence variants were associated with atherosclerotic burden, but not with primarily thrombotic phenotypes. © 2012 American College of Cardiology Foundation.",apolipoprotein A;abdominal aorta aneurysm;allele;angiocardiography;arterial wall thickness;article;atherosclerosis;brain ischemia;coronary artery atherosclerosis;coronary artery disease;coronary artery obstruction;disease predisposition;disease severity;gene;gene sequence;genetic association;genetic variability;human;intracranial aneurysm;LPA gene;peripheral occlusive artery disease;phenotype;priority journal;risk assessment;sample size;single nucleotide polymorphism;systemic atherosclerosis;venous thromboembolism,"Helgadottir, A.;Gretarsdottir, S.;Thorleifsson, G.;Holm, H.;Patel, R. S.;Gudnason, T.;Jones, G. T.;Van Rij, A. M.;Eapen, D. J.;Baas, A. F.;Tregouet, D. A.;Morange, P. E.;Emmerich, J.;Lindblad, B.;Gottster, A.;Kiemeny, L. A.;Lindholt, J. S.;Sakalihasan, N.;Ferrell, R. E.;Carey, D. J.;Elmore, J. R.;Tsao, P. S.;Grarup, N.;Jørgensen, T.;Witte, D. R.;Hansen, T.;Pedersen, O.;Pola, R.;Gaetani, E.;Magnadottir, H. B.;Wijmenga, C.;Tromp, G.;Ronkainen, A.;Ruigrok, Y. M.;Blankensteijn, J. D.;Mueller, T.;Wells, P. S.;Corral, J.;Soria, J. M.;Souto, J. C.;Peden, J. F.;Jalilzadeh, S.;Mayosi, B. M.;Keavney, B.;Strawbridge, R. J.;Sabater-Lleal, M.;Gertow, K.;Baldassarre, D.;Nyyssnen, K.;Rauramaa, R.;Smit, A. J.;Mannarino, E.;Giral, P.;Tremoli, E.;De Faire, U.;Humphries, S. E.;Hamsten, A.;Haraldsdottir, V.;Olafsson, I.;Magnusson, M. K.;Samani, N. J.;Levey, A. I.;Markus, H. S.;Kostulas, K.;Dichgans, M.;Berger, K.;Kuhlenbumer, G.;Ringelstein, E. B.;Stoll, M.;Seedorf, U.;Rothwell, P. M.;Powell, J. T.;Kuivaniemi, H.;Onundarson, P. T.;Valdimarsson, E.;Matthiasson, S. E.;Gudbjartsson, D. F.;Thorgeirsson, G.;Quyyumi, A. A.;Watkins, H.;Farrall, M.;Thorsteinsdottir, U.;Stefansson, K.",2012,,,0,
1768,Pratical Single Photon Emission Computed Tomography (SPECT) for the community hospital,"Single Photon Emission Computed Tomography (SPECT) can be used to image the cross-sectional distribution of radiopharmaceuticals in the body. In this way, the SPECT technique both improves image contrasts and provides more complete three dimensional information. Both detection and localization of lesions are improved. Information not available through the use of either traditional planar nuclear medicine techniques or other imaging modalities is provided. In particular, the following diagnostic benefits may be achieved: (1) improved detection of lesions responsible for back, hip, knee, and TMJ pain, (2) improved detection and characterization of liver hemangiomas, (3) improved detection of both coronary artery disease and myocardial infarctions, and (4) relatively inexpensive regional cerebral blood flow (rCBF) studies for detection of cerebrovascular disease, Alzheimer's disease, and the full functional consequences of head trauma.",radioisotope;article;bone disease;cerebrovascular disease;community hospital;computer analysis;coronary artery disease;human;liver hemangioma;quality control;single photon emission computer tomography,"Hellman, R. S.;Collier, B. D.;Krasnow, A. Z.;Kir, M.",1990,,,0,
1769,"The altered homeostatic theory: A hypothesis proposed to be useful in understanding and preventing ischemic heart disease, hypertension, and diabetes - including reducing the risk of age and atherosclerosis","Evidence will be presented to support the usefulness of the altered homeostatic theory in understanding basic pathogenetic mechanisms of ischemic heart disease (IHD), hypertension, and diabetes, and in improving prevention of these disorders. The theory argues that: IHD, hypertension, and diabetes share the same basic pathogenesis; risk factors favor a sympathetic homeostatic shift; preventative factors favor a parasympathetic homeostatic shift; risk and preventative factors oppose each other through a dynamic risk/prevention balance; and prevention should be based on improving the risk/prevention balance. Prevention based on improving the risk/prevention balance should be more effective, as this method is regarded as reflecting more accurately basic pathogenetic mechanisms. As example, the theory argues that the risk of supposedly nonmodifiable risk factors as age and the risk of relatively nonmodifiable atherosclerosis can be reduced significantly. The possible validity of the altered homeostatic theory was tested by a study based on multiple associations. Findings support a common pathogenesis for IHD, hypertension, and diabetes based on a sympathetic homeostatic shift, and the usefulness of prevention based on improving the risk/prevention balance by using standard pharmaceutical and lifestyle preventative measures. The same set of multiple and diverse risk factors favored IHD, hypertension, and diabetes, and the same set of multiple and diverse pharmaceutical and lifestyle preventative measures prevented these disorders. Also, the same set of preventative agents generally improved cognitive function and bone density, and reduced the incidence of Alzheimer's disease, atrial fibrillation, and cancer. Unexpectedly, evidence was developed that four major attributes of sympathetic activation represent four major risk factors; attributes of sympathetic activation are a tendency toward thrombosis and vasoconstriction, lipidemia, inflammation, and hyperglycemia, and corresponding risk factors are endothelial dysfunction (which expresses thrombosis/vasoconstriction and epitomizes this tendency), dyslipidemia, inflammation, and insulin resistance. These findings, plus other information, provide evidence that dyslipidemia acts mainly as a marker of risk of IHD, rather than being the basic mechanism of this disorder. However, prevention generally is based solely on improvement of dyslipidemia; basing prevention on dyslipidemia relatively underemphasizes the importance of other significant risk factors and, by certifying its validity, discourages alternate pathogenetic approaches. Also, development of myocardial infarction is approached differently. It seems generally accepted that dyslipidemia results rather automatically in infarction through the sequence of atherosclerosis, atherosclerotic complications, and thrombosis. In contrast, distinction is made between development of atherosclerosis and acute induction of infarction - where atherosclerosis is only one of multiple risk factors. © 2006 Elsevier Ltd. All rights reserved.",acetylsalicylic acid;antibiotic agent;antidiabetic agent;antihypertensive agent;bile acid sequestrant;dipeptidyl carboxypeptidase inhibitor;estrogen;folic acid;hydroxymethylglutaryl coenzyme A reductase inhibitor;peroxisome proliferator activated receptor agonist;progesterone;adipose tissue;adrenergic system;Alzheimer disease;article;atherosclerosis;bone density;neoplasm;cardiovascular risk;causal attribution;cholinergic activity;cholinergic system;cognition;diabetes mellitus;disease association;disease control;disease course;disease marker;drug screening;dyslipidemia;endothelial dysfunction;atrial fibrillation;heart infarction;homeostasis;human;hyperglycemia;hyperlipidemia;hypertension;hypothalamus hypophysis adrenal system;inflammation;insulin resistance;ischemic heart disease;lifestyle;low drug dose;pathogenesis;priority journal;risk factor;risk reduction;sympathetic tone;thrombosis;validity;vasoconstriction;aspirin,"Hellstrom, H. R.",2007,,,0,
1770,Research with patients incompetent to give informed consent,,competence;decision making;dementia;heart infarction;human;informed consent;medical ethics;medical research;mental disease;practice guideline;short survey,"Helmchen, H.",1998,,,0,
1771,Adjustment of treatment for geriatric patients with diabetes,,exendin 4;hemoglobin A1c;insulin detemir;insulin glargine;isophane insulin;pioglitazone;rosiglitazone;sitagliptin;vildagliptin;Alzheimer disease;article;diabetes mellitus;geriatric patient;human;hypoglycemia;impaired glucose tolerance;insulin sensitivity;insulin treatment;ischemic heart disease;non insulin dependent diabetes mellitus;oral glucose tolerance test;quality of life,"Helmstädter, I.",2008,,,0,
1772,Predicting mortality following hip fracture: an analysis of comorbidities and complications,"Background: Hip fracture is common in the geriatric population. These patients have multiple comorbidities that complicate treatment and recovery such that poor functional outcomes often result. Since functional outcomes are associated with comorbidities and complications it is important to define the contributing factors. Aims: To describe comorbidities common to geriatric hip fracture patients and determine predictability of complications and mortality based on comorbidities. Methods: Data in this study were sourced from information prospectively collected for evaluation of a new orthogeriatric service established at a University Teaching Hospital over the period of 1 year. Results: The median age was 82 years (range 54–100) and 73 % were female (N = 206). Common comorbidities included hypertension (51 %), dementia (28 %), osteoporosis (19 %), ischaemic heart disease (IHD) (15 %) and chronic obstructive pulmonary disease (15 %). In predicting 1-year mortality based on comorbidities, the final model included age, IHD, delay to surgery and explained 26 % of the variability in mortality. Predicting 1-year mortality based on complications, the final model included age and respiratory complications and explained 26 % of the variability in mortality. There was a significant association between having respiratory complications and chronic obstructive pulmonary disease (p < 0.001) with 63 % of those with respiratory complications having chronic obstructive pulmonary disease. Conclusions: This study highlights specific patient comorbidities and medical complications that could be used to guide clinical assessment, management and targeted interventions that improve outcomes in this patient group.",adult;age;aged;anemia;article;bladder dysfunction;blood transfusion;chronic obstructive lung disease;comorbidity;complication;delirium;dementia;female;fragility fracture;geriatric patient;hip fracture;human;hypertension;ischemic heart disease;major clinical study;male;middle aged;mortality;osteoporosis;postoperative complication;predictive value;prospective study;respiratory tract infection,"Henderson, C. Y.;Ryan, J. P.",2015,,,0,
1773,Aspirin for the next generation,"First used as an analgesic and antipyretic, investigations into aspirin's anti-inflammatory effects led to its establishment in 1974 as a drug that altered the activity of platelets to influence the course and incidence of myocardial infarction and cerebrovascular disease. It became the standard in treatment and prevention of vascular disorders. The 25th International Scientific Meeting on aspirin held at the Royal College of Physicians in London on 24th October 2012 took aspirin into fresh fields, among them cancer, diabetes, dementia and gynaecology.",Hughes syndrome;aspirin;cancer;dementia;diabetes,"Henderson, N.;Smith, T.",2013,,10.3332/ecancer.2013.300,0,
1774,Raloxifene for women with Alzheimer disease,"Objective: To determine whether raloxifene, a selective estrogen receptor modulator, improves cognitive function compared with placebo in women with Alzheimer disease (AD) and to provide an estimate of cognitive effect. Methods: This pilot study was conducted as a randomized, double-blind, placebo-controlled trial, with a planned treatment of 12 months. Women with late-onset AD of mild to moderate severity were randomly allocated to high-dose (120 mg) oral raloxifene or identical placebo provided once daily. The primary outcome compared between treatment groups at 12 months was change in the Alzheimer's Disease Assessment Scale, cognitive subscale (ADAS-cog). Results: Forty-two women randomized to raloxifene or placebo were included in intent-to-treat analyses (mean age 76 years, range 68-84), and 39 women contributed 12-month outcomes. ADAS-cog change scores at 12 months did not differ significantly between treatment groups (standardized difference 0.03, 95% confidence interval -0.39 to 0.44, 2-tailed p 0.89). Raloxifene and placebo groups did not differ significantly on secondary analyses of dementia rating, activities of daily living, behavior, or a global cognition composite score. Caregiver burden and caregiver distress were similar in both groups. Conclusions: Results on the primary outcome showed no cognitive benefits in the raloxifene-treated group. Classification of evidence: This study provides Class I evidence that for women with AD, raloxifene does not have a significant cognitive effect. The study lacked the precision to exclude a small effect.",placebo;raloxifene;aged;Alzheimer disease;Alzheimer Disease Assessment Scale;article;brain ischemia;caregiver burden;clinical article;cognition;colon cancer;congestive heart failure;controlled study;daily life activity;disease severity;distress syndrome;double blind procedure;drug efficacy;drug megadose;drug safety;female;human;patient compliance;pneumonia;priority journal;randomized controlled trial;treatment outcome,"Henderson, V. W.;Ala, T.;Sainani, K. L.;Bernstein, A. L.;Stephenson, B. S.;Rosen, A. C.;Farlow, M. R.",2015,,,0,
1775,Health outcomes and cost of care among older adults with schizophrenia: a 10-year study using medical records across the continuum of care,"OBJECTIVES: The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared with older patients without schizophrenia. METHODS: An observational cohort study of 31,588 older adults (mean age: 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999-2008. Of these, 1,635 (5.2%) were diagnosed with schizophrenia and 757 (2.4%) had this diagnosis confirmed in the community mental health center. Patients' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available. MEASUREMENTS: Rates of comorbid conditions, healthcare utilization, costs, and mortality. RESULTS: Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% versus 38.84%), chronic obstructive pulmonary disease (52.71% versus 41.41%), and hypothyroidism (36.72% versus 26.73%) than the patients without schizophrenia (p <0.001). They had significantly lower rates of cancer (30.78% versus 43.18%) and significantly higher rates of dementia (64.46% versus 32.13%). The patients with schizophrenia had significantly higher mortality risk (hazard ratio: 1.25, 95% confidence interval: 1.07-1.47) than the patients without schizophrenia. They also had significantly higher rates of healthcare utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia. CONCLUSIONS: The management of older adult patients with schizophrenia is creating a serious burden for our healthcare system, requiring the development of integrated models of healthcare.",Age of Onset;Aged;Case-Control Studies;Cohort Studies;Comorbidity;Continuity of Patient Care/*economics/*statistics & numerical data;Female;Health Care Costs/*statistics & numerical data;Health Services for the Aged/*economics/*statistics & numerical;data/trends/*utilization;Health Status;Humans;Male;Medicaid/economics;Medical Records;Medicare/economics;Mental Health Services/*economics/*statistics & numerical data/utilization;Schizophrenia/*economics/epidemiology/mortality;United States/epidemiology;cancer;dementia;hospital care;mortality;nursing home,"Hendrie, H. C.;Tu, W.;Tabbey, R.;Purnell, C. E.;Ambuehl, R. J.;Callahan, C. M.",2014,May,10.1016/j.jagp.2012.10.025,0,
1776,Effect of pioglitazone medication on the incidence of dementia,"Objective Peroxisome proliferator activated receptor γ-activating drugs show various salutary effects in preclinical models of neurodegenerative disease. The decade-long clinical usage of these drugs as antidiabetics now allows for evaluation of patient-oriented data sources. Methods Using observational data from 2004-2010, we analyzed the association of pioglitazone and incidence of dementia in a prospective cohort study of 145,928 subjects aged ≥60 years who, at baseline, were free of dementia and insulin-dependent diabetes mellitus. We distinguished between nondiabetics, diabetics without pioglitazone, diabetics with prescriptions of <8 calendar quarters of pioglitazone, and diabetics with ≥8 quarters. Cox proportional hazard models explored the relative risk (RR) of dementia incidence dependent on pioglitazone use adjusted for sex, age, use of rosiglitazone or metformin, and cardiovascular comorbidities. Results Long-term use of pioglitazone was associated with a lower dementia incidence. Relative to nondiabetics, the cumulative long-term use of pioglitazone reduced the dementia risk by 47% (RR = 0.53, p = 0.029). If diabetes patients used pioglitazone <8 quarters, the dementia risk was comparable to those of nondiabetics (RR = 1.16, p = 0.317), and diabetes patients without a pioglitazone treatment had a 23% increase in dementia risk (RR = 1.23, p < 0.001). We did not find evidence for age effects, nor for selection into pioglitazone treatment due to obesity. Interpretation These findings indicate that pioglitazone treatment is associated with a reduced dementia risk in initially non-insulin-dependent diabetes mellitus patients. Prospective clinical trials are needed to evaluate a possible neuroprotective effect in these patients in an ageing population.",insulin;metformin;pioglitazone;rosiglitazone;adult;age;aged;article;atrial fibrillation;cerebrovascular disease;comorbidity;comparative study;controlled study;dementia;disease association;drug effect;female;follow up;human;hypercholesterolemia;hypertension;incidence;ischemic heart disease;major clinical study;male;non insulin dependent diabetes mellitus;prescription;priority journal;risk factor;risk reduction;sex difference;treatment duration;treatment outcome;treatment response;very elderly,"Heneka, M. T.;Fink, A.;Doblhammer, G.",2015,,,0,
1777,Co-transplantation of autologous adult stem cells together with differentiated derivatives of human embryonic stem cells. A novel strategy to enhance the efficacy of autologous cell-transplantation therapy?,,"Animals;Creutzfeldt-Jakob Syndrome/therapy;Humans;Myocardial Infarction/therapy;Stem Cell Transplantation/*methods;Transplantation Immunology/genetics/*immunology;Transplantation, Autologous","Heng, B. C.;Cao, T.",2005,May-Jun,10.1111/j.1067-1927.2005.130320.x,0,
1778,"Safety profile of semagacestat, a gamma-secretase inhibitor: IDENTITY trial findings","Objective: Semagacestat, a γ-secretase inhibitor, demonstrated an unfavorable risk-benefit profile in a Phase 3 study of patients with Alzheimer's disease (IDENTITY trials), and clinical development was halted. To assist in future development of γ-secretase inhibitors, we report detailed safety findings from the IDENTITY study, with emphasis on those that might be mechanistically linked to γ-secretase inhibition. Research design and methods: The IDENTITY trial was a double-blind, placebo-controlled trial of semagacestat (100 mg and 140 mg), in which 1537 patients age 55 years and older with probable Alzheimer's disease were randomized. Treatment-emergent adverse events (TEAEs) are reported by body system along with pertinent laboratory, vital sign, and ECG findings. Results: Semagacestat treatment was associated with increased reporting of suspected Notch-related adverse events (gastrointestinal, infection, and skin cancer related). Other relevant safety findings associated with semagacestat treatment included cognitive and functional worsening, skin-related TEAEs, renal and hepatic changes, increased QT interval, and weight loss. With few exceptions, differences between semagacestat and placebo treatment groups were no longer significant after cessation of treatment with active drug. Conclusions: Many of these safety findings can be attributed to γ-secretase inhibition, and may be valuable to researchers developing γ-secretase inhibitors.",placebo;semagacestat;acne;actinic keratosis;acute kidney failure;adult;aged;allergic reaction;alopecia;Alzheimer disease;anaphylaxis;article;basal cell carcinoma;body weight disorder;breast disease;bronchitis;cognitive defect;congestive heart failure;connective tissue disease;controlled study;coughing;decreased appetite;dehydration;depression;dermatitis;diarrhea;double blind procedure;drug dose reduction;drug safety;drug withdrawal;ear infection;electrocardiogram;epistaxis;erythema;eye disease;faintness;female;flatulence;folliculitis;functional disease;gastroesophageal reflux;gastrointestinal disease;gastrointestinal hemorrhage;hair color;head injury;heart ventricle tachycardia;hemorrhoid;herpes simplex;hot flush;human;hyperhidrosis;hypernatremia;hypopigmentation;hypotension;immunopathology;infectious pneumonia;infestation;keratoacanthoma;kidney disease;laboratory test;liver disease;lung cancer;lung tumor;maculopapular rash;major clinical study;male;mediastinum disease;melanoma;metabolic disorder;musculoskeletal disease;mycosis;nausea and vomiting;neck pain;neurologic disease;nutritional disorder;otalgia;papular rash;pneumonia;prostate hypertrophy;pruritus;psoriasis,"Henley, D. B.;Sundell, K. L.;Sethuraman, G.;Dowsett, S. A.;May, P. C.",2014,,,0,
1779,MRI biomarkers of vascular damage and atrophy predicting mortality in a memory clinic population,"Background and Purpose-MRI biomarkers play an important role in the diagnostic work-up of dementia, but their prognostic value is less well-understood. We investigated if simple MRI rating scales predict mortality in a memory clinic population. Methods-We included 1138 consecutive patients attending our memory clinic. Diagnostic categories were:subjective complaints (n=220), mild cognitive impairment (n=160), Alzheimer disease (n = 357), vascular dementia (n=46), other dementia (n = 136), and other diagnosis (n = 219). Baseline MRIs were assessed using visual rating scales for medial temporal lobe atrophy (range, 0-4), global cortical atrophy (range, 0-3), and white matter hyperintensities (range, 0-3). Number of microbleeds and presence of infarcts were recorded. Cox-regression models were used to calculate the risk of mortality. Results-Mean follow-up duration was 2.6 (±1.9) years. In unadjusted models, all MRI markers except infarcts predicted mortality. After adjustment for age, sex, and diagnosis, white matter hyperintensities, and microbleeds predicted mortality (white matter hyperintensities:hazard ratio [HR], 1.2;95% CI, 1.0-1.4;microbleeds:HR, 1.02 95% CI, 1.00-1.03;categorized:HR, 1.5;95% CI, 1.1-2.0). The predictive effect of global cortical atrophy was restricted to younger subjects (HR, 1.7;95% CI, 1.2-2.6). An interaction between microbleeds and global cortical atrophy indicated that mortality was especially high in patients with both microbleeds and global cortical atrophy. Conclusion-Simple MRI biomarkers, in addition to their diagnostic use, have a prognostic value with respect to mortality in a memory clinic population. Microbleeds were the strongest predictor of mortality. © 2009 American Heart Association, Inc.",age;aged;Alzheimer disease;article;blood vessel injury;brain atrophy;brain infarction;calculation;cognitive defect;confidence interval;controlled study;dementia;diagnostic procedure;female;follow up;global cortical atrophy;hazard ratio;human;major clinical study;male;mortality;multiinfarct dementia;nuclear magnetic resonance imaging;prediction;priority journal;prognosis;proportional hazards model;risk assessment;sex;temporal lobe;temporal lobe atrophy;vision;white matter,"Henneman, W. J. P.;Sluimer, J. D.;Cordonnier, C.;Baak, M. M. E.;Scheltens, P.;Barkhof, F.;Van Der Flier, W. M.",2009,,,0,
1780,Rationale and design of the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study,"Background: One of the leading causes of mortality worldwide is ischemic stroke, which is a major contributor to neurological disability and dementia. Terutroban is a specific thromboxane A<inf>2</inf> receptor antagonist with antithrombotic, antivasoconstrictive, and antiatherosclerotic properties, which make it a promising tool for secondary prevention of ischemic stroke. Methods and Results: The Prevention of Cerebrovascular and Cardiovascular Events of Ischemic Origin with Terutroban in Patients with a History of Ischemic Stroke or Transient Ischemic Attack (PERFORM) Study is an international, multicenter, randomized, double-blind, parallel-group study in patients aged >55 years who have suffered ischemic strokes (<3 months) or transient ischemic attacks (<8 days), and who are stable at inclusion with no intracranial hemorrhage or nonischemic neurological diseases. Patients are randomly allocated to terutroban (30 mg/day) or aspirin (100 mg/day). The primary efficacy end point is a composite of ischemic stroke (fatal or nonfatal), myocardial infarction (fatal or nonfatal), or other vascular death (excluding hemorrhagic death of any origin). Safety is evaluated by assessing hemorrhagic events. The first patient was randomized in February 2006 and more than 19,000 patients will be included. Conclusions: The PERFORM Study will explore the benefits of terutroban in secondary prevention of ischemic stroke. The study results are expected in 2011. © 2009 S. Karger AG, Basel.",adult;aged;article;brain hemorrhage;cardiovascular disease/dt [Drug Therapy];cerebrovascular accident/dt [Drug Therapy];cerebrovascular accident/dt [Drug Therapy];cerebrovascular accident/pc [Prevention];cerebrovascular disease/dt [Drug Therapy];controlled study;drug effect;drug safety;female;heart death;heart infarction;human;male;morning dosage;priority journal;secondary prevention;transient ischemic attack/dt [Drug Therapy];transient ischemic attack/pc [Prevention];transient ischemic attack/dt [Drug Therapy];acetylsalicylic acid/cm [Drug Comparison];acetylsalicylic acid/dt [Drug Therapy];terutroban/cm [Drug Comparison];terutroban/dt [Drug Therapy];terutroban/pd [Pharmacology];Sr-stroke,"Hennerici, Mg",2009,,10.1159/000209263,0,1781
1781,Rationale and design of the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study,"Background: One of the leading causes of mortality worldwide is ischemic stroke, which is a major contributor to neurological disability and dementia. Terutroban is a specific thromboxane A<sub>2</sub> receptor antagonist with antithrombotic, antivasoconstrictive, and antiatherosclerotic properties, which make it a promising tool for secondary prevention of ischemic stroke. Methods and Results: The Prevention of Cerebrovascular and Cardiovascular Events of Ischemic Origin with Terutroban in Patients with a History of Ischemic Stroke or Transient Ischemic Attack (PERFORM) Study is an international, multicenter, randomized, double-blind, parallel-group study in patients aged >55 years who have suffered ischemic strokes (<3 months) or transient ischemic attacks (<8 days), and who are stable at inclusion with no intracranial hemorrhage or nonischemic neurological diseases. Patients are randomly allocated to terutroban (30 mg/day) or aspirin (100 mg/day). The primary efficacy end point is a composite of ischemic stroke (fatal or nonfatal), myocardial infarction (fatal or nonfatal), or other vascular death (excluding hemorrhagic death of any origin). Safety is evaluated by assessing hemorrhagic events. The first patient was randomized in February 2006 and more than 19,000 patients will be included. Conclusions: The PERFORM Study will explore the benefits of terutroban in secondary prevention of ischemic stroke. The study results are expected in 2011. 2009 S. Karger AG, Basel.",adult // aged // article // brain hemorrhage // cardiovascular disease/dt [Drug Therapy] // cerebrovascular accident/dt [Drug Therapy] // cerebrovascular accident/pc [Prevention] // cerebrovascular disease/dt [Drug Therapy] // controlled study // drug e;Sr-stroke,"Hennerici, M. G.",2009,,10.1159/000209263,0,
1782,Leukoaraiosis predicts poor 90-day outcome after acute large cerebral artery occlusion,"Background: To date limited information regarding outcome-modifying factors in patients with acute intracranial large artery occlusion (ILAO) in the anterior circulation is available. Leukoaraiosis (LA) is a common finding among patients with ischemic stroke and has been associated with poor post-stroke outcomes but its association with ILAO remains poorly characterized. This study sought to clarify the contribution of baseline LA and other common risk factors to 90-day outcome (modified Rankin Scale, mRS) after stroke due to acute anterior circulation ILAO. Methods: We retrospectively analyzed 1,153 consecutive patients with imaging-confirmed ischemic stroke during a 4-year period (2007-2010) at a single academic institution. The final study cohort included 87 patients with acute ILAO subjected to multimodal CT imaging within 24 h of symptom onset. LA severity was assessed using the van Swieten scale on non-contrast CT. Leptomeningeal collaterals were graded using CT angiogram source images. Hemorrhagic transformation (HT) was determined on follow-up CT. Multivariate logistic regression controlling for HT, treatment modality, demographic, as well as baseline clinical and imaging characteristics was used to identify independent predictors of a poor outcome (90-day mRS >2). Results: The median National Institutes of Health Stroke Scale (NIHSS) at baseline was 15 (interquartile range 9-21). Twenty-four percent of the studied patients had severe LA. They were more likely to have hypertension (p = 0.028), coronary artery disease (p = 0.015), poor collaterals (p < 0.001), higher baseline NIHSS (p = 0.003), higher mRS at 90 days (p < 0.001), and were older (p = 0.002). Patients with severe LA had a uniformly poor outcome (p < 0.001) irrespective of treatment modality. Poor outcome was independently associated with higher baseline NIHSS (p < 0.001), worse LA (graded and dichotomized, p < 0.001), reduced leptomeningeal collaterals (graded and dichotomized, p < 0.001), presence of HT (p < 0.001), presence of parenchymal hemorrhages (p = 0.01), baseline mRS (p = 0.002), and older age (p = 0.043). The association between severe LA (p = 0.0056; OR 13.86; 95% CI 1.94-∞) and baseline NIHSS (p = 0.0001; OR 5.11; 95% CI 2.07-14.49 for each 10-point increase) with poor outcome maintained after adjustment for confounders in the final regression model. In this model, there was no significant association between presence of HT and poor outcome (p = 0.0572). Conclusion: Coexisting LA may predict poor functional outcome in patients with acute anterior circulation ILAO independent of other known important outcome predictors such as comorbid state, admission functional deficit, collateral status, hemorrhagic conversion, and treatment modality. © 2012 S. Karger AG, Basel.",alteplase;adult;aged;alcohol abuse;article;brain circulation;brain hemorrhage;brain ischemia;clinical feature;cohort analysis;computed tomographic angiography;congestive heart failure;controlled study;coronary artery disease;dementia;diabetes mellitus;disease association;disease severity;dyslipidemia;endovascular surgery;female;follow up;atrial fibrillation;human;hypertension;image analysis;intracranial large artery occlusion;leptomeninx;leukoaraiosis;major clinical study;male;National Institutes of Health Stroke Scale;neuroimaging;occlusive cerebrovascular disease;outcome assessment;peripheral vascular disease;predictive value;priority journal;Rankin scale;retrospective study;risk factor;smoking,"Henninger, N.;Lin, E.;Baker, S. P.;Wakhloo, A. K.;Takhtani, D.;Moonis, M.",2012,,,0,
1783,Alzheimer's disease in late-life dementia: A minor toxic consequence of devastating cerebrovascular dysfunction,"Alzheimer's disease (AD) is thought to be the most common cause of late-life dementia. But pure AD is infrequent whereas AD pathology is often insufficient to explain dementia in the elderly. Conversely, cerebrovascular disease is omnipresent and the crucial role of microvascular alterations increasingly recognized in late dementia or ""Alzheimer syndrome"". Pathomechanisms of vascular cognitive impairment are still debated but recent data indicate that the initial concept of chronic low grade cerebral hypoxia should not have been abandoned. Thus, it is proposed that windkessel dysfunction is the missing link between vascular and craniospinal senescence on the one hand, and chronic low grade cerebral hypoxia, ""senile brain degeneration"" and ""Alzheimer syndrome"" on the other hand. An age-related decrease in the buffering capacity of both the vessels and the craniospinal cavity favours cerebral hypoxia; due to increased capillary pulsatility with disturbances in capillary exchanges or due to a marked reduction in craniospinal compliance with a mechanical reduction in cerebral arterial inflow. ""Invisible"" windkessel dysfunction, most often related to ""hardening of the arteries"" may be the most frequent pathomechanism of late-onset dementia whereas associated mild or moderate AD may be merely a toxic manifestation of a primarily hypoxic disease. Structural patterns of arteriosclerotic dementia fit well with an underlying arterial windkessel dysfunction: with secondary mechanical damage to the cerebral small vessels and the brain and predominantly deep hypoxia. The clinical significance of leukoaraïosis, small foci of necrosis, ventricular dilatation, hippocampal and cortical atrophy is in good agreement with their value as indirect markers of windkessel dysfunction. An age-related ""invisible"" reduction in craniospinal compliance may also contribute to the associations between heart failure, arterial hypotension and cognitive impairment in the elderly and to the high percentage of dementia of unknown origin in the very old. Both neuropathological and clinical overlap between AD and windkessel dysfunction can explain that cerebrovascular dysfunction remains misdiagnosed for AD in the elderly. Evidence of the key role of cerebrovascular dysfunction should markedly facilitate and widen therapeutic research in late-life dementia. Routine MRI including direct assessment of intracranial dynamics should be increasingly used to define etiological subtypes of the ""Alzheimer syndrome"" and develop a well-targeted therapeutic strategy. © 2007 Elsevier Ltd. All rights reserved.",Alzheimer disease;article;cerebrovascular disease;cognitive defect;disease activity;disease association;disease course;heart failure;hippocampus;human;hypotension;neuropathology;priority journal;windkessel dysfunction,"Henry-Feugeas, M. C.",2008,,,0,
1784,Drugs with potential cardiac adverse effects: Retrospective study in a large cohort of parkinsonian patients,"Drugs with potential cardiac adverse effects are commonly prescribed in Parkinson's disease (PD). To describe demographic and clinical characteristics in a group of PD patients with cardiac events and to evaluate risk factors. Patients and methods.-We sampled 506 consecutive PD patients (211 women/295 men), median age 68.3 ± 10.6 years (range 36-95) and median disease duration 11.2 ± 6.5 years (range 1-49). Medications with potential cardiac effects, i.e. QT prolongation (citalopram, escitalopram, venlafaxine, sertraline, domperidone, amantadine, solifenacin), ventricular arrhythmia (rivastigmine, clozapine, midodrine, sildenafil, tadalafil) and ischemic heart disease (rasagiline, entacapone, tadalafil) were recorded. Demographic and clinical data were collected prospectively; cardiac events were obtained retrospectively. Results.-Twenty-four patients (4.7%) (9 women/15 men) presented a cardiac event. Fifteen (62.5%) patients had dysautonomia, 4 (16.6%) a history of heart disease and 8 (33.3%) were taking one or more drugs with a definite potential cardiac adverse effect. Age (75.9 ± 6.6 yr vs. 67.8 ± 11 yr), disease duration (14.7 ± 3.6 yr vs. 11 ± 6.5 yr), dysautonomia (62.5% vs. 24.5%) and dementia associated with PD (37.5% vs. 14.6%) were significantly higher in the group with cardiac events (P < 0.05). Cofactors increasing the risk for cardiovascular events were age and dysautonomia. Discussion/Conclusion.-Our results indicate that the neurodegenerative process in Parkinson's disease is associated with a higher risk of cardiovascular complications.",amantadine;antiparkinson agent;catechol methyltransferase inhibitor;citalopram;clozapine;domperidone;dopamine receptor stimulating agent;entacapone;escitalopram;inotropic agent;levodopa;midodrine;rasagiline;rivastigmine;sertraline;sildenafil;solifenacin;tadalafil;venlafaxine;adult;aged;article;dementia;disease duration;dysautonomia;female;heart;heart disease;heart ventricle arrhythmia;human;ischemic heart disease;major clinical study;male;Parkinson disease,"Heranval, A.;Lefaucheur, R.;Fetter, D.;Rouille, A.;Le Goff, F.;Maltete, D.",2016,,,0,
1785,A model to predict central-line-associated bloodstream infection among patients with peripherally inserted central catheters: The MPC score,"BACKGROUND Peripherally inserted central catheters (PICCs) are associated with central-line-associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed. OBJECTIVE To operationalize or prioritize CLABSI risk factors when making decisions regarding the use of PICCs using a risk model to estimate an individual's risk of PICC-CLABSI prior to device placement. METHODS Using data from the Michigan Hospital Medicine Safety consortium, patients that experienced PICC-CLABSI between January 2013 and October 2016 were identified. A Cox proportional hazards model with robust sandwich standard error estimates was then used to identify factors associated with PICC-CLABSI. Based on regression coefficients, points were assigned to each predictor and summed for each patient to create the Michigan PICC-CLABSI (MPC) score. The predictive performance of the score was assessed using time-dependent area-under-the-curve (AUC) values. RESULTS Of 23,088 patients that received PICCs during the study period, 249 patients (1.1%) developed a CLABSI. Significant risk factors associated with PICC-CLABSI included hematological cancer (3 points), CLABSI within 3 months of PICC insertion (2 points), multilumen PICC (2 points), solid cancers with ongoing chemotherapy (2 points), receipt of total parenteral nutrition (TPN) through the PICC (1 point), and presence of another central venous catheter (CVC) at the time of PICC placement (1 point). The MPC score was significantly associated with risk of CLABSI (P<.0001). For every point increase, the hazard ratio of CLABSI increased by 1.63 (95% confidence interval, 1.56-1.71). The area under the receiver-operating-characteristics curve was 0.67 to 0.77 for PICC dwell times of 6 to 40 days, which indicates good model calibration. CONCLUSION The MPC score offers a novel way to inform decisions regarding PICC use, surveillance of high-risk cohorts, and utility of blood cultures when PICC-CLABSI is suspected. Future studies validating the score are necessary. Infect Control Hosp Epidemiol 2017;38:1155-1166.",peripherally inserted central venous catheter;acetylsalicylic acid;antibiotic agent;antineoplastic agent;antithrombocytic agent;hemoglobin;hydroxymethylglutaryl coenzyme A reductase inhibitor;infusion fluid;acquired immune deficiency syndrome;adult;age;aged;antibiotic therapy;article;blood clotting disorder;body mass;cancer chemotherapy;catheter infection;central venous catheter;cerebrovascular accident;cerebrovascular disease;Charlson Deyo comorbidity index;chronic obstructive lung disease;clinical assessment tool;clinical decision making;clinical outcome;cohort analysis;comorbidity assessment;congestive heart failure;controlled study;deep vein thrombosis;dementia;diabetes mellitus;diagnostic test accuracy study;disease assessment;disease association;estimated glomerular filtration rate;female;gender;heart infarction;hematologic malignancy;hemiplegia;hemodialysis;high risk patient;human;Human immunodeficiency virus infection;hyperlipidemia;hypertension;infection risk;inflammatory bowel disease;international normalized ratio;kidney failure;kidney transplantation;length of stay;liver disease;lung disease;lung embolism;major clinical study;male;measurement error;medical history;Michigan Peripherally Inserted Central Catheter Central Line Associated Bloodstream Infection Risk Score;middle aged;paraplegia;peptic ulcer;peripheral vascular disease;pneumonia;predictive value;predictor variable;race;rheumatoid arthritis;risk assessment;risk factor;sepsis;short bowel syndrome;smoking;solid malignant neoplasm;terminal disease;thrombocyte count;total parenteral nutrition;transient ischemic attack;vascular access;venous stasis,"Herc, E.;Patel, P.;Washer, L. L.;Conlon, A.;Flanders, S. A.;Chopra, V.",2017,,10.1017/ice.2017.167,0,
1786,Statin therapy in geriatrics,,Aged;Alzheimer Disease/*drug therapy;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects/*therapeutic use;Myocardial Ischemia/*drug therapy,"Hereu, P.;Vallano, A.",2008,Nov-Dec,,0,
1787,Why patients have fear of being admitted to a nursing home?,,anxiety disorder;clinical feature;dementia;diabetes mellitus;heart failure;heredity;home care;human;letter;medical ethics;physical examination;prognosis,"Herhahn, J.",2009,,,0,
1788,Ambulatory blood pressure monitoring in the prediction of cardiovascular events and effects of chronotherapy: rationale and design of the MAPEC study,"Ambulatory blood pressure (BP) measurements (ABPM) correlate more closely with target organ damage and cardiovascular events than clinical cuff measurements. ABPM reveals the significant circadian variation in BP, which in most individuals presents a morning increase, small post-prandial decline, and more extensive lowering during nocturnal rest. However, under certain pathophysiological conditions, the nocturnal BP decline may be reduced (non-dipper pattern) or even reversed (riser pattern). This is clinically relevant because the non-dipper and riser circadian BP patterns constitute a risk factor for left ventricular hypertrophy, microalbuminuria, cerebrovascular disease, congestive heart failure, vascular dementia, and myocardial infarction. Hence, there is growing interest in how to best tailor and individualize the treatment of hypertension according to the specific circadian BP pattern of each patient. All previous trials that have demonstrated an increased cardiovascular risk in non-dipper as compared to dipper patients have relied on the prognostic significance of a single ABPM baseline profile from each participant without accounting for possible changes in the BP pattern during follow-up. Moreover, the potential benefit (i.e., reduction in cardiovascular risk) associated with the normalization of the circadian BP variability (conversion from non-dipper to dipper pattern) from an appropriately envisioned treatment strategy is still a matter of debate. Accordingly, the MAPEC (Monitorizacion Ambulatoria de la Presion Arterial y Eventos Cardiovasculares, i.e., Ambulatory Blood Pressure Monitoring and Cardiovascular Events) study was designed to investigate whether the normalization of the circadian BP profile toward more of a dipper pattern by chronotherapeutic strategies (i.e., specific timing during the 24 h of BP-lowering medications according to the 24 h BP pattern) reduces cardiovascular risk. The prospective MAPEC study investigates 3,000 diurnally active men and women >18 yrs of age. At inclusion, BP and wrist activity are measured for 48 h. The initial evaluation also includes a detailed medical history, an electrocardiogram, and screening laboratory blood and urine tests. The same evaluation procedure is scheduled yearly or more frequently (quarterly) if treatment adjustment is required for BP control. Cardiovascular morbidity and mortality are thus evaluated on the basis of changes in BP during follow-up. The MAPEC study, now on its fourth year of follow-up, investigates the potential decrease in cardiovascular, cerebrovascular, and renal risk from the proper modeling of the circadian BP profile by the timed administration (chronotherapy) of antihypertensive medication, beyond the reduction of clinic-determined daytime or ABPM-determined 24 h mean BP levels. Copyright © Informa Healthcare USA, Inc.","Adult;Antihypertensive Agents [administration & dosage] [therapeutic use];Blood Pressure [drug effects] [physiology];Blood Pressure Monitoring, Ambulatory;Cardiovascular Diseases [drug therapy] [physiopathology];Chronotherapy;Circadian Rhythm [physiology];Female;Humans;Hypertension [drug therapy] [physiopathology];Male;Middle Aged;Prospective Studies;Registries;Risk Factors;Spain;actimetry;adult;blood pressure monitoring;blood pressure regulation;cardiovascular disease/dt [Drug Therapy];cardiovascular risk;cerebrovascular disease;chronotherapy;circadian rhythm;controlled study;electrocardiogram;female;follow up;heart left ventricle hypertrophy;human;hypertension/dt [Drug Therapy];major clinical study;male;microalbuminuria;pathophysiology;review;sleep waking cycle;urinalysis;amlodipine/dt [Drug Therapy];antihypertensive agent/dt [Drug Therapy];doxazosin/dt [Drug Therapy];nebivolol/dt [Drug Therapy];spirapril/dt [Drug Therapy];torasemide/dt [Drug Therapy];valsartan/dt [Drug Therapy];Sr-htn","Hermida, Rc",2007,,10.1080/07420520701535837,0,1789
1789,Ambulatory blood pressure monitoring in the prediction of cardiovascular events and effects of chronotherapy: rationale and design of the MAPEC study,"Ambulatory blood pressure (BP) measurements (ABPM) correlate more closely with target organ damage and cardiovascular events than clinical cuff measurements. ABPM reveals the significant circadian variation in BP, which in most individuals presents a morning increase, small post-prandial decline, and more extensive lowering during nocturnal rest. However, under certain pathophysiological conditions, the nocturnal BP decline may be reduced (non-dipper pattern) or even reversed (riser pattern). This is clinically relevant because the non-dipper and riser circadian BP patterns constitute a risk factor for left ventricular hypertrophy, microalbuminuria, cerebrovascular disease, congestive heart failure, vascular dementia, and myocardial infarction. Hence, there is growing interest in how to best tailor and individualize the treatment of hypertension according to the specific circadian BP pattern of each patient. All previous trials that have demonstrated an increased cardiovascular risk in non-dipper as compared to dipper patients have relied on the prognostic significance of a single ABPM baseline profile from each participant without accounting for possible changes in the BP pattern during follow-up. Moreover, the potential benefit (i.e., reduction in cardiovascular risk) associated with the normalization of the circadian BP variability (conversion from non-dipper to dipper pattern) from an appropriately envisioned treatment strategy is still a matter of debate. Accordingly, the MAPEC (Monitorizacion Ambulatoria de la Presion Arterial y Eventos Cardiovasculares, i.e., Ambulatory Blood Pressure Monitoring and Cardiovascular Events) study was designed to investigate whether the normalization of the circadian BP profile toward more of a dipper pattern by chronotherapeutic strategies (i.e., specific timing during the 24 h of BP-lowering medications according to the 24 h BP pattern) reduces cardiovascular risk. The prospective MAPEC study investigates 3,000 diurnally active men and women >/=18 yrs of age. At inclusion, BP and wrist activity are measured for 48 h. The initial evaluation also includes a detailed medical history, an electrocardiogram, and screening laboratory blood and urine tests. The same evaluation procedure is scheduled yearly or more frequently (quarterly) if treatment adjustment is required for BP control. Cardiovascular morbidity and mortality are thus evaluated on the basis of changes in BP during follow-up. The MAPEC study, now on its fourth year of follow-up, investigates the potential decrease in cardiovascular, cerebrovascular, and renal risk from the proper modeling of the circadian BP profile by the timed administration (chronotherapy) of antihypertensive medication, beyond the reduction of clinic-determined daytime or ABPM-determined 24 h mean BP levels.","Adult;Antihypertensive Agents/*administration & dosage/therapeutic use;Blood Pressure/drug effects/*physiology;*Blood Pressure Monitoring, Ambulatory;Cardiovascular Diseases/*drug therapy/physiopathology;*Chronotherapy;Circadian Rhythm/physiology;Female;Humans;Hypertension/*drug therapy/physiopathology;Male;Middle Aged;Prospective Studies;Registries;Risk Factors;Spain","Hermida, R. C.",2007,,10.1080/07420520701535837,0,
1790,Risk factors for cardiovascular events of antidementia drugs in Alzheimer's disease patients,"Background: Antidementia drugs have been associated with an increased risk of cardiovascular events. The objective of this study was to identify the predictors for cardiovascular events among patients with Alzheimer's disease (AD) on antidementia drugs, mining large longitudinal claims data. Methods: Using 2006-2011 claims from a 5% random sample of Medicare beneficiaries, I identified patients with AD who filled a prescription for an antidementia drug between 2007 and 2011. I followed them from the initiation of the antidementia drug until a cardiovascular event or December 31, 2011, censored by death or discontinuation of antidementia drugs. The outcome was the incidence of cardiovascular events, which include acute myocardial infarction, bradycardia, syncope, atrioventricular block, QT prolongation, and ventricular tachycardia. Covariates included predefined patient characteristics and empirical attributes identified from the claims, including International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, Healthcare Common Procedure Coding System codes, and therapeutic classes of all prescriptions filled. After using feature selection to choose the top covariates, a logistic regression with multivariate variable selection was constructed. Results: With an accuracy of 83.9% and a sensitivity of 93.3%, the algorithm identified 22 predictors for cardiovascular events, including a history of ischemic heart disease, congestive heart failure, syncope, stroke or transient ischemic attack, diabetes, number of other comorbidities, and procedures including venipuncture and radiologic examinations. Conclusion: The results of this study can help clinicians identify AD patients with a higher risk of cardiovascular events who therefore should be prescribed antidementia drugs cautiously.",acute heart infarction;Alzheimer disease;atrioventricular block;bradycardia;cardiovascular disease;clinical study;comorbidity;congestive heart failure;death;diabetes mellitus;diagnosis;diagnostic test accuracy study;faintness;Healthcare Common Procedure Coding System;heart ventricle tachycardia;human;ICD-9;logistic regression analysis;medicare;mining;prescription,"Hernandez, I.",2016,,,0,1791
1791,Risk factors for cardiovascular events of antidementia drugs in Alzheimer's disease patients,"Background Antidementia drugs have been associated with an increased risk of cardiovascular events. The objective of this study was to identify the predictors for cardiovascular events among patients with Alzheimer's disease (AD) on antidementia drugs, mining large longitudinal claims data. Methods Using 2006–2011 claims from a 5% random sample of Medicare beneficiaries, I identified patients with AD who filled a prescription for an antidementia drug between 2007 and 2011. I followed them from the initiation of the antidementia drug until a cardiovascular event or December 31, 2011, censored by death or discontinuation of antidementia drugs. The outcome was the incidence of cardiovascular events, which include acute myocardial infarction, bradycardia, syncope, atrioventricular block, QT prolongation, and ventricular tachycardia. Covariates included predefined patient characteristics and empirical attributes identified from the claims, including International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, Healthcare Common Procedure Coding System codes, and therapeutic classes of all prescriptions filled. After using feature selection to choose the top covariates, a logistic regression with multivariate variable selection was constructed. Results With an accuracy of 83.9% and a sensitivity of 93.3%, the algorithm identified 22 predictors for cardiovascular events, including a history of ischemic heart disease, congestive heart failure, syncope, stroke or transient ischemic attack, diabetes, number of other comorbidities, and procedures including venipuncture and radiologic examinations. Conclusion The results of this study can help clinicians identify AD patients with a higher risk of cardiovascular events who therefore should be prescribed antidementia drugs cautiously.",nootropic agent;adult;aged;algorithm;Alzheimer disease;article;cardiovascular disease;cardiovascular procedure;cerebrovascular accident;comorbidity;congestive heart failure;controlled study;data mining;diabetes mellitus;faintness;female;human;ischemic heart disease;major clinical study;male;measurement accuracy;medicare;priority journal;radiological procedures;random sample;sensitivity and specificity;transient ischemic attack;vein puncture;very elderly,"Hernandez, I.",2016,,10.1016/j.jcgg.2016.01.002,0,
1792,Bone turnover markers in statin users: A population-based analysis from the Camargo Cohort Study,"Objective: To analyze the effects of statin use on bone turnover markers (BTM), in participants from a large population-based cohort. Subjects and methods: Cross-sectional study that included 2431 subjects (1401 women and 930 men) from the Camargo Cohort. We analyzed the differences in serum BTM between statin or non-statin users, by means of a generalized linear model, adjusted for a wide set of covariates and stratified by diabetes status. We also studied the effect of the type of statin, dose, pharmacokinetic properties, and length of treatment, on BTM. Results: Five hundred subjects (21%) were taking statins (273 women and 227 men). Overall, they had lower levels of aminoterminal propeptide of type I collagen (PINP) and C-terminal telopeptide of type I collagen (CTX) than non-users (p < 0.0001). BTM levels were significantly lower in diabetic women using statins, than in female non-statin users with diabetes. In men, we found similar results, but only for CTX. All the statins users had lower levels of BTM than non-users, except subjects taking fluvastatin that showed slightly higher values. In the whole sample, no differences between dose or drug-potency were noted regarding BTM. When comparing with non-statin users, only subjects taking lipophilic statins had lower BTM levels (p < 0.0001). Serum CTX levels were lower in women using statins for more than 3 vs. 1-3 years (p = 0.006). Conclusions: In a large population-based cohort, serum BTM were lower in participants taking statins than in non-users, and this effect was modulated by diabetes status. Overall, this decrease in BTM was more evident in subjects receiving the more lipophilic statins, especially when using for more than 3 years. © 2013 Elsevier Ireland Ltd.",alkaline phosphatase;atorvastatin;biological marker;C reactive protein;C terminal telopeptide of type I collagen;calcium;cholesterol;collagen;fluindostatin;glucose;high density lipoprotein cholesterol;low density lipoprotein cholesterol;mevinolin;parathyroid hormone;phosphate;pravastatin;propeptide of type I collagen;simvastatin;triacylglycerol;unclassified drug;age;alcohol consumption;alkaline phosphatase blood level;article;body mass;bone density;bone turnover;calcium blood level;calcium intake;cerebrovascular disease;cholesterol blood level;chronic obstructive lung disease;controlled study;cross-sectional study;dementia;drug potency;drug use;educational status;falling;family history;female;femur neck;gender;glomerulus filtration rate;glucose blood level;hip fracture;human;hypertension;ischemic heart disease;lumbar spine;major clinical study;male;menopause;non insulin dependent diabetes mellitus;ossification;osteolysis;parathyroid hormone blood level;phosphate blood level;population research;protein blood level;smoking;spine fracture;treatment duration;triacylglycerol blood level;waist circumference,"Hernández, J. L.;Olmos, J. M.;Romaña, G.;Martinez, J.;Castillo, J.;Yezerska, I.;Ramos, C.;González-Macías, J.",2013,,,0,
1793,Treatment of refractory hiccups with amantadine,"Persistent or intractable hiccups are not uncommon at the end of life, occurring in approximately 4% to 9% of patients, and can cause considerable suffering, including difficulties in eating, drinking, and speaking, insomnia, pain, fatigue, and depression. In palliative practice, the etiology of hiccups is often either unknown or untreatable, and empirical pharmacologic treatment is the norm. Unfortunately, many of the agents reported as effective for hiccups can cause undesirable sedation. The authors describe a patient with end-stage vascular dementia and a 4-year history of idiopathic intractable hiccups who responded dramatically to amantadine, a nonsedating dopamine agonist. The role of dopamine in hiccups is somewhat ambiguous and likely not central to their cause or treatment. Amantadine may be a reasonable option for patients with distressing hiccups who cannot tolerate a sedating agent.",amantadine;baclofen;chlorpromazine;dopamine;gabapentin;haloperidol;isosorbide dinitrate;metoclopramide;omeprazole;ondansetron;simethicone;abdominal radiography;aged;article;atrial fibrillation;case report;chronic kidney disease;clinical practice;computer assisted tomography;congestive heart failure;conscious sedation;coronary artery disease;daily life activity;dementia;diabetes mellitus;drug megadose;drug tolerability;eating disorder;esophagogastroduodenoscopy;esophagus stenosis;functional assessment;Functional Assessment Staging Tool;gastritis;gastrointestinal hemorrhage;hiccup;hospital admission;human;idiopathic disease;intractable hiccup;long term care;low drug dose;male;medical history;multiinfarct dementia;palliative therapy;peripheral vascular disease;speech disorder;stomach emptying;study;thorax radiography;treatment response,"Hernandez, S. L.;Fasnacht, K. S.;Sheyner, I.;King, J. M.;Stewart, J. T.",2015,,,0,
1794,Factors associated To medication changes in institutionalized elderly people,"Objective: To identify the factors associated to the number of medication changes (MC) in institutionalized elderly. Method: Prospective study conducted during four months. The number of MC was recorded weekly. We analyzed the factors associated with a high number of changes (four or more), calculating the Odds Ratio as a measure of association and the Fisher's exact test for statistical significance. Results: 997 MC were recorded in 234 elderly. 42.7% of the patients had four or more MC. The factors associated with a high number of MC were, chronic renal failure, immobility syndrome, loss of visual acuity, comorbidity, and polypharmacy. Conclusions: A high number of MC is associated with factors considered as risk indicators of drug-related problems. The number of MC in institutionalized patients may be an indicator to prioritize medication review.",aged;article;cerebrovascular accident;chronic kidney failure;comorbidity;constipation;dementia;depression;drug substitution;dyslipidemia;female;fracture;geriatric patient;hearing disorder;atrial fibrillation;heart failure;human;hypertension;immobilization;insomnia;major clinical study;male;non insulin dependent diabetes mellitus;polyarthritis;polypharmacy;prospective study;risk assessment;urine incontinence;visual disorder,"Hernández Soto, L. E.;Ruiz-Canela López, M.;Beltrán Gárate, I.;Castellanos Lácar, C.;Beitia Berrotarán, G.;Lasheras Aldaz, B.",2013,,,0,
1795,Treatment of comorbid depression in medical illness,,amfebutamone;amitriptyline;amoxapine;antiarrhythmic agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;citalopram;clomipramine;desipramine;doxepin;duloxetine;fluoxetine;fluvoxamine;imipramine;maprotiline;mirtazapine;nefazodone;nortriptyline;paroxetine;phenelzine;placebo;protriptyline;serotonin uptake inhibitor;sertraline;tranylcypromine;trazodone;tricyclic antidepressant agent;venlafaxine;anticholinergic syndrome;asthma;chronic obstructive lung disease;chronic pain;comorbidity;dementia;depression;diabetes mellitus;diabetic neuropathy;drug efficacy;drug safety;epilepsy;heart arrhythmia;heart failure;heart infarction;heart muscle conduction disturbance;human;hypertension;ischemic heart disease;kidney disease;letter;liver disease;neuropathic pain;recommended drug dose;sedation;side effect;smoking cessation;thyroid disease,"Herring, C.;Muzyk, A. J.;Jamerson, B.",2010,,,0,
1796,"Ginkgo biloba extract EGb 761<sup>®</sup> in dementia with neuropsychiatric features: A randomised, placebo-controlled trial to confirm the efficacy and safety of a daily dose of 240 mg","A multi-centre, double-blind, randomised, placebo-controlled, 24-week trial with 410 outpatients was conducted to demonstrate efficacy and safety of a 240 mg once-daily formulation of Ginkgo biloba extract EGb 761<sup>®</sup> in patients with mild to moderate dementia (Alzheimer's disease or vascular dementia) associated with neuropsychiatric symptoms. Patients scored 9 to 23 on the SKT cognitive battery, at least 6 on the Neuropsychiatric Inventory (NPI), with at least one of four key items rated at least 4. Primary outcomes were the changes from baseline to week 24 in the SKT and NPI total scores. The ADCS Clinical Global Impression of Change (ADCS-CGIC), Verbal Fluency Test, Activities of Daily Living International Scale (ADL-IS), DEMQOL-Proxy quality-of-life scale and 11-point box scales for tinnitus and dizziness were secondary outcome measures. Patients treated with EGb 761<sup>®</sup> (n = 200) improved by 2.2 ± 3.5 points (mean ± sd) on the SKT total score, whereas those receiving placebo (n = 202) changed only slightly by 0.3 ± 3.7 points. The NPI composite score improved by 4.6 ± 7.1 in the EGb 761<sup>®</sup>-treated group and by 2.1 ± 6.5 in the placebo group. Both drug-placebo comparisons were significant at p < 0.001. Patients treated with EGb 761<sup>®</sup> also showed a more favourable course in most of the secondary efficacy variables. In conclusion, treatment with EGb 761<sup>®</sup> at a once-daily dose of 240 mg was safe and resulted in a significant and clinically relevant improvement in cognition, psychopathology, functional measures and quality of life of patients and caregivers. © 2012 Elsevier Ltd.",Ginkgo biloba extract;placebo;abdominal pain;adult;Alzheimer disease;article;clinical feature;Clinical Global Impression scale;cognition;controlled study;daily life activity;dementia;disease severity;dizziness;double blind procedure;drug efficacy;drug induced headache;drug safety;female;heart arrest;human;hypertension;infarction;major clinical study;male;mental disease;multicenter study;multiinfarct dementia;neurologic examination;outcome assessment;pneumonia;priority journal;quality of life;randomized controlled trial;rating scale;somnolence;tinnitus;transient ischemic attack;treatment duration;verbal fluency test;viral respiratory tract infection;egb 761,"Herrschaft, H.;Nacu, A.;Likhachev, S.;Sholomov, I.;Hoerr, R.;Schlaefke, S.",2012,,,0,
1797,Mobility assessment of hip fracture patients during a post-acute rehabilitation program,"Our aim was to describe improvement in mobility level in hip fracture patients during a post-acute rehabilitation program and examine variables that may impede mobility improvement. A retrospective chart review of 138 patients with a proximal hip fracture, admitted consecutively during 2006 was conducted. Main outcome measurements were: 6-meter-walking-time (6mWT), rate of improvement (RI) in the 6mWT, gait velocity (GV), functional independence measure (FIM), motor FIM (mFIM) and length of stay (LOS). Most patients (118, 85.5%) showed improvement in the 6mWT (mean 16.05 ± 20.2. s, median 12.08). At discharge, 117 patients (84.7%) achieved GV within household ambulation (<0.4. m/s). Patients with high initial GV needed shorter rehabilitation time compare to patients with low admission GV (27.5 ± 12.1 days vs. 31.7 ± 12.2 days; p=. 0.042). The high RI group (≥1. s/day) achieved significantly higher admission and discharge FIM scores (70.7 ± 15.9 vs. 64.1 ± 16.9, p=. 0.023; 87.3 ± 15.8 vs. 79.9 ± 17.4, p=. 0.013, respectively) and higher admission and discharge mFIM scores (45.3 ± 12.9 vs. 40.8.1 ± 12.7, p=. 0.049; 60.7 ± 12.4 vs. 56.2 ± 13.4, p=. 0.045, respectively) compared with the low performance group (<1. s/day). Logistic regression analyzed the variables with significant predictive value for achieving high RI (≥1. s/day): performance of the 6mWT at FIM ≥ 4 (OR 1.092; 95% CI, 1.056-1.129) and admission FIM score (OR 1.054; 95% CI, 1.023-1.085). Post-acute hip fracture patients capable of bearing weight on their injured leg, with minimal assistance [manual assistance of ≤25% (FIM ≥ 4)] may considerably improve their mobility regardless of their disability, cognitive level or neurological history. Most patients achieved GV enabling them to ambulate short distances within the home. © 2011 Elsevier Ireland Ltd.",albumin;6 meter walking time;aged;article;cerebrovascular accident;chronic obstructive lung disease;cognition;comorbidity;congestive heart failure;dementia;depression;diabetes mellitus;dialysis;educational status;female;Functional Independence Measure;gait;gender;hip fracture;hospital admission;hospital discharge;household;human;hypertension;ischemic heart disease;length of stay;major clinical study;male;medical history;medical record review;motor performance;neoplasm;outcome assessment;Parkinson disease;patient mobility;peripheral vascular disease;post acute rehabilitation program;priority journal;rehabilitation care;vascular disease;walking;weight bearing,"Hershkovitz, A.;Beloosesky, Y.;Brill, S.",2012,,,0,
1798,Factors associated with medication regimen complexity in residents of long-term care facilities,"Polypharmacy and multimorbidity are highly prevalent in long-term care facilities (LTCFs). However, no previous research has investigated factors associated with medication regimen complexity in older residents living in LTCFs. To investigate factors associated with medication regimen complexity in LTCFs. This was a cross-sectional study across six LTCFs in South Australia. Medication, clinical and diagnostic data were extracted from each residents medication and medical record. Residents medication regimen complexity was quantified using the validated 65-item Medication Regimen Complexity Index (MRCI). Multinomial logistic regression analyses were used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for variables associated with high regimen complexity. There were a total of 383 participants in the study. The mean age of the participants was 87.5 (standard deviation [SD]: 6.2) years. The median MRCI was 43.5 (range: 4-113). The median number of regular and as-needed medications was 13.0 (range: 1-30). Chronic pulmonary disease (OR: 5.10, 95% CI: 2.21-11.8), diabetes (OR: 3.22, 95% CI: 1.51-6.86) and congestive heart failure (OR: 3.13, 95% CI: 1.10-8.85) were associated with high regimen complexity. Independence in activities of daily living (ADLs) (OR: 0.72, 95% CI: 0.62-0.84) and diagnosed dementia (OR: 0.34, 95% CI: 0.17-0.67) were inversely associated with high regimen complexity.LTCF residents are at-risk of high medication regimen complexity. Diabetes, congestive heart failure and chronic pulmonary diseases were associated with high regimen complexity, whereas dementia was inversely associated with high regimen complexity.",aged;article;Australia;cerebrovascular disease;chronic lung disease;congestive heart failure;controlled study;daily life activity;dementia;diabetes mellitus;drug therapy;female;health care facility;human;long term care;major clinical study;male;medical record;polypharmacy;priority journal;resident,"Herson, M.;Bell, J. S.;Tan, E. C. K.;Emery, T.;Robson, L.;Wimmer, B. C.",2015,,,0,
1799,Three-dimensional mri analysis of individual volume of lacunes in CADASIL,"BACKGROUND AND PURPOSE: Three-dimensional MRI segmentation may be useful to better understand the physiopathology of lacunar infarctions. Using this technique, the distribution of lacunar infarctions volumes has been recently reported in patients with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Whether the volume of each lacune (individual lacunar volume [ILV]) is associated with the patients' other MRI lesions or vascular risk factors has never been investigated. The purpose of this study was to study the impact of age, vascular risk factors, and MRI markers on the ILV in a large cohort of patients with CADASIL. METHODS: Of 113 patients with CADASIL, 1568 lacunes were detected and ILV was estimated after automatic segmentation on 3-dimensional T1-weighted imaging. Relationships between ILV and age, blood pressure, cholesterol, diabetes, white matter hyperintensities load, number of cerebral microbleeds, apparent diffusion coefficient, brain parenchymal fraction, and mean and median of distribution of lacunes volumes at the patient level were investigated. We used random effect models to take into account intraindividual correlations. RESULTS: The ILV varied from 4.28 to 1619 mm. ILV was not significantly correlated with age, vascular risk factors, or different MRI markers (white matter hyperintensity volume, cerebral microbleed number, mean apparent diffusion coefficient or brain parenchymal fraction). In contrast, ILV was positively correlated with the patients' mean and median of lacunar volume distribution (P≤0.0001). CONCLUSIONS: These results suggest that the ILV is not related to the associated cerebral lesions or to vascular risk factors in CADASIL, but that an individual predisposition may explain predominating small or predominating large lacunes among patients. Local anatomic factors or genetic factors may be involved in these variations. Copyright © 2009 American Heart Association. All rights reserved.",adult;article;brain atrophy;brain hemorrhage;brain size;CADASIL;cardiovascular risk;controlled study;diffusion coefficient;disease association;female;human;major clinical study;male;nuclear magnetic resonance imaging;priority journal;three dimensional imaging;white matter,"Hervé, D.;Godin, O.;Dufouil, C.;Viswanathan, A.;Jouvent, E.;Pachaí, C.;Guichard, J. P.;Bousser, M. G.;Dichgans, M.;Chabriat, H.",2009,,,0,
1800,Shape and volume of lacunar infarcts: A 3D MRI study in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,"Background and Purpose - The shape and exact size of lacunar infarcts have been investigated only postmortem. Recent imaging techniques based on triangulation and connectivity can now be used for 3D segmentation of cerebral lesions. The shape and size of lacunar infarcts was investigated using these techniques in 10 cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients. Methods - We segmented 102 lacunar infarcts on T1-weighted images. The surface of the corresponding set of voxels was computed as a mesh of triangles. Thereafter, the shape of each lesion in 3D was visually analyzed by 2 investigators. Results - The volume of lesions ranged from 10.5 to 1146 mm, with 93% of them having a volume <500 mm; 83% lacunar infarcts had a spheroid or ovoid shape, but 17% presented as sticks, slabs, or with a complex shape. Lesions with multiple components appeared larger than the others, and a tail extension was noticed in 13 of 102 lesions. Conclusions - These results suggest the following: (1) most lacunar infarcts in CADASIL have a volume far below one third of that of a sphere of 15 mm in diameter, the upper limit currently used for their identification on 2D imaging; (2) a significant proportion of lacunar infarcts have a shape distinct from the spheroid-ovoid morphology; and (3) lesions with a complex shape may result from the involvement of the largest small arteries, confluence of ischemic lesions, or secondary tissue degeneration. The segmentation of lacunar infarcts appears promising to better understand the pathophysiology of tissue lesions secondary to small vessel diseases. © 2005 American Heart Association, Inc.",adult;artery diameter;article;brain infarction;brain infarction size;CADASIL;cadaver;clinical article;diagnostic test;human;image analysis;image quality;lacunar stroke;nuclear magnetic resonance imaging;pathophysiology;priority journal;three dimensional imaging,"Hervé, D.;Mangin, J. F.;Molko, N.;Bousser, M. G.;Chabriat, H.",2005,,,0,
1801,Alzheimer's disease and co-morbidity: Increased prevalence and possible risk factors of excess mortality in a naturalistic 7-year follow-up,"Background: Subjects with late-onset Alzheimer's disease (AD) have to be sufficiently healthy to live long enough to experience and to be diagnosed with dementia in later life. In contrast, neurodegeneration and cognitive deficits in AD may increase the frequency of co-morbid disorders and their possible influence on mortality. Consequently, we investigated whether the pattern of co-morbidity and its relevance for later death differed between hospitalized AD and age-matched controls subjects. Methods: Co-morbid diseases with a prevalence of more than 1% at hospital admission were compared between 634 hospitalized AD and 72,244 control subjects aged above 70 years admitted to the University of Birmingham NHS Trust between 1 January 2000 to 31 December 2007. Risk factors, i.e. co-morbid diseases that were predictors of mortality within the 7-year follow-up, were identified and compared. Results: Subjects with AD suffer more eating disorders, infections, brain diseases and neck of femur fractures than other hospitalized elderly patients. In contrast, some cardiovascular diseases and diabetes mellitus were less prevalent in AD subjects in comparison with hospitalized controls. Diseases that might have contributed to later mortality in AD were pneumonia, ischemic heart disease and gastroenteritis, but there were no significant differences in their impact on mortality compared to other hospitalized elderly subjects with the same co-morbidities in multivariate logistic regression analyses. Conclusion: Patients with AD have a different pattern of co-morbidity, but die from the same diseases as other hospitalized patients. Infections including pneumonia and diseases that may occur secondary to neurodegeneration and cognitive decline may need special attention in patients with AD who may not be able to identify or report the early symptoms. Preventive measures may be helpful to reduce the high risk and fatal consequences of undetected disease in AD.",age distribution;aged;Alzheimer disease;article;brain disease;cardiovascular risk;comorbidity;controlled study;eating disorder;ethnicity;female;femur fracture;follow up;gastroenteritis;geriatric care;hospital admission;hospital patient;human;imaging;ischemic heart disease;long term care;major clinical study;male;memory;mortality;multicenter study (topic);pneumonia;prevalence;priority journal;retrospective study;risk factor;sex difference;social psychology;survival rate;very elderly,"Heun, R.;Schoepf, D.;Potluri, R.;Natalwala, A.",2013,,,0,
1802,McLeod myopathy revisited: More neurogenic and less benign,"The X-linked McLeod neuroacanthocytosis syndrome (MLS) has originally been denoted as 'benign' McLeod myopathy. We assessed the clinical findings and the muscle pathology in the eponymous index patient, Hugh McLeod, and in nine additional MLS patients. Only one patient had manifested with neuromuscular symptoms. During a mean follow-up of 15 years, however, eight patients including the initial index patient showed elevated skeletal muscle creatine kinase levels ranging from 300 to 3000 U/L, and had developed muscle weakness and atrophy. Two patients had disabling leg weakness. Muscle histology was abnormal in all 10 patients. Clear but unspecific myopathic changes were found in only four patients. All patients, however, had neurogenic changes of variable degree. Post-mortem motor and sensory nerve examinations support the view that muscle atrophy and weakness are predominantly due to an axonal motor neuropathy rather than to a primary myopathy. Multisystem manifestations developed in eight patients at a mean age of 39 years. Three patients manifested with psychiatric features comprising schizophrenia-like psychosis and personality disorder, two presented with generalized seizures and one with chorea. During follow-up, seven patients developed chorea, six had psychiatric disorders, five had cognitive decline and three had generalized seizures. Five patients died because of MLS-related complications including sudden cardiac death, chronic heart failure and pneumonia between 55 and 69 years. In conclusion, our findings confirm that MLS is not a benign condition but rather a progressive multisystem disorder sharing many features with Huntington's disease. © The Author (2007). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.",creatine kinase;adult;article;autopsy;chorea;clinical article;controlled study;creatine kinase blood level;follow up;genetic analysis;tonic clonic seizure;heart death;heart failure;histology;human;human tissue;Huntington chorea;hypertranslucent lung;mcleod neuroacanthocytosis syndrome;mental deterioration;mental disease;molecular genetics;motor nerve;motor neuropathy;muscle atrophy;muscle weakness;neuromuscular disease;personality disorder;pneumonia;priority journal;psychosis;schizophrenia;sensory nerve;skeletal muscle;systemic disease;X chromosome linked disorder,"Hewer, E.;Danek, A.;Schoser, B. G.;Miranda, M.;Reichard, R.;Castiglioni, C.;Oechsner, M.;Goebel, H. H.;Heppner, F. L.;Jung, H. H.",2007,,,0,
1803,Prevalence and patterns of multimorbidity among the elderly in Burkina Faso: Cross-sectional study,"Objectives: To assess the prevalence and distribution patterns of multimorbidity among urban older adults in Burkina Faso. Methods: Cross-sectional study among community-dwelling elderly people aged ≥60 in Bobo-Dioulasso. We performed interviews, clinical examination and medical record review. Multimorbidity was defined as co-occurrence of at least two chronic diseases in one person whether as a coincidence or not. Results: The overall prevalence of multimorbidity among older adults was 65%. Age ≥70 was associated with multimorbidity in multivariate analysis: adjusted OR = 1.65, 95% CI (1.01-2.68, P = 0.04). The most common chronic diseases were hypertension (82%) 95% CI (78; 86), malnutrition (39%) 95% CI (34; 44), visual impairments (28%) 95% CI (24; 33) and diabetes mellitus (27%) 95% CI (22; 31). Those aged ≥70 had significantly more malnutrition (50% vs. 31%, P = 0.0003) and osteoarthritis (8% vs. 3%, P = 0.01) than those aged 60-69. Conclusions: The high prevalence of multimorbidity requires a reorganization of healthcare systems in sub-Saharan Africa, especially in Burkina Faso. Interventions and care guidelines usually focused on individual diseases should be improved to better reflect this reality.",adult;aged;article;Burkina Faso;cardiovascular disease;chronic disease;chronic obstructive lung disease;clinical examination;community living;comorbidity assessment;cross-sectional study;dementia;diabetes mellitus;female;geriatrics;groups by age;health care system;hearing impairment;heart arrhythmia;heart failure;human;hypertension;interview;major clinical study;male;malnutrition;medical record review;neoplasm;osteoarthritis;Parkinson disease;peripheral occlusive artery disease;prevalence;thyroid disease;visual impairment,"Hien, H.;Berthé, A.;Drabo, M. K.;Meda, N.;Konaté, B.;Tou, F.;Badini-Kinda, F.;Macq, J.",2014,,,0,
1804,Factors predictive of survival after percutaneous endoscopic gastrostomy in the elderly: is dementia really a risk factor?,"OBJECTIVES: Outcomes, especially survival, after percutaneous endoscopic gastrostomy (PEG) in patients with dementia remain unclear. The aims of this study were to assess the impact of dementia on survival after PEG and to explore the risk factors in elderly patients. METHODS: A total of 311 consecutive Japanese patients who underwent PEG were enrolled in this retrospective cohort study. Dementia was defined according to the standard criteria. After the clinical characteristics of patients with and without dementia were compared, the Kaplan-Meier method and Cox proportional-hazards regression analysis were applied to analyze survival rates. RESULTS: Survival was not significantly different between the two groups. The 12-month survival rate of patients with dementia (N = 143) was 51%, and that of patients without dementia (N = 168) was 49%. More than 20% of patients with dementia lived more than 3 yr after PEG. The predictors of poor survival after PEG were previous subtotal gastrectomy (odds ratio [OR] 2.619, 95% confidence interval [CI] 1.367-5.019), serum albumin <2.8 g/dL (OR 2.081, 95% CI 1.490-2.905), age >80 yr (OR 1.721, 95% CI 1.234-2.399), chronic heart failure (OR 1.541, 95% CI 1.096-2.168), and male gender (OR 1.407, 95% CI 1.037-1.909). CONCLUSIONS: In our series, there was no evidence to support a poorer prognosis after PEG in elderly people with dementia compared with the cognitively preserved elderly. However, if patients are male or of advanced age, have a low serum albumin, chronic heart failure, or subtotal gastrectomy, physicians should inform families that a poor prognosis is expected before performing PEG.","Aged;Chi-Square Distribution;*Dementia;*Endoscopy, Gastrointestinal;Female;Gastrostomy/*methods/mortality;Humans;Japan/epidemiology;Male;Predictive Value of Tests;Prognosis;Proportional Hazards Models;Retrospective Studies;Risk Factors;Survival Rate","Higaki, F.;Yokota, O.;Ohishi, M.",2008,Apr,10.1111/j.1572-0241.2007.01719.x,0,
1805,Relationship between number of medical conditions and quality of care,"BACKGROUND: There is emerging concern that the methods used to measure the quality of care unfairly penalize providers caring for patients with multiple chronic conditions. We therefore sought to study the relationship between the quality of care and the number of medical conditions a patient has. METHODS: We assessed measurements of the quality of medical care received in three cohorts of community-dwelling adult patients in the Community Quality Index study, the Assessing Care of Vulnerable Elders study, and the Veterans Health Administration project (7680 patients in total). We analyzed the relationship between the quality of care that patients received, defined as the percentage of quality indicators satisfied among those for which patients were eligible, and the number of chronic medical conditions each patient had. We further explored the roles of characteristics of patients, use of health care (number of office visits and hospitalizations), and care provided by specialists as explanations for the observed relationship. RESULTS: The quality of care increased as the number of medical conditions increased. Each additional condition was associated with an increase in the quality score of 2.2% (95% confidence interval [CI], 1.7 to 2.7) in the Community Quality Index cohort, of 1.7% (95% CI, 1.1 to 2.4) in the Assessing Care of Vulnerable Elders cohort, and of 1.7% (95% CI, 0.7 to 2.8) in the Veterans Health Administration cohort. The relationship between the quality of care and the number of conditions was little affected by adjustment for the difficulty of delivering the care recommended in a quality indicator and for the fact that, because of multiple conditions requiring the same care, a patient could be eligible to receive the same care process more than once. Adjustment for characteristics of patients, use of health care, and care provided by specialists diminished the relationship, but it remained positive. CONCLUSIONS: The quality of care, measured according to whether patients were offered recommended services, increases as a patient's number of chronic conditions increases. Copyright © 2007 Massachusetts Medical Society.",adult;aged;ambulatory care;article;asthma;breast cancer;chronic obstructive lung disease;cohort analysis;colorectal cancer;community;confidence interval;coronary artery disease;decubitus;dementia;depression;diabetes mellitus;dyspepsia;female;health care;health care management;health care quality;health service;atrial fibrillation;heart failure;hospitalization;human;hypertension;kidney failure;male;medical care;medical specialist;osteoarthritis;osteoporosis;patient care;priority journal;prostate cancer;prostate hypertrophy;quality control;cerebrovascular accident;urine incontinence;veteran,"Higashi, T.;Wenger, N. S.;Adams, J. L.;Fung, C.;Roland, M.;McGlynn, E. A.;Reeves, D.;Asch, S. M.;Kerr, E. A.;Shekelle, P. G.",2007,,,0,
1806,"A Pilot Trial to Increase Hospice Enrollment in an Inner City, Academic Emergency Department","Background Hospice is underutilized, with over 25% of enrolled patients receiving hospice care for 3 days or less. The inner city emergency department (ED) is a highly trafficked area for patients in the last 6 months of life, and is a potential location for identification of hospice-eligible patients and early palliative care (PC) intervention. Objectives We evaluated the feasibility of an ED PC intervention to identify hospice-eligible patients to accelerate PC consultation and hospice enrollment. Methods This prospective, pilot study established a program in the ED via education and a direct line of communication between the ED and PC to identify hospice-eligible patients, with the goal of facilitating disposition to hospice within 24 h. Data were analyzed for time to PC consultation, length of stay, emergency physician (EP) appropriateness of referral, and time from hospitalization to mortality. Results In a 6-month period, EPs identified 88 hospice-eligible patients with 91% accuracy. Of the patients identified, 59% died within 3 months of their visit to the ED. Time to PC consultation was 2.3 days (SD 2.3), and 57% of those seen by PC were discharged to hospice, vs. 30% of those not consulted (p = 0.038). The potential median hospice length of stay was 31.5 days, better than for the institution as a whole. Conclusions Our pilot study presents a unique approach to early identification and disposition of hospice-appropriate patients, and suggests EPs may have sufficient prognostic accuracy to perform this task.",article;consultation;dementia;emergency physician;emergency ward;feasibility study;genetic disorder;heart failure;hematologic disease;hematologic malignancy;hospice care;hospitalization;human;Human immunodeficiency virus infection;length of stay;liver failure;lung disease;major clinical study;medicare;mortality;neurologic disease;observational study;palliative therapy;patient identification;patient referral;pilot study;primary tumor;priority journal;prognosis;prospective study;solid malignant neoplasm;university hospital,"Highet, B. H.;Hsieh, Y. H.;Smith, T. J.",2016,,10.1016/j.jemermed.2016.03.018,0,
1807,"Plasma Amyloid-β Levels, Cerebral Small Vessel Disease, and Cognition: The Rotterdam Study","Background: Plasma amyloid-β (Aβ) levels are increasingly studied as a potential, accessible marker of cognitive impairment and dementia. The most common plasma Aβ isoforms, i.e., Aβ1-40 and Aβ 1-42 have been linked with risk of Alzheimer's disease. However, it remains under-explored whether plasma Aβ levels including novel Aβ 1-38 relate to vascular brain disease and cognition in a preclinical-phase of dementia Objective: To examine the association of plasma Aβ levels (i.e., Aβ1-38, Aβ 1-40, and Aβ 1-42) with markers of cerebral small vessel disease (SVD) and cognition in a large population-based setting. Methods: We analyzed plasma A-1 levels in 1201 subjects from two independent cohorts of the Rotterdam Study. Markers of SVD [lacunes, white matter hyperintensity (WMH) volume] were assessed on brain MRI (1.5T). Cognition was assessed by a detailed neuropsychological battery. In each cohort, the association of Aβ levels with SVD and cognition was performed using regression models. Estimates were then pooled across cohorts using inverse variance meta-Analysis with fixed effects. Results: Higher levels of plasma Aβ 1-38, Aβ 1-40, Aβ 1-42, and Aβ 1-40/ Aβ 1-42 ratio were associated with increasing lacunar and microbleeds counts. Moreover, higher levels ofAβ1-40 andAβ 1-40/ Aβ1-42 were significantly associated with largerWMH volumes. With regard to cognition, a higher level of Aβ 1-38 Aβ 1-40 and Aβ 1-40/ Aβ 1-42 was related to worse performance on cognitive test specifically in memory domain. Conclusion: Higher plasma levels of Aβ levels are associated with subclinical markers of vascular disease and poorer memory. Plasma Aβ levels thus mark the presence of vascular brain pathology.",nuclear magnetic resonance scanner;VISION MR;amyloid beta protein;amyloid beta protein[1-38];amyloid beta protein[1-40];amyloid beta protein[1-42];antihypertensive agent;apolipoprotein E;edetic acid;unclassified drug;adult;aged;antihypertensive therapy;article;cerebrovascular disease;cognitive defect;cohort analysis;female;human;hypertension;ischemic heart disease;major clinical study;male;mean arterial pressure;memory;middle aged;neuroimaging;neuropathology;nuclear magnetic resonance imaging;priority journal;protein blood level;recognition;risk assessment;smoking,"Hilal, S.;Akoudad, S.;Van Duijn, C. M.;Niessen, W. J.;Verbeek, M. M.;Vanderstichele, H.;Stoops, E.;Arfan Ikram, M.;Vernooij, M. W.",2017,,10.3233/jad-170458,0,
1808,Markers of cardiac dysfunction in cognitive impairment and dementia,"Markers of cardiac dysfunction such as amino terminal pro-brain natriuretic peptide (NTpro-BNP) and high sensitivity cardiac troponin T (hs-cTnT) may be associated with dementia. However, limited data exist on their association with either pre-dementia stages, that is, cognitive impairment no dementia (CIND), or the burden of cerebrovascular diseases (CeVD).We therefore, examined the association of these biomarkers of cardiac dysfunction with CeVD in both CIND and dementia.A case-control study, with cases recruited from memory clinics and controls from memory clinics and community. All subjects underwent collection of blood samples, neuropsychological assessment, and neuroimaging. Subjects were classified as CIND and dementia based on clinical criteria whilst significant CeVD was defined as the presence of cortical infarcts and/or more than 2 lacunes and/or confluent white matter lesions in two regions of brain on Age-Related White Matter Changes Scale.We included a total of 35 controls (mean age: 65.9 years), 78 CIND (mean age: 70.2 years) and 80 cases with dementia (mean age: 75.6 years). Plasma concentrations of hs-cTnT were associated significantly with CeVD in both CIND (odds ratios [OR]: 9.05; 95% confidence interval [CI]: 1.64-49.79) and dementia (OR: 16.89; 95%CI: 2.02-142.67). In addition, NTpro-BNP was associated with dementia with CeVD (OR: 7.74; 95%CI: 1.23-48.58). These associations were independent of other vascular risk factors.In this study, we showed that plasma NTproBNP and hs-cTnT are associated with dementia and CIND, only when accompanied by presence of CeVD.",amino terminal pro brain natriuretic peptide;troponin T;Age Related White Matter Changes Scale;aged;article;assessment of humans;brain infarction;case control study;cerebrovascular disease;cognitive defect;congestive heart failure;controlled study;dementia;diabetes mellitus;disease association;female;atrial fibrillation;heart disease;heart infarction;human;hypertension;major clinical study;male;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;priority journal;protein blood level;white matter lesion;Magnetom Trio Tim,"Hilal, S.;Chai, Y. L.;Ikram, M. K.;Elangovan, S.;Yeow, T. B.;Xin, X.;Chong, J. Y.;Venketasubramanian, N.;Richards, A. M.;Chong, J. P. C.;Lai, M. K. P.;Chen, C.",2015,,,0,
1809,Association Between Subclinical Cardiac Biomarkers and Clinically Manifest Cardiac Diseases With Cortical Cerebral Microinfarcts,"Importance: Subclinical and clinical cardiac diseases have been previously linked to magnetic resonance imaging (MRI) manifestations of cerebrovascular disease, such as lacunes and white matter hyperintensities, as well as dementia. Cortical cerebral microinfarcts (CMIs), a novel MRI marker of cerebral vascular disease, have not been studied, to date, in relation to subclinical and clinical cardiac diseases. Objective: To examine the association of blood biomarkers of subclinical cardiac disease and clinically manifest cardiac diseases with CMIs graded on 3-T MRI in a memory clinic population. Design, Setting, and Participants: This baseline cross-sectional analysis of a cohort study performed from August 12, 2010, to July 28, 2015, included 464 memory clinic participants. All participants underwent collection of blood samples, neuropsychological assessment, and 3-T MRI. Exposures: N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) concentrations were measured by electrochemiluminescence immunoassays. Cardiac disease was defined as a history of atrial fibrillation, ischemic heart diseases, or congestive heart failure. Main Outcomes and Measures: The CMIs were graded according to a previously validated protocol. Results: Of 464 participants, 124 had insufficient blood plasma samples and 97 had no CMI grading (none, incomplete, or ungradable MRI), leaving a sample size of 243 for final analysis (mean [SD] age, 72.8 [9.1] years; 116 men [42.9%]). Seventy participants (28.8%) had cortical CMIs (median, 1; range, 0-43). Compared with participants with no CMIs, those with CMIs had a significantly higher prevalence of atrial fibrillation (rate ratio [RR], 1.62; 95% CI, 1.20-21.8), ischemic heart disease (RR, 4.31; 95% CI, 3.38-5.49), and congestive heart failure (RR, 2.05; 95% CI, 1.29-3.25). Significantly higher levels of NT-proBNP (RR, 3.16; 95% CI, 2.33-4.27) and hs-cTnT (RR, 2.17; 95% CI, 1.00-4.74) were found in participants with CMIs. In multivariate models adjusted for demographics and vascular risk factors, higher levels of NT-proBNP (RR, 3.19; 95% CI, 2.62-3.90) and hs-cTnT (RR, 4.86; 95% CI, 3.03-7.08) were associated with CMIs. These associations persisted even after excluding patients with clinically manifest cardiac disease. Conclusions and Relevance: This study found that biomarkers of subclinical cardiac disease and clinically manifest cardiac diseases were associated with CMIs on 3-T MRI in patients attending a memory clinic, suggesting that cardiac disease may contribute to the development of CMIs. Hence, cardiac dysfunction should be targeted as a potentially modifiable factor to prevent CMI-related brain injury.","0 (Peptide Fragments);0 (Troponin T);0 (pro-brain natriuretic peptide (1-76));114471-18-0 (Natriuretic Peptide, Brain);Aged;Aged, 80 and over;Atrophy/diagnostic imaging/etiology;Cerebral Cortex/diagnostic imaging/ pathology;Cognition Disorders/etiology;Cohort Studies;Cross-Sectional Studies;Female;Heart Diseases/blood/complications/diagnostic imaging;Humans;Imaging, Three-Dimensional;Magnetic Resonance Imaging;Male;Middle Aged;Natriuretic Peptide, Brain/ blood;Peptide Fragments/ blood;Troponin T/ blood","Hilal, S.;Chai, Y. L.;van Veluw, S.;Shaik, M. A.;Ikram, M. K.;Venketasubramanian, N.;Richards, A. M.;Biessels, G. J.;Chen, C.",2017,Apr 01,,0,
1810,"Ankle-brachial index, cognitive impairment and cerebrovascular disease in a chinese population","Background: Previous studies have assessed the association between ankle-brachial index (ABI) and cognition, mainly using brief cognitive tests. We investigated whether ABI was associated with cognition independent of neuroimaging markers of cerebrovascular disease. Methods: Chinese subjects (n = 278, aged ≥60 years) were recruited from the ongoing Epidemiology of Dementia in Singapore (EDIS) Study. Ankle and brachial blood pressures were measured, and low ABI was defined as ≤0.9. A neuropsychological battery was utilized to determine cognition. Cognitive impairment no dementia (CIND) and dementia were diagnosed according to standard diagnostic criteria. Magnetic resonance imaging (MRI) was used to obtain semiquantitative and quantitative markers of cerebrovascular disease and atrophy. Results: A low ABI was related to the presence of intracranial stenosis (odds ratio, OR = 1.71; 95% confidence interval, CI: 1.13-2.59), but not with the presence of infarcts, microbleeds or grey matter, white matter and white matter lesion volumes. Furthermore, a low ABI was associated with poorer overall cognitive function and CIND-moderate/dementia (OR = 2.26; 95% CI: 1.11-4.59), independent of cardiovascular risk factors, and the MRI markers related to cerebrovascular disease and atrophy. Conclusion: We found an association between a low ABI and cognitive impairment, independent of any MRI marker of cerebral small vessel disease or large artery atherosclerotic disease.",C reactive protein;adult;aged;ankle brachial index;article;attention;blood pressure measurement;brain atrophy;brain hemorrhage;brain infarction;brain size;cardiovascular risk;cerebrovascular disease;Chinese;cognition;cognitive defect;dementia;depression;diabetes mellitus;female;gray matter;human;hyperlipidemia;hypertension;intracranial stenosis;ischemic heart disease;language;major clinical study;male;neuroimaging;neuropsychological test;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;smoking;stenosis;verbal memory;visual memory;white matter;white matter lesion,"Hilal, S.;Saini, M.;Tan, C. S.;Catindig, J. A.;Dong, Y. H.;Leon, L. B. S.;Niessen, W. J.;Vrooman, H.;Wong, T. Y.;Chen, C.;Venketasubramanian, N.;Ikram, M. K.",2014,,,0,
1811,Effects of pioglitazone or exercise in older adults with mild cognitive impairment and insulin resistance: A pilot study,"Aims: To examine the effects of pioglitazone or endurance exercise training on cognitive function in older adults with mild cognitive impairment (MCI) and insulin resistance. Methods: Seventy-eight adults (mean age ± SD: 65 ± 7 years) with central obesity and MCI were randomized to 6 months of endurance exercise, pioglitazone or control. Results: Sixty-six participants completed the study. Exercise training did not significantly increase peak oxygen uptake compared to control (p=0.12). Compared to control, insulin resistance improved in the pioglitazone group (p=0.002) but not in the exercise group (p=0.25). There was no measureable effect of pioglitazone or exercise on cognitive performance compared to control. Conclusion: In this pilot study, pioglitazone improved insulin resistance but not cognitive performance in older adults with MCI and insulin resistance.",NCT00736996;oxygen;pioglitazone;placebo;adult;aged;article;clinical article;cognition;controlled study;double blind procedure;drug dose increase;endurance training;female;heart failure;human;insulin resistance;male;mild cognitive impairment;musculoskeletal disease;outcome assessment;oxygen consumption;patient compliance;peripheral edema;pilot study;priority journal;randomized controlled trial;upper respiratory tract infection,"Hildreth, K. L.;Van Pelt, R. E.;Moreau, K. L.;Grigsby, J.;Hoth, K. F.;Pelak, V.;Anderson, C. A.;Parnes, B.;Kittelson, J.;Wolfe, P.;Nakamura, T.;Linnebur, S. A.;Trujillo, J. M.;Aquilante, C. L.;Schwartz, R. S.",2015,,,0,
1812,Prevalence of APO e4 allele in Israeli ethnic groups,"The 4 allele of the APOE gene, coding for apo-lipoprotein E, is the most common genetic risk factor for Alzheimer's disease and a significant risk factor for coronary atherosclerosis. There is therefore much interest in studying its frequency in different ethnic groups. We examined its frequency in Jews originating from Libya, Buchara and Ethiopia and in Jews of Sepharadi and Ashkenazi origins. Its frequency among Ethiopian immigrants was 0.27, significantly higher than in the other groups, in which the frequency was between 0.067 and 0.10. These differences in allele frequency may serve as a basis for future studies in Israel to assess the relative contributions of genetic and environmental factors to the incidence of dementia.",apolipoprotein E;apolipoprotein E4;Africa;allele;Alzheimer disease;article;coronary artery atherosclerosis;ethnic group;ethnology;Europe;gene frequency;genetics;human;Israel;Jew;risk factor,"Hilkevich, O.;Chapman, J.;Bone, B. S.;Korczyn, A. D.",1999,,,0,
1813,Mortality and cancer incidence among individuals with Down syndrome,"Background: Individuals with Down syndrome (DS) have a predisposition to leukemia and possibly other cancers and excess mortality from other conditions, but information on the magnitude of risk associated with specific cancers or causes of death is sparse. Methods: Mortality experience and cancer incidence were evaluated in a combined cohort of 4872 individuals with a hospital discharge diagnosis of DS in Sweden (1965-1993) or Denmark (1977-1989) by linkage to national cancer and vital statistics registries. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were estimated by comparison with age, sex, and calendar-year expected values. Results: Individuals with DS had an increased risk of incident acute lymphocytic (SIR, 24.2; 95% confidence interval [CI], 15.2-36.6; n=22) and acute nonlymphocytic (SIR, 28.2; 95% CI, 15.7-48.3; n = 14) leukemias. Risks of testicular cancer (SIR, 3.7; 95% CI, 1.0-9.4; n = 4) and liver cancer (SIR, 6.0; 95% CI, 1.2-17.5; n=3) were also elevated. Individuals with DS also experienced elevated mortality attributed to stomach cancer (SMR, 6.4; 95% CI, 1.7-16.4; n=4), dementia and Alzheimer disease (SMR, 54.1; 95% CI, 27.9-94.4), epilepsy (SMR, 30.4; 95% CI, 13.9-57.7), ischemic heart disease (SMR, 3.9; 95% CI, 2.7-5.4), other heart disease (SMR, 16.5; 95% CI, 11.0-23.7), cerebrovascular disease (SMR, 6.0; 95% CI, 3.5-9.6), infectious diseases (SMR, 12.0; 95% 6.0-21.4), and congenital anomalies (SMR, 25.8; 95% CI, 21.0-31.4). Conclusions: Individuals with DS have a substantially increased risk of mortality due to specific causes and may have an elevated risk of other incident cancers in addition to leukemia. These results provide clues regarding chromosome 21 gene involvement in diseases that complicate DS and are important for disease detection and care of affected individuals.",acute lymphoblastic leukemia;acute myeloblastic leukemia;adolescent;adult;age;aged;Alzheimer disease;article;cancer incidence;cancer mortality;cancer registry;cancer risk;cancer statistics;cerebrovascular disease;child;cohort analysis;confidence interval;congenital malformation;dementia;Denmark;Down syndrome;epilepsy;evaluation study;female;gender;heart disease;hospital discharge;human;infection;ischemic heart disease;liver cancer;major clinical study;male;priority journal;risk assessment;standard;stomach cancer;Sweden;testis cancer,"Hill, D. A.;Gridley, G.;Cnattingius, S.;Mellemkjaer, L.;Linet, M.;Adami, H. O.;Olsen, J. H.;Nyren, O.;Fraumeni Jr, J. F.",2003,,,0,
1814,Parkinson's disease,"Idiopathic parkinsonism occurs late in life and death often occurs from other conditions such as myocardial infarction, stroke or cancer. Before adequate treatment for parkinsonism was available immobility and dysphagia resulted in death from aspiration pneumonia, urinary tract infection and trauma incurred by falling. With treatment these complications have been avoided and thus life expectancy is prolonged, and because the underlying pathology continues, new aspects and consequences of the progression of the disease are likely to emerge. Dementia is one of the consequences of this increased survival on chronic levodopa therapy. Dementia is now recognised as part of the clinical syndrome of isiopathic parkinsonism. It tends to occur in the advanced stage of the disease and in patients where the disease begins late in life. It exhibits as a progressive personality and intellectual decline, with blunting of interest and drive, limitation of intellectual activity and an apparent slowing of thought processes and memory. From the evidence that is now available it would seem that idiopathic parkinsonism is the result of premature ageing with loss of neurones, mainly in the substantia nigra but also in other areas of brain such as the cortex, causing not only disability of locomotion and posture, but also intellectual change. The symptoms are relieved by therapy but the underlying pathological process is unchanged. The advent of levodopa marked a dramatic step forward in the treatment of Parkinson's disease and also heralded the era of treatment of disease associated with abnormal neurotransmission.",amantadine;benserazide;benserazide plus levodopa;bromocriptine;carbidopa;carbidopa plus levodopa;chlorpromazine;diazepam;haloperidol;levodopa;selegiline;tricyclic antidepressant agent;central nervous system;clinical study;drug therapy;major clinical study;Parkinson disease;parkinsonism;therapy;madopar;sinemet;valium,"Hill, J. W.",1979,,,0,
1815,Physicians as patients: Choices regarding their own resuscitation,"Background: Attitudes toward cardiopulmonary resuscitation have changed considerably during the last 30 years. Although physicians are routinely involved in the decision making about cardiopulmonary resuscitation for their patients, little is known about their collective preferences regarding it for themselves. Methods: A questionnaire was distributed at an internal medicine primary care review course at an urban community hospital. Of the 111 physicians registered at the meeting, 72 (65%) completed the questionnaire and serve as the basis for the results. Physicians were asked if they would want cardiopulmonary resuscitation for themselves in the presence of an acute myocardial infarction, Alzheimer's disease, and nine other advanced chronic diseases at the projected ages of 40, 60, and 80 years. Results: At all projected ages, physicians' desire for cardiopulmonary resuscitation with any advanced chronic disease was significantly less than with an acute myocardial infarction (P≤.000001 except for rheumatoid arthritis). Fewer physicians wanted cardiopulmonary resuscitation at age 80 years than at 40 years for any disease (P≤.002). The results did not differ when analyzed by respondents' age, gender, or primary care specialty, or the size of the community in which they practiced. Conclusions: The results of this initial survey indicate that most physicians would not want cardiopulmonary resuscitation with a variety of underlying chronic diseases and corresponding functional impairments- particularly with advancing age. Conversely, with an acute myocardial infarction, all physicians surveyed would desire cardiopulmonary resuscitation at age 40 years, and many would continue to desire it with advancing age.",Alzheimer disease;article;heart infarction;human;physician attitude;primary medical care;priority journal;questionnaire;resuscitation;statistical analysis,"Hillier, T. A.;Patterson, J. R.;Hodges, M. O.;Rosenberg, M. R.",1995,,,0,
1816,Prehospital cardiac arrest survival and neurologic recovery,"Many studies of prehospital defibrillation have been conducted but the effects of airway intervention are unknown and neurologic follow-up has been incomplete. A non-randomized cohort prospective study was conducted to determine the effectiveness of defibrillation in prehospital cardiac arrest. Two ambulance companies in the study area developed a defibrillation protocol and they formed the experimental group. A subgroup of these patients received airway management with an esophageal obturator airway (EOA) or endotracheal intubation (ETT). The control group was composed of patients who suffered a prehospital cardiac arrest and did not receive prehospital defibrillation. All survivors were assessed for residual deficits using the Sickness Impact Profile (SIP) and the Dementia Rating Scale (DRS). A total of 221 patients were studied over a 32-month period. Both the experimental group (N = 161) and the control group (N = 60) were comparable with respect to age, sex distribution, and ambulance response time. Survival to hospital discharge was 2/60 (3.3%) in the control group and 12/161 (6.3%) in the experimental group. This difference is not statistically significant. Survival in the experimental group by airway management technique was basic airway support (3/76 3.9%), EOA (3/67 4.5%), and ETT (6/48 12.5%). The improved effect on survival by ETT management was statistically significant. Survivors had minor differences in memory, work, and recreation as compared to ischemic heart disease patients as measured by the SIP and DRS. No effect of defibrillation was found on survival to hospital discharge. However, endotracheal intubation improved survival in defibrillated patients. Survivors had a good functional outcome.",adolescent;adult;aged;ambulance;article;cognition;controlled study;defibrillation;dementia;endotracheal intubation;female;heart arrest;hospital care;human;major clinical study;male;memory;prognosis;quality of life;rating scale;survival,"Hillis, M.;Sinclair, D.;Butler, G.;Cain, E.",1993,,,0,
1817,B-type natriuretic peptide and severity of cognitive disorder,"Background: Natriuretic peptides have been linked to cognitive disorder in previous studies. The aim of this study was to examine the association between the severity of cognitive disorder and the levels of B-type natriuretic peptide (BNP) in an older general population. Material and methods: This study is a part of the larger population-based, multidisciplinary Kuopio 75+ health study. A total of 601 subjects aged 75 or older participated in the study. A subgroup of 126 individuals was diagnosed with cognitive disorder, and the severity of the disease was assessed. The participants were tested for BNP. Analysis of covariance was carried out to study the relationship between BNP and the stage of cognitive disorder. Results: The association between the level of cognitive disorder and BNP resembled an inverse U-shaped curve, with higher levels of BNP observed among participants with mild cognitive disorder when compared to cognitively intact participants or counterparts with more severe cognitive disorder. This effect remained after adjustment for age (P = 0·02). However, association between BNP and level of cognitive disorder was lost in further adjustment with covariates connected to the levels of BNP. Conclusion: The previously reported elevation of natriuretic peptides among individuals with diagnosed cognitive disorder was found only in people with milder stages of the disorder. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.",angiotensin receptor antagonist;beta adrenergic receptor blocking agent;brain natriuretic peptide;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;aged;Alzheimer disease;antihypertensive therapy;article;blood sampling;clinical assessment;cognitive defect;computer assisted tomography;controlled study;dementia;diffuse Lewy body disease;disease severity;female;groups by age;heart failure;human;hypertension;laboratory test;major clinical study;male;multiinfarct dementia;neuroimaging;nuclear magnetic resonance imaging;predictive value;priority journal;protein blood level;risk factor,"Hiltunen, M.;Nieminen, T.;Kettunen, R.;Hartikainen, S.;Sulkava, R.;Vuolteenaho, O.;Kerola, T.",2013,,,0,
1818,Depressive symptoms and cardiovascular burden-related mortality among the aged,"Background: Depressive symptoms have been linked to increased cardiovascular mortality among the elderly. This study was aimed to test the independent and additive predictive value of depressive symptoms and B-type natriuretic peptide (BNP), a marker of direct cardiovascular stress and a strong predictor of mortality, together with traditional cardiovascular risk markers on total and cardiovascular mortalities in a general elderly population. Methods: A total of 508 subjects aged 75 or older participated in the study. The prognostic capacity of depressive symptoms and BNP in regard to total and cardiovascular mortalities was assessed with Cox regression analyses. Depressive symptoms were handled as a dichotomous variable based on the Zung self-rated depression scale score with a cut-off point of 40. Results: The median follow-up time was 84 months with an interquartile range of 36-99 months. Depressive symptoms reflected susceptibility to all-cause (HR 1·60; 95% CI 1·26-2·04) and cardiovascular mortalities (HR 1·81; 95% CI 1·30-2·52) only in univariable analyses. When cardiovascular illnesses and risk markers were taken into account, depressive symptoms lost their significance as an independent predictor of mortality. BNP as a continuous variable was a significant predictor of both all-cause (HR 1·44; 95% CI 1·22-1·69) and cardiovascular mortalities (HR 1·79; 95% CI 1·44-2·22) in fully adjusted models including depressive symptoms as a covariate. Conclusions: The prognostic capacity of depressive symptoms is closely linked to cardiovascular morbidity and has no independent power in an elderly general population. BNP remains a strong harbinger of death regardless of depressive symptoms status. © 2014 Stichting European Society for Clinical Investigation Journal Foundation.",brain natriuretic peptide;creatinine;hemoglobin;high density lipoprotein cholesterol;aged;article;body mass;cardiovascular disease;cardiovascular mortality;cardiovascular risk;cerebrovascular accident;cholesterol blood level;controlled study;creatinine clearance;dementia;depression;diabetes mellitus;diagnostic test accuracy study;female;follow up;atrial fibrillation;heart failure;heart infarction;hemoglobin blood level;human;major clinical study;male;medical history;morbidity;mortality;New York Heart Association class;prediction;predictive value;priority journal;prognosis;protein blood level;psychological rating scale;systolic blood pressure;very elderly;Zung self rated depression scale,"Hiltunen, M.;Nieminen, T.;Kettunen, R.;Hartikainen, S.;Sulkava, R.;Vuolteenaho, O.;Kerola, T.",2014,,,0,
1819,Genome-wide association analysis of self-reported events in 6135 individuals and 252 827 controls identifies 8 loci associated with thrombosis,"Thrombotic diseases are among the leading causes of morbidity and mortality in the world. To add insights into the genetic regulation of thrombotic disease, we conducted a genome-wide association study (GWAS) of 6135 self-reported blood clots events and 252 827 controls of European ancestry belonging to the 23andMe cohort of research participants. Eight loci exceeded genome-wide significance. Among the genome-wide significant results, our study replicated previously known venous thromboembolism (VTE) loci near the F5, FGA-FGG, F11, F2, PROCR and ABO genes, and the more recently discovered locus near SLC44A2. In addition, our study reports for the first time a genome-wide significant association between rs114209171, located upstream of the F8 structural gene, and thrombosis risk. Analyses of expression profiles and expression quantitative trait loci across different tissues suggested SLC44A2, ILF3 and AP1M2 as the three most plausible candidate genes for the chromosome 19 locus, our only genome-wide significant thrombosis-related locus that does not harbor likely coagulation-related genes. In addition, we present data showing that this locus also acts as a novel risk factor for stroke and coronary artery disease (CAD). In conclusion, our study reveals novel common genetic risk factors for VTE, stroke and CAD and provides evidence that self-reported data on blood clots used in a GWAS yield results that are comparable with those obtained using clinically diagnosed VTE. This observation opens up the potential for larger meta-analyses, which will enable elucidation of the genetics of thrombotic diseases, and serves as an example for the genetic study of other diseases.",blood clot;cerebrovascular accident;chromosome 19;controlled study;coronary artery disease;diagnosis;gene expression profiling;genetic polymorphism;genetic regulation;genetic risk;genetic susceptibility;genetic association;human;meta analysis;quantitative trait locus;risk factor;structural gene;thrombosis;venous thromboembolism;endogenous compound;endothelial protein C receptor,"Hinds, D. A.;Buil, A.;Ziemek, D.;Martinez-Perez, A.;Malik, R.;Folkersen, L.;Germain, M.;Mälarstig, A.;Brown, A.;Soria, J. M.;Dichgans, M.;Bing, N.;Franco-Cereceda, A.;Souto, J. C.;Dermitzakis, E. T.;Hamsten, A.;Worrall, B. B.;Tung, J. Y.;Sabater-Lleal, M.",2016,,,0,
1820,Cause-specific mortality of grand multiparous women in Finland,"Knowledge is limited on mortality of grand multiparous women (≥5 deliveries), whose hormonal, metabolic, and social conditions differ from the average. The authors studied overall and cause-specific mortality in 1974-2001 among 87,922 grand multiparous women including 3,678 grand grand multiparous women (≥10 deliveries) in Finland. Standardized mortality ratios were defined as ratios of observed to expected numbers of deaths, both derived from national cause-of-death files. During follow-up, 18,870 grand multiparous women and 625 grand grand multiparous women died (standardized mortality ratios (SMRs) = 0.95 and 1.01, respectively). Decreased mortality among grand multiparous women was found for cancers of the breast (SMR = 0.64, 95% confidence interval (CI): 0.59, 0.69), corpus uteri (SMR = 0.68, 95% CI: 0.56, 0.80), ovary (SMR = 0.68, 95% CI: 0.60, 0.75), bladder (SMR = 0.59, 95% CI: 0.41, 0.82), and respiratory tract (SMR = 0.80, 95% CI: 0.72, 0.88). The only malignant tumor associated with elevated mortality was kidney cancer (SMR = 1.38, 95% CI: 1.21, 1.56). The standardized mortality ratio was also low for dementia (SMR = 0.78, 95% CI: 0.72, 0.84), respiratory diseases (SMR = 0.80, 95% CI: 0.75, 0.85), and accidents and violent causes (SMR = 0.79, 95% CI: 0.73, 0.84). Mortality from diabetes mellitus (SMR = 1.42, 95% CI: 1.29, 1.55) and ischemic heart disease (SMR = 1.10, 95% CI: 1.08, 1.13) was increased. According to this study, overall mortality among grand multiparous women is not elevated. Low mortality from cancers is offset by higher mortality from cardiovascular conditions and diabetes mellitus. Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved.",accident;article;bladder cancer;breast cancer;cancer mortality;cause of death;confidence interval;controlled study;dementia;diabetes mellitus;disease association;female;Finland;human;ischemic heart disease;kidney cancer;mortality;multipara;ovary cancer;respiratory tract cancer;respiratory tract disease;uterus cancer,"Hinkula, M.;Kauppila, A.;Näyhä, S.;Pukkala, E.",2006,,,0,
1821,Leukocyte telomere length is linked to vascular risk factors not to Alzheimer’s disease in the VITA study,"Association of telomere shortening with overall dementia or Alzheimer’s disease is described controversially and the pathophysiologic relevance is unclear. Whether patients, suffering from pure probable Alzheimer’s disease or pure vascular dementia, have shorter leukocyte telomeres than cognitively healthy controls was determined. Leukocyte telomere lengths (LTLs) of 597 participants of the VITA study (longitudinal community-based age-cohort [mean 75.7 (±0.45) years] study: 243 male; 578 non-demented at baseline) were compared with different aspects of cognition, risk factors of dementia and survival. LTLs of 264 persons cognitively healthy at baseline (mild cognitive impaired excluded) and all follow-ups (mean = 5643 bp, SD = 736) did not show any difference to LTLs of 43 incident pure possible (mean = 5548 bp; SD = 666) or 34 incident pure probable Alzheimer’s diseases (mean = 5712 bp; SD = 695; post hoc Dunnett test: MD = −95; SE = 119; p = 0.67 and MD =+68.3; SE = 132; p = 0.84, res.). 264 stably cognitively healthy showed a trend to longer telomeres than 6 incident vascular dementias (mean = 5643 bp, SD = 736 vs mean = 5101 bp, SD = 510; t test: T = 1.8; df = 268; p = 0.07). Males (n = 243; mean = 5470 bp; SD = 684) had significantly shorter telomeres than females (n = 354; mean = 5686 bp; SD = 714; t test: T = −3.7; df = 595; p = 0.0001) and died significantly earlier (113.7 vs 130.1 months: Log Rank Chi square = 12.2; p = 0.0001). Shorter telomeres were associated with prevalence of more than one vascular risk factor (n = 587; mean = 5728; SD = 723 vs mean = 5533; SD = 691; t test: T = 3.1; df = 576; p = 0.002) and, as a trend, with poorer survival (Cox Regression: Wald = 4.9; p = 0.026; OR = 0.98; 95% CI 0.96–0.99). In 75.7 years old persons, no association of LTL with incident pure Alzheimer’s disease was found. Significantly shorter telomeres were associated with sum of vascular risk factors, males and early mortality in males. Exclusion of mixed dementias may improve the search for risk factors more specific for Alzheimer’s disease.",antihypertensive agent;antilipemic agent;apolipoprotein E;C reactive protein;cyanocobalamin;folic acid;hemoglobin A1c;high density lipoprotein cholesterol;low density lipoprotein cholesterol;triacylglycerol;vitamin D;aged;Alzheimer disease;article;body mass;cardiovascular disease;cardiovascular risk;cerebrovascular accident;cognition;cohort analysis;controlled study;diffuse Lewy body disease;female;heart infarction;human;leukocyte;major clinical study;male;medical history;mild cognitive impairment;mortality;multiinfarct dementia;non insulin dependent diabetes mellitus;prevalence;priority journal;sex difference;smoking;telomere length;vitamin intake,"Hinterberger, M.;Fischer, P.;Huber, K.;Krugluger, W.;Zehetmayer, S.",2017,,10.1007/s00702-017-1721-z,0,
1822,Development and validation of QMortality risk prediction algorithm to estimate short term risk of death and assess frailty: cohort study,"Objectives To derive and validate a risk prediction equation to estimate the short term risk of death, and to develop a classification method for frailty based on risk of death and risk of unplanned hospital admission.Design Prospective open cohort study.Participants Routinely collected data from 1436 general practices contributing data to QResearch in England between 2012 and 2016. 1079 practices were used to develop the scores and a separate set of 357 practices to validate the scores. 1.47 million patients aged 65-100 years were in the derivation cohort and 0.50 million patients in the validation cohort.Methods Cox proportional hazards models in the derivation cohort were used to derive separate risk equations in men and women for evaluation of the risk of death at one year. Risk factors considered were age, sex, ethnicity, deprivation, smoking status, alcohol intake, body mass index, medical conditions, specific drugs, social factors, and results of recent investigations. Measures of calibration and discrimination were determined in the validation cohort for men and women separately and for each age and ethnic group. The new mortality equation was used in conjunction with the existing QAdmissions equation (which predicts risk of unplanned hospital admission) to classify patients into frailty groups.Main outcome measure The primary outcome was all cause mortality.Results During follow-up 180 132 deaths were identified in the derivation cohort arising from 4.39 million person years of observation. The final model included terms for age, body mass index, Townsend score, ethnic group, smoking status, alcohol intake, unplanned hospital admissions in the past 12 months, atrial fibrillation, antipsychotics, cancer, asthma or chronic obstructive pulmonary disease, living in a care home, congestive heart failure, corticosteroids, cardiovascular disease, dementia, epilepsy, learning disability, leg ulcer, chronic liver disease or pancreatitis, Parkinson's disease, poor mobility, rheumatoid arthritis, chronic kidney disease, type 1 diabetes, type 2 diabetes, venous thromboembolism, anaemia, abnormal liver function test result, high platelet count, visited doctor in the past year with either appetite loss, unexpected weight loss, or breathlessness. The model had good calibration and high levels of explained variation and discrimination. In women, the equation explained 55.6% of the variation in time to death (R2), and had very good discrimination-the D statistic was 2.29, and Harrell's C statistic value was 0.85. The corresponding values for men were 53.1%, 2.18, and 0.84. By combining predicted risks of mortality and unplanned hospital admissions, 2.7% of patients (n=13 665) were classified as severely frail, 9.4% (n=46 770) as moderately frail, 43.1% (n=215 253) as mildly frail, and 44.8% (n=223 790) as fit.Conclusions We have developed new equations to predict the short term risk of death in men and women aged 65 or more, taking account of demographic, social, and clinical variables. The equations had good performance on a separate validation cohort. The QMortality equations can be used in conjunction with the QAdmissions equations, to classify patients into four frailty groups (known as QFrailty categories) to enable patients to be identified for further assessment or interventions.","Aged;Algorithms;Decision Support Techniques;Female;Frail Elderly;Humans;Life Style;Male;Mortality;Prospective Studies;Risk Assessment/ methods;Socioeconomic Factors;www.icmje.org/coi_disclosure.pdf (available on request from the corresponding;author) and declare: JHC is codirector of QResearch, a not-for-profit;organisation, which is a joint partnership between the University of Nottingham;and Egton Medical Information Systems (leading commercial supplier of IT for 55%;of general practices in the UK). JHC is also a paid director of ClinRisk, which;produces open and closed source software to ensure the reliable and updatable;implementation of clinical risk equations within clinical computer systems to;help improve patient care. CC is a paid consultant statistician for ClinRisk.;This work and any views expressed within it are solely those of the authors and;not of any affiliated bodies or organisations.","Hippisley-Cox, J.;Coupland, C.",2017,Sep 20,,0,
1823,"A 86-year-old woman with dementia, gait and speech disturbance, and right hemiparesis","We report a 86-year-old woman who developed dementia, gait disturbance, speech disturbance, and right hemiparesis. The patient was well until March of 1979 when upon wakening up on one morning she noted slurring of her speech and weakness in her left upper and lower extremities. These symptoms cleared up during the next several months, however, she noted weakness in her left leg again in May 1985. In 1988, her posture became stooped and she walked in small steps. In 1990, she developed memory disturbance and difficulty in naming. In March 1993, she developed weakness in her right hand; she was treated with aspirin and amantadine HCl, however, she deteriorated during the next two week period, and was admitted to our hospital on March 27, 1993. On admission, she appeared alert, however, she could not answer verbally to questions; she could only utter unintelligible sounds. Apparently she was markedly demented. Her blood pressure was 170/98 mmHg, and general physical examination was unremarkable. Cranial nerves were grossly normal except for marked non-fluency in her word expression. She could not stand or walk, and apparently her right upper and lower extremities were paralyzed with some contracture. Deep reflexes were normally active without asymmetry. Chaddock sign was positive bilaterally. Sensory examination was difficult. Pertinent laboratory examination included WBC 13,000/μl, BUN 152mg/dl, creatinine 3.75mg/dl, CRP 20.1mg/dl; a chest X-ray film revealed pneumonic shadow in the upper and the middle right lung fields. Cranial CT scan revealed multiple lacunar infarctions in both basal ganglia and cerebral white matters; periventricular lucency was also noted. She was treated with antibiotics and intravenous fluid. Acid-fast bacilli were recovered from sputum, and she was transferred to another hospital for the treatment of pulmonary tuberculosis. After its treatment she returned to our hospital on July 8, 1993, when her condition was complicated with aspiration pneumonia. On admission, she was semi-comatose, and no intelligible words were heard. Right facial paresis of the central type was noted. She was unable to stand or walk, and her right upper and lower extremities were paretic. Deep reflexes were increased with extensor toe sign on the right. She was treated with chemotherapy and intravenous fluid, however, her clinical course was complicated with respiratory as well as urinary tract infections. She developed cardiac as well as renal failure and expired on September 25, 1993. She was discussed in a neurological CPC, and the chief discussant arrived at the conclusion that the patient had Binswanger's disease, recent large artery thrombosis in the territory of the left internal carotid artery, renal failure, cardiac failure, hepatic failure, and pneumonia. Post-mortem examination revealed sclerosing glomerulonephritis, pneumonia, a small fresh myocardial infarction, and severe atherosclerosis in the aorta. In the central nervous system, 50 to 70% narrowing was noted in the left middle cerebral artery. An old cerebral infarction was involving the subcortical region of the left frontal lobe extending into the caudate nucleus as well as putamen. The question was whether or not the patient had motor aphasia. Evaluation was a bit difficult because of concomitant dementia. Some participants ascribed her severe non-fluency to combined lesions in the white matter that lies next to the body of the lateral ventricle and that lies in the lateral aspect of the anterior horn.",acetylsalicylic acid;amantadine;aged;aorta atherosclerosis;artery thrombosis;article;Binswanger encephalopathy;brain infarction;case report;dementia;female;gait disorder;glomerulonephritis;heart failure;heart infarction;hemiparesis;human;kidney failure;liver failure;pneumonia;speech disorder,"Hirabayashi, K.;Morikawa, N.;Mori, H.;Miyake, T.;Suda, K.;Kondo, T.;Mizuno, Y.",1995,,,0,
1824,The present state and subject of home hospice for patients with non-cancer disorders,"In order to clarify the issues regarding home hospice for patients with non-cancer disorders, the patients' death at home was compared with that of terminal cancer patients treated in our clinic. The following results were obtained: In the non-cancer disorder group, the number of deaths of female patients was greater than that of male patients. In this same group, the average age of patients at death was greater by 6.7 years and the period of home care was longer than that in the terminal cancer group. The underlying diseases in the cases belonging to the non-cancer disorder group were mainly dementia, chronic respiratory failure, intractable neurological disease, and cerebral stroke. Complicated palliative care was not essential during the medical treatment of cases with non cancer disorders, unlike in cases of terminal cancer. The amounts of opioid consumed during home hospice and the frequency of transfusion on and before the day of death at home in the non-cancer disorder group were less than those in the terminal cancer group. In the non-cancer disorder group, death was predicted in 57.1% of the cases. It was relatively easy to presume the prognosis in patients with chronic respiratory failure, intractable neurological disease, or renal failure who preferred not to receive life-prolonging medical treatment and in the cases with dementia. However, this did not hold true for patients with cerebral stroke. With regard to patients who had diseases other than dementia and who preferred not to receive life-prolonging medical treatment, their living-will was an essential factor in the decision making process. However, for the patients with dementia, a consensus-based approach involving both the patients' family and the healthcare worker was important. In the future, it is essential to consider the procedures of hospice care for the patients with non-cancer disorders based on a disease structure, a medical system, and values in Japan.",aged;article;cerebrovascular accident;chronic obstructive lung disease;congestive heart failure;decision making;dementia;female;home care;hospice care;human;male;methodology;nursing,"Hirahara, S.",2004,,,0,
1825,Differences in cardiac management and in-hospital mortality between elderly patients with and without dementia after acute myocardial infarction: findings from TAMIS data,"AIM: In the United States, a study has shown that dementia is a significant factor negatively associated with medical treatment. Because the increasing number of the elderly has resulted in cause a rise in patients with dementia or acute myocardial infarction (AMI), or both, we need to know the differences in in-hospital mortality between patients with or without dementia in patients with AMI. METHODS: We used data from 13 acute care hospitals including in the data from the Tokai Acute Myocardial Infarction Study (TAMIS), a retrospective study of all patients admitted to these hospitals from 1995 to 1997 with a diagnosis of AMI. We abstracted the baseline and procedural characteristics from detailed chart reviews. A total of 22 patients with dementia and 1,030 with no dementia who were aged 65 and over were included in the present study, and were divided into two groups according to their diagnosis of dementia. We compared the baseline and procedure characteristics and clinical outcomes between the two groups. RESULTS: Patients with dementia were older and more likely to have either a lower body mass index score or ADL impairment. As for medical history, patients with dementia were more likely to have a history of cerebrovascular disease, and less likely to have a history of angina or smoking. Before and after multivariable adjustment, no significant difference was found in in-hospital mortality between patients with or without dementia. CONCLUSIONS: Our study demonstrates that AMI elderly patients with dementia were not less likely to be undertreated and did not have a higher in-hospital mortality rate than non-dementia patients.",Aged;Alzheimer Disease/*complications;Female;Humans;Male;Myocardial Infarction/*mortality/*therapy;Retrospective Studies,"Hirakawa, Y.;Masuda, Y.;Kuzuya, M.;Iguchi, A.;Uemura, K.",2007,Sep,,0,
1826,Effect of emergency percutaneous coronary intervention on in-hospital mortality of very elderly (80+ years of age) patients with acute myocardial infarction,"It is still controversial whether percutaneous coronary intervention (PCI) is effective in improving in-hospital survival in very elderly patients. Therefore, using data from the Tokai Acute Myocardial Infarction Study II, we studied the effect of emergency PCI on the in-hospital mortality of very elderly (80+ years of age) patients with acute myocardial infarction (AMI). The study was a prospective study of all consecutive patients admitted to the 15 acute care hospitals in the Tokai region with the diagnosis of AMI from 2001 to 2003. A total of 211 patients undergoing emergency PCI and 176 patients not undergoing PCI were included in the present analysis. We compared the baseline and procedural characteristics and the clinical outcomes between the 2 groups. Patients without emergency PCI were older and had an increased prevalence of female gender, ADL impairment, and dementia in comparison with those with PCI. They also showed poorer clinical conditions. They were less likely to be transferred to intensive care or coronary care units and to be given intra-aortic balloon pumps. The patients with emergency PCI had nearly one-third the in-hospital mortality rate of the patients without emergency PCI. According to multivariate analysis, emergency PCI was still identified as an independent predictor of in-hospital death, with an adjusted odds ratio of 0.26 (95% CI, 0.07-0.97). The results indicated that emergency PCI has a preventative effect on in-hospital mortality in Japanese AMI patients 80 years of age and older.","Age Factors;Aged, 80 and over;*Angioplasty, Balloon, Coronary;*Emergency Treatment;Female;Humans;Inpatients;Male;Myocardial Infarction/*mortality/*therapy;Prospective Studies;Sex Factors","Hirakawa, Y.;Masuda, Y.;Kuzuya, M.;Kimata, T.;Iguchi, A.;Uemura, K.",2006,Sep,,0,
1827,Transthyretin channel formation in lipid membranes: Implications for pathogenesis,"Transthyretin (TTR) is the protein whose variants form amyloid fibrils in familial amyloid polyneuropathy, cardiomyopathy, and central nervous system amyloidosis. We demonstrate that TTR is capable of spontaneously inserting into planar phospholipid bilayer membranes to form ion permeable channels. The physiologic properties of these channels are similar to those of amyloid channels formed by peptides associated with Alzheimer's disease, Parkinson's disease, diabetes mellitus, prion disease, and chronic inflammatory disease. These properties include: (1) a variety of single channel conductances, (2) irreversibility of channel insertion, (3) voltage independence of channel conductance, (4) inhibition of channel formation by Congo red, (5) reversible channel blockade by zinc ion, and (6) poor ion selectivity. These properties would tend to decrease membrane or mitochondrial potentials, run down ion gradients, disrupt calcium homeostasis, and deplete cellular energy stores. The striking resemblance of these various amyloid channels suggests they play a critical role in cellular pathophysiology. © 2011 Informa UK, Ltd.",amyloid;congo red;ion channel;prealbumin;zinc ion;Alzheimer disease;article;calcium homeostasis;cell energy;channel gating;chronic inflammation;diabetes mellitus;ion permeability;lipid membrane;membrane conductance;membrane potential;mitochondrial membrane potential;Parkinson disease;pathogenesis;phospholipid bilayer;prion disease;priority journal,"Hirakura, Y.;Azimov, R.;Azimova, R.;Javier, F.;Schweitzer, E. S.;Kagan, B. L.",2011,,,0,
1828,Improving outcome in geriatric peritoneal dialysis patients,"OBJECTIVE: Few data are available about elderly patients on peritoneal dialysis (PD). In the present study, we reviewed our experience with patients aged 70 years or more at the start of peritoneal dialysis (PD). DESIGN: This retrospective study was conducted at a single center in Japan. PATIENTS AND METHODS: Of 222 patients managed using PD at our hospital between 1991 and 2001 (including 219 cases of PD first), 150 patients were aged under 70 years and 72 patients were 70 years of age or older. For the two groups of patients, we determined clinical data, erythropoietin and PD prescriptions, reasons for selecting PD (elderly patients only), urine and ultrafiltration volumes, comprehensive functional assessment, quality of life (QOL), comorbidity, technique survival rate, and causes of death. RESULTS: Serum creatinine, serum beta(2)-microglobulin, total dose of erythropoietin (EPO) needed to maintain hematocrit at 30%, number of continuous ambulatory peritoneal dialysis (CAPD) exchanges, and total volume of dialysis solution prescribed were significantly lower in the elderly patients as compared with patients aged under 70 years. The main reasons for starting PD in elderly patients at our hospital were advanced age (57%), patient's choice (25%), and cardiovascular complications (9%). Residual renal function was well maintained in CAPD patients aged 70 years or more as compared with patients aged under 70 years. Ultrafiltration volume was lower in the elderly CAPD patients. Scores on the Revised Hasegawa Dementia Scale, the Physical Self-Maintenance Scale, and the Instrumental Activities of Daily Living scale were significantly higher in CAPD patients than in hemodialysis patients. Subjective assessment using a linear analog scale showed a high QOL score in the elderly patients for overall feelings of well-being, mood, and anxiety. At the time of dialysis introduction, the major existing disorders in patients over 80 years of age were mostly cardiovascular disorders such as heart failure, myocardial infarction, serious arrhythmia, and cerebrovascular disease. The median technique survival in patients aged 70 years or more was 31.5 months. The main causes of death in elderly PD patients were heart failure (35.7%), peritonitis (14.3%), and cerebrovascular disease (11.9%). CONCLUSION: Peritoneal dialysis should be considered the treatment method of choice when introducing dialysis in elderly patients.","Aged;Aged, 80 and over;Female;Humans;Male;*Peritoneal Dialysis;Peritoneal Dialysis, Continuous Ambulatory;Quality of Life;Retrospective Studies;Treatment Outcome","Hiramatsu, M.",2003,Dec,,0,
1829,Effects of leisure activities at home on perceived care burden and the endocrine system of caregivers of dementia patients: A randomized controlled study,"Background: Psychological stress associated with caregiving is thought to underlie the high incidence of hypertension, ischemic heart disease, and mortality, as well as reduced immune function, among caregivers of dementia patients. Here, we examined the effects of periodic leisure activities performed by caregivers of dementia patients with care recipients at home on perceived care burden and levels of stress hormones. Methods: Participants were 42 caregivers aged ≥ 65 years of patients diagnosed with Alzheimer's dementia. They were randomly assigned to intervention and non-intervention groups. The intervention group underwent a leisure activity program (30 min/3 times/week for 24 weeks) with the care recipient, and the control group underwent normal care activities. Results: The Zarit Burden Interview (ZBI) score, a subjective indicator of care burden, significantly decreased after intervention in the intervention group (p < 0.05), whereas no difference was observed in the control group. No significant changes were observed in adrenaline, noradrenaline, dopamine, and cortisol levels in both groups. Conclusions: The lack of changes in stress hormone levels despite a decrease in subjective care burden in the intervention group might be explained by the effects of the chosen leisure activity on the neuroendocrine system. Our findings suggest that periodic leisure activities can reduce perceived care burden among caregivers of dementia patients. However, in order to evaluate accurately the effects of leisure activities of the present study, long-term follow-up of both caregivers and care recipients is necessary. The Nagoya University Department of Medicine Ethics Committee Clinical Trials Registry Number is 1290.",adrenalin;dopamine;hydrocortisone;noradrenalin;adrenalin blood level;aged;Alzheimer disease;article;caregiver burden;clinical effectiveness;controlled study;diastolic blood pressure;dopamine blood level;endocrine system;female;health program;home care;human;hydrocortisone blood level;intervention study;leisure;male;noradrenalin blood level;outcome assessment;randomized controlled trial;stress assessment;systolic blood pressure;Zarit Burden Interview,"Hirano, A.;Umegaki, H.;Suzuki, Y.;Hayashi, T.;Kuzuya, M.",2016,,,0,
1830,Melas: An original case and clinical criteria for diagnosis,"We describe the full history and postmortem findings in one of the first identified cases of mitochondrial encephalomyopathy with stroke-like episodes (MELAS). To clarify diagnostic criteria, we analyzed 69 reported cases. The syndrome should be suspected by the following three invariant criteria: (1) stroke-like episode before age 40 yr; (2) encephalopathy characterized by seizures, dementia, or both; and (3) lactic acidosis, ragged-red fibers (RRF), or both. The diagnosis may be considered secure if there are also at least two of the following: normal early development, recurrent headache, or recurrent vomiting. There are incomplete syndromes in relatives of patients with the full syndrome and incomplete syndromes might also be encountered in sporadic cases. Some MELAS patients have features of the Kearns-Sayre syndrome (KSS) or myoclonic epilepsy with ragged-red fibers (MERRF), but none had the full KSS syndrome. In partial or confusing cases, analysis of mitochondrial DNA (mtDNA) may point to the correct diagnosis; however, not all patients with clinical MELAS have had the typical mtDNA point mutation and some patients with the mutation have clinical syndromes other than MELAS.",mitochondrial DNA;adolescent;adult;article;autopsy;brain disease;case report;child;dementia;encephalomyopathy;female;headache;human;human tissue;Kearns Sayre syndrome;lactic acidosis;male;medical literature;mitochondrion;myoclonus epilepsy;onset age;point mutation;relative;seizure;cerebrovascular accident;syndrome delineation;vomiting,"Hirano, M.;Ricci, E.;Koenigsberger, M. R.;Defendini, R.;Pavlakis, S. G.;DeVivo, D. C.;DiMauro, S.;Rowland, L. P.",1992,,,0,
1831,"What is the true definition of a ""Do-Not-Resuscitate"" order? A Japanese perspective","BACKGROUND: Japan has no official guidelines for do-not-resuscitate (DNR) orders. Therefore, we investigated the effect of DNR orders on physician decision making in relation to performing noncardiopulmonary resuscitation (CPR) and CPR procedures. METHODS: A case-scenario-based questionnaire that included a case of advanced cancer, a case of advanced dementia, and a case of nonadvanced heart failure was administered to physicians. The questions determined whether physicians would perform different non-CPR procedures and CPR procedures in the presence or absence of DNR orders. The number of non-CPR procedures each physician would perform and the number of physicians who would perform each non-CPR and CPR procedure in the absence and presence of DNR ocrders were compared. Physicians from three Japanese municipal acute care hospitals participated. RESULTS: We analyzed 111 of 161 (69%) questionnaires. Physicians would perform significantly fewer non-CPR procedures in the presence of DNR orders than in the absence of DNR orders for all three case scenarios (median [interquartile range] percentages: Case 1: 72% [45%-90%] vs 100% [90%-100%]; Case 2: 55% [36%-72%] vs 91% [63%-100%]; Case 3: 78% [55%-88%] vs 100% [88%-100%]). Fewer physicians would perform non-CPR and CPR procedures in the presence of DNR orders than in the absence of DNR orders. However, considerable numbers of physicians would perform electric shock treatment for ventricular fibrillation in the presence of DNR orders (Case 1: 26%; Case 2: 16%; Case 3: 20%). CONCLUSION: DNR orders affect physician decision making about performing non-CPR procedures. Although some physicians would perform CPR for ventricular fibrillation in the presence of DNR orders, others would not. Therefore, a consensus definition for DNR orders should be developed in Japan, otherwise DNR orders may cause harm.",code status;do-not-resuscitate order (DNR),"Hiraoka, E.;Homma, Y.;Norisue, Y.;Naito, T.;Kataoka, Y.;Hamada, O.;Den, Y.;Takahashi, O.;Fujitani, S.",2016,,10.2147/ijgm.s105302,0,1832
1832,What is the true definition of a “Do-Not-Resuscitate” order? A Japanese perspective,"Background: Japan has no official guidelines for do-not-resuscitate (DNR) orders. Therefore, we investigated the effect of DNR orders on physician decision making in relation to performing noncardiopulmonary resuscitation (CPR) and CPR procedures. Methods: A case-scenario-based questionnaire that included a case of advanced cancer, a case of advanced dementia, and a case of nonadvanced heart failure was administered to physicians. The questions determined whether physicians would perform different non-CPR procedures and CPR procedures in the presence or absence of DNR orders. The number of non-CPR procedures each physician would perform and the number of physicians who would perform each non-CPR and CPR procedure in the absence and presence of DNR ocrders were compared. Physicians from three Japanese municipal acute care hospitals participated. Results: We analyzed 111 of 161 (69%) questionnaires. Physicians would perform significantly fewer non-CPR procedures in the presence of DNR orders than in the absence of DNR orders for all three case scenarios (median [interquartile range] percentages: Case 1: 72% [45%–90%] vs 100% [90%–100%]; Case 2: 55% [36%–72%] vs 91% [63%–100%]; Case 3: 78% [55%–88%] vs 100% [88%–100%]). Fewer physicians would perform non-CPR and CPR procedures in the presence of DNR orders than in the absence of DNR orders. However, considerable numbers of physicians would perform electric shock treatment for ventricular fibrillation in the presence of DNR orders (Case 1: 26%; Case 2: 16%; Case 3: 20%). Conclusion: DNR orders affect physician decision making about performing non-CPR procedures. Although some physicians would perform CPR for ventricular fibrillation in the presence of DNR orders, others would not. Therefore, a consensus definition for DNR orders should be developed in Japan, otherwise DNR orders may cause harm.",dobutamine;furosemide;noradrenalin;oxygen;sodium chloride;adult;advanced cancer;aged;antibiotic therapy;arterial gas;article;artificial ventilation;blood culture;blood transfusion;case report;central venous catheter;resuscitation;compression therapy;computer assisted tomography;controlled study;cross-sectional study;dementia;do not resuscitate;electric shock;heart arrest;heart failure;heart ventricle fibrillation;hemodialysis;human;intensive care unit;Japan;Japanese (people);male;medical decision making;medical order;noninvasive ventilation;oxygen therapy;physician;questionnaire;very elderly,"Hiraoka, E.;Homma, Y.;Norisue, Y.;Naito, T.;Kataoka, Y.;Hamada, O.;Den, Y.;Takahashi, O.;Fujitani, S.",2016,,10.2147/ijgm.s105302,0,
1833,Death from dialysis termination,"The only detailed analysis of dialysis termination by viable patients was reported by Neu and Kjellstrand (N Engl J Med 1986; 314: 14-20) from the USA. We analysed a similar series from Halifax, Nova Scotia, to add to our understanding of this important mode of treatment rejection by dialysis patients. Of 178 chronic dialysis patients at risk from January 1982 to May 1987, 11 viable patients (6%) stopped dialysis (16% of all patient deaths) after a mean of 22 +/- 7 months of therapy. Mean age at death was 67 +/- 5 years. The majority of these patients were receiving in-centre haemodialysis. Six patients independently decided to stop therapy, while in three cases physicians first proposed termination. In only two cases did the family propose termination. All patients died in hospital a mean of 10 +/- 2 days after the last dialysis. Dementia was the reason for stopping treatment in only two cases, while chronic heart failure with poor exercise tolerance was the major precipitant. One patient suffered from diabetes mellitus. We were not able to differentiate patients terminating therapy from those continuing treatment on the basis of age or co-morbidity, suggesting that subjective patient perception of their condition is a critical factor in stopping dialysis.","Adaptation, Psychological;Adult;Aged;Aged, 80 and over;Attitude to Death;Female;Heart Failure/complications;Humans;Kidney Failure, Chronic/complications/*mortality/psychology;Male;Middle Aged;*Patient Compliance;Quality of Life;Renal Dialysis/*psychology;Retrospective Studies;Social Support;*Withholding Treatment;Death and Euthanasia;Empirical Approach;Halifax (NS);Professional Patient Relationship;Victoria General Hospital (Halifax, Nova Scotia)","Hirsch, D. J.",1989,,,0,
1834,Deep venous thrombosis in hip joint surgical geriatric patients diagnosed by radioiodinated fibrinogen,"125I fibrinogen was used to detect deep venous thrombosis in a series of 74 geriatric femoral fracture/hip joint surgical patients (mean age 77.9 years). The frequency of deep venous thrombosis was 58.9%. The calf proved to be the most common site of thrombosis (58.2%). In two thirds of the patients the thrombosis was detected within two days of the operation. In a majority of cases the thrombosis developed in the operated limb, and the incidence of thrombosis was slightly higher in patients operated on for fresh fractures than in those operated on for hip joint arthrosis or old fractures. The state of the cardiovascular system proved to be of major importance for the formation of thrombi: all patients with cardiac failure at the time of the operation developed postoperative thromboses and the percentage of thrombosis was also high in patients with cardiac arrhythmias shortly before or at the time of the operation. The presence of neuropsychiatric disorders (dementia, post apoplectic states) also increased the incidence of thrombosis. Adequate anticoagulant therapy with warfarin yielded good protection against deep venous thrombosis: only one of the 17 patients with post operative TT values below 20% had thrombosis, while the incidence of thrombosis in 44 patients with TT>20% was 75%. Infusions of dextran may also be of value, especially in preventing extensive thrombosis.",anticoagulant agent;fibrinogen i 125;unclassified drug;age;article;brain infarction;cardiovascular disease;cerebrovascular accident;chronic brain disease;classification;dementia;femur neck fracture;geriatrics;heart arrhythmia;heart failure;hip;major clinical study;osteoarthritis;surgery;thrombosis,"Hirsjarvi, E.;Palmberg, S.;Lepantalo, M. J. A.",1975,,,0,
1835,New Evidence on the Persistence of Health Spending,"Surprisingly little is known about long-term spending patterns in the under-65 population. Such information could inform efforts to improve coverage and control costs. Using the MarketScan claims database, we characterize the persistence of health care spending in the privately insured, under-65 population. Over a 6-year period, 69.8% of enrollees never had annual spending in the top 10% of the distribution and the bottom 50% of spenders accounted for less than 10% of spending. Those in the top 10% in 2003 were almost as likely (34.4%) to be in the top 10% five years later as one year later (43.4%). Many comorbid conditions retained much of their predictive power even 5 years later. The persistence at both ends of the spending distribution indicates the potential for adverse selection and cream skimming and supports the use of disease management, particularly for those with the conditions that remained strong predictors of high spending throughout the follow-up period.",acquired immune deficiency syndrome;adult;aged;alcohol use disorder;anxiety disorder;article;bipolar disorder;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;economics;employee;female;follow up;health care cost;health care policy;health insurance;health maintenance organization;health status;heart infarction;human;kidney disease;liver disease;major clinical study;major depression;male;medicare;mood disorder;organic psychosyndrome;peptic ulcer;peripheral vascular disease;personality disorder;posttraumatic stress disorder;preferred provider organization;private health insurance;psychosis;rheumatic disease;schizophrenia;solid tumor;substance abuse,"Hirth, R. A.;Gibson, T. B.;Levy, H. G.;Smith, J. A.;Calónico, S.;Das, A.",2015,,,0,
1836,An autopsy case of fatal repellent air freshener poisoning,"We describe a first fatal case of repellent air freshener ingestion. A 79-year-old Japanese man with Alzheimer-type senile dementia orally ingested repellent air freshener containing three surfactants: polyoxyethylene 9-lauryl ether, polyoxyethylene (40) hydrogenated castor oil, and lauric acid amidopropyl amine oxide (weight ratio of 1.3%). About 1. h after the collapse, he was in cardiopulmonary arrest and subsequently died 10. h after his arrival. The forensic autopsy performed 5.5. h after death revealed the 380. ml of stomach contents with a strong mint perfume identical to that of the repellent air freshener and the findings of acute death. Toxicologically, 9.1. μg/ml and 558.2. μg/ml of polyoxyethylene 9-lauryl ether were detected from the serum and stomach contents taken at autopsy. Generally, ingestion of anionic or non-ionic surfactants have been considered as safe. However, because the patient suffered from cardiac insufficiency with a low dose of repellent air freshener ingestion, medical staff members must evaluate the elderly patient for cardiac and circulatory problems regardless of the ingested dose. Not only medical and nursing staff members, but also families who are obliged to care for elderly persons must be vigilant to prevent accidental ingestion of toxic substances generally used in the household.",hydrogenated castor oil;lauric acid amidopropyl amine oxide;lauric acid derivative;perfume;polidocanol;macrogol;repellent air freshener;surfactant;unclassified drug;aged;Alzheimer disease;article;autopsy;blood examination;blood level;cardiopulmonary arrest;case report;collapse;fatality;forensic toxicology;heart failure;human;hypertrophy;ingestion;intoxication;Japanese (people);laboratory test;male;mortality;repellent air freshener poisoning;senile dementia;stomach content,"Hitosugi, M.;Tsukada, C.;Yamauchi, S.;Matsushima, K.;Furukawa, S.;Morita, S.;Nagai, T.",2015,,,0,
1837,Comorbidity trajectories in working age cancer survivors: A national study of Swedish men,"Background A large proportion of cancer survivors are of working age, and maintaining health is of interest both for their working and private life. However, patterns and determinants of comorbidity over time among adult cancer survivors are incompletely described. We aimed to identify distinct comorbidity trajectories and their potential determinants. Methods In a cohort study of Swedish men born between 1952 and 1956, men diagnosed with cancer between 2000 and 2003 (n = 878) were matched with cancer-free men (n = 4340) and followed over five years after their first year of survival. Comorbid diseases were identified using hospital diagnoses and included in the analysis using group-based trajectory modelling. The association of socioeconomic and developmental characteristics were assessed using multinomial logit models. Results Four distinct comorbidity trajectories were identified. As many as 84% of cancer survivors remained at very low levels of comorbidity, and the distribution of trajectories was similar among the cancer survivors and the cancer-free men. Increases in comorbidity were seen among those who had comorbid disease at baseline and among those with poor summary disease scores in adolescence. Socioeconomic characteristics and physical, cognitive and psychological function were associated with types of trajectory in unadjusted models but did not retain independent relationships with them after simultaneous adjustment. Conclusions Among working-age male cancer survivors, the majority remained free or had very low levels of comorbidity. Those with poorer health in adolescence and pre-existing comorbid diseases at cancer diagnosis may, however, benefit from follow-up to prevent further increases in comorbidity.",acquired immune deficiency syndrome;adult;anxiety;article;cancer registry;cancer risk;cancer survival;cancer survivor;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cognition;cohort analysis;colorectal cancer;comorbidity;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;follow up;heart infarction;hemiplegia;human;illness trajectory;infection;kidney disease;leukemia;liver disease;lung cancer;major clinical study;male;marriage;osteoporosis;paraplegia;peripheral vascular disease;priority journal;rheumatic disease;skin cancer;socioeconomics;Swedish citizen;thyroid cancer;urogenital tract cancer;work,"Hiyoshi, A.;Fall, K.;Bergh, C.;Montgomery, S.",2017,,10.1016/j.canep.2017.03.001,0,
1838,Factors associated with increased risk for dementia in individuals age 80 years or older with congestive heart failure,"BACKGROUND AND RESEARCH OBJECTIVE: An increasing body of evidence shows that individuals diagnosed with congestive heart failure (CHF) are at a higher risk for dementia. However, the prevalence rate of dementia among persons with CHF in very old individuals has not been previously reported, and little is known about the comorbidities that place old persons with CHF at a higher risk for dementia. The aim of this study was to compare the prevalence of dementia in individuals 80 years or older who have CHF with that in individuals without CHF and to identify factors related to dementia in individuals diagnosed with CHF. METHODS: A total of 702 participants from a Swedish population-based longitudinal study (Octogenerian Twin) were included. The group consisted of same-sex twin pairs, age 80 years or older, and 138 participants had CHF. Dementia was diagnosed according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Generalized estimating equations including gender, age and educational level, waist circumference, diabetes, hypertension, smoking, depression, and blood values were used in a case-control analysis. RESULTS: Individuals with CHF had a significantly higher prevalence of vascular dementia, 16% vs 6% (P < 0.001), and of all types of dementia, 40% vs 30% (P < 0.01), than those not diagnosed with CHF. The generalized estimating equation models showed that depression, hypertension, and/or increased levels of homocysteine were all associated with a higher risk for dementia in individuals with CHF. Diabetes was specifically associated with an increased risk for vascular dementia. CONCLUSIONS: The prevalence of dementia was higher among individuals with CHF than in those without CHF. Diabetes, depression, and hypertension in patients with CHF require special attention from healthcare professionals because these conditions are associated with an elevated risk for dementia. Higher levels of homocysteine were also found to be a marker of dementia in patients with CHF. Further research is needed to identify the factors related to dementia in individuals 80 years or older diagnosed with CHF.","Aged, 80 and over;Biomarkers/blood;Dementia/*epidemiology;Dementia, Vascular/blood/epidemiology;Depression/epidemiology;Diabetes Mellitus/epidemiology;Female;Heart Failure/blood/*epidemiology;Homocysteine/blood;Humans;Hypertension/epidemiology;Male;Prevalence","Hjelm, C.;Brostrom, A.;Dahl, A.;Johansson, B.;Fredrikson, M.;Stromberg, A.",2014,Jan-Feb,10.1097/JCN.0b013e318275543d,0,
1839,"Association between sleep-disordered breathing, sleep-wake pattern, and cognitive impairment among patients with chronic heart failure","AimsChronic heart failure (CHF) and sleep-disordered breathing (SDB) are often co-existing problems among the elderly. Apnoeic events may cause cognitive impairment. The aim of the study was to compare sleep and wake patterns, insomnia, daytime sleepiness, and cognitive function in community-dwelling CHF patients, with and without SDB, and to investigate the association between sleep-related factors and cognitive dysfunction.Methods and resultsIn this cross-sectional observational study, SDB was measured with an ApneaLink device and defined as an apnoea-hypopnoea index (AHI) ≥15/h of sleep. Sleep and wake patterns were measured with actigraphy for 1 week. Insomnia was measured with the Minimal Insomnia Symptom Scale, daytime sleepiness with the Epworth Sleepiness Scale, and cognitive function with a neuropsychological test battery. A total of 137 patients (68% male, median age 72 years, 58% NYHA functional class II) were consecutively included. Forty-four per cent had SDB (AHI ≥15). The SDB group had significantly higher saturation time below 90%, more difficulties maintaining sleep, and lower levels of daytime sleepiness compared with the non-SDB group. Cognitive function and sleep and wake patterns did not differ between the SDB and the non-SDB group. Insomnia was associated with decreased global cognition.ConclusionThe prevalence of cognitive dysfunction was low in this population with predominantly mild to moderate CHF. This might have influenced the lack of associations between cognitive function and SDB. Insomnia was the only sleep-related factor significantly influencing cognition. All rights reserved. © 2013 The Author.",brain natriuretic peptide;creatinine;actimetry;age;aged;apnea hypopnea index;article;body mass;cardiac patient;clinical assessment tool;cognition;cognitive defect;comorbidity;controlled study;correlational study;creatinine blood level;cross-sectional study;daytime somnolence;dementia;depression;depth perception;diagnostic equipment;educational status;episodic memory;Epworth sleepiness scale;executive function;female;gender;atrial fibrillation;heart failure;human;hypertension;insomnia;insulin dependent diabetes mellitus;major clinical study;male;Minimal Insomnia Symptom Scale;neuropsychological test;non insulin dependent diabetes mellitus;observational study;oxygen saturation;pacemaker;priority journal;protein blood level;psychomotor performance;semantic memory;sleep disordered breathing;sleep waking cycle;smoking;ApneaLink,"Hjelm, C.;Strömberg, A.;Årestedt, K.;Broström, A.",2013,,,0,
1840,Comorbidity and outcome in patients with coronary artery disease,,neoplasm;cause of death;cerebrovascular disease;chronic respiratory tract disease;cohort analysis;comorbidity;coronary artery atherosclerosis;coronary artery disease;cost of illness;dementia;diabetes mellitus;female;high risk population;human;kidney disease;male;mortality;non invasive measurement;note;outcomes research;prediction;priority journal;prognosis;quality of life;risk factor;standard;survival,"Hlatky, M. A.",2004,,,0,
1841,Association of Proton Pump Inhibitors Usage with Risk of Pneumonia in Dementia Patients,"OBJECTIVES: To determine the association between usages of proton pump inhibitors (PPIs) and subsequent risk of pneumonia in dementia patients. DESIGN: Retrospective cohort study. SETTING: Taiwanese National Health Insurance Research Database. PARTICIPANTS: The study cohort consisted of 786 dementia patients with new PPI usage and 786 matched dementia patients without PPI usage. MEASUREMENTS: The study endpoint was defined as the occurrence of pneumonia. The Cox proportional hazard model was used to estimate the pneumonia risk. Defined daily dose methodology was applied to evaluate the cumulative and dose-response relationships of PPI. RESULTS: Incidence of pneumonia was higher among patients with PPI usage (adjusted hazard ratio (HR) = 1.89; 95% CI = 1.51-2.37). Cox model analysis also demonstrated that age (adjusted HR = 1.05; 95% CI = 1.03-1.06), male gender (adjusted HR = 1.57; 95% CI = 1.25-1.98), underlying cerebrovascular disease (adjusted HR = 1.30; 95% CI = 1.04-1.62), chronic pulmonary disease (adjusted HR = 1.39; 95% CI = 1.09-1.76), congestive heart failure (adjusted HR = 1.54; 95% CI = 1.11-2.13), diabetes mellitus (adjusted HR = 1.54; 95% CI = 1.22-1.95), and usage of antipsychotics (adjusted HR = 1.29; 95% CI = 1.03-1.61) were independent risk factors for pneumonia. However, usage of cholinesterase inhibitors and histamine receptor-2 antagonists were shown to decrease pneumonia risk. CONCLUSION: PPI usage in dementia patients is associated with an 89% increased risk of pneumonia.","0 (Histamine H2 Antagonists);0 (Proton Pump Inhibitors);Age Factors;Aged;Databases, Factual;Dementia/ complications;Female;Histamine H2 Antagonists/administration & dosage/adverse effects;Humans;Incidence;Male;Pneumonia/chemically induced/ epidemiology;Proton Pump Inhibitors/administration & dosage/ adverse effects;Retrospective Studies;Risk Factors;Sex Factors;Taiwan/epidemiology;dementia;pneumonia;population-based study;proton-pump inhibitors","Ho, S. W.;Teng, Y. H.;Yang, S. F.;Yeh, H. W.;Wang, Y. H.;Chou, M. C.;Yeh, C. B.",2017,Jul,,0,
1842,Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life,"Context Anticholinergic drugs can cause several side effects, impairing cognition and quality of life (QOL). Cancer patients are often exposed to increasing cumulative anticholinergic load (ACL) as they approach death, but this burden has not been examined in patients with nonmalignant diseases. Objectives To determine ACL and its impact in noncancer versus cancer palliative care patients. Methods We performed a secondary analysis of 244 subjects enrolled in a randomized controlled trial. ACL was quantified with the Anticholinergic Drug Scale. We used multivariable regression to calculate the effect of ACL on key outcomes, including drowsiness, fatigue, and QOL. Patients were stratified by diagnosis, and drugs were grouped as symptom management (SM) or disease management (DM). Results Overall, ACL in cancer and noncancer patients was not significantly different (2.6 vs. 2.4; P = 0.23). SM drugs caused greater anticholinergic exposure than DM drugs in both cancer and noncancer patients (2.3 vs. 0.5, and 1.5 vs. 1.3, respectively; both P < 0.05); however, DM drugs exposed noncancer patients to relatively more ACL than cancer patients (1.2 vs. 0.6, P < 0.0001). ACL was associated with worse fatigue (odds ratio, 1.08; CI, 1.002–1.17) and worse QOL (odds ratio, 0.89; CI, 0.80–0.98). Conclusions ACL is associated with worse fatigue and QOL and may not differ significantly between cancer and noncancer patients nearing end of life. SM drugs are more responsible for ACL in cancer and noncancer patients, although DM drugs contribute significantly to ACL in the latter group. We recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.",cholinergic receptor blocking agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;adult;aged;article;cancer fatigue;cancer palliative therapy;cancer patient;cerebrovascular disease;chronic obstructive lung disease;congestive heart failure;controlled study;death;dementia;drowsiness;female;human;kidney disease;leukemia;lymphoma;major clinical study;male;malignant neoplasm;metastasis;outcome assessment;quality of life;randomized controlled trial;secondary analysis;terminal care;very elderly;wellbeing,"Hochman, M. J.;Kamal, A. H.;Wolf, S. P.;Samsa, G. P.;Currow, D. C.;Abernethy, A. P.;LeBlanc, T. W.",2016,,10.1016/j.jpainsymman.2016.03.020,0,
1843,Menopausal hormone therapy and prevention of chronic diseases: IMS members react to the recent JAMA paper,,conjugated estrogen;medroxyprogesterone acetate;placebo;adverse outcome;breast cancer;cerebrovascular accident;dementia;diabetes mellitus;gallbladder disease;good clinical practice;heart infarction;hip fracture;hormonal therapy;human;ischemic heart disease;lung embolism;menopause;mortality;note;outcome assessment;postmenopause;priority journal;quality of life;randomized controlled trial (topic);urine incontinence;vasomotor disorder;venous thromboembolism,"Hodis, H. N.",2014,,,0,
1844,Guidelines for nursing homes in the USA,,chronic pain;decubitus;dehydration;dementia;depression;falling;heart failure;long term care;mental health;nursing home;nutritional status;osteoporosis;practice guideline;short survey;United States;urine incontinence,"Hoek, F.;Smalbrugge, M.",2002,,,0,
1845,Decompensation in psychoses in the aged and treatment with diamox,,"Acetazolamide/*therapeutic use;Aged;Dementia/*complications;*Heart Failure;*Mental Disorders;*Psychotic Disorders;*ACETAZOLAMIDE/therapeutic use;*CONGESTIVE HEART FAILURE/in aged;*PSYCHOSES, SENILE/complications","Hoff, H.;Pateisky, K.",1958,Aug 1,,0,
1846,"Re: ""Midlife dietary intake of antioxidants and risk of late-life incident dementia: the Honolulu-Asia Aging Study""",,Age of Onset;Aged;Antioxidants/*adverse effects;Coronary Artery Disease/complications;Dementia/*epidemiology/*etiology;Diet Surveys;Female;Humans;Male;Mental Recall;Middle Aged;Reproducibility of Results;Research Design;Risk Assessment;Stroke/complications;Time Factors,"Hoffmann, K.;Bergmann, M. M.",2004,Oct 1,10.1093/aje/kwh285,0,
1847,Prevalence of chronic diseases in the elderly; the ERGO study (Erasmus Rotterdam Health and the Elderly),"In the Rotterdam Study, prevalence and determinants of chronic diseases in the elderly (age > or = 55 years), were investigated in inhabitants of Ommoord, a suburb of Rotterdam. The study focused on cardiac diseases (myocardial infarction, angina pectoris, cardiovascular risk factors), glaucoma, macular degeneration, osteoporosis, osteoarthrosis and invalidity, dementia (Alzheimer's disease, vascular dementia, Parkinson's disease), epilepsy, cerebrovascular accident. The number of participants was 7983 (3105 men, 4878 women), a response of 78%. The participants were interviewed and were twice examined in an out-patient clinic. The results will be described in subsequent issues of this journal.","Aged;Aged, 80 and over;Bone Diseases/epidemiology;Central Nervous System Diseases/epidemiology;Chronic Disease/*epidemiology;Cohort Studies;Eye Diseases/epidemiology;Female;Heart Diseases/epidemiology;Humans;Joint Diseases/epidemiology;Male;Middle Aged;Netherlands/epidemiology;Prevalence;Risk Factors","Hofman, A.;Boerlage, P. A.;Bots, M. L.;den Breeijen, J. H.;de Bruijn, A. M.;Grobbee, D. E.;Hoes, A. W.;de Jong, P. T.;Koenders, M. J.;Odding, E.;et al.",1995,Sep 30,,0,
1848,The Rotterdam Study: Objectives and design update,"The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in the Netherlands. The study targets cardiovascular, neurological, ophthalmological and endocrine diseases. As of 2008 about 15,000 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in some 600 research articles and reports (see http://www.epib.nl/rotterdamstudy ). This article gives the reasons for the study and its design. It also presents a summary of the major findings and an update of the objectives and methods. © 2007 Springer Science+Business Media B.V.",antihypertensive agent;antioxidant;corticosteroid;hydroxymethylglutaryl coenzyme A reductase inhibitor;hypocholesterolemic agent;nonsteroid antiinflammatory agent;thiazide diuretic agent;zinc;age distribution;Alzheimer disease;anxiety disorder;artery disease;article;atherosclerosis;blood analysis;brain radiography;cardiovascular disease;cerebrovascular disease;cognition;computer assisted tomography;data analysis;degenerative disease;demography;depression;dietary intake;drug safety;endocrine disease;epidemiological data;eye disease;genetic risk;genome analysis;genotype;grief;heart failure;heart infarction;human;hypothyroidism;inflammation;information processing;ischemic heart disease;mental disease;metabolism;methodology;Netherlands;neuroimaging;neurologic disease;neurologic examination;neuropathology;nutrition;open angle glaucoma;Parkinson disease;parkinsonism;pharmacoepidemiology;pharmacogenetics,"Hofman, A.;Breteler, M. M. B.;Van Duijn, C. M.;Krestin, G. P.;Pols, H. A.;Stricker, B. H. C.;Tiemeier, H.;Uitterlinden, A. G.;Vingerling, J. R.;Witteman, J. C. M.",2007,,,0,
1849,The rotterdam study: 2014 objectives and design update,"The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods. © 2013 Springer Science+Business Media Dordrecht.",biological marker;Alzheimer disease;article;atherosclerosis;basal cell carcinoma;blood analysis;cardiovascular disease;cerebrovascular accident;chronic obstructive lung disease;cognitive defect;cohort analysis;comorbidity;dementia;diagnostic procedure;differential diagnosis;disease classification;disease marker;DNA methylation;echography;electrocardiography;electromyography;endocrine disease;eye disease;fatty liver;follow up;gene identification;gene sequence;genetic association;genetic database;genetic variability;genomics;hearing disorder;atrial fibrillation;heart failure;heart infarction;human;incidence;inflammation;ischemic heart disease;lifestyle;liver disease;liver fibrosis;lung function test;malignant neoplastic disease;medical research;mental disease;methodology;multidetector computed tomography;myopia;neurologic disease;nuclear magnetic resonance imaging;nutritional assessment;open angle glaucoma;osteoarthritis;otorhinolaryngology;Parkinson disease;parkinsonism;peer review organization;pharmacogenetics;physical examination;polyneuropathy;prevalence;publication;respiratory tract disease;age related macular degeneration;risk assessment;RNA analysis;single nucleotide polymorphism;skin disease;squamous cell carcinoma,"Hofman, A.;Murad, S. D.;Van Duijn, C. M.;Franco, O. H.;Goedegebure, A.;Arfan Ikram, M.;Klaver, C. C. W.;Nijsten, T. E. C.;Peeters, R. P.;Stricker, B. H. C.;Tiemeier, H. W.;Uitterlinden, A. G.;Vernooij, M. W.",2013,,,0,
1850,The Rotterdam Study: 2012 objectives and design update,"The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods. © 2011 The Author(s).",Alzheimer disease;anxiety;article;atherosclerosis;cardiovascular disease;cardiovascular risk;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;dementia;depression;electrocardiogram;electron beam tomography;endocrine disease;eye disease;genetic association;genetic risk;genotype;atrial fibrillation;heart failure;heart infarction;high resolution computer tomography;human;ischemic heart disease;liver disease;medical research;mental disease;motor performance;multidetector computed tomography;myopia;neoplasm;Netherlands;neurologic disease;open angle glaucoma;optical coherence tomography;osteoporosis;Parkinson disease;pharmacoepidemiology;prospective study;respiratory tract disease;retina blood vessel;age related macular degeneration;skin disease;sleep disorder;spirometry;study design,"Hofman, A.;Van Duijn, C. M.;Franco, O. H.;Ikram, M. A.;Janssen, H. L. A.;Klaver, C. C. W.;Kuipers, E. J.;Nijsten, T. E. C.;Stricker, B. H. C.;Tiemeier, H.;Uitterlinden, A. G.;Vernooij, M. W.;Witteman, J. C. M.",2011,,,0,
1851,Cardiac pathology in neuronal ceroid lipofuscinoses - A clinicopathologic correlation in three patients,"We report the clinical details and the pathology of the heart at autopsy of three neuronal ceroid lipofuscinosis (NCL) patients. Two patients were diagnosed as classical juvenile NCL and one as a variant juvenile NCL (JNCL) with granular osmiophilic deposits (GRODs). Cardiac findings during life were retrospectively evaluated and included left ventricular hypertrophy with repolarization disturbances (ECG findings) in two patients with classical JNCL and severe bradycardia with periods of sinus arrest in one of them, severe supraventricular tachycardias during anaesthesia in the variant JNCL-patient. At autopsy myocardial and valvular storage of lipopigments, diagnostic for NCL, was observed histologically and confirmed ultrastructurally in all three cases. In two patients with JNCL the storage was associated with hypertrophy and dilation of both ventricles, degenerative myocardial changes, interstitial fibrosis and fatty replacement. Abundant accumulation and degeneration were seen in all components of the conduction system in three patients, which outreached at several places by far the storage of the adjacent myocardium. Our observations indicate a prominent involvement of the heart in NCL, with preference of storage for the conduction system of the heart.",lipofuscin;adipose tissue;adult;anesthesia;article;autopsy;bioaccumulation;bradycardia;case report;clinical feature;clinical observation;controlled study;correlation function;degenerative disease;disease association;disease classification;disease severity;electrocardiogram;evaluation study;female;heart dilatation;heart disease;heart left ventricle hypertrophy;heart muscle;heart muscle conduction system;heart repolarization;heart ventricle hypertrophy;histopathology;human;male;neuronal ceroid lipofuscinosis;priority journal;retrospective study;sinus arrest;supraventricular tachycardia;ultrastructure,"Hofman, I. L.;Van Der Wal, A. C.;Dingemans, K. P.;Becker, A. E.",2001,,,0,
1852,Dementia and comorbid conditions,"Dementia belongs to the most frequently occurring problems among older patients. For most types of dementia no causal therapy is currently available. Comorbid somatic conditions in patients with dementia are the rule rather than the exception. These potentially modifiable conditions are of major interest and they can therefore play an important role. This includes the strict management of risk factors as well as the avoidance of drugs with delirogenic, anticholinergic and dementing side effects. Thus, treatment of delirium, hypertension, heart failure, anemia, diabetes is important to reduce the symptoms of dementia itself. Possible therapeutic treatment options are described.",anemia;article;comorbidity;delirium;dementia;diabetes mellitus;heart failure;human;hypertension;risk factor,"Hofmann, W.",2017,,10.1007/s00108-016-0182-z,0,
1853,TTP disease course is independent of myeloma treatment and response,,bortezomib;calcium;creatinine;cyclosporin;dexamethasone;fresh frozen plasma;hemoglobin;immunoglobulin A;immunoglobulin G;lactate dehydrogenase;lenalidomide;melphalan;thalidomide;troponin;von Willebrand factor cleaving proteinase;abdominal pain;adult;bone marrow biopsy;calcium blood level;case report;compression fracture;creatinine blood level;disease course;drug response;female;gammopathy;heart infarction;hematopoietic stem cell transplantation;hemoglobin blood level;human;hypercalcemia;immunoglobulin blood level;letter;low back pain;male;mental deterioration;microthrombus;multiple cycle treatment;multiple myeloma;peripheral neuropathy;petechia;plasma transfusion;plasmapheresis;priority journal;faintness;thrombocyte count;thrombotic thrombocytopenic purpura,"Hofmeister, C. C.;Jin, M.;Cataland, S. R.;Benson, D. M.;Wu, H.",2010,,,0,
1854,An introduction to the nutrition and metabolism of choline,"Choline is a ubiquitous water soluble nutrient, often associated with the B vitamins; however, not yet officially defined as a B vitamin. It is important in the synthesis of phospholipid components of cell membranes, and plasma lipoproteins, providing structural integrity as well as being important in cell signaling; it is also important in the synthesis of the neurotransmitter acetylcholine, and the oxidized form of choline, glycine betaine, serves as an important methyl donor in the methionine cycle. It is present in a wide variety of foods, and is endogenously synthesized in humans through the sequential methylation of phosphatidylethanolamine. The present article represents an introduction to the nutrition, metabolism, and physiological functions of choline and choline derivatives in humans. The association of choline and choline derivatives in risk of chronic disease, including: neural tube defects, coronary artery disease, cancer, Alzheimer's disease, dementia, and memory, and cystic fibrosis is reviewed. © 2012 Bentham Science Publishers.",acetylcholine;alanine aminotransferase;aspartate aminotransferase;betaine;ceramide;choline;cobalamin;cyanocobalamin;diacylglycerol;folic acid;glycerophosphorylcholine;homocysteine;lysophosphatidylcholine;phosphatidylcholine;phosphatidylethanolamine methyltransferase;s adenosylmethionine;sphingomyelin;thrombocyte activating factor;absorption;alanine aminotransferase blood level;Alzheimer disease;aminotransferase blood level;article;cancer risk;cereal;coronary artery disease;cystic fibrosis;dementia;dietary intake;digestion;disease association;dizziness;DNA methylation;egg yolk;enzyme localization;excretion;fatty liver;fish;fruit;human;Huntington chorea;hydrolysis;hypotension;lipid metabolism;lipid transport;memory;methylation;neural tube defect;neurotransmission;nonalcoholic fatty liver;nutrition;osmosis;risk assessment;salivation;senile dementia;side effect;signal transduction;smelling;soybean;sweating;faintness;tardive dyskinesia;unspecified side effect;vegetable;vitamin deficiency;vitamin metabolism;vitamin supplementation;vomiting;wheat germ,"Hollenbeck, C. B.",2012,,,0,
1855,"Cognition, mood, and purpose in life in neuromyelitis optica spectrum disorder",,aquaporin 4;adult;Alzheimer disease;article;cerebrovascular accident;clinical article;clinical assessment tool;cognition;cognitive defect;comorbidity;controlled study;depression;disability;disease duration;Expanded Disability Status Scale;female;gray matter;heart infarction;human;male;mood;motor performance;myelooptic neuropathy;neuromyelitis optica spectrum disorder;physical activity;priority journal;purpose in life test;task performance;white matter injury,"Hollinger, K. R.;Franke, C.;Arenivas, A.;Woods, S. R.;Mealy, M. A.;Levy, M.;Kaplin, A. I.",2016,,,0,
1856,Biomarkers of microvascular endothelial dysfunction predict incident dementia: a population-based prospective study,"Background: Cerebral endothelial dysfunction occurs in a spectrum of neurodegenerative diseases. Whether biomarkers of microvascular endothelial dysfunction can predict dementia is largely unknown. We explored the longitudinal association of midregional pro-atrial natriuretic peptide (MR-proANP), C-terminal endothelin-1 (CT-proET-1) and midregional proadrenomedullin (MR-proADM) with dementia and subtypes amongst community-dwelling older adults. Methods: A population-based cohort of 5347 individuals (men, 70%; age, 69 ± 6 years) without prevalent dementia provided plasma for determination of MR-proANP, CT-proET-1 and MR-proADM. Three-hundred-and-seventy-three patients (7%) were diagnosed with dementia (120 Alzheimer's disease, 83 vascular, 102 mixed, and 68 other aetiology) over a period of 4.6 ± 1.3 years. Relations between baseline biomarker plasma concentrations and incident dementia were assessed using multivariable Cox regression analysis. Results: Higher levels of MR-proANP were significantly associated with increased risk of all-cause and vascular dementia (hazard ratio [HR] per 1 SD: 1.20, 95% confidence interval [CI], 1.07–1.36; P = 0.002, and 1.52; 1.21–1.89; P < 0.001, respectively). Risk of all-cause dementia increased across the quartiles of MR-proANP (p for linear trend = 0.004; Q4, 145–1681 pmol L−1 vs. Q1, 22–77 pmol L−1: HR: 1.83; 95%CI: 1.23–2.71) and was most pronounced for vascular type (p for linear trend = 0.005: HR: 2.71; 95%CI: 1.14–6.46). Moreover, the two highest quartiles of CT-proET-1 predicted vascular dementia with a cut-off value at 68 pmol L−1 (Q3–Q4, 68–432 pmol L−1 vs. Q1–Q2,4–68 pmol L−1; HR: 1.94; 95%CI: 1.12–3.36). Elevated levels of MR-proADM indicated no increased risk of developing dementia after adjustment for traditional risk factors. Conclusions: Elevated plasma concentration of MR-proANP is an independent predictor of all-cause and vascular dementia. Pronounced increase in CT-proET-1 indicates higher risk of vascular dementia.",atrial natriuretic factor;endothelin 1;high density lipoprotein;hydroxymethylglutaryl coenzyme A reductase inhibitor;proadrenomedullin;aged;Alzheimer disease;article;brain region;carboxy terminal sequence;controlled study;dementia;disease association;endothelial dysfunction;female;follow up;heart failure;human;major clinical study;male;microvascularization;multiinfarct dementia;Parkinson disease;priority journal;prospective study;protein blood level;reference value;risk factor,"Holm, H.;Nägga, K.;Nilsson, E. D.;Ricci, F.;Melander, O.;Hansson, O.;Bachus, E.;Magnusson, M.;Fedorowski, A.",2017,,10.1111/joim.12621,0,
1857,Excess mortality during hospital stays among patients with recorded diabetes compared with those without diabetes,"Aim: To assess the additional mortality during hospital admissions among patients with recorded diabetes and identify the extent of variation in English provider trusts. Methods: Inpatient admissions to all English hospitals between April 2010 and March 2012 were extracted from Hospital Episode Statistics. Binary logistic regression was used to standardize for age, sex, deprivation, method and reason for admission, co-morbidities and type of trust. Trust level standardized mortality ratios for inpatients with recorded diabetes were compared with those without recorded diabetes and with published measures of hospital mortality. Results: Of the 10 169 003 hospital admissions analysed, 11.2% had recorded diabetes, but 21.5% of inpatient deaths occurred in this group. After adjustment for case mix, hospital admissions in patients with recorded diabetes had a 6.4% greater risk of dying (2052 more deaths over 2 years) than would be expected compared with similar patients without recorded diabetes. The additional risk of death was significantly greater in smaller trusts. The highest additional risk of death was found in hospital admissions of younger female patients admitted electively. At provider trust level, 37.4% of variation in adjusted mortality in patients with recorded diabetes was explained by the mortality in those without recorded diabetes. Conclusion: A diagnosis of diabetes has an adverse impact on hospital mortality that cannot be explained by usual case-mix adjustments, and the additional risk of dying is greatest among hospital admissions that would normally have a low risk of death. This implies that diabetes may override the usual risk factors for hospital mortality. © 2013 Crown copyright. Diabetic Medicine © 2013 Diabetes UK.",adult;article;case mix;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;female;heart infarction;hemiplegia;hospital admission;hospitalization;human;International Classification of Diseases;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;mortality;peripheral vascular disease;risk factor;standardized mortality ratio,"Holman, N.;Hillson, R.;Young, R. J.",2013,,,0,
1858,Nursing care study--psychiatric unit,,Dementia/nursing;Humans;Myocardial Infarction/nursing;Nursing,"Holmes, D. E.",1966,Jul,,0,
1859,Reconsidering medication appropriateness for patients late in life,,acetylsalicylic acid;analgesic agent;atorvastatin;calcium;chlorpropamide;fluticasone propionate;furosemide;hydroxymethylglutaryl coenzyme A reductase inhibitor;ipratropium bromide;isosorbide mononitrate;lisinopril;metolazone;salbutamol sulfate;simvastatin;theophylline;acute disease;cancer screening;clinical feature;comorbidity;congestive heart failure;coronary artery disease;cost benefit analysis;dementia;diabetes mellitus;emphysema;functional disease;heart failure;human;hypertension;kidney failure;life expectancy;medical assessment;medical care;medical information;note;nursing home;osteoarthritis;practice guideline;prescription;priority journal;treatment indication;aspirin,"Holmes, H. M.;Hayley, D. C.;Alexander, G. C.;Sachs, G. A.",2006,,,0,
1860,Soliciting an herbal medicine and supplement use history at hospice admission,"Background: Reconciling medication use and performing drug utilization review on admission of a patient into hospice care are essential in order to safely prescribe medications and to prevent possible adverse drug events and drug-drug interactions. As part of this process, fully assessing herbal medicine and supplement use in hospice patients is crucial, as patients in hospice may be likely to use these medications and may be more vulnerable to their potential adverse effects. Objective: Our purpose was to identify herbals, vitamins, and supplements that should be routinely assessed on every hospice admission because of their higher likelihood of use or higher risk of adverse effects or drug interactions. Methods: Experts in the fields of palliative medicine, pharmacy, and alternative medicine were asked to complete a Web-based survey on 37 herbals, vitamins, supplements, and natural products, rating likelihood of use, potential for harm, and recommendation to include it on the final list on a scale of 1 to 5 (least to most likely to agree). Results: Twenty experts participated in the survey. Using a cutoff of 3.75 for inclusion of a medication on the final list, 12 herbal medicines were identified that should be routinely and specifically assessed on hospice admission. Conclusions: Although assessing all herbal medicine use is ideal, thorough detection of herbals may be challenging. The list of herbals and supplements identified by this survey could be a useful tool for medication reconciliation in hospice and could aid in identifying potentially harmful medication use at the end of life. © 2010, Mary Ann Liebert, Inc.",alprazolam;anticoagulant agent;anticonvulsive agent;antidepressant agent;antidiabetic agent;antihypertensive agent;antithrombocytic agent;calcium channel blocking agent;central depressant agent;contraceptive agent;corticosteroid;cyclosporin;deglycyrrhizinated liquorice;diuretic agent;Echinacea extract;fish oil;garlic extract;ginger extract;Ginkgo biloba extract;ginseng extract;kava extract;levodopa;melatonin;midazolam;omeprazole;saquinavir;trazodone;unindexed drug;vitamin;warfarin;abdominal cramp;abdominal discomfort;allergic reaction;amenorrhea;anxiety disorder;artery disease;arthralgia;article;asthma;atherosclerosis;eructation;bleeding;bleeding time;body odor;breast tenderness;cerebrovascular accident;circadian rhythm sleep disorder;cluster headache;colon cancer;common cold;confusion;congestive heart failure;constipation;daytime drowsiness;dementia;depression;dermatomycosis;diabetes mellitus;diabetic retinopathy;diarrhea;diet supplementation;disorientation;dizziness;drowsiness;drug efficacy;drug mechanism;drug potentiation;dyspepsia;edema;enlarged pupil;extrapyramidal symptom;fever;fishy aftertaste;flatulence;gastrointestinal irritation;gastrointestinal symptom;genital herpes;glaucoma;halitosis;headache;health survey;heart palpitation;heartburn;herbal medicine;hospice care;hospital admission;human;hypercholesterolemia;hypertension;hypertension encephalopathy;hypokalemia;hypokalemic myopathy;hypotension;influenza;insomnia;irritability;jet lag;kidney disease;lavender;leg disease;lethargy;leukopenia;libido disorder;liver injury;loose feces;lower extremity weakness;lung edema;medical expert;memory disorder;menopausal anxiety;menopausal syndrome;morning sickness;mouth disease;mouth irritation;myalgia;myoglobinuria;myopathy;nausea;nervousness;oculomotor nerve disease;odor;palliative therapy;postoperative nausea and vomiting;premenstrual syndrome;preoperative anxiety;preoperative sedation;prostate cancer;pruritus;pupil disease;quadriplegia;rash;rating scale;Raynaud phenomenon;rectum cancer;rhabdomyolysis;rheumatoid arthritis;risk factor;sexual dysfunction;side effect;skin allergy;skin bruising;skin manifestation;skin pruritus;skin redness;sleep disorder;sodium retention;solid tumor;sore throat;spotting;Stevens Johnson syndrome;stomach cancer;stomach disease;stomach pain;stomach upset;sunburn;tachycardia;tardive dyskinesia;taste disorder;throat irritation;thrombocyte dysfunction;thrombocytopenia;tick bite;tongue disease;tongue numbness;transient depressive symptom;tremor;unpleasant taste;urinary tract infection;vagina bleeding;vagina mycosis;vertigo;vomiting;water retention;withdrawal syndrome;xerostomia,"Holmes, H. M.;Kaiser, K.;Jackson, S.;McPherson, M. L.",2010,,,0,
1861,Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation - Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF),"Background Obstructive sleep apnea (OSA) is common in patients with atrial fibrillation (AF). Little is known about the impact of OSA on AF treatment and long-term outcomes. We studied whether patients with OSA have a greater likelihood of progressing to more persistent forms of AF or require more hospitalizations and/or worse outcomes compared with patients without OSA. Methods A total of 10,132 patients were enrolled between June 2010 and August 2011 in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) and followed for up to 2 years. The prevalence of OSA and continuous positive airway pressure (CPAP) treatment was captured at baseline. The association between OSA and major cardiovascular outcomes was analyzed using multivariable hierarchical logistic regression modeling and Cox frailty regression model. Results Of the 10,132 patients with AF, 1,841 had OSA. Patients with OSA were more symptomatic (22% vs 16% severe/disabling symptoms; P <.0001) and more often on rhythm control therapy (35% vs 31%; P =.0037). In adjusted analyses, patients with OSA had higher risk of hospitalization (hazard ratio [HR], 1.12; 95% CI, 1.03-1.22; P =.0078), but no difference in the risks of death (HR, 0.94; 95% CI, 0.77-1.15; P =.54); the composite of CV death, myocardial infarction, and stroke/transient ischemic attack (HR, 1.07; 95% CI, 0.85-1.34; P =.57); major bleeding (HR, 1.18; 95% CI, 0.96-1.46; P =.11); or AF progression (HR, 1.06; 95% CI, 0.89-1.28; P =.51). Patients with OSA on CPAP treatment were less likely to progress to more permanent forms of AF compared with patients without CPAP (HR, 0.66; 95% CI, 0.46-0.94; P =.021). Conclusion Compared with those without, AF patients with OSA have worse symptoms and higher risks of hospitalization, but similar mortality, major adverse cardiovascular outcome, and AF progression rates. Clinical Trial Registration: NCT01165710 (http://www.clinicaltrials.gov).",NCT01165710;aged;alcohol abuse;article;atrial fibrillation;body mass;brain hemorrhage;cardiovascular mortality;cerebrovascular accident;chronic obstructive lung disease;cognitive defect;cohort analysis;controlled clinical trial;controlled study;dementia;diabetes mellitus;diastolic blood pressure;disease course;female;functional status;gastrointestinal hemorrhage;heart failure;heart infarction;heart left ventricle ejection fraction;hospitalization;human;hyperlipidemia;hypertension;major clinical study;male;outcome assessment;peripheral vascular disease;positive end expiratory pressure;priority journal;sleep disordered breathing;smoking;systolic blood pressure;transient ischemic attack;valvular heart disease;very elderly,"Holmqvist, F.;Guan, N.;Zhu, Z.;Kowey, P. R.;Allen, L. A.;Fonarow, G. C.;Hylek, E. M.;Mahaffey, K. W.;Freeman, J. V.;Chang, P.;Holmes, D. N.;Peterson, E. D.;Piccini, J. P.;Gersh, B. J.",2015,,,0,
1862,Hyperammonemia associated with valproic acid use in elderly psychiatric patients,"Valproic acid (VPA) is associated with hyperammonemia; however, little is known about this phenomenon in the geriatric psychiatric population. Of 12 such patients prescribed VPA, 83.3% had elevated ammonia. This occurred in the absence of elevated liver enzymes, and there was no association of VPA serum-level to hyperammonemia. © 2012 American Psychiatric Association.",alanine aminotransferase;alkaline phosphatase;ammonia;aspartate aminotransferase;bilirubin;phenytoin;risperidone;valproic acid;aged;alanine aminotransferase blood level;alkaline phosphatase blood level;Alzheimer disease;ammonia blood level;article;aspartate aminotransferase blood level;bilirubin blood level;bipolar disorder;chronic kidney failure;comorbidity;congestive heart failure;coronary artery disease;delirium;diabetes mellitus;disease association;elderly care;human;hyperammonemia;hyperlipidemia;hypertension;lethargy;liver function test;medical record review;mental patient;Mini Mental State Examination;multiinfarct dementia;prescription;priority journal;retrospective study;schizoaffective psychosis;side effect,"Holroyd, S.;Overdyke, J. T.",2012,,,0,
1863,Head injury in early adulthood and the lifetime risk of depression,"BACKGROUND: Depressive symptoms are common and can be debilitating in the months after head injury. Head injury can also have long-term cognitive effects, but little is known about the long-term risk of depression associated with head injury. We investigated the lifetime rates of depressive illness 50 years after closed head injury. METHODS: Participants were male World War II veterans who served during 1944-1945 and were hospitalized at that time for a head injury, pneumonia, or laceration, puncture, or incision wounds. We used military medical records to establish the presence and severity of closed head injuries. Veterans with (n = 520) and without (n = 1198) head injuries were interviewed in 1996-1997 for their lifetime history of depressive illness. Men with dementia were excluded. RESULTS: Veterans with head injury were more likely to report major depression in subsequent years and were more often currently depressed. Using logistic regression and controlling for age and education, the lifetime prevalence of major depression in the head injured group was 18.5% vs 13.4% in those with no head injury (odds ratio = 1.54, 95% confidence interval = 1.17-2.04). Current major depression was detected in 11.2% of the veterans with head injuries vs 8.5% of those without head injury (odds ratio = 1.63, 95% confidence interval = 1.07-2.50). This increase in depression could not be explained by a history of myocardial infarction, a history of cerebrovascular accident, or history of alcohol abuse. The lifetime risk of depression increased with severity of the head injury. CONCLUSION: The risk of depression remains elevated for decades following head injury and seems to be highest in those who have had a severe head injury.","Adult;Aged;Brain Injury, Chronic/psychology;Cohort Studies;Depression/etiology/psychology;Depressive Disorder/*etiology/psychology;Depressive Disorder, Major/etiology/psychology;Follow-Up Studies;Head Injuries, Closed/*complications/psychology;Humans;Male;Middle Aged;Risk Assessment;Veterans/*psychology","Holsinger, T.;Steffens, D. C.;Phillips, C.;Helms, M. J.;Havlik, R. J.;Breitner, J. C.;Guralnik, J. M.;Plassman, B. L.",2002,Jan,,0,
1864,Severe sulfonylurea-induced hypoglycemia: A problem of uncritical prescription and deficiencies of diabetes care in geriatric patients,"Objective: Severe sulfonylurea-induced hypoglycemia (SH) remains a life-threatening and under-reported condition. We investigated the incidence of SH and clinical characteristics of patients with type 2 diabetes mellitus (T2DM) to demonstrate typical risk constellations. Methods: In a prospective population-based observational study, all consecutive cases of SH in the period 2000 2009 in a German area with 200,000 inhabitants were registered. Severe hypoglycemia was defined as a symptomatic event requiring treatment with intravenous glucose and was confirmed by a blood glucose measurement of < 50 mg/dl. Results: A mean incidence of seven episodes of SH per year and 100,000 inhabitants was registered. The 139 hypoglycemic individuals had been treated with glimepiride (n = 98), glibenclamide (n = 40) or gliquidone (n = 1). No preparation showed a constant doseeffect relationship, SH occurring within a wide dose range. The patients were characterized as follows: age 77.5 ± 9.4 years, duration of diabetes 11 ± 7 years, body mass index 26.3 ± 4.9 kg/m2, HbA1c 6.6 ± 1.3%, creatinine clearance 46 ± 24 ml/min with renal insufficiency in 73% and co-medication 7 ± 3 drugs. Two-thirds of all subjects lived independently at home whereas a third were cared for by a home nursing service or received care in nursing homes. In all, 30% had participated in diabetes education programs. In 31%, systematic blood glucose monitoring was performed. Conclusions: Uncritical prescription of sulfonylureas neglecting crucial contraindications particularly renal insufficiency and deficiencies of diabetes care contributed substantially to the risk of SH in the mainly geriatric patients. There is a need for alternative therapeutic concepts that minimize the risk of hypoglycemia in geriatric patients with T2DM. © 2010 Informa UK, Ltd.",creatinine;glibenclamide;glimepiride;gliquidone;glucose;hemoglobin A1c;insulin;metformin;sulfonylurea;adult;aged;article;controlled study;creatinine clearance;dementia;diabetes education;disease duration;disease severity;dose response;drug contraindication;female;geriatric patient;glucose blood level;heart failure;home care;human;hypoglycemia;incidence;kidney failure;major clinical study;male;malignant neoplastic disease;non insulin dependent diabetes mellitus;nursing home;polypharmacy;prescription;risk factor,"Holstein, A.;Hammer, C.;Hahn, M.;Kulamadayil, N. S. A.;Kovacs, P.",2010,,,0,
1865,Unusual neurological manifestation of severe digitoxin intoxication with bilateral ballism and visual hallucinations,,digitoxin;aged;article;atrial fibrillation;case report;comorbidity;dementia;disease course;dizziness;drug withdrawal;electrocardiogram;electrocardiography monitoring;follow up;gastrointestinal symptom;hemiballism;hospital discharge;human;involuntary movement;male;Mini Mental State Examination;neurologic disease;systolic heart failure;very elderly;visual hallucination,"Holstein, A.;Hassan, A.;Patzer, O. M.;Rohde, M.",2015,,,0,
1866,Diffusion magnetic resonance histograms as a surrogate marker and predictor of disease progression in CADASIL a two-year follow-up study,"Background and Purpose - Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a cerebral small vessel disease caused by mutations in the NOTCH3 gene. MRI is sensitive in detecting preclinical involvement and changes over time. However, little is known about correlations between MRI metrics and clinical measures on a longitudinal scale. In this study, we assessed the role of quantitative MRI (T2-lesion volume and diffusion tensor imaging [DTI]-derived metrics) in monitoring and predicting disease progression. Methods - Sixty-two CADASIL subjects were followed prospectively over a period of 26.3±1.2 months. Dual-echo scans, DTI scans, and clinical scales were obtained at baseline and at follow-up. T2-lesion volumes were determined quantitatively, and histograms of mean diffusivity (MD) were produced. Results - At follow-up, T2-lesion volumes and MD histogram metrics had changed significantly (all P<0.01). Lesion volumes and average MD correlated with clinical scores at baseline. Changes of average MD correlated with changes of the Rankin score, the National Institutes of Health Stroke Scale score, and the structured interview for the diagnosis of Alzheimer dementia and multiinfarct dementia score (all P<0.01). On multivariate analysis, average MD and systolic blood pressure at baseline were predictors of changes of average MD during follow-up. Moreover, average MD was the main predictor of clinical progression. Sample size estimates showed that the number of individuals required to detect a treatment effect in an interventional trial may be reduced when using MD histograms as an end point. Conclusions - This study establishes correlations between changes of DTI histogram metrics and clinical measures over time. DTI histograms may be used as an adjunct outcome measure in future therapeutic trials. Moreover, DTI histogram metrics predict disease progression in CADASIL. © 2005 American Heart Association, Inc.",Notch3 receptor;adult;Alzheimer disease;article;CADASIL;controlled study;diffusion weighted imaging;disease course;disease marker;female;follow up;gene mutation;histogram;human;longitudinal study;major clinical study;male;monitoring;multiinfarct dementia;outcome assessment;priority journal;prospective study;quantitative diagnosis;Rankin scale;scoring system;sensitivity and specificity;systolic blood pressure,"Holtmannspötter, M.;Peters, N.;Opherk, C.;Martin, D.;Herzog, J.;Brückmann, H.;Sämann, P.;Gschwendtner, A.;Dichgans, M.",2005,,,0,
1867,"Feelings of loneliness, but not social isolation, predict dementia onset: Results from the Amsterdam Study of the Elderly (AMSTEL)","Background Known risk factors for Alzheimer's disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce. Methods We tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort study among 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed (Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT)). Logistic regression analysis was used to examine the association between social isolation and feelings of loneliness and the risk of dementia, controlling for sociodemographic factors, medical conditions, depression, cognitive functioning and functional status. Results After adjustment for other risk factors, older persons with feelings of loneliness were more likely to develop dementia (OR 1.64, 95% CI 1.05 to 2.56) than people without such feelings. Social isolation was not associated with a higher dementia risk in multivariate analysis. Conclusions Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.",ADL disability;aged;alcohol abuse;arthritis;article;cerebrovascular disease;clinical assessment tool;cognition;cohort analysis;controlled study;dementia;demography;depression;diabetes mellitus;epilepsy;female;functional status;generalized anxiety disorder;Geriatric Mental State Automated Geriatric Examination for Computer Assisted Taxonomy;heart arrhythmia;human;hypertension;incidence;ischemic heart disease;loneliness;major clinical study;male;neoplasm;osteoarthritis;Parkinson disease;prediction;prevalence;priority journal;respiratory tract disease;risk factor;smoking;social isolation;social support;traumatic brain injury;very elderly,"Holwerda, T. J.;Deeg, D. J. H.;Beekman, A. T. F.;Van Tilburg, T. G.;Stek, M. L.;Jonker, C.;Schoevers, R. A.",2014,,,0,
1868,"Donepezil treatment of patients with severe Alzheimer's disease in a Japanese population: Results from a 24-week, double-blind, placebo-controlled, randomized trial","Background/Aims: A 24-week, randomized, parallel-group, double-blind placebo-controlled study was conducted to evaluate the efficacy and tolerability of donepezil in severe Alzheimer's disease (AD). Methods: Patients with severe AD (Mini-Mental State Examination score 1-12; modified Hachinski Ischemic Score ≤6; Functional Assessment Staging ≥6) were enrolled in this study in Japan. A total of 325 patients were randomized to donepezil 5 mg/day (n = 110), donepezil 10 mg/day (n = 103) or placebo (n = 112). Primary outcome measures were change from baseline to endpoint in the Severe Impairment Battery (SIB) and Clinician's Interview-Based Impression of Change-plus caregiver input (CIBIC-plus) at the endpoint visit. Results: Donepezil 5 mg/day and 10 mg/day were significantly superior to placebo on the SIB, with a least-squares mean treatment difference of 6.7 and 9.0, respectively (p < 0.001 compared with placebo). CIBIC-plus analyses showed significant differences in favor of donepezil 10 mg/day over placebo at endpoint (p = 0.003). A statistically significant dose-response relationship was demonstrated with the SIB and CIBIC-plus. Donepezil was well tolerated. Conclusion: This study confirmed the effectiveness of donepezil 10 mg/day in patients with severe AD and demonstrated a significant dose-response relationship. Donepezil at dosages of both 5 mg/day and 10 mg/day is safe and well tolerated in Japanese patients with severe AD. Copyright © 2008 S. Karger AG.",donepezil;placebo;adult;aged;Alzheimer disease;anorexia;article;clinical trial;constipation;controlled clinical trial;controlled study;decreased appetite;diarrhea;disease severity;dose response;double blind procedure;drug efficacy;drug tolerability;drug withdrawal;female;fever;heart arrhythmia;heart infarction;human;Japanese (people);major clinical study;male;multicenter study;outcome assessment;pneumonia;priority journal;randomized controlled trial;restlessness;side effect,"Homma, A.;Imai, Y.;Tago, H.;Asada, T.;Shigeta, M.;Iwamoto, T.;Takita, M.;Arimoto, I.;Koma, H.;Ohbayashi, T.",2008,,,0,
1869,Clinical correlation of vascular parkinsonism,"Vascular parkinsonism has not been well defined and the clinical correlation of vascular parkinsonism is still not clear. The aim of the study was to estimate prevalence of occurrence of vascular parkinsonism, analysis of risk factors leading to its development and to identify clinical features that suggest a vascular origin. 214 patients with Parkinson's disease were examined. Their ages ranged from 37 to 88 years (median 66.4 years). Evidence of vascular parkinsonism was assessed using a vascular rating scale previously described by Winikates and Jankovic. Statistical analysis was performed with Mann-Whitney U test, chi 2 Pearson test, chi 2 Yates test, Spearman rank correlation and Student's t test. Out of 214 patients 8 were proved to have developed Parkinson's disease due to vascular disease, what gave 3.74%. Out of risk factors for stroke 5 patients had hypertension, 3 had diabetes mellitus, 2 suffered from heart disease, 2 had infarctus myocardii, 1 had hyperlipidemia, 1 had atrial fibrillation. Additionally, those patients had neuroimaging (CT or MRI) evidence of vascular disease in one or more vascular territories. Patients with vascular parkinsonism were older, had shorter duration of disease, were more likely to present rigidity rather than tremor. Dementia and incontinence were more common in vascular group than in Parkinson's disease group. Patients with vascular parkinsonism were also significantly more likely to have corticospinal findings. Proving that Parkinson's disease had vascular etiology is extremely difficult. The test results are inconclusive.","Adult;Aged;Aged, 80 and over;Brain/*blood supply/pathology/radiography;Cerebrovascular Circulation/physiology;Dementia/diagnosis/epidemiology;Female;Humans;Hypertension/epidemiology;Magnetic Resonance Imaging;Male;Middle Aged;Parkinsonian Disorders/diagnosis/epidemiology/*physiopathology;Prevalence;Risk Factors;Tomography, X-Ray Computed;Urinary Incontinence/diagnosis/epidemiology","Honczarenko, K.;Budzianowska, A.",2003,,,0,
1870,An estimation of the incidence of tuberous sclerosis complex in a nationwide retrospective cohort study (1997–2010),"Background: Tuberous sclerosis complex (TSC) is caused by mutations in TSC1 and TSC2, leading to mammalian target of rapamycin hyperactivation. Patients with TSC develop hamartomas in brain, lungs, liver and skin. Two epidemiological studies, performed in Minnesota, U.S.A., have estimated the incidence of TSC to be 0·28–0·56 per 100 000 person-years (PY), based on < 12 patients. Furthermore, whether common comorbidities are associated with this rare disease is not known. Objectives: To estimate the incidence of TSC and investigate the associations of TSC with other comorbidities, including diabetes, peptic ulcers, stroke and myocardial infarction. Methods: We estimated the incidence and prevalence of TSC and its comorbidities from 1997 to 2010, based on the Catastrophic Illness Certificate disease database and a beneficiary cohort of 1 million people. Results: The incidence of TSC in Taiwan is 0·153 per 100 000 PY. The number of patients identified with TSC in Taiwan doubled from 206 in 2006 to 471 in 2010. In 2010, the prevalence of TSC in Taiwan was estimated to be 1·58 in 100 000. We confirmed that female patients with TSC are more likely to develop renal tumours than male patients. Surprisingly, patients with TSC have a significantly decreased risk of developing peptic ulcers compared with controls. Conclusions: This is the first large-scale and longitudinal incidence study of TSC. This study provides compelling evidence that TSC mutations in humans are associated with a decreased risk of peptic ulcers.",adult;aged;article;cerebrovascular accident;cohort analysis;comorbidity;comparative study;controlled study;dementia;diabetes mellitus;disease association;female;gene mutation;genetic association;heart infarction;high risk patient;human;incidence;kidney disease;kidney tumor;major clinical study;male;peptic ulcer;prevalence;priority journal;retrospective study;risk assessment;risk factor;seizure;sex difference;tuberous sclerosis;tuberous sclerosis complex;urinary tract tumor,"Hong, C. H.;Tu, H. P.;Lin, J. R.;Lee, C. H.",2016,,,0,
1871,Preoperative comorbidities and relationship of comorbidities with postoperative complications in patients undergoing transurethral prostate resection,"Purpose: We retrospectively identified preoperative comorbidities and analyzed the relationship of the comorbidities to postoperative complications in patients treated with transurethral prostate resection. Materials and Methods: We reviewed the surgical and clinical records of 1,878 patients who underwent transurethral prostate resection at a single university hospital between January 2006 and December 2009. Variables included preoperative comorbidities, intraoperative data and postoperative complications, including mortality. Results: Only 32.6% of the patients had no observed preoperative comorbidity and the other 67.4% had at least 1. The incidence of comorbidities increased with age (p <0.001). The overall postoperative complication rate was 5.8%. There were 3 deaths for an overall 0.16% 30-day mortality rate. The postoperative complication rate was significantly higher in patients who had a comorbidity preoperatively and were 50 to 59 (p = 0.043), 60 to 69 (p = 0.028) and 70 to 79 years old (p = 0.017). The Charlson comorbidity index was significantly associated with postoperative complications (r2 = 0.221, p = 0.012). Conclusions: Almost two-thirds of the patients who underwent transurethral prostate resection had various preoperative comorbidities. The fact that the preoperative comorbidity was significantly related to postoperative complications after transurethral prostate resection should be considered in perioperative management in this population. © 2011 American Urological Association Education and Research, Inc.",adult;aged;angina pectoris;article;bleeding;cardiovascular disease;central nervous system disease;cerebrovascular disease;chronic kidney failure;chronic obstructive lung disease;comorbidity;controlled study;coronary artery disease;dementia;depression;diabetes mellitus;dysuria;heart arrhythmia;atrial fibrillation;heart failure;heart valve replacement;hematuria;human;hypertension;incidence;infection;intraoperative period;kidney injury;lung disease;major clinical study;male;medical record;mortality;neoplasm;Parkinson disease;postoperative complication;postoperative period;preoperative period;priority journal;retrospective study;sepsis;spine disease;thyroid disease;transurethral resection;university hospital,"Hong, J. Y.;Yang, S. C.;Ahn, S.;Kil, H. K.",2011,,,0,
1872,Increases in the risk of cognitive impairment and alterations of cerebral beta-amyloid metabolism in mouse model of heart failure,"Epidemiological and clinico-pathological studies indicate a causal relationship between heart disease and Alzheimer's disease (AD). To learn whether heart disease causes an onset of AD, mice with myocardial infarction (MI) and congestive heart failure (HF) were used to test neuropsychiatric and cognitive behaviors as well as for measurements of AD related protein markers. To this end, adult mice were subjected to ligation of left anterior descending artery (LAD) and about two weeks later high-frequency echocardiography was performed to exam the resulting cardiac structure and function. Three months after successful induction of chronic heart failure (CHF) these mice showed an impairment of learning in the Morris Water Maze task. In addition, the expression of selected molecules, which are involved in beta-amyloid metabolism, apoptosis and inflammation on the level of gene transcription and translation, was altered in CHF mice. Our findings provide a plausible explanation that CHF increases the risk of cognitive impairments and alters cerebral beta-amyloid metabolism. In addition, our data indicate that the cerebral compensatory mechanisms in response to CHF are brain area and gender specific.","Alzheimer Disease/etiology/genetics/metabolism/physiopathology;Amyloid beta-Peptides/*metabolism;Animals;Anxiety/complications;Apoptosis;Biological Transport;Blood-Brain Barrier/metabolism;Brain/*metabolism/pathology/physiopathology;*Cognition;Disease Models, Animal;Female;Glucose/metabolism;Heart Failure/complications/*metabolism/pathology/physiopathology;Learning;Locomotion;Male;Mice;Mice, Inbred C57BL;Myocardium/metabolism/pathology;Positron-Emission Tomography;Risk;Sex Characteristics;Tomography, X-Ray Computed;Transcription, Genetic","Hong, X.;Bu, L.;Wang, Y.;Xu, J.;Wu, J.;Huang, Y.;Liu, J.;Suo, H.;Yang, L.;Shi, Y.;Lou, Y.;Sun, Z.;Zhu, G.;Behnisch, T.;Yu, M.;Jia, J.;Hai, W.;Meng, H.;Liang, S.;Huang, F.;Zou, Y.;Ge, J.",2013,,10.1371/journal.pone.0063829,0,
1873,Myocardial infarction in the differential diagnosis of dementias in the elderly,"The incidence of cerebral lesions in relation to myocardial infarction (MI) was evaluated on the basis of data obtained from medical records and autopsy reports on 269 psychogeriatric patients, in a 13-year retrospective study. Among 84 demented patients with MI, brain infarcts and hemorrhages were found in 42 percent, and Alzheimer's disease in 17 percent; (combination in 8 percent). In contrast, among 70 demented patients without MI, brain infarcts and hemorrhages were found in 11 percent, and Alzheimer's disease in 43 percent; (combination in 6 percent). Therefore, when it is difficult to differentiate senile dementia (Alzheimer's disease) from dementia due to cerebrovascular impairment, data on the presence or absence of myocardial infarction may prove useful.","Aged;Alzheimer Disease/*diagnosis;Cerebral Infarction/etiology;Dementia/*diagnosis/etiology;Diagnosis, Differential;Female;Humans;Male;Myocardial Infarction/*complications;Retrospective Studies","Hontela, S.;Schwartz, G.",1979,Mar,,0,
1874,The sound and the fury: Was it all worth it?,"The initial report of coronary heart disease (CHD) results from the trial of menopausal hormone therapy within the Women's Health Initiative precipitated substantial surprise and concern in the epidemiology research community over the apparent differences between the trial results and those of observational studies. What followed was 6 years of discussion and debate, frequently acrimonious, along with intense methodologic and substantive research attempting to reconcile or explain the apparent differences. The results have been an impressive improvement in methods to contrast and combine studies of differing designs, dramatic illustrations of some central epidemiologic principles, insights into likely mechanisms of CHD, and increasing clarity of the public health message about menopausal hormone therapy. © 2008 by Lippincott Williams & Wilkins.",estrogen;gestagen;blood clot;dementia;gallbladder disease;hormonal therapy;human;ischemic heart disease;menopausal syndrome;note;osteoporosis;priority journal;public health;quality of life;risk;cerebrovascular accident;urine incontinence,"Hoover, R. N.",2008,,,0,
1875,Takotsubo cardiomyopathy following laparoscopic port placement in a patient with ovarian cancer,,acetylsalicylic acid;clopidogrel;creatine kinase MB;heparin;troponin I;acute coronary syndrome;anamnesis;anticoagulant therapy;arterial gas;article;brain hemorrhage;brain hernia;cancer grading;cancer patient;cancer staging;cardiogenic shock;case report;confusion;congestive cardiomyopathy;differential diagnosis;disease association;disseminated intravascular clotting;echocardiography;female;heart left ventricle ejection fraction;heparin induced thrombocytopenia;human;hypoxia;intensive care unit;intraaortic balloon pump;laparoscopic port placement;laparoscopic surgery;lung angiography;lung embolism;mental deterioration;ovary cancer;postmenopause;postoperative nausea;preoperative evaluation;priority journal;respiratory alkalosis,"Hope, E.;Smith, M.;Zeligs, K.;Hamilton, C. A.;Miller, C.",2013,,,0,
1876,Delirium in surgery intensive care unit,"Delirium is a common event in the hospitalized surgical patiens. The pathophysiology of delirium is incompletely understood yet, but numerous risk factors for the development of delirium have been already identified. A literature review was performed using the National Library of Medicine PubMed database and Web of Science, including all resources within the period 1991-2011, additional references were found through bibliography reviews of relevant articles. The key word ""delirium"" with the following terms:""intensive care unit"",""antipsychotics"", ""benzodiazepine"", ""opioids"", ""elderly"", ""management"". Constraints limiting time period of publications or their language were not applied. Reference lists of publications identified by these procedures were hand-searched for additional relevant references. Delirium in the ICU (intensive care unit) is not only a frightening experience for the patient and his or her family; it is also a challenge for the nurses and physicians taking care of the patient. Furthermore, it is also associated with worse outcome, prolonged hospitalisation, increased costs, long-term cognitive impairment and higher mortality rates. Predisposing factors, such as age, impairment, and nature and severity of comorbidity, increase the risk of experiencing delirium during hospitalization. The management of delirium involves the concurrent search for and treatment of the underlying aetiology while actively controlling the symptoms of delirium. Antipsychotics are demonstrating efficacy in controlling the symptoms of delirium with less extrapyramidal side effects. Proper diagnosis and treatment is important in the medical setting and significantly decreases the burden on the patient, caregivers, and medical system. © 2011 Act Nerv Super Rediviva.",analgesic agent;anticonvulsive agent;antihistaminic agent;antihypertensive agent;antiparkinson agent;baclofen;bromide;cardiotonic agent;central stimulant agent;chlorpropamide;cholinergic receptor blocking agent;clomethiazole;corticosteroid;cytostatic agent;diazepam;disulfiram;dopamine;haloperidol;hypnotic agent;lorazepam;melperone;narcotic agent;nonsteroid antiinflammatory agent;olanzapine;quetiapine;risperidone;sedative agent;sulpiride;tiapride;unindexed drug;agitation;alcohol withdrawal;analgesia;anemia;anoxia;article;attention disturbance;body mass;brain damage;brain dysfunction;brain hemorrhage;brain infection;brain ischemia;cardiopulmonary bypass;cognitive defect;congestive heart failure;consciousness disorder;contusion;delirium;delirium tremens;delusion;dementia;differential diagnosis;disease course;disease severity;disorientation;dyskinesia;dystonia;emotional disorder;extrapyramidal symptom;gastrointestinal symptom;hallucination;human;Human immunodeficiency virus infection;hypertension encephalopathy;hyperthermia;hypovolemia;injury;intensive care;kidney disease;lethargy;liver disease;malnutrition;memory disorder;meningitis;metabolic disorder;mydriasis;neoplasm;pallor;paranoia;pathophysiology;perception disorder;phobia;pneumonia;postoperative delirium;psychomotor disorder,"Horacek, R.;Prasko, J.;Mainerova, B.;Látalová, K.;Grosmanova, T.;Blahut, L.;Horakova, M.",2011,,,0,
1877,Sy 05-2 Progression of Hypertensive Heart Disease: New Therapeutic Approach,"Hypertensive patients have greater chances of such cardiovascular events as stroke, coronary heart disease, heart or renal failure, peripheral artery disease, and dementia. It is also well recognized that diabetes increases the cardiovascular risks in concert with hypertension. Therefore, main goals for an innovation of anti-hypertensive therapy would be to achieve further risk reduction by targeting the functional, metabolic, and structural alterations associated with hypertension. Professors Dzau and Braunwald et al proposed the concept of ""the cardiovascular disease continuum"" in 1991, and that hypertension may trigger the chain of events, leading to end-stage heart disease; however, this concept was quite new at that time, and there was some discussion whether ""the cardiovascular disease continuum"" is true or not. Fifteen years later, accumulating clinical and basic research evidence confirmed the validity of the concept of this cardiovascular disease continuum. Oxidative stress, and inflammation play a role in the initiation and continuation of this chain. Therefore, targeting oxidative stress and inflammation are important to interrupt the cardiovascular disease continuum. However, so far, neither anti-oxidative nor anti-inflammation strategy can work well to prevent hypertension and its related cardiovascular diseases. Low-grade inflammation has been proposed to play a key role in the pathogenesis of hypertension, and both innate and adaptive immune responses may participate in this process. Recent evidence also defined important roles of T-cell and T-cell-derived cytokines associated with angiotensin (Ang) II and catecholamine. We expect these new findings could provide us with novel avenues to beat hypertension, in terms of anti-oxidative stress and/or anti-inflammation.Renin-angiotensin-aldosterone system (RAAS) plays a significant role in the cardiovascular disease continuum interacting with adrenergic system and other various mediators, and thereby RAAS mediates adaptive and maladaptive responses to tissue injury. Sympathetic hyperactivity and the activation of RAAS may promote hypertension or work as an amplifier of the pressor influence of other factors such as metabolic factors. Therefore, RAAS and sympathetic nervous system are the major targets of treatment of hypertension and its related cardiovascular complications. The two main interventional approaches, transcatheter renal denervation and baroreflex activation therapy, have been used in clinical practice for treatment of resistant hypertension and the renal denervation is also being evaluated for treatment of various comorbidities, although the efficacy of invasive sympatho-deactivating interventions have not yet been conclusively validated. In the past two decades, the development of the drugs for the treatment of hypertension and cardiovascular diseases has been largely focused on the inhibitors of RAAS, including immunization against Ang II.Novel pathways beyond the classical actions of RAAS, the angiotensin converting enzyme (ACE)/Ang II/Ang II type 1 (AT1) receptor axis, have been highlighted: the ACE2/Ang-(1-7)/Mas receptor axis and Ang II type 2 (AT2) receptor as a new opposing axis against the classical RAS axis as a protective arm of RAAS. Moreover, identification of alamandine and its receptor, Mas-related G-protein coupled receptor, provides new insights for the understanding of the physiological and pathophysiological role of the RAS. Further elucidation of the regulatory mechanisms of the functions of new protective arm of RAS beyond the classical RAAS could provide us with possibilities for the development of novel drugs that regulate RAAS in a more sophisticated manner, thereby treating hypertensive patients and achieving cardiovascular risk reduction more efficiently. Agonists of protective arm of RAS have been developed as new drugs for hypertension and several drugs of the agonists of protective arm of RAS are now in clinical trials. Several novel Ang II receptor interacting proteins have been also reported. AT1 receptor-assoc ated protein (ATRAP) was cloned by us as specific binding protein of AT1 receptor C-terminal, and we and others reported that ATRAP could act as a negative regulator in AT1 receptor-mediated effects at least in part by the enhancement of AT1 receptor internalization. We cloned AT2 receptor interacting protein (ATIP) as a protein interacting specifically with the C-terminal tail of the AT2 receptor. We and others demonstrated that ATIP enhanced an important role of AT2 receptor-mediated wide variety of pathophysiological functions. Further elucidation of the functional regulation of these Ang II receptor associated proteins including their transcriptional control, and finding possible ligands could be helpful for new drug developments.I will review and discuss in this symposium ""Progression of Hypertensive Heart Disease"" focusing on the new therapeutic pharmacological approach with recent clinical evidences.",,"Horiuchi, M.",2016,Sep,10.1097/01.hjh.0000499911.34772.01,0,
1878,Differential patterns of age-related mortality increase in middle age and old age,"It is often assumed that aging is a uniform process throughout adulthood because of the approximately linear increase of logarithmic mortality. We explored this assumption by analyzing cause-specific mortality increases in France (1979-1994). Rising rapidly at ages 30-54 years (""middle age"") are death rates from malignant neoplasms at various sites, acute myocardial infarction, hypertensive disease, and liver cirrhosis. Steeply increasing at 65-89 years (""old age"") are death rates from certain infectious diseases, particularly of the respiratory system; certain types of accidents; nonalcoholic mental disorders (probably due mainly to Alzheimer's disease and senile dementia); heart failure; cerebrovascular disease; and some ""vague"" categories. The processes at work may be fundamentally different in these two life history stages, such that the mortality rise in middle age reflects specific chronic diseases that develop prematurely in some high-risk individuals, whereas the mortality increase in old age is dominated by senescent processes that eventually raise the vulnerability of almost all individuals to multiple pathologies.","Adult;Age Factors;Aged;Aged, 80 and over;Aging/*physiology;*Cause of Death;Female;Humans;Linear Models;Male;Middle Aged;Mortality/*trends;Risk Factors","Horiuchi, S.;Finch, C. E.;Mesle, F.;Vallin, J.",2003,Jun,,0,
1879,End-of-Life Care: Whose Decision Is It Anyway? A Case Study in an Assisted Living Facility,,aged;assisted living facility;case report;congestive heart failure;daily life activity;dementia;family;health care cost;hospice care;hospitalization;human;letter;life sustaining treatment;male;medical assessment;medical decision making;medical ethics;medical order;medication therapy management;patient transport;terminal care;very elderly,"Hornick, D. N.;Paynter, C.;Dailey, M. W.;Young, Y.",2016,,,0,
1880,High blood pressure as a risk factor for incident stroke among very old people: A population-based cohort study,"Introduction: High blood pressure (BP) increases the risk of stroke, but there is limited evidence from studies including very old people. The aim was to investigate risk factors for incident stroke among very old people. Methods: A prospective population-based cohort study was performed among participants aged at least 85 years in northern Sweden. The 955 participants were tested at their homes. BP was measured manually after 5-min supine rest. Incident stroke data were collected from medical charts guided by hospital registry, death records, and 5-year reassessments. Cox proportional hazards models were used. Results: The stroke incidence was 33.8/1000 person-years (94 stroke events) during a mean follow-up period of 2.9 years. In a comprehensive multivariate model, atrial fibrillation [hazard ratio 1.85, 95% confidence interval (CI) 1.07-3.19] and higher SBP (hazard ratio 1.19, 95% CI 1.08-1.30 per 10-mmHg increase) were associated with incident stroke overall. However, higher SBP was not associated with incident stroke in participants with SBP less than 140mmHg (hazard ratio 0.90, 95% CI 0.53-1.53 per 10-mmHg increase). In additional multivariate models, DBP at least 90mmHg (hazard ratio 2.45, 95% CI 1.47-4.08) and SBP at least 160mmHg (vs. <140 mmHg; hazard ratio 2.80, 95% CI 1.53-5.14) were associated with incident stroke. The association between BP and incident stroke was not affected by interactions related to sex, dependence in activities of daily living, or cognitive impairment. Conclusion: High SBP (≤160 mmHg) and DBP (≤90mmHg) and atrial fibrillation appeared to be risk factors for incident stroke among very old people.",acetylsalicylic acid;angiotensin 1 receptor antagonist;beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;warfarin;age;aged;article;atrial fibrillation;cerebrovascular accident;cohort analysis;congestive heart failure;delirium;dementia;diastolic blood pressure;female;follow up;gait;Geriatric Depression Scale;human;hypertension;incidence;major clinical study;male;mean arterial pressure;Mini Mental State Examination;nutritional assessment;priority journal;prospective study;pulse pressure;risk assessment;systolic blood pressure;very elderly,"Hörnsten, C.;Weidung, B.;Littbrand, H.;Carlberg, B.;Nordström, P.;Lövheim, H.;Gustafson, Y.",2016,,,0,
1881,Risk of disability pension for patients diagnosed with haematological malignancies: A register-based cohort study,"Patients with haematological malignancies are at increased risk of experiencing work-related problems. The aims of this study were to compare the risk of disability pension (DP) among patients diagnosed with eight subtypes of haematological malignancies to a reference cohort, and to determine if relative risks differ between these subtypes; to evaluate the influence of socioeconomic factors, demographic factors, and clinical factors on the risk of DP; and to investigate if these associations differ between the reference cohort and the patient cohort.Material and methods. We combined data from national registers on Danish patients diagnosed with haematological malignancies between 2000 and 2007 and a reference cohort without a history of these diseases. A total of 3194 patients and 28 627 reference individuals were followed until DP, emigration, old age pension or anticipatory pension, death or 26 February 2012, whichever came first.Results. A total of 550 (17%) patients and 1511 (5%) reference individuals were granted DP. Age- and gender-adjusted relative risks differed significantly between the subgroups of haematological malignancies and ranged from 2.64 (95% CI 1.84-3.78) for patients with Hodgkin lymphoma to 12.53 (95% CI 10.57-14.85) for patients with multiple myeloma. In the patient cohort we found that gender, age, comorbidity, ethnicity, educational level, household income, history of long-term sick leave, and need of treatment with anxiolytics or antidepressants after diagnosis were associated with receiving DP. However, most of these associations were stronger in the reference cohort.Conclusion. All eight subtypes of haematological malignancies were associated with an increased risk of DP compared to the reference cohort. The relative risks differed according to subtype, and patients with multiple myeloma had the highest risk of DP. Furthermore, most socioeconomic, demographic and clinical factors had a stronger impact on the risk of DP in the reference cohort than in the patient cohort.",antidepressant agent;anxiolytic agent;academic advisement;adult;article;cancer incidence;cancer registry;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;chronic lymphatic leukemia;chronic myeloid leukemia;cohort analysis;congestive heart failure;connective tissue disease;controlled study;Danish citizen;dementia;demography;diabetes mellitus;disability pension;ethnicity;female;follicular lymphoma;heart infarction;hematologic malignancy;Hodgkin disease;household;human;income;large cell lymphoma;liver disease;major clinical study;male;medical leave;middle aged;multiple myeloma;pension;peripheral vascular disease;priority journal;risk factor;sex difference;socioeconomics,"Horsboel, T. A.;Nielsen, C. V.;Andersen, N. T.;Nielsen, B.;De Thurah, A.",2014,,,0,
1882,Long-term prognosis after out-of-hospital cardiac arrest,"Objective: In this study we aimed to report survival beyond 6 months, including quality of life, for patients after out-of-hospital cardiac arrest (OHCA) with a physician-based EMS in an urban area. Methods: We collected data related to OHCA prospectively during a 2-year period. Long-term survival was determined by cross-referencing our database with two Danish national registries. Patients older than 18 years who had survived for more than 6 months after OHCA were contacted, and after informed written consent was obtained, an interview was conducted in their home and a questionnaire on quality of life (SF-36) and the mini mental state examination (MMSE) were administered. Results: We had data on 984 cases of OHCA. In 512 cases CPR was attempted and at 6 months, a total of 63 patients were alive corresponding to 12.3% [95% CI: 9.7-15.5%] of all who were treated. Of the 33 patients examined, the median MMSE was 29 (16-30) and two patients, corresponding to 6%, [95% CI: 0.7-20.6%] had an MMSE below 24. Two out of eight aspects of the SF-36 were significantly worse than national norms at the same age, but none of the summary scores differed significantly. Conclusion: Survival beyond 6 months was found in 12.3% OHCA in a physician-based EMS. Summary scores of quality of life were not significantly different from the national norm but 2 out of 8 subscores were lower. Signs of dementia were uncommon as only 6% had an MMSE score below 24. © 2006 Elsevier Ireland Ltd. All rights reserved.",adult;aged;article;confidence interval;data base;dementia;female;heart arrest;human;information processing;major clinical study;male;Mini Mental State Examination;outpatient;physician;priority journal;prognosis;prospective study;quality of life;questionnaire;survival time;urban area,"Horsted, T. I.;Rasmussen, L. S.;Meyhoff, C. S.;Nielsen, S. L.",2007,,,0,
1883,Etiologies of Parkinsonism in a century-long autopsy-based cohort,"We investigated the distribution of different etiologies underlying Parkinsonism in a hospital-based autopsy collection, studied the demographic data and evaluated diagnostic accuracy using histopathological examination as the gold standard. Out of a total of 9359 consecutive autopsy cases collected between 1914 and 2010, we identified 261 individuals who carried a clinical diagnosis of a Parkinsonian syndrome at death. A detailed neuropathological examination revealed idiopathic Parkinson's disease (PD) in 62.2%, progressive supranuclear palsy (PSP) in 4.2%, multiple system atrophy (MSA) in 2.3%, corticobasal degeneration (CBD) in 1.2%, postencephalitic Parkinsonism (PEP) in 2.7%, vascular Parkinsonism (VaP) in 8.8% and Alzheimer-type pathology (ATP) of the substantia nigra in 8%. The diagnostic accuracy of PD in our cohort was lower (71.2%) than those reported in previous studies, although it tended to increase during the last decades up to 85.7%. Of particular interest, we found that PD, while being the most frequent cause of Parkinsonism, was greatly overdiagnosed, with VaP and ATP being the most frequent confounding conditions. © 2012 The Authors; Brain Pathology © 2012 International Society of Neuropathology.",article;autopsy;bronchopneumonia;caudate nucleus;cause of death;cerebrovascular accident;cohort analysis;comorbidity;corticobasal degeneration;diagnostic accuracy;endocarditis;gastrointestinal hemorrhage;heart infarction;hippocampus;human;hypertension;idiopathic disease;immunoreactivity;locus ceruleus;lung edema;lung embolism;mesencephalon;neurologic examination;Parkinson disease;parkinsonism;postencephalitis parkinsonism;progressive supranuclear palsy;respiratory failure;sensitivity and specificity;sepsis;Shy Drager syndrome;substantia nigra;temporal cortex;vascular parkinsonism,"Horvath, J.;Burkhard, P. R.;Bouras, C.;Kövari, E.",2013,,,0,
1884,"The Japan Statin Treatment Against Recurrent Stroke (J-STARS): A Multicenter, Randomized, Open-label, Parallel-group Study","Background: Although statin therapy is beneficial for the prevention of initial stroke, the benefit for recurrent stroke and its subtypes remains to be determined in Asian, in whom stroke profiles are different from Caucasian. This study examined whether treatment with low-dose pravastatin prevents stroke recurrence in ischemic stroke patients. Methods: This is a multicenter, randomized, open-label, blinded-endpoint, parallel-group study of patients who experienced non-cardioembolic ischemic stroke. All patients had a total cholesterol level between 4.65 and 6.21. mmol/L at enrollment, without the use of statins. The pravastatin group patients received 10. mg of pravastatin/day; the control group patients received no statins. The primary endpoint was the occurrence of stroke and transient ischemic attack (TIA), with the onset of each stroke subtype set to be one of the secondary endpoints. Finding: Although 3000 patients were targeted, 1578 patients (491 female, age 66.2. years) were recruited and randomly assigned to pravastatin group or control group. During the follow-up of 4.9 ± 1.4 years, although total stroke and TIA similarly occurred in both groups (2.56 vs. 2.65%/year), onset of atherothrombotic infarction was less frequent in pravastatin group (0.21 vs. 0.64%/year, p = 0.0047, adjusted hazard ratio 0.33 [95%CI 0.15 to 0.74]). No significant intergroup difference was found for the onset of other stroke subtypes, and for the occurrence of adverse events. Interpretation: Although whether low-dose pravastatin prevents recurrence of total stroke or TIA still needs to be examined in Asian, this study has generated a hypothesis that it may reduce occurrence of stroke due to larger artery atherosclerosis. Funding: This study was initially supported by a grant from the Ministry of Health, Labour and Welfare, Japan. After the governmental support expired, it was conducted in collaboration between Hiroshima University and the Foundation for Biomedical Research and Innovation.",NCT00221104;cholesterol;high density lipoprotein;low density lipoprotein;pravastatin;triacylglycerol;adult;aged;article;blood pressure;blood vessel injury;brain hemorrhage;brain ischemia;cerebrovascular accident;cognitive defect;controlled study;dementia;diet therapy;disease severity;exercise;female;follow up;funding;heart infarction;human;lacunar stroke;low drug dose;major clinical study;male;multicenter study;priority journal;randomized controlled trial;recurrent disease;scoring system;transient ischemic attack,"Hosomi, N.;Nagai, Y.;Kohriyama, T.;Ohtsuki, T.;Aoki, S.;Nezu, T.;Maruyama, H.;Sunami, N.;Yokota, C.;Kitagawa, K.;Terayama, Y.;Takagi, M.;Ibayashi, S.;Nakamura, M.;Origasa, H.;Fukushima, M.;Mori, E.;Minematsu, K.;Uchiyama, S.;Shinohara, Y.;Yamaguchi, T.;Matsumoto, M.",2015,,,0,
1885,Cohort profile: The Amirkola Health and Ageing Project (AHAP),"This is the first comprehensive cohort study of the health of older people ever conducted in Iran. The aim of this project is to investigate the health status of older people in Amirkola in the northern part of Iran, near the Caspian Sea. The Amirkola Health and Ageing Project (AHAP) is mainly concerned with geriatric medical problems, such as falling, bone fragility and fractures, cognitive impairment and dementia, poor mobility and functional dependence. It is planned that all participants will be re-examined after 2 years. Data are collected via questionnaire, examinations and venepuncture. AHAP started in April 2011 and 1616 participants had been seen by 18 July 2012, the end of the baseline stage of this study. The participation rate was 72.3%. The prevalence of self-reported hypertension (41.2%) and diabetes mellitus (23.3%) are high. Only 14.4% of older people considered their health as excellent or good in comparison with others at this age. The prevalence of osteoporosis (T score≤-2.5) was 57.4% in women and 16.1% in men, and 38.2 % of older people were vitamin D deficient (<20 ng/ml). Researchers interested in using the information are invited to contact the principal investigator Seyed Reza Hosseini (hosseinim46@yahoo.com).",adult;aged;aging;angina pectoris;article;bone fragility;cerebrovascular accident;chronic lung disease;cognitive defect;congestive heart failure;daily life activity;dementia;depression;diabetes mellitus;epilepsy;falling;female;follow up;fracture;headache;health status;heart infarction;hospitalization;human;hypertension;hypothyroidism;major clinical study;male;neoplasm;osteoporosis;Parkinson disease;physical activity;prevalence;questionnaire;social support;urine incontinence;very elderly;vitamin D deficiency,"Hosseini, S. R.;Cumming, R. G.;Kheirkhah, F.;Nooreddini, H.;Baian, M.;Mikaniki, E.;Taghipour-darzi, M.;Niaki, H. A.;Rasolinejad, S. A.;Mostafazadeh, A.;Parsian, H.;Bijani, A.",2014,,,0,
1886,Risk of cardiovascular morbidity and sudden death with risperidone and paliperidone treatment: analysis of 64 randomized1,"Purpose: To estimate risk of sudden death and cardiovascular (CV)/cerebrovascular events during treatment with oral and long-acting injectable risperidone (RIS) and paliperidone (PALI). Methods: The research database consisted of 41 placebo-controlled (PC) trials involving RIS and PALI in the indications schizophrenia (RIS = 5, PALI = 11), schizoaffective disorder (PALI = 2), bipolar I disorder (RIS = 7, PALI = 3), dementia (RIS = 6), disruptive behavior or conduct disorder (RIS = 5), autistic disorder (RIS = 2), and 23 active-controlled (AC) trials in schizophrenia (RIS = 21, PALI = 2). Treatment-emergent CV adverse events were identified using 7 predefined Standardized MedDRA Queries (SMQs) suggestive of medically important events that often precede CV death: embolic/thrombotic events, cerebrovascular disorders, ischemic heart disease, cardiac arrhythmias, cardiac failure, Torsades/QT prolongation, and convulsions. Mantel-Haenszel approach stratified by study was used to estimate the common odds ratios (OR) and 95% confidence intervals (CIs), comparing RIS/PALI (combined) to placebo. Results: PC trials included 11 090 patients randomized to RIS (n = 2958), PALI (n = 3554), placebo (n = 3517), or active controls (n = 1061). Risk (OR) of sudden death could not be assessed because there was only a single event. Risk was significantly increased in the combined RIS/PALI group for 5 of 7 SMQs (criteria not met for ischemic heart disease and convulsions SMQs). At the preferred term level, risk (OR [95% CI]) was increased in the combined RIS/PALI group vs placebo for 6 of 49 unique terms for which ORs were calculable: syncope (2.8 [1.2, 6.8]), tachycardia (2.4 [1.5, 36]), palpitations (3.1 [1.1, 8.7]), edema peripheral (1.6 [1.1, 2.4]), dysarthria (3.7 [1.7, 8.2]), and transient ischemic attack (3.6 [1.2, 10.7]). Elderly vs nonelderly patients had a numerically greater OR for all SMQs, except ischemic heart disease. In the combined PC and AC trials, incidence of CV death was low and similar across groups. Our findings are limited by the exclusion per protocol of patients with major or clinically unstable CV disease and the relatively short treatment duration (median = 42 days for RIS/PALI). Conclusions and Future Directions: Evidence from a large safety database of patients enrolled in randomized, double-blind, controlled studies shows increased risk for several CV events with RIS and PALI treatment, consistent with their known pharmacologic profile and product information.",risk;human;pharmacist;sudden death;college;morbidity;patient;ischemic heart disease;controlled study;death;data base;heart arrhythmia;schizophrenia;convulsion;syncope;tachycardia;heart palpitation;edema;dysarthria;transient ischemic attack;aged;treatment duration;safety;schizoaffective psychosis;bipolar I disorder;dementia;disruptive behavior;conduct disorder;autism;cerebrovascular disease;heart failure;confidence interval;paliperidone;risperidone;placebo,"Hough, Dw;Karcher, K;Nuamah, I;Palumbo, J;Berlin, Ja;Baseman, A;Xu, Y;Kent, J",2011,,10.1177/0897190011403437,0,1887
1887,Risk of cardiovascular morbidity and sudden death with risperidone and paliperidone treatment: Analysis of 64 randomized1,"Purpose: To estimate risk of sudden death and cardiovascular (CV)/cerebrovascular events during treatment with oral and long-acting injectable risperidone (RIS) and paliperidone (PALI). Methods: The research database consisted of 41 placebo-controlled (PC) trials involving RIS and PALI in the indications schizophrenia (RIS = 5, PALI = 11), schizoaffective disorder (PALI = 2), bipolar I disorder (RIS = 7, PALI = 3), dementia (RIS = 6), disruptive behavior or conduct disorder (RIS = 5), autistic disorder (RIS = 2), and 23 active-controlled (AC) trials in schizophrenia (RIS = 21, PALI = 2). Treatment-emergent CV adverse events were identified using 7 predefined Standardized MedDRA Queries (SMQs) suggestive of medically important events that often precede CV death: embolic/thrombotic events, cerebrovascular disorders, ischemic heart disease, cardiac arrhythmias, cardiac failure, Torsades/QT prolongation, and convulsions. Mantel-Haenszel approach stratified by study was used to estimate the common odds ratios (OR) and 95% confidence intervals (CIs), comparing RIS/PALI (combined) to placebo. Results: PC trials included 11 090 patients randomized to RIS (n = 2958), PALI (n = 3554), placebo (n = 3517), or active controls (n = 1061). Risk (OR) of sudden death could not be assessed because there was only a single event. Risk was significantly increased in the combined RIS/PALI group for 5 of 7 SMQs (criteria not met for ischemic heart disease and convulsions SMQs). At the preferred term level, risk (OR [95% CI]) was increased in the combined RIS/PALI group vs placebo for 6 of 49 unique terms for which ORs were calculable: syncope (2.8 [1.2, 6.8]), tachycardia (2.4 [1.5, 36]), palpitations (3.1 [1.1, 8.7]), edema peripheral (1.6 [1.1, 2.4]), dysarthria (3.7 [1.7, 8.2]), and transient ischemic attack (3.6 [1.2, 10.7]). Elderly vs nonelderly patients had a numerically greater OR for all SMQs, except ischemic heart disease. In the combined PC and AC trials, incidence of CV death was low and similar across groups. Our findings are limited by the exclusion per protocol of patients with major or clinically unstable CV disease and the relatively short treatment duration (median = 42 days for RIS/PALI). Conclusions and Future Directions: Evidence from a large safety database of patients enrolled in randomized, double-blind, controlled studies shows increased risk for several CV events with RIS and PALI treatment, consistent with their known pharmacologic profile and product information.",risk;human;pharmacist;sudden death;college;morbidity;patient;ischemic heart disease;controlled study;death;data base;heart arrhythmia;schizophrenia;convulsion;syncope;tachycardia;heart palpitation;edema;dysarthria;transient ischemic attack;aged;treatment duration;safety;schizoaffective psychosis;bipolar I disorder;dementia;disruptive behavior;conduct disorder;autism;cerebrovascular disease;heart failure;confidence interval;paliperidone;risperidone;placebo,"Hough, D. W.;Karcher, K.;Nuamah, I.;Palumbo, J.;Berlin, J. A.;Baseman, A.;Xu, Y.;Kent, J.",2011,,10.1177/0897190011403437,0,
1888,Comorbidity has negligible impact on treatment and complications but influences survival in breast cancer patients,"In the present study, we investigated whether age and serious comorbid conditions influence treatment decisions, complications and survival in breast cancer patients. The Eindhoven Cancer Registry records patient, tumour and therapy characteristics of all patients diagnosed with cancer in the southern part of the Netherlands. Additional information on severity of comorbidity and serious complications was collected for a random sample of 527 breast cancer patients (aged 40 years and older). More than 70% of the patients ≥80 exhibited high severity of comorbidity compared to 6% of those aged 40-49 years. Treatment was not influenced by severity of comorbidity. Less than 30% of the breast cancer patients had complications after diagnosis. The number of complications was not related to age or severity of comorbidity. The hazard ratio (HR) of dying for patients with low/moderate severity of comorbidity was 2.4 for those aged 40-69 years and 1.6 for those aged ≥70 years, after adjustment for age, nodal status and treatment. For patients with high severity of comorbidity, the risk of dying was almost three times higher. Older breast cancer patients with serious comorbidity were not treated differently and did not have more complications compared to those without comorbidity, but they exhibited a worse prognosis. © 2004 Cancer Research UK.",antineoplastic agent;adult;aged;Alzheimer disease;anemia;arthritis;article;asthma;bleeding;breast cancer;cancer mortality;cancer registry;cancer survival;cardiovascular disease;chronic lung disease;comorbidity;congestive heart failure;controlled study;deep vein thrombosis;depression;diabetes mellitus;disease severity;eye disease;female;fracture;gastrointestinal disease;hearing impairment;heart arrest;heart arrhythmia;heart disease;heart infarction;human;hypertension;infection;kidney failure;liver disease;lymphedema;mental health;mitral valve disease;nausea;Netherlands;obesity;Parkinson disease;pneumonia;priority journal;prognosis;randomization;risk assessment;cerebrovascular accident;thromboembolism;thyroid disease;urinary tract disease,"Houterman, S.;Janssen-Heijnen, M. L. G.;Verheij, C. D. G. W.;Louwman, W. J.;Vreugdenhil, G.;Van Der Sangen, M. J. C.;Coebergh, J. W. W.",2004,,,0,
1889,Outcomes of acute myocardial infarction in nonagenarians,"To evaluate survival after acute myocardial infarction (AMI) in nonagenarians, we conducted a retrospective chart review of 177 consecutive patients > or =90 years of age admitted from 2000 to 2006 with a primary diagnosis of AMI confirmed by peak troponin I > or =1.5 microg/L. Mean follow-up was 3.7 years (range 4 months to 6.7 years). Mean age was 93 years, 34% were men, and 60% were Caucasian. Common co-morbidities included hypertension (67%), dyslipidemia (28%), atrial fibrillation (28%), renal insufficiency (27%), dementia (23%), and previous cerebrovascular events (22%). Mean peak troponin was 20 mug/L (range 1.5 to 183 microg/L). Cardiac catheterization was performed within 48 hours in 42 patients (24%) and after 48 hours in 14 patients (8%); 40 patients (23%) received an intervention. Hospital mortality was 15% (n = 27). Survival at 30 days, 90 days, and 1 year were 78%, 69%, and 47%. Independent predictors of shorter survival time by Cox analysis included body mass index <25 kg/m2 (p <0.001), creatinine > or =2.0 mg/dl (p = 0.001), hemoglobin <11.0 g/dl (p = 0.016), and dementia (p = 0.027). Patients receiving aspirin, clopidogrel, beta blockers, and renin-angiotensin system inhibitors appeared to have a lower mortality. In conclusion, AMI in nonagenarians is associated with high mortality, with over 50% of patients dying within one year of presentation; elevated creatinine and lower hemoglobin are strong predictors of adverse prognosis, and lower body mass index and the presence of dementia add independent prognostic significance.","Adrenergic beta-Antagonists/therapeutic use;Aged, 80 and over;Angiotensin-Converting Enzyme Inhibitors/therapeutic use;Cardiac Catheterization;Drug Therapy, Combination;Electrocardiography;Female;Follow-Up Studies;Hospital Mortality/trends;Humans;Male;Missouri/epidemiology;Myocardial Infarction/diagnosis/drug therapy/*mortality;Platelet Aggregation Inhibitors/therapeutic use;Prognosis;Retrospective Studies;Risk Factors;Survival Rate/trends;Time Factors","Hovanesyan, A.;Rich, M. W.",2008,May 15,10.1016/j.amjcard.2008.01.012,0,
1890,Ethical aspects of stem cell research. Legislation and guidelines in Europe,"Research on different types of stem cells is of major interest because of its apparent very promising therapeutic prospects, such as for Parkinson's and Alzheimer's disease, spinal cord injuries, stroke, diabetes, cardiac failure, liver failure, cartilage injuries, severe blood diseases, cancer etc. Stem cells can be derived from different sources: adult tissue, foetal tissues, and from in vitro fertilised embryos. Depending on their origin they have varying capacity to multiply and differentiate to other cell types. It is at present not possible to predict which types of cells will be best suitable for various therapeutic situations. Embryonic stem cells have been shown capable of differentiating into all the different tissues and cell types of the body, but they cannot form a new individual. Because of the ethics question involved, The European Group on Ethics on Science and New Technologies for the European Commission and Parliament (EGE), and the Ethics Committee of the Nordic Council of Ministers have prepared reports and given guidelines for research on stem cells. According to the guidelines, every country should regulate the research. Only embryos, which cannot be used in infertility treatment, and have been donated for research, can be used. Creation of embryos solely for research purposes, including somatic cell nuclear transfer, is not regarded as acceptable for the time being. Both partners of the donating couple have to sign an informed consent document. Ongoing research in Sweden is well in line with these European and Nordic recommendations.",adult;article;cell clone;cell differentiation;cytology;embryo transfer;Europe;fetal tissue transplantation;health care facility;hematopoietic stem cell transplantation;human;legal aspect;medical ethics;physiology;practice guideline;research;stem cell,"Hovatta, O.;Ahrlund-Richter, L.",2001,,,0,
1891,Donepezil for the treatment of agitation in Alzheimer's disease,"BACKGROUND: Agitation is a common and distressing symptom in patients with Alzheimer's disease. Cholinesterase inhibitors improve cognitive outcomes in such patients, but the benefits of these drugs for behavioral disturbances are unclear. METHODS: We randomly assigned 272 patients with Alzheimer's disease who had clinically significant agitation and no response to a brief psychosocial treatment program to receive 10 mg of donepezil per day (128 patients) or placebo (131 patients) for 12 weeks. The primary outcome was a change in the score on the Cohen-Mansfield Agitation Inventory (CMAI) (on a scale of 29 to 203, with higher scores indicating more agitation) at 12 weeks. RESULTS: There was no significant difference between the effects of donepezil and those of placebo on the basis of the change in CMAI scores from baseline to 12 weeks (estimated mean difference in change [the value for donepezil minus that for placebo], -0.06; 95% confidence interval [CI], -4.35 to 4.22). Twenty-two of 108 patients (20.4%) in the placebo group and 22 of 113 (19.5%) in the donepezil group had a reduction of 30% or greater in the CMAI score (the value for donepezil minus that for placebo, -0.9 percentage point; 95% CI, -11.4 to 9.6). There were also no significant differences between the placebo and donepezil groups in scores for the Neuropsychiatric Inventory, the Neuropsychiatric Inventory Caregiver Distress Scale, or the Clinician's Global Impression of Change. CONCLUSIONS: In this 12-week trial, donepezil was not more effective than placebo in treating agitation in patients with Alzheimer's disease. (ClinicalTrials.gov number, NCT00142324.) Copyright © 2007 Massachusetts Medical Society.",NCT00142324;donepezil;placebo;risperidone;aged;agitation;Alzheimer disease;anorexia;article;chest infection;clinical trial;controlled clinical trial;controlled study;diarrhea;drug fatality;falling;female;femur fracture;follow up;gastrointestinal hemorrhage;heart infarction;human;major clinical study;male;multicenter study;nausea;orthostatic hypotension;priority journal;randomized controlled trial;rash;seizure;sensitivity analysis;side effect;cerebrovascular accident;treatment outcome;treatment response;urinary tract infection;vomiting,"Howard, R. J.;Juszczak, E.;Ballard, C. G.;Bentham, P.;Brown, R. G.;Bullock, R.;Burns, A. S.;Holmes, C.;Jacoby, R.;Johnson, T.;Knapp, M.;Lindesay, J.;O'Brien, J. T.;Wilcock, G.;Katona, C.;Jones, R. W.;Decesare, J.;Rodger, M.",2007,,,0,
1892,Using routine inpatient data to identify patients at risk of hospital readmission,"BACKGROUND: A relatively small percentage of patients with chronic medical conditions account for a much larger percentage of inpatient costs. There is some evidence that case-management can improve health and quality-of-life and reduce the number of times these patients are readmitted. To assess whether a statistical algorithm, based on routine inpatient data, can be used to identify patients at risk of readmission and who would therefore benefit from case-management. METHODS: Queensland database study of public-hospital patients, who had at least one emergency admission for a chronic medical condition (e.g., congestive heart failure, chronic obstructive pulmonary disease, diabetes or dementia) during 2005/2006. Multivariate logistic regression was used to develop an algorithm to predict readmission within 12 months. The performance of the algorithm was tested against recorded readmissions using sensitivity, specificity, and Likelihood Ratios (positive and negative). RESULTS: Several factors were identified that predicted readmission (i.e., age, co-morbidities, economic disadvantage, number of previous admissions). The discriminatory power of the model was modest as determined by area under the receiver operating characteristic (ROC) curve (c = 0.65). At a risk score threshold of 50, the algorithm identified only 44.7% (95% CI: 42.5%, 46.9%) of patients admitted with a reference condition who had an admission in the next 12 months; 37.5% (95% CI: 35.0%, 40.0%) of patients were flagged incorrectly (they did not have a subsequent admission). CONCLUSION: A statistical algorithm based on Queensland hospital inpatient data, performed only moderately in identifying patients at risk of readmission. The main problem is that there are too many false negatives, which means that many patients who might benefit would not be offered case-management.",Algorithms;Comorbidity;Female;Health Services Research;Humans;Inpatients/*statistics & numerical data;Likelihood Functions;Logistic Models;Male;Patient Readmission/*statistics & numerical data;Predictive Value of Tests;Queensland;Risk;Sensitivity and Specificity,"Howell, S.;Coory, M.;Martin, J.;Duckett, S.",2009,Jun 09,10.1186/1472-6963-9-96,0,
1893,Physician specialty and quality of care for CHF: Different patients or different patterns of practice?,"Background: Previous reports have suggested that internists employ evidence-based care for congestive heart failure (CHF) less frequently than cardiologists. Reasons for this possible difference are unclear. Methods: A retrospective review of 185 consecutive patients admitted to a Canadian tertiary care facility between April 1998 and March 1999 with a primary diagnosis of CHF and who were treated by internists (IM group) or cardiologists (CARD group) was conducted. Results: The CARD group (n=65) was younger (70 versus 76 years, P<0.001) and had larger left ventricular end-diastolic diameter by echocardiography (57 versus 51 mm, P=0.006) than the IM group (n=120). The CARD group documented ejection fraction in 90% of cases versus 54% in the IM group (P<0.05). There was no difference in angiotensin-converting enzyme (ACE) inhibitor usage (68% versus 63%, P=0.48) or optimal ACE dosage (CARD 50% versus IM 42%, P=0.44). Multivariate predictors of ACE inhibitor usage were serum creatinine, male sex, peripheral edema and increasing serum glucose. The CARD group had higher usage of beta-blockers (69% versus 49%, P<0.009), lipid lowering medication (35% versus 17%, P<0.004) and warfarin therapy for atrial fibrillation (74% versus 28%, P<0.005). Conclusion: The data suggest that Canadian cardiologists and internists use ACE inhibitors equally and care for a relatively similar group of CHF patients. However, beta-blockade, warfarin, lipid lowering therapy and documentation of critical data occurred more frequently under cardiologist care. The possibility that there may be a gradation of adoption of newer guidelines for CHF care according to physician speciality is raised.",acetylsalicylic acid;angiotensin receptor antagonist;antilipemic agent;beta adrenergic receptor blocking agent;creatinine;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;glucose;low density lipoprotein cholesterol;potassium;sodium;warfarin;adult;aged;article;Canada;cardiology;clinical practice;congestive heart failure;controlled study;creatinine blood level;data analysis;dementia;drug contraindication;drug dose regimen;drug efficacy;echocardiography;female;gastrointestinal hemorrhage;gender identity;glucose blood level;health care quality;atrial fibrillation;heart left ventricle enddiastolic volume;hospital discharge;human;length of stay;major clinical study;male;medical education;medical specialist;multivariate analysis;peripheral edema;practice guideline;prediction;prescription;retrospective study;statistical analysis,"Howlett, J. G.;Cox, J. L.;Haddad, H.;Stanley, J.;McDonald, M.;Johnstone, D. E.",2003,,,0,
1894,"Improving in-hospital mortality in elderly patients after acute coronary syndrome--a nationwide analysis of 97,220 patients in Taiwan during 2004-2008","BACKGROUND: Elderly patients seem to have especially poor outcomes after acquiring acute coronary syndrome (ACS). We conducted this study to examine the in-hospital mortality by utilization of invasive coronary therapies and age in a nationwide population in Taiwan. METHODS: This observational study was conducted on a retrospective cohort from January 2004 to December 2008. Epidemiological features, including incidence rate and clinical characteristics of ACS in a Chinese population were investigated. Risk factors of in-hospital mortality, including myocardial infarction, shock, previous history of stroke, chronic kidney disease, diabetes mellitus, congestive heart failure, pneumonia, chronic obstructive pulmonary disease, dementia, peripheral arterial occlusive disease, septicemia and the use of invasive coronary procedures, were explored using a logistic regression model. RESULTS: A total of 97,220 patients were enrolled, and 53.6% of them were elderly. A significant decrease in the utilization rate of invasive coronary therapies (diagnostic coronary angiography and PCI) and increased in-hospital mortality (p<0.001) were observed as patient age increased. Adjusted multivariate logistic regression analysis revealed that the impact of PCI in reducing in-hospital mortality is consistent across age groups, including those older than 75 years old. CONCLUSIONS: Our nationwide study provides evidence that PCI is associated with significant improvement of in-hospital mortality in patients with ACS. Even the very elderly patients could benefit from PCI. However, currently the utilization rate of PCI in the aging population still does not present enough. A prospective study is indicated to corroborate the findings of this study.","Acute Coronary Syndrome/diagnosis/*mortality;Age Factors;Aged;Aged, 80 and over;Cohort Studies;Female;Hospital Mortality/*trends;Humans;Incidence;Male;Middle Aged;Retrospective Studies;Taiwan","Hsieh, T. H.;Wang, J. D.;Tsai, L. M.",2012,Feb 23,10.1016/j.ijcard.2011.10.009,0,
1895,Temporal trend in androgen status and androgen-sensitive outcomes in older men,"Context: Although androgen status decreases with aging in unselected men, the contemporaneous relationship over time between circulating hormones and androgen-sensitive outcomes has not been reported. Objectives: To investigate the temporal relationships between age-specific androgen status and muscle (mass, strength), hemoglobin, and prostate-specific antigen (PSA). Design, Setting and Participants: Men aged 70 years and older from the Concord Health and Ageing in Men Project study were assessed at baseline (2005-2007; n = 1705) and at 2-year (n = 1367) and 5-year follow-up (n = 958). Main Outcomes and Measures: At all assessments, serum T, dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry, and serum SHBG, LH, and FSH were measured by immunoassay together with calculation of free T (cFT). Muscle mass, strength of upper (hand grip) and lower (walking speed) limbs, hemoglobin, and prostate size (serum PSA) were measured. Results: Serum hormones showed longitudinal, within-man decreases in serum T (-2.6%/y), DHT (-2.6%/y), E1 (-3.2%/y), and cFT (-2.8%/y) but increases in serum E2 (2.6%/y), SHBG (1.3%/y), LH (1.9%/y), and FSH (1.8%/y). Significant positive correlation was observed between changes in serum T with muscle mass, strength, and hemoglobin but not with PSA across the three time-points. Changes in serum DHT, cFT, and E1 had significant correlation with muscle mass, strength, and hemoglobin, but not with PSA. Conclusions: These extended observational data are consistent with the impact of reduced androgen status on some somatic features of male aging. However, they do not exclude reverse causality or independent effects of aging on both androgen status and androgen-sensitive outcomes.",androgen;androstanolone;estradiol;estrone;follitropin;hemoglobin;luteinizing hormone;prostate specific antigen;sex hormone binding globulin;testosterone;aged;androgen blood level;article;cerebrovascular accident;comorbidity;controlled study;correlation analysis;cross-sectional study;dementia;depression;diabetes mellitus;estradiol blood level;estrone blood level;follitropin blood level;follow up;globulin blood level;grip strength;heart infarction;hemoglobin blood level;human;immunoassay;liquid chromatography-mass spectrometry;luteinizing hormone blood level;male;muscle mass;muscle strength;prostate size;protein blood level;testosterone blood level;trend study;walking speed,"Hsu, B.;Cumming, R. G.;Hirani, V.;Blyth, F. M.;Naganathan, V.;Le Couteur, D. G.;Seibel, M. J.;Waite, L. M.;Handelsman, D. J.",2016,,10.1210/jc.2015-3810,0,
1896,Association of Dementia and Peptic Ulcer Disease: A Nationwide Population-Based Study,"OBJECTIVE: We determine the association between dementia and the subsequent peptic ulcer disease (PUD). METHODS: We identified patients with diagnosed dementia in the Taiwan National Health Insurance Research Database. A comparison cohort without dementia was frequency-matched by age, sex, and comorbidities, and the occurrence of PUD was evaluated in both cohorts. RESULTS: The dementia and control cohort consisted of 6014 patients with dementia and 17 830 frequency-matched patients without dementia, respectively. The incidence of PUD (hazard ratio, 1.27; 95% confidence interval, 1.18-1.37; P < .001) was higher among patients with dementia. Cox models showed that being female, diabetes mellitus, chronic kidney disease, coronary artery disease, and chronic obstructive pulmonary disease were independent risk factors for PUD in patients with dementia. CONCLUSION: Dementia might increase the risk of developing PUD.",Taiwan National Health Insurance Research Database;dementia;peptic ulcer disease,"Hsu, C. C.;Hsu, Y. C.;Chang, K. H.;Lee, C. Y.;Chong, L. W.;Lin, C. L.;Kao, C. H.",2016,Aug,10.1177/1533317515617546,0,
1897,"International collaborative partnership for the study of atrial fibrillation (INTERAF): Rationale, design, and initial descriptives",,antiarrhythmic agent;anticoagulant agent;dabigatran;warfarin;anticoagulant therapy;arterial thromboembolism;article;atrial fibrillation;bleeding;brain hemorrhage;cardioversion;catheter ablation;cerebrovascular accident;chronic kidney failure;coronary artery disease;dementia;disease registry;heart failure;human;left atrial appendage closure device;paroxysmal atrial fibrillation;permanent atrial fibrillation;prevalence;priority journal;quality of life;thrombosis prevention,"Hsu, J. C.;Akao, M.;Abe, M.;Anderson, K. L.;Avezum, A.;Glusenkamp, N.;Kohsaka, S.;Lane, D. A.;Lip, G. Y. H.;Ma, C. S.;Masoudi, F. A.;Potpara, T. S.;Siong, T. W.;Turakhia, M. P.;Tse, H. F.;Rumsfeld, J. S.;Maddox, T. M.",2016,,10.1161/jaha.116.004037,0,
1898,Peptide potential,,amino acid;carboxyl group;luteinizing hormone;natriuretic peptide receptor A;nucleic acid;peptide;polymer;polysaccharide;protein;acute heart failure;allergy;Alzheimer disease;amino acid analysis;biological therapy;biotechnology;cardiovascular disease;degenerative disease;drug indication;drug industry;drug manufacture;drug targeting;heart failure;high performance liquid chromatography;Huntington chorea;metabolic disorder;neoplasm;Parkinson disease;peptide synthesis;peptide therapy;protein purification;quality control;short survey;solid phase synthesis;synthesis;tissue injury;toxicology;ultra performance liquid chromatography,"Hu, G.",2009,,,0,
1899,Building bonds,,gonadorelin;recombinant protein;thrombin;trifluoroacetic acid;acute heart failure;Alzheimer disease;amino acid sequence;amino acid synthesis;apoptosis;biotechnology;cardiovascular disease;conjugation;cost effectiveness analysis;degenerative disease;drug delivery system;drug industry;drug manufacture;freeze drying;high performance liquid chromatography;Huntington chorea;hydrophobicity;mass spectrometry;metabolic disorder;peptide synthesis;protein aggregation;protein assembly;protein binding;protein expression;protein hydrolysis;protein modification;protein purification;quality control;short survey;signal transduction;solid phase synthesis;structure analysis;ultra performance liquid chromatography,"Hu, G.",2011,,,0,
1900,Structural and functional changes of the coronary arteries in elderly senile patients with essential hypertension,"The aim of this study was to evaluate the effect of aging on the changes to the structure and function of coronary arteries in senile elderly patients with essential hypertension. Patients (aged 60-80 years) were divided into three groups. The 195 hypertensive patients were divided into four sub-groups according to the duration of hypertension. The changes to the coronary arteries (left and right) of all those patients were tested using the following index by 64 coronary computed tomography (CT) scans. The 24 h systolic blood pressure (SBP) and other blood biochemical parameters were assayed for all patients. We found that the value of the body mass index (BMI), total cholesterol (TC) and low density lipoproteins (LDL) were lower, but age and high density lipoproteins (HDL) were higher in the group of very elderly patients with hypertension (Group I; P<0.05) compared with those of a group of elderly patients with hypertension (Group III). The left anterior descending branch calcification score (CSLAD), total calcification score (CST), pulse pressure (PP), the left main branch calcification score (CSLM), the left circumflex branch calcification score (CSLCX) were significantly increased in Group I compared with Group III (P<0.01 and P<0.05, respectively). In addition, the 24 h SBP value for Group I was higher than in the 'very elderly without hypertension' group (Group II). Hence, in elderly patients, a decrease in the levels of BMI, HDL, TC and LDL accompanies aging. Furthermore, the decline of arterial compliance and increase in arterial stiffness develops with age. Aging is more likely to lead to atherosclerosis in the coronary arteries, particularly in the left main coronary artery and its main branches. Aging is an uncontrollable risk factor, which plays a crucial role in coronary artery atherosclerosis.",cholesterol;high density lipoprotein;low density lipoprotein;aged;aging;arterial stiffness;artery compliance;article;blood chemistry;body mass;computer assisted tomography;controlled study;coronary artery;coronary artery atherosclerosis;coronary artery calcium score;coronary artery circumflex branch;coronary risk;disease duration;essential hypertension;female;geriatric patient;human;left anterior descending coronary artery;left coronary artery;major clinical study;male;pulse pressure;senility;systolic blood pressure,"Hu, J.;Zhu, F.;Xie, J.;Cheng, X.;Chen, G.;Tai, H.;Fan, S.",2013,,,0,
1901,Prophylactic Cranial Irradiation in Advanced Breast Cancer: A Case for Caution,"Purpose: Prophylactic cranial irradiation (PCI) has a well-recognized role in the treatment of leukemia and small-cell lung cancer. Clinical utility has yet to be determined for breast cancer, where an emerging group at high risk of brain metastasis has fuelled consideration of PCI. Methods and Materials: In reviewing our experience with PCI as part of a complex protocol for advanced breast cancer, we present descriptive data on late central nervous system outcomes in those receiving PCI. After high-dose anthracycline-based induction chemotherapy, Stage IIIB/IV breast cancer responders underwent tandem autologous marrow transplantation. Those in continued remission were referred for PCI. Whole-brain radiotherapy was delivered by usual means, at 36 Gy in 20 fractions. Results: Twenty-four women, with median age 45 (28-61), were enrolled between 1995 and 1998. Disease was largely metastatic (79%), and 75% were previously exposed to chemotherapy or hormonotherapy. Ten patients received PCI, at a median of 13.4 (11.8-16.5) months from study entry. Six patients developed brain metastases, 2 despite PCI. Striking functional decline was documented in 3 patients (at 9 months, 4 years, and 5 years post-PCI), including one previously high-functioning woman requiring full care for posttreatment dementia. Conclusions: We present a series of advanced breast cancer patients treated prophylactically with whole-brain radiotherapy following an aggressive chemotherapy regimen. Although the therapeutic benefit of PCI is not ascertainable here, we describe brain metastases occurring despite PCI and serious long-term neurobehavioral sequelae in PCI-treated patients. Any further investigation of PCI in high-risk breast cancer will need to be approached with caution. © 2009 Elsevier Inc. All rights reserved.",antidepressant agent;bisphosphonic acid derivative;carmustine;cisplatin;cyclophosphamide;donepezil;epirubicin;fludarabine;fluorouracil;folinic acid;gabapentin;granulocyte colony stimulating factor;melphalan;mesna;methotrexate;neuroleptic agent;razoxane;trastuzumab;acute kidney failure;acute leukemia;adult;advanced cancer;Alzheimer disease;apathy;article;ataxia;attention deficit disorder;autologous bone marrow transplantation;bone metastasis;brain dysfunction;brain hemorrhage;brain metastasis;brain radiation;breast cancer;cancer combination chemotherapy;cancer hormone therapy;cancer mortality;cancer prevention;cancer radiotherapy;cancer regression;cancer recurrence;cancer survival;cancer therapy;clinical article;clinical protocol;cognitive defect;continuous infusion;dementia;disease severity;drug megadose;falling;female;heart arrest;human;intellectual impairment;memory disorder;multiple cycle treatment;nuclear magnetic resonance imaging;peripheral blood stem cell transplantation;priority journal;psychomotor retardation;radiation dose;sepsis;treatment response;tremor;vein occlusion;verbal memory;visual memory,"Huang, F.;Alrefae, M.;Langleben, A.;Roberge, D.",2009,,,0,
1902,Comparison of therapeutic effects and side effects between fluoxetine hydrochloride and clomipramine in patients with vascular depression,"Background: Most of patients with depression suffer from cardiovascular or cerebrovascular diseases. This kind of depression is conceptualized as vascular depression. Specific 5-hydroxytryptamine (5-HT) uptake inhibitors are proved to have a definite therapeutic effect on depression, but their influence on vascular depression need to be confirmed. Objective: To compare the therapeutic effects and side effects between fluoxetine hydrochloride and clomipramine in patients with vascular depression. Design: Randomized controlled investigation. Setting: It was conducted at the Cardiological Department of the First Hospital Affiliated to Xinxiang Medical College. Participants: From January 2003 to December 2004, inpatients and outpatients at the Cardiology Department of the First Hospital Affiliated to Xinxiang Medical College were selected. Inclusion criteria: 1 a diagnosis of depression according to the diagnostic criteria of the Chinese Classification of Mental Disorder (CCMD); 2 a diagnosis of vascular depression according to the clinical definition suggested by Alexopoulos et al, which is, before the onset of depression, cardiovascular diseases or cerebrovascular diseases have been evidenced already; 3 with an age less than 70 years old; 4 and getting informed consents from the patients and their relatives. Exclusion criteria: 1 having a history of drug allergy; 2 having consciousness disorders and obvious dementia symptoms; 3 having severe impairment in cardiac function, hepatic function or renal function; 4 having severe mental disorders, 5 and having trauma, tumor, inflammation or demyelination in brain, and a history of depression. Sixty eligible patients were selected and divided into the experimental group and the control group, 30 patients in each group. Methods: With promoting-blood-circulation-to-remove-blood-stasis medication, patients in experimental group took oral fluoxetine hydrochloride (20 mg/day) while patients in control group took oral clomipramine (starting with a dose of 25 mg/time and then adding to 50-250 mg/day, tid, according to the state of illness and the patients' tolerance), the duration of the medication in each group was 12 weeks. Before treatment and at post-treatment week 4, 6 and 12, the therapeutic effects on depression were assessed using Hamilton Depression (HAMD) Rating Scale respectively, and pre-treatment and post-treatment adverse reactions and side effects were recorded as well. Descriptive data were shown as percentage, comparison between groups was performed using Chi-square test, and measurement data was compared with t Test. Main outcome measures: Primary outcomes included 1 Comparison of pre- and post-treatment HAMD scores between the two groups. 2 Comparison of post-treatment therapeutic effects between the two groups. Secondary outcomes included: adverse events and side effects. Results: In each group, 30 patients completed the medication and entered the statistical analysis procedure. 1 Comparison of HAMD scores between the two groups: In experimental group, the HAMD scores at post-treatment week 6 and 12 were lower than the pre-treatment scores (12.40 +/-4.30, 7.80+/-4.36 and 21.30+/-2.64; P < 0.01), and lower than those in control group (at post-treatment week 6: 13.20+/-4.90; at post-treatment week 12: 7.90+/-4.20; t=3.98, 5.02, P < 0.01). 2 Comparison of improvement in depression between the two groups: In experimental group, the effective rate at post-treatment week 6 and 12 were higher than those in control group (week 6: 93% and 87%; week 12: 97% and 93%, P > 0.05). 3 Comparison of adverse events and side effects between the two groups: In experimental group, there were 8 patients had adverse events and side effects, 2 of them might be linked to the medication, with manifestation of nausea and thirsty. In control group, the number was 13, 10 of them might be linked to the medication, with manifestation of thirsty, constipation, voiding dysfunction, dizziness and excitation. The occurrence rate of side effects was lower in therapeutic group than in control group 27% and 43%, P < 0.01). Conclusion: The therapeutic effect of fluoxetine hydrochloride was close to that of clomipramine. And the patients' tolerance to fluoxetine hydrochloride is better than their tolerance to clomipramine.",adult;aged;article;cardiology;cardiovascular disease/di [Diagnosis];cerebrovascular disease/di [Diagnosis];chi square test;China;Chinese;circulation;clinical article;clinical trial;constipation/si [Side Effect];controlled clinical trial;controlled study;data analysis;depression/di [Diagnosis];depression/dt [Drug Therapy];disease classification;dizziness/si [Side Effect];drug dose regimen;drug efficacy;drug tolerance;excitation;experimentation;female;Hamilton scale;hemostasis;hospital department;hospital patient;human;informed consent;male;medical documentation;mental disease/di [Diagnosis];mental disease/dt [Drug Therapy];micturition disorder/si [Side Effect];nausea/si [Side Effect];outpatient;patient selection;randomized controlled trial;scoring system;side effect/dt [Drug Therapy];side effect/si [Side Effect];statistical analysis;thirst;vascular disease/di [Diagnosis];cholinergic receptor blocking agent/dt [Drug Therapy];clomipramine/ae [Adverse Drug Reaction];clomipramine/ct [Clinical Trial];clomipramine/cm [Drug Comparison];clomipramine/do [Drug Dose];clomipramine/dt [Drug Therapy];clomipramine/po [Oral Drug Administration];fluoxetine/ae [Adverse Drug Reaction];fluoxetine/ct [Clinical Trial];fluoxetine/cm [Drug Comparison];fluoxetine/do [Drug Dose];fluoxetine/dt [Drug Therapy];fluoxetine/po [Oral Drug Administration];Salvia miltiorrhiza extract/ae [Adverse Drug Reaction];Salvia miltiorrhiza extract/ct [Clinical Trial];Salvia miltiorrhiza extract/cm [Drug Comparison];Salvia miltiorrhiza extract/dt [Drug Therapy];adverse drug reaction;brain;cardiovascular disease;cerebrovascular disease;classification;consciousness disorder;constipation;control group;dementia;demyelination;diagnosis;dizziness;drug hypersensitivity;drug therapy;general aspects of disease;heart function;hospital;hospital patient;inflammation;injury;kidney function;liver function;medical school;mental disease;micturition disorder;nausea;patient;side effect;Student t test;tumor;vascular disease;cholinergic receptor blocking agent;clomipramine;fluoxetine;Salvia miltiorrhiza extract;serotonin;Sr-depressn: sr-stroke,"Huang, L-L",2005,,,0,
1903,Comparison of therapeutic effects and side effects between fluoxetine hydrochloride and clomipramine in patients with vascular depression,"Background: Most of patients with depression suffer from cardiovascular or cerebrovascular diseases. This kind of depression is conceptualized as vascular depression. Specific 5-hydroxytryptamine (5-HT) uptake inhibitors are proved to have a definite therapeutic effect on depression, but their influence on vascular depression need to be confirmed. Objective: To compare the therapeutic effects and side effects between fluoxetine hydrochloride and clomipramine in patients with vascular depression. Design: Randomized controlled investigation. Setting: It was conducted at the Cardiological Department of the First Hospital Affiliated to Xinxiang Medical College. Participants: From January 2003 to December 2004, inpatients and outpatients at the Cardiology Department of the First Hospital Affiliated to Xinxiang Medical College were selected. Inclusion criteria: 1 a diagnosis of depression according to the diagnostic criteria of the Chinese Classification of Mental Disorder (CCMD); 2 a diagnosis of vascular depression according to the clinical definition suggested by Alexopoulos et al, which is, before the onset of depression, cardiovascular diseases or cerebrovascular diseases have been evidenced already; 3 with an age less than 70 years old; 4 and getting informed consents from the patients and their relatives. Exclusion criteria: 1 having a history of drug allergy; 2 having consciousness disorders and obvious dementia symptoms; 3 having severe impairment in cardiac function, hepatic function or renal function; 4 having severe mental disorders, 5 and having trauma, tumor, inflammation or demyelination in brain, and a history of depression. Sixty eligible patients were selected and divided into the experimental group and the control group, 30 patients in each group. Methods: With promoting-blood-circulation-to-remove-blood-stasis medication, patients in experimental group took oral fluoxetine hydrochloride (20 mg/day) while patients in control group took oral clomipramine (starting with a dose of 25 mg/time and then adding to 50-250 mg/day, tid, according to the state of illness and the patients' tolerance), the duration of the medication in each group was 12 weeks. Before treatment and at post-treatment week 4, 6 and 12, the therapeutic effects on depression were assessed using Hamilton Depression (HAMD) Rating Scale respectively, and pre-treatment and post-treatment adverse reactions and side effects were recorded as well. Descriptive data were shown as percentage, comparison between groups was performed using Chi-square test, and measurement data was compared with t Test. Main outcome measures: Primary outcomes included 1 Comparison of pre- and post-treatment HAMD scores between the two groups. 2 Comparison of post-treatment therapeutic effects between the two groups. Secondary outcomes included: adverse events and side effects. Results: In each group, 30 patients completed the medication and entered the statistical analysis procedure. 1 Comparison of HAMD scores between the two groups: In experimental group, the HAMD scores at post-treatment week 6 and 12 were lower than the pre-treatment scores (12.40 +4.30, 7.80+4.36 and 21.30+2.64; P < 0.01), and lower than those in control group (at post-treatment week 6: 13.20+4.90; at post-treatment week 12: 7.90+4.20; t=3.98, 5.02, P < 0.01). 2 Comparison of improvement in depression between the two groups: In experimental group, the effective rate at post-treatment week 6 and 12 were higher than those in control group (week 6: 93% and 87%; week 12: 97% and 93%, P > 0.05). 3 Comparison of adverse events and side effects between the two groups: In experimental group, there were 8 patients had adverse events and side effects, 2 of them might be linked to the medication, with manifestation of nausea and thirsty. In control group, the number was 13, 10 of them might be linked to the medication, with manifestation of thirsty, constipation, voiding dysfunction, dizziness and excitation. The occurrence rate of side effects was lower in therapeutic group than in control group (27% and 4 %, P < 0.01). Conclusion: The therapeutic effect of fluoxetine hydrochloride was close to that of clomipramine. And the patients' tolerance to fluoxetine hydrochloride is better than their tolerance to clomipramine.",adult // aged // article // cardiology // cardiovascular disease/di [Diagnosis] // cerebrovascular disease/di [Diagnosis] // chi square test // China // Chinese // circulation // clinical article // clinical trial // constipation/si [Side Effect] // con;Sr-depressn: sr-stroke,"Huang, L. L.",2005,,,0,1902
1904,Association between psychiatric disorders and osteoarthritis: A nationwide longitudinal population-based study,"Although the association between depressive disorders and osteoarthritis (OA) has been studied, the association of other psychiatric disorders with OA remains unclear. Here, we investigated whether psychiatric disorders are risk factors for OA. The data were obtained from the Longitudinal Health Insurance Database 2005 of Taiwan. We collected the ambulatory care claim records of patients who were diagnosed with psychiatric disorders according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes between January 1, 2004 and December 31, 2008. The prevalence and adjusted hazard ratios (HRs) of osteoarthritis among patients with psychiatric disorders and the control cohort were estimated. Of 74,393 patients with psychiatric disorders, 16,261 developed OA during the 7-year follow-up period. The crude HR for OA was 1.44 (95% confidence interval [CI], 1.39-1.49), which was higher than that of the control cohort. The adjusted HR for OA was 1.42 (95% CI, 1.39-1.42) among patients with psychiatric disorders during the 7-year follow-up period. Further analysis revealed that affective psychoses, neurotic illnesses or personality disorders, alcohol and drug dependence or abuse, and other mental disorders were risk factors for OA. This large-scale longitudinal population-based study revealed that affective psychoses, personality disorders, and alcohol and drug dependence or abuse are risk factors for OA.",acquired immune deficiency syndrome;adult;affective psychosis;aged;alcohol abuse;alcoholism;article;bipolar disorder;cerebrovascular disease;chronic lung disease;cohort analysis;comparative study;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;disease association;drug abuse;drug dependence;female;follow up;heart infarction;hemiplegia;human;Human immunodeficiency virus infection;kidney disease;liver disease;longitudinal study;major clinical study;male;mental disease;metastasis;middle aged;neurosis;osteoarthritis;paranoid psychosis;paraplegia;peptic ulcer;peripheral vascular disease;personality disorder;priority journal;rheumatic disease;schizophrenia;urbanization,"Huang, S. W.;Wang, W. T.;Lin, L. F.;Liao, C. D.;Liou, T. H.;Lin, H. W.",2016,,,0,
1905,"Diabetes, hepatocellular carcinoma, and mortality in hepatitis C-infected patients: A population-based cohort study","Background and Aim: The effect of diabetes mellitus (DM) on the development of hepatocellular carcinoma (HCC) and all-cause mortality after HCC development in chronic hepatitis C virus (HCV)-infected patients remains inconclusive. This cohort study aimed to investigate these issues using the Taiwanese National Health Insurance Research Database. Methods: We retrieved and enrolled newly diagnosed DM patients with HCV from the Longitudinal Cohort of Diabetes Patients database. Propensity score matching—including age, sex, alcohol-related liver disease, and baseline liver cirrhosis—was used to identify and enroll HCV patients without DM from the Longitudinal Health Insurance Database (n = 1686). A multi-state model was used to investigate transitions from “start-to-HCC,” “start-to-death,” and “HCC-to-death.”. Results: The multi-state model showed higher cumulative hazards for “start-to-HCC,” “start-to-death,” and “HCC-to-death” transitions in the DM (vs non-DM) cohort. The cumulative probability of death with or without HCC after 10 years of follow-up was higher in the DM cohort than in the non-DM cohort. Multivariable transition-specific Cox models demonstrated that DM significantly increased the risk for transition from “start-to-HCC” (adjusted hazard ratio [aHR] 1.36; 95% confidence interval [CI] 1.16–1.59; P < 0.001), “start-to-death” (aHR 2.61; 95% CI: 2.05–3.33; P < 0.001), and “HCC-to-death” (aHR 1.36; 95% CI 1.10–1.68; P = 0.005). The effect of liver cirrhosis on “start-to-HCC” and “start-to-death” transitions decreased over time, particularly within 2 years. Conclusions: Diabetes mellitus increased the risk of HCC development in HCV-infected patients and the risk of all-cause mortality in patients with or without HCC.",adult;age;aged;alcohol liver cirrhosis;alcohol liver disease;article;ascites;brain disease;cardiovascular disease;cause of death;Charlson Comorbidity Index;chronic lung disease;clinical feature;congestive heart failure;dementia;diabetes mellitus;diabetic patient;female;follow up;heart infarction;hemiplegia;hepatitis C;hepatorenal syndrome;human;kidney disease;liver cell carcinoma;liver cirrhosis;major clinical study;male;middle aged;mortality;obesity;paraplegia;peptic ulcer;priority journal;rheumatic disease;risk assessment;risk factor;sex;varicosis,"Huang, T. S.;Lin, C. L.;Lu, M. J.;Yeh, C. T.;Liang, K. H.;Sun, C. C.;Shyu, Y. C.;Chien, R. N.",2017,,10.1111/jgh.13670,0,
1906,Risk of subsequent dementia in patients with hypertensive encephalopathy: a nationwide population-based study in Taiwan,"BACKGROUND/AIMS: We investigated the association of hypertensive encephalopathy (HE) with subsequent dementia. METHODS: Using universal insurance claims data, we identified a study cohort of 5,504 participants with HE newly diagnosed between 1997 and 2010 and a comparison cohort of 22,016 healthy participants. Incidence and risks of dementia were estimated for both cohorts until the end of 2010. RESULTS: The dementia incidence was 1.45-fold [95% confidence interval (CI) = 1.27-1.66] higher in the study cohort than in the comparison cohort, with an adjusted hazard ratio (HR) of 1.38 (95% CI = 1.19-1.59) for the study cohort. The risk was higher for males than for females and elderly patients. With an incidence of 13.4 per 1,000 person-years, the HR of dementia increased to 2.09 (95% CI = 1.18-3.71) for the HE patients with the comorbidities of head injury and diabetes compared to those without HE and comorbidities. The risk of developing dementia declined with the follow-up time. CONCLUSION: Hypertensive patients with HE displayed a significantly higher risk for dementia than those without HE. The risk increased further in those with the comorbidities of head injury and diabetes. Physicians should be aware of the link between HE and dementia when assessing patients with HE.","Adult;Age Factors;Aged;Aged, 80 and over;Cohort Studies;Comorbidity;Craniocerebral Trauma/*epidemiology;Dementia/*epidemiology;Depression/epidemiology;Diabetes Mellitus/*epidemiology;Female;Humans;Hypertension/epidemiology;Hypertensive Encephalopathy/*epidemiology;Incidence;Male;Middle Aged;Multivariate Analysis;Myocardial Infarction/epidemiology;Proportional Hazards Models;Risk Factors;Sex Factors;Taiwan/epidemiology;Time Factors","Huang, W. S.;Tseng, C. H.;Lin, C. L.;Lin, C. Y.;Sung, F. C.;Kao, C. H.",2014,,10.1159/000357701,0,
1907,"To treat or not to treat, cheyne-stokes respiration in a young adult with vascular encephalopathy","Cheyne-Stokes respiration (CSR) is a form of sleep-disordered breathing characterised by recurrent central sleep apnoea alternating with a crescendo-decrescendo pattern of tidal volume, relatively rare observation in sleep labs. It is mainly seen in severe heart failure and stroke. We report the case of a young man with CSR after sudden onset of seizure in the context of hypertensive exacerbation leading to the diagnosis of a leukoencephalopathy, and comment on differential diagnoses, prognostic and therapeutic outcomes. The very uniqueness of this case consists in the extremely young age for developing a vascular encephalopathy in the absence of genetic diseases and without previous diagnose of hypertension. There is no adequate explanation for the origin of vascular encephalopathy; also there is lack of evidence regarding the benefits and modality of treatment for CSR in neurologic diseases. Thus, we were forced to find the best compromise in a nocturnal oxygen therapy and follow-up.",amlodipine;etiracetam;metoprolol;Notch3 receptor;ramipril;urapidil;adult;anticonvulsant therapy;apnea hypopnea index;article;brain dysfunction;case report;cerebrovascular disease;Cheyne Stokes breathing;chromosome 19;cold sweat;confusion;daytime somnolence;diffusion weighted imaging;dysplastic nevus;Epworth sleepiness scale;genetic screening;hospital admission;hospitalization;human;human tissue;hypertension;male;medical documentation;medical history;microangiopathy;neurologic examination;nuclear magnetic resonance imaging;obesity;patient referral;physical examination;seizure;skin biopsy;snoring;tachycardia;wakefulness;world health organization,"Hubatsch, M.;Englert, H.;Wagner, U.",2016,,,0,
1908,Pathological consequences of VCP mutations on human striated muscle,"Mutations in the valosin-containing protein (VCP, p97) gene on chromosome 9p13-p12 cause a late-onset form of autosomal dominant inclusion body myopathy associated with Paget disease of the bone and frontotemporal dementia (IBMPFD). We report on the pathological consequences of three heterozygous VCP (R93C, R155H, R155C) mutations on human striated muscle. IBMPFD skeletal muscle pathology is characterized by degenerative changes and filamentous VCP- and ubiquitin-positive cytoplasmic and nuclear protein aggregates. Furthermore, this is the first report demonstrating that mutant VCP leads to a novel form of dilatative cardiomyopathy with inclusion bodies. In contrast to post-mitotic striated muscle cells and neurons of IBMPFD patients, evidence of protein aggregate pathology was not detected in primary IBMPFD myoblasts or in transient and stable transfected cells using wild-type-VCP and R93C-, R155H-, R155C-VCP mutants. Glutathione S-transferase pull-down experiments showed that all three VCP mutations do not affect the binding to Ufd1, Npl4 and ataxin-3. Structural analysis demonstrated that R93 and R155 are both surface-accessible residues located in the centre of cavities that may enable ligand-binding. Mutations at R93 and R155 are predicted to induce changes in the tertiary structure of the VCP protein. The search for putative ligands to the R93 and R155 cavities resulted in the identification of cyclic sugar compounds with high binding scores. The latter findings provide a novel link to VCP carbohydrate interactions in the complex pathology of IBMPFD. © The Author (2006). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.",glutathione transferase;nuclear protein;ubiquitin;valosin containing protein;article;congestive cardiomyopathy;controlled study;frontotemporal dementia;gene mutation;heterozygosity;human;human tissue;inclusion body myositis;ligand binding;muscle atrophy;muscle biopsy;muscle cell;mutational analysis;myoblast;neuropathology;nucleotide sequence;Paget bone disease;prediction;priority journal;protein aggregation;protein binding;protein carbohydrate interaction;protein localization;protein tertiary structure;skeletal muscle;structure analysis;wild type,"Hübbers, C. U.;Clemen, C. S.;Kesper, K.;Böddrich, A.;Hofmann, A.;Kämäräinen, O.;Tolksdorf, K.;Stumpf, M.;Reichelt, J.;Roth, U.;Krause, S.;Watts, G.;Kimonis, V.;Wattjes, M. P.;Reimann, J.;Thal, D. R.;Biermann, K.;Evert, B. O.;Lochmüller, H.;Wanker, E. E.;Schoser, B. G. H.;Noegel, A. A.;Schröder, R.",2007,,,0,
1909,"Implementation of a telephone-based secondary preventive intervention after acute coronary syndrome (ACS): participation rate, reasons for non-participation and 1-year survival","BACKGROUND: Acute coronary syndrome (ACS) is a major cause of death from a non-communicable disease. Secondary prevention is effective for reducing morbidity and mortality, but evidence-based targets are seldom reached and new interventional methods are needed. The present study is a feasibility study of a telephone-based secondary preventive programme in an unselected ACS cohort. METHODS: The NAILED (Nurse-based Age-independent Intervention to Limit Evolution of Disease) ACS trial is a prospective randomized controlled trial. All eligible patients admitted for ACS were randomized to usual follow-up by a general practitioner or telephone follow-up by study nurses. The intervention was made by continuous telephone contact, with counseling on healthy living and titration of medicines to reach target values for blood pressure and blood lipids. Exclusion criteria were limited to physical inability to follow the study design or participation in another study. RESULTS: A total of 907 patients were assessed for inclusion. Of these, 661 (72.9%) were included and randomized, 100 (11%) declined participation, and 146 (16.1%) were excluded. The main reasons for exclusion were participation in another trial, dementia, and advanced disease. ""Excluded"" and ""declining"" patients were significantly older with more co-morbidity, decreased functional status, and had more seldom received education above compulsory school level than ""included"" patients. Non-participants had a higher 1-year mortality than participants. CONCLUSIONS: Nurse-led telephone-based follow-up after ACS can be applied to a large proportion in an unselected clinical setting. Reasons for non-participation, which were associated with increased mortality, include older age, multiple co-morbidities, decreased functional status and low level of education. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN96595458 (archived by WebCite at http://www.webcitation.org/6RlyhYTYK). Application date: 10 July 2011.",,"Huber, D.;Henriksson, R.;Jakobsson, S.;Stenfors, N.;Mooe, T.",2016,Feb 15,10.1186/s13063-016-1203-x,0,1910
1910,"Implementation of a telephone-based secondary preventive intervention after acute coronary syndrome (ACS): participation rate, reasons for non-participation and 1-year survival","METHODS: The NAILED (Nurse-based Age-independent Intervention to Limit Evolution of Disease) ACS trial is a prospective randomized controlled trial. All eligible patients admitted for ACS were randomized to usual follow-up by a general practitioner or telephone follow-up by study nurses. The intervention was made by continuous telephone contact, with counseling on healthy living and titration of medicines to reach target values for blood pressure and blood lipids. Exclusion criteria were limited to physical inability to follow the study design or participation in another study.RESULTS: A total of 907 patients were assessed for inclusion. Of these, 661 (72.9%) were included and randomized, 100 (11%) declined participation, and 146 (16.1%) were excluded. The main reasons for exclusion were participation in another trial, dementia, and advanced disease. ""Excluded"" and ""declining"" patients were significantly older with more co-morbidity, decreased functional status, and had more seldom received education above compulsory school level than ""included"" patients. Non-participants had a higher 1-year mortality than participants.CONCLUSIONS: Nurse-led telephone-based follow-up after ACS can be applied to a large proportion in an unselected clinical setting. Reasons for non-participation, which were associated with increased mortality, include older age, multiple co-morbidities, decreased functional status and low level of education.TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN96595458 (archived by WebCite at http://www.webcitation.org/6RlyhYTYK). Application date: 10 July 2011.BACKGROUND: Acute coronary syndrome (ACS) is a major cause of death from a non-communicable disease. Secondary prevention is effective for reducing morbidity and mortality, but evidence-based targets are seldom reached and new interventional methods are needed. The present study is a feasibility study of a telephone-based secondary preventive programme in an unselected ACS cohort.",Acute Coronary Syndrome [mortality] [physiopathology];Glomerular Filtration Rate;Nurses;Patient Participation [statistics & numerical data];Prospective Studies;Secondary Prevention [methods];Telephone;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-htn,"Huber, D;Henriksson, R;Jakobsson, S;Stenfors, N;Mooe, T",2016,,10.1186/s13063-016-1203-x,0,
1911,Ophthalmic drugs as part of polypharmacy in nursing home residents with glaucoma,"BACKGROUND: Glaucoma comprises age-related neurodegenerative diseases of retinal ganglion cells, the worldwide prevalence of which is increasing. Local pharmacotherapy is the primary treatment option, especially in the elderly. But this therapeutic approach may include risks for adverse drug effects and drug-drug interactions, of particular importance in frail nursing home resident populations. OBJECTIVE: The aim of the present study was to investigate anti-glaucoma pharmacotherapy in nursing home residents in the context of multi-morbidity and related systemic co-medication. METHODS: Data for 8,685 nursing home residents with 88,695 drug prescriptions were analysed according to diagnosis and local or systemic pharmacotherapy. Data were provided in anonymous form by a German public health insurance company. RESULTS: The study cohort was characterized by a mean age of 83.6 +/- 7.3 years (range: 65-106 years), 21 % of nursing home residents were at least 90 years old and 83.7 % were women. For each nursing home resident, an average of 6.0 +/- 3.3 different drugs were registered. A diagnosis of glaucoma was recorded in 520 (6.0 %) nursing home residents; all subjects had co-existing medical conditions. Dementia was a frequent co-morbidity, diagnosed in 51.7 % of nursing home residents with glaucoma. Anti-glaucoma drugs contributed to 0.5 % of all prescriptions and were prescribed to 341 nursing home residents. The most frequently used anti-glaucoma ophthalmics were beta-blockers (n = 219), followed by prostaglandin analogues (n = 101) and carbonic anhydrase inhibitors (n = 86). Local anti-glaucoma therapy was co-prescribed with a systemic pharmacotherapy in 338 nursing home residents. An ophthalmic agent was, on average, combined with 6.5 +/- 3.2 prescriptions for systemic agents. Thus, 71.9 % of nursing home residents were prescribed ophthalmic beta-blockers and a concomitant antihypertensive medication; local and systemic beta-blockers were combined in 20.2 % of these patients. Co-treatment with cardiac glycosides or calcium antagonists was found in 13 % of nursing home residents prescribed ophthalmic parasympathomimetics, and in 14 % of those prescribed ophthalmic beta-blockers, with the potential for drug-drug interactions to influence cardiac function. CONCLUSIONS: Anti-glaucoma pharmacotherapy in nursing home residents is frequently prescribed in the context of polypharmacy. This may modify the efficacy and safety of local and systemic therapies. Therefore, individualized pharmacotherapy that integrates anti-glaucoma drug therapy into the overall treatment rationale in nursing home residents is necessary. However, to realize this concept, further clinical research in nursing home residents is warranted.","Aged;Aged, 80 and over;Cohort Studies;Comorbidity;Drug Combinations;Drug Prescriptions/statistics & numerical data;Female;Glaucoma/*drug therapy/epidemiology;Humans;Male;*Nursing Homes;*Polypharmacy","Huber, M.;Kolzsch, M.;Stahlmann, R.;Hofmann, W.;Bolbrinker, J.;Drager, D.;Kreutz, R.",2013,Jan,10.1007/s40266-012-0036-x,0,
1912,Hydroxybenzoic acids and their derivatives as peroxynitrite scavengers,"A social challenge of the 21(st) century is to reduce the incidence of chronic diseases. A balanced diet rich in polyphenols could contribute to reduce the risk and to the prevention of diabetes, coronary heart disease, cancer, Alzheimer's diseases and cataract(1). Hydroxybenzoic acids (HBA) and their derivatives, which are one of the substances responsible for these beneficial properties, are known mainly due to their antioxidant properties(2). They are effective scavengers of free radicals and reactive nitrogen species, such as peroxynitrite. Peroxynitrite is resulting from the reaction of nitric oxide with superoxide, causes lipid peroxidation and subsequent cellular damage and is responsible for the inactivation of many enzymes, activation of stress signalling pathways, release of proapoptotic factors, as well as cardiovascular dysfunction in septic schock(3). In this study we have tested 2-HBA, 3-HBA, 4-HBA, acetylsalicylic acid, 4-HBA methyl and propyl esters, 2,3-dihydroxybenzoic acid (DHBA), 2,5-DHBA, 2,4-DHBA, 2,6-DHBA, 3,5-DHBA, 3,4-DHBA, gallic acid and caffeic acid, by UV/VIS spectroscopy. The best ability to scavenge peroxynitrite was observed for gallic acid, 2,4-DHBA, 3,5-DHBA and caffeic acid. Improved comprehension of the complex relationship between the antioxidant properties of substances and their structure is important to understand their proper use in the prevention and treatment of diseases and for the detection of pathological processes. Monitoring and improved understanding of the antioxidant properties of hydroxybenzoic acid derivatives are important due to their frequent use in modern medical nutrition therapies.",,"Hubkova, B.;Velika, B.;Birkova, A.;Guzy, J.;Marekova, M.",2014,Oct,10.1016/j.freeradbiomed.2014.10.770,0,
1913,A fractured inferior vena cava filter strut migrating to the left pulmonary artery,Inferior vena cava filters are increasingly used in patients with recurrent venous thromboembolism who are contraindicated to anticoagulation. Migration of a broken strut to the pulmonary artery is a very rare complication of these filters. We report the case of an 83-year-old female who experienced this complication with the migratory strut remaining in the same position for years. This case provides evidence that such filters probably have higher rates of complications than what has been thought that remain asymptomatic. The indications and the management of complications of such devices need to be studied further.,vena cava filter;anticoagulant agent;glyceryl trinitrate;acute coronary syndrome;aged;Alzheimer disease;angina pectoris;anticoagulant therapy;article;case report;clinical feature;computer assisted tomography;coronary artery disease;deep vein thrombosis;Doppler flowmetry;dyspnea;female;human;hyperlipidemia;hypertension;hypotension;inferior vena cava filter strut migration;lung embolism;medical device complication;priority journal;thorax pain;treatment response;very elderly,"Hudali, T.;Zayed, A.;Karnath, B.",2015,,,0,
1914,Myocardial infarction after hip fracture repair: A population-based study,"Objectives To quantify the occurrence of myocardial infarction (MI) occurring in the early postoperative period after surgical hip fracture repair and estimate the effect on 1-year mortality. Design A population-based, historical cohort study of individuals who underwent surgical repair of a hip fracture that used the computerized medical record linkage system of the Rochester Epidemiology Project. Setting Academic and community hospitals, outpatient offices, and nursing homes in Olmsted County, Minnesota. Participants Over the 15-year study period (1988-2002), 1,116 elderly adults underwent surgical repair of a hip fracture. Measurements At the end of the first 7 days after hip fracture repair, participants were classified into one of three groups: clinically verified MI (cv-MI), subclinical myocardial ischemia, and no myocardial ischemia. One-year mortality was compared between these groups. Multivariate models assessed risk factors for early postoperative cv-MI and 1-year mortality. Results Within the first 7 days after hip fracture repair, 116 (10.4%) participants experienced cv-MI and 41 (3.7%) subclinical myocardial ischemia. Overall 1-year mortality was 22%, with no difference between those with subclinical myocardial ischemia and those with no myocardial ischemia. One-year mortality for those with cv-MI (35.8%) was significantly higher than for the other two groups. Occurrence of early postoperative cv-MI, male sex, and history of heart failure or dementia were independently associated with greater 1-year mortality, whereas prefracture home residence and preoperative higher hemoglobin were protective. Conclusion Rates of early postoperative, cv-MI after hip fracture repair exceed rates after other major orthopedic surgeries and are independently associated with greater 1-year mortality. © 2012, The American Geriatrics Society.",aged;article;controlled study;female;heart infarction;heart muscle ischemia;hip fracture;hip surgery;human;major clinical study;male;medical record;mortality;population research;risk factor,"Huddleston, J. M.;Gullerud, R. E.;Smither, F.;Huddleston, P. M.;Larson, D. R.;Phy, M. P.;Melton Iii, L. J.;Roger, V. L.",2012,,,0,
1915,Pre-existing psychiatric disorder in the burn patient is associated with worse outcomes,"Objective To compare patient and burn characteristics between patients who had a pre-existing psychiatric diagnosis and patients who did not in a Burn Unit at an academic hospital. Background Psychosocial issues are common in patients recovering from a burn; however, little is known regarding hospital course and discharge outcomes in patients with a pre-existing psychiatric diagnosis presenting with a burn. Baseline medical comorbidities of burn patients have been shown to be a significant risk for in-hospital mortality. Methods A retrospective chart review of 479 consecutive patients admitted to the Burn Unit of an academic hospital in Halifax, Nova Scotia between March 2nd 1995 and June 1st 2013 was performed. Extensive data regarding patient and burn characteristics and outcomes was collected. Patients with and without pre-existing psychiatric diagnoses at the time of hospital admission were compared. Results Sixty-three (13%) patients had a psychiatric diagnosis, with the most common being depression (52%). Forty-percent (n = 25/63) of these patients had multiple pre-existing psychiatric diagnoses. Patients with a psychiatric diagnosis had a greater total-body-surface-area (TBSA)% covered by a third-degree burn (p = 0.001), and were more likely to have an inhalation injury (p < 0.001). These patients were also significantly more likely to experience 6 of the 10 most prevalent in-hospital complications and had a higher mortality rate (p = 0.02). They were less likely to be discharged home (p = 0.001), and more likely to go to a home hospital (p = 0.04) or rehabilitation facility (p = 0.03). Psychiatric diagnosis was associated with significantly more placement issues (e.g. rehab bed unavailability, homeless) upon discharge from the Burn Unit (p = 0.01). The risk of death in burn patients with pre-existing psychiatric disorders was about three times the risk of death in patients with no psychiatric disorders when adjusting for other potential confounders (95% CI, 1.13–9.10; p-value 0.03). Conclusion Presence of a pre-existing psychiatric disorder in the burn patient was associated with worse outcomes and was a significant predictor of death. Psychiatric diagnoses should be identified early in burn treatment and efforts should be made to ensure a comprehensive approach to inpatient support and patient discharge to reduce unfavorable burn outcomes and placement issues.",abdominal compartment syndrome;adjustment disorder;adult;anxiety disorder;article;attention deficit disorder;bacteremia;bipolar disorder;bleeding;burn;burn patient;cellulitis;cerebrovascular accident;comparative study;congestive heart failure;delirium;delirium tremens;delusional disorder;dementia;depression;drug dependence;female;general condition deterioration;generalized anxiety disorder;heart arrhythmia;hospital admission;hospital discharge;hospital mortality;human;kidney failure;lung burn;lung edema;major clinical study;male;mental disease;mood disorder;mortality rate;Nova Scotia;outcome assessment;personality disorder;pneumonia;pneumothorax;posttraumatic stress disorder;psychiatric diagnosis;respiratory failure;retrospective study;schizophrenia;seizure;septicemia;urinary tract infection;wound infection,"Hudson, A.;Al Youha, S.;Samargandi, O. A.;Paletz, J.",2017,,10.1016/j.burns.2017.01.022,0,
1916,Perioperative Consultation for Patients with Preexisting Neurologic Disorders,"As the population ages, the prevalence of many neurologic diseases is increasing. At the same time, older patients are undergoing more surgical procedures. This confluence of events puts neurohospitalists in a unique position to provide both pre- and postoperative guidance to minimize complications, improve clinical outcomes, and decrease health care costs in patients with neurologic comorbidities. Early preoperative consultation is recommended for patients with severe, poorly controlled, or decompensated neurologic disease, a recent stroke, or those undergoing procedures with a high risk of neurologic complications. The neurohospitalist's role includes optimizing management of preexisting diseases, such as epilepsy, neuromuscular disorders, Parkinson's disease, dementia, and cerebrovascular disease, as well as providing guidance for perioperative management and clarification of risks. In the postoperative period, the neurohospitalist will frequently be consulted to mitigate any negative impact of neurologic complications that do occur.",acute kidney failure;amyotrophic lateral sclerosis;article;artificial ventilation;aspiration pneumonia;atelectasis;breathing exercise;cardiomyopathy;carotid artery obstruction;cerebrovascular accident;cerebrovascular disease;comorbidity;delayed emergence from anesthesia;delirium;epilepsy;human;hypercapnia;lung disease;lung function;muscle rigidity;muscular dystrophy;myasthenia gravis;neurologic disease;neurological complication;neuromuscular disease;parkinsonism;perioperative period;pneumonia;positive end expiratory pressure;postoperative complication;postoperative period;preoperative evaluation;priority journal;septicemia;surgical infection,"Hudson, K. A.;Greene, J. G.",2015,,,0,
1917,End of life content in geriatric textbooks: What is the current situation?,"Background: Physicians caring for elderly people encounter death and dying more frequently than their colleagues in most other disciplines. Therefore we sought to examine the end-of-life content in popular geriatric textbooks and determine their usefulness in helping geriatricians manage patients at the end of their lives. Methods: Five popular geriatric textbooks were chosen. Chapters on Alzheimer's disease, stroke, chronic heart failure, chronic obstructive pulmonary disease and lung cancer were examined because of their high mortality rates among the elderly patients. Text relevant to end-of-life care was highlighted. Two reviewers independently coded text into 10 pre specified domains and rated them for the presence of end-of-life information. Content was rated as absent, minimally helpful, or helpful. The proportion of helpful information was calculated. Results: The textbook with the best end-of-life coverage contained 38% helpful information, the worst had only 15% helpful information. Minimally helpful information ranged from 24% to 50%. As much as 61% of the content in one textbook contained no helpful information at all. Of the ten domains, epidemiology, disease progression and prognostic factors were fairly well covered. Information on advance care planning, ethical issues, decision making and effects of death and dying on patient's family were generally lacking under the individual diseases though they were covered as general topics in other parts of the textbooks. All except one textbook dedicated a chapter to the care of the dying. Conclusion: This study showed that end-of-life content in geriatric textbooks differed significantly. Most of the textbooks lack good coverage on end-of-life care and more can be done to improve on this. © 2006 Wu et al; licensee BioMed Central Ltd.",Alzheimer disease;article;chronic obstructive lung disease;death education;disease course;ethics;geriatric care;heart failure;lung cancer;medical decision making;medical information;mortality;patient care planning;prognosis;cerebrovascular accident,"Huei, Y. W.;Malik, F. A.;Higginson, I. J.",2006,,,0,
1918,Marc Cluzel,,amyloid beta protein antibody;aging;Alzheimer disease;cardiovascular disease;drug indication;drug industry;drug research;funding;heart infarction;human;licensing;molecular mechanics;note;organizational efficiency;priority journal;teamwork,"Hughes, B.",2010,,,0,
1919,Trend towards increased cardiovascular event rate in women on HRT in US study,,conjugated estrogen;estrogen;medroxyprogesterone;progesterone;atherosclerosis;breast cancer;cardiovascular risk;clinical trial;colorectal cancer;deep vein thrombosis;dementia;heart disease;heart infarction;hormonal therapy;human;long term care;lung embolism;note;osteoporosis;postmenopause;risk assessment;cerebrovascular accident,"Hughes, S.",2000,,,0,
1920,Midlife fruit and vegetable consumption and risk of dementia in later life in Swedish twins,"OBJECTIVE: Diet may be associated with risk of dementia and Alzheimer disease (AD). The authors examined the association between fruit and vegetable consumption in midlife and risk for all types of dementia and AD. METHODS: Participants were 3,779 members of the Swedish Twin Registry who completed a diet questionnaire approximately 30 years before cognitive screening and full clinical evaluation for dementia as part of the study of dementia in Swedish Twins (HARMONY) study. Among the participants, 355 twins were diagnosed with dementia. Among these, 81 twin pairs were discordant for dementia (50 discordant for AD). Data were analyzed with logistic regression for the entire sample using generalized estimating equations to adjust for relatedness of twins and with conditional logistic regression for the co-twin control design. RESULTS: In fully adjusted models, a medium or great proportion of fruits and vegetables in the diet, compared with no or small, was associated with a decreased risk of dementia and AD. This effect was observed among women and those with angina. Similar, but nonsignificant, odds ratios were found in the co-twin control analyses. CONCLUSION: The findings suggest that higher fruit and vegetable consumption may reduce the risk of dementia, especially among women and those with angina pectoris in midlife.","Adult;Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/*prevention & control;Angina Pectoris/complications;Dementia/*prevention & control;*Diet;Diseases in Twins/prevention & control;Female;*Fruit;Humans;Male;Middle Aged;Risk Factors;Sex Characteristics;*Vegetables","Hughes, T. F.;Andel, R.;Small, B. J.;Borenstein, A. R.;Mortimer, J. A.;Wolk, A.;Johansson, B.;Fratiglioni, L.;Pedersen, N. L.;Gatz, M.",2010,May,10.1097/JGP.0b013e3181c65250,0,
1921,Update in prevention of ischaemic stroke,Stroke is a leading cause of death. For many years epidemiological data have identified a number of risk factors for ischaemic stroke. Only recently have clinical trials been conducted to assess the effect of intervention on reducing cerebrovascular disease. We review the current medical and surgical means of stroke prevention in light of the latest information from trials and guidelines.,acetylsalicylic acid;adenosine diphosphate;antihypertensive agent;antilipemic agent;antithrombocytic agent;arachidonic acid;beta adrenergic receptor blocking agent;calcium antagonist;cerivastatin;clopidogrel;dipeptidyl carboxypeptidase inhibitor;dipyridamole;diuretic agent;fibrinogen;hydroxymethylglutaryl coenzyme A reductase inhibitor;indapamide;insulin;lipid;liver enzyme;low density lipoprotein cholesterol;perindopril;placebo;pravastatin;ramipril;simvastatin;thromboxane A2;ticlopidine;tissue plasminogen activator;unindexed drug;warfarin;adult;aged;angioplasty;article;carotid endarterectomy;cause of death;cerebrovascular accident;cerebrovascular disease;clinical study;clinical trial;controlled study;coughing;dementia;depression;electrolyte disturbance;exercise;gastrointestinal symptom;heart infarction;hematologic disease;human;hypertension;immobilization;ischemic heart disease;lifestyle;liver disease;medical information;mortality;myopathy;obesity;physical disability;practice guideline;protective equipment;rash;rhabdomyolysis;rheumatic heart disease;risk factor;smoking;smoking cessation;weight reduction;aspirin;baycol;lipobay,"Hui, A. C. F.;Wong, K. S.",2002,,,0,
1922,Assessment of the role of ageing and non-ageing factors in death from non-communicable diseases based on a cumulative frequency model,"To quantify the effects of ageing and non-ageing factors, a characterization of the effects of ageing, genetic, and exogenous variables on 12 major non-communicable diseases was evaluated using a model assessing cumulative frequency of death and survival by age group from dead and surviving populations based on mortality statistics. Indices (0-1) of the roles of ageing (ARD), genetics (GRD) and exogenous (ERD) variables in deaths due to disease were established, and the sum of ARD, GRD and ERD was 1 (value of each indices was <1). Results showed that ageing plays an important role in death from chronic disease; exogenous factors may contribute more to the pattern of chronic disease than genetic factors (ARD, GRC and ERD were 0.818, 0.058 and 0.124 respectively for all non-communicable diseases). In descending order, ERD for non-communicable diseases were breast cancer, leukaemia, cancer of the cervix uteri and uterus, liver cancer, nephritis and nephropathy, stomach cancer, lung cancer, diabetes, cerebrovascular disease, coronary heart disease, COPD, and Alzheimer's disease, while a smaller ERD indicated a tendency of natural death. An understanding of the aforementioned complex relationships of specific non-communicable diseases will be beneficial in designing primary prevention measures for non-communicable diseases in China.",,"Hui, L.",2017,Aug 15,,0,
1923,Cognitive impairment in heart failure: results from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) randomized trial,"METHODS AND RESULTSWe included 611 patients from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) and assessed cognitive function [Hodkinson Abbreviated Mental Test (AMT)] in relation to severity of HF (NYHA class, NT-proBNP) at baseline and 18 months (n = 382) and effects on hospitalization-free survival and mortality. SCI (i.e. AMT score ? 7) was present in 9.2% of patients at baseline, but only 20% of them had a diagnosis of dementia. Prevalence of SCI remained stable during follow-up. SCI was present at baseline more often in NYHA IV patients compared with NYHA II [odds ratio 2.94; 95% confidence interval (CI) 1.15-7.51, P = 0.025], but it was not related to NT-proBNP levels. SCI was related to higher mortality (hazard ratio 1.53, 95% CI 1.02-2.30, P = 0.04), but not hospitalization-free survival. Changes in HF severity were not significantly related to changes in cognitive function.CONCLUSIONSCI is a frequent, but often unrecognized finding in HF patients, but the influence of HF severity and its changes on cognitive function were less than hypothesized. Trial registration ISRCTN43596477.AIMSUp to 50% of patients with heart failure (HF) may suffer from severe cognitive impairment (SCI), but longitudinal studies are sparse, and effects of changes in HF severity on cognitive function are unknown. Therefore, we assessed the prevalence of SCI in HF patients, its relationship with HF severity, its effects on morbidity and mortality, and the relationship between changes in HF severity and cognitive function.","Angiotensin-Converting Enzyme Inhibitors [therapeutic use];Cognition Disorders [diagnosis] [etiology] [therapy];Exercise Therapy;Heart Failure [complications] [diagnosis] [therapy];Hospitalization;Intelligence Tests;Natriuretic Peptide, Brain [blood];Peptide Fragments [blood];Prevalence;Prospective Studies;Severity of Illness Index;Aged[checkword];Aged, 80 and over[checkword];Humans[checkword];aged;article;clinical assessment;cognition;cognitive defect;congestive heart failure;dementia;disease severity;exercise tolerance;female;heart failure;heart left ventricle ejection fraction;human;major clinical study;male;mortality;priority journal;randomized controlled trial (topic);survival rate;amino terminal pro brain natriuretic peptide/ec [Endogenous Compound];aged;confidence interval;congestive heart failure;diagnosis;follow up;hazard ratio;heart left ventricle ejection fraction;hospitalization;human;longitudinal study;mental test;morbidity;New York Heart Association class;patient;prevalence;risk;survival;therapy;natriuretic factor;Sr-dementia","Huijts, M;Oostenbrugge, Rj;Duits, A;Burkard, T;Muzzarelli, S;Maeder, Mt;Schindler, R;Pfisterer, Me;Brunner-La, Rocca Hp",2013,,10.1093/eurjhf/hft020,0,
1924,Cognitive impairment in heart failure: results from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) randomized trial,"AIMS: Up to 50% of patients with heart failure (HF) may suffer from severe cognitive impairment (SCI), but longitudinal studies are sparse, and effects of changes in HF severity on cognitive function are unknown. Therefore, we assessed the prevalence of SCI in HF patients, its relationship with HF severity, its effects on morbidity and mortality, and the relationship between changes in HF severity and cognitive function. METHODS AND RESULTS: We included 611 patients from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) and assessed cognitive function [Hodkinson Abbreviated Mental Test (AMT)] in relation to severity of HF (NYHA class, NT-proBNP) at baseline and 18 months (n = 382) and effects on hospitalization-free survival and mortality. SCI (i.e. AMT score ? 7) was present in 9.2% of patients at baseline, but only 20% of them had a diagnosis of dementia. Prevalence of SCI remained stable during follow-up. SCI was present at baseline more often in NYHA IV patients compared with NYHA II [odds ratio 2.94; 95% confidence interval (CI) 1.15-7.51, P = 0.025], but it was not related to NT-proBNP levels. SCI was related to higher mortality (hazard ratio 1.53, 95% CI 1.02-2.30, P = 0.04), but not hospitalization-free survival. Changes in HF severity were not significantly related to changes in cognitive function. CONCLUSION: SCI is a frequent, but often unrecognized finding in HF patients, but the influence of HF severity and its changes on cognitive function were less than hypothesized. Trial registration ISRCTN43596477.","Angiotensin-Converting Enzyme Inhibitors [therapeutic use];Cognition Disorders [diagnosis] [etiology] [therapy];Exercise Therapy;Heart Failure [complications] [diagnosis] [therapy];Hospitalization;Intelligence Tests;Natriuretic Peptide, Brain [blood];Peptide Fragments [blood];Prevalence;Prospective Studies;Severity of Illness Index;Aged[checkword];Aged, 80 and over[checkword];Humans[checkword];Sr-dementia","Huijts, M.;Oostenbrugge, R. J.;Duits, A.;Burkard, T.;Muzzarelli, S.;Maeder, M. T.;Schindler, R.;Pfisterer, M. E.;Brunner-La Rocca, H. P.",2013,,10.1093/eurjhf/hft020,0,1923
1925,The Impact of Chronic Glycogen Synthase Kinase-3 Inhibition on Remodeling of Normal and Pre-Diabetic Rat Hearts,"PURPOSE: There is an ongoing search for new drugs and drug targets to treat diseases like Alzheimer's disease, cancer and type 2 diabetes (T2D). Both obesity and T2D are characterized by the development of a cardiomyopathy associated with increased hypertension and compensatory left ventricular hypertrophy. Small, specific glycogen synthase kinase-3 (GSK-3) inhibitors were developed to replace lithium chloride for use in psychiatric disorders. In addition, they were advocated as treatment for T2D since GSK-3 inhibition improves blood glucose handling. However, GSK-3 is a regulator of hypertrophic signalling in the heart via phosphorylation of NFATc3 and beta-catenin respectively. In view of this, we hypothesized that chronic inhibition of GSK-3 will induce myocardial hypertrophy or exacerbate existing hypertrophy. METHODS: Rats with obesity-induced prediabetes were treated orally with GSK-3 inhibitor (CHIR118637 (CT20026)), 30 mg/kg/day for the last 8 weeks of a 20-week diet high in sugar content vs a control diet. Biometric and biochemical parameters were measured, echocardiography performed and localization and co-localization of NFATc3 and GATA4 determined in cardiomyocytes. RESULTS: Obesity initiated myocardial hypertrophy, evidenced by increased ventricular mass (1.158 +/- 0.029 vs 0.983 +/- 0.03 g) and enlarged cardiomyocytes (18.86 +/- 2.25 vs 14.92 +/- 0.50um(2)) in association with increased end-diastolic diameter (EDD = 8.48 +/- 0.11 vs 8.15 +/- 0.10 mm). GSK-3 inhibition (i) increased ventricular mass only in controls (1.075 +/- 0.022 g) and (ii) EDD in both groups (controls: 8.63 +/- 0.07; obese: 8.72 +/- 0.15 mm) (iii) localized NFATc3 and GATA4 peri-nuclearly. CONCLUSION: Indications of onset of myocardial hypertrophy in both control and obese rats treated with a GSK-3 inhibitor were found. It remains speculation whether these changes were adaptive or maladaptive.",Cardiac hypertrophy;Gata4;Gsk-3;NFATc3;Pre-diabetes,"Huisamen, B.;Hafver, T. L.;Lumkwana, D.;Lochner, A.",2016,Jun,10.1007/s10557-016-6665-2,0,
1926,Family history of neurodegenerative and vascular diseases in ALS: a population-based study,"OBJECTIVE: To determine whether the frequency of Parkinson disease (PD), dementia, and vascular diseases in relatives of patients with amyotrophic lateral sclerosis (ALS) differs from the frequency of those diseases in relatives of controls, providing further information about the association between these diseases. METHODS: We studied the occurrence of neurodegenerative and vascular diseases in families of patients with ALS in a prospective, population-based, case-control study in the Netherlands between 2006 and 2009, using the recurrence risk lambda. Family history data were obtained by asking participants to fill in questionnaires. RESULTS: A total of 635 patients and 1,616 controls were included. The frequency of dementia was mildly increased only among parents and siblings of patients with sporadic ALS (lambda1.32; 95 confidence interval [CI] 1.10-1.59), not among grandparents, or aunts and uncles. The risk of PD was not elevated (any relative: lambda 0.91; 95% CI 0.70-1.17). Among relatives of patients with familial ALS, no significantly increased risk of neurodegenerative diseases was found. A reduced risk of vascular diseases was found in relatives of patients with sporadic ALS (stroke: lambda 0.90; 95% CI 0.80-1.01 and myocardial infarction: lambda 0.86; 95% CI 0.79-0.94), and in relatives of patients with familial ALS (stroke: lambda 0.88; 95% CI 0.61-1.27 and myocardial infarction: lambda 0.61; 95% CI 0.43-0.86). CONCLUSIONS: This large, prospective, population-based study showed that familial aggregation of ALS, dementia, and PD is substantially lower than previously thought. The lowered risk of vascular diseases in relatives of patients with ALS supports the view that a beneficial vascular risk profile increases ALS susceptibility.",Aged;Amyotrophic Lateral Sclerosis/*epidemiology;Case-Control Studies;Community Health Planning;*Family Health;Female;Humans;Linear Models;Male;Middle Aged;Netherlands;Neurodegenerative Diseases/*epidemiology;Retrospective Studies;Vascular Diseases/*epidemiology,"Huisman, M. H.;de Jong, S. W.;Verwijs, M. C.;Schelhaas, H. J.;van der Kooi, A. J.;de Visser, M.;Veldink, J. H.;van den Berg, L. H.",2011,Oct 4,10.1212/WNL.0b013e318231530b,0,
1927,Coronary artery disease is associated with Alzheimer disease neuropathology in APOE4 carriers,,"Aged, 80 and over;Alleles;Alzheimer Disease/*complications/*genetics/pathology;Aortic Diseases/complications/genetics;Apolipoprotein E4/*genetics;Atherosclerosis/complications/genetics;Brain/pathology;Cardiomegaly/complications/genetics/pathology;Comorbidity;Coronary Disease/*complications/genetics;Female;Genetic Predisposition to Disease;Genotype;Heart Ventricles/pathology;Humans;Male;Neurofibrillary Tangles;Organ Size;Plaque, Amyloid;Severity of Illness Index","Hulette, C. M.;Welsh-Bohmer, K.",2007,Feb 6,10.1212/01.wnl.0000256286.78188.dd,0,
1928,Coronary artery disease is associated with Alzheimer disease neuropathology in APOE4 carriers 1,,apolipoprotein E4;smooth muscle actin;Alzheimer disease;aorta valve disease;coronary artery disease;disease association;genetic association;heart muscle contractility;heart muscle ischemia;heart muscle perfusion;heterozygote;human;letter;mitral valve disease;neuropathology;priority journal,"Hulette, C. M.;Welsh-Bohmer, K.",2007,,,0,
1929,Deriving consumer-facing disease concepts for family health histories using multi-source sampling,"The family health history has long been recognized as an effective way of understanding individuals' susceptibility to familial disease; yet electronic tools to support the capture and use of these data have been characterized as inadequate. As part of an ongoing effort to build patient-facing tools for entering detailed family health histories, we have compiled a set of concepts specific to familial disease using multi-source sampling. These concepts were abstracted by analyzing family health history data patterns in our enterprise data warehouse, collection patterns of consumer personal health records, analyses from the local state health department, a healthcare data dictionary, and concepts derived from genetic-oriented consumer education materials. Collectively, these sources yielded a set of more than 500 unique disease concepts, represented by more than 2500 synonyms for supporting patients in entering coded family health histories. We expect that these concepts will be useful in providing meaningful data and education resources for patients and providers alike. © 2010 Elsevier Inc.",allergy;Alzheimer disease;article;asthma;breast cancer;cataract;colorectal cancer;consumer health information;coronary artery disease;depression;diabetes mellitus;disease predisposition;emphysema;epilepsy;familial disease;family health;family history;glaucoma;health care organization;heart disease;heart infarction;hepatitis;human;Human immunodeficiency virus infection;hypercholesterolemia;hypertension;kidney disease;lung cancer;medical record;neoplasm;non insulin dependent diabetes mellitus;obesity;osteoporosis;ovary cancer;patient education;priority journal;prostate cancer;rheumatic fever;sampling;stomach disease;cerebrovascular accident;thyroid disease;tuberculosis;ulcerative colitis,"Hulse, N. C.;Wood, G. M.;Haug, P. J.;Williams, M. S.",2010,,,0,
1930,Risk and cause of death in patients diagnosed with Myeloproliferative Neoplasms in Sweden between 1973 and 2005: A population-based study,"Purpose Myeloproliferative neoplasms (MPNs) are associated with a shortened life expectancy. We assessed causes of death in patients with MPN and matched controls using both relative risks and absolute probabilities in the presence of competing risks. Patients and Methods From Swedish registries, we identified 9,285 patients with MPN and 35,769 matched controls. A flexible parametric model was used to estimate cause-specific hazard ratios (HRs) of death and cumulative incidence functions, each with 95% CIs. Results In patients with MPN, the HRs of death from hematologic malignancies and infections were 92.8 (95% CI, 70.0 to 123.1) and 2.7 (95% CI, 2.4 to 3.1), respectively. In patients age 70 to 79 years at diagnosis (the largest patient group), the HRs of death from cardiovascular and cerebrovascular disease were 1.5 (95% CI, 1.4 to 1.7) and 1.5 (95% CI, 1.3 to 1.8), respectively; all were statistically significantly elevated compared with those of controls. In the same age group, no difference was observed in the 10-year probability of death resulting from cardiovascular disease in patients with MPN versus controls (16.8% v 15.2%) or cerebrovascular disease (5.6% v 5.2%). In patients age 50 to 59 years at diagnosis, the 10-year probability of death resulting from cardiovascular and cerebrovascular disease was elevated, 4.2% versus 2.1% and 1.9% versus 0.4%, respectively. Survival in patients with MPN increased over time, mainly because of decreased probabilities of dying as a result of hematologic malignancies, infections, and, in young patients, cardiovascular disease. Conclusion Patients with MPN had an overall higher mortality rate than that of matched controls, primarily because of hematologic malignancy, infections, and vascular events in younger patients. Evidently, there is still a need for effective disease-modifying agents to improve patient outcomes.",adult;aged;article;cancer incidence;cancer mortality;cancer risk;cancer survival;cardiovascular disease;cardiovascular mortality;cause of death;cerebrovascular disease;congestive heart failure;controlled study;dementia;female;groups by age;heart arrhythmia;hematologic malignancy;human;infection;life expectancy;lung disease;major clinical study;male;middle aged;myelodysplastic syndrome;myelofibrosis;myeloproliferative neoplasm;population research;priority journal;risk assessment;solid tumor;Sweden;vein thrombosis,"Hultcrantz, M.;Wilkes, S. R.;Kristinsson, S. Y.;Andersson, T. M. L.;Derolf, A. R.;Eloranta, S.;Samuelsson, J.;Landgren, O.;Dickman, P. W.;Lambert, P. C.;Björkholm, M.",2015,,,0,
1931,The future of healthcare and the pharmaceutical industry - A CEO view,"In the century or so since the birth of the research-based pharmaceutical industry, there has never been a more demanding time. The most pressing issue facing virtually all big pharmaceutical companies today is research and development productivity. Despite huge investments in research and development, the number of new medicines cleared for market has declined. On the other hand, there has never been a more exciting time to do healthcare research. New sciences and technologies are opening up radically new perspectives and opportunities for the future. Medical practice is undergoing a historic shift towards more personalized medicine. Over the next 10 years we can expect significant progress in the treatment of major diseases. © 2004 WPMH GmbH. Published by Elsevier Ireland Ltd.",trastuzumab;Alzheimer disease;antibiotic resistance;breast cancer;neoplasm;cancer diagnosis;drug industry;drug marketing;drug research;genomics;health care;health care delivery;health care need;heart failure;human;Human immunodeficiency virus infection;investment;life expectancy;malaria;mammography;medical practice;pharmacogenomics;priority journal;quality of life;rheumatic disease;risk factor;severe acute respiratory syndrome;short survey,"Humer, F. B.",2004,,,0,
1932,Predictors of subjective cognitive difficulties in older adults with atherosclerotic vascular disease,"OBJECTIVE: The objective of this study was to describe the relationship among cognitive test performance, psychological symptoms, and subjective cognitive difficulties in older adults with atherosclerotic vascular disease. METHOD: Participants were 80 adults over the age of 55 with an unequivocal diagnosis of atherosclerotic vascular disease. Participants completed measures of neuropsychological functioning, psychological symptoms, and two measures of subjective cognitive difficulties. RESULTS: Psychological symptoms were most strongly associated with higher levels of reported cognitive difficulties. Overall neuropsychological functioning was modestly related to subjective cognitive difficulties but did not remain significant after controlling for psychological symptoms. CONCLUSIONS: In this sample of older adults with atherosclerotic vascular disease, self-reported cognitive difficulties were most strongly related to overall level of psychological distress and not to actual cognitive test scores. Therefore, psychological factors may play an important role in the phenomenon of self-perceived cognitive decline in geriatric populations.","Aged;Aged, 80 and over;Awareness;Cognition Disorders/*diagnosis/psychology;Coronary Disease/psychology;Dementia, Vascular/*diagnosis/psychology;Female;Humans;Intracranial Arteriosclerosis/*diagnosis/psychology;Longitudinal Studies;Male;Mental Disorders/diagnosis/psychology;Middle Aged;*Neuropsychological Tests/statistics & numerical data;Personality Inventory/statistics & numerical data;Psychometrics;Reference Values;*Self Disclosure;Statistics as Topic","Humphreys, C. T.;Moser, D. J.;Hynes, S. M.;Reese, R. L.;Haynes, W. G.",2007,Apr,10.1097/01.JGP.0000246868.32129.d5,0,
1933,Representativeness of patients enrolled in infl uential clinical trials: A comparison of substance dependence with other medical disorders,"Objective: The purpose of this study was to determine whether randomized trials of treatments for substance dependence differ from those for other medical disorders on quality of enrollment information reporting and sample representativeness. Method: Twenty highly cited clinical trials (publication date 2002-2010) of treatments for each of 14 prevalent disorders were identifi ed by structured literature search. The disorders were alcohol dependence, drug dependence, nicotine dependence, Alzheimer's disease, breast cancer, colorectal cancer, chronic obstructive pulmonary disease, depression, diabetes, HIV/AIDS, hypertension, ischemic heart disease, lung cancer, and schizophrenia. The 280 clinical trials were coded for number of individuals screened for eligibility, number of screened individuals meeting eligibility criteria, and number of eligible individuals refusing to participate. Results: Substance-dependence treatment trials were signifi cantly more likely to track and report enrollment information (75% vs. 45% of clinical trials for other disorders, p <.001). Substance-dependence trials did not differ from trials focused on other disorders on mean rate of non-enrollment. Across disorders, the primary driver of non-enrollment appeared to be clinical trial exclusion criteria rather than eligible patients refusing to enroll. Conclusions: Relative to other disorders, trials in the substancedependence fi eld do a better (although imperfect) job of tracking and reporting enrollment information. Low enrollment rates and unrepresentative samples are not challenges unique to treatment outcome studies in the substance-dependence fi eld. Across a range of disorders, clinical trials that use eligibility criteria judiciously are more likely to produce fi ndings that generalize to front-line clinical practice than are trials that restrict enrollment to a small and unrepresentative subset of patients.",addiction;article;human;methodology;patient selection;randomized controlled trial (topic);refusal to participate;treatment outcome,"Humphreys, K.;Maisel, N. C.;Blodgett, J. C.;Finney, J. W.",2013,,,0,
1934,"Extent and reporting of patient nonenrollment in influencial randomized clinical trials, 2002 to 2010",,acquired immune deficiency syndrome;alcoholism;Alzheimer disease;article;breast cancer;chronic obstructive lung disease;clinical practice;colorectal cancer;depression;diabetes mellitus;drug dependence;external validity;human;hypertension;ischemic heart disease;lung cancer;medical literature;priority journal;publication;randomized controlled trial (topic);research subject;schizophrenia;tobacco dependence,"Humphreys, K.;Maisel, N. C.;Blodgett, J. C.;Fuh, I. L.;Finney, J. W.",2013,,,0,
1935,Hormone replacement therapy in the older adult,"The growth in information about hormone replacement therapy (HRT) over the past few years has been impressive. This review summarizes the latest information on HRT and cardiovascular disease, osteoporotic fractures, and cognitive function. The risks of HRT (e.g., stroke, breast cancer, and venous thromboembolism) clearly outweigh the benefits (e.g., reduction in osteoporotic fractures). The use of HRT for primary or secondary prevention of coronary heart disease or to decrease the risk of cognitive dyfunction is also not supported. While the evidence in older adults is substantial, there is some controversy regarding the effectiveness of HRT initiated in women at the start of menopause.",alpha tocopherol;ascorbic acid;conjugated estrogen plus medroxyprogesterone acetate;estradiol;estradiol valerate;estrogen;gestagen;placebo;artery intima proliferation;artery reocclusion;article;atherosclerosis;bone density;breast cancer;cancer risk;cardiovascular disease;cardiovascular risk;cause of death;clinical trial;cognitive defect;dementia;female;geriatric care;heart death;heart reinfarction;hip fracture;hormone substitution;human;ischemic heart disease;lung embolism;meta analysis;Mini Mental State Examination;morbidity;mortality;postmenopause;postmenopause osteoporosis;primary prevention;risk assessment;risk benefit analysis;risk reduction;safety;secondary prevention;cerebrovascular accident;women's health,"Humphries, K. H.;McElhaney, J.",2006,,,0,
1936,Self-monitoring and self-titration of antihypertensive medications result in better systolic blood pressure control,"Objective. To examine the effect of self-monitoring of blood pressure and self-titration of antihypertensive medications among hypertensive patients with cardiovascular disease, diabetes, or chronic kidney disease. Design. Unblinded randomized controlled trial. Setting and participants. The study was conducted in central and east England. Patients with poorly controlled blood pressure with a last recorded systolic blood pressure of at least 145 mm Hg at 59 UK primary care practices were invited to participate. Patients had to be at least 35 years old and have at least 1 of the following comorbidities: transient ischemic attack or stroke, stage 3 chronic kidney disease, or history of coronary artery bypass graft surgery, myocardial infarction, or angina. Patients were excluded if they could not self-monitor blood pressure, had dementia or failed a cognitive screen using the short-orientation memory concentration test, had postural hypotension, took more than 3 antihypertensive medications, had an acute cardiovascular event within the previous 3 months, were receiving care from a specialist for their hypertension, were pregnant, or had a terminal disease. Participants were randomized to the self-management intervention or usual care. Intervention. Patients in the self-management group were asked to monitor their blood pressure using an automated blood pressure monitor and to titrate their blood pressure medications using an individualized 3-step plan devised by the patient with their family physician. They were trained to do these tasks in 2- or 3-hour sessions. Patients were instructed to take their blood pressure twice each morning for the first week of each month; if 4 or more blood pressure readings during the measurement week for 2 consecutive months were higher than the target blood pressure, patients were to follow their individualized plan to change their medications. The target blood pressure was 120/75 mm Hg, following British guidelines for patients with stroke, diabetes, chronic kidney disease, or coronary heart disease. If patients exhausted all 3 steps for medication titration, they were to return to their family physician for additional instructions. Patients in the usual care group had a routine blood pressure check and medication review appointment with their family physician, which was followed by follow-up care at the discretion of the family physician for blood pressure measurement, blood pressure targets, or adjustment of medication. Main outcome measure. The primary outcome was systolic blood pressure at 12 months. The difference in outcomes between the intervention and usual care groups was examined while accounting for baseline blood pressure and other clinical factors. 6 blood pressures were taken at 1-minute intervals after an initial 5 minutes of rest. Blood pressure was taken by an electronic automated blood pressure machine. The mean of the second and third readings were used as primary outcome. Outcome assessor was not blinded to group assignment. The primary analysis included all cases with complete data, and a sensitivity analysis with multiple imputations was also performed. Preplanned subgroup analyses included older vs. younger age-groups, men vs. women, and other risk groups. Main results. Among 10,764 patients assessed for eligibility, 3353 were excluded as they were considered by their family physician to be housebound, have a terminal illness, or not be a suitable candidate. Among the 7411 invited to participate, 4207 did not respond to the invitation and 2003 declined participation (with a third who did not want to alter their own medications, and a third who did not want to measure their own blood pressure). Among the 1201 who attended the baseline clinic, 138 withdrew their consent and 508 were deemed ineligible. A total of 555 were randomized, and 220 in the intervention group and 230 in the control group completed the study and provided outcome data (81%). Patients in the self-management group had a 9.2 mm Hg-lower systolic blood pressure at 12 months (95% CI, 5.7-12.7) compa ed with the usual care group. The self-management group also had a larger increase in the intake of antihypertensive drugs compared with controls, with an increase in both doses and number of medications. Although adverse symptoms were common in both groups, there were no significant differences in adverse symptoms between groups. Conclusions. Self-management of hypertension among patients with stroke, cardiovascular disease, and other high-risk conditions is safe and effective in achieving better blood pressure control. Copyright 2014 by Turner White Communications Inc., Wayne, PA. All rights reserved.",adult;angina pectoris;blood pressure monitoring;blood pressure regulation;cardiovascular disease;cerebrovascular accident;chronic kidney disease;comorbidity;controlled study;coronary artery bypass graft;diabetes mellitus;drug dose titration;heart infarction;human;hypertension/dt [Drug Therapy];major clinical study;randomized controlled trial;review;self care;self concept;self monitoring;systolic blood pressure;titrimetry;transient ischemic attack;United Kingdom;antihypertensive agent/ct [Clinical Trial];antihypertensive agent/dt [Drug Therapy];blood pressure;blood pressure measurement;blood pressure monitor;control group;dementia;drug therapy;female;follow up;general practitioner;groups by age;high risk population;hospital;hypertension;interpersonal communication;ischemic heart disease;machine;male;medical specialist;memory;orthostatic hypotension;patient;patient history of coronary artery bypass graft;primary medical care;reading;risk;sensitivity analysis;surgery;systolic blood pressure;terminal disease;antihypertensive agent;Sr-htn,"Hung, W",2014,,,0,
1937,"A prospective study of symptoms, function, and medication use during acute illness in nursing home residents: design, rationale and cohort description","BACKGROUND: Nursing home residents are at high risk for developing acute illnesses. Compared with community dwelling adults, nursing home residents are often more frail, prone to multiple medical problems and symptoms, and are at higher risk for adverse outcomes from acute illnesses. In addition, because of polypharmacy and the high burden of chronic disease, nursing home residents are particularly vulnerable to disruptions in transitions of care such as medication interruptions in the setting of acute illness. In order to better estimate the effect of acute illness on nursing home residents, we have initiated a prospective cohort which will allow us to observe patterns of acute illnesses and the consequence of acute illnesses, including symptoms and function, among nursing home residents. We also aim to examine the patterns of medication interruption, and identify patient, provider and environmental factors that influence continuity of medication prescribing at different points of care transition. METHODS: This is a prospective cohort of nursing home residents residing in two nursing homes in a metropolitan area. Baseline characteristics including age, gender, race, and comorbid conditions are recorded. Participants are followed longitudinally for a planned period of 3 years. We record acute illness incidence and characteristics, and measure symptoms including depression, pain, withdrawal symptoms, and function using standardized scales. RESULTS: 76 nursing home residents have been followed for a median of 666 days to date. At baseline, mean age of residents was 74.4 (+/- 11.9); 32% were female; 59% were white. The most common chronic conditions were dementia (41%), depression (38%), congestive heart failure (25%) and chronic obstructive lung disease (27%). Mean pain score was 4.7 (+/- 3.6) on a scale of 0 to 10; Geriatric Depression Scale (GDS-15) score was 5.2 (+/- 4.4). During follow up, 138 acute illness episodes were identified, for an incidence of 1.5 (SD 2.0) episodes per resident per year; 74% were managed in the nursing home and 26% managed in the acute care setting. CONCLUSION: In this report, we describe the conceptual model and methods of designing a longitudinal cohort to measure acute illness patterns and symptoms among nursing home residents, and describe the characteristics of our cohort at baseline. In our planned analysis, we will further estimate the effect of the use and interruption of medications on withdrawal and relapse symptoms and illness outcomes.","Acute Disease;Aged;Aged, 80 and over;Analgesics, Opioid/*therapeutic use;Antidepressive Agents/*therapeutic use;Antipsychotic Agents/*therapeutic use;Cohort Studies;Female;Follow-Up Studies;*Homes for the Aged/trends;Humans;Male;Middle Aged;*Nursing Homes/trends;Prospective Studies;Research Design;*Severity of Illness Index","Hung, W. W.;Liu, S.;Boockvar, K. S.",2010,Jul 14,10.1186/1471-2318-10-47,0,
1938,"90-day mortality after 409 096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: A retrospective analysis","Background Death within 90 days after total hip replacement is rare but might be avoidable dependent on patient and treatment factors. We assessed whether a secular decrease in death caused by hip replacement has occurred in England and Wales and whether modifiable perioperative factors exist that could reduce deaths. Methods We took data about hip replacements done in England and Wales between April, 2003, and December, 2011, from the National Joint Registry for England and Wales. Patient identifiers were used to link these data to the national mortality database and the Hospital Episode Statistics database to obtain details of death, sociodemographics, and comorbidity. We assessed mortality within 90 days of operation by Kaplan-Meier analysis and assessed the role of patient and treatment factors by Cox proportional hazards model. Findings 409 096 primary hip replacements were done to treat osteoarthritis. 1743 patients died within 90 days of surgery during 8 years, with a substantial secular decrease in mortality, from 0·56% in 2003 to 0·29% in 2011, even after adjustment for age, sex, and comorbidity. Several modifiable clinical factors were associated with decreased mortality according to an adjusted model: posterior surgical approach (hazard ratio [HR] 0·82, 95% CI 0·73-0·92; p=0·001), mechanical thromboprophylaxis (0·85, 0·74-0·99; p=0·036), chemical thromboprophylaxis with heparin with or without aspirin (0·79, 0·66-0·93; p=0·005), and spinal versus general anaesthetic (0·85, 0·74-0·97; p=0·019). Type of prosthesis was unrelated to mortality. Being overweight was associated with lower mortality (0·76, 0·62-0·92; p=0·006). Interpretation Postoperative mortality after hip joint replacement has fallen substantially. Widespread adoption of four simple clinical management strategies (posterior surgical approach, mechanical and chemical prophylaxis, and spinal anaesthesia) could, if causally related, reduce mortality further.",acetylsalicylic acid;heparin;article;cerebrovascular disease;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;female;heart infarction;hemiplegia;hip arthroplasty;hip osteoarthritis;human;liver disease;major clinical study;male;obesity;observational study;paraplegia;peptic ulcer;peripheral vascular disease;priority journal;retrospective study;rheumatic disease;surgical mortality;thrombosis;thrombosis prevention;total hip prosthesis;United Kingdom;aspirin,"Hunt, L. P.;Ben-Shlomo, Y.;Clark, E. M.;Dieppe, P.;Judge, A.;MacGregor, A. J.;Tobias, J. H.;Vernon, K.;Blom, A. W.",2013,,,0,
1939,Comparison of survival analysis and palliative care involvement in patients aged over 70 years choosing conservative management or renal replacement therapy in advanced chronic kidney disease,"Background: There are limited data on the outcomes of elderly patients with chronic kidney disease undergoing renal replacement therapy or conservative management. Aims: We aimed to compare survival, hospital admissions and palliative care access of patients aged over 70 years with chronic kidney disease stage 5 according to whether they chose renal replacement therapy or conservative management. Design: Retrospective observational study. Setting/participants: Patients aged over 70 years attending pre-dialysis clinic. Results: In total, 172 patients chose conservative management and 269 chose renal replacement therapy. The renal replacement therapy group survived for longer when survival was taken from the time estimated glomerular filtration rate <20 mL/min (p < 0.0001), <15 mL/min (p < 0.0001) and <12 mL/min (p = 0.002). When factors influencing survival were stratified for both groups independently, renal replacement therapy failed to show a survival advantage over conservative management, in patients older than 80 years or with a World Health Organization performance score of 3 or more. There was also a significant reduction in the effect of renal replacement therapy on survival in patients with high Charlson's Comorbidity Index scores. The relative risk of an acute hospital admission (renal replacement therapy vs conservative management) was 1.6 (p < 0.05; 95% confidence interval = 1.14-2.13). A total of 47% of conservative management patients died in hospital, compared to 69% undergoing renal replacement therapy (Renal Registry data). Seventy-six percent of the conservative management group accessed community palliative care services compared to 0% of renal replacement therapy patients. Conclusions: For patients aged over 80 years, with a poor performance status or high co-morbidity scores, the survival advantage of renal replacement therapy over conservative management was lost at all levels of disease severity. Those accessing a conservative management pathway had greater access to palliative care services and were less likely to be admitted to or die in hospital. © The Author(s) 2013.",aged;article;cause of death;Charlson Comorbidity Index;chronic kidney disease;chronic lung disease;controlled study;dementia;diabetes mellitus;elderly care;geriatric disorder;glomerulus filtration rate;heart failure;hospital admission;human;hypertension;major clinical study;observational study;palliative therapy;renal replacement therapy;retrospective study;risk factor;survival,"Hussain, J. A.;Mooney, A.;Russon, L.",2013,,,0,
1940,New drugs of 1997,"OBJECTIVE: To provide information regarding the most important properties of the new therapeutic agents marketed in 1997. DATA SOURCES: Published studies, drug information reference sources, and product labeling. DATA SYNTHESIS: A record-setting number of 45 new therapeutic agents were marketed in 1997. The indications and information on dosage and administration for each new agent are reviewed, as are the most important pharmacokinetic properties, adverse events, drug interactions, and other precautions. Practical considerations for the use of the new agents are also discussed. Where possible, the properties of the new drugs are compared with those of older drugs marketed for the same indications. CONCLUSION: A number of the new therapeutic agents marketed in 1997 have important advantages over older medications. An understanding of the properties of these agents is important for the pharmacist to effectively counsel patients about their use and to serve as a valuable source of information for other health professionals regarding these drugs.",analgesic agent;antihypertensive agent;antiinfective agent;antineoplastic agent;drug;fibrinolytic agent;neuroleptic agent;Alzheimer disease;article;congestive heart failure;drug approval;drug therapy;food and drug administration;human;United States,"Hussar, D. A.",1998,,,0,
1941,Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes,"BACKGROUND: Despite safety-related concerns, psychotropic medications are frequently prescribed to manage behavioural symptoms in older adults, particularly those with dementia. We assessed the comparative safety of different classes of psychotropic medications used in nursing home residents. METHODS: We identified a cohort of patients who were aged 65 years or older and had initiated treatment with psychotropics after admission to a nursing home in British Columbia between 1996 and 2006. We used proportional hazards models to compare rates of death and rates of hospital admissions for medical events within 180 days after treatment initiation. We used propensity-score adjustments to control for confounders. RESULTS: Of 10,900 patients admitted to nursing homes, atypical antipsychotics were initiated by 1942, conventional antipsychotics by 1902, antidepressants by 2169 and benzodiazepines by 4887. Compared with users of atypical antipsychotics, users of conventional antipsychotics and antidepressants had an increased risk of death (rate ratio [RR] 1.47, 95% confidence interval [CI] 1.14-1.91 for conventional antipsychotics and RR 1.20, 95% CI 0.96-1.50 for antidepressants), and an increased risk of femur fracture (RR 1.61, 95% CI 1.03-2.51 for conventional antipsychotics and RR 1.29, 95% CI 0.86-1.94 for antidepressants). Users of benzodiazepines had a higher risk of death (RR 1.28, 95% CI 1.04-1.58) compared with users of atypical antipsychotics. The RR for heart failure was 1.54 (95% CI 0.89-2.67), and for pneumonia it was 0.85 (95% CI 0.56-1.31). INTERPRETATION: Among older patients admitted to nursing homes, the risks of death and femur fracture associated with conventional antipsychotics, antidepressants and benzodiazepines are comparable to or greater than the risks associated with atypical antipsychotics. Clinicians should weigh these risks against the potential benefits when making prescribing decisions.","Aged;Aged, 80 and over;Antidepressive Agents/adverse effects;Antipsychotic Agents/adverse effects;Benzodiazepines/adverse effects;British Columbia;Cohort Studies;Dementia/drug therapy;Female;Femoral Fractures/epidemiology/etiology;Hospitalization/*statistics & numerical data;Humans;Kaplan-Meier Estimate;Male;Nursing Homes/*statistics & numerical data;Proportional Hazards Models;Psychotropic Drugs/*adverse effects;Risk Factors","Huybrechts, K. F.;Rothman, K. J.;Silliman, R. A.;Brookhart, M. A.;Schneeweiss, S.",2011,Apr 19,10.1503/cmaj.101406,0,
1942,Comparative safety of antipsychotic medications in nursing home residents,"Objectives To compare the risk of major medical events in nursing home residents newly initiated on conventional or atypical antipsychotic medications (APMs). Design Cohort study, using linked Medicaid, Medicare, Minimum Data Set, and Online Survey Certification and Reporting data. Propensity score-adjusted proportional hazards models were used to compare risks for medical events at a class and individual drug level. Setting Nursing homes in 45 U.S. states. Participants Eighty-three thousand nine hundred fifty-nine Medicaid-eligible residents aged 65 and older who initiated APM treatment after nursing home admission in 2001 to 2005. Measurements Hospitalization for myocardial infarction, cerebrovascular events, serious bacterial infections, and hip fracture within 180 days of treatment initiation. Results Risks of bacterial infections (hazard ratio (HR) = 1.25, 95% confidence interval (CI) = 1.05-1.49) and possibly myocardial infarction (HR = 1.23, 95% CI = 0.81-1.86) and hip fracture (HR = 1.29, 95% CI = 0.95-1.76) were higher, and risks of cerebrovascular events (HR = 0.82, 95% CI = 0.65-1.02) were lower in participants initiating conventional APMs than in those initiating atypical APMs. Little variation existed between individual atypical APMs, except for a somewhat lower risk of cerebrovascular events with olanzapine (HR = 0.91, 95% CI = 0.81-1.02) and quetiapine (HR = 0.89, 95% CI = 0.79-1.02) and a lower risk of bacterial infections (HR = 0.83, 95% CI = 0.73-0.94) and possibly a higher risk of hip fracture (HR = 1.17, 95% CI = 0.96-1.43) with quetiapine than with risperidone. Dose-response relationships were observed for all events (HR = 1.12, 95% CI = 1.05-1.19 for high vs low dose for all events combined). Conclusion These associations underscore the importance of carefully selecting the specific APM and dose and monitoring their safety, especially in nursing home residents who have an array of medical illnesses and are undergoing complex medication regimens. © 2012, The American Geriatrics Society.",aripiprazole;atypical antipsychotic agent;chlorpromazine;fluphenazine;haloperidol;neuroleptic agent;olanzapine;perphenazine;quetiapine;risperidone;thioridazine;ziprasidone;aged;article;bacterial infection;dose response;drug safety;female;heart infarction;hip fracture;hospitalization;human;major clinical study;male;nursing home patient;pneumonia;risk assessment;cerebrovascular accident;transient ischemic attack,"Huybrechts, K. F.;Schneeweiss, S.;Gerhard, T.;Olfson, M.;Avorn, J.;Levin, R.;Lucas, J. A.;Crystal, S.",2012,,,0,
1943,Long-term survival in elderly patients hospitalized for heart failure: 14-year follow-up from a prospective randomized trial,"METHODSA cohort of 282 elderly (mean +/- SD age, 79.2 +/- 6.1 years) patients with heart failure were followed for up to 14 years after enrollment in a prospective randomized multidisciplinary disease management trial conducted from 1990 through 1994. Kaplan-Meier survival curves were constructed to assess the probability of survival during the follow-up period. A Cox proportional hazards model was developed to identify independent predictors of long-term survival. C statistics were calculated to assess the utility of the model for predicting mortality at 6 months, 1 year, and 5 years.RESULTSDuring the 14-year follow-up period, 269 patients (95%) died and the median survival was 894 days. Cox analysis identified 7 variables that were independent predictors of shorter survival time: older age (hazard ratio [HR], 1.14 per 5 years; 95% confidence interval [CI], 1.03-1.26), serum sodium level less than 135 mEq/L (HR, 1.67; 95% CI, 1.19-2.32), coronary artery disease (HR 1.51; 95% CI, 1.16-1.95), dementia (HR, 2.02; 95% CI, 1.13-3.61), peripheral vascular disease (HR, 1.74; 95% CI, 1.20-2.52), systolic blood pressure (HR, 0.95 per 10 mm Hg; 95% CI, 0.92-0.98), and serum urea nitrogen level (HR, 1.20 per 10 mg/dL [3.57 mmol/L]; 95% CI, 1.12-1.29). C statistics for the model were 0.84, 0.79, and 0.75 at 6 months, 1 year, and 5 years, respectively. A risk score for mortality was developed using the 7 independent predictor variables. One-year mortality rates among patients with 0 to 1 (n = 89), 2 to 3 (n = 153), and 4 or more (n = 37) risk factors were 9.0%, 22.2%, and 73.0%, respectively (P<.001).CONCLUSIONSAmong elderly patients hospitalized with heart failure, median survival is about 2.5 years. However, there is considerable heterogeneity in survival, with 25% of patients dying within 1 year and 25% surviving for more than 5 years. A simple 7-item risk score, based on data readily available at the time of admission, provides a reliable estimate of prognosis.BACKGROUNDThe growing heart failure epidemic imposes a substantial burden on the US health care system. The ability to accurately assess prognosis would allow clinicians to triage patients to appropriate therapy and to plan the intensity of care following hospital discharge.","Age Factors;Blood Pressure;Blood Urea Nitrogen;Coronary Artery Disease [complications];Dementia [complications];Follow-Up Studies;Heart Failure [complications] [diagnosis] [mortality];Peripheral Vascular Diseases [complications];Prognosis;Risk Factors;Sodium [blood];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Sr-htn: sr-vasc","Huynh, Bc;Rovner, A;Rich, Mw",2006,,10.1001/archinte.166.17.1892,0,
1944,Long-term survival in elderly patients hospitalized for heart failure: 14-year follow-up from a prospective randomized trial,"BACKGROUND: The growing heart failure epidemic imposes a substantial burden on the US health care system. The ability to accurately assess prognosis would allow clinicians to triage patients to appropriate therapy and to plan the intensity of care following hospital discharge. METHODS: A cohort of 282 elderly (mean +/- SD age, 79.2 +/- 6.1 years) patients with heart failure were followed for up to 14 years after enrollment in a prospective randomized multidisciplinary disease management trial conducted from 1990 through 1994. Kaplan-Meier survival curves were constructed to assess the probability of survival during the follow-up period. A Cox proportional hazards model was developed to identify independent predictors of long-term survival. C statistics were calculated to assess the utility of the model for predicting mortality at 6 months, 1 year, and 5 years. RESULTS: During the 14-year follow-up period, 269 patients (95%) died and the median survival was 894 days. Cox analysis identified 7 variables that were independent predictors of shorter survival time: older age (hazard ratio [HR], 1.14 per 5 years; 95% confidence interval [CI], 1.03-1.26), serum sodium level less than 135 mEq/L (HR, 1.67; 95% CI, 1.19-2.32), coronary artery disease (HR 1.51; 95% CI, 1.16-1.95), dementia (HR, 2.02; 95% CI, 1.13-3.61), peripheral vascular disease (HR, 1.74; 95% CI, 1.20-2.52), systolic blood pressure (HR, 0.95 per 10 mm Hg; 95% CI, 0.92-0.98), and serum urea nitrogen level (HR, 1.20 per 10 mg/dL [3.57 mmol/L]; 95% CI, 1.12-1.29). C statistics for the model were 0.84, 0.79, and 0.75 at 6 months, 1 year, and 5 years, respectively. A risk score for mortality was developed using the 7 independent predictor variables. One-year mortality rates among patients with 0 to 1 (n = 89), 2 to 3 (n = 153), and 4 or more (n = 37) risk factors were 9.0%, 22.2%, and 73.0%, respectively (P<.001). CONCLUSIONS: Among elderly patients hospitalized with heart failure, median survival is about 2.5 years. However, there is considerable heterogeneity in survival, with 25% of patients dying within 1 year and 25% surviving for more than 5 years. A simple 7-item risk score, based on data readily available at the time of admission, provides a reliable estimate of prognosis.","Age Factors;Blood Pressure;Blood Urea Nitrogen;Coronary Artery Disease [complications];Dementia [complications];Follow-Up Studies;Heart Failure [complications] [diagnosis] [mortality];Peripheral Vascular Diseases [complications];Prognosis;Risk Factors;Sodium [blood];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Sr-htn: sr-vasc","Huynh, B. C.;Rovner, A.;Rich, M. W.",2006,,10.1001/archinte.166.17.1892,0,1943
1945,Administrative data is as good as medical chart review for comorbidity ascertainment in patients with infections in Singapore,"The Charlson comorbidity index (CCI) is widely used for control of confounding from comorbidities in epidemiological studies. International Classification of Diseases (ICD)-coded diagnoses from administrative hospital databases is potentially an efficient way of deriving CCI. However, no studies have evaluated its validity in infectious disease research. We aim to compare CCI derived from administrative data and medical record review in predicting mortality in patients with infections. We conducted a cross-sectional study on 199 inpatients. Correlation analyses were used to compare comorbidity scores from ICD-coded administrative databases and medical record review. Multivariable regression models were constructed and compared for discriminatory power for 30-day in-hospital mortality. Overall agreement was fair [weighted kappa 0·33, 95% confidence interval (CI) 0·23-0·43]. Kappa coefficient ranged from 0·17 (95% CI 0·01-0·36) for myocardial infarction to 0·85 (95% CI 0·59-1·00) for connective tissue disease. Administrative data-derived CCI was predictive of CCI â5 from medical record review, controlling for age, gender, resident status, ward class, clinical speciality, illness severity, and infection source (C = 0·773). Using the multivariable model comprising age, gender, resident status, ward class, clinical speciality, illness severity, and infection source to predict 30-day in-hospital mortality, administrative data-derived CCI (C = 0·729) provided a similar C statistic as medical record review (C = 0·717, P = 0·8548). In conclusion, administrative data-derived CCI can be used for assessing comorbidities and confounding control in infectious disease research.",acquired immune deficiency syndrome;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled study;correlation analysis;cross-sectional study;data base;decision support system;dementia;diabetes mellitus;disease classification;disease severity;female;heart infarction;hemiplegia;mortality;human;infection;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;medical record;peripheral vascular disease;random sample;risk factor;scoring system;Singapore;solid tumor;ulcer;validity,"Hwang, J.;Chow, A.;Lye, D. C.;Wong, C. S.",2016,,,0,
1946,Long-term statin therapy is associated with better episodic memory in aged familial hypercholesterolemia patients in comparison with population controls,"The cognitive status of aged familial hypercholesterolemia (FH) patients treated with long-term statin therapy was compared with that of population controls. A comprehensive cohort of 43 elderly (age > or = 65 years) patients all with the same FH North Karelia mutation living in North Karelia (eastern Finland) was identified, 37 of whom (aged 65 to 84 years) agreed to participate. All but one of these FH patients had been using statins for approximately 15 years. Population-based controls (aged 65 to 84 years, n= 309) were the participants of the Health 2000 Survey living in eastern Finland. The cognitive assessment was conducted with tests for verbal fluency, Word List Learning (WLL) and Word List Delayed Recall (WLDR) subtests in the Consortium to Establish a Registry for Alzheimer's disease test battery. After adjustment for age, gender, education, diabetes mellitus, and coronary heart disease, FH patients were more likely to be in the top tertile of the WLDR (Odds ratio (OR) 3.40, 95% confidence interval (CI) 1.52-7.63) and WLL3 (OR 2.83, 95% CI 1.28-6.25) subtests. When the FH patients were subdivided according to the median length of their statin therapy, the ORs to be in the top tertile in the WLDR subtest were 1.65 (95% CI 0.52-5.25) for those with less and 5.40 (95% CI 1.74-17.72) in those individuals with more than median length of statin therapy. In conclusion, aged FH patients receiving long-term statin therapy exhibited better episodic memory than population controls, and this association became even more pronounced with longer statin therapy.","Aged;Aged, 80 and over;Aging/*physiology;Cognition/drug effects/physiology;Family Health;Female;Finland;*Health Surveys;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use;Hypercholesterolemia/*drug therapy/genetics;Logistic Models;Male;Mental Recall/*drug effects/physiology;Time Factors","Hyttinen, L.;TuulioHenriksson, A.;Vuorio, A. F.;Kuosmanen, N.;Harkanen, T.;Koskinen, S.;Strandberg, T. E.",2010,,10.3233/jad-2010-091381,0,
1947,"Chronic disease self-management support for persons with dementia, in a clinical setting","The burden of chronic disease is greater in individuals with dementia, a patient group that is growing as the population is aging. The cornerstone of optimal management of chronic disease requires effective patient self-management. However, this is particularly challenging in older persons with a comorbid diagnosis of dementia. The impact of dementia on a person's ability to self-manage his/her chronic disease (eg, diabetes mellitus or heart failure) varies according to the cognitive domain(s) affected, severity of impairment and complexity of self-care tasks. A framework is presented that describes how impairment in cognitive domains (attention and information processing, language, visuospatial ability and praxis, learning and memory and executive function) impacts on the five key processes of chronic disease self-management. Recognizing the presence of dementia in a patient with chronic disease may lead to better outcomes. Patients with dementia require individually tailored strategies that accommodate and adjust to the individual and the cognitive domains that are impaired, to optimize their capacity for self-management. Management strategies for clinicians to counter poor self-management due to differentially impaired cognitive domains are also detailed in the presented framework. Clinicians should work in collaboration with patients and care givers to assess a patient's current capabilities, identify potential barriers to successful self-management and make efforts to adjust the provision of information according to the patient's skill set. The increasing prevalence of age-related chronic illness along with a decline in the availability of informal caregivers calls for innovative programs to support self-management at a primary care level.",chronic disease;cognitive domains;dementia;self-management,"Ibrahim, J. E.;Anderson, L. J.;MacPhail, A.;Lovell, J. J.;Davis, M. C.;Winbolt, M.",2017,,,0,
1948,Hypertrophic cardiomyopathy: A rare case of vascular dementia. A case report,"Herein, we report a case of a 51 year old man who experienced three ischemic cerebral infarcts in a time of few months. The patient consulted after the third accident. Neurological presentation included pseudobulbar syndrome with a mild cognitive deficit, aphasia, left hemiparesia, hemiasomatognosia and homonymous lateral hemianopsia. Cerebral tomodensitometry and magnetic resonance imaging evidenced large infracts images involving right middle cerebral artery territory and bilateral borderline zones in the junction of the territories of the middle and posterior cerebral arteries. Ambulatory 24 hours ECG recording (Holter) revealed two hits of nonsustained ventricular tachycardia. Transoesophageal echocardiography conveyed to the diagnosis of hypertrophic cardiomyopathy and displayed the presence of a left auricular thrombus. Anticoagulant therapy and rehabilitation allowed a substantial recovering of the patient's cognitive functions and wasting of the intracardiac thrombus. The clinical features observed in our patient meet the recommended DSM IV diagnosis criteria of vascular dementia, an exceptional complication of HCM. The clinical findings, neuroimagery investigation results, and the chronological link between cerebral attacks and cognitive function deterioration argue for a demential syndrome of vascular origin resulting from multiple embolic infarcts involving medium sized arteries (mutli-infarct dementia). The authors emphasize the rarity of such observation. HCM must be considered as a potential cause of embolic stroke and likewise a multi-infarct dementia.",amiodarone;anticoagulant agent;antivitamin K;periciazine;adult;ambulatory monitoring;anticoagulant therapy;aphasia;article;brain infarction;brain ischemia;case report;cognitive defect;heart atrium thrombosis;heart rehabilitation;heart ventricle tachycardia;hemianopia;hemiplegia;Holter monitoring;human;hypertrophic cardiomyopathy;male;multiinfarct dementia;neurologic examination;nuclear magnetic resonance imaging;pseudobulbar palsy;radiodensitometry;transesophageal echocardiography;cordarone;neuleptil,"Ibtissem, B. H.;Mohamed Néjib, T.;Mohsen, H.",2002,,,0,
1949,Relation between thyroid and cardiac functions and the geriatric rating scale,"To assess the effects of thyroid hormone and cardiac function on senile dementia, relations between serum thyroid hormone concentrations, hemodynamic parameters and dementia rating scale scores were studied in 83 subjects aged 70 and over. Age and serum-free T3 concentrations had a significantly negative correlation in all subjects and in subjects without dementia, but not when analysed only in dementia subjects. Regarding the genesis of dementia, serum free T3 concentrations and cardiac index were both significantly lower in cerebrovascular dementia than in those without dementia. Moreover, subjects with cerebrovascular dementia showed significantly lower serum free T3 concentrations and cardiac index than those with senile dementia of Alzheimer's type in all age groups. These findings suggest that cognitive function is closely related to serum free T3 and cardiac function in subjects with cerebrovascular dementia and that serum free T3 concentrations may be a good indicator, reflecting health and cognitive status.","Aged;Aged, 80 and over;Alzheimer Disease/*etiology;Cardiac Output, Low/complications;Cardiography, Impedance;Dementia/*etiology;Dementia, Vascular/*etiology;Female;*Geriatric Assessment;Heart Diseases/*complications;Hemodynamics/physiology;Humans;Male;*Neuropsychological Tests;Risk Factors;Thyroid Diseases/*complications;Thyroid Function Tests;Thyroid Hormones/blood","Ichibangase, A.;Nishikawa, M.;Iwasaka, T.;Kobayashi, T.;Inada, M.",1990,Jun,,0,
1950,Disability as a covariate in risk adjustment models for predicting hospital deaths,"Risk-adjusted hospital mortality rates are frequently used as putative indicators of hospital quality. These figures could become increasingly important as efforts escalate to contain U.S. health care costs while simultaneously maintaining or improving quality of care. Most risk adjustment methods today employ coded diagnostic information sometimes supplemented with more detailed clinical data obtained from medical records. This article considers whether risk-adjusted hospital mortality rates should account for baseline patient disability. Accounting for baseline disability when calculating hospital mortality rates makes clinical sense, especially for conditions such as heart failure or coronary artery bypass grafting surgery, where patients' cardiac-related functional status strongly predicts their imminent outcomes. A small body of research suggests the strength of disability in predicting hospital mortality, even in comparison with indicators of acute physiologic status and comorbid illness. However, the feasibility of obtaining complete and accurate data on patients' baseline disability will be challenging and requires further investigation. The risk of not adjusting for baseline disability could be efforts by physicians and hospitals to avoid treating patients with significant disabilities. © 2014 Elsevier Inc.",antineoplastic agent;APACHE;cancer chemotherapy;cerebrovascular accident;chronic obstructive lung disease;clinical research;comorbidity;coronary artery bypass graft;dementia;diabetes mellitus;disability;disease severity;Expanded Disability Status Scale;health hazard;heart failure;heart infarction;hospital;hospital admission;hospitalization;human;hypertension;injury;medical information;mental disease;mortality;multiple sclerosis;neoplasm;note;percutaneous coronary intervention;physician;pneumonia;predictor variable;priority journal;protein calorie malnutrition;risk assessment;risk factor;stroke patient;surgical mortality;transluminal coronary angioplasty,"Iezzoni, L. I.",2014,,,0,
1951,Chronic conditions and risk of in-hospital death,"Objective. This study examined the relationship of in-hospital death and 13 conditions likely to have been present prior to the patient's admission to the hospital, defined using secondary discharge diagnosis codes. Data Sources and Study Setting. 1988 California computerized hospital discharge abstract data, including 24 secondary diagnosis coding slots, from all general, acute care hospitals. Study Design. The odds ratio for in-hospital death associated with each of 13 chronic conditions was computed from a multivariable logistic regression using patient age and all chronic conditions to predict in- hospital death. Data Extraction. All 1,949,276 general medical and surgical admissions of persons over 17 years of age were included. Patients were assigned to four groups according to the mortality rate of their reason for admission; some analyses separated medical and surgical hospitalizations. Principal Findings. Overall mortality was 4.4 percent. For all cases, mortality varied by chronic condition, ranging from 5.3 percent for coronary artery disease to 18.6 percent for nutritional deficiencies. The odds ratios associated with the presence of a chronic condition were generally highest for patients in the rare mortality group. Although chronic conditions were more commonly listed for medical patients, the associated odds ratios were generally higher for surgical patients, particularly in lower mortality groups. Conclusions. Studies examining death rates need to consider the influence of chronic conditions. Chronic conditions had a particularly significant association with the likelihood of death for admission types generally associated with low mortality rates and for surgical hospitalizations. The accuracy and completeness of discharge diagnoses require further study, especially relating to chronic illnesses.",acquired immune deficiency syndrome;article;neoplasm;chronic disease;chronic kidney failure;chronic liver disease;chronic lung disease;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;functional disease;hospitalization;human;mortality;nutritional deficiency;peripheral vascular disease;surgical patient,"Iezzoni, L. I.;Heeren, T.;Foley, S. M.;Daley, J.;Hughes, J.;Coffman, G. A.",1994,,,0,
1952,Haloperidol and sudden cardiac death in dementia: autopsy findings in psychiatric inpatients,"OBJECTIVE: Treatment with haloperidol has been shown, in studies using death certificates and prescription files, to be associated with an excess of sudden cardiac deaths, and regulatory warnings highlight this risk in patients with dementia. We used autopsy findings to determine whether the rate of sudden cardiac death is greater in cases of unexpected deaths of patients with dementia treated with haloperidol. METHODS: From 1989 through 2013, 1219 patients with a primary diagnosis of dementia with behavioral disturbance were admitted to a psychiatric hospital, and 65 (5.3%) died suddenly. Sixty-five patients (5.3%) died unexpectedly. Complete post-mortem examinations after the sudden death were performed in 55 (84.6%) patients. Twenty-seven of the autopsied cases (49.1%) had been treated with haloperidol orally (2.2 mg +/- 2.1 mg/day), the only antipsychotic used in this cohort. Univariable comparisons and multivariable regression analyses compared the groups of patients with or without sudden cardiac death. RESULTS: The leading causes of death were sudden cardiac death (32.7%), myocardial infarction (25.5% of patients), pneumonia (23.6%), and stroke (10.9%). Patients with sudden cardiac death and those with anatomically established cause of death were similar regarding the use of haloperidol (p = 0.5). Sudden cardiac death patients were more likely to suffer from Alzheimer's dementia (p = 0.027) and to have a past history of heart disease (p = 0.0094), and less likely to have been treated with a mood stabilizer (p = 0.024), but none of these variables were independent predictors of sudden cardiac death. CONCLUSION: Autopsy data suggest that oral haloperidol is not associated with increased risk of sudden cardiac death in psychiatric inpatients with dementia.","Aged;Aged, 80 and over;Antipsychotic Agents/*adverse effects;Autopsy;Death, Sudden, Cardiac/*etiology;Dementia/drug therapy;Female;Haloperidol/*adverse effects;Humans;Male;Middle Aged;Multivariate Analysis;Risk Factors;Death;Dementia;Haloperidol;Unexpected","Ifteni, P.;Grudnikoff, E.;Koppel, J.;Kremen, N.;Correll, C. U.;Kane, J. M.;Manu, P.",2015,Dec,10.1002/gps.4277,0,
1953,Changes in intellectual function during perioperative period evaluated by Hasegawa's Dementia Scale,"In 190 patients, we studied changes in intellectual status during perioperative period using Hasegawa's Dementia Scale (HDS-R), and analyzed preoperative, intraoperative, and postoperative risk factors. HDS-R is one of the most popular scoring tests for evaluating dementia or delirium. Risk factors impairing preoperative score were aging, and preoperative complications including cerebral vascular disease, old myocardial infarction, arrythmia, and diabetes mellitus. Risk factors impairing postoperative score were, in addition to above-mentioned factors, hypoproteinemia and postoperative stressful conditions such as prolonged fever, pain, bed rest, and naso-gastric tube. In the patients who showed postoperative score deterioration, the incidence of old myocardial infarction, hypertension, and postoperative stressful conditions was significantly greater. In the patients who showed postoperative score improvement, local anesthesia including epidural and spinal anesthesia was used more often. In conclusion, aging or preoperative complications such as cerebral vascular disease, old myocardial infarction, arrythmia, and diabetes mellitus are high risks for the development of postoperative dementia and delirium under general surgical procedures and general anesthesia. Intraoperative management with patients awake using local anesthesia and postoperative stress-less conditions are important to avoid postoperative dementia.","Aged;Anesthesia, General;Cerebrovascular Disorders;Dementia/*diagnosis;Diabetes Mellitus;Female;Humans;*Intelligence Tests;Intraoperative Care;Male;Middle Aged;Myocardial Infarction;Postoperative Complications/*diagnosis;Risk","Igarashi, T.;Konishi, A.;Sonehara, D.;Asahara, H.",1995,Jan,,0,
1954,The study of neuropsychological alterations following coronary artery bypass operation as predicted by computed tomography scan of the brain,"The objective of this clinical study is to provide information regarding the association between coexistent cerebrovascular disease and neuropsychological abnormalities after coronary artery bypass operations. Computed tomography scan of the brain was performed in 104 patients pre-operatively, and their post-operative neuropsychological functions were evaluated. The patients were categorized as follows according to the CT findings: Seventy-three patients showed normal or slight cerebral cortical atrophy which usually seen in patients over fifty of age (group A). Sixteen showed moderate or severe cortical atrophy (group B). Fifteen patients demonstrated the characteristic findings of Binswanger type; severe white matter hypodensity especially in frontal horns and dilated ventricles (group C). Overt neuropsychological dysfunction was not observed in patient in groups A and B. Six patients in group C showed a combination of dementia, bizarre behavior, disorientation and gait dyspraxia following bypass operations. The pseudobulbar signs were also found in 3 patients. These clinical abnormalities persisted for six days to three weeks, and were most often reversible. Although the underlying mechanism of these deleterious alterations is not elucidated, the ischemic nature of the characteristic white matter lesions was highly suspected. The arteriosclerotic changes of the arteriole of the cerebral cortex and hypoperfusion during cardio-pulmonary bypass were supposed to be responsible. Therefore it was concluded that special attention should be focused on neurological evaluation for bypass surgery in group C patients.","Adult;Aged;Aged, 80 and over;Brain/*radiography;Cerebrovascular Circulation;Cerebrovascular Disorders/physiopathology/*psychology/radiography;*Coronary Artery Bypass;Coronary Disease/surgery;Female;Humans;Male;Middle Aged;Postoperative Period;*Tomography, X-Ray Computed","Iguchi, A.;Sato, K.;Sadahiro, M.;Endo, M.;Yokoyama, H.;Ohmi, M.",1993,Jan,,0,
1955,Multifactorial vascular risk factor intervention to prevent cognitive impairment after stroke and TIA: A 12-month randomized controlled trial,"Objectives: Vascular risk factor control may not only prevent stroke but also reduce the risk of dementia. We investigated whether a multifactorial intervention program reduces the incidence of cognitive symptoms one-year after stroke and transient ischemic attack in first ever stroke patients without cognitive decline prior to the stroke. Materials and methods: Patients suffering their first ever stroke were included in this randomized, evaluator-blinded, controlled trial with two parallel groups. Baseline examination included extensive assessment of exposure to vascular risk factors and cognitive assessments regarding memory, attention, and executive function. After discharge, patients were allocated to either intensive vascular risk factor intervention or care as usual. The primary end points were changes in trailmaking test A and 10-word test from baseline to 12 months follow-up. Results: One hundred ninety-five patients were randomized. The difference between groups in trail-making test A, adjusted for baseline measurements, was 3·8 s (95% confidence interval: -4·2 to 11·9; P = 0·35) in favor of the intervention group. The difference between groups in the 10-word recall test was 1·1 words (95% confidence interval: -0·5 to 2·7; P = 0·17) in favor of the intervention group. We did not observe any differences in the secondary outcomes of incident dementia or mild cognitive impairment. Conclusions: We could not demonstrate cognitive effects of an intensive risk factor intervention at one-year poststroke. Longer follow-up and a more heterogeneous study sample might have lead to larger effects. More effective methods for managing the risk of further cognitive decline after stroke are needed.",NCT00506818;cholesterol;hemoglobin A1c;homocysteine;low density lipoprotein cholesterol;aged;alcohol consumption;article;attention;body mass;cardiovascular risk;cerebrovascular accident;cognitive defect;controlled study;dementia;diabetes mellitus;diet;executive function;female;atrial fibrillation;human;hyperlipidemia;hypertension;ischemic heart disease;major clinical study;male;memory;mild cognitive impairment;obesity;physical activity;priority journal;psychologic test;randomized controlled trial;single blind procedure;smoking;transient ischemic attack;word recognition,"Ihle-Hansen, H.;Thommessen, B.;Fagerland, M. W.;Øksengård, A. R.;Wyller, T. B.;Engedal, K.;Fure, B.",2014,,,0,
1956,Prognostic Impact of Revascularization in Poor-Risk Patients With Critical Limb Ischemia: The PRIORITY Registry (Poor-Risk Patients With and Without Revascularization Therapy for Critical Limb Ischemia),"Objectives The authors sought to investigate the prognostic impact of revascularization for poor-risk CLI patients in real-world settings. Background Critical limb ischemia (CLI) is often accompanied with various comorbidities, and frailty is not rare in the population. Although previous studies suggested favorable outcomes of revascularization for CLI patients, those studies commonly included the healthier, that is, less frail patients. Methods This was a multicenter prospective observational study, registering patients who presented with CLI and who required assistance for their daily lives because of their disability in activities of daily living (ADL) and/or impairment of cognitive function. Revascularization was either planned (revascularization group) or not planned (non-revascularization group). The primary endpoint was 1-year survival, and was compared between the revascularization and non-revascularization groups, using the propensity score-matching method. Results Between January 2014 and April 2015, a total of 662 patients were registered, of those 100 non-revascularization patients were included. A total of 625 patients (94.4%) completed the 1-year follow-up. Death was observed in 223 patients (33.7%). After propensity score matching, the 1-year survival rate was 55.9% in the revascularization group versus 51.0% in the non-revascularization group, with no significant difference (p = 0.120). In the subgroups alive at 1 year after revascularization, health-related quality of life was significantly improved compared with baseline, whereas ADL scores were unchanged from baseline and still remained significantly worse than before CLI onset. Conclusions The 1-year overall survival rate was not significantly different between the revascularization and non-revascularization groups in poor-risk CLI patients. (Poor-Risk Patients With and Without Revascularization Therapy for Critical Limb Ischemia; [PRIORITY Registry]; UMIN000012871)",UMIN000012871;ADL disability;aged;ankle brachial index;ankle pressure;article;cerebrovascular accident;clinical outcome;cognitive defect;controlled study;critical limb ischemia;daily life activity;death;dementia;diabetes mellitus;dialysis;endovascular surgery;female;foot infection;general condition deterioration;heart failure;human;infection;ischemic heart disease;leg revascularization;low risk patient;lower limb;major clinical study;male;observational study;overall survival;pain;priority journal;propensity score;quality of life;reconstructive surgery;rest pain;revascularization;sensitivity analysis;survival rate,"Iida, O.;Uematsu, M.;Takahara, M.;Soga, Y.;Azuma, N.;Nanto, S.",2017,,10.1016/j.jcin.2017.03.012,0,
1957,Effects of chair yoga therapy on physical fitness in patients with psychiatric disorders: A 12-week single-blind randomized controlled trial,"Introduction Since falls may lead to fractures and have serious, potentially fatal outcomes, prevention of falls is an urgent public health issue. We examined the effects of chair yoga therapy on physical fitness among psychiatric patients in order to reduce the risk of falls, which has not been previously reported in the literature. Methods In this 12-week single-blind randomized controlled trial with a 6-week follow-up, inpatients with mixed psychiatric diagnoses were randomly assigned to either chair yoga therapy in addition to ongoing treatment, or treatment-as-usual. Chair yoga therapy was conducted as twice-weekly 20-min sessions over 12 weeks. Assessments included anteflexion in sitting, degree of muscle strength, and Modified Falls Efficacy Scale (MFES) as well as QOL, psychopathology and functioning. Results Fifty-six inpatients participated in this study (36 men; mean ± SD age, 55.3 ± 13.7 years; schizophrenia 87.5%). In the chair yoga group, significant improvements were observed in flexibility, hand-grip, lower limb muscle endurance, and MFES at week 12 (mean ± SD: 55.1 ± 16.6 to 67.2 ± 14.0 cm, 23.6 ± 10.6 to 26.8 ± 9.7 kg, 4.9 ± 4.0 to 7.0 ± 3.9 kg, and 114.9 ± 29.2 to 134.1 ± 11.6, respectively). Additionally, these improvements were observable six weeks after the intervention was over. The QOL-VAS improved in the intervention group while no differences were noted in psychopathology and functioning between the groups. The intervention appeared to be highly tolerable without any notable adverse effects. Conclusions The results indicated sustainable effects of 20-min, 12-week, 24-session chair yoga therapy on physical fitness. Chair yoga therapy may contribute to reduce the risk of falls and their unwanted consequences in psychiatric patients.",UMIN000015711;anticonvulsive agent;aripiprazole;benzodiazepine;fluphenazine;haloperidol;lithium;olanzapine;perospirone;quetiapine;risperidone;adult;anemia;angina pectoris;article;chair;clinical assessment;constipation;controlled study;dementia;diabetes mellitus;Falls Efficacy Scale;female;fitness;follow up;hand grip;hepatitis C;hospital patient;human;hyperlipidemia;hypertension;leg muscle;low back pain;major clinical study;male;mental disease;mental patient;middle aged;mood disorder;muscle strength;neuritis;outcome assessment;physical parameters;priority journal;randomized controlled trial;schizophrenia;seizure;single blind procedure;sitting;treatment outcome;yoga,"Ikai, S.;Uchida, H.;Mizuno, Y.;Tani, H.;Nagaoka, M.;Tsunoda, K.;Mimura, M.;Suzuki, T.",2017,,10.1016/j.jpsychires.2017.07.015,0,
1958,Detection of preclinically latent hyperperfusion due to stroke-like episodes by arterial spin-labeling perfusion MRI in MELAS patients,"In stroke-like episodes (SEs) of patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), the detection of preclinically latent lesions is a challenge. We report regional cerebral hyperperfusion observed on arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) in the preclinical phase more than 3 months before the clinical onset of SEs in 3 MELAS patients. These hyperperfused areas were not detected by conventional MRI in the preclinical phase and developed into acute lesions at the clinical onset of SEs, suggesting that ASL imaging has the potential for predicting the emergence of SEs. © 2013 Elsevier B.V. and Mitochondria Research Society.",acetylsalicylic acid;anticonvulsive agent;arginine;dexamethasone;diuretic agent;gabapentin;insulin;lactic acid;phenytoin;propofol;pyruvic acid;adult;alanine aminotransferase blood level;arterial spin labeling perfusion magnetic resonance imaging;article;brain disease;brain perfusion;cardiomyopathy;case report;clinical assessment;clinical feature;congestive heart failure;cortical sensory aphasia;diabetes mellitus;early diagnosis;epilepsy;female;headache;hearing impairment;hemianopia;human;ischemia;lactate blood level;latent period;male;medical history;MELAS syndrome;mental deterioration;mitochondrial myopathy;myoclonus;nausea;nystagmus;occipital lobe;oxidative stress;paresthesia;perception deafness;perfusion weighted imaging;priority journal;remission;stroke like episode;temporal lobe;temporal lobe epilepsy;vomiting,"Ikawa, M.;Yoneda, M.;Muramatsu, T.;Matsunaga, A.;Tsujikawa, T.;Yamamoto, T.;Kosaka, N.;Kinoshita, K.;Yamamura, O.;Hamano, T.;Nakamoto, Y.;Kimura, H.",2013,,,0,
1959,"Long-term safety and efficacy of donepezil in patients with dementia with lewy bodies: Results from a 52-week, open-label, multicenter extension study","Background/Aims: To investigate the safety and efficacy of long-term administration (52 weeks) of donepezil in patients with dementia with Lewy bodies (DLB). Methods: This was a 52-week, multicenter, open-label extension study. Up to 8 weeks after the completion of the preceding randomized, placebo-controlled trial (RCT), patients started treatment with 3 mg of donepezil daily for 2 weeks, followed by 5 mg daily for the remaining 50 weeks. Cognitive function, behavioral and psychiatric symptoms, cognitive fluctuations, and caregiver burden were assessed using the Mini-Mental State Examination, Neuropsychiatric Inventory, Cognitive Fluctuation Inventory, and the Zarit Caregiver Burden Interview, respectively. Safety parameters were monitored throughout. Results: In total, 108 patients were enrolled in the study. Cognitive function and dementia-related behavioral symptoms, including cognitive fluctuations, were improved after the start of donepezil treatment, and improvement was maintained for 52 weeks. Reduction in caregiver burden observed in the preceding RCT returned to the baseline level at 52 weeks. There was no significant imbalance in the incidence of adverse events (AEs) by onset time, and delayed AE onset induced by the long-term administration of donepezil was unlikely to appear. Conclusion: The long-term administration of donepezil at 5 mg/day was well tolerated in patients with DLB and is expected to exhibit lasting effects, improving impaired cognitive function and psychiatric symptoms up to 52 weeks. © 2013 S. Karger AG, Basel.",donepezil;placebo;acute pancreatitis;aged;article;asphyxia;atrioventricular block;blood pressure;bradycardia;caregiver burden;chronic drug administration;cognition;compression fracture;constipation;controlled study;contusion;creatine kinase blood level;decreased appetite;dehydration;diarrhea;diffuse Lewy body disease;drug efficacy;drug safety;falling;female;gastrointestinal symptom;heart infarction;heart ventricle extrasystole;hematuria;human;incidence;insomnia;major clinical study;male;mental disease;Mini Mental State Examination;multicenter study;neuropsychiatry;open study;parkinsonism;pneumonia;priority journal;proteinuria,"Ikeda, M.;Mori, E.;Kosaka, K.;Iseki, E.;Hashimoto, M.;Matsukawa, N.;Matsuo, K.;Nakagawa, M.;Katayama, S.;Higashi, Y.;Yamada, T.;Maruki, Y.;Orimo, S.;Yoshiiwa, A.;Hanyu, H.;Yokochi, M.;Kimura, T.;Mizoguchi, K.;Nakanishi, A.;Tsukamoto, T.;Taniguchi, N.;Okamoto, K.;Kitamura, T.;Nakano, Y.;Kato, T.;Shimada, K.;Hiji, M.;Yoshiyama, Y.;Kitamura, Y.;Takahashi, S.;Akishita, M.;Washimi, Y.;Yamamoto, Y.;Kobayashi, M.;Udaka, F.;Osaki, Y.;Hino, H.;Kanda, T.;Kishimoto, T.;Oguro, H.;Matsuoka, T.;Tsugu, Y.;Fujii, N.;Kawase, Y.",2013,,,0,
1960,Unrecognized myocardial infarction in relation to risk of dementia and cerebral small vessel disease,"BACKGROUND AND PURPOSE: Men, but not women, with unrecognized myocardial infarction (MI) have an increased risk of cardiac events and stroke compared with those without MI or with recognized MI. We investigated whether unrecognized MI is also a risk factor for dementia and cerebral small vessel disease (white matter lesions and brain infarction) in 2 population-based cohort studies. METHODS: In the Rotterdam Study, 6347 participants were classified at baseline (1990 to 1993) into those with recognized MI (subdivided into Q-wave and non-Q-wave MI), with unrecognized MI, and without MI based on electrocardiography and interview and were followed for incident dementia (n=613) until January 1, 2005. In the Rotterdam Scan Study, 436 nondemented persons were similarly classified based on electrocardiography and interview and underwent brain MRI for the assessment of white matter lesions and brain infarction. RESULTS: In men, unrecognized MI was associated with an increased risk of dementia (compared with men without MI hazard ratio, 2.14; 95% CI, 1.37 to 3.35) and with more white matter lesions and more often brain infarction on MRI. In women, no associations were found with unrecognized MI. Recognized MI was not associated with the risk of dementia in either sex. Men, but not women, with recognized MI had more often any brain infarction or asymptomatic brain infarction, especially if they had Q-wave MI. No consistent associations were found between recognized Q-wave or non-Q-wave MI and severity of white matter lesions. Additional adjustment for cardiovascular risk factors did not change the results. CONCLUSIONS: Men with unrecognized MI have an increased risk of dementia and more cerebral small vessel disease.","Aged;Aged, 80 and over;Brain/blood supply/pathology/physiopathology;Brain Ischemia/diagnosis/*epidemiology/physiopathology;Cerebral Arteries/*pathology/physiopathology;Cohort Studies;Comorbidity;Dementia, Vascular/diagnosis/*epidemiology/physiopathology;Electrocardiography;Female;Heart/physiopathology;Humans;Incidence;Male;Microcirculation/*pathology/physiopathology;Middle Aged;Myocardial Infarction/diagnosis/*epidemiology/physiopathology;Nerve Fibers, Myelinated/pathology;Netherlands/epidemiology;Predictive Value of Tests;Prevalence;Prospective Studies;Risk Factors;Sex Distribution;Sex Factors","Ikram, M. A.;van Oijen, M.;de Jong, F. J.;Kors, J. A.;Koudstaal, P. J.;Hofman, A.;Witteman, J. C.;Breteler, M. M.",2008,May,10.1161/strokeaha.107.501106,1,
1961,"Epidemiology, co-morbidities, and medication use of patients with alzheimer's disease or vascular dementia in the UK","Epidemiologic studies on age-specific incidence rates (IRs) separating Alzheimer's disease (AD) and vascular dementia (VaD) in the UK are scarce. We sought to assess IRs of AD and VaD in the UK and to compare co-morbidities and medication use between patients with AD, VaD, or without dementia. We identified cases aged ≥65 years with an incident diagnosis of AD or VaD between 1998 and 2008 using the General Practice Research Database (GPRD). We assessed IRs, stratified by age and gender, matched one dementia-free control patient to each demented patient, and analyzed co-morbidities and medication use. We identified 7,086 AD and 4,438 VaD cases. Overall, the IR of AD was 1.59/1,000 person-years (py) (95% CI 1.55-1.62) and the IR of VaD 0.99/1,000 py (95% CI 0.96-1.02). For AD, IRs were higher for women than for men, but not for VaD. Except for orthostatic hypotension, the prevalence of all cardiovascular (CV) co-morbidities and exposure to CV drugs was lower in patients with AD than in corresponding controls, whereas the opposite was true for VaD. The lower prevalence of CV diseases in patients with AD may be a true finding or the result of a channeling effect, i.e., the possibility that demented patients with CV diseases may be more likely diagnosed with VaD than AD. © 2013 - IOS Press and the authors. All rights reserved.",aged;Alzheimer disease;article;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;depression;diabetes mellitus;enteritis;epilepsy;female;gender;atrial fibrillation;human;hypercholesterolemia;hypertension;incidence;ischemic heart disease;major clinical study;male;multiinfarct dementia;orthostatic hypotension;osteoporosis;prevalence;priority journal;rheumatoid arthritis;thyroid disease;United Kingdom,"Imfeld, P.;Brauchli Pernus, Y. B.;Jick, S. S.;Meier, C. R.",2013,,,0,
1962,Alcohol use of older adults: Drinking alcohol for medicinal purposes,,alcohol;age;aged;alcohol consumption;anemia;asthma;cardiovascular disease;common cold;controlled study;dementia;depression;diabetes mellitus;Finland;fracture;gender;heart infarction;human;hypertension;income;indigestion;ischemic heart disease;leisure;letter;major clinical study;marriage;neoplasm;osteoarthritis;pain;Parkinson disease;peptic ulcer;prevalence;priority journal;prophylaxis;red wine;rheumatoid arthritis;self medication;sleep disorder;cerebrovascular accident;structured questionnaire,"Immonen, S.;Valvanne, J.;Pitkälä, K. H.",2011,,,0,
1963,Cardiac arrest due to food asphyxiation in adults: Resuscitation profiles and outcomes,"Aim: Food asphyxiation is uncommon but unignorable cause of sudden death in the elderly. Several autopsy studies, which identified those at particular risk, have been conducted on the subject. Resuscitation profiles and outcomes of food asphyxiation victims presenting with out-of-hospital cardiac arrest (OHCA) to the emergency department, however, have rarely been reported. Methods: Data on adults (≥20 years) presenting with OHCA after witnessed food asphyxiation were retrieved from an institutional database. Clinical variables were evaluated to identify their demographic characteristics. Their outcomes, represented by return of spontaneous circulation (ROSC) and survival rate, were also investigated. Results: Sixty-nine food asphyxiation victims presenting with OHCA were identified during the 4-year period. Food asphyxiation occurred most frequently in the age group of 71-80 years, followed by that of 81-90 years. The majority of victims had medical conditions that adversely affected mastication/swallowing, such as dementia. Bystander cardiopulmonary resuscitation (CPR) was performed only in 26%, although bystanders often attempted to clear the airway without performing CPR. Despite the high ROSC rate of 78%, only 7% survived to discharge. Asphyxiation-ROSC interval might play a crucial role in determining the outcomes: the interval was ≤10. min in all survivors, while it was longer than 10. min in all non-survivors. Conclusion: Because of their advanced age and debilitating general condition, it may be difficult to substantially improve the outcomes of food asphyxiation victims. Effort should be directed to prevent food asphyxiation, and public education to perform standard CPR for food asphyxiation victims including the Heimlich manoeuvre is warranted. © 2010 Elsevier Ireland Ltd.",antibiotic agent;adult;aged;airway;article;asphyxia;aspiration pneumonia;autopsy;circulation;controlled study;dementia;demography;emergency ward;female;food asphyxiation;general condition;heart arrest;Heimlich maneuver;human;major clinical study;male;mastication;outcome assessment;priority journal;resuscitation;standard;sudden death;survival rate;swallowing;victim,"Inamasu, J.;Miyatake, S.;Tomioka, H.;Shirai, T.;Ishiyama, M.;Komagamine, J.;Maeda, N.;Ito, T.;Kase, K.;Kobayashi, K.",2010,,,0,
1964,Acetylcholinesterase inhibitors attenuate atherogenesis in apolipoprotein E-knockout mice,"OBJECTIVE: Donepezil, a reversible acetylcholinesterase inhibitor, improves cognitive function of Alzheimer's disease. Stimulation of cholinergic system was reported to improve long-term survival of rats with chronic heart failure and to attenuate inflammatory response in mice with lipopolysaccharide-induced sepsis. We sought to determine whether the pharmacological stimulation of cholinergic system by donepezil reduces atherogenesis in apolipoprotein (Apo) E-knockout (KO) mice. METHODS AND RESULTS: Male ApoE-KO mice (10-week-old) were fed a high-fat diet and received infusion of angiotensin (Ang) II (490 ng/kg/day). Donepezil or physostigmine was administered for 4 weeks. Oral administration of donepezil (5 mg/kg/day) or infusion of physostigmine (2 mg/kg/day) significantly attenuated atherogenesis (Oil Red O-positive area) without significant changes in heart rate, blood pressure and total cholesterol levels. Administration of donepezil suppressed expression of monocyte chemoattractant protein-1 and tumor necrosis factor-alpha, NADPH oxidase activity and production of reactive oxygen species in the aorta. CONCLUSION: The present study revealed novel anti-oxidative and anti-atherosclerotic effects of pharmacological stimulation of cholinergic system by donepezil. Donepezil may be used as a novel therapeutics for the atherosclerotic cardiovascular diseases.","Alzheimer Disease/drug therapy;Animals;Apolipoproteins E/*genetics;Atherosclerosis/*enzymology;Cardiovascular Diseases;Cholinesterase Inhibitors/*pharmacology;Cytokines/metabolism;Indans/pharmacology;Inflammation;Lipopolysaccharides/metabolism;Male;Mice;Mice, Knockout;Oxidative Stress;Piperidines/pharmacology;Sepsis","Inanaga, K.;Ichiki, T.;Miyazaki, R.;Takeda, K.;Hashimoto, T.;Matsuura, H.;Sunagawa, K.",2010,Nov,10.1016/j.atherosclerosis.2010.07.027,0,
1965,"Immunohistochemical determination of HIF, TSP-1, ADAMTS1, and ADAMTS8 expressions in the brains of Alzheimer’s disease patients: A preliminary autopsy study","Objective: Alzheimer’s disease (AD) is a progressive neurodegenerative disease that mostly affects the elderly population. Recent studies performed in AD highlight the pathophysiological relevance of disintegrin and metalloproteinase with thrombospondin type 1-like motifs (ADAMTS) genes and their products, namely hypoxia inducible factor-1 (HIF-1) and thrombospondin-1 (TSP-1). Thus, the aim of this study was to describe and identify the distribution, characteristics, and any changes in the expression and immunoreactivity for HIF-1, TSP-1, and ADAMTS1 and 8 in AD brains. Materials and Methods: Nine patients who were autopsied in the Council of Forensic Medicine, Bursa Morgue Department in 2013, were selected. All patients were sent for autopsy to the Morgue Department within 8 h after death. At the autopsy, tissue samples of the organs were obtained for histopathological examination for determining the cause of death. Among these, two patients were clinically diagnosed with AD. Results: Immunohistochemical staining was performed, and the staining intensity/extensity was evaluated using a semiquantitative scoring system. Median distribution (extensity) scores of the immunohistochemical staining were estimated as 2 for HIF-1, 0.67 for TSP-1, 3.11 for ADAMTS1, and 2.78 for ADAMTS8. Intensity scores were estimated as 1.22 for HIF-1, 0.56 for TSP-1, 3 for ADAMTS1, and 2.11 for ADAMTS8. Conclusion: Our study suggests that ADAMTS1 and ADAMTS8 expressions are not specific for AD. To understand and provide definitive data on all aspects of metalloproteinases, extracellular matrix proteins, and transcriptional factor effects to AD, further studies are needed, where other metalloproteinases and related molecules/enzymes should be studied.",ADAMTS1 protein;ADAMTS8 protein;hypoxia inducible factor 1;thrombospondin 1;unclassified drug;a disintegrin and metalloproteinase with thrombospondin motifs 1 gene;a disintegrin and metalloproteinase with thrombospondin motifs 8 gene;adult;aged;Alzheimer disease;aorta dissection;article;brain biopsy;brain hemorrhage;controlled study;coronary artery disease;female;gene;gene expression;head injury;heart failure;histopathology;human;human tissue;immunohistochemistry;male;middle aged;very elderly,"İnanır, N. T.;Eren, F.;Fedakar, R.;Eren, B.;Demircan, K.;Gürses, M. S.;Ural, M.;Akyol, S.;Aynekin, B.",2016,,,0,
1966,"Microinfarcts in an older population-representative brain donor cohort (MRC CFAS): Prevalence, relation to dementia and mobility, and implications for the evaluation of cerebral Small Vessel Disease","Introduction: Microinfarcts, small ischaemic foci common in ageing brain, are associated with dementia and gait dysfunction. We determined their relationship with dementia, mobility and cerebrovascular disease in an older population-representative brain donor cohort. These data on microinfarcts were evaluated in relation to pathological assessments of clinically significant cerebral small vessel disease (SVD). Methods: Microinfarcts were assessed in the MRC Cognitive Function and Ageing Study (n = 331). Nine brain areas were staged according to the number of areas affected. Results: 36% of brains showed at least 1 microinfarct. Higher cortical microinfarct stage was associated with dementia at death (OR 1.41, 95% CI 1.02; 1.96, P = 0.038), whilst cortical and subcortical microinfarct stages were associated with impaired mobility (OR 1.36, 95% CI 1.05–1.74; P 0.018) and falls (OR 1.96, 95% CI 1.11–3.43; P = 0.02). Adding data on microinfarcts to a definition of SVD, based on white matter lesions (WMLs), lacunes and significant arteriosclerosis, were assessed by comparing area under ROC curve (AUC) with and without microinfarcts. SVD was significantly related to dementia status with or without inclusion of microinfarcts. Modelling potential pathological definitions of SVD to predict dementia or impaired mobility indicated optimal prediction using combined assessment of WMLs, lacunes and microinfarcts. Conclusion: Cortical (dementia) and subcortical microinfarcts (impaired mobility) are related to diverse clinical outcomes. Optimal pathological assessment of significant SVD in brain ageing is achieved based on WMLs, lacunes and microinfarcts and may not require subjective assessment of the extent and severity of arteriosclerosis.",adult;aged;aging;angina pectoris;arteriosclerosis;article;brain infarction;brain region;cerebrovascular accident;cerebrovascular disease;clinical outcome;dementia;diabetes mellitus;falling;female;heart infarction;human;immobility;major clinical study;male;microinfarction;neuropathology;organ donor;prevalence;priority journal;receiver operating characteristic;risk factor;subcortex;very elderly;white matter lesion,"Ince, P. G.;Minett, T.;Forster, G.;Brayne, C.;Wharton, S. B.",2017,,10.1111/nan.12363,0,
1967,"Focused Risk Analysis: Regression Model Based on 5,314 Total Hip and Knee Arthroplasty Patients from a Single Institution","We aimed to identify significant demographic, preoperative comorbidity and surgical predictors for major complications for use in the development of a risk prediction tool for a well-defined population as Total Joint Arthroplasty (TJA) patients. Data on 5314 consecutive patients who underwent primary total hip or knee arthroplasty from October 1, 2008 through September 30, 2011 at a single institution were used in a multivariate regression analysis. The overall incidence of a primary endpoint (reoperation during same admission, extended length of stay, and 30-day readmission) was 3.8%. Significant predictors include certain preexisting genitourinary, circulatory and respiratory conditions; ASA. >2; advanced age and prolonged operating time. Mental health conditions demonstrate a strong predictive effect for subsequent serious complication(s) in TJA patients and should be included in a risk-adjustment tool.",adult;aged;anemia;article;blood clotting disorder;cerebrovascular accident;chronic kidney failure;chronic liver disease;chronic obstructive lung disease;chronic pancreatitis;comorbidity;congestive heart failure;constipation;coronary artery disease;delirium;dementia;demography;depression;diabetes mellitus;diverticulosis;female;gastroenteritis;heart infarction;hepatitis;hip arthroplasty;hospital readmission;human;irritable colon;length of stay;major clinical study;male;mental disease;operation duration;pancreas disease;paralytic ileus;Parkinson disease;peripheral vascular disease;pneumonia;postoperative complication;psychosis;respiratory tract disease;risk assessment;sleep disordered breathing;total knee replacement;transient ischemic attack;ulcerative colitis;urinary tract infection;urine retention;urogenital tract disease;valvular heart disease;venous thromboembolism,"Inneh, I. A.;Lewis, C. G.;Schutzer, S. F.",2014,,,0,
1968,Modelling the burden of disease associated malnutrition,"Background & aims: Disease associated malnutrition (DAM) is a frequent but often unrecognised problem associated with increased morbidity and utilisation of health care, decreased quality of life and premature mortality. The aim was to estimate the financial and health burden of DAM in Europe. Methods: A model was developed to estimate direct incremental health care costs and health loss (including increased mortality and reduced quality of life expressed in lost quality adjusted life years [QALYs]). Ten primary diseases were incorporated into the model: stroke, coronary heart disease, breast cancer, colorectal cancer, head and neck cancer, chronic obstructive pulmonary disease, dementia, depression, musculoskeletal disorders and chronic pancreatitis. Results: In Europe in 2009, the direct financial burden of DAM in ten primary diseases was over 31 billion EUR and DAM was responsible for 5.7 million lost life years and 9.1 million QALYs. The total monetary value of health and financial burden of DAM exceeds 305 billion EUR annually. Conclusions: In Europe, DAM only in ten primary disease areas represents a significant contribution to the total burden of disease estimated by the WHO to be 255 million DALYs annually. Policy makers should support programmes to extend the clinical and economic evidence base of nutritional care, with the ultimate aim of reducing the resource burden associated with malnutrition. © 2012 European Society for Clinical Nutrition and Metabolism.",article;biological model;breast cancer;chronic obstructive lung disease;chronic pancreatitis;colorectal cancer;dementia;depression;disease association;Europe;financial management;head and neck cancer;health care cost;health program;human;ischemic heart disease;length of stay;malnutrition;mortality;musculoskeletal disease;nutritional health;quality adjusted life year;quality of life;sensitivity analysis;cerebrovascular accident;world health organization,"Inotai, A.;Nuijten, M.;Roth, E.;Hegazi, R.;Kaló, Z.",2012,,,0,
1969,Mental disorders in childhood: Shifting the focus from behavioral symptoms to neurodevelopmental trajectories,,antidepressant agent;biological marker;neuroleptic agent;omega 3 fatty acid;Alzheimer disease;attention deficit disorder;autism;behavior disorder;bipolar disorder;brain development;brain maturation;cerebrovascular accident;childhood;coronary artery disease;degenerative disease;developmental disorder;frontal cortex;functional neuroimaging;gene expression profiling;genetics;human;Huntington chorea;illness trajectory;ischemic heart disease;mental disease;morbidity;mortality;Parkinson disease;priority journal;psychosis;psychosocial withdrawal;recreation;risk assessment;schizophrenia;sensitivity and specificity;short survey;substance abuse;thorax pain,"Insel, T. R.",2014,,,0,
1970,Vascular risk factors and leuko-araiosis,"Leuko-araiosis was found in 49 of 140 demented patients compared with 12 out of 110 control subjects. Thirty-one of 95 patients with dementia of the Alzheimer's type had leuko-araiosis. A history of stroke was four times more frequent in patients with leuko-araiosis than in those without leuko-araiosis (17.4% and 4.4%, respectively). It occurred in 25% of controls with leuko-araiosis compared with only 2% of those without leuko-araiosis. Mean systolic blood pressure was associated with leuko-araiosis. No association was found for diastolic blood pressure, myocardial infarction, angina, diabetes, or carotid bruits. On logistic regression analysis, the strong association between dementia and leuko-araiosis was mainly explained by a history of stroke. There are common factors in leuko-araiosis and stroke, but stroke alone does not account for leuko-araiosis.",age;central nervous system;computer analysis;computer assisted tomography;dementia;diagnosis;human;leukoaraiosis;major clinical study;peripheral vascular system;priority journal;psychological aspect;cerebrovascular accident,"Inzitari, D.;Diaz, F.;Fox, A.",1987,,,0,
1971,Risk and predictors of motor-performance decline in a normally functioning population-based sample of elderly subjects: the Italian Longitudinal Study on Aging,"OBJECTIVES: To examine risk and predictors of motor-performance (MP) decline targeting subjects performing normally at an initial observation. DESIGN: Cohort study. SETTING: A subsample of the Italian Longitudinal Study on Aging (aged 65-84). PARTICIPANTS: One thousand fifty-two subjects (mean age+/-standard deviation = 71+/-5, 69% men) with normal MP at baseline. MEASUREMENTS: Six tests (standing up from a chair, stepping up, tandem walk, standing on one leg, walking speed, and steps turning 180 degrees ) were used to assess MP at baseline and after 3 years. Baseline characteristics were potential predictors of MP decline. RESULTS: Of the 1,052 subjects performing normally at baseline, 166 (15.8%) had declined in MP at follow-up. Older age, female sex, lower education, symptoms of distal symmetrical neuropathy, cognitive impairment without dementia, parkinsonism, heart failure, anemia, depressive symptoms, worse Mini-Mental State Examination score, and lost activities of daily living and instrumental activities of daily living (IADLs) were significantly associated with MP decline in univariate comparisons. Older age (odds ratio (OR) = 3.84, 95% confidence interval (CI) = 2.14-6.88 comparing age classes > or =80 with 65-69), female sex (OR=1.50, 95% CI = 1.03-2.20), distal symmetric neuropathy (OR = 2.00, 95% CI = 1.03-3.87), depressive symptoms (OR = 1.85, 95% CI = 1.17-2.24), and baseline IADLs (OR = 1.22, 95% CI = 1.08-1.37 for each lost activity) independently predicted MP decline after regression analysis. CONCLUSION: In a population-based cohort of elderly people with normal MP, one-sixth declined in 3 years. Age, sex, distal symmetrical neuropathy, depressive symptoms, and baseline IADLs independently predicted this decline. Distal symmetrical neuropathy is underestimated in the clinical and epidemiological evaluation of motor decline in older people.","*Activities of Daily Living;Aged;Aged, 80 and over;*Disability Evaluation;Female;Follow-Up Studies;Geriatric Assessment/*statistics & numerical data;*Health Status;Humans;Italy;Male;*Mobility Limitation;Retrospective Studies;Walking/*physiology","Inzitari, M.;Carlo, A.;Baldereschi, M.;Pracucci, G.;Maggi, S.;Gandolfo, C.;Bonaiuto, S.;Farchi, G.;Scafato, E.;Carbonin, P.;Inzitari, D.",2006,Feb,10.1111/j.1532-5415.2005.00584.x,0,
1972,Geriatric Screening Tools to Select Older Adults Susceptible for Direct Transfer From the Emergency Department to Subacute Intermediate-Care Hospitalization,"Objectives: Early transfer to intermediate-care hospitals, low-tech but with geriatric expertise, represents an alternative to conventional acute hospitalization for selected older adults visiting emergency departments (EDs). We evaluated if simple screening tools predict discharge destination in patients included in this pathway. Design, Setting, and Participants: Cohort study, including patients transferred from ED to the intermediate-care hospital Parc Sanitari Pere Virgili, Barcelona, during 14 months (2012-2013) for exacerbated chronic diseases. Measurements: At admission, we collected demographics, comprehensive geriatric assessment, and 3 screening tools (Identification of Seniors at Risk [ISAR], SilverCode, and Walter indicator). Outcome: Discharge destination different from usual living situation (combined death and transfer to acute hospitals or long-term nursing care) versus return to previous situation (home or nursing home). Results: Of 265 patients (mean age ± SD = 85.3 ± 7.5, 69% women, 58% with acute respiratory infections, 38% with dementia), 80.8% returned to previous living situation after 14.1 ± 6.5 days (mean ± SD). In multivariable Cox proportional hazard models, ISAR >3 points (hazard ratio [HR] 2.06, 95% confidence interval [95% CI] 1.16-3.66) and >1 pressure ulcers (HR 2.09, 95% CI 1.11-3.93), but also continuous ISAR, and, in subanalyses, Walter indicator, increased the risk of negative outcomes. Using ROC curves, ISAR showed the best prediction among other variables, although predictive value was poor (AUC = 0.62 (0.53-0.71) for ISAR >3 and AUC = 0.65 (0.57-0.74) for continuous ISAR). ISAR and SilverCode showed fair prediction of acute hospital readmissions. Conclusions: Among geriatric screening tools, ISAR was independently associated with discharge destination in older adults transferred from ED to intermediate care. Predictive validity was poor. Further research on selection of candidates for alternatives to conventional hospitalization is needed.",aged;article;Barthel index;Charlson Comorbidity Index;chronic disease;cohort analysis;decubitus;dementia;demography;disease exacerbation;emergency ward;female;geriatric assessment;heart failure;hospital;hospital readmission;human;intermediate care hospital;major clinical study;male;nursing home;outcome assessment;patient transport;prediction;predictive validity;respiratory tract infection;urinary tract infection,"Inzitari, M.;Gual, N.;Roig, T.;Colprim, D.;Pérez-Bocanegra, C.;San-José, A.;Jimenez, X.",2015,,,0,
1973,Treatment and outcomes of nonagenarians with ST-elevation myocardial infarction,"There is no age limit for reperfusion therapy in the current guidelines for the treatment of patients with ST-elevation myocardial infarction (STEMI). Reperfusion therapy, although associated with better outcomes, is not always offered to the oldest patients. A retrospective analysis at our institution of all patients >/= 90 years of age with a diagnosis of acute coronary syndrome at discharge from 2004 to 2008 identified 24 patients with STEMI. The majority of patients were Caucasian, females, hypertensive, with a low incidence of dementia and diabetes. Only 29% of patients presented to the hospital in less than 6 hours. Thirteen patients were treated with percutaneous coronary intervention (PCI) and 11 patients were treated medically. The in-hospital mortality was 23% in the PCI group and 36% in the medical therapy group. Kaplan-Meier analysis demonstrated a survival benefit favoring PCI, which disappeared when only patients presenting after 6 hours to the hospital were analyzed. PCI-treated patients had no procedure-associated complications and had a good prognosis if they survived to hospital discharge. PCI should be offered to nonagenarians presenting with STEMI.","Age Factors;Aged, 80 and over;Angioplasty, Balloon, Coronary;Electrocardiography;Female;Hospital Mortality;Humans;Male;Myocardial Infarction/diagnosis/mortality/*therapy;Survival Analysis;Survival Rate","Ionescu, C. N.;Amuchastegui, M.;Ionescu, S.;Marcu, C. B.;Donohue, T.",2010,Oct,,0,
1974,Predictors of outcome in patients with chronic heart failure over a 5 year follow-up period,"Introduction: Chronic heart failure (CHF) is associated with a significant morbidity and a mortality rate worse than many cancers. Contemporary observational studies have demonstrated an improvement in expected survival but nonetheless survival remains limited. Currently used prognostic models, though helpful, are largely derived from pharmaceutical randomised controlled trials where comorbidities (e.g. renal failure, cancer or dementia) were screened-out to a greater extent. These models are not widely used as some of these models require fairly complex calculations and others have not been validated recently in the era of modern drugs and device therapies. We aimed to identify factors influencing out come in ambulatory heart failure patients and to devise a simple scoring system to identify patients approaching end stage CHF and, hence, suitable for palliative care approach. Methods: Demographic, clinical and social data were extracted from Lothian heart failure database for ambulatory CHF patients enrolled from 2004 to 2010. Hospital records were reviewed to obtain missing data. Multiple regression and Cox proportional-hazards model was used to identify factors predicting outcome. Results: The overall study cohort included 1326 ambulatory CHF patients managed in physician or nurse led out-patient clinics. The mean age for patients was 76 years and 63% were males. 54% patients had ischemic heart failure and 76% patients had moderate to severe left ventricular systolic dysfunction on echocardiogram. Every patient was considered for evidence-based therapy, but only 54% patients could tolerate beta-blockers and 74% received ACE inhibitors throughout study period. Independent predictors of mortality included: higher NYHA class, low systolic BP, lack of exercise, anaemia, low body weight, renal impairment, lack of beta-blocker therapy, diabetes mellitus and number of hospital admissions. Hospital admissions were predicted by higher NYHA class, lack of ACE inhibitor and beta-blocker therapy, high white cell count, old age, living with carer, lack of exercise and mitral regurgitation on echocardiogram. Conclusion: Our study provides a contemporary real-world overview of factors affecting outcomes in ambulatory CHF patients. We have proposed a simple scoring system to identify end stage CHF patients appropriate for consideration of palliative care. A formal prospective study to evaluate this scoring system is warranted.",human;patient;heart failure;follow up;society;cardiology;model;therapy;scoring system;survival;mortality;neoplasm;echocardiography;palliative therapy;hospital admission;exercise;observational study;randomized controlled trial;kidney failure;dementia;device therapy;data base;proportional hazards model;physician;nurse;outpatient;multiple regression;male;heart muscle ischemia;systolic dysfunction;evidence based practice;anemia;body weight;diabetes mellitus;hospital;leukocyte count;senescence;mitral valve regurgitation;prospective study;morbidity;medical record;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor,"Iqbal, J.;Young, G.;Reid, J.;Denvir, M.",2011,,10.1093/eurheartj/ehr322,0,1975
1975,Predictors of outcome in patients with chronic heart failure over a 5 year follow-up period,"Introduction: Chronic heart failure (CHF) is associated with a significant morbidity and a mortality rate worse than many cancers. Contemporary observational studies have demonstrated an improvement in expected survival but nonetheless survival remains limited. Currently used prognostic models, though helpful, are largely derived from pharmaceutical randomised controlled trials where comorbidities (e.g. renal failure, cancer or dementia) were screened-out to a greater extent. These models are not widely used as some of these models require fairly complex calculations and others have not been validated recently in the era of modern drugs and device therapies. We aimed to identify factors influencing out come in ambulatory heart failure patients and to devise a simple scoring system to identify patients approaching end stage CHF and, hence, suitable for palliative care approach. Methods: Demographic, clinical and social data were extracted from Lothian heart failure database for ambulatory CHF patients enrolled from 2004 to 2010. Hospital records were reviewed to obtain missing data. Multiple regression and Cox proportional-hazards model was used to identify factors predicting outcome. Results: The overall study cohort included 1326 ambulatory CHF patients managed in physician or nurse led out-patient clinics. The mean age for patients was 76 years and 63% were males. 54% patients had ischemic heart failure and 76% patients had moderate to severe left ventricular systolic dysfunction on echocardiogram. Every patient was considered for evidence-based therapy, but only 54% patients could tolerate beta-blockers and 74% received ACE inhibitors throughout study period. Independent predictors of mortality included: higher NYHA class, low systolic BP, lack of exercise, anaemia, low body weight, renal impairment, lack of beta-blocker therapy, diabetes mellitus and number of hospital admissions. Hospital admissions were predicted by higher NYHA class, lack of ACE inhibitor and beta-blocker therapy, high white cell count, old age, living with carer, lack of exercise and mitral regurgitation on echocardiogram. Conclusion: Our study provides a contemporary real-world overview of factors affecting outcomes in ambulatory CHF patients. We have proposed a simple scoring system to identify end stage CHF patients appropriate for consideration of palliative care. A formal prospective study to evaluate this scoring system is warranted.",human;patient;heart failure;follow up;society;cardiology;model;therapy;scoring system;survival;mortality;neoplasm;echocardiography;palliative therapy;hospital admission;exercise;observational study;randomized controlled trial;kidney failure;dementia;device therapy;data base;proportional hazards model;physician;nurse;outpatient;multiple regression;male;heart muscle ischemia;systolic dysfunction;evidence based practice;anemia;body weight;diabetes mellitus;hospital;leukocyte count;senescence;mitral valve regurgitation;prospective study;morbidity;medical record;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor,"Iqbal, J;Young, G;Reid, J;Denvir, M",2011,,10.1093/eurheartj/ehr322,0,
1976,Evaluation the efficasy of Boswellia serrata on patients with mild to moderate Alzheimer disease,"Inclusion criteria: Inclusion criteria: mild to moderate Alzheimer disease patients Exclusion criteria: parkinson; multiple sclorosis; heart failure stage C and D of AHA/ACC classification; ischemic heart disease; uncontrolled hypertension; schizophrenia; active peptic ulcer; uncontrolled diabetes and alcohol abuse. Exclusion criteria: <Condition>patients with mild to moderate Alzheimer Alzheimer disease, unspecified</Condition> Intervention 1: Control group:6 placebo capsules daily. Intervention 2: Intervention group:6 kondor capsules daily. memory. Timepoint: at the first and every month up to 3 months. Method of measurement: CDR (clinical dementia rating)",Sr-dementia,Irct2015051822306N,2016,,,0,
1977,Risk factor profiles for early and delayed mortality after hip fracture: Analyses of linked Australian Department of Veterans' Affairs databases,"Introduction One-year mortality after hip fracture may exceed 30% with a very large number of reported risk factors. Determinants of mortality beyond 1 year are rarely described. This study employs multiple data linkages to examine mortality rates, risk factor profiles and age-specific excess mortality at intervals from 30 days to 4 years. Methods Retrospective cohort study of linked administrative datasets describing hospital episodes, residential aged care (RAC) admissions and date of death for 2552 Australian veterans and war widows hospitalised for hip fracture in 2008-09. Associations between time to death and patient age, sex, pre-fracture accommodation, fracture type, treatment options, selected comorbidities and complications were tested in Cox proportional hazards models. Results In a population with mean age of 86.6 years (range 54-100 years), overall death rate was 11% at 30 days, 34% at 1 year, 47% at 2 years and 67% after 4 years. For males hospitalised from RAC 1-year mortality was 72%, contrasting with 19% for females from the community. Risk of death within 1 year was increased by male sex, increasing age, pre-fracture RAC residency, transfer to intensive care and coexistent cancer, cardiac and renal failure, cerebrovascular disease and pressure ulcers. Patients selected for rehabilitation had lower mortality rates. Patterns of determinants for mortality changed over time. Above-expected age-specific mortality was sustained for 4 years except for males 90 years and older. Conclusion Pre-fracture RAC residence was the strongest determinant factor for mortality. Patients selected for rehabilitation had lower mortality rates. The profiles of explanatory variables for death altered with increasing time from the index fracture event.",adult;age;aged;anemia;article;Australia;cerebrovascular disease;cohort analysis;comorbidity;decubitus;delirium;dementia;diabetes mellitus;female;heart failure;hip fracture;hospital admission;human;intensive care;ischemic heart disease;kidney failure;major clinical study;male;mortality;neoplasm;priority journal;respiratory tract infection;retrospective study;risk assessment;risk factor;sex difference;skin ulcer;surgical infection;survival time;urinary tract infection;very elderly;veteran,"Ireland, A. W.;Kelly, P. J.;Cumming, R. G.",2015,,,0,
1978,Sex differences in short-term outcomes after acute ischemic stroke: The fukuoka stroke registry,"BACKGROUND AND PURPOSE - : Variable sex differences in clinical outcomes after stroke have been reported worldwide. This study aimed to elucidate whether sex is an independent risk factor of poor functional outcome after acute ischemic stroke. METHODS - : Using the database of patients with acute stroke registered in the Fukuoka Stroke Registry in Japan from 1999 to 2013, 6236 previously independent patients with first-ever ischemic stroke who were admitted within 24 hours of onset were included in this study. Baseline characteristics were assessed on admission. Study outcomes included neurological improvement, neurological deterioration, and poor functional outcome (modified Rankin Scale score, 3-6 at discharge). Logistic regression analyses were performed to evaluate the association between sex and clinical outcomes. RESULTS - : Overall, 2398 patients (38.5%) were women. Severe stroke (National Institutes of Health Stroke Scale score, ≥8) on admission was more prevalent in women than in men. The frequency of neurological improvement or deterioration during hospitalization was not different between the sexes. After adjusting for possible confounders, including age, stroke subtype and severity, risk factors, and poststroke treatments, it was found that female sex was independently associated with poor functional outcome at discharge (odds ratio, 1.30; 95% confidence interval, 1.08-1.57). There was heterogeneity of the association between sex and poor outcome according to age: women had higher risk of poor outcome than men among patients aged ≥70 years, but no clear sex difference was found in patients aged <70 years. CONCLUSIONS - : Female sex was associated with the risk of poor functional outcome at discharge after acute ischemic stroke.",anticoagulant agent;antidiabetic agent;antihypertensive agent;aged;anticoagulant therapy;antihypertensive therapy;article;brain infarction;brain ischemia;cardioembolic stroke;diabetes mellitus;diabetic patient;disease association;disease course;drinking behavior;dyslipidemia;female;fibrinolytic therapy;atrial fibrillation;hospitalization;human;hypertension;ischemic heart disease;length of stay;major clinical study;male;mental deterioration;National Institutes of Health Stroke Scale;outcome assessment;priority journal;Rankin scale;rehabilitation care;risk factor;sex difference;smoking;stroke patient,"Irie, F.;Kamouchi, M.;Hata, J.;Matsuo, R.;Wakisaka, Y.;Kuroda, J.;Ago, T.;Kitazono, T.;Ishitsuka, T.;Fujimoto, S.;Ibayashi, S.;Kusuda, K.;Arakawa, S.;Tamaki, K.;Sadoshima, S.;Irie, K.;Fujii, K.;Okada, Y.;Yasaka, M.;Nagao, T.;Ooboshi, H.;Omae, T.;Toyoda, K.;Nakane, H.;Sugimori, H.;Fukuda, K.;Fukushima, Y.",2015,,,0,
1979,Antihistamine-associated myoclonus: A case report,,allopurinol;amlodipine;arotinolol;aspartate aminotransferase;candesartan;clonazepam;diazepam;epinastine;furosemide;oxatomide;aged;Alzheimer disease;aspartate aminotransferase blood level;brain atrophy;cardiomegaly;case report;cognitive defect;drug induced disease;drug withdrawal;flapping tremor;heart left ventricle hypertrophy;human;hypertension;hyperuricemia;involuntary movement;letter;male;Mini Mental State Examination;myoclonus;nuclear magnetic resonance imaging;priority journal;prurigo;urea nitrogen blood level,"Irioka, T.;Machida, A.;Yokota, T.;Mizusawa, H.",2008,,,0,
1980,An approach to the management of medical problems in demented patients,"Because Alzheimer's disease and other forms of dementia predominantly occur in older persons, other acute and chronic medical illnesses can be expected to accompany the cognitive disorder. As life expectancy for older persons and demented patients increases, management of medical illnesses in patients with dementia will become increasingly problematic. Skillful management of medical illnesses is particularly important among these patients for several reasons. First, the activity of medical problems influences cognitive performance. Just as cognition is impaired with nonspecific stress such as insufficient sleep, poor nutrition, and psychologic pressure, there is evidence that poor control of chronic medical illnesses, such as diabetes and hypertension, compromise cognitive function. Since the prevalence of unrecognized medical diseases is high amont demented elderly persons, medical conditions need to be aggressively identified and treated. Second, quality of life can be compromised markedly by inattention to medical concerns. By improving mobility of arthritis, reducing dyspnea of chronic obstructive pulmonary disease and restoring exercise intolerance caused by heart disease, the demented person is given greater opportunity to experience a reasonable quality of life. Third, proper management of medical problems reduces stress on caregivers. By ensuring that treatment of medical problems is efficient and effective, caregiver burden is minimized. Symptoms of medical illness, such as arthritic pain, often constitute major contributors to caregiver stress. The combination of appropriate medical management and enlightened caregiver cooperation will be most successful in controlling patient symptoms and thereby reducing stress.",acetohexamide;antacid agent;beta adrenergic receptor blocking agent;calcium antagonist;chlorpropamide;cimetidine;dipeptidyl carboxypeptidase inhibitor;diuretic agent;glibenclamide;glipizide;glyceryl trinitrate;isosorbide;nonsteroid antiinflammatory agent;paracetamol;ranitidine;sucralfate;sulfonylurea derivative;tolazamide;tolbutamide;aged;angina pectoris;dementia;diabetes mellitus;drug indication;human;hypertension;osteoarthritis;short survey,"Irvine, P.",1988,,,0,
1981,Interaction between apolipoprotein-E and angiotensin-converting enzyme genotype in Alzheimer's disease,"Both apolipoprotein-E (apo-E) ε4 allele and angiotensin-converting enzyme (ACE) deletion (D) polymorphism have been associated with a high risk for coronary heart disease. Increased frequency of the ε4 allele has also been reported in patients with late-onset of familial and sporadic Alzheimer's disease (AD). The primary aim of this study is to examine the possible relationship between the ACE gene polymorphism and AD. The second aim of this study is to explore the relation of the ACE and apo-E genotypes with AD. Polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), and agarose gel electrophoresis techniques were used to determine the apo-E and ACE genotypes. The frequencies of ACE D and ACE insertion (I) allele among AD patients and controls were 55.7 percent versus 44.2 percent and 51.7 versus 48.2 percent, respectively. Apo-E allele frequencies in the AD group for ε2, ε3 and ε4 were, 1.7 percent, 96.5 percent, and 1.7 percent, respectively. The apo-E allele frequencies of healthy groups for ε2, ε3 and ε4 were 1 percent, 56 percent, and 1.7 percent, respectively. In conclusion ACE D and apo ε4 allele were found to be more frequent in patients with Alzheimer's disease than in the control group.",apolipoprotein E;dipeptidyl carboxypeptidase;agar gel electrophoresis;aged;allele;Alzheimer disease;article;clinical article;controlled study;disease association;DNA polymorphism;female;gene frequency;genotype;human;ischemic heart disease;male;polymerase chain reaction;protein protein interaction;restriction fragment length polymorphism,"Isbir, T.;Agaçhan, B.;Yilmaz, H.;Aydin, M.;Kara, I.;Eker, D.;Eker, E.",2001,,,0,
1982,Epidemiology of dyslipidemia in chronic kidney disease,"Dyslipidemia is an established risk factor for atherosclerotic disease, such as stroke and ischemic heart disease, and is often detected in patients with chronic kidney disease (CKD). The role of dyslipidemia in CKD progression, however, is not well understood. CKD patients are heterogeneous and may include those who are malnourished or have hypoalbuminemia associated with proteinuria and a low estimated glomerular filtration rate (eGFR). Recent intervention trials showed no clear-cut benefits of statin treatment, particularly for CKD patients on dialysis. In CKD patients, multiple confounding variables such as proteinuria and the presence of cardiovascular disease may mask the effects of statins. Among them, proteinuria is a potent predictor of CKD progression (eGFR decline) and the development of end-stage renal disease. CKD patients are at high risk not only for end-stage renal disease, but also for cardiovascular disease, infection, malnutrition, and other comorbid conditions frequently associated with the elderly population. Evaluation and the target range of treatment of dyslipidemia should be individualized. © 2014 Japanese Society of Nephrology.",bicarbonate;calcium;creatinine;high density lipoprotein cholesterol;low density lipoprotein cholesterol;phosphate;serum albumin;triacylglycerol;acute kidney failure;albuminuria;article;body mass;cerebrovascular accident;cholesterol blood level;chronic kidney disease;creatinine blood level;dementia;diabetes mellitus;dyslipidemia;end stage renal disease;glomerulus filtration rate;heart infarction;hemodialysis;history;human;hypertension;incidence;ischemic heart disease;Japan;Japanese (people);population;prevalence;proteinuria;renal replacement therapy;rhabdomyolysis;risk factor;sex difference;sudden cardiac death,"Iseki, K.",2014,,,0,
1983,Endoscopic third ventriculostomy for hydrocephalus in a patient with Klippel–Feil syndrome: a case report,A patient with Klippel–Feil syndrome presented with hydrocephalus secondary to intraventricular hemorrhage. Fusion of the cervical vertebrae may have impeded cerebrospinal fluid flow. Change in the properties of cerebrospinal fluid flow after hemorrhage may have induced noncommunicating hydrocephalus. Endoscopic third ventriculostomy was effective for the treatment of hydrocephalus associated with Klippel–Feil syndrome.,aged;article;balloon catheter;brain hemorrhage;brain interventricular foramen;case report;choroid plexus;computer assisted tomography;consciousness disorder;dementia;female;gait disorder;Glasgow coma scale;hearing impairment;heart left ventricle hypertrophy;human;hydrocephalus;Klippel Feil syndrome;laparoscopic video camera;mammillary body;musculoskeletal system parameters;nuclear magnetic resonance imaging;pituitary stalk;posterior cranial fossa volume;priority journal;takotsubo cardiomyopathy;third ventriculostomy;tuber cinereum,"Ishida, T.;Inoue, T.;Fujimura, M.;Shimoda, Y.;Ezura, M.;Uenohara, H.;Tominaga, T.",2017,,10.1002/ccr3.1063,0,
1984,The brain stem and the spinal functions at brain death and similar states (Japanese),"In two cases, brain death was caused by brain edema and highly increased cranial pressure after status epilepticus, and in one case, by rupture of a supraclinoid aneurysm of the right internal carotid artery. In the last case, suspected brain death was caused by recurrence of heart failure at the final stage of Creutzfeldt Jakob disease. The results obtained from these four cases were as follows: The shock state of 'spinal cord' or 'spinal cord and cerebrum', i.e. neural shock, was observed in all four cases, just when the patients fell into brain death or similar states. At this time, spontaneous movements, any response to stimulation and muscle tone disappeared, and abrupt fall of blood pressure was observed. In four cases, neural shock continued for 35, 40, 10 and 3 hr, respectively. Special caution was required for the judgment of brain death, because neural shock continued for a long time in certain cases and cerebrospinal shock was sometimes mistaken as brain death. Thus the judgment of brain death should be made after reappearance of the spinal reflexes, which are the signs of recovery from neural shock. Neurological changes examined were as follows: Cranial nerve reflexes: Although the corneal reflex was observed in 1 case until immediately before brain death, brain functions identified by light reaction, the pharyngeal reflex, caloric nystagmus and so on, disappeared at a considerably early stage before brain death. The orbicularis oculi and the orbicularis oris reflexes, which increase at the time of central nerve disorders, were observed after disappearance of the above mentioned reactions or reflexes. Deep tendon reflexes: The tibioadductor reflex was elicited in a brain death case, but, it was difficult to elicit the deep tendon reflexes in the lower limbs, whereas they were obtainable in the upper ones. The biceps, the triceps and the radial periosteal reflexes were observed in three brain death cases. Pathological reflexes: These were classified into two groups, i.e. physiologic flexor reflexes and reflexes relative to Babinski's sign. Although the latter disappeared in three brain death cases, the former were observed in two cases, especially in the upper limbs as with tendon reflexes. Superficial reflexes: The abdominal reflex and the plantar reflex were observed in a case of brain death. Reflexes of spinal automatism: Flexion, (extension), and massflexion reflexes were elicited by pain, touch and pressure in two cases of brain death. Sometimes they were accompanied by rotation of the head, probably elicted by the spinal accessory nerve reflex. Spontaneous movements: Flexion movements like fasciculation were observed in four limbs in two cases of brain death. These were considered to be the consequence of increased reflexes of spinal automatism. Autonomic function: Complete mydriasis was not observed in three cases of brain death, and a slight degree of anisocoria was found in two cases. Peristaltic movements were observed in two cases. Socalled abrupt fall of blood pressure and flattening of EEG are not proof of brain death, because these phenomena were observed in spinal or cerebrospinal shock before brain death in two cases.",brain artery aneurysm;brain death;brain edema;brain stem;Creutzfeldt Jakob disease;electroencephalography;epileptic state;forensic medicine;spinal cord,"Ishiguro, T.;Hayashi, M.;Kamisasa, A.",1973,,,0,
1985,Etiology and factors contributing to the severity and mortality of community-acquired pneumonia,"OBJECTIVE: Community-acquired pneumonia (CAP) remains a major cause of death. No studies have reported the use of rapid influenza diagnostic tests (RIDT) for the etiological diagnosis, and the factors contributing to severity and mortality have not yet been fully investigated. The aim of this study was to review the etiologies of CAP using RIDT and to identify risk factors related to the severity and mortality of the disease. METHODS: This retrospective study assessed these factors in hospitalized patients, with special emphasis on microbial etiology. RESULTS: A total of 1,032 patients aged 63.9+/-18.3 years were studied, 66.2% of whom were men. Microbial identification was obtained in 57.0% of the cases. The most frequent causative microbial agents were Streptococcus pneumoniae, Mycoplasma pneumoniae and the influenza virus, and the second most frequent pathogens in the patients with severe CAP and the non-survivors were S. pneumoniae and the influenza virus. Age (>/=65 years), chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus, dementia and Legionella spp. infection and polymicrobial infection were each found to be independent factors related to severity in the multivariate analysis, whereas ""unidentified pathogen"" was found to be an independent factor for non-severe CAP. Age (>/=65 years), chronic pulmonary aspergillosis, post-lung cancer surgery and severe CAP were found to be independent factors for non-survival according to a multivariate analysis. CONCLUSION: In addition to S. pneumoniae, the influenza virus was a frequent cause of CAP overall and a frequent causative pathogen in both severe cases of CAP and non-survivors. Legionella spp. infection and polymicrobial infection were found to be an independent factor for the severity of CAP along with advanced age and certain comorbidities. An advanced age, certain respiratory comorbidities and severe CAP were found to be important independent factors for the mortality of CAP.","Adult;Aged;Aged, 80 and over;Community-Acquired Infections/drug therapy/*etiology/mortality;Enzyme Inhibitors/therapeutic use;Female;Humans;Influenza, Human/diagnosis/etiology/mortality;Japan/epidemiology;Legionnaires' Disease/etiology/mortality;Male;Middle Aged;Multivariate Analysis;Neuraminidase/antagonists & inhibitors;Pneumonia/drug therapy/*etiology/mortality;Pneumonia, Mycoplasma/etiology/mortality;Pneumonia, Pneumococcal/etiology/mortality;Pneumonia, Viral/etiology/mortality;Retrospective Studies;Risk Factors","Ishiguro, T.;Takayanagi, N.;Yamaguchi, S.;Yamakawa, H.;Nakamoto, K.;Takaku, Y.;Miyahara, Y.;Kagiyama, N.;Kurashima, K.;Yanagisawa, T.;Sugita, Y.",2013,,,0,
1986,Severe cortical involvement in MV2 Creutzfeldt-Jakob disease: An autopsy case report,"MV2 type sporadic Creutzfeldt-Jakob disease (sCJD) is reported to have a long duration and marked involvement of the cerebral deep gray matter. We describe an autopsied long-surviving sCJD case of MV2. In the early stages, the patient exhibited memory impairment, attention deficit and semantic memory disorder. Diffusion-weighted MRI showed abnormal hyperintensity signals along the cerebral cortex, sparing the thalami and basal ganglia. Pathological observations included: severe spongiosis throughout the cerebral cortex, several kuru plaques and plaque-like PrP deposits in the cerebellum, with only minimal degeneration in the thalami and basal ganglia. Our case suggests that MV2 has a wide clinicopathological spectrum, which ranges from ""VV2"" to ""MM2"" type. © 2006 Japanese Society of Neuropathology.",acute heart failure;aged;article;attention deficit disorder;autopsy;basal ganglion;brain cortex;case report;cause of death;cerebellum;cerebrospinal fluid analysis;clinical feature;Creutzfeldt Jakob disease;diffusion weighted imaging;disease severity;electroencephalography;female;human;human tissue;intelligence quotient;kuru;memory disorder;neuroimaging;neuropathology;nuclear magnetic resonance imaging;priority journal;semantics;thalamus;Wechsler intelligence scale,"Ishihara, K.;Sugie, M.;Shiota, J. I.;Kawamura, M.;Kitamoto, T.;Nakano, I.",2006,,,0,
1987,Evaluation of the effects of galantamine on cardiac function in elderly patients with Alzheimer's disease,"BACKGROUND: Galantamine, a cholinesterase inhibitor, is used as a first-line drug in the treatment of Alzheimer's disease (AD). However, it may have vagotonic effects, which may cause bradycardia and/or heart block in patients with or without a history of cardiac disease. OBJECTIVE: The purpose of this study was to evaluate the effects of galantamine on electrophysiology and arterial blood pressure in elderly patients with AD. METHODS: From March 2008 through August 2009, consecutive patients >/=65 years of age were approached for enrollment and underwent a comprehensive geriatric assessment. Patients with newly diagnosed AD who were enrolled in the study were treated with galantamine extended-release capsules using a 2- to 4-week titration schedule. The starting dosage was 8 mg once daily. After 2 to 4 weeks on the initial dosage, the dosage was increased to 16 mg once daily. After another 2 to 4 weeks, if galantamine was still well tolerated, the dosage was increased to 24 mg once daily. ECG parameters and blood pressure were recorded at baseline and at each galantamine dose level (8, 16, and 24 mg/d); blood pressure was measured once daily. The study lasted -4 months after baseline assessment. RESULTS: Sixty-four patients with newly diagnosed AD were enrolled in the study, 51 of whom completed the study (28 women and 23 men; mean age, 78.5 years). No significant changes relative to baseline occurred in any of the ECG parameters or arterial blood pressure at any of the investigated dosages of galantamine. CONCLUSION: None of the dosages of galantamine investigated in this study significantly altered ECG parameters or arterial blood pressure (relative to baseline) in these elderly patients with AD.","Aged;Aged, 80 and over;Alzheimer Disease/*drug therapy;Blood Pressure/drug effects;Bradycardia/*chemically induced;Cholinesterase Inhibitors/administration & dosage/*adverse effects/therapeutic;use;Delayed-Action Preparations;Diagnostic and Statistical Manual of Mental Disorders;Dose-Response Relationship, Drug;Female;Galantamine/administration & dosage/*adverse effects/therapeutic use;Heart Block/*chemically induced;Humans;Male;Nootropic Agents/administration & dosage/*adverse effects/therapeutic use;Patient Dropouts","Isik, A. T.;Bozoglu, E.;Naharci, M. I.;Kilic, S.",2010,Oct,10.1016/j.amjopharm.2010.09.001,0,
1988,"The effects of sitagliptin, a DPP-4 inhibitor, on cognitive functions in elderly diabetic patients with or without Alzheimer's disease","Aims The present study aimed to evaluate effect of sitagliptin, a dipeptidyl peptidase-4 inhibitor (DPP-4I), on cognitive functions in elderly diabetic patients with and without cognitive impairment. Methods 253 elderly patients with type 2 DM, were enrolled in this prospective and observational study. After comprehensive geriatric assessment, the patients were divided into either sitagliptin or non-sitagliptin group. Results A total of 205 patients who completed the study (52 with Alzheimer's Disease (AD)) were re-evaluated 6 months later. Sixth-month evaluation revealed no difference between sitagliptin and non-sitagliptin groups in terms of weight, body mass index, and HbA1c (p > 0.05). However, the number of patients that required reduced insulin dose was significantly higher in the sitagliptin group (p = 0.01). Sitagliptin therapy was associated with an increase in the Mini-Mental State Examination (MMSE) scores (p = 0.034); patients without AD receiving only sitagliptin or insulin showed higher MMSE scores as compared to the patients receiving metformin alone (p = 0.024). Likewise, the change in MMSE scores in AD patients receiving sitagliptin was significant and indicated improvement as compared to the patients receiving metformin (p = 0.047). Conclusion Besides its effects similar to those of insulin and metformin in glycemic control and in reducing need for insulin, 6-month sitagliptin therapy may also associated with improvement of cognitive function in elderly diabetic patients with and without AD. Further randomized controlled trials are needed to support these results.",albumin;cholinesterase inhibitor;cyanocobalamin;folic acid;glucose;hemoglobin A1c;insulin;low density lipoprotein cholesterol;memantine;metformin;sitagliptin;thyrotropin;triacylglycerol;activity of daily living assessment;aged;Alzheimer disease;article;body mass;body weight;cardiovascular disease;chronic obstructive lung disease;cognition;cognitive defect;comorbidity;congestive heart failure;controlled study;coronary artery disease;daily life activity;depression;diabetic patient;disease duration;drug efficacy;drug tolerability;female;geriatric assessment;Geriatric Depression Scale;glucose blood level;glycemic control;human;hypertension;hypoglycemia;major clinical study;male;Mini Mental State Examination;Mini Nutritonal Assessment Short Form;non insulin dependent diabetes mellitus;nutritional assessment;observational study;oral glucose tolerance test;peripheral vascular disease;prevalence;prospective study;risk factor;scoring system,"Isik, A. T.;Soysal, P.;Yay, A.;Usarel, C.",2017,,10.1016/j.diabres.2016.12.010,0,
1989,Comorbidity and Survival in Lung Cancer Patients,"BACKGROUND: As the population of the United States ages, there will be increasing numbers of lung cancer patients with comorbidities at diagnosis. Comorbid conditions are important factors in both the choice of the lung cancer treatment and outcomes. However, the impact of individual comorbid conditions on patient survival remains unclear. METHODS: A population-based cohort study of 5,683 first-time diagnosed lung cancer patients was captured using the Nebraska Cancer Registry (NCR) linked with the Nebraska Hospital Discharge Data (NHDD) between 2005 and 2009. A Cox proportional hazards model was used to analyze the effect of comorbidities on the overall survival of patients stratified by stage and adjusting for age, race, sex, and histologic type. RESULTS: Of these patients, 36.8% of them survived their first year after lung cancer diagnosis, with a median survival of 9.3 months for all stages combined. In this cohort, 26.7% of the patients did not have any comorbidity at diagnosis. The most common comorbid conditions were chronic pulmonary disease (52.5%), diabetes (15.7%), and congestive heart failure (12.9%). The adjusted overall survival of lung cancer patients was negatively associated with the existence of different comorbid conditions such as congestive heart failure, diabetes with complications, moderate or severe liver disease, dementia, renal disease, and cerebrovascular disease, depending on the stage. CONCLUSIONS: The presence of comorbid conditions was associated with worse survival. Different comorbid conditions were associated with worse outcomes at different stages. IMPACT: Future models for predicting lung cancer survival should take individual comorbid conditions into consideration.","Adolescent;Adult;Aged;Child;Child, Preschool;Comorbidity/trends;Diabetes Mellitus/*epidemiology;Female;Heart Failure/*epidemiology;Humans;Infant;Infant, Newborn;Kaplan-Meier Estimate;Lung Neoplasms/*epidemiology;Male;Middle Aged;Nebraska/epidemiology;Pulmonary Disease, Chronic Obstructive/*epidemiology;Retrospective Studies;Risk Assessment/*methods;Risk Factors;*SEER Program;Survival Rate/trends;Young Adult","Islam, K. M.;Jiang, X.;Anggondowati, T.;Lin, G.;Ganti, A. K.",2015,Jul,10.1158/1055-9965.epi-15-0036,0,
1990,Individualizing glycemic targets in type 2 diabetes mellitus: Implications of recent clinical trials,,"2,4 thiazolidinedione derivative;creatinine;glucose;hemoglobin A1c;incretin;insulin;metformin;sulfonylurea derivative;albuminuria;Alzheimer disease;article;autonomic neuropathy;blood glucose monitoring;cardiovascular disease;cerebrovascular disease;cognition;comorbidity;creatinine blood level;dementia;diabetic microangiopathy;diabetic neuropathy;diabetic patient;diabetic retinopathy;disease duration;disease severity;drug targeting;edema;fracture;gastrointestinal symptom;glucose blood level;glycemic control;health education;heart failure;heart infarction;high risk patient;human;hypoglycemia;insulin hypoglycemia;insulin treatment;intensive care;Japanese (people);mental health;microalbuminuria;Mini Mental State Examination;non insulin dependent diabetes mellitus;outcome assessment;patient satisfaction;priority journal;quality of life;secondary prevention;self care;side effect;social psychology;socioeconomics;weight gain","Ismail-Beigi, F.;Moghissi, E.;Tiktin, M.;Hirsch, B.;Inzucchi, S. E.;Genuth, S.",2011,,,0,
1991,"A study comparing the safety and effects of a new compound, ACI-35 with placebo in patients with mild to moderate Alzheimer's disease","Inclusion criteria: 1. Probable AD according to NINCDS-ADRDA criteria 2. Age equal to or over 60 and equal to or less than 85 years 3. Mini-Mental Status Examination (MMSE) 18 ? 28 points at screening 4. Patient must be receiving a stable dose of acetylcholinesterase inhibitors for at least 3 months prior to screening 5. Patient cared for by a reliable spouse or other live-in caregiver who gives written consent to assist with clinical assessments and report safety issues 6. Patient who in the opinion of the investigator are able to understand and sign written informed consent, and to comply with all study procedures (Note that consent must be obtained prior to conducting any trial-related procedures) 7. Women must be post-menopausal for at least one year and/or surgically sterilized 8. Female partner of male patients who are not postmenopausal or surgically sterilized must use reliable contraceptive measures e.g. double barrier contraception or hormonal contraception Exclusion criteria: 1. MRI scan at screening which shows an alternative cause other than AD for the dementia, e.g. space occupying lesions, hydrocephalus, significant vascular disease 2. Any medical conditions other than AD which may confound the assessment of cognition performance, e.g. Parkinson?s disease, Lewy Body Dementia, vascular dementia 3. Any medical conditions (e.g. uncontrolled epilepsy, uncontrolled hypertension) which would hamper safety assessments and/or alter the ability to complete the study 4. Significant hearing or visual impairment or other issues judged relevant by the investigator preventing to comply with the protocol and to perform the outcome measures 5. Patient receiving any anticoagulant drug, or aspirin at doses greater than 100 mg daily 6. Patient receiving memantine 7. Use of tricyclic antidepressants, neuroleptics, systemic corticosteroids, immune modifying drugs including cyclosporine and mycophenolate 8. History of hemorrhagic stroke 9. History of non-hemorrhagic stroke or myocardial infarction within one year before screening 10. History of major depression, bipolar disorders, schizophrenia or other major psychiatric disorder according to DSM-5 11. History of sustained behavioural disturbances secondary to Alzheimer?s disease such as hallucinations, delusions, agitation or nocturnal behavioural disturbances 12. History of inflammatory neurology disorders including meningoencephalitis 13. History of autoimmune disease with potential for CNS involvement 14. History of cancer other than localized skin cancer within the past 5 years before screening 15. Vascular dementia according to NINDS-AIREN criteria 16. Severe infections or a major surgical operation within 3 months prior to screening 17. History of chronic or recurrent infectious or inflammatory conditions such as recurrent urinary tract infections which could hamper interpretation of safety 18. Abuse of drug or alcohol within the past five years 19. Clinically significant abnormal vital signs (including sustained sitting blood pressure greater than 160/90 mm Hg) 20. Clinically significant arrhythmias or other abnormalities on ECG at screening. (Minor abnormalities documented as clinically insignificant by the investigator will be allowed) 21. Clinically significant abnormalities of clinical haematology or biochemistry including, but not limited to, elevations greater than 1.5 times the upper limit of normal of SGOT, SGPT, or creatinine at screening 22. Elevated prothrombin or partial thromboplastin time at screening 23. Positive syphilis serology, Hepatitis B or C at screening 24. Vitamin B12 or folate deficiency or hypothyroidism unless on replacement therapy for at least 3 months prior screening 25. Any vaccine received within the past 2 months before screening, including influenza vaccine which if indicated must be given at least 8 weeks prior to screening 26. Previously received AD immune therapeutic agents or vaccines 27. Previously received Tau immune therapeutic agents or vaccines or investigational agents targeting Tau pathology 28. Patient anticipate to rece ve any vaccination other than influenza vaccine during the study 29. MRI examination cannot be done for any reason, including metal implants contraindicated for MRI studies and claustrophobia 30. Patient who has donated blood or blood products during the 30 days prior to screening or who plan to donate blood while participating in the study or within four weeks after completion of the study. <Condition>Alzheimer's disease Mental and Behavioural Disorders Alzheimer's disease</Condition> Participants are randomly allocated to one of four groups using a secure interactive web based randomisation system. Group 1: Receive a low dose of ACI-35 on a stable dosing regime of 5 administrations over a 6 month period Group 2: Receive a medium dose of ACI-35 on a stable dosing regime of either 3 or 5 administrations over a 6 month period Group 3: Receive a high dose of ACI-35 on a stable dosing regime of either 2 or 3 administrations over a 6 month period Group 4: Receive a placebo on a stable dosing regime of either 2, 3 or 5 administrations over a 6 month period In each group, this will be followed by a late booster injection about 6 months or 16 months after the initial dosing period. This will be followed by a treatment free safety follow up period of 6 months. 1. Adverse events are measured by recording vital signs and completing a physical and neurological examination at each clinic visit 2. Routine haematology and biochemistry in blood and urine is measured at baseline and periodically every second or four weeks in the initial 3 months of treatment, then every 3 months until the end of the study 3. Five MRI and ECG measurements are taken during the entire study duration. Two lumbar punctures for cerebrospinal fluid (CSF) drawing are done at baseline and after one year of treatment. 4. Immunogenicity (antibody titre response against pTau) is measured using blood samples drawn at each visit and measured at specific interim analyses, after 6 and 12 months of treatment, as well as after the safety follow-up period is completed 1. Antibody titre response is measured using blood samples which are drawn at each visit and measured at specific interim analyses, after 6 and 12 months of treatment, as well as after the safety follow-up period is completed 2. Biomarkers are measured using blood samples drawn at baseline and periodically every second or four weeks in the initial 3 months of treatment, then every 3 months until the end of the study. The biomarkers will be measured at specific interim analyses, after 6 and 12 months of treatment, as well as after the safety follow-up period is completed 3. Cognitive and Clinical Effects are measured using ADAS-cog, MMSE, Trail Making Test and Fluency Tests and the Clinical Global Impression of Change Disability Assessment in Dementia and Neuropsychiatric Inventory Scale at baseline, 14, 26, 50 and 60 weeks",Sr-dementia,Isrctn,2015,,,0,
1992,Effect of a dual intervention in elderly heart failure patients with cognitive impairment and their caregivers after hospital discharge: a randomized controlled trial,"Inclusion criteria: Consecutive patients diagnosed with acute HF and discharged from the Geriatric Service of the Cáceres Hospital Complex (Spain) are included. The patients are diagnosed according to the criteria of the European Society of Cardiology and must have: 1. A hospital stay of more than 2 days 2. A responsible caregiver After inclusion and exclusion criteria are reviewed, patients/caregivers will be asked if they would be willing to take a cognitive screening test and potentially participate in the study. If cognitive impairment is present they will be included in the study after patients and caregivers to sign informed consent. Exclusion criteria: 1. Terminal patients (with an expected survival of less than 6 months) 2. Bedridden patients 3. Patients with severe dementia (Global Deterioration Scale grade 7) or other serious psychiatric disease 4. Patients who were impossible to follow up 5. Patients in retirement homes 6. Patients or caregivers who refused to participate <Condition>Heart failure; Disease management programs; Elderly patients; Cognitive Impairment. Circulatory System</Condition> Intervention group: The disease management program (DMP) has four main components: 1. Educational intervention on management of heart failure (HF) to improve patient and caregiver's knowledge of the disease and management skills 2. Monitoring and improvement of therapy according to international guidelines 3. Monitoring of clinical, functional, neuropsychological status and comorbidity of the patient 4. Monitoring of caregiver burden and social network The intervention program consists of two phases: 1. First phase: prior to discharge the DMP multidisciplinary team, consisting of a geriatrician (case manager), a nurse and a social worker assesses and has an in-depth interview with the patients and their caregivers. Later the patients and their caregivers receive formal education session about the disease using an information manual explaining details regarding the disease, such as diet, weight control, exercise, lifestyle, and medication, as well as how to recognize cardiac decompensation symptoms, following the guidelines of de ESC. The educational session is adapted to the degree of cognitive impairment (CI) of the patient and it is focused in the caregiver. In addition, the case manager provides information to the caregiver about the process of CI, their symptoms and their management. As support material they will be given an informative manual on HF and manual control recommendations of psychological and behavioral symptoms related to CI. 2. Second phase: regular follow-up is scheduled. Nurse contact each patient, via telephone, 48 hours after the hospital discharge, to record any problems. After 10 days, the team examines the patients/caregivers in the geriatric day care hospital (GDCH), using educational reinforcements and evaluating for possible cardiac decompensation. The subsequent follow-ups occur at the GDCH, 1 and 3 months after the hospital discharge. During these programmed sessions, the team assesses the patients/caregivers for treatment complian Event-free survival, defined as the time elapsed until the first readmission or until death of the patient for any cause during the study period. The hospital readmissions (total and HF-related) and mortality (total or HF-related) are accounted for. For event-free patients, the data were censored on the last day of the study. The event-free variable is tested using the Kaplan-Meier survival curve and the log-rank test. A sequential survival analysis is performed, using the Cox model, to determine if the treatment of the patients is an independent event predictor after adjustment for other relevant covariables. 1. Caregiver's knowledge of the disease (HF) and management skills, using a 15-question scale developed by DeWalt et al (Patient Education and Counseling 55 (2004) 78?86) and management skills, assessed using the European Heart Failure Self-care Behaviour Scale (EHFScBS). Scales scores at baseline and 6 months will be calculated for each group in he t ial estimating the effect of the DMP as the difference between groups 2. Adherence to treatment, assessed via interview and Morisky-Green test score at baseline and 6 months 3. Change during the study in control of neuropsychiatric symptoms, assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q) scores at baseline and 6 months 4. The effect of the DMP on caregiver burden, estimated as the change in the Caregiver Burden Interview during the study 5. Cost analysis, assessed via the difference between groups in sanitary system direct costs",Sr-dementia,Isrctn,2016,,,0,
1993,Ethical perspectives on pharmacogenomic profiling in the drug development process,"Pharmacogenomics, which is a field that encompasses the study of genetic polymorphisms that underlie individual differences in drug response, is rapidly advancing. The potential for the widespread use of pharmacogenomics in the drug development process merits an examination of its fundamental impact on clinical-trial design and practice. This article provides a critical analysis of some of the issues that pertain to pharmacogenomics in the drug development process. In particular, four areas will be discussed: clinical-trial design; subject stratification; some new social risks; and economic concerns. Recommendations are offered for addressing the issues that are discussed and anticipating the regulatory needs for pharmacogenomics-based trials.",amoxicillin;antihypertensive agent;clozapine;generic drug;montelukast;new drug;omeprazole;orphan drug;pravastatin;tacrine;zileuton;Alzheimer disease;article;asthma;clinical practice;clinical trial;coronary artery atherosclerosis;cost effectiveness analysis;drug approval;drug efficacy;drug legislation;drug marketing;drug research;drug response;drug safety;drug screening;drug synthesis;economic aspect;experimental design;peptic ulcer;gene expression profiling;genetic polymorphism;human;pharmacogenomics;postmarketing surveillance;priority journal;risk assessment;schizophrenia;social aspect,"Issa, A. M.",2002,,,0,
1994,Retrospective multicenter study of surgical treatments for osteoporotic vertebral fractures,"Background. Although many surgical procedures are available for treating osteoporotic vertebral fractures, there have been no comprehensive multicenter surveys in Japan focusing on surgical treatments for these fractures. This study aimed at (1) conducting a retrospective multicenter study to survey surgical treatments performed at referral center hospitals in various regions in Japan and (2) analyzing situations and problems related to the surgical treatments of osteoporotic vertebral fractures in Japanese hospitals. Methods. Among 738 patients who were hospitalized in 13 hospitals in various regions in Japan between 2005 and 2006 for osteoporotic vertebral fractures, 84 patients (11.4%) who underwent spinal surgery were enrolled. These patients were retrospectively analyzed regarding cause of injury, preoperative symptoms, preoperative neurological function, surgical procedures, periods of bed rest, length of hospital stay, and ambulatory status at discharge from hospital. Results. As to the cause of spinal fracture, 38 patients (45% of the surgical patients) could not identify a specifi c cause of their spinal fracture. Preoperative neurological motor weakness in legs was observed in 41 (49%). With regard to surgical treatment, posterior spinal reconstruction surgery was performed in 50 patients (60%), vertebroplasty in 26 (31%), anterior reconstruction surgery in 6 (7%), anterior and posterior combined reconstruction surgery in 1, and posterior decompression alone in 1 patient. In all, 70 patients (83.3%), whose periods of hospital stay averaged 52.8 days, could walk by themselves at the time of discharge; 14 (16.7%), whose periods of hospital stay averaged 44.7 days, could not walk by themselves at the time of discharge. Conclusions. Even after a large variety of surgical procedures were tried to treat osteoporotic vertebral fractures and long hospital stays, about 17% of the patients were unable to walk by themselves at the time of discharge from hospital. © The Japanese Orthopaedic Assocation.",acute heart infarction;adult;aged;article;brace;controlled study;dementia;depression;female;fragility fracture;gastrointestinal hemorrhage;human;intermethod comparison;Japan;length of stay;limb weakness;long term care;major clinical study;male;patient care;percutaneous vertebroplasty;plastic surgery;preoperative evaluation;prosthesis loosening;pseudomembranous colitis;spinal cord decompression;spinal cord injury;urinary tract infection;spine fracture,"Ito, M.;Harada, A.;Nakano, T.;Kuratsu, S.;Deguchi, M.;Sueyoshi, Y.;MacHida, M.;Yonezawa, Y.;Matsuyama, Y.;Wakao, N.",2010,,,0,
1995,Clinical courses of two male siblings with Fabry disease on hemodialysis,"Fabry disease is an X-linked recessive disease resulting from a deficiency of the lysosomal hydrolase α-galactosidase A. In male patients with the classic hemizygous form, acroparesthesias, hypohidrosis, corneal opacities, and dysfunction of the heart, brain, and kidney are observed. Recently, it was reported that 0.5-1.2% of male chronic hemodialysis (HD) patients were diagnosed as having Fabry disease based on the measurement of α-galactosidase A activity. Fabry disease is thought to be an important cause of end-stage renal disease. There are a few reports of patients with Fabry disease on long-term HD. Here we report two male siblings with classical type Fabry disease on HD. They had acroparesthesias, and hypohidrosis. Their mother had severe heart failure due to a heterozygous form of Fabry disease. Case 1 is a 44-year-old male. He had mid-cerebral apoplexy at 30 years of age. He started maintenance HD in 2000. Remarkable left ventricular hypertophy and conduction disorders of the heart were found. In 2004, he collapsed and ventricular-tachycardia and severe hypoxic brain damage were found. Now his consciousness level has been in the range of 100 to 300 on the Japan Coma Scale. Case 2 is a 40-year-old male. He started maintenance HD in 1993. Malnutrition due to chronic diarrhea and severe ischemic change in the brain were found. In 1998, he had severe joint pain of shoulders and fingers with ectopic calcifications detected by X ray. The ectopic calcifications were extended to the whole body. In 2004, his dementia by ischemic change in the brain has rapidly progressed. In conclusion, cardiovascular complications, cerebrovascular manifestations, painful ectopic carcifications, and chronic diarrheas in our patients were considered to be specific symptoms of Fabry disease. Young HD patients with these symptoms will need to be examined for Fabry disease.",alpha galactosidase;lysosome enzyme;adult;anhidrosis;arthralgia;article;brain dysfunction;brain hypoxia;calcification;case report;cerebrovascular accident;chronic diarrhea;controlled study;cornea opacity;dementia;disease course;enzyme activity;enzyme deficiency;Fabry disease;heart disease;heart failure;heart left ventricle hypertrophy;heart muscle conduction disturbance;heart ventricle tachycardia;hemizygosity;hemodialysis;human;kidney dysfunction;kidney failure;male;malnutrition;paresthesia;sibling;X chromosome recessive disorder;X ray analysis,"Itoh, K.;Tanaka, M.;Matsushita, K.;Miyamura, N.;Nishida, K.;Araki, E.;Nonoguchi, H.;Tomita, K.",2005,,,0,
1996,Atherosclerosis is not implicated in association of APOE ε4 with AD,,apolipoprotein E;adult;aged;allele;Alzheimer disease;aorta;autopsy;basilar artery;brain atherosclerosis;controlled study;coronary artery atherosclerosis;genotype;human;human tissue;internal carotid artery;major clinical study;neurofibrillary tangle;note;pathogenesis;priority journal;risk factor;senile plaque;vascular amyloidosis,"Itoh, Y.;Yamada, M.;Sodeyama, N.;Suematsu, N.;Matsushita, M.;Otomo, E.;Mizusawa, H.",1999,,,0,
1997,Long-term safety and tolerability of bapineuzumab in patients with Alzheimer's disease in two phase 3 extension studies,"Background: Immunotherapy with monoclonal antibodies that target amyloid beta has been under investigation as a treatment for patients with Alzheimer's disease (AD). The 3000 and 3001 phase 3 clinical studies of intravenous bapineuzumab assessed safety and efficacy in patients with mild to moderate AD recruited in over 26 countries. This article describes the long-term safety and tolerability of bapineuzumab in the extension studies for these two protocols. Methods: The long-term safety and tolerability of intravenous-administered bapineuzumab in patients with AD was evaluated in apolipoprotein E ϵ4 allele noncarriers (Study 3002, extension of Study 3000) and apolipoprotein E ϵ4 allele carriers (Study 3003, extension of Study 3001). Those receiving bapineuzumab in the parent study were continued at the same dose; if receiving placebo, patients began bapineuzumab. Bapineuzumab doses were 0.5 mg/kg in both studies and also 1.0 mg/kg in the noncarrier study. Clinical efficacy of bapineuzumab was also assessed in exploratory analyses. Results: Because of lack of efficacy in two other phase 3 trials, the parent protocols were stopped early. As a result, Studies 3002 and 3003 were also terminated. In total, 492 and 202 patients were enrolled in Studies 3003 and 3002, respectively. In apolipoprotein E ϵ4 carriers (Study 3003), treatment-emergent adverse events occurred in 70.7 % of the patients who originally received placebo and 66.9 % of those who originally received bapineuzumab. In noncarriers, treatment-emergent adverse events occurred in 82.1 % and 67.6 % of patients who received placebo + bapineuzumab 0.5 mg/kg and placebo + bapineuzumab 1.0 mg/kg, respectively, and in 72.7 % and 64.3 % of those who received bapineuzumab + bapineuzumab 0.5 mg/kg and 1.0 mg/kg, respectively. Amyloid-related imaging abnormalities with edema or effusions were the main bapineuzumab-associated adverse events in both studies, occurring in approximately 11 % of placebo + bapineuzumab and 4 % of bapineuzumab + bapineuzumab groups overall. Exploratory analyses of clinical efficacy were not significantly different between groups in either study. Conclusions: In these phase 3 extension studies, intravenous bapineuzumab administered for up to approximately 3 years showed no unexpected safety signals and a safety profile consistent with previous bapineuzumab trials. Trial registration: Noncarriers (Study 3002): ClinicalTrials.gov NCT00996918. Registered 14 October 2009. Carriers (Study 3003): ClinicalTrials.gov NCT00998764. Registered 16 October 2009.",NCT00996918;NCT00998764;apolipoprotein E4;bapineuzumab;Alzheimer disease;anxiety;article;brain edema;brain hemorrhage;cardiomyopathy;diarrhea;disease duration;drug dose reduction;drug efficacy;drug fatality;drug response;drug safety;drug tolerability;drug treatment failure;drug withdrawal;female;gait disorder;gastroenteritis;headache;heart failure;human;major clinical study;male;multicenter study;phase 3 clinical trial;priority journal;rhinopharyngitis;side effect;treatment duration;treatment outcome;urinary tract infection,"Ivanoiu, A.;Pariente, J.;Booth, K.;Lobello, K.;Luscan, G.;Hua, L.;Lucas, P.;Styren, S.;Yang, L.;Li, D.;Black, R. S.;Brashear, H. R.;McRae, T.",2016,,,0,
1998,Agreement between nosologist and cardiovascular health study review of deaths: implications of coding differences,"OBJECTIVES: To compare nosologist coding of underlying cause of death according to the death certificate with adjudicated cause of death for subjects aged 65 and older in the Cardiovascular Health Study (CHS). DESIGN: Observational. SETTING: Four communities: Forsyth County, North Carolina (Wake Forest University); Sacramento County, California (University of California at Davis); Washington County, Maryland (Johns Hopkins University); and Pittsburgh, Pennsylvania (University of Pittsburgh). PARTICIPANTS: Men and women aged 65 and older participating in CHS, a longitudinal study of coronary heart disease and stroke, who died through June 2004. MEASUREMENTS: The CHS centrally adjudicated underlying cause of death for 3,194 fatal events from June 1989 to June 2004 using medical records, death certificates, proxy interviews, and autopsies, and results were compared with underlying cause of death assigned by a trained nosologist based on death certificate only. RESULTS: Comparison of 3,194 CHS versus nosologist underlying cause of death revealed moderate agreement except for cancer (kappa=0.91, 95% confidence interval (CI)=0.89-0.93). kappas varied according to category (coronary heart disease, kappa=0.61, 95% CI=0.58-0.64; stroke, kappa=0.59, 95% CI=0.54-0.64; chronic obstructive pulmonary disease, kappa=0.58, 95% CI=0.51-0.65; dementia, kappa=0.40, 95% CI=0.34-0.45; and pneumonia, kappa=0.35, 95% CI=0.29-0.42). Differences between CHS and nosologist coding of dementia were found especially in older ages in the sex and race categories. CHS attributed 340 (10.6%) deaths due to dementia, whereas nosologist coding attributed only 113 (3.5%) to dementia as the underlying cause. CONCLUSION: Studies that use only death certificates to determine cause of death may result in misclassification and potential bias. Changing trends in cause-specific mortality in older individuals may be a function of classification process rather than incidence and case fatality.","Aged;Aged, 80 and over;Cause of Death;Coronary Disease/*mortality;*Death Certificates;Female;*Forms and Records Control;Humans;Longitudinal Studies;Male;Stroke/*mortality","Ives, D. G.;Samuel, P.;Psaty, B. M.;Kuller, L. H.",2009,Jan,10.1111/j.1532-5415.2008.02056.x,0,
1999,An autopsy case of a centenarian with the pathology of senile dementia of the neurofibrillary tangle type,"A Japanese woman showed slowly progressive memory disturbance since the age of 85 years. Later, disorientation gradually appeared. Head computed tomography revealed severe hippocampal atrophy, particularly in the posterior portion, and lateral ventricular dilatation, particularly in the inferior horn at the age of 99 years. The amygdala was relatively preserved from atrophy, and atrophy of the frontal lobe was relatively mild for her age. Apolipoprotein E gene analysis showed the ε3 homozygous phenotype. The woman died at the age of 101 years, and her clinical diagnosis was mild Alzheimer's disease. No apparent behavioural and psychological symptoms of dementia were observed during the disease course. Autopsy revealed severe hippocampal atrophy with numerous neurofibrillary tangles and ghost tangles, particularly in the hippocampal region, but senile plaques were rarely observed in the brain. The pathological findings were compatible with senile dementia of the neurofibrillary tangle type, whereas other neurodegenerative disorders were not recognized. The clinicopathologic findings of the present case are considered significant for the clinical diagnosis and pathogenesis of senile dementia of the neurofibrillary tangle type.",apolipoprotein E;acute heart failure;aged;Alzheimer disease;amygdala;article;autopsy;brain atrophy;case report;cause of death;computer assisted tomography;female;frontal lobe;hearing impairment;homozygosity;human;human tissue;hydrothorax;Japanese (people);kyphosis;mental deterioration;neurofibrillary tangle;senile dementia;very elderly,"Iwasaki, Y.;Deguchi, A.;Mori, K.;Ito, M.;Mimuro, M.;Yoshida, M.",2017,,10.1111/psyg.12198,0,
2000,Clinicopathologic findings of argyrophilic grain dementia in a case of mild cognitive impairment converting to dementia,"An 84-year-old Japanese woman with no family history of dementia visited our memory clinic complaining of memory disturbance. Neurological examination revealed no apparent motor abnormalities, focal cerebral signs, parkinsonism, or cerebellar dysfunction. Hasegawa's Dementia Scale-Revised (HDS-R) and Mini mental state examination (MMSE) scores were 24 and 23 points, respectively. MRI revealed left-side-dominant dilatation of the inferior horn of the lateral ventricle. Although egocentric behavior was remarkable, no disturbance of intelligence was apparent at the first examination, and she was diagnosed as having mild cognitive impairment. Her memory disturbance and disorientation gradually worsened. Atrophy of the cerebrum and dilatation of the lateral ventricle advanced gradually on MRI. Two years later, she required care to perform activities of daily living. HDS-R and MMSE scores had dropped to 13 and 18 points, respectively, and conversion to dementia was diagnosed. Ability to perform 3D cube-copying was well preserved. The patient died due to acute myocardial infarction at the age of 87. The clinical diagnosis was Alzheimer disease. At autopsy, the brain weighed 1,250 g, and argyrophilic grains were widely observed in the limbic system, corresponding to Saito's stage III. Neuron loss, gliosis, spongiform change, and tissue rarefaction were recognized in the superficial layer of the parahippocampal gyrus. Ballooned neurons, pretangles, oligodendroglial coiled bodies, and neuropil threads were also observed. Neurofibrillary tangles and senile plaques, mainly consisting of diffuse plaque, were recognized as corresponding to Braak stage III and CERAD stage B, respectively. Neither Lewy nor Pick bodies were observed. Although mild phosphorylated TDP-43 immunoreactivity was observed, it was suspected to be due to secondary degeneration of tau deposition. The patient was diagnosed pathologically as having argyrophilic grain dementia. The clinical findings of the present patient reveal important observations that help to clinically discriminate between various dementias such as Alzheimer disease and argyrophilic grain dementia.",aged;argyrophilic grain dementia;article;autopsy;case report;dementia;fatality;female;Hasegawa Dementia Scale Revised;human;human tissue;memory disorder;mild cognitive impairment;Mini Mental State Examination;rating scale,"Iwasaki, Y.;Mori, K.;Ito, M.;Tatsumi, S.;Mimuro, M.;Yoshida, M.",2012,,,0,
2001,Autopsy findings in a case of dementia with Lewy bodies with marked autonomic failure and repetitive cardiopulmonary arrest,"We report herein a patient with dementia with Lewy bodies (DLB) who presented with severe autonomic failure, dementia and parkinsonism. At onset, the 70-year-old man exhibited dementia and gait disturbance. Over the next 3 years, he developed symptoms of autonomic dysfunction, such as sleep apnea, orthostatic hypotension and bladder and bowel dysfunction. Cranial magnetic resonance imaging revealed moderate frontotemporal atrophy. Single photon emission computed tomography images depicted bilateral hypoperfusion in the parietal lobes. Interestingly, recurrent episodes of cardiopulmonary arrest together with unconsciousness occurred during the 2-year period before the patient died at the age of 74. At autopsy, axial slices of the brainstem showed depigmentation of the substantia nigra and locus ceruleus. Lewy bodies were present in areas of the brainstem such as the substantia nigra, locus ceruleus, solitary nucleus, raphe nucleus and dorsal vagal nucleus and in the intermediolateral column of the spinal cord, sympathetic ganglia, parahippocampal gyrus and cerebral cortex. Neuronal loss was observed in the intermediolateral column, but neurons in the sympathetic ganglia were well preserved. On the basis of the clinical history and pathological findings, we diagnosed this as a case of DLB. There are a few reported cases of DLB associated with various manifestations of autonomic failure. In our patient, autonomic failure including cardiopulmonary arrest may have resulted from widespread impairment of the autonomic nervous system.",aged;article;autonomic dysfunction;bladder dysfunction;brain perfusion;cardiopulmonary arrest;case report;dementia;feces incontinence;gait disorder;histopathology;human;Lewy body;male;neuroimaging;nuclear magnetic resonance imaging;orthostatic hypotension;parkinsonism;single photon emission computer tomography;sleep disordered breathing,"Iwasaki, Y.;Yokokawa, Y.;Aiba, I.;Yoshida, M.",2005,,,0,
2002,One year follow up in ischemic brain injury and the role of Alzheimer factors,"Ongoing interest in brain ischemia research has provided data showing that ischemia may be involved in the pathogenesis of Alzheimer disease. Brain ischemia in the rat produces a stereotyped pattern of selective neuronal degeneration, which mimics early Alzheimer disease pathology. The objective of this study was to further develop and characterize cardiac arrest model in rats, which provides practical way to analyze Alzheimer-type neurodegeneration. Rats were made ischemic by cardiac arrest. Blood-brain barrier (BBB) insufficiency, accumulation of different parts of amyloid precursor protein (APP) and platelets inside and outside BBB vessels were investigated in ischemic brain up to 1-year survival. Ischemic brain tissue demonstrated haphazard BBB changes. Toxic fragments of APP deposits were associated with the BBB vessels. Moreover our study revealed platelet aggregates in- and outside BBB vessels. Toxic parts of APP and platelet aggregates correlated very well with BBB permeability. Progressive injury of the ischemic brain parenchyma may be caused not only by a degeneration of neurons destroyed during ischemia but also by chronic damage in BBB. Chronic ischemic BBB insufficiency with accumulation of toxic components of APP in the brain tissue perivascular space, may gradually over a lifetime, progress to brain atrophy and to full blown Alzheimer-type pathology.",amyloid precursor protein;Alzheimer disease;animal;article;atrophy;blood brain barrier;brain;brain ischemia;disease course;disease model;female;heart arrest;metabolism;nerve degeneration;pathology;permeability;rat;thrombocyte aggregation;time;Wistar rat,"Jabłoński, M.;Maciejewski, R.;Januszewski, S.;Ułamek, M.;Pluta, R.",2011,,,0,
2003,Rate of medial temporal lobe atrophy in typical aging and Alzheimer's disease,"OBJECTIVES: To determine the annual rates of volumetric change of the hippocampus and temporal horn in cognitively normal elderly control subjects and individually matched patients with AD, and to test the hypothesis that these rates were different. BACKGROUND: Cross-sectional studies consistently reveal cerebral atrophy in elderly nondemented subjects compared with healthy young adults, and greater atrophy in patients with AD relative to elderly control subjects. However, rates of atrophy are estimated most accurately by performing serial measurements in the same individuals. METHODS: MRI-based volumetric measurements of the hippocampi and temporal horns were performed in 24 cognitively normal subjects aged 70 to 89 years who were individually matched with respect to gender and age with 24 patients with AD. Each subject underwent an MRI protocol twice, separated by 12 months or more. RESULTS: The mean annual rate of hippocampal volume loss among control subjects was -1.55+/-1.38% and the temporal horns increased in volume by 6.15+/-7.69% per year. These rates were significantly greater among AD patients: hippocampus, -3.98+/-1.92% per year, p < 0.001; temporal horn, 14.16+/-8.47% per year, p = 0.002. CONCLUSION: A statistically significant yearly decline in hippocampal volume and an increase in temporal horn volume was identified in elderly control subjects who represent typical aging individuals. These rates were approximately 2.5 times greater in patients with AD than in individually age- and gender-matched control subjects.","Aged;Aged, 80 and over;Aging/*pathology;Alzheimer Disease/epidemiology/genetics/*pathology;Apolipoproteins E/genetics;Atrophy;Comorbidity;Diabetes Mellitus, Type 1/epidemiology;Female;Genotype;Hippocampus/pathology;Hormone Replacement Therapy;Humans;Hypertension/epidemiology;Male;Myocardial Ischemia/epidemiology;Prevalence;Reproducibility of Results;Risk Factors;Temporal Lobe/*pathology","Jack, C. R., Jr.;Petersen, R. C.;Xu, Y.;O'Brien, P. C.;Smith, G. E.;Ivnik, R. J.;Tangalos, E. G.;Kokmen, E.",1998,Oct,,0,
2004,Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment,"OBJECTIVE: To test the hypothesis that MRI-based measurements of hippocampal volume are related to the risk of future conversion to Alzheimer's disease (AD) in older patients with a mild cognitive impairment (MCI). BACKGROUND: Patients who develop AD pass through a transitional state, which can be characterized as MCI. In some patients, however, MCI is a more benign condition, which may not progress to AD or may do so slowly. PATIENTS: Eighty consecutive patients who met criteria for the diagnosis of MCI were recruited from the Mayo Clinic Alzheimer's Disease Center/Alzheimer's Disease Patient Registry. METHODS: At entry into the study, each patient received an MRI examination of the head, from which the volumes of both hippocampi were measured. Patients were followed longitudinally with approximately annual clinical/cognitive assessments. The primary endpoint was the crossover of individual MCI patients to the clinical diagnosis of AD during longitudinal clinical follow-up. RESULTS: During the period of longitudinal observation, which averaged 32.6 months, 27 of the 80 MCI patients became demented. Hippocampal atrophy at baseline was associated with crossover from MCI to AD (relative risk [RR], 0.69, p = 0.015). When hippocampal volume was entered into bivariate models-using age, postmenopausal estrogen replacement, standard neuropsychological tests, apolipoprotein E (APOE) genotype, history of ischemic heart disease, and hypertension-the RRs were not substantially different from that found univariately, and the associations between hippocampal volume and crossover remained significant. CONCLUSION: In older patients with MCI, hippocampal atrophy determined by premorbid MRI-based volume measurements is predictive of subsequent conversion to AD.","Aged;Aged, 80 and over;Aging/pathology;Alzheimer Disease/genetics/mortality/*pathology;Apolipoproteins E/genetics;Cognition Disorders/*pathology;Estrogen Replacement Therapy;Hippocampus/*pathology;Humans;Hypertension/pathology;Magnetic Resonance Imaging;Middle Aged;Myocardial Ischemia/pathology;Predictive Value of Tests;Survival Analysis","Jack, C. R., Jr.;Petersen, R. C.;Xu, Y. C.;O'Brien, P. C.;Smith, G. E.;Ivnik, R. J.;Boeve, B. F.;Waring, S. C.;Tangalos, E. G.;Kokmen, E.",1999,Apr 22,,0,
2005,Multimorbidity patterns are differentially associated with functional ability and decline in a longitudinal cohort of older women,"Background: we aimed to identify multimorbidity patterns and relate these patterns to functional ability and decline. Methods: we included 7,270 participants of the older cohort of the Australian Longitudinal Study on Women's Health, who were surveyed every 3 years from 2002 to 2011. We used factor analysis to identify multimorbidity patterns from 31 selfreported chronic conditions among women aged 76-81 in 2002. We applied a linear increments model to account for attrition and related the multimorbidity patterns to functional ability and decline at subsequent surveys, as measured by activities of daily living (ADL) and instrumental activities of daily living (IADL). For each pattern, we determined mean ADL and IADL scores in the middle and highest third of factor score in comparison to a reference group. Results: we identified three multimorbidity patterns, labelled musculoskeletal/somatic (MSO), neurological/mental health (NMH) and cardiovascular (CVD). High factor scores for NMH, MSO and CVD were associated with significantly higher mean ADL and IADL scores (poorer functional ability) in 2005 compared with the reference group of low factor scores for all three factors. The CVD pattern was associated with the greatest decline in ADL between 2005 and 2011, whereas the NMH pattern was associated with the greatest decline in IADL. Conclusions: distinct multimorbidity patterns were differentially associated with functional ability and decline. Given the paucity of studies on multimorbidity patterns, future studies should seek to assess the reproducibility of our findings in other populations and settings, and investigate the potential implications for improved prediction of functional decline.",activity of daily living assessment;aged;aging;allergy;Alzheimer disease;angina pectoris;anxiety disorder;arthritis;article;asthma;Australia;backache;breathing disorder;bronchitis;cardiovascular disease;cerebrovascular accident;chronic disease;cohort analysis;comorbidity;controlled study;dementia;depression;diabetes mellitus;digestive system disease;disease association;dizziness;emphysema;female;foot disease;functional disease;functional status;headache;hearing disorder;heart infarction;human;hypertension;indigestion;iron deficiency;joint stiffness;longitudinal study;migraine;musculoskeletal disease;neurologic disease;osteoporosis;priority journal;risk assessment;self report;skin cancer;thorax pain;urogenital tract disease;visual disorder,"Jackson, C. A.;Jones, M.;Tooth, L.;Mishra, G. D.;Byles, J.;Dobson, A.",2015,,,0,
2006,Toward a Clearer Portrayal of Confounding Bias in Instrumental Variable Applications,"Recommendations for reporting instrumental variable analyses often include presenting the balance of covariates across levels of the proposed instrument and levels of the treatment. However, such presentation can be misleading as relatively small imbalances among covariates across levels of the instrument can result in greater bias because of bias amplification. We introduce bias plots and bias component plots as alternative tools for understanding biases in instrumental variable analyses. Using previously published data on proposed preference-based, geography-based, and distance-based instruments, we demonstrate why presenting covariate balance alone can be problematic, and how bias component plots can provide more accurate context for bias from omitting a covariate from an instrumental variable versus non-instrumental variable analysis. These plots can also provide relevant comparisons of different proposed instruments considered in the same data. Adaptable code is provided for creating the plots.",article;atrial fibrillation;cerebrovascular disease;chronic kidney disease;confounding variable;dementia;diabetes mellitus;geography;heart failure;heart infarction;heart muscle revascularization;hyperlipidemia;instrumental variable analysis;ischemic heart disease;kidney disease;lung disease;neoplasm;nomenclature;priority journal;transient ischemic attack;treatment outcome,"Jackson, J. W.;Swanson, S. A.",2015,,,0,
2007,Predicting 2-Year Risk of Developing Pneumonia in Older Adults without Dementia,"OBJECTIVES: To develop three prognostic indices of varying degree of required detail for 2-year pneumonia risk in older adults. DESIGN: Retrospective cohort study. SETTING: Group Health (GH), an integrated healthcare delivery system. PARTICIPANTS: Community-dwelling dementia-free individuals aged 65 and older who had been GH members for at least 2 years before start of follow-up and were enrolled in the Adult Changes in Thought study (N = 3,375; development cohort, n = 2,250; validation cohort, n = 1,125. MEASUREMENTS: Potential pneumonia risk factors were identified from questionnaire data and interviewer assessments of functional status, medical history, smoking and alcohol use, cognitive function, personal care, and problem solving. Risk factors were also identified based on physical measures such as grip strength and gait speed and administrative database information on comorbid illnesses, laboratory tests, and prescriptions dispensed. Incident community-acquired pneumonia was defined presumptively from administrative data and validated using medical record review. RESULTS: Participants (59% female) contributed 12,998 visits at which risk factors were assessed; 642 pneumonia events were observed during follow-up. Age, sex, chronic obstructive pulmonary disease, congestive heart failure, body mass index, and use of inhaled or oral corticosteroids were critical predictors in all prognostic indices. A risk score based on these seven variables, information on which is commonly available in electronic medical records (EMRs), had equal or better performance (c-index = 0.69 in the validation cohort) than scores including more-detailed data such as functional status. CONCLUSION: Data commonly available in EMRs can stratify older adults into groups with varying subsequent 2-year pneumonia risk.",aged 80 and older;pneumonia;predictive value of tests,"Jackson, M. L.;Walker, R.;Lee, S.;Larson, E.;Dublin, S.",2016,Jul,10.1111/jgs.14228,0,
2008,Risk Factors for Mild Cognitive Impairment in German Primary Care Practices,"BACKGROUND: Mild cognitive impairment (MCI) is a common mental disorder affecting around 16% of elderly people without dementia. MCI is considered an intermediate state between normal cognition and dementia. OBJECTIVE: To analyze risk factors for the development of MCI in German primary care practices. METHODS: In total, 3,604 MCI patients and 3,604 controls without MCI were included between January 2010 and December 2015. Several disorders potentially associated with MCI were determined. Multivariate logistic regression models were fitted with MCI as a dependent variable and other disorders as potential predictors. RESULTS: The mean age was 75.2 years and 45.3% of patients were men. MCI development was found to be associated with 12 disorders: intracranial injury, anxiety disorder, depression, mental and behavioral disorders due to alcohol use, stroke, hyperlipidemia, obesity, hypertension, Parkinson's disease, sleep disorder, coronary heart disease, and diabetes with odds ratios ranging from 1.13 (diabetes) to 2.27 (intracranial injury). CONCLUSION: Intracranial injury, anxiety, and depression showed the strongest association with MCI. Further analyses are needed to gain a better understanding of the MCI risk factors.",Germany;mild cognitive impairment;primary practices;risk factors,"Jacob, L.;Bohlken, J.;Kostev, K.",2017,,,0,
2009,Prevalence of Use of Cardiovascular Drugs in Dementia Patients Treated in General Practices in Germany,"Background: Dementia is a chronic disease associated with numerous cardiovascular disorders. Objective: To analyze the prevalence of cardiovascular drug use in dementia patients treated in general practices in Germany. Methods: The present study included patients who were diagnosed with dementia (Alzheimer's disease, vascular dementia, or unspecified dementia) in 2015. The main outcome measure was the proportion of patients using cardiovascular drugs. Demographical and clinical variables included age, sex, dementia type, and cardiovascular co-diagnoses. A multivariate logistic regression model was used to analyze the association between cardiovascular drug use and these variables. Results: We identified 7,987 and 1,268 dementia patients with and without prescriptions for cardiovascular drugs, respectively. The share of individuals who received cardiovascular treatments was 86.3. Diuretics (20.9), beta blocking agents (20.0), and ACE inhibitors (17.4) were the three most commonly prescribed types of medications. Patients between the ages of 71-80 (OR=1.59), 81-90 (OR=1.61), and over 90 years (OR=1.48) were more likely to receive cardiovascular drugs than patients under the age of 70 years. Moreover, compared to those with unspecified dementia, individuals with Alzheimer's disease had a lower chance while those with vascular dementia had a higher chance of being prescribed these drugs (ORs equal to 0.81 and 1.22, respectively). Finally, we found a positive association between the use of cardiovascular drugs and all co-diagnoses (ORs ranging from 1.23 to 7.12). Conclusion: The prevalence of cardiovascular drug use in dementia patients was around 86. This use was significantly associated with such factors as age, type of dementia, and co-diagnoses.",beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;aged;Alzheimer disease;article;dementia;diabetes mellitus;disease association;female;general practice;Germany;heart arrhythmia;heart failure;human;hyperlipidemia;hypertension;ischemic heart disease;major clinical study;male;multiinfarct dementia;outcome assessment;prescription;prevalence;priority journal;retrospective study;very elderly,"Jacob, L.;Bohlken, J.;Kostev, K.",2017,,10.3233/jad-161234,0,
2010,Impact of comorbidities on the cost of depression drug therapy in general practices in Germany,"Background The goal of this study was to analyze the impact of comorbidities on the cost of antidepressant drug therapy in patients with depression treated in German general practices (GPs). Methods The present study included 31,741 patients diagnosed with depression and treated with antidepressant drugs in 2015. Demographic data included age, gender, and type of health insurance coverage. Twenty comorbidities were included. The study sample was stratified by age, gender, type of health insurance coverage, type of comorbidity, and number of comorbidities. The annual antidepressant treatment cost per patient was calculated based on pharmacy sale prices. The multivariate regression analysis was fitted to estimate the adjusted treatment cost differences. Results The annual cost of antidepressant drugs was €107 in the population. It was similar in men and in women (difference of €1) but was significantly higher in individuals with private health insurance coverage than in people with public health insurance coverage (difference of €63). The annual cost increased with age, from €85 in patients aged 40 years or younger to €116 in patients aged between 61 and 70 years (difference of €11), and with the number of comorbidities, from €78 when there was no comorbidity to €134 when there were more than 5 comorbidities (difference of €57). Conclusion The cost of antidepressant treatment in Germany increased with the number of comorbidities.",antidepressant agent;adjustment disorder;adult;age;aged;anxiety disorder;article;behavior disorder;cerebrovascular accident;clinical pharmacy;comorbidity;dementia;depression;diabetes mellitus;drug cost;epilepsy;female;gender;general practice;Germany;health insurance;heart failure;human;hyperlipidemia;hypertension;ischemic heart disease;kidney failure;major clinical study;male;middle aged;neoplasm;osteoarthritis;osteoporosis;Parkinson disease;phobia;population;priority journal;public health insurance;rheumatoid arthritis;somatoform disorder,"Jacob, L.;Kostev, K.",2016,,,0,
2011,"Anticoagulation for stroke prevention in elderly patients with atrial fibrillation, including those with falls and/or early-stage dementia: a single-center, retrospective, observational study","BACKGROUND: Anticoagulation for stroke prevention is underused in elderly patients with nonvalvular atrial fibrillation (AF). Those with falls and/or early dementia may be at particular risk for stroke and hemorrhage. OBJECTIVE: The aim of this study was to determine the prescribing patterns, risks, and benefits of anticoagulation with warfarin or acetylsalicylic acid (ASA) in elderly patients with AF at risk for stroke and hemorrhage, including those with falls and/or dementia. METHODS: In this single-center, retrospective, observational study, data from patients aged > or =65 years with chronic nonvalvular AF treated at an urban academic geriatrics practice over a 1-year period were included. Eligible patients were receiving noninvasive management of AF with warfarin or ASA. Data were assessed to determine the prevalences of stroke, hemorrhage, falls, and the possible effects of anticoagulation with dementia. Outcomes events at 12 months, including time-in-therapeutic range (TTR), stroke, hemorrhage, and death, were determined. The stroke risk in each patient was estimated using the CHADS(2) (congestive heart failure, hypertension, age > or =75 years, diabetes, history of stroke or transient ischemic attack) score, and the risk for hemorrhage was estimated using the Outpatient Bleeding Risk Index. RESULTS: A total of 112 patients (mean age, 82 years) were identified; 106 were included in the present analysis (80 women, 26 men); 6 were not receiving antithrombotic therapy and thus were excluded from the analysis. Warfarin was prescribed in 85% (90 patients); ASA, 15% (16). International normalized ratio testing was done frequently, with a median interval of 13.7 days between tests (92% within 28 days). No association was found between an improved TTR and the number of tests per unit of time or the number of patients per clinician. The distributions of both the CHADS(2) and Outpatient Bleeding Risk Index scores were not significantly different between the warfarin and ASA groups. The proportions of patients treated with warfarin were not significantly different between the groups with a high risk for hemorrhage and the groups at lower risk. At 12 months in the 90 patients initially treated with warfarin, the rate of stroke was 2% (2 patients); major hemorrhage, 6% (5); and death, 20% (18). Mortality was greater in patients with falls (45% [5/11]) and/or dementia (47% [8/17]) compared with those without either falls or dementia (12% [8/65]). CONCLUSIONS: In this well-monitored geriatric population with chronic AF, including patients with falls and/or dementia, a high percentage were prescribed warfarin (85%), with low rates of stroke, hemorrhage, and death at 12 months despite a low TTR. Patients with falls and/or dementia had a high mortality rate (approximately 45%).","Accidental Falls;Aged;Aged, 80 and over;Anticoagulants/adverse effects/*therapeutic use;Aspirin/adverse effects/therapeutic use;Atrial Fibrillation/complications/*drug therapy/mortality;Dementia/*complications;Female;Fibrinolytic Agents/adverse effects/therapeutic use;Hemorrhage/epidemiology/etiology;Humans;International Normalized Ratio/methods;Male;Practice Patterns, Physicians';Retrospective Studies;Risk Factors;Stroke/*prevention & control;Warfarin/adverse effects/therapeutic use","Jacobs, L. G.;Billett, H. H.;Freeman, K.;Dinglas, C.;Jumaquio, L.",2009,Jun,10.1016/j.amjopharm.2009.06.002,0,
2012,A 10-year experience with combined modality therapy for Stage III small cell lung carcinoma,"During the past 10 years, 240 patients with Stage III small cell lung carcinoma (SCLC) were treated with one of five chemotherapy programs plus thoracic irradiation. In addition, prophylactic cranial irradiation was administered concurrently with thoracic irradiation to 194 patients receiving CAML-HC, VCAM, or MOCA. Seventy-two patients had disease confined to the chest (Stage IIIM0), 30 patients had disease in the chest plus ipsilateral supraclavicular nodal involvement (Stage IIIM0(SCN+)) and 138 patients had distant metastatic disease (Stage IIIM1); the median survivals were 15.2 months, 12.6 months, and 8.4 months, respectively. The overall complete response rate was 30% and the overall response rate (complete and partial) was 76%. The overall response rates by stage were 86% for Stage IIIM0, 90% for Stage IIIM0(SCN+), and 67% for Stage IIIM1. Eight patients (3%) were alive and free of disease at 24 months. Due to continued disease relapse in this group (4 of 8 patients), long-term survivors should not be identified for a minimum of 3.5 years from the time of initial therapy. Prophylactic cranial irradiation (PCI) effectively reduced the incidence of central nervous system (CNS) relapse in patients with a complete response to therapy (44% relapse without PCI versus 13% relapse with PCI, P < 0.01). More effective chemotherapy is required for the successful treatment and improved long-term survival of patients with SCLC.",altretamine;cyclophosphamide;doxorubicin;etoposide;folinic acid;lomustine;methotrexate;vincristine;adverse drug reaction;brain radiation;cancer chemotherapy;cancer combination chemotherapy;cancer radiotherapy;cardiomyopathy;cardiotoxicity;central nervous system;dementia;drug comparison;drug efficacy;drug therapy;heart;heart arrhythmia;human;intoxication;intravenous drug administration;small cell lung cancer;major clinical study;nervous system;neurotoxicity;oral drug administration;priority journal;respiratory system;therapy,"Jacobs, R. H.;Greenburg, A.;Bitran, J. D.",1986,,,0,
2013,Post-stroke cognitive impairment: High prevalence and determining factors in a cohort of mild stroke,"Background: Because of the aging population and a rise in the number of stroke survivors, the prevalence of post-stroke cognitive impairment (PSCI) is increasing. Objective: To identify the factors associated with 3-month PSCI. Methods: All consecutive stroke patients without pre-stroke dementia, mild cognitive disorders, or severe aphasia hospitalized in the Neurology Department of Dijon, University Hospital, France (November 2010-February 2012) were included in this prospective cohort study. Demographics, vascular risk factors, and stroke data were collected. A first cognitive evaluation was performed during the hospitalization using the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MOCA). Patients assessable at 3 months were categorized as cognitively impaired if the MMSE score was ≤26/30 and MOCA <26/30 or if the neuropsychological battery confirmed PSCI when the MMSE and MOCA were discordant. Multivariable logistic models were used to determine factors associated with 3-month PSCI. Results: Among the 280 patients included, 220 were assessable at 3 months. The overall frequency of 3-month PSCI was 47.3%, whereas that of dementia was 7.7%. In multivariable analyses, 3-month PSCI was associated with age, low education level, a history of diabetes mellitus, acute confusion, silent infarcts, and functional handicap at discharge. MMSE and MOCA scores during hospitalization were associated with 3-month PSCI (OR = 0.63; 95% CI: 0.54-0.74; p < 0.0001 and OR = 0.67; 95% CI: 0.59-0.76; p < 0.0001, respectively). Conclusion: Our study underlines the high frequency of PSCI in a cohort of mild stroke. The early cognitive diagnosis of stroke patients could be useful by helping physicians to identify those at a high risk of developing PSCI. © 2014 - IOS Press and the authors. All rights reserved.",acute confusion;aged;alcohol abuse;aphasia;article;brain hemorrhage;brain infarction;brain ischemia;cognitive defect;cohort analysis;computer assisted tomography;dementia;demography;diabetes mellitus;female;follow up;France;atrial fibrillation;heart infarction;hospitalization;human;hypercholesterolemia;hypertension;leukoaraiosis;major clinical study;male;mechanical thrombectomy;mental health;Mini Mental State Examination;Montreal cognitive assessment;National Institutes of Health Stroke Scale;prevalence;priority journal;risk factor;sleep disordered breathing;statistical model;stroke patient;transient ischemic attack;university hospital;very elderly,"Jacquin, A.;Binquet, C.;Rouaud, O.;Graule-Petot, A.;Daubail, B.;Osseby, G. V.;Bonithon-Kopp, C.;Giroud, M.;Béjot, Y.",2014,,,0,
2014,Connecting the dots: Applications of network medicine in pharmacology and disease,"In 2011, >2.5 million people died from only 15 causes in the United States. Ten of these involved complex or infectious diseases for which there is insufficient knowledge or treatment, such as heart disease, influenza, and Alzheimer's disease. 1 Complex diseases have been difficult to understand due to their multifarious genetic and molecular fingerprints, while certain infectious agents have evolved to elude treatment and prophylaxis. Network medicine provides a macroscopic approach to understanding and treating such illnesses. It integrates experimental data on gene, protein, and metabolic interactions with clinical knowledge of disease and pharmacology in order to extend the understanding of diseases and their treatments. The resulting ""big picture"" allows for the development of computational and mathematical methods to identify novel disease pathways and predict patient drug response, among others. In this review, we discuss recent advances in network medicine. © 2013 American Society for Clinical Pharmacology and Therapeutics.",atorvastatin;B Raf kinase;beta adrenergic receptor blocking agent;cyclooxygenase 2;cytochrome P450 3A4;insulin;K ras protein;nonsteroid antiinflammatory agent;ritonavir;STAT1 protein;tamoxifen;acute heart infarction;Alzheimer disease;article;breast cancer;cancer chemotherapy;cancer growth;cancer prognosis;cancer survival;carcinogenesis;cerebrovascular accident;cholera;clinical pharmacology;colorectal cancer;dengue;drug targeting;estrogen receptor positive breast cancer;finger dermatoglyphics;gene;gene expression;gene p53;genetic association;genotype phenotype correlation;glioblastoma;pollen allergy;human;hypoglycemic coma;influenza;malaria;medicine;metastatic colorectal cancer;myopathy;network medicine;non insulin dependent diabetes mellitus;obesity;ovary cancer;pancreas adenocarcinoma;pancreas cancer;personalized medicine;priority journal;prostate cancer;protein protein interaction;respiratory syncytial virus infection;rhabdomyolysis;Rhinovirus infection;schizophrenia;single nucleotide polymorphism;survival rate;treatment response;triple negative breast cancer;virus cell interaction,"Jacunski, A.;Tatonetti, N. P.",2013,,,0,
2015,Clinical outcomes in patients with generalized periodic discharges,"Purpose Generalized periodic discharges (GPDs) are frequently identified in the EEGs of hospitalized patients but their prognostic significance remains unclear. We retrospectively reviewed clinical data in patients with GPDs to elucidate factors associated with in-hospital mortality. Method We reviewed data from inpatients at three different hospitals affiliated with our institution in whom GPDs were reported on routine EEGs by fellowship-trained electroencephalographers during the years 2010–2012. Cox regression was used to determine statistical association between in-hospital death and demographics, medical comorbidities, neurological and neuroimaging abnormalities and antiepileptic drug use. Results We identified 113 patients with GPDs. The mean age was 70.4 years and 70 (61.9%) were women. There were 60 inpatient deaths (53.1%). The variables significantly associated with in-hospital mortality were dementia, poor mental status at the time of the EEG, chronic focal abnormalities on neuroimaging, cardiac arrest and chronic obstructive pulmonary disease (COPD). Conclusion Dementia, poor mental status during EEG, chronic focal abnormalities on neuroimaging, cardiac arrest and COPD are independently associated with increased in-hospital mortality in patients with GPDs (P < 0.05).",anticonvulsive agent;aged;article;chronic obstructive lung disease;clinical outcome;comorbidity;comparative study;dementia;descriptive research;disease association;drug use;electroencephalogram;epileptic discharge;female;heart arrest;hospital mortality;human;major clinical study;male;mental health;neuroimaging;priority journal;retrospective study;survival analysis;tonic clonic seizure,"Jadeja, N.;Zarnegar, R.;Legatt, A. D.",2017,,10.1016/j.seizure.2016.11.025,0,
2016,How biomarkers can improve clinical drug development,"In summary, the current report describes several uses of biomarkers towards rational drug development. In our opinion, selection of the dose range and doses for further investigation in the pivotal trials is the single most important use of biomarkers. Utility of biomarker knowledge in identifying patients with important differences and in making various regulatory decisions was also presented. Better appreciation of the underlying mechanism of disease and drug action, routine collection of biomarker data and sophisticated analyses as early as possible in drug development might lead to optimal drug therapy and more efficient use of available resources.",analgesic agent;antiarrhythmic agent;antidepressant agent;beta adrenergic receptor blocking agent;biological marker;cholinesterase inhibitor;dofetilide;dutasteride;epidermal growth factor receptor 2;imatinib;metoprolol;perindopril;sotalol;trastuzumab;warfarin;Alzheimer disease;angina pectoris;article;beta adrenergic receptor blocking;chronic myeloid leukemia;clinical trial;drug approval;drug dose regimen;drug formulation;drug quality;drug release;drug selectivity;drug synthesis;genetic heterogeneity;heart arrest;heart infarction;heart ventricle fibrillation;human;hypertension;population genetics;prostate hypertrophy;tachycardia;thromboembolism;gleevec,"Jadhav, P. R.;Mehta, M. U.;Gobburu, J. V. S.",2004,,,0,
2017,Predictors of survival with Alzheimer's disease: a community-based study,"Factors associated with reduced survival were investigated in elderly people diagnosed as having Alzheimer's disease (AD) and in those free of dementia at diagnosis. The study population comprised 155 people free of dementia and 222 with AD; all were aged 75 years and over and were part of a two-stage prevalence study of dementia during 1988 in Melton Mowbray, Leicestershire. An increased risk of death was found for those with a history of heavy alcohol use, lower cognitive function, a history of heart failure and those in institutional care, these factors acting in the same manner for persons free of dementia and those with AD. For the non-demented group a greater risk of death was found with increasing age and for those with a history of cancer. A greater risk of death was found for males with AD compared to females with the risk increasing over time. The longer survival of women over men may explain the sex differences found in the prevalence of AD without accompanying differences in incidence.","Activities of Daily Living/classification;Aged;Aged, 80 and over;Alzheimer Disease/diagnosis/*mortality;Cause of Death;Comorbidity;Cross-Sectional Studies;England/epidemiology;Female;Follow-Up Studies;Humans;Incidence;Male;Neuropsychological Tests;Risk Factors;Sex Factors;Survival Rate","Jagger, C.;Clarke, M.;Stone, A.",1995,Jan,,0,
2018,Hidden dysfunctioning in subacute stroke,"Background and Purpose - Determining cognitive dysfunctioning (CDF) after stroke is an important issue because it influences choices for management in terms of return to previous activities. Because previous research in subacute stroke has shown important variations in CDF rates, we aimed to describe the frequency and neuropsychological profile of CDF in subacute stroke outside dementia. We used a large battery of tests to screen any potentially hidden CDF. Methods - Patients with Mini-Mental State Examination scores ≥23 were prospectively and consecutively included 2 weeks after a first-ever ischemic brain infarct. Stroke features were based on MRI. Four domains were evaluated: instrumental and executive functions, episodic memory, and working memory (WM). Patients were scored using means and compared with education- and age-matched control subjects. Then we attributed Z-scores for each test and each domain. The most relevant cognitive tests characterizing CDF were determined using logistic regression. Results - Among 177 patients (mean age, 50.6 years), 91.5% failed in at least one cognitive domain. WM was the most impaired domain (87.6%) with executive functions (64.4%), episodic memory (64.4%), and instrumental functions (24.9%) being relatively preserved. CDF was associated with age, education, depression, neurological deficit, and leukoaraiosis in bivariate analysis. Using logistic regression, WM tests and age predicted CDF (Modified Paced Auditorial Serial Addition Test: OR=0.96 CI=0.93 to 0.98; Owen-spatial-WM: OR=1.07 CI=1.02 to 1.12; age: OR=0.96 CI=0.93 to 0.98). Conclusion - CDF appears to be almost constant, although underestimated, in subacute stroke. WM could reflect some hidden dysfunctioning, which may interfere with rehabilitation and return to work. Clinical routine may include WM tests in young patients with mild stroke. © 2009 American Heart Association Inc.",adult;article;brain infarction;brain ischemia;cerebrovascular accident;clinical feature;cognitive defect;controlled study;dementia;depression;educational status;episodic memory;female;human;leukoaraiosis;major clinical study;male;Mini Mental State Examination;neurologic disease;neuropsychological test;nuclear magnetic resonance imaging;priority journal;risk factor;working memory,"Jaillard, A.;Naegele, B.;Trabucco-Miguel, S.;LeBas, J. F.;Hommel, M.",2009,,,0,
2019,C-reactive protein as a predictor of cardiovascular events in elderly patients with chronic kidney disease,"BACKGROUND: Few studies have evaluated the relationship between high-sensitivity C-reactive protein (hs-CRP) and vascular events in the elderly with chronic kidney disease (CKD). METHODS: The association of hs-CRP with vascular events was examined according to CKD status in 3,166 participants of the Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg, Bavaria (INVADE study). CKD was defined as a creatinine clearance <60 ml/min estimated by the Cockcroft-Gault formula. hs-CRP was used as a binary variable > or <2.1 mg/L (median value). Vascular events were defined as a composite of myocardial infarction, stroke and vascular death. RESULTS: After 4 years of follow-up, 204 participants (6.4%) experienced a major cardiovascular event. High hs-CRP levels and CKD at baseline were associated with a greater risk of vascular events. Compared with patients with low hs-CRP and non-CKD, the adjusted hazard ratio (95% confidence interval) for vascular events was 1.42 (1.11-2.21) for low hs-CRP and CKD, 1.57 (1.21-2.34) for high hs-CRP and non-CKD and 1.93 (1.45-2.89) for high hs-CRP and CKD. CONCLUSIONS: These results suggest that high hs-CRP levels provide prognostic information in patients with CKD.","Age Factors;Aged;Aged, 80 and over;Biomarkers/blood;C-Reactive Protein/*metabolism;Cardiovascular Diseases/blood/*epidemiology/immunology/mortality;Chi-Square Distribution;Comorbidity;Creatinine/blood;Disease Progression;Female;Follow-Up Studies;Germany/epidemiology;Humans;Kaplan-Meier Estimate;Least-Squares Analysis;Male;Middle Aged;Predictive Value of Tests;Proportional Hazards Models;Prospective Studies;Renal Insufficiency, Chronic/blood/*epidemiology/immunology/mortality;Risk Assessment;Risk Factors;Time Factors;Up-Regulation","Jalal, D.;Chonchol, M.;Etgen, T.;Sander, D.",2012,Sep-Oct,10.5301/jn.5000047,0,
2020,GERD: Its burning desire for treatment,,proton pump inhibitor;chronic kidney disease;dementia;diet;fracture;gastroesophageal reflux;heart infarction;hip fracture;human;hypomagnesemia;lifestyle;note;pathophysiology;risk factor,"Jalloh, M.",2016,,,0,
2021,Apolipoprotein E: the resilience gene,"The apolipoprotein E (apoE) gene has been implicated in various conditions, most notably Alzheimer's disease and coronary artery disease. A predisposing role of the apoE4 isoform and a protective role of apoE2 isoform in those diseases have been documented. Here we investigated the role of apoE in resilience to trauma. Three hundred and forty-three US veterans were genotyped for apoE and were assessed for their lifetime trauma exposure (trauma score, T) and severity of posttraumatic stress disorder symptoms (PCL). The ratio PCL/T indicates sensitivity to trauma; hence, its inverse indicates resilience, R, to trauma. We found a significantly higher resilience in participants with apoE genotype containing the E2 allele (E2/2, E2/3) as compared to participants with the E4 allele (E4/4, E4/3). In addition, when the categorical apoE genotype was reexpressed as the number of cysteine residues per apoE mole (CysR/mole), a highly significant positive association was found between resilience and CysR/mole, such that resilience was systematically higher as the number of CysR/mole increased, from zero CysR/mole in E4/4 to four CysR/mole in E2/2. These findings demonstrate the protective role of the CysR/mole apoE in resilience to trauma: the more CysR/mole, the higher the resilience. Thus, they are in accord with other findings pointing to a generally protective role of increasing number of CysR/mole (from E4/4 to E2/2) in other diseases. However, unlike other conditions (e.g., Alzheimer's disease and coronary artery disease), resilience to trauma is not a disease but an adaptive response to trauma. Therefore, the effects of apoE seem to be more pervasive along the CysR/mole continuum, most probably reflecting underlying effects on brain synchronicity and its variability that we have documented previously (Leuthold et al., Exp Brain Res 226:525-536, 2013).",ApoE;Resilience;Trauma,"James, L. M.;Engdahl, B. E.;Georgopoulos, A. P.",2017,Jun,,0,
2022,2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee (JNC 8),,angiotensin receptor antagonist;antihypertensive agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;thiazide type diuretic;unclassified drug;adult disease;antihypertensive therapy;borderline hypertension;chronic kidney disease;cognitive defect;dementia;diabetes mellitus;diet;erectile dysfunction;evidence based practice;exercise;health care personnel;heart infarction;heart rehabilitation;human;hypertension;lifestyle modification;note;organization and management;population;practice guideline;priority journal;quality of life;randomized controlled trial (topic);weight control,"James, P. A.;Oparil, S.;Carter, B. L.",2014,,,0,
2023,HRT in women with type 2 diabetes,,estrogen;statin (protein);Alzheimer disease;clinical practice;clinical trial;cognitive defect;drug effect;drug efficacy;drug safety;evidence based medicine;general practitioner;high risk population;hormone substitution;human;ischemic heart disease;letter;non insulin dependent diabetes mellitus;risk assessment;spine fracture,"Jamieson, A.",2000,,,0,
2024,Protective effect of resveratrol on beta-amyloid-induced oxidative PC12 cell death,"Beta-amyloid peptide is considered to be responsible for the formation of senile plaques that accumulate in the brains of patients with Alzheimer's disease. There has been compelling evidence supporting the idea that beta-amyloid-induced cytotoxicity is mediated through the generation of reactive oxygen intermediates (ROIs). Considerable attention has been focused on identifying phytochemicals that are able to scavenge excess ROIs, thereby protecting against oxidative stress and cell death. Resveratrol (3,5,4'-trihydroxy-trans-stilbene), a phytoalexin found in the skin of grapes, has strong antioxidative properties that have been associated with the protective effects of red wine consumption against coronary heart disease (""the French paradox""). In this study, we have investigated the effects of resveratrol on beta-amyloid-induced oxidative cell death in cultured rat pheochromocytoma (PC12) cells. PC12 cells treated with beta-amyloid exhibited increased accumulation of intracellular ROI and underwent apoptotic death as determined by characteristic morphological alterations and positive in situ terminal end-labeling (TUNEL staining). Beta-amyloid treatment also led to the decreased mitochondrial membrane potential, the cleavage of poly(ADP-ribose)polymerase, an increase in the Bax/Bcl-X(L) ratio, and activation of c-Jun N-terminal kinase. Resveratrol attenuated beta-amyloid-induced cytotoxicity, apoptotic features, and intracellular ROI accumulation. Beta-amyloid transiently induced activation of NF-kappaB in PC12 cells, which was suppressed by resveratrol pretreatment.","Amyloid beta-Peptides/*metabolism;Animals;Antioxidants/*pharmacology;Apoptosis;Blotting, Western;Cell Death;Cell Nucleus/metabolism;Cell Survival;Coloring Agents/pharmacology;Dose-Response Relationship, Drug;In Situ Nick-End Labeling;Membrane Potentials;Microscopy, Fluorescence;Mitochondria/metabolism","Jang, J. H.;Surh, Y. J.",2003,Apr 15,,0,
2025,Fatal systemic infection following an outpatient hysteroscopic diagnosis of a chronic pyometra: A case report and survey of practice,,antibiotic agent;aged;antibiotic prophylaxis;case report;Caucasian;chronic pyometra;clinical examination;Clostridium difficile infection;comorbidity;dementia;drug megadose;endometrial thickness;fatal systemic infection;female;fine needle aspiration biopsy;follow up;heart failure;hospital discharge;human;human tissue;hypertension;hysteroscopy;infection;intensive care;letter;pelvic examination;pelvic inflammatory disease;priority journal;pyometra;septic shock;uterine cervix cytology;uterus cavity;uterus perforation;vagina bleeding;vagina discharge,"Janjua, A.;Smith, P.;Dawoud, K.;Gray, J.;Clark, J.",2015,,,0,
2026,Codon 311 (Cys → Ser) polymorphism of paraoxonase-2 gene is associated with apolipoprotein E4 allele in both Alzheimer's and vascular dementias,"The gene of an esterase enzyme, called paraoxonase (PON, EC.3.1.8.1.) is a member of a multigene family that comprises three related genes PON1, PON2, and PON3 with structural homology clustering on the chromosome 7. The PON1 activity and the polymorphism of the PON1 and PON2 genes have been found to be associated with risk of cardiovascular diseases such as hypercholesterolaemia, non-insulin-dependent diabetes, coronary heart disease (CHD) and myocardial infaction. The importance of cardiovascular risk factors in the pathomechanism of Alzheimer's disease (AD) and vascular dementia (VD) prompted us to examine the genetic effect of PON2 gene codon 311 (Cys→Ser; PON2*S) polymorphism and the relationship between the PON2*S allele and the other dementia risk factor, the apoE polymorphism in these dementias. The PON2*C and PON2*S allele frequencies were similar in both AD (25% and 75%) and VD groups (23% and 77%), respectively, compared with the controls (27% and 73%). The ratio of the PON2*S carriers was significantly higher among the apoE4 allele carrier AD (27%) and VD (25%) groups than in the control (12%). Our results indicate that the PON2*S and apoE4 alleles have interactive effect on the development of the two most common forms of dementias AD and VD, and further support the hypothesis that cardiovascular factors contribute to the development of AD.",apolipoprotein E4;aryldialkylphosphatase;cholesterol;cysteine;DNA;esterase;aryldialkylphosphatase 2;serine;unclassified drug;adult;aged;allele;Alzheimer disease;article;cardiovascular disease;chromosome 7;codon;controlled study;disease predisposition;DNA polymorphism;enzyme activity;female;genetic analysis;genetic association;genetic marker;genetic polymorphism;genetic risk;genetic susceptibility;heart infarction;human;hypercholesterolemia;ischemic heart disease;major clinical study;male;multiinfarct dementia;non insulin dependent diabetes mellitus;pathogenesis;priority journal;risk assessment;risk factor;sequence homology,"Janka, Z.;Juhász, A.;Rimanóczy, Á;Boda, K.;Márki-Zay, J.;Kálmán, J.",2002,,,0,
2027,"Prevalence, awareness, treatment and control of hypertension among the elderly residing in rural area of Haldwani Block, in Nainital District of Uttarakhand","Introduction: Raised blood pressure is a major cardiovascular risk factor. If left uncontrolled, hypertension causes stroke, myocardial infarction, cardiac failure, dementia, renal failure and blindness, causing human suffering and imposing severe fnancial and service burdens on health systems. The objective of the study is to fnd out the prevalence, awareness, treatment and control of hypertension and also to know the factors in?uencing hypertension among elderly population. Materials and Methods: Community based cross-sectional study was conducted in rural feld practice area under the department of Community Medicine in Haldwani block of district Nainital. The study was conducted from November 2013 to October 2014. Elderly, who had completed sixty years of age at the time of study, gave consent and volunteer to participate, were included in the study. A pretested, semi-structured questionnaire was administered to collect data from 440 elderly which was later entered into Microsoft excel and was analyzed using SPSS 16. Chi square test was used to test the association and p<0.05 was considered signifcant. Result: The prevalence of hypertension among the elderly was 38.86%. Awareness, treatment and blood pressure under control was seen among 59.06%, 76.24% and 19.48% respectively. Hypertension was signifcantly associated with literacy status, employment status, higher socioeconomic status, increased body mass index, and presence of diabetes. Conclusion: The prevalence of hypertension was quite high among the elderly while the awareness, treatment and control of blood pressure were low among those who were found to be hypertensive.",academic achievement;adult;aged;article;awareness;blood pressure regulation;body mass;community;controlled study;cross-sectional study;diabetes mellitus;disease association;employment;female;human;hypertension;India;major clinical study;male;middle aged;prevalence;questionnaire;rural area;semi structured interview;socioeconomics;volunteer,"Janki, B.;Singh, R. C. M.;Sadhana, A.",2016,,10.5530/jcdr.2016.3.3,0,
2028,Epidemiology yesterday and today,Current problems in epidemiology in the Czech Republic in comparison with the past orientation are discussed. Reasons for transition from the epidemiology of communicable diseases towards the epidemiology of chronic noninfectious diseases are described. The importance of epidemiologic methodology is pointed out.,acquired immune deficiency syndrome;article;communicable disease;comparative study;Creutzfeldt Jakob disease;Czech Republic;Enterovirus;epidemiology;evidence based medicine;genetic predisposition;Helicobacter pylori;Herpes simplex virus;human;Human immunodeficiency virus infection;ischemic heart disease;liver cell carcinoma;methodology;pneumonia;preventive medicine;public health,"Janout, V.",2001,,,0,
2029,Aripiprazole for the treatment of patients with agitation associated with dementia of the Alzheimer's type,"Inclusion criteria: 1. Patients whose legal representatives can provide informed consent (Informed consent from the patients where possible). 2. Patients who satisfy both of the following diagnostic criteria: - Diagnosis of major neurocognitive disorder due to Alzheimer's disease according to DSM-5 - Diagnosis of probable Alzheimer's disease according to NINCDS-ADRDA 3. Hospitalized patients or care facility patients 4. Patients with an MMSE score of 1 to 22;Inclusion criteria: 1. Patients whose legal representatives can provide informed consent (Informed consent from the patients where possible). 2. Patients who satisfy both of the following diagnostic criteria: - Diagnosis of major neurocognitive disorder due to Alzheimer's disease according to DSM-5 - Diagnosis of probable Alzheimer's disease according to NINCDS-ADRDA 3. Hospitalized patients or care facility patients 4. Patients with an MMSE score of 1 to 22 Exclusion criteria: 1. Patients with complications of dementia or memory impairment other than Alzheimer's type dementia 2. Dementia patients with a Modified Hachinski Ischemic Score of 5 or higher 3. Patients with psychological symptoms or behavioral disorders that are clearly due to other medical conditions or substances 4. Patients with a complication or history of stroke or transient ischemic attack, except for asymptomatic stroke 5. Patients with heart failure classified as NYHA III or IV 6. Patients who require drug therapy for arrhythmia or ischemic heart disease 7. Body weight of less than 30 kg 8. Patients with a high risk of suicide 9. Patients with a complication or history of seizure disorder 10. Patients with a complication or history of neuroleptic malignant syndrome, tardive dyskinesia, paralytic ileus, or rhabdomyolysis 11. Patients with thyroid disease (except if the disease has been stabilized with drug therapy for 3 months or longer prior to time of informed consent);Exclusion criteria: 1. Patients with complications of dementia or memory impairment other than Alzheimer's type dementia 2. Dementia patients with a Modified Hachinski Ischemic Score of 5 or higher 3. Patients with psychological symptoms or behavioral disorders that are clearly due to other medical conditions or substances 4. Patients with a complication or history of stroke or transient ischemic attack, except for asymptomatic stroke 5. Patients with heart failure classified as NYHA III or IV 6. Patients who require drug therapy for arrhythmia or ischemic heart disease 7. Body weight of less than 30 kg 8. Patients with a high risk of suicide 9. Patients with a complication or history of seizure disorder 10. Patients with a complication or history of neuroleptic malignant syndrome, tardive dyskinesia, paralytic ileus, or rhabdomyolysis 11. Patients with thyroid disease (except if the disease has been stabilized with drug therapy for 3 months or longer prior to time of informed consent)",Sr-dementia,JapicCti,2015,,,0,
2030,Phase III clinical study of SUN Y7017 Safety evaluation of 1-step titration with 3-step titration in patients with moderate to severe Alzheimer's disease,"Inclusion criteria: 1. Patients with a diagnosis of dementia of the Alzheimer's type based on DSM-IV-TR and probable Alzheimer's disease according to the NINCDS-ADRDA diagnostic criteria. 2. Patients with a diagnosis of AD based on brain computed tomography (CT) or magnetic resonance imaging (MRI) within 1 year prior to randomization 3. Patients with an MMSE score from 1 to 19 at enrollment 4. Patients aged between 50 and 85 years when consent is obtained. 5. Patients who are ambulatory without walking aids or with a modest aid such as a walking stick. Patients are also required to have good enough eyesight and hearing to undergo the tests and examinations scheduled in the study (eye glasses or hearing aids can be used) 6. Patients whose caregivers are cooperative and reliable enough to manage the study drug, attend study visits with the patient, and check the patient's clinical condition throughout the study period. Patients who will have the same caregiver, in principle, for every study visit throughout the study Exclusion criteria: 1. Patients with other type of dementia that is not AD 2. Patients with Significant neurological disorders 3. Musculoskeletal diseases that may hamper conduct of the tests and examinations required in this study 4. Any of the following diseases or symptoms 1) diastolic pressure >=110 mmHg or systolic pressure <90 mmHg 2) Myocardial infarction within 6 months prior to the date of giving informed consent 3) Congestive heart failure (NYHA class III or IV ) 4) Severe renal impairment 5) Severe hepatic impairment 6) Uncontrolled diabetes mellitus 7) Malignant tumor 5. A history of alcoholism or drug dependence 6. A history of hypersensitivity to any component of memantine hydrochloride 7. Planned change of the subject's living environment (admission to a nursing facility, moving house, etc.) during the study period <Condition>Moderate to severe Alzheimer's disease</Condition> <Intervention ></Intervention> Adverse events leading to discontinuation of the study SIB-J, J-CGIC, MMSE",Sr-dementia,JapicCti,2016,,,0,
2031,Vascular factors in suspected normal pressure hydrocephalus,"Objective: We examined clinical and imaging findings of suspected idiopathic normal pressure hydrocephalus (iNPH) in relation to vascular risk factors and white matter lesions (WMLs), using a nested case-control design in a representative, population-based sample. Methods: From a population-based sample, 1,235 persons aged 70 years or older were examined with CT of the brain between 1986 and 2000. We identified 55 persons with hydrocephalic ventricular enlargement, i.e., radiologic findings consistent with iNPH. Among these, 26 had clinical signs that fulfilled international guideline criteria for probable iNPH. These cases were labeled suspected iNPH. Each case was matched to 5 controls from the same sample, based on age, sex, and study cohort. Data on risk factors were obtained from clinical examinations and the Swedish Hospital Discharge Register. History of hypertension, diabetes mellitus (DM), smoking, overweight, history of coronary artery disease, stroke/TIA, and WMLs on CT were examined. Risk factors associated with iNPH with a p value <0.1 in χ 2 tests were included in conditional logistic regression models. Results: In the regression analyses, suspected iNPH was related to moderate to severe WMLs (odds ratio [OR] 5.2; 95% confidence interval [CI]: 1.5-17.6), while hydrocephalic ventricular enlargement was related to hypertension (OR 2.7; 95% CI: 1.1-6.8), moderate to severe WMLs (OR 6.5; 95% CI: 2.1-20.3), and DM (OR 4.3; 95% CI: 1.1-16.3). Conclusions: Hypertension, WMLs, and DM were related to clinical and imaging features of iNPH, suggesting that vascular mechanisms are involved in the pathophysiology. These findings might have implications for understanding disease mechanisms in iNPH and possibly prevention.",aged;article;cardiovascular risk;case control study;cerebrovascular accident;computer assisted tomography;controlled study;coronary artery disease;dementia;diabetes mellitus;disease severity;female;human;hypertension;major clinical study;major depression;male;Mini Mental State Examination;neuroimaging;neuropathology;normotensive hydrocephalus;obesity;practice guideline;priority journal;prophylaxis;smoking;Sweden;transient ischemic attack;white matter lesion,"Jaraj, D.;Agerskov, S.;Rabiei, K.;Marlow, T.;Jensen, C.;Guo, X.;Kern, S.;Wikkelsø, C.;Skoog, I.",2016,,,0,
2032,Effect of increasing active travel in urban England and Wales on costs to the National Health Service,"Increased walking and cycling in urban areas and reduced use of private cars could have positive effects on many health outcomes. We estimated the potential effect of increased walking and cycling in urban England and Wales on costs to the National Health Service (NHS) for seven diseases--namely, type 2 diabetes, dementia, cerebrovascular disease, breast cancer, colorectal cancer, depression, and ischaemic heart disease--that are associated with physical inactivity. Within 20 years, reductions in the prevalences of type 2 diabetes, dementia, ischaemic heart disease, cerebrovascular disease, and cancer because of increased physical activity would lead to savings of roughly UK pound17 billion (in 2010 prices) for the NHS, after adjustment for an increased risk of road traffic injuries. Further costs would be averted after 20 years. Sensitivity analyses show that results are invariably positive but sensitive to assumptions about time lag between the increase in active travel and changes in health outcomes. Increasing the amount of walking and cycling in urban settings could reduce costs to the NHS, permitting decreased government expenditure on health or releasing resources to fund additional health care.","Accidents, Traffic/economics/statistics & numerical data;Adolescent;Adult;Aged;Aged, 80 and over;Bicycling/*economics;Cerebrovascular Disorders/economics/prevention & control;Cost Savings;Costs and Cost Analysis;Dementia/economics/prevention & control;Depressive Disorder/economics/prevention & control;Diabetes Mellitus, Type 2/economics/prevention & control;England;Exercise/physiology;Female;Health Care Costs;Humans;Male;Middle Aged;Models, Economic;Myocardial Ischemia/economics/prevention & control;Neoplasms/economics/prevention & control;Sedentary Lifestyle;State Medicine/*economics;Travel/economics;Urban Health;Wales;Walking/*economics;Wounds and Injuries/economics;Young Adult","Jarrett, J.;Woodcock, J.;Griffiths, U. K.;Chalabi, Z.;Edwards, P.;Roberts, I.;Haines, A.",2012,Jun 9,10.1016/s0140-6736(12)60766-1,0,
2033,Genetic predictors of common disease: Apolipoprotein E genotype as a paradigm,"PURPOSE: Genetic variation of a common genetic polymorphism at the structural locus for apolipoprotein E (apoE) has been associated with risk of elevated serum lipids, coronary artery disease, and Alzheimer disease, all of which are multifactoral disorders and are inherited in a complex fashion. Although the apoE polymorphism is only one risk factor in a complex pattern of inheritance, it gives us a foothold into the understanding of the genetic architecture of these disorders. However, apoE also exemplifies the complications that can arise in the use of genetic markers to predict disease. This paper considers the study of apolipoprotein E genotype effects as an example of the following analytical complications: changes in allele frequencies and allele effects with age, pleiotrophic effects of genetic loci, the existence of more than one alternative allele at a locus, and the expectation of a variety of interactions. METHODS: Publications that exemplify these complications are cited and discussed. No original analyses are presented. RESULTS: There is evidence that the relative frequency of the apoE ε4 allele declines with age after the sixth decade of life and that the effects of the APOE allele on lipids also may be age-dependent. Grouping of genotypes may not accurately characterize the effects of individual genotypes. Interactions between APOE genotype and a number of factors, including family history of dementia, are demonstrated for the effects of APOE in Alzheimer disease as well as for the effects of apoE on serum lipids. CONCLUSION: Careful attention must be paid to these and other analytical issues when genotype is a predictor.",apolipoprotein E;lipid;Alzheimer disease;article;coronary artery disease;gene frequency;genetic marker;genetic polymorphism;genotype;human;hyperlipidemia;priority journal,"Jarvik, G. P.",1997,,,0,
2034,Predicting mortality after kidney transplantation: A clinical tool,"An increasing number of patients referred for transplantation are older and have complex comorbidity affecting outcome. Patient counseling is often empiric and time consuming. For the physician there are few clinical tools available to help quantify survival chances after transplantation. We used registry data to develop a series of tables that could be used in the clinical setting to predict survival probability. Using data from the Canadian Organ Replacement Registry, we generated clinical survival tables using Cox's regression model. Model covariates included age, race, gender, treatment period, primary renal disease cause, donor source, months on dialysis and comorbidities. A total of 6324 patients were included, 22% had >1 comorbid condition at baseline. After adjustment for age, gender and cause of renal disease, increased comorbidity was strongly associated with reduced patient-survival (P < 0.05). Age and comorbidity specific clinical survival tables showing the expected 1-, 3- and 5-year patient survival probabilities were generated. Separate tables were created for diabetics, nondiabetics, living-donor organs and deceased-donor transplantation. Patient-specific survival data can be estimated from registry data. We suggest annual or biannual tables generated by national registries across Europe and N. America, may be useful to those physicians faced with counseling patients and families. © 2005 European Society for Organ Transplantation.",acquired immune deficiency syndrome;adult;angina pectoris;article;cerebrovascular accident;chronic obstructive lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled study;coronary artery bypass surgery;dementia;diabetes mellitus;female;heart infarction;human;kidney disease;kidney transplantation;leukemia;liver disease;lung edema;lymphoma;major clinical study;male;metastasis;mortality;peripheral vascular disease;priority journal;survival rate;ulcer,"Jassal, S. V.;Schaubel, D. E.;Fenton, S. S. A.",2005,,,0,
2035,Survival rate and pressure ulcer prevalence in patients with and without dementia: a retrospective study,"OBJECTIVE: This retrospective study aimed to investigate the prevalence of pressure ulcers (PUs) in older patients with advanced dementia versus older patients without dementia but with other comorbidities, such as diabetes, ischaemic heart disease and chronic renal failure. PUs were thought to be more prevalent and to present a higher risk of mortality in patients with dementia. METHOD: PUs were assessed on admission using the European Pressure Ulcer Advisory Panel (EPUAP) staging system. Patients were classified as either with or without dementia according to Reisberg's functional assessment staging test (FAST). The prevalence of PUs and the survival rates were analysed and compared in both groups. The combined effect of PUs and dementia on survival was assessed using the Cox proportional hazard model. RESULTS: The median survival rate of patients with PUs and dementia was 63 days, significantly lower than in patients with PUs without dementia 117 days. Both groups had similar other comorbidities. CONCLUSION: These findings underscore the requirement for geriatricians and health professionals to be more vigilant in examining PUs as dementia progresses.",aged;case control study;cohort analysis;comorbidity;dementia;diabetes mellitus;female;human;Israel;chronic kidney failure;male;mortality;heart muscle ischemia;decubitus;prevalence;retrospective study;severity of illness index;survival rate;very elderly,"Jaul, E.;Rosenzweig, J. P.;Meiron, O.",2017,,10.12968/jowc.2017.26.7.400,0,
2036,Does this dementia patient meet the prognosis eligibility requirements for hospice enrollment?,,aged;Alzheimer disease;article;case report;congestive heart failure;coronary artery disease;delirium;dementia;female;health insurance;hip fracture;hospice care;hospice eligibility;human;hypertension;medicare;nursing home;osteoporosis;palliative therapy;practice guideline;prognosis;systolic dysfunction;terminal care,"Jayes, R. L.;Arnold, R. M.;Fromme, E. K.",2012,,,0,
2037,Bullous pemphigoid and internal diseases - A case-control study,"To study associations of bullous pemphigoid (BP) with internal diseases, we conducted a retrospective case control study assessing the frequency of selected diseases - diabetes mellitus, neurological diseases, malignant tumors, benign prostate hyperplasia, hypertension and ischemic heart disease in patients with BP. 89 patients with BP, whose data were retrieved from the register of the Centre of bullous diseases from the period of 1991-2006, were matched with 89 controls of the same age and gender, recruited from patients treated for other skin diseases. The frequency of internal diseases at the time of the onset of BP was evaluated by unconditional logistic regression adjusted for age and gender and maximum likelihood test for contingency tables. Neurological disease was found in 42.7% of the patients and in 19.1% of controls. This difference was statistically significant (p value = 0.001). Moreover, regression analysis has shown that patients with neurological disease in the age group ≥ 80 years have significantly higher risk of pemphigoid than patients without neurological disease (odds ratio 10.55; 95% confidence interval 2.68 to 41.49). Most frequent were cerebral stroke in men and dementia in women. For other diseases and other age groups, no statistically significant influence was found.",aged;Alzheimer disease;article;basal cell carcinoma;bladder cancer;breast cancer;bullous pemphigoid;case control study;cerebrovascular accident;clinical assessment;colon cancer;controlled study;dementia;depression;diabetes mellitus;disease association;endometrium cancer;enzyme linked immunosorbent assay;epilepsy;female;groups by age;human;hypertension;immunofluorescence test;ischemic heart disease;logistic regression analysis;major clinical study;male;malignant neoplastic disease;metastasis;mycosis;neurofibromatosis;neurologic disease;paraproteinemia;poliomyelitis;polyneuropathy;prostate cancer;prostate hypertrophy;retrospective study;risk assessment;schizophrenia;squamous cell carcinoma;stomach cancer,"Jedlickova, H.;Hlubinka, M.;Pavlik, T.;Semradova, V.;Budinska, E.;Vlasin, Z.",2010,,,0,
2038,Stroke risk profile predicts white matter hyperintensity volume: The Framingham study,"Background and Purpose - Previous studies of cardiovascular risk factors and white matter hyperintensity (WMH) on brain MRI have been limited by the failure to exclude symptomatic cerebrovascular disease and dementia or by the use of semiquantitative rather than quantitative methods to measure WMH volume (WMHV). We examined the relationship between Framingham Stroke Risk Profile (FSRP) and WMHV measured quantitatively in a stroke and dementia-free subset of the Framingham Offspring Cohort. Methods - Brain MRI was performed in 1814 members of the Framingham Offspring Cohort. Pixel-based quantitative measures of WMHV corrected for head size were obtained using a semiautomated algorithm. WMHV was not normally distributed and therefore was log-transformed (LWMHV). The FSRP and its component risk factors measured a mean of 7.5 years before MRI were related to both continuous measures of LWMHV and to the presence of large volumes of LWMHV (LWMHV-large). All analyses were adjusted for age and sex. Results - FSRP was strongly associated with LWMHV and LWMHV-large. Age, smoking, history of cardiovascular disease, hypertension, and left ventricular hypertrophy by electrocardiogram were all significantly related to LWMHV or LWMHV-large. Conclusions - FSRP and several cardiovascular risk factors were related to both WMHV measured continuously and to a categorical designation of large volumes of WMH. These findings provide strong evidence of a vascular basis for WMH.",adult;age;aged;article;cardiovascular risk;cerebrovascular disease;cohort analysis;dementia;diabetes mellitus;female;heart left ventricle hypertrophy;human;hypertension;major clinical study;male;nuclear magnetic resonance imaging;priority journal;quantitative analysis;smoking;cerebrovascular accident;white matter,"Jeerakathil, T.;Wolf, P. A.;Beiser, A.;Massaro, J.;Seshadri, S.;D'Agostino, R. B.;DeCarli, C.",2004,,,0,
2039,Low cardiac index is associated with incident dementia and Alzheimer disease: the Framingham Heart Study,"BACKGROUND: Cross-sectional epidemiological and clinical research suggests that lower cardiac index is associated with abnormal brain aging, including smaller brain volumes, increased white matter hyperintensities, and worse cognitive performances. Lower systemic blood flow may have implications for dementia among older adults. METHODS AND RESULTS: A total of 1039 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, and dementia formed our sample (age, 69+/-6 years; 53% women). Multivariable-adjusted proportional hazard models adjusting for Framingham Stroke Risk Profile score (age, sex, systolic blood pressure, antihypertensive medication, diabetes mellitus, cigarette smoking, cardiovascular disease history, atrial fibrillation), education, and apolipoprotein E4 status related cardiac magnetic resonance imaging-assessed cardiac index (cardiac output divided by body surface area) to incident all-cause dementia and Alzheimer disease (AD). Over the median 7.7-year follow-up period, 32 participants developed dementia, including 26 cases of AD. Each 1-SD unit decrease in cardiac index increased the relative risk of both dementia (hazard ratio [HR]=1.66; 95% confidence interval [CI], 1.11-2.47; P=0.013) and AD (HR=1.65; 95% CI, 1.07-2.54; P=0.022). Compared with individuals with normal cardiac index, individuals with clinically low cardiac index had a higher relative risk of dementia (HR=2.07; 95% CI, 1.02-4.19; P=0.044). If participants with clinically prevalent cardiovascular disease and atrial fibrillation were excluded (n=184), individuals with clinically low cardiac index had a higher relative risk of both dementia (HR=2.92; 95% CI, 1.34-6.36; P=0.007) and AD (HR=2.87; 95% CI, 1.21-6.80; P=0.016) compared with individuals with normal cardiac index. CONCLUSION: Lower cardiac index is associated with an increased risk for the development of dementia and AD.","Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology;Cardiac Output, Low/*complications;Cross-Sectional Studies;Dementia/*epidemiology;Female;Follow-Up Studies;Humans;Incidence;Male;Massachusetts;Middle Aged;Risk Factors;Alzheimer disease;blood circulation;brain;cardiac output;dementia;hemodynamics","Jefferson, A. L.;Beiser, A. S.;Himali, J. J.;Seshadri, S.;O'Donnell, C. J.;Manning, W. J.;Wolf, P. A.;Au, R.;Benjamin, E. J.",2015,Apr 14,10.1161/circulationaha.114.012438,1,
2040,The Vanderbilt Memory & Aging Project: Study Design and Baseline Cohort Overview,"Background: Vascular health factors frequently co-occur with Alzheimer's disease (AD). A better understanding of how systemic vascular and cerebrovascular health intersects with clinical and pathological AD may inform prevention and treatment opportunities. Objective:To establish the Vanderbilt Memory & Aging Project, a case-control longitudinal study investigating vascular health and brain aging, and describe baseline methodology and participant characteristics. Methods: From September 2012 to November 2014, 335 participants age 60- 92 were enrolled, including 168 individuals with mild cognitive impairment (MCI, 73±8 years, 41 female) and 167 age-, sex-, and race-matched cognitively normal controls (NC, 72±7 years, 41 female). At baseline, participants completed a physical and frailty examination, fasting blood draw, neuropsychological assessment, echocardiogram, cardiac MRI, and brain MRI. A subset underwent 24-hour ambulatory blood pressure monitoring and lumbar puncture for cerebrospinal fluid (CSF) collection. Results: As designed, participant groups were comparable for age (p = 0.31), sex (p = 0.95), and race (p = 0.65). MCI participants had greater Framingham Stroke Risk Profile scores (p = 0.008), systolic blood pressure values (p = 0.008), and history of left ventricular hypertrophy (p = 0.04) than NC participants. As expected, MCI participants performed worse on all neuropsychological measures (p-values < 0.001), were more likely to be APOE ϵ4 carriers (p = 0.02), and had enhanced CSF biomarkers, including lower Aβ42 (p = 0.02), higher total tau (p = 0.004), and higher p-tau (p = 0.02) compared to NC participants. Conclusion:Diverse sources of baseline and longitudinal data will provide rich opportunities to investigate pathways linking vascular and cerebrovascular health, clinical and pathological AD, and neurodegeneration contributing to novel strategies to delay or prevent cognitive decline.",biological marker;adult;aged;aging;article;blood;blood pressure monitoring;brain;cardiovascular magnetic resonance;case control study;cerebrospinal fluid;controlled study;echocardiography;female;Framingham risk score;health;heart left ventricle hypertrophy;human;longitudinal study;lumbar puncture;major clinical study;male;memory;mild cognitive impairment;neuropsychological test;nuclear magnetic resonance imaging;priority journal;study design;systolic blood pressure,"Jefferson, A. L.;Gifford, K. A.;Acosta, L. M. Y.;Bell, S. P.;Donahue, M. J.;Davis, L. T.;Gottlieb, J.;Gupta, D. K.;Hohman, T. J.;Lane, E. M.;Libon, D. J.;Mendes, L. A.;Niswender, K.;Pechman, K. R.;Rane, S.;Ruberg, F. L.;Su, Y. R.;Zetterberg, H.;Liu, D.",2016,,,0,
2041,Relation of left ventricular ejection fraction to cognitive aging (from the Framingham Heart Study),"Heart failure is a risk factor for Alzheimer's disease and cerebrovascular disease. In the absence of heart failure, it was hypothesized that left ventricular ejection fraction (LVEF), an indicator of cardiac dysfunction, would be associated with preclinical brain magnetic resonance imaging (MRI) and neuropsychological markers of ischemia and Alzheimer disease in the community. Brain MRI, cardiac MRI, neuropsychological, and laboratory data were collected from 1,114 Framingham Heart Study Offspring Cohort participants free from clinical stroke or dementia (aged 40 to 89 years, mean age 67 +/- 9 years, 54% women). Neuropsychological and neuroimaging markers of brain aging were related to cardiac MRI-assessed LVEF. In multivariable-adjusted linear regressions, LVEF was not associated with any brain aging variable (p values >0.15). However, LVEF quintile analyses yielded several U-shaped associations. Compared to the referent (quintile 2 to 4), the lowest quintile (quintile 1) LVEF was associated with lower mean cognitive performance, including Visual Reproduction Delayed Recall (beta = -0.27, p <0.001) and Hooper Visual Organization Test (beta = -0.27, p <0.001). Compared to the referent, the highest quintile (quintile 5) LVEF values also were associated with lower mean cognitive performance, including Logical Memory Delayed Recall (beta = -0.18, p = 0.03), Visual Reproduction Delayed Recall (beta = -0.17, p = 0.03), Trail Making Test Part B - Part A (beta = -0.22, p = 0.02), and Hooper Visual Organization Test (beta = -0.20, p = 0.02). Findings were similar when analyses were repeated excluding prevalent cardiovascular disease. In conclusion, although these observational cross-sectional data cannot establish causality, they suggest a nonlinear association between LVEF and measures of accelerated cognitive aging.","Adult;Aged;Aged, 80 and over;Aging/*physiology;Brain/*pathology;Cognition/*physiology;Cohort Studies;Female;Humans;Longitudinal Studies;*Magnetic Resonance Imaging;Male;Middle Aged;Multivariate Analysis;Myocardium/pathology;Neuropsychological Tests;Stroke Volume/*physiology","Jefferson, A. L.;Himali, J. J.;Au, R.;Seshadri, S.;Decarli, C.;O'Donnell, C. J.;Wolf, P. A.;Manning, W. J.;Beiser, A. S.;Benjamin, E. J.",2011,Nov 1,10.1016/j.amjcard.2011.06.056,0,
2042,Cardiac index is associated with brain aging: the Framingham Heart Study,"BACKGROUND: Cardiac dysfunction is associated with neuroanatomic and neuropsychological changes in aging adults with prevalent cardiovascular disease, theoretically because systemic hypoperfusion disrupts cerebral perfusion, contributing to subclinical brain injury. We hypothesized that cardiac function, as measured by cardiac index, would be associated with preclinical brain magnetic resonance imaging (MRI) and neuropsychological markers of ischemia and Alzheimer disease in the community. METHODS AND RESULTS: Brain MRI, cardiac MRI, neuropsychological, and laboratory data were collected on 1504 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, or dementia (age, 61+/-9 years; 54% women). Neuropsychological and brain MRI variables were related to cardiac MRI-assessed cardiac index (cardiac output/body surface area). In multivariable-adjusted models, cardiac index was positively related to total brain volume (P=0.03) and information processing speed (P=0.02) and inversely related to lateral ventricular volume (P=0.048). When participants with clinically prevalent cardiovascular disease were excluded, the relation between cardiac index and total brain volume remained (P=0.02). Post hoc comparisons revealed that participants in the bottom cardiac index tertile (values <2.54) and middle cardiac index tertile (values between 2.54 and 2.92) had significantly lower brain volumes (P=0.04) than participants in the top cardiac index tertile (values >2.92). CONCLUSIONS: Although observational data cannot establish causality, our findings are consistent with the hypothesis that decreasing cardiac function, even at normal cardiac index levels, is associated with accelerated brain aging.","Adult;Aged;Aged, 80 and over;Aging/*pathology/psychology;Alzheimer Disease/etiology/pathology/psychology;Brain/*pathology;Cardiovascular Diseases/complications/*pathology/psychology;Cohort Studies;Cross-Sectional Studies;Female;*Health Status Indicators;Humans;Magnetic Resonance Imaging;Male;Middle Aged","Jefferson, A. L.;Himali, J. J.;Beiser, A. S.;Au, R.;Massaro, J. M.;Seshadri, S.;Gona, P.;Salton, C. J.;DeCarli, C.;O'Donnell, C. J.;Benjamin, E. J.;Wolf, P. A.;Manning, W. J.",2010,Aug 17,10.1161/circulationaha.109.905091,0,
2043,Lower cardiac output is associated with greater white matter hyperintensities in older adults with cardiovascular disease,"OBJECTIVES: To preliminarily examine the association between cardiac output, a measure of systemic blood flow, and structural brain magnetic resonance imaging indices of white matter hyperintensities (WMHs). DESIGN: Cross-sectional. SETTING: University medical setting. PARTICIPANTS: Thirty-six older adults without dementia with prevalent cardiovascular disease (aged 56-85). MEASUREMENTS: Cardiac output, WMHs. RESULTS: Partial correlations, adjusting for age and history of hypertension, yielded an inverse relationship between WMHs adjacent to subcortical nuclei and cardiac output (correlation coefficient=-0.48, P=.03); as cardiac output decreased, WMHs increased significantly. No significant associations were found between cardiac output and total WMHs or periventricular WMHs. CONCLUSION: These preliminary data suggest that systemic blood flow, measured according to cardiac output, is inversely associated with WMHs adjacent to the subcortical nuclei. Cerebrovascular degeneration and the chronicity of hypoperfusion may exacerbate the susceptibility of white matter integrity to alterations in blood flow in older adults.","Age Factors;Aged;Aged, 80 and over;Cardiac Output/*physiology;Cardiac Output, Low/*complications/physiopathology/ultrasonography;Cerebrovascular Circulation/*physiology;Cross-Sectional Studies;Echocardiography, Doppler;Female;Humans;Hypoxia, Brain/*etiology/pathology;Magnetic Resonance Imaging;Male;Middle Aged;Prognosis;Prospective Studies;Risk Factors;Severity of Illness Index;Ventricular Function, Left/*physiology","Jefferson, A. L.;Tate, D. F.;Poppas, A.;Brickman, A. M.;Paul, R. H.;Gunstad, J.;Cohen, R. A.",2007,Jul,10.1111/j.1532-5415.2007.01226.x,0,
2044,A response to: The effects of vascular disease on late onset Parkinson's disease (Papapetropoulos et al.) 1,,Alzheimer disease;brain ischemia;clinical feature;disease severity;human;ischemic heart disease;letter;leukoencephalopathy;neuropathology;Parkinson disease;priority journal;risk factor;cerebrovascular accident,"Jellinger, K.",2006,,,0,
2045,Elderly individuals with FTLD,,antihypertensive agent;nootropic agent;aged;aggression;amyloid plaque;anorexia;brain atrophy;case report;computer assisted tomography;death;dementia;depression;disorientation;dysarthria;dysphagia;faintness;female;frontal lobe;frontotemporal dementia;gait disorder;hand tremor;heart failure;hippocampal sclerosis;human;hyporeflexia;letter;limbic cortex;memory disorder;mental deterioration;neurofibrillary tangle;neuropathology;parietal lobe;pneumonia;priority journal;self neglect;substantia nigra;temporal lobe;white matter lesion,"Jellinger, K. A.",2013,,,0,
2046,Is there pure vascular dementia in old age?,"Vascular dementia (VaD) has been suggested to be the most common form of dementia in old age, but clinico-pathologic studies showed big differences in its epidemiology. A retrospective hospital-based study of the frequency and pathology of ""pure"" VaD (due to cerebrovascular disease without other pathologies) was performed in 1110 consecutive autopsy cases of demented elderly in Vienna, Austria. It assessed clinical, general autopsy data and neuropathology including immunohistochemistry. Neuropathologic diagnosis followed current consensus criteria. Four age groups (7th to 10th decades) were evaluated. ""Pure"" VaD was observed in 10.8% of the total cohort, decreasing from age 60 to 90+. 85-95% had histories of diabetes, morphologic signs of hypertension, 65% myocardial infarction/cardiac decompensation, and 75% a history of stroke(s). Neuritic AD-pathology was low (mean Braak stages 1.2-1.6). Morphologic subtypes (multi-infarct (MID), subcortical arteriosclerotic (SAE)-the most frequent, and strategic infarct dementia (SID)) showed no age-related differences. By contrast, AD (without vascular or Lewy pathologies), mixed dementia (AD + cerebrovascular encephalopathy), and AD with minor cerebrovascular lesions increased with age. AD + Lewy pathology and other dementias decreased significantly over age 90. This retrograde study using strict morphologic diagnostic criteria confirmed the existence of ""pure"" VaD in old age, with a tendency to decline at age 90+, while AD and AD + cerebrovascular pathologies showed considerable age-related increase. Another autopsy study distinguishing two age groups of demented showed a significant increase of both AD and cerebral amyloid angiopathy (CAA), but decrease of VaD over age 85, while in a small subgroup of old subjects CAA without considerable AD-pathology may be an independent risk factor for cognitive decline. © 2010 Elsevier B.V. All rights reserved.",aged;article;Austria;autopsy;Binswanger encephalopathy;cohort analysis;controlled study;diabetes mellitus;diffuse Lewy body disease;female;groups by age;heart failure;heart infarction;hospital based case control study;human;hypertension;immunohistochemistry;major clinical study;male;medical history;morphology;multiinfarct dementia;neuropathology;patient assessment;priority journal;retrospective study;risk factor;vascular amyloidosis,"Jellinger, K. A.;Attems, J.",2010,,,0,
2047,Prevalence and pathology of vascular dementia in the oldest-old,"The prevalence of both Alzheimer's disease (AD) and vascular dementia (VaD) increase with advancing age, but epidemiologic data above age 85 are imprecise and inconsistent. A retrospective hospital-based study of the prevalence and pathology of VaD was performed in 1700 consecutive autopsy cases of demented elderly in Vienna, Austria (mean age 84.3 ± 5.4 SD; 90% over age 70). It assessed clinical and general autopsy data and neuropathology including immunohistochemistry. Neuropathologic diagnosis followed current consensus criteria. Four age groups (7th to 10th decade) were evaluated. ""Pure"" VaD (due to cerebrovascular disease without other pathologies; neuritic Braak stages 1.2-1.6) was observed in 12.3% of the total cohort, decreasing between age 60 and 90+ from 15.0 to 8.7%. Morphologic subtypes (subcortical arteriosclerotic encephalopathy, multi-infarct encephalopathy, and strategic infarct dementia) showed no age-related differences. By contrast, AD (without concomitant pathologies; 45.6% of total), mixed dementia (AD + cerebrovascular encephalopathy; 5.5%), and AD with minor cerebrovascular lesions (22.3%) increased with age. The relative prevalence of AD + Lewy pathology (9.3%) remained fairly stable, whereas other dementias (5.0%) decreased significantly over age 90. 85% of the patients with ""pure"" VaD had histories of diabetes, 75% of stroke(s), 95% morphologic signs of hypertension, 65% myocardial infarction (recent and old ones), 97% cerebral hypertonic- arteriosclerotic microangiopathy (associated with cerebral amyloid angiopathy in 23%) and 90% severe atherosclerosis of large cerebral arteries. Similar autopsy findings were seen in mixed dementia (MIX) and in AD + minor cerebrovascular lesions. Major vascular lesions differed between VaD and MIX, VaD showing more than 60% subcortical infarcts, MIX only 43% such lesions. This retrograde hospital-based study using strict morphologic diagnostic criteria confirmed the existence of ""pure"" VaD in old age, with a tendency to decline after age 90, while AD and AD + cerebrovascular pathologies showed considerable age-related increase, and ""pure"" AD slightly decreasing after age 90. © 2010 IOS Press and the authors. All rights reserved.",aged;Alzheimer disease;article;Austria;autopsy;brain atherosclerosis;diabetes mellitus;female;geriatric disorder;heart infarction;human;human tissue;hypertension;immunohistochemistry;major clinical study;male;mixed depression and dementia;multiinfarct dementia;priority journal;retrospective study;cerebrovascular accident;vascular amyloidosis,"Jellinger, K. A.;Attems, J.",2010,,,0,
2048,Prevalence of dementia disorders in the oldest-old: An autopsy study,"The prevalence of Alzheimer disease (AD) and vascular dementia (VD) increases with advancing age, but less so after age 90 years. A retrospective hospital-based study of the relative prevalence of different disorders was performed in 1, 110 consecutive autopsy cases of demented elderly in Vienna, Austria (66% females, MMSE <20; mean age 83.3 ± 5.4 SD years). It assessed clinical, general autopsy data and neuropathology including immunohistochemistry. Neuropathologic diagnosis followed current consensus criteria. Four age groups (7-10th decade) were evaluated. In the total cohort AD pathology was seen in 82.9% (""pure"" AD 42.9%; AD+ other pathologies 39.9%), VD in 10.8% (mixed dementia, MIX, i.e. AD+ vascular encephalopathy in 5.5%); other disorders in 5.7%, and negative pathology in 0.8%. The relative prevalence of AD increased from age 60 to 89 years and decreased slightly after age 90+, while ""pure"" VD diagnosed in the presence of vascular encephalopathy of different types with low neuritic AD pathology (Braak stages<3; mean 1.2-1.6) decreased progressively from age 60 to 90+; 85-95% of these patients had histories of diabetes, morphologic signs of hypertension, 65% myocardial infarction/cardiac decompensation, and 75% a history of stroke(s). Morphologic subtypes, subcortical arteriosclerotic (the most frequent), multi-infarct encephalopathy, and strategic infarct dementia showed no age-related differences. The relative prevalence of AD+ Lewy pathology remained fairly constant with increasing age. Mixed dementia and AD with minor cerebrovascular lesions increased significantly with age, while other dementias decreased. This retrospective study using strict morphologic criteria confirmed increased prevalence of AD with age, but mild decline at age 90+, and progressive decline of VD, while AD + vascular pathologies including MIX showed considerable age-related increase, confirming that mixed pathologies account for most dementia cases in very old persons. A prospective clinicopathologic study in oldest- old subjects showed a significant increase in both AD and cerebral amyloid angiopathy (CAA), but decrease in VD over age 85, while in a small group of old subjects CAA without considerable AD pathology may be an independent risk factor for cognitive decline. ©Springer-Verlag 2010.",adult;aged;Alzheimer disease;article;Austria;autopsy;brain atherosclerosis;brain disease;brain infarction;cerebrovascular disease;cohort analysis;dementia;diabetes mellitus;diffuse Lewy body disease;disease course;female;groups by age;heart failure;heart infarction;human;hypertension;immunohistochemistry;male;Mini Mental State Examination;morphology;multiinfarct dementia;neuropathology;prevalence;priority journal;retrospective study;cerebrovascular accident,"Jellinger, K. A.;Attems, J.",2010,,,0,
2049,Neuropathology and general autopsy findings in nondemented aged subjects,"A retrospective study of the essential general pathology and neuropathological features in 100 nondemented individuals aged 65 years or older (mean 81.23 ± 5.47 y) was performed using semiquantitative methods. 91% of the patients had a history of hypertension, 31% malignancies, 24% COPD, 18% myocardial infarction, and 4% stroke. Major causes of death were cardiovascular decompensation, pneumonia, acute myocardial infarction, and malignancies. General autopsy revealed severe systemic and coronary atherosclerosis in 86 and 90%, respectively, renal angioangiolosclerosis in 82%, acute or recurrent myocardial infarction in 65%, and other diseases. Neuropathology showed average brain weight of 1,163 ± 113 g, mild to moderate brain atrophy, absent to mild atherosclerosis of large cerebral arteries in 46%, mild, moderate and severe one in 31, 17, and 6%, respectively. There were considerable discrepancies in the severity between generalized/ aortic and intracranial atherosclerosis, only less than one-third being comparable. Negative Khachaturian criteria and CERAD Stage 0 were observed in 83 and 86%, respectively, only 13% with CERAD Stage A, and 1% Stage B. Braak neuritic stages ranged from 0 to II (53%), II - III (29%) to III - IV (18%), none scoring Grade V or VI. The average Braak score was 2.3 ± 0.8. Vascular pathologies were common; CAA was absent in 61%, mild or moderate in 36% and severe in 3%. Mild to severe lacunar state in basal ganglia and/or white matter was seen in 73%, hippocampal sclerosis in 3 cases, while only 9% were free of cerebrovascular lesions. Lewy bodies were observed in 5 brains involving substantia nigra (n = 3), cerebral cortex (n = 1) and medulla oblongata (n = 1), 1 case representing incidental Lewy body disease. τ pathology in brainstem was observed in 60 cases (60%). Mixed cerebral pathologies (cerebrovascular lesions and moderate neuritic Braak stages) were observed in 6 cases (mean age 89.6 y). The importance of mixed pathologies in nondemented elderly, being less frequent than in other studies, remains to be elucidated. © 2012 Dustri-Verlag Dr. K. Feistle.",acute heart infarction;aged;aging;aorta atherosclerosis;article;autopsy;basal ganglion;Braak score;brain artery;brain atherosclerosis;brain atrophy;brain cortex;brain stem;brain weight;cardiovascular disease;cause of death;CERAD score;coronary artery atherosclerosis;dementia;diffuse Lewy body disease;disease severity;female;hippocampal sclerosis;human;human tissue;incidental finding;Khachaturian criteria;kidney disease;lacunar stroke;Lewy body;male;medulla oblongata;neoplasm;neuropathology;pneumonia;priority journal;quantitative analysis;recurrent disease;renal angioangiolosclerosis;retrospective study;scoring system;substantia nigra;systemic disease;white matter,"Jellinger, K. A.;Attems, J.",2012,,,0,
2050,"Evidence, ethics and medication management in older people",,antihypertensive agent;benzodiazepine;nonsteroid antiinflammatory agent;prostaglandin synthase inhibitor;psychotropic agent;spironolactone;warfarin;adverse drug reaction;antihypertensive therapy;arthritis;article;beneficence;clinical decision making;clinical evaluation;clinical practice;clinical trial (topic);cognitive defect;comorbidity;dementia;disease severity;drug efficacy;drug surveillance program;elderly care;evidence based medicine;gastrointestinal hemorrhage;health care personnel;atrial fibrillation;heart failure;human;incidence;informed consent;justice;medical ethics;mortality;patient autonomy;patient care;patient monitoring;polypharmacy;practice guideline;prescription;prevalence;quality of life;resource allocation;risk reduction;treatment withdrawal,"Jenkins, N.",2010,,,0,
2051,Upregulation of autophagy genes and the unfolded protein response in human heart failure,"The cellular environment of the mammalian heart constantly is challenged with environmental and intrinsic pathological insults, which affect the proper folding of proteins in heart failure. The effects of damaged or misfolded proteins on the cell can be profound and result in a process termed ""proteotoxicity"". While proteotoxicity is best known for its role in mediating the pathogenesis of neurodegenerative diseases such as Alzheimer's disease, its role in human heart failure also has been recognized. The UPR involves three branches, including PERK, ATF6, and IRE1. In the presence of a misfolded protein, the GRP78 molecular chaperone that normally interacts with the receptors PERK, ATF6, and IRE-1 in the endoplasmic reticulum detaches to attempt to stabilize the protein. Mouse models of cardiac hypertrophy, ischemia, and heart failure demonstrate increases in activity of all three branches after removing GRP78 from these internal receptors. Recent studies have linked elevated PERK and CHOP in vitro with regulation of ion channels linked with human systolic heart failure. With this in mind, we specifically investigated ventricular myocardium from 10 patients with a history of conduction system defects or arrhythmias for expression of UPR and autophagy genes compared to myocardium from non-failing controls. We identified elevated Chop, Atf3, and Grp78 mRNA, along with XBP-1-regulated Cebpa mRNA, indicative of activation of the UPR in human heart failure with arrhythmias.",Chop;Grp78;Heart failure;Ire-1;unfolded protein response,"Jensen, B. C.;Bultman, S. J.;Holley, D.;Tang, W.;de Ridder, G.;Pizzo, S.;Bowles, D.;Willis, M. S.",2017,,,0,
2052,Development and validation of a comorbidity scoring system for patients with cirrhosis,"Background & Aims At least 40% of patients with cirrhosis have comorbidities that increase mortality. We developed a cirrhosis-specific comorbidity scoring system (CirCom) to help determine how these comorbidities affect mortality and compared it with the generic Charlson Comorbidity Index. Methods We used data from nationwide health care registries to identify Danish citizens diagnosed with cirrhosis in 1999-2008 (n = 12,976). They were followed through 2010 and characterized by 34 comorbidities. We used Cox regression to assign severity weights to comorbidities with an adjusted mortality hazard ratio (HR) ≥1.20. Each patient's CirCom score was based on, at most, 2 of these comorbidities. Performance was measured with Harrell's C statistic and the Net Reclassification Index (NRI) and results were compared with those obtained using the Charlson Index (based on 17 comorbidities). Findings were validated in 2 separate cohorts of patients with alcohol-related cirrhosis or chronic hepatitis C. Results The CirCom score included chronic obstructive pulmonary disease, acute myocardial infarction, peripheral arterial disease, epilepsy, substance abuse, heart failure, nonmetastatic cancer, metastatic cancer, and chronic kidney disease; 24.2% of patients had 1 or more of these, and mortality correlated with the CirCom score. Patients' CirCom score correlated with their Charlson Comorbidity Index (Kendall's τ = 0.57; P <.0001). Compared with the Charlson Index, the CirCom score increased Harrell's C statistic by 0.6% (95% confidence interval: 0.3%-0.8%). The NRI for the CirCom score was 5.2% (95% confidence interval: 3.7%-6.9%), and the NRI for the Charlson Index was 3.6% (95% confidence interval: 2.3%-5.0%). Similar results were obtained from the validation cohorts. Conclusions We developed a scoring system to predict mortality among patients with cirrhosis based on 9 comorbidities. This system had higher C statistic and NRI values than the Charlson Comorbidity Index, and is easier to use. It could therefore be a preferred method to predict death or survival of patients and for use in epidemiologic studies. © 2014 by the AGA Institute.",acute heart infarction;acute pancreatitis;adult;alcohol liver cirrhosis;article;bipolar disorder;cardiomyopathy;cerebrovascular disease;Charlson Comorbidity Index;chronic kidney disease;chronic obstructive lung disease;chronic pancreatitis;cirrhosis specific comorbidity scoring system;comorbidity;connective tissue disease;controlled study;dementia;depression;diabetes mellitus;epilepsy;female;follow up;heart arrhythmia;heart failure;hepatitis C;human;hypertension;ischemic heart disease;major clinical study;male;metastasis;mortality;neoplasm;osteoporosis;peptic ulcer;peptic ulcer bleeding;peripheral occlusive artery disease;prediction and forecasting;priority journal;psoriasis;schizophrenia;scoring system;substance abuse;survival rate;ulcer perforation;validation study;valvular heart disease;venous thromboembolism,"Jepsen, P.;Vilstrup, H.;Lash, T. L.",2014,,,0,
2053,PPARγ agonists-Antidiabetic drugs with a potential role in the treatment of diseases other than diabetes,"The use of thiazolidinediones (TZDs) for treating patients with type 2 diabetes mellitus (T2DM) has been expansively increasing. Although troglitazone was withdrawn from the market, rosiglitazone and pioglitazone are currently available in several countries worldwide. Insulin resistance is one of the major pathophysiological alterations in T2DM and can be decreased by using TZDs. TZDs can be used in combination with other oral antidiabetic drugs, preferably with metformin or sulfonylureas. The effects of TZDs are explained by their peroxisome proliferator activator receptor-γ (PPARγ) activating characteristics. Activation of PPARγ leads to lowering blood glucose in diabetic patients but this mechanism may also result in prevention of T2DM. TZDs due to their specific PPARγ activation can be used for reducing cardiovascular risk and even for decreasing certain cardiovascular events. In addition, TZDs are considered promising for the treatment of patients with clinical conditions other than diabetes. Some of the benefits of TZDs have been documented by randomised controlled clinical trials while others are still to be proven. TZDs have well characterised side effects, therefore the benefit-risk ratio should carefully be evaluated. © 2007 Elsevier Ireland Ltd. All rights reserved.","2,4 thiazolidinedione derivative;antidiabetic agent;glibenclamide;glimepiride;glucose;insulin;metformin;peroxisome proliferator activated receptor gamma agonist;pioglitazone;placebo;rosiglitazone;sulfonylurea;troglitazone;Alzheimer disease;aminotransferase blood level;article;asthma;cardiovascular disease;cardiovascular risk;clinical trial;congestive heart failure;diabetic patient;drug dose titration;drug effect;drug potentiation;drug use;drug withdrawal;edema;fluid retention;fracture;gastrointestinal disease;glucose blood level;HIV associated lipodystrophy;human;hypoglycemia;insulin resistance;liver toxicity;lung edema;market;monotherapy;multiple sclerosis;non insulin dependent diabetes mellitus;nonalcoholic fatty liver;ovary polycystic disease;pathophysiology;psoriasis vulgaris;risk reduction;side effect;ulcerative colitis;weight gain","Jermendy, G.",2007,,,0,
2054,"Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study","BACKGROUND: Pharmacotherapy in the older adult is a complex field involving several different medical professionals. The evidence base for pharmacotherapy in elderly patients in primary care relies on only a few clinical trials, thus documentation must be improved, particularly in the field of complementary and alternative medicine (CAM) like phytotherapy, homoeopathy, and anthroposophic medicine. This study describes diagnoses and therapies observed in elderly patients treated with anthroposophic medicine in usual care. METHODS: Twenty-nine primary care physicians in Germany participated in this prospective, multicenter observational study on prescribing patterns. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients were at least 60 years of age. Multiple logistic regression analysis was used to determine factors associated with anthroposophic prescriptions. RESULTS: In 2005, a total of 12 314 prescriptions for 3076 patients (68.1% female) were included. The most frequent diagnoses were hypertension (11.1%), breast cancer (3.5%), and heart failure (3.0%). In total, 30.5% of the prescriptions were classified as CAM remedies alone, 54.4% as conventional pharmaceuticals alone, and 15.1% as a combination of both. CAM remedies accounted for 41.7% of all medications prescribed (35.5% anthroposophic). The adjusted odds ratio (AOR) for receiving an anthroposophic remedy was significantly higher for the first consultation (AOR = 1.65; CI: 1.52-1.79), treatment by an internist (AOR = 1.49; CI: 1.40-1.58), female patients (AOR = 1.35; CI: 1.27-1.43), cancer (AOR = 4.54; CI: 4.12-4.99), arthropathies (AOR = 1.36; CI: 1.19-1.55), or dorsopathies (AOR = 1.34; CI: 1.16-1.55) and it decreased with patient age (AOR = 0.97; CI: 0.97-0.98). The likelihood of being prescribed an anthroposophic remedy was especially low for patients with hypertensive diseases (AOR = 0.36; CI: 0.32-0.39), diabetes mellitus (AOR = 0.17; CI: 0.14-0.22), or metabolic disorders (AOR = 0.17; CI: 0.13-0.22). CONCLUSION: The present study is the first to provide a systematic overview of everyday anthroposophic medical practice in primary care for elderly patients. Practitioners of anthroposophic medicine prescribe both conventional and complementary treatments. Our study may facilitate further CAM-research on indications of, for example, dementia or adverse drug reactions in the elderly.","Age Factors;Aged;Aged, 80 and over;*Anthroposophy;Female;Follow-Up Studies;Humans;Male;Middle Aged;Patient Care/*methods/trends;Pharmaceutical Preparations/*administration & dosage;Primary Health Care/*methods/trends;Prospective Studies;Time Factors","Jeschke, E.;Ostermann, T.;Tabali, M.;Vollmar, H. C.;Kroz, M.;Bockelbrink, A.;Witt, C. M.;Willich, S. N.;Matthes, H.",2010,Jul 21,10.1186/1471-2318-10-48,0,
2055,Prescribing patterns in dementia: A multicentre observational study in a German network of CAM physicians,"Background: Dementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM) by analysing prescribing patterns and comparing them to current treatment guidelines in Germany.Methods: Twenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including Ginkgo biloba.Results: During the 5-year study period (2004-2008), 577 patients with dementia were included (median age: 81 years (IQR: 74-87); 69% female). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all) followed by cholinesterase inhibitors (17.6%). The adjusted odds ratio (AOR) for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88), co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90), and heart failure (AOR = 4.85; CI: 3.42-6.88). The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). The prescription of Ginkgo biloba was associated with sex (female: AOR = 0.41; CI: 0.19-0.89), patient age (AOR = 1.06; CI: 1.02-1.10), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16).Conclusions: This study provides a comprehensive analysis of everyday practice for treatment of dementia in primary care in physicians with a focus on CAM. The prescribing frequency for anti-dementia drugs is equivalent to those found in other German studies, while the administration of Ginkgo biloba is significantly higher. © 2011 Jeschke et al; licensee BioMed Central Ltd.",anticonvulsive agent;antidepressant agent;antiparkinson agent;benzodiazepine;butyrophenone;cholinergic receptor blocking agent;cholinesterase inhibitor;donepezil;ergot alkaloid;galantamine;Ginkgo biloba extract;hypnotic agent;memantine;neuroleptic agent;nimodipine;nootropic agent;piracetam;risperidone;rivastigmine;sedative agent;selegiline;adult;aged;alternative medicine;Alzheimer disease;article;clinical practice;comorbidity;dementia;diabetes mellitus;disease classification;female;general practitioner;Germany;heart failure;human;hypertension;major clinical study;male;medical specialist;multiinfarct dementia;multivariate logistic regression analysis;observational study;Parkinson disease;practice guideline;prescription;sex difference,"Jeschke, E.;Ostermann, T.;Vollmar, H. C.;Tabali, M.;Schad, F.;Matthes, H.",2011,,,0,
2056,Pharmacologic profile of certoparin,"The low molecular weight heparins (LMWHs) are now not only used for the prophylaxis and treatment of deep vein thrombosis (DVT), but also for the management of acute coronary syndromes. Beside these approved usages, the LMWHs have been developed for indications such as thrombotic and ischaemic stroke, cancer-associated thrombotic and vascular disorders, Alzheimer's disease and a variety of inflammatory disorders. In the United States, there are three approved LMWHs (enoxaparin, dalteparin and ardeparin). In Canada, reviparin and tinzaparin are also approved. The European Union has taken the lead; eight LMWHs are approved for various indications. Certoparin represents one of the earlier LMWHs used for DVT prophylaxis and treatment, with additional indications currently under development. Certoparin represents an isoamyl nitrite depolymerised LMWH with comparable structural characteristics to other nitrous acid depolymerised products such as nadroparin and reviparin. While comparable in structure to dalteparin, this agent differs in function due to a secondary purification process that is employed in the manufacture of dalteparin. The preclinical pharmacology of this drug has been extensively investigated. Although indication specific dosing and the optimisation of use in, for example, acute coronary syndromes and thrombotic stroke, may be require, certoparin represents a typical LMWH with comparable performance characteristics to some other agents. This chapter describes some of the preclinical and clinical pharmacologic characteristics of this drug. This information will be useful in designing clinical trials for newer indications of this drug.",certoparin;dalteparin;low molecular weight heparin;nadroparin;reviparin;Alzheimer disease;article;Canada;neoplasm;chemical structure;clinical trial;deep vein thrombosis;drug purification;European Union;heart muscle ischemia;human;meta analysis;prophylaxis;cerebrovascular accident;thrombocytopenia;thrombosis;United States;vascular disease,"Jeske, W.;Wolf, H.;Ahsan, A.;Fareed, J.",1999,,,0,
2057,How Serious Is Erectile Dysfunction in Men's Lives? Comparative Data From Korean Adults,"PURPOSE: Whereas sexual function has long been assumed to be an important component of adult men's lives, the impact of sexual dysfunction has not been estimated in parallel to other modern disease entities. We compared the seriousness of erectile dysfunction (ED) with that of other diseases by use of self-administered questionnaires. MATERIALS AND METHODS: Between January 2012 and July 2012, 434 healthy male volunteers (group 1) and 263 ED patients (group 2) were enrolled. The questionnaire consisted of the following: ""If you must undergo only one disease in all your life, which disease could you select among these items or ED?"" The comparative disease entities included hypertension, diabetes mellitus (oral hypoglycemic agent/insulin injection), hemodialysis, myocardial infarction, herpes zoster, chronic sinusitis, chronic otitis media, gastric cancer (early/late), lung cancer (early/late), liver cancer (early/late), and dementia. RESULTS: Group 1 recognized ED as being a more serious disease than hypertension, diabetes mellitus (oral hypoglycemic agent), herpes zoster, chronic sinusitis, and chronic otitis media. In comparison, group 2 recognized ED as being a more serious condition than diabetes mellitus (insulin injection) and dementia (p<0.001 and p<0.001, respectively). In particular, ED was deemed to be more serious than hemodialysis, gastric cancer (early), lung cancer (early), and liver cancer (early) by men in group 2 in their 30s to 40s, and these results were statistically significant compared with the same age subgroups in group 1 (p<0.001, p<0.007, p<0.02, and p<0.007, respectively). CONCLUSIONS: In contrast with their healthy counterparts, Korean men with ED recognized ED as being as serious as hemodialysis, dementia, and early stage cancer, which reflects the severe bother of ED in Korean patients.",Erectile dysfunction;Quality of life;Questionnaires,"Ji, Y. S.;Choi, J. W.;Ko, Y. H.;Song, P. H.;Jung, H. C.;Moon, K. H.",2013,Jul,10.4111/kju.2013.54.7.467,0,
2058,"The effects of DL-3-n-butylphthalide in patients with vascular cognitive impairment without dementia caused by subcortical ischemic small vessel disease: A multicentre, randomized, double-blind, placebo-controlled trial","Introduction Vascular cognitive impairment without dementia is very common among the aged and tends to progress to dementia, but there have been no proper large-scale intervention trials dedicated to it. Vascular cognitive impairment without dementia caused by subcortical ischemic small vessel disease (hereinafter, subcortical Vascular cognitive impairment without dementia) represents a relatively homogeneous disease process and is a suitable target for therapeutic trials investigating Vascular cognitive impairment without dementia. Preclinical trials showed that dl-3-n-butylphthalide (NBP) is effective for cognitive impairment of vascular origin. Methods In this randomized, double-blind, placebo-controlled trial, we enrolled patients aged 50-70 years who had a diagnosis of subcortical Vascular cognitive impairment without dementia at 15 academic medical centers in China. Inclusion criteria included a clinical dementia rating ≥0.5 on at least one domain and global score ≤0.5; a mini-mental state examination score ≥20 (primary school) or ≥24 (junior school or above); and brain magnetic resonance imaging consistent with subcortical ischemic small vessel disease. Patients were randomly assigned to NBP 200 mg three times daily or matched placebo (1:1) for 24 weeks according to a computer-generated randomization protocol. All patients and study personnel were masked to treatment assignment. Primary outcome measures were the changes in Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) and clinician's interview-based impression of change plus caregiver input (CIBIC-plus) after 24 weeks. All patients were monitored for adverse events (AEs). Outcome measures were analyzed for both the intention-to-treat (ITT) population and the per protocol population. Results This study enrolled 281 patients. NBP showed greater effects than placebo on ADAS-cog (NBP change -2.46 vs. placebo -1.39; P =.03; ITT) and CIBIC-plus (80 [57.1%] vs. 59 [42.1%] patients improved; P =.01; ITT). NBP-related AE were uncommon and primarily consisted of mild gastrointestinal symptoms. Discussion Over the 6-month treatment period, NBP was effective for improving cognitive and global functioning in patients with subcortical vascular cognitive impairment without dementia and exhibited good safety.",ChiCTR-TRC 09000440;butylphthalide;dl 3 n butylphthalide;unclassified drug;adult;aged;Alzheimer disease;article;brain hemorrhage;brain ischemia;caregiver;Clinical Dementia Rating;cognitive defect;controlled study;dementia;dizziness;double blind procedure;drug safety;female;fracture;gastrointestinal symptom;heart arrhythmia;heart infarction;human;influenza A (H1N1);major clinical study;male;Mini Mental State Examination;multicenter study;nuclear magnetic resonance imaging;outcome assessment;priority journal;randomized controlled trial;subcortical ischemic small vessel disease;transient ischemic attack;vascular cognitive impairment,"Jia, J.;Wei, C.;Liang, J.;Zhou, A.;Zuo, X.;Song, H.;Wu, L.;Chen, X.;Chen, S.;Zhang, J.;Wu, J.;Wang, K.;Chu, L.;Peng, D.;Lv, P.;Guo, H.;Niu, X.;Chen, Y.;Dong, W.;Han, X.;Fang, B.;Peng, M.;Li, D.;Jia, Q.;Huang, L.",2016,,,0,
2059,Effect of carotid atherosclerosis on mild cognitive impairment,"Objective: To examine the effect of carotid atherosclerosis on mild cognitive impairment (MCI). Methods: 1886 relatively healthy Guangzhou residents without history of stroke, myocardial infarction, pulmonary heart disease and malignant tumor were recruited in this study by simple random selection. MCI and carotid color ultrasound were measured in these subjects by using the Mini Mental State Examination (MMSE), the 10-word list learning task (CWL) and common carotid artery intima-medial thickness (IMT) as indicators. Results: (1) The 300 (15.9%) subjects with MCI were identified. No significant difference in MCI prevalence between the sexes was identified. (2) Significant associations between CWL and traditional cardiovascular risk factors, such as older age, smoking and increased waist circumference, blood pressure and lipids were found. (3) After adjusting for multiple potential confounders, increasing IMT was significantly associated with both decreased CWL (β=-1.05, 95% CI: -1.73 - -0.36) and MMSE score (β=-0.95, 95% CI: -1.67--0.23). (4) After adjusting for age, sex, education, physical activity, smoking, waist circumference and high- and low-density lipoprotein cholesterol, IMT was significantly thicker in the MCI group than the normal (0.76 mm vs 0.74 mm, F=6.9, P < 0.01). Conclusions: The severity of MCI was significantly and linearly associated with increased IMT, suggesting that preventing atherosclerosis may help to reduce the incidence and development of dementia.",high density lipoprotein cholesterol;lipid;low density lipoprotein cholesterol;arterial wall thickness;article;blood pressure;cardiovascular risk;carotid atherosclerosis;color ultrasound flowmetry;common carotid artery;groups by age;human;learning test;major clinical study;mild cognitive impairment;Mini Mental State Examination;physical activity;sex difference;smoking;waist circumference,"Jiang, C. Q.;Xu, L.;Lam, T. Q.;Lin, J. M.;Liu, B.;Jin, Y. L.;Zhang, W. S.;Yue, X. J.;Cheng, K. K.;Thomas, G. N.",2010,,,0,
2060,Common complications of elderly stroke patients with community rehabilitation administration,"Aim: To analyze the common complications of senile stroke, and explore the influence of complication on the rehabilitation of the elderly stroke patients and the significance of the reinforce administration of the complications. Methods: The age, gender distribution and common complications were analyzed in 116 patients with different strokes from the Department of Rehabilitation Medicine, Changning District Zunyi Community Health Center of Shanghai City. All the patients, aged above 60 years old, were in accordance with the diagnositic criteria established in the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, and were identified with cranial CT or MRI, had the disease course < 6 months, while those with craniocerebral injury were excluded. Results: Among the elderly stroke patients, 86.3% had cerebral arterial thrombosisr, 11.2% had hemorrhagic apoplexy, 2.7% had mixture stroke, male patients accounted for 54.3%, and female patients accounted for 45.7%. Hypertension, diabetes mellitus and coronary heart disease were the first three common complications of all the complications. Conclusion: Elderly stroke patients mainly suffer from cerebral arterial thrombosis, and the incidence rate is higher in male patients who are easier to suffer complications. The attack of stroke has obvious positive relation with age in female patients. To the elderly stroke patients, complications should be actively controlled, and rehabilitation effect should be effectively improved to prevent the recurrence.",adult;age distribution;aged;article;brain hemorrhage;China;computer assisted tomography;controlled study;diabetes mellitus;disease control;disease duration;female;geriatric patient;head injury;health center;human;hypertension;incidence;ischemic heart disease;major clinical study;male;neurological complication;nuclear magnetic resonance imaging;occlusive cerebrovascular disease;recurrent disease;rehabilitation center;senility;sex ratio;cerebrovascular accident,"Jiang, H.;Wang, K.",2004,,,0,
2061,Occurrence of suppurative parotitis in elderly people remains a bad omen,,antibiotic agent;bacteremia;bronchitis;candidiasis;dehydration;dementia;disease association;heart failure;human;letter;mortality;mouth hygiene;parotitis;patient care;pneumonia;prevalence;prognosis;septic shock;survival,"Jibidar, H.;Souchon, S.;Miric, D.;Bagher, M.;Fondop, E.;Lezy-Hallet, A. M.",2008,,,0,
2062,Statins and the risk of dementia,"Background: Dementia affects an estimated 10% of the population older than 65 years. Because vascular and lipid-related mechanisms are thought to have a role in the pathogenesis of Alzheimer's disease and vascular dementia, we did an epidemiological study of the potential effect of HMGCoA (3 hydroxy-3methylglutaryl-coenzyme A) reductase inhibitors (statins) and other lipid-lowering agents on dementia. Methods: We used a nested case-control design with information derived from 368 practices which contribute to the UK-based General Practice Research Database. The base study population included three groups of patients age 50 years and older: all individuals who had received lipid-lowering agents (LLAs); all individuals with a clinical diagnosis of untreated hyperlipidaemia; and a randomly selected group of other individuals. From this base population, all cases with a computer-recorded clinical diagnosis of dementia were identified. Each case was matched with up to four controls derived from the base population on age, sex, practice, and index date of case. Findings: The study encompassed 284 cases with dementia and 1 080 controls. Among controls 13% had untreated hyperlipidaemia, 11% were prescribed statins, 7% other LLAs, and 69% had no hyperlipidaemia or LLA exposure. The relative risk estimates of dementia adjusted for age, sex, history of coronary-artery disease, hypertension, coronary-bypass surgery and cerebral ischaemia, smoking and body mass index for individuals with untreated hyperlipidaemia (odds ratio 0.72 [95% Cl 0.45-1.14]), or treated with non-statin LLAs (0.96 [0.47-1.97], was close to 1.0 and not significant compared with people who had no diagnosis of hyperlipidaemia or exposure to other lipid-lowering drugs. The adjusted relative risk for those prescribed statins was 0.29 (0.13-0.63; p=0.002). Interpretation: Individuals of 50 years and older who were prescribed statins had a substantially lowered risk of developing dementia, independent of the presence or absence of untreated hyperlipidaemia, or exposure to non-statin LLAs. The available data do not distinguish between Alzheimer's disease and other forms of dementia.",antilipemic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;adult;aged;Alzheimer disease;article;body mass;brain ischemia;controlled study;coronary artery bypass graft;coronary artery disease;dementia;female;human;hyperlipidemia;hypertension;major clinical study;male;multiinfarct dementia;pathogenesis;priority journal;smoking;United Kingdom,"Jick, H.;Zornberg, G. L.;Jick, S. S.;Seshadri, S.;Drachman, D. A.",2000,,,0,
2063,Charlson comorbidity index in ischemic stroke and intracerebral hemorrhage as predictor of mortality and functional outcome after 6 months,"Background: The Charlson Comorbidity Index (CCI) is commonly used in outcome and mortality studies. Our aim was to investigate the association between CCI score and the functional outcome and mortality 6 months after ischemic stroke (IS) or intracerebral hemorrhage. Methods: This was a prospective observational cohort of patients with spontaneous intracerebral hemorrhage and IS admitted to the stroke unit during 18 months. The modified Rankin scale (mRS) score was obtained for subjects 6 months after event. The CCI score was dichotomized (low comorbidity 0 or 1 versus high ≥2) for analysis. The mRS score was also dichotomized (good outcome, mRS score 0 or 1 versus poor outcome, mRS score ≥2). Results: In all, 175 patients were enrolled in the study. Logistic regression showed that those with a high CCI score (≥2) had 37.3% increased odds of having a poor outcome (≥2) at 6 months and 68.4% greater odds of death at 6 months. Conclusions: Comorbid medical conditions independently influence outcome after IS or intracerebral hemorrhage. © 2013 by National Stroke Association.",acquired immune deficiency syndrome;aged;article;brain hemorrhage;brain ischemia;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;dementia;demography;diabetes mellitus;disease association;dyslipidemia;female;heart infarction;hemiplegia;human;hypertension;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;mortality;National Institutes of Health Stroke Scale;outcome assessment;peripheral vascular disease;prediction;priority journal;Rankin scale;solid tumor;ulcer,"Jiménez Caballero, P. E.;López Espuela, F.;Portilla Cuenca, J. C.;Ramírez Moreno, J. M.;Pedrera Zamorano, J. D.;Casado Naranjo, I.",2013,,,0,
2064,Early alteration of adrenergic cardiac function in parkinsonisms with Lewy bodies,"BACKGROUND: 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy is clinically used to estimate myocardial sympathetic damage in some forms of heart disease, autonomic nerve disturbance in diabetic neuropathy, and disturbance of the autonomic nervous system in neurodegenerative disease. In the present study, examinations were performed to clarify the rate and characteristics of cardiac sympathetic disturbance in Parkinson's disease (PD) and usefulness of 123I-MIBG myocardial scintigraphy to differentiate PD from the Lewy Body Disease (LBD). MATERIAL AND METHODS: 108 subjects were studied. There were 70 patients with PD, 21 patients with LBD, and 17 age-matched normal subjects without neurological disease. The clinical parameters evaluated were severity of the process (measured by Hoehn and Yahr Scale), vegetative manifestations, development time and use of medication taken. Myocardial adrenergic function was analyzed by imaging with 123I-MIBG. Early (15 min) and delayed (4 h) images of the thorax in the anterior view were obtained after injection of 123I-MIBG (111 MBq). The qualitative and semiquantitative 123I-MIBG uptake was quantified by calculating a heart-to-mediastinum ratio (HMR) and analyzed in a blind manner. RESULTS: The mean H/M ratio in patients with PD and LBD was significantly lower than in controls (p < 0.05). This is independent of development time, process severity, use of medication or vegetative manifestations. The HMR obtained in LBD patients is less clear than in PD. CONCLUSION: 123I-MIBG myocardial scintigraphy might detect early disturbances of the sympathetic nervous system in PD and LBD.","*3-Iodobenzylguanidine;Diagnosis, Differential;Female;Heart/physiopathology/*radionuclide imaging;Humans;Lewy Body Disease/physiopathology/*radionuclide imaging;Male;Parkinson Disease/physiopathology/*radionuclide imaging;*Radiopharmaceuticals;Receptors, Adrenergic/physiology;Sympathetic Nervous System/physiopathology","Jimenez-Hoyuela Garcia, J. M.;Campos Arillo, V.;Rebollo Aguirre, A. C.;Gomez Doblas, J. J.;Gutierrez Hurtado, A.",2005,Mar-Apr,,0,
2065,The cerebral hemodynamics in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,"OBJECTIVE: To investigate the cerebral hemodynamics in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). METHODS: The blood flow velocity of cerebral arteries was measured by using transcranial Doppler ultrasound (TCD) in 6 cases with CADASIL and a quite number of age and sex matched control subjects. All patients (4 were symptomatic and 2 asymptomatic), being an established CADASIL family with the diagnosis confirmed by clinical characteristics, neuroimaging, pathology and molecular genetics, had abnormal mark signals on MR imagining and no history of hypertension, diabetes, heart disease and migraine. A routinely TCD detection, including peak-systolic velocity (Vp), end-diastolic velocity (Vd), mean velocity (Vm) and pulsatility index (PI), was carried out on the bilateral middle cerebral arteries (MCA), anterior cerebral arteries (ACA), posterior cerebral arteries (PCA) and vertebral arteries (VA) as well as the basilar artery (BA). A comparison between the cases and controls was made. Then, the changes of flow velocity in middle cerebral arteries (MCA) of the patients with CADASIL were observed before and after breathholding tests. In addition, brain CT perfusion imaging (CTP) was carried out in all the cases by using 16-slice spiral CT. RESULTS: The appearances of frequency spectrum were nearly normal in all the cases and there was no abnormality between the two sides on velocity (P > 0.05). As compared with the controls, the bilateral Vp, Vd and Vm in ACA and PCA were decreased obviously (P < 0.05). The velocity parameters of MCA with the exception of left Vm and right PI showed changes (P < 0.05) and there were no changes of PI in the bilateral ACA, PCA and Left MCA (P > 0.05). Moreover, there were marked changes in MCA (including Vm, Vd and PI) of all the cases as compared with the controls after breathholding (P < 0.01). Brain perfusion imaging showing the regional cerebral blood flow and regional cerebral blood volume in frontal lobes were obviously decreasing (P < 0.01) and there was no significant variation of mean transit time (MTT). CONCLUSIONS: The characteristic hemodynamic changes in our group is the decreasing flow velocity in bilateral ACA, PCA and MCA and the dominating low flow area occurring usually in frontal and temporal lobes. These changes are in conformity with the ischemic area shown in pathology and neuroimaging in CADASIL patients.",Adult;Blood Flow Velocity;CADASIL/*physiopathology/ultrasonography;*Cerebrovascular Circulation;Female;Humans;Male;Middle Aged,"Jin, D. X.;Chen, X. Y.;Huang, H.;Zhang, X.",2006,Dec,,0,
2066,Increased Framingham 10-year risk of coronary heart disease in middle-aged and older patients with psychotic symptoms,"OBJECTIVE: The Framingham 10-risk of coronary heart disease (CHD) has been a widely studied estimate of cardiovascular risk in the general population. However, few studies have compared the relative risk of developing CHD in antipsychotic-treated patients with different psychiatric disorders, especially in older patients with psychotic symptoms. In this study, we compared the 10-year risk of developing CHD among middle-aged and older patients with psychotic symptoms to that in the general population. METHOD: We analyzed baseline data from a study examining metabolic and cardiovascular effects of atypical antipsychotics in patients over age 40 with psychotic symptoms. After excluding patients with prior history of CHD and stroke, 179 subjects were included in this study. Among them, 68 had a diagnosis of schizophrenia, 42 mood disorder, 38 dementia, and 31 PTSD. Clinical evaluations included medical and pharmacologic treatment history, physical examination, and clinical labs for metabolic profiles. Using the Framingham 10-year risk of developing CHD based on the Framingham Heart Study (FHS), we calculated the risk CHD risk for each patient, and then compared relative risk in each psychiatric diagnosis to the risks reported in the FHS. RESULTS: The mean age of entire sample was 63 (range 40-94) years, 68% were men. The Framingham 10-year risk of CHD was increased by 79% in schizophrenia, 72% in PTSD, 61% in mood disorder with psychosis, and 11% in dementia relative to the risk in general population from the FHS. CONCLUSIONS: In this sample of middle-aged and older patients with psychotic symptoms, we found a significantly increased 10-year risk of CHD relative to the estimated risk from FHS, with the greatest increased risk for patients with schizophrenia and PTSD. Development of optimally tailored prevention and intervention efforts to decrease different risk components in these patients could be an important step to help decrease the risks of CHD and overall mortality in this vulnerable population.","Adult;Age Factors;Aged;Aged, 80 and over;Anti-Anxiety Agents/adverse effects/therapeutic use;Anticonvulsants/adverse effects/therapeutic use;Antidepressive Agents/adverse effects/therapeutic use;Antipsychotic Agents/adverse effects/therapeutic use;Cause of Death;Coronary Disease/chemically induced/*mortality;Dementia/diagnosis/drug therapy/*mortality/psychology;Drug Therapy, Combination;Female;Follow-Up Studies;Humans;Male;Metabolic Syndrome X/chemically induced/diagnosis/mortality/psychology;Middle Aged;Mood Disorders/diagnosis/drug therapy/*mortality/psychology;Psychotic Disorders/diagnosis/drug therapy/*mortality/psychology;Risk;Schizophrenia/diagnosis/drug therapy/*mortality;*Schizophrenic Psychology;Stress Disorders, Post-Traumatic/diagnosis/drug therapy/*mortality/psychology","Jin, H.;Folsom, D.;Sasaki, A.;Mudaliar, S.;Henry, R.;Torres, M.;Golshan, S.;Glorioso, D. K.;Jeste, D.",2011,Feb,10.1016/j.schres.2010.10.029,0,
2067,Mechanism of Sini Tang against lipid peroxidation injury in vessel endothelium,"Aim. To compare the clinical effects against lipid peroxidation injury of vascular endothelium in senile patients with coronary heart disease (CHD) between ""Snil"" decoction and Vitamin E for investigation of mechanism of ""Sini"" decoction in prevention of CHD. Methods. Sixty senile patients with CHD, 28 males and 32 females, aged 59-81 years old, were randomly divided into three groups of 20 patients each: ""Sini"" decoction Bianbing and Bianzheng groups, and Vitamin E group, and 10 health old peoplewere used as controls, 6 males and 4 females, aged 59-74 years old. The indices of blood lipid metabolism and lipid perozidation injury of vascular endothelium, including SOD activity and the concentrations of MDA, NO and ET, were observed before and after treatment respectively. Results. ""Sini"" decoction improved partial indices of lipid metabolism, ECG and cardiac angina. Between Bianzheng and Vitamin E groups, the differences in serum TC, LDL-C and ApoA1/apoB were significant (P < 0.01). ""Sini"" decoction also decreased the concentrations of plasma MDA and ET-1, and increased SOD activity and NO level obviously. Conclusion. ""Sini"" decoction prevents vascular endothelium against against lipid peroxidation injury, and regulates the function of endothelial cells. ""Sini"" decoction may be performed to regulate blood lipid metabolism and the function of endothelial cells for prevention of CHD.","3,4 methylenedioxyamphetamine;alpha tocopherol;apolipoprotein A1;apolipoprotein B;Chinese drug;cholesterol;lipid;low density lipoprotein cholesterol;nitric oxide;sini tang;unclassified drug;adult;aged;article;blood vessel injury;cell function;cholesterol blood level;clinical trial;comparative study;controlled study;drug mechanism;electrocardiography;endothelium cell;female;human;ischemic heart disease;lipid blood level;lipid metabolism;lipid peroxidation;major clinical study;male;randomized controlled trial;regulatory mechanism;senility;vascular endothelium","Jin, M. H.;Wu, W. K.;Qin, J.;Chen, S. Q.",2003,,,0,
2068,Reduced Cardiovascular Functions in Patients with Alzheimer's Disease,"Previous studies have suggested that cardiovascular functions might play a critical role in Alzheimer's disease (AD) pathogenesis. However, the relationship among heart function, blood flow of cerebral vessels, and AD remains unclear. In the present study, AD patients (n = 34) and age- and gender-matched cognitively normal controls (n = 34) were recruited. Demographic and comorbidity information was collected. The ejection fraction was measured using echocardiography, and the mean velocity, pulsatility index (PI), and resistance index (RI) of the basilar artery (BA), left terminal internal carotid artery (LTICA), and right terminal internal carotid artery (RTICA) were measured using transcranial Doppler. The data of lacunae, white matter changes, and plaques in the aortic arch and carotid arteries were collected from brain magnetic resonance imaging and computed tomography angiography images. Compared with normal controls, AD patients had lower ejection fractions and cerebral blood flow velocities and higher RI and PI in the BA, LTICA, and RTICA, as well as more plaques in the aortic and carotid arteries. In the multivariate logistic regression analysis, the ejection fraction and the mean velocity of the BA and LTICA were independently associated with AD after adjusting for age, gender, education, vascular risk factors, arterial plaques, and brain ischemic lesions detected in the brain images. These findings suggest that heart function and vascular condition may play important roles in AD pathogenesis. Improving cardiovascular functions could be a promising approach for the prevention and treatment of AD.",Alzheimer's disease;cerebral blood flow;ejection fractions;heart,"Jin, W. S.;Bu, X. L.;Wang, Y. R.;Li, L.;Li, W. W.;Liu, Y. H.;Zhu, C.;Yao, X. Q.;Chen, Y.;Gao, C. Y.;Zhang, T.;Zhou, H. D.;Zeng, F.;Wang, Y. J.",2017,,,0,
2069,A percentage analysis of the telomere length in Parkinson's disease patients,"Telomeres are the repeated sequences at the chromosome ends which undergo shortening with cell division. The telomere shortening of the peripheral leukocytes is also facilitated by enhanced oxidative stress in various kinds of disease including ischemic heart disease, diabetes mellitus, apoplexy, and Alzheimer's disease. Telomere shortening in Parkinson's disease (PD) has not yet been reported. The pathogenesis for PD is also regarded to be associated with oxidative stress. We investigated 28 Japanese male PD patients ages 47-69. Although we could not find a statistical difference in the mean telomere length of peripheral leukocytes between the PD patients and the control participants, we found the mean telomere lengths to be shorter than 5 kb in only the PD patients and a significant PD-associated decrease in the telomeres with a length ranging from 23.1 to 9.4 kb in the patients in their 50s and 60s. These observations suggest that telomere shortening is accelerated in PD patients in comparison to the normal population. Copyright 2008 by The Gerontological Society of America.",adult;aged;article;chromosome size;clinical article;controlled study;human;Japanese (people);leukocyte;male;Parkinson disease;priority journal;restriction fragment;telomere,"Jing, Z. G.;Maeda, T.;Sugano, M.;Oyama, J. I.;Higuchi, Y.;Suzuki, T.;Makino, N.",2008,,,0,
2070,Trends in Prevalence and Determinants of Potentially Inappropriate Prescribing in the United States: 2007 to 2012,"Objectives To estimate the prevalence and determinants of the use of potentially inappropriate medications (PIMs) in older U.S. adults using the 2012 Beers criteria. Design Retrospective cohort study in a random national sample of Medicare beneficiaries. Setting Fee-for-service Medicare beneficiaries from 2007 to 2012. Participants U.S. population aged 65 and older with Parts A, B, and D enrollment in at least 1 month during a calendar year (N = 38,250 individuals; 1,308,116 observations). Measurements The 2012 Beers criteria were used to estimate the prevalence of the use of PIMs in each calendar month and over a 12-month period using data on diagnoses or conditions present in the previous 12 months. Generalized estimating equations were used to account for the dependence of multiple monthly observations of a single person when estimating 95% confidence intervals (CIs), and logistic regression was used to identify independent determinants of PIM use. Results The point prevalence of the use of PIMs decreased from 37.6% (95% CI = 37.0-38.1) in 2007 to 34.2% (95% CI = 33.6-34.7) in 2012, with a statistically significant 2% (95% CI = 1-3%) decline per year assuming a linear trend. The 1-year period prevalence declined from 64.9% in 2007 to 56.6% in 2012. The strongest predictor of PIM use was the number of drugs dispensed. Individuals aged 70 and older and those seen by a geriatrician were less likely to receive a PIM. Conclusion From 2007 to 2012, the prevalence of PIM use in older U.S. adults decreased according to the 2012 Beers criteria, although it remains high, still affecting one-third each month and more than half over 12 months. The number of dispensed prescriptions could be used to target future interventions.",cholinergic receptor blocking agent;clonidine;dextropropoxyphene;digoxin;estrogen;glibenclamide;psychotropic agent;sedative agent;2012 beers criteria;aged;article;assessment of humans;cognitive defect;cohort analysis;congestive heart failure;delirium;dementia;drug choice;falling;female;fracture;geriatrician;human;major clinical study;male;medicare;potentially inappropriate medication;prevalence;retrospective study;United States;very elderly,"Jirón, M.;Pate, V.;Hanson, L. C.;Lund, J. L.;Jonsson Funk, M.;Stürmer, T.",2016,,,0,
2071,Characteristics and drug use patterns of older antidepressant initiators in Germany,"Purpose: The purpose of this study was to investigate characteristics, drug use patterns, and predictors for treatment choice in older German patients initiating antidepressant (AD) treatment. Methods: Using the German Pharmacoepidemiological Research Database, we identified a cohort of AD initiators aged at least 65 years between 2005 and 2011. Potential indications, co-morbidity, and co-medication as well as treatment patterns such as the duration of the first treatment episode were assessed. In addition, a logistic regression model was used to identify independent predictors for initiating treatment with tricyclic ADs (TCAs) compared to selective serotonin reuptake inhibitors (SSRIs). Results: Overall, 508,810 individuals were included in the cohort. About 55 % of patients initiated AD treatment with TCAs, followed by 22 % receiving SSRIs. During the study period, a decrease of treatment initiation with TCAs was observed. Higher age and male sex as well as being diagnosed with depression were highly associated with SSRI treatment, whereas pain and sleeping disorders were strong predictors for initiating TCA treatment. The duration of the first treatment episode was substantially longer in SSRI users compared to TCA initiators (median 119 vs. 43 days). Conclusions: Potential indications and drug use patterns in older German AD initiators varied substantially for different drug classes and single agents. Given the anticholinergic and sedative properties of TCAs, the frequent use of this drug class though probably related to indications such as pain was remarkable.",amitriptyline;antidepressant agent;anxiolytic agent;citalopram;herbaceous agent;homeopathic agent;hypnotic agent;monoamine oxidase inhibitor;neuroleptic agent;nootropic agent;noradrenalin uptake inhibitor;opiate;opipramol;sedative agent;serotonin noradrenalin reuptake inhibitor;serotonin uptake inhibitor;tricyclic antidepressant agent;trimipramine;aged;anxiety disorder;article;cerebrovascular disease;cohort analysis;comorbidity;congestive heart failure;dementia;depression;drug indication;drug preference;drug use;female;German (citizen);Germany;groups by age;human;Hypericum perforatum;ischemic heart disease;major clinical study;male;pain;population research;priority journal;sleep disorder;treatment duration,"Jobski, K.;Schmedt, N.;Kollhorst, B.;Krappweis, J.;Schink, T.;Garbe, E.",2017,,10.1007/s00228-016-2145-7,0,
2072,Angiotensin-converting enzyme and progression of white matter lesions and brain atrophy - The SMART-MR study,"High levels of angiotensin-converting-enzyme (ACE) may increase the risk of dementia through blood pressure elevation and subsequent development of cerebral small-vessel disease. However, high ACE levels may also decrease this risk through amyloid degradation which prevents brain atrophy. Within the SMART-MR study, a prospective cohort study among patients with symptomatic atherosclerotic disease, serum ACE levels were measured at baseline and a 1.5 Tesla brain MRI was performed at baseline and after on average (range) 3.9 (3.0-5.8) years of follow-up in 682 persons (mean age 58 ± 10 years). Brain segmentation was used to quantify total, deep, and periventricular white matter lesion (WML) volume, and total brain, cortical gray matter and ventricular volume (%ICV). Lacunar infarcts were rated visually. Regression analyses were used to examine the prospective associations between serum ACE and brain measures. Patients with the highest serum ACE levels (>43.3 U/L) had borderline significantly more progression of deep WML volumes than patients with the lowest ACE levels (<21.8 U/L); mean difference (95% CI) in change was 0.20 (-0.02; 0.43) %ICV. On the contrary, patients with the highest serum ACE levels had significantly less progression of cortical brain atrophy than patients with the lowest ACE levels; mean difference (95% CI) in change was 0.78 (0.21; 1.36) %ICV. Serum ACE was not associated with subcortical atrophy, periventricular WML, or lacunar infarcts. Our results show that higher ACE activity is associated with somewhat more progression of deep WML volume, but with less progression of cortical brain atrophy. This suggests both detrimental and beneficial effects of high ACE levels on the brain. © 2012 - IOS Press and the authors. All rights reserved.",angiotensin receptor antagonist;beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase;dipeptidyl carboxypeptidase inhibitor;diuretic agent;abdominal aorta aneurysm;adult;aged;alcohol consumption;antihypertensive therapy;article;body mass;brain atherosclerosis;brain atrophy;brain damage;brain size;brain ventricle;cerebrovascular disease;cohort analysis;controlled study;diabetes mellitus;disease association;disease course;enzyme blood level;female;follow up;gray matter;human;hypertension;ischemic heart disease;lacunar stroke;major clinical study;male;nuclear magnetic resonance imaging;peripheral occlusive artery disease;priority journal;prospective study;smoking;white matter;white matter lesion,"Jochemsen, H. M.;Geerlings, M. I.;Grool, A. M.;Vincken, K. L.;Mali, W. P. T. M.;Van Der Graaf, Y.;Muller, M.",2012,,,0,
2073,Prevalence and risk factors of postoperative delirium in patients undergoing open heart surgery in northwest of Iran,"Introduction: Delirium as a relatively common complication following cardiac surgery remains a contributory factor in postoperative mortality and an obstacle to early discharge of patients. Methods: In the present study 329 patients who underwent open heart surgery between 1st January 2008 to 1st January 2009 in Shahid Madani Heart Center, Tabriz, Iran were enrolled. Results: Overall 4.9% of patients developed delirium after cardiac surgery. We found atrial fibrillation (P = 0.005), lung diseases (P = 0.04) and hypertension (P = 0.02) to be more common in patients who develop delirium postoperatively. Furthermore, the length of intensive care unit (ICU) stay, cardiopulmonary bypass (CPB) time, and ventilation period were also significantly increased. Also a statistically meaningful relationship between the female gender and development of delirium was also noted (P = 0.02). On the other hand no meaningful relationship was detected between diabetes, history of cerebral vascular diseases, peripheral vascular diseases, myocardial infarction, development of pneumonia following surgery, and laboratory levels of sodium, potassium, glucose, and complete blood cell count (CBC) including white blood cells, red blood cells, platelets in the blood-hemoglobin and hematocrits. Also environmental factors like presence of other patients or companion with the patient, and objects like clock, window and calendar in the patient's room did not affect prevention of delirium. Conclusion: Based on this and other investigations, it can be suggested to use MMPI test to recognize pathologic elements to prevented delirium after surgery and complementary treatment for coping with delirium. © 2013 by Tabriz University of Medical Sciences.",creatinine;glucose;hemoglobin;potassium;sodium;adult;aortic valve repair;article;artificial ventilation;blood level;cardiopulmonary bypass;cerebrovascular disease;controlled study;dementia;diabetes mellitus;disease association;environmental factor;erythrocyte count;female;atrial fibrillation;heart infarction;hematocrit;human;hypertension;intensive care unit;Iran;length of stay;leukocyte count;lung disease;major clinical study;male;medical history;open heart surgery;operation duration;outcome assessment;patient assessment;peripheral vascular disease;pneumonia;postoperative delirium;prevalence;risk factor;sex difference;thrombocyte count,"Jodati, A.;Safaie, N.;Raoofi, M.;Ghorbani, L.;Ranjbar, F.;Noorazar, G.;Mosharkesh, M.",2013,,,0,
2074,Progressive multifocal leukoencephalopathy in an immunocompetent patient?,"Background: Progressive multifocal leukoencephalopathy (PML) is a rapidly progressive, potentially fatal, demyelinating disease affecting immunosuppressed patients. PML is rarely reported in cases with no underlying disease or immunosuppression-associated condition. Case Report: We present a 72-year-old previously healthy woman who developed a progressive neurological condition affecting the entire nervous system which led to her death within 5 months. PML was diagnosed at autopsy. Conclusion: PML should be considered in patients with progressive neurological disorders involving the white matter, even in the absence of previous immunomodulatory treatment or immunosuppression.",aged;aphasia;apraxia;article;autopsy;bronchopneumonia;case report;cholelithiasis;computer assisted tomography;contrast enhancement;coronary artery atherosclerosis;death;demyelination;dysphasia;female;frontal lobe;hemiparesis;hospital admission;human;ileum tumor;immunocompromized patient;infection;kidney cyst;laboratory test;lymphocyte count;mental deterioration;nervous system;neurologic disease;nuclear magnetic resonance spectroscopy;occipital lobe;parietal lobe;persistent vegetative state;personality disorder;priority journal;progressive multifocal leukoencephalopathy;rash;white matter;white matter lesion;whole body CT,"Johansen, K. K.;Torp, S. H.;Rydland, J.;Aasly, J. O.",2013,,,0,
2075,Comorbidities Drive Outcomes for Both Malignancy-Associated and Non-Malignancy-Associated Hemophagocytic Syndrome,"Background Secondary hemophagocytic syndrome (SHPS) is a syndrome that develops as a result of infection, autoimmunity, or underlying malignancy. We studied novel predictors of mortality among adults with SHPS. Patients and Methods SHPS were identified from the Nationwide Inpatient Sample for 2009 to 2011 using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes. Charlson comorbidity index (CCI) was used for comorbidity assessment, excluding malignancy. Patient- and hospital-related factors on mortality were assessed by chi-square test or analysis of variance. P values were 2 sided, and the level of significance was.05. Results A total of 276 patient hospitalizations with SHPS were identified. Forty-four had an associated malignancy, 38 (86%) of which were hematologic. Median age was 42 years (range, 18-89 years). A total of 66% (n = 182) had a CCI of 0, 13% (n = 27) had a CCI of 1, and 21% (n = 57) had a CCI of 2 or more. On bivariate analysis, inpatient mortality rate was significantly higher in malignancy-associated hemophagocytic syndrome (HPS) (odds ratio [OR], 2.07; P =.04), age ≥ 50 years (OR, 3.46; P <.01), CCI ≥ 2 (OR, 3.04; P <.01), and Medicare patients (OR, 2.32; P <.01). In multivariate analysis, CCI ≥ 2 remained an independent predictor of survival in the overall study cohort (OR, 3.52; 95% confidence interval, 1.51-8.18; P <.01). Conclusion Malignancy-associated HPS, CCI ≥ 2, age > 50 years, and Medicare patients were associated with a worse in-hospital mortality. In multivariate analysis, greater comorbidity burden appeared to be the single most important predictor of mortality. This suggests that outcomes for adults with HPS are predicated by the extent of organ dysfunction at diagnosis.",antineoplastic agent;acquired immune deficiency syndrome;adult;aged;article;autoimmunity;cancer chemotherapy;cancer mortality;cerebrovascular disease;Charlson Comorbidity Index;chronic kidney disease;chronic obstructive lung disease;comorbidity;comorbidity assessment;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;female;heart infarction;hemiplegia;hemophagocytic syndrome;histoplasmosis;hospitalization cost;human;Human immunodeficiency virus infection;ICD-9-CM;length of stay;liver disease;major clinical study;male;outcome assessment;peptic ulcer;peripheral vascular disease;rheumatoid arthritis;secondary hemophagocytic syndrome;systemic lupus erythematosus,"Johnson, B.;Giri, S.;Nunnery, S. E.;Wiedower, E.;Jamy, O.;Yaghmour, G.;Chandler, J. C.;Martin, M. G.",2016,,,0,
2076,Unlearning,,adrenalin;amiodarone;atropine;bicarbonate;calcium;lidocaine;defibrillator;evidence based medicine;heart arrest;human;learning;medical education;medical school;memory;priority journal;resuscitation;risk management;senility;short survey;survival,"Johnson, C.",2005,,,0,
2077,The effect on health of alternate day calorie restriction: Eating less and more than needed on alternate days prolongs life,"Restricting caloric intake to 60-70% of normal adult weight maintenance requirement prolongs lifespan 30-50% and confers near perfect health across a broad range of species. Every other day feeding produces similar effects in rodents, and profound beneficial physiologic changes have been demonstrated in the absence of weight loss in ob/ob mice. Since May 2003 we have experimented with alternate day calorie restriction, one day consuming 20-50% of estimated daily caloric requirement and the next day ad lib eating, and have observed health benefits starting in as little as two weeks, in insulin resistance, asthma, seasonal allergies, infectious diseases of viral, bacterial and fungal origin (viral URI, recurrent bacterial tonsillitis, chronic sinusitis, periodontal disease), autoimmune disorder (rheumatoid arthritis), osteoarthritis, symptoms due to CNS inflammatory lesions (Tourette's, Meniere's) cardiac arrhythmias (PVCs, atrial fibrillation), menopause related hot flashes. We hypothesize that other many conditions would be delayed, prevented or improved, including Alzheimer's, Parkinson's, multiple sclerosis, brain injury due to thrombotic stroke atherosclerosis, NIDDM, congestive heart failure. Our hypothesis is supported by an article from 1957 in the Spanish medical literature which due to a translation error has been construed by several authors to be the only existing example of calorie restriction with good nutrition. We contend for reasons cited that there was no reduction in calories overall, but that the subjects were eating, on alternate days, either 900 calories or 2300 calories, averaging 1600, and that body weight was maintained. Thus they consumed either 56% or 144% of daily caloric requirement. The subjects were in a residence for old people, and all were in perfect health and over 65. Over three years, there were 6 deaths among 60 study subjects and 13 deaths among 60 ad lib-fed controls, non-significant difference. Study subjects were in hospital 123 days, controls 219, highly significant difference. We believe widespread use of this pattern of eating could impact influenza epidemics and other communicable diseases by improving resistance to infection. In addition to the health effects, this pattern of eating has proven to be a good method of weight control, and we are continuing to study the process in conjunction with the NIH. © 2006 Elsevier Ltd. All rights reserved.",allergy;Alzheimer disease;article;asthma;autoimmune disease;bacterial infection;body weight;brain injury;caloric intake;caloric restriction;congestive heart failure;eating;Gilles de la Tourette syndrome;heart arrhythmia;human;insulin resistance;lifespan;medical literature;Meniere disease;multiple sclerosis;mycosis;osteoarthritis;Parkinson disease;priority journal;upper respiratory tract infection;virus infection;weight reduction,"Johnson, J. B.;Laub, D. R.;John, S.",2006,,,0,
2078,"Diagnosis, prognosis and awareness of dying in nursing homes: towards the Gold Standard?","BACKGROUND: In Western society and increasingly elsewhere, death has become medicalised and 'hospitalised' even when people are enduring deteriorating terminal conditions such as dementia and heart failure. In an attempt to rationalise and dignify the place and manner of death, evidence is emerging that the adoption of end-of-life care pathways and models can improve the experience of the end-of-life care across a range of care settings. Each of these demands skills and knowledge in the assessment and prediction of the dying trajectory. AIM: In this study, we report complexities facing relatives, residents and nursing home staff in the awareness, diagnosis and prediction of the dying trajectory. METHODS: Data were collected and analysed within a broadly qualitative methodology. The contexts were two nursing homes in the Greater Manchester area, each at different stages of implementing 'Gold Standards Framework' approaches to planning end-of-life care with residents and their relatives. From 2008 to 2011 and with appropriate consent, data were collected by a mixture of interviews and participant observation with residents, relatives and staff. Appropriate ethics approvals were sought and given. RESULTS: Key emerging themes were diagnosis and awareness of dying in which there is no substitute for experience. Significant resource is needed to engage staff, residents and relatives/carers with the idea of advance care planning. CONCLUSIONS: Talking to residents and relatives about their feelings and wishes for care at the end of life remains especially difficult, but education and training in key skills and knowledge can engender confidence. Challenges include diagnosing and predicting dying trajectories. IMPLICATIONS FOR PRACTICE: Advance care planning can reduce the distress from and number of inappropriate hospital admissions, but requires determination and consistent application of the approach. This can be very challenging in the face of staff rotation and the unpredictability both of the dying trajectory and the decision-making of some out of hours medical staff.",Advance Care Planning/*standards;*Attitude of Health Personnel;*Attitude to Death;*Awareness;*Geriatric Nursing;Great Britain;Humans;Interviews as Topic;Nursing Homes/*standards;Patient Care Planning/*standards;Prognosis;Qualitative Research;*Quality Improvement;Terminal Care/*standards;awareness;communication;diagnosis of dying;end-of-life care;nursing homes,"Johnson, M.;Attree, M.;Jones, I.;Al Gamal, E.;Garbutt, D.",2014,Jun,10.1111/opn.12024,0,
2079,The clinical decision regarding hormone replacement therapy,"The complexity of the decision to recommend hormone replacement therapy (HRT) for the postmenopausal woman depends on the medical status of the patient, her concerns and goals, and the indications being considered. This article suggests a practical approach that leads to informed, collaborative decision making between the health care professional and patient.",estrogen;article;breast cancer;colon cancer;dementia;drug induced disease;endometriosis;endometrium cancer;estrogen deficiency;estrogen therapy;female;human;hypertension;ischemic heart disease;liver disease;medical decision making;melanoma;menopause;postmenopause;postmenopause osteoporosis;practice guideline;priority journal;cerebrovascular accident;vein thrombosis,"Johnson, S. R.",1997,,,0,
2080,Prediction of survival for patients with bullous pemphigoid: A prospective study,"Objective: To identify the prognostic factors of bullous pemphigoid (BP). Design: Prospective study of patients with BP included in a randomized, controlled trial. Setting: Twenty dermatology departments in France. Patients: One hundred seventy patients with BP initially treated with a 40-g/d dosage of clobetasol propionate cream (testing sample) and 171 patients initially treated with oral corticosteroids at a dosage of 0.5 or of 1.0 mg/kg per day, depending on the extent of BP (validation samples). Main Outcome Measures: The end point was overall survival during the first year after BP diagnosis. From the testing sample, associations of clinical and biological variables with overall survival were assessed using univariate and multivariate analyses. Selected predictors were included in a prognostic model. To verify that these predictors were not dependent on the treatment used, the model was then validated independently on the 2 series of BP patients treated with oral corticosteroids. Results: Median age of the BP patients included in the testing sample was 83 years. The 1-year Kaplan-Meier survival rate was 74%. From univariate analysis, the main deleterious predictors were demographic factors (ie, older age and female sex), associated medical conditions (ie, cardiac insufficiency, history of stroke, and dementia), and low Karnofsky score, which is a measure of the patient's general condition. No factors directly related to BP, in particular extent of cutaneous lesions, were shown to be related to the patients' prognosis. From multivariate analysis, only older age (P=.02) and low Karnofsky score (P<.001) appeared independently predictive of death. From the Cox model including these 2 predictors, the predicted 1-year survival rates were 90% (95% confidence interval [CI], 85%-96%) for patients 83 years or younger with Karnofsky score greater than 40, 79% (95% CI, 69%-90%) for patients older than 83 years with Karnofsky score greater than 40, 65% (95% CI, 50%-86%) for patients 83 years or younger with Karnofsky score of 40 or less, and 38% (95% CI, 26%-57%) for patients older than 83 years with Karnofsky score of 40 or less. Kaplan-Meier survival distributions of patients from the validation samples appeared clearly separated according to these 4 categories and were in close agreement with corresponding predicted 1-year survival rates obtained from the testing sample. Conclusions: The prognosis of patients with BP is influenced by age and Karnofsky score. These predictors are easy to use and should facilitate the management of BP. ©2005 American Medical Association. All rights reserved.",clobetasol propionate;corticosteroid;prednisone;prednisone acetate;age distribution;aged;article;controlled study;dementia;demography;drug dose reduction;female;follow up;heart failure;human;major clinical study;male;pemphigoid;prediction;priority journal;prognosis;prospective study;scoring system;sex difference;skin defect;statistical analysis;cerebrovascular accident;survival rate;cortancyl,"Joly, P.;Benichou, J.;Lok, C.;Hellot, M. F.;Saiag, P.;Tancrede-Bohin, E.;Sassolas, B.;Labeille, B.;Doutre, M. S.;Gorin, I.;Pauwels, C.;Chosidow, O.;Caux, F.;Estève, E.;Dutronc, Y.;Sigal, M.;Prost, C.;Maillard, H.;Guillaume, J. C.;Roujeau, J. C.",2005,,,0,
2081,Modifying protein misfolding,,2101;afegostat;agents acting on the peripheral nervous and neuromuscular systems;agents affecting metabolism;amyloid beta protein;larazotide;at 2220;binding protein;copper zinc superoxide dismutase;1 deoxynojirimycin;migalastat;prealbumin;rapamycin;tafamidis;TAR binding protein 43;cystic fibrosis transmembrane conductance regulator;unclassified drug;Alzheimer disease;amyloid cardiomyopathy;amyloid neuropathy;amyotrophic lateral sclerosis;autophagy;cardiomyopathy;clinical trial;combination chemotherapy;cystic fibrosis;drug development;drug industry;drug mechanism;endoplasmic reticulum;Fabry disease;human;Parkinson disease;priority journal;protein degradation;protein misfolding;protein stability;protein structure;protein targeting;short survey;at 1001,"Jones, D.",2010,,,0,
2082,Is Dementia in Decline? Historical Trends and Future Trajectories,,"Coronary Artery Disease/*epidemiology/history;Dementia/*epidemiology/history;History, 20th Century;History, 21st Century;Humans;Prevalence;United States/epidemiology","Jones, D. S.;Greene, J. A.",2016,Feb 11,10.1056/NEJMp1514434,0,
2083,Genetic associations of autopsy-confirmed vascular dementia subtypes,"Background/Aims: Genetic risk factors have not been clearly established for vascular dementias (VaD) related to stroke and cerebrovascular disease. Methods: Samples were genotyped for APOE, MTHFR and ICAM. Aβ levels and choline acetyltransferase (ChAT) activities were assayed in controls and individuals with VaD. Results: Associations were found between the APOE-ε4 allele and mixed dementia, infarct/stroke dementia and subcortical ischemic vascular dementia (SIVD), and higher Aβ1-42 levels and decreased ChAT activity. MTHFR was more associated with SIVD, mixed dementia, and lower ChAT activity. Conclusions: The study demonstrates important differences in the genetic associations of VaD and begins to clarify the genetic basis of key pathological substrates. Copyright © 2011 S. Karger AG, Basel.",amyloid beta protein;amyloid beta protein[1-42];apolipoprotein E;choline acetyltransferase;intercellular adhesion molecule 1;methylenetetrahydrofolate reductase (NADPH2);article;autopsy;cerebrovascular disease;demography;disease association;enzyme activity;genetic association;heart infarction;human;multiinfarct dementia;priority journal;risk factor;cerebrovascular accident,"Jones, E. L.;Kalaria, R. N.;Sharp, S. I.;O'Brien, J. T.;Francis, P. T.;Ballard, C. G.",2011,,,0,
2084,Characterization of glaucoma medication adherence in kaiser permanente Southern California,"Purpose: To describe adherence to glaucoma medications. Patients and Methods: Medication adherence was investigated using the computerized records of Kaiser Permanente Southern California, a group model health maintenance organization that provides care to 3.4 million residents of Southern California. Eligible glaucoma patients were diagnosed between 2005 and 2009 and had medical and prescription drug coverage between 2005 and 2009. Utilization and adherence parameters were calculated for each of the 5 years from the incident date. Results: A total of 17,943 newly diagnosed glaucoma patients were identified between the years 2005 and 2009. Of patients diagnosed with glaucoma in 2005, 71% were continuously eligible for 5 years. Medication adherence was calculated using a medication possession ratio. Adherence was bimodal and not normal in distribution. Overall, the mean age of the entire group was 66 years, with 56% being 65 years of age or older. The high adherence group tended to be older, more likely to be female, and more likely to be white. The low adherent group (younger) tended to have more and worse diabetes, renal disease, myocardial infarction, and stroke. Conclusions: The shape of the adherence distribution appears bimodal, so analysis based on parametric measures may not be appropriate. Investigations of adherence should probably be performed separately for the low, mid, and high groups.",antiglaucoma agent;antilipemic agent;prescription drug;acquired immune deficiency syndrome;adult;age;aged;American Indian;article;Asian;Black person;Caucasian;cerebrovascular accident;comorbidity;dementia;diabetes mellitus;disease severity;education;emergency ward;female;follow up;gender;glaucoma;health care utilization;health insurance;health maintenance organization;heart failure;heart infarction;Hispanic;human;Human immunodeficiency virus infection;hypertension;income;kidney disease;liver disease;major clinical study;male;medication compliance;paralysis;patient compliance;peptic ulcer;peripheral vascular disease;priority journal;race;rheumatic disease;United States,"Jones, J. P.;Fong, D. S.;Fang, E. N.;Mesirov, C. A.;Patel, V.",2016,,,0,
2085,Risk of mortality (including sudden cardiac death) and major cardiovascular events in users of olanzapine and other antipsychotics: A study with the general practice research database,"Objective. Assess risk of cardiac events and mortality among users of olanzapine and other antipsychotics relative to nonusers. Methods. The General Practice Research Database was used to identify cohorts of antipsychotic users and nonusers with psychiatric illness. Outcomes included cardiac mortality, sudden cardiac death (SCD), all-cause mortality (excluding suicide), coronary heart disease (CHD), and ventricular arrhythmias (VA). Results. 183,392 antipsychotic users (including 20,954 olanzapine users) and 193,920 psychiatric nonusers were identified. There was a significantly higher rate of cardiac mortality (adjusted RR [aRR]: 1.53, CI, 1.12-2.09) in olanzapine users relative to psychiatric nonusers, consistent with findings for both atypical and typical antipsychotics. Relative to psychiatric nonusers, no increased risk of all-cause mortality was observed among olanzapine users (aRR: 1.04, CI, 0.93-1.17), but elevated all-cause mortality risk was observed when compared to all antipsychotic users (aRR: 1.75, CI, 1.64-1.87). There was no increased risk of CHD or VA among olanzapine users relative to psychiatric nonusers, consistent with findings for atypical but not typical antipsychotics. SCD cases were uncommon. Conclusions. Use of antipsychotic agents was associated with increased risk of all-cause and cardiac mortality. Patients treated with olanzapine were found to be at increased risk of cardiac mortality versus psychiatric nonusers. © 2013 Meghan E. Jones et al.",antidepressant agent;anxiolytic agent;neuroleptic agent;olanzapine;adult;aged;article;bipolar disorder;cardiovascular disease;cardiovascular mortality;cohort analysis;controlled study;data base;dementia;disease association;drug megadose;female;follow up;general practice;heart ventricle arrhythmia;human;ischemic heart disease;major clinical study;major depression;male;mental disease;middle aged;mortality;outcome assessment;priority journal;risk assessment;schizophrenia;sudden cardiac death;very elderly;young adult,"Jones, M. E.;Campbell, G.;Patel, D.;Brunner, E.;Shatapathy, C. C.;Murray-Thomas, T.;Van Staa, T. P.;Motsko, S.",2013,,,0,
2086,Update on lipids and C-reactive protein in acute and chronic coronary heart disease,,apolipoprotein B;bile acid;C reactive protein;fenofibrate;fibric acid derivative;high density lipoprotein cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;nicotinic acid;placebo;rosuvastatin;triacylglycerol;acute disease;Alzheimer disease;aorta stenosis;article;cardiovascular disease;cardiovascular risk;cholesterol blood level;chronic disease;clinical trial;combination chemotherapy;disease marker;drug choice;drug mechanism;drug megadose;drug potentiation;heart protection;human;ischemic heart disease;monotherapy;primary prevention;protein blood level;recurrent disease;reference value;risk reduction;triacylglycerol blood level,"Jones, P. H.",2010,,,0,
2087,Significant variation in P2Y12 inhibitor use after peripheral vascular intervention in Medicare beneficiaries,"There is no consensus regarding whether to use antithrombotic medications in patients with peripheral artery disease after lower-extremity peripheral vascular intervention. OBJECTIVES: The main hypothesis is that significant variation exists regarding use of antithrombotic medications after lower-extremity peripheral vascular intervention. We sought to examine the patterns of postprocedural antithrombotic medication use and associated factors in Medicare patients. METHODS: We measured rates of P2Y12 inhibitor use after peripheral vascular intervention in a 100% national sample of Medicare beneficiaries with Part D prescription drug coverage. We used logistic regression modeling to examine associations between patient and clinical factors and P2Y12 inhibitor use. RESULTS: Between 2010 and 2012, a total of 85,830 patients underwent peripheral vascular intervention and had prescription drug claims. Overall, 18.3% of patients were treated with an oral anticoagulant, 19.1% received no P2Y12 inhibitor, 30.8% received a P2Y12 inhibitor before and after the procedure, 6.2% received a P2Y12 inhibitor for up to 30 days after the procedure, and 25.6% received a P2Y12 inhibitor for more than 30 days after the procedure. After adjustment, factors associated with P2Y12 inhibitor use included male sex; black race; history of renal disease, dementia, or heart failure; physician specialty; and clinical setting of the procedure. We observed a strong interaction effect between clinical setting and physician specialty (P < .001). CONCLUSIONS: One-fifth of patients who underwent lower-extremity peripheral vascular intervention did not fill a prescription for a P2Y12 inhibitor. Patients whose operators were surgeons or radiologists had lower odds of P2Y12 inhibitor use. More research to determine the optimal use and duration of antithrombotic medications after the procedure is warranted.",,"Jones, W. S.;Mi, X.;Qualls, L. G.;Turley, R. S.;Vemulapalli, S.;Peterson, E. D.;Patel, M. R.;Curtis, L. H.",2016,Sep,10.1016/j.ahj.2016.06.002,0,
2088,Exploring homogeneity of correlation structures of gene expression datasets within and between etiological disease categories,"The literature shows that classifiers perform differently across datasets and that correlations within datasets affect the performance of classifiers. The question that arises is whether the correlation structure within datasets differ significantly across diseases. In this study, we evaluated the homogeneity of correlation structures within and between datasets of six etiological disease categories; inflammatory, immune, infectious, degenerative, hereditary and acute myeloid leukemia (AML). We also assessed the effect of filtering; detection call and variance filtering on correlation structures. We downloaded microarray datasets from ArrayExpress for experiments meeting predefined criteria and ended up with 12 datasets for non-cancerous diseases and six for AML. The datasets were preprocessed by a common procedure incorporating platform-specific recommendations and the two filtering methods mentioned above. Homogeneity of correlation matrices between and within datasets of etiological diseases was assessed using the Box's M statistic on permuted samples. We found that correlation structures significantly differ between datasets of the same and/or different etiological disease categories and that variance filtering eliminates more uncorrelated probesets than detection call filtering and thus renders the data highly correlated.",acute myeloblastic leukemia;Alzheimer disease;article;asthma;classifier;controlled study;correlation analysis;craniofacial synostosis;disease classification;diseases;dystonia;filtration;Gaucher disease;gene expression;genetic variability;heart failure;human;mucocutaneous lymph node syndrome;PFAPA syndrome;psoriasis;ulcerative colitis,"Jong, V. L.;Novianti, P. W.;Roes, K. C. B.;Eijkemans, M. J. C.",2014,,,0,
2089,Cognitive impairment in AMD,,carotenoid;omega 3 fatty acid;xanthophyll;zeaxanthin;Alzheimer disease;cerebrovascular accident;cognitive defect;diet supplementation;disease association;human;hypertension;ischemic heart disease;letter;medical history;priority journal;age related macular degeneration;risk factor;smoking;transient ischemic attack;traumatic brain injury;visual acuity,"Jonna, G.;Katz, M. S. J.;Fingerhut, D. E.",2013,,,0,
2090,Association of the Charlson comorbidity index with mortality in systemic lupus erythematosus,"Objective To investigate whether comorbidity as assessed by the Charlson Comorbidity Index (CCI) is associated with mortality in a long-term followup of systemic lupus erythematosus (SLE) patients. Methods Data were collected from 499 SLE patients attending the Lupus Clinic at the McGill University Health Center, Montreal, Quebec, Canada, and 170 SLE patients from the Department of Rheumatology at Lund University Hospital, Lund, Sweden. This included data on comorbidity, demographics, disease activity, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), and antiphospholipid antibody syndrome (APS). Variables were entered into a Cox proportional hazards survival model. Results Mortality risk in the Montreal cohort was associated with the CCI (hazard ratio [HR] 1.57 per unit increase in the CCI, 95% confidence interval [95% CI] 1.18-2.09) and age (HR 1.04 per year increase in age, 95% CI 1.00-1.09). The CCI and age at diagnosis were also associated with mortality in the Lund cohort (CCI: HR 1.35, 95% CI 1.13-1.60; age: HR 1.09, 95% CI 1.05-1.12). Furthermore, the SDI was associated with mortality in the Lund cohort (HR 1.40, 95% CI 1.19-1.64), while a wide CI for the estimate in the Montreal cohort prevented a definitive conclusion (HR 1.20, 95% CI 0.97-1.48). We did not find a strong association between mortality and sex, race/ethnicity, disease activity, or APS in either cohort. Conclusion In this study, comorbidity as measured by the CCI was associated with decreased survival independent of age, lupus disease activity, and damage. This suggests that the CCI may be useful in capturing comorbidity for clinical research in SLE. Copyright © 2011 by the American College of Rheumatology.",acquired immune deficiency syndrome;acute heart infarction;adolescent;adult;aged;antiphospholipid syndrome;arthritis;article;Canada;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;dementia;discoid lupus erythematosus;disease activity;ethnic difference;female;follow up;glomerulonephritis;hazard ratio;health survey;hemiplegia;human;inflammation;lymphoma;major clinical study;male;mortality;mouth ulcer;peripheral vascular disease;photosensitivity;rash;risk assessment;rutabaga;seizure;systemic lupus erythematosus;university hospital,"Jönsen, A.;Clarke, A. E.;Joseph, L.;Belisle, P.;Bernatsky, S.;Nived, O.;Bengtsson, A. A.;Sturfelt, G.;Pineau, C. A.",2011,,,0,
2091,Retrospective analysis of health variables in a Reykjavík nursing home 1983-2002 (corrected),"BACKGROUND: A municipal nursing home with 68 beds in Reykjavík, opened in mid-year 1982. OBJECTIVES: To analyse changes in demographic, health and outcome variables over 20 years. DESIGN: Retrospective analyses of data from medical records of all diseased persons with cross-sectional comparison of five four-year intervals. SETTING: Droplaugarstadir Nursing Home in Reykjavík. The nursing home is supervised by fully qualified nurses and provides maintenance rehabilitation. Medical services are delivered from a specialist geriatric hospital department. RESIDENTS: All residents who died 1983 to 2002 [corrected]. MEASUREMENTS: Demographic data, type of dwelling before admission, Nursing Home Pre-admission Assessment Score (NAPA), mobility- and cognitive score, drug usage and a list of medical diagnoses. All recorded health events during stay, falls and fractures, medical and specialist consultations. Advance directives, as recorded and end-of-life treatment, place of death, clinical diagnosis of cause of death and length of stay. RESULTS: The total number of medical records read numbered 385, including 279 females and 106 males. The mean age on admission was 85 (+/- 7) years. During the first 4 years the majority of residents came from their own private homes or residential settings but in the last four years, 60% were admitted directly from a hospital ward. The mortality rate was 17% per year in the first period and the majority died in a hospital. This ratio took a sharp turn as the mortality rate increased to 40%, and in the last period only 2 of 97 deaths took place in a hospital. Admission mobility- and cognitive scores showed increased disability with time. The most common diagnosis on admission was dementia (56%), ischemic heart disease (46%), fractures (35%) and strokes (27%). Parkinsonism and maturity onset diabetes had a low prevalence rate of 6%. A mean NHPA of 57 (+/- 17) points confirmed a high dependency selection. The mean number of drugs per patient was 5.3 (+/- 3), including 1.1 (+/- 1) for psychoactive drugs and sedatives. The most common health events during residents? stay were urinary and respiratory infections, heart failure, cardiac- and cerebral events and pulmonary disorders. Hip fractures occurred in 45 residents (12%) and other types of fractures in 47 during their stay in the nursing home. The number of medical visits and specialist referrals increased with time. Palliative care was the most common form of treatment at end of life. Pneumonia was most commonly recorded cause of death in medical notes. The yearly mortality rate was 29% and the mean length of stay was 3 (+/- 2,9) years for the whole period. LIMITATIONS: Retrospective analyses have many inherent drawbacks and the information in medical records tend to be scanty. Analyses of disabilities, as described in the medical record, can only be descriptive and health events are likely to be underreported. Statistical methods have a less meaningful role for interpretation as only diseased persons were included and survivors excluded. However, the length of time, uniform medical care and turnover rate of residents generate useful information on the patterns of the nursing home service during a time of considerable change. CONCLUSIONS: This retrospective analysis indicates increasing frailty in nursing home patients admitted over a period of 20 years. With time the residents are more often admitted directly from a hospital rather than from an individual dwelling. Most deaths took place in the nursing home and were preceded with informal or formal palliative care directives, which was a significant change over time. The data indicates growing efficiency in the nursing home selection processes due to the NHPA and improvements in holistic geriatric care. This development is in keeping with the Icelandic health care policy for elderly people to stay longer in their own home with access to a nursing home placement when needed.",aged;article;cerebrovascular accident;cognition;comparative study;cross-sectional study;dementia;disabled person;female;fracture;health status;heart muscle ischemia;home for the aged;human;Iceland;locomotion;male;nursing home;retrospective study;statistics,"Jónsson, A.;Bernhöft, I.;Bernhardsson, K.;Jónsson, P. V.",2005,,,0,
2092,Comparative disease patterns in the elderly and the very old: a retrospective autopsy study,"One hundred autopsy reports of persons who died in Iceland aged 90 years or over were studied and the causes of death were recorded. Another 100 autopsy reports of persons aged 70 years and under were used as controls. The disease pattern of those aged 70 or under did not differ much from that appearing in the Icelandic National Mortality Statistics, all ages included. However, in those aged 90 and over, the number of important diseases was higher and pneumonia, in particular, occurred more frequently both as an intervening and as an underlying cause of death. In the older age group, dementia was 3.4 times more common in males and 4.7 times more common in females. Malignant neoplasms were less frequent as causes of death in the older age group. In the older age group there was a much lower frequency of myocardial infarction compared with the controls, although the degree of arteriosclerosis did not differ in these two groups.",*Aged;Cholelithiasis/mortality;Coronary Disease/mortality;Dementia/mortality;Diverticulum/mortality;Female;Humans;Male;*Morbidity;Neoplasms/mortality;Retrospective Studies,"Jonsson, A.;Hallgrimsson, J.",1983,May,,0,
2093,Apathy is a prominent neuropsychiatric feature of radiological white-matter changes in patients with dementia,"Objective: Cerebral white-matter changes (WMCs) are frequently found in dementia and have been proposed to be related to vascular factors and a certain symptomatological profile. However, few studies have included both vascular factors and a broad spectrum of cognitive, neurological and psychiatric symptoms, easily detectable by the physician in the everyday clinical work. The objective was to study the relationships between WMCs on MRI/CT and neuropsychiatric symptoms and vascular factors in patients with cognitive impairment. Methods: One hundred and seventy-six patients with Alzheimer's disease, vascular dementia, mixed dementia, and mild cognitive impairment were included. All patients underwent a standardized examination including medical history, clinical examinations, laboratory tests and brain imaging (CT or MRI). The identification and severity degree of WMCs was assessed blindly to clinical findings, using a semi-quantitative scale. For statistical analyses, patients were grouped based on absence or presence of WMCs. Significant variables in bivariate analyses were included as predictors in stepwise multiple logistic regression analyses. Results: Bivariate analyses showed significant associations between WMCs and age, gender, blood pressure, hypertension, ischaemic heart disease and TIA/RIND. Furthermore, there were significant associations between WMCs and apathy, mental slowness, disinhibition, gait disturbance and focal neurologic symptoms. The multivariate logistic model revealed apathy, mental slowness and age as the most consistent predicting factors for WMCs, together with MRI as a radiological method for the detection of WMCs. Conclusions: The findings indicate that WMCs in patients with dementia are associated with a dysexecutive-related behavioural symptom profile, vascular factors related to small and large vessel diseases and age. Copyright © 2009 John Wiley & Sons, Ltd.",adult;aged;agnosia;Alzheimer disease;anamnesis;apathy;aphasia;apraxia;article;ataxia;Babinski reflex;blood pressure;carotid artery obstruction;clinical examination;cognition;computer assisted tomography;concentration loss;controlled study;depression;diabetes mellitus;disease severity;disorientation;dysarthria;dysphagia;female;gait disorder;hallucination;heart arrhythmia;human;hypertension;hypokinesia;hypotension;inhibition (psychology);intermittent claudication;ischemic heart disease;jaw opening reflex;laboratory test;language disability;major clinical study;male;memory disorder;mental capacity;mental disease;mild cognitive impairment;mixed depression and dementia;multiinfarct dementia;myoclonus;neurologic disease;nuclear magnetic resonance imaging;paranoia;restlessness;rigidity;cerebrovascular accident;thought disorder;transient ischemic attack;tremor;wakefulness;white matter,"Jonsson, M.;Edman, Å;Lind, K.;Rolstad, S.;Sjögren, M.;Wallin, A.",2010,,,0,
2094,Is analysis of the reticulocyte haemoglobin equivalent a useful test for the diagnosis of iron deficiency anaemia in geriatric patients?,"Background: Iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are common in elderly patients but there are no standard diagnostic criteria. The reticulocyte haemoglobin equivalent (Ret-He) is routinely measured by modern automated blood analysers and is an early indicator of iron deficiency. The aim of this study was to investigate whether the Ret-He level as calculated by the Sysmex XE-5000 automated blood analyser is a useful parameter for the diagnosis of IDA in a geriatric hospitalized population. Methods: In a prospective study, blood samples were collected in 26 geriatric patients with IDA and 111 patients with ACD diagnosed according to generally accepted laboratory and clinical criteria. A blood count including Ret-He, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and standard iron parameters was performed in each patient. Results: Haemoglobin, Ret-He, MCV, MCH and MCHC levels were all significantly lower in IDA as compared to ACD patients. However, the area under the curve (AUC) was greater for MCH (0.87, 95% CI 0.78-0.95) and MCHC (0.86, 95% CI 0.76-0.96) then for Ret-He (0.828, 95% CI 0.73-0.93) and MCV (0.80, 95% CI 0.68-0.91). A Ret-He cut-off value of 26 pg had a sensitivity and specificity based on its optimal combination of 85% and 69% respectively. Conclusion: Analysis of Ret-He does not perform better than the classical red cell indices such as MCH and MCHC in differentiating IDA and ACD in geriatric patients. © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.",acute bacterial parotitis;aged;anemia;anemia of chronic disease;aortic aneurysm infection;article;bacterial arthritis;benign gastrointestinal lesion;benign tumor;bladder cancer;blood analysis;blood cell count;blood sampling;breast cancer;cellulitis;chronic obstructive lung disease;colorectal cancer;colorectal polyp;comorbidity;controlled study;decubitus;dementia;diabetes mellitus;diagnostic test;empyema;erysipelas;erythrocyte parameters;female;gastrointestinal infection;geriatric patient;giant cell arteritis;gout;heart failure;human;idiopathic disease;infection;intervertebral disk degeneration;iron deficiency anemia;laboratory test;lung cancer;major clinical study;male;mean corpuscular hemoglobin;mean corpuscular hemoglobin concentration;mean corpuscular volume;osteomyelitis;ovary cancer;parameters;parotitis;prostate cancer;respiratory tract infection;reticulocyte haemoglobin equivalent;rheumatic polymyalgia;rheumatoid arthritis;sepsis;urinary tract infection,"Joosten, E.;Lioen, P.;Brusselmans, C.;Indevuyst, C.;Boeckx, N.",2013,,,0,
2095,The Clinical and Health Economic Value of Clinical Laboratory Diagnostics,"The ultimate goal of diagnostic testing is to guide disease management in order to improve patient outcomes and patient well-being. Patient populations are rarely homogenous and accurate diagnostic tests can dissect the patient population and identify those patients with similar symptoms but very different underlying pathophysiology that will respond differently to different treatments. This stratification of patients can direct patients to appropriate treatment and is likely to result in clinical benefits for patients and economic benefits for the healthcare system. In this article we look at the clinical and economic benefits afforded by clinical laboratory diagnostics in three disease areas that represent substantial clinical and healthcare burdens to society; heart failure, Alzheimer's disease and asthma.",clinical benefit;guided therapy;health economic benefit;in vitro diagnostics,"Jordan, B.;Mitchell, C.;Anderson, A.;Farkas, N.;Batrla, R.",2015,Jan,,0,
2096,A new day dawns: women without oestrogen or is a balance best?,"Building on the 30-year success story with tamoxifen, the question now is whether one agent can be used for treatment and prevention or should new medicines be targeted to specific applications? The early results with anastrozole suggest it could replace tamoxifen for treatment and should be tested as a preventive. Unfortunately, long-term testing of aromatase inhibitors will be required to avoid concerns about osteoporosis, Alzheimer's disease and coronary heart disease. Most importantly, the knowledge gained with tamoxifen has resulted in a new generation of selective oestrogen receptor modulators that can be used to prevent osteoporosis, breast cancer and uterine cancer. It is now clear that strategies utilising aromatase inhibitors and selective oestrogen receptor modulators will provide much needed options for individualised treatments.",Aromatase Inhibitors;Breast Neoplasms/*drug therapy/prevention & control;Clinical Trials as Topic;Estrogen Antagonists/*therapeutic use;Female;Humans;Nitriles/therapeutic use;Tamoxifen/*therapeutic use;Triazoles/therapeutic use,"Jordan, V. C.",2002,,,0,
2097,Reason of wrong capacity evaluation to rehabilitation of brain injury following heart arrest,,brain disease;dementia;heart arrest;human;note;outcome assessment;prognosis;resuscitation,"Jørgensen, E. O.",2007,,,0,
2098,Comorbidity in elderly cancer patients in relation to overall and cancer-specific mortality,"Background: Aims of this study were to describe the prevalence of comorbidity in newly diagnosed elderly cancer cases compared with the background population and to describe its influence on overall and cancer mortality. Methods: Population-based study of all 70 year-olds in a Danish province diagnosed with breast, lung, colorectal, prostate, or ovarian cancer from 1 January 1996 to 31 December 2006. Comorbidity was measured according to Charlson's comorbidity index (CCI). Prevalence of comorbidity in newly diagnosed cancer patients was compared with a control group by conditional logistic regression, and influence of comorbidity on mortality was analysed by Cox proportional hazards method. Results: A total of 6325 incident cancer cases were identified. Elderly lung and colorectal cancer patients had significantly more comorbidity than the background population. Severe comorbidity was associated with higher overall mortality in the lung, colorectal, and prostate cancer patients, hazard ratios 1.51 (95% CI 1.24-1.83), 1.41 (95% CI 1.14-1.73), and 2.14 (95% CI 1.65-2.77), respectively. Comorbidity did not affect cancer-specific mortality in general. Conclusion: Colorectal and lung cancer was associated with increased comorbidity burden in the elderly compared with the background population. Comorbidity was associated with increased overall mortality in elderly cancer patients but not consistently with cancer-specific mortality. © 2012 Cancer Research UK All rights reserved.",aged;article;breast cancer;cancer chemotherapy;cancer mortality;cancer patient;case control study;cause of death;cerebrovascular disease;chronic lung disease;colorectal cancer;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;disease association;disease severity;elderly care;female;hazard ratio;hemiplegia;human;ischemic heart disease;kidney disease;liver disease;lung cancer;major clinical study;male;ovary cancer;overall survival;peripheral vascular disease;population research;prevalence;priority journal;proportional hazards model;prostate cancer;risk factor;ulcer,"Jørgensen, T. L.;Hallas, J.;Friis, S.;Herrstedt, J.",2012,,,0,
2099,Falls and comorbidity: the pathway to fractures,"AIMS: To compare nationwide time trends and mortality in hip and proximal humeral fractures; to explore associations between incidences of falls risk related comorbidities (FRICs) and incidence of fractures. METHODS: The study is a retrospective cohort study using nationwide Danish administrative registries from 2000 through 2009. Individuals aged 65 years or older who experienced a hip or a proximal humeral fracture were included. Incidence of hip and of proximal humeral fractures, incidence of FRICs (ischemic heart disease, COPD, dementia, depression, diabetes, heart failure, osteoporosis, Parkinson's disease and stroke) and incidence rate ratios (IRR) for fractures in patients with FRICs, and all-cause mortality up to 10 years after a hip or a proximal humeral fracture were analysed. RESULTS: A total of 89,150 patients experienced hip fractures and 48,581 proximal humeral fractures. From 2000 through 2009, the incidence of hip fractures per 100,000 individuals declined by 198 (787 to 589, OR = 0.75, CI: 0.72-0.80) among males and by 483 (1758 to 1275, OR = 0.74, CI: 0.72-0.77) among females. Incidences of FRICs decreased. The absolute reduction in fractures was most pronounced for the age group above 75 years (2393 to 1884, OR = 0.81, CI: 0.78-0.83), but the relative reduction was more pronounced in the age group of 65-75 years old (496 to 342, OR = 0.70, CI: 0.66-0.74). IRRs for hip fractures and for proximal humeral fractures were significantly elevated in patients with FRICs. CONCLUSIONS: The results suggest that the overall reduction in fractures can be explained by reduction in falls related comorbidity.","Accidental Falls/*statistics & numerical data;Aged;Aged, 80 and over;Cause of Death/trends;*Comorbidity;Databases, Factual;Dementia/epidemiology;Denmark/epidemiology;Depression/epidemiology;Diabetes Mellitus/epidemiology;Female;Heart Failure/epidemiology;Hip Fractures/*epidemiology/mortality;Humans;Male;Myocardial Ischemia/epidemiology;Osteoporosis/epidemiology;Parkinson Disease/epidemiology;Pulmonary Disease, Chronic Obstructive/epidemiology;Retrospective Studies;Risk Factors;Shoulder Fractures/*epidemiology/mortality;Stroke/epidemiology;Time Factors;Comorbidity;elderly;falls;fractures;hip fracture;humeral fracture","Jorgensen, T. S.;Hansen, A. H.;Sahlberg, M.;Gislason, G. H.;Torp-Pedersen, C.;Andersson, C.;Holm, E.",2014,May,10.1177/1403494813516831,0,
2100,Lead in your body,,lead;porphobilinogen synthase;porphobilinogen synthase 1 1;porphobilinogen synthase 2;unclassified drug;adult;aged;allele;blood level;concentration (parameters);cortical bone;dementia;environmental exposure;genetic polymorphism;genotype;heart infarction;high risk population;human;hypertension;lead poisoning;major clinical study;male;medical research;note;patella;priority journal;risk factor;cerebrovascular accident;symptomatology;trabecular bone,"Josephson, J.",2001,,,0,
2101,Genome-wide meta-analysis associates HLA-DQA1/DRB1 and LPA and lifestyle factors with human longevity,"Genomic analysis of longevity offers the potential to illuminate the biology of human aging. Here, using genome-wide association meta-analysis of 606,059 parents' survival, we discover two regions associated with longevity (HLA-DQA1/DRB1 and LPA). We also validate previous suggestions that APOE, CHRNA3/5, CDKN2A/B, SH2B3 and FOXO3A influence longevity. Next we show that giving up smoking, educational attainment, openness to new experience and high-density lipoprotein (HDL) cholesterol levels are most positively genetically correlated with lifespan while susceptibility to coronary artery disease (CAD), cigarettes smoked per day, lung cancer, insulin resistance and body fat are most negatively correlated. We suggest that the effect of education on lifespan is principally mediated through smoking while the effect of obesity appears to act via CAD. Using instrumental variables, we suggest that an increase of one body mass index unit reduces lifespan by 7 months while 1 year of education adds 11 months to expected lifespan.",apolipoprotein E;C reactive protein;cyclin dependent kinase inhibitor 2A;cyclin dependent kinase inhibitor 2B;high density lipoprotein cholesterol;HLA DQA1 antigen;HLA DRB1 antigen;insulin;low density lipoprotein cholesterol;nicotinic receptor;omega 3 fatty acid;transcription factor FKHRL1;triacylglycerol;adult;aged;Alzheimer disease;article;blood pressure;body fat;body mass;brain ischemia;breast cancer;causality;chemical structure;cholesterol blood level;coronary artery disease;diet restriction;disease predisposition;educational status;experience;female;gene locus;genetic association;genetic susceptibility;genome-wide association study;human;insulin resistance;lifespan;lifestyle;longevity;lung cancer;major clinical study;male;menarche;Mendelian randomization analysis;mortality;non insulin dependent diabetes mellitus;obesity;parent;phenotype;risk factor;single nucleotide polymorphism;smoking;social status;squamous cell lung carcinoma;survival;waist hip ratio,"Joshi, P. K.;Pirastu, N.;Kentistou, K. A.;Fischer, K.;Hofer, E.;Schraut, K. E.;Clark, D. W.;Nutile, T.;Barnes, C. L. K.;Timmers, P. R. H. J.;Shen, X.;Gandin, I.;McDaid, A. F.;Hansen, T. F.;Gordon, S. D.;Giulianini, F.;Boutin, T. S.;Abdellaoui, A.;Zhao, W.;Medina-Gomez, C.;Bartz, T. M.;Trompet, S.;Lange, L. A.;Raffield, L.;Van Der Spek, A.;Galesloot, T. E.;Proitsi, P.;Yanek, L. R.;Bielak, L. F.;Payton, A.;Murgia, F.;Concas, M. P.;Biino, G.;Tajuddin, S. M.;Seppälä, I.;Amin, N.;Boerwinkle, E.;Børglum, A. D.;Campbell, A.;Demerath, E. W.;Demuth, I.;Faul, J. D.;Ford, I.;Gialluisi, A.;Gögele, M.;Graff, M.;Hingorani, A.;Hottenga, J. J.;Hougaard, D. M.;Hurme, M. A.;Ikram, M. A.;Jylhä, M.;Kuh, D.;Ligthart, L.;Lill, C. M.;Lindenberger, U.;Lumley, T.;Mägi, R.;Marques-Vidal, P.;Medland, S. E.;Milani, L.;Nagy, R.;Ollier, W. E. R.;Peyser, P. A.;Pramstaller, P. P.;Ridker, P. M.;Rivadeneira, F.;Ruggiero, D.;Saba, Y.;Schmidt, R.;Schmidt, H.;Slagboom, P. E.;Smith, B. H.;Smith, J. A.;Sotoodehnia, N.;Steinhagen-Thiessen, E.;Van Rooij, F. J. A.;Verbeek, A. L.;Vermeulen, S. H.;Vollenweider, P.;Wang, Y.;Werge, T.;Whitfield, J. B.;Zonderman, A. B.;Lehtimäki, T.;Evans, M. K.;Pirastu, M.;Fuchsberger, C.;Bertram, L.;Pendleton, N.;Kardia, S. L. R.;Ciullo, M.;Becker, D. M.;Wong, A.;Psaty, B. M.;Van Duijn, C. M.;Wilson, J. G.;Jukema, J. W.;Kiemeney, L.;Uitterlinden, A. G.;Franceschini, N.;North, K. E.;Weir, D. R.;Metspalu, A.;Boomsma, D. I.;Hayward, C.;Chasman, D.;Martin, N. G.;Sattar, N.;Campbell, H.;Esko, T.;Kutalik, Z.;Wilson, J. F.",2017,,10.1038/s41467-017-00934-5,0,
2102,"ICARUSS, the Integrated Care for the Reduction of Secondary Stroke trial: rationale and design of a randomized controlled trial of a multimodal intervention to prevent recurrent stroke in patients with a recent cerebrovascular event, ACTRN=12611000264987","Background: The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are readily manageable in primary care setting. Implementation of best-practice recommendations for risk factor management is calculated to reduce stroke recurrence by around 80%. However, risk factor management in stroke survivors has generally been poor at primary care level. A model of care that supports long-term effective risk factor management is needed. Aim: To determine whether the model of Integrated Care for the Reduction of Recurrent Stroke (ICARUSS) will, through promotion of implementation of best-practice recommendations for risk factor management reduce the combined incidence of stroke, myocardial infarction and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. Design: A prospective, Australian, multicentre, randomized controlled trial. Setting: Academic stroke units in Melbourne, Perth and the John Hunter Hospital, New South Wales. Subjects: 1000 stroke survivors recruited as from March 2007 with a recent (<3 months) stroke (ischaemic or haemorrhagic) or a TIA (brain or eye). Randomization: Randomization and data collection are performed by means of a central computer generated telephone system (IVRS). Intervention: Exposure to the ICARUSS model of integrated care or usual care. Primary outcome: The composite of stroke, MI or death from any vascular cause, whichever occurs first. Secondary outcomes: Risk factor management in the community, depression, quality of life, disability and dementia. Statistical power: With 1000 patients followed up for a median of one-year, with a recurrence rate of 7-10% per year in patients exposed to usual care, the study will have at least 80% power to detect a significant reduction in primary end-points Conclusion: The ICARUSS study aims to recruit and follow up patients between 2007 and 2013 and demonstrate the effectiveness of exposure to the ICARUSS model in stroke survivors to reduce recurrent stroke or vascular events and promote the implementation of best practice risk factor management at primary care level. Copyright © 2015 World Stroke Organization.",article;Australia;cardiovascular risk;cerebrovascular accident/dm [Disease Management];cerebrovascular accident/pc [Prevention];clinical effectiveness;community care;controlled study;dementia;depression;disability;heart infarction/pc [Prevention];human;intervention study;major clinical study;medical practice;multicenter study;outcome assessment;patient care;patient education;patient participation;priority journal;prospective study;quality of life;randomized controlled trial;recurrence risk;recurrent disease/dm [Disease Management];recurrent disease/pc [Prevention];risk assessment;risk management;risk reduction;stroke unit;telephone interview;transient ischemic attack;Australian;brain;cerebrovascular accident;community;computer;death;exposure;eye;follow up;heart infarction;hospital;human;information processing;model;patient;prevention;primary medical care;randomization;randomized controlled trial;risk factor;survivor;telephone;Sr-stroke,"Joubert, J;Davis, Sm;Hankey, Gj;Levi, C;Olver, J;Gonzales, G;Donnan, Ga",2015,,10.1111/ijs.12510,0,
2103,"ICARUSS, the Integrated Care for the Reduction of Secondary Stroke trial: Rationale and design of a randomized controlled trial of a multimodal intervention to prevent recurrent stroke in patients with a recent cerebrovascular event, ACTRN=12611000264987","Background: The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are readily manageable in primary care setting. Implementation of best-practice recommendations for risk factor management is calculated to reduce stroke recurrence by around 80%. However, risk factor management in stroke survivors has generally been poor at primary care level. A model of care that supports long-term effective risk factor management is needed. Aim: To determine whether the model of Integrated Care for the Reduction of Recurrent Stroke (ICARUSS) will, through promotion of implementation of best-practice recommendations for risk factor management reduce the combined incidence of stroke, myocardial infarction and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. Design: A prospective, Australian, multicentre, randomized controlled trial. Setting: Academic stroke units in Melbourne, Perth and the John Hunter Hospital, New South Wales. Subjects: 1000 stroke survivors recruited as from March 2007 with a recent (<3 months) stroke (ischaemic or haemorrhagic) or a TIA (brain or eye). Randomization: Randomization and data collection are performed by means of a central computer generated telephone system (IVRS). Intervention: Exposure to the ICARUSS model of integrated care or usual care. Primary outcome: The composite of stroke, MI or death from any vascular cause, whichever occurs first. Secondary outcomes: Risk factor management in the community, depression, quality of life, disability and dementia. Statistical power: With 1000 patients followed up for a median of one-year, with a recurrence rate of 7-10% per year in patients exposed to usual care, the study will have at least 80% power to detect a significant reduction in primary end-points Conclusion: The ICARUSS study aims to recruit and follow up patients between 2007 and 2013 and demonstrate the effectiveness of exposure to the ICARUSS model in stroke survivors to reduce recurrent stroke or vascular events and promote the implementation of best practice risk factor management at primary care level.",article;Australia;cardiovascular risk;cerebrovascular accident/dm [Disease Management];cerebrovascular accident/pc [Prevention];clinical effectiveness;community care;controlled study;dementia;depression;disability;heart infarction/pc [Prevention];human;intervention study;major clinical study;medical practice;multicenter study;outcome assessment;patient care;patient education;patient participation;priority journal;prospective study;quality of life;randomized controlled trial;recurrence risk;recurrent disease/dm [Disease Management];recurrent disease/pc [Prevention];risk assessment;risk management;risk reduction;stroke unit;telephone interview;transient ischemic attack;Sr-stroke,"Joubert, J.;Davis, S. M.;Hankey, G. J.;Levi, C.;Olver, J.;Gonzales, G.;Donnan, G. A.",2015,,10.1111/ijs.12510,0,2102
2104,Heterologous expression of human membrane receptors in the yeast Saccharomyces cerevisiae,"Due to their implication in numerous diseases like cancer, cystic fibrosis, epilepsy, hyperinsulinism, heart failure, hypertension, and Alzheimer disease, membrane proteins (MPs) represent around 50% of drug targets. However, only 204 crystal structures of MPs have been solved. Structural analysis requires large quantities of pure and active proteins. The majority of medically and pharmaceutically relevant MPs are present in tissues at low concentration, which makes heterologous expression in large-scale production-adapted cells a prerequisite for structural studies. The yeast Saccharomyces cerevisiae is a convenient host for the production of mammalian MPs for functional and structural studies. Like bacteria, they are straightforward to manipulate genetically, are well characterized, can be easily cultured, and can be grown inexpensively in large quantities. The advantage of yeast compared to bacteria is that they have protein-processing and posttranslational modification mechanisms related to those found in mammalian cells. The recombinant rabbit muscle Ca(2+)-ATPase (adenosine triphosphatase), the first heterologously expressed mammalian MP for which the crystal structure was resolved, has been produced in S. cerevisiae. In this chapter, the focus is on expression of recombinant human integral MPs in a functional state at the plasma membrane of the yeast S. cerevisiae. Optimization of yeast culture and of MP preparations is detailed for two human receptors of the Hedgehog pathway: Patched and Smoothened.","Blotting, Western;Electrophoresis, Polyacrylamide Gel;*Gene Expression;Genetic Vectors/genetics;Humans;Membrane Proteins/*genetics/*isolation & purification/metabolism;Receptors, Cell Surface/genetics/isolation & purification/metabolism;Receptors, G-Protein-Coupled/genetics/isolation & purification/metabolism;Saccharomyces cerevisiae/*genetics","Joubert, O.;Nehme, R.;Bidet, M.;Mus-Veteau, I.",2010,,10.1007/978-1-60761-344-2_6,0,
2105,Intracortical infarcts in small vessel disease: A combined 7-T postmortem MRI and neuropathological case study in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy,"BACKGROUND AND PURPOSE - The purpose of this study was to report the detection of infarcts of the cerebral cortex in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) using high-resolution postmortem 7-T MRI in association with pathological examination. METHODS - Whole brain high-resolution MRI data were obtained postmortem at 7 T in a 53-year-old patient with CADASIL. These MRI data were used to guide the neuropathological examination of the cortex. RESULTS - Combined with neuropathology, MRI allowed the delineation of intracortical infarcts confirmed by histological examination in this case. These lesions were not visible on the last in vivo MRI obtained at 1.5 T and were difficult to detect on neuropathological examination only. CONCLUSIONS - Postmortem high-resolution MRI may help to detect intracortical infarcts in CADASIL and possibly in other small vessel diseases of the brain. © 2011 American Heart Association, Inc.",adult;article;brain cortex lesion;brain infarction;brain region;CADASIL;cadaver;case report;diagnostic imaging;histopathology;human;human tissue;image analysis;immunohistochemistry;male;microangiopathy;neuropathology;nuclear magnetic resonance imaging;priority journal;7-T clinical MRI scanner,"Jouvent, E.;Poupon, C.;Gray, F.;Paquet, C.;Mangin, J. F.;Le Bihan, D.;Chabriat, H.",2011,,,0,
2106,Brain atrophy is related to lacunar lesions and tissue microstructural changes in CADASIL,"BACKGROUND AND PURPOSE - Cerebral atrophy has been recently recognized as a key marker of disease progression in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The contribution of subcortical cerebral lesions in this process remains undetermined. The aim of this study was to investigate the relationships between cerebral volume and different types of subcortical MRI lesions in CADASIL. METHODS - Demographic, clinical, and laboratory data from 147 patients with CADASIL recruited from a prospective cohort study were analyzed. Validated methods were used to determine the ratio of brain volume to intracranial cavity volume (brain parenchymal fraction [BPF]), volume of white matter hyperintensities, volume of lacunar lesions, number of cerebral microhemorrhages, and mean apparent diffusion coefficient. Associations between BPF, clinical scales, and the different subcortical MRI markers were tested. RESULTS - BPF obtained in 129 patients was significantly associated with the Mattis dementia rating scale (P<0.0001), Mini-Mental State Examination (P=0.002), and modified Rankin scale (P<0.0001) after adjustment for age and sex. Multiple linear regression modeling showed that BPF was independently associated with mean apparent diffusion coefficient (P<0.0001), volume of lacunar lesions (P=0.004), and age (P<0.0001), accounting for 46% of the observed variance in BPF but not with volume of white matter hyperintensities or number of microhemorrhages. CONCLUSIONS - In association with age, mean apparent diffusion coefficient and volume of lacunar lesions are strong and independent MRI predictors of BPF, a key marker of cognitive and motor disability in CADASIL. These results suggest brain atrophy is related to remote and/or diffuse consequences of both lacunar lesions and widespread microstructural alterations within the brain outside lacunar lesions. © 2007 American Heart Association, Inc.",adult;age;aged;article;brain atrophy;brain damage;brain hemorrhage;brain microcirculation;brain size;CADASIL;cognitive defect;cohort analysis;controlled study;dementia;demography;diffusion coefficient;disease marker;female;human;major clinical study;male;Mini Mental State Examination;motor dysfunction;multiple linear regression analysis;neuroimaging;nuclear magnetic resonance imaging;parenchyma;prediction;priority journal;prospective study;Rankin scale;rating scale;tissue structure;validity;variance;volumetry;white matter,"Jouvent, E.;Viswanathan, A.;Mangin, J. F.;O'Sullivan, M.;Guichard, J. P.;Gschwendtner, A.;Cumurciuc, R.;Buffon, F.;Peters, N.;Pachaï, C.;Bousser, M. G.;Dichgans, M.;Chabriat, H.",2007,,,0,
2107,Percutaneous transhepatic cholecystoscopic gallstone fragmentation: A novel approach for the medically unfit patient?,Management of the surgically unfit patient with symptomatic cholelithiasis can be fraught with difficulty. We describe the case of one such gentleman in whom percutaneous transhepatic cholecystoscopy was used to completely fragment a large gallbladder calculus through the use of a nephroscope and Swiss lithoclast Master.,abdominal pain;aged;biliary stent;blood analysis;case report;cholecystectomy;common bile duct stone;computer assisted tomography;congestive heart failure;dementia;depression;endoscopic retrograde cholangiopancreatography;atrial fibrillation;hepatitis;hepatobiliary radiography;human;hypertension;hypospadias;hypotension;jaundice;kidney infection;male;medical history;nephroscope;non insulin dependent diabetes mellitus;note;nursing home;osteoarthritis;percutaneous transhepatic cholecystoscopic gallstone fragmentation;physical examination;septic shock;stone dissolution;tachycardia,"Joyce, D. P.;Thomas, A. Z.;O'Kelly, F.;Malone, D.;Quinlan, D.",2013,,,0,
2108,"A multicenter, randomized controlled trial of cilostazol in patients with mild cognitive impairment","Inclusion criteria: 1) Age between 55-84 (inclusive) 2) Study partner who lives with subject available for all visits 3) Patients with MCI who satisfy the core clinical criteria of NIA/AA for MCI (nearly equivalent to mild neurocognitive disorder in DSM-5) and who also satisfy the following three criteria: i) Memory complaint by subject or study partner Type I: Memory complaint by subject that is verified by a study partner Type II: Otherwise, memory complaint by study partner with the evidence of memory impairment Note) Memory complaint by subject that is not verified by study partner will be excluded. ii) Mini-Mental State Examination (MMSE) scores between 22 and 28 (inclusive) iii) Clinical Dementia Rating (CDR) = 0.5 4) Written informed consent provided for study participation Exclusion criteria: 1) Parkinson's disease, Huntington's disease, normal pressure hydrocephalus, progressive supranuclear palsy, epilepsy, multiple sclerosis, cerebral infection, or subsequent complication caused by head trauma. 2) Findings of multiple infarction, brain tumor, or subdural hematoma on MRI performed within 48 weeks before provisional registration. 3) Contraindications for MRI such as magnetic body or metal. 4) History of major depression or bipolar disorder within 48 weeks before provisional registration, alcohol or other substance abuse within 96 weeks before provisional registration, other diseases or unstable conditions. 5) Poorly controlled diabetes mellitus (HbA1c>9.0%) within 24 weeks before provisional registration. 6) Cognitive impairment due to deficiency of vitamin B12 or folate. 7) Neurosyphilis. 8) Thyroid function abnormality. 9) Psychoactive drugs within 4 weeks before provisional registration. 10) Oral anticoagulants within 4 weeks before provisional registration. 11) Double antiplatelet therapy (cf. Aspirin, Clopidogrel but not Cilostazol) within 4 weeks before provisional registration. 12) Poorly controlled diabetes mellitus treated with insulin within 4 weeks before provisional registration. 13) Episode of hypoglycemic attack with loss of consciousness within 4 weeks before provisional registration. 14) Anti-dementia drugs within 4 weeks before provisional registration. 15) Participation in any other new drug study for Alzheimer's disease. 16) Current bleeding or bleeding disorders. 17) Congestive heart failure. 18) Coronary artery stenosis. 19) Sustained high blood pressure within 2 weeks before provisional registration. 20) History of drug hypersensitivity to Cilostazol. 21) The subject or the subject's spouse pregnant or breast-feeding at the time of provisional registration. 22) Difficulty in neuropsychological tests due to hearing or visual impairment. 23) Considered by the principal investigator to be ineligible. <Condition>Mild cognitive impairment (MCI)</Condition> After the registration, the Site Investigators should start protocol treatment within 28 days including the day of registration. Protocol treatment defines as follows; Investigational Treatment: Cilostazol 50mg B.I.D. p.o. 96 Weeks After the registration, the Site Investigators should start protocol treatment within 28 days including the day of registration. Protocol treatment defines as follows; Comparative Treatment: Placebo B.I.D. p.o. 96 Weeks To evaluate the efficacy of Cilostazol with respect to the cognitive function measured by MMSE in patients with MCI (mild cognitive impairment) 1.To evaluate the efficacy of Cilostazol in preventing conversion from MCI to All-cause Dementia. 2.To evaluate the efficacy of Cilostazol with respect to the cognitive function measured by CDR-SB in patients with MCI. 3.To evaluate the efficacy of Cilostazol with respect to the cognitive function measured by ADAS-Cog 14 in patients with MCI. 4.To evaluate the efficacy of Cilostazol with respect to the cognitive function measured by the Logical Memory subtest of the Wechsler Memory Scale-Revised (WMS-R) in patients with MCI. 5.To evaluate the efficacy of Cilostazol with respect to the activity of daily living measu ed by Alzheimer's Disease Cooperative St dy - Activities of Daily Living in MCI (ADCS-MCI-ADL). 6.To evaluate the efficacy of Cilostazol with respect to the brain atrophy measured by brain MRI in patients with MCI.",Sr-dementia,"Jprn, Umin",2015,,,0,
2109,"Effect of supplement involved ferulic acid, glycerophosphocholine and ginkgo leaf extract on mild cognitive impairment: a randomized, double-blind, placebo-controlled, parallel-group clinical trial","Inclusion criteria: 1 Subjects with MCI and who meet the following criteria Amnestic MCI CDR 0 or 0.5 MMSE 22-26 and/or ADAS-jcog 5-15 2 Subjects who giving written informed consent Exclusion criteria: 1) Subjects who use or plan to use go drugs affecting cognitive function or dementia. 2) Subjects who constantly use Kampo preparation affecting cognitive function or dementia. 3) Subjects who constantly use functional supplement affecting cognitive function or dementia. 4) Subjects who have psychiatric disorder (schizophrenia, mania, depression, severe cardiopathy, delirium, alcoholism etc.) affecting cognitive function or dementia with the exception of complete remission. 5) Subjects who take medical treatment for psychoneurosis (confusion, hallucination, delusion, abnormal behavior etc.) with antipsychotic drug. 6) Subjects with metabolic disease (hypothyroidism, deficiency of vitamin B12, etc.) affecting cognitive function or dementia. 7) Subjects with liver disease, renal disease or hypoactivity of renal function (eGFR&lt;=20 mL/min). 8) Subjects with type 2 diabetes and HbA1c&gt;8.4%, insulin treatment or taking drug for insulin secretion accelerating agent. 9) Subjects with chronic obstructive lung disease (COPD) and oxygen therapy in home or FEV1&lt;30%. 10) Subjects with essential hypertension or uncontrolled hyperlipidemia. 11) Subjects who have medical history of gastrointestinal surgery or hospitalization for head injury within 10 years. 12) Subjects who have history of intracerebral hemorrhage, subarachnoid hemorrhage, cardiac hypertrophy?cardiac failure, ischemic heart disease(IHD), nephrosclerosis, aortic dissection, cerebral infarction. 13) Subjects who take medical treatment for cancer. 14) Subjects who are planned to participate in other clinical study. 15) Subjects who are judged as unsuitable for the study by the investigator for other reason. <Condition>Mild Cognitive impairment</Condition> Test food:tablet(ferulic acid, glycerophosphocholine, ginkgo leaf extract) Administration period:180days Control food:tablet(not contained ferulic acid, glycerophosphocholine, ginkgo leaf extract) Administration period:180days Clinical Gloval Impression Criteria: Changes of cognitive impairment in comparison with before intervention. 1. Remarkable improvement of MCI 2. Improvement of MCI 3. No change 4. Hypofunction of cognitive Term for evaluation: 3 months, 6 months ADAS-jcog(total, test), MMSE",Sr-dementia,"Jprn, Umin",2016,,,0,
2110,"Community-based study about the efficacy of Melissa officinalis extract which contained rosmarinic acid on cognitive function in older adults with subjective cognitive impairment and mild cognitive impairment: a double blind, placebo-controlled, parallel-design, randomized control trial","Inclusion criteria: 1. Age between 65-79 years old at informed consent 2. Residents in Nanao-city, Japan and its environs 3. Subjects fulfilled the diagnostic criteria of subjective cognitive impairment and mild cognitive impairment 4. MMSE score more than 24 points at screening test 5. Subjects have reading comprehension equivalent to the six grade of elementary school, and subjects without intellectual disabilities 6. Physical findings, vital signs, and laboratory examination at screening test are within normal limits or within the acceptable range 7. Subjects agree to provide a blood or urine to test laboratory examination and APOE genotype 8. Subjects can administrate the tablets and subject's family can manage taking medicine 9. Subjects agree not to change the lifestyle such as exercise and eating habits Exclusion criteria: 1. Subjects who have mental illness such as schizophrenia, bipolar disorder, depression etc. based on the diagnostic criteria of DSM-5 2. GDS-15 score more than 6 points at screening test 3. Subjects with uncontrolled health problem such as diabetes mellitus, hypertension, heart failure, angina pectoris, renal dysfunction, etc.. within 3 months before screening period. The researcher determines that there is a medically significant risk 4. Subjects who has malignancy within 5 years before screening period. Except for the low risk of recurrence cases who has no recurrence for 3 years. The researcher must determine whether to exclude the subjects with malignancy 5. Subjects administrated the prohibited concomitant therapy within prohibition period shown in Table1 6. Subjects who has previous history of alcohol and/or drug abuse 7. Subjects who has hypersensitivity to polyphenols 8. Subjects who has drug and/or food allergy 9. The subjects judged to inadequacy by the researcher Table1. Prohibited concomitant therapy (Prohibition period) Cholinesterase inhibitors and glutamate NMDA receptor antagonist (3 months) Daily administration of anticholinergic drugs (4 weeks) Antidepressant drugs (4 weeks) Antipsychotic drugs (4 weeks) Mood-stabilizing drugs and anticonvulsants (4 weeks) Daily administration of hypnotic, sedative/benzodiazepines (4 weeks) Daily administration of narcotic analgesics (4 weeks) Anti-Parkinson's disease treatment drugs (3 months) <Condition>subjective cognitive impairment and mild cognitive impairment</Condition> (1) To take 500 mg (10 capsules) rosmarinic acid per day for 96weeks (2) To stop rosmarinic acid administration at 96th week of the test (1) To take placebo (10 capsules) per day for 96 weeks (2) To stop placebo administration at 96th week of the test The changes of ADAS-cog scores between baseline and 48-week/ 96-week after intake of rosmarinic acid (1) Comprehensive effects: The changes of CDR-SB scores between baseline and 48-week/ 96-week after intake of rosmarinic acid (2) Efficacy of prevention on the developing dementia: The incidence of dementia defined as Major neurocognitive disorder in DSM-5 (3) The total volume of the hippocampus: The changes of the total hippocampal volume quantified by MRI between baseline and 96-week after intake of rosmarinic acid (4) Activities of daily living: The changes of Barthel index and IADL scores between baseline and 48-week/ 96-week after intake of rosmarinic acid (5) Neuropsychological evaluation: The changes of MMSE scores between baseline and 48-week/ 96-week after intake of rosmarinic acid (6) Safety of rosmarinic acid: To evaluate safety of long-term intake of rosmarinic acid. Including incidence of adverse event, vital signs, laboratory examination, and head MRI. (7) The changes of biomarkers (blood amyloid-beta protein etc) and the association between biomarkers and cognition (ADAS-cog score etc) (8) Compliance rate: The differences of the results of Primary and Secondary outcomes for each compliance rate.",Sr-dementia,"Jprn, Umin",2016,,,0,
2111,The efficacy of ferulic acid in the treatment of dementia (double-blinded study),"Inclusion criteria: The subjects with mild cognitive impairment are registered from Shimnane University Hospital and public subscripiton. MMSE is from 24 to 28. Exclusion criteria: metabolic encephalopathy(hypothyroidism),head trauma,malignancy,alcohl abuse, mental disorder,chronic renal failure, chronic heart failure,chronic liver injury and patients treated by major tranquilizer. The treatment group is taking capsules of Ferulic Acid for 12 months. The placebo group is taking capsules not containing Ferulic acid for 12 months. ADAS-Jcog(pre-treatment and one year follow up) Hasegawa Dementia Rating Scale, Mini Mental State Examination, Apathy scale,Self Depression Scale, FAB, ADAS-Jcog, Wechsler Memory Scale Revised, MRI(Default mode network,hippocampal atrophy)",Sr-dementia,"Jprn, Umin",2016,,,0,
2112,An evaluation of the impact of seniors on a rheumatology referral clinic: Demographics and pharmacotherapy,"The aging population is impacting subspecialty areas outside of geriatrics. Rheumatic diseases increase with age. Therapy for these diseases can add to polypharmacy and negatively impact other comorbidities. This is a retrospective chart review of all patients attending a rheumatology subspeciality clinic over 1 year. Referrals were prescreened and excluded probable degenerative axial and peripheral disease and chronic pain syndromes. Data were collected on demographics, diagnoses, and medications. Two hundred ninety-five new patients were seen. Seventy-eight (26%) were seniors (age, >65 years) with a mean age of 73 years (65-90). Comparing the >65 to <65 age groups, the prevalence of inflammatory arthritides (rheumatoid arthritis (RA), psoriatic arthritis, palindromic rheumatism) was comparable: 48% vs 53%; however, osteoarthritis and polymyalgia rheumatica were twice as common in the older group. Comorbidities in the >65 age group included hypertension (31%), osteoporosis (27%), diabetes (15%), hypothyroidism (11%), and coronary artery disease (9%). Only one patient had documented dementia. There were no cases of uncontrolled hypertension identified, and all patients were receiving a mixture of anti-hypertensives. Eighty-one percent of osteoporosis patients were on antiresorptives, but only 40% of prednisone users were taking bisphosphonates. For RA, treatment was somewhat comparable between the groups, with all but two patients receiving disease-modifying antirheumatic drugs. Eleven percent were on biologics. Seniors comprise a significant number of referrals. Pharmacotherapy differs in seniors, with more use of prednisone and a probable contribution of polypharmacy. This study highlights the need for reciprocal knowledge by both geriatricians and rheumatologists to optimize the management of these complex patients. © 2011 Clinical Rheumatology.",antihypertensive agent;bisphosphonic acid derivative;disease modifying antirheumatic drug;hydroxychloroquine;leflunomide;methotrexate;nonsteroid antiinflammatory agent;prednisone;adult;aged;article;comorbidity;complex regional pain syndrome;coronary artery disease;dementia;diabetes mellitus;female;fibromyalgia;gout;groups by age;human;hypertension;hypothyroidism;major clinical study;male;medical record review;myositis;osteoarthritis;osteoporosis;palindromic rheumatism;patient referral;priority journal;psoriatic arthritis;rheumatic disease;rheumatic polymyalgia;rheumatoid arthritis;scleroderma;spondyloarthropathy;systemic lupus erythematosus,"Juby, A.;Davis, P.",2011,,,0,
2113,Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture,"OBJECTIVES: To evaluate risk factors for preoperative and postoperative delirium. DESIGN: Prospective cohort study. SETTING: Departments of orthopedic surgery in two Norwegian hospitals. PARTICIPANTS: Three hundred sixty-four patients with and without cognitive impairment, aged 65 and older. MEASUREMENTS: Patients were screened daily for delirium using the Confusion Assessment Method. Established risk factors and risk factors regarded as clinically important according to expert opinion were explored in univariate analyses. Variables associated with the outcomes (P<.05) were entered into multivariate logistic regression models. RESULTS: Delirium was present in 50 of 237 (21.1%) assessable patients preoperatively, whereas 68 of 187 (36.4%) patients developed delirium postoperatively (incident delirium). Multivariate logistic regression identified four risk factors for preoperative delirium: cognitive impairment (adjusted odds ratio (AOR)=4.7, 95% confidence interval (CI)=1.9-11.3), indoor injury (AOR=3.6, 95% CI=1.1-12.2), fever (AOR=3.4, 95% CI=1.5-7.7), and preoperative waiting time (AOR=1.05, 95% CI=1.0-1.1 per hour). Cognitive impairment (AOR=2.9, 95% CI=1.4-6.2), indoor injury (AOR=2.9, 95% CI=1.1-6.3), and body mass index (BMI) less than 20.0 (AOR=2.9, 95% CI=1.3-6.7) were independent and statistically significant risk factors for postoperative delirium. CONCLUSION: Time from admission to operation is a risk factor for preoperative delirium, whereas low BMI is an important risk factor for postoperative delirium in hip fracture patients. Cognitive impairment and indoor injury are independent risk factors for preoperative and postoperative delirium. © 2009, The American Geriatrics Society.",acetylsalicylic acid;beta adrenergic receptor blocking agent;diuretic agent;fentanyl;hydroxymethylglutaryl coenzyme A reductase inhibitor;ketamine;psychotropic agent;serotonin uptake inhibitor;zopiclone;aged;anticholinergic effect;anxiety disorder;article;body mass;body temperature;cognitive defect;comorbidity;confusion;delirium;depression;drug effect;drug use;female;femur intertrochanteric fracture;femur neck fracture;femur subtrochanteric fracture;general anesthesia;geriatric patient;hip arthroplasty;hip fracture;home accident;human;hypertension;ischemic heart disease;logistic regression analysis;major clinical study;male;multivariate analysis;osteosynthesis;outcome assessment;postoperative period;preoperative period;psychosis;rating scale;risk factor;spinal anesthesia;surgical patient;univariate analysis,"Juliebø, V.;Bjøro, K.;Krogseth, M.;Skovlund, E.;Ranhoff, A. H.;Wyller, T. B.",2009,,,0,
2114,Delirium is not associated with mortality in elderly hip fracture patients,"BACKGROUND: The relationship between delirium and mortality remains obscure. The aims of this study were to investigate the effect of delirium and the interaction between delirium and chronic cognitive impairment on mortality in elderly hip fracture patients. METHODS: This is a prospective observational study, including 331 hip fracture patients. Information on comorbidity, medications and clinical findings was collected at the time of fracture. Information on cause and time of death was obtained from the Norwegian Cause of Death Register. Patients were screened for delirium by the Confusion Assessment Method. RESULTS: Delirium was not associated with mortality when adjusting for the severity of chronic cognitive impairment, measured by the Infor- mant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Estimated by Kaplan-Meier plots, delirium in patients with dementia was significantly associated with an increased risk of death from stroke (p = 0.004) and dementia (p </= 0.001). CONCLUSIONS: No association between delirium and mortality was demonstrated when adjusting for the IQCODE score, but delirium in patients with prefracture dementia was associated with an increased risk of death from stroke and dementia. The effect of delirium on the cause of death might be explained by an aggravation of an ongoing neuro-inflammation.","Accidental Falls;Aged;Aged, 80 and over;Comorbidity;Coronary Disease/epidemiology;*Delirium/epidemiology/etiology;Dementia/*complications/mortality;Female;*Hip Fractures/complications/mortality;Humans;Infection/epidemiology;Institutionalization;Intelligence Tests;Male;Neoplasms/epidemiology;Norway;Prospective Studies;Pulmonary Disease, Chronic Obstructive/epidemiology;Risk Factors;Severity of Illness Index;Stroke/epidemiology","Juliebo, V.;Krogseth, M.;Skovlund, E.;Engedal, K.;Ranhoff, A. H.;Wyller, T. B.",2010,,10.1159/000318819,0,
2115,Cardiac and cerebral manifestations of antiphospholipid syndrome,"We describe cardiac and cerebral manifestations in 27 patients with the antiphospholipid syndrome and give a review of the literature. PATIENTS AND METHODS: We studied 27 patients with either cardiac, cerebral or both manifestations, who also were diagnosed with the antiphospholipid syndrome (APS). All patients fulfilled the proposed classification criteria for the APS according to the Scientific Standardisation Committee of the International Society of Thrombosis and Haemostasis (1). Three patients died. RESULTS: Eighteen of the 27 patients had coronary artery disease with either thrombotic coronary occlusions, high grade stenosis or complete vessel occlusion. In three patients the left main artery was involved. Ten patients had involvement of the left anterior descending artery (LAD), 6 patients of the circumflex artery (RCX) and 5 patients had involvement of the right coronary artery (RCA). As valvular lesions have been described in association with the APS it should be noted that in 16 cases there was mitral- and/or aortic valve disease and in 3 cases tricuspid valve disease. Four patients underwent mitral- and/or aortic- and/or tricuspid valve replacement. 7 patients presented with a history of cerebrovascular involvement; 5 of these patients had cerebral infarction, one patient recurrent cerebral bleeding under oral anticoagulation and another patient presented with cognitive disorders. Three of the 7 patients had a prior history of myocardial infarction, whereas 3 patients underwent mitral or aortic valve replacement. CONCLUSION: The frequent occurrence of coronary disease, cardiac valvular disease and cerebral disease in patients diagnosed with APS may suggest a causative relationship between the presence of PL antibodies and vascular disease.",Adult;Aged;Antiphospholipid Syndrome/*diagnosis;Cerebral Hemorrhage/diagnosis;Cerebral Infarction/*diagnosis;Coronary Angiography;Coronary Thrombosis/*diagnosis;Dementia/diagnosis;Female;Follow-Up Studies;Heart Valve Diseases/*diagnosis;Humans;Male;Middle Aged;Myocardial Infarction/*diagnosis;Retrospective Studies;Risk Factors,"Jung, F.;Miesbach, W.;Scharrer, I.",2002,Aug,,0,
2116,Frequency of ApoE genotypes and associations with memory and attention in heart failure,"Introduction: Decrease in memory and attention function are common in both heart failure (HF) and Alzheimer's disease (AD). Among HF patients without AD, 23- 50% experience memory loss and 15-27% experience attention impairment. Among AD patients, the presence of HF was associated with poor memory and attention. Apolipoprotein E (APOE) epsilon4 allele is a genetic risk factor for vascular degeneration and subsequent late-onset AD. However, the genetic risk factor for memory and attention impairments have rarely been investigated in patients with HF. Aims: Objectives were to: 1) characterize the major allelic frequency of two variants in the APOE gene in HF patients; and 2) evaluate differences in memory and attention based on absence or presence of the APOE epsilon4 alleles. Methods: This is a secondary analysis of baseline data from a randomized controlled cognitive training intervention among 29 HF patients. A candidate gene analysis of APOE was completed for 26 patients (77% men, mean age 61 yrs). The Taqman SNP genotyping assay was used for the two genetic variants of APOE, rs7412 and rs429358, in the blood. Memory was measured using the Hopkins Verbal Learning Test, recall and delayed recall. Attention was measured using the CogState Identification test. Baseline data were used for analysis. The analysis was completed using descriptives, Fisher's exact, Mann-Whitney tests, and linear regressions. Results: The frequencies of APOE genotypes were: epsilon2/ epsilon2 = 0%; epsilon2/epsilon3 = 20.7%; epsilon3/epsilon3 = 55.2%; epsilon2/epsilon4 = 3.4%; epsilon3/epsilon4 = 20.7%; and epsilon4/ epsilon4 = 0%. The APOE epsilon4 allele was present in 7 patients (24%) and absent in 22 patients (76%). HF patients with APOE epsilon4 were 5 years younger than patients without APOE epsilon4, but it was not statistically significant. Memory or attention did not differ by APOE epsilon4 status (Table). Possible covariates (i.e., age, premorbid intellect, HF severity) were evaluated in linear regression analyses, and there was no evidence for confounding effects. Conclusions: The APOE epsilon4 allele was present in nearly 1/4 of patients, which is similar to the frequency in general older US population. In this small cohort, no association between APOE epsilon4 and memory or attention was found. Future studies are needed to deepen our understanding of APOE epsilon4 genotypes and memory and attention impairment in HF. (Table Presented).",adult;Alzheimer disease;attention;blood;clinical article;controlled clinical trial;controlled study;female;gene frequency;genetic risk;genetic variability;heart failure;Hopkins verbal learning test;human;intellect;linear regression analysis;male;memory disorder;middle aged;randomized controlled trial;rank sum test;secondary analysis;single nucleotide polymorphism;apolipoprotein E;endogenous compound,"Jung, M;Harrison, J;Titler, M;Koelling, Tm;Dorsey, Sg;Bakoyannis, G;Giordani, B;Pressler, Sj",2016,,,0,
2117,Healthy dietary patterns and oxidative stress as measured by fluorescent oxidation products in nurses’ health study,"Healthy diets may lower oxidative stress and risk of chronic diseases. However, no previous studies examined associations between diet and fluorescent oxidation products (FlOP), a global marker of oxidative stress. We evaluated associations between healthy eating patterns (Alternative Healthy Eating Index (AHEI), Dietary Approach to Stop Hypertension (DASH), and Alternate Mediterranean Diet (aMED)) and FlOP, measured at three excitation/emission wavelengths (FlOP_360, FlOP_320, FlOP_400) from 2021 blood samples collected from 1688 women within the Nurses’ Health Study. AHEI, DASH, and aMED scores were significantly positively associated with FlOP_360 and FlOP_320 concentrations (p-trend ≤ 0.04), but not associated with FlOP_400. Among specific food groups that contribute to these diet scores, significantly positive associations were observed with legumes and vegetables for FlOP_360, vegetables and fruits for FlOP_320, and legumes and alcohol for FlOP_400. Inverse associations were observed with nuts, sweets or desserts, and olive oil for FlOP_360, nuts for FlOP_320 and sweets or desserts for FlOP_400 (all p-trend ≤ 0.05). However, FlOP variation due to diet was small compared to overall FlOP variation. In conclusion, AHEI, DASH, and aMED scores were unexpectedly positively, but weakly, associated with FlOP_360 and FlOP_320. However, these findings should be interpreted cautiously as the determinants of FlOP concentrations are not fully understood.",carbohydrate;carotenoid;fluorescent dye;phospholipid;reactive oxygen metabolite;adult;Alzheimer disease;apoptosis;article;body mass;controlled study;cross-sectional study;diet supplementation;dietary intake;female;heart infarction;human;hypertension;ischemic heart disease;major clinical study;male;oxidative stress;questionnaire;risk factor,"Jung, S.;Smith-Warner, S. A.;Willett, W. C.;Wang, M.;Wu, T.;Jensen, M.;Hankinson, S. E.;Eliassen, A. H.",2016,,,0,
2118,Dementia is a risk factor for major adverse cardiac and cerebrovascular events in elderly Korean patients initiating hemodialysis: a Korean national population-based study,"BACKGROUND: Dementia is common in end-stage renal disease (ESRD) patients on hemodialysis (HD) and is associated with worse outcomes. This study aimed to investigate the risk of major adverse cardiac and cerebrovascular event (MACCE) in elderly patients with dementia initiating HD. METHODS: Using the database from the Health Insurance Review & Assessment Service, we analyzed 10,171 patients aged 65 years or older who had initiated dialysis from 2005 to 2008. MACCE was defined as a composite outcome of all-cause mortality, nonfatal acute myocardial infarction, target vessel revascularization, and nonfatal ischemic and hemorrhagic stroke. The Kaplan-Meier method and Cox proportional hazards model were used, and further comparisons using propensity-score matching at 1:2 ratio were also performed. RESULTS: A total of 303 elderly patients (3.0%) had dementia at initiating HD. During follow-up, dementia was a significant predictor of MACCE after adjustment for confounding variables. In addition, further analyzed in the propensity-score matched groups, dementia was an independent predictor of both nonfatal ischemic stroke and all-cause mortality. CONCLUSIONS: Dementia is an independent risk factor for mortality and ischemic stroke in elderly ESRD patients initiating HD. Patients with dementia who start dialysis should be closely monitored to reduce the risk of mortality and ischemic stroke.",Dementia;Hemodialysis;Ischemic stroke;Mortality,"Jung, S. M.;Kim, C. T.;Kang, E. W.;Kim, K. H.;Lee, S.;Oh, H. J.;Kim, S. J.;Kang, D. H.;Choi, K. B.;Ryu, D. R.;Kim, H.",2017,Apr 06,,0,
2119,Comorbidity as a mediator of survival disparity between younger and older women diagnosed with metastatic breast cancer,"The presence of comorbidity becomes increasingly important for its prognostic effect on survival in breast cancer patients with advancing age. This study aimed to evaluate the role of comorbidities including hypertension as a mediator of disparity in survival after metastasis diagnosis between younger (≤51 years) and older (>51 years) patients. A total of 553 patients 26-88 years of age with breast cancer metastasis diagnosis from 1 large urban practice were followed between January 1, 1999, and June 30, 2008. Comorbidity variables and survival were analyzed using Cox regression model. To assess comorbidity variables as a mediator of age-survival relationship, 2 approaches have been applied: (1) Baron Kenny approach and (2) alternative assessment to compute the percentage change in the hazard ratios (HRs). The median survival was 40 months, with 265 (47.9%) alive and 288 (52.1%) dead. Older patients had worse survival than younger patients (HR, 1.43; 95% confidence interval [CI], 1.11-1.84). Hypertension was related to survival (HR, 1.45; 95% CI, 1.12-1.89) when age and other covariates were controlled. The effect of age on survival was no longer significant after adjustment for hypertension (HR, 1.26; 95%, CI 0.97-1.65) or hypertension-augmented Charlson comorbidity score (HR, 1.24; 95% CI, 0.95-1.63). Hypertension-augmented Charlson comorbidity score or hypertension was a strong mediator of age-survival relationship among metastatic breast cancer patients, explaining survival disparity between younger and older patients by 44% and 40%, respectively. The study findings suggest that hypertension should be included in the comorbidity information for decision-making support programs. © 2011 American Heart Association, Inc.",acquired immune deficiency syndrome;adult;aged;article;breast cancer;breast metastasis;cancer patient;cancer survival;cerebrovascular disease;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;female;health disparity;heart infarction;hemiplegia;human;hypertension;kidney disease;leukemia;liver disease;lymphoma;major clinical study;peripheral vascular disease;priority journal;prognosis;scoring system;ulcer,"Jung, S. Y.;Rosenzweig, M.;Linkov, F.;Brufsky, A.;Weissfeld, J. L.;Sereika, S. M.",2012,,,0,
2120,Clinical and differential diagnosis of multi-infarct dementia and Alzheimer's disease,"Multi-infarct dementia (MID) and dementia of the Alzheimer type (DAT) are the main syndromes in the elderly. This study aims at evaluating the possible differentiation of these syndromes on a clinical basis. The patient population consisted of demented patients hospitalized during the period April 1, 1988-September 30, 1990 at the Department of Cerebrovascular Diseases. The study included 40 patients with MID and 25 with DAT. The clinical diagnosis of dementia included medical history, neurological examination, psychiatric interview and laboratory diagnostic investigations. The severity of the dementia symptoms was rated by many rating scales and a battery of neuropsychological tests. This model of clinical procedure permitted for differential diagnosis between vascular and degenerative dementia, according to DSM-III-R criteria. Patients with multi-infarct dementia of the Alzheimer type did not differ significantly with regard to age, mean duration of cognitive impairment and level of education. In the DAT group women outnumbered men, and this was statistically significant. It should be emphasized, that a great majority of patients with cerebrovascular lesions developed early cognitive impairment, that means within the first year after stroke. In the MID group hypertension, heart disease and smoking were statistically more frequent than in the DAT group. For the preliminary evaluation the severity of cognitive impairment was quantified by Mini-Mental State and Dementia Scale. These scales showed that the degree of dementia was significantly greater in DAT patients as compared to MID patients, whereas the severity of depression assessed by Hamilton's Scale was mild and similar in both group.(ABSTRACT TRUNCATED AT 250 WORDS)","Alzheimer Disease/*diagnosis/etiology;Brain/*blood supply;Brain Ischemia/*complications;Dementia, Multi-Infarct/*diagnosis/etiology;Diabetic Angiopathies/complications;Diagnosis, Differential;Female;Humans;Hypertension/complications;Male;Risk Factors;Sex Factors","Jura, E.",1992,Jan-Feb,,0,
2121,Heart failure management in skilled nursing facilities: A scientific statement from the American Heart Association and the Heart Failure Society of America,"Heart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age. 1 Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2,3 Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities. Several issues make it important to address HF care in SNFs. The healthcare environment and characteristics of SNF residents are distinct from those of communitydwelling adults. Comorbid illness unrelated to HF (eg, dementia, hip fracture) increases with age >75 years, and these conditions may complicate both the initial HF diagnosis and ongoing management. 4-6 Morbidity and mortality rates are significantly increased for hospitalized older adults with HF discharged to SNFs compared with those discharged to other sites. 7Transitions between hospitals and SNFs may be problematic. 8 SNF 30-day rehospitalization rates for HF range from 27% to 43%, 7,9,10 and long-term care residents sent to the emergency department are at increased risk for hospital admission and death. 11 The purpose of this scientific statement is to provide guidance for management of HF in SNFs to improve patient-centered outcomes and reduce hospitalizations. This statement addresses unique issues of SNF care and adapts HF guidelines and other recommendations to this setting.",angiotensin receptor antagonist;beta adrenergic receptor blocking agent;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydralazine;mineral;mineralocorticoid antagonist;nitric acid derivative;protein;sodium;vitamin;aerobic exercise;article;blood chemistry;cardiac resynchronization therapy device;cardiovascular mortality;cardiovascular risk;caregiver;compensation;coronary artery disease;curriculum;dietary intake;emergency care;functional status;health literacy;heart ejection fraction;heart failure;hospice care;hospital discharge;hospitalization;human;ischemic heart disease;medical society;morbidity;muscle training;neuromuscular electrical stimulation;nonischemic cardiomyopathy;nursing home;nursing home patient;nursing home personnel;nursing management;nursing staff;nutritional assessment;pacemaker implantation;pathogenesis;patient assessment;patient care;patient education;patient monitoring;physical examination;practice guideline;priority journal;quality of life;rehabilitation care;remote sensing;resistance training;sodium balance;staff training;terminal care;thorax radiography;total quality management;valvular heart disease;verbal communication;written communication,"Jurgens, C. Y.;Goodlin, S.;Dolansky, M.;Ahmed, A.;Fonarow, G. C.;Boxer, R.;Arena, R.;Blank, L.;Buck, H. G.;Cranmer, K.;Fleg, J. L.;Lampert, R. J.;Lennie, T. A.;Lindenfeld, J.;Piña, I. L.;Semla, T. P.;Trebbien, P.;Rich, M. W.",2015,,,0,
2122,The impact of comorbidities on hip fracture mortality: a retrospective population-based cohort study,"Summary: The impact of comorbidities on hip fracture-related excess mortality was assessed in a population-based age- and sex-matched cohort over 10 years. On average, only 1 out of 12 excess deaths over 10 years was related to pre-fracture life-threatening comorbidities. The presence of life-threatening comorbidities increased the excess risk of death after hip fracture. Purpose: This work aimed to estimate the impact of pre-fracture comorbidities on the 10-year excess risk of all-cause death after hip fracture among Estonian men and women ≥ 50 years of age. Methods: Retrospective, population-based 10-year study of people aged ≥ 50 in two cohorts: those with a hip fracture and an age- and sex-matched random sample from the national health insurance fund for comparison. Results: We found that hip fracture was a strong independent risk factor for death. Upon adjustment for Charlson Comorbidities Index (CCI) score, the impact of life-threatening comorbidities on average hip fracture-related excess mortality was modest: only 8% of excess deaths over 10 years were related to comorbidities. Upon stratification by CCI groups, the excess risk of patients in CCI groups ≥ 3 and 1–2 exceeded that in the CCI 0 group over 5–7 years, indicating that in patients with life-threatening comorbidities, a hip fracture accelerates the chain of lethal events and brings deaths from other conditions forward. The impact of comorbidities was age- and time-dependent: in younger hip fracture patients, the comorbidities almost doubled the excess risk from a fracture in 10 years; in older patients, the effect was shorter and modest. Conclusions: The presence of pre-fracture comorbidities increases the risk of excess death in hip fracture patients, but the comorbidity impact on aggregated excess mortality is modest.",adult;age;aged;all cause mortality;article;cause of death;Charlson Comorbidity Index;cohort analysis;comorbidity assessment;congestive heart failure;dementia;Estonian (citizen);female;hip fracture;human;male;malignant neoplasm;population research;prevalence;priority journal;retrospective study;sex difference,"Jürisson, M.;Raag, M.;Kallikorm, R.;Lember, M.;Uusküla, A.",2017,,10.1007/s11657-017-0370-z,0,
2123,Heart disease as a risk factor for dementia,"As life expectancy lengthens, dementia is becoming a significant human condition in terms of its prevalence and cost to society worldwide. It is important in that context to understand the preventable and treatable causes of dementia. This article exposes the link between dementia and heart disease in all its forms, including coronary artery disease, myocardial infarction, atrial fibrillation, valvular disease, and heart failure. This article also explores the cardiovascular risk factors and emphasizes that several of them are preventable and treatable. In addition to medical therapies, the lifestyle changes that may be useful in retarding the onset of dementia are also summarized.",Alzheimer's disease;atrial fibrillation;cardiovascular risk factors;coronary artery disease;heart failure;myocardial infarction;prevention;valvular disease,"Justin, B. N.;Turek, M.;Hakim, A. M.",2013,,10.2147/clep.s30621,0,
2124,"Risk Factors Associated With Cognitive, Functional, and Behavioral Trajectories of Newly Diagnosed Dementia Patients","BACKGROUND: Dementia results in changes in cognition, function, and behavior. We examine the effect of sociodemographic and clinical risk factors on cognitive, functional, and behavioral declines in incident dementia patients. METHODS: We used longitudinal data from the National Alzheimer's Coordinating Center to evaluate cognitive (Mini-Mental State Exam [MMSE]), functional (Functional Activities Questionnaire [FAQ]), and behavioral (Neuropsychiatric Inventory Questionnaire [NPI-Q] severity score) trajectories for incident dementia patients over an 8-year period. We evaluated trajectories of 457 patients with mixed effects linear regression models. RESULTS: In the first year, cognition worsened by -1.518 (95% confidence interval [CI] -1.745, -1.291) MMSE points (0-30 scale). Education, race, and region of residence predicted cognition at diagnosis. Age of onset, geographic region of residence, and history of hypertension and congestive heart failure predicted cognitive changes. Function worsened by 3.464 (95% CI 3.131, 3.798) FAQ points in the first year (0-30 scale). Cognition, gender, race, region of residence and place of residence, and a history of stroke and hypercholesterolemia predicted function at diagnosis. Place of residence and a history of diabetes predicted functional changes. Behavioral symptoms worsened by 0.354 (95% CI 0.123, 0.585) NPI-Q points in the first year (0-36 scale). Age of onset, region of residence, and history of hypertension and psychiatric problems predicted behaviors at diagnosis. Cognition explained changes in behavior. CONCLUSIONS: Sociodemographic characteristics and clinical comorbidities predict cognitive and functional changes. Only cognitive status explains behavioral decline. Results provide an understanding of the characteristics that impact cognitive, functional, and behavioral decline.",Alzheimer's;Dementia;Health services;Public health,"Jutkowitz, E.;MacLehose, R. F.;Gaugler, J. E.;Dowd, B.;Kuntz, K. M.;Kane, R. L.",2016,Apr 29,10.1093/gerona/glw079,0,2125
2125,"Risk Factors Associated With Cognitive, Functional, and Behavioral Trajectories of Newly Diagnosed Dementia Patients","BACKGROUND: Dementia results in changes in cognition, function, and behavior. We examine the effect of sociodemographic and clinical risk factors on cognitive, functional, and behavioral declines in incident dementia patients. METHODS: We used longitudinal data from the National Alzheimer's Coordinating Center to evaluate cognitive (Mini-Mental State Exam [MMSE]), functional (Functional Activities Questionnaire [FAQ]), and behavioral (Neuropsychiatric Inventory Questionnaire [NPI-Q] severity score) trajectories for incident dementia patients over an 8-year period. We evaluated trajectories of 457 patients with mixed effects linear regression models. RESULTS: In the first year, cognition worsened by -1.518 (95% confidence interval [CI] -1.745, -1.291) MMSE points (0-30 scale). Education, race, and region of residence predicted cognition at diagnosis. Age of onset, geographic region of residence, and history of hypertension and congestive heart failure predicted cognitive changes. Function worsened by 3.464 (95% CI 3.131, 3.798) FAQ points in the first year (0-30 scale). Cognition, gender, race, region of residence and place of residence, and a history of stroke and hypercholesterolemia predicted function at diagnosis. Place of residence and a history of diabetes predicted functional changes. Behavioral symptoms worsened by 0.354 (95% CI 0.123, 0.585) NPI-Q points in the first year (0-36 scale). Age of onset, region of residence, and history of hypertension and psychiatric problems predicted behaviors at diagnosis. Cognition explained changes in behavior. CONCLUSIONS: Sociodemographic characteristics and clinical comorbidities predict cognitive and functional changes. Only cognitive status explains behavioral decline. Results provide an understanding of the characteristics that impact cognitive, functional, and behavioral decline.",aged;cognitive defect;complication;daily life activity;dementia;female;human;male;mental disease;pathophysiology;psychology;risk factor;socioeconomics;time factor,"Jutkowitz, E.;MacLehose, R. F.;Gaugler, J. E.;Dowd, B.;Kuntz, K. M.;Kane, R. L.",2017,,10.1093/gerona/glw079,0,
2126,FRAIL-NH predicts outcomes in long term care,"Background/Objectives: To investigate the predictive validity of the short, simple FRAIL-NH frailty screening tool in the long term care population and to then compare the predictive validity with the frailty index (FI) for 6-month adverse health outcomes. Design: Retrospective study using the Minimum Data Set (MDS) 3.0 and chart review from June-December 2014. Setting: Two Long Term Care Facilities in Saint Louis, MO. Participants: 270 patients ages ≥ 65 years old residing in long term care. Measurements: Frailty was measured using the FRAIL-NH and Frailty Index (FI) criteria. Adverse outcomes measured at 6-month follow-up included falls, hospitalizations, and hospice enrollment/mortality. Results: Based on screening tool used frailty prevalence was 48.7% for FRAIL-NH and 30.3% for FI. The FRAIL-NH pre-frail (Adjusted Odds Ratio [AOR]=2.62; 95% Confidence Interval [CI]=1.25–5.54; p=0.11) classification was associated with 6 month risk of falling and mortality/hospice enrollment was associated with the frail classification, AOR=3.96 (1.44–10.87, p=0.007). Combining the pre-frail and frail categories both measures predicted 6 month mortality with the FRAIL-NH being the strongest predictor (AOR=3.36; 95%CI=1.26–8.98; p=0.016) and the FI was a more modest predictor with an AOR of 2.28; 95%CI=1.01–5.15; p=0.047. When directly comparing the FRAIL-NH to the FI, the FRAIL-NH pre-frail were at increased risk of falling, AOR=2.42 (1.11–5.92, p=0.027) and the FRAIL-NH frail were at increased risk of hospice enrollment/death, OR=3.25 (1.04–10.86) p=0.044. Conclusion: In comparison to the FI, the FRAIL-NH preformed just as well at screening for frailty and was a slightly better predictor of adverse outcomes. The FRAIL-NH is a brief, easy-to-administer frailty screening tool appropriate for long term care patients and predicts increased risk of falls in the pre-frail and mortality/hospice enrollment in the frail.",aged;Alzheimer disease;article;cognition;congestive heart failure;dementia;diabetes mellitus;falling;fatigue;female;frail elderly;hospice care;hospitalization;human;incontinence;long term care;major clinical study;male;medical record review;mobilization;predictive validity;priority journal;psychosis;very elderly,"Kaehr, E. W.;Pape, L. C.;Malmstrom, T. K.;Morley, J. E.",2016,,,0,
2127,Use of transdermal drug formulations in the elderly,"Transdermal drug delivery systems are pharmaceutical forms designed to administer a drug through the skin to obtain a systemic effect. They ensure a constant rate of drug administration and a prolonged action. Several different types of transdermal delivery devices are available on the market. They are either matrix or reservoir systems and their main current uses are to treat neurological disorders, pain and coronary artery disease, and as hormone replacement therapy. Transdermal drug administration has a number of advantages compared with the oral route: it avoids gastrointestinal absorption and hepatic first-pass metabolism, minimizes adverse effects arising from peak plasma drug concentrations and improves patient compliance. Compared with the parenteral route, transdermal administration entails no risk of infection. For elderly people, who are often polymedicated, transdermal drug delivery can be a good alternative route of administration. Transdermal absorption depends on passive diffusion through the different layers of the skin. As skin undergoes many structural and functional changes with increasing age, it would be useful to know whether these alterations affect the transdermal diffusion of drugs. Studies have shown that age-related changes in hydration and lipidic structure result in an increased barrier function of the stratum corneum only for relatively hydrophilic compounds. In practice, no significant differences in absorption of drugs from transdermal delivery systems have been demonstrated between young and old individuals. The need for dose adaptation in elderly patients using transdermal drug delivery systems is therefore not related to differences in skin absorption but rather to age-related cardiovascular, cerebral, hepatic and/or renal compromise, and to ensuing geriatric pharmacokinetic and pharmacodynamic changes. © 2008 Adis Data Information BV. All rights reserved.",apomorphine;buprenorphine;dopamine receptor stimulating agent;estradiol;estrogen derivative;fentanyl;glyceryl trinitrate;insulin;levodopa;lisuride;morphine;nicotine;opiate;organic nitrate;oxybutynin;physostigmine;placebo;progesterone;rivastigmine;rotigotine;selegiline;tacrine;testosterone;adjuvant therapy;aging;Alzheimer disease;andropause related disorder;angina pectoris;anticholinergic effect;application site reaction;chronic pain;clinical trial;coronary artery disease;dementia;diabetes mellitus;dose response;drug dosage form comparison;drug dose increase;drug formulation;drug mechanism;drug megadose;drug metabolism;drug release;elderly care;human;hydration;hypertension;liver toxicity;low drug dose;major depression;nausea;note;overactive bladder;Parkinson disease;priority journal;side effect;skin function;skin penetration;skin structure;somnolence;transdermal drug administration;transdermal patch;treatment indication;unspecified side effect,"Kaestli, L. Z.;Wasilewski-Rasca, A. F.;Bonnabry, P.;Vogt-Ferrier, N.",2008,,,0,
2128,Midlife stroke risk and cognitive decline: A 10-year follow-up of the Whitehall II cohort study,"Background: Stroke is associated with an increased risk of dementia. However, it is unclear whether risk of stroke in those free of stroke, particularly in nonelderly populations, leads to differential rates of cognitive decline. Our aim was to assess whether risk of stroke in mid life is associated with cognitive decline over 10 years of follow-up. Methods: We studied 4153 men and 1657 women (mean age, 55.6 years at baseline) from the Whitehall II study, a longitudinal British cohort study. We used the Framingham Stroke Risk Profile (FSRP), which incorporates age, sex, systolic blood pressure, diabetes mellitus, smoking, prior cardiovascular disease, atrial fibrillation, left ventricular hypertrophy, and use of antihypertensive medication. Cognitive tests included reasoning, memory, verbal fluency, and vocabulary assessed three times over 10 years. Longitudinal associations between FSRP and its components were tested using mixed-effects models, and rates of cognitive change over 10 years were estimated. Results: Higher stroke risk was associated with faster decline in verbal fluency, vocabulary, and global cognition. For example, for global cognition there was a greater decline in the highest FSRP quartile (-0.25 of a standard deviation; 95% confidence interval: -0.28 to -0.21) compared with the lowest risk quartile (P =.03). No association was observed for memory and reasoning. Of the individual components of FSRP, only diabetes mellitus was associated independently with faster cognitive decline (β = -0.06; 95% confidence interval, -0.01 to 0.003; P =.03). Conclusion: Elevated stroke risk at midlife is associated with accelerated cognitive decline over 10 years. Aggregation of risk factors may be especially important in this association. © 2013 The Alzheimer¢s Association. All rights reserved.",antihypertensive agent;adult;article;cardiovascular disease;cerebrovascular accident;cognition;cognitive defect;diabetes mellitus;female;follow up;atrial fibrillation;heart left ventricle hypertrophy;human;major clinical study;male;memory;priority journal;risk factor;smoking;systolic blood pressure,"Kaffashian, S.;Dugravot, A.;Brunner, E. J.;Sabia, S.;Ankri, J.;Kivimäki, M.;Singh-Manoux, A.",2013,,,0,
2129,Methodological challenges in assessing the impact of comorbidities on costs in Alzheimer’s disease clinical trials,"Background: Alzheimer’s disease (AD) is associated with considerable costs and has a significant impact on health and social care systems. Objective: This study assessed whether baseline comorbidities present in 2,594 patients with AD participating in two semagacestat randomized placebo-controlled trials (RCTs) would significantly impact overall costs. Methods: Resource utilization was captured using the Resource Utilization in Dementia Scale-Lite. Comorbidities and concomitant medications were tabulated via patient and caregiver reports. Only baseline data were analyzed. Direct and indirect costs per month were calculated per patient. The relationship between cost and explanatory variables was explored in a regression model. Results: The baseline monthly cost of care in this RCT population was £1,147 ± 2,483, with informal care costs accounting for 75 % of costs. Gender, age, and functional status were significant predictors of costs (p ≤ 0.0001). The cost ratio was not impacted when the number of comorbidities was added to the model (cost ratio = 0.95; 95 % CI 0.91–0.99) or when combined with the number of concomitant medications (cost ratio = 0.97; 95 % CI 0.95–1.00). Inconsistent findings related to the impact of individual comorbidities on costs were noted in sensitivity analyses. Conclusions: The number of comorbidities, alone or when combined with concomitant medications, did not impact baseline costs of care, perhaps because RCTs often enroll less severely ill and more medically stable patients. However, higher costs were consistently associated with greater functional impairment similar to non-RCT databases. Supplemental sources (e.g., claims databases) are likely needed to better estimate the effects of disease and treatment on costs of illness captured in RCTs for AD.",NCT0054568;angiotensin II antagonist;antidepressant agent;beta adrenergic receptor blocking agent;biguanide derivative;corticosteroid;cyanocobalamin;dihydropyridine derivative;dipeptidyl carboxypeptidase inhibitor;donepezil;galantamine;hydroxymethylglutaryl coenzyme A reductase inhibitor;memantine;placebo;potassium sparing diuretic agent;rivastigmine;semagacestat;thiazide diuretic agent;thyroid hormone;age distribution;aged;Alzheimer disease;article;assessment of humans;cerebrovascular accident;chronic obstructive lung disease;comorbidity;depression;diabetes mellitus;epilepsy;female;functional status;health care cost;health care utilization;heart muscle ischemia;human;hyperlipidemia;hypertension;major clinical study;male;neoplasm;observational study;priority journal;randomized controlled trial (topic);Resource Utilization in Dementia Scale Lite;retrospective study;sex difference;urinary tract infection,"Kahle-Wrobleski, K.;Fillit, H.;Kurlander, J.;Reed, C.;Belger, M.",2015,,,0,
2130,Left ventricular hypertrophy on electrocardiogram: prognostic implications from a 10-year cohort study of older subjects: a report from the Bronx Longitudinal Aging Study,"OBJECTIVE: The objective of this study was to report on the prevalence, incidence and prognosis of left ventricular hypertrophy (LVH) on the electrocardiogram (ECG) in a cohort of ambulatory older men and women. DESIGN: A prospective, longitudinal study of 10 years duration with ECGs obtained at baseline and on an annual basis. SETTING AND PATIENTS: A community-based cohort study consisting of 459 subjects (aged 75-85, mean age 79 years). MEASUREMENTS: Baseline and follow up ECGs were interpreted using the Minnesota Code. Prevalence and incidence of LVH and ECG were determined as well as regression of ECG LVH. Clinical event rates measured were incidence of total mortality, myocardial infarction (MI, fatal and non-fatal), cardiovascular mortality, cardiovascular disease (fatal and non-fatal), stroke (fatal and non-fatal), all-cause dementia, and multi-infarct dementia. Differences in event rates between groups (those subjects with and without LVH) were compared as tests between proportions. A Cox Proportional Hazards Regression Analysis was performed to compare the relative independent predictive values of different competing factors, including age, gender, serum cholesterol, digitalis use, body mass, index, Blessed Dementia Scale, cigarette smoking, LVH at baseline, LVH ar baseline (persisting), new LVH, new LVH (persisting), new LVH (regressed), previous MI by history of ECG, hypertension by history, and cardiomegaly by X-ray (cardiothoracic ratio > or = 50%). RESULTS: At baseline, 9.2% of subjects (n = 42) had LVH on ECG and a mortality rate of 11.7/100 persons years versus 4.9/100 persons years for subjects without baseline LVH (P < .0001), and MI rate of 7.5/100 persons years with LVH versus 2.6/100 persons years without LVH (P < .0001), and a cardiovascular mortality rate of 7.2/100 persons years without LVH versus 2.7/100 person years without LVH. Subjects who developed new LVH on ECG (n = 39) had a mortality rate of 14.4/100 person-years compared with 4.4/100 person-years for those without LVH (P < .0001), a cardiovascular mortality rate of 11.1/100 person years versus 2.0/100 person years without LVH (P < .0001), and an MI rate of 6.1/100 person years versus 2.0/100 person years without LVH (P < .01). Subjects in whom the ECG LVH pattern disappeared over time had fewer cardiovascular mortal and morbid events than those with persistent LVH. According to the regression analyses, persistent LVH from baseline was an independent predictor of MI, overall cardiovascular disease, and total mortality. Newly developing LVH with subsequent regression was an independent predictor of overall cardiovascular disease and death. CONCLUSIONS: An increased prevalence and incidence of LVH on ECG, irrespective cause, is associated with a poor prognosis in very old men and women. Regression of ECG LVH in older people, irrespective of cause, may confer improvement in risk for cardiovascular disease.","Aged;Aged, 80 and over;*Aging;Cardiovascular Diseases/epidemiology/mortality;*Electrocardiography;Female;Humans;Hypertrophy, Left Ventricular/diagnosis/*epidemiology;Incidence;Longitudinal Studies;Male;Predictive Value of Tests;Prevalence;Prognosis;Regression Analysis","Kahn, S.;Frishman, W. H.;Weissman, S.;Ooi, W. L.;Aronson, M.",1996,May,,1,
2131,Recovery After Open and Laparoscopic Right Hemicolectomy: A Comparison,"Background: Enhanced Recovery after Surgery (ERAS) programs have gained popularity with potential to accelerate recovery and reduce morbidity after colectomy. We were interested in comparing recovery after open right colectomy within an ERAS program compared with laparoscopic right colectomy in a standard care perioperative environment. Methods: Between October 2005 and June 2009, prospective data were collected on consecutive patients undergoing elective open right colectomy within an established ERAS setting (OpERAS). Similarly, between March 2008 and June 2009, data were collected on consecutive patients undergoing laparoscopic right hemicolectomy with conventional care (LapCon). Exclusion criteria for both groups were: ASA ≥ 4, formation of a stoma, and dementia or mental illness rendering the patient unable to comply with instructions. Perioperative variables were collected. The surgical recovery score (SRS) was used as a validated means to measure convalescence on d 1, 3, 7, 30, and 60 postoperatively. Results: There were 74 patients in the OpERAS and 39 patients in the LapCon groups. At baseline, there were no significant demographic differences except that more patients had malignancy in OpERAS group. Mean operating time was longer in the LapCon group. Median day stay was 4 (3-28) in OpERAS and 5 (2-18) in LapCon (P = 0.032). There was no statistical difference in the incidence of complications or the severity of complications. There were no significant differences in SRS after surgery at any time point. Conclusion: When perioperative care is optimized, recovery after elective open right hemicolectomy is comparable with laparoscopic resection. Studies looking at the combination of laparoscopy and ERAS are warranted. © 2010 Elsevier Inc.",adult;aged;anastomosis leakage;article;cardiopulmonary insufficiency;clinical trial;constipation;controlled clinical trial;controlled study;convalescence;deep vein thrombosis;dementia;demography;disease severity;elective surgery;female;hemicolectomy;human;ileus;intermethod comparison;laparoscopic right hemicolectomy;length of stay;major clinical study;male;mental disease;open right hemicolectomy;operation duration;perioperative period;postoperative complication;postoperative vomiting;priority journal;prospective study;scoring system;stoma;surgical infection;surgical recovery score;urinary tract infection;urine retention;validation process,"Kahokehr, A.;Sammour, T.;Zargar-Shoshtari, K.;Srinivasa, S.;Hill, A. G.",2010,,,0,
2132,Left ventricular hypertrophy and blood pressure as predictors of cognitive decline in old age,"BACKGROUND AND AIMS: The relationships between blood pressure (BP) and cognition are complex and are still partly unclear. The impact of history of hypertension, present BP levels, and left ventricular hypertrophy (LVH) on cognition was investigated in a 10-year follow-up study of an aged population. METHODS: The population-based sample consisted of 75-, 80- and 85-year-old individuals at baseline (N=650). Their history of hypertension was investigated, and present BP values were recorded several times. Echocardiographic examinations were performed twice at 3-year intervals, and electrocardiography (ECG) at entry. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) at baseline and at 10 years, and by the Clinical Dementia Rating (CDR) at baseline, at 1, 5 and 10 years. RESULTS: At baseline, elderly individuals with impaired cognition or dementia had lower BP, but thicker left ventricle posterior wall (LVPW), greater cardiac mass, and more often signs of LVH in ECG than those without cognitive deficits. Echocardiographic LVH, but not BP, predicted cognitive decline in a 5-year follow-up. Patients who died demented within 5 years were characterized by low BP and thin LVPW. Baseline BP and echocardiographic variables were not significantly different between those who had and had not cognitive decline at 10 years, but declining BP tended to precede cognitive deficits. CONCLUSIONS: Results indicate that, the closer cognitive decline, the lower the BP, and suggest that, although LVH is a risk factor of cognitive decline, it loses its predictive value in old age.","Aged;Aged, 80 and over;Aging/physiology/psychology;Blood Pressure/*physiology;Cognition Disorders/diagnosis/*etiology;Data Interpretation, Statistical;Dementia/diagnosis/etiology/physiopathology;Echocardiography;Echocardiography, Doppler, Color;Electrocardiography;Female;Finland;Follow-Up Studies;Heart/anatomy & histology;Heart Ventricles/pathology/physiopathology;Humans;Hypertension/*complications/physiopathology;Hypertrophy, Left Ventricular/etiology/*pathology;Male;Mental Status Schedule;Organ Size;Prognosis;Prospective Studies","Kahonen-Vare, M.;Brunni-Hakala, S.;Lindroos, M.;Pitkala, K.;Strandberg, T.;Tilvis, R.",2004,Apr,,0,
2133,Preoperative complications and intraoperative hemodynamic changes in very old patients with femoral neck fractures,"We compared preoperative complications and intraoperative hemodynamic changes in very old patients, 85 years or older, and those with elderly patients aged 70-84 for hip fracture repair. Spinal anesthesia with 0.25 or 0.5% of bupivacaine was performed except for the patients with dementia and/or deformity of the spinal column. The incidence of cardiac disease and anemia was higher in very old patients than in elder patients, and its odds ratios were 2.29 and 3.10, respectively. There is no difference in intraoperative hemodynamic changes between the two groups. Two patients of very old groups had severe intraoperative complications, heart failure and grave arrythmia, but other patients underwent the operation without severe complication. In conclusion, even in very old patients with hip fracture, spinal anesthesia was performed safely unless patients had serious diseases preoperatively.",aged;anemia;article;controlled study;dementia;elderly care;femur neck fracture;heart disease;hemodynamics;hip fracture;human;peroperative care;postoperative complication;preoperative period;spinal anesthesia;spine malformation,"Kajikawa, S.;Suzuki, M.;Yokoi, M.",2000,,,0,
2134,Cholinoceptive and cholinergic properties of cardiomyocytes involving an amplification mechanism for vagal efferent effects in sparsely innervated ventricular myocardium,"Our recent studies have shown that, as indicated by vagal stimulation, an acetylcholinesterase inhibitor donepezil, an anti-Alzheimer's disease drug, prevents progression of heart failure in rats with myocardial infarction, and activates a common cell survival signal shared by acetylcholine (ACh) in vitro. On the basis of this and evidence that vagal innervation is extremely poor in the left ventricle, we assessed the hypothesis that ACh is produced by cardiomyocytes, which promotes its synthesis via a positive feedback mechanism. Rat cardiomyocytes expressed choline acetyltransferase (ChAT) in the cytoplasm and vesicular acetylcholine transporter with the vesicular structure identified by immunogold electron microscopy, suggesting that cardiomyocytes possess components for ACh synthesis. Intracellular ACh in rat cardiomyocytes was identified with physostigmine or donepezil. However, with atropine, the basal ACh content was reduced. In response to exogenous ACh or pilocarpine, cardiomyocytes increased the transcriptional activity of the ChAT gene through a muscarinic receptor and ChAT protein expression, and, finally, the intracellular ACh level was upregulated by pilocarpine. Knockdown of ChAT by small interfering RNA accelerated cellular energy metabolism, which is suppressed by ACh. Although physostigmine had a minimal effect on the ChAT promoter activity by inhibiting acetylcholinesterase, donepezil resulted in elevation of the activity, protein expression and intracellular ACh level even in the presence of sufficient physostigmine. Orally administered donepezil in mice increased the ChAT promoter activity in a reporter gene-transferred quadriceps femoris muscle and the amount of cardiac ChAT protein. These findings suggest that cardiomyocytes possess an ACh synthesis system, which is positively modulated by cholinergic stimuli. Such an amplification system in cardiomyocytes may contribute to the beneficial effects of vagal stimulation on the ventricles.","Acetylcholine/analysis/biosynthesis;Animals;Cells, Cultured;Choline O-Acetyltransferase/analysis;Heart Ventricles;Humans;Indans/pharmacology;Mice;Muscarinic Agonists/pharmacology;Myocytes, Cardiac/*metabolism;Piperidines/pharmacology;RNA, Small Interfering/pharmacology;Rats;Vagus Nerve/*physiology;Vesicular Acetylcholine Transport Proteins/analysis","Kakinuma, Y.;Akiyama, T.;Sato, T.",2009,Sep,10.1111/j.1742-4658.2009.07208.x,0,
2135,Vascular basis for brain degeneration: Faltering controls and risk factors for dementia,"The integrity of the vascular system is essential for the efficient functioning of the brain. Aging-related structural and functional disturbances in the macro- or microcirculation of the brain make it vulnerable to cognitive dysfunction, leading to brain degeneration and dementing illness. Several faltering controls, including impairment in autoregulation, neurovascular coupling, blood-brain barrier leakage, decreased cerebrospinal fluid, and reduced vascular tone, appear to be responsible for varying degrees of neurodegeneration in old age. There is ample evidence to indicate vascular risk factors are also linked to neurodegenerative processes preceding cognitive decline and dementia. The strongest risk factor for brain degeneration, whether it results from vascular or neurodegenerative mechanisms or both, is age. However, several modifiable risks such as cardiovascular disease, hypertension, dyslipidemia, diabetes, and obesity enhance the rate of cognitive decline and increase the risk of Alzheimer's disease in particular. The ultimate accumulation of brain pathological lesions may be modified by genetic influences, such as the apolipoprotein E ε4 allele and the environment. Lifestyle measures that maintain or improve cardiovascular health, including consumption of healthy diets, moderate use of alcohol, and implementation of regular physical exercise are important factors for brain protection. © 2010 International Life Sciences Institute.",apolipoprotein E4;gamma glutamyltransferase;glial fibrillary acidic protein;glucose transporter 1;aging;Alzheimer disease;article;atherosclerosis;autoregulation;blood brain barrier;brain degeneration;brain infarction;brain perfusion;cerebrospinal fluid;smoking;cognition;cognitive defect;dementia;diabetes mellitus;disease course;Down syndrome;dyslipidemia;head injury;human;hypertension;lifestyle modification;metabolic syndrome X;microvasculature;obesity;physical activity;risk factor;sex difference;silent myocardial infarction;sitting;cerebrovascular accident;vascular disease;white matter,"Kalaria, R. N.",2010,,,0,
2136,Risk factors and neurodegenerative mechanisms in stroke related dementia,"Considerable evidence indicates that systemic vascular diseas-es are associated with neurodegenerative processes preceding cognitive decline and dementia. Conditions such as hyperten-sion, diabetes, atrial fibrillation, ischemic heart disease, dysli-pidaemia and obesity have propensity to induce strokes, which increase risk of dementia up to five-fold in the elderly. The link between vascular diseases and clinical Alzheimer's disease (AD) also exists but pathological confirmation has often been lacking. However, more than 30% of stroke survivors will de-velop dementia within two years. Transient ischaemic attacks and silent infarcts may unmask neurodegenerative processes characterized by primary pathologies such as those found in AD. Cerebral infarction and neurodegenerative pathologies are additive and accelerate dementia. Medial temporal atro-phy is a strong predictor of dementia and also appears a fea-ture in demented stroke survivors with minimal AD pathol-ogy. The atrophy is attributed to selective smaller cell volumes in the hippocampus and likely frontal lobe that may reflect loss of neuronal arborization and connectivity. Therapeutic strategies that maintain or restore functional morphology in surviving neurons could prevent further cognitive decline in post stroke and ageing related dementias.",age;aged;Alzheimer disease;article;brain infarction;brain mapping;cerebrovascular accident;cognition;cognitive defect;degenerative disease;dementia;female;hippocampus;human;male;metabolism;methodology;middle aged;pathology;risk factor;transient ischemic attack,"Kalaria, R. N.",2012,,,0,
2137,Anti-phosphatidylethanolamine antibodies in patients with Sneddon's syndrome,"Anti-phosphatidylethanolamine antibodies (aPE) belong to the group of anti-phospholipid antibodies (aPL) and are directed against neutral phospholipid, connected with co-factor protein, while cardiolipin antibodies (aKL) are directed against negative phospholipid. The paper presents a study of prevalence and clinical significance of IgG aPE in 28 patients (22 women and 6 men, mean age 47.6 +/- 11.6 years) with Sneddon's syndrome (SS), which consists in cerebrovascular disturbances and extensive livedo reticularis. IgG aPE were detected by immune-enzyme assay. The upper normal limit, calculated as mean + 3SD after studying 19 healthy donors, was 0.303 optic density units. aPE were found in 15 (54%), aKL and/or lupus anticoagulant (LA)--in 6 (21%) patients with SS. aPE were found in 10 (46%) out of 22 aKL- and LA-negative patients. Among the aPE-positive patients there was a higher incidence of cortic dementia (53% vs. 8%, p = 0.02), the widening of cortical sulci, detected by means of computed tomography and magnetic resonance imaging (73% vs. 31%, p = 0.05), and mild renal syndrome (73% vs. 16%, p = 0.03). Besides, they displayed a higher rate of headaches (87% vs. 62%), chorea (33% vs. 8%), epilepsy (27% vs. 8%), non-carrying of pregnancy (91% vs. 50%), peripheral venous thrombosis (27% vs. 15%), coronary heart disease (47% vs. 31%), cardiac valvular thickening, detected by means of EchoCG (93% vs. 69%), arterial hypertension (87% vs. 54%), thrombocytopenia (20% vs. 0), anemia (40% vs. 15%); however, the difference was not significant. The results show that aPE detection, performed in addition to detection of classic immunological antiphospholipid syndrome markers (aKL and LA), increases the portion of aPE-positive patients with SS by 33%. aPE are often (in 46% of cases) found in aKL- and LA-negative patients with SS. aPE is likely to be the most significant factor of thrombosis in small arteries of the brain cortex and kidneys, which could explain their association with dementia and renal syndrome.","Adult;Antibodies, Antiphospholipid/blood/*immunology;Biomarkers/blood;Brain/pathology/radiography;Female;Humans;Magnetic Resonance Imaging;Male;Middle Aged;Phosphatidylethanolamines/*immunology;Pregnancy;Risk Factors;Sneddon Syndrome/blood/diagnosis/*immunology;Tomography, X-Ray Computed","Kalashnikova, L. A.;Aleksandrova, E. N.;Novikov, A. A.;Dobrynina, L. A.;Nasonov, E. L.;Sergeeva, E. V.;Berkovskii, A. L.",2005,,,0,
2138,Clotting factor VIII in Sneddon syndrome,"Hyperactivity of coagulation factor VIII (fVIII) marks hypercoagulation. FVIII enhances activity of factor IX and their combination activates factor X, which is of primary importance in prothrombin transformation into thrombin, on the phospholipid membrane. The activity of fVIII was studied in 28 patients (26 women, 2 men, mean age 49.6 +/- 7.8 years) with Sneddon's syndrome (SS). SS manifests clinically similarly to primary antiphospholipid syndrome (PAS). The leading of them are ischemic disorders of cerebral circulation (IDCC) and advanced livedo present in all the examinees. Hyperactivity of fVIII was registered in 21 (75%) of 28 patients. Most of thrombosis-related symptoms occurred more frequently in patients with high than normal activity of fVIII: ischemic strokes (91% vs 57%, p > 0.05), repeated strokes (71% vs 0%, p = 0.0014), transient IDCC (76% vs 57%, p > 0.05), vascular dementia (43% vs 0%, p > 0.05), ischemic heart disease (43% vs 0%, p > 0.05), thickening of heart valves according to echocardiography (91% vs 57%, p > 0.05), peripheral venous thromboses (24% vs 0%, p > 0.05). In high fVIII activity cardiolipin antibodies occurred more rarely (24% vs 43%, p > 0.05) but lupus anticoagulant was seen more often (47% vs 14%, p > 0.05). High fVIII activity was in 8 of 12 aPL-negative patients. It is demonstrated that elevated fVIII activity is an essential mechanism of thrombosis development in SS. The cause of this enhanced activity is suggested to be special aPL in interaction with which fVIII becomes insensitive to inactivation with protein C. The activity of protein C was normal in all the cases.",blood clotting factor 8;phospholipid antibody;adult;article;biosynthesis;blood;female;human;male;metabolism;middle aged;Sneddon syndrome,"Kalashnikova, L. A.;Berkovskii, A. L.;Dobrynina, L. A.;Sergeeva, E. V.;Kozlov, A. A.;Aleksandrova, E. N.;Nasonov, E. L.",2003,,,0,
2139,Risk factors for subcortical arteriosclerotic encephalopathy,"Subcortical arteriosclerotic encephalopathy (SAE) is a chronic progressive form of brain blood supply deficiency. Risk factors for SAE development were studied in 65 patients (42 men and 23 women, mean age 60.5 +/- 7.5 years). A control group included 31 patients (17 men and 14 women, mean age 59.3 +/- 7.4 years) with isolated clinically meaningful lacunar infarcts. A main risk factor for SAE was arterial hypertension (AH) emerging in 98.5% of the patients, which, according to twenty-four hour monitoring, differed significantly from that in the patients with isolated lacunar infarcts. In SAE, diastolic pressure was higher, systolic AP variability was detected more frequent, physiological AP decreased rarely in the nighttime, but AP fell down extremely more often. A frequency of other risk factors (ischemic disease, atrial fibrillation, diabetes mellitus, smoking, elevation of hematocrit, fibrinogen and platelet aggregation) did not differ significantly comparing to isolated lacunar infarcts. Hypercholesterolemia was detected more frequently in the controls than in the SAE patients. The study revealed that AP with hemodynamic features, pathogenetically crucial for development of disseminated arteriolosclerosis in small brain arteries and arterioles as well as for diffuse white matter damage in brain hemispheres characteristic for SAE, is a main risk factor for SAE.",article;diabetes mellitus;female;heart muscle ischemia;human;hypercholesterolemia;hypertension;male;middle aged;multiinfarct dementia;risk factor;smoking,"Kalashnikova, L. A.;Kulov, B. B.",2002,,,0,
2140,Moderate alcohol consumption may improve mental capacity in elderly,The studies on the effect of moderate alcohol consumption on mental capacity in elderly and inflammatory markers in coronary heart disease are reviewed. © 2007 Neuroendocrinology Letters.,alcohol;alcohol consumption;cardiovascular system;dementia;disease marker;drinking behavior;follow up;geriatric patient;human;inflammation;ischemic heart disease;mental capacity;mental deterioration;mental function;mental performance;psychomotor performance;red wine;short survey,"Kalavsky, E.",2007,,,0,
2141,"Cerebrovascular disease, the apolipoprotein e4 allele, and cognitive decline in a community-based study of elderly men","Background and Purpose: Cerebrovascular disease and the apolipoprotein e4 (APOE*4) allele are both important risk factors for cognitive decline. We investigated the combined effect of APOE*4 and cerebrovascular disease on cognitive decline. Methods: Data are from a cohort of 353 men, aged 69 to 89 years at baseline, living in Zutphen, Netherlands. The 30-point Mini-Menial State Examination (MMSE) was used to measure cognitive decline (drop of >2 points) from 1990 to 1993 (14% of the sample). Odds ratios (OR [95% confidence interval]) for cognitive decline were adjusted for age, education, and baseline MMSE score. Results: Compared with those without APOE*4 and without a history of cerebrovascular disease, the adjusted OR was 4.7 (1.7 to 12.7) for subjects without APOE*4 but with cerebrovascular disease, 3.3 (1.6 to 6.8) for those with APOE*4 and no cerebrovascular disease, and 17.2 (2.7 to 110.0) for those with both risk factors. The risk for cerebrovascular disease and APOE*4 combined was more than expected from the separate effects. The combined risk of coronary heart disease and APOE*4 was 6.1 (1.7 to 22.3). The analysis of cardiovascular risk factors showed that the risk of cognitive decline was highest in subjects with both APOE*4 and a high cholesterol level, high fibrinogen level, normal blood pressure, or diabetes mellitus. Conclusions: Cerebrovascular disease and APOE*4 may have a synergistic effect on cognitive decline.",apolipoprotein E4;aged;article;cerebrovascular disease;cognitive defect;human;ischemic heart disease;longitudinal study;major clinical study;male;mental test;priority journal;risk factor,"Kalmijn, S.;Feskens, E. J. M.;Launer, L. J.;Kromhout, D.",1996,,,0,
2142,Metabolic cardiovascular syndrome and risk of dementia in Japanese-American elderly men: The Honolulu-Asia aging study,"Cardiovascular risk factors often cluster into a metabolic syndrome that may increase the risk of dementia. The objective of the present study was to assess the long-term association between clustered metabolic cardiovascular risk factors measured at middle age and the risk of dementia in old age. This prospective cohort study of cardiovascular disease was started in 1965 and was extended to a study of dementia in 1991. The subjects were Japanese-American men with an average age of 52.7±4.7 (mean±SD) years at baseline. Dementia was diagnosed in 215 men, according to international criteria, and was based on a clinical examination, neuropsychological testing, and an informant interview. The z scores were calculated for 7 risk factors (random postload glucose, diastolic and systolic blood pressures, body mass index, subscapular skinfold thickness, random triglycerides, and total cholesterol). The relative risk (RR [95% CI]) of dementia (subtypes) per 1 SD increase in the sum of the z scores was assessed after adjustment for age, education, occupation, alcohol consumption, cigarette smoking, and years of childhood lived in Japan. The z-score sum was higher in demented subjects than in nondemented subjects, indicating a higher risk factor burden (0.74 versus -0.06, respectively; P=0.008). Per SD increase in the z-score sum, the risk of dementia was increased by 5% (RR 1.05, 95% CI 1.02 to 1.09). The z-score sum was specifically associated with vascular dementia (RR 1.11, 95% CI 1.05 to 1.18) but not with Alzheimer's disease (RR 1.00, 95% CI. 0.94 to 1.05). Clustering of metabolic cardiovascular risk factors increases the risk of dementia (mainly, dementia of vascular origin).",cholesterol;triacylglycerol;adult;aged;aging;Alzheimer disease;article;Asian American;blood pressure monitoring;body mass;cardiovascular disease;dementia;human;insulin resistance;Japan;major clinical study;male;multiinfarct dementia;priority journal;risk factor;skinfold thickness;syndrome X,"Kalmijn, S.;Foley, D.;White, L.;Burchfiel, C. M.;Curb, J. D.;Petrovitch, H.;Ross, G. W.;Havlik, R. J.;Launer, L. J.",2000,,,0,
2143,Total homocysteine and cognitive decline in a community-based sample of elderly subjects: The Rotterdam study,"Homocysteine has been associated with an increased risk of cardiovascular disease. Cardiovascular diseases have been related to cognitive decline. The authors investigated the association of homocysteine with concurrent cognitive impairment and subsequent cognitive decline in a random sample of 702 community-dwelling respondents aged 55 years or over to the prospective Rotterdam Study in 1990-1994. Multiple logistic regression was used to calculate odds ratios and 95 percent confidence intervals for the association between total homocysteine levels and cognitive impairment (Mini- Mental State Examination (MMSE) score <26) and cognitive decline (drop in MMSE score of >1 point/year). Mean duration of follow-up was 2.7 years. After adjustment for age, sex, and education, there was no relation between total homocysteine and cognitive impairment (highest vs. lowest tertile: odds ratio (OR) = 1.30, 95% confidence interval (CI): 0.50, 3.38) or cognitive decline (middle vs. lowest tertile: OR = 1.14, 95% CI: 0.67, 1.93; highest vs. lowest tertile: OR = 0.91, 95% CI: 0.52, 1.58). Subjects who were lost to follow-up due to death or nonresponse had slightly higher age-adjusted homocysteine levels and lower MMSE scores at baseline. Sensitivity analyses showed that selective loss to follow-up was not a likely explanation for the absence of an association in the participants. Although a relation between homocysteine and reduced cognitive function is biologically plausible, this study suggests no such association in a community-based sample of the elderly.",homocystine;adult;aged;aging;aptitude test;article;atherosclerosis;blood level;cardiovascular risk;clinical trial;cognitive defect;congestive cardiomyopathy;cyanocobalamin deficiency;dementia;disease association;female;folic acid deficiency;follow up;homocystinuria;human;major clinical study;male;Netherlands;neurotoxicity;prevalence;regression analysis;cerebrovascular accident;thrombosis,"Kalmijn, S.;Launer, L. J.;Lindemans, J.;Bots, M. L.;Hofman, A.;Breteler, M. M. B.",1999,,,0,
2144,What i learnt from mom,,aging;Alzheimer disease;bone density;clinical feature;congestive heart failure;disease course;electronic prescribing;falling;femur fracture;health care system;human;medical record review;patient care;pelvis fracture;priority journal;short survey;cerebrovascular accident,"Kamerow, D.",2010,,,0,
2145,What is a clinical geneticist? Insights and an audit from first year training,,BRCA2 protein;glucocorticoid receptor;agenesis;agyria;Aicardi syndrome;alkaptonuria;alpha 1 antitrypsin deficiency;alpha thalassemia;Alport syndrome;aphasia;Australia;autism;Beckwith Wiedemann syndrome;bicuspid aortic valve;branchiootorenal syndrome;breast cancer;CADASIL;Caffey disease;cat cry syndrome;caudal regression syndrome;centronuclear myopathy;cerebellum hypoplasia;cerebral palsy;chondrodysplasia punctata;chromosome aberration;cleft palate;clinical geneticist;colorectal cancer;congenital adrenal hyperplasia;congestive cardiomyopathy;consanguinity;consultation;corpus callosum;craniofacial synostosis;cystic fibrosis;desmoid tumor;developmental disorder;Down syndrome;dysplasia;ectodermal dysplasia;Ehlers Danlos syndrome;embryopathy;face dysmorphia;Fallot tetralogy;familial Mediterranean fever;family history;fetal alcohol syndrome;fragile X syndrome;gene deletion;gene mutation;gene translocation;genetic counseling;genetic disorder;genetic screening;Goldenhar syndrome;hearing impairment;hemangioblastoma;hemophilia A;hereditary motor sensory neuropathy;hereditary nonpolyposis colorectal cancer;human;Huntington chorea;hypertrophic cardiomyopathy;hypertrophy;hypodontia;insulin resistance;joint laxity;Klippel Feil syndrome;Leber hereditary optic neuropathy;letter;limb reduction defect;lipodystrophy;malignant hyperthermia;Marfan syndrome;maternally inherited diabetes and deafness;medical audit;medical expert;microcephaly;microphthalmia;myotonic dystrophy;neurofibromatosis;neuronal migration disorder;neuropathy;Noonan syndrome;nursing;oculocutaneous albinism;Opitz syndrome;ovary cancer;pancytopenia;paraganglioma;periventricular heterotopia;phenylketonuria;pheochromocytoma;pigment epithelium;polyposis;prenatal diagnosis;priority journal;psychology;pulmonary hypertension;retinoblastoma;Rett syndrome;Rubinstein syndrome;seizure;septooptic dysplasia;short stature;Silver Russell syndrome;Sotos syndrome;syndrome CHARGE;syndrome VATER;Tay Sachs disease;testis cancer;Thomsen disease;training;trisomy 8;tuberous sclerosis;Turner syndrome;von Hippel Lindau disease;Williams Beuren syndrome;X linked mental retardation,"Kamien, B.",2010,,,0,
2146,Immediate causes of death of demented and non-demented elderly,"OBJECTIVE: To investigate the immediate causes of death, in autopsied demented and non-demented elderly. DESIGN: Retrospective clinicopathologic correlations. SETTING: Acute and intermediate care geriatric hospital. PARTICIPANTS: 342 hospitalized demented and non-demented elderly (mean age 84.94 +/- 6.9 years) who underwent consecutive postmortem examinations: 120 demented patients with either vascular dementia (VaD, n = 34), mixed dementia (MD, n = 65) or Alzheimer's disease (AD, n=21) neuropathologically confirmed and 222 nondemented elderly. RESULTS: Primary causes of death were similar in both demented and non-demented patients; the commonest were cardiovascular disease and bronchopneumonia. Cardiac causes of death and especially cardiac failure were more frequent in VaD than in AD or MD (respectively P = 0.027 and 0.005). Dementia was an underlying but never a primary cause of death. CONCLUSIONS: Immediate causes of death are similar in elderly demented and non-demented patients.","Aged;Alzheimer Disease/*complications;Cardiovascular Diseases/mortality;*Cause of Death;Dementia, Vascular/*complications;Female;Humans;Male;Pneumonia/mortality;Retrospective Studies","Kammoun, S.;Gold, G.;Bouras, C.;Giannakopoulos, P.;McGee, W.;Herrmann, F.;Michel, J. P.",2000,,,0,
2147,Pleiotropic effects of angiotensin II receptor signaling in cardiovascular homeostasis and aging,"Most of the pathophysiological actions of angiotensin II (Ang II) are mediated through the Ang II type 1 (AT<inf>1</inf>) receptor, a member of the seven-transmembrane G protein-coupled receptor family. Essentially, AT<inf>1</inf> receptor signaling is beneficial for organismal survival and procreation, because it is crucial for normal organ development, and blood pressure and electrolyte homeostasis. On the other hand, AT<inf>1</inf> receptor signaling has detrimental effects, such as promoting various aging-related diseases that include cardiovascular diseases, diabetes, chronic kidney disease, dementia, osteoporosis, and cancer. Pharmacological or genetic blockade of AT<inf>1</inf> receptor signaling in rodents has been shown to prevent the progression of aging-related phenotypes and promote longevity. In this way, AT<inf>1</inf> receptor signaling exerts antagonistic and pleiotropic effects according to the ages and pathophysiological conditions. Here we review the pleiotropic effects of AT<inf>1</inf> receptor signaling in cardiovascular homeostasis and aging.",angiotensin II;angiotensin receptor;dipeptidyl carboxypeptidase;renin;aging;article;blood pressure;cardiomyopathy;cardiovascular disease;cardiovascular function;chronic kidney disease;dementia;diabetes mellitus;disease association;homeostasis and regulation;human;hypotension;hypovolemia;longevity;neoplasm;organogenesis;osteoporosis;pleiotropy;priority journal;signal processing;signal transduction;survival;vasoconstriction,"Kamo, T.;Akazawa, H.;Komuro, I.",2015,,,0,
2148,Albuminuria predicts early neurological deterioration in patients with acute ischemic stroke,"Background Reduced glomerular filtration rate (GFR) and albuminuria have been independently associated with an increased risk of stroke and unfavorable long-term outcomes. However, the association between GFR, albuminuria, and early neurological deterioration (END) in patients with ischemic stroke has not been well studied to date. We therefore investigated the ability of estimated GFR (eGFR) and albuminuria to predict END in patients with acute ischemic stroke. Methods We retrospectively enrolled 294 patients that were admitted to our stroke center with acute ischemic stroke between January 2011 and September 2012. General blood and urine examinations, including eGFR and urinary albumin/creatinine ratio (UACR) measurements, were performed on admission. Kidney dysfunction was defined by a low eGFR value (< 60 mL/min/1.73 m2) and/or increased albuminuria (≥ 30 mg/g creatinine). END was defined as a ≥ 2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after admission. Results Kidney dysfunction was diagnosed in 200 of the 294 patients (68.0%). END was observed in 60 patients (20.4%). Age, blood glucose level on admission, UACR on admission, and NIHSS score on admission were significantly associated with END, while no relationship between eGFR on admission and END was identified. A multivariable logistic regression analysis showed that END was positively associated with high UACR (≥ 39.6 mg/g creatinine) and a high NIHSS score (≥ 6 points). Conclusions Our data suggest that high UACR on admission may predict END in patients with acute ischemic stroke. Larger prospective studies are required to validate the correlation between albuminuria and END.",albumin;creatinine;glucose;aged;albumin blood level;albuminuria;article;brain ischemia;cardioembolic stroke;controlled study;creatinine urine level;diabetes mellitus;disease association;disease severity;dyslipidemia;estimated glomerular filtration rate;female;glucose blood level;human;hypertension;ischemic heart disease;kidney dysfunction;major clinical study;male;mental deterioration;microalbuminuria;National Institutes of Health Stroke Scale;prediction;priority journal;retrospective study;risk factor;smoking,"Kanamaru, T.;Suda, S.;Muraga, K.;Okubo, S.;Watanabe, Y.;Tsuruoka, S.;Kimura, K.",2017,,10.1016/j.jns.2016.11.007,0,
2149,"A 78-year-old women with rheumatoid arthritis, right hemiparesis, and renal failure","We report a 78-year old woman with 30 years history of rheumatoid arthritis and nephrotic syndrome, who developed right hemiparesis and renal failure recently. The patient was diagnosed as having rheumatoid arthritis in 1965, and had been treated with gold-sol, steroid hormone, and non-steroidal antiinflammatory drugs intermittently. Later on her clinical course was complicated by nephrotic syndrome, however, her renal function was well compensated. Otherwise, she was apparently doing well until October of 1988 when she had an onset of anomic aphasia; she was 73-year-old at that time. She was admitted to our hospital; a cranial CT scan at that time revealed a low density area in the left temporal region, and she was diagnosed as suffering from an atherothrombotic infarction involving the left middle cerebral artery territory. She recovered soon and was discharged for out patient follow up with ticlopidine 100 mg/day. She was doing well until December 15, 1990, when she had an acute onset of nausea, vomiting, and speech disturbance; she was admitted to our hospital for the second time. On admission, she was alert, but she had motor aphasia, right hemiparesis, and dysarthria. A cranial CT scan revealed a low density area in the left temporal region extending into adjacent frontal and parietal areas including the angular gyrus; in addition, leukoaraiosis, cortical atrophy, and ventricular dilatation were noted. She was treated supportively, and she showed improvement in her aphasia, however, moderate weakness remained in her right upper and lower extremities. She was discharged for out patient follow up. She was doing well until May 21, 1993, when she developed difficulty in swallowing and speech. She became unable to take foods orally and she was admitted again on May 31. On admission, she was a febrile and BP was 120/80 mmHg. General physical examination was unremarkable except for pitting edema and multiple contracture of her joints. On neurologic examination, she was alert but appeared to have aphasia and dementia; she could utter only a few simple words, and was able to understand only simple questions. Evaluation of apraxia and agnosia was impossible. Cranial nerves appeared intact. She was unable to walk because of 'weakness' and contracture. No motor paralysis was present, but detailed muscle strength could not be evaluated. She had no rigidity or spasticity, however, Gegenhalten was noted bilaterally. No abnormal involuntary movement was seen. Deep reflexes were diminished generally, and plantar response was extensor on the leat. She was able to recognize painful stimuli. Pertinent laboratory findings were as follows; WBC 9,600/μl, Ht 34.4%, platelet 194,000/μl, ESR 104 mm/hr, TP 5.0 g/dl, albumin 2.7 g/dl, BUN 87 mg/dl, creatinine 3.86 mg/dl, glucose 87 mg/dl, Na 151 mEq/l, K 6.4 mEq/l, Cl 122 mEq/l, creatinine-clearance 5.6 ml/min, urinary protein 379 mg/dl, and granular cast 3+; liver profile was normal. A cranial CT scan was essentially unchanged compared to the previous one taken at the time of her last admission, in that, a low density area in the left temporal lobe, leukoaraiosis, ventricular dilatation, and fronto-temporal atrophy were noted. She was treated by intravenous fluid with improvement in her dehydration, however, her nephrotic syndrome did not improve. Her clinical course was complicated by bilateral pleural effusion and bronchopneumonia mainly in the right lower lobe. Her pleural effusion increased and ascites was also noted on June 17. She developed respiratory distress, and expired on June 28, 1993. The patient was discussed in a neurological CPC, and the chief discussant arrived at the conclusion that the patient had nephrotic syndrome due to renal amyloidosis which was caused by rheumatoid arthritis, secondary amyloidosis involving the heart, gastrointestinal tract and peripheral nerves, and large artery thrombosis involving the left middle cerebral artery territory.",corticosteroid;gold salt;nonsteroid antiinflammatory agent;ticlopidine;aged;article;brain infarction;case report;computer assisted tomography;female;hemiparesis;human;kidney failure;nephrotic syndrome;rheumatoid arthritis,"Kanazawa, A.;Hattori, Y.;Ohmuro, H.;Mori, H.;Shirai, T.;Imai, H.;Mizuo, Y.",1994,,,0,
2150,Apo-Eε4 allele in conjunction with Aβ42 and tau in CSF: Biomarker for Alzheimer's disease,"The objective of this study was to elucidate an association between Apo-Eε4 allele and CSF biomarkers Aβ42 and tau for the diagnosis of Alzheimer's Disease (AD) patients. Aβ42 and tau protein concentrations in CSF were measured by using ELISA assays. The levels of Aβ42 were found to be decreased where as tau levels increased in AD patients. Moreover in AD patients Apo-Eε4 allele carriers have shown low Aβ42 levels (328.86 ± 99.0 pg/ml) compared to Apo-Eε4 allele non-carriers (367.52 ± 57.37 pg/ml), while tau levels were higher in Apo-Eε4 allele carriers (511 ± 44.67 pg/ml) compared to Apo-Eε4 allele non-carriers (503.75 ± 41.08 pg/ml). Combination of Aβ42 and tau resulted in sensitivity of 75.38% and specificity of 94.82% and diagnostic accuracy of 84.30% for AD compared with the controls. Therefore low Aβ42 and elevated tau concentrations in CSF may prove to be a better diagnostic marker for AD along with the Apo-Eε4 allele. © 2011 Bentham Science Publishers Ltd.",amyloid beta protein[1-42];apolipoprotein E4;tau protein;adult;aged;allele;Alzheimer disease;article;cerebrospinal fluid;controlled study;diagnostic accuracy;enzyme linked immunosorbent assay;female;human;major clinical study;male;priority journal;protein blood level;sensitivity and specificity;systolic heart failure,"Kandimalla, R. J. L.;Prabhakar, S.;Binukumar, B. K.;Wani, W. Y.;Gupta, N.;Sharma, D. R.;Sunkaria, A.;Grover, V. K.;Bhardwaj, N.;Jain, K.;Gill, K. D.",2011,,,0,
2151,"Cardiac sarcoidosis: Epidemiology, characteristics, and outcome over 25 years in a nationwide study","Background-This study was designed to assess the epidemiology, characteristics, and outcome of cardiac sarcoidosis (CS) in Finland. Methods and Results-We identified in retrospect all adult (>18 years of age) patients diagnosed with histologically confirmed CS in Finland between 1988 and 2012. A total of 110 patients (71 women) 51±9 years of age (mean±SD) were found and followed up for outcome events to the end of 2013. The annual detection rate of CS increased >20-fold during the 25-year period, reaching 0.31 in 1×105 adults between 2008 and 2012. The 2012 prevalence of CS was 2.2 in 1×105. Nearly two thirds of patients had clinically isolated CS. Altogether, 102 of the 110 patients received immunosuppressive therapy, and 56 received an intracardiac defibrillator. Left ventricular function was impaired (ejection fraction <50%) in 65 patients (59%) at diagnosis and showed no overall change over 12 months of steroid therapy. During follow-up (median, 6.6 years), 10 patients died of a cardiac cause, 11 patients underwent transplantation, and another 11 patients suffered an aborted sudden cardiac death. The Kaplan-Meier estimates for 1-, 5-, and 10-year transplantation-free cardiac survival were 97%, 90%, and 83%, respectively. Heart failure at presentation predicted poor outcome (log-rank P=0.0001) with a 10-year transplantation-free cardiac survival of only 53%. Conclusions-The detection rate of CS has increased markedly in Finland over the last 25 years. With current therapy, the prognosis of CS appears better than generally considered, but patients presenting with heart failure still have poor longterm outcome.",amiodarone;angiotensin receptor antagonist;azathioprine;beta adrenergic receptor blocking agent;corticosteroid;cyclosporin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;fluorodeoxyglucose f 18;infliximab;methotrexate;prednisone;adult;aged;angiocardiography;article;artificial heart pacemaker;atrioventricular conduction;breast cancer;cerebrovascular accident;clinical examination;colon cancer;complete heart block;coronary artery disease;defibrillator;diffuse Lewy body disease;drug withdrawal;echocardiography;event free survival;female;Finland;follow up;heart conduction;heart death;heart ejection fraction;heart failure;heart left ventricle function;heart muscle biopsy;heart ventricle fibrillation;histopathology;human;hypokalemia;immunosuppressive treatment;insomnia;joint necrosis;lymph node;major clinical study;male;mediastinum lymph node;myopathy;New York Heart Association class;outcome assessment;patient;positron emission tomography;prevalence;priority journal;psychosis;retrospective study;sarcoidosis;steroid therapy;sudden cardiac death;sudden death;survival rate;thorax radiography;treatment duration,"Kandolin, R.;Lehtonen, J.;Airaksinen, J.;Vihinen, T.;Miettinen, H.;Ylitalo, K.;Kaikkonen, K.;Tuohinen, S.;Haataja, P.;Kerola, T.;Kokkonen, J.;Pelkonen, M.;Pietilä-Effati, P.;Utrianen, S.;Kupari, M.",2015,,,0,
2152,Risk factors for intracranial hemorrhage and nonhemorrhagic stroke after fibrinolytic therapy (from the GUSTO-I trial),"Of 592 patients in the Global Utilization of Streptokinase and tPA for Occluded Arteries-I trial who had a stroke during initial hospitalization, the risk for intracranial hemorrhage was significantly greater in those with recent facial or head trauma (odds ratio 13.0, 95% confidence interval 3.4 to 85.5); dementia was additionally associated with an increased risk for intracranial hemorrhage (odds ratio 3.4, 95% confidence interval 1.2 to 10.2). Because facial or head trauma may greatly influence treatment decisions, this risk factor should be incorporated into models designed to estimate the risks and benefits of fibrinolytic therapy. © 2004 by Excerpta Medica, Inc.",fibrinolytic agent;streptokinase;tissue plasminogen activator;adult;aged;article;brain hemorrhage;confidence interval;controlled study;dementia;disease association;drug effect;face injury;female;fibrinolytic therapy;head injury;heart infarction;hospitalization;human;major clinical study;male;priority journal;risk assessment;risk benefit analysis;risk factor;statistical significance;cerebrovascular accident;treatment outcome,"Kandzari, D. E.;Granger, C. B.;Simoons, M. L.;White, H. D.;Simes, J.;Mahaffey, K. W.;Gore, J.;Weaver, W. D.;Longstreth Jr, W. T.;Stebbins, A.;Lee, K. L.;Califf, R. M.;Topol, E. J.",2004,,,0,
2153,Metabolic Disorders of the Brain: Part I,"Due to nonspecific clinical presentation, diagnosis of metabolic disorders affecting the brain is very challenging for physicians. It is always the constellation of the clinical examination, biochemical assay and imaging that helps in reaching the diagnosis of metabolic disorders. Diagnosis of these disorders or even limiting the differential diagnosis on imaging may pose a formidable challenge to the radiologist. In these two articles (Metabolic Disorders of the Brain: Parts I and II) we have tried to highlight the important clinical and imaging pearls of the major and more commonly encountered metabolic disorders. In the first article we discuss metabolic disorders related to dysfunction of the cellular organelle namely lysosomal, peroxisomal, and mitochondrial. We have also discussed the relevant genetic abnormalities, biochemical findings and application of newer imaging techniques which may aid in diagnosis of these various disorders. © 2011 Elsevier Inc..",beta galactosidase;cerebroside sulfatase;galactosylceramidase;glucosylceramide;glycosphingolipid;palmitoyl protein thioesterase;palmitoyl protein thioesterase 1;sphingolipid;sulfatide;unclassified drug;adrenoleukodystrophy;article;autosomal recessive disorder;brain disease;chondrodysplasia punctata;clinical feature;computer assisted tomography;diagnostic imaging;Fabry disease;globoid cell leukodystrophy;GM1 gangliosidosis;human;Kearns Sayre syndrome;Leigh disease;lipidosis;MELAS syndrome;MERRF syndrome;metabolic disorder;metachromatic leukodystrophy;mitochondrial DNA disorder;mucopolysaccharidosis;neuronal ceroid lipofuscinosis;nuclear magnetic resonance imaging;pathophysiology;peroxisomal acyl CoA oxidase deficiency;peroxisome;priority journal;protein deficiency;Refsum disease;Tay Sachs disease;Zellweger syndrome,"Kanekar, S.;Gustas, C.",2011,,,0,
2154,Comorbidities in patients with primary Sjögren's syndrome: A registry-based case-control study,"Objective. Although multiple diseases associated with primary Sjögren's syndrome (pSS) have been reported, reliable data regarding the prevalence of specific medical comorbidities among patients with pSS remain sparse. We investigated the prevalence and risk for a broad spectrum of medical conditions among patients with pSS in Taiwan. Methods. A total of 1974 patients with pSS were eligible for inclusion in the study group. We randomly selected 9870 enrollees matched with the study subjects, using the Taiwan National Health Insurance Research Dataset for 2006 and 2007, inclusive. Conditional logistic regression analyses conditioned on sex, age, monthly income, and level of urbanization of the patient's community were used to calculate the odds ratios (OR) of various comorbid conditions. Results. Pearson chi-square tests revealed that patients with pSS had significantly higher prevalence of hyperlipidemia, cardiac arrhythmias, headaches, migraines, fibromyalgia (FM), asthma, pulmonary circulation disorders, hypothyroidism, liver disease, peptic ulcers, hepatitis B, deficiency anemias, depression, and psychoses. Conditional regression analyses showed that, compared to patients without the condition, patients with pSS were more likely to have hyperlipidemia (OR 1.42), cardiac arrhythmias (OR 1.32), headaches (OR 1.47), migraines (OR 1.86), FM (OR 1.71), asthma (OR 1.54), pulmonary circulation disorders (OR 1.42), hypothyroidism (OR 2.37), liver disease (OR 1.89), peptic ulcers (OR 1.88), hepatitis B (OR 2.34), deficiency anemias (OR 1.33), depression (OR 2.57), and psychoses (OR 2.15). Conclusion. The prevalence of several comorbidities was increased among the patients with pSS. Our study provides epidemiological data for comorbidities among pSS patients in an ethnic Chinese population. Copyright © 2010. All rights reserved.",adult;aged;anemia;article;asthma;biliary cirrhosis;case control study;Chinese;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;electrolyte disturbance;epilepsy;female;fibromyalgia;headache;heart arrhythmia;hepatitis B;human;hyperlipidemia;hypertension;hypothyroidism;interstitial cystitis;ischemic heart disease;kidney failure;liver disease;lymphoma;major clinical study;male;migraine;multiple sclerosis;myasthenia gravis;neoplasm;paralysis;peptic ulcer;peripheral vascular disease;polyneuropathy;prevalence;priority journal;psychosis;pulmonary vascular disease;risk assessment;Sjoegren syndrome;solid tumor;cerebrovascular accident;Taiwan;tuberculosis;urinary tract infection,"Kang, J. H.;Lin, H. C.",2010,,,0,
2155,Anesthetic management of a patient with huntington's chorea - A case report,"Huntington's chorea is a rare hereditary disorder of the nervous system. It is inherited as an autosomal dominant disorder and is characterized by progressive chorea, dementia and psychiatric disturbances. The best anesthetic technique is yet to be established for these patients with increased risk of aspiration due to involvement of pharyngeal muscles and an exaggerated response to sodium thiopental and succinylcholine. The primary goal in general anesthesia for these patients is to provide airway protection and a rapid and safe recovery. We report the anesthetic management of a 51-year-old patient with Huntington's chorea admitted for an emergency operation. © the Korean Society of Anesthesiologists, 2013.",glycopyrronium bromide;lidocaine;ondansetron;propofol;pyridostigmine;remifentanil;rocuronium;adult;anesthesia level;article;blood pressure monitoring;case report;dysphagia;electrocardiography;end tidal carbon dioxide tension;fiberoptic bronchoscopy;general anesthesia;heart left ventricle hypertrophy;heart muscle relaxation;human;Huntington chorea;intubation;leukocytosis;low drug dose;male;physical examination;postoperative nausea and vomiting;thorax radiography,"Kang, J. M.;Chung, J. Y.;Han, J. H.;Kim, Y. S.;Lee, B. J.;Yi, J. W.",2013,,,0,
2156,Epidemiological features of chronic and Alzheimer's diseases in the community-based elderly living in cities and counties in Hebei province,"To understand the epidemiological features of Alzheimer's disease (AD) in the community-based elderly living in cities and counties in Hebei province. Under the stratified random sampling method, Mini Mental State Examination (MMSE) was used to evaluate senile dementia and Activity of Daily Living Scale (ADL) and to evaluate the daily lives of the elderly. Related dementia standard on the diagnose of AD and its subtypes was used. Statistically, data was analyzed through SPSS 13.0 software. The overall prevalence was 64.84% (2355/3632) on chronic diseases in those elderly who were over 60 years of age while AD appeared to be high and increased with age. The prevalence rate of dementia was 7.24% (263/3632), in which AD accounted for 4.87% (177/3632). Rates for other chronic diseases were as follows:hypertension (32.35%), diabetes (11.37%), chronic obstructive pulmonary disease (9.25%), coronary heart disease (8.84%) and stroke (7.16%). The prevalence of AD increased with age and was related to the low degree of education having. Elderly living in the communities of Hebei province showed high prevalent rates of chronic diseases including AD, which had become the major kind of diseases related to old age.",aged;aging;Alzheimer disease;article;China;chronic disease;dementia;demography;female;human;male;middle aged;prevalence;questionnaire;very elderly,"Kang, M. Y.;Gao, Y. M.;Huo, H. Q.;Chen, Y. M.;Wang, J.;Li, M. J.;Du, T.",2011,,,0,
2157,Research in brief,,aflibercept;bevacizumab;diuretic agent;lenvatinib;octreotide;ranibizumab;acromegaly;blood pressure;blood pressure regulation;cancer survival;cardiovascular risk;child death;Danish citizen;dementia;diabetes mellitus;diabetic macular edema;disease association;drug response;heart failure;hospital admission;human;insulin dependent diabetes mellitus;ischemic heart disease;non insulin dependent diabetes mellitus;note;priority journal;progeny;progression free survival;risk assessment;systolic blood pressure;thyroid cancer;treatment outcome;visual acuity,"Kang, S.",2015,,,0,
2158,Risk factors for hip fracture in men from southern europe: The MEDOS study,"The aims of this study were to identify risk factors for hip fracture in men aged 50 years or more. We identified 730 men with hip fracture from 14 centers from Portugal, Spain, France, Italy, Greece and Turkey during the course of a prospective study of hip fracture incidence and 1132 age-stratified controls selected from the neighborhood or population registers. The questionnaire examined aspects of work, physical activity past and present, diseases and drugs, height, weight, indices of co-morbidity and consumption of tobacco, alcohol, calcium, coffee and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), low sunlight exposure, a low degree of recreational physical activity, low consumption of milk and cheese, and a poor mental score. Co-morbidity including sleep disturbances, loss of weight, impaired mental status and poor appetite were also significant risk factors. Previous stroke with hemiplegia, prior fragility fractures, senile dementia, alcoholism and gastrectomy were associated with significant risk, whereas osteoarthrosis, nephrolithiasis and myocardial infarction were associated with lower risks. Taking medications was not associated with a difference in risk apart from a protective effect with the use of analgesics independent of co-existing osteoarthrosis and an increased risk with the use of antiepileptic agents. Of the potentially 'reversible' risk factors, BMI, leisure exercise, exposure to sunlight and consumption of tea and alcohol and tobacco remained independent risk factors after multivariate analysis, accounting for 54% of hip fractures. Excluding BMI, 46% of fractures could be explained on the basis of the risk factors sought. Of the remaining factors low exposure to sunlight and decreased physical activity accounted for the highest attributable risks (14% and 9% respectively). The use of risk factors to predict hip fractures had relatively low sensitivity and specificity (59.6% and 61.0% respectively). We conclude that lifestyle factors are associated with significant differences in the risk of hip fracture. Potentially remediable factors including a low degree of physical exercise and a low BMI account for a large component of the total risk.",alcohol;calcium;adult;aged;alcohol consumption;appetite;article;body height;body mass;body weight;cheese;coffee;comorbidity;dietary intake;Europe;France;Greece;hemiplegia;hip fracture;human;Italy;major clinical study;male;mental health;milk;physical activity;Portugal;priority journal;questionnaire;risk factor;senile dementia;sleep disorder;smoking;Spain;cerebrovascular accident;sun exposure;tea;tobacco;Turkey (republic);weight reduction;work,"Kanis, J.;Johnell, O.;Gullberg, B.;Allander, E.;Elffors, L.;Ranstam, J.;Dequeker, J.;Dilsen, G.;Gennari, C.;Lopes Vaz, A.;Lyritis, G.;Mazzuoli, G.;Miravet, L.;Passeri, M.;Perez Cano, R.;Rapado, A.;Ribot, C.",1999,,,0,
2159,Overview of Fracture Prediction Tools,"The characterization of risk factors for fracture that contribute significantly to fracture risk, over and above that provided by the bone mineral density, has stimulated the development of risk assessment tools. The more adequately evaluated tools, all available online, include the FRAX® tool, the Garvan fracture risk calculator and, in the United Kingdom only, QFracture®. Differences in the input variables, output, and model construct give rise to marked differences in the computed risks from each calculator. Reasons for the differences include the derivation of fracture probability (FRAX) rather than incidence (Garvan and QFracture), limited calibration (Garvan), and inappropriate source information (QFracture). These differences need to be taken into account in the evaluation of assessment guidelines.",orthopedic software;anticonvulsive agent;antidepressant agent;age;alcohol consumption;angina pectoris;article;asthma;body height;body weight;bone density;chronic kidney failure;chronic liver disease;comparative study;controlled study;dementia;early menopause;endocrine disease;epilepsy;ethnicity;falling;family history;fracture;fragility fracture;Garvan fracture risk calculator;Garvan tool;heart infarction;hip fracture;human;malabsorption;malignant neoplasm;musculoskeletal disease assessment;orthopedic equipment;Parkinson disease;practice guideline;prediction;priority journal;QFracture tool;rheumatoid arthritis;risk assessment;risk factor;sex difference;smoking;spine fracture;systemic lupus erythematosus;wrist fracture;FRAX,"Kanis, J. A.;Harvey, N. C.;Johansson, H.;Odén, A.;McCloskey, E. V.;Leslie, W. D.",2017,,10.1016/j.jocd.2017.06.013,0,
2160,Cardiovascular responses during dental treatments in home-bound patients,"The purpose of this study was to investigate cardiovascular responses during dental treatments according to medical history, patient's age, and kind of dental treatments in home-bound patients and to determine whether the cardiovascular responses could be predicted by these items. Three hundred and fifty one homebound patients (2,504 cases: 1,342 males and 1,162 females) undergoing dental treatments at a local dental center participated in this study. Systolic blood pressure (SBP) and heart rate (HR) were recorded using an automatic noninvasive pressure device throughout their treatments. In addition, cases with extreme increase in SBP and/or HR were reviewed. Of 4,686 total cases, 1,184 cases (25.3%) were hypertension, 1,470 cases (31.3%) were cerebrovascular diseases, and 239 cases (5.1%) were Parkinson's disease. SBP while sitting the dental chair in hypertension groups was significantly higher than other groups. No relationship was observed between hemodynamic changes and medical history, patient's age, and kind of dental treatments despite small statistically significant differences. There were 120 cases undergoing local anesthesia (2% lidocaine solution containing 12.5 μg/ml epinephrine) during their treatments in which SBP and HR recordings could be analyzed. SBP and HR changed by 5.4±16.6 mmHg and 4.4±9.4 bpm respectively after local anesthesia. SBP and HR increased in 79 cases (14.1±13.1 mmHg) and 81 cases (8.9±8.0 bpm), respectively. No relationship was observed between hemodynamic changes and medical history and patient's age. SBP increased over 180 mmHg in 172 cases (6.9%) and HR increased over 100 bpm in 62 cases (2.5%). Medical history, patient's age and kind of dental treatments could not predict cardiovascular responses during dental treatments in home-bound patients. Two percent lidocaine solution containing 12.5 μg/ml epinephrine administered in this study (1.3±0.5 ml) did not cause systemic complications. Since some patients showed relatively large hemodynamic changes, it is suggested that monitoring the patients is vital for safety during dental treatments in home-bound patients.",adrenalin;lidocaine;nifedipine;adult;age;aged;anamnesis;article;cardiovascular response;cerebrovascular disease;dementia;dental procedure;female;fracture;heart arrhythmia;heart rate;hemodynamics;human;hypertension;ischemic heart disease;local anesthesia;low back pain;major clinical study;male;muscle disease;Parkinson disease;patient;patient monitoring;prediction;safety;side effect;spinal cord injury;systolic blood pressure,"Kano, M.;Ichinohe, T.;Kaneko, Y.",2004,,,0,
2161,Prosthetic joint infection following invasive dental procedures and antibiotic prophylaxis in patients with hip or knee arthroplasty,"OBJECTIVES We aimed to clarify whether invasive dental treatment is associated with increased risk of prosthetic joint infection (PJI) and whether prophylactic antibiotics may lower the infection risk remain unclear. DESIGN Retrospective cohort study. PARTICIPANTS All Taiwanese residents (N=255,568) who underwent total knee or hip arthroplasty between January 1, 1997, and November 30, 2009, were screened. METHODS The dental cohort consisted of 57,066 patients who received dental treatment and were individually matched 1:1 with the nondental cohort by age, sex, propensity score, and index date. The dental cohort was further divided by the use or nonuse of prophylactic antibiotics. The antibiotic and nonantibiotic subcohorts comprised 6,513 matched pairs. RESULTS PJI occurred in 328 patients (0.57%) in the dental subcohort and 348 patients (0.61%) in the nondental subcohort, with no between-cohort difference in the 1-year cumulative incidence (0.6% in both, P=.3). Multivariate-adjusted Cox regression revealed no association between dental procedures and PJI. Furthermore, PJI occurred in 13 patients (0.2%) in the antibiotic subcohort and 12 patients (0.18%) in the nonantibiotic subcohorts (P=.8). Multivariate-adjusted analyses confirmed that there was no association between the incidence of PJI and prophylactic antibiotics. CONCLUSIONS The risk of PJI is not increased following dental procedure in patients with hip or knee replacement and is unaffected by antibiotic prophylaxis.",knee prosthesis;total hip prosthesis;antibiotic agent;adult;antibiotic prophylaxis;article;cerebrovascular disease;chronic liver disease;chronic lung disease;congestive heart failure;connective tissue disease;dementia;dental procedure;diabetes mellitus;drug efficacy;female;heart infarction;hemiplegia;human;infection prevention;infection risk;invasive procedure;leukemia;lymphoma;major clinical study;male;malignant neoplasm;metastasis;middle aged;moderate hepatic impairment;moderate renal impairment;peptic ulcer;peripheral vascular disease;prosthesis infection;retrospective study;risk reduction;severe hepatic impairment;severe renal impairment;Taiwanese;total knee arthroplasty,"Kao, F. C.;Hsu, Y. C.;Chen, W. H.;Lin, J. N.;Lo, Y. Y.;Tu, Y. K.",2017,,10.1017/ice.2016.248,0,
2162,Mitochondrial disease with encephalopathy or limb girdle myopathy: a report of five cases,"Over the past 13 years at VGH-Taipei, five cases were morphologically defined as having mitochondrial disease and clinically presented with syndromes other than chronic progressive external ophthalmoplegia. There were two cases presenting with dementia, extensive and symmetrical intracerebral calcification but no clinical and other laboratory evidence of skeletal muscle affection; one case with MERRF syndrome; one case with congenital myopathy and cardiomyopathy; and one case with prednisolone-responsive and polymyositis-like myopathy. The following comments are made: 1. The inexplicably lower incidence of encephalopathy group might result from inadequate alertness of clinicians. 2. The clinical classification might have some clinical convenience, but, identification of defects at the DAN level and determination of the phenotypic expression with clinical, morphologic and biochemical methods are fundamental for future rational diagnosis and classification of mitochondrial diseases.",adolescent;adult;article;brain;case report;computer assisted tomography;human;limb;male;middle aged;mitochondrial encephalomyopathy;mitochondrial myopathy;pathology;radiography,"Kao, K. P.;Tsai, C. P.",1994,,,0,
2163,"Progressive dementia, visual deficits, amyotrophy, and microinfarcts","Data from three patients and 22 previously reported cases suggest that cerebral microinfarction causes a recognizable clinical syndrome. All cases present with stroke, followed by progressive dementia and often with visual field deficits, peripheral vascular disease, and signs of motor neuron dysfunction. The average age at onset is 45, and most patients have been men. Many patients have had valvular or ischemic heart disease; in one of our cases, mitral stenosis caused embolic microinfarcts.",adult;autopsy;brain infarction;cardiovascular system;case report;central nervous system;dementia;diagnosis;etiology;heart;heart disease;histology;human;mitral valve stenosis;muscle;muscle atrophy;muscle biopsy;peripheral vascular system;priority journal;cerebrovascular accident;therapy;visual field defect;visual system,"Kaplan, J. G.;Katzman, R.;Horoupian, D.",1985,,,0,
2164,Williams (Williams Beuren) syndrome: A distinct neurobehavioral disorder,,Clostridium toxin;elastin;fk 506 binding protein;helix loop helix protein;immunophilin;leucine zipper protein;LIM protein;receptor;syntaxin;transcription factor;transducin;Alzheimer disease;anesthesia;Arnold Chiari malformation;article;attention deficit disorder;behavior disorder;binocular vision;brain size;chromosome 7q;chromosome deletion;clinical feature;cognition;cognitive defect;cytogenetics;depth perception;developmental disorder;early diagnosis;education;eye color;face dysmorphia;growth acceleration;heart ventricle hypertrophy;human;hypermetropia;hyperreflexia;hypertension;iris disease;joint laxity;kidney malformation;loudness recruitment;muscle hypotonia;neuropathology;polymerase chain reaction;priority journal;short stature;short term memory;sleep disorder;speech therapy;cerebrovascular accident;support group;tooth malformation;urine incontinence;vascular disease;visual disorder;visuomotor coordination;vocational education;Williams Beuren syndrome,"Kaplan, P.;Wang, P. P.;Francke, U.",2001,,,0,
2165,Backbone amide linker (BAL) strategy for Nα-9-fluorenylmethoxycarbonyl (Fmoc) solid-phase synthesis of peptide aldehydes,"A rapid and efficient strategy has been developed for the general synthesis of complex peptide aldehydes. Nα-Benzyloxycarbonylamino acids were converted to protected aldehyde building blocks for solid-phase synthesis in four steps and moderate overall yields. The aldehydes were protected as 1,3-dioxolanes except for one case where a dimethyl acetal was used. These protected amino aldehyde monomers were then incorporated onto 5-[(2 or 4)-formyl-3,5-dimethoxyphenoxy]butyryl-resin (BAL-PEG-PS) by reductive amination, following which the penultimate residue was introduced by HATU-mediated acylation. The resultant resin-bound dipeptide unit, anchored by a backbone amide linkage (BAL), was extended further by routine Fmoc chemistry procedures. Several model peptide aldehydes were prepared in good yields and purities. Some epimerization of the C-terminal residue occurred (10% to 25%), due to the intrinsic stereolability conferred by the aldehyde functional group, rather than any drawbacks to the synthesis procedure. Coyright © 2005 European Peptide Society and John Wiley & Sons, Ltd.","1,3 dioxolane derivative;9 fluorenylmethyl chloroformate;aldehyde derivative;amide;antipain;calpain;calpeptin;cathepsin B;chymostatin;chymotrypsin;cvs 1123;cysteine;efegatran;elastase;elastatinal;interleukin 1beta converting enzyme;kallikrein;l 709049;leupeptin;ly 338387;monomer;peptide derivative;plasmin;protein inhibitor;proteinase;proteinase inhibitor;resin;thrombin;trypsin;unclassified drug;unindexed drug;acquired immune deficiency syndrome;acylation;adult respiratory distress syndrome;Alzheimer disease;amination;article;carboxy terminal sequence;cataract;chemical procedures;contraception;controlled study;drug structure;drug synthesis;emphysema;epimerization;heart infarction;inflammation;inflammatory disease;metastasis potential;muscular dystrophy;osteolysis;pancreatitis;priority journal;proteinase inhibition;rheumatoid arthritis;solid phase synthesis;cerebrovascular accident;structure analysis;thrombosis;ly 294468","Kappel, J. C.;Barany, G.",2005,,,0,
2166,Updated standardized endpoint definitions for transcatheter aortic valve implantation: The valve academic research consortium-2 consensus document (varc-2),"Objectives: The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection. BACKGROUND: A recent study confirmed that VARC definitions have already been incorporated into clinical and research practice and represent a new standard for consistency in reporting clinical outcomes of patients with symptomatic severe aortic stenosis (AS) undergoing TAVI. However, as the clinical experience with this technology has matured and expanded, certain definitions have become unsuitable or ambiguous. METHODS AND Results: Two in-person meetings (held in September 2011 in Washington, DC, USA, and in February 2012 in Rotterdam, Netherlands) involving VARC study group members, independent experts (including surgeons, interventional and non-interventional cardiologists, imaging specialists, neurologists, geriatric specialists, and clinical trialists), the US Food and Drug Administration (FDA), and industry representatives, provided much of the substantive discussion from which this VARC-2 consensus manuscript was derived. This document provides an overview of risk assessment and patient stratification that need to be considered for accurate patient inclusion in studies. Working groups were assigned to define the following clinical endpoints: mortality, stroke, myocardial infarction, bleeding complications, acute kidney injury, vascular complications, conduction disturbances and arrhythmias, and a miscellaneous category including relevant complications not previously categorized. Furthermore, comprehensive echocardiographic recommendations are provided for the evaluation of prosthetic valve (dys)function. Definitions for the quality of life assessments are also reported. These endpoints formed the basis for several recommended composite endpoints. Conclusions: This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVI and/or surgical aortic valve replacement. This initiative and document can furthermore be used as a model during current endeavours of applying definitions to other transcatheter valve therapies (for example, mitral valve repair). Published on behalf of the European Association for Cardio-Thoracic Surgery. The article has been co-published in the European Heart Journal, EuroIntervention, Journal of the American College of Cardiology, and Journal of Thoracic and Cardiovascular Surgery. All rights reserved. © The Author 2012.",accuracy;acute kidney failure;article;blood transfusion;cardiovascular mortality;cerebrovascular accident;clinical decision making;clinical evaluation;cognition;cognitive defect;comorbidity;consensus;cost effectiveness analysis;dementia;Doppler echocardiography;follow up;heart arrhythmia;heart infarction;heart muscle conduction disturbance;heart muscle revascularization;high risk patient;human;life expectancy;limb ischemia;mild cognitive impairment;patient selection;postoperative hemorrhage;priority journal;prosthetic valve dysfunction;quality of life;risk assessment;risk benefit analysis;standardization;surgical mortality;transcatheter aortic valve implantation;transient ischemic attack;transthoracic echocardiography,"Kappetein, A. P.;Head, S. J.;Généreux, P.;Piazza, N.;Van Mieghem, N. M.;Blackstone, E. H.;Brott, T. G.;Cohen, D. J.;Cutlip, D. E.;Van Es, G. A.;Hahn, R. T.;Kirtane, A. J.;Krucoff, M. W.;Kodali, S.;Mack, M. J.;Mehran, R.;Rodés-Cabau, J.;Vranckx, P.;Webb, J. G.;Windecker, S.;Serruys, P. W.;Leon, M. B.",2012,,,0,
2167,N-Terminal Pro-B Type Natriuretic Peptide is Associated with Mild Cognitive Impairment in the General Population,"BACKGROUND: N-terminal pro-B type natriuretic peptide (NT-proBNP) is a marker of cardiac stress and is linked with silent cardiac diseases. While associations of cognitive impairment with manifest cardiovascular diseases are established, data on whether subclinical elevation of NT-proBNP levels below clinically established threshold of heart failure is related with cognitive functioning, especially mild cognitive impairment (MCI), is rare. OBJECTIVE: Aim of the present study was to investigate the cross-sectional association of NT-proBNP levels and MCI in a population-based study sample without heart failure. METHODS: We used data from the second examination of the population based Heinz-Nixdorf-Recall-Study. Subjects with overt coronary heart disease and subjects with NT-proBNP levels indicating potential heart failure (NT-proBNP>/=300 pg/ml) were excluded from this analysis. Participants performed a validated brief cognitive assessment and were classified either as MCI [subtypes: amnestic-MCI (aMCI), non-amnestic-MCI (naMCI)], or cognitively-normal. RESULTS: We included 419 participants with MCI (63.1+/-7.4 y; 47% men; aMCI n = 209; naMCI n = 210) and 1,206 cognitively normal participants (62.42+/-7.1 y; 48% men). NT-proBNP-levels>/=125 pg/ml compared to <125 pg/ml were associated with MCI in fully adjusted models (OR 1.65 (1.23;2.23) in the total sample, 1.73 (1.09;2.74) in men and 1.63(1.10;2.41) in women). For aMCI, the fully adjusted OR was 1.53 (1.04;2.25) and for naMCI, the fully adjusted OR was 1.34 (1.09; 166) in the total sample. CONCLUSION: Within normal ranges and without manifest heart failure, higher NT-proBNPlevels are associated with MCI and both MCI subtypes independent of traditional cardiovascular risk factors and sociodemographic parameters.",Alzheimer's disease;Bnp,"Kara, K.;Mahabadi, A. A.;Weimar, C.;Winkler, A.;Neumann, T.;Kalsch, H.;Dragano, N.;Moebus, S.;Erbel, R.;Jockel, K. H.;Jokisch, M.",2016,Sep 14,10.3233/jad-160635,0,2168
2168,N-Terminal Pro-B Type Natriuretic Peptide is Associated with Mild Cognitive Impairment in the General Population,"BACKGROUND: N-terminal pro-B type natriuretic peptide (NT-proBNP) is a marker of cardiac stress and is linked with silent cardiac diseases. While associations of cognitive impairment with manifest cardiovascular diseases are established, data on whether subclinical elevation of NT-proBNP levels below clinically established threshold of heart failure is related with cognitive functioning, especially mild cognitive impairment (MCI), is rare. OBJECTIVE: Aim of the present study was to investigate the cross-sectional association of NT-proBNP levels and MCI in a population-based study sample without heart failure. METHODS: We used data from the second examination of the population based Heinz-Nixdorf-Recall-Study. Subjects with overt coronary heart disease and subjects with NT-proBNP levels indicating potential heart failure (NT-proBNP>/=300 pg/ml) were excluded from this analysis. Participants performed a validated brief cognitive assessment and were classified either as MCI [subtypes: amnestic-MCI (aMCI), non-amnestic-MCI (naMCI)], or cognitively-normal. RESULTS: We included 419 participants with MCI (63.1+/-7.4 y; 47% men; aMCI n = 209; naMCI n = 210) and 1,206 cognitively normal participants (62.42+/-7.1 y; 48% men). NT-proBNP-levels>/=125 pg/ml compared to <125 pg/ml were associated with MCI in fully adjusted models (OR 1.65 (1.23;2.23) in the total sample, 1.73 (1.09;2.74) in men and 1.63(1.10;2.41) in women). For aMCI, the fully adjusted OR was 1.53 (1.04;2.25) and for naMCI, the fully adjusted OR was 1.34 (1.09; 166) in the total sample. CONCLUSION: Within normal ranges and without manifest heart failure, higher NT-proBNPlevels are associated with MCI and both MCI subtypes independent of traditional cardiovascular risk factors and sociodemographic parameters.",Alzheimer's disease;Bnp;NT-proBNP;mild cognitive impairment;natriuretic peptides,"Kara, K.;Mahabadi, A. A.;Weimar, C.;Winkler, A.;Neumann, T.;Kalsch, H.;Dragano, N.;Moebus, S.;Erbel, R.;Jockel, K. H.;Jokisch, M.",2017,,,0,
2169,"Simultaneous occurrence of metabolic, hematologic, neurologic and cardiac complications after Roux-en-Y gastric bypass for morbid obesity","Roux-en-Y gastric bypass (RYGB) is a commonly performed procedure in the surgical treatment of morbid obesity. Since a major anatomical alteration is made, this procedure may lead to significant postoperative complications, including nutritional deficiencies related to malabsorption. As a consequence of micronutrient deficiencies, secondary metabolic, hematologic and neurologic complications might also develop. Each of these complications is well reported in the literature; however, there are limited data on the simultaneous occurrence of these complications in a single patient. In this report, we aimed to present the diagnosis and management of metabolic, hematologic, neurologic and cardiac complications, which occurred simultaneously in a 57-year-old female patient after undergoing laparoscopic RYGB procedure.",albumin;antiemetic agent;calcium;ceruloplasmin;copper;gluconate calcium;hemoglobin;human albumin;magnesium sulfate;multivitamin;proton pump inhibitor;zinc;zinc sulfate;abdominal radiography;adult;albumin blood level;anemia;aplastic anemia;article;body mass;brain ischemia;calcium blood level;case report;ceruloplasmin blood level;cholelithiasis;computer assisted tomography;copper blood level;copper deficiency;dementia;dyspepsia;echography;erythrocyte transfusion;fatigue;female;follow up;food intake;gait disorder;gastric bypass surgery;heart arrest;heart disease;heart ventricle fibrillation;hematologic disease;hemoglobin blood level;hepatomegaly;histopathology;hospital admission;hospitalization;human;hypoalbuminemia;hypocalcemia;hypomagnesemia;laboratory test;laparoscopic surgery;leukocyte count;malnutrition;medical history;medical record;metabolic disorder;middle aged;morbid obesity;muscle weakness;nausea;neuroimaging;neurologic disease;neurologic examination;nuclear magnetic resonance imaging;nutritional status;operation duration;operative blood loss;pancytopenia;postoperative complication;priority journal;prosopagnosia;resuscitation;sinus rhythm;thrombocyte;vitamin supplementation;zinc deficiency,"Kara, M.;Gundogdu, Y.;Karsli, M.;Ozben, V.;Onder, F. O.;Baca, B.",2016,,,0,
2170,Which parameters affect long-term mortality in older adults: is comprehensive geriatric assessment a predictor of mortality?,"Background: Determining predictors of mortality among older adults might help identify high-risk patients and enable timely intervention. Aims: The aim of the study was to identify which variables predict geriatric outpatient mortality, using routine geriatric assessment tools. Methods: We analyzed the data of 1141 patients who were admitted to the geriatric medicine outpatient clinic between 2001 and 2004. Comprehensive geriatric assessment was performed by an interdisciplinary geriatric team. Mortality rate was determined in 2015. The parameters predicting survival were examined. Results: Median age of the patients (415 male, 726 female) was 71.7 years (53–95 years). Mean survival time was 12.2 years (95 % CI; 12–12.4 years). In multivariate analysis, age (OR: 1.16, 95 % CI: 1.09–1.23, p < 0.001), smoking (OR: 2.51, 95 % CI: 1.18–5.35, p = 0.017) and metabolic syndrome (OR: 2.20, 95 % CI: 1.05–4.64, p = 0.038) were found to be independent risk factors for mortality. MNA-SF scores (OR: 0.84, 95 % CI: 0.71–1.00, p = 0.050) and free T3 levels (OR: 0.70, 95 % CI: 0.49–1.00, p = 0.052) had borderline significance. Discussion: The present study showed that the risk conferred by metabolic syndrome is beyond its individual components. Our findings confirm previous studies on the prognostic role of nutritional status, as reflected by MNA-SF. Serum fT3, a simple laboratory test, may also be used in geriatric outpatient clinics to identify individuals at risk. Conclusions: The results of the study demonstrated the need for addressing modifiable risk factors such as smoking, metabolic syndrome, and undernutrition in older adults.",albumin;cholesterol;creatinine;cyanocobalamin;high density lipoprotein;liothyronine;low density lipoprotein;parathyroid hormone;salicylic acid;urea;uric acid;adult;aged;article;atrial fibrillation;body mass;bone density;cerebrovascular accident;cholesterol blood level;chronic obstructive lung disease;congestive heart failure;creatinine blood level;dementia;diabetes mellitus;female;free liothyronine index;geriatric assessment;human;laboratory test;major clinical study;male;metabolic syndrome X;Mini Mental State Examination;mortality;mortality rate;Parkinson disease;smoking;survival time;urea blood level;uric acid blood level;weight reduction,"Kara, O.;Canbaz, B.;Kizilarslanoglu, M. C.;Arik, G.;Sumer, F.;Aycicek, G. S.;Varan, H. D.;Kilic, M. K.;Dogru, R. T.;Cınar, E.;Kuyumcu, M. E.;Yesil, Y.;Ulger, Z.;Yavuz, B. B.;Halil, M.;Cankurtaran, M.",2017,,10.1007/s40520-016-0574-x,0,
2171,Biomarkers of alzheimer’s disease and vascular dementia simultaneously sampled from serum and cerebrospinal fluid,"Introduction: Alzheimer’s disease, which is a progressive disease accompanied by behavioral problems and decreased activities of daily living with early cognitive decline, and vascular dementia, which is related to cerebrovascular lesions with gradual, progressive cognitive decline, are common in the elderly. Currently, pathological examination is the gold standard in both Alzheimer’s disease and vascular dementia and studies to elucidate the role of cytokines in their pathophysiology using cerebrospinal fluid and serum biological markers have been intensified. In this study, cerebrospinal fluid and serum biomarker levels from both Alzheimer’s disease and vascular dementia patients were examined. Materials and Method: Thirty patients diagnosed with Alzheimer’s disease (Group 1) and vascular dementia (Group 2) were enrolled in this study. Serum interleukin-1β, tumor necrosis factor--α, and interleukin-6 levels as well as serum and cerebrospinal fluid protein carbonyl, glutathione and β-amyloid levels from Groups 1 and 2 (N=15 each) patients were compared. Results: Serum interleukin-1β, tumor necrosis factor-α, and β-amyloid levels as well as serum and cerebrospinal fluid protein carbonyl and glutathione levels were not statistically different (p>0.05) between Group 1 and Group 2. Serum interlukin-6 levels and cerebrospinal fluid β-amyloid levels were significantly higher and lower, respectively, in Group 2 than in Group 1 (p<0.05). Conclusion: In this study, serum interleukin-6 levels were higher, whereas cerebrospinal fluid β-amyloid levels were lower, in vascular dementia patients than in Alzheimer’s disease patients.",amyloid beta protein;biological marker;carbonyl derivative;cytokine;glutathione;interleukin 1beta;interleukin 6;tumor necrosis factor;aged;Alzheimer disease;article;blood analysis;blood level;cerebrospinal fluid analysis;cerebrospinal fluid level;clinical article;comparative study;controlled clinical trial;controlled study;correlation analysis;diabetes mellitus;enzyme immunoassay;female;human;hypertension;ischemic heart disease;male;multiinfarct dementia;prospective study;sensitivity and specificity;smoking,"Karadaş, Ö;Koç, G.;Özön, A. Ö;Öztürk, B.;Konukoğlu, D.",2017,,,0,
2172,Association of Serum Vitamin D with the Risk of Incident Dementia and Subclinical Indices of Brain Aging: The Framingham Heart Study,"BACKGROUND: Identifying nutrition- and lifestyle-based risk factors for cognitive impairment and dementia may aid future primary prevention efforts. OBJECTIVE: We aimed to examine the association of serum vitamin D levels with incident all-cause dementia, clinically characterized Alzheimer's disease (AD), MRI markers of brain aging, and neuropsychological function. METHODS: Framingham Heart Study participants had baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations measured between 1986 and 2001. Vitamin D status was considered both as a continuous variable and dichotomized as deficient (<10 ng/mL), or at the cohort-specific 20th and 80th percentiles. Vitamin D was related to the 9-year risk of incident dementia (n = 1663), multiple neuropsychological tests (n = 1291) and MRI markers of brain volume, white matter hyperintensities and silent cerebral infarcts (n = 1139). RESULTS: In adjusted models, participants with vitamin D deficiency (n = 104, 8% of the cognitive sample) displayed poorer performance on Trail Making B-A (beta= -0.03 to -0.05+/-0.02) and the Hooper Visual Organization Test (beta= -0.09 to -0.12+/-0.05), indicating poorer executive function, processing speed, and visuo-perceptual skills. These associations remained when vitamin D was examined as a continuous variable or dichotomized at the cohort specific 20th percentile. Vitamin D deficiency was also associated with lower hippocampal volumes (beta= -0.01+/-0.01) but not total brain volume, white matter hyperintensities, or silent brain infarcts. No association was found between vitamin D deficiency and incident all-cause dementia or clinically characterized AD. CONCLUSIONS: In this large community-based sample, low 25(OH)D concentrations were associated with smaller hippocampal volume and poorer neuropsychological function.",Alzheimer's disease;brain;dementia;diet;lifestyle;magnetic resonance imaging;neuropsychology;nutritional status;risk factors;vitamin D,"Karakis, I.;Pase, M. P.;Beiser, A.;Booth, S. L.;Jacques, P. F.;Rogers, G.;DeCarli, C.;Vasan, R. S.;Wang, T. J.;Himali, J. J.;Annweiler, C.;Seshadri, S.",2016,,10.3233/jad-150991,0,
2173,Emergency presentations with nonspecific complaints-the burden of morbidity and the spectrum of underlying disease: Nonspecific complaints and underlying disease,"The prevalence of diagnoses, morbidity, and mortality of patients with nonspecific complaints (NSC) presenting to the emergency department (ED) is unknown. To determine the prevalence of diagnoses, acute morbidity, and mortality of patients with NSC. Prospective observational study with a 30-day follow-up. Patients presenting to 2 EDs were enrolled by a study team and diagnosed according to the World Health Organization ICD-10 System. Of 217,699 presentations to theEDfromMay 2007 through to February 2011, a total of 1300 patients were enrolled. After exclusion of 90 patients who fulfilled exclusion criteria, 1210 patients were analyzed. No patient was lost to follow-up. In patients with NSC, the underlying diseases were spread throughout 18 chapters of the ICD-10. A total of 58.7% of the patients were diagnosed with acute morbidity. Thirty-day mortality was 6.4%overall. Patientswith acutemorbidity and suffering fromheart failure and pneumonia had mortalities >15%; patients lacking acute morbidity, but suffering from functional impairment or depression/anxiety had mortalities of 0%. Although the history did not allow any prediction, age and sex were predictive of morbidity and mortality. The differential diagnoses in patients presenting with NSC is broad. Acute morbidity and mortality were high in the presented cohort, the predictors of morbidity and mortality being age and sex rather than the nature of the complaints.Urgently needed management strategies could be based on these results.",NCT00920491;age;aged;anxiety disorder;article;cohort analysis;dehydration;dementia;depression;diagnosis related group;electrolyte disturbance;emergency care;emergency health service;female;follow up;functional disease;general aspects of disease;heart failure;human;ICD-10;kidney failure;major clinical study;male;malignant neoplastic disease;morbidity;mortality;nonspecific complaint;observational study;pneumonia;priority journal;prospective study;sex difference;urinary tract infection;very elderly,"Karakoumis, J.;Nickel, C. H.;Kirsch, M.;Rohacek, M.;Geigy, N.;Müller, B.;Ackermann, S.;Bingisser, R.",2015,,,0,
2174,Fatalities related to medical restraint devices-Asphyxia is a common finding,"A total of seven detailed death investigations is reported where death occurred while being restrained by a belt or a protective cover. The casualties were elderly persons who mostly showed considerable pre-existing diseases, especially dementia and coronary atherosclerosis. Concerning the cause of death, three groups were differentiated: (I) mechanical asphyxia from strangulation. (II) Mechanical asphyxia from thoracic/abdominal compression. (III) Compression of thorax/abdomen without clear signs of asphyxia. Subgroups II and III each involved one case of rib fractures without preceding resuscitation. In subgroup III, the presence of considerable compression of the trunk and the absence of a natural cause of death strongly indicate a causal connection between compression and death, e.g. from a shortened course of fatal asphyxia, endocrine stress reactions or a head-down-position: cardiac arrest in a helpless situation. The method of restraint was inadequate in most cases in that only one device was used which did not restrict the capability to move sufficiently. A good clinical documentation including medical indication, duration and method of restraint and a description/photograph of the original on-site appearance is essential but was not present in most cases. Therefore, prophylaxis is based on a clear medical indication, the proper use of restraint devices, detailed instructions of the nursing personnel and close monitoring. The forensic investigation should aim at a complete reconstruction based on autopsy, histology, toxicology and inspection of the scene and the medical records. © 2008 Elsevier Ireland Ltd. All rights reserved.",aged;article;asphyxia;clinical article;compression;death;dementia;fatality;female;forensic medicine;geriatric patient;heart arrest;human;human tissue;medical documentation;medical restraint;nursing care;patient abandonment;photography;priority journal;resuscitation;rib fracture;strangulation;Segufix,"Karger, B.;Fracasso, T.;Pfeiffer, H.",2008,,,0,
2175,Clinical characteristics and outcome in elderly patients with traumatic brain injury: For establishment of management strategy,"In recent years, instances of neurotrauma in the elderly have been increasing. This article addresses the clinical characteristics, management strategy, and outcome in elderly patients with traumatic brain injury (TBI). Falls to the ground either from standing or from heights are the most common causes of TBI in the elderly, since both motor and physiological functions are degraded in the elderly. Subdural, contusional and intracerebral hematomas are more common in the elderly than the young as the acute traumatic intracranial lesion. High frequency of those lesions has been proposed to be associated with increased volume of the subdural space resulting from the atrophy of the brain in the elderly. The delayed aggravation of intracranial hematomas has been also explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of the elderly TBI, although its mechanisms are not fully understood. In addition, widely used pre-injury anticoagulant and antiplatelet therapies may be associated with delayed aggravation, making the management difficult for elderly TBI. It is an urgent issue to establish preventions and treatments for elderly TBI, since its outcome has been remained poor for more than 40 years.",acetylsalicylic acid;anticoagulant agent;apixaban;blood clotting factor 7;dabigatran;desmopressin;edoxaban;fresh frozen plasma;idarucizumab;rivaroxaban;ticlopidine;vasodilator agent;vitamin K group;warfarin;accidental injury;article;brain blood flow;brain damage;brain hematoma;brain vasospasm;chronic obstructive lung disease;computer assisted tomography;coronary artery thrombosis;coronary stent;dementia;diffusion weighted imaging;edema;falling;hemiparesis;human;hyperemia;hypovolemia;hypoxia;intracranial pressure;kidney dysfunction;outcome assessment;posttraumatic stress disorder;reperfusion injury;stent thrombosis;subdural hematoma;traffic accident;traumatic brain injury,"Karibe, H.;Hayashi, T.;Narisawa, A.;Kameyama, M.;Nakagawa, A.;Tominaga, T.",2017,,10.2176/nmc.st.2017-0058,0,
2176,Curcumin and Endothelial Function: Evidence and Mechanisms of Protective Effects,"BACKGROUND: The endothelium is a large paracrine organ regulating cell growth, vascular tone and thrombogenicity as well as platelet and leukocyte interactions. Endothelial function can be assessed by noninvasive techniques [e.g. flow-mediated vasodilation, nitroglycerin-mediated dilation and pulse wave velocity] and measuring specific circulating biomarkers [cell adhesion molecules, endothelial microparticles and endothelial progenitor cells]. Impaired endothelial function plays a key role in the development of atherosclerosis, arterial hypertension, heart failure, ischemia-reperfusion injury, Alzheimer's disease and other conditions. Endothelial function is also involved in growth and proliferation of tumor cells. METHODS: We performed a literature review and assessed the role of the natural polyphenol, curcumin, as a potential inexpensive, well-tolerated, and safe agent for improving endothelial function. RESULTS: Curcumin exerts several positive pharmacological effects; these include anti-inflammatory, antioxidant, anti-hypertensive, anti-cancer, antiviral, anti-infective and wound-healing properties. Specifically, curcumin's anti-inflammatory effects are thought to be caused by reducing trans-endothelial monocyte migration by reduction of mRNA and protein expression of intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and P-selectin and by modulating NFkappaB, JNK, p38 and STAT-3 in endothelial cells. Dietary curcumin supplementation can also increase antioxidant activity through the induction of heme oxygenase-1, a scavenger of free radicals, and by reduction of reactive oxygen species and Nox-2. CONCLUSIONS: Curcumin appears to improve endothelial function but additional research is needed to determine the precise mechanism(s) and biomarkers involved in curcumin's therapeutic effects on endothelial dysfunction.",Curcumin;adhesion molecules;endothelial function;flow-mediated vasodilation;nitroglycerin-mediated dilation;pulse wave velocity,"Karimian, M. S.;Pirro, M.;Johnston, T. P.;Majeed, M.;Sahebkar, A.",2017,,,0,
2177,Genetic susceptibility to cardiovascular disease and risk of dementia,"Cardiovascular disease (CVD) is a well-established risk factor for dementia, but it is not clear whether the association is of a causal nature or due to shared risk factors. We investigated how genetic susceptibility for CVD affects the risk of dementia, as well as the association between CVD and dementia, using data from Swedish Twin Registry (N = 13,234). Furthermore, we utilized summary statistics to perform Mendelian randomization (MR) analysis to investigate the causal effect of coronary heart disease (CARDIoGRAMplusC4D Consortium et al. 2013, Nature Genetics 45;25-33) on Alzheimers disease (AD) (Lambert et al. 2013, Nature Genetics 45;1452-8), and gene enrichment analysis to investigate biological pathways in common to both disorders. We found an increased rate of dementia during the first three years after a CVD diagnosis (Hazard Ratio [HR] 2.04, 95 % CI 1.61-2.57), which was attenuated more than three years after CVD (HR 1.09, 95 % CI 0.90-1.33). We found no direct effect of a CVD genetic risk score (GRS) on dementia (HR 1.00, 95 % CI 0.98-1.01). However, we found the GRS to mediate the association between CVD and dementia during the first three years after a CVD diagnosis in a linear manner, going from a HR of 1.64 (95 % CI 1.02-2.65) in the first quartile to 2.53 (95 % CI 1.67-3.84) in the fourth quartile of the GRS (p-value trend<0.0001). MR analysis found no causal effect of CVD on AD (Odds Ratio 0.96, 95 % CI 0.90-1.04). Gene enrichment analysis showed VEGF signaling and homocysteine metabolism to be important pathways for both diseases. In conclusion, we found no evidence of a causal effect of CVD on dementia or AD. However, genetically predisposed CVD was a stronger risk factor for dementia compared to CVD with a predominantly environmental pathology, possibly due to shared influences via VEGF signaling and homocysteine metabolism.",controlled clinical trial;controlled study;dementia;diagnosis;genetic predisposition;genetic risk;genetics;hazard ratio;human;ischemic heart disease;major clinical study;Mendelian randomization analysis;metabolism;odds ratio;pathology;randomized controlled trial;register;risk factor;statistical significance;statistics;endogenous compound;homocysteine;vasculotropin,"Karlsson, I;Hagg, S;Ploner, A;Song, C;Gatz, M;Pedersen, N",2015,,10.1007/s10519-015-9742-6,0,
2178,Genetic susceptibility to cardiovascular disease and risk of dementia,"Several studies have shown cardiovascular disease (CVD) to be associated with dementia, but it is not clear whether CVD per se increases the risk of dementia or whether the association is due to shared risk factors. We tested how a genetic risk score (GRS) for coronary artery disease (CAD) affects dementia risk after CVD in 13 231 Swedish twins. We also utilized summarized genome-wide association data to study genetic overlap between CAD and Alzheimer s disease (AD), and additionally between shared risk factors and each disease. There was no direct effect of a CAD GRS on dementia (hazard ratio 0.99, 95% confidence interval (CI): 0.98-1.01). However, the GRS for CAD modified the association between CVD and dementia within 3 years of CVD diagnosis, ranging from a hazard ratio of 1.59 (95% CI: 1.05-2.41) in the first GRS quartile to 1.91 (95% CI: 1.28-2.86) in the fourth GRS quartile. Using summary statistics, we found no genetic overlap between CAD and AD. We did, however, find that both AD and CAD share a significant genetic overlap with lipids, but that the overlap arose from clearly distinct gene clusters. In conclusion, genetic susceptibility to CAD was found to modify the association between CVD and dementia, most likely through associations with shared risk factors.",,"Karlsson, I. K.;Ploner, A.;Song, C.;Gatz, M.;Pedersen, N. L.;Hagg, S.",2017,May 30,,0,
2179,Alcohol dementia and alcohol delirium in aged alcoholics,"In the present study, 126 alcoholics aged 60 years or older were compared with 104 alcoholics aged 35-45 years. No dementia was found in the younger group, whereas 62.7% of the aged patients had dementia; the dementia being irreversible in 32.9% of such patients. Cases of so-called alcohol dementia excluding organic brain diseases accounted for 42.1%. The percentage of aged alcoholics having dementia increased with age, being far beyond the frequency of senile dementia in the general aged. Among various physical complications, hepatic injury and myocardiopathy were more frequent in the aged alcoholics than in general aged people, suggesting that hypertension, myocardiopathy and hepatic injury underlie the manifestation of dementia. There was no case of dementia attributable to the direct effect of alcohol distinctly exceeding tile effects of various physical factors. Problem behaviors characteristic of the aged group included 'being soaked in drink' and being inebriated, showing no correlation with the presence or absence of dementia. There was no significant difference in frequency of delirium between the aged group and the younger group. However, in aged alcoholics delirium tended to continue for a longer period during abstinence and was more likely to occur even during non-abstinence. A similar trend was found in aged alcoholics with dementia compared with those without dementia.",adult;aged;alcohol abstinence;alcohol psychosis;article;cardiomyopathy;controlled study;delirium tremens;alcohol intoxication;human;hypertension;liver injury;major clinical study,"Kasahara, H.;Karasawa, A.;Ariyasu, T.;Thukahara, T.;Satou, J.;Ushijima, S.",1996,,,0,
2180,A novel scoring system for identifying high-risk patients undergiong carotid stenting,"Background/Objective: In patients with severe concurrent coronary and carotid artery disease, two different treatment strategies may be used: simultaneous endarterectomy and coronary bypass surgery, and carotid stenting with delayed coronary bypass surgery after a few weeks. To evaluate the safety and efficacy of carotid stenting with delayed coronary bypass surgery after a few weeks in patients referred to Tehran Heart Center, Tehran, Iran and to determine the independent predictors that may be used to identify the appropriate treatment plan for such patients. Methods: This prospective study was performed from December 2003 through October 2004. Symptomatic patients with >60% stenosis and asymptomatic patients with >80% stenosis were included in this study. The risks and benefits of carotid stenting were explained. Patients were excluded from the study if any of the following was applicable: age ≥85 years, history of a major stroke within the last week, pregnancy, intracranial tumor or arteriovenous malformation, severely disabled as a result of stroke or dementia, and intracranial stenosis that exceeded the severity of the extracranial stenosis. Thirty consecutive patients who underwent carotid stenting were enrolled in this study. Results: The mean ± SD age of patients was 66.3 ± 8 years. The procedural success rate was 96.7%. During a mean ± SD follow-up period of 5.6 ± 3.2 months, 4 (17%) deaths occurred; none of which were attributed to a neurologic causes. Moreover, 1 (3%) patient developed a minor nonfatal stroke with transient cognitive disorder. Most of patients (80%) with major complications acquired a score of ≥26. Conclusion: To reduce the rate of carotid stenting complications in high-risk patients with heart disease, to optimize the patient selections, and to determine the best treatment strategy, based on the clinical and lesion characteristics of patients, we proposed a new scoring system.",adult;aged;article;cardiovascular surgery;carotid artery disease;clinical article;clinical feature;clinical protocol;cognitive defect;controlled study;coronary artery bypass surgery;coronary stent;endarterectomy;female;follow up;heart infarction;high risk population;human;Iran;male;mortality;neurologic disease;patient referral;patient selection;prediction;process optimization;prospective study;risk assessment;risk benefit analysis;safety;scoring system;cerebrovascular accident;treatment indication,"Kassaian, S. E.;Kazemi-Saleh, D.;Alidoosti, M.;Salarifar, M.;Haji-Zeinali, A. M.;Hakki-Kazazi, E.;Sahraian, A. M.;Gheini, M. R.;Abbasi, S. H.",2006,,,0,
2181,Advance care planning: Preferences for care at the end of life,"Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.",article;dementia;heart failure;human;living will;lung emphysema;medical decision making;medical ethics;pain;palliative therapy;patient attitude;resuscitation;terminal care,"Kass-Bartelmes, B. L.;Hughes, R.",2004,,,0,
2182,Statins in threatened stroke,,cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;simvastatin;statine derivative;triacylglycerol;adult;aged;cholesterol blood level;clinical trial;cognitive defect;controlled clinical trial;controlled study;female;health care cost;heart infarction;heart muscle revascularization;human;incidence;major clinical study;male;mortality;prevention;priority journal;randomized controlled trial;short survey;cerebrovascular accident;triacylglycerol blood level,"Kaste, M.",2003,,,0,
2183,Imaging and clinical predictors of unfavorable outcome in medically treated symptomatic intracranial atherosclerotic disease,"Patients with symptomatic intracranial atherosclerotic disease (sICAD) have an increased risk of stroke and vascular death. The aim of the study was to evaluate the natural history and outcome of patients with sICAD treated medically. Methods: The study population was first-ever transient ischemic attack (TIA) or stroke patients presenting to our institute who on vascular imaging had isolated intracranial atherosclerosis as cause of their symptoms and have a follow-up of 90 days. Unfavorable outcome was defined as occurrence of TIA, stroke, acute coronary event, and/or vascular death. Results: Fifty-three (11.8%) of the 449 ischemic stroke patients had sICAD. The risk of stroke in sICAD was 8.9%, 11.1%, 13.3%, and 15.6% in first 7 days, 30 days, 90 days, and 1 year, respectively. Five (11.1%) had cardiovascular events and accounted for 50% of mortality. The predictors of unfavorable outcome were presented as limb weakness (85.7% versus 58.8%, hazard ratio 1.5; 95% confidence interval [CI],.05-.9; P =.04), National Institutes of Health Stroke Scale (NIHSS) score 8 at admission (50% versus 5.9%, hazard ratio 8.5; 95% CI,.007-.5; P =.02), magnetic resonance imaging (MRI) with multiple diffusion-weighted imaging (DWI) lesions (65.4% versus 26.7%; 95% CI,.04-.7; P =.01), and angiography suggestive of diffuse atherosclerosis (50% versus 11.8%; 95% CI, odds ratio.02-.7; P =.009). On stepwise multiple regression, variables for unfavorable outcome were NIHSS score of 8 or more at admission (P =.001), multiple DWI lesion on MRI (P =.04), and diffuse atherosclerosis on angiography (P =.006). Conclusion: The patients with sICAD have a high risk of stroke and cardiac events even on aggressive medical treatment. Clinical and imaging features can identify this high-risk group. © 2014 by National Stroke Association.",acetylsalicylic acid;clopidogrel;warfarin;acute coronary syndrome;acute heart infarction;adult;article;brain angiography;brain atherosclerosis;brain ischemia;computed tomographic angiography;congestive heart failure;contrast enhancement;conventional angiography;deterioration;diffusion weighted imaging;female;fibrinolytic therapy;follow up;high risk population;history;human;limb weakness;magnetic resonance angiography;major clinical study;male;mental deterioration;National Institutes of Health Stroke Scale;outcome assessment;priority journal;Rankin scale;risk assessment;stroke patient;sudden cardiac death;symptomatic intracranial atherosclerotic disease;transient ischemic attack;unstable angina pectoris;aspirin,"Kate, M.;Sylaja, P. N.;Kesavadas, C.;Thomas, B.",2014,,,0,
2184,Charlson comorbidity index: Does it accurately predict the morbidity and mortality after percutaneous nephrolithotomy?,,accuracy;acquired immune deficiency syndrome;adolescent;adult;aged;blood transfusion;cerebrovascular disease;Charlson Comorbidity Index;child;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;heart infarction;hemiplegia;human;incidence;infant;kidney disease;leukemia;liver disease;lymphoma;major clinical study;morbidity;note;percutaneous nephrolithotomy;peripheral vascular disease;postoperative hemorrhage;prediction;preschool child;retrospective study;school child;surgical mortality;surgical risk;ulcer,"Kathpalia, R.",2012,,,0,
2185,Cardiac Biomarkers Predict 1-Year Mortality in Elderly Patients Undergoing Hip Fracture Surgery,"This prospective study included 152 elderly patients (mean age, 80 years; range, 72-88 years) with a hip fracture treated surgically. Comorbidities were evaluated, and B-type natriuretic peptide was measured at baseline and at postoperative days 4 and 5 in addition to troponin I. Major cardiac events were recorded, and 1-year mortality was assessed. Comorbidity models with the important multivariate predictors of 1-year mortality were analyzed. Overall, 9 patients (6%) experienced major cardiac events postoperatively during their hospitalization. Three patients (2%) died postoperatively, at days 5, 7, and 10, from autopsy-confirmed myocardial infarction. Three patients (2%) experienced a nonfatal myocardial infarction, and 3 patients (2%) experienced acute heart failure. At 1-year follow-up, 37 patients (24%) had died. Age older than 80 years (P=.000), renal failure (P=.016), cardiovascular disease (P=.003), respiratory disease (P=.010), Parkinson disease (P=.024), and dementia (P=.000) were univariate predictors of 1-year mortality. However, in the multivariate model, only age older than 80 years (P=.000) and dementia (P=.024) were important predictors of 1-year mortality. In all comorbidity models, age older than 80 years and dementia were important predictors of 1-year mortality. Postoperative increase in B-type natriuretic peptide was the most important predictor of 1-year mortality. Receiver operating characteristic curve analysis showed a threshold of 90 ng/mL of preoperative B-type natriuretic peptide (area under the curve=0.773, 95% confidence interval, 0.691-0.855, P<.001) had 82% sensitivity and 62% specificity to predict 1-year mortality. Similarly, a threshold of 190 ng/mL of postoperative B-type natriuretic peptide (area under the curve=0.753, 95% confidence interval, 0.662-0.844, P<.001) had 70% sensitivity and 77% specificity to predict the study endpoint. [Orthopedics. 2017; 40(3):e417-e424.].",,"Katsanos, S.;Mavrogenis, A. F.;Kafkas, N.;Sardu, C.;Kamperidis, V.;Katsanou, P.;Farmakis, D.;Parissis, J.",2017,May 01,,0,
2186,Prevalence of stroke and coexistent conditions: Disparities between indigenous and nonindigenous Western Australians,"Background: Worldwide, the prevalence of stroke is poorly described in indigenous populations, despite high stroke burden. This paper reports the average point prevalence of hospitalized stroke and coexistent conditions (2007-2011) in indigenous and nonindigenous people in Western Australia, the largest and most sparsely populated Australian jurisdiction. Methods: Using state-wide linked hospital and mortality data, indigenous and nonindigenous prevalent stroke cases (aged 25-84 years) were identified after reviewing stroke admissions over a fixed 20-year look-back period. Prevalent cases were those alive at midyear of each study year. The 2007-2011 period prevalence was a weighted average of annual prevalence. Histories of 11 comorbidities were identified using the 20-year look-back period. Results: Indigenous cases comprised 5% of the average 13591 annual prevalent cases. Indigenous patients were more likely to be younger, female, and have unknown stroke type. Indigenous prevalence was higher at every age. The age-standardized prevalence in indigenous men (33·7 per 1000; 95% confidence interval 31·9-35·4) was 3.7 times greater than in nonindigenous men (9·1 per 1000; 95% confidence interval 9·0-9·2). The corresponding estimates for women were 27·1 per 1000 (25·7-28·4) and 6·1 per 1000 (6·0-6·2) (ratio=4·4). The percentage with selected comorbid conditions was substantially higher for indigenous patients. Conclusions: The high stroke prevalence in indigenous Western Australians, coupled with clinical complexity from comorbid conditions, requires access to culturally appropriate medical, rehabilitation, and logistical support. Intensified primary and secondary prevention is needed to reduce the impact of stroke on indigenous people.",adult;aged;article;Australia;cerebrovascular accident;chronic kidney disease;chronic obstructive lung disease;comorbidity;controlled study;dementia;diabetes mellitus;female;health disparity;atrial fibrillation;heart failure;human;Indigenous Australian;major clinical study;male;mental disease;middle aged;mortality;peripheral occlusive artery disease;prevalence;priority journal;rheumatic heart disease;stroke patient;very elderly,"Katzenellenbogen, J. M.;Knuiman, M. W.;Sanfilippo, F. M.;Hobbs, M. S. T.;Thompson, S. C.",2014,,,0,
2187,Development of dementing illnesses in an 80-year-old volunteer cohort,"We have prospectively followed over a 5-year period 434 volunteers who were at intake ambulatory, functional, presumably nondemented, and between 75 and 85 years of age. Fifty-six (an incidence of 3.53 per 100 person-years at risk) developed a progressive dementia: 32 met diagnostic criteria for Alzheimer's disease (AD) (an incidence of 2.0 per 100 person-years at risk), 15 had vascular or mixed dementia, and 9 had other disorders or remain undiagnosed. New cases of dementia were as common as myocardial infarction and twice as common as stroke. Risk factors for both dementia and AD were age (over 80) and gender (female); other reported risk factors such as family history, prior head injury, thyroid disease, maternal age, and smoking were not risk factors for AD in this elderly cohort. Prior stroke was the major risk factor for vascular or mixed dementia; diabetes and left ventricular hypertrophy but not a history of hypertension per se were also risk factors for vascular dementia. The major predictor of the development of AD was the mental status score on entry. The 58.5% of the cohort who made zero to two errors on a 33-item mental status test had a less than 0.6% per year chance of developing AD, whereas the 16% of the cohort with five to eight errors on this test developed AD at a rate of over 12% per year. Thus, it is possible to identify a large cohort of 80-year-olds who are at low risk for AD and a smaller cohort at very high risk.",aged;Alzheimer disease;dementia;female;heart infarction;human;longitudinal study;major clinical study;male;normal human;priority journal;psychological aspect;cerebrovascular accident,"Katzman, R.;Aronson, M.;Fuld, P.;Kawas, C.;Brown, T.;Morgenstern, H.;Frishman, W.;Gidez, L.;Eder, H.;Ooi, W. L.",1989,,,0,
2188,"A cladistic model of ACE sequence variation with implications for myocardial infarction, Alzheimer disease and obesity","Sequence variation in ACE, which encodes angiotensin I converting enzyme, contributes to a large proportion of variability in plasma ACE levels, but the extent to which this impacts upon human disease is unresolved. Most efforts to associate ACE with other heritable traits have involved a single Alu insertion/deletion polymorphism, despite the probable existence of other functional sequence variants with effects that may not be consistently detectable by solely typing the Alu indel. Here, utilizing single nucleotide polymorphisms (SNPs) that differentiate major ACE clades in European populations, we demonstrate a number of significant phenotype associations across more than 4000 Swedish individuals. In a systematic analysis of metabolic phenotypes, effects were detected upon several traits, including fasting plasma glucose levels, insulin levels and measures of obesity (P-values ranging from 0.046 to 8.4 × 10-6). Extending cladistic models to the study of myocardial infarction and Alzheimer disease, significant associations were observed with greater effect sizes than those typically obtained in large-scale meta-analyses based on the Alu indel. Population frequencies of ACE genotypes were also found to change with age, congruent with previous data suggesting effects upon longevity. Clade models consistently outperformed those based upon single markers, reinforcing the importance of taking into consideration the possible confounding effects of allelic heterogeneity in this genomic region. Utilizing computational tools, potential functional variants are highlighted that may underlie phenotypic variability, which is discussed along with the broader implications these results may have for studies attempting to link variation in ACE to human disease. © Oxford University Press 2004; all rights reserved.",dipeptidyl carboxypeptidase;glucose;insulin;adult;age distribution;aged;Alzheimer disease;article;cladistics;controlled study;Europe;female;gene frequency;gene sequence;genetic analysis;genetic association;genetic code;genetic heterogeneity;genetic linkage;genetic trait;genetic variability;genotype phenotype correlation;glucose blood level;heart infarction;human;insulin blood level;longevity;major clinical study;male;mathematical computing;obesity;population genetics;priority journal;single nucleotide polymorphism;statistical significance;Sweden,"Katzov, H.;Bennet, A. M.;Kehoe, P.;Wiman, B.;Gatz, M.;Blennow, K.;Lenhard, B.;Pedersen, N. L.;de Faire, U.;Prince, J. A.",2004,,,0,
2189,The geriatric puzzle. Assessment challenges of elderly trauma patients,"Assessing elderly patients is like putting together a jigsaw puzzle. In the case described, it's entirely possible that the patient stumbled and fell, bumping his head and bruising his chest. His confusion is probably secondary to dementia, and his vital signs indicate a lack of serious injury. However, it's just as likely that the patient is hypotensive and unable to mount a compensatory tachycardia, has an expanding subdural hematoma, multiple rib fractures with a hemothorax and a ruptured spleen. And it could be worse. His diabetes could be out of control. He could suffer from chronic congestive heart failure, and his living will could be sticking out of his pocket. As the elderly population increases in number, their medical and social issues grow as well. The onus is on us, as healthcare providers, to learn about the aging population and the special problems they present so that we can continue to improve the quality of care we deliver.","Accidental Falls;Accidents, Traffic;Aged;Aging/physiology;Brain Injuries;Cognition;Elder Abuse;Emergency Treatment/*standards;*Geriatric Assessment;Humans;Lung Volume Measurements;Physical Examination;Wounds and Injuries/*therapy","Kauder, D.",2000,Jul,,0,
2190,Impact of intravenous heparin on quantification of circulating microRNAs in patients with coronary artery disease,"MicroRNAs are small non-coding RNAs that are detectable in plasma and serum. Circulating levels of microRNAs have been measured in various studies related to cardiovascular disease. Heparin is a potential confounder of microRNA measurements due to its known interference with polymerase chain reactions. In this study, platelet-poor plasma was obtained from patients undergoing cardiac catheterisation for diagnostic coronary angiography, or for percutaneous coronary intervention, both before and after heparin administration. Heparin had pronounced effects on the assessment of the exogenous C. elegans spike-in control (decrease by approx. 3 cycles), which disappeared 6 hours after the heparin bolus. Measurements of endogenous microRNAs were less sensitive to heparin medication. Normalisation of individual microRNAs with the average cycle threshold value of all microRNAs provided a suitable alternative to normalisation with exogenous C. elegans spike-in control in this setting. Thus, both the timing of blood sampling relative to heparin dosing and the normalisation procedure are critical for reliable microRNA measurements in patients receiving intravenous heparin. This has to be taken into account when designing studies to investigate the relation of circulating microRNAs to acute cardiovascular events or coronary intervention. © Schattauer 2013.",heparin;microRNA;aged;angiocardiography;article;Caenorhabditis elegans;clinical article;controlled study;coronary artery disease;female;heart catheterization;human;male;outcome assessment;percutaneous coronary intervention;priority journal;real time polymerase chain reaction,"Kaudewitz, D.;Lee, R.;Willeit, P.;McGregor, R.;Markus, H. S.;Kiechl, S.;Zampetaki, A.;Storey, R. F.;Channon, K. M.;Mayr, M.",2013,,,0,
2191,Long-term care in dementia: Patients and caregivers,"General principles of managing chronic, age-associated diseases apply as much to Alzheimer's disease (AD) and other late-life dementing disorders as they do to congestive heart failure or osteoarthritis. Beyond efforts to maintain residual tissue or organ function, important physician roles include promoting general well-being and helping patients and their caregivers adjust to disease-related limitations. Physicians provide essential information to patients and their families about the disease, its social and legal ramifications, and community resources to facilitate care. Therefore, physicians must be knowledgeable about broadly intersecting medical, legal, financial, and ethical issues surrounding the long-term management of AD and other dementias. The many challenges faced by patients with dementia and their caregivers over time underscore the need for an ongoing diagnostic and therapeutic alliance with primary care physicians. This article reviews salient aspects of long-term care for patients with AD and other dementias, highlighting the vital and varied roles of physicians in managing these chronic brain disorders.",anticonvulsive agent;buspirone;carbamazepine;cholinergic receptor blocking agent;citalopram;fluoxetine;fluvoxamine;gabapentin;melatonin;mirtazapine;neuroleptic agent;olanzapine;paroxetine;quetiapine;sertraline;trazodone;valproate semisodium;aged;Alzheimer disease;article;caregiver;chronic brain disease;clinical trial;community;congestive heart failure;controlled clinical trial;controlled study;dementia;family;financial management;health promotion;human;legal aspect;long term care;medical ethics;medical information;osteoarthritis;physician;primary medical care;randomized controlled trial;side effect;sociology;wellbeing,"Kaufer, D. I.",2001,,,0,
2192,Pharmaceutical approval update,,17 methylnaltrexone;antibiotic agent;cytochrome P450 3A inducer;cytochrome P450 3A4;deutetrabenazine;infliximab;live vaccine;methotrexate;naldemedine;neuroleptic agent;prolactin;tetrabenazine;abdominal pain;agitation;akathisia;ankylosing spondylitis;antiviral therapy;constipation;Crohn disease;cytopenia;demyelinating disease;depression;diarrhea;digestive system perforation;drug approval;drug dose increase;drug dose titration;drug hypersensitivity;drug substitution;drug withdrawal;fatigue;gastroenteritis;gastrointestinal obstruction;headache;heart failure;hepatitis B;human;Huntington chorea;hyperprolactinemia;hypersensitivity;infection;infection risk;liver toxicity;long term exposure;lupus like syndrome;lymphoma;multicenter study (topic);mycosis;nausea;neuroleptic malignant syndrome;note;parkinsonism;psoriasis vulgaris;psoriatic arthritis;QT prolongation;randomized controlled trial (topic);recommended drug dose;restlessness;rheumatoid arthritis;risk benefit analysis;sedation;somnolence;suicidal ideation;ulcerative colitis;xerostomia;austedo;relistor;renflexis;symproic,"Kaufman, M. B.",2017,,,0,
2193,Cognitive resilience to apolipoprotein E ε4: Contributing factors in black and white older adults,"IMPORTANCE: Apolipoprotein E (APOE) ε4 is an established risk factor for cognitive decline and the development of dementia, but other factors may help to minimize its effects. OBJECTIVE: Using APOE ε4 as an indicator of high risk, we investigated factors associated with cognitive resilience among black and white older adults who are APOE ε4 carriers. DESIGN, SETTING, AND PARTICIPANTS: Participants included 2487 community-dwelling older (aged 69-80 years at baseline) black and white adults examined at 2 community clinics in the prospective cohort Health, Aging, and Body Composition (Health ABC) study. The baseline visits occurred from May 1997 through June 1998. Our primary analytic cohort consisted of 670 APOE ε4 carriers (329 black and 341 white participants) who were free of cognitive impairment at baseline and underwent repeated cognitive testing during an 11-year follow-up (through 2008) using the Modified Mini-Mental State Examination. MAIN OUTCOMES AND MEASURES: We stratified all analyses by race. Using the Modified Mini-Mental State Examination scores, we assessed normative cognitive change in the entire cohort (n = 2487) and classified the APOE ε4 carriers as being cognitively resilient vs nonresilient by comparing their cognitive trajectories with those of the entire cohort. We then conducted bivariate analyses and multivariable random forest and logistic regression analyses to explore factors predictive of cognitive resilience in APOE ε4 carriers. RESULTS: Among white APOE ε4 carriers, the strongest predictors of cognitive resilience were, in relative order of importance, no recent negative life events, a higher literacy level, advanced age, a higher educational level, and more time spent reading. Among black APOE ε4 carriers, the strongest predictors of cognitive resilience were, in relative order of importance, a higher literacy level, a higher educational level, female sex, and the absence of diabetes mellitus. In follow-up logistic regression models, higher literacy level (adjusted odds ratio [OR], 9.50 [95%CI, 2.67-60.89]), a higher educational level (adjusted OR for college graduate vs less than high school, 3.81 [95%CI, 1.13-17.56]), and age (adjusted OR for 73-76 vs 69-72 years, 2.01 [95%CI, 1.13-3.63]) had significant independent effects in predicting cognitive resilience among white APOE ε4 carriers. Among black APOE ε4 carriers, a higher literacy level (adjusted OR, 2.27 [95%CI, 1.29-4.06]) and a higher educational level (adjusted OR for high school graduate/some college vs less than high school, 2.86 [95%CI, 1.54-5.49]; adjusted OR for college graduate vs less than high school, 2.52 [95%CI, 1.14-5.62]) had significant independent effects in predicting cognitive resilience. CONCLUSIONS AND RELEVANCE: Although APOE ε4 carriers are at high risk for cognitive decline, our findings suggest possible intervention targets, including the enhancement of cognitive reserve and improvement of other psychosocial and health factors, to promote cognitive resilience among black and white APOE ε4 carriers.",apolipoprotein E;apolipoprotein E4;aged;aging;article;Black person;Caucasian;cerebrovascular accident;cognition;cognitive resilience;cohort analysis;community living;comorbidity;coping behavior;depression;diabetes mellitus;educational status;genetic risk;genotype;health status;heart infarction;heterozygote;human;hypertension;income;intervention study;Mini Mental State Examination;obesity;priority journal;risk factor;scoring system;sex difference;single nucleotide polymorphism;sleep time;speech intelligibility;very elderly,"Kaup, A. R.;Nettiksimmons, J.;Harris, T. B.;Sink, K. M.;Satterfield, S.;Metti, A. L.;Ayonayon, H. N.;Yaffe, K.",2015,,,0,
2194,Memory complaints and risk of cognitive impairment after nearly 2 decades among older women,"Objectives: To investigate the association between subjective memory complaints (SMCs) and long-term risk of cognitive impairment in aging because most previous studies have followed individuals for only a few years. Methods: Participants were 1,107 cognitively normal, community-dwelling older women (aged 65 years and older at baseline) in a prospective study of aging. SMCs were assessed shortly after baseline and repeatedly over time with the yes/no question, ""Do you feel you have more problems with memory than most?"" Cognitive status 18 years later (normal or impaired with mild cognitive impairment or dementia) was determined by an expert panel. Using logistic regression, we investigated the association between SMCs over time and risk of cognitive impairment, adjusting for demographics, baseline cognition, and characteristics that differed between those with and without SMCs. Results: At baseline, 8.0% of participants (n 89) endorsed SMCs. Baseline SMCs were associated with increased risk of cognitive impairment 18 years later (adjusted odds ratio [OR] 1.7, 95% confidence interval 1.1-2.8). Results were unchanged after excluding participants with depression. The association between SMCs and cognitive impairment was greatest at the last SMC assessment time point (18 years before diagnosis: adjusted OR 1.7 [1.1-2.9]; 14 years before diagnosis: adjusted OR 1.6 [0.9-2.7]; 10 years before diagnosis: adjusted OR 1.9 [1.1-3.1]; 4 years before diagnosis: adjusted OR 3.0 [1.8-5.0]). Conclusions: SMCs are associated with cognitive impairment nearly 2 decades later among older women. SMCs may be a very early symptom of an insidious neurodegenerative disease process, such as Alzheimer disease.",aged;aging;article;cognition;cognitive defect;controlled study;demography;depression;disease association;educational status;female;groups by age;heart infarction;human;major clinical study;memory disorder;Mini Mental State Examination;priority journal;prospective study;subjective memory complaint,"Kaup, A. R.;Nettiksimmons, J.;Leblanc, E. S.;Yaffe, K.",2015,,,0,
2195,"Depression and its relationship to function and medical status, by dementia status, in nursing home admissions","OBJECTIVE: To determine rates of depression by dementia status in a statewide sample of nursing home admissions, and associations with medical comorbidity and physical functioning. METHODS: Trained interviewers obtained information from nursing home residents, staff, significant others, and medical records. RESULTS: A total of 22.3% were classified depressed in the nondemented status and 23.6% in the demented status. Depression status was significantly associated with more physical dependencies regardless of dementia status. In the nondemented, there was also a significant positive association with number of comorbidities. One interaction, dementia with comorbidity at the highest levels of comorbidity, was significant in looking at association with depression. CONCLUSION: There is significant depressive symptomatology in nursing home admissions, which is also associated with difficulty in physical function and with the number of medical comorbidities in the nondemented. Application of the two measures used in this study represents a strategy to assess depression in all nursing home residents.","Activities of Daily Living;Aged;Aged, 80 and over;Cognition Disorders/epidemiology;Comorbidity;Coronary Disease/epidemiology;Dementia/diagnosis/*epidemiology/*psychology;Depression/diagnosis/*epidemiology/*psychology;Female;Health Status;Humans;Hypertension/epidemiology;Male;Neuropsychological Tests;Nursing Homes/*statistics & numerical data;Patient Admission/*statistics & numerical data;Pulmonary Disease, Chronic Obstructive/epidemiology;Severity of Illness Index;Surveys and Questionnaires","Kaup, B. A.;Loreck, D.;Gruber-Baldini, A. L.;German, P.;Menon, A. S.;Zimmerman, S.;Burton, L.;Magaziner, J.",2007,May,10.1097/JGP.0b013e31803c54f7,0,
2196,Genes for a 'Wellderly' Life,"A long, healthy life is a desire and priority for most people. Genetic factors for longevity do not fully explain healthy aging. Recent research suggests that, in addition to other factors, healthy aging is at least in part the result of protective genetic variants for Alzheimer's disease (AD) and coronary artery disease (CAD).",,"Kauwe, J. S.;Goate, A.",2016,Aug,10.1016/j.molmed.2016.05.011,0,
2197,Prevalence of depression and cognitive impairment in old age in Trabzon,"Objective: The aim of this study is to determine the prevalence of depression and cognitive impairment, in addition to investigate the relation between these disorders and sociodemographic variables in 55 years of age and older population of Trabzon city. Methods: There has been interviewed with the aged of 55 and over 3093 people who represented Trabzon province. In the study, sociodemographic data form, the Standardized Mini Mental State Examination (MMSE) form, Geriatric Depression Scale forms were administered. Results: The prevalence of the depression was found to be 13.6% and the prevalence of the cognitive impairment was detected as 17.1% in the 55 years and over aged group in the province of Trabzon. The presence of depression was detected significantly in females and in those with cognitive impairment. The rate of occurring depression has increased significantly with age. Female gender, ageing, to be widowed, low educational level, hypertension, smoking, a history of head trauma, myocardial infarction, cerebrovascular accident (CVA), Parkinson's disease, a history of rheumatic disease, left-handedness were determined as the possible risks for depression. Increased MMSE score, male gender, longer educational period, smoking was found out as reduce the risk of depression. The risk factors for cognitive impairment include; female gender, ageing, being single, being uneducated, head injury, CVA, Parkinson's disease, a history of rheumatic disease and depression. Male gender, increased educational level, being married, alcohol and tobacco use was found to decrease the risk for cognitive impairment. The number of individuals with cognitive impairment and the level of cognitive impairment increase with age. Conclusion: Depression and cognitive impairment are common in in 55 years of age and older population, and increase with age progression and seem to be related to each other. Women are under greater risk for both disorders. Improving education and physical health protection may be protective for both disorders.",alcohol;adult;aging;alcohol consumption;article;cerebrovascular accident;smoking;cognitive defect;controlled study;demography;depression;educational status;female;Geriatric Depression Scale;groups by age;head injury;heart infarction;human;hypertension;major clinical study;male;Mini Mental State Examination;Parkinson disease;prevalence;rheumatic disease;risk reduction;senescence;sex difference;social aspect;tobacco,"Kavakci, Ö;Bilici, M.;Çam, G.;Ülgen, M.",2011,,,0,
2198,To the editor,,antihypertensive agent;cyanocobalamin;histamine H2 receptor antagonist;hydroxymethylglutaryl coenzyme A reductase inhibitor;proton pump inhibitor;age;aged;Alzheimer disease;cerebrovascular accident;comorbidity;cyanocobalamin deficiency;dementia;depression;diabetes mellitus;disease association;dyslipidemia;ethnicity;gender;Germany;human;hypertension;ischemic heart disease;letter;polypharmacy;priority journal;risk factor,"Kawada, T.",2016,,,0,
2199,General anesthesia for a 100-year-old woman with chronic heart failure,"With the expanding elderly population in Japan, general anesthesia in patients above 80 years of age has become routine and is increasing. We report on a case of general anesthesia for a 100-year-old woman with chronic heart failure. This patient could not decide on anything about her own treatment plan because of dementia, and the operation was undertaken from strong request of her family. There was no cardiopulmonary instability during the operation, but heart failure became worse postoperatively, and it took nearly a month before the patient could leave the hospital. As for the operation and general anesthesia in the elderly, it is important not only to assess their perioperative physical risks but also to consider family background and postoperative course.",aged;article;case report;decision making;dementia;female;general anesthesia;heart failure;human;Japan;risk assessment;surgical risk;treatment planning,"Kawaguchi, Y.;Hirosawa, T.;Shinozaki, Y.;Hirota, K.",2011,,,0,
2200,Clinical picture and social characteristics of super-elderly patients with heart failure in Japan,"The number of super-elderly patients older than 80 years with chronic heart failure (HF) is dramatically increased in Japan; however, therapeutic strategies for patients 80 years or older remains to be established. The present investigation was undertaken to clarify the clinical picture and socioeconomic characteristics of super-elderly HF patients. A total of 380 consecutive patients with acute HF or acutely worsening chronic HF were divided into three groups according to age: patients younger than 60 years, those 60 to 80 years, and those 80 years or older (super-elderly group). HF patients in the super-elderly group initially presented with more atypical symptoms at admission compared with those in the younger age group. The prevalence of HF with preserved ejection fraction was more pronounced compared with the patients in the younger age group. Furthermore, the social background was quite different for the 3 groups in several respects: recurrent hospitalization, the prevalence of dementia, and the number of patients living alone all increased with age. The lack of social support in patients with HF is a problem that needs to be resolved in the ""super-graying"" societies such as Japan.","Age Distribution;Aged;Aged, 80 and over;Comorbidity;Dementia/epidemiology;Female;Heart Failure/epidemiology/*physiopathology;Hospitalization/statistics & numerical data;Humans;Japan;Male;Middle Aged;Residence Characteristics/statistics & numerical data","Kawai, Y.;Inoue, N.;Onishi, K.",2012,Nov-Dec,10.1111/j.1751-7133.2012.00297.x,0,
2201,Conservative Treatment for Fracture of the Proximal Femur with Complications,"We retrospectively compared two groups of patients with hip fractures and severe complications. One group had been treated surgically; the other group had been treated conservatively to prevent worsening of general status, with transfer to wheelchair as soon as possible. This study aimed to determine if early prognosis after conservative treatment would be worse than that following surgical treatment. MATERIALS AND METHODS: Subjects were patients (n=230) with hip fracture who had been admitted and treated at our hospital from 1993 through 2006. Patients' medical records were retroactively investigated to obtain information on age, sex, complications, type of fracture, and course of subsequent hospitalizations. Additional information for conservatively treated patients included reasons for avoiding surgery and time-to-transfer to wheelchair. In case of death, the cause and timing of death were investigated. RESULTS: Of the 230 patients, 22 (mean age, 83.5 years) were treated conservatively. Complications at admission included cardiac disease, respiratory disease, malignancy, renal disease, dementia, and other conditions. Multiple complications were commonly seen. The reasons for selecting conservative treatment were cardiac function disturbance in 13 cases and decision of patients' families in 9 cases. Almost all patients were able to transfer to wheelchair. A total of 9 patients died in the hospital: 8 were in the surgical treatment group and 1 was in the conservative treatment group. The patients who died in the surgical treatment group had a mean age of 80.3 years, and pneumonia was the main cause of death. The timing of death ranged from 12 to 129 days after surgery. The number of perioperative deaths was 3 (1.4%). DISCUSSION AND CONCLUSION: This study showed that in patients with hip fractures, severe complications, and poor general conditions, early prognosis after conservative treatment aiming for early transfer to wheelchair is no worse than that following surgical treatment. Thus, conservative treatment should be considered for patients with poor ability for activities of daily living.",,"Kawaji, H.;Uematsu, T.;Oba, R.;Takai, S.",2016,,10.1272/jnms.83.2,0,
2202,Disseminated associated with tsunami lung,"Many survivors of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011, contracted a systemic disorder called ""tsunami lung,"" a series of severe systemic infections following aspiration pneumonia caused by near drowning in the tsunami. Generally, the cause of aspiration pneumonia is polymicrobial, including fungi and aerobic and anaerobic bacteria, but Aspergillus infection is rarely reported. Here we report a case of tsunami lung complicated by disseminated aspergillosis, as diagnosed during autopsy. © 2012 Daedalus Enterprises.",adrenalin;beta glucan;cefotiam;ciprofloxacin;creatine kinase;dopamine;lactate dehydrogenase;micafungin;piperacillin plus tazobactam;procalcitonin;adult respiratory distress syndrome;aged;article;aspiration pneumonia;atelectasis;autopsy;blood gas analysis;case report;computer assisted tomography;disease association;disease severity;dyspnea;female;heart abscess;heart arrest;histopathology;human;human cell;human tissue;immunocompromized patient;infection prevention;intubation;kidney abscess;leukocyte count;lung aspergillosis;lung disease;lung extravascular fluid;lung infiltrate;mental deterioration;near drowning;noncardiogenic lung edema;patient monitoring;pleura empyema;resuscitation;septic shock;sputum culture;thorax radiography;tsunami lung,"Kawakami, Y.;Tagami, T.;Kusakabe, T.;Kido, N.;Kawaguchi, T.;Omura, M.;Tosa, R.",2012,,,0,
2203,Werner's syndrome associated with progressive subcortical vascular encephalopathy of the Binswanger type,"A 56-year-old woman with Werner's syndrome was admitted to our hospital because of intractable foot ulcer and malnutrition. She presented dementia consisting of childish behaviour, loss of intelligence, and severe amnesia. Brain CT revealed diffuse periventricular low density areas, and brain MRI also disclosed periventricular high intensity areas under T2-intensified conditions. These findings gave a diagnosis of progressive subcortical vascular encephalopathy of the Binswanger type, which seemed to be the cause of her dementia. She finally died of heart failure due to acute myocardial infarction. Mild to moderate demyelinization was found in the subcortical area of the autopsied cerebrum, confirming the clinical diagnosis. Generalized atherosclerosis characteristic of Werner's syndrome may have predisposed this patient to Binswanger's encephalopathy.",adult;article;Binswanger encephalopathy;case report;computer assisted tomography;dementia;demyelination;disease association;female;human;nuclear magnetic resonance imaging;Werner syndrome,"Kawamura, H.;Mori, S.;Murano, S.;Yokote, K.;Tamura, K.;Saito, Y.",1999,,,0,
2204,Evaluation of Percutanous Endoscopic Gastrostomy in Elderly Patients with Silicosis and Co-morbidities,"To clarify the indications and usefulness of Percutanous endoscopic gastrostomy (PEG) in patients with Silicosis and some co-morbidities, we analyzed eight cases of silicosis, who suffered from dysphagia and had received a PEG for tube feeding during the period from 1998 to 2002. The characteristics, and clinical course, of each case were statistically analyzed before and during PEG usage. All cases were bed-ridden males, with a mean age of 80 years. The profusion rate (PR) grade of silicosis was for five cases in category 2, and for three cases in category 4. Most of the co-morbidities were dementia (five cases), and chronic heart failure (four cases). There were no significant improvements in the measured nutrition criteria (albumin, lymphocytes) nor in respiratory function (arterial O2) between before and during PEG usage. Tube feeding through the PEG was not performed in three cases because of repeated aspiration pneumonia. The mean duration of PEG usage was 9 months, ranging from 5 to 20 months. Five cases died of the co-morbidities. Furthermore, there was significant deterioration in the bacteriological data (p=0.001), suggesting a worsening of the swallowing disturbances during PEG usage, or the emergence of more resistant organisms as a result of empirical antibiotic therapy. The present results suggest that the indications of PEG in cases of severe chronic obstructive pulmonary disease (COPD) such as silicosis, associated with other morbidities, and with dysphagia, are somewhat limited. The patient's general condition should be an important factor in deciding whether or not this technique should be used.",aged;antibiotic resistance;arterial oxygen tension;article;aspiration pneumonia;clinical article;comorbidity;dementia;disease course;dysphagia;heart failure;human;male;nutrition;percutaneous endoscopic gastrostomy;respiratory function;silicosis;surgical technique;treatment indication;feeding apparatus,"Kawano, M.;Anan, H.;Shimizu, M.",2003,,,0,
2205,Retinal microvascular signs and 10-year risk of cerebral atrophy: The atherosclerosis risk in communities (ARIC) study,"Background and Purpose-: Cerebral atrophy, detected as ventricular enlargement or sulcal widening on MRI, is recognized as a risk factor for vascular dementia or Alzheimer disease. However, its underlying pathophysiology is not known. We examined whether retinal microvascular assessment could provide predictive information on the risk of ventricular enlargement and sulcal widening on MRI. Methods-: A prospective, population-based study was conducted of 810 middle-aged persons without clinical stroke or MRI infarcts. All participants had a first cranial MRI and retinal photography in 1993 to 1995 and returned for a repeated MRI in 2004 to 2006 (median follow-up of 10.5 years). Retinal photographs were graded for presence of retinopathy and retinal microvascular abnormalities, and MRI images were graded for ventricular size and sulcal size according to standardized protocols. Ventricular enlargement and sulcal widening were defined as an increase in ventricular size or sulcal size of ≥3 of 10 grades between baseline and follow-up. Results-: After adjusting for age, gender, and cardiovascular risk factors, retinopathy and arteriovenous nicking at baseline were associated with 10-year ventricular enlargement (OR and 95% CI: 2.03, 1.20 to 4.42 for retinopathy and 2.19, 1.23 to 3.90 for arteriovenous nicking). Retinal signs were not associated with 10-year sulcal widening. Conclusions-: Retinopathy and arteriovenous nicking are predictive of long-term risk of ventricular enlargement, but not of sulcal widening, independent of cardiovascular risk factors. These data support a microvascular etiology for subcortical but not cortical cerebral atrophy. © 2010 American Heart Association, Inc.",adult;article;brain atrophy;brain infarction;brain size;brain ventricle;cardiovascular risk;clinical assessment;female;follow up;human;major clinical study;male;neuroimaging;nuclear magnetic resonance imaging;photography;priority journal;retina blood vessel;retinopathy;cerebrovascular accident;subiculum;sulcal widening;ventricular enlargement,"Kawasaki, R.;Cheung, N.;Mosley, T.;Islam, A. F. M.;Sharrett, A. R.;Klein, R.;Coker, L. H.;Knopman, D. S.;Shibata, D. K.;Catellier, D.;Wong, T. Y.",2010,,,0,
2206,Potential genetic biomarkers in the early diagnosis of Alzheimer disease: APOE and BIN1,"Background/aim: Alzheimer disease (AD) is triggered by interactions of multiple genetic and environmental factors. The APOE gene E4 allele is the best-known risk factor for AD, yet it represents a small ratio of genetic factors. According to genome-wide association studies, the BIN1 gene is the second important risk factor for AD, following the APOE gene. We aimed to identify a novel biomarker indicating susceptibility to AD by investigating APOE alleles and BIN1 gene polymorphisms in a Turkish population. Materials and methods: Fifty-three AD patients and 56 controls were included to examine polymorphism and allele frequency of the APOE and BIN1 genes. Genomic DNAs were isolated from whole blood by SDS/proteinase K treatment, phenol-chloroform extraction, and ethanol precipitation. RFLP was done for identification of polymorphisms in the APOE gene and allele-specific PCR was used for the BIN1 gene. Results: Frequency of the APOE E4 allele was higher in the AD patient group, while the frequency of the E2 allele was higher in controls. The E4/E4 genotype was detected in the AD patient group, while this genotype was not observed in the controls. The frequencies of BIN1 alleles were similar in both groups. Conclusion: There was a strong association between AD and the APOE E4 allele, while no such relation was observed with BIN1 gene polymorphism.",aged;Alzheimer disease;APOE gene;article;BIN1 gene;controlled study;DNA isolation;DNA polymorphism;early diagnosis;female;gene;gene frequency;gene sequence;genetic susceptibility;human;hypertension;ischemic heart disease;major clinical study;male;Mini Mental State Examination;polymerase chain reaction;restriction fragment length polymorphism,"Kaya, G.;Gündüz, E.;Acar, M.;Hatipoğlu, Ö F.;Acar, B.;İlhan, A.;Gündüz, M.",2015,,,0,
2207,Complicating factors and results of cataract surgery in aged patients,"It is estimated that the number of elderly patients undergoing cataract surgery is increasing year by year. The author investigated complicating factors and results of cataract surgery in 50 patients (63 eyes) among 195 patients more than 80 years old treated at Sanuma General Hospital between April 1996 and March 1997. Complicating factors present preoperatively included systemic conditions such as hypertension, diabetes mellitus, ischemic heart disease, and senile dementia. Complications encountered during the operation included a few cases in which it was difficult for the patient to remain supine, necessitating a change in position. Almost all patients who were restless or anxious responded to explanations of what was happening, although a few needed a sedative medication. After cataract surgery, 6 patients were restless and needed to have family present to calm them. Postoperative visual acuity improved in almost all cases. In addition, we evaluated changes in activities of daily living (ADL) after surgery in 11 patients who were living in an institution for the aged. ADL improved after surgery in all 11 cases, showing that cataract surgery can be helpful in improving ADL in elderly patients.",aged;anxiety;article;cataract;cataract extraction;clinical article;daily life activity;diabetes mellitus;female;human;hypertension;ischemic heart disease;male;restlessness;senile dementia,"Kayaba, Y.",1997,,,0,
2208,Predictors of nosocomial bloodstream infections in older adults,"OBJECTIVES: To identify predictors and construct a prediction model for nosocomial bloodstream infection (BSI) in older adults. DESIGN: Retrospective case-control study. SETTING: Hospitals belonging to the Duke Infection Control Outreach Network. PARTICIPANTS: Patients age 65 and older with a nosocomial BSI and matched uninfected controls. MEASUREMENT: Multiple variables were captured and compared between groups. Independent predictors were identified using conditional logistic regression. A prediction model and score was constructed. RESULTS: Eight hundred thirty cases were compared with 830 controls. Eighty-one percent of nosocomial BSIs were catheter related (CRBSI). Methicillin-resistant Staphylococcus aureus (MRSA) was the most common pathogen isolated (23%). Independent predictors of nosocomial BSI in older adults were male sex, obesity, low McCabe score on admission, presence of a central line at admission, gastrostomy at admission, recent surgery, and urinary incontinence. A prediction model score greater than 11 (total possible score 23) was predictive of infection. CONCLUSION: MRSA is a common cause of CRBSI in older adults. Male sex, obesity, the presence of a central line, a gastrostomy tube, and urinary incontinence at the time of admission were independent predictors of BSI in hospitalized older adults. The prediction model constructed in this study should be validated prospectively in a different cohort. © 2011, The American Geriatrics Society.",immunosuppressive agent;ADL disability;aged;article;bacterium identification;bacterium isolation;bloodstream infection;case control study;catheter infection;central venous catheter;cerebrovascular accident;chronic obstructive lung disease;clinical assessment;coagulase negative Staphylococcus;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;diabetes mellitus with end organ damage;dialysis;feeding;gastrostomy;geriatric patient;heart infarction;hemiplegia;hospital infection;human;Human immunodeficiency virus infection;immunosuppressive treatment;infection control;logistic regression analysis;major clinical study;methicillin resistant Staphylococcus aureus;multivariate analysis;obesity;patient safety;peptic ulcer;prognosis;retrospective study;risk reduction;urine incontinence,"Kaye, K. S.;Marchaim, D.;Chen, T. Y.;Chopra, T.;Anderson, D. J.;Choi, Y.;Sloane, R.;Schmader, K. E.",2011,,,0,
2209,"Vascular risk factors, brain infarcts and nonspecific white matter lesions","Nonspecific white matter lesions are often seen on MR scans of elderly people. The purpose of present article is to examine the potential relationship between MR detected nonspecific white matter lesions, vascular risk factors and different type of brain infarcts. Our study group consisted of 89 male and female aged from 28 to 90 with history of cerebrovascular risk factors and no dementia. Nonspecific white matter lesions were found in 49 (55%). Clinical data retrieved from the patient files included age, sex, presence of hypertension, presence of diabetes mellitus and presence of vascular disease (defined as a history of angina pectoris, myocardial infarction, congestive heart failure, intermittent claudi-cation or vascular surgery). Patients with vascular cognitive impairment and nonspecific white matter lesions were vastly older than these free of lesions (t-test P=0.001). History of hypertension we founded in 81.6% in patients with lesions and 62.5% without lesions (t-test P=0.043). Patients with white matter lesions more often presented with lacunar brain infarcts (t-test P=0.0002). Analyses of other factors exhibited that no significant difference was found in the distribution of diabetes mellitus, angina pectoris, myocardial infarction, congestive heart failure and valvular disease among groups with and without lesions. Left ventricular hypertrophy, ischemic ST-T patterns and dysrhythmia on electrocardiograms were also not significantly associated with white matter lesions. Our results confirm that development of white matter lesions correlated vastly with age, hypertension and lacunar brain infarcts.",adult;aged;angina pectoris;article;brain infarction;cerebrovascular disease;congestive heart failure;dementia;diabetes mellitus;electrocardiogram;female;heart arrhythmia;heart infarction;heart left ventricle hypertrophy;human;hypertension;intermittent claudication;major clinical study;male;nuclear magnetic resonance imaging;risk factor,"Kazakov, D.",2005,,,0,
2210,Clinical spectrum of valosin containing protein (VCP)-opathy,"Introduction: Valosin containing protein (VCP) mutations cause a rare disorder characterized by hereditary inclusion body myopathy, Paget disease of bone (PDB), and frontotemporal dementia (FTD) with variable penetrance. VCP mutations have also been linked to amyotrophic lateral sclerosis and Charcot-Marie-Tooth disease type 2. Methods: Review of clinical, serological, electrophysiological, and myopathological findings of 6 VCP-opathy patients from 4 unrelated families. Results: Patients manifested muscle weakness between ages 40 and 53 years and developed predominant asymmetric limb girdle weakness. One patient had distal weakness at onset and co-existing peripheral neuropathy. Another patient had PDB, 1 had mild cognitive deficits, and 1 had FTD. All patients had myopathic and neurogenic electromyographic findings with predominant neurogenic changes in 2. Rimmed vacuoles were infrequent, while neurogenic changes were prominent in muscle biopsies. Conclusions: VCP-opathy is a multifaceted disorder in which myopathy and peripheral neuropathy can coexist. The electrophysiological and pathological neurogenic changes raise the possibility of coexisting motor neuron involvement. Muscle Nerve, 2015 Muscle Nerve 54: 94–99, 2016 Muscle Nerve 54: 94–99, 2016.",alkaline phosphatase;bisphosphonic acid derivative;valosin containing protein;adult;alkaline phosphatase blood level;arm weakness;article;bone density;clinical article;clinical feature;cognition;cognitive defect;diastolic dysfunction;dysphagia;electromyography;electrophysiology;female;frontotemporal dementia;heart left ventricle hypertrophy;heart right bundle branch block;human;infraspinatus muscle;limb weakness;male;middle aged;muscle action potential;muscle biopsy;muscle weakness;myopathy;osteopenia;Paget bone disease;paresthesia;peripheral neuropathy;priority journal;quadriceps femoris muscle;retrospective study;serology;valosin containing protein opathy;vastus medialis muscle,"Kazamel, M.;Sorenson, E. J.;McEvoy, K. M.;Jones, L. K.;Leep-Hunderfund, A. N.;Mauermann, M. L.;Milone, M.",2016,,,0,
2211,Mild cognitive impairment with associated inflammatory and cortisol alterations as independent risk factor for postoperative delirium,"AIMS: The present study aimed to determine the impact of mild cognitive impairment (MCI) on the development of postoperative delirium and, secondly, to assess the association between MCI and raised perioperative cortisol, cytokine, cobalamin and homocysteine levels. METHODS: The study recruited 113 consecutive adult patients scheduled for cardiac surgery with cardiopulmonary bypass. The patients were examined preoperatively with the Montreal Cognitive Assessment and Trail Making Test. A diagnosis of MCI was established based upon the criteria of the National Institute on Aging and Alzheimer's Association. Patients were screened for delirium within the first 5 days postoperatively. RESULTS: MCI was diagnosed in 24.8% of the patients, whereas the frequency of delirium was 36%. A multivariate analysis demonstrated that individuals with MCI were at a significantly higher risk of postoperative delirium (OR = 6.33, p = 0.002). Preoperative cortisol, postoperative cortisol and IL-2 plasma levels were higher in the MCI group as compared to non-MCI subjects. CONCLUSION: MCI is associated with a higher risk of postoperative delirium. Perioperative cortisol and inflammatory alterations observed in MCI may provide a physiological explanation for this increased risk.",Aged;Coronary Artery Bypass/*adverse effects;Coronary Artery Disease/complications/*surgery;*Delirium/blood/diagnosis/etiology/physiopathology/psychology;Female;Humans;Hydrocortisone/*blood;Inflammation/metabolism;Intelligence Tests;Interleukin-2/*blood;Male;Middle Aged;*Mild Cognitive Impairment/complications/diagnosis/physiopathology/psychology;Multivariate Analysis;Postoperative Complications/blood/diagnosis/physiopathology/psychology;Preoperative Care/methods;Risk Assessment;Risk Factors,"Kazmierski, J.;Banys, A.;Latek, J.;Bourke, J.;Jaszewski, R.;Sobow, T.;Kloszewska, I.",2014,,10.1159/000357454,0,
2212,Blood pressure variability and dementia rating scale performance in older adults with cardiovascular disease,"OBJECTIVE: The present study examined the relationship between multiple indices of blood pressure (BP) and cognitive function (as measured by the Dementia Rating Scale). BACKGROUND: Cardiovascular disease (CVD) is associated with cognitive dysfunction and cerebrovascular pathology in the elderly and is a known risk factor for stroke and Alzheimer disease. Yet, the mechanisms for the effects of CVD on cognitive function are not well understood. METHODS: Participants were 97 nondemented older adults with CVD who underwent neuropsychologic assessment, and a 2-hour cardiovascular laboratory protocol. RESULTS: After controlling for age and years of education, results of hierarchical linear regression analyses indicate a significant positive relationship between a function of BP variability (SD of systolic BP divided by the average diastolic BP) and cognitive function (R change=0.042, F (1, 85)=5.434, P<0.05). No relationship emerged between any other BP index and cognitive function. CONCLUSIONS: Contrary to expectations, greater BP variability was associated with better, not poorer, cognitive test performance. These findings suggest that the relationship between BP and cognitive function is more complicated than originally conceptualized and requires further investigation. © 2007 Lippincott Williams & Wilkins, Inc.",adult;aged;article;attention;blood pressure variability;cardiovascular disease;cardiovascular parameters;cognition;concept formation;controlled study;dementia;diabetes mellitus;diastolic blood pressure;educational status;female;heart failure;heart infarction;heart output;heart surgery;human;hypertension;laboratory test;linear regression analysis;major clinical study;male;memory;neuropsychological test;priority journal;rating scale;systolic blood pressure,"Keary, T. A.;Gunstad, J.;Poppas, A.;Paul, R. H.;Jefferson, A. L.;Hoth, K. F.;Sweet, L. H.;Forman, D. E.;Cohen, R. A.",2007,,,0,
2213,Maximising the use of HRT: Focus an hysterectomised women,"Hysterectomy is one of the most common gynaecological surgical operations performed in the UK. In addition to causing the early onset of the menopause, hysterectomy can lead some women to be at a increased risk of future CHD and osteoporosis owing to declining oestrogen levels. Hysterectomised women are therefore an ideal group to receive hormone replacement (HRT). However, only small numbers of women receive HRT owing to the number of factors, including fear of potential complications and adverse side effects. Of those women who do receive HRT, compliance with therapy is low. In this article, the authors weigh the benefits of HRT, in terms of relief of menopausal symptoms, and prevention of osteoperosis, Alzheimer's disease and cardiovascular disease, against the known risks. The authors suggest that compliance with HRT could be optimised by profiling patients in general practice and by educating women on the long-term benefits of HRT.",estrogen;article;estrogen blood level;female;hormone substitution;human;hysterectomy;ischemic heart disease;menopause;onset age;osteoporosis;patient compliance;patient education;risk benefit analysis;United Kingdom,"Keating, F. S.;Manassiev, N.;Stevenson, J. C.",1999,,,0,
2214,Causal Assessment of Serum Urate Levels in Cardiometabolic Diseases Through a Mendelian Randomization Study,"Background Although epidemiological studies have reported positive associations between circulating urate levels and cardiometabolic diseases, causality remains uncertain. Objectives Through a Mendelian randomization approach, we assessed whether serum urate levels are causally relevant in type 2 diabetes mellitus (T2DM), coronary heart disease (CHD), ischemic stroke, and heart failure (HF). Methods This study investigated 28 single nucleotide polymorphisms known to regulate serum urate levels in association with various vascular and nonvascular risk factors to assess pleiotropy. To limit genetic confounding, 14 single nucleotide polymorphisms exclusively associated with serum urate levels were used in a genetic risk score to assess associations with the following cardiometabolic diseases (cases/controls): T2DM (26,488/83,964), CHD (54,501/68,275), ischemic stroke (14,779/67,312), and HF (4,526/18,400). As a positive control, this study also investigated our genetic instrument in 3,151 gout cases and 68,350 controls. Results Serum urate levels, increased by 1 SD due to the genetic score, were not associated with T2DM, CHD, ischemic stroke, or HF. These results were in contrast with previous prospective studies that did observe increased risks of these 4 cardiometabolic diseases for an equivalent increase in circulating urate levels. However, a 1 SD increase in serum urate levels due to the genetic score was associated with increased risk of gout (odds ratio: 5.84; 95% confidence interval: 4.56 to 7.49), which was directionally consistent with previous observations. Conclusions Evidence from this study does not support a causal role of circulating serum urate levels in T2DM, CHD, ischemic stroke, or HF. Decreasing serum urate levels may not translate into risk reductions for cardiometabolic conditions.",angiopoietin;angiopoietin like protein 3;angiopoietin like protein 4;apolipoprotein A1;apolipoprotein A2;apolipoprotein A5;apolipoprotein B;apolipoprotein C3;apolipoprotein E;ataxin 2;blood clotting factor 7;cholesterol;cystatin C;endothelial leukocyte adhesion molecule 1;eotaxin;fatty acid;fibroblast growth factor 21;gelatinase B;glucose;hemoglobin A1c;high density lipoprotein cholesterol;insulin;lipoprotein;low density lipoprotein cholesterol;PADGEM protein;stromal cell derived factor 1;triacylglycerol;unclassified drug;unindexed drug;urate;vasculotropin A;article;body height;body mass;body weight;brain ischemia;cholesterol blood level;controlled study;diastolic blood pressure;disease association;estimated glomerulus filtration rate;genetic association;genetic risk;genetic risk score;genetic variability;glomerulus filtration rate;glucose blood level;gout;heart failure;heart rate;hemoglobin blood level;hip circumference;human;insulin blood level;insulin resistance;ischemic heart disease;lipoprotein blood level;Mendelian randomization analysis;non insulin dependent diabetes mellitus;obesity;pleiotropy;priority journal;protein blood level;risk factor;single nucleotide polymorphism;systolic blood pressure;triacylglycerol blood level;uric acid blood level;waist circumference;waist hip ratio,"Keenan, T.;Zhao, W.;Rasheed, A.;Ho, W. K.;Malik, R.;Felix, J. F.;Young, R.;Shah, N.;Samuel, M.;Sheikh, N.;Mucksavage, M. L.;Shah, O.;Li, J.;Morley, M.;Laser, A.;Mallick, N. H.;Zaman, K. S.;Ishaq, M.;Rasheed, S. Z.;Memon, F. U. R.;Ahmed, F.;Hanif, B.;Lakhani, M. S.;Fahim, M.;Ishaq, M.;Shardha, N. K.;Ahmed, N.;Mahmood, K.;Iqbal, W.;Akhtar, S.;Raheel, R.;O'Donnell, C. J.;Hengstenberg, C.;März, W.;Kathiresan, S.;Samani, N.;Goel, A.;Hopewell, J. C.;Chambers, J.;Cheng, Y. C.;Sharma, P.;Yang, Q.;Rosand, J.;Boncoraglio, G. B.;Kazmi, S. U.;Hakonarson, H.;Köttgen, A.;Kalogeropoulos, A.;Frossard, P.;Kamal, A.;Dichgans, M.;Cappola, T.;Reilly, M. P.;Danesh, J.;Rader, D. J.;Voight, B. F.;Saleheen, D.",2016,,,0,
2215,"Unexplained high fever in an elderly patient treated with clonidine, duloxetine, and atorvastatin","Background: Drug-induced fever is a clinical diagnosis and should always be considered when the fever is constant and high without a clear source of infection. Although drug-induced fever has been reported with other centrally acting antihypertensive drugs such as methyldopa, published reports of this adverse effect with clonidine in humans were not identified in a search of the literature. Case summary: A 66-year-old institutionalized white female with a history of morbid obesity (body mass index, 40 kg/m2), Alzheimer's dementia, hypertension, and depression presented to a hospital in Boston, Massachusetts (Caritas Saint Elizabeth's Medical Center) with generalized weakness and shortness of breath and was found to have a non-ST segment elevation myocardial infarction. Before hospitalization, the patient was taking memantine 10 mg PO BID, donepezil 10 mg PO once daily, duloxetine 60 mg PO once daily, clonidine 0.1 mg PO TID, metoprolol 50 mg PO BID, and amlodipine 10 mg PO once daily. On admission, the patient was initiated on aspirin 325 mg, atorvastatin 80 mg, and clopidogrel 75 mg PO daily. Her dose of clonidine was increased to 0.2 mg PO TID to optimize blood pressure control, and metoprolol and amlodipine were continued at the same doses. The patient developed fever on the third day after the cardiac catheterization. The fever ranged from 99.0°F to 102.7°F. The physical examination, laboratory data analysis, multiple blood cultures, urinalysis, chest radiograph, and a computed tomography of the head, chest, abdomen, and pelvis did not reveal any source of infection. On the sixth day after admission, clonidine was reduced to the baseline dose of 0.1 mg PO TID and on the ninth day it was stopped. The patient was afebrile on the twelfth day and remained so for the duration of her hospitalization. Naranjo scores for her newly initiated concomitant medications were as follows: aspirin, 1; atorvastatin, 3; clonidine, 6; and clopidogrel, 1. The rating of 6 for clonidine suggests that it was probably associated with the fever in this patient. Conclusion: We describe a case of drug-induced fever probably associated with clonidine administration. The higher dose of clonidine alone or in interaction with duloxetine and atorvastatin may have contributed to the development of drug-induced fever. © 2009 Excerpta Medica Inc. All rights reserved.",acetylsalicylic acid;amlodipine;atorvastatin;clonidine;clopidogrel;donepezil;duloxetine;memantine;metoprolol;aged;Alzheimer disease;article;blood culture;blood pressure regulation;case report;computer assisted tomography;dementia;depression;drug dose increase;drug dose reduction;drug fever;drug megadose;drug withdrawal;female;heart catheterization;heart infarction;human;hypertension;laboratory test;morbid obesity;physical examination;thorax radiography;urinalysis,"Kelesidis, T.;Kelesidis, I.",2009,,,0,
2216,Hormone substitution therapy in menopause,"Postmenopausal estrogen deprivation is a major cause for vasomotor and psychic complaints and for urogenital dysfunction, it is also a risk factor for osteoporosis, hip fracture, cardiovascular disease and possibly dementia. Hormone replacement therapy is highly effective in improving hot flushes, insomnia, depression and genital atrophia, but it prevents bone mineral loss and coronary heart disease as well. The potential risk for thromboembolism remains small and there is no final proof for a significant increase of breast cancer. Hysterectomized women may be treated with unopposed estrogens, otherwise progestogens must be added in a cyclic or continuous manner in order to protect the endometrium. Natural estrogens are to be preferred, they may be administered orally, percutaneously or vaginally. Long acting subcutaneous implants are also gaining interest. Prolonged treatment for many years is essential in order to be preventive. Compliance by motivation and comprehensive care is therefore indispensable.",conjugated estrogen;cyproterone acetate;dydrogesterone;estradiol;estradiol valerate;estrogen;ethinylestradiol;gestagen;medroxyprogesterone acetate;norethisterone acetate;progesterone;depression;estrogen deficiency;female;flushing;hormone substitution;human;insomnia;intramuscular drug administration;intravaginal drug administration;menopause;oral drug administration;short survey;subcutaneous drug administration;transdermal drug administration,"Keller, P. J.;Maurer-Major, E.",1997,,,0,
2217,Should systematic risk assessment and immediate intervention of the acutely ill patient replace the traditional management paradigm?,"The outcome of the traditional diagnostic history and physical depends entirely on the availability, ability and diligence of an individual doctor. An alternative is a team-based approach that performs the following tasks: a focused assessment, monitoring of the response to initial treatment, and then determining what further management is appropriate (calling for urgent help if it is required). This concept is based on risk prediction rather than diagnosis, and is captured by the mnemonic FAITH3 (Focused Assessment, Initial Treatment, hAssessing response, calling for Help and Handing over care). © 2012 Rila Publications Ltd.",acetylsalicylic acid;amylase;beta adrenergic receptor blocking agent;electrolyte;low molecular weight heparin;acute coronary syndrome;air conditioning;analgesia;antibiotic therapy;blood cell count;coronary care unit;death;delirium;dementia;diabetic ketoacidosis;dyspnea;epigastric pain;heart arrest;heart arrhythmia;heart infarction;hospital admission;human;hypotension;hypoxia;infection;infusion;life expectancy;liver function test;lung embolism;medical education;mental health;patient assessment;peptic ulcer;physical examination;renal replacement therapy;risk assessment;short survey,"Kellett, J.",2012,,,0,
2218,Disability and decline in physical function associated with hospital use at end of life,"BACKGROUND: Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions. OBJECTIVE: To concurrently examine regional and patient factors, including disability and functional decline, associated with end-of-life hospital use. DESIGN/PARTICIPANTS: We sampled decedents aged 65 and older (n = 2,493) from the Health and Retirement Study (2000-2006), and linked data from individual Medicare claims and the Dartmouth Atlas of Health Care. Two-part regression models estimated the relationship between total hospital days in the last 6 months and patient characteristics including physical function, while adjusting for regional resources and hospital care intensity (HCI). KEY RESULTS: Median hospital days was 7 (range = 0-183). 53% of respondents had functional decline. Compared with decedents without functional decline, those with severe disability or decline had more regression-adjusted hospital days (range 3.47-9.05, depending on category). Dementia was associated with fewer days (-3.02); while chronic kidney disease (2.37), diabetes (2.40), stroke or transient ischemic attack (2.11), and congestive heart failure (1.74) were associated with more days. African Americans and Hispanics had more days (5.91 and 4.61, respectively). Those with family nearby had 1.62 fewer days and hospice enrollees had 1.88 fewer days. Additional hospital days were associated with urban residence (1.74) and residence in a region with more specialists (1.97) and higher HCI (2.27). CONCLUSIONS: Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.","Activities of Daily Living;Aged;Aged, 80 and over;Chronic Disease;Dementia/physiopathology;Disability Evaluation;Disabled Persons/statistics & numerical data;Female;Frail Elderly/*statistics & numerical data;Geriatric Assessment/methods;Hospitalization/*statistics & numerical data;Humans;Length of Stay/statistics & numerical data;Longitudinal Studies;Male;Medicare/statistics & numerical data/*utilization;Socioeconomic Factors;Terminal Care/methods/*utilization;United States","Kelley, A. S.;Ettner, S. L.;Morrison, R. S.;Du, Q.;Sarkisian, C. A.",2012,Jul,10.1007/s11606-012-2013-9,0,
2219,Out-of-pocket spending in the last five years of life,"BACKGROUND: A key objective of the Medicare program is to reduce risk of financial catastrophe due to out-of-pocket healthcare expenditures. Yet little is known about cumulative financial risks arising from out-of-pocket healthcare expenditures faced by older adults, particularly near the end of life. DESIGN: Using the nationally representative Health and Retirement Study (HRS) cohort, we conducted retrospective analyses of Medicare beneficiaries' total out-of-pocket healthcare expenditures over the last 5 years of life. PARTICIPANTS: We identified HRS decedents between 2002 and 2008; defined a 5 year study period using each subject's date of death; and excluded those without Medicare coverage at the beginning of this period (n = 3,209). MAIN MEASURES: We examined total out-of-pocket healthcare expenditures in the last 5 years of life and expenditures as a percentage of baseline household assets. We then stratified results by marital status and cause of death. All measurements were adjusted for inflation to 2008 US dollars. RESULTS: Average out-of-pocket expenditures in the 5 years prior to death were $38,688 (95 % Confidence Interval $36,868, $40,508) for individuals, and $51,030 (95 % CI $47,649, $54,412) for couples in which one spouse dies. Spending was highly skewed, with the median and 90th percentile equal to $22,885 and $89,106, respectively, for individuals, and $39,759 and $94,823, respectively, for couples. Overall, 25 % of subjects' expenditures exceeded baseline total household assets, and 43 % of subjects' spending surpassed their non-housing assets. Among those survived by a spouse, 10 % exceeded total baseline assets and 24 % exceeded non-housing assets. By cause of death, average spending ranged from $31,069 for gastrointestinal disease to $66,155 for Alzheimer's disease. CONCLUSION: Despite Medicare coverage, elderly households face considerable financial risk from out-of-pocket healthcare expenses at the end of life. Disease-related differences in this risk complicate efforts to anticipate or plan for health-related expenditures in the last 5 years of life. © 2012 Society of General Internal Medicine.",aged;Alzheimer disease;article;cerebrovascular accident;cohort analysis;congestive heart failure;cost control;death;dementia;diabetes mellitus;falling;female;financial management;gastrointestinal disease;health care cost;heart disease;human;hypertension;lung disease;major clinical study;male;marriage;medicaid;medical record review;medicare;memory disorder;neoplasm;retrospective study;survival,"Kelley, A. S.;McGarry, K.;Fahle, S.;Marshall, S. M.;Du, Q.;Skinner, J. S.",2013,,,0,
2220,Attacking amyloid,,amyloid;amyloid beta protein;binding protein;congo red;Alzheimer disease;article;atomic force microscopy;binding affinity;cardiomyopathy;dissociation constant;familial amyloid polyneuropathy;IC50;inhibition kinetics;neurotoxicity;Parkinson disease;plasticity;priority journal;protein aggregation;protein binding;protein interaction;protein structure,"Kelly, J. W.",2005,,,0,
2221,An in silico appraisal to identify high affinity anti-apoptotic synthetic tetrapeptide inhibitors targeting the mammalian caspase 3 enzyme,"Apoptosis is a general phenomenon of all multicellular organisms and caspases form a group of important proteins central to suicide of cells. Pathologies like cancer, Myocardial infarction, Stroke, Sepsis, Alzheimer's, Psoriasis, Parkinson and Huntington diseases are often associated with change in caspase 3 mediated apoptosis and therefore, caspases may serve as potential inhibitory targets for drug development. In the present study, two series of synthetic acetylated tetrapeptides containing aldehyde and fluromethyl keto groups respectively at the C terminus were proposed. All these compounds were evaluated for binding affinity against caspase 3 structure. In series 1 compound Ac-DEHD-CHO demonstrated appreciable and high binding affinity (Rerank Score: -138.899) against caspase 3. While in series 2 it was Ac-WEVD-FMK which showed higher binding affinity (Rerank Score: -139.317). Further these two compounds met ADMET properties and demonstrated to be non- toxic.",Aldehydes;Animals;*Apoptosis;*Caspase 3;*Caspase Inhibitors;Computer Simulation;Drug Discovery;Humans;Mammals;*Molecular Docking Simulation,"Kelotra, S.;Jain, M.;Kelotra, A.;Jain, I.;Bandaru, S.;Nayarisseri, A.;Bidwai, A.",2014,,,0,
2222,"Different Experiences and Goals in Different Advanced Diseases: Comparing Serial Interviews With Patients With Cancer, Organ Failure, or Frailty and Their Family and Professional Carers","CONTEXT: Quality care for people living with life-limiting illnesses is a global priority. A detailed understanding of the varied experiences of people living and dying with different conditions and their family and professional caregivers should help policymakers and clinicians design and deliver more appropriate and person-centered care. OBJECTIVES: To understand how patients with different advanced conditions and their family and professional caregivers perceive their deteriorating health and the services they need. METHODS: We used a narrative framework to synthesize eight methodologically comparable, longitudinal, and multiperspective interview studies. We compared the end-of-life experiences of people dying from cancer (lung, glioma, and colorectal cancer), organ failure (heart failure, chronic obstructive pulmonary disease, and liver failure), and physical frailty and those of their family and professional caregivers in socioeconomically and ethnically diverse populations in Scotland. RESULTS: The data set comprised 828 in-depth interviews with 156 patients, 114 family caregivers, and 170 health professionals. Narratives about cancer typically had a clear beginning, middle, and an anticipated end. Cancer patients gave a well-rehearsed account of their illness, hoping for recovery alongside fear of dying. In contrast, people with organ failure and their family caregivers struggled to pinpoint when their illness began, or to speak openly about death, hoping instead to avoid further deterioration. Frail older people tended to be frustrated by their progressive loss of independence, fearing dementia or nursing home admission more than dying. CONCLUSION: These contrasting illness narratives affect and shape the experiences, thoughts, and fears of patients and their carers in the last months of life. Palliative care offered by generalists or specialists should be provided more flexibly and equitably, responding to the varied concerns and needs of people with different advanced conditions.",Cancer;end-of-life care;frailty;illness trajectories;organ failure;palliative care;qualitative longitudinal research;serial interviews,"Kendall, M.;Carduff, E.;Lloyd, A.;Kimbell, B.;Cavers, D.;Buckingham, S.;Boyd, K.;Grant, L.;Worth, A.;Pinnock, H.;Sheikh, A.;Murray, S. A.",2015,Aug,10.1016/j.jpainsymman.2015.02.017,0,
2223,Hypertension in the elderly,"In those aged 65-85 years, the major causes of death and disability are cardiovascular diseases (myocardial infarction, sudden death and stroke). Clinical trials in elderly patients have demonstrated unequivocally that effective blood pressure reduction in hypertensive patients up to the age of 85 years significantly reduces this mortality and morbidity. The larger trials are referred to as the SHEP trial (chlorthalidone), the STOP trial (β-blockers and/or diuretics), the MRC Elderly Trial (atenolol or diuretic) and the SYST-EUR trial (nitrendipine). Patients entered into clinical trials are a selected population; those with serious coexisting diseases and with a poor prognosis are usually excluded. For this reason one has to carefully consider whether the results of these trials would provide the best treatment for the next patient the doctor sees who would probably not meet the entry criteria. Elderly hypertensives may fall into one of three categories. The sick elderly with serious disorders such as cancer or dementia have a poor quality of life and a bad prognosis. They should not be given antihypertensive drugs. The medically complicated elderly have serious disorders, which usually require drug therapy and the medical condition and the drugs used in treatment may complicate the choice of antihypertensive drugs. The potential adverse effects of adding another form of drug treatment may outweigh the potential benefits. The fit elderly do derive considerable benefit from adequate blood pressure control and need an effective, well-tolerated antihypertensive drug. The choice of drug to control blood pressure in the elderly is difficult. An effective, well-tolerated antihypertensive with little potential to interact with coexisting disorders and other drugs is needed.",antihypertensive agent;atenolol;beta adrenergic receptor blocking agent;chlortalidone;diuretic agent;nitrendipine;aged;article;blood pressure regulation;neoplasm;cardiovascular disease;cause of death;dementia;disability;drug choice;human;hypertension;morbidity;mortality;prognosis;quality of life;risk benefit analysis;treatment planning,"Kendall, M. J.",1998,,,0,
2224,"Aging, stress, and sudden cardiac death","Cardiac arrhythmia leading to sudden death is a common disease of middle age, but its impact on the survival and function of older adults has been largely ignored. This is in spite of the facts that (a) cardiovascular diseases already complicate or account for 25% of the dementias: (b) as many as half of all sudden deaths occur in individuals 75 years or olders; and (c) 30%-50% of those resuscitated are left with significant cognitive deficits. Age-related stressors (bereavement, social isolation, retirement dissatisfaction, changes in major life events, and household size) have been empirically linked to cardiovascular mortality, and there is reason to believe that the unifying emotional result of these stressors is episodic depression. We studied 88 patients during acute treatment for life-threatening arrhythmia. Follow-up mortality was significantly related to depression and cognitive impairment found at initial assessment. Impairment correlated with measures of depression, functional status, heart failure, and ventricular tachycardia, but not arrhythmia severity or treatment efficacy. Our results from middle-aged adults suggest that therapeutic advances that increase the number of arrhythmia survivors may proportionately raise the percentage of vascular dementia cases in the elderly and that some degree of the observed morbidity and mortality may be a manifestation of depression and dementia. If confirmed, these findings would also indicate that psychosocial interventions, in addition to biomedical advances, will be needed to maximally reduce sudden cardiac mortality and arrhythmia-related morbidity. We suggest that psychosocial interventions for patients at risk for sudden death focus on (a) reduction of age-related stressors through (b) aggressive treatment of depression and (c) early identification of and preparation for the behavioral sequelae of cognitive impairment.",age;aged;bereavement;cardiovascular disease;cardiovascular system;central nervous system;cognition;dementia;dissatisfaction;epidemiology;etiology;heart;heart arrhythmia;heart death;human;major clinical study;mortality;psychological aspect;retirement;social aspect;social isolation;stress,"Kennedy, G. J.;Fisher, J. D.",1987,,,0,
2225,Medical comorbidity and mental disorders in older adults,"Comorbidity is a common characteristic of mental illness in all age groups. In younger persons, however, the comorbidity is often a manifestation of substance abuse or personality disorder complicating another major mental illness. In older adults comorbidity is most often characterized by concurrent mental and physical illness with cardiovascular and cerebrovascular diseases playing the most prominent role in both the etiology and prognosis. Excessive or persistent disability is the common ground upon which medical comorbidity and mental disorders manifest their relationship.",2 aminobutyric acid;acetylsalicylic acid;alpha amino 3 hydroxy 5 methyl 4 isoxazolepropionic acid;amitriptyline;AMPA receptor antagonist;anticoagulant agent;antidepressant agent;antioxidant;benzodiazepine;calcium channel blocking agent;calpastatin;citicoline;clonidine;desipramine;donepezil;dopamine;dopamine receptor blocking agent;ganglioside;glutamate receptor antagonist;methylphenidate;moclobemide;noradrenalin;phenobarbital;propentofylline;psychotropic agent;serotonin antagonist;serotonin uptake inhibitor;sodium channel blocking agent;trazodone;unindexed drug;aged;behavior disorder;cardiovascular disease;cerebrovascular disease;comorbidity;congestive heart failure;coronary artery disease;dementia;depression;gerontopsychiatry;human;life event;mental disease;motor dysfunction;Parkinson disease;personality disorder;physical disease;psychologic assessment;risk factor;screening;serotonin syndrome;short survey;cerebrovascular accident,"Kennedy, G. J.;Frazier, A.",1999,,,0,
2226,Olanzapine does not enhance cognition in non-agitated and non-psychotic patients with mild to moderate Alzheimer's dementia,"Objective: This was an exploratory study of olanzapine as potential treatment for improvement in cognition in patients with Alzheimer's disease without prominent psychobehavioral symptoms. Methods: Non-psychotic/non-agitated patients (n = 268) with Alzheimer's disease, who had baseline Mini-Mental State Examination (MMSE) scores of 14-26 were randomized to treatment with olanzapine (2.5 to 7.5 mg/d) or placebo for 26 weeks. The primary objectives were to determine if treatment with olanzapine improved cognition as indexed by the Alzheimer's disease Assessment Scale for Cognition (ADAS-Cog) and the Clinician's Interview-Based Impression of Change (CIBIC) after 26 weeks of therapy. Results: Patients treated with olanzapine vs placebo experienced significant worsening ADAS-Cog scores at weeks 12 (p = 0.03) and 26 (p = 0.004). Changes in CIBIC scores were not significantly different between treatment groups at either assessment. A post hoc analysis revealed that olanzapine-treated patients with more cognitive impairment at baseline (MMSE scores of 14-18) (n = 35) experienced significantly greater deterioration in ADAS-Cog performance than patients in the placebo group (n = 24; p < 0.001); whereas in patients with less cognitive impairment (n = 78, baseline MMSE scores of 23-26) between-group ADAS-Cog changes were not significant. Conclusion: In this 26-week study non-psychotic/non-agitated patients with Alzheimer's disease treated with olanzapine experienced significant worsening of cognition as compared to placebo. Copyright © 2005 John Wiley & Sons, Ltd.",olanzapine;placebo;adult;aged;agitation;Alzheimer disease;amblyopia;amnesia;anxiety disorder;article;asthenia;cerebrovascular disease;clinical trial;cognition;cognitive defect;confusion;constipation;controlled clinical trial;controlled study;delirium;delusion;depression;diarrhea;disease severity;dizziness;double blind procedure;drug dose regimen;drug efficacy;drug safety;drug tolerability;dry skin;dyskinesia;extrapyramidal symptom;female;fever;flu like syndrome;gait disorder;gastrointestinal toxicity;hallucination;heart failure;human;insomnia;interview;intestine obstruction;major clinical study;male;multicenter study;muscle twitch;pain;peripheral edema;psychosis;randomized controlled trial;rating scale;reference value;scoring system;side effect;somnolence;tachycardia;treatment outcome;urinary tract infection;urine retention;vascular disease;weight gain;xerostomia,"Kennedy, J.;Deberdt, W.;Siegal, A.;Micca, J.;Degenhardt, E.;Ahl, J.;Meyers, A.;Kaiser, C.;Baker, R. W.",2005,,,0,
2227,Carotid sinus syndrome is common in dementia with Lewy bodies and correlates with deep white matter lesions,"Background: Carotid sinus syndrome (CSS) is a common cause of syncope in older persons. There appears to be a high prevalence of carotid sinus hypersensitivity (CSH) in patients with dementia with Lewy bodies (DLB) but not in Alzheimer's disease. Objective: To compare the prevalence of CSH in DLB and Alzheimer's disease, and to determine whether there is an association between CSH induced hypotension and brain white matter hyperintensities on magnetic resonance imaging (MRI). Methods: Prevalence of CSH was compared in 38 patients with DLB (mean (SD) age, 76 (7) years), 52 with Alzheimer's disease (80 (6) years), and 31 case controls (73 (5) years) during right sided supine carotid sinus massage (CSM). CSH was defined as cardioinhibitory (CICSH; >3 s asystole) or vasodepressor (VDCSH; >30 mm Hg fall in systolic blood pressure (SBP)). T2 weighted brain MRI was done in 45 patients (23 DLB, 22 Alzheimer). Hyperintensities were rated by the Scheltens scale. Results: Overall heart rate response to CSM was slower (RR interval = 3370 ms (640 to 9400)) and the proportion of patients with CICSH greater (32%) in DLB than in Alzheimer's disease (1570 (720 to 7800); 11.1%) or controls (1600 (720 to 3300); 3.2%) (p<0.01)). The strongest predictor of heart rate slowing and CSH was a diagnosis of DLB (Wald 8.0, p<0.005). The fall in SBP during carotid sinus massage was greater with DLB (40 (22) mm Hg) than with Alzheimer's disease (30 (19) mm Hg) or controls (24 (19) mm Hg) (both p<0.02). Deep white matter hyperintensities were present in 29 patients (64%). In DLB, there was a correlation between magnitude of fall in SBP during CSM and severity of deep white matter changes (R = 0.58, p = 0.005). Conclusions: Heart rate responses to CSM are prolonged in patients with DLB, causing hypotension. Deep white matter changes from microvascular disease correlated with the fall in SBP. Microvascular pathology is a key substrate of cognitive impairment and could be reversible in DLB where there are exaggerated heart rate responses to carotid sinus stimulation.",cardiovascular agent;digoxin;diltiazem;dipeptidyl carboxypeptidase inhibitor;diuretic agent;isosorbide;nifedipine;prazosin;aged;article;heart arrest;bradycardia;brain injury;carotid sinus massage;carotid sinus syndrome;controlled study;correlation analysis;dementia;female;heart rate;human;hypotension;Lewy body;major clinical study;male;nuclear magnetic resonance imaging;prediction;prevalence;priority journal,"Kenny, R. A.;Shaw, F. E.;O'Brien, J. T.;Scheltens, P. H.;Kalaria, R.;Ballard, C.",2004,,,0,
2228,When best practice is bad medicine: A new approach to rationing tertiary health services in South Africa,,acetylsalicylic acid;antiretrovirus agent;BCG vaccine;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;rivastigmine;Alzheimer disease;article;cost effectiveness analysis;drug cost;drug efficacy;drug marketing;good clinical practice;health care cost;health care delivery;health care financing;health care planning;health care quality;health care system;health economics;highly active antiretroviral therapy;human;Human immunodeficiency virus infection;human rights;ischemic heart disease;medical education;national health service;patient care;primary health care;public health;quality adjusted life year;resource allocation;socioeconomics;South Africa;tertiary health care;tuberculosis;aspirin,"Kenyon, C.;Ford, N.;Boulle, A.",2008,,,0,
2229,Hepatic computed tomography changes caused by amiodarone,,alanine aminotransferase;amiodarone;aspartate aminotransferase;bilirubin;thyroglobulin antibody;thyroid hormone;thyroid peroxidase antibody;thyrotropin;aged;aorta valve replacement;aorta valve stenosis;case report;chronic drug administration;computer assisted tomography;congestive heart failure;dementia;drug dose reduction;drug overdose;drug withdrawal;female;free liothyronine index;free thyroxine index;human;hypothyroidism;liver density;liver dysfunction;note;paroxysmal atrial fibrillation;very elderly,"Kenzaka, T.",2015,,,0,
2230,How to spot mitochondrial disease in adults,,adenosine triphosphate;cell nucleus DNA;lactic acid;mitochondrial DNA;mitochondrial protein;article;ataxia;autosomal dominant optic atrophy;cell metabolism;cerebrospinal fluid analysis;chronic progressive external ophthalmoplegia;dementia;disorders of mitochondrial functions;dystonia;echocardiography;electrocardiography;electroencephalography;electromyography;extrachromosomal inheritance;family history;fatigue;hereditary motor sensory neuropathy;heteroplasmy;Kearns Sayre syndrome;lactate blood level;Leber hereditary optic neuropathy;Leigh disease;MELAS syndrome;MERRF syndrome;middle aged;mitochondrial respiration;MNGIE syndrome;myalgia;myoclonus;myopathy;NARP syndrome;nerve conduction;neuroimaging;optic nerve atrophy;optic nerve disease;oxidative phosphorylation;parkinsonism;perception deafness;peripheral neuropathy;phenotype;retinopathy;seizure;spasticity,"Keogh, M. J.;Chinnery, P. F.",2013,,,0,
2231,The relationships between alcohol and dementia,"In recent years, a number of observational studies have shown that when consumed in moderation, alcohol may contribute to healthy living, reducing the risks of both coronary artery disease and dementia. While the ill effects of excessive drinking on cognition have been extensively described, there are no clinical or pathological consensus criteria defining alcohol-induced dementia. In fact, its existence as a distinct entity is controversial. More research on the effects of alcohol on the brain is needed in order to advise patients on the potential risks and benefits of alcohol consumption.",alcohol;estrogen;nonsteroid antiinflammatory agent;aged;alcohol abuse;alcohol consumption;article;brain blood flow;smoking;clinical observation;cognition;cognitive defect;coronary artery disease;dementia;diabetes mellitus;dietary intake;differential diagnosis;disease association;drinking behavior;health status;human;lifestyle;medical research;nuclear magnetic resonance imaging;pathophysiology;patient counseling;physical activity;risk assessment;risk benefit analysis;single photon emission computer tomography;thrombocyte aggregation inhibition;wine,"Keren, R.",2003,,,0,
2232,Documenting life-support preferences in hospitalized patients,"Purpose: The purpose of this article was to determine the extent to which patients at high risk of hospital death who undergo cardiopulmonary resuscitation (CPR) have previously had their life support preferences addressed and documented. Materials and Methods: We conducted a retrospective chart review of all patients older than 18 years of age hospitalized for more than 24 hours who sustained a cardiac arrest with attempted CPR at our tertiary care university teaching hospital during 1994 (n = 71). We searched all hospital charts specifying ICD-9 codes: Cardiac arrest, ventricular fibrillation, ventricular tachycardia, asystole, electromechanical dissociation, defibrillation, or CPR. Patients were selected if (1) they had a true cardiac arrest (abrupt cessation of spontaneous circulation) and (2) had attempted CPR or defibrillation. Patients were classified as 'high risk' if they satisfied at least one of the following: modified prearrest morbidity index ≤ 7, moderate/severe dementia, day 1 APACHE II score > 24 or ≤ 4 dysfunctional organ systems. Results: We searched 147 charts; of 71 patients meeting inclusion criteria, 53 were high risk. Of patients at high risk of sustaining a cardiopulmonary arrest during the index hospital admission, 3 (6%) had preferences addressed within the first 24 hours of hospitalization, 7 (13%) had delayed discussion of preferences before arrest, 23 (43%) had preferences addressed post arrest, and 20 (38%) had no documented discussions. Of the 23 high-risk patients initially surviving cardiac arrest, all were subsequently given 'do not resuscitate' orders. Univariate analysis of factors associated with life-support discussion before cardiac arrest were previous cardiac arrest (OR, 5.9) and APACHE II score > 24 (OR, 1.1), although neither reached statistical significance. None of the 32 patients with a modified PAM index ≤ 7 (32 of 71) survived hospitalization. Only 3 patients survived to hospital discharge. Conclusions: Early communication regarding life-support preferences is important in high-risk patients so that inappropriate or unwanted treatment is not implemented. Given that optimal care includes addressing and documenting life-support preferences in high-risk patients early in their hospitalization, this standard was infrequently met.",adult;article;heart arrest;cardiopulmonary arrest;defibrillation;female;health care delivery;heart ventricle fibrillation;heart ventricle tachycardia;high risk patient;hospital admission;human;informed consent;major clinical study;male;resuscitation;survival rate;teaching hospital,"Kernerman, P.;Cook, D. J.;Griffith, L. E.",1997,,,0,
2233,Mini-Mental State Examination score and B-type natriuretic peptide as predictors of cardiovascular and total mortality in an elderly general population,"INTRODUCTION. The aim of the present study was to examine the power of B-type natriuretic peptide (BNP) and mild cognitive impairment as independent predictors of total and cardiovascular mortality in combination with established cardiovascular risk markers in an elderly general population without severe cognitive impairment. METHODS. A total of 499 individuals, aged more than 75 years, were examined and followed up for a median of 7.9 years in a prospective population-based stratified cohort study carried out in eastern Finland. The Cox proportional hazards regression model was used to determine the impact of multiple factors on total and cardiovascular mortality. RESULTS. In a multivariable model including established cardiovascular risk factors and conditions, both continuous BNP (adjusted hazard ratio (HR) 1.44 for a 1-SD change; 95% confidence interval (CI) 1.22-1.77; P < 0.001) and continuous MMSE score (HR 0.81 for a 1-SD change; 95% CI 0.70-0.94; P = 0.007) were independently associated with all-cause mortality. In a multivariable model, BNP remained a significant predictor of cardiovascular mortality, while MMSE score lost its significance. CONCLUSIONS. BNP, a measure of cardiovascular burden, and MMSE score 18-23, an indicator of mild cognitive impairment, are both independent predictors of total mortality. BNP and MMSE score may potentially be useful in screening elderly patients for elevated risk of mortality.","Aged;Cardiovascular Diseases/*mortality;Cognition Disorders/blood/*diagnosis;Dementia/blood/*diagnosis;Female;Finland/epidemiology;Geriatric Assessment;Heart Failure/diagnosis/mortality;Humans;Male;Mild Cognitive Impairment/blood/diagnosis;*Mortality;Multivariate Analysis;Natriuretic Peptide, Brain/*blood;*Neuropsychological Tests;Predictive Value of Tests;Proportional Hazards Models;Prospective Studies","Kerola, T.;Hiltunen, M.;Kettunen, R.;Hartikainen, S.;Sulkava, R.;Vuolteenaho, O.;Nieminen, T.",2011,Dec,10.3109/07853890.2010.526137,0,
2234,Changes in prescribing and healthcare resource utilization after FDA Drug Safety Communications involving zolpidem-containing medications,"Purpose: Products containing the sedative/hypnotic zolpidem were subject to Drug Safety Communications (DSCs) in January and May 2013 describing the risk of next-morning impairment and recommending lower starting doses particularly for women. This study aimed to assess whether zolpidem DSCs were associated with prescribing-pattern changes between January 2011 and December 2013. Methods: We assessed overall dispensings of zolpidem-containing products between January 2011 and December 2013 by conducting a time-series analysis. Analyses were stratified by gender because the DSC contained gender-specific information. Participants were patients drawn from the Optum Clinformatics data source of commercially insured people in the USA. We evaluated changes in mean prescribed dose of the two drugs and health care utilization metrics. Results: Each month of the study, more than 80 000 patients received a zolpidem-containing product and approximately one-tenth as many received eszopiclone. The two DSCs did not affect the downward trajectory of new zolpidem prescriptions. However, there was an increase in use of lower-dose forms of zolpidem (30% increase, p < 0.001), coupled with a reduction in higher-dose forms (13% decrease, p = 0.03), so that the average dose decreased after the DSCs (from 9.7 mg to 9.4 mg, p < 0.001), a change that was not seen with eszopiclone (from 2.74 mg to 2.74 mg, p = 0.45). Conclusion: The DSCs related to zolpidem-containing products shifted prescribing toward the lower-dose formulations, consistent with the recommendations in the DSCs. Copyright © 2017 John Wiley & Sons, Ltd.",eszopiclone;zolpidem;zolpidem tartrate;adult;aged;article;asthma;cerebrovascular accident;cerebrovascular disease;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;drowsiness;drug dose increase;drug formulation;drug release;drug safety;female;food and drug administration;health care utilization;human;hypertension;insomnia;low drug dose;major clinical study;male;malignant neoplasm;obesity;prescription;prevalence;priority journal;seasonal variation;sex difference;time series analysis;ambien;ambien cr;lunesta;zolpimist,"Kesselheim, A. S.;Donneyong, M.;Dal Pan, G. J.;Zhou, E. H.;Avorn, J.;Schneeweiss, S.;Seeger, J. D.",2017,,10.1002/pds.4215,0,
2235,"On the relationship between all-cause, cardiovascular, cancer and residual mortality rates with age","Background: The existence of a highly significant linear relationship between the natural logarithm (In) all-cause mortality rate and age at the population level is firmly established (r2>0.99). The slope and intercept of the equation, however, vary markedly between populations. Whether this relationship also applies to specific disease entities has not been established. Methods: Use was made of mortality rates for all-cause, total cardiovascular, total cancer and residual diseases. The midpoint of 5-year age classes between the ages of 35 and 84 years, obtained for both sexes, were analysed. The mean of the three latest available years, from the period 1997-1999 were used. Results: The relationship also applies to a slightly lesser degree to the relationship between total cardiovascular mortality rate, consisting predominantly of ischemic heart disease and stroke, and age (r 2>0.99). Marginally better relationships are obtained using a second-degree polynomial equation between In all-cause mortality rate and age, age2 as independent variables. Total In cancer mortality rate, however, behaves differently with a significant negative deviation of the mortality rate from linearity at older ages. Residual mortality (non-cancer, non-cardiovascular) mortality shows a mirror pattern to cancer mortality. This residual mortality expressed as a percentage of all-cause mortality varies markedly between populations. The level of some major constituents of the residual mortality rates (respiratory diseases, pneumonia, ill-defined causes and senility) also varies markedly. Conclusions: The magnitude of the variation suggests misclassification or misdiagnosis of several important disease entities, for example, between senility and stroke or between pneumonia and lung cancer. This questions the validity of disease-specific mortality rates especially at older ages, making their comparison between countries less reliable. © 2005 The European Society of Cardiology.",adult;age;aged;article;cancer mortality;cardiovascular disease;cause of death;diagnostic error;female;human;ischemic heart disease;lung cancer;male;pneumonia;priority journal;respiratory tract disease;senility;sex difference;cerebrovascular accident,"Kesteloot, H. E. C.;Verbeke, G.",2005,,,0,
2236,"All-cause and disease-specific mortality among male, former elite athletes: an average 50-year follow-up","AIM: To investigate life expectancy and mortality among former elite athletes and controls. METHODS: HR analysis of cause-specific deaths sourced from the national death registry for former Finnish male endurance, team and power sports athletes (N=2363) and controls (N=1657). The median follow-up time was 50 years. RESULTS: Median life expectancy was higher in the endurance (79.1 years, 95% CI 76.6 to 80.6) and team (78.8, 78.1 to 79.8) sports athletes than in controls (72.9, 71.8 to 74.3). Compared to controls, risk for total mortality adjusted for socioeconomic status and birth cohort was lower in the endurance ((HR 0.70, 95% CI 0.61 to 0.79)) and team (0.80, 0.72 to 0.89) sports athletes, and slightly lower in the power sports athletes (0.93, 0.85 to 1.03). HR for ischaemic heart disease mortality was lower in the endurance (0.68, 0.54 to 0.86) and team sports (0.73, 0.60 to 0.89) athletes. HR for stroke mortality was 0.52 (0.33 to 0.83) in the endurance and 0.59 (0.40 to 0.88) in the team sports athletes. Compared to controls, the risk for smoking-related cancer mortality was lower in the endurance (HR 0.20, 0.08 to 0.47) and power sports (0.40, 0.25 to 0.66) athletes. For dementia mortality, the power sports athletes, particularly boxers, had increased risk (HR 4.20, 2.30 to 7.81). CONCLUSIONS: Elite athletes have 5-6 years additional life expectancy when compared to men who were healthy as young adults. Lower mortality for cardiovascular disease was in part due to lower rates of smoking, as tobacco-related cancer mortality was especially low.","Adult;Aged;Aged, 80 and over;Case-Control Studies;Cause of Death;Dementia/mortality;Finland/epidemiology;Follow-Up Studies;Humans;*Life Expectancy;Male;Middle Aged;Myocardial Infarction/mortality;Neoplasms/mortality;Sports/*statistics & numerical data;Stroke/mortality;Survival Analysis;Young Adult;Athletics;Cardiovascular epidemiology;Elite performance;Epidemiology","Kettunen, J. A.;Kujala, U. M.;Kaprio, J.;Backmand, H.;Peltonen, M.;Eriksson, J. G.;Sarna, S.",2015,Jul,10.1136/bjsports-2013-093347,0,
2237,"All-cause and disease-specific mortality among male, former elite athletes: an average 50-year follow-up","AIM: To investigate life expectancy and mortality among former elite athletes and controls. METHODS: HR analysis of cause-specific deaths sourced from the national death registry for former Finnish male endurance, team and power sports athletes (N=2363) and controls (N=1657). The median follow-up time was 50 years. RESULTS: Median life expectancy was higher in the endurance (79.1 years, 95% CI 76.6 to 80.6) and team (78.8, 78.1 to 79.8) sports athletes than in controls (72.9, 71.8 to 74.3). Compared to controls, risk for total mortality adjusted for socioeconomic status and birth cohort was lower in the endurance ((HR 0.70, 95% CI 0.61 to 0.79)) and team (0.80, 0.72 to 0.89) sports athletes, and slightly lower in the power sports athletes (0.93, 0.85 to 1.03). HR for ischaemic heart disease mortality was lower in the endurance (0.68, 0.54 to 0.86) and team sports (0.73, 0.60 to 0.89) athletes. HR for stroke mortality was 0.52 (0.33 to 0.83) in the endurance and 0.59 (0.40 to 0.88) in the team sports athletes. Compared to controls, the risk for smoking-related cancer mortality was lower in the endurance (HR 0.20, 0.08 to 0.47) and power sports (0.40, 0.25 to 0.66) athletes. For dementia mortality, the power sports athletes, particularly boxers, had increased risk (HR 4.20, 2.30 to 7.81). CONCLUSIONS: Elite athletes have 5-6 years additional life expectancy when compared to men who were healthy as young adults. Lower mortality for cardiovascular disease was in part due to lower rates of smoking, as tobacco-related cancer mortality was especially low.",adult;aged;case control study;cause of death;cerebrovascular accident;dementia;epidemiology;Finland;follow up;heart infarction;human;life expectancy;male;middle aged;mortality;neoplasm;sport;statistics and numerical data;survival analysis;very elderly;young adult,"Kettunen, J. A.;Kujala, U. M.;Kaprio, J.;Bäckmand, H.;Peltonen, M.;Eriksson, J. G.;Sarna, S.",2015,,10.1136/bjsports-2013-093347,0,
2238,Cholinergic neuronal deficits in CADASIL,"BACKGROUND AND PURPOSE - Previous evidence from MRI and acetylcholinesterase histochemistry suggests cholinergic fibers are affected in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). METHODS - As a measure of cholinergic function, we assessed choline acetyltransferase (ChAT) activities in the frontal and temporal neocortices and the immunocytochemical distribution of ChAT and p75 neurotrophin receptor (P75) by in vitro imaging in the nucleus basalis of Meynert of CADASIL subjects. RESULTS - ChAT activities were significantly reduced by 60% to 70% in frontal and temporal cortices of CADASIL cases, as were ChAT and P75 immunoreactivities in the nucleus basalis. CONCLUSIONS - Our findings suggest cholinergic neuronal impairment in CADASIL and implicate cholinomimetic therapy for subcortical vascular dementias. © 2007 American Heart Association, Inc.",choline acetyltransferase;neurotrophin receptor;protein p75;adult;aged;article;CADASIL;cellular distribution;cholinergic activity;cholinergic nerve;clinical article;controlled study;enzyme activity;female;frontal cortex;histochemistry;human;human tissue;immunocytochemistry;immunoreactivity;male;Meynert basal nucleus;nerve function;nerve lesion;neuroimaging;neurologic disease;neuropathology;priority journal;protein localization;temporal cortex,"Keverne, J. S.;Low, W. C. R.;Ziabreva, I.;Court, J. A.;Oakley, A. E.;Kalaria, R. N.",2007,,,0,
2239,Use of vitamin D in various disorders,"Approximately 1 billion people worldwide have been identified as vitamin D deficient in the 21st century, and the number is on the rise; non-classical actions of vitamin D were initially recognized around 30 y ago when receptors for vitamin D were detected in neoplastic cells lines. The aim of this review is to provide a brief overview of the non-classical actions of vitamin D. Reports describing the associations of non skeletal actions of vitamin D, especially pertaining to the immune system, inflammatory disorders, cancers and cardiovascular disease have been summarized in this paper. Reports support a role for the active form of vitamin D in mediating normal function of both the innate and adaptive immune systems. Studies also suggest a link between vitamin D deficiency and autoimmune diseases, such as rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus and type 1diabetes. There is believed to be an inverse association between serum 25-hydroxyvitamin D concentrations and the incidence of colorectal cancer, sporadic colorectal adenoma and breast cancer. Vitamin D deficiency has been linked with various cardiovascular diseases such as hypertension, myocardial infarction, and stroke. Several epidemiological and genetic studies suggest a strong association between vitamin D and non skeletal acute and chronic disorders. However, currently, robust clinical data are still lacking to support raising intake requirements and target vitamin D plasma levels. Nonetheless, the high prevalence of vitamin D deficiency is alarming and requires implementation of clear supplementation guidelines. © 2012 Dr. K C Chaudhuri Foundation.",25 hydroxyvitamin D;calcium;placebo;vitamin D;adaptive immunity;Alzheimer disease;article;autoimmune disease;breast cancer;cancer incidence;cancer risk;cardiovascular disease;cerebrovascular accident;cognitive defect;colorectal adenoma;colorectal cancer;dementia;disease association;heart infarction;human;hypertension;inflammation;innate immunity;insulin dependent diabetes mellitus;neoplasm;obesity;prevalence;rheumatoid arthritis;risk reduction;systemic lupus erythematosus;systemic sclerosis;vitamin blood level;vitamin D deficiency;vitamin intake;vitamin supplementation,"Khadilkar, V. V.;Khadilkar, A. V.",2013,,,0,
2240,The Influence of Diabetes Mellitus Duration and Type of Therapy on Cognitive Decline,"We studied 120 patients with compensated diabetes mellitus type 2 (DM-2). The inclusion criterion was the absence of memory loss complaints from the patient and/or his/her relatives. The exclusion criteria were diabetes decompensation, myocardial infarction and/or stroke in anamnesis, glomerular filtration rate below 60 ml/min, the presence of proliferative retinopathy, and/or other endocrine diseases. To diagnose the cognitive decline (CD) we used Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA test), Trail Making Test (parts A and B). 77.5 % patients with type 2 diabetes out of 120 had moderate CD; 5 % had a significant CD (dementia). The control group consisted of 50 patients with arterial hypertension, which was comparable with the DM-2 group. In assessing the correlations, we found that the CD in DM-2 group is independent of disease duration and the type of diabetic therapy. We discovered a positive correlation between the age of patients and the speed of cognitive decline. Comparison of patients in DM-2 group with the control group showed that results in patients with hypertension (MMSE, MoCA test) were significantly higher (p < 0.01), and the test time of TMT part A and part B was significantly lower (p < 0.01) than that in patients with DM-2. The authors believe that the CD in DM-2 has different pathogenic mechanisms than other complications of type 2 diabetes mellitus, in particular, the insulin resistance of brain tissue.",insulin;oral antidiabetic agent;adult;antihypertensive therapy;article;cognitive defect;controlled study;correlation analysis;disease duration;disease severity;female;human;hypertension;major clinical study;male;middle aged;Mini Mental State Examination;Montreal cognitive assessment;non insulin dependent diabetes mellitus;trail making test,"Khairullin, I.;Abakumova, A.;Esin, R.;Esin, O.",2017,,10.1007/s12668-016-0345-3,0,
2241,Improving Chronic Diseases Management Through the Development of an Evidence-Based Resource,"OBJECTIVE: There is a large gap between evidence and practice within health care, particularly within the field of chronic disease. To reduce this gap and improve the management of chronic disease, a collaborative partnership between two schools within a large university and two industry partners (a large regional rural hospital and a rural community health center) in rural Victoria, Australia, was developed. The aim of the collaboration was to promote the development of translation science and the implementation of evidence-based health care in chronic disease with a specific focus on developing evidence-based resources that are easily accessed by clinicians. METHODS: A working group consisting of members of the collaborating organizations and an internationally renowned expert reference group was formed. The group acted as a steering committee and was tasked with developing a taxonomy of the resources. In addition, a peer review process of all resources was established. A corresponding reference group consisting of researchers and clinicians who are clinical experts in various fields was involved in the review process. The resources developed by the group include evidence summaries and recommended practices made available on a web-based database, which can be accessed via subscription by clinicians and researchers worldwide. RESULTS: As of mid-2014, there were 109 new evidence summaries and 25 recommended practices detailing the best available evidence on topics related to chronic disease management including asthma, diabetes, heart failure, dementia, and others. Training sessions and a newsletter were developed for clinicians within the node to enable them to use the content effectively. LINKING EVIDENCE TO ACTION: This paper describes the processes involved in the successful development of the collaborative partnership and its evolution into producing a valuable resource for the translation of evidence into practice in the areas of chronic disease management. The resource developed is being used by clinicians to inform practice and support their clinical decision making.",Australia;Chronic Disease/*therapy;Cooperative Behavior;*Disease Management;Evidence-Based Practice/methods/*standards;Humans;Translational Medical Research/*methods;Chronic disease management;evidence based-healthcare;evidence translation,"Khalil, H.;Chambers, H.;Munn, Z.;Porritt, K.",2015,Jun,10.1111/wvn.12087,0,
2242,Elements affecting wound healing time: An evidence based analysis,"The purpose of this study was to identify the predominant client factors and comorbidities that affected the time taken for wounds to heal. A prospective study design used the Mobile Wound Care (MWC) database to capture and collate detailed medical histories, comorbidities, healing times and consumable costs for clients with wounds in Gippsland, Victoria. There were 3,726 wounds documented from 2,350 clients, so an average of 1.6 wounds per client. Half (49.6%) of all clients were females, indicating that there were no gender differences in terms of wound prevalence. The clients were primarily older people, with an average age of 64.3 years (ranging between 0.7 and 102.9 years). The majority of the wounds (56%) were acute and described as surgical, crush and trauma. The MWC database categorized the elements that influenced wound healing into 3 groups - factors affecting healing (FAH), comorbidities, and medications known to affect wound healing. While there were a multitude of significant associations, multiple linear regression identified the following key elements: age over 65 years, obesity, nonadherence to treatment plan, peripheral vascular disease, specific wounds associated with pressure/friction/shear, confirmed infection, and cerebrovascular accident (stroke). Wound healing is a complex process that requires a thorough understanding of influencing elements to improve healing times.",acute heart infarction;adult;age;aged;Alzheimer disease;anemia;article;asthma;cellulitis;cerebrovascular accident;chronic obstructive lung disease;chronic wound;colostomy;comorbidity;congestive heart failure;coronary artery disease;crush trauma;data base;decubitus;deep vein thrombosis;dementia;depression;diabetes mellitus;emphysema;endocrine disease;evidence based medicine;female;friction;gastroesophageal reflux;gastrointestinal disease;health care cost;history;human;hyperlipidemia;hypertension;hyperthyroidism;hypotension;hypothyroidism;infection;kidney failure;leg ulcer;limited mobility;liver disease;lymphedema;major clinical study;malabsorption;male;medical history;mental disease;metabolic disorder;mood disorder;musculoskeletal disease;neoplasm;neurologic disease;nutritional disorder;obesity;osteoarthritis;osteomyelitis;osteoporosis;paraplegia;Parkinson disease;peripheral vascular disease;pressure;priority journal;prospective study;respiratory tract disease;rheumatoid arthritis;seizure;sex difference;skin abscess;skin fistula;skin injury;treatment planning;urine incontinence;wound care;wound healing;wound healing time,"Khalil, H.;Cullen, M.;Chambers, H.;Carroll, M.;Walker, J.",2015,,,0,
2243,Depression as the presenting feature of tuberous sclerosis,"Tuberous sclerosis is a rare autosomal dominant disorder in which neurological involvement manifests in the form of seizures, mental retardation, affective and behavioural derangements. We report a case, whose main presenting feature was major depression, not mentioned in previous literature.",antibiotic agent;anticonvulsive agent;antidepressant agent;phenytoin;adult;agitation;anorexia;article;behavior disorder;cardiopulmonary arrest;case report;clinical feature;consanguineous marriage;death;female;fever;tonic clonic seizure;human;hypopigmentation;kidney disease;leukocytosis;major depression;mental deterioration;skin defect;tuberous sclerosis,"Khan, G. A.;Hassan, G.;Tak, S. I.;Kundal, D. C.;Kak, M.;Tanveer, M.;Yaseen, M.;Margoob, M. A.;Hussain, A.;Khan, G. Q.",2003,,,0,
2244,Predictors of early mortality after hip fracture surgery,"PURPOSE: The aim of this study was to examine causes and potential risk factors for 30-day mortality after hip fracture surgery (HFS) at a high-volume tertiary-care hospital. METHODS: We retrospectively reviewed 467 patients who underwent HFS at our institution. Multivariate analysis was undertaken to identify potential predictors of early mortality. RESULTS: The 30-day mortality rate was 7.5% (35/467). The most common causes of death were pneumonia (37.1%, 13/35), acute coronary syndrome (31.4%, 11/35) and sepsis (14.3%, 5/35). Surgery after 48 hours of admission had a significantly higher 30-day mortality rate (11 % versus 4%, p = 0.006). There was a significant difference in age (p = 0.034), admission source (p < 0.001), preoperative haemoglobin (p < 0.001), walking ability (p = 0.004), number of comorbidities (p = 0.004) and pre-existing dementia (p = 0.01), cardiac disease (p < 0.001), chronic obstructive pulmonary disorder (COPD) (p = 0.036) and renal failure (p = 0.007) between the 30-day mortality group and the rest of the cohort. Surgical delay greater than 48 hours, admission source and pre-existing cardiac disease were identified as the strongest predictors of 30-day mortality. CONCLUSION: Surgical delay is an important but avoidable determinant of early mortality after HFS. Respiratory and cardiac function needs to be optimised postoperatively with early intervention in patients with signs of cardiovascular compromise or infection.","Aged;Aged, 80 and over;Cohort Studies;Comorbidity;Dementia/epidemiology/mortality;Female;*Fracture Fixation;Heart Diseases/*epidemiology/mortality;Hip Fractures/*epidemiology/mortality/*surgery;Humans;Kidney Diseases/epidemiology/mortality;Male;Models, Statistical;Multivariate Analysis;Pneumonia/*epidemiology/mortality;Retrospective Studies;Risk Factors;Sepsis/epidemiology/mortality;Survival Rate","Khan, M. A.;Hossain, F. S.;Ahmed, I.;Muthukumar, N.;Mohsen, A.",2013,Nov,10.1007/s00264-013-2068-1,0,
2245,Hypoxia driven glycation: Mechanisms and therapeutic opportunities,"Tumor masses are deprived of oxygen and characterized by enhanced glucose uptake followed by glycolysis. Elevated glucose levels induce non-enzymatic glycosylation or glycation of proteins which leads to accumulation of advanced glycation end products (AGE). These AGE molecules bind to their respective receptors called the receptor for advanced glycation end products (RAGE) and initiate several aberrant signaling pathways leading to onset of diseases such as diabetes, Alzheimer's, atherosclerosis, heart failure and cancer. The role of AGE in cancer progression is being extensively studied in recent years. As cancer cells are hypoxic in nature and adapted to glycolysis, which induces glycation, its effects need to be understood in greater detail. Since AGE-RAGE signaling is involved in cancer progression, inhibition of AGE-RAGE interaction could be a potential therapeutic target. The purpose of this review is to highlight the role of AGE-RAGE interaction in hypoxic cancer cells.",cancer growth;gene inactivation;glycation;glycolysis;hypoxia;advanced glycation end product;advanced glycation end product receptor;endogenous compound;hypoxia inducible factor 1alpha,"Khan, M. I.;Rath, S.;Adhami, V. M.;Mukhtar, H.",2017,,10.1016/j.semcancer.2017.05.008,0,
2246,Ethnicity and sex affect diabetes incidence and outcomes,"OBJECTIVE - Diabetes guidelines recommend aggressive screening for type 2 diabetes in Asian patients because they are considered to have a higher risk of developing diabetes and potentially worse prognosis. We determined incidence of diabetes and risk of death or macrovascular complications by sex among major Asian subgroups, South Asian and Chinese, and white patients with newly diagnosed diabetes. RESEARCH DESIGN AND METHODS - Using population-based administrative data from British Columbia and Alberta, Canada (1997-1998 to 2006-2007), we identified patients with newly diagnosed diabetes aged ≥35 years and followed them for up to 10 years for death, acute myocardial infarction, stroke, or hospitalization for heart failure. Ethnicity was determined using validated surname algorithms. RESULTS - There were 15,066 South Asian, 17,754 Chinese, and 244,017 white patients with newly diagnosed diabetes. Chinese women and men had the lowest incidence of diabetes relative to that of white or South Asian patients, who had the highest incidence. Mortality in those with newly diagnosed diabetes was lower in South Asian (hazard ratio 0.69 [95% CI 0.62- 0.76], P < 0.001) and Chinese patients (0.69 [0.63- 0.74], P < 0.001) then in white patients. Risk of acute myocardial infarction, stroke, or heart failure was similar or lower in the ethnic groups relative to that of white patients and varied by sex. CONCLUSIONS - The incidence of diagnosed diabetes varies significantly among ethnic groups. Mortality was substantially lower in South Asian and Chinese patients with newly diagnosed diabetes than in white patients. © 2011 by the American Diabetes Association.",insulin;oral antidiabetic agent;acute heart infarction;adult;aged;article;Asian;Caucasian;cerebrovascular disease;Chinese;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;dementia;diabetes control;diabetes mellitus;ethnicity;evaluation and follow up;female;heart failure;high risk population;hospitalization;human;hypertension;incidence;kidney disease;major clinical study;male;mortality;neoplasm;outcome assessment;peripheral vascular disease;prognosis;risk assessment;screening;sex difference;South Asia;cerebrovascular accident,"Khan, N. A.;Wang, H.;Anand, S.;Jin, Y.;Campbell, N. R. C.;Pilote, L.;Quan, H.",2011,,,0,
2247,"Long-term health outcomes in a British cohort of breast, colorectal and prostate cancer survivors: a database study","BACKGROUND: The community-based incidence of cancer treatment-related long-term consequences is uncertain. We sought to establish the burden of health outcomes that have been associated with treatment among British long-term cancer survivors. METHODS: We identified 26,213 adults from the General Practice Research Database who have survived 5 years or more following breast, colorectal or prostate cancer. Four age-, sex- and general practice-matched non-cancer controls were selected for each survivor. We considered the incidence of treatment-associated health outcomes using Cox proportional hazards models. RESULTS: Breast cancer survivors had an elevated incidence of heart failure (hazards ratio (HR) 1.95, 95% confidence interval (CI) 1.27-3.01), coronary artery disease (HR 1.27, 95% CI 1.11-1.44), hypothyroidism (HR 1.26, 95% CI 1.02-1.56) and osteoporosis (HR 1.26, 95% CI 1.13-1.40). Among colorectal cancer survivors, there was increased incidence of dementia (HR 1.68, 95% CI 1.20-2.35), diabetes (HR 1.39, 95% CI 1.12-1.72) and osteoporosis (HR 1.41, 95% CI 1.15-1.73). Prostate cancer survivors had the highest risk of osteoporosis (HR 2.49, 95% CI 1.93-3.22). CONCLUSIONS: The study confirms the occurrence of increased incidence of chronic illnesses in long-term cancer survivors attributable to underlying lifestyle and/or cancer treatments. Although the absolute risk of the majority of late effects in the cancer survivors cohort is low, identifying prior risk of osteoporosis by bone mineral density scanning for prostate survivors should be considered. There is an urgent need to improve primary care recording of cancer treatment.","Aged;Breast Neoplasms/diagnosis/epidemiology/*therapy;Cohort Studies;Colorectal Neoplasms/diagnosis/epidemiology/*therapy;*Databases, Factual;Female;Follow-Up Studies;Great Britain/epidemiology;Humans;Male;Prostatic Neoplasms/diagnosis/epidemiology/*therapy;*Quality of Health Care;Survivors/*statistics & numerical data;Treatment Outcome","Khan, N. F.;Mant, D.;Carpenter, L.;Forman, D.;Rose, P. W.",2011,Nov 8,10.1038/bjc.2011.420,0,
2248,"Assessment of anxiety and depression in hospitalized cardiac patients of Faisalabad institute of cardiology, Pakistan","Purpose: To assess the level of anxiety and depression in hospitalized cardiac patients in Faisalabad Institute of Cardiology, Faisalabad, Pakistan. Methods: The study was conducted on hospitalized cardiac patients at Faisalabad Institute of Cardiology (FIC), Faisalabad. Aga Khan University Anxiety and Depression Scale (AKUADS) was applied to estimate the occurrence of depression and anxiety in selected participants. This study involved 400 diagnosed hospitalized cardiac patients and another 400 participants without cardiac disease as control group. Results: The anxiety and depression level in hospitalized cardiac patient’s was 79.5% (318), compared with 68.25% (273) of the control group. Female patients were also more prone to depression than male patients. Psychological suffering was 1.80 times more in the hospitalized cardiac patients (OR = 1.804, 95%CI = 1.308-2.488, p = 0.0001). The results showed that gender was the leading factor in the occurrence of co-morbidities such as depression and anxiety. Conclusion: Depression symptoms are more common among hospitalized patients than in those without cardiac disease. Close monitoring is required and patients with psychiatric illness should be referred for appropriate treatment to overcome this risk.",adult;Aga Khan University Anxiety and Depression Scale;anxiety disorder;article;behavior change;cardiac patient;cardiology;comorbidity assessment;congestive heart failure;coronary artery disease;cross-sectional study;dementia;depression;female;hallucination;heart infarction;heart left ventricle failure;human;hypertension;lifestyle modification;logistic regression analysis;major clinical study;male;middle aged;psychologic assessment;questionnaire;rheumatic heart disease;scoring system;socioeconomics;young adult,"Khan, S. A.;Azhar, S.;Asad, S. M.;Iqbal, A.;Kousar, R.;Ahmad, M.;Taha, A.;Murtaza, G.",2016,,10.4314/tjpr.v15i11.25,0,
2249,"Neuroglycopenic Seizures: Sulfonylureas, Sulfamethoxazole, or Both?",,cotrimoxazole;glipizide;glucose;glycosylated hemoglobin;linagliptin;lorazepam;sulfamethoxazole;aged;Alzheimer disease;article;case report;chronic kidney failure;consciousness level;daily life activity;drug dose reduction;drug substitution;drug withdrawal;emergency ward;female;follow up;glucose blood level;glycemic control;human;hypertension;ischemic heart disease;lethargy;morning dosage;non insulin dependent diabetes mellitus;outpatient department;priority journal;seizure;tonic clonic seizure;very elderly,"Khan, U.;Seetharaman, S.;Merchant, R.",2017,,10.1016/j.amjmed.2016.08.011,0,
2250,Epidemiological aspects of ageing,"A major societal challenge is to improve quality of life and prevent or reduce disability and dependency in an ageing population. Increasing age is associated with increasing risk of disability and loss of independence, due to functional impairments such as loss of mobility, hearing and vision; a major issue must be how far disability can be prevented. Ageing is associated with loss of bone tissue, reduction in muscle mass, reduced respiratory function, decline in cognitive function, rise in blood pressure and macular degeneration which predispose to disabling conditions such as osteoporosis, heart disease, dementia and blindness. However, there are considerable variations in different communities in terms of the rate of age-related decline. Large geographic and secular variations in the age-adjusted incidence of major chronic diseases such as stroke, hip fracture, coronary heart disease, cancer, visual loss from cataract, glaucoma and macular degeneration suggest strong environmental determinants in diet, physical activity and smoking habit. The evidence suggests that a substantial proportion of chronic disabling conditions associated with ageing are preventable, or at least postponable and not an inevitable accompaniment of growing old. Postponement or prevention of these conditions may not only increase longevity, but, more importantly, reduce the period of illnesses such that the majority of older persons may live high-quality lives, free of disability, until very shortly before death. We need to understand better the factors influencing the onset of age-related disability in the population, so that we have appropriate strategies to maintain optimal health in an ageing population.","*Aged;*Aged, 80 and over;*Aging;Cause of Death/trends;Disabled Persons;Epidemiologic Methods;Female;*Health Status;Humans;*Life Expectancy;Male;*Quality of Life","Khaw, K. T.",1997,Dec 29,10.1098/rstb.1997.0168,0,
2251,"Chronic use of proton pump inhibitors, adverse events and potential biological mechanisms: A translational analysis","Proton pump inhibitors (PPIs) are among the most frequently prescribed drugs. Even if PPI are usually considered as safe, there is a growing concern for a range of adverse effects of chronic PPI therapy often in the absence of appropriate indications. We propose, after a summary of renal, cardiovascular and neurological complications (dementia, chronic kidney disease, myocardial infarction and stroke), an integrative overview of the potential biological mechanisms involved. Eleven positive pharmacoepidemiological studies, mainly based on health insurance database linkage to hospital database, reported an increased risk of complications associated to PPI use and often a graded association suggesting also a possible dose-response relationship. Several mechanisms have been suggested through in vitro studies (endothelial dysfunction, endothelial senescence, hypomagnesemia, increase of chromogranin A levels, decrease of nitric oxide in endothelial cells) leading to the impairment of vascular homesostasis, paving the way to these complications. Evidence that PPIs may have off-targets and pleiotropic effects are mounting and may impose a cautious attitude in the prescription of PPI's, especially in elderly and/or in the context of chronic use.",Endothelial dysfunction;Pharmacoepidemiology;Pharmacovigilance;Proton pump inhibitors;Safety;Vascular risk,"Kheloufi, F.;Frankel, D.;Kaspi, E.;Lepelley, M.;Mallaret, M.;Boucherie, Q.;Roll, P.;Micallef, J.",2017,Oct 14,,0,
2252,"Use of erbisol in chronic pancreatitis, depending on treatment options and concurrent ischemic heart disease in old and senile persons","In old and senile persons, chronic pancreatitis is known to be accompanied by an uncontrolled intensification of process of free-radical lipid oxidation and inhibition of mechanisms of antiradical defence. The use of erbisol in the instituted therapeutic complex has been found to raise the efficiency of the system of glutathione and glutathione-dependent enzymes, to effect the inhibition of process of free-radical oxidation, improvement of conditions under which the synthesis of reduced glutathione is normally seen to proceed, realization of antiperoxide, disulphide reductase- and ribonucleotide reductase functions of the system as a whole. Moreover, there gets improved the incretory and exacrinous functions of the pancreas.","Adjuvants, Immunologic/administration & dosage/*therapeutic use;Administration, Oral;Alzheimer Disease/complications;Biological Factors/administration & dosage/*therapeutic use;Chronic Disease;Cohort Studies;Drug Administration Schedule;Female;Humans;Male;Middle Aged;Myocardial Ischemia/*complications;Pancreatitis/*complications/*drug therapy;Treatment Outcome","Khristich, T. N.;Nikolaenko, A. N.;Kendzerskaia, T. B.",2001,Jul-Aug,,0,
2253,Therapy: Risks associated with chronic PPI use-signal or noise?,,histamine H2 receptor antagonist;proton pump inhibitor;acute kidney failure;adverse outcome;chronic drug administration;chronic kidney disease;Clostridium difficile infection;community acquired pneumonia;dementia;disease association;dosage schedule comparison;drug safety;drug utilization;effect size;gastroesophageal reflux;heart infarction;hip fracture;human;hypomagnesemia;interstitial nephritis;long term care;peptic ulcer;priority journal;risk assessment;risk benefit analysis;risk factor;short survey;statistical analysis,"Kia, L.;Kahrilas, P. J.",2016,,,0,
2254,Treatment of in-transit melanoma with intralesional Bacillus Calmette-Guérin (BCG) and topical imiquimod 5% cream: A report of 3 cases,"Local therapy for in-transit melanoma (ITM) is a treatment alternative for patients who are not good candidates for systemic therapy, regional therapy, or surgical management. In this case report, we describe 3 patients with ITM who were treated with intralesional Bacillus Calmette-Guérin (ILBCG) and/or topical imiquimod. Treatment course was dictated by the clinical response. Patient 1's response to ILBCG monotherapy was not sufficient to cause disease regression; however, transition to topical imiquimod therapy resulted in complete and sustained response. Although patient 2 responded to ILBCG and imiquimod, she developed a hypersensitivity reaction to ILBCG; when topical imiquimod was continued as monotherapy, her clinical response was complete. Patient 3 responded completely to ILBCG monotherapy in injected lesions, but expired shortly thereafter from unrelated disease. Reports like this one are needed to define the success measures of local therapy in the treatment of ITM.",BCG vaccine;clobetasol;imiquimod;paracetamol;aged;article;BCG vaccination;cancer immunotherapy;cancer patient;case report;chill;colony forming unit;computer assisted emission tomography;computer assisted tomography;congestive heart failure;conservative treatment;cream;dementia;disease course;drug efficacy;drug hypersensitivity;drug safety;erythema;eyelid edema;female;fever;human;in transit melanoma;in-transit metastasis;inflammation;lichenoid;lower leg;male;melanoma;monotherapy;pancreas adenocarcinoma;papule;priority journal;satellite metastasis;skin biopsy;skin defect;skin induration;skin pigmentation;small intestine obstruction;subcutaneous nodule;treatment outcome;treatment response;tumor localization;tumor volume;ulcer;very elderly,"Kibbi, N.;Ariyan, S.;Faries, M.;Choi, J. N.",2015,,,0,
2255,"A retrospective consecutive case-series study on the effect of systemic treatment, length of admission time, and co-morbidities in 98 bullous pemphigoid patients admitted to a tertiary centre","Bullous pemphigoid (BP) is a common blistering disease caused by antibodies directed against hemi-desmosomal proteins BPAG1 and BPAG2. The disease is characterised by intense pruritus and blistering of the skin. The systemic treatment with the highest level of evidence for BP is systemic glucocorticoids. However, since the disease often occurs in the elderly patients, and since the most common co-morbidities are diabetes and neurological diseases, glucocorticoid-sparing drugs are often introduced. We retrospectively identified all BP patients admitted to our tertiary clinic over a 7-year period in order to register demography, treatment and co-morbidities. The most common steroid-sparing drugs were azathioprine (87%) and methotrexate (11%). Less than 2% were treated with dapsone, rituximab and cyclosporin A. As expected, we found a relatively high rate of neurological disorders, diabetes, and malignancies, but surprisingly we also found an increased rate of cardiovascular diseases compared to the Danish population in general.",alcohol;azathioprine;cyclosporin A;dapsone;glucocorticoid;immunomodulating agent;methotrexate;mycophenolate mofetil;prednisolone;rituximab;adjuvant therapy;adult;aged;alcohol abuse;article;bullous pemphigoid;case study;cerebrovascular accident;chronic urticaria;comorbidity;congestive cardiomyopathy;congestive heart failure;controlled study;dementia;demography;diabetes mellitus;diagnostic error;disease severity;drug dose comparison;drug hypersensitivity;drug megadose;epidermolysis bullosa acquisita;female;heart infarction;hospital admission;human;immunosuppressive treatment;length of admission time;low drug dose;lung disease;major clinical study;male;malignant neoplastic disease;monotherapy;neurologic disease;outcome assessment;outpatient care;parkinsonism;priority journal;recurrence risk;remission;retrospective study;scabies;sex difference;systemic therapy;tertiary health care;time;vasculitis,"Kibsgaard, L.;Bay, B.;Deleuran, M.;Vestergaard, C.",2015,,,0,
2256,Increased frequency of multiple sclerosis among patients with bullous pemphigoid: a population-based cohort study on comorbidities anchored around the diagnosis of bullous pemphigoid,"Background: Bullous pemphigoid (BP) is a disease of the elderly and may be associated with neurological and cardiovascular diseases and diabetes. Mortality rates strongly exceed those of the background population. Objectives: To investigate the frequency of comorbidities and their temporal relation to BP. Methods: A register-based matched-cohort study on all Danish patients with a hospital-based diagnosis of BP (n = 3281). The main outcomes were multiple sclerosis (MS), Parkinson disease (PD), Alzheimer disease (AD), stroke, diabetes types 1 and 2, malignancies, ischaemic heart disease (IHD), hypertension and eventually death. Results: At baseline, patients with BP had increased prevalences of MS [odds ratio (OR) 9·7, 95% confidence interval (CI) 6·0–15·6], PD (OR 4·2, 95% CI 3·1–5·8), AD (OR 2·6, 95% CI 1·8–3·5) and stroke (OR 2·7, 95% CI 2·4–2·9). Furthermore, malignancies, cardiovascular disease and diabetes were over-represented among patients with BP: type 1 diabetes (OR 3·1, 95% CI 2·5–3·8), type 2 diabetes (OR 2·3, 95% CI 2·0–2·6), malignancies (OR 1·3, 95% CI 1·1–1·4), IHD (OR 1·7, 95% CI 1·5–1·9) and hypertension (OR 2·0, 95% CI 1·8–2·2). During follow-up, the risk of MS was significantly higher among patients with BP [hazard ratio (HR) 9·4, 95% CI 4·9–18·0], even if events during the first year after diagnosis of BP were excluded (HR 5·1, 95% CI 2·3–11·3). Patients with BP had an average increased mortality rate of 2·04 (95% CI 1·96–2·13). Conclusions: We discovered a significantly increased frequency of MS among patients with BP. At the time of diagnosis, patients with BP had an excessive number of comorbidities and an increased mortality rate over the following years.",adult;aged;Alzheimer disease;article;bullous pemphigoid;cerebrovascular accident;cohort analysis;comorbidity;death;female;follow up;human;hypertension;ICD-8;insulin dependent diabetes mellitus;ischemic heart disease;major clinical study;male;malignant neoplasm;middle aged;mortality rate;multiple sclerosis;non insulin dependent diabetes mellitus;outcome assessment;Parkinson disease;priority journal;time of death;very elderly,"Kibsgaard, L.;Rasmussen, M.;Lamberg, A.;Deleuran, M.;Olesen, A. B.;Vestergaard, C.",2017,,10.1111/bjd.15405,0,
2257,The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness,"The use of prescription drugs in older people is high and many commonly prescribed drugs have anticholinergic effects. We examined the relationship between ACB on mortality and in-patient length of stay in the oldest old hospitalised population. This was a retrospective analysis of prospective audit using hospital audit data from acute medical admissions in three hospitals in England and Scotland. Baseline use of possible or definite anticholinergics was determined according to the Anticholinergic Cognitive Burden Scale. The main outcome measures were decline in-hospital mortality, early in-hospital mortality at 3- and 7-days and in-patient length of stay. A total of 419 patients (including 65 patients with known dementia) were included [median age. = 92.9, inter-quartile range (IQR) 91.4-95.1 years]. 256 (61.1%) were taking anticholinergic medications. Younger age, greater number of pre-morbid conditions, ischemic heart disease, number of medications, higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis. There were no significant differences observed in terms of in-patient mortality, in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories. Compared to those without cardiovascular disease, patients with cardiovascular disease showed similar outcome regardless of ACB load (either =0 or >0 ACB). We found no association between ACB and early (within 3- and 7-days) and in-patient mortality and hospital length of stay outcomes in this cohort of oldest old in the acute medical admission setting. © 2014 Elsevier Ireland Ltd.",amitriptyline;atenolol;cholinergic receptor blocking agent;codeine;creatinine;digoxin;furosemide;isosorbide mononitrate;morphine;prednisolone;ranitidine;urea;acute disease;aged;aged hospital patient;anticholinergic burden;Anticholinergic Cognitive Burden Scale;anticholinergic effect;article;cardiovascular disease;comorbidity;controlled study;creatinine blood level;dementia;drug use;female;high risk population;hospital admission;human;ischemic heart disease;length of stay;major clinical study;male;mortality;outcome assessment;pharmacological parameters;priority journal;rating scale;retrospective study;risk assessment;treatment outcome;urea blood level;very elderly,"Kidd, A. C.;Musonda, P.;Soiza, R. L.;Butchart, C.;Lunt, C. J.;Pai, Y.;Hameed, Y.;Fox, C.;Potter, J. F.;Myint, P. K.",2014,,,0,
2258,Dear L,,death;dementia;general practitioner;heart failure;heart infarction;human;kidney disease;note;patient care planning;prisoner of war,"Kidd, M.",2016,,,0,
2259,NCX and NCKX operation in ischemic neurons,"Within the first 2 min of global brain ischemia, extracellular [K+] ([K+]o) increases above 60 mM and [Na+](o) drops to about 50 mM, indicating a massive K+ efflux and Na+ influx, a phenomenon known as anoxic depolarization (AD). Similar ionic shifts take place during repetitive peri-infarct depolarizations (PID) in the area penumbra in focal brain ischemia. The size of ischemic infarct is determined by the duration of AD and PID. However, the mechanism of cytosolic [Ca2+] ([Ca2+]c) elevation during AD or PID is poorly understood. Our data show that the exposure of cultured rat hippocampal CA1 neurons to AD-like conditions promptly elevates [Ca2+]c to about 30 microM. These high [Ca2+]c elevations depend on external Ca2+ and can be prevented by removing Na+ or by simultaneously inhibiting NMDA and AMPA/kainate receptors. These data indicate that [Ca2+]c elevations during AD result from Na+ influx via either NMDA or AMPA/kainate channels. The mechanism of the Na-dependent [Ca2+]c elevations may involve a reversal of plasmalemmal Na+/Ca2+ (NCX) and/or Na+/Ca2+ + K+ (NCKX) exchangers. KB-R7943, an NCX inhibitor, suppresses a fraction of the Na-dependent Ca2+ influx during AD. Therefore, Ca2+ influx via NCX and a KB-R7943-resistant pathway (possibly NCKX) is involved. Inhibition of the Na-dependent Ca2+ influx is likely to decrease ischemic brain damage. No drugs are known that are able to inhibit the KB-R7943-resistant component of Na-dependent Ca2+ influx during AD. The present data encourage development of such agents as potential therapeutic means to limit ischemic brain damage after stroke or heart attack.","Alzheimer Disease/physiopathology;Brain Ischemia/*physiopathology;Calcium/metabolism;Cells, Cultured;Humans;Neurons/*physiology;Sodium/metabolism;Sodium-Calcium Exchanger/*physiology;Stroke/physiopathology","Kiedrowski, L.",2007,Mar,10.1196/annals.1387.035,0,
2260,Scales for the evaluation of end-of-life care in advanced dementia: Sensitivity to change,"The paucity of valid and reliable instruments designed to measure end-of-life experiences limits advanced dementia and palliative care research. Two end-of-life in dementia (EOLD) scales that evaluate the experiences of severely cognitively impaired persons and their health care proxies (HCP) have been developed: (1) symptom management (SM) and (2) satisfaction with care (SWC). The aim of this study was to examine the sensitivity of the EOLD scales in detecting significant differences in clinically relevant outcomes in nursing home residents with advanced dementia. The SM-EOLD scale was sensitive to detecting changes in comfort among residents with pneumonia, pain, dyspnea, and receiving burdensome interventions. The SWC-EOLD scale was sensitive to detecting changes in HCP satisfaction with the care of residents when addressing whether the health care provider spent >15 minutes discussing the resident's advanced care planning, whether the physician counseled about the resident's live expectancy, whether the resident resided in a special care unit, and whether the physician counseled possible resident health problems. This study extends the psychometric properties of the EOLD scales by showing the sensitivity to clinically meaningful change in these scales to specific outcomes related to end-of-life care and quality of life among residents with end-stage advanced dementia and their HCPs.© 2012 by Lippincott Williams & Wilkins.",aged;agitation;Alzheimer disease;anxiety;article;chronic obstructive lung disease;cognitive defect;comorbidity;congestive heart failure;coronary artery disease;custodial care;dementia;depression;dyspnea;end of life in dementia scale;fear;female;functional disease;health care personnel;human;intensive care unit;life expectancy;major clinical study;male;assessment of humans;neoplasm;nursing home;nursing home patient;pain;palliative therapy;patient care planning;patient comfort;patient satisfaction;personnel;pneumonia;priority journal;terminal care;vascular disease;verbal communication,"Kiely, D. K.;Shaffer, M. L.;Mitchell, S. L.",2012,,,0,
2261,"Parkinson's disease dementia: Correlations between clinical, neuropsychological and neuropathological features","Introduction: Cognitive disorders such as deficit of attention and executive and visuoconstructive dysfunctions occur in Parkinson's disease dementia (PDD). Memory impairment is not an early feature and statement not well delimited. Case report: A 78-year-old man with PDD underwent neuropsychological assessment and moreover demonstrated memory decline. After death, pathology examination of the brain and immunohistochemy analysis confirmed PD and showed Lewy body pathology (LBP) in the insula, limbic and especially in CA3 hippocampus areas. Hippocampus and gyrus parahippocampic also exhibited neurofibrillary tangles. Lack of senile plaque and lack of beta A4 amyloid deposition were noticeable in the whole brain examination. Conclusion: Severe executive dysfunctions are probably related to LBP and dysfunction in memory process may be related to DNF lesions in medial temporal area. © 2010 Elsevier Masson SAS.",amyloid beta protein;amyloid beta protein 4;antiparkinson agent;catechol methyltransferase inhibitor;clozapine;levodopa;unclassified drug;aged;Alzheimer disease;article;brain;bronchopneumonia;case report;clinical assessment;clinical evaluation;clinical feature;diffuse Lewy body disease;heart muscle ischemia;hippocampus;histopathology;hospitalization;human;immunohistochemistry;insula;limbic cortex;male;memory disorder;Mini Mental State Examination;neurofibrillary tangle;neuroimaging;neurologic examination;neuropsychological test;orthostatic hypotension;Parkinson disease;senile plaque;subiculum;visual hallucination,"Kiesmann, M.;Vogel, T.;Kaltenbach, G.;Mohr, M.",2010,,,0,
2262,Perioperative evaluation and care of patients with mild to moderate cerebrovascular disease: It's time to develop treatment guidelines!,,Alzheimer disease;brain perfusion;cerebrovascular disease;cognitive defect;heart failure;human;letter;medical society;mild cognitive impairment;patient care;perioperative period;practice guideline;priority journal;white matter injury,"Kietaibl, C.;Markstaller, K.;Klein, K. U.",2017,,10.1097/ana.0000000000000279,0,
2263,Atrial fibrillation is an independent determinant of low cognitive function: A cross-sectional study in elderly men,"Background and Purpose - Cerebrovascular disease is increasingly recognized as a cause of dementia and cognitive decline. We have previously reported an association between hypertension and diabetes and low cognitive function in the elderly. Atrial fibrillation is another main risk factor for cerebrovascular disease. The aim of this study was to investigate whether atrial fibrillation is associated with low cognitive function in elderly men with and without previous manifest stroke. Methods - This was a cross- sectional study based on a cohort of 952 community-living men, aged 69 to 75 years, in Uppsala, Sweden. Cognitive functions were assessed by the Mini- Mental State Examination and the Trail Making Tests, and a composite z score was calculated. The relation between atrial fibrillation and cognitive z score was analyzed, with stroke and other vascular risk factors taken into account. Results - All analyses were adjusted for age, education, and occupational level. Men with atrial fibrillation (n=44) had lower mean adjusted cognitive z scores (-0.26±0.11) than men without atrial fibrillation (+0.14±0.03; P=0.0003). The exclusion of stroke patients did not alter this relationship; the mean cognitive z score was -0.24±0.12 in the 36 men with atrial fibrillation and +0.17±0.03 in those without atrial fibrillation (P=0.0004), corresponding to a difference of 0.4 SDs between groups. Adjustments for 24-hour diastolic blood pressure and heart rate, diabetes, and ejection fraction did not change this relationship. Men with atrial fibrillation who were treated with digoxin (n=27) performed markedly better (-0.05±0.21) than those without treatment (n=9; -1.14±0.34; adjusted P=0.0005). PreVious myocardial infarction was not associated with impaired cognitive results. Conclusions - In these community-living elderly men, we found an association between atrial fibrillation and low cognitive function independent of stroke, high blood pressure, and diabetes. Interventional studies are needed to answer the question of whether optimal treatment of atrial fibrillation may prevent or postpone cognitive decline and dementia.",digoxin;aged;article;cerebrovascular disease;cognitive defect;controlled study;atrial fibrillation;human;major clinical study;male;prevalence;priority journal;risk factor;Sweden,"Kilander, L.;Andrén, B.;Nyman, H.;Lind, L.;Boberg, M.;Lithell, H.",1998,,,0,
2264,Postoperative Mortality after Hip Fracture Surgery: A 3 Years Follow Up,"BACKGROUND AND AIMS: To determine mortality rates and predisposing factors in patients operated for a hip fracture in a 3-year follow-up period. METHODS: The study included patients who underwent primary surgery for a hip fracture.The inclusion criteria were traumatic, non-traumatic, osteoporotic and pathological hip fractures requiring surgery in all age groups and both genders. Patients with periprosthetic fractures or previous contralateral hip fracture surgery and patients who could not be contacted by telephone were excluded. At 36 months after surgery, evaluation was made using a structured telephone interview and a detailed examination of the hospital medical records, especially the documents written during anesthesia by the anesthesiologists and the documents written at the time of follow-up visits by the orthopaedic surgeons. A total of 124 cases were analyzed and 4 patients were excluded due to exclusion criteria. The collected data included demographics, type of fracture, co-morbidities, American Society of Anesthesiologists (ASA) scores, anesthesia techniques, operation type (intramedullary nailing or arthroplasty; cemented-noncemented), peroperative complications, refracture during the follow-up period, survival period and mortality causes. RESULTS: The total 120 patients evaluated comprised 74 females(61.7%) and 46 males(38.3%) with a mean age of 76.9+/-12.8 years (range 23-95 years). The ASA scores were ASA I (0.8%), ASA II (21.7%), ASA III (53.3%) and ASA IV (24.2%). Mortality was seen in 44 patients (36.7%) and 76 patients (63.3%) survived during the 36-month follow-up period. Of the surviving patients, 59.1% were female and 40.9% were male.The survival period ranged between 1-1190 days. The cumulative mortality rate in the first, second and third years were 29.17%, 33.33% and 36.67% respectively. The factors associated with mortality were determined as increasing age, high ASA score, coronary artery disease, congestive heart failure, Alzheimer's disease, Parkinson's disease, malignancycementation and peroperative complications such as hypotension (p<0.05). Mortality was highest in the first month after fracture. CONCLUSION: The results of this study showed higher mortality rates in patients with high ASA scores due to associated co-morbidities such as congestive heart failure, malignancy and Alzheimer's disease or Parkinson's disease. The use of cemented prosthesis was also seen to significantly increase mortality whereas no effect was seen from the anesthesia technique used. Treatment of these patients with a multidiciplinary approach in an orthogeriatric ward is essential. There is a need for further studies concerning cemented vs. uncemented implant use and identification of the best anesthesia technique to decrease mortality rates in these patients.",,"Kilci, O.;Un, C.;Sacan, O.;Gamli, M.;Baskan, S.;Baydar, M.;Ozkurt, B.",2016,,10.1371/journal.pone.0162097,0,2265
2265,Postoperative mortality after hip fracture surgery: A 3 years follow up,"Background and Aims: To determine mortality rates and predisposing factors in patients operated for a hip fracture in a 3-year follow-up period. Methods: The study included patients who underwent primary surgery for a hip fracture. The inclusion criteria were traumatic, non-traumatic, osteoporotic and pathological hip fractures requiring surgery in all age groups and both genders. Patients with periprosthetic fractures or previous contralateral hip fracture surgery and patients who could not be contacted by telephone were excluded. At 36 months after surgery, evaluation was made using a structured telephone interview and a detailed examination of the hospital medical records, especially the documents written during anesthesia by the anesthesiologists and the documents written at the time of follow-up visits by the orthopaedic surgeons. A total of 124 cases were analyzed and 4 patients were excluded due to exclusion criteria. The collected data included demographics, type of fracture, co-morbidities, American Society of Anesthesiologists (ASA) scores, anesthesia techniques, operation type (intramedullary nailing or arthroplasty; cemented-noncemented), peroperative complications, refracture during the followup period, survival period and mortality causes. Results: The total 120 patients evaluated comprised 74 females(61.7%) and 46 males(38.3%) with a mean age of 76.9-12.8 years (range 23-95 years). The ASA scores were ASA I (0.8%), ASA II (21.7%), ASA III (53.3%) and ASA IV (24.2%). Mortality was seen in 44 patients (36.7%) and 76 patients (63.3%) survived during the 36-month follow-up period. Of the surviving patients, 59.1% were female and 40.9% were male. The survival period ranged between 1-1190 days. The cumulative mortality rate in the first, second and third years were 29.17%, 33.33% and 36.67% respectively. The factors associated with mortality were determined as increasing age, high ASA score, coronary artery disease, congestive heart failure, Alzheimer's disease, Parkinson's disease, malignancy cementation and peroperative complications such as hypotension (p<0.05). Mortality was highest in the first month after fracture. Conclusion: The results of this study showed higher mortality rates in patients with high ASA scores due to associated co-morbidities such as congestive heart failure, malignancy and Alzheimer's disease or Parkinson's disease. The use of cemented prosthesis was also seen to significantly increase mortality whereas no effect was seen from the anesthesia technique used. Treatment of these patients with a multidiciplinary approach in an orthogeriatric ward is essential. There is a need for further studies concerning cemented vs. uncemented implant use and identification of the best anesthesia technique to decrease mortality rates in these patients.",adult;age;aged;Alzheimer disease;American Society of Anesthesiologists score;arthroplasty;article;cemented prosthesis;cementless prosthesis;comorbidity;congestive heart failure;coronary artery disease;disease predisposition;embolism;female;follow up;fracture treatment;hip fracture;human;hypotension;intramedullary nailing;major clinical study;male;malignant neoplasm;medical record;mortality rate;Parkinson disease;peroperative complication;recurrent disease;scoring system;structured interview;surgical mortality;survival;telephone interview,"Kilci, O.;Un, C.;Sacan, O.;Gamli, M.;Baskan, S.;Baydar, M.;Ozkurt, B.",2016,,10.1371/journal.pone.0162097,0,
2266,NF-kappabeta signaling and chronic inflammatory diseases: exploring the potential of natural products to drive new therapeutic opportunities,"Chronic inflammation has a key role in the pathogenesis of multiple diseases that represent major public health and financial concerns, including heart failure (HF), Alzheimer's disease (AD) and arthritis. Nuclear factor kappa beta (NF-kappabeta) is a central component of inflammation; owing to its upstream signaling position, it is considered an attractive target for new anti-inflammatory therapeutics. Hydroxytyrosol is an orally bioavailable polyphenol, obtained from olives, which inhibits NF-kappabeta activity and has elicited promising efficacy signals in several inflammatory diseases. Here, we further examine the role of NF-kappabeta in inflammation, provide an introduction to natural products and their anti-inflammatory effects and explore the potential of hydroxytyrosol as a new approach to combating the burden of chronic inflammatory diseases.",Animals;Anti-Inflammatory Agents/pharmacology/*therapeutic use;Atherosclerosis/drug therapy/metabolism;Biological Products/pharmacology/therapeutic use;Heart Failure/drug therapy/metabolism;Humans;Inflammation/metabolism;Metabolic Diseases/drug therapy/metabolism,"Killeen, M. J.;Linder, M.;Pontoniere, P.;Crea, R.",2014,Apr,10.1016/j.drudis.2013.11.002,0,
2267,Diagnostic challenges in the older patient,"Older patients often present with a long, complex history and a clinical picture that frequently includes co-morbidities. It is essential that health professionals caring for older patients become familiar with common age-related changes, and the specific clinical factors that complicate the diagnostic process. A case-based approach is taken in this article to explore the diagnostic challenges in caring for older patients. Three areas of focus are used: a) polypharmacy, b) cognitive issues such as delirium, dementia and depression, and c) increased odds of pathologies and chronic illnesses. © 2012 Killinger; licensee BioMed Central Ltd.",antibiotic agent;aged;Alzheimer disease;backache;cancer risk;chiropractic practice;cholecystitis;chronic disease;common cold symptom;confusion;delirium;depression;diagnostic procedure;dizziness;drug safety;falling;geriatric care;head injury;heart infarction;human;note;pathology;patient care;pelvis pain syndrome;polypharmacy;priority journal;prostate cancer;psychotrauma,"Killinger, L. Z.",2012,,,0,
2268,Sudden neurologic death masquerading as out-of-hospital sudden cardiac death,"Objective: To characterize the frequency of and risk factors for out-of-hospital sudden neurologic deaths. Methods: During the initial 25 months (February 1, 2011-March 1, 2013) of the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death Study, we captured incident WHO criteria sudden cardiac deaths (SCDs) through active surveillance of consecutive out-of-hospital deaths, which must be reported to the medical examiner by law. All cases were referred for full autopsy with detailed examination of the heart and cranial vault, toxicology, and histology. A multidisciplinary committee adjudicated a final cause of death. Results: Of 352 incident SCDs, 335 (95%) underwent systematic evaluation including full autopsy. Of these 335 cases, 18 (5.4%) were sudden neurologic deaths (mean age 60.6 years [SD 17.6, range 27-87]; 67.7% female), which accounted for 14.9% of the 121 noncardiac sudden deaths. The risk of sudden neurologic death compared to non-neurologic SCD was lower in male and white participants (p < 0.01). Neurologic causes included intracranial hemorrhage (8), sudden unexpected death in epilepsy (6, including 2 with juvenile myoclonic epilepsy), aneurysmal subarachnoid hemorrhage (2), acute ischemic stroke (1), and aspiration from Huntington disease (1). Most deaths were unwitnessed (16; 89%) with asystole at presentation (17; 94%). Prior stroke/TIA was not associated with risk of stroke (odds ratio [OR] 1.4 [95% confidence interval (CI) 0.18-11.8], p 0.73), but antithrombotic medication use was (OR 3.9 [95% 1.01-15.5], p 0.05). Conclusions: Sudden neurologic death is an important cause of out-of-hospital apparent SCDs. Low prevailing autopsy rates may result in systematic misclassification of apparent SCDs and underestimation of the incidence of sudden neurologic death.",anticoagulant agent;adult;aged;alcohol withdrawal;anticoagulant therapy;article;autopsy;brain hemorrhage;brain ischemia;cardiomyopathy;Caucasian;cause of death;cerebrovascular accident;clinical feature;controlled study;coronary artery disease;drug overdose;female;heart arrest;heart failure;heart ventricle fibrillation;hernia incarceration;human;human tissue;Huntington chorea;hypertrophy;implantable cardioverter defibrillator;lung embolism;male;middle aged;mortality;myoclonus epilepsy;neurologic disease;out of hospital cardiac arrest;priority journal;subarachnoid hemorrhage;sudden cardiac death;sudden death;sudden neurologic death;transient ischemic attack;very elderly,"Kim, A. S.;Moffatt, E.;Ursell, P. C.;Devinsky, O.;Olgin, J.;Tseng, Z. H.",2016,,,0,
2269,Myocardial Ischemia Induces SDF-1α Release in Cardiac Surgery Patients,"In the present observational study, we measured serum levels of the chemokine stromal cell-derived factor-1α (SDF-1α) in 100 patients undergoing cardiac surgery with cardiopulmonary bypass at seven distinct time points including preoperative values, myocardial ischemia, reperfusion, and the postoperative course. Myocardial ischemia triggered a marked increase of SDF-1α serum levels whereas cardiac reperfusion had no significant influence. Perioperative SDF-1α serum levels were influenced by patients’ characteristics (e.g., age, gender, aspirin intake). In an explorative analysis, we observed an inverse association between SDF-1α serum levels and the incidence of organ dysfunction. In conclusion, time of myocardial ischemia was identified as the key stimulus for a significant upregulation of SDF-1α, indicating its role as a marker of myocardial injury. The inverse association between SDF-1α levels and organ dysfunction association encourages further studies to evaluate its organoprotective properties in cardiac surgery patients.",acetylsalicylic acid;creatine kinase MB;procalcitonin;stromal cell derived factor 1alpha;aged;article;cardiopulmonary bypass;controlled study;disease association;female;heart muscle ischemia;heart muscle reperfusion;heart protection;heart surgery;human;human cell;in vitro study;incidence;leukocyte count;major clinical study;male;observational study;priority journal;protein blood level;protein secretion;treatment duration;upregulation,"Kim, B. S.;Jacobs, D.;Emontzpohl, C.;Goetzenich, A.;Soppert, J.;Jarchow, M.;Schindler, L.;Averdunk, L.;Kraemer, S.;Marx, G.;Bernhagen, J.;Pallua, N.;Schlemmer, H. P.;Simons, D.;Stoppe, C.",2016,,,0,
2270,FLAIR Hyperintense Vessel Sign of Both MCAs with Severe Heart Failure,"Introduction. Fluid-attenuated inversion recovery hyperintense vessels (FHVs) can be seen in patients with occlusion or severe stenosis of the cerebral arteries. FHVs are known to reflect stagnant or slow blood flow within the cerebral artery. Case Report. A 75-year-old woman presented with suddenly developed gait disturbance. She had a history of hypertension, heart failure, and dementia. Brain MRI demonstrated FHVs within both middle cerebral arteries (MCAs). However, there was no acute ischemic lesion and severe stenosis or occlusion of the cerebral arteries. In the baseline routine laboratory investigations, the AST, ALT, and B-type natriuretic peptide levels were elevated. Transthoracic echocardiography (TTE) showed mitral valve prolapse with severe regurgitation. Blood pressure control and conservative management for ischemic hepatitis were performed. After 7 days, the transaminase levels were normalized, and the patient was able to walk with normal gait. Conclusions. In this patient, underlying chronic cerebral hypoperfusion and additionally decreased systemic perfusion seemed to provoke ischemic hepatitis and contribute to the development of FHVs.",,"Kim, D.;Lee, S. Y.;Seo, K. D.",2016,,10.1155/2016/5169056,0,
2271,Blood pressure and mortality in very old people: Letters to the editor,,adult;aged;blood pressure;blood pressure measurement;clinical practice;dementia;diabetes mellitus;geriatrics;atrial fibrillation;heart failure;human;letter;major clinical study;Mini Mental State Examination;mortality;survival;systolic blood pressure,"Kim, D. H.;Hajjar, I.",2009,,,0,
2272,Risk of hospitalization for hypoglycemia among older Korean people with diabetes mellitus: Interactions between treatment modalities and comorbidities,"The objective of this study was to carry out a large population-based study to understand the factors associated with hypoglycemiarelated hospitalizations among older Korean adults with diabetes mellitus. This study analyzed data from a subset of the 2013 Health Insurance and Review and Assessment service-Adult Patient Sample. A total of 307,170 subjects, comprising 41.7% men and 58.3% women, had diabetes mellitus. Hypertension (80.8%) was the most common comorbidity, and dyslipidemia (59.0%) and ischemic heart disease (21.3%) were also prevalent. Approximately half of the patients with diabetes had >2 comorbidities, and two-thirds of the patients had >3 comorbidities. The proportion of patients taking insulin or sulfonylureas was 54.9%, and 23.2% of the patients were taking other medications. About 21.9% of the patients were treated nonpharmacologically. A total of 2867 hypoglycemia-related admission occurred, the incident rate was 9.33 per 1000 person. The risk was higher among female patients and older patients with several comorbidities, including cardiovascular disease, cerebrovascular disease, chronic liver disease, chronic kidney disease, dementia, and malignancies. Treatment modalities, including insulin and sulfonylureas, were associated with a high risk of hypoglycemia. After adjustments for age, sex, the different comorbidities, and the treatment modalities, we determined that chronic kidney disease and dementia were associated with a high risk of hypoglycemia-related hospitalization (odds ratio [OR]=2.52 and OR=1.93, respectively). Furthermore, patients with chronic kidney disease or dementia who were treated with sulfonylureas and insulin had very high risks of hypoglycemia, and the incident rate was 66.6 and 63.75 per 1000 person, respectively. In conclusion, the presence of comorbidities, especially chronic kidney disease and dementia, increased the risk of hypoglycemiaassociated hospitalization within this population of older patients with diabetes. The impact of the treatment modality, for example, insulin or sulfonylureas, on hypoglycemia was much greater among these patients.: CKD = chronic kidney disease, CLD = chronic liver disease, DPP-4 = dipeptidyl peptidase-4, GLP-1 = glucagonlike peptide-1, HbA1c = glycated hemoglobin, HIRA = Health Insurance Review & Assessment services, HIRA-APS = Health Insurance Review & Assessment services-Adult Patient Sample, ICD = International Classification of Disease, OR = odds ratio, TZDs = thiazolidinediones.",dipeptidyl peptidase IV inhibitor;insulin;metformin;sulfonylurea;age;aged;article;cardiovascular disease;cerebrovascular disease;chronic kidney failure;chronic liver disease;cohort analysis;dementia;diabetes mellitus;diabetic patient;dyslipidemia;female;hospitalization;human;hypertension;hypoglycemia;ischemic heart disease;Korean (people);major clinical study;male;malignant neoplasm;national health insurance;priority journal,"Kim, H. M.;Seong, J. M.;Kim, J.",2016,,10.1097/md.0000000000005016,0,
2273,Incidence and predictors of silent embolic cerebral infarction following diagnostic coronary angiography,"BACKGROUND: Coronary angiography (CAG) is an invasive diagnostic procedure, which could lead to procedure related complications. One of the well known post-procedural complications is cerebral embolic infarction with or without symptoms. Silent embolic cerebral infarction (SECI) has clinical significance because it can progress to a decline in cognitive function and increase the risk of dementia in the long term. The aim of this study was to detect the incidence and predictors of SECI after diagnostic CAG using diffusion-weighted magnetic resonance imaging (DW-MRI). METHODS: A total of 197 patients with coronary artery disease who underwent DW-MRI for evaluation of intracranial vasculopathy before coronary artery bypass graft surgery were retrospectively enrolled in the present study. DW-MRI was performed within 48 h after diagnostic CAG. SECI was diagnosed as presence of focal bright high signal intensity in DW-MRI. Patients were divided into groups according to presence/absence of SECI (+ SECI vs. - SECI, respectively). The clinical and angiographic characteristics were analyzed and independent predictors were evaluated. RESULTS: Of the 197 patients, SECI occurred in 20 patients (10.2%) after diagnostic CAG. Age, female gender, frequency of underlying atrial fibrillation, extent of coronary disease, and fluoroscopic time during diagnostic CAG were not different between the + SECI and - SECI groups. Left ventricular ejection fraction was significantly lower in the + SECI group than in the - SECI group (45.9 +/- 8.5% vs. 51.4 +/- 13.1%, p=0.014) and performance rate of internal mammary artery (IMA) angiography was significantly higher in the + SECI group compared with the - SECI group (85% vs. 37.2%, p<0.001). By multivariate analysis, performing IMA angiography was the only predictor of SECI (OR=14.642; 95% CI=3.201 to 66.980, p=0.001). CONCLUSIONS: The incidence of SECI after diagnostic CAG was not infrequent. Diagnostic CAG with IMA angiography may increase the risk of SECI.",Aged;Asymptomatic Diseases/*epidemiology;Cerebral Infarction/*epidemiology/pathology;Coronary Angiography/*adverse effects/*statistics & numerical data;Coronary Artery Disease/*radiography;Diffusion Magnetic Resonance Imaging;Female;Humans;Incidence;Intracranial Embolism/*epidemiology/pathology;Male;Middle Aged;Multivariate Analysis;Predictive Value of Tests;Retrospective Studies,"Kim, I. C.;Hur, S. H.;Park, N. H.;Jun, D. H.;Cho, Y. K.;Nam, C. W.;Kim, H.;Han, S. W.;Choi, S. Y.;Kim, Y. N.;Kim, K. B.",2011,Apr 14,10.1016/j.ijcard.2009.10.053,0,
2274,The apolipoprotein E ε4 haplotype is an important predictor for recurrence in ischemic cerebrovascular disease,"Objective: To determine whether a specific apolipoprotein E (APOE) allele is a predictor for ischemic cerebrovascular disease (ICVD). Background: The role of APOE in atherosclerosis has been a focus of intensive research. The APOE ε4 allele is overrepresented in Alzheimer's disease, atherosclerosis, ischemic heart disease, and ICVD. Also, ε4 carriers have higher cholesterol levels than non-ε4 carriers. Methods: We performed a prospective, longitudinal study on patients who have ICVD. The patients were recruited from St. Mary Hospital, Korea, and investigated for ICVD through interviews and by reviewing their medical records and neuroimaging studies. APOE genotypes were determined for each patient. Results: 20 of the 91 enrolled patients had recurrent ICVD, yielding a 3-year cumulative recurrence rate of 22%. Carriers of the ε4 allele had a 3-year recurrence rate of 53%, as compared with only 16% for patients who had the APOE non-ε4 allele (the risk ratio was 4.11; the 95% CI was 1.49-11.32; P<0.01). Conclusions: Our results make possible the identification of patients with ICVD who are at high risk for recurrence by assessing their APOE genotype. Also, this data might be clinically useful in methods for assessing potential strategies for prevention. © 2002 Elsevier Science B.V. All rights reserved.",apolipoprotein E;protein subunit;adult;aged;allele;article;cerebrovascular disease;confidence interval;controlled study;female;genotype;haplotype;human;interview;Korea;longitudinal study;major clinical study;male;medical record;prediction;priority journal;prospective study;recurrent disease,"Kim, J. S.;Han, S. R.;Chung, S. W.;Kim, B. S.;Lee, K. S.;Kim, Y. I.;Yang, D. W.;Kim, K. S.;Kim, J. W.",2003,,,0,
2275,Pre-stroke glycemic control is associated with early neurologic deterioration in acute atrial fibrillation-related ischemic stroke,"Background It has been suggested that AF-related ischemic stroke (IS) that is accompanied by atherosclerotic burden have poorer outcomes. The aim of this study was to investigate the importance of pre-stroke glycemic control (PSGC) on the early neurologic deterioration (END) of patients with acute AF-related IS. Methods We retrospectively recruited 121 patients with AF-related IS who also had Diabetes mellitus (DM). The HbA1C level was measured in all subjects. END was defined as an increase in the National Institute of Health Stroke Scale (NIHSS) score of 4 NIHSS points within 7 days of symptom onset compared to the initial NIHSS score. Results In this study, 20.7% (25 patients) were classified as having a poor PSGC status with a HbA1C level above 8.0%. In the univariate analysis, a poor PSGC status (p < 0.01), smoking (p = 0.01), severe neurologic deficits at admission (p = 0.01), and a larger size of ischemic lesions on DWI (p < 0.01) were associated with the occurrence of END. In the multivariate model, a poor PSGC status (p = 0.02) and larger size of ischemic lesions on MRI (p < 0.01) were independent predictors of END in acute AF-related IS. Conclusion The HbA1c level upon admission was independently associated with significant prediction of END in acute AF-related IS.",hemoglobin A1c;acute heart infarction;aged;article;brain ischemia;cerebrovascular accident;clinical outcome;diabetes mellitus;diffusion weighted imaging;female;glycemic control;hospital admission;human;major clinical study;male;mental deterioration;new-onset atrial fibrillation;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;predictive value;priority journal;retrospective study;smoking;valvular heart disease,"Kim, J. S.;Kim, R. Y.;Cha, J. K.;Rha, H. W.;Kang, M. J.;Kim, D. H.;Park, H. S.;Choi, J. H.;Huh, J. T.;Lee, I. K.",2017,,10.1016/j.ensci.2017.06.005,0,
2276,Clinical Implications of Changes in Individual Platelet Reactivity to Aspirin over Time in Acute Ischemic Stroke,"Background and Purpose - Time-dependent changes in individual platelet reactivity have been detected in patients with coronary artery disease. Therefore, we sought to evaluate the time-dependent changes in platelet reactivity to aspirin during the acute stage after ischemic stroke and the clinical implications of variable patient responses to aspirin in acute ischemic stroke. Methods - We conducted a single-center, prospective, observational study. The acute aspirin reaction unit (ARU) was measured after 3 hours of aspirin loading, with higher values indicating increased platelet reactivity despite aspirin therapy. The follow-up ARU was measured on the fifth day of consecutive aspirin intake. The numeric difference between the follow-up ARU and the acute ARU was defined as ΔARU and was stratified into quartiles. Early neurological deterioration was regarded as an early clinical outcome. Results - Both the acute ARU (476±69 IU) and the follow-up ARU (451±68 IU) were measured in 349 patients in this study. Early neurological deterioration was observed in 72 patients (20.6%). Changes in aspirin platelet reactivity over time showed an approximately Gaussian distribution. The highest ΔARU quartile was independently associated with early neurological deterioration (odds ratio, 3.19; 95% confidence interval, 1.43-7.10; P=0.005) by multivariate logistic regression analysis. Conclusions - The results of our study showed that the increase in platelet reactivity to aspirin over time is independently associated with early neurological deterioration in patients with acute ischemic stroke. In addition, during the acute stage of ischemic stroke, serial platelet reactivity assays may be more useful than a single assay for identifying the clinical implications of aspirin platelet reactivity after ischemic stroke.",acetylsalicylic acid;aged;article;blood clotting parameters;brain ischemia;cardiovascular risk;clinical evaluation;coronary artery disease;female;follow up;human;loading drug dose;maintenance drug dose;major clinical study;male;mental deterioration;observational study;platelet reactivity;priority journal;prospective study;sensitivity analysis;thrombocyte aggregation;thrombocyte function,"Kim, J. T.;Heo, S. H.;Choi, K. H.;Nam, T. S.;Choi, S. M.;Lee, S. H.;Park, M. S.;Kim, B. C.;Kim, M. K.;Saver, J. L.;Cho, K. H.",2015,,,0,
2277,Cerebral embolism of iodized oil (Lipiodol) after transcatheter arterial chemoembolization for hepatocellular carcinoma,"Cerebral lipiodol embolism is a rare complication of transcatheter arterial chemoembolization (TACE). Its pathological mechanism remains ambiguous despite several investigations. In Case 1, a 67-year-old man with hepatocellular carcinoma (HCC) experienced neurological deficits soon after undergoing a fourth session of TACE. Computed tomography (CT) scan showed multiple hyperdense lesions along the gyrus of frontal lobes and in the subcortical white matter. Transcranial Doppler (TCD) and transesophageal echocardiogram performed during the intravenous injection of agitated saline documented the presence of a right-to-left shunt (RLS) by demonstrating microbubbles in the left middle cerebral artery and left atrium. In Case 2, a 63-year-old woman underwent a third TACE due to a large HCC. After the procedure, her mental status deteriorated. Brain CT showed multiple hyperdense lesions on the cerebral and cerebellar cortex. TCD with agitated saline showed multiple microembolic signals shortly after the injection of agitated saline. The risk of cerebral lipiodol embolism may increase with recurrence and progression of HCC in patients who have a pre-existing RLS in the heart or lung. A test for the detection of an RLS may be necessary to identify patients with a heightened risk of cerebral embolism when multiple TACE procedures are required. TACE for HCC can cause pulmonary embolism or infarction.1,2 However, cerebral lipiodol embolism is rare after TACE. There have been several reports of cerebral embolism after TACE, but their exact mechanism has not yet been fully elucidated. We report herein 2 patients who developed cerebral lipiodol embolism after undergoing multiple TACE procedures for remnant HCC through a pre-existing RLS. © 2009 by the American Society of Neuroimaging.",doxorubicin;gelfoam;iodinated poppyseed oil;adult;aged;article;brain cortex;brain embolism;cancer growth;cancer recurrence;case report;cerebellum cortex;chemoembolization;computer assisted tomography;Doppler echography;female;frontal lobe;heart left atrium;heart right left shunt;human;liver cell carcinoma;male;mental deterioration;middle cerebral artery;neurologic disease;transesophageal echocardiography;white matter;lipiodol,"Kim, J. T.;Heo, S. H.;Choi, S. M.;Lee, S. H.;Park, M. S.;Kim, B. C.;Kim, Y.;Kim, M. K.;Cho, K. H.",2009,,,0,
2278,Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance claims database,"BACKGROUND: Chronic heart failure accounts for a great deal of the morbidity and mortality in the aging population. Evidence-based treatments include angiotensin-2 receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACE-I), beta-blockers, and aldosterone antagonists. Underutilization of these treatments in heart failure patients were frequently reported, which could lead to increase morbidity and mortality. The aim of this study was to evaluate the utilization of evidence-based treatments and their related factors for elderly patients with chronic heart failure. METHODS: This is retrospective observational study using the Korean National Health Insurance claims database. We identified prescription of evidence based treatment to elderly patients who had been hospitalized for chronic heart failure between January 1, 2005, and June 30, 2006. RESULTS: Among the 28,922 elderly patients with chronic heart failure, beta-blockers were prescribed to 31.5%, and ACE-I or ARBs were prescribed to 54.7% of the total population. Multivariable logistic regression analyses revealed that the prescription from outpatient clinic (prevalent ratio, 4.02, 95% CI 3.31-4.72), specialty of the healthcare providers (prevalent ratio, 1.26, 95% CI, 1.12-1.54), residence in urban (prevalent ratio, 1.37, 95% CI, 1.23-1.52) and admission to tertiary hospital (prevalent ratio, 2.07, 95% CI, 1.85-2.31) were important factors associated with treatment underutilization. Patients not given evidence-based treatment were more likely to experience dementia, reside in rural areas, and have less-specialized healthcare providers and were less likely to have coexisting cardiovascular diseases or concomitant medications than patients in the evidence-based treatment group. CONCLUSIONS: Healthcare system factors, such as hospital type, healthcare provider factors, such as specialty, and patient factors, such as comorbid cardiovascular disease, systemic disease with concomitant medications, together influence the underutilization of evidence-based pharmacologic treatment for patients with heart failure.","Age Factors;Aged;Aged, 80 and over;Cardiovascular Agents/*therapeutic use;Chi-Square Distribution;Chronic Disease;Comorbidity;Databases, Factual/statistics & numerical data;Drug Utilization;Drug Utilization Review;Evidence-Based Medicine/statistics & numerical data;Female;Guideline Adherence/statistics & numerical data;Heart Failure/diagnosis/*drug therapy/epidemiology;Humans;Insurance, Health/statistics & numerical data;Logistic Models;Male;Multivariate Analysis;Patient Selection;Polypharmacy;Practice Guidelines as Topic;Practice Patterns, Physicians'/*statistics & numerical data;Republic of Korea/epidemiology;Retrospective Studies","Kim, J. Y.;Kim, H. J.;Jung, S. Y.;Kim, K. I.;Song, H. J.;Lee, J. Y.;Seong, J. M.;Park, B. J.",2012,Jul 31,10.1186/1471-2261-12-60,0,
2279,"Rofecoxib, Merck, and the FDA 1 (multiple letters)",,acetylsalicylic acid;cyclooxygenase 2 inhibitor;naproxen;nonsteroid antiinflammatory agent;placebo;rofecoxib;Alzheimer disease;cardiovascular disease;cardiovascular risk;clinical trial;colorectal disease;drug effect;food and drug administration;heart infarction;human;letter;priority journal;prostate cancer;randomization;side effect;stomach polyp;cerebrovascular accident;thrombocyte aggregation;vioxx,"Kim, P. S.;Reicin, A. S.;Villalba, L.;Witter, J.;Wolfe, M. M.;Topol, E. J.",2004,,,0,
2280,Discriminative and Distinct Phenotyping by Constrained Tensor Factorization,"Adoption of Electronic Health Record (EHR) systems has led to collection of massive healthcare data, which creates oppor- tunities and challenges to study them. Computational phenotyping offers a promising way to convert the sparse and complex data into meaningful concepts that are interpretable to healthcare givers to make use of them. We propose a novel su- pervised nonnegative tensor factorization methodology that derives discriminative and distinct phenotypes. We represented co-occurrence of diagnoses and prescriptions in EHRs as a third-order tensor, and decomposed it using the CP algorithm. We evaluated discriminative power of our models with an Intensive Care Unit database (MIMIC-III) and demonstrated superior performance than state-of-the-art ICU mortality calculators (e.g., APACHE II, SAPS II). Example of the resulted phenotypes are sepsis with acute kidney injury, cardiac surgery, anemia, respiratory failure, heart failure, cardiac arrest, metastatic cancer (requiring ICU), end-stage dementia (requiring ICU and transitioned to comfort-care), intraabdominal conditions, and alcohol abuse/withdrawal.",,"Kim, Y.;El-Kareh, R.;Sun, J.;Yu, H.;Jiang, X.",2017,Apr 25,,0,
2281,Absence of outcome difference in elderly patients with and without dementia after acute myocardial infarction,"It is still unclear whether the presence of dementia has a negative effect on survival in elderly patients with acute myocardial infarction (AMI). Therefore, using data from the Tokai Acute Myocardial Infarction Study II (TAMIS-II), we set out to clarify the differences in in-hospital and long-term mortality between AMI patients with and without dementia. The study was a prospective study of all consecutive patients admitted to 15 acute care hospitals in the Tokai region with a diagnosis of AMI between 2001 and 2003. A total of 1837 patients (62 with dementia and 1775 without dementia) with AMI, aged 65 and over, were included in the present analysis. Patients with dementia were in general older, female, and impaired in their daily activities. They were also more likely to have a history of myocardial infarction, heart failure, cerebrovascular disease, and less likely to have a history of angina or smoking. They were less likely to have chest pain on arrival and lateral myocardial infarction. The percentage of patients with dementia who were transferred to an intensive care unit/coronary care unit or who were given percutaneous coronary intervention was lower. At discharge, the percentage of patients with dementia treated with aspirin was lower, and that of patients with dementia treated with diuretics was higher. In-hospital death rates for patients with and without dementia were 17.7% and 11.1% during hospitalization, respectively (P = 0.101). Long-term mortality after AMI was higher among patients with dementia before adjustment (24.2% versus 14.6%, P = 0.004). However, we were unable to detect differences after adjustment for potential confounders. Thus, our findings suggest that dementia has minimal effects on long-term mortality in patients with AMI.","Aged;Aged, 80 and over;Case-Control Studies;Dementia/*complications/mortality;Female;Follow-Up Studies;Hospitalization;Humans;Male;Myocardial Infarction/*mortality/*psychology/therapy;Prospective Studies;Survival Rate;Treatment Outcome","Kimata, T.;Hirakawa, Y.;Uemura, K.;Kuzuya, M.",2008,Sep,,0,
2282,Psychiatric illness in patients with end-stage renal disease,"PURPOSE: We sought to determine the prevalence of psychiatric illness in hospitalized patients with end-stage renal disease. We also examined the association between end-stage renal disease treatment modality and risk of hospitalization with a diagnosis of a mental disorder, and compared rates of hospitalization with a diagnosis of psychiatric illness in renal failure patients to patients with other chronic medical illnesses. SUBJECTS AND METHODS: We performed a cohort study of all Medicare-enrolled dialysis patients in 1993. Risk of hospitalization with a diagnosis of a mental disorder among renal failure patients was compared with Medicare patients with diabetes mellitus, ischemic heart disease, cerebrovascular disease, and peptic ulcer disease. RESULTS: Almost 9% of all dialysis patients were hospitalized with a mental disorder. Men, African-Americans, and younger patients were more likely to be hospitalized with a mental disorder. The adjusted risk of hospitalization for peritoneal dialysis patients was lower compared with hemodialysis patients for any mental disorder, depression, and alcohol and drug use. Hospitalization with mental disorders was 1.5 to 3.0 times higher for renal failure patients compared with other chronically ill patients. CONCLUSIONS: Hospitalization with a psychiatric illness is common among the US end-stage renal disease population. Depression, dementia and drug-related disorders were especially common. The coexistence of psychiatric illness in patients with renal failure who require specialized medical regimens represents a challenge to nephrologists in diagnosis and treatment. Disparities between hospitalization rates of psychiatric illnesses among end- stage renal disease patients compared with other chronically ill populations warrant further research.",adolescent;adult;aged;alcohol abuse;article;cerebrovascular disease;controlled study;depression;diabetes mellitus;drug abuse;female;hemodialysis;hospitalization;human;ischemic heart disease;kidney failure;major clinical study;male;medicare;mental disease;peptic ulcer;peritoneal dialysis;priority journal,"Kimmel, P. L.;Thamer, M.;Richard, C. M.;Ray, N. F.",1998,,,0,
2283,Sy 12-3 Are Ras Inhibitors Necessary for All Patients with Diabetes and Chronic Kidney Disease?,"There is accumulating evidence that RAS inhibitors not only reduce blood pressure, but also exert pleiotropic effects, including a renoprotective effect, amelioration of insulin resistance, reduction in onset of diabetes, and suppression of cardiovascular remodelling,. However, the definite benefit of RAS inhibition in treatment of hypertension with CKD or DM is not conclusive. We previously performed the OlmeSartan and Calcium Antagonists Randomized (OSCAR) study comparing the preventive effect of high-dose ARB therapy versus ARB plus CCB combination therapy on cardiovascular morbidity and mortality in 1164 Japanese elderly hypertensive patients with baseline type 2 diabetes and/or CVD (Am J Med (2012)). This trial showed that there was no significant difference in the incidence of primary events (fatal and non-fatal cardiovascular events and non-cardiovascular death) between ARB plus CCB therapy and high-dose ARB therapy. However, ARB + CCB combination lowered blood pressure more than high-dose ARB, and the combined ARB and CCB therapy reduced the incidence of primary events better than high-dose ARB monotherapy in patients with baseline CVD. Further prespecified CKD subanalysis of the OSCAR study has shown that ARB plus CCB therapy also reduces the incidence of primary events more than high-dose ARB therapy in patients with CKD (eGFR <60 ml/min/1.73 m) (Kidney Int (2013)). Therefore, better blood pressure control by ARB + CCB combination than high-dose ARB monotherapy is associated with lower incidence of cardiovascular events by ARB + CCB combination. Our trial support the notion that better blood pressure control rather than greater inhibition of RAS is important for providing the benefit of ARB-based therapy in elderly hypertensive patients with baseline CKD or CVD.In type 2 diabetic patients, an increased urinary albumin creatinine ratio (UACR) is associated with the development of diabetic nephropathy and macrovascular disease. HOPE sub-study indicates that microalbuminuria is a risk factor for cardiovascular events, all-cause death and hospitalization for congestive heart failure. Further, the increased plasma BNP levels can also predict risk of death and cardiovascular events after adjustment for traditional risk factors. A trial of telmisartan prevention of cardiovascular diseases (ATTEMPT-CVD) was performed to compare the effects of ARB therapy and those of non-ARB standard therapy on UACR and BNP level changes in 1,228 hypertensive patients (Eur J Prev Cardiol (2016)). In this prospective randomized trial, the ARB group had a significant effect on UACR and plasma BNP level changes compared with the non-ARB group, and ARB treatment caused a smaller increase in plasma BNP and a greater decrease in UACR than non-ARB treatment, independently of blood pressure control. These findings suggest the benefit of RAS inhibition in improvement of UACR and BNP.Either DM or CKD is significantly associated with high incidence of dementia or Alzheimer's disease (AD). Therefore, dementia or AD is a key target for treatment of hypertension with baseline DM or CKD. However, the benefit of antihypertensive therapy in prevention of dementia or AD remains to be defined. Interestingly, epidemiological or observational studies show that the use of RAS blockers is associated with lower incidence of dementia or AD. Thus, the potential role of RAS in pathophysiology of dementia or AD is paid much attention. However, the underlying mechanisms are unknown. In preclinical study, we have found that CKD significantly enhances cognitive impairment in a mouse model of AD and RAS inhibition ameliorates cognitive impairment in AD mouse with CKD. Furthermore, we found that brain angiotensin II plays a pivotal role in pathogenesis of AD through oxidative stress, inflammation, or cerebral amyloid angiopathy. Therefore, it is possible that RAS inhibition may be potentially promising for prevention of dementia or AD.In conclusion, although RAS inhibition is beneficial for treatment of hypertension complicated by CKD or DM, appropriate blood pr ssure control is necessary for the reduction of cardiovascular events by RAS inhibition-based therapy. Furthermore, further clinical and preclinical studies regarding the significance of RAS inhibition in dementia or AD is needed to define the potential benefit of RAS inhibition in treatment of hypertension with DM or CKD.",,"Kim-Mitsuyama, S.",2016,Sep,10.1097/01.hjh.0000500947.18349.b5,0,
2284,Anesthesia for patients with neurological diseases,"Several surgical treatments can be employed for the patients with neurological disorders, such as multiple sclerosis, Guillain-Barré syndrome, Parkinson's disease, amyotrophic lateral sclerosis, Alzheimer disease and spinal cord injury. It is possible that anesthesia related complications are induced in these neurologically complicated patients in the perioperative period. Respiratory dysfunction and autonomic nervous system dysfunction are most common in this population. Respiratory muscle weakness and bulbar palsy may cause aspiration pneumonia. Sometimes, postoperative ventilatory support is mandatory in these patients. Autonomic nervous system dysfunction may cause hypotension secondary to postural changes, blood loss, or positive airway pressure. Some therapeutic agents prescribed for neurological symptoms have drug interaction with anesthetic agents. Patients with motor neuron disease should be considered to be vulnerable to hyperkalemia in response to a depolarizing muscle relaxant. Although perioperative treatment guideline for most neurologic disorders has not been reported to lessen perioperative morbidity, knowledge of the clinical features and the interaction of common anesthetics with the drug therapy is important in planning intraoperative and postoperative management.",alfentanil;isoflurane;suxamethonium;vecuronium;Alzheimer disease;amyotrophic lateral sclerosis;anesthesia;anesthesia complication;apoptosis;article;breathing muscle;bulbar paralysis;deep vein thrombosis;delirium;dementia;drug hypersensitivity;dystonia;Guillain Barre syndrome;heart arrest;human;hyperkalemia;hypotension;motor neuron disease;multiple sclerosis;neurologic disease;Parkinson disease;postoperative care;preoperative evaluation;spinal cord injury;weakness,"Kimura, M.;Saito, S.",2010,,,0,
2285,What's in the R&D pipeline for pharma?,,antivirus agent;atorvastatin;biosyn;ceftobiprole medocaril;glyminox;hydralazine plus isosorbide dinitrate;imatinib;nootropic agent;panitumumab;prx 03140;rituximab;unclassified drug;Alzheimer disease;article;bacterial pneumonia;clinical trial;colorectal cancer;congestive heart failure;drug formulation;drug industry;drug marketing;drug research;economic aspect;human;Human immunodeficiency virus infection;hypercholesterolemia;hypertriglyceridemia;individualization;kidney cancer;lung cancer;methicillin resistant Staphylococcus aureus;nonhodgkin lymphoma;organization and management;skin infection;statistical analysis;statistical significance;bidil;glivec;lipitor,"Kincaid, L.",2005,,,0,
2286,Acute coronary syndromes: Is early abciximab beneficial in STEMI?,,blood pressure;body mass;cardiovascular risk;comorbidity;dementia;Denmark;diabetes mellitus;groups by age;heart infarction;hospitalization;human;incidence;kidney disease;liver disease;mortality;note;Poland;prevalence;priority journal;sex difference;social status;survival;United Kingdom,"King, A.",2012,,,0,
2287,Imperatives for DUCHENNE MD: A simplified guide to comprehensive care for duchenne muscular dystrophy,"Duchenne muscular dystrophy (DMD) is a progressive, life-limiting muscle-wasting disease. Although no curative treatment is yet available, comprehensive multidisciplinary care has increased life expectancy significantly in recent decades. An international consensus care publication in 2010 outlined best-practice care, which includes corticosteroid treatment, respiratory, cardiac, orthopedic and rehabilitative interventions to address disease manifestations. While disease specialists are largely aware of these care standards, local physicians responsible for the day-to-day care of patients and families may be less familiar. To facilitate optimal care, a one-page document has been generated from published care recommendations, summarizing the key elements of comprehensive care for people living with DMD (“Imperatives for Duchenne muscular dystrophy). This document was developed through an international collaboration between Parent Project Muscular Dystrophy (PPMD), United Parent Projects Muscular Dystrophy (UPPMD) and TREAT-NMD.",aminotransferase;bisphosphonic acid derivative;calcium;corticosteroid;creatine kinase;steroid;vitamin D;article;bone density;cardiomyopathy;cardiovascular magnetic resonance;child;chronic wasting disease;cognitive development;constipation;deterioration;disease carrier;Duchenne muscular dystrophy;echocardiography;exon skipping;follow up;gastroesophageal reflux;genetic screening;health care;heart arrhythmia;heart failure;heart muscle fibrosis;human;hypertransaminasemia;immunization;life expectancy;lung function test;mental health;mother;motor dysfunction;muscle injury;nutritional status;occupational therapy;scoliosis;stretching exercise,"Kinnett, K.;Rodger, S.;Vroom, E.;Furlong, P.;Aartsma-Rus, A.;Bushby, K.",2015,,,0,
2288,Philip B Gorelick: Changing neurological practice in the USA,,acetylsalicylic acid;ticlopidine;alcohol consumption;Alzheimer disease;blood pressure;cardiovascular disease;cerebrovascular accident;cerebrovascular disease;clinical practice;cognition;cognitive defect;curriculum;dementia;heart infarction;human;leadership;lowest income group;medical society;nervous system;neuroanatomy;neurology;note;pilot study;priority journal;risk factor;skill;United States,"Kirby, T.",2016,,,0,
2289,Neurocardiac dysregulation and neurogenic arrhythmias in a transgenic mouse model of Huntington's disease,"Huntington's disease (HD) is a heritable neurodegenerative disorder, with heart disease implicated as one major cause of death. While the responsible mechanism remains unknown, autonomic nervous system (ANS) dysfunction may play a role. We studied the cardiac phenotype in R6/1 transgenic mice at early (3 months old) and advanced (7 months old) stages of HD. While exhibiting a modest reduction in cardiomyocyte diameter, R6/1 mice had preserved baseline cardiac function. Conscious ECG telemetry revealed the absence of 24-h variation of heart rate (HR), and higher HR levels than wild-type littermates in young but not older R6/1 mice. Older R6/1 mice had increased plasma level of noradrenaline (NA), which was associated with reduced cardiac NA content. R6/1 mice also had unstable R-R intervals that were reversed following atropine treatment, suggesting parasympathetic nervous activation, and developed brady- and tachyarrhythmias, including paroxysmal atrial fibrillation and sudden death. c-Fos immunohistochemistry revealed greater numbers of active neurons in ANS-regulatory regions of R6/1 brains. Collectively, R6/1 mice exhibit profound ANS-cardiac dysfunction involving both sympathetic and parasympathetic limbs, that may be related to altered central autonomic pathways and lead to cardiac arrhythmias and sudden death.","Animals;Atrial Fibrillation/etiology/genetics/*physiopathology;Atropine/pharmacology;Autonomic Nervous System/physiopathology;Bradycardia/etiology/genetics/*physiopathology;Death, Sudden/etiology;Disease Models, Animal;Heart/innervation;Heart Rate/drug effects/physiology;Huntington Disease/*complications/genetics;Mice;Mice, Transgenic;Myocardium/pathology;Myocytes, Cardiac/pathology/physiology;Neurons/physiology;Norepinephrine/blood;Tachycardia/etiology/genetics/*physiopathology","Kiriazis, H.;Jennings, N. L.;Davern, P.;Lambert, G.;Su, Y.;Pang, T.;Du, X.;La Greca, L.;Head, G. A.;Hannan, A. J.;Du, X. J.",2012,Nov 15,10.1113/jphysiol.2012.238113,0,
2290,"Hospital readmissions: Patient, carer and clinician views","Aim: To explore patients, carers, and clinician views and identify factors, which affect the likelihood of hospital readmission. Methods: A cross sectional retrospective study of adult medical patients readmitted to hospital within 28 days of discharge. Medical and nursing records were reviewed and patients and their carers were interviewed regarding their views about their discharge and readmission. Data were collected regarding demographic, social and medical profiles. Results: Seventy-seven patients were readmitted over a five-week period out of 1289 patients discharged during the previous five weeks, representing a 6% readmission rate. Mean (SD) age of readmitted patients was 71.3 (14.6) years. Forty patients (51.9%) were aged ≥75 and 39 (50.6%) were males. Mean (SD) number of comorbidities was 3.68 (1.82). Mean (SD) number of medications was 7.79 (4.14). Most common reasons for readmission were exacerbation of chronic obstructive pulmonary disease and acute coronary syndrome. Mean (SD) time to readmission was 11.6 (8.2) days. Fifty (64.9%) patients were readmitted within 14 days of discharge. Forty eight (62.3%) patients were readmitted with the same medical condition as their previous discharge. Fifty (64.9%) patients and 45 (66.2%) carers felt that discharge was appropriate. Forty five (58.0%) patients and 44 (57.0%) carers thought that readmission was unavoidable. Clinicians considered 56 (72.7%) discharges appropriate and 55 (71.5%) readmissions unavoidable. A trend towards higher readmission rate among patients ≥ 75 years was noted (7.2% vs 5.1%, p=0.1). Conclusion: Although the majority of discharges are appropriate, up to a third of readmission may be avoidable in the views of carers, patients and clinicians. Patients and carers should be consulted regarding readiness for discharge before leaving hospital.",acute coronary syndrome;adult;age;aged;article;caregiver;cellulitis;chest infection;chronic obstructive lung disease;comorbidity;confusion;controlled study;cross-sectional study;dementia;demography;diabetes mellitus;disease exacerbation;drug use;female;health care quality;health status;heart failure;hospital discharge;hospital readmission;human;hypertension;information processing;interpersonal communication;interview;ischemic heart disease;major clinical study;male;medical record review;migraine;osteoarthritis;patient attitude;physician attitude;sex ratio;social aspect;time,"Kirk, E.;Prasad, M. K.;Abdelhafiz, A. H.",2006,,,0,
2291,Native American veterans with vascular risk factors have high rates of vascular cognitive impairment,"Background: Rates of cardiovascular disease and stroke are elevated in Native Americans, and a greater propensity to develop vascular cognitive impairment (VCI) rather than Alzheimer-type dementia has been inferred, supporting a need for further research in VCI in this population. We determined rates and patterns of memory loss among Native American veterans with multiple vascular risk factors. Methods: Native American veterans >=50 years old with >=2 vascular risk factors, including smoking history, hyperlipidemia, diabetes, coronary artery disease, or peripheral arterial disease, were recruited between September 2015 and May 2016. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were used to screen for cognitive impairment and depression. Patients with MoCA scores <26 were referred for imaging studies, memory loss serology, neuropsychiatric testing and clinical assessment by a memory loss physician. Final cognitive status was assigned by blinded adjudication. Results: We recruited 60 Native Americans aged 50-86 (mean+/-SD: 64+/-7.1 years); 90% were male, 95% had at least high-school education, and 69% had some college or advanced degrees. Risk factors included hypertension (92%), hyperlipidemia (88%), diabetes (47%), and prior/current smoking (78%). Eight (13%) with severe depression were excluded, leaving 23/51 with abnormal MoCA scores (44%, 95%CI 30%-59%). All with cognitive impairment were male compared to 83% among non-impaired subjects (p=0.059). Fifteen completed additional evaluation for memory loss, including 4/15 with normal MoCA scores who requested evaluation based on symptoms. Results were adjudicated as normal (4), or as having non-amnestic MCI (4), vascular MCI (5), and vascular dementia (2). MoCA correctly identified cognitive status in 86% (Kappa 0.66, 95%CI 0.23-1.00). Conclusions: Native American veterans have high rates of vascular cognitive impairment, which exceed rates of cognitive impairment documented in previously published older non-Native American cohorts. These results highlight the need for improved vascular risk reduction among Native American veterans. Further study is needed to identify ways to improve care in this underserved and understudied population.",adult;American Indian;amnesia;Beck Depression Inventory;cardiovascular risk;clinical study;clinical trial;cognitive defect;controlled clinical trial;controlled study;coronary artery disease;diabetes mellitus;education;female;high school;human;hyperlipidemia;hypertension;imaging;male;middle aged;Montreal cognitive assessment;multiinfarct dementia;peripheral occlusive artery disease;physician;serology;single blind procedure;smoking;symptom;veteran,"Kirkpatrick, Ac;Stoner, Ja;Donna-Ferreira, Fm;Malatinszky, Gc;Elias, Am;Guthery, Ld;Garcia-Martino, Da;Makharoblidze, E;Prodan, Ci",2017,,,0,
2292,"Older Age, Comorbid Illnesses, and Injury Severity Affect Immediate Outcome in Elderly Trauma Patients","INTRODUCTION: Trauma in elderly population is frequent and is associated with significant mortality, not only due to age but also due to complicated factors such as the severity of injury, preexisting comorbidity, and incomplete general assessment. Our primary aim was to determine whether age, Injury Severity Score (ISS), and preexisting comorbidities had an adverse effect on the outcome in patients aged 65 years and above following blunt trauma. METHODS: We included 1027 patients aged >/=65 years who were admitted to our Level I Trauma Center following blunt trauma. Patients' charts were reviewed for demographics, ISS, mechanism of injury, preexisting comorbidities, Intensive Care Unit and hospital length of stay, complications, and in-hospital mortality. RESULTS: The mean age of injured patients was 78.8 +/- 8.3 years (range 65-109). The majority of patients had mild injury severity (ISS 9-14, 66.8%). Multiple comorbidities (>/=3) were found in 233 patients (22.7%). Mortality during the hospitalization stay (n = 35, 3.4%) was associated with coronary artery disease, renal failure, dementia, and warfarin use (P < 0.05). Chronic anticoagulation treatment was recorded in 13% of patients. The addition of a single comorbidity increased the odds of wound infection to 1.29 and sepsis to 1.25. Both age and ISS increased the odds of death as -1.08 and -2.47, respectively. CONCLUSIONS: Our analysis shows that age alone in elderly trauma population is not a robust measure of outcome, and more valuable predictors such as injury severity, preexisting comorbidities, and medications are accounted for adverse outcome. Trauma care in this population with special considerations should be tailored to meet their specific needs.",Blunt trauma;complications;geriatric trauma;injury severity;mortality,"Kirshenbom, D.;Ben-Zaken, Z.;Albilya, N.;Niyibizi, E.;Bala, M.",2017,Jul-Sep,,0,
2293,End-of-life preferences of the general public: Results from a Japanese national survey,"PURPOSE: To determine under different End-of-Life (EoL) scenarios the preferences of the general public for EoL care setting and Life-sustaining-Treatments (LST), and to develop a new framework to assess these preferences. METHOD: Using a 2-stage, geographical cluster sampling method, we conducted a postal survey across Japan of 2000 adults, aged 20+. Four EoL scenarios were used: cancer, cardiac failure, dementia and persistent vegetative state (PVS). RESULTS: We received 969 valid responses (response rate 48.5%). Preference for EoL care setting varied by illness with those wishing to spend EoL at home only 39% for cancer, 22% for cardiac failure, and 10-11% for dementia and PVS. Preference for LST differed by scenario and treatment type. In cancer, cardiac failure and dementia, about half to two thirds expressed a preference for antibiotics and fluid drip infusion but few for nasogastric (NG) tube feeding, percutaneous endoscopic gastrostomy (PEG), ventilation or cardiopulmonary resuscitation (CPR). Although our models accounted for only 3-9% of the variance, preferences to receive LST were associated with preference to spend EoL in hospital for cancer and cardiac failure but not dementia. CONCLUSIONS: Few people preferred to die at home, while a preference for hospital was largely determined by factors other than preference for LST.","Dementia, primary senile degenerative;Japan;Life support care;Palliative care;Public opinion;Terminal care","Kissane, L. A.;Ikeda, B.;Akizuki, R.;Nozaki, S.;Yoshimura, K.;Ikegami, N.",2015,Nov,10.1016/j.healthpol.2015.04.014,0,
2294,Recurrence and prognosis in ischemic stroke patients with anticardiolipin antibody in Japan,"Anticardiolipin antibody (aCL) is considered to be one of the contributory factors in the development of cerebral infarction. We compared the recurrence and prognosis of 20 ischemic stroke patients with positive IgG aCL who had no collagen vascular diseases with those in 120 patients with negative IgG aCL. The aCL-positive patients comprised 18 females and 2 males aged 43-79 (mean 64) years and the mean follow-up period was 5.6 years. The aCL-negative patients comprised 82 males and 38 females aged 40-84 (mean 64.2) years and the mean follow-up period was 5.8 years. There was no significant difference in age and mean follow-up period between the two groups. We examined the recurrence rate and the intervals from the onset to the recurrence in both groups. We investigated the relationship between the recurrence of stroke and chronological changes in titer of aCL in patients with positive aCL. We also evaluated the effectiveness of antiplatelet agents for the prevention of recurrent stroke in both groups. A positive aCL level was defined as one which was > 3 standard deviations (S.D.) above the mean level for normal controls. A high titer of aCL was defined as being > 7 S.D. above the normal mean value. Among the 20 patients with positive aCL, recurrence of ischemic stroke occurred in 10 (50%) (cerebral thrombosis in 8 and cerebral embolism in 2) and myocardial infarction developed in 2 patients. As regards the number of ischemic episodes of stroke, recurrence occurred twice in 4 and once in 6 patients. The stroke recurred within 1 year in 3 patients, between 1 and 2 years in 4, and between 2 and 5 years in 3. The recurrence of stroke occurred in the distribution of the perforating arteries in 3 patients, the cortical arteries in 6 and a brain stem-cerebellar lesion in 1. On the other hand, recurrence of ischemic stroke developed in 23 (19.2%) of the 120 patients with negative aCL during the follow-up period. A significant difference in recurrence rate existed between the two groups (p < 0.01). The percentage of recurrent ischemic stroke within 2 years after the onset was 70% in aCL-positive patients and 65.2% in aCL-negative patients, respectively. Concerning the relationship between recurrence of stroke and changes in the aCL titers, the recurrence rate was higher in patients with a continuously elevated titer of aCL (83.3%) than in those with a low titer of aCL (25%). The recurrence rate of ischemic stroke in the positive patients with no risk factors for stroke was 50%. This rate was not different from that in those with risk factors. Antiplatelet agent alone such as aspirin or ticlopidine was not effective for preventing the recurrence of stroke in patients with positive aCL. Seven patients (28.6%) died of vascular diseases during the follow-up period among the positive aCL patients. The cause of death was multi-infarct dementia in 3, basilar thrombosis in 1, middle cerebral artery occlusion in 1, asphyxia in 1, and heart failure due to myocardial infarction in 2 patients. As regards the cause of death of the II (9.2%) among 120 aCL-negative patients, 4 patients died of cerebrovascular diseases, 4 of myocardial infarction, 3 of pneumonia. We conclude that the prognosis tended to be poor in ischemic stroke patients with aCL, and the recurrence rate was significantly high in aCL-positive patients as compared to aCL-negative ones, especially in patients with a continuously elevated titer of aCL antiplatelet agent alone was not effective for the prevention of recurrent stroke.",acetylsalicylic acid;antithrombocytic agent;cardiolipin antibody;ticlopidine;adult;aged;article;cerebrovascular accident;controlled study;drug therapy;female;human;major clinical study;male;prevention;prognosis;recurrent disease;risk factor,"Kitagawa, Y.;Shinohara, Y.;Niwa, K.;Yoshitoshi, M.;Kametsu, Y.",1994,,,0,
2295,Guidance and nursing of a patient with acute myocardial infarction and senile dementia: a case study,,aged;article;case report;dementia;female;heart infarction;human;nursing,"Kitahata, Y.;Shinkai, M.;Kido, T.",1988,,,0,
2296,"Modifiable Factors Associated with Cognitive Impairment in 1,143 Japanese Outpatients: The Project in Sado for Total Health (PROST)","BACKGROUND/AIMS: Evidence on modifiable factors associated with cognitive impairment in Japanese patients is scarce. This study aimed to determine modifiable factors for cognitive impairment in a Japanese hospital-based population. METHODS: Subjects of this cross-sectional study were 1,143 patients of Sado General Hospital (Niigata, Japan) registered in the Project in Sado for Total Health (PROST) between June 2008 and September 2014. We assessed disease history, body mass index (BMI), leisure time physical activity, walking time, smoking and drinking habits, and consumption of vegetables, fruits, and green tea as predictors, with cognitive impairment defined by the Mini-Mental State Examination (score <24) as an outcome. Multiple logistic regression analysis was performed to calculate odds ratios (ORs) for cognitive impairment. RESULTS: The mean subject age was 68.9 years, and the prevalence of cognitive impairment was 21.5%. Multivariate analysis revealed that age (p < 0.001), low BMI (<21.1; OR 1.39, 95% CI 1.12-1.72), a history of stroke (p = 0.003), a history of myocardial infarction (p = 0.038), low fruit consumption (p for trend = 0.012), and low green tea consumption (p for trend = 0.032) were independently associated with a higher prevalence of cognitive impairment. CONCLUSIONS: Modifiable factors, such as low BMI, low fruit consumption, and low green tea consumption, are associated with cognitive impairment. Longitudinal studies will be needed to confirm these findings.",Aged;Body mass index;Cognition;Cross-sectional study;Dementia;Epidemiology;Mini-Mental State Examination,"Kitamura, K.;Watanabe, Y.;Nakamura, K.;Sanpei, K.;Wakasugi, M.;Yokoseki, A.;Onodera, O.;Ikeuchi, T.;Kuwano, R.;Momotsu, T.;Narita, I.;Endo, N.",2016,May-Aug,10.1159/000447963,0,
2297,Soluble amyloid precursor protein 770 is released from inflamed endothelial cells and activated platelets: a novel biomarker for acute coronary syndrome,"BACKGROUND: Separate monitoring of the cleavage products of different amyloid beta precursor protein (APP) variants may provide useful information. RESULTS: We found that soluble APP770 (sAPP770) is released from inflamed endothelial cells and activated platelets as judged by ELISA. CONCLUSION: sAPP770 is an indicator for endothelial and platelet dysfunctions. SIGNIFICANCE: How sAPP770 is released in vivo has been shown. Most Alzheimer disease (AD) patients show deposition of amyloid beta (Abeta) peptide in blood vessels as well as the brain parenchyma. We previously found that vascular endothelial cells express amyloid beta precursor protein (APP) 770, a different APP isoform from neuronal APP695, and produce Abeta. Since the soluble APP cleavage product, sAPP, is considered to be a possible marker for AD diagnosis, sAPP has been widely measured as a mixture of these variants. We hypothesized that measurement of the endothelial APP770 cleavage product in patients separately from that of neuronal APP695 would enable discrimination between endothelial and neurological dysfunctions. Using our newly developed ELISA system for sAPP770, we observed that inflammatory cytokines significantly enhanced sAPP770 secretion by endothelial cells. Furthermore, we unexpectedly found that sAPP770 was rapidly released from activated platelets. We also found that cerebrospinal fluid mainly contained sAPP695, while serum mostly contained sAPP770. Finally, to test our hypothesis that sAPP770 could be an indicator for endothelial dysfunction, we applied our APP770 ELISA to patients with acute coronary syndrome (ACS), in which endothelial injury and platelet activation lead to fibrous plaque disruption and thrombus formation. Development of a biomarker is essential to facilitate ACS diagnosis in clinical practice. The results revealed that ACS patients had significantly higher plasma sAPP770 levels. Furthermore, in myocardial infarction model rats, an increase in plasma sAPP preceded the release of cardiac enzymes, currently used markers for acute myocardial infarction. These findings raise the possibility that sAPP770 can be a useful biomarker for ACS.","Acute Coronary Syndrome/diagnosis/*metabolism/physiopathology;Aged;Alzheimer Disease/metabolism;Amyloid beta-Protein Precursor/*metabolism;Animals;Biomarkers/metabolism;Blood Platelets/cytology/*metabolism;Cells, Cultured;Endothelial Cells/*immunology;Female;Humans;Male;Peptide Fragments/*metabolism;*Platelet Activation;Rats;Rats, Sprague-Dawley","Kitazume, S.;Yoshihisa, A.;Yamaki, T.;Oikawa, M.;Tachida, Y.;Ogawa, K.;Imamaki, R.;Hagiwara, Y.;Kinoshita, N.;Takeishi, Y.;Furukawa, K.;Tomita, N.;Arai, H.;Iwata, N.;Saido, T.;Yamamoto, N.;Taniguchi, N.",2012,Nov 23,10.1074/jbc.M112.398578,0,
2298,A case of donepezil-related torsades de pointes,"An 80-year-old woman with Alzheimer's dementia presented with diarrhoea, vomiting and worsening confusion following an increase in donepezil dose from 5 to 10 mg. The ECG revealed prolongation of QTc interval. Soon after admission, she became unresponsive with polymorphic ventricular tachycardia (VT). Cardiopulmonary resuscitation with a 200 J shock was successful in establishing cardiac output. Following the discontinuation of donepezil, the QTc interval normalized and no further arrhythmias were recorded. Treatment with anticholinesterase inhibitors may result in lifethreatening VT. Vigilance is required for the identification of this condition in patients presenting with presyncope, syncope or seizures.",donepezil;fluoxetine;aged;Alzheimer disease;angiocardiography;article;case report;confusion;coronary artery atherosclerosis;diarrhea;dose response;drug dose increase;drug dose reduction;drug withdrawal;electrocardiography;female;follow up;human;medical history;mitral valve regurgitation;outcome assessment;polymorphic ventricular tachycardia;priority journal,"Kitt, J.;Irons, R.;Al-Obaidi, M.;Missouris, C.",2015,,,0,
2299,Further evidence for plasma progranulin as a biomarker in bipolar disorder,"Background A recent study suggested that progranulin (encoded by the fronto-temporal dementia risk gene GRN) plasma levels are decreased in bipolar disorder (BD). Replication of this finding is however lacking. Methods Progranulin plasma levels of bipolar patients (n=104) and healthy controls (n=80) were measured by enzyme-linked immunosorbent assay (ELISA). Participants were also genotyped for three single nucleotide polymorphisms (SNPs) in the GRN gene (rs2879096, rs4792938 and rs5848), and the effect of genetic variation on progranulin levels was examined. Results Plasma progranulin levels were decreased in BD (ANCOVA, p=0.001). Furthermore, age was significantly and positively correlated with plasma progranulin (Pearson).©2014 Elsevier B.V. All rights reserved.",anticonvulsive agent;antidepressant agent;lithium;neuroleptic agent;progranulin;adult;aged;article;bipolar disorder;bipolar I disorder;bipolar II disorder;controlled study;depression;enzyme linked immunosorbent assay;female;genetic variability;genotype;human;major clinical study;male;mania;middle aged;priority journal;protein blood level;sample size;semi structured interview;single nucleotide polymorphism;young adult,"Kittel-Schneider, S.;Weigl, J.;Volkert, J.;Geßner, A.;Schmidt, B.;Hempel, S.;Kiel, T.;Olmes, D. G.;Bartl, J.;Weber, H.;Kopf, J.;Reif, A.",2014,,,0,
2300,"Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study","OBJECTIVE: To examine the relation of midlife raised blood pressure and serum cholesterol concentrations to Alzheimer's disease in later life. DESIGN: Prospective, population based study. SETTING: Populations of Kuopio and Joensuu, eastern Finland. PARTICIPANTS: Participants were derived from random, population based samples previously studied in a survey carried out in 1972, 1977, 1982, or 1987. After an average of 21 years' follow up, a total of 1449 (73%) participants aged 65-79 took part in the re-examination in 1998. MAIN OUTCOME MEASURES: Midlife blood pressure and cholesterol concentrations and development of Alzheimer's disease in later life. RESULTS: People with raised systolic blood pressure (>/=160 mm Hg) or high serum cholesterol concentration (>/=6.5 mmol/l) in midlife had a significantly higher risk of Alzheimer's disease in later life, even after adjustment for age, body mass index, education, vascular events, smoking status, and alcohol consumption, than those with normal systolic blood pressure (odds ratio 2.3, 95% confidence interval 1.0 to 5.5) or serum cholesterol (odds ratio 2.1, 1.0 to 4.4). Participants with both of these risk factors in midlife had a significantly higher risk of developing Alzheimer's disease than those with either of the risk factors alone (odds ratio 3.5, 1.6 to 7.9). Diastolic blood pressure in midlife had no significant effect on the risk of Alzheimer's disease. CONCLUSION: Raised systolic blood pressure and high serum cholesterol concentration, and in particular the combination of these risks, in midlife increase the risk of Alzheimer's disease in later life.","Adult;Aged;Alzheimer Disease/*etiology;Apolipoproteins E/genetics;Female;Finland;Follow-Up Studies;Genotype;Humans;Hypercholesterolemia/*complications;Hypertension/*complications;Ischemic Attack, Transient/complications;Longitudinal Studies;Male;Middle Aged;Myocardial Infarction/complications;Risk Factors;Systole","Kivipelto, M.;Helkala, E. L.;Laakso, M. P.;Hanninen, T.;Hallikainen, M.;Alhainen, K.;Soininen, H.;Tuomilehto, J.;Nissinen, A.",2001,Jun 16,,0,
2301,Inflammation: Friend and Foe,,amino terminal pro brain natriuretic peptide;biglycan;cathepsin K;collagen type 1;dipeptidyl carboxypeptidase inhibitor;elastin;gelatinase A;gelatinase B;interleukin 1;mimecan;tumor necrosis factor alpha;Alzheimer disease;atherosclerosis;brain ventricle dilatation;cartilage degeneration;collagen degradation;heart failure;human;inflammation;inflammatory bowel disease;note;priority journal;rheumatoid arthritis,"Kjekshus, J.",2015,,,0,
2302,Pl 03-3 the Future Development of Drug Therapy for Hypertension,"There is a whole armament of good drugs for treatment of hypertension including diuretics, calcium antagonist, angiotensin receptor antagonists and angiotensin converting enzyme inhibitors. Secondary drugs mostly used for special indications include beta-blockers, alpha-blockers, mineralocorticoid receptor antagonists (aldosterone antagonists), renin-inhibitors, centrally acting drugs, direct vasodilators and others.A variety of new drugs targeting different pressor mechanism exist and have partly been studies experimentally but will unlikely make it to clinical use in human hypertension. The reason for this is mainly the fact that all existing drugs are generic and inexpensive. The clinical development of new drugs has thus halted because industry does not get paid back for their investments. A recent example is the angiotensin receptor neprilysin inhibitor which has success in the treatment of heart failure at least partly because of powerful blood pressure lowering properties. However, one may also wonder whether potential harmful effects from long term treatment such as deposition of beta-amyloid in the brain may influence the risk of Alzheimer and prohibit development for use in hypertension.Against the solid documentation of today's first line drugs on preventing the cardiovascular complications of hypertension potential new drugs on the market would need to be tested in mega-trials before likely to be successful. Even if proven effective the cost issue would remain as a major barrier.Thus, the future development of drug therapy for hypertension would be improving the clinical aspects including overcoming clinical inertia and adherence to the drugs. In other words education of physicians and patients to make the right choices and follow-up on treatment that has been initiated. Targets are always the same - patients with well controlled blood pressure and without side effects. Adherence may be facilitated with drug monitoring in blood and urine, and combinations of complimentary drugs - usually given once daily and in the same pill. People with uncontrolled hypertension should be detected and treated to target blood pressure <140/90 mmHg, rather rapidly in high risk people, and then maintained with controlled BP <140/90 mmHg.",,"Kjeldsen, S.",2016,Sep,10.1097/01.hjh.0000500942.87853.29,0,
2303,Treatment of hypertension and the price to pay; adverse events and discontinuation from randomized treatment in clinical trials,,antihypertensive agent;beta adrenergic receptor blocking agent;calcium antagonist;dipeptidyl carboxypeptidase inhibitor;diuretic agent;placebo;adverse drug reaction;Alzheimer disease;ankle edema;antihypertensive therapy;atrial fibrillation;cardiovascular disease;cardiovascular risk;cerebrovascular accident;cognitive defect;coughing;diastolic blood pressure;dizziness;doctor patient relation;drug withdrawal;electrolyte disturbance;evidence based medicine;faintness;follow up;heart failure;heart infarction;human;hypertension;kidney dysfunction;kidney failure;meta analysis (topic);note;priority journal;prognosis;randomized controlled trial (topic);risk reduction;systolic blood pressure,"Kjeldsen, S. E.;Os, I.;Redon, J.",2016,,,0,
2304,"A population-based study of drug use in the very old living in a rural district of Sweden, with focus on cardiovascular drug consumption: comparison with an urban cohort","PURPOSE: To describe drug use among the elderly, with focus on cardiovascular drugs and regional differences. METHODS: Cross-sectional data from a Swedish population-based study on ageing and dementia were used. In rural Nordanstig, drug-use data for 918 participants, 75 years and older (N1), were collected during the period 1995-1998. The data for 335 participants, 84 years and older (N84+), were compared with 418 subjects of the same age group in urban Kungsholmen (K5), data collected 1997-1998. RESULTS: Over 90% of the participants were using drugs regularly or 'as needed'. The most common were cardiovascular drugs, nervous system drugs and drugs for the alimentary tract and metabolism. Polypharmacy (five drugs or more) was common, especially among the oldest, 46% (N84+) and 50% (K5). ACE-inhibitors were used by only 24% of the N1 participants with heart failure. Significantly fewer of cognitively impaired participants were treated with ACE-inhibitors (OR: 0.44) and beta-blockers (OR: 0.50). Significant regional differences among the oldest old were found, with more cardiovascular (OR: 2.72) and less antithrombotic drugs (OR: 0.43) in the rural 84+ group. CONCLUSIONS: The extensive drug consumption, high prevalence of polypharmacy and regional differences stress the need for rigorous monitoring of drug use in the elderly. The data also indicate undertreatment of some cardiovascular diseases in the elderly with cognitive impairment.",Aged;Cardiovascular Agents/*administration & dosage;Educational Status;Female;*Geriatrics;Housing;Humans;Male;*Pharmacoepidemiology;*Polypharmacy;Population Surveillance/*methods;*Rural Population;Sweden;*Urban Population,"Klarin, I.;Fastbom, J.;Wimo, A.",2003,Dec,10.1002/pds.878,0,
2305,The use of angiotensin-converting enzyme inhibitors and other drugs with cardiovascular effects by non-demented and demented elderly with a clinical diagnosis of heart failure. A population-based study of the very old,"Objectives: The aim of this study was to investigate drug treatment patterns for heart failure (HF) in the very elderly and, in particular, to determine if angiotensin-converting enzyme inhibitors (ACEIs) were under-used by demented persons. Methods: The 265 participants investigated in this study were all 75 years and older, with HF and using cardiovascular drugs, and were part of the Nordanstig cohort (919 persons) of the population-based Kungsholmen project. Data on demographics, medical conditions, including dementia and HF from the baseline investigation 1995-1998, and drug use data from the baseline and follow-up (1999-2001) investigations were used. Results: ACEIs were used by 25.7% of the participants. After adjustment for sociodemographic and medical background factors, there was no significant difference in ACEI use by dementia status, but use was lower with increasing age: the odds ratio (OR) was 0.11 and the 95% confidence interval (95%CI) was 0.01-0.95 between participants 90 years and older and those 75-79 years old (p=0.045). Use was also lower in those persons living in an institution compared to community-living elderly (OR: 0.28; 95% CI: 0.09-0.91; p=0.034). Only 15.8% of the participants used beta-blockers. Of the 12.8% using calcium channel blockers, 82% used preparations with negative inotropic effects. Non-steroid antiinflammatory drugs (NSAIDS), contraindicated in HF, were used by 10.6%. Conclusions: No significant difference in ACEI utilization related to dementia diagnosis was shown, but the study did reveal a significantly lower use in the oldest age group and in elderly persons living in institutions. The low utilization rates of ACEIs and beta-blockers, the high proportion of calcium channel blockers with negative inotropic effects, and the fairly frequent use of NSAIDs in the study cohort suggest that the quality in drug treatment of very old people with HF can be improved. © Springer-Verlag 2006.",anticoagulant agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;captopril;cardiac glycoside;cardiovascular agent;cilazapril;dipeptidyl carboxypeptidase inhibitor;diuretic agent;enalapril;lisinopril;nonsteroid antiinflammatory agent;quinapril;ramipril;vasodilator agent;aged;article;confidence interval;controlled study;dementia;drug contraindication;drug effect;drug use;female;follow up;heart failure;human;major clinical study;male;population research;priority journal;Sweden,"Klarin, I.;Fastbom, J.;Wimo, A.",2006,,,0,
2306,Effects of C-reactive protein and pentosan polysulphate on human complement activation,"Complement (C) activation is believed to play an adverse role in several chronic degenerative disease processes, including atherosclerosis, myocardial infarction and Alzheimer's disease. We developed several in vitro quantitative assays to evaluate processes which activate C in human serum, and to assess candidates which might block that activation. Binding of C-reactive protein (CRP) to immobilized cell surfaces was used as a tissue-based method of activation, while immunoglobulin G in solution was used as a surrogate antibody method. Activation was assessed by deposition of C fragments on fixed cell surfaces, or by capture of C5b-9 from solution. We observed that several cell lines, including SH-SY5Y, U-937, THP-1 and ECV304, bound CRP and activated C following attachment of cells to a plastic surface by means of air drying. Treatment of human neuroblastoma SH-SY5Y cells with the reactive oxygen intermediates generated by xanthine (Xa) - xanthine oxidase (XaOx) prior to air drying or by hydrogen peroxide solutions after air drying, enhanced C activation, possibly through oxidation of the cell lipid membrane. Several C inhibitors were tested for their effectiveness in blocking these systems. Pentosan polysulphate (PPS), an orally active agent, blocked C activation in the same concentration range of 1-1000 microg/ml as heparin, dextran sulphate, compstatin and fucoidan. PPS may have practical application as a C inhibitor.","C-Reactive Protein/*pharmacology;Complement Activation/*drug effects;Complement Inactivator Proteins/pharmacology;Complement Membrane Attack Complex/immunology;Humans;Pentosan Sulfuric Polyester/*pharmacology;Tumor Cells, Cultured","Klegeris, A.;Singh, E. A.;McGeer, P. L.",2002,Jul,,0,
2307,Twelve-month follow-up of left atrial appendage occlusion with Amplatzer Amulet,"Background: The Amplatzer Amulet (St. Jude Medical, Minneapolis, MN, USA) is a second generation Amplatzer device for left atrial appendage (LAA) occlusion (LAAO) for stroke prophylaxis in patients with atrial fibrillation. This research sought to assess the clinical performance of the Amplatzer Amulet device and in follow up for 12 months. Methods: In this single-center registry patients with atrial fibrillation and contraindication to oral anticoagulation underwent LAAO with the Amplatzer Amulet device. Follow-up was performed before discharge, by transesophageal echocardiography (TEE) after 6 weeks and telephone interview after 3, 6 and 12 months. Results: Between October 2014 and August 2015 50 patients (76.1 ± 8.3 years; 30 male) were enrolled. Procedural success was achieved in 49 (98%) patients. Major periprocedural adverse events were observed in 4 (8%) of patients: 1 device embolization, 2 pericardial effusions requiring pericardiocentesis and 1 prolonged hospital stay due to retropharyngeal hematoma from the TEE probe. Follow-up TEE was available in 38 of 50 patients showing complete LAA sealing in all. 2 device-related thrombi were also documented. At 12-month follow-up 7 patients had died unrelated to the device. Ischemic stroke occurred in 3 patients. According to neurological examination two were classified as microangiopathic and not cardio-embolic. The other one could not be classified. Bleeding complications (5 minor, 3 major) were documented in 8 patients. Conclusions: Although minimizing procedure-related complications remains challenging, LAAO with the Amplatzer Amulet device showed high procedural success and excellent LAA sealing.",septal occluder;acetylsalicylic acid;clopidogrel;heparin;thrombin;aged;angiography;artery occlusion;article;atrial fibrillation;bacterial peritonitis;cardiovascular mortality;chronic kidney failure;clinical article;clinical outcome;computer assisted tomography;controlled study;death;dementia;device embolization;dual antiplatelet therapy;false aneurysm;female;fluoroscopy;follow up;gastrointestinal hemorrhage;heart atrium appendage;heart failure;heart infarction;heart tamponade;hematoma;hospitalization;human;male;National Institutes of Health Stroke Scale;patent foramen ovale;pericardial effusion;pericarditis;subarachnoid hemorrhage;telephone interview;thrombus;transesophageal echocardiography;transient ischemic attack;transthoracic echocardiography;urinary tract infection;Amplatzer Amulet,"Kleinecke, C.;Park, J. W.;Gödde, M.;Zintl, K.;Schnupp, S.;Brachmann, J.",2017,,10.5603/CJ.a2017.0017,0,
2308,Herbal medications: Possible importance for anaesthesia and intensive care medicine,"There is a great enthusiasm for herbal medications with increasing and widespread use among the population in various countries. A certain scepticism towards the use of pharmaceutical drugs may promote the use of herbal medicines such as echinacea, ginger, garlic, ginkgo, cranberry, valerian or St. John's wort even in western countries. Although considered safe among users, adverse effects such as increased bleeding tendencies, hypertension and hepatotoxicity can occur. Physicians should caution patients on the adverse side effects of herbal medicines and interactions between herbal medicines and pharmaceutical drugs, leading to various and uncontrollable deterioration of vital functions in the perioperative period. Although evidence-based data are lacking, anaesthesiologists and surgeons should be familiar with the effects of herbal medicines and should enquire about the use of these agents in the preoperative assessment. Currently available data suggest that herbal medications should be discontinued up to 2 weeks before elective surgery, although no guidelines of scientific societies have yet been published. © 2007 Springer Medizin Verlag.",alfentanil;contraceptive agent;cranberry extract;cyclosporin A;Echinacea extract;electrolyte;Ephedra extract;garlic extract;ginger extract;Ginkgo biloba extract;ginseng extract;Glycyrrhiza glabra extract;herbaceous agent;Hypericum perforatum extract;kava;lidocaine;midazolam;valerian;water;Alzheimer disease;anesthesist;article;asthma;atherosclerosis;bleeding;cardiovascular system;cataract;colic;constipation;cranberry;depression;drug interaction;Echinacea;edema;elective surgery;electrolyte balance;endocrine system;Ephedra;evidence based medicine;fear;garlic;ginger;Glycyrrhiza glabra;headache;heart infarction;heart palpitation;herbal medicine;human;hyperglycemia;Hypericum perforatum;hyperkalemia;hypertension;hypokalemia;hypotension;immune system;infection;influenza;insomnia;kidney circulation;liver toxicity;muscle cramp;muscle hypertonia;nausea;neurotoxicity;patient safety;perioperative period;photosensitivity;physician;practice guideline;preoperative evaluation;sedation;side effect;surgeon;tachycardia;withdrawal reflex,"Kleinschmidt, S.;Rump, G.;Kotter, J.",2007,,,0,
2309,Treatment of posttraumatic syringomyelia: Clinical article,"Object. This paper presents results of a prospective study for patients undergoing surgery for posttraumatic syringomyelia between 1991 and 2010. Methods. A group of 137 patients with posttraumatic syringomyelia were evaluated (mean age 45 ± 13 years, mean follow-up 51 ± 51 months) with pre- and postoperative MRI and clinical examinations presenting in this period and followed prospectively by outpatient visits and questionnaires. Surgery was recommended for symptomatic patients with a progressive course. Short-term results were determined within 3 months of surgery, whereas long-term outcomes in terms of clinical recurrences were studied with Kaplan-Meier statistics. Results. Three groups were distinguished according to the type of trauma: Group A, patients with spinal trauma but without cord injury (ASIA E, n = 37); Group B, patients with an incomplete cord injury (ASIA C or D, n = 55); and Group C, patients with complete loss of motor function or a complete cord injury (ASIA A or B, n = 45). Overall, 61 patients with progressive symptoms underwent 71 operations. Of these operations, 61 consisted of arachnolysis, untethering, and duraplasty at the trauma level (that is, decompression), while 4 ASIA A patients underwent a cordectomy. The remaining procedures consisted of placement of a thecoperitoneal shunt, 2 opiate pump placements, and 2 anterior and 1 posterior cervical decompression and fusion. Seventy-six patients were not treated surgically due to lack of neurological progression or refusal of an operation. Neurological symptoms remained stable for 10 years in 84% of the patients for whom surgery was not recommended due to lack of neurological progression. In contrast, 60% of those who declined recommended surgery had neurological progression within 5 years. For patients presenting with neurological progression, outcome was better with decompression. Postoperatively, 61% demonstrated a reduction of syrinx size. Although neurological symptoms generally remained unchanged after surgery, 47% of affected patients reported a postoperative improvement of their pain syndrome. After 3 months, 51% considered their postoperative status improved and 41% considered it unchanged. In the long-term, favorable results were obtained for Groups A and C with rates for neurological deterioration of 6% and 14% after 5 years, respectively. In Group B, this rate was considerably higher at 39%, because arachnolysis and untethering to preserve residual cord function could not be fully achieved in all patients. Cordectomy led to neurological improvement and syrinx collapse in all 4 patients. Conclusions. The technique of decompression with arachnolysis, untethering, and duraplasty at the level of the underlying trauma provides good long-term results for patients with progressive neurological symptoms following ASIA A, B and E injuries. Treatment of patients with posttraumatic syringomyelia after spinal cord injuries with preserved motor functions (ASIA C and D) remains a major challenge. Future studies will have to establish whether thecoperitoneal shunts would be a superior alternative for this subgroup.",adolescent;adult;aged;anterior spine fusion;article;ataxia;child;clinical examination;disease course;dysesthesia;female;follow up;heart arrest;hematoma;human;hypesthesia;liquorrhea;long term care;major clinical study;male;mental deterioration;motor dysfunction;neurologic disease;nuclear magnetic resonance imaging;outpatient care;posterior spine fusion;postoperative pain;postoperative period;posttraumatic syringomyelia;preschool child;prospective study;questionnaire;recurrent disease;school child;spinal cord decompression;spinal cord injury;surgical infection;symptom;syringomyelia;urinary tract infection,"Klekamp, J.",2012,,,0,
2310,Platelet biomarkers in tumor growth,"As the clinical use of biologic response modifiers continues to increase, the old way of estimating effective doses in oncology, i.e. reaching dose-limiting toxicities, is becoming obsolete. Biologic response modifiers and targeted therapies are less toxic and their effective dose is often left shifted on the dose response curve. This is why the majority of pharmaceutical companies have opened new programs seeking biomarker of therapeutic response, and why numerous research programs have been announcing Request for Applications in order to find and evaluate biomarkers of disease. Because of the ease of procurement of the clinical specimen, plasma and serum, remain the favorite clinical analytes. However, the sheer numbers of different plasma proteins, the many thousand fold differences in the amounts of the potential protein biomarkers, and the lack of specificity of plasma proteins have hindered the search. The ability to detect changes in the levels of proteins expressed in picomolar quantities are mired by the presence of more abundant nonspecific proteins such as albumin or immunoglobulins. Most meaningful changes, those that occur in the amounts of free proteins, remain very difficult to evaluate. The recent discovery that angiogenesis regulators are actively and selectively sequestered in platelets early in cancer, has led to renewed hopes of finding circulating biomarkers that would help in early disease detection, and improve our ability to detect an early therapeutic response. There are early indicators that this is the case in other diseases as well, and that the focus may be shifting from analyzing plasma and serum, to analyzing platelets. © 2011 Bentham Science Publishers.",acetylsalicylic acid;adenosine diphosphate;adrenalin;albumin;amyloid beta protein;amyloid precursor protein;beta thromboglobulin;biological marker;CD31 antigen;collagen;endothelial leukocyte adhesion molecule 1;fibroblast growth factor 2;immunoglobulin;PADGEM protein;platelet derived growth factor;prostacyclin;prostate specific antigen;serotonin;sertraline;thrombocyte activating factor;thrombocyte factor 4;thromboxane A2;thromboxane B2;vascular cell adhesion molecule 1;vasculotropin;acute coronary syndrome;Alzheimer disease;analytic method;article;atherosclerosis;biological activity;breast adenocarcinoma;cellular distribution;colorectal carcinoma;depression;drug targeting;half life time;human;liposarcoma;matrix assisted laser desorption ionization time of flight mass spectrometry;phenotype;priority journal;protein analysis;protein blood level;protein expression;protein function;protein localization;protein secretion;proteomics;surface enhanced laser desorption ionization time of flight mass spectrometry;thrombocyte activation;thrombocyte aggregation;thrombocyte count;thrombocyte function;tumor growth;tumor vascularization,"Klement, G. L.",2011,,,0,
2311,Complementary/Integrative Therapies That Work: A Review of the Evidence,"Significant evidence supports the effectiveness and safety of several complementary or integrative treatment approaches to common primary care problems. Acupuncture is effective in the management of chronic low back pain. Mind-body interventions such as cognitive behavior therapy, yoga, tai chi, qi gong, and music therapy may be helpful for treating insomnia. Exercise can reduce anxiety symptoms. Herbal preparations and nutritional supplements can be useful as first-line therapy for certain conditions, such as fish oil for hypertriglyceridemia, St. John's wort for depression, and Ginkgo biloba extract for dementia, or as adjunctive therapy, such as coenzyme Q10 for heart failure. Probiotic supplementation can significantly reduce the likelihood of antibiotic-associated diarrhea. Physicians should caution patients about interactions, and counsel them about the quality and safety of herbal and nutritional supplements.",,"Kligler, B.;Teets, R.;Quick, M.",2016,Sep 1,,0,
2312,Factors associated with pre-stroke dementia: the cracow stroke database,"BACKGROUND: Many stroke patients who fulfilled diagnostic criteria for dementia three months after stroke had a mental deterioration before stroke, implying an underlying neurodegenerative process. The goal of this study was to determine the factors associated with pre-stroke dementia in hospitalised-based population. SUBJECTS AND METHODS: Pre-stroke cognitive decline was evaluated in 250 stroke patients using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Patients with IQCODE score > or=104 were classified as having pre-stroke dementia. Clinical, radiological, and biochemical data of patients with and without pre-stroke dementia were compared. RESULTS: Pre-stroke dementia was found in 12% of 250 stroke patients. Patients with pre-stroke dementia were older, suffered more frequently from ischemic heart disease and diabetes, and had more frequently prior cerebrovascular disease. These patients had significantly more brain atrophy and number of old infarcts on CT than patients without pre-stroke dementia. Serum gamma-globulins levels at admission were significantly higher in patients with pre-stroke dementia. In logistic regression analysis female gender (OR 3.47, CI 95% 1.25-9.64), history of previous stroke (OR 3.46, CI 95 % 1.26-9.51), the number of old infarcts on CT (OR 1.58, CI 95 % 1.08-2.33) and serum gamma-globulins level (OR 1.19, CI 95 % 1.02-1.40) were independently associated with pre-stroke dementia. CONCLUSIONS: Female gender and previous ischemic stroke are the most important determinants of pre-stroke cognitive decline.","Aged;Aged, 80 and over;Cerebrovascular Disorders/*complications/epidemiology/physiopathology;Cognition Disorders/*etiology;Dementia/*complications/epidemiology;Female;Humans;Male;Middle Aged;Neuropsychological Tests;Psychiatric Status Rating Scales;Risk Factors;Surveys and Questionnaires","Klimkowicz, A.;Dziedzic, T.;Polczyk, R.;Pera, J.;Slowik, A.;Szczudlik, A.",2004,May,10.1007/s00415-004-0384-5,0,
2313,Quality of life in the follow-up of uveal melanoma patients after CyberKnife treatment,"To assess quality of life in uveal melanoma patients within the first and second year after CyberKnife radiosurgery. Overall, 91 uveal melanoma patients were evaluated for quality of life through the Short-form (SF-12) Health Survey at baseline and at every follow-up visit over 2 years after CyberKnife radiosurgery. Statistical analysis was carried out using SF Health Outcomes Scoring Software and included subgroup analysis of patients developing secondary glaucoma and of patients maintaining a best corrected visual acuity (BCVA) of the treated eye of 0.5 log(MAR) or better. Analysis of variance, Greenhouse-Geisser correction, Student's t-test, and Fisher's exact test were used to determine statistical significance. Physical Functioning (PF) and Role Physical (RP) showed a significant decrease after CyberKnife radiosurgery, whereas Mental Health (MH) improved (P=0.007, P<0.0001 and P=0.023). MH and Social Functioning (SF) increased significantly (P=0.0003 and 0.026) in the no glaucoma group, MH being higher compared with glaucoma patients (P=0.02). PF and RP were significantly higher in patients with higher BCVA at the second follow-up (P=0.02). RP decreased in patients with BCVA<0.5 log(MAR) (P=0.013). Vitality (VT) increased significantly in patients whose BCVA could be preserved (P=0.031). Neither tumor localization nor size influenced the development of secondary glaucoma or change in BCVA. Although PF and RP decreased over time, MH improved continuously. Prevention of secondary glaucoma has a significant influence on both SF and MH, whereas preservation of BCVA affects VT. Emotional stability throughout follow-up contributes positively toward overall quality of life. CyberKnife radiosurgery may contribute to attenuation of emotional distress in uveal melanoma patients. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.",bevacizumab;adult;aged;Alzheimer disease;article;best corrected visual acuity;brachytherapy;breast cancer;cancer recurrence;cancer staging;cerebrovascular accident;colon cancer;depression;diabetes mellitus;emotional stability;female;follow up;gamma knife radiosurgery;glaucoma;heart arrhythmia;heart infarction;hepatitis C;human;hypertension;ischemic heart disease;kidney cancer;major clinical study;male;mental health;metastasis;multiple myeloma;neovascular glaucoma;priority journal;prostate cancer;quality of life;secondary glaucoma;Short Form 12;social interaction;stereotactic radiosurgery;subretinal fluid;tumor localization;uvea melanoma;visual acuity;avastin,"Klingenstein, A.;Fürweger, C.;Nentwich, M. M.;Schaller, U. C.;Foerster, P. I.;Wowra, B.;Muacevic, A.;Eibl, K. H.",2013,,,0,
2314,Brain autopsy in organic solvent syndrome,"General autopsy findings, brain weight and brain pathology were studied in 98 men and five women who had been exposed occupationally to organic solvents over several years and assessed by the Danish National Board of Industrial Injuries for chronic toxic encephalopathy. The findings were compared with a forensic control material and a hospital control material. As in the general population, the most common causes of death among the exposed workers were heart failure and other vascular diseases. Due to the composition of the material (forensic cases), the number of suicides and violent deaths was high. Atherosclerosis was the most common CNS finding, but in comparison with the two control materials, no increase in the frequency of atherosclerosis or of Alzheimer's disease was found. Brain weights of the exposed workers corresponded closely to brain weights in the control materials, alter correction for body height, body weight and age. Chronic alcoholism was correlated with slightly reduced brain weight.",organic solvent;adult;article;brain disease;controlled study;female;human;human tissue;major clinical study;male;priority journal,"Klinken, L.;Arlien-Soborg, P.",1993,,,0,
2315,Views of internists towards uses of PGD,"Preimplantation genetic diagnosis (PGD) is increasingly available, but how physicians view it is unclear. Internists are gatekeepers and sources of information, often treating disorders for which PGD is possible. This quantitative study surveyed 220 US internists, who were found to be divided. Many would recommend PGD for cystic fibrosis (CF; 33.7%), breast cancer (BRCA; 23.4%), familial adenomatous polyposis (FAP; 20.6%) and familial hypertrophic cardiomyopathy (19.9%), but few for social sex selection (5.2%); however, in each case, >50% were unsure. Of those surveyed, 4.9% have suggested PGD to patients. Only 7.1% felt qualified to answer patient questions about it. Internists who would refer for PGD had completed medical training less recently and, for CF, were more likely to have privately insured patients (P < 0.033) and patients who reported genetic discrimination (P < 0.013). Physicians more likely to refer for BRCA and FAP were less likely to have patients ask about genetic testing. This study suggests that internists often feel they have insufficient knowledge about it and may refer for PGD based on limited understanding. They view possible uses of PGD differently, partly reflecting varying ages of onset and disease treatability. These data have critical implications for training, research and practice. Preimplantation genetic diagnosis (PGD) allows embryos to be screened prior to transfer to a woman's womb for various genetic markers. This procedure raises complex medical, social, psychological and ethical issues, but how physicians view it is unclear. Internists are gatekeepers and sources of information, often treating disorders for which PGD use is possible. We surveyed 220 US internists, who were found to be divided: many would recommend PGD for cystic fibrosis (CF; 33.7%), breast cancer (BRCA; 23.4%), familial adenomatous polyposis (FAP; 20.6%), and familial hypertrophic cardiomyopathy (FHC; 19.9%) and a few for sex selection (5.2%); but in each case, >50% were unsure. Of those surveyed, 4.9% have suggested PGD to patients. Only 7.1% felt qualified to answer patient questions. Internists who would refer for PGD completed medical training less recently and, for CF, were more likely to have privately insured patients and patients who reported genetic discrimination. Physicians more likely to refer for BRCA and FAP were less likely to have patients ask about genetic testing. This quantitative study suggests that internists often feel they have insufficient knowledge and may refer for PGD based on limited understanding. They view possible uses of PGD differently, partly reflecting varying ages of onset and disease treatability. Internists should be made aware of the potential benefit of PGD, but also be taught to refer patients, when appropriate, to clinical geneticists who could then refer the patient to an IVF/PGD team. These data thus have critical implications for training, research and practice. © 2012, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.",adenomatous polyp;adult;article;breast cancer;cardiology;cystic fibrosis;Duchenne muscular dystrophy;endocrinology;enteritis;familial hypertrophic cardiomyopathy;female;general practice;genetic privacy;genetic screening;health care policy;hematology;hereditary breast and ovarian cancer syndrome;human;Huntington chorea;insulin dependent diabetes mellitus;intensive care;internist;long QT syndrome;male;medical education;medical genetics;medical practice;nephrology;oncology;patient referral;preimplantation genetic diagnosis;prenatal diagnosis;private health insurance;professional knowledge;quantitative study;retinoblastoma;rheumatology,"Klitzman, R.;Chung, W.;Marder, K.;Shanmugham, A.;Chin, L. J.;Stark, M.;Leu, C. S.;Appelbaum, P. S.",2013,,,0,
2316,Direct lateral lumbar interbody fusion for degenerative conditions: Early complication profile,"STUDY DESIGN/SETTING: A community hospital prospective, nonrandomized chart review. March 2004 to December 2006, 58 patients were treated. Adverse events: new complaints and increasing length of stay limit early mobilization and require consultation with other physicians or reoperation. These formed the focus of the study. OBJECTIVE: Assess patient demographics and adverse events related to direct lateral lumbar approach. SUMMARY OF BACKGROUND DATA: Clinicians advocate anterior column support for lumbar conditions. Minimally invasive stabilization of lumbar spine via direct lateral approach gained popularity owing to perceived decrease in patient morbidity. METHODS: Mild or major adverse events during hospital stay or within 6 weeks of discharge were considered early complications and designated as medical, approach, or implant related. A historical cohort of open posterior spinal fusion patients was used for comparison. RESULTS: Forty-three female and 15 male patients with a mean age of 61 years formed the study group. Surgery performed included 38 single level, 19 2-level, and 1 3-level case. Adverse events occurred in 13 patients (22.4%); 8 events were approach, 3 medical, and 1 implant bone interface related. Major complications occurred in 5 patients (8.6%). Two patients (3.4%) with L4 nerve injury showed residual motor effects, at 1 year postoperatively. Significant differences were noted between single and 2-level cases; Estimated blood loss (EBL) and operative time. Open posterior fusion patients experienced greater operative time and increased EBL compared with minimally invasive cases. CONCLUSIONS: Major adverse events approximated 8.6% with approach-related complaints of nerve irritation nearing 3.4%. Mild complications occurred in 13.7% of patients. Meralgia paresthetica was a primary approach-related complaint. Most complaints significantly reduced by first postoperative visit. One patient (1.7%) had symptoms lasting over a year that did not adversely affect function. Significant finding related to exposure, that is, 1-versus 2-level cases. Overall morbidity reduction noted by EBL is considerably less compared with the historical cohort. Direct lateral lumbar interbody fusion has proven to be of value. © 2009 Lippincott Williams & Wilkins, Inc.",adult;article;bleeding;controlled study;degenerative disease;dementia;demography;direct lateral lumbar interbody fusion;female;heart infarction;human;lumbar spine;major clinical study;male;meralgia paresthetica;motor dysfunction;muscle spasm;nerve injury;operation duration;priority journal;spine fusion;urine retention,"Knight, R. Q.;Schwaegler, P.;Hanscom, D.;Roh, J.",2009,,,0,
2317,"An open-label, 24-week pilot study of the methyl donor betaine in Alzheimer disease patients","We investigated the safety and tolerability of betaine in patients with Alzheimer disease (AD). Betaine is an alternative methyl donor, distinct from the folate-and cobalamin-dependent conversion pathway between homocysteine and methionine. Betaine has been used successfully to reduce homocysteine levels in homocystinuria. The rationale for betaine in AD was to decrease serum homocysteine levels and to increase brain methionone and S-adenosylmethionine, both of which might delay disease progression. Hyperhomocysteinemia is a possible risk factor for AD. Eight patients with probable mild AD (7 men; mean age, 69.6 years; mean Mini-Mental State Exam score, 23.7) received oral betaine (3 g twice daily) for 24 weeks. All patients were on donepezil 10 mg/day for at least 3 months before entry and throughout the study. One patient suffered a myocardial infarction and withdrew after 6 weeks. Another patient, who completed the trial, experienced diarrhea and prostatitis. Four of the 7 patients who completed the trial were rated on the Clinician's Global Impression of Change as worse after 24 weeks. On the cognitive portion of the AD Assessment Scale, 2 patients worsened by at least five points over 24 weeks, whereas the others had changes in scores of no more than two points either way. Six of 8 patients tolerated betaine for 24 weeks without difficulty. Several patients worsened over 24 weeks, but as a pilot study without a control group, efficacy measurements cannot be interpreted. The current study provides a basis for pursuing larger controlled trials with betaine in AD. The homocysteine to S-adenosylmethionine pathway is of interest in AD therapeutics.","Administration, Oral;Aged;Aged, 80 and over;Alzheimer Disease/*drug therapy/pathology;Betaine/adverse effects/*pharmacology/therapeutic use;Cognition Disorders/drug therapy/etiology;Disease Progression;Female;Gastrointestinal Agents/adverse effects/*pharmacology/therapeutic use;Homocysteine/*metabolism;Humans;Male;Mental Status Schedule;Middle Aged;Risk Factors;Treatment Outcome","Knopman, D.;Patterson, M.",2001,Jul-Sep,,0,
2318,Brain injury biomarkers are not dependent on β-amyloid in normal elderly,"Objective: The new criteria for preclinical Alzheimer disease (AD) proposed 3 stages: abnormal levels of β-amyloid (stage 1), stage 1 plus evidence of brain injury (stage 2), and stage 2 plus subtle cognitive changes (stage 3). However, a large group of subjects with normal β-amyloid biomarkers have evidence of brain injury; we labeled them as the ""suspected non-Alzheimer pathophysiology"" (sNAP) group. The characteristics of the sNAP group are poorly understood. Methods: Using the preclinical AD classification, 430 cognitively normal subjects from the Mayo Clinic Study of Aging who underwent brain magnetic resonance (MR), 18fluorodeoxyglucose (FDG), and Pittsburgh compound B positron emission tomography (PET) were evaluated for FDG PET regional volumetrics, MR regional brain volumetrics, white matter hyperintensity volume, and number of infarcts. We examined cross-sectional associations across AD preclinical stages, those with all biomarkers normal, and the sNAP group. Results: The sNAP group had a lower proportion (14%) with apolipoprotein E ε4 genotype than the preclinical AD stages 2 + 3. The sNAP group did not show any group differences compared to stages 2 + 3 of the preclinical AD group on measures of FDG PET regional hypometabolism, MR regional brain volume loss, cerebrovascular imaging lesions, vascular risk factors, imaging changes associated with α-synucleinopathy, or physical findings of parkinsonism. Interpretation: Cognitively normal persons with brain injury biomarker abnormalities, with or without abnormal levels of β-amyloid, were indistinguishable on a variety of imaging markers, clinical features, and risk factors. The initial appearance of brain injury biomarkers that occurs in cognitively normal persons with preclinical AD may not depend on β-amyloidosis. © 2013 American Neurological Association.",alpha synuclein;amyloid beta protein;apolipoprotein E4;biological marker;fluorodeoxyglucose f 18;Pittsburgh compound B;aged;Alzheimer disease;angina pectoris;angioplasty;article;brain atrophy;brain infarction;brain injury;brain size;cardiovascular risk;cerebrovascular accident;cerebrovascular disease;clinical feature;congestive heart failure;coronary artery bypass surgery;coronary artery disease;cross-sectional study;diabetes mellitus;female;genotype;atrial fibrillation;heart infarction;human;hypertension;male;neuroimaging;normal human;nuclear magnetic resonance imaging;parkinsonism;positron emission tomography;priority journal;smoking;white matter,"Knopman, D. S.;Jack Jr, C. R.;Wiste, H. J.;Weigand, S. D.;Vemuri, P.;Lowe, V. J.;Kantarci, K.;Gunter, J. L.;Senjem, M. L.;Mielke, M. M.;Roberts, R. O.;Boeve, B. F.;Petersen, R. C.",2013,,,0,
2319,Functional impairment of precerebral arteries in Huntington disease,"Background Cardiovascular pathology of Huntington disease (HD) appears to be complex; while microvascular dysfunction seems to appear early, deaths from cardiomyopathy and stroke might occur in the late phase of HD. Methods Our study evaluated global risk factors for coronary heart disease (CHD), structure and function of precerebral arteries in 41 HD subjects and 41 matched controls. HD subjects were divided into groups by the United Huntington disease rating scale (presymptomatic-PHD, early-EHD, midstage-MHD and late-LHD). CHD risk factors assessment and Doppler examination of precerebral arteries were performed, including measurements of the carotid artery intima-media thickness (IMT), and parameters indicating local carotid artery distensibility (stiffness index β, pulse wave velocity, pressure strain elasticity module and carotid artery compliance). Results In the HD and controls we identified a comparable number of non-obstructive plaques (< 50% lumen narrowing). No obstructive plaques (> 50% lumen narrowing) were found. There was significantly increased IMT in MHD. In PHD and EHD the parameters of arterial stiffness were significantly higher and the carotid artery compliance was significantly lower. Conclusions Our results reveal functional vascular pathology in PHD, EHD, and MHD. Precerebral arteries dysfunction in HD therefore appears to be mostly functional and in agreement with recently described autonomic nervous system changes in HD.",neuroleptic agent;serotonin uptake inhibitor;adult;arterial stiffness;arterial wall thickness;artery compliance;article;brain artery;clinical article;controlled study;coronary risk;Doppler ultrasonography;elasticity;female;functional disease;human;Huntington chorea;ischemic heart disease;male;middle aged;precerebral artery;priority journal;pulse wave;risk assessment,"Kobal, J.;Cankar, K.;Pretnar, J.;Zaletel, M.;Kobal, L.;Teran, N.;Melik, Z.",2017,,10.1016/j.jns.2016.10.033,0,
2320,Hormone therapy in women after heart transplantation,"Background Hormone therapy (HT) for menopausal women has been controversial regarding cardiac outcomes and adverse effects. Studies suggest that HT may cause increase in heart disease, stroke, and cancer. The use of HT in heart transplantation has not been firmly established. Methods The records of 356 female heart transplant recipients, undergoing transplantation from 1994 to 2011, were reviewed. We found 19 patients after age 35 years who were initiated on HT for noncontraceptive purposes. These patients were compared 1:3 with a contemporaneous control group matched for age, sex, era, and time after heart transplantation (paired for time from transplantation to initiation of HT). We assessed for subsequent 5-year survival, freedom from cardiac allograft vasculopathy (CAV; stenosis ≥30%), freedom from nonfatal major adverse cardiac events (NF-MACE; myocardial infarction, heart failure, percutaneous cardiac intervention, stroke, and need for pacemaker/defibrillator), and subsequent 1-year freedom from any-treated rejection. Additionally, we compared significant adverse effects of HT between groups. Results HT patients compared with control subjects revealed no significant difference in subsequent 5-year survival (79% vs 75%; P =.66), freedom from CAV (90% vs 88%; P =.85), or NF-MACE (90% vs 93%; P =.65). There was also no significant difference in subsequent 1-year freedom from any-treated rejection between the groups. Other adverse effects of HT including subsequent 5-year incidence of thrombosis (pulmonary embolus), malignancy, and stroke were also similar to control subjects. Conclusions HT is not associated with poor outcome or adverse effects in female heart transplant patients after age 35 years. However, a larger cohort of patients is necessary to confirm these observations. © 2013 by Elsevier Inc. All rights reserved.",adult;article;blood clot;cardiac allograft vasculopathy;cerebrovascular accident;clinical article;controlled study;defibrillator;dementia;female;gallbladder disease;graft recipient;heart disease;heart failure;heart infarction;heart transplantation;hormonal therapy;human;incidence;lung embolism;neoplasm;percutaneous coronary intervention;priority journal;stenosis;survival time;thrombosis;treatment outcome;vagina bleeding,"Kobashigawa, L. C.;Hamilton, M.;Rafiei, M.;Stern, L.;Bairey Merz, C. N.",2013,,,0,
2321,Cardiac function in elderly patients with dementia,"Evaluation of cardiac function is very important in elderly patients because it is closely related to the prognosis. Appropriate evaluation is especially important to treat and prevent the progression of dementia since its pathology differs greatly depending on type. In the present study, we evaluated the cardiac function of patients with senile dementia using echocardiography. Included in the present study' were 11 patients with Binswanger-type dementia (BI)), 12 with cerebrovascular dementia (VD) of other types, 16 with senile dementia of Alzheimer-type (SDAT) and 15 controls. Left ventricular function was assessed by Mode M based on left ventricular end-diastolic dimension (LVDd), left ventricular end-systolic dimension (LVDs), left ventricular dimension shortening (FS), left ventricular ejection fraction (EF) and cardiac out put (CO). LVDd was significantly larger in the BD group than in the control, and LVDs was also significantly larger in the BD group than in the three other groups. FS was significantly decreased in the BD group compared to the SDAT and controls. FS was also significantly decreased in the VD group compared to the control. EF was significantly decreased in the BD group compared to the three other groups, and it was also significantly decreased in the VD group compared to the controls. There was no significant inter-group difference in SV or CO. FS and EF were found to be decreased in patients with cerebrovascular dementia, especially BD, indicating the presence of latent left ventricular hypofunction in these patients. This finding is important in predicting the prognosis of patients and conducting treatment and prevention.",adult;Alzheimer disease;article;Binswanger encephalopathy;clinical article;controlled study;female;heart function;heart left ventricle ejection fraction;heart left ventricle enddiastolic volume;heart output;human;male;multiinfarct dementia;senile dementia,"Kobayashi, Y.;Hanyu, H.;Sugiyama, T.;Abe, S.;Takasaki, M.;Maehata, Y.;Katsunuma, H.",1995,,,0,
2322,Serum vitamin D deficiency and its association with systemic disease in exfoliation syndrome,"Purpose: To determine the association of serum vitamin D levels with exfoliation syndrome (XFS) and evaluate its impact on co-associated systemic diseases. Methods: Forty patients with XFS and 40 control subjects without XFS were recruited for this study. Se rum concentrations of 25-hydroxy vitamin D [25(OH) D] were measured by high-performance liquid chromatography. Vitamin D deficiency was defined as a serum 25(OH) D concentration of <20 ng/mL. A detailed medical history including hypertension, diabetes mellitus, ischemic heart disease, cerebrovas-cular stroke, autoimmune disease, and neurologic disorders such as Parkinson disease and Alzheimer disease was recorded. Student t test and chi-square test was used for statistical evaluations. Results: The mean age of patients with XFS and control subjects was 69.6 ± 8.1 years (range 58-90 years) and 67.1 ± 6.3 years (range 60-86 years), respectively (p>0.05). Mean 25(OH) D levels did not differ between XFS (19.8 ± 8.3 ng/mL) and control (19.9 ± 10.3 ng/mL) groups (p = 0.978). Patients with XFS had higher prevalence of cerebrovascular (p = 0.026) and cardiovascular disease (p = 0.001). There was no association between the systemic disease status and serum vitamin D levels of patients with XFS. Conclusions: Although vitamin D levels were similar between XFS and control subjects, the levels were found to be decreased in both groups. Patients with XFS had a significantly higher preva-lence of cerebrovascular and cardiovascular disease as compared to controls independent of their serum 25(OH) D levels. Low vitamin D level does not appear to be linked to XFS in the studied population. © 2013 Wichtig Editore.",25 hydroxyvitamin D;adult;age distribution;aged;Alzheimer disease;anamnesis;article;autoimmune disease;cerebrovascular accident;clinical article;controlled study;diabetes mellitus;disease association;down regulation;female;high performance liquid chromatography;human;hypertension;ischemic heart disease;male;neurologic disease;Parkinson disease;prevalence;priority journal;pseudoexfoliation;statistical analysis;systemic disease;vitamin blood level;vitamin D deficiency,"Kocabeyoglu, S.;Mocan, M. C.;Irkec, M.;Pinar, A.;Bozkurt, B.;Orhan, M.",2013,,,0,
2323,Psychophysiological concepts of stress induced cardiomyopathy with broken heart syndrome as a paradigm,"Psychiatric disease, particularly depression and stress disorders, worsen the outcome of cardiovascular disease substantially. Although this mind-heart interaction is known since the 1930s, many questions with regard to the underlying pathophysiology remain to be answered. Apart from psychological stress and psychiatric disease, inflammatory or psychoimmunology processes, metabolic or endocrinological mechanisms may be involved as are lifestyle and effects of drug treatment. The takotsubo or broken heart cardiomyopathy, which can be regularly referred to stressful event, may serve as paradigm to understand pathological base of the mind-heart relation.","5,10 methylenetetrahydrofolate reductase (FADH2);acetylsalicylic acid;amfebutamone;amiodarone;amisulpride;aripiprazole;asenapine;C reactive protein;citalopram;dipeptidyl carboxypeptidase inhibitor;fluoxetine;heparin;interleukin 6;mirtazapine;moclobemide;nitrate;olanzapine;omega 3 fatty acid;paroxetine;quetiapine;reactive oxygen metabolite;risperidone;serotonin transporter;sertraline;sotalol;tranylcypromine;triacylglycerol;tumor necrosis factor alpha;tyramine;warfarin;article;cardiomyopathy;cardiovascular disease;cardiovascular risk;coping behavior;dementia;depression;disease association;heart arrhythmia;heart disease;heart failure;heart left ventricle failure;human;hypercortisolism;hyperhomocysteinemia;hyperlipidemia;inflammation;insulin resistance;lifestyle;low birth weight;mental disease;mental stress;metabolic syndrome X;muscle hypertonia;obesity;panic;psychophysiology","Koch, H. J.",2013,,,0,
2324,TaqMan systems for genotyping of disease-related polymorphisms present in the gene encoding apolipoprotein E,"Polymorphisms of the gene encoding apolipoprotein E have been implicated in the pathogenesis of peripheral and coronary artery disease and neurodegenerative disorders such as sporadic and late-onset familial forms of Alzheimer's disease. We have developed TaqMan assay systems for the single nucleotide polymorphisms -219G/T, located in the promoter of the apolipoprotein E gene, 113G/C, present in the transcriptional enhancer element of intron 1, 334T/C, determining Cys or Arg as amino acid residue 112 of mature apolipoprotein E, and 472C/T, determining Arg or Cys as residue 158. The accuracy of genotype determination with the TaqMan systems was demonstrated by analyses with restriction endonucleases. We determined the genotypes of the apolipoprotein E polymorphisms in 2349 study subjects. The genotypes were distributed as: -219GG = 27.3%, -219GT = 49.1%, and -219TT = 23.6% (p = 0.435); 113GG = 41.3%, 113GC = 45.2%, and 113CC = 13.5% (p = 0.343); 334TT = 73.4%, 334TC = 24.7%, and 334CC = 1.9% (p = 0.539); 472CC = 86.3%, 472CT=12.8%, and 472TT= 0.9% ( p = 0.004) (Hardy-Weinberg equilibrium estimates are given in parentheses). The allele combinations which define the three major isoforms of apolipoprotein E, namely apoE2, apoE3, and apoE4, had the following allele frequencies: 334T/472T (epsilon2; 112Cys/158Cys) = 7.3%, 334T/472C (epsilon3; 112Cys/158Arg) = 78.4%, and 334C/472C (epsilon4; 112Arg/158Arg) = 14.2%, respectively. ApoE genotypes were distributed as: epsilon2epsilon2 = 0.9%, epsilon2epsilon3 = 11.2%, epsilon2epsilon4 = 1.6%, epsilon3epsilon3 = 61.3%, epsilon3epsilon4 = 23.1%, and epsilon4epsilon4 = 1.9% (p = 0.014). The TaqMan assays allow for fast and sensitive genotyping and are especially suitable for studies including large numbers of participants.","Alleles;Apolipoproteins E/blood/*genetics;Automation;Coronary Artery Disease/blood/genetics;DNA Primers/genetics;*Fluorescent Dyes;Gene Frequency;*Genetic Techniques;Genetics, Population;Genotype;Haplotypes/genetics;Humans;Linkage Disequilibrium;Oligonucleotide Probes/chemistry/genetics;Polymerase Chain Reaction/methods;Polymorphism, Single Nucleotide/*genetics;Taq Polymerase/metabolism","Koch, W.;Ehrenhaft, A.;Griesser, K.;Pfeufer, A.;Muller, J.;Schomig, A.;Kastrati, A.",2002,Nov,10.1515/cclm.2002.197,0,
2325,"Undiagnosed cognitive impairment, health status and depressive symptoms in patients with type 2 diabetes","Aims Type 2 diabetes (T2DM) is associated with cognitive impairment. We examined whether undiagnosed cognitive impairment in T2DM-patients is associated with a reduced health status and depressive symptoms. Methods In an observational study, 225 T2DM-patients aged < 70 years were examined at their homes and (some of them) at a memory clinic for undiagnosed cognitive impairment (dementia or mild cognitive impairment [MCI], defined according to internationally accepted criteria). Questionnaires assessing health status (SF-36, EQ-5D, EQ-VAS) and depressive symptoms (CES-D) were filled out. Health status and depressive symptoms were compared between patients with and without cognitive impairment. Results Patients with cognitive impairment (n = 57) showed significantly lower scores on the physical and mental summary scores of the SF-36 than patients with normal cognition (difference: 3.5 (95%-CI 0.7-6.3, p = 0.02, effect size 0.41) and 2.9 (95%-CI 0.3-5.6; p = 0.03, effect size 0.37). EQ-5D index and EQ-VAS scores were significantly lower in patients with cognitive impairment. Depression (CES-D < 16) occurred almost twice as often in patients with cognitive impairment (RR 1.8; 95%-CI: 1.1-3.0). Conclusions Undiagnosed cognitive impairment in T2DM-patients is associated with a reduced health status and more depressive symptoms. Detection of cognitive impairment in T2DM-patients identifies a vulnerable patient group that could benefit from tailored treatment and care.",cholesterol;creatinine;hemoglobin A1c;aged;angina pectoris;article;cerebrovascular accident;cholesterol blood level;cognition;cognitive defect;controlled study;correlational study;creatinine blood level;dementia;depression;diabetic patient;diastolic blood pressure;disease duration;effect size;female;health status;heart infarction;human;major clinical study;male;mental health;mild cognitive impairment;non insulin dependent diabetes mellitus;observational study;priority journal;questionnaire;sensitivity analysis;Short Form 36;social interaction;systolic blood pressure;transient ischemic attack;vascular surgery,"Koekkoek, P. S.;Biessels, G. J.;Kooistra, M.;Janssen, J.;Kappelle, L. J.;Rutten, G. E. H. M.",2015,,,0,
2326,Relation of left ventricular hypertrophy and geometry to asymptomatic cerebrovascular damage in essential hypertension,"Increased left ventricular (LV) mass and abnormal geometry have a powerful prognostic value for cardiovascular morbidity and mortality including stroke. However, there have been no studies on the association between LV hypertrophy and preclinical brain damage in essential hypertensive patients. In the present study, we investigated the relation between LV hypertrophy and asymptomatic cerebrovascular damage identified by magnetic resonance imaging in 150 essential hypertensive patients, with an emphasis on LV geometry. Patients were divided into the following 4 groups according to their LV mass index and relative wall thickness; normal ventricular geometry (n = 50), concentric remodeling (n = 22), eccentric hypertrophy (n = 44), and concentric LV hypertrophy (n = 34). Lacunar lesions and leukoaraiosis were evaluated. The prevalence of lacunae was significantly higher in patients with LV remodeling than in patients with normal LV (chi-square 19.6, p = 0.0002). The number of lacunae was significantly higher in patients with LV hypertrophy than in patients with normal LV or concentric remodeling (F [3,146] = 8.03, p<0.0001). The severity of leukoaraiosis was also significantly greater in patients with LV hypertrophy than in patients with a normal left ventricle (chi-square 14.5, p = 0.02). Stepwise regression analysis confirmed that LV mass index and relative wall thickness, in addition to age and systolic blood pressure, were independent predictors for asymptomatic cerebrovascular damage, even in the absence of neurologic abnormalities. In hypertensive patients, LV hypertrophy, and especially concentric LV hypertrophy, provides important prognostic information on the presence of pre-clinical brain damage.","Blood Pressure;Brain/*pathology;Dementia, Multi-Infarct/*diagnosis/epidemiology/etiology;Female;Follow-Up Studies;Heart Ventricles/*pathology;Humans;Hypertension/*complications/physiopathology;Hypertrophy, Left Ventricular/*complications/diagnosis;Magnetic Resonance Imaging;Male;Middle Aged;Prevalence;Prognosis;Retrospective Studies;Severity of Illness Index;Survival Rate","Kohara, K.;Zhao, B.;Jiang, Y.;Takata, Y.;Fukuoka, T.;Igase, M.;Miki, T.;Hiwada, K.",1999,Feb 1,,0,
2327,Multiple-system atrophy and medications: How to minimize the risk of falling,"An 89-year-old female resident in the assisted living section of a continuing care retirement community complained of dizziness and lightheadedness at 10 am daily and was experiencing frequent falls. The facility staff requested a consultant pharmacist perform an extensive review of her medications and medical conditions. Following a chart review and interview with the resident, the consultant pharmacist found that her past medical history consists of coronary artery disease, atrial fibrillation, congestive heart failure, hypertension, dyslipidemia, osteoporosis, gastroesophageal reflux disease, glaucoma, mild dementia, overactive bladder, and Parkinson's disease (PD). The nursing staff monitored the resident's blood pressure during these episodes and determined that the resident was experiencing orthostatic hypotension (OH). During the review, the consultant pharmacist found a recent neurology note that concluded the resident may have multiple-system atrophy (MSA) and her therapy for PD may not be beneficial. As autonomic dysfunction is a common feature of MSA, it is important to minimize the use of medications that can cause or aggravate OH. Additionally, data suggest only a modest and nonsustained response to levodopa in patients with MSA. Therefore, the pharmacist recommended multiple medication changes as well as follow-up monitoring by the patient and assisted living community staff to minimize medication-related problems such as falls. © 2011 American Society of Consultant Pharmacists, Inc. All rights reserved.",alendronic acid;alpha adrenergic receptor blocking agent;caffeine;calcium carbonate;carbidopa plus levodopa;cholinergic receptor blocking agent;desmopressin;dihydroergotamine;donepezil;ephedrine;fludrocortisone;irbesartan;levodopa;levothyroxine;levothyroxine sodium;midodrine;nonsteroid antiinflammatory agent;papaverine;paracetamol;pravastatin;prostaglandin E1;pseudoephedrine;pyridostigmine;rasagiline;riluzole;sildenafil;somatostatin;droxidopa;timolol maleate;trospium chloride;yohimbine;aged;article;blood pressure monitoring;case report;chronic disease;compression garment;constipation;dementia;dizziness;drug dose reduction;drug efficacy;drug response;drug withdrawal;dyskinesia;dyslipidemia;dystonia;erectile dysfunction;fall risk;falling;female;fluid intake;glaucoma;high sodium intake;human;hypothyroidism;incontinence;intermittent catheterization;medical history;neurogenic bladder;orthostatic hypotension;osteoporosis;overactive bladder;pain;palliative therapy;Parkinson disease;parkinsonism;penis prosthesis;physical activity;positive end expiratory pressure;Shy Drager syndrome;stridor;acetaminophen;aricept;avapro;fosamax;pravachol;sanctura xr;sinemet;synthroid,"Kohli, J.;Brandt, N.",2011,,,0,
2328,De novo P102L mutation in a patient with Gerstmann-Sträussler-Scheinker disease,,genomic DNA;glutamic acid;prion protein;protein;valine;amyloid plaque;aspiration pneumonia;ataxia;autosomal dominant inheritance;basal ganglion;brain cortex;brain disease;brain hernia;brain stem;brain weight;cardiopulmonary insufficiency;cerebellum;cerebrospinal fluid analysis;codon;contracture;dysarthria;dysphagia;electroencephalogram;evoked brain stem auditory response;eye tracking;family history;gait disorder;gene mutation;gene sequence;genetic analysis;Gerstmann Straussler Scheinker syndrome;hearing aid;hearing impairment;human;immunohistochemistry;immunoreactivity;letter;Mini Mental State Examination;missense mutation;motor cortex;nuclear magnetic resonance imaging;nystagmus;perception deafness;priority journal;protein cerebrospinal fluid level;quadriplegia;saccadic eye movement;speech disorder;spinal cord atrophy;tendon reflex;thalamus;thoracic spinal cord;tonsil;unsteadiness;urge incontinence;urinary catheter;urine retention;wheelchair,"Kojović, M.;Glavač, D.;Ožek, B.;Zupan, A.;Popović, M.",2011,,,0,
2329,Therapy-Related Spontaneous Pectoral Muscle Hematoma: A Case Report and Review of the Literature,,alanine aminotransferase;aspartate aminotransferase;carbidopa;enoxaparin;entacapone;fresh frozen plasma;furosemide;hemoglobin;lansoprazole;levodopa;piperacillin;tazobactam;warfarin;acute kidney failure;aged;Alzheimer disease;case report;computer assisted tomography;female;heart failure;hemoglobin blood level;hemorrhagic shock;human;hypotension;international normalized ratio;laboratory test;letter;leukocyte count;medical history;mitral valve replacement;muscle hematoma;Parkinson disease;pectoral muscle hematoma;pneumonia;tachycardia,"Koklu, H.;Oge Koklu, N.;Aksoy Khurami, F.;Duman, E.;Meral, A.",2016,,,0,
2330,Impact of night-time blood pressure on cerebral white matter hyperintensity in elderly hypertensive patients,"AIM: Cerebral white matter hyperintensity (WMH) is highly prevalent in the elderly population, and increases the risk of dementia and stroke. We investigated the relationship between ambulatory blood pressure monitoring levels and quantitatively measured WMH volumes among elderly hypertensive patients with well-controlled blood pressure (BP) to re-evaluated effective hypertension management methods to prevent the progression of WMH. METHODS: Participants comprised 84 hypertensive patients aged between 65 and 75 years without symptomatic heart failure, ischemic heart disease, atrial fibrillation, stroke or cognitive dysfunction. RESULTS: Linear regression analysis showed that office BP was not associated with WMH volume increases. Raised night-time systolic BP (P = 0.013) were associated with greater WMH volumes during ambulatory blood pressure monitoring. To clarify the effect of asleep systolic BP on WML volume, we then classified patients into two systolic BP groups as follows: <125 mmHg (n = 47) and >/=125 mmHg (n = 37). Baseline characteristics were almost similar in both groups, except the dipper type of circadian BP variation was significantly common in the group with night-time systolic BP <125 mmHg. However, WMH volume was greater in the group with night-time systolic BP >/=125 mmHg than that in the <125 mmHg group (9.0 +/- 8.4 mL vs 4.1 +/- 4.3 mL, P = 0.015). CONCLUSION: Higher night-time systolic BP levels were observed to contribute greater WMH volumes in elderly hypertensive patients. To prevent the progression of WMH, controlling BP on the basis of ambulatory blood pressure monitoring is important.","Aged;Aging/*physiology;Antihypertensive Agents/therapeutic use;Blood Pressure/physiology;Blood Pressure Determination/*methods;Blood Pressure Monitoring, Ambulatory;*Circadian Rhythm;Cohort Studies;Diffusion Magnetic Resonance Imaging/methods;Disease Progression;Female;Humans;Hypertension/complications/*diagnosis/drug therapy;Japan;Leukoaraiosis/etiology/pathology;Linear Models;Male;Prognosis;Prospective Studies;Risk Assessment;White Matter/*pathology;ambulatory blood pressure monitoring;cerebral white matter hyperintensity;circadian blood pressure variation;night-time blood pressure;office blood pressure","Kokubo, M.;Shimizu, A.;Mitsui, T.;Miyagi, M.;Nomoto, K.;Murohara, T.;Toba, K.;Sakurai, T.",2015,Dec,10.1111/ggi.12662,0,
2331,"Neurofibrillary tangles in ALS and Parkinsonism-dementia complex focus in Kii, Japan","Brains of 41 residents without neurodegenerative diseases in the high-incidence area of ALS/parkinsonism-dementia complex (ALS/PDC) of the Kii Peninsula of Japan were neuropathologically examined. Neurofibrillary tangles (NFTs) in the hippocampal area were present in 11 of the 41 cases, but the frequency of NFT-positive cases in each age group was similar to that of the normal Japanese population and far less than that of Guamanians without ALS/PDC.","Adolescent;Adult;Aged;Aged, 80 and over;Amyotrophic Lateral Sclerosis/*epidemiology;Brain/*pathology;Cause of Death;Cerebrovascular Disorders/pathology;Cluster Analysis;Dementia/*epidemiology;Female;Hippocampus/pathology;Humans;Japan/epidemiology;Liver Cirrhosis/pathology;Male;Middle Aged;Myocardial Infarction/pathology;Neoplasms/*pathology;Neurofibrillary Tangles/*pathology;Parkinson Disease/*epidemiology;Prevalence;Pulmonary Disease, Chronic Obstructive/pathology;Violence","Kokubo, Y.;Kuzuhara, S.",2004,Dec 28,,0,
2332,Delirium and dementia in acute medical admissions of elderly patients in Iceland,"A prospective study was carried out in a general hospital in Reykjavik to evaluate the prevalence of delirium and dementia among 331 patients 70 years and older who were admitted as an emergency to the medical department. Cognitive function was screened with Mental Status Questionnaire (MSQ) and Mini-Mental State Examination (MMSE) and diagnosed according to DSM-III-R for delirium and dementia. Other information obtained included social and demographic factors, drug consumption, the main condition underlying the delirium and outcome. Severe cognitive dysfunction was present in 32% of all acutely admitted patients 70 years and older, which were diagnosed further as delirium 14% and dementia 18%. At follow-up, concurrent dementia was found in 70% of the delirium patients. The main causes for delirium were cardiac failure 27%, stroke 22% and sepsis 16% and the mortality rate was 32% compared with 8% in dementia alone. The prognosis of patients with delirium and dementia depends on detecting these disorders, and the clinical skills of physicians working with acutely ill elderly patients can be improved by relatively simple screening questionnaires such as the MSQ and MMSE.",aged;article;delirium;dementia;female;heart failure;human;Iceland;major clinical study;male;mortality;sepsis;cerebrovascular accident,"Kolbeinsson, H.;Jonsson, A.",1993,,,0,
2333,Role of PCSK9 antibodies in cardiovascular disease: Critical considerations of mortality and neurocognitive findings from the current literature,"Monoclonal antibodies targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) are a novel lipid-lowering approach found to improve clinical outcomes in patients with dyslipidemia. With coronary artery disease remaining the most frequent cause of morbidity and mortality worldwide, a drug offering a true mortality reduction should be appropriately regarded as a novel blockbuster in cardiovascular medicine, provided that significant side effects do not emerge. However, a recent study may suggest an increase of neurocognitive adverse events with those drugs. A critical overview of current evidence on neurocognitive outcomes as well as the meta-analytical approach with open-label extension trials evaluating PCSK9 monoclonal antibodies is needed to avoid potential controversy.",alirocumab;cholesterol;evolocumab;ezetimibe;monoclonal antibody;placebo;proprotein convertase subtilisin kexin type 9 antibody;unclassified drug;article;cardiovascular disease;cardiovascular mortality;cholesterol blood level;clinical trial (topic);cognition;cognitive defect;coronary artery disease;dementia;disorders of higher cerebral function;drug efficacy;drug safety;heart infarction;human;hypercholesterolemia;meta analysis;open study;outcome assessment;priority journal;randomized controlled trial (topic),"Kołodziejczak, M.;Navarese, E. P.",2016,,,0,
2334,Polymorphism in ABCA1 influences CSF 24S-hydroxycholesterol levels but is not a major risk factor of Alzheimer's disease,"The ATP-binding cassette transporter A1 (ABCA1) mediates reverse cholesterol transport, polymorphisms have been shown to influence the levels of cholesterol and of HDL and the risk of coronary artery disease. Since altered cholesterol metabolism is also involved in Alzheimer's disease (AD), the effects of two ABCA1 polymorphisms (G-395C promoter polymorphism (rs 2246293) and exonic R219K) on the risk of AD in 241 AD patients and 294 non-demented controls, and on CSF cholesterol and 24S-hydroxycholesterol in 74 AD patients and 42 non-demented controls were investigated. None of the investigated ABCA1 polymorphisms influenced the risk of AD. However, the ABCA1 G-395C polymorphism influenced CSF levels of 24S-hydroxycholesterol, but not of cholesterol, whereas the R219K influenced neither CSF levels of 24S-hydroxycholesterol nor cholesterol. Our data support the observation that ABCA1 polymorphisms influence cholesterol metabolism of the brain, but might not act as a major risk factor in AD.","ATP Binding Cassette Transporter 1;ATP-Binding Cassette Transporters/*genetics;Aged;Aged, 80 and over;Alzheimer Disease/cerebrospinal fluid/*genetics;Cholesterol/cerebrospinal fluid;Female;Gene Frequency;Genotype;Humans;Hydroxycholesterols/*cerebrospinal fluid;Linkage Disequilibrium;Male;Middle Aged;Multivariate Analysis;*Polymorphism, Genetic;Risk Factors","Kolsch, H.;Lutjohann, D.;Jessen, F.;Von Bergmann, K.;Schmitz, S.;Urbach, H.;Maier, W.;Heun, R.",2006,May,,0,
2335,Association of the C766T polymorphism of the low-density lipoprotein receptor-related protein gene with alzheimer's disease,"The low-density lipoprotein receptor-related protein (LRP) is one of the most important cholesterol receptors in the brain. Gene variation of its ligand, apolipoprotein E, is a major genetic risk-factor for Alzheimer's disease (AD). The C-allele of the silent C766T polymorphism in exon 3 of the LRP gene might be associated with AD, however, results are conflicting and thus discussed controversially. Consequently, we compared the prevalence of this polymorphism in a homogenous cohort of patients with AD and control subjects. We found that carriers of a C-allele were at lower risk of AD; in agreement with this observation, AD patients who were carriers of a C-allele presented with a later age at onset of the disease than carriers of the TT genotype. These data suggest that LRP polymorphism influences the risk as well as the age at onset of AD. Our results contrast with other studies which described the C-allele to be a risk-factor for AD, but are in line with a recent publication on the effect of LRP polymorphism on longevity and on the risk for coronary artery disease. Further research on LRP polymorphisms is needed to evaluate their effects on the risk of AD, on coronary artery disease and on longevity. © 2003 Wiley-Liss, Inc.",low density lipoprotein receptor;aged;allele;Alzheimer disease;article;cardiovascular risk;controlled study;coronary artery disease;DNA polymorphism;exon;female;genetic association;genetic risk;genetic variability;genotype;heterozygote;human;longevity;major clinical study;male;onset age;priority journal;risk factor,"Kölsch, H.;Ptok, U.;Mohamed, I.;Schmitz, S.;Rao, M. L.;Maier, W.;Heun, R.",2003,,,0,
2336,"Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-Elevation myocardial infarction in the United States","Background: Limited information is available on the contemporary and potentially changing trends in the incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction (STEMI). Methods and Results: We queried the 2003-2010 Nationwide Inpatient Sample databases to identify all patients ≥40 years of age with STEMI and cardiogenic shock. Overall and age-, sex-, and race/ethnicity-specific trends in incidence of cardiogenic shock, early mechanical revascularization, and intra-aortic balloon pump use, and inhospital mortality were analyzed. From 2003 to 2010, among 1 990 486 patients aged ≥40 years with STEMI, 157 892 (7.9%) had cardiogenic shock. The overall incidence rate of cardiogenic shock in patients with STEMI increased from 6.5% in 2003 to 10.1% in 2010 (Ptrend<0.001). There was an increase in early mechanical revascularization (30.4% to 50.7%, Ptrend<0.001) and intra-aortic balloon pump use (44.8% to 53.7%, Ptrend<0.001) in these patients over the 8-year period. Inhospital mortality decreased significantly, from 44.6% to 33.8% (Ptrend<0.001; adjusted OR, 0.71; 95% CI, 0.68 to 0.75), whereas the average total hospital cost increased from $35 892 to $45 625 (Ptrend<0.001) during the study period. There was no change in the average length of stay (Ptrend=0.394). These temporal trends were similar in patients <75 and =75 years of age, men and women, and across each racial/ethnic group. Conclusions: The incidence of cardiogenic shock complicating STEMI has increased during the past 8 years together with increased use of early mechanical revascularization and intra-aortic balloon pumps. There has been a concomitant decrease in riskadjusted inhospital mortality, but an increase in total hospital costs during this period. © 2014 by American Heart Association, Inc.",adult;African American;aged;article;Asian;blood clot lysis;blood transfusion;cardiogenic shock;cardiovascular mortality;carotid artery disease;chronic lung disease;comorbidity;congestive heart failure;coronary artery bypass graft;coronary artery disease;coronary artery recanalization;dementia;dyslipidemia;ethnic difference;family history;female;heart catheterization;Hispanic;hospital admission;hospital cost;hospital discharge;hospitalization;human;incidence;intraaortic balloon pump;length of stay;major clinical study;male;medicaid;medically uninsured;medicare;outcome assessment;percutaneous coronary intervention;priority journal;revascularization;smoking,"Kolte, D.;Khera, S.;Aronow, W. S.;Mujib, M.;Palaniswamy, C.;Sule, S.;Jain, D.;Gotsis, W.;Ahmed, A.;Frishman, W. H.;Fonarow, G. C.",2014,,,0,
2337,Factors associated with antithrombotic treatment decisions for stroke prevention in atrial fibrillation in the Stockholm region after the introduction of NOACs,"Purpose: The purpose of this study was to investigate the influence of patient characteristics such as age and stroke and bleeding risks on decisions for antithrombotic treatment in patients with atrial fibrillation (AF). Methods: This was a retrospective, population-based study including AF patients initiated with either warfarin, dabigatran, rivaroxaban, apixaban, or low-dose aspirin (ASA) between March 2015 and February 2016. Multivariate models were used to calculate adjusted odds ratios (aOR) for factors associated with treatment decisions. Results: A total of 6765 newly initiated patients were included, most with apixaban (46.4%) and least with ASA (6.7%). There were more comorbidities in patients initiated with ASA or warfarin compared to the cohort average. Patients with high stroke risks had higher chances of receiving ASA (CHA2DS2-VASc ≥5 vs 0; aOR 2.01; 95% confidence interval (CI) 1.12–3.33). Among patients receiving oral anticoagulants, patients with high bleeding risks more often received warfarin (ATRIA score 5–10 vs 0–3; aOR 1.40; CI 1.20–1.64). Among NOACs, apixaban was preferred for patients with higher stroke risks (aOR 1.78; CI 1.31–2.41), high bleeding risks (aOR 1.54; CI 1.26–1.88) and high age (age group ≥85 vs 0–65; aOR 1.84; CI 1.44–2.35). Conversely, dabigatran treatment was associated with lower ages and lower risks. Conclusions: High stroke and bleeding risks favored choices of warfarin or ASA. Among patients receiving NOACs, apixaban was favored for elderly and high-risk patients whereas dabigatran was used in lower risk patients. The inadvertent use of ASA, especially among those with high stroke risks, should be further discouraged.",acetylsalicylic acid;anticoagulant agent;apixaban;clopidogrel;dabigatran;rivaroxaban;warfarin;adolescent;adult;aged;alcoholism;anemia;anticoagulant therapy;article;atrial fibrillation;bleeding;cerebrovascular accident;child;chronic obstructive lung disease;comorbidity;decision making;dementia;diabetes mellitus;falling;female;heart failure;high risk patient;human;hypertension;infant;kidney disease;liver disease;low drug dose;major clinical study;male;malignant neoplasm;newborn;obesity;patient selection;population research;prescription;priority journal;retrospective study;venous thromboembolism;very elderly,"Komen, J.;Forslund, T.;Hjemdahl, P.;Wettermark, B.",2017,,10.1007/s00228-017-2289-0,0,
2338,Use of Age and Medical Comorbidity to Assess Long-term Other-cause Mortality Risk in a Cohort of Men Undergoing Prostate Biopsy at an Academic Medical Center,"Objective To assess life expectancy and biopsy outcomes in men undergoing prostate biopsy at an academic medical center. Methods We analyzed men who underwent prostate biopsy at our medical center between July 2012 and June 2014. Long-term other-cause mortality risk was determined using survival tables. Indications for biopsy and biopsy outcomes were assessed, and compared among men with varying mortality risks. Results A total of 417 men underwent prostate biopsy, in whom 14-year other-cause mortality risk ranged from 9% to 74%. One hundred ninety-three men (46.3%) were considered low-mortality risk (<40% risk of 14-year mortality), 131 (31.4%) intermediate risk (41%-55% 14-year mortality), and 93 (22.3%) high risk (>55% 14-year mortality). Of the 417 patients who underwent biopsy, 149 (35.7%) were found to have prostate cancer. There was no significant difference in the rate of positive biopsies (P = .72), distribution of Gleason scores (P = .60), or percentage of positive biopsy cores (P = .74) between mortality risk groups. However, by UCSF Cancer of the Prostate Risk Assessment score, there was significant trend toward higher-risk prostate cancer in men with intermediate and high-mortality risk (P = .04). Conclusion In this analysis, a large number of men with limited life expectancies underwent prostate biopsy. The majority of these men had negative biopsies or low-risk cancers, suggesting that they were unlikely to benefit from biopsy. To avoid potentially unnecessary prostate biopsies, the practitioner must give serious consideration to a patient's age and medical comorbidities before making a recommendation as to whether biopsy should be performed.",acquired immune deficiency syndrome;adult;aged;angina pectoris;anxiety disorder;arthritis;article;cancer risk;chronic kidney failure;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;dementia;depression;diabetes mellitus;digital rectal examination;electronic medical record;Gleason score;heart infarction;hemiplegia;high risk population;human;human tissue;hypertension;inflammatory bowel disease;leukemia;life expectancy;liver cirrhosis;long term care;major clinical study;male;metastasis;mortality risk;outcome assessment;peptic ulcer;peripheral vascular disease;prediction;priority journal;prostate biopsy;prostate cancer;retrospective study;risk assessment;solid malignant neoplasm,"Kominsky, H. D.;Bashline, M.;Eun, D.;Pontari, M. A.;Mydlo, J. H.;Reese, A. C.",2017,,10.1016/j.urology.2016.09.006,0,
2339,Risk factors for unexpected death from suffocation in elderly patients hospitalized for pneumonia,"Aim: Unexpected death from suffocation as a result of ortholaryngeal mucinous secretions or vomitus during recovery from pneumonia is devastating for patients, their families and medical professionals. This study aimed to determine the risk factors for unexpected death from suffocation in elderly patients hospitalized for pneumonia. Methods: This study was carried out with patients aged 65years and older that were hospitalized for pneumonia and died of any cause. Unexpected death from suffocation was defined as: (i) being in the recovery stage of pneumonia; (ii) presenting stable vital signs a week before death; (iii) dying within 24h after suffocation; and (iv) aspiration confirmed by transtracheal suction. The clinical features and courses, and methods of feeding were retrospectively analyzed. Results: A total of 11 patients that had an unexpected death from suffocation and 62 patients who died of other causes were enrolled. There were significantly more patients that received tube feeding after admission (continuation and introduction) among the patients who had died of suffocation (63.6%) than in those who had died of other causes (12.9%; P<0.001). A multiple logistic regression analysis showed that tube feeding after admission was strongly associated with unexpected death from suffocation (adjusted odds ratio 9.536, P=0.047) after adjusting for sex, age, level of serum albumin, PaO2/FIO2 ratio, the pneumonia severity score and performance status. Conclusion: A continuation of tube feeding after admission is thus considered to be a significant predictor of unexpected death from suffocation in elderly patients with pneumonia. © 2012 Japan Geriatrics Society.",serum albumin;acute kidney failure;aged;article;asphyxia;brain hemorrhage;brain infarction;brain injury;clinical feature;Peptoclostridium difficile;dementia;disease severity;enteric feeding;female;gastrointestinal hemorrhage;geriatric patient;heart failure;human;hyperalimentation;interstitial pneumonia;major clinical study;male;malnutrition;mycosis;Parkinson disease;pneumonia;priority journal;progressive supranuclear palsy;risk factor;vomiting,"Komiya, K.;Ishii, H.;Okabe, E.;Iwashita, T.;Miyajima, H.;Tsubone, T.;Ohama, M.;Kushima, H.;Matsumoto, B.;Kadota, J. I.",2013,,,0,
2340,Atomic structure of GRK5 reveals distinct structural features novel for G protein-coupled receptor kinases,"G protein-coupled receptor kinases (GRKs) are members of the protein kinase A, G, and C families (AGC) and play a central role in mediating G protein-coupled receptor phosphorylation and desensitization. One member of the family, GRK5, has been implicated in several human pathologies, including heart failure, hypertension, cancer, diabetes, and Alzheimer disease. To gain mechanistic insight into GRK5 function, we determined a crystal structure of full-length human GRK5 at 1.8 Å resolution. GRK5 in complex with the ATP analog 5′-adenylyl β,γ-imidodiphosphate or the nucleoside sangivamycin crystallized as a monomer. The C-terminal tail (C-tail) of AGC kinase domains is a highly conserved feature that is divided into three segments as follows: the C-lobe tether, the active-site tether (AST), and the N-lobe tether (NLT). This domain is fully resolved in GRK5 and reveals novel interactions with the nucleotide and N-lobe. Similar to other AGC kinases, the GRK5 AST is an integral part of the nucleotide-binding pocket, a feature not observed in other GRKs. The AST also mediates contact between the kinase N- and C-lobes facilitating closure of the kinase domain. The GRK5 NLT is largely displaced from its previously observed position in other GRKs. Moreover, although the autophosphorylation sites in the NLT are >20 Å away from the catalytic cleft, they are capable of rapid cis-autophosphorylation suggesting high mobility of this region. In summary, we provide a snapshot of GRK5 in a partially closed state, where structural elements of the kinase domain C-tail are aligned to form novel interactions to the nucleotide and N-lobe not previously observed in other GRKs.",adenylylimidodiphosphate;calmodulin;G protein coupled receptor kinase;G protein coupled receptor kinase 5;G protein coupled receptor kinase 6;monomer;nucleotide;rhodopsin kinase;sangivamycin;alpha helix;amino terminal sequence;article;autophosphorylation;carboxy terminal sequence;cell membrane;cellular distribution;crystal structure;enzyme active site;human;interactions with nucleic acid;priority journal;protein analysis;protein conformation;protein function;protein interaction;protein localization;protein stability;sequence alignment;structure analysis;X ray crystallography,"Komolov, K. E.;Bhardwaj, A.;Benovic, J. L.",2015,,,0,
2341,Riser Blood Pressure Pattern Is Associated With Mild Cognitive Impairment in Heart Failure Patients,"BACKGROUND: The riser pattern, an abnormal blood pressure (BP) rhythm in which sleep BP exceeds awake BP, is a predictor of future stroke events. Although the riser pattern is caused by autonomic dysfunction, its significance in heart failure (HF) patients is not established. HF patients often suffered from cognitive impairment (CI), but the relationship between riser pattern and CI is not clearly understood. We tested the hypothesis that the riser pattern is associated with mild CI, a form of brain damage that could develop to dementia. METHODS: We performed Mini-Mental State Examination (MMSE), ambulatory BP monitoring (ABPM), echocardiography, and blood tests in 444 HF patients just before leaving hospitals. Mild CI, a measure of cognitive function, was defined as the score <26. RESULTS: The mean age of the patients was 68+/-13 years; 61.5% were male; 22.5% were riser pattern. The MMSE score was significantly lower in the Riser group than in the Non-dipper and Dipper group (23+/-4 vs. 25+/-5, 26+/-4, respectively, P < 0.01). In multivariable logistic regression analysis, a riser pattern was significantly associated with mild CI (odds ratio 2.38, 95% confidence intervals 1.29-4.42, P < 0.01) after adjusting for significant covariates. CONCLUSIONS: The riser pattern was associated with mild CI in HF patients. An abnormal circadian BP rhythm in HF patients is clinically significant as a potential indicator of subclinical brain damage.","Aged;Aged, 80 and over;Biomarkers;*Blood Pressure;*Circadian Rhythm;Female;Heart Failure/*complications/physiopathology;Humans;Male;Middle Aged;Mild Cognitive Impairment/*etiology;Prospective Studies;ambulatory blood pressure monitoring;blood pressure;cognitive function;heart failure;hypertension;riser.","Komori, T.;Eguchi, K.;Saito, T.;Nishimura, Y.;Hoshide, S.;Kario, K.",2016,Feb,10.1093/ajh/hpv086,0,
2342,"Exercise, fitness and cognition - A randomised controlled trial in older individuals: The DR's EXTRA study","Background: Observational studies suggest that higher levels of physical activity and cardiorespiratory fitness associate with improved cognition. However, evidence from randomised controlled trials (RCT) is limited. We hypothesised that increased regular exercise improves cognition in older individuals. The trial is registered: ISRCTN45977199 (http://isrctn.org). Methods: A population sample of 1335 men and women aged 57-78 years was randomised into aerobic exercise, resistance exercise, diet, combined aerobic exercise and diet, combined resistance exercise and diet or reference group for a 4-year intervention. Here, we report 2-year interim data. Exercise was assessed by a questionnaire and by maximal oxygen uptake (VO2max), an objective measure of exercise, and cognition using Consortium to establish a registry for Alzheimer's disease (CERAD) neuropsychological tests. Findings: In the intention to treat analyses, regular exercise increased in exercise groups, but remained unchanged in reference and diet only groups (P < 0.001 between groups). VO2max remained unchanged in exercise groups, but decreased in reference and diet only groups (P < 0.001 between groups). There were between group differences neither in cognition, nor in the association of VO2max to cognition during the first 2 years of intervention. In secondary analyses, improved VO2max was associated with improved immediate memory in aerobic (β = 0.11, P = 0.001), resistance (β = 0.08, P = 0.018), diet (β = 0.09, P = 0.029) and combined aerobic and diet groups (β = 0.09, P = 0.013), with improved delayed memory in diet group (β = 0.08, P = 0.015) and with verbal performance in aerobic group (β = 0.14, P = 0.044). Those who were in the upper gender-specific VO 2max tertile had a 66.0% (95% confidence interval [CI] 34.2-82.4%, P = 0.001) lower, and those in the middle tertile a 56.4% (95% CI 22.6-75.4%, P = 0.005) lower risk of developing impaired delayed memory compared to those in the lower VO2max tertile, after adjusting for potential confounders. Conclusions: Present data from a large RCT among older individuals failed to show between group differences on the effects of regular exercise on cognition. However, secondary analyses suggest that higher levels of fitness may potentially mitigate memory impairment. © 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society.",ISRCTN45977199;adult;aerobic exercise;aged;angina pectoris;article;bicycle ergometry;clinical trial;cognition;controlled clinical trial;controlled study;diet;disease course;dizziness;exercise;female;fitness;human;hypothesis;major clinical study;male;memory disorder;muscle training;neuropsychological test;oxygen consumption;population;questionnaire;randomized controlled trial;resistance training;risk factor;sex difference;verbal behavior,"Komulainen, P.;Kivipelto, M.;Lakka, T. A.;Savonen, K.;Hassinen, M.;Kiviniemi, V.;Hänninen, T.;Rauramaa, R.",2010,,,0,
2343,"Abnormal tau deposition in neurons, but not in glial cells in the cerebral tissue surrounding arteriovenous malformation","We report an autopsy case of arteriovenous malformation (AVM) of the right frontal lobe in a 50-year-old man, in whom post mortem examination revealed massive tau deposition in the affected cerebral cortex. The patient was diagnosed as having AVM at the age of 21 years, and died of unknown cause at the age of 50 years. Immunostaining with anti-phosphorylated tau antibody (AT8) revealed many NFTs and neuropil threads, but not glial tau accumulation, in the right frontal cortex surrounding the AVM. The NFTs and neuropil threads contained both 3-repeat and 4-repeat tau. Ultrastructurally, the NFTs consisted of paired helical filaments. In the other brain areas, a few NFTs were found in the parahippocampal gyrus. There was no amyloid deposition in the brain. A variety of disease conditions, including brain tumor, viral encephalitis, angioma and cervical spondylotic myelopathy, have been reported to show Alzheimer-type NFTs. The present findings indicate that abnormal tau deposition can occur in neurons, but not in glial cells, of the affected cerebral cortex surrounding AVM. © 2011 Japanese Society of Neuropathology.",anticonvulsive agent;tau protein;adult;anticonvulsant therapy;arteriovenous malformation;article;autopsy;basal cistern;brain artery aneurysm rupture;brain tissue;cancer surgery;cardiopulmonary arrest;case report;coil embolization;frontal cortex;human;immunohistochemistry;liver cell carcinoma;male;neurofibrillary tangle;neuropil thread;nuclear magnetic resonance imaging;parahippocampal gyrus;partial hepatectomy;priority journal;seizure;subarachnoid hemorrhage;ultrastructure,"Kon, T.;Mori, F.;Tanji, K.;Miki, Y.;Tomiyama, M.;Baba, M.;Umehara, Y.;Kurotaki, H.;Wakabayashi, K.",2012,,,0,
2344,Prognostic and risk factors in patients hospitalized with bacterial pneumonia,"We studied 316 adults with community-and hospital-acquired bacterial pneumonia admitted from January 1998 to July 2003. Of these, 66 (20.9%) died. Classified by age, none under 70 died, but mortality increased to 22.6% in the 70-79 age group, 31.6% in the 80-89 age group and 24.2% in the group over 90. Mortality was 3.4% (6/177) for mild pneumonia, 32.0% (24/75) for moderate pneumonia, and 56.3% (36/64) for severe pneumonia. Mortality in hospital-acquired pneumonia (69.1%) was significantly higher than that in community-acquired pneumonia (10.7%). This may result from the higher percentage of moderate by and severe by ill patients who contracted hospital-acquired pneumonia, since 80% of those with hospital-acquired pneumonia were in the moderate and severe group compared to 36.4% of those with community-acquired pneumonia. For antibiotic regimens, mortality was 18.2% to 36.4% for patients who underwent Penicillins-Cephems therapy compared with 51.6% to 66.7% for Carbapenems-Quinolones therapy. The reasons for these differences remain unclear. Our study indicates that severity of illness, age, and antibiotic therapy were factors correlated with death from pneumonia. Underlying diseases such as respiratory failure, chronic heart failure, cerebrovascular disease, renal failure, malignancy, and senile dementia may also be associated with mortality.","Age Factors;Aged;Aged, 80 and over;Anti-Bacterial Agents/therapeutic use;Community-Acquired Infections/mortality;Cross Infection/mortality;Female;Hospitalization;Humans;Male;Middle Aged;Pneumonia, Bacterial/drug therapy/*mortality;Prognosis;Risk Factors","Kondo, A.;Morinaga, Y.;Sasaki, E.;Hisamatsu, T.;Izumikawa, K.;Hara, K.;Izumikawa, K.;Kohno, S.",2007,May,,0,
2345,Anesthetic management of cerebrotendinous xanthomatosis,"We reported an anesthetic management of a 50's woman with cerebrotendinous xanthomatosis. She presented extensive xanthoma on her left heel, which was surgically resected because it was repeatedly infected. Problems listed before her anesthetic management were ischemic cardiac disease, carotid artery atherosclerosis, deep thrombophlebitis, and dementia. We chose general anesthesia with propofol, remifentanil, and rocuronium. The anesthetic management was uneventful and there were no complications. She could quickly emerge from anesthesia. Cerebrotendinous xanthomatosis is associated with various diseases such as those of the progressive central nervous system and the coronary artery, as well as respiratory diseases due to accumulation of cholestanol in all of tissues throughout the body. Therefore, we considered that preoperative examination was necessary prior to surgery in a patient with cerebrotendinous xanthomatosis.",cholestanol;propofol;remifentanil;rocuronium;adult;article;carotid atherosclerosis;case report;central nervous system;cerebrotendinous xanthomatosis;coronary artery;deep vein thrombosis;dementia;disease association;female;general anesthesia;human;ischemic heart disease;middle aged;preoperative evaluation;respiratory tract disease,"Kondo, H.;Kato, T.;Sugimoto, Y.;Hamada, H.;Kawamoto, M.",2014,,,0,
2346,Creutzfeldt-Jakob disease is not associated with other disorders except organ resections in 88 autopsies in Japan,"This case control observation was based on 88 autopsies of Creutzfeldt-Jakob disease (CJD) along with three control diseases (550 craniocervical injuries, 403 myocardial infarctions and 440 cases of pulmonary tuberculosis) retrieved from the annual records of autopsies in Japan for 1964-1978. Recorded pathological findings, excluding those of the stated diseases, their treatments, agonal and other irrelevant changes, were classified and compared by age and sex. No increase was observed over control diseases in the frequency of nonneoplastic complications in CJD, regardless of the classification made from an etiological, functional, topographical or morphological point of view. The number of neoplasms was also comparable among these diseases. The frequency of organ resections was increased. There was little evidence supporting the idea that CJD is associated with other disorders recognizable at autopsy, excluding organ resections.",autopsy;central nervous system;Creutzfeldt Jakob disease;electron microscopy;geographic distribution;histology;human;Japan;organ resection,"Kondo, K.",1984,,,0,
2347,B-type natriuretic peptide plasma levels are elevated in subcortical vascular dementia,"High levels of B-type natriuretic peptide (BNP), a serum marker of congestive heart failure, are associated with an increased risk for cognitive decline. However, no study has yet assessed this marker in different subtypes of dementia. We tested the hypothesis that BNP has a more significant association with vascular dementia than Alzheimer disease. Plasma BNP was measured in 15 patients with subcortical vascular dementia, in 19 Alzheimer patients without evidence of vascular comorbidity, and in age-matched controls. Compared with controls (28+/-7 ng/l), BNP was elevated in subcortical vascular dementia (63+/-17 ng/l; P=0.03), but not in Alzheimer disease (36+/-5 ng/l). In conclusion, subcortical vascular dementia is indeed associated with moderately elevated BNP levels, whereas this could not be shown for Alzheimer disease. This probably reflects the larger cardiovascular burden in patients with subcortical vascular dementia.","Aged;Alzheimer Disease/blood/diagnosis/physiopathology;Biomarkers/analysis/blood;Brain/blood supply/*metabolism/physiopathology;Brain Ischemia/etiology/pathology/physiopathology;Causality;Cerebral Arteries/pathology/physiopathology;Cerebrovascular Circulation/physiology;Comorbidity;Dementia, Vascular/*blood/*etiology/physiopathology;Heart Failure/*blood/*complications/physiopathology;Humans;Natriuretic Peptide, Brain/analysis/*blood;Predictive Value of Tests;Up-Regulation/physiology","Kondziella, D.;Gothlin, M.;Fu, M.;Zetterberg, H.;Wallin, A.",2009,Jun 17,10.1097/WNR.0b013e328326f82f,0,
2348,Change of the cognitive function after open heart surgery,"The changes of cognitive function after open heart surgery was examined using the Hasegawa's Dementia Scale (max. 30 points) in 47 patients with average age of 61.7 years. The patient's score was obtained preoperatively, and 1st and 7th postoperative days. Patients with postoperative scores above 24 points were classified as Non-Decline group, and those below 23 points as Decline group; comparative analyses were done on the relationship between various perioperative factors on both groups. Anesthesia was induced with low-dose fentanyl and isoflurane nitrous oxide in oxygen. The average operating time was 331 minutes, and the cardiopulmonary bypass time was 108 minutes with normothermia. There were 31 Non-Decline cases, and 16 (34 %) Decline cases on the 1st and 5 (10 %) on the 7th postoperative day. The largest decrease in the Decline group was seen on the 1st postoperative day, and there were 4 cases of dementia. The factors in which a significant difference was observed between the 2 groups were age, amount of transfusion, extubation time, preoperative complications and postoperative cardiac index, and these was not related to the operation or ECC time. Moreover there were high incidences of postoperative complications, especially LOS, in the Decline group. It was concluded that one of the largest contributing factors of abnormality of the cognitive function postoperatively was age, and other factors such as pre- and postoperative general conditions of the patients, especially cardiac function, might also be related. The length of hospitalization in the cases of decreased cognitive function was longer.",fentanyl;isoflurane;nitrous oxide;adult;age;aged;anesthesia;article;cardiopulmonary bypass;clinical article;cognition;dementia;extubation;female;heart index;human;length of stay;male;open heart surgery;postoperative period;transfusion,"Konishi, A.;Kikuchi, K.;Igarashi, T.",1995,,,0,
2349,Clinical significance of white matter changes in senile dementia of the Alzheimer type,,Aged;Alzheimer Disease/*pathology;Brain/*pathology;Diabetes Mellitus/pathology;Humans;Hypertension/pathology;Myocardial Ischemia/pathology;Reference Values;Retrospective Studies,"Kono, I.;Mori, S.;Nakajima, K.;Kizu, O.;Yamada, K.;Sakai, Y.",2002,Nov,,0,
2350,Do white matter changes have clinical significance in Alzheimer's disease?,"Background: Although white matter changes visible with MRI are generally considered to result from ischemia, it has become clear that these changes also appear in patients with Alzheimer's disease (AD). However, their significance in AD is unknown. Objective: We evaluated the clinical significance of white matter changes in AD. Methods: Ninety-six AD patients (79.4 ± 5.92 years old) and 48 age-matched control subjects (80.0 ± 7.03 years old) participated in the study. Three neuroradiologists assessed the degree of periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) using a modified Fazekas' rating scale. We examined whether there was a difference in the severity and the histogram pattern of the white matter changes, or in vascular factors (hypertension, diabetes mellitus, and ischemic heart disease) between the two groups. We also analyzed the association between the severity of the white matter changes and the degree of dementia (MMSE score and disease duration). Results: There were no differences in the vascular factors between AD and control subjects. The degree of PVH in AD was severe compared with that in the control subjects. In histograms of the number of subjects with each degree of PVH severity, the distribution of AD patients had peaks at both the low and intermediate degrees of PVH, while most of the controls had a low degree of PVH. There was no difference in the degree or the histogram pattern of DWMH between the two groups. The severity of white matter changes was not associated with severity of dementia in AD. Conclusions: Although PVH might have several causative factors, and may have some clinical significance, the change itself does not contribute to the progression of AD. Copyright © 2004 S. Karger AG, Basel.",aged;Alzheimer disease;article;comparative study;controlled study;dementia;diabetes mellitus;disease duration;disease severity;female;histogram;human;hypertension;ischemic heart disease;major clinical study;male;neuroradiology;priority journal;rating scale;scoring system;statistical significance;white matter,"Kono, I.;Mori, S.;Nakajimaa, K.;Nakagawa, M.;Watanabe, Y.;Kizu, O.;Yamada, K.;Sakai, Y.",2004,,,0,
2351,Depression risk in patients with heart failure in primary care practices in Germany,"BACKGROUND: The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices. METHODS: This study was a retrospective database analysis in Germany utilizing the Disease Analyzer(R) Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date. RESULTS: HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression. CONCLUSIONS: The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.",antidepressants;depression;primary care;risk factors,"Konrad, M.;Bohlken, J.;Rapp, M. A.;Kostev, K.",2016,Jun 16,10.1017/s1041610216000867,0,2352
2352,Depression risk in patients with heart failure in primary care practices in Germany,"Background: The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices. Methods: This study was a retrospective database analysis in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date. Results: HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression. Conclusions: The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.",adult;aged;article;controlled study;depression;disease association;female;follow up;Germany;health insurance;heart failure;human;major clinical study;male;prevalence;primary medical care;retrospective study;risk assessment;risk factor;sex difference,"Konrad, M.;Bohlken, J.;Rapp, M. A.;Kostev, K.",2016,,10.1017/s1041610216000867,0,
2353,Depression risk in patients with coronary heart disease in Germany,"AIM: To determine the prevalence of depression and its risk factors among patients with coronary heart disease (CHD) treated in German primary care practices. METHODS: Longitudinal data from nationwide general practices in Germany (n = 1072) were analyzed. Individuals initially diagnosed with CHD (2009-2013) were identified, and 59992 patients were included and matched (1:1) to 59992 controls. The primary outcome measure was an initial diagnosis of depression within five years after the index date among patients with and without CHD. Cox proportional hazards models were used to adjust for confounders. RESULTS: Mean age was equal to 68.0 years (SD = 11.3). A total of 55.9% of patients were men. After a five-year follow-up, 21.8% of the CHD group and 14.2% of the control group were diagnosed with depression (P < 0.001). In the multivariate regression model, CHD was a strong risk factor for developing depression (HR = 1.54, 95%CI: 1.49-1.59, P < 0.001). Prior depressive episodes, dementia, and eight other chronic conditions were associated with a higher risk of developing depression. Interestingly, older patients and women were also more likely to be diagnosed with depression compared with younger patients and men, respectively. CONCLUSION: The risk of depression is significantly increased among patients with CHD compared with patients without CHD treated in primary care practices in Germany. CHD patients should be routinely screened for depression to ensure improved treatment and management.",Coronary heart disease;Depression;Primary care;Quality of life;Risk factors,"Konrad, M.;Jacob, L.;Rapp, M. A.;Kostev, K.",2016,Sep 26,10.4330/wjc.v8.i9.547,0,2354
2354,Depression risk in patients with coronary heart disease in Germany,"AIM To determine the prevalence of depression and its risk factors among patients with coronary heart disease (CHD) treated in German primary care practices. METHODS Longitudinal data from nationwide general practices in Germany (n = 1072) were analyzed. Individuals initially diagnosed with CHD (2009-2013) were identified, and 59992 patients were included and matched (1:1) to 59992 controls. The primary outcome measure was an initial diagnosis of depression within five years after the index date among patients with and without CHD. Cox proportional hazards models were used to adjust for confounders. RESULTS Mean age was equal to 68.0 years (SD = 11.3). A total of 55.9% of patients were men. After a five-year follow-up, 21.8% of the CHD group and 14.2% of the control group were diagnosed with depression (P < 0.001). In the multivariate regression model, CHD was a strong risk factor for developing depression (HR = 1.54, 95%CI: 1.49-1.59, P < 0.001). Prior depressive episodes, dementia, and eight other chronic conditions were associated with a higher risk of developing depression. Interestingly, older patients and women were also more likely to be diagnosed with depression compared with younger patients and men, respectively. CONCLUSION The risk of depression is significantly increased among patients with CHD compared with patients without CHD treated in primary care practices in Germany. CHD patients should be routinely screened for depression to ensure improved treatment and management.",adult;aged;article;controlled study;dementia;depression;disease association;female;follow up;Germany;high risk patient;human;ischemic heart disease;longitudinal study;major clinical study;male;outcome assessment;prevalence;primary medical care;retrospective study;risk factor,"Konrad, M.;Jacob, L.;Rapp, M. A.;Kostev, K.",2016,,10.4330/wjc.v8.i9.547,0,
2355,"""Mors auxilium vitae""-Causes of death of body donors in an Austrian anatomical department","Background: Anatomical dissection is, despite several critical annotations, a highly valuable component of under- and postgraduate medical education and research. Our current causes-of-death statistics on our body donors is aimed to find out to which extent they are representative of the Austrian population. Methods: We evaluated the causes of death stated in their death certificates of a total of 3399 people who donated their bodies to our department in the course of the last 25 years (1988-2013). The categorisation is based on the official ICD-10-WHO classification. Results: Our data show a prevalence of cardiovascular diseases in about half of the donors (42%) examined; no gender difference could be revealed in cardiovascular diseases. Tumours were responsible for about 20% of deaths, lead by lung cancer; cancers showed a slight male excess. All other deaths were caused by diseases of the respiratory system, the digestive organs, the genitourinary system, the nervous system, alimentary and metabolic disorders, infections and blood diseases, psychiatric disorders, external and other causes in descending order. Compared to the official Austrian and German statistics, there are only minor deviations. Conclusion: Our data clearly show that body donors, at least in our department, depict a representative sample of Austrian population in terms of their causes of death. Therefore anatomical dissection provides appropriate insight into the morbidity of the increasing major target population of medicine, the elders. Limitations in the acceptance by age, excluding either young or old donors, which appear to exist in other anatomical departments, will limit this representativeness. Being aware of these facts, the anatomical dissection course cannot only provide anatomical learning experiences but can also provide an introduction to the basics of epidemiology. Therefore, a topographical dissection course remains an indispensable method for both undergraduate and postgraduate training as well as for research.",accident;adolescent;adult;age;aged;Alzheimer disease;article;Austria;Austrian;bladder cancer;brain atherosclerosis;breast cancer;cachexia;carcinoma;cause of death;central nervous system tumor;cheilocarcinoma;child;controlled study;death certificate;dementia;diabetes mellitus;donor;drowning;esophagus tumor;falling;female;gallbladder carcinoma;gender;German (citizen);Germany;hematologic disease;human;ICD-10;infant;intestine cancer;ischemic heart disease;kidney cancer;kidney failure;liver cancer;liver cirrhosis;lung cancer;lymphatic system tumor;male;metabolic disorder;mouth cancer;multiple sclerosis;mycosis;newborn;pancreas carcinoma;Parkinson disease;peptic ulcer;pharynx cancer;pneumonia;prevalence;prostate cancer;retrospective study;senility;sepsis;sex difference;skin cancer;stomach cancer;suffocation;suicide;thyroid cancer;world health organization,"Konschake, M.;Brenner, E.",2014,,,0,
2356,"Cardiovascular thrombotic events in controlled, clinical trials of rofecoxib","Background-In comparing aspirin, nonselective nonsteroidal antiinflammatory agents (NSAIDs), and cyclooxygenase (COX)-2 inhibitors, variation in platelet inhibitory effects exists that may be associated with differential risks of cardiovascular (CV) thrombotic events. Among the randomized, controlled trials with the COX-2 inhibitor rofecoxib, one study demonstrated a significant difference between rofecoxib and its NSAID comparator (naproxen) in the risk of CV thrombotic events. A combined analysis of individual patient data was undertaken to determine whether there was an excess of CV thrombotic events in patients treated with rofecoxib compared with those treated with placebo or nonselective NSAIDs. Methods and Results-CV thrombotic events were assessed across 23 phase IIb to V rofecoxib studies. Comparisons were made between patients taking rofecoxib and those taking either placebo, naproxen (an NSAID with near-complete inhibition of platelet function throughout its dosing interval), or another nonselective NSAIDs used in the development program (diclofenac, ibuprofen, and nabumetone). The major outcome measure was the combined end point used by the Antiplatelet Trialists' Collaboration, which includes CV, hemorrhagic, and unknown deaths; nonfatal myocardial infarctions; and nonfatal strokes. More than 28 000 patients, representing > 14 000 patient-years at risk, were analyzed. The relative risk for an end point was 0.84 (95% CI: 0,51, 1.38) when comparing rofecoxib with placebo; 0.79 (95% CI: 0.40, 1.55) when comparing rofecoxib with non-naproxen NSA1Ds; and 1.69 (95% CI: 1.07, 2.69) when comparing rofecoxib with naproxen. Conclusions-This analysis provides no evidence for an excess of CV events for rofecoxib relative to either placebo or the non-naproxen NSAIDs that were studied. Differences observed between rofecoxib and naproxen are likely the result of the antiplatelet effects of the latter agent.",cyclooxygenase 1 inhibitor;cyclooxygenase 2 inhibitor;diclofenac;ibuprofen;nabumetone;naproxen;nonsteroid antiinflammatory agent;placebo;rofecoxib;adult;Alzheimer disease;arthritis;article;cardiovascular disease;clinical trial;controlled clinical trial;controlled study;drug induced disease;female;gastrointestinal toxicity;human;major clinical study;male;meta analysis;osteoarthritis;outcomes research;phase 2 clinical trial;phase 3 clinical trial;priority journal;randomized controlled trial;rheumatoid arthritis;risk assessment;cerebrovascular accident;thrombosis;vioxx,"Konstam, M. A.;Weir, M. R.;Reicin, A.;Shapiro, D.;Sperling, R. S.;Barr, E.;Gertz, B. J.",2001,,,0,
2357,Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: A retrospective cohort study,"Objectives The UK's Quality and Outcomes Framework permits practices to exempt patients from financially-incentivised performance targets. To better understand the determinants and consequences of being exempted from the framework, we investigated the associations between exception reporting, patient characteristics and mortality. We also quantified the proportion of exempted patients that met quality targets for a tracer condition (diabetes). Design Retrospective longitudinal study, using individual patient data from the Clinical Practice Research Datalink. Setting 644 general practices, 2006/7 to 2011/12. Participants Patients registered with study practices for at least one year over the study period, with at least one condition of interest (2 460 341 in total). Main outcome measures Exception reporting rates by reason (clinical contraindication, patient dissent); all-cause mortality in year following exemption. Analyses with logistic and Cox proportional-hazards regressions, respectively. Results The odds of being exempted increased with age, deprivation and multimorbidity. Men were more likely to be exempted but this was largely attributable to higher prevalence of conditions with high exemption rates. Modest associations remained, with women more likely to be exempted due to clinical contraindication (OR 0.90, 99% CI 0.88 to 0.92) and men more likely to be exempted due to informed dissent (OR 1.08, 99% CI 1.06 to 1.10). More deprived areas (both for practice location and patient residence) were non-linearly associated with higher exception rates, after controlling for comorbidities and other covariates, with stronger associations for clinical contraindication. Compared with patients with a single condition, odds ratios for patients with two, three, or four or more conditions were respectively 4.28 (99% CI 4.18 to 4.38), 16.32 (99% CI 15.82 to 16.83) and 68.69 (99% CI 66.12 to 71.37) for contraindication, and 2.68 (99% CI 2.63 to 2.74), 4.02 (99% CI 3.91 to 4.13) and 5.17 (99% CI 5.00 to 5.35) for informed dissent. Exempted patients had a higher adjusted risk of death in the following year than non-exempted patients, regardless of whether this exemption was for contraindication (hazard ratio 1.37, 99% CI 1.33 to 1.40) or for informed dissent (1.20, 99% CI 1.17 to 1.24). On average, quality standards were met for 48% of exempted patients in the diabetes domain, but there was wide variation across indicators (ranging from 8 to 80%). Conclusions Older, multimorbid and more deprived patients are more likely to be exempted from the scheme. Exception reported patients are more likely to die in the following year, whether they are exempted by the practice for a contraindication or by themselves through informed dissent. Further research is needed to understand the relationship between exception reporting and patient outcomes.",adult;article;asthma;atrial fibrillation;cause of death;cerebrovascular accident;chronic kidney disease;chronic obstructive lung disease;cohort analysis;comorbidity;comparative study;controlled study;dementia;depression;diabetes mellitus;epilepsy;female;financial management;health program;heart failure;human;hypertension;hypothyroidism;ischemic heart disease;learning disorder;longitudinal study;major clinical study;male;malignant neoplastic disease;mental disease;middle aged;morbidity;mortality;outcome assessment;patient coding;primary care pay for performance program;primary medical care;retrospective study;socioeconomics;survival;United Kingdom,"Kontopantelis, E.;Springate, D. A.;Ashcroft, D. M.;Valderas, J. M.;Van Der Veer, S. N.;Reeves, D.;Guthrie, B.;Doran, T.",2016,,,0,
2358,Plasma ubiquinol-10 as a marker for disease: Is the assay worthwhile?,"Ubiquinol-10 and ubiquinone-10 were measured in plasma of patients with several pathologies known to be associated with increased oxidative stress. Plasma ubiquinol-10, expressed as a percentage of total ubiquinol-10 + ubiquinone-10, was found to be significantly lower in hyperlipidaemic patients and in patients with liver diseases than in age-matched control subjects. In contrast, no decrease in ubiquinol-10 was detected in plasma of patients with coronary heart disease and Alzheimer's disease. Except for ubiquinol-10, no other lipophilic antioxidant was found to be decreased in patients with liver diseases. These data suggest that the level of ubiquinol- 10 in human plasma may serve as a marker for liver dysfunction, reflecting its diminished reduction by the liver rather than increased consumption by oxidants.",hydroquinone derivative;ubidecarenone;adult;aged;Alzheimer disease;article;controlled study;disease marker;enzyme blood level;human;hyperlipidemia;ischemic heart disease;liver disease;liver dysfunction;major clinical study;oxidative stress;priority journal,"Kontush, A.;Schippling, S.;Spranger, T.;Beisiegel, U.",1999,,,0,
2359,Biventricular takotsubo cardiomyopathy associated with epilepsy,"We describe a case of Takotsubo cardiomyopathy in an elderly woman after status epilepticus. In an emergency echocardiography, not only left ventricular apical ballooning but also right ventricular apical hypokinesia was observed. After a medical management, the patient’s condition was improved and a follow-up echocardiography showed substantial recovery of left and right ventricular apical ballooning.",acetylsalicylic acid;anticonvulsive agent;beta adrenergic receptor blocking agent;choline alfoscerate;dipeptidyl carboxypeptidase inhibitor;diuretic agent;donepezil;hydroxymethylglutaryl coenzyme A reductase inhibitor;levacecarnine;lorazepam;methylphenidate;phenytoin;triflusal;valproic acid;aged;angiocardiography;article;blood gas analysis;brain hemorrhage;cardiogenic shock;cardiomegaly;case report;central venous catheter;diffusion weighted imaging;disease association;electrocardiography;epilepsy;epileptic state;female;human;metabolic acidosis;multiinfarct dementia,"Koo, N.;Yoon, B. W.;Song, Y.;Lee, C. K.;Lee, T. Y.;Hong, J. Y.",2015,,,0,
2360,Diet or diuretic? Treatment of newly diagnosed mild to moderate hypertension in the elderly,"The aim of this study was to assess the effectivity of dietary measures in the treatment of hypertension. Therefore, a single-blind randomised clinical trial was carried out in elderly persons with recently diagnosed hypertension. Patients were recruited from a general practice (6555 persons) during visits or after written invitation or invitation by phone. New hypertensive patients (with measurements taken on three different occasions >159 mm Hg systolic and/or >94 mm Hg diastolic), aged 60-80 years, without target-organ damage, dementia, diabetes mellitus or malignant disease entered a 3-month intervention programme of either intensive dietary counselling, receiving a sodium-reduced (<100 mmol/24h), potassium-enriched (>75 mmol/24h), and weight-reducing diet (BMI <25), or only 25 mg chlorthalidone a day. Forty-two newly diagnosed hypertensive subjects met the inclusion criteria. Two dropped out from the chlorthalidone group, one with side effects and another after a myocardial infarction. Although blood pressure (BP) in the diet group decreased less than in the drug group, of the patients in the diet group 45% fell back to a normal systolic and 50% to a normal diastolic BP (drug treatment group, systolic 75% and diastolic 85%). In contrast with the diet group, lipid spectrum and blood glucose concentration in the diuretic group, however, deteriorated slightly. The dietary intervention was effective in elderly patients with a systolic or diastolic BP in the range of 160-180 and 95-100 mm Hg, respectively. Reduction in weight should be the primary aim. It is argued that sodium reduction can be achieved better by collective measures. In patients with a BP of more than 180 mm Hg systolic or 100 mm Hg diastolic, dietary advice and drug treatment should be combined.","Diuretics [therapeutic use];Hypertension [diet therapy] [drug therapy] [metabolism];Patient Compliance;Single-Blind Method;Weight Loss;Aged[checkword];Aged, 80 and over[checkword];Humans[checkword];Sr-behavmed: sr-dementia: sr-endoc: sr-htn: sr-vasc","Koopman, H;Devillé, W;Eijk, Jt;Donker, Aj;Spreeuwenberg, C",1997,,,0,2361
2361,Diet or diuretic? Treatment of newly diagnosed mild to moderate hypertension in the elderly,"The aim of this study was to assess the effectivity of dietary measures in the treatment of hypertension. Therefore, a single-blind randomised clinical trial was carried out in elderly persons with recently diagnosed hypertension. Patients were recruited from a general practice (6555 persons) during visits or after written invitation or invitation by phone. New hypertensive patients (with measurements taken on three different occasions >159 mm Hg systolic and/or >94 mm Hg diastolic), aged 60-80 years, without target-organ damage, dementia, diabetes mellitus or malignant disease entered a 3-month intervention programme of either intensive dietary counselling, receiving a sodium-reduced (<100 mmol/24h), potassium-enriched (>75 mmol/24h), and weight-reducing diet (BMI <25), or only 25 mg chlorthalidone a day. Forty-two newly diagnosed hypertensive subjects met the inclusion criteria. Two dropped out from the chlorthalidone group, one with side effects and another after a myocardial infarction. Although blood pressure (BP) in the diet group decreased less than in the drug group, of the patients in the diet group 45% fell back to a normal systolic and 50% to a normal diastolic BP (drug treatment group, systolic 75% and diastolic 85%). In contrast with the diet group, lipid spectrum and blood glucose concentration in the diuretic group, however, deteriorated slightly. The dietary intervention was effective in elderly patients with a systolic or diastolic BP in the range of 160-180 and 95-100 mm Hg, respectively. Reduction in weight should be the primary aim. It is argued that sodium reduction can be achieved better by collective measures. In patients with a BP of more than 180 mm Hg systolic or 100 mm Hg diastolic, dietary advice and drug treatment should be combined.","Diuretics [therapeutic use];Hypertension [diet therapy] [drug therapy] [metabolism];Patient Compliance;Single-Blind Method;Weight Loss;Aged[checkword];Aged, 80 and over[checkword];Humans[checkword];Sr-behavmed: sr-dementia: sr-endoc: sr-htn: sr-vasc","Koopman, H.;Devillé, W.;Eijk, J. T.;Donker, A. J.;Spreeuwenberg, C.",1997,,,0,
2362,Incidence and prevalence of health problems in a group of nursing home patients with dementia. A comparison with family practice,"The objective of this study was to describe the health problems of a group dementia patients on admission and during residence in a Dutch nursing home and to compare these with figures of patients of 75 years and over from general practice. In 890 nursing home patients suffering from dementia prevalence of health problems on admission and the incidence during the residence were classified by means of the ICHPPC-2-defined. The differences between men and women were studied as was the influence of the season on the incidence during the stay. Results were compared with figures of patients of seventy five year and over from the continuous morbidity registration (CMR) from 'Nijmegen'. The most frequently occurring health problems on admission were: varicose veins of legs, acquired deformation of the spine, presbyacusis, hypertension, arthrosis, COPD, cerebrovascular disorders, heart murmur, cataract and chronic ischemic heart disease. During the residence the following health problems were frequently diagnosed: urinary tract infection, side effect of medicine, constipation, pneumonia, pressure sore, feeding problem, contusion, heart failure, cold and conjunctivitis. There were clear differences between men and women. Especially the incidence of intercurrent diseases showed great differences from the patterns in general practice. Prevalence of health problems on admission to the nursing home home agreed mor with figures from general practice. Respiratory tract infections frequently occurred in winter and urinary tract infections, pressure sores and conjunctivitis seemed to occur more in the summer. Nursing home patients with dementia have a lot of chronic and intercurrent health problems. They differ clearly from patients in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)","Aged;Aged, 80 and over;*Comorbidity;Dementia/*complications;Family Practice;Female;Humans;Incidence;Inpatients;Male;Nursing Homes;Patients/classification;Prevalence;Seasons;Sex Factors","Koopmans, R. T.;van den Hoogen, H. J.;van Weel, C.",1994,Dec,,0,
2363,Medical disorders among patients admitted to a public sector psychiatric inpatient unit,"Active and important physical disorders are common among public-sector psychiatric patients and are frequently undetected. A total of 289 patients who were consecutively admitted to a public psychiatric hospital were screened for physical disorders and given medical evaluations when screening results suggested an active and important physical disorder. Twenty-nine percent of the patients had such disorders. Of the 119 disorders detected, 24 (20 percent) were newly diagnosed for 23 patients (8 percent). Physical disorders that may have caused or exacerbated patients' psychiatric symptoms affected 2 percent and 3.5 percent of the patients, respectively. Patients admitted to psychiatric inpatient units should be carefully evaluated for physical disease.",adjustment disorder;adult;aged;alcohol liver disease;anemia;article;brain degeneration;cachexia;cellulitis;chronic obstructive lung disease;comorbidity;controlled study;cyanocobalamin deficiency;dementia;diabetes mellitus;disease exacerbation;female;folic acid deficiency;heart infarction;hepatitis;hospital patient;human;hyperthyroidism;hypoparathyroidism;hypothyroidism;laboratory test;major clinical study;male;mental disease;mental hospital;mood disorder;organic brain syndrome;physical examination;proteinuria;quadriplegia;questionnaire;schizophrenia;screening test;senile dementia;syphilis;thalassemia;urinary tract infection;withdrawal syndrome,"Koran, L. M.;Sheline, Y.;Imai, K.;Kelsey, T. G.;Freedland, K. E.;Mathews, J.;Moore, M.",2002,,,0,
2364,The prevention of the dementia epidemic,"Alzheimer's disease (AD) is considered to be the most common dementing disorder. The understanding of this disorder has greatly advanced over the past few years, and new therapeutic options have been developed. Another disorder, vascular dementia (VaD), is a syndrome with multiple etiologies operating through a variety of different mechanisms. The combination of AD and VaD is extremely common, making mixed dementia the most common type of dementia. Risk factors for VaD, which are the common vascular risk factors, are presently known to apply also to AD. Cholinergic deficits occur in both conditions. The identification of several genetic factors that can contribute to vascular damage, as well as possible auto-immune damage to vascular components, are important. It is remarkable that amyloid precursor protein (APP) mutations can cause the typical pathological changes of AD as well as amyloid deposition around blood vessels. These may lead to deficient blood perfusion to the brain, changes of the blood-brain barrier, as well as cerebral hemorrhages. Interestingly, attention to risk factors, such as hypertension, coronary artery disease, hyperlipidemia and smoking could reduce or delay the incidence of dementia, both vascular and AD. © 2007.",amyloid precursor protein;antihypertensive agent;antilipemic agent;antioxidant;cyanocobalamin;estrogen;folic acid;mutant protein;nonsteroid antiinflammatory agent;Alzheimer disease;article;blood brain barrier;brain hemorrhage;brain perfusion;cholinergic activity;clinical feature;coronary artery disease;epidemic;genetic risk;heredity;human;hyperlipidemia;hypertension;incidence;multiinfarct dementia;pathogenesis;priority journal;risk factor;smoking,"Korczyn, A. D.;Vakhapova, V.",2007,,,0,
2365,Evaluation of the association between the neutrophil to lymphocyte ratio and mortality in the patients followed up with the diagnosis of sepsis,"Aim: Neutrophil-to-lymphocyte ratio (NLR) is an easily measurable biomarker from complete blood count. NLR has been investigated previously as a potential predictor of survival rates in various types of cancers. However, there is a limited number of studies performed regarding the usefulness of NLR for predicting mortality in patients with sepsis. Our aim in this study was to evaluate the association between NLR and mortality of the patients with sepsis in an intensive care unit (ICU). Material and Method: We retrospectively assessed the patients who were followed up with the diagnosis of sepsis in the internal medicine ICU of our hospital between September 1, 2014 and December 31, 2015. Demographic, clinical, and laboratory data were obtained from the patients’ medical records. Results: A total of 104 patients were included in the study. ICU mortality was 57.7% in patients with sepsis. When survivors and non-survivors in theICU were assessed regarding neutrophil counts, lymphocyte counts, and NLR, no statistically significant difference was determined (p>0.05). While the mortality rate in ICU increased with increasing quartile of NLR, no significant difference was determined in ICU mortality (all p>0.05). Also there was no relationship between NLR and hospital mortality and 6-months mortality in patients with sepsis (p>0.05). Discussion: No significant correlation was found between NLR and mortality rate in the ICU and long-term mortality in patients with sepsis.",bilirubin;C reactive protein;creatinine;hypertensive factor;abdominal infection;acute pancreatitis;adult;aged;Alzheimer disease;article;artificial ventilation;blood cell count;cancer survival;cerebrovascular accident;Charlson Comorbidity Index;chronic kidney failure;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;demography;diabetes mellitus;female;Glasgow coma scale;hospital mortality;human;intensive care unit;lymphocyte count;major clinical study;male;medical record;mortality;neutrophil count;neutrophil lymphocyte ratio;polymorphonuclear cell;predictor variable;respiratory tract infection;retrospective study;sepsis;septic shock;soft tissue infection;survival rate;urinary tract infection;very elderly,"Korkmaz, P.;Erarslan, S.;Toka, O.",2017,,10.4328/jcam.4816,0,
2366,"Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes","BACKGROUND: The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health. OBJECTIVE: We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010–2012 Health and Retirement Study provided a representative sample of U.S. adults 50 years of age or older (n = 16,640). MAIN MEASURES: Outcomes were: Self-reported fair/poor health, self-rated worse health at 2 years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes. KEY RESULTS: Twenty-nine percent and 23 % of respondents reported fair/poor health and self-rated worse health at 2 years, respectively, and 5 % died in 2 years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80 %); b) for self-rated worse health at 2 years: 68.5 years of age or older, difficulty walking several blocks and being in fair/poor health (60 %); and c) for 2-year mortality: 80.5 years of age or older, and presenting with limitations in both ADLs and IADLs (> 40 %). CONCLUSIONS: Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.",ADL disability;adult;aged;Alzheimer disease;arthritis;article;cerebrovascular accident;chronic disease;congestive heart failure;daily life activity;depression;diabetes mellitus;disease classification;female;follow up;functional disease;geriatric disorder;health status;heart arrhythmia;heart infarction;human;hypertension;lung disease;major clinical study;male;middle aged;neoplasm;outcome assessment;prediction;self concept;underweight;very elderly;visual impairment;walking difficulty,"Koroukian, S. M.;Schiltz, N.;Warner, D. F.;Sun, J.;Bakaki, P. M.;Smyth, K. A.;Stange, K. C.;Given, C. W.",2016,,,0,
2367,Costs and cost-driving factors for acute treatment of adults with status epilepticus: A multicenter cohort study from Germany,"Objective: To provide first data on inpatient costs and cost-driving factors due to nonrefractory status epilepticus (NSE), refractory status epilepticus (RSE), and super-refractory status epilepticus (SRSE). Methods: In 2013 and 2014, all adult patients treated due to status epilepticus (SE) at the university hospitals in Frankfurt, Greifswald, and Marburg were analyzed for healthcare utilization. Results: We evaluated 341 admissions in 316 patients (65.7 ± [standard deviation]18.2 years; 135 male) treated for SE. Mean costs of hospital treatment were €14,946 (median €5,278, range €776–€152,911, €787 per treatment day) per patient per admission, with a mean length of stay (LOS) of 19.0 days (median 14.0, range 1–118). Course of SE had a significant impact on mean costs, with €8,314 in NSE (n = 137, median €4,597, €687 per treatment day, 22.3% of total inpatient costs due to SE), €13,399 in RSE (n = 171, median €7,203, €638/day, 45.0% of total costs, p < 0.001), and €50,488 in SRSE (n = 33, median €46,223, €1,365/day, 32.7% of total costs, p < 0.001). Independent cost-driving factors were SRSE, ventilation, and LOS of >14 days. Overall mortality at discharge was 14.4% and significantly higher in RSE/SRSE (20.1%) than in NSE (5.8%). Significance: Acute treatment of SE, and particularly SRSE and ventilation, are associated with high hospital costs and prolonged LOS. Extrapolation to the whole of Germany indicates that SE causes hospital costs of >€200 million per year. Along with the demographic change, incidence of SE will increase and costs for hospital treatment and sequelae of SE will rise.",anesthetic agent;benzodiazepine derivative;adult;aged;anticonvulsant therapy;article;cerebrovascular accident;cerebrovascular disease;cohort analysis;congestive heart failure;dementia;diabetes mellitus;emergency care;epileptic state;female;Germany;health care utilization;heart disease;heart infarction;hemiplegia;hospital admission;hospital cost;hospital discharge;hospital patient;hospital readmission;human;lung ventilation;major clinical study;male;multicenter study;nonrefractory status epilepticus;organ;priority journal;refractory status epilepticus;retrospective study;super refractory status epilepticus;very elderly,"Kortland, L. M.;Alfter, A.;Bähr, O.;Carl, B.;Dodel, R.;Freiman, T. M.;Hubert, K.;Jahnke, K.;Knake, S.;von Podewils, F.;Reese, J. P.;Runge, U.;Senft, C.;Steinmetz, H.;Rosenow, F.;Strzelczyk, A.",2016,,10.1111/epi.13584,0,
2368,Small hippocampal size in cognitively normal subjects with coronary artery disease,"OBJECTIVE: Hippocampal size reduction detected by three-dimensional structural magnetic resonance imaging (3D-MRI) represents an important hallmark of Alzheimer's disease (AD). Recently, epidemiological and neuropathological studies have associated coronary artery disease (CAD) and cardiovascular risk factors with AD. The present study aimed to assess whether small hippocampal size is also a feature of CAD. METHODS: Hippocampal volumes were assessed in 20 men with CAD and 20 healthy matched control subjects by use of 3D-MRI. Subjects with a history of neurological or psychiatric disorder, or signs of cognitive impairment were rigorously excluded. RESULTS: Compared with controls, subjects with CAD had significantly smaller (-14%) hippocampal volumes. Cardiovascular risk factors were not related to hippocampal volumes of CAD subjects. CONCLUSIONS: Our results demonstrate small hippocampal size in CAD subjects without any cognitive impairment. Future studies should clarify whether the annual rate of hippocampal volume loss of persons with CAD is greater than that of healthy individuals and predicts later cognitive decline or dementia.","Causality;Cognition Disorders [epidemiology] [pathology];Coronary Artery Disease [epidemiology] [pathology];Germany [epidemiology];Hippocampus [pathology];Imaging, Three-Dimensional [methods];Magnetic Resonance Imaging [methods];Organ Size;Reference Values;Risk Assessment [methods];Risk Factors;Humans[checkword];Male[checkword];Middle Aged[checkword]","Koschack, J.;Irle, E.",2005,,10.1016/j.neurobiolaging.2004.08.009,0,2369
2369,Small hippocampal size in cognitively normal subjects with coronary artery disease,"METHODSHippocampal volumes were assessed in 20 men with CAD and 20 healthy matched control subjects by use of 3D-MRI. Subjects with a history of neurological or psychiatric disorder, or signs of cognitive impairment were rigorously excluded.RESULTSCompared with controls, subjects with CAD had significantly smaller (-14%) hippocampal volumes. Cardiovascular risk factors were not related to hippocampal volumes of CAD subjects.CONCLUSIONSOur results demonstrate small hippocampal size in CAD subjects without any cognitive impairment. Future studies should clarify whether the annual rate of hippocampal volume loss of persons with CAD is greater than that of healthy individuals and predicts later cognitive decline or dementia.OBJECTIVEHippocampal size reduction detected by three-dimensional structural magnetic resonance imaging (3D-MRI) represents an important hallmark of Alzheimer's disease (AD). Recently, epidemiological and neuropathological studies have associated coronary artery disease (CAD) and cardiovascular risk factors with AD. The present study aimed to assess whether small hippocampal size is also a feature of CAD.","Causality;Cognition Disorders [epidemiology] [pathology];Coronary Artery Disease [epidemiology] [pathology];Germany [epidemiology];Hippocampus [pathology];Imaging, Three-Dimensional [methods];Magnetic Resonance Imaging [methods];Organ Size;Reference Values;Risk Assessment [methods];Risk Factors;Humans[checkword];Male[checkword];Middle Aged[checkword]","Koschack, J;Irle, E",2005,,10.1016/j.neurobiolaging.2004.08.009,0,
2370,Factors related to the high fall rate in long-term care residents with dementia,"BACKGROUND: Falls in long-term care residents with dementia represent a costly but unresolved safety issue. The aim of the present study was to (1) determine the incidence of falls, fall-related injuries and fall circumstances, and (2) identify the relationship between patient characteristics and fall rate in long-term care residents with dementia. METHODS: Twenty long-term care residents with dementia (80 +/- 11 years; 60% male) participated. Falls were recorded on a standardized form, concerning fall injuries, time and place of fall and if the fall was witnessed. Patient characteristics (66 variables) were extracted from medical records and classified into the domains: demographics, activities of daily living, mobility, cognition and behavior, vision and hearing, medical conditions and medication use. We used partial least squares (PLS) regression to determine the relationship between patient characteristics and fall rate. RESULTS: A total of 115 falls (5.1 +/- 6.7 falls/person/year) occurred over 19 months, with 85% of the residents experiencing a fall, 29% of falls had serious consequences and 28% was witnessed. A combination of impaired mobility, indicators of disinhibited behavior, diabetes, and use of analgesics, beta blockers and psycholeptics were associated with higher fall rates. In contrast, immobility, heart failure, and the inability to communicate were associated with lower fall rates. CONCLUSIONS: Falls are frequent and mostly unwitnessed events in long-term care residents with dementia, highlighting the need for more effective and individualized fall prevention. Our analytical approach determined the relationship between a high fall rate and cognitive impairment, related to disinhibited behavior, in combination with mobility disability and fall-risk-increasing-drugs (FRIDs).","Accidental Falls/*statistics & numerical data;Aged;Aged, 80 and over;Dementia/*complications;Female;Humans;Incidence;Long-Term Care/statistics & numerical data;Male;Middle Aged;Nursing Homes/*statistics & numerical data;Risk Factors;partial least square analyses","Kosse, N. M.;de Groot, M. H.;Vuillerme, N.;Hortobagyi, T.;Lamoth, C. J.",2015,May,10.1017/s104161021400249x,0,
2371,Predictors of early discontinuation of basal insulin therapy in type 2 diabetes in primary care,"Aims To identify patient-related characteristics and other impact factors predicting early discontinuation of basal insulin therapy in type 2 diabetes in primary care. Methods A total of 4837 patients who started basal insulin therapy (glargine: n = 3175; NPH: n = 1662) in 1072 general and internal medicine practices throughout Germany were retrospectively analyzed (Disease Analyser Database: 01/2008-03/2014). Early discontinuation was defined as switching back to oral antidiabetic drugs (OAD) therapy within 90 days after first basal insulin prescription (index date, ID). Patient records were assessed 365 days prior and post ID. Logistic regression models were used to adjust for age, sex, diabetes duration, diabetologist care, disease management program participation, HbA1c, and comorbidity. Results Within 3 months after ID, 202 (6.8%) of glargine patients switched back to OAD (NPH: 130 (8.5%); p < 0.05). In multivariable logistic regression, predictors of early basal insulin discontinuation were ≥1 documented hypoglycemia before ID (adjusted Odds ratio; 95% CI: 2.20; 1.27-3.82), diagnosed depression (1.31; 1.01-1.70) and referrals to specialists within 90 days after ID (2.06; 1.61-2.63). Diabetologist care (0.57; 0.36-0.89) and glargine treatment (vs. NPH: 0.78; 0.61-0.98) were related to a lower odds of having early insulin discontinuation. Conclusions Less than 10% of type 2 diabetes patients switched back to oral antidiabetic drugs within 90 days after start of basal insulin therapy. In particular, patients with baseline depression and frequent or severe hypoglycemia have a higher likelihood for early discontinuation of basal insulin, whereas use of insulin glargine and diabetologist care are related to an increased chance of continuous insulin treatment.",hemoglobin A1c;insulin;insulin glargine;isophane insulin;oral antidiabetic agent;aged;article;cerebrovascular accident;Charlson Comorbidity Index;comorbidity;dementia;depression;diabetic retinopathy;disease duration;drug substitution;drug withdrawal;female;Germany;glycemic control;heart failure;heart infarction;human;hypertension;hypoglycemia;infection;insulin treatment;ischemic heart disease;kidney failure;major clinical study;male;non insulin dependent diabetes mellitus;obesity;peripheral neuropathy;peripheral vascular disease;primary medical care;priority journal;retrospective study;very elderly,"Kostev, K.;Dippel, F. W.;Rathmann, W.",2016,,,0,
2372,Persistence with opioid treatment in Germany in patients suffering from chronic non-malignant or cancer pain,"Background: The aim of the present study was to assess factors influencing opioid persistence in a large patient cohort of 32,158 patients receiving opioid treatment for either chronic non-malignant or cancer pain. Methods: Data from 32,158 patients with first-time prescription of an opioid in the timeframe from January 2009 until December 2013 treated in 115 orthopedic, 104 neurological and 1129 general practitioner practices were retrospectively analyzed (Disease Analyzer database Germany). A Cox proportional hazards regression model was used to estimate the relationship between non-persistence and the demographic and clinical variables described previously for a maximum follow-up period of 1 year. Results: After 1 year of follow-up, 69% of patients treated with opioids had stopped medication intake (refill gap of 90 days). There was a significantly increased risk of treatment discontinuation for younger patients (<40 years HR: 1.45; 41-50 years HR: 1.37; 51-60 years HR: 1.23; 61-70 years HR: 1.22) as compared with patients aged >70. Cancer pain was associated with a significantly lower risk of therapy discontinuation (HR: 0.69), whereas persistence was considerably less probable for diagnoses such as various kinds of back pain (HR: 1.26), osteoarthritis (HR: 1.14) and spondylarthritis (HR: 1.09). Chronic comorbidities such as diabetes, hypertension, heart insufficiency, and dementia were associated with a decreased risk of treatment discontinuation. Conclusion: Our study showed that persistence with opioid treatment is associated with cancer pain, chronic comorbidities and depression, while younger age and chronic non-malignant pain (especially due to back pain) increase the possibility of opioid discontinuation. It will be the task of future studies to assess reasons for opioid discontinuation in more detail, which is an important step towards improving patient care and health outcomes.",opiate;adult;aged;analgesia;article;backache;cancer pain;cancer patient;chronic pain;cohort analysis;comorbidity;controlled study;dementia;diabetes mellitus;disease association;drug withdrawal;female;follow up;general practice;general practitioner;Germany;heart failure;human;hypertension;major clinical study;male;middle aged;osteoarthritis;prescription;spondylarthritis,"Kostev, K.;Wartenberg, F.;Richter, H.;Reinwald, M.;Heilmaier, C.",2015,,,0,
2373,Relation of coronary atherosclerosis and apolipoprotein E genotypes in Alzheimer patients,"BACKGROUND AND PURPOSE: Apolipoprotein E (apoE) epsilon 4 allele has been associated with a high risk for coronary heart disease. Increased frequency of the epsilon 4 allele has also been reported in patients with late-onset familial and sporadic Alzheimer's disease (AD). The aim of this study was to investigate the degree of coronary and cerebral atherosclerosis in a neuropathologically verified series of AD patients with different apoE genotypes. In addition, we studied the relationship between the degree of coronary and cerebral atherosclerosis and the extent of beta-amyloid (A beta) accumulation. METHODS: We studied 38 subjects (32 patients with definite AD and 6 age-matched control subjects) for whom postmortem autopsy delay was less than 8 hours. ApoE genotypes were identified through Hha I digestion of the polymerase chain reaction-amplified samples. We used A beta immunohistochemistry to detect diffuse and neuritic plaques as well as cerebrovascular amyloid. The degree of coronary and cerebral atherosclerosis was rated as none, mild, moderate, or severe. RESULTS: The apoE genotypes of the AD patients were epsilon 4/4 2, epsilon 3/4 19, epsilon 3/3 9, and epsilon 3/2 2. We found more severe atherosclerosis of the coronary vessels among AD patients with the apoE epsilon 4 allele compared with those AD patients without the epsilon 4 allele (chi 2 = 4.1, df = 1, P < .05). The extent of cerebral atherosclerosis did not differ among AD subgroups with and without the epsilon 4 allele. The degree of coronary or cerebral atherosclerosis was not related to the amount of amyloid accumulation in the frontal and temporal cortices or in the hippocampal structures. CONCLUSIONS: This study confirms the association of apoE epsilon 4 allele with coronary atherosclerosis in AD patients.","Aged;Aged, 80 and over;Alleles;Alzheimer Disease/*etiology/*genetics/mortality;Amyloid/analysis;Apolipoproteins E/*genetics;Autopsy;Brain/metabolism/pathology;Coronary Artery Disease/*complications/metabolism;Coronary Vessels/metabolism/pathology;Female;Genotype;Humans;Male","Kosunen, O.;Talasniemi, S.;Lehtovirta, M.;Heinonen, O.;Helisalmi, S.;Mannermaa, A.;Paljarvi, L.;Ryynanen, M.;Riekkinen, P. J., Sr.;Soininen, H.",1995,May,,0,
2374,"Low cholesterol, statins and outcomes in patients with first-ever acute ischemic stroke","BACKGROUND: High cholesterol has been associated with better stroke outcomes. Conversely, a protective effect of prestroke statin use in the acute phase of stroke has been reported. The effect of low cholesterol on outcome in patients with and without prestroke statin treatment has not been studied. We assessed the association between low cholesterol and ischemic stroke short- and long-term outcomes and studied potential interactions with statin treatment in patients with a first-ever ischemic stroke in a prospective national registry. METHODS: Ischemic stroke patients in the National Acute Stroke Israeli (NASIS) registry with a first-ever stroke and no previous disability, dementia or cancer admitted in all hospitals nationwide during 2-month periods in 2004, 2007 and 2010 were included (n = 1,895). Cholesterol levels </=155 mg/dl (1st quintile) were defined as low cholesterol and patients treated with statins for at least 7 days before stroke onset were categorized as prestroke statin treated. Severe stroke (NIHSS >/=11), total anterior circulation infarction, poor functional outcome (defined as discharged to a nursing facility or modified Rankin Scale >3 or death), and mortality at discharge and at 3 years were the study outcomes. Associations between low cholesterol and outcomes at discharge were assessed separately in patients with and without prestroke statin treatment using multiple logistic regression analyses. Mortality at 3 years was assessed in a subset of 681 patients with Cox proportional hazard models. RESULTS: Patients were 67.4 +/- 13.5 years old on average; 43.1% were women. Low cholesterol was associated with higher rates of stroke risk factors. Controlling for age, sex, hypertension, diabetes, current smoking, ischemic heart disease, congestive heart failure and atrial fibrillation, low cholesterol was significantly associated with severe stroke, total anterior circulation infarction and poor functional outcome in patients with and without statin treatment. There were no interactions between low cholesterol and prestroke statin therapy in association with outcomes. Short- and long-term mortality rates were increased for patients with low cholesterol (5.2% at discharge and 35% at 3-years) compared with higher levels (2.5% at discharge and 20.5% at 3 years). Adjusted mortality risks were increased for patients with low cholesterol; however, this finding was statistically significant only for patients not on statins before the stroke. CONCLUSIONS: Low cholesterol is associated with increased stroke severity and poorer functional outcome in patients with and without prestroke statin use. Low-cholesterol statin-naive patients show increased risks of mortality. 'Reverse epidemiology' in the association between cholesterol and outcome is possible in patients with ischemic stroke.","Aged;Aged, 80 and over;Cholesterol/*blood;Female;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use;Hypercholesterolemia/blood/*drug therapy;Israel/epidemiology;Kaplan-Meier Estimate;Longitudinal Studies;Male;Middle Aged;Prognosis;Proportional Hazards Models;Prospective Studies;Registries;Retrospective Studies;Risk Factors;*Severity of Illness Index;Stroke/*diagnosis/epidemiology/*mortality;Survival Rate","Koton, S.;Molshatzki, N.;Bornstein, N. M.;Tanne, D.",2012,,10.1159/000342302,0,
2375,Mortality and predictors of death 1 month and 3 years after first-ever ischemic stroke: data from the first national acute stroke Israeli survey (NASIS 2004),"BACKGROUND: Despite declining age-adjusted stroke mortality rates, the disease remains the third most common cause of death in Israel. Based on a national survey, we examined mortality rates during the first 3 years after a first-ever acute ischemic stroke (IS) and the major predictors of short-term (1 month) and long-term (3 years) mortality. METHODS: In the National Acute Stroke Israeli Survey (NASIS 2004), data were collected on all hospitalized stroke patients in Israel during a 2-month period. Mortality rates for first-ever IS were assessed at 1 month and 3 years and predictors of death were evaluated using the Cox proportional hazard model. RESULTS: A total of 1,079 first-ever IS patients were included. Survival data were complete for over 99% of patients. Cumulative mortality rates were 9.9% at 1 month and 31.1% at 3 years. Of the survivors at 1 month, 23.5% did not survive for 3 years. At 1 month, the hazard ratio (HR) for death significantly increased with stroke severity. One-month mortality was also associated with a decreased level of consciousness (HR 2.9, 95% CI 1.7-5.1), total anterior circulation infarction (TACI); HR 4.9, 95% CI 1.6-15.2), temperature on admission (HR 1.5, 95% CI 1.1-2.1 per 1 degrees C), age (HR 1.04, 95% CI 1.02-1.07 per year) and glucose levels on admission (HR 1.003, 95% CI 1.001-1.006 per 1 mg/dl). Age-adjusted proportions of diabetes and chronic heart failure were considerably higher in the deceased compared with survivors at 3 years (48 vs. 38 and 21 vs. 9%, respectively). In the multivariate survival analyses, predictors of death at 1 month also predicted death at 3 years; however, history of dementia (HR 1.5, 95% CI 1.0-2.4), diabetes (HR 1.6, 95% CI 1.0-2.4), peripheral artery disease (HR 1.7, 95% CI 1.1-2.8), chronic heart failure (HR 1.6, 95% CI 1.1-2.4) and malignancy (HR 1.7, 95% CI 1.1-2.7) were additional predictors of long-term mortality for patients surviving the first month after stroke. CONCLUSIONS: Approximately one third of patients did not survive 3 years after the first-ever IS. While age and markers of severe stroke were the major predictors of death at 1 month, comorbidities and variables associated with atherosclerotic vascular disease predicted long-term mortality. Improved control of these factors can potentially reduce long-term mortality in stroke victims.",Acute Disease;Age Factors;Aged;Brain Ischemia/*diagnosis/epidemiology/*mortality;Comorbidity;Female;Follow-Up Studies;Humans;Intracranial Arteriosclerosis/epidemiology;Israel;Kaplan-Meier Estimate;Male;Multivariate Analysis;Prognosis;Proportional Hazards Models;Prospective Studies;Severity of Illness Index;Stroke/*diagnosis/epidemiology/*mortality;Survival Analysis;Time Factors,"Koton, S.;Tanne, D.;Green, M. S.;Bornstein, N. M.",2010,,10.1159/000264826,0,
2376,Pathology supported genetic testing and treatment of cardiovascular disease in middle age for prevention of alzheimer's disease,"Chronic, multi-factorial conditions caused by a complex interaction between genetic and environmental risk factors frequently share common disease mechanisms, as evidenced by an overlap between genetic risk factors for cardiovascular disease (CVD) and Alzheimer's disease (AD). Single nucleotide polymorphisms (SNPs) in several genes including ApoE, MTHFR, HFE and FTO are known to increase the risk of both conditions. The E4 allele of the ApoE polymorphism is the most extensively studied risk factor for AD and increases the risk of coronary heart disease by approximately 40%. It furthermore displays differential therapeutic responses with use of cholesterol-lowering statins and acetylcholinesterase inhibitors, whichmay also be due to variation in the CYP2D6 gene in some patients. Disease expression may be triggered by gene-environment interaction causing conversion of minor metabolic abnormalities into major brain disease due to cumulative risk. A growing body of evidence supports the assessment and treatment of CVD risk factors in midlife as a preventable cause of cognitive decline, morbidity and mortality in old age. In this review, the concept of pathology supported genetic testing (PSGT) for CVD is described in this context. PSGTcombines DNA testing with biochemical measurements to determine gene expression and to monitor response to treatment. The aim is to diagnose treatable disease subtypes of complex disorders, facilitate prevention of cumulative risk and formulate intervention strategies guided from the genetic background. CVD provides a model to address the lifestyle link in most chronic diseases with a genetic component. Similar preventative measures would apply for optimisation of heart and brain health. © Springer Science+Business Media, LLC 2012.",apolipoprotein E;cyanocobalamin;folic acid;low density lipoprotein receptor;pyridoxine;riboflavin;thiamine;Alzheimer disease;article;body mass;cardiac patient;cardiovascular disease;cholesterol blood level;familial hypercholesterolemia;genetic screening;heart infarction;hemochromatosis;human;hypercholesterolemia;hypertension;iron metabolism;middle aged;neurofibrillary tangle;pathology;single nucleotide polymorphism,"Kotze, M. J.;Rensburg, S. J. V.",2012,,,0,
2377,Beneficial effects of mild stress (Hormetic Effects): Dietary restriction and health,"Hormesis is defined as a dose-response phenomenon characterized by low-dose stimulation and high-dose inhibition, and has been recognized as representing an overcompensation for mild environmental stress. The beneficial effects of mild stress on aging and longevity have been studied for many years. In experimental animals, mild dietary stress (dietary restriction, DR) without malnutrition delays most age-related physiological changes, and extends maximum and average lifespan. Animal studies have also demonstrated that DR can prevent or lessen the severity of cancer, stroke, coronary heart disease, autoimmune disease, allergy, Parkinson's disease and Alzheimer's disease. The effects of DR are considered to result from hormetic mechanisms. These effects were reported by means of various DR regimens, such as caloric restriction, total-nutrient restriction, alternate-day fasting, and short-term fasting. Mild dietary stress, including restriction of amount or frequency of intake, is the essence of DR. For more than 99% of their history, humans lived as hunter-gatherers and adapted to restrictions in their food supply. On the other hand, an oversufficiency of food for many today has resulted in the current global epidemic of obesity and obesity-related diseases. DR may be used, therefore, as a novel approach for therapeutic intervention in several diseases, when detailed information about effects of mild dietary stress on human health is obtained from clinical trials.",adaptation;animal;article;caloric restriction;human;methodology;physiological stress;physiology;preventive medicine,"Kouda, K.;Iki, M.",2010,,,0,
2378,High prevalence of dementia and cognitive impairment in indigenous Australians,,immunoglobulin G antibody;Alzheimer disease;antibody blood level;antibody titer;atherosclerosis;Australia;blood brain barrier;cerebrospinal fluid;cerebrovascular disease;cognitive defect;dementia;developing country;disease severity;Helicobacter infection;Helicobacter pylori;human;hypertension;indigenous people;ischemic heart disease;letter;pathophysiology;peripheral neuropathy;prevalence;priority journal;rural population;urban population;urea breath test;vascular disease,"Kountouras, J.;Gavalas, E.;Boziki, M.;Zavos, C.;Deretzi, G.;Grigoriadis, N.;Tsiaousi, E.;Katsinelos, P.;Chatzopoulos, D.;Tzilves, D.;Kouklakis, G.",2009,,,0,
2379,"The links between complex coronary disease, cerebrovascular disease, and degenerative brain disease","Our appreciation of the complexity of cardiovascular disease is growing rapidly. Consistent with the fact that the vasculature is an omnipresent system that carries blood to every organ in the body, an expanding number of conditions are now known to be directly associated with disturbed cardiovascular function or vascular pathology. In particular, cardiovascular disease has recently been implicated as playing a major role in dementia and other forms of degenerative brain disease. Here, we explore some of the many emerging relationships between cardiovascular risk factors, complex coronary artery disease, cerebrovascular disease, and degenerative brain disease. © 2012 New York Academy of Sciences.",sirtuin 1;article;cardiovascular risk;carotid artery obstruction;carotid artery stenting;carotid endarterectomy;cerebrovascular disease;complex coronary artery disease;coronary artery disease;degenerative disease;human;hypertension,"Kovacic, J. C.;Castellano, J. M.;Fuster, V.",2012,,,0,
2380,The influence of the H.E.L.P. system on yield shear stress in vascular disease,"At a constant haematocrit ratio the yield shear stress (YSS) depends on the level of fibrinogen and on the influence of other plasma constituents, erythrocyte membrane changes on the red cells and fibrinogen interaction. The study of the influence of the H.E.L.P. system on the value of YSS was carried out in 9 patients with vascular disease (acute stroke - 3 patients -, multi- infarct dementia - 3 patients -, peripheral arteriosclerotic vascular disease - 2 patients - and coronary heart disease - 1 patient -) in the model of diluted plasma media varying in fibrinogen concentration. The H.E.L.P. system application significantly decreased the value of YSS (p<0.001), which was related to the parallel reduction of the fibrinogen level (p<0.001) and plasma viscosity (p<0.001). The significant coefficients of correlations were found out between following parameters: YSS and fibrinogen (p<0.001), YSS and plasma viscosity (p<0.001) and fibrinogen and plasma viscosity (p<0.001).",fibrinogen;heparin;low density lipoprotein cholesterol;triacylglycerol;adult;aged;article;blood rheology;cerebrovascular disease;clinical article;female;fibrinogen blood level;hematological parameters;human;ischemic heart disease;lipid blood level;male;multiinfarct dementia;peripheral vascular disease;plasma viscosity;priority journal;cerebrovascular accident;vascular disease,"Kowal, P.;Walzl, M.;Walzl, B.;Lechner, H.",1993,,,0,
2381,Coronary artery bypass graft surgery in a 103-year-old female patient,,acetylsalicylic acid;amlodipine;atorvastatin;beta adrenergic receptor blocking agent;calcium channel blocking agent;clopidogrel;dipeptidyl carboxypeptidase inhibitor;sartan derivative;aged;angiocardiography;anticoagulant therapy;case report;coronary artery bypass graft;coronary artery occlusion;drug dose reduction;drug withdrawal;electrocardiogram;end to side anastomosis;EuroSCORE;extracorporeal circulation;faintness;female;fibrinolytic therapy;follow up;heart left ventricle ejection fraction;heart rehabilitation;hospital admission;human;hypertension;internal mammary artery;left anterior descending coronary artery;left coronary artery;mental deterioration;Mini Mental State Examination;muscle hypotonia;New York Heart Association class;non ST segment elevation myocardial infarction;note;physical examination;rehabilitation care;right coronary artery;surgical risk;thoracotomy;transthoracic echocardiography;very elderly,"Kowalczuk-Wieteska, A.;Jaworska, I.;Filipiak, K.;Grzebieniak, T.;Zembala, M.",2015,,,0,
2382,Functional disturbances and diseases in the elderly,,Angelica root;flavonoid;Ginkgo biloba extract;plant extract;procyanidin;Alzheimer disease;anorexia;arteriosclerosis;cardiovascular disease;Centaurea;convalescence;degenerative disease;fatigue;Fumarioideae;functional disease;Gentianaceae;Ginkgo biloba;heart failure;human;medicinal plant;mental disease;phytotherapy;short survey;tinnitus;urinary tract disease,"Kraft, K.",2006,,,0,
2383,Preventive phytotherapy options,"Prevention of common diseases is increasingly becoming the focus of attention and public interest. Prevention measures should be feasible and preferably without side effects. This applies to phytotherapy, among others, which therefore could provide appropriate tools for prevention. However, studies on prevention are very time-consuming, expensive and error-prone. As a result, high quality studies are rare; this is true and comprehensible also for prevention studies on herbal medicinal drugs. Nevertheless studies were published with the following indications: Alzheimer/dementia (Ginkgo biloba), common cold (Echinacea spec.) and, with some restriction, coronary heart disease (Allium sativum).",herbaceous agent;Alzheimer disease;article;common cold;drug indication;Echinacea;garlic;Ginkgo biloba;herbal medicine;human;ischemic heart disease;phytotherapy;prevention,"Kraft, K.",2016,,,0,
2384,Postischemic dementia; a case report,,article;CARDIAC ARREST/complications;heart arrest;mental disease,"Kral, V. A.",1955,,,0,
2385,Venlafaxin-associated post-ictal asystole during electroconvulsive therapy,"While post-stimulus asystoles occur quite often during electroconvulsive therapy (ECT) post-ictal or post-seizure sinus bradycardias or even asystoles are rare events. We report the case of an 82-year-old female patient with a current major depressive episode, who developed the rare event of a post-ictal asystole of 6 s and 4 ventricular escape beats during ECT. In the past this patient with a bipolar disorder and mild Alzheimer's disease had already been frequently treated with ECT with good success and no adverse events. Relevant comedication was venlafaxin, quetiapine, donepezil and clonidine, anesthesia was performed with ketamine and succinylcholine. Concurrent medication was completely unchanged compared to previous ECT sessions with the exception of venlafaxine, presumably at high serum levels. In summary, in line with some already existing reports, we expect the noradrenergic action of venlafaxin to have contributed substantially to the post-ictal asystole and want to indicate that the combination of ECT and venlafaxin might be harmful especially in the elderly population. © Georg Thieme Verlag KG Stuttgart · New York.",clonidine;donepezil;levothyroxine;pantoprazole;quetiapine;torasemide;venlafaxine;aged;Alzheimer disease;anesthesia induction;article;heart arrest;bipolar II disorder;case report;depression;disease severity;drug dose reduction;drug induced disease;electroconvulsive therapy;essential hypertension;female;human;hypercholesterolemia;hypothyroidism;laboratory test;Mini Mental State Examination;Montgomery Asberg Depression Rating Scale;non insulin dependent diabetes mellitus;noradrenergic system;postictal asystole;priority journal;psychosomatic disorder,"Kranaster, L.;Janke, C.;Hausner, L.;Frölich, L.;Sartorius, A.",2012,,,0,
2386,BSE-associated prion-amyloid cardiomyopathy in primates,"Prion amyloidosis occurred in the heart of 1 of 3 macaques intraperitoneally inoculated with bovine spongiform encephalopathy prions. This macaque had a remarkably long duration of disease and signs of cardiac distress. Variant Creutzfeldt-Jakob disease, caused by transmission of bovine spongiform encephalopathy to humans, may manifest with cardiac symptoms from prion-amyloid cardiomyopathy.","Amyloidosis/*pathology;Animals;Brain/pathology;Cardiomyopathies/*etiology/*pathology;Cattle;Creutzfeldt-Jakob Syndrome/*pathology/*transmission;Encephalopathy, Bovine Spongiform/pathology/*transmission;Macaca mulatta;Muscle, Skeletal/pathology;Myocardium/pathology;Bse;PrPSc;bovine spongiform encephalopathy;cardiomyopathy;primates;prions;vCJD;variant Creutzfeldt-Jakob disease","Krasemann, S.;Mearini, G.;Kramer, E.;Wagenfuhr, K.;Schulz-Schaeffer, W.;Neumann, M.;Bodemer, W.;Kaup, F. J.;Beekes, M.;Carrier, L.;Aguzzi, A.;Glatzel, M.",2013,Jun,10.3201/eid1906.120906,0,
2387,Aging: A revisited theory based on free radicals generated by NOX family NADPH oxidases,"Reactive oxygen species (ROS), often also referred to as free radicals, play an important role in aging. It is widely assumed that mitochondria are the predominant source of ROS relevant for the aging process. In this hypothesis article, we suggest that the role of ROS generated by NOX family NADPH oxidases has been largely overlooked in aging theories. NOX NADPH oxidases form a seven member gene family and are high level ROS-generating enzymes. As opposed to mitochondria, which generate ROS as a byproduct of their metabolism, NOX enzymes are professional ROS generators. From an experimental point of view, there is now abundant evidence for the involvement of NOX enzymes in age-associated diseases. The role of NOX enzymes in the aging process itself and their relative contribution as compared to mitochondria needs further investigations. © 2006 Elsevier Inc. All rights reserved.",free radical;protein DUOX1;protein DUOX2;reactive oxygen metabolite;reduced nicotinamide adenine dinucleotide phosphate oxidase;reduced nicotinamide adenine dinucleotide phosphate oxidase 1;reduced nicotinamide adenine dinucleotide phosphate oxidase 2;reduced nicotinamide adenine dinucleotide phosphate oxidase 3;reduced nicotinamide adenine dinucleotide phosphate oxidase 4;reduced nicotinamide adenine dinucleotide phosphate oxidase 5;unclassified drug;aging;Alzheimer disease;amyotrophic lateral sclerosis;cardiovascular disease;cataract;enzyme activity;enzyme localization;heart failure;heart ventricle hypertrophy;human;mitochondrion;multigene family;nerve degeneration;osteoporosis;Parkinson disease;presbyacusis;priority journal;respiratory chain;short survey;cerebrovascular accident,"Krause, K. H.",2007,,,0,
2388,Chronic condition mortality in the Medicare population,"The census and proportion of the US population that is age 65 years and older has never been as high. Medicare data files are a valuable source of data on medical conditions and care that can be used to study the older age population. We obtained access to The CMS Medicare data files including a 5% sample of annual Beneficiary Annual Summary (BASF) files for the years 1999-2009, and the most current Vital Status file available at the time of our request (2011). The Vital Status file enabled us to assess longitudinal follow-up for survival analysis. Data from over 3 million beneficiaries were available. The BASF files include summarized data pertaining to condition categories, defined by the Chronic Conditions Data Warehouse (CCW), which was of primary interest for this analysis. Cox regression models were used to assess the mortality risk associated with a set of 15 chronic conditions, as well as severity factors based on summary claims data. We were able to confirm a number of expectations, such as the high level of mortality risk with lung cancer, congestive heart failure, and in the oldest ages, Alzheimer's disease and related dementias. We were also able to identify chronic conditions that behave more as chronic conditions individuals may ""live with"" rather than ""die of."" Depression, diabetes, prostate and breast cancer are present for longer durations and/or are associated with low or no increased mortality risk in the Medicare population. Inpatient confinement or skilled nursing facility utilization were markers for increased risk, as expected. Unexpectedly, frequent physician visits (>10/year) was a marker for more favorable mortality, perhaps indicating that close supervision of chronic conditions lead to improved survival.",Aged;Chronic Disease/*mortality;Female;Health Services/utilization;Humans;Male;Medicare/*statistics & numerical data;Risk Assessment;Skilled Nursing Facilities/statistics & numerical data;Survival Analysis;Time Factors;United States/epidemiology,"Krause, K. J.;Bloom, T.",2012,,,0,
2389,"High levels of serum C-reactive protein are associated with greater risk of all-cause mortality, but not dementia, in the oldest-old: Results from the 90+ study","OBJECTIVES: To evaluate whether high levels of C-reactive protein (CRP) in serum are associated with greater risk of all-cause dementia or mortality in the oldest-old. DESIGN: Prospective. SETTING: Research clinic and in-home visits. PARTICIPANTS: Population-based sample of adults (N=227; aged 93.9±2.8) from The 90+ Study, a longitudinal cohort study of people aged 90 and older. MEASUREMENTS: CRP levels were divided into three groups according to the assay detection limit: undetectable (<0.5 mg/dL), detectable (0.5-0.7 mg/dL), and elevated (≥0.8 mg/dL). Neurological examination was used to determine dementia diagnosis (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria). Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were computed using Cox regression, and results were stratified according to and apolipoprotein E4 (APOE4) genotype. RESULTS: Subjects with detectable CRP levels had significantly greater risk of mortality (HR=1.7, 95% CI=1.0-2.9), but not dementia (HR=1.2, 95% CI=0.6-2.1), 0.4 to 4.5 years later than subjects with undetectable CRP. The highest relative risk for dementia and mortality was in APOE4 carriers with detectable CRP (dementia HR=4.5, 95% CI=0.9-23.3; mortality HR=5.6, 95% CI=1.0-30.7). CONCLUSION: High levels of CRP are associated with greater risk of mortality in people aged 90 and older, particularly in APOE4 carriers. There was a trend toward greater risk of dementia in APOE4 carriers with high CRP levels, although this relationship did not reach significance. High levels of CRP in the oldest-old represent a risk factor for negative outcomes. © 2009 The American Geriatrics Society.",apolipoprotein E4;C reactive protein;adult;aged;article;cardiopulmonary arrest;cardiovascular disease;cause of death;clinical evaluation;clinical research;clinical trial;cohort analysis;controlled study;dementia;diagnostic value;disease association;enzymatic assay;female;genotype;hazard ratio;human;longitudinal study;major clinical study;male;neoplasm;neurologic examination;outpatient department;pneumonia;population based case control study;professional practice;proportional hazards model;prospective study;protein blood level;risk factor;senescence;sensitivity analysis;septic shock,"Kravitz, B. A.;Corrada, M. M.;Kawas, C. H.",2009,,,0,
2390,Insulin resistance: a risk marker for disease and disability in the older person,"Clinical metabolic studies have demonstrated that insulin action declines progressively with age in humans. In addition to its close association with Type 2 diabetes, which reduces life expectancy in older people, age-related insulin resistance is implicated in pathogenesis of several highly prevalent disorders for which ageing is a major risk factor. These include atherosclerotic cardiovascular disease, dementia, frailty and cancer. Accordingly, insulin resistance may be viewed as biomarker of age-related ill health and reduced lifespan. The rapidly rising number of older people, coupled with a high prevalence of insulin resistance resulting from obesity and sedentary lifestyles, presents unprecedented public health and societal challenges. Studies of centenarians have shown that preserved whole-body sensitivity to insulin is associated with longevity. The mechanisms through which insulin action is associated with age-related diseases remain unclear. Changes in body composition, i.e. sarcopenia and excess adiposity, may be more potent than age per se. Moreover, the impact of insulin resistance has been difficult to disentangle from the clustering of vascular risk factors that co-segregate with the insulin resistance-hyperinsulinaemia complex. Potentially modifiable mediators of age-related changes in insulin sensitivity include alterations in adipocytokines, impaired skeletal myocyte mitochondrial function and brown fat activity. The hypothesis that improving or maintaining insulin sensitivity preserves health and extends lifespan merits further evaluation. Practical non-pharmacological interventions directed against age-related insulin resistance remain underdeveloped. Novel metabolically active pharmacological agents with theoretical implications for some age-related disorders are entering clinical trials. However, recent adverse experiences with the thiazolidinediones suggest the need for a cautious approach to the use of insulin sensitizing drugs in older people. This could be particularly important in the absence of diabetes where the risk to benefit analysis may be less favourable.","Aged;*Aging;Biomarkers;Coronary Artery Disease/*blood/epidemiology/physiopathology;Diabetes Mellitus, Type 2/*blood/epidemiology/physiopathology;Diabetic Angiopathies/*blood/epidemiology/physiopathology;Disability Evaluation;Disease Progression;Female;Humans;*Insulin Resistance;Male;Obesity/*blood/complications/epidemiology;Predictive Value of Tests;Risk Factors;Sentinel Surveillance;Thiazolidinediones/*adverse effects","Krentz, A. J.;Viljoen, A.;Sinclair, A.",2013,May,10.1111/dme.12063,0,
2391,The impact of personal genomics on risk perceptions and medical decision-making,,Alzheimer disease;genetic risk;genomics;health hazard;human;ischemic heart disease;letter;medical decision making;perception;population risk;priority journal,"Krieger, J. L.;Murray, F.;Roberts, J. S.;Green, R. C.",2016,,,0,
2392,Cognitive function and disability in late life: An ecological validation of the 10/66 battery of cognitive tests among community-dwelling older adults in South India,"Background: The 10/66 Dementia Research Group developed and validated a culture and education fair battery of cognitive tests for diagnosis of dementia in population-based studies in low-income and middle-income countries including India. Aims: This study examined the association between individual domains of the 10/66 battery of cognitive tests and 'disability' and 'functional impairment' in community-dwelling older adults in South India. Methods: One hundred twenty-nine adults aged 60-90years residing in Karunapura, in the city of Mysore, were interviewed in their own homes. Cognitive functioning was measured by administering the 10/66 battery of cognitive tests that composes of Community Screening Instrument for Dementia (CSI'D' COGSCORE), verbal fluency (VF) and word list memory recall (WLMR). A reliable informant was interviewed to ascertain if the subject's cognitive problems have resulted in functional impairment. Disability was measured by WHO Disability Schedule-II (DAS). Results: The women had significantly lower CSI'D' COGSCORE score when compared with men (p=0.002). The presence of 'functional impairment' resulting from cognitive decline was significantly associated with lower scores on VF (p=0.03), WLMR (p=0.03) and CSI'D' COGSCOREs (p<0.01). There was a significant inverse association between WHO DAS II score and WLMR (p=0.004), VF (0.006) and CSI'D' COGSCORE scores (p≤0.001) even after adjusting for self-reported ischaemic heart disease, stroke, chronic obstructive airway disease, hypertension and diabetes. Conclusions: Lower scores on individual domains of the 10/66 battery of cognitive tests are associated with higher levels of disability and functional impairment in community-dwelling older adults. These culture and education fair tests are suitable for use in population-based research in India.",adult;cerebrovascular accident;chronic obstructive lung disease;cognition;cognitive defect;controlled study;diabetes mellitus;disability;education;female;functional disease;human;hypertension;India;ischemic heart disease;major clinical study;screening;validation process;word list recall,"Krishna, M.;Beulah, E.;Jones, S.;Sundarachari, R.;A, S.;Kumaran, K.;Karat, S. C.;Copeland, J. R. M.;Prince, M.;Fall, C.",2015,,,0,
2393,"Prolonged Transesophageal Echocardiography Use in the ICU: Maximizing Benefit, Minimizing Risk","Transesophageal echocardiography (TEE) has gained increasing popularity in the operating room and intensive care settings. The use of TEE can often times diagnose pathology that is missed by transthoracic echocardiography (TTE); in addition, it can be used as a guide to continuously monitor a patient's hemodynamics, along with observing the direct cardiac effects of fluid and vasopressor therapy. We present a case of acute fulminant hepatic failure in the ICU, where TEE allowed a rapid diagnosis. We performed prolonged TEE monitoring (72 hours) of the patient to monitor the patient's response to therapeutic interventions. We also discuss the diagnostic and therapeutic implications of prolonged TEE placement in the ICU. In addition, particular strategies to optimize the benefit and minimize the risk of this exciting, yet underutilized, technology are discussed. © 2011 The Author(s).",alanine aminotransferase;alkaline phosphatase;ammonia;aspartate aminotransferase;bilirubin;creatinine;heparin;noradrenalin;potassium;abdominal pain;acute kidney failure;acute liver failure;adult;antiphospholipid syndrome;article;artificial ventilation;blood clotting disorder;case report;chill;clinical examination;disease association;disease severity;fatigue;female;fever;heart failure;heart right ventricle hypertrophy;hemodynamic monitoring;human;hypotension;intensive care unit;international normalized ratio;leg swelling;lung embolism;mental deterioration;nausea;priority journal;pulmonary hypertension;renal replacement therapy;respiratory tract intubation;risk benefit analysis;transesophageal echocardiography;vomiting,"Krishnamoorthy, V.;Nicolau, R.;Ozcan, M. S.;Frazin, L.;Schwartz, D. E.",2011,,,0,
2394,Primary knee and hip arthroplasty among nonagenarians and centenarians in the United States,"Objective. The number of individuals ages ≥100 years in the US is expected to increase considerably in the future along with the need for arthroplasties. This report focuses on the poorly studied epidemiology and mortality outcomes of arthroplasty among these individuals. Methods. We describe the epidemiology of knee and hip arthroplasties among centenarians using data from a large hospital discharge database in the US (the Nationwide Inpatient Sample) during the period 1993 through 2002. We used nonagenarians as the comparison group with adjustment for differences in the prevalence of congestive heart failure, neurologic diseases such as dementia and stroke, renal and hepatic diseases, obesity, anemia, malignancy, coagulopathy, and depression and other psychiatric illnesses. Cox regression models were used to study the mortality outcomes following arthroplasty. Results. Overall, there were 679 hip arthroplasties and 7 knee arthroplasties among centenarians in this database. The corresponding figures for nonagenarians were 33,975 and 2,050, respectively. A vast majority (83%) of hip arthroplasty recipients were women. Risk-adjusted mortality estimates following arthroplasty for centenarians were higher than for nonagenarians (hazard ratio 1.46, 95% confidence interval 1.10-1.95). However, this was similar to differences in overall in-hospital mortality (hazard ratio 1.36, 95% confidence interval 1.32-1.40) between these 2 age categories. Conclusion. In the US population, hip and knee arthroplasty are very rarely performed among centenarians. Our in-hospital mortality data suggest that arthroplasties should not be denied to centenarians solely because of short-term postoperative life expectancy estimates. © 2007, American College of Rheumatology.",aged;aging;anemia;arthroplasty;article;blood clotting disorder;confidence interval;congestive heart failure;data base;dementia;depression;elderly care;female;hip arthroplasty;hospital discharge;hospital patient;human;kidney disease;knee arthroplasty;life expectancy;liver disease;major clinical study;male;malignant neoplastic disease;mental disease;mortality;neurologic disease;obesity;outcome assessment;population research;postoperative period;proportional hazards model;recipient;risk assessment;cerebrovascular accident;United States,"Krishnan, E.;Fries, J. F.;Kwoh, C. K.",2007,,,0,
2395,Use of rivastigmine or galantamine and risk of adverse cardiac events: A database study from the netherlands,"Background: Two cholinesterase inhibitors (ChEIs), rivastigmine and galantamine, are used to treat Alzheimer disease in the Netherlands. Several adverse cardiac events have been reported for these medications. Objective: We aimed to assess if the use of ChEIs increased the risk of cardiac events in the Netherlands. Methods: A cohort crossover study of the PHARMO Record Linking System database included patients who initiated ChEIs at age 50 years or older, had at least 1 dispensing of a ChEI drug between 1998 and 2008, a 1-year history in PHARMO, and 1 subsequent dispensing of any medication. Two outcomes were assessed: a first hospitalization for syncope or atrioventricular block. Poisson and Cox regression were used to calculate incidence densities and hazard ratios for cardiac events during periods with ChEI use, compared with periods without ChEI use. Results: During the complete observation period of 8.9 years (interquartile range 6.7 to 10.2) there were 132 first hospitalizations for atrioventricular block and 17 first hospitalizations for syncope among 3358 patients. The adjusted incidence densities were significantly increased during ChEI exposure for syncope and atrioventricular block, when compared with the background incidence densities in the roughly 5 years before the last year before ChEI initiation. However, when exposed periods were compared with the unexposed periods 1 year before ChEI initiation and times after exposure, the adjusted hazard ratios remained increased for syncope and atrioventricular block, but increases were not significant anymore. Conclusions: Exposure to ChEIs might increase the risk of adverse cardiac events, but small numbers of cases limit conclusions about the risk in this population and research on larger study samples is needed. © 2012 Elsevier HS Journals, Inc.",alpha adrenergic receptor blocking agent;antiarrhythmic agent;anticoagulant agent;anticonvulsive agent;antidiuretic agent;antithrombocytic agent;atypical antipsychotic agent;benzodiazepine;beta adrenergic receptor blocking agent;calcium antagonist;digoxin;dipeptidyl carboxypeptidase inhibitor;galantamine;histamine H2 receptor antagonist;nitrate;oral antidiabetic agent;rivastigmine;serotonin uptake inhibitor;tricyclic antidepressant agent;aged;article;atrioventricular block;cardiovascular risk;cohort analysis;crossover procedure;data base;drug exposure;drug use;faintness;female;hazard ratio;hospitalization;human;major clinical study;male;morbidity;Netherlands;priority journal;proportional hazards model;treatment outcome,"Kröger, E.;Berkers, M.;Carmichael, P. H.;Souverein, P.;Van Marum, R.;Egberts, T.",2012,,,0,
2396,Adverse Drug Reactions Reported With Cholinesterase Inhibitors: An Analysis of 16 Years of Individual Case Safety Reports From VigiBase,"Background: No worldwide pharmacovigilance study evaluating the spectrum of adverse drug reactions (ADRs) induced by cholinesterase inhibitors (ChEI) in Alzheimer’s disease has been conducted since their emergence on the market. Objective: To describe ChEI related ADRs in Alzheimer’s disease (donepezil, rivastigmine, and galantamine) and characterize their seriousness as reported by national pharmacovigilance systems to VigiBase, a World Health Organization International Drug Monitoring Program database, between 1998 and 2013. Methods: All ChEI related reports, submitted to VigiBase between 1998 and 2013 from the five continents were extracted. Analyses were carried out for general, serious, and nonserious ADRs. Results: A total of 18 955 reports (43 753 ADRs) from 58 countries were reported: 60.1% in women; mean age 77.4 ± 9.1 years. Most reports originated from Europe (47.6%) and North America (40.4%). Rivastigmine and donepezil were involved in most reports (41.4% each). The most frequently reported ADRs were neuropsychiatric (31.4%), gastrointestinal (15.9%), general (11.9%), and cardiovascular (11.7%) disorders. During the 2006-2013 period, serious ADRs remained more often reported than nonserious ones; the most serious were neuropsychiatric (34.0%), general (14.0%), cardiovascular (12.1%), and gastrointestinal (11.6%) disorders. Medication errors were reported in 2.0% of serious cases. Death occurred in 2.3% of the reports. Conclusions: This international pharmacovigilance study highlights the ADR pattern induced by ChEIs. Neuropsychiatric events were the most frequently reported ADRs. Serious cardiovascular events were frequently reported, suggesting that their significance has probably been previously underestimated. Given the frailty of the patients and the frequent comedications, caution is advised before introducing a ChEI.",cholinesterase inhibitor;donepezil;galantamine;psychotropic agent;rivastigmine;abdominal discomfort;abdominal pain;aged;aggression;agitation;Alzheimer disease;antisocial personality disorder;anxiety;application site reaction;article;asthenia;asthma;atrioventricular block;behavior disorder;bladder disease;bradycardia;brain hemorrhage;breathing disorder;bronchospasm;bronchus obstruction;cardiovascular disease;cerebrovascular accident;cholestasis;cholestatic hepatitis;chronic obstructive lung disease;confusion;connective tissue disease;consciousness disorder;convulsion;coughing;data analysis;depression;diarrhea;disease severity;disorientation;dizziness;drug fatality;drug induced disease;drug overdose;drug safety;drug surveillance program;dysarthria;dyskinesia;dysphagia;dyspnea;ear disease;edema;Europe;eye disease;faintness;fatigue;feces incontinence;female;fever;gait disorder;gastrointestinal hemorrhage;gastrointestinal symptom;hallucination;headache;heart arrest;heart arrhythmia;heart bundle branch block;heart disease;heart muscle conduction disturbance;heart supraventricular arrhythmia;heart ventricle arrhythmia;hematemesis;hematologic disease;hepatitis;hepatobiliary disease;human;hyperhidrosis;hypertension;hyperthermia;hypotension;hypothermia;infection;infestation;injury;inner ear disease;insomnia;intoxication;irritability;jaundice;kidney disease;kidney dysfunction;kidney failure;language disability;lethargy;liver dysfunction;liver injury;liver toxicity;lymphatic system disease;major clinical study;malaise;male;mediastinum disease;medication error;melena;mental disease;metabolic disorder;mortality;motor dysfunction;muscle contraction;musculoskeletal disease;myoclonus;nausea;neoplasm;neurologic disease;neuromuscular disease;North America;nutritional disorder;pain;paranoia;perception disorder;polypharmacy;priority journal;psychopathy;rash;reference database;respiratory distress;respiratory failure;respiratory tract disease;sedation;seizure;shock;side effect;skin disease;skin pruritus;sleep disorder;somnolence;speech disorder;thorax disease;tremor;unconsciousness;urethra disease;urinary tract disease;urine incontinence;urine retention;vascular disease;VigiBase;vomiting,"Kröger, E.;Mouls, M.;Wilchesky, M.;Berkers, M.;Carmichael, P. H.;van Marum, R.;Souverein, P.;Egberts, T.;Laroche, M. L.",2015,,,0,
2397,Catatonia in the emergency department,,benzodiazepine;creatine kinase;haloperidol;lorazepam;olanzapine;agitation;aspiration pneumonia;auditory hallucination;automatic obedience;blood pressure;blunted affect;body temperature;catalepsy;catatonia;catatonic schizophrenia;creatine kinase blood level;echolalia;emergency medicine;gegenhalten;heart arrhythmia;heart infarction;heart rate;human;hypertension;hyperthermia;hypotension;kidney failure;leukocytosis;medical history;mental deterioration;mortality;muscle rigidity;note;oxygen saturation;physical examination;priority journal;psychologic assessment;psychological pillow;psychomotor disorder;recommended drug dose;tachycardia;tachypnea;waxy flexibility,"Kroll, K. E.;Kroll, D. S.;Pope, J. V.;Tibbles, C. D.",2012,,,0,
2398,Impact of hospitalization for acute myocardial infarction on adherence to statins among older adults,"Background - Little is known about the impact of hospitalization for an acute myocardial infarction (AMI) on subsequent adherence to statins. Methods and Results - Using administrative claims from a 5% random sample of Medicare beneficiaries, we identified a cohort of Medicare patients aged ≥65 years, hospitalized from 2007 to 2011, taking statins in the year before AMI hospitalization (n=6618). We then determined the proportion of patients nonadherent to statins (proportion of days covered <80%) in the year before AMI hospitalization who became statin adherent (proportion of days covered ≥80%) in the year after AMI hospitalization. The proportion of statin-adherent patients who became nonadherent was also studied. These proportions were compared with patients hospitalized for pneumonia (n=11 471) and patients not hospitalized (n=158 099) in 2010 and 2011. Among patients nonadherent to statins before AMI hospitalization, 37.7% became adherent after discharge. Patients hospitalized for AMI were more likely to become adherent than patients hospitalized for pneumonia (adjusted relative risk: 1.70; 95% confidence interval, 1.57-1.84) or patients not hospitalized (adjusted relative risk: 1.79; 95% confidence interval, 1.68-1.90). Among patients adherent to statins before AMI hospitalization, 32.6% became nonadherent after discharge. Those hospitalized for AMI were less likely to become nonadherent than those hospitalized for pneumonia (adjusted relative risk: 0.93; 95% confidence interval 0.88-0.98) but more likely to become nonadherent than patients without hospitalizations (adjusted relative risk: 1.41; 95% confidence interval, 1.35-1.48). Conclusions - Among nonadherent patients, hospitalization for AMI was associated with increased likelihood of becoming adherent to statins compared with hospitalization for pneumonia or no hospitalizations. Among adherent patients, hospitalization for AMI was associated with increased likelihood of becoming nonadherent to statins compared with no hospitalizations.",hydroxymethylglutaryl coenzyme A reductase inhibitor;acute heart infarction;age distribution;aged;article;dementia;depression;diabetes mellitus;female;frail elderly;health impact assessment;home care;hospital discharge;hospitalization;human;ischemic heart disease;lowest income group;major clinical study;male;medicare;medication compliance;patient attitude;pneumonia;priority journal;risk factor;total quality management,"Kronish, I. M.;Ross, J. S.;Zhao, H.;Muntner, P.",2016,,,0,
2399,Apolipoprotein E genotypes in pseudoexfoliation syndrome and pseudoexfoliation glaucoma,"PURPOSE: Pseudoexfoliation (PEX) syndrome, an age-related, systemic, elastic microfibrillopathy, is characterized by fibrillar-granular deposits in the anterior segment of the eye. Although not representing a true amyloidosis, PEX syndrome shares some features with amyloid disorders, such as Alzheimer disease. It has been shown that amyloid-associated proteins also occur in association with PEX fibrils. Apolipoprotein E (Apo-E) is directly involved in these amyloid deposition and fibrils formation. The epsilon4 allele of APOE gene was shown to be associated both with an increased risk for coronary heart disease and late-onset Alzheimer disease. In this study, we therefore investigated whether APOE alleles are associated with PEX syndrome and/or PEX glaucoma (PEXG) in 2 large cohorts of German and Italian origin. METHODS: The 3 common APOE alleles epsilon2, epsilon3, and epsilon4 were genotyped in 661 unrelated patients (459 PEXG and 202 PEX patients) and 342 healthy individuals of German origin and furthermore in 209 unrelated patients (133 PEXG and 76 PEX patients) and 190 healthy individuals of Italian origin using TaqMan assays for allelic discrimination. A genetic association study was then performed. RESULTS: The epsilon3 allele was found to be the most common in both populations (80% to 83%), whereas the epsilon2 allele was the rarest (6% to 9%). No significant differences in allele and genotype frequencies between both groups were observed in either population. CONCLUSION: Our data show that APOE genotypes are not associated with PEX and PEXG in either Germans or Italians.","Aged;Aged, 80 and over;Alleles;Apolipoproteins E/*genetics;Exfoliation Syndrome/*genetics;Female;Genotype;Glaucoma, Open-Angle/*genetics;Humans;Intraocular Pressure;Male;Middle Aged","Krumbiegel, M.;Pasutto, F.;Mardin, C. Y.;Weisschuh, N.;Paoli, D.;Gramer, E.;Weber, B. H.;Kruse, F. E.;Schlotzer-Schrehardt, U.;Reis, A.",2010,Oct-Nov,10.1097/IJG.0b013e3181ca76c4,0,
2400,An attempt at evaluating borderline conditions of Parkinson's disease and its preclinical stage on the basis of clinical and morphological correlation,"The aim of the investigations was to find to what extent neurodegenerative changes develop in the brains of patients with no clinical symptoms of dementia, parkinsonism and other neurodegenerative diseases. It has been found that neurodegenerative pathology, as evaluated using immunohistochemical methods with monoclonal antibodies (Mab) against ubiquitin, tau protein, α-synuclein, and β-amyloid, occurs more frequently than the presence of Lewy bodies. The degenerative changes involved the neurones of cerebral and cerebellar cortex, basal ganglia and medulla oblongata, where neurofibrillary tangles were found. Mab positive materials have been found in the cytoplasm of the cell body and the cell processes (axons) of the neurones and glial cells. Senile plaques, β-amyloid positive, were frequently noted.",alpha synuclein;amyloid beta protein;levodopa;monoclonal antibody;tau protein;ubiquitin;adult;aged;aging;article;basal ganglion;brain atherosclerosis;brain cell;brain cortex;brain degeneration;brain disease;brain hemorrhage;brain infarction;brain injury;cerebellum cortex;clinical article;clinical feature;controlled study;cytoplasm;death;degenerative disease;dementia;disease duration;female;glia cell;heart disease;heart infarction;histopathology;human;human cell;human tissue;immunohistochemistry;Lewy body;liver injury;male;medulla oblongata;morphology;nerve cell degeneration;nerve fiber;neurofibrillary tangle;Parkinson disease;parkinsonism;pathology;pneumonia;senile plaque;spleen injury;stomach ulcer,"Krygowska-Wajs, A.;Adamek, D.;Szczudlik, A.;Kałuza, J.",2002,,,0,
2401,Increased synphilin-1 expression in human elderly brains with substantia nigra Marinesco bodies,"The aim of the present study was to examine the expression of synphilin-1, α-synuclein, and tyrosine hydroxylase in human elderly brains and the incidence of Marinesco bodies (MBs, intranuclear inclusions) in the neuromelanin-containing substantia nigra neurons. The brains of twenty-two individuals without clinical signs and symptoms of parkinsonism and dementia and an additional two parkinsonian patients were dissected and subjected to histopathological examination and western blotting. Ubiquitin-positive and α-synuclein-negative MBs were found in 0.84-9.45% of the nigral neurons from brains of 15 healthy individuals and both parkinsonian patients. The frequency of pigmented nigral neurons containing MBs was positively correlated with age. The levels of tyrosine hydroxylase in the caudate nucleus and putamen decreased with age, and were inversely correlated with the MB frequency. The level of synphilin-1 in the caudate nucleus was positively correlated both with age and the MBs. Additionally, the MB appearance was correlated with synphilin-1 level in the substantia nigra. No significant correlation between α-synuclein expression and age or MBs was found. Our results suggest that synphilin-1 expression increases with aging. Further studies on expression of this protein in elderly brains are warranted. Copyright © 2008 by Institute of Pharmacology Polish Academy of Sciences.",alpha synuclein;cytosol aminopeptidase;synphilin 1;tyrosine 3 monooxygenase;unclassified drug;adult;aged;article;caudate nucleus;cause of death;clinical article;dementia;heart arrest;histopathology;human;human tissue;Lewy body;marinesco body;nerve cell;neurofibrillary tangle;parkinsonism;protein expression;putamen;respiratory failure;substantia nigra;Western blotting,"Krygowska-Wajs, A.;Lenda, T.;Adamek, D.;Moskała, M.;Kuter, K.;Kunz, J.;Smiałlowa, M.;Ossowska, K.",2008,,,0,
2402,Baseline memory problems associate with clinical impairments eight years later: Centralized follow-up in the preadvise trial,"Background: the Prevention of Alzheimer's Disease (AD) by Vitamin E and Selenium (PREADVISE) trial-an ancillary study to SELECT (prostate cancer prevention trial)-was designed as a 2X2 factorial, double blind, RCT. PREADVISE began enrolling volunteers from 130 participating SELECT study sites in 2002. In 2008, SELECT suspended supplementation in light of an interim futility analysis, and both trials converted to exposure studies. In 2010, all study sites closed, and PREADVISE participants who consented to continued observation were enrolled in centralized follow-up (CFU). Cognitive screenings in CFU are conducted via telephone, and PREADVISE remains blinded to treatment arm. Methods: Subjects:PREADVISE enrolled 7,547 non-demented men age 62 or older (60 if africanamerican); enrollment ceased in 2009. 4,246 of these men volunteered for CFU. To date, 3,702 have been screened at least once during CFU. Procedures: PREADVISE uses a two-tiered system of annual cognitive screening. Additional data on medication use and comorbid conditions are collected during the screening interview. The Memory impairment Screen (MIS) has been used throughout the study as the first level screening instrument. Men who obtain poor scores on the MIS (< 6/8) are asked to complete a second, more extensive screening instrument. Pre-CFU, an expanded Consortium to establish a registry in AD (CERAD) battery was used. Because this battery cannot be completed via telephone, the telephone interview for Cognitive Status-Modified (TICS-M) is now used. In either case, men who fail the second level screen are asked to schedule a memory and thinking work-up with their local physician and submit their medical records. A consensus diagnosis based on the screening and medical record data is given by an expert team. For men who refuse the medical work-up, a diagnosis based on screening data only is assigned. Levels of certainty designated ""confirmed"" and ""suspected"" respectively are assigned to each diagnosis accordingly. Statistical Analysis: a stepwise Cox proportional hazards regression was used to estimate the time (from baseline) until an impairment (either suspected or confirmed) was first observed. Variables included in the full model were both fixed and time-dependent. Fixed variables include baseline age, education (<high school vs. High school+), race (africanamerican vs. Not african-american), ethnicity (hispanic vs. Nonhispanic), mother's age at childbirth, dementia family history, comorbidities reported at baseline (macular degeneration, cataract, congestive heart failure, heart attack, CaBG, angioplasty, angina, hypertension, tia, arrhythmia, and statin use), memory complaints (none vs. Changes vs. Problems) reported at baseline, and ever history of diabetes. Time-dependent variables include reports of depression, anxiety, alcohol problem, elevated cholesterol, anti-hypertensive use, hypoglycemia, thyroid disorder, and sleep apnea. Time-dependent variables were considered present only if the first report of the condition preceded the first impairment. Results: PREADVISE participants providing at least one CFU data point in the current study were 67.7+/-5.0 years old at enrollment and comprise 8.1% africanamericans. The men are highly educated, with over 86% reporting more than a high school education, and contribute an average of 8.0+/-2.1 assessments. The most common comorbidity reported at baseline was hypertension (36.8%), 21.6% of participants reported using a statin, and memory complaints were made by 22.6%. Family history of dementia was also reported by 22.6%. High cholesterol, which was ascertained over time, was reported by 68.1% of participants. Other commonly reported time-dependent variables include use of an anti-hypertensive (63.7%), sleep apnea (18.4%), and depression (11.2 %). Ever history of diabetes was reported by 18.2%. A total of 433 (11.8%) of participants had observed impairments: 330 (8.9%) suspected mild cognitive impairment (MCI), 84 (2.3%) confirmed MCI, 4 (0.1%) suspected dementia, and 15 (0.4%) confirmed dementia. Th azard of an observed impairment was significantly increased by older age at baseline (1-year increment =1.10), baseline hypertension ( =1.88), baseline memory complaint (changes vs. None =1.36, problems vs. None =2.32), africanamerican race ( =3.13), high school education or less ( =1.61), and ever history of diabetes ( =1.29). A significantly reduced hazard of an observed impairment was associated with antihypertensive use (=0.37) and report of high cholesterol ( =0.75). Conclusion: the presence of memory impairment after 8 years of follow-up is associated with report of a memory problem at study enrollment. Further, awareness and report of changing memory function is also predictive of reduced performance over time and suggests the utility of self-report for future prevention trials. Consistent with the epidemiological literature on dementia, hypertension, diabetes, and education emerged as significant risk factors for objectively measured memory dysfunction as did african american ethnicity. Also consistent with prior studies, antihypertensives and hypercholesterolemia (statin use) emerged as 'protective' factors. The effect of education on the evolution of impaired memory may be associated with brain reserve and less sensitivity of memory screening measures in better educated participants. With one additional year of screening, evaluation of these risk factors in light of the 5 years of supplement use should provide additional information of antioxidants as potential modifiers of these risk factors.",memory;follow up;clinical trial (topic);Alzheimer disease;human;male;screening;education;dementia;high school;diabetes mellitus;hypertension;dependent variable;diagnosis;risk factor;colony forming unit;prevention study;telephone;ethnicity;memory disorder;family history;medical record;sleep disordered breathing;African American;hazard;proportional hazards model;volunteer;statistical analysis;prostate cancer;thyroid disease;comorbidity;hypercholesterolemia;cognitive reserve;consensus;cancer prevention;anxiety;physician;prevention;tic;telephone interview;register;heart infarction;congestive heart failure;cataract;angioplasty;angina pectoris;retina macula degeneration;heart arrhythmia;interview;drug therapy;procedures;childbirth;arm;hypoglycemia;Hispanic;mild cognitive impairment;self report;supplementation;model;exposure;maternal age;antihypertensive agent;cholesterol;statin (protein);alcohol;selenium;alpha tocopherol;antioxidant,"Kryscio, R.;Abner, E.;Caban-Holt, A.;Mathews, M.;Schmitt, F.",2013,,,0,2403
2403,Baseline memory problems associate with clinical impairments eight years later: centralized follow-up in the preadvise trial,"Background: the Prevention of Alzheimer's Disease (AD) by Vitamin E and Selenium (PREADVISE) trial-an ancillary study to SELECT (prostate cancer prevention trial)-was designed as a 2X2 factorial, double blind, RCT. PREADVISE began enrolling volunteers from 130 participating SELECT study sites in 2002. In 2008, SELECT suspended supplementation in light of an interim futility analysis, and both trials converted to exposure studies. In 2010, all study sites closed, and PREADVISE participants who consented to continued observation were enrolled in centralized follow-up (CFU). Cognitive screenings in CFU are conducted via telephone, and PREADVISE remains blinded to treatment arm. Methods: Subjects:PREADVISE enrolled 7,547 non-demented men age 62 or older (60 if africanamerican); enrollment ceased in 2009. 4,246 of these men volunteered for CFU. To date, 3,702 have been screened at least once during CFU. Procedures: PREADVISE uses a two-tiered system of annual cognitive screening. Additional data on medication use and comorbid conditions are collected during the screening interview. The Memory impairment Screen (MIS) has been used throughout the study as the first level screening instrument. Men who obtain poor scores on the MIS (< 6/8) are asked to complete a second, more extensive screening instrument. Pre-CFU, an expanded Consortium to establish a registry in AD (CERAD) battery was used. Because this battery cannot be completed via telephone, the telephone interview for Cognitive Status-Modified (TICS-M) is now used. In either case, men who fail the second level screen are asked to schedule a memory and thinking work-up with their local physician and submit their medical records. A consensus diagnosis based on the screening and medical record data is given by an expert team. For men who refuse the medical work-up, a diagnosis based on screening data only is assigned. Levels of certainty designated ""confirmed"" and ""suspected"" respectively are assigned to each diagnosis accordingly. Statistical Analysis: a stepwise Cox proportional hazards regression was used to estimate the time (from baseline) until an impairment (either suspected or confirmed) was first observed. Variables included in the full model were both fixed and time-dependent. Fixed variables include baseline age, education (<high school vs. High school+), race (africanamerican vs. Not african-american), ethnicity (hispanic vs. Nonhispanic), mother's age at childbirth, dementia family history, comorbidities reported at baseline (macular degeneration, cataract, congestive heart failure, heart attack, CaBG, angioplasty, angina, hypertension, tia, arrhythmia, and statin use), memory complaints (none vs. Changes vs. Problems) reported at baseline, and ever history of diabetes. Time-dependent variables include reports of depression, anxiety, alcohol problem, elevated cholesterol, anti-hypertensive use, hypoglycemia, thyroid disorder, and sleep apnea. Time-dependent variables were considered present only if the first report of the condition preceded the first impairment. Results: PREADVISE participants providing at least one CFU data point in the current study were 67.7+/-5.0 years old at enrollment and comprise 8.1% africanamericans. The men are highly educated, with over 86% reporting more than a high school education, and contribute an average of 8.0+/-2.1 assessments. The most common comorbidity reported at baseline was hypertension (36.8%), 21.6% of participants reported using a statin, and memory complaints were made by 22.6%. Family history of dementia was also reported by 22.6%. High cholesterol, which was ascertained over time, was reported by 68.1% of participants. Other commonly reported time-dependent variables include use of an anti-hypertensive (63.7%), sleep apnea (18.4%), and depression (11.2 %). Ever history of diabetes was reported by 18.2%. A total of 433 (11.8%) of participants had observed impairments: 330 (8.9%) suspected mild cognitive impairment (MCI), 84 (2.3%) confirmed MCI, 4 (0.1%) suspected dementia, and 15 (0.4%) confirmed dementia. The azard of an observed impairment was significantly increased by older age at baseline (1-year increment =1.10), baseline hypertension ( =1.88), baseline memory complaint (changes vs. None =1.36, problems vs. None =2.32), africanamerican race ( =3.13), high school education or less ( =1.61), and ever history of diabetes ( =1.29). A significantly reduced hazard of an observed impairment was associated with antihypertensive use (=0.37) and report of high cholesterol ( =0.75). Conclusion: the presence of memory impairment after 8 years of follow-up is associated with report of a memory problem at study enrollment. Further, awareness and report of changing memory function is also predictive of reduced performance over time and suggests the utility of self-report for future prevention trials. Consistent with the epidemiological literature on dementia, hypertension, diabetes, and education emerged as significant risk factors for objectively measured memory dysfunction as did african american ethnicity. Also consistent with prior studies, antihypertensives and hypercholesterolemia (statin use) emerged as 'protective' factors. The effect of education on the evolution of impaired memory may be associated with brain reserve and less sensitivity of memory screening measures in better educated participants. With one additional year of screening, evaluation of these risk factors in light of the 5 years of supplement use should provide additional information of antioxidants as potential modifiers of these risk factors.",memory;follow up;clinical trial (topic);Alzheimer disease;human;male;screening;education;dementia;high school;diabetes mellitus;hypertension;dependent variable;diagnosis;risk factor;colony forming unit;prevention study;telephone;ethnicity;memory disorder;family history;medical record;sleep disordered breathing;African American;hazard;proportional hazards model;volunteer;statistical analysis;prostate cancer;thyroid disease;comorbidity;hypercholesterolemia;cognitive reserve;consensus;cancer prevention;anxiety;physician;prevention;tic;telephone interview;register;heart infarction;congestive heart failure;cataract;angioplasty;angina pectoris;retina macula degeneration;heart arrhythmia;interview;drug therapy;procedures;childbirth;arm;hypoglycemia;Hispanic;mild cognitive impairment;self report;supplementation;model;exposure;maternal age;antihypertensive agent;cholesterol;statin (protein);alcohol;selenium;alpha tocopherol;antioxidant,"Kryscio, R;Abner, E;Caban-Holt, A;Mathews, M;Schmitt, F",2013,,,0,
2404,"Diagnosis, Prevalence, Awareness, Treatment, Prevention, and Control of Hypertension in Cameroon: Protocol for a Systematic Review and Meta-Analysis of Clinic-Based and Community-Based Studies","BACKGROUND: Hypertension holds a unique place in population health and health care because it is the leading cause of cardiovascular disease and the most common noncommunicable condition seen in primary care worldwide. Without effective prevention and control, raised blood pressure significantly increases the risk of stroke, myocardial infarction, chronic kidney disease, heart failure, dementia, renal failure, and blindness. There is an urgent need for stakeholders-including individuals and families-across the health system, researchers, and decision makers to work collaboratively for improving prevention, screening and detection, diagnosis and evaluation, awareness, treatment and medication adherence, management, and control for people with or at high risk for hypertension. Meeting this need will help reduce the burden of hypertension-related disease, prevent complications, and reduce the need for hospitalization, costly interventions, and premature deaths. OBJECTIVE: This review aims to synthesize evidence on the epidemiological landscape and control of hypertension in Cameroon, and to identify elements that could potentially inform interventions to combat hypertension in this setting and elsewhere in sub-Saharan Africa. METHODS: The full search process will involve several steps, including selecting relevant databases, keywords, and Medical Subject Headings (MeSH); searching for relevant studies from the selected databases; searching OpenGrey and the Grey Literature Report for gray literature; hand searching in Google Scholar; and soliciting missed publications (if any) from relevant authors. We will select qualitative, quantitative, or mixed-methods studies with data on the epidemiology and control of hypertension in Cameroon. We will include published literature in French or English from electronic databases up to December 31, 2016, and involving adults aged 18 years or older. Both facility and population-based studies on hypertension will be included. Two reviewers of the team will independently search, screen, extract data, and assess the quality of selected studies using suitable tools. Selected studies will be analyzed by narrative synthesis, meta-analysis, or both, depending on the nature of the data retrieved in line with the review objectives. RESULTS: This review is part of an ongoing research program on disease prevention and control in the context of the dual burden of communicable and noncommunicable diseases in Africa. The first results are expected in 2017. CONCLUSIONS: This review will provide a comprehensive assessment of the burden of hypertension and control measures that have been designed and implemented in Cameroon. Findings will form the knowledge base relevant to stakeholders across the health system and researchers who are involved in hypertension prevention and control in the community and clinic settings in Cameroon, as a yardstick for similar African countries. TRIAL REGISTRATION: PROSPERO registration number: CRD42017054950; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42017054950 (Archived by WebCite at http://www.webcitation.org/6qYSjt9Jc).",Africa;Cameroon;awareness;comorbidity;control;diagnosis;ecology;hypertension;management;medication adherence;meta-analysis;prevention;protocol;systematic review;treatment,"Kuate Defo, B.;Mbanya, J. C.;Tardif, J. C.;Ekundayo, O.;Perreault, S.;Potvin, L.;Cote, R.;Kengne, A. P.;Choukem, S. P.;Assah, F.;Kingue, S.;Richard, L.;Pongou, R.;Frohlich, K.;Saji, J.;Fournier, P.;Sobngwi, E.;Ridde, V.;Dube, M. P.;De Denus, S.;Mbacham, W.;Lafrance, J. P.;Nsagha, D. S.;Mampuya, W.;Dzudie, A.;Cloutier, L.;Zarowsky, C.;Tanya, A.;Ndom, P.;Hatem, M.;Rey, E.;Roy, L.;Borges Da Silva, R.;Dagenais, C.;Todem, D.;Weladji, R.;Mbanya, D.;Emami, E.;Njoumemi, Z.;Monnais, L.;Dubois, C. A.",2017,May 29,,0,
2405,Influences of donepezil on cardiovascular system--possible therapeutic benefits for heart failure--donepezil cardiac test registry (DOCTER) study,"To study prospectively influences of donepezil, an acetylcholinesterase inhibitor against Alzheimer disease, on cardiovascular system, we evaluated cardiovascular changes occurring during new initialized treatment with donepezil in 49 dementia patients over 6 months. No patient suffered from cardiovascular events. In clinical changes between baseline and the first evaluation after donepezil treatment, heart rate and plasma brain natriuretic peptide (BNP) levels as a marker for heart failure did not change (BNP: 59.62 +/- 62.71 pg/mL at baseline to 53.18 +/- 42.34 pg/mL at first evaluation; P = 0.262). We further examined plasma BNP levels in 2 groups into which the patients were divided at baseline according to the cut-off plasma BNP level of 60 pg/mL. In patients with high level of BNP, the BNP levels decreased after administration of donepezil (116.39 +/- 76.58 pg/mL at baseline to 82.24 +/- 46.64 pg/mL at first evaluation; P = 0.011) with the tendency to be reduced in the follow-up period. BNP did not change in patients with low level of BNP. Donepezil seemed to be safe in patients with dementia without symptomatic heart disease and significantly decreased plasma BNP levels in patients with subclinical chronic heart failure.","Aged;Aged, 80 and over;Cardiovascular Physiological Phenomena/*drug effects;Female;Follow-Up Studies;Heart Diseases/blood/drug therapy/epidemiology;Heart Failure/blood/*drug therapy/epidemiology;Humans;Indans/pharmacology/*therapeutic use;Male;Piperidines/pharmacology/*therapeutic use;Prospective Studies;*Registries;Treatment Outcome","Kubo, T.;Sato, T.;Noguchi, T.;Kitaoka, H.;Yamasaki, F.;Kamimura, N.;Shimodera, S.;Iiyama, T.;Kumagai, N.;Kakinuma, Y.;Diedrich, A.;Jordan, J.;Robertson, D.;Doi, Y. L.",2012,Sep,10.1097/FJC.0b013e3182609a74,0,
2406,Further assessment of atrial fibrillation as a risk factor for gastroesophageal reflux disease: a multicenter questionnaire survey,"OBJECTIVE: Although both atrial fibrillation (AF) and gastroesophageal reflux disease (GERD) are common diseases, the relationship between these two conditions remains controversial, depending on the study design and type of AF. Therefore, we focused on the relationship between nonvalvular AF and GERD. METHODS: A total of 479 consecutive subjects (255 men and 224 women, mean age: 60.4 +/- 12.8 years), including outpatients at several hospitals (n=201) and participants of an annual health screening program (n=278), were enrolled. Subjects with valvular AF, malignancy or dementia were excluded. The frequency scale for symptoms of GERD (F-scale) was applied after obtaining each patient's informed consent for screening symptomatic GERD with a total cutoff score of 8 points. The score on the questionnaire was correlated with the baseline characteristics extracted from the patients' medical records. RESULTS: The total F-scale scores were significantly higher in the older patients (>/= 60 years) than in the younger patients (<60 years) (p=0.017) and increased in the following order: permanent AF > paroxysmal AF > sinus rhythm (p=0.003). The incidence of GERD increased in the same order among the patients with the various heart rhythm classifications (p<0.001). Coronary heart disease, hypertension, diabetes and dyslipidemia were not correlated with the F-scale scores or incidence of GERD. The stepwise discriminant analyses demonstrated that nonvalvular AF alone was significantly associated with symptomatic GERD (Wilks' lambda=0.983, p=0.004). CONCLUSION: This multicenter study demonstrated that nonvalvular AF is significantly correlated with symptomatic GERD. This small sample survey warrants a future study of a large-scale cohort.","Adult;Aged;Aged, 80 and over;Atrial Fibrillation/*complications/epidemiology;Cross-Sectional Studies;Female;Gastroesophageal Reflux/epidemiology/*etiology;Humans;Incidence;Japan/epidemiology;Male;Mass Screening;Middle Aged;Outpatients;Risk Factors;Surveys and Questionnaires","Kubota, S.;Nakaji, G.;Shimazu, H.;Odashiro, K.;Maruyama, T.;Akashi, K.",2013,,,0,
2407,"FDA warns claims for pharmacy-made ""bio-identical"" hormones are misleading",,estriol;estrogen;hormone;progesterone;Alzheimer disease;blood clotting;breast cancer;cardiovascular risk;drug formulation;drug legislation;drug marketing;food and drug administration;gallbladder disease;heart disease;heart infarction;hormone substitution;medical practice;neoplasm;pharmaceutical care;priority journal;short survey;cerebrovascular accident;women's health,"Kuehn, B. M.",2008,,,0,
2408,Effort under way to prepare physicians to care for growing elderly population,,aging;balance disorder;behavior disorder;clinical competence;clinical practice;cognitive defect;curriculum;delirium;dementia;depression;dizziness;doctor patient relation;falling;funding;gait disorder;geriatric care;health care organization;health care personnel;health care planning;health care quality;health promotion;heart infarction;hospital care;indwelling catheter;infection;inner ear disease;medical care;medical education;medical society;medical specialist;medical student;palliative therapy;priority journal;residency education;scientific literature;self care;sepsis;short survey;cerebrovascular accident,"Kuehn, B. M.",2009,,,0,
2409,NIH program to boost pipeline for drugs to treat rare and neglected diseases,,African trypanosomiasis;Chagas disease;cystic fibrosis;drug development;drug identification;drug industry;drug potency;drug research;funding;health care organization;health program;human;Huntington chorea;leishmaniasis;licensing;muscular dystrophy;national health organization;priority journal;rare disease;short survey,"Kuehn, B. M.",2009,,,0,
2410,Causes of death associated with Alzheimer disease: Variation by level of cognitive impairment before death,"OBJECTIVE: To describe causes of death for patients with Alzheimer disease (AD) and other dementing illnesses enrolled in a population-based Alzheimer disease patient registry (ADPR) and to describe the variation in causes by the level of cognitive impairment before death in probable AD cases. SETTING: The ADPR enrolls and diagnoses newly recognized potential dementia cases occurring in a large, stable health maintenance organization. To date, 654 cases have been enrolled and followed annually to monitor cognitive decline and verify initial diagnosis. DESIGN: Longitudinal descriptive study. PATIENTS: ADPR enrollees who have died. MEASUREMENTS: Death certificates were obtained for all who died (total n = 104, probable AD = 55); reported causes of death were reviewed by a physician to determine the underlying cause. AD patients were categorized according to their Mini-Mental State Exam score (cognitive impairment) within 12 months of death as (a) mildly (21+), (b) moderately (15-20), or (c) severely (0-14) impaired, and underlying cause and all reported causes of death for each group were tabulated. MAIN RESULTS: Among probable AD patients, pneumonia and AD were most often recorded on death certificates when cognitive impairment within the year prior to death had reached the severe level; heart disease, stroke, and other common causes of death predominated in AD patients who were less cognitively impaired. CONCLUSIONS: When AD cases were followed from first diagnosis to death, the causes of death varied by level of cognitive impairment. Illnesses potentially amenable to treatment caused death at all levels of disease, but more so early in the course of AD. Cognitive impairment may make patients less able to recognize and report symptoms of medical problems, thereby complicating efforts to intervene.",adult;Alzheimer disease;article;brain hemorrhage;cardiovascular disease;cause of death;cerebrovascular disease;cognitive defect;controlled study;disease severity;female;human;ischemic heart disease;major clinical study;male;neoplasm;pneumonia;cerebrovascular accident,"Kukull, W. A.;Brenner, D. E.;Speck, C. E.;Nochlin, D.;Bowen, J.;McCormick, W.;Teri, L.;Pfanschmidt, M. L.;Larson, E. B.",1994,,,0,
2411,Comparison of contemporaneous responses for EQ-5D-3L and Minnesota Living with Heart Failure; a case for disease specific multiattribute utility instrument in cardiovascular conditions,"Background The EQ-5D-3L, a generic multi-attribute utility instrument (MAUI), is widely employed to assist in economic evaluations in health care. The EQ-5D-3L lacks sensitivity when used in conditions such as cardiovascular disease (CVD). Although there are number of CVD specific quality of life instruments, currently, there are no CVD specific MAUIs. The aim of this study is to investigate the discriminative ability and responsiveness of the EQ-5D-3L and the Minnesota Living with Heart Failure Questionnaire (MLHF), a CVD specific quality of life instrument in a group of heart failure patients. Methods The psychometric performance of the EQ-5D-3L and the MLHF was assessed using data from a randomised trial for a heart failure management intervention. The two instruments were compared for discrimination, responsiveness and agreement. The severity groups were defined using New York Heart Association functional classes. Results The effect sizes for severe classes were generally similar showing good discrimination. The MLHF recorded better responsiveness between the time points than the EQ-5D-3L which was indicated by higher effect sizes and standardised response means. The change in MLHF summary scores between the time points was significant (p < 0.005; paired t-test). The overall agreement between the two measures was low. Conclusion The low correlation indicates that the two classification systems cover different aspects of health space. Comparison of CVD specific instruments with other generic MAUIs such as EQ-5D-3L and AQOL-8D is recommended for further research.",adult;aged;aging;ankle edema;anxiety;article;cardiovascular disease;Charlson Comorbidity Index;comorbidity;congestive heart failure;controlled study;dementia;depression;disease severity;economic evaluation;effect size;EQ 5D 3L questionnaire;female;health care;heart failure;heart infarction;human;leg edema;length of stay;major clinical study;male;Minnesota Living with Heart Failure Questionnaire;physical activity;priority journal;psychometry;quality of life;questionnaire;scoring system;self care;very elderly,"Kularatna, S.;Byrnes, J.;Chan, Y. K.;Carrington, M. J.;Stewart, S.;Scuffham, P. A.",2017,,10.1016/j.ijcard.2016.11.030,0,
2412,Potent humanin analog increases glucose-stimulated insulin secretion through enhanced metabolism in the beta cell,"Humanin (HN) is a 24-aa polypeptide that offers protection from Alzheimer's disease and myocardial infarction, increases insulin sensitivity, improves survival of beta cells, and delays onset of diabetes. Here we examined the acute effects of HN on insulin secretion and potential mechanisms through which they are mediated. Effects of a potent HN analog, HNGF6A, on glucose-stimulated insulin secretion (GSIS) were assessed in vivo and in isolated pancreatic islets and cultured murine beta cell line (betaTC3) in vitro. Sprague-Dawley rats (3 mo old) that received HNGF6A required a significantly higher glucose infusion rate and demonstrated higher insulin levels during hyperglycemic clamps compared to saline controls. In vitro, compared to scrambled peptide controls, HNGF6A increased GSIS in isolated islets from both normal and diabetic mice as well as in betaTC3 cells. Effects of HNGF6A on GSIS were dose dependent, K-ATP channel independent, and associated with enhanced glucose metabolism. These findings demonstrate that HNGF6A increases GSIS in whole animals, from isolated islets and from cells in culture, which suggests a direct effect on the beta cell. The glucose-dependent effects on insulin secretion along with the established effects on insulin action suggest potential for HN and its analogs in the treatment of diabetes.","Animals;Cells, Cultured;Diabetes Mellitus, Type 2/metabolism;Glucose/metabolism;Insulin/blood/*secretion;Insulin-Secreting Cells/*drug effects/metabolism;Intracellular Signaling Peptides and Proteins/*pharmacology;KATP Channels/metabolism;Male;Mice;Mice, Inbred C57BL;Mice, Knockout;Rats;Rats, Sprague-Dawley;Receptors, Leptin/genetics;diabetes;hyperglycemic clamps;pancreatic islets","Kuliawat, R.;Klein, L.;Gong, Z.;Nicoletta-Gentile, M.;Nemkal, A.;Cui, L.;Bastie, C.;Su, K.;Huffman, D.;Surana, M.;Barzilai, N.;Fleischer, N.;Muzumdar, R.",2013,Dec,10.1096/fj.13-231092,0,
2413,Does Ginkgo biloba reduce the risk of cardiovascular events?,"METHODS AND RESULTSThe double-blind trial randomly assigned 3069 participants over 75 years of age to 120 mg of G biloba EGb 761 twice daily or placebo. Mean follow-up was 6.1 years. The identification and classification of CVD was based on methods used in the Cardiovascular Health Study. Differences in time to event between G biloba and placebo were evaluated using Cox proportional hazards regression adjusted for age and sex. There were 355 deaths in the study, 87 due to coronary heart disease with no differences between G biloba and placebo. There were no differences in incident myocardial infarction (n=164), angina pectoris (n=207), or stroke (151) between G biloba and placebo. There were 24 hemorrhagic strokes, 16 on G biloba and 8 on placebo (not significant). There were only 35 peripheral vascular disease events, 12 (0.8%) on G biloba and 23 (1.5%) on placebo (P=0.04, exact test). Most of the peripheral vascular disease cases had either vascular surgery or amputation.CONCLUSIONSThere was no evidence that G biloba reduced total or CVD mortality or CVD events. There were more peripheral vascular disease events in the placebo arm. G biloba cannot be recommended for preventing CVD. Further clinical trials of peripheral vascular disease outcomes might be indicated.CLINICAL TRIAL REGISTRATIONclinicaltrials.gov Identifier: NCT00010803.BACKGROUNDCardiovascular disease (CVD) was a preplanned secondary outcome of the Ginkgo Evaluation of Memory Study. The trial previously reported that Ginkgo biloba had no effect on the primary outcome, incident dementia.","Age Factors;Cardiovascular Agents [therapeutic use];Cardiovascular Diseases [etiology] [mortality] [prevention & control];Double-Blind Method;Evidence-Based Medicine;Ginkgo biloba;Hospitalization;Plant Extracts [therapeutic use];Practice Guidelines as Topic;Proportional Hazards Models;Risk Assessment;Risk Factors;Time Factors;Treatment Outcome;United States [epidemiology];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Sr-compmed: sr-dementia: sr-pvd","Kuller, Lh;Ives, Dg;Fitzpatrick, Al;Carlson, Mc;Mercado, C;Lopez, Ol;Burke, Gl;Furberg, Cd;DeKosky, St",2010,,10.1161/CIRCOUTCOMES.109.871640,0,
2414,Potential prevention of Alzheimer disease and dementia,"The prevention of dementia is of critical importance. The increasing population of high-risk older individuals will result in an increasing prevalence of dementia. Primary prevention of dementia and Alzheimer disease can take either a public health or high-risk preventive medicine approach. At the present time, there is little evidence to support a specific primary public health approach such as a specific nutrient. The possible association of vascular disease with dementia may offer the best preventive high-risk approach. The identification of individuals with clinical and subclinical vascular disease is possible. There is a very high prevalence of subclinical cerebral infarction in older individuals. Specific treatments can prevent clinical disease such as stroke and coronary heart disease. Whether therapies will prevent some dementia can be determined.",Alzheimer Disease/*prevention & control;Clinical Trials as Topic;Dementia/*prevention & control;Humans,"Kuller, L. H.",1996,Fall,,0,
2415,Issues of clinical trial design and data interpretations in hypertension,"There are many drug studies for the treatment of hypertension. Most studies compare one drug with another to determine if a drug or class of drugs have unique benefits. In evaluating drug trials, separation of hypertension as compared with atherosclerotic events is important. Trials that focus on prevention of hypertension, especially with new noninvasive markers, may have a bigger part in reducing morbidity and mortality due to elevated blood pressure.",Antihypertensive Agents/*therapeutic use;Arteriosclerosis/prevention & control;Clinical Trials as Topic;Coronary Disease/prevention & control;Dementia/prevention & control;Humans;Hypertension/*drug therapy/*prevention & control;*Research Design;Treatment Outcome,"Kuller, L. H.",1999,Aug,,0,
2416,Risk factors for dementia in the Cardiovascular Health Study cognition study,"Several predispocitional and genetic factors are thought to be involved in the etiology of Alzheimer s disease (AD). Except for age, there is no consensus among researchers about the factors that can best predict AD. Some studies have found that, older women, cerebrovascular risk factors (hypertension, ischemic heart disease, diabetes mellitus), and the presence of the apolipoprotein E (APOE) 4 allele to be associated with the development of dementia and AD. However, there are a few large scale studies that have entered magnetic resonance imaging (MRI) findings in the analysis of risk factors for AD. The Cardiovascular Health Study Cognition Study evaluated the determinants of the risk of dementia, diagnosed in 1998 99, among 3608 participants >65 years of age who had MRIof the brain in 1991 through 1994. In this cohort, there were 480 incident dementia cases, and 330 were diagnosed as AD. The CHS found that age, Modified Mini Mental State Examination scores, cerebral ventricular size, severity of white matter lesions, number of MRI identified infarcts, and the presence of the APOE 4 allele were predictors of dementia. This study showed the importance of controlling for neuroimaging findings the study of risk factors for dementia. Scores of global cognitive measures, the presence of the APOE 4 allele, and MRI of the brain were strong predictors of dementia and AD.","Aged;Aged, 80 and over;Apolipoprotein E4;Apolipoproteins E/genetics;Brain/pathology;Cardiovascular Diseases/epidemiology;Cohort Studies;Dementia/*epidemiology/genetics;Depression/epidemiology;Female;Follow-Up Studies;Humans;Incidence;Magnetic Resonance Imaging;Male;Neuropsychological Tests;Proportional Hazards Models;Risk Factors;United States/epidemiology","Kuller, L. H.",2003,Jul 16-31,,1,
2417,Commentary: Hazards of studying women: The oestrogen oestrogen/progesterone dilemma,,estrogen;progesterone;atherosclerosis;breast cancer;cholesterol blood level;coronary artery obstruction;coronary risk;dementia;epidemiological data;female;human;incidence;ischemic heart disease;menopause;mortality;note;primary prevention;priority journal;risk assessment;risk reduction;secondary prevention;cerebrovascular accident;blood clotting;venous thromboembolism,"Kuller, L. H.",2004,,,0,
2418,Invited commentary: The 21st century epidemiologist-a need for different training?,"The accompanying paper by Ogino et al. (Am J Epidemiol. 2012;176(8):659-667) cogently suggests a need for including modern approaches like molecular pathological epidemiology (MPE) in our research. However, Ogino et al. make an assumption that epidemiology has previously not included pathology or modern technologies in epidemiologic studies and that there is a unique need for the specialty of MPE. The new molecular pathology is yet another technique that can improve epidemiologic investigations. There is a long tradition of combining good pathology with epidemiologic research, especially in studies of cardiovascular disease. Large epidemiologic studies have successfully integrated specialty expertise in a collaborative and mutually beneficial approach to test specific hypotheses. The author is concerned that MPE techniques, whether they involve metabolomics, genomics, proteomics, or microarrays, will come to drive epidemiologic studies without any specific hypothesis-testing or unique population characteristics. The epidemiologist would then become little more than a collector of study subjects and a distributor of the various specimens to the laboratories. © 2012 The Author.",trimethylamine oxide;Alzheimer disease;article;autopsy;blood pressure variability;cardiovascular risk;cerebrovascular accident;coronary artery atherosclerosis;disease severity;disease transmission;ischemic heart disease;metabolomics;molecular epidemiology;molecular pathological epidemiology;pathology;proteomics;race difference;sudden death,"Kuller, L. H.",2012,,,0,
2419,Point: Is there a future for innovative epidemiology?,,Alzheimer disease;atherosclerosis;blood pressure;cerebrospinal fluid;cholesterol blood level;computer assisted tomography;congestive heart failure;epidemiology;heart arrhythmia;atrial fibrillation;human;ischemic heart disease;low birth weight;medical research;neoplasm;note;nuclear magnetic resonance imaging;nutritional deficiency;positron emission tomography;prematurity;smoking;sudden death;United States,"Kuller, L. H.",2013,,,0,
2420,Does Ginkgo biloba reduce the risk of cardiovascular events?,"BACKGROUND: Cardiovascular disease (CVD) was a preplanned secondary outcome of the Ginkgo Evaluation of Memory Study. The trial previously reported that Ginkgo biloba had no effect on the primary outcome, incident dementia. METHODS AND RESULTS: The double-blind trial randomly assigned 3069 participants over 75 years of age to 120 mg of G biloba EGb 761 twice daily or placebo. Mean follow-up was 6.1 years. The identification and classification of CVD was based on methods used in the Cardiovascular Health Study. Differences in time to event between G biloba and placebo were evaluated using Cox proportional hazards regression adjusted for age and sex. There were 355 deaths in the study, 87 due to coronary heart disease with no differences between G biloba and placebo. There were no differences in incident myocardial infarction (n=164), angina pectoris (n=207), or stroke (151) between G biloba and placebo. There were 24 hemorrhagic strokes, 16 on G biloba and 8 on placebo (not significant). There were only 35 peripheral vascular disease events, 12 (0.8%) on G biloba and 23 (1.5%) on placebo (P=0.04, exact test). Most of the peripheral vascular disease cases had either vascular surgery or amputation. CONCLUSIONS: There was no evidence that G biloba reduced total or CVD mortality or CVD events. There were more peripheral vascular disease events in the placebo arm. G biloba cannot be recommended for preventing CVD. Further clinical trials of peripheral vascular disease outcomes might be indicated. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00010803.","Age Factors;Cardiovascular Agents [therapeutic use];Cardiovascular Diseases [etiology] [mortality] [prevention & control];Double-Blind Method;Evidence-Based Medicine;Ginkgo biloba;Hospitalization;Plant Extracts [therapeutic use];Practice Guidelines as Topic;Proportional Hazards Models;Risk Assessment;Risk Factors;Time Factors;Treatment Outcome;United States [epidemiology];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Sr-compmed: sr-dementia: sr-pvd","Kuller, L. H.;Ives, D. G.;Fitzpatrick, A. L.;Carlson, M. C.;Mercado, C.;Lopez, O. L.;Burke, G. L.;Furberg, C. D.;DeKosky, S. T.",2010,,10.1161/circoutcomes.109.871640,0,2413
2421,"Subclinical Atherosclerosis, Cardiac and Kidney Function, Heart Failure, and Dementia in the Very Elderly","BACKGROUND: Heart failure (HF) and dementia are major causes of disability and death among older individuals. Risk factors and biomarkers of HF may be determinants of dementia in the elderly. We evaluated the relationship between biomarkers of cardiovascular disease and HF and risk of dementia and death. Three hypotheses were tested: (1) higher levels of high-sensitivity cardiac troponin T, N-terminal of prohormone brain natriuretic peptide, and cystatin C predict risk of death, cardiovascular disease, HF, and dementia; (2) higher levels of cardiovascular disease biomarkers are associated with increased risk of HF and then secondary increased risk of dementia; and (3) risk of dementia is lower among participants with a combination of lower coronary artery calcium, atherosclerosis, and lower high-sensitivity cardiac troponin T (myocardial injury). METHODS AND RESULTS: The Cardiovascular Health Study Cognition Study was a continuation of the Cardiovascular Health Study limited to the Pittsburgh, PA, center from 1998-1999 to 2014. In 1992-1994, 924 participants underwent magnetic resonance imaging of the brain. There were 199 deaths and 116 developed dementia before 1998-1999. Of the 609 participants eligible for the Pittsburgh Cardiovascular Health Study Cognition Study, 87.5% (n=532) were included in the study. There were 120 incident HF cases and 72% had dementia. In 80 of 87, dementia preceded HF. A combination of low coronary artery calcium score and low high-sensitivity cardiac troponin T was significantly associated with reduced risk of dementia and HF. CONCLUSIONS: Most participants with HF had dementia but with onset before HF. Lower high-sensitivity cardiac troponin T and coronary artery calcium was associated with low risk of dementia based on a small number of events. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.",coronary artery calcium;dementia;epidemiology;heart failure;risk factors,"Kuller, L. H.;Lopez, O. L.;Gottdiener, J. S.;Kitzman, D. W.;Becker, J. T.;Chang, Y.;Newman, A. B.",2017,Jul 22,,0,
2422,"Subclinical cardiovascular disease and death, dementia, and coronary heart disease in patients 80+ years","Background The successful prevention and treatment of coronary heart disease (CHD) and stroke has resulted in a substantial increase in longevity, with subsequent growth in the population of older people at risk for dementia. Objectives The authors evaluated the relationship of coronary and other peripheral atherosclerosis to risk of death, dementia, and CHD in the very elderly. Because the extent of vascular disease differs substantially between men and women, sex- and race-specific analyses were included, with a specific focus on women with low coronary artery calcium (CAC) Agatston scores. Methods We evaluated the relationship between measures of subclinical cardiovascular disease (CAC, carotid intimal medial thickness, stenosis, and ankle brachial index) and risk of dementia, CHD, and total mortality in 532 participants of the Cardiovascular Health Study-Cognition Study from 1998/1999 (mean age, 80 years) to 2012/2013 (mean age, 93 years). Results Thirty-six percent of participants had CAC scores >400. Women and African-Americans had lower CAC scores. Few men had low CAC scores. CAC score and number of coronary calcifications were directly related to age-adjusted total mortality and CHD. The age-specific incidence of dementia was higher than for CHD. Only about 25% of deaths were caused by CHD and 16% by dementia. Approximately 64% of those who died had a prior diagnosis of dementia. White women with low CAC scores had a significantly decreased incidence of dementia. Conclusions In subjects 80+ years of age, there is a greater incidence of dementia than of CHD. CAC, as a marker of atherosclerosis, is a determinant of mortality, and risk of CHD and myocardial infarction. White women with low CAC scores had a significantly decreased risk of dementia. A very important unanswered question, especially in the very elderly, is whether prevention of atherosclerosis and its complications is associated with less Alzheimer disease pathology and dementia.",NCT00005133;African American;aged;ankle brachial index;arterial wall thickness;article;atherosclerosis;cardiovascular disease;coronary artery calcification;coronary artery calcium score;dementia;female;follow up;human;ischemic heart disease;major clinical study;male;morbidity;mortality;priority journal;risk assessment;stenosis;very elderly,"Kuller, L. H.;Lopez, O. L.;MacKey, R. H.;Rosano, C.;Edmundowicz, D.;Becker, J. T.;Newman, A. B.",2016,,,0,
2423,Health-protective and adverse effects of the apolipoprotein E epsilon2 allele in older men,"OBJECTIVES: To reexamine a health-protective role of the common apolipoprotein E (APOE) polymorphism focusing on connections between the APOE epsilon2-containing genotypes and impairments in instrumental activities of daily living (IADLs) in older (> or = 65) men and women and to examine how diagnosed coronary heart disease (CHD), Alzheimer's disease, colorectal cancer, macular degeneration, and atherosclerosis may mediate these connections. DESIGN: Retrospective cross-sectional study. SETTING: The unique disability-focused data from a genetic subsample of the 1999 National Long Term Care Survey linked with Medicare service use files. PARTICIPANTS: One thousand seven hundred thirty-three genotyped individuals interviewed regarding IADL disabilities. MEASUREMENTS: Indicators of IADL impairments, five geriatric disorders, and epsilon2-containing genotypes. RESULTS: The epsilon2/3 genotype is a major contributor to adverse associations between the epsilon2 allele and IADL disability in men (odds ratio (OR)=3.09, 95% confidence interval (CI)=1.53-6.26), although it provides significant protective effects for CHD (OR=0.55, 95% CI=0.33-0.92), whereas CHD is adversely associated with IADL disability (OR=2.18, 95% CI=1.28-3.72). Adjustment for five diseases does not significantly alter the adverse association between epsilon2-containing genotypes and disability. Protective effects of the epsilon2/3 genotype for CHD (OR=0.52, 95% CI=0.27-0.99) and deleterious effects for IADLs (OR=3.50, 95% CI=1.71-7.14) for men hold in multivariate models with both these factors included. No significant associations between the epsilon2-containing genotypes and IADL are found in women. CONCLUSION: The epsilon2 allele can play a dual role in men, protecting them against some health disorders, while promoting others. Strong adverse relationships with disability suggest that epsilon2-containing genotypes can be unfavorable factors for the health and well-being of aging men.","Activities of Daily Living;Age Factors;Aged;Alzheimer Disease/*genetics;Apolipoprotein E2/*genetics;Cardiovascular Diseases/*genetics;Colorectal Neoplasms/*genetics;Cross-Sectional Studies;Female;Genotype;Humans;Macular Degeneration/*genetics;Male;Polymorphism, Genetic/*genetics;Retrospective Studies;Sex Factors","Kulminski, A. M.;Ukraintseva, S. V.;Arbeev, K. G.;Manton, K. G.;Oshima, J.;Martin, G. M.;Il'yasova, D.;Yashin, A. I.",2008,Mar,10.1111/j.1532-5415.2007.01574.x,0,
2424,The apolipoprotein E epsilon2 allele and aging-associated health deterioration in older males,,Aged;Aging/*genetics/metabolism;Alleles;Alzheimer Disease/blood/genetics;Apolipoprotein E2/*genetics;Colorectal Neoplasms/blood/genetics;Coronary Disease/blood/genetics;DNA/*genetics;Female;Genetic Predisposition to Disease;Genotype;Humans;Macular Degeneration/blood/genetics;Male;Prognosis,"Kulminski, A. M.;Ukraintseva, S. V.;Yashin, A. I.",2007,Sep,10.1111/j.1532-5415.2007.01311.x,0,
2425,Comparative studies on complications occurring during and after surgery in elderly patients with and without cardiovascular disorders,"Comparative studies of the differences in elderly patients with and without cardiovascular disorders were made in regard to complications occurring during and after operation. The subjects included 38 patients (6 men and 32 women) aged 70 to 99 years (mean: 84 years) at Nagoya City Kouseiin Geriatric Hospital who had orthopedic surgery under general anesthesia, between March 1990 and October 1992. Diseases identified in these subjects were sequelae of cerebrovascular disease (38 subjects), heart disease (22 subjects), hypertension (9 subjects), senile dementia (6 subjects), Parkinson's disease (5 subjects), malignant disease (3 subjects) and diabetes mellitus (2 subjects). They were initially divided into 2 groups according to ultrasonic cardiography: a normal group comprising 20 patients without cardiovascular abnormalities, and a disorder group comprising 18 patients with reduction of left ventricule function, left ventricular hypertrophy and/or valvular disease (more than moderate). All subjects were examined with regard to age, weight, the nutrition index proposed by Onodera, activity of daily living (ADL), cardiac output, left ventricular ejection fraction, serum level of BUN and albumin etc. Moreover, the disorder group subjects were divided into 2 groups according to the presence or absence of heart failure occurring after surgery. In addition to the above-mentioned, we also studied the duration of surgery and anesthesia, and water balance during and after surgery. Results showed that the ADL and nutrition index in the disorder group were lower compared to the normal group.(ABSTRACT TRUNCATED AT 250 WORDS)","Aged;Aged, 80 and over;Cardiovascular Diseases/*complications;Female;Heart Failure/complications;Humans;Incidence;Intraoperative Complications/*epidemiology;Japan/epidemiology;Male;Orthopedics;Postoperative Complications/*epidemiology","Kumai, T.;Ogihara, M.;Miyagawa, K.;Yamamato, T.;Takeichi, F.",1993,Nov,,0,
2426,Neuroprotective effect of carvedilol against aluminium induced toxicity: possible behavioral and biochemical alterations in rats,"Aluminium, is a trace element available in the Earth's crust naturally and has a toxic potential for humans. It has been suggested as a contributing factor in the pathogenesis of Alzheimer's disease. beta-Adrenoceptor blocking agents (beta-blockers) have been established as therapeutics for the treatment of patients with hypertension, ischemic heart diseases, chronic heart failure, arrhythmias and glaucoma. Over the years, however, beta-blockers have been associated with an incidence, albeit low, of central nervous system (CNS) side effects. In addition, noradrenergic receptors play a modulatory role in many nerve functions, including vigilance, attention, reward, learning and memory. Therefore, the present study has been designed to explore the possible role of carvedilol, an adrenergic antagonist against aluminium chloride-induced neurotoxicity in rats. Aluminium chloride (100 mg/kg) was administered daily for six weeks that significantly increased cognitive dysfunction in the Morris water maze and oxidative damage as indicated by a rise in lipid peroxidation and nitrite concentration and depleted reduced glutathione, superoxide dismutase, catalase and glutathione S-transferase activity compared to sham treatment. Chronic aluminium chloride treatment also significantly increased acetylcholinesterase activity and the aluminium concentration in brain compared to sham. Chronic administration of carvedilol (2.5 and 5 mg/kg, po) daily to rats for a period of 6 weeks significantly improved the memory performance tasks of rats in the Morris water maze test, attenuated oxidative stress (reduced lipid peroxidation, nitrite concentration and restored reduced glutathione, superoxide dismutase, catalase and glutathione S-transferase activity), decreased acetylcholinesterase activity and aluminium concentration in aluminium-treated rats compared to control rats (p < 0.05). Results of this study demonstrated the neuroprotective potential of carvedilol in aluminium chloride-induced cognitive dysfunction and oxidative damage.","Adrenergic beta-Antagonists/administration & dosage/*pharmacology;Aluminum Compounds/pharmacokinetics/*toxicity;Animals;Brain/metabolism/physiopathology;Carbazoles/administration & dosage/*pharmacology;Chlorides/pharmacokinetics/*toxicity;Cognition Disorders/chemically induced/drug therapy;Dose-Response Relationship, Drug;Male;Maze Learning/drug effects;Neuroprotective Agents/administration & dosage/*pharmacology;Neurotoxicity Syndromes/etiology/prevention & control;Oxidative Stress/drug effects;Propanolamines/administration & dosage/*pharmacology;Rats;Rats, Wistar;Tissue Distribution","Kumar, A.;Prakash, A.;Dogra, S.",2011,,,0,
2427,Critical role of proline and glycine conservation with repeats in neurodegenerative disorders,"Progressive neurodegenerative diseases like Huntington's, Alzheimer's disease, Down's syndrome, Tay Sachs disease, spino cerebellar ataxia 2,kennedy disease, Dentatorubral - pallidoluysian atrophy and ALS have been gradually realized to be evolved from the common cellular and physiological pathways. The aim was to identify possible biases in the amino acid repeat patterns with respect to the repeats in other sequences responsible for neurodegenerative disorders, as this could be informative for specific constraints operating in the repetitive structures. Previous studies suggest the misfolding of the amyloid proteins as one of the most prominent causes. Our study reveals the critical role of proline and glycine conservation with Alanine, glycine, proline residue repeat polymorphism levels. Proline toxicities have been found involved in cardiac muscle disorder, neuro transmitter disorder, congestive heart failure and major depression found in most of the degenerative diseases worked on. We inspected the relative position 58 where proline conservation was seen in spino cerebellar ataxia 2 and Huntington giving rise to the common symptoms of the disease. Our study also suggests that Q repeats mostly fall in helical regions indicating responsible Proteins to be the surface proteins which cause different severe symptoms and effects. © Internet Scientific Publications, LLC., 1996 to 2010.",alanine;amyloid protein;glycine;membrane protein;proline;amino acid substitution;article;congestive heart failure;degenerative disease;dentatorubropallidoluysian atrophy;disease course;gene expression;genetic conservation;genetic polymorphism;genetic variability;heart muscle;human;Huntington chorea;major depression;spinocerebellar degeneration;symptomatology,"Kumar, A.;Srivastava, S.;Keshore, V.;Chengappa, K.;Sinha, A.;Kant, R.",2010,,,0,
2428,Shrinking brain in an expanding skull,,bisphosphonic acid derivative;calcitonin;aged;Alzheimer disease;article;bone pain;brain atrophy;case report;cerebellum atrophy;congestive heart failure;degenerative disease;dementia;female;fracture nonunion;human;hydrocephalus;hypercalcemia;mental deterioration;nerve compression;neuroimaging;nuclear magnetic resonance imaging;Paget bone disease;priority journal;skull,"Kumar, N.;Watson Jr, R. E.",2005,,,0,
2429,Protective effects of 17beta estradiol on altered age related neuronal parameters in female rat brain,"Biological aging is a fundamental process observed in almost all living beings. During aging the brain experiences structural, molecular, and functional alterations. Aging in females and males is considered as the end of natural protection against age related diseases like osteoporosis, coronary heart disease, diabetes, Alzheimer's and Parkinson's disease. These changes increase during menopausal condition in females when the level of estradiol is decreased. The aim of the present study was to investigate the anti-aging and protective potential of 17beta estradiol (E2) treatment on activities of membrane linked ATPases (Na(+)K(+) ATPase, Ca(2)(+)ATPase), antioxidant enzymes (superoxide dismutases, glutathione-S-transferases), intrasynaptosomal calcium levels, membrane fluidity and neurolipofuscin in the brain of aging female rats of 3 months (young), 12 months (adult) and 24 months (old) age groups, and to see whether these changes are restored to normal levels after exogenous administration of E2 (0.1 mug/g body weight for one month).The results obtained in the present work revealed that normal aging was associated with significant decrease in the activities of membrane linked ATPases, antioxidant enzymes and an increase in neurolipofuscin, intrasynaptosomal calcium levels in brain of aging female rats. The present study showed that E2 treatment reversed the changes to near normal levels. E2 treatment appears to be beneficial in preventing some of the age related changes in the brain, an important anti-aging effect of the hormone.","Adenosine Triphosphatases/metabolism;Aging/*drug effects;Animals;Antioxidants/metabolism;Brain/*drug effects/metabolism;Calcium/metabolism;Estradiol/*pharmacology;Female;Lipofuscin;Neuroprotective Agents/*pharmacology;Rats;Rats, Wistar;Synaptosomes/metabolism","Kumar, P.;Kale, R. K.;McLean, P.;Baquer, N. Z.",2011,Sep 8,10.1016/j.neulet.2011.07.024,0,
2430,Physiological and biochemical effects of 17beta estradiol in aging female rat brain,"Aging in females and males is considered as the end of natural protection against age related diseases like osteoporosis, coronary heart disease, diabetes, Alzheimer's disease and Parkinson's disease. These changes increase during menopausal condition in females when the level of estradiol is decreased. The objective of this study was to observe the changes in activities of monoamine oxidase, glucose transporter-4 levels, membrane fluidity, lipid peroxidation levels and lipofuscin accumulation occurring in brains of female rats of 3 months (young), 12 months (adult) and 24 months (old) age groups, and to see whether these changes are restored to normal levels after exogenous administration of estradiol (0.1 mug/g body weight for 1 month). The results obtained in the present work revealed that normal aging was associated with significant increases in the activity of monoamine oxidase, lipid peroxidation levels and lipofuscin accumulation in the brains of aging female rats, and a decrease in glucose transporter-4 level and membrane fluidity. Our data showed that estradiol treatment significantly decreased monoamine oxidase activity, lipid peroxidation and lipofuscin accumulation in brain regions of aging rats, and a reversal of glucose transporter-4 levels and membrane fluidity was achieved, therefore it can be concluded from the present findings that estradiol's beneficial effects seemed to arise from its antilipofuscin, antioxidant and antilipidperoxidative effects, implying an overall anti-aging action. The results of this study will be useful for pharmacological modification of the aging process and applying new strategies for control of age related disorders.","Aging/*drug effects/metabolism;Animals;Blood Glucose/drug effects;Body Weight/drug effects;Brain/*drug effects/metabolism;Estradiol/*pharmacology;Estrogens/*pharmacology;Female;Glucose Transporter Type 4/metabolism;Immunohistochemistry;Insulin/blood;Lipid Peroxidation/drug effects;Lipofuscin/metabolism;Membrane Fluidity/drug effects;Membrane Lipids/metabolism;Monoamine Oxidase/metabolism;Neuroprotective Agents/*pharmacology;RNA, Messenger/metabolism;Rats;Rats, Wistar","Kumar, P.;Taha, A.;Kale, R. K.;Cowsik, S. M.;Baquer, N. Z.",2011,Jul,10.1016/j.exger.2011.02.008,0,
2431,Positron emission tomography: An advanced nuclear medicine imaging technique from research to clinical practice,,fluorodeoxyglucose f 18;radioisotope;tracer;Alzheimer disease;angiogenesis;apoptosis;article;benign tumor;biological function;brain metabolism;breast cancer;cancer staging;cardiology;cell viability;clinical practice;clinical research;computer assisted tomography;cyclotron;diagnostic accuracy;diagnostic imaging;differential diagnosis;drug uptake;epilepsy;function test;gene expression;half life time;heart infarction;hypoxia;in vivo study;infection;inflammation;joint prosthesis;malignant neoplastic disease;metastasis;motor dysfunction;multidrug resistance;neurologic disease;neurotransmission;non invasive measurement;nuclear magnetic resonance imaging;nuclear medicine;oncology;positron emission tomography;priority journal;prognosis;prosthesis infection;pyrexia idiopathica;radioactivity;scar;sensitivity and specificity;tumor hypoxia,"Kumar, R.;Jana, S.",2004,,,0,
2432,"Insulin Glargine Induced Persistent Intractable Hypoglycemia, with Variable Presentations in Older Diabetic Patients: An Experience of 4 Cases",,glucose;hemoglobin A1c;insulin glargine;adult;aged;case report;chronic kidney disease;comorbidity;continuous infusion;coronary artery disease;dementia;depression;diabetes mellitus;diet;disease duration;drug dose reduction;female;heart failure;hospitalization;human;hypertension;hypoglycemia;lethargy;letter;male;peripheral vascular disease;seizure;ulcer;weakness,"Kumari, J.;Dharmarajan, T. S.",2009,,,0,
2433,Cardiovascular dementia - a different perspective,"The number of dementia patients has been growing in recent years and dementia represents a significant threat to aging people all over the world. Recent research has shown that the number of people affected by Alzheimer's disease (AD) and dementia is growing at an epidemic pace. The rapidly increasing financial and personal costs will affect the world's economies, health care systems, and many families. Researchers are now exploring a possible connection among AD, vascular dementia (VD), diabetes mellitus (type 2, T2DM) and cardiovascular diseases (CD). This correlation may be due to a strong association of cardiovascular risk factors with AD and VD, suggesting that these diseases share some biologic pathways. Since heart failure is associated with an increased risk of AD and VD, keeping the heart healthy may prove to keep the brain healthy as well. The risk for dementia is especially high when diabetes mellitus is comorbid with severe systolic hypertension or heart disease. In addition, the degree of coronary artery disease (CAD) is independently associated with cardinal neuropathological lesions of AD. Thus, the contribution of T2DM and CD to AD and VD implies that cardiovascular therapies may prove useful in preventing AD and dementia.",Alzheimer's disease;Cardiovascular disease;Heart;Kidney;Ngf;Vascular dementia.,"Kumari, U.;Heese, K.",2010,Mar 26,10.2174/1874091x01004010029,0,
2434,Cognitive Decline in Patients with Leukoaraiosis Within 5 Years after Initial Stroke,"BACKGROUND: Leukoaraiosis (LA) is closely associated with cognitive deficits. The association between LA and cognitive disorders, such as mild cognitive impairment (MCI) and dementia, after initial stroke has not been systematically studied. In this study, we sought to identify whether LA contributes to the occurrence of certain type of cognitive disorders after initial stroke. METHODS: Data from our Stroke Registry were examined, and 5-year follow-up data for LA and cognitive disorders were analyzed. We performed Kaplan-Meier analysis and log-rank test to assess the predictive value of LA for risk of cognitive decline and the Cox proportional hazards model to test the risk factors studied as independent determinants of cognitive impairment. RESULTS: The frequency of patients with normal cognitive function decreased significantly at 5 years compared with initial stroke (78% vs 70%; odds ratio, 1.51; 95% confidence interval, 1.41-1.62). Of 8784 patients, 1659 (19%) had dementia and 964 (11%) had MCI at the final analysis. After 5 years of follow-up, survival analysis showed that all patients with LA had an increased probability of MCI compared with those without LA (P < .0001). Patients with LA had an increased chance of dementia compared with those without LA (P < .0001) at the end of follow-up. Cognitive decline probability was significantly higher in patients with severe LA compared with those with mild/moderate LA (P < .0001). Cox regression analyses showed that recurrence of stroke (hazard ratio [HR], 3.92 [95% CI, 3.26-4.72]), hypertension (HR, 1.11 [95% CI, 1.0-1.22]), LA (HR, 1.15 [95% CI, 1.05-1.25]), age (HR, 1.05 [95% CI, 1.04-1.06]), hypercholesterolemia (HR, .86 [95% CI, .77-.95]), higher LDL cholesterol (HR, 1.21 [95% CI, 1.11-1.32]), lower HDL cholesterol (HR, .90 [95% CI, .83-.98]), coronary heart disease (HR, .85 [95% CI, .77-.94]), and National Institutes of Health Stroke Scale score at admission (HR, .77 [95% CI, .72-.82]) were also significantly associated with cognitive impairments. CONCLUSIONS: Our findings suggest that patients with LA may be at risk of developing new cognitive impairments at long-term period after initial stroke. The evaluation of the concomitant risk factors, besides providing insights about the possible mechanisms behind the cognitive dysfunction present in LA, may be of help for the prevention of cognitive impairments.","Adult;Aged;Aged, 80 and over;Chi-Square Distribution;Cognition Disorders/classification/diagnosis/*epidemiology/*etiology/mortality;Dementia/diagnosis/epidemiology/etiology/metabolism;Disease Progression;Female;Humans;Kaplan-Meier Estimate;Leukoaraiosis/*complications/epidemiology/mortality;Longitudinal Studies;Male;Middle Aged;Neuropsychological Tests;Registries;Severity of Illness Index;Stroke/classification/*epidemiology/mortality;Turkey/epidemiology;Leukoaraiosis;cognitive disorders;mild cognitive impairment;vascular dementia","Kumral, E.;Gulluoglu, H.;Alakbarova, N.;Deveci, E. E.;Colak, A. Y.;Caginda, A. D.;Evyapan, D.;Orman, M.",2015,Oct,10.1016/j.jstrokecerebrovasdis.2015.06.012,0,
2435,Is lipoprotein (a) protective of dementia?,"Lipoprotein(a) [Lp(a)]-an established risk factor for vascular disease, has been suggested to be associated with risk of dementia, however no prospective evidence exists to support this finding. We aimed to assess the association of Lp(a) with dementia risk. Lp(a) concentration was assessed at baseline in a prospective cohort of 2532 men aged 42-61 years. During a median follow-up of 24.9 years, 228 new cases of dementia were recorded. Lp(a) was approximately log-linearly associated with dementia risk. In age-adjusted analysis, the hazard ratio for dementia in a comparison of extreme quartiles of Lp(a) levels was 0.68 (95 % CI: 0.47-0.99), which persisted after adjustment for several physical measures, history of coronary heart disease, smoking status, history of diabetes, serum lipids, alcohol consumption, and socio-economic status 0.68 (0.46-0.99). Lp(a) is protective of future dementia risk in a middle-aged male Caucasian population. Further research is needed replicate these findings.",Dementia;Lipoprotein(a);Risk factor,"Kunutsor, S. K.;Khan, H.;Nyyssonen, K.;Laukkanen, J. A.",2016,Jul 13,10.1007/s10654-016-0184-0,0,
2436,Is lipoprotein (a) protective of dementia?,"Lipoprotein(a) [Lp(a)]–an established risk factor for vascular disease, has been suggested to be associated with risk of dementia, however no prospective evidence exists to support this finding. We aimed to assess the association of Lp(a) with dementia risk. Lp(a) concentration was assessed at baseline in a prospective cohort of 2532 men aged 42–61 years. During a median follow-up of 24.9 years, 228 new cases of dementia were recorded. Lp(a) was approximately log-linearly associated with dementia risk. In age-adjusted analysis, the hazard ratio for dementia in a comparison of extreme quartiles of Lp(a) levels was 0.68 (95 % CI: 0.47–0.99), which persisted after adjustment for several physical measures, history of coronary heart disease, smoking status, history of diabetes, serum lipids, alcohol consumption, and socio-economic status 0.68 (0.46–0.99). Lp(a) is protective of future dementia risk in a middle-aged male Caucasian population. Further research is needed replicate these findings.",lipid;lipoprotein A;alcohol consumption;dementia;diabetes mellitus;disease association;human;ischemic heart disease;letter;lipid blood level;medical history;neuroprotection;protein function;risk assessment;smoking;social status,"Kunutsor, S. K.;Khan, H.;Nyyssönen, K.;Laukkanen, J. A.",2016,,10.1007/s10654-016-0184-0,0,
2437,Gamma glutamyltransferase and risk of future dementia in middle-aged to older Finnish men: A new prospective cohort study,"Introduction We assessed the association of gamma glutamyltransferase (GGT) with risk of dementia. Methods Serum GGT activity was assessed at baseline in the Kuopio Ischemic Heart Disease prospective cohort of 2415 relatively healthy men with good cognitive function. Correction was made for within-person variability in GGT levels. Results During an average follow-up of 22 years, 219 new cases of dementia were recorded. Serum GGT was log-linearly associated with risk of dementia. The hazard ratio (HR) (95% CIs) for dementia per 1 standard deviation (SD) higher baseline loge GGT values was 1.33 (95% CI = 1.14–1.55) after adjustment for several established and emerging risk factors. The corresponding HR was 1.52 (95% CI = 1.22–1.89) after correction for within-person variability. Discussion GGT is positively, log-linearly, and independently associated with future risk of dementia in the general male population. Further research is needed to unravel the mechanistic pathways of GGT in the pathogenesis of dementia.",antihypertensive agent;antilipemic agent;gamma glutamyltransferase;adult;age;alcohol consumption;article;body mass;cognition;cohort analysis;dementia;diabetes mellitus;enzyme activity;enzyme blood level;Finn (citizen);follow up;human;ischemic heart disease;major clinical study;male;medical history;middle aged;molecular pathology;neuropathology;physical activity;priority journal;prospective study;risk factor;smoking;social status;systolic blood pressure,"Kunutsor, S. K.;Laukkanen, J. A.",2016,,,0,
2438,Association between recent use of fluoroquinolones and rhegmatogenous retinal detachment: A population-based cohort study,"Background. An association between use of oral fluoroquinolones (FQs) and retinal detachment remains controversial. This study was to determine the association of recent use of oral FQs and rhegmatogenous retinal detachment (RRD) after adjustment for confounding factors known to be associated with RRD.Methods. This retrospective population-based cohort study with parallel groups included adults treated with an oral FQ (FQ cohort = 178 179 prescriptions) and propensity score-matched adults treated with oral amoxicillin (amoxicillin cohort = 178 179 prescriptions). The data were extracted from the Taiwan National Health Insurance Research Database from 1998 to 2010. Interaction terms were used to identify populations at risk. RRD was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification.Results. During the 90-day follow-up period, 96 patients (0.054%) in the FQ cohort developed RRD compared to 46 (0.026%) among the matched amoxicillin cohort. The overall adjusted hazard ratio (HR) for FQ use and RRD was 2.07 (95% confidence interval [CI], 1.45-2.96). The interval between use of oral FQs and onset of RRD was 35.5 days (interquartile range, 14-57 days). Interaction terms were not significant for age, sex, diabetes, indications for antimicrobials, or underlying ophthalmic conditions. The adjusted HRs differed for specific FQs. These were 10.68 (95% CI, 3.28-34.82) for ciprofloxacin, 2.41 (95% CI,. 76-7.68) for levofloxacin, 2.00 (95% CI, 1.06-3.79) for norfloxacin, and 1.17 (95% CI,. 59-2.31) for ofloxacin. Conclusions. The use of oral FQs was associated with the subsequent occurrence of RRD. The FQ risk was independent of age, sex, diabetes, indications for antimicrobials, and underlying ophthalmic conditions. Certain FQs carried higher risk of RRD. © The Author 2013.",amoxicillin;ciprofloxacin;levofloxacin;lomefloxacin;norfloxacin;ofloxacin;adult;article;asthma;autoimmune disease;cerebrovascular disease;chronic kidney disease;chronic liver disease;chronic obstructive lung disease;coronary artery disease;dementia;diabetes mellitus;dyslipidemia;female;follow up;heart arrhythmia;heart failure;heart infarction;human;hypertension;major clinical study;male;middle aged;neoplasm;observational study;peptic ulcer;peripheral vascular disease;priority journal;respiratory tract infection;retina detachment;retrospective study;risk,"Kuo, S. C.;Chen, Y. T.;Lee, Y. T.;Fan, N. W.;Chen, S. J.;Li, S. Y.;Liu, C. J.;Chen, T. L.;Chen, T. J.;Fung, C. P.",2014,,,0,
2439,Association between comorbidities and dementia in diabetes mellitus patients: population-based retrospective cohort study,"AIMS: Most diabetes mellitus (DM) patients have several comorbidities; the correlation of these comorbidities with dementia in DM requires clarification. METHODS: Using claims data from Taiwan National Health Insurance, we identified 33,709 DM adults before the year 2000 and randomly selected 67,066 non-DM patients matched by sex and age. Subjects were followed until diagnosis with dementia, excluded due to death/withdrawal from the insurance program, or followed until 2011. We compared the incidence and hazard ratio (HR) for dementia in both cohorts. RESULTS: Comorbidities were more prevalent in DM patients, including hypertension, hyperlipidemia, stroke, coronary artery and/or kidney disease. The HR was higher for the DM cohort with comorbidities than those without: 1.88 vs. 1.46 with hypertension; 1.56 vs. 1.39 with hyperlipidemia; 1.73 vs. 1.37 with coronary artery disease; 2.36 vs. 2.29 with stroke and 1.88 vs. 1.50 with kidney disease. The HR for dementia in diabetics rose from 1.41 in those without comorbidities to 2.49 in those with >/=4 comorbidities. In the DM cohort, HR was 1.22 for non-insulin-users and 1.41 for insulin-users, and 1.49 for type 1 DM and 1.23 for type 2 DM. CONCLUSION: Diabetic patients have an elevated risk of dementia, and comorbidity increases this risk.","Age Factors;Cohort Studies;Comorbidity;Dementia/chemically induced/*epidemiology/prevention & control;Diabetes Complications/chemically induced/*epidemiology/prevention & control;Diabetes Mellitus, Type 1/drug therapy/*epidemiology;Diabetes Mellitus, Type 2/drug therapy/*epidemiology;Electronic Health Records;Female;Humans;Hypoglycemic Agents/adverse effects/therapeutic use;Incidence;Insulin/adverse effects/therapeutic use;Kaplan-Meier Estimate;Longitudinal Studies;Male;Middle Aged;National Health Programs;Prevalence;Proportional Hazards Models;Retrospective Studies;Risk Factors;Taiwan/epidemiology;Dementia;Epidemiology;Retrospective cohort;Risk","Kuo, S. C.;Lai, S. W.;Hung, H. C.;Muo, C. H.;Hung, S. C.;Liu, L. L.;Chang, C. W.;Hwu, Y. J.;Chen, S. L.;Sung, F. C.",2015,Nov-Dec,10.1016/j.jdiacomp.2015.06.010,1,
2440,Factors affecting survival of patients with hip fractures,"The preoperative findings of 111 patients after 117 fractures of the proximal femur were recorded retrospectively. Data on survival, present type of residence and ambulatory status were analyzed. After age and sex, the presence of dementia, renal insufficiency and cardiac failure seemed to be the most important factors affecting the outcome. A full preoperative evaluation of patients with a proximal femoral fracture is needed to identify those at risk. This evaluation may help in the selection of the operative procedure.","Aged;Aged, 80 and over;Comorbidity;Female;Femoral Fractures/mortality;Femoral Neck Fractures/mortality;Hip Fractures/*mortality;Humans;Life Style;Male;Middle Aged;Prognosis;Prospective Studies;Regression Analysis;Risk Factors;Survival Analysis","Kuokkanen, H. O.;Korkala, O. L.",1992,,,0,
2441,"Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries","BACKGROUND: Prediction models can help clinicians provide the best and most appropriate care to their patients and can help policy makers design services for groups at highest risk for poor outcomes. OBJECTIVE: To develop prediction models identifying both risk factors and protective factors for functional deterioration, institutionalization, and death. DESIGN: Cohort study using data from the Medicare Current Beneficiary Survey (MCBS) SETTING: Community survey. PARTICIPANTS: This study included 21,264 Medicare beneficiaries 65 years of age and older who participated in the MCBS from the 2001-2008 entry panels and were followed up for 2 years. METHODS: The index was derived in 60% and validated in the remaining 40%. beta Coefficients from a multinomial logistic regression model were used to derive points, which were added together to create scores associated with the outcome. MAIN OUTCOME MEASURE: The outcome was activity of daily living (ADL) stage transitions over 2 years following entry into the MCBS. Beneficiaries were categorized into 1 of 4 outcome categories: stable or improved function, functional deterioration, institutionalization, or death. RESULTS: Our model identified 16 factors for functional deterioration (age, gender, education, living arrangement, dual eligibility, proxy use, Alzheimer disease/dementia, angina pectoris/coronary heart disease, diabetes, emphysema/asthma/chronic obstructive pulmonary disease, mental/psychiatric disorder, Parkinson disease, stroke/brain hemorrhage, hearing impairment, vision impairment, and baseline ADL stage) after backward selection (P < .05). Compared to stable or improved function, the risk of functional deterioration ranged from </=1 to >/=6, </=4 to >/=22 for the risk of institutionalization, and </=3 to >/=16 for the risk of death. CONCLUSION: Predictive indices, or point and scoring systems used to predict outcomes, can identify elderly Medicare beneficiaries at risk for functional deterioration, institutionalization, and death and can aid policy makers, clinicians, and family members in improving care for older adults and supporting successful aging in the community. LEVEL OF EVIDENCE: I.",,"Kurichi, J. E.;Kwong, P. L.;Xie, D.;Bogner, H. R.",2017,Apr 26,,0,
2442,Accelerated solvent extraction for quantitative measurement of fatty acids in plasma and erythrocytes,"Consumption of fish rich in n-3 highly unsaturated FAs (i.e., EPA and DHA) has been suggested to decrease the risk of lifestyle-related diseases such as coronary heart disease, cancer, diabetes, and dementia. Blood levels of those FA are known appropriate biomarkers of both the corresponding dietary FA intakes and fish consumption. In place of traditional handwork methods for extracting FA, we performed an accelerated solvent extraction (ASE) for at least 13 selected FA in plasma and erythrocytes to measure them by GLC. The FA levels (concentrations and compositions) in 35-50 microL of plasma or erythrocytes were extracted by ASE and measured by GLC. Intra- and interassay coefficients of variation were < or = 6.0% for both blood materials, except with a minor group of FA (< or = 1.0% of total FA). When ASE was compared with two traditional handwork methods, FA levels in plasma from 18 healthy subjects were all coincident with very high Pearson's correlation coefficients for the three sets of the same 18 samples (r > or = 0.85 to 0.95, P < 0.0001), except for 18:0 (r = 0.59, P < 0.01). Using ASE and GLC, we have developed a new method for determination the levels of FA in plasma and erythrocytes as biomarkers for dietary intake of fish, fat, and FA. This new method makes it feasible to measure small volumes of samples, automatically, quantitatively, routinely, easily, rapidly and cheaply, with acceptable precision and accuracy.",Acyltransferases/blood/isolation & purification;Blood Chemical Analysis/*methods;Blood Specimen Collection/methods;Erythrocytes/*chemistry;Fatty Acids/*analysis/*blood/*isolation & purification;Humans;Lipids/blood/isolation & purification;Reproducibility of Results;Solvents/pharmacology;Tissue Extracts/chemistry,"Kuriki, K.;Tajima, K.;Tokudome, S.",2006,Jun,,0,
2443,A case of pernicious anemia with type A gastritis in an extremely elderly patient with dementia and heart failure,"A 90-year-old woman was referred and admitted to our hospital because of progressing dementia, decreased appetite, and general fatigue. Blood tests on admission disclosed: white cell count, 2,900 /mm3; hemoglobin 5.6 g/dl; mean corpuscular volume; 139.7 μm. Based on the presence of pancytopenia, macrocytic anemia, and elevated lactate dehydrogenises, we suspected pernicious anemia. We administered vitamin B12, which improved the blood test results and the signs of dementia. Gastrointestinal tract examination showed type A gastritis. Tests for anti-intrinsic factor antibody and anti-gastric parietal cell antibody were positive, which help confirm a diagnosis of pernicious anemia. Pernicious anemia is an autoimmune disease common among those aged 50-60 years. Cases aged over 90 years are rare. However, the numbers of extremely elderly patients are expected to increase with the growth of the elderly population. Fortunately, pernicious anemia is easy to treat. We need to make an appropriate diagnosis of pernicious anemia in the oldest elderly patients.",cyanocobalamin;aged;article;case report;dementia;female;gastritis;heart failure;human;pernicious anemia,"Kuroda, S.;Morita, S.",2008,,,0,
2444,Hypothalamic digoxin related membrane Na+-K+ ATPase inhibition and familial basal ganglia calcification,"The isoprenoid pathway produces three key metabolites - digoxin (membrane sodium-potassium ATPase inhibitor and regulator of intracellular calcium-magnesium ratios), dolichol (regulator of N-glycosylation of proteins) and ubiquinone (free radical scavenger). The pathway was assessed in a rare and specific type of familial basal ganglia calcification described. The family had a coexistence of basal ganglia calcification (six out of 10 cases), schizophrenia, Parkinson's disease, Alzheimer's disease, rheumatoid arthritis, systemic tumours and syndrome X and were all right hemispheric dominant. The isoprenoid pathway was also studied for comparison in right hemispheric dominant, bihemispheric dominant and left hemispheric dominant individuals. The isoprenoid pathway was upregulated with increased digoxin synthesis in familial basal ganglia calcification. Membrane sodium-potassium ATPase inhibition can lead on to increase in intracellular calcium and calcification of the basal ganglia. There was increase in tryptophan catabolites and a reduction in tyrosine catabolites. There was also an increase in dolichol and glycoconjugate levels with reduced lysosomal stability in these patients. The ubiquinone levels were low and free radical levels increased. The cholesterol-phospholipid ratio was increased and glycoconjugate level of the RBC membrane reduced in these group of patients. No significance difference was noted in family members with and without basal ganglia calcification. This findings were correlated with the pathogenesis of syndrome X, immune mediated diseases, degenerations, tumours and psychiatric disorders noted in the familial basal ganglia calcification described. The biochemical patterns obtained in familial basal ganglia calcification correlated with those in right hemispheric dominance. © 2002 Published by Elsevier Science Ireland Ltd. and the Japan Neuroscience Society.",adenosine triphosphatase (potassium sodium);calcium;digoxin;dolichol;glycoconjugate;tryptophan;ubiquinone;adult;aged;Alzheimer disease;article;calcium cell level;clinical article;controlled study;disease association;enzyme inhibition;Fahr disease;female;hemispheric dominance;human;left hemisphere;male;Parkinson disease;pathogenesis;priority journal;protein synthesis;rheumatoid arthritis;right hemisphere;schizophrenia;syndrome X,"Kurup, R. K.;Kurup, P. A.",2002,,,0,
2445,Schizoid neurochemical pathology-induced membrane Na+-K + ATPase inhibition in relation to neurological disorders,"Psychiatric abnormalities have been described in primary neurological disorders like multiple sclerosis, primary generalized epilepsy, Parkinson's disease, subacute sclerosing panencephalitis (SSPE), central nervous system glioma, and syndrome X with vascular dementia. It was therefore considered pertinent to compare monoamine neurotransmitter pattern in schizophrenia with those in the disorders described above. The end result of neurotransmission is changes in membrane Na+-K+ ATPase activity. Membrane Na+-K+ ATPase inhibition can lead to magnesium depletion, which can lead to an upregulated isoprenoid pathway. The isoprenoid pathway produces three important metabolites-digoxin, an endogenous membrane Na +-K+ ATPase inhibitor; ubiquinone, a membrane antioxidant and component of mitochondrial electron transport chain; and dolichol, important in N-glycosylation of protein. The serum/plasma levels of digoxin, dolichol, ubiquinone, magnesium, HMG CoA reductase activity, and RBC Na +-K+ ATPase activity were estimated in all these disorders. The result showed that the concentration of serum tryptophan and serotonin was high and serum tyrosine, dopamine, adrenaline, and noradrenaline low in all the disorders studied. The plasma HMG CoA reductase activity, serum digoxin, and serum dolichol levels were high and serum ubiquinone levels, serum magnesium, and RBC Na+-K+ ATPase activity were low in all the disorders studied. The significance of these changes in the pathogenesis of syndrome X, multiple sclerosis, primary generalized epilepsy, schizophrenia, SSPE, and Parkinson's disease is discussed in the setting of the interrelationship between these disorders documented in literature.",digoxin;dolichol;ubiquinone;adult;article;controlled study;enzyme activity;epilepsy;female;glioma;human;major clinical study;male;membrane transport;multiinfarct dementia;multiple sclerosis;neurochemistry;neurologic disease;neurotransmission;Parkinson disease;schizoidism;syndrome X,"Kurup, R. K.;Kurup, P. A.",2003,,,0,
2446,Young-onset dementia,"Young-onset dementia is a neurologic syndrome that affects behavior and cognition of patients younger than 65 years of age. Although frequently misdiagnosed, a systematic approach, reliant upon attainment of a detailed medical history, a collateral history, neuropsychological testing, laboratory studies, and neuroimaging, may facilitate earlier and more accurate diagnosis with subsequent intervention. The differential diagnosis of young-onset dementia is extensive and includes early-onset forms of adult neurodegenerative conditions including Alzheimer's disease, vascular dementia, frontotemporal dementia, Lewy body dementias, Huntington's disease, and prion disease. Late-onset forms of childhood neurodegenerative conditions may also present as young-onset dementia and include mitochondrial disorders, lysosomal storage disorders, and leukodystrophies. Potentially reversible etiologies including inflammatory disorders, infectious diseases, toxic/metabolic abnormalities, transient epileptic amnesia, obstructive sleep apnea, and normal pressure hydrocephalus also represent important differential diagnostic considerations in young-onset dementia. This review will present etiologies, diagnostic strategies, and options for management of young-onset dementia with comprehensive summary tables for clinical reference. © Georg Thieme Verlag KG Stuttgart, New York.",cholinesterase inhibitor;donepezil;galantamine;memantine;rivastigmine;Alexander disease;Alzheimer disease;anxiety;article;Behcet disease;brain biopsy;CADASIL;cerebrospinal fluid analysis;consciousness disorder;Creutzfeldt Jakob disease;delayed diagnosis;dementia;depression;diagnostic error;differential diagnosis;diffuse Lewy body disease;disease duration;drug exposure;electroencephalography;electromyography;endocrine disease;Fabry disease;Fahr disease;frontotemporal dementia;functional disease;Gaucher disease;head injury;heavy metal poisoning;HIV associated dementia;human;Huntington chorea;intestine lipodystrophy;Kearns Sayre syndrome;lactic acidosis;MELAS syndrome;MERRF syndrome;Mini Mental State Examination;mitochondrial encephalopathy;multiinfarct dementia;multiple sclerosis;neuroimaging;neurosyphilis;Niemann Pick disease;normotensive hydrocephalus;nuclear magnetic resonance imaging;onset age;Pelizaeus Merzbacher disease;positron emission tomography;prion disease;priority journal;progressive multifocal leukoencephalopathy;sarcoidosis;Tay Sachs disease;traumatic brain injury,"Kuruppu, D. K.;Matthews, B. R.",2013,,,0,
2447,The apolipoprotein E gene and Alzheimer disease phenotype,"The relevance of the apolipoprotein E epsilon 4 allele as risk factor for Alzheimer's disease is independent of age. This was demonstrated in 126 patients and 72 healthy controls. The age in both groups varied between 44 and 95 years. An earlier onset of symptoms among carriers of the epsilon 4 allele, however, was observed only in the oldest patients. This may reflect a selection bias which is due to the association of the epsilon 4 allele with two competitive age-dependent risks: for Alzheimer's disease and for coronary heart disease. In a subsample of 64 patients who had participated in a longitudinal study no relationship was found between the apolipoprotein E genotype and clinical symptoms or symptom progression.","Adult;Aged;Aged, 80 and over;Alleles;Alzheimer Disease/*genetics;Apolipoprotein E4;Apolipoproteins E/*genetics;Female;Genotype;Humans;Male;Mental Status Schedule;Middle Aged;*Phenotype;Risk Factors","Kurz, A.;Egensperger, R.;Lautenschlager, N.;Haupt, M.;Altland, K.;Graeber, M. B.;Muller, U.",1995,May-Jun,,0,
2448,Pathogenic factors and the anatomical basis of vascular psychoses (Russian),"In a study on brain morphology in cases of vascular psychoses it was possible to distinguish the following varieties: psychoses in 'pure' atherosclerosis, a combination of atherosclerosis with hypertensive disease, a combination of atherosclerosis with senile dementia and rheumatic fever, hypotensive psychoses, and psychoses developing on the basis of vascular dystonia and rheumatic vasculitis. Special questions are related to psychoses in cardiovascular disorders (heart failure, etc.). The frequency of each form in the anatomic material collected in one of the psychiatric prosectories is reported.",atherosclerosis;autopsy;brain atherosclerosis;hypertension;major clinical study;psychosis;radiology;rheumatic disease;senile dementia,"Kushelev, V. P.",1973,,,0,
2449,Minimizing the risk of hypoglycemia in patients with type 2 diabetes mellitus,"Hypoglycemia is a major barrier to achieving glycemic goals in patients with diabetes. Both acute and chronically recurrent hypoglycemic events appear to have long-term consequences for patients with type 2 diabetes mellitus (T2DM). Chronically recurrent hypoglycemia may lead to an impairment of the counterregulatory system, with the potential for the development of hypoglycemia unawareness syndrome, increased severe hypoglycemia-associated hospitalization, and increased mortality. Hypoglycemic events may also have negative implications in cardiovascular disease and/or dementia. Avoidance of hypoglycemia by treating with appropriate, individualized regimens for patients with T2DM should be a primary focus of physicians. Utilizing traditional agents (eg, metformin and thiazolidinediones) that do not promote hypoglycemia, in combination with newer agents such as dipeptidyl peptidase-4 inhibitors and incretin mimetics, could offer a therapeutic advantage when trying to help patients reach their hemoglobin A1c goal without the added risk of hypoglycemia. © 2010 Via et al, publisher and licensee Dove Medical Press Ltd.",alpha glucosidase inhibitor;amylin receptor agonist;antidiabetic agent;chlorpropamide;dipeptidyl peptidase IV inhibitor;exendin 4;glibenclamide;gliclazide;glinide;glitazone derivative;glucagon like peptide 1 receptor agonist;hemoglobin A1c;indapamide plus perindopril;insulin;metformin;pioglitazone;rosiglitazone;saxagliptin;sitagliptin;sulfonylurea;unclassified drug;article;blood glucose monitoring;cardiovascular disease;clinical feature;clinical trial;congestive heart failure;dementia;drug efficacy;drug mechanism;fluid retention;gastrointestinal symptom;glycemic control;hospitalization;human;hypoglycemia;insulin hypoglycemia;morbidity;mortality;nausea;non insulin dependent diabetes mellitus;outcome assessment;prevalence;risk reduction;side effect;diamicron;preterax,"Kushner, P.",2010,,,0,
2450,Serotonin syndrome following levodopa treatment in diffuse Lewy body disease,"Serotonin syndrome results from an acute hyperserotonergic state. It is a rare and potentially fatal complication of drugs that affect the central nervous system serotonin levels. It is characterised by a triad of clinical features comprising altered sensorium, autonomic instability and neuromuscular hyperexcitability, in different combinations. We present an atypical case of serotonin syndrome related to levodopa use in a patient of probable Lewy body dementia. This case highlights the difficulty in diagnosis and management of cases with serotonin syndrome in the absence of history of a known serotonergic drug and the fact that levodopa can contribute to its occurrence. Copyright 2014 BMJ Publishing Group. All rights reserved.",artesunate;carbidopa plus levodopa;ceftriaxone;cyproheptadine;fluorodeoxyglucose;levodopa;noradrenalin;paracetamol;rivastigmine;adult;article;attention disturbance;brain infection;case report;cognitive defect;dementia;differential diagnosis;diffuse Lewy body disease;drug dose increase;drug dose reduction;drug withdrawal;fever;fluid therapy;Glasgow coma scale;heart arrest;human;hypotension;laboratory test;malaria;male;middle aged;muscle rigidity;myoclonus;nasogastric tube;neuroleptic malignant syndrome;parkinsonism;patient compliance;physical examination;positron emission tomography;sensory dysfunction;serotonin syndrome;tachypnea;tremor;virus encephalitis;visual hallucination,"Kushwaha, S.;Panda, A. K.;Malhotra, H. S.;Kaur, M.",2014,,,0,
2451,Chart Review at the Department of Elder Affairs in Central Florida of Disease Prevalence Among Recipients of Elderly Services,,acquired immune deficiency syndrome;alcohol abuse;Alzheimer disease;anemia;arthritis;asthma;blindness;cardiomyopathy;chronic kidney failure;congestive heart failure;coronary artery disease;data analysis;depression;diabetes mellitus;Down syndrome;elderly care;emphysema;gastroesophageal reflux;geriatric disorder;health service;atrial fibrillation;heart infarction;human;Human immunodeficiency virus infection;hypertension;letter;liver failure;medical record review;neoplasm;Parkinson disease;peptic ulcer;peripheral vascular disease;prevalence;schizophrenia;seizure;cerebrovascular accident;thyroid disease,"Kutner, M. A.;Kutner, M.",2010,,,0,
2452,Clinical picture and surgical treatment of pulmonary carcinoma in elderly and senile patients,"The clinical picture and course of the disease, as well as surgical management of elderly and senile patients suffering from pulmonary carcinoma are rather specific. The affection is often caused not only by age-related anatomo-physiological changes but also by concomitant diseases of the vitally important organs. Ischemic heart disease is the most frequent and severe affection that sometimes results in grave and lethal complications during and after the operation. One of the ways of extending the age-specific operability and of reducing the incidence of cardiopulmonary complications is the performance (according to indications) of economic interventions among which lobectomy should be maximal. Elaboration of the methods for prognosing possible operative and postoperative complications permitted to determine more exactly the indications and contraindications to surgical treatment of elderly and senile patients.",aged;lung carcinoma;major clinical study;respiratory system;senility;therapy;thorax surgery,"Kuzin, M. I.;Adamyan, A. A.;Bagaudinov, K. G.",1980,,,0,
2453,Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study,"INTRODUCTION: The association between history of coronary artery bypass graft surgery (CABG) and dementia risk remains unclear. METHODS: We conducted a prospective cohort analysis using data on 3155 elderly adults free from prevalent dementia from the US population-based Cardiovascular Health Study (CHS) with adjudicated incident all-cause dementia, Alzheimer disease (AD), vascular dementia (VaD), and mixed dementia. RESULTS: In the CHS, the hazard ratio (HR) for all-cause dementia was 1.93 [95% confidence interval (CI), 1.36-2.74] for those with CABG history compared with those with no CABG history after adjustment for potential confounders. Similar HRs were observed for AD (HR=1.71; 95% CI, 0.98-2.98), VaD (HR=1.42; 95% CI, 0.56-3.65), and mixed dementia (HR=2.73; 95% CI, 1.55-4.80). The same pattern of results was observed when these CHS findings were pooled with a prior prospective study, the pooled HRs were 1.96 (95% CI, 1.42-2.69) for all-cause dementia, 1.71 (95% CI, 1.04-2.79) for AD and 2.20 (95% CI, 0.78-6.19) for VaD. DISCUSSION: Our results suggest CABG history is associated with long-term dementia risk. Further investigation is warranted to examine the causal mechanisms which may explain this relationship or whether the association reflects differences in coronary artery disease severity.",,"Kuzma, E.;Airdrie, J.;Littlejohns, T. J.;Lourida, I.;Thompson-Coon, J.;Lang, I. A.;Scrobotovici, M.;Thacker, E. L.;Fitzpatrick, A.;Kuller, L. H.;Lopez, O. L.;Longstreth, W. T., Jr.;Ukoumunne, O. C.;Llewellyn, D. J.",2017,Apr-Jun,,0,
2454,J-shaped relationship between resting pulse rate and all-cause mortality in community-dwelling older people with disabilities 9,,beta adrenergic receptor blocking agent;angiocardiography;blood pressure;cardiovascular risk;cerebrovascular disease;chronic disease;community care;congestive heart failure;daily life activity;decubitus;dementia;diabetes mellitus;elderly care;electrocardiography;follow up;health service;home care;human;hypertension;ischemic heart disease;letter;mortality;neoplasm;physical disability;prescription;proportional hazards model;pulse rate,"Kuzuya, M.;Enoki, H.;Iwata, M.;Hasegawa, J.;Hirakawa, Y.",2008,,,0,
2455,Attitude of cardiologists on the use of invasive procedures in frail older patients with coronary heart disease in Japan 4,,coronary artery dilatation;dementia;functional assessment;geriatric disorder;human;ischemic heart disease;letter;patient selection;survival rate,"Kuzuya, M.;Iguchi, A.",2000,,,0,
2456,Outcomes in elderly patients with end-stage renal disease: Comparison of renal replacement therapy and conservative management,"Background/purpose With global socioeconomic development and improvement in the general health care system, life expectancy increases, resulting in an increasing incidence of end-stage renal disease in the elderly population. We compared the survival rate in elderly patients aged ≥ 65 years with Stage 5 chronic kidney disease, managed with either renal replacement therapy (RRT) or conservative treatment. We also tried to identify factors associated with survival in these two groups. Methods This is a single-center retrospective study of patients aged ≥ 65 years with Stage 5 chronic kidney disease, who were referred to the nephrology team for renal advance care planning to assist in decision making for RRT or conservative treatment from 2005 to 2013. They were followed up till death or till December 31, 2014. Baseline characteristics (demographics, clinical data, functional status, socioeconomic factors, and laboratory parameters) and mortality data between the two groups were compared. Results A total of 558 patients were recruited during the study period, in which 126 (22.6%) patients opted for RRT and 432 (77.4%) for conservative treatment. Patients with less significant comorbidities, lower modified Charlson's Comorbidity Index scores, better functional and mental statuses, as well as better socioeconomic status were more likely to choose RRT. The RRT group had a longer median survival of 44.6 months compared with 10.0 months in the conservative treatment group. The survival advantage of the RRT group was lost in patients older than 85 years, or in those with high comorbidity (modified Charlson's Comorbidity Index score of ≥11) or dependent mobility. Age, comorbidity, and mobility were predictors of mortality in the RRT group. For the conservative group, age, mobility, and gender were predictors of mortality. Conclusion Elderly patients with end-stage renal disease can be benefited from RRT. However, the survival advantage of RRT was lost in very-advanced-age patients older than 85 years of age, in those with high comorbidity, or in functionally dependent patients. ;;; ≥ 65 5 ; (RRT) ; ; ≥ 65 5 2005 2013 ;; RRT 2014 12 31 558 ; 126 (22.6%) RRT;432 (77.4%) RRT 44.6 ; 10.0 ; >85 (mCCI ≥ 11);RRT RRT ;,; RRT,; >85 ;RRT Keywords: end-stage renal failure; palliative care; renal replacement therapy",albumin;calcium;phosphate;acute coronary syndrome;advance care planning;aged;albumin blood level;article;calcium blood level;cause of death;cerebrovascular accident;Charlson Comorbidity Index;chronic kidney failure;chronic lung disease;clinical decision making;cohort analysis;comorbidity;congestive heart failure;conservative treatment;continuous ambulatory peritoneal dialysis;dementia;diabetes mellitus;end stage renal disease;female;follow up;functional status;human;hyperlipidemia;hypertension;immobility;interview;ischemic heart disease;limited mobility;liver disease;major clinical study;male;malignant neoplasm;mental health;mortality;outcome assessment;peripheral vascular disease;peritonitis;phosphate blood level;pneumonia;priority journal;renal replacement therapy;retrospective study;social status;socioeconomics;survival rate;walker,"Kwok, W. H.;Yong, S. P.;Kwok, O. L.",2016,,10.1016/j.hkjn.2016.04.002,0,
2457,Metabolic syndrome as an independent risk factor of silent brain infarction in healthy people,"Background and Purpose - Metabolic syndrome (MetS) is associated with an increased risk of the subsequent development of cardiovascular disease or stroke. Moreover, a silent brain infarction (SBI) can predict clinical overt stroke or dementia. We examined the associations between SBI and MetS in apparently healthy individuals. Methods - We evaluated 1588 neurologically healthy subjects (927 males and 661 females) who underwent brain MRI at Seoul National University Hospital Healthcare System Gangnam Center. MetS was defined using the criteria of the National Cholesterol Education Program Adult Treatment Panel III. We examined associations between full syndrome (≥3 of the 5 conditions) as well as its components and SBI by controlling possible confounders. Results - Eighty-eight (5.5%) were found to have ≥1 SBI on MRI. Age was found to be significantly related to SBI prevalence (odds ratio [OR], 1.06; 95% CI, 1.04 to 1.09). A history of coronary artery disease was associated with an elevated odds ratio of SBI (OR, 2.83; 95% CI, 1.38 to 5.82), and MetS was significantly associated with SBI (OR, 2.18; 95% CI, 1.38 to 3.44). The components model of MetS showed a strong significance between an elevated blood pressure (OR, 3.75; 95% CI, 2.05 to 6.85) and an impaired fasting glucose (OR, 1.74; 95% CI, 1.08 to 2.80) and the risk of SBI. Conclusions - MetS was found to be significantly associated with SBI. This finding has clinical utility in terms of identifying healthy people at increased risk of developing SBI. © 2006 American Heart Association, Inc.",adult;age;aged;article;blood pressure;brain infarction;cardiovascular disease;coronary artery disease;dementia;disease association;fasting blood glucose;female;glucose blood level;high risk population;human;major clinical study;male;metabolic syndrome X;National Cholesterol Education Program Adult Treatment Pannel III;nuclear magnetic resonance imaging;panel study;prevalence;priority journal;risk factor;South Korea;cerebrovascular accident;university hospital,"Kwon, H. M.;Beom, J. K.;Lee, S. H.;Seung, H. C.;Oh, B. H.;Yoon, B. W.",2006,,,0,
2458,List of drugs in development for neurodegenerative diseases: Update September 2005,,"nebicapone;1 (benzo[b]thien 5 yl) 2 (2 diethylaminoethoxy)ethanol;10,10 bis(4 pyridinylmethyl) 9(10h) anthracenone;17alpha estradiol;coluracetam;2 (3 pyridinyl)quinuclidine;2 [4 (2,5 difluorobenzyloxy)phenoxy] 5 ethoxyaniline;2 [4 methoxy 3 (2 phenylethoxy)phenyl] n,n dipropylethylamine;pozanicline;2,3 dihydro 3,4 cyclopentano 1,2,4 benzothiadiazine 1,1 dioxide;27 o [3 [2 (3 carboxyacryloylamino) 5 hydroxyphenyl]acryloyloxy]myricerone;3 (2 carboxy 2 phenylethenyl) 4,6 dichloro 1h indole 2 carboxylic acid;3 (2 carboxy 4,6 dichloro 3 indolyl)propionic acid;3 allyl 6 chloro 2,3,4,5 tetrahydro 7,8 dihydroxy 1 phenyl 1h 3 benzazepine;3 amino 1,1 bis(3 fluorophenyl)butane;3 aminopropylbutylphosphinic acid;3,3',4,4' tetrahydro 6,6',8,8' tetramethoxy 3,3' dimethyl[10,10' bi 2 oxanthracene] 4,9,9' (1h,1'h) triol 4 acetate;3,4 dihydro 4,4 dimethyl 1,3 benzoselenazine;3,6,7,9 tetrahydro 2 (3 isoxazolyl)imidazo[4,5 d]pyrano[4,3 b]pyridine;4 (2 fluorophenyl) 6 methyl 2 (1 piperazinyl)thieno[2,3 d]pyrimidine;4 carboxymethylamino 5,7 dichloro 2 quinolinecarboxylic acid;ibipinabant;4 methylglutamic acid;5 (3,5 di tert butyl 4 hydroxybenzylidene) 4 thiazolidinone;5 (4 chlorophenyl) 4 ethyl 2,4 dihydro 2 methyl 3h 1,2,4 triazol 3 one;6 quinoxalinecarboxylic acid piperidide;pardoprunox;7 b 12;7 dipropylamino 2,3,5,6,7,8 hexahydronaphtho[2,3 b]furan;8 [4 [3 (5 fluoro 1h indol 3 yl)propyl] 1 piperazinyl] 2 methyl 1,4 benzoxazin 3(4h) one;a 35380;a 366833;ac 184897;ac 90222;vanutide cridificar;pimavanserin;ad gl 0002;adnf 14;adx 2;adx 4;aeg 3482;aeol 10113;aeol 10150;af 150;agt 100;agt 120;agt 140;agt 160;agy 207;ak 275;davunetide;al 208;al 309;aloxistatin acid;alpha [[1 butyl 5 [2 [(2 carboxyphenyl)methoxy] 4 methoxyphenyl] 1h pyrazol 4 yl]methylene] 6 methoxy 1,3 benzodioxole 5 propanoic acid;analgesic agent;angiogenic factor;anorexigenic agent;anticonvulsive agent;antidepressant agent;antidiabetic agent;antiemetic agent;antihypertensive agent;antiinfective agent;antiinflammatory agent;antineoplastic agent;antioxidant;antiparkinson agent;anxiolytic agent;apoptosis inhibitor;ar 139525;ar a 008055;ar r 18565;selumetinib;arundic acid;arx 2000;arx 2001;arx 2002;as 004509;as 600292;(1,3 benzothiazol 2 yl)[2 [2 (3 pyridinyl)ethylamino] 4 pyrimidinyl]acetonitrile;ascomycin;autovac;av 201;drinabant;az 36041;azd 0328;azd 9272;ba 1016;bapineuzumab;bay 36 7620;bay 38 7271;bay 44 2041;bay x 9227;bd 1054;bgc 20 1178;crobenetine;bls 602;bls 605;bp 897;abio 0801;bts 72664;bvt 2989;c 7617;c 9136;Alzheimer disease vaccine;cardiovascular agent;cas 93;cdd 0102;cdd 0304;cee 03 310;central muscle relaxant;9,12 epoxy 5,16 bis[(ethylthio)methyl] 2,3,9,10,11,12 hexahydro 10 hydroxy 9 methyl 1 oxo 1h diindolo[1,2,3 fg:3',2',1' kl]pyrrolo[3,4 i][1,6]benzodiazocine 10 carboxylic acid methyl ester;cep 3122;cep 4143;cere 110;cere 120;cere 130;terestigmine;indantadol;ckd 705;cm 2433;cnic 568;cns 2103;cns 5065;cns 5161;contrast medium;cp 132484;cp 283097;cp 465022;cpc 304;ct 500;dar 201;dd 20207;decahydro 6 (2h tetrazol 5 ylmethyl) 3 isoquinolinecarboxylic acid;tezampanel;decahydro 6 phosphonomethyl 3 isoquinolinecarboxylic acid;disufenton sodium;dp 103;dp 109;dr 2313;dy 9760 e;perampanel;e 2012;e 2051;e 2101;eab 318;ef 7412;egis 7444;eglumetad;eht 201;eht 202;er 127528;ethyleneglycol 1,2 bis(2 aminophenyl) ether n,n,n',n' tetraacetic acid bis(2 octyloxyethyl) ester;f 10981;f 2 ccg i;farampator;fce 29642 a;fce 39484 a;fk 962;fp 7832;fpl 16283;fr 210575;gero 46;ggf 2;Ginkgo biloba extract;retigabine;gmc 1111;gpi 14683;gpi 1485;growth factor;gt 1061;gt 3381;harkoseride;homotaurine;hypnotic agent;ica 69673;icosapentaenoic acid ethyl ester;igt 440103;immunomodulating agent;ino 1001;isovaleramide;ispronicline;istradefylline;it 657;kf 17329;krp 17329;krp 199;krx 411;l 687306;l 701252;lau 0501;rocepafant;lecozotan;lhm 123;liga 20;lurasidone;ly 354006;semagacestat;mibampator;ly 483518;m 40401;pyridoxal 5 phosphate;mc 45228;mc 45308;mc 5422;coleneuramide;mdl 102288;mem 1003;mem 1414;mip 170 d;mito 4565;mrx 820;mt 5;muscle relaxant agent;mw 01 2 151 wh;mx 1013;n (2 aminoethyl) 5 (3 fluorophenyl) 4 thiazolecarboxamide;n (7 hydroxy 2,2,4,6 tetramethyl 1 indanyl) 4 (3 methoxyphenyl) 1 piperazineacetamide;n 3393;n [4 [2 (6 cyano 1,2,3,4 tetrahydro 2 isoquinolinyl)ethyl]cyclohexyl] 4 quinolinecarboxamide;n acetylcysteinylasparaginylprolylarginylglycylaspartyl(o methyltyrosyl)arginylcysteinamide cyclic 1,9 disulfide;rivanicline;n sec butyl 1 (2 chlorophenyl) n methyl 3 isoquinolinecarboxamide;nbi 30702;ncx 2216;nepp 10;nerispirdine;neuroleptic agent;neuroprotective agent;ngx 267;nh 02 d;nnc 07 0775;nootropic agent;nox 700;np 0361;nrt 115;2 [5 (4 dimethylsulfamoylphenyl) 6,7,8,9 tetrahydro 8 methyl 2 oxo 1h pyrrolo[3,2 h]isoquinolin 3 yliminoxy] 4 hydroxybutyric acid;tesofensine;nt 69 l;nw 1048;nxd 5150;nxd 9062;olanzapine;p 58;p 9939;pan 408;pan 527;pan 811;pbt 1;pbt 2;pd 132026;pd 148903;pd 150606;pd 159265;pd 90780;pdc 008 004;pn 277;pn 401;pnu 101033 e;pnu 170413;pnu 177854;pol 255;ppi 1019;ppi 368;pre 103;protective agent;prs 211220;prx 03140;pti 777;pym 50018;pym 50028;qg 2283;qr 333;qs 21;gantenerumab;r 1485;r 1577;radequinil;radiopharmaceutical agent;ren 1654;ren 1820;secretin;rjr 1401;ro 09 2210;rpr 104632;rs 100642;rs 4073;s 14820;s 1746;s 176251;s 33113 1;n [4 [2 (8 cyano 1,3a,4,9b tetrahydro 1 benzopyrano[3,4 c]pyrrol 2(3h) yl)ethyl]phenyl]acetamide;s 34730;s 34730 1;sar 502250;saruplase;vabicaserin;scio 323;talmapimod;sgs 518;sib 1765 f;n (4 fluorophenylsulfonyl)valylleucinal;skf 74652;sl 34 0026;sl 65 0155;snx 482;sp 08;sp 233;spasmolytic agent;spc 9766;sph 1371;spi 014;spm 914;spm 935;paliroden;srn 003 556;ssr 125047;ssr 146977;ssr 180575;1,4 diazabicyclo[3.2.2]nonane 4 carboxylic acid 4 bromophenyl ester;ssr 181507;ssr 482073;2 chloro n [alpha (2 piperidinyl)benzyl] 3 trifluoromethylbenzamide;sun c 5174;sun n 8075;sym 2207;t 2000;t 2001;t 817 ma;tc 2559;tc 4959;tei 3356;tei d 1614;tk 14;tra 418;ts 011;u 74500 a;ucm 3100;uk 279276;uk 351666;uk 356297;uk 356464;unclassified drug;unindexed drug;v 10153;vipadenant;vasodilator agent;vp 025;vx 799;way 855;win 63480 2;win 67500;win 68100;win 69211;gabapentin enacarbil;y 931;yjp 60107;ykp 1358;zk 807762;zset 845;zt 1;alcoholism;allergic rhinitis;alopecia;Alzheimer disease;amnesia;amyloidosis;angina pectoris;anorexia nervosa;anxiety disorder;arthritis;article;asthma;ataxia;atherosclerosis;atrophy;attention deficit disorder;autoimmune disease;bacterial infection;bipolar disorder;bone disease;brain hypoxia;brain injury;brain ischemia;breast tumor;cachexia;neoplasm;cardiovascular disease;cataract;cerebrovascular disease;chronic obstructive lung disease;clinical trial;cocaine dependence;cognitive defect;colitis;colon tumor;congestive heart failure;convulsion;coughing;cystitis;deep vein thrombosis;degenerative disease;dementia;diabetes mellitus;diabetic neuropathy;drug dependence;encephalitis;endocrine disease;enteritis;enteropathy;epilepsy;erectile dysfunction;eye disease;fragile X syndrome;gastrointestinal tumor;gene therapy;genetic disorder;glaucoma;glioma;graft rejection;headache;hearing disorder;heart arrhythmia;heart infarction;hematologic disease;hepatitis;herpes simplex;hormone deficiency;human;Human immunodeficiency virus infection;Huntington chorea;hypercholesterolemia;hypertension;immune deficiency;incontinence;infertility;inflammation;influenza;injury;insomnia;insulin dependent diabetes mellitus;irritable colon;ischemia;ischemic heart disease;leukopenia;liver disease;lung embolism;lung fibrosis;lung malformation;Lyme disease;major depression;melanoma;mental disease;metabolic disorder;middle ear disease;motor neuron disease;mucosa inflammation;multiple sclerosis;muscle hypertonia;muscular dystrophy;myasthenia gravis;nervous system inflammation;nervous system tumor;neurologic disease;neuropathic pain;neurotoxicity;obesity;osteoporosis;pain;pancreas tumor;pancreatitis;panic;paralysis;Parkinson disease;peripheral neuropathy;peripheral occlusive artery disease;pneumocystosis;pollakisuria;priority journal;prostate tumor;protozoal infection;psoriasis;psychosis;reperfusion injury;respiratory distress;respiratory distress syndrome;restenosis;restless legs syndrome;age related macular degeneration;retinitis pigmentosa;retinopathy;rheumatoid arthritis;schizophrenia;sepsis;septic shock;sleep disorder;spinal cord injury;systemic lupus erythematosus;thalassemia;thromboembolism;tinnitus;toxicity;tremor;ulcerative colitis;urinary tract disease;uveitis;virus infection;vomiting;a 74187;aab 001;abt 089;ac 3933;acc 001;acp 103;al 108;arry 142886;as 601245;ave 1625;bia 3 202;biii 890 cl;btg 1640;bxt 51072;cad 106;cep 1347;chf 2060;chf 3381;cx 516;cx 691;dp b 99;e 2007;egb 761;ep 475;es 242 1;fk 520;gke 841;hp 184;kw 6002;lau 8080;lax 101;ly 178002;ly 233536;ly 235959;ly 293558;ly 354740;ly 450139;ly 451395;mc 1;mcc 257;mci 225;mdl 100748;mdl 105519;mdl 27266;mdl 29951;mito 4509;mkc 231;mnd 21;mx 4509;nc 531;ne 100;nps 1407;nps 1776;ns 1209;ns 2330;nxy 059;ono 2506;opc 14117;org 24448;pk 11195;r 1450;rg 1068;rjr 2403;rjr 2429;ro 41 1049;s 0139;s 14297;s 18986;s 33138;s 8510;sb 234551;sb 277011;sca 136;scio 469;sea 0400;sgs 742;sja 6017;skf 82958;slv 308;slv 314;slv 319;sm 13496;spm 927;sr 57667;sra 333;ssr 180711;ssr 504734;sym 2081;t 588;tc 1734;tp 9201;v 2006;xe 991;xp 13512;zydis","Kwon, M. O.;Herrling, P.",2005,,,0,
2459,List of drugs in development for neurodegenerative diseases,,"1 (benzofuran 2 yl) 2 propylaminopentane;3,5 dihydroxyphenylglycine;a 366833;abaperidone;abciximab;ac 184897;agt 140;agy 207;davunetide;altropane;Alzheimer disease vaccine;AMPA receptor antagonist;ancrod;antineoplastic agent;antiparkinson agent;apopain inhibitor;asenapine;av 201;azd 1080;benzothiophene derivative;besonprodil;beta secretase inhibitor;bradykinin B2 receptor antagonist;cardiotrophin 1;caspase 3 inhibitor;ciproxifan;cyclosporin A;dopamine 2 receptor stimulating agent;enzyme inhibitor;n methyl dextro aspartic acid receptor blocking agent;neuroleptic agent;neuroprotective agent;nootropic agent;phenserine;recombinant ciliary neurotrophic factor;saruplase;unclassified drug;unindexed drug;Alzheimer disease;angina pectoris;article;brain ischemia;carcinoma;cardiovascular disease;clinical trial;degenerative disease;drug effect;drug inhibition;drug mechanism;human;ischemic heart disease;multiple sclerosis;Parkinson disease;priority journal;psychosis;restenosis;schizophrenia;thromboembolism;a 74187;al 108","Kwon, M. O.;Herrling, P.",2006,,,0,
2460,A comparative study on comorbidity measurements with lookback period using health insurance database: Focused on patients who underwent percutaneous coronary intervention,"Objectives : To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser' s comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. Methods : This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. Results : Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: ±10.2) and 64.8% of the population was male. Among them, 1,598 (2.6%) had died in hospital. While the predictive ability of the Elixhauser's comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. Conclusions : In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.",acquired immune deficiency syndrome;acute heart infarction;adult;aged;alcohol abuse;anemia;angina pectoris;article;blood clotting disorder;cardiogenic shock;cerebrovascular disease;chronic obstructive lung disease;comorbidity;comparative study;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;female;heart arrhythmia;hemiplegia;hospital admission;human;Human immunodeficiency virus infection;hyperlipidemia;hypertension;hypothyroidism;kidney disease;kidney failure;leukemia;liver disease;lymphoma;major clinical study;male;metastasis;mortality;national health insurance;neurologic disease;obesity;paralysis;paraplegia;peptic ulcer;percutaneous coronary intervention;peripheral vascular disease;predictive validity;prevalence;psychosis;retrospective study;rheumatoid arthritis;statistical analysis;cerebrovascular accident;valvular heart disease;weight reduction,"Kyoung, H. K.;Lee, S. A.",2009,,,0,
2461,Widened QRS interval and left ventricular systolic depression after propafenone and promazine exposure,,5 hydroxypropafenone;cytochrome P450 1A2;cytochrome P450 2A6;cytochrome P450 2B6;cytochrome P450 2C19;cytochrome P450 2D6;cytochrome P450 2E1;cytochrome P450 3A4;depropylpropafenone;promazine;action potential;aged;bradycardia;case report;congestive cardiomyopathy;congestive heart failure;dementia;demethylation;drug elimination;drug exposure;drug half life;drug metabolism;dyspnea;ECG abnormality;female;genotype;atrial fibrillation;heart muscle conduction disturbance;human;in vitro study;in vivo study;left ventricular systolic depression;left ventricular systolic dysfunction;letter;mitral valve regurgitation;peripheral edema;pulmonary hypertension;QRS complex;QRS widening,"La Rocca, R.;Ferrari-Toninelli, G.;Patanè, S.",2014,,,0,
2462,Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial,"METHODSDuring the years 2011 to 12, 160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants, 80 patients will serve as controls in usual community care. Sessions may include topics on dementia, community services, active lifestyle and prevention for cognitive decline, spousal relationship, future planning and emotional well-being. The patients and spouses will have their separate group sessions (ten participants per group) once a week for eight weeks. Main outcome measures will be patients' HRQoL (15D) and spousal caregivers' HRQoL (RAND-36), and sense of competence (SCQ). Secondary measures will be caregivers' psychological well-being (GHQ-12) and coping resources, patients' depression, cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two-year follow-up.DISCUSSIONThis is a 'proof-of-concept' study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention.TRIAL REGISTRATIONACTRN12611001173987.BACKGROUNDAfter diagnosis of a dementing illness, patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health-related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma, heart failure and osteoarthritis. However, self-management interventions have not been studied in dementia. Therefore, our aim was to examine, in an objective-oriented group intervention, the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of caregivers.","Caregivers [psychology];Community Health Nursing [methods] [organization & administration];Dementia [nursing] [psychology] [rehabilitation];Geriatric Nursing [methods] [organization & administration];Geriatrics [methods] [organization & administration];Outcome Assessment (Health Care);Power (Psychology);Program Evaluation;Prospective Studies;Psychotherapy, Group [methods] [organization & administration];Quality of Life;Research Design;Self Care [methods];Self-Help Groups;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword]","Laakkonen, Ml;Hölttä, Eh;Savikko, N;Strandberg, Te;Suominen, M;Pitkälä, Kh",2012,,10.1186/1745-6215-13-133,0,
2463,Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial,"BACKGROUND: After diagnosis of a dementing illness, patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health-related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma, heart failure and osteoarthritis. However, self-management interventions have not been studied in dementia. Therefore, our aim was to examine, in an objective-oriented group intervention, the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of caregivers. METHODS: During the years 2011 to 12, 160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants, 80 patients will serve as controls in usual community care. Sessions may include topics on dementia, community services, active lifestyle and prevention for cognitive decline, spousal relationship, future planning and emotional well-being. The patients and spouses will have their separate group sessions (ten participants per group) once a week for eight weeks. Main outcome measures will be patients' HRQoL (15D) and spousal caregivers' HRQoL (RAND-36), and sense of competence (SCQ). Secondary measures will be caregivers' psychological well-being (GHQ-12) and coping resources, patients' depression, cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two-year follow-up. DISCUSSION: This is a 'proof-of-concept' study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention. TRIAL REGISTRATION: ACTRN12611001173987.","Aged;Caregivers/*psychology;Community Health Nursing/methods/organization & administration;Dementia/nursing/*psychology/*rehabilitation;Female;Geriatric Nursing/methods/organization & administration;Geriatrics/methods/organization & administration;Humans;Male;Outcome Assessment (Health Care);Power (Psychology);Program Evaluation;Prospective Studies;Psychotherapy, Group/*methods/organization & administration;Quality of Life;Research Design;Self Care/*methods;Self-Help Groups","Laakkonen, M. L.;Holtta, E. H.;Savikko, N.;Strandberg, T. E.;Suominen, M.;Pitkala, K. H.",2012,Aug 07,10.1186/1745-6215-13-133,0,
2464,Cardioinhibitory carotid sinus hypersensitivity: Prevalence and predictors in 502 outpatients,"Background: Cardioinhibitory response (CIR) is defined as asystole ≥3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). Pacemaker implantation is indicated for patients with unexplained syncope episodes and CIR. Objective: To determine the prevalence and predictors of CIR in patients with a high prevalence of cardiovascular disease, and assess the clinical significance of CIR in patients with a history of unexplained syncope or falls. Methods: Cross-section design study. Outpatients, aged ≥50 years, referred to the electrocardiography sector of a tertiary hospital. Those with dementia, carotid bruit, and history of myocardial infarction, stroke or transient ischemic attack in the preceding 3 months were excluded. CSM was performed by a single investigator, with the patients in the supine position. CSM was applied on the right side and then on the left side during 10 seconds each time. Results: 502 patients underwent CSM. CIR was present in 52 patients (10.4%; 95% CI: 7.7%-13%). Independent predictors of CIR were male gender (OR: 2.61%; CI 95%: 1.3%-5.1%), structural heart disease (OR: 3.28%; CI 95%: 1.3%-7.9%) and baseline heart rate (P<0.05). The sensitivity of the CIR to CSM in syncope evaluation was low (9.8%). Specificity was high (89.5%), being even better in women (95.3%) and in those without structural heart disease (96.2%). Conclusion: CIR was detected in 10.4% of the patients aged ≥ 50 years. In males and in patients with structural heart disease CIR was more common. In women and patients with no apparent structural heart disease, the presence of CIR was a highly specific finding in the evaluation of syncope or falls.",adult;anamnesis;article;cardiovascular disease;carotid sinus hypersensitivity;clinical feature;controlled study;demography;disease duration;dysarthria;electrocardiography;falling;female;human;major clinical study;male;outpatient care;paresis;prevalence;sex difference;supine position;faintness;tertiary health care;visual field defect,"Lacerda, G. D. C.;Pedrosa, R. C.;De Lacerda, R. C.;Dos Santos, M. C.;Perez, M. D. A.;Teixeira, A. B.;De Siqueira-Filho, A. G.",2008,,,0,
2465,Evaluating hospital care for individuals with Alzheimer's disease using inpatient quality indicators,"The purpose of this study was to determine whether persons with Alzheimer's disease (AD) were at greater risk for in-hospital mortality than non-AD patients as a result of poor quality of care. The study focused on six common medical conditions that result in hospital mortality. Using 1995 to 2000 data from New York state (n = 7,021,065), analysts compared mortality risk for individuals with and without AD. Among men, adjusted odds of death were greater for those with AD for gastrointestinal (GI) hemorrhage (+52 percent), congestive heart failure (CHF) (+42 percent), hip fracture (+35 percent), and acute myocardial infarction (AMI) (+30 percent) (all p < .0001). Among women, AD did not affect risks for most conditions. The results of the study show that men with AD are at higher risk of hospital mortality for common medical conditions, which may indicate poor quality of care. Their risk of hospital death was greater than that of men without AD for AMI, CHF, hip fracture, and GI hemorrhage. Their risk was also greater than that of women with AD for CHF, pneumonia, hip fracture, and GI hemorrhage. With the exception of pneumonia, this risk difference notably exceeded the analogous difference between women and men without AD. Hospital staff should be alerted to greater mortality risk for men with AD, as this risk may indicate lower quality of care.",acute heart infarction;adult;aged;Alzheimer disease;article;congestive heart failure;controlled study;female;gastrointestinal hemorrhage;health care quality;hip fracture;hospital care;hospital patient;hospital personnel;human;major clinical study;male;mortality;pneumonia;sex difference;cerebrovascular accident,"Laditka, J. N.;Laditka, S. B.;Cornman, C. B.",2005,,,0,
2466,Cognitive dysfunction in cardiovascular diseases,"A multitude of modifiable risk factors during the median phase of life are often causative for cognitive dysfunction (CD) in old age. High evidence exists for cigarette smoking, diabetes, physical inactivity and sleeping disorders. Single large scale population based studies proof it for hypertension, hypercholesterinemia and depression, conflicting evidence exists for obesity and work stress. Little attention is paid to the close association between cardiovascular disease conditions and CD, particularly for atrial fibrillation, heart failure and for older patients with coronary heart disease. Undetected CD may be responsible for non-adherence and failure of self-care programs in chronic heart patients.",article;cardiovascular disease;cognitive defect;human,"Ladwig, K. H.",2016,,,0,
2467,A human phenome-interactome network of protein complexes implicated in genetic disorders,"We performed a systematic, large-scale analysis of human protein complexes comprising gene products implicated in many different categories of human disease to create a phenome-interactome network. This was done by integrating quality-controlled interactions of human proteins with a validated, computationally derived phenotype similarity score, permitting identification of previously unknown complexes likely to be associated with disease. Using a phenomic ranking of protein complexes linked to human disease, we developed a Bayesian predictor that in 298 of 669 linkage intervals correctly ranks the known disease-causing protein as the top candidate, and in 870 intervals with no identified disease-causing gene, provides novel candidates implicated in disorders such as retinitis pigmentosa, epithelial ovarian cancer, inflammatory bowel disease, amyotrophic lateral sclerosis, Alzheimer disease, type 2 diabetes and coronary heart disease. Our publicly available draft of protein complexes associated with pathology comprises 506 complexes, which reveal functional relationships between disease-promoting genes that will inform future experimentation.","Bayes Theorem;Databases, Genetic;Databases, Protein;Genetic Diseases, Inborn;Genetic Predisposition to Disease/*genetics;Humans;Mutation;Phenotype;*Protein Conformation;*Protein Interaction Mapping;Proteins/*adverse effects/genetics;Proteome/*genetics;*Proteomics","Lage, K.;Karlberg, E. O.;Storling, Z. M.;Olason, P. I.;Pedersen, A. G.;Rigina, O.;Hinsby, A. M.;Tumer, Z.;Pociot, F.;Tommerup, N.;Moreau, Y.;Brunak, S.",2007,Mar,10.1038/nbt1295,0,
2468,Whipple's disease and Tropheryma whipplei infections,"Whipple's disease, caused by Tropheryma whipplei, involves mainly more than 50 years old Caucasian male, suffering of arthralgia, weight loss and diarrhea. Immunosuppressive treatment prescribed for an erroneous diagnosis of inflammatory rheumatism can cause a worsening of clinical manifestations while antibiotics prescribed for concomitant infection improves the clinical status. Positive T.whipplei PCR performed on saliva and stool samples are a screening suggestive of Whipple's disease. The diagnosis must be confirmed by positive periodic acid Schiff staining or immunohistochemistry performed on small-bowel biopsies. Localized chronic infections are defined by the absence of histological duodenal involvement. Endocarditis mainly occurs in 60-year-old men with arthralgia, cardiac insufficiency or embolic events, frequently without fever. Encephalitis causes diverse clinical involvement mainly with cognitive and psychiatric involvement, dementia, ataxia and weight gain. Uveitis and arthritis are typically chronic, and are frequently resistant to immunosuppressive treatment. PCR performed on various tissues and fluids are the key of the diagnosis, but culture is more sensitive in neurological involvement. The treatment with doxycycline (200. mg/day) and hydroxychloroquine (600. mg/day) for a length of 12 months followed by a lifetime treatment by doxycycline (200. mg/day) should be recommended in classic Whipple's disease. In localized infections, a treatment with doxycycline (200. mg/day) and hydroxychloroquine (600. mg/day) is recommended for 12 to 18 months followed by a lifetime follow-up.",antibiotic agent;doxycycline;hydroxychloroquine;adult;antibiotic therapy;arthralgia;arthritis;article;ataxia;case report;Caucasian;concurrent infection;dementia;diagnostic error;encephalitis;endocarditis;follow up;heart failure;human;human tissue;immunohistochemistry;immunosuppressive treatment;intestine biopsy;intestine lipodystrophy;male;periodic acid Schiff stain;treatment duration;treatment outcome;uveitis;weight gain;weight reduction,"Lagier, J. C.",2014,,,0,
2469,Frequency of phenotype-genotype discrepancies at the apolipoprotein E locus in a large population study,"Apolipoprotein E (apoE) genotypes were determined in a random subset of 1041 subjects enrolled in the Framingham Offspring Study by using DNA amplification followed by restriction isotyping. The results were compared with the apoE phenotypes previously assessed by isoelectric focusing. Discrepancies in apoE allele assignment were found in 98 subjects (9.4%). Both genotype and phenotype were reassessed in these subjects. Genotype misclassification was observed in 20 subjects, whereas the initial phenotype assignment was modified in 46 subjects. No concordance between apoE phenotype and genotype remained in 32 subjects (3.07%). Both methods resulted in similar apoE allele frequencies. Furthermore, no differences were observed regarding the average allelic effect on total cholesterol, LDL cholesterol, or HDL cholesterol concentrations; however, a significant difference was noted on triglyceride concentrations. Our results indicate that most discrepancies between genotype and phenotype assessment of apoE polymorphism were due to sample mishandling, data entry, and technical difficulties rather than true discordances.",apolipoprotein E;cholesterol;high density lipoprotein cholesterol;low density lipoprotein cholesterol;adult;aged;allele;Alzheimer disease;article;chromosome 19;dementia;female;gene locus;genetic variability;genotype;human;ischemic heart disease;major clinical study;male;phenotype;polymerase chain reaction;risk factor,"Lahoz, C.;Osgood, D.;Wilson, P. W. F.;Schaefer, E. J.;Ordovas, J. M.",1996,,,0,
2470,Apolipoprotein E genotype and cardiovascular disease in the Framingham Heart Study,"BACKGROUND: Apolipoprotein (apo) E is a constituent of lipoproteins with considerable variation due to cysteine-arginine exchanges. The apo E4 (Arg112-Cys) polymorphism has been associated with dementia and hypercholesterolemia. We investigated the relation of APOE genotype to cardiovascular disease (CVD) in the Framingham Offspring Study. METHODS AND RESULTS: DNA was isolated from 3413 study participants and APOE genotypes were determined utilizing the polymerase chain reaction and restriction isotyping. In the entire group of subjects, 20.7% had apo E4/4 or E3/4 (Group E4); 14.1% had apo E2/2 or E2/3 (Group E2) and 63.9% had the apo E3/3 genotype (Group E3). Subjects with E2/4 (1.3%) were excluded. Period prevalence of CVD between examinations 1 and 5 (1971-1994) (366 events) was related to APOE genotype. Age adjusted period prevalence of CVD in men was 18.6% for Group E4, 18.2% for Group E2 and 12.7% for Group E3 (P=0.004); while in women these rates were 9.9, 4.9, and 6.6%, respectively (P=0.037). After adjustment for non-lipid risk factors the relative odds for CVD in Group E2 men was 1.79 (P=0.0098) and in Group E4 it was 1.63 (P=0.0086) compared with the Group E3; while in Group E4 women it was 1.56 (P=0.054). After adjustment for all CVD risk factors, the relative odds in Group E2 men was 1.94 (P=0.004) and in Group E4 men it was 1.51 (P=0.0262). CONCLUSIONS: The presence of the apo E2 or apo E4 alleles in men is associated with significantly greater CVD risk. This genotypic information may help to identify individuals at increased risk for CVD events.",Adolescent;Adult;Aged;Alleles;Apolipoprotein E2;Apolipoprotein E4;Apolipoproteins E/*genetics;Cardiovascular Diseases/*epidemiology/*genetics;Child;Cohort Studies;Coronary Disease/epidemiology/genetics;Female;Genetic Predisposition to Disease;Genotype;Humans;Male;Massachusetts;Middle Aged;Odds Ratio;Prevalence;Sex Distribution,"Lahoz, C.;Schaefer, E. J.;Cupples, L. A.;Wilson, P. W.;Levy, D.;Osgood, D.;Parpos, S.;Pedro-Botet, J.;Daly, J. A.;Ordovas, J. M.",2001,Feb 15,,0,
2471,Clinical images: Central pontine myelinolysis,,sodium;sodium chloride;vitamin K group;ADL disability;aged;article;case report;central pontine myelinolysis;coma;dementia;diffusion weighted imaging;disorientation;female;gingiva bleeding;heart failure;human;hyponatremia;international normalized ratio;leg edema;neuroimaging;nuclear magnetic resonance imaging;prognosis;prothrombin time;sodium blood level,"Lai, C. C.;Tan, C. K.;Lin, S. H.;Chen, H. W.",2011,,,0,
2472,Risk of pneumonia in new users of cholinesterase inhibitors for dementia,"Objectives To compare the risk of pneumonia in older adults receiving donepezil, galantamine, or rivastigmine for dementia. Design Retrospective cohort study. Setting Nationally representative 5% sample of Medicare databases. Participants Medicare beneficiaries aged 65 and older who newly initiated cholinesterase inhibitor therapy between 2006 and 2009. Measurements Pneumonia, defined as the presence of a diagnosis code for pneumonia as the primary diagnosis on an inpatient claim or on an emergency department claim followed by dispensing of appropriate antibiotics. Cox proportional hazards models were used to estimate the risk of pneumonia. Subgroup analyses and sensitivity analyses were conducted using alternative pneumonia definitions and adjustments using high-dimensional propensity scores to test the robustness of the results. Results The mean age of 35,570 new users of cholinesterase inhibitors (30,174 users of donepezil, 1,176 users of galantamine, 4,220 users of rivastigmine) was 82; 75% were women, and 82% were white. The cumulative incidence of pneumonia was 51.9 per 1,000 person-years. The risk of pneumonia for rivastigmine users was 24% lower than that of donepezil users (hazard ratio (HR) = 0.75, 95% confidence interval (CI) = 0.60-0.93). Risk in galantamine users (HR = 0.87, 95% CI = 0.62-1.23) was not significantly different from risk in donepezil users. Results of subgroup and sensitivity analyses were similar to the primary results. Conclusion The risk of pneumonia was lower in individuals receiving rivastigmine than in those receiving donepezil. Additional studies are needed to confirm the findings of pneumonia risk between the oral and transdermal forms of rivastigmine and in users of galantamine.",anticonvulsive agent;antidepressant agent;cholinesterase inhibitor;donepezil;galantamine;loop diuretic agent;neuroleptic agent;rivastigmine;adult;age;aged;article;chronic obstructive lung disease;cohort analysis;dementia;diffuse Lewy body disease;female;follow up;geriatric patient;health care utilization;heart failure;human;incidence;major clinical study;male;Parkinson disease;pneumonia;retrospective study;risk assessment;sensitivity analysis,"Lai, E. C. C.;Wong, M. B.;Iwata, I.;Zhang, Y.;Hsieh, C. Y.;Kao Yang, Y. H.;Setoguchi, S.",2015,,,0,
2473,Treatment With Prothrombin Complex Concentrate to Enable Emergency Lumbar Puncture in Patients Receiving Vitamin K Antagonists,"Study objective Lumbar punctures are frequently necessary in neurologic emergencies, but effective oral anticoagulation with vitamin K antagonists represents a contraindication. We report the effectiveness of prothrombin complex concentrates to reverse vitamin K antagonist to enable emergency lumbar punctures, as well as evaluate lumbar puncture– and prothrombin complex concentrates–related complications. Methods Consecutive patients treated with prothrombin complex concentrates between December 2004 and June 2014 to enable emergency lumbar puncture were included. International normalized ratio (INR) before and after prothrombin complex concentrates treatment and the time between start of reversal treatment and lumbar puncture were recorded. A target INR of less than or equal to 1.5 was defined as effective prothrombin complex concentrates treatment. Bleeding events, thromboembolic events, and allergic reactions after prothrombin complex concentrates treatment were identified and classified as “related,” “probably,” “possibly,” “unlikely related,” or “not related” to the lumbar puncture and prothrombin complex concentrates infusion. Results Thirty-seven patients were included (64.9% men; median age 76.0 years; interquartile range [IQR] 71.0 to 84.0 years). The intervention with prothrombin complex concentrates was effective in 33 of 37 patients (89.2%; 95% confidence interval [CI], 78.4% to 97.3%). The median INR was 2.2 (IQR 1.8 to 2.9; 95% CI, 1.9 to 2.5) before and 1.3 (IQR 1.2 to 1.4; 95% CI, 1.2 to 1.3) after prothrombin complex concentrates treatment. The median time between start of prothrombin complex concentrates treatment and lumbar puncture was 135 minutes (IQR 76 to 266 minutes; 95% CI, 84 to 198 minutes). One clinically irrelevant intracranial subdural hematoma “related” to the lumbar puncture developed. No allergic reaction was observed, but 2 of 37 patients (5.4%; 95% CI, 0% to 13.5%) experienced a thromboembolic event (1 ischemic stroke, classified “unlikely related,” and 1 myocardial infarction, “possibly related” to prothrombin complex concentrates treatment). Conclusion Reversing the effect of vitamin K antagonist with prothrombin complex concentrates to enable emergency lumbar puncture appears effective and safe, particularly in regard to bleeding events.",anticoagulant agent;antivitamin K;heparin;heparinoid;phenprocoumon;prothrombin complex;rivaroxaban;aged;allergic reaction;anticoagulant therapy;article;atrial fibrillation;brain disease;brain ischemia;brain lymphoma;cardiomyopathy;central nervous system infection;clinical article;computer assisted tomography;deep vein thrombosis;dementia;encephalitis;epileptic state;female;headache;heart infarction;human;international normalized ratio;intervertebral disk degeneration;lumbar puncture;lung embolism;male;mechanical heart valve;medical record review;meningitis;nuclear magnetic resonance imaging;osteochondrosis;outcome assessment;priority journal;subarachnoid hemorrhage;subdural hematoma,"Laible, M.;Beynon, C.;Sander, P.;Purrucker, J.;Müller, O. J.;Möhlenbruch, M.;Ringleb, P. A.;Rizos, T.",2016,,10.1016/j.annemergmed.2016.03.003,0,
2474,The role and impact of SNPs in pharmacogenomics and personalized medicine,"Over 10 million SNPs have been discovered to date as the result of both a private and public effort in the past two decades. Extensive investigations on SNPs have been performed to assess clinical applications for pharmacogenomics and Personalized Medicine. Recently, around the 10th anniversary of the first publication by the Human Genome Project, Hamburg and Collins addressed questions regarding the progress of the genomics field and its impact on pharmacogenomics / Personalized Medicine. Similar questions remain around the potential link of SNPs to Personalized Medicine applications, and the extent to which they have impacted ""real world"" clinical practices. Built upon these previous efforts, and to achieve our objectives of describing and assessing the role of SNPs and their impact on Personalized Medicine, this article analyzes and summarizes the clinical relevance, molecular mechanisms, clinical evidence, and preliminary regulatory and clinical guideline information of relevant SNPs. In addition, it focuses on two applications directly related to Personalized Medicine drug therapeutics: predictive biomarkers for patient stratification and dose selection. In summary, this article attempts to provide a general and comprehensive view of the role of SNPs in pharmacogenomics and Personalized Medicine, as well as a practical view of their impact on clinical practice today. © 2011 Bentham Science Publishers Ltd.",acetylsalicylic acid;atomoxetine;azathioprine;biological marker;carbamazepine;clopidogrel;cytochrome P450 2C19;cytochrome P450 2C9;cytochrome P450 2D6;donepezil;eslicarbazepine acetate;ximelagatran;fosphenytoin sodium;glucuronosyltransferase 1A1;HLA antigen;HLA DR antigen;imipramine;inosinate dehydrogenase;irinotecan;lamotrigine;mercaptopurine;nilotinib;nortriptyline;oxcarbazepine;pazopanib;phenytoin;serotonin uptake inhibitor;tamoxifen;tetrabenazine;tricyclic antidepressant agent;unclassified drug;unindexed drug;warfarin;acute coronary syndrome;acute lymphoblastic leukemia;allele;Alzheimer disease;artery thrombosis;article;attention deficit disorder;bone marrow suppression;bone marrow toxicity;breast cancer;chronic myeloid leukemia;colorectal cancer;depression;diarrhea;drug clearance;drug metabolism;drug response;dysphagia;dystonia;enzyme activity;epilepsy;febrile neutropenia;genotype;human;Huntington chorea;hyperbilirubinemia;hyperthermia;liver toxicity;maculopapular rash;neuroleptic malignant syndrome;neutropenia;personalized medicine;pharmacogenomics;phenotype;single drug dose;single nucleotide polymorphism;Stevens Johnson syndrome;toxic epidermal necrolysis;vein thrombosis;aspirin;camptosar;coumadin;exanta;exarta;plavix;strattera;tasigna;votrient;xenazine,"Laing, R. E.;Hess, P.;Shen, Y.;Wang, J.;Hu, S. X.",2011,,,0,
2475,New evidence on risk-benefit profile of combined hormone replacement therapy for postmenopausal women,"The risks and benefits of long-term postmenopausal hormone replacement therapy (HRT) have long been a source of controversy. Based on numerous non-randomised observational studies, most investigators believed until recently that the use of HRT reduces the risk of osteoporosis, colorectal cancer, cardiovascular events, Alzheimer's dementia, and possibly stroke but increases the risk of thromboembolic events and possibly breast cancer. Overall, benefit has been considered to outweigh risk. However, these findings have been criticised as selection bias of relatively healthy women may have affected the observed long-term effects in these non-randomised studies. Recently, two large prospective, randomised, double-blind, placebo-controlled studies of continuous-combined oestrogen-progestin therapy for postmenopausal women have been published. These studies, the Heart and Oestrogen/progestin Replacement Study (HERS) and the Women's Health Initiative (WHI), have drawn much attention from both the health profession and the public. It is essential for the practitioners prescribing HRT to interpret the study results with care and to convey the message to the public correctly.",conjugated estrogen plus medroxyprogesterone acetate;estrogen;gestagen;placebo;adult;aged;Alzheimer disease;article;biliary tract disease;breast cancer;cardiovascular disease;clinical observation;colorectal cancer;controlled study;dementia;double blind procedure;drug effect;endometrium cancer;evidence based medicine;female;fracture;general practitioner;health care system;hormone substitution;human;ischemic heart disease;osteoporosis;outcomes research;patient compliance;patient selection;postmenopause;prescription;prospective study;public health service;randomized controlled trial;risk benefit analysis;risk management;cerebrovascular accident;thromboembolism;treatment failure;vein thrombosis,"Lam, P. M.;Chung, T. K. H.;Haines, C.",2003,,,0,
2476,Stoke prevention in diabetes,"Diabetes and ischemic stroke are common disorders that often arise together. Diabetics are at 1.5 to three times the risk of stroke compared with the general population and the associated mortality and morbidity is greater than in those without this underlying condition. Importantly, the relation between disturbed glucose metabolism and cerebrovascular disease is not restricted to acute ischemic stroke. Diabetes is also associated with more insidious ischaemic damage to the brain, mainly manifesting as small-vessel disease and increased risk of cognitive decline and dementia. This paper shows the epidemiologic relationships of stroke in type 2 diabetes and suggest that rigorous assessment and treatment of associated risk factors can substantially reduce the risk of stroke in patients with diabetes.",hydroxymethylglutaryl coenzyme A reductase inhibitor;age;antihypertensive therapy;article;atrial fibrillation;cardiovascular disease;cerebrovascular accident;diabetic patient;disease association;gender;glycemic control;heart left ventricle hypertrophy;high risk patient;human;incidence;non insulin dependent diabetes mellitus;prevalence;prognosis;randomized controlled trial (topic);recurrent disease;risk factor;risk reduction;smoking;systolic blood pressure,"Lamaida, N.;Pizza, V.;Lamaida, E.;Capuano, E.;Capuano, E.;Capuano, R.;Capuano, V.;Russo, L.;Rastrelli, L.;Saturnino, C.;Capasso, A.",2016,,,0,
2477,Economic impact of workplace productivity losses due to allergic rhinitis compared with select medical conditions in the United States from an employer perspective,"Objective: To evaluate the cost of lost productivity in the workplace due to allergic rhinitis compared to other selected medical conditions from an employer perspective. Setting and participants: A total of 8267 US employees at 47 employer locations who volunteered to participate in health/wellness screenings. Measurements: The Work Productivity Short Inventory was used to assess the impact of a predefined group of health conditions on workplace productivity for the previous 12 months. Both absenteeism and presenteeism (lost productivity while at work) were recorded. Costs were calculated using a standard hourly wage. Results: Allergic rhinitis was the most prevalent of the selected conditions; 55% of employees reported experiencing allergic rhinitis symptoms for an average of 52.5 days, were absent 3.6 days per year due to the condition, and were unproductive 2.3 h per workday when experiencing symptoms. The mean total productivity (absenteeism + presenteeism) losses per employee per year were US $593 for allergic rhinitis, $518 for high stress, $277 for migraine, $273 for depression, $269 for arthritis/rheumatism, $248 for anxiety disorder, $181 for respiratory infections, $105 for hypertension or high blood pressure, $95 for diabetes, $85 for asthma, and $40 for coronary heart disease. The mean total productivity loss per employee per year due to caregiving was $102 for pediatric respiratory infections, $85 for pediatric allergies, $49 for Alzheimer's disease, and $42 for otitis media/earache. Conclusions: Allergies are major contributors to the total cost of health-related absenteeism and presenteeism. Payers and employers need to consider this when determining health benefits for employees. © 2006 Librapharm Limited.",absenteeism;allergic rhinitis;allergy;Alzheimer disease;analysis of variance;anxiety disorder;arthritis;article;asthma;caregiver;comparative study;controlled study;cost benefit analysis;depression;diabetes mellitus;economic aspect;female;health care;human;hypertension;ischemic heart disease;major clinical study;male;migraine;otalgia;otitis media;prevalence;productivity;respiratory tract infection;rheumatic disease;stress;symptomatology;United States;wellbeing;workplace,"Lamb, C. E.;Ratner, P. H.;Johnson, C. E.;Ambegaonkar, A. J.;Joshi, A. V.;Day, D.;Sampson, N.;Eng, B.",2006,,,0,
2478,Palliative care provision in the emergency department: barriers reported by emergency physicians,"BACKGROUND: There is increasing interest in moving palliative care (PC) upstream to the emergency department (ED). However, barriers to PC provision in ED exist and are not yet clearly delineated. OBJECTIVE: To elicit the ED physicians' perceived barriers to provision of PC in the ED. METHODS: ED physicians at an urban, level-1 trauma center completed an anonymous survey. Participants ranked 23 statements on a five-point Likert-like scale (1=strongly disagree to 5=strongly agree). Statements covered four main domains of PC barriers: (1) education and training, (2) communication, (3) ED environment, and (4) personal beliefs. Respondents were also asked if they would initiate a PC consultation for ED-specific clinical scenarios (based on established triggers). RESULTS: Sixty-seven percent (30/45) of eligible participants completed the survey, average age 31 years. Respondents listed two major barriers to ED PC provision: lack of 24 hour availability of PC team (mean 4.4) and lack of access to complete medical records (mean 4.2). Almost all respondents agreed they would initiate a PC consultation for a hospice patient in respiratory distress, and the majority would consult for massive intracranial hemorrhage, traumatic arrest, or metastatic cancer. However inpatient triggers like frequent readmits for organ failure issues, e.g., dementia, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD), were rarely chosen for an ED PC consultation. CONCLUSION: We identify two main ED physician-perceived barriers to PC provision: lack of access to medical records and lack of 24/7 availability of PC team. ED physicians may not use the same criteria to initiate PC consultation as used in traditional inpatient PC trigger models. Outlining ED-specific triggers may help streamline the palliative consultation process.","Adult;*Attitude of Health Personnel;Emergency Service, Hospital/manpower/*organization & administration;Female;Health Services Accessibility;Humans;Male;*Palliative Care;Patient Care Team/organization & administration;Personnel Staffing and Scheduling;Physicians/*psychology;Surveys and Questionnaires","Lamba, S.;Nagurka, R.;Zielinski, A.;Scott, S. R.",2013,Feb,10.1089/jpm.2012.0402,0,
2479,Independent association of an APOE gene promoter polymorphism with increased risk of myocardial infarction and decreased APOE plasma concentrations - The ECTIM Study,"Apolipoprotein E (APOE) is a major protein in lipid metabolism existing in three common isoforms: APOE2, -3 and -4. The ε4 allele of the APOE gene (APOE) coding for the APOE4 isoform is associated with an increased risk of myocardial infarction (MI) and of Alzheimer's disease (AD). Recently, several polymorphisms in the APOE regulatory region have been reported. Some of these have been associated with AD and modified APOE allelic mRNA expression in AD brains. Here, we have investigated whether three of these promoter polymorphisms (-491AT, -427CT and -219GT) can also modify cardiovascular risk. The hypothesis was tested in a large multicentre case-control study of MI, the ECTIM Study, on 567 cases and 678 controls. Among the three APOE promoter polymorphisms tested, only the -219T allele was associated with a significantly increased risk of MI (OR = 1.29, 95% CI: 1.09-1.52, P < 0.003) and the effect was shown to be independent of the presence of the other mutations, including the APOE ε2/ε3/ε4 polymorphism. Moreover, the -219T allele greatly decreased the APOE plasma concentrations in a dose-dependent manner (P < 0.008). These data indicate that the -219GT polymorphism of the APOE regulatory region emerges as a new genetic susceptibility risk factor for MI and constitutes another common risk factor for both neurodegenerative and cardiovascular diseases.",apolipoprotein E;isoprotein;messenger RNA;adult;Alzheimer disease;article;cardiovascular risk;controlled study;genetic polymorphism;genetic susceptibility;heart infarction;human;lipid metabolism;lipoprotein blood level;major clinical study;male;multicenter study;priority journal;promoter region,"Lambert, J. C.;Brousseau, T.;Defosse, V.;Evans, A.;Arveiler, D.;Ruidavets, J. B.;Haas, B.;Cambou, J. P.;Luc, G.;Ducimetière, P.;Cambien, F.;Chartier-Harlin, M. C.;Amouyel, P.",2000,,,0,
2480,Fetal-type variants of the posterior cerebral artery and concurrent infarction in the major arterial territories of the cerebral hemisphere,"Fetal-type or fetal posterior cerebral artery (FPCA) is a variant of cerebrovascular anatomy in which the distal posterior cerebral artery (PCA) territory is perfused by a branch of the internal carotid artery (ICA). In the presence of FPCA, thromboembolism in the anterior circulation may result in paradoxical PCA territory infarction with or without concomitant infarction in the territories of the middle (MCA) or the anterior (ACA) cerebral artery. We describe 2 cases of FPCA and concurrent acute infarction in the PCA and ICA territories—right PCA and MCA in Patient 1 and left PCA, MCA, and ACA in Patient 2. Noninvasive angiography detected a left FPCA in both patients. While FPCA was clearly the mechanism of paradoxical infarction in Patient 2, it turned out to be an incidental finding in Patient 1 when evidence of a classic right PCA was uncovered from an old computed tomography scan image. Differences in anatomical details of the FPCA in each patient suggest that the 2 FPCAs are developmentally different. The FPCA of Patient 1 appeared to be an extension of the embryonic left posterior communicating artery (PcomA). Patient 2 had 2 PCAs on the left (PCA duplication), classic bilateral PCAs, and PcomAs, and absent left anterior choroidal artery (AchoA), suggesting developmental AchoA-to-FPCA transformation on the left. These 2 cases underscore the variable anatomy, clinical significance, and embryological origins of FPCA variants.",acetylsalicylic acid;warfarin;aged;anatomical variation;angiography;article;atrial fibrillation;Babinski reflex;brain blood flow;brain ischemia;case report;cerebral artery disease;computer assisted tomography;dementia;diffusion weighted imaging;echocardiography;electrocardiography;electroencephalography;female;fetal posterior cerebral artery;heart infarction;human;hyperlipidemia;hypertension;long term care;mitral valve replacement;nerve conduction disorder;neurologic examination;nuclear magnetic resonance imaging;posterior cerebral artery;posterior communicating artery;priority journal;somnolence;vertebral artery;very elderly,"Lambert, S. L.;Williams, F. J.;Oganisyan, Z. Z.;Branch, L. A.;Mader, E. C.",2016,,10.1177/2324709616665409,0,
2481,Medicinal mishap: Neutropenia with quetiapine,,acetylsalicylic acid;diltiazem;donepezil;furosemide;omeprazole;quetiapine;salbutamol;sertraline;tiotropium bromide;aged;Alzheimer disease;anamnesis;anxiety;article;case report;diastolic heart failure;female;gastritis;heart arrhythmia;atrial fibrillation;hospital admission;human;leukocyte count;lung edema;neutropenia;pleura effusion;psychosis;thorax radiography;aspirin,"Landau, J.;Lu, K.;Choo, C.;Greenberg, P.",2008,,,0,
2482,Benefits vs the harms of automated external defibrillator use 10,,automated external defibrillator;brain damage;cognitive defect;dementia;depression;dysplasia;heart arrest;hemiparesis;hospital care;human;letter;locked in syndrome;medical ethics;medical liability;memory disorder;mental capacity;priority journal;resuscitation;risk benefit analysis;treatment outcome,"Landau, W. M.;Jaffe, A. S.;Wetzel, R. D.",2006,,,0,
2483,National quality-of-care standards in home-based primary care,,caregiver;daily life activity;dementia;evidence based medicine;family counseling;geriatric patient;health care cost;health care quality;heart failure;home care;human;letter;medicare;mortality;patient care;practice guideline;primary medical care;priority journal;survival,"Landers, S. H.",2007,,,0,
2484,Functional status and clinical correlates in cognitively impaired community-living older people,"We describe the prevalence of cognitive impairment in a population of community-living older people, its association with functional decline, and degree of comorbidity. In addition, we examined the relationship between different levels of cognitive impairment and mortality. We conducted an observational study of 1787 patients aged 65 years and above with any degree of cognitive impairment. Patient data were collected with the Minimum Data Set for Home Care. More than 50% of patients had some level of cognitive impairment, which correlates with the degree of physical frailty. On the contrary, patients with cognitive impairment appear to have fewer comorbid conditions and are less likely to receive medications than patients with normal cognitive status. In particular, hypertension, congestive heart failure, chronic obstructive pulmonary disease, cancer, diabetes mellitus, and osteoporosis are found more frequently among patients with normal mental status compared with those showing some level of cognitive defects. Yet, more severe cognitive impairment is associated with a higher mortality rate. Demented patients are characterized by a high prevalence of functional disability and by increased mortality. This increased morbidity and mortality rate is associated with a lower prevalence of comorbid clinical conditions and drug use, relative to patients with normal cognitive performance. The present findings support the possibility that severe cognitive impairment has an independent effect on survival.","*Activities of Daily Living;Aged;Aged, 80 and over;Chronic Disease;Cognition Disorders/*epidemiology;Comorbidity/trends;Dementia/*epidemiology;Drug Utilization;Female;Frail Elderly/psychology/*statistics & numerical data;Humans;Italy/epidemiology;Male;Severity of Illness Index;Survival Rate/trends","Landi, F.;Onder, G.;Cattel, C.;Gambassi, G.;Lattanzio, F.;Cesari, M.;Russo, A.;Bernabei, R.",2001,Spring,,0,
2485,Stroke subtyping for genetic association studies? A comparison of the CCS and TOAST classifications,"Background: A reliable and reproducible classification system of stroke subtype is essential for epidemiological and genetic studies. The Causative Classification of Stroke system is an evidence-based computerized algorithm with excellent inter-rater reliability. It has been suggested that, compared to the Trial of ORG 10172 in Acute Stroke Treatment classification, it increases the proportion of cases with defined subtype that may increase power in genetic association studies. We compared Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications in a large cohort of well-phenotyped stroke patients. Methods: Six hundred ninety consecutively recruited patients with first-ever ischemic stroke were classified, using review of clinical data and original imaging, according to the Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications. Results: There was excellent agreement subtype assigned by between Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system (kappa=0��85). The agreement was excellent for the major individual subtypes: large artery atherosclerosis kappa=0��888, small-artery occlusion kappa=0��869, cardiac embolism kappa=0��89, and undetermined category kappa=0��884. There was only moderate agreement (kappa=0��41) for the subjects with at least two competing underlying mechanism. Thirty-five (5��8%) patients classified as undetermined by Trial of ORG 10172 in Acute Stroke Treatment were assigned to a definite subtype by Causative Classification of Stroke system. Thirty-two subjects assigned to a definite subtype by Trial of ORG 10172 in Acute Stroke Treatment were classified as undetermined by Causative Classification of Stroke system. Conclusions: There is excellent agreement between classification using Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke systems but no evidence that Causative Classification of Stroke system reduced the proportion of patients classified to undetermined subtypes. The excellent inter-rater reproducibility and web-based semiautomated nature make Causative Classification of Stroke system suitable for multicenter studies, but the benefit of reclassifying cases already classified using the Trial of ORG 10172 in Acute Stroke Treatment system on existing databases is likely to be small. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.",aged;artery occlusion;article;atherosclerosis;brain ischemia;cardioembolic stroke;Causative Classification of Stroke system;cohort analysis;disease classification;echocardiography;embolism;female;genetic association;heart left ventricle hypertrophy;human;intermethod comparison;interrater reliability;magnetic resonance angiography;major clinical study;male;neuroimaging;nuclear magnetic resonance imaging;phenotype;priority journal;reproducibility;Trial of Org 10172 in Acute Stroke Treatment classification,"Lanfranconi, S.;Markus, H. S.",2013,,,0,
2486,Two Liters a Day Keep the Doctor Away? Considerations on the Pathophysiology of Suboptimal Fluid Intake in the Common Population,"Suboptimal fluid intake may require enhanced release of antidiuretic hormone (ADH) or vasopressin for the maintenance of adequate hydration. Enhanced copeptin levels (reflecting enhanced vasopressin levels) in 25% of the common population are associated with enhanced risk of metabolic syndrome with abdominal obesity, type 2 diabetes, hypertension, coronary artery disease, heart failure, vascular dementia, cognitive impairment, microalbuminuria, chronic kidney disease, inflammatory bowel disease, cancer, and premature mortality. Vasopressin stimulates the release of glucocorticoids which in turn up-regulate the serum- and glucocorticoid-inducible kinase 1 (SGK1). Moreover, dehydration upregulates the transcription factor NFAT5, which in turn stimulates SGK1 expression. SGK1 is activated by insulin, growth factors and oxidative stress via phosphatidylinositide-3-kinase, 3-phosphoinositide-dependent kinase PDK1 and mTOR. SGK1 is a powerful stimulator of Na+/K+-ATPase, carriers (e.g. the Na+,K+,2Cl- cotransporter NKCC, the NaCl cotransporter NCC, the Na+/H+ exchanger NHE3, and the Na+ coupled glucose transporter SGLT1), and ion channels (e.g. the epithelial Na+ channel ENaC, the Ca2+ release activated Ca2+ channel Orai1 with its stimulator STIM1, and diverse K+ channels). SGK1 further participates in the regulation of the transcription factors nuclear factor kappa-B NFkappaB, p53, cAMP responsive element binding protein (CREB), activator protein-1, and forkhead transcription factor FKHR-L1 (FOXO3a). Enhanced SGK1 activity fosters the development of hypertension, obesity, diabetes, thrombosis, stroke, inflammation including inflammatory bowel disease and autoimmune disease, cardiac fibrosis, proteinuria, renal failure as well as tumor growth. The present brief review makes the case that suboptimal fluid intake in the common population may enhance vasopressin and glucocorticoid levels thus up-regulating SGK1 expression and favouring the development of SGK1 related pathologies.",Cancer;Chronic kidney disease;Copeptin;Glucocorticoids;Metabolic syndrome;Vasopressin,"Lang, F.;Guelinckx, I.;Lemetais, G.;Melander, O.",2017,,,0,
2487,"Is obesity a marker of robustness in vulnerable hospitalized aged populations? Prospective, multicenter cohort study of 1 306 acutely ill patients","Background: The ""obesity paradox"" is poorly understood in vulnerable older hospitalized populations. Objectives: To prospectively analyze the impact of body mass index (BMI) and comorbidities on early (6-week), one- and two-year mortality. Design: Prospective multicenter study with a two-year follow-up of old patients participating in the SAFES cohort study. Settings: Nine university hospitals in France. Participants: Patients aged 75 or older hospitalized in medical divisions through the emergency department. Measurement: Inpatients' characteristics were obtained through a comprehensive geriatric assessment of inpatients, conducted in the first week of hospitalization. All-cause mortalities at 6-week, one- and two-year were determined using bivariable and multivariable Cox proportional hazard model. Results: The SAFES cohort included 1,306 patients, aged 85±6 years, with a majority of women (65%). One- and two-year mortality were inversely associated with BMI ≥30 kg/m2 while early mortality was not, and positively associated with age, burden of comorbidities, walking disorders, level of dependency and presence of a dementia syndrome. Survival rates between patients in low (< 18.0 kg/m2) and intermediate (18-24.9 and 25-29.9 kg/m2) BMI categories were not significant. Conclusion: While our findings seem to confirm the reality of the ""obesity paradox"" in vulnerable older hospitalized population, the exact understanding of underlying mechanisms and even the truthfulness of this paradoxical relationship are still fraught with considerable methodological, epidemiological and metabolic challenges. © 2014 Serdi and Springer-Verlag France.",acute heart infarction;aged;aged hospital patient;anthropometry;article;body mass;cerebrovascular disease;cohort analysis;comorbidity;connective tissue disease;critically ill patient;dementia;diabetes mellitus;emergency ward;female;follow up;geriatric assessment;geriatric patient;heart failure;hospitalization;human;Human immunodeficiency virus infection;independence;kidney disease;liver disease;lung disease;major clinical study;male;mortality;multicenter study;neoplasm;nutritional status;obesity;paraplegia;peptic ulcer;peripheral vascular disease;priority journal;survival rate;university hospital;very elderly;vulnerable population;walking difficulty,"Lang, P. O.;Mahmoudi, R.;Novella, J. L.;Tardieu, E.;Bertholon, L. A.;Nazeyrollas, P.;Blanchard, F.;Jolly, D.;Drame, M.",2014,,,0,
2488,Interdisciplinary Geriatric and Psychiatric Care Reduces Potentially Inappropriate Prescribing in the Hospital: Interventional Study in 150 Acutely Ill Elderly Patients with Mental and Somatic Comorbid Conditions,"Background: Potentially inappropriate medications and prescription omissions (PO) are highly prevalent in older patients with mental comorbidities. Objective: To evaluate the effect of interdisciplinary geriatric and psychiatric care on the appropriateness of prescribing. Design: Prospective and interventional study. Setting: Medical-psychiatric unit in an academic geriatric department. Participants: Participants were 150 consecutive acutely ill patients aged on average 80.0 ± 8.1 years suffering from mental comorbidities and hospitalized for any acute somatic condition. Intervention: From admission to discharge, daily collaboration provided by senior geriatrician and psychiatrist working in a usual geriatric interdisciplinary care team. Measurements: Potentially inappropriate medications and PO were detected and recorded by a trained independent investigator using STOPP/START criteria at admission and discharge. Results: Compared with admission, the intervention reduced the total number of medications prescribed at discharge from 1347 to 790 (P < .0001) and incidence rates for potentially inappropriate medications and PO reduced from 77% to 19% (P < .0001) and from 65% to 11% (P < .0001), respectively. Independent predictive factors for PIP at discharge were being a faller (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.43-2.09) and for PO, the increased number of medications (OR 1.54; 95% CI 1.13-1.89) and a Charlson comorbidity index greater than 2 (OR 1.85; 95% CI 1.38 - 2.13). Dementia and/or presence of psychiatric comorbidities were predictive factors for both potentially inappropriate medications and PO at discharge. Conclusion: These findings hold substantial promise for the prevention of IP and OP in such a comorbid and polymedicated population. Further evaluations are, however, still needed to determine if such an intervention reduces potentially inappropriate prescribing medication-related outcomes, such as incidence of adverse drug events, rehospitalization, or mortality. © 2012 American Medical Directors Association, Inc.",acetylsalicylic acid;antidepressant agent;beta 2 adrenergic receptor stimulating agent;calcium;calcium channel blocking agent;cholinergic receptor blocking agent;clopidogrel;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;loop diuretic agent;metformin;neuroleptic agent;proton pump inhibitor;vitamin D;warfarin;aged;Alzheimer disease;anemia;ankle edema;anxiety disorder;artery disease;arthritis;article;asthma;atherosclerosis;bleeding;cerebrovascular disease;chronic kidney disease;chronic lung disease;chronic obstructive lung disease;cognitive defect;comorbidity;congestive heart failure;constipation;delirium;dementia;depression;diabetes mellitus;eating disorder;evaluation study;extrapyramidal symptom;falling;female;geriatric care;geriatric patient;heart arrhythmia;atrial fibrillation;heart failure;heart infarction;hospital admission;hospital discharge;hospitalization;human;hydrocephalus;hypertension;hyponatremia;ileus;intervention study;ischemic heart disease;low back pain;major clinical study;male;medical error;mental health care;metabolic disorder;multiple myeloma;myelodysplastic syndrome;non insulin dependent diabetes mellitus;osteoporosis;parkinsonism;peptic ulcer;peripheral vascular disease;personality disorder;physician;pneumonia;polyarthritis;prediction;prescription;primary hyperparathyroidism;prospective study;psychiatrist;cerebrovascular accident;urinary tract infection;vascular disease;aspirin,"Lang, P. O.;Vogt-Ferrier, N.;Hasso, Y.;Le Saint, L.;Dramé, M.;Zekry, D.;Huber, P.;Chamot, C.;Gattelet, P.;Prudent, M.;Gold, G.;Michel, J. P.",2012,,,0,
2489,Hypertension care: Striking the proper balance,,adrenergic receptor stimulating agent;amlodipine;angiotensin receptor antagonist;antihypertensive agent;beta adrenergic receptor blocking agent;caffeine;calcium channel blocking agent;clonidine;creatinine;diltiazem;dipeptidyl carboxypeptidase inhibitor;diuretic agent;felodipine;hydralazine;methyldopa;minoxidil;nifedipine;nonsteroid antiinflammatory agent;potassium;reserpine;thiazide diuretic agent;tricyclic antidepressant agent;verapamil;angioneurotic edema;antihypertensive therapy;article;bradycardia;cardiovascular disease;chronic kidney disease;clinical trial;constipation;coughing;creatinine blood level;dehydration;dementia;depression;diastolic blood pressure;dizziness;drug cost;fluid retention;geriatric disorder;atrial fibrillation;heart failure;heart infarction;heart muscle conduction disturbance;human;hypertension;hypokalemia;hypotension;kidney failure;medical practice;mortality;orthostatic hypertension;orthostatic hypotension;pain;patient compliance;peripheral edema;polypharmacy;potassium blood level;practice guideline;recurrent disease;renin angiotensin aldosterone system;respiratory tract disease;sedation;sexual dysfunction;side effect;sodium restriction;sodium retention;stable angina pectoris;cerebrovascular accident;supraventricular tachycardia;faintness;systolic blood pressure;systolic hypertension;tachycardia;treatment indication;weight reduction;xerostomia,"Langan, R. C.;Bordelon, P. C.;Ghetu, M. V.",2009,,,0,
2490,"Alzheimer's disease, cerebrovascular dysfunction and the benefits of exercise: From vessels to neurons","Exercise training promotes extensive cardiovascular changes and adaptive mechanisms in both the peripheral and cerebral vasculature, such as improved organ blood flow, induction of antioxidant pathways, and enhanced angiogenesis and vascular regeneration. Clinical studies have demonstrated a reduction of morbidity and mortality from cardiovascular disease among exercising individuals. However, evidence from recent large clinical trials also suggests a substantial reduction of dementia risk - particularly regarding Alzheimer's disease (AD) - with regular exercise. Enhanced neurogenesis and improved synaptic plasticity have been implicated in this beneficial effect. However, recent research has revealed that vascular and specifically endothelial dysfunction is essentially involved in the disease process and profoundly aggravates underlying neurodegeneration. Moreover, vascular risk factors (VRFs) are probably determinants of incidence and course of AD. In this review, we emphasize the interconnection between AD and VRFs and the impact of cerebrovascular and endothelial dysfunction on AD pathophysiology. Furthermore, we describe the molecular mechanisms of the beneficial effects of exercise on the vasculature such as activation of the vascular nitric oxide (NO)/endothelial NO synthase (eNOS) pathway, upregulation of antioxidant enzymes, and angiogenesis. Finally, recent prospective clinical studies dealing with the effect of exercise on the risk of incident AD are briefly reviewed. We conclude that, next to upholding neuronal plasticity, regular exercise may counteract AD pathophysiology by building a vascular reserve. © 2008 Elsevier Inc. All rights reserved.",antioxidant;brain derived neurotrophic factor;cyclic GMP;endothelial nitric oxide synthase;nitric oxide;vasculotropin;Alzheimer disease;angiogenesis;antioxidant activity;brain atherosclerosis;brain blood flow;brain protection;cardiovascular disease;cardiovascular risk;cerebrovascular disease;cognitive defect;disease exacerbation;endothelial dysfunction;exercise;atrial fibrillation;human;hypercholesterolemia;hypertension;incidence;ischemic heart disease;morbidity;mortality;nerve degeneration;nervous system development;neurofibrillary tangle;neuropathology;organ blood flow;oxidative stress;pathophysiology;priority journal;risk factor;risk reduction;short survey;signal transduction;synaptic membrane;upregulation;vascular endothelium,"Lange-Asschenfeldt, C.;Kojda, G.",2008,,,0,
2491,PET in clinical work. A refined instrument for imaging,"Positron emission tomography (PET) enables in vivo studies to be performed in patients to investigate the binding or metabolism of biologically/functionally active substances labelled with short-lived positron-emitting radionuclides. The procedure has been used for discriminative analysis of physiology and function, both normal and pathological. The range of clinical applications includes studies of cerebral ischaemia and heart diseases, tumor diagnosis and treatment follow-up, presurgical work-up in cases of epilepsy, and characterization and treatment follow-up in cases of dementia. The clinical uses of PET are outlined in a review of the last three years' experience at the PET centre at Uppsala University.","Alzheimer Disease/metabolism/radionuclide imaging;Brain Ischemia/metabolism/radionuclide imaging;Brain Neoplasms/metabolism/radionuclide imaging;Coronary Disease/metabolism/radionuclide imaging;Epilepsy/metabolism/radionuclide imaging;Gastrointestinal Neoplasms/metabolism/radionuclide imaging;Humans;Mental Disorders/metabolism/radionuclide imaging;Multiple Endocrine Neoplasia/metabolism/radionuclide imaging;Nervous System Diseases/metabolism/radionuclide imaging;*Tomography, Emission-Computed","Langstrom, B.;Bergstrom, K.;Bergstrom, M.;Valind, S.",1995,Sep 6,,0,
2492,Evaluation and management of orthostatic hypotension,"Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position. It results from an inadequate physiologic response to postural changes in blood pressure. Orthostatic hypotension may be acute or chronic, as well as symptomatic or asymptomatic. Common symptoms include dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headache. Less common symptoms include syncope, dyspnea, chest pain, and neck and shoulder pain. Causes include dehydration or blood loss; disorders of the neurologic, cardiovascular, or endocrine systems; and several classes of medications. Evaluation of suspected orthostatic hypotension begins by identifying reversible causes and underlying associated medical conditions. Head-up tilt-table testing can aid in confirming a diagnosis of suspected orthostatic hypotension when standard orthostatic vital signs are nondiagnostic; it also can aid in assessing treatment response in patients with an autonomic disorder. Goals of treatment involve improving hypotension without excessive supine hypertension, relieving orthostatic symptoms, and improving standing time. Treatment includes correcting reversible causes and discontinuing responsible medications, when possible. Nonpharmacologic treatment should be offered to all patients. For patients who do not respond adequately to nonpharmacologic treatment, fludrocortisone, midodrine, and pyridostigmine are pharmacologic therapies proven to be beneficial. © 2011 American Academy of Family Physicians.",fludrocortisone;midodrine;placebo;pyridostigmine;amyloidosis;anticholinergic effect;article;autonomic neuropathy;bleeding;cardiovascular disease;clinical feature;congestive heart failure;dehydration;diabetic neuropathy;diaphoresis;diastolic blood pressure;diet therapy;differential diagnosis;diffuse Lewy body disease;disease severity;drug cost;drug dose increase;drug dose titration;drug efficacy;drug induced headache;drug safety;dyspnea;endocrine disease;fasciculation;glycemic control;health service;hemodynamics;human;hypersalivation;hypertension;hypokalemia;isometric exercise;lifestyle modification;loose feces;neck pain;neurologic disease;orthostatic hypotension;paresthesia;Parkinson disease;pathophysiology;patient care;peripheral edema;physical activity;pruritus;pure autonomic failure;reflex;shoulder pain;Shy Drager syndrome;side effect;sodium urine level;symptomatology;faintness;systolic blood pressure;thorax pain;tilt table test;treatment contraindication;weight gain;mestinon,"Lanier, J. B.;Mote, M. B.;Clay, E. C.",2011,,,0,
2493,Rapid Endovascular Warming for Profound Hypothermia,"Profound hypothermia is associated with high mortality and morbidity. Optimal outcomes have been reported with invasive extracorporeal warming techniques not readily available in most hospitals. Endovascular warming devices may provide a less invasive alternative. A 68-year-old woman developed profound hypothermia after environmental exposure. On arrival, she was comatose, severely bradycardic, without palpable pulses, and with a core body temperature of 23.0°C (72°F). Attempts to warm her with traditional methods during 2 hours were ineffective. An endovascular temperature control system was placed and effectively warmed the patient at about 3°C (4.5°F) per hour, with return of hemodynamic stability. When hypothermia is profound, surface warming works poorly and invasive strategies, including cardiopulmonary bypass, are recommended. Rapid warming from profound hypothermia can be accomplished with endovascular systems, and these may be an effective alternative to more invasive extracorporeal methods. © 2008 American College of Emergency Physicians.",aged;article;blood;body temperature;bradycardia;case report;catheter;coma;control system;core temperature;dementia;devices;emergency treatment;endovascular warming;environmental exposure;female;geriatric patient;heart arrest;human;hypothermia;medical device;priority journal;treatment outcome;warming;Bair Hugger,"Laniewicz, M.;Lyn-Kew, K.;Silbergleit, R.",2008,,,0,
2494,Depression in a patient with Alzheimer's disease,,acetylsalicylic acid;donepezil;losartan;paracetamol;aged;Alzheimer disease;article;case report;clinical feature;coronary artery disease;depression;female;human;hypertension;ischemic heart disease;laboratory test;osteoarthritis,"Lantz, M. S.",2010,,,0,
2495,Risk of cerebrovascular accident associated with use of antipsychotics: Population-based case-control study,"OBJECTIVES: To explore the association between use of antipsychotics and risk of cerebrovascular accident (CVA) in individuals with dementia aged 65 and older. DESIGN: Population-based case-control study. SETTING: UK-based electronic primary care records in the General Practice Research Database (GPRD). PARTICIPANTS: Individuals with dementia aged 65 and older registered in the database between January 1, 1995, and June 22, 2007. MEASUREMENTS: Odds ratio (OR) of CVA in users versus nonusers of antipsychotics (typical or atypical) and in users of typical versus atypical antipsychotics. Multivariate analyses were performed using logistic regression models to adjust for potential confounders: demographic variables, comorbidity, and concomitant treatments. RESULTS: After adjusting for confounding variables, the OR of CVA associated with use of only typical antipsychotics versus no antipsychotics in individuals with dementia aged 65 and older was 1.16 (95% confidence interval (CI)=1.07-1.27) and for use of only atypical antipsychotics versus no antipsychotics was 0.62 (95% CI=0.53-0.72). In the comparison of typical versus atypical antipsychotics, the OR was 1.83 (95% CI=1.57-2.14). CONCLUSION: No reasons were found to question the cerebrovascular safety of atypical antipsychotics in older adults with dementia. The typical antipsychotics appear to be associated with a higher risk of CVA, although the risk disappears after use is discontinued. © 2011, The American Geriatrics Society.",anticoagulant agent;antihypertensive agent;antilipemic agent;atypical antipsychotic agent;haloperidol;insulin;neuroleptic agent;olanzapine;oral antidiabetic agent;prochlorperazine;risperidone;thioridazine;aged;article;case control study;cerebrovascular accident;controlled study;dementia;diabetes mellitus;female;atrial fibrillation;heart failure;heart infarction;human;hyperlipidemia;hypertension;major clinical study;male;mitral valve stenosis;obesity;population based case control study;risk assessment;United Kingdom,"Laredo, L.;Vargas, E.;Blasco, A. J.;Aguilar, M. D.;Moreno, A.;Portolés, A.",2011,,,0,
2496,Clinical Vagus Nerve Stimulation Paradigms Induce Pronounced Brain and Body Hypothermia in Rats,"Vagus nerve stimulation (VNS) is a widely used neuromodulation technique that is currently used or being investigated as therapy for a wide array of human diseases such as epilepsy, depression, Alzheimer's disease, tinnitus, inflammatory diseases, pain, heart failure and many others. Here, we report a pronounced decrease in brain and core temperature during VNS in freely moving rats. Two hours of rapid cycle VNS (7s on/18s off) decreased brain temperature by around [Formula: see text]C, while standard cycle VNS (30[Formula: see text]s on/300[Formula: see text]s off) was associated with a decrease of around [Formula: see text]C. Rectal temperature similarly decreased by more than [Formula: see text]C during rapid cycle VNS. The hypothermic effect triggered by VNS was further associated with a vasodilation response in the tail, which reflects an active heat release mechanism. Despite previous evidence indicating an important role of the locus coeruleus-noradrenergic system in therapeutic effects of VNS, lesioning this system with the noradrenergic neurotoxin DSP-4 did not attenuate the hypothermic effect. Since body and brain temperature affect most physiological processes, this finding is of substantial importance for interpretation of several previously published VNS studies and for the future direction of research in the field.",Eeg;Vagus nerve stimulation;electrophysiology;rat;temperature,"Larsen, L. E.;Lysebettens, W. V.;Germonpre, C.;Carrette, S.;Daelemans, S.;Sprengers, M.;Thyrion, L.;Wadman, W. J.;Carrette, E.;Delbeke, J.;Boon, P.;Vonck, K.;Raedt, R.",2017,Aug,,0,
2497,Survival after Initial Diagnosis of Alzheimer Disease,"Background: Alzheimer disease is an increasingly common condition in older people. Knowledge of life expectancy after the diagnosis of Alzheimer disease and of associations of patient characteristics with survival may help planning for future care. Objective: To investigate the course of Alzheimer disease after initial diagnosis and examine associations hypothesized to correlate with survival among community-dwelling patients with Alzheimer disease. Design: Prospective observational study. Setting: An Alzheimer disease patient registry from a base population of 23 000 persons age 60 years and older in the Group Health Cooperative, Seattle, Washington. Patients: 521 newly recognized persons with Alzheimer disease enrolled from 1987 to 1996 in an Alzheimer disease patient registry. Measurements: Baseline measurements included patient demographic features, Mini-Mental State Examination score, Blessed Dementia Rating Scale score, duration since reported onset of symptoms, associated symptoms, comorbid conditions, and selected signs. Survival was the outcome of interest. Results: The median survival from initial diagnosis was 4.2 years for men and 5.7 years for women with Alzheimer disease. Men had poorer survival across all age groups compared with females. Survival was decreased in all age groups compared with the life expectancy of the U.S. population. Predictors of mortality based on proportional hazards models included a baseline Mini-Mental State Examination score of 17 or less, baseline Blessed Dementia Rating Scale score of 5.0 or greater, presence of frontal lobe release signs, presence of extrapyramidal signs, gait disturbance, history of falls, congestive heart failure, ischemic heart disease, and diabetes at baseline. Limitations: The base population, although typical of the surrounding Seattle community, may not be representative of other, more diverse populations. Conclusions: In this sample of community-dwelling elderly persons who received a diagnosis of Alzheimer disease, survival duration was shorter than predicted on the basis of U.S. population data, especially for persons with onset at relatively younger ages. Features significantly associated with reduced survival at diagnosis were increased severity of cognitive impairment, decreased functional level, history of falls, physical examination findings of frontal release signs, and abnormal gait. The variables most strongly associated with survival were measures of disease severity at the time of diagnosis. These results should be useful to patients and families experiencing Alzheimer disease, other caregivers, clinicians, and policymakers when planning for future care needs.",adult;age distribution;aged;Alzheimer disease;article;clinical observation;comorbidity;congestive heart failure;correlation analysis;diabetes mellitus;disease activity;disease course;disease severity;extrapyramidal symptom;female;gait disorder;human;ischemic heart disease;life expectancy;major clinical study;male;Mini Mental State Examination;mortality;priority journal;prospective study;rating scale;sex difference;survival;treatment planning,"Larson, E. B.;Shadlen, M. F.;Wang, L.;McCormick, W. C.;Bowen, J. D.;Teri, L.;Kukull, W. A.",2004,,,0,
2498,Comprehensive evaluation of the incidence of late effects in 5-year survivors of breast cancer,"Late effects of breast cancer affect the quality of survivorship. Using administrative data, we compared the occurrence of almost all ICD9 codes among older breast cancer survivors to that among a matched comparison cohort to generate new hypotheses. Breast cancer patients 65 years or older diagnosed 1990-1994 in 6 integrated care settings and who survived at least 5 years were matched with a cohort of women without a history of breast cancer on care setting, age, and calendar time. We collected data on the occurrence of incident ICD9 codes beginning 6 years after the breast cancer diagnosis date and continuing to year 15, and comparable data for the matched woman. We calculated hazard ratios (HRs) and 95% confidence intervals associating breast cancer survivorship with incidence of each ICD9 code. We used semi-Bayes methods to address multiple comparisons. Older breast cancer survivors had about the same occurrence of diseases and conditions 6-15 years after breast cancer diagnosis as comparable women. The median of 564 adjusted HRs equaled 1.06, with interquartile range 0.92-1.3. The distribution of HRs pertaining to cancer-related ICD codes was shifted toward positive associations, and the distribution pertaining to cardiovascular-related ICD codes was shifted toward negative associations. In this hypothesis-scanning study, we observed little difference in the occurrence of non-breast cancer-related diseases and conditions among older, long-term breast cancer survivors, and comparable women without a history of breast cancer. © Springer Science+Business Media 2014.",acquired immune deficiency syndrome;age distribution;aged;article;breast cancer;cancer incidence;cancer survival;cancer survivor;cardiovascular disease;cerebrovascular accident;cerebrovascular disease;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;disease association;female;follow up;heart infarction;hemiplegia;human;kidney disease;leukemia;liver disease;lymphoma;major clinical study;malignant neoplastic disease;peripheral vascular disease;priority journal;quality of life;ulcer;very elderly,"Lash, T. L.;Thwin, S. S.;Yood, M. U.;Geiger, A. M.;Bosco, J.;Quinn, V. P.;Field, T. S.;Pawloski, P. A.;Silliman, R. A.",2014,,,0,
2499,Amyloid-beta peptides in plasma and cognitive decline after 1 year follow-up in Alzheimer's disease patients,"Plasma levels of amyloid-beta (Abeta) peptides are potential biomarkers of early cognitive impairment and of Alzheimer's disease (AD) risk. However, the association of Abeta peptides with the rate of cognitive decline in AD patients is still unclear. In the present study we demonstrate that Abeta(1)(-)(4)(2) plasma levels show a significant correlation with the rate of cognitive decline and are significantly increased in AD patients with fast cognitive decline (decrease of Mini-Mental Status Examination (MMSE) score >/= 5/year; n = 12) compared to AD patients with slow cognitive decline (decrease of MMSE score </= 4/year; n = 28), independent of baseline MMSE scores, age and cholinesterase inhibitor intake, but dependent on history of myocardial infarction and history of stroke in a multivariate analysis. These results suggest that Abeta(1)(-)(4)(2) plasma levels are associated with the rate of cognitive decline in AD patients and may be influenced by atherosclerotic vasculopathies such as stroke and myocardial infarction.","Aged;Aged, 80 and over;Alzheimer Disease/*blood/*psychology;Amyloid beta-Peptides/*blood;Biomarkers/blood;Cognition Disorders/*blood/*psychology;Female;Follow-Up Studies;Humans;Male;Middle Aged;Myocardial Infarction/blood/psychology;Prospective Studies;Stroke/blood/psychology;Time Factors","Laske, C.;Sopova, K.;Gkotsis, C.;Eschweiler, G. W.;Straten, G.;Gawaz, M.;Leyhe, T.;Stellos, K.",2010,,,0,
2500,Delirium in critical care patients,,analgesic agent;chlorpromazine;enalapril;furosemide;haloperidol;morphine;neuroleptic agent;olanzapine;quetiapine;risperidone;aged;article;attention disturbance;case report;confusion;consciousness disorder;delirium;delusion;dementia;depression;depth perception;differential diagnosis;disorientation;dystonia;education program;environmental factor;extrapyramidal symptom;female;fracture fixation;hallucination;hearing aid;heart failure;hip fracture;hospital admission;hospitalization cost;human;hypertension;hypoxemia;indwelling urinary catheter;intensive care unit;language disability;length of stay;medical history;memory disorder;neuroleptic malignant syndrome;nursing intervention;orthostatic hypotension;osteoporosis;oxygen therapy;patient assessment;patient controlled analgesia;patient safety;postoperative pain;postoperative period;priority journal,"Laske, R. A.;Stephens, B.",2016,,,0,
2501,"Digoxin and cognitive performance in patients with heart failure: a cohort, pharmacoepidemiological survey","BACKGROUND: Cognitive dysfunction is a prevalent condition among patients with heart failure (HF), and is independently associated with disability and mortality. A large study of patients with atrial fibrillation incidentally demonstrated superior cognitive performance among participants who received digoxin. Interestingly, endogenous cerebral digoxin influences neuronal Na(+)-dependent transport of calcium and amino acids, as well as the release and reuptake of several neurotransmitters involved in cognitive functioning. OBJECTIVE: To assess whether treatment with digoxin might improve cognition in patients with HF. METHODS: This pharmacoepidemiological cohort study included hospitalized elderly people (age > or = 65 years) from the GIFA (Gruppo Italiano di Farmacoepidemiologia nell'Anziano [Italian Group of Pharmacoepidemiology in the Elderly]) study. The GIFA study included 13,598 patients (1590 with a verified diagnosis of HF) without cerebrovascular or Alzheimer's disease. The main outcome measure was cognitive performance, which was assessed on admission and immediately before discharge using the Hodkinson Abbreviated Mental Test. The diagnosis of HF was verified by the study investigators. RESULTS: Among participants with HF, cognitive performance improved in 25% of 1172 participants who received digoxin compared with 16% of remaining patients (p < 0.0001). Among participants without HF, cognition improved in 23% of 2431 patients receiving digoxin compared with 17% of untreated patients (p < 0.0001). According to logistic regression analysis, the probability (odds ratio) of improving cognitive performance associated with administration of digoxin was 1.69 (95% CI 1.20, 2.38) among patients with HF, and 1.13 (95% CI 0.98, 1.31) among patients without HF, after adjusting for potential confounders. Analysis of the interaction term 'use of digoxin by diagnosis of HF' in fully adjusted logistic regression confirmed (p = 0.018) that the association between use of digoxin and improving cognitive performance varied according to diagnosis of HF. CONCLUSION: Treatment with digoxin might selectively improve cognitive performance among older patients with HF.","Aged;Aged, 80 and over;Anti-Arrhythmia Agents/*therapeutic use;Cognition/*drug effects;Digoxin/*therapeutic use;Female;Heart Failure/complications/*drug therapy;Humans;Italy/epidemiology;Male;Middle Aged;Pharmacoepidemiology","Laudisio, A.;Marzetti, E.;Pagano, F.;Cocchi, A.;Bernabei, R.;Zuccala, G.",2009,,10.2165/0002512-200926020-00002,0,
2502,Noninvasive ventilation in older adults admitted to a pneumogeriatric unit,,carbon dioxide;oxygen;quetiapine;acute heart failure;aged;arterial gas;blood oxygen tension;carbon dioxide tension;cause of death;cerebrovascular accident;chronic kidney disease;chronic obstructive lung disease;clinical article;delirium;dementia;face ulcer;female;geriatric care;geriatric patient;hospitalization;human;letter;low drug dose;male;muscle weakness;noninvasive ventilation;oxygen therapy;pH;stomach distension;treatment outcome;ulcer;very elderly,"Laudisio, A.;Scarlata, S.;Pedone, C.;Cortese, L.;Zito, A.;Antonelli Incalzi, R.",2014,,,0,
2503,Vitamins,"• Based on strong research evidence, all infants should receive 400 IU/day of vitamin D beginning in the first few days of age to prevent vitamin D deficiency and rickets. (8) • Based on strong research evidence, children and adolescents age >1 year may require as much as 600 IU/day of vitamin D. (11) • Based on strong research evidence, all newborns should receive 1 mg of vitamin K at birth to prevent vitamin K deficiency bleeding. (13) • Based on strong research evidence, preconceptional and pregnant women should be supplemented with folate to decrease the likelihood of neural tube defects. (15).",2 oxoacid;7 dehydrocholesterol;alpha tocopherol;ascorbic acid;calcitriol;calcium;carotenoid;colecalciferol;cyanocobalamin;ergocalciferol;ergosterol;folic acid;nicotinic acid;pyridoxine;retinoic acid;retinol;rhodopsin;riboflavin;thiamine;tryptophan;vitamin K group;alpha tocopherol deficiency;article;aseptic meningitis;ataxia;autoimmune disease;beriberi;cardiomegaly;cardiovascular disease;case report;child;colon Crohn disease;conjunctiva;cyanocobalamin deficiency;Darier disease;dementia;depression;dermatitis;diarrhea;drowsiness;dyspnea;epithelium cell;female;folic acid deficiency;Hodgkin disease;human;hypocalcemia;infant;insulin dependent diabetes mellitus;Korsakoff psychosis;kyphosis;macrocytic anemia;male;muscle atonia;nicotinic acid deficiency;night blindness;osteoarthritis;partial blindness;pellagra;preschool child;pyridoxine deficiency;retinol deficiency;retinol intoxication;riboflavin deficiency;rickets;schizophrenia;scurvy;tachycardia;vitamin D deficiency;vitamin K deficiency;Wernicke encephalopathy;Wernicke Korsakoff syndrome;wheezing,"Lauer, B.;Spector, N.",2012,,,0,
2504,Longitudinal Patterns of Spending Enhance the Ability to Predict Costly Patients: A Novel Approach to Identify Patients for Cost Containment,"Background: With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be used to classify patients into dynamic long-term spending patterns. Objectives: To classify patients by their spending patterns over a 1-year period and to assess the ability of models to predict patients in the highest spending trajectory and the top 5% of annual spending using prior-year predictors. Subjects: We identified all fully insured adult members enrolled in a large US nationwide insurer and used medical and prescription data from 2009 to 2011. Research Design: Group-based trajectory modeling was used to classify patients by their spending patterns over a 1-year period. We assessed the predictive ability of models that categorized patients in the top fifth percentile of annual spending and in the highest spending trajectory, using logistic regression and split-sample validation. Models were estimated using investigator-specified variables and a proprietary risk-adjustment method. Results: Among 998,651 patients, in the best-performing model, prediction was strong for patients in the highest trajectory group (C-statistic: 0.86; R 2: 0.47). The C-statistic of being in the top fifth percentile of spending in the best-performing model was 0.82 (R 2: 0.26). Approaches using nonproprietary investigator-specified methods performed almost as well as other risk-adjustment methods (C-statistic: 0.81 vs. 0.82). Conclusions: Trajectory modeling may be a useful way to predict costly patients that could be implementable by payers to improve cost-containment efforts.",acquired immune deficiency syndrome;adult;alcohol consumption;Alzheimer disease;article;atrial fibrillation;behavior;cerebrovascular accident;chronic liver disease;chronic obstructive lung disease;cohort analysis;congestive heart failure;cost control;diabetes mellitus;drug cost;end stage renal disease;female;health insurance;human;Human immunodeficiency virus infection;hyperlipidemia;hypertension;ICD-9;kidney disease;liver disease;longitudinal study;major clinical study;major depression;male;malignant neoplasm;obesity;osteoporosis;patient attitude;patient identification;prediction;prescription;priority journal;risk assessment;sensitivity analysis;stress;tobacco use,"Lauffenburger, J. C.;Franklin, J. M.;Krumme, A. A.;Shrank, W. H.;Brennan, T. A.;Matlin, O. S.;Spettell, C. M.;Brill, G.;Choudhry, N. K.",2017,,10.1097/mlr.0000000000000623,0,
2505,Sauna bathing is inversely associated with dementia and Alzheimer's disease in middle-aged Finnish men,"Background: there are no previous studies linking repeated heat exposure of sauna and the risk of memory diseases. We aimed to investigate whether frequency of sauna bathing is associated with risk of dementia and Alzheimer's disease. Setting: prospective population-based study. Methods: the frequency of sauna bathing was assessed at baseline in the Kuopio Ischaemic Heart Disease population-based prospective cohort study of 2,315 apparently healthy men aged 42-60 years at baseline, with baseline examinations conducted between 1984 and 1989. Hazard ratios (HRs) with 95% confidence intervals (CIs) for dementia and Alzheimer's disease were ascertained using Cox-regression modelling with adjustment for potential confounders. Results: during a median follow-up of 20.7 (interquartile range 18.1-22.6) years, a total of 204 and 123 diagnosed cases of dementia and Alzheimer's disease were respectively recorded. In analysis adjusted for age, alcohol consumption, body mass index, systolic blood pressure, smoking status, Type 2 diabetes, previous myocardial infarction, resting heart rate and serum low-density lipoprotein cholesterol, compared with men with only 1 sauna bathing session per week, the HR for dementia was 0.78 (95% CI: 0.57-1.06) for 2-3 sauna bathing sessions per week and 0.34 (95% CI: 0.16-0.71) for 4-7 sauna bathing sessions per week. The corresponding HRs for Alzheimer's disease were 0.80 (95% CI: 0.53-1.20) and 0.35 (95% CI: 0.14-0.90). Conclusion: in this male population, moderate to high frequency of sauna bathing was associated with lowered risks of dementia and Alzheimer's disease. Further studies are warranted to establish the potential mechanisms linking sauna bathing and memory diseases.",Alzheimer's disease;Older people;dementia;epidemiology;prospective study,"Laukkanen, T.;Kunutsor, S.;Kauhanen, J.;Laukkanen, J. A.",2017,Mar 01,,0,
2506,Regional differences in rates of dementia: MRC-CFAS,,Alzheimer disease;dementia;diagnostic accuracy;health survey;human;incidence;ischemic heart disease;memory disorder;morbidity;neuroimaging;neuropathology;population research;prevalence;priority journal;risk assessment;sex difference;short survey,"Launer, L. J.",2005,,,0,
2507,Regional variability in the prevalence of cerebral white matter lesions: an MRI study in 9 European countries (CASCADE),"White matter lesions (WML) on MRI of the brain are common in both demented and nondemented older persons. They may be due to ischemic events and are associated with cognitive and physical impairments. It is not known whether the prevalence of these WML in the general population differs across European countries in a pattern similar to that seen for coronary heart disease. Here we report the prevalence of WML in 1,805 men and women drawn from population-based samples of 65- to 75-year-olds in ten European cohorts. Data were collected using standardized methods as a part of the multicenter study CASCADE (Cardiovascular Determinants of Dementia). Centers were grouped by region: south (Italy, Spain, France), north (Netherlands, UK, Sweden), and central (Austria, Germany, Poland). In this 10-year age stratum, 92% of the sample had some lesions, and the prevalence increased with age. The prevalence of WML was highest in the southern region, even after adjusting for differences in demographic and selected cardiovascular risk factors. Brain aging leading to disabilities will increase in the future. As a means of hypothesis generation and for health planning, further research on the geographic distribution of WML may lead to the identification of new risk factors for these lesions.","Aged/*physiology;Aging/physiology;Blood Pressure/physiology;Brain/*pathology;Brain Diseases/*epidemiology/*pathology;Cohort Studies;Education;Europe/epidemiology;Female;Humans;Image Processing, Computer-Assisted;Magnetic Resonance Imaging;Male;Neuropsychological Tests;Risk Factors;Socioeconomic Factors","Launer, L. J.;Berger, K.;Breteler, M. M.;Dufouil, C.;Fuhrer, R.;Giampaoli, S.;Nilsson, L. G.;Pajak, A.;de Ridder, M.;van Dijk, E. J.;Sans, S.;Schmidt, R.;Hofman, A.",2006,,10.1159/000089233,0,
2508,Alcoholic Cardiomyopathy: Multigenic Changes Underlie Cardiovascular Dysfunction,"Alcoholism is the third leading cause of preventable death in the United States. Aside from promoting cardiomyopathies, chronic alcohol consumption is associated with an increased risk of dementia, the development of liver or pancreas failure, and cancers of the oral cavity and pharynx. Although a J-shaped curve for all cause mortality has been identified for average alcohol consumption, irregular heavy drinking also carries significantly greater risks for cardiovascular disease. Alcohol induced cardiovascular disease has a complex multigenic etiology. There is significant variation in the initial presentation of alcoholic cardiomyopathy with diastolic dysfunction possibly being the first indication. Ethanol exposure generates toxic metabolites, primarily acetaldehyde and ROS, which activate several cell signaling systems to alter cell function across many levels. Sudden cardiac death is a known occurrence of alcoholism that may be linked to an arrhythmogenic effect of alcohol. Microscopic and molecular examination of diseased hearts has demonstrated abnormal alterations to various cellular components, including the mitochondria and myofibrils. These studies have shown not only the direct impact on myocardial contractility but also disrupted metabolism that determines the long-term survival of the myocardium. Significant variations in the response to chronic alcohol consumption may be related to unique genotypes that modify the metabolic response to ethanol. Future studies to further characterize the role of different genotypes will help indentify those genotypes are more susceptible to chronic alcohol consumption.",Alcoholic cardiomyopathy;Alcoholism;Heart failure,"Laurent, D.;Edwards, J. G.",2014,Jan-Mar,,0,
2509,Chronic somatic comorbidity and excess mortality due to natural causes in persons with schizophrenia or bipolar affective disorder,"Background: Suicide and death by accidents in persons with schizophrenia and bipolar disorder are common, but excess mortality from natural death accounts for even more years of life lost. The impact of somatic comorbidity, however, often is not duly considered in analyses and explanations of excess mortality in patients with psychotic disorders. Objective/Methods: This study investigates and evaluates the impact of 19 severe chronic diseases on excess mortality due to diseases and medical conditions (natural death) in individuals with psychotic disorders compared with the general population using a population-based cohort study in Denmark. Incidence/mortality rate ratios of admission/mortality were calculated using survival analysis. Results: Cohort members with psychotic disorders had higher incidence rates of hospital contacts for almost all of the 19 disorders than the general population. The mortality rate ratio (MRR) of natural death was 7.10 (95% CI 6.45, 7.81) for schizophrenic men, decreasing to 4.64 (95% CI 4.21, 5.10) after adjustment for the somatic disorders. The same pattern existed in women and in both genders with bipolar disorder. Highest MRRs were observed for psychotic patients without hospital admissions with the investigated somatic disorders. Conclusion: Chronic somatic diseases accounted for half of the excess mortality in patients with schizophrenia or bipolar disorder. Chronic disorders investigated in this paper seem to be under-treated or under-detected among such patients. © 2011 Laursen et al.",acquired immune deficiency syndrome;adolescent;adult;article;bipolar disorder;cerebrovascular disease;chronic disease;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;Denmark;disease severity;female;heart infarction;hemiplegia;hospital admission;human;incidence;insulin dependent diabetes mellitus;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;malignant neoplastic disease;mortality;non insulin dependent diabetes mellitus;peripheral vascular disease;schizophrenia;sex difference;survival,"Laursen, T. M.;Munk-Olsen, T.;Gasse, C.",2011,,,0,
2510,"Optimal lipids, statins, and dementia",,"Anticholesteremic Agents/*therapeutic use;Cholesterol, HDL/blood;Cholesterol, LDL/blood;Coronary Artery Disease/*blood/*drug therapy;Dementia/*blood/*drug therapy;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use;Lipids/*blood","Lavie, C. J.;Milani, R. V.",2005,Mar 15,10.1016/j.jacc.2004.12.019,0,
2511,"Optimal lipids, statins, and dementia 2 (multiple letters)",,atorvastatin;high density lipoprotein cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein;mevinolin;pravastatin;simvastatin;Alzheimer disease;amnesia;atherosclerosis;cardiovascular risk;clinical trial;cognition;cognitive defect;cost effectiveness analysis;data base;dementia;disease course;drug use;heart muscle ischemia;human;incidence;letter;lifestyle;medical research;non insulin dependent diabetes mellitus;prevalence;priority journal;publication;risk assessment;risk factor;cerebrovascular accident,"Lavie, C. J.;Milani, R. V.;O'Keefe Jr, J. H.;Cordain, L.;Harris, W. H.;Moe, R. M.;Vogel, R.",2005,,,0,
2512,Association of depressed mood and mortality in older adults with and without cognitive impairment in a prospective naturalistic study,"Objective: The authors examined predictors of mortality in individuals age 50 or older with or without cognitive impairment in a 12-year prospective naturalistic study of subcortical ischemic vascular disease focusing on symptoms of depressed mood, apathy, anhedonia, or anergia. Method: A total of 498 participants were recruited from the community and from memory clinics into a multicenter longitudinal study of subcortical ischemic vascular disease. For baseline cognitive status, 36% of participants were assessed as cognitively intact, 31% as cognitively impaired, and 33% as demented. All participants underwent a research protocol MRI, and 41% were classified as having subcortical lacunes. Depressed mood, anhedonia, anergia, and apathy were assessed at baseline using a structured behavioral assessment. Cox regression models were used to investigate the associations between neuropsychiatric symptoms and mortality, controlling for age, gender, race, education level, cognitive status, presence of vascular lacunes, and vascular risk factors. Results: Of 498 participants, 175 (35%) died over the follow-up period, with a median survival time of 5.6 years. In the multivariate analyses, cognitive impairment, age, male gender, depressed mood, and the presence of lacunes predicted higher mortality. Participants with both lacunes and depressed mood had the shortest survival among all cognitive groups. The mortality hazard ratio for participants with depressed mood was 2.2 (95% CI=1.5-3.2) after adjustment for cognitive status, age, gender, education level, race, lacunes, and all vascular conditions. Conclusions: These findings suggest the importance of detecting depressed mood in individuals with cerebrovascular disease and of developing more aggressive treatment and preventive interventions for this vulnerable population.",adult;aged;anhedonia;apathy;article;cardiovascular risk;cognition;cognitive defect;community;congestive heart failure;coronary artery bypass graft;dementia;depression;diabetes mellitus;disease association;educational status;female;follow up;hazard ratio;heart arrhythmia;heart infarction;human;hyperlipidemia;hypertension;longitudinal study;major clinical study;male;mortality;multivariate analysis;neuropsychiatry;nuclear magnetic resonance imaging;predictor variable;priority journal;proportional hazards model;prospective study;race;sex ratio;cerebrovascular accident;survival time;vascular disease,"Lavretsky, H.;Zheng, L.;Weiner, M. W.;Mungas, D.;Reed, B.;Kramer, J. H.;Jagust, W.;Chui, H.;Mack, W. J.",2010,,,0,
2513,White matter lesions on magnetic resonance imaging and their relationship with vascular risk factors in memory clinic attenders,"BACKGROUND: The association between white matter lesions on magnetic resonance imaging (MRI) and the presence of vascular risk factors has been investigated in different populations, and results have varied widely. However, this relationship has not been adequately addressed in memory clinic attenders who have relatively early cognitive impairment. OBJECTIVES: This study was undertaken to determine the relationship between the severity of white matter lesions and vascular risk factors in elderly subjects referred to a Memory Clinic, irrespective of their diagnoses. Patients attending the Memory Clinic had relatively early, mild cognitive impairment and differed, in this respect, from typical unselected community-based samples and from patients with established dementia. The study also investigated whether periventricular and deep white matter lesions differed in their relationship with vascular risk factors. METHODS: All patients assessed in the Memory Clinic at Leicester General Hospital between April 1998 and October 2000 who had undergone an MRI scan were included in the study. They received a comprehensive clinical and cognitive assessment, a standard dementia laboratory screen and evaluation of vascular risk factors. MRI scans were reviewed by two independent raters and semi-quantitative ratings of the severity of white matter lesions were made using standardised protocols. The relationship between cerebral white matter lesions and vascular risk factor variables was examined by multiple linear regression. RESULTS: One hundred and seventy-seven subjects were included in the study. The mean age was 69.8 and the mean MMSE score was 23.2. Of the risk factors investigated, only age and prior cerebrovascular disease were significantly associated with severe periventricular white matter lesions; age, hypertension and diabetes were significantly associated with severe deep white matter lesions. CONCLUSIONS: Periventricular and deep white matter lesions are differentially influenced by vascular risk factors.","Adult;Age Factors;Aged;Aged, 80 and over;Atrial Fibrillation/complications/pathology;Brain/*pathology;Cerebral Ventricles/pathology;Cerebrovascular Disorders/complications/pathology;Cognition Disorders/complications/*pathology;Diabetes Complications/pathology;Female;Humans;Hypertension/complications/pathology;Magnetic Resonance Imaging;Male;Middle Aged;Myocardial Infarction/complications/pathology;Risk Factors","Lazarus, R.;Prettyman, R.;Cherryman, G.",2005,Mar,10.1002/gps.1283,0,
2514,Identification of potential organ donors of advanced age in EDs,"Objective: In France and in Belgium, as in many countries, there is a shortage of organs for transplantation, which has led to strategies to recruit older potential donors who may die of stroke. Methods: We conducted a post hoc analysis to identify potential organ donors with cardiac function among a population of dying patients in emergency departments. This population had been selected for a separate multicenter prospective observational study. We identified patients who died of a neurologic cause but had no clinical findings affecting their donor status. Results: Of 2420 patients in the study, 407 died of a neurologic cause; and 233 of these were excluded because of clinical factors that made them ineligible as organ donors. The remaining 174 patients (7.2% of dying patients) could be considered potential organ donors. Their mean age was 75.2 ± 11 years. Sixty-eight (39%) were intubated, and 60 of these (34.5%) were mechanically ventilated. In addition, 94 patients (54%) died within 12 hours (median, 9.3 hours) after admission; and 13 (7%) died while receiving a maximum level of care. No diagnostic procedures were performed to assess brain death. Conclusion: A significant number of patients who die in emergency departments could be organ donors, including approximately 7% between 60 and 85 years of age with life-threatening neurologic diseases. However, this percentage may be reduced by family opposition. Emergency physicians should collaborate with intensive care units and local organ donation teams to optimize end-of-life care and maximize the number of potential donors. © 2012 Elsevier Inc. All rights reserved.",adult;aged;article;artificial ventilation;brain hemorrhage;brain ischemia;cause of death;chronic respiratory tract disease;coronary artery disease;dementia;diabetes mellitus;donor selection;dying;emergency ward;head injury;heart function;human;intubation;liver disease;major clinical study;multicenter study;neurologic disease;observational study;organ donor;patient care;post hoc analysis;priority journal;prospective study,"Le Conte, P.;Riochet, D.;Labastire, L.;Auneau, J. C.;Legeard, E.;Van Tricht, M.;Batard, E.;Montassier, E.;Martinage, A.;Potel, G.",2012,,,0,
2515,Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients,"Background: Geriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive. Objectives: We compared general anesthesia (GA) and peripheral nerve blocks (PNBs) on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF) undergoing hemiarthroplasty. Materials and methods: This retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People's Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality. Results: Seventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely to have dementia (χ2=10.45, P=0.001). The most common complications were acute cardiovascular events, electrolyte disturbances, and delirium. Postoperative acute respiratory events and hypoxemia both were also common, but no differences were found between groups (χ2=0.68, P=0.410; χ2=3.42, P=0.065, respectively). Key factors negatively influencing mortality included: age, male gender, American Society of Anesthesiologists status, dementia, perioperative cardiovascular events and respiratory events, postoperative stroke, myocardial infarction, and hypoxia. Conclusion: Mortality and postoperative complications are not statistically significantly different between PNBs and GA among eldery patients undergoing hemiarthroplasty for FNF. © 2014 Liu et al.",etomidate;midazolam;propofol;remifentanil;rocuronium;sufentanil;age;aged;article;cardiovascular disease;cerebrovascular accident;Chinese;comorbidity;controlled study;delirium;dementia;drug dose titration;electrolyte disturbance;female;femur neck fracture;general anesthesia;geriatric patient;heart infarction;hip arthroplasty;human;hypoxemia;hypoxia;intensive care;laryngeal mask;length of stay;major clinical study;male;mortality;nerve block;operation duration;operative blood loss;postoperative complication;respiratory tract disease;retrospective study;sex difference,"Le Liu, J.;Wang, X. L.;Gong, M. W.;Mai, H. X.;Pei, S. J.;Yuan, W. X.;Zhang, H.",2014,,,0,
2516,Did King Herod suffer from a rheumatic disease?,"Herod the Great was appointed “king of Jews,” to govern Judea, by the Roman Emperor and Senate. He lived from 73/74 BCE to 4 CE. He died with an illness and symptoms that have been the source of considerable speculation. Richard Strauss depicted Herod in his classic opera, “Salome.” That opera was derived from a play of the same name by Oscar Wilde, which was based on an 1876 painting, “Salome Dancing Before Herod,” by Gustave Moreau. The operatic Herod was afflicted with an illness characterized by dementia, hallucinations, paranoia, alcoholism (from drinking the Emperor’s wine), violence, twitches, and sterility; different interpretations showed him also with falls, chills, shaking, thirst, forgetfulness, and sleepiness, for which we suggest the novel diagnosis of chronic lead intoxication (which can manifest to rheumatologists as saturnine gout). He had compatible symptoms (encephalopathy and neuromuscular abnormalities) and consumed excessive quantities of imperial wine, known to be highly contaminated with lead and likely associated with similar symptoms among Roman aristocracy. Herod’s demented cruelties—an oppressive reign which including the beheading of John the Baptist—exacerbated the political climate and may have contributed to the subsequent violent 7-year revolt culminating in the destruction of the second temple. How different might history have been if Herod the Great had been abstemious?",alcohol;abdominal pain;alcohol consumption;alcoholism;amebiasis;amyloidosis;article;Behcet disease;cause of death;chill;congestive heart failure;dementia;diabetes mellitus;Fournier gangrene;hallucination;human;kidney failure;lead poisoning;leg edema;liver cirrhosis;male sterility;mental instability;muscle twitch;neuromuscular disease;paranoia;parasitosis;polydipsia;priority journal;pruritus;rheumatic disease;somnolence;symptom;tachypnea;vasculitis;violence;virus meningitis,"Leatherwood, C.;Panush, R. S.",2017,,10.1007/s10067-017-3583-z,0,
2517,When and where do hip fractures occur? A population-based study,"Summary: We investigated the effects of socio-demographic and health factors on timing and location of hip fracture among 484 subjects. Time of fracture varied between community dwellers and residential care facility dwellers, and in relation to subjects' psychotropic drug status. Indoor hip fracture incidence increased on snow-covered days. Introduction: This paper aims to describe the timing and whereabouts of hip fracture cases in a population-based setting and to relate these factors with residential and health status, seasonal variation, and snow-covered ground. Methods: We consecutively included 484 incident hip fracture events (age ≥50 years) admitted to a Swedish orthopedic department during a 1-year period. Data concerning socio-demographic details, fall location, time of fracture, comorbidity, and medications were collected from in-patient medical records and through patient or caregiver interviews. Results: The expected peak in fracture occurrence during daytime was observed among community dwellers but not among subjects living in residential care. Hip fracture was twice as likely to occur during nighttime hours among psychotropic drug users (adjusted odds ratio (Adj. OR), 2.20; 95 % confidence interval (CI), 1.12-4.30) compared to those not receiving these medications. Subjects without dementia, taking psychotropic drugs, were also more likely to fracture during nighttime hours (Adj. OR, 2.91; 95 % CI, 1.40-6.0). We observed an increase in indoor hip fracture incidence on snow-covered days among community dwellers (incidence rate ratio, 1.34; 95 % CI, 1.02-1.74). We observed only a weak seasonal trend in hip fracture incidence, based on month, among community dwellers who fractured indoors. Conclusions: Special attention and possibly fall-preventive efforts should be directed not only toward those living in residential care facilities but also toward community-dwelling subjects taking psychotropic drugs since these groups have a higher incidence of nighttime hip fracture. Further research aiming to explain the seasonal variation of indoor fracture incidence among community dwellers is warranted. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation.",diuretic agent;psychotropic agent;sedative agent;adult;aged;article;caregiver;cerebrovascular disease;cervical spine fracture;comorbidity;dementia;falling;female;femur trochanteric fracture;geography;hip fracture;human;hypertension;incidence;interview;ischemic heart disease;major clinical study;male;medical record review;multiple trauma;night;polypharmacy;population research;priority journal;residential care;retrospective study;winter,"Leavy, B.;Åberg, A. C.;Melhus, H.;Mallmin, H.;Michaëlsson, K.;Byberg, L.",2013,,,0,
2518,Chronic lithium neurotoxicity presenting as Parkinson's disease,A 71 year old man who had been on lithium for 9 years for mania presented with an encephalopathic illness which was almost certainly due to lithium intoxication. Having recovered from this acute episode (although he was left with some sequelae) he was recommenced on lithium for his manic symptoms with a careful control of his blood levels. After remaining fairly stable for 8 years he presented with features suggestive of Parkinsonism and was admitted to hospital for investigation. There was no history of taking additional medication such as antidepressants or antipsychotics. He died in hospital and a post-mortem examination confirmed the cause of death as acute myocardial infarction. However histological examination of the brain revealed neurological sequelae of chronic lithium intoxication. There was no evidence of degenerative condition such as Parkinsonism or Alzheimer's disease.,chlorpromazine;fluphenazine;lithium carbonate;aged;article;brain disease;case report;human;intoxication;intramuscular drug administration;male;mania;parkinsonism;priority journal,"Lecamwasam, D.;Synek, B.;Moyles, K.;Ghose, K.",1994,,,0,
2519,Long-term experience of a trial in multi-infarct dementia,"A report is given on the natural history of multi-infarct dementia (MID) in 94 patients over a period of 5 years and describes neuroimaging criteria that may be used in order to more reliably separate vascular (VD) from primary degenerative types of dementia (DTD). The annual mortality rate of MID patients was 13%. Age and nocturnal confusion were found to be the most efficient predictors for fatal prognosis. Psychosocial adjustment, in contrast, indicated better outcome. In respect to differential diagnosis MRI revealed infarcts, basal ganglia lacunes and confluent white matter lesions as the most effective discriminators between VD and DTD. The typical patchy pattern found in almost half of the patients with VD, and significant differences in 5-7 Hz range as shown by EEG mapping can also be used for increasing the accuracy of the clinical diagnosis.",Aging;Alzheimer Disease/complications/psychology;Cerebrovascular Disorders/complications/physiopathology;Clinical Trials as Topic;Dementia/etiology/psychology/*therapy;Humans;Myocardial Infarction/*complications;Prospective Studies;Risk Factors,"Lechner, H.;Schmidt, R.;Goetz, B.",1990,,,0,
2520,Heyde's syndrome: Exploring the link between aortic stenosis and an acquired bleeding disorder,"Heyde's syndrome was first proposed in 1958. It refers to gastrointestinal haemorrhage resulting from a combination of aortic stenosis with angiodysplasia. This report explores the case of a 93-year-old lady who was admitted to hospital following a neck of femur fracture. She suffered from multiple comorbidities including renal failure and congestive heart failure secondary to critical aortic stenosis. As an inpatient she suffered an exacerbation of both her heart and renal failure postoperatively. A week later she suffered from heavy upper gastro-intestinal bleeding, which failed to respond to pharmacological and endoscopic therapies as well as angiographic embolisation. The pathophysiology of Heyde's syndrome: an acquired von Willebrand deficiency syndrome has a much wider impact than was commonly thought, both in terms of how common it is and in how the association may be extrapolated to a wide range of bleeding disorders, rather than simply angiodysplasia associated gastrointestinal haemorrhage. Copyright 2013 BMJ Publishing Group. All rights reserved.",acetylsalicylic acid;adrenalin;alendronic acid;omeprazole;aged;angiodysplasia;aorta stenosis;arthroplasty;article;artificial embolism;blood transfusion;case report;chronic kidney disease;comorbidity;congestive heart failure;dementia;disease association;disease exacerbation;drug withdrawal;duodenitis;duodenum ulcer;dyspnea;echocardiography;endoscopic therapy;esophagogastroduodenoscopy;female;femur neck fracture;fluid resuscitation;follow up;gastritis;gastroduodenal artery;gastrointestinal endoscopy;gastrointestinal hemorrhage;atrial fibrillation;heart left ventricle hypertrophy;Heyde syndrome;human;hypertension;hypotension;hypothyroidism;kidney failure;lung edema;melena;mitral valve regurgitation;priority journal;treatment failure;treatment outcome;treatment planning;treatment response,"Ledingham, D.",2013,,,0,
2521,Inferential processing of context: studies of cognitively impaired subjects,"Language comprehension tasks involving pronoun coreference were administered to a group of demented patients, a group of patients with cardiac disease, and groups of normal elderly persons and young adults. Pronoun coreference was constrained by either lexical, syntactic, or contextual cues. No differences were found between old and young subjects for any task. While the demented patients were impaired on all tasks, the cardiac patients were specifically impaired in the inferential processing of context.","Adult;Aged;Cognition Disorders/*psychology;*Concept Formation;Dementia/*psychology;Dyslexia, Acquired/*psychology;Female;Humans;Male;Myocardial Infarction/*psychology;Semantics","LeDoux, J. F.;Blum, C.;Hirst, W.",1983,Jul,,0,
2522,Association of primary cutaneous amyloidosis with atopic dermatitis: A nationwide population-based study in Taiwan,"Background Primary cutaneous amyloidosis (PCA) is a pruritic skin disorder most commonly seen in Southeast Asia and South America. Association of PCA with atopic dermatitis (AD) has been reported in the literature. However, no large-scale epidemiological study of PCA and its associations with other diseases has been conducted so far. Objectives We aimed to provide overall demographic data and comorbidities of patients with PCA based on a nationwide database in Taiwan. Methods Cases of PCA were collected from records of National Health Insurance claims from 2000 to 2007. We analysed patients' gender, age when the diagnosis was first made, and the overall 8-year prevalence. We also investigated comorbidities. Results The overall 8-year prevalence of PCA was 7·87 per 10 000 persons. Although there was no significant gender difference in the prevalence of PCA, men and women showed a different peak age (men, 71-80 years; women, 41-50 years) and a different age distribution at diagnosis. The mean age at diagnosis of PCA was significantly younger for women than for men. Men sought medical assistance for PCA more frequently than women. There was a higher disease activity from May to September than during other months. PCA was strongly associated with AD (odds ratio 7·18). Patients with PCA had a higher comorbidity of hyperlipidaemia and diabetes mellitus. Conclusions This is the first nationwide population-based epidemiological study of PCA. We demonstrate that PCA can be associated with other disorders, especially AD. © 2010 British Association of Dermatologists.",adult;age distribution;aged;allergic rhinitis;amyloidosis;anxiety disorder;article;asthma;atopic dermatitis;comorbidity;coronary artery disease;dementia;demography;diabetes mellitus;disease activity;disease association;dysthymia;female;gender;heart failure;human;hyperlipidemia;hyperparathyroidism;hypertension;kidney failure;major clinical study;male;medical care;pheochromocytoma;prevalence;primary cutaneous amyloidosis;priority journal;seasonal variation;skin disease;cerebrovascular accident;Taiwan;thyroid cancer,"Lee, D. D.;Huang, C. K.;Ko, P. C.;Chang, Y. T.;Sun, W. Z.;Oyang, Y. J.",2011,,,0,
2523,Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model,"CONTEXT: A predictive model of mortality in heart failure may be useful for clinicians to improve communication with and care of hospitalized patients. OBJECTIVES: To identify predictors of mortality and to develop and to validate a model using information available at hospital presentation. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of 4031 community-based patients presenting with heart failure at multiple hospitals in Ontario, Canada (2624 patients in the derivation cohort from 1999-2001 and 1407 patients in the validation cohort from 1997-1999), who had been identified as part of the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. MAIN OUTCOME MEASURES: All-cause 30-day and 1-year mortality. RESULTS: The mortality rates for the derivation cohort and validation cohort, respectively, were 8.9% and 8.2% in hospital, 10.7% and 10.4% at 30 days, and 32.9% and 30.5% at 1 year. Multivariable predictors of mortality at both 30 days and 1 year included older age, lower systolic blood pressure, higher respiratory rate, higher urea nitrogen level (all P<.001), and hyponatremia (P<.01). Comorbid conditions associated with mortality included cerebrovascular disease (30-day mortality odds ratio [OR], 1.43; 95% confidence interval [CI], 1.03-1.98; P =.03), chronic obstructive pulmonary disease (OR, 1.66; 95% CI, 1.22-2.27; P =.002), hepatic cirrhosis (OR, 3.22; 95% CI, 1.08-9.65; P =.04), dementia (OR, 2.54; 95% CI, 1.77-3.65; P<.001), and cancer (OR, 1.86; 95% CI, 1.28-2.70; P =.001). A risk index stratified the risk of death and identified low- and high-risk individuals. Patients with very low-risk scores (< or =60) had a mortality rate of 0.4% at 30 days and 7.8% at 1 year. Patients with very high-risk scores (>150) had a mortality rate of 59.0% at 30 days and 78.8% at 1 year. Patients with higher 1-year risk scores had reduced survival at all times up to 1 year (log-rank, P<.001). For the derivation cohort, the area under the receiver operating characteristic curve for the model was 0.80 for 30-day mortality and 0.77 for 1-year mortality. Predicted mortality rates in the validation cohort closely matched observed rates across the entire spectrum of risk. CONCLUSIONS: Among community-based heart failure patients, factors identifiable within hours of hospital presentation predicted mortality risk at 30 days and 1 year. The externally validated predictive index may assist clinicians in estimating heart failure mortality risk and in providing quantitative guidance for decision making in heart failure care.","Aged;Comorbidity;Female;Heart Failure/*mortality/therapy;Hospitalization;Humans;Male;*Models, Statistical;Prognosis;Reproducibility of Results;Retrospective Studies;Risk Assessment;Ventricular Dysfunction, Left","Lee, D. S.;Austin, P. C.;Rouleau, J. L.;Liu, P. P.;Naimark, D.;Tu, J. V.",2003,Nov 19,10.1001/jama.290.19.2581,0,
2524,Early deaths in patients with heart failure discharged from the emergency department a population-based analysis,"Background: Although approximately one third of patients with heart failure (HF) visiting the emergency department (ED) are discharged home, little is known about their care and outcomes. Methods and Results: We examined the acute care and early outcomes of patients with HF who visited an ED and were discharged without hospital admission in Ontario, Canada, from April 2004 to March 2007. Among 50 816 patients (age, 76.4±11.6 years; 49.4% men) visiting an ED for HF, 16 094 (31.7%) were discharged without hospital admission. A total of 4.0% died within 30 days from admission, and 1.3% died within 7 days of discharge from the ED. Although multiple (≥2) previous HF admissions (odds ratio [OR], 1.64; 95% CI, 1.14 to 2.31), valvular heart disease (OR, 1.37; 95% CI, 1.00 to 1.84), peripheral vascular disease (OR, 1.41; 95% CI, 1.00 to 1.93), and respiratory disease (OR, 1.33; 95% CI, 1.08 to 1.63) increased the risk of 30-day death among those discharged from the ED, presence of these conditions did not increase the likelihood of admission. Patients were more likely to be admitted if they were older (OR, 1.08; 95% CI, 1.06 to 1.10 per decade), arrived by ambulance (OR, 2.02; 95% CI, 1.93 to 2.12), had a higher triage acuity score (OR, 4.12; 95% CI, 3.84 to 4.42), or received resuscitation in the ED (OR, 2.85; 95% CI, 2.68 to 3.04). In those with comparable predicted risks of death, subsequent 90-day mortality rates were higher among discharged than admitted patients (11.9% versus 9.5%; log-rank P=0.016). Conclusions: Patients with HF who are discharged from the ED have substantial risks of early death, which, in some cases, may exceed that of hospitalized patients. © 2010 American Heart Association, Inc.",adult;age;aged;ambulance;article;cerebrovascular disease;coronary artery bypass graft;defibrillator;dementia;diabetes mellitus;emergency ward;female;gender;heart failure;heart infarction;hospital admission;hospital discharge;human;kidney disease;length of stay;major clinical study;male;mortality;neoplasm;patient transport;percutaneous coronary intervention;peripheral vascular disease;population research;priority journal;probability;registration time;respiratory tract disease;resuscitation;rheumatic disease;risk assessment;sinus node;time;valvular heart disease,"Lee, D. S.;Schull, M. J.;Alter, D. A.;Austin, P. C.;Laupacis, A.;Chong, A.;Tu, J. V.;Stukel, T. A.",2010,,,0,
2525,Symptomatic orthostatic tremor with progressive cognitive impairment in spinal cord lesions,,acetylsalicylic acid;cholinesterase inhibitor;donepezil;adult;article;brain atrophy;case report;cerebrospinal fluid analysis;cognitive defect;dementia;human;hypertrophic cardiomyopathy;laminectomy;male;Mini Mental State Examination;nuclear magnetic resonance imaging;orthostatic tremor;senile dementia;spinal cord lesion;treatment response;tremor,"Lee, H. M.;Kwon, D. Y.;Park, M. H.;Koh, S. B.;Kim, S. H.",2012,,,0,
2526,Education and Healthcare System Effects on Tooth Loss and Dementia Incidence in Later Life,,cholesterol;cardiovascular risk;cerebrovascular accident;dementia;diabetes mellitus;educational status;follow up;health care system;health education;heart infarction;human;hypertension;incidence;Japan;letter;mental capacity;multiinfarct dementia;periodontal disease;prospective study;self care;study design,"Lee, J. L.;Liu, X. B.;Yoo, J. W.",2017,,10.1111/jgs.15000,0,
2527,Coronary artery calcium is associated with cortical thinning in cognitively normal individuals,"To evaluate the association between coronary artery calcium (CAC) and cortical thickness in a large sample of cognitively normal individuals, with special emphasis in determining if the association thickness has regional brain specificity and if it is mediated by white matter hyperintensities (WMH). A total of 512 participants were included in this study. CAC scores were assessed by multi-detector computed tomography. Cortical thickness was measured using a surface-based method. Linear mixed models were used to assess the association between CAC scores and cortical thickness. In fully adjusted models, increased CAC scores were associated with cortical thinning across several brain regions, which generally overlapped with the distribution of default mode network. The association between CAC scores and cortical thickness was significantly stronger in participants with moderate or severe WMH compared to those with none or mild WMH, even though CAC scores were not associated with WMH. In cognitively normal adults, CAC was associated with cortical thinning in areas related to cognitive function. This association was evident after adjusting for multiple coronary artery disease risk factors and for WMH, suggesting that CAC may be more closely related to Alzheimer's Disease-type disease rather than to cerebral small vessel disease.",,"Lee, J. S.;Kang, D.;Jang, Y. K.;Kim, H. J.;Na, D. L.;Shin, H. Y.;Kang, M.;Yang, J. J.;Lee, J. M.;Lee, J.;Kim, Y. J.;Park, K. C.;Guallar, E.;Seo, S. W.;Cho, J.",2016,Oct 03,10.1038/srep34722,0,
2528,"Survival prediction in nursing home residents using the Minimum Data Set subscales: ADL Self-Performance Hierarchy, Cognitive Performance and the Changes in Health, End-stage disease and Symptoms and Signs scales","Background: With the intention to aid planning for elderly focused public health and residential care needs in rapidly aging societies, a simple model using only age, gender and three Minimum Data Set (MDS) subscales (MDS-ADL Self-Performance Hierarchy, MDS-Cognitive Performance and the MDS-Changes in Health, End-stage disease and Symptoms and Signs scales) was used to estimate long-term survival of older people moving into nursing homes. Methods: A total of 1820 nursing home residents were assessed by the MDS 2.0 and their mortality status 5 years later was used to develop a survival prediction model. Result: In December 2006, 54.2 of subjects were dead. Older age at nursing home admission (HR 1.036 per 1-year increment, 95 CI 1.0281.045), men (HR 1.895, 95 CI 1.6512.175), higher impairment level according to the MDS-ADL (HR 1.135 per 1-unit increment, 95 CI 1.0991.173) and MDS-CPS (HR 1.077 per 1-unit increment, 95 CI 1.0331.123), and more frail on the MDS-CHESS (HR 1.150 per 1-unit increment, 95 CI 1.0421.268), were all independent predictors of shorter survival after nursing home admission in multivariate analysis. Survival function was derived from the fitted Cox regression model. Survival time of nursing home residents with different combinations of risk factors were estimated through the survival function. Conclusion: The MDS-ADL, MDS-CPS and MDS-CHESS scales, in addition to age and gender, provide prognostic information in terms of survival time after institutionalization. The model may be useful for health care and residential care planning in an ageing community.",aged;Alzheimer disease;article;clinical feature;cognition;congestive heart failure;controlled study;dementia;diabetes mellitus;female;health care;human;hypertension;major clinical study;male;mortality;neoplasm;nursing home;priority journal;rating scale;risk factor;cerebrovascular accident;survival rate,"Lee, J. S. W.;Chau, P. P. H.;Hui, E.;Chan, F.;Woo, J.",2009,,,0,
2529,Office-Based Case Finding for Chronic Obstructive Pulmonary Disease in Older Adults in Primary Care,"Background. Chronic Obstructive Pulmonary Disease (COPD) is underdiagnosed in primary care. Aim. To explore the utility of proactive identification of COPD in patients 75 years of age and older in a Canadian primary care setting. Methods. Canadian Thoracic Society (CTS) screening questions were administered to patients with a smoking history of 20 pack-years or more; those with a positive screen were referred for postbronchodilator spirometry. Results. A total of 107 patients (21%), of 499 screened, had a 20-pack-year smoking history; 105 patients completed the CTS screening. Forty-four (42%) patients were positive on one or more questions on the screening; significantly more patients with a previous diagnosis of COPD (64%) were positive on the CTS compared to those without a previous diagnosis of COPD (30%). Of those who were not previously diagnosed with COPD (N = 11), four (36%) were newly diagnosed with COPD. Conclusion. A systematic two-stage method of screening for COPD, using CTS screening questions followed by spirometric confirmation, is feasible in the context of a busy primary care setting. More research is needed to assess the value of restricting screening to patients with a smoking history of 20 pack-years and on the sensitivity and specificity of these measures.",aged;article;atrial fibrillation;case finding;chronic obstructive lung disease;coronary artery disease;coughing;dementia;dyspnea;female;forced expiratory volume;forced vital capacity;heart infarction;human;hyperlipidemia;hypertension;major clinical study;male;medical record review;mild cognitive impairment;osteoporosis;patient referral;primary medical care;priority journal;screening;smoking;spirometry,"Lee, L.;Patel, T.;Hillier, L. M.;Milligan, J.",2016,,,0,
2530,Risk factors for medical complication after lumbar spine surgery: A multivariate analysis of 767 patients,"Study Design.: Multivariate analysis of prospectively collected registry data. Objective.: Using multivariate analysis to determine significant risk factors for medical complication after lumbar spine surgery. Summary of Background Data.: Several studies have examined the occurrence of medical complication after spine surgery. However, many of these studies have been done utilizing large national databases. Although these allow for analysis of thousands of patients, potentially influential covariates are not accounted for in these retrospective studies. Furthermore, the accuracy of these retrospective data collection in these databases has been called into question. Methods.: The Spine End Results Registry (2003-2004) is a collection of prospectively collected data on all patients who underwent spine surgery at our two institutions. Extensive demographic and medical information were prospectively recorded as described previously by Mirza et al. Complications were defined in detail a priori and were prospectively recorded for at least 2 years after surgery. We analyzed risk factors for medical complication after lumbar spine surgery using univariate and multivariate analysis. Results.: We analyzed data from 767 patients who met out inclusion criteria. The cumulative incidences of complication after lumbar spine surgery per organ system are as follows: cardiac, 13%; pulmonary, 7%; gastrointestinal, 6.7%; neurological, 8.2%; hematological, 17.5%; and urologic complications, 10.3%. The occurrence of cardiac or respiratory complication after lumbar spine surgery was significantly associated with death within 2 years (relative risk: 6.09 and 10.9, respectively). Several significant risk factors were identified for organ-specific complications. Among these, surgical invasiveness appeared to be the largest risk factor for cardiac, pulmonary, neurological, and hematological complications. Conclusion.: Risk factors identified in this study can be beneficial to clinicians and patients alike when considering surgical treatment of the lumbar spine. Future analyses and models that predict the occurrence of medical complication after lumbar spine surgery may be of further benefit for surgical decision making. © 2011, Lippincott Williams & Wilkins.",adult;aged;anemia;article;cardiovascular disease;cerebrovascular disease;chronic obstructive lung disease;congestive heart failure;dementia;demography;female;gastrointestinal disease;hematologic disease;human;kidney disease;lumbar spine surgery;lung disease;major clinical study;male;neurological complication;postoperative complication;priority journal;prospective study;rheumatoid arthritis;risk factor;spine surgery;urinary tract disease,"Lee, M. J.;Hacquebord, J.;Varshney, A.;Cizik, A. M.;Bransford, R. J.;Bellabarba, C.;Konodi, M. A.;Chapman, J.",2011,,,0,
2531,A 10-year update of CHOP-Bleo in the treatment of diffuse large-cell lymphoma,,bleomycin;cyclophosphamide;cytarabine;doxorubicin;etoposide;ifosfamide;methotrexate;prednisone;vincristine;vincristine sulfate;adverse drug reaction;blood and hemopoietic system;bone marrow depression;cancer chemotherapy;cancer combination chemotherapy;cardiotoxicity;congestive heart failure;dementia;drug dose;drug efficacy;drug therapy;heart;human;intoxication;intravenous drug administration;large cell lymphoma;lung toxicity;lymphatic system;lymphoma;major clinical study;nervous system;neurotoxicity;oral drug administration;peripheral neuropathy;priority journal;respiratory system;therapy;adriamycin;oncovin,"Lee, R.;Cabanillas, F.;Bodey, G. P.;Freirech, E. J.",1986,,,0,
2532,An assessment of survival among Korean elderly patients initiating dialysis: a national population-based study,"BACKGROUND: Although the proportion of the elderly patients with incident end-stage renal disease (ESRD) patients has been increasing in Korea, there has been a lack of information on outcomes of dialysis treatment. This study aimed to assess the survival rate and to elucidate predictors for all-cause mortality among elderly Korean patients initiating dialysis. METHODS: We analyzed 11,301 patients (6,138 men) aged 65 years or older who had initiated dialysis from 2005 to 2008 and had followed up (median, 37.8 months; range, 3-84 months). Baseline demographics, comorbidities and mortality data were obtained using the database from the Health Insurance Review & Assessment Service. RESULTS: The unadjusted 5-year survival rate was 37.6% for all elderly dialysis patients, and the rate decreased with increasing age categories; 45.9% (65 approximately 69), 37.5% (70 approximately 74), 28.4% (75 approximately 79), 24.1% (80 approximately 84), and 13.7% (>/=85 years). The multivariate Cox proportional hazard model revealed that age, sex, dialysis modality, the type of insurance, and comorbidities such as diabetes mellitus, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, hemiparesis, liver disease, and any malignancy were independent predictors for mortality. In addition, survival rate was significantly higher in patients on hemodialysis compared to patients on peritoneal dialysis during the whole follow-up period in the intention-to-treat analysis. CONCLUSIONS: Survival rate was significantly associated with age, sex, and various comorbidities in Korean elderly patients initiating dialysis. The results of our study can help to provide relevant guidance on the individualization strategy in elderly ESRD patients requiring dialysis.","Age Factors;Aged;Aged, 80 and over;Female;Humans;Kaplan-Meier Estimate;Kidney Failure, Chronic/*epidemiology/*therapy;Male;Proportional Hazards Models;Renal Dialysis/*statistics & numerical data;Republic of Korea/epidemiology;Sex Factors;Survival Rate","Lee, S.;Ryu, J. H.;Kim, H.;Kim, K. H.;Ahn, H. S.;Hann, H. J.;Cho, Y.;Park, Y. M.;Kim, S. J.;Kang, D. H.;Choi, K. B.;Ryu, D. R.",2014,,10.1371/journal.pone.0086776,0,
2533,Prevalence and risk factors of silent cerebral infarction in apparently normal adults,"Cerebrovascular disease is a major cause of death and disability in adults. Silent cerebral infarction (SCI) portends more severe cerebral infarctions or may lead to insidious progressive brain damage resulting in vascular dementia. This study was designed to evaluate the prevalence and risk factors of SCI in an apparently normal adult population. Nine hundred ninety-four consecutive symptom-free adults (mean age 49.0+/-7.7; men:women 830:164) who underwent brain magnetic resonance imaging at the Center for Health Promotion at Samsung Medical Center were assessed. All were neurologically normal in history and physical examination. A total of 121 SCI lesions was observed in 58 subjects. The lesion prevalence adjusted for patient age was 5.1%. There was no gender difference in prevalence. Ninety-nine lesions were <1 cm in diameter, 15 were between 1 and 2 cm, 3 were between 2 and 3 cm, and 4 were >3 cm in diameter. The most frequent site of the SCI lesion was basal ganglia, after which the periventricular white matter, cerebral cortex, and thalamus were the most frequent sites. Old age, hypertension, a history of coronary artery disease, evidence of cardiomegaly in chest radiographs, and high fasting glucose/hemoglobin A1c levels were associated with SCI on univariate analysis. Multivariate analysis demonstrated old age and hypertension to be independent risk factors for SCI, and mild alcohol consumption was revealed as an independent protective factor against SCI.",Adult;Age Factors;Aged;Alcohol Drinking;Female;Humans;Male;Middle Aged;Multivariate Analysis;Myocardial Infarction/*epidemiology/etiology;Prevalence;Risk Factors,"Lee, S. C.;Park, S. J.;Ki, H. K.;Gwon, H. C.;Chung, C. S.;Byun, H. S.;Shin, K. J.;Shin, M. H.;Lee, W. R.",2000,Jul,,0,
2534,Epileptic nystagmus: A case report and systematic review,"Purpose: We aimed to define the characteristics of epileptic nystagmus and correlate those with other clinical findings in a large number of patients. Methods: We report a patient with epileptic nystagmus and additionally reviewed the reported clinical features of 36 more patients through a systematic literature search. We analyzed the characteristics of epileptic nystagmus and attempted correlations of those with alertness of the patients and epileptic foci on EEG. Results: All 33 patients with unilateral horizontal nystagmus showed nystagmus beating away from the side of ictal discharges. Epileptic nystagmus was preceded by gaze deviation in 21 patients, with contraversive in 19 and ipsiversive in 2. Seizures associated with epileptic nystagmus were mostly focal (25/29, 86.2%) with or without loss of awareness. Ictal discharges originated from the occipital (n = 16), parietal (n = 9), temporo-occipital (n = 6), frontal (n = 4), and temporal (n = 3) areas, and two patients had multiple epileptic foci. Seizures were usually symptomatic (24/37, 64.9%). The presence of preceding gaze deviation and midline crossing of the nystagmus did not correlate with the ictal onset zone or alertness of the patients. Recording of epileptic nystagmus was available only in 6 patients, and the epileptic nystagmus could be localized to the saccadic areas in two and to the smooth pursuit areas in another two. Two patients showed the features of epileptic nystagmus from both areas. Conclusion: Even though the localizing value of epileptic nystagmus seems limited in previous reports, the fast phase of epileptic nystagmus was almost always directed away from the epileptic focus that mostly arose from the posterior part of the cerebral hemisphere.",etiracetam;fosphenytoin sodium;aged;Alzheimer disease;aphasia;article;brain edema;brain infarction;case report;diabetes mellitus;drowsiness;electroencephalography;epileptic nystagmus;female;heart infarction;human;hypertension;lethargy;nuclear magnetic resonance imaging;nystagmus;seizure;single photon emission computer tomography,"Lee, S. U.;Suh, H. I.;Choi, J. Y.;Huh, K.;Kim, H. J.;Kim, J. S.",2014,,,0,
2535,Reduced Cardiovascular Mortality Associated with Early Vascular Access Placement in Elderly Patients with Chronic Kidney Disease,"Elderly patients with cardiovascular comorbidities are more likely to die before progressing to the need for undergoing hemodialysis; so deferring their predialysis vascular access (VA) surgery has been suggested. However, recent declines in cardiovascular mortality in the US population may have changed this consideration. We assessed whether there has been a parallel decrease in cardiovascular comorbidity in elderly chronic kidney disease (CKD) patients undergoing predialysis access surgery, and whether this impacted clinical outcomes after access creation and cardiovascular events after hemodialysis initiation. Methods: We identified 3,418 elderly patients undergoing predialysis VA creation from 2004 to 2009, divided them into 3 time cohorts (2004-2005, 2006-2007 and 2008-2009), and assessed their clinical outcomes during 2 years of follow-up. Results: There was a progressive decrease in patients with history of peripheral vascular disease (from 66.5 to 59.7%, p < 0.005), heart failure (from 47.0 to 35.8%, p < 0.005), and myocardial infarction (from 6.5 to 3.3%, p < 0.001) from 2004 to 2009. Death before hemodialysis decreased from 17.5 to 12.6%, survival without hemodialysis increased from 14.5 to 19.0%, and hemodialysis initiation remained constant at ∼68% (p < 0.001). The incidence of death or cardiovascular event in the first year of hemodialysis decreased from 2004-2005 to 2008-2009 (HR 0.83, 95% CI 0.69-0.99; p = 0.04). Conclusion: In the context of a changing population from 2004 to 2009, a progressive decrease in cardiovascular comorbidities in elderly CKD patients undergoing predialysis VA surgery was associated with a decrease in death before hemodialysis and cardiovascular events after starting hemodialysis. These insights should be translated into more thoughtful consideration as to which elderly patients should undergo predialysis access surgery.",aged;article;cardiovascular mortality;cerebrovascular accident;cerebrovascular disease;chronic kidney disease;chronic obstructive lung disease;comorbidity;congestive heart failure;dementia;depression;diabetes mellitus;heart failure;heart infarction;hemodialysis;human;hypertension;ischemic heart disease;major clinical study;peripheral vascular disease;priority journal;vascular access,"Lee, T.;Thamer, M.;Zhang, Q.;Zhang, Y.;Allon, M.",2016,,,0,
2536,Osteoarthritis: A Comorbid Marker for Longer Life?,"Purpose: Diseases are often described and studied in isolation, yet there is increasing recognition of the complex interrelatedness of diseases and treatments in patients with multiple chronic diseases. Our objective was to describe the impact of selected diseases involving chronic inflammation (chronic obstructive pulmonary disease [COPD], osteoarthritis, and rheumatoid arthritis) on mortality. Methods: We identified a cohort aged 55 to 64 years with one or more chronic conditions. Clusters of mutually exclusive disease combinations were created. Five-year all-cause mortality was determined and the relative risk (RR) of mortality was estimated when COPD, osteoarthritis, and rheumatoid arthritis were added to clusters. Results: In 741,847 persons the 5-year mortality rates were lowest among persons with one condition and increased with more chronic conditions. The presence of osteoarthritis in a cluster was an exception where the risk was lower compared with that cluster without osteoarthritis: COPD (RR = 0.73 [95% confidence interval (CI), 0.65, 0.81]); ischemic heart disease (0.63 [0.52, 0.76]); hypertension (0.77 [0.71, 0.83]); dementia (0.63 [0.42, 0.93]); depression (0.65 [0.50, 0.84]); hypertension plus diabetes (0.85 [0.77, 0.93]); and ischemic heart disease plus hypertension (0.83 [0.73, 0.94]). Conclusions: The association between osteoarthritis and lower rates of mortality is notable and replicating these findings to explore causal relationships is important. © 2007 Elsevier Inc. All rights reserved.",adult;article;chronic disease;chronic inflammation;chronic obstructive lung disease;cluster analysis;cohort analysis;comorbidity;confidence interval;controlled study;diabetes mellitus;human;hypertension;ischemic heart disease;longevity;major clinical study;mortality;osteoarthritis;priority journal;rheumatoid arthritis;risk assessment,"Lee, T. A.;Pickard, A. S.;Bartle, B.;Weiss, K. B.",2007,,,0,
2537,"Acinetobacter baumannii and Acinetobacter genospecies 13tu and 3 bacteraemia: Comparison of clinical features, prognostic factors and outcomes","Objectives: To investigate the clinical impact of different genospecies of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB complex; A. baumannii, Acinetobacter gen. sp. 13TU and Acinetobacter gen. sp. 3) on the severity of bacteraemia. Methods: We retrospectively compared the clinical features and outcomes of patients with bacteraemia caused by A. baumannii, Acinetobacter gen. sp. 13TU or Acinetobacter gen. sp. 3. The genospecies were identified using oligonucleotide array sequence analysis (interspacer sequence), and the clonality of Acinetobacter gen. sp. 13TU and 3 isolates was determined by PFGE analysis. Results: A total of 215 patients with bacteraemia due to ACB complex were evaluated. Among them, 117 (54.4%) had A. baumannii bacteraemia, 77 (35.8%) had Acinetobacter gen. sp. 13TU bacteraemia and 21 (9.8%) had Acinetobacter gen. sp. 3 bacteraemia. A. baumannii bacteraemia was associated with a higher 14 day mortality rate (P<0.001), a higher 30 day mortality rate (P<0.001) and a higher in-hospital mortality rate than bacteraemia due to Acinetobacter gen. sp. 13TU or Acinetobacter gen. sp. 3. Independent prognostic factors for the 30 day mortality included the Charlson co-morbidity index (P<0.001) and Pitt bacteraemia score (P<0.001). Bloodstream infection caused by a multidrug-resistant A. baumannii isolate appeared to be associated with a poor outcome (P=0.069). There was no clonal spread of Acinetobacter gen. sp. 13TU or Acinetobacter gen. sp. 3 during the study period. Conclusions: Bacteraemia due to multidrug-resistant strains but not A. baumannii per se appears to be associated with poor outcome. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.",amikacin;carbapenem;cefepime;ceftazidime;ciprofloxacin;colistin;doripenem;gentamicin;imipenem;levofloxacin;meropenem;piperacillin plus tazobactam;sultamicillin;tigecycline;timentin;abdominal infection;Acinetobacter baumannii;Acinetobacter calcoaceticus;acquired immune deficiency syndrome;adult;antibiotic sensitivity;antibiotic therapy;article;bacteremia;bacterial strain;central venous catheter;cerebrovascular accident;chronic lung disease;clonal variation;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;disease severity;female;genotype;heart infarction;hemiplegia;human;kidney disease;length of stay;leukemia;liver disease;lymphoma;major clinical study;male;metastasis;mortality;peptic ulcer;peripheral occlusive artery disease;pneumonia;prognosis;retrospective study;sequence analysis;urinary tract infection;wound,"Lee, Y. C.;Huang, Y. T.;Tan, C. K.;Kuo, Y. W.;Liao, C. H.;Lee, P. I.;Hsueh, P. R.",2011,,,0,
2538,Effects of selective serotonin reuptake inhibitors versus tricyclic antidepressants on cerebrovascular events: A nationwide population-based cohort study,"Depression is a common disorder worldwide and is strongly associated with stroke. Use of antidepressants could potentially decrease the risk of stroke in patients with depression. However, the role of selective serotonin reuptake inhibitors (SSRIs), the most frequently prescribed antidepressant in this era, in the risk of stroke showed inconsistent results. We aimed to assess the association between the use of different types of antidepressants, SSRIs and tricyclic antidepressants (TCAs), and the risk of cerebrovascular events in patients with depression or anxiety. A nationwide population-based cohort study was retrospectively conducted in patients with depression or anxiety who started to take SSRIs and TCAs identified from the Taiwan National Health Insurance claims database (2001-2009). We examined the association between the 2 types of antidepressants and incidence of stroke using a proportional hazard model adjusted for stroke risk factors. Among the 24,662 SSRI and 14,736 TCA initiators, the crude incidence rate for stroke was 10.03 and 13.77 per 100 person-years, respectively. Selective serotonin reuptake inhibitor use was not associated with risk of stroke as compared with TCAs in the time-fixed analysis. After adjusting for baseline propensity scores in the time-varying analysis, SSRI use significantly reduced risk of stroke as compared with TCAs with the adjusted hazard ratio of 0.67 (95% confidence interval, 0.47-0.96). The effect persisted even after considering the antidepressant dosage (hazard ratio, 0.65 [0.42 to 0.99]). In summary, use of SSRIs was associated with a reduced risk for stroke, as compared with TCAs, in this specific disease population. © 2013 by Lippincott Williams & Wilkins.",angiotensin receptor antagonist;antiarrhythmic agent;anticoagulant agent;antilipemic agent;antithrombocytic agent;benzodiazepine derivative;beta adrenergic receptor blocking agent;calcium channel blocking agent;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;estrogen;hypnotic agent;insulin;mood stabilizer;neuroleptic agent;nitrate;nonsteroid antiinflammatory agent;oral antidiabetic agent;proton pump inhibitor;serotonin uptake inhibitor;tricyclic antidepressant agent;adult;alcoholism;anxiety disorder;article;bipolar disorder;cerebrovascular accident;cerebrovascular disease;chronic hepatitis;chronic kidney disease;chronic lung disease;comparative study;dementia;depression;drug effect;drug use;female;gastrointestinal hemorrhage;gout;atrial fibrillation;heart failure;hospitalization;hospitalization cost;human;hyperlipidemia;hypertension;ischemic heart disease;major clinical study;male;migraine;neuropathy;osteoarthritis;peptic ulcer;prescription;priority journal;psychopharmacotherapy;retrospective study;rheumatoid arthritis;sleep disorder;substance abuse;Taiwan;thyroid disease;treatment duration;urine incontinence,"Lee, Y. C.;Lin, C. H.;Lin, M. S.;Lin, J. W.;Chang, C. H.;Lai, M. S.",2013,,,0,
2539,Increased risk of dementia in patients with mild traumatic brain injury: a nationwide cohort study,"BACKGROUND: It is known that the risk of dementia in patients with moderate to severe traumatic brain injury (TBI) is higher. However, the relationship between mild traumatic brain injury (mTBI) and dementia has never been established. OBJECTIVES: We investigated the incidences of dementia among patients with mTBI in Taiwan to evaluate if there is higher risk compared with general population. METHODS: We utilized a sampled National Health Insurance (NHI) claims data containing one million beneficiaries. We followed all adult beneficiaries from January 1, 2005 till December 31, 2009 to see if they had been diagnosed with dementia. We further identify patients with mTBI and compared their risk of dementia with the general population. RESULTS: We identified 28551 patients with mTBI and 692382 without. After controlled for age, gender, urbanization level, socioeconomic status, diabetes, hypertension, coronary artery disease, hyperlipidemia, history of alcohol intoxication, history of ischemic stroke, history of intracranial hemorrhage and Charlson Comorbidity Index Score, the adjusted hazard ratio is 3.26 (95% Confidence interval, 2.69-3.94). CONCLUSIONS: TBI is an independent significant risk factor of developing dementia even in the mild type.",Adolescent;Adult;Aged;Brain Injuries/*complications/epidemiology;Cohort Studies;Dementia/epidemiology/*etiology;Female;Humans;Male;Middle Aged;Multivariate Analysis;Prevalence;Proportional Hazards Models;Risk Factors;Sensitivity and Specificity;Young Adult,"Lee, Y. K.;Hou, S. W.;Lee, C. C.;Hsu, C. Y.;Huang, Y. S.;Su, Y. C.",2013,,10.1371/journal.pone.0062422,0,
2540,Pharmacist intervention to detect drug adverse events on admission to the emergency department: Two case reports of neuroleptic malignant syndrome,"What is known and objective: Neuroleptic malignant syndrome (NMS) is a rare but severe adverse effect of antipsychotic drugs. Case description: We report two cases of NMS highlighted by clinical pharmacists in an emergency unit during summer. One of them was fatal. Medication reconciliation processes performed at admission identified treatment with loxapine for one of them and with loxapine and clozapine for the other. Interview of the patients highlighted clinical symptoms suggesting NMS, allowing the pharmacists to alert the medical team. What is new and conclusion: Adverse drug events may be severe and clinical pharmacists in emergency departments can help to detect them.",C reactive protein;ceftriaxone;clozapine;creatine kinase;creatinine;duloxetine;lactic acid;levofloxacin;loxapine;metformin;muscle relaxant agent;myoglobin;noradrenalin;piribedil;potassium;procalcitonin;sodium;tropatepine;valproic acid;acute kidney failure;adult;adverse drug reaction;aged;article;artificial ventilation;body mass;body weight;brain damage;breathing rate;cardiopulmonary arrest;case report;clinical examination;clinical feature;confusion;dehydration;depression;diabetes mellitus;drug surveillance program;emergency ward;extrapyramidal symptom;fever;Glasgow coma scale;hospital admission;hospital infection;human;hypertension;hypotension;intensive care unit;intervention study;Klebsiella pneumoniae infection;leukocyte count;liver failure;lung infection;male;mania;medical history;medication therapy management;mental disease;metabolic acidosis;morbid obesity;multiinfarct dementia;multiple organ failure;muscle rigidity;neuroleptic malignant syndrome;oxygen saturation;persecutory delusion;pharmacist;psychosis;resuscitation;rhabdomyolysis;schizophrenia;summer;tachycardia,"Leenhardt, F.;Perier, D.;Pinzani, V.;Giraud, I.;Villiet, M.;Castet-Nicolas, A.;Gourhant, V.;Breuker, C.",2017,,10.1111/jcpt.12531,0,
2541,Complete atrioventricular block during galantamine therapy 4,,galantamine;complete heart block;dementia;heart muscle ischemia;human;hypertension;letter;risk factor,"Leenrjens, A. F. G.;Kragten, J. A.",2006,,,0,
2542,An analysis of risk factors for withdrawal from dialysis before death,"Withdrawal from dialysis has been a significant cause of mortality among dialysis patients, accounting for 6 to 22% of deaths. Since 1990, a new death notification form has allowed more detailed analyses of withdrawal from dialysis separate from causes of death. Using the U.S. Renal Data System data base, this study examined 116,829 deaths in adult patients from 1990 to 1995. Adjusted odds ratios were calculated for the risk of withdrawal using logistic regression. Adjustments included age at death, ethnicity, gender, cause of death, primary cause of end-stage renal disease, time on dialysis, and dialysis modality. In addition, odds ratios of withdrawal were calculated for deaths in patients who started dialysis after age 65. Death was preceded by withdrawal significantly more frequently in women than in men, more than twice as frequently in Caucasians than in African-Americans or Asians, and more frequently in older than in younger age groups. Patients who died of chronic diseases (e.g., dementia, malignancy) were much more likely to withdraw before death, whereas patients who died from more acute causes (e.g., coronary artery disease) were less likely to withdraw before death. It is concluded that patients who are Caucasian, female, older, or die of chronic or progressive diseases are more likely to withdraw from dialysis before death. The ethnic and gender differences in withdrawal do not appear to have a medical explanation from this analysis. Further research along sociologic lines is needed to better explain the differences in withdrawal from chronic dialysis.","Adolescent;Adult;Age Distribution;Aged;Aged, 80 and over;Analysis of Variance;*Cause of Death;Female;Humans;Kidney Failure, Chronic/*mortality/therapy;Logistic Models;Longitudinal Studies;Male;Middle Aged;Odds Ratio;Registries;*Renal Dialysis/mortality;Risk Factors;Sex Distribution;Survival Rate;*Treatment Refusal;United States/epidemiology","Leggat, J. E., Jr.;Bloembergen, W. E.;Levine, G.;Hulbert-Shearon, T. E.;Port, F. K.",1997,Nov,,0,
2543,The effect of comorbidity burden on health care utilization for patients with cancer using hospice,"Background: The treatment of patients with advanced cancer with multiple comorbid illnesses is complex. Although an increasing number of such patients are being referred to hospice, the comorbidity burden of this patient population is largely unknown but has implications for the complexity of care provided by hospices. This study reports the comorbidity burden in a national sample of hospice users with cancer and estimates the effect of higher comorbidity on health care use and site of death. Methods: Cross-sectional study using Surveillance, Epidemiology and End Results-Medicare data for hospice users who died of cancer in 2002 (N=27,166). We measured comorbidity burden using the Charlson comorbidity index and used multivariable generalized estimating equations to estimate the association between comorbidity burden and the following outcomes: emergency department and intensive care unit (ICU) admission, hospitalization, hospice disenrollment, and hospital death. Results: Patients with cancer who used hospice had an average Charlson comorbidity index value of 1.24, including 18.8% who suffered from comorbid dementia. In analyses adjusted for patient demographics, site of primary cancer, and number of days with hospice, higher comorbidity burden was associated with higher likelihood of emergency department admission (odds ratio [OR]=1.69, 95% confidence interval [CI] 1.52, 1.87), ICU admission (OR=3.28, 95% CI 2.45, 4.38), inpatient hospitalization (OR=2.14, 95% CI 1.90, 2.42), hospice disenrollment (OR=1.41, 95% CI 1.29, 1.56) and hospital death (OR=2.51, 95% CI 2.08, 3.02). Conclusion: These findings underscore the complexity of the hospice patient population and highlight a potential need to risk adjust the per diem hospice reimbursement rates to account for increased resource requirements for hospices serving patients with higher comorbidity burden. © 2011 Mary Ann Liebert, Inc.",aged;article;cancer localization;cancer mortality;cancer patient;cancer registry;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;clinical assessment tool;comorbidity;congestive heart failure;controlled study;cross-sectional study;dementia;diabetes mellitus;emergency care;female;health care utilization;hospice care;hospital admission;hospitalization;human;intensive care;major clinical study;male;mortality,"Legler, A.;Bradley, E. H.;Carlson, M. D. A.",2011,,,0,
2544,Impact of telehealth on healthcare utilization by congestive heart failure patients,"Background: Advances in telehealth are proving to be extremely conducive to effective management of congestive heart failure (CHF) and other disease states, particularly in ambulatory settings. In order to assess the impact of telehealth on healthcare utilization in CHF patients, telehealth technology was introduced into a demonstration project established by the Secretary of Health and Human Services. Demonstration projects examine health delivery factors that encourage the delivery of improved quality of care and have already implemented protocols to evaluate methods to improve quality of care and reduce expenditures provided to Medicare beneficiaries with chronic conditions (including methods to permit Medicare beneficiaries to direct their own healthcare needs and services). This study, funded in June of 2002 by the Centers for Medicare and Medicare Services, focused on The Jewish Home & Hospital Services, Lifecare Plus (New York, NY, USA), one of the US's federally funded national demonstration projects. The study measured the impact of managing CHF patients via telehealth technology on overall healthcare utilization, physician office visits, emergency department (ED) visits, and hospital readmissions. Methods: To be eligible for the Jewish Home & Hospital Services Lifecare Plus demonstration project, patients had to be aged ≥65 years, have both Medicare parts A & B, have had at least three doctor visits or one hospitalization in the previous 12 months, reside at a Manhattan or Bronx address in New York, and have one of the following diagnoses: heart disease, diabetes, liver disease, lung disease, vascular disease, cerebrovascular disease, psychotic major depression or anxiety, cancer, Alzheimer disease, or dementia. This particular study included 20 homebound CHF patients, of whom 10 were in the telehealth study group and 10 were in the control group. Results: The findings demonstrated that patients managing their CHF via telehealth technology decreased their overall utilization of healthcare resources by 41% (p = 0.00183). Physician office visits decreased by 43% (p = 0.00253), ED visits by 33% (p = 0.3770), and hospitalizations by 29% (p = 0.3872). Conclusions: The significant reduction in overall healthcare utilization and physician office visits demonstrate that this technology could offer significant cost savings for long-term disease management and could offer clinicians a new form of service delivery that may improve the quality of care. Hopefully, the outcomes of this study will serve as a catalyst for future larger studies, thus reducing the obvious limitations associated with small studies such as this one. © 2006 Adis Data Information BV. All rights reserved.",aged;ambulatory care;article;clinical article;congestive heart failure;controlled study;emergency ward;health care delivery;health care quality;health care utilization;health program;hospital readmission;human;medicare;telehealth,"Lehmann, C. A.;Mintz, N.;Giacini, J. M.",2006,,,0,
2545,Saliva secretion and oral flora in prolonged nasogastric tube-fed elderly patients,"Background: In a previous study we showed that prolonged nasogastric tube feeding is associated with pathogenic oral flora. Objective: To reexamine the impact of prolonged nasogastric tube feeding on the oral microbiota and to explore the salivary flow and composition in elderly patients in long-term care. Methods: We compared a group of elderly patients fed by nasogastric tube with a control group of elderly patients in long-term care who are fed orally. Bacteriotogic studies were performed by culturing samples from the oropharynx. Saliva studies included quantitative and biochemical analysis of basal and stimulated salivary flow. Results: Bacteriotogic studies performed in 90 patients revealed a significantly higher prevalence of gram-negative bacteria In nasogastric tube-fed patients (73% vs. 13%, P < 0.001). It is emphasized that Pseudomonas aeruginosa and Klebsiella pneumoniae were commonly and exclusively isolated from the oral flora of the nasogastric tube-fed patients (P < 0.001, P < 0.05). In the saliva studies performed on 23 nasogastric tube-fed and 21 control patients, basal and stimulated salivary flow was not significantly different in the two groups, however the ratio of stimulated to basal flow was reduced in the nasogastric tube-fed group (P < 0.05). Significant differences were also found in the concentrations of sodium, amylase, phosphor and magnesium. Noteworthy was the concentration of uric acid, the main non-enzymatic antioxidant of saliva, which was significantly lower in nasogastric-tube fed patients (P < 0.002). Conclusions: These findings suggest that prolonged nasogastric tube feeding is associated with pathologic colonization of the oropharynx and with alterations in the saliva that are related to the risk of aspiration pneumonia. Further research is called for, as well as a thorough revision of the existing oral cleansing procedures in these patients.",amylase;antidepressant agent;antioxidant;antiparkinson agent;beta adrenergic receptor blocking agent;calcium;chlorine;diuretic agent;glucose;magnesium;neuroleptic agent;nitrogen;phosphorus;protein;sodium;urea;uric acid;aged;article;aspiration pneumonia;bacterial colonization;bacterium culture;bacterium isolation;biochemistry;comparative study;concentration (parameters);congestive heart failure;controlled study;dementia;depression;diabetes mellitus;elderly care;female;Gram negative bacterium;human;hypertension;ischemic heart disease;Klebsiella pneumoniae;long term care;major clinical study;male;microbiological examination;mouth flora;nose feeding;oropharynx;Parkinson disease;prevalence;Pseudomonas aeruginosa;quantitative analysis;saliva;saliva analysis;saliva level;salivation;cerebrovascular accident,"Leibovitz, A.;Plotnikov, G.;Habot, B.;Rosenberg, M.;Wolf, A.;Nagler, R.;Graf, E.;Segal, R.",2003,,,0,
2546,Cardiac Rupture: New Features of the Old Disease,"OBJECTIVES: Myocardial rupture is a rare but a fatal complication of acute myocardial infarction. During recent years, treatment strategies of acute myocardial infarction have changed. Primary percutaneous coronary interventions have replaced fibrinolytic therapy, thus reducing one of the major risk factors for myocardial rupture. In this work, we describe a group of patients who suffered myocardial rupture, none of whom were treated with thrombolytic therapy. METHODS: The digital database of our hospital was searched for all patients who experienced myocardial rupture between 2008 and 2015. The demographic, clinical, angiographic and echocardiographic data of these patients were analyzed. RESULTS: Out of 2,380 patients admitted with acute myocardial infarction, 12 (0.5%) developed myocardial rupture. The mean age was 78 years, and there were 7 males and 5 females. Ten patients already had pericardial effusion on admission. Seven patients underwent coronary angiography, whilst primary percutaneous intervention was performed in 4 patients. Six patients entered the operating room and all survived the procedure. All patients who were treated conservatively died due to rupture. Factors related to the treatment strategy were advanced age (>/= 90 years) and cognitive impairment. CONCLUSIONS: The risk of myocardial rupture may be diminished by primary coronary intervention during myocardial infarction, but mortality remains high. An early, comprehensive echocardiographic examination and rapid surgery may contribute to improved survival.","Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/complications;Cerebrovascular Disorders/complications;Coronary Angiography;Female;Health Status;Heart Rupture/*etiology/*mortality;Humans;Male;Myocardial Infarction/*complications/therapy;Percutaneous Coronary Intervention;Pericardial Effusion/etiology;Retrospective Studies;Troponin/blood","Leitman, M.;Tsatskin, L.;Hendler, A.;Blatt, A.;Peleg, E.;Vered, Z.",2016,,10.1159/000442815,0,
2547,Quality of life in patients after anti-arrhythmic devices implantation,"THE AIM OF STUDY: To assess changes in quality of life in patients with advanced heart failure before ICD or CRTD implantation and after 6 months follow-up period. MATERIAL AND METHODS: The quality of life study was performed in group consisting of 98 patients (69 male, mean age 70.4 +/- 8.60 years), who underwent CRTD implantation (48 patients, 33 male, mean age 70.6 +/- 9.12 years) or ICD implantation (50 patients, 36 male, mean age 70.3 +/- 8.16 years) before the procedure and after 6 months of follow-up. Inclusion criteria were as follows: patients with indications to ICD or CRTD implantation, complete quality of life questionnaires before the procedure and after 6 months follow-up, lack of diagnosed dementia. The quality of life assessment was performed using patient's self-assessment with SF-36 and DASI questionnaires. Patients' self-assessment, NYHA class and ejection fraction was compared before the implantation and after 6 months. Additionally, co-morbidities and experiencing of high voltage therapy were analyzed. RESULTS: In the whole group after 6 months NYHA class improved from mean 2.9 +/- 0.5 to 2.3 +/- 0.84, p < 0.001; in CRTD group from mean 3.0 +/- 0.62 to 2.3 +/- 0.95, p < 0.001; in ICD group from mean 2.9 +/- 0.35 to 2.2 +/- 0.74, p < 0.001. In the whole group after 6 months ejection fraction improved from mean 27.7 +/- 6.92 to 31.0 +/- 7.23%, p < 0.001; in CRTD group from mean 25.3 +/- 7.85 to 32.4 +/- 8.98%, p < 0.001; in ICD group there was no significant improvement of ejection fraction. After CRTD implantation improvement of quality of life was achieved in SF36 and DASI questionnaires. There was no significant improvement in ICD group. DASI index is deteriorated by device's interventions (cardioversions) (regression index=3.45, odds ratio OR = 31.5, 95% confidence interval OR = 8.2-121, p < 0.001) and presence of permanent atrial fibrillation (regression index = 1,243, odds ratio OR = 3.45, 95% confidence interval OR = 1.03-11.7, p < 0.042). SF36 index is deteriorated by presence of kidney failure (regression index = 1.91, odds ratio OR = 6.74, 95% confidence interval OR = 1.75-26, p < 0.005) and permanent atrial fibrillation (regression index = 2.27, odds ratio OR = 9.7, 95% confidence interval OR = 3.1-29.6, p < 0.001). CONCLUSIONS: Cardiac resynchronization therapy (CRTD) improves quality of life, NYHA class and left ventricle ejection fraction. Implantable cardioverter-defibrillator (ICD) does not significantly improve quality of life, NYHA class or left ventricle ejection fraction. Only in the CRTD group a significant positive correlation between changes in DASI and SF36 indexes and left ventricle ejection fraction was achieved. Experiencing cardioversion/defibrillation from implantable device and co morbidities (diabetes mellitus, arterial hypertension, kidney failure, permanent atrial fibrillation) significantly deteriorate patients' self assessment of quality of life.","Aged;Cardiac Resynchronization Therapy/*psychology;Defibrillators, Implantable/*psychology;Female;Heart Failure/psychology/*therapy;Humans;Male;*Quality of Life;Self-Assessment;Surveys and Questionnaires","Lelakowska-Piela, M.;Pudlo, J.;Rydlewska, A.;Senderek, T.;Lelakowski, J.",2013,Dec,,0,
2548,Applanation tonometry in mice: a novel noninvasive technique to assess pulse wave velocity and arterial stiffness,"Arterial stiffening is the root cause of a range of cardiovascular complications, including myocardial infarction, left ventricular hypertrophy, stroke, renal failure, dementia, and death, and a hallmark of the aging process. The most important in vivo parameter of arterial stiffness is pulse wave velocity (PWV). Clinically, PWV is determined noninvasively using applanation tonometry. Unlike the clinical value of arterial stiffness and PWV, techniques to determine PWV in mice are scarce. The only way to determine aortic PWV noninvasively in the mouse is by using ultrasound echo Doppler velocimetry. It is a fast, efficient, and accurate technique, but the required tools are expensive and technically complex. Here, we describe the development and validation of a novel technique to assess carotid-femoral PWV noninvasively in mice. This technique is based on applanation tonometry as used clinically. We were able to establish a reproducible reference value in wild-type mice (3.96+/-0.05 m/s) and to detect altered carotid-femoral PWV values in endothelial nitric oxide synthase knockout mice (4.66+/-0.05 m/s; P<0.001 compared with control), and in mice sedated with sodium pentobarbital (2.89+/-0.17 m/s; P<0.001 compared with control). Also, carotid-femoral PWV was pharmacologically modulated and measured in a longitudinal experiment with endothelial nitric oxide synthase knockout mice to demonstrate the applicability of this technique. In general, applanation tonometry can be used to measure carotid-femoral PWV noninvasively in mice. The experimental setup is simple, and the technical requirements are basic, making this technique readily implementable in any mouse model-based research facility interested in arterial stiffness.",Animals;Cardiovascular Diseases/*physiopathology;Carotid Arteries/*physiopathology;Femoral Artery/*physiopathology;Manometry/methods;Mice;Pulse Wave Analysis/*methods;Vascular Stiffness/*physiology;aging;pulse wave analysis;vascular stiffness,"Leloup, A. J.;Fransen, P.;Van Hove, C. E.;Demolder, M.;De Keulenaer, G. W.;Schrijvers, D. M.",2014,Jul,10.1161/hypertensionaha.114.03312,0,
2549,About the person of trust (multiple letters),,Alzheimer disease;blood vessel injury;coma;decision making;ethics;France;heart arrest;human;letter;medical literature;public health;publication;resuscitation;trust,"Lemaire, F.;Manaouil, C.",2005,,,0,
2550,Predictors of long-term mortality after severe sepsis in the elderly,"BACKGROUND: Mortality rates after severe sepsis are extremely high, and the main focus of most research is short-term mortality, which may not be associated with long-term outcomes. The purpose of this study was to examine long-term mortality after a severe sepsis and identify factors associated with this mortality. METHODS: The authors performed a population-based study using Veterans' Affairs administrative data of patients aged 65 years and older. The outcome of interest was mortality > 90 days following hospitalization. Our primary analyses were Cox proportional hazard models to examine specific risk factors for long-term mortality. RESULTS: There were 2,727 patients that met the inclusion criteria. Overall mortality was 55%, and 1- and 2-year mortality rates were 31% and 43%, respectively. Factors significantly associated with long-term mortality included congestive heart failure, peripheral vascular disease, dementia, diabetes with complications and use of mechanical ventilation. Smoking cessation and cardiac medications were associated with decreased long-term mortality rates. CONCLUSIONS: The authors identified several factors, including receipt of mechanical ventilation, which were significantly associated with increased long-term mortality for survivors of severe sepsis. This information will help clinicians discuss prognosis with patients and their families.","Aged;Aged, 80 and over;Comorbidity;Databases, Factual;Dementia/complications;Female;Heart Failure/complications;Hospitalization;Humans;Male;Respiration, Artificial/adverse effects;Risk Factors;Sepsis/complications/*mortality;Time Factors;United States/epidemiology;United States Department of Veterans Affairs","Lemay, A. C.;Anzueto, A.;Restrepo, M. I.;Mortensen, E. M.",2014,Apr,10.1097/MAJ.0b013e318295a147,0,
2551,"VA nursing home residents with substance use disorders: Mental health comorbidities, functioning, and problem behaviors","OBJECTIVES: This research addresses whether residents with substance use disorders (SUDs) in VA nursing homes (VANHs) are distinctive in terms of their demographic characteristics, medical and mental health comorbidities, functioning, and problem behaviors. METHODS: Residents over age 55 admitted to VANHs (n = 27,002) were identified in VA administrative files, and SUD and non-SUD residents were compared. RESULTS: Compared with other residents, the residents with SUDs (18% of admissions over age 55) were more likely to be younger, male, African-American, unmarried, have low income and a tobacco use disorder. Controlling for demographic factors and smoking, SUD residents were more likely to have mental health comorbidities (dementia, serious mental illness, depressive disorders, and post-traumatic stress disorder), as well as AIDS/hepatitis, pulmonary disease, gastro-intestinal disorders, and injuries. SUD residents were less likely to have cancer, diabetes, neurological disorders, heart failure, and renal failure. SUD residents were more independent in activities of daily living, such as mobility and toileting. They were more likely to engage in verbal disruption but not in other problem behaviors such as aggression. With demographic factors and comorbidities controlled, the functioning differences were diminished, and SUD and non-SUD residents did not differ in the levels of problem behaviors. DISCUSSION: VANH residents with SUDs have distinctive patterns of comorbidities and functioning. SUD appears to represent a separate risk factor for VANH admission. Residents with SUDs present challenges but may have good potential for positive discharge outcomes if their substance use problems and limited resources can be addressed.",addiction;aged;article;comorbidity;daily life activity;factual database;female;government;health status;hospital admission;human;male;mental disease;mental health;nursing home;antisocial personality disorder;United States,"Lemke, S.;Schaefer, J. A.",2010,,,0,
2552,Who Take Naps? Self-Reported and Objectively Measured Napping in Very Old Women,"Background: Despite the widespread belief that napping is common among older adults, little is known about the correlates of napping. We examined the prevalence and correlates of self-reported and objectively measured napping among very old women. Methods: We studied 2,675 community-dwelling women (mean age 84.5 +/- 3.7 years; range 79-96). Self-reported napping was defined as a report of regular napping for >/=1 hour per day. Individual objective naps were defined as >/=5 consecutive minutes of inactivity as measured by actigraphy and women were characterized as ""objective nappers"" if they had at least 60 minutes of naps per day. Results: Seven percent of the women only had self-reported napping, 29% only had objective napping, and 14% met the criteria for both. Multinomial logistic regression showed that the independent correlates of ""both subjective and objective napping"" were age (per 5 year odds ratio [OR] = 1.59; 95% CI: 1.31-1.93), depressive symptoms (per SD of score, OR = 1.53; 1.32-1.77), obesity (OR =1.93; 1.42-2.61), current smoking (OR = 3.37; 1.56-7.30), heavier alcohol drinking (OR = 0.49; 0.34-0.71), history of stroke (OR = 1.56; 1.08-2.26), diabetes (OR = 2.40; 1.61-3.57), dementia (OR = 3.31; 1.27-8.62), and Parkinson's disease (OR = 7.43; 1.87-29.50). Besides, having objective napping alone was associated with age and diabetes, whereas subjective napping was associated with stroke and myocardial infarction. These associations were independent of nighttime sleep duration and fragmentation. Conclusions: Daytime napping is very common in women living in their ninth decade and both subjective and objective napping were significantly related to age and comorbidities. Future studies are needed to better understand napping and its health implications.",Actigraphy;Daytime napping;Predictor;Siesta;Sleep,"Leng, Y.;Stone, K.;Ancoli-Israel, S.;Covinsky, K.;Yaffe, K.",2017,Feb 18,,0,
2553,"Adaptive, Dose-finding Phase 2 Trial Evaluating the Safety and Efficacy of ABT-089 in Mild to Moderate Alzheimer Disease","ABT-089, an α 4 β 2 neuronal nicotinic receptor partial agonist, was evaluated for efficacy and safety in mild to moderate Alzheimer disease patients receiving stable doses of acetylcholinesterase inhibitors. This phase 2 double-blind, placebo-controlled, proof-of-concept, and dose-finding study adaptively randomized patients to receive ABT-089 (5, 10, 15, 20, 30, or 35 mg once daily) or placebo for 12 weeks. The primary efficacy endpoint was the Alzheimer's Disease Assessment Scale, cognition subscale (ADAS-Cog) total score. A Bayesian response-adaptive randomization algorithm dynamically assigned allocation probabilities based on interim ADAS-Cog total scores. A normal dynamic linear model for dose-response relationships and a longitudinal model for predicting final ADAS-cog score were employed in the algorithm. Stopping criteria for futility or success were defined. The futility stopping criterion was met, terminating the study with 337 patients randomized. No dose-response relationship was observed and no dose demonstrated statistically significant improvement over placebo on ADAS-Cog or any secondary endpoint. ABT-089 was well tolerated at all dose levels. When administered as adjunctive therapy to acetylcholinesterase inhibitors, ABT-089 was not efficacious in mild to moderate Alzheimer disease. The adaptive study design enabled the examination of a broad dose range, enabled rapid determination of futility, and reduced patient exposure to nonefficacious doses of the investigational compound.",NCT00555204;donepezil;galantamine;placebo;pozanicline;rivastigmine;adult;aged;Alzheimer disease;Alzheimer Disease Assessment Scale;Alzheimer Disease Assessment Scale cognition portion score;Alzheimer Disease Cooperative Study Activities of Daily Living score;article;cause of death;clinical evaluation;comparative effectiveness;controlled study;coronary artery atherosclerosis;coronary artery disease;coughing;disease severity;dizziness;dose calculation;double blind procedure;drug efficacy;drug safety;drug tolerability;drug treatment failure;drug withdrawal;fatigue;female;headache;human;hypertension;incidence;major clinical study;male;multicenter study;nausea;phase 2 clinical trial;priority journal;randomized controlled trial;rash;rhinopharyngitis;scoring system;thorax pain;treatment duration;treatment outcome;treatment response;upper respiratory tract infection;urinary tract infection;vomiting;abt 089,"Lenz, R. A.;Pritchett, Y. L.;Berry, S. M.;Llano, D. A.;Han, S.;Berry, D. A.;Sadowsky, C. H.;Abi-Saab, W. M.;Saltarelli, M. D.",2015,,,0,
2554,Somatic changes despite good health - Nutritional influences,"The specificity of the aging organism consists of functional and structural changes in different organs and tissues combined with decreasing functional capacity. Aging per se does not represent a pathological status. Changes in the elderly can be well demonstrated in the muscle and skeletal system. Osteoporosis leads to immobilisation due to pain followed by declining muscle strength and postural control. Sensory functions are also reduced: hearing, vision, smell and taste. Coordination of central nervous functions is equally impaired. The lack of adaptation to frequent alterations induces impairment in independent living of the elderly. Nutrition represents a major factor contributing to the aging process. Thus, life quality and life expectancy are directly influenced. Very old age alone does not imply automatically illness and malnutrition. During aging, food intake decreases steadily although energy demand does not diminish in the same way. Causes for the difference in supply and needs are due to changes in regulation of appetite and thirst, in gastrointestinal motility and secretion as well as in reduced metabolic rates. Numerous drugs also impair food intake by different mechanisms. Further risk factors for malnutrition in the elderly are poverty, social isolation, dementia, depression, alcoholism, chewing problems, cancer, radiation therapy, chronical infections and physical impairment due to COPD or heart failure. Consequent assessment of nutritional state and specific nutritional support are valuable tools to improve the nutritional and functional status in the elderly.",adaptation;aging;alcoholism;appetite;article;body posture;neoplasm;dementia;depression;elderly care;energy expenditure;food intake;functional assessment;gastrointestinal motility;gastrointestinal secretion;health behavior;hearing;human;immobilization;infection;life expectancy;malnutrition;mastication;metabolism;muscle strength;musculoskeletal system;nutrition;nutritional status;nutritional support;odor;osteoporosis;poverty;quality of life;radiotherapy;risk factor;sensory dysfunction;social isolation;taste;thirst;vision,"Lenzen-Großimlinghaus, R.",2003,,,0,
2555,"Burden of multimorbidity in relation to age, gender and immigrant status: A cross-sectional study based on administrative data","Objectives Many studies have investigated multimorbidity, whose prevalence varies according to settings and data sources. However, few studies on this topic have been conducted in Italy, a country with universal healthcare and one of the most aged populations in the world. The aim of this study was to estimate the prevalence of multimorbidity in a Northern Italian region, to investigate its distribution by age, gender and citizenship and to analyse the correlations of diseases. Design Cross-sectional study based on administrative data. Setting Emilia-Romagna, an Italian region with-1/44.4 million inhabitants, of which almost one-fourth are aged ≥65 years. Participants All adults residing in Emilia-Romagna on 31 December 2012. Hospitalisations, drug prescriptions and contacts with community mental health services from 2003 to 2012 were traced to identify the presence of 17 physical and 9 mental health disorders. Primary and secondary outcome measures Descriptive analysis of differences in the prevalence of multimorbidity in relation to age, gender and citizenship. The correlations of diseases were analysed using exploratory factor analysis. Results The study population included 622 026 men and 751 011women, with a mean age of 66.4 years. Patients with multimorbidity were 33.5% in 75 years and >60% among patients aged ≥90 years; among patients aged ≥65 years, the proportion of multimorbidity was 39.9%. After standardisation by age and gender, multimorbidity was significantly more frequent among Italian citizens than among immigrants. Factor analysis identified 5 multimorbidity patterns: (1) psychiatric disorders, (2) cardiovascular, renal, pulmonary and cerebrovascular diseases, (3) neurological diseases, (4) liver diseases, AIDS/HIV and substance abuse and (5) tumours. Conclusions Multimorbidity was highly prevalent in Emilia-Romagna and strongly associated with age. This finding highlights the need for healthcare providers to adopt individualised care plans and ensure continuity of care.",acquired immune deficiency syndrome;adult;age;aged;anxiety disorder;article;bipolar disorder;cerebrovascular disease;chronic lung disease;citizenship;congestive heart failure;cross-sectional study;dementia;depression;diabetes mellitus;drug dependence;dysthymia;female;heart infarction;human;hypertension;immigrant;intellectual impairment;Italy;major clinical study;male;malignant neoplasm;middle aged;morbidity;multiple chronic conditions;outcome assessment;paralysis;patient care;peptic ulcer;peripheral vascular disease;personality disorder;prevalence;psychosis;rheumatic disease;schizophrenia;solid malignant neoplasm;somatoform disorder;substance abuse;very elderly;young adult,"Lenzi, J.;Avaldi, V. M.;Rucci, P.;Pieri, G.;Fantini, M. P.",2016,,10.1136/bmjopen-2016-012812,0,
2556,"Carvedilol in elderly patients with chronic heart failure, a 12 weeks randomized, placebo controlled open trial","The encouraging results of recent multicenter clinical trials conducted in the US on the effect of carvedilol therapy in patients with chronic heart failure, prompted us to verify its tolerability in a group of elderly patients. For the open, randomized, placebo-controlled study, we selected 40 patients (28 men and 12 women, mean age 76.8+/-5.9 years) with mild, moderate or severe chronic heart failure. Exclusion criteria included dementia, chronic hepatitis, renal failure, severe vascular disease and respiratory failure. All patients were receiving treatment with digitalis, furosemide and ACE inhibitors. The study lasted 12 weeks. During the first week, all subjects received oral placebo or carvedilol, at a dose of 6.25 mg twice daily. The twice daily dose was then increased to 12.5 mg during weeks 2-4 and to 25 mg from weeks 5-12. At 0, after the 2 weeks of run-in, 4 and 12 weeks patients underwent assessment of systolic and diastolic blood pressure, heart rate, left ventricular ejection fraction, cognitive status and functional ability. Our findings indicate that elderly patients with congestive heart failure tolerate carvedilol therapy well. Carvedilol slightly improves heart function without altering functional or cognitive ability. A larger-scale trial in geriatric patients is now required to determine whether this treatment will reduce serious morbidity or mortality from heart failure.",,"Leonetti, Luparini R;Celli, V;Piccirillo, G;Guidi, V;Cacciafesta, M;Marigliano, V",1999,,,0,2557
2557,"Carvedilol in elderly patients with chronic heart failure, a 12 weeks randomized, placebo controlled open trial","The encouraging results of recent multicenter clinical trials conducted in the US on the effect of carvedilol therapy in patients with chronic heart failure, prompted us to verify its tolerability in a group of elderly patients. For the open, randomized, placebo-controlled study, we selected 40 patients (28 men and 12 women, mean age 76.8+/-5.9 years) with mild, moderate or severe chronic heart failure. Exclusion criteria included dementia, chronic hepatitis, renal failure, severe vascular disease and respiratory failure. All patients were receiving treatment with digitalis, furosemide and ACE inhibitors. The study lasted 12 weeks. During the first week, all subjects received oral placebo or carvedilol, at a dose of 6.25 mg twice daily. The twice daily dose was then increased to 12.5 mg during weeks 2-4 and to 25 mg from weeks 5-12. At 0, after the 2 weeks of run-in, 4 and 12 weeks patients underwent assessment of systolic and diastolic blood pressure, heart rate, left ventricular ejection fraction, cognitive status and functional ability. Our findings indicate that elderly patients with congestive heart failure tolerate carvedilol therapy well. Carvedilol slightly improves heart function without altering functional or cognitive ability. A larger-scale trial in geriatric patients is now required to determine whether this treatment will reduce serious morbidity or mortality from heart failure.",,"Leonetti Luparini, R.;Celli, V.;Piccirillo, G.;Guidi, V.;Cacciafesta, M.;Marigliano, V.",1999,,,0,
2558,The Causal Effect of Vitamin D Binding Protein (DBP) Levels on Calcemic and Cardiometabolic Diseases: A Mendelian Randomization Study,"Observational studies have shown that vitamin D binding protein (DBP) levels, a key determinant of 25-hydroxy-vitamin D (25OHD) levels, and 25OHD levels themselves both associate with risk of disease. If 25OHD levels have a causal influence on disease, and DBP lies in this causal pathway, then DBP levels should likewise be causally associated with disease. We undertook a Mendelian randomization study to determine whether DBP levels have causal effects on common calcemic and cardiometabolic disease. We measured DBP and 25OHD levels in 2,254 individuals, followed for up to 10 y, in the Canadian Multicentre Osteoporosis Study (CaMos). Using the single nucleotide polymorphism rs2282679 as an instrumental variable, we applied Mendelian randomization methods to determine the causal effect of DBP on calcemic (osteoporosis and hyperparathyroidism) and cardiometabolic diseases (hypertension, type 2 diabetes, coronary artery disease, and stroke) and related traits, first in CaMos and then in large-scale genome-wide association study consortia. The effect allele was associated with an age- and sex-adjusted decrease in DBP level of 27.4 mg/l (95% CI 24.7, 30.0; n = 2,254). DBP had a strong observational and causal association with 25OHD levels (p = 3.2×10−19). While DBP levels were observationally associated with calcium and body mass index (BMI), these associations were not supported by causal analyses. Despite well-powered sample sizes from consortia, there were no associations of rs2282679 with any other traits and diseases: fasting glucose (0.00 mmol/l [95% CI −0.01, 0.01]; p = 1.00; n = 46,186); fasting insulin (0.01 pmol/l [95% CI −0.00, 0.01,]; p = 0.22; n = 46,186); BMI (0.00 kg/m2 [95% CI −0.01, 0.01]; p = 0.80; n = 127,587); bone mineral density (0.01 g/cm2 [95% CI −0.01, 0.03]; p = 0.36; n = 32,961); mean arterial pressure (−0.06 mm Hg [95% CI −0.19, 0.07]); p = 0.36; n = 28,775); ischemic stroke (odds ratio [OR] = 1.00 [95% CI 0.97, 1.04]; p = 0.92; n = 12,389/62,004 cases/controls); coronary artery disease (OR = 1.02 [95% CI 0.99, 1.05]; p = 0.31; n = 22,233/64,762); or type 2 diabetes (OR = 1.01 [95% CI 0.97, 1.05]; p = 0.76; n = 9,580/53,810). DBP has no demonstrable causal effect on any of the diseases or traits investigated here, except 25OHD levels. It remains to be determined whether 25OHD has a causal effect on these outcomes independent of DBP. Please see later in the article for the Editors' Summary.",25 hydroxyvitamin D;calcium;glucose;insulin;parathyroid hormone;vitamin D binding protein;aged;article;calcium blood level;cardiometabolic disease;chemoluminescence;clinical assessment;cohort analysis;controlled study;female;gene frequency;genetic association;genetic variability;genotype phenotype correlation;genotyping technique;human;instrumental variable analysis;major clinical study;male;Mendelian randomization analysis;meta analysis (topic);metabolic disorder;observational study;prospective study;single nucleotide polymorphism;vitamin blood level,"Leong, A.;Rehman, W.;Dastani, Z.;Greenwood, C.;Timpson, N.;Langsetmo, L.;Berger, C.;Fu, L.;Wong, B. Y. L.;Malik, S.;Malik, R.;Hanley, D. A.;Cole, D. E. C.;Goltzman, D.;Richards, J. B.",2014,,,0,
2559,Use of endobronchial ultrasonography in the diagnosis of a pulmonary artery aneurysm,"We present the case of an 84-year-old man with nonmassive hemoptysis and an obstructing endobronchial mass who was referred for rigid bronchoscopy and biopsy of the lesion. We illustrate how the pulsatile movement of his endobronchial lesion could be differentiated by convex probe endobronchial ultrasound bronchoscopy to be a vascular lesion rather than an endobronchial mass or tumor. Although convex probe endobronchial ultrasonography has many mediastinal applications, it has yet to be used to characterize endobronchial masses. We describe the first case of using convex probe endobronchial ultrasonography in the diagnosis of a left upper lobe pulmonary artery aneurysm presenting as an endobronchial mass. © 2014 by The Society of Thoracic Surgeons.",aged;article;artifact;artificial ventilation;bronchus biopsy;case report;cerebrovascular accident;color ultrasound flowmetry;computed tomographic angiography;congestive heart failure;dementia;endobronchial biopsy;endobronchial ultrasonography;fiberoptic bronchoscopy;heart ventricle extrasystole;hemoptysis;human;human tissue;lung nodule;magnetic resonance angiography;male;nuclear magnetic resonance imaging;priority journal;pulmonary artery aneurysm;respiratory distress;tracheostomy;vascular lesion;very elderly,"Lerner, A. D.;Riker, D. R.",2014,,,0,
2560,"Norton scale, hospitalization length, complications, and mortality in elderly patients admitted to internal medicine departments","Background: The Norton scale is used for assessing pressure ulcer risk. The association between admission Norton scale scores (ANSS), hospitalization length, complications, and mortality in elderly patients admitted to internal medicine departments has never been studied. Objective: To determine if ANSS are associated with hospitalization length, complications, in-hospital mortality, and 1-year mortality in elderly patients admitted to an internal medicine department. Methods: Medical charts of consecutive elderly (≥65 years) patients admitted to a single internal medicine department between January and March 2009 were studied for ANSS, demographics, comorbidities, hospitalization length, complications during hospitalization, in-hospital mortality, and 1-year mortality. Complications during hospitalization included acute coronary syndrome, major arrhythmias, major bleeding, stroke, systemic infections, organ failure, thromboembolism, etc. ANSS ≤14 were considered low. Results: The final cohort included 259 elderly patients: 54.4% were women, the mean age was 81.6 years, and the mean hospitalization length was 3.7 days. Overall, 7.3% of the patients had complications other than pressure ulcers, 3.9% died during hospitalization, and 28.6% died within 1 year. The mean ANSS was 15.4, and 37.8% of the patients had low ANSS. Patients with low ANSS had longer hospitalization (4.7 vs. 2.9 days; p = 0.002), a higher incidence of complications during hospitalization (odds ratio: 3.9; p = 0.006), and higher rates of in-hospital mortality (odds ratio: 7.0; p = 0.007) relative to patients with high ANSS. Regression analysis showed that ANSS were independently negatively associated with hospitalization length, complications during hospitalization, and in-hospital mortality (p < 0.0001, p = 0.003, and p = 0.018, respectively) regardless of age, gender, comorbidities, and pressure ulcer appearance. Rates of 1-year mortality were similar in patients with low and high ANSS. Conclusions: The Norton scale may be used for predicting hospitalization length, complications during hospitalization other than pressure ulcers, and in-hospital mortality in elderly patients admitted to an internal medicine department. Copyright © 2013 S. Karger AG, Basel.",acute coronary syndrome;acute kidney failure;adult;aged;article;bleeding;bronchitis;cerebrovascular accident;chronic kidney failure;chronic obstructive lung disease;cohort analysis;comorbidity;confusion;congestive heart failure;controlled study;decubitus;dementia;depression;dyslipidemia;dyspnea;elderly care;electrolyte disturbance;faintness;female;fever;gastrointestinal hemorrhage;gastrointestinal infection;heart arrhythmia;atrial fibrillation;heart failure;hospital admission;hospital department;hospitalization;human;hypertension;incidence;infection;ischemic heart disease;length of stay;major clinical study;male;medical record;mortality;non insulin dependent diabetes mellitus;norton scale;osteoporosis;Parkinson disease;pleura effusion;pneumonia;pneumothorax;priority journal;rating scale;retrospective study;sepsis;smoking;soft tissue infection;thorax pain;thromboembolism;urinary tract infection;venous thromboembolism;vertigo,"Leshem-Rubinow, E.;Vaknin, A.;Sherman, S.;Justo, D.",2013,,,0,
2561,Myocardial infarction in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL),"Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an angiopathy caused by mutations in the NOTCH3 gene. Typical microvascular changes are found throughout the arterial tree, but the documented disease expression is confined to the central nervous system. In an ongoing CADASIL study, we noted a number of patients with early acute myocardial infarction (before the age of 50 years), as well as patients with electrocardiogram (ECG) abnormalities. We analyzed these data to determine whether myocardial ischemia is associated with NOTCH3 mutations. ECGs were recorded in mutated (n = 41) and nonmutated (n = 22) individuals from 15 genetically confirmed CADASIL families, and blindly classified according to the Minnesota code. Cardiologic history was assessed and cardiovascular disease risk factors were determined. Evidence for myocardial infarction was defined as a positive history for acute myocardial infarction and/or a Minnesota Code 1 (Q-waves) on ECG. We examined CADASIL myocardial tissue ultrastructurally and immunohistochemically for evidence of microangiopathy. We found that almost 25% (10/41) of mutation carriers had evidence of myocardial infarction, versus none of the 22 nonmutation carriers (p = 0.011). Five had a medical history of acute myocardial infarction, and 5 had current pathologic Q-waves on ECG. Acute myocardial infarction occurred at a mean age of 39.6 +/- 5.22 years, and predated major neurologic symptoms of CADASIL in all cases. Pathologic examination of myocardial tissue revealed typical CADASIL arteriopathic changes of the coronary microvasculature. To our knowledge, this is the first study showing that NOTCH3 mutation carriers may be at increased risk of early acute myocardial infarction, expanding CADASIL disease expression beyond the central nervous system to include the heart.","Acute Disease;Adult;Dementia, Multi-Infarct/*complications/diagnosis/*genetics;Electrocardiography;Female;Humans;Immunohistochemistry;Male;Middle Aged;Myocardial Infarction/*complications/*genetics;Myocardium/pathology;Point Mutation/genetics;Proto-Oncogene Proteins/*genetics;*Receptors, Cell Surface;Receptors, Notch","Lesnik Oberstein, S. A.;Jukema, J. W.;Van Duinen, S. G.;Macfarlane, P. W.;van Houwelingen, H. C.;Breuning, M. H.;Ferrari, M. D.;Haan, J.",2003,Jul,10.1097/01.md.0000085054.63483.40,0,
2562,Identifying unintended consequences of quality indicators: A qualitative study,"Background: For the first 5 years of the UK primary care pay for performance scheme, the Quality and Outcomes Framework (QOF), quality indicators were introduced without piloting. However, in 2009, potential new indicators were piloted in a nationally representative sample of practices. This paper describes an in-depth exploration of family physician, nurse and other primary-care practice staff views of the value of piloting with a particular focus on unintended consequences of 13 potential new QOF indicators. Method: Fifty-seven family-practice professionals were interviewed in 24 representative practices across England. Results: Almost all interviewees emphasised the value of piloting in terms of an opportunity to identify unintended consequences of potential QOF indicators in 'real world' settings with staff who deliver day-to-day care to patients. Four particular types of unintended consequences were identified: measure fixation, tunnel vision, misinterpretation and potential gaming. 'Measure fixation,' an inappropriate attention on isolated aspects of care, appeared to be the key unintended consequence. In particular, if the palliative care indicator had been introduced without piloting, this might have incentivised poorer care in a minority of practices with potential harm to vulnerable patients. Conclusions: It is important to identify concerns and experiences about unintended consequences of indicators at an early stage when there is time to remove or adapt problem indicators. Since the UK government currently spends over £1 billion each year on QOF, the £150 000 spent on each piloting cohort (0.0005% of the total QOF budget) appears to be good value for money.",article;asthma;clinical practice;dementia;diabetes mellitus;female;general practitioner;health care delivery;health care personnel;health care quality;heart infarction;human;interview;male;mental disease;nurse;outcome assessment;palliative therapy;qualitative research,"Lester, H. E.;Hannon, K. L.;Campbell, S. M.",2011,,,0,
2563,Education and the risk for Alzheimer's disease: sex makes a difference. EURODEM pooled analyses. EURODEM Incidence Research Group,"The hypothesis that a low educational level increases the risk for Alzheimer's disease remains controversial. The authors studied the association of years of schooling with the risk for incident dementia and Alzheimer's disease by using pooled data from four European population-based follow-up studies. Dementia cases were identified in a two-stage procedure that included a detailed diagnostic assessment of screen-positive subjects. Dementia and Alzheimer's disease were diagnosed by using international research criteria. Educational level was categorized by years of schooling as low (< or =7), middle (8-11), or high (> or =12). Relative risks (95% confidence intervals) were estimated by using Poisson regression, adjusting for age, sex, study center, smoking status, and self-reported myocardial infarction and stroke. There were 493 (328) incident cases of dementia (Alzheimer's disease) and 28,061 (27,839) person-years of follow-up. Compared with women with a high level of education, those with low and middle levels of education had 4.3 (95% confidence interval: 1.5, 11.9) and 2.6 (95% confidence interval: 1.0, 7.1) times increased risks, respectively, for Alzheimer's disease. The risk estimates for men were close to 1.0. Finding an association of education with Alzheimer's disease for women only raises the possibility that unmeasured confounding explains the previously reported increased risk for Alzheimer's disease for persons with low levels of education.","Age Distribution;Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology;*Educational Status;Epidemiologic Research Design;Europe/epidemiology;Female;Humans;Incidence;Male;Prospective Studies;Risk Factors;Sex Distribution;Sex Factors","Letenneur, L.;Launer, L. J.;Andersen, K.;Dewey, M. E.;Ott, A.;Copeland, J. R.;Dartigues, J. F.;Kragh-Sorensen, P.;Baldereschi, M.;Brayne, C.;Lobo, A.;Martinez-Lage, J. M.;Stijnen, T.;Hofman, A.",2000,Jun 1,,0,
2564,Co-morbidities of persons dying of Parkinson's disease,"Introduction: Disease interactions can alter functional decline near the end of life (EOL). Parkinson's disease (PD) is characterized by frequent occurrences of co-morbidities but data challenges have limited studies investigating co-morbidities across a broad range of diseases. The goal of this study was to describe disease associations with PD. Methods: We conducted an analysis of death certificate data from 1998 to 2005 in Nova Scotia. All death causes were utilized to select individuals dying of PD and compare with the general population and an age-sex-matched sample without PD. We calculated the mean number of death causes and frequency of disease co-occurrence. To account for the chance occurrence of co-morbidities and measure the strength of association, observed to expected ratios were calculated. Results: PD decedents had a higher mean number of death causes (3.37) than the general population (2.77) and age-sex-matched sample (2.88). Cancer was the most common cause in the population and matched sample but fifth for those with PD. Cancer was one of nine diseases that occurred less often than what would be expected by chance while four were not correlated with PD. Dementia and pneumonia occurred with PD 2.53 ([CI] 2.21-2.85) and 1.83 (CI 1.58-2.08) times more often than expected. The strength of association for both is reduced but remains statistically significant when controlling for age and sex. Discussion: Those with PD have a higher number of co-morbidities even after controlling for age and sex. Individuals dying with PD are more likely to have dementia and pneumonia, which has implications for the provision of care at EOL. © W. S. Maney & Son Ltd 2013.",acute heart infarction;aged;article;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;death certificate;dementia;diabetes mellitus;dying;essential hypertension;female;human;ICD-10;ICD-9;ischemic heart disease;kidney failure;major clinical study;male;multiple sclerosis;neoplasm;palliative therapy;Parkinson disease;peripheral vascular disease;pneumonia;septicemia,"Lethbridge, L.;Johnston, G. M.;Turnbull, G.",2013,,,0,
2565,Blood Pressure and Heart Rate Measures Associated With Increased Risk of Covert Brain Infarction and Worsening Leukoaraiosis in Older Adults,"OBJECTIVE: In people without previous stroke, covert findings on serial magnetic resonance imaging (MRI) of incident brain infarcts and worsening leukoaraiosis are associated with increased risk for ischemic stroke and dementia. We evaluated whether various measures of blood pressure (BP) and heart rate are associated with these MRI findings. APPROACH AND RESULTS: In the CHS (Cardiovascular Health Study), a longitudinal cohort study of older adults, we used relative risk regression to assess the associations of mean, variability, and trend in systolic BP, diastolic BP, and heart rate measured at 4 annual clinic visits between 2 brain MRIs with incident covert brain infarction and worsening white matter grade (using a 10-point scale to characterize leukoaraiosis). We included participants who had both brain MRIs, no stroke before the follow-up MRI, and no change in antihypertensive medication status during follow-up. Among 878 eligible participants, incident covert brain infarction occurred in 15% and worsening white matter grade in 27%. Mean systolic BP was associated with increased risk for incident covert brain infarction (relative risk per 10 mm Hg, 1.28; 95% confidence interval, 1.12-1.47), and mean diastolic BP was associated with increased risk for worsening white matter grade (relative risk per 10 mm Hg, 1.45; 95% confidence interval, 1.24-1.69). These findings persisted in secondary and sensitivity analyses. CONCLUSIONS: Elevated mean systolic BP is associated with increased risk for covert brain infarction, and elevated mean diastolic BP is associated with increased risk for worsening leukoaraiosis. These findings reinforce the importance of hypertension in the development of silent cerebrovascular diseases, but the pathophysiologic relationships to BP for each may differ.",0 (Antihypertensive Agents);Age Factors;Aged;Antihypertensive Agents/therapeutic use;Blood Pressure/drug effects;Cerebral Infarction/diagnostic imaging/ epidemiology/physiopathology;Disease Progression;Female;Heart Rate;Humans;Hypertension/diagnosis/drug therapy/ epidemiology/physiopathology;Incidence;Leukoaraiosis/diagnostic imaging/ epidemiology/physiopathology;Longitudinal Studies;Magnetic Resonance Imaging;Male;Prospective Studies;Pulsatile Flow;Risk Factors;Time Factors;United States/epidemiology;blood pressure;hypertension;leukoaraiosis,"Leung, L. Y.;Bartz, T. M.;Rice, K.;Floyd, J.;Psaty, B.;Gutierrez, J.;Longstreth, W. T., Jr.;Mukamal, K. J.",2017,Aug,,0,
2566,Rationalising data use for general practice: A missed opportunity?,,ambulatory care;article;chronic kidney disease;chronic obstructive lung disease;comorbidity;consultation;data analysis;data extraction;dementia;depression;general practice;health care need;health care policy;hospital admission;human;hyperglycemia;hypertension;information processing;information system;informed consent;ischemic heart disease;medical record;morbidity;patient care planning;performance;premature mortality;prevalence;public health;quality control;workload,"Levene, L. S.;Walker, N.;Baker, R.;Wilson, A.;Honeyford, C.",2016,,,0,
2567,Vascular risk factors for Alzheimer’s disease,"Recent studies support a role of the vascular factor in the development of not only cerebrovascular disease but also Alzheimer’s disease (AD). Mechanisms of vascular risk factors involved in the pathogenesis of AD remain poorly studied so far. In a number of studies on the evaluation of the efficacy of antihypertensive drugs, statins, aspirin in patients with already developed AD, neuroprotective effect was not shown. Nevertheless, there is evidence that hypertension, diabetes mellitus, metabolic syndrome, hyperlipidemia, hyperhomocysteinemia, obesity, atherosclerosis, atrial fibrillation, smoking play a role in the pathogenesis of AD. It is important to study the role of these factors in the pathogenesis of AD since the timed modification of vascular factors in the middle age can reduce the risk of AD and offers new perspectives for its prevention.",Alzheimer disease;article;atherosclerosis;atrial fibrillation;diabetes mellitus;human;hyperhomocysteinemia;hyperlipidemia;hypertension;metabolic syndrome X;obesity;risk factor;smoking,"Levin, O. S.;Trusova, N. A.",2013,,,0,
2568,A Prognostic Model for 1-Year Mortality in Older Adults after Hospital Discharge,"Purpose: To develop and validate a prognostic index for 1-year mortality of hospitalized older adults using standard administrative data readily available after discharge. Subjects and methods: The prognostic index was developed and validated retrospectively in 6382 older adults discharged from general medicine services at an urban teaching hospital over a 4-year period. Potential risk factors for 1-year mortality were obtained from administrative data and examined using logistic regression models. Each risk factor associated independently with mortality was assigned a weight based on the odds ratios, and risk scores were calculated for each patient by adding the points of each independent risk factor present. Patients in the development cohort were divided into quartiles of risk based on their final risk score. A similar analysis was performed on the validation cohort to confirm the original results. Results: Risk factors independently associated with 1-year mortality included: aged 70 to 74 years (1 point); aged 75 years and greater (2 points); length of stay at least 5 days (1 point); discharge to nursing home (1 point); metastatic cancer (2 points); and other comorbidities (congestive heart failure, peripheral vascular disease, renal disease, hematologic or solid, nonmetastatic malignancy, and dementia, each 1 point). In the derivation cohort, 1-year mortality was 11% in the lowest-risk group (0 or 1 point) and 48% in the highest-risk group (4 or greater points). Similarly, in the validation cohort, 1-year mortality was 11% in the lowest risk group and 45% in the highest-risk group. The area under the receiver operating characteristic curve was 0.70 for the derivation cohort and 0.68 for the validation cohort. Conclusion: Reasonable prognostic information for 1-year mortality in older patients discharged from general medicine services can be derived from administrative data to identify high-risk groups of persons. © 2007 Elsevier Inc. All rights reserved.",aged;article;comorbidity;congestive heart failure;dementia;female;hematologic malignancy;high risk population;hospital discharge;human;kidney disease;length of stay;major clinical study;male;metastasis;mortality;nursing home;peripheral vascular disease;priority journal;prognosis;receiver operating characteristic;risk factor;teaching hospital,"Levine, S. K.;Sachs, G. A.;Jin, L.;Meltzer, D.",2007,,,0,
2569,Complications associated with surgical repair of syndromic scoliosis,"Background: There are a number of syndromes that have historically been associated with scoliosis e.g.: Marfan, Down, and Neurofibromatosis. These syndromes have been grouped together as one etiology of scoliosis, known as syndromic scoliosis. While multiple studies indicate that these patients are at high risk for perioperative complications, there is a paucity of literature regarding the collective complication rates and surgical needs of this population. Methods: PubMed and Embase databases were searched for literature encompassing the surgical complications associated with the surgical management of patients undergoing correction of scoliosis in the syndromic scoliosis population. Following exclusion criteria, 24 articles were analyzed for data regarding these complications. Results: The collective complication rates and findings of these articles were categorized based on specific syndrome. The rates and types of complications for each syndrome and the special needs of patients with each syndrome are discussed. Several complication trends of note were observed, including but not limited to the universally nearly high rate of wound infections (>5% in each group), high rate of pulmonary complications in patients with Rett syndrome (29.2%), high rate (>10%) of dural tears in Marfan and Ehlers-Danlos syndrome patients, high rate (>20%) of implant failure in Down and Prader-Willi syndrome patients, and high rate (>25%) of pseudarthrosis in Down and Ehlers-Danlos patients. Conclusions: Though these syndromes have been classically grouped together under the umbrella term ""syndromic,"" there may be specific needs for patients with each of these ailments. Given the high rate of complications, further research is necessary to understand the unique needs for each of these patient groups in the preoperative, intraoperative, and postoperative settings.",article;bleeding;cardiomyopathy;device failure;Down syndrome;Ehlers Danlos syndrome;Friedreich ataxia;human;liquorrhea;lung disease;Marfan syndrome;neurofibromatosis;osteogenesis imperfecta;paralysis;pneumonia;pneumothorax;Prader Willi syndrome;priority journal;pseudarthrosis;radiography;respiratory tract disease;Rett syndrome;scoliosis;wound infection,"Levy, B. J.;Schulz, J. F.;Fornari, E. D.;Wollowick, A. L.",2015,,,0,
2570,Costs and benefits of pharmaceuticals: The value equation for older Americans,"Recent increases in drug expenditures are primarily due to the availability of more and better therapy rather than price inflation. Investment in new drugs generates savings throughout the health care system. Increased use of drugs, especially newer agents, has also resulted in increased longevity and reduced disability. Benefits from new pharmaceuticals far outweigh their costs for many key diseases of the elderly. Even incremental improvements in drug therapies contribute substantially to improved care. Chronic illness, disability, and an aging population will drive future health care spending. Pharmaceutical innovation will be an integral part of effective strategies to address this challenge. The availability of individualized therapy for the elderly will soon increase based on our rapidly growing understanding of the molecular and genetic basis of disease. This is expected to result in major advances in preventing, treating and perhaps even curing many of the costly, life-threatening, and disabling diseases afflicting older Americans. The adequacy of drug benefit programs for elderly patients depends on the extent to which the range of drug therapies necessary for appropriate care are covered. Policies that foster the availability of unique pharmaceuticals can have important implications for treatment outcomes, quality of life, cost containment, and ongoing research investment in newer and more effective medicines. Such policies increase the diversity of agents within drug classes and thereby enable differentiated, individualized therapy. A wide range of choices is especially important for elderly patients, who have the greatest need for individualized care and are at greatest risk for compromised outcomes if choices are overly circumscribed.",alendronic acid;alpha adrenergic receptor blocking agent;antidepressant agent;benzodiazepine;beta adrenergic receptor blocking agent;betaxolol;calcium;calcium channel blocking agent;captopril;carbamazepine;clonidine;esomeprazole;ethinylestradiol plus norethisterone;famotidine;fluoxetine;fluticasone propionate plus salmeterol;galantamine;glibenclamide plus metformin;hirulog;hydroxymethylglutaryl coenzyme A reductase inhibitor;leuprorelin;magnesium;meloxicam;metformin;naltrexone;neuroleptic agent;rivastigmine;triptorelin;unindexed drug;unoprostone isopropyl ester;aging;alcoholism;Alzheimer disease;anxiety disorder;arthritis;article;asthma;blood clotting disorder;breast cancer;chronic disease;chronic pain;cost benefit analysis;cost control;dementia;depression;diabetes mellitus;disability;drug cost;drug efficacy;drug use;elderly care;epilepsy;genetics;glaucoma;health care availability;health care cost;health care need;health care policy;health care system;health insurance;heart disease;heart infarction;heartburn;human;hypertension;individualization;longevity;mammography;medical decision making;molecular mechanics;obsessive compulsive disorder;opiate addiction;osteoporosis;panic;posttraumatic stress disorder;preventive medicine;prostate cancer;quality of life;risk assessment;schizophrenia;treatment outcome;trigeminus neuralgia;United States,"Levy, R. A.",2002,,,0,
2571,CADASIL patient with extracellular calcium deposits,"We report the case of a 57-year-old male patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) diagnosed on the basis of ultrastructural and genetic examinations. Ultrastructurally, granular osmiophilic material (GOM) deposits, degeneration and loss of vascular smooth muscle cells (VSMC) and pericytes in small arterial and capillary vessels from skin-muscle biopsy typical of CADASIL were visible. Degeneration of pericytes and endothelial cells were often pronounced, which resulted in a complete disappearance of mural cells and extremely severe thickening of the basement membrane. Degenerative changes in blood vessels, especially evident in skeletal muscle arterioles, also included significant vacuolization of VSMC, misshapen nuclei both in vessel wall cells and skeletal muscle fibres, and deposits of a hyaline material and calcium in the vessel wall. Abundant calcium deposits were located in the vascular basement membrane and exhibited laminar morphology with abnormally arranged light and dark bands. In the basement membrane of the most severely affected microvessels, only clusters of calcium deposits and remnants of the mural cells were observed. Laminar calcifications were also observed within the basement membrane surrounding skeletal muscle fibres. Such abundant calcium deposits in CADASIL have not as yet been described. Morphological findings, described in this report, expand the spectrum of histopathological changes in this genetically determined angiopathy.",calcium;hyalin;Notch3 receptor;osmium;abdominal aorta aneurysm;adult;article;attention disturbance;basement membrane;behavior change;blood vessel;blood vessel wall;brain ischemia;CADASIL;calcification;capillary;case report;cell degeneration;cognitive defect;coronary artery disease;endothelium cell;epilepsy;executive function;exon;extracellular calcium;family history;gene mutation;genetic analysis;headache;heart aneurysm;heart failure;hemiparesis;human;human tissue;male;memory disorder;microscopy;microvasculature;middle aged;migraine;mood disorder;morphology;muscle biopsy;neurologic examination;nuclear magnetic resonance imaging;pericyte;pseudobulbar palsy;skeletal muscle;skin biopsy;smooth muscle fiber;ultrastructure;vascular smooth muscle;white matter,"Lewandowska, E.;Wierzba-Bobrowicz, T.;Buczek, J.;Gromadzka, G.;Dziewulska, D.",2013,,,0,
2572,White matter changes in stroke patients. Relationship with stroke subtype and outcome,"White matter changes (WMC), detected by imaging techniques, are frequent in stroke patients. The aim of the study was to determine how WMC relate to stroke subtypes and to stroke outcome. We made a systematic Medline search for articles appearing with two of the following key words: either 'WMC or white matter lesions or leukoencephalopathy or leukoaraiosis' and 'stroke or cerebral infarct or cerebral hemorrhage or cerebrovascular disease or transient ischemic attack (TIA)'. WMC, as defined radiologically, are present in up to 44% of patients with stroke or TIA and in 50% of patients with vascular dementia. WMC are more frequent in patients with lacunar infarcts, deep intracerebral hemorrhages, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and cerebral amyloid angiopathy. After an acute ischemic stroke, WMC are associated with a higher risk of death or dependency, recurrent stroke of any type, cerebral bleeding under anticoagulation, myocardial infarction, and poststroke dementia. WMC in stroke patients are often associated with small-vessel disease and lead to a higher risk of death, and poor cardiac and neurological outcome. However, several questions remain open and need further investigations.",anticoagulant therapy;article;autosomal dominant inheritance;bleeding;brain hemorrhage;brain infarction;cerebrovascular disease;dementia;diagnostic imaging;heart infarction;human;leukoaraiosis;leukoencephalopathy;mortality;multiinfarct dementia;priority journal;recurrent disease;cerebrovascular accident;transient ischemic attack;treatment outcome;vascular amyloidosis;white matter,"Leys, D.;Englund, E.;Del Ser, T.;Inzitari, D.;Fazekas, F.;Bornstein, N.;Erkinjuntti, T.;Bowler, J. V.;Pantoni, L.;Parnetti, L.;De Reuck, J.;Ferro, J.;Bogousslavsky, J.",1999,,,0,
2573,Cerebral ischemic stroke in young adults,"The main differences between ischemic strokes occurring in young adults and those occurring in the elderly are the breakdown of causes with high incidence of « unknown causes » and « other determined causes », and an overall favorable outcome. Cervical-artery dissection is the leading cause of cerebral ischemia in young adults and is usually associated with a good outcome. Depending on how exhaustive the diagnostic work-up was, up to 50% of patients have no clear cause. Mortality and recurrence rates are low, especially in patients with a negative diagnostic work-up, but epilepsy is frequent. Research should focus on the identification of new causes, and on their natural history.",age distribution;artery dissection;brain artery;brain atherosclerosis;CADASIL;cardiomyopathy;cerebrovascular accident;disease course;epidemiological data;heart atrium septum defect;human;incidence;mortality;pregnancy;prognosis;recurrent disease;risk factor;short survey,"Leys, D.;Lucas, C.;Gautier, C.;Hachulla, E.;Pruvo, J. P.",2004,,,0,
2574,Epidemiology of vascular dementia,"Although epidemiological studies are limited by diagnostic uncertainties, they suggest that stroke increases the risk of dementia. The mortality rate is higher in vascular dementia (VaD) than in Alzheimer's disease (AD). Community-based studies have provided several consistent findings: (i) age dependence with prevalence rates doubling every 5 years, (ii) a higher frequency in men and (iii) nation-to-nation differences. The prevalence of VaD ranges from 2.2% in 70-to 79-year-old women, to 16.3% in men >80 years. One sixth of acute stroke patients have preexisting dementia. The incidence of VaD has been studied much less extensively than that of AD, and substantial variations in the incidence rates have been observed: annual incidence rates (per 100,000) range from 20 to 40 between 60 and 69 years of age and from 200 to 700 over 80. The incidence rate of VaD declined over the last 2 decades, probably as a consequence of effective stroke-prevention. It is generally assumed that risk factors for VaD are those of stroke, with arterial hypertension as leading factor, followed by atherosclerotic disease, low education level, alcohol abuse and heart disease. Stroke characteristics, such as lacunar infarction and left-sided hemispheric lesions, are major determinants of VaD. The cerebrovascular lesions are likely to be the only cause of dementia in strategic infarcts, in lacunar state, in hereditary cystatin C amyloid angiopathy and in CADASIL. However, white matter changes, and associated Alzheimer pathology, which are both frequent in this age category, may also contribute to the cognitive decline.",adult;age distribution;aged;Alzheimer disease;article;atherosclerosis;controlled study;female;human;hypertension;incidence;major clinical study;male;multiinfarct dementia;prevalence;priority journal;risk factor;cerebrovascular accident,"Leys, D.;Pasquier, F.;Parnetti, L.",1998,,,0,
2575,Analysis of the structure of services provided in the healthcare facilities in long term care in Slovakia,"Background: Long-term care for people with chronic illnesses and disabilities present an urgent challenge around the world. Methods: For the data collection from health care facilities, we used questionnaire method. Results and conclusion: The return rate of questionnaire was very high, 70 % questionnaires from health care facilities were returned. In health care facilities, the age structure of clients was highest in 76-85 years (41 %), the length of stay of a patient in a healthcare facility was in 73 % patients up to 3 weeks. The most frequent performed activities at employees were health-nursing care (72 %). For 31 % health care facilities, the waiting time is 1 week. The length of stay of patient in healthcare facility is impacted in 63 % by combination of health and social problems. For diagnosis structure of patients, the most frequent is ischemic heart disease, heart attack, hypertension (37 %), sudden cerebrovascular accident (25 %), locomotive disease (25 %) and dementia (22 %).",adult;aged;article;human;length of stay;long term care;middle aged;nursing home;organization and management;questionnaire;Slovakia,"Lezovic, M.",2009,,,0,
2576,Changes in the expression of the Alzheimer's disease-associated presenilin gene in drosophila heart leads to cardiac dysfunction,"Mutations in the presenilin genes cause the majority of early-onset familial Alzheimer's disease. Recently, presenilin mutations have been identified in patients with dilated cardiomyopathy (DCM), a common cause of heart failure and the most prevalent diagnosis in cardiac transplantation patients. However, the molecular mechanisms, by which presenilin mutations lead to either AD or DCM, are not yet understood. We have employed transgenic Drosophila models and optical coherence tomography imaging technology to analyze cardiac function in live adult Drosophila. Silencing of Drosophila ortholog of presenilins (dPsn) led to significantly reduced heart rate and remarkably age-dependent increase in end-diastolic vertical dimensions. In contrast, overexpression of dPsn increased heart rate. Either overexpression or silencing of dPsn resulted in irregular heartbeat rhythms accompanied by cardiomyofibril defects and mitochondrial impairment. The calcium channel receptor activities in cardiac cells were quantitatively determined via real-time RT-PCR. Silencing of dPsn elevated dIP3R expression, and reduced dSERCA expression; overexprerssion of dPsn led to reduced dRyR expression. Moreover, overexpression of dPsn in wing disc resulted in loss of wing phenotype and reduced expression of wingless. Our data provide novel evidence that changes in presenilin level leads to cardiac dysfunction, owing to aberrant calcium channel receptor activities and disrupted Wnt signaling transduction, indicating a pathogenic role for presenilin mutations in DCM pathogenesis.","Alzheimer Disease/genetics;Animals;Animals, Genetically Modified;Blotting, Western;Calcium Channels/genetics/metabolism;Cardiomyopathies/*genetics/*physiopathology;Drosophila Proteins/genetics;Drosophila melanogaster/*genetics;Presenilins/*genetics;Real-Time Polymerase Chain Reaction;Tomography, Optical Coherence;Wnt Signaling Pathway/genetics","Li, A.;Zhou, C.;Moore, J.;Zhang, P.;Tsai, T. H.;Lee, H. C.;Romano, D. M.;McKee, M. L.;Schoenfeld, D. A.;Serra, M. J.;Raygor, K.;Cantiello, H. F.;Fujimoto, J. G.;Tanzi, R. E.",2011,May,,0,
2577,Mutations of presenilin genes in dilated cardiomyopathy and heart failure,"Two common disorders of the elderly are heart failure and Alzheimer disease (AD). Heart failure usually results from dilated cardiomyopathy (DCM). DCM of unknown cause in families has recently been shown to result from genetic disease, highlighting newly discovered disease mechanisms. AD is the most frequent neurodegenerative disease of older Americans. Familial AD is caused most commonly by presenilin 1 (PSEN1) or presenilin 2 (PSEN2) mutations, a discovery that has greatly advanced the field. The presenilins are also expressed in the heart and are critical to cardiac development. We hypothesized that mutations in presenilins may also be associated with DCM and that their discovery could provide new insight into the pathogenesis of DCM and heart failure. A total of 315 index patients with DCM were evaluated for sequence variation in PSEN1 and PSEN2. Families positive for mutations underwent additional clinical, genetic, and functional studies. A novel PSEN1 missense mutation (Asp333Gly) was identified in one family, and a single PSEN2 missense mutation (Ser130Leu) was found in two other families. Both mutations segregated with DCM and heart failure. The PSEN1 mutation was associated with complete penetrance and progressive disease that resulted in the necessity of cardiac transplantation or in death. The PSEN2 mutation showed partial penetrance, milder disease, and a more favorable prognosis. Calcium signaling was altered in cultured skin fibroblasts from PSEN1 and PSEN2 mutation carriers. These data indicate that PSEN1 and PSEN2 mutations are associated with DCM and heart failure and implicate novel mechanisms of myocardial disease. © 2006 by The American Society of Human Genetics. All rights reserved.",aspartic acid;glycine;leucine;serine;adult;aged;Alzheimer disease;article;calcium signaling;cell culture;clinical study;congestive cardiomyopathy;controlled study;death;degenerative disease;disease association;disease course;DNA sequence;female;gene;gene expression;gene identification;gene mutation;genetic analysis;genetic disorder;genetic linkage;genomics;heart development;heart failure;heart graft;human;human cell;human tissue;major clinical study;male;missense mutation;molecular mechanics;mutational analysis;myocardial disease;nucleotide sequence;pathogenesis;presenilin 1 gene;presenilin 2 gene;priority journal;prognosis;sequence alignment;sequence analysis;skin fibroblast,"Li, D.;Parks, S. B.;Kushner, J. D.;Nauman, D.;Burgess, D.;Ludwigsen, S.;Partain, J.;Nixon, R. R.;Allen, C. N.;Irwin, R. P.;Jakobs, P. M.;Litt, M.;Hershberger, R. E.",2006,,,0,
2578,Alzheimer's Disease Increases the Incidence of Hospitalization Due to Fall-related Bone Fracture in Elderly Chinese,"Background The risk of falls and fractures caused by falls is higher for older adults with Alzheimer's disease (AD) than for older adults without dementia. This main aim of this study was to investigate the influence of AD on the incidence of hospitalization due to fall-related bone fracture in elderly Chinese patients. A secondary aim was to investigate whether AD has an effect on fracture location. Methods Patients aged ≧65 years who were hospitalized at a tertiary hospital in north China from 2002 to 2012 were recruited. Consecutive patients with the diagnosis of AD at discharge were compared with an age-matched control group of patients without dementia. Results The study included 345 AD patients and 1380 controls. The proportion of patients in the AD group hospitalized because of fall-related bone fracture (15.7%) was significantly higher than in the control group (2.4%). Multivariate analysis showed that age and osteoporosis increased the risk of hospitalized AD patients having a history of bone fracture. There was no significant difference in fracture location between the groups. Conclusion On the basis of our findings, we conclude that AD may increase the incidence of hospitalization due to falls and bone fracture. We also found that AD has no effect on fracture location, but larger studies are needed to confirm this finding. Physicians and family members should emphasize the possibility of falls and bone fracture in patients with AD. Our findings suggest that preventing falls in AD patients may reduce the number of hospitalized AD patients.",aged;aged hospital patient;Alzheimer disease;article;atrial fibrillation;China;Chinese;chronic hepatitis;chronic obstructive lung disease;controlled study;coronary artery disease;falling;female;fracture;heart failure;hospital discharge;hospitalization;human;hyperlipidemia;hypertension;incidence;kidney disease;major clinical study;male;medical history;neoplasm;osteoporosis;priority journal;risk factor;tertiary care center,"Li, F.",2016,,10.1016/j.ijge.2015.09.003,0,
2579,"Determinants of formal care use and expenses among in-home elderly in Jing'an district, Shanghai, China","The need for formal care among the elderly population has been increasing due to their greater longevity and the evolution of family structure. We examined the determinants of the use and expenses of formal care among in-home elderly adults in Shanghai. A two-part model based on the data from the Shanghai Long-Term Care Needs Assessment Questionnaire was applied. A total of 8428 participants responded in 2014 and 7100 were followed up in 2015. The determinants of the probability of using formal care were analyzed in the first part of the model and the determinants of formal care expenses were analyzed in the second part. Demographic indicators, living arrangements, physical health status, and care type in 2014 were selected as independent variables. We found that individuals of older age; women; those with higher Activities of Daily Living (ADL) scores; those without spouse; those with higher income; those suffering from stroke, dementia, lower limb fracture, or advanced tumor; and those with previous experience of formal and informal care were more likely to receive formal care in 2015. Furthermore, age, income and formal care fee in 2014 were significant predictors of formal care expenses in 2015. Taken together, the results showed that formal care provision in Shanghai was not determined by ADL scores, but was instead more related to income. This implied an inappropriate distribution of formal care among elderly population in Shanghai. Additionally, it appeared difficult for the elderly to quit the formal care once they begun to use it. These results highlighted the importance of assessing the need for formal care, and suggested that the government offer guidance on formal care use for the elderly.",adult;aged;article;brain ischemia;China;daily life activity;decision making;dementia;demography;evolution;female;financial statement;general practitioner;government;health;health care utilization;human;hypertension;ischemic heart disease;limb fracture;Long Term Care Needs Assessment Questionnaire;major clinical study;male;marriage;middle aged;probability;questionnaire;social determinants of health;socioeconomics,"Li, F.;Fang, X.;Gao, J.;Ding, H.;Wang, C.;Xie, C.;Yang, Y.;Jin, C.",2017,,10.1371/journal.pone.0176548,0,
2580,Serum cholesterol and risk of Alzheimer disease: a community-based cohort study,"OBJECTIVES: To examine the association of serum total cholesterol (TC) and high density lipoprotein (HDL) levels and subsequent incidence of dementia and Alzheimer disease (AD) in a population-based cohort study. METHODS: A cohort of cognitively intact persons, aged 65 and older, was randomly selected from Group Health Cooperative (GHC), a large health maintenance organization, and was assessed biennially for dementia. Premorbid levels of TC and HDL were obtained from a computerized clinical laboratory database at GHC. Cox proportional hazards regression was used to calculate hazard ratios (HR, 95% CI) for dementia and AD associated with quartiles of TC and HDL levels. RESULTS: Of the 2,356 eligible participants, 2,141 had at least one serum TC measure prior to the initial enrollment. Using the lowest TC quartiles as the reference group, the HR in the highest TC quartiles was not significantly elevated for dementia (1.16, 0.81 to 1.67) or for AD (1.00, 0.61 to 1.62) after adjusting for age, sex, education, baseline cognition, vascular comorbidities, body mass index, and lipid-lowering agent use. Serum HDL showed a similar lack of significant association with risk of dementia or AD. Models that included the presence of one or more APOE-epsilon4 alleles showed a typical association of epsilon4 with AD risk. This association was not materially modified by inclusion of TC level. CONCLUSION: The data do not support an association between serum total cholesterol or high density lipoprotein in late life and subsequent risk of dementia or Alzheimer disease (AD). The increased risk of AD with APOE-epsilon4 is probably not mediated by serum total cholesterol levels.","Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/*blood/*epidemiology/physiopathology;Causality;Cholesterol/*blood;Cholesterol, HDL/blood;Cohort Studies;Coronary Artery Disease/epidemiology;Female;Humans;Hyperlipidemias/*blood/*epidemiology/physiopathology;Hypertension/epidemiology;Hypolipidemic Agents/therapeutic use;Male;Prospective Studies;Risk Factors;Sex Factors;Washington/epidemiology","Li, G.;Shofer, J. B.;Kukull, W. A.;Peskind, E. R.;Tsuang, D. W.;Breitner, J. C.;McCormick, W.;Bowen, J. D.;Teri, L.;Schellenberg, G. D.;Larson, E. B.",2005,Oct 11,10.1212/01.wnl.0000178989.87072.11,0,
2581,Apolipoprotein E-epsilon 4 allele and familial risk in Alzheimer's disease,"Recent studies have found an association between presence of apolipoprotein E (APOE) epsilon 4 allele and Alzheimer's disease (AD). The present study compared the cumulative risk of primary progressive dementia (PPD) in relatives of AD probands carrying at least one copy of the epsilon 4 allele with the relatives of AD probands not carrying epsilon 4 and with relatives of non-demented controls. Our aim was to determine whether the familial aggregation of PPD in relatives of AD probands is primarily due to those carrying epsilon 4. Seventy-seven neuropathologically diagnosed AD patients were obtained as probands through our Alzheimer's Disease Research Center Brain Bank. AD probands were genotyped for APOE. As a comparison group, 198 non-demented probands were also included. Through family informants, demographic and diagnostic data were collected on 382 first-degree relatives (age > or = 45 years) of AD probands and 848 relatives of the controls. We found that the cumulative risk of PPD in both relatives of AD probands with and without the epsilon 4 allele was significantly higher than that in the relatives of non-demented controls. However, the increased risk in the relatives of AD probands with the epsilon 4 allele was marginally, but not significantly, lower than the risk in the relatives of probands without epsilon 4. A greater likelihood of death by heart diseases over developing PPD in relatives of AD probands with epsilon 4 (3.1-fold increase) was found compared to relatives of probands without epsilon 4 (1.7-fold increase), especially prior to age 70, although the difference was not statistically significant. The increased familial risk for PPD in the relatives of AD probands with the APOE-epsilon 4 allele relative to controls suggests that familial factors in addition to APOE-epsilon 4 are risk factors for AD. Differential censorship from increased mortality of heart diseases may have prevented a higher incidence of PPD among the relatives of probands with epsilon 4.","Age of Onset;Aged;Aged, 80 and over;Alleles;Alzheimer Disease/*genetics;Analysis of Variance;Apolipoprotein E4;Apolipoproteins E/*genetics;Case-Control Studies;Cause of Death;Coronary Disease/genetics/mortality;Dementia/*genetics;Demography;Female;Genotype;Humans;Male;Middle Aged;Probability;Risk Assessment","Li, G.;Silverman, J. M.;Altstiel, L. D.;Haroutunian, V.;Perl, D. P.;Purohit, D.;Birstein, S.;Lantz, M.;Mohs, R. C.;Davis, K. L.",1996,,10.1002/(SICI)1098-2272(1996)13:3&lt;285::AID-GEPI5&gt;3.0.CO;2-5,0,
2582,Can we predict individual combined benefit and harm of therapy? Warfarin therapy for atrial fibrillation as a test case,"Objectives: To construct and validate a prediction model for individual combined benefit and harm outcomes (stroke with no major bleeding, major bleeding with no stroke, neither event, or both) in patients with atrial fibrillation (AF) with and without warfarin therapy. Methods: Using the Kaiser Permanente Colorado databases, we included patients newly diagnosed with AF between January 1, 2005 and December 31, 2012 for model construction and validation. The primary outcome was a prediction model of composite of stroke or major bleeding using polytomous logistic regression (PLR) modelling. The secondary outcome was a prediction model of all-cause mortality using the Cox regression modelling. Results: We included 9074 patients with 4537 and 4537 warfarin users and non-users, respectively. In the derivation cohort (n = 4632), there were 136 strokes (2.94%), 280 major bleedings (6.04%) and 1194 deaths (25.78%) occurred. In the prediction models, warfarin use was not significantly associated with risk of stroke, but increased the risk of major bleeding and decreased the risk of death. Both the PLR and Cox models were robust, internally and externally validated, and with acceptable model performances. Conclusions: In this study, we introduce a new methodology for predicting individual combined benefit and harm outcomes associated with warfarin therapy for patients with AF. Should this approach be validated in other patient populations, it has potential advantages over existing risk stratification approaches as a patient-physician aid for shared decision-making.",albumin;antibiotic agent;antidepressant agent;antifungal agent;antilipemic agent;antithrombocytic agent;cardiac agent;central nervous system agents;creatinine;gastrointestinal agent;hemoglobin;nonsteroid antiinflammatory agent;tuberculostatic agent;warfarin;acquired immune deficiency syndrome;aged;alcohol abuse;anemia;area under the curve;article;atrial fibrillation;bleeding;cardiovascular disease;cerebrovascular accident;CHADS2 score;chronic lung disease;comorbidity;congestive heart failure;controlled study;creatinine blood level;decision making;dementia;diabetes mellitus;drug fatality;female;hazard ratio;health care delivery;heart infarction;hemiplegia;hospital admission;hospital patient;human;Human immunodeficiency virus infection;hyperlipidemia;hypertension;international normalized ratio;kidney disease;liver disease;major clinical study;male;malignant neoplastic disease;mortality rate;paraplegia;peptic ulcer;peripheral vascular disease;prediction;receiver operating characteristic;rheumatic disease;risk assessment;sensitivity analysis;survival;transient ischemic attack,"Li, G.;Thabane, L.;Delate, T.;Witt, D. M.;Levine, M. A. H.;Cheng, J.;Holbrook, A.",2016,,,0,
2583,Vascular risk factors promote conversion from mild cognitive impairment to Alzheimer disease,"Objective: Growing evidence suggests that vascular risk factors (VRF) contribute to cognitive decline. The aim of this study was to investigate the impact of VRF on the conversion from mild cognitive impairment (MCI) to Alzheimer disease (AD) dementia. Methods: A total of 837 subjects with MCI were enrolled at baseline and followed up annually for 5 years. The incidence of AD dementia was investigated. A mixed random effects regression model was used to analyze the association between VRF and the progression of MCI assessed with Mini-Mental State Examination and instrumental Activities of Daily Living. Cox proportional hazard models were used to identify the association between VRF and dementia conversion, and to examine whether treatment of VRF can prevent dementia conversion. Results: At the end of the follow-up, 298 subjects converted to AD dementia, while 352 remained MCI. Subjects with VRF had a faster progression in cognition and function relative to subjects without. VRF including hypertension, diabetes, cerebrovascular diseases, and hypercholesterolemia increased the risk of dementia conversion. Those subjects with MCI in whom all VRF were treated had a lower risk of dementia than those who had some VRF treated. Treatment of individual VRF including hypertension, diabetes, and hypercholesterolemia was associated with the reduced risk of AD conversion. Conclusion: VRF increased the risk of incident AD dementia. Treatment of VRF was associated with a reduced risk of incident AD dementia. Although our findings are observational, they suggest active intervention for VRF might reduce progression in MCI to AD dementia. © AAN Enterprises, Inc.",apolipoprotein;adult;aged;alcohol consumption;Alzheimer disease;article;cardiovascular disease;cardiovascular risk;cerebrovascular disease;Chinese;smoking;cognition;daily life activity;diabetes mellitus;disease course;female;follow up;atrial fibrillation;heart infarction;human;hypercholesterolemia;hypertension;major clinical study;male;mild cognitive impairment;Mini Mental State Examination;obesity;priority journal;risk reduction,"Li, J.;Wang, Y. J.;Zhang, M.;Xu, Z. Q.;Gao, C. Y.;Fang, C. Q.;Yan, J. C.;Zhou, H. D.",2011,,,1,
2584,Prevalence of resuscitation orders among residents from aged care facilities admitted to general medical units,,Australia;cardiopulmonary arrest;cognitive defect;cross-sectional study;decision making;dementia;elderly care;hospital admission;hospitalization;human;letter;medical record review;New Zealand;prevalence;priority journal;residential care;resuscitation;terminal care,"Li, J. Y. Z.;Yong, T. Y.;McNeill, D.;Spriggs, D.;Fazal, M.;Hakendorf, P.;Ben-Tovim, D. I.;Thompson, C. H.",2012,,,0,
2585,"Sex differences in the presentation, care, and outcomes of transient ischemic attack: Results from the Ontario stroke registry","Background and Purpose - Little is known about whether sex differences exist in the presentation, management, and outcomes of transient ischemic attack. Methods - We conducted a cohort study of 5991 consecutive patients with transient ischemic attack admitted to 11 stroke centers in Ontario, Canada, between July 1, 2003, and March 31, 2008 and compared presenting symptoms, processes of care, and outcomes in women and men. We used linkages to administrative databases to evaluate mortality and recurrent vascular events within 30 days and 1 year of the initial presentation, with multivariable analyses to assess whether sex differences persisted after adjustment for age and comorbid conditions. Results - The most common presenting symptoms for both sexes were weakness, speech impairment, and sensory deficit, with headache being slightly more frequent in women. Women were less likely than men to undergo carotid imaging, carotid endarterectomy, or receive lipid-lowering therapy. One-year mortality was slightly lower in women than in men (adjusted hazard ratio, 0.77; 95% confidence interval, 0.63-0.94). Conclusions - We found only minor sex differences in the presentation and management of transient ischemic attack, suggesting that current public awareness campaigns focusing on classic warning signs are appropriate for both women and men. Future work should focus on evaluating whether lower rates of carotid imaging, endarterectomy, and lipid-lowering therapy in women reflect undertreatment of women or are appropriate based on patient eligibility.",anticoagulant agent;antihypertensive agent;antilipemic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;warfarin;anticoagulant therapy;antihypertensive therapy;arm weakness;article;atrial fibrillation;Canada;carotid endarterectomy;cerebrovascular accident;cognitive defect;cohort analysis;dementia;diabetes mellitus;dysarthria;dysphagia;female;headache;heart infarction;human;hypertension;major clinical study;male;mortality;peripheral vascular disease;priority journal;recurrent disease;sensory deprivation;sex difference;speech disorder;transient ischemic attack;visual field defect;weakness,"Li, O. L.;Silver, F. L.;Lichtman, J.;Fang, J.;Stamplecoski, M.;Wengle, R. S.;Kapral, M. K.",2016,,,0,
2586,Increased whole blood viscosity is associated with silent cerebral infarction,"BACKGROUND: The presence of silent cerebral infarction (SCI) increases the risk of transient ischemia attack, symptomatic stroke, cardiovascular disease and dementia. Increased viscosity is associated with aging, obesity, carotid intima-media thickness, metabolic syndrome, hypertension, diabetes, ischemic heart disease, and stroke. AIMS: The purpose of the study was to assess the hemorheological parameters levels in SCI patients. METHODS: A cross-sectional study was conducted to evaluate the association between hemorheological parameters and SCI in 1487 subjects (868 men and 619 women) undergoing medical check-up. RESULTS: The participants with SCI had higher whole blood viscosity (WBV) levels at low shear rate than those without SCI (10.34 +/- 1.77 mPa.s vs. 8.98 +/- 0.88 mPa.s; P < 0.001). Moreover, the subjects with a high WBV had a higher prevalence of SCI. Logistic regression analysis revealed that a significant association of WBV levels with the risk of SCI after adjustment for confounding factors (OR: 2.025; 95% CI: 1.750-2.343; P < 0.001). CONCLUSIONS: Whole blood viscosity at low shear rate is a novel indicator for SCI regardless of classical cardiovascular risk factors. Early measurement of whole blood viscosity may be helpful to assess the risk of stroke.",Adult;*Blood Viscosity;Cerebral Infarction/*blood/diagnosis;Cross-Sectional Studies;Female;Humans;Magnetic Resonance Imaging;Male;Middle Aged;Silent cerebral infarction;atherosclerosis;risk factors;whole blood viscosity,"Li, R. Y.;Cao, Z. G.;Li, Y.;Wang, R. T.",2015,,10.3233/ch-131760,0,
2587,Decreased serum bilirubin is associated with silent cerebral infarction,"Objective-The presence of silent cerebral infarction (SCI) increases the risk of transient ischemia attack, symptomatic stroke, cardiovascular disease, and dementia. Total bilirubin (TB) levels were demonstrated to be decreased in carotid intima-media thickness, cardiovascular disease, stroke, and peripheral arterial disease. However, little information is available concerning the correlation between TB and SCI. Approach and results-A cross-sectional study was conducted to evaluate the association between TB and SCI in 2865 subjects (1831 men and 1034 women) undergoing medical checkup. The participants with SCI had lower TB levels than those without SCI. The subjects with a low TB had a higher prevalence of SCI. Moreover, partial correlation showed that TB levels were tightly correlated with brachial-Ankle pulse wave velocity after adjusting for confounding covariates (r=-0.149; P<0.001). Multivariate logistic regression analysis revealed that higher TB was associated with a lower risk of SCI (odds ratio, 0.925; 95% confidence interval, 0.897-0.954; P<0.001). Conclusions-TB is a novel biochemical indicator for SCI regardless of classical cardiovascular risk factors. Early measurement of TB may be useful to assess the risk of SCI. © 2014 American Heart Association, Inc.",alanine aminotransferase;aspartate aminotransferase;bilirubin;cholesterol;gamma glutamyltransferase;glucose;high density lipoprotein cholesterol;low density lipoprotein cholesterol;triacylglycerol;adult;age distribution;aged;alanine aminotransferase blood level;alcohol consumption;article;aspartate aminotransferase blood level;bilirubin blood level;body mass;brain infarction;cardiovascular risk;cholesterol blood level;correlation analysis;cross-sectional study;diastolic blood pressure;disease association;female;gamma glutamyl transferase blood level;glomerulus filtration rate;glucose blood level;human;major clinical study;male;middle aged;priority journal;pulse wave;sex difference;smoking;systolic blood pressure;triacylglycerol blood level,"Li, R. Y.;Cao, Z. G.;Zhang, J. R.;Li, Y.;Wang, R. T.",2014,,,0,
2588,Low level non-invasive vagus nerve stimulation: A novel feasible therapeutic approach for atrial fibrillation,,Alzheimer disease;antiarrhythmic activity;atrial fibrillation;autonomic nervous system;clinical effectiveness;epilepsy;feasibility study;heart arrhythmia;heart failure;heart muscle refractory period;heart ventricle fibrillation;human;letter;neuromodulation;non invasive procedure;obesity;priority journal;risk benefit analysis;tinnitus;treatment indication;vagus nerve stimulation,"Li, S.;Zhou, X.;Yu, L.;Jiang, H.",2015,,,0,
2589,A cardiac tamponade in the hypertensive patient presenting as abdominal fullness,"Cardiac tamponade is a medical emergency consisting of an accumulation of fluid in the pericardial space which is rapidly progressing and fatal. Because cardiac tamponade is ultimately a clinical diagnosis, mindful consideration for atypical presentations is essential for the reduction of mortality in the acute setting. Our patient was a 77 year-old female admitted after presenting with general malaise, weakness, somnolence, altered mental status and urinary incontinence found to have CML (chronic myeloid leukemia) on confirmatory bone marrow biopsy after suspicions arose from a leukocytosis of 34,000 cells per mcL with 85% neutrophils and elevated blasts (8%). Initial vital signs revealed mild tachycardia, mild tachypnea and blood pressure elevated to 162/84 mm Hg along with a temperature of 38.7 °C and oxygen saturation of 96% on 2 l by nasal cannula. She received the standard of care for a community acquired pneumonia and was started on treatment with decitabine as further work-up was unremarkable. An abdominal CT performed for abdominal fullness later displayed a large pericardial effusion. Repeat echocardiography exhibited right atrial diastolic collapse, inferior vena cava dilatation (IVC) without inspiratory collapse > 50% and the large pericardial effusion consistent with tamponade. The blood pressure remained hypertensive until she suddenly went into cardiac arrest after being intubated for a pericardial window and expired. Our case highlights the need to keep cardiac tamponade as a differential in the hypertensive individual with abdominal complaints as atypical presentations can obscure diagnosis, delay treatment and increase mortality.",decitabine;abdominal disease;abdominal fullness;aged;article;body temperature;bone marrow biopsy;cancer chemotherapy;case report;cava vein disease;chronic myeloid leukemia;community acquired pneumonia;echocardiography;elevated blood pressure;female;heart arrest;heart atrium arrhythmia;heart tamponade;human;hypertension;inferior vena cava dilatation;leukocytosis;malaise;mental deterioration;nasal cannula;neutrophil count;oxygen saturation;pericardial effusion;pericardiotomy;priority journal;right atrial diastolic collapse;somnolence;tachycardia;tachypnea;urine incontinence;vital sign;weakness,"Li, W.;Subedi, R.;Madhira, B.",2017,,10.1016/j.ajem.2017.01.012,0,
2590,High-amylose corn exhibits better antioxidant activity than typical and waxy genotypes,"The consumption of fruits, vegetables, and whole grains rich in antioxidative phytochemicals is associated with a reduced risk of chronic diseases such as cancer, coronary heart disease, diabetes, Alzheimer's disease, cataract, and aged-related functional decline. For example, phenolic acids are among the main antioxidative phytochemicals in grains that have been shown to be beneficial to human health. Corn (Zea mays L.) is a major staple food in several parts of the world; thus, the antioxidant activity of several corn types was evaluated. The 2,2-Diphenyl-1-picryhydrazyl free radical (DPPH*) scavenging activity, total phenolic content (TPC), antioxidant capacity of lipid-soluble substances (ACL), oxygen radical absorbance capacity (ORAC), and phenolic acid compositions of typical and mutant genotypes (typical-1, waxy, typical-2, and high-amylose) were investigated. The DPPH* scavenging activity at 60 min was 34.39-44.51% in methanol extracts and 60.41-67.26% in HCl/methanol (1/99, v/v) extracts of corn. The DPPH* scavenging activity of alkaline hydrolysates of corn ranged from 48.63 to 64.85%. The TPC ranged from 0.67 to 1.02 g and from 0.91 to 2.15 g of ferulic acid equiv/kg of corn in methanol and HCl/methanol extracts, respectively. The TPC of alkaline hydrolysates ranged from 2.74 to 6.27 g of ferulic acid equiv/kg of corn. The ACL values were 0.41-0.80 and 0.84-1.59 g of Trolox equiv/kg of corn in methanol and HCl/methanol extracts, respectively. The ORAC values were 10.57-12.47 and 18.76-24.92 g of Trolox equiv/kg of corn in methanol and HCl/methanol extracts, respectively. ORAC values of alkaline hydrolysates ranged from 42.85 to 68.31 g of Trolox equiv/kg of corn. The composition of phenolic acids in alkaline hydrolysates of corn was p-hydroxybenzoic acid (5.08-10.6 mg/kg), vanillic acid (3.25-14.71 mg/kg), caffeic acid (2.32-25.73 mg/kg), syringic acid (12.37-24.48 mg/kg), p-coumaric acid (97.87-211.03 mg/kg), ferulic acid (1552.48-2969.10 mg/kg), and o-coumaric acid (126.53-575.87 mg/kg). Levels of DPPH* scavenging activity, TPC, ACL, and ORAC in HCl/methanol extracts were obviously higher than those present in methanol extracts. There was no significant loss of antioxidant capacity when corn was dried at relatively high temperatures (65 and 93 degrees C) postharvest as compared to drying at ambient temperatures (27 degrees C). Alkaline hydrolysates showed very high TPC, ACL, and ORAC values when compared to methanol and HCl/methanol extracts. High-amylose corn had a better antioxidant capacity than did typical (nonmutant) corn genotypes.",Amylose/*analysis;Antioxidants/*analysis/pharmacology;Biphenyl Compounds;Free Radical Scavengers/pharmacology;Genotype;Hydroxybenzoates/analysis;Mutation;Phenols/analysis;Picrates;Seeds/*chemistry;Zea mays/*chemistry/*genetics,"Li, W.;Wei, C. V.;White, P. J.;Beta, T.",2007,Jan 24,10.1021/jf0622432,0,
2591,Genetics of late-onset Alzheimer's disease: Progress and prospect,"Genetic susceptibility factors for late-onset Alzheimer's disease remain largely elusive, with the exception of apolipoprotein E4 (APOE e4) as the only confirmed genetic risk factor. Numerous other putative risk markers have been proposed, although all suffer inconsistent replication. These results suggest that modest effect sizes are likely to be the norm for non-APOE-related factors. This unsettling situation has been similar to other complex diseases such as diabetes and cardiovascular diseases until very recently, when a spate of new, although weak, genetic markers has been convincingly linked to these conditions. If we assume that multiple weak factors together with APOE e4, account for the genetic contribution to late-onset Alzheimer's disease risk, it will require the concerted efforts of the greater Alzheimer's genetics community to pool existing genetic resources and/or data to identify novel genetic risk factors that are genuine. Increased confidence in the disease-associated factors will provide the foundation to develop better diagnostic and prognostic tests, select new drug targets and, perhaps, olucidate pharmacogenetic markers that assist in making the best treatment decisions. © 2007 Future Medicine Ltd.",aldosterone synthase;amyloid beta protein;apolipoprotein E4;cholesterol ester transfer protein;cholinesterase inhibitor;death associated protein kinase;glyceraldehyde 3 phosphate dehydrogenase;hydralazine plus isosorbide dinitrate;placebo;pravastatin;presenilin 1;presenilin 2;rosiglitazone;simvastatin;Alzheimer disease;article;clinical trial;diagnostic procedure;disease association;drug targeting;gene deletion;gene insertion;genetic analysis;genetic association;genetic marker;genetic predisposition;genetic risk;genetic susceptibility;genotype;haplotype;heart failure;heart infarction;human;ischemic heart disease;medical decision making;pathogenesis;pharmacogenetics;phenotype;prognosis;risk assessment;risk factor;single nucleotide polymorphism;bidil,"Li, Y.;Grupe, A.",2007,,,0,
2592,Association of Notch3 single-nucleotide polymorphisms and lacunar infarctions in patients,"Cerebrovascular disease is a leading cause of morbidity and mortality worldwide, which is influenced by genetic and environmental factors. The aim of the present study was to examine the association between single‑nucleotide polymorphisms (SNPs) in Notch3 exons 3‑6 and lacunar infarction by comparing SNPs between control subjects and those with lacunar infarction. A single‑center case‑control study was conducted to investigate the association between Notch3 SNPs and risk of stroke. A total of 140 patients were included in the study, 30 of whom had no infarction (control) and 110 had lacunar infarction. Lacunar patients were divided into the ‘pure lacunar’ and ‘lacunar + leukoarasis’ groups based on brain imaging. All the patients were of Chinese Han ethnicity, and the male to female ratio was 84:56. Patient clinical histories included hypertension, diabetes mellitus (DM), hyperlipidemia, and heart disease were recorded. The Notch3 sequence was obtained from the National Centser for Biotechnology Information database. Notch3 was amplified by polymerase chain reaction from whole blood samples, and exons 3‑6 were sequenced to identify SNPs. The result showed that there was no significant difference in the prevalence of hypertension, DM, hyperlipidemia, and heart disease between the control and lacunar infarction patients. Notabley, the age of the lacunar + leukoarasis patients was significantly higher than that of the control and pure lacunar patients (P<0.05). Eight SNPs were detected at low frequencies, and only rs3815388 and rs1043994 exhibited slightly higher frequencies. A χ2 test indicated that Notch3 SNPs, particularly rs1043994, were associated with lacunar infarction (P<0.05). In conclusion, the result of the present study have shown that Notch3 SNPs, particularly rs1043994, are associated with lacunar infarction.",Notch3 receptor;age;aged;article;CADASIL;case control study;computer assisted tomography;controlled study;female;gene frequency;genetic association;genetic risk;human;lacunar stroke;leukoaraiosis;major clinical study;male;nuclear magnetic resonance imaging;polymerase chain reaction;single nucleotide polymorphism,"Li, Y.;Liu, N.;Chen, H.;Huang, Y.;Zhang, W.",2016,,,0,
2593,Prevalence for isolated systolic hypertension and analysis on its relative factors in 1002 cases >or= 80 year old persons,"OBJECTIVE: To study and analysis prevalence and incidence of target organ injury and the relative factors for isolated systolic hypertension (ISH) in Beijing. METHODS: 1002 cases aged 80 to 99 years were investigated in 28 cadre retirement centers in Beijing. Blood pressure was taken for three times with mercurial sphygmomanometer in every person, the mean values were recorded and the relative material was gathered according to questionnaire after the health education. Physical examination form of outpatient department and inpatient case history in fixed hospital were analyzed. RESULTS: In 1002 very old persons, there were 673 hypertensive patients (67.2%) and 455 ISH (45.4%). Among all hypertensive patients, the rate of ISH was 67.6% and double hypertension was 32.4%. Awareness rate was 87.90% and 97.71%, taking antihypertensive drug rate was 77.58% and 80.73%, control rate was 58.68% and 62.84% in ISH and in double hypertension group, respectively, which were no significant differences between the two groups. There was no significant difference in morbidities of cardiac heart disease, myocardial infarction and chronic renal insufficiency between the two groups. The incidences of heart failure, cerebrovascular disease, disability and dementia were 4.62% and 8.72%, 41.54% and 55.50%, 10.55% and 16.06%, 8.57% and 12.84% in ISH and double hypertension group, respectively, which were significant differences between the two groups (P < 0.01). The susceptible age period for ISH was 70 to 79 years in this study. CONCLUSION: ISH is more common in hypertensive patients in very old persons at 28 cadre retirement centers in Beijing. Morbidity of heart failure, cerebrovascular disease, disability and dementia were higher in double hypertension group compared with those in ISH group. The results showed that increase of both systolic and diastolic blood pressure was more dangerous than that of systolic pressure only for very old persons. The improvement of small arterial plastic and the control of blood pressure to target level (< 140/90 mm Hg) in very old hypertensive patients are very important for decreasing the incidence of target organ injury and increasing their life quality and late survival rate.","Aged, 80 and over;Cardiovascular Diseases/epidemiology;Cerebrovascular Disorders/epidemiology;China/epidemiology;Diabetes Mellitus/epidemiology;Female;Humans;Hyperlipidemias/epidemiology;Hypertension/*epidemiology/*physiopathology;Kidney Failure, Chronic/epidemiology;Male;Prevalence;Systole","Li, Y. F.;Zhao, R. X.;Bu, C. Y.;Chen, H.;Li, X.;Wang, L. H.;Peng, X. J.",2005,Apr,,0,
2594,Moderate- to high-intensity statins for secondary prevention in patients with type 2 diabetes mellitus on dialysis after acute myocardial infarction,"Background: Evidences support the benefits of moderate- to high-intensity statins for patients with acute myocardial infarction (AMI) except for those with type 2 diabetes mellitus (T2DM) on dialysis after AMI. This study was aimed to investigate the safety and efficacy of secondary prevention of cardiovascular diseases using moderate- to high-intensity statins in T2DM patients on dialysis after AMI. Methods: A simulated prospective cohort study was conducted between January 1st, 2001 and December 31st, 2013 utilizing data from the Taiwan National Health Insurance Research Database. A total of 882 patients with T2DM on dialysis after AMI were selected as the study cohort. Cardiovascular efficacy and safety of moderate- to high-intensity statins were evaluated by comparing outcomes of 441 subjects receiving statins after AMI to 441 matched subjects not receiving statins after AMI. The primary composite outcome included cardiovascular death, non-fatal myocardial infarction and non-fatal ischemic stroke. Results: The Kaplan-Meier event rate for the primary composite outcomes at 8 years was 30.2% (133 patients) in the statin group compared with 25.2% (111 patients) in the non-statin group (hazard ratio [HR],.98; 95% confidence interval [CI].76-1.27). Significantly lower risks of non-fatal ischemic stroke (HR,.58; 95% CI.35-.98) and all-cause mortality (HR,.70; 95% CI.59-.84) were found in the statin group. Conclusions: In T2DM patients on dialysis after AMI, the use of moderate- to high-intensity statins has neutral effects on composite cardiovascular events but may reduce risks of non-fatal ischemic stroke and all-cause mortality.",hydroxymethylglutaryl coenzyme A reductase inhibitor;acute heart infarction;acute hepatitis;adult;aged;all cause mortality;article;brain hemorrhage;brain ischemia;cardiovascular disease;cardiovascular mortality;cohort analysis;controlled study;dementia;drug efficacy;drug safety;end stage renal disease;female;heart failure;heart infarction;hemodialysis;human;major clinical study;male;malignant neoplasm;non insulin dependent diabetes mellitus;peritoneal dialysis;priority journal;prospective study;rhabdomyolysis;secondary prevention;simulation;Taiwan;very elderly,"Li, Y. R.;Tsai, S. S.;Lin, Y. S.;Chung, C. M.;Chen, S. T.;Sun, J. H.;Liou, M. J.;Chen, T. H.",2017,,10.1186/s13098-017-0272-7,0,
2595,Apolipoprotein E genotyping using PCR-GoldMag lateral flow assay and its clinical applications,"A polymerase chain reaction-gold magnetic nanoparticles lateral flow assay (PCR-GoldMag LFA) has been developed via integrating multiplex amplification refractory mutation system PCR (multiARMSPCR) with GoldMagbased LFA for the visual detection of singlenucleotide polymorphisms (SNPs). This assay was applied to genotype Apolipoprotein E (ApoE). ApoE genotyping is important due to the predictive value for the development of coronary artery disease and Alzheimer's disease. The method requires two steps: i) Simultaneous amplifications of the two polymorphic codons (ApoE 158 and 112), performed in separated reactions using multiARMSPCR; and ii) detection of the wildtype and mutant PCR products via dual immunoreactions, which can be performed in ~5 min. Within two LFAs, antidigoxin antibodyconjugated GoldMag probes bind digoxinlabeled wildtype PCR products, and antifluorescein isothiocyanate (FITC) antibody-conjugated GoldMag probes bind FITClabeled mutant PCR products. All PCR products are biotin labeled and are detected by streptavidin-coated regions on the LFA strip, resulting in a red color. The current approach is capable of detecting the SNPs of ApoE in ~1.5 h, with a broad detection range from 101,000 ng of genomic DNA. Thus, the present protocol may facilitate simple, fast and costeffective screening for important SNPs, as demonstrated by the evaluation of the prevalence of ApoE variants in a Han Chinese cohort.",,"Lian, T.;Hui, W.;Li, X.;Zhang, C.;Zhu, J.;Li, R.;Wan, Y.;Cui, Y.",2016,Nov,10.3892/mmr.2016.5768,0,
2596,Apolipoprotein e genotyping using PCR-GoldMag lateral flow assay and its clinical applications,"A polymerase chain reactiongold magnetic nanoparticles lateral flow assay (PCRGoldMag LFA) has been developed via integrating multiplex amplification refractory mutation system PCR (multiARMSPCR) with GoldMagbased LFA for the visual detection of singlenucleotide polymorphisms (SNPs). This assay was applied to genotype Apolipoprotein E (ApoE). ApoE genotyping is important due to the predictive value for the development of coronary artery disease and Alzheimer's disease. The method requires two steps: i) Simultaneous amplifications of the two polymorphic codons (ApoE 158 and 112), performed in separated reactions using multiARMSPCR; and ii) detection of the wildtype and mutant PCR products via dual immunoreactions, which can be performed in ~5 min. Within two LFAs, antidigoxin antibodyconjugated GoldMag probes bind digoxinlabeled wildtype PCR products, and antifluorescein isothiocyanate (FITC) antibodyconjugated GoldMag probes bind FITClabeled mutant PCR products. All PCR products are biotin labeled and are detected by streptavidincoated regions on the LFA strip, resulting in a red color. The current approach is capable of detecting the SNPs of ApoE in ~1.5 h, with a broad detection range from 10-1,000 ng of genomic DNA. Thus, the present protocol may facilitate simple, fast and costeffective screening for important SNPs, as demonstrated by the evaluation of the prevalence of ApoE variants in a Han Chinese cohort.",biotin;digoxin antibody;fluorescein isothiocyanate;genomic DNA;gold nanoparticle;magnetic nanoparticle;streptavidin;apolipoprotein E gene;article;codon;gene;gene amplification;genetic variability;genotype;Han Chinese;human;immunoassay;immunoreactivity;lateral flow assay;multiplex amplification refractory mutation system polymerase chain reaction;mutant;nucleotide sequence;polymerase chain reaction;single nucleotide polymorphism;wild type,"Lian, T.;Hui, W.;Li, X.;Zhang, C.;Zhu, J.;Li, R.;Wan, Y.;Cui, Y.",2016,,10.3892/mmr.2016.5768,0,2595
2597,Risk and prediction of dementia in patients with atrial fibrillation - A nationwide population-based cohort study,"Background Atrial fibrillation (AF) is associated with an increased risk of cognitive impairment and functional decline, and may contribute to development of dementia. Objectives Data from a nationwide large-scale population-based cohort study are lacking. Besides, how best to predict the occurrence of incident dementia among AF subjects remains uncertain. Methods A total of 332,665 AF subjects without dementia were identified as the study group from the ""National Health Insurance Research Database"" in Taiwan. For each study patient, one age- and sex-matched subject without AF and dementia was selected as the control group. The study end point was occurrence of dementia, and the usefulness of CHADS<inf>2</inf> and CHA<inf>2</inf>DS<inf>2</inf>-VASc scores in predicting dementia was analyzed. Results During the follow-up, 29,012 AF patients experienced dementia with an annual incidence of 2.12%, higher than non-AF subjects (1.50%). Patients with AF possessed a higher risk of dementia with a hazard ratio (HR) of 1.420 after adjustments for age, gender, baseline differences and medication use. Among AF patients, the CHADS<inf>2</inf> and CHA<inf>2</inf>DS<inf>2</inf>-VASc scores were significant predictors of dementia with an adjusted HR of 1.520 and 1.497 per 1 increment of the CHADS<inf>2</inf> and CHA<inf>2</inf>DS<inf>2</inf>-VASc scores, respectively. The c-index for CHA<inf>2</inf>DS<inf>2</inf>-VASc in predicting dementia (0.611, 95% confidence interval [CI] = 0.608-0.614) was significantly higher than the CHADS<inf>2</inf> score (0.589, 95% CI = 0.586-0.592) (DeLong test p < 0.001). Conclusions In this nationwide cohort study, AF was independently associated with a higher risk of dementia. The CHA<inf>2</inf>DS<inf>2</inf>-VASc score can be used to estimate the risk of dementia in AF patients.",acetylsalicylic acid;angiotensin receptor antagonist;clopidogrel;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;warfarin;aged;article;atrial fibrillation;autoimmune disease;cerebrovascular accident;CHA2DS2 VASc score;CHADS2 score;chronic obstructive lung disease;cohort analysis;controlled study;dementia;diabetes mellitus;disease association;dyslipidemia;end stage renal disease;female;follow up;heart failure;human;hypertension;incidence;major clinical study;male;population research;prediction;priority journal;risk factor;Taiwan;vascular disease,"Liao, J. N.;Chao, T. F.;Liu, C. J.;Wang, K. L.;Chen, S. J.;Tuan, T. C.;Lin, Y. J.;Chang, S. L.;Lo, L. W.;Hu, Y. F.;Chung, F. P.;Tsao, H. M.;Chen, T. J.;Lip, G. Y. H.;Chen, S. A.",2015,,,0,
2598,Effectiveness of comprehensive geriatric assessment-based intervention to reduce frequent emergency department visits: A report of four cases,"A small number of clustered visits by emergency department frequent users (EDFUs) may over-consume emergency care resources. We report the effectiveness of comprehensive geriatric assessment (CGA)-based multidisciplinary team (MDT) care for four EDFUs, in reducing ED visits. Case 1 had visited the ED twice/month due to chest discomfort. Her ED visits were significantly reduced to 0.2 visits/month following CGA-based MDT care. Case 2 had failed back surgery syndrome and bipolar disorder. His ED visit was reduced from 2.8 visits to 0.8 visits/month following CGA-based MDT intervention. Case 3 had chronic obstructive pulmonary disease, heart failure, and urinary incontinence, with a urinary catheter in place. He made 31 ED visits (5.1 visits/month) before his lung cancer and depression were discovered by CGA. He died 2 months later. Case 4 made 27 ED visits (2.7 visits/month) due to dizziness. His problems of early dementia and neglect were identified by CGA, and he visited the ED only once following MDT intervention. In conclusion, CGA-based MDT intervention successfully reduced ED visits among these EDFUs, but further investigation is needed to evaluate the effectiveness of geriatric services in the ED. © 2012, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.",antidepressant agent;antihistaminic agent;benzodiazepine;vasodilator agent;acute coronary syndrome;aged;article;bipolar disorder;bladder catheterization;case report;chest tightness;chronic obstructive lung disease;clinical effectiveness;comprehensive geriatric assessment;dementia;depression;dizziness;emergency care;emergency patient;emergency ward;failed back surgery syndrome;female;fever;geriatric assessment;geriatric care;geriatric patient;heart failure;hospital admission;human;intervention study;lung cancer;malaise;male;priority journal;psychopharmacotherapy;thorax pain;urine incontinence;vertigo,"Liao, M. C.;Chen, L. K.;Chou, M. Y.;Laing, C. K.;Lin, Y. T.;Lo, Y. K.;Hwang, S. J.;Wann, S. R.",2012,,,0,
2599,The association between chronic obstructive pulmonary disease and dementia: a population-based retrospective cohort study,"BACKGROUND AND PURPOSE: Chronic obstructive pulmonary disease (COPD) is frequently associated with various comorbidities. However, the proportion of COPD patients with dementia has not been adequately examined. This retrospective cohort study investigated the association between COPD and dementia by using a nationwide population-based database in Taiwan. METHODS: Data were retrieved from the Taiwanese National Health Insurance Research Database and analyzed using multivariate Cox proportional hazards regression models to assess the effects of COPD on the risk of dementia after adjusting for demographic characteristics and comorbidities. RESULTS: The COPD cohort exhibited a higher prevalence of diabetes, hypertension, coronary artery disease, head injury and depression at baseline than did the non-COPD cohort (P < 0.0001). After adjusting for covariates, the COPD patients exhibited a 1.27-fold higher risk of developing dementia (hazard ratio 1.27, 95% confidence interval 1.20-1.36). The incidence rate was higher in patients with frequent acute exacerbations than in the non-COPD patients regardless of whether a hospital admission or emergency room visit was required (hazard ratio 196.8 vs. 41.7, 95% confidence intervals 145.9-265.5 and 22.3-78.0). CONCLUSION: This study shows that COPD is associated with a subsequent higher risk of dementia after adjusting for comorbidities. Specifically, the association between COPD and dementia is greater in patients with more frequent acute exacerbation events of COPD.","Aged;Comorbidity;Dementia/*epidemiology;Female;Humans;Male;Middle Aged;Pulmonary Disease, Chronic Obstructive/*epidemiology;Retrospective Studies;Risk;Taiwan/epidemiology;acute exacerbation;chronic obstructive pulmonary disease;dementia","Liao, W. C.;Lin, C. L.;Chang, S. N.;Tu, C. Y.;Kao, C. H.",2015,Feb,10.1111/ene.12573,0,
2600,Sharing pathogenetic mechanisms between acute myocardial infarction and Alzheimer's disease as shown by partially overlapping of gene variant profiles,"Gene variants that promote inflammation and cholesterol metabolism have been associated with acute myocardial infarction (AMI) and Alzheimer's disease (AD). We investigated a panel of relevant polymorphisms to distinguish genetic backgrounds for AMI and AD: IL10 -1082G/A, IL6 -174G/C, TNF -308G/A, IFNG +874T/A, SERPINA3 -51G/T, HMGCR -911C/A, APOE epsilon2/3/4 (280 AMI cases, 257 AD cases, and 1307 population controls, all Italian (presumed risk alleles are shown in bold). Six genetic risk sets I to VI were identified by fuzzy latent classification: I had low risk; II and III had low risk before age 65 (II, III); low risk sets lacked pro-inflammatory alleles for HMGCR-TNF-APOE. Pro-inflammatory alleles for SERPINA3-IL10-IFNG were found for high risk sets IV to VI. Set IV 'AMI < age 40, AD < age 65' included risk alleles for HMGCR. Set V 'AMI over a broad range of age' included risk alleles for TNF+IL6. Set VI 'AMI at ages 40 to 55, AD ages 65+' included APOE epsilon4. Close resemblance to the high risk sets, as indicated by membership scores close to one, defined high relative risks. We conclude that AMI and AD share genetic backgrounds involving cholesterol metabolism and the upregulation of inflammation and that gene-gene interactions in relevant sets of genes may be useful in defining inherited risk for common disorders.","Adult;Aged;Aged, 80 and over;Alzheimer Disease/*etiology/*genetics;Female;Gene Expression Profiling/*methods;Genes, Overlapping;Genetic Predisposition to Disease/genetics;Genetic Variation/*genetics;Humans;Male;Middle Aged;Myocardial Infarction/*etiology/*genetics;Risk Factors","Licastro, F.;Chiappelli, M.;Caldarera, C. M.;Porcellini, E.;Carbone, I.;Caruso, C.;Lio, D.;Corder, E. H.",2011,,10.3233/jad-2010-090871,0,
2601,Intervention trials in patient with cerebrovascular risk: Clinical applications,"In Western countries ischemic stroke rapresents the third mortality cause after CAD and cancer, the first mortality cause in advanced age and an important cause of disability and cognitive impairment. Several trials regarding cerebrovascular risk reduction evaluated either stroke endpoint (HOT, HOPE, UKPDS) and disability and cognitive impairment outocomes (SYST-EUR, PROGRESS, LIFE, HPS). PROGRESS study reported, in the active treatment group, a 28% reduction of stroke recurrence. Indeed, a subanalysis of this study reported respectively a 34% and 45% reduction of dementia and cognitive impairment composite outcomes. LIFE trial,in hypertensive patients with left ventricular hypertrophy, reported a 24.9% reduction of stroke relative risk in losartan group in comparison with atenolol group. HPS trial, the largest trial regarding statin treatment, reported in simvastatin group a 25% reduction of first stroke occurrance. On the basis of the results of this study, it's conveivable a protective action of statin regarding dementia and cognitive impairment through a reduction of cerebrovascular events recurrence rate, lowering APOE effects and amyloid deposition. In conclusion, these clinical trials, evaluating several active treatments opened new views in cerebrovascular events treatment and prevention, with a significative and sometimes important stroke reduction.",alpha tocopherol;amyloid protein;apolipoprotein E;ascorbic acid;atenolol;beta carotene;captopril;dipeptidyl carboxypeptidase inhibitor;felodipine;hydrochlorothiazide;hydroxymethylglutaryl coenzyme A reductase inhibitor;indapamide;losartan;nitrendipine;perindopril;placebo;ramipril;simvastatin;aging;article;cerebrovascular accident;clinical practice;clinical trial;cognitive defect;coronary artery disease;dementia;heart left ventricle hypertrophy;human;hypertension;malignant neoplastic disease;mortality;patient care;physical disability;recurrence risk;recurrent disease;risk assessment;risk reduction;treatment outcome,"Licata, G.;Pinto, A.;Tuttolomondo, A.",2003,,,0,
2602,A novel mutation af Cln3 associated with delayed-classic juvenile ceroid lipofuscinois and autophagic vacuolar myopathy,"Juvenile neuronal-ceroid-lipofuscinosis (JNCL) is a lysosomal storage disease caused by mutations in CLN3. The most frequent mutation is a 1.02-kb deletion that, when homozygous, causes the classical clinical presentation.Patients harboring mutations different than the major deletion show a marked clinical heterogeneity, including protracted disease course with possible involvement of extraneuronal tissues. Cardiac involvement is relatively rare in JNCL and it is usually due to myocardial storage of ceroid-lipofuscinin. Only recently, histopathological findings of autophagic vacuolar myopathy (AVM) were detected in JNCL patients with severe cardiomyopathy.We describe a 35-year-old male showing a delayed-classic JNCL with visual loss in childhood and neurological manifestations only appearing in adult life. He had an unusual CLN3 genotype with an unreported deletion (p.Ala349_Leu350del) and the known p.His315Glnfs*67 mutation. Autophagic vacuolar myopathy was shown by muscle biopsy. At clinical follow-up, moderately increased CPK levels were detected whereas periodic cardiac assessments have been normal to date.Adult neurologists should be aware of protracted JNCL as cause of progressive neurological decline in adults. The occurrence of autophagic vacuolar myopathy necessitates periodic cardiac surveillance, which is not usually an issue in classic JNCL due to early neurological death.",creatine kinase;dystrophin;HLA A1 antigen;lactate dehydrogenase;lysosome associated membrane protein 2;messenger RNA;adult;adulthood;amino acid substitution;article;autophagic vacuolar myopathy;behavior disorder;case report;cell ultrastructure;cell vacuole;child;childhood;Cln3 gene;cognitive defect;depression;disease course;disorientation;dysphasia;electroencephalogram;electromyogram;electroretinogram;epileptic discharge;evoked muscle response;evoked somatosensory response;evoked visual response;exon;extrapyramidal symptom;gene;gene deletion;gene mutation;genetic association;genetic heterogeneity;genotype;human;human tissue;intron;laboratory test;lamellar body;language disability;long term memory;male;memory disorder;mental deterioration;muscle biopsy;mutational analysis;myoclonus;myopathy;neuronal ceroid lipofuscinosis;nuclear magnetic resonance imaging;retinitis pigmentosa;school child;sequence analysis;skin biopsy;tonic clonic seizure;visual field defect;visual impairment;walking difficulty,"Licchetta, L.;Bisulli, F.;Fietz, M.;Valentino, M. L.;Morbin, M.;Mostacci, B.;Oliver, K. L.;Berkovic, S. F.;Tinuper, P.",2015,,,0,
2603,Response,,atmosphere;dementia;heart infarction;letter;liver cirrhosis;multiple sclerosis;pancreas cancer;pertussis;priority journal;sudden death,"Lichtenstein, D. A.;Mezière, G. A.",2010,,,0,
2604,Studies reveal new HRT dangers,,estrogen;progesterone;bone density;breast cancer;cancer incidence;combination chemotherapy;dementia;endometrium cancer;female;fracture;female genital tract cancer;hormonal therapy;hormone substitution;human;ischemic heart disease;long term care;menopause;note;osteoporosis;ovary cancer;postmenopause;priority journal;cerebrovascular accident;uterus bleeding,"Liddle, R.",2003,,,0,
2605,Further studies with lisuride in Parkinson's disease,"Lisuride was administered to 63 patients with advanced Parkinson's disease (PD) who were no longer satisfactorily responding to levodopa. The group included 40 patients with 'on-off' phenomena. Lisuride alone (13 patients) or combined with levodopa (50 patients) resulted in a 34% decrease in PD disability as assessed in the 'on' period, a 16% decrease in disability as assessed in the 'off' period, and a 96% increase in the numbers of hours in which patients were 'on' (from 5.5 to 10.8 h). All of these changes were significant (p ≤ 0.001). 37 of the 63 patients (59%) improved at least one-stage on lisuride. The major adverse effect limiting the use of lisuride was the occurrence of an organic confusional syndrome. This was related, in part, to the presence of an underlying dementia and to the concurrent use of anticholinergic drugs.",carbidopa;carbidopa plus levodopa;cholinergic receptor blocking agent;levodopa;lisuride;adverse drug reaction;aged;angina pectoris;cardiotoxicity;cardiovascular system;central nervous system;confusion;congestive cardiomyopathy;delusion;drug therapy;dyskinesia;edema;gastrointestinal toxicity;hallucination;heart;human;intoxication;major clinical study;nausea;nervous system;neurotoxicity;oral drug administration;orthostatic hypotension;Parkinson disease;therapy;sinemet,"Lieberman, A. N.;Goldstein, M.;Gopinathan, G.",1983,,,0,
2606,Unconventional removal of large bronchial foreign bodies,,aged;article;balloon dilatation;bronchoscope;bronchoscopy;case report;dementia;equipment design;foreign body;heart infarction;human;devices;male;methodology;radiography,"Lieberum, B.",2010,,,0,
2607,A comparison of charlson and elixhauser comorbidity measures to predict colorectal cancer survival using administrative health data,"BACKGROUND: Cancer survival is related to features of the primary malignancy and concurrent presence of nonmalignant diseases (comorbidities), including weight-related conditions (obesity, weight loss). The Charlson and Elixhauser methods are 2 well-known methods that take comorbidities into account when explaining survival. They differ in both the number and categorization of comorbidities. METHODS: Cancer, comorbidity, and survival data were acquired from inpatient administrative hospital records in 574 colorectal cancer patients. Robust Poisson regression was used to analyze 2- and 3-year survival according to cancer features and comorbidities classified by the Charlson and Elixhauser methods. Data for weight-related conditions (body mass index, weight loss) and performance status were acquired upon a new patient visit to the regional cancer center. Discrimination was assessed with the concordance (c) statistic. RESULTS: A base model (age, sex, stage) had excellent discrimination (c-statistic, 0.824 [2-year survival] and 0.827 [3-year survival]). The addition of Charlson comorbidities did not outperform the base model (c-statistic, 0.831 [2-year survival] and 0.833 [3-year survival]). Elixhauser comorbidities added higher discrimination compared with the base model, both in stage and overall (c-statistic, 0.852 [2-year survival] and 0.854 [3-year survival]; P <.01). The greatest increase in the c-statistic contributed by the addition of the Elixhauser comorbidities occurred in stage II patients (increased from 0.683 to 0.838). Overall, the Elixhauser comorbidities outperformed the Charlson comorbidities (P <.05). The use of self-reported weight and performance status data significantly increased discrimination by the Elixhauser method in 2-year but not 3-year survival. CONCLUSIONS: The Elixhauser method is a superior comorbidity risk-adjustment model for colorectal cancer survival prediction. Cancer 2011;117:1957-1965. © 2010 American Cancer Society.",adult;aged;article;body mass;cancer mortality;cancer staging;cancer survival;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;colorectal cancer;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;Elixhauser comorbidity method;female;heart infarction;human;kidney disease;length of stay;liver disease;major clinical study;male;methodology;overall survival;peptic ulcer;prediction;priority journal;receiver operating characteristic;survival rate;weight reduction,"Lieffers, J. R.;Baracos, V. E.;Winget, M.;Fassbender, K.",2011,,,0,
2608,Lenticulostriate arterial lumina are normal in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy: A high-field in vivo MRI study,"Background and Purpose- Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary small vessel disease. Although postmortem studies have demonstrated mural thickening in leptomeningeal arteries and lenticulostriate perforating arteries, it is unclear whether this also leads to luminal narrowing. High-field MRI scanners enable in vivo imaging of the lumen of the lenticulostriate arteries. The aim of this study is to examine the luminal diameters of lenticulostriate arteries in living patients with CADASIL and to investigate whether luminal narrowing is correlated with the number of lacunar infarcts in the basal ganglia. Methods- Twenty-two NOTCH3 mutation carriers and 11 healthy control subjects were examined using high-resolution 3-dimensional time-of-flight MR angiography imaging on a 7-T MRI scanner. Scans were analyzed for the presence of focal stenotic segments. The total number, length, and total cross-sectional area of lenticulostriate arteries were measured and compared between mutation carriers and control subjects. These measurements were correlated with age, disease duration, and number of lacunar infarcts in the basal ganglia. Results- No stenotic segments were observed. No differences between mutation carriers and control subjects were found in total number of end branches (mutation carriers: mean, 14.6; control subjects: mean, 12.8), length of the lenticulostriate system, or total cross-sectional area of lenticulostriate artery lumina. Measurements of lenticulostriate artery lumina were not associated with lacunar infarct load in the basal ganglia area or with basal ganglia hyperintensities. Conclusions- Three-dimensional time-of-flight MR angiographic on 7 T showed no differences in luminal diameters of lenticulostriate arteries between patients with CADASIL and control subjects. © 2010 American Heart Association, Inc.",Notch3 receptor;adult;age;aged;artery diameter;artery intima;artery occlusion;article;basal ganglion;brain artery;brain infarction;brain ventricle;CADASIL;clinical article;controlled study;correlation analysis;disease duration;female;human;in vivo study;magnetic resonance angiography;male;mutation;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;priority journal;striate cortex;three dimensional imaging;time of flight mass spectrometry,"Liem, M. K.;Van Der Grond, J.;Versluis, M. J.;Haan, J.;Webb, A. G.;Ferrari, M. D.;Van Buchem, M. A.;Oberstein, S. A. J. L.",2010,,,0,
2609,A novel VCP mutation underlies scapuloperoneal muscular dystrophy and dropped head syndrome featuring lobulated fibers,"Introduction: Valosin-containing protein (VCP) is a ubiquitously expressed, multifunctional AAA-ATPase protein. Its dominant mutations cause hereditary inclusion body myopathy associated with Paget disease of bone and frontotemporal dementia (IBMPFD) or amyotrophic lateral sclerosis. The pattern of muscle weakness in IBMPFD patients is variable and includes limb-girdle, scapuloperoneal, distal, or axial distributions. Case Report: We report a 63-year-old man with progressive scapuloperoneal weakness, head drop, and hyperCKemia since age 40 years. Electromyography showed myopathic changes and rare myotonic discharges. Muscle biopsy revealed numerous lobulated fibers, few fibers with glycogen accumulation, and rare fibers with polyglucosan bodies. Rimmed vacuoles and congophilic inclusions, often seen in IBMPFD, were absent. VCP sequencing identified a novel heterozygous c. 1160G>A mutation resulting in p.Asn387Ser substitution. Conclusions: Our patient broadens the pathological spectrum of VCP-myopathy and emphasizes the importance of VCP analysis in patients with scapuloperoneal muscular dystrophy despite the absence of Paget disease, dementia, rimmed vacuoles, or intracellular amyloid deposition. © 2014 Wiley Periodicals, Inc.","1,4 alpha glucan branching enzyme;calpain 3;caveolin 3;creatine kinase;dysferlin;protein;valosin containing protein;adult;article;case report;creatine kinase blood level;diastolic dysfunction;dropped head syndrome;electromyography;gene mutation;head and neck disease;heart left ventricle hypertrophy;human;immunoreactivity;lobulated fiber;lung function test;male;middle aged;motor unit potential;muscle biopsy;muscular dystrophy;neuropathy;priority journal;protein urine level;proteinuria;scapuloperoneal muscular dystrophy;tendon reflex","Liewluck, T.;Milone, M.;Mauermann, M. L.;Castro-Couch, M.;Cerhan, J. H.;Murthy, N. S.",2014,,,0,
2610,Cardiovascular risk management in community-dwelling elderly: opportunities for prevention,"DESIGNCross-sectional analysis of Dutch community-dwelling subjects aged 70-78 years without dementia who were included in the cluster randomized preDIVA trial (Prevention of Dementia by Intensive Vascular care).METHODSThe prevalence of hypertension and other cardiovascular risk factors are described for participants with and without a history of cardiovascular disease (CVD). Projected benefits of blood pressure decrease are calculated using data from a meta-analysis and a large national registry.RESULTSOf 3534 subjects, more than one-third (n?=?1230, 35.2%) have a history of cardiovascular disease. Overall, 63% of subjects have two or more cardiovascular risk factors amenable to treatment. Systolic blood pressure (SBP) is ?160?mmHg in 37% of patients with CVD, of which 28% is untreated. In subjects without a history of CVD, 41% have a SBP???160?mmHg of which 52% is untreated. A 5-15?mmHg decrease in SBP is projected to prevent 12-32% of coronary heart disease and 16-41% of strokes, respectively. This corresponds with 14-38 prevented cases within 2 years in our intervention group (n?=?1895).CONCLUSIONSHypertension and other cardiovascular risk factors are very common in elderly subjects. Current (primary and secondary) prevention programmes appear insufficient. Improved antihypertensive treatment has the potential to prevent a substantial proportion of strokes and coronary heart disease in this population.BACKGROUNDThere is little information on the prevalence of hypertension and other modifiable cardiovascular risk factors in community-dwelling elderly in the Netherlands and the potential impact of improving antihypertensive treatment on major cardiovascular events.",Age Factors;Antihypertensive Agents [therapeutic use];Blood Pressure [drug effects];Cardiovascular Diseases [epidemiology] [physiopathology] [prevention & control];Chi-Square Distribution;Community Health Services;Cross-Sectional Studies;Health Services for the Aged;Hypertension [drug therapy] [epidemiology] [physiopathology];Independent Living;Netherlands [epidemiology];Prevalence;Primary Prevention [methods];Registries;Risk Assessment;Risk Factors;Secondary Prevention [methods];Systole;Time Factors;Treatment Outcome;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword],"Ligthart, Sa;Richard, E;Gool, Wa;Moll, van Charante Ep",2012,,10.1177/1741826711422979,0,2611
2611,Cardiovascular risk management in community-dwelling elderly: opportunities for prevention,"BACKGROUND: There is little information on the prevalence of hypertension and other modifiable cardiovascular risk factors in community-dwelling elderly in the Netherlands and the potential impact of improving antihypertensive treatment on major cardiovascular events. DESIGN: Cross-sectional analysis of Dutch community-dwelling subjects aged 70-78 years without dementia who were included in the cluster randomized preDIVA trial (Prevention of Dementia by Intensive Vascular care). METHODS: The prevalence of hypertension and other cardiovascular risk factors are described for participants with and without a history of cardiovascular disease (CVD). Projected benefits of blood pressure decrease are calculated using data from a meta-analysis and a large national registry. RESULTS: Of 3534 subjects, more than one-third (n?=?1230, 35.2%) have a history of cardiovascular disease. Overall, 63% of subjects have two or more cardiovascular risk factors amenable to treatment. Systolic blood pressure (SBP) is ?160?mmHg in 37% of patients with CVD, of which 28% is untreated. In subjects without a history of CVD, 41% have a SBP???160?mmHg of which 52% is untreated. A 5-15?mmHg decrease in SBP is projected to prevent 12-32% of coronary heart disease and 16-41% of strokes, respectively. This corresponds with 14-38 prevented cases within 2 years in our intervention group (n?=?1895). CONCLUSIONS: Hypertension and other cardiovascular risk factors are very common in elderly subjects. Current (primary and secondary) prevention programmes appear insufficient. Improved antihypertensive treatment has the potential to prevent a substantial proportion of strokes and coronary heart disease in this population.",Age Factors;Antihypertensive Agents [therapeutic use];Blood Pressure [drug effects];Cardiovascular Diseases [epidemiology] [physiopathology] [prevention & control];Chi-Square Distribution;Community Health Services;Cross-Sectional Studies;Health Services for the Aged;Hypertension [drug therapy] [epidemiology] [physiopathology];Independent Living;Netherlands [epidemiology];Prevalence;Primary Prevention [methods];Registries;Risk Assessment;Risk Factors;Secondary Prevention [methods];Systole;Time Factors;Treatment Outcome;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword],"Ligthart, S. A.;Richard, E.;Gool, W. A.;Moll van Charante, E. P.",2012,,10.1177/1741826711422979,0,
2612,Anxiety and depression among out-of-hospital cardiac arrest survivors,"Aim: Survivors of out-of-hospital cardiac arrest (OHCA) may experience psychological distress but the actual prevalence is unknown. The aim of this study was to investigate anxiety and depression within a large cohort of OHCA-survivors. Methods: OHCA-survivors randomized to targeted temperature of 33. °C or 36. °C within the Target Temperature Management trial (TTM-trial) attended a follow-up after 6 months that included the questionnaire Hospital Anxiety and Depression Scale (HADS). A control group with ST-elevation myocardial infarction (STEMI) completed the same follow-up. Correlations to variables assumed to be associated with anxiety and depression in OHCA-survivors were tested. Results: At follow-up 278 OHCA-survivors and 119 STEMI-controls completed the HADS where 24% of OHCA-survivors (28% in 33. °C group/22% in 36. °C group, p= 0.83) and 19% of the STEMI-controls reported symptoms of anxiety (OR 1.32; 95% CI (0.78-2.25), p= 0.30). Depressive symptoms were reported by 13% of OHCA-survivors (equal in both intervention groups, p= 0.96) and 8% of STEMI-controls (OR 1.76; 95% CI (0.82-3.79), p= 0.15). Anxiety and depression among OHCA-survivors correlated to Health-Related Quality-of-Life, and subjectively reported cognitive deterioration by patient or observer. In addition, depression was associated with a poor neurological outcome. Conclusion: One fourth of OHCA-survivors reported symptoms of anxiety and/or depression at 6 months which was similar to STEMI-controls and previous normative data. Subjective cognitive problems were associated with an increased risk for psychological distress. Since psychological distress affects long-term prognosis of cardiac patients in general it should be addressed during follow-up of survivors with OHCA due to a cardiac cause.ClinicalTrials.gov NCT01020916/. NCT01946932.",nct01020916;adult;anxiety;article;cardiac patient;controlled study;depression;disease association;distress syndrome;female;follow up;Hospital Anxiety and Depression Scale;human;major clinical study;male;mental deterioration;multicenter study;out of hospital cardiac arrest;outcome assessment;priority journal;prognosis;questionnaire;randomized controlled trial;risk factor,"Lilja, G.;Nilsson, G.;Nielsen, N.;Friberg, H.;Hassager, C.;Koopmans, M.;Kuiper, M.;Martini, A.;Mellinghoff, J.;Pelosi, P.;Wanscher, M.;Wise, M. P.;Östman, I.;Cronberg, T.",2015,,,0,
2613,Prediction of post-stroke dementia using NINDS-CSN 5-minute neuropsychology protocol in acute stroke,"BACKGROUND: The National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute neuropsychology protocol consists of only verbal tasks, and is proposed as a brief screening method for vascular cognitive impairment. We evaluated its feasibility within two weeks after stroke and ability to predict the development of post-stroke dementia (PSD) at 3 months after stroke. METHOD: We prospectively enrolled subjects with ischemic stroke within seven days of symptom onset who were consecutively admitted to 12 university hospitals. Neuropsychological assessments using the NINDS-CSN 5-minute and 60-minute neuropsychology protocols were administered within two weeks and at 3 months after stroke onset, respectively. PSD was diagnosed with reference to the American Heart Association/American Stroke Association statement, requiring deficits in at least two cognitive domains. RESULTS: Of 620 patients, 512 (82.6%) were feasible for the NINDS-CSN 5-minute protocol within two weeks after stroke. The incidence of PSD was 16.2% in 308 subjects who had completed follow-up at 3 months after stroke onset. The total score of the NINDS-CSN 5-minute protocol differed significantly between those with and without PSD (4.0 +/- 2.7, 7.4 +/- 2.7, respectively; p < 0.01). A cut-off value of 6/7 showed reasonable discriminative power (sensitivity 0.82, specificity 0.67, AUC 0.74). The NINDS-CSN 5-minute protocol score was a significant predictor for PSD (adjusted odds ratio 6.32, 95% CI 2.65-15.05). DISCUSSION: The NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.",cerebral infarction;montreal cognitive assessment;post-stroke dementia;vascular cognitive impairment,"Lim, J. S.;Oh, M. S.;Lee, J. H.;Jung, S.;Kim, C.;Jang, M. U.;Lee, S. H.;Kim, Y. J.;Kim, Y.;Park, J.;Kang, Y.;Yu, K. H.;Lee, B. C.",2017,May,,0,
2614,Outcomes of a contemporary amputation series,"Background: The aim of this study was to determine the outcomes of a contemporary amputation series. Methods: A retrospective audit of 87 cases of major lower limb amputation from January 2000 to December 2002 from the Department of Vascular Surgery, Royal Perth Hospital, was conducted. Results: The mean age of the study population was 70.1 ± 14.3 years; the male : female ratio was 3.35:1. Comorbid problems included diabetes (49.4%), smoking (81.6%), hypertension (77.0%), ischaemic heart disease (58.6%), stroke (25.3%), raised creatinine level (34.5%) and chronic airway limitation (25.3%). Preamputation vascular reconstructive procedures were common, 34.5% in a previous admission and 23.0% in the same admission. The main indication was critical limb ischaemia (75.9%) followed by diabetic infection (17.2%). There were 51 below-knee (58.6%), 5 through-knee (5.7%) and 31 above-knee (35.6%.) amputations. The below-knee amputation to above-knee amputation ratio was 1.65:1. The overall wound infection rate was 26.4%; the infection rates for below-knee (29.4%) and above-knee (22.6%) amputation did not differ significantly (P = 0.58). Revision rates were 17.6% for below-knee, 20% for through-knee and none for above-knee amputations. Twenty patients (23.0%) underwent subsequent contralateral amputation. Thirty-nine patients (44.8%) were selected as suitable for a prosthesis by a rehabilitation physician; 31 (79.5%) used the prosthesis both indoors and outdoors and 6 (15.4%) used it indoors only within 3 months. Cumulative mortality at 30 days, 6 months, 12 months and 24 months was 10.1, 28.7, 43.1 and 51.7%, respectively. Conclusion: This series agrees with the current published work in finding that patients undergoing major lower limb amputation are older, with a high prevalence of comorbid conditions. Successful prosthesis rehabilitation depends on patient selection and a multidisciplinary approach. Despite a low immediate mortality, the overall long-term results of lower limb amputation remain dismal. © 2006 Royal Australasian College of Surgeons.",creatinine;above knee amputation;acute heart infarction;aged;article;below knee amputation;Buerger disease;cerebrovascular accident;chronic obstructive lung disease;comorbidity;controlled study;creatinine blood level;dementia;diabetes mellitus;female;atrial fibrillation;human;hypercholesterolemia;hypertension;infection rate;ischemic heart disease;knee prosthesis;major clinical study;male;medical audit;outcome assessment;patient selection;retrospective study;smoking;surgical infection;surgical mortality;surgical patient;wound infection,"Lim, T. S.;Finlayson, A.;Thorpe, J. M.;Sieunarine, K.;Mwipatayi, B. P.;Brady, A.;Abbas, M.;Angel, D.",2006,,,0,
2615,What is the best strategy for successful bowel preparation under special conditions?,"Adequate bowel preparation is important for successful colonoscopic examination. Several effective colonic cleansing agents are available and routinely prescribed, but each carries its own limitations and benefits from particular dosing regimens. The most frequently prescribed colonic cleansing agent, the polyethylene glycol (PEG) cathartic solution, suffers from low patient compliance in general, due to its unpalatable taste and smell coupled with the large ingested volumes required. However, PEG is preferred over other cathartics for use in individuals of advanced age, sufferers of chronic kidney disease, heart failure and inflammatory bowel disease, and women who are pregnant or lactating. The laxative agents sodium phosphate (NaP) and sodium picosulfate plus magnesium citrate have been applied and have improved patient compliance and tolerance. NaP, however, should be avoided in individuals with impaired renal function or plasma clearance, such as those with chronic kidney disease, who are taking drugs that affect renal function, or who suffer from heart failure. Other special conditions that may affect an individual's tolerance of the cathartic agent or ability to complete the administration routine include stroke, severe constipation, hematochezia, suspicious lower gastrointestinal bleeding, and mental disorders such as dementia. All ingestible bowel preparation solutions can be instilled into the stomach and duodenum through nasogastric tube or esophagogastroduodenoscope with the aid of a water irrigation pump for patients with difficulties swallowing or ingesting the large volumes of fluid required. In addition, dietary regimens based on clear liquids and low-residue foods for 1-4 d prior to the colonoscopy may be supplemental bowel preparation strategies. Achieving an effective and safe cleansing of the bowel is important for successful colonoscopy in all patients, so full knowledge of the individual's condition and capabilities is necessary to select the most appropriate colonic cleansing agent and delivery regimen. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.",enema;laxative;macrogol;picosulfate sodium;sodium dihydrogen phosphate;age;article;cerebrovascular accident;chronic kidney disease;colonoscopy;constipation;diabetes mellitus;dysphagia;esophagogastroduodenoscopy;gastrointestinal hemorrhage;heart failure;human;hypertension;intestine preparation;kidney dysfunction;lactation;mental disease;nasogastric tube;patient compliance;plasma clearance;rectum hemorrhage,"Lim, Y. J.;Hong, S. J.",2014,,,0,
2616,"Atheromatosis extent in coronary artery disease is not correlated with apolipoprotein-E polymorphism and its plasma levels, but associated with cognitive decline","BACKGROUND: Apolipoprotein-E (apoE) epsilon4 allele is a known risk factor for Alzheimer's disease (AD). Polymorphism of apoE is also one of the most important genetic markers for coronary artery disease (CAD). The allelic variation in the apoE gene has a significant effect on inter-individual variation of lipids and lipoprotein plasma levels as well. This study investigated whether apoE polymorphism affects the plasma levels of apoE and the possible association to CAD extent and cognitive functions. METHODS: Plasma apoE levels and apoE genotypes were evaluated of subjects with normal coronary arteries, and individuals with angiographycally confirmed mild/moderate or severe atheromatosis. The cognitive performance of the volunteers was also measured by mini-mental state examination (MMSE). RESULTS: Out of the 6 expected genotypes, only 5 were detected in participants: E3/3 (56.0%), E3/4 (23.6%), E4/4 (8.2%), E2/4 (3.3%), E2/3 (8.9%). The epsilon3 allele (72%) was the most frequent, followed by epsilon4 (22%) and epsilon2 (6%). No difference was found in plasma levels of either apoE or in apoE genotype frequencies among the groups, however MMSE scores of CAD patients irrespective of their atheromatosis extent were significantly lower than that seen in the normal population. CONCLUSIONS: Although neither apoE plasma levels, nor apoE polymorphism in patients presenting with mild/moderate or severe atheromatosis showed to be associated with CAD severity, the presence of atheromatosis in the heart vessels positively correlated with cognitive dysfunction.","Adult;Aged;Analysis of Variance;Apolipoprotein E4/blood/genetics;Cognition Disorders/blood/*genetics;Coronary Angiography/methods;Coronary Artery Disease/blood/complications/*genetics/radiography;DNA Mutational Analysis;Female;Gene Frequency;Genotype;Humans;Lipids/blood;Lipoproteins/blood;Male;Mental Status Schedule;Middle Aged;Neuropsychological Tests;Plaque, Atherosclerotic/blood/etiology/*genetics;Polymorphism, Genetic/*genetics","Lima, L. M.;Carvalho, M.;Ferreira, C. N.;Fernandes, A. P.;Neto, C. P.;Garcia, J. C.;Reis, H. J.;Janka, Z.;Palotas, A.;Sousa, M.",2010,Sep,,0,
2617,"C-reactive protein, APOE genotype and longitudinal cognitive change in an older population","Background: circulating measures of inflammatory markers, such as C-reactive protein (CRP) have been associated with an increased risk of future cognitive decline. However, the nature of the relationship among the very old (>75 years) is unclear. Cross-sectional evidence suggests that elevated CRP may even be protective in this age group. This study examines these associations longitudinally. Methods: logistic regression was used to investigate the association between CRP and drop in cognitive performance (≥3 point change on the Mini-Mental State Examination) over a 4-year period in a population of 266 people, mean age 77 years. Results: increased levels of CRP were associated with a decreased risk of a drop in cognitive performance; however, this association was only seen in those without an APOE e4 allele [odds ratio of decline per unit increase in ln(CRP) 0.57, P = 0.04]. The magnitude of the finding remained consistent after adjustment for cardiovascular confounders (smoking, drinking, MI, stroke, diabetes, education, medication and blood pressure). For those with an e4 allele, the relationship with longitudinal cognitive decline was neither statistically significant nor in a consistent direction after controlling for acute inflammation. Conclusions: This study strengthens previous cross-sectional findings and shows elevated levels of CRP to be linked to a decreased risk of longitudinal cognitive decline in the very old. However, as with prior analyses, this was only observed in those not carrying an APOE e4 allele. Future work on larger APOE e4 allele carrying samples is required to determine the nature of the association in this population. © The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.",apolipoprotein E4;C reactive protein;aged;alcohol consumption;allele;article;cerebrovascular accident;cognitive defect;dementia;diabetes mellitus;educational status;female;genotype;heart infarction;human;hypertension;logistic regression analysis;longitudinal study;major clinical study;male;population research;priority journal;prospective study;protein blood level;smoking,"Lima, T. A. S.;Adler, A. L.;Minett, T.;Matthews, F. E.;Brayne, C.;Marioni, R. E.",2014,,,0,
2618,Prediction of vascular risk after stroke - protocol and pilot data of the prospective Cohort with incident stroke (PROSCIS),"Rationale: Long-term risk of vascular disease is substantially increased after stroke with several models proposed to predict subsequent stroke and other vascular events after an index event. However, recent validation studies demonstrate limited predictive properties of available prognostic models. Aims: We aim to determine prediction models of different complexity for the combined vascular end-point of stroke, myocardial infarction, and vascular death at three-years after first-ever stroke. An independent external validation of the developed models will be performed. Design: Prospective observational hospital-based cohort study of patients after first-ever stroke. Methods: The new predictive models will be developed using the following steps: (1) Development of a basic score based on clinical history data (e.g. hypertension, myocardial infarction, and atrial fibrillation); (2) Development of an advanced score including additional factors such as blood-based biomarkers and results of vascular imaging; (3) Comparing the models fit using different methods (discrimination, calibration); (4) Assessment of clinical utility of an advanced score using methods based on reclassification tables (e.g. net reclassification improvement, integrated discrimination improvement, decision curve analysis); and (5) Investigation of external validity. Outcomes: Primary outcome is a combined vascular end-point composed of stroke, myocardial infarction, and vascular death at three-years after stroke. Furthermore, each component of the composite end-point will be investigated individually and the patterns and time points of risk transitions between vascular end-points and stroke sub-types will be determined. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.",NCT01364168;biological marker;adult;aged;article;cardiovascular risk;cerebrovascular accident;diagnostic imaging;diagnostic test;external validity;female;heart infarction;human;major clinical study;male;neurologic examination;outcome assessment;priority journal;psychologic assessment;scoring system;vascular death;vascular disease,"Liman, T. G.;Zietemann, V.;Wiedmann, S.;Jungehuelsing, G. J.;Endres, M.;Wollenweber, F. A.;Wellwood, I.;Dichgans, M.;Heuschmann, P. U.",2013,,,0,
2619,Atypical presentations of older adults at the emergency department and associated factors,"Objectives: The objectives were to determine the prevalence of atypical presentations among older adults at the Emergency Department (ED) of a tertiary care hospital and to identify factors associated with these presentations. Material and methods: A retrospective medical record audit was randomly reviewed in 633 patients who were aged ≥65 years who attended the ED of Srinagarind Medical School Hospital in 2013. Demographic data were collected and were analyzed using descriptive statistics. Regression analysis was used to analyze the variables associated with the outcomes. Results: The prevalence of an atypical presentation was 28.6% (181/633 cases). The failure to develop fever with a disease known to cause fever was the most common atypical presentation of illness (34.42%). Independent factors associated with atypical presentations were complicated urinary tract infection (UTI) (odds ratios (OR) 4.66, 95% confidence interval (CI) 2.0, 10.84, p=. 0.00) and a background of dementia (OR 3.48, 95% CI 1.38, 8.77, p=. 0.008). Conclusions: The prevalence of atypical presentations of older adults at the ED was about a third. The absence of fever with a disease known to cause fever was the most common atypical presentation. Complicated UTI and demented patients were the independent risk factors associated with the atypical presentations. Early awareness of non-specific presentations and applying comprehensive geriatric assessments among older patients at the ED is recommended.",acute abdomen;acute diarrhea;age;aged;article;bacterial endocarditis;bronchitis;consciousness disorder;controlled study;dementia;demography;disease association;emergency care;emergency ward;falling;fatigue;feeding disorder;female;fever;food poisoning;geriatric assessment;heart muscle ischemia;human;lung abscess;major clinical study;male;medical record;multivariate analysis;obstructive uropathy;pain;pneumonia;prevalence;priority journal;pulse rate;regression analysis;retrospective study;risk factor;septic shock;skin infection;soft tissue infection;soft tissue injury;statistics;symptomatology;tertiary care center;tuberculosis;univariate analysis;urinary tract infection;vertigo,"Limpawattana, P.;Phungoen, P.;Mitsungnern, T.;Laosuangkoon, W.;Tansangworn, N.",2016,,,0,
2620,Repeat Hospitalizations Predict Mortality in Patients With Heart Failure,"INTRODUCTION: Heart failure (HF) affects more than 5.1 million Americans and is projected to increase. Understanding the relationship between hospitalization and mortality can help to guide clinical management. The aim of the study is to evaluate the impact of repeat HF hospitalizations on all-cause mortality and to determine risk variables related to patient mortality. MATERIALS AND METHODS: Using administrative data from the Military Health System, a cohort of patients with an index admission for HF between 2007 and 2011 was identified. HF hospitalizations were defined as any hospital claim with an International Classification of Diseases, Ninth Revision diagnosis of 428.xx in the primary diagnosis field over the 7-year study period (2007-2013). Patients were subsequently categorized based on total number of HF hospitalizations. A multivariate Cox regression model, adjusting for age, sex, and comorbidities, was used to estimate hazard ratios. Kaplan-Meier survival curves were constructed based on the frequency of HF hospitalizations. RESULTS: Of the 51,286 patients admitted for HF, 54.7% were male with a mean (SD) age of 76.3 (10.8) years, and 29,714 died during 135,211 person-years of follow-up. Mean survival time was 2.6, 1.8, 1.5, and 1.3 years after the first, second, third, and fourth hospitalization, respectively. The mortality rate of patients at 30 days and 1 year postindex HF hospitalization was 7.4% and 27.3%, respectively. A history of dementia and chronic kidney disease without dialysis decreased overall survival. CONCLUSIONS: Repeat HF hospitalizations remain a strong predictor of mortality for existing patients with HF. As a result, clinicians and patients can individualize the optimal treatment strategy and resources on the basis of the suspected prognosis.",,"Lin, A. H.;Chin, J. C.;Sicignano, N. M.;Evans, A. M.",2017,Sep,,0,
2621,Comparison of Comorbid Medical Conditions in the National Cancer Database and the SEER–Medicare Database,"Background: Physicians routinely factor comorbidities into diagnostic and treatment decisions. Analyses of treatment patterns and outcomes using the National Cancer Data Base (NCDB) usually adjust for comorbidities; however, the completeness of comorbidity ascertainment in the NCDB has never been assessed. We compared the prevalence of comorbidities captured in the NCDB and Surveillance, Epidemiology, and End Results (SEER)–Medicare among female breast, non-small-cell lung, and colorectal cancer patients aged ≥66. Methods: In the NCDB, ten fields were searched for comorbidities. In the SEER–Medicare dataset, Medicare claims were used to identify comorbidities for two time periods: 12 months prior to diagnosis (Prior) and Index claim alone. Chi-square tests were used to compare comorbidity prevalence using propensity score-matched subsamples from each dataset. Kaplan–Meier survival analyses by Charlson–Deyo comorbidity score and data source were conducted. Results: Comorbidity prevalence in NCDB did not differ significantly from that identified in SEER–Medicare Index claims across all three cancer sites, except for congestive heart failure, chronic pulmonary disease, and renal disease. However, when compared to the prevalence identified through SEER–Medicare Prior claims, comorbidity prevalence in the NCDB was lower. Overall survival rates by NCDB comorbidity scores were nearly identical to those based on SEER–Medicare Index claims but were lower than those based on SEER–Medicare Prior claims, particularly in higher comorbidity score categories. Conclusions: The study found overall similarity of comorbidity prevalence between NCDB and SEER–Medicare Index claims, but much less similarity between NCDB and SEER–Medicare Prior claims. Future researchers should understand the limitation of comorbidities ascertained in the NCDB and interpret results accordingly.",acquired immune deficiency syndrome;aged;article;breast cancer;cancer patient;cancer prognosis;cancer registry;cancer surgery;cancer survival;cerebrovascular disease;charlson deyo comorbidity score;chronic lung disease;colorectal cancer;comorbidity;comorbidity assessment;congestive heart failure;controlled study;dementia;diabetes mellitus;factual database;female;heart infarction;hemiplegia;human;kidney disease;major clinical study;male;medicare;mild hepatic impairment;moderate hepatic impairment;national cancer database;non small cell lung cancer;overall survival;paraplegia;peptic ulcer;peripheral vascular disease;prevalence;propensity score;rheumatic disease;severe hepatic impairment;survival rate;survival time;very elderly,"Lin, C. C.;Virgo, K. S.;Robbins, A. S.;Jemal, A.;Ward, E. M.",2016,,10.1245/s10434-016-5508-5,0,
2622,"Age, dementia and care patterns after admission for acute coronary syndrome: an analysis from a nationwide cohort under the National Health Insurance coverage","BACKGROUND: The number of elderly and the prevalence of dementia have grown considerably in recent years. Little is known about how aging and dementia affect care patterns after discharge for acute coronary syndrome (ACS). OBJECTIVE: This study was designed to assess the impact of dementia on care patterns after admission for patients with ACS across different age groups. METHODS: Of 87,321 patients hospitalized for ACS between 1 January 2006 and 31 December 2007, 1,835 patients with dementia and 3,670 matched patients without dementia (1:2 ratio, matched by age, sex and hospital level) were identified from Taiwan's National Health Insurance Research Database. Use of interventional therapies at hospitalization and guideline-recommended medications post-discharge were compared between patients with and without dementia across different age groups (</=65, 66-75, 76-85, >/=86 years). Multivariate logistic regression models were performed to examine the impact of dementia on care patterns. RESULTS: Overall, dementia was associated with a 27% lower likelihood of receipt of interventional therapies [adjusted odds ratio (OR) = 0.73; 95% CI 0.63, 0.83] and a 22% lower likelihood of guideline-recommended medications (adjusted OR = 0.78; 95% CI 0.68, 0.89) in ACS patients. The use of interventional therapies and guideline-recommended medications decreased with age, and interactions between age and dementia were found. The proportions of patients receiving interventional therapies were 39.4% (without dementia) versus 21.8% (with dementia) in the youngest age group and 18.6% (without dementia) versus 14.5% (with dementia) in the oldest age group. Patients with dementia (age </=65 years 73.6%; age 66-75 years 82.3%; age 76-85 years 71.8%; age >/=86 years 55.6%) were less likely to receive guideline-recommended medications as compared with those without dementia (age </=65 years 85.6%; age 66-75 years 87.5%; age 76-85 years 81.2%; age >/=86 years 62.0%). CONCLUSION: Dementia and aging were associated with decreased use of interventional therapies and guideline-recommended medications in ACS patients.","Acute Coronary Syndrome/*complications/*therapy;Age Factors;Aged;Aged, 80 and over;Cohort Studies;Dementia/*complications;Female;Humans;Male;Middle Aged;*National Health Programs;*Patient Admission;Patient Care/economics/*statistics & numerical data;Taiwan","Lin, C. F.;Wu, F. L.;Lin, S. W.;Bai, C. H.;Chan, D. C.;Gau, C. S.;Hsiao, F. Y.;Shen, L. J.",2012,Oct,10.1007/s40266-012-0011-6,0,
2623,"Oral treatment with herbal formula B307 alleviates cardiac failure in aging R6/2 mice with Huntington's disease via suppressing oxidative stress, inflammation, and apoptosis","Cardiac failure is often observed in aging patients with Huntington's disease (HD). However, conventional pharmacological treatments for cardiac failure in HD patients have rarely been studied. Chinese herbal medicines, especially combined herbal formulas, have been widely used to treat cardiac dysfunctions over the centuries. Thus, we assess whether oral treatment with herbal formula B307 can alleviate cardiac failure in transgenic mice with HD. After oral B307 or vehicle treatment for 2 weeks, cardiac function and cardiomyocytes in 12-week-old male R6/2 HD mice and their wild-type littermate controls (WT) were examined and then compared via echocardiography, immunohistochemistry, and Western blotting. We found that cardiac performance in aging R6/2 HD mice had significantly deteriorated in comparison with their WT (P<0.01). Cardiac expressions of superoxide dismutase 2 (SOD2) and B-cell lymphoma 2 (Bcl-2) in aging R6/2 HD mice were significantly lower than their WT (P<0.01), but cardiac expressions of tumor necrosis factor alpha (TNF-alpha), neurotrophin-3 (3-NT), 4-hydroxynonenal (4-HNE), Bcl-2-associated X protein (Bax), calpain, caspase 12, caspase 9, and caspase 3 of aging R6/2 HD mice were significantly higher than their WT (P<0.05). Furthermore, we found that cardiac performance in aging R6/2 HD mice had significantly improved under oral B307 treatment (P<0.05). Cardiac expressions of SOD2 and Bcl-2 of aging R6/2 HD mice were significantly higher under oral B307 treatment (P<0.01), but cardiac expressions of TNF-alpha, 3-NT, 4-HNE, Bax, calpain, caspase 12, caspase 9, and caspase 3 of aging R6/2 HD mice were significantly reduced under oral B307 treatment (P<0.05). Oral B307 treatment may briefly alleviate cardiac failure in aging HD R6/2 mice via suppressing cardiac oxidative stress, inflammation, and apoptosis. We suggested that the herbal formula B307 may be further developed as a potential health supplement for ameliorating cardiac failure associated with aging.","Administration, Oral;Aging/*physiology;Animals;Apoptosis/drug effects;Cell Line, Tumor;Disease Models, Animal;Drugs, Chinese Herbal/*pharmacology;Heart Failure/*etiology/physiopathology/*prevention & control;Huntington Disease/*complications;Inflammation/drug therapy/physiopathology;Inflammation Mediators/metabolism;Male;Mice;Mice, Transgenic;Oxidative Stress/drug effects;Chinese herbal medicines;aging;cardiomyocytes;echocardiography;transgenic mouse model","Lin, C. L.;Wang, S. E.;Hsu, C. H.;Sheu, S. J.;Wu, C. H.",2015,,10.2147/cia.s86493,0,
2624,Comparison of comorbid conditions between open-angle glaucoma patients and a control cohort: A case-control study,"Objective: To determine the prevalence of selected comorbidities in patients with open-angle glaucoma (OAG) and whether these comorbidities are more prevalent among individuals with OAG than those without OAG. Design: A retrospective, nationwide, case-control study using an administrative database. Participants: The study group comprised 76 673 OAG patients. The comparison group comprised 230 019 subjects matched to the study cohort. Methods: Data were collected retrospectively from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of OAG (International Classification of Diseases, 9th Revision, Clinical Modification codes 365.1365.11) in 2005 (n = 76 673). The comparison cohort comprised randomly selected patients (3 for every 1 OAG patient; n = 230 019) matched with the study group in terms of age, gender, urbanization level, and monthly income. In total, 31 medical comorbidities were selected based mainly on the Elixhauser Comorbidity Index. Separate conditional logistic regression analyses were used to estimate the adjusted odds ratio for each of the medical comorbidities between patients with and without OAG. Main Outcome Measures: The prevalences of selected comorbidities. Results: More than half (50.5%) of the OAG patients had hypertension, and more than 30% had hyperlipidemia or diabetes (30.5% and 30.2%, respectively). The prevalences of 28 of 31 comorbidities were significantly higher for OAG patients than subjects without glaucoma after adjusting for age, gender, urbanization level, and monthly income. The adjusted odds ratio was more than 1.50 for hypertension, hyperlipidemia, systemic lupus erythematosus, diabetes, hypothyroidism, fluid and electrolyte disorders, depression, and psychosis. Among the studied comorbidities, the prevalence difference of the OAG group minus the control group was 3% or higher for hypertension, hyperlipidemia, stroke, diabetes, liver disease, and peptic ulcer. Conclusions: Open-angle glaucoma patients are significantly more likely to have comorbidities, many of which can be life threatening or can affect the quality of life appreciably. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2010 American Academy of Ophthalmology.",adult;aged;anemia;article;asthma;case control study;chronic obstructive lung disease;clinical assessment;comorbidity;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;electrolyte disturbance;epilepsy;female;headache;heart arrhythmia;hepatitis B;human;hyperlipidemia;hypertension;hypothyroidism;income;ischemic heart disease;kidney failure;liver disease;logistic regression analysis;lung disease;major clinical study;male;metastasis;migraine;open angle glaucoma;paralysis;peptic ulcer;peripheral vascular disease;priority journal;psychosis;quality of life;retrospective study;rheumatoid arthritis;solid tumor;cerebrovascular accident;systemic lupus erythematosus;Taiwan;tuberculosis;urbanization,"Lin, H. C.;Chien, C. W.;Hu, C. C.;Ho, J. D.",2010,,,0,
2625,Does clinical inertia vary by personalized a1c goal? a study of predictors and prevalence of clinical inertia in a U.S. managed-care setting,"Objective: Clinical inertia is defined as failure to initiate or intensify therapy despite an inadequate treatment response. We assessed the prevalence and identified the predictors of clinical inertia among patients with type 2 diabetes (T2DM) based on personalized goals. Methods: Three hemoglobin A 1c (A1C) targets (American Diabetes Association A1C <7.0%; modified Ismail-Beigi et al; and Healthcare Effectiveness Data and Information Set) were used when identifying adult patients with T2DM who experienced above-target A1C values during the index period (July 1, 2008 to June 30, 2012) in a U.S. managed-care claims database (IMPACT™). Clinical inertia was defined as no intensification of treatment during the response period. Demographic and clinical characteristics were analyzed to identify predictors of treatment intensification. Results: Irrespective of A1C target, the majority of patients with T2DM (70.4 to 72.8%) experienced clinical inertia in the 6 months following the index event, with 5.3 to 6.2% of patients intensifying treatment with insulin. Patients with a lower likelihood of intensification were older, used >1 oral antidiabetes drug during the baseline period, and had an above-target A1C more recently. Treatment intensification was associated with patients who had point-of-service insurance, mental illness, an endocrinologist visit in the baseline period, or higher index A1C. Conclusion: The prevalence of clinical inertia among patients with T2DM in a U.S. managed-care setting is high and has increased over more recent years. Factors predicting increased risk of clinical inertia may help identify ""at-risk"" populations and assist in developing strategies to improve their management.",beta adrenergic receptor blocking agent;hemoglobin A1c;statin (protein);adult;aged;article;dementia;heart failure;heart infarction;human;mental disease;middle aged;neuropathy;non insulin dependent diabetes mellitus;obesity;observational study;prevalence;retrospective study;risk factor;thoracic aorta aneurysm;vascular disease,"Lin, J.;Zhou, S.;Wei, W.;Pan, C.;Lingohr-Smith, M.;Levin, P.",2016,,10.4158/ep15868.or,0,
2626,Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer's disease and related disorders,"BACKGROUND: Individuals with Alzheimer's disease and related disorders (ADRD) have more frequent hospitalizations than individuals without ADRD, and some of these admissions may be preventable with proactive outpatient care. METHODS: This study was a cross-sectional analysis of Medicare claims data from 195,024 fee-for-service ADRD beneficiaries aged >/=65 years and an equal number of matched non-ADRD controls drawn from the 5% random sample of Medicare beneficiaries in 2007-2008. We analyzed the proportion of patients with potentially avoidable hospitalizations (PAHs, as defined by the Medicare Ambulatory Care Indicators for the Elderly) and used logistic regression to examine patient characteristics associated with PAHs. We used paired t tests to compare Medicare expenditures by ADRD status, stratified by whether there were PAHs related to a particular condition. RESULTS: Compared with matched non-ADRD subjects, Medicare beneficiaries with ADRD were significantly more likely to have PAHs for diabetes short-term complications (OR = 1.43; 95% CI 1.31-1.57), diabetes long-term complications (OR = 1.08; 95% CI = 1.02-1.14), and hypertension (OR = 1.22; 95% CI 1.08-1.38), but less likely to have PAHs for chronic obstructive pulmonary disease (COPD)/asthma (OR = 0.85; 95% CI 0.82-0.87) and heart failure (OR = 0.89; 95% CI 0.86-0.92). Risks of PAHs increased significantly with comorbidity burden. Among beneficiaries with a PAH, total Medicare expenditures were significantly higher for those subjects who also had ADRD. CONCLUSION: Medicare beneficiaries with ADRD were at a higher risk of PAHs for certain uncontrolled comorbidities and incurred higher Medicare expenditures compared with matched controls without dementia. ADRD appears to make the management of some comorbidities more difficult and expensive. Ideally, ADRD programs should involve care management targeting high-risk patients with multiple chronic conditions.","Alzheimer Disease/economics/*epidemiology;Asthma/economics/epidemiology;Comorbidity;Cross-Sectional Studies;Diabetes Complications/economics/epidemiology;Hospitalization/economics/*statistics & numerical data;Humans;Hypertension/economics/epidemiology;*Medicare/economics/statistics & numerical data;Pulmonary Disease, Chronic Obstructive/economics/epidemiology;United States/epidemiology","Lin, P. J.;Fillit, H. M.;Cohen, J. T.;Neumann, P. J.",2013,Jan,10.1016/j.jalz.2012.11.002,0,
2627,Hospitalizations for ambulatory care sensitive conditions and unplanned readmissions among Medicare beneficiaries with Alzheimer's disease,"INTRODUCTION: Medicare beneficiaries with Alzheimer's disease and related dementias (ADRDs) may have more potentially avoidable hospitalizations and readmissions than people without dementia. These hospitalizations may be indicative of access barriers, problems in continuity of care, inefficient resource use, and poor patient outcomes. METHODS: We examined national frequency and costs of ambulatory care sensitive condition hospitalizations and unplanned, all-cause, and condition-specific 30-day readmissions in >2.7 million fee-for-service ADRD patients using 2013 Medicare claims data. RESULTS: In 2013, 410,000 Medicare ADRD patients had ambulatory care sensitive condition hospitalizations or unplanned 30-day readmissions costing $4.7 billion. One in 10 ADRD patients were hospitalized for a potentially avoidable condition. Almost one in five hospitalized ADRD patients had an unplanned 30-day readmission. Readmission rates were highest among ADRD patients initially hospitalized for heart failure (22%) and chronic obstructive pulmonary disease (21%). DISCUSSION: Our findings may suggest potential deficiencies in ambulatory care and postdischarge care related to managing comorbidities among Medicare fee-for-service ADRD patients.",Alzheimer's disease;Ambulatory care sensitive conditions;Health care costs;Hospitalizations;Readmissions,"Lin, P. J.;Zhong, Y.;Fillit, H. M.;Cohen, J. T.;Neumann, P. J.",2017,Oct,,0,
2628,"Commentary on ""relation between prefracture characteristics and perioperative complications in the elderly adult patient with hip fracture""",,anemia;congestive heart failure;delirium;dementia;disease association;disease classification;fracture;functional status;geriatric care;geriatric patient;health care quality;hip fracture;hospitalization;human;morbidity;note;operation duration;outcome assessment;pain;palliative therapy;patient monitoring;patient satisfaction;peroperative complication;postoperative care;postoperative complication;prefracture;preoperative period;quality of life;risk assessment;surgical mortality;surgical risk;surgical technique;urinary tract malformation,"Lin, R. J.",2012,,,0,
2629,Clinical associations of delirium in hospitalized adult patients and the role of on admission presentation,"OBJECTIVE: To describe clinical associations of delirium in hospitalized patients and relationships to on admission presentation. DESIGN: Retrospective analysis of an administrative hospitalization database 1998-2007. SETTING: Acute care hospitalizations in the New York State (NYS). MEASUREMENTS: Four categories of diagnosis related group (DRG) hospitalizations were extracted from a NYS administrative database: pneumonia, congestive heart failure, urinary tract/kidney infection (UTI), and lower extremity orthopedic surgery (LEOS) DRGs. These hospitalizations were examined for clinical associations with delirium coding both on and after admission. RESULTS: Delirium was coded in 0.8% of the cohort, of which an on admission diagnosis was present in 59%. On admission delirium was strongly associated with dementia (adjusted odds ratio 0, 95%CI 5.8-6.3) and with adverse drug effects (ADEs) (adjusted odds ratio 4.6, 95%CI 4.3, 5.0). After admission delirium was even more highly associated with ADEs (adjusted odds ratio 22.2, 95%CI 20.7-23.7). The UTI DRG category had the greatest proportion of on admission delirium. However after admission delirium was more common in the LEOS DRG category. Over time, there was a greater increase in delirium proportions in the UTI DRG category, and an overall increase in coding for encephalopathy states (potential alternative delirium descriptors). CONCLUSION: ADEs play an important role in delirium regardless of whether or not it is present on admission. While the finding that most delirium hospitalizations presented on admission suggests that delirium impacts more as a clinical admitting determinant, in-hospital prevention strategies may still have benefit in targeted settings where after admission delirium is more frequent, such as patients with LEOS.","Age Factors;Aged;Aged, 80 and over;Cohort Studies;Delirium/diagnosis/*epidemiology;Drug-Related Side Effects and Adverse Reactions/complications;Female;Heart Failure/complications;Humans;Lower Extremity/surgery;Male;Multivariate Analysis;New York/epidemiology;Orthopedics/statistics & numerical data;Patient Admission/*statistics & numerical data;Retrospective Studies;Urologic Diseases/complications","Lin, R. Y.;Heacock, L. C.;Bhargave, G. A.;Fogel, J. F.",2010,Oct,10.1002/gps.2500,0,
2630,"Drug-induced, dementia-associated and non-dementia, non-drug delirium hospitalizations in the United States, 19982005: An analysis of the national inpatient sample","Background: The incidence and pattern of delirium recorded in a broad spectrum of American hospitalizations has not been well described. The National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project is an administrative database of hospitalizations in the US that affords an opportunity to examine for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes relating to delirium. Objective: To examine the prevalence of delirium diagnoses and associated clinical factors, including adverse drug effects, in a broad spectrum of hospitalizations in the US. Delirium was grouped into three categories: drug-induced delirium, dementia-associated delirium, and non-dementia, non-drug (NDND). Methods: Hospitalizations during the years 19982005 in the NIS databases were examined. These databases represent samples of hospitalizations that allow for national prevalence estimates. ICD-9 codes for drug-induced, dementiaassociated and NDND delirium were identified in the hospitalizations for each year. Delirium tremens was not considered in this classification, and paediatric and psychiatric admissions were excluded. Yearly prevalence for drug-induced, dementia-associated and NDND delirium were tabulated, and time trends were analysed with negative binomial regression. A hospitalization subset cohort with urinary tract/kidney infection, pneumonia, heart failure and lower extremity orthopaedic surgery diagnosis-related group categories was also analysed for clinical associations with the presence of the three categories of delirium using multinomial logistic regression. ICD-9 E codes (external causes of injury) constituting adverse drug effects were identified and considered as clinical predictors. Results: Delirium was recorded in 1 269 185 (0.54%) non-psychiatric adult hospitalizations during the study years. Whereas the overall prevalence of dementia-associated delirium and NDND delirium decreased over time, drug-induced delirium prevalence increased (p < 0.0001). As expected, the presence of dementia and adverse drug effects had the strongest associations with dementia-associated and drug-induced delirium, respectively, in the cohort hospitalizations. Drug-induced delirium and NDND delirium had the strongest associations with lower extremity orthopaedic surgery hospitalizations and urinary tract/kidney infection hospitalizations, respectively. Among the NDND co-morbid conditions, volume depletion and sodium imbalance had the strongest, albeit modest, associations with delirium. The association between decade of age and delirium was strongest for NDND delirium (adjusted odds ratio 1.53; 95% CI 1.52, 1.53), but age had significant associations with drug-induced and dementia-associated delirium as well. In the cohort, the most frequent adverse effects codes were for opioids and for benzodiazepines or other sedatives, which were noted in 21.3% and 15.2% of drug-induced delirium hospitalizations, respectively. Conclusions: Drug-induced delirium is being increasingly identified in hospitalized patients. Administrative hospitalization databases constitute a resource to explore factors and trends associated with delirium. The findings suggest that interventions focusing on adverse drug effects have the greatest potential for preventing delirium. © 2010 Adis Data Information BV. All rights reserved.",analgesic agent;benzodiazepine derivative;corticosteroid;opiate;psychotropic agent;sedative agent;aged;article;delirium;dementia;disease association;female;heart failure;hospitalization;human;International Classification of Diseases;kidney infection;major clinical study;male;pneumonia;prevalence;priority journal;United States;urinary tract infection,"Lin, R. Y.;Heacock, L. C.;Fogel, J. F.",2010,,,0,
2631,Disproportionate effects of dementia on hospital discharge disposition in common hospitalization categories,"BACKGROUND: The impact of dementia on hospitalization discharge dispositions (HDDs) in the United States has not been quantified, and dementia prevalence in various hospitalization categories has not been detailed in recent years. OBJECTIVE: To characterize hospitalizations prevalent with dementia, and to examine the relationship between dementia and HDDs. DESIGN: A retrospective cross-sectional study. SETTING: 2000 to 2012 National Inpatient Sample databases. PATIENTS: Hospitalizations in persons ≥65 years old assigned to 1 of 12 Diagnosis Related Groups (DRGs) with a high number of dementia patients. INTERVENTION: None. MEASUREMENTS: The databases were queried for 12 DRGs (versions 18/24). Predictor effects for dementia on HDD categories were modeled adjusting for other defined comorbidities/covariates using logistic regression. Adjusted predictor effects of dementia on HDD in the DRG groupings were determined. Dementia prevalence and trends were assessed. RESULTS: Increasing proportions of dementia were noted in 4 DRGs studied. Dementia was strongly associated with being discharged to a nonhome setting. The most marked dementia effects were noted in DRGs 174 (gastrointestinal hemorrhage), 88 (chronic obstructive pulmonary disease), 182 (esophagitis/gastroenteritis), 138 (cardiac arrhythmias), 127 (congestive heart failure), and 89 (simple pneumonia and pleurisy), where there was at least a 76% reduction in the adjusted odds ratio (0.18-0.24) for home discharge. In contrast, DRGs 14 (stroke), 79 (respiratory infections/ inflammations), and 320 (kidney/urinary infections) had a smaller reduction in dementia-associated adjusted odds ratio (0.41-0.46) for home discharge. DRGs 79 and 320 had the highest proportions of dementia (>10%). CONCLUSIONS: Dementia proportions in many hospitalization categories have increased. The variable effect of dementia on home discharge suggests that dementia has a differential influence on hospital discharge disposition depending on the DRG. These findings have implications for healthcare allocation and long-term care planning.",article;chronic obstructive lung disease;comorbidity;congestive heart failure;cross-sectional study;data base;dementia;diagnosis related group;disease association;esophagitis;gastroenteritis;gastrointestinal hemorrhage;heart arrhythmia;hospital discharge;hospital discharge disposition;hospitalization;human;kidney infection;pleurisy;pneumonia;prevalence;priority journal;respiratory tract infection;retrospective study;trend study;United States;urinary tract infection,"Lin, R. Y.;Scanlan, B. C.;Liao, W.;Nguyen, T. P. T.",2015,,,0,
2632,Association between antipsychotic use and risk of acute myocardial infarction: a nationwide case-crossover study,"BACKGROUND: Antipsychotic medications have been increasingly and more widely prescribed despite continued uncertainty about their association with the incidence of acute myocardial infarction (AMI). METHODS AND RESULTS: We investigated the risk of AMI associated with antipsychotic treatment in 56 910 patients with schizophrenia, mood disorders, or dementia first hospitalized or visiting an emergency room for AMI in 1999 to 2009. A case-crossover design was used to compare the distributions of antipsychotic exposure for the same patient across 1 to 30 and 91 to 120 days just before the AMI event. Adjustments were made for comedications and outpatient visits. The adjusted odds ratio of AMI risk was 2.52 (95% confidence interval, 2.37-2.68) for any antipsychotics, 2.32 (95% confidence interval, 2.17-2.47) for first-generation antipsychotics, and 2.74 (95% confidence interval, 2.49-3.02) for second-generation antipsychotics. The risk significantly increased (P<0.001) with elevations in dosage and in short-term use (</=30 days). Male patients, elderly patients, and patients with dementia were at significantly increased risk (all P<0.001). Physically healthier patients with no preexisting diabetes mellitus, hypertension, or dyslipidemia were at significantly greater risk (P<0.001), largely because they had been exposed to higher doses of antipsychotics (P<0.001). A study of the selected binding of antipsychotics to 14 neurotransmitter receptors revealed only dopamine type 3 receptor antagonism to be significantly associated with AMI risk (adjusted odds ratio, 2.59; 95% confidence interval, 2.43-2.75; P<0.0001). CONCLUSIONS: Antipsychotic use may be associated with a transient increase in risk for AMI, possibly mediated by dopamine type 3 receptor blockades. Further education on drug safety and research into the underlying biological mechanisms are needed.","Adolescent;Adult;Age Factors;Aged;Aged, 80 and over;Antipsychotic Agents/*adverse effects/*therapeutic use;Cross-Over Studies;Dose-Response Relationship, Drug;Female;Humans;Incidence;Male;Middle Aged;Myocardial Infarction/*epidemiology;Retrospective Studies;Risk Factors;Schizophrenia/*drug therapy/epidemiology;Sex Factors;Taiwan/epidemiology;Young Adult;antipsychotic agents;coronary disease;dementia;mood disorders;myocardial infarction;schizophrenia","Lin, S. T.;Chen, C. C.;Tsang, H. Y.;Lee, C. S.;Yang, P.;Cheng, K. D.;Li, D. J.;Wang, C. J.;Hsieh, Y. C.;Yang, W. C.",2014,Jul 15,10.1161/circulationaha.114.008779,0,
2633,Depression and the risk of vascular dementia: a population-based retrospective cohort study,"OBJECTIVE: To examine the association between the risks of depression and vascular dementia (VaD) based on Taiwan's National Health Insurance Research Database. METHODS: This retrospective longitudinal matched-cohort study used National Health Insurance Research Database data from 49,955 participants (9,991 with new onset depression, 39,964 controls). A Cox regression analysis was performed on the whole sample and the subgroup of patients with depression. We further excluded patients who developed VaD within 3 or 5 years after enrollment to evaluate depression as an independent risk factor for or a prodrome of VaD. RESULTS: During the 10-year follow-up period, the incidence rate ratio of VaD between patients with depression and controls was 4.24 [95% confidence interval (CI) 2.90-6.21, P < 0.001]. After adjustment for covariates, the hazard ratio (HR) of VaD in patients with depression was 3.10 (95% CI 2.13-4.52, P < 0.001). In the whole sample, risk factors for VaD besides depression were aged >/=60 years (HR = 20.08), hypertension (HR = 1.70), diabetes (HR = 1.61), coronary artery disease (HR = 2.26), head injury (HR = 2.20), and cerebrovascular disease (HR = 3.02). In patients with depression, aged >/=60 years (HR = 32.16), coronary artery disease (HR = 2.82), head injury (HR = 2.06), and cerebrovascular disease (HR = 2.37) remained risk factors for VaD. After excluding those who developed VaD within 3 or 5 years, HRs remained high (3.28, 95% CI 2.03-5.31, P < 0.001; 2.12, 95% CI 1.05-4.25, P = 0.035, respectively). CONCLUSIONS: Our findings suggest that depression is an independent risk factor for subsequent VaD. Older age, cerebrovascular disease, head injury, and coronary artery disease might increase the risk of VaD among patients with depression.",dementia;depression;epidemiology;risk factors;vascular disease,"Lin, W. C.;Hu, L. Y.;Tsai, S. J.;Yang, A. C.;Shen, C. C.",2016,May 9,10.1002/gps.4493,0,
2634,Depression and the risk of vascular dementia: a population-based retrospective cohort study,"Objective: To examine the association between the risks of depression and vascular dementia (VaD) based on Taiwan's National Health Insurance Research Database. Methods: This retrospective longitudinal matched-cohort study used National Health Insurance Research Database data from 49,955 participants (9,991 with new onset depression, 39,964 controls). A Cox regression analysis was performed on the whole sample and the subgroup of patients with depression. We further excluded patients who developed VaD within 3 or 5 years after enrollment to evaluate depression as an independent risk factor for or a prodrome of VaD. Results: During the 10-year follow-up period, the incidence rate ratio of VaD between patients with depression and controls was 4.24 [95% confidence interval (CI) 2.90–6.21, P < 0.001]. After adjustment for covariates, the hazard ratio (HR) of VaD in patients with depression was 3.10 (95% CI 2.13–4.52, P < 0.001). In the whole sample, risk factors for VaD besides depression were aged ≥60 years (HR = 20.08), hypertension (HR = 1.70), diabetes (HR = 1.61), coronary artery disease (HR = 2.26), head injury (HR = 2.20), and cerebrovascular disease (HR = 3.02). In patients with depression, aged ≥60 years (HR = 32.16), coronary artery disease (HR = 2.82), head injury (HR = 2.06), and cerebrovascular disease (HR = 2.37) remained risk factors for VaD. After excluding those who developed VaD within 3 or 5 years, HRs remained high (3.28, 95% CI 2.03–5.31, P < 0.001; 2.12, 95% CI 1.05–4.25, P = 0.035, respectively). Conclusions: Our findings suggest that depression is an independent risk factor for subsequent VaD. Older age, cerebrovascular disease, head injury, and coronary artery disease might increase the risk of VaD among patients with depression.",adult;age;aged;article;cerebrovascular disease;cohort analysis;comorbidity;controlled study;coronary artery disease;data base;depression;diabetes mellitus;disease association;female;follow up;hazard ratio;head injury;human;hypertension;incidence;insurance;longitudinal study;major clinical study;male;multiinfarct dementia;population research;retrospective study;risk assessment;risk factor;Taiwan,"Lin, W. C.;Hu, L. Y.;Tsai, S. J.;Yang, A. C.;Shen, C. C.",2017,,10.1002/gps.4493,0,2633
2635,Newly diagnosed gastroesophageal reflux disease increased the risk of acute exacerbation of chronic obstructive pulmonary disease during the first year following diagnosis--a nationwide population-based cohort study,"BACKGROUND: While prior studies have demonstrated that chronic obstructive pulmonary disease (COPD) is associated with gastroesophageal reflux disease (GERD), and that GERD is associated with acute exacerbations of COPD (AECOPD), no study to date has been able to establish temporality in this relationship. The purpose of this cohort study was to explore the impact of a new diagnosis of GERD on the risk of subsequent AECOPD. METHODS: We used a retrospective population-based cohort design to analyse the data of 1976 COPD subjects with GERD as an exposure cohort and 3936 COPD subjects without GERD as a comparison group. We individually tracked each subject in this study for 12 months and identified those subjects who experienced an episode of AECOPD. Hazard ratios (HR) were calculated using Cox proportional hazards regression analysis. RESULTS: The incidence of AECOPD was 4.08 and 2.79 per 100 person-year in individuals with and without GERD, respectively (p = 0.012). Following adjustment for sex, age, ischaemic heart disease, heart failure, atrial fibrillation, hypertension, osteoporosis, anxiety, diabetes mellitus, angina, stroke, anaemia, dementia, occupational category, monthly insurance premium, number of OPD visits and COPD severity. The stepwise Cox regression analysis revealed that GERD was independently associated with an increased risk of AECOPD (HR = 1.48, 95% CI = 1.10-1.99). CONCLUSION: This study demonstrated that GERD is an independent risk factor for AECOPD. Caution should be exercised when assessing GERD symptoms in patients with COPD.",,"Lin, Y. H.;Tsai, C. L.;Chien, L. N.;Chiou, H. Y.;Jeng, C.",2015,Mar,10.1111/ijcp.12501,0,
2636,"Secondary cancers, comorbidities and mortality associated with nitrogen mustard therapy in patients with mycosis fungoides: A 30-year population-based cohort study","Background Topical nitrogen mustard is a widely used therapy in patients with mycosis fungoides (MF). However, it remains controversial whether nitrogen mustard therapy is associated with increased risk of secondary cancers and chronic pulmonary diseases in patients with MF. Objectives To assess the risk of secondary cancers, comorbidities, mortality and cause-specific mortality in patients with MF treated with nitrogen mustard compared with patients not receiving this treatment. Methods Linking the Danish nationwide registries in a 30-year population-based cohort study, we compared 110 patients with MF from a regional Danish centre using nitrogen mustard treatment with 193 patients from Danish centres not using nitrogen mustard. The two cohorts were compared by Cox regression analysis. Results Overall, secondary cancers were not significantly increased [hazard ratio (HR) 0·84, 95% confidence interval (CI) 0·46-1·56], and subanalyses showed no significantly increased risk of nonmelanoma skin cancers, malignant melanomas or cancers in the respiratory organs in the nitrogen mustard-treated cohort. Furthermore, we found no significantly increased risk of any category of comorbidity, including chronic pulmonary diseases, in patients treated with nitrogen mustard (HR 0·93, 95% CI 0·48-1·81). Moreover, mortality and cause-specific mortality did not significantly differ between the two cohorts. Conclusions This study does not support any previous suspicion of increased risk of secondary cancers and chronic pulmonary diseases among patients with MF treated with nitrogen mustard. Furthermore, mortality and cause-specific mortality were not influenced by nitrogen mustard treatment. Thus our findings indicate that topical nitrogen mustard is a safe therapy in patients with MF. What's already known about this topic? Nitrogen mustard therapy is widely used in patients with mycosis fungoides (MF). It remains controversial whether nitrogen mustard therapy is associated with secondary cancers and chronic pulmonary diseases in MF. What does this study add? Nitrogen mustard therapy is not associated with increased risk of secondary cancers and comorbidities in MF. Nitrogen mustard therapy does not influence mortality and causes of death in MF. Nitrogen mustard is a safe therapy in patients with MF. © 2013 British Association of Dermatologists.",chlormethine;acquired immune deficiency syndrome;adolescent;adult;aged;article;attributable risk;basal cell carcinoma;cancer mortality;cancer risk;cancer therapy;cause of death;cerebrovascular disease;Charlson Comorbidity Index;child;chronic lung disease;cohort analysis;colorectal cancer;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;female;follow up;heart infarction;hemiplegia;human;kidney disease;liver disease;maintenance therapy;major clinical study;male;medical record review;melanoma;metastasis;middle aged;mycosis fungoides;peptic ulcer;peripheral vascular disease;preschool child;priority journal;school child;squamous cell carcinoma;very elderly;young adult,"Lindahl, L. M.;Fenger-Grøn, M.;Iversen, L.",2014,,,0,
2637,"Potential drug-disease interactions in frail, hospitalized elderly veterans","BACKGROUND: Drugs can improve quality of life for many older people, but they may cause adverse health outcomes (eg, drug-disease interactions) if used inappropriately. OBJECTIVE: To determine the prevalence of potential drug-disease interactions as defined by explicit criteria and examine associations between sociodemographic and health status variables and potential drug-disease interactions. METHODS: The study design was cross-sectional. We evaluated 397 frail elderly inpatients from the Geriatric Evaluation and Management trial conducted at 11 Veterans Affairs Medical Centers. Drug-disease interactions were defined using explicit criteria from consensus expert panels of geriatricians from the US and Canada. RESULTS: Overall, 159 (40.1%) patients had one or more potential drug-disease interaction. The most common potential interactions were calcium-channel blockers and heart failure (12.3%) and β-blockers and diabetes (6.8%). Multivariable logistic regression analyses revealed that age ≥75 years (adjusted OR 2.43; 95% Cl 1.52 to 3.88), being married (adjusted OR 1.77; 95% Cl 1.11 to 2.82), comorbidity index defined by Charlson method (adjusted OR 1.19; 95% Cl 1.05 to 1.34), and use of multiple prescription drugs (5-8: adjusted OR 4.17; 95% Cl 1.96 to 8.88, ≥9: adjusted OR 9.22; 95% Cl 4.26 to 19.95), were significantly (p < 0.05) associated with having one or more potential drug-disease interaction. CONCLUSIONS: Potential drug-disease interactions are common in hospitalized elderly patients and are related to specific sociodemographic and health status factors. Further research is needed to examine the relationship between health outcomes and drug-disease interactions.",acetylsalicylic acid;amphetamine derivative;antihistaminic agent;benzodiazepine derivative;beta adrenergic receptor blocking agent;beta adrenergic receptor stimulating agent;calcium channel blocking agent;chlorpromazine;cholinergic receptor blocking agent;clozapine;corticosteroid;cyclooxygenase 2 inhibitor;decongestive agent;desipramine;disopyramide;hypnotic sedative agent;methylphenidate;metoclopramide;monoamine oxidase inhibitor;muscle relaxant agent;nonsteroid antiinflammatory agent;opiate;potassium;serotonin uptake inhibitor;spasmolytic agent;theophylline;thiazide diuretic agent;thioridazine;tricyclic antidepressant agent;unindexed drug;age;aged;article;asthma;chronic kidney failure;chronic obstructive lung disease;comorbidity;constipation;dementia;demography;diabetes mellitus;disease exacerbation;elderly care;falling;female;glaucoma;gout;health status;heart arrhythmia;heart block;heart failure;hospitalization;human;hypertension;insomnia;major clinical study;male;marriage;peptic ulcer;peripheral vascular disease;polypharmacy;prescription;prevalence;priority journal;prostate hypertrophy;quality of life;Raynaud phenomenon;risk assessment;risk factor;seizure;side effect;faintness;urine incontinence,"Lindblad, C. I.;Artz, M. B.;Pieper, C. F.;Sloane, R. J.;Hajjar, E. R.;Ruby, C. M.;Schmader, K. E.;Hanlon, J. T.",2005,,,0,
2638,Clinically important drug-disease interactions and their prevalence in older adults,"Background: Older adults may have decreased homeostatic reserve, have multiple chronic diseases, and take multiple medications. Therefore, they are at risk for adverse outcomes after receiving a drug that exacerbates a chronic disease. Objectives: The aims of this study were to compile a list of clinically important drug-disease interactions in older adults, obtain the consensus of a multidisciplinary panel of geriatric health care professionals on these interactions, and determine the prevalence of these interactions in a sample of outpatients. Methods: This analysis included a 2-round modified Delphi survey and cross-sectional study. Possible drug-disease interactions in patients aged ≥65 years were identified through a search of the English-language literature indexed on MEDLINE and International Pharmaceutical Abstracts (1966-July 2004) using terms that included drug-disease interaction, medication errors, and inappropriate prescribing. Nine health care professionals with expertise in geriatrics (2 geriatricians, 7 geriatric clinical pharmacist specialists) were selected based on specialty training and continuing clinical work in geriatrics, academic appointments, and geographic location. The panel rated the importance of the potential drug-disease interactions using a 5-point Likert scale (from 1 = definitely not serious to 5 = definitely serious). Consensus on a drug-disease interaction was defined as a lower bound of the 95% CI ≥4.0. The prevalence of drug-disease interactions was determined by applying the consensus criteria to a convenience sample of frail older veterans at hospital discharge who were enrolled in a health services intervention trial. Results: The panel reached consensus on 28 individual drug-disease interactions involving 14 diseases or conditions. Overall, 205 (15.3%) of the 1340 veterans in the sample had >_1 drug-disease interaction. The 2 most common drug-disease interactions were use of first-generation calcium channel blockers in patients with congestive heart failure and use of aspirin in patients with peptic ulcer disease (both, 3.7%). Conclusions: A survey of multidisciplinary geriatric health care professionals resulted in a concise consensus list of clinically important drug-disease interactions in older adults. Further research is needed to examine the impact of these drug-disease interactions on health outcomes and their applicability as national measures for the prevention of drug-related problems. © 2006 Excerpta Medica, Inc.",acetylsalicylic acid;barbituric acid derivative;benzodiazepine derivative;bethanechol;calcium channel blocking agent;carbamazepine;central stimulant agent;cholinergic receptor blocking agent;corticosteroid;digoxin;diltiazem;disopyramide;hypnotic sedative agent;iron derivative;methylphenidate;muscle relaxant agent;nalidixic acid;nifedipine;nitrofurantoin;nonsteroid antiinflammatory agent;opiate derivative;phenytoin;procainamide;propranolol;pseudoephedrine;quinidine;tetracycline;tricyclic antidepressant agent;unindexed drug;verapamil;aged;aging;article;chronic disease;chronic kidney failure;chronic obstructive lung disease;congestive heart failure;constipation;dementia;depression;diabetes mellitus;disease exacerbation;falling;gout;health practitioner;health service;heart arrhythmia;heart block;hemostasis;hospital discharge;human;hypertension;outcome assessment;outpatient;peptic ulcer;prevalence;prostate hypertrophy;risk assessment;side effect,"Lindblad, C. I.;Hanlon, J. T.;Gross, C. R.;Sloane, R. J.;Pieper, C. F.;Hajjar, E. R.;Ruby, C. M.;Schmader, K. E.;Multidisciplinary Consensus, P.",2006,,,0,
2639,"Cerebral lesions on magnetic resonance imaging, heart disease, and vascular risk factors in subjects without stroke. A population-based study","BACKGROUND AND PURPOSE: To assess the prevalence of asymptomatic abnormalities on magnetic resonance imaging of the brain and their possible relation to hypertension, heart disease, and carotid artery disease, we studied 77 randomly selected subjects (mean age, 65.1 years; range, 36 to 95 years) with no history of focal brain lesions. METHODS: The study protocol included magnetic resonance imaging of the brain, transthoracic and transesophageal echocardiography, ultrasonography of the carotid arteries, and electrocardiographic recording. Deep and periventricular white matter hyperintensities on magnetic resonance imaging were assessed both separately and together. RESULTS: On magnetic resonance imaging of the brain 62.3% (95% confidence interval [CI], 51.5% to 73.2%) of the subjects had white matter hyperintensities. These abnormalities increased significantly with age (chi 2 test; P = .0001), from 13.6% (95% CI, 0% to 28.0%) of subjects aged younger than 55 years to 85.2% (95% CI, 71.8% to 98.6%) of subjects aged 75 years or older. Six subjects had deep gray matter hyperintensities localized in the basal ganglia, and one had a cerebellar infarction. Stepwise logistic regression analysis identified age and a history of heart disease (but not echocardiographic findings) to be independently associated with deep and periventricular white matter hyperintensities. Hypertension was only independently associated with periventricular white matter hyperintensities. Of the 68 subjects examined with both transthoracic and transesophageal echocardiography, potential cardioembolic sources were detected in 38.2% (95% CI, 26.7% to 49.8%) of the subjects with transthoracic echocardiography and in 47.1% (95% CI, 35.2% to 58.9%) of those with transthoracic and transesophageal echocardiography combined. In subjects aged 75 years or older, a possible cardiac embolic source was detected in 64.0% on transthoracic echocardiography and in 72.0% on transthoracic and transesophageal echocardiography combined, compared with 5.3% and 15.8%, respectively, in subjects aged younger than 55 years. CONCLUSIONS: White matter hyperintensities and potential cardioembolic sources are frequently present in asymptomatic individuals, stressing the need for age-matched control subjects in studies of patients with stroke or dementia.","Adult;Aged;Brain Diseases/*diagnosis/epidemiology/ultrasonography;Carotid Stenosis/diagnosis/etiology;Cerebrovascular Disorders/diagnosis/epidemiology/etiology/ultrasonography;Echocardiography, Transesophageal;Embolism/complications/diagnosis;Female;Heart Diseases/complications/*diagnosis/epidemiology/ultrasonography;Humans;Magnetic Resonance Imaging;Male;Middle Aged;Risk Factors","Lindgren, A.;Roijer, A.;Rudling, O.;Norrving, B.;Larsson, E. M.;Eskilsson, J.;Wallin, L.;Olsson, B.;Johansson, B. B.",1994,May,,0,
2640,Valsartan treatment of hypertension - Does VALUE add value?,,amlodipine;antihypertensive agent;atenolol;candesartan;diuretic agent;hydrochlorothiazide;losartan;placebo;valsartan;blood pressure;cardiovascular disease;cognitive defect;dementia;diabetes mellitus;heart infarction;heart left ventricle hypertrophy;human;hypertension;note;priority journal;cerebrovascular accident;treatment outcome,"Lindholm, L. H.",2004,,,0,
2641,Hypertension in the elderly,"The elderly are the most rapidly growing population group in the world. Data collected over a 30-year period have demonstrated the increasing prevalence of hypertension with age. The risk of coronary artery disease, stroke, congestive heart disease, chronic kidney insufficiency and dementia is also increased in this subgroup of hypertensives. Hypertension in the elderly patients represents a management dilemma to cardiovascular specialists and other practioners. During the last years and before the findings of the Systolic Hypertension in Europe Trial were published, the general medical opinion considered not to decrease blood pressure values similarly to other younger patients, in order to avoid possible ischemic events and poor oxygenation of the organs (brain, heart, kidney). The aim of this review article is to highlight the importance of treating hypertension in aged population in order to improve their quality of life and lower the incidence of the cardiovascular complications.",Elderly;Hypertension;Pathophysiology;Treatment,"Lionakis, N.;Mendrinos, D.;Sanidas, E.;Favatas, G.;Georgopoulou, M.",2012,May 26,10.4330/wjc.v4.i5.135,0,
2642,Treatment of atrial fibrillation in a district general hospital,"OBJECTIVE: To assess current strategies used to investigate and manage acute atrial fibrillation in hospital. DESIGN: Prospective survey of all acute admissions over 6 months. SETTING: District general hospital serving a population of 230,000 in north east Glasgow. SUBJECTS: 2686 patients admitted as emergency cases over 6 months. RESULTS: Of the 2686 patients, 170 (age range 38-95, mean (SD) 73.5 (10.6) years; 70 men (41%) and 100 women (59%)) were admitted with atrial fibrillation. The principal underlying medical conditions were ischaemic heart disease in 79 (46.5%), rheumatic heart disease in 26 (15.3%), and thyroid disease in six (3.5%). Cardiac failure was present on admission in 61 (36%), cerebrovascular events in 23 (14%), and myocardial infarction in 17 (10%). Of those with a history of atrial fibrillation (102 (60%) including 10 with paroxysmal atrial fibrillation) treatment on admission included digoxin in 71 (70%), warfarin in 20 (20%), and aspirin in 17 (17%); the aspirin was predominantly given for concomitant vascular disease. The mean (SD) inpatient stay was 16 days (19.7) (range 1-154) largely due to the patients with stroke. Thyroid function tests were performed in only 63% and echocardiography in 33%. Overall, the rate of introduction of anticoagulation (seven patients) and attempted cardioversion (21 patient: 19 pharmacological and two electrical) was surprisingly low. Only 49 patients (34% of those not on warfarin) had contraindications to anticoagulation: these included peptic ulcer or gastrointestinal bleeding in 18 (12%), dementia in eight (6%), chronic renal failure or dialysis in eight (6%), and alcohol excess in four (3%). CONCLUSION: Standard investigations were inadequately used in patients with atrial fibrillation and there was a reluctance to perform cardioversion or to start anticoagulant treatment.","Adult;Aged;Aged, 80 and over;Aspirin/therapeutic use;Atrial Fibrillation/drug therapy/*therapy/ultrasonography;Digoxin/therapeutic use;Echocardiography;Electric Countershock;Emergencies;Female;Hospitalization;Humans;Length of Stay;Male;*Medical Audit;Middle Aged;Scotland;Thyroid Function Tests;Warfarin/therapeutic use","Lip, G. Y.;Tean, K. N.;Dunn, F. G.",1994,Jan,,0,
2643,"More evidence on blocking the renin-angiotensin-aldosterone system in cardiovascular disease and the long-term treatment of hypertension: Data from recent clinical trials (CHARM, EUROPA, ValHEFT, HOPE-TOO and SYST-EUR2)",,alpha tocopherol;angiotensin receptor antagonist;antihypertensive agent;antilipemic agent;antithrombocytic agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;candesartan;dipeptidyl carboxypeptidase inhibitor;enalapril;hydrochlorothiazide;nitrendipine;perindopril;placebo;ramipril;spironolactone;valsartan;bleeding;neoplasm;cardiovascular disease;clinical trial;coronary artery disease;coughing;dementia;drug effect;drug hypersensitivity;drug withdrawal;follow up;gastrointestinal symptom;atrial fibrillation;heart failure;heart infarction;heart left ventricle ejection fraction;hospital admission;human;hyperkalemia;hypertension;hypotension;kidney dysfunction;long term care;morbidity;mortality;note;renin angiotensin aldosterone system;risk;secondary prevention;systolic hypertension;treatment outcome,"Lip, G. Y. H.;Beevers, D. G.",2003,,,0,
2644,The use of atypical antipsychotics in nursing homes,"Background: Use of atypical antipsychotics for ""off-label"" indications, such as behavioral and psychological symptoms of dementia, depression, and bipolar disorder, have been frequently reported, although not systematically studied. We describe the pattern of atypical antipsychotic use among nursing home residents and identify demographic and clinical correlates. Method: We conducted a cross-sectional study on 139,714 nursing home residents living in 1732 nursing homes in 5 U.S. states from Jan. 1, 1999, to Jan. 31, 2000. Data were obtained from the computerized Minimum Data Set (MDS) assessment records. Results: Behavior problems associated with cognitive impairment were manifest in 86,514 residents, and, of these, 18.2% received an antipsychotic. Approximately 11% received an atypical antipsychotic, while 6.8% received a conventional agent. Clinical correlates of atypical antipsychotic use were Parkinson's disease (adjusted odds ratio [OR] = 1.57, 95% confidence interval [CI] = 1.34 to 1.84), depression (OR = 1.35, 95% CI = 1.24 to 1.46), antidepressant use (OR = 1.38, 95% CI = 1.27 to 1.49), Alzheimer's disease (OR = 1.21, 95% CI = 1.12 to 1.32), non-Alzheimer dementia (OR = 1.15, 95% CI = 1.07 to 1.24), and cholinesterase inhibitor use (OR = 1.74, 95% CI = 1.52 to 1.98). Severe functional impairment was inversely related to atypical antipsychotic use (OR = 0.76, 95% CI = 0.65 to 0.89). Conclusion: Atypical antipsychotics are now used more than conventional antipsychotic agents in U.S. nursing homes. Indications and dosages seem appropriate relative to labeling. Clinical and demographic differences between atypical and conventional antipsychotic users tend to be relatively small, suggesting that other factors may explain the choice of prescribing physicians. The impact of facility factors, economic forces, and physician characteristics needs to be investigated.",antiarrhythmic agent;antidepressant agent;antihypertensive agent;antiparkinson agent;anxiolytic agent;atypical antipsychotic agent;chlorpromazine;chlorprothixene;cholinesterase inhibitor;clozapine;fluphenazine;haloperidol;hypnotic agent;loxapine;mesoridazine;molindone;neuroleptic agent;olanzapine;perphenazine;prochlorperazine;promazine;quetiapine;risperidone;thioridazine;tiotixene;triflupromazine;aged;Alzheimer disease;article;behavior disorder;cognitive defect;computer system;confidence interval;controlled study;correlation analysis;daily life activity;demography;depression;diabetes mellitus;disease association;disease severity;drug dose regimen;drug information;drug use;economic aspect;female;functional disease;good clinical practice;heart arrhythmia;heart failure;human;hypertension;major clinical study;male;medical record;mental disease;neurologic disease;nursing home;Parkinson disease;prescription;prevalence;priority journal;psychopharmacotherapy;residential care;treatment indication;United States,"Liperoti, R.;Mor, V.;Lapane, K. L.;Pedone, C.;Gambassi, G.;Bernabei, R.",2003,,,0,
2645,Antipsychotic drug interactions and mortality among nursing home residents with cognitive impairment,"Objective: Among elderly individuals with dementia, the use of antipsychotics has been associated with serious adverse events including ischemic stroke and death. Multiple medications can interact with antipsychotics and increase the risk of such adverse events. The purpose of this retrospective, longitudinal cohort study was to estimate the prevalence of potential antipsychotic drug interactions and their effect on increasing the risk of death among cognitively impaired elderly individuals treated with antipsychotics. Methods: We conducted a retrospective longitudinal cohort study in 59 nursing homes of 7 European Union countries and Israel. The study was conducted during the years 2009 to 2011. Participants were cognitively impaired individuals aged 65 years or older residing in the participating nursing homes and being treated with antipsychotics (N = 604). Risk of death associated with potential antipsychotic drug interactions was the main outcome. The inter-Resident Assessment Instrument for Long Term Care Facilities (interRAI LTCF) was used to assess participants. Follow-up time was 12 months. Results: The prevalence of potential antipsychotic drug interactions was 46.0%. Antipsychotic drug interactions were associated with higher mortality (incidence rate of 0.26 per person-year in the antipsychotic drug-interaction group versus 0.17 per person year in the no antipsychotic drug-interaction group). After adjusting for potential confounders, risk of death was higher in the group of residents with potential antipsychotic drug interactions relative to those unexposed to such interactions (hazard ratio = 1.71; 95% CI, 1.15-2.54). Conclusions: Part of the observed excess risk of death associated with the use of antipsychotic medications in elderly individuals with cognitive impairment may be attributable to antipsychotic drug interactions. Antipsychotics should be used with extreme caution especially among those individuals receiving concomitant cardiovascular or psychotropic medications.",benzodiazepine derivative;beta adrenergic receptor blocking agent;calcium antagonist;carbamazepine;chlorpromazine;cholinergic receptor blocking agent;citalopram;clozapine;dipeptidyl carboxypeptidase inhibitor;diuretic agent;escitalopram;haloperidol;melperone;narcotic analgesic agent;neuroleptic agent;olanzapine;paroxetine;quetiapine;risperidone;sertraline;thioridazine;tiapride;tricyclic antidepressant agent;aged;agranulocytosis;article;cognitive defect;cohort analysis;controlled study;depressed blood pressure;disease association;drug safety;European Union;falling;female;follow up;heart failure;human;incidence;ischemic heart disease;Israel;longitudinal study;major clinical study;male;mortality;nursing home patient;outcome assessment;prevalence;QT prolongation;retrospective study;risk factor;sedation;seizure;side effect,"Liperoti, R.;Sganga, F.;Landi, F.;Topinkova, E.;Denkinger, M. D.;Van Der Roest, H. G.;Foebel, A. D.;Finne-Soveri, H.;Bernabei, R.;Onder, G.",2017,,10.4088/JCP.15m10303,0,
2646,Risk factors for late-life cognitive decline and variation with age and sex in the Sydney Memory and Ageing Study,"INTRODUCTION: An aging population brings increasing burdens and costs to individuals and society arising from late-life cognitive decline, the causes of which are unclear. We aimed to identify factors predicting late-life cognitive decline. METHODS: Participants were 889 community-dwelling 70-90-year-olds from the Sydney Memory and Ageing Study with comprehensive neuropsychological assessments at baseline and a 2-year follow-up and initially without dementia. Cognitive decline was considered as incident mild cognitive impairment (MCI) or dementia, as well as decreases in attention/processing speed, executive function, memory, and global cognition. Associations with baseline demographic, lifestyle, health and medical factors were determined. RESULTS: All cognitive measures showed decline and 14% of participants developed incident MCI or dementia. Across all participants, risk factors for decline included older age and poorer smelling ability most prominently, but also more education, history of depression, being male, higher homocysteine, coronary artery disease, arthritis, low health status, and stroke. Protective factors included marriage, kidney disease, and antidepressant use. For some of these factors the association varied with age or differed between men and women. Additional risk and protective factors that were strictly age- and/or sex-dependent were also identified. We found salient population attributable risks (8.7-49.5%) for older age, being male or unmarried, poor smelling ability, coronary artery disease, arthritis, stroke, and high homocysteine. DISCUSSION: Preventing or treating conditions typically associated with aging might reduce population-wide late-life cognitive decline. Interventions tailored to particular age and sex groups may offer further benefits.","Age Distribution;Aged;Aged, 80 and over;Cognition;Epidemiological Monitoring;Female;Humans;Longitudinal Studies;Male;Mild Cognitive Impairment/epidemiology/*etiology/psychology;Multivariate Analysis;New South Wales;Odds Ratio;Risk Factors;Sex Distribution","Lipnicki, D. M.;Sachdev, P. S.;Crawford, J.;Reppermund, S.;Kochan, N. A.;Trollor, J. N.;Draper, B.;Slavin, M. J.;Kang, K.;Lux, O.;Mather, K. A.;Brodaty, H.",2013,,10.1371/journal.pone.0065841,1,
2647,Left ventricular structure and function in children infected with human immunodeficiency virus: the prospective P2C2 HIV Multicenter Study. Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection (P2C2 HIV) Study Group,"BACKGROUND: The frequency of, course of, and factors associated with cardiovascular abnormalities in pediatric HIV are incompletely understood. METHODS AND RESULTS: A baseline echocardiogram (median age, 2.1 years) and 2 years of follow-up every 4 months were obtained as part of a prospective study on 196 vertically HIV-infected children. Age- or body surface area-adjusted z scores were calculated by use of data from normal control subjects. Although 88% had symptomatic HIV infection, only 2 had CHF at enrollment, with a 2-year cumulative incidence of 4.7% (95% CI, 1.5% to 7.9%). All mean cardiac measurements were abnormal at baseline (decreased left ventricular fractional shortening [LV FS] and contractility and increased heart rate and LV dimension, mass, and wall stresses). Most of the abnormal baseline cardiac measurements correlated with depressed CD4 cell count z scores and the presence of HIV encephalopathy. Heart rate and LV mass showed significantly progressive abnormalities, whereas FS and contractility tended to decline. No association was seen between longitudinal changes in FS and CD4 cell count z score. Children who developed encephalopathy during follow-up had depressed initial FS, and FS continued to decline during follow-up. CONCLUSIONS: Subclinical cardiac abnormalities in HIV-infected children are common, persistent, and often progressive. Dilated cardiomyopathy (depressed contractility and dilatation) and inappropriate LV hypertrophy (elevated LV mass in the setting of decreased height and weight) were noted. Depressed LV function correlated with immune dysfunction at baseline but not longitudinally, suggesting that the CD4 cell count may not be a useful surrogate marker of HIV-associated LV dysfunction. However, the development of encephalopathy may signal a decline in FS.","AIDS Dementia Complex/pathology/physiopathology;Adolescent;CD4 Lymphocyte Count;Child;Child, Preschool;Disease Progression;Echocardiography;Female;HIV Infections/*pathology/physiopathology;Humans;Infant;Infant, Newborn;Male;Prospective Studies;Risk Factors;Ventricular Dysfunction, Left/*pathology/physiopathology","Lipshultz, S. E.;Easley, K. A.;Orav, E. J.;Kaplan, S.;Starc, T. J.;Bricker, J. T.;Lai, W. W.;Moodie, D. S.;McIntosh, K.;Schluchter, M. D.;Colan, S. D.",1998,Apr 7,,0,
2648,Glucose control in older adults with diabetes mellitus-more harm than good?,,glucose;insulin;metformin;pioglitazone;bladder cancer;blood glucose monitoring;cardiovascular risk;clinical practice;cognitive defect;dementia;diabetes mellitus;drug clearance;fluid retention;fragility fracture;glucose blood level;glycemic control;heart failure;human;hyperglycemia;hypoglycemia;kidney function;medical decision making;non insulin dependent diabetes mellitus;note;patient participation;polypharmacy;priority journal;quality of life;risk factor;therapeutic error;visual acuity;weight gain,"Lipska, K. J.;Montori, V. M.",2013,,,0,
2649,Risk factors for acquiring pneumococcal infections,"To identify risk factors for developing pneumococcal infections, we carried out a case-controlled study on a retrospectively constituted cohort of 3074 clinic patients in a presumed high-risk population. Culture-proved penumococcal infections were identified in 63 men over a period of 5.5 years, yielding an estimated incidence of 6.3 cases per 1000 person-years. By comparing these patients with 130 uninfected control patients, the relative risk of pneumococcal infections related to various exposures was calculated by logistic regression analysis. Statistically significant independent risk factors (and their relative risks) were as follows: dementia (5.82), seizure disorders (4.38), current cigarette smoking (4.00), congestive heart failure (3.83), cerebrovascular disease (3.82), institutionalization (3.13), and chronic obstructive pulmonary disease (2.38). Risk was increased with age and previous hospitalizations, and, to a nonsignificant degree, by hotel residence (3.93), lung cancer (2.24), previous smoking (2.14), corticosteroid use (1.81), and alcoholism (1.35); but not by diabetes mellitus (0.99), nonlung malignancies (0.93), nonwhite race (0.89), or ischemic heart disease (0.58).",age;clinical article;epidemiology;high risk population;human;infection;priority journal;risk factor;Streptococcus infection;Streptococcus pneumoniae,"Lipsky, B. A.;Boyko, E. J.;Inui, T. S.",1986,,,0,
2650,Exceptional parental longevity associated with lower risk of Alzheimer's disease and memory decline,"OBJECTIVES: To determine whether offspring of parents with exceptional longevity (OPEL) have a lower rate of dementia than offspring of parents with usual survival (OPUS). DESIGN: Community-based prospective cohort study. SETTING: Bronx, New York. PARTICIPANTS: A volunteer sample of 424 community-residing older adults without dementia aged 75 to 85 recruited from Bronx County starting in 1980 and followed for up to 23 years. MEASUREMENTS: Epidemiological, clinical, and neuropsychological assessments were completed every 12 to 18 months. OPEL were defined as having at least one parent who reached the age of at least 85. OPUS were those for whom neither parent reached the age of 85. Dementia was diagnosed according to case conference consensus based on Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria without access to information on parental longevity. Alzheimer's disease was diagnosed using established criteria. RESULTS: Of 424 subjects, 149 (35%) were OPEL, and 275 (65%) were OPUS. Mean age at entry for both groups was 79. The OPEL group had a lower incidence of Alzheimer's disease (hazard ratio=0.57, 95% confidence interval=0.35-0.93). After adjusting for sex, education, race, hypertension, myocardial infarction, diabetes mellitus, and stroke, results were essentially unchanged. OPEL also had a significantly lower rate of memory decline on the Selective Reminding Test (SRT) than OPUS (P=.03). CONCLUSION: OPEL develop dementia and Alzheimer's disease at a significantly lower rate than OPUS. Demographic and medical confounders do not explain this result. Factors associated with longevity may protect against dementia and Alzheimer's disease.","Aged;Aged, 80 and over;Aging/genetics;Alzheimer Disease/*epidemiology/genetics;Dementia/epidemiology/genetics;Female;Humans;Incidence;Linear Models;*Longevity;Longitudinal Studies;Male;Memory Disorders/*epidemiology/genetics;Neuropsychological Tests;New York City/epidemiology;*Parents;Proportional Hazards Models;Prospective Studies;Risk Factors","Lipton, R. B.;Hirsch, J.;Katz, M. J.;Wang, C.;Sanders, A. E.;Verghese, J.;Barzilai, N.;Derby, C. A.",2010,Jun,10.1111/j.1532-5415.2010.02868.x,0,
2651,Double jeopardy for the mentally ill: Higher cardiovascular risk and reduced frequency of certain interventional procedures,"This observational database study utilized data from three administrative databases to determine the relative effect of psychiatric disease status on mortality and utilization of in-patient procedures for cardiovascular conditions. The study results indicated that psychiatric patients exhibit significantly greater mortality compared with other groups of patients, despite adjustments for relevant socioeconomic and clinical factors. Compounding the problem, the authors further determined that cardiovascular medical procedures were underutilized in this population. This important study reveals significant public health implications for a patient population already at elevated risk for cardiovascular morbidity and mortality due to lifestyle, medical comorbidities and certain antipsychotic therapies. This study now offers supportive evidence that inequities in primary care health delivery systems provide a partial explanation for the excess cardiovascular risk observed in mentally ill patients. The widespread recognition of this issue should prompt additional research and consequent remedial action by medical providers and those institutions that support them. © 2007 Future Medicine Ltd.",article;cardiovascular procedure;cardiovascular risk;comorbidity;coronary artery bypass surgery;data base;dementia;health care delivery;health care utilization;heart catheterization;high risk patient;hospital admission;hospital patient;hospitalization;human;ischemic heart disease;lifestyle;mental disease;mental patient;mood disorder;mortality;observational study;primary health care;priority journal;psychosis;public health;transluminal coronary angioplasty,"L'Italien, G. J.",2007,,,0,
2652,The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial,"BACKGROUND: The prognostic benefits of blood pressure lowering treatment in elderly hypertensive patients were established more than a decade ago, but are less clear in those with mildly to moderately elevated blood pressure. OBJECTIVE: To assess whether candesartan-based antihypertensive treatment in elderly patients with mildly to moderately elevated blood pressure confers a reduction in cardiovascular events, cognitive decline and dementia. DESIGN: Prospective, double-blind, randomized, parallel-group study conducted in 1997-2002. SETTING AND PARTICIPANTS: The study was of 4964 patients aged 70-89 years, with systolic blood pressure 160-179 mmHg, and/or diastolic blood pressure 90-99 mmHg, and a Mini Mental State Examination (MMSE) test score >or= 24. A total of 527 centres in 15 countries participated in the study. INTERVENTION: Patients were assigned randomly to receive the angiotensin receptor blocker candesartan or placebo, with open-label active antihypertensive therapy added as needed. As a consequence, active antihypertensive therapy was extensively used in the control group (84% of patients). Mean follow-up was 3.7 years. MAIN OUTCOME MEASURES: The primary outcome measure was major cardiovascular events, a composite of cardiovascular death, non-fatal stroke and non-fatal myocardial infarction. Secondary outcome measures included cardiovascular death, non-fatal and fatal stroke and myocardial infarction, cognitive function measured by the MMSE and dementia. RESULTS: Blood pressure fell by 21.7/10.8 mmHg in the candesartan group and by 18.5/9.2 mmHg in the control group. A first major cardiovascular event occurred in 242 candesartan patients and in 268 control patients; risk reduction with candesartan was 10.9% [95% confidence interval (CI), -6.0 to 25.1, P = 0.19]. Candesartan-based treatment reduced non-fatal stroke by 27.8% (95% CI, 1.3 to 47.2, P = 0.04), and all stroke by 23.6% (95% CI, -0.7 to 42.1, P = 0.056). There were no significant differences in myocardial infarction and cardiovascular mortality. Mean MMSE score fell from 28.5 to 28.0 in the candesartan group and from 28.5 to 27.9 in the control group (P = 0.20). The proportions of patients who had a significant cognitive decline or developed dementia were not different in the two treatment groups. CONCLUSIONS: In elderly hypertensive patients, a slightly more effective blood pressure reduction during candesartan-based therapy, compared with control therapy, was associated with a modest, statistically non-significant, reduction in major cardiovascular events and with a marked reduction in non-fatal stroke. Cognitive function was well maintained in both treatment groups in the presence of substantial blood pressure reductions. Both treatment regimens were generally well tolerated.","Antihypertensive Agents [administration & dosage] [adverse effects] [therapeutic use];Benzimidazoles [administration & dosage] [adverse effects] [therapeutic use];Biomarkers [blood];Blood Pressure [drug effects];Cardiovascular Diseases [diagnosis] [mortality] [physiopathology];Cognition [drug effects];Dementia [diagnosis] [physiopathology];Dose-Response Relationship, Drug;Double-Blind Method;Europe [epidemiology];Follow-Up Studies;Helsinki Declaration;Hydrochlorothiazide [administration & dosage] [adverse effects] [therapeutic use];Hypertension [diagnosis] [drug therapy] [mortality];Prognosis;Prospective Studies;Risk Reduction Behavior;Severity of Illness Index;Survival Analysis;Tetrazoles [administration & dosage] [adverse effects] [therapeutic use];Time Factors;Treatment Outcome;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];aged;aging;antihypertensive therapy;article;blood pressure;borderline hypertension/dt [Drug Therapy];borderline hypertension/ep [Epidemiology];cardiovascular risk;clinical trial;cognition;confidence interval;controlled clinical trial;controlled study;dementia;diastolic blood pressure;disease severity;female;follow up;heart death;heart infarction;human;major clinical study;male;Mini Mental State Examination;mortality;priority journal;prognosis;prospective study;randomized controlled trial;scoring system;stroke;systolic blood pressure;treatment outcome;types of study;angiotensin receptor antagonist/ct [Clinical Trial];angiotensin receptor antagonist/dt [Drug Therapy];candesartan/ct [Clinical Trial];candesartan/dt [Drug Therapy];placebo;Sr-dementia: sr-htn: sr-stroke","Lithell, H.;Hansson, L.;Skoog, I.;Elmfeldt, D.;Hofman, A.;Olofsson, B.;Trenkwalder, P.;Zanchetti, A.",2003,,10.1097/01.hjh.0000059028.82022.89,0,
2653,The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial,"OBJECTIVETo assess whether candesartan-based antihypertensive treatment in elderly patients with mildly to moderately elevated blood pressure confers a reduction in cardiovascular events, cognitive decline and dementia.DESIGNProspective, double-blind, randomized, parallel-group study conducted in 1997-2002.SETTING AND PARTICIPANTSThe study was of 4964 patients aged 70-89 years, with systolic blood pressure 160-179 mmHg, and/or diastolic blood pressure 90-99 mmHg, and a Mini Mental State Examination (MMSE) test score >or= 24. A total of 527 centres in 15 countries participated in the study.INTERVENTIONPatients were assigned randomly to receive the angiotensin receptor blocker candesartan or placebo, with open-label active antihypertensive therapy added as needed. As a consequence, active antihypertensive therapy was extensively used in the control group (84% of patients). Mean follow-up was 3.7 years.MAIN OUTCOME MEASURESThe primary outcome measure was major cardiovascular events, a composite of cardiovascular death, non-fatal stroke and non-fatal myocardial infarction. Secondary outcome measures included cardiovascular death, non-fatal and fatal stroke and myocardial infarction, cognitive function measured by the MMSE and dementia.RESULTSBlood pressure fell by 21.7/10.8 mmHg in the candesartan group and by 18.5/9.2 mmHg in the control group. A first major cardiovascular event occurred in 242 candesartan patients and in 268 control patients; risk reduction with candesartan was 10.9% [95% confidence interval (CI), -6.0 to 25.1, P = 0.19]. Candesartan-based treatment reduced non-fatal stroke by 27.8% (95% CI, 1.3 to 47.2, P = 0.04), and all stroke by 23.6% (95% CI, -0.7 to 42.1, P = 0.056). There were no significant differences in myocardial infarction and cardiovascular mortality. Mean MMSE score fell from 28.5 to 28.0 in the candesartan group and from 28.5 to 27.9 in the control group (P = 0.20). The proportions of patients who had a significant cognitive decline or developed dementia were not different in the two treatment groups.CONCLUSIONSIn elderly hypertensive patients, a slightly more effective blood pressure reduction during candesartan-based therapy, compared with control therapy, was associated with a modest, statistically non-significant, reduction in major cardiovascular events and with a marked reduction in non-fatal stroke. Cognitive function was well maintained in both treatment groups in the presence of substantial blood pressure reductions. Both treatment regimens were generally well tolerated.BACKGROUNDThe prognostic benefits of blood pressure lowering treatment in elderly hypertensive patients were established more than a decade ago, but are less clear in those with mildly to moderately elevated blood pressure.","Antihypertensive Agents [administration & dosage] [adverse effects] [therapeutic use];Benzimidazoles [administration & dosage] [adverse effects] [therapeutic use];Biomarkers [blood];Blood Pressure [drug effects];Cardiovascular Diseases [diagnosis] [mortality] [physiopathology];Cognition [drug effects];Dementia [diagnosis] [physiopathology];Dose-Response Relationship, Drug;Double-Blind Method;Europe [epidemiology];Follow-Up Studies;Helsinki Declaration;Hydrochlorothiazide [administration & dosage] [adverse effects] [therapeutic use];Hypertension [diagnosis] [drug therapy] [mortality];Prognosis;Prospective Studies;Risk Reduction Behavior;Severity of Illness Index;Survival Analysis;Tetrazoles [administration & dosage] [adverse effects] [therapeutic use];Time Factors;Treatment Outcome;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];aged;aging;antihypertensive therapy;article;blood pressure;borderline hypertension/dt [Drug Therapy];borderline hypertension/ep [Epidemiology];cardiovascular risk;clinical trial;cognition;confidence interval;controlled clinical trial;controlled study;dementia;diastolic blood pressure;disease severity;female;follow up;heart death;heart infarction;human;major clinical study;male;Mini Mental State Examination;mortality;priority journal;prognosis;prospective study;randomized controlled trial;scoring system;stroke;systolic blood pressure;treatment outcome;types of study;angiotensin receptor antagonist/ct [Clinical Trial];angiotensin receptor antagonist/dt [Drug Therapy];candesartan/ct [Clinical Trial];candesartan/dt [Drug Therapy];placebo;aged;control group;death;hypertension;intervention study;patient;prognosis;receptor blocking;risk reduction;therapy;venous pressure;angiotensin 1 receptor;angiotensin receptor;candesartan;receptor blocking agent;Sr-dementia: sr-htn: sr-stroke","Lithell, H;Hansson, L;Skoog, I;Elmfeldt, D;Hofman, A;Olofsson, B;Trenkwalder, P;Zanchetti, A",2003,,10.1097/01.hjh.0000059028.82022.89,0,2652
2654,The Study on COgnition and Prognosis in the Elderly (SCOPE); outcomes in patients not receiving add-on therapy after randomization,"OBJECTIVE: To assess clinical outcomes in the Study on COgnition and Prognosis in the Elderly (SCOPE) in patients who did not receive add-on antihypertensive therapy after randomization, i.e. in patients that best reflect the original intention of a placebo-controlled trial. DESIGN: Post-hoc analysis of a prospective, randomized, controlled trial. SETTINGS AND PARTICIPANTS: Five hundred and twenty-seven centres in 15 countries participated in SCOPE. Patients aged 70-89 years, with systolic blood pressure 160-179 mmHg and/or diastolic blood pressure 90-99 mmHg, and preserved cognitive function were eligible. Out of 4937 patients in SCOPE, 2098 did not receive add-on therapy. INTERVENTION: The number of patients who received candesartan 8-16 mg once daily was 1253, and 845 received placebo. Mean follow-up was 3.7 and 3.5 years, respectively. MAIN OUTCOME MEASURES: Primary: major cardiovascular events (cardiovascular mortality, non-fatal stroke or non-fatal myocardial infarction). Secondary: total mortality, cardiovascular mortality, fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, cognitive function, and dementia. RESULTS: The treatment groups were generally well balanced for baseline characteristics. Blood pressure fell by 21.8/11.0 mmHg in the candesartan group and by 17.2/8.4 mmHg in the placebo group. There were significant relative risk reductions with candesartan in major cardiovascular events (32%, P = 0.013), cardiovascular mortality (29%, P = 0.049), and total mortality (27%, P = 0.018). There were no significant differences between the treatment groups in cognitive outcomes. Both treatments were generally well tolerated. CONCLUSIONS: Treatment of elderly patients with mild hypertension is beneficial and supports current recommendations. Candesartan appears an appropriate therapy in such patients, in view of its favourable tolerability profile and ability to reduce major cardiovascular events.",Antihypertensive Agents [administration & dosage] [adverse effects];Benzimidazoles [administration & dosage] [adverse effects];Blood Pressure [drug effects];Cardiovascular Diseases [mortality];Cognition;Follow-Up Studies;Hypertension [drug therapy] [mortality];Prognosis;Prospective Studies;Risk Adjustment;Tetrazoles [administration & dosage] [adverse effects];Treatment Outcome;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];add on therapy;aged;antihypertensive therapy;article;backache/si [Side Effect];blood pressure;bronchitis/si [Side Effect];clinical trial;cognition;controlled clinical trial;controlled study;demography;dizziness/si [Side Effect];double blind procedure;drug tolerability;drug withdrawal;female;follow up;heart infarction;human;hypertension/dt [Drug Therapy];Kaplan Meier method;major clinical study;male;mortality;multicenter study;outcomes research;priority journal;prognosis;randomization;randomized controlled trial;risk reduction;sensitivity analysis;stroke;vertigo/si [Side Effect];candesartan/ae [Adverse Drug Reaction];candesartan/dt [Drug Therapy];hydrochlorothiazide/dt [Drug Therapy];Sr-htn: sr-stroke,"Lithell, H.;Hansson, L.;Skoog, I.;Elmfeldt, D.;Hofman, A.;Olofsson, B.;Trenkwalder, P.;Zanchetti, A.",2004,,,0,
2655,The Study on COgnition and Prognosis in the Elderly (SCOPE); outcomes in patients not receiving add-on therapy after randomization,"DESIGNPost-hoc analysis of a prospective, randomized, controlled trial.SETTINGS AND PARTICIPANTSFive hundred and twenty-seven centres in 15 countries participated in SCOPE. Patients aged 70-89 years, with systolic blood pressure 160-179 mmHg and/or diastolic blood pressure 90-99 mmHg, and preserved cognitive function were eligible. Out of 4937 patients in SCOPE, 2098 did not receive add-on therapy.INTERVENTIONThe number of patients who received candesartan 8-16 mg once daily was 1253, and 845 received placebo. Mean follow-up was 3.7 and 3.5 years, respectively.MAIN OUTCOME MEASURESPrimary: major cardiovascular events (cardiovascular mortality, non-fatal stroke or non-fatal myocardial infarction). Secondary: total mortality, cardiovascular mortality, fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, cognitive function, and dementia.RESULTSThe treatment groups were generally well balanced for baseline characteristics. Blood pressure fell by 21.8/11.0 mmHg in the candesartan group and by 17.2/8.4 mmHg in the placebo group. There were significant relative risk reductions with candesartan in major cardiovascular events (32%, P = 0.013), cardiovascular mortality (29%, P = 0.049), and total mortality (27%, P = 0.018). There were no significant differences between the treatment groups in cognitive outcomes. Both treatments were generally well tolerated.CONCLUSIONSTreatment of elderly patients with mild hypertension is beneficial and supports current recommendations. Candesartan appears an appropriate therapy in such patients, in view of its favourable tolerability profile and ability to reduce major cardiovascular events.OBJECTIVETo assess clinical outcomes in the Study on COgnition and Prognosis in the Elderly (SCOPE) in patients who did not receive add-on antihypertensive therapy after randomization, i.e. in patients that best reflect the original intention of a placebo-controlled trial.",Antihypertensive Agents [administration & dosage] [adverse effects];Benzimidazoles [administration & dosage] [adverse effects];Blood Pressure [drug effects];Cardiovascular Diseases [mortality];Cognition;Follow-Up Studies;Hypertension [drug therapy] [mortality];Prognosis;Prospective Studies;Risk Adjustment;Tetrazoles [administration & dosage] [adverse effects];Treatment Outcome;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];add on therapy;aged;antihypertensive therapy;article;backache/si [Side Effect];blood pressure;bronchitis/si [Side Effect];clinical trial;cognition;controlled clinical trial;controlled study;demography;dizziness/si [Side Effect];double blind procedure;drug tolerability;drug withdrawal;female;follow up;heart infarction;human;hypertension/dt [Drug Therapy];Kaplan Meier method;major clinical study;male;mortality;multicenter study;outcomes research;priority journal;prognosis;randomization;randomized controlled trial;risk reduction;sensitivity analysis;stroke;vertigo/si [Side Effect];candesartan/ae [Adverse Drug Reaction];candesartan/dt [Drug Therapy];hydrochlorothiazide/dt [Drug Therapy];aged;antihypertensive therapy;borderline hypertension;cognition;dementia;diastolic blood pressure;hospital patient;hypertension;patient;post hoc analysis;prognosis;randomization;receptor blocking;risk factor;systolic blood pressure;therapy;venous pressure;angiotensin 1 receptor;candesartan;placebo;Sr-htn: sr-stroke,"Lithell, H;Hansson, L;Skoog, I;Elmfeldt, D;Hofman, A;Olofsson, B;Trenkwalder, P;Zanchetti, A",2004,,,0,2654
2656,Potential clinical applications of PET/magnetic resonance imaging,"Hybrid PET/magnetic resonance (MR) imaging, which combines the excellent anatomic information and functional MR imaging parameters with the metabolic and molecular information obtained with PET, may be superior to PET/computed tomography or MR imaging alone for a wide range of disease conditions. This review highlights potential clinical applications in neurologic, cardiovascular, and musculoskeletal disease conditions, with special attention to applications in oncologic imaging. © 2013 Elsevier Inc.","1 fluoro 3 (2 nitro 1 imidazolyl) 2 propanol f 18;16 alpha fluoroestradiol 17beta f 18;2 (2 nitro 1 h imidazol 1 yl) n (2,2,3,3,3pentafluoropropyl) acetamide f 18;3' fluorothymidine f 18;4 fluorobenzoyl annexin V f 18;6 fluorodihydroxyphemylalanine f 18;acetic acid c 11;ammonia n 13;catecholamine derivative;choline c 11;diacetyl bis(n4 methylthiosemicarbazone) cu 64;estrogen receptor;fluorocholine f 18;fluorodeoxyglucose f 18;galacto arginine glycine aspartate f 18;hydroxyephedrine c 11;metaiodobenzylguanidine i 124;methionine c 11;O (2 fluoroethyl) L tyrosine f 18;palmitic acid c 11;radiopharmaceutical agent;rubidium 82;sodium fluoride f 18;somatostatin receptor;thymidine c 11;ultrasmall superparamagnetic iron oxide;unclassified drug;water o 15;yttrium 90;aerobic metabolism;Alzheimer disease;amino acid metabolism;angiogenesis;apoptosis;article;atherosclerosis;atherosclerotic plaque;blood flow;bone marrow metastasis;bone metabolism;bone scintiscanning;brachial plexus;brain metastasis;brain tumor;breast carcinoma;breast lesion;cancer staging;cardiomyopathy;cell proliferation;chemical environment;childhood cancer;cognitive defect;colorectal carcinoma;comparative study;computed tomography scanner;congestive cardiomyopathy;contrast enhancement;diabetic foot;differentiated thyroid cancer;diffusion tensor imaging;diffusion weighted imaging;early diagnosis;endometrium cancer;false positive result;fatty acid metabolism;follow up;functional disease;functional magnetic resonance imaging;glioma;glucose metabolism;gray matter;head and neck squamous cell carcinoma;heart infarction;heart innervation;heart left ventricle function;heart muscle ischemia;heart muscle perfusion;histology;Hodgkin disease;human;hypoxia;hysterectomy;image quality;image reconstruction;ionizing radiation;kidney carcinoma;Langerhans cell histiocytosis;liver cell carcinoma;liver metastasis;long term survival;longitudinal study;lung lesion;lung metastasis;non small cell lung cancer;lung tumor;lymph node dissection;lymph node metastasis;magnetic field;magnetic resonance elastography;malignant transformation;meta analysis;myocardial perfusion imaging;myocarditis;nephroblastoma;neuroblastoma;neurofibromatosis;non invasive procedure;nuclear magnetic resonance imaging;nuclear magnetic resonance spectroscopy;overall survival;pancreas cancer;patient selection;pattern recognition;pheochromocytoma;pilot study;positron emission tomography;primary tumor;priority journal;prospective study;prostate cancer;radiation exposure;radiofrequency radiation;raphe nucleus;rectum carcinoma;retrospective study;rheumatoid arthritis;seizure;soft tissue sarcoma;sudden cardiac death;survival rate;thorax radiography;treatment planning;treatment response;tumor recurrence;tumor volume;vasculitis;white matter","Littooij, A. S.;Torigian, D. A.;Kwee, T. C.;De Keizer, B.;Alavi, A.;Nievelstein, R. A. J.",2013,,,0,
2657,Impact of community health workers on elderly patients' advance care planning and health care utilization,"Background: Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences. Objective: To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment. Research Design: A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation. Subjects: The 818 patients were 74.2 years old (mean); 78% women; 51% African American; 43% white. Measures: Documentation of ACP conversation in electronic health record fields and health care utilization outcomes. Results: In this target population ACP documentation rose from 3.4% (pre-CCA training) to 47.9% (post) of patients who had at least 1 discussion about ACP in the electronic health record. In the 1-year preintervention period, there were no differences in admissions, emergency department (ED) visits, and outpatient visits between patients who did and did not have ACP discussion. After adjusting for prior hospitalization and ED use histories, ACP discussions were associated with a 34% less probability of hospitalization (hazard ratios, 0.66; 95% confidence interval, 0.45-0.97), and similar effects are apparent on ED use independent of age and prior ED use effects. Conclusions: Patients with chronic diseases including mild cognitive impairment can engage in ACP conversations with trusted home health care providers. Having ACP conversation is associated with significant reduction in seeking urgent health care and in hospitalizations.",advance care planning;African American;aged;arthritis;article;Caucasian;cerebrovascular accident;chronic disease;chronic obstructive lung disease;clinical decision support system;congestive heart failure;coronary artery disease;dementia;depression;diabetes mellitus;electronic health record;emergency ward;female;health auxiliary;health care need;health care utilization;home visit;hospitalization;human;ICD-9;major clinical study;male;malignant neoplasm;mild cognitive impairment;Mini Mental State Examination;outpatient;Patient Health Questionnaire 9;priority journal;qualitative analysis;quantitative analysis;semi structured interview;senescence,"Litzelman, D. K.;Inui, T. S.;Griffin, W. J.;Perkins, A.;Cottingham, A. H.;Schmitt-Wendholt, K. M.;Ivy, S. S.",2017,,10.1097/mlr.0000000000000675,0,
2658,Characterization of the classical biological false-positive reaction in the serological test for syphilis in the modern era,"To characterize the CBFP reaction in the modern era, we analyzed the results of parallel rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TPPA) tests from a total of 63,765 blood samples obtained at Zhongshan Hospital in the Medical College of Xiamen University from May 2008 to February 2013. Among the 63,765 tested blood samples, 206 (0.32%) had the CBFP reaction. In multivariate analysis, an increased likelihood of the CBFP reaction was associated with female subjects, subjects ≥ 80 years old, and subjects between 16 and 35 years old (P < 0.05). The CBFP reaction occurred in association with 17 categories of disease, including 60 types of diseases, in the 206 subjects. To our knowledge, a number of these diseases had not been previously reported to be associated with the CBFP in the RPR test, including false labor, megaloblastic anemias, aplastic anemias, redundant prepuce, congenital malformation of heart, and salpingitis. Among the 206 patients with the CBFP reaction, 35 patients were subjected to follow-up for five years. 26 out of 35 these patients were at a 1:1 initial RPR titer, 8 out of 35 patients were at a 1:2 initial RPR titer, and 1 out of 35 patients were at a 1:4 initial RPR titer. 30 subjects had their RPR seroreverted. In our opinion, additional CBFP research using a large sample population will contribute to the identification of additional underlying serious disorders that are not related to syphilis. Such results could be useful for the prediction and diagnosis of these diseases. © 2014 Elsevier B.V.",abducens nerve paralysis;adolescent;adult;aged;agglutination test;Alzheimer disease;anaphylactoid purpura;aplastic anemia;article;coronary artery atherosclerosis;autoimmune hemolytic anemia;bacterial endocarditis;bacterial pneumonia;benign tumor;beta thalassemia;brain hemorrhage;brain infarction;carotid artery aneurysm;carotid artery injury;cholelithiasis;classical biological false positive reaction;condyloma acuminatum;congenital heart malformation;dementia;dermatitis;dislocation;dizziness;ectopic pregnancy;endometriosis;epilepsy;essential tremor;female;femur neck fracture;follow up;heart arrhythmia;herpes zoster;human;hypertension;idiopathic thrombocytopenic purpura;kidney failure;knee osteoarthritis;laboratory diagnosis;lung fibrosis;major clinical study;male;male infertility;malignant neoplastic disease;medical examination;megaloblastic anemia;missed abortion;priority journal;prostate hypertrophy;psoriasis;reagin test;respiratory failure;rheumatic heart disease;salpingitis;serology;Sjoegren syndrome;skin infection;sprain;subarachnoid hemorrhage;syphilis;systemic lupus erythematosus;tension pneumothorax;treponema pallidum particle agglutination test;tuberous sclerosis;upper respiratory tract infection;urethritis;urticaria;uterus bleeding;uterus prolapse;vagina bleeding;vaginitis;virus meningitis,"Liu, F.;Liu, L. L.;Guo, X. J.;Xi, Y.;Lin, L. R.;Zhang, H. L.;Huang, S. J.;Chen, Y. Y.;Zhang, Y. F.;Zhang, Q.;Huang, G. L.;Tong, M. L.;Jiang, J.;Yang, T. C.",2014,,,0,
2659,The small molecule luteolin inhibits N-acetyl-alpha-galactosaminyltransferases and reduces mucin-type O-glycosylation of amyloid precursor protein,"Mucin-type O-glycosylation is the most abundant type of O-glycosylation. It is initiated by the members of polypeptide N-acetyl-alpha-galactosaminyltransferase (ppGalNAc-T) family and closely associated with both physiological and pathological conditions such as coronary artery disease or Alzheimer' s disease. The lack of direct and selective inhibitors of ppGalNAc-Ts has largely impeded research progress in understanding the molecular events in mucin-type O-glycosylation. Here, we report that a small molecule, the plant flavonoid luteolin, selectively inhibits ppGalNAc-Ts in vitro and in cells. We found that luteolin inhibits ppGalNAc-T2 through a peptide/protein-competitive manner but not promiscuously, e.g. via aggregation-based activity. X-ray structural analysis revealed that luteolin binds to the PxP motif-binding site found in most protein substrates, which was further validated by comparing the interactions between luteolin with wildtype enzyme and mutants using 1H NMR-based binding experiments. Functional studies disclosed that luteolin at least partially reduced production of beta-amyloid (Abeta) protein by selectively inhibiting the activity of ppGalNAc-T isoforms. In conclusion, our study provides key structural and functional details on luteolin inhibiting ppGalNAc-T activity, opening up the way for further optimization of more potent and specific ppGalNAc-T inhibitors. Moreover, our findings may inform future investigations into site-specific O-GalNAc glycosylation and into the molecular mechanism of luteolin-mediated ppGalNAc-T inhibition.",O-glycosylation;amyloid precursor protein (APP);crystal structure;glycoprotein;glycosylation inhibitor;glycosyltransferase;luteolin;ppGalNAc-T,"Liu, F.;Xu, K.;Xu, Z.;Rivas, M. L.;Li, X.;Lu, J.;Delso, I.;Merino, P.;Hurtado-Guerrero, R.;Zhang, Y.",2017,Oct 23,,0,
2660,Total body irradiation compared with BEAM: Long-term outcomes of peripheral blood autologous stem cell transplantation for non-Hodgkin's lymphoma,"Purpose: The optimal preparative regimen for non-Hodgkin's lymphoma patients undergoing autologous peripheral blood stem cell transplantation (PBSCT) is unknown. We compared a total body irradiation (TBI)-based regimen with a chemotherapy-alone regimen. Methods and Materials: A retrospective cohort study was performed at a Canadian cancer center. The TBI regimen consisted of cyclophosphamide, etoposide, and TBI 12 Gy in six fractions (CY/E/TBI). The chemotherapy-alone regimen consisted of carmustine, etoposide, cytarabine, and melphalan (BEAM). We compared the acute and long-term toxicities, disease relapse-free survival, and overall survival (OS). Results: Of 73 patients, 26 received CY/E/TBI and 47 received BEAM. The median follow-up for the CY/E/TBI group was 12.0 years and for the BEAM group was 7.3 years. After PBSCT, no differences in acute toxicity were seen between the two groups. The 5-year disease relapse-free survival rate was 50.0% and 50.7% in the CY/E/TBI and BEAM groups, respectively (p = .808). The 5-year OS rate was 53.9% and 63.8% for the CY/E/TBI and BEAM groups, respectivey (p = .492). The univariate analysis results indicated that patients with Stage IV, with chemotherapy-resistant disease, and who had received PBSCT before 2000 had inferior OS. A three-way categorical analysis revealed that transplantation before 2000, rather than the conditioning regimen, was a more important predictive factor of long-term outcome (p = .034). Conclusion: A 12-Gy TBI-based conditioning regimen for PBSCT for non-Hodgkin's lymphoma resulted in disease relapse-free survival and OS similar to that after BEAM. PBSCT before 2000, and not the conditioning regimen, was an important predictor of long-term outcomes. TBI was not associated with more acute toxicity or pneumonitis. We found no indication that the TBI regimen was inferior or superior to BEAM. Copyright © 2010 Elsevier Inc. Printed in the USA. All rights reserved.",carmustine;cyclophosphamide;cytarabine;etoposide;granulocyte colony stimulating factor;melphalan;acute myeloblastic leukemia;acute toxicity;adult;aged;article;autologous stem cell transplantation;Canada;cancer center;cancer combination chemotherapy;cancer recurrence;cancer resistance;cancer staging;cataract;cohort analysis;comparative study;congestive heart failure;controlled study;dementia;diarrhea;disease free survival;drug fatality;febrile neutropenia;female;follow up;human;immunosuppressive treatment;interstitial pneumonia;major clinical study;male;mucosa inflammation;neutropenia;nonhodgkin lymphoma;overall survival;pneumonia;prediction;priority journal;prostate cancer;radiation dose fractionation;retrospective study;skin manifestation;survival rate;treatment outcome;whole body radiation,"Liu, H. W.;Seftel, M. D.;Rubinger, M.;Szwajcer, D.;Demers, A.;Nugent, Z.;Schroeder, G.;Butler, J. B.;Cooke, A.",2010,,,0,
2661,Mitochondrial targeting of human NADH dehydrogenase (ubiquinone) flavoprotein 2 (NDUFV2) and its association with early-onset hypertrophic cardiomyopathy and encephalopathy,"BACKGROUND: NADH dehydrogenase (ubiquinone) flavoprotein 2 (NDUFV2), containing one iron sulfur cluster ([2Fe-2S] binuclear cluster N1a), is one of the core nuclear-encoded subunits existing in human mitochondrial complex I. Defects in this subunit have been associated with Parkinson's disease, Alzheimer's disease, Bipolar disorder, and Schizophrenia. The aim of this study is to examine the mitochondrial targeting of NDUFV2 and dissect the pathogenetic mechanism of one human deletion mutation present in patients with early-onset hypertrophic cardiomyopathy and encephalopathy. METHODS: A series of deletion and point-mutated constructs with the c-myc epitope tag were generated to identify the location and sequence features of mitochondrial targeting sequence for NDUFV2 in human cells using the confocal microscopy. In addition, various lengths of the NDUFV2 N-terminal and C-terminal fragments were fused with enhanced green fluorescent protein to investigate the minimal region required for correct mitochondrial import. Finally, a deletion construct that mimicked the IVS2+5_+8delGTAA mutation in NDUFV2 gene and would eventually produce a shortened NDUFV2 lacking 19-40 residues was generated to explore the connection between human gene mutation and disease. RESULTS: We identified that the cleavage site of NDUFV2 was located around amino acid 32 of the precursor protein, and the first 22 residues of NDUFV2 were enough to function as an efficient mitochondrial targeting sequence to carry the passenger protein into mitochondria. A site-directed mutagenesis study showed that none of the single-point mutations derived from basic, hydroxylated and hydrophobic residues in the NDUFV2 presequence had a significant effect on mitochondrial targeting, while increasing number of mutations in basic and hydrophobic residues gradually decreased the mitochondrial import efficacy of the protein. The deletion mutant mimicking the human early-onset hypertrophic cardiomyopathy and encephalopathy lacked 19-40 residues in NDUFV2 and exhibited a significant reduction in its mitochondrial targeting ability. CONCLUSIONS: The mitochondrial targeting sequence of NDUFV2 is located at the N-terminus of the precursor protein. Maintaining a net positive charge and an amphiphilic structure with the overall balance and distribution of basic and hydrophobic amino acids in the N-terminus of NDUFV2 is important for mitochondrial targeting. The results of human disease cell model established that the impairment of mitochondrial localization of NDUFV2 as a mechanistic basis for early-onset hypertrophic cardiomyopathy and encephalopathy.","Brain Diseases/*genetics;Cardiomyopathy, Hypertrophic/*genetics;Cells, Cultured;Cloning, Molecular;Humans;Mitochondria/*metabolism;Mutation;NADH, NADPH Oxidoreductases/chemistry/*genetics/*metabolism;Protein Subunits/*genetics","Liu, H. Y.;Liao, P. C.;Chuang, K. T.;Kao, M. C.",2011,May 06,10.1186/1423-0127-18-29,0,
2662,Differential effects of angiotensin II receptor blockers on Abeta generation,"Angiotensin II receptor blockers (ARBs) are widely prescribed for the medication of systemic hypertension and congestive heart failure. It has been reported that ARBs can reduce the risk for the onset of Alzheimer's disease (AD) and have beneficial effects on dementia. Neurotoxic amyloid beta-protein (Abeta) is believed to play a causative role in the development of AD. However, whether ARBs regulate Abeta generation remains largely unknown. Here, we studied the effect of ARBs on Abeta generation and found that telmisartan significantly increased Abeta40 and Abeta42 generation, but decreased the Abeta42/Abeta40 ratio. However, losartan, valsartan and candesartan did not increase Abeta generation, while olmesartan significantly increased Abeta42 generation. We also found that telmisartan increased the Abeta generation through angiotensin type 1a receptor (AT1a) and the receptor-related phosphotidylinositide 3-kinases (PI3K) pathway. Our findings revealed the different effects of ARBs on Abeta generation and provide new evidence for the relationship between antihypertensive treatment and AD pathogenesis.","Amyloid beta-Peptides/*biosynthesis;Angiotensin II Type 1 Receptor Blockers/*adverse effects;Animals;Benzimidazoles/adverse effects;Benzoates/adverse effects;Cells, Cultured;Fibroblasts/drug effects/metabolism;Imidazoles/adverse effects;Losartan/adverse effects;Mice, Inbred C57BL;Mice, Knockout;Peptide Fragments/*biosynthesis;Phosphatidylinositol 3-Kinases/metabolism;Receptor, Angiotensin, Type 1/genetics/metabolism;Signal Transduction;Tetrazoles/adverse effects;Valine/adverse effects/analogs & derivatives;Valsartan;Alzheimer's disease;Amyloid beta-protein;Angiotensin II receptor blockers","Liu, J.;Liu, S.;Tanabe, C.;Maeda, T.;Zou, K.;Komano, H.",2014,May 1,10.1016/j.neulet.2014.03.030,0,
2663,Analysis of risk factors of cognitive handicap and senile dementia in honorary retired and ordinary retired cadres from 51 cadre sanatoriums of 11 areas in the Yellow River Valley,"Aim: To investigate the prevalence rate of senile dementia and the cognitive handicap of senile persons in Yellow River Valley of Lanzhou military area command and analyze the risk factor. Methods: Neuropsychological scale (HDS) (22-30.5 points as mild abnormality, 10.5-21.5 points as in prophase of dementia, ≤ 10 points as in dementia) and clinical memory scale (CMS) (≤80 points as abnormality) were given to the 2 944 subjects aged over 60 years among 16 538 people of the 11 areas of 51 cadre sanatorium in the Yellow River Valley. An investigation was given to the subjects one by one. The persons being diagnosed as having abnormality by the two scales were as case group. At the same time, general conditions, height above sea level, history of family heredity, history of past disease, living habit and so on including 5 aspects and 30 risk factors were surveyed. The result of investigation was analyzed with multiple regression analysis with SPSS 10.0 software. Results: A total of 2 944 testees were involved in the result analysis. 1 The prevalence rate of senile dementia was as following, 0.71% in dementia, 2.11% in pre-dementia, 28.46% in mile dementia, with the total prevalence rate of 31.28%. 2 Result of multiple regression analysis: brain atrophy (t =-6.304), great life events (t =-5.328), advanced age (t = -5.415), no appetite for tea (t =-3.802), cerebral infarction (t =-3.343), female (t =-2.604), coronary heart disease (t =2.496), low cultured degree (t =1.973), profession (t =1.965), high height above sea level (t =1.957) were associated with senile dementia (P < 0.05). Conclusion: 1 The occurrence of senile dementia and cognitive handicap is closely related with the 10 risk factors those are brain atrophy, great life events, advanced age, no appetite for tea, cerebral infarction, female, coronary heart disease, low cultured degree, profession, high height above sea level. 2 It shows that the incidenbe rate of dementia is low, whereas the incidence rates of pre-dementia and mild abnormality are high, so some interventional therapies should be carried out actively to those in pre-dementia and with mild dementia.",adult;age distribution;aged;article;body height;brain atrophy;brain infarction;China;cognitive defect;disease association;educational status;elderly care;family history;female;food preference;general condition;human;ischemic heart disease;life event;lifestyle;major clinical study;male;military service;multiple regression;neuropsychological test;occupation;pensioner;prevalence;risk factor;senile dementia;sex difference;soldier,"Liu, J. L.;Gao, H.;Song, F.;Wang, X. H.;Yang, C.;Zhao, Z. H.",2007,,,0,
2664,Case-control association mapping by proxy using family history of disease,"Collecting cases for case-control genetic association studies can be time-consuming and expensive. In some situations (such as studies of late-onset or rapidly lethal diseases), it may be more practical to identify family members of cases. In randomly ascertained cohorts, replacing cases with their first-degree relatives enables studies of diseases that are absent (or nearly absent) in the cohort. We refer to this approach as genome-wide association study by proxy (GWAX) and apply it to 12 common diseases in 116,196 individuals from the UK Biobank. Meta-analysis with published genome-wide association study summary statistics replicated established risk loci and yielded four newly associated loci for Alzheimer's disease, eight for coronary artery disease and five for type 2 diabetes. In addition to informing disease biology, our results demonstrate the utility of association mapping without directly observing cases. We anticipate that GWAX will prove useful in future genetic studies of complex traits in large population cohorts.",adult;aged;Alzheimer disease;article;biobank;case control study;cohort analysis;controlled study;coronary artery disease;female;first-degree relative;gene frequency;gene locus;gene mapping;genome-wide association study;human;immunosurveillance;major clinical study;male;meta analysis (topic);non insulin dependent diabetes mellitus;phenotype;priority journal;proxy;United Kingdom,"Liu, J. Z.;Erlich, Y.;Pickrell, J. K.",2017,,10.1038/ng.3766,0,
2665,"Large-scale prediction of adverse drug reactions using chemical, biological, and phenotypic properties of drugs","Dementia with Lewy bodies was first recognized as a separate entity about 30 years ago. The prevalence varies from 0% to 5% in the general population, and this disease accounts for 0% to 30.5% of all dementia cases. Dementia with Lewy bodies is considered the second most common cause of degenerative dementia after Alzheimer's disease. The disease is characterized by alpha-synuclein immunoreactive protein deposits in both neurons and glial cells. The protein deposits are especially prominent in dopaminergic neurons, where they can be detected using conventional histological stains, such as hematoxylin and eosin, and are commonly referred to as Lewy bodies. The diagnosis of dementia with Lewy bodies is based on the presence of dementia as well as 2 of the following 3 core diagnostic features: 1) fluctuating cognition, 2) visual hallucinations, and 3) movement disorder. Diagnostic tests include laboratory data, structural and functional imaging, and electroencephalography. Differential diagnosis of dementia with Lewy bodies focuses on other later life dementia syndromes, other parkinsonian diseases (Parkinson's disease, progressive supranuclear palsy, corticobasal degeneration), and primary psychiatric illnesses. There is type 1b evidence to support treatment with cholinesterase inhibitors. Glutamatergic and dopaminergic therapies are used as well. Standard neuroleptics are contraindicated, and atypical agents should be used cautiously. Nonpharmacologic measures - therapeutic environment, psychological and social support, physical activity, behavioral management strategies, caregivers' education and support, and different services - could be suggested.",cerivastatin;protein;rofecoxib;adverse drug reaction;algorithm;article;Bayesian learning;biological activity;conceptual framework;controlled study;drug structure;drug surveillance program;drug targeting;heart infarction;human;intermethod comparison;k nearest neighbor;logistic regression analysis;machine learning;model;phenotype;prediction;random forest;rhabdomyolysis;support vector machine;validation study;baycol;vioxx,"Liu, M.;Wu, Y.;Chen, Y.;Sun, J.;Zhao, Z.;Chen, X. W.;Matheny, M. E.;Xu, H.",2012,,,0,
2666,Application of 1H magnetic resonance spectroscopy in the diagnosis and treatment of mild cognitive impairment,"Objective: To investigate the role of proton magnetic resonance spectroscopy (1H-MRS) in the diagnosis and treatment of mild cognitive impairment (MCI). Methods: the MCI patients were randomly divided into experiment group and the control group. When grouping, the patients were performed the Mini-Mental State Examination (MMSE) scoring, 1H-MRS detection, and calculated the ratios of N-Acetylaspartate/creatine (NAA/Cr), N-Acetylaspartate/myo-inositol (NAA/mI) and choline-containing compounds/creatine (Cho/Cr). The experiment group was orally administrated the huperzine tablet for six months. The changes of MMSE score and 1H-MRS indicators were observed, and the follow up lasted a year to calculate the conversion ratio of MCI to dementia; according to whether existed the dementia conversion, the control group was divided into two subgroups for the analysis of differences in the 1H-MRS indicators when grouping. Results: The MMSE score, changes of 1H-MRS indicators and conversion ratio of dementia of the treatment group were statistically significant to the control group (P<0.01). The dementia-conversion subgroup had the statistical significance in 1H-MRS indicators than the non-conversion subgroup (P<0.01). Conclusions: Proton magnetic resonance spectroscopy is helpful for the early diagnosis of mild cognitive impairment in dementia patients.",cholinesterase inhibitor;creatine;huperzine;inositol;n acetylaspartic acid;nootropic agent;unclassified drug;adult;aged;article;Chinese medicine;clinical article;cognitive function test;controlled study;dementia;diabetes mellitus;diagnostic accuracy;diet;early diagnosis;evaluation study;exercise;female;follow up;hippocampus;human;hypertension;ischemic heart disease;male;memory disorder;mild cognitive impairment;Mini Mental State Examination;parietal lobe;posterior cingulate;predictive value;proton nuclear magnetic resonance;very elderly,"Liu, N.;Huang, X.;Huang, X.;Liu, S.;Chen, H.;Li, X.;Peng, W.",2016,,,0,
2667,Far from resolved: Stromal cell-based iTRAQ research of muscle-invasive bladder cancer regarding heterogeneity,"The aim of the present study was to globally characterize the cancer stroma expression profile of muscle-invasive bladder cancer in different metastatic risk groups and to discuss the decisive role of biological pathway change in cancer heterogeneity. Laser capture microdissection was employed to harvest purified muscle-invasive bladder cancer stromal cells derived from 30 clinical samples deriving from 3 different metastatic risk groups. Isobaric tags for relative and absolute quantitation (iTRAQ) and two-dimensional liquid chromatography tandem mass spectrometry (2D LC-MS/MS) were used to identify the differentially expressed proteins. Subsequently, the differentially expressed proteins were further analyzed by bioinformatics tools. After completing the above tasks, the proteins of interest were further compared with the published litterature. We identified 1,049 differentially expressed proteins by paired comparison (high risk vs. median, low risk and normal groups; median risk vs. low risk and normal groups, low risk vs. normal group; a total of 6 comparisons). A total of 510,549,548 proteins as significantly altered (ratio fold-change ≥1.5 or ≤0.667 between the metastatic potential risk group and the normal group) were presented in the low/ median/high metastatic risk group, respectively. Pathway analysis revealed that the differentially expressed proteins were mainly located in the Kyoto Encyclopedia of Genes and Genomes pathways, including focal adhesion pathway, systemic lupus erythematosus pathway and ECM-receptor interaction pathway. In addition, several proteins such as EXOC4, MYH10 and MMP-9 may serve as candidate biomarkers of muscle-invasive bladder cancer. Our study confirmed that stromal cells, an important part of the cancer tissue, are pivotal for regulating the heterogeneity of cancer. Common changes in biological pathways determined the malignant phenotype of muscle-invasive bladder cancer, and biomarker discovery should take into account both neoplastic cells and their corresponding stromata.",alpha 2 macroglobulin;alpha actinin 1;alpha actinin 4;beta actin;CD59 antigen;collagen;exocyst;fibronectin;gelatinase B;growth factor receptor bound protein 2;heat shock protein 90;Hermes antigen;hypoxia inducible factor 1;laminin;macrophage migration inhibition factor;myosin;S phase kinase associated protein;talin;tenascin;thrombospondin 1;vasculotropin;Alzheimer disease;amebiasis;article;cation exchange;cell heterogeneity;clinical article;clinical pathway;congestive cardiomyopathy;controlled study;high risk population;human;human cell;human tissue;hypertrophic cardiomyopathy;isobaric tags for relative and absolute quantitation;laser capture microdissection;liquid chromatography;low risk population;male;mass spectrometry;metastasis potential;muscle invasive bladder cancer;Parkinson disease;pertussis;phenotype;priority journal;protein analysis;protein expression;protein processing;quantitative analysis;Staphylococcus infection;stroma cell;systemic lupus erythematosus;tandem mass spectrometry;tight junction,"Liu, P. F.;Wang, Y. H.;Cao, Y. W.;Jiang, H. P.;Yang, X. C.;Wang, X. S.;Niu, H. T.",2014,,,0,
2668,Serious conditions for ED elderly fall patients: a secondary analysis of the Basel Non-Specific Complaints study,"Objective Falls among older adults are a public health problem and are multifactorial. We sought to determine whether falls predict more serious conditions in older adult patients presenting to the emergency department (ED) with a “nonspecific complaint” (NSC). A secondary objective was to examine what factors predicted serious conditions among older adult patients with a fall. Methods This study was a secondary analysis of a prospective delayed-type cross-sectional diagnostic study that included a 30-day follow-up. We included patients 65 years and older who presented to the ED from May 2007 and July 2011 with a NSC and had an Emergency Severity Index score of 2 or 3. We then compared the serious conditions among older adults who presented to the ED with a fall with those who did not fall in a cohort of patients with NSC. Results We had 1111 patients enrolled in our study; 518 (47%) of them had fallen. We found that 310 (60%) of elderly fall patients vs 349 (59%) of nonfall patients had a 30-day serious condition (P = .74). In multiple logistic regression analysis, falls did not predict serious conditions or 30-day mortality among all NSC patients. Among fall patients, male sex, diuretic use, and generalized weakness predicted serious conditions. Conclusion Fall patients share many features with nonfall NSC patient. However, falls did not increase the risk of serious conditions. Falls in the elderly could be considered under the broader entity of NSC.",diuretic agent;aged;anemia;anxiety;article;behavior disorder;brain hemorrhage;cohort analysis;cross-sectional study;dehydration;dementia;depression;drug use;electrolyte disturbance;emergency ward;epilepsy;faintness;falling;female;follow up;functional disease;gait disorder;general condition;heart failure;heart muscle ischemia;human;injury;ischemia;kidney failure;major clinical study;male;malignant neoplastic disease;mental disease;mortality;orthostatic hypotension;pneumonia;priority journal;prospective study;secondary analysis;urinary tract infection;weakness,"Liu, S. W.;Sri-On, J.;Tirrell, G. P.;Nickel, C.;Bingisser, R.",2016,,,0,
2669,Influence of Amyloid-β on Cognitive Decline after Stroke/Transient Ischemic Attack: Three-Year Longitudinal Study,"Background and Purpose-We hypothesized that comorbid amyloid-beta (Aβ) deposition played a key role in long-term cognitive decline in subjects with stroke/transient ischemic attack. Methods-We recruited 72 subjects with cognitive impairment after stroke/transient ischemic attack to receive Carbon-11-labeled Pittsburgh compound B positron emission tomography. We excluded subjects with known clinical Alzheimer's disease. Those with and without Alzheimer's disease-like Aβ deposition were classified as mixed vascular cognitive impairment (mVCI, n=14) and pure VCI (pVCI, n=58), respectively. We performed Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment to evaluate global cognition and cognitive domains (memory, visuospatial function, language, attention, and executive function) at 3 to 6 months (baseline) and annually for 3 years after the index event. We compared cognitive changes between mVCI and pVCI using linear mixed models and analysis of covariance adjusted for age and education. Results-Over 3 years, there were significant differences between mVCI and pVCI on change of MMSE score over time (group×time interaction, P=0.007). We observed a significant decline on MMSE score (P=0.020) in the mVCI group but not in the pVCI group (P=0.208). The annual rates of decline on MMSE (P=0.023) and Montreal Cognitive Assessment score (P=0.003) were greater in the mVCI group than in the pVCI group. Memory, visuospatial, and executive function domain scores on the Montreal Cognitive Assessment were related to Aβ deposition. Conclusions-Compared with subjects without Alzheimer's disease-like Aβ deposition, those with Aβ deposition experienced a more severe and rapid cognitive decline over 3 years after stroke/transient ischemic attack. Aβ was associated with changes in multiple cognitive domains.",amyloid beta protein;Pittsburgh compound B;age;aged;Alzheimer disease;article;atrial fibrillation;attention;cardiovascular risk;cerebrovascular accident;cognition;cognitive defect;congestive heart failure;depth perception;diabetes mellitus;education;executive function;female;human;hyperlipidemia;hypertension;ischemic heart disease;language;longitudinal study;major clinical study;male;memory;Mini Mental State Examination;Montreal cognitive assessment;positron emission tomography;priority journal;transient ischemic attack,"Liu, W.;Wong, A.;Au, L.;Yang, J.;Wang, Z.;Leung, E. Y. L.;Chen, S.;Ho, C. L.;Mok, V. C. T.",2015,,,0,
2670,"The China Stroke Secondary Prevention Trial (CSSPT) protocol: a double-blinded, randomized, controlled trial of combined folic acid and B vitamins for secondary prevention of stroke","RATIONALE: Epidemiological studies suggest that elevated homocysteine is linked to stroke and heart disease. However, the results of lowering homocysteine levels in reducing the risk of stroke recurrence are controversial. AIMS: The study aims to evaluate whether homocysteine-lowering therapy with folic acid and vitamins B6 and B12 reduces recurrent stroke events and other combined incidence of recurrent vascular events and vascular death in ischemic stroke patients of low folate regions. DESIGN: This is a multicenter, randomized, double-blinded, placebo-controlled trial. Patients (n = 8000, ? = 0.05, ? = 0.10) within one-month of ischemic stroke (large-artery atherosclerosis or small-vessel occlusion) or hypertensive intracerebral haemorrhage with plasma homocysteine level ? 15 ?mol/l will be enrolled. Eligible patients will be randomized by a web-based, random allocation system to receive multivitamins (folic acid 0.8 mg, vitamin B6 10 mg, and vitamin B12 500 ?g) or matching placebo daily with a median follow-up of three-years. STUDY OUTCOMES: Patients will be evaluated at six monthly intervals. The primary outcome event is the composite event 'stroke, myocardial infarction, or death from any vascular cause', whichever occurs first. Secondary outcome measures include nonvascular death, transient ischemic attack, depression, dementia, unstable angina, revascularization procedures of the coronary, and cerebral and peripheral circulations. DISCUSSION: This is the first multicenter randomized trial of secondary prevention for ischemic stroke in a Chinese population with a higher homocysteine level but without folate food fortification.",adult;aged;article;atherosclerosis;blood vessel occlusion;brain circulation;brain hemorrhage;brain ischemia/pc [Prevention];brain ischemia/dt [Drug Therapy];controlled study;coronary artery blood flow;dementia;depression;double blind procedure;follow up;heart infarction;human;incidence;major clinical study;multicenter study;outcome assessment;peripheral circulation;priority journal;randomized controlled trial;revascularization;secondary prevention;transient ischemic attack;unstable angina pectoris;vitamin supplementation;cyanocobalamin/cb [Drug Combination];cyanocobalamin/dt [Drug Therapy];cyanocobalamin/ct [Clinical Trial];folic acid/cb [Drug Combination];folic acid/dt [Drug Therapy];folic acid/ct [Clinical Trial];homocysteine/ec [Endogenous Compound];placebo;pyridoxine/cb [Drug Combination];pyridoxine/dt [Drug Therapy];pyridoxine/ct [Clinical Trial];Sr-stroke,"Liu, X.;Shi, M.;Xia, F.;Han, J.;Liu, Z.;Wang, B.;Yang, F.;Li, L.;Wu, S.;Wang, L.;Liu, N.;Lv, Y.;Zhao, G.",2015,,10.1111/ijs.12017,0,2671
2671,"The China Stroke Secondary Prevention Trial (CSSPT) protocol: a double-blinded, randomized, controlled trial of combined folic acid and B vitamins for secondary prevention of stroke","AIMS: The study aims to evaluate whether homocysteine-lowering therapy with folic acid and vitamins B6 and B12 reduces recurrent stroke events and other combined incidence of recurrent vascular events and vascular death in ischemic stroke patients of low folate regions.DESIGN: This is a multicenter, randomized, double-blinded, placebo-controlled trial. Patients (n = 8000, ? = 0.05, ? = 0.10) within one-month of ischemic stroke (large-artery atherosclerosis or small-vessel occlusion) or hypertensive intracerebral haemorrhage with plasma homocysteine level ? 15 ?mol/l will be enrolled. Eligible patients will be randomized by a web-based, random allocation system to receive multivitamins (folic acid 0.8 mg, vitamin B6 10 mg, and vitamin B12 500 ?g) or matching placebo daily with a median follow-up of three-years.STUDY OUTCOMES: Patients will be evaluated at six monthly intervals. The primary outcome event is the composite event 'stroke, myocardial infarction, or death from any vascular cause', whichever occurs first. Secondary outcome measures include nonvascular death, transient ischemic attack, depression, dementia, unstable angina, revascularization procedures of the coronary, and cerebral and peripheral circulations.DISCUSSION: This is the first multicenter randomized trial of secondary prevention for ischemic stroke in a Chinese population with a higher homocysteine level but without folate food fortification.RATIONALE: Epidemiological studies suggest that elevated homocysteine is linked to stroke and heart disease. However, the results of lowering homocysteine levels in reducing the risk of stroke recurrence are controversial.",adult;aged;article;atherosclerosis;blood vessel occlusion;brain circulation;brain hemorrhage;brain ischemia/pc [Prevention];brain ischemia/dt [Drug Therapy];controlled study;coronary artery blood flow;dementia;depression;double blind procedure;follow up;heart infarction;human;incidence;major clinical study;multicenter study;outcome assessment;peripheral circulation;priority journal;randomized controlled trial;revascularization;secondary prevention;transient ischemic attack;unstable angina pectoris;vitamin supplementation;cyanocobalamin/cb [Drug Combination];cyanocobalamin/dt [Drug Therapy];cyanocobalamin/ct [Clinical Trial];folic acid/cb [Drug Combination];folic acid/dt [Drug Therapy];folic acid/ct [Clinical Trial];homocysteine/ec [Endogenous Compound];placebo;pyridoxine/cb [Drug Combination];pyridoxine/dt [Drug Therapy];pyridoxine/ct [Clinical Trial];Sr-stroke: sr-vasc,"Liu, X;Shi, M;Xia, F;Han, J;Liu, Z;Wang, B;Yang, F;Li, L;Wu, S;Wang, L;Liu, N;Lv, Y;Zhao, G",2015,,10.1111/ijs.12017,0,
2672,"Delayed-start analysis: Mild Alzheimer's disease patients in solanezumab trials, 3.5 years","Introduction Solanezumab is an anti-amyloid monoclonal antibody in clinical testing for treatment of Alzheimer's disease (AD). Its mechanism suggests the possibility of slowing the progression of AD. Methods A possible disease-modifying effect of solanezumab was assessed using a new statistical method including noninferiority testing. Performance differences were compared during the placebo-controlled period with performance differences after the placebo patients crossed over to solanezumab in the delayed-start period. Results Noninferiority of the 14-item Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog14) and Alzheimer's Disease Cooperative Study Activities of Daily Living inventory instrumental items (ADCS-iADL) differences was met through 132 weeks, indicating that treatment differences observed in the placebo-controlled period remained, within a predefined margin, after the placebo group initiated solanezumab. Solanezumab was well tolerated, and no new safety concerns were identified. Discussion The results of this secondary analysis show that the mild subgroup of solanezumab-treated patients who initiated treatment early, at the start of the placebo-controlled period, retained an advantage at most time points in the delayed-start period.",apolipoprotein E4;placebo;solanezumab;aged;Alzheimer disease;Alzheimer Disease Assessment Scale;Alzheimer disease assessment scale cognitive subscale;Alzheimer disease cooperative study activities of daily living inventory;angina pectoris;article;clinical assessment tool;disease course;disease severity;drug safety;drug tolerability;early intervention;female;heart arrhythmia;heart infarction;human;major clinical study;male;Mini Mental State Examination;priority journal,"Liu-Seifert, H.;Siemers, E.;Holdridge, K. C.;Andersen, S. W.;Lipkovich, I.;Carlson, C.;Sethuraman, G.;Hoog, S.;Hayduk, R.;Doody, R.;Aisen, P.",2015,,,0,
2673,Coma,Coma is caused by temporary or permanent damage to the ascending reticular system or to both cerebral hemispheres. It follows that the differential diagnosis of coma is wide. Emergency management of the comatose patient should be instituted as soon as possible to prevent secondary cerebral injury. Accurate diagnosis of the cause requires careful history taking and meticulous general medical and neurological examination followed by targeted investigations. © 2010 Elsevier Ltd. All rights reserved.,alcohol;amphetamine;anesthetic agent;barbituric acid derivative;carbon monoxide;cyanide;lead;methanol;opiate;salicylic acid;sedative agent;thallium;acute disseminated encephalomyelitis;anamnesis;arteriovenous malformation;artery thrombosis;basilar artery;brain hemorrhage;brain injury;brain ischemia;brain stem injury;catatonia;central pontine myelinolysis;cerebellum hemorrhage;coma;computer assisted tomography;consciousness;Creutzfeldt Jakob disease;differential diagnosis;eclampsia;electrolyte disturbance;emergency care;encephalitis;endocarditis;epidural hematoma;epileptic state;Glasgow coma scale;Hashimoto encephalopathy;heart arrest;hemisphere;human;hypercapnia;hyperglycemia;hypertension encephalopathy;hyperthermia;hyperthyroidism;hypoglycemia;hypopituitarism;hypothermia;hypothyroidism;hypoxemia;inborn error of metabolism;infarction;kidney failure;leukoencephalopathy;liver failure;lumbar puncture;malaria;medical examination;meningism;meningitis;multiple sclerosis;neurologic examination;ophthalmoscopy;persistent vegetative state;porphyria;priority journal;reticular formation;Reye syndrome;sepsis;short survey;cerebrovascular accident;subarachnoid hemorrhage;subdural empyema;subdural hematoma;temperature;vasculitis;vein thrombosis;Wernicke encephalopathy,"Liversedge, T.;Hirsch, N.",2010,,,0,
2674,The pathogenesis of brain failure in the aged,,"Aged;Arrhythmias, Cardiac/complications;Cerebrovascular Circulation;Dementia/*etiology;Electrocardiography;Humans;Ischemic Attack, Transient/complications;Middle Aged;Myocardial Infarction/complications","Livesley, B.",1977,,,0,
2675,Long-term survival and toxicity in small cell lung cancer. Southwest Oncology Group study,"In the first study of combined chemotherapy of radiation therapy for small cell lung cancer by the Southwest Oncology Group, 17 patients survived more than 5 years after treatment was initiated (4.6%). Late relapse, or a second primary malignancy 3 to 6 years after diagnosis, accounted for death in 5 of these patients. Late recurrences involved the chest, bone, and liver; none occurred in the central nervous system. Disease-free survival continues in 10 patients (6% of those with limited disease and 1% of those with extensive-stage disease) at a minimal follow-up in excess of 6 years. One definite case of chronic treatment-related toxicity occurred: congestive cardiomyopathy after 450 mg/m2 of doxorubicin, successfully managed with digitalis and diuretics. One severe neurologic problem (orthostatic hypotension with preterminal dementia) and 2 less severe neurologic complications (occasional falling episodes without documented cause and cerebrovascular accident) may be treatment-related. Progressive pulmonary disability, post-herpetic pain syndromes, organic brain syndrome, and hematologic abnormalities have not been observed to date. Nitrosourea administration and/or co-administration of a nitrosourea or methotrexate during the induction phase of treatment with radiotherapy to the brain may account for the higher incidence of complications observed by others in long-term survivors.",cyclophosphamide;doxorubicin;lomustine;methotrexate;nitrosourea derivative;vincristine;adverse drug reaction;cancer combination chemotherapy;cardiotoxicity;cardiovascular system;chemotherapy;clinical article;congestive cardiomyopathy;dementia;drug therapy;heart;human;intoxication;intravenous drug administration;small cell lung cancer;nervous system;neurotoxicity;orthostatic hypotension;radiotherapy;respiratory system;survival;therapy;toxicity,"Livingston, R. B.;Stephens, R. L.;Bonnet, J. D.",1984,,,0,
2676,Dementia and other chronic diseases in older adults in havana and matanzas: The 10/66 study in Cuba,"INTRODUCTION: Chronic non-communicable diseases are the leading cause of death worldwide, except in Sub-Saharan Africa. Nonetheless, one of these conditions, dementia, is the major contributor to disability-adjusted life years in people aged ≥60 years. Few epidemiological studies exist of the prevalence and impact of dementia and selected chronic diseases in older adults in Latin America. OBJECTIVE: Describe prevalence of dementia, other chronic vascular diseases and cardiovascular risk factors, as well as resulting disabilities and care needs generated in adults aged ≥65 years in Havana City and Matanzas provinces, Cuba. METHODS: The 10/66 study is a prospective longitudinal study involving a cohort of 3015 adults aged ≥65 years in municipalities of Havana City and Matanzas provinces, divided into two phases: a cross-sectional door-to-door study conducted in 2003-2006, and a follow-up and assessment phase in 2007-2010. This article reports findings from the first phase. Hypertension diagnosis was based on criteria from the International Society for Hypertension; diabetes mellitus on American Diabetes Association criteria; stroke according to WHO definitions; and dementia according to criteria of the American Psychiatric Society's Diagnostic and Statistical Manual of Mental Disorders DSMIV and the 10/66 International Dementia Research Group. Ischemic heart disease was defined by self-report of previous physician diagnosis. Study variables included age, sex, educational level, substance use (alcohol, tobacco) and dietary habits. A structured physical and neurological exam, including blood pressure measurement, was performed on all participants. Laboratory tests included complete blood count, fasting blood glucose, total cholesterol and lipoprotein fractions, triglycerides and apolipoprotein E genotype. Prevalence and standardized morbidity ratios (crude and adjusted) were calculated for chronic diseases studied with 95% confidence intervals, using a Poisson regression model and indirect standardization. RESULTS: The study assessed 2944 older adults (response rate 97.6%) and found high prevalence of vascular risk factors and of chronic non-communicable diseases: hypertension 73.0% (95% CI 71.4-74.7), diabetes mellitus 24.8% (95% CI 22.9-26.5), ischemic heart disease 14.1% (95% CI 12.9-15.4), dementia 10.8% (95% CI 9.7-12.0) and stroke 7.8% (95% CI 6.9-8.8). The majority of participants (85%) had more than one cardiovascular risk factor. The main cause of disability and dependency in the study population was dementia. CONCLUSION: The high prevalence of chronic diseases observed in the elderly - with the consequent morbidity, disability and dependency - highlights the need for prevention, early diagnosis and risk factor control, particularly given the demographic and epidemiologic transition faced by Cuba and other developing countries.",aged;article;cardiovascular risk;chronic disease;Cuba;dementia;diabetes mellitus;disability;female;follow up;human;hypertension;ischemic heart disease;major clinical study;male;prevalence;cerebrovascular accident;vascular disease,"Llibre Rodríguez, J. D. J.;Valhuerdi, A.;Calvo, M.;Garciá, R. M.;Guerra, M.;Laucerique, T.;Loṕez, A. M.;Llibre, J. C.;Noriega, L.;Sańchez, I. Y.;Porto, R.;Arencibia, F.;Marcheco, B.;Moreno, C.",2011,,,0,
2677,"Prevalence of stroke and associated risk factors in older adults in Havana City and Matanzas Provinces, Cuba (10/66 population-based study)","INTRODUCTION: Cerebrovascular disease (CVD) is the third cause of death and second cause of disability and dementia in adults aged ¡Ý65 years worldwide. The few epidemiological studies of stroke in Latin America generally report lower prevalence and different patterns than developed countries. OBJECTIVE: Estimate the prevalence of stroke and associated risk factors in adults aged ¡Ý65 years in Havana City and Matanzas provinces, Cuba. METHODS: Single phase, cross-sectional, door-to-door study of 3015 adults aged ¡Ý65 years in selected municipalities of Havana City and Matanzas provinces. Variables studied were age, sex, educational level, and self-report and description of chronic disease (stroke, heart attack, angina, and diabetes mellitus), substance use (alcohol, tobacco), and dietary habits. Respondents were given a structured physical and neurological exam, and blood pressure was measured. Laboratory tests comprised complete blood count, fasting glucose, total cholesterol and fractions, triglycerides, and apolipoprotein E (APOE) genotype. Diagnosis of stroke was based on the World Health Organization's definition. Stroke prevalence ratios (crude and adjusted), with 95% confidence intervals (CI), were calculated for the variables studied using a Poisson regression model. Risk association was analyzed using multiple logistic regression for dichotomous responses. RESULTS: Assessments were made of 2944 older adults (97.6% response rate). Prevalence of stroke was 7.8% (95% CI 6.9-8.8), and was higher in men. The risk profile for this population group included history of hypertension (OR 2.8; 95% CI 2.0-4.0), low HDL cholesterol (OR 2.6; 95% CI 1.7-3.9), male sex (OR 1.7; 95% CI 1.2-2.5), anemia (OR 1.6; 95% CI 1.1-2.5), history of ischemic heart disease (OR 1.5; 95% CI 1.0-2.3), carrier of one or two apolipoprotein E4 genotype (APOE ε4) alleles (OR 1.4; 95% CI 1.0-2.0), and advanced age (OR 1.3; 95% CI 1.1-1.9). CONCLUSIONS: Stroke prevalence in this study is similar to that reported for Europe and North America, and higher than that observed in other Latin American countries. The risk profile identified includes classic risk factors plus anemia and APOE ε4 genotype.",apolipoprotein E4;cholesterol;glucose;high density lipoprotein cholesterol;triacylglycerol;age;aged;alcohol consumption;anemia;angina pectoris;article;blood cell count;blood pressure measurement;cardiovascular risk;cholesterol blood level;clinical assessment;Cuba;diabetes mellitus;dietary intake;disease association;gene frequency;genotype;glucose blood level;heart infarction;human;ischemic heart disease;major clinical study;medical history;neurologic examination;physical examination;prevalence;risk factor;self report;sex difference;smoking;cerebrovascular accident;triacylglycerol blood level,"Llibre Rodríguez, J. D. J.;Valhuerdi Cepero, A.;Fernández Concepción, O.;Llibre Guerra, J. C.;Porto Alvarez, R.;López Medina, A. M.;Marcheco Teruel, B.;Moreno Carbonell, C.",2010,,,0,
2678,Reply,,chronic obstructive lung disease;dementia;DSM-5;early diagnosis;empirical research;etiology;human;ischemic heart disease;letter;mental patient;mild cognitive impairment;neuropsychiatry;prevalence;priority journal;validation study,"Lobo, A.;Dewey, M.;López Antón, R.;Lobo, E.;Modrego, P.;Rodríguez Mañas, L.",2015,,,0,
2679,Back to the future: hormone replacement therapy as part of a prevention strategy for women at the onset of menopause,"In the late 1980s, several observational studies and meta-analyses suggested that hormone replacement therapy (HRT) was beneficial for prevention of osteoporosis, coronary heart disease, dementia and decreased all-cause mortality. In 1992, the American College of Physicians recommended HRT for prevention of coronary disease. In the late 1990s and early 2000s, several randomized trials in older women suggested coronary harm and that the risks, including breast cancer, outweighed any benefit. HRT stopped being prescribed at that time, even for women who had severe symptoms of menopause. Subsequently, reanalyzes of the randomized trial data, using age stratification, as well as newer studies, and meta-analyses have been consistent in showing that younger women, 50-59 years or within 10 years of menopause, have decreased coronary disease and all-cause mortality; and did not have the perceived risks including breast cancer. These newer findings are consistent with the older observational data. It has also been reported that many women who abruptly stopped HRT had more risks, including more osteoporotic fractures. The current data confirm a ""timing"" hypothesis for benefits and risks of HRT, showing that younger have many benefits and few risks, particularly if therapy is predominantly focused on the estrogen component. We discuss these findings and put into perspective the potential risks of treatment, and suggest that we may have come full circle regarding the use of HRT. In so doing we propose that HRT should be considered as part of a general prevention strategy for women at the onset of menopause. Copyright © 2016 Elsevier Ireland Ltd",breast cancer;college;controlled clinical trial;controlled study;dementia;drug therapy;female;fragility fracture;hormone substitution;human;ischemic heart disease;menopause;meta analysis;mortality;observational study;osteoporosis;physician;prevention;randomized controlled trial;stratification;symptom;estrogen,"Lobo, Ra;Pickar, Jh;Stevenson, Jc;Mack, Wj;Hodis, Hn",2016,,10.1016/j.atherosclerosis.2016.10.005,0,
2680,Where are we 10 years after the women's health initiative?,"The media attention surrounding the publication of the initial results of WHI in 2002 led to fear and confusion regarding the use of hormonal therapy (HT) after menopause. This led to a dramatic reduction in prescriptions for HT in the United States and around the world. Although in 2002 it was stated that the results pertained to all women receiving HT, subsequent studies from the Women's Health Initiative (WHI) and others clearly showed that younger women and those close to menopause had a very beneficial risk-to-benefit ratio. Indeed, the results showed similar protective effects for coronary disease and a reduction in mortality that had been shown in earlier observational studies, which had also focused on younger symptomatic women. In younger women, the increased number of cases of venous thrombosis and ischemic stroke was low, rendering them ""rare"" events using World Health Organization nomenclature. Breast cancer rates were also low and were found to be decreased with estrogen alone. In women receiving estrogen and progestogen for the first time in the WHI, breast cancer rates did not increase significantly for 7 years. Other data suggest that other regimens and the use of other progestogens may also be safer. It has been argued that in the 10 years since WHI, many women have been denied HT, including those with severe symptoms, and that this has significantly disadvantaged a generation of women. Some reports have also suggested an increased rate of osteoporotic fractures since the WHI. Therefore, the question is posed as to whether we have now come full circle in our understanding of the use of HT in younger women. Although it is appropriate to treat women with symptoms at the onset of menopause, because there is no proven therapy for primary prevention, in some women the use of HT for this role may at least be entertained. Copyright © 2013 by The Endocrine Society.",conjugated estrogen;estradiol;estrogen;gestagen;medroxyprogesterone;nomegestrol acetate;norethisterone acetate;placebo;progesterone;promegestone;age distribution;Alzheimer disease;arterial wall thickness;article;brain ischemia;breast cancer;cancer risk;cardiovascular response;cerebrovascular accident;cognition;coronary artery calcium score;coronary artery disease;cost effectiveness analysis;dementia;diabetes mellitus;drug efficacy;fragility fracture;heart infarction;heart protection;hormonal therapy;hormone response;human;menopause;mood;osteoporosis;priority journal;randomized controlled trial (topic);risk assessment;risk factor;risk reduction;vein thrombosis;women's health,"Lobo, R. A.",2013,,,0,
2681,Prevention of diseases after menopause,"Women may expect to spend more than a third of their lives after menopause. Beginning in the sixth decade, many chronic diseases will begin to emerge, which will affect both the quality and quantity of a woman's life. Thus, the onset of menopause heralds an opportunity for prevention strategies to improve the quality of life and enhance longevity. Obesity, metabolic syndrome and diabetes, cardiovascular disease, osteoporosis and osteoarthritis, cognitive decline, dementia and depression, and cancer are the major diseases of concern. Prevention strategies at menopause have to begin with screening and careful assessment for risk factors, which should also include molecular and genetic diagnostics, as these become available. Identification of certain risks will then allow directed therapy. Evidence-based prevention for the diseases noted above include lifestyle management, cessation of smoking, curtailing excessive alcohol consumption, a healthy diet and moderate exercise, as well as mentally stimulating activities. Although the most recent publications from the follow-up studies of the Women's Health Initiative do not recommend menopause hormonal therapy as a prevention strategy, these conclusions may not be fully valid for midlife women, on the basis of the existing data. For healthy women aged 50-59 years, estrogen therapy decreases coronary heart disease and all-cause mortality; this interpretation is entirely consistent with results from other randomized, controlled trials and observational studies. Thus. as part of a comprehensive strategy to prevent chronic disease after menopause, menopausal hormone therapy, particularly estrogen therapy may be considered as part of the armamentarium.",acetylsalicylic acid;alendronic acid;bazedoxifene;bisphosphonic acid derivative;denosumab;estrogen;gestagen;hydroxymethylglutaryl coenzyme A reductase inhibitor;metformin;placebo;raloxifene;selective estrogen receptor modulator;adult;alcohol consumption;Alzheimer disease;arthritis;article;atherosclerosis;breast cancer;cancer mortality;cardiovascular disease;cardiovascular mortality;cerebrovascular accident;chronic arthritis;chronic disease;cognitive defect;dementia;depression;diabetes mellitus;diet supplementation;diet therapy;endometrium cancer;estrogen therapy;evidence based practice;exercise;follow up;fragility fracture;genetic analysis;heart failure;heart infarction;hip fracture;hormonal therapy;human;insulin resistance;ischemic heart disease;lifestyle;longevity;menopause;meta analysis (topic);metabolic syndrome X;molecular diagnostics;mortality;neoplasm;non insulin dependent diabetes mellitus;obesity;osteoarthritis;osteopenia;osteoporosis;primary prevention;prophylaxis;quality of life;randomized controlled trial (topic);risk assessment;screening;smoking cessation;sudden death;systematic review (topic);unstable angina pectoris;women's health,"Lobo, R. A.;Davis, S. R.;De Villiers, T. J.;Gompel, A.;Henderson, V. W.;Hodis, H. N.;Lumsden, M. A.;Mack, W. J.;Shapiro, S.;Baber, R. J.",2014,,,0,
2682,Somatic and psychiatric comorbidity in the general elderly population: Results from the ZARADEMP Project,"Objective: In a representative sample of the elderly population in a southern European city, we tested the hypothesis that there is an association between general somatic and general psychiatric morbidity. Methods: A stratified random sample of 4803 individuals aged ≥55 years was selected for the baseline study in the ZARADEMP Project. The elderly were assessed with standardized Spanish versions of instruments, including the Geriatric Mental State (GMS)-AGECAT. Psychiatric cases were diagnosed according to GMS-AGECAT criteria, and somatic morbidity was documented with the EURODEM Risk Factors Questionnaire. Results: General comorbidity clustered in 19.9% of the elderly when hypertension was removed from the somatic conditions category, with 33.5% of the sample remaining free from both somatic and psychiatric illnesses. General comorbidity was associated with age, female gender, and limited education, but did not increase systematically with age. The frequency of psychiatric illness was higher among the somatic cases than among noncases, and the frequency of somatic morbidity among the psychiatric cases was higher than among noncases. This association between somatic and psychiatric morbidity remained statistically significant after controlling for age, gender, and education [odds ratio (OR)=1.61; confidence interval (CI)=1.38-1.88]. Most somatic categories were associated with psychiatric illness, but after adjusting for demographic variables and individual somatic illnesses, the association remained statistically significant only for cerebrovascular accidents (CVAs) (OR=1.47; CI=1.09-1.98) and thyroid disease (OR=1.67; CI=1.10-2.54). Conclusion: This is the first study to document that there is a positive and statistically significant association between general somatic morbidity and general psychiatric morbidity in the (predominantly) elderly population. CVAs and thyroid disease may have more weight in this association. © 2008 Elsevier Inc. All rights reserved.",adult;aged;aging;angina pectoris;anxiety disorder;article;cerebrovascular accident;comorbidity;dementia;depression;diabetes mellitus;disease association;disease severity;epilepsy;female;head injury;heart infarction;human;hypertension;major clinical study;male;mental disease;prevalence;questionnaire;risk factor;thyroid disease,"Lobo-Escolar, A.;Saz, P.;Marcos, G.;Quintanilla, M. Á;Campayo, A.;Lobo, A.",2008,,,0,
2683,Use of rational phytopharmaceuticals in the daily practice,"Medicinal herbs are some of the oldest remedies in human medicine. The so-called rational phytopharmaceuticals have been derived from these traditional remedies whose applications were predominated by empirical means. Rational phytopharmaceuticals are characterised by the currently available evidence regards their quality, clinical efficacy, and safety. Since these preparations are specially prepared extracts there is the issue of equivalence to the original herb(s). The pharmaceutical and bio-pharmaceutical quality and bio-equivalence of the preparations must be documented by means of pharmacokinetic data, bioassays or specialised efficacy studies in order to document the equivalence of herb and preparation. The pharmacological effects and clinical efficacy of standardised Crataegus and Ginkgo biloba extracts in chronic cardiac insufficiency, NYHA II, and Alzheimer dementia patients were investigated in this study to demonstrate that these preparations are suitable alternatives to chemically-defined preparations.",Crataegus extract;Ginkgo biloba extract;Alzheimer disease;article;bioequivalence;drug quality;heart failure;herb;human;phytotherapy;crataegutt;egb 761;faros 300;li 132;ws 1442,"Loew, D.",2000,,,0,
2684,Meta-analysis of genetic association studies supports a contribution of common variants to susceptibility to common disease,"Association studies offer a potentially powerful approach to identify genetic variants that influence susceptibility to common disease1-4, but are plagued by the impression that they are not consistently reproducible5,6. In principle, the inconsistency may be due to false positive studies, false negative studies or true variability in association among different populations4-8. The critical question is whether false positives overwhelmingly explain the inconsistency. We analyzed 301 published studies covering 25 different reported associations. There was a large excess of studies replicating the first positive reports, inconsistent with the hypothesis of no true positive associations (P < 10-14). This excess of replications could not be reasonably explained by publication bias and was concentrated among 11 of the 25 associations. For 8 of these 11 associations, pooled analysis of follow-up studies yielded statistically significant replication of the first report, with modest estimated genetic effects. Thus, a sizable fraction (but under half) of reported associations have strong evidence of replication; for these, false negative, underpowered studies probably contribute to inconsistent replication. We conclude that there are probably many common variants in the human genome with modest but real effects on common disease risk, and that studies using large samples will convincingly identify such variants.",apolipoprotein E;catechol methyltransferase;cytotoxic T lymphocyte antigen 4;gene product;glucose transporter 1;glucose transporter 2;glutathione transferase M1;protein ABCC8;protein DRD2;protein DRD3;protein GYS1;protein SERPINE1;sterol regulatory element binding protein 1c;unclassified drug;Alzheimer disease;article;bipolar disorder;breast cancer;coronary artery disease;correlation analysis;disease association;follow up;fragility fracture;genetic analysis;genetic susceptibility;genetic variability;head and neck cancer;heart infarction;human;hypertension;insulin dependent diabetes mellitus;non insulin dependent diabetes mellitus;pathogenesis;priority journal;reproducibility;schizophrenia,"Lohmueller, K. E.;Pearce, C. L.;Pike, M.;Lander, E. S.;Hirschhorn, J. N.",2003,,,0,
2685,Risk factors for death in chronic critical illness,,adult;aged;artificial ventilation;cerebrovascular accident;chronic obstructive lung disease;cohort analysis;comparative study;congestive heart failure;critical illness;death;dementia;diabetes mellitus;end stage renal disease;human;hypertension;length of stay;liver cirrhosis;major clinical study;middle aged;note;obesity;priority journal;renal replacement therapy;retrospective study;risk factor;sepsis;survival;tracheostomy,"Lokhandwala, S.;Escobar, B.;Chahin, A.;McCague, N.;Ghassemi, M.;Feng, M.;Celi, L. A.",2015,,,0,
2686,"Brain Imaging and Genetic Risk in the Pediatric Population, Part 1. Inherited Metabolic Diseases","In this article, the genotype-MR phenotype correlation of the most common or clinically important inherited metabolic diseases (IMD) in the pediatric population is reviewed. A nonsystematic search of the PubMed/Medline database of relevant studies about ""genotype-phenotype correlation"" in IMD was performed. Some MR phenotypes related to specific gene mutations were found, such as bilateral hypertrophy of inferior olives in patients harboring POLG and SURF1 mutations, and central lesions in the cervical spinal cord in patients with nonketotic hyperglycinemia harboring GLRX5 gene mutation.",adrenoleukodystrophy;Alpers disease;article;brain;metabolic encephalopathy;cerebrotendinous xanthomatosis;child;chronic progressive external ophthalmoplegia;citrullinemia;congenital disorder of glycosylation;diagnosis;energy metabolism;Fabry disease;free sialic acid storage disease;galactosemia;genetic risk;genetics;genotype phenotype correlation;globoid cell leukodystrophy;glutaric aciduria type 1;GM1 gangliosidosis;homocystinuria;human;inborn error of metabolism;isovaleric acidemia;Kearns Sayre syndrome;Leber hereditary optic neuropathy;Leigh disease;maple syrup urine disease;Maroteaux Lamy syndrome;MELAS syndrome;MERRF syndrome;metachromatic leukodystrophy;methylmalonic acidemia;MNGIE syndrome;mucolipidosis;mucopolysaccharidosis;multiple sulfatase deficiency;neuroimaging;neuronal ceroid lipofuscinosis;Niemann Pick disease;nuclear magnetic resonance imaging;ornithine transcarbamylase deficiency;oxidation defect;pathology;phenylketonuria;priority journal;procedures;propionic acidemia;Refsum disease;sialuria;Smith Lemli Opitz syndrome;Tay Sachs disease;Zellweger syndrome,"Longo, M. G.;Vairo, F.;Souza, C. F.;Giugliani, R.;Vedolin, L. M.",2015,,,0,
2687,Diseases and drugs that increase risk of acute large bowel ischemia,"BACKGROUND & AIMS: Information is limited on risk factors for acute large bowel ischemia (ALBI). We investigated diseases and drugs associated with ALBI. METHODS: We compared patients hospitalized with ALBI and controls through multivariate analysis of prior outpatient/emergency department/inpatient diagnoses and pharmacy dispensing records. RESULTS: There were 379 cases and 1516 controls (median age, 69 y; range, 25-97 y; 74.4% female). Disorders that were diagnosed in more cases than controls, based on univariate analysis (P < .05), included hypertension, diabetes, chronic obstructive pulmonary disease, atrial fibrillation, congestive heart failure, depression, asthma, coronary artery disease, dementia, rheumatoid arthritis, irritable bowel syndrome, dialysis dependency, diarrhea, and constipation. Drugs dispensed to more cases than controls were antihypertensives, opioids, statins, female hormones, potentially constipating drugs, histamine H(2)-antagonists, immunomodulators, digoxin, clopidogrel/ticlopidine, taxanes/vinca alkaloids, and antibiotics. In all cases, ALBI was associated independently with hypertension (adjusted odds ratio [AOR], 3.21, 95% confidence interval [CI]; 2.28-4.53; P < .0001), chronic obstructive pulmonary disease (AOR, 3.13; 95% CI, 2.06-4.75; P < .0001), diarrhea (AOR, 2.36; 95% CI, 1.13-4.89; P = .0218), atrial fibrillation (AOR, 2.21; 95% CI, 1.34-3.64; P = .0019), congestive heart failure (AOR, 1.94; 95% CI, 1.11-3.39; P = .0205), diabetes (AOR, 1.82; 95% CI, 1.31-2.53; P = .0004), antibiotics (AOR, 3.30; 95% CI, 2.19-4.96; P < .0001), opioids (AOR, 1.96; 95% CI, 1.43-2.67; P < .0001), and potentially constipating drugs (AOR, 1.75; 95% CI, 1.25-2.44; P = .0012). Analysis of only women revealed similar associations except for diarrhea plus rheumatoid arthritis (AOR, 3.27; 95% CI, 1.07-9.96; P = .0370), irritable bowel syndrome (AOR, 2.72; 95% CI, 1.04-7.14; P = .0424), and female hormones (AOR, 1.88; 95% CI, 1.30-2.73; P = .0009). CONCLUSIONS: Heterogeneous diseases and drugs increase the risk of ALBI, consistent with multifactorial pathogenesis.","Adult;Aged;Aged, 80 and over;Animals;Case-Control Studies;*Drug-Related Side Effects and Adverse Reactions;Female;Humans;Intestine, Large/*pathology;Ischemia/*epidemiology/*etiology;Male;Middle Aged;Risk Factors","Longstreth, G. F.;Yao, J. F.",2010,Jan,10.1016/j.cgh.2009.09.006,0,
2688,Neuropsychiatric correlates of cerebral white-matter radiolucencies in probable Alzheimer's disease,"We evaluated the neuropsychological functions, rate of disease progression, and psychiatric characteristics of 22 patients with probable Alzheimer's disease in whom periventricular white-matter radiolucencies (PWMRs) were seen on the computed tomographic scan of the brain and compared them with 22 matched patients with Alzheimer's disease without PWMRs. Executive/attention, lexical/semantic, memory/learning, and visuospatial functions did not differ between the two groups at baseline or at the 1-year follow-up examination. The frequency of major depression, delusions, and hallucinations did not differ between the groups. However, patients with PWMRs had significantly higher Hachinski Rating scores at both visits and were more likely to develop cerebrovascular disease during follow-up than were controls with Alzheimer's disease. These preliminary results suggest that the presence of PWMRs is not associated with specific cognitive and psychiatric features or with an altered rate of progression of Alzheimer's disease but does predict the development of clinically significant cerebrovascular disease.",Aged;Alzheimer Disease/physiopathology/*psychology/radiography;Blood Pressure;Cerebral Cortex/*radiography;Cerebral Ventriculography;Cerebrovascular Disorders/etiology/physiopathology;Coronary Disease/complications;Female;Humans;Hypertension/complications;Male;Middle Aged;*Neuropsychological Tests,"Lopez, O. L.;Becker, J. T.;Rezek, D.;Wess, J.;Boller, F.;Reynolds, C. F., 3rd;Panisset, M.",1992,Aug,,0,
2689,Risk factors for mild cognitive impairment in the Cardiovascular Health Study Cognition Study: part 2,"OBJECTIVE: To examine the risk factors for mild cognitive impairment (MCI) in a longitudinal population study-the Cardiovascular Health Study Cognition Study. DESIGN: We examined the factors that in the period 1991 through 1994 predicted the development of MCI in all participants of the Cardiovascular Health Study Cognition Study. Further examination was conducted in the Pittsburgh, Pa, cohort (n = 927), where participants with MCI were classified as having either the MCI amnestic-type or the MCI multiple cognitive deficits-type. SETTING: Multicenter population study. PATIENTS: This study includes all participants of the Cardiovascular Health Study Cognition Study (n = 3608) who had a magnetic resonance imaging (MRI) scan of the brain between 1991 and 1994, and detailed neuropsychological, neurological, and medical evaluations to identify the presence of MCI or dementia in the period 1998 to 1999. The mean time between the closest clinical examination to the MRI and the diagnostic evaluation for cognitive disorders was 5.8 years for the Cardiovascular Health Study Cognition Study cohort and 6.0 years for the Pittsburgh cohort. MAIN OUTCOME MEASURES: Risk factors for MCI at the time of the MRI were identified using logistic regression, controlling for age, race, educational level, baseline Modified Mini-Mental State Examination and Digit Symbol Test scores, measurements of depression, MRI findings (atrophy, ventricular volume, white matter lesions, and infarcts), the presence of the apolipoprotein E (APOE) epsilon4 allele, hypertension, diabetes mellitus, and heart disease. RESULTS: Mild cognitive impairment (n = 577) was associated with race (African American), low educational level, low Modified Mini-Mental State Examination and Digit Symbol Test scores, cortical atrophy, MRI-identified infarcts, and measurements of depression. The MCI amnestic-type was associated with MRI-identified infarcts, the presence of the APOE epsilon4 allele, and low Modified Mini-Mental State Examination scores. The MCI multiple cognitive deficits-type was associated with low Modified Mini-Mental State Examination and Digit Symbol Test scores. CONCLUSIONS: The development of MCI is associated with measurements of cognition and depression, racial and constitutional factors, and cerebrovascular disease. Early cognitive deficits seem to be a common denominator for the 2 forms of MCI; the presence of cerebrovascular disease and the APOE epsilon4 allele is associated with the amnestic type of MCI.",Aged;Apolipoprotein E4;Apolipoproteins E/genetics;Brain/pathology;Cardiovascular Diseases/*epidemiology/genetics/*psychology;Cognition Disorders/*epidemiology/genetics/*psychology;Cohort Studies;Depressive Disorder/complications/psychology;Female;Humans;Logistic Models;Longitudinal Studies;Magnetic Resonance Imaging;Male;Mood Disorders/epidemiology;Pennsylvania/epidemiology;Population;Risk Factors,"Lopez, O. L.;Jagust, W. J.;Dulberg, C.;Becker, J. T.;DeKosky, S. T.;Fitzpatrick, A.;Breitner, J.;Lyketsos, C.;Jones, B.;Kawas, C.;Carlson, M.;Kuller, L. H.",2003,Oct,10.1001/archneur.60.10.1394,0,
2690,Mortality-associated factors in patients with Alzheimer's disease treated with galantamine,"BACKGROUND AND OBJECTIVE: To study the effect of clinical and demographic variables on mortality in patients with probable Alzheimer's disease treated with the cholinesterase inhibitor galantamine. PATIENTS AND METHOD: This retrospective cohort study reviewed 172 medical records, gathering information such as demographic and clinical variables, adverse events, number of withdrawals and duration of treatment with galantamine. RESULTS: Of 172 patients, 18.6% had adverse events. Galantamine was well tolerated in 15.4% of patients but they abandoned the treatment because of several reasons after a median duration of treatment of 13.3 months and an average dose of 15.0 mg/day. The overall rate of mortality was 12.5%, being, 19.0% for those who abandoned the treatment and 11.3% for those who dit not. The univariate analysis showed that patients who died were older, had had more antipsychotic medications, had a higher total Blessed score and had suffered from more episodes of heart failure. The associated variables in the multivariate analysis using a binary logistic regression were mortality, sex, age, hypertension, heart failure, arrhythmia, antipsychotic treatment and greater cognitive impairment. CONCLUSIONS: The duration and the dose of treatment with galantamine were not associated with increased mortality. Related variables were an advanced age, male sex, cardiovascular diseases and antipsychotic treatment.","Aged;Aged, 80 and over;Alzheimer Disease/*drug therapy/mortality;Cholinesterase Inhibitors/*therapeutic use;Female;Galantamine/*therapeutic use;Humans;Male;Retrospective Studies","Lopez-Pousa, S.;Garre Olmo, J.;Vilalta Franch, J.;Turon Estrada, A.;Soler Cors, O.;Pericot Nierga, I.",2006,Jul 8,,0,
2691,Comparative analysis of mortality in patients with Alzheimer's disease treated with donepezil or galantamine,"BACKGROUND: few studies have analysed the effect of the long-term use of cholinesterase inhibitors (ChEIs) on mortality. OBJECTIVE: to compare the long-term effects of galantamine and donepezil treatment on the mortality rate in Alzheimer's disease (AD) patients. DESIGN: a retrospective cohort study. SETTING AND SUBJECTS: 404 patients referred by primary care centres to a Memory Clinic who were diagnosed with probable AD and who were prescribed treatment with donepezil or galantamine. METHODS: standardised review of the patient's medical records. RESULTS: 14.5% of the patients showed intolerance to the treatment with ChEIs during the first 15 days. Of those patients who initially tolerated the treatment, 18.5% gave it up after a mean duration of 13.36 months and a mean dose of 7.5 mg/day of donepezil or 14.3 mg/day of galantamine. The mean duration of the treatment in patients who did not abandon the treatment was 25.4 months and the mean dose was 8.1 mg/day of donepezil or 20.0 mg/day of galantamine. There were no differences in the mortality rate between patients treated with donepezil or galantamine (13.7 versus 12.2; P = 0.75). The multivariate analysis through binary logistic regression showed that the variables associated with mortality were male gender, older age, heart failure, treatment with antipsychotic drugs and a high score on the Global Deterioration Scale. CONCLUSIONS: the duration and the dose of donepezil or galantamine are not related to an increase in mortality. The related variables were advanced age, the severity of the dementia, being male, heart failure and treatment with antipsychotic drugs.","Aged;Aged, 80 and over;Alzheimer Disease/*drug therapy/epidemiology/*mortality;Chi-Square Distribution;Cholinesterase Inhibitors/administration & dosage/*therapeutic use;Cohort Studies;Comorbidity;Female;Galantamine/administration & dosage/*therapeutic use;Humans;Indans/administration & dosage/*therapeutic use;Male;Middle Aged;Piperidines/administration & dosage/*therapeutic use;Retrospective Studies;Treatment Outcome","Lopez-Pousa, S.;Olmo, J. G.;Franch, J. V.;Estrada, A. T.;Cors, O. S.;Nierga, I. P.;Gelada-Batlle, E.",2006,Jul,10.1093/ageing/afj083,0,
2692,Dementia associates with undermedication of cardiovascular diseases in the elderly: A population-based study,"Objective: To compare medication use in patients suffering from cardiovascular disease with and without dementia. Subjects: All inhabitants aged 75 and older in Lieto, Finland (n = 462, participation rate 82%). Measurements: Direct standardised assessments of dementia and cardiovascular diseases. Quantification of drug use by self-report and by prescription and drug container checks. Results: In multivariate analyses, the odds ratio for demented cardiovascular patients receiving any cardiovascular medication (use vs. non-use) was 0.31 (95% confidence interval 0.12-0.82). Compared to the non-demented, demented stroke patients were treated less often with antithrombotic agents (p = 0.041) and demented hypertensive patients less often with β-blockers (p = 0.045). Conclusion: Demented cardiovascular patients, even mildly to moderately demented, were prescribed fewer evidence-based cardiovascular medications than non-demented patients. Copyright © 2006 S. Karger AG.",angiotensin 2 receptor antagonist;antiarrhythmic agent;anticoagulant agent;antidepressant agent;antiglaucoma agent;antigout agent;antihypertensive agent;antilipemic agent;antipyretic analgesic agent;anxiolytic agent;beta adrenergic receptor blocking agent;calcium antagonist;calcium channel blocking agent;cardiac glycoside;cardiovascular agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hypnotic sedative agent;laxative;loop diuretic agent;neuroleptic agent;nitric acid derivative;nonsteroid antiinflammatory agent;oral antidiabetic agent;potassium sparing diuretic agent;sulfonamide;thyroxine;trimethoprim;unindexed drug;vasodilator agent;aged;article;cardiovascular disease;congestive heart failure;controlled study;dementia;disease severity;female;Finland;atrial fibrillation;human;hypercholesterolemia;hypertension;ischemic heart disease;major clinical study;male;multivariate analysis;prescription;priority journal;quantitative analysis;self report;standardization;cerebrovascular accident,"Löppönen, M.;Räihä, I.;Isoaho, R.;Vahlberg, T.;Puolijoki, H.;Kivelä, S. L.",2006,,,0,
2693,Potential therapeutic competition in community-living older adults in the U.S.: Use of medications that may adversely affect a coexisting condition,"Objective: The 75% of older adults with multiple chronic conditions are at risk of therapeutic competition (i.e. treatment for one condition may adversely affect a coexisting condition). The objective was to determine the prevalence of potential therapeutic competition in community-living older adults. Methods: Cross-sectional descriptive study of a representative sample of 5,815 community-living adults 65 and older in the U.S, enrolled 2007-2009. The 14 most common chronic conditions treated with at least one medication were ascertained from Medicare claims. Medication classes recommended in national disease guidelines for these conditions and used by ≥2% of participants were identified from in-person interviews conducted 2008-2010. Criteria for potential therapeutic competition included: 1), well-acknowledged adverse medication effect; 2) mention in disease guidelines; or 3) report in a systematic review or two studies published since 2000. Outcomes included prevalence of situations of potential therapeutic competition and frequency of use of the medication in individuals with and without the competing condition. Results: Of 27 medication classes, 15 (55.5%) recommended for one study condition may adversely affect other study conditions. Among 91 possible pairs of study chronic conditions, 25 (27.5%) have at least one potential therapeutic competition. Among participants, 1,313 (22.6%) received at least one medication that may worsen a coexisting condition; 753 (13%) had multiple pairs of such competing conditions. For example, among 846 participants with hypertension and COPD, 16.2% used a nonselective beta-blocker. In only 6 of 37 cases (16.2%) of potential therapeutic competition were those with the competing condition less likely to receive the medication than those without the competing condition. Conclusions: One fifth of older Americans receive medications that may adversely affect coexisting conditions. Determining clinical outcomes in these situations is a research and clinical priority. Effects on coexisting conditions should be considered when prescribing medications. © 2014 Lorgunpai et al.",alpha adrenergic receptor blocking agent;angiotensin receptor antagonist;beta adrenergic receptor blocking agent;beta adrenergic receptor stimulating agent;bisphosphonic acid derivative;calcium channel blocking agent;cholinesterase inhibitor;clopidogrel;corticosteroid;cyclooxygenase 2 inhibitor;dipeptidyl carboxypeptidase inhibitor;glitazone derivative;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;levothyroxine;metformin;proton pump inhibitor;selective estrogen receptor modulator;serotonin noradrenalin reuptake inhibitor;serotonin uptake inhibitor;steroid 5alpha reductase inhibitor;sulfonylurea;thiazide diuretic agent;tricyclic antidepressant agent;warfarin;aged;article;chronic disease;chronic obstructive lung disease;community;competition;coronary artery disease;cross-sectional study;dementia;depression;diabetes mellitus;drug use;gastroesophageal reflux;atrial fibrillation;heart failure;human;hyperlipidemia;hypertension;hypothyroidism;interview;major clinical study;medicare;osteoarthritis;osteoporosis;peptic ulcer;practice guideline;prevalence;prostate hypertrophy;therapeutic competition;United States;very elderly,"Lorgunpai, S. J.;Grammas, M.;Lee, D. S. H.;McAvay, G.;Charpentier, P.;Tinetti, M. E.",2014,,,0,
2694,Comorbidity is a major determinant of severity in acute diverticulitis,"Background: Acute colonic diverticulitis may be simple or very complicated. Not much is understood about what factors determine severity. Answering this question may have therapeutic implications. Methods: A retrospective review was performed consisting of teaching hospital admissions for simple or complicated acute diverticulitis. The intent was to identify characteristics of and differences between the 2 groups. The Charlson index was used to assess states of preexisting health (comorbidity). Results: In multivariate analysis, the presence of a major degree of comorbidity (Charlson score 3 or greater) was strongly associated with complicated disease (P = 0.02) as was the use of nonsteroidal anti-inflammatory drugs (P = .01). Deaths were not seen below age 50, and high Charlson score also strongly predicted mortality (P < .0001). Conclusions: There are significant differences between patients presenting with simple and complicated diverticulitis, and the amount of associated comorbidity (as measured by Charlson score) appears to be a major one. Because of the high mortality seen in patients with Charlson scores 3 or greater and complicated diverticulitis, we believe that an early surgical approach should be considered for them, particularly if they are 50 or older. © 2007 Excerpta Medica Inc. All rights reserved.",acetylsalicylic acid;corticosteroid;nonsteroid antiinflammatory agent;acquired immune deficiency syndrome;adult;article;cerebrovascular disease;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;disease severity;diverticulitis;drug use;female;heart infarction;hemiplegia;human;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;mortality;peptic ulcer;peripheral vascular disease;priority journal;retrospective study;solid tumor;aspirin,"Lorimer, J. W.;Doumit, G.",2007,,,0,
2695,Prevalence and correlates of dementia: survey of the last days of life,"OBJECTIVES: To estimate the prevalence and correlates of dementia at death and to assess the usefulness of death certificate data in the reporting of dementia. METHODS: The authors analyzed next-of-kin interviews for 599 male and 628 female decedents using data from the National Institute on Aging's Survey of the Last Days of Life. RESULTS: Death certificate data in this population show the prevalence of dementia to be less than 1%, consistent with previous reports based on death certificates but a substantial underestimate compared to the 11.9% reported in a national survey. Using a dementia index based on the informant's report of whether the decedent had been diagnosed with a dementing illness and the extent of her or his cognitive and functional limitations, this study found a prevalence of dementia of 8.5%. A high score on the dementia index was significantly associated with older age, Parkinson's disease, and incontinence. Lower relative odds for dementia at death were found for people with either a lifetime history or a death certificate report of cancer. Similarly, people with a lifetime history of coronary heart disease were found to have lower relative odds for dementia at death. CONCLUSION: These results suggest that informant interviews may be a useful source of data to examine factors associated with dementia and to estimate the prevalence of dementia in the last year of life.","Age Distribution;Aged;Aged, 80 and over;Data Collection;*Death;Death Certificates;Dementia/*epidemiology;Female;Humans;Male;Odds Ratio;Prevalence;Sex Distribution;Surveys and Questionnaires;United States/epidemiology","Losonczy, K. G.;White, L. R.;Brock, D. B.",1998,May-Jun,,0,
2696,Impact of Comorbidities on Outcome After Total Hip Arthroplasty,"Background Patient-reported outcome scores gain increasing importance in quantifying clinical success and procedure remuneration. Our aim was to evaluate the impact of comorbidity on joint-specific outcome and general health in patients undergoing elective total hip arthroplasty (THA). Methods Longitudinal data on THA procedures were used to evaluate the association between comorbidity and surgical outcome in terms of joint-specific measures and general health (Forgotten Joint Score-12 [FJS-12], Oxford Hip Score [OHS], and Short Form-12) at 1-year follow-up. Comorbidities comprised the Charlson comorbidity index (CCI), low back pain (LBP), pain from other joints (POJ), and body mass index. Results We analyzed data from 251 THA patients (age: 67.7 ± 11.8 years; 58.2% female). Most common conditions were POJ (75.9%), LBP (55.1%), connective tissue disease (12.1%), and diabetes (5.6%). With regard to postoperative improvement, we did not find statistically significant differences between patients with or without CCI comorbidities (FJS-12, +38.7 vs +43.2, P =.370; OHS, +15.6 vs +17.9, P =.100) or POJ (FJS-12, +39.9 vs +45.1, P =.325; OHS, +17.3 vs +16.6, P =.645). Patients with LBP showed less improvement on the FJS-12 than those without LBP (+35.6 vs +49.1; P =.002), whereas no difference was found for the OHS (+17.9 vs +16.5; P =.266). Conclusion Patients with comorbid conditions report lower preoperative and postoperative outcome scores compared with patients with no such conditions; however, there was no statistically significant association of CCI comorbidities and POJ with postoperative improvement in joint-specific outcomes. LBP was found to have a negative impact on postoperative improvement in terms of joint awareness.",acquired immune deficiency syndrome;aged;arthralgia;article;body mass;cerebrovascular disease;Charlson Comorbidity Index;chronic obstructive lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;disease association;disease severity;female;Forgotten Joint Score 12;heart infarction;hemiplegia;hip osteoarthritis;human;leukemia;liver disease;longitudinal study;low back pain;lymphoma;major clinical study;male;mental health;musculoskeletal disease assessment;obesity;Oxford Hip Score;peptic ulcer;peripheral vascular disease;retrospective study;Short Form 12;total hip prosthesis;treatment outcome,"Loth, F. L.;Giesinger, J. M.;Giesinger, K.;MacDonald, D. J.;Simpson, A. H. R. W.;Howie, C. R.;Hamilton, D. F.",2017,,10.1016/j.arth.2017.04.013,0,
2697,Diagnostic challenges in movement disorders: Sensory Ataxia Neuropathy Dysarthria and Ophthalmoplegia (SANDO) syndrome,"A woman in her early 60s presented to our Movement Disorders Centre with a 5-year history of progressive peripheral neuropathy, gait instability with falls, blurred vision, cognitive impairment and tremors. The patient was found to have profound sensory ataxia, chronic ophthalmoplegia, dementia with significant deficits in registration and construction and bilateral resting tremor of the hands. Investigations revealed an unremarkable MRI of the brain, negative cerebrospinal fluid studies, and unremarkable chemistries. Nerve conduction studies found a severe sensorimotor axonal polyneuropathy. Genetic testing revealed a compound heterozygous mutation in the POLG1 gene consistent with the diagnosis of Sensory Ataxia Neuropathy Dysarthria and Ophthalmoplegia (SANDO) syndrome.",DNA directed DNA polymerase gamma;gabapentin;serotonin uptake inhibitor;topiramate;valproic acid;adult;article;ataxia;blurred vision;case report;cerebrospinal fluid analysis;cognitive defect;congestive heart failure;dementia;depression;diabetic neuropathy;differential diagnosis;disease duration;disorders of mitochondrial functions;electromyography;falling;female;gait disorder;gene;gene mutation;genetic analysis;heterozygosity;human;hypertension;hypothyroidism;medical history;motor dysfunction;nerve conduction;non insulin dependent diabetes mellitus;nuclear magnetic resonance imaging;ophthalmoplegia;parkinsonism;patient monitoring;peripheral neuropathy;POLG1 gene;polyneuropathy;priority journal;sensory ataxia neuropathy dysarthria and ophthalmoplegia syndrome;Shy Drager syndrome;spinocerebellar degeneration;tremor,"Lovan, A.;Haq, I. U.;Balakrishnan, N.",2013,,,0,
2698,The Wonder of Plants,,Aesculus hippocastanum extract;alpha adrenergic receptor blocking agent;alpha tocopherol;alpha tocotrienol;beta carotene;calcium;celecoxib;chondroitin;Cimicifuga racemosa extract;cranberry extract;Crataegus extract;Echinacea purpurea extract;fish oil;flavonoid;ginger extract;Ginkgo biloba extract;glucosamine;hyperforin;hypericin;Hypericum perforatum extract;mineral;multivitamin;natural product;non prescription drug;rofecoxib;Sabal extract;sertraline;Silybum marianum extract;turmeric;unindexed drug;acupuncture;Aesculus hippocastanum;alternative medicine;Alzheimer disease;antiinflammatory activity;antioxidant activity;article;cardiovascular disease;certification;chronic vein insufficiency;Actaea racemosa;clinical trial;congestive heart failure;dementia;diet supplementation;drug approval;drug withdrawal;Echinacea purpurea;education program;evidence based medicine;food intake;ginger;Ginkgo biloba;hepatitis C;herbal medicine;human;Hypericum perforatum;knee osteoarthritis;legal aspect;major depression;medical ethics;menopausal syndrome;priority journal;prostate hypertrophy;religion;Silybum marianum;spiritual healing;urinary tract infection;vitamin intake;celebrex;vioxx,"Low Dog, T.",2005,,,0,
2699,Racial and Ethnic Variability in the Prevalence and Incidence of Comorbidities Associated with Gastric Cancer in the United States,"Purpose: Comorbidities are known to impact quality of life, treatment choices, and survival. Our objectives were to characterize comorbid conditions in a cohort of elderly gastric cancer patients and to determine if there is variability in the prevalence or incidence of the comorbid conditions across racial/ethnic groups. Methods: A total of 12,612 individuals, ≥66 years of age, diagnosed with gastric cancer between 2000 and 2007, and an equal number of gender- and region-matched cancer-free individuals, were identified using the National Cancer Institute’s Surveillance, Epidemiology, and End Results registry linked to Medicare claims in the United States. The prevalence (%) in the year before diagnosis and the 12-month incidence rates after diagnosis were estimated for 32 chronic and ten acute comorbid conditions for the entire cohort and by race/ethnicity (Asian, Black, Hispanic, White, and other) and Asian subgroups (e.g., Chinese, Filipino, Japanese, Pacific Islander). Results: White and Black cases exhibited the highest prevalence of most comorbid conditions. Asian and Pacific Islander cases exhibited the lowest. There was substantial variability in the 12-month incidence of the comorbidities across the racial/ethnic groups. Electrolyte disorder was the most common incident condition among Whites and Blacks. With the exception of Whites, anemia was the most common incident condition in all racial and ethnic groups 180 days following chemotherapy. Conclusions: There is variability in the prevalence and incidence in comorbidities across racial/ethnic groups.",antineoplastic agent;glucose;aged;Alzheimer disease;anemia;artery thrombosis;article;Asian;atrial fibrillation;Black person;bone necrosis;cancer registry;Caucasian;cerebrovascular disease;Chinese;cholecystitis;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;controlled study;coronary artery disease;depression;diabetes mellitus;diarrhea;disease association;dyspnea;electrolyte disturbance;ethnic difference;female;Filipino (people);heart arrhythmia;hemiplegia;hip fracture;Hispanic;human;hyperglycemia;hypertension;incidence;infection;Japanese (people);kidney disease;liver disease;major clinical study;male;nephrotic syndrome;neutropenia;oral mucositis;osteoarthritis;osteoporosis;Pacific Islander;pancreatitis;peripheral vascular disease;pneumonia;prevalence;priority journal;race difference;rash;rheumatic disease;stomach cancer;stomach ulcer;thrombocytopenia;thromboembolism;United States;unspecified side effect;very elderly,"Lowe, K. A.;Danese, M. D.;Gleeson, M. L.;Langeberg, W. J.;Ke, J.;Kelsh, M. A.",2016,,,0,
2700,Protein aging Extracellular amyloid formation and intracellular repair,"Soluble proteins can undergo spontaneous structural and conformational alterations that lead to their stable aggregation into amyloid fibrils. Amyloidogenic proteins have been implicated in several types of age-related pathologic changes. For example, transthyretin amyloid accumulation in the heart can lead to cardiac failure, while beta-amyloid deposition within the microvasculature and gray matter of the brain is linked to cerebral hemorrhage and neuronal death. Over the course of evolution, protein structures have developed that largely resist such aggregation. Spontaneous chemical modifications correlated with the normal aging process, however, including the deamidation, isomerization, and racemization of asparaginyl and aspartyl residues, as well as the oxidation and glycation of various amino acid residues, may contribute to amyloid formation by altering protein structure. In fact, a recent chemical analysis of neuritic plaque and vascular beta-amyloid deposits from the brains of Alzheimer's disease victims has revealed that the majority of the aspartyl residues in beta-amyloid are in the isomerized and/or racemized configuration. Although enzymes exist that can reverse at least part of this damage for intracellular proteins, the accumulation of extracellular proteins containing altered residues might contribute to the deterioration of heart, brain, and other tissues that occurs with aging and disease.",,"Lowenson, J. D.;Roher, A. E.;Clarke, S.",1994,Jan-Feb,10.1016/1050-1738(94)90019-1,0,
2701,"Comparative Pathology of Aging Great Apes: Bonobos, Chimpanzees, Gorillas, and Orangutans","The great apes (chimpanzees, bonobos, gorillas, and orangutans) are our closest relatives. Despite the many similarities, there are significant differences in aging among apes, including the human ape. Common to all are dental attrition, periodontitis, tooth loss, osteopenia, and arthritis, although gout is uniquely human and spondyloarthropathy is more prevalent in apes than humans. Humans are more prone to frailty, sarcopenia, osteoporosis, longevity past reproductive senescence, loss of brain volume, and Alzheimer dementia. Cerebral vascular disease occurs in both humans and apes. Cardiovascular disease mortality increases in aging humans and apes, but coronary atherosclerosis is the most significant type in humans. In captive apes, idiopathic myocardial fibrosis and cardiomyopathy predominate, with arteriosclerosis of intramural coronary arteries. Similar cardiac lesions are occasionally seen in wild apes. Vascular changes in heart and kidneys and aortic dissections in gorillas and bonobos suggest that hypertension may be involved in pathogenesis. Chronic kidney disease is common in elderly humans and some aging apes and is linked with cardiovascular disease in orangutans. Neoplasms common to aging humans and apes include uterine leiomyomas in chimpanzees, but other tumors of elderly humans, such as breast, prostate, lung, and colorectal cancers, are uncommon in apes. Among the apes, chimpanzees have been best studied in laboratory settings, and more comparative research is needed into the pathology of geriatric zoo-housed and wild apes. Increasing longevity of humans and apes makes understanding aging processes and diseases imperative for optimizing quality of life in all the ape species.",aging;bonobo;chimpanzee;geriatrics;gorilla;great ape;nonhuman primate;orangutan,"Lowenstine, L. J.;McManamon, R.;Terio, K. A.",2016,Mar,10.1177/0300985815612154,0,
2702,Admissions to a welfare home,"200 admissions to a large residential home in Edinburgh were examined shortly after admission. 50% of these persons were over 80 yrs of age. A large majority were widowed, single, divorced or separated. A quarter of all admissions came from hospitals and half were admitted from home. The remainder came from hostels or other homes where there was felt to be less adequate care. 75% of persons admitted had some degree of functional impairment and in 61% of cases it was clearly ascertained that disability was a major factor leading to admission. 19% of cases suffered from moderate or severe dementia. 9% were suffering from depressive illnesses, 15% were afflicted with acute illnesses such as pneumonia, recent strokes, burns and congestive cardiac failure. The commonest single condition found was cerebral arteriosclerosis manifesting as dementia, incontinence and impaired walking. 36% of patients were requiring physiotherapy which was not available in the home. 36% of admissions should have been admitted to hospital rather than to a home. Another 39% although considerably disabled would also have merited a full geriatric assessment. At follow up one to two years after admission only a quarter of the residents presented no problem in management, but by this time, only about half the original admissions were still within the home. The overall mortality was 28%. It is concluded that the case has been made for a full geriatric assessment to be carried out when an old person makes application for admission to a residential home, and that physicians with experience in geriatric medicine should hold regular clinics in homes to which large numbers of elderly disabled persons are admitted. Adequate records should be initiated preferably before admission and continued thereafter. Finally, if homes are going to be increasingly used to house large numbers of elderly and disabled persons the staffing and facilities will have to be appropriate and must become the joint concern of the social work departmnt and the regional hospital board.",aged;geriatric center;methodology;nursing home;statistics,"Lowther, C. P.;McLeod, H. M.",1974,,,0,
2703,Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010,"Background: Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. Methods: We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. Findings: In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in death worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. Interpretation: Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. Funding: Bill & Melinda Gates Foundation. © 2012 Elsevier Ltd.",acquired immune deficiency syndrome nursing;adolescent;adult;African trypanosomiasis;age;aged;Alzheimer disease;article;autopsy;bronchus cancer;cause of death;cerebrovascular accident;child;chronic kidney disease;chronic obstructive lung disease;congenital syphilis;consensus;diabetes mellitus;diarrhea;fatality;female;health survey;hepatitis E;hospital;human;incidence;infant;injury;ischemic heart disease;leishmaniasis;liver cancer;liver cirrhosis;lower respiratory tract infection;lung cancer;major clinical study;malaria;male;measles;meningitis;mortality;neoplasm;newborn;newborn disease;nutritional disorder;parathyroid gland;pertussis;posthumous care;prediction;pregnancy disorder;premature mortality;preschool child;prevalence;priority journal;prostate cancer;registration;school child;sex;statistical model;systematic error;tetanus;trachea cancer;tuberculosis;typhoid fever;validity;vascular disease,"Lozano, R.;Naghavi, M.;Foreman, K.;Lim, S.;Shibuya, K.;Aboyans, V.;Abraham, J.;Adair, T.;Aggarwal, R.;Ahn, S. Y.;Alvarado, M.;Anderson, H. R.;Anderson, L. M.;Andrews, K. G.;Atkinson, C.;Baddour, L. M.;Barker-Collo, S.;Bartels, D. H.;Bell, M. L.;Benjamin, E. J.;Bennett, D.;Bhalla, K.;Bikbov, B.;Abdulhak, A. B.;Birbeck, G.;Blyth, F.;Bolliger, I.;Boufous, S.;Bucello, C.;Burch, M.;Burney, P.;Carapetis, J.;Chen, H.;Chou, D.;Chugh, S. S.;Coffeng, L. E.;Colan, S. D.;Colquhoun, S.;Colson, K. E.;Condon, J.;Connor, M. D.;Cooper, L. T.;Corriere, M.;Cortinovis, M.;De Vaccaro, K. C.;Couser, W.;Cowie, B. C.;Criqui, M. H.;Cross, M.;Dabhadkar, K. C.;Dahodwala, N.;De Leo, D.;Degenhardt, L.;Delossantos, A.;Des Jarlais, D. C.;Dharmaratne, S. D.;Dorsey, E. R.;Driscoll, T.;Duber, H.;Ebel, B.;Erwin, P. J.;Espindola, P.;Ezzati, M.;Feigin, V.;Flaxman, A. D.;Forouzanfar, M. H.;Fowkes, F. G. R.;Franklin, R.;Fransen, M.;Freeman, M. K.;Gabriel, S. E.;Gakidou, E.;Gaspari, F.;Gillum, R. F.;Gonzalez-Medina, D.;Halasa, Y. A.;Haring, D.;Harrison, J. E.;Havmoeller, R.;Hay, R. J.;Hotez, P. J.;Hoy, D.;Jacobsen, K. H.;James, S. L.;Jasrasaria, R.;Jayaraman, S.;Johns, N.;Karthikeyan, G.;Kassebaum, N.;Keren, A.;Khoo, J. P.;Knowlton, L. M.;Kobusingye, O.;Koranteng, A.;Krishnamurthi, R.;Lipnick, M.;Lipshultz, S. E.;Ohno, S. L.;Mabweijano, J.;Macintyre, M. F.;Mallinger, L.;March, L.;Marks, G. B.;Marks, R.;Matsumori, A.;Matzopoulos, R.;Mayosi, B. M.;McAnulty, J. H.;McDermott, M. M.;McGrath, J.;Mensah, G. A.;Merriman, T. R.;Michaud, C.;Miller, M.;Miller, T. R.;Mock, C.;Mocumbi, A. O.;Mokdad, A. A.;Moran, A.;Mulholland, K.;Nair, M. N.;Naldi, L.;Narayan, K. M. V.;Nasseri, K.;Norman, P.;O'Donnell, M.;Omer, S. B.;Ortblad, K.;Osborne, R.;Ozgediz, D.;Pahari, B.;Pandian, J. D.;Rivero, A. P.;Padilla, R. P.;Perez-Ruiz, F.;Perico, N.;Phillips, D.;Pierce, K.;Pope Iii, C. A.;Porrini, E.;Pourmalek, F.;Raju, M.;Ranganathan, D.;Rehm, J. T.;Rein, D. B.;Remuzzi, G.;Rivara, F. P.;Roberts, T.;De León, F. R.;Rosenfeld, L. C.;Rushton, L.;Sacco, R. L.;Salomon, J. A.;Sampson, U.;Sanman, E.;Schwebel, D. C.;Segui-Gomez, M.;Shepard, D. S.;Singh, D.;Singleton, J.;Sliwa, K.;Smith, E.;Steer, A.;Taylor, J. A.;Thomas, B.;Tleyjeh, I. M.;Towbin, J. A.;Truelsen, T.;Undurraga, E. A.;Venketasubramanian, N.;Vijayakumar, L.;Vos, T.;Wagner, G. R.;Wang, M.;Wang, W.;Watt, K.;Weinstock, M. A.;Weintraub, R.;Wilkinson, J. D.;Woolf, A. D.;Wulf, S.;Yeh, P. H.;Yip, P.;Zabetian, A.;Zheng, Z. J.;Lopez, A. D.;Murray, C. J.;Denenberg, J.;Hoen, B.",2012,,,0,
2704,A new target for cellular protection - Na+ -Ca2+ exchanger,"Na+-Ca2+ exchanger (Sodium-calcium exchanger, NCX) is a bidirectional and electrogenic transporter, which produces a current called Na+-Ca2+ exchange current (I(Na-Ca)). It plays a prominent role in regulation of intracellular Ca2+ homeostasis and mainly helps to extrude excessive Ca2+. Its activity is regulated by many factors and changes under different pathological situations such as heart (brain) ischemia, heart failure and Alzheimer's disease. NCX is a potent and important target for cellular protection.",amiloride;calcium ion;dichlorobenzamil;manganese;nickel;sodium calcium exchange protein;sodium ion;Alzheimer disease;article;calcium cell level;calcium homeostasis;cell protection;heart failure;heart muscle ischemia;regulatory mechanism;sodium calcium exchange;sodium transport;transport kinetics,"Lu, J.;Wang, X. L.",2000,,,0,
2705,Association between autoimmune rheumatic diseases and the risk of dementia,"METHODSData were obtained from the Longitudinal Health Insurance Database 2000 (LHID2000). We included 1221 patients receiving ambulatory or hospitalization care and 6105 non-ARD patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied for 5 years to identify the subsequent manifestation of dementia. The data obtained were analyzed by Cox proportional hazard regression.RESULTSDuring the 5-year follow-up period, 30 ARD (2.48%) and 141 non-ARD patients (2.31%) developed dementia. During the 5-year follow-up period, there were no significant differences in the risks of any type of dementia (adjusted hazard ratio (HR), 1.18; 95% CI, 0.79-1.76) in the ARD group after adjusting for demographics and comorbidities.CONCLUSIONSWithin the 5-year period, patients with and without ARD were found to have similar risks of developing dementia.AIMAutoimmune rheumatic diseases (ARD) are characterized by systemic inflammation and may affect multiple organs and cause vascular events such as ischemic stroke and acute myocardial infarction. However, the association between ARD and increased risk of dementia is uncertain. This is a retrospective cohort study to investigate and compare the risk of dementia between patients clinically diagnosed with ARD and non-ARD patients during a 5-year follow-up period.","Autoimmune Diseases [complications] [epidemiology];Databases, Factual;Dementia [epidemiology] [etiology];Follow-Up Studies;Retrospective Studies;Rheumatic Diseases [complications] [epidemiology];Risk Factors;Taiwan;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]","Lu, K;Wang, Hk;Yeh, Cc;Huang, Cy;Sung, Ps;Wang, Lc;Muo, Ch;Sung, Fc;Chen, Hj;Li, Yc;Chang, Lc;Tsai, Kj",2014,,10.1155/2014/861812,0,2706
2706,Association between autoimmune rheumatic diseases and the risk of dementia,"AIM: Autoimmune rheumatic diseases (ARD) are characterized by systemic inflammation and may affect multiple organs and cause vascular events such as ischemic stroke and acute myocardial infarction. However, the association between ARD and increased risk of dementia is uncertain. This is a retrospective cohort study to investigate and compare the risk of dementia between patients clinically diagnosed with ARD and non-ARD patients during a 5-year follow-up period. METHODS: Data were obtained from the Longitudinal Health Insurance Database 2000 (LHID2000). We included 1221 patients receiving ambulatory or hospitalization care and 6105 non-ARD patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied for 5 years to identify the subsequent manifestation of dementia. The data obtained were analyzed by Cox proportional hazard regression. RESULTS: During the 5-year follow-up period, 30 ARD (2.48%) and 141 non-ARD patients (2.31%) developed dementia. During the 5-year follow-up period, there were no significant differences in the risks of any type of dementia (adjusted hazard ratio (HR), 1.18; 95% CI, 0.79-1.76) in the ARD group after adjusting for demographics and comorbidities. CONCLUSIONS: Within the 5-year period, patients with and without ARD were found to have similar risks of developing dementia.","Autoimmune Diseases [complications] [epidemiology];Databases, Factual;Dementia [epidemiology] [etiology];Follow-Up Studies;Retrospective Studies;Rheumatic Diseases [complications] [epidemiology];Risk Factors;Taiwan;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]","Lu, K.;Wang, H. K.;Yeh, C. C.;Huang, C. Y.;Sung, P. S.;Wang, L. C.;Muo, C. H.;Sung, F. C.;Chen, H. J.;Li, Y. C.;Chang, L. C.;Tsai, K. J.",2014,,10.1155/2014/861812,0,
2707,"Gout and the risk of Alzheimer's disease: A population-based, BMI-matched cohort study","Objective: While gout is associated with cardiovascular (CV)-metabolic comorbidities and their sequelae, the antioxidant effects of uric acid may have neuroprotective benefits. We evaluated the potential impact of incident gout on the risk of developing Alzheimer's disease (AD) in a general population context. Methods: We conducted an age-matched, sex-matched, entry-time-matched and body mass index (BMI)-matched cohort study using data from The Health Improvement Network, an electronic medical record database representative of the UK general population, from 1 January 1995 to 31 December 2013. Up to five non-gout individuals were matched to each case of incident gout by age, sex, year of enrolment and BMI. We compared incidence rates of AD between the gout and comparison cohorts, excluding individuals with prevalent gout or dementia at baseline. Multivariate hazard ratios (HRs) were calculated, while adjusting for smoking, alcohol use, physician visits, social deprivation index, comorbidities and medication use. We repeated the same analysis among patients with incident osteoarthritis (OA) as a negative control exposure. Results: We identified 309 new cases of AD among 59 224 patients with gout (29% female, mean age 65 years) and 1942 cases among 238 805 in the comparison cohort over a 5-year median follow up (1.0 vs 1.5 per 1000 person-years, respectively). Univariate (age-matched, sex-matched, entry-time-matched and BMI-matched) and multivariate HRs for AD among patients with gout were 0.71 (95% CI 0.62 to 0.80) and 0.76 (95% CI 0.66 to 0.87), respectively. The inverse association persisted among subgroups stratified by sex, age group (<75 and ≥75 years), social deprivation index and history of CV disease. The association between incident OA and the risk of incident AD was null. Conclusions: These findings provide the first general population-based evidence that gout is inversely associated with the risk of developing AD, supporting the purported potential neuroprotective role of uric acid.",uric acid;adult;aged;Alzheimer disease;article;body mass;cardiovascular risk;cerebrovascular accident;cohort analysis;controlled study;electronic medical record;female;follow up;gout;hazard ratio;human;ischemic heart disease;major clinical study;male;medical history;neuroprotection;osteoarthritis;population based case control study;priority journal;risk assessment;risk factor;social isolation,"Lu, N.;Dubreuil, M.;Zhang, Y.;Neogi, T.;Rai, S. K.;Ascherio, A.;Hernán, M. A.;Choi, H. K.",2016,,,0,
2708,Relation of cardiac ventricular repolarization and global cognitive performance in a community population,"Atherosclerosis is a risk factor for dementia. However, little is known about the association between cognitive performance and a widely used indicator of coronary heart disease, at rest electrocardiography. We identified 839 older residents (mean age 81 years, 58% black) from a geographically defined biracial community in Chicago, Illinois, who had undergone extensive cognitive performance testing and met the electrocardiographic eligibility criteria, including a QRS duration of < 120 ms. We then examined multivariate regression coefficients that described the associations between global cognitive performance and 4 novel descriptors of ventricular repolarization waveforms. All analyses were adjusted for age, gender, education, and race. The T wave nondipolar voltage had a significant association with global cognitive performance (p = 0.01), and this association largely remained after adjustment for cardiovascular disease risk factors (p = 0.03). In contrast, global cognitive performance was not significantly associated with the rate-adjusted QT interval, the voltage change from the beginning to end of the ST segment in lead V(5), or the spatial angle between the mean QRS and T wave vectors. In conclusion, the strengths of the associations varied between the novel electrocardiographic descriptors of ventricular repolarization and global cognitive performance. Nevertheless, the significant association observed with T wave nondipolar voltage suggests that the cardiac effects of heart disease are associated with cognitive declines.","Aged;Aged, 80 and over;Cardiac Pacing, Artificial/*methods;Cognition/*physiology;Cognition Disorders/etiology/physiopathology/*psychology;Disease Progression;Electrocardiography;Female;Follow-Up Studies;Heart Diseases/complications/*physiopathology/psychology;Heart Rate;Heart Ventricles/*physiopathology;Humans;Male;Prognosis;Retrospective Studies;Tachycardia, Ventricular/complications/*physiopathology/therapy;Ventricular Function, Left/*physiology","Lucas, B. P.;Mendes de Leon, C. F.;Prineas, R. J.;Bienias, J. L.;Evans, D. A.",2010,Oct 15,10.1016/j.amjcard.2010.06.031,0,
2709,"Religion, spirituality and cardiovascular disease: Research, clinical implications, and opportunities in Brazil","In this paper we comprehensively review published quantitative research on the relationship between religion, spirituality (R/S), and cardiovascular (CV) disease, discuss mechanisms that help explain the associations reported, examine the clinical implications of those findings, and explore future research needed in Brazil on this topic. First, we define the terms religion, spirituality, and secular humanism. Next, we review research examining the relationships between R/S and CV risk factors (smoking, alcohol/drug use, physical inactivity, poor diet, cholesterol, obesity, diabetes, blood pressure, and psychosocial stress). We then review research on R/S, cardiovascular functions (CV reactivity, heart rate variability, etc.), and inflammatory markers (IL-6, IFN-γ, CRP, fibrinogen, IL-4, IL-10). Next we examine research on R/S and coronary artery disease, hypertension, stroke, dementia, cardiac surgery outcomes, and mortality (CV mortality in particular). We then discuss mechanisms that help explain these relationships (focusing on psychological, social, and behavioral pathways) and present a theoretical causal model based on a Western religious perspective. Next we discuss the clinical applications of the research, and make practical suggestions on how cardiologists and cardiac surgeons can sensitively and sensibly address spiritual issues in clinical practice. Finally, we explore opportunities for future research. No research on R/S and cardiovascular disease has yet been published from Brazil, despite the tremendous interest and involvement of the population in R/S, making this an area of almost unlimited possibilities for researchers in Brazil.",article;Brazil;cardiovascular disease;cardiovascular surgery;human;humanism;medical research;pathophysiology;psychological aspect;religion;risk factor;self concept;treatment outcome,"Lucchese, F. A.;Koenig, H. G.",2013,,,0,
2710,Gustav mahler - 100th anniversary of death,"Gustav Mahler, late romantic composer whose works were forbidden and destroyed, found his place in history of music as a leading figure of his time. His life was filled with hard work and personal tragedies. By the time he had achieved the deserved recognition, his health almost completely deteriorated. Problems started in his youth with frequent purulent anginas, but soon complications of rheumatic fever developed. His unhealthy habits of smoking, irregular feeding patterns and almost continuous stress contributed to his state. Attacks of angina pectoris interrupted his stage performances. By the age of 51 he had developed bacterial endocarditis and died in sepsis and renal failure after morphine shots.",acetylsalicylic acid;immunomodulating agent;morphine;aggression;angina pectoris;arthritis;article;bacterial endocarditis;cauterization;diphtheria;education;emotional stress;Europe;family history;feeding behavior;France;hemorrhoid;human;kidney failure;life history;mental deterioration;migraine;mortality;musician;peripheral edema;philosophy;physical stress;rheumatic fever;scarlet fever;sepsis;smoking;streptococcal pharyngitis;stress;tachycardia,"Lucijanić, M.;Breitenfeld, D.;Pavić, J.;Miletić, J.;Buljan, D.;Granić, R.",2011,,,0,
2711,Alcohol and the heart : Anecdotes on the history of a checkered relationship,"The cultural and natural scientific ambivalence of the heart and alcohol has long been the subject of philosophical, artistic, intellectual and emotional discussions, not uncommonly in a romanticizing manner. The indulgence of alcoholic beverages in moderation is contrasted by the inestimable risks and dangers of alcohol abuse with many cardiovascular implications, such as cardiac arrhythmia, cardiomyopathy and arterial hypertension. The inspirational mental effects of alcohol have been emphasized in many citations from Classical Antiquity through the Middle Ages and even in modern times. In addition to wine and beer many alcoholic drinks, such as Champagne, sparkling wines, whisky (or whiskey), brandy (Cognac) and fruit brandies have a nearly ritual culture of traditions and customs, without which social life would be unthinkable. The interplay between enjoyment and displeasure is emphasized in the year 2016 with the 500-year jubilee of the German purity requirements for beer with countless events, including the Bavarian State Exhibition 2016. Recently, evidence of a neuroprotective effect of alcohol was reported with an improvement of intellectual capacity, which could counteract the widely occurring dementia syndrome. Millions of people could profit from this effect.",Alcohol consumption;Beer;Cardiovascular diseases;Champagne;Wine,"Luderitz, B.",2016,Sep,10.1007/s00059-016-4468-7,0,
2712,Hypertension and stroke—current perspectives for diabetes patients,"Background: In Germany, stroke remains the second most common cause of death after coronary heart disease and is the leading cause of disability in adults. Due to the demographic trends, it is expected that the prevalence will continue to increase, which is associated with increasing health care costs. Discussion: A—modifiable—risk factor for stroke is arterial hypertension. Thus, consequent high blood pressure treatment is the most important and effective tool for both primary and secondary prevention of stroke. It has also been demonstrated that hypertension has an influence on vascular and Alzheimer’s dementia. Because diabetes mellitus is associated with chronic cerebral damage and also a significantly increased risk of stroke, the control of hypertension in diabetes patients is particularly important. Perspectives: No consensus or controversies exist for the target blood pressure ranges/target windows in various constellations, for the selection and combination of antihypertensive agents, for a possible J/U relationship between blood pressure and cerebro-/cardiovascular events as well as the limit values for the initiation of drug therapy in patients with/without diabetes. Since 2013, the multicenter, randomized ESH/CHL-SHOT trial has been examining how a greater reduction in blood pressure (<135 to 125 or even <125 mmHg) affects the recurrence of stroke, cardiovascular outcome, and cognitive decline in older patients. Results are expected in November 2018.",Alzheimer disease;article;brain damage;cardiovascular risk;cause of death;cerebrovascular accident;clinical assessment tool;dementia;diabetes mellitus;disease association;health care cost;human;hypertension;ischemic heart disease;prevalence;primary prevention;secondary prevention,"Lüders, S.;Schrader, J.",2015,,,0,
2713,"UK research spend in 2008 and 2012: comparing stroke, cancer, coronary heart disease and dementia","OBJECTIVE: To assess UK governmental and charity research funding in 2012 for cancer, coronary heart disease (CHD), dementia and stroke, and to make comparisons with 2008 levels. DESIGN: Analysis of research expenditure. SETTING: United Kingdom. MAIN OUTCOME MEASURES: We identified UK governmental agencies and charities providing health research funding to determine the 2012 levels of funding for cancer, CHD, dementia and stroke. Levels of research funding were compared to burden of disease measures, including prevalence, disability adjusted life years and economic burden. RESULTS: The combined research funding into cancer, CHD, dementia and stroke by governmental and charity organisations in 2012 was pound856 million, of which pound544 million (64%) was devoted to cancer, pound166 million (19%) to CHD, pound90 million (11%) to dementia and pound56 million (7%) to stroke. For every pound10 of health and social care costs attributable to each disease, cancer received pound1.08 in research funding, CHD pound0.65, stroke pound0.19 and dementia pound0.08. A considerable shift in the distribution of government research funding was observed between 2008 and 2012. In 2008, 66% of governmental research funding into the four conditions under study was devoted to cancer, 21% to CHD, 9% to dementia and 4% to stroke. In 2012, the proportions devoted to dementia and stroke had increased to 21% and 12%, respectively, with cancer accounting for 45% of total research spend. CONCLUSIONS: Although there has been much progress by government to increase levels of research funding for dementia and stroke, these areas remain underfunded when compared with the burden of disease.","Biomedical Research/*economics;Charities/economics;Coronary Disease/*economics/epidemiology;Cost of Illness;Dementia/*economics/epidemiology;Financing, Government/economics;Great Britain/epidemiology;Health Expenditures;Humans;Neoplasms/*economics/epidemiology;Prevalence;Quality-Adjusted Life Years;Stroke/*economics/epidemiology;Cancer;Cost-of-illness;Research funding","Luengo-Fernandez, R.;Leal, J.;Gray, A.",2015,Apr 13,10.1136/bmjopen-2014-006648,0,
2714,"UK research expenditure on dementia, heart disease, stroke and cancer: Are levels of spending related to disease burden?","Background and purpose: A UK government review recommended that the impact of disease on the population and economy should be assessed to inform health research priorities. This study aims to quantify UK governmental and charity research funding for dementia, cancer, coronary heart disease (CHD) and stroke in 2007/08 and assess whether the levels of research expenditure are aligned with disease and economic burden. Methods: We identified UK governmental agencies and charities providing health research funding and determined their levels of funding for dementia, cancer, CHD and stroke. Research funding levels were compared to the number of cases, disability-adjusted life years (DALYs) and economic burden. Economic costs were estimated using data on morbidity, mortality, health and social care use, private costs and other related indicators. Results: Research funding to the four diseases was £833million, of which £590million (71%) was devoted to cancer, £169million (20%) to CHD, £50million (6%) to dementia and £23million (4%) to stroke. Cancer received £482 in research funding per 1000 DALYs lost, CHD received £266, dementia received £166, with stroke receiving £71. In terms of economic burden, for every £1million of health and social care costs attributable to each disease, cancer received £129269 in research funding, CHD received £73153, stroke received £8745 and dementia received £4882. Conclusions: Most health research funding in the UK is currently directed towards cancer. When compared to their burden, our analysis suggests that research spending on dementia and stroke is severely underfunded in comparison with cancer and CHD. Click to view the accompanying paper in this issue. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.",article;cost of illness;dementia;disability adjusted life year;funding;government;health care cost;human;ischemic heart disease;medical research;morbidity;mortality;neoplasm;priority journal;quality of life;sensitivity analysis;social care;cerebrovascular accident;United Kingdom,"Luengo-Fernandez, R.;Leal, J.;Gray, A. M.",2012,,,0,
2715,Estrogen and atherosclerosis,,estrogen;estrogen receptor;adult;aged;Alzheimer disease;article;autopsy;body mass;cardiovascular risk;cell function;controlled study;coronary artery;coronary artery atherosclerosis;diabetes mellitus;DNA polymorphism;endothelium cell;estrogen activity;estrogen therapy;female;Finland;gene linkage disequilibrium;gene replication;genetic association;genetic variability;genotype;heart infarction;heredity;histopathology;hormone substitution;human;hypertension;lifestyle;major clinical study;male;phenotype;postmenopause;promoter region;prostate carcinoma;RNA splicing,"Luft, F. C.",2002,,,0,
2716,Prolonged survival in 2 nonagenarians with heart failure and severe aortic stenosis,"The prevalence of severe aortic stenosis is 6% in persons 85 to 86 years of age according to a Finnish population-based report. In the United States, the population over 80 years old is projected to rise from the current 7 million to 25 million by the year 2050. Thus, aortic stenosis in aging adults, and the management questions it poses, will be increasingly common. We report herein the cases of 2 nonagenarian patients with severe symptomatic aortic stenosis who far outlived the natural history of this disease. We suspect that we are seeing a change in the prognosis of senile aortic stenosis as a result of advances in the geriatric care and management of advanced heart failure. Furthermore, the unusual longevity of these patients was made possible by the remarkable holistic care given by a dedicated, altruistic caregiver who had training in psychology, theology, and nursing. © 2008 by the Texas Heart® Institute.",acetylsalicylic acid;aldosterone antagonist;beta adrenergic receptor blocking agent;digoxin;dihydropyridine;furosemide;aged;Alzheimer disease;anamnesis;aorta stenosis;article;case report;cholecystectomy;clinical feature;congestive heart failure;coronary artery disease;disease severity;female;gastroesophageal reflux;atrial fibrillation;heart infarction;human;hyperlipidemia;hypertension;intervertebral disk hernia;medical assessment;osteoporosis;Paget bone disease;prognosis;vertebral canal stenosis;aspirin,"Lui, C. Y.;Alexander, N.",2008,,,0,
2717,Multimodal analysis to predict shunt surgery outcome of 284 patients with suspected idiopathic normal pressure hydrocephalus,"Objectives: Optimal selection of idiopathic normal pressure hydrocephalus (iNPH) patients for shunt surgery is challenging. Disease State Index (DSI) is a statistical method that merges multimodal data to assist clinical decision-making. It has previously been shown to be useful in predicting progression in mild cognitive impairment and differentiating Alzheimer’s disease (AD) and frontotemporal dementia. In this study, we use the DSI method to predict shunt surgery response for patients with iNPH. Methods: In this retrospective cohort study, a total of 284 patients (230 shunt responders and 54 non-responders) from the Kuopio NPH registry were analyzed with the DSI. Analysis included data from patients’ memory disorder assessments, age, clinical symptoms, comorbidities, medications, frontal cortical biopsy, CT/MRI imaging (visual scoring of disproportion between Sylvian and suprasylvian subarachnoid spaces, atrophy of medial temporal lobe, superior medial subarachnoid spaces), APOE genotyping, CSF AD biomarkers, and intracranial pressure. Results: Our analysis showed that shunt responders cannot be differentiated from non-responders reliably even with the large dataset available (AUC = 0.58). Conclusions: Prediction of the treatment response in iNPH is challenging even with our extensive dataset and refined analysis. Further research of biomarkers and indicators predicting shunt responsiveness is still needed.",amyloid beta protein[1-42];apolipoprotein E2;apolipoprotein E3;apolipoprotein E4;biological marker;hydroxymethylglutaryl coenzyme A reductase inhibitor;phosphoprotein;phosphorylated tau 181 protein;tau protein;unclassified drug;adult;aged;alcohol abuse;Alzheimer disease;article;balance impairment;brain atrophy;brain biopsy;brain ventricle peritoneum shunt;cerebrospinal fluid analysis;cerebrovascular accident;Clinical Dementia Rating;cognitive defect;cohort analysis;computer assisted tomography;congestive heart failure;controlled study;coronary artery disease;diabetes mellitus;Disease State Index;female;gait disorder;genotype;headache;heart arrhythmia;human;hypertension;intracranial pressure;major clinical study;male;medial temporal lobe;memory disorder;Mini Mental State Examination;neuroimaging;normotensive hydrocephalus;nuclear magnetic resonance imaging;onset age;Parkinson disease;predictive value;priority journal;prognosis;prognostic assessment;retrospective study;sensitivity and specificity;statistical analysis;subarachnoid space;suprasylvian gyrus;surgical patient;Sylvian fissure;symptom;transient ischemic attack;treatment outcome;treatment response;urine incontinence;vertigo,"Luikku, A. J.;Hall, A.;Nerg, O.;Koivisto, A. M.;Hiltunen, M.;Helisalmi, S.;Herukka, S. K.;Sutela, A.;Kojoukhova, M.;Mattila, J.;Lötjönen, J.;Rummukainen, J.;Alafuzoff, I.;Jääskeläinen, J. E.;Remes, A. M.;Soininen, H.;Leinonen, V.",2016,,10.1007/s00701-016-2980-4,0,
2718,Pain characteristics and pain control in european nursing homes: Cross-sectional and longitudinal results from the services and health for elderly in long term care (SHELTER) study,"Objective and Design: Few studies have compared cross-national characteristics of residents with pain in European long term care facilities. The SHELTER project, a cross-national European study on nursing home residents, provides the opportunity to examine this issue. The present study aimed to evaluate key figures about pain and compare them with seven European countries and Israel. Setting, Participants, and Measurements: A total of 3926 nursing home residents were assessed by the interRAI instrument for Long Term Care Facilities (interRAI LTCF). Prevalence of pain, frequency, intensity, consistency, and control were estimated and compared cross-nationally. Correlates between patient-related characteristics and inadequate pain management were tested using bivariate and multivariate logistic regression models. Results: Overall, 1900 (48.4%) residents suffered from pain. Pain prevalence varied significantly among countries, ranging from 19.8% in Israel to 73.0% in Finland. Pain was positively associated with female gender, fractures, falls, pressure ulcers, sleeping disorders, unstable health conditions, cancer, depression, and number of drugs. It was negatively associated with dementia. In a multivariate logistic regression model, all associations remained except for sleeping disorders. Clinical correlations varied considerably among countries. Although in 88.1% of cases, pain was self-rated by the residents as sufficiently controlled, in only 56.8% of cases was pain intensity self-rated as absent or mild. Pain control and intensity improved within 1 year. Conclusion: Pain prevalence is high and varies considerably across Europe. Although most residents considered pain as adequately controlled, a closer look confirmed that many still suffer from high pain intensities. Analyzing the reasons behind these differences may help to improve pain management. © 2013 American Medical Directors Association, Inc.",ADL disability;aged;analgesia;article;breakthrough pain;cerebrovascular accident;chronic obstructive lung disease;congestive heart failure;Czech Republic;decubitus;dementia;depression;diabetes mellitus;facial expression;female;Finland;fracture;France;functional status;geriatric assessment;Geriatric Depression Scale;Germany;health care policy;human;ischemic heart disease;Israel;Italy;long term care;major clinical study;male;neoplasm;Netherlands;nursing home;nursing home patient;pain;pain assessment;prevalence;self concept;sleep disorder;United Kingdom,"Lukas, A.;Mayer, B.;Fialová, D.;Topinkova, E.;Gindin, J.;Onder, G.;Bernabei, R.;Nikolaus, T.;Denkinger, M. D.",2013,,,0,
2719,The clinical course of advanced dementia,,"Comorbidity;Dementia/*complications/mortality;Heart Failure/complications;Humans;Neoplasms/complications;Pulmonary Disease, Chronic Obstructive/complications","Luo, P.;Zhang, L.;Fei, Z.",2010,Jan 28,,0,
2720,Predictors of nursing home admission of individuals without a dementia diagnosis before admission - results from the Leipzig Longitudinal Study of the Aged (LEILA 75+),"BACKGROUND: In previous decades a substantial number of community-based studies mostly including dementia cases examined predictors of nursing home admission (NHA) among elderly people. However, no one study has analysed predictors of NHA for individuals without developing dementia before NHA. METHODS: Data were derived from the Leipzig Longitudinal Study of the Aged, a population-based study of individuals aged 75 years and older. 1,024 dementia-free older adults were interviewed six times on average every 1.4 years. Socio-demographic, clinical, and psychometric variables were obtained. Kaplan-Meier estimates were used to determine mean time to NHA. Cox proportional hazards regression was used to examine predictors of long-term NHA. RESULTS: Of the overall sample, 7.8 percent of the non-demented elderly (n = 59) were admitted to nursing home (NH) during the study period. The mean time to NHA in the dementia-free sample was 7.6 years. Characteristics associated with a shorter time to NHA were increased age, living alone, functional and cognitive impairment, major depression, stroke, myocardial infarction, a low number of specialist visits and paid home helper use. CONCLUSIONS: Severe physical or psychiatric diseases and living alone have a significant effect on NHA for dementia-free individuals. The findings offer potentialities of secondary prevention to avoid or delay NHA for these elderly individuals. Further investigation of predictors of institutionalization is warranted to advance understanding of the process leading to NHA for this important group.","Aged;Aged, 80 and over;Dementia/*diagnosis/epidemiology;Female;Forecasting;Germany/epidemiology;Humans;Interviews as Topic;Longitudinal Studies;Male;*Nursing Homes;*Patient Admission;Proportional Hazards Models","Luppa, M.;Luck, T.;Matschinger, H.;Konig, H. H.;Riedel-Heller, S. G.",2010,Jun 29,10.1186/1472-6963-10-186,0,
2721,Is walking speed a vital sign? Absolutely!,"Health care professionals use vital signs routinely in caring for older adults. Because vital signs reflect the interaction of many physiological systems, they are effective indicators of general health. Vital signs can be quickly and accurately measured using commonly available equipment. Because normal values have been established, vital signs can be used to identify those individuals who require further evaluation and differential diagnosis to identify possible contributors when vital signs are abnormal, as well as those who would benefit from intervention to restore health and reduce risk of adverse health events. In rehabilitation, vital signs serve as an index of activity and exercise tolerance and are frequently used as an outcome measure to assess efficacy of intervention. This article begins by defining the characteristics of a ""good"" vital sign, reviews how classical vital signs (heart rate, respiratory rate, blood pressure, and body temperature) are used to guide clinical practice, evaluates how pain has come to be considered the fifth vital sign, and proposes that walking speed meets criteria as an effective vital sign in later life. Walking speed not only is a robust outcome measure but is also a powerful predictor of functional decline, risk of development of frailty, and risk of mortality. Drawing on current best evidence from epidemiologic and clinical research literature, the goal of this article was to motivate readers to adopt measurement of walking speed as a vital sign for all older adults in their care across all physical therapy practice settings. © 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins.",beta adrenergic receptor blocking agent;calcium channel blocking agent;angina pectoris;anorexia;anxiety;article;atherosclerosis;autonomic nervous system;backache;blood pressure;blood pressure measurement;body temperature;bradycardia;breathing rate;cardiopulmonary hemodynamics;cardiovascular system;chemoreceptor;chronic kidney disease;dehydration;depression;differential diagnosis;endocrine system;environmental temperature;exercise;exercise tolerance;fall risk;geriatric rehabilitation;health care personnel;health care system;heart arrhythmia;heart failure;heart infarction;heart rate;hip fracture;human;hypertension;hyperthermia;hypotension;hypothalamus function;hypothermia;hypovolemic shock;kidney disease;limbic system;malaise;metabolic syndrome X;morbidity;mortality;multiinfarct dementia;musculoskeletal system;nervous system;nociception;non insulin dependent diabetes mellitus;osteoarthritis;osteoporosis;pain;Parkinson disease;peripheral occlusive artery disease;physiotherapy practice;pressoreceptor;quality of life;respiratory distress;respiratory failure;risk factor;spinal cord infection;cerebrovascular accident;tachycardia;total hip prosthesis;treatment planning;spine fracture;vital sign;walking speed,"Lusardi, M. M.",2012,,,0,
2722,Insulin Resistance and Future Cognitive Performance and Cognitive Decline in Elderly Patients with Cardiovascular Disease,"BACKGROUND: The role of insulin resistance (IR) in the pathogenesis of cognitive performance is not yet clear. OBJECTIVE: To examine the associations between IR and cognitive performance and change in cognitive functions two decades later in individuals with cardiovascular disease with and without diabetes. METHODS: A subset of 489 surviving patients (mean age at baseline 57.7+/-6.5 y) with coronary heart disease who previously participated in the secondary prevention Bezafibrate Infarction Prevention (BIP trial; 1990-1997), were included in the current neurocognitive study. Biochemical parameters including IR (using the homeostasis model of assessment; HOMA-IR) were measured at baseline. During 2004-2008, computerized cognitive assessment and atherosclerosis parameters were measured (T1; n = 558; mean age 72.6+/-6.4 years). A second cognitive assessment was performed during 2011-2013 (T2; n = 351; mean age 77.2+/-6.4 years). Cognitive function, overall and in specific domains, was assessed. We used linear regression models and linear mixed models to evaluate the differences in cognitive performance and decline, respectively. RESULTS: Controlling for potential confounders, IR (top HOMA-IR quartile versus others) was associated with subsequent poorer cognitive performance overall (beta= -4.45+/-Standard Error (SE) 1.54; p = 0.004) and on tests of memory and executive function among non-diabetic patients (beta= -7.16+/-2.38; p = 0.003 and beta= -3.33+/-1.84; p = 0.073, respectively). Moreover, among non-diabetic patients, IR was related to a greater decline overall (beta= -0.17+/-0.06; p = 0.008), and in memory (beta= -0.22+/-0.10; p = 0.024) and executive function (beta= -0.19+/-0.08; p = 0.012). The observed associations did not differ after excluding subjects with prevalent stroke or dementia. CONCLUSION: IR is related to subsequent poorer cognitive performance and greater cognitive decline among patients with cardiovascular disease with and without diabetes.",Cardiovascular disease;cognitive decline;cognitive impairments;insulin resistance,"Lutski, M.;Weinstein, G.;Goldbourt, U.;Tanne, D.",2017,,,0,
2723,Clinical features in 4 Chinese families with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL),"OBJECTIVE: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is an inherited cerebral arteriolar disease in adulthood, which is caused by NOTCH3 gene mutation. The main symptoms were migraine, cerebral stroke, later with mood disorders and dementia in Caucasian patients. Recently, the disease was also recognized in Asian patients, in whom the migraine is rarely reported. In order to give the clinical features of Chinese patients, we described the clinical symptoms in 4 CADASIL families. METHODS: CADASIL was diagnosed by the investigation of ultra-structure changes of arteriole in sural nerve and NOTCH3 gene mutation in the 4 index cases. Detailed clinical and routine laboratory examinations were performed in these 4 patients, including electrocardiography, nerve conduction velocity, serum glycogen, and serum homocysteine. Additionally, we also collected the clinical data of the other 83 family members through interviews and the available medical records. RESULTS:Of the 83 persons, 29 were classified as clinical suspected patients, who presented one or more of the disease-related neurological symptoms, such as cerebral ischemic events and the cognitive impairment. All of them showed no common risk factors for stroke, such as diabetic mellitus, hypertension, and heart disease. The clinical suspected patients distributed in every consecutive generations and involved both sexes, which was according to the autosomal dominant inherited pattern. The onset age of the disease ranged from 28 to 70-year-old and mainly between the 4th and the 5th decades. The main symptoms were recurrent episodic vertigo, with or without hemiplegia. At the same time or a little bit later, the cognitive impairment was developed in some patients. Compared with the typical presentations of the disease in European patients, none of our 29 patients showed migraine,one index case showed mild sensory disturbance in extremities. Elevated serum homocysteine level and abnormal of nerve conduction study in two index cases (3 and 4) were noticed. CONCLUSION: The onset age of the disease of our patients is similar to that of Caucasian patients. The main symptoms were stroke and dementia. Involvement of post circulation system was the main clinical feature for ischemic events in our patients. Dementia could be found in the early stage of disease. Migraine should not be regarded as a common clinical feature in our patients. The involvement of the peripheral nerves expanded the disease expression outside the central nervous system.","glycogen;homocysteine;Notch receptor;NOTCH3 protein, human;adult;article;blood;CADASIL;case report;electron microscopy;female;genetics;human;male;middle aged;mutation;pathology;pedigree;ultrastructure;vascular smooth muscle","Lv, H.;Yao, S.;Zhang, W.;Wang, Z. X.;Huang, Y. N.;Niu, X. Y.;Zhang, Z.;Yuan, Y.",2004,,,0,
2724,Two-year outcome of high-risk benign prostate hyperplasia patients treated with transurethral prostate resection by plasmakinetic or conventional procedure,"Objective: To perform a systematic comparison of transurethral plasmakinetic resection of the prostate (PKRP) to conventional transurethral resection of the prostate for treating benign prostate hyperplasia (BPH) in aged high-risk patients. Methods: Three hundred twenty-nine symptomatic patients diagnosed with BPH underwent endourological treatment by transurethral resection of the prostate (n = 136) or PKRP (n = 193). Preoperative and postoperative assessments were conducted for the International Prostate Symptom Scores, quality of life (QoL), postvoid residual urine (PVRU) volumes, maximal urine flow rates (Qmax.), and prostate-specific antigen. Perioperative data were collected for operative time, weight of resected tissue, blood loss, cases of open surgery, duration of bladder irrigation, and duration of catheter use. Patients were re-evaluated at postoperative months 3, 6, 12, 18, and 24. Postoperative complications were recorded. Results: In the perioperative period, no significant differences were found between the 2 surgery groups for weight of resected tissue or cases of open surgery. However, PKRP was associated with significantly shorter operative time, duration of bladder irrigation, and duration of catheter use, as well as less blood loss. At the 2-year follow-up, both procedures were found to have significantly improved International Prostate Symptom Scores, QoL, Qmax., PVRU, and prostate-specific antigen. In addition, each procedure was associated with some postoperative complications, some of which were significantly reduced in one over the other, such as secondary hemorrhage in PKRP. Conclusion: The currently available endourological treatments, transurethral resection of the prostate, and PKRP, are safe and effective therapies for treating aged high-risk patients with benign prostatic hyperplasia (BPH), although PKRP is superior in many aspects, including perioperative outcomes. © 2012 Elsevier Inc.",prostate specific antigen;aged;Alzheimer disease;anemia;article;bladder irrigation;bleeding;brain atrophy;cerebrovascular accident;controlled study;cor pulmonale;diabetes mellitus;follow up;heart arrhythmia;heart failure;high risk patient;human;hypertension;intermethod comparison;International Prostate Symptom Score;major clinical study;male;operation duration;outcome assessment;Parkinson disease;perioperative period;postoperative complication;postvoid residual urine volume;preoperative evaluation;priority journal;prostate hypertrophy;prostate surgery;quality of life;transurethral plasmakinetic resection of the prostate;transurethral resection;treatment duration;urine flow rate,"Lv, L.;Wang, L.;Fan, M.;Ju, W.;Pang, Z.;Zhu, Z.;Li, B.;Xiao, Y.;Zeng, F.",2012,,,0,
2725,Associations between single and multiple cardiometabolic diseases and cognitive abilities in 474 129 UK Biobank participants,"Aims: Cardiometabolic diseases (hypertension, coronary artery disease [CAD] and diabetes are known to associate with poorer cognitive ability but there are limited data on whether having more than one of these conditions is associated with additive effects. We aimed to quantify the magnitude of their associations with non-demented cognitive abilities and determine the extent to which these associations were additive. Methods and results: We examined cognitive test scores in domains of reasoning, information processing speed and memory, included as part of the baseline UK Biobank cohort assessment (N = 474 129 with relevant data), adjusting for a range of potentially confounding variables. The presence of hypertension, CAD and diabetes generally associated with poorer cognitive scores on all tests, compared with a control group that reported none of these diseases. There was evidence of an additive deleterious dose effect of an increasing number of cardiometabolic diseases, for reasoning scores (unstandardized additive dose beta per disease = -0.052 score points out of 13, 95% CI [confidence intervals] -0.063 to - 0.041, P < 0.001), log reaction time scores (exponentiated beta = 1.005, i.e. 0.5% slower, 95% CI 1.004-1.005, P < 0.001) and log memory errors (exponentiated beta = 1.005 i.e. 0.5% more errors; 95% CI 1.003-1.008). Conclusion: Cardiometabolic diseases are associated with worse cognitive abilities, and the potential effect of an increasing number of cardiometabolic conditions appears additive. These results reinforce the notion that preventing or delaying cardiovascular disease or diabetes may delay cognitive decline and possible dementia.",Cognitive ability;Coronary artery disease;Diabetes;Hypertension;UK Biobank,"Lyall, D. M.;Celis-Morales, C. A.;Anderson, J.;Gill, J. M.;Mackay, D. F.;McIntosh, A. M.;Smith, D. J.;Deary, I. J.;Sattar, N.;Pell, J. P.",2017,Feb 21,,0,
2726,"Alzheimer disease genetic risk factor APOE e4 and cognitive abilities in 111,739 UK Biobank participants","BACKGROUND: the apolipoprotein (APOE) e4 locus is a genetic risk factor for dementia. Carriers of the e4 allele may be more vulnerable to conditions that are independent risk factors for cognitive decline, such as cardiometabolic diseases. OBJECTIVE: we tested whether any association with APOE e4 status on cognitive ability was larger in older ages or in those with cardiometabolic diseases. SUBJECTS: UK Biobank includes over 500,000 middle- and older aged adults who have undergone detailed medical and cognitive phenotypic assessment. Around 150,000 currently have genetic data. We examined 111,739 participants with complete genetic and cognitive data. METHODS: baseline cognitive data relating to information processing speed, memory and reasoning were used. We tested for interactions with age and with the presence versus absence of type 2 diabetes (T2D), coronary artery disease (CAD) and hypertension. RESULTS: in several instances, APOE e4 dosage interacted with older age and disease presence to affect cognitive scores. When adjusted for potentially confounding variables, there was no APOE e4 effect on the outcome variables. CONCLUSIONS: future research in large independent cohorts should continue to investigate this important question, which has potential implications for aetiology related to dementia and cognitive impairment.",Apoe;Alzheimer disease,"Lyall, D. M.;Ward, J.;Ritchie, S. J.;Davies, G.;Cullen, B.;Celis, C.;Bailey, M. E.;Anderson, J.;Evans, J.;McKay, D. F.;McIntosh, A. M.;Sattar, N.;Smith, D. J.;Deary, I. J.;Pell, J. P.",2016,Jul,10.1093/ageing/afw068,0,
2727,"Alzheimer disease genetic risk factor APOE e4 and cognitive abilities in 111,739 UK Biobank participants","Background: the apolipoprotein (APOE) e4 locus is a genetic risk factor for dementia. Carriers of the e4 allele may be more vulnerable to conditions that are independent risk factors for cognitive decline, such as cardiometabolic diseases.Objective: we tested whether any association with APOE e4 status on cognitive ability was larger in older ages or in those with cardiometabolic diseases.Subjects: UK Biobank includes over 500,000 middle- and older aged adults who have undergone detailed medical and cognitive phenotypic assessment. Around 150,000 currently have genetic data. We examined 111,739 participants with complete genetic and cognitive data.Methods: baseline cognitive data relating to information processing speed, memory and reasoning were used. We tested for interactions with age and with the presence versus absence of type 2 diabetes (T2D), coronary artery disease (CAD) and hypertension.Results: in several instances, APOE e4 dosage interacted with older age and disease presence to affect cognitive scores. When adjusted for potentially confounding variables, there was no APOE e4 effect on the outcome variables.Conclusions: future research in large independent cohorts should continue to investigate this important question, which has potential implications for aetiology related to dementia and cognitive impairment.",apolipoprotein E4;adult;age;aged;allele;Alzheimer disease;article;biobank;cognition;cohort analysis;coronary artery disease;female;gene locus;genetic association;genetic risk;genotype;heart disease;human;hypertension;male;memory;metabolic disorder;non insulin dependent diabetes mellitus;perception;reasoning;risk factor,"Lyall, D. M.;Ward, J.;Ritchie, S. J.;Davies, G.;Cullen, B.;Celis, C.;Bailey, M. E. S.;Anderson, J.;Evans, J.;McKay, D. F.;McIntosh, A. M.;Sattar, N.;Smith, D. J.;Deary, I. J.;Pell, J. P.",2016,,10.1093/ageing/afw068,0,
2728,"Population-based study of medical comorbidity in early dementia and ""Cognitive Impairment, No Dementia (CIND)"". Association with functional and cognitive impairment: The Cache County Study","Objective: Authors investigated medical comorbidity in persons with dementia and ""Cognitive Impairment, No Dementia"" (CIND). Methods: The Cache County Study is an ongoing population-based study of the epidemiology of dementia, the risk factors for conversion from CIND to dementia, and the progression of dementia. As part of the study's first incidence wave, persons with dementia (N = 149), CIND (N = 225), or without cognitive impairment (N = 321) were identified and studied. Participants received comprehensive clinical evaluations and were rated on the General Medical Health Rating (GMHR), a global measure of seriousness of medical comorbidity. Participants and informants also completed the Mini-Mental State Exam and provided self-report information about comorbid medical conditions and functioning in activities of daily living. Results: There were few differences in number or type of comorbid medical conditions between persons with CIND and dementia, but persons with dementia were prescribed more medications. Stroke was more common in dementia participants, but other illnesses common in old age were not significantly different across cognitive groups. Medical comorbidity was more serious in both dementia and CIND, such that both groups were less likely to have ""little to no"" comorbidity. Seriousness of medical comorbidity was significantly associated with worse day-to-day functioning and cognition. Conclusions: Persons with CIND and dementia have more serious medical comorbidity than comparable persons without cognitive impairment. This comorbidity may play a role in the progression of CIND and dementia. Future studies should investigate the role of medical comorbidity and its treatment on dementia onset or progression, as well as the mechanisms mediating its neuropathologic effects. © 2005 American Association for Geriatric Psychiatry.",apolipoprotein E;aged;arthritis;article;case control study;chronic pain;cognitive defect;cognitive impairment no dementia;comorbidity;controlled study;daily life activity;dementia;diabetes mellitus;Diagnostic and Statistical Manual of Mental Disorders;disease course;disease severity;female;follow up;gastrointestinal disease;General Medical Health Rating;headache;heart infarction;human;hypercholesterolemia;hypertension;incidence;major clinical study;male;Mini Mental State Examination;neuropathology;population research;prescription;rating scale;risk factor;self report;cerebrovascular accident;thyroid disease,"Lyketsos, C. G.;Toone, L.;Tschanz, J.;Rabins, P. V.;Steinberg, M.;Onyike, C. U.;Corcoran, C.;Norton, M.;Zandi, P.;Breitner, J. C. S.;Welsh-Bohmer, K.",2005,,,0,
2729,Mortality outcomes among status aboriginals and whites with heart failure,"Background: Aboriginals have more cardiovascular risk factors than do non-Aboriginals that predispose them to the development of heart failure (HF). Whether long-term mortality outcomes and health care use differ between Aboriginals and whites with HF is unknown. Methods: The population consisted of all Albertans aged ≥ 20 years with an incident HF hospitalization between 2000 and 2008. Aboriginal status is recorded in the Alberta Health Care Insurance Registry and white ethnicity was determined using previously validated surname analysis algorithms. Cox and logistic regression was used to examine mortality outcomes after adjustment for key variables. Results: Compared with whites (n = 42,288), status aboriginal patients with HF (n = 1158) were significantly younger (mean age, 62.6 vs 75.4 years; P < 0.0001) and had higher rates of diabetes (45% vs 29%; P < 0.0001) and chronic obstructive pulmonary disease (40% vs 36%; P < 0.0001) but lower rates of most other comorbidities. Although crude mortality rates were lower in status Aboriginals than in whites at 1 year (22% vs 31%; P < 0.0001) and at 5 years (48% vs 59%; P < 0.0001), after adjustment, status Aboriginals exhibited increased mortality at 1 year (adjusted odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01-1.38) and 5 years (adjusted OR, 1.39; 95% CI, 1.16-1.67). Compared with whites, status Aboriginals used more health care resources in the years before and after an incident HF hospitalization but less specialist care. Conclusions: Although status Aboriginals hospitalized for the first time with HF are > 10 years younger, they use more health care resources and have increased short- and long-term mortality compared with their white counterparts. © 2014 Canadian Cardiovascular Society.",adult;article;cardiovascular risk;Caucasian;cerebrovascular disease;chronic obstructive lung disease;comorbidity;controlled study;dementia;demography;diabetes mellitus;disease duration;disease predisposition;female;atrial fibrillation;heart failure;heart muscle ischemia;hospitalization;human;hypertension;incidence;income;indigenous people;kidney failure;male;mortality;neoplasm;outcome assessment,"Lyons, K. J.;Ezekowitz, J. A.;Liu, W.;McAlister, F. A.;Kaul, P.",2014,,,0,
2730,Progressive stroke-like symptoms in a patient with sporadic creutzfeldt-jakob disease,"Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare neurodegenerative disorder in which accumulation of a pathogenic isoform of prion protein (PrPSc) induces neuronal damage with distinct pathologic features. The prognosis of sCJD is devastating: rapid clinical decline is followed by death generally within months after onset of symptoms. The classic clinical manifestations of sCJD are rapidly progressing dementia, myoclonus, and ataxia. However, the spectrum of clinical features can vary considerably. We describe a definite, neuropathologically verified sCJD in a 67-year-old woman who initially presented with progressive stroke-like symptoms: left-sided hemiparesis and ataxia within a few days. The initial brain magnetic resonance imaging (MRI) showed bilateral cortical hyperintensity on diffusion-weighted sequences (DWI) resembling multiple ischemic lesions. Despite anticoagulation with low-molecular-weight heparin, the patient deteriorated rapidly, became dysphagic and bedridden with myoclonic jerks on her left side extremities correlating with intermittent high-amplitude epileptiform discharges on electroencephalography (EEG). Basal ganglia hyperintense signal changes in addition to cortical ribboning were seen in DWI images of a follow-up MRI. Repeated EEG recordings showed an evolution to periodic sharp wave complexes. Protein 14-3-3 was positive in her cerebrospinal fluid specimen, in addition to an abnormally high total tau level. In the terminal stage the patient was in an akinetic, mutistic state with deteriorating consciousness. She died 19 days after admission to the hospital. Neuropathologic investigation corroborated the clinical diagnosis of sCJD with spongiform degeneration and immunohistochemical demonstration of the deposition of pathologic PrPSc. © 2010 S. Karger AG, Basel.",candesartan;cholesterol;clonazepam;dalteparin;dipyridamole;fentanyl;glucose;low molecular weight heparin;prion protein;protein 14 3 3;tau protein;aged;akinesia;anticoagulation;apnea;apraxia;article;ataxia;autopsy;balance impairment;basal ganglion;brain;brain cortex;brain embolism;brain ischemia;brain spongiosis;case report;cerebrospinal fluid analysis;cholesterol blood level;clinical feature;consciousness;Creutzfeldt Jakob disease;death;diffusion weighted imaging;disease exacerbation;drug dose increase;dysphagia;echocardiography;electroencephalography;epileptic discharge;facial nerve paralysis;fatigue;female;gait disorder;glucose blood level;heart ventricle hypertrophy;hemiparesis;hospital admission;human;hypertension;immunohistochemistry;insomnia;low drug dose;magnetic resonance angiography;memory disorder;myoclonus;nasogastric tube;neurologic examination;neuropathology;nuclear magnetic resonance;nuclear magnetic resonance imaging;occipital lobe;pain;parietal lobe;patient transport;priority journal;protein blood level;repeat procedure;speech disorder;cerebrovascular accident;temporal lobe;tendon reflex;thrombosis prevention;tinnitus;urinalysis;white matter,"Lyytinen, J.;Sairanen, T.;Valanne, L.;Salmi, T.;Paetau, A.;Pekkonen, E.",2010,,,0,
2731,Incidence and risk factors of delirium in the elderly general surgical patient,"Background This study evaluates the incidence of delirium and risk factors associated with delirium in elderly patients admitted to a general surgical ward. Methods Patients aged over 60 years who were admitted with an acute or elective general surgical diagnosis were eligible for this prospective cohort study. Risk factors associated with delirium were analyzed using univariate and multivariate analysis to identify those independently associated with delirium. Results A total of 209 patients were included in the study. The incidence of delirium was 16.9% (23.2% for acute admission, P <.001). Variables associated with delirium were dementia, presence of an urinary catheter, cognitive decline at admission measured with the mini-mental state examination, white blood cell count >10.0 × 109/L, and urea >7.5 mmol/L. Median length of hospital stay was 13 days (range 3-85) for patients with delirium versus 7 (range 1-54) for patients without (P =.002). Conclusions The incidence of delirium is high in elderly patients, especially after an acute admission, leading to an increase in length of hospital stay. To minimize delirium, associated risk factors must be identified and, if possible, treated. © 2014 Elsevier Inc. All rights reserved.",albumin;antiarrhythmic agent;antihistaminic agent;antiparkinson agent;benzodiazepine;bronchodilating agent;C reactive protein;diuretic agent;hemoglobin;morphine;nonsteroid antiinflammatory agent;potassium;sodium;spasmolytic agent;urea;adult;aged;alcohol consumption;appendicitis;article;brain infarction;cognitive defect;colorectal cancer;congestive heart failure;controlled study;delirium;dementia;drug use;female;general surgery;hearing aid;heart infarction;hernia;hip fracture;hospital admission;human;ileus;incidence;intoxication;length of stay;leukocyte count;major clinical study;male;medical history;Mini Mental State Examination;nasogastric tube;nursing home;nutritional status;observational study;peripheral occlusive artery disease;pharmaceutical care;postoperative complication;priority journal;prospective study;risk factor;smoking;spectacles;surgical patient;transient ischemic attack;urinary catheter;wound infection,"M.m. De Castro, S.;Ünlü, Ç;B. Tuynman, J.;Honig, A.;Van Wagensveld, B. A.;Steller, E. P.;C. Vrouenraets, B.",2014,,,0,
2732,Prevalence of mild cognitive impairment and its subtypes among Chinese older adults: Role of vascular risk factors,"Background/Aims: The prevalence of mild cognitive impairment (MCI) and its subtypes among Chinese older adults, and the contribution of vascular risk factors (VRF) and vascular disorders to MCI remain unclear. This study aims to investigate the prevalence of MCI and its different subtypes, and clarify the role of VRF and vascular diseases in the occurrence of MCI. Methods: A random sample of 5,214 nondementia (DSM-IV) individuals aged ≥65 years underwent neuropsychological assessments and clinical examinations. MCI, including amnestic MCI-single domain (aMCI-SD), amnestic MCI-multiple domains (aMCI-MD), nonamnestic MCI-single domain (naMCI-SD), and nonamnestic MCI-multiple domains (naMCI-MD), was defined according to modifications of the Petersen criteria. VRF (smoking, obesity, and diabetes) and vascular disorders (myocardial infarction, atrial fibrillation, stroke, and hypertension) were assessed based on information through self-report and medical records. Data were analyzed using multivariate logistic regression. Results: The prevalence of MCI was 11.33% (95% CI: 8.21-14.43), and that of aMCI-SD, aMCI-MD, naMCI-SD, and naMCI-MD was 4.48% (95% CI: 2.24-6.74), 2.09% (95% CI: 0.80-3.38), 4.22% (95% CI: 1.38-7.08), and 0.53% (95% CI: 0.32-0.75), respectively. The prevalence of MCI is higher in women than in men. Multivariate logistic regression analysis shows that VRF and vascular diseases were significantly related to increase the odds of MCI and its specific subtype. Conclusions: The prevalence of MCI is almost 11% among Chinese older adults. VRF and vascular disorders are associated with MCI, especially naMCI.",antihypertensive agent;adult;aged;amnesia;amnestic mild cognitive impairment multiple domain;amnestic mild cognitive impairment single domain;article;atrial fibrillation;cardiovascular risk;cerebrovascular accident;Chinese;clinical assessment;clinical examination;controlled study;diabetes mellitus;disease classification;DSM-IV;female;heart infarction;human;hypertension;major clinical study;male;medical record;mild cognitive impairment;neuropsychological test;nonamnestic mild cognitive impairment multiple domain;nonamnestic mild cognitive impairment single domain;obesity;petersen criteria;prevalence;priority journal;risk assessment;risk factor;self report;sex difference;smoking;vascular disease,"Ma, F.;Wu, T.;Zhao, J.;Ji, L.;Song, A.;Zhang, M.;Huang, G.",2016,,,0,
2733,Risk factors for drug-resistant bacterial pneumonia in older patients hospitalized with pneumonia in a Chinese population,"The relationship between healthcareassociated pneumonia (HCAP) and resistant bacteria is unclear. The aim of this study was to identify the risk factors for pneumonia caused by drug-resistant bacteria (DRB). A prospective cohort study was conducted at a tertiary teaching hospital in Hong Kong. Consecutive older patients (aged ≥565 years) were hospitalized with pneumonia from January 2004 to June 2005. DRB comprised methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae and Acinetobacter baumannii. The entire cohort consisted of 1176 older patients. Of 472 (40.1%) patients with etiological diagnosis established, bacterial pneumonia was found in 354 (30.1%) cases. DRB were isolated in 48 patients: P. aeruginosa (41), MRSA (5) and ESBL producing enteric bacilli (3). Co-infection with P. aeruginosa and MRSA was found in one patient. The prevalence of DRB in culture-positive pneumonia was 20.1% (48/239). Patients with DRB were more likely to have limitation in activities of daily living, bronchiectasis, dementia, severe pneumonia, recent hospitalization and recent antibiotic use. Logistic regression revealed that bronchiectasis [relative risk (RR) 14.12, P = 0.002], recent hospitalization (RR 4.89, P < 0.001) and severe pneumonia (RR 2.42, P = 0.010) were independent predictors of drug-resistant bacterial pneumonia. Recent hospitalization is the only risk factor for HCAP which is shown to be associated with DRB. Nursing home residence is not a risk factor. The concept of HCAP may not be totally applicable in Hong Kong where the prevalence of drug-resistant pathogens in pneumonia is low. © The Author 2011. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.",antibiotic agent;Acinetobacter baumannii;adult;antibiotic therapy;article;artificial ventilation;asthma;bacterial pneumonia;blood culture;bronchiectasis;cerebrovascular accident;Chinese;Chlamydia pneumoniae;chronic kidney disease;chronic liver disease;chronic obstructive lung disease;cohort analysis;congestive heart failure;dementia;diabetes mellitus;Escherichia coli;extended spectrum beta lactamase producing Enterobacteriaceae;female;Haemophilus influenzae;hospital infection;hospital patient;hospitalization;human;immunosuppressive treatment;ischemic heart disease;Klebsiella pneumoniae;major clinical study;male;methicillin resistant Staphylococcus aureus;methicillin resistant Staphylococcus aureus infection;mixed infection;Moraxella catarrhalis;Mycobacterium tuberculosis;Mycoplasma pneumoniae;pneumoconiosis;practice guideline;priority journal;prospective study;Pseudomonas aeruginosa;Pseudomonas infection;risk factor;Staphylococcus aureus;Streptococcus pneumoniae,"Ma, H. M.;Ip, M.;Woo, J.;Hui, D. S. C.;Lui, G. C. Y.;Lee, N. L. S.;Chan, P. K. S.;Rainer, T. H.",2013,,,0,
2734,Cardiovascular morbidity and the use of inhaled bronchodilators,"We used the Manitoba Health database to examine the relationship between use of inhaled respiratory drugs in people with chronic obstructive respiratory diseases and cardiovascular hospitalizations from 1996 through 2000. The drugs examined were beta agonists [BA], ipratropium bromide IB, and inhaled steroids (ICS). End points were first hospitalizations for supraventricular tachycardia, myocardial infarction, heart failure or stroke. A nested case control analysis was employed comparing people with and without cardiovascular events. Cases and controls were matched for gender and age, and conditional logistic regression was used in multivariate analysis considering other respiratory drugs, respiratory diagnosis and visit frequency, non-respiratory, non-cardiac comorbidities, and receipt of drugs for cardiovascular disease. In univariate analyses, BA, IB and ICS were all associated with hospitalizations for cardiovascular disease, but in multivariate analyses ICS did not increase risk while both BA and IB did. There were interactions between respiratory and cardiac drugs receipt in that bronchodilator associated risks were higher in people not taking cardiac drugs; this was especially true for stroke. There were strong interactions with specific cardiac drugs; for example, both BA and IB substantially increased the risk of supraventricular tachycardia in patients not anti-arryhthmic agents, but not in the presence of such agents. We conclude that bronchodilator therapy for chronic obstructive diseases is associated with increased cardiovascular risk, especially in patients without previous cardiovascular diagnoses, and that this is unlikely due to the severity of the respiratory disease, since risk was not increased with ICS. © 2008 Dove Medical Press Limited. All rights reserved.",antiarrhythmic agent;antihypertensive agent;beta adrenergic receptor blocking agent;beta adrenergic receptor stimulating agent;bronchodilating agent;calcium channel blocking agent;cholinergic receptor blocking agent;corticosteroid;dipeptidyl carboxypeptidase inhibitor;furosemide;hypocholesterolemic agent;ipratropium bromide;nitrate;adult;article;asthma;bronchitis;cardiovascular disease;cardiovascular risk;cerebrovascular accident;chronic obstructive lung disease;collagen disease;comorbidity;controlled study;dementia;diabetes mellitus;female;heart failure;heart infarction;hospitalization;human;kidney failure;liver disease;major clinical study;male;morbidity;mortality;peptic ulcer;supraventricular tachycardia,"Macie, C.;Wooldrage, K.;Manfreda, J.;Anthonisen, N.",2008,,,0,
2735,Appropriate baseline laboratory testing following ACEI or ARB initiation by Medicare FFS beneficiaries,"BACKGROUND: Laboratory testing to identify contraindications and adverse drug reactions is important for safety of patients initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Rates and predictors of appropriate testing among Medicare fee-for-service beneficiaries are unknown. PURPOSE: The study's purpose was to examine baseline laboratory testing rates, identify predictors of suboptimal testing, and assess the prevalence of abnormal creatinine and potassium among beneficiaries initiating ACE inhibitors or ARBs. DESIGN AND SUBJECTS: Retrospective cohort of 101 376 fee-for-service beneficiaries from 10 eastern US states in 1 July to 30 November 2011. MAIN MEASURES: Appropriate monitoring for serum creatinine or serum potassium was defined as evidence of an outpatient claim within 180 days before or 14 days after the index prescription fill date. KEY RESULTS: Thirty-eight percent of beneficiaries were men, 78% were White race, 26% had prevalent heart failure, and 89% had prevalent hypertension. Rates of appropriate baseline laboratory testing were 82.7% for potassium, 83.2% for creatinine, and 82.6% for both potassium and creatinine 180 days prior to initiation. In logistic regression, men (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.11, 1.19), African-Americans (OR = 1.26, 95%CI: 1.20, 1.32), and beneficiaries with Alzheimer's disease and related disorders (OR = 1.22, 95%CI: 1.15, 1.28) or stroke (OR = 1.34, 95%CI: 1.26, 1.43) were more likely to experience suboptimal testing. At baseline, hyperkalemia was relatively uncommon (5.8%), and elevated creatinine values were rare (1.4%). CONCLUSIONS: Appropriate monitoring could be improved for African-American beneficiaries and beneficiaries with a history of stroke or Alzheimer's disease and related disorders initiating ACE inhibitors or ARBs. Copyright (c) 2016 John Wiley & Sons, Ltd.",ACE inhibitor;Arb;beneficiary;creatinine;lab test;medicare;pharmacoepidemiology;potassium,"Maciejewski, M. L.;Hammill, B. G.;Qualls, L. G.;Hastings, S. N.;Wang, V.;Curtis, L. H.",2016,Sep,10.1002/pds.3994,0,
2736,Regional cerebral arterial transit time hemodynamics correlate with vascular risk factors and cognitive function in men with coronary artery disease,"Background and Purpose: Arterial transit time is the time needed for blood to travel from large arteries to capillaries, as estimated from arterial spin-labeling MR imaging. The purpose of this study was to determine whether vascular risk factors and cognitive performance are related to regional differences in cerebral arterial transit time in patients with coronary artery disease who are at risk for cognitive decline. Materials and Methods: Arterial transit time was estimated from multiple postlabel delay pseudocontinuous arterial spin-labeling images obtained from 29 men with coronary artery disease. Tests of memory, attention, processing speed, and executive function were administered. Principal component analysis was used to create separate models of cognition and vascular risk, which were related to brain regions through voxelwise analyses of arterial transit time maps. Results: Principal component analysis identified 2 components of vascular risk: 1) ""pressor"" (age, systolic blood pressure, and pulse pressure) and 2) ""obesity"" (body fat percentage and body mass index). Obesity was inversely related to arterial transit time in the posterior cingulate, precuneus, lateral occipital cortices, middle temporal gyrus, and frontal pole (P corrected < .05), whereas pressor was not significant. Cognitive scores were factored into a single component. Poor performance was inversely related to precuneus arterial transit time (P corrected < .05). The average arterial transit time in regions identified by obesity was associated with poorer cognitive function (r2 = 0.21, t = -2.65, P = .01). Conclusions: Altered cerebral hemodynamics, notably in nodal structures of the default mode network, may be one way that vascular risk factors impact cognition in patients with coronary artery disease.",age;aged;arterial transit time;article;assessment of humans;attention;body mass;brain mapping;brain region;California verbal learning test;clinical article;cognition;comparative study;coronary artery disease;coronary hemodynamics;correlational study;default mode network;demography;executive function;functional magnetic resonance imaging;human;male;memory;mental deterioration;metabolic parameters;neuroimaging;nuclear magnetic resonance scanner;obesity;pulse pressure;radiological parameters;risk factor;spin labeling;systolic blood pressure;time;Wechsler intelligence scale;3T system Discovery MR750,"MacIntosh, B. J.;Swardfager, W.;Robertson, A. D.;Tchistiakova, E.;Saleem, M.;Oh, P. I.;Herrmann, N.;Stefanovic, B.;Lanctôt, K. L.",2015,,,0,
2737,Chlamydia pneumoniae infection alters the junctional complex proteins of human brain microvascular endothelial cells,"Chlamydia pneumoniae has been identified and associated with multiple sclerosis (MS) and Alzheimer's disease (AD) pathogenesis, although the relationship of this organism in these diseases remains controversial. We have hypothesized that one potential avenue of infection is through the junctional complexes between the blood-brain barrier (BBB) endothelia. C. pneumoniae is characteristically a respiratory pathogen, but has been implicated in atherosclerosis, coronary artery disease, and neuroinflammatory conditions. C. pneumoniae infection may lead to endothelial damage, junctional alterations, and BBB breakdown. Therefore, in this study, C. pneumoniae infection of human brain microvascular endothelial cells (HBMECs) resulted in increased expression of the zonula adherens proteins beta-catenin, N-cadherin, and VE-cadherin, and decreased expression of the tight junctional protein occludin, as determined by immunocytochemistry and Western blot analyses. These events may underlie a mechanism for the regulation of paracellular permeability while maintaining barrier integrity during C. pneumoniae infection associated with neuropathologies such as MS and AD.","Antigens, CD;Brain/*blood supply/cytology;Cadherins/metabolism;Cell Membrane/physiology;Cells, Cultured;Chlamydophila Infections/microbiology;Chlamydophila pneumoniae/metabolism/*pathogenicity;Cytoskeletal Proteins/metabolism;Endothelium, Vascular/cytology/*microbiology/physiology;Humans;Immunohistochemistry;Membrane Proteins/analysis/immunology;Occludin;Tight Junctions/*metabolism;Trans-Activators/metabolism;Up-Regulation/physiology;beta Catenin","MacIntyre, A.;Hammond, C. J.;Little, C. S.;Appelt, D. M.;Balin, B. J.",2002,Dec 17,,0,
2738,Aerobic treadmill training effectively enhances cardiovascular fitness and gait function for older persons with chronic stroke,"QUESTION: Does high-intensity aerobic treadmill exercise improve cardiovascular fitness and gait function in people with chronic stroke? DESIGN: Randomised, controlled trial. SETTING: An outpatient rehabilitation centre in Germany. PARTICIPANTS: Individuals with chronic stroke >60 years of age with residual gait impairment, and ability to walk on the treadmill at >/=0.3km/h for 3 minutes were eligible. Serious cardiovascular conditions (eg, angina pectoris, heart failure, valvular dysfunction, peripheral arterial occlusive disease), dementia, aphasia, and major depression were exclusion criteria. Randomisation of 38 participants allocated 20 to the intervention group and 18 to the usual care group. INTERVENTIONS: The intervention group underwent treadmill training (3 times/week) for 3 months. The program was intended to achieve 30-50 minutes of treadmill training at 60-80% of the maximum heart rate reserve as determined by a maximum effort exercise test. The training was supervised by a physician and/or physiotherapist. The usual care group received conventional care physiotherapy for 1 hour 1-3 times a week without any aerobic training. OUTCOME MEASURES: The primary outcomes were peak oxygen consumption rate and the 6-minute walk test. Secondary outcome measures were self-selected and maximum walking speeds as measured in the 10-m walk test, Berg balance score, 5-Chair-Rise test, Rivermead Mobility Index, and Medical Outcomes Study Short-Form 12 (SF- 12). The outcomes were measured at baseline, immediately after completion of training, and at 12 months. RESULTS: 36 participants completed the study. After the 3-month training period, the change in peak oxygen consumption rate was significantly more in the treatment group, by 6.3mL/kg/min (95% CI 5.7 to 6.9). The change in distance achieved in the 6-minute walk test was also significantly more in the treatment group by 53 metres (95% CI 32 to 75). Among the secondary outcomes, maximum walking speed (by 0.14m/s, 95% CI 0.08 to 0.20), Berg balance score (by 2.6 points, 95% CI 0.5 to 4.7), and SF-12 Mental score (by 4.0 points, 95% CI 3.4 to 4.6) improved significantly more in the treadmill training group than the usual care group after the treatment period. The groups did not differ significantly on the remaining secondary outcomes. It was reported that compared to baseline peak oxygen consumption rate and 6-minute walk test distance were significantly improved at 12 months. CONCLUSION: A high-intensity treadmill training program improves cardiovascular fitness and gait in older adults with chronic stroke.",,"Mackay-Lyons, M.",2012,,10.1016/s1836-9553(12)70131-5,0,
2739,Competing causes of Death: A death certificate study,"Background: Despite the widespread interest in competing causes of death, empirical information on interrelationships between causes of death is scarce. We have used death certificate information to estimate the prevalence of competing causes of death at the moment of dying from specific underlying causes of death. Materials and Methods: In a stratified sample of 5975 deaths occurring in The Netherlands in 1990, information contained in the death certificate was used to determine the presence of diseases which, in the hypothetical case of elimination of the underlying cause of death, could develop into a new underlying cause of death. Poisson regression analysis was used to describe variation in age- and sex-adjusted prevalence of competing causes of death between different underlying causes. Results: Per 100 deaths, 46.2 competing causes were identified (52.0 after reweighting to take away the effects of stratification). The most frequent competing causes, all occurring in more than 2% of deaths, were: senile dementia, diabetes mellitus, ischemic heart disease, cerebrovascular disease, chronic obstructive lung disease, hypertensive disease, and arteriosclerosis. The overall prevalence of competing causes is relatively high among deaths from respiratory diseases (relative risk for respiratory diseases as compared with all underlying causes (RR) = 1.42 (95% CI, 1.25-1.62)), relatively low among deaths from neoplasms (RR = 0.54 (95% CI, 0.47-0.62)), and in between among deaths from cardiovascular diseases (RR = 1.08 (95% CI, 0.95-1.22)). Conclusion: Although it cannot be excluded that some of the variation in prevalence of competing causes by underlying cause is due to selective underregistration of coexisting diseases on death certificates, the results of this study suggest that conventional estimates of gains in life expectancy after elimination of neoplasms are much less biased by the effect of competing causes than the corresponding estimates for cardiovascular diseases and particularly respiratory diseases.",arteriosclerosis;article;cardiovascular disease;cause of death;cerebrovascular disease;chronic obstructive lung disease;death certificate;diabetes mellitus;disease activity;human;hypertension;ischemic heart disease;life expectancy;mortality;neoplasm;Netherlands;priority journal;regression analysis;respiratory tract disease;senile dementia,"Mackenbach, J. P.;Kunst, A. E.;Lautenbach, H.;Oei, Y. B.;Bijlsma, F.",1997,,,0,
2740,What pharmacists can do to tackle the major causes of death in Scotland,,Alzheimer disease;attitude to health;behavior disorder;dementia;demography;drug misuse;fatality;health care personnel;health care policy;home care;human;ischemic heart disease;life expectancy;lifestyle;national health service;neoplasm;pharmaceutical care;pharmacist;pneumonia;registration;short survey;cerebrovascular accident;United Kingdom,"MacKinnon, A.",2012,,,0,
2741,News and reviews,,acetylsalicylic acid;antineoplastic agent;antithrombocytic agent;dipyridamole;thrombin inhibitor;warfarin;ximelagatran;aged;angioplasty;blood clot lysis;body build;cataract;cataract extraction;chondrocalcinosis;coronary stent;dementia;diabetes mellitus;distress syndrome;elderly care;emergency ward;esophagus cancer;geriatric disorder;geriatric hospital;geriatric patient;health care facility;atrial fibrillation;heart infarction;heart valve replacement;hip fracture;hospital admission;human;life expectancy;lifestyle;marathon runner;medical assessment;melanoma;Mini Mental State Examination;note;orthostatic hypotension;osteoarthritis;priority journal;cerebrovascular accident;sun exposure;task performance;treatment planning;aspirin,"MacLennan, W. J.",2003,,,0,
2742,Dementia and immobility,"Structured physical and psychiatric assessments were performed on 100 elderly women with dementia admitted to either a geriatric or a geriatric psychiatry unit, and the relationship between physical and mental factors and the ability to transfer was investigated. There was an association between limited mobility and physical and psychiatric evidence of cerebrovascular and cardiac disease; but none between mobility and most measures of degree of dementia, vision, hearing, balance, cerebellar function, position sense, ankle reflexes, postural hypotension, locomotor disease, medication or ratings for depression, anxiety, irritability, hostility, lack of co-operation, suspiciousness, or distractibility. This suggests that in dementia the main cause of limited mobility is focal neurological damage.","Aged;Aged, 80 and over;Aging/*physiology/psychology;Cerebrovascular Disorders/physiopathology;Coronary Disease/physiopathology;Dementia/etiology/*physiopathology;Female;Humans;*Immobilization","MacLennan, W. J.;Ballinger, B. R.;McHarg, A.;Ogston, S. A.",1987,Jan,,0,
2743,Lack of association between apolipoprotein E genotype and ischaemic stroke in a Scottish population,"Background: Apolipoprotein E ε4 allele has been associated with increased risk of coronary heart disease, and is also a major genetic susceptibility locus for Alzheimer's disease. Some studies have shown an association between apoE genotype and ischaemic stroke or outcome following stroke, while other studies have failed to do so. Materials and methods: Using PCR and the Taqman fluorescence system to detect polymorphisms we examined apoE genotype in 266 ischaemic stroke cases and in a control population. Results: We found no association between apoeE ε 4 allele distribution and ischaemic stroke, or with outcome following stroke as measured using the Rankin score. Conclusion: This study disagrees with a recent meta-analysis, and suggests that further studies are required to clarify the exact relationship between apoE genotype and ischaemic stroke.",apolipoprotein E;adult;aged;article;cardiovascular risk;cerebrovascular accident;controlled study;disease association;female;genetic polymorphism;genetic susceptibility;genotype;human;major clinical study;male;polymerase chain reaction;priority journal;United Kingdom,"MacLeod, M. J.;De Lange, R. P.;Breen, G.;Meiklejohn, D.;Lemmon, H.;St. Clair, D.",2001,,,0,
2744,"Experiences of predictive testing in young people at risk of Huntington's disease, familial cardiomyopathy or hereditary breast and ovarian cancer","While debate has focused on whether testing of minors for late onset genetic disorders should be carried out if there is no medical benefit, less is known about the impact on young people (<25 years) who have had predictive testing often many years before the likely onset of symptoms. We looked at the experiences of young people who had had predictive testing for a range of conditions with variable ages at onset and options for screening and treatment. A consecutive series of 61 young people who had a predictive test aged 15-25 years at the Clinical Genetic Service, Manchester, for HD, HBOC (BrCa 1 or 2) or FCM (Hypertrophic Cardiomyopathy or Dilated Cardiomyopathy), were invited to participate. Thirty-six (36/61; 59%) agreed to participate (10 HD, 16 HBOC and 10 FCM) and telephone interviews were audiotaped, transcribed and analysed using Interpretative Phenomenological Analysis. None of the participants expressed regret at having the test at a young age. Participants saw the value of pretest counselling not in facilitating a decision, but rather as a source of information and support. Differences emerged among the three groups in parent/family involvement in the decision to be tested. Parents in FCM families were a strong influence in favour of testing, in HBOC the decision was autonomous but usually congruent with the views of parents, whereas in HD the decision was autonomous and sometimes went against the opinions of parents/grandparents. Participants from all three groups proposed more tailoring of predictive test counselling to the needs of young people.","Adolescent;Adult;Breast Neoplasms/*diagnosis/genetics;Cardiomyopathy, Dilated/*diagnosis/genetics;Female;Genetic Predisposition to Disease/*psychology;Genetic Testing/*ethics/methods;Humans;Huntington Disease/*diagnosis/genetics;Male;Ovarian Neoplasms/*diagnosis/genetics;Parents/psychology;Patients/psychology;Self Report","MacLeod, R.;Beach, A.;Henriques, S.;Knopp, J.;Nelson, K.;Kerzin-Storrar, L.",2014,Mar,10.1038/ejhg.2013.143,0,
2745,Cyclooxygenase inhibitors: A never ending story?,,acetylsalicylic acid;celecoxib;cyclooxygenase 1;cyclooxygenase 2;cyclooxygenase 2 inhibitor;naproxen;nonsteroid antiinflammatory agent;prostaglandin E1;prostaglandin E2;prostaglandin synthase inhibitor;rofecoxib;valdecoxib;Alzheimer disease;article;cardiovascular disease;cardiovascular risk;coronary artery bypass graft;drug industry;drug information;food and drug administration;health care organization;heart infarction;human;Italy;patient care;patient monitoring;prescription;United States;aspirin;vioxx,"Macrì, R.;Manfredi, C.",2006,,,0,
2746,Adverse reactions associated with oral and parenteral use of cephalosporins: A retrospective population-based analysis,"Background Few studies have provided population-based, route-specific data on allergy to cephalosporin or incidence of serious adverse drug reactions (ADRs). Objective We investigated the incidence of new reports of cephalosporin-associated ""allergy"" and serious ADRs. Methods We identified all members of the Kaiser Permanente Southern California health plan given cephalosporins (from January 1, 2010, through December 31, 2012), all new reports of cephalosporin-associated allergy, and all serious ADRs. Results There were 622,456 health plan members exposed to 901,908 courses of oral cephalosporins and 326,867 members exposed to 487,630 courses of parenteral cephalosporins over the 3-year study period. New reports of allergy to cephalosporin were more frequent among women (0.56%; 95% CI, 0.54% to 0.57%) than among men (0.43%; 95% CI, 0.41% to 0.44%) per course (P <.0001). The most frequent serious cephalosporin-associated ADRs were Clostridium difficile infection within 90 days (0.91%), nephropathy within 30 days (0.15%), and all-cause death within 1 day (0.10%). None correlated with history of drug allergy. Physician-documented cephalosporin-associated anaphylaxis occurred with 5 oral exposures (95% CI, 1/1,428,571-1/96,154) and 8 parenteral exposures (95% CI, 1/200,000-1/35,971) (P =.0761). There were 3 documented cephalosporin-associated serious cutaneous adverse reactions (95% CI, 0-1 in 217,291). All were associated with the use of another antibiotic at the same time as cephalosporin. Conclusions Cephalosporins are widely and safely used, even in individuals with a history of penicillin allergy. Physician-documented cephalosporin-associated anaphylaxis and serious cutaneous adverse reactions are rare compared with C difficile infection within 90 days, nephropathy within 30 days, and all-cause death within 1 day.",cephalosporin;creatinine;hemoglobin;lactate dehydrogenase;adult;adverse drug reaction;Alzheimer disease;anaphylaxis;article;Clostridium difficile infection;coronary artery disease;creatinine blood level;drug exposure;drug hypersensitivity;eosinophil count;eosinophilia;female;heart infarction;hemoglobin blood level;hemolytic anemia;human;incidence;kidney disease;lactate dehydrogenase blood level;lung cancer;major clinical study;male;medical history;mortality;penicillin allergy;pneumonia;priority journal;serious cutaneous adverse reaction;sex ratio;skin disease;Stevens Johnson syndrome;toxic epidermal necrolysis;urticaria,"Macy, E.;Contreras, R.",2015,,,0,
2747,Risk factors for nursing home-acquired pneumonia 2 (multiple letters),,antacid agent;influenza vaccine;Pneumococcus vaccine;steroid;tranquilizer;adult;aged;alcohol abuse;analysis of variance;anamnesis;antibiotic therapy;carcinoma;chronic obstructive lung disease;congestive heart failure;controlled study;dementia;dentition;diabetes mellitus;disease course;disease transmission;drug use;dysphagia;hospitalization;human;length of stay;letter;long term care;nasogastric tube;nursing home;pneumonia;priority journal;risk assessment;risk factor;seizure;statistical significance;steroid therapy;stomach tube;cerebrovascular accident;tobacco dependence;tracheostomy;vomiting,"Madariaga, M. G.;Thomas, A.;Cannady Jr, P. B.;Mylotte, J. M.",2003,,,0,
2748,Sacrifice of a human heart,,Alzheimer disease;cardiologist;caregiver support;college;drug industry;heart infarction;human;medical education;medical ethics;medical student;note;physician attitude;professional student relation;teacher,"Maddy, R. E.",2014,,,0,
2749,White matter changes and cognitive decline in a ten-year follow-up period: A pilot study on a single-center cohort from the leukoaraiosis and disability study,"Aims: To describe the contribution of white matter lesions to the long-term neuropsychological profiles of different groups of clinical diagnoses, and to identify neuropsychological predictors of cognitive impairment in a 10-year follow-up. Methods: The Lisbon subcohort of the Leukoaraiosis and Disability (LADIS) study was re-evaluated performing a clinical, functional and cognitive evaluation [including Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) and ADAS-Cog with the extension for vascular impairment (VADAS-Cog), the 9-word version of the California Verbal Learning Test (CVLT-9), the Trail-Making test and the Stroop test] as well as an MRI scan. Using clinical diagnostic criteria, participants were identified as having no cognitive impairment (NI), cognitive impairment but no dementia (CIND) or dementia (DEM), and the effect of time on clinical diagnosis and neuropsychological profiles was analyzed. Results: From the initial group of 66 participants, 37 out of 41 survivors (90%) were re-evaluated (mean age 81.40 years, 57% women). Fifteen patients (41%) had DEM, 12 (32%) CIND and 10 (27%) NI. Over time, the three groups presented distinct profiles in the MMSE [F2, 62 = 15.85, p = 0.000], ADAS [F2, 62 = 15.85, p = 0.000] and VADAS [F2, 48 = 5.87, p = 0.008]. Logistic regression analysis identified higher scores on MMSE (β = 1.14, p = 0.03, OR = 3.13, 95% CI 1.09-8.97) as predictors of NI after 10 years of follow-up. Conclusion: Higher scores on baseline MMSE were the only neuropsychological predictors of NI after 10 years.",aged;Alzheimer disease;Alzheimer Disease Assessment Scale;article;California verbal learning test;cause of death;cerebrovascular accident;clinical article;cognition;cognitive defect;disease severity;executive function;female;follow up;heart failure;human;leukoaraiosis;male;Mini Mental State Examination;neuropsychological test;nuclear magnetic resonance imaging;pilot study;Portuguese (citizen);priority journal;Stroop test;trail making test;very elderly;white matter lesion,"Madureira, S.;Verdelho, A.;Moleiro, C.;Santos, C.;Scheltens, P.;Gouw, A.;Ferro, J.",2016,,,0,
2750,Plasma/Serum Plasmalogens: Methods of Analysis and Clinical Significance,"Age-related diseases, such as atherosclerosis and dementia, are associated with oxidative stress and chronic inflammation. Peroxisome dysfunction may be related to aging and age-related pathologies, possibly through the derangement of redox homeostasis. The biosyntheses of plasmalogens (Pls), a subclass of glycerophospholipids, are primarily regulated by peroxisomes. Thus, plasma Pls may reflect the systemic functional activity of peroxisomes and serve as potential biomarkers for diseases related to oxidative stress and aging. Recently, we have established three promising analytical methods for plasma/serum Pls using high-performance liquid chromatography with radioactive iodine, liquid chromatography-tandem mass spectrometry, and enzymatic assay. These methods were validated and used to obtain detailed molecular information regarding these molecules. In cross-sectional studies on asymptomatic, coronary artery disease, and elderly dementia individuals, we found that serum choline Pls, particularly those containing oleic and linoleic acid in the sn-2 position of the glycerol backbone, may serve as reliable antiatherogenic biomarkers. Furthermore, we also found that serum ethanolamine Pls were effective in discriminating cognitive impairment. These results support our hypothesis and further studies are clearly needed to elucidate Pls pathophysiologic significance.","Adult;Aged;Aged, 80 and over;Atherosclerosis/*blood;Chromatography, Liquid/methods;Coronary Artery Disease/*blood;Dementia/*blood;Female;Humans;Male;Mass Spectrometry/methods;Middle Aged;Plasmalogens/analysis/*blood;Young Adult;Atherosclerosis;Biomarker;Coronary artery disease;Dementia;Ether glycerophospholipid;Liquid chromatography-tandem mass spectrometry;Peroxisome;Plasmalogen","Maeba, R.;Nishimukai, M.;Sakasegawa, S.;Sugimori, D.;Hara, H.",2015,,10.1016/bs.acc.2015.03.005,0,
2751,Improvement and validation of (1)(2)(5)I-high-performance liquid chromatography method for determination of total human serum choline and ethanolamine plasmalogens,"BACKGROUND: Serum plasmalogens (Pls) have gained interest in several clinical symptoms such as metabolic syndrome/atherosclerosis or Alzheimer's disease possibly because of their antioxidant properties. We have developed a highly sensitive and simple method to determine plasmenylcholine (PlsCho; choline plasmalogen) and plasmenylethanolamine (PlsEtn; ethanolamine plasmalogen) separately, using a radioactive iodine and high-performance liquid chromatography ((125)I-HPLC method). The present study reports the improvement and validation of (125)I-HPLC method by introducing a quantitative standard (QS) and online detection with a flow gamma-counter. METHODS: 1-Alkenyl 2,3-cyclic glycerophosphate was prepared as QS from l-alpha-lyso plasmenylcholine by enzymatic treatment with phospholipase D. Online detection with a flow gamma-counter was investigated to be available to quantify Pls. The method validation was carried out in terms of selectivity, sensitivity, linearity, precision, accuracy and recovery. RESULTS: Linearity was established over the concentration range 5-300 mumol/L for Pls and QS with regression coefficients >0.99. The accuracy and reliability were satisfactory. The method has been applied to the determination of human serum Pls from healthy subjects and the elderly with dementia or artery stenoses. CONCLUSIONS: The improved (125)I-HPLC method is useful as an autoanalytical system for a routine diagnostic test of human serum Pls.","Aged;Aged, 80 and over;Animals;Calibration;Case-Control Studies;Cattle;Chromatography, High Pressure Liquid/*methods;Coronary Stenosis/*blood;Dementia/*blood;Female;Gamma Rays;Glycerophosphates/biosynthesis;Humans;Iodine Radioisotopes;Male;Phospholipase D/metabolism;Plasmalogens/*blood;Reference Standards;Reproducibility of Results;Sensitivity and Specificity","Maeba, R.;Yamazaki, Y.;Nezu, T.;Okazaki, T.",2012,Jan,10.1258/acb.2011.011069,0,
2752,Correlation of hippocampal atrophy with hyperhomocysteinemia in hemodialysis patients: An exploratory pilot study,"Background Cognitive impairment is one of the important critical issues in hemodialysis (HD) patients. However, the associating factors of brain atrophy in HD patients have not been fully elucidated. Purpose and methods Brain magnetic resonance imaging (MRI) was performed in 34 of total 72 HD outpatients in our dialysis center. These MRI images were analyzed by an application software; Voxelbased Specific Regional Analysis System for Alzheimer's Disease (VSRAD). VSRAD quantitatively calculates the extent of brain atrophy (percent of volume reduction) comparing with a MRI imaging database of 80 age-matched healthy controls. The extent of both hippocampal and whole-brain atrophy was evaluated with possible contributing factors. Results In all patients, the mean extent of hippocampal atrophy was 27.3%, and the mean extent of whole-brain atrophy was 11.2%. The extent of hippocampal atrophy was significantly correlated with low body mass index (BMI), total serum homocysteine (tHcy) levels, and brachialankle pulse wave velocity (baPWV). The extent of whole-brain atrophy showed significant correlations with age, hypoalbuminemia, and baPWV. Based on the multiple regression analysis, tHcy was an independent determinant of hippocampal atrophy (β = 0.460, R2 = 0.189, P<0.01); while age was an independent determinant of whole-brain atrophy (β = 0.594, R2 = 0.333, P<0.01). Conclusions In this exploratory pilot study, hippocampal atrophy was significantly correlated with hyperhomocysteinemia in HD patients.",angiotensin receptor antagonist;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;homocysteine;age;aged;ankle brachial index;article;atherosclerotic plaque;body mass;brain atrophy;chronic glomerulonephritis;chronic kidney failure;chronic pyelonephritis;clinical article;controlled study;diabetes mellitus;diabetic nephropathy;exploratory research;female;heart left ventricle mass;hemodialysis patient;hippocampus;human;hyperhomocysteinemia;hypertension;hypoalbuminemia;ischemic heart disease;kidney failure;male;Mini Mental State Examination;nephrosclerosis;nuclear magnetic resonance imaging;parahippocampal gyrus;peripheral occlusive artery disease;pilot study;pulse wave;risk factor;treatment duration;voxel based morphometry;VSRAD plus,"Maesato, K.;Ohtake, T.;Mochida, Y.;Ishioka, K.;Oka, M.;Moriya, H.;Hidaka, S.;Kobayashi, S.",2017,,10.1371/journal.pone.0175102,0,
2753,Effects of ω -3 PUFAs supplementation on myocardial function and oxidative stress markers in typical rett syndrome,"Rett syndrome (RTT) is a devastating neurodevelopmental disorder with a 300-fold increased risk rate for sudden cardiac death. A subclinical myocardial biventricular dysfunction has been recently reported in RTT by our group and found to be associated with an enhanced oxidative stress (OS) status. Here, we tested the effects of the naturally occurring antioxidants ω-3 polyunsaturated fatty acids (ω-3 PUFAs) on echocardiographic parameters and systemic OS markers in a population of RTT patients with the typical clinical form. A total of 66 RTT girls were evaluated, half of whom being treated for 12 months with a dietary supplementation of ω-3 PUFAs at high dosage (docosahexaenoic acid 71.9 ± 13.9 mg/kg b.w./day plus eicosapentaenoic acid 115.5 ± 22.4 mg/kg b.w./day) versus the remaining half untreated population. Echocardiographic systolic longitudinal parameters of both ventricles, but not biventricular diastolic measures, improved following ω-3 PUFAs supplementation, with a parallel decrease in the OS markers levels. No significant changes in the examined echocardiographic parameters nor in the OS markers were detectable in the untreated RTT population. Our data indicate that ω-3 PUFAs are able to improve the biventricular myocardial systolic function in RTT and that this functional gain is partially mediated through a regulation of the redox balance. © 2014 Silvia Maffei et al.",25 hydroxyvitamin D;4 hydroxynonenal;butylcresol;docosahexaenoic acid;fish oil;heme;hemoglobin;icosapentaenoic acid;isoprostane derivative;neuroprostane;omega 3 fatty acid;absence of side effects;adolescent;adult;article;biventricular myocardial systolic function;body height;body mass;body weight;bone densitometry;child;controlled study;diastolic blood pressure;diet supplementation;disease marker;drug megadose;echocardiography;female;head circumference;heart function;heart rate;heart ventricle function;human;longitudinal study;major clinical study;oxidative stress;priority journal;randomized controlled trial;regulatory mechanism;Rett syndrome;school child;single blind procedure;sudden cardiac death;systolic blood pressure;treatment duration;vitamin blood level;young adult,"Maffei, S.;De Felice, C.;Cannarile, P.;Leoncini, S.;Signorini, C.;Pecorelli, A.;Montomoli, B.;Lunghetti, S.;Ciccoli, L.;Durand, T.;Favilli, R.;Hayek, J.",2014,,,0,
2754,Comorbidity in Dementia: Update of an Ongoing Autopsy Study,"Objectives: To examine systemic and central nervous system (CNS) comorbidities of individuals with dementia evaluated during general autopsy. Design: Retrospective cohort study. Setting: A large tertiary academic medical center in Los Angeles, California. Participants: Individuals with clinically and neuropathologically diagnosed dementia who received complete autopsies (n = 86) and individuals with dementia who received partial (brain only) autopsies (n = 132). Measurements: Information on cause of death and systemic and CNS comorbidities was obtained from autopsy reports and clinical information as available from the medical records. Findings were tabulated with respect to type of dementia, semiquantitative assessment of the severity of cerebral amyloid angiopathy, semiquantitative assessment of the severity of cerebrovascular disease, and evidence of ischemic damage in the brain. Results: Of 218 subjects with dementia, 175 (80.3%) had Alzheimer's disease alone or in combination with other lesions that might contribute to cognitive impairment, such as cerebrovascular disease and diffuse Lewy body disease (DLBD), 14 (6.4%) had frontotemporal dementia, and seven (3.2%) had isolated DLBD. The most common cause of death in participants with dementia was pneumonia (n = 57, 66.3%), followed by cardiovascular disease (n = 14, 16.3%). Eighteen subjects (20.9%) had lung disease, and 16 (18.6%) had evidence of an old or recent myocardial infarction. Clinically undiagnosed neoplasms included colonic adenocarcinoma, metastatic pulmonary neuroendocrine carcinoma, meningioma, and Schwannoma. Conclusion: Significant comorbidities were discovered at autopsy in individuals with dementia. Understanding the causes of death and associated comorbidities in individuals with various subtypes of dementia is important in the assessment of end-of-life care in these individuals. © 2014, The Authors.",dementia;autopsy;comorbidity;neuropathology;human;United States;cause of death;cerebrovascular disease;brain;diffuse Lewy body disease;central nervous system;cognitive defect;neurilemoma;university hospital;cohort analysis;neoplasm;vascular amyloidosis;terminal care;medical record;pneumonia;cardiovascular disease;lung disease;heart infarction;frontotemporal dementia;adenocarcinoma;carcinoma;meningioma;death,"Magaki, S.;Yong, W. H.;Khanlou, N.;Tung, S.;Vinters, H. V.",2014,,,0,
2755,Diabetes as a risk factor for cognitive decline in older patients,"Aims: To assess the role of type 2 diabetes as a risk factor for cognitive decline among elderly people. Methods: Analyses were carried out on data from the Italian Longitudinal Study on Aging, a study on 5,632 subjects aged 65-84 years, with baseline in 1992 and follow-ups in 1996 and 2000. Results:At baseline, diabetic women had significantly worse scores on all cognitive tests compared to nondiabetic women, but did not show worsening over time, whereas men with diabetes did not show worse scores on cognitive tests at baseline compared to nondiabetic males; however, diabetes in men was associated with a risk of cognitive decline over time, particularly in attention. Higher levels of HbA1c were associated with poorer performance on memory tests at follow-up in both sexes. Conclusion: The impact of diabetes on cognitive status might differ in older men and women, probably because of a survival effect, with a higher mortality at a younger age among diabetic men. The metabolic and cardiovascular abnormalities associated with diabetes might be responsible for the cognitive decline, at different rates and ages, in men and women. The routine assessment of diabetes complications in the elderly should include cognitive evaluation in both sexes. Copyright © 2008 S. Karger AG.",glucose;hemoglobin A1c;aged;aging;angina pectoris;article;attention disturbance;blood sampling;cardiovascular disease;congestive heart failure;controlled study;dementia;depression;diagnostic test;disease duration;electrocardiogram;female;follow up;geriatric patient;glucose blood level;heart arrhythmia;heart infarction;human;hypertension;laboratory test;longitudinal study;male;memory;mental deterioration;Mini Mental State Examination;mortality;non insulin dependent diabetes mellitus;parkinsonism;performance;peripheral neuropathy;priority journal;risk factor;screening;smoking;spirometry;cerebrovascular accident,"Maggi, S.;Limongi, F.;Noale, M.;Romanato, G.;Tonin, P.;Rozzini, R.;Scafato, E.;Crepaldi, G.",2009,,,0,
2756,The Italian Longitudinal Study on Aging (ILSA): design and methods,"The Italian Longitudinal Study on Aging (ILSA) is a population-based, longitudinal study of the health status of Italians aged 65-84 years. The main objectives of ILSA are the study of the prevalence and incidence rates of common chronic conditions in the older population, and the identification of their risk and protective factors. ILSA is also designed to assess age-associated physical and mental functional changes. A random sample of 5632 individuals, stratified by age and gender using the equal allocation strategy, was identified on the demographic lists of the registry office of eight municipalities: Genova, Segrate (Milano), Selvazzano-Rubano (Padova), Impruneta (Firenze), Fermo (Ascoli Piceno), Napoli, Casamassima (Bari), and Catania. An extensive investigation, including interviews, physical exams, and laboratory tests, was conducted at baseline to identify the presence of cardiovascular disease (ischemic heart disease, hypertension, congestive heart failure, arrhythmia, intermittent claudication), diabetes, impaired glucose tolerance, thyroid dysfunction, dementia, parkinsonism, stroke, and peripheral neuropathy, as well as assess physical and mental functional status. The baseline examination was carried out between March 1992 and June 1993; a second comprehensive examination will begin in March 1995. An interim hospital discharge data survey and a mortality survey are currently ongoing to assess the hospitalization rate and the cause-specific mortality rate in this study cohort.","Aged;Aged, 80 and over;Aging;Cardiovascular Diseases/*epidemiology;Cohort Studies;Cross-Sectional Studies;Data Collection;Endocrine System Diseases/*epidemiology;Female;Humans;Italy/epidemiology;Longitudinal Studies;Male;Mental Disorders/*epidemiology;Metabolic Diseases/*epidemiology;Nervous System Diseases/*epidemiology;Quality Control","Maggi, S.;Zucchetto, M.;Grigoletto, F.;Baldereschi, M.;Candelise, L.;Scarpini, E.;Scarlato, G.;Amaducci, L.",1994,Dec,,0,
2757,The management of patients presenting with hypernatraemia: Is aggressive management appropriate?,"Hypernatraemia is a common finding among patients presenting to hospital. The aim of this observational study was to discover what types of patients presented with hypernatraemia and whether they were appropriately managed. The management of hypernatraemia was audited against common standards of care. Hypernatraemia at presentation carries a poor prognosis and in this study management of hypernatraemia was found to be done poorly, possibly because for many patients aggressive management was deemed inappropriate. The majority of patients who present with hypernatraemia are older, dependent and/or suffer from cognitive impairment. Many of these patients do not have a reversible cause for their hypernatraemia. These patients need to be recognised, ideally in the community, so that inappropriate admission can be avoided, but also on presentation to hospital so that appropriate care, which may be end-of-life care, can be provided. © Royal College of Physicians 2014. All rights reserved.",antibiotic agent;glucose;infusion fluid;sodium;sodium chloride;aged;article;case report;clinical feature;cognitive defect;dementia;dysphagia;female;health care quality;human;hypernatremia;ischemic heart disease;lower respiratory tract infection;medical audit;medical history;observational study;osteoarthritis;prognosis;terminal care;very elderly,"Maggs, F. G.",2014,,,0,
2758,Recent advances in endocrine metabolic immune disorders drug targeting: An editorial overview,This editorial overview is aimed at reviewing all the work published by the Journal Endocrine Metabolic Immune Disorders-Drug Targets over the period 2012-2014. The main body of publications has been divided either into a section based on special issues and meeting proceedings or various specific sections according to different types of pathologies related to the field of endocrine metabolic immune disorder-drug targeting.,adenosine deaminase;adiponectin;amiodarone;dopamine;glucocorticoid;gonadotropin;immunoglobulin E;interleukin 22;leptin receptor;nicotinamide phosphoribosyltransferase;omega 3 fatty acid;osteopontin;peroxisome proliferator activated receptor agonist;vasoactive intestinal polypeptide;vasoactive intestinal polypeptide receptor;vildagliptin;vitamin D;Alzheimer disease;article;atherosclerosis;atrophic gastritis;cachexia;diabetic cardiomyopathy;diastolic dysfunction;drug targeting;ectopic thyroid gland;head and neck cancer;heart failure;helminthiasis;human;hyperglycemia;hypothyroidism;immunomodulation;Lactobacillus plantarum;milk allergy;muscle disease;non insulin dependent diabetes mellitus;obesity;rickets;thyroid carcinoma;trichinosis,"Magrone, T.;Jirillo, E.",2015,,,0,
2759,Apolipoproteine E4 isoform and Alzheimer's disease,"We studied apolipoprotein E (apoE) phenotype in 113 patients with possible and Alzheimer's disease (AD), 49 patients with Parkinson's disease (including 11 patients with dementia) and 23 patients with mixed and vascular dementia. Normal controls were 498 young, healthy blood donors previously recorded. All patients were assayed for blood lipid parameters. All AD patients underwent a neuropsychological evaluation (including a mini-mental status and 5 subtests of Cole and Dastoor hierarchic dementia scale) and a detailed interrogation of them and their caregivers about their familial and personal medical history. The recorded data included age at onset, clinical subtype (i.e. amnesic or aphaso-apraxic), occurrence of fits, cases of probable dementia in relatives, and ages of their parents at death. There was a significant association between the fourth isoform of apoE and AD, as in previous works. We did not found such an association for PD patients (even with dementia) nor mixed and vascular demented patients. We failed to find any association between any clinical characteristic of the patients and the biological subgroups defined by the number of ε4 alleles, except with regard for the age of onset. Suprisingly, the mothers of ε4 bearers had a significantly longer life than mothers of other patients. We failed to found any significant difference of apoE2 isoform frequency between AD patients and controls. AD patients had higher levels of cholesterol and apoA1 than did MP and mixed and vascular demented patients. ApoA1 level is known to constitute a protective factor against coronary heart disease, which is usually increased by the presence of apoE-ε4. The presence of this protective factor, perphaps genetically determined as well, could be necessary for the survival of the survival of the patients (and their mothers) until the age of onset of AD without any lethal coronary heart disease.",apolipoprotein E;cholesterol;adult;aged;Alzheimer disease;article;controlled study;coronary artery disease;dementia;female;human;major clinical study;male;Parkinson disease,"Mahieux, F.;Couderc, R.;Moulignier, A.;Bailleul, S.;Podrabinek, N.;Laudet, J.",1995,,,0,
2760,Left Ventricular Hypertrophy and Cognitive Decline in Old Age,"BACKGROUND: Patients with advanced heart failure run a greater risk of dementia. Whether early cardiac structural changes also associate with cognitive decline is yet to be determined. OBJECTIVE: We tested whether left ventricular hypertrophy (LVH) derived from electrocardiogram associates with cognitive decline in older subjects at risk of cardiovascular disease. METHODS: We included 4,233 participants (mean age 75.2 years, 47.8% male) from PROSPER (PROspective Study of Pravastatin in the Elderly at Risk). LVH was assessed from baseline electrocardiograms by measuring the Sokolow-Lyon index. Higher levels of Sokolow-Lyon index indicate higher degrees of LVH. Cognitive domains involving selective attention, processing speed, and immediate and delayed memory were measured at baseline and repeated during a mean follow-up of 3.2 years. RESULTS: At baseline, LVH was not associated with worse cognitive function. During follow-up, participants with higher levels of LVH had a steeper decline in cognitive function including in selective attention (p = 0.009), processing speed (p = 0.010), immediate memory (p < 0.001), and delayed memory (p = 0.002). These associations were independent of cardiovascular risk factors, co-morbidities, and medications. CONCLUSION: LVH assessed by electrocardiogram associates with steeper decline in cognitive function of older subjects independent of cardiovascular risk factors and co-morbidities. This study provides further evidence on the link between subclinical cardiac structural changes and cognitive decline in older subjects.",Cardiovascular disease;cognitive function;elderly;left ventricular hypertrophy,"Mahinrad, S.;Vriend, A. E.;Jukema, J. W.;van Heemst, D.;Sattar, N.;Blauw, G. J.;Macfarlane, P. W.;Clark, E. N.;de Craen, A. J. M.;Sabayan, B.",2017,,,0,
2761,Natural hormone therapy for menopause,"Menopausal women are deficient in estrogen, progesterone, and frequently in testosterone and DHEA. Hormone replacement therapy (HRT) in the United States has generally consisted of one or two agents, typically equine estrogen and medroxyprogesterone, with increased risk of heart attack, stroke, dementia, and breast cancer [WHI trials]. Bio-identical hormones [chemically endogenous hormones] have gained popularity and can be mixed according to physician's orders by compounding pharmacists in the United States. However, there is little published information about the use of such hormones. This paper reports a 12 plus months follow up on 189 patients who were administered natural estrogen plus progesterone with or without DHEA or testosterone according to a rationalized protocol described later. Ninety-seven percent of the patients experienced varying degrees of symptom control, whereas three had minimal or questionable benefit. Mental symptoms experienced upon presentation improved in 90% of the patients. Sixty percent of the patients, who had gained weight during menopause, lost an average of 14.8lbs [SD 11.98lbs]. Complications described with traditional HRT did not develop in this group of patients. These findings point out a need for larger controlled trials of similar protocols in the management of menopause. © 2009 Informa UK Ltd.",biest;estrogen;prasterone;progesterone;testosterone;unclassified drug;adult;article;breast cancer;cancer risk;cardiovascular risk;controlled study;dementia;female;heart infarction;hormonal therapy;hormone deficiency;hormone substitution;human;libido disorder;major clinical study;menopausal syndrome;menopause;mental disease;natural hormone therapy;priority journal;cerebrovascular accident;treatment outcome;United States;vaginal dryness;weight reduction,"Mahmud, K.",2010,,,0,
2762,Problems of older adults living alone after hospitalization,"OBJECTIVE: To describe functional deficits among older adults living alone and receiving home nursing following medical hospitalization, and the association of living alone with lack of functional improvement and nursing home utilization 1 month after hospitalization. DESIGN: Secondary analysis of a prospective cohort study. PARTICIPANTS: Consecutive sample of patients age 65 and over receiving home nursing following medical hospitalization. Patients were excluded for new diagnosis of myocardial infarction or stroke in the previous 2 months, diagnosis of dementia if living alone, or nonambulatory status. Of 613 patients invited to participate, 312 agreed. MEASUREMENTS: One week after hospitalization, patients were assessed in the home for demographic information, medications, cognition, and self-report of prehospital and current mobility and function in activities of daily living (ADLs) and independent activities of daily living (IADLs). One month later, patients were asked about current function and nursing home utilization. The outcomes were lack of improvement in ADL function and nursing home utilization 1 month after hospitalization. RESULTS: One hundred forty-one (45%) patients lived alone. After hospital discharge, 40% of those living alone and 62% of those living with others had at least 1 ADL dependency (P =.0001). Patients who were ADL-dependent and lived alone were 3.3 (95% confidence interval [95% CI], 1.4 to 7. 6) times less likely to improve in ADLs and 3.5 (95% CI, 1.0 to 11. 9) times more likely to be admitted to a nursing home in the month after hospitalization. CONCLUSION: Patients who live alone and receive home nursing after hospitalization are less likely to improve in function and more likely to be admitted to a nursing home, compared with those who live with others. More intensive resources may be required to continue community living and maximize independence.","*Activities of Daily Living;Aged;Aged, 80 and over;Cohort Studies;Demography;Female;*Home Care Services;Humans;Male;Patient Discharge;Prospective Studies;Residence Characteristics;Risk Factors;Social Support;Socioeconomic Factors","Mahoney, J. E.;Eisner, J.;Havighurst, T.;Gray, S.;Palta, M.",2000,Sep,,0,
2763,Latin American position on the current status of hormone therapy during the menopausal transition and thereafter,"Objective: Data from placebo-controlled, randomized clinical trials conducted during the past few years resulted in critical re-evaluation of the overall health benefits of hormone therapy (HT) in women during the menopausal transition and thereafter. These data stimulated vigorous debate among experts and produced several position papers by North American and European authorities providing guidance on the use of HT. It is well known that cultural, geographic and ethnic differences influence the acceptance and risk perception of HT. Therefore, it was considered essential to present a position specifically relevant to Latin American countries. Methods: A Latin American Expert Panel, convening in Salvador, Bahia, Brazil, obtained consensus on recommendations for HT that incorporated the findings of the most recently published reports. The panelists' opinions were surveyed by means of the Likert scale along five categories ranging from complete agreement to complete disagreement. Results: The Panel presented 13 recommendations and considered three additional issues relevant to HT use. There was consensus that HT during the perimenopause and thereafter is warranted in Latin American women in particular for the management of vasomotor symptoms. HT may also be an option for osteoporosis prevention in women at significant risk, after evaluation of risks/benefits and after consideration of alternative therapies. HT should be individualized and prescribed at the lowest effective dose. Conclusions: The Panel concluded that HT remains a safe and effective treatment option for peri- and postmenopausal Latin American women. © 2006 Elsevier Ireland Ltd. All rights reserved.",alpha adrenergic receptor blocking agent;anticonvulsive agent;antidepressant agent;antihypertensive agent;beta adrenergic receptor blocking agent;clonidine;conjugated estrogen;conjugated estrogen plus medroxyprogesterone acetate;estradiol;estrogen;fluoxetine;gabapentin;gestagen;medroxyprogesterone acetate;paroxetine;tibolone;venlafaxine;article;Brazil;breast cancer;cancer risk;cardiovascular disease;clinical trial;cognitive defect;consensus;dementia;gallbladder disease;heart infarction;heart protection;hormonal therapy;human;ischemic heart disease;menopausal syndrome;menopause;osteoporosis;practice guideline;risk assessment;risk benefit analysis;South and Central America;statistical significance;vasomotor disorder;venous thromboembolism,"Maia Jr, H.;Albernaz, M. A.;Baracat, E. C.;Barbosa, I. C.;Bossemeyer, R.;Bueno, A. H.;Campos, O. G.;Carranza-Lira, S.;Casas, P. F.;Castro, A. M.;de Lima, G. R.;de Melo, N. R.;Fernandes, C. E.;González, J. S.;Larrañaga, F. E.;Siseles, N.;Uribe, A. M.;Vilchez, R. M.",2006,,,0,
2764,Gallstone ileus in an older nursing home resident,,aged;Alzheimer disease;case report;cholelithiasis;computer assisted tomography;conservative treatment;constipation;daily life activity;emergency surgery;female;gallbladder carcinoma;gallstone ileus;human;hypokalemia;ischemic heart disease;letter;non insulin dependent diabetes mellitus;nursing home patient;peripheral vascular disease;retrospective study;very elderly,"Mak, L. Y.;Chan, T. C.;Chan, F. H. W.;Liu, S. H.",2016,,,0,
2765,Is timing everything? new insights into why the effect of estrogen therapy on memory might be age dependent,,brain derived neurotrophic factor;conjugated estrogen;estradiol;estrogen;gestagen;medroxyprogesterone acetate;microRNA;sirtuin 1;Alzheimer disease;article;cardiovascular disease;cerebrovascular accident;chronic disease;cognition;cognitive defect;cohort analysis;colorectal cancer;dementia;dendritic spine;estrogen therapy;follow up;gene expression;heart infarction;hippocampus;human;ischemic heart disease;memory;menstrual cycle;mild cognitive impairment;mortality;nerve cell plasticity;neuroimaging;priority journal;protein expression;randomized controlled trial (topic);risk assessment;vasomotor disorder;verbal memory;women's health,"Maki, P.",2013,,,0,
2766,"Clinically Confirmed Stroke with Negative Diffusion-Weighted Imaging Magnetic Resonance Imaging: Longitudinal Study of Clinical Outcomes, Stroke Recurrence, and Systematic Review","Background and Purpose-We sought to establish whether the presence (versus absence) of a lesion on magnetic resonance imaging (MRI) with diffusion weighting (DWI-MRI) at presentation with acute stroke is associated with worse clinical outcomes at 1 year. Methods-We recruited consecutive patients with a nondisabling ischemic stroke and performed DWI-MRI. Patients were followed up at 1 year to establish stroke recurrence (clinical or on MRI), cognitive impairment (Addenbrooke Cognitive Assessment Revised,<88) and modified Rankin Scale. Results-A median of 4 days post stroke, one third (76/264; 29%) of patients did not have a DWI lesion (95% confidence interval, 23%-35%). There was no statistically significant difference between those with and without a DWI lesion with respect to age or vascular risk factors. Patients without a lesion were more likely to be women or have previous stroke. At 1 year, 11 of 76 (14%) patients with a DWI-negative index stroke had a clinical diagnosis of recurrent stroke or transient ischemic attack, 33% had cognitive impairment (Addenbrooke Cognitive Assessment Revised <88), and 40% still had modified Rankin Scale >1, no different from DWI-positive patients; DWI-positive patients were more likely to have a new lesion on MRI (14%), symptomatic or asymptomatic, than DWI-negative patients (2%; P=0.02). Our data were consistent with 6 other studies (total n=976), pooled proportion of DWI-negative patients was 21% (95% confidence interval, 12%-32%). Conclusions-Nearly one third of patients with nondisabling stroke do not have a relevant lesion on acute DWI-MRI. Patients with negative DWI-MRI had no better prognosis than patients with a lesion. DWI-negative stroke patients should receive secondary prevention.",adult;aged;article;atrial fibrillation;carotid artery obstruction;cerebrovascular accident;cognitive defect;dementia;diffusion weighted imaging;female;follow up;human;ischemic heart disease;longitudinal study;major clinical study;male;nuclear magnetic resonance imaging;observational study;outcome assessment;priority journal;prognosis;prospective study;Rankin scale;recurrent disease;risk assessment;stroke patient;transient ischemic attack;treatment outcome,"Makin, S. D. J.;Doubal, F. N.;Dennis, M. S.;Wardlaw, J. M.",2015,,,0,
2767,Cerebral amyloid angiopathy,"Cerebral amyloid angiopathy (CAA) is characterized by the deposition of Beta-amyloid protein in the media and adventitia of small arteries and capillaries. It may be an independent disease, but is often combined with Alzheimer's disease (AD). This review will discuss up-to-date understanding of the pathophysiology, clinical manifestations of CAA, its diagnosis with neuroimaging and biomarkers. Cerebral microbleeds (CMBs) may be considered as neuroimaging markers of AD and CAA. The clinical significance of CAA is defined by the risk of intracerebral hemorrhages during thrombolytic therapy and warfarin therapy in patients with acute myocardial infarction, pulmonary embolism, ischemic stroke.",,"Makotrova, T. A.;Levin, O. S.;Arablinskii, A. V.",2014,,,0,
2768,"Long-term, open-label, safety study of once-daily ropinirole extended/prolonged release in early and advanced Parkinson's disease","Long-term safety of once-daily ropinirole extended/prolonged release (ropinirole XL/PR) was evaluated in subjects with early and advanced Parkinson's disease (PD) in this study, 101468/248. Subjects (n = 419) who completed one of three prior studies evaluating ropinirole XL/PR for the treatment of PD were enrolled in this open-label, multicenter, extension study, and were to be followed for up to 73 months. Ropinirole XL/PR was titrated/continued, and adjusted as appropriate during the maintenance phase (maximum 24 mg/d). Levodopa (L-dopa) and other nondopamine agonist PD medications were permitted. Safety outcomes that were investigated included frequency of adverse events (AEs). Subjects preference regarding once daily versus three times daily study medication regimens was also investigated in a subset of the study population. The median duration of ropinirole XL/PR exposure was 1275 d. Most subjects (87%) reported at least one AE, with the most common (≥ 10%) AEs being, back pain (14%), hallucinations (13%), somnolence (11%) and peripheral edema (11%). Twenty-five percent of subjects discontinued the study prematurely due to an AE during the treatment period. Long-term treatment with ropinirole XL/PR was not associated with any new or unexpected safety concerns in patients with early and advanced PD, and a majority of subjects preferred the once-daily dosing regimen.",NCT00632736;antiparkinson agent;levodopa;ropinirole;acute respiratory failure;adult;aorta aneurysm;arthralgia;article;aspiration pneumonia;atrial fibrillation;backache;bronchopneumonia;colon cancer;confusion;controlled study;crossover procedure;dementia;depression;dizziness;drug safety;drug withdrawal;dyskinesia;falling;female;fever;hallucination;headache;heart arrhythmia;heart infarction;human;impulse control disorder;influenza;insomnia;lung cancer;lung embolism;major clinical study;male;medication compliance;multicenter study (topic);multicenter study;multiple organ failure;nausea;open study;osteoarthritis;Parkinson disease;patient compliance;peripheral edema;practice guideline;randomized controlled trial (topic);side effect;somnolence;staphylococcal bacteremia;treatment duration;virus infection,"Makumi, C. W.;Asgharian, A.;Ellis, J.;Shaikh, S.;Jimenez, T.;Vanmeter, S.",2016,,,0,
2769,Systemic skin whitening/lightening agents: What is the evidence,,arachidonic acid;ascorbic acid;cisplatin;cysteine;depigmenting agent;DOPA;eumelanin;gamma glutamyltransferase;glutathione;Glycyrrhiza glabra extract;hyaluronic acid;hydroquinone;monophenol monooxygenase;pheomelanin;tranexamic acid;abdominal pain;acquired immune deficiency syndrome;alcohol liver disease;Alzheimer disease;antioxidant activity;article;atherosclerosis;bioavailability;cell membrane;cell transport;cerebrovascular accident;chloasma;chronic fatigue syndrome;circulation;depigmentation;detoxification;diet supplementation;disseminated intravascular clotting;DNA damage;drug hypersensitivity;drug marketing;food and drug administration;heart infarction;human;hydrolysis;keratinocyte;kidney circulation;lung embolism;mammal cell;melanocyte;melanogenesis;melanosome;multiple sclerosis;nephrotoxicity;Parkinson disease;protein expression;rash;skin color;Stevens Johnson syndrome;subarachnoid hemorrhage;systemic circulation;toxic epidermal necrolysis;venous thromboembolism,"Malathi, M.;Thappa, D.",2013,,,0,
2770,Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease,"OBJECTIVE: The purpose of this study was to examine the relationship between vascular disease (and vascular risk factors), cognition and motor phenotype in Parkinson's disease (PD). METHODS: Recently diagnosed PD cases were enrolled in a multicenter prospective observational longitudinal cohort study. Montreal cognitive assessment (normal >23, mild cognitive impairment 22 to 23 or lower but without functional impairment, and dementia 21 or less with functional impairment) and Movement Disorder Society Unified PD Rating Scale part 3 (UPDRS 3) scores were analyzed in relation to a history of vascular events and risk factors. RESULTS: In 1759 PD cases, mean age 67.5 (standard deviation 9.3) years, mean disease duration 1.3 (standard deviation 0.9) years, 65.2% were men, 4.7% had a history of prior stroke or transient ischemic attack, and 12.5% had cardiac disease (angina, myocardial infarction, heart failure). In cases without a history of vascular disease, hypertension was recorded in 30.4%, high cholesterol 27.3%, obesity 20.7%, diabetes 7.2%, and cigarette smoking in 4.6%. Patients with prior stroke or transient ischemic attack were more likely to have cognitive impairment (42% vs 25%) and postural instability gait difficulty (53.5% vs 39.5%), but these findings were not significant after adjustment for age, sex, and disease duration (P = .075). The presence of more than 2 vascular risks was associated with worse UPDRS 3 motor scores (beta coefficient 4.05, 95% confidence interval 1.48, 6.61, p = .002) and with cognitive impairment (ordinal odds ratio 2.24, 95% confidence interval 1.34, 3.74, p = .002). In 842 patients (47.8%) with structural brain imaging, white matter leukoaraiosis, but not lacunar or territorial infarction, was associated with impaired cognition (p = .006) and postural instability gait difficulty (p = .010). CONCLUSION: Vascular comorbidity is significantly associated with cognitive and gait impairment in patients with early PD, which may have prognostic and treatment implications. (c) 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.",Parkinson's disease;cerebrovascular;diabetes;gender;phenotype,"Malek, N.;Lawton, M. A.;Swallow, D. M.;Grosset, K. A.;Marrinan, S. L.;Bajaj, N.;Barker, R. A.;Burn, D. J.;Hardy, J.;Morris, H. R.;Williams, N. M.;Wood, N.;Ben-Shlomo, Y.;Grosset, D. G.",2016,Oct,10.1002/mds.26698,0,
2771,Outcome of carotid artery stenting at 2 years follow-up: Comparison of nitinol open cell versus stainless steel closed cell stent design,"Aim. The aim of this study was to compare the clinical and ultrasound outcome of carotid artery stenting at 2-year follow-up in patients treated with open-cell nitinol stents versus patients treated with closed cell stainless steel stents. Methods. This was a non-randomized, retrospective study including 123 patients in whom 132 carotid stent-procedures were performed. Nine patients were treated bilaterally. All patients presented with severe asymptomatic (≥80%) or symptomatic (>70%) carotid artery stenosis and were treated by carotid angioplasty and stent placement with or without filter embolic protection system. Follow-up consisted of physical evaluation at 1, 6, 12 and 24 months and assessment of the stent patency by ultrasound examination at 6, 12 and 24 months after the stent procedure. Results. In 72 procedures a closed cell stainless steel stent was implanted, in the remaining 60 procedures an open cell nitinol stent was placed. In 8 patients with a stainless steel stent (11%) and in 6 patients with a nitinol stent (10%) a stroke occurred during the follow-up period (P=0.79). Ultrasound examination revealed an in-stent restenosis of 50% to 80% in the stainless steel group (N.=9, 15%) and in the nitinol group (N.=10, 17%) (P=0.7). Conclusion. At 2-year follow-up after carotid artery stenting, there is no difference in clinical outcome or in stent patency among patients treated with open versus closed cell design stents. Subsequendy the type of carotid stent design does not seem to impact the overall midterm outcome after carotid artery stenting.",nitinol;stainless steel;abdominal aorta aneurysm;aged;Alzheimer disease;angioplasty;article;brain hemorrhage;carotid artery;carotid artery obstruction;cause of death;clinical assessment;controlled study;convalescence;epileptic state;female;follow up;heart arrest;heart failure;hematoma;human;major clinical study;male;multiple organ failure;outcome assessment;pneumonia;respiratory failure;restenosis;retrospective study;stent;cerebrovascular accident;transient ischemic attack;ultrasound;visual field defect,"Maleux, G.;Marrannes, J.;Heye, S.;Daenens, K.;Verhamme, P.;Thijs, V.",2009,,,0,
2772,Cardiac monitoring for cholinesterase inhibitors: A survey,"Background: There is no consensus on the monitoring for rare but potentially serious cardiac adverse events associated with cholinesterase inhibitor drugs in the treatment of dementia. Different protocols have been proposed, with and without ECG examination. We surveyed an urban old age psychiatry service to investigate the variables that may influence the implementation of such protocols. Methods: Case notes of 45 consecutive patients assessed for dementia were scrutinized, to establish how many underwent an ECG or other cardiac examination prior to drug treatments. Data were collected on demographics, medical conditions and drug treatments. Patient files were searched for indications of investigations and any outcomes. Results: Half of all patients treated with a cholinesterase inhibitor (11/22) had an ECG before treatment. In five cases no pulse or cardiac symptoms were recorded in the absence of an ECG. Medical history, findings on examination, seniority of the clinician, and patient cooperation all may have influenced whether patients had an ECG. In three cases treatment was not prescribed due to concerns over cardiac effects, and with five ECGs new diagnoses were made. A protocol based on pulse monitoring would only have indicated ECGs in two out of 22 cases. Conclusions: Several factors may influence decisions on cardiac monitoring. Fewer ECGs could be done if only pulse and cardiac symptoms were monitored before cholinesterase inhibitor prescription, but new cardiac diagnoses might then be missed. Protocols can be devised to incorporate both cardiac investigation and cholinesterase inhibitor monitoring. © 2009 International Psychogeriatric Association.",amiodarone;beta adrenergic receptor blocking agent;cholinesterase inhibitor;donepezil;neuroleptic agent;tamoxifen;venlafaxine;Alzheimer disease;article;cardiovascular disease;cardiovascular risk;clinical article;clinical decision making;diffuse Lewy body disease;drug monitoring;electrocardiography monitoring;first degree atrioventricular block;atrial fibrillation;heart disease;heart left ventricle hypertrophy;heart muscle ischemia;heart right bundle branch block;human;hypertension;multiinfarct dementia;patient monitoring,"Maliepaard, D.;MacEwan, T.",2009,,,0,
2773,Tissue ischemia worsens during hemodialysis in end-stage renal disease patients,"Background: Cognitive deficit is a common problem in end-stage renal disease (ESRD) patients. Ultrafiltration and hemodialysis lead to profound hemodynamic changes. The aim of this pilot study was to describe brain and hand oxygenation values in ESRD patients and their changes during hemodialysis. Methods: Twenty-seven patients treated by chronic hemodialysis and 17 controls patients of the same age were included in the study. Regional saturation of oxygen (SrO2) was measured at the brain frontal lobe and at the hand with dialysis access using the INVOS 5100C. In 17 of ESRD patients, SrO2 was also monitored throughout hemodialysis. Finger systolic blood pressure and basic hemodialysis and laboratory data were collected. Results: Dialysis patients had lower brain and also hand SrO2 values at rest (51.5 ± 10.9 vs. 68 ± 7%, p<0.0001 and 55 ± 16 vs. 66 ± 8%, p = 0.03, respectively). Both values further decreased during the first 35 minutes of hemodialysis (brain SrO2 to 47 ± 8%, p<0.0001 and hand to 45 ± 14%, p<0.0001, respectively). The brain SrO2 decrease was related to the ultrafiltration rate, the hand SrO2 decrease to the finger pressure and to blood hemoglobin. Conclusions: Chronic dialysis patients suffer from tissue ischemia and that even worsens after the beginning of hemodialysis. This observation may contribute to the understanding of cognitive deficit etiology.",hemoglobin;adult;aged;article;blood pump;clinical article;cognitive defect;congestive heart failure;controlled study;coronary artery disease;dementia;diabetes mellitus;dyslipidemia;end stage renal disease;female;heart rate;hemodialysis;hemodynamics;human;hypertension;ischemia;male;non invasive measurement;oxygen saturation;oxygenation;pilot study;smoking;thromboembolism;tissue perfusion;ultrafiltration;very elderly,"Malik, J.;Kudlicka, J.;Lachmanova, J.;Valerianova, A.;Rocinova, K.;Bartkova, M.;Tesar, V.",2017,,10.5301/jva.5000630,0,
2774,The last nail,,estrogen;gestagen;placebo;breast cancer;cardiovascular disease;clinical trial;cognitive defect;colorectal cancer;defibrillator;dementia;drug safety;estrogen therapy;heart infarction;heart left ventricle ejection fraction;hip fracture;hormone substitution;human;medical decision making;medical ethics;note;postmenopause;primary prevention;risk benefit analysis;cerebrovascular accident;thromboembolism;treatment outcome;vasomotor disorder,"Malik, P.",2004,,,0,
2775,Multilocus genetic risk score associates with ischemic stroke in case-control and prospective cohort studies,"Background and Purpose - Genome-wide association studies have revealed multiple common variants associated with known risk factors for ischemic stroke (IS). However, their aggregate effect on risk is uncertain. We aimed to generate a multilocus genetic risk score (GRS) for IS based on genome-wide association studies data from clinical-based samples and to establish its external validity in prospective population-based cohorts. Methods - Three thousand five hundred forty-eight clinic-based IS cases and 6399 controls from the Wellcome Trust Case Control Consortium 2 were used for derivation of the GRS. Subjects from the METASTROKE consortium served as a replication sample. The validation sample consisted of 22 751 participants from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium. We selected variants that had reached genome-wide significance in previous association studies on established risk factors for IS. Results - A combined GRS for atrial fibrillation, coronary artery disease, hypertension, and systolic blood pressure significantly associated with IS both in the case-control samples and in the prospective population-based studies. Subjects in the top quintile of the combined GRS had >2-fold increased risk of IS compared with subjects in the lowest quintile. Addition of the combined GRS to a simple model based on sex significantly improved the prediction of IS in the combined clinic-based samples but not in the population-based studies, and there was no significant improvement in net reclassification. Conclusions - A multilocus GRS based on common variants for established cardiovascular risk factors was significantly associated with IS both in clinic-based samples and in the general population. However, the improvement in clinical risk prediction was found to be small. © 2014 American Heart Association, Inc.",adult;aged;area under the curve;article;brain ischemia;case control study;cohort analysis;controlled study;coronary artery disease;diastolic blood pressure;external validity;female;follow up;genetic association;genetic risk;genetic variability;atrial fibrillation;human;hypertension;major clinical study;male;middle aged;multilocus genetic risk score;assessment of humans;prediction;priority journal;prospective study;risk factor;systolic blood pressure;validation study,"Malik, R.;Bevan, S.;Nalls, M. A.;Holliday, E. G.;Devan, W. J.;Cheng, Y. C.;Ibrahim-Verbaas, C. A.;Verhaaren, B. F. J.;Bis, J. C.;Joon, A. Y.;De Stefano, A. L.;Fornage, M.;Psaty, B. M.;Ikram, M. A.;Launer, L. J.;Van Duijn, C. M.;Sharma, P.;Mitchell, B. D.;Rosand, J.;Meschia, J. F.;Levi, C.;Rothwell, P. M.;Sudlow, C.;Markus, H. S.;Seshadri, S.;Dichgans, M.",2014,,,0,
2776,Mortality after regular implantations of total hip prostheses,"Operative and post operative (two months) mortality among 1280 patients undergoing total hip replacement is studied. Mortality rate was 1%. The main cause is pulmonary embolism, then mental deterioration and anaesthesia. Use of methylmethacrylate did not cause death. Rheumatoid arthritis could increase the risk.","Aged;Anesthesia, General/adverse effects/*mortality;Arrhythmias, Cardiac/etiology;Bacterial Infections/mortality;Dementia/mortality;Female;Heart Failure/etiology;Hip Prosthesis/*mortality;Humans;Male;Middle Aged;Postoperative Complications/mortality;Pulmonary Edema/etiology;Pulmonary Embolism/mortality;Retrospective Studies","Malingue, S.;Perramant, Y.;Le Guyader, M. H.;Le Bourdonnec, A.;Courtois, B.",1986,May,,0,
2777,Vascular comorbidities linked with early-onset dementia,,adult;cerebrovascular accident;chronic kidney disease;cognition;comorbidity;cross-sectional study;dementia;diabetes mellitus;disease registry;heredity;human;hypertension;ischemic heart disease;longitudinal study;medical informatics;middle aged;onset age;peripheral vascular disease;prevalence;primary medical care;priority journal;public health;risk factor;Scotsman;short survey;transient ischemic attack;vascular disease,"Malkki, H.",2015,,,0,
2778,Cholinesterase inhibitors and cardiovascular disease: A survey of old age psychiatrists' practice 4,,cholinesterase inhibitor;aged;Alzheimer disease;angina pectoris;bradycardia;cardiovascular disease;clinical practice;clinical trial;comorbidity;congestive heart failure;consensus;drug safety;drug tolerability;electrocardiogram;health survey;atrial fibrillation;heart block;heart left bundle branch block;heart right bundle branch block;human;hypertension;letter;orthostatic hypotension;prescription;priority journal;psychiatrist,"Malone, D. M.;Lindesay, J.",2007,,,0,
2779,Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes after Coronary Stent Implantation (from the Nobori-2 Study),"Co-morbidities have typically been considered as prevalent cardiovascular risk factors and cardiovascular diseases rather than systematic measures of general co-morbidity burden in patients who underwent percutaneous coronary intervention (PCI). Charlson co-morbidity index (CCI) is a measure of co-morbidity burden providing a means of quantifying the prognostic impact of 22 co-morbid conditions on the basis of their number and prognostic impact. The study evaluated the impact of the CCI on cardiac mortality and major adverse cardiovascular events (MACE) after PCI through analysis of the Nobori-2 study. The prognostic impact of CCI was studied in 3,067 patients who underwent PCI in 4,479 lesions across 125 centers worldwide on 30-day and 1- and 5-year cardiac mortality and MACE. Data were adjusted for potential confounders using stepwise logistic regression; 2,280 of 3,067 patients (74.4%) had ≥1 co-morbid conditions. CCI (per unit increase) was independently associated with an increase in both cardiac death (odds ratio [OR] 1.47 95% confidence interval [CI] 1.20 to 1.80, p = 0.0002) and MACE (OR 1.29 95% CI 1.14 to 1.47, p ≤0.0011) at 30 days, with similar observations recorded at 1 and 5 years. CCI score ≥2 was independently associated with increased 30-day cardiac death (OR 4.25, 95% CI 1.24 to 14.56, p = 0.02) at 1 month, and this increased risk was also observed at 1 and 5 years. In conclusion, co-morbid burden, as measured using CCI, is an independent predictor of adverse outcomes in the short, medium, and long term. Co-morbidity should be considered in the decision-making process when counseling patients regarding the periprocedural risks associated with PCI, in conjunction with traditional risk factors. ;copy; 2015 Elsevier Inc.",acquired immune deficiency syndrome;acute coronary syndrome;adult;adverse outcome;article;cardiac patient;cardiovascular risk;Charlson Comorbidity Index;chronic kidney disease;chronic obstructive lung disease;congestive heart failure;connective tissue disease;coronary stent;coronary stenting;counseling;dementia;diabetes mellitus;drug eluting coronary stent;female;follow up;heart death;heart infarction;hemiplegia;human;leukemia;liver disease;lymphoma;male;middle aged;morbidity;outcome assessment;peptic ulcer;percutaneous coronary intervention;peripheral vascular disease;prevalence;priority journal;risk factor;solid tumor,"Mamas, M. A.;Fath-Ordoubadi, F.;Danzi, G. B.;Spaepen, E.;Kwok, C. S.;Buchan, I.;Peek, N.;De Belder, M. A.;Ludman, P. F.;Paunovic, D.;Urban, P.",2015,,,0,
2780,Factors Associated with Pneumonia-caused Death in Older Adults with Autopsy-confirmed Dementia,"Objective A better understanding of risk factors for pneumonia-caused death may help to improve the clinical management of dementia. Methods A retrospective observational study was conducted by reviewing the medical charts and autopsy reports of 204 patients who were admitted to hospital, underwent a post-mortem examination, and who were neuropathologically diagnosed with dementia. The risk factors for pneumonia-caused death were examined both as underlying and immediate causes of death using logistic regression models. Results A high frequency of pneumonia-caused death was observed both in underlying- (37.3%) and immediate- (44.1%) cause of death, but varied according to the subtypes of dementia. The factors related to pneumonia-caused death (underlying) were subtypes of dementia; Alzheimer's disease (odds ratio [OR], 2.891; 95% confidence interval [CI], 1.459-5.730); argyrophilic grain disease (OR, 3.148; 95% CI, 0.937-10.577); and progressive supranuclear palsy (OR, 34.921; 95% CI, 3.826-318.775), dysphagia (OR, 2.045; 95% CI, 1.047-3.994), diabetes mellitus (OR, 3.084; 95% CI, 1.180-8.061) and conversely related with heart failure (OR, 0.149; 95% CI, 0.026-0.861). Factors relating to pneumonia-caused death (immediate) were incidence of pneumonia during hospitalizations (OR, 32.579; 95%CI, 4.308-246.370), gender-male (OR, 2.060; 95% CI, 1.098-3.864), and conversely related with malignant neoplasm (OR, 0.220; 95% CI, 0.058-0.840). Conclusion The different factors relating to the pneumonia-caused death were evaluated depending on whether pneumonia was the underlying- or immediate-cause of death. Strengthening clinical management on dysphagia and diabetes mellitus, and preventing incidence of pneumonia during hospitalization appear to be the important for the terminal stage of hospitalized patients with dementia.","Aged;Aged, 80 and over;Alzheimer Disease/complications;Autopsy;Cause of Death;Deglutition Disorders/complications;Dementia/ complications;Female;Hospitalization;Humans;Incidence;Logistic Models;Male;Odds Ratio;Pneumonia/complications/epidemiology/ mortality;Retrospective Studies;Risk Factors;Alzheimer's disease;dementia;dementia with Lewy bodies;dysphagia;pneumonia;pneumonia-caused death","Manabe, T.;Mizukami, K.;Akatsu, H.;Hashizume, Y.;Ohkubo, T.;Kudo, K.;Hizawa, N.",2017,,,0,
2781,Serious illness conversations in ESRD,"Dialysis-dependent ESRD is a serious illness with high disease burden, morbidity, and mortality. Mortality in the first year on dialysis for individuals over age 75 years old approaches 40%, and even those with better prognoses face multiple hospitalizations and declining functional status. In the last month of life, patients on dialysis over age 65 years old experience higher rates of hospitalization, intensive care unit admission, procedures, and death in hospital than patients with cancer or heart failure, while using hospice services less. This high intensity of care is often inconsistent with the wishes of patients on dialysis but persists due to failure to explore or discuss patient goals, values, and preferences in the context of their serious illness. Fewer than 10% of patients on dialysis report having had a conversation about goals, values, and preferences with their nephrologist, although nearly 90% report wanting this conversation. Many nephrologists shy away from these conversations, because they do not wish to upset their patients, feel that there is too much uncertainty in their ability to predict prognosis, are insecure in their skills at broaching the topic, or have difficulty incorporating the conversations into their clinical workflow. In multiple studies, timely discussions about serious illness care goals, however, have been associated with enhanced goal-consistent care, improved quality of life, and positive family outcomes without an increase in patient distress or anxiety. In this special feature article, we will (1) identify the barriers to serious illness conversations in the dialysis population, (2) review best practices in and specific approaches to conducting serious illness conversations, and (3) offer solutions to overcome barriers as well as practical advice, including specific language and tools, to implement serious illness conversations in the dialysis population.",article;artificial feeding;artificial ventilation;decision making;dementia;dialysis;diet restriction;documentation;end stage renal disease;general practitioner;heart failure;hospitalization;human;institutionalization;intensive care unit;morbidity;mortality;quality of life;resuscitation,"Mandel, E. I.;Bernacki, R. E.;Block, S. D.",2017,,10.2215/cjn.05760516,0,
2782,Multimorbidity in Heart Failure: Effect on Outcomes,"Objectives: To investigate the effect of the number and type of comorbid conditions on death and hospitalizations in individuals with incident heart failure (HF). Design: Population-based cohort study. Setting: Olmsted County, Minnesota. Participants: Olmsted County, Minnesota, residents with incident HF from 2000 to 2010 (mean age 76 ± 14, 56% female) (N = 1,714). Measurements: The prevalence of 16 chronic conditions obtained at HF diagnosis classified into three groups: cardiovascular (CV) related, other physical, and mental. Results: The mean number of conditions per participant was 2.6 ± 1.5 for CV-related conditions, 1.3 ± 1.1 for other physical conditions, and 0.30 ± 0.61 for mental conditions. After a mean follow-up of 4.2 years, 1,073 deaths and 6,306 hospitalizations had occurred. After adjustment for age, sex, ejection fraction, in- or outpatient status, and number of other conditions, an increase of one other physical condition was associated with a 14% (HR = 1.14, 95% CI = 1.08–1.20) greater risk of death and a 26% (HR = 1.26, 95% CI = 1.20–1.32) greater risk of hospitalization, and an increase of one mental condition was associated with a 31% (HR = 1.31, 95% CI = 1.19–1.44) greater risk of death and an 18% (HR = 1.18, 95% CI = 1.07–1.29) greater risk of hospitalization. In contrast, an increase of one CV-related condition was not associated with greater risk of death and was associated with a 10% (HR = 1.10, 95% CI = 1.06–1.15) greater risk of hospitalization. Conclusion: CV-related conditions are the most common type of comorbid conditions in individuals with HF, but other physical and mental conditions are more strongly associated with death and hospitalizations. This underscores the effect of non-CV conditions on outcomes in HF.",aged;article;cardiovascular mortality;cardiovascular risk;chronic kidney disease;chronic obstructive lung disease;comorbidity assessment;dementia;diabetes mellitus;disease association;female;follow up;heart ejection fraction;heart failure;hospitalization;human;hyperlipidemia;hypertension;major clinical study;male;mental disease;mental health;mortality;neoplasm;outpatient;prevalence;schizophrenia;substance abuse,"Manemann, S. M.;Chamberlain, A. M.;Boyd, C. M.;Gerber, Y.;Dunlay, S. M.;Weston, S. A.;Jiang, R.;Roger, V. L.",2016,,,0,
2783,"Physical function, physical activity and recent falls. Results from the ""Invecchiamento e Longevità nel Sirente (ilSIRENTE)"" Study","Background and aims: A fall is a common and traumatic event in the life of older persons. This study aims: 1) to explore the relationship between recent falls and measures of physical function in elders, and 2) to examine the role played by habitual physical activity in the relationship between recent falls and physical function. Methods: We used baseline data from 361 community-dwelling persons aged ≥80 years (mean age 85.9 yrs) enrolled in the ""Invecchiamento e Longevità nel Sirente (ilSIRENTE)"" study. Physical performance was assessed using the Short Physical Performance Battery (SPPB) and usual gait speed. Muscle strength was measured by hand grip strength. Functional status was assessed by the Basic (ADL) and Instrumental Activities of Daily Living (IADL) scales. Self-reported recent falls over the previous three months were recorded. Analyses of covariance were performed to evaluate the relationship between recent fall events and physical function measures. Results: Fifty participants (13.9%) reported at least one recent fall. Physically active participants had fewer falls and significantly higher physical function compared with sedentary subjects, regardless of recent falls. Significant interactions for physical activity were found in the relationships of usual gait speed and SPPB with recent fall history (p for interaction terms <0.01). A difference in usual gait speed and SPPB according to history of recent falls was found only in physically active subjects. Conclusions: Physical performance measures are negatively associated with recent falls in physically active, but not sedentary, participants. Physical activity is associated with better physical function, independently of recent fall history. ©2008, Editrice Kurtis.",aged;analysis of covariance;artery disease;article;body mass;cerebrovascular disease;cognition;comorbidity;congestive heart failure;controlled study;daily life activity;dementia;demography;diabetes mellitus;falling;female;functional status;gait;grip strength;hand grip;hearing impairment;human;hypertension;ischemic heart disease;longevity;lung disease;male;malignant neoplastic disease;marriage;muscle strength;normal human;osteoarthritis;Parkinson disease;physical activity;physical capacity;physical performance;self report;sitting;visual impairment;walking speed,"Mangani, I.;Cesari, M.;Russo, A.;Onder, G.;Maraldi, C.;Zamboni, V.;Marchionni, N.;Bernabei, R.;Pahor, M.;Landi, F.",2008,,,0,
2784,Guidelines for end-of-life and palliative care in Indian intensive care units′ ISCCM consensus Ethical Position Statement,"Purpose To develop an ethical framework and practical procedure for limiting inappropriate therapeutic interventions to improve the quality of care of the dying in the intensive care unit through a professional consensus process. Evidence Since the publication of the last guideline in 2005,[1] there has been an exponential increase in empirical information and discussion on the subject. The literature reviewed address key surveys, observational studies, randomized controlled and interventional studies as well as guidelines and recommendations for education and quality improvement from all over the world and India. Established and evolving bioethical and medico-legal opinions in the world and in India are also included in this review. The search terms were: End-of-life care; DNR directives; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care; end-of-life care in India; cultural variations. Materials and Methods Proposals from the Chair were debated and recommendations were formulated through a consensus process. The members of the Committee took into account the established ethical principles and procedural practices elsewhere in the world, incorporating the sociocultural and legal perspectives unique to this country.",barbituric acid derivative;carbapenem;morphine;opiate;article;artificial ventilation;beneficence;bioethics;brain death;cancer center;cancer patient;cardiopulmonary insufficiency;coma;correlation analysis;court;decision making;dementia;disease marker;distress syndrome;endotracheal intubation;ethical decision making;euthanasia;family counseling;health care;hospital bed;human;Indian;intensive care;intensive care unit;intervention study;law;legal aspect;long term care;mortality;newborn care;pain;palliative therapy;passive euthanasia;persistent vegetative state;personal autonomy;physician;practice guideline;prospective study;quadriplegia;resuscitation;suicide attempt;survival;systemic circulation;terminal disease;tertiary health care;treatment withdrawal,"Mani, R. K.;Amin, P.;Chawla, R.;Divatia, J. V.;Kapadia, F.;Khilnani, P.;Myatra, S. N.;Prayag, S.;Rajagopalan, R.;Todi, S. K.;Uttam, R.",2012,,,0,
2785,Long-term survival after chronic subdural haematoma,"Outcome after chronic subdural haematoma (CSDH) is invariably assumed favourable: however, little data regarding long term survival (LTS) exists. One study reported excess mortality restricted to year 1, but with expected actuarial rates thereafter. We aimed to determine LTS after CSDH in a retrospective analysis relative to actuarial data from age-matched controls. Data was obtained in n = 155, (M:F 97:58, 69.3 ± 2.3 years). Follow-up maxima was 14.19 years (mean: 4.02 ± 3.07 years, median: 5.2 years). Mortality in-hospital, at 6 months, 1 year, 2 years and 5 years was n = 13 (8.39%), n = 22 (14.19%), n = 31 (20.35%), n = 42 (27.1%) and n = 54 (34.84%). LTS was significantly worse than controls (5.29 ± 0.59 years vs. 17.74 ± 1.8 years, hazard ratio [HR]: 3.52, P < 0.0001). Death most frequently related to pneumonia/sepsis and ischemic heart disease (IHD). Median modified Rankin score (mRS) in those discharged home (n = 94, 60.65%) was 2 [IQR: 1–3]. Discharge mRS in those who died at 6 months, 1 year, 2 years and 5 years was 5 [IQR: 3–6], 5 [IQR: 4–6], 3 [IQR: 1–3], 4 [IQR: 2–5]. Discharge mRS was significantly worse with year 1 mortality (P = 0.014). LTS related to discharge mRS (HR: 37.006, P < 0.001), post-operative motor-score (HR: 0.581, P = 0.0026), IHD (HR: 5.186, P = 0.005), warfarin-use (HR: 5.93, P = 0.036) and dementia (HR: 5.39, P = 0.031). No long term recurrences (LTR) were recorded. Although most were discharged home with mRS = 2, LTS was markedly less than previously reported: peers lived 12.4 years longer. Although greater in year 1, excess mortality was not restricted to year 1, but continued throughout prolonged follow-up. LTS related to discharge disability and dependence, and co-morbid risk factors for cerebral atrophy. No LTR suggests that, once ultimately closed, the ‘subdural space’ remains closed. CSDH patients represent a vulnerable group who require continued long-term medical surveillance.",warfarin;age distribution;aged;article;brain atrophy;comorbidity;controlled study;dementia;female;follow up;functional assessment;hospital discharge;human;ischemic heart disease;life expectancy;long term survival;major clinical study;male;mortality rate;neuromuscular function;pneumonia;priority journal;Rankin scale;retrospective study;risk assessment;risk factor;sepsis;sex difference;subdural hematoma,"Manickam, A.;Marshman, L. A. G.;Johnston, R.",2016,,10.1016/j.jocn.2016.05.026,0,
2786,Diabetes care among older adults in primary care in Austria--a cross-sectional study,"QUESTIONS UNDER STUDY: The prevalence of diabetes mellitus in the older population is high, but hardly any data are available on current diabetes care in the primary care setting. We aimed at investigating the diabetes management of older patients with type 2 diabetes (T2DM) in the primary care setting, including adherence to current guidelines, comparing patients aged 70-79 years to those aged 80 years and above. METHODS: From November 2008 through March 2009 a total of 23 primary care physicians and one consultant in internal medicine consecutively enrolled 203 unselected patients with T2DM aged >/=70 years. RESULTS: From the 203 study participants 66% were 70-79 years of age, and 34% were 80 years or older. Mean HbA1c and LDL-cholesterol were not significantly different between the older and the younger age group (7.6 +/- 1.6 vs. 7.1 +/- 0.9%; p = 0.080; and 122 +/- 40 vs. 114 +/- 34 mg/dl; p = 0.273), whereas BMI was lower (27.5 +/- 5.0 vs. 29.6 +/- 5.0 kg/m2, p = 0.010), and the prevalent rates of coronary heart disease (55.1 vs. 37.1%, p = 0.011) and of dementia (29% vs. 6.1%, p = 0.001) were higher in the older age group. LDL-cholesterol (77.6% vs. 66.7%, p = 0.012), creatinine clearance (34.6% vs. 30.9%, p = 0.049) but not HbA1c (74.6% vs.73.9; p = 0.520) were monitored significantly less often in the older than in the younger age group. CONCLUSIONS: While glycaemic control on average appears strict, there may be ample room for improvement in reaching lipid targets and in the monitoring of lipid and renal function among older adults in primary care, in particular among individuals aged >/=80 years.","Age Factors;Aged;Aged, 80 and over;Austria;Body Mass Index;Chi-Square Distribution;Cholesterol, HDL/blood;Cholesterol, LDL/*blood;Creatinine/*blood/urine;Cross-Sectional Studies;Diabetes Mellitus, Type 2/*blood/drug therapy/physiopathology;Female;Glomerular Filtration Rate;Hemoglobin A, Glycosylated/*metabolism;Humans;Male;*Practice Patterns, Physicians';Statistics, Nonparametric;Triglycerides/blood","Mann, E.;Vonbank, A.;Drexel, H.;Saely, C. H.",2012,Aug 23,10.4414/smw.2012.13646,0,2787
2787,Diabetes care among older adults in primary care in Austria: A cross-sectional study,"QUESTIONS UNDER STUDY: The prevalence of diabetes mellitus in the older population is high, but hardly any data are available on current diabetes care in the primary care setting. We aimed at investigating the diabetes management of older patients with type 2 diabetes (T2DM) in the primary care setting, including adherence to current guidelines, comparing patients aged 70-79 years to those aged 80 years and above. METHODS: From November 2008 through March 2009 a total of 23 primary care physicians and one consultant in internal medicine consecutively enrolled 203 unselected patients with T2DM aged ≥70 years. RESULTS: From the 203 study participants 66% were 70-79 years of age, and 34% were 80 years or older. Mean HbA1c and LDL-cholesterol were not significantly different between the older and the younger age group (7.6 ± 1.6 vs. 7.1 ± 0.9%; p = 0.080; and 122 ± 40 vs. 114 ± 34 mg/dl; p = 0.273), whereas BMI was lower (27.5 ± 5.0 vs. 29.6 ± 5.0 kg/m2, p = 0.010), and the prevalent rates of coronary heart disease (55.1 vs. 37.1%, p = 0.011) and of dementia (29% vs. 6.1%, p = 0.001) were higher in the older age group. LDL-cholesterol (77.6% vs. 66.7%, p = 0.012), creatinine clearance (34.6% vs. 30.9%, p = 0.049) but not HbA1c (74.6% vs.73.9; p = 0.520) were monitored significantly less often in the older than in the younger age group. CONCLUSIONS: While glycaemic control on average appears strict, there may be ample room for improvement in reaching lipid targets and in the monitoring of lipid and renal function among older adults in primary care, in particular among individuals aged ≥80 years.",glitazone derivative;hemoglobin A1c;insulin;low density lipoprotein cholesterol;metformin;sulfonylurea;aged;article;Austria;body mass;creatinine clearance;cross-sectional study;disease management;female;glycemic control;human;ischemic heart disease;kidney function;major clinical study;male;non insulin dependent diabetes mellitus;patient compliance;physician;practice guideline;prevalence;primary medical care,"Mann, E.;Vonbank, A.;Drexel, H.;Saely, C. H.",2012,,,0,
2788,Prophylaxis of cerebrovascular events in dementia patients receiving risperidone,"Objective: To determine if differences exist in prescribing for cerebrovascular adverse event (CAE) prophylaxis between residents receiving risperidone therapy and those with no antipsychotic therapy. Design: Retrospective, multicentered, cross-sectional study. Setting: Ten long-term care facilities. Participants: A total of 200 residents residing in skilled nursing facilities. The study group (n = 95) included residents with a risk factor for a CAE receiving risperidone. The control group (n = 105) consisted of residents with a risk factor for a CAE and not receiving antipsychotic therapy. Measurements: Data collected included patient age, gender, risk factor for CAE, and CAE prophylaxis. Statistics were performed using Chi-squared tests. Results: Fifty-six percent of the study group was not on an agent for CAE prophylaxis, compared with 36% of the control group. Conclusion: This study demonstrated with statistical significance that CAE prophylaxis was less likely in the risperidone group. We are implementing a pharmacist-driven initiative to add antiplatelet therapies in all patients who have at least one risk factor for CAE. Copyright© 2005, American Society of Consultant Pharmacists, Inc. All rights reserved.",acetylsalicylic acid;clopidogrel;risperidone;warfarin;aged;anemia;article;cerebrovascular disease;chi square distribution;clinical trial;controlled study;deep vein thrombosis;dementia;diabetes mellitus;dyslipidemia;female;headache;heart arrhythmia;heart failure;hematocrit;human;hypertension;information processing;long term care;major clinical study;male;multicenter study;nursing care;peripheral vascular disease;pharmacist;prophylaxis;randomized controlled trial;resident;retrospective study;risk factor;statistical significance,"Mann, J.;O'Hara, L.",2005,,,0,
2789,A review of the management of heart failure in long-term care residents,"OBJECTIVE: The objective of this study was to describe the characteristics of long-term care residents with heart failure (HF), to evaluate the management of HF, and to compare their management with nationally published American College of Cardiology/American Heart Association guidelines. DESIGN/SETTING: Residents in long-term care facilities were identified by diagnosis of HF within their electronic medical record. PARTICIPANTS: Data were collected on 302 residents in 19 long-term care facilities. The average age of the study population was 83.2 +/- 11.1 years and comprised 68.5% females. RESULTS: Diabetes, obesity, hypertension, coronary artery disease, dementia, and hypothyroidism were identified in greater than 30% of residents. A diuretic was prescribed in 76.8% of residents. Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers were prescribed to 40.7% and 38.4% of residents, respectively; 16.2% of residents received both agents. Residents with diabetes or hypertension were not prescribed ACE inhibitors more often than residents without these comorbidities. Digoxin was prescribed more frequently in residents with atrial fibrillation (P = 0.028). Hospital admissions related to HF were documented in 30 (9.9%) residents within the past 12 months. CONCLUSIONS: According to guidelines, most patients with HF should be routinely managed with a combination of four types of drugs: a diuretic, an ACE inhibitor, a betablocker, and, often, digoxin. Improvement in HF outcomes resulting in reduced morbidity and mortality may be achieved through greater adherence to nationally recognized guidelines. Opportunities exist for health care professionals to improve the management of residents with HF through appropriate drug therapy management.","Adrenergic beta-Antagonists/therapeutic use;Aged;Aged, 80 and over;Angiotensin-Converting Enzyme Inhibitors/therapeutic use;Calcium Channel Blockers/therapeutic use;Cardiovascular Agents/administration & dosage/*therapeutic use;Digoxin/therapeutic use;Diuretics/therapeutic use;Drug Therapy, Combination;Drug Utilization;Female;Heart Failure/*drug therapy;Homes for the Aged;Humans;*Long-Term Care;Male;Middle Aged;Nursing Homes","Mann, J. L.;Evans, T. S.",2006,Mar,,0,
2790,Raising a long-ignored question,,alpha adrenergic receptor blocking agent;blood pressure monitoring;cardiovascular risk;cerebrovascular disease;cognitive defect;disease association;heart infarction;heart left ventricle hypertrophy;human;multiinfarct dementia;note;nuclear magnetic resonance imaging;orthostatic hypertension;prognosis;reproducibility;risk factor;seat;standing;statistical analysis;cerebrovascular accident;supine position;systolic blood pressure;tilt table test;treatment indication;treatment outcome,"Mann, S. J.",2003,,,0,
2791,Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials,"OBJECTIVETo report a comprehensive, integrated overview of findings from the 2 Women's Health Initiative (WHI) hormone therapy trials with extended postintervention follow-up.DESIGN, SETTING, AND PARTICIPANTSA total of 27,347 postmenopausal women aged 50 to 79 years were enrolled at 40 US centers.INTERVENTIONSWomen with an intact uterus received conjugated equine estrogens (CEE; 0.625 mg/d) plus medroxyprogesterone acetate (MPA; 2.5 mg/d) (n?=?8506) or placebo (n?=?8102). Women with prior hysterectomy received CEE alone (0.625 mg/d) (n?=?5310) or placebo (n?=?5429). The intervention lasted a median of 5.6 years in CEE plus MPA trial and 7.2 years in CEE alone trial with 13 years of cumulative follow-up until September 30, 2010.MAIN OUTCOMES AND MEASURESPrimary efficacy and safety outcomes were coronary heart disease (CHD) and invasive breast cancer, respectively. A global index also included stroke, pulmonary embolism, colorectal cancer, endometrial cancer, hip fracture, and death.RESULTSDuring the CEE plus MPA intervention phase, the numbers of CHD cases were 196 for CEE plus MPA vs 159 for placebo (hazard ratio [HR], 1.18; 95% CI, 0.95-1.45) and 206 vs 155, respectively, for invasive breast cancer (HR, 1.24; 95% CI, 1.01-1.53). Other risks included increased stroke, pulmonary embolism, dementia (in women aged ?65 years), gallbladder disease, and urinary incontinence; benefits included decreased hip fractures, diabetes, and vasomotor symptoms. Most risks and benefits dissipated postintervention, although some elevation in breast cancer risk persisted during cumulative follow-up (434 cases for CEE plus MPA vs 323 for placebo; HR, 1.28 [95% CI, 1.11-1.48]). The risks and benefits were more balanced during the CEE alone intervention with 204 CHD cases for CEE alone vs 222 cases for placebo (HR, 0.94; 95% CI, 0.78-1.14) and 104 vs 135, respectively, for invasive breast cancer (HR, 0.79; 95% CI, 0.61-1.02); cumulatively, there were 168 vs 216, respectively, cases of breast cancer diagnosed (HR, 0.79; 95% CI, 0.65-0.97). Results for other outcomes were similar to CEE plus MPA. Neither regimen affected all-cause mortality. For CEE alone, younger women (aged 50-59 years) had more favorable results for all-cause mortality, myocardial infarction, and the global index (nominal P?<?.05 for trend by age). Absolute risks of adverse events (measured by the global index) per 10,000 women annually taking CEE plus MPA ranged from 12 excess cases for ages of 50-59 years to 38 for ages of 70-79 years; for women taking CEE alone, from 19 fewer cases for ages of 50-59 years to 51 excess cases for ages of 70-79 years. Quality-of-life outcomes had mixed results in both trials.CONCLUSIONS AND RELEVANCEMenopausal hormone therapy has a complex pattern of risks and benefits. Findings from the intervention and extended postintervention follow-up of the 2 WHI hormone therapy trials do not support use of this therapy for chronic disease prevention, although it is appropriate for symptom management in some women.TRIAL REGISTRATIONclinicaltrials.gov Identifier: NCT00000611.IMPORTANCEMenopausal hormone therapy continues in clinical use but questions remain regarding its risks and benefits for chronic disease prevention.","Breast Neoplasms [epidemiology] [prevention & control];Colorectal Neoplasms [epidemiology];Coronary Disease [epidemiology] [prevention & control];Drug Therapy, Combination;Endometrial Neoplasms [epidemiology];Estrogens [administration & dosage] [adverse effects];Estrogens, Conjugated (USP) [administration & dosage] [adverse effects];Follow-Up Studies;Hip Fractures [epidemiology];Hormone Replacement Therapy [adverse effects];Medroxyprogesterone Acetate [administration & dosage] [adverse effects];Postmenopause;Pulmonary Embolism [epidemiology];Quality of Life;Risk;Stroke [epidemiology];Treatment Outcome;United States [epidemiology];Aged[checkword];Female[checkword];Humans[checkword];Middle Aged[checkword];Sr-incont: sr-dementia: sr-menstr","Manson, Je;Chlebowski, Rt;Stefanick, Ml;Aragaki, Ak;Rossouw, Je;Prentice, Rl;Anderson, G;Howard, Bv;Thomson, Ca;LaCroix, Az;Wactawski-Wende, J;Jackson, Rd;Limacher, M;Margolis, Kl;Wassertheil-Smoller, S;Beresford, Sa;Cauley, Ja;Eaton, Cb;Gass, M;Hsia, J;Johnson, Kc;Kooperberg, C;Kuller, Lh;Lewis, Ce;Liu, S;Martin, Lw;Ockene, Jk;O'Sullivan, Mj;Powell, Lh;Simon, Ms;Horn, L;Vitolins, Mz;Wallace, Rb",2013,,10.1001/jama.2013.278040,0,
2792,Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the women's health initiative randomized trials,"The Women's Health Initiative (WHI) was a placebo-controlled randomized study that investigated the benefits and risks of 2 menopausal hormone regimens in healthy normal postmenopausal women. The present report provides a comprehensive, integrated overview of findings from the intervention and extended postintervention phases of 2 WHI trials: one used conjugated equine estrogens (CEEs) plus medroxyprogesterone acetate (MPA), and the other used CEEs alone.Between 1993 and 1998, 27,347 postmenopausal women aged 50 to 79 years were enrolled at 40 US centers. Women with an intact uterus were randomized to receive a regimen of CEEs (0.625 mg/d) plus MPA (2.5 mg/d) (n = 8506) or placebo (n = 8102). Women with prior hysterectomy were randomized to receive CEEs alone (0.625 mg/d) (n = 5310) or placebo (n = 5429). The intervention phase of the CEEs plus MPA trial lasted a median of 5.6 years, and that of the CEEs alone trial lasted a median of 7.2 years with 13 years of cumulative follow-up until September 30, 2010. Primary efficacy and safety outcomes for both trials were coronary heart disease (CHD) and invasive breast cancer, respectively. A global index of other health outcomes included stroke, pulmonary embolism, colorectal cancer, endometrial cancer, hip fracture, and death.Benefits in the CEEs plus MPA intervention phase included decreased hip fractures, diabetes, and vasomotor symptoms. During the intervention phase in the CEEs plus MPA group, there were 196 CHD cases versus 159 for placebo (hazard ratio [HR], 1.18; 95% confidence interval [CI], 0.95-1.45), and 206 invasive breast cancer cases versus 155 for placebo (HR, 1.24; 95% CI, 1.01-1.53). Moreover, risks increased for stroke, pulmonary embolism, dementia (in women aged >65 years), gallbladder disease, and urinary incontinence. Among women in the CEEs plus MPA group, most risks and benefits dissipated after intervention, but there was persisting elevation in risk of breast cancer (434 cases vs 323 for placebo; HR, 1.28; 95% CI, 1.11-1.48).During the intervention phase in the CEEs alone group, risks and benefits were more balanced; there were 204 CHD cases versus 222 cases for placebo (HR, 0.94; 95% CI, 0.78-1.14) and 104 cases of invasive breast cancer compared with 135 for placebo (HR, 0.79; 95% CI, 0.61-1.02). Moreover, during cumulative follow-up, 168 cases of breast cancer were diagnosed in the CEEs alone group compared with 216 for the placebo; the HR was 0.79, with a 95% CI of 0.65 to 0.97. Other outcomes in this group were similar to the CEEs plus MPA group. All-cause mortality was not affected with either regimen. Younger women (aged 50-59 years) in the CEEs alone group had more favorable results during the intervention phase than older women for all-cause mortality, myocardial infarction, and the global index.Compared with placebo, absolute risks of adverse events in the CEEs plus MPA group assessed using global index data were lower in younger women: women aged 50 to 69 years had 12 more adverse events per 10,000 person-years, whereas those aged 70 to 79 years had 38 more. In the CEEs alone group, women aged 50 to 59 years had 19 fewer adverse events per 10,000 person-years, and women aged 70 to 79 years had 51 more adverse events. In both trials, results of quality-of-life outcomes were mixed.These findings do not support the use of CEEs plus MPA or CEEs alone in postmenopausal women for prevention of chronic disease. However, hormonal treatment may be beneficial in generally healthy women during early menopause for management of moderate to severe menopausal symptoms. © 2014 by Lippincott Williams & Wilkins.",breast cancer;cancer risk;cerebrovascular accident;colorectal cancer;death;dementia;diabetes mellitus;drug efficacy;drug safety;endometrium cancer;estrogen therapy;follow up;gallbladder disease;heart infarction;hip fracture;hormonal therapy;human;intervention study;ischemic heart disease;lung embolism;menopausal syndrome;monotherapy;mortality;note;outcome assessment;patient history of hysterectomy;postmenopause;randomized controlled trial;randomized controlled trial (topic);urine incontinence;vasomotor disorder;women's health;conjugated estrogen;medroxyprogesterone acetate;chronic disease;confidence interval;early menopause;female;hazard ratio;health;human;prevention;quality of life;risk;safety;uterus;conjugated estrogen;hormone;medroxyprogesterone acetate;placebo,"Manson, Je;Chlebowski, Rt;Stefanick, Ml;Aragaki, Ak;Rossouw, Je;Prentice, Rl;Anderson, G;Howard, Bv;Thomson, Ca;Lacroix, Az;Wactawski-Wende, J;Jackson, Rd;Limacher, M;Margolis, Kl;Wassertheil-Smoller, S;Beresford, Sa;Cauley, Ja;Eaton, Cb;Gass, M;Hsia, J;Johnson, Kc;Kooperberg, C;Kuller, Lh;Lewis, Ce;Liu, S;Martin, Lw;Ockene, Jk;O'Sullivan, Mj;Powell, Lh;Simon, Ms;Horn, L;Vitolins, Mz;Wallace, Rb",2014,,10.1097/01.ogx.0000444679.66386.38,0,2791
2793,Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials,"IMPORTANCE: Menopausal hormone therapy continues in clinical use but questions remain regarding its risks and benefits for chronic disease prevention. OBJECTIVE: To report a comprehensive, integrated overview of findings from the 2 Women's Health Initiative (WHI) hormone therapy trials with extended postintervention follow-up. DESIGN, SETTING, AND PARTICIPANTS: A total of 27,347 postmenopausal women aged 50 to 79 years were enrolled at 40 US centers. INTERVENTIONS: Women with an intact uterus received conjugated equine estrogens (CEE; 0.625 mg/d) plus medroxyprogesterone acetate (MPA; 2.5 mg/d) (n?=?8506) or placebo (n?=?8102). Women with prior hysterectomy received CEE alone (0.625 mg/d) (n?=?5310) or placebo (n?=?5429). The intervention lasted a median of 5.6 years in CEE plus MPA trial and 7.2 years in CEE alone trial with 13 years of cumulative follow-up until September 30, 2010. MAIN OUTCOMES AND MEASURES: Primary efficacy and safety outcomes were coronary heart disease (CHD) and invasive breast cancer, respectively. A global index also included stroke, pulmonary embolism, colorectal cancer, endometrial cancer, hip fracture, and death. RESULTS: During the CEE plus MPA intervention phase, the numbers of CHD cases were 196 for CEE plus MPA vs 159 for placebo (hazard ratio [HR], 1.18; 95% CI, 0.95-1.45) and 206 vs 155, respectively, for invasive breast cancer (HR, 1.24; 95% CI, 1.01-1.53). Other risks included increased stroke, pulmonary embolism, dementia (in women aged ?65 years), gallbladder disease, and urinary incontinence; benefits included decreased hip fractures, diabetes, and vasomotor symptoms. Most risks and benefits dissipated postintervention, although some elevation in breast cancer risk persisted during cumulative follow-up (434 cases for CEE plus MPA vs 323 for placebo; HR, 1.28 [95% CI, 1.11-1.48]). The risks and benefits were more balanced during the CEE alone intervention with 204 CHD cases for CEE alone vs 222 cases for placebo (HR, 0.94; 95% CI, 0.78-1.14) and 104 vs 135, respectively, for invasive breast cancer (HR, 0.79; 95% CI, 0.61-1.02); cumulatively, there were 168 vs 216, respectively, cases of breast cancer diagnosed (HR, 0.79; 95% CI, 0.65-0.97). Results for other outcomes were similar to CEE plus MPA. Neither regimen affected all-cause mortality. For CEE alone, younger women (aged 50-59 years) had more favorable results for all-cause mortality, myocardial infarction, and the global index (nominal P?<?.05 for trend by age). Absolute risks of adverse events (measured by the global index) per 10,000 women annually taking CEE plus MPA ranged from 12 excess cases for ages of 50-59 years to 38 for ages of 70-79 years; for women taking CEE alone, from 19 fewer cases for ages of 50-59 years to 51 excess cases for ages of 70-79 years. Quality-of-life outcomes had mixed results in both trials. CONCLUSIONS AND RELEVANCE: Menopausal hormone therapy has a complex pattern of risks and benefits. Findings from the intervention and extended postintervention follow-up of the 2 WHI hormone therapy trials do not support use of this therapy for chronic disease prevention, although it is appropriate for symptom management in some women. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00000611.","Breast Neoplasms [epidemiology] [prevention & control];Colorectal Neoplasms [epidemiology];Coronary Disease [epidemiology] [prevention & control];Drug Therapy, Combination;Endometrial Neoplasms [epidemiology];Estrogens [administration & dosage] [adverse effects];Estrogens, Conjugated (USP) [administration & dosage] [adverse effects];Follow-Up Studies;Hip Fractures [epidemiology];Hormone Replacement Therapy [adverse effects];Medroxyprogesterone Acetate [administration & dosage] [adverse effects];Postmenopause;Pulmonary Embolism [epidemiology];Quality of Life;Risk;Stroke [epidemiology];Treatment Outcome;United States [epidemiology];Aged[checkword];Female[checkword];Humans[checkword];Middle Aged[checkword];Sr-incont: sr-dementia: sr-menstr","Manson, J. E.;Chlebowski, R. T.;Stefanick, M. L.;Aragaki, A. K.;Rossouw, J. E.;Prentice, R. L.;Anderson, G.;Howard, B. V.;Thomson, C. A.;LaCroix, A. Z.;Wactawski-Wende, J.;Jackson, R. D.;Limacher, M.;Margolis, K. L.;Wassertheil-Smoller, S.;Beresford, S. A.;Cauley, J. A.;Eaton, C. B.;Gass, M.;Hsia, J.;Johnson, K. C.;Kooperberg, C.;Kuller, L. H.;Lewis, C. E.;Liu, S.;Martin, L. W.;Ockene, J. K.;O'Sullivan, M. J.;Powell, L. H.;Simon, M. S.;Horn, L.;Vitolins, M. Z.;Wallace, R. B.",2013,,10.1001/jama.2013.278040,0,2791
2794,"Risks from, and appropriate use of, blood products","Transfusion medicine has come a long way since the discovery of ABO blood groups by the Austrian scientist Karl Landsteiner in 1900. There has been continual improvement in the quality and safety of blood products available for clinical use, but, as with any treatment, there are associated risks. However, the UK national haemovigilance scheme has shown that most of those related to blood products are due to human error and could be prevented. Indeed, the most frequently reported category of transfusion reaction is 'incorrect blood component tranfused', which is nearly always due to an error of patient identification or prescribing, and can be fatal. Junior doctors are most often implicated, as they are delegated responsibility for blood-product prescribing and many mistakes arise due to lack of knowledge. While a lot of media emphasis has been put on the risk of viral and, more recently, prion transmission, transfusion-transmitted infections are very rare. In the UK there have only been four cases of confirmed variant Creutzfeldt-Jakob disease due to blood transfusion, and the risk of HIV transmission is approximately one per four million units transfused. Other problems, such as febrile, allergic and haemolytic reactions, are much more common. The use of red cells, platelets, fresh frozen plasma and cryoprecipitate requires understanding both of their content and of the clinical situations in which they are used. Doctors need to be aware of these issues in order to use blood products appropriately. © 2008 Royal College of Physicians of Edinburgh.",fresh frozen plasma;allergic reaction;article;blood group ABO incompatibility;blood transfusion;blood transfusion reaction;clinical practice;erythrocyte transfusion;heart arrest;heart failure;hemoglobin blood level;hemolysis;human;Human immunodeficiency virus infection;mortality;prescription;professional knowledge;risk assessment;therapeutic error;thrombocyte count;thrombocyte transfusion;treatment contraindication;variant Creutzfeldt Jakob disease,"Manson, L. M.;Preston, G. C.",2008,,,0,
2795,A case of intravascular large B cell lymphoma: New clinical and immunohistochemical findings,"Intravascular large B cell lymphoma (IVLBCL) is a rare extranodal non-Hodgkin lymphoma characterized by proliferation of malignant cells within the lumen of small vessels, with a predilection for the CNS and the skin. IVLBCL clinical course is highly aggressive, clinical signs and symptoms are not specific and may consist of neurological and cognitive impairment, fever of unknown origin and cutaneous lesions, lacking of a typical neuroimaging pattern. For all these reasons the diagnosis is commonly missed and the exitus is frequent, therefore post mortem evaluation is necessary to clarify the clinical history. We present a case of IVLBCL in a 62-year-old woman with unusual symptomatology, mimicking a vascular, multi-infarctual cerebropathy. Hachinski Ischemic Score was 7 suggesting a vascular dementia. Autopsy was unable to define the nature of the disease. Immunohistochemical analysis for cluster of differentiation 20 (CD20) revealed the ubiquitous presence of malignant lymphoid B-cells into the vessel of all organs analyzed, allowing the definitive diagnosis of IVLBCL. The atypical cells expressed high levels of anti-apoptotic proteins B-cell lymphoma 2 (Bcl-2) and Galectin-3, and showed cellular myelocytomatosis (c-Myc) staining in <50% of tumor nuclei. Conversely, cells were immunonegative for multiple myeloma-1 (MUM1), CD3, CD44, CD30, CD34 and CD133. Fluorescent in situ hybridization analysis for MYC rearrangements was negative. The high expression of Galectin-3 provides new insights in the understanding of molecular pathogenesis of IVLBCL; indeed, such a finding represents a prognostic factor for other types of lymphoma and should, in the same way, be taken into account in IVLBCL.",CD20 antigen;galectin 3;protein bcl 2;adult;article;ataxic gait;B lymphocyte;brain cortex;case report;clinical feature;dementia;female;fluorescence in situ hybridization;gene rearrangement;glia cell;heart failure;human;hypertension;hypoxia;immunofluorescence test;immunohistochemistry;immunoreactivity;ischemia;large cell lymphoma;lymphoid cell;mental deterioration;middle aged;neuroimaging;neurologic examination;nuclear magnetic resonance imaging;oncogene c myc;paresthesia;priority journal;pyrexia idiopathica;white matter,"Mansueto, G.;Di Vito, A.;Belluomo, C.;Murino, P.;Natella, V.;Camastra, C.;Presta, I.;Malara, N.;de Rosa, G.;Donato, G.;Mignogna, C.",2016,,,0,
2796,"Changes in morbidity and chronic disability in the U.S. elderly population: Evidence from the 1982, 1984, and 1989 National Long Term Care Surveys","We examined changes in the reported prevalence of 16 medical conditions in the U.S. population age 65 and above using data from the 1982, 1984, and 1989 National Long Term Care Surveys. Changes in those disease prevalence rates were examined both as observed, and after standardizing for changes in the age, sex, and disability distributions in the U.S. elderly population between 1982 and 1989. We found significant declines in the net prevalence of the 16 medical conditions between 1982 and 1989. Significant changes were found in different disability, age, and gender groups and after standardizing for declines in disability in addition to age and sex. The declines in morbidity reported between 1982 and 1989 are consistent with the declines reported in the 1982 and 1989 National Long Term Care Surveys in the age and sex standardized prevalence of chronic disability and institutionalization.",adult;aged;arteriosclerosis;arthritis;article;asthma;bronchitis;neoplasm;daily life activity;dementia;diabetes mellitus;disability;emphysema;female;fracture;health survey;heart disease;heart infarction;human;hypertension;institutionalization;life expectancy;long term care;major clinical study;male;medicare;morbidity;Parkinson disease;pneumonia;prevalence;priority journal;cerebrovascular accident;United States;vascular disease,"Manton, K. G.;Stallard, E.;Corder, L.",1995,,,0,
2797,The dynamics of dimensions of age-related disability 1982 to 1994 in the U.S. elderly population,"Declines in chronic disability were observed in the National Long Term Care Survey (NLTCS) 1982 to 1994. We analyzed the 1982, 1984, 1989, and 1994 NLTCS to identify the dimensions of chronic disability from multivariate analyses of a rich battery of measures of the ability (or inability) to perform specific activities. Changes over time in the prevalence of individual disability dimensions can be tracked to evaluate the rate of age-related losses of specific functions, 1982-1994. Seven dimensions described changes in the age dependence of 27 activities of daily living, instrumental activities of daily living, and physical performance measures in community and institutional resident elderly individuals over the 12 year period. Adjusted for age, the healthiest dimension with the best physical function experienced the largest increase in prevalence (3.3%) implying a decline in age-related disability. Disability declines were correlated with reductions in select health conditions (e.g., dementia and circulatory disease) over the study period.","Activities of Daily Living;Age Factors;Aged;Aged, 80 and over;*Aging;Arteriosclerosis/epidemiology;Cerebrovascular Disorders/epidemiology;Chronic Disease/epidemiology;Dementia/epidemiology;Disabled Persons/*statistics & numerical data;Health Status;Humans;Institutionalization;Likelihood Functions;Longitudinal Studies;Multivariate Analysis;Musculoskeletal Diseases/epidemiology;Myocardial Infarction/epidemiology;Prevalence;Psychomotor Performance;United States/epidemiology;Vascular Diseases/epidemiology","Manton, K. G.;Stallard, E.;Corder, L. S.",1998,Jan,,0,
2798,Severe hypoglycemia in patients with known diabetes requiring emergency department care: A report from an Italian multicenter study,"Aims To describe the characteristics and associated risk factors of patients with established diabetes who required Emergency Department (ED) care for severe hypoglycemia. Methods We performed an observational retrospective study to identify all cases of severe hypoglycemia among attendees at the EDs of three Italian University hospitals from January 2010 to December 2014. Results Overall, 520 patients with established diabetes were identified. Mean out-of-hospital blood glucose concentrations at the time of the hypoglycemic event were 2.2 ± 1.3 mmol/L. Most of these patients were frail and had multiple comorbidities. They were treated with oral hypoglycemic drugs (43.6%), insulin (42.8%), or both (13.6%). Among the oral hypoglycemic drugs, glibenclamide (54.5%) and repaglinide (25.7%) were the two most frequently used drugs, followed by glimepiride (11.3%) and gliclazide (7.5%). Hospitalization rates and in-hospital deaths occurred in 35.4% and in 2.3% of patients, respectively. Cirrhosis (odds ratio [OR] 6.76, 95% confidence interval [CI] 1.24–36.8, p < 0.05), chronic kidney disease (OR 2.42, 95% CI 1.11–8.69, p < 0.05) and center (Sapienza University OR 3.70, 95% CI 1.57–8.69, p < 0.05) were the strongest predictors of increased rates of hospital admission. Conclusions Severe hypoglycemia is a remarkable burden for patients with established diabetes and increases the risk of adverse clinical outcomes (in-hospital death and hospitalization), mainly in elderly and frail patients. This study further reinforces the notion that careful attention should be taken by health care providers when they prescribe drug therapy in elderly patients with serious comorbidities.",glibenclamide;gliclazide;glimepiride;glucose;insulin;metformin;oral antidiabetic agent;repaglinide;age;aged;article;chronic kidney disease;chronic obstructive lung disease;comorbidity;dementia;emergency care;female;glucose blood level;heart arrhythmia;hospitalization;human;hypoglycemia;insulin dependent diabetes mellitus;insulin pump;ischemic heart disease;length of stay;liver cirrhosis;major clinical study;male;malignant neoplastic disease;mortality;non insulin dependent diabetes mellitus;observational study;prediction;priority journal;retrospective study;risk factor,"Mantovani, A.;Grani, G.;Chioma, L.;Vancieri, G.;Giordani, I.;Rendina, R.;Rinaldi, M. E.;Andreadi, A.;Coccaro, C.;Boccardo, C.;Fraenza, C.;Bertazzoni, G.;Bellia, A.;Zoppini, G.;Targher, G.;Baroni, M. G.;Lauro, D.;D'Armiento, M.;Bonora, E.",2016,,,0,
2799,Apolipoprotein E polymorphism and C-reactive protein in dyslipidemic middle-aged men,,apolipoprotein E2;apolipoprotein E3;apolipoprotein E4;C reactive protein;cholesterol;allele;Alzheimer disease;atherosclerosis;cholesterol blood level;cholesterol transport;dyslipidemia;foam cell;gene locus;genetic polymorphism;heart infarction;human;inflammation;letter;pathogenesis;phenotype;priority journal;protein secretion;protein transport;risk factor;smoking,"Mänttäri, M.;Manninen, V.;Palosuo, T.;Ehnholm, C.",2001,,,0,
2800,Cardiovascular death in rheumatoid arthritis: a population-based study,"OBJECTIVE: To determine whether systemic inflammation confers any additional risk for cardiovascular death among patients with rheumatoid arthritis (RA), after adjusting for traditional cardiovascular risk factors and comorbidities. METHODS: Using the population-based data resources of the Rochester Epidemiology Project, we assembled an incidence cohort of all Rochester, Minnesota residents ages >or=18 years who first fulfilled the American College of Rheumatology 1987 criteria for RA between January 1, 1955 and January 1, 1995. All subjects were followed up longitudinally through their complete (inpatient, outpatient) medical records, beginning at age 18 years and continuing until death, migration, or January 1, 2001. Detailed information on the occurrence of various cardiovascular risk factors (personal history of coronary heart disease [CHD], congestive heart failure, smoking, hypertension, dyslipidemia, body mass index [BMI], diabetes mellitus, menopausal status) as well as indicators of systemic inflammation and RA disease severity (rheumatoid factor [RF] seropositivity, erythrocyte sedimentation rate [ESR], joint swelling, radiographic changes, RA nodules, RA complications, RA treatments, disease duration) and comorbidities were collected on all subjects. Causes of death were ascertained from death certificates and medical records. Cox regression models were used to estimate the independent predictors of cardiovascular death. RESULTS: This inception cohort comprised a total of 603 RA patients whose mean age was 58 years, of whom 73% were women. During a mean followup of 15 years, 354 patients died and cardiovascular disease was the primary cause of death in 176 patients. Personal history of CHD, smoking, hypertension, low BMI, and diabetes mellitus, as well as comorbidities, including peripheral vascular disease, cerebrovascular disease, chronic pulmonary disease, dementia, ulcers, malignancies, renal disease, liver disease, and history of alcoholism, were all significant risk factors for cardiovascular death (P < 0.01 for each). Multivariable Cox regression analyses, controlled for cardiovascular risk factors and comorbidities, revealed that the risk of cardiovascular death was significantly higher among RA patients with at least 3 ESR values of >or=60 mm/hour (hazard ratio [HR] 2.03, 95% confidence interval [95% CI] 1.45-2.83), RA vasculitis (HR 2.41, 95% CI 1.00-5.81), and RA lung disease (HR 2.32, 95% CI 1.11-4.84). CONCLUSION: These results indicate that markers of systemic inflammation confer a statistically significant additional risk for cardiovascular death among patients with RA, even after controlling for traditional cardiovascular risk factors and comorbidities.","Adult;Aged;Arthritis, Rheumatoid/epidemiology/*immunology;Biomarkers;Cardiovascular Diseases/epidemiology/*immunology/mortality;Comorbidity;Female;Humans;Incidence;Longitudinal Studies;Male;Middle Aged;Risk;Risk Factors","Maradit-Kremers, H.;Nicola, P. J.;Crowson, C. S.;Ballman, K. V.;Gabriel, S. E.",2005,Mar,10.1002/art.20878,0,
2801,"Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial","BACKGROUND: Whether cardiac rehabilitation (CR) is effective in patients older than 75 years, who have been excluded from most trials, remains unclear. We enrolled patients 46 to 86 years old in a randomized trial and assessed the effects of 2 months of post-myocardial infarction (MI) CR on total work capacity (TWC, in kilograms per meter) and health-related quality of life (HRQL). METHODS AND RESULTS: Of 773 screened patients, 270 without cardiac failure, dementia, disability, or contraindications to exercise were randomized to outpatient, hospital-based CR (Hosp-CR), home-based CR (Home-CR), or no CR within 3 predefined age groups (middle-aged, 45 to 65 years; old, 66 to 75 years; and very old, >75 years) of 90 patients each. TWC and HRQL were determined with cycle ergometry and Sickness Impact Profile at baseline, after CR, and 6 and 12 months later. Within each age group, TWC improved with Hosp-CR and Home-CR and was unchanged with no CR. The improvement was similar in middle-aged and old persons but smaller, although still significant, in very old patients. TWC reverted toward baseline by 12 months with Hosp-CR but not with Home-CR. HRQL improved in middle-aged and old CR and control patients but only with CR in very old patients. Complications were similar across treatment and age groups. Costs were lower for Home-CR than for Hosp-CR. CONCLUSIONS: Post-MI Hosp-CR and Home-CR are similarly effective in the short term and improve TWC and HRQL in each age group. However, with lower costs and more prolonged positive effects, Home-CR may be the treatment of choice in low-risk older patients.",Aged;Exercise Tolerance;Female;Health Care Costs;Home Care Services;Hospitalization;Humans;Male;Middle Aged;Myocardial Infarction/economics/*rehabilitation;Quality of Life;Treatment Outcome,"Marchionni, N.;Fattirolli, F.;Fumagalli, S.;Oldridge, N.;Del Lungo, F.;Morosi, L.;Burgisser, C.;Masotti, G.",2003,May 6,10.1161/01.cir.0000066322.21016.4a,0,
2802,"Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial","METHODS AND RESULTSOf 773 screened patients, 270 without cardiac failure, dementia, disability, or contraindications to exercise were randomized to outpatient, hospital-based CR (Hosp-CR), home-based CR (Home-CR), or no CR within 3 predefined age groups (middle-aged, 45 to 65 years; old, 66 to 75 years; and very old, >75 years) of 90 patients each. TWC and HRQL were determined with cycle ergometry and Sickness Impact Profile at baseline, after CR, and 6 and 12 months later. Within each age group, TWC improved with Hosp-CR and Home-CR and was unchanged with no CR. The improvement was similar in middle-aged and old persons but smaller, although still significant, in very old patients. TWC reverted toward baseline by 12 months with Hosp-CR but not with Home-CR. HRQL improved in middle-aged and old CR and control patients but only with CR in very old patients. Complications were similar across treatment and age groups. Costs were lower for Home-CR than for Hosp-CR.CONCLUSIONSPost-MI Hosp-CR and Home-CR are similarly effective in the short term and improve TWC and HRQL in each age group. However, with lower costs and more prolonged positive effects, Home-CR may be the treatment of choice in low-risk older patients.BACKGROUNDWhether cardiac rehabilitation (CR) is effective in patients older than 75 years, who have been excluded from most trials, remains unclear. We enrolled patients 46 to 86 years old in a randomized trial and assessed the effects of 2 months of post-myocardial infarction (MI) CR on total work capacity (TWC, in kilograms per meter) and health-related quality of life (HRQL).",Exercise Tolerance;Health Care Costs;Home Care Services;Hospitalization;Myocardial Infarction [economics] [rehabilitation];Quality of Life;Treatment Outcome;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-vasc,"Marchionni, N;Fattirolli, F;Fumagalli, S;Oldridge, N;Lungo, F;Morosi, L;Burgisser, C;Masotti, G",2003,,10.1161/01.CIR.0000066322.21016.4A,0,
2803,Low prevalence of hyponatremia codification in departments of internal medicine and its prognostic implications,"OBJECTIVE: Hyponatremia is the most frequent ionic disorder among ambulatory and hospitalized populations. The aim of the study is to describe the profile of patients admitted to internal medicine departments of Spanish hospitals with a diagnostic codification of hyponatremia in their discharge sheets. METHODS: Data from the Minimum Basic Data Set (MBDS) of discharged patients from all departments of internal medicine (IM) of the Spanish National Health System (NHS) between 2007 and 2010 were analyzed to describe the profile of patients with diagnostic codification of hyponatremia. RESULTS: A total of 2,134,363 admittances were analyzed, identifying 31,933 (1.5%) with a diagnostic code of hyponatremia (18.3% as principal diagnosis and 81.7% as secondary diagnosis). Mortality among patients with codified hyponatremia was markedly higher than in patients without this condition (13.1% vs 9.8% [OR 1.38; 95% CI 1.33-1.41]). Hyponatremia codification was independently associated with a higher risk of readmission (OR 1.33 CI 95% 1.29-1.38). Average length of stay for patients with hyponatremia was 11.67 days (SD 13.01), compared to 9.84 days (SD 11.61) among the general population admitted to IM (p < 0.001). Mean cost per admission in the presence of codified hyponatremia was euro4023 (SD euro2531), compared to euro3537 (SD euro2858.02); p < 0.001. Hyponatremia was more prevalent among patients with the following conditions: dementia, chronic and acute renal failure, hepatic cirrhosis, pressure ulcers, heart failure, and depression. CONCLUSIONS: We found an extremely low prevalence of hyponatremia codification in our series (1.5%). Hyponatremia is underreported and undertreated although numerous studies have shown its devastating impact on hospital admittance. The first step in order to improve this situation is to raise awareness among physicians about a problem that despite its high prevalence is still overlooked.","Aged;Aged, 80 and over;Costs and Cost Analysis;Female;*Hospitals;Humans;Hyponatremia/diagnosis/economics/etiology/*mortality/therapy;Length of Stay/economics;Male;Middle Aged;Patient Readmission/economics;Prevalence;Retrospective Studies;Risk Factors;Spain/epidemiology","Marco, J.;Barba, R.;Matia, P.;Plaza, S.;Mendez, M.;Canora, J.;Zapatero, A.",2013,Dec,10.1185/03007995.2013.836079,0,
2804,Sedation with sevoflurane in a procedure outside the operating theatre using the AnaConDa® device,,ether derivative;hypnotic sedative agent;sevoflurane;Alzheimer disease;angina pectoris;artificial heart pacemaker;artificial ventilation;case report;chronic obstructive lung disease;deep sedation;devices;equipment design;filtration;hospital subdivisions and components;human;hypertension;laryngeal mask;letter;male;mechanical ventilator;methodology;nebulizer;restlessness;very elderly;volatilization,"Marcos Vidal, J. M.;González de Castro, R.;Higuera Miguélez, E.;Soria Gulina, C.",2013,,,0,
2805,Case reports of postmarketing adverse event experiences with olanzapine intramuscular treatment in patients with agitation,"Objective: Agitation is a medical emergency with increased risk for poor outcome. Successful treatment often requires intramuscular (IM) psychotropics. Safety data from the first 21 months of olanzapine IM, approved in the United States for the treatment of agitation associated with schizophrenia and bipolar disorder, are presented. Method: A Lilly-maintained safety database was searched for all spontaneous adverse events (AEs) reported in temporal association with olanzapine IM treatment. Results: The estimated worldwide patient exposure to olanzapine IM from January 1, 2004, through September 30, 2005, was 539,000; 160 cases containing AEs were reported from patients with schizophrenia (30%), bipolar disorder (21%), unspecified psychosis (10%), dementia (8%), and depression (5%). Many reported concomitant treatment with benzodiazepines (39%) or other antipsychotics (54%). The most frequently reported events involved the following organ systems: central nervous (21%), cardiac (12%), respiratory (6%), vascular (6%), and psychiatric (5%). Eighty-three cases were considered serious, including 29 fatalities. In these fatalities, concomitant benzodiazepines or other antipsychotics were reported in 66% and 76% of cases, respectively. The most frequently reported events in the fatal cases involved the following organ systems: cardiovascular (41%), respiratory (21%), general (17%), and central nervous (10%). The majority of fatal cases (76%) included comorbid conditions and potentially clinically significant risk factors for AEs. Conclusions: Clinicians should use care when treating agitated patients, especially when they present with concurrent medical conditions and are treated with multiple medications, which may increase the risk of poor or even fatal outcomes. Clinicians should use caution when using olanzapine IM and parenteral benzodiazepines simultaneously. © Copyright 2010 Physicians Postgraduate Press, Inc.",aciclovir;hydrocortisone;alprazolam;amisulpride;amoxicillin;benzatropine mesilate;benzodiazepine derivative;biperiden;bisoprolol fumarate;carbamazepine;ceftriaxone;cefuroxime;cefuroxime axetil;chlorpromazine;chlorprothixene;clonazepam;clorazepate;clorazepate dipotassium;clozapine;cyclobarbital;diazepam;diclofenac;doxazosin;eszopiclone;fentanyl;ferrous fumarate;flupentixol decanoate;furosemide;haloperidol;haloperidol decanoate;insulin aspart;insulin detemir;lamotrigine;levothyroxine sodium;levomepromazine;lithium carbonate;lorazepam;methylprednisolone;methylprednisolone acetate;mirtazapine;neuroleptic agent;nikethamide;olanzapine;omeprazole;phenytoin;promazine;promethazine;propranolol;quetiapine;risperidone;tramadol;valproic acid;trihexyphenidyl;unclassified drug;unindexed drug;diclofenac potassium;zotepine;zuclopenthixol;zuclopenthixol decanoate;adolescent;adult;aged;agitation;article;bipolar disorder;central nervous system disease;comorbidity;creatine kinase blood level;dementia;depression;drug safety;falling;fatality;female;fever;heart arrest;heart disease;human;major clinical study;male;mental disease;neuroleptic malignant syndrome;postmarketing surveillance;priority journal;psychosis;respiratory tract disease;schizophrenia;side effect;somnolence;vascular disease;akineton;ala cort;amoxil;ativan;carbatrol;cardura;ceftin;clozaril;cogentin;depacon;depakene;depo medrol;diastat;dilantin;duragesic;equetro;eskalith;fazaclo;flector;gen xene;haldol;hi cor;inderal;innopran;klonopin;lamictal;lasix;levemir;levo t;lithobid;lunesta;medrol;niravam;novolog;onsolis;phenytek;prilosec;Promethacon;Promethegan;remeron;risperdal;rocephin;ryzolt;seroquel;stavzor;synthroid;tranxene;trimox;ultram;valium;xanax;zebeta;zinacef;zipsor;zovirax;zyprexa,"Marder, S. R.;Sorsaburu, S.;Dunayevich, E.;Karagianis, J. L.;Dawe, I. C.;Falk, D. M.;Dellva, M. A.;Carlson, J. L.;Cavazzoni, P. A.;Baker, R. W.",2010,,,0,
2806,Predicting Which Patients will Likely Benefit from Subglottic Secretion Drainage Endotracheal Tubes: A Retrospective Study,"BACKGROUND: Subglottic secretion drainage endotracheal tubes (SSD ETTs) have been shown to decrease ventilator-associated pneumonia and are recommended for patients intubated > 48 h or 72 h. However, it is difficult to determine which patients will be intubated > 48 h or 72 h at the time of intubation. OBJECTIVE: We attempted to determine which patient characteristics were associated with intubations >/= 48 h or 72 h in order to guide proper placement of SSD ETTs. METHODS: The medical records of 2,159 ventilated patients at a single institution were retrospectively reviewed for intubation duration, age, sex, race, body mass index, weight, intubation reason, whether the intubation was emergent, operative status, intensive care unit (ICU) diagnosis, intubation location, ICU location, comorbidities (e.g., congestive heart failure, chronic obstructive pulmonary disorder, coronary artery disease, dementia, and liver disease), acute kidney injury (AKI), and chronic renal injury. A multivariate regression analysis was then performed with all reliable data. RESULTS: The following were associated with intubation >/= 48 h: neuroscience critical care unit (NCCU) admission (risk ratio [RR] = 1.85; 95% confidence interval [CI] 1.34-2.56), emergent intubation (RR = 1.97; 95% 1.28-3.03), comorbid dementia (RR = 2.31; 95% 1.28-4.18), nonoperative intubation (RR = 1.77; 95% 1.28-4.18), and AKI (RR = 3.32; 95% 2.56-4.3). The following were independently associated with intubation >/= 72 h: NCCU admission (RR = 2.2; 95 CI 1.57-3.08), nonoperative intubation (RR = 3.38; 95% CI 2.63-4.35), comorbid dementia (RR = 3.03; 95% CI 1.67-5.48), and AKI (RR = 3.11; 95% CI 2.38-4.07). CONCLUSION: Nonoperative intubation, emergent intubation, history of dementia, admission to NCCU and AKI all appear to be independently associated with increased RRs for either >/= 48 h or 72 h of ventilation.",Vap;intubation;prevention;subglottic secretion drainage endotracheal tubes;ventilator-associated pneumonia,"Mareiniss, D. P.;Xu, T.;Pham, J. C.;Hsieh, Y. H.;Zhao, J.;Nguyen, C.;Nguyen, M.;Winters, B.",2016,Mar,10.1016/j.jemermed.2015.10.039,0,
2807,Brain in Congenital Heart Disease Across the Lifespan: The Cumulative Burden of Injury,"The number of patients surviving with congenital heart disease (CHD) has soared over the last 3 decades. Adults constitute the fastest-growing segment of the CHD population, now outnumbering children. Research to date on the heart-brain intersection in this population has been focused largely on neurodevelopmental outcomes in childhood and adolescence. Mutations in genes that are highly expressed in heart and brain may cause cerebral dysgenesis. Together with altered cerebral perfusion in utero, these factors are associated with abnormalities of brain structure and brain immaturity in a significant portion of neonates with critical CHD even before they undergo cardiac surgery. In infancy and childhood, the brain may be affected by risk factors related to heart disease itself or to its interventional treatments. As children with CHD become adults, they increasingly develop heart failure, atrial fibrillation, hypertension, diabetes mellitus, and coronary disease. These acquired cardiovascular comorbidities can be expected to have effects similar to those in the general population on cerebral blood flow, brain volumes, and dementia. In both children and adults, cardiovascular disease may have adverse effects on achievement, executive function, memory, language, social interactions, and quality of life. Against the backdrop of shifting demographics, risk factors for brain injury in the CHD population are cumulative and synergistic. As neurodevelopmental sequelae in children with CHD evolve to cognitive decline or dementia during adulthood, a growing population of CHD can be expected to require support services. We highlight evidence gaps and future research directions.",congenital abnormalities;heart diseases,"Marelli, A.;Miller, S. P.;Marino, B. S.;Jefferson, A. L.;Newburger, J. W.",2016,May 17,10.1161/circulationaha.115.019881,0,
2808,Homocysteine and disability in hospitalized geriatric patients,"Elevated total homocysteine (tHcy) concentrations have been found to be associated with cardiovascular disease and dementia in old age. The present study was performed to identify the prevalence of hyperhomocysteinemia (HHcy) and to analyze the association between tHcy concentration and sociodemographic characteristics, nutritional parameters, and cognitive and functional status in this sample of hospitalized geriatric patients. A total of 214 patients (77% females) 65+ years old admitted into an acute care geriatric ward of an internal medical department in the Northern Italy were studied. tHcy concentration was measured using a high-performance liquid chromatography with fluorescence detection (HPLC-F). Information about nutrition (body mass index [BMI], serum albumin, cholesterol, and transferrin) was collected on admission. Functional status was investigated with the Basic Activities of Daily Living scale (ADL) and the Instrumental Activities of Daily Living scale (IADL); cognitive and affective status were assessed by the Mini-Mental State Evaluation (MMSE) and the Geriatric Depression Scale (GDS). The mean tHcy concentration was 18.4 ± 13.1 μmol/L; 74.2% of males and 68.9% of females had HHcy (>12 μmol/L). Sixty-four percent of patients with normal serum vitamin B 12 and folate concentrations had HHcy. Elevated tHcy concentrations were associated with older age, male gender, increasing serum creatinine, lower MMSE score, and disability. The mean tHcy concentration depended on the occurrence of different diseases. Patients affected by atherosclerotic diseases, such as ischemic heart diseases, cerebrovascular diseases, and dementia had higher mean tHcy concentration than those without diagnosed vascular diseases. In multivariate analysis, vitamin B12, folate, serum albumin, creatinine, and disability emerged as factors associated with tHcy, adjusted for age, gender, education, MMSE score, and atherosclerotic diseases. Our results suggest that the prevalence of HHcy in hospitalized patients is very high, even in subjects with normal cobalamin and folate concentrations. High Hcy concentration can be associated with functional impairment. © 2004 Elsevier Inc. All rights reserved.",cholesterol;cyanocobalamin;folic acid;homocysteine;serum albumin;transferrin;aged;article;atherosclerosis;body mass;cerebrovascular disease;cognition;creatinine blood level;daily life activity;dementia;demography;depression;disability;female;fluorescence;functional assessment;geriatric patient;high performance liquid chromatography;hospital admission;hospitalization;human;hyperhomocysteinemia;ischemic heart disease;Italy;major clinical study;male;Mini Mental State Examination;multivariate analysis;nutrition;prevalence;priority journal;rating scale;vitamin blood level,"Marengoni, A.;Cossi, S.;De Martinis, M.;Calabrese, P. A.;Orini, S.;Grassi, V.",2004,,,0,
2809,Hyperhomocysteinemia in old age: is this a considerable finding?,,Aged;Aging/*blood;Arteriosclerosis/*blood;Coronary Artery Disease/*blood;Dementia/*blood;Female;Humans;Hyperhomocysteinemia/*epidemiology;Male;Multivariate Analysis;Prevalence;Risk Factors,"Marengoni, A.;Ghisla, M. K.;Cossi, S.;DeMartinis, M.;Calabrese, P. A.;Zanolini, G.;Grassi, V.;Baroni, F.;Leonardi, R.",2002,Oct,,0,
2810,Comparison of disease clusters in two elderly populations hospitalized in 2008 and 2010 on behalf of REPOSI investigators,"Background: As chronicity represents one of the major challenges in the healthcare of aging populations, the understanding of how chronic diseases distribute and co-occur in this part of the population is needed. Objectives: The aims of this study were to evaluate and compare patterns of diseases identified with cluster analysis in two samples of hospitalized elderly. Methods: Data were obtained from the multicenter 'Registry Politerapie SIMI (REPOSI)' that included people aged 65 or older hospitalized in internal medicine and geriatric wards in Italy during 2008 and 2010. The study sample from the first wave included 1,411 subjects enrolled in 38 hospitals wards, whereas the second wave included 1,380 subjects in 66 wards located in different regions of Italy. To analyze patterns of multimorbidity, a cluster analysis was performed including the same diseases (19 chronic conditions with a prevalence >5%) collected at hospital discharge during the two waves of the registry. Results: Eight clusters of diseases were identified in the first wave of the REPOSI registry and six in the second wave. Several diseases were included in similar clusters in the two waves, such as malignancy and liver cirrhosis; anemia, gastric and intestinal diseases; diabetes and coronary heart disease; chronic obstructive pulmonary disease and prostate hypertrophy. Conclusion: These findings strengthened the idea of an association other than by chance of diseases in the elderly population.",aged;anemia;anxiety disorder;arthritis;article;cerebrovascular disease;chronic disease;chronic kidney failure;chronic obstructive lung disease;cluster analysis;comparative study;dementia;diabetes mellitus;disease assessment;disease classification;dyslipidemia;dyspnea;enteropathy;faintness;female;fever;geriatric patient;atrial fibrillation;heart failure;hospital admission;hospitalization;human;hypertension;ischemic heart disease;Italy;liver cirrhosis;major clinical study;male;pain;prevalence;priority journal;prostate hypertrophy;stomach disease;thyroid disease;ward,"Marengoni, A.;Nobili, A.;Pirali, C.;Tettamanti, M.;Pasina, L.;Salerno, F.;Corrao, S.;Iorio, A.;Marcucci, M.;Franchi, C.;Mannucci, P. M.",2013,,,0,
2811,Patterns of chronic multimorbidity in the elderly population,"OBJECTIVES: To describe patterns of comorbidity and multimorbidity in elderly people. DESIGN: A community-based survey. SETTING: Data were gathered from the Kungsholmen Project, a urban, community-based prospective cohort in Sweden. PARTICIPANTS: Adults aged 77 and older living in the community and in institutions of the geographically defined Kungsholmen area of Stockholm (N=1,099). MEASUREMENTS: Diagnoses based on physicians' examinations and supported by hospital records, drug use, and blood samples. Patterns of comorbidity and multimorbidity were evaluated using four analytical approaches: prevalence figures, conditional count, logistic regression models, and cluster analysis. RESULTS: Visual impairments and heart failure were the diseases with the highest comorbidity (mean 2.9 and 2.6 co-occurring conditions, respectively), whereas dementia had the lowest (mean 1.4 comorbidities). Heart failure occurred rarely without any comorbidity (0.4%). The observed prevalence of comorbid pairs of conditions exceeded the expected prevalence for several circulatory diseases and for dementia and depression. Logistic regression analyses detected similar comorbid pairs. The cluster analysis revealed five clusters. Two clusters included vascular conditions (circulatory and cardiopulmonary clusters), and another included mental diseases along with musculoskeletal disorders. The last two clusters included only one major disease each (diabetes mellitus and malignancy) together with their most common consequences (visual impairment and anemia, respectively). CONCLUSION: In persons with multimorbidity, there exists co-occurrence of diseases beyond chance, which clinicians need to take into account in their daily practice. Some pathological mechanisms behind the identified clusters are well known; others need further clarification to identify possible preventative strategies.",Aged;Cluster Analysis;Comorbidity/*trends;Female;Humans;Logistic Models;Male;Mental Disorders/epidemiology;Musculoskeletal Diseases/epidemiology;Prevalence;Sweden/epidemiology;Vascular Diseases/epidemiology,"Marengoni, A.;Rizzuto, D.;Wang, H. X.;Winblad, B.;Fratiglioni, L.",2009,Feb,10.1111/j.1532-5415.2008.02109.x,0,
2812,Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden,"We explored the role of age, gender, and socioeconomic status in the occurrence of chronic diseases and multimorbidity in 1099 elderly participants in the Kungsholmen Project. Cardiovascular and mental diseases were the most common chronic disorders. Of the participants, 55% had multimorbidity. Advanced age, female gender, and lower education were independently associated with a more than 50% increased risk for multimorbidity. Multimorbidity is the most common clinical picture of the elderly and may be increased by unhealthy behaviors linked to education.",aged;article;cardiovascular disease;chronic disease;comorbidity;dementia;education;female;health behavior;heart failure;human;hypertension;major clinical study;male;mental disease;sex difference;social status;Sweden,"Marengoni, A.;Winblad, B.;Karp, A.;Fratiglioni, L.",2008,,,0,
2813,Prevalence of apolipoprotein E alleles in healthy subjects and survivors of ischemic stroke: an Italian Case-Control Study,"BACKGROUND AND PURPOSE: The epsilon4 allele of the apolipoprotein E (apoE) has been related to the occurrence of myocardial infarction, but its association with ischemic stroke is controversial. We have evaluated the relation between apoE alleles and the occurrence of cerebrovascular ischemia. METHODS: The apoE epsilon genotypes of 100 patients with a documented history of ischemic stroke without clinically apparent dementia (stroke+) and 108 subjects without such history (stroke-) were determined. The relative frequency of the apoE alleles and genotypes was estimated in 398 healthy subjects aged < 40 years from the same ethnic background. RESULTS: The frequency of the apoE epsilon4 allele in stroke+ (0.18 [95% CI, 0.12 to 0.25]) was higher than in stroke- (0.07 [95% CI, 0.03 to 0.12]; P<.001) or in healthy subjects (0.09 [95% CI, 0.07 to 0.12]; P<.001). Carriers of the epsilon4 allele differed between stroke+ (0.30 [95% CI, 0.19 to 0.42]) and stroke- (0.12 [95% CI, 0.5 to 0.22]; P=.004) or healthy subjects (0.16 [95% CI; 0.12 to 0.22]; P=.015). Accordingly, epsilon3/epsilon3 homozygotes were less frequent in stroke+ (0.59 [95% CI, 0.45 to 0.71]) than in stroke- (0.72 [95% CI, 0.59 to 0.82]; P=.063) or in healthy subjects (0.73 [95% CI, 0.67 to 0.78]; P=.01). In a multiple logistic regression analysis, age (P<.03), positive family history (P<.04) and apoE (P<.002) independently contributed to a stroke history, with epsilon4 carriers exhibiting a higher estimated risk (odds ratio, 5.05). CONCLUSIONS: Our data show an association between apoE gene and a personal history of ischemic stroke and support the possibility that the apoE gene is a susceptibility locus for the risk of cerebrovascular ischemic disease.","Adult;Aged;Aged, 80 and over;Alleles;Apolipoproteins E/blood/*genetics;Brain Ischemia/blood/epidemiology/*genetics;Case-Control Studies;Dementia, Vascular/blood/etiology/genetics;Female;Homozygote;Humans;Italy;Male;Middle Aged;Odds Ratio;Reference Values;Risk Factors;*Survivors","Margaglione, M.;Seripa, D.;Gravina, C.;Grandone, E.;Vecchione, G.;Cappucci, G.;Merla, G.;Papa, S.;Postiglione, A.;Di Minno, G.;Fazio, V. M.",1998,Feb,,0,
2814,Medical conditions as risk factors for pressure ulcers in an outpatient setting,"OBJECTIVES: the purpose of this study was to evaluate the likelihood that the presence of certain medical conditions in older ambulatory patients are associated with the risk of developing a new pressure ulcer. DESIGN: a cohort study. SETTING AND SUBJECTS: a large outpatient record database from the United Kingdom called the General Practice Research Database. METHODS: the frequency of disease was reported as simple percentages and the associations between the medical conditions and the development of a pressure ulcer as instantaneous rate ratios. RESULTS: we studied 75,168 older individuals. Pressure ulcers occurred in 1,211 individuals. The medical conditions that were significantly associated with the development of a pressure ulcer after adjustment were: Alzheimer's disease, congestive heart failure, chronic obstructive pulmonary disease, cerebral vascular accident, diabetes mellitus, deep venous thrombosis, hip fracture, hip surgery, limb paralysis, lower limb oedema, malignancy, malnutrition, osteoporosis, Parkinson's disease, rheumatoid arthritis, and urinary tract infections. Angina, hypertension, and pneumonia were inversely associated with the development of a pressure ulcer. CONCLUSIONS: it is important that physicians recognise that patients with many medical conditions may be at higher risk for pressure ulcers so that even in the ambulatory care environment appropriate prevention and detection strategies can be directed towards the patients who are most likely to benefit.","Aged;Aged, 80 and over;Alzheimer Disease/complications;Confounding Factors (Epidemiology);Female;Heart Failure/complications;Humans;Male;Pressure Ulcer/*epidemiology;Risk Factors","Margolis, D. J.;Knauss, J.;Bilker, W.;Baumgarten, M.",2003,May,,0,
2815,"Home blood pressure telemonitoring and case management to control hypertension: hyperlink design, baseline characteristics, and intervention adherence","We describe a study of long-term hypertension outcomes that compares home BP telemonitoring and pharmacist case management vs. usual care. HyperLink is a cluster-randomized trial (N=450 patients) being conducted in 16 clinics of an integrated health system in Minneapolis/St. Paul, that were randomly assigned to either the Telemonitoring Intervention (TI) or Usual Care (UC). Recruitment materials are mailed to adult primary care patients whose last two BP measurements in the electronic medical record were uncontrolled in the previous 12 months. To be eligible, they are required to have uncontrolled BP confirmed at a research clinic visit. Other medical exclusion criteria are minimal: pregnancy, recent cardiovascular events, symptomatic heart failure, stage 4/5 kidney disease, and dementia. Patients in the TI arm receive a home BP telemonitor that stores and transmits BP measurements. They work with a clinical pharmacist who may adjust their treatment based on home BP according to an approved protocol. Following one intake clinic visit, participants and pharmacists communicate by telephone every 2 to 4 weeks for 6 months. Patients are instructed to take 2 to 3 BP readings on three mornings and three evenings each week, and to transmit the stored BP data to the pharmacist weekly. Adherence is defined as sending >=6 home BP measurements per week. The primary outcome is BP control measured at the research clinic visit at 6 months. Secondary outcomes are BP control maintenance at 12 and 18 months, satisfaction and costs. Recruitment began March 1, 2009, and will be completed as predicted in September 2010. During the first 8 months, 195 participants were recruited, of whom 47% were female, 19% were minority race/ethnicity and 53% were from TI clinics. Adherence with the telephone visits was excellent with completion of 359/ 370 (97%; 95% CI 95%-99%) protocol-mandated telephone visits. Adherence to the home BP measurement schedule was also high, with 73/80 (91%; 95% CI 85%-97%) participants sending an average of >=6 BP measurements per week. This novel intervention could be implemented widely in diverse and large patient populations based on performance in this randomized trial. 25th Annual Scientific Meeting and Exposition of the American Society of Hypertension; 2010 May 1-4; New York, NY, USA",Sr-htn,"Margolis, Kl;Kerby, Tj;Asche, Se;MacIosek, Mv;Meyers, Pj;Sperl-Hillen, Jm;Tiwana, Sk;O'Connor, Pj",2010,,10.1111/j.1751-7176.2010.00282.x,0,2816
2816,"Home blood pressure telemonitoring and case management to control hypertension: Hyperlink design, baseline characteristics, and intervention adherence","We describe a study of long-term hypertension outcomes that compares home BP telemonitoring and pharmacist case management vs. usual care. HyperLink is a cluster-randomized trial (N=450 patients) being conducted in 16 clinics of an integrated health system in Minneapolis/St. Paul, that were randomly assigned to either the Telemonitoring Intervention (TI) or Usual Care (UC). Recruitment materials are mailed to adult primary care patients whose last two BP measurements in the electronic medical record were uncontrolled in the previous 12 months. To be eligible, they are required to have uncontrolled BP confirmed at a research clinic visit. Other medical exclusion criteria are minimal: pregnancy, recent cardiovascular events, symptomatic heart failure, stage 4/5 kidney disease, and dementia. Patients in the TI arm receive a home BP telemonitor that stores and transmits BP measurements. They work with a clinical pharmacist who may adjust their treatment based on home BP according to an approved protocol. Following one intake clinic visit, participants and pharmacists communicate by telephone every 2 to 4 weeks for 6 months. Patients are instructed to take 2 to 3 BP readings on three mornings and three evenings each week, and to transmit the stored BP data to the pharmacist weekly. Adherence is defined as sending >=6 home BP measurements per week. The primary outcome is BP control measured at the research clinic visit at 6 months. Secondary outcomes are BP control maintenance at 12 and 18 months, satisfaction and costs. Recruitment began March 1, 2009, and will be completed as predicted in September 2010. During the first 8 months, 195 participants were recruited, of whom 47% were female, 19% were minority race/ethnicity and 53% were from TI clinics. Adherence with the telephone visits was excellent with completion of 359/ 370 (97%; 95% CI 95%-99%) protocol-mandated telephone visits. Adherence to the home BP measurement schedule was also high, with 73/80 (91%; 95% CI 85%-97%) participants sending an average of >=6 BP measurements per week. This novel intervention could be implemented widely in diverse and large patient populations based on performance in this randomized trial. 25th Annual Scientific Meeting and Exposition of the American Society of Hypertension; 2010 May 1-4; New York, NY, USA",Sr-htn,"Margolis, K. L.;Kerby, T. J.;Asche, S. E.;MacIosek, M. V.;Meyers, P. J.;Sperl-Hillen, J. M.;Tiwana, S. K.;O'Connor, P. J.",2010,,10.1111/j.1751-7176.2010.00282.x,0,
2817,Vascular risk factors in mild cognitive impairment subtypes: Findings from the ReGAl project,"Background and Aim: To investigate the role of vascular risk factors in different subtypes of mild cognitive impairment (MCI) in a multicentric, clinic-based, cross-sectional study. Methods: Two-hundred and seven subjects with MCI were included in the study: 33 with single non-memory MCI (snmMCI), 42 with multiple-domain amnestic MCI (mdMCI-a) and 132 with amnestic MCI (aMCI). Several clinical vascular risk factors and magnetic resonance imaging (MRI) brain lesions were evaluated. Results: snmMCI showed a higher frequency of ischaemic heart disease and of transient ischaemic attack (TIA)/stroke, a higher Hachinski ischaemic score and a higher frequency of white-matter lesions on MRI compared to aMCI. Subjects with mdMCI-a showed clinical characteristics similar to aMCI, except for a higher frequency of a history of TIA/stroke. Conclusion: Our findings suggest that snmMCI may be considered a vascular cognitive disorder. Copyright © 2007 S. Karger AG.",aged;article;clinical trial;cognitive defect;female;human;ischemic heart disease;major clinical study;male;multicenter study;nuclear magnetic resonance imaging;priority journal;risk factor;cerebrovascular accident;transient ischemic attack;vascular disease;white matter,"Mariani, E.;Monastero, R.;Ercolani, S.;Mangialasche, F.;Caputo, M.;Feliziani, F. T.;Vitale, D. F.;Senin, U.;Mecocci, P.",2007,,,0,
2818,"The relationship between apolipoprotein E, dementia, and vascular illness","The purpose of this study was to concurrently assess the relationship of Apolipoprotein E (APOE) with both dementias and vascular illnesses in the very old. Nine hundred and fifty nine subjects (mean age 85 years) in a long- term care facility were genotyped and cognitively tested with the Mini Mental State Exam. All subjects were studied for the relationship of APOE with atherosclerotic heart disease, hypertension, or stroke without concomitant dementia. Four hundred fifty individuals met criteria for inclusion into one of the following groups: Alzheimer's disease (n = 318), vascular dementia (n = 49), or not demented controls (n = 83) and were investigated for the relationship between APOE and these diagnostic categories. APOE ε4 was not associated with atherosclerotic heart disease, hypertension, or stroke without concomitant dementia. The APOE ε3 allele was more common in men with atherosclerotic heart disease. In contrast, the APOE ε4 allele was more common in patients with Alzheimer's disease (22%) and vascular dementia (26%) than in not demented controls (7%). APOE ε4 is associated with dementias in the very old, whereas its relationship with either peripheral or central nervous system vascular disease without dementia is not as robust.",apolipoprotein E;apolipoprotein E4;aged;aging;allele;Alzheimer disease;article;controlled study;coronary artery atherosclerosis;female;human;hypertension;major clinical study;male;multiinfarct dementia;priority journal;cerebrovascular accident,"Marin, D. B.;Breuer, B.;Marin, M. L.;Silverman, J.;Schmeidler, J.;Greenberg, D.;Flynn, S.;Mare, M.;Lantz, M.;Libow, L.;Neufeld, R.;Altstiel, L.;Davis, K. L.;Mohs, R. C.",1998,,,0,
2819,Dying of non neoplasic palliative old patients in a general hospital 2 (multiple letters),,dementia;dying;evaluation study;general hospital;geriatric care;geriatric patient;heart failure;hospital care;human;letter;medical decision making;palliative therapy;practice guideline;terminally ill patient,"Marín-Gámez, N.;Kessel-Sardiñas, H.;Rodríguez-Galdeano, M.;Cervantes-Bonet, B.;Formiga, F.;Pujol, R.",2004,,,0,
2820,Life tables adjusted for comorbidity more accurately estimate noncancer survival for recently diagnosed cancer patients,"Objectives To provide cancer patients and clinicians with more accurate estimates of a patient's life expectancy with respect to noncancer mortality, we estimated comorbidity-adjusted life tables and health-adjusted age. Study Design and Setting Using data from the Surveillance Epidemiology and End Results-Medicare database, we estimated comorbidity scores that reflect the health status of people who are 66 years of age and older in the year before cancer diagnosis. Noncancer survival by comorbidity score was estimated for each age, race, and sex. Health-adjusted age was estimated by systematically comparing the noncancer survival models with US life tables. Results Comorbidity, cancer status, sex, and race are all important predictors of noncancer survival; however, their relative impact on noncancer survival decreases as age increases. Survival models by comorbidity better predicted noncancer survival than the US life tables. The health-adjusted age and national life tables can be consulted to provide an approximate estimate of a person's life expectancy, for example, the health-adjusted age of a black man aged 75 years with no comorbidities is 67 years, giving him a life expectancy of 13 years. Conclusion The health-adjusted age and the life tables adjusted by age, race, sex, and comorbidity can provide important information to facilitate decision making about treatment for cancer and other conditions. © 2013 Elsevier Inc. All rights reserved.",acquired immune deficiency syndrome;acute heart infarction;aged;article;cancer diagnosis;cancer patient;cancer survival;cerebrovascular disease;chronic hepatitis;chronic kidney failure;chronic obstructive lung disease;comorbidity;controlled study;dementia;diabetes mellitus;female;health status;heart infarction;human;life expectancy;life table;liver cirrhosis;liver disease;major clinical study;male;mortality;paralysis;priority journal;rheumatic disease;ulcer;vascular disease,"Mariotto, A. B.;Wang, Z.;Klabunde, C. N.;Cho, H.;Das, B.;Feuer, E. J.",2013,,,0,
2821,A Review on HDL-cholesterol alterations in metabolic syndrome,"The metabolic syndrome increases the risk of many diseases. There are many investigations on the role and alterations of High-Density Lipoprotein (HDL)-cholesterol in different diseases. HDL-cholesterol is an important component of metabolic syndrome. Low HDL-cholesterol has been shown among subjects with metabolic syndrome. Low levels of HDL-cholesterol are collaborated with elevated risk of cardiovascular disease, coronary heart disease, myocardial infarction, stoke and Alzheimer disease. The increased prevalence of metabolic syndrome and its relation with low levels of HDL-cholesterol accentuate its diagnostic importance and medical care. The aim of present study was to review HDL-cholesterol alterations in metabolic syndrome. © 2013 Asian Network for Scientific Information.",high density lipoprotein cholesterol;triacylglycerol;Alzheimer disease;article;cardiovascular risk;cerebrovascular accident;heart infarction;human;ischemic heart disease;metabolic syndrome X;non insulin dependent diabetes mellitus;obesity;physical activity;prevalence,"Marjani, A.",2013,,,0,
2822,Pharmacotherapy update: Newer data on older medications,,acetylsalicylic acid;alpha tocopherol;antioxidant;ascorbic acid;cholinesterase inhibitor;cyanocobalamin;dipyridamole;donepezil;folic acid;homocysteine;olanzapine;placebo;pyridoxine;quetiapine;retinol;risperidone;selenium;zopiclone;Alzheimer disease;behavior therapy;clinical trial;cognition;cognitive therapy;diarrhea;drug dose increase;drug release;drug withdrawal;evening dosage;hallucination;headache;heart muscle ischemia;human;insomnia;intermethod comparison;mortality;practice guideline;short survey;sleep time;cerebrovascular accident;task performance;treatment outcome;unspecified side effect;vitamin supplementation;aspirin,"Mark Ruscin, J.",2008,,,0,
2823,Stroke genetics,"Stroke represents an enormous health problem worldwide. It describes a clinical syndrome which can be caused by a number of different pathologies, rather than a single disease. Over 80% of strokes are ischaemic, as opposed to haemorrhagic. This review covers advances in the genetics of both monogenic and multifactorial ischaemic stroke. Like many other complex diseases, progress in identifying genes for multifactorial stroke has been disappointing. However, genome-wide association study (GWAS) technology is starting to have a major impact on our understanding of the genetics of stroke. Early studies have shown that genetic associations identified with other diseases known to be associated with stroke, such as coronary heart disease and atrial fibrillation, are themselves genetic risk factors for stroke. A number of stroke GWASs are nearing completion; these have identified novel associations with ischaemic stroke. Most associations reported to date are with specific stroke subtypes. This parallels findings from monogenic causes of stroke where individual mutations usually predispose to specific stroke subtypes. This has implications for the understanding of the pathogenesis of stroke, and emphasizes the importance of careful stroke subtyping in genetic epidemiology studies. So far, studies have looked for genetic risk factors for stroke acting independently of environmental factors. However, we know that conventional environmental risk factors are important in stroke pathogenesis, and considerable evidence suggests that gene-environment interactions will be important. Identifying these is likely to require much larger sample sizes. © The Author 2011. Published by Oxford University Press. All rights reserved.",arachidonate 5 lipoxygenase activating protein;beta catenin;blood clotting factor 5 Leiden;cyclin dependent kinase inhibitor;dipeptidyl carboxypeptidase;gelatinase A;leukotriene A4 hydrolase;methylenetetrahydrofolic acid;nitric oxide;Notch3 receptor;protein serine threonine kinase;prothrombin;transcription factor Pitx2;zinc finger protein;arterial wall thickness;artery disease;article;atherosclerosis;brain infarction;brain ischemia;CADASIL;carboxy terminal sequence;cardioembolic stroke;cerebrovascular accident;cognitive defect;cohort analysis;coronary artery disease;dementia;depression;gene expression;gene locus;gene mutation;genetic association;genetic heterogeneity;genetic risk;genotype environment interaction;atrial fibrillation;heart infarction;hemiparesis;human;hypertension;ischemic heart disease;lactic acidosis;lacunar stroke;longitudinal study;meta analysis (topic);migraine with aura;mitochondrial encephalomyopathy;molecular pathology;multiinfarct dementia;nuclear magnetic resonance imaging;peripheral vascular disease;phenotype;priority journal;replication study;thrombosis,"Markus, H. S.",2011,,,0,
2824,"Letter by Marlicz et al Regarding Article, ""proton Pump Inhibitors Accelerate Endothelial Senescence""",,nonsteroid antiinflammatory agent;probiotic agent;proton pump inhibitor;trimethylamine;trimethylamine oxide;acute coronary syndrome;atherosclerosis;capillary endothelial cell;capsule endoscopy;cell proliferation;cerebrovascular accident;chronic disease;dementia;endothelial dysfunction;endothelium cell;endotoxemia;gene;heart infarction;human;kidney failure;letter;long term exposure;microbiome;pericyte;priority journal;protein homeostasis;risk;Salmonella enterica serovar Typhimurium;senescence;telomere,"Marlicz, W.;Koulaouzidis, A.;Loniewski, I.;Koulaouzidis, G.",2016,,,0,
2825,A Purple Flag in the ER,,ceftriaxone;aged;blood culture;case report;creatinine blood level;dementia;dyspnea;emergency ward;Escherichia coli;female;fever;Gram negative infection;heart failure;heat exhaustion;human;hyperkalemia;hypertension;hypotension;Klebsiella pneumoniae;leukocyte count;leukocytosis;note;Proteus mirabilis;Pseudomonas aeruginosa;urinalysis;urinary catheter;urinary tract infection;urine culture;urosepsis,"Marques, R.;Leite, J.;Rua, J.;Fortuna, J.",2017,,10.1097/ipc.0000000000000539,0,
2826,Nursing home-acquired pneumonia. A case-control study,"To determine if there are any unique features of nursing home-acquired pneumonia we carried out a case-control study wherein each patient admitted with nursing home-acquired pneumonia was age- and sex-matched with a patient with community-acquired pneumonia. There were 36 men and 38 women in the nursing home group. The mean age of both groups was 74 years. The mortality rate for nursing home-acquired pneumonia it was 40.5%, whereas for community-acquired pneumonia it was 28% (P = NS). Patients with nursing home-acquired pneumonia had a significantly higher incidence of dementia and cerebrovascular accidents, and patients with community-acquired pneumonia were more likely to be smokers and to have chronic obstructive pulmonary disease. Aspiration pneumonia was more common among patients with nursing home-acquired pneumonia (P less than .001), and Hemophilus influenza pneumonia more common among the patients with community-acquired infection (P less than .01). Sputum for culture could be obtained in only 31 and 39% of the patients--contributory to the high rates of pneumonia of unknown etiology 63.5 and 56.1% for the nursing home group and the control subjects, respectively. Patients with nursing home-acquired pneumonia received cloxacillin and aminoglycosides more frequently than patients with community-acquired pneumonia (P less than .05), and patients with community-acquired pneumonia received erythromycin more frequently than patients with nursing home-acquired pneumonia (P less than .05). Complications were common during the hospital stay of these patients--the most frequent being congestive heart failure, urinary tract infection, renal failure, and respiratory failure.","Age Factors;Aged;Cerebrovascular Disorders/complications;Dementia/complications;Female;Haemophilus Infections/diagnosis/epidemiology/mortality;Haemophilus influenzae;Humans;Lung Diseases, Obstructive/complications;Male;*Nursing Homes;Pneumonia/*diagnosis/epidemiology/mortality;Pneumonia, Aspiration/diagnosis/epidemiology/mortality;Sex Factors;Smoking;Sputum/microbiology","Marrie, T. J.;Durant, H.;Kwan, C.",1986,Oct,,0,
2827,Community-acquired pneumonia and do not resuscitate orders,"OBJECTIVES: From a cohort of patients with community-acquired pneumonia (CAP) who required admission to hospital, to describe the subset of patients having a do not resuscitate (DNR) order and to compare them with those who did not have such an order. DESIGN: Retrospective subset analysis of data from the pneumonia patient outcomes research team study. SETTING: Three hospitals in the United States and one in Canada. PARTICIPANTS: Hospitalized patients aged 18 and older with CAP. MEASUREMENTS: Sociodemographic Features, severity of illness, antibiotic therapy, length of stay, mortality, admission to special care units, and mortality attributable to pneumonia. RESULTS: The 199 (14.9%) of 1,339 inpatients with CAP who had a DNR order written within 24 hours of admission and an additional 96 (7.2%) patients who had such an order written later were compared with the 1,044 who never had a DNR order. The 199 patients with an initial DNR and 96 later DNR were older (median age 81 and 78 vs 65 years, respectively; P < .001), more likely to be white (92.5% and 90.6% vs 84.8%; P = .007), and more likely to have come from a nursing home or chronic care facility (53.8% and 31.3% vs 4.5%; P < .001). The two DNR groups received more antibiotics for a longer time than the never DNR patients. The DNR patients had longer lengths of stay than the never DNR patients (medians 9 and 12 vs 7 days). There were 89 in-hospital deaths among the 1,339 patients, but only 11 of these were among patients who did not have a DNR order during the first 30 days (sensitivity, specificity, and positive and negative predictive values of a DNR order for in-hospital mortality were 87.6%, 82.6%, 26.4%, and 98.9%, respectively). The 90-day mortality rates were 43.2% for the initial DNR group, 61.5% in the later DNR group, and 4.7% for the never DNR group (P < .001). Pneumonia-attributable mortality accounted for most of the in-hospital deaths but did not differ by DNR status. Only 31.7% of the initial DNR patients and 24.0% of the later DNR patients were discharged home, versus 82.6% of the other patients (P < .001). In a multivariate analysis, the following were predictive of initial DNR: age, nursing home care, active cancer, dementia, neuromuscular disorders, altered mental status, low systolic blood pressure, tachypnea, abnormal hematocrit, abnormal blood urea nitrogen, and absence of alcohol or intravenous drug abuse. In similar analyses of DNR at any time, additional predictors included aspiration, low white blood count, chronic pulmonary disease, cerebrovascular disease, and congestive heart failure. CONCLUSION: Most in-hospital pneumonia deaths occur in patients who have a DNR order. DNR orders written within 24 hours of admission primarily reflect comorbid status, whereas DNR orders written later during hospitalization reflect the futility of care plus comorbidity.",aminoglycoside;aminopenicillin;antibiotic agent;cephalosporin derivative;macrolide;penicillin derivative;adult;age;aged;antibiotic therapy;article;communicable disease;comorbidity;demography;disease severity;female;hospital admission;human;intensive care unit;length of stay;major clinical study;male;medical documentation;mortality;nursing home;pneumonia;prediction;resuscitation;risk factor;sensitivity and specificity;social aspect,"Marrie, T. J.;Fine, M. J.;Kapoor, W. N.;Coley, C. M.;Singer, D. E.;Obrosky, D. S.",2002,,,0,
2828,Patient characteristics but not virulence factors discriminate between asymptomatic and symptomatic E. coli bacteriuria in the hospital,"BACKGROUND: Escherichia coli is a common cause of asymptomatic and symptomatic bacteriuria in hospitalized patients. Asymptomatic bacteriuria (ASB) is frequently treated with antibiotics without a clear indication. Our goal was to determine patient and pathogen factors suggestive of ASB. METHODS: We conducted a 12-month prospective cohort study of adult inpatients with E. coli bacteriuria seen at a tertiary care hospital in St. Louis, Missouri, USA. Urine cultures were taken at the discretion of treating physicians. Bacterial isolates were tested for 14 putative virulence genes using high-throughput dot-blot hybridization. RESULTS: The median age of the 287 study patients was 65 (19-101) years; 78% were female. Seventy percent had community-acquired bacteriuria. One-hundred ten (38.3%) patients had ASB and 177 (61.7%) had symptomatic urinary tract infection (sUTI). Asymptomatic patients were more likely than symptomatic patients to have congestive heart failure (p = 0.03), a history of myocardial infarction (p = 0.01), chronic pulmonary disease (p = 0.045), peripheral vascular disease (p = 0.04), and dementia (p = 0.03). Patients with sUTI were more likely to be neutropenic at the time of bacteriuria (p = 0.046). Chronic pulmonary disease [OR 2.1 (95% CI 1.04, 4.1)] and dementia [OR 2.4 (95% CI 1.02, 5.8)] were independent predictors for asymptomatic bacteriuria. Absence of pyuria was not predictive of ASB. None of the individual virulence genes tested were associated with ASB nor was the total number of genes. CONCLUSIONS: Asymptomatic E. coli bacteriuria in hospitalized patients was frequent and more common in patients with dementia and chronic pulmonary disease. Bacterial virulence factors could not discriminate symptomatic from asymptomatic bacteriurias. Asymptomatic E. coli bacteriuria cannot be predicted by virulence screening.","Adult;Aged;Aged, 80 and over;Asymptomatic Infections/*epidemiology;Bacteriuria/epidemiology/*microbiology/urine;Escherichia coli/genetics/isolation & purification/*pathogenicity;Escherichia coli Infections/epidemiology/*microbiology/urine;Escherichia coli Proteins/genetics;Female;Humans;Male;Middle Aged;Multivariate Analysis;Prospective Studies;Risk Factors;Treatment Outcome;Virulence Factors/*genetics","Marschall, J.;Piccirillo, M. L.;Foxman, B.;Zhang, L.;Warren, D. K.;Henderson, J. P.",2013,May 10,10.1186/1471-2334-13-213,0,
2829,Electroencephalographic Findings in Arteriopathic Psychoses and Senile Dementia,,"*Alzheimer Disease;*Coronary Disease;*Dementia;*Electroencephalography;*Geriatrics;*Intracranial Arteriosclerosis;*Psychotic Disorders;*Statistics as Topic;*Cerebral arteriosclerosis;*Psychoses;*Psychoses, senile;*Statistics","Martelli, G.",1964,,,0,
2830,Multiple imputation for estimating hazard ratios and predictive abilities in case-cohort surveys,"BACKGROUND: The weighted estimators generally used for analyzing case-cohort studies are not fully efficient and naive estimates of the predictive ability of a model from case-cohort data depend on the subcohort size. However, case-cohort studies represent a special type of incomplete data, and methods for analyzing incomplete data should be appropriate, in particular multiple imputation (MI). METHODS: We performed simulations to validate the MI approach for estimating hazard ratios and the predictive ability of a model or of an additional variable in case-cohort surveys. As an illustration, we analyzed a case-cohort survey from the Three-City study to estimate the predictive ability of D-dimer plasma concentration on coronary heart disease (CHD) and on vascular dementia (VaD) risks. RESULTS: When the imputation model of the phase-2 variable was correctly specified, MI estimates of hazard ratios and predictive abilities were similar to those obtained with full data. When the imputation model was misspecified, MI could provide biased estimates of hazard ratios and predictive abilities. In the Three-City case-cohort study, elevated D-dimer levels increased the risk of VaD (hazard ratio for two consecutive tertiles = 1.69, 95%CI: 1.63-1.74). However, D-dimer levels did not improve the predictive ability of the model. CONCLUSIONS: MI is a simple approach for analyzing case-cohort data and provides an easy evaluation of the predictive ability of a model or of an additional variable.","Aged;Biomarkers/analysis;Blood Coagulation/physiology;*Cohort Studies;Computer Simulation;Coronary Disease/epidemiology/etiology;Data Interpretation, Statistical;Dementia, Vascular/epidemiology/etiology;Female;Fibrinolysis/physiology;France;Humans;Male;*Predictive Value of Tests;*Proportional Hazards Models;Reproducibility of Results;Residence Characteristics;Risk Assessment/*methods;Selection Bias;Social Class;Survival Analysis","Marti, H.;Carcaillon, L.;Chavance, M.",2012,Mar 09,10.1186/1471-2288-12-24,0,
2831,Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy,"The aim of this study was to investigate the association between clinical variables and all-cause and respiratory mortality in patients with chronic obstructive pulmonary disease (COPD) undergoing long-term oxygen therapy (LTOT). The authors retrospectively studied a historic cohort of 128 patients with COPD (126 males, mean age ±SD 68.9±9.7 yrs, body mass index (BMI) 25.1 ±4.5 kg·m-2, and forced expiratory volume in one second 25.4±8.8% predicted), who were being treated with long-term oxygen therapy in a tertiary teaching hospital between 1992 and 1999. Comorbidity, assessed with the Charlson Index, was present in 38% of the patients. Vital status and cause of death were assessed through the population death registry. A total of 78 patients (61%) had died by the end of follow-up. Three-year survival was 55%. Death was due to respiratory causes in 77% of cases. On Cox analysis, BMI <25 kg·m-2, comorbid conditions, age ≥70 yrs and cor pulmonale were associated with all-cause mortality. The BMI and comorbidity were the only significant predictive factors when the analysis was restricted to respiratory mortality. In conclusion, body mass index <25 kg·m-2 and comorbidity were predictors of all-cause and respiratory mortality in a cohort of chronic obstructive pulmonary disease patients treated with long-term oxygen therapy. These factors should be taken into account when considering the management and prognosis of these patients. Copyright © ERS Journals Ltd 2006.",beta 2 adrenergic receptor stimulating agent;corticosteroid;diuretic agent;ipratropium bromide;oxygen;xanthine derivative;adult;aged;article;body mass;body weight;cause of death;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;cor pulmonale;dementia;diabetes mellitus;female;follow up;forced expiratory volume;heart infarction;human;kidney disease;leukemia;liver disease;long term care;major clinical study;male;malignant neoplastic disease;mortality;overall survival;oxygen therapy;peptic ulcer;peripheral vascular disease;priority journal;retrospective study;risk factor;survival rate;teaching hospital,"Marti, S.;Muñoz, X.;Rios, J.;Morell, F.;Ferrer, J. J.",2006,,,0,
2832,Blood pressure variability in Binswanger's disease and isolated lacunar infarction,"To determine whether blood pressure (BP) variability is increased in hypertensive patients with Binswanger's disease (BD), we studied two samples of consecutive treated hypertensive patients: (1) 11 with BD (mean age 71.3 +/- 5.2 years); (2) 16 with lacunar infarction (mean age 65.2 +/- 8.3 years) without cognitive impairment. An averaged baseline office BP was obtained for 3 consecutive weeks. Ambulatory BP monitoring was then carried out to obtain the averaged mean systolic (SBP) and diastolic BP, and BP variability was defined as the standard deviation of consecutive BP values. RESULTS: Diurnal SBP variability was significantly increased in the BD group (p = 0.04). However, with the analysis of covariance for age and baseline office BP, the difference was no longer significant (p = 0.17 and p = 0.09, respectively). We conclude that increased BP variability in BD patients is probably due to older age and increased baseline office BP. Increased BP variability may be a risk factor for small-vessel disease, but not for cognitive impairment.","Age Factors;Aged;Analysis of Variance;Blood Pressure/*physiology;Blood Pressure Monitoring, Ambulatory;Body Mass Index;Brain Infarction/complications/*physiopathology;Circadian Rhythm/*physiology;Coronary Disease/complications;Dementia, Vascular/complications/*physiopathology;Diabetes Complications;Female;Humans;Hypertension/complications/*physiopathology;Male;Smoking;Statistics, Nonparametric","Marti-Fabregas, J.;Valencia, C.;Lopez-Contreras, J.;Roca-Cusachs, A.;Sole, M. J.;Garcia-Sanchez, C.;Marti-Vilalta, J. L.",2001,,47644,0,
2833,In reply,,nonsteroid antiinflammatory agent;Alzheimer disease;clinical feature;cognition;coronary artery atherosclerosis;drug effect;human;letter;priority journal;treatment response,"Martin, B. K.;Brandt, J.;Breitner, J. C. S.;Craft, S.;Evans, D.;Green, R.;Mullan, M.;Piantadosi, S.;Szekely, C.",2009,,,0,
2834,Metabolic disturbances associated with antiretroviral therapy and HIV infection,,aminotransferase;amylase;anabolic agent;antidiabetic agent;antilipemic agent;C peptide;carnitine;cholesterol;didanosine;DNA polymerase;fibric acid derivative;growth hormone;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;lipid;low density lipoprotein;metformin;nucleoside derivative;oxygenase;pentobarbital;proteinase inhibitor;RNA directed DNA polymerase;RNA directed DNA polymerase inhibitor;stavudine;triacylglycerol;tricyclic antidepressant agent;unindexed drug;valproic acid;vitamin D;zidovudine;article;body fat;bone density;bone mineral;cardiomyopathy;clinical feature;controlled study;dementia;diet;diet supplementation;disease association;disease severity;disorders of mitochondrial functions;exercise;female;glucose metabolism;highly active antiretroviral therapy;human;Human immunodeficiency virus infection;hypercholesterolemia;hypertriglyceridemia;kidney disease;laboratory test;lactic acidemia;lactic acidosis;lifestyle;lipid blood level;lipodystrophy;liposuction;liver disease;male;metabolic disorder;muscle hypotonia;myopathy;osteopenia;pancreatitis;pancytopenia;peripheral neuropathy;plastic surgery,"Martin, D.",2002,,,0,
2835,Genetics and the pathobiology of ageing,"Genetics offers a powerful approach to the elucidation of mechanisms underlying specific components of the senescent phenotype of our species. Perhaps thousands of gene variations have escaped the force of natural selection and thus play roles in the genesis of different patterns of ageing in man. It is possible that a subset of these genes may be of particular importance in how most people age. While variations at the Werner helicase locus could be one such example, several lines of evidence suggest that mutation at that locus leads to a 'private' mechanism of ageing. It will be important, however, to investigate polymorphisms underlying the regulation of expression of this gene in the general population. Polymorphisms (normally occurring variants of a gene, or sequence of DNA), rather than mutations, may also prove to be more relevant to our understanding of the differing susceptibilities of people to common disorders such as late onset Alzheimer's disease. Polymorphic forms of the Apolipoprotein E gene is a good example. It remains to be seen if the pathogenetic framework (beta amyloidosis) derived from studies of the several rare mutations responsible for early onset familial forms of the disease proves relevant to the pathogenesis of the vastly more prevalent sporadic forms of the disorder. In contrast to the satisfying progress on the genetics of the diseases of ageing, research on the genetic basis for unusually robust retention of structure and function in old age has been neglected and requires a higher priority for the future. Such research should include studies of environmental agents and should address mechanisms of 'sageing', a stage in the life course characterized by an extensive utilization of behavioural and physiological adaptations to compensate for functional declines. For the genetics of longevity, we have to turn to genetically tractable organisms such as nematodes and fruit flies. Such studies have provided significant support for the oxidative stress theory of ageing. It will be important to learn more about the age-related pathologies and pathophysiologies of these organisms.",apolipoprotein E;DNA;aged;aging;Alzheimer disease;article;genetic polymorphism;genetic variability;genetics;heart infarction;human;life expectancy;longevity;male;pathophysiology;phenotype;physiology;Werner syndrome,"Martin, G. M.",1997,,,0,
2836,The homozygous R504C mutation in MTO1 gene is responsible for ONCE syndrome,"We report clinical and biochemical finding from three unrelated patients presenting ONCE (Optic Neuropathy, Cardiomyopathy and Encephalopathy with lactic acidosis and combined oxidative phosphorylation deficiency) syndrome. Whole-exome sequencing (WES) of the three patients and the healthy sister of one of them was used to identify the carry gene. Clinical and biochemical findings were used to filter variants, and molecular, in silico and genetic studies were performed to characterize the candidate variants. Mitochondrial DNA (mtDNA) defects involving mutations, deletions or depletion were discarded, whereas WES uncovered a double homozygous mutation in the MTO1 gene (NM_001123226:c.1510C>T, p.R504C, and c.1669G>A, p.V557M) in two of the patients and the homozygous mutation p.R504C in the other. Therefore, our data confirm p.R504C as pathogenic mutation responsible of ONCE syndrome, and p.V557M as a rare polymorphic variant.",5 methyltetrahydrofolic acid;alanine;carnitine;clobazam;clonazepam;creatine kinase;cytochrome c oxidase;folinic acid;homovanillic acid;idebenone;lactic acid;lamotrigine;levetiracetam;mitochondrial DNA;MTO1 protein;nadolol;protein;reduced nicotinamide adenine dinucleotide dehydrogenase (ubiquinone);unclassified drug;adolescent;adult;arachnoid cyst;article;ataxia;brain disease;cardiomyopathy;case report;cerebrospinal fluid;complex partial seizure;creatine kinase blood level;dysmetria;dyspnea;echography;electroencephalography;female;gene deletion;gene frequency;gene mutation;genetic analysis;homozygote;human;human tissue;hyperlactatemia;hypertrophic obstructive cardiomyopathy;intellectual impairment;lactic acidosis;learning disorder;male;mental deterioration;metabolic acidosis;muscle biopsy;optic nerve atrophy;optic nerve disease;priority journal;ptosis;seizure;tachycardia;tricuspid valve regurgitation;whole exome sequencing;young adult,"Martín, M. Á;García-Silva, M. T.;Barcia, G.;Delmiro, A.;Rodríguez-García, M. E.;Blázquez, A.;Francisco-Álvarez, R.;Martín-Hernández, E.;Quijada-Fraile, P.;Tejada-Palacios, P.;Arenas, J.;Santos, C.;Martínez-Azorín, F.",2017,,10.1111/cge.12815,0,
2837,Prevalence of hypertension in elderly long-term care residents in Spain. The Geriatric HTA study,"BACKGROUND AND OBJECTIVE: This study aimed to estimate the prevalence of hypertension in elderly long-term care residents in Spain and to describe such population in terms of comorbidity and hypertension treatment and control. PATIENTS AND METHOD: A countrywide cross-sectional study was conducted in May 2003 among long-term care residents aged 65 or more. Patients in palliative care units were excluded. Hypertension was defined in patients who fulfilled at least one of the following criteria: diagnosis of hypertension on the medical record, antihypertensive medication and/or highest blood pressure values during the previous year ≥ 140/90 mmHg. RESULTS: Overall, 13,272 subjects -mean age (standard deviation) 82.9 (7.5) years (range: 65-106 years)- were included from 223 centres; 70.6% were women. Almost 2 thirds of patients met at least one hypertension criterion (8,242 patients, 62.1%; 95% confidence interval, 61.3-62.9%). In those patients, other frequent cardiovascular risk factors were obesity (26.3%), diabetes (25.7%) and dislipemia (23.8%). A concomitant diagnosis of dementia, peripheral vascular disease, stroke or congestive heart failure was present in 37.1%, 28.3%, 26.0% and 25.1%, respectively. The proportion of hypertensive patients receiving at least one antihypertensive drug was 69.7%. Diuretics were the most commonly used agents (46.3%), followed by angiotensine converting enzyme inhibitors (34.6%). The latest blood pressure measurement was < 140/90 mmHg in 60.4% of the hypertensive patients. CONCLUSIONS: Elderly long-term care residents in Spain showed a high prevalence of hypertension and other cardiovascular risk factors, and a substantial degree of associated clinical conditions. The proportion of antihypertensive drug therapy was comparable to those reported in similar studies.",alpha adrenergic receptor blocking agent;angiotensin 2 receptor antagonist;beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;loop diuretic agent;potassium sparing diuretic agent;thiazide diuretic agent;aged;article;blood pressure monitoring;cardiovascular risk;comorbidity;congestive heart failure;dementia;diabetes mellitus;disease control;dyslipidemia;elderly care;female;human;hypertension;long term care;major clinical study;male;medical record;nursing home patient;obesity;peripheral vascular disease;prevalence;Spain;cerebrovascular accident,"Martín-Baranera, M.;Sánchez Ferrín, P.;Armario, P.;Villanueva Pérez, M. D.;Padilla García, J. A.;Arzuaga Moreno, J. M.;Cortes Castell, J. V.;Martínez Martos, A.;Castellón Sánchez Del Pino, A.;Gutiérrez Rodrĩguez, J.;Lõpez Cuevas, M. N.;Velasco Prieto, J.;Ortiz Cochero, E.;Noya Delgado, V.;Sarasola Ormazábal, I.;Cilleros Prieto, A.;Puig García, C.;Barceló Marqués, M.;Del Alcázar Muñoz, I.;Jamaleddine El-Ejjeh, W.;Paule Llussà, M.;Pla Taulats, M.;Tartinyà I Artigas, N.;Azabal Gómez, R.;Montserrat, L. A.;Carral Rodríguez, E.;Benítez Camps, M.;Coll Bertran, V.;Dot Ventalló, A.;Ferrer Ginés, S.;Gasol I Lascorz, J.;Lorenzo, R.;Martínez Lavega, P.;Sanmartí Montiu, M.;Solans Marsà, M.;Uran Cardona, R. C.;Vergara Rivera, A.;Loncan Vidal, M. P.;Bosqued Franco, F.;Azana Carlos, V.;Trigueros, S. M.;Carriedo Bonilla, I.;Ferreri Planelles, M.;Fernández López, M.;Gutiérrez Jiménez, N.;Ruiz Aguinada, M. L.;Fernández Gallego, M. L.;Casas Floriano, R.;Treviño Hernando, D.;Aguilar Casacuberta, M.;Pou, T.;Ariño Blasco, S.;Núñez Rico, A.;Cardiel Bun, A.;Domínguez Bachs, A.;Alsina Navarro, M. R.;Vila García, F.;Zapater Dolz, J. M.;Prat I Esquirol, R.;Cancio Gómez, M. J.;Perpinyà I Torregrossa, M.;Roma Casol, J.;Peña Solé, M.;Solé Magre, M. R.;Rodríguez Font, J. P.;Vázquez Roa, Ç;Vaisman Sluvis, F.;Gato Almeida, F.;Sáez Moya, V.;López Egea, M. C.;Ximenis Vidal, A.;Coma Roca, V.;Menni, B.;Bartomeus Puchulutegui, A.;Cañete Valdés, S.;Festcher Eickhoff, A.;Pérez Edo, I.;Costa Orriols, I.;Bautista, M. R.;Sanz I Torrent, C.;Segura Segura, P.;Miranda González, A.;Ruiz Cano, S.;Pintado De Las Heras, V.;Comas Estalella, A.;Mateo Valerio, J.;Urbaneja Toledano, M. T.;Domínguez Acedo, F.;Cayetano Mateos, M. C.;Navarro Moreno, C.;Barcena Amigo, F.;González González, A. I.;Clèrigo Cuevas, N.;Higuero Piris, C.;Santamaría Villa, M. C.;Gutiérrez Toca, H.;Martínez Ortiz, M. M.;Simó Falcó, M. D.;Crespo Pérez, M. A.;Hernández Romero, J. Á;Rodríguez Vidal, V.;Navarro Olivera, F. J.;Del Carmen Fabre Rodríguez, M.;Gómez Sujar, M. C.;Rubio Castillejo, R.;Muñóz Dueñas, R.;Rodrigo Pérez, M. C.;Campos Arangüete, Á;Carralero Palomero, M. C.;Gómez Martínez, M. J.;Pastor Budia, M.;Morales, P. A.;Martínez Cuesta, M. C.;Pardo Ayuso, S.;Serra Giralt, D.;Puigbó Castañe, M. D.;Tubert Caballé, N.;Vila Subirana, T.;Martínez Calomer, C.;Elhamshari Ter, K.;Batista Vila, D.;Torres I Rubiverla, X.;Orihuela Moreno, G.;García Sánchez, M. C.;Torres Olivares, B.;Avadia Trueba, J.;Olazabal Martínez, T.;Pérez De Mendiguren Ruiz De Olalla, I.;Ezquicia Urbieta, M.;Ruiz Moreno, C.;Cano Marqués, A.;García García, R.;Sánchez Pérez, J.;Imaz González, C.;Sobrón Monge, I.;Hernández Redero, F. J.;Pellitero García, M. R.;Molero Gómez, A.;Velilla Díez, L. T.;Ollè Espluga, N.;Trepat, M. F.;Nadal I Creus, I.;Canal I Sotelo, J.;Aragones Barbansa, R.;Lloret I Riart, P.;Domínguez Gadea, C.;Pujol Salud, J.;Sansa Foixench, R.;Albanell Tortadès, N.;Pellisé Mayench, N.;Boixader I Soler, M.;Zapata Poyatos, A.;Melines I Rius, R. M.;Salvador I Milian, E.;Vila I Fumàs, A.;Grafiña Sánchez, M. B.;Herrero Ramos, P. E.;López Ventura, M.;García Blanco, A.;Vargas Fernández, M. D.;Valdés Chiong, E.;González Hernández, M. B.;Tobaruela González, J. L.;Carretero Orcoyén, V. A.;Cuartero Gracia, P.;López Tierno, T.;Montes Lluch, M.;Puga, A. I.;Santiago García, M. C.;Sanz Reguero, P.;Bertobe Landrove, E.;Hendi Malas, M. F.;Blanco Pérez, M.;Saldecelonio Lavin, L.;Antón Castelló, J. L.;Pita Carranza, A. J.;Castillo Polo, A.;Herrador Martínez, P. M.;Jiménez Hornos, M. D.;Larrosa Sánchez, M. Á;Santo Medina, E.;Acosta Sánchez, J. A.;Cobo Najar, M. J.;Garre Alcázar, P.;Lucerga Romera, J.;Martínez Mallo, M. J.;Urdau Caspistegui, B.;Beorlegui Primo, A.;Clemente Guerrero, M. P.;Echevarrieta Arana, J.;Elizalde Oriz, M. A.;Guijarro Gerata, J. L.;San Martín Ganuza, M. L.;Vizcay Redín, Á;Barrosa Taboada, M.;Carballo Pérez, J. L.;Donis Domeque, J.;Luengo Cifuentes, J.;Mateos Arroyo, L. F.;Berrocal Sánchez, M. D.;Macias, A. V.;Cano Álvarez, D.;Essouissi Abbas, L.;Martinson De Cárdenas, A.;Valdenebro Alonso, A.;Rivero Quintana, B.;Palma Ordóñez, J.;Raduá Fayos, F. J.;Vidal Bel, J.;Mallol Mirón, F.;Molina De Miguel, P.;Mazzanti Mignaqui, G.;Magarolas Jordá, R.;Pi Sánchez, J.;Puig Cuyás, J. M.;Gonzalo Casado, E.;Monnè Aspa, S.;Martínez Almazán, E.;Cuesta López, R.;García Gómez, J. A.;Rodríguez Moreno, I.;García López, O. S.;Mestre Teodoro, E.;Atanes Montero, I.;Guillén Hernández, G. E.;Fernández Calabria, C.;Miñana Lorente, J.;Golfe Ángel, F. J.;Montero, E. M.;Alfonso Aquilino, J. V.;Mínguez Fernández, M.;Ribera Sanz, J.;Fernández Martínez, F.;Sanchís Blasco, J. F.;Marín Arroyo, M. J.;Fernández Jega, E.;Alonso Rodríguez, L.;Del Río Sola, M. D.;Miranda Gárate, F. J.;Blasco Solana, M.;Pastor Eixarch, P.;Serrano Oliver, A.;Gutiérrez Álvarez, G.",2006,,,0,
2838,Community-acquired pneumonia among the elderly: Differences between patients living at home and in nursing homes,"OBJECTIVE: The etiology, presentation, and prognosis of community-acquired pneumonia (CAP) among nursing home residents are believed to differ from those of other groups. However, few Spanish studies have confirmed those assumptions or studied regional differences in CAP etiology. PATIENTS AND METHODS: A prospective study which included all patients over 65 years of age admitted to our hospital with CAP was carried out over a period of 18 months (2002-2003). We examined clinical, analytical, and radiographic characteristics paying particular attention to functional status - using the Eastern Cooperative Oncology Group (ECOG) scale and Barthel and Karnofsky indices - and comorbidity. Two blood cultures, a Legionella antigen test in urine, and serology for atypical bacteria were used for the etiologic diagnosis; bacterial cultures of respiratory samples were also used in certain cases. RESULTS: Ninety-one patients, 25 of whom were nursing home residents, were enrolled. The nursing home residents were older than the other patients (mean [SD] age of 82 [4] compared with 73 [5]; P=.0001) and had greater comorbidity (P=.0001) - with a significantly greater presence of diabetes mellitus, cerebrovascular disease, congestive heart failure, and dementia. They also had a poorer functional status (ECOG, 2.09 [0.9] compared with 0.93 [1.1], P=.001; Barthel Indes, 19 [33] compared with 77 [35], P=.001; Karnofsky Index, 51 [17] compared with 78 [23], P=.001). Regarding clinical characteristics, significant differences were found for respiratory rate (39 [11] compared with 27 [7] breaths/min; P=.001), blood pressure (69.5 [20] compared with 79.2 [18] mm Hg; P=.029), and temperature (36.6 [1.2] compared with 37.7 [1.1]°C; P=.001). CAP patients from nursing homes presented a greater number of affected lobules in chest x-rays (P=.004), more hypoxemia, acidosis, anemia, hypoalbuminemia, and greater scores of urea and creatinine. Fine Scale scores were also greater (134 [26] compared with 95 [28]; P=.001) as was mortality (7/25 compared with 3/66; P=.005). Few patients had an etiologic diagnosis and no significant differences were observed between the groups. The variable that predicted mortality in elderly patients in this series, according to stepwise logistic regression, was urea (adjusted R 2=0.452). CONCLUSIONS: In our sample population, nursing home residents were older, had greater comorbidity, and severe functional impairment. Under these circumstances the severity of CAP increases and becomes an important cause of mortality despite the fact that the etiologic agents do not appear to differ from those of the other patients.",bacterial antigen;creatinine;urea;acidosis;aged;anemia;article;bacterium culture;blood culture;blood pressure measurement;breathing;cerebrovascular disease;clinical feature;community acquired pneumonia;comorbidity;congestive heart failure;creatinine blood level;dementia;diabetes mellitus;home care;hospital admission;human;hypoalbuminemia;hypoxemia;Legionella;logistic regression analysis;major clinical study;mortality;nursing home;oncology;prognosis;prospective study;scoring system;serology;temperature measurement;thorax radiography;urea blood level;urinalysis,"Martínez-Moragón, E.;García Ferrer, L.;Serra Sanchis, B.;Fernández Fabrellas, E.;Gómez Belda, A.;Juive Pardo, R.",2004,,,0,
2839,Update on Geriatric Cardiology,"This article contains a review of the main developments in the field of geriatric cardiology reported during 2008. The focus is on research concerning the specific characteristics of elderly patients with heart failure, arrhythmias, ischemic heart disease, and aortic valve disease. © 2009 Sociedad Española de Cardiología.",acetylsalicylic acid;amiodarone;angiotensin 2 receptor antagonist;antiangina pectoris agent;antiarrhythmic agent;anticoagulant agent;beta adrenergic receptor blocking agent;bisoprolol;captopril;carvedilol;clopidogrel;cypher;dipeptidyl carboxypeptidase inhibitor;diuretic agent;dronedarone;enalapril;enoxaparin;fosinopril;heparin;hydroxymethylglutaryl coenzyme A reductase inhibitor;irbesartan;lisinopril;metoprolol;paclitaxel;quinapril;ramipril;rapamycin;rosuvastatin;unclassified drug;anticoagulant therapy;aorta valve disease;article;bleeding;cardiology;cardiovascular disease;cerebrovascular accident;clinical practice;clinical trial;defibrillation;defibrillator;dementia;drug eluting stent;drug half life;geriatric disorder;heart arrhythmia;atrial fibrillation;heart atrium flutter;heart failure;heart infarction;heart muscle revascularization;heart rhythm;heart valve prosthesis;heart ventricle fibrillation;heart ventricle tachycardia;human;ischemic heart disease;postoperative complication;practice guideline;sinus rhythm;stable angina pectoris;sudden death;thromboembolism;transluminal coronary angioplasty;treatment indication;aspirin;CoreValve;Edwards-Sapiens,"Martínez-Sellés, M.;López-Palop, R.;Datino, T.;Bañuelos, C.",2009,,,0,
2840,Cessation rate of anti-osteoporosis treatments and risk factors in Spanish primary care settings: a population-based cohort analysis,"Summary: Among 95,057 patients ≥50 years with new anti-osteoporosis medications (AOM) (2001–2013) in primary care, 1-year cessation was 51% (28%–68%), higher in men, smokers, patients with missing lifestyle data, and out normal BMI, and lower in those aged 60–79, with recent fractures or other anti-osteoporotics, suggesting non-severe osteoporosis and less risk awareness. Purpose: Low compliance to anti-osteoporosis medications (AOM) has been previously reported. We aimed to estimate 1-year cessation rates of different AOMs as used in Spanish healthcare settings, and to identify associated risk factors. Methods: A cohort study was performed using primary care records data (BIFAP). Patients entered the cohort when aged 50 years in 2001–2013, with ≥1 year of data available, and identified as incident users of AOM (1-year washout). Participants were divided into six cohorts: alendronate, other oral bisphosphonates, selective oestrogen receptor modulators, strontium ranelate, teriparatide, and denosumab. Patients were followed from therapy initiation to the earliest of cessation (90-day refill gap), switching (to alternative AOM), loss to follow-up, death, or end of 2013. One-year therapy cessation was estimated using life tables. Hazard ratios (of cessation) according to age, sex, lifestyle factors, morbidity, and co-medication were estimated after stepwise backwards selection. Results: A total of 95,057 AOM users were identified (91% women; mean age 68). One-year cessation was 51% overall, highest for strontium ranelate (68%), and lowest for denosumab (28%). Cessation probability was higher in men (14% to 2.1-fold), smokers (>6%), and patients with missing BMI (19–28%) or smoking (6–20%) data, and overweight/obese/underweight (7% to 2.6-fold increase compared to normal weight). Patients aged 60–79 years, with a recent fracture or other drugs used for osteoporosis, had better persistence. Conclusions: Over half of the patients initiating AOM stopped therapy within the first year after initiation. The described risk factors for cessation could be proxies for non-severe osteoporosis, and/or disease/risk awareness, which could inform the targeting of high-risk patients for monitoring and/or interventions aimed at improving persistence.",anticoagulant agent;bazedoxifene;calcitonin;clodronic acid;denosumab;disease modifying antirheumatic drug;elcatonin;etidronic acid;glucocorticoid;ibandronic acid;parathyroid hormone;parathyroid hormone[1-34];raloxifene;risedronic acid;strontium ranelate;tiludronic acid;vitamin D;zoledronic acid;adult;age;aged;alcohol abuse;aneurysm;article;asthma;body mass;cerebrovascular disease;Charlson Comorbidity Index;chronic obstructive lung disease;cohort analysis;controlled study;dementia;diabetes mellitus;female;follow up;fracture;heart failure;heart infarction;hemiplegia;hormone substitution;human;kidney disease;lifestyle;liver disease;major clinical study;male;malignant neoplasm;medication compliance;metastasis;middle aged;obesity;overall survival;peptic ulcer;peripheral occlusive artery disease;phlebitis;population based case control study;prescription;primary medical care;priority journal;rheumatoid arthritis;risk factor;sex;smoking;treatment duration;underweight;vein insufficiency,"Martín-Merino, E.;Huerta-Álvarez, C.;Prieto-Alhambra, D.;Montero-Corominas, D.",2017,,10.1007/s11657-017-0331-6,0,
2841,Comorbidity associated with obesity in a large population: The APNA study,"Background Overweight and obesity are major causes of comorbidities which can lead to further morbidity and mortality. The main objective of the present study was to estimate the comorbidity associated with obesity in 40,010 patients attending Primary Health Care Centres in Navarra. Methods It is a descriptive cross-sectional study. The association of overweight and obesity in different diseases was studied. Odds ratios (OR) adjusted for age and sex were calculated by unconditional logistic regression, using as reference patients with body mass index (BMI) lower than 25 kg/m2. Results Increasing BMI is associated with glucose intolerance (OR: 1.07; 95% CI: 1.06-1.08), dyslipidemia (OR: 1.04; 95% CI: 1.03-1.04), hypertension (OR: 1.12; 95% CI: 1.12-1.13), type 2 diabetes (OR: 1.11; 95% CI: 1.10-1.11), kidney failure (OR: 1.04; 95% CI: 1.03-1.05), and osteoarthritis (OR: 1.06; 95% CI: 1.05-1.06). Moreover, all the degrees of obesity are associated with asthma (OR type I obesity: 1.33; OR type II obesity: 1.69; OR type III obesity: 1.75), heart failure (OR type I obesity: 1.68; OR type II obesity: 2.78; OR type III obesity: 4.35), and severe mental disorders (OR type I obesity: 2.02; OR type II obesity: 2.33; OR type III obesity: 2.50). Type II and morbid obesity are associated with chronic obstructive pulmonary disease and depression. Conclusion Our study showed a positive association of the overweight and obesity with glucose intolerance, dyslipidemia, type 2 diabetes, hypertension, osteoarthritis, and kidney failure. An interesting point is the association of higher levels of BMI with depression.",adult;aged;article;asthma;atrial fibrillation;body mass;breast cancer;chronic obstructive lung disease;clinical practice;colon cancer;comorbidity;controlled study;cross-sectional study;dementia;depression;disease association;dyslipidemia;female;glucose intolerance;heart failure;human;hypertension;kidney failure;lung cancer;major clinical study;male;mental disease;middle aged;morbid obesity;neoplasm;non insulin dependent diabetes mellitus;obesity;osteoarthritis;prevalence;primary health care;priority journal;prostate cancer;pulmonary hypertension;sensitivity analysis;young adult,"Martin-Rodriguez, E.;Guillen-Grima, F.;Martí, A.;Brugos-Larumbe, A.",2015,,,0,
2842,"Telomere length predicts poststroke mortality, dementia, and cognitive decline","Objective: Long-term cognitive development is variable among stroke survivors, with a high proportion developing dementia. Early identification of those at risk is highly desirable to target interventions for secondary prevention. Telomere length in peripheral blood mononuclear cells was tested as prognostic risk marker. Methods: A cohort of 195 nondemented stroke survivors was followed prospectively from 3 months after stroke for 2 years for cognitive assessment and diagnosis of dementia and for 5 years for survival. Telomere lengths in peripheral blood mononuclear cells were measured at 3 months after stroke by in-gel hybridization. Hazard ratios for survival in relation to telomere length and odds ratios for dementia were estimated using multivariate techniques, and changes in Mini-Mental State Examination scores between baseline and 2 years were related to telomere length using multivariate linear regression. Results: Longer telomeres at baseline were associated with reduced risk for death (hazard ratio for linear trend per 1,000bp = 0.52; 95% confidence interval, 0.28-0.98; p = 0.04, adjusted for age) and dementia (odds ratio for linear trend per 1,000bp = 0.19; 95% confidence interval, 0.07-0.54; p = 0.002) and less reduction in Mini-Mental State Examination score (p = 0.04, adjusted for baseline score). Interpretation: Telomere length is a prognostic marker for poststroke cognitive decline, dementia, and death. © 2006 American Neurological Association.",apolipoprotein E4;age;aged;angina pectoris;article;cognitive defect;cohort analysis;controlled study;dementia;female;follow up;atrial fibrillation;heart failure;heart infarction;human;human cell;hybridization;hypertension;major clinical study;male;Mini Mental State Examination;mortality;multivariate analysis;oxidative stress;peripheral blood mononuclear cell;priority journal;prognosis;prospective study;secondary prevention;cerebrovascular accident;survival rate;telomere,"Martin-Ruiz, C.;Dickinson, H. O.;Keys, B.;Rowan, E.;Kenny, R. A.;Von Zglinicki, T.",2006,,,0,
2843,Effect of age and dementia on the prevalence of cardiovascular disease,"Prevalence of cardiovascular abnormalities in age-matched persons with multi-infarct dementia, Alzheimer's disease, and cognitively intact controls was measured. Both the multi-infarct and Alzheimer groups had statistically more documented myocardial infartions, atherosclerotic cardiovascular disease, left bundle branch block, and atrial fibrillation than controls. Alzheimer's disease may affect the cardiovascular system through some central mechanism or by indirect means.",aged;Alzheimer disease;article;cardiovascular disease;controlled study;female;heart infarction;human;major clinical study;male;multiinfarct dementia;priority journal,"Martins, C.;Gambert, S. R.;Gupta, K. L.;Schultz, B. M.",1990,,,0,
2844,The Effect of Frailty on 30-day Mortality Risk in Older Patients With Acute Heart Failure Attended in the Emergency Department,"Objective: The objective was to determine the effect of frailty on risk of 30-day mortality in nonseverely disabled older patients with acute heart failure (AHF) attended in emergency departments (EDs). Methodology: The Frailty-AHF Study is a retrospective analysis of a multicenter, observational, prospective, cohort study (Older-AHF Register). This study included consecutive patients > 65 years of age without severe functional dependence or dementia attended for AHF in three Spanish EDs for 4 months. Frailty was defined by frailty phenotype as the presence of three or more domains. Baseline and episode characteristics and 30-day mortality were collected in all the patients. Results: A total of 465 patients with a mean (+/-SD) age of 82 (+/-7) years were included, 283 (61.0%) being female and 225 (51.3%) with severe comorbidity (Charlson index > 3). Frailty was present in 169 (36.3%). The rate of 30-day mortality was 7.3%. Frailty adjusted for potential confounding factors was an independent factor associated with 30-day mortality (adjusted hazard ratio = 2.5; 95% confidence interval = 1.0 to 6.0; p = 0.047). Conclusion: The presence of frailty is an independent risk factor of 30-day mortality in nonsevere dependent older patients attended with AHF in EDs. Copyright © 2016 by the Society for Academic Emergency Medicine",acute heart failure;aged;article;Charlson Comorbidity Index;cohort analysis;comorbidity;dementia;dependent personality disorder;disabled person;emergency ward;female;frailty;human;major clinical study;male;mortality risk;multicenter study;observational study;priority journal;prospective study;retrospective study;risk factor;clinical trial;confidence interval;controlled clinical trial;controlled study;hazard ratio;phenotype;very elderly,"Martin-Sanchez, Fj;Rodriguez-Adrada, E;Mueller, C;Vidan, Mt;Christ, M;Frank, Peacock W;Rizzi, Ma;Alquezar, A;Pinera, P;Aragues, Pl;Llorens, P;Herrero, P;Jacob, J;Fernandez, C;Miro, O",2017,,10.1111/acem.13124,0,2845
2845,The Effect of Frailty on 30-day Mortality Risk in Older Patients With Acute Heart Failure Attended in the Emergency Department,"OBJECTIVE: The objective was to determine the effect of frailty on risk of 30-day mortality in nonseverely disabled older patients with acute heart failure (AHF) attended in emergency departments (EDs). METHODOLOGY: The Frailty-AHF Study is a retrospective analysis of a multicenter, observational, prospective, cohort study (Older-AHF Register). This study included consecutive patients >/= 65 years of age without severe functional dependence or dementia attended for AHF in three Spanish EDs for 4 months. Frailty was defined by frailty phenotype as the presence of three or more domains. Baseline and episode characteristics and 30-day mortality were collected in all the patients. RESULTS: A total of 465 patients with a mean (+/-SD) age of 82 (+/-7) years were included, 283 (61.0%) being female and 225 (51.3%) with severe comorbidity (Charlson index >/= 3). Frailty was present in 169 (36.3%). The rate of 30-day mortality was 7.3%. Frailty adjusted for potential confounding factors was an independent factor associated with 30-day mortality (adjusted hazard ratio = 2.5; 95% confidence interval = 1.0 to 6.0; p = 0.047). CONCLUSION: The presence of frailty is an independent risk factor of 30-day mortality in nonsevere dependent older patients attended with AHF in EDs.","Acute Disease;Aged;Aged, 80 and over;Comorbidity;Emergency Service, Hospital;Female;Frail Elderly;Heart Failure/ mortality;Humans;Male;Prognosis;Prospective Studies;Retrospective Studies;Risk Factors;Time Factors","Martin-Sanchez, F. J.;Rodriguez-Adrada, E.;Mueller, C.;Vidan, M. T.;Christ, M.;Frank Peacock, W.;Rizzi, M. A.;Alquezar, A.;Pinera, P.;Aragues, P. L.;Llorens, P.;Herrero, P.;Jacob, J.;Fernandez, C.;Miro, O.",2017,Mar,,0,
2846,The effect of frailty on 30-day mortality risk in older patients with acute heart failure attended in the Emergency Department,"OBJECTIVE: To determine the effect of frailty on risk of 30-day mortality in non-severely disabled older patients with acute heart failure (AHF) attended in emergency departments (EDs). METHODOLOGY: The Frailty-AHF Study is a retrospective analysis of a multicentre, observational, prospective, cohort study (Older-AHF Register). This study included consecutive patients >/= 65 years of age without severe functional dependence or dementia attended for AHF in 3 Spanish EDs during 4 months. Frailty was defined by frailty phenotype as the presence of 3 or more domains. Baseline and episode characteristics and 30-day mortality were collected in all the patients. RESULTS: A total of 465 patients with a mean age of 82 (SD 7) years were included, 283 (61.0%) being female and 225 (51.3%) with severe comorbidity (Charlson index >/= 3). Frailty was present in 169 (36.3%). The rate of 30-day mortality was 7.3%. Frailty adjusted for potential confounding factors was an independent factor associated with 30-day mortality (adjusted HR=2.5; 95%CI 1.0-6.0; p=0.047). CONCLUSION: The presence of frailty is an independent risk factor of 30-day mortality in non-severe dependent older patients attended with AHF in EDs. This article is protected by copyright. All rights reserved.",acute heart failure;emergency department;frailty;older,"Martin-Sanchez, F. J.;Rodriguez-Adrada, E.;Mueller, C.;Vidan, M. T.;Christ, M.;Peacock, W. F.;Rizzi, M. A.;Alquezar, A.;Pinera, P.;Lazaro Aragues, P.;Llorens, P.;Herrero, P.;Jacob, J.;Fernandez, C.;Miro, O.",2016,Oct 31,10.1111/acem.13124,0,
2847,Incarcerated and eventrated abdominal wall hernia reconstruction with autologous double-layer dermal graft in the field of purulent peritonitis—A case report,"Introduction Double-layer dermal grafts are used for the management of complicated abdominal wall hernias in obese, high risk patients. The method has not yet been used in case of emergency in septic/dirty environment. Case report A 76-year old female patient (BMI 36.7 kg/m2) was admitted with mechanical bowel obstruction and sepsis caused by a third time recurred, incarcerated and eventrated abdominal wall hernia. During the emergency surgery perforation of the terminal ileum and the ascending colon was detected, along with a feculent peritonitis and extended abdominal wall necrosis. Extended right hemicolectomy and necrectomy of the abdominal wall were performed. The surgery resulted in an abdominal wall defect measuring 223 cm2, for the management of which direct closure was not possible. Using a specific method, an autologous dermal graft was prepared from the redundant skin. The first dermal graft was placed under the abdominal wall with 5 cm overlap, and the second layer was placed onto the first layer with 3 cm overlap in a perforated fashion. The operating time was 250 min. No significant intra-abdominal pressure elevation was measured. No reoperation was performed. On the fifth postoperative day, the patient was mobilised. She was discharged in satisfactory general condition on the 18th postoperative day. There is no recurrent hernia 8 months after the surgery. Discussion Abdominal wall reconstruction was possible in a necrotic, purulent environment by using a de-epithelised autologous double layer dermal graft, without synthetic or biological graft implantation. The advantage of the procedure was cost-effectivity, and the disadvantage was that only in an obese patient is the sufficient quantity of dermal graft available. Conclusion A homogeneous internal and perforated outer dermal graft was suitable for bridging the abdominal gap in the case of an obese, high risk patient. Autologous dermal grafts can be a safe and feasible alternative to biological meshes in emergency abdominal wall surgeries. Evaluation of a case series can be the next cornerstone of the method described above.",cilastatin plus imipenem;enoxaparin;mannitol;abdominal pain;abdominal pressure;abdominal radiography;abdominal wall closure;abdominal wall hernia;acute abdomen;aged;anemia;antibiotic therapy;article;ascending colon;autologous double layer dermal graft;body mass;body temperature;carbohydrate diet;case report;cholecystectomy;colon perforation;computer assisted tomography;echography;elastic abdominal belt;emergency surgery;enterococcal infection;Enterococcus faecalis;erythrocyte transfusion;Escherichia coli infection;eventrated abdominal wall hernia;female;fever;general condition;general medical device;heart infarction;hemicolectomy;hernia incarceration;hernioplasty;human;hypertension;intensive care;intestine surgery;ischemic heart disease;laboratory test;laparotomy;medical history;morbid obesity;muscle relaxation;nasogastric tube;necrectomy;necrosis;non insulin dependent diabetes mellitus;open surgery;operating table;operative blood loss;patient history of surgery;peritonitis;physical examination;physiotherapy;postoperative care;postoperative infection;postoperative thrombosis;priority journal;protein diet;senile dementia;septic shock;side to side ileo transversostomy;skin autograft;small intestine perforation;suture;thorax radiography;thrombosis prevention;Velcro,"Martis, G.;Rózsahegyi, M.;Deák, J.;Damjanovich, L.",2017,,10.1016/j.ijscr.2016.12.002,0,
2848,Βeta-fibrinogen gene promoter A -455 allele associated with poor longterm survival among 55-71 years old Caucasian women in Finnish stroke cohort,"Background: Women die of stroke more often than men. After menopause, the incidence of ischemic stroke increases rapidly. Elevated fibrinogen levels and smoking have been associated with an increased risk of stroke. In gene-cluster haplotype analyses, the beta-fibrinogen (FGB) promoter -455 G/A polymorphic locus was most strongly associated with elevated plasma fibrinogen levels. We investigated whether the FGB -455 G/A polymorphism and smoking might interact with sex on longterm survival of acute stroke sufferers. Methods: The Stroke Aging Memory (SAM) cohort comprising 486 consecutive stroke patients (55-85 years, 246 men, 240 women) subjected to clinical and MRI examination was followed over 12.5 years. During this period 347 (71.4%) patients died. The genotypes of the FGB -455 G/A polymorphism were determined by PCR. Results: The FGB -455 G/A polymorphism genotype distributions were 64.7%, 32.1%, and 3.2% for GG, GA, and AA, respectively. During the follow-up, the FGB -455 A + genotype did not associate with survival, nor was there any genotype-by-smoking interaction on poor outcome in the total study population. However, women aged 55-71 years who carried the FGB -455 A-allele showed worse survival regardless of smoking status compared to non-smoking FGB -455 GG homozygotes (non-smokers, crude HR = 5.21, 95% CI: 1.38-19.7; smokers, crude HR = 7.03, 95% CI: 1.81-27.3). This association persisted in adjusted analyses. No such association was observed for women in the oldest age-group, nor among men.Conclusion: The A + genotype of the FGB -455 G/A polymorphism associated with poor survival among 55-71 years old Caucasian women in the Finnish stroke cohort.",beta fibrinogen;C reactive protein;fibrinogen;high density lipoprotein cholesterol;unclassified drug;adult;aged;allele;article;brain ischemia;cardioembolic stroke;carotid artery obstruction;Caucasian;cause of death;cerebrovascular accident;cohort analysis;controlled study;dementia;diabetes mellitus;female;fibrinogen blood level;follow up;gene cluster;genetic association;genetic polymorphism;genotype;haplotype;heart arrhythmia;atrial fibrillation;heart infarction;heterozygote;homozygote;human;hypercholesterolemia;hypertension;hypertriglyceridemia;lacunar stroke;long term survival;major clinical study;male;neuroimaging;nuclear magnetic resonance imaging;outcome assessment;polymerase chain reaction;promoter region;smoking;stroke patient,"Martiskainen, M.;Oksala, N.;Pohjasvaara, T.;Kaste, M.;Oksala, A.;Karhunen, P. J.;Erkinjuntti, T.",2014,,,0,
2849,Clonazepam-associated bradycardia in a disabled elderly woman with multiple complications,"We herein report an 87-year-old woman who was taking clonazepam at 1.5 mg/day. She was hospitalized with an old cerebral infarction complicated with symptomatic epilepsy, dementia, dyslipidemia, and chronic cholecystitis. Electrocardiogram revealed severe bradycardia at 31 beats/min. The bradycardia disappeared on day 3 after clonazepam withdrawal, although the serum clonazepam level had been within normal limits. She was diagnosed with clonazepam-associated bradycardia, which was likely related to the potential calcium channel-blocking properties of clonazepam. Because of age-related pharmacokinetic and pharmacodynamic changes, the adverse effects of clonazepam should be considered, especially in disabled elderly individuals with multiple comorbidities.",amino terminal pro brain natriuretic peptide;clonazepam;sucralfate;ursodeoxycholic acid;abscess;aged;article;atrioventricular block;bradycardia;brain infarction;cardiomegaly;case report;clinical article;disability;drug withdrawal;dyslipidemia;edema;electrocardiography;emphysematous cholecystitis;epilepsy;female;heart arrhythmia;human;hypoalbuminemia;insulin resistance;kidney failure;lung congestion;ST segment elevation;subclinical hypothyroidism;thorax radiography;very elderly,"Maruyoshi, H.;Maruyoshi, N.;Hirosue, M.;Ikeda, K.;Shimamoto, M.",2017,,10.2169/internalmedicine.8234-16,0,
2850,Multimorbidity and functional status in community-dwelling older adults,"Background Multimorbidity is common in older people and may contribute to many adverse health events, such as disability. The aim of the study was to investigate how chronic health conditions (single, paired, and grouped) affect functional independence. Method We used two samples (a one-time, convenience sample and a nationally representative cross-sectional survey) of community-dwelling people of 65 years old or over, with a total of 2818 subjects in Spain. To assess functional independence, we used the Barthel index, administered as an interview. Information about the presence of 11 chronic health problems was collected by interview or review of their medical chart. Explanatory factor analysis was performed to assess associations between chronic health conditions. Results Diabetes mellitus and hypertension emerged as the pair of chronic health conditions that most affected functional status [OR 1.98; 95% CI (1.51-2.60)], followed by visual and hearing impairment. A synergistic effect was found (p < 0.05) for the cardiovascular disease and hypertension pair. Four multimorbidity groups emerged from the factor analysis: sensory and bone; cancer, lung and gastrointestinal; cardiovascular and metabolic; neuropsychiatric disorders. The neuropsychiatric disorders group was the most strongly associated with physical impairment [OR 4.94; 95% CI (2.71-8.99)], followed by the sensory and bones group [OR 1.90; 95% CI (1.56-2.31)]. Conclusion Despite its low prevalence, the neuropsychiatric disorders group was most strongly associated with lower functional status. Analysis of the relationship between chronic medical conditions and functional status could be useful to develop primary health care strategies to improve functional independence in older people with comorbidities. © 2014 European Federation of Internal Medicine.",aged;Alzheimer disease;arthritis;article;asthma;bronchitis;cardiovascular disease;cognitive defect;comorbidity;cross-sectional study;dementia;diabetes mellitus;digestive system ulcer;female;functional status;hearing impairment;heart failure;heart infarction;hemorrhoid;human;hypertension;interview;liver disease;major clinical study;male;medical record review;metabolic disorder;neoplasm;osteoarthritis;osteoporosis;Parkinson disease;physical disease;retrospective study;varicosis;visual impairment,"Marventano, S.;Ayala, A.;Gonzalez, N.;Rodríguez-Blázquez, C.;Garcia-Gutierrez, S.;Forjaz, M. J.",2014,,,0,
2851,Evaluation of four comorbidity indices and Charlson comorbidity index adjustment for colorectal cancer patients,"Introduction: Cancer survival is related not only to primary malignancy but also to concomitant nonmalignant diseases. The aim of this study was to investigate the prognostic capacity of four comorbidity indices [the Charlson comorbidity index (CCI), the Elixhauser method, the National Institute on Aging (NIA) and National Cancer Institute (NCI) comorbidity index, and the Adult Comorbidity Evaluation-27 (ACE-27)] for both cancer-related and all-cause mortality among colorectal cancer patients. A modified version of the CCI adapted for colorectal cancer patients was also built. Methods: The study population comprised 468 cases of colorectal cancer diagnosed between 1 January 2000 and 31 December 2010 at a community hospital. Data were prospectively collected and abstracted from patients' clinical records. Kaplan-Meier method and multivariate logistic regression models were performed for survival and risk of death analysis. Results: Only moderate or severe renal disease [hazard ratio (HR) 2.71, 95 % confidence interval (CI) 1.11-6.63] and AIDS (HR 3.27, 95 % CI 1.23-8.68) were independently associated with cancer-specific mortality, with a population attributable risk of 5.18 and 4.36 %, respectively. For each index, the highest comorbidity burden was significantly associated with poorer overall survival (NIA/NCI: HR 2.14, 95 % CI 1.14-4.01; Elixhauser: HR 1.98, 95 % CI 1.09-1.42; ACE-27: HR 1.78, 95 % CI 1.07-1.23; CCI: HR 1.68, 95 % CI 1.05-1.42) and cancer-specific survival. The modified version of the CCI resulted in a higher predictive power compared with other indices studied (cancer-specific mortality HR=2.37, 95 % CI 1.37-4.08). Conclusions: The comorbidity assessment tools provided better prognostic prevision of prospective outcome of colorectal cancer patients than single comorbid conditions. © 2014 Springer-Verlag.",acquired immune deficiency syndrome;Adult Comorbidity Evaluation 27;aged;alcohol abuse;Alzheimer disease;anemia;angina pectoris;arthritis;article;asthma;attributable risk;cancer mortality;cancer patient;cancer specific survival;cancer staging;cerebrovascular disease;Charlson Comorbidity Index;colorectal cancer;comorbidity;congestive heart failure;connective tissue disease;deep vein thrombosis;dementia;depression;diabetes mellitus;disease severity;electrolyte disturbance;elixhauser method;evaluation study;female;follow up;fracture;gallbladder disease;heart arrhythmia;heart infarction;human;hypertension;kidney disease;liver disease;lung disease;major clinical study;male;assessment of humans;national cancer institute comorbidity index;national institute on aging comorbidity index;neurologic disease;osteoporosis;overall survival;pancreas disease;paralysis;Parkinson disease;peptic ulcer;priority journal;prospective study;smoking;social status;thyroid disease;urinary tract disease;valvular heart disease;weight reduction,"Marventano, S.;Grosso, G.;Mistretta, A.;Bogusz-Czerniewicz, M.;Ferranti, R.;Nolfo, F.;Giorgianni, G.;Rametta, S.;Drago, F.;Basile, F.;Biondi, A.",2014,,,0,
2852,Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study,"Background: Patient nonadherence to cardiac medications following acute coronary syndrome (ACS) is associated with increased risk of recurrent events. However, the prevalence of cognitive dysfunction and poor health literacy among ACS patients and their association with medication nonadherence are poorly understood. Methods: We assessed rates of cognitive dysfunction and poor health literacy among participants of a clinical trial that tested the effectiveness of an intervention to improve medication adherence in patients hospitalized with ACS. Of 254 patients, 249 completed the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) survey, an assessment of risk for poor literacy, and the St Louis University Mental Status (SLUMS) exam, a tool assessing for neurocognitive deficits, during ACS hospitalization. We assessed if SLUMS or REALM-R scores were associated with medication adherence. Results: Based on SLUMS score, 14% of patients were categorized as having dementia, and 52% with mild neurocognitive disorder (MNCD). Based on REALM-R score of 6, 34% of patients were categorized as at risk for poor health literacy. There was no association between poor health literacy and medication nonadherence. Of those with MNCD, 35.5% were nonadherent, compared to 17.5% with normal cognitive function and 6.7% with dementia. In multivariable analysis, cognitive dysfunction was associated with medication nonadherence (P=0.007), mainly due to an association between MNCD and nonadherence (odds ratio =12.2, 95% confidence interval =1.9 to 243; P=0.007). Cognitive status was not associated with adherence in patients randomized to the intervention. Conclusion: Cognitive dysfunction and risk for poor health literacy are common in patients hospitalized with ACS. We found an association between MNCD and medication nonadherence in the usual care group but not in the intervention group. These findings suggest efforts to screen for MNCD are needed during ACS hospitalization to identify patients at risk for nonadherence and who may benefit from an adherence intervention.",acute coronary syndrome;aged;article;cerebrovascular disease;chronic kidney disease;chronic lung disease;cognitive defect;comorbidity;controlled clinical trial;controlled study;dementia;depression;diabetes mellitus;female;health literacy;hospitalization;human;hyperlipidemia;hypertension;major clinical study;male;medication compliance;mental health;multicenter study;multivariate analysis;non ST segment elevation myocardial infarction;patient care;peripheral occlusive artery disease;prospective study;Rapid Estimate of Adult Literacy in Medicine Revised;rating scale;risk assessment;sensitivity and specificity;smoking;St Louis University Mental Status exam;ST segment elevation myocardial infarction;survival rate;survival time;unstable angina pectoris;validation process;veteran,"Marzec, Ln;Carey, Ep;Lambert-Kerzner, Ac;Giacco, Ej;Melnyk, Sd;Bryson, Cl;Fahdi, Ie;Bosworth, Hb;Fiocchi, F;Michael, Ho P",2015,,10.2147/PPA.S75110,0,
2853,Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study,"BACKGROUND: Patient nonadherence to cardiac medications following acute coronary syndrome (ACS) is associated with increased risk of recurrent events. However, the prevalence of cognitive dysfunction and poor health literacy among ACS patients and their association with medication nonadherence are poorly understood. METHODS: We assessed rates of cognitive dysfunction and poor health literacy among participants of a clinical trial that tested the effectiveness of an intervention to improve medication adherence in patients hospitalized with ACS. Of 254 patients, 249 completed the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) survey, an assessment of risk for poor literacy, and the St Louis University Mental Status (SLUMS) exam, a tool assessing for neurocognitive deficits, during ACS hospitalization. We assessed if SLUMS or REALM-R scores were associated with medication adherence. RESULTS: Based on SLUMS score, 14% of patients were categorized as having dementia, and 52% with mild neurocognitive disorder (MNCD). Based on REALM-R score of </=6, 34% of patients were categorized as at risk for poor health literacy. There was no association between poor health literacy and medication nonadherence. Of those with MNCD, 35.5% were nonadherent, compared to 17.5% with normal cognitive function and 6.7% with dementia. In multivariable analysis, cognitive dysfunction was associated with medication nonadherence (P=0.007), mainly due to an association between MNCD and nonadherence (odds ratio =12.2, 95% confidence interval =1.9 to 243; P=0.007). Cognitive status was not associated with adherence in patients randomized to the intervention. CONCLUSION: Cognitive dysfunction and risk for poor health literacy are common in patients hospitalized with ACS. We found an association between MNCD and medication nonadherence in the usual care group but not in the intervention group. These findings suggest efforts to screen for MNCD are needed during ACS hospitalization to identify patients at risk for nonadherence and who may benefit from an adherence intervention.",medication adherence,"Marzec, L. N.;Carey, E. P.;Lambert-Kerzner, A. C.;Del Giacco, E. J.;Melnyk, S. D.;Bryson, C. L.;Fahdi, I. E.;Bosworth, H. B.;Fiocchi, F.;Ho, P. M.",2015,,10.2147/ppa.s75110,0,
2854,"Which, and how limited number of polymorphisms should be selected per disease, risk assessment, health profile or biological system?",,apolipoprotein E4;cerivastatin;cholesterol;DNA;drug metabolizing enzyme;gene product;hydroxymethylglutaryl coenzyme A reductase inhibitor;hypocholesterolemic agent;Alzheimer disease;bioinformatics;cardiovascular disease;cholesterol blood level;chromosome 1q;diabetes mellitus;DNA determination;drug industry;drug safety;epistaxis;gene expression;gene frequency;gene function;gene interaction;gene locus;gene mutation;genetic analysis;genetic heterogeneity;genetic risk;genetic screening;genomics;genotype phenotype correlation;haplotype;health status;heart infarction;human;kidney failure;note;pharmacogenomics;priority journal;protein expression;quantitative trait locus mapping;retinopathy;risk assessment;single nucleotide polymorphism;cerebrovascular accident,"Masana, L.;Madan, T.;Visvikis, S.;Sass, C.;Baranova, H.;Bonnet, J.;Dembinska, A.;Ehrlich, H.;Gueyffier, F.;Schmitz, G.;Siest, G.;Zannis, V.",2003,,,0,
2855,Hot-news and perspectives in the risedronate treatment,"Risedronate is a very potent inhibitor of bone resorption which is used in treatment of postmenopausal osteoporosis and Paget disease. Many pre-registration osteopoporosis studies showed its rapid significant effect on risk reduction of vertebral and non-vertebral fractures, positive effect on bone density and bone metabolism as well as on clinical symptomatology and laboratory tests in Paget disease. The authors reviewed recent past 3 years studies which give new knowledge about effectivity in postmenopausal osteoporosis (5- and 7-years of clinical experience and histological studies, usage in men, elderly women, patients with renal failure, high-risk patients using NSAID), describe its effectivity in different types of secondary osteoporosis (osteoporosis after immobilization, inflammatory bowel diseases, rheumatoid arthritis, anorexia nervosa, Alzheimer disease) and as a hot-news in treatment of other diseases (osteoarthritis, extraosseal calcifications, chronic diffuse sclerotising osteoymelitis, periodontitis, Chagas disease).",nonsteroid antiinflammatory agent;risedronic acid;Alzheimer disease;anorexia nervosa;article;bone density;bone disease;bone metabolism;Chagas disease;demography;drug effect;enteritis;high risk patient;human;kidney failure;osteoarthritis;osteolysis;osteomyelitis;Paget bone disease;periodontitis;postmenopause osteoporosis;rheumatoid arthritis;risk reduction;spine fracture,"Masaryk, P.;Letkovská, A.;Luliak, M.",2006,,,0,
2856,Immunodistribution of amyloid beta protein (Aβ) and advanced glycation end-product receptors (RAGE) in choroid plexus and ependyma of resuscitated patients,"RAGE (receptor for advanced glycation end-products) participates in the influx transport of glycated Aβ (amyloid beta) from the blood to the brain. Because little is known of the RAGE operating in brain barriers such as those in the choroid plexus and ependyma, the aim of the present study was to examine the immunodistributions of RAGE and Aβ peptides in the choroid plexus where the blood-cerebrospinal fluid barrier (B-CSF) is located, and in ependyma of the brain ventricles associated with functions of the cerebrospinal fluid-brain barrier (CSF-B). The study was performed on patients over 65 years successfully resuscitated after cardiac arrest with survival a few weeks. The control group consisted of age-matched individuals who were not resuscitated and died immediately after cardiac arrest. In resuscitated patients, but not in controls, RAGE receptors were localized in choroid plexus (CP) epithelial cells and in ependymal cells bordering the brain ventricles. These cells form the B-CSF and CSF-B barriers. The presence of Aβ was detected within the CP blood vessels and in the basement membrane of the CP epithelium. In numerous cytoplasmic vacuoles of CP epithelial and ependymal cells Aβ protein was found and our observations suggest that the contents of those vacuoles were undergoing progressive digestion. The results demonstrated that CP epithelium and ependymal cells, equipped with RAGE receptors, not only play an important role in the creation of amyloid deposits in the brain but are also places where Aβ may be utilized. The RAGE transportation system should be a main target in the therapy of brain amyloidosis, a well-known risk factor of Alzheimer disease.",advanced glycation end product receptor;amyloid;amyloid beta protein;aged;article;basement membrane;blood cerebrospinal fluid barrier;brain blood vessel;brain cerebrospinal fluid barrier;brain ventricle;cell vacuole;choroid plexus;clinical article;controlled study;ependyma;ependyma cell;epithelium cell;heart arrest;human;human tissue;permeability barrier;protein localization;resuscitation;survival,"Maślińska, D.;Laure-Kamionowska, M.;Taraszewska, A.;Derȩgowski, K.;Maśliński, S.",2011,,,0,
2857,Fatty acids: Which ones do we need?,"It is important to ensure that any fat consumed is of a beneficial type. More emphasis should be placed on MUFAs and n3 PUFAs to replace both SFAs and n6 PUFAs. This will help to ensure an appropriate balance of n3 to n6 PUFAs and a reduced intake of SFAs. This could help to reduce the risk of CVD and other chronic conditions with an inflammatory component. Irrespective of the type of fatty acids contained, all fats provide 9kcal (37kJ) per gram, making fat the most concentrated source of energy in the diet and a potentially significant risk factor for obesity so, although some fatty acids are essential for health, total fat intake should still be limited. Topping up on EFAs is best done through dietary measures. Usually, it is the n3 EFAs that are needed. Hence the best advice is to eat n3-rich oily fish and seeds or seed oils (see Panel 1, p749). For people who do not like eating oily fish and who are concerned about the risk of CVD, a supplement providing 1g of n3 fatty acids (from fish oils) can be suggested. If supplements are used, because of their instability, it is best to buy them in small quantities and to keep them refrigerated.",arachidic acid;arachidonic acid;behenic acid;conjugated linoleic acid;decanoic acid;docosahexaenoic acid;erucic acid;essential fatty acid;fatty acid;fish oil;gamma linolenic acid;high density lipoprotein cholesterol;icosapentaenoic acid;lauric acid;linoleic acid;linolenic acid;linseed oil;low density lipoprotein cholesterol;monounsaturated fatty acid;myristic acid;oleic acid;omega 3 fatty acid;omega 6 fatty acid;palmitic acid;saturated fatty acid;stearic acid;triacylglycerol;vegetable oil;alcoholism;anticoagulation;antiinflammatory activity;atherosclerosis;cardiovascular disease;cardiovascular risk;chemical structure;cholesterol metabolism;Crohn disease;dementia;depression;diabetes mellitus;diet supplementation;drug stability;drug storage;energy resource;fat intake;fatty acid analysis;fish;food composition;freezing;heart infarction;heart ventricle arrhythmia;human;hypertension;low fat diet;malignant neoplastic disease;mental function;mood disorder;note;nutritional deficiency;nutritional requirement;obesity;rheumatoid arthritis;risk factor;risk reduction;schizophrenia;cerebrovascular accident;ulcerative colitis,"Mason, P.",2004,,,0,
2858,Potential uses for coenzyme Q10,,adenosine triphosphate;antihypertensive agent;beta adrenergic receptor blocking agent;clonidine;gemfibrozil;hydralazine;hydrochlorothiazide;hydroxymethylglutaryl coenzyme A reductase inhibitor;immunostimulating agent;magnesium;methyldopa;placebo;tricyclic antidepressant agent;ubidecarenone;aging;angina pectoris;antioxidant activity;article;breast cancer;cardiomyopathy;cardiovascular disease;clinical trial;congestive heart failure;diet supplementation;dietary intake;disease association;dizziness;dose response;drug absorption;drug blood level;drug efficacy;drug eruption;drug megadose;drug safety;drug tolerance;energy metabolism;energy yield;enzyme deficiency;exercise test;gastrointestinal symptom;heart function;heart surgery;heredity;human;human tissue;Huntington chorea;hypertension;hyperthyroidism;migraine;mitochondrial membrane;nucleic acid synthesis;oxidative stress;Parkinson disease;postoperative care;quality of life;risk factor,"Mason, P.",2005,,,0,
2859,Electronic medical record data to identify variables associated with a fibromyalgia diagnosis: Importance of health care resource utilization,"BACKGROUND: Diagnosis of fibromyalgia (FM) is often challenging. Identifying factors associated with an FM diagnosis may guide health care providers in implementing appropriate diagnostic and management strategies. METHODS: This retrospective study used the de-identified Humedica electronic medical record (EMR) database to identify variables associated with an FM diagnosis. Cases (n=4,296) were subjects ≥18 years old with ≥2 International Classification of Diseases, Ninth Revision (ICD-9) codes for FM (729.1) ≥30 days apart during 2012, associated with an integrated delivery network, with ≥1 encounter with a health care provider in 2011 and 2012. Controls without FM (no-FM; n=583,665) did not have the ICD-9 codes for FM. Demographic, clinical, and health care resource utilization variables were extracted from structured EMR data. Univariate analysis identified variables showing significant differences between the cohorts based on odds ratios (ORs). RESULTS: Consistent with FM epidemiology, FM subjects were predominantly female (78.7% vs 64.5%; P<0.0001) and slightly older (mean age 53.3 vs 52.7 years; P=0.0318). Relative to the no-FM cohort, the FM cohort was characterized by a higher prevalence of nearly all evaluated comorbidities; the ORs suggested a higher likelihood of an FM diagnosis (P<0.0001), especially for musculoskeletal and neuropathic pain conditions (OR 3.1 for each condition). Variables potentially associated with an FM diagnosis included higher levels of use of specific health care resources including emergency-room visits, outpatient visits, hospitalizations, and medications. Units used per subject for emergency-room visits, outpatient visits, hospitalizations, and medications were also significantly higher in the FM cohort (P<0.0001), confirming resource utilization as an important variable associated with an FM diagnosis. CONCLUSION: Significant differences between the FM and no-FM cohorts were observed for nearly all the demographic, clinical, and health care resource variables, suggesting an association with FM diagnosis. These results also support use of EMR data for identifying variables associated with FM, which may help in the diagnosis and management of this condition.",opiate;acquired immune deficiency syndrome;adult;African American;amnesia;article;Asian;Caucasian;cerebrovascular disease;Charlson Comorbidity Index;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;dyskinesia;dyspareunia;electronic medical record;emergency ward;fatigue;fibromyalgia;gastrointestinal disease;headache;health care personnel;health care utilization;health insurance;heart infarction;hemiplegia;human;ICD-9;interstitial cystitis;kidney disease;liver disease;major clinical study;malignant neoplastic disease;mental disease;migraine;morbid obesity;musculoskeletal pain;myalgia;myositis;neuropathic pain;obesity;observational study;outpatient care;pain;paraplegia;peptic ulcer;prevalence;restless legs syndrome;retrospective study;sleep disorder;solid tumor;temporomandibular joint disorder;thorax pain;tinnitus;vascular disease,"Masters, E. T.;Mardekian, J.;Emir, B.;Clair, A.;Kuhn, M.;Silverman, S. L.",2015,,,0,
2860,"Drinking water contamination from perfluoroalkyl substances (PFAS): an ecological mortality study in the Veneto Region, Italy","Background: : Perfluoroalkyl substances (PFAS), a heterogeneous group of highly stable man-made chemicals, have been widely used since 1960s and can be detected almost ubiquitously in all environmental matrices. In Italy, on January 2014, drinking water contamination in an area of the Veneto Region was detected mainly due to the drain of fluorinated chemicals by a manufacturing company operating since 1964. : The present ecological mortality study was aimed at comparing mortality for some causes of death selected on the basis of previous reported associations, during the period 1980-2013, in municipalities with PFAS contaminated and uncontaminated drinking water on the basis of the levels indicated by the Italian National Health Institute (ISS). Sex-specific number, standardized mortality rates and rate ratios (RR) for PFAS contaminated and uncontaminated areas were computed for each cause of death through the ENEA epidemiological database. : In both sexes, statistically significant RRs were detected for all causes mortality, diabetes, cerebrovascular diseases, myocardial infarction and Alzheimer's disease. In females, RRs significantly higher than 1.0 were also observed for kidney and breast cancer, and Parkinson's disease. Increased risk, although not statistically significant, was observed for bladder cancer in both sexes, and for testicular cancer, pancreatic cancer and leukemia in males only. : Higher mortality levels for some causes of death, possibly associated with PFAS exposure, were detected in contaminated municipalities in comparison with uncontaminated ones with similar socioeconomic status and smoking habits. These results warrant further individual level analytic studies to delineate casual associations.",,"Mastrantonio, M.;Bai, E.;Uccelli, R.;Cordiano, V.;Screpanti, A.;Crosignani, P.",2017,May 23,,0,
2861,Outcomes of intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 90 years or older,"Although age is a major risk factor for stroke, physicians are often reluctant to use thrombolytic agents in those who are very old. No published study provides detailed information on the use of intravenous tissue plasminogen activator (tPA) in patients aged 90 years or older. We retrospectively reviewed the use of intravenous tPA for patients 90 years or older who were admitted with acute ischemic stroke to the hospital at 4 academic centers from March 1, 1999, to March 1, 2008. We reviewed the clinical features of the patients at presentation, complications, and outcomes. Twentytwo patients (11 women; median age, 93 years; range, 90-101 years) were identified who had received intravenous tPA for symptoms of acute ischemic stroke (average time to treatment, 143 minutes; range, 90-180 minutes; no tPA protocol violations; mean National Institutes of Health Stroke Scale score, 15; range, 5-28). Nearly all patients were highly functional at baseline (median modified Rankin Scale [mRS] score, 1; median Barthel Index score, 95), and all but one performed the activities of daily living with little or no assistance before stroke. By the 30-day follow-up, 2 patients (9%) had a favorable outcome (mRS score, 0-2) and 2 (9%) had moderate disability (mRS score, 3). Most patients died (n=10) or experienced severe disability, defined as an mRS score of 4 or 5 (n=5). Asymptomatic intracerebral hemorrhage occurred in 3 patients (14%) and was nonfatal. Most patients aged 90 years or older who received intravenous tPA for acute ischemic stroke had poor 30-day functional outcomes or died. Intravenous tPA treatment in this age group does not improve the outcome of ischemic stroke. © 2009 Mayo Foundation for Medical Education and Research.",tissue plasminogen activator;aged;Alzheimer disease;article;Barthel index;cause of death;cerebrovascular accident;clinical article;clinical assessment;clinical feature;clinical protocol;comorbidity;congestive heart failure;controlled study;daily life activity;diagnostic imaging;diffuse Lewy body disease;diffusion weighted imaging;disability;dyslipidemia;echocardiography;fatality;female;follow up;atrial fibrillation;human;hypertension;male;mild cognitive impairment;outcome assessment;Rankin scale;retrospective study;risk factor;scoring system;survival;treatment outcome;treatment response,"Mateen, F. J.;Nasser, M.;Spencer, B. R.;Freeman, W. D.;Shuaib, A.;Demaerschalk, B. M.;Wijdicks, E. F. M.",2009,,,0,
2862,Is Streptococcus bovis a urinary pathogen?,"The Streptococcus bovis group (SBG) comprises several microorganisms associated with human infections. They have been associated with bacteremia, endocarditis, biliary tract infection, meningitis, and colorectal cancer, but their role as urinary pathogens is not well known. The objective of this investigation was to discover the incidence and clinical significance of the bacteriuria associated with this complex. A retrospective analysis of all adult patients with bacteriuria caused by SBG during the period 1995–2012 was carried out. During the study period, SBG was isolated in 153 adult patients, who had a mean age of 67 years, most of them being women (80 %). Most of our patients (65 %) had some underlying disease, with urologic disease being the most common (37 %), followed by diabetes mellitus (27 %) and neurologic disease (25 %). Among the 88 patients in whom we were able to correctly assess symptoms, 45 % had asymptomatic bacteriuria, 35 % had lower urinary tract infection, and 20 % had upper urinary tract infection. In 14 cases (9 %), SBG was also isolated in blood cultures. Most of the isolates of SBG (72 %) were S. gallolyticus subsp. pasteurianus. All isolates were susceptible to penicillin, 98 % to nitrofurantoin, and 77 % to fosfomycin. Although SBG bacteriuria is uncommon, it should not always be taken as a contaminant, mainly when S. pasteurianus is isolated, because it may cause urinary tract infections and, occasionally, sepsis, whereas when S. gallolyticus is isolated from urine, it may be a marker of underlying endocarditis and colorectal cancer.",amoxicillin plus clavulanic acid;beta lactam antibiotic;cefotaxime;ciprofloxacin;clindamycin;cotrimoxazole;doxycycline;erythromycin;fosfomycin;levofloxacin;nitrofurantoin;penicillin derivative;adult;aged;antibiotic sensitivity;article;asymptomatic bacteriuria;bacterial endocarditis;bacterium isolation;bacteriuria;blood culture;bloodstream infection;Charlson Comorbidity Index;colon adenoma;colon polyp;controlled study;dementia;diabetes mellitus;disease association;endocarditis;female;fever;heart failure;human;incidence;major clinical study;male;mental health;middle aged;mitral valve regurgitation;neurologic disease;obstructive uropathy;priority journal;prostate biopsy;prostate cancer;pyuria;retrospective study;sepsis;septic shock;Streptococcus equinus;Streptococcus gallolyticus;Streptococcus infection;symptom;urinary tract disease;urinary tract infection;urine culture;very elderly;villous adenoma,"Matesanz, M.;Rubal, D.;Iñiguez, I.;Rabuñal, R.;García-Garrote, F.;Coira, A.;García-País, M. J.;Pita, J.;Rodriguez-Macias, A.;López-Álvarez, M. J.;Alonso, M. P.;Corredoira, J.",2015,,,0,
2863,Characteristics and temporal pattern of the readmissions of patients with multiple hospital admissions in the medical departments of a general hospital,"INTRODUCTION: Patients with multiple hospital admissions represent a small percentage of total hospitalizations but result in a considerable proportion of the healthcare expenditure. There are no studies that have analyzed their long-term clinical evolution. OBJECTIVES: To study the characteristics, temporal patterns of readmissions and clinical evolution of patients with multiple hospital admission in the long term. METHODS: A retrospective study was conducted of all hospital admissions in the medical area of the Hospital of Lugo (Spain) between January 1, 2000 and December 31, 2012, based on data from the center's minimum basic data set. RESULTS: A total of 139,249 hospital admissions for 62,515 patients were studied. Six hospital admissions were recorded for 6.4% of the patients. The overall mortality rate was 16% (9982 patients). The readmissions rate steadily increased with each new admission, from 48% after the first event to 74.6% after the fifth. The rate of hospital readmission before 30days increased from 18.3% in the second admission to 36.3% in the sixth. The number of chronic diseases increased from 3.1 (SD, 2) in the first hospital admission up to 4.9 (2.8) in the sixth. The Department of Internal Medicine treated a third of all hospital admissions. In the sixth hospitalization, conditions associated with admission in Internal Medicine were CIRS score, age, heart failure, COPD, dementia, diabetes, atrial fibrillation and anemia. CONCLUSIONS: Patients with multiple hospital admissions are complex patients whose temporal pattern of readmissions changes with time, such that each hospital admission constitutes a factor facilitating the next.","Age Factors;Aged;*Chronic Disease/epidemiology/therapy;Female;Hospital Departments/methods/statistics & numerical data;Hospitals, General/*statistics & numerical data;Humans;Internal Medicine/organization & administration;Length of Stay/*statistics & numerical data;Male;Patient Readmission/*statistics & numerical data;Retrospective Studies;Spain/epidemiology;Time Factors;Comorbidity;Hospital multiple admission;Hospital readmission","Matesanz-Fernandez, M.;Monte-Secades, R.;Iniguez-Vazquez, I.;Rubal-Bran, D.;Guerrero-Sande, H.;Casariego-Vales, E.",2015,Dec,10.1016/j.ejim.2015.09.020,0,
2864,The burden of disease and injury in Australia,"An overview of the results of the Australian Burden of Disease (ABD) study is presented. The ABD study was the first to use methodology developed for the Global Burden of Disease study to measure the burden of disease and injury in a developed country. In 1996, mental disorders were the main causes of disability burden, responsible for nearly 30% of total years of life lost to disability (YLD), with depression accounting for 8% of the total YLD. Ischaemic heart disease and stroke were the main contributors to the disease burden disability-adjusted life years (DALYs), together causing nearly 18% of the total disease burden. Risk factors such as smoking, alcohol consumption, physical inactivity, hypertension, high blood cholesterol, obesity and inadequate fruit and vegetable consumption were responsible for much of the overall disease burden in Australia. The lessons learnt from the ABD study are discussed, together with methodological issues that require further attention.",alcohol consumption;alcoholism;article;asthma;Australia;neoplasm;cholesterol blood level;chronic obstructive lung disease;comorbidity;dementia;depression;developed country;diabetes mellitus;disability;fruit;hearing impairment;human;hypertension;injury;ischemic heart disease;life expectancy;mortality;obesity;osteoarthritis;physical activity;risk factor;smoking;cerebrovascular accident;suicide;traffic accident;vegetable,"Mathers, C. D.;Vos, E. T.;Stevenson, C. E.;Begg, S. J.",2001,,,0,
2865,Risk factors for hospital re-presentation among older adults following fragility fractures: A systematic review and meta-analysis,"Background: Older adults hospitalized with fragility fractures are at high risk of negative events that can culminate in re-presentations to hospital emergency departments or readmissions to hospital. This systematic review aimed to identify patient, clinical, or hospital-related factors that are identifiable at the index admission and that may be associated with re-presentations to hospital emergency departments or hospital readmissions in older adults following fragility fractures. Methods: Four electronic databases (PubMed, CINAHL, Embase, and Scopus) were searched. A suite of search terms identified peer-reviewed English-language articles that examined potential correlates of hospital re-presentation in older adults (mean age≥65 years) who were discharged from hospital following treatment for fragility fractures. A three-stage screening process (titles, abstracts, full text) was conducted by two researchers independently. Participant characteristics, study design, potential correlates examined, analyses, and findings were extracted for studies included in the review. Quality and risk of bias were assessed with the Effective Public Health Practice Project Quality Assessment Tool. The strength of evidence was incorporated into a best evidence synthesis, and meta-analysis was conducted where effect pooling was possible. Results: Eleven of 35 eligible studies were categorized as high quality studies. These studies reported that age, higher Cumulative Illness Rating scores, American Society of Anesthesiologists scores>3, longer length of stay, male sex, cardiovascular disease, low post-operative hemoglobin, kidney disease, dementia and cancer were factors identified at the index admission that were predictive of subsequent re-presentation to hospital. Age was the only predictor for which pooling of effects across studies was possible: pooling was conducted for re-presentation≤30 days (pooled OR, 1.27; 95 % CI, 1.14-1.43) and>30 days (pooled OR, 1.23; 95 % CI, 1.01-1.50). Conclusions: The best-evidence synthesis, in addition to the meta-analysis, identified a range of factors that may have utility in guiding clinical practice and policy guidelines for targeted interventions to reduce the need for re-presentation to hospital among this frail clinical population. The paucity of studies investigating re-presentations to hospital emergency departments without admission was an important gap in the literature identified in this review. Key limitations were exclusion of non-English language studies and grey literature. Systematic review registration: PROSPERO CRD42015019379.",hemoglobin;age distribution;American Society of Anesthesiologists score;article;cardiovascular disease;comorbidity;Cumulative Illness Rating score;dementia;fragility fracture;gender;heart infarction;hemoglobin blood level;hip fracture;hospital readmission;human;humerus fracture;kidney disease;kidney failure;length of stay;lung embolism;meta analysis (topic);neoplasm;pneumonia;postoperative complication;postoperative period;risk assessment;risk factor;scoring system;sepsis;systematic review (topic);urinary tract infection,"Mathew, S. A.;Gane, E.;Heesch, K. C.;McPhail, S. M.",2016,,,0,
2866,Invasive strategy in acute coronary syndrome 3,,acute coronary syndrome;anticoagulation;cardiac patient;clinical practice;comorbidity;dementia;geriatric patient;human;letter;life expectancy;mass screening;outcome assessment;priority journal;risk factor,"Mathew, S. T.;Pakala, A. V.;Thadani, U.",2016,,,0,
2867,Thirty-day prevalence of delirium among very old people: a population-based study of very old people living at home and in institutions,"Delirium has mainly been studied in various patient samples and in people living in institutions. The present study investigates the 30-day prevalence of delirium in a population-based sample of very old people in northern Sweden and Finland. Seven hundred and eight persons aged 85 years and older from the GErontological Regional DAtabase (GERDA) were assessed. Information was also collected from relatives, carers and medical records. Assessments performed were among others the Organic Brain Syndrome (OBS) scale, the Mini Mental State Examination (MMSE), and the Geriatric Depression Scale-15 (GDS-15). Delirium, depression and dementia diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The prevalence of delirium was 17% among 85 year-olds, 21% among 90 year-olds and 39% among participants aged 95 years and older (p<0.001). Delirium prevalence among individuals without dementia was lower than among those with dementia (5% vs. 52%, p<0.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression (Odds Ratio (OR)=2.0, 95% Confidence Interval (CI)=1.2-3.3), heart failure (OR=2.1, 95% CI=1.2-3.7), institutional living (OR 4.4, 95% CI=2.4-8.2) and prescribed antipsychotics (OR=3.0, 95% CI=1.5-6.0). Delirium is highly prevalent among very old people with dementia. Depression, heart failure, institutional living and prescribed antipsychotic medication seem to be associated with delirium.","Age Factors;Aged, 80 and over/*psychology/statistics & numerical data;Delirium/*epidemiology;Dementia/epidemiology;Depression/epidemiology;Female;Finland/epidemiology;Health Status;Homes for the Aged/statistics & numerical data;Humans;Independent Living/psychology/statistics & numerical data;Institutionalization/statistics & numerical data;Male;Neuropsychological Tests;Prevalence;Sweden/epidemiology;80 and over;Aged;Cross-sectional study;Delirium;Dementia;Epidemiology","Mathillas, J.;Olofsson, B.;Lovheim, H.;Gustafson, Y.",2013,Nov-Dec,10.1016/j.archger.2013.04.012,0,
2868,Vaccinations in children's palliative care - Our proposal for the algorithm,"Despite the fact that children under palliative care suffer from totally different diseases, they share similar health problems, among them respiratory tract infections. Vaccination is one of the most effective methods in infection prophylaxis. Practice proves that some patients with no contraindications to vaccination are not immunized in accordance with national vaccination program, which is obviously unfavorable to the children's health. Yet, immunizations bring in significant profit to chronically ill patients: reduce the frequency of respiratory tract infections occurrence (vaccines against pneumococcal infections, Haemophilus influenzae type b, influenza), cause the decrease in antibiotics administration, prevent from infectious diseases (e.g. varicella, hepatitis type B) and, therefore, improve the life quality and duration. The article presents the author's personal experience gained in Wroclaw Children's Hospice where 27 children between the ages of 1-25 years are taken care of (the average age - 11 years, median - 12,5 years). The hospice care lasted from a few days to several years. The reason why children were under hospice care were the following conditions: cerebral palsy (7 cases), the condition after cardiac arrest (3 cases), spinal muscular atrophy (2 cases), chronic lung disease (2 cases), metachromatic leukodystrophy (2 cases), Niemann-Pick disease, Menkes syndrome, neuronal ceroid lipofuscinosis, the condition after craniocerebral trauma, Aicardi syndrome, congenital defect of central nervous system, Edwards syndrome, Hallervorden disease, muscular dystrophy and brain tumor. We propose our own algorithm in the approach to vaccinations. Vaccination of hospice patients may bring about problems such as: necessity of vaccination in the patients' homes, the requirement of infectious diseases specialist's consultation, the fear of pain and the high costs of vaccines not refunded by the government. Conclusions: Vaccination is an underestimated element of children's palliative care. When vaccination is contraindicated or difficult to perform, people from the patients' closest circle should be vaccinated in order to make the infection transmission impossible. It is essential that people who maintain contact with chronically ill children should be vaccinated against influenza annually. Copyright © 2008 Almamedia.",antibiotic agent;Haemophilus influenzae type b vaccine;Pneumococcus vaccine;adolescent;adult;Aicardi syndrome;article;brain tumor;central nervous system malformation;cerebral palsy;chickenpox;child;child health care;chronic disease;chronic lung disease;clinical article;clinical protocol;Edwards syndrome;female;heart arrest;hepatitis B;hospice care;human;infection prevention;male;Menkes syndrome;metachromatic leukodystrophy;muscular dystrophy;neurodegeneration with brain iron accumulation;neuronal ceroid lipofuscinosis;Niemann Pick disease;palliative therapy;quality of life;respiratory tract infection;spinal muscular atrophy;vaccination,"Matkowska-Kocjan, A.;Kuchar, E.;Szenborn, L.",2008,,,0,
2869,Identification of an early transcriptomic signature of insulin resistance and related diseases in lymphomonocytes of healthy subjects,"Insulin resistance is considered to be a pathogenetic mechanism in several and diverse diseases (e.g. type 2 diabetes, atherosclerosis) often antedating them in apparently healthy subjects. The aim of this study is to investigate with a microarray based approach whether IR per se is characterized by a specific pattern of gene expression. For this purpose we analyzed the transcriptomic profile of peripheral blood mononuclear cells in two groups (10 subjects each) of healthy individuals, with extreme insulin resistance or sensitivity, matched for BMI, age and gender, selected within the MultiKnowledge Study cohort (n = 148). Data were analyzed with an ad-hoc rank-based classification method. 321 genes composed the gene set distinguishing the insulin resistant and sensitive groups, within which the ""Adrenergic signaling in cardiomyocytes"" KEGG pathway was significantly represented, suggesting a pattern of increased intracellular cAMP and Ca2+, and apoptosis in the IR group. The same pathway allowed to discriminate between insulin resistance and insulin sensitive subjects with BMI >25, supporting his role as a biomarker of IR. Moreover, ASCM pathway harbored biomarkers able to distinguish healthy and diseased subjects (from publicly available data sets) in IR-related diseases involving excitable cells: type 2 diabetes, chronic heart failure, and Alzheimer's disease. The altered gene expression profile of the ASCM pathway is an early molecular signature of IR and could provide a common molecular pathogenetic platform for IR-related disorders, possibly representing an important aid in the efforts aiming at preventing, early detecting and optimally treating IR-related diseases.","0 (Biomarkers);0 (Blood Glucose);Adult;Alzheimer Disease/blood/ genetics;Biomarkers/ metabolism;Blood Glucose/metabolism;Case-Control Studies;Diabetes Mellitus, Type 2/blood/ genetics;Female;Healthy Volunteers;Heart Failure/blood/ genetics;Humans;Insulin Resistance/ genetics;Leukocytes, Mononuclear/ metabolism;Male;Transcriptome","Matone, A.;Derlindati, E.;Marchetti, L.;Spigoni, V.;Dei Cas, A.;Montanini, B.;Ardigo, D.;Zavaroni, I.;Priami, C.;Bonadonna, R. C.",2017,,,0,
2870,Identification of an early transcriptomic signature of insulin resistance and related diseases in lymphomonocytes of healthy subjects,"Insulin resistance is considered to be a pathogenetic mechanism in several and diverse diseases (e.g. type 2 diabetes, atherosclerosis) often antedating them in apparently healthy subjects. The aim of this study is to investigate with a microarray based approach whether IR per se is characterized by a specific pattern of gene expression. For this purpose we analyzed the transcriptomic profile of peripheral blood mononuclear cells in two groups (10 subjects each) of healthy individuals, with extreme insulin resistance or sensitivity, matched for BMI, age and gender, selected within the MultiKnowledge Study cohort (n = 148). Data were analyzed with an ad-hoc rank-based classification method. 321 genes composed the gene set distinguishing the insulin resistant and sensitive groups, within which the “Adrenergic signaling in cardiomyocytes” KEGG pathway was significantly represented, suggesting a pattern of increased intracellular cAMP and Ca2+, and apoptosis in the IR group. The same pathway allowed to discriminate between insulin resistance and insulin sensitive subjects with BMI >25, supporting his role as a biomarker of IR. Moreover, ASCM pathway harbored biomarkers able to distinguish healthy and diseased subjects (from publicly available data sets) in IR-related diseases involving excitable cells: type 2 diabetes, chronic heart failure, and Alzheimer’s disease. The altered gene expression profile of the ASCM pathway is an early molecular signature of IR and could provide a common molecular pathogenetic platform for IR-related disorders, possibly representing an important aid in the efforts aiming at preventing, early detecting and optimally treating IR-related diseases.",biological marker;calcium ion;cyclic AMP;adult;age;Alzheimer disease;apoptosis;article;body mass;cardiac muscle cell;cohort analysis;controlled study;early diagnosis;female;gender;gene expression;gene identification;heart failure;human;human cell;human experiment;insulin resistance;insulin sensitivity;male;microarray analysis;non insulin dependent diabetes mellitus;normal human;pathogenicity;peripheral blood mononuclear cell;transcriptomics,"Matone, A.;Derlindati, E.;Marchetti, L.;Spigoni, V.;Dei Cas, A.;Montanini, B.;Ardigò, D.;Zavaroni, I.;Priami, C.;Bonadonna, R. C.",2017,,10.1371/journal.pone.0182559,0,
2871,Probable and possible transfusion-transmitted dengue associated with NS1 antigen-negative but RNA confirmed-positive red blood cells,"BACKGROUND In the absence of active blood donation screening, dengue viruses (DENV) have been implicated in only a limited number of transfusion transmissions worldwide. This study attempted to identify if blood from donors testing negative by an NS1-antigen (Ag) enzyme-linked immunosorbent assay (ELISA) but confirmed positive for DENV RNA caused DENV-related disease in recipients during the epidemic years of 2010 to 2012 in Puerto Rico. STUDY DESIGN AND METHODS Donation aliquots testing negative by an investigational NS1-Ag ELISA were stored frozen and retested retrospectively using a research transcription-mediated amplification assay (TMA) detecting DENV RNA. All RNA-reactive donations were subject to confirmatory RNA and antibody testing. Recipient tracing was conducted for all components manufactured from TMA-reactive components. Medical chart review, recipient interview, and follow-up sampling occurred for 42 recipients transfused with TMA-reactive components. RESULTS Six of 42 recipients developed new-onset fever in the 2 weeks posttransfusion; three (50%) received RNA confirmed-positive, NS1-Ag-negative red blood cell (RBC) units. One recipient of a high-titer unit (7 × 107 DENV-4 RNA copies/mL) developed severe dengue, and a second recipient had only fever recorded but had a negative sepsis work-up. New fever attributable to DENV infection in a third recipient was confounded by fever potentially attributable to posttransfusion sepsis. CONCLUSIONS In our retrospective study, NS1-Ag detected 20% of all RNA confirmed-positive donations demonstrating limitations of NS1-Ag ELISA for blood donation screening. We identified one recipient with a clinical syndrome compatible with severe dengue who had received an NS1-Ag-negative but RNA confirmed-positive RBC unit. This investigation illustrates the difficulty in confirming transfusion transmission in dengue-endemic areas among severely ill transfusion recipients.",antibiotic agent;Dengue virus nonstructural protein antigen;immunoglobulin G antibody;immunoglobulin M;immunoglobulin M antibody;unclassified drug;virus antigen;virus RNA;adolescent;adult;aged;anemia;antibiotic therapy;article;blood transfusion;child;cholangiography;clinical article;controlled study;dementia;dengue;enzyme linked immunosorbent assay;erythrocyte;erythrocyte transfusion;false positive result;female;fever;follow up;human;hypertension;hypoalbuminemia;hypothermia;hypothyroidism;interview;ischemic heart disease;jaundice;leukopenia;lung cancer;male;medical record review;melena;non insulin dependent diabetes mellitus;pancreas cancer;pericardial effusion;pleura effusion;rectum hemorrhage;reverse transcription polymerase chain reaction;sepsis;shock;thrombocytopenia;transfusion transmitted dengue;urine culture;very elderly,"Matos, D.;Tomashek, K. M.;Perez-Padilla, J.;Muñoz-Jordán, J.;Hunsperger, E.;Horiuchi, K.;Noyd, D.;Winton, C.;Foster, G.;Lanteri, M.;Linnen, J. M.;Stramer, S. L.",2016,,,0,
2872,Successful endoscopic ultrasound-guided fine-needle aspiration of the pelvic lesion through the sigmoid colon,"Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a useful modality when the target is a lymph node located in the mediastinum, perigastric area or perirectum. Although it is difficult to carry out EUS-FNA of the colon using an oblique view linear scope, we report two cases of successful EUS-FNA of the lesions via the proximal sigmoid colon using a recently available new convex type EUS scope. Case 1 was a 77-year-old Japanese woman noted to have multiple lymph node swelling in the para-aortic area and in the pelvis. Case 2 was a 60-year-old Japanese woman noted to have a large mass in the left lower abdomen. In case 1, oral EUS showed no lymph node swelling. In both cases, EUS with forward-viewing radial echoendoscope was carried out via the anus, and multiple lymph-node swelling or a large mass was observed near the proximal sigmoid colon. In the EUS-FNA for these cases, we used a new convex-type EUS scope that has an oblique view, but with a wide-angled optical device giving a view similar to a forward one. EUS-FNA was successfully carried out on the lesions. The pathological specimen revealed diffuse large B-cell lymphoma in case 1 and gastrointestinal stromal tumor (GIST) in case 2. © 2010 Japan Gastroenterological Endoscopy Society.",hemoglobin;stem cell factor receptor;adult;aged;anemia;anorexia;article;ascites;fine needle aspiration biopsy;blood culture;case report;colonoscopy;computer assisted tomography;dementia;diabetes mellitus;endoscopic echography;esophagogastroduodenoscopy;fatigue;female;fever;gastrointestinal stromal tumor;heart failure;heart infarction;hemoglobin blood level;human;human tissue;hypertension;hysterectomy;immunohistochemistry;jaw tumor;leukocyte count;liver biopsy;myoma;paraaortic lymph node;pelvic disease;sigmoid;Staphylococcus epidermidis;swelling;tumor volume,"Matsui, N.;Akahoshi, K.;Motomura, Y.;Kubokawa, M.;Endoh, S.;Matsuura, R.;Oda, H.;Nakashima, Y.;Oya, M.;Nakamura, K.",2010,,,0,
2873,Sudden death in Parkinson's disease: A retrospective autopsy study,"The aim of this paper is to reveal the causes of death and to verify sudden death of Parkinson's disease (PD) in an autopsy study. We reviewed the clinical data and the causes of death in 16 PD patients who had postmortem examinations. Prior to autopsy, nine patients died of known causes: five patients died of aspiration pneumonia, two of myocardial infarction, one of asphyxia, and one of dilated cardiomyopathy. Autopsy confirmed that the putative causes of death were compatible with the pathological ones. The remaining seven patients died suddenly of unknown causes. Autopsy revealed that the causes of death were asphyxia in two patients and perforation of a duodenal ulcer in one patient. Autopsy did not determine the causes of unknown death in the remaining four patients. Consequently, autopsy revealed that eight patients died of swallowing problems such as aspiration pneumonia and asphyxia, four of sudden death, three of cardiac problems, and one of a gastrointestinal problem. Although there was a bias that all patients had a postmortem examination, our study revealed that several PD patients died of sudden death without any satisfactory causes of death determined even by autopsy. Therefore, we propose that a non-negligible number of PD patients die of sudden death. © 2014 Elsevier B.V.",amantadine;bromocriptine;carbidopa plus levodopa;clotiazepam;etizolam;flunitrazepam;haloperidol;levodopa;midodrine;pergolide;sennoside;droxidopa;tiapride;trihexyphenidyl;adult;aged;agitation;akinesia;article;asphyxia;aspiration pneumonia;autonomic dysfunction;autopsy;cardiopulmonary arrest;cardiovascular disease;cause of death;clinical article;congestive cardiomyopathy;constipation;dementia;disease duration;duodenum perforation;duodenum ulcer;dysphagia;female;femur neck fracture;gastrointestinal symptom;head tilting;heart infarction;hemispheric dominance;hospital admission;hospital discharge;hospital patient;hospitalization;human;immobility;insomnia;loss of appetite;male;middle aged;muscle rigidity;neurologic gait disorder;orthostatic hypotension;outpatient;Parkinson disease;patient transport;priority journal;retrospective study;sudden death;supine position;time of death;treatment response;tremor;unconsciousness;urogenital tract disease;very elderly;walking difficulty,"Matsumoto, H.;Sengoku, R.;Saito, Y.;Kakuta, Y.;Murayama, S.;Imafuku, I.",2014,,,0,
2874,Present status of J-stars and substudies,"Background: In Japan, it is still unclear whether hyperlipidemia is a risk factor of recurrent stroke in the ischemic stroke patients, though statin therapy could decrease the incidence of coronary heart disease and first occurrence of stroke in Japanese patients with hypercholesterolaemia (MEGA study). The neuroprotective mechanism beyond cholesterol-lowering effects could be expected to attenuate cerebrovascular inflammation and atherosclerosis. Objective: This study hypothesizes if the treatment with a low-dose pravastatin (10 mg/day) prevents recurrent stroke in Japanese patients with ischemic stroke with safety. Design: J-STARS is a multicenter, prospective, randomized, open label, blinded-endpoint, active controlled, parallel group trial. Population Studied: Eligibility includes, 1) ischemic stroke from 1 month to 3 years after the onset, except for cardiogenic embolism, 2) 45-80 years old, and 3) total cholesterol level of 180-240 mg/dL without the prescription of statin. Exclusion criteria includes, ischemic stroke of other determined cause according to the TOAST classification, ischemic heart disease necessary to require statin, and hemorrhagic disorders. Interventions: Patients were randomized into the group receiving pravastatin 10 mg/day or that having no statin. Outcome Measures: The primary outcome for this study is cerebrovascular events. The secondary outcomes include the events of ischemic or hemorrhagic stroke, cardiovascular events, death of all causes, hospital admission, dementia, and cognitive impairment. Statistical Analysis: The final analysis will be performed by employing Kaplan-Meier survival method, a stratified log-rank test and Cox proportional hazard model. Trial Status: A total of 1578 patients were recruited from 123 centers by 2009, and completed follow-up at February, 2014 (mean 4.7 years at January, 2014). Mean age 66.2 years; 25.4% atherothrombotic infarction, 64.2% lacunar infarction. The protocol paper including baseline data has been published (Nagai Y et al., Int J Stroke, 2013). The latest status including substudies (e.g. J-STARS Echo, hsCRP and Genomics) will be presented at the conference.",cerebrovascular accident;Asia;human;brain ischemia;patient;ischemic heart disease;Japanese (people);safety;statistical analysis;therapy;low drug dose;atherosclerosis;hyperlipidemia;hospital admission;dementia;cognitive defect;survival;log rank test;population;inflammation;brain hemorrhage;hypercholesterolemia;bleeding disorder;stroke patient;classification;genomics;infarction;death;prescription;cholesterol blood level;follow up;embolism;proportional hazards model;risk factor;lacunar stroke;Japan;statin (protein);pravastatin;cholesterol,"Matsumoto, M.;Hosomi, N.;Aoki, S.;Fukushima, M.;Nagai, Y.;Minematsu, K.;Yokota, C.;Origasa, H.;Uchiyama, S.;Ibayashi, S.",2014,,10.1159/000367674,0,2875
2875,Present status of J-stars and substudies,"Background: In Japan, it is still unclear whether hyperlipidemia is a risk factor of recurrent stroke in the ischemic stroke patients, though statin therapy could decrease the incidence of coronary heart disease and first occurrence of stroke in Japanese patients with hypercholesterolaemia (MEGA study). The neuroprotective mechanism beyond cholesterol-lowering effects could be expected to attenuate cerebrovascular inflammation and atherosclerosis. Objective: This study hypothesizes if the treatment with a low-dose pravastatin (10 mg/day) prevents recurrent stroke in Japanese patients with ischemic stroke with safety. Design: J-STARS is a multicenter, prospective, randomized, open label, blinded-endpoint, active controlled, parallel group trial. Population Studied: Eligibility includes, 1) ischemic stroke from 1 month to 3 years after the onset, except for cardiogenic embolism, 2) 45-80 years old, and 3) total cholesterol level of 180-240 mg/dL without the prescription of statin. Exclusion criteria includes, ischemic stroke of other determined cause according to the TOAST classification, ischemic heart disease necessary to require statin, and hemorrhagic disorders. Interventions: Patients were randomized into the group receiving pravastatin 10 mg/day or that having no statin. Outcome Measures: The primary outcome for this study is cerebrovascular events. The secondary outcomes include the events of ischemic or hemorrhagic stroke, cardiovascular events, death of all causes, hospital admission, dementia, and cognitive impairment. Statistical Analysis: The final analysis will be performed by employing Kaplan-Meier survival method, a stratified log-rank test and Cox proportional hazard model. Trial Status: A total of 1578 patients were recruited from 123 centers by 2009, and completed follow-up at February, 2014 (mean 4.7 years at January, 2014). Mean age 66.2 years; 25.4% atherothrombotic infarction, 64.2% lacunar infarction. The protocol paper including baseline data has been published (Nagai Y et al., Int J Stroke, 2013). The latest status including substudies (e.g. J-STARS Echo, hsCRP and Genomics) will be presented at the conference.",cerebrovascular accident;Asia;human;brain ischemia;patient;ischemic heart disease;Japanese (people);safety;statistical analysis;therapy;low drug dose;atherosclerosis;hyperlipidemia;hospital admission;dementia;cognitive defect;survival;log rank test;population;inflammation;brain hemorrhage;hypercholesterolemia;bleeding disorder;stroke patient;classification;genomics;infarction;death;prescription;cholesterol blood level;follow up;embolism;proportional hazards model;risk factor;lacunar stroke;Japan;statin (protein);pravastatin;cholesterol,"Matsumoto, M;Hosomi, N;Aoki, S;Fukushima, M;Nagai, Y;Minematsu, K;Yokota, C;Origasa, H;Uchiyama, S;Ibayashi, S",2014,,10.1159/000367674,0,
2876,A case of cardiac arrests before and after emergent exploratory laparotomy for panperitonitis,"We report a case of cardiac arrest before and after emergent exploratory laparotomy for panperitonitis in an 84-year-old woman with a history of hypertension, gastric ulcer, uterine myoma and dementia. She complained of lower abdominal pain, and suffered from septic shock and DIC. The first cardiac arrest occurred after anesthesia induction. Following resuscitation, a left hemicolectomy and colostomy were performed. The second cardiac arrest occurred immediately after the operation. Cardiac arrest in this case may have been due to preexisting cardiac dysfunction enhanced by septic shock. Prompt preoperative evaluation of cardiac function is necessary for successful circulatory management during anesthesia induction for surgical patients in septic shock.",aged;anamnesis;anesthesia induction;article;case report;clinical feature;colostomy;female;heart arrest;hemicolectomy;human;panperitonitis;peritonitis;preoperative evaluation;resuscitation;septic shock,"Matsuo, A.;Ueki, R.;Yamaguchi, T.;Tatara, T.;Kohama, K.;Terashima, M.;Kotani, J.",2012,,,0,
2877,Arterial stiffness independently predicts cardiovascular events in an elderly community - Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study,"We investigated the predictive value of arterial stiffness to assess cardiovascular risk in elderly community-dwelling people by means of a multivariate Cox model. In 298 people older than 75 years (120 men and 178 women, average age: 79.6 years), brachial-ankle pulse wave velocity (baPWV) was measured between the right arm and ankle in a supine position. The LILAC study started on July 25, 2000, consultation was repeated yearly, and the last follow-up ended on November 30, 2004. During this follow-up span of 1227 days, there were nine cardiovascular deaths, the cause of death being myocardial infarction for two men and three women or stroke for two men and two women. In Cox proportional hazard models, baPWV as well as age, Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale Revised (HDSR) and the low-frequency/high-frequency (LF/HF) ratio showed a statistically significant association with the occurrence of cardiovascular death. A two-point increase in MMSE and HDSR score significantly protected against cardiovascular death, the relative risk (RR) being 0.776 (P = 0.0369) and 0.753 (P = 0.0029), respectively. The LF/HF ratio also was significant (P = 0.025), but the other indices of HRV were not. After adjustment for age and HDSR, a 200 cm/s increase in baPWV was associated with a 30.2% increase in risk (RR = 1.302, 95% CI: 1.110-1.525), and a 500 cm/s increase in baPWV with a 93.3% increase in risk (RR = 1.933, 95% CI: 1.300-2.874, P = 0.0011), whereas the LF/HF ratio was no longer associated with a statistically significant increase in cardiovascular mortality. In elderly community-dwelling people, arterial stiffness measured by means of baPWV predicted the occurrence of cardiovascular death beyond the prediction provided by age, gender, blood pressure and cognitive functions. baPWV should be added to the cardiovascular assessment in various clinical settings, including field medical surveys and preventive screening. The early detection of risk by chronomics allows the timely institution of prophylactic measures, thereby shifting the focus from rehabilitation to prehabilitation medicine, as a public service to several Japanese towns. © 2005 Elsevier SAS. All rights reserved.",aged;aging;ankle;arm;article;cardiovascular disease;cardiovascular risk;cognition;community care;controlled study;disease association;female;follow up;human;longevity;major clinical study;male;Mini Mental State Examination;multivariate analysis;prediction;priority journal;pulse wave;risk assessment;statistical analysis,"Matsuoka, O.;Otsuka, K.;Murakami, S.;Hotta, N.;Yamanaka, G.;Kubo, Y.;Yamanaka, T.;Shinagawa, M.;Nunoda, S.;Nishimura, Y.;Shibata, K.;Saitoh, H.;Nishinaga, M.;Ishine, M.;Wada, T.;Okumiya, K.;Matsubayashi, K.;Yano, S.;Ichihara, K.;Cornélissen, G.;Halberg, F.;Ozawa, T.",2005,,,0,
2878,'PrP systemic deposition disease': Clinical and pathological characteristics of novel familial prion disease with 2-bp deletion in codon 178,"Background and purpose: A novel TYPE of prion disease associated mainly with autonomic-sensory polyneuropathy was reported by us previously. Methods: Here the autopsy pathology for patient 1 (the sister) and the clinical characteristics of her younger brother (patient 2) are newly reported. Polymerase chain reaction based restriction fragment length polymorphism analysis of the prion protein gene (PRNP) was performed on both patients and their father (normal control). Results: Polymerase chain reaction based restriction fragment length polymorphism analysis revealed a 2-bp deletion (CT) in codon 178 that causes an additional variable 25 amino acids at the C terminal, from the mutation site to the premature stop codon at codon 203, in both patients 1 and 2 but not in their father. The autopsy of patient 1 showed remarkable prion protein (PrP) deposits in the sympathetic ganglion and peripheral nerves, correlated to her severe autonomic sensory failure. PrP deposits were also found in the central nervous system and peripheral organs such as the heart, lung, stomach, jejunum, ileum, colon, urinary bladder and adrenal gland. The symptoms and biopsy findings of patient 2 were nearly the same as those reported previously for patient 1. His cognitive function was well preserved, but autonomic functions were severely impaired. His biopsied samples showed PrP deposits in the sural nerve and nerve plexuses of the stomach and colon. Conclusion: The present unique 2-bp deletion (CT) in codon 178 induced a 'PrP systemic deposition disease' such as pan-autonomic failure, sensory neuropathy and mild cognitive impairment with a specific pathology.",prion protein;adult;article;autonomic neuropathy;autopsy;carboxy terminal sequence;clinical feature;codon;cognition;faintness;female;gene deletion;gene mutation;heart failure;human;hypothermia;male;nerve plexus;orthostatic hypotension;pneumonia;polymerase chain reaction;polyneuropathy;prion disease;priority journal;restriction fragment length polymorphism;sensory neuropathy;stop codon;sural nerve;sympathetic ganglion;urine retention;vomiting,"Matsuzono, K.;Honda, H.;Sato, K.;Morihara, R.;Deguchi, K.;Hishikawa, N.;Yamashita, T.;Kono, S.;Ohta, Y.;Iwaki, T.;Abe, K.",2016,,,0,
2879,Mechanisms of neurodegeration in type 2 diabetes and the neuroprotective potential of dipeptidyl peptidase 4 inhibitors,"Prospective epidemiological studies suggest that type 2 diabetes is a risk factor for neurodegenerative pathologies such as Alzheimer disease, vascular dementia, and Parkinson disease. Drugs that act as incretin receptor agonists or inhibit the proteolytic degradation of incretins (dipeptidyl peptidase 4 inhibitors) have been approved since 2005 for use in diabetes treatment. Dipeptidyl peptidase 4 (DPP4) cleaves N-terminal dipeptides from polypeptides when the second residue is proline, hydroxyproline, dehydroproline or alanine. The inhibition of DPP4 hydrolytic activities extends the halflife of these peptides by preventing their degradation. Several peptides have been identified as DPP4 substrates, including neuropeptides, chemokines, and the incretin hormones; hence the pleomorphic effects of DPP4 inhibition. Recently, the neuroprotective properties of these drugs have been evaluated in cell cultures and animal models, not yet in human trials. Although mechanisms distinct from glycaemic control alone have been claimed to account for protection against neuronal degeneration, the precise cellular mechanism by which DPP4 inhibitors exert their neuroprotective effects remain unknown. The present review is focused on the candidate pathways that could be involved in mediating DPP4 inhibitors-mediated protection against neuronal degeneration.",alogliptin;calcitonin gene related peptide;chemokine;dipeptidyl peptidase IV inhibitor;gastric inhibitory polypeptide;gastrin releasing peptide;glucagon like peptide 1;hydrolase;incretin;intermedin;macrophage derived chemokine;macrophage inflammatory protein 1alpha;macrophage inflammatory protein 2;neuropeptide;neuropeptide Y;saxagliptin;sitagliptin;vildagliptin;Alzheimer disease;article;cell culture;degenerative disease;diabetes mellitus;diffuse Lewy body disease;energy metabolism;glucagon release;heart infarction;multiinfarct dementia;nerve cell degeneration;neuroprotection;non insulin dependent diabetes mellitus;Parkinson disease,"Matteucci, E.;Giampietro, O.",2015,,,0,
2880,Cerebral amyloid angiopathy related hemorrhage after stroke thrombolysis: Case report and literature review,"Cerebral amyloid angiopathy (CAA) predisposes to symptomatic intracerebral hemorrhage (sICH) after combined thrombolytic and anticoagulant treatment of acute myocardial infarction. However, the role of CAA in stroke thrombolysis has not been established. Here, we describe a confirmed case of CAA-related hemorrhage in a patient receiving thrombolysis for acute ischemic stroke. On autopsy, immunohistochemistry revealed amyloid-β positive staining in thickened cortical and meningeal arteries at sites of hemorrhage. Further research is urgently needed to determine the hemorrhage risk related to CAA in stroke thrombolysis and develop better diagnostic tools to identify CAA in the emergency room.",alteplase;amyloid beta protein;aged;Alzheimer disease;article;autopsy;brain hemorrhage;brain hernia;brain infarction;brain ischemia;case report;clinical feature;cortical thickness (brain);drug induced headache;drug infusion;female;fibrinolytic therapy;human;human tissue;immunohistochemistry;meningeal artery;neurofibrillary tangle;neuropathology;priority journal;senile plaque;staining;stroke patient;subarachnoid hemorrhage;subdural hematoma;vascular amyloidosis;vascular necrosis,"Mattila, O. S.;Sairanen, T.;Laakso, E.;Paetau, A.;Tanskanen, M.;Lindsberg, P. J.",2015,,,0,
2881,Cardiac myxomas: A long term study,"From 1980 to 1992 we followed 12 patients with cardiac myxomas for an average of 4.4 years (8 months-11 years). Presenting symptoms were neurological in four patients (hemiparesis, aphasia, visual field deficits, progressive dementia or vertigo), progressive dyspnoea in six, pulmonary embolism in one, and peripheral arterial or renal emboli in three. The diagnosis was suspected clinically in 11 patients. It was confirmed by echocardiography in ten and by thoracic CT in one. All these patients had cardiac surgery. One diagnosis was made at autopsy; the patient died unexpectedly during surgery for emboli to the leg arteries. At follow-up, two additional patients had died, one from myocardial infarction and one from rhabdomyosarcoma. Only one of the nine surviving patients had recurrent symptoms after cardiac surgery. His dementia continued to progress. The patients without new symptoms after cardiac surgery had normal MRI of the brain or residual ischaemic lesions. MRI of the patient with progressive dementia showed multiple cerebral lesions with a bright centre and a dark rim on T1- and T2-weighted spin-echo images. On CT there were many calcified lesions. CT, MR angiography and contrast angiography revealed multiple fusiform aneurysms. The rare occurrence of progressive neurological symptoms after myxoma resection with multiple cerebral lesions and aneurysms should suggest myxoma metastases to the brain.",adult;aged;aphasia;artery embolism;article;brain artery aneurysm;cause of death;clinical article;computer assisted tomography;dementia;dyspnea;echocardiography;female;heart infarction;heart myxoma;hemiparesis;human;kidney artery embolism;lung embolism;magnetic resonance angiography;male;mortality;priority journal;recurrent disease;rhabdomyosarcoma;symptom;vertigo;visual field defect,"Mattle, H. P.;Maurer, D.;Sturzenegger, M.;Ozdoba, C.;Baumgartner, R. W.;Schroth, G.",1995,,,0,
2882,Multidomain lifestyle interventions for the prevention of cognitive decline after ischemic stroke randomized trial,"Background and Purpose.Cognitive impairment occurs in.30% of all stroke survivors. However, effective therapies aimed at preventing poststroke cognitive decline are lacking. We assessed the efficacy of a multidomain intervention on preventing cognitive decline after stroke. Methods.In this randomized, observer-blind trial patients were recruited within 3 months after an acute stroke in 5 Austrian neurological centers. Patients were assigned to a 24-month lifestyle-based multidomain intervention or standard stroke care. Primary outcomes were the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) and occurrence of cognitive decline in the composite scores of at least 2 of 5 cognitive domains at 24 months. Results.A total of 101 patients were randomized into multi-intervention and 101 into standard care during June 2010 and November 2012. Of them, 76 patients in the intervention group and 83 in the control group were included in the final intention-to-treat analysis. At 24 months, 8 of 76 (10.5%) patients in the intervention group and 10 of 83 (12.0%) patients in the control group showed cognitive decline corresponding to a relative risk reduction of 0.874 (95% confidence interval, 0.364.2.098). The change in ADAS-cog from baseline to 24 months was not different either (median 0 [IQR,-1 to 2] in both groups; P=0.808). Conclusions.This trial found no benefit of 24-month multidomain intervention with focus on improvement in lifestyle and vascular risk factors on the incidence of poststroke cognitive decline in comparison with standard stroke care. Studies with a larger sample size are needed.",NCT01109836;adult;aged;Alzheimer Disease Assessment Scale;article;body mass;brain ischemia;clinical effectiveness;cognitive defect;controlled study;executive function;heart infarction;human;information processing;intention to treat analysis;lifestyle modification;major clinical study;medication compliance;multidomain lifestyle intervention;outcome assessment;physical activity;priority journal;randomized controlled trial;recurrent disease;single blind procedure;spatial memory;standard;transient ischemic attack;visual memory;working memory,"Matz, K.;Teuschl, Y.;Firlinger, B.;Dachenhausen, A.;Keindl, M.;Seyfang, L.;Tuomilehto, J.;Brainin, M.",2015,,,0,
2883,High doses of B vitamins may worsen diabetic nephropathy,"Background: Diabetic nephropathy resulting in end-stage renal disease is a reality for more than 44 percent of patients with diabetes mellitus. In addition to the medical challenges, treatment of nephropathy causes a serious financial burden, costing the United States more than $10 billion annually. Observational studies have suggested a relationship between elevated plasma homocysteine levels and the risk of developing diabetic nephropathy. House and colleagues hypothesized that B-vitamin therapy, which has been shown to lower homocysteine levels, would slow diabetic nephropathy and prevent subsequent vascular events, such as myocardial infarction and stroke.The Study: The DIVINe (Diabetic Intervention with Vitamins to Improve Nephropathy) study, a multicenter, randomized, double-blind, placebo-controlled trial of patients with types 1 or 2 diabetes, was conducted between May 2001 and July 2007. Adults with diabetes and known renal disease were eligible, although those with stages 4 or 5 renal failure, expected survival of less than three years, creatinine clearance of less than 30 mL per minute per 1.73 m2 (0.50 mL per second per m2), or those already on dialysis were excluded. In all, 238 patients were randomized to receive a daily B-vitamin supplement tablet that included folic acid (2.5 mg), vitamin B6 (25 mg), and vitamin B12 (1 mg) or a matching placebo. Follow-up occurred at six-month intervals for up to 36 months. Patients were permitted to take all other vitamin supplements but not additional doses of the B vitamins studied in the trial. A baseline glomerular filtration rate (GFR) and plasma homocysteine level were established for each patient, and levels were checked periodically throughout the study. The primary end point was progression of nephropathy, as measured by change in GFR. Secondary end points included dialysis, occurrence of vascular events, all-cause mortality, cognitive decline, and amputation.Results: Although the initial trial size of 286 patients was designed to provide 80 percent power to detect a 25 percent reduction in GFR, the authors stopped enrollment after 252 patients when it was noted that the intervention group's GFR was falling faster than the predicted rate of the placebo group. The data and safety monitoring committee determined that continuing the study would not likely yield a significant benefit in the primary end point. Although the intervention group had significantly lower homocysteine levels than the placebo group at 36 months, the B-vitamin group had a statistically significant decrease in mean GFR (16.5 mL per minute per 1.73 m2 [0.28 mL per second per m2]) compared with placebo (10.7 mL per minute per m2 [0.18 mL per second per m2]; P =.02). Equal numbers of patients progressed to dialysis in each group, but patients in the B-vitamin group had higher rates of myocardial infarction, stroke, revascularization, and all-cause mortality. None of the individual events reached statistical significance, but the overall rate of secondary outcomes was statistically significant (P =.04).Conclusion: The authors conclude that supplementation with high doses of B vitamins lowers plasma homocysteine levels but worsens diabetic nephropathy and increases the risk of cerebrovascular and cardiovascular events in patients with diabetes. Other nonvitamin methods of reducing plasma homocysteine levels should be investigated. © 2011 by the American Academy of Family Physicians.",cyanocobalamin;folic acid;homocysteine;placebo;pyridoxine;vitamin B group;amino acid blood level;amputation;article;cardiovascular risk;cause of death;cerebrovascular disease;clinical effectiveness;diabetic nephropathy;dialysis;disease exacerbation;dose response;drug effect;drug efficacy;drug megadose;drug safety;follow up;glomerulus filtration rate;human;mental deterioration;outcome assessment;treatment duration,"Maurer, M. A.",2011,,,0,
2884,A life in the day of Mrs W 2,,morphine;aged;caregiver;case report;clinical protocol;Peptoclostridium difficile;death;decubitus;diabetes mellitus;distress syndrome;dying;female;heart infarction;hip fracture;home care;human;interpersonal communication;kidney failure;letter;life event;multiinfarct dementia;nursing care;pain;pneumonia;cerebrovascular accident,"Mawdsley, A. H.",2009,,,0,
2885,"Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada","Objectives: Assisted living (AL) is an increasingly used residential option for older adults with dementia; however, lower staffing rates and service availability raise concerns that such residents may be at increased risk for adverse outcomes. Our objectives were to determine the incidence of hospitalization over 1 year for dementia residents of designated AL (DAL) facilities, compared with long-term care (LTC) facilities, and identify resident- and facility-level predictors of hospitalization among DAL residents. Methods: Participants were 609 DAL (mean age 85.7 ± 6.6 years) and 691 LTC (86.4 ± 6.9 years) residents with dementia enrolled in the Alberta Continuing Care Epidemiological Studies. Research nurses completed a standardized comprehensive assessment of residents and interviewed family caregivers at baseline (2006-2008) and 1 year later. Standardized administrator interviews provided facility level data. Hospitalization was determined via linkage with the provincial Inpatient Discharge Abstract Database. Multivariable Cox proportional hazards models were used to identify predictors of hospitalization. Results: The cumulative annual incidence of hospitalization was 38.6% (34.5%-42.7%) for DAL and 10.3% (8.0%-12.6%) for LTC residents with dementia. A significantly increased risk for hospitalization was observed for DAL residents aged 90+ years, with poor social relationships, less severe cognitive impairment, greater health instability, fatigue, high medication use (11+ medications), and 2+ hospitalizations in the preceding year. Residents from DAL facilities with a smaller number of spaces, no chain affiliation, and from specific health regions showed a higher risk of hospitalization. Conclusions: DAL residents with dementia had a hospitalization rate almost 4-fold higher than LTC residents with dementia. Our findings raise questions about the ability of some AL facilities to adequately address the needs of cognitively impaired residents and highlight potential clinical, social, and policy areas for targeted interventions to reduce hospitalization risk.",age distribution;aged;arthritis;article;assisted living facility;Canada;caregiver;cognitive defect;comorbidity;controlled study;daily life activity;dementia;depression;emergency care;female;geriatric patient;health status;hospital admission;hospitalization;human;hypertension;ischemic heart disease;length of stay;long term care;male;marriage;nursing care;osteoporosis;palliative therapy;randomized controlled trial;risk factor;sex ratio;social interaction;very elderly;vulnerable population,"Maxwell, C. J.;Amuah, J. E.;Hogan, D. B.;Cepoiu-Martin, M.;Gruneir, A.;Patten, S. B.;Soo, A.;Le Clair, K.;Wilson, K.;Hagen, B.;Strain, L. A.",2015,,,0,
2886,Family data underused to track disease,,leucine rich repeat kinase 2;cause of death;data analysis;family history;gene mutation;genetic variability;genome analysis;genotype;heart infarction;Huntington chorea;note;online system;Parkinson disease;pedigree analysis;phenotype;priority journal;single nucleotide polymorphism;web browser,"May, M.",2010,,,0,
2887,Palliative care teams' cost-saving effect is larger for cancer patients with higher numbers of comorbidities,"Patients with multiple serious conditions account for a high proportion of health care spending. Such spending is projected to continue to grow substantially as a result of increased insurance eligibility, the ever-rising cost of care, the continued use of nonbeneficial high-intensity treatments at the end of life, and demographic changes. We evaluated the impact of palliative care consultation on hospital costs for adults with advanced cancer, excluding those with dementia. We found that compared to usual care, the receipt of a palliative care consultation within two days of admission was associated with 22 percent lower costs for patients with a comorbidity score of 2-3 and with 32 percent lower costs for those with a score of 4 or higher. Earlier consultation was also found to be systematically associated with a larger cost-saving effect for all subsamples defined by multimorbidity. Given ongoing workforce shortages, targeting early specialist palliative care to hospitalized patients with advanced cancer and higher numbers of serious concurrent conditions could improve care while complementing strategies to curb the growth of health spending.",acquired immune deficiency syndrome;adult;advanced cancer;aged;alcohol abuse;anemia;article;blood clotting disorder;cancer palliative therapy;cancer patient;chronic lung disease;comorbidity;congestive heart failure;cost control;cost effectiveness analysis;depression;diabetes mellitus;drug abuse;electrolyte disturbance;Elixhauser comorbidity index;female;health care cost;health impact assessment;heart arrhythmia;hospital admission;hospital cost;hospital patient;human;Human immunodeficiency virus infection;hypertension;hypothyroidism;kidney failure;liver disease;lymphoma;major clinical study;male;malnutrition;medical specialist;metastasis;morbidity;neurologic disease;obesity;outcome assessment;paralysis;patient referral;peptic ulcer;peripheral vascular disease;personnel shortage;psychosis;rheumatoid arthritis;secondary analysis;solid tumor;valvular heart disease;workload,"May, P.;Garrido, M. M.;Cassel, J. B.;Kelley, A. S.;Meier, D. E.;Normand, C.;Stefanis, L.;Smith, T. J.;Morrison, R. S.",2016,,,0,
2888,Racial/ethnic differences in dementia risk among older type 2 diabetic patients: The diabetes and aging study,"OBJECTIVE: Although patients with type 2 diabetes have double the risk of dementia, potential racial/ethnic differences in dementia risk have not been explored in this population. We evaluated racial/ethnic differences in dementia and potential explanatory factors among older diabetic patients. RESEARCH DESIGN AND METHODS: We identified 22,171 diabetic patients without preexisting dementia aged ≥60 years (14,546 non-Hispanic whites, 2,484 African Americans, 2,363 Latinos, 2,262 Asians, 516 Native Americans) from the Kaiser Permanente Northern California Diabetes Registry. We abstracted prevalent medical history (1 January 1996 to 31 December 1997) and dementia incidence (1 January 1998 to 31 December 2007) from medical records and calculated age-adjusted incidence densities. We fit Cox proportional hazards models adjusted for age, sex, education, diabetes duration, and markers of clinical control. RESULTS: Dementia was diagnosed in 3,796 (17.1%) patients. Age-adjusted dementia incidence densities were highest among Native Americans (34/1,000 person-years) and African Americans (27/1,000 person-years) and lowest among Asians (19/1,000 person-years). In the fully adjusted model, hazard ratios (95% CIs) (relative to Asians) were 1.64 (1.30-2.06) for Native Americans, 1.44 (1.24-1.67) for African Americans, 1.30 (1.15-1.47) for non-Hispanic whites, and 1.19 (1.02-1.40) for Latinos. Adjustment for diabetes-related complications and neighborhood deprivation index did not change the results. CONCLUSIONS: Among type 2 diabetic patients followed for 10 years, African Americans and Native Americans had a 40-60% greater risk of dementia compared with Asians, and risk was intermediate for non-Hispanic whites and Latinos. Adjustment for sociodemographics, diabetes-related complications, and markers of clinical control did not explain observed differences. Future studies should investigate why these differences exist and ways to reduce them. © 2014 by the American Diabetes Association.",African American;aged;American Indian;article;Asian;Caucasian;cerebrovascular disease;congestive heart failure;controlled study;dementia;diabetic retinopathy;disease control;disease duration;end stage renal disease;ethnic difference;female;gangrene;heart infarction;Hispanic;human;incidence;leg amputation;leg ulcer;major clinical study;male;non insulin dependent diabetes mellitus;peripheral vascular disease;race difference;socioeconomics;United States,"Mayeda, E. R.;Karter, A. J.;Huang, E. S.;Moffet, H. H.;Haan, M. N.;Whitmer, R. A.",2014,,,0,
2889,Cause of death in Washington state veterans hospitalized with acute coronary syndromes in the veterans health administration,"Background: In the United States, relatively little is known about cause of death in individuals who die prior to or after hospital discharge for acute coronary syndromes (ACS). The purpose of this report was to compare baseline patient characteristics according to whether the underlying cause of death was cardiac or non-cardiac. Methods: We linked cause of death information from Washington State death records to the Department of Veterans Affairs (VA) External Peer Review Program ACS registry. From 524 individuals who were hospitalized for ACS in veterans hospitals located in Washington State or Oregon, we identified 136 individuals who according to VA death records died during the years 2003 to 2005. Of these, 117 (86%) were found in Washington State death records. Sociodemographic variables, as well as underlying and secondary causes of death, were obtained from Washington State death records provided by the Washington State Department of Health. Clinical variables, including medical histories, presentation on admission, and in-hospital death were extracted from the VA ACS registry. Results: Somewhat surprisingly, only 52% of veterans died of cardiac causes when only the underlying cause of death was used. However, when secondary causes of death were added to the definition, the proportion that died of cardiac causes increased to 81%. Patient characteristics were similar in the two groups, although small numbers limited the ability to detect statistically significant differences. Conclusion: These preliminary findings suggest that it is important to consider secondary causes as well as the underlying one when classifying deaths as cardiac or non-cardiac. © 2008 Maynard et al; licensee BioMed Central Ltd.",acetylsalicylic acid;antilipemic agent;antithrombocytic agent;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;accident;acute coronary syndrome;acute heart infarction;aged;anamnesis;article;coronary artery atherosclerosis;cardiomyopathy;cardiovascular disease;cause of death;cerebrovascular accident;congestive heart failure;controlled study;decubitus;dementia;demography;diabetes mellitus;disease registry;female;gastrointestinal disease;atrial fibrillation;hospitalization;human;hypertension;kidney disease;major clinical study;male;medical record review;neoplasm;polyneuropathy;public hospital;respiratory tract disease;United States;vascular disease;veteran,"Maynard, C.;Lowy, E.;McDonell, M.;Fihn, S. D.",2008,,,0,
2890,The use of percutaneous coronary intervention in black and white veterans with acute myocardial infarction,"BACKGROUND: It is uncertain whether black white differences in the use of percutaneous coronary intervention (PCI) persist in the era of drug eluting stents. The purpose of this study is to determine if black veterans with acute myocardial infarction (AMI) are less likely to receive PCI than their white counterparts. METHODS: This study included 680 black and 3529 white veterans who were admitted to Veterans Health Administration (VHA) medical centers between July 2003 and August 2004. Information for this study was collected as part of the VHA External Peer Review Program for quality monitoring and improvement for a variety of medical conditions and procedures, including AMI. In addition, Department of Veterans Affairs workload files were used to determine PCI utilization after hospital discharge. Standard statistical methods including the Chi-square, 2 sample t-test, and logistic regression with a cluster correction for medical center were used to assess the association between race and the use of PCI < or = 30 days from admission. RESULTS: Black patients were younger, more often had diabetes mellitus, renal disease, or dementia and less often had lipid disorders, previous coronary artery bypass surgery, or chronic obstructive pulmonary disease than their white counterparts. Equal proportions of blacks and whites underwent cardiac catheterization < or = 30 days after admission, but the former were less likely to undergo PCI (32% vs. 40%, p < 0.0001). This difference persisted after multivariate adjustment, although measures of the extent of coronary artery disease were not available. CONCLUSION: Given the equivalent use of cardiac catheterization, it is possible that less extensive or minimal coronary artery disease in black patients could account for the observed difference.","African Americans/*statistics & numerical data;Aged;Aged, 80 and over;Angioplasty, Balloon, Coronary/*utilization;Cardiac Catheterization/utilization;Coronary Artery Bypass/utilization;European Continental Ancestry Group/*statistics & numerical data;Female;Hospitals, Veterans/*standards;Humans;Logistic Models;Male;Middle Aged;Myocardial Infarction/*ethnology/*therapy;*Patient Selection;Retrospective Studies;Time Factors;United States;United States Department of Veterans Affairs;*Utilization Review;Veterans/*statistics & numerical data","Maynard, C.;Sun, H.;Lowy, E.;Sales, A. E.;Fihn, S. D.",2006,Aug 21,10.1186/1472-6963-6-107,0,
2891,Twenty years and still counting: Including women as participants and studying sex and gender in biomedical research,"Background: This paper chronicles attempts in the United States over the past 20 years to fully represent women in clinical trials and ensure the study of sex and gender in biomedical research. We maintain that productive science with the aim of serving the public health requires examining the influence of sex and gender on health outcomes. Discussion: This section provides a historical perspective on the changes in recommendations and requirements of both the National Institutes of Health - the world's largest single funder of biomedical research - and the U.S. Food and Drug Administration - the world's most influential regulator of drugs and medical devices - for the acceptable conduct of research as it relates to sex and gender. We also cite all reports by the U.S. Institute of Medicine and the U.S. Congress' General Accountability Office issued from 1990 to the present on the inclusion of sex and gender in research, and selected high-impact published studies that illustrate and document the paucity of, yet the need for, inclusion of females and consideration of sex and gender in research across an array of biomedical disciplines. Summary: The key message of this paper is that it has been 20 years since the first requirements to include women as well as men in clinical trials and analyze results by sex were mandated by a U.S. federal law, yet not nearly enough progress has been made. Recent signs of potential change in both policy and practice of scientific inquiry suggest much more progress may be within reach. However, awaiting a cultural shift to allow the study of sex and gender to be embraced is not seen as an effective strategy for change. Rather, specific instrumental recommendations are offered for how to include the study of sex and gender in research so as to increase our understanding and promotion of health for the benefit of all.",Alzheimer disease;article;breast cancer;cardiovascular disease;cause of death;clinical practice;depression;documentation;feasibility study;food and drug administration;gender and sex;health care policy;health promotion;human;Human immunodeficiency virus infection;ischemic heart disease;law;lung cancer;medical research;multiple sclerosis;national health organization;obesity;organization;osteoporosis;pain;papillomavirus infection;postmenopause;practice guideline;premenopause;risk factor;sex difference;sleep;smoking;thyroid disease;United States;uterine cervix cancer,"Mazure, C. M.;Jones, D. P.",2015,,,0,
2892,Impact of post-operative complications on quality of life after pancreatectomy,"Context Pancreatectomies for malignant and benign diseases are increasingly being performed worldwide. Recent studies, that have evaluated quality of life in pancreatectomy, have reported conflicting outcomes. Objective This study was undertaken to analyze the quality of life changes reported by patients with pancreatic cancer undergoing pancreatectomy. Design Post-hoc analysis was performed of a clinical trial examining the safety of intraoperative autotransfusion during oncologic resections. Main outcome measures Perioperative (90-day) complications were graded prospectively using a validated 5-point scale. Quality of life parameters were recorded prospectively by a single trained interviewer preoperatively, at the first post-operative outpatient visit, and at 6 weeks, 3 months, and 6 months follow-up using the EORTC QLQ-C30 and FACT-An instruments. Results Pancreatectomy for adenocarcinoma was performed in 34 patients with a median follow-up of 2 years (range: 1-1.5 years). Major (grade ≥ 3) complications occurred in 12 (35.3%) of patients. Early (<6 month) recurrence was noted in 2 patients (5.9%). Increased severity of fatigue, pain, dyspnea, and loss of appetite over baseline were noted at initial follow-up (P<0.05); however, symptom scores normalized at 6-week follow-up, and remained stable at 6 months. No significant difference was noted in quality of life metrics between patients with or without major complications (P>0.11). A significant (P=0.023) decline in cognitive function vs. baseline was noted at 6-month follow-up after pancreatectomy. Using a repeated-measures generalized linear model, neither age, nor complication occurrence, nor adjuvant therapy, nor early recurrence accounted for this cognitive decline (P>0.10). Conclusion Quality of life metrics tend to normalize to preoperative levels after pancreatectomy at 6 weeks post-operatively. The occurrence of major complications does not predict a decreased quality of life. The decrease in self-reported cognitive function at six months in this cohort merits further study.",acute kidney failure;adult;aged;anemia;anorexia;article;atelectasis;blood autotransfusion;clinical article;Clostridium difficile infection;controlled study;disease severity;dyspnea;fatigue;female;follow up;heart infarction;human;ileus;length of stay;liver abscess;male;mental deterioration;operation duration;outcome assessment;outpatient care;pancreas adenocarcinoma;pancreas resection;patient safety;peroperative complication;peroperative care;pneumonia;postoperative care;postoperative complication;postoperative pain;quality of life;cancer recurrence;small intestine obstruction;surgical wound,"Mbah, N.;Brown, R. E.;St. Hill, C. R.;Bower, M. R.;Ellis, S. F.;Scoggins, C. R.;McMasters, K. M.;Martin, R. C. G.",2012,,,0,
2893,Osteo-articular manifestations of amyloidosis,"Whether it is overload disease or mispleated proteins, amyloid is a great pretender. This is especially true for all of the osteo-articular manifestations of amyloid light chain (AL) amyloidosis, which may mimic rheumatoid arthritis, polymyalgia rheumatica, a myeloma or a bone tumour. To improve the prognosis, AL amyloidosis must be considered in front of atypical osteo-articular manifestations. Amyloidosis Ab2 M of chronic haemodialysis (members' arthropathy and destructive spondylitis) is a specific entity that needs to be differentiated from other osteoarthropathies of chronic renal failure. It has become exceptional since the progress of haemodialysis. Finally transthyretin amyloidosis(ATTR) can be responsible for carpal tunnel syndrome(CTS) in its genetic and senile form. Although amyloidosis is rare, it represents one of the aetiologies of CSC, regardless of its type. In the specific context of haemodialysis, this poses no difficulty for the clinician. Yet AL amyloidosis must be considered more often, as must senile amyloidosis ATTR in the elderly. It seems obvious that the anatomo-pathologic analysis with specific staining with Congo red - see typing - should be systematically performed in the case of surgical neurolysis. Amyloidosis is defined by the extracellular deposit of proteins which share common tinctorial affinities, a fibril aspect under electron microscopy and spatial conformation called beta pleated. Once regarded as a mere overload disease, it is currently considered as a disease of misfolded proteins. Indeed, it is certain that abnormalities of spatial pattern play an essential role in the responsibility for the pathology of many proteins whose amyloid fibre is the final common way. They involve both changes in the conformation of proteins and other major in vivo interactions between amyloid protein and the extracellular matrix. In most cases, amyloidosis represents the bulk of histopathological lesions and its pathogenic role is certain. In other cases, it is only one elementary lesion of the disease and its role is controversial. The amyloidosis responsible for osteo-articular manifestations are the AL immunoglobulin amyloidosis, the beta2-microglobulin amyloidosis in patients under haemodialysis and finally the amyloidosis of transthyretin (genetic and senile). Rheumatological manifestations of immunoglobulin amyloidosis are numerous and often indicative of the disease. Deposits affect joint and periarticular structures. The most common presentation is a progressively developing bilateral symmetric polyarthritis with negative immunology and absent specific structural abnormalities. Carpal tunnel syndrome (CTS) is very common and should suggest the aetiology. Other clinical representations are rarer as an isolated bone tumour (amyloidoma) or integrating systemic AL amyloidosis. β 2-Microglobulin amyloidosis occurs in patients under chronic haemodialysis. It is responsible for CTS, arthralgia and above all a specific destructive spondyloarthropathy. The transthyretin amyloidosis also causes CTS. © 2012 Elsevier Ltd. All rights reserved.",amyloid beta protein;amyloid P component;amyloid protein;apolipoprotein A1;beta 2 microglobulin;bortezomib;C reactive protein;colchicine;cyclophosphamide;dexamethasone;gadolinium;glycosaminoglycan;immunoglobulin G;immunoglobulin kappa chain;immunoglobulin lambda chain;lenalidomide;melphalan;nonsteroid antiinflammatory agent;pomalidomide;prealbumin;prednisone;technetium 99m;thalidomide;aging;Alzheimer disease;amyloidosis;ankylosing spondylitis;arthralgia;arthropathy;arthroscopy;article;bone destruction;bone scintiscanning;bone swelling;bone tumor;carpal tunnel syndrome;cervical spine;chondrosarcoma;chronic kidney failure;clinical feature;drug megadose;electromyogram;electron microscopy;extracellular matrix;familial amyloidosis;fiber;hand osteoarthritis;heart failure;hemodialysis patient;histopathology;human;incidence;kidney amyloidosis;kidney transplantation;low drug dose;muscle atrophy;myeloma;nuclear magnetic resonance imaging;osteoarthritis;osteosclerosis;pathologic fracture;peripheral neuropathy;polyarthritis;priority journal;prognosis;protein conformation;protein expression;proteomics;randomized controlled trial (topic);rheumatic polymyalgia;rheumatoid arthritis;spine fracture;spondyloarthropathy;synovectomy;synovial fluid;temporal arteritis,"M'Bappé, P.;Grateau, G.",2012,,,0,
2894,Minerva,,cyclosporin A;Ginkgo biloba extract;retinol;steroid;acute heart infarction;braille;brain tumor;breast cancer;clinical trial;coronary risk;dementia;eye color;eye refraction;general aspects of disease;human;intraocular foreign body;iron overload;laparoscopy;maternal welfare;meat;note;occupational health;priority journal;retinol deficiency;salmonellosis;ulcerative colitis;vaginitis;egb 761,"McAlister, J. G.;McNaught, A.;Schulenburg, W. E.",1997,,,0,
2895,Glutamate-based depression GBD,"We describe a new term: glutamate-based depression (GBD). GBD is defined as a chronic depressive illness associated with environmental stress and diseases associated with altered glutamate neurotransmission. We hypothesize that glutamate-induced over-activation of extrasynaptic NMDA receptors in the subgenual cingulate area called Brodmann's 25 plays an important role in the etiology of depression and may be responsible for the high incidence of co-morbid depression associated in diseases with glutamate etiology. While depression is a syndrome with multiple possible etiologies, we propose that a disruption in glutamatergic neurotransmission may underline a substantial proportion of clinically observed depression. The high rates of depressive symptoms associated with various disorders in which altered glutamatergic functions have been identified, may suggest a common pathophysiological mechanism is underlying the diverse clinical presentations.","Affect/physiology;Alzheimer Disease/complications;Arthritis, Rheumatoid/complications;Chronic Pain/complications;Cognition/physiology;Coronary Artery Disease/complications;Depression/*etiology/*metabolism/physiopathology;Diabetes Complications/etiology/psychology;Fibromyalgia/complications;Glutamic Acid/*metabolism;Gyrus Cinguli/metabolism/physiopathology;Humans;Huntington Disease/complications;Inflammation/complications;Interferons/metabolism;Models, Neurological;Models, Psychological;Parkinson Disease/complications;Receptors, N-Methyl-D-Aspartate/metabolism;Risk Factors;Stroke/complications;Synaptic Transmission","McCarthy, D. J.;Alexander, R.;Smith, M. A.;Pathak, S.;Kanes, S.;Lee, C. M.;Sanacora, G.",2012,May,10.1016/j.mehy.2012.02.009,0,
2896,Care of the patient on long-term oral glucocorticoids,"Prolonged oral glucocorticoid therapy is particularly prevalent in older adults, and these patients are vulnerable to the varied complications of this treatment. Care must be taken to use the lowest possible dose and the shortest duration of therapy. © Istockphoto/Mlos Jokic.",alendronic acid;amitriptyline;bisphosphonic acid derivative;calcium;calcium carbonate;citalopram;corticotropin;cyclophosphamide;cytochrome P450 3A;cytochrome P450 3A4;cytochrome P450 3A5;cytochrome P450 3A7;dexamethasone;diazepam;glucocorticoid;hydrocortisone;indometacin;insulin;lansoprazole;methylprednisolone;nonsteroid antiinflammatory agent;omeprazole;pantoprazole;phenobarbital;prednisolone;progesterone;propranolol;rabeprazole;rifampicin;unindexed drug;vitamin D;acne;acquired hemolytic anemia;alopecia;ankylosing spondylitis;asthma;idiopathic thrombocytopenic purpura;avascular necrosis;behavior change;bone densitometry;brain tumor;cancer chemotherapy;cardiovascular risk;cataract;chronic obstructive lung disease;congestive heart failure;dementia;depression;dermatomyositis;Duchenne muscular dystrophy;enteritis;euphoria;fluid retention;fragility fracture;glomerulonephritis;glucose metabolism;heart infarction;human;hyperglycemia;hypertension;hypertrichosis;insomnia;interstitial lung disease;long term care;memory disorder;muscle weakness;myasthenia gravis;myopathy;nephrotic syndrome;nonalcoholic fatty liver;osteolysis;patient care;peripheral neuropathy;peripheral occlusive artery disease;purpura;rheumatic polymyalgia;rheumatoid arthritis;secondary osteoporosis;short survey;side effect;small vessel vasculitis;stomach ulcer;cerebrovascular accident;systemic lupus erythematosus;caltrate,"McCarthy, S.;Kotowicz, M.",2011,,,0,
2897,How can socioeconomic inequalities in hospital admissions be explained? a cohort study,"Objectives: To investigate which antecedent risk factors can explain the social patterning in hospital use. Design: Prospective cohort study with up to 37 years of follow-up. Setting: Representative community sample in the West of Scotland. Participants: 7049 men and 8353 women aged 45-64 years were recruited into the study from the general population between 1972 and 1976 (78% of the eligible population). Primary and secondary outcome measures: Hospital admissions and bed days by cause and by classification into emergency or non-emergency. Results: All-cause hospital admission rate ratios (RRs) were not obviously socially patterned for women (RR 1.04, 95% CI 0.98 to 1.10) or men (RR 1.0, 95% CI 0.94 to 1.06) in social classes IV and V compared with social classes I and II. However, cardiovascular disease, coronary heart disease and stroke in women, and respiratory disease for men and women were socially patterned, although this attenuated markedly with the addition of baseline risk factors. Hospital bed days were generally socially patterned and the differences were largely explained by baseline risk factors. The overall RRs of mental health admissions in contrast were socially patterned for women (RR 1.77, 95% CI 1.38 to 2.27) and men (RR 1.51, 95% CI 1.11 to 2.06) in social classes IV and V compared with social classes I and II, but the pattern did not attenuate with the addition of baseline risk factors. Emergency hospital admissions were associated with lower social class, but there was an inverse relationship for non-emergency hospital admissions. Conclusions: Overall admissions to hospital were only marginally socially patterned, and less than would be expected on the basis of the gradient in baseline risk. However, there was marked social patterning in admissions for mental health problems. Non-emergency hospital admissions were patterned inversely according to risk. Further work is required to explain and address this inequitable gradient in healthcare use.",adult;Alzheimer disease;angina pectoris;article;blood sampling;body mass;bronchitis;cardiovascular disease;cerebrovascular accident;cholesterol blood level;cohort analysis;community sample;diabetes mellitus;emergency care;female;follow up;health care utilization;hospital;hospital admission;human;ischemic heart disease;major clinical study;male;mental health care;prospective study;respiratory tract disease;risk assessment;screening test;self report;social class;social status;socioeconomics;systolic blood pressure,"McCartney, G.;Hart, C.;Watt, G.",2013,,,0,
2898,Policosanol safely down-regulates HMG-CoA reductase - potential as a component of the Esselstyn regimen,"Many of the wide-ranging health benefits conferred by statin therapy are mediated, not by reductions in LDL cholesterol, but rather by inhibition of isoprenylation reactions essential to the activation of Rho family GTPases; this may be the mechanism primarily responsible for the favorable impact of statins on risk for ischemic stroke, senile dementia, and fractures, as well as the anti-hypertensive and platelet-stabilizing actions of these drugs. Indeed, the extent of these benefits is such as to suggest that most adults would be wise to take statins; however, owing to the significant expense of statin therapy, as well as to the potential for dangerous side effects that mandates regular physician follow-up, this strategy appears impractical. However, policosanol, a mixture of long-chain aliphatic alcohols extractable from sugar cane wax, has shown cholesterol-lowering potency comparable to that of statins, and yet appears to be devoid of toxic risk. Recent evidence indicates that policosanol down-regulates cellular expression of HMG-CoA reductase, and thus has the potential to suppress isoprenylation reactions much like statins do. Consistent with this possibility, the results of certain clinical and animal studies demonstrate that policosanol has many effects analogous to those of statins that are not likely explained by reductions of LDL cholesterol. However, unlike statins, policosanol does not directly inhibit HMG-CoA reductase, and even in high concentrations it fails to down-regulate this enzyme by more than 50% - thus likely accounting for the safety of this nutraceutical. In light of the fact that policosanol is quite inexpensive and is becoming available as a non-prescription dietary supplement, it may represent a practical resource that could enable the general public to enjoy health benefits comparable to those conferred by statins. In a long-term clinical study enrolling patients with significant symptomatic coronary disease, Esselstyn has demonstrated that a low-fat, whole-food vegan diet, coupled with sufficient statin therapy to maintain serum cholesterol below 150 mg/dL, can stop the progression of coronary disease and virtually eliminate further risk for heart attack. A comparable regimen, in which policosanol is used in place of statins, may represent a practical strategy whereby nearly everyone willing to commit to health-protective eating can either prevent coronary disease, or prevent pre-existing coronary disease from progressing to a life-threatening event.","Animals;Cholesterol, LDL/blood;Clinical Trials as Topic;Cohort Studies;Diet, Vegetarian;Dietary Fats/administration & dosage/adverse effects;Dietary Supplements;Double-Blind Method;Drug Costs;Enzyme Activation/drug effects;Fatty Alcohols/adverse effects/economics/*therapeutic use;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects/*therapeutic use;Hypercholesterolemia/complications/diet therapy;Insulin Resistance;Lovastatin/adverse effects/therapeutic use;Myocardial Infarction/etiology/*prevention & control;Platelet Activation/drug effects;Protein Prenylation/drug effects;Protein Processing, Post-Translational/drug effects;Rabbits;Rats;Safety;rho GTP-Binding Proteins/antagonists & inhibitors","McCarty, M. F.",2002,Sep,,0,
2899,Endocytic pathway alterations in human hippocampus after global ischemia and the influence of APOE genotype,"Apolipoprotein ε4 (apoE, protein; APOE, gene) allele is the most important genetic risk factor for development of Alzheimer's disease and is also associated with poor outcome after brain injury. Although the mechanisms underlying this susceptibility are currently unknown, recent experimental evidence suggests that APOE genotype may influence activity in the endocytic pathway of neurons. This study determined whether alterations in the endocytic pathway occurred in medial temporal lobe sections after brain injury because of cardiorespiratory arrest and whether these alterations were influenced by APOE genotype. Antibodies to two proteins involved in endocytosis, rabaptin-5 and rab4, were used as markers of endocytic pathway activity. Alterations in immunoreactivity were examined in medial temporal lobe sections in the postmortem brain of patients who experienced an episode of global ischemia and in controls. After global ischemia there was a marked increase in immunoreactivity of both endocytic markers, rabaptin-5 and rab4, in neurons, and to a lesser extent in glia compared to controls. Furthermore, possession of an APOE ε4 allele was associated with specific alterations in the endocytic pathway. After global ischemia, there was no influence of APOE genotype on the extent of rabaptin-5 immunoreactivity. However, there was a statistically significant influence of APOE genotype on the extent of rab4 immunoreactivity in response to global ischemia. These results indicate marked alterations in the endocytic pathway after global ischemia that are dependent on APOE genotype. This may underlie the important influence of APOE genotype on brain injury and disease.",antibody;apolipoprotein E;cell protein;protein subunit;Rab protein;rabaptin 5 protein;unclassified drug;adult;allele;article;autopsy;brain nerve cell;cardiopulmonary insufficiency;clinical article;controlled study;endocytosis;female;genotype;glia;hippocampus;human;human tissue;immunoreactivity;ischemia;male;priority journal;protein localization;temporal lobe,"McColl, B. W.;Graham, D. I.;Weir, C. J.;White, F.;Horsburgh, K.",2003,,,0,
2900,4-Hydroxynonenal immunoreactivity is increased in human hippocampus after global ischemia,"Oxidative stress and lipid peroxidation may contribute to the pathology of neurodegenerative disorders such as Alzheimer's disease (AD) and cerebral ischemia. 4-Hydroxynonenal (4-HNE) is a toxic by-product of lipid peroxidation, and immunoreactivity to 4-HNE has been used to examine lipid peroxidation in the pathogenesis of AD and ischemia. This study sought to determine 1) if there are cellular alterations in 4-HNE immunoreactivity in the human hippocampus after global ischemia, and 2) whether possession of an apolipoprotein E (APOE) ε4 allele influenced the extent of 4-HNE immunoreactivity. 4-HNE immunoreactivity was assessed semi-quantitatively in the temporal lobe of a group of controls (n = 44) and in a group of patients who had an episode of global ischemia as a result of a cardiorespiratory arrest and subsequently died (n = 56, survival ranged from 1hr to 42days). There was minimal cellular 4-HNE immunoreactivity in the control group. However, compared to controls, 4-HNE immunoreactivity was significantly increased in neurons (p < 0.0002) and glia (p < 0.0001) in the hippocampal formation after global ischemia. Possession of an APOE ε4 allele did not influence the extent of neuronal or glial 4-HNE immunostaining in the control or global ischemia group. There was a significant negative correlation between the extent of neuronal 4-HNE immunoreactivity with survival period after global ischemia (r2 = 0.0801; p < 0.036) and a significant positive correlation between the extent of glial 4-HNE immunoreactivity and survival after global ischemia (r2 = 0.2958; p < 0.0001). The data indicate a marked increase in neuronal and glial 4-HNE. This substantiates a role for lipid peroxidation in the pathogenesis of cerebral ischemia. There was no indication that APOE genotype influenced the extent of 4-HNE immunoreactivity.",4 hydroxynonenal;apolipoprotein E4;adult;aged;allele;article;autopsy;brain ischemia;cardiopulmonary insufficiency;cell kinetics;controlled study;female;genotype;hippocampus;human;human tissue;immunohistochemistry;immunoreactivity;lipid peroxidation;major clinical study;male;oxidative stress;protein expression;survival rate;temporal lobe,"McCracken, E.;Graham, D. I.;Nilsen, M.;Stewart, J.;Nicoll, J. A. R.;Horsburgh, K.",2001,,,0,
2901,"Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada","OBJECTIVES: Describe nursing home polypharmacy prevalence in the context of prescribing for diabetes and hypertension and determine possible associations between lower surrogate markers for treated hypertension and diabetes (overtreatment) and polypharmacy. DESIGN: Cross-sectional study. SETTING: 6 nursing homes in British Columbia, Canada. PARTICIPANTS: 214 patients residing in one of the selected facilities during data collection period. PRIMARY AND SECONDARY OUTCOME MEASURES: Polypharmacy was defined as >/=9 regular medications. Overtreatment of diabetes was defined as being prescribed at least one hypoglycaemic medication and a glycosylated haemoglobin (HbA1c) </=7.5%. Overtreatment of hypertension required being prescribed at least one hypertension medication and having a systolic blood pressure </=128 mm Hg. Polypharmacy prescribing, independent of overtreatment, was calculated by subtracting condition-specific medications from total medications prescribed. RESULTS: Data gathering was completed for 214 patients, 104 (48%) of whom were prescribed >/=9 medications. All patients were very frail. Patients with polypharmacy were more likely to have a diagnosis of hypertension (p=0.04) or congestive heart failure (p=0.003) and less likely to have a diagnosis of dementia (p=0.03). Patients with overtreated hypertension were more likely to also experience polypharmacy (Relative Risk (RR))1.77 (1.07 to 2.96), p=0.027). Patients with overtreated diabetes were prescribed more non-diabetic medications than those with a higher HbA1c (11.0+/-3.7vs 7.2+/-3.1, p=0.01). CONCLUSION: Overtreated diabetes and hypertension appear to be prevalent in nursing home patients, and the presence of polypharmacy is associated with more aggressive treatment of these risk factors. The present study was limited by its small sample size and cross-sectional design. Further study of interventions designed to reduce overtreatment of hypertension and diabetes is needed to fully understand the potential links between polypharmacy and potential of harms of condition-specific overtreatment.",diabetes;elderly;frailty;hypertension;nursing home;over treatment,"McCracken, R.;McCormack, J.;McGregor, M. J.;Wong, S. T.;Garrison, S.",2017,Aug 11,,0,
2902,Carotid artery stenting (CAS) - The unwritten chapter,,artificial embolism;carotid artery stenting;carotid endarterectomy;cerebrovascular accident;death;dementia;embolism;heart infarction;human;microembolism;note;priority journal,"McCready, R. A.",2013,,,0,
2903,MCQs,,acetylsalicylic acid;albumin;alkaline phosphatase;amlodipine;aspartate aminotransferase;atenolol;atorvastatin;bendroflumethiazide;bilirubin;C reactive protein;cocodamol;creatinine;digoxin;furosemide;gliclazide;hemoglobin;isosorbide mononitrate;lisinopril;metformin;potassium;ramipril;sodium;abdominal radiography;aged;albumin blood level;alkaline phosphatase blood level;Alzheimer disease;anorexia;antibiotic therapy;aspartate aminotransferase blood level;bedtime dosage;bilirubin blood level;Charles Bonnet syndrome;cholelithiasis;clinical article;confusion;coughing;creatinine blood level;dementia;falling;female;foot edema;foot ulcer;geriatrics;atrial fibrillation;hemoglobin blood level;human;hypertension;hypotension;international normalized ratio;jaundice;knee osteoarthritis;leukocyte count;liver function test;malaise;male;malnutrition;nausea;non insulin dependent diabetes mellitus;note;Parkinson disease;pneumonia;potassium blood level;macular degeneration;sensory neuropathy;sodium blood level;stab wound;stable angina pectoris;tachycardia;total hip prosthesis;upper abdominal pain;urine color;visual acuity;visual hallucination;weight reduction,McCreanor;Delves;Corrado;Edwards;Hales;Bhat;Ahearn;Baker;Charlton;Allen;Abdulla;Rangasamy;Umasankar,2010,,,0,
2904,Variation in health conditions among groups of adults with disabilities in primary care,"The literature on the health of adults with disabilities focuses on one disability compared to a comparison group. This study allows cross disability comparisons with the hypothesis. Adults with disabilities had higher odds of having common health conditions, compared to adults without disability in the same practice. A retrospective record review of 1449 patients with disability and 2084 patients without disability included individuals with sensory impairments (n = 117), developmental disabilities (n = 692), trauma-related impairments (n = 155) and psychiatric impairments (n = 485). The only two health conditions with statistically significantly increased odds for all groups with disabilities were dementia and epilepsy. Patients with developmental disabilities were less likely to have coronary artery disease, cancer, and obesity. Those with sensory impairments had increased odds for congestive heart failure, diabetes, transient ischemic attacks and death. Patients with trauma disabilities had increased odds for chronic obstructive pulmonary disease, and depression. Finally, psychiatric patients had increased odds for most of the investigated condition. In conclusion, there were many similarities in the risk for common health conditions such as asthma, cancer, coronary artery disease, depression, hypertension, and obesity, among patients with and without disability. Some of the conditions with increased odds ratios, including depression, seizures, and dementia are secondary to the primary disability.",Adult;Chronic Disease;Cohort Studies;*Comorbidity;Disabled Persons/*statistics & numerical data;Female;*Health Surveys;Humans;Male;Middle Aged;Prevalence;Primary Health Care/*utilization;Rural Health/statistics & numerical data;South Carolina/epidemiology;Urban Health/statistics & numerical data,"McDermott, S.;Moran, R.;Platt, T.;Dasari, S.",2006,Jun,,0,
2905,Health conditions among women with a disability,"BACKGROUND: This study was designed to determine if the incidence of some common health conditions was higher among 770 women with a disability compared with 1097 women without a disability and 679 men with a disability in the same primary care medical practices. METHODS: This is a retrospective cohort study that used record review of individuals with sensory impairments (n = 117), developmental disabilities (n = 692), trauma-related impairments (n = 155), and psychiatric impairments (n = 485) and 1097 patients without a disability. RESULTS: Diabetes, hypertension, and obesity, three important predictors of morbidity and mortality, were not significantly more likely to occur in women with disabilities compared with others in the same medical practice. Dementia had higher hazard ratios (HRs) for women with sensory, developmental, and trauma disability. However, women with trauma disability had a significantly lower (HR) for dementia compared with men with the same disability. Women with sensory disability were at higher risk for transient ischemic attack (TIA) compared with women in the same practice without disability, and there was no difference in HRs compared with men with disability. Women with disability related to trauma were at higher risk for depression compared with women in the same practice without disability and compared with men with the same disability. Some conditions, such as congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), have opportunities for prevention, as they are associated with smoking, physical inactivity, and diet. CONCLUSIONS: Healthcare providers should be aware of risks associated with specific impairment groups so they can implement prevention and treatment strategies.","Adult;Attitude to Health;Cohort Studies;Dementia/epidemiology;Depression/epidemiology;Diabetes Mellitus, Type 2/epidemiology;Disabled Persons/*statistics & numerical data;Female;*Health Status;Heart Failure/epidemiology;Humans;Hypertension/epidemiology;Male;Middle Aged;Neoplasms/epidemiology;Obesity/epidemiology;Pulmonary Disease, Chronic Obstructive/epidemiology;Retrospective Studies;Smoking/epidemiology;*Women's Health","McDermott, S.;Moran, R.;Platt, T.;Dasari, S.",2007,Jun,10.1089/jwh.2007.0363,0,
2906,"Heart disease, schizophrenia, and affective psychoses: Epidemiology of risk in primary care","A retrospective cohort design was used to study risk factors and cardiovascular end points among adults, with and without psychoses, receiving primary care. Earlier onset of risk factors and heart disease was noted among individuals with schizophrenia compared to those with affective psychoses and no disabilities. Patients with schizophrenia had increased relative risk for obesity, congestive heart failure, dementia, depression and death, while patients with affective psychoses had increased risk for dementia and diabetes. © 2005 Springer Science+Business Media, Inc.",adult;affective psychosis;article;cohort analysis;congestive heart failure;controlled study;death;dementia;depression;diabetes mellitus;disability;female;heart disease;human;male;obesity;primary medical care;psychosis;risk factor;schizophrenia,"McDermott, S.;Moran, R.;Platt, T.;Isaac, T.;Wood, H.;Dasari, S.",2005,,,0,
2907,Adverse reactions to drugs used in the treatment of Alzheimer's disease,"Drugs used to treat Alzheimer's disease. Their adverse effects include abdominal pain, anorexia, dizziness, nausea, vomiting, diarrhoea, headache and insomnia. Copyright © Lippincott Williams & Wilkins.",amiodarone;antihypertensive agent;atypical antipsychotic agent;beta adrenergic receptor blocking agent;cholinesterase inhibitor;digoxin;donepezil;galantamine;memantine;neuroleptic agent;placebo;rivastigmine;abdominal pain;aggression;agitation;Alzheimer disease;anorexia;article;asthenia;bradycardia;confusion;convulsion;diarrhea;dizziness;drug tolerability;fatigue;headache;heart failure;human;hypertension;insomnia;lassitude;malaise;meta analysis (topic);muscle cramp;nausea;nausea and vomiting;peripheral edema;randomized controlled trial (topic);side effect;faintness;tremor;urine incontinence;vertigo;vomiting;weakness;weight reduction,"McDowell, S. E.",2011,,,0,
2908,Reappraisal of levodopa therapy for Parkinson's disease. A three year experience with outpatients in private practice,"Of 26 out patients with parkinsonism who began therapy with levodopa 2 or more yr ago, 15 (58%) remain in treatment. Of this remainder, 8 are deteriorating mentally as well as in terms of dexterity and mobility. Four have maintained good improvement while 3 have maintained a slight improvement over their initial ratings. Their average age is 69, while the average age of those discontinuing treatment was 71. Twenty two of the original group have had or continue to display signs of cerebral arteriosclerosis. The average duration of illness for the treatment group is 9 yr. Age, length of illness and signs of central nervous system impairment may be related to their lack of improvement and also to the lower maintenance dosage tolerated. Long term maintenance levodopa may be advantageous for selected patients, but was ineffective or intolerable for the majority in this series. For the physician in private practice, the long term benefits of levodopa therapy may be less than he has been given to expect from larger cooperative studies.",amantadine;levodopa;tranquilizer;adverse drug reaction;brain atherosclerosis;cardiotoxicity;dementia;drug therapy;dyskinesia;heart infarction;involuntary movement;mental capacity;mental disease;motor performance;nausea;oral drug administration;orthostatic hypotension;Parkinson disease;psychosis;sudden death;therapy;tremor;vomiting,"McFarland, H. R.",1974,,,0,
2909,Absence of sex differences in the evaluation of patients hospitalized for transient ischemic attacks,"BACKGROUND: Sex has been shown to affect the extent of evaluation and treatment of patients with coronary artery disease. This study investigates potential differences in the evaluation of hospitalized men and women with transient ischemic attacks to determine whether a similar bias exists. METHODS: The 1989 MedisGroups comparative database was used to analyze a convenience sample consisting of all family and internal medicine patients with the primary admission diagnosis-related group (DRG) of ""transient ischemic attack."" RESULTS: Women comprised 1933 of the 3165 admissions. The mean age for women was 1.88 years older than for men (P < .01). Women were three times more likely to reside in a nursing home before admission (P < .01), but had a lower prevalence of dementia (P < .05). The 1232 men had a higher severity of illness score at admission (P < .05), and were 5.3% more likely to be admitted to a teaching hospital than women (P < .01). Men were also more likely than women to be admitted to large hospitals (P < .01). There were no differences between sexes in the use of cranial computed tomography, carotid or cardiac Doppler, or carotid arteriography. Adjusted means for hospital charges, morbidity, and mortality did not differ between sexes, but length of stay was longer by 1.5 days for women compared with men (P < .01). CONCLUSIONS: In-hospital evaluation of elderly patients with transient ischemic attacks did not differ significantly between men and women. This finding does not exclude the possibility of a difference in workup for men as compared with women in the ambulatory management of this condition.","Aged;Aged, 80 and over;Diagnosis-Related Groups;Family Practice;Female;Health Services Research;Humans;Internal Medicine;Ischemic Attack, Transient/*diagnosis/therapy;Length of Stay/statistics & numerical data;Male;Outcome Assessment (Health Care);Patient Admission/*statistics & numerical data;Practice Patterns, Physicians'/*statistics & numerical data;Prejudice;Quality Assurance, Health Care;Residence Characteristics;Sampling Studies;Severity of Illness Index;Sex Factors","McGann, K. P.;Marion, G. S.;Szewczyk, M. B.;Davis, S. W.",1994,Aug,,0,
2910,"Safety and Exploratory Efficacy at 36 Months in Open-HART, an Open-Label Extension Study of Pridopidine in Huntington's Disease","Background: Open-HART is an open-label extension of HART, a randomized, placebo-controlled, dose-ranging, parallelgroup study. Objective: To evaluate safety and exploratory efficacy of open-label pridopidine over 36 months in subjects with Huntington's disease (HD). Methods: Open-HART subjects were treated with pridopidine 45 mg twice daily (BID). After initial evaluation by telephone (Week 1) and in person (Month 1), in-person visits occurred every 3 months, alternating between safety and clinical visits (safety plus Unified Huntington's Disease Rating Scale [UHDRS] assessment). The UHDRS was performed for pre-specified analysis as a secondary outcome measure. Adverse events (AEs), laboratory values, and electrocardiography were monitored throughout. Results: Most subjects (89%) reported at least one AE, with 30% experiencing treatment-related AEs. The most common AEs during the first year were falls (12.7%), anxiety (9.3%), insomnia (8.5%), irritability (6.8%), and depression (5.9%). Ninety-nine percent of subjects took concomitant medications. Two seizures were reported as AEs. No arrhythmias or suicide attempts were reported. Five deaths occurred, all considered treatment unrelated. Secondary exploratory analyses of subjects on pridopidine demonstrated motor deterioration (as measured by the UHDRS total motor score) consistent with HD's natural history, as shown in large observational studies. A post-hoc, exploratory analysis of TFC performance compared to placebo groups from other long-term HD studies demonstrated no significant effect for pridopidine on TFC progression after correction for multiple comparisons. Conclusions: Pridopidine 45 mg BID was generally safe and tolerable in HD subjects over 36 months. TMS declined in a manner consistent with the known natural history of HD.",NCT01306929;citalopram;clonazepam;escitalopram;fluoxetine;lorazepam;memantine;mirtazapine;paroxetine;placebo;pridopidine;sertraline;tetrabenazine;trazodone;valproic acid;zolpidem;adult;anxiety disorder;article;aspiration pneumonia;body weight disorder;chorea;consciousness disorder;controlled study;contusion;convulsion;death;delirium;depression;diarrhea;drug efficacy;drug safety;drug withdrawal;electrocardiography;endocarditis;falling;female;headache;heart infarction;human;Huntington chorea;incidence;injury;insomnia;intoxication;irritability;major clinical study;male;middle aged;multicenter study;multiple myeloma;observational study;open study;personality disorder;priority journal;randomized controlled trial;retina detachment;seizure;side effect;subdural hematoma;suicidal ideation;treatment duration;Unified Huntington Disease Rating Scale;vomiting,"McGarry, A.;Kieburtz, K.;Abler, V.;Grachev, I. D.;Gandhi, S.;Auinger, P.;Papapetropoulos, S.;Hayden, M.",2017,,10.3233/jhd-170241,0,
2911,Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography,"BACKGROUND: Elderly patients diagnosed with acute cholecystitis (AC) may undergo both ultrasonography (US) and computed tomography (CT). METHODS: A total of 475 patients (age, >64 y) with AC were included. RESULTS: Groups included US alone (n = 240), CT alone (n = 60), and CT + US (n = 168). Sixty patients (35.7%) in the US + CT group had inflammation in both studies, 34 (20.2%) had inflammation only on US, and 32 (19.0%) had inflammation only on CT. In the US + CT group, detection of cholelithiasis was not different, but mean common bile duct size did not correlate. There was no difference among the groups in age, sex, medical service admission, nonambulatory status, dementia, diabetes, or coronary artery disease. Peritonitis, leukocytosis, and acidosis were more frequent in the 2 groups undergoing CT. The cholecystectomy rate was lowest (and the complication rate was highest) in the CT + US group. CONCLUSIONS: CT often is used in the diagnosis of AC in the elderly, especially those with more acute presentations. CT and US findings may be complementary in AC.","Acidosis/epidemiology;Aged;Cholecystectomy;Cholecystitis, Acute/*radiography/*ultrasonography;Cholelithiasis/radiography/ultrasonography;Common Bile Duct/radiography/ultrasonography;Female;Humans;Leukocytosis/epidemiology;Male;Peritonitis/epidemiology;Postoperative Complications/epidemiology;Tomography, X-Ray Computed","McGillicuddy, E. A.;Schuster, K. M.;Brown, E.;Maxfield, M. W.;Davis, K. A.;Longo, W. E.",2011,Nov,10.1016/j.amjsurg.2011.06.012,0,
2912,Incidence of periprosthetic fractures after hip hemiarthroplasty: Are uncemented prostheses unsafe?,"Displaced intracapsular fractures of the neck of femur are routinely treated in the elderly with either cemented or uncemented hemiarthroplasty. Recent evidence suggests a superior outcome with the use of cement, but uncemented prostheses are still employed for those with multiple co-morbidities or particular frailty. In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) recommendations are used to identify which patients should receive a cemented prosthesis. These are simply based upon the presence of cardiorespiratory disease, particularly in the frail elderly patient. Between January 2007 and June 2010, a total of 1397 patients with neck-of-femur fractures presented to our unit. Retrospective analysis was performed with particular attention given to the rate of postoperative periprosthetic fracture. As many as 546 fractures were treated with hemiarthroplasty, of which 183 were treated with a cemented Exeter Trauma Stem (ETS) and 363 were treated with an uncemented Austin-Moore prosthesis (AMP). At the time of our retrospective analysis, we found that 15 (4%) patients treated with an uncemented prosthesis went on to sustain a periprosthetic fracture. There were no periprosthetic fractures in the cemented group (p=0.004). Data analysis by case-note review of those patients sustaining a periprosthetic fracture was then performed. Seven (50%) suffered from confusion secondary to dementia, six (43%) had a history of significant cardiac disease (recent myocardial infarction (MI) or cardiac failure) and two (14%) had known renal impairment. The mean time to fracture after uncemented hemiarthroplasty was 2 years. The majority (80%) were fractures which required further surgery. Revision surgery in these patients was associated with an overall complication rate of 42% (mainly deep infection and haemorrhage requiring transfusion). Two of the patients had a fracture that could be treated conservatively. It is concluded that, in conjunction with the treating senior anaesthetist, cemented implants should be considered in all patients, especially those who are deemed to be frail and with multiple co-morbidities. A periprosthetic fracture rate of 14% at a mean of 2 years after uncemented hemiarthroplasty represents a potentially unacceptable risk for such a frail population. In particular, we feel that the AMP should not be used for treating displaced intracapsular neck-of-femur fractures.","Aged;Aged, 80 and over;Bone Cements/therapeutic use;Cementation/*adverse effects;Comorbidity;Female;*Frail Elderly;Hemiarthroplasty/*adverse effects/mortality;Hip Prosthesis/adverse effects;Humans;Incidence;Male;Periprosthetic Fractures/*epidemiology/etiology/mortality/surgery;Practice Guidelines as Topic;Randomized Controlled Trials as Topic;Reoperation/*mortality;Retrospective Studies;Scotland/epidemiology;Treatment Outcome;Austin-Moore prosthesis;Cemented hemiarthroplasty;Hip fractures;Hip hemiarthroplasty;Periprosthetic fracture;Uncemented hemiarthroplasty","McGraw, I. W.;Spence, S. C.;Baird, E. J.;Eckhardt, S. M.;Ayana, G. E.",2013,Dec,10.1016/j.injury.2013.07.023,0,
2913,Statin withdrawal in people with dementia,"Background: There are approximately 24 million people worldwide with dementia; this is likely to increase to 81 million by 2040. Dementia is a progressive condition, and usually leads to death eight to ten years after first symptoms. End-of-life care should emphasise treatments that optimise quality of life and physicians should minimise unnecessary or non-beneficial interventions. Statins are 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors; they have become the cornerstone of pharmacotherapy for the management of hypercholesterolaemia but their ability to provide benefit is unclear in the last weeks or months of life. Withdrawal of statins may improve quality of life in people with advanced dementia, as they will not be subjected to unnecessary polypharmacy or side effects. However, they may help to prevent further vascular events in people of advanced age who are at high risk of such events.Objectives: To evaluate the effects of withdrawal or continuation of statins in people with dementia on: cognitive outcomes, adverse events, behavioural and functional outcomes, mortality, quality of life, vascular morbidity, and healthcare costs.Search methods: We searched ALOIS (medicine.ox.ac.uk/alois/), the Cochrane Dementia and Cognitive Improvement Group Specialised Register on 11 February 2016. We also ran additional searches in MEDLINE, EMBASE, PsycINFO, CINAHL, Clinical.Trials.gov and the WHO Portal/ICTRP on 11 February 2016, to ensure that the searches were as comprehensive and as up-to-date as possible.Selection criteria: We included all randomised, controlled clinical trials with either a placebo or 'no treatment' control group. We applied no language restrictions.Data collection and analysis: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, using standard methodological procedures expected by Cochrane. We found no studies suitable for inclusion therefore analysed no data.Main results: The search strategy identified 28 unique references, all of which were excluded.Authors' conclusions: We found no evidence to enable us to make an informed decision about statin withdrawal in dementia. Randomised controlled studies need to be conducted to assess cognitive and other effects of statins in participants with dementia, especially when the disease is advanced.",,"McGuinness, B.;Cardwell Chris, R.;Passmore, P.",2016,,10.1002/14651858.CD012050.pub2,0,
2914,"Association of the Hospital Volume of Frail Surgical Patients Cared for with Outcomes after Elective, Major Noncardiac Surgery: A Retrospective Population-based Cohort Study","Background: Frailty is a risk factor for adverse postoperative outcomes. Hospitals that perform higher volumes of surgery have better outcomes than low-volume providers. We hypothesized that frail patients undergoing elective surgery at hospitals that cared for a higher volume of similarly frail patients would have improved outcomes. Methods: We conducted a retrospective, population-based cohort study using linked administrative data in Ontario, Canada. We identified all adult major, elective noncardiac surgery patients who were frail according to the validated Johns Hopkins Adjusted Clinical Groups (ACG®) frailty-defining diagnoses indicator. Hospitals were categorized into frailty volume quintiles based on volumes of frail surgical patients cared for. Multilevel, multivariable modeling measured the association of frailty volume with 30-day survival (primary outcome), complications, failure to rescue (secondary outcomes), and costs (tertiary outcome). Results: Of 63,381 frail patients, 708 (1.1%) died after surgery. The thirty-day mortality rate in the lowest volume quintile was 1.1% compared to 0.9% in the highest. After adjustment for surgical risk, demographic characteristics, comorbidities, and clustering within hospitals, we found a significant association between frailty volume and improved survival (highest volume vs. lowest volume quintile: hazard ratio 0.51; 95% CI, 0.35 to 0.74; P < 0.0001). Although complication rates did not vary significantly between hospitals, failure-to-rescue rates were inversely related to volume. Conclusions: Frail patients have reduced survival and increased failure to rescue when they undergo operations at hospitals having a lower volume of frail surgical patients. Concentration of perioperative care in centers that frequently treat high-risk frail patients could improve population outcomes.",angiotensin receptor antagonist;antiarrhythmic agent;anticoagulant agent;anticonvulsive agent;antidepressant agent;antithrombocytic agent;benzodiazepine derivative;beta adrenergic receptor blocking agent;bronchodilating agent;corticosteroid;dipeptidyl carboxypeptidase inhibitor;donepezil;galantamine;insulin;memantine;neuroleptic agent;oral antidiabetic agent;prescription drug;rivastigmine;aged;alcohol abuse;anemia;aneurysm surgery;artery bypass;article;ASA score;blood clotting disorder;body weight disorder;carotid endarterectomy;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;comorbidity;comorbidity assessment;controlled study;cystectomy;dementia;demography;depression;diabetes mellitus;drug abuse;elective surgery;endovascular aneurysm repair;esophagus resection;failure to rescue (health care);female;frail elderly;frailty;gastrectomy;geriatric patient;geriatric surgery;health care cost;heart atrium arrhythmia;heart failure;hemiplegia;high risk patient;high volume hospital;human;Human immunodeficiency virus infection;hypertension;intestine surgery;kidney disease;liver disease;liver resection;low volume hospital;lung disease;lung lobectomy;lung resection;major clinical study;major surgery;male;malignant neoplasm;metastasis;mortality rate;nephrectomy;obesity;Ontario;outcome assessment;pancreaticoduodenectomy;patient care;peptic ulcer;peripheral vascular disease;population research;postoperative complication;prescription;priority journal;psychosis;renal replacement therapy;retrospective study;rheumatic disease;secondary analysis;surgical mortality;surgical patient;surgical risk;survival analysis;total hip prosthesis;total knee arthroplasty;valvular heart disease,"McIsaac, D. I.;Wijeysundera, D. N.;Huang, A.;Bryson, G. L.;Van Walraven, C.",2017,,10.1097/aln.0000000000001536,0,
2915,"U.S. Burden of Disease-Past, Present and Future","Purpose: To review the history and challenges of ""burden of disease"" studies, how these are dependent on robust epidemiologic data as well as complex conceptual constructions, and to identify the public health policy issues these studies can most usefully inform. Methods: The emergence of the concept of the ""burden of disease"" in the public health literature is reviewed, with a focus on the results of an analysis of data from the United States that used the methodology presented in the Global Burden of Disease Study. Results: The systematic analysis of public health mortality data to identify major health problems was conducted by Graunt in 16th-century London. He found that many of the predominant sources of mortality were not the focus of public attention. Today, despite refinements in epidemiologic measurement methods designed to capture the impact of non-fatal health conditions, there are similar incongruities between the major public health problems and expenditures on prevention interventions. Conclusions: Controversies surrounding the interpretation of ""burden of disease"" studies are not new. Particularly in developed countries, these studies appear more useful for setting research priorities rather than allocating resources to support prevention efforts. Such investigations are not possible without ongoing support for systematic collection and analysis of descriptive epidemiologic data. © 2009 Elsevier Inc. All rights reserved.",article;breast cancer;burden of illness;chronic obstructive lung disease;dementia;diabetes mellitus;disability;disability adjusted life expectancy;disease severity;history;human;ischemic heart disease;life expectancy;life table;lung cancer;major depression;mortality;osteoarthritis;priority journal;quality adjusted life year;risk factor;cerebrovascular accident;traffic accident;United States,"McKenna, M. T.;Zohrabian, A.",2009,,,0,
2916,Final conclusions and recommendations of the National Lipid Association Statin Safety Assessment Task Force,"This article summarizes the final conclusions of the National Lipid Association (NLA) Statin Safety Task Force, based on a review and independent research of New Drug Application (NDA) information, US Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) data, cohort and clinical trial results, and analysis of administrative claims database information and the assessment of its 4 Expert Panels, which focused on issues of statin safety with regard to liver, muscle, renal, and neurologic systems. Practical guidance in the form of recommendations to health professionals who manage the coronary artery disease risk of patients with statin therapy is provided.","Adverse Drug Reaction Reporting Systems;Alanine Transaminase/blood;Aspartate Aminotransferases/blood;Cognition/physiology;Creatine Kinase/blood;Databases, Factual;Dementia/epidemiology;Dose-Response Relationship, Drug;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*administration & dosage/*adverse;effects;Liver Failure/chemically induced/diagnosis;Muscular Diseases/chemically induced;Peripheral Nervous System Diseases/epidemiology;Proteinuria/epidemiology;Renal Insufficiency/epidemiology","McKenney, J. M.;Davidson, M. H.;Jacobson, T. A.;Guyton, J. R.",2006,Apr 17,10.1016/j.amjcard.2006.02.030,0,
2917,Human embryonic stem cell lines: Socio-legal concerns and therapeutic promise,"Stem cell lines would be very valuable for the repair of diseased or damaged organs. Stem cells derived from adult tissues raise few ethical problems, and would not be rejected if derived from the patient. They show considerable plasticity and might be appropriate for some clinical conditions, but they tend not to grow well in culture. Stem cells derived from the early human embryo proliferate indefinitely in culture and can give rise to many different tissues, but their derivation requires destruction of the embryo, which is not ethically acceptable in some countries. Other countries allow strictly regulated destructive research on human embryos, usually those that have been produced for infertile couples in infertility clinics. Embryos that are no longer required for the couple's own reproductive project could be donated for research rather than just discarded. Different approaches are being developed to avoid immunological rejection of embryonic stem cells used for therapy. Derivation of embryonic stem cell lines by somatic cell nuclear transfer ('cloning') from the patients themselves might be one possible approach, but is unlikely to be used in routine clinical practice if more cost-effective methods are available. © 2002 Académie des sciences / Éditions scientifiques et médicales Elsevier SAS.",Alzheimer disease;article;autotransplantation;cell culture;cell growth;cell line;cell nucleus transplantation;cell proliferation;clinical practice;cost effectiveness analysis;diabetes mellitus;embryo;embryo cell;embryo death;graft rejection;health center;hepatitis;human;human cell;infertility therapy;ischemic heart disease;medical ethics;medical research;medicolegal aspect;molecular cloning;multiple sclerosis;Parkinson disease;plasticity;reproduction;rheumatoid arthritis;social aspect;somatic cell;stem cell;stem cell transplantation;cerebrovascular accident;treatment outcome,"McLaren, A.",2002,,,0,
2918,"Clinical and economic burden of community-acquired pneumonia in the Veterans Health Administration, 2011: a retrospective cohort study","Purpose: The burden of community-acquired pneumonia (CAP) is not well described in the US Veterans Health Administration (VHA). Methods: CAP was defined as having a pneumonia diagnosis with evidence of chest X-ray, and no evidence of prior (90 days) hospitalization/long-term care. We calculated incidence rates of adult CAP occurring in inpatient or outpatient VHA settings in 2011. We also estimated the proportion of VHA CAP patients who were hospitalized, were readmitted within 30 days of hospital discharge, and died (any cause) in the year following diagnosis. Incremental costs during the 90 days following a CAP diagnosis were estimated from the perspective of the VHA. Results: In 2011, 34,101 Veterans developed CAP (35,380 episodes) over 7,739,757 VHA person-years. Median age of CAP patients was 65 years (95 % male). CAP incidence rates were higher for those aged ≥50 years. A majority of Veterans aged 50–64 (53 %) and ≥65 (66 %) years had ≥1 chronic medical (moderate risk) or immunocompromising (high risk) condition. Compared to those at low-risk (healthy), moderate- and high-risk Veterans were >3 and >6 times more likely to develop CAP, respectively. The percentage of CAP patients who were hospitalized was 45 %, ranging from 12 % (age 18–49, low risk) to 57 % (age ≥65, high risk). One-year all-cause mortality rates ranged from 1 % (age 18–49, low risk) to 36 % (age ≥65, high risk). Annual VHA medical expenditure related to CAP was estimated to be $750 million (M) ($415M for those aged ≥65 years). Conclusion: A focus on CAP prevention among older Veterans and those with comorbid or immunocompromising conditions is important.",adult;age;aged;article;Black person;Caucasian;cerebrovascular disease;chronic obstructive lung disease;clinical and economic burden;cohort analysis;community acquired pneumonia;comorbidity;controlled study;coronary artery disease;dementia;diabetes mellitus;economic aspect;female;health care cost;heart disease;heart failure;high risk population;hospital discharge;hospital patient;human;immunocompromized patient;incidence;length of stay;liver disease;low risk population;lung disease;major clinical study;male;medical history;medicare;middle aged;middle risk population;mortality;outpatient;retrospective study;risk;thorax radiography;veteran,"McLaughlin, J. M.;Johnson, M. H.;Kagan, S. A.;Baer, S. L.",2015,,,0,
2919,A secret weapon,,adenosine triphosphate;antineoplastic agent;glucose;article;brain blood flow;brain cortex;cardiomyopathy;cardiovascular magnetic resonance;coronary artery blood flow;dementia;depression;differential diagnosis;disease course;drug efficacy;functional neuroimaging;glycolysis;human;image analysis;ischemic heart disease;kidney blood flow;longitudinal study;magnetic field;medical decision making;neuroanatomy;nuclear magnetic resonance imaging;nuclear magnetic resonance spectroscopy;patient monitoring;patient safety;phospholipid metabolism;positron emission tomography;quantitative analysis;radiation exposure;radioactivity;reproducibility;sensitivity and specificity;signal noise ratio;treatment response,"McLennan, R.",2012,,,0,
2920,The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: Interrupted time series analysis,"Objective: To evaluate the effects of Quality and Outcomes Framework (QOF) incentivised case finding for depression on diagnosis and treatment in targeted and non-targeted long-term conditions. Design: Interrupted time series analysis. Setting: General practices in Leeds, UK. Participants: 65 (58%) of 112 general practices shared data on 37 229 patients with diabetes and coronary heart disease targeted by case finding incentives, and 101 008 patients with four other long-term conditions not targeted (hypertension, epilepsy, chronic obstructive pulmonary disease and asthma). Intervention: Incentivised case finding for depression using two standard screening questions. Main outcome measures: Clinical codes indicating new depression-related diagnoses and new prescriptions of antidepressants. We extracted routinely recorded data from February 2002 through April 2012. The number of new diagnoses and prescriptions for those on registers was modelled with a binomial regression, which provided the strength of associations between time periods and their rates. Results: New diagnoses of depression increased from 21 to 94/100 000 per month in targeted patients between the periods 2002-2004 and 2007-2011 (OR 2.09; 1.92 to 2.27). The rate increased from 27 to 77/100 000 per month in non-targeted patients (OR 1.53; 1.46 to 1.62). The slopes in prescribing for both groups flattened to zero immediately after QOF was introduced but before incentivised case finding (p<0.01 for both). Antidepressant prescribing in targeted patients returned to the pre-QOF secular upward trend (Wald test for equivalence of slope, z=0.73, p=0.47); the slope was less steep for non-targeted patients (z=-4.14, p<0.01). Conclusions: Incentivised case finding increased new depression-related diagnoses. The establishment of QOF disrupted rising trends in new prescriptions of antidepressants, which resumed following the introduction of incentivised case finding. Prescribing trends are of concern given that they may include people with mild-to-moderate depression unlikely to respond to such treatment.",antidepressant agent;prescription drug;adult;article;asthma;case finding;chronic obstructive lung disease;data extraction;dementia;depression;diabetes mellitus;disease association;epilepsy;female;financial incentive;financial management;general practice;human;hypertension;ischemic heart disease;major clinical study;male;middle aged;patient coding;prescription;register;retrospective study;time series analysis;trend study;United Kingdom,"McLintock, K.;Russell, A. M.;Alderson, S. L.;West, R.;House, A.;Westerman, K.;Foy, R.",2014,,,0,
2921,Revised GMS2: A target too far?,,angiotensin receptor antagonist;cholesterol;dipeptidyl carboxypeptidase inhibitor;article;asthma;blood pressure monitoring;neoplasm;chronic kidney disease;chronic obstructive lung disease;contract;dementia;depression;diabetes mellitus;epilepsy;finance;general practitioner;glomerulus filtration rate;health care quality;atrial fibrillation;heart failure;heart infarction;human;hypertension;hypothyroidism;income;ischemic heart disease;learning disorder;medical practice;medical service;mental health;obesity;osteoporosis;outcome assessment;palliative therapy;smoking;cerebrovascular accident;transient ischemic attack;workload,"Mead, M.",2006,,,0,
2922,Subtle post-procedural cognitive dysfunction after atrial fibrillation ablation,"OBJECTIVES: This study sought to determine whether post-operative neurocognitive dysfunction (POCD) occurs after ablation for atrial fibrillation (AF). BACKGROUND: Ablation for AF is a highly effective strategy; however, the risk of transient ischemic attack and stroke is approximately 0.5% to 1%. In addition, magnetic resonance imaging studies report a 7% to 14% prevalence of silent cerebral infarction. Whether cerebral ischemia results in POCD after ablation for AF is not well established. METHODS: The study included 150 patients; 60 patients undergoing ablation for paroxysmal atrial fibrillation (PAF), 30 patients undergoing ablation for persistent atrial fibrillation (PeAF), and 30 patients undergoing ablation for supraventricular tachycardia (SVT) were compared with a matched nonoperative control group of patients with AF awaiting radiofrequency ablation (n = 30). Eight neuropsychological tests were administered at baseline and at 2 days and 90 days post-operatively. The tests were administered at the same time points to the nonoperative control group. The reliable change index was used to calculate POCD. RESULTS: The prevalences of POCD at day 2 post-procedure were 28% in patients with PAF, 27% in patients with PeAF, 13% in patients with SVT, and 0% in control patients with AF (p = 0.007). At day 90, the prevalences of POCD were 13% in patients with PAF, 20% in patients with PeAF, 3% in patients with SVT, and 0% in control patients with AF (p = 0.03). When analyzing the 3 procedural groups together, 29 of 120 patients (24%) manifested POCD at day 2 and 15 of 120 patients (13%) at day 90 post-procedure (p = 0.029). On univariate analysis, increasing left atrial access time was associated with POCD at day 2 (p = 0.04) and day 90 (p = 0.03). CONCLUSIONS: Ablation for AF is associated with a 13% to 20% prevalence of POCD in patients with AF at long-term follow-up. These results were seen in a patient population with predominant CHADS2 (Congestive heart failure, Hypertension, Age >/=75 years, Diabetes mellitus, previous Stroke/transient ischemic attack) scores of 0 to 1, representing the majority of patients undergoing ablation for AF. The long-term implications of these subtle changes require further study.","Adult;Aged;Atrial Fibrillation/classification/*surgery;Case-Control Studies;*Catheter Ablation;Cognition Disorders/epidemiology/*etiology;Female;Follow-Up Studies;Humans;Male;Middle Aged;Neuropsychological Tests;*Postoperative Complications;Prevalence;Tachycardia, Supraventricular/surgery;Act;Af;Cerad;Chads(2);Ci;Congestive heart failure, Hypertension, Age >/=75 years, Diabetes mellitus,;previous Stroke/transient ischemic attack;Consortium to Establish a Registry for Alzheimer's Disease;Iq;Mri;Or;Paf;Pocd;PeAF;Rci;Rfa;Svt;ablation;activated clotting time;atrial fibrillation;confidence interval;intelligence quotient;magnetic resonance imaging;neurocognitive dysfunction;odds ratio;outcomes;paroxysmal atrial fibrillation;persistent atrial fibrillation;post-operative cognitive dysfunction;radiofrequency ablation;reliable change index;supraventricular tachycardia","Medi, C.;Evered, L.;Silbert, B.;Teh, A.;Halloran, K.;Morton, J.;Kistler, P.;Kalman, J.",2013,Aug 6,10.1016/j.jacc.2013.03.073,0,
2923,Metabolomics and the diagnosis of human diseases -A guide to the markers and pathophysiological pathways affected,"This review was designed as a handbook of metabolomic markers of high significance for a wide range of human diseases. This is the first report to collate results from recent studies in a format that allows ready identification of key metabolites by cross-comparisons of results from one disease to another. All the data presented in this work were obtained by previous research carried out exclusively during clinical trials in humans. Also, discussion of the pathophysiological pathways linked to the markers described is provided. The clinical assays focused on non-targeted or targeted metabolomics and metabolite profiling (focused assays which only refer to a limited array of known biomarkers, applying discriminatory and bioinformatic tools to them) as well as predictive modelling based on clinical trials. The data also highlight pathways and biological compounds that are disrupted at early stages of the diseases, in order to help elucidate target compounds and the pathophysiology of the considered diseases for early prognosis and diagnosis using noninvasive samples (saliva, sputum, serum, plasma, blood, urine, tissue, faecal water or faeces). In the tables, the candidate metabolites for biomarkers of diagnosis, or the biomarkers themselves, are detailed, indicating the type of sample in which they were detected and their up- or down-regulation (if calculated). The metabolites derived from each study have been filtered carefully, according to the analytical platform, and biostatistical discriminant analyses developed. Among the pool of data provided, those reaching a level of significance of p=0.05-0.0001, according to the Bonferroni correction, Steel- Dwass t- or Wilcoxon matched pair tests, are shown. © 2014 Bentham Science Publishers.",acute coronary syndrome;Alzheimer disease;argininosuccinic aciduria;article;atherosclerosis;bladder cancer;blood sampling;breast cancer;cardiovascular disease;celiac disease;central nervous system;cerebrovascular disease;colorectal cancer;coronary artery disease;Crohn disease;depression;diabetes mellitus;diseases;down regulation;esophagus cancer;feces analysis;heart failure;heart infarction;heart muscle ischemia;homocystinuria;human;Huntington chorea;hypertension;idiopathic intracranial hypertension;inborn error of metabolism;insulin dependent diabetes mellitus;insulin sensitivity;interstitial cystitis;kidney carcinoma;Lesch Nyhan syndrome;liver cell carcinoma;lung cancer;maple syrup urine disease;metabolite;metabolomics;methylmalonic acidemia;mouth squamous cell carcinoma;multiple sclerosis;neoplasm;neurologic disease;non insulin dependent diabetes mellitus;osteoarthritis;ovary carcinoma;pancreas cancer;Parkinson disease;pathophysiology;phenylketonuria;preeclampsia;propionic acidemia;prostate cancer;reperfusion injury;saliva analysis;sputum analysis;stomach cancer;tyrosinemia;ulcerative colitis;upregulation;uremia;urinalysis;urogenital tract cancer;uterine cervix carcinoma,"Medina, S.;Domínguez-Perles, R.;Gil, J. I.;Ferreres, F.;Gil-Izquierdo, A.",2014,,,0,
2924,Demographic and epidemiological determinants of healthcare costs in Netherlands: Cost of illness study,"Objectives: To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex. Design: Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most important sectors (hospitals, nursing homes, inpatient psychiatric care, institutions for mentally disabled people) have national registries. Total expenditures for each sector were subdivided into 21 age groups, sex, and 34 diagnostic groups. Setting: Netherlands, 1994. Main outcome measures: Proportion of healthcare budget spent on each category of disease and cost of health care per person at various ages. Results: After the first year of life, costs per person for children were lowest. Costs rose slowly throughout adult life and increased exponentially from age 50 onwards till the oldest age group (≤ 95). The top five areas of healthcare costs were mental retardation, musculoskeletal disease (predominantly joint disease and dorsopathy), dementia, a heterogeneous group of other mental disorders, and ill defined conditions. Stroke, all cancers combined, and coronary heart disease ranked 7, 8, and 10, respectively. Conclusions: The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularly mental disability. A large share of the healthcare budget is spent on long term nursing care, and this cost will inevitably increase further in an ageing population. Non-specific cost containment measures may endanger the quality of care for old and mentally disabled people.",adult;aged;arthropathy;article;neoplasm;child;cost of illness;dementia;demography;epidemiology;female;health care cost;health care delivery;health care need;health care quality;human;ischemic heart disease;male;mental deficiency;mental disease;musculoskeletal disease;Netherlands;nursing;priority journal;register;senescence;cerebrovascular accident,"Meerding, W. J.;Bonneux, L.;Polder, J. J.;Koopmanschap, M. A.;Van der Maas, P. J.",1998,,,0,
2925,Palliative care needs in COPD patients with or without cancer: An epidemiological study,"Chronic obstructive pulmonary disease (COPD) is a growing cause of morbidity and mortality worldwide. However, many patients with severe COPD do not receive adequate palliative care. The main goals of our study were to identify the percentage of hospital patients with palliative care needs, particularly those who suffer from COPD. Data were collected prospectively from inpatients at the University Medical Centre Freiburg (Freiburg, Germany). Based on the World Health Organization definition of palliative care, the treating physician reported for each patient discharged whether the patient had palliative care needs or not. Data from 39849 patients could be analysed, of which 1455 were suffering from COPD. Of all COPD patients, 9.1% had palliative care needs. In COPD patients with palliative care needs, hospital stay was significantly longer (13.7 versus 10.3 days) than in the group without palliative care needs, and significantly more patients died during their hospital stay (8.3% versus 3.7%). The presence of metastases was the highest risk factor for developing palliative care needs (OR 4.18). Furthermore, a main diagnosis of COPD implied an increased probability of palliative care needs (OR 1.87). Our results show that COPD patients have a high risk of developing palliative care needs. Further efforts are required to provide palliative care to COPD patients.",aged;article;cancer risk;chronic obstructive lung disease;comorbidity;controlled study;dementia;depression;female;Germany;health care need;hospital patient;human;ischemic heart disease;length of stay;major clinical study;male;metastasis;mortality;neoplasm;palliative therapy;priority journal;probability;prospective study;risk assessment;risk factor;world health organization,"Meffert, C.;Hatami, I.;Xander, C.;Becker, G.",2015,,,0,
2926,International report: Local response following the great east Japan Earthquake 2011,,antiparkinson agent;neuroleptic agent;prescription drug;angina pectoris;article;building;consultation;dementia;diabetes mellitus;disaster planning;disease severity;earthquake;elderly care;emergency;emergency ward;fracture;hospital;hospital personnel;human;Japan;laboratory;mental health;neuroscience;outpatient;patient care;patient safety;patient transport;posttraumatic stress disorder;priority journal;psychiatrist;psychotherapist;psychotrauma;rapid response team;refugee;weakness,"Meguro, K.",2011,,,0,
2927,Atrophy of the parahippocampal gyrus is prominent in heart failure patients without dementia,"AIMS: The exacerbation of heart failure (HF) induces brain damage and cognitive impairment (CI), which frequently attenuates the effects of treatment. However, it is not clear whether HF patients without clinical dementia demonstrate increased risk of CI. We examined whether local atrophy in the parahippocampal gyrus, a potential predictor of CI, is prominent in HF patients without clinical dementia. METHODS AND RESULTS: Twenty stable HF patients with a history of admission due to decompensated HF or presentation of apparent pulmonary congestion following chest X-ray and 17 controls were enrolled in this observational, analytical, cross-sectional, case-control study. Patients with dementia were excluded from this study based on the results of cognitive assessment. Three-dimensional T1 weighted magnetic resonance image analysis was performed to evaluate the severity of local brain atrophy using software based on statistical parametric mapping. Z-score values were calculated to evaluate the severity of atrophy in the total brain and parahippocampal gyrus. The severity of total brain atrophy was similar between HF patients (8.0 +/- 2.9%) and controls (6.5 +/- 3.1%). However, the Z-score was significantly higher in the HF group (1.12 +/- 0.49) in comparison with the control group (0.63 +/- 0.36, P = 0.002). The Z-score value did not correlate with age, ejection fraction, left atrial dimension, left ventricular dimensions, or brain natriuretic peptides in the HF group but did correlate with the Clinical Frailty Scale. CONCLUSIONS: Local atrophy in the parahippocampal gyrus was prominent in HF patients without clinical dementia. This finding showed that HF patients without dementia feature a potential risk for developing CI.",Brain atrophy;Cognitive function;Frailty;Heart failure;Mri,"Meguro, T.;Meguro, Y.;Kunieda, T.",2017,Jul 17,,0,
2928,Regression coefficient–based scoring system should be used to assign weights to the risk index,"Objective Some previously developed risk scores contained a mathematical error in their construction: risk ratios were added to derive weights to construct a summary risk score. This study demonstrates the mathematical error and derived different versions of the Charlson comorbidity score (CCS) using regression coefficient–based and risk ratio–based scoring systems to further demonstrate the effects of incorrect weighting on performance in predicting mortality. Study Design and Setting This retrospective cohort study included elderly people from the Clinical Practice Research Datalink. Cox proportional hazards regression models were constructed for time to 1-year mortality. Weights were assigned to 17 comorbidities using regression coefficient–based and risk ratio–based scoring systems. Different versions of CCS were compared using Akaike information criteria (AIC), McFadden's adjusted R2, and net reclassification improvement (NRI). Results Regression coefficient–based models (Beta, Beta10/integer, Beta/Schneeweiss, Beta/Sullivan) had lower AIC and higher R2 compared to risk ratio–based models (HR/Charlson, HR/Johnson). Regression coefficient–based CCS reclassified more number of people into the correct strata (NRI range, 9.02–10.04) compared to risk ratio–based CCS (NRI range, 8.14–8.22). Conclusion Previously developed risk scores contained an error in their construction adding ratios instead of multiplying them. Furthermore, as demonstrated here, adding ratios fail to even work adequately from a practical standpoint. CCS derived using regression coefficients performed slightly better than in fitting the data compared to risk ratio–based scoring systems. Researchers should use a regression coefficient–based scoring system to develop a risk index, which is theoretically correct.",acquired immune deficiency syndrome;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comparative effectiveness;congestive cardiomyopathy;dementia;diabetes mellitus;geriatric patient;heart infarction;hemiplegia;human;kidney disease;liver disease;metastasis;mortality;neoplasm;peptic ulcer;peripheral vascular disease;priority journal;proportional hazards model;retrospective study;rheumatic disease;risk assessment,"Mehta, H. B.;Mehta, V.;Girman, C. J.;Adhikari, D.;Johnson, M. L.",2016,,10.1016/j.jclinepi.2016.03.031,0,
2929,"Cardiac imaging in the geriatric population: What do we think we know, and what do we need to learn?","Cardiac imaging plays an important role in coronary artery disease (CAD), congestive heart failure (HF) and valvular heart disease (VHD) in the elderly. Imaging defines the structure and function of the cardiac system, refining the understanding of patients' anatomy and physiology and informing a host of clinical care decisions, including prognosis. Yet there is a paucity of evidence to guide the rational use of many imaging modalities in patients of advanced age, a population with considerable clinical heterogeneity, high prevalence and burden of cardiovascular disease (CVD) and atypical presentations of CVD. This paper discusses important considerations for cardiac imaging for older adults, particularly in regard to CAD, VHD and HF, and then presents domains for future research to produce data that would inform clinical care guidelines, appropriate use criteria and imaging lab protocols to address the unique needs of the fast-growing elderly population.",age;aorta stenosis;article;bronchospasm;cardiac imaging;cardiovascular magnetic resonance;chronic obstructive lung disease;clinical decision making;clinical feature;cognitive defect;computer assisted tomography;congestive heart failure;coronary artery disease;dementia;disease predisposition;echocardiography;electrocardiogram;frail elderly;geriatric care;glomerulus filtration rate;high risk population;human;isotope labeling;kidney function;mitral valve regurgitation;practice guideline;prevalence;prognostic assessment;radiation exposure;scintiscanning;single photon emission computer tomography;transesophageal echocardiography;transthoracic echocardiography;valvular heart disease,"Mehta, N.;Chokshi, N. P.;Kirkpatrick, J. N.",2014,,,0,
2930,Hyperhomocysteinemia hastens myocardial infarct and stroke. Prevention.with leaf salads and vitamins,,"Adult;Age Factors;Aged;Arteriosclerosis/etiology/prevention & control;Clinical Trials as Topic;Dementia/etiology;*Diet;Drug Therapy, Combination;Female;Folic Acid/administration & dosage/*therapeutic use;Fruit;Homocysteine/blood;Humans;Hyperhomocysteinemia/*complications/*prevention & control;Male;Myocardial Infarction/*etiology;Prospective Studies;Risk Factors;Sex Factors;Stroke/*etiology;Vegetables;Vitamin B 12/administration & dosage/*therapeutic use;Vitamin B 6/administration & dosage/*therapeutic use","Meissner, T.",2003,Mar 6,,0,
2931,Huntington's disease induced cardiac amyloidosis is reversed by modulating protein folding and oxidative stress pathways in the Drosophila heart,"Amyloid-like inclusions have been associated with Huntington's disease (HD), which is caused by expanded polyglutamine repeats in the Huntingtin protein. HD patients exhibit a high incidence of cardiovascular events, presumably as a result of accumulation of toxic amyloid-like inclusions. We have generated a Drosophila model of cardiac amyloidosis that exhibits accumulation of PolyQ aggregates and oxidative stress in myocardial cells, upon heart-specific expression of Huntingtin protein fragments (Htt-PolyQ) with disease-causing poly-glutamine repeats (PolyQ-46, PolyQ-72, and PolyQ-102). Cardiac expression of GFP-tagged Htt-PolyQs resulted in PolyQ length-dependent functional defects that included increased incidence of arrhythmias and extreme cardiac dilation, accompanied by a significant decrease in contractility. Structural and ultrastructural analysis of the myocardial cells revealed reduced myofibrillar content, myofibrillar disorganization, mitochondrial defects and the presence of PolyQ-GFP positive aggregates. Cardiac-specific expression of disease causing Poly-Q also shortens lifespan of flies dramatically. To further confirm the involvement of oxidative stress or protein unfolding and to understand the mechanism of PolyQ induced cardiomyopathy, we co-expressed expanded PolyQ-72 with the antioxidant superoxide dismutase (SOD) or the myosin chaperone UNC-45. Co-expression of SOD suppressed PolyQ-72 induced mitochondrial defects and partially suppressed aggregation as well as myofibrillar disorganization. However, co-expression of UNC-45 dramatically suppressed PolyQ-72 induced aggregation and partially suppressed myofibrillar disorganization. Moreover, co-expression of both UNC-45 and SOD more efficiently suppressed GFP-positive aggregates, myofibrillar disorganization and physiological cardiac defects induced by PolyQ-72 than did either treatment alone. Our results demonstrate that mutant-PolyQ induces aggregates, disrupts the sarcomeric organization of contractile proteins, leads to mitochondrial dysfunction and increases oxidative stress in cardiomyocytes leading to abnormal cardiac function. We conclude that modulation of both protein unfolding and oxidative stress pathways in the Drosophila heart model can ameliorate the detrimental PolyQ effects, thus providing unique insights into the genetic mechanisms underlying amyloid-induced cardiac failure in HD patients.","Amyloid/metabolism/toxicity;Amyloidosis/complications/*genetics/metabolism/pathology;Animals;Disease Models, Animal;Drosophila melanogaster/genetics/physiology;Gene Expression Regulation;Heart/physiopathology;Humans;Huntington Disease/complications/*genetics/metabolism/pathology;Microtubule-Associated Proteins/*genetics;Mutation;Oxidative Stress/genetics;Peptides/*genetics;*Protein Folding;Signal Transduction;Superoxide Dismutase/biosynthesis","Melkani, G. C.;Trujillo, A. S.;Ramos, R.;Bodmer, R.;Bernstein, S. I.;Ocorr, K.",2013,,10.1371/journal.pgen.1004024,0,
2932,Poststroke dementia predicts poor survival in long-term follow-up: influence of prestroke cognitive decline and previous stroke,"BACKGROUND: The aim of this study was to investigate the influence of poststroke dementia on long-term survival after acute stroke and also to assess the possible influence of prestroke cognitive decline and previous stroke on this relationship. METHODS: A total of 451 consecutive patients with acute ischaemic stroke admitted to hospital were included in the study and followed up for 12 years. Dementia was diagnosed 3 months after stroke in 115 patients (25.5%). RESULTS: In Kaplan-Meier analysis, poststroke dementia predicted poor long-term survival (5.1 years vs 8.8 years in patients who did not have poststroke dementia; p<0.001). Prestroke cognitive decline had a negative influence on survival in patients with poststroke dementia (3.8 years vs 5.8 years; p<0.001); however, previous stroke did not affect survival in these patients (p = 0.676). In stepwise Cox regression proportional hazards analysis adjusted for significant covariates, poststroke dementia (hazard ratio (HR) 1.53; p = 0.003), advanced age (HR 1.07; p<0.001), severity of stroke (HR 1.91; p<0.001), smoking (HR 1.35; p = 0.035), cardiac failure (HR 1.61; p = 0.003) and atrial fibrillation (HR 1.89; p = 0.035) were all independent predictors of poor long-term survival. Poststroke dementia (HR 2.33; p<0.001), advanced age (HR 1.07; p<0.001) and poor Rankin score (HR 2.15; p = 0.001) were associated with death from brain-related causes, including infarction, haemorrhage and dementia. CONCLUSIONS: Long-term follow-up of our large well-defined poststroke cohort indicated that in patients with acute stroke, dementia is a significant predictor of poor long-term survival and death from brain-associated causes. Prestroke cognitive decline seems to have an additional negative influence on survival, but previous stroke does not seem to affect survival.","Age Factors;Aged;Aged, 80 and over;Cause of Death;Cognition Disorders/*etiology/psychology;Cohort Studies;Data Interpretation, Statistical;Dementia/*etiology;Female;Finland/epidemiology;Follow-Up Studies;Humans;Kaplan-Meier Estimate;Male;Middle Aged;Risk Factors;Selection Bias;Sex Factors;Socioeconomic Factors;Stroke/*complications;Survival;Survival Analysis","Melkas, S.;Oksala, N. K.;Jokinen, H.;Pohjasvaara, T.;Vataja, R.;Oksala, A.;Kaste, M.;Karhunen, P. J.;Erkinjuntti, T.",2009,Aug,10.1136/jnnp.2008.166603,0,
2933,"The link between vasculogenic erectile dysfunction, coronary artery disease, and peripheral artery disease: Role of metabolic factors and endovascular therapy","Erectile dysfunction (ED) is estimated to affect 150 million people worldwide and may indicate diffuse systemic macrovascular disease. Endothelial dysfunction represents the probable pathophysiological link between vasculogenic ED, coronary artery disease (CAD), and peripheral artery disease (PAD), and the artery size hypothesis along with evidence-based research support ED as the incident clinical event. Given that many common risk factors for atherosclerosis, including smoking, diabetes mellitus, hyperlipidemia, and obesity are prevalent and causative in patients with ED, it is likely that metabolic factors play a crucial role in the link between the two disorders. The interplay of these factors provides a unifying physiological, endocrinological, and behavioral model for the association between ED, CAD, and PAD. Current therapy is unlikely to reverse the natural history of ED. Percutaneous revascularization may improve ED symptoms, and thereby quality of life, in a select group of patients. Large prospective studies are needed to define male pelvic arterial anatomy and thus enhance the utilization of internal pudendal angiography and revascularization. In this review, we provide an overview of normal erectile anatomy and physiology, the pathophysiology of ED, currently accepted diagnostic imaging modalities and treatments for ED, and recently investigated endovascular therapies for ED.",apomorphine;cyclic GMP;dopamine;nitric oxide;phentolamine;prostaglandin E1;sildenafil;tadalafil;testosterone;vardenafil;zotarolimus;aging;alcohol consumption;alcoholism;Alzheimer disease;androgen deficiency;ankle brachial index;arterial insufficiency;arterial pressure;arteriography;artery diameter;artery dilatation;article;atherogenesis;atherosclerosis;blunt trauma;cavernosography;cerebrovascular accident;coronary artery disease;depression;diabetes mellitus;disease predisposition;dopaminergic nerve cell;Doppler flowmetry;drug eluting stent;drug induced disease;dyslipidemia;endothelium injury;erectile dysfunction;fibrosis;flow rate;hemochromatosis;human;hypercholesterolemia;hyperlipidemia;hyperprolactinemia;hypogonadotropic hypogonadism;hypophysis tumor;hypothalamus;hypoxia;insulin resistance;internal iliac artery;libido disorder;life event;lifestyle;lifestyle modification;lung disease;medical history;multiple sclerosis;nonadrenergic noncholinergic nerve;Parkinson disease;pathophysiology;penis;penis artery;penis prosthesis;percutaneous coronary intervention;percutaneous transluminal angioplasty;performance anxiety;peripheral neuropathy;peripheral occlusive artery disease;physical examination;priapism;revascularization;risk factor;schizophrenia;sedentary lifestyle;sexual abuse;sexual counseling;sexual dysfunction;sexual education;sexual function;sexual satisfaction;sleep disorder;sleep disordered breathing;smoking;smooth muscle relaxation;social problem;spinal cord injury;stress;tactile stimulation;vein occlusion,"Meller, S. M.;Stilp, E.;Walker, C. N.;Mena-Hurtado, C.",2013,,,0,
2934,Milk--the promoter of chronic Western diseases,"Common chronic diseases of Western societies, such as coronary heart disease, diabetes mellitus, cancer, hypertension, obesity, dementia, and allergic diseases are significantly influenced by dietary habits. Cow's milk and dairy products are nutritional staples in most Western societies. Milk and dairy product consumption is recommended by most nutritional societies because of their beneficial effects for calcium uptake and bone mineralization and as a source of valuable protein. However, the adverse long-term effects of milk and milk protein consumption on human health have been neglected. A hypothesis is presented, showing for the first time that milk protein consumption is an essential adverse environmental factor promoting most chronic diseases of Western societies. Milk protein consumption induces postprandial hyperinsulinaemia and shifts the growth hormone/insulin-like growth factor-1 (IGF-1) axis to permanently increased IGF-1 serum levels. Insulin/IGF-1 signalling is involved in the regulation of fetal growth, T-cell maturation in the thymus, linear growth, pathogenesis of acne, atherosclerosis, diabetes mellitus, obesity, cancer and neurodegenerative diseases, thus affecting most chronic diseases of Western societies. Of special concern is the possibility that milk intake during pregnancy adversely affects the early fetal programming of the IGF-1 axis which will influence health risks later in life. An accumulated body of evidence for the adverse effects of cow's milk consumption from fetal life to childhood, adolescence, adulthood and senescence will be provided which strengthens the presented hypothesis.","Animals;Chronic Disease/*epidemiology;Female;Humans;Milk/*adverse effects/*statistics & numerical data;*Milk, Human;*Models, Biological;Pregnancy;Prenatal Exposure Delayed Effects/*epidemiology;Risk Assessment;Western World","Melnik, B. C.",2009,Jun,10.1016/j.mehy.2009.01.008,0,
2935,A novel neurological phenotype in mice lacking mitochondrial manganese superoxide dismutase,"Reactive oxygen species (ROS) have been implicated in a wide range of degenerative processes including amyotrophic lateral sclerosis, ischemic heart disease, Alzheimer disease, Parkinson disease and aging. ROS are generated by mitochondria as the toxic by-products of oxidative phosphorylation, their energy generating pathway. Genetic inactivation of the mitochondrial form of superoxide dismutase in mice results in dilated cardiomyopathy, hepatic lipid accumulation and early neonatal death. We report that treatment with the superoxide dismutase (SOD) mimetic Manganese 5, 10, 15, 20-tetrakis (4-benzoic acid) porphyrin (MnTBAP) rescues these Sod2tm1Cje(-/-) mutant mice from this systemic pathology and dramatically prolongs their survival. The animals instead develop a pronounced movement disorder progressing to total debilitation by three weeks of age. Neuropathologic evaluation reveals a striking spongiform degeneration of the cortex and specific brain stem nuclei associated with gliosis and intramyelinic vacuolization similar to that observed in cytotoxic edema and disorders associated with mitochondrial abnormalities such as Leighs disease and Canavans disease. We believe that due to the failure of MnTBAP to cross the blood brain barrier progressive neuropathology is caused by excessive mitochondrial production of ROS. Consequently, MnTBAP-treated Sod2tm1Cje(-/-) mice may provide an excellent model for examining the relationship between free radicals and neurodegenerative diseases and for screening new drugs to treat these disorders.","Animals;Brain/pathology;Brain Stem/pathology/ultrastructure;Cerebral Cortex/pathology/ultrastructure;DNA, Mitochondrial/*genetics;Free Radical Scavengers/pharmacology;Humans;Lipid Metabolism;Liver/metabolism;Metalloporphyrins/*pharmacology;Mice;Mice, Knockout;Mitochondria/enzymology;Neurodegenerative Diseases/drug therapy/*genetics/pathology;Neurons/pathology;Superoxide Dismutase/*deficiency/*genetics;Survival Rate;Trigeminal Nuclei/pathology/ultrastructure;Vacuoles/pathology/ultrastructure","Melov, S.;Schneider, J. A.;Day, B. J.;Hinerfeld, D.;Coskun, P.;Mirra, S. S.;Crapo, J. D.;Wallace, D. C.",1998,Feb,10.1038/ng0298-159,0,
2936,X-ray crystal structure of human calcium-bound S100A1,"S100A1 is a member of the S100 family of Ca2+-binding proteins and regulates several cellular processes, including those involved in Ca2+ signaling and cardiac and skeletal muscle function. In Alzheimer's disease, brain S100A1 is overexpressed and gives rise to disease pathologies, making it a potential therapeutic target. The 2.25 A resolution crystal structure of Ca2+-S100A1 is solved here and is compared with the structures of other S100 proteins, most notably S100B, which is a highly homologous S100-family member that is implicated in the progression of malignant melanoma. The observed structural differences in S100A1 versus S100B provide insights regarding target protein-binding specificity and for targeting these two S100 proteins in human diseases using structure-based drug-design approaches.",Alzheimer's disease;S100;S100a1;S100b;calcium-binding proteins;cardiomyopathy;crystal structure,"Melville, Z.;Aligholizadeh, E.;McKnight, L. E.;Weber, D. J.;Pozharski, E.;Weber, D. J.",2017,Apr 01,,0,
2937,"Outcomes of treated hypertension in 79,376 patients aged 80 years and older: linked records based cohort analysis","Background Randomised controlled trials (RCT) have so far provided limited evidence for blood pressure targets in adults aged 80 years, with guidelines recommending varying targets. Treating hypertension in this group is complicated by age-related physiological changes, and is suspected that older adults are vulnerable to adverse events caused by low systolic blood pressures (SBP). Under-reporting and short follow-up times in available RCTs make it impossible to confirm or disproof this. This study aims to estimate outcomes by attained SBP in an older hypertensive population. Methods This study uses records-based cohort analysis of 79,376 subjects, with 11.9 years follow-up in linked primary care, inpatient and death certificate data. The population includes adults aged >80 years treated for hypertension, and free of dementia, cancer, coronary heart disease, stroke, heart failure or end stage renal failure. The SBP target maintained in the 3 years prior to baseline defined exposure groups, and outcomes analysed during follow-up are all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, heart failure and fragility fractures. Cox proportional hazards models and competing risk models were used to assess the relation between achieved blood pressures and outcomes. Results There was a U-shaped association between SBP and mortality, with lowest risk identified at SBP=150+/-5mmHg. We identified 10,339 patients with SBP below 135mmHg, where mortality risk was raised (Hazard Ratio 1.25 95% CI 1.19 to 1.31) compared to the reference group (SBP=150+/-5mm Hg). Similarly, risk of incident heart failure increased below SBP 125mmHg. Higher blood pressures (above 164mmHg) was associated with increased rates of cardiovascular mortality and incident stroke. There was no association between SBP and incident fragility fractures. Conclusions An SBP target close to 150mmHg, measured in routine clinical practice, was associated with lower mortality risks for hypertensive patients aged 80 and over. Lower blood pressures, especially those reaching 15 or more mmHg below 150mmHg, are associated with increased risk of death and cardiovascular outcomes. It may be necessary to include a lower SBP limit in treatment guidelines for managing hypertension in older adults.",hypertension;patient;human;cohort analysis;American;geriatrics;society;mortality;risk;blood pressure;adult;follow up;heart failure;cerebrovascular accident;population;fragility fracture;cardiovascular mortality;dementia;model;death certificate;proportional hazards model;hospital patient;primary medical care;randomized controlled trial;heart infarction;systolic blood pressure;exposure;end stage renal disease;ischemic heart disease;death;very elderly;hazard ratio;clinical practice;neoplasm,"Melzer, D;Delgado, J;Masoli, J;Kuchel, Ga",2016,,10.1111/jgs.14231,0,2938
2938,"Outcomes of treated hypertension in 79,376 patients aged 80 years and older: Linked records based cohort analysis","Background Randomised controlled trials (RCT) have so far provided limited evidence for blood pressure targets in adults aged 80 years, with guidelines recommending varying targets. Treating hypertension in this group is complicated by age-related physiological changes, and is suspected that older adults are vulnerable to adverse events caused by low systolic blood pressures (SBP). Under-reporting and short follow-up times in available RCTs make it impossible to confirm or disproof this. This study aims to estimate outcomes by attained SBP in an older hypertensive population. Methods This study uses records-based cohort analysis of 79,376 subjects, with 11.9 years follow-up in linked primary care, inpatient and death certificate data. The population includes adults aged >80 years treated for hypertension, and free of dementia, cancer, coronary heart disease, stroke, heart failure or end stage renal failure. The SBP target maintained in the 3 years prior to baseline defined exposure groups, and outcomes analysed during follow-up are all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, heart failure and fragility fractures. Cox proportional hazards models and competing risk models were used to assess the relation between achieved blood pressures and outcomes. Results There was a U-shaped association between SBP and mortality, with lowest risk identified at SBP=150+/-5mmHg. We identified 10,339 patients with SBP below 135mmHg, where mortality risk was raised (Hazard Ratio 1.25 95% CI 1.19 to 1.31) compared to the reference group (SBP=150+/-5mm Hg). Similarly, risk of incident heart failure increased below SBP 125mmHg. Higher blood pressures (above 164mmHg) was associated with increased rates of cardiovascular mortality and incident stroke. There was no association between SBP and incident fragility fractures. Conclusions An SBP target close to 150mmHg, measured in routine clinical practice, was associated with lower mortality risks for hypertensive patients aged 80 and over. Lower blood pressures, especially those reaching 15 or more mmHg below 150mmHg, are associated with increased risk of death and cardiovascular outcomes. It may be necessary to include a lower SBP limit in treatment guidelines for managing hypertension in older adults.",hypertension;patient;human;cohort analysis;American;geriatrics;society;mortality;risk;blood pressure;adult;follow up;heart failure;cerebrovascular accident;population;fragility fracture;cardiovascular mortality;dementia;model;death certificate;proportional hazards model;hospital patient;primary medical care;randomized controlled trial;heart infarction;systolic blood pressure;exposure;end stage renal disease;ischemic heart disease;death;very elderly;hazard ratio;clinical practice;neoplasm,"Melzer, D.;Delgado, J.;Masoli, J.;Kuchel, G. A.",2016,,10.1111/jgs.14231,0,
2939,Effects of the diabetes linked TCF7L2 polymorphism in a representative older population,"BACKGROUND: A polymorphism in the transcription factor 7-like 2 (TCF7L2) gene has been found to be associated with type 2 diabetes in case-control studies. We aimed to estimate associations of the marker rs7903146 (C/T) polymorphism with fasting glucose, lipids, diabetes prevalence and complications in an older general population. METHODS: In total, 944 subjects aged > or = 65 years from the population representative InCHIANTI study were enrolled in this study. Those with fasting blood glucose of > or = 7 mmol/l or physician diagnosis were considered diabetic. Cut-off points for impaired fasting glucose (IFG) were > or = 5.6 mmol/l to < 7 mmol/l. RESULTS: In the general population sample, minor (T) allele carriers of rs7903146 had higher fasting blood glucose (FBG) (p = 0.028) but lower fasting insulin (p = 0.030) and HOMA2b scores (p = 0.001), suggesting poorer beta-cell function. T allele carriers also had smaller waist circumference (p = 0.009), lower triglyceride levels (p = 0.006), and higher high-density lipoprotein cholesterol (p = 0.008). The prevalence of diabetes or IFG was 32.4% in TT carriers and 23.3% in CC carriers; adjusted OR = 1.67 (95% confidence interval 1.05 to 2.65, p = 0.031). Within the diabetic and IFG groups, fewer T allele carriers had metabolic syndrome features (p = 0.047) or had experienced a myocardial infarction (p = 0.037). Conversely, T allele carriers with diabetes had poorer renal function (reduced 24-hour creatinine clearance, p = 0.013), and possibly more retinopathy (p = 0.067). Physician-diagnosed dementia was more common in the T carriers (in diabetes p = 0.05, with IFG p = 0.024). CONCLUSION: The TCF7L2 rs7903146 polymorphism is associated with lower insulin levels, smaller waist circumference, and lower risk lipid profiles in the general elderly population. Patients with diabetes who are carriers of the minor allele are less likely to have metabolic-syndrome features, but may experience more microvascular complications, although the number of cases was small. If replicated, these findings may have implications for developing treatment approaches tailored by genotype.","Aged;Aged, 80 and over;Aging/*genetics;Body Size;Cohort Studies;Diabetes Mellitus/*genetics;Female;Humans;Insulin/blood;Italy;Lipids/blood;Male;*Polymorphism, Genetic;TCF Transcription Factors/*genetics;Transcription Factor 7-Like 2 Protein","Melzer, D.;Murray, A.;Hurst, A. J.;Weedon, M. N.;Bandinelli, S.;Corsi, A. M.;Ferrucci, L.;Paolisso, G.;Guralnik, J. M.;Frayling, T. M.",2006,Dec 20,10.1186/1741-7015-4-34,0,
2940,Cardiogenic seizure with bradyarrhythmia: Documentation of the mechanism during asystole,,aged;Alzheimer disease;article;heart arrest;bradycardia;case report;electrocardiography;electroencephalogram;female;human;priority journal;seizure;faintness,"Mendes, L. A.;Davidoff, R.",1993,,,0,
2941,Environmentally dependent delusions in dementia 2,,aged;case report;cognitive defect;delusion;edema;environmental factor;heart right ventricle failure;human;letter;male;multiinfarct dementia;priority journal,"Mendez, M. F.;Swanberg, M.",2001,,,0,
2942,Yield of diagnostic tests in evaluating syncopal episodes in older patients,"Background: Syncopal episodes are common among older adults; etiologies range from benign to life threatening. We determined the frequency, yield, and costs of tests obtained to evaluate older persons with syncope. We also calculated the cost per test yield and determined whether the San Francisco syncope rule (SFSR) improved test yield. Methods: Review of 2106 consecutive patients 65 years or older admitted following a syncopal episode. Results: Electrocardiograms (in 99% of admissions), telemetry (in 95%), cardiac enzyme tests (in 95%), and head computed tomographic (CT) scans (in 63%) were the most frequently obtained tests. Results from cardiac enzymes tests, CT scans, echocardiography, carotid ultrasonography, and electroencephalography all affected diagnosis or management in less than5%of cases and helped determine the etiology of syncope less than 2% of the time. Postural blood pressure (BP) recording, performed in only 38% of episodes, had the highest yield with respect to affecting diagnosis (18%-26%) or management (25%-30%) and determining etiology of the syncopal episode (15%-21%). The cost per test affecting diagnosis or management was highest for electroencephalography ($32 973), CT scans ($24 881), and cardiac enzymes test ($22 397) and lowest for postural BP recording ($17-$20). The yields and costs for cardiac tests were better among patients meeting, vs those not meeting, the SFSR. For example, the cost per cardiac enzymes test affecting diagnosis or management was $10 331 in those meeting, vs $111 518 in those not meeting, the SFSR. Conclusions: Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope. ©2009 American Medical Association. All rights reserved.",heart enzyme;aged;article;blood pressure measurement;body posture;carotid artery;clinical examination;computer assisted tomography;coronary artery disease;dehydration;dementia;diabetes mellitus;diagnostic imaging;diagnostic test;echocardiography;echography;electrocardiogram;electroencephalography;enzyme blood level;female;geriatric patient;health care cost;heart arrest;atrial fibrillation;heart block;heart infarction;hospital billing;human;hyperlipidemia;hypertension;major clinical study;male;orthostatic hypotension;physical examination;priority journal;sick sinus syndrome;cerebrovascular accident;faintness;telemetry,"Mendu, M. L.;McAvay, G.;Lampert, R.;Stoehr, J.;Tinetti, M. E.",2009,,,0,
2943,"Trends in the health status of older Manitobans, 1985 to 1999","Trends in the health status of the entire senior population aged 65 years or older in Manitoba were examined over a 14-year period (1985-1999) using administrative data (about 50,000 individuals). Significant health gains were apparent for a number of important indicators, including acute myocardial infarction, stroke, cancer, and hip fractures, although some of these gains were restricted to urban areas. Improvements in these health indicators are significant, as they can have major implications for individuals' need for health services and ability to live independently. In contrast, chronic diseases were on the rise, with the prevalence of diabetes, hypertension, and dementia increasing substantially over the 14-year period. These trends suggest a need for a policy emphasis on prevention, such as reducing the prevalence of obesity, which is one risk factor for diabetes. Moreover, having sufficient care options in place for the growing number of individuals with dementia is an issue that will have to be addressed.","Aged;Aged, 80 and over;Female;*Geriatric Assessment;*Health Status Indicators;Humans;Male;Manitoba","Menec, V. H.;Lix, L.;MacWilliam, L.",2005,Spring,,0,
2944,Diabetes in the Elderly,,"2,4 thiazolidinedione derivative;acarbose;alpha glucosidase inhibitor;angiotensin receptor antagonist;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;fibric acid derivative;glibenclamide;gliclazide;glimepiride;glucose;glycosylated hemoglobin;insulin;insulin derivative;insulin detemir;insulin glargine;isophane insulin;linagliptin;liraglutide;long acting insulin;metformin;oral antidiabetic agent;phosphodiesterase inhibitor;pioglitazone;rosiglitazone;saxagliptin;sitagliptin;sulfonylurea;thiazide diuretic agent;article;cardiovascular disease;clinical assessment;cognition;congestive heart failure;continuous infusion;dementia;depression;diabetes mellitus;diagnostic test;disease course;disease predisposition;drug dose escalation;drug tolerance;drug use;dyslipidemia;edema;elderly care;erectile dysfunction;exercise;fracture;functional status;gastrointestinal disease;glucose blood level;glycemic control;hemoglobin blood level;human;hypertension;hypoglycemia;insulin release;nursing home;nutrition;personalized medicine;physical activity;risk reduction","Meneilly, G. S.;Knip, A.;Tessier, D.",2013,,,0,
2945,"Do psychiatric comorbidities influence inpatient death, adverse events, and discharge after lower extremity fractures?","Background: Psychiatric comorbidity is known to contribute to illness (the state of feeling unwell/unable to rely on one's body) and increased use of healthcare resources, but the effect on inpatient outcomes in fracture care is relatively unexplored. Questions/purposes: Our primary null hypothesis is that a concomitant diagnosis of depression, anxiety, dementia, or schizophrenia is not associated with (1) discharge to another care facility rather than home after lower extremity fractures. Secondary study questions address the associations between psychiatric comorbidity and (2) longer inpatient stay and inpatient (3) adverse events; (4) blood transfusion; and (5) mortality after lower extremity fractures. Methods: Using the National Hospital Discharge Survey database, we analyzed a total estimated number of 10,669,449 patients with lower limb fractures from 1990 to 2007. Sixty-four percent were women, and the mean ± SD age was 67 ± 22 years. The prevalence in the study population was 3.2% for depression, 1.6% for anxiety, 0.6% for schizophrenia, and 2.9% for dementia. Results: A discharge diagnosis of psychiatric comorbidity was associated with a lower rate of discharge to home after accounting for an association with greater medical comorbidity (schizophrenia: odds ratio [OR], 5.6, 95% confidence interval [CI], 5.5-5.8; dementia: OR, 1.3, 95% CI, 1.2-1.3; depression: OR, 1.2, 95% CI, 1.2-1.3; anxiety: OR, 1.04, 95% CI, 1.02-1.06). Hospital stay was longer for patients with schizophrenia and dementia but shorter in patients with depression or anxiety compared with patients without any mental disorders. Schizophrenia was associated with more in-hospital adverse events and depression and anxiety with fewer events. A diagnosis of depression was associated with blood transfusion. Psychiatric comorbidity was not associated with a higher risk of in-hospital death. Conclusions: Optimal inpatient management of patients with lower extremity fractures should account for the influence of psychiatric comorbidities, dementia and schizophrenia in particular. © 2013 The Association of Bone and Joint Surgeons®.",acute heart infarction;acute kidney failure;adult;adverse outcome;aged;anemia;anxiety disorder;article;blood transfusion;comorbidity;controlled study;deep vein thrombosis;dementia;depression;disease association;fat embolism;female;heart arrest;heart ventricle arrhythmia;hospital discharge;human;hypotension;leg injury;length of stay;lung congestion;lung embolism;lung insufficiency;major clinical study;male;mortality;pneumonia;priority journal;psychiatric diagnosis;schizophrenia;wound complication,"Menendez, M. E.;Neuhaus, V.;Bot, A. G. J.;Vrahas, M. S.;Ring, D.",2013,,,0,
2946,The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery,"Background: Scores derived from comorbidities can help with risk adjustment of quality and safety data. The Charlson and Elixhauser comorbidity measures are well-known risk adjustment models, yet the optimal score for orthopaedic patients remains unclear. Questions/purposes: We determined whether there was a difference in the accuracy of the Charlson and Elixhauser comorbidity-based measures in predicting (1) in-hospital mortality after major orthopaedic surgery, (2) in-hospital adverse events, and (3) nonroutine discharge. Methods: Among an estimated 14,007,813 patients undergoing orthopaedic surgery identified in the National Hospital Discharge Survey (1990-2007), 0.80% died in the hospital. The association of each Charlson comorbidity measure and Elixhauser comorbidity measure with mortality was assessed in bivariate analysis. Two main multivariable logistic regression models were constructed, with in-hospital mortality as the dependent variable and one of the two comorbidity-based measures (and age, sex, and year of surgery) as independent variables. A base model that included only age, sex, and year of surgery also was evaluated. The discriminative ability of the models was quantified using the area under the receiver operating characteristic curve (AUC). The AUC quantifies the ability of our models to assign a high probability of mortality to patients who die. Values range from 0.50 to 1.0, with 0.50 indicating no ability to discriminate and 1.0 indicating perfect discrimination. Results: Elixhauser comorbidity adjustment provided a better prediction of in-hospital case mortality (AUC, 0.86; 95% CI, 0.86-0.86) compared with the Charlson model (AUC, 0.83; 95% CI, 0.83-0.84) and to the base model with no comorbidities (AUC, 0.81; 95% CI, 0.81-0.81). In terms of relative improvement in predictive performance, the Elixhauser measure performed 60% better than the Charlson score in predicting mortality. The Elixhauser model discriminated inpatient morbidity better than the Charlson measure, but the discriminative ability of the model was poor and the difference in the absolute improvement in predictive power between the two models (AUC, 0.01) is of dubious clinical importance. Both comorbidity models exhibited the same degree of discrimination for estimating nonroutine discharge (AUC, 0.81; 95% CI, 0.81-0.82 for both models). Conclusions: Provider-specific outcomes, particularly inpatient mortality, may be evaluated differently depending on the comorbidity risk adjustment model selected. Future research assessing and comparing the performance of the Charlson and Elixhauser measures in predicting long-term outcomes would be of value. Level of Evidence: Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence. © 2014 The Association of Bone and Joint Surgeons®.",acquired immune deficiency syndrome;adult;aged;alcohol abuse;anemia;article;blood clotting disorder;cerebrovascular disease;Charlson Comorbidity Index;chronic kidney failure;chronic lung disease;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;drug abuse;electrolyte disturbance;Elixhauser comorbidity index;female;health care survey;heart arrhythmia;heart infarction;hemiplegia;human;hypertension;leukemia;liver disease;lymphoma;major clinical study;male;measurement accuracy;obesity;orthopedic surgery;paraplegia;peptic ulcer;peripheral vascular disease;prediction;priority journal;receiver operating characteristic;rheumatic disease;solid tumor;surgical mortality;weight reduction,"Menendez, M. E.;Neuhaus, V.;Van Dijk, C. N.;Ring, D.",2014,,,0,
2947,Hydrolysis and Dissolution of Amyloids by Catabodies,"Catalytic antibodies (catabodies) hold potential for superior immunotherapy because of their turnover capability and no or minimal induction of inflammatory responses. Catabodies neutralize and remove target antigens more potently than conventional antibodies. Depending on the catalytic rate constant, a single catabody molecule degrades thousands to millions of target molecules over its useful lifespan, whereas conventional antibodies only form reversibly associated, stoichiometric complexes with the target. Thus, removal of the antibody-bound target requires accessory phagocytic cells that ingest the immune complexes, which is usually accompanied by release of inflammatory mediators. In comparison, catabodies bind the target only transiently, and the rapid and direct target destruction reduces the concentration of immune complexes that can activate inflammatory processes. These features are especially pertinent when large target amounts at anatomically vulnerable sites must be removed, e.g., amyloids. We reported specific catabodies to misfolded transthyretin (misTTR) amyloid and amyloid beta peptide (Abeta). Accumulation of the oligomeric and fibrillized amyloid TTR forms causes diverse systemic pathologies, including cardiomyopathy, polyneuropathy, and skeletal diseases. Brain Abeta aggregates are thought to cause central nervous system degenerative disease, chiefly Alzheimer's disease. We describe methods for testing catabody-mediated degradation and dissolution of Abeta and TTR.",Amyloid beta;Amyloids;Catalytic antibodies;Dissolution assay;Hydrolysis assay;Transthyretin,"Meretoja, V. V.;Paul, S.;Planque, S. A.",2017,,,0,
2948,,"Catalytic antibodies (catabodies) hold potential for superior immunotherapy because of their turnover capability and no or minimal induction of inflammatory responses. Catabodies neutralize and remove target antigens more potently than conventional antibodies. Depending on the catalytic rate constant, a single catabody molecule degrades thousands to millions of target molecules over its useful lifespan, whereas conventional antibodies only form reversibly associated, stoichiometric complexes with the target. Thus, removal of the antibody-bound target requires accessory phagocytic cells that ingest the immune complexes, which is usually accompanied by release of inflammatory mediators. In comparison, catabodies bind the target only transiently, and the rapid and direct target destruction reduces the concentration of immune complexes that can activate inflammatory processes. These features are especially pertinent when large target amounts at anatomically vulnerable sites must be removed, e.g., amyloids. We reported specific catabodies to misfolded transthyretin (misTTR) amyloid and amyloid β peptide (Aβ). Accumulation of the oligomeric and fibrillized amyloid TTR forms causes diverse systemic pathologies, including cardiomyopathy, polyneuropathy, and skeletal diseases. Brain Aβ aggregates are thought to cause central nervous system degenerative disease, chiefly Alzheimer’s disease. We describe methods for testing catabody-mediated degradation and dissolution of Aβ and TTR.",amyloid;amyloid beta protein;amyloid beta protein[1-40];amyloid beta protein[1-42];catalytic antibody;immunoglobulin A;immunoglobulin G;immunoglobulin light chain;immunoglobulin M;immunoglobulin M antibody;misfolded transthyretin amyloid;oligomer;unclassified drug;antigen antibody complex;beta sheet;binding affinity;controlled study;dissolution;electrophoresis;fluorescence;human;immunotherapy;iodination;molecular weight;plasma;protein binding;protein degradation;protein determination;protein hydrolysis,"Meretoja, V. V.;Paul, S.;Planque, S. A.",2017,,10.1007/978-1-4939-7180-0_9,0,
2949,But he has no chest pain,"Atypical presentations of acute coronary syndromes (ACS) are not uncommon and have been associated with higher mortality probably, because these patients are misdiagnosed and undertreated. They are most frequently encountered in older patients, women and in patients with diabetes, chronic renal failure or dementia. It is also well described in the literature that many chemotherapy agents are associated with myocardial ischaemic events. In addition to that, patients with cancer frequently receive large doses of opiate analgesics for chronic pain, which can obscure the symptoms of myocardial ischaemia. In this case report, we describe a patient who was receiving chemotherapy and large doses of opiate analgesics and presented with atypical symptoms for ACS. Our aim is to raise awareness of this challenging group of patients and the necessity to pay particular attention to symptoms other than chest pain as potential indicators of myocardial ischaemia.",abciximab;acetylsalicylic acid;beta adrenergic receptor blocking agent;cisplatin;clopidogrel;diazepam;dipeptidyl carboxypeptidase inhibitor;gemcitabine;hydroxymethylglutaryl coenzyme A reductase inhibitor;ibuprofen;morphine sulfate;nitrate;paracetamol;tirofiban;troponin T;acute coronary syndrome;adjuvant therapy;adult;article;bladder carcinoma;cancer chemotherapy;cardiovascular risk;case report;angiocardiography;coronary artery circumflex branch;creatinine blood level;cystectomy;diaphoresis;dyspnea;electrocardiogram;everolimus eluting coronary stent;heart sound;hemoglobin blood level;human;left anterior descending coronary artery;leukocyte count;low back pain;male;middle aged;nuclear magnetic resonance imaging;priority journal;smoking;spinal cord compression;spine fracture,"Merinopoulos, I.;Bloore, D.",2014,,,0,
2950,Molecular imaging of misfolded protein pathology for early clues to involvement of the heart,,"3,3 diphosphono 1,2 propanodicarboxylic acid tc 99m;amyloid;amyloid beta protein;amyloid protein;aprotinin;biological marker;brain natriuretic peptide;congo red;florbetapir f 18;Pittsburgh compound B;prealbumin;technetium 99m;thioflavine;unclassified drug;Alzheimer disease;amyloid plaque;amyloidosis;beta sheet;cardiotoxicity;cardiovascular magnetic resonance;cause of death;clinical feature;drug half life;heart amyloidosis;heart disease;heart function;heart injury;heart scintiscanning;human;light chain;molecular imaging;molecular probe;monoclonal immunoglobulinemia;neurologic disease;note;positron emission tomography;protein folding;protein structure;radioactivity;single photon emission computer tomography","Merlini, G.;Narula, J.;Arbustini, E.",2014,,,0,
2951,Survival after initial hospitalisation for heart failure: a multilevel analysis of patients in Swedish acute care hospitals,"STUDY OBJECTIVE: Although national variation in short-term prognosis (that is, 30 day mortality) after a patient's first hospitalisation for heart failure may depend on individual differences between patients, dissimilarities in hospital practices may also influence prognosis. This study, therefore, sought to disentangle patient determinants from institutional factors that might explain such variation. DESIGN: A multilevel logistic regression modelling was performed with patients (1st level) nested in hospitals (2nd level). Institutional effects (that is, 2nd level variance and intra-hospital correlation) were calculated unadjusted and adjusted for specific patient (that is, age and previous diseases) and institutional (that is, size of hospital) characteristics. Patients were followed up until death or 30 days from hospital admission. SETTING: Hospitals in Sweden. PATIENTS: The study identified all the 20420 men and 17923 women (ages 65 to 85) admitted to the 90 acute care hospitals in Sweden during the period 1992-1995 for their first hospitalisation attributable to heart failure. MAIN RESULTS: Patient age and previous diseases (particularly senile dementia) were major determinants of impaired prognosis. Institutional factors explained only 1.6% and 2.3% of the total variation in 30 day mortality in men and women, respectively. These modest institutional effects remained after adjusting for patient age and previous diseases, but were in part explained by hospital size. CONCLUSIONS: National variation in short-term prognosis after an initial hospitalisation for heart failure was mainly explained by differences between patients, with hospital factors playing a minor part. Of the latter, hospital size seemed to emerge as one determinant (that is, the greater the number of patients, the better the individual prognosis).","Acute Disease;Aged;Aged, 80 and over;Analysis of Variance;Female;Health Facility Size;Heart Failure/*mortality;Hospital Mortality;*Hospitalization/statistics & numerical data;Humans;Logistic Models;Male;Multivariate Analysis;Prognosis;Registries;Survival Analysis;Survival Rate;Sweden/epidemiology","Merlo, J.;Ostergren, P. O.;Broms, K.;Bjorck-Linne, A.;Liedholm, H.",2001,May,,0,
2952,ApoE genotype does not affect plasma tPA and PAI-1 antigen levels,"The presence of one or two apoliprotein E4 (apoE4) alleles constitutes a major risk factor for Alzheimer's disease (AD) and coronary heart disease (CHD). Numerous observations have suggested that misregulation of proteases may be instrumental in both diseases. Tissue-type plasminogen activator (tPA) has been recently demonstrated to play a key role in neuronal plasticity and in experimental neurodegeneration. One receptor for the ApoE protein is the LRP/alpha 2 macroglobulin receptor, which also binds to and endocytoses tPA and plasminogen activator inhibitor I (PAI-1). Here we tested whether the apoE genotype has an influence on the plasma levels of these proteins. We demonstrate that there is no difference in plasma levels of tPA- and PAI-1-antigens between middled-aged individuals with one apoE4 allele and those having none. This suggests that the impact of apoE4 on Alzheimer's disease is not the result of altered clearance of tPA or PAI-1 by the LRP receptor.",Adult;Apolipoproteins E/*genetics;Female;Genotype;Humans;Male;Plasminogen Activator Inhibitor 1/*blood;Tissue Plasminogen Activator/*blood;alpha-Macroglobulins/metabolism,"Mermod, J. J.;Kruithof, E. K.;Alouani, S.;Quiquerez, A. L.;Sadoul, R.",1997,Apr 18,,0,
2953,Comparison of risk estimates for selected diseases and causes of death,"Background. Lifetime risk estimates of disease are limited by long-term data extrapolations and are less relevant to individuals who have already lived a period of time without the disease, but are approaching the age at which the disease risk becomes common. In contrast, short-term age- conditional risk estimates, such as the risk of developing a disease in the next 10 years among those alive and free of the disease at a given age, are less restricted by long-term extrapolation of current rates and can present patients with risk information tailored to their age. This study focuses on short-term age-conditional risk estimates for a broad set of important chronic diseases and nondisease causes of death among white and black men and women. Methods. The Feuer et at. (1993, Journal of the National Cancer Institute) [15] method was applied to data from a variety of sources to obtain risk estimates for select cancers, myocardial infarction, diabetes mellitus, multiple sclerosis, Alzheimer's, and death from motor vehicle accidents, homicide or legal intervention, and suicide. Results. Acute deaths from suicide, homicide or legal intervention, and fatal motor vehicle accidents dominate the risk picture for persons in their 20s, with only diabetes mellitus and end-stage renal disease therapy (for blacks only) having similar levels of risk in this age range. Late in life, cancer, acute myocardial infarction, Alzheimer's, and stroke become most common. The chronic diseases affecting the population later in life present the most likely diseases someone will face. Several interesting differences in disease and death risks were derived and reported among age-specific race and gender subgroups of the population. Conclusion. Presentation of risk estimates for a broad set of chronic diseases and nondisease causes of death within short- term age ranges among population subgroups provides tailored information that may lead to better educated prevention, screening, and control behaviors and more efficient allocation of health resources.",Alzheimer disease;article;neoplasm;cancer risk;coronary risk;diabetes mellitus;heart infarction;homicide;human;multiple sclerosis;priority journal;risk factor;suicide;traffic accident,"Merrill, R. M.;Kessler, L. G.;Udler, J. M.;Rasband, G. C.;Feuer, E. J.",1999,,,0,
2954,Hypofractionated radiation therapy for treatment of bladder carcinoma in patients aged 90 years and more: A new paradigm to be explored?,"Introduction: There are only scarce data on the optimal management of patients who present with a bladder carcinoma and who are aged 90 years and older. Patients and methods: We retrospectively reviewed records from radiotherapy departments from two university hospitals, two private centers and one public center to identify patients who underwent radiotherapy for bladder cancer over the past decade and who were aged 90 years or older. From 2003 to 2013, 14 patients aged 90 years or older receiving RT for bladder malignant tumors were identified. Results: Mean age was 92.7 years. Ten patients (71 %) had a general health status altered (PS 2–3) at the beginning of RT. A total of 14 RT courses were delivered, including six treatments (43 %) with curative intent and eight treatments (57 %) with palliative intent. Palliative intent mainly encompassed hemostatic RT (36 %). At last follow-up, two patients (14 %) experienced complete response, one patient (7 %) experienced partial response, three patients (21 %) had their disease stable, and three patients (21 %) experienced tumor progression, of whom two patients with the progression of symptoms. There was no reported high-grade acute local toxicity in 14 patients (100 %). One patient experienced delayed grade 2 toxicity with pain and lower urinary tract symptoms. At last follow-up, seven patients (50 %) were deceased. Cancer was the cause of death for five patients. Conclusion: Hypofractionated radiotherapy remains feasible for nonagenarians with bladder cancer. Further investigations including analysis of geriatric comorbidities and impact of treatments on quality of life should be conducted.",antineoplastic agent;aged;article;bladder carcinoma;cancer immunotherapy;cancer radiotherapy;cancer staging;chronic respiratory failure;clinical article;clinical effectiveness;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;distant metastasis;female;hematuria;human;hypertension;hypofractionated radiotherapy;lower urinary tract symptom;male;medical record review;outcome assessment;pain;radiation dose;radiation dose fractionation;radiation injury;radiation safety;survival prediction;survival time;transurethral resection;treatment duration;very elderly,"Méry, B.;Falk, A. T.;Assouline, A.;Trone, J. C.;Guy, J. B.;Rivoirard, R.;Auberdiac, P.;Escure, J. L.;Moncharmont, C.;Moriceau, G.;Almokhles, H.;de Laroche, G.;Pacaut, C.;Guillot, A.;Chargari, C.;Magné, N.",2015,,,0,
2955,New Information on the genetics of stroke,"Ischemic stroke, white matter hyperintensities related to small vessel ischemia, and intracranial aneurysms all show heritability. This review focuses on recent progress in understanding the molecular genetics of these disorders. Also reviewed is recent progress in understanding single-gene disorders in which stroke is a major feature of the phenotype, including CADASIL, CARASIL, hereditary angiopathy with nephropathy, aneurysm and muscle cramps, and Fabry disease and progress in pharmacogenomics as it relates to response to antiplatelet therapy. © 2010 Springer Science+Business Media, LLC.","clopidogrel;phosphodiesterase IV;prasugrel;acute coronary syndrome;aneurysm;article;autosomal recessive disorder;brain atherosclerosis;brain hemorrhage;brain infarction;brain ischemia;CADASIL;CARASIL;chromosome 9p;CYP2C19 gene;Fabry disease;family history;gene;gene mutation;genetic association;genetic risk;atrial fibrillation;heart infarction;hereditary angiopathy with nephropathy, aneurysm and muscle cramps;human;intracranial aneurysm;kidney disease;leukoencephalopathy;linkage analysis;molecular genetics;moyamoya disease;muscle cramp;percutaneous coronary intervention;pharmacogenomics;phenotype;single nucleotide polymorphism;stent thrombosis;subarachnoid hemorrhage;transient ischemic attack;vascular disease;white matter","Meschia, J. F.",2011,,,0,
2956,Stroke genetics network (SiGN) study design and rationale for a genome-wide association study of ischemic stroke subtypes,"Background and Purpose-Meta-analyses of extant genome-wide data illustrate the need to focus on subtypes of ischemic stroke for gene discovery. The National Institute of Neurological Disorders and Stroke SiGN (Stroke Genetics Network) contributes substantially to meta-analyses that focus on specific subtypes of stroke. Methods-The National Institute of Neurological Disorders and Stroke SiGN includes ischemic stroke cases from 24 genetic research centers: 13 from the United States and 11 from Europe. Investigators harmonize ischemic stroke phenotyping using the Web-based causative classification of stroke system, with data entered by trained and certified adjudicators at participating genetic research centers. Through the Center for Inherited Diseases Research, the Network plans to genotype 10 296 carefully phenotyped stroke cases using genome-wide single nucleotide polymorphism arrays and adds to these another 4253 previously genotyped cases, for a total of 14 549 cases. To maximize power for subtype analyses, the study allocates genotyping resources almost exclusively to cases. Publicly available studies provide most of the control genotypes. Center for Inherited Diseases Research- generated genotypes and corresponding phenotypes will be shared with the scientific community through the US National Center for Biotechnology Information database of Genotypes and Phenotypes, and brain MRI studies will be centrally archived. Conclusions-The Stroke Genetics Network, with its emphasis on careful and standardized phenotyping of ischemic stroke and stroke subtypes, provides an unprecedented opportunity to uncover genetic determinants of ischemic stroke. © 2013 American Heart Association, Inc.",adult;aged;article;bacterial endocarditis;biotechnology;brain ischemia;brain vasculitis;CADASIL;cerebral sinus thrombosis;cerebrovascular accident;congestive cardiomyopathy;disseminated intravascular clotting;female;genetic analysis;genetic association;genetics;genotype;heart atrium myxoma;heparin induced thrombocytopenia;human;major clinical study;male;mitochondrial encephalopathy;national health organization;neuroimaging;nuclear magnetic resonance imaging;phenotype;priority journal;single nucleotide polymorphism,"Meschia, J. F.;Arnett, D. K.;Ay, H.;Brown, R. D.;Benavente, O. R.;Cole, J. W.;De Bakker, P. I. W.;Dichgans, M.;Doheny, K. F.;Fornage, M.;Grewal, R. P.;Gwinn, K.;Jern, C.;Conde, J. J.;Johnson, J. A.;Jood, K.;Laurie, C. C.;Lee, J. M.;Lindgren, A.;Markus, H. S.;McArdle, P. F.;McClure, L. A.;Mitchell, B. D.;Schmidt, R.;Rexrode, K. M.;Rich, S. S.;Rosand, J.;Rothwell, P. M.;Rundek, T.;Sacco, R. L.;Sharma, P.;Shuldiner, A. R.;Slowik, A.;Wassertheil-Smoller, S.;Sudlow, C.;Thijs, V. N. S.;Woo, D.;Worrall, B. B.;Wu, O.;Kittner, S. J.",2013,,,0,
2957,Treatment of patients with unresectable squamous head and neck cancer with induction chemotherapy followed by hyperfractionated radiotherapy,"Purpose: The contribution of induction chemotherapy (CT) followed by hyperfractionated radiotherapy (hfRT) in unresectable squamous head and neck cancer has been evaluated in a single institution as an assistencial protocol. Patients and methods: From March 1994 to June 2000 all consecutive patients with unresectable disease were treated with four courses of platin plus fluorouracil based CT followed by hfRT. Tumor resectability and response was assessed by a multidisciplinary committee. Results: Ninety-nine patients (pts) were treated. All of them had stage IV-M0 disease: 67 T4, 88 N2-N3. Tumor location: 62 oropharynx, 22 hypopharynx, eight oral cavity and seven larynx. Tumor response at the end of treatment: 61 patients complete response, 17 partial response, two stable disease, 10 progressive disease and nine unevaluated. With a median follow-up of 70 months the 5-year loco-regional control and overall survival was 30.3% (95% CI: 21.9-38.6) and 21.6% (95% CI: 13.4-29.8), respectively. Loco-regional control and overall survival is significantly influenced by prior response to induction CT. Main grade 3-4 toxicity related to CT was stomatitis, but there were five patients with an ischemic event. Grade 3-4 acute toxicity related to hfRT: 47 stomatitis, 20 epithelitis. Chronic toxicity related to hfRT: six emergency tracheotomies due to laryngeal edema, five pneumonia and one mucous/soft-tissue necrosis. There were eight toxic related deaths. Conclusion: Induction CT followed by hfRT might increase the overall survival rate in unresectable disease. HfRT resulted in a high rate of acute toxicity and its use would not be warranted in those patients with no response to induction CT who had a low probability of long-term control. © 2007 Elsevier Masson SAS. All rights reserved.",carboplatin;cisplatin;docetaxel;fluorouracil;adult;aged;anemia;article;aspiration pneumonia;cancer chemotherapy;cancer mortality;cancer surgery;cancer survival;cause of death;chemotherapy induced emesis;clinical protocol;confidence interval;continuous infusion;dementia;diarrhea;disease severity;drug fatality;emergency surgery;epithelium;follow up;head and neck cancer;heart muscle ischemia;human;hypopharynx carcinoma;ischemia;kidney dysfunction;larynx carcinoma;larynx edema;major clinical study;mouth carcinoma;mucosa;multimodality cancer therapy;multiple cycle treatment;neutropenia;oropharynx carcinoma;priority journal;radiation necrosis;radiotherapy;soft tissue;squamous cell carcinoma;stomatitis;thrombocytopenia;tissue necrosis;tracheotomy;treatment response;tumor localization,"Mesía, R.;Majem, M.;Barretina Ginesta, M. P.;Galiana, R.;Mañós, M.;Guedea, F.;Montes, A.;Monner, A.;Pérez, J.;Cardenal, F.",2008,,,0,
2958,Thirty-Day Readmission Following Total Hip and Knee Arthroplasty - A Preliminary Single Institution Predictive Model,"We sought to identify demographic or care process variables associated with increased 30-day readmission within the total hip and knee arthroplasty patient population. Using this information, we generated a model to predict 30-day readmission risk following total hip and knee arthroplasty procedures. Longer index length of stay, discharge disposition to a nursing facility, blood transfusion, general anesthesia, anemia, anticoagulation status prior to index admission, and Charlson Comorbidity Index greater than 2 were identified as independent risk factors for readmission. Care process factors during the hospital stay appear to have a large predictive value for 30-day readmission. Specific comorbidities and patient demographic factors showed less significance. The predictive nomogram constructed for primary total joint readmission had a bootstrap-corrected concordance statistic of 0.76. © 2014 Elsevier Inc.",narcotic agent;acute heart infarction;adult;aged;anemia;anticoagulation;article;blood transfusion;case control study;Charlson Comorbidity Index;comorbidity;coronary artery disease;deep vein thrombosis;dementia;demography;female;general anesthesia;health care facility;heart failure;hospital discharge;hospital readmission;human;length of stay;major clinical study;male;medicaid;medicare;patient care;peripheral vascular disease;postoperative period;predictive value;retrospective study;risk;risk factor;total hip prosthesis;total knee replacement,"Mesko, N. W.;Bachmann, K. R.;Kovacevic, D.;LoGrasso, M. E.;O'Rourke, C.;Froimson, M. I.",2014,,,0,
2959,Combination therapy and target organ protection in hypertension and diabetes mellitus,"Both essential hypertension and diabetes mellitus affect the same major target organs - the brain, the fundi, the heart, and the kidneys. The common denominator of hypertensive/diabetic target organ disease is the vascular tree. Both hypertension and diabetes are well identified risk factors for atherogenesis. Coronary artery disease is much more common in diabetic hypertensive patients than in patients suffering from hypertension or diabetes alone. Typical for the diabetic hypertensive heart are extensive degenerative changes and a greater degree of hypertrophy compared with the nondiabetic hypertensive heart. The combined presence of hypertension and diabetes concomitantly affects glomerular filtration rate and renal blood flow, thereby greatly accelerating a decrease in renal function. Hypertension accelerates the development of diabetic retinopathy; hypertensive/diabetic cerebral disease leads to vascular dementia, transient ischemic attacks, and strokes. A decrease in the hemodynamic and glycemic burden is the primary goal in the management of the hypertensive diabetic patients. Both diuretics and β-blockers have been reported to adversely affect the overall risk factor profile in the diabetic patient. In contrast, the postsynaptic α-blockers, the calcium antagonists, and the angiotensin-converting enzyme inhibitors have been reported to be either neutral or beneficial with regard to the overall metabolic risk factor profile. The combination of a heart rate lowering calcium antagonist, particularly verapamil, with an ACE inhibitor offers some potential to either prevent or reverse target organ disease associated with hypertension and diabetes.",alpha adrenergic receptor blocking agent;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;verapamil;article;atherogenesis;coronary artery disease;diabetes mellitus;diabetic retinopathy;essential hypertension;glomerulus filtration rate;human;hypertension;kidney blood flow;multiinfarct dementia;priority journal;risk factor;cerebrovascular accident;transient ischemic attack,"Messerli, F. H.;Grossman, E.;Michalewicz, L.",1997,,,0,
2960,"Of fads, fashion, surrogate endpoints and dual RAS blockade","BACKGROUND: Dual renin-angiotensin system (RAS) blockade, mostly by combining an angiotensin converting enzyme (ACE) inhibitor with an angiotensin receptor blocker (ARB), is increasingly used in patients with hypertension and diabetes and/or proteinuria and in those with resistant heart failure. However, in the zest of achieving greater nephroprotection and cardioprotection, even patients with uncomplicated essential hypertension are not uncommonly treated with dual RAS blockade. EVIDENCE: In 2003 the COOPERATE trial, seemed to confirm that dual RAS blockade was beneficial and that proteinuria reduction was synonymous with nephroprotection. This study had to be withdrawn recently attesting to the suspicion that the data looked to good to be true. Moreover, the large prospective ONTARGET data argue against a nephroprotective effect of dual RAS blockade and together with renal findings from ACCOMPLISH, cast doubt on albuminuria/proteinuria being a reliable surrogate endpoint for renal outcome. Although in heart failure, dual RAS blockade had some benefit without reducing mortality, there remains a distinct safety issue with regard to hyperkalemia and elevated creatinine. Neither in ischaemic heart disease nor in left ventricular hypertrophy had dual RAS blockade any benefits when compared with single RAS blockade. Of note, the combination of an ACE inhibitor with an ARB was recently shown to reduce the risk of dementia. All dual RAS blockade may be created equal and the combination of valsartan with aliskiren, a direct renin inhibitor will be evaluated in diabetic patients in the prospective, randomized ALTITUDE study. CONCLUSIONS: For the time being, given the adverse effects and lack of consistent survival benefits, the use of dual RAS blockade should be avoided unless ironclad data emerge to the contrary.","Aged;Angiotensin Receptor Antagonists/*therapeutic use;Angiotensin-Converting Enzyme Inhibitors/*therapeutic use;Cognition Disorders/prevention & control;Coronary Disease/*drug therapy;Dementia/prevention & control;Diabetic Angiopathies/*drug therapy;Drug Therapy, Combination;Female;Heart Failure/*drug therapy;Humans;Hypertension/*drug therapy;Male;Randomized Controlled Trials as Topic;Renin-Angiotensin System/drug effects;Terminology as Topic;Ventricular Dysfunction, Left/drug therapy","Messerli, F. H.;Staessen, J. A.;Zannad, F.",2010,Sep,10.1093/eurheartj/ehq255,0,
2961,"The relationships between atherosclerosis, heart disease, type 2 diabetes and dementia","Type 2 diabetes in the elderly is associated with increased incidence of vascular disease, particularly, atherosclerosis of large blood vessels. Together with other risk factors such as dyslipidemia, atherosclerosis increases the risk for coronary heart disease and stroke. Most studies that have examined the impact of type 2 diabetes and other heart disease risk factors on cognitive functions do not provide evidence that heart disease risk factors (with the possible exception of triglycerides) further increase the likelihood of observing cognitive deficits in diabetic patients. However, none of these studies used imaging techniques to evaluate atherosclerosis or evidence of cerebrovascular disease, such as infarctions. The few studies that have included brain imaging suggest that evidence of cerebrovascular disease further increases the risk for dementia in diabetic patients. The results of longitudinal studies suggest that diabetes is an independent risk factor for cognitive decline and dementia. The pattern of neuropsychological performance observed in type 2 diabetic patients appears to be the result of multiple interacting processes developing over time. In addition to the detrimental effects of protracted impaired glucose regulation on the central nervous system, type 2 diabetes pathology also encompasses the detrimental effects of associated complications such as cerebrovascular disease, which is likely the main cause of the observed processing speed/reaction time decrements.",article;atherosclerosis;brain infarction;cerebrovascular disease;cognition;cognitive defect;dementia;disease association;dyslipidemia;heart disease;human;impaired glucose tolerance;ischemic heart disease;neuropsychology;non insulin dependent diabetes mellitus;risk factor;cerebrovascular accident;vascular disease,"Messier, C.;Awad, N.;Gagnon, M.",2004,,,0,
2962,A case of severe dyspnea and an unusual bronchoscopy: The Chilaiditi syndrome,,adult;Alzheimer disease;article;bronchoscopy;bronchus obstruction;cardiopulmonary insufficiency;case report;Chilaiditi syndrome;computer assisted tomography;dyspnea;emphysema;female;gastrointestinal disease;hemidiaphragm;human;hyperinflation;hypoxia;priority journal;thorax radiography;trachea compression,"Messina, M.;Paolucci, E.;Casoni, G.;Gurioli, C.;Poletti, V.",2008,,,0,
2963,Clinical update on nursing home medicine: 2010,,aldosterone;amlodipine;angiotensin receptor antagonist;atorvastatin;benzodiazepine;beta adrenergic receptor blocking agent;bezafibrate;bile acid sequestrant;calcium channel blocking agent;cholinesterase inhibitor;colestyramine;digoxin;dihydropyridine derivative;dipeptidyl carboxypeptidase inhibitor;eszopiclone;ezetimibe;fenofibrate;fibric acid derivative;fish oil;hydroxymethylglutaryl coenzyme A reductase inhibitor;levothyroxine;memantine;nicotinic acid;phenytoin;ramelteon;rosuvastatin;trazodone;unindexed drug;valproic acid;zaleplon;abdominal pain;amnesia;angioneurotic edema;anorexia;article;bacteriuria;bleeding;cardiac resynchronization therapy;cholecystitis;clinical trial;cognitive defect;confusion;constipation;dementia;depression;dietary intake;dizziness;drug effect;drug half life;drug mechanism;drug megadose;drug therapy;drug withdrawal;dyslipidemia;dysphagia;edema;exercise;fatigue;flushing;gastrointestinal symptom;hallucination;headache;heart arrhythmia;heart failure;human;hypertriglyceridemia;hypotension;insomnia;insulin resistance;kidney disease;liver function test;long term care;myalgia;myopathy;nausea;nightmare;nursing home;polypharmacy;risk assessment;side effect;taste disorder;treatment failure;unspecified side effect;urinary tract infection;weight reduction,"Messinger-Rapport, B. J.;Morley, J. E.;Thomas, D. R.;Gammack, J. K.",2010,,,0,
2964,Clinical Update on Nursing Home Medicine: 2008,"In 2007 we provided an overview of clinical advances in the nursing home based on a series of presentations at the American Medical Directors Association.1 This will now be a regular yearly series. Topics covered this year are nutrition, exercise, diabetes mellitus, lipids, hypertension, pressure ulcers, COPD, and osteoporosis. © 2008 American Medical Directors Association.",NCT00120289;alpha adrenergic receptor blocking agent;alpha glucosidase inhibitor;angiotensin receptor antagonist;beta adrenergic receptor blocking agent;bile acid sequestrant;bisphosphonic acid derivative;calcitonin;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;dronabinol;ezetimibe;fibric acid derivative;fish oil;glitazone derivative;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;insulin glargine;ipratropium bromide;levalbuterol;megestrol acetate;metformin;nicotinic acid;recombinant enzyme;recombinant hyaluronidase;salmeterol;selective androgen receptor modulator;sitagliptin;thiazide diuretic agent;topiramate;unindexed drug;absence of side effects;angioneurotic edema;anorexia;article;bradycardia;cachexia;cardiovascular disease;cholecystitis;chronic obstructive lung disease;clinical trial;constipation;continuous infusion;coughing;decubitus;dehydration;dementia;diabetes mellitus;drug efficacy;drug mechanism;drug safety;edema;elderly care;electrolyte disturbance;evidence based medicine;fishy burp;flushing;frail elderly;gastrointestinal symptom;glucose intolerance;heart arrhythmia;atrial fibrillation;heart failure;human;hyperlipidemia;hypertension;insulin hypoglycemia;insulin resistance;kinesiotherapy;liver function test;liver toxicity;morning dosage;muscle atrophy;muscle disease;myopathy;nausea;nursing home;nutrition;nutritional assessment;osteoporosis;outcome assessment;patient positioning;peptic ulcer;peripheral neuropathy;quality of life;risk benefit analysis;risk factor;risk reduction;side effect;smoking cessation;cerebrovascular accident;thrombocyte aggregation;thrombocytopenia;urine incontinence;weight reduction;wound care;wound dressing,"Messinger-Rapport, B. J.;Thomas, D. R.;Gammack, J. K.;Morley, J. E.",2008,,,0,
2965,June 2015 at a glance,,Comorbidity;Dementia/*epidemiology;Heart Failure/*epidemiology/*therapy;Humans,"Metra, M.",2015,Jun,10.1002/ejhf.301,0,
2966,"The disease pattern of elderly medical patients in Rwanda, central Africa","In a study of the disease pattern of the elderly in Rwanda, all patients aged 60 or more, hospitalized in a one-year period at the Medical Department, University Hospital, Butare, were examined prospectively. One hundred and ninety-two patients were included; most were subsistence farmers having a mainly vegetarian diet and living in large families. Infections (37.5% of the patients) and liver cirrhosis (31.8%) were the problems most frequently encountered. Primary hepatocellular cancer was diagnosed in 5.7% of the patients and was the most frequent malignancy. The hospitalized elderly occupied 17.5% of the available beds in the Medical Department. Their disease pattern was different from that of younger patients, making heavier demands on the medical resources. Malaria and upper intestinal inflammation were less frequent in the elderly; liver cirrhosis, primary hepatocellular cancer, pneumonia, prostatic cancer, cardiovascular pathology, chronic renal pathology and chronic lung disease were more prevalent. Several age-related conditions frequently observed in industrialized countries (e.g. coronary heart disease, stroke, gallstones, renal cysts, dementia) were rare. The study thus illustrates the concept of 'secondary aging': to the primary changes induced by the aging process, additional alterations are added which depend upon the environment and the lifestyle, resulting in a varying disease pattern. Health policies thus must take into account that the demographic transition in developing countries may result in a pattern of diseases different from that seen in industrialized countries; care must be taken when transposing data obtained from elderly populations in industrialized countries.","Aged;Agricultural Workers' Diseases/*epidemiology;Carcinoma, Hepatocellular/*epidemiology;Cardiovascular Diseases/epidemiology;Communicable Diseases/*epidemiology;Developing Countries;Diabetes Mellitus, Type 2/epidemiology;Diet;Female;Hospitalization/statistics & numerical data;Humans;Life Style;Liver Cirrhosis/*epidemiology/etiology;Liver Neoplasms/*epidemiology;Male;Middle Aged;Prospective Studies;Risk Factors;Rwanda/epidemiology","Mets, T. F.",1993,Oct,,0,
2967,ber die laquo;Omnipotenz>> der Chelattherapie,"About the 'Omnipotence' of the Chelation Therapy In the eighties the 'method of treatment proven in many thousands of cases over 20 years' was transferred from the USA to Germany (enjoys a priori considerable faith) using very dubious promises. It was Clarke et al. who introduced this 'therapy' in 1955. The dubious promise was to maintain that the chelation therapy eliminates or alleviates symptoms in the case of the following illnesses: Alzheimer's disease, senility, schizophrenia, rheumatoid arthritis, osteoarthritis, gout, renal calculus, apoplectic coma, gallstones, multiple sclerosis, osteoporosis, chronic fatigue syndrome, varicose veins, hypertension, failure of memory, scleroderma, Raynaud's disease, digitalis intoxication, intermittent claudication, diabetic ulcer, disturbance of the blood supply, ulcer on the legs, snake poison, impotence, emotional difficulties, defective hearing, vision disorder. There is not the slightest proof of effectiveness for any of the listed indications. The burden of proof lies with the supplier. Even in the case of the relatively often examined peripheral atherosclerotic changes (claudicatio intermittens) there is no proof that EDTA has a greater effect than placebo. For coronary heart disease too there is no evidence for any usefulness of the chelation therapy beyond that of a placebo effect. Only controlled studies can help to improve the therapy in the sense of 'Evidence-based medicine'. Retrospective investigations on thousands of patients cannot 'prove' anything, although this is maintained again andagain.",,"Meyer, F. P.",1998,,21151,0,
2968,MRI abnormalities associated with mild cognitive impairments of vascular (VMCI) versus neurodegenerative (NMCI) types prodromal for vascular and Alzheimer's dementias,"BACKGROUND AND OBJECTIVES: Mild Cognitive Impairments (MCIs) are identifiable clinical entities, in neurodegenerative forms, as prodromal for Alzheimer's type (DAT) or in vascular forms, as prodromal for vascular dementia (VaD). The present longitudinal study compares and contrasts MRI abnormalities among MCI subjects as they progress to DAT versus VaD. Subjects converting to DAT and VaD confirmed ultimate diagnosis during MCI staging. In ""mixed cases"" the predominant MRI pathology was judged the primary cause. SUBJECTS AND METHODS: Subjects (n = 153) were selected from elderly outpatient volunteers who have been enrolled for 25 years in planned longitudinal studies of aging, stroke and dementia. Cognitively normal (CN, n = 52), MCI of neurodegenerative (N-MCI, n = 30) and vascular (V-MCI), n = 35) subtypes, plus converted DAT (n = 19) and VaD (n = 17) were diagnosed according to established protocols. Combined Mini-Mental-Cognitive Capacity Screening Examinations (CMC) screened, identified and confirmed MCIs or dementias. Cerebral MRI abnormalities were analyzed utilizing volumetric measurements and visual rating scales. RESULTS: Compared with persistently cognitively normal subjects, MCI subjects and converted dementias were significantly older without significant gender differences, but cognitively impaired subjects were older than the CN group since age is a risk factor for cognitive decline. Histories of hypertension, heart disease, diabetes mellitus, TIAs and strokes were more frequent among subjects with VMCI and VaD, confirming that all vascular risk factors contribute to vascular cognitive decline, but since vascular risk factors were treated, not all progressed to VAD. Family history of neurodegenerative disease, particularly DAT, were more prevalent among NMCI and converted DAT subjects. VMCI showed more extensive leucoaraiosis and lacunar infarcts than subjects with NMCI. NMCI, prodromal for dementia of Alzheimer's type (DAT), showed more medial temporal lobe atrophy with enlarged temporal horns, and fewer vascular lesions.","Aged;Aged, 80 and over;Alzheimer Disease/*pathology;Cognition Disorders/*pathology;Dementia, Vascular/*pathology;Female;Humans;*Magnetic Resonance Imaging;Male;Middle Aged;Nerve Degeneration/pathology;Neuropsychological Tests;Severity of Illness Index","Meyer, J. S.;Huang, J.;Chowdhury, M.",2005,Dec,,0,
2969,Aetiological considerations and risk factors for multi-infarct dementia,"One hundred and seventy five multi-infarct dementia (MID) patients were evaluated for risk factors for stroke as well as for the types of cerebrovascular lesions that were present. The incidence of associated risk factors for stroke were as follows: hypertension (66%), heart disease (48%), cigarette smoking (37%), diabetes mellitus (20%), moderate alcohol consumption (19%) and hyperlipidaemia (21%). The most frequently occurring type of lesions were multiple lacunar infarctions of the brain (43%). These were combined wtih other types of stroke in an additional 21%. Atherosclerotic occlusive disease of the carotid and vertebrobasilar arteries occurred alone in 18% and was associated with other types of stroke in another 25%. Embolic cerebral infarctions were present alone in 8% and were combined with other types of stroke in 15%. MID was more frequent in men (62%) than women (p < 0.002). Mean bihemispheric gray matter cerebral blood flow (CBF) values showed a fluctuating course and when results were pooled and compared between different types of MID, extracranial occlusive disease and/or multiple lacunar infarctions resulted in lowest CBF values. The location of cerebral infarctions was more importantly related to cognitive impairments than was the total volume of infarcted brain. Mortality rates among 125 MID patients followed for 31 months has been 5%. Correct clinical classification of the types of cerebrovascular lesions was confirmed in three necropsied cases.",adult;aged;alcohol consumption;brain infarction;dementia;diabetes mellitus;fatality;female;heart disease;human;hyperlipidemia;hypertension;major clinical study;male;multiinfarct dementia;priority journal;risk;smoking,"Meyer, J. S.;McClintic, K. L.;Rogers, R. L.;Sims, P.;Mortel, K. F.",1988,,,0,
2970,Geriatric psychopharmacology: evolution of a discipline,"The development of geriatric psychopharmacology was built on advances in geriatric psychiatry nosology and clinical pharmacology and on increased investment in aging research by the National Institute of Mental Health and by academic institutions. Application of the US Food and Drug Administration's geriatric labeling rule provided further impetus. Developments in the knowledge about 3 principal classes of medications (antidepressants, antipsychotics, and treatments for Alzheimer's disease) illustrate the trajectory of geriatric psychopharmacology research. Nonetheless, the loss of information about age effects that has resulted from applying age exclusion criteria in studies limited to either younger adults or geriatric patients is regrettable. Antidepressant trials have moved from studying younger and medically well ""geriatric"" samples to focusing on ""older old"" persons and those with significant medical comorbidity including coronary artery disease, cerebrovascular disease, and dementia. Increased specificity is reflected in studies of relationships between specific neuropsychological deficits, specific brain abnormalities, and antidepressant responsiveness. Clinical trials in older adults have demonstrated that the efficacy of antipsychotic medications continues across the lifespan, but that sensitivity to specific side effects changes in older age, with poor tolerability frequently mitigating the benefits of treatment. Treatments for Alzheimer's disease have fallen within the purview of geriatric psychopharmacology. The research focus is increasingly shifting from treatments to slow the course of cognitive decline to studies of early diagnosis and of interventions designed to prevent the development of deficits in vulnerable individuals. The importance of geriatric psychopharmacology will grow further as the average lifespan increases all over the world.","Aged;Aged, 80 and over;Alzheimer Disease/drug therapy/history;Antidepressive Agents/history/therapeutic use;Antipsychotic Agents/history/therapeutic use;Dementia/drug therapy/history;Depressive Disorder, Major/drug therapy/history;Drug Approval/history;Drug Labeling/history;Geriatric Psychiatry/*history/trends;History, 20th Century;History, 21st Century;Humans;Psychopharmacology/*history/trends;Schizophrenia/drug therapy/history;United States;United States Food and Drug Administration/history","Meyers, B. S.;Jeste, D. V.",2010,Nov,10.4088/JCP.10r06485gry,0,
2971,Pathologically confirmed chronic traumatic encephalopathy in a 25-year-old former college football player,,cyclobenzaprine;topiramate;adult;anxiety;bicuspid aortic valve;blurred vision;brain concussion;case report;college;disease association;football;headache;heart arrest;histopathology;human;insomnia;letter;male;memory disorder;neck pain;neurologist;neuropathology;neuropsychological test;priority journal;retrospective study;tauopathy;tinnitus;traumatic brain injury,"Mez, J.;Solomon, T. M.;Daneshvar, D. H.;Stein, T. D.;McKee, A. C.",2016,,,0,
2972,Recognition of dementia in hospitalized older adults,,aggression;agitation;Alzheimer disease;behavior;chronic obstructive lung disease;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;high risk patient;hospital patient;human;medical record;memory disorder;questionnaire;short survey;stress,"Mezey, M.;Maslow, K.",2007,,,0,
2973,"Prisoner of war status, posttraumatic stress disorder, and dementia in older veterans","Background It is not known whether prisoners of war (POWs) are more likely to develop dementia independently of the effects of posttraumatic stress disorder (PTSD). Methods We performed a retrospective cohort study in 182,879 U.S. veterans age 55 years and older, and examined associations between POW status and PTSD at baseline (October 1, 2000-September 30, 2003), and incident dementia during follow-up (October 1, 2003-September 30, 2012). Results A total of 484 veterans (0.3%) reported being POWs, of whom 150 (31.0%) also had PTSD. After adjusting for demographics, medical and psychiatric comorbidities, period of service, and the competing risk of death, the risk of dementia was increased in veterans who were POWs only (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.30-1.98) or had PTSD only (HR, 1.52; 95% CI, 1.41-1.64) and was greatest in veterans who were POWs and also had PTSD (HR, 2.24; 95% CI, 1.72-2.92). Conclusions POW status and PTSD increase risk of dementia in an independent, additive manner in older veterans. © 2014 Published by Elsevier Inc. on behalf of The Alzheimer's Association.",alcohol;aged;alcohol abuse;article;cerebrovascular disease;chronic lung disease;cohort analysis;comorbidity;controlled study;death;dementia;diabetes mellitus;disease association;drug abuse;follow up;heart infarction;human;hypertension;kidney disease;major clinical study;major depression;obesity;peripheral vascular disease;posttraumatic stress disorder;priority journal;prisoner of war;retrospective study;risk factor;tobacco use;traumatic brain injury;United States;very elderly;veterans health,"Meziab, O.;Kirby, K. A.;Williams, B.;Yaffe, K.;Byers, A. L.;Barnes, D. E.",2014,,,0,
2974,Arterioles of the lenticular nucleus in CADASIL,"BACKGROUND AND PURPOSE - In cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) the arteriopathy leads to recurrent infarcts in cerebral white matter (WM) and deep gray matter (GM), whereas cortex is spared. To assess the pathogenesis of deep GM infarcts, we analyzed structural changes in arterioles of the lenticular nucleus (LN) in 6 CADASIL patients. METHODS - Five elderly and one 32-year-old deceased CADASIL patients were studied. Seven elderly and 4 young deceased persons without cerebrovascular diseases served as controls. In addition to immunohistochemical analysis the external and luminal diameters of arterioles in the LN, cerebral cortex and WM were measured. The thickness of arteriolar wall and sclerotic index were calculated. RESULTS - In CADASIL patients, LN arterioles were immunoreactive for the extracellular domain of Notch3 and collagen I, whereas α-smooth muscle actin staining was irregular or negative. No major leakage of plasma fibrinogen or fibronectin was observed. Although in patients the walls of LN arterioles were significantly thicker than in controls, definite stenosis was not observed. Arteriolar lumina in the LN were not only significantly larger than in the WM, where most lacunar infarcts in CADASIL occur, but also larger than in cortical GM, where infarcts virtually never exist. CONCLUSIONS - Fibrotic thickening of the arteriolar walls without consequent stenosis occurs in the LN of CADASIL patients. The pathogenesis of lacunar infarcts in the WM and LN seem to be different, stenosis in the former and probably hemodynamic disturbances in the latter. © 2006 American Heart Association, Inc.",alpha smooth muscle actin;collagen type 1;fibrinogen;fibronectin;Notch3 receptor;adult;aged;arteriole;artery wall;article;atherosclerosis;blood level;blood vessel diameter;brain cortex;brain infarction;brain infarction size;brain nucleus;CADASIL;calculation;cerebrovascular disease;clinical article;clinical assessment;comparative study;control group;controlled study;extracellular matrix;female;fibrinogen blood level;fibrosis;gray matter;hemodynamics;human;human tissue;immunohistochemistry;immunoreactivity;male;measurement;morphology;pathogenesis;priority journal;protein domain;staining;stenosis;structure analysis;white matter,"Miao, Q.;Paloneva, T.;Tuisku, S.;Roine, S.;Poyhonen, M.;Viitanen, M.;Kalimo, H.",2006,,,0,
2975,Cardiovascular polymorbidity related to neuropathological findings. A review of 904 autopsies,"In the past decades, the recognition of polymorbidity as an important characteristic of geriatric medicine lead to important improvements in the multidisciplinary approach of the elderly. Coexistence of somatic and psychiatric diseases with various forms of etiopathogenic relations has been described early in this century. Dementia may be caused, aggravated, revealed or randomly accompanied by somatic diseases and inversely. However, very few attempts have been made in order to analyze the significance of these associations. This study is meant to give a better epidemiological knowledge of the relation between cardiovascular diseases and cerebral aging. This could lead to a better diagnostic approach and to a more complete physiopathological conception of dementia. 904 autopsy reports (patients who died between 1972 and 1986 in the Hopital de Geriatrie of Genova) have been reviewed and classified in three groups according to neuropathological findings: 335 subjects with vascular encephalopathy of various types, 382 patients with degenerative diseases of Alzheimer type and 187 patients with normal brain. The subjects of these three groups had not all been considered demented. For each patient, age, sex, cause of death and 14 cardiovascular items have been appointed. The patients of the Alzheimer group died older and were more often women than those of the two other groups. The subjects of the vascular group died older than those of the normal group and were more often men than those of the two other groups. Stoke was considered to be the cause of death in 3% of the vascular patients whereas, by definition, it was absent from the two other groups. Pulmonary embolism was a more frequent cause of death for women with normal brain than for women with vascular encephalopathy. No difference in the other causes of death (myocardial infarction, cardiac failure, hemorrhage, pneumonia, infections) has been noted between the three groups. Brown atrophy of the heart was less frequent in the vascular group than in the two other groups. Cardiac hypertrophy, cardiac dilation myocardial infarction, generalized, renal and cervico-cephalic arteriosclerosis were more frequent in the vascular group than in the two other groups. Aneurysm of the aorta and valvulopathy were more frequent in the vascular group than in the other two groups but statistical difference appeared only with the Alzheimer group. There was no significant difference between the three groups as for the other five items (cardiac failure, atrial fibrillation, recent myocardial infarction, coronary arteriosclerosis, and thrombotic state). These results confirm the relation between cardiovascular diseases and vascular encephalopathy. There could be a common etiology or an etiopathogenic relation between somatic and cerebral arteriosclerosis. Women live longer and develop more degenerative disorders than men. Men are more easily subject to vascular diseases than women. Cardiovascular polymorbidity is an extremely important problem in the elderly with an average 6.07 of the mentioned cardiovascular disease per patient.",aged;aging;Alzheimer disease;article;cardiovascular disease;dementia;female;human;human tissue;major clinical study;male;neuropathology;priority journal,"Michel, J. P.;Bruchez, M.;Constantinidis, J.;Bouras, C.;Grab, B.;Mc Gee, W.",1991,,,0,
2976,[Management of an elderly patient in the emergency room at the end of life : A medical ethics challenge] Management eines alteren Patienten in der Notaufnahme am Lebensende : Eine medizinethische Herausforderung,"A 94-year-old patient with cardiogenic shock due to myocardial infarction was admitted via the emergency room. A coronary angiography and intensive care were requested. The need for care due to dementia was known. After case discussion in the interdisciplinary and multiprofessional treatment team, the decision for a palliative care concept in the form of symptom control was made in the emergency room, taking into account the patient's medical history, the current situation, and the presumed patient consent. The integration of medical ethics aspects and palliative medicine into ""geriatric emergency medicine"" will present a challenge in the future.",Emergency medicine;Geriatrics;Medical ethics;Palliative care;Shared decision making,"Michels, G.;Nies, R.;Ortmann, S.;Pfister, R.;Salomon, F.",2017,Aug 03,,0,
2977,Management of an elderly patient in the emergency room at the end of life: A medical ethics challenge,"A 94-year-old patient with cardiogenic shock due to myocardial infarction was admitted via the emergency room. A coronary angiography and intensive care were requested. The need for care due to dementia was known. After case discussion in the interdisciplinary and multiprofessional treatment team, the decision for a palliative care concept in the form of symptom control was made in the emergency room, taking into account the patient’s medical history, the current situation, and the presumed patient consent. The integration of medical ethics aspects and palliative medicine into “geriatric emergency medicine” will present a challenge in the future.",aged;cardiogenic shock;case report;coronary angiography;dementia;emergency medicine;emergency ward;female;geriatrics;heart infarction;human;intensive care;male;medical ethics;medical history;palliative therapy;shared decision making;symptom;very elderly,"Michels, G.;Nies, R.;Ortmann, S.;Pfister, R.;Salomon, F.",2017,,10.1007/s00063-017-0329-2,0,
2978,Cerebrovascular diseases at the C. Mondino National Institute of Neurology: From Ottorino Rossi to the present day,"This paper traces the development of research and healthcare models in the field of cerebrovascular disorders at the C. Mondino National Institute of Neurology in Pavia, Italy. It starts with a description of the original experiences of Ottorino Rossi and his thesis on atherosclerosis which date back to the beginning of the last century; it then illustrates the connections between his seminal essay and the future directions followed by research in this institute, through to the development of one of the first stroke units in Italy. In this context, we examine a large range of scientific approaches, many related to cerebrovascular diseases (such as headaches) and autonomic disorders, and some of their biological and physiological markers. The originality of an approach also based on tools of advanced technology, including information technology, is emphasised, as is the importance of passion and perseverance in the pursuit of extraordinary results in what is an extremely complex and difficult field. © CIC Edizioni Internzionali.",biological marker;Alzheimer disease;angiography;article;atherosclerosis;atherosclerotic plaque;thrombosis;autonomic dysfunction;Binswanger encephalopathy;bioengineering;brain circulation;brain ischemia;CADASIL;cardiovascular risk;cerebrovascular disease;computer assisted tomography;disease registry;electroencephalography;emergency health service;emergency ward;genetic polymorphism;headache;health care;health care organization;health service;heart infarction;hospital;hospitalization;human;hypertension;intensive care;Italy;leukoaraiosis;leukoencephalopathy;medical research;microaneurysm;multiinfarct dementia;neurology;neuropathology;neuropsychology;neuroscience;nuclear magnetic resonance imaging;patient care;perfusion;peripheral occlusive artery disease;phenotype;physician;physiotherapist;psychologist;recanalization;risk factor;social worker;cerebrovascular accident;stroke unit;thrombectomy,"Micieli, G.;Martignoni, E.;Sandrini, G.;Bono, G.;Nappi, G.",2011,,,0,
2979,APOE Genotype in the Ethnic Majority and Minority Groups of Laos and the Implications for Non-Communicable Diseases,"BACKGROUND: Increasing age is associated with elevated risk of non-communicable diseases, including dementia and Alzheimer's disease (AD). The apolipoprotein E (APOE) epsilon4 allele is a risk factor not only for AD, but also for cognitive decline, depressive symptoms, stroke, hypertension, coronary heart disease, cardiovascular disease, and diabetes. The Lao People's Democratic Republic (Laos) is undergoing development; consequently, life expectancy has risen. To evaluate the future risk of non-communicable diseases, we investigated APOE genotypes and anthropometric characteristics in the Laotian population. METHODOLOGY/PRINCIPAL FINDINGS: Subjects were 455 members of the Lao Loum majority and 354 members of ethnic minorities. APOE genotypes, anthropometric characteristics, blood pressure, and blood glucose were recorded. To compare individual changes, health examination data collected 5 years apart were obtained from a subset of Lao Loum subjects. APOE epsilon4 allele frequencies were higher among minorities (31.3%) than among Lao Loum (12.6%). In Lao Loum, but not in minorities, mean waist circumference and blood pressure increased significantly across age groups. Comparisons of health conditions between the beginning and end of the 5-year period revealed significant increases in obesity and blood glucose levels in Lao Loum. APOE epsilon4 carriers exhibited significant increases in resting heart rate in both ethnic groups. CONCLUSIONS/SIGNIFICANCE: A higher epsilon4 allele frequency was observed in Laotian minorities than in the Laotian majority. Furthermore, higher obesity, blood pressure and blood glucose were observed in the middle-aged ethnic majority. Therefore, given these genetic and non-communicable disease risk factors, it seems likely that as the Laotian population ages, elevated rates of non-communicable aging-related diseases, such as dementia, will also become more prevalent.",,"Midorikawa, K.;Soukaloun, D.;Akkhavong, K.;Southivong, B.;Rattanavong, O.;Sengkhygnavong, V.;Pyaluanglath, A.;Sayasithsena, S.;Nakamura, S.;Midorikawa, Y.;Murata, M.",2016,,10.1371/journal.pone.0155072,0,
2980,Huntington's disease is a multi-system disorder,"Huntington's disease (HD) is one of the most common non-curable rare diseases and is characterized by choreic movements, psychiatric symptoms, and slowly progressive dementia. HD is inherited as an autosomal dominant disorder with complete penetrance. Although brain pathology has become a hallmark of HD, there is a critical mass of new studies suggesting peripheral tissue pathology as an important factor in disease progression. In particular, recently published studies about skeletal muscle malfunction and HD-related cardiomyopathy in HD mouse models strongly suggest their important roles, leading to upcoming preclinical and clinical trials. One might conclude that therapeutic approaches in HD should not be restricted only to the brain pathology but instead major efforts should also be made to understand the cross-talk between diseased tissues like the CNS-Heart or CNS-skeletal muscle axes.",Huntington's disease;cardiomyopathy;neurodegeneration;peripheral tissue pathology;skeletal muscle atrophy;triplet repeat disorder,"Mielcarek, M.",2015,,10.1080/21675511.2015.1058464,0,
2981,The Huntington's disease-related cardiomyopathy prevents a hypertrophic response in the R6/2 mouse model,"Huntington's disease (HD) is neurodegenerative disorder for which the mutation results in an extra-long tract of glutamines that causes the huntingtin protein to aggregate. It is characterized by neurological symptoms and brain pathology that is associated with nuclear and cytoplasmic aggregates and with transcriptional deregulation. Despite the fact that HD has been recognized principally as a neurological disease, there are multiple epidemiological studies showing that HD patients exhibit a high rate of cardiovascular events leading to heart failure. To unravel the mechanistic basis of cardiac dysfunction in HD, we employed a wide range of molecular techniques using the well-established genetic R6/2 mouse model that develop a considerable degree of the cardiac atrophy at end stage disease. We found that chronic treatment with isoproterenol, a potent beta-adrenoreceptor agonist, did not change the overall gross morphology of the HD murine hearts. However, there was a partial response to the beta-adrenergenic stimulation by the further re-expression of foetal genes. In addition we have profiled the expression level of Hdacs in the R6/2 murine hearts and found that the isoproterenol stimulation of Hdac expression was partially blocked. For the first time we established the Hdac transcriptional profile under hypertrophic conditions and found 10 out of 18 Hdacs to be markedly deregulated. Therefore, we conclude that R6/2 murine hearts are not able to respond to the chronic isoproterenol treatment to the same degree as wild type hearts and some of the hypertrophic signals are likely attenuated in the symptomatic HD animals.","Adrenergic beta-Antagonists/pharmacology;Animals;Brain-Derived Neurotrophic Factor/metabolism;Cardiomyopathies/etiology/*pathology;Collagen Type VI/metabolism;Disease Models, Animal;Down-Regulation;Female;Heart/drug effects;Histone Deacetylases/metabolism;Huntington Disease/complications/*pathology;Hypertrophy;Isoproterenol/pharmacology;Male;Mice;Mice, Inbred C57BL;Mice, Inbred DBA;Myocardium/*pathology","Mielcarek, M.;Bondulich, M. K.;Inuabasi, L.;Franklin, S. A.;Muller, T.;Bates, G. P.",2014,,10.1371/journal.pone.0108961,0,
2982,Dysfunction of the CNS-heart axis in mouse models of Huntington's disease,"Cardiac remodelling and contractile dysfunction occur during both acute and chronic disease processes including the accumulation of insoluble aggregates of misfolded amyloid proteins that are typical features of Alzheimer's, Parkinson's and Huntington's disease (HD). While HD has been described mainly as a neurological disease, multiple epidemiological studies have shown that HD patients exhibit a high incidence of cardiovascular events leading to heart failure, and that this is the second highest cause of death. Given that huntingtin is ubiquitously expressed, cardiomyocytes may be at risk of an HD-related dysfunction. In mice, the forced expression of an expanded polyQ repeat under the control of a cardiac specific promoter led to severe heart failure followed by reduced lifespan. However the mechanism leading to cardiac dysfunction in the clinical and pre-clinical HD settings remains unknown. To unravel this mechanism, we employed the R6/2 transgenic and HdhQ150 knock-in mouse models of HD. We found that pre-symptomatic animals developed connexin-43 relocation and a significant deregulation of hypertrophic markers and Bdnf transcripts. In the symptomatic animals, pronounced functional changes were visualised by cardiac MRI revealing a contractile dysfunction, which might be a part of dilatated cardiomyopathy (DCM). This was accompanied by the re-expression of foetal genes, apoptotic cardiomyocyte loss and a moderate degree of interstitial fibrosis. To our surprise, we could identify neither mutant HTT aggregates in cardiac tissue nor a HD-specific transcriptional dysregulation, even at the end stage of disease. We postulate that the HD-related cardiomyopathy is caused by altered central autonomic pathways although the pathogenic effects of mutant HTT acting intrinsically in the heart may also be a contributing factor.","Animals;Cardiomyopathy, Dilated/*genetics/pathology;Connexin 43/genetics;Disease Models, Animal;Heart Failure/genetics/pathology;Humans;Huntington Disease/*genetics/physiopathology;Mice;Myocardial Contraction/*genetics;Nerve Tissue Proteins/biosynthesis/*genetics;Nuclear Proteins/biosynthesis/*genetics;Ventricular Remodeling","Mielcarek, M.;Inuabasi, L.;Bondulich, M. K.;Muller, T.;Osborne, G. F.;Franklin, S. A.;Smith, D. L.;Neueder, A.;Rosinski, J.;Rattray, I.;Protti, A.;Bates, G. P.",2014,Aug,10.1371/journal.pgen.1004550,0,
2983,Serum sphingomyelins and ceramides are early predictors of memory impairment,"A blood-based biomarker of Alzheimer's disease (AD) progression could be instrumental in targeting asymptomatic individuals for treatment early in the disease process. Given the direct connection between sphingomyelins (SM), ceramides, and apoptosis, these lipids may be indicators of neurodegeneration and AD progression. Baseline serum SM and ceramides from 100 women enrolled in a longitudinal population-based study were examined as predictors of cognitive impairment. Participants were followed up to six visits over 9 years. Baseline lipids, in tertiles, were examined in relation to cross-sectional and incident impairment (<1.5 S.D. below standard norms) on HVLT-immediate and -delayed memory recall and Trails A and B. SM and ceramides varied in relation to the timing of HVLT-delayed impairment: low levels were associated with cross-sectional impairment; high levels predicted incident impairment in asymptomatic individuals. Lipids were not associated with loss-to-follow-up. Results suggest serum SM and ceramides vary according to the timing of the onset of memory impairment and may be good pre-clinical predictors, or biomarkers, of memory impairment: a deficit observed early in AD pathogenesis. © 2008 Elsevier Inc. All rights reserved.",biological marker;ceramide;cholesterol;creatinine;galactosylceramide;glucose;hydroxymethylglutaryl coenzyme A reductase inhibitor;lactosylceramide;lipid;sphingomyelin;sulfatide;triacylglycerol;aged;Alzheimer disease;angina pectoris;apoptosis;article;blood analysis;body mass;smoking;controlled study;diabetes mellitus;diastolic blood pressure;diet restriction;disease course;drug targeting;dyslipidemia;educational status;electrospray mass spectrometry;exercise;female;follow up;heart infarction;human;major clinical study;malignant neoplastic disease;memory disorder;nerve degeneration;neuropsychological test;prediction;priority journal;cerebrovascular accident;systolic blood pressure,"Mielke, M. M.;Bandaru, V. V. R.;Haughey, N. J.;Rabins, P. V.;Lyketsos, C. G.;Carlson, M. C.",2010,,,0,
2984,Interaction between vascular factors and the APOE epsilon4 allele in predicting rate of progression in Alzheimer's disease,"Vascular factors have been shown to affect the rate of Alzheimer's disease (AD) progression. However, the effect of the APOE epsilon4 allele on rate of progression has been ambiguous. Little research to date has examined an interaction between vascular factors and the APOE epsilon4 allele in predicting decline among AD patients. 216 participants with incident AD from a population of elderly persons in Cache County, Utah, were followed for a mean of 3.3 years and 4.2 follow-up visits. A history of vascular risk factors and conditions and anti-hypertensive use was assessed at the diagnostic visit. Linear mixed effects models tested interactions between the vascular factors, APOE epsilon4, and time as predictors of clinical progression on the Mini-Mental State Exam (MMSE) and Clinical Dementia Rating-Sum of Boxes (CDR-SB). Multiple comparisons were corrected using the Holm-Bonferroni method. There was a 3-way interaction between stroke, APOE epsilon4 and time in predicting MMSE decline (LR chi(2) = 10.32, 2 df, p = 0.006). For the CDR-SB, there were 3-way interactions between the APOE epsilon4, time and either myocardial infarction (LR chi(2) = 17.83, 2 df, p = 0.0001) or stroke (LR chi(2) = 11.48, 2 df, p = 0.003. Results suggest a complex relationship between the APOE epsilon4 and vascular factors in predicting cognitive and functional progression. Among individuals with a history of stroke or myocardial infarction at baseline, progression of AD is influenced by APOE epsilon4 carrier status and varies by time after AD diagnosis.","Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology/*genetics;Apolipoprotein E4/*genetics;Cardiovascular Diseases/*epidemiology;Community Health Planning;Disease Progression;Female;Humans;Longitudinal Studies;Male;Mental Status Schedule;Predictive Value of Tests;Risk Factors;United States/epidemiology","Mielke, M. M.;Leoutsakos, J. M.;Tschanz, J. T.;Green, R. C.;Tripodis, Y.;Corcoran, C. D.;Norton, M. C.;Lyketsos, C. G.",2011,,10.3233/jad-2011-110086,0,
2985,Vascular factors predict rate of progression in Alzheimer disease,"BACKGROUND: While there is considerable epidemiologic evidence that cardiovascular risk factors increase risk of incident Alzheimer disease (AD), few studies have examined their effect on progression after an established AD diagnosis. OBJECTIVE: To examine the effect of vascular factors, and potential age modification, on rate of progression in a longitudinal study of incident dementia. METHODS: A total of 135 individuals with incident AD, identified in a population-based sample of elderly persons in Cache County, UT, were followed with in-home visits for a mean of 3.0 years (range: 0.8 to 9.5) and 2.1 follow-up visits (range: 1 to 5). The Clinical Dementia Rating (CDR) Scale and Mini-Mental State Examination (MMSE) were administered at each visit. Baseline vascular factors were determined by interview and physical examination. Generalized least-squares random-effects regression was performed with CDR Sum of Boxes (CDR-Sum) or MMSE as the outcome, and vascular index or individual vascular factors as independent variables. RESULTS: Atrial fibrillation, systolic hypertension, and angina were associated with more rapid decline on both the CDR-Sum and MMSE, while history of coronary artery bypass graft surgery, diabetes, and antihypertensive medications were associated with a slower rate of decline. There was an age interaction such that systolic hypertension, angina, and myocardial infarction were associated with greater decline with increasing baseline age. CONCLUSION: Atrial fibrillation, hypertension, and angina were associated with a greater rate of decline and may represent modifiable risk factors for secondary prevention in Alzheimer disease. The attenuated decline for diabetes and coronary artery bypass graft surgery may be due to selective survival. Some of these effects appear to vary with age.","Age Distribution;Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology;Angina Pectoris/epidemiology;Antihypertensive Agents/therapeutic use;Atrial Fibrillation/epidemiology;Cardiovascular Diseases/*epidemiology;Cohort Studies;Comorbidity;Coronary Artery Bypass/statistics & numerical data;Diabetes Mellitus/epidemiology;Disability Evaluation;Disease Progression;Female;Humans;Hypertension/epidemiology;Incidence;Longitudinal Studies;Male;Myocardial Infarction/epidemiology;Neuropsychological Tests;Predictive Value of Tests;Survival Rate;Utah/epidemiology","Mielke, M. M.;Rosenberg, P. B.;Tschanz, J.;Cook, L.;Corcoran, C.;Hayden, K. M.;Norton, M.;Rabins, P. V.;Green, R. C.;Welsh-Bohmer, K. A.;Breitner, J. C.;Munger, R.;Lyketsos, C. G.",2007,Nov 6,10.1212/01.wnl.0000279520.59792.fe,0,
2986,MELAS--mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes syndrome--two cases confirmed by biochemical and molecular investigations. Differential diagnosis of stroke causes,"Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes syndrome (MELAS) is a maternally inherited multisystem disease caused by mutations of the mitochondrial DNA. The characteristic clinical features are: encephalopathy manifesting as dementia and seizures, stroke-like episodes at young age (usually < 40), lactic acidosis and myopathy with ragged-red fibres. Other frequent manifestations include: sensorineural deafness, diabetes, hypoparathyroidism, peripheral neuropathy and cardiomyopathy. We present two patients with MELAS who were diagnosed 4 and 9 years respectively following the onset of the disease despite the characteristic clinical pictures. The differential diagnostics of inborn and acquired disorders causing stroke is included. We regard that mitochondrial diseases are still insufficiently known and are frequently misdiagnosed. The knowledge is indispensable for establishing diagnosis and accurate genetic counselling. Although there is no specific therapy for mitochondrial diseases to date, coenzyme Q and various vitamins as well as moderate degree exercise might be recommended.",mitochondrial DNA;adolescent;adult;article;case report;cerebrovascular accident;computer assisted tomography;cytochrome c oxidase deficiency;differential diagnosis;female;genetics;human;male;MELAS syndrome;nuclear magnetic resonance imaging;pathology;time,"Mierzewska, H.;Mroczek, K.;Pronicki, M.;Pronicka, E.;Karczmarewicz, E.;Bartnik, E.;Zdzienicka, E.;Seniów, J.;Schmidt-Sidor, B.;Taraszewska, A.;Palasik, W.",2002,,,0,
2987,DNA polymorphisms of the age-related gene in geriatric diseases,,"Aged;Aged, 80 and over;Alzheimer Disease/*genetics;Case-Control Studies;DNA/*genetics;Diabetes Mellitus, Type 2/*genetics;Humans;Myocardial Infarction/*genetics;Ossification of Posterior Longitudinal Ligament/*genetics;*Polymorphism, Genetic","Miki, T.;Lin, Y.;Nakura, J.;Morishima, A.;Kohara, K.",1999,Apr,,0,
2988,Effect of Infla-Kine supplementation on the gene expression of inflammatory markers in peripheral mononuclear cells and on C-reactive protein in blood,"BACKGROUND: Chronic inflammation is a predisposing factor to numerous degenerative diseases including cancer, heart failure and Alzheimer's disease. Infla-Kine is a natural supplement comprised of a proprietary blend of Lactobacillus fermentum extract, burdock seed (arctigenin), zinc, alpha lipoic acid, papaya enzyme and an enhanced absorption bio-curcumin complex (BCM-95(R)). METHODS: Infla-Kine was administered twice daily to 24 health volunteers for 4 weeks. Quantitative RT-PCR was used to assess mRNA transcripts of IL-1b, IL8, IL-6, NF-kappaB, and TNF-alpha from peripheral blood mononuclear cells (PBMC). C reactive protein (CRP) was measured from serum. Additionally, quality of life questionnaires were employed to assess general feeling of well-being. Assessments were made before treatment and at conclusion of treatment (4 weeks). RESULTS: As compared to pre-treatment, after 4 weeks, a statistically significant reduction of IL8, IL-6, NF-kappaB, and TNF-alpha transcripts was observed in PBMC. Furthermore, reduction of IL-1b transcript and serum CRP was observed but did not reach statistical significance. Quality of life improvements were most prevalent in muscle and joint pains. CONCLUSIONS: Overall, our data demonstrate that twice daily administration of Infla-Kine for 4 weeks reduces inflammatory markers and quality of life in healthy volunteers.",,"Mikirova, N. A.;Kesari, S.;Ichim, T. E.;Riordan, N. H.",2017,Oct 20,,0,
2989,"Mental and psychological conditions, medical comorbidity and functional limitation: Differential associations in older adults with cognitive impairment, depressive symptoms and co-existence of both","Objective Cognitive impairment and depressive symptoms are common among the geriatric population but the co-occurrence of both is rarely studied. The purpose of this study was to identify and compare the factors associated with three groups of elderly people: those assessed with cognitive impairment alone (COG), depressive symptoms alone (DEP) or co-existence of both (COG-DEP). Methods The cross-sectional study included 600 community-dwellers ages 65 and older. All participants underwent a comprehensive evaluation. Global cognition was measured by the Mini-Mental State Examination (MMSE) and depressive symptoms were defined by the Geriatric Depression Scale (GDS). Specific chronic illnesses relevant to the Charlson comorbidity index (CCI) were self-reported. Functional status was evaluated by the Katz' basic (ADL) and Lawton's instrumental (IADL) activities of daily living scales. Results COG-DEP was explained by IADL dependence (OR: 11.9, 95% CI: 4.59-30.78), ADL dependence (OR: 11.5, 95% CI: 5.59-23.69), cerebrovascular disease (OR: 3.6, 95% CI: 1.48-8.68), congestive heart failure (OR: 3.4, 95% CI: 1.77-6.59) and diabetes (OR: 2.6, 95% CI: 1.30-5.18), but it was best predicted by functional limitations in the adjusted model. Being functionally dependent and medically ill with shorter life expectancy was shown to significantly increase the odds of being DEP. Functional limitation in IADL was without distinction associated to COG, DEP and COG-DEP. Conclusion The present results on COG, DEP and COG-DEP show the particular relevance of certain medical comorbidities and functional limitations to those three distinct groups of elderly people. Copyright © 2010 John Wiley & Sons, Ltd.",age;aged;article;cerebrovascular disease;chronic obstructive lung disease;cognition;cognitive defect;community living;comorbidity;congestive heart failure;connective tissue disease;cross-sectional study;daily life activity;dementia;depression;diabetes mellitus;educational status;female;functional disease;functional status;gender;Geriatric Depression Scale;geriatric patient;hearing impairment;heart infarction;human;life expectancy;liver disease;major clinical study;male;Mini Mental State Examination;neoplasm;peripheral vascular disease;self report;ulcer;visual impairment,"Millán-Calenti, J. C.;Maseda, A.;Rochette, S.;Vázquez, G. A.;Sánchez, A.;Lorenzo, T.",2011,,,0,
2990,"Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality","The aim of this study is to establish the existing relationship among variables referred to the person, specifically age and gender, and the functional dependence in basic ADL and in IADL, as well as the possible relationship it has with the increase of morbidity and mortality in a random sample of 598 individuals older than 65 years. Of these individuals, 34.6% were categorized as dependent for at least one ADL, and 53.5% if we refer to IADL. Regarding the ADL, the risk of dependence increases (odds ratio = OR = 1.089) per year of age, (OR = 2.48) in women's case; while there is an IADL correlation between age and the score (r = -0.527; p < 0.001). A relationship exists between dependence and the days of hospitalization (for ADL: r = -0.12, p = 0.018 and IADL: r = -0.97, p = 0.003), the number of visits to the doctor (ADL: r = -0.27, p < 0.001; IADL: r = -0.25, p < 0.001) or the presence of concomitant pathologies such as dementia (ADL: p < 0.001; IADL: p < 0.001). There is a significant association between age, gender and dependence, as well as between dependence and morbidity and mortality, so that dependence could be used as a predictor of both. © 2009 Elsevier Ireland Ltd. All rights reserved.",ADL disability;age distribution;aged;anemia;article;dementia;disease association;female;functional assessment;functional status;heart failure;hospitalization;human;length of stay;male;marriage;morbidity;mortality;neoplasm;prediction;prevalence;priority journal;rating scale;scoring system;sex difference;cerebrovascular accident,"Millán-Calenti, J. C.;Tubío, J.;Pita-Fernández, S.;González-Abraldes, I.;Lorenzo, T.;Fernández-Arruty, T.;Maseda, A.",2010,,,0,
2991,"Prevalence of cognitive impairment: effects of level of education, age, sex and associated factors","AIMS: To examine the prevalence of cognitive impairment in a Spanish elderly population and to analyse its association with some social and medical factors. METHODS: We randomly selected a representative sample (n = 600) of people over 65 from Naron Council (A Coruna). Socio-demographic and biomedical data were collected and cognitive status was assessed using the Mini-Mental State Examination (MMSE). RESULTS: We determined variations in the prevalence from 35.2%, when age or level of education distribution was not applied, to 22.2% when they were applied. Women showed a higher probability of cognitive impairment than men. Negative correlation was observed between the age of the subject and the MMSE score (Spearman correlation rho = -0.45, p < 0.001), with the possibility of developing cognitive impairment increasing each year. For our sample, cognitive impairment was associated with an increase of morbidity and mortality in the elderly population. This association was found with the presence of dementia, heart failure, anaemia, stroke and auditory deficits. CONCLUSIONS: Knowledge of the real prevalence rates, together with the establishment of adequate preventive and intervention measures, can be factors that may diminish the socio-sanitary impact of cognitive impairment.","Age Distribution;Aged;Aged, 80 and over;*Aging;Cognition Disorders/*diagnosis/*epidemiology/prevention & control;Educational Status;Female;Humans;Male;Morbidity;*Neuropsychological Tests;Predictive Value of Tests;Prevalence;Risk Factors;Sex Distribution;Spain/epidemiology","Millan-Calenti, J. C.;Tubio, J.;Pita-Fernandez, S.;Gonzalez-Abraldes, I.;Lorenzo, T.;Maseda, A.",2009,,10.1159/000257086,0,
2992,Evaluating the prevalence of potentially inappropriate prescribing in older adults in intermediate care facilities: a cross-sectional observational study,"Background Potentially inappropriate prescribing (PIP) [encompassing potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs)], is prevalent amongst older adults in primary and secondary care. However, PIP prevalence in intermediate care (IC) is unknown. Objective To determine the prevalence of PIMs/PPOs and associated patient factors. Setting Three IC facilities in Northern Ireland. Method The Screening Tool of Older People’s Prescriptions and the Screening Tool to Alert doctors to Right Treatment were used to identify PIP over 8 weeks. Wilcoxon signed-rank tests were performed to compare the prevalence of PIMs/PPOs at admission and discharge. Spearman’s correlation coefficients were calculated to determine factors associated with PIMs/PPOs (p < 0.05 considered significant). Main outcome measure Prevalence of PIMs/PPOs. Results 74 patients [mean age 83.5(±7.4) years] were included. Discharge medication data were available for 30 (40.5%) patients. 53 (71.6%) and 22 (73.3%) patients had ≥1 PIM at admission and discharge, respectively. 45 (60.8%) and 15 (50.0%) patients had ≥1 PPO at admission and discharge, respectively. No significant difference was found in PIM/PPO prevalence at admission compared to discharge (Z = −0.36, p = 0.72; Z = −1.63, p = 0.10). Increasing comorbidity and medication regimen complexity were associated with PIMs at admission (r = 0.265, p = 0.023; r = 0.338 p = 0.003). The number of medicines was correlated with PIMs at admission (r = 0.391, p = 0.001) and discharge (r = 0.515, p = 0.004). Conclusion Whilst IC represents an ideal setting in which to review prescribing, this study found PIP to be highly prevalent in older adults in IC, with no detectably significant change in prevalence between admission to and discharge from this setting.",acetylsalicylic acid;angiotensin receptor antagonist;antihypertensive agent;antivitamin K;benzodiazepine derivative;beta adrenergic receptor blocking agent;blood clotting factor 10a inhibitor;bronchodilating agent;calcium;cholinergic receptor blocking agent;cholinesterase inhibitor;clopidogrel;dipeptidyl carboxypeptidase inhibitor;dipyridamole;loop diuretic agent;neuroleptic agent;opiate;proton pump inhibitor;thrombin inhibitor;tricyclic antidepressant agent;vitamin D;aged;aging;article;asthma;bleeding;bradycardia;Charlson Comorbidity Index;clinical assessment tool;closed angle glaucoma;comorbidity;controlled study;coronary artery disease;cross-sectional study;delirium;dementia;esophagitis;falling;female;health care facility;heart muscle conduction disturbance;hospital admission;hospital discharge;human;hyperkalemia;hypertension;inappropriate prescribing;Ireland;length of stay;Lewy body;major clinical study;male;nursing home;observational study;osteopenia;osteoporosis;pain;parkinsonism;peptic ulcer;peripheral vascular disease;polypharmacy;potentially inappropriate medication;prevalence;primary medical care;priority journal;prostatism;screening test;Screening Tool of Older People Prescriptions;Screening Tool to Alert doctors to Right Treatment;secondary health care;systolic heart failure;urine incontinence;very elderly;vitamin supplementation,"Millar, A.;Hughes, C.;Ryan, C.",2017,,10.1007/s11096-017-0452-4,0,
2993,Update on dementia medications for 2004,,alpha tocopherol;anticoagulant agent;beta carotene;calcium;cholinesterase inhibitor;donepezil;galantamine;Ginkgo biloba extract;glutamic acid;magnesium;memantine;rivastigmine;selenium;warfarin;acupuncture;agitation;alternative medicine;Alzheimer disease;anorexia;bleeding;cardiopulmonary insufficiency;cellular distribution;cognition;dementia;diarrhea;diet supplementation;disease course;dizziness;dose response;drug approval;drug dose regimen;drug efficacy;drug mechanism;extrapyramidal symptom;falling;family counseling;food and drug administration;hallucination;headache;human;insomnia;Lewy body;longevity;multiinfarct dementia;music therapy;nausea;neuroprotection;note;patient education;practice guideline;relaxation training;side effect;sleep disorder;urine incontinence;aricept;exelon;namenda;reminyl,"Miller, C. A.",2004,,,0,
2994,"Homocysteine, vitamin B6, and vascular disease in AD patients","BACKGROUND: Cerebrovascular disease is a cause of dementia and is associated with elevated plasma levels of homocysteine. Patients with AD tend to have unexplained elevations of homocysteine concentrations vs healthy control subjects. Vitamin B(6) status, a potential determinant of plasma homocysteine, has not been characterized in patients with AD. OBJECTIVE: To investigate plasma homocysteine, vitamin B(6) status, and the occurrence of vascular disease in patients with AD. METHODS: Forty-three patients with AD and 37 control subjects without AD were studied for homocysteine, B vitamin status (folate, vitamin B(12), pyridoxal-5'-phosphate [PLP]), kidney function (creatinine), and thyroid function (thyroid-stimulating hormone, thyroxin). In addition, the presence of vascular disease was assessed by reviewing both medical histories and brain imaging data provided by CT and MRI. RESULTS: The OR for elevated plasma homocysteine (>12 micromol/L) was only 2.2 (not significant) for subjects with AD. In contrast, the OR was 10.0 (p = 0.03) for subjects with vascular disease (n = 26). The OR for low plasma PLP (<25 nmol/L) was 12.3 (p = 0.01) for patients with AD. No significant relationship was observed between vascular disease and PLP level or between plasma homocysteine and PLP concentrations. CONCLUSIONS: Elevated plasma homocysteine in patients with AD appears related to vascular disease and not AD pathology. In addition, low vitamin B(6) status is prevalent in patients with AD. It remains to be determined if elevated plasma homocysteine or low vitamin B(6) status directly influences AD pathogenesis or progression.","Aged;Aged, 80 and over;Alzheimer Disease/*blood;Angina Pectoris/blood;Brain Infarction/blood;Coronary Disease/blood;Female;Heart Failure/blood;Homocysteine/*blood;Humans;Ischemic Attack, Transient/blood;Male;Myocardial Infarction/blood;Odds Ratio;Pyridoxal Phosphate/blood;Stroke/blood;Vascular Diseases/*blood;Vitamin B 6/*blood","Miller, J. W.;Green, R.;Mungas, D. M.;Reed, B. R.;Jagust, W. J.",2002,May 28,,0,
2995,Risk stratification for return emergency department visits among high-risk patients,"OBJECTIVES: To compare 2 methods of identifying patients at high-risk of repeat emergency department (ED) use: high Care Assessment Need (CAN) score (≥90), derived from a model using Veterans Health Administration (VHA) data, and ""Super User"" status, defined as more than 3 ED visits within 6 months of the index ED visit. STUDY DESIGN: Retrospective cohort study. METHODS: Using McNemar's test, we compared rates of high-risk classification between CAN score and Super User status. We examined differences in patient characteristics and healthcare utilization across 4 levels of risk classification: high CAN and Super User status (n = 198), CAN <90 and non-Super User (n = 622), high CAN and non-Super User (n = 616), or Super User and CAN score <90 (n = 106). We used logistic regression to identify associations between risk classification and any ED visit within 90 days. RESULTS: Of 1542 veterans, 52.8% (n = 814) had a CAN score ≥90 and 19.7% (n = 304) were Super Users (P <.0001), indicating discrepant rates of high-risk classification. However, we found no differences in patient characteristics. Rates of subsequent ED use were high: 63.1% of patients had 1 or more ED visits. No levels of risk classification were associated with subsequent ED use within 90 days (P = .25). CONCLUSIONS: Among the VHA users with multimorbidity and 3 or more prior ED visits or hospitalizations, subsequent ED use was high. Although CAN scores have demonstrated utility for predicting hospitalizations and deaths, prior utilization and multimorbidity without further risk classification identified a high-risk group for repeat ED use.",adult;anemia;anxiety disorder;article;assessment of humans;Care Assessment Need score;Charlson Comorbidity Index;chronic kidney failure;chronic lung disease;clinical outcome;cohort analysis;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;drug dependence;emergency patient;emergency ward;female;health care utilization;health service;high risk patient;hospital readmission;hospital utilization;human;hypertension;intermethod comparison;ischemic heart disease;major clinical study;male;mental disease;middle aged;multiple chronic conditions;patient identification;peripheral vascular disease;posttraumatic stress disorder;priority journal;retrospective study;risk assessment;super user status;veteran,"Miller, K. E. M.;Duan-Porter, W.;Stechuchak, K. M.;Mahanna, E.;Coffman, C. J.;Weinberger, M.;Van Houtven, C. H.;Oddone, E. Z.;Morris, K.;Schmader, K. E.;Hendrix, C. C.;Kessler, C.;Hastings, S. N.",2017,,,0,
2996,Factors Associated with the High Prevalence of Short Hospice Stays,"This study's goal was to gain an understanding of the factors associated with hospice stays of 7 days or less (i.e., short hospice stays), and to test the hypothesis that independent of changes in sociodemographics, diagnoses, and site-of-care, the likelihood of a short hospice stay increased over time. We examined hospice stays for 46,655 nursing home and 80,507 non-nursing home patients admitted between October 1994 and September 1999 to 21 hospices across 7 states, and owned by 1 provider. Logistic regression was used to determine the factors significantly associated with a higher probability of a short stay. Compared to patients admitted in (fiscal year) 1995, and controlling for potential confounders, the probability of a short stay significantly increased in each year after 1995 in nursing homes, and in 1999 in non-nursing home settings. In (fiscal year) 1995, a nursing home resident admitted to hospice had a 26% probability (95% confidence interval [CI] 0.24, 0.28) of a less than 8-day stay and, in (fiscal year) 1999, the probability was 33% (95% CI 0.31, 0.34); a non-nursing home patient had a 32% probability in 1995 (95% CI 0.30, 0.34) and a 36% probability in 1999 (95% CI 0.34, 0.37). The probability of a short hospice stay was greater for patients with noncancer diagnoses, independent of year of hospice admission. In this paper we discuss the possible underlying reasons for the increased probability of short hospice stays and we speculate on what this increase may mean in terms of hospice's ability to provide high-quality end-of-life care.",adult;age;aged;article;neoplasm;chronic obstructive lung disease;controlled study;dementia;demography;female;health care quality;health insurance;heart failure;hospice care;hospital admission;human;kidney failure;length of stay;logistic regression analysis;major clinical study;male;marriage;nursing home;oligophrenia;probability;race;cerebrovascular accident;treatment outcome,"Miller, S. C.;Weitzen, S.;Kinzbrunner, B.",2003,,,0,
2997,"Risk factors for hospital admission in the 28 days following a community-acquired pneumonia diagnosis in older adults, and their contribution to increasing hospitalisation rates over time: A cohort study","Objectives: To determine factors associated with hospitalisation after community-acquired pneumonia (CAP) among older adults in England, and to investigate how these factors have contributed to increasing hospitalisations over time. Design: Cohort study. Setting: Primary and secondary care in England. Population: 39 211 individuals from the Clinical Practice Research Datalink, who were eligible for linkage to Hospital Episode Statistics and mortality data, were aged ≥65 and had at least 1 CAP episode between April 1998 and March 2011. Main outcome measures: The association between hospitalisation within 28 days of CAP diagnosis (a 'post-CAP' hospitalisation) and a wide range of comorbidities, frailty factors, medications and vaccinations. We examined the role of these factors in post-CAP hospitalisation trends. We also looked at trends in post-CAP mortality and length of hospitalisation over the study period. Results: 14 comorbidities, 5 frailty factors and 4 medications/vaccinations were associated with hospitalisation (of 18, 12 and 7 considered, respectively). Factors such as chronic lung disease, severe renal disease and diabetes were associated with increased likelihood of hospitalisation, whereas factors such as recent influenza vaccination and a recent antibiotic prescription decreased the odds of hospitalisation. Despite adjusting for these and other factors, the average predicted probability of hospitalisation after CAP rose markedly from 57% (1998-2000) to 86% (2009-2010). Duration of hospitalisation and 28-day mortality decreased over the study period. Conclusions: The risk factors we describe enable identification of patients at increased likelihood of post-CAP hospitalisation and thus in need of proactive case management. Our analyses also provide evidence that while comorbidities and frailty factors contributed to increasing post-CAP hospitalisations in recent years, the trend appears to be largely driven by changes in service provision and patient behaviour.",antibiotic agent;corticosteroid;hydroxymethylglutaryl coenzyme A reductase inhibitor;influenza vaccine;Pneumococcus vaccine;steroid;aged;alcohol consumption;anxiety;article;cerebrovascular disease;chronic lung disease;cohort analysis;community acquired pneumonia;comorbidity;congestive heart failure;connective tissue disease;decubitus;dementia;depression;diabetes mellitus;disease severity;falling;fatigue;female;hemiplegia;hospital admission;hospitalization;human;incontinence;influenza vaccination;ischemic heart disease;kidney disease;length of stay;leukemia;liver disease;lymphoma;major clinical study;male;metastasis;mortality;neurologic disease;outcome assessment;peptic ulcer;prescription;sex difference;smoking;terminal disease;underweight;vaccination;very elderly,"Millett, E. R. C.;De Stavola, B. L.;Quint, J. K.;Smeeth, L.;Thomas, S. L.",2015,,,0,
2998,Multimorbidity is associated with better quality of care among vulnerable elders,"BACKGROUND: Older patients with multiple chronic conditions may be at higher risk of receiving poorer overall quality of care compared with those with single or no chronic conditions. Possible reasons include competing guidelines for individual conditions, burden of numerous recommendations, and difficulty implementing treatments for multiple conditions. OBJECTIVES: We sought to determine whether coexisting combinations of 8 common chronic conditions (hypertension, coronary artery disease, chronic obstructive pulmonary disease, osteoarthritis, diabetes mellitus, depression, osteoporosis, and having atrial fibrillation or congestive heart failure) are associated with overall quality of care among vulnerable older patients. MATERIALS AND METHODS: Using an observational cohort study, we enrolled 372 community-dwelling persons 65 years of age or older who were at increased risk for death or functional decline within 2 years. We included (1) a comprehensive measure (% of quality indicators satisfied) of quality of medical and geriatric care that accounted for patient preference and appropriateness in light of limited life expectancy and advanced dementia, and (2) a measure of multimorbidity, either as a simple count of conditions or as a combination of specific conditions. RESULTS: : Multimorbidity was associated with greater overall quality scores: mean proportion of quality indicators satisfied increased from 47% for elders with none of the prespecified conditions to 59% for those with 5 or 6 conditions (P < 0.0001), after controlling for number of office visits. Patients with greater multimorbidity also received care that was better than would be expected based on the specific set of quality indicators they triggered. CONCLUSIONS: Among older persons at increased risk of death or functional decline, multimorbidity results in better, rather than worse, quality of care.","Aged;Aged, 80 and over;Chronic Disease/epidemiology/*therapy;Cohort Studies;*Comorbidity;Female;Health Services for the Aged/*standards;Humans;Linear Models;Male;Managed Care Programs/*standards;Quality Indicators, Health Care;*Quality of Health Care;United States/epidemiology;Vulnerable Populations","Min, L. C.;Wenger, N. S.;Fung, C.;Chang, J. T.;Ganz, D. A.;Higashi, T.;Kamberg, C. J.;MacLean, C. H.;Roth, C. P.;Solomon, D. H.;Young, R. T.;Reuben, D. B.",2007,Jun,10.1097/MLR.0b013e318030fff9,0,
2999,Effect of compound danshen on neural function defect and free radicals in patients with cerebral infarction,"Background: Various etiological mechanisms are involved in cerebral infarction. Both free radicals and lipid peroxidation participate in the atherosclerosis and damage of neural cells after cerebral ischemia. Compound danshen (Radix Salviae Miltiorrhizae) is a common prescribed Chinese herb, acting on activating blood circulation and removing stasis for cerebral infarction and coronary heart disease, but its mechanism has been unknown in many aspects. Objective: To observe the effect of compound danshen on neural function defect and free radicals in patients with cerebral infarction so as to probe into its possible mechanisms. Design: A randomized controlled trial. Setting: Neurological Internal Department of a hospital affiliated to one university. Participants: Totally 538 inpatients were collected in Neurological Internal Department of First Hospital affiliated to Jinzhou Medical College from February to December 2002, their diagnosis compiled with ""Diagnostic Keys on Every Type Cerebral Vascular Disorders"" adopted on the 4th National Academic Meeting on Cerebral Vascular Disorders, and determined by cerebral CT scan. All of those were the first attack of atherosclerosis cerebral infarction in 72 hours. The patients with cardiac infarction, heart failure, auricular fibrillation, insufficiency of liver and kidney function, hemorrhage of digestive tract, vascular dementia and bulbar paralysis and the patients who could not be well cooperated were not included. A total of 68 patients compiled with the standards, of which, 38 patients were male and 30 patients female, aged varied from 52 to 78 years, at the average of (64.62 + 5.80) years. The patients selected were randomized into study group and the control by lot-drawing method according to the hospitalized sequence and volunteer principle of the control. Methods: The basic treatment was same in two groups. In study group, compound danshen injection was added together with physiological saline 250 mL for intra-venous drip, once daily, continuous 14 days made one course. In the control, thrombosis removing injection 15 mL was added together with physiological saline 250 mL for intra-venous drip, once daily, continuous 14 days made one course. Main outcome measures: 1 Evaluation on defect severity of clinical neural function; 2 Evaluation of clinical therapeutic effects; 3 Level of serum lipoperoxide(LPO) and activity of superoxide dismutase (SOD). Results: Statistical differences presented in declined scores of severity of neural function defect after treatment in two groups compared with their own controls (in study group: 28.62 + 6.76 vs 13.84 + 8.16; in the control: 28.58 + 7.05 vs 21.52 + 8.24, t = 8.134, t = 3.796 respectively, P < 0.001). The score in study group was declined more obviously compared with the control after treatment, indicating very significant difference (t = 3.861, P < 0.001). The effective rate of compound danshen injection was 88.24% in treatment of cerebral infarction, which significantly superior to that in the control (67.65% ) (chi<sup>2</sup>=4.19, P < 0.05). Compound danshen remarkably reduced serum LPO level [(8.69 + 1.28) nmol/L vs (5.86 + 1.42) nmol/L, t = 8.628, P < 0.001] and statistical differences presented compared with the result in the control after treatment [(5.86, + 1.42) amol/L vs (8.56 + 0.95) nmol/L, t = 9.125, P < 0.001]. Simultaneously, SOD activity in serum was significantly increased, [(26.25 + 4.64) mkat/g vs (30.01 + 3.87) mkat/g, t = 3.629, P < 0.001] indicating statistical differences compared with the result in the control after treatment [(30.01 + 3.87) mkat/g vs (26.33 + 4.14) mkat/g, t = 3.778, P < 0.001]. Conclusion: Compound danshen improves significantly neural function defect in patients with cerebral infarction, with definite therapeutic effects on the treatment. It can reduce serum LPO content and increase serum SOD activity in patients with cerebral infarction. It is predicted that removing free radicals and anti-lipid peroxidation damage is probably one of the important mechanisms of it, which pro i es a further theoretic evidence for the treatment of cerebral infarction clinically.",adult;aged;article;brain atherosclerosis;brain infarction/di [Diagnosis];brain infarction/dt [Drug Therapy];clinical trial;computer assisted tomography;controlled clinical trial;controlled study;disease severity;drug efficacy;drug mechanism;enzyme activity;female;human;lipid blood level;major clinical study;male;nerve function;randomized controlled trial;Salvia miltiorrhiza;statistical significance;anticoagulant agent/ct [Clinical Trial];anticoagulant agent/dt [Drug Therapy];anticoagulant agent/iv [Intravenous Drug Administration];free radical/ec [Endogenous Compound];lipid peroxide/ec [Endogenous Compound];Salvia miltiorrhiza extract/ct [Clinical Trial];Salvia miltiorrhiza extract/dt [Drug Therapy];Salvia miltiorrhiza extract/iv [Intravenous Drug Administration];Salvia miltiorrhiza extract/pd [Pharmacology];sodium chloride/iv [Intravenous Drug Administration];superoxide dismutase/ec [Endogenous Compound];Sr-stroke: sr-compmed,"Min, L. Q.;Wang, X. J.;Yang, L.;Ma, W. Y.;Yuan, J.;Liu, X. W.",2005,,,0,3000
3000,Effect of compound danshen on neural function defect and free radicals in patients with cerebral infarction,"Background: Various etiological mechanisms are involved in cerebral infarction. Both free radicals and lipid peroxidation participate in the atherosclerosis and damage of neural cells after cerebral ischemia. Compound danshen (Radix Salviae Miltiorrhizae) is a common prescribed Chinese herb, acting on activating blood circulation and removing stasis for cerebral infarction and coronary heart disease, but its mechanism has been unknown in many aspects. Objective: To observe the effect of compound danshen on neural function defect and free radicals in patients with cerebral infarction so as to probe into its possible mechanisms. Design: A randomized controlled trial. Setting: Neurological Internal Department of a hospital affiliated to one university. Participants: Totally 538 inpatients were collected in Neurological Internal Department of First Hospital affiliated to Jinzhou Medical College from February to December 2002, their diagnosis compiled with ""Diagnostic Keys on Every Type Cerebral Vascular Disorders"" adopted on the 4th National Academic Meeting on Cerebral Vascular Disorders, and determined by cerebral CT scan. All of those were the first attack of atherosclerosis cerebral infarction in 72 hours. The patients with cardiac infarction, heart failure, auricular fibrillation, insufficiency of liver and kidney function, hemorrhage of digestive tract, vascular dementia and bulbar paralysis and the patients who could not be well cooperated were not included. A total of 68 patients compiled with the standards, of which, 38 patients were male and 30 patients female, aged varied from 52 to 78 years, at the average of (64.62 +/- 5.80) years. The patients selected were randomized into study group and the control by lot-drawing method according to the hospitalized sequence and volunteer principle of the control. Methods: The basic treatment was same in two groups. In study group, compound danshen injection was added together with physiological saline 250 mL for intra-venous drip, once daily, continuous 14 days made one course. In the control, thrombosis removing injection 15 mL was added together with physiological saline 250 mL for intra-venous drip, once daily, continuous 14 days made one course. Main outcome measures: 1 Evaluation on defect severity of clinical neural function; 2 Evaluation of clinical therapeutic effects; 3 Level of serum lipoperoxide(LPO) and activity of superoxide dismutase (SOD). Results: Statistical differences presented in declined scores of severity of neural function defect after treatment in two groups compared with their own controls (in study group: 28.62 +/- 6.76 vs 13.84 +/- 8.16; in the control: 28.58 +/- 7.05 vs 21.52 +/- 8.24, t = 8.134, t = 3.796 respectively, P < 0.001). The score in study group was declined more obviously compared with the control after treatment, indicating very significant difference (t = 3.861, P < 0.001). The effective rate of compound danshen injection was 88.24% in treatment of cerebral infarction, which significantly superior to that in the control (67.65% ) (chi<sup>2</sup>=4.19, P < 0.05). Compound danshen remarkably reduced serum LPO level [(8.69 +/- 1.28) nmol/L vs (5.86 +/- 1.42) nmol/L, t = 8.628, P < 0.001] and statistical differences presented compared with the result in the control after treatment [(5.86, +/- 1.42) amol/L vs (8.56 +/- 0.95) nmol/L, t = 9.125, P < 0.001]. Simultaneously, SOD activity in serum was significantly increased, [(26.25 +/- 4.64) mkat/g vs (30.01 +/- 3.87) mkat/g, t = 3.629, P < 0.001] indicating statistical differences compared with the result in the control after treatment [(30.01 +/- 3.87) mkat/g vs (26.33 +/- 4.14) mkat/g, t = 3.778, P < 0.001]. Conclusion: Compound danshen improves significantly neural function defect in patients with cerebral infarction, with definite therapeutic effects on the treatment. It can reduce serum LPO content and increase serum SOD activity in patients with cerebral infarction. It is predicted that removing free radicals and anti-lipid peroxidation damage is probably one of the important mec anisms of it, which provides a further theoretic evidence for the treatment of cerebral infarction clinically.",adult;aged;article;brain atherosclerosis;brain infarction/di [Diagnosis];brain infarction/dt [Drug Therapy];clinical trial;computer assisted tomography;controlled clinical trial;controlled study;disease severity;drug efficacy;drug mechanism;enzyme activity;female;human;lipid blood level;major clinical study;male;nerve function;randomized controlled trial;Salvia miltiorrhiza;statistical significance;anticoagulant agent/ct [Clinical Trial];anticoagulant agent/dt [Drug Therapy];anticoagulant agent/iv [Intravenous Drug Administration];free radical/ec [Endogenous Compound];lipid peroxide/ec [Endogenous Compound];Salvia miltiorrhiza extract/ct [Clinical Trial];Salvia miltiorrhiza extract/dt [Drug Therapy];Salvia miltiorrhiza extract/iv [Intravenous Drug Administration];Salvia miltiorrhiza extract/pd [Pharmacology];sodium chloride/iv [Intravenous Drug Administration];superoxide dismutase/ec [Endogenous Compound];atherosclerosis;bleeding;brain infarction;brain ischemia;bulbar paralysis;cerebrovascular disease;Chinese herb;circulation;diagnosis;digestive system;etiology;heart atrium fibrillation;heart failure;heart infarction;hospital;hospital patient;injection;ischemic heart disease;kidney function;lipid peroxidation;liver;medical school;multiinfarct dementia;nerve cell;patient;Salvia miltiorrhiza;serum;thrombosis;university;volunteer;anticoagulant agent;free radical;lipid peroxide;Salvia miltiorrhiza extract;sodium chloride;superoxide dismutase;Sr-stroke: sr-compmed,"Min, L-Q;Wang, X-J;Yang, L;Ma, W-Y;Yuan, J;Liu, X-W",2005,,,0,
3001,Amyloid imaging mismatch,"An 82-year-old man with suspected systemic amyloidosis and complete atrioventricular block underwent vascular biopsy during his pacemaker implantation with pathology showing amyloid deposits. Tc-aprotinin SPECT revealed increased radiotracer uptake along the left ventricular wall, consistent with cardiac amyloidosis. C-PiB PET/CT performed for the evaluation of amyloid deposits in the brain showed findings suggestive of Alzheimer disease without abnormal radiotracer concentration in the myocardium to match the Tc-aprotinin SPECT findings. Dynamic PET images showed increased C-PiB concentration in the left ventricular myocardium at 2 minutes after injection, with subsequent tracer clearance by approximately 5 minutes, consistent with normal C-PiB biodistribution. © 2012 Lippincott Williams & Wilkins, Inc.",amyloid;aprotinin;aprotinin tc 99m;Pittsburgh compound B;technetium 99m;unclassified drug;aged;Alzheimer disease;amnesia;article;artificial heart pacemaker;atrioventricular block;case report;complete heart block;computer assisted tomography;heart amyloidosis;heart left ventricle wall;heart muscle;human;human tissue;male;positron emission tomography;single photon emission computer tomography,"Minamimoto, R.;Ishii, K.;Kubota, K.;Morooka, M.;Okasaki, M.;Ito, K.;Mitsumoto, T.;Nakajima, K.;Sato, T.;Mochizuki, M.;Okazaki, O.",2012,,,0,
3002,"Beware of ""instant slim"" and other stories",,angiotensin receptor antagonist;candesartan;irbesartan;losartan;olmesartan;sibutramine;telmisartan;valsartan;accidental death;acute heart infarction;anxiety disorder;bipolar disorder;blood pressure regulation;cerebrovascular accident;clinical practice;consultation;dehydration;dementia;depression;drug efficacy;drug safety;evidence based medicine;heart failure;human;hypertension;mental disease;non insulin dependent diabetes mellitus;personality disorder;practice guideline;priority journal;schizophrenia;short survey;sport;weight reduction,"Minerva, L.",2013,,,0,
3003,Predicting mortality in older patients. The VELCA Study,"BACKGROUND AND AIMS: Mortality at older age, during and after hospitalization, can be determined by several factors, beyond the direct cause for hospital admission, which are not yet fully understood. The aim of this study was to assess predictors of inpatient mortality and one-year mortality in older Italians, hospitalized for dementia, heart failure, chronic obstructive pulmonary disease, stroke, hip fracture and myocardial infarction at the Verona Teaching Hospital, Northern Italy. METHODS: At admission, 429 patients aged 65 years and older reported information on: sociodemographic characteristics, Barthel index at admission and two weeks before, and severity of investigated diagnosis; at discharge: diagnosis, comorbid conditions, complications from hospital records, drug therapy, and Barthel index. One year after discharge, an ad hoc questionnaire for those subjects found to have died on phone contact was administered to a proxy to collect data on new hospital admissions, onset of new conditions, need for formal care, a short version of the Barthel index one month before death, and the place of death. RESULTS: Sex and specific diseases at admission were not significant predictors of inpatients, nor was one-year mortality in this cohort, whereas the presence of any comorbid conditions doubled the risk of mortality at one year compared with patients without comorbidity. Those patients who had moderate to severe/total dependency in ADL at admission were three times more likely to have died at discharge than those who were independent. The same risk for mortality at one-year follow-up was found in those patients who were severely or totally dependent at preadmission, at admission, or at discharge. CONCLUSIONS: Functional status and comorbidity are key risk factors for mortality in the elderly. Therefore, multidimensional assessment, including functional status prior to hospitalization should always be assessed, and should be considered a relevant predictor of short- and long-term outcomes.","*Activities of Daily Living;*Aged;Aged, 80 and over;Disabled Persons/classification/statistics & numerical data;Female;Hospital Mortality;Hospitalization;Humans;Male;Marital Status;*Mortality;Occupations;Predictive Value of Tests","Minicuci, N.;Maggi, S.;Noale, M.;Trabucchi, M.;Spolaore, P.;Crepaldi, G.",2003,Aug,,0,
3004,The implementation of integrated care: the empirical validation of the Development Model for Integrated care,"Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia. Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests. The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 ± 18, 42 ± 13, and 45 ± 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated care activities. Although the patient composites and the characteristics of the 84 participating integrated care services differed considerably, the results confirm that the clusters and the vast majority of DMIC elements are relevant to all three groups. Therefore, the DMIC can serve as a general quality management tool for integrated care. Applying the model in practice can help in steering further implementations as well as the development of new integrated care practices.",article;dementia;empirical research;health care survey;heart infarction;human;integrated health care system;mass communication;Netherlands;nonbiological model;organization and management;cerebrovascular accident;validation study,"Minkman, M. M.;Vermeulen, R. P.;Ahaus, K. T.;Huijsman, R.",2011,,,0,
3005,A survey study to validate a four phases development model for integrated care in the Netherlands,"BACKGROUND: The development of integrated care is a complex and long term process. Previous research shows that this development process can be characterised by four phases: the initiative and design phase; the experimental and execution phase; the expansion and monitoring phase and the consolidation and transformation phase. In this article these four phases of the Development Model for Integrated Care (DMIC) are validated in practice for stroke services, acute myocardial infarct (AMI) services and dementia services in the Netherlands. METHODS: Based on the pre-study about the DMIC, a survey was developed for integrated care coordinators. In total 32 stroke, 9 AMI and 43 dementia services in the Netherlands participated (response 83%). Data were collected on integrated care characteristics, planned and implemented integrated care elements, recognition of the DMIC phases and factors that influence development. Data analysis was done by descriptive statistics, Kappa tests and Pearson's correlation tests. RESULTS: All services positioned their practice in one of the four phases and confirmed the phase descriptions. Of them 93% confirmed to have completed the previous phase. The percentage of implemented elements increased for every further development phase; the percentage of planned elements decreased for every further development phase. Pearson's correlation was .394 between implemented relevant elements and self-assessed phase, and up to .923 with the calculated phases (p < .001). Elements corresponding to the earlier phases of the model were on average older. Although the integrated care services differed on multiple characteristics, the DMIC phases were confirmed. CONCLUSIONS: Integrated care development is characterised by a changing focus over time, often starting with a large amount of plans which decrease over time when progress on implementation has been made. More awareness of this phase-wise development of integrated care, could facilitate integrated care coordinators and others to evaluate their integrated care practices and guide further development. The four phases model has the potential to serve as a generic quality management tool for multiple integrated care practices.","*Delivery of Health Care, Integrated;Dementia/therapy;*Models, Organizational;Myocardial Infarction/therapy;National Health Programs;Netherlands;Program Development/*methods;Stroke/therapy;Surveys and Questionnaires","Minkman, M. M.;Vermeulen, R. P.;Ahaus, K. T.;Huijsman, R.",2013,Jun 13,10.1186/1472-6963-13-214,0,
3006,Development and validation of a risk score to identify patients at high risk for opioid-related adverse drug events,"BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged &gt; 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8[%] (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2[%] (n = 449) of patients, 5.5[%] (n = 202) were low risk with an ORADE, and 6.7[%] (n = 247) were high risk without an ORADE. Overall, 20.6[%] (n = 344) of high-risk patients experienced = 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3[%] (n = 107) of lowrisk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0[%] higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients.",codeine;dextropropoxyphene;fentanyl;hydrocodone;hydromorphone;methadone;morphine;opiate;oxycodone;pethidine;adult;age;article;asthma;bradypnea;chronic obstructive lung disease;congestive heart failure;constipation;controlled study;coronary artery atherosclerosis;Crohn disease;dementia;depression;diabetes mellitus;diverticulitis;drug induced disease;female;gastroesophageal reflux;gastrointestinal surgery;heart arrhythmia;high risk patient;hospital patient;hospital readmission;hospitalization cost;human;hypertension;hypoxemia;incidence;irritable colon;length of stay;low risk patient;lung insufficiency;major clinical study;male;multivariate logistic regression analysis;nausea and vomiting;obesity;oliguria;opioid related adverse drug event;osteoarthritis;outcome assessment;paralytic ileus;postoperative care;postoperative pain;prostate hypertrophy;pulmonary hypertension;respiratory tract disease;retrospective study;risk assessment;sleep disordered breathing;surgical patient;ulcerative colitis;urine retention,"Minkowitz, H. S.;Scranton, R.;Gruschkus, S. K.;Nipper-Johnson, K.;Menditto, L.;Dandappanavar, A.",2014,,10.18553/jmcp.2014.20.9.948,0,
3007,V1-V2-V3-V4 T wave inversion: Left or right ventricle?,"An 84-year-old woman, affected by Alzheimer's disease, presented to the emergency department with intense dyspnoea. Since ECG was showing T wave inversion in anterior leads and troponin-T was high, the patient was admitted to our unit with a diagnosis of anterior non-ST elevation myocardial infarction. However, the patient's medical history and a further review of the ECG led us to suspect a pulmonary embolism (PE) as a possible differential clinical diagnosis. We tested this alternative hypothesis: echocardiography as well as contrast-enhanced CT scan confirmed the diagnosis of PE. We describe these misleading ECG findings together with a brief discussion of electrocardiographical changes in pulmonary embolism. Copyright 2013 BMJ Publishing Group. All rights reserved.",anticoagulant agent;troponin T;aged;Alzheimer disease;article;case report;computer assisted tomography;contrast enhancement;differential diagnosis;Doppler echography;dyspnea;echocardiography;electrocardiography;emergency ward;female;heart left ventricle;heart right ventricle;hospital admission;hospital discharge;human;lung embolism;medical history;non ST segment elevation myocardial infarction;patient referral;prescription;priority journal;T wave inversion;treatment outcome,"Mirijello, A.;Pola, R.;Saviano, L.;Landolfi, R.",2013,,,0,
3008,IMPROV-ED study: outcomes after discharge for an episode of acute-decompensated heart failure and comparison between patients discharged from the emergency department and hospital wards,"Objective: To define the short- and mid-term outcomes of patients discharged after an episode of acute-decompensated heart failure (ADHF) and evaluate the differences between patients discharged directly from the emergency department (ED) and those discharged after hospitalization. Methods: We performed a prospective, multicenter, cohort-designed study, including consecutive patients diagnosed with ADHF in 27 Spanish EDs. Thirty-four variables on epidemiology, comorbidity, baseline status, vital signs, signs of congestion, laboratory tests, and treatment were collected in every patient. The primary outcome was a combined endpoint of ED revisit (without hospitalization) or hospitalization due to ADHF, or all-cause death. Secondary outcomes were each of these three events individually. Outcomes were obtained by survival analysis at different timepoints in the entire cohort, and crude and adjusted comparisons were carried out between patients discharged directly from the ED and after hospitalization. Results: Of the 3233 patients diagnosed with ADHF during a 2-month period, we analyzed 2986 patients discharged alive: 787 (26.4%) discharged from the ED and 2199 (73.6%) after hospitalization. The cumulative percentages of events for the whole cohort (at 7/30/180 days) for the combined endpoint were 7.8/24.7/57.8; for ED revisit 2.5/9.4/25.5; for hospitalization 4.6/15.3/40.7; and for death 0.9/4.3/16.8. After adjustment for patient profile and center, significant increases were found in the hazard ratios for ED- compared to hospital-discharged patients in the combined endpoint, ED revisit and hospitalization, being higher at short-term [at 7 days, 2.373 (1.678–3.355), 2.069 (1.188–3.602), and 3.071 (1.915–4.922), respectively] than at mid-term [at 180 days, 1.368 (1.160–1.614), 1.642 (1.265–2.132), and 1.302 (1.044–1.623), respectively]. No significant differences were found in death. Conclusions: Patients with ADHF discharged from the ED have worse outcomes, especially at short term, than those discharged after hospitalization. The definition and implementation of effective strategies to improve patient selection for direct ED discharge are needed.",acute heart failure;aged;article;atrial fibrillation;cerebrovascular disease;chronic kidney failure;chronic obstructive lung disease;clinical outcome;cohort analysis;comorbidity;comparative study;death;dementia;diabetes mellitus;dyslipidemia;emergency ward;female;follow up;hospital discharge;hospitalization;human;hypertension;ischemic heart disease;major clinical study;male;multicenter study (topic);New York Heart Association class;patient selection;prospective study;survival analysis;valvular heart disease;vital sign,"Miró, Ò;Gil, V.;Xipell, C.;Sánchez, C.;Aguiló, S.;Martín-Sánchez, F. J.;Herrero, P.;Jacob, J.;Mebazaa, A.;Harjola, V. P.;Llorens, P.",2017,,10.1007/s00392-016-1065-y,0,
3009,Short-term prognostic factors in elderly patients seen in emergency departments for acute heart failure,"Introduction and objectives. To investigate factors associated with short-term mortality in elderly patients seen in emergency departments for an episode of acute heart failure. Methods. A prospective, non-interventional, multicenter, cohort study was carried out in patients aged 65 years and older who were treated in the emergency department of one of eight tertiary hospitals in Spain. Twenty-eight independent variables that could influence mortality at 30 days were assessed. They covered epidemiological and clinical factors and daily functioning. Data were obtained by reviewing medical records or by interviewing the patient or a relative. Multivariate logistic regression analysis was performed. results. The study included 623 patients, 42 of whom (6.7%) died within 30 days of visiting the emergency department. Four variables were significantly associated with higher mortality: functional dependence at baseline (i.e., Barthel index=60; odds ratio [OR]=2.9; 95% confidence interval [CI], 1.2-6.5), New York Heart Association class IIIIV (OR=3; 95% CI, 1.3-7), systolic blood pressure <100 mmHg (OR=4.8; 95% CI, 1.6-14.5) and blood sodium <135 mEq/l (OR=4.2; 95% CI, 1.8-9.6). conclusions. Several factors evaluated on initial assessment in the emergency department, including the level of functional dependence, were found to determine a poor short-term prognosis in elderly patients who present with an episode of acute heart failure. © 2009 Sociedad Española de Cardiología.",sodium;acute heart failure;aged;arterial pressure;article;cardiac patient;cerebrovascular disease;smoking;clinical assessment;dementia;diabetes mellitus;disease classification;dyslipidemia;dyspnea;edema;emergency ward;female;functional status;heart failure;heart fibrillation;heart muscle ischemia;heart perfusion;hepatomegaly;human;hypertension;kidney failure;major clinical study;male;medical record review;mortality;multivariate logistic regression analysis;paroxysmal dyspnea;prognosis;prospective study;retrospective study;sodium blood level;Spain;systolic blood pressure;tachycardia;valvular heart disease,"Miró, Ò;Llorens, P.;Javier Martín-Sánchez, F.;Herrero, P.;Pavón, J.;José Pérez-Durá, M.;Bella Álvarez, A.;Jacob, J.;González, C.;Jorge González-Armengol, J.;Gil, V.;Alonso, H.",2009,,,0,
3010,Racial difference in sarcoidosis mortality in the United States,"BACKGROUND: The clinical presentation and outcome of sarcoidosis varies by race. However, the race difference in mortality outcome remains largely unknown. METHODS: We studied mortality related to sarcoidosis from 1999 through 2010 by examining data on multiple causes of death from the National Center for Health Statistics. We compared the comorbid conditions between sarcoidosis-related deaths with deaths caused by car accidents (previously healthy control subjects) and rheumatoid arthritis (chronic disease control subjects) in both African Americans and Caucasians. RESULTS: From 1999 through 2010, sarcoidosis was reported as an immediate cause of death in 10,348 people in the United States with a combined overall mean age-adjusted mortality rate of 2.8 per 1 million person-years. Of these, 6,285 were African American and 3,984 Caucasian. The age-adjusted mortality rate for African Americans was 12 times higher than for Caucasians. African Americans died at an earlier age than Caucasians. African Americans living in the District of Columbia and North Carolina and Caucasians living in Vermont had higher mortality rates. Although the total sarcoidosis age-adjusted mortality rate had not changed over the 12 year period studied, this rate increased for Caucasians (R = 0.747, P = .005) but not for African Americans. Compared with the control groups, pulmonary hypertension was significantly more common in individuals with sarcoidosis. CONCLUSIONS: This nationwide population-based study exposes a significant difference in ethnicity and sex among people dying of sarcoidosis in the United States. Pulmonary hypertension investigation should be considered in all patients with sarcoidosis, especially African Americans.",acute respiratory failure;adult;African American;age distribution;aged;article;asthma;coronary artery atherosclerosis;atypical mycobacteriosis;Caucasian;cause of death;chronic kidney failure;chronic obstructive lung disease;comorbidity;controlled study;dementia;diabetes mellitus;ethnic difference;female;geographic distribution;heart failure;human;Human immunodeficiency virus infection;hypertension;liver failure;lung fibrosis;major clinical study;male;middle aged;mortality;neoplasm;pneumonia;priority journal;pulmonary hypertension;race difference;respiratory arrest;retrospective study;rheumatoid arthritis;sarcoidosis;septicemia;sex ratio;traffic accident;tuberculosis;United States;very elderly,"Mirsaeidi, M.;Machado, R. F.;Schraufnagel, D.;Sweiss, N. J.;Baughman, R. P.",2015,,,0,
3011,"The N-terminal pro B-type natriuretic peptide, and risk of dementia and cognitive decline: a 10-year follow-up study in the general population","BACKGROUND: The N-terminal pro B-type natriuretic peptide (NT-proBNP) has a well-documented prognostic value for cardiovascular disease (CVD) and higher levels are associated with cognitive-dysfunction in patients with CVD. However, how NT-proBNP relates to incident dementia and cognitive-decline in community-dwelling persons is unknown. METHODS: Between 1997 and 2001, serum NT-proBNP was measured in 6040 participants (mean age 69 years, 57% women) free of heart-failure and dementia from the Rotterdam Study. Participants were continuously followed-up for incident dementia until 2012, for 56,616 person-years. Cognition was assessed at baseline and reassessed between 2002 and 2006 by Letter-Digit-Substitution-task, Stroop test and Word-Fluency test. Associations of NT-proBNP with dementia (555 cases), Alzheimer's disease (357 cases) and vascular dementia (32 cases) were assessed linearly, and in quartiles using Cox regression. Associations of NT-proBNP with cognitive-decline were assessed using multiple linear regression. All analyses were repeated after excluding patients with CVD. RESULTS: Higher NT-proBNP was associated with a higher risk of dementia, even after excluding patients with CVD and adjusting for cardiovascular risk factors, HR per SD 1.27 (95% CI 1.13 to 1.44). Associations were particularly strong for vascular dementia, HR per SD 2.04 (95% CI 1.18 to 3.55), but also for Alzheimer's disease when comparing the second and third quartile with first. Higher NT-proBNP was cross-sectionally associated with poorer performance in multiple cognitive tests but longitudinally only in Letter-Digit-Substitution-task. CONCLUSIONS: NT-proBNP reflecting subclinical CVD is associated with dementia, particularly vascular dementia. NT-proBNP can be a useful marker of imminent cognitive-decline and dementia in absence of clinical CVD.","Aged;Alzheimer Disease/diagnosis/genetics/psychology;Biomarkers/analysis;Cardiovascular Diseases/complications;Cognition Disorders/*diagnosis/genetics/psychology;Cross-Sectional Studies;Dementia/*diagnosis/genetics/psychology;Female;Follow-Up Studies;Humans;Incidence;Male;Natriuretic Peptide, Brain/*analysis/genetics;Neuropsychological Tests;Peptide Fragments/*analysis/genetics;Prognosis;Risk Factors;Socioeconomic Factors;Alzheimer's disease;Dementia;Epidemiology","Mirza, S. S.;de Bruijn, R. F.;Koudstaal, P. J.;van den Meiracker, A. H.;Franco, O. H.;Hofman, A.;Tiemeier, H.;Ikram, M. A.",2016,Apr,10.1136/jnnp-2014-309968,0,
3012,10-year trajectories of depressive symptoms and risk of dementia: a population-based study,"Background Late-life depressive symptoms have been extensively studied for their relationship with incident dementia, but have been typically assessed at a single timepoint. Such an approach neglects the course of depression, which, given its remitting and relapsing nature, might provide further insights into the complex association of depression with dementia. We therefore repeatedly measured depressive symptoms in a population of adults over a decade to study the subsequent risk of dementia. Methods Our study was embedded in the Rotterdam Study, a population-based study of adults aged 55 years or older in Rotterdam (Netherlands), ongoing since 1990. The cohort is monitored continuously for major events by data linkage between the study database and general practitioners. We examined a cohort of participants who were free from dementia, but had data for depressive symptoms from at least one examination round in 1993–95, 1997–99, or 2002–04. We assessed depressive symptoms with the validated Dutch version of the Center for Epidemiology Depression Scale (CES-D) and the Hospital Anxiety and Depression Scale-Depression. We used these data to identify 11-year trajectories of depressive symptoms by latent class trajectory modelling. We screened participants for dementia at each examination round and followed up participants for 10 years for incident dementia by latent trajectory from the third examination round to 2014. We calculated hazard ratios (HR) for dementia by assigned trajectory using two Cox proportional hazards models (model 1 adjusted for age and sex only, and model 2 adjusted additionally for APOEɛ4 carrier status, educational level, body-mass index, smoking, alcohol consumption, cognitive score, use of antidepressants, and prevalent disease status at baseline). We repeated the analyses censoring for incident stroke, restricting to Alzheimer's disease as an outcome, and accounting for mortality as a competing risk for dementia. Findings From 1993–2004, we obtained data for depressive symptoms from at least one examination round for 3325 participants (median age: 74·88 years [IQR 70·62–80·06], 1995 [60%] women). We identified five trajectories of depressive symptoms in these 3325 individuals, characterised by maintained low CES-D scores (low; 2441 [73%]); moderately high starting scores but then remitting (decreasing; 369 [11%]); low starting scores, increasing, then remitting (remitting; 170 [5%]); low starting scores that steadily increased (increasing; 255 [8%]); and maintained high scores (high; 90 [3%]). During 26 330 person-years, 434 participants developed incident dementia. Only the trajectory with increasing depressive symptoms was associated with a higher risk of dementia compared with the low depressive symptom trajectory, using model 2 (HR 1·42, 95% CI 1·05–1·94; p=0·024). Additionally, only the increasing trajectory was associated with a higher risk of dementia compared with the low trajectory after censoring for incident stroke (1·58, 1·15–2·16; p=0·0041), restricting to Alzheimer's disease as an outcome (1·44, 1·03–2·02; p=0·034), and accounting for mortality as a competing risk (1·45, 1·06–1·97; p=0·019). Interpretation Risk of dementia differed with different courses of depression, which could not be captured by a single assessment of depressive symptoms. The higher risk of dementia only in the increasing trajectory suggests depression might be a prodrome of dementia. Funding Erasmus Medical Center; ZonMw; the Netherlands Ministry of Education Culture and Science; and the Netherlands Ministry for Health, Welfare and Sports.",acute heart infarction;aged;alcohol consumption;Alzheimer disease;article;body mass;Center for Epidemiological Studies Depression Scale;cerebrovascular accident;dementia;depression;female;Hospital Anxiety and Depression Scale;human;hypertension;male;Mini Mental State Examination;Netherlands;non insulin dependent diabetes mellitus;priority journal,"Mirza, S. S.;Wolters, F. J.;Swanson, S. A.;Koudstaal, P. J.;Hofman, A.;Tiemeier, H.;Ikram, M. A.",2016,,10.1016/s2215-0366(16)00097-3,0,
3013,Stroke- the most important cause of the newly diagnosed epilepsy in the elderly,"About 35% of all newly diagnosed epileptic seizures in people older than 60 years are caused by stroke. The incidence of the early epileptic seizures is 2.4-5.4%, and for the late seizures 3-4.5%. Seizures after stroke are most often simple partial seizures with or without secondary generalization, and less often complex partial seizures. In early seizure these are acute biochemical cellular changes, and in late seizures gliosis. Althoung the risk for developing epilepsy was 17-35% after early seizures, the risk of developing epilepsy after late seizures increased to 65-90%. Combination of coronary heart disease, hypertonia and cardiovascular disease occur in 65% of patients over 75 year old. Intrahospitalmortality in patients with stroke with epileptic seizures was 37.9% compared to patients without seizures (14.4%). Early seizures cause highermortality than late seizures which can be explained by sinergistic effect of of the damaged tissue due to the seizure and vascular ischaemia. European authors in 2007 indicate that lavetiracetam, lamotrigine and gabapentin were first line drugs, followed by topiramate and valproate in elderly patients. Oxcarbazepine and carbamazepine were not highly recommended because of the associated hyponatremia, cardiac disorders and interaction potentials. The standard antiepileptic drug for focal epilepsy is still carbamazepine, and valproate is most commonly used for generalized epilepsy- even in older patients. Epidemiological studies on epilepsy treatment in the elderly show steady increase in the number of patients. Therefore, elderly patients require special attention.Monotherapy in lowdoses is often sufficient, enzyme inducing drug are used too frequently.",carbamazepine;clonazepam;diazepam;etiracetam;gabapentin;lamotrigine;methylphenobarbital;oxazepam;oxcarbazepine;phenobarbital;phenytoin;pregabalin;primidone;topiramate;valproic acid;warfarin;aged;article;behavior change;bone strength;cardiovascular disease;cerebrovascular accident;comorbidity;dementia;emotional disorder;epilepsy;follow up;heart disease;human;hyponatremia;insomnia;ischemic heart disease;mortality;muscle hypertonia;ossification;osteoporosis;parkinsonism;sedation;seizure;side effect;tremor,"Miškov, S.;Bošnjak, J.;Roje-Bedeković, M.;Mikula, I.;Dežmalj-Grbelja, L.;KopačEvić, L.;Vida, D.;Bašić-Kes, V.",2012,,,0,
3014,Key comorbid conditions that are predictive of survival among hemodialysis patients,"Background and objectives: Abstracting information about comorbid illnesses from the medical record can be timeconsuming, particularly when a large number of conditions are under consideration. We sought to determine which conditions are most prognostic and whether comorbidity continues to contribute to a survival model once laboratory and clinical parameters have been accounted for. Design, setting, participants, & measurements: Comorbidity data were abstracted from the medical records of Dialysis Outcomes and Practice Pattern Study (DOPPS) I, II, and III participants using a standardized questionnaire. Models that were composed of different combinations of comorbid conditions and case-mix factors were compared for explained variance (R2) and discrimination (c statistic). Results: Seventeen comorbid conditions account for 96% of the total explained variance that would result if 45 comorbidities that were expected to be predictive of survival were added to a demographics-adjusted survival model. These conditions together had more discriminatory power (c statistic 0.67) than age alone (0.63) or serum albumin (0.60) and were equivalent to a combination of routine laboratory and clinical parameters (0.67). The strength of association of the individual comorbidities lessened when laboratory/clinical parameters were added, but all remained significant. The total R2 of a model adjusted for demographics and laboratory/clinical parameters increased from 0.13 to 0.17 upon addition of comorbidity. Conclusions: A relatively small list of comorbid conditions provides equivalent discrimination and explained variance for survival as a more extensive characterization of comorbidity. Comorbidity adds to the survival model a modest amount of independent prognostic information that cannot be substituted by clinical/laboratory parameters. Copyright © 2009 by the American Society of Nephrology.",albumin;insulin;acquired immune deficiency syndrome;adult;age distribution;albumin blood level;amputation;anamnesis;article;ascites;case mix;cellulitis;cerebrovascular accident;chronic obstructive lung disease;comorbidity;dementia;depression;diabetes mellitus;disease association;female;gangrene;gastrointestinal hemorrhage;heart failure;heart infarction;hemodialysis patient;home care;hospitalization;human;Human immunodeficiency virus infection;major clinical study;male;malignant neoplastic disease;medical record;neurologic disease;oxygen supply;peripheral vascular disease;prediction;prognosis;questionnaire;recurrent disease;sex difference;substance abuse;survival;variance,"Miskulin, D.;Bragg-Gresham, J.;Gillespie, B. W.;Tentori, F.;Pisoni, R. L.;Tighiouart, H.;Levey, A. S.;Port, F. K.",2009,,,0,
3015,Atrioventricular block and diastolic dysfunction in a patient with sanfilippo C,"A 39-year-old woman with Sanfilippo C syndrome was referred to our department for the treatment of bradycardia. An electrocardiogram revealed a second degree atrioventricular block, and pacemaker implantation was performed with the patient under general anesthesia. A transthoracic echocardiogram showed normal left ventricular systolic function, moderate mitral regurgitation due to mitral valve prolapse, and a high E/e' ratio, indicating left ventricular diastolic dysfunction. The present patient exhibited a rare case of Sanfilippo syndrome complicated with conduction disturbances, mitral regurgitation, and diastolic dysfunction. © 2010 The Japanese Society of Internal Medicine.",heparan sulfate;adult;article;artificial heart pacemaker;atrioventricular block;bradycardia;calcium urine level;case report;clinical feature;dementia;developmental disorder;diastolic dysfunction;Doppler echocardiography;electrocardiogram;endotracheal intubation;enzyme assay;female;hearing impairment;heart left ventricle hypertrophy;heart left ventricle mass;heart rate;human;mental development;mitral valve regurgitation;mucopolysaccharidosis;pericardial effusion;Sanfilippo syndrome;transthoracic echocardiography,"Misumi, I.;Chikazawa, S.;Ishitsu, T.;Higuchi, S.;Shimazu, T.;Ikeda, C.;Uchino, M.;Shibata, Y.;Ebihara, K.;Akahoshi, R.",2010,,,0,
3016,Morbidity and Survival in Elderly Patients Undergoing Free Flap Reconstruction: A Retrospective Cohort Study,"Objective: To review a single institution’s outcomes of free flap reconstruction of the head and neck in patients aged ≥80 years as compared with those <80 years. Study Design: Retrospective cohort study. Setting: Tertiary academic hospital. Subjects and Methods: Patients aged ≥ 80 years who underwent free flap reconstruction of the head and neck between 2007 and 2013 were identified and matched by type of reconstruction with a cohort of younger patients. Outcome measures included flap success, length of stay, discharge disposition, complications, and 2-year mortality. Associations between complications and comorbidities were also evaluated. Results: Sixty-six patients aged ≥80 years were identified, and a paired sample <80 years old was selected. There were 3 flap failures per group and 1 perioperative mortality in the elderly group. There was no significant difference in length of stay or major complications between groups. Significantly more elderly patients were discharged to a nursing facility. There was no significant difference in mortality rates at 2 years postoperatively. No associations were seen between level of comorbidity and complications among the elderly group. Conclusion: Free flap reconstruction of the head and neck remains a viable option in patients of advanced age. Similar outcomes in terms of flap success, complications, and length of hospitalization can be achieved as compared with younger patients undergoing similar reconstructions. The role of comorbid disease as a predictor of complications remains unclear. There is no significant difference in 2-year mortality for elderly free flap patients versus younger controls.",aged;anterolateral thigh flap;article;basal cell carcinoma;cerebrovascular accident;chronic obstructive lung disease;cohort analysis;controlled study;dementia;diabetes mellitus;disease association;female;fibula graft;flap success;free flap reconstruction;free tissue graft;graft failure;head and neck surgery;heart arrhythmia;heart infarction;hospital discharge;human;latissimus dorsi flap;length of stay;major clinical study;male;morbidity;mortality;postoperative complication;radial forearm flap;retrospective study;scoring system;squamous cell carcinoma;survival;very elderly,"Mitchell, C. A.;Goldman, R. A.;Curry, J. M.;Cognetti, D. M.;Krein, H.;Heffelfinger, R.;Luginbuhl, A.",2017,,10.1177/0194599817696301,0,
3017,Care home managers' knowledge of palliative care: a Northern Irish study,"AIM: The aim of this study was to determine care home managers' knowledge of palliative care using the palliative care quiz for nursing (PCQN). BACKGROUND: Palliative care is strongly advocated for all people living with advancing incurable illness. Within a care home setting there should be a particular emphasis on the importance of palliative care, particularly for those residents who, because of their advancing age, are likely to live with non-malignant diseases such as dementia, chronic obstructive pulmonary disease or heart failure to name a few. METHODS: Before the beginning of a workshop on optimising palliative care for people living in care homes, 56 care home managers (all nurses) completed the PCQN, a validated questionnaire that is used to assess a nurse's knowledge of palliative care, as part of a learning exercise. RESULTS: The quiz consisted of 20 questions for which participants could answer true, false or don't know. The average score was 12.89 correct answers out of a possible 20 (64.45%). CONCLUSION: This study highlights the need to develop the knowledge and competence of care home managers in relation to palliative care. This is particularly important given the increasing number of people who are living with non-malignant disease within a care home setting.",*Clinical Competence;Humans;Northern Ireland;*Nursing Homes;*Palliative Care;Care home managers;Care homes;Non-malignant disease;Nursing homes;Older people;Palliative care,"Mitchell, G.;McGreevy, J.;Preshaw, D. H.;Agnelli, J.;Diamond, M.",2016,May,10.12968/ijpn.2016.22.5.230,0,
3018,The authors reply,,acute heart infarction;breast cancer;chronic obstructive lung disease;comorbidity;congestive heart failure;dementia;health care policy;health education;hospitalization;letter;metastasis;mortality;neoplasm;parenteral nutrition;patient care;patient referral;priority journal;resuscitation;terminal disease;feeding apparatus,"Mitchell, S. L.;Hamel, M. B.",2010,,,0,
3019,The advanced dementia prognostic tool: a risk score to estimate survival in nursing home residents with advanced dementia,"CONTEXT: Estimating life expectancy is challenging in advanced dementia. OBJECTIVES: To create a risk score to estimate survival in nursing home (NH) residents with advanced dementia. METHODS: This was a retrospective cohort study performed in the setting of all licensed U.S. NHs. Residents with advanced dementia living in U.S. NHs in 2002 were identified using Minimum Data Set (MDS) assessments. Mortality data from Medicare files were used to determine 12-month survival. Independent variables were selected from the MDS. Cox proportional hazards regression was used to model survival. The accuracy of the final model was assessed using the area under the receiver operating characteristic curve (AUROC). To develop a risk score, points were assigned to variables in the final model based on parameter estimates. Residents meeting hospice eligibility guidelines for dementia, based on MDS data, were identified. The AUROC assessed the accuracy of hospice guidelines to predict six-month survival. RESULTS: Over 12 months, 40.6% of residents with advanced dementia (n=22,405) died. Twelve variables best predicted survival: length of stay, age, male, dyspnea, pressure ulcers, total functional dependence, bedfast, insufficient intake, bowel incontinence, body mass index, weight loss, and congestive heart failure. The AUROC for the final model was 0.68. The risk score ranged from 1 to 32.5 points (higher scores indicate worse survival). Only 15.9% of residents met hospice eligibility guidelines for which the AUROC predicting six-month survival was 0.53. CONCLUSION: A mortality risk score derived from MDS data predicted six-month survival in advanced dementia with moderate accuracy. The predictive ability of hospice guidelines, simulated with MDS data, was poor.",Dementia/*mortality;Female;Hospice Care;Humans;*Life Expectancy;Male;Nursing Homes;Predictive Value of Tests;Prognosis;Proportional Hazards Models;ROC Curve;Retrospective Studies;Risk;Severity of Illness Index;United States,"Mitchell, S. L.;Miller, S. C.;Teno, J. M.;Davis, R. B.;Shaffer, M. L.",2010,Nov,10.1016/j.jpainsymman.2010.02.014,0,
3020,Elvis is back: Musical hallucinations in a parkinson disease patient,"Hallucinations are common among patients with Parkinson disease (PD). Hallucinations, typically transitory and occurring at night, are classically visual and occur in 30% of treated patients; auditory hallucinations are rare. A musical hallucination (MH) is a rare type of complex auditory hallucination reported in only six PD patients so far. To the best of our knowledge, we present the first reported case of a patient with Parkinson disease who experienced auditory and visual MH. Copyright © 2010 by The Southern Medical Association.",amantadine;carbidopa plus levodopa;clonazepam;entacapone;pramipexole;adult;article;atrophy;auditory hallucination;case report;clinical examination;disease course;dyskinesia;heart left ventricle hypertrophy;human;male;Mini Mental State Examination;musical hallucination;nuclear magnetic resonance imaging;Parkinson disease;visual hallucination,"Mittal, M.;Giron, L. T.",2010,,,0,
3021,"A 63-year-old man with dementia, ataxia and VI nerve palsy 3",,abducens nerve paralysis;adult;ataxia;B cell lymphoma;brain atrophy;cardiopulmonary insufficiency;case report;cause of death;cognitive defect;computer assisted tomography;dementia;DNA extraction;histopathology;human;letter;male;metastasis;nausea;nuclear magnetic resonance imaging;polymerase chain reaction;sella turcica tumor;faintness;visual impairment;vomiting,"Mittelbronn, M.;Kröber, S. M.;Wersebe, A.;Weller, M.;Hewer, W.;Meyermann, R.;Kaiserling, E.;Beschorner, R.",2007,,,0,
3022,"Prevalence, predictors and prognosis of patients with heart failure requiring nursing care","BACKGROUND: Although the need for nursing care (NC) in heart failure (HF) patients is recognized, detailed information on the current status in Japan is lacking. METHODS AND RESULTS: In the CHART-2 Study, we obtained information on daily life, physical ability, nutrition and mental status for 4,174 patients (mean age, 67.1+/-10.8 years; 73.3% male) out of 10,219 patients. We examined the prevalence, baseline characteristics and clinical outcomes of stage B and C/D HF patients requiring NC. The prevalence of HF requiring NC was significantly higher in stage C/D (38.6%) than in stage B (30.4%; P<0.001). Among the reasons for requiring NC, physical dysfunction was most prevalent in both stage B (20.6%) and C/D (29.0%). Compared with the non-NC group, the NC group was characterized by higher age, higher prevalence of female gender and cerebrovascular disease, and increased plasma brain natriuretic peptide regardless of HF stage. During a median follow-up of 12.7 months after the survey, the NC group had a significantly higher mortality compared with the non-NC group (9.6% vs. 3.6%, P<0.001). On multivariate logistic analysis depressive mental status (hazard ratio [HR], 3.61; P<0.001) and dementia (HR, 2.70; P<0.001) were significantly associated with NC need. CONCLUSIONS: In HF patients, NC need is considerably high and is associated with increased mortality regardless of HF stage in Japan.","Activities of Daily Living;Age Factors;Aged;Aged, 80 and over;Disease-Free Survival;Female;Follow-Up Studies;Heart Failure/*mortality/*nursing;Humans;Japan/epidemiology;Male;Middle Aged;Natriuretic Peptide, Brain;Nursing Care;Prevalence;Sex Factors;Survival Rate","Miura, M.;Sakata, Y.;Nochioka, K.;Takada, T.;Tadaki, S.;Ushigome, R.;Yamauchi, T.;Takahashi, J.;Miyata, S.;Shiba, N.;Shimokawa, H.",2014,,,0,
3023,Dialysis patients' preferences regarding cardiopulmonary resuscitation and withdrawal of dialysis in Japan,"The aim of this study is to show the preferences of Japanese dialysis patients for receiving cardiopulmonary resuscitation (CPR) in their current health status, if they were severely demented, or if they had terminal cancer and to determine their desires about continuing dialysis if they were severely demented or had terminal cancer. A questionnaire survey including the three scenarios was administered to 450 dialysis patients in 15 hospitals in Japan. Three hundred ninety-eight patients completed the questionnaires for a response rate of 88%. The majority of responding patients were men and were undergoing hemodialysis. Only 5% of the patients had discussed their preferences regarding CPR with their physicians, and 29%, with their family members. Forty-two percent of the patients answered that they would want to receive CPR if they experienced cardiopulmonary arrest in their current health status, and 12% answered in the affirmative if they were seriously demented or had terminal cancer. Eighteen percent of the patients would want to continue dialysis if they were demented, and 45%, if they had terminal cancer. Statistical analysis showed that more patients who were working tended to want to continue dialysis if they had terminal cancer than those who were not (53% versus 37%; P < 0.014). Patients' age and preferences did not statistically correlate. Preferences of Japanese dialysis patients for CPR and dialysis vary according to differences in health status, and only a minority would want to receive CPR for cardiopulmonary arrest even in their current health status. © 2001 by the National Kidney Foundation, Inc.",adult;aged;article;neoplasm;cardiopulmonary arrest;dementia;female;hemodialysis;hemodialysis patient;human;Japan;major clinical study;male;questionnaire;resuscitation;statistical analysis;terminal disease;work capacity,"Miura, Y.;Asai, A.;Nagata, S.;Ohnishi, M.;Shimbo, T.;Hosoya, T.;Fukuhara, S.",2001,,,0,
3024,Clinical study of scabies during the past five years in Nishifukuoka Hospital,"We experienced a total of 25 cases (male:female = 8:17) of scabies from June 2003 to September 2007 at Nishifukuoka Hospital and studied the clinical features in these patients. The mean age was 81.7 years. There were 6 patients with diabetes and hypertention, 7 patients with dementia, 5 patients with cerebral infarction, and 3 patients with cancer and myocardial infarction as past illnesses. The scabies rashes varied from involving one part of the body to the whole body. Scabies was significantly more prevalent in winter compared to summer. Mites were found more frequently in the toes and axilla. We suggest that 8 patients contracted scabies in a hospital, 8 patients in a nursing home, 2 patients at home, and 1 patient from a friend. We treated the patients with ivermectin or crotamiton ointment and benzoyl benzoate lotion. We did not observe any side effects of the ivermectin. One patient relapsed one and a half months after the end of treatment Elderly patients with xerotic dermatitis or tinea unguium should be examined with a suspicion of scabies.",antiparasitic agent;benzoyl benzoate;crotamiton;ivermectin;unclassified drug;absence of side effects;article;cancer patient;clinical article;clinical feature;comorbidity;female;human;Japan;male;prevalence;relapse;scabies,"Miyachi, M.;Kubota, Y.;Matsuo, M.;Tanigawa, O.;Nakayama, J.;Ando, K.",2009,,,0,
3025,"Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke","One-third of patients with acute ischemic stroke develop early neurologic worsening, which is associated with increased mortality and long-term functional disability. We investigated the predictive factors for neurologic deterioration in patients with acute ischemic stroke within 1 week of onset. We retrospectively investigated 643 patients who were admitted within 2 days of acute ischemic stroke between April 2007 and March 2010. Neurologic deterioration was defined as an increase of 4 points or more in the National Institutes of Health Stroke Scale (NIHSS) score within 1 week of admission. We retrieved data on demographic and clinical characteristics, medications, and stroke subtypes. Out of 537 patients, deterioration was noted in 64 patients (11.9%; deterioration group). Multivariate analysis identified history of myocardial infarction (P <.001), NIHSS score ≥8 at onset (P <.001), high leukocyte count (P =.035), low-density lipoprotein cholesterol ≥140 mg/dL (P =.002), and hemoglobin A1c ≥7% (P =.006) as significant factors associated with deterioration. Branch atheromatous disease was more frequent in the deterioration group, and >90% of patients with deterioration either were discharged to nursing home care or died. Multivariate analysis of magnetic resonance imaging findings identified internal carotid/middle cerebral artery occlusion (each P <.001), striate capsular infarction (P =.030), pontine infarction (P =.047), and lesion size of 15-30 mm (P =.011) as independent factors associated with deterioration. Stroke patients with a high low-density lipoprotein level, high hemoglobin A1c level on admission, a history of myocardial infarction, and high NIHSS score are at high risk for neurologic deterioration. Patients with multiple risk factors for deterioration can benefit most from intensive monitoring. © 2013 by National Stroke Association.",hemoglobin A1c;high density lipoprotein cholesterol;aged;article;atheromatosis;brain ischemia;disease association;female;heart infarction;hospital admission;human;internal carotid artery occlusion;leukocyte count;major clinical study;male;mental deterioration;middle cerebral artery occlusion;National Institutes of Health Stroke Scale;nuclear magnetic resonance imaging;pons infarction;predictor variable;priority journal;retrospective study;striate capsular infarction,"Miyamoto, N.;Tanaka, Y.;Ueno, Y.;Kawamura, M.;Shimada, Y.;Tanaka, R.;Hattori, N.;Urabe, T.",2013,,,0,
3026,"Safety and pharmacokinetics of PF-04360365 following a single-dose intravenous infusion in Japanese subjects with mild-to-moderate Alzheimer's disease: A multicenter, randomized, double-blind, placebo-controlled, dose-escalation study","Objective: PF-04360365 is a humanized IgG2Δa anti-amyloid β (Aβ) antibody designed to improve outcome in Alzheimer's disease (AD). Single doses of 0.1 - 10 mg/kg were safe and well tolerated in Western (mostly Caucasian) subjects with mild-to-moderate AD. This Phase 1, multicenter, randomized, double-blind, dose-escalation study was the first to evaluate the safety, pharmacokinetics, pharmacodynamics, and immunogenicity of PF-04360365 in Japanese subjects. Materials and methods: 30 subjects with mild-to-moderate AD were enrolled. In each cohort, 3 subjects received PF-04360365 (0.1, 0.5, 1, 5, or 10 mg/kg) and 1 subject received placebo as a single 2-hour intravenous infusion. Subjects were monitored as inpatients for 24 hours and then as outpatients for 1 year. Results: All subjects completed the study. There were no serious or National Cancer Institute Common Terminology Criteria for Adverse Events grade ≥ 3 adverse events, hypersensitivity reactions, or anti-drug antibodies. No clinical or MRI evidence of brain microhemorrhage, cerebral edema, or encephalitis was observed. PF-04360365 plasma concentrations increased with dose, and pharmacokinetics were consistent with a small steady-state volume of distribution, slow clearance, and long elimination half-life. Cerebrospinal fluid (CSF):plasma ratios were < 0.5%. Plasma Aβ species showed dose-dependent increases in Cmax and AUC∞, but CSF biomarkers did not differ clearly between treatment arms. Conclusions: PF-04360365 was safe and well tolerated in Japanese subjects. Pharmacokinetics and plasma pharmacodynamic responses in Japanese subjects were comparable to those in Western subjects. to T-cell-mediated and/or Fc-mediated immune responses [8, 9, 10]. Passive vaccination with bapineuzumab, an investigational monoclonal antibody that recognizes the N-terminus of Aβ and has an IgG1 fixed region, showed some preliminary signs of efficacy, but cerebral vasogenic edema was noted in 10% of subjects in two trials [11, 12]. Solanezumab, another monoclonal antibody, binds to the mid-domain of soluble Aβ and also has an IgG1 fixed region [5]. In a Phase II trial of 6 months, it showed no therapeutic benefit [13]. PF-04360365 (ponezumab) is a humanized IgG2Δa that recognizes amino acids 33-40 of the Aβ40 peptide. It is hypothesized to sequester Aβ in the blood and shift the brain-blood equilibrium towards the periphery, thereby depleting brain Aβ stores (the peripheral sink hypothesis) [5, 6, 14]. PF-04360365 may have potential safety advantages over other monoclonal antibodies being investigated for AD, as IgG2 antibodies generally have less immune effector activity than IgG1 isotypes [15, 16]. Furthermore, PF-04360365 incorporates two amino acid replacements (A330S and P331S) on the Fc region of the antibody that may further reduce immune effector function by minimizing complement activation and antibody-dependent cell-mediated cytotoxicity. PF-04360365 targets the C-terminus of the Aβ peptide and binds to soluble Aβ (not fibrils or plaques). The compound's specificity may explain its reduced potential to induce microglial activation in vivo [17]. PF-04360365 has been shown to be safe and well tolerated after single-dose administration in Western (mostly Caucasian) subjects with mild-to-moderate AD, displaying an approximately linear pharmacokinetic (PK) profile [18, 19]. Here, we report the first study results of PF-04360365 in Japanese subjects with mild-to-moderate AD.",NCT00607308;amyloid beta protein;drug antibody;placebo;ponezumab;adult;aged;allergic reaction;Alzheimer disease;area under the curve;article;brain atrophy;brain edema;brain hemorrhage;clinical article;contact dermatitis;controlled study;volume of distribution;double blind procedure;drug blood level;drug cerebrospinal fluid level;drug clearance;drug dose escalation;drug elimination;drug half life;drug safety;drug tolerability;encephalitis;female;headache;heart muscle ischemia;herpes zoster;human;hyperlipidemia;immunogenicity;Japanese (people);male;maximum plasma concentration;Mini Mental State Examination;multicenter study;neck pain;pharmacodynamics;phase 1 clinical trial;randomized controlled trial;rash;rhinopharyngitis;sialoadenitis;time to maximum plasma concentration;unspecified side effect;upper respiratory tract infection;weight reduction;young adult;pf 04360365,"Miyoshi, I.;Fujimoto, Y.;Yamada, M.;Abe, S.;Zhao, Q.;Cronenberger, C.;Togo, K.;Ishibashi, T.;Bednar, M. M.;Kupiec, J. W.;Binneman, B.",2013,,,0,
3027,Polypharmacy with common diseases in hospitalized elderly patients,"BACKGROUND: Elderly persons are exposed to polypharmacy because of multiple chronic conditions. Many risk factors for polypharmacy have been identified including age, race/ethnicity, sex, educational achievement level, health status, and number of chronic diseases. However, drugs prescribed for individual diseases have not been analyzed. OBJECTIVE: The objective of this study was to analyze each common disease in the elderly with respect to prescribed drugs and polypharmacy. METHODS: A 1-year (January through December 2009) cross-sectional study was performed in which all drugs given to hospitalized elderly patients (age, >65 years) were investigated. Common diseases of the elderly were separated into disease groups including hypertension, hyperlipidemia, gastric ulcer, previous stroke, reflux esophagitis, diabetes mellitus, malignancy, osteoporosis, angina pectoris, congestive heart failure, chronic obstructive pulmonary disease, dementia, and depression. RESULTS: Among 1768 elderly patients, the mean (range) age of study patients was 78 (65 to 100) years. The mean (SD) number of diseases was 7.7 (3.4), and the number of drugs overall was 4.9 (3.6). The number of drugs and prevalence of polypharmacy were hypertension, 5.2 (3.9 [51%]); hyperlipidemia, 5.6 (3.8 [58%]); gastric ulcer, 5.4 (3.8 [53%]); previous stroke, 5.8 (3.2 [61%]); reflux esophagitis, 5.6 (3.8 [40%]), diabetes mellitus, 5.6 (3.1 [54%]); malignancy, 4.1 (3.1 [37%]); osteoporosis, 5.4 (3.4 [45%]); angina pectoris, 5.7 (3.6 [42%]); congestive heart failure, 6.1 (4.0 [60%]); chronic obstructive pulmonary disease, 5.0 (3.5 [53%]); dementia, 5.1 (3.2 [52%]); and depression, 7.0 (4.2 [73%]). CONCLUSIONS: When assessing the risk of polypharmacy, physicians should carefully consider the type of any chronic disease. Elderly patients with multiple diseases may be subjected to further polypharmacy.","Age Factors;Aged;Aged, 80 and over;Chronic Disease;Cross-Sectional Studies;Female;Hospitalization/*statistics & numerical data;Humans;Male;*Polypharmacy;Practice Patterns, Physicians'/*statistics & numerical data;Prescription Drugs/administration & dosage/*therapeutic use;Retrospective Studies","Mizokami, F.;Koide, Y.;Noro, T.;Furuta, K.",2012,Apr,10.1016/j.amjopharm.2012.02.003,0,
3028,BAG3 plays a central role in proteostasis in the heart,"Proteinopathies are characterized by the accumulation of misfolded proteins, which ultimately interfere with normal cell function. While neurological diseases, such as Huntington disease and Alzheimer disease, are well-characterized proteinopathies, cardiac diseases have recently been associated with alterations in proteostasis. In this issue of the JCI, Fang and colleagues demonstrate that mice with cardiac-specific deficiency of the co-chaperone protein BCL2-associated athanogene 3 (BAG3) develop dilated cardiomyopathy that is associated with a destabilization of small HSPs as the result of a disrupted interaction between BAG3 and HSP70. Together, the results of this study suggest that strategies to upregulate BAG3 during cardiac dysfunction may be beneficial.","0 (Adaptor Proteins, Signal Transducing);0 (Apoptosis Regulatory Proteins);0 (HSP70 Heat-Shock Proteins);Adaptor Proteins, Signal Transducing;Animals;Apoptosis Regulatory Proteins;Cardiomyopathy, Dilated;HSP70 Heat-Shock Proteins;Heart;Mice","Mizushima, W.;Sadoshima, J.",2017,Aug 01,,0,
3029,Drugs for blessing and marketing of curse,,angiotensin 2 receptor antagonist;antibiotic agent;atenolol;beta adrenergic receptor blocking agent;calcium channel blocking agent;cholesterol;dipeptidyl carboxypeptidase inhibitor;losartan;timolol;acquired immune deficiency syndrome;Alzheimer disease;cardiovascular disease;clinical trial;death;general practice;genetic manipulation;health statistics;human;hypercholesterolemia;hypertension;infection control;ischemic heart disease;lifestyle;malaria;molecular biology;mortality;pathophysiology;pharmacogenetics;practice guideline;risk factor;short survey;tuberculosis,"Moan, A.;Skattebøl, A.",2006,,,0,
3030,Whipple's disease with monosymptomatic cerebral manifestation in a case of non-small cell lung cancer,"A cancer patient with symptoms of confusion and kachexia would lead one to think primarily of cerebral metastasis. However, the combination of these symptoms can also be caused by other diseases such as chronic inflammatory bowel disease, anorexia, or multisystemic infectious diseases, for example tuberculosis, or Whipple's disease. Whipple's disease is a rare infectious disease, caused by the bacterium Tropheryma whippelii, which was partially sequenced in 1991. In most cases involvement of the gastrointestinal tract is the primary manifestation of the disease followed by involvement of the lymph nodes, joints or heart, but an isolated neurologic presentation is uncommon and has only been sporadically described. A 65-year old man was admitted to the hospital due to confusion and a suspicious pulmonary shadow in his chest X-ray. He had a history of cigarette smoking for 30 years and drank 3 bottles of beer each day before admission. Three weeks prior to admission confusion and progressive apathy occurred. The cerebral computer tomography was normal, apart from a minimal cortical atrophy, and inflammatory markers were slightly elevated. He developed hypotension and tachycardia. While alcohol addiction was suspected he received benzodiazepins, fluid substitution and catecholamins. Despite intensive therapy he died within 48 hours after hospital admission. At autopsy there was no evidence for coronary heart disease or pulmonary embolism. Examination of the brain showed multiple granulomas especially within the basal ganglia's and at the brain trunk. Histological investigation of these areas showed Sieracki, cells, typically for Whipple's disease. In ""atypical"" cases, Whipple's disease is first manifested in the central nervous system, although no intestinal involvement can further complicate the correct diagnosis. Despite being rare, Whipple's disease must be discussed in cases of consumption and symptoms of dementia. © Georg Thieme Verlag KG Stuttgart.",aged;anamnesis;article;brain disease;brain metastasis;case report;clinical feature;human;human tissue;intestine lipodystrophy;non small cell lung cancer;male;symptom;Tropheryma whipplei,"Mock, B. A.;Brodhun, M.;Ohms, M.;Kroegel, C.",2005,,,0,
3031,Masala,,carvedilol;cimetidine;paroxetine;pseudomonic acid;rosiglitazone;cancer prevention;cancer risk;cardiovascular risk;cerebrovascular accident;cognitive defect;colorectal cancer;criminal law;diabetes mellitus;disease classification;drug contamination;drug industry;drug safety;gray matter;heart infarction;human;hypertension;invasive procedure;jurisprudence;kidney failure;kidney transplantation;law suit;lifestyle modification;medical research;mental deterioration;note;obesity;practice guideline;renal replacement therapy;resuscitation;sleep time;tooth extraction;avandia;bactroban;coreg;paxil;tagamet,"Modi, G. K.",2010,,,0,
3032,"Dementia and ""Obesity Paradox"": Is This for Real or Are We Missing Something? An Epidemiologist's Perspective",,Alzheimer disease;body mass;chronic kidney disease;dementia;diabetes mellitus;heart failure;human;letter;mortality;obesity;selection bias;survival;weight reduction,"Moga, D. C.;Abner, E. L.;Brouwer, E. S.",2015,,,0,
3033,Effects of statins on the progression of cerebral white matter lesion : PPost hoc analysis of the ROCAS (Regression of Cerebral Artery Stenosis) study,"Arteriosclerotic related cerebral white matter lesion (WML) is associated with increased risk of death, stroke, dementia, depression, gait disturbance, and urinary incontinence. We investigated the effects of statins on WML progression by performing a post hoc analysis on the ROCAS (Regression of Cerebral Artery Stenosis) study, which is a randomized, double-blind, placebo-controlled study evaluating the effects of statins upon asymptomatic middle cerebral artery stenosis progression among stroke-free individuals. Two hundreds and eight randomized subjects were assigned to either placebo (n = 102) or simvastatin 20 mg daily (n = 106) for 2 years. Baseline severity of WML was graded visually into none, mild, and severe. Volume (cm3) of WML was determined quantitatively at baseline and at end of study using a semi-automated method based on MRI. Primary outcome was the change in WML volume over 2 years. After 2 years of follow-up, there was no significant change in WML volume between the active and the placebo group as a whole. However, stratified analysis showed that for those with severe WML at baseline, the median volume increase in the active group (1.9 cm3) was less compared with that in the placebo group (3.0 cm3; P = 0.047). Linear multivariate regression analysis identified that baseline WML volume (β = 0.63, P < 0.001) and simvastatin treatment (β = -0.214, P = 0.043) independently predicted change in WML volume. Our findings suggest that statins may delay the progression of cerebral WML only among those who already have severe WML at baseline. © 2009 Springer-Verlag.",antihypertensive agent;antithrombocytic agent;hemoglobin A1c;low density lipoprotein cholesterol;oral antidiabetic agent;placebo;simvastatin;triacylglycerol;adult;age;aged;article;brain size;cholesterol blood level;controlled study;diastolic blood pressure;disease course;disease severity;drug effect;female;follow up;hemoglobin blood level;human;ischemic heart disease;leukoaraiosis;major clinical study;male;middle cerebral artery occlusion;nuclear magnetic resonance imaging;post hoc analysis;priority journal;quantitative analysis;cerebrovascular accident;systolic blood pressure;treatment duration;treatment outcome;triacylglycerol blood level;white matter,"Mok, V. C. T.;Lam, W. W. M.;Fan, Y. H.;Wong, A.;Ng, P. W.;Tsoi, T. H.;Yeung, V.;Wong, K. S.",2009,,,0,
3034,Extensive association of common disease variants with regulatory sequence,"Overlap between non-coding DNA regulatory sequences and common variant associations can help to identify specific cell and tissue types that are relevant for particular diseases. In a systematic manner, we analyzed variants from 94 genome-wide association studies (reporting at least 12 loci at p<5×10-8) by projecting them onto 466 epigenetic datasets (characterizing DNase I hypersensitive sites; DHSs) derived from various adult and fetal tissue samples and cell lines including many biological replicates. We were able to confirm many expected associations, such as the involvement of specific immune cell types in immune-related diseases and tissue types in diseases that affect specific organs, for example, inflammatory bowel disease and coronary artery disease. Other notable associations include adrenal glands in coronary artery disease, the immune system in Alzheimer's disease, and the kidney for bone marrow density. The association signals for some GWAS (for example, myopia or age at menarche) did not show a clear pattern with any of the cell or tissue types studied. In general, the identified variants from GWAS tend to be located outside coding regions. Altogether, we have performed an extensive characterization of GWAS signals in relation to cell and tissue-specific DHSs, demonstrating a key role for regulatory mechanisms in common diseases and complex traits.",adult;Alzheimer disease;article;bone marrow;controlled study;coronary artery disease;epigenetics;fetus;genetic association;genetic variability;human;human cell;human tissue;immunocompetent cell;inflammatory bowel disease;kidney;limit of detection;limit of quantitation;myopia;regulatory RNA sequence;reliability;reproducibility;single nucleotide polymorphism,"Mokry, M.;Harakalova, M.;Asselbergs, F. W.;De Bakker, P. I. W.;Nieuwenhuis, E. E. S.",2016,,10.1371/journal.pone.0165893,0,
3035,New frontiers in palliative care,"Palliative care is an interdisciplinary approach provided to patients and their families when the medical expectation of recovery is negligible. Palliative care does not focus on a single disease. However, it takes into account the integrity of the human being, allowing the patient to improve his or her quality of life and relief from the suffering imposed by adverse medical conditions. The increasing need for a comprehensive approach in health care for patients and families suffering from cancer and noncancer chronic degenerative diseases makes palliative care an indispensable resource in today's society. The current demographic changes and the increased incidence of cancer and chronic diseases is consolidating the practice of palliative care and expanding its frontiers to face new research challenges in areas such as palliative care in children and nonmalignant diseases, public health policy, education in palliative care, and euthanasia. © 2013 Elsevier Inc.",acquired immune deficiency syndrome;advanced cancer;Alzheimer disease;amyotrophic lateral sclerosis;article;cancer incidence;caregiver support;cerebrovascular accident;child care;chronic disease;chronic liver disease;chronic obstructive lung disease;clinical decision making;congestive heart failure;cost effectiveness analysis;ethnic group;euthanasia;evidence based medicine;follow up;health care policy;health care system;human;interpersonal communication;kidney failure;medical education;multiple sclerosis;palliative therapy;primary medical care;public health;quality of life;randomized controlled trial (topic);social psychology;social stress;survival time;terminally ill patient,"Molina Giraldo, S. M.",2013,,,0,
3036,PREDICTing Mortality in the Emergency Department: External Validation and Derivation of a Clinical Prediction Tool,"Background: The Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at 1 year to select those who would benefit from advanced care planning. Such goals-of-care discussion can improve patients’ ability to communicate what they want out of their healthcare and, in cases of end of life, potentially reduce the number of futile interventions. Using a cutoff of 13 points, PREDICT had a reported 95.3% specificity and 53.9% sensitivity for 1-year mortality. We externally validated PREDICT and derived a simpler modified PREDICT tool to systematically identify high-risk patients eligible for goals-of-care discussions and palliative care consultation in the ED. Methods: This was an observational cohort study of a random sample of 927 patients aged 55+ seen in the ED in 2014. We identified advance healthcare directives (AHDs) on file. We summarized diagnostic accuracy of the clinical tool to predict 1-year mortality using sensitivity, specificity, and area under the curve (AUC). We refined PREDICT using multivariable modeling. We followed reporting guidelines including STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) for cohort studies and Standards for Reporting of Diagnostic Accuracy (STARD). Results: A total of 927 patients were included: 55.0% were male, 63 (7.0%) were nursing home residents, 389 (42.0%) patients had an AHD in their medical record at the time of ED visit, and 245 (26.4%) were deceased at 1 year. Of the 780 patients with PREDICT scores < 13, a total of 164 (21.0%; 95% confidence interval [CI] = 18.3–24.1) were deceased at 1 year, and of the 147 patients with PREDICT scores ≥ 13, a total of 81 (55.1%; 95% CI = 46.7–63.2) were deceased at 1 year. The AUC of the PREDICT score was 0.717 (95% CI = 0.680–0.754), sensitivity was 33.1% (95% CI = 27.3–39.4), and specificity was 90.3% (95% CI = 87.8–92.4) to predict 1-year mortality. The modified PREDICT tool resulted in an AUC of 0.709 (95% CI = 0.671–0.747). We decided to select this model as the preferred model, as the variable of intensive care unit (ICU) admission with multiorgan failure can be difficult to assess in the ED and may delay advanced care planning. Reweighting the score did not improve fit or the AUC, so points assigned to each variable were not adjusted. Conclusion: PREDICT is an easy tool to administer to be able to identify patients who are at high risk of 1-year mortality and who could benefit from AHDs, goals-of-care discussion, and when appropriate in the context of an end-of-life setting, palliative medicine consultation. External validation of PREDICT was successful in our population. We simplified PREDICT and derived a new tool, the modified PREDICT minus ICU tool, without significantly altering the sensitivity, specificity, and AUC for death at 1 year. The next steps include external validation of the newly derived rule and prospective implementation.",adult;advance care planning;aged;article;assisted living facility;cerebrovascular accident;chronic obstructive lung disease;cohort analysis;congestive heart failure;consultation;coronary artery disease;dementia;diabetes mellitus;diagnostic accuracy;emergency ward;female;follow up;heart infarction;high risk patient;hospital admission;hospitalization;human;intensive care unit;living will;major clinical study;male;malignant neoplasm;mortality risk;multiple organ failure;nursing home;nursing home patient;observational study;palliative therapy;patient referral;practice guideline;prediction;priority journal;retrospective study;risk assessment;sensitivity and specificity;United States,"Moman, R. N.;Loprinzi Brauer, C. E.;Kelsey, K. M.;Havyer, R. D.;Lohse, C. M.;Bellolio, M. F.",2017,,10.1111/acem.13197,0,
3037,The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients,"PURPOSE: To examine the relative impact of 16 common chronic conditions and increasing morbidity on health-related quality of life (HRQL) in a population-based sample of home care clients in Ontario, Canada. METHODS: Participants were adult clients assessed with the Resident Assessment Instrument for Home Care (RAI-HC) between January and June 2009 and diagnosed with one (or more) of 16 common chronic conditions. HRQL was evaluated using the Minimum Data Set-Health Status Index (MDS-HSI), a preference-based measure derived from items captured in the RAI-HC. Multivariable linear regression models assessed the relative impact of each condition, and increasing number of diagnoses, on MDS-HSI scores. RESULTS: Mean (SD) MDS-HSI score in the study population (n = 106,159) was 0.524 (0.213). Multivariable analysis revealed a statistically significant (p < 0.05) and clinically important (difference >/= 0.03) decrease in MDS-HSI scores associated with stroke (-0.056), osteoarthritis (-0.036), rheumatoid arthritis (-0.033) and congestive heart failure (CHF, -0.030). Differences by age and sex were observed; most notably, the negative impact associated with dementia was greater among men (-0.043) than among women (-0.019). Further, HRQL decreased incrementally with additional diagnoses. In all models, chronic conditions and number of diagnoses accounted for a relatively small proportion of the variance observed in MDS-HSI. CONCLUSION: Clinically important negative effects on HRQL were observed for clients with a previous diagnosis of stroke, osteo- and rheumatoid arthritis, or CHF, as well as with increasing levels of multimorbidity. Findings provide baseline preference-based HRQL scores for home care clients with different diagnoses and may be useful for identifying, targeting and evaluating care strategies toward populations with significant HRQL impairments.",Chronic disease;Health status;Home care services;Ontario/epidemiology;Quality of life,"Mondor, L.;Maxwell, C. J.;Bronskill, S. E.;Gruneir, A.;Wodchis, W. P.",2016,Oct,10.1007/s11136-016-1281-y,0,
3038,Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomized trials,"Background: Previous research have consistently reported Mediterranean diet to be associated with a reduced risk of chronic diseases. Several meta-analyses on this issue have been published so far. However, some inconsistencies still remain. Purpose: To summarize the evidence and evaluate the strength of validity of the association between adherence to Mediterranean diet and multiple health outcomes. Methods: We conducted an umbrella review of meta-analyses of observational studies (cohort, cross-sectional, and case-control design) and randomized controlled trials (RCTs) that examined the association between adherence to Mediterranean diet and multiple health outcomes. For each association, we estimated the summary effect size by random-effects and fixed-effects models, the 95% confidence interval, and the 95% prediction interval. We also assessed the between-study heterogeneity and evidence for small-study effects. We further applied standardized methodological criteria to evaluate the epidemiological credibility of the statistically significant associations. Results: Twelve meta-analyses of observational studies and 14 meta-analyses of RCTs investigating the association between adherence to Mediterranean diet and 32 different health outcomes, for a total population of over than 12,700,000 subjects, were selected. A robust evidence, identified by a p value <0.001, a large simple size, and not a considerable heterogeneity between studies, for a greater adherence to Mediterranean diet and a reduced the risk of overall mortality, cardiovascular diseases, coronary heart disease, myocardial infarction, overall cancer, neurodegenerative disease, dementia and diabetes was found. For most of the site-specific cancers, as well as for inflammatory and metabolic parameters, the evidence was only suggestive or weak. Conversely, no significant evidence was reported for bladder, endometrial and ovarian cancers, as well as for LDL-cholesterol levels. Conclusions: The present umbrella review of meta-analyses investigating the possible association between adherence to Mediterranean diet and clinical outcomes reported a robust evidence for the beneficial role of Mediterranean diet versus some relevant clinical outcomes such as overall mortality, cardiovascular disease, cancer, neurodegenerative disease and diabetes.",bladder cancer;cancer epidemiology;cancer size;cancer susceptibility;clinical outcome;confidence interval;controlled clinical trial;controlled study;degenerative disease;dementia;diabetes mellitus;effect size;endometrium cancer;female;heart infarction;human;male;Mediterranean diet;meta analysis;metabolic parameters;mortality;observational study;ovary cancer;population based case control study;prediction;randomized controlled trial;statistical significance;validity;low density lipoprotein cholesterol,"Monica, Dinu M;Pagliai, G;Casini, A;Sofi, F",2017,,,0,
3039,Signs of Coronary Involvement in Arteriopathic Psychoses,,"*Coronary Disease;*Dementia;*Electrocardiography;*Geriatrics;*Intracranial Arteriosclerosis;*Psychotic Disorders;*Cerebral arteriosclerosis;*Psychoses, senile","Montebelli, M. L.",1964,,,0,
3040,Deep brain stimulation of the subthalamic nucleus in advanced Parkinson's disease: five year follow-up at a Portuguese center,"INTRODUCTION: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) is safe and effective. Most series report stable long-term motor responses. AIM: To report the long-term outcome of STN-DBS in advanced stage PD patients at a Portuguese center. PATIENTS AND METHODS: Motor status was evaluated before surgery ('off' medication and best 'on'), post-operatively, and at five years ('on' medication and stimulation) using UPDRS part III. Axial symptoms subscores were quantified. Disability was assessed with the modified Rankin Scale (mRS). Development of dementia was assessed at 6 months and five years post-DBS. RESULTS: Of the 183 patients submitted to STN-DBS, 71 had completed 5 years of follow-up. Ten patients were not included: two died (cancer, myocardial infarction), five were lost to follow-up and three had their stimulation systems removed. Motor function improved by 78% and 66% postoperatively and at five years, respectively. There was improvement of axial symptoms postoperatively, with significant worsening at five years (p<0.001). mRS scores improved postoperatively, but declined at five years, although most patients (88.5%) remained ambulatory (mRS<4). One patient (1.6%) and 19 patients (31,2%) were demented at 6 months and 5 years, respectively. Patients who developed dementia were significantly older than non-demented patients (56.5+/-7.8 vs 63.7+/-5.9 years-old; p<0.001). CONCLUSIONS: In this series STN-DBS proved its efficacy regarding motor symptom improvement even five years after the procedure. Deterioration of axial symptoms and disability, as well as new onset dementia were observed in this period, but the possible role of STN-DBS as a causative factor is yet to be defined. Publisher: TITLE: Estimulacion cerebral profunda del nucleo subtalamico en la enfermedad de Parkinson avanzada: seguimiento de cinco anos en un centro portugues. Introduccion. La estimulacion cerebral profunda (ECP) del nucleo subtalamico (NST) en la enfermedad de Parkinson (EP) es segura y eficaz: en la mayoria de series se describen respuestas motoras duraderas y estables. Objetivo. Informar sobre el desenlace a largo plazo de la ECP del NST en pacientes con EP avanzada atendidos en un centro hospitalario portugues. Pacientes y metodos. El estado motor se valoro con la escala unificada de valoracion de la enfermedad de Parkinson, parte III, antes de la intervencion quirurgica -en dos situaciones: sin efecto de la medicacion (off) y bajo el mejor efecto (on)-, en el postoperatorio y al cabo de cinco anos (medicacion y estimulacion en on). Se cuantificaron las puntuaciones de cada sintoma axial. La incapacidad se evaluo con la escala de Rankin modificada (mRS). La aparicion de demencia se valoro seis meses y cinco anos despues de la ECP. Resultados. Setenta y uno de los 183 pacientes sometidos a la ECP del NST concluyeron los cinco anos de seguimiento. Diez de ellos quedaron excluidos: dos por fallecimiento (cancer e infarto de miocardio), cinco por perdida de seguimiento y tres por la retirada del sistema de estimulacion. La funcion motora manifesto una mejora del 78% en el postoperatorio y del 66% a los cinco anos. En el postoperatorio se aprecio mejoria de los sintomas axiales, pero al cabo de los cinco anos habian empeorado de manera significativa (p < 0,001). Las puntuaciones de la mRS tambien mejoraron en el postoperatorio, pero a los cinco anos tambien habian disminuido, pese a que la mayoria (88,5%) conservaba la capacidad ambulatoria (mRS < 4). Un paciente (1,6%) manifesto demencia a los seis meses, mientras que otros 19 (31,2%) la manifestaron al cabo de los cinco anos. La edad de los pacientes dementes era notablemente mayor (56,5 +/- 7,8 frente a 63,7 +/- 5,9 anos; p < 0,001). Conclusiones. En esta serie de casos, la ECP del NST demostro su eficacia en la mejora de los sintomas motores, aunque habian transcurrido cinco anos desde la implantacion. En ese periodo hubo un deterioro de los sintomas axiales y de la incapacidad, y surgieron casos de demencia, pero el posible papel de la ECP del NST como factor causal resta pendiente de concretar. Spa",Activities of Daily Living;Adult;Aged;*Deep Brain Stimulation;Dementia/etiology;Disability Evaluation;Disease Progression;Female;Follow-Up Studies;Humans;Male;Middle Aged;Mobility Limitation;Parkinson Disease/physiopathology/psychology/*therapy;Portugal;Severity of Illness Index;Subthalamic Nucleus/*physiopathology;Treatment Outcome,"Monteiro, A.;Andrade, C.;Rosas, M. J.;Linhares, P.;Massano, J.;Vaz, R.;Garrett, C.",2014,May 16,,0,
3041,"Migraine, white matter hyperintensities, and subclinical brain infarction in a diverse community: The northern manhattan study","Background and Purpose: Migraine with aura is a risk factor for ischemic stroke. The goals of this study are to examine the association between migraine and subclinical cerebrovascular damage in a race/ethnically diverse older population-based cohort study. METHODS-: In the Northern Manhattan Study (NOMAS), we quantified subclinical brain infarctions and white matter hyperintensity volumes among participants with self-reported migraine, confirmed by the International Classification of Headache Disorders-2 criteria. RESULTS-: Of 546 study participants with imaging and migraine data (41% men; mean age at MRI, 71±8 years; mostly Hispanic [65%]), those reporting migraine overall had double the odds of subclinical brain infarction (adjusted odds ratio, 2.1; 95% confidence interval, 1.0-4.2) when compared with those reporting no migraine, after adjusting for sociodemographics and vascular risk factors. No association was observed between migraine with or without aura and white matter hyperintensity volume. CONCLUSIONS-: Migraine may be a risk factor for subclinical brain infarction. Prospective studies are needed in race/ethnically diverse populations. © 2014 American Heart Association, Inc.",adult;aged;article;brain infarction;brain region;cardiovascular risk;community care;disease association;disease classification;ethnic group;female;human;international classification of headache disorder 2;major clinical study;male;migraine;migraine aura;nervous system parameters;neuroimaging;population risk;priority journal;risk assessment;risk factor;self report;white matter,"Monteith, T.;Gardener, H.;Rundek, T.;Dong, C.;Yoshita, M.;Elkind, M. S. V.;Decarli, C.;Sacco, R. L.;Wright, C. B.",2014,,,0,
3042,"Do-not-resuscitation orders: When, why and how can they be done?","The main goal of medical treatment is to benefit patients by restoring or maintaining their health. Nevertheless, prolonging life at all costs is not acceptable. Cardiopulmonary resuscitation (CPR) should not be started in all cardiac arrest case, but rather if it is indicated. The competent patient, by means of a valid informed consent, is entitled to accept or refuse any diagnostic or therapeutic procedure (except for that required by law), including CPR in case of a cardiac arrest (CA). Deliberation on CPR should be started with the patient if he or she has a high likelihood of suffering CA, within a process of advanced care planning. This is done ideally in an out-patient setting and mainly when the patient suffers a chronic illness or a potentially fatal severe condition. Other guidelines recommend starting CPR discussions with all adults admitted to hospital. Some neurological diseases in which it is recommended are end-stage dementia, progressive degenerative diseases and serious brain lesions. If the patient or his legal surrogate does not accept CPR, a do-not-attempt resuscitation order (DNAR) should be entered in his/her medical record. The DNAR order validity is based on following hospital or institutional rules. The DNAR order should be reviewed under special circumstances.",article;brain damage;chronic disease;degenerative disease;heart arrest;human;informed consent;neurologic disease;outpatient;patient autonomy;patient right;resuscitation;terminal care;treatment refusal,"Monzón, J. L.;Saralegui, I.",2005,,,0,
3043,Use of cholinesterase inhibitors and bradycardia risk,,beta adrenergic receptor blocking agent;cholinesterase inhibitor;donepezil;galantamine;rivastigmine;aged;Alzheimer disease;bradycardia;cohort analysis;controlled study;female;heart failure;heart infarction;high risk population;human;hypertension;major clinical study;male;note;risk assessment;risk factor;aricept;exelon;razadyne,"Moon, K. T.",2010,,,0,
3044,Acute cor pulmonale due to pulmonary tumor thrombotic microangiopathy in two patients with breast cancer,,brain natriuretic peptide;carboplatin;cisplatin;cyclophosphamide;D dimer;docetaxel;doxorubicin;fibrinogen;gemcitabine;lactate dehydrogenase;troponin I;vinorelbine tartrate;acute cor pulmonale;adult;anisopoikilocytosis;arterial gas;blood gas analysis;blood smear;breast cancer;breast carcinoma;cancer adjuvant therapy;cancer radiotherapy;cancer recurrence;case report;cerebral sinus thrombosis;cor pulmonale;crackle;deep vein thrombosis;disseminated intravascular clotting;dyspnea;female;heart right ventricle failure;heart right ventricle hypertrophy;hematologic disease;hemolytic anemia;human;hyperglycemia;hypoxemia;hypoxia;ketonuria;letter;lung auscultation;lung cancer;lung embolism;lung metastasis;mental deterioration;metabolic acidosis;metabolic encephalopathy;metastatic breast cancer;middle aged;multiple cycle treatment;nuclear magnetic resonance imaging;oxygen therapy;partial thromboplastin time;protein blood level;prothrombin time;pulmonary hypertension;pulmonary tumor thrombotic microangiopathy;thorax radiography;thrombotic thrombocytopenic purpura;transthoracic echocardiography;tricuspid valve regurgitation;triple negative breast cancer;wheezing;x-ray computed tomography,"Moon, S. Y.;Lee, K. H.;Lee, J. S.;Yang, H. S.;Lee, H. G.;Cho, Y. H.;Yoon, S. Y.",2017,,10.3904/kjim.2015.107,0,
3045,Age and sex variation in prevalence of chronic medical conditions in older residents of U.S. nursing homes,"OBJECTIVES: To investigate patterns in prevalences of chronic medical conditions over the age span of long-term stay nursing home residents and between the sexes with data from the 2004 National Nursing Home Survey (NNHS). DESIGN: Retrospective, cross-sectional study. SETTING: U.S. nursing homes. PARTICIPANTS: Nationally representative sample comprising 11,788 long-term stay residents (3,003 (25%) men, 8,785 (75%) women) aged 65 and older. MEASUREMENTS: Clinical Classifications Software was used to group International Classification of Diseases, Ninth Revision, codes to identify the 20 most-prevalent chronic medical conditions. SAS survey procedures were used to account for design effects of stratification and clustering to generate nationally representative estimates of prevalences of medical conditions. RESULTS: Average age was 84, with women older than men (85 vs 81, P = .02) and 67% of women aged 80 to 95. Women required more assistance with activities of daily living. The most frequent chronic medical conditions were hypertension (men 53%, women 56%), dementia (men 45%, women 52%), depression (men 31%, women 37%), arthritis (men 26%, women 35%), diabetes mellitus (men 26%, women 23%), gastroesophageal reflux disease (GERD) (men 23%, women 23%), atherosclerosis (men 24%, women 20%), congestive heart failure (CHF) (men 18%, women 21%), cerebrovascular disease (CVD) (men 24%, women 19%), and anemia (men 17%, women 20%). Sex differences in prevalences existed for all but constipation, GERD, and hypertension. Diabetes mellitus, CVD, and lipid disorders decreased with age in men and women. Atrial fibrillation, anemia, arthritis, CHF, dementia, and thyroid disease increased with age in men and women. Age-related patterns differed between the sexes for diabetes mellitus, hypertension, and Parkinson's disease. CONCLUSION: The profile of chronic medical conditions varies over the age span of nursing home residents and differs between men and women. This knowledge should guide educational and care efforts in long-term care.","Activities of Daily Living;Age Distribution;Aged;Aged, 80 and over;Chronic Disease/*epidemiology;Cross-Sectional Studies;Female;Geriatric Assessment/*methods;Humans;Long-Term Care;Male;Nursing Homes/*statistics & numerical data;Prevalence;Retrospective Studies;Risk Factors;Sex Distribution;United States/epidemiology","Moore, K. L.;Boscardin, W. J.;Steinman, M. A.;Schwartz, J. B.",2012,Apr,10.1111/j.1532-5415.2012.03909.x,0,
3046,Patterns of chronic co-morbid medical conditions in older residents of U.S. nursing homes: differences between the sexes and across the agespan,"OBJECTIVE: There are limited data on combinations of co-morbid conditions to guide efforts to improve therapeutic strategies in patients with multiple co-morbid conditions. To some extent, this may be due to limited data on combinations of co-morbid conditions in patient groups. Our goal was to determine the most common co-morbid medical conditions in older residents of U.S. nursing homes and identify sex differences in prevalences and changes across the agespan of nursing residents. DESIGN: Cross sectional analysis of National Nursing Home Survey (NNHS)--a nationally representative sample with comprehensive medical data on nursing home residents. SETTING: 1174 Nursing homes. PARTICIPANTS: Long term stay residents of U.S. Nursing Homes aged 65 years and older (11,734 :8745 women, 2989 men). MEASUREMENTS: Determination of the prevalences of the most frequent two and three disease combinations identified using Clinical Classifications Software (CCS) for ICD-9-CM and a composite vascular disease diagnosis (atherosclerosis and/or coronary artery disease, and/or peripheral arterial disease, and/or cerebrovascular disease or stroke) from the most recent and only NNHS survey with comprehensive medical diagnosis information. RESULTS: Frequent 2-disease combinations were: hypertension (HTN) + dementia (DEM) in 27%, HTN + any Vascular (Vasc) disease (26%), HTN + depression(DEP) 21%, HTN + arthritis(ARTH) 20%, DEM + Vasc (21%), DEM+Depression 19%, Arthritis + DEM 17%, DEP + Vasc (16%), ARTH + Vasc (15%), followed by HTN + GERD (14%) and ARTH + DEP (14%). Frequent 3-disease combinations: HTN +VASC+ DEP in 13%, HTN +DEM +DEP (11%), and HTN+Arthritis+DEM (10%). HTN was in 80% of the top 3-disease combinations, Vasc in 50%, HTN+VASC in 35%, DEM or DEP in 40%, ARTH in 25% and GERD in 20%. Combinations with anemia, arthritis, dementia, heart failure, osteroporosis, thyroid disease were higher in women, COPD combinations higher in men. As age increased, dementia, depression, arthritis, and anemia with hypertension were common co-morbid combinations, diabetes and heart failure were not. CONCLUSIONS: Hypertension, vascular disease, dementia, arthritis, depression, and gastro-esophageal reflux disease were part of the most prevalent co-morbid conditions. Multimorbidity patterns can be identified in nursing home residents and vary with age and by sex.","Age Distribution;Aged;Aged, 80 and over;Arthritis/epidemiology;Chronic Disease/*epidemiology;*Comorbidity;Cross-Sectional Studies;Dementia/epidemiology;Depression/epidemiology;Female;Gastroesophageal Reflux/epidemiology;Geriatric Assessment;*Health Surveys;Humans;Hypertension/epidemiology;Male;*Nursing Homes;Prevalence;Sex Distribution;United States/epidemiology;Vascular Diseases/epidemiology","Moore, K. L.;Boscardin, W. J.;Steinman, M. A.;Schwartz, J. B.",2014,Apr,10.1007/s12603-014-0001-y,0,
3047,Aging phenotype and its relationship with IGF-I gene promoter polymorphisms in elderly people living in Catalonia,"Genetic variations in the Insulin/IGF-I genes pathway have been related to longevity, dementia, metabolic diseases and cancer. The purpose of the present study was to investigate the 192. bp allele of IGF-I gene promoter and its relationship with metabolic syndrome (MS) components, mental and nutritional state, muscle strength and functional capacity in an aged Spanish population. Design: Population-based study (Mataró Ageing Study), including 292 subjects (144 men and 148 women, mean age 77.0 ± 5.4). Anthropometric variables, lipid profile, glucose and blood pressure (BP) were measured; mental state (MMSE), nutritional state (MNA) and Barthel scale were performed, and were correlated to the presence of the 192. bp allele of IGF-1 gene promoter polymorphisms. Results: MS (ATP-III criteria) was found in 49.5% (41.4% in men and 57.6% in women). The 192. bp allele of IGF-I gene promoter was distributed as: 41.9% homozygous, 44.3% heterozygous and 13.9% were non-carriers of this allele. A lower prevalence of metabolic syndrome was observed in homozygous (41.9% vs 54.9% in heterozygous. +. non-carriers, p=. 0.031). Mental state (MMSE), nutritional state (MNA) and Barthel scale were better in homozygous individuals compared to heterozygous and non-carriers (p=. 0.015, p=. 0.026 and 0.047, respectively). In men, MNA was better in homozygous with no differences in MMSE and Barthel scales. In homozygous women, BP was lower (p=. 0.009) and Barthel scale was better (p=. 0.05) with no differences in MMSE and MNA. Conclusion: Homozygosity for the 192. bp allele of the IGF-I gene polymorphism suggests a healthier aging condition, with less prevalence of cardiometabolic disturbances, and better mental, nutritional and functional state. © 2011.",high density lipoprotein;low density lipoprotein;somatomedin C;triacylglycerol;age;aged;aging;allele;article;Barthel index;blood pressure;body height;body mass;cardiovascular risk;cerebrovascular disease;controlled study;diabetes mellitus;female;functional status;gender;genetic association;genetic polymorphism;genotype;glucose blood level;heart infarction;heterozygosity;homozygosity;hormone blood level;human;hypertension;ischemic heart disease;lipoprotein blood level;major clinical study;male;metabolic disorder;Mini Mental State Examination;muscle strength;neoplasm;nutritional status;phenotype;population research;prevalence;priority journal;promoter region;Spain;triacylglycerol blood level;waist circumference,"Mora, M.;Perales, M. J.;Serra-Prat, M.;Palomera, E.;Buquet, X.;Oriola, J.;Puig-Domingo, M.",2011,,,0,
3048,Description of therapeutic project in patients older than 75 years with eGFR < 20 ml/min/1.73m2,"Background: Incidence of end-stage renal disease (ESRD) is growing in patients > 75 years. The decision to start dialysis is sometimes difficult in elderly patients. However, a randomised controlled trial is not ethical to evaluate the benefit of dialysis. Objective: Description of characteristics and therapeutic models of patients older than 75 years with estimated glomerular filtration rate (eGFR) under 20 mL/min/1.73 m<sup>2</sup> not yet on dialysis treatment followed by nephrologists. Methods: More than 550 patients were included in this prospective cohort study in 24 nephrology centres in France. In and outpatients were included for a period of 4 months in each centre. Socio-demographic, co-morbidities, autonomy and therapeutic models were collected for each patient. Results: Characteristics at inclusion were as follows: mean age 82.6 + 4.8 years; men 58%, mean eGFR (modification of diet for renal disease) 13 + 4 mL/min/1.73m<sup>2</sup>, diabetes 36%, body mass index 28 + 8 kg/m<sup>2</sup>, systolic blood pressure 144 + 22 mmHg, diastolic blood pressure 74 + 11 mmHg, proteinuria 1 [0-2] g/g, treatment with angiotensin converting enzyme 45%; cardiac failure 30%, active cancer 10%, dementia 5%, autonomy for transfer 78% and 80% were outpatients. Discussion: The therapeutic models were as follows: no planned dialysis because of stable kidney function (42%); planned dialysis (24%); indication of dialysis discussed (16%), no indication of dialysis because of patient, family or physician's decision (16%). Patients without indication of dialysis are older and more frequently have dementia and cancer. Conclusion: In these elderly patients with eGFR below 20 mL/min/1.73m<sup>2</sup>, followed by a nephrologist, few dialysis are yet planned. Frequency and type of co-morbidities are different according to the therapeutic model.",human;society;nephrology;United Kingdom;patient;dialysis;model;neoplasm;nephrologist;dementia;aged;morbidity;outpatient;diabetes mellitus;kidney disease;renal replacement therapy;diet;glomerulus filtration rate;physician;kidney function;France;cohort analysis;body mass;randomized controlled trial;diastolic blood pressure;proteinuria;heart failure;systolic blood pressure;kidney failure;male;dipeptidyl carboxypeptidase,"Moranne, O.;Vigneau, C.;Couchoud, C.",2011,,10.1159/000327892,0,3049
3049,Description of therapeutic project in patients older than 75 years with eGFR < 20 ml/min/1.73m2,"Background: Incidence of end-stage renal disease (ESRD) is growing in patients > 75 years. The decision to start dialysis is sometimes difficult in elderly patients. However, a randomised controlled trial is not ethical to evaluate the benefit of dialysis. Objective: Description of characteristics and therapeutic models of patients older than 75 years with estimated glomerular filtration rate (eGFR) under 20 mL/min/1.73 m<sup>2</sup> not yet on dialysis treatment followed by nephrologists. Methods: More than 550 patients were included in this prospective cohort study in 24 nephrology centres in France. In and outpatients were included for a period of 4 months in each centre. Socio-demographic, co-morbidities, autonomy and therapeutic models were collected for each patient. Results: Characteristics at inclusion were as follows: mean age 82.6 +/- 4.8 years; men 58%, mean eGFR (modification of diet for renal disease) 13 +/- 4 mL/min/1.73m<sup>2</sup>, diabetes 36%, body mass index 28 +/- 8 kg/m<sup>2</sup>, systolic blood pressure 144 +/- 22 mmHg, diastolic blood pressure 74 +/- 11 mmHg, proteinuria 1 [0-2] g/g, treatment with angiotensin converting enzyme 45%; cardiac failure 30%, active cancer 10%, dementia 5%, autonomy for transfer 78% and 80% were outpatients. Discussion: The therapeutic models were as follows: no planned dialysis because of stable kidney function (42%); planned dialysis (24%); indication of dialysis discussed (16%), no indication of dialysis because of patient, family or physician's decision (16%). Patients without indication of dialysis are older and more frequently have dementia and cancer. Conclusion: In these elderly patients with eGFR below 20 mL/min/1.73m<sup>2</sup>, followed by a nephrologist, few dialysis are yet planned. Frequency and type of co-morbidities are different according to the therapeutic model.",human;society;nephrology;United Kingdom;patient;dialysis;model;neoplasm;nephrologist;dementia;aged;morbidity;outpatient;diabetes mellitus;kidney disease;renal replacement therapy;diet;glomerulus filtration rate;physician;kidney function;France;cohort analysis;body mass;randomized controlled trial;diastolic blood pressure;proteinuria;heart failure;systolic blood pressure;kidney failure;male;dipeptidyl carboxypeptidase,"Moranne, O;Vigneau, C;Couchoud, C",2011,,10.1159/000327892,0,
3050,Palliative care in non-malignant conditions,"Up until now specialised palliative care has traditionally been offered to patients suffering from cancer. However, the age of our population is increasing and more old and old-old live until they die from one or more chronic non-malignant conditions. Patients dying from e.g. chronic heart failure must at one and the same time receive treatment for the actual deteriorating state of the heart condition as well as pure symptom control. Prognosticating the time of referral to specialist palliative care services is more difficult in non-malignant conditions.",Dementia/nursing/therapy;Geriatric Nursing;Heart Diseases/nursing/therapy;Humans;Lung Diseases/nursing/therapy;*Palliative Care/methods;Prognosis;Stroke/nursing/therapy;Terminal Care/methods,"Morch, M. M.;Davidson, A. N.",2007,Oct 29,,0,
3051,Non-ergot dopamine agonist rotigotine as a promising therapeutic tool in atypical parkinsonism syndromes: A 24 months pilot observational open-label study,"Rotigotine (RTG) is a non-ergot dopamine agonist developed as a new transdermal formulation, indicated for use in early and advanced Parkinson's disease (PD). The potential advantages of the RTG patch include immediacy of effect onset, constant drug delivery, better tolerability avoiding drug peaks and easy of use, helping patient's compliance. So, RTG patch appears to be a suitable candidate in the treatment of patients with atypical parkinsonism. The present is an observational study to evaluate the efficacy and tolerability of RTG in patients affected by atypical parkinsonian disorders. 61 subjects with diagnosis of atypical parkinsonian disorders were treated with transdermal RTG. Diagnosis was: Parkinson disease with dementia, multiple system atrophy parkinsonian type, multiple system atrophy cerebellar type, progressive sopranuclear palsy, cortico-basal degeneration, Lewy body dementia and fronto-temporal dementia with parkinsonism. Patients were evaluated by UPDRS-III, NPI, MMSE and adverse events (AEs) were recorded. Patients treated with RTG show an overall decrease of UPDRS III scores without increasing behavioral disturbances. Main adverse events (AE) were hypotension (14 patients), nausea (13), vomiting (5), drowsiness (5), tachycardia (2) dystonia (3 patients, all treated with concomitant l-dopa). On the whole, 16 patients were affected by AE and 7 patients suspended RTG treatment due to AE (vomiting, tachycardia and sleepiness). In our population transdermal RTG seems to be effective and well tolerated. Due to its system of drug delivery, RTG appears to be a suitable therapy in elderly patients as it has a good tolerability profile, improves patient's compliance and helps management of fragile patients. © 2014 Elsevier Ltd. All rights reserved.",dopamine receptor stimulating agent;levodopa;rotigotine;aged;article;congestive heart failure;corticobasal degeneration;diffuse Lewy body disease;drowsiness;drug dose increase;drug dose titration;drug efficacy;drug tolerability;drug withdrawal;dystonia;frontotemporal dementia;human;hypotension;major clinical study;Mini Mental State Examination;nausea;Neuropsychiatric Inventory;observational study;open study;Parkinson disease with dementia;parkinsonism;pilot study;priority journal;progressive supranuclear palsy;psychologic test;Shy Drager syndrome;somnolence;tachycardia;Unified Parkinson Disease Rating Scale;vomiting,"Moretti, D. V.;Binetti, G.;Zanetti, O.;Frisoni, G. B.",2014,,,0,
3052,"Olanzapine as a possible treatment of behavioral symptoms in vascular dementia: Risks of cerebrovascular events - A controlled, open-label study","Behavioral problems produce excess disability, potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they have the potential for significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism and akathisia. We followed up (for 12 months) a group of 346 consecutive outpatients, with a diagnosis of subcortical vascular dementia or multi-infarctual dementia. Patients eligible for this open-label study were required to have behavioral problems (BPSD). Patients were divided into two groups, Group A received olanzapine 2.5-7.5 mg/day while Group B received typical antipsychotics. Patients in both groups were allowed to continue any previous therapy. Patients in both groups were significantly improved in their BPSD. Our patients had a host of medical conditions and received numerous concomitant medications. Given the potential complications associated with these therapeutic agents, these patients tolerated olanzapine quite well. On examination of consequences of adverse events, particularly somnolence, postural instability, and postural hypotension, it appeared that cerebrovascular events were not present. Moreover, no anticholinergic effect was recorded. These findings suggest that olanzapine could be a safe and effective treatment even for elderly population in suitable doses and receiving the adequate follow-up.",acetylsalicylic acid;amiloride;amlodipine;antidiabetic agent;antihypertensive agent;antilipemic agent;atorvastatin;benzodiazepine;bronchodilating agent;calcium antagonist;cholinesterase inhibitor;digoxin;enalapril;furosemide;glibenclamide;glimepiride;glyceryl trinitrate;haloperidol;hydrochlorothiazide;isosorbide mononitrate;losartan;neuroleptic agent;olanzapine;pravastatin;promazine;ramipril;simvastatin;telmisartan;ticlopidine;aged;anger;angina pectoris;anorexia;anticholinergic effect;article;behavior disorder;body posture;cerebrovascular disease;clinical trial;controlled clinical trial;controlled study;diabetes mellitus;drug efficacy;drug safety;drug tolerability;falling;female;follow up;gait disorder;atrial fibrillation;heart infarction;human;increased appetite;kidney failure;lung embolism;major clinical study;male;multiinfarct dementia;nausea;open study;orthostatic hypotension;outpatient;peripheral vascular disease;pneumonia;priority journal;risk factor;side effect;somnolence;treatment outcome;weight gain,"Moretti, R.;Torre, P.;Antonello, R. M.;Cattaruzza, T.;Cazzato, G.",2005,,,0,
3053,Gabapentin for the Treatment of Behavioural Alterations in Dementia: Preliminary 15-Month Investigation,"Background: Although the core feature of dementia is progressive cognitive disruption, non-cognitive behavioural problems are expressed in most patients with dementia during the course of their illness. While psychotropic drugs are frequently used to control behavioural symptoms, comorbidities, which are very common in the geriatric population, could often limit their use. Gabapentin may be a potential treatment in such situations. Methods: In this open, baseline comparison study 20 patients with probable Alzheimer's disease with behavioural alterations and serious comorbidities (paralytic ileus, open-angle glaucoma, ischaemic cardiopathy, hepatic failure or severe prostatic hyperplasia) received gabapentin for 15 months. Patients were allowed to continue any previous therapy for concurrent diseases. However, concomitant antipsychotic or benzodiazepine intake was not permitted. Results: Gabapentin appeared to be efficacious and well tolerated in this patient population, and did not appear to interact with other drugs. General benefit is reflected by a reduction of caregiver stress. No patients withdrew before the end of the study and no serious adverse events were reported. Conclusion: The results of this study in patients with probable Alzheimer's disease with behavioural alterations and serious comorbidities indicate that gabapentin provides significant and sustained efficacy in terms of behaviour, with associated reductions in caregiver burden. The results of an ongoing larger, randomised, double-blind study of gabapentin are keenly awaited and may help to provide a safer and more efficacious treatment option for this group of patients.",donepezil;gabapentin;rivastigmine;aged;Alzheimer disease;article;behavior disorder;clinical article;clinical examination;clinical trial;comorbidity;controlled clinical trial;controlled study;drug efficacy;female;human;ischemic heart disease;liver failure;male;neurologic disease;open angle glaucoma;open study;paralytic ileus;priority journal;prostate hypertrophy;sedation;side effect;vertigo,"Moretti, R.;Torre, P.;Antonello, R. M.;Cazzato, G.;Bava, A.",2003,,,0,
3054,The established and emerging uses of aspirin,"In this paper, summary narratives on the established and emerging uses of aspirin are presented. On the former, aspirin is used to treat conditions such as headache and also reduce the risks associated with cardiovascular disease and also with pre-eclampsia. On the latter, aspirin might be taken more widely by individuals over 50 years, used as a dietary supplement to possibly reduce cancer risk and used post-transplant to improve organ survival. Aspirin will continue to be an important therapeutic agent and to generate considerable interest among the research community for the foreseeable future. © Basic & Clinical Pharmacology & Toxicology 2006.",acetylsalicylic acid;antihypertensive agent;folic acid;hydroxymethylglutaryl coenzyme A reductase inhibitor;polypill;aging;Alzheimer disease;analgesia;cancer risk;cancer survival;cardiovascular disease;diet supplementation;disease association;disease free survival;drug contraindication;drug indication;graft survival;headache;heart infarction;heart muscle ischemia;human;kidney failure;kidney transplantation;Parkinson disease;preeclampsia;pregnancy complication;priority journal;risk reduction;short survey;cerebrovascular accident;tissue transplantation;aspirin,"Morgan, G.",2006,,,0,
3055,Electrocardiographic effects of rivastigmine,"The electrocardiographic (ECG) effects of rivastigmine treatment were assessed in mild to moderately severe Alzheimer's disease (AD) by analysis of four 26-week, double-blind, multicenter, placebo-controlled, phase III clinical trials. Of an initial 2791 patients, 77% completed treatment. Seventy-one percent required at least one concomitant medication for conditions other than AD, with 34% requiring cardiovascular medications. Safety assessments included ECGs, adverse events, vital signs, and clinical laboratory parameters. Pooled 12-lead ECG data were analyzed by an independent cardiologist blinded to treatment group and clinical information. Heart rate, PR, QRS, and QTc intervals did not differ significantly between treatment and placebo groups. Percentage change from baseline for PR, QRS, and QTc intervals was also no different. In conclusion, rivastigmine appears not to produce adverse effects on cardiac function assessed by ECG.","Alzheimer Disease [drug therapy];Bradycardia [chemically induced] [physiopathology];Carbamates [adverse effects] [therapeutic use];Cardiovascular System [drug effects];Cholinesterase Inhibitors [adverse effects] [therapeutic use];Dose-Response Relationship, Drug;Electrocardiography;Heart Diseases [chemically induced] [physiopathology];Heart Rate [drug effects];Phenylcarbamates;Rivastigmine;Tachycardia [chemically induced] [physiopathology];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-dementia","Morganroth, J.;Graham, S.;Hartman, R.;Anand, R.",2002,,,0,
3056,Electrocardiographic effects of rivastigmine,"The electrocardiographic (ECG) effects of rivastigmine treatment were assessed in mild to moderately severe Alzheimer's disease (AD) by analysis of four 26-week, double-blind, multicenter, placebo-controlled, phase III clinical trials. Of an initial 2791 patients, 77% completed treatment. Seventy-one percent required at least one concomitant medication for conditions other than AD, with 34% requiring cardiovascular medications. Safety assessments included ECGs, adverse events, vital signs, and clinical laboratory parameters. Pooled 12-lead ECG data were analyzed by an independent cardiologist blinded to treatment group and clinical information. Heart rate, PR, QRS, and QTc intervals did not differ significantly between treatment and placebo groups. Percentage change from baseline for PR, QRS, and QTc intervals was also no different. In conclusion, rivastigmine appears not to produce adverse effects on cardiac function assessed by ECG.","Alzheimer Disease [drug therapy];Bradycardia [chemically induced] [physiopathology];Carbamates [adverse effects] [therapeutic use];Cardiovascular System [drug effects];Cholinesterase Inhibitors [adverse effects] [therapeutic use];Dose-Response Relationship, Drug;Electrocardiography;Heart Diseases [chemically induced] [physiopathology];Heart Rate [drug effects];Phenylcarbamates;Rivastigmine;Tachycardia [chemically induced] [physiopathology];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-dementia","Morganroth, J;Graham, S;Hartman, R;Anand, R",2002,,,0,3055
3057,Nimodipine in the treatment of probable Alzheimer's disease. Results of two multicentre trials,"The results of both in vitro and animal studies suggest that calcium dysregulation plays an important role in neuronal cell degeneration, and thus support the use of calcium antagonists for the treatment of Alzheimer's disease (AD). The aim of this pooled analysis of 2 multicentre randomised trials was to assess the efficacy and tolerability of nimodipine administered for 6 months in a total of 1648 patients with probable AD. There were no statistically significant differences between nimodipine and placebo for any of the primary outcome variables. However, significant improvements in the secondary variable, Mini Mental State Examination (MMSE; p = 0.004) score, compared with the placebo group, were noted when the individual study data were pooled. Differences favouring nimodipine also emerged when patients were stratified according to their baseline MMSE scores. In more severely impaired patients (MMSE scores 12 to 18), nimodipine 180 mg/day was significantly superior to placebo for Alzheimer's Disease Assessment Scale (ADAS) total (p = 0.01) and cognitive (p = 0.035) scores as well as MMSE total score (p = 0.006). Secondary analyses of these data indicated that patients with more severe cognitive disturbances, yet able to recall ≥ 1 word twice in succession (BSR test), demonstrated the greatest response to nimodipine 180 mg/day treatment. Nimodipine was well tolerated when administered at either 90 or 180 mg/day. In conclusion, although nimodipine did not significantly slow disease progression in the overall study population, patients with moderately severe dementia did appear to benefit from nimodipine treatment, especially those who performed well on the selective reminding test.",nimodipine;adult;aged;Alzheimer disease;article;blood toxicity;cardiotoxicity;clinical trial;cognition;controlled study;data analysis;disease course;double blind procedure;drug efficacy;drug fatality;drug tolerability;female;gastrointestinal toxicity;heart infarction;human;major clinical study;male;mental health;mental test;meta analysis;metabolic disorder;multicenter study;neurotoxicity;priority journal;randomized controlled trial;respiratory tract disease;skin toxicity;treatment outcome;urogenital tract disease,"Morich, F. J.;Bieber, F.;Lewis, J. M.;Kaiser, L.;Cutler, N. R.;Escobar, J. I.;Willmer, J.;Petersen, R. C.;Reisberg, B.;Auerbach, S.;Boyer, J.;Branconnier, R.;Burns, E.;Dubovsky, S.;Earl, N.;Eisner, L.;Fanale, J.;Ferguson, J.;Fornazzari, L.",1996,,,0,
3058,"A double-blind, placebo-controlled, ascending-dose, randomized study to evaluate the safety, tolerability and effects on cognition of AL-108 after 12 weeks of intranasal administration in subjects with mild cognitive impairment","Background/Aims: AL-108-211 was a placebo-controlled, ascending-dose study that explored the safety, tolerability and efficacy of 12 weeks of treatment with AL-108 in subjects with amnestic mild cognitive impairment. Methods: A total of 144 subjects were randomized in a 2:1 drug:placebo ratio. Subjects were enrolled into the low-dose group or placebo and then to the high-dose group or placebo. Pooling of the placebo groups yielded 3 groups (approx. 48/group) whose baseline demographics and disease characteristics were well matched. Results: AL-108 was generally safe and well tolerated. Analyses of efficacy data failed to detect a statistically significant difference between the treatment groups on the composite cognitive memory score. Analyses of the individual cognitive tasks identified signals of potential efficacy in 2 tests of memory and attention. Conclusion: These data suggest that AL-108 was generally safe, well tolerated and merits additional investigation as a treatment for Alzheimer's disease. Copyright © 2013 S. Karger AG, Basel.",NCT00422981;davunetide;placebo;acute psychosis;adult;aged;article;attention;breast tumor;cardiomyopathy;case control study;cognition;congestive heart failure;constipation;controlled study;double blind procedure;drug blood level;drug dose increase;drug effect;drug efficacy;drug induced headache;drug megadose;drug safety;drug tolerability;drug withdrawal;duodenal ulcer bleeding;female;atrial fibrillation;heart infarction;human;infection;low drug dose;major clinical study;male;mental task;mild cognitive impairment;musculoskeletal pain;patient compliance;phase 1 clinical trial;priority journal;randomized controlled trial;rheumatoid arthritis;rhinopharyngitis;rhinorrhea;single drug dose;spatial memory;Streptococcus pneumonia;treatment duration;urinary tract infection;working memory;al 108,"Morimoto, B. H.;Schmechel, D.;Hirman, J.;Blackwell, A.;Keith, J.;Gold, M.;Schmechel, D.;Kirby, L.;Huszar, L.;Walling, D.;Pai, K.;Huffman, C.;Harper, L.;McGill, L.;Stedman, M.;Vatakis, N.;Winston, J.;Gerard, G.;Ross, J.;Ross, J.;Mohammed, B.;Farmer, M.;Thein, S.",2013,,,0,
3059,Tilting-induced decrease in systolic blood pressure in bedridden hypertensive elderly inpatients: Effects of azelnidipine,"The object of this study was to examine blood pressure (BP) variability due to postural change in elderly hypertensive patients. The subjects studied were 154 elderly inpatients in a hospital for the elderly (48 male and 106 female; median age: 82 years), consisting of age- and sex-matched bedridden (n=39) and non-bedridden (n=39) normotensive controls and bedridden (n=38) and non-bedridden (n=38) hypertensive patients. BP and pulse rate (PR) were measured in the supine position, then again after a 2-min, 45 deg head-up tilt with the legs horizontal. The decrease in systolic BP (SBP) on tilting in the bedridden hypertensive group (median: -10 mmHg; range: -32 to 9 mmHg) was significantly (p<0.008) greater than those in the other three groups. Monotherapy with azelnidipine, a long-acting calcium channel blocker, for 3 months not only significantly reduced the basal BP and PR of hypertensive patients in the two groups, but also significantly (p<0.05) attenuated the tilt-induced decrease in the SBP to -3 mmHg (-19 to 25 mmHg) and enhanced the change in PR from -1 bpm (-10 to 7 bpm) to 1 bpm (-4 to 23 bpm) in the bedridden hypertensive group. Our findings indicate that tilt-induced decrease in SBP is a rather common phenomenon in bedridden elderly hypertensive patients, and that treatment with azelnidipine attenuates tilt-induced decrease in SBP, probably through an improvement of baroreceptor sensitivity.",albumin;azelnidipine;calcium channel blocking agent;ADL disability;aged;article;bed;blood pressure measurement;blood pressure regulation;blood pressure variability;body posture;controlled study;dementia;diabetes mellitus;diastolic blood pressure;female;head position;hospital patient;human;hypertension;hypoalbuminemia;immobilization;ischemic heart disease;Japanese (people);major clinical study;male;monotherapy;pressoreceptor;pulse rate;receptor sensitivity;cerebrovascular accident;supine position;systolic blood pressure;tilting;treatment duration;treatment outcome,"Morimoto, S.;Takahashi, T.;Okaishi, K.;Nakahashi, T.;Nomura, K.;Kanda, T.;Okuro, M.;Murai, H.;Nishino, T.;Matsumoto, M.",2006,,,0,
3060,Factors related to the long-term prognosis of home-based medical care subjects,"AIM: The purpose of this study is to identify the factors affecting long-term prognosis of home-based medical care subjects. METHODS: We evaluated 290 subjects, who received home-based medical care between January 2012 and May 2015. We evaluated several aspects of the activities of daily living, such as the ability to walk, use of the toilet, self-feeding and self-administering of medications, as well as their cognition, activities, and abilities to communicate. The influence of these parameters on major adverse cardiovascular cerebrovascular events, non-cardiovascular, cerebrovascular events and the incidence of death was evaluated. RESULTS: The mean age of the subjects was 83 years old and 38% of them were male: dementia or previous cerebral infarction was their main diagnosis. They required assistance for almost all activities of daily living except for feeding. Primary health concerns included 103 (37.0%) subjects had non-cardiovascular, cerebrovascular events, 63 subjects (21.7%) had pneumonia, and 48 subjects (16.6%) suffered major adverse cardiovascular cerebrovascular events, including 22 subjects (7.6%) with congestive heart failure. Sixty-one subjects (21.0%) died. The activities of daily living and cognition correlated strongly with non-cardiovascular, cerebrovascular events and death. CONCLUSION: Our results indicated the activities of daily living and cognition strongly influence the occurrence of non-cardiovascular, cerebrovascular events and death in subjects receiving home-based medical care. Therefore, intervention should be targeted at improving these subjects' abilities to perform activities of daily living.",,"Morita, M.",2015,,10.3143/geriatrics.52.383,0,3061
3061,Factors related to the long-term prognosis of home-based medical care subjects,"AIM: The purpose of this study is to identify the factors affecting long-term prognosis of home-based medical care subjects. METHODS: We evaluated 290 subjects, who received home-based medical care between January 2012 and May 2015. We evaluated several aspects of the activities of daily living, such as the ability to walk, use of the toilet, self-feeding and self-administering of medications, as well as their cognition, activities, and abilities to communicate. The influence of these parameters on major adverse cardiovascular cerebrovascular events, non-cardiovascular, cerebrovascular events and the incidence of death was evaluated. RESULTS: The mean age of the subjects was 83 years old and 38% of them were male: dementia or previous cerebral infarction was their main diagnosis. They required assistance for almost all activities of daily living except for feeding. Primary health concerns included 103 (37.0%) subjects had non-cardiovascular, cerebrovascular events, 63 subjects (21.7%) had pneumonia, and 48 subjects (16.6%) suffered major adverse cardiovascular cerebrovascular events, including 22 subjects (7.6%) with congestive heart failure. Sixty-one subjects (21.0%) died. The activities of daily living and cognition correlated strongly with non-cardiovascular, cerebrovascular events and death. CONCLUSION: Our results indicated the activities of daily living and cognition strongly influence the occurrence of non-cardiovascular, cerebrovascular events and death in subjects receiving home-based medical care. Therefore, intervention should be targeted at improving these subjects' abilities to perform activities of daily living.",cognition;female;frail elderly;home care;human;independent living;male;prognosis;time factor;very elderly;walking,"Morita, M.",2015,,10.3143/geriatrics.52.383,0,
3062,Autopsy analyses of the muscular dystrophies,"Life span, causes of death, weight of heart, liver, brain, and main pathological changes of internal organs were analysed on 329 autopsy cases of muscular dystrophies. These included 249 cases of Duchenne muscular dystrophy (DMD), 3 Becker muscular dystrophies (BMD), 14 limb-girdle muscular dystrophies (LGMD), 3 fascioscapulohumeral muscular dystrophies (FSH), 18 Fukuyama type congenital muscular dystrophies (FCMD) and 17 myotonic dystrophies (MyD). In DMD the life span has definitely prolonged in recent years. Pulmonary infection, which was once the major cause of death, has greatly decreased in recent years. Instead, respiratory and cardiac failures caused by dystrophic changes of respiratory and cardiac muscles were more closely related to the causes of death in many recent cases. Myocardial fibrosis was observed in most of the patients with DMD, BMD, LGMD, FCMD and MyD. The distribution of cardiac lesions was similar in BMD, LGMD and FCMD as in DMD. In MyD the disorders involved more frequently conductive muscles resulting in arrhythmias. The dystrophic cardiomyopathy seemed to be a part of the essential changes in all types of muscular dystrophy, although different in intensity and rate of morbidity. Alzheimer's neurofibrillary changes were observed in the brain of some cases of FCMD and MyD, suggesting the possibility of precocious aging of the brain in some patients of the muscular dystrophies.",Adolescent;Adult;Brain/pathology;Cause of Death;Child;Female;Humans;Liver/pathology;Longevity;Male;Muscular Dystrophies/classification/*pathology;Myocardium/pathology,"Moriuchi, T.;Kagawa, N.;Mukoyama, M.;Hizawa, K.",1993,Jun,,0,
3063,NOS3 gene rs1799983 polymorphism and incident dementia in elderly stroke survivors,"Stroke is a major risk factor for the development of dementia in the elderly. It is unclear which genes influence risk of delayed dementia after stroke. We tested a single nucleotide polymorphism (SNP) in endothelial nitric oxide synthase (NOS3) gene at codon 298 (single-nucleotide polymorphism rs1799983; p.Asp298Glu) in a cohort of 355 older (>75 years) stroke survivors, who had detailed cognitive assessments from 3 months poststroke, i.e., baseline when the patients were free of dementia and subsequently at annual intervals. Of these, 253 participants were genotyped for polymorphisms in NOS3 and apolipoprotein E (APOE). Our analysis showed that homozygosity for NOS3 TT rather than the GT or GG genotype was a significant factor in the development of dementia. The presence of TT genotype increased risk of incident dementia compared with GG genotype; hazard ratio, 3.14 (95% confidence interval, 1.64-5.99; p = 0.001). We hypothesize that this may be mediated by reduction of nitric oxide production and cerebral perfusion. Our findings, if replicated widely, have implications for treatments to ameliorate cognitive decline in stroke survivors. © 2011 Elsevier Inc.",apolipoprotein E;endothelial nitric oxide synthase;aged;article;codon;cognitive defect;controlled study;dementia;diabetes mellitus;female;gene;genetic susceptibility;genotype;atrial fibrillation;homozygosity;human;hypercholesterolemia;hypertension;ischemic heart disease;major clinical study;male;NOS3 gene;priority journal;single nucleotide polymorphism;cerebrovascular accident;survivor,"Morris, C. M.;Ballard, C. G.;Allan, L.;Rowan, E.;Stephens, S.;Firbank, M.;Ford, G. A.;Kenny, R. A.;O'Brien, J. T.;Kalaria, R. N.",2011,,,0,
3064,As i see it,,Alzheimer disease;body weight management;cancer prevention;cardiovascular risk;climacterium;cognition;diabetes mellitus;genetic counseling;health care delivery;health care personnel;hormone substitution;human;ischemic heart disease;menopause;national health service;note;obesity;osteoporosis;postmenopause;reproductive health;risk assessment,"Morris, E.",2014,,,0,
3065,Senior adult oncology: Three cases of advanced cancer in patients of advanced age,,alkaline phosphatase;antibiotic agent;aspartate aminotransferase;azacitidine;carcinoembryonic antigen;cytarabine;epidermal growth factor receptor 2;estrogen receptor;idarubicin;mucin;progesterone receptor;transcription factor Cdx2;trastuzumab;abdominal discomfort;acute myeloblastic leukemia;advanced cancer;aged;alkaline phosphatase blood level;amnesia;article;aspartate aminotransferase blood level;bloating;bone marrow biopsy;cancer survival;case report;cellulitis;cerebrovascular accident;colorectal cancer;computer assisted tomography;congestive heart failure;dementia;disease association;disease free survival;dyspepsia;female;gene mutation;human;hypertension;intraductal carcinoma;life expectancy;mastalgia;nausea and vomiting;needle biopsy;non insulin dependent diabetes mellitus;overall survival;patient care;polymerase chain reaction;positron emission tomography;priority journal;triple negative breast cancer;tumor volume,"Morris, G. J.;Swartz, K.;Chapman, A. E.;Lichtman, S. M.;Levitz, J. S.;Ravandi, F.;Chan, K. R.",2012,,,0,
3066,Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data,"BACKGROUND: Older adults remain the highest utilization group with unplanned visits to emergency departments and hospital admissions. Many have considered what leads to this high utilization and the answers provided have depended upon the independent measures available in the datasets used. This project was designed to further understanding of the reasons for older adult ED visits and admissions to acute care hospitals. METHODS: A secondary analysis of data from a cross-national sample of community residing elderly, 60 years of age or older, and most of whom received services from a local home-care program was conducted. The assessment instrument used in this study is the interRAI HC (home care), designed for use in assessing elderly home care recipients. The model specification stage of the study identified the baseline independent variables that do and do not predict the follow-up measure of hospitalization and ED use. Stepwise logistic regression was used next to identify characteristics that best identified elders who subsequently entered a hospital or visited an ED. The items generated from the final multivariate logistic equation using the interRAI home care measures comprise the interRAI Hospital-ED Risk Index. RESULTS: Independent measures in three key domains of clinical complications, disease diagnoses and specialized treatments were related to subsequent hospitalization or ED use. Among the eighteen clinical complication measures with higher, meaningful odds ratios are pneumonia, urinary tract infection, fever, chest pain, diarrhea, unintended weight loss, a variety of skin conditions, and subject self-reported poor health. Disease diagnoses with a meaningful relationship with hospital/ED use include coronary artery disease, congestive heart failure, cancer, emphysema and renal failure. Specialized treatments with the highest odds ratios were blood transfusion, IV infusion, wound treatment, radiation and dialysis. Two measures, Alzheimer's disease and day care appear to have a protective effect for hospitalization/ED use with lower odds ratios. CONCLUSIONS: Examination into ""preventable"" hospitalizations and re-hospitalizations for older adults who have the highest rates of utilization are occurring beneath an umbrella of assuring the highest quality of care and controlling costs. The interRAI Hospitalization-ED Risk Index offers an effective approach to predicting hospitalization utilization among community dwelling older adults.","Aged;Aged, 80 and over;Canada;Emergency Service, Hospital/*utilization;Female;Finland;Geriatric Assessment;*Home Care Services;Humans;Logistic Models;Male;Odds Ratio;Risk Assessment;Surveys and Questionnaires;United States","Morris, J. N.;Howard, E. P.;Steel, K.;Schreiber, R.;Fries, B. E.;Lipsitz, L. A.;Goldman, B.",2014,Nov 14,10.1186/s12913-014-0519-z,0,
3067,Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data,"BACKGROUND: Older adults remain the highest utilization group with unplanned visits to emergency departments and hospital admissions. Many have considered what leads to this high utilization and the answers provided have depended upon the independent measures available in the datasets used. This project was designed to further understanding of the reasons for older adult ED visits and admissions to acute care hospitals. METHODS: A secondary analysis of data from a cross-national sample of community residing elderly, 60 years of age or older, and most of whom received services from a local home-care program was conducted. The assessment instrument used in this study is the interRAI HC (home care), designed for use in assessing elderly home care recipients. The model specification stage of the study identified the baseline independent variables that do and do not predict the follow-up measure of hospitalization and ED use. Stepwise logistic regression was used next to identify characteristics that best identified elders who subsequently entered a hospital or visited an ED. The items generated from the final multivariate logistic equation using the interRAI home care measures comprise the interRAI Hospital-ED Risk Index. RESULTS: Independent measures in three key domains of clinical complications, disease diagnoses and specialized treatments were related to subsequent hospitalization or ED use. Among the eighteen clinical complication measures with higher, meaningful odds ratios are pneumonia, urinary tract infection, fever, chest pain, diarrhea, unintended weight loss, a variety of skin conditions, and subject self-reported poor health. Disease diagnoses with a meaningful relationship with hospital/ED use include coronary artery disease, congestive heart failure, cancer, emphysema and renal failure. Specialized treatments with the highest odds ratios were blood transfusion, IV infusion, wound treatment, radiation and dialysis. Two measures, Alzheimer's disease and day care appear to have a protective effect for hospitalization/ED use with lower odds ratios. CONCLUSIONS: Examination into ""preventable"" hospitalizations and re-hospitalizations for older adults who have the highest rates of utilization are occurring beneath an umbrella of assuring the highest quality of care and controlling costs. The interRAI Hospitalization-ED Risk Index offers an effective approach to predicting hospitalization utilization among community dwelling older adults.",aged;Canada;female;Finland;geriatric assessment;home care;hospital emergency service;human;male;odds ratio;questionnaire;risk assessment;statistical model;United States;utilization;very elderly,"Morris, J. N.;Howard, E. P.;Steel, K.;Schreiber, R.;Fries, B. E.;Lipsitz, L. A.;Goldman, B.",2014,,10.1186/s12913-014-0519-z,0,3066
3068,Adverse Outcomes After Initial Non-surgical Management of Subdural Hematoma: A Population-Based Study,"BACKGROUND: Little is known about the natural history of non-surgically managed subdural hematoma (SDH). The purpose of this study is to determine rates of adverse events after non-surgical management of SDH and whether these outcomes differ depending on traumatic versus nontraumatic etiology. A retrospective cohort study was conducted using administrative claims data on all emergency department visits and acute care hospitalizations at nonfederal facilities in California from 2005 to 2011, Florida from 2005 to 2012, and New York from 2006 to 2011. We included patients who were discharged home after hospitalization with a first-recorded diagnosis of SDH and no record of surgical hematoma evacuation. METHODS: Patients were followed for readmission with SDH, readmission for surgical SDH evacuation, and fatal readmission with SDH. Survival statistics and the log-rank test were used to compare rates of these adverse events after traumatic versus nontraumatic SDH. Multivariable Cox regression analysis was used to compare hazards for traumatic versus nontraumatic etiology while adjusting for age, sex, race, insurance status, presence of dementia, alcohol use, acquired abnormalities in coagulation, acquired abnormalities in platelet function, hypertension, atrial fibrillation, venous thromboembolism, ischemic stroke, coronary heart disease, and valvular disease. RESULTS: We identified 27,502 conservatively treated patients with SDH, of which 70.9% were traumatic and 29.1% nontraumatic. Compared to patients with traumatic SDH, patients with nontraumatic SDH had significantly higher rates of subsequent hospitalization with SDH (cumulative 90-day rates: 15.3 % [95% CI 14.5-16.1%] vs. 10.3% [95% CI 9.9-10.8%]), surgical SDH evacuation (7.8% [95% CI 7.3-8.5%] vs. 5.5% [95% CI 5.2-5.8%]), and SDH-related in-hospital death (1.0% [95% CI 0.8-1.2%] vs. 0.4% [95 % CI 0.3-0.5%]). In multivariable Cox regression analysis, nontraumatic etiology was associated with a higher hazard of readmission with SDH (HR 1.4; 95% CI 1.3-1.5), surgery (HR 1.3; 95% CI 1.2-1.4), and in-hospital mortality (HR 1.9; 95% CI 1.4-2.5). Our findings were unchanged in sensitivity analyses that also adjusted for Elixhauser comorbidities. CONCLUSIONS: Approximately one in eight patients with a conservatively managed SDH was readmitted with SDH within 90 days. A substantial proportion of these readmissions involved surgical hematoma evacuation. These outcomes occurred significantly more often after nontraumatic as compared to traumatic SDH.",Nonsurgical management;Nontraumatic subdural hematoma;Readmission rates;Subdural hematoma;Trauma,"Morris, N. A.;Merkler, A. E.;Parker, W. E.;Claassen, J.;Connolly, E. S.;Sheth, K. N.;Kamel, H.",2016,Apr,10.1007/s12028-015-0178-x,0,
3069,Development of diet-induced insulin resistance in adult Drosophila melanogaster,"The fruit fly Drosophila melanogaster is increasingly utilized as an alternative to costly rodent models to study human diseases. Fly models exist for a wide variety of human conditions, such as Alzheimer's and Parkinson's Disease, or cardiac function. Advantages of the fly system are its rapid generation time and its low cost. However, the greatest strength of the fly system are the powerful genetic tools that allow for rapid dissection of molecular disease mechanisms. Here, we describe the diet-dependent development of metabolic phenotypes in adult fruit flies. Depending on the specific type of nutrient, as well as its relative quantity in the diet, flies show weight gain and changes in the levels of storage macromolecules. Furthermore, the activity of insulin-signaling in the major metabolic organ of the fly, the fat body, decreases upon overfeeding. This decrease in insulin-signaling activity in overfed flies is moreover observed when flies are challenged with an acute food stimulus, suggesting that overfeeding leads to insulin resistance. Similar changes were observed in aging flies, with the development of the insulin resistance-like phenotype beginning at early middle ages. Taken together, these data demonstrate that imbalanced diet disrupts metabolic homeostasis in adult D. melanogaster and promotes insulin-resistant phenotypes. Therefore, the fly system may be a useful alternative tool in the investigation of molecular mechanisms of insulin resistance and the development of pharmacologic treatment options.","Age Factors;Animals;Dietary Fats/metabolism;Dietary Proteins/metabolism;Disease Models, Animal;Drosophila melanogaster/*metabolism;Insulin/metabolism;Insulin Resistance/*physiology;Signal Transduction;Sucrose/metabolism","Morris, S. N.;Coogan, C.;Chamseddin, K.;Fernandez-Kim, S. O.;Kolli, S.;Keller, J. N.;Bauer, J. H.",2012,Aug,10.1016/j.bbadis.2012.04.012,0,
3070,Practice tips. Keep a purple book: record every detail of an elderly person's care,,"Aged;Dementia, Vascular/therapy;Family Practice;Geriatrics/*methods;Heart Failure/therapy;Humans;*Medical Records;Patient Care Management/*methods","Morrison, M. L.",2006,Jun,,0,
3071,Palliative care,,anticonvulsive agent;anxiolytic agent;benzodiazepine derivative;bisphosphonic acid derivative;chlorpromazine;corticosteroid;dexamethasone;fentanyl derivative;haloperidol;laxative;megestrol acetate;methadone;morphine derivative;nonsteroid antiinflammatory agent;olanzapine;opiate;oxycodone;paracetamol;psychostimulant agent;risperidone;serotonin uptake inhibitor;tricyclic antidepressant agent;aged;Alzheimer disease;anorexia;anxiety disorder;article;bereavement;case report;clinical feature;constipation;delirium;depression;doctor patient relation;dyspnea;evidence based medicine;health care planning;heart failure;hip fracture;human;hypertension;male;medical assessment;nausea;pain;palliative therapy;pneumonia;practice guideline;priority journal;side effect;social psychology;ulcer,"Morrison, R. S.;Meier, D. E.",2004,,,0,
3072,Geriatric content in pharmacotherapy and therapeutics textbooks,"OBJECTIVES: To determine the extent to which therapeutics textbooks address age-related medication information. METHODS: Criteria for 5 disease states prevalent among geriatric patients were developed based on the content of a geriatric textbook and from expert reviewers' input. The criteria were used to determine the degree to which geriatric content was addressed in 3 therapeutics textbooks. RESULTS: The therapeutics textbooks contained less than half of the critical points for 3 disease states: chronic obstructive pulmonary disease, heart failure, and diabetes mellitus (31%, 33%, and 46%, respectively). In addition, the textbooks addressed only one half to two thirds of the criteria for the remaining 2 disease states of osteoarthritis and dementia (55% and 68%, respectively). Criteria specific to the elderly were addressed less often than criteria that were important but not unique to the elderly (38% and 63%, respectively). CONCLUSIONS: Current therapeutics textbooks have significant gaps in geriatric medication information. Users of these textbooks must supplement them with primary literature or a geriatric textbook for more comprehensive medication therapy management information.",Aged;*Drug Therapy;Geriatrics/*education;Humans;*Textbooks as Topic,"Mort, J. R.;Delafuente, J. C.;Odegard, P. S.",2006,Dec 15,,0,
3073,Diabetes mellitus as a risk factof for stroke,"To evaluate the relative potency of diabetes mellitus as a risk factor for stroke, the relative frequency of stroke symptoms was compared among cohorts with and without diabetes. Stroke symptoms were classified as atherothrombotic cerebral infarctions, transient ischemic attacks, reversible ischemic neurologic deficits, and multi-infarct dementia. The groups were compared according to the occurrence of these symptoms, and both cross-sectional and lingitudinal designs were used to study 293 consecutive patients referred to this laboratory and to contrast groups with and without diabetes. Hypertension, heart disease, and stroke symptoms and signs were more frequent among diabetics than among age-matched nondiabetics. Among diabetics, strokes occurred at an earlier age and were more common among men. Regression analyses assigned diabetes second to hypertension as a risk factor for stroke, followed by heart disease and smoking. Diabetes associated with hypertension or hyperlipidemia added significantly to stroke risk. Initially, cerebral blood flow values and cognitive test scores were equivalent among diabetics and nondiabetics; after 3 years, cognition became significantly impaired among diabetics, despite better maintenance of cerebral blood flow among treated diabetics compared with nondiabetics. Diabetes acts to compound risk for stroke not only by promoting cerebral atherogenesis but also by aggravating other risk factors including hypertension, heart disease, and hyperlipidemia.",adult;age;aged;article;controlled study;diabetes mellitus;female;heart disease;human;hyperlipidemia;hypertension;major clinical study;male;priority journal;risk factor;sex difference;smoking;cerebrovascular accident,"Mortel, K. F.;Meyer, J. S.;Sims, P. A.;McClintic, K.",1990,,,0,
3074,Diagnosis of pulmonary malignancy after hospitalization for pneumonia,"BACKGROUND: Many physicians recommend that patients receive follow-up chest imaging after the diagnosis of pneumonia to ensure that a pulmonary malignancy is not missed. However, there is little research evidence to support this practice. Our aims were to assess the frequency of the diagnosis of pulmonary malignancy, and to identify risk factors for pulmonary malignancy following hospitalization for pneumonia. METHODS: By excluding patients with a prior diagnosis of pulmonary malignancy, we examined the incidence of a new pulmonary malignancy diagnosis in inpatients aged >/=65 years with a discharge diagnosis of pneumonia in fiscal years 2002-2007, and at least 1 year of Department of Veterans Affairs outpatient care before the index admission. RESULTS: Of 40,744 patients hospitalized with pneumonia, 3760 (9.2%) patients were diagnosed with pulmonary malignancy after their index pneumonia admission. Median time to diagnosis was 297 days, with only 27% diagnosed within 90 days of admission. Factors significantly associated with a new diagnosis of pulmonary malignancy included history of chronic pulmonary disease, any prior malignancy, white race, being married, and tobacco use. Increasing age, Hispanic ethnicity, need for intensive care unit admission, and a history of congestive heart failure, stroke, dementia, or diabetes with complications were associated with a lower incidence of pulmonary malignancy. CONCLUSION: A small, but clinically important, proportion of patients are diagnosed with pulmonary malignancy posthospitalization for pneumonia. Additional research is needed to examine whether previously undiagnosed pulmonary malignancies might be detected at admission, or soon after, for those hospitalized with pneumonia.","Age Distribution;Aged;Aged, 80 and over;Case-Control Studies;Cohort Studies;Community-Acquired Infections/epidemiology/radiography/therapy;Databases, Factual;Female;Follow-Up Studies;Hospitalization/*statistics & numerical data;Hospitals, Veterans;Humans;Incidence;Kaplan-Meier Estimate;Lung Neoplasms/*diagnosis/*epidemiology;Male;Monitoring, Physiologic/methods;Patient Discharge;Pneumonia/*epidemiology/*radiography/therapy;Probability;Proportional Hazards Models;Risk Assessment;Sex Distribution;Survival Analysis;Time Factors","Mortensen, E. M.;Copeland, L. A.;Pugh, M. J.;Fine, M. J.;Nakashima, B.;Restrepo, M. I.;de Molina, R. M.;Anzueto, A.",2010,Jan,10.1016/j.amjmed.2009.08.009,0,
3075,Impact of statins and ACE inhibitors on mortality after COPD exacerbations,"Background: The purpose of our study was to examine the association of prior outpatient use of statins and angiotensin converting enzyme (ACE) inhibitors on mortality for subjects ≥ 65 years of age hospitalized with acute COPD exacerbations.Methods: We conducted a retrospective national cohort study using Veterans Affairs administrative data including subjects ≥65 years of age hospitalized with a COPD exacerbation. Our primary analysis was a multilevel model with the dependent variable of 90-day mortality and hospital as a random effect, controlling for preexisting comorbid conditions, demographics, and other medications prescribed.Results: We identified 11,212 subjects with a mean age of 74.0 years, 98% were male, and 12.4% of subjects died within 90-days of hospital presentation. In this cohort, 20.3% of subjects were using statins, 32.0% were using ACE inhibitors or angiotensin II receptor blockers (ARB). After adjusting for potential confounders, current statin use (odds ratio 0.51, 95% confidence interval 0.40-0.64) and ACE inhibitor/ARB use (0.55, 0.46-0.66) were significantly associated with decreased 90-day mortality.Conclusion: Use of statins and ACE inhibitors prior to admission is associated with decreased mortality in subjects hospitalized with a COPD exacerbation. Randomized controlled trials are needed to examine whether the use of these medications are protective for those patients with COPD exacerbations. © 2009 Mortensen et al; licensee BioMed Central Ltd.",angiotensin receptor antagonist;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;aged;article;Caucasian;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;controlled study;dementia;demography;dependent variable;diabetes mellitus;disease association;disease exacerbation;drug use;ethnicity;female;heart infarction;hemiplegia;Hispanic;hospitalization;human;kidney disease;liver disease;major clinical study;male;mortality;Black person;neoplasm;outpatient;peptic ulcer;peripheral vascular disease;prescription;randomization;retrospective study;rheumatic disease;solid tumor;cerebrovascular accident,"Mortensen, E. M.;Copeland, L. A.;Pugh, M. J. V.;Restrepo, M. I.;de Molina, R. M.;Nakashima, B.;Anzueto, A.",2009,,,0,
3076,Oesophageal Obstruction from a Pharmacobezoar Resulting in Death,"Formation of an intestinal pharmacobezoar is a rare condition. It may form after intake of various oral pharmaceutical preparations of drugs, both as a result of an acute overdose and through chronic use of therapeutic doses of a drug. We report a case with a patient presenting with an oesophageal pharmacobezoar and complete obstruction of the oesophagus and severe toxic symptoms and death related to oral ingestion of multiple drugs.",acetylcysteine;acetylsalicylic acid;activated carbon;antibiotic agent;bicarbonate;diazepam;ivabradine;lidocaine;metoprolol;mirtazapine;morphine;nifedipine;noradrenalin;oxazepam;oxygen;paracetamol;simvastatin;trandolapril;acute coronary syndrome;aged;article;aspiration pneumonia;autopsy;basal cell carcinoma;bezoar;cancer surgery;case report;computer assisted tomography;death;dementia;depressed blood pressure;drug blood level;drug overdose;esophageal pharmacobezoar;esophagus obstruction;foreign body;gastroscopy;home care;human;hypotension;intensive care unit;male;medical history;nasogastric tube;oropharynx;oxygen saturation;oxygen supply;palliative therapy;priority journal;pulse rate;sinus rhythm;sustained release preparation;thorax radiography;traffic accident;unconsciousness;very elderly,"Mortensen, K. E.;Munkholm, J.;Dalhoff, K. P.;Hoegberg, L. C. G.",2017,,10.1111/bcpt.12662,0,
3077,Effect of human apoE4 on the clearance of chylomicron-like lipid emulsions and atherogenesis in transgenic mice,"Apolipoprotein (apo) E is a ligand for lipoprotein receptors and mediates the cellular uptake of several different lipoproteins. Human apoE occurs in three allelic forms designated E2, E3, and E4. The E2 isoform is associated with changes in lipoprotein metabolism, and the E4 isoform is associated with Alzheimer's disease and an increased risk of coronary heart disease. In this study transgenic mice were generated to assess the effect of a sustained increase in plasma apoE4 concentration. The transgenic animals had three- to sixfold increases in total plasma apoE, associated primarily with the non-high-density lipoprotein (HDL) fractions of plasma lipoproteins. In response to an atherogenic diet the transgenic mice developed hypercholesterolemia similar to that in nontransgenic mice but did not experience the decrease in HDL cholesterol normally observed in this strain of C57BL/6 mice. The rate of plasma clearance of a lipid emulsion mimicking lymph chylomicrons was measured in transgenic mice expressing the human apoE4 gene and compared with the clearance rate in nontransgenic control animals. In animals fed a low-fat diet the emulsion lipids were cleared significantly more rapidly from the plasma of transgenic than control mice. In animals adapted to a high-fat diet, the clearance of chylomicron remnants was slowed markedly in both transgenic and control mice and was not significantly accelerated in transgenic compared with control animals. We also investigated the effect of increasing the plasma concentration of apoE4 on the progression of atherosclerotic heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)","Animals;Apolipoprotein E4;Apolipoproteins/blood;Apolipoproteins E/genetics/*pharmacology;Arteriosclerosis/*etiology/genetics/pathology;Chylomicrons/*metabolism;Emulsions;Humans;Lipase/metabolism;*Lipid Metabolism;Lipids/blood;Lipoproteins/blood;Mice;Mice, Transgenic;Receptors, LDL/metabolism","Mortimer, B. C.;Redgrave, T. G.;Spangler, E. A.;Verstuyft, J. G.;Rubin, E. M.",1994,Oct,,0,
3078,Neuropsychological performance is associated with vascular function in patients with atherosclerotic vascular disease,"OBJECTIVE: We previously reported preliminary data (N=14) demonstrating a significant and positive relationship between forearm vascular function and neuropsychological performance in individuals with atherosclerotic vascular disease (AVD). The current study was conducted to confirm and extend those findings in a much larger, nonoverlapping sample. METHODS AND RESULTS: Participants were 82 individuals with AVD, with no history of stroke, cardiac surgery, or dementia. Forearm vascular function was measured before and after brachial artery infusion of vasoactive agents (acetylcholine, nitroprusside, verapamil). Neuropsychological functioning was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status. Statistical analysis included multiple regression and partial correlations, controlling for education. Vascular function was significantly and positively associated with neuropsychological performance [R2 change = 0.116, F change (3,74) = 3.72, P = 0.015]. Follow-up analyses indicated that smooth muscle function was the aspect of vascular function most strongly associated with neuropsychological performance. Individual vascular risk factors were not significantly associated with neuropsychological performance when controlling for vascular function. CONCLUSIONS: Better vascular function is significantly associated with better neuropsychological performance in individuals with AVD. It is possible that this relationship exists in healthy elderly individuals as well, although this cannot be determined based on the existing data, because a healthy comparison group was not studied. With additional research, measures of vascular function might be useful in the early identification of individuals who are at greatest risk for developing vascular cognitive impairment.","Aged;Cardiovascular System/*physiopathology;Cognition/physiology;Cognition Disorders/*etiology/physiopathology;Coronary Artery Disease/*complications/physiopathology/*psychology;Female;Forearm/blood supply;Humans;Male;Middle Aged;Muscle, Smooth, Vascular/physiopathology;Neuropsychological Tests;Regression Analysis","Moser, D. J.;Robinson, R. G.;Hynes, S. M.;Reese, R. L.;Arndt, S.;Paulsen, J. S.;Haynes, W. G.",2007,Jan,10.1161/01.ATV.0000250973.93401.2d,0,
3079,Prevalence and characteristics of hospitalized adults on chronic opioid therapy,"BACKGROUND: As chronic opioid therapy (COT) becomes more common, complexity of pain management in the inpatient setting increases; little is known about medical inpatients on COT. OBJECTIVE: To determine the prevalence of COT among hospitalized patients and to compare outcomes among these patients relative to those not receiving COT. DESIGN: Observational study of inpatient and outpatient administrative data. PARTICIPANTS: All veterans with acute medical admissions to 129 Veterans Administration hospitals during fiscal years 2009 to 2011, residing in the community, and with outpatient pharmacy use. MEASUREMENTS: We defined COT as 90 or more days of opioids prescribed in the 6 months prior to hospitalization. Patient characteristics included demographic variables and major comorbidities. Outcomes included 30-day readmission and death during hospitalization or within 30 days, with associations ascertained using multivariable logistic regression. RESULTS: Of 122,794 hospitalized veterans, 31,802 (25.9%) received COT. These patients differed from comparators in age, sex, race, residence, and presence of chronic noncancer pain, chronic obstructive pulmonary disease, complicated diabetes, cancer, and mental health diagnoses including post-traumatic stress disorder. After adjustment for demographic factors, comorbidities, and admission diagnosis, COT was associated with hospital readmission (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.10-1.20) and death (OR: 1.19, 95% CI: 1.10-1.29). CONCLUSIONS: COT is common among medical inpatients. Patients on COT differ from patients without COT beyond dissimilarities in pain and cancer diagnoses. Occasional and chronic opioid use are associated with increased risk of hospital readmission, and COT is associated with increased risk of death. Additional research relating COT to hospitalization outcomes is warranted. © 2013 Society of Hospital Medicine.",codeine;dextropropoxyphene;dihydrocodeine;fentanyl;hydrocodone;hydromorphone;methadone;morphine;opiate;oxycodone;oxymorphone;pentazocine;pethidine;tapentadol;tramadol;adult;aged;article;cancer pain;chronic obstructive lung disease;chronic pain;comorbidity;controlled study;death;dementia;demography;drug use;female;heart failure;hospital admission;hospital patient;hospital readmission;hospitalization;human;intensive care unit;kidney disease;length of stay;major clinical study;male;mental disease;middle aged;observational study;posttraumatic stress disorder;prescription;priority journal;race;treatment duration;veteran,"Mosher, H. J.;Jiang, L.;Vaughan Sarrazin, M. S.;Cram, P.;Kaboli, P. J.;Vander Weg, M. W.",2014,,,0,
3080,The heart does not have Alzheimer's disease: Electrical and mechanical cardiac memory after ventricular pacing,,defibrillation;defibrillator;heart function;heart left bundle branch block;heart left ventricle failure;heart repolarization;heart ventricle pacing;hemodynamics;human;mortality;note;priority journal;protein expression;QRS complex;T wave,"Moss, A. J.",2004,,,0,
3081,Menopausal hormone therapy for the primary prevention of chronic conditions: U.S. preventive services task force recommendation statement,"Description: Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation statement on hormone therapy for the prevention of chronic conditions in postmenopausal women. Methods: The USPSTF commissioned a review of the literature to update evidence about the benefits and harms of using menopausal hormone therapy to prevent chronic conditions, as well as whether the benefits and harms of hormone therapy differ by population subgroups defined by age; the presence of comorbid medical conditions; and the type, dose, and method of hormonal delivery. Population: This recommendation applies to postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions. It does not apply to women who are considering hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness. It also does not apply to women younger than 50 years who have had surgical menopause. Recommendation: The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women. (Grade D recommendation). The USPSTF recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. (Grade D recommendation).",conjugated estrogen;medroxyprogesterone acetate;age distribution;article;breast cancer;tumor invasion;cancer risk;cerebrovascular accident;chronic disease;cognition;colorectal cancer;comorbidity;deep vein thrombosis;dementia;diabetes mellitus;gallbladder disease;hip fracture;hormonal therapy;hot flush;human;hysterectomy;ischemic heart disease;lung embolism;menopause;postmenopause;primary prevention;priority journal;risk benefit analysis;risk factor;thromboembolism;urine incontinence;vaginal dryness,"Moyer, V. A.",2013,,,0,
3082,Medical needs and survival of NHS continuing care residents,"BACKGROUND AND AIMS: To determine the medical needs and survival of patients admitted to NHS continuing care beds for the frail elderly. METHODS: A retrospective cohort study of admissions during one year to 222 beds in south-east Glasgow. Case-sheet review identified the diagnoses on admission. Medical interventions were allocated to one of six predetermined categories. Mortality data was collected up to four years after admission. RESULTS: One hundred and eighty nine patients (65 male and 133 female) were admitted, 183 (92%) for NHS continuing care. The overall survival at three months was 47.8% and 38.5% at six months. In total 1585 interventions were recorded, 56.3% of admissions required one or more major intervention. Seventy eight (75.7%) of these were managed in the continuing care setting avoiding transfer to an acute hospital bed. CONCLUSIONS: Older people resident in NHS continuing care have a short life expectancy and require frequent medical interventions. Much of this can be provided in the NHS continuing care setting avoiding admission to the acute sector. Shift of care for these patients to private nursing homes may not provide such support.","Aged;Aged, 80 and over;Cerebrovascular Disorders/epidemiology;Cohort Studies;Dementia/epidemiology;Female;Frail Elderly;Heart Failure/epidemiology;*Homes for the Aged;Humans;Length of Stay/statistics & numerical data;Male;*National Health Programs;*Needs Assessment;Neoplasms/epidemiology;Patient Admission/statistics & numerical data;Respiration Disorders/epidemiology;Retrospective Studies;Scotland/epidemiology;Survival Analysis","Moylan, T.;Roberts, M.;Murray, S.",2008,Aug,,0,
3083,Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry: A Cross-sectional Study of Common Conditions in the United States,"Background:Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties.Methods and Findings:We undertook a cross-sectional study of the most recent publication between 2000 and 2013 from national and international guideline panels making decisions about definitions or diagnostic criteria for common conditions in the United States. We assessed whether proposed changes widened or narrowed disease definitions, rationales offered, mention of potential harms of those changes, and the nature and extent of disclosed ties between members and pharmaceutical or device companies.Of 16 publications on 14 common conditions, ten proposed changes widening and one narrowing definitions. For five, impact was unclear. Widening fell into three categories: creating ""pre-disease""; lowering diagnostic thresholds; and proposing earlier or different diagnostic methods. Rationales included standardising diagnostic criteria and new evidence about risks for people previously considered to not have the disease. No publication included rigorous assessment of potential harms of proposed changes.Among 14 panels with disclosures, the average proportion of members with industry ties was 75%. Twelve were chaired by people with ties. For members with ties, the median number of companies to which they had ties was seven. Companies with ties to the highest proportions of members were active in the relevant therapeutic area. Limitations arise from reliance on only disclosed ties, and exclusion of conditions too broad to enable analysis of single panel publications.Conclusions:For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies.Please see later in the article for the Editors' Summary. © 2013 Moynihan et al.",amlodipine plus benazepril;amphetamine;atomoxetine;bapineuzumab;budesonide plus formoterol;continuous erythropoiesis receptor activator;donepezil;duloxetine;fluticasone propionate;irbesartan;iron;losartan;methylphenidate;montelukast;nicotinic acid;novel erythropoiesis stimulating protein;olanzapine;omalizumab;peginesatide;quetiapine;rivaroxaban;rosuvastatin;sertraline;simvastatin;solanezumab;tiotropium bromide;unindexed drug;zafirlukast;ziprasidone;Alzheimer disease;anemia;article;asthma;attention deficit disorder;bipolar depression;chronic kidney disease;chronic obstructive lung disease;clinical decision making;cross-sectional study;disease severity;DSM-5;economic aspect;financial management;health care personnel;heart infarction;human;hypercholesterolemia;hypertension;industry;organization;panel study;practice guideline;United States,"Moynihan, R. N.;Cooke, G. P. E.;Doust, J. A.;Bero, L.;Hill, S.;Glasziou, P. P.",2013,,,0,
3084,"Apolipoprotein E genetic polymorphism, serum lipoproteins, and breast cancer risk","Apolipoprotein E (apoE) is a polymorphic gene involved in lipid metabolism with three common variant alleles (epsilon2, epsilon3, and epsilon4). The epsilon4 allele has been associated with elevated levels of cholesterol as well as greater risk of coronary heart disease and Alzheimer's disease. In this case-control study we examined whether apoE genotype affected the association between serum lipids and breast cancer risk. In a subset of a study in western New York, 260 women with incident, primary breast cancer and 332 community controls were interviewed and provided blood samples. Polymerase chain reaction-restriction fragment length polymorphism analyses of the apoE polymorphism were performed. Participants were classified as apoE2 (epsilon2, epsilon2 or epsilon2, epsilon3), apoE3 (epsilon3, epsilon3), or apoE4 (epsilon4, epsilon4 or epsilon4, epsilon3). No unconditional logistic regression was used to compute adjusted odds ratios (ORs) and 95% confidence intervals (CI). Compared with women with the apoE3 genotype, there were no associations with risk for women with the apoE2 (OR=1.0; 95% CI=0. 91-1.64) or apoE4 genotype (OR=0.97; 95% CI=0.63-1.54). Higher serum levels of total cholesterol, HDL cholesterol, and LDL cholesterol were not associated with risk, either in the total sample or among subgroups of women defined by apoE genotype. Women with the highest serum triglyceride levels had an increase in risk (OR=1.63; 95% CI=1. 03-2.59) compared to women with the lowest levels. This effect was not apparent among women with the apoE2 or apoE3 genotype, but much stronger among women with the apoE4 genotype (OR=4.69; 95% CI=1. 49-14.7). These data suggest that the apoE4 genotype may modify the association between serum triglycerides and breast cancer risk.","Aged;Apolipoproteins E/*genetics;Breast Neoplasms/*epidemiology/*genetics;Case-Control Studies;Cholesterol/blood;Cholesterol, Dietary;Dietary Fats;European Continental Ancestry Group;Female;Genotype;Humans;Lipoproteins/*blood;Lipoproteins, HDL/blood;Lipoproteins, LDL/blood;Middle Aged;New York/epidemiology;*Polymorphism, Genetic;Risk Factors;Triglycerides/blood","Moysich, K. B.;Freudenheim, J. L.;Baker, J. A.;Ambrosone, C. B.;Bowman, E. D.;Schisterman, E. F.;Vena, J. E.;Shields, P. G.",2000,Jan,,0,
3085,Alzheimer-type neuropathological changes in morbidly obese elderly individuals,"OBJECTIVE: Middle age obesity increases risk for Alzheimer disease (AD). This study evaluated neuropathological changes in morbidly obese patients ranging in age from 21-70 years. METHODS: 12 autopsied morbidly obese patients (> or = 136 kg, BMI 45.3-81.1, 7 male, 5 female, ages 21-70), without cognitive impairment, were compared to 10 non-obese controls (52-106 kg, BMI 17.4-32.5, 8 male, 2 female, ages 29-74), and 3 AD controls (1 male, 2 female, ages 63-78). Standard hippocampal sections were stained for Bielschowsky, A beta (4G8), tau (AT8), or A beta PP (monoclonal, Pierce) and evaluated using semiquantitative criteria. RESULTS: Obese patients had normal-sized brains, but larger hearts (713 +/- 273 vs. 438 +/- 71 g, p <0.01). Only rare brain lesions were noted in any patients < 65 years. Obese patients > 65 years showed high levels of all indices, in some cases comparable to those seen in AD. Compared to non-obese, non-AD controls, the differences in tau and A beta PP expression (but not A beta) were significant (p < 0.05, Mann-Whitney U-test). CONCLUSION: Alzheimer-type neuropathological changes were frequent in our small sample of morbidly obese elderly individuals without clinical history of cognitive impairment, approaching those seen in Alzheimer disease for some patients. Such changes were not seen in younger obese patients. These changes may be attributable to comorbid conditions such as congestive heart failure, obstructive sleep apnea, or metabolic lipid abnormalities.","Adult;Age Factors;Aged;Alzheimer Disease/*etiology/metabolism/pathology;Amyloid/metabolism;Brain/metabolism/*pathology;*Comorbidity;Female;Humans;Immunohistochemistry;Male;Middle Aged;Obesity, Morbid/*complications/metabolism/pathology","Mrak, R. E.",2009,Jan-Feb,,0,
3086,Neurofeedback as supportive therapy after stroke. Case report,"Background: New developments and trends in neurophysiology are presented from the point of view of diagnostics and the new technology available. Based on their own experiences and the literature available, the authors have analyzed neurofeedback, a new rehabilitation method which combines elements of psycho- and neurophysiotherapy. Objective: To explore the usefulness of neurofeedback therapy for stroke patients. The progress of a female patient with Broca's aphasia receiving therapy is analyzed, in which neurofeedback was used alongside more traditional rehabilitation methods. Methods: The report describes the case of a 53-year-old woman following a hemorrhagic stroke in the left hemisphere, with a past myocardial infarction, hypertension and 40-year-long history of cigarette smoking. A number of tests were used to assess the patient's neurological and neuropsychological functioning. Results: An increase in the proportion of β waves in the left hemisphere of the brain and an increase in the amplitude of the SMR in the right hemisphere. Δ and τ waves decreased in both amplitude and percentage in the two hemispheres. Also, a reduction in the τ/β to t/SMR ration was observed. In comparative tests positive results obtained in terms of: concentration, visual perception, categorizing, as well as the regulation of affect and reduction in the aphasia symptoms. Conclusions: Previous studies suggest that neurofeedback leads to lasting symptom reduction. This needs to be confirmed with tests on larger samples using standardized assessment procedures.",decongestive agent;adult;affect;antihypertensive therapy;anxiety;apraxia of speech;article;ataxic aphasia;B wave;Barthel index;brain edema;brain hematoma;brain hemorrhage;brain tomography;case report;cerebrovascular accident;clinical assessment;clinical evaluation;clinical feature;cognition;cognitive rehabilitation;electroencephalogram;executive function;facial nerve injury;female;heart infarction;hemiplegic gait;hospital admission;human;hypertension;hypesthesia;impulsiveness;left hemisphere;medical history;mental concentration;mental deterioration;motor performance;neurofeedback;neurophysiology;neuropsychology;physical examination;psychosis;right hemisphere;smoking;spatial orientation;stroke patient;T wave;tendon reflex;vision,"Mroczkowska, D.;Bialkowska, J.;Rakowska, A.",2014,,,0,
3087,Hormone replacement therapy - Practical consequences based on the total evidence,"According to forensic criteria the results of WHI and HERS must be considered when patients are informed, although patient groups with a high cardiovascular risk and too old in age were investigated with only one preparation. In contrast, it is inapprehensible why also the faulty and low-grade designed Million Women Study is still listed in the patient information leaflet. Based on the total evidence HRT can treat climacteric and urogenital complaints and prevent osteoporotic fractures. These are currently the only official indications. At an early point of start, a reduction of coronary infarcts can be awaited. However, for women older than 60 years or with pre-existing atherosclerotic lesions, a risk increase is possible. Risks for diabetes mellitus as well as colon cancer can strongly be reduced already by short-term therapy. Since prevention of M. Alzheimer seems only to be possible when starting early, but this disease, however, is manifested very late, the risk of developing breast cancer during long-term HRT appears to be of more concern. The patients should be advised about this problem as well as the risks for venous thrombosis and stroke, but adequately in comparison to other risk factors. These risks cannot be excluded during any HRT, but they can be minimised by a differentiated, individually adapted choice of preparation.",estradiol;estrogen;Alzheimer disease;article;breast carcinogenesis;cancer risk;cardiovascular risk;colon cancer;coronary artery atherosclerosis;coronary risk;deep vein thrombosis;diabetes mellitus;fragility fracture;heart infarction prevention;hormonal carcinogenesis;hormonal therapy;hormone substitution;human;long term care;menopausal syndrome;patient education;patient information;postmenopause;risk factor;short course therapy;cerebrovascular accident;urogenital tract disease,"Mueck, A. O.",2009,,,0,
3088,Whole exome sequence analysis reveals a homozygous mutation in PNPLA2 as the cause of severe dilated cardiomyopathy secondary to neutral lipid storage disease,,alanine aminotransferase;aspartate aminotransferase;beta adrenergic receptor blocking agent;brain natriuretic peptide;creatine kinase;dipeptidyl carboxypeptidase inhibitor;eplerenone;troponin I;warfarin;adult;akinesia;amino acid substitution;article;blood analysis;case report;computer assisted tomography;congestive cardiomyopathy;consanguineous marriage;defibrillation;disease severity;DNA determination;electrocardiography;exome;follow up;gene;gene mutation;gene sequence;heart left ventricle ejection fraction;heart left ventricle failure;heart ventricle tachycardia;homozygosity;human;lipidosis;mutational analysis;nuclear magnetic resonance imaging;physical examination;PNPLA2 gene;priority journal;QRS interval;sequence analysis;sinus rhythm;systolic heart murmur;T wave inversion;transthoracic echocardiography;young adult,"Muggenthaler, M.;Petropoulou, E.;Omer, S.;Simpson, M. A.;Sahak, H.;Rice, A.;Raju, H.;Conti, F. J.;Bridges, L. R.;Anderson, L. J.;Sharma, S.;Behr, E. R.;Jamshidi, Y.",2016,,,0,
3089,The so-called hormone replacement therapy in menopause and postmenopause,"Hormone replacement therapy (HRT) is effective in ameliorating hot flushes, night sweats, and vaginal atrophy. HRT is ineffective in urinary incontinence, depression, Morbus Alzheimer and in the secondary prevention of coronary heart disease. In fact, during the first year of treatment, HRT is associated with an increased risk of cardiovascular complications. Evidence is lacking for the effectiveness of HRT in the primary and secondary prevention of non-vertebral fractures and the primary prevention of coronary heart disease, neoplasm, and Morbus Alzheimer, respectively. HRT leads to an increased risk of thromboembolic complications and gall bladder disease. The extent of increase of breast cancer risk due to HRT is not yet known. A combination of estrogens with progestins is necessary in order to prevent estrogen induced endometrial cancer.",estrogen;gestagen;adult;aged;Alzheimer disease;article;breast cancer;cancer risk;cardiovascular disease;depression;female;fracture;gallbladder disease;hormone substitution;hot flush;human;ischemic heart disease;menopause;neoplasm;postmenopause;thromboembolism;urine incontinence;vagina atrophy,"Muhlhauser, I.;Meyer, G.",2000,,,0,
3090,A descriptive evaluation of eligibility for therapy among veterans with chronic hepatitis C virus infection,"Goal: To assess the number of chronic hepatitis C patients eligible for therapy. Background: Recent studies have shown improved response rates to treatment of chronic hepatitis C infection. However, treatment with interferon alfa has major side effects, and many patients may not be eligible for therapy. Study: One hundred consecutive patients with positive hepatitis C serologies at the Durham Veterans Affairs Medical Center were evaluated. Medical records were reviewed, and the patients were interviewed. Patients were considered ineligible for therapy if they had severe mental illness, hazardous alcohol consumption, current drug abuse, decompensated cirrhosis, dementia, terminal illness, diabetic ketoacidosis, and severe cardiac or pulmonary disease or if they were homeless. Results: Of the 100 patients, 92% were male and 51% were African American. The mean age was 47.3 ± 5.6 years. Only 32 of the 100 patients were eligible for therapy. Hazardous alcohol consumption was present in 44%. Major depressive symptoms were present in 12%. Conclusions: The minority of chronic hepatitis C patients were eligible for therapy. Significant rates of hazardous alcohol consumption and psychiatric disorders were present. For these patients to complete or become eligible for therapy, a multidisciplinary approach with psychiatric and substance abuse treatment will be necessary.",alpha interferon;adult;alcohol consumption;article;chronic liver disease;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;depression;diabetes mellitus;female;hepatitis C;Hepatitis C virus;human;Human immunodeficiency virus infection;kidney failure;major clinical study;male;Black person;posttraumatic stress disorder;priority journal;quality of life;sex difference;soldier;substance abuse,"Muir, A. J.;Provenzale, D.",2002,,,0,
3091,Joint effect of mid- and late-life blood pressure on the brain: The AGES-Reykjavik Study,"Objective: We hypothesized that in participants with a history of hypertension, lower late-life blood pressure (BP) will be associated with more brain pathology. Methods: Participants are 4,057 older men and women without dementia with midlife (mean age 50 ± 6 years) and late-life (mean age 76 ± 5 years) vascular screening, cognitive function, and brain structures onMRI ascertained as part of the Age, Gene/Environment Susceptibility (AGES)- Reykjavik Study. Results: The association of late-life BP to brain measures depended on midlife hypertension history. Higher late-life systolic and diastolic BP (DBP) was associated with an increased risk of white matter lesions and cerebral microbleeds, and this was most pronounced in participants without a history of midlife hypertension. In contrast, in participants with a history of midlife hypertension, lower late-life DBP was associated with smaller total brain and gray matter volumes. This finding was reflected back in cognitive performance; in participants with midlife hypertension, lower DBP was associated with lower memory scores. Conclusion: In this large population-based cohort, late-life BP differentially affects brain pathology and cognitive performance, depending on the history of midlife hypertension. Our study suggests history of hypertension is critical to understand how late-life BP affects brain structure and function. © 2014 American Academy of Neurology.",cholesterol;adult;aged;antihypertensive therapy;article;blood pressure;body mass;brain;brain hemorrhage;brain infarction;brain size;cerebrovascular disease;cholesterol blood level;cognition;coronary artery disease;diabetes mellitus;diastolic blood pressure;education;female;gray matter;heart failure;human;hypertension;major clinical study;male;nuclear magnetic resonance imaging;priority journal;pulse pressure;smoking;systolic blood pressure;white matter;white matter lesion,"Muller, M.;Sigurdsson, S.;Kjartansson, O.;Aspelund, T.;Lopez, O. L.;Jonnson, P. V.;Harris, T. B.;Van Buchem, M.;Gudnason, V.;Launer, L. J.",2014,,,0,
3092,The natural history of community-acquired pneumonia in COPD patients: A population database analysis,"Background: Patients with Chronic Obstructive Pulmonary Disease (COPD) are at higher risk of developing Community-Acquired Pneumonia (CAP) than patients in the general population. However, no studies have been performed in general practice assessing longitudinal incidence rates for CAP in COPD patients or risk factors for pneumonia onset. Methods: A cohort of COPD patients aged ≥ 45 years, was identified in the General Research Practice Database (GPRD) between 1996 and 2005, and annual and 10-year incidence rates of CAP evaluated. A nested case-control analysis was performed, comparing descriptors in COPD patients with and without CAP using conditional logistic regression generating odds ratios (OR) and 95% confidence intervals (CI). Results: The COPD cohort consisted of 40,414 adults. During the observation period, 3149 patients (8%) experienced CAP, producing an incidence rate of 22.4 (95% CI 21.7-23.2) per 1000 person years. 92% of patients with pneumonia diagnosis had suffered only one episode. Multivariate modelling of pneumonia descriptors in COPD indicate that age over 65 years was significantly associated with increased risk of CAP. Other independent risk factors associated with CAP were co-morbidities including congestive heart failure (OR 1.4, 95% CI 1.2-1.6), and dementia (OR 2.6, 95%CI 1.9-3.). Prior severe COPD exacerbations requiring hospitalization (OR 2.7, 95% CI 2.3-3.2) and severe COPD requiring home oxygen or nebulised therapy (OR 1.4, 95% CI 1.1-1.6) were also significantly associated with risk of CAP. Conclusion: COPD patients presenting in general practice with specific co-morbidities, severe COPD, and age >65 years are at increased risk of CAP. © 2012 Elsevier Ltd. All rights reserved.",adult;aged;article;chronic obstructive lung disease;community acquired pneumonia;comorbidity;congestive heart failure;controlled study;data base;dementia;disease exacerbation;female;general practice;high risk patient;home oxygen therapy;hospitalization;human;major clinical study;male;morbidity;nebulization;population dynamics;priority journal;risk factor,"Müllerova, H.;Chigbo, C.;Hagan, G. W.;Woodhead, M. A.;Miravitlles, M.;Davis, K. J.;Wedzicha, J. A.",2012,,,0,
3093,Predictors of Receiving a Prosthesis for Adults With Above-Knee Amputations in a Well-Defined Population,"Background Prior studies have identified age as a factor in determining an individual's likelihood of receiving a prosthesis following a lower limb amputation. These studies are limited to specific subsets of the general population and are unable to account for preamputation characteristics within their study populations. Our study seeks to determine the effect of preamputation characteristics on the probability of receiving a prosthesis for the general population in the United States. Objective To identify preamputation characteristics that predict of the likelihood of receiving a prosthesis following an above-knee amputation. Design A retrospective, population-based cohort study. Setting Olmsted County, Minnesota (2010 population: 144,248). Participants Individuals (n = 93) over the age of 18 years who underwent an above-knee amputation, that is, knee disarticulation or transfemoral amputation, while residing in Olmsted County, MN, between 1987 and 2013. Methods Characteristics affecting the receipt of a prosthesis were analyzed using a logistic regression and a random forest algorithm for classification trees. Preamputation characteristics included age, gender, amputation etiology, year of amputation, mobility, cognitive ability, comorbidities, and time between surgery and the prosthesis decision. Main Outcome Measures The association of preamputation characteristics with the receipt of a prosthesis following an above-knee amputation. Results Twenty-four of the participants received a prosthesis. The odds of receiving a prosthesis were almost 30 times higher in those able to walk independently prior to an amputation relative to those who could not walk independently. A 10-year increase in age was associated with a 53.8% decrease in the likelihood of being fit for a prosthesis (odds ratio = 0.462, P =.030). Time elapsed between surgery and the prosthesis decision was associated with a rise in probability of receiving a prosthesis for the first 3 months in the random forest algorithm. No other observed characteristics were associated with receipt of a prosthesis. Conclusions The association of preamputation mobility and age with the likelihood of being fit for a prosthesis is well understood. The effect of age, after controlling for confounders, still persists and is associated with the likelihood of being fit for a prosthesis.",above knee amputation;above knee prosthesis;adult;age;aged;Alzheimer disease;amputee;article;assistive technology device;cerebrovascular disease;cognition;cohort analysis;comorbidity;congestive heart failure;controlled study;death;dementia;female;frail elderly;gender;human;independence;injury;insulin dependent diabetes mellitus;kidney disease;limited mobility;major clinical study;male;mental disease;mental health;middle aged;Minnesota;mobilization;neoplasm;non insulin dependent diabetes mellitus;patient decision making;peripheral vascular disease;population research;predictive value;predictor variable;preoperative evaluation;priority journal;prosthesis implantation;random forest;retrospective study;rheumatic disease;United States;walker;walking,"Mundell, B. F.;Kremers, H. M.;Visscher, S.;Hoppe, K. M.;Kaufman, K. R.",2016,,10.1016/j.pmrj.2015.11.012,0,
3094,Atrial fibrillation,"Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients' functionality with the disease. Nonetheless, it remains imperative that further research into AF epidemiology, genetics, detection, and treatments continues to push forward rapidly as the worldwide population ages dramatically over the next 20 years.",cerebrovascular accident;dementia;devices;drug therapy;epidemiology;faintness;genetics;heart arrhythmia;atrial fibrillation;heart failure;human;patient;population;prevalence;procedures;therapy;anticoagulant agent,"Munger, T. M.;Wu, L. Q.;Shen, W. K.",2014,,,0,
3095,Aplicability of the clinical trials outcomes in heart failure to older people 7,,beta adrenergic receptor blocking agent;bisoprolol;dipeptidyl carboxypeptidase inhibitor;enalapril;metoprolol;spironolactone;aged;alcoholism;chronic obstructive lung disease;clinical trial;comorbidity;controlled clinical trial;controlled study;dementia;elderly care;female;heart failure;heart left ventricle ejection fraction;heart left ventricle function;heart muscle ischemia;human;letter;major clinical study;male;mortality;treatment outcome;valvular heart disease,"Muñoz García, A. J.;Sánchez González, C.;Jiménez Navarro, M. F.;De Teresa Galván, E.",2005,,,0,
3096,Noise pollution and arterial hypertension,,antihypertensive agent;catecholamine;cholesterol;cortisone;fatty acid;glucose;phospholipid;triacylglycerol;acute coronary syndrome;aircraft noise;article;blood clotting;blood pressure;cardiovascular risk;cerebrovascular accident;cholesterol blood level;consensus;coronary artery disease;dementia;diastolic blood pressure;elevated blood pressure;endothelial dysfunction;environmental exposure;fatty acid blood level;glucose blood level;heart infarction;heart output;heart rate;heart rate variability;human;hypertension;noise pollution;pathophysiology;peripheral occlusive artery disease;phospholipid blood level;priority journal;systolic blood pressure;traffic;traffic noise;triacylglycerol blood level;work environment,"Munzel, T.;Schmidt, F.;Gori, T.",2016,,,0,
3097,"Cognitive impairment in elderly, non-insulin dependent diabetic men in Bangladesh","This was a case-comparison study to determine whether there was any association between non-insulin dependent diabetes mellitus (NIDDM) and cognitive impairment in subjects over the age of 65 years. Forty-eight non-insulin dependent diabetic males were compared with eighteen non-diabetic age & sex-matched controls. There was significantly higher cognitive impairment in the diabetic group compared to the control group when cognitive function was tested using the Mini-Mental State Examination (MMSE). However, after adjustment for confounding variables such as hypertension and cerebrovascular diseases there was no significant association between NIDDM per se and cognitive impairment. Other risk factors of cognitive impairment may be investigated.",aged;article;Bangladesh;case control study;cerebrovascular disease;cognition;cognitive defect;comparative study;dementia;epidemiology;heart muscle ischemia;human;hypertension;male;mental health;non insulin dependent diabetes mellitus;physiology;risk factor,"Muqit, M. M.;Ferdous, H. S.",1998,,,0,
3098,Anesthetic management of elderly patients aged 90 years or older,"The authors experienced 55 cases of anesthetic management in 52 elderly surgical patients, 14 men and 38 women, aged 90 to 101 years with an average of 92.1 +/- 2.1 years for the past ten years. Surgical procedures included 38 cases of orthopedic, 14 cases of general surgical and 3 cases of ophthalmic operations. Thirteen cases out of them were emergency. General, epidural, spinal, and local anesthesia were applied in 34 cases, 18 cases, 2 cases, and one case out of these elderly patients, respectively. These general anesthesia consisted of total intravenous anesthesia with propopol, fentanyl and ketamine in 27 cases, sevoflurane with nitrous oxide in 4 cases, isoflurane with nitrous oxide or air in 2 cases, and thiopental anesthesia in one case. The elderly patients had past history of heart disease, dementia, hypertension, cerebral infarction/hemorrhage, diabetes mellitus and others. Their preoperative examinations revealed anemia, hypoproteinemia, renal hypofunction, serum electrolytes imbalance, and others. Vasopessors were given to 42% of the patients during anesthesia and surgery. Their postoperative complications included myocardial infarction, paroxysmal atrial fibrillation, hypotension following anemia, transient hemiparesis, delirium and so on. Two patients developed myocardial infarction postoperatively and died thereafter. The authors suggest that appropriate anesthetic management for elderly patients aged 90 years or older requires proper preoperative evaluation, sufficient vigilance of hemodynamics with direct arterial pressure measurement, reliable preparation of medical agents, and awareness of impairment of circulatory function and others by aging.","Aged;*Aged, 80 and over;Anesthesia, General/*methods/statistics & numerical data;Anesthesia, Inhalation/statistics & numerical data;Anesthesia, Intravenous/statistics & numerical data;Female;Humans;Male;Perioperative Care;*Surgical Procedures, Operative","Murakawa, T.;Anzawa, N.;Hashimoto, Y.;Sakai, I.;Matsuki, A.",2004,Feb,,0,
3099,Juvenile neuronal ceroid-lipofuscinosis with hypertrophic cardiomyopathy and left ventricular noncompaction: A case report,"We report a 17-year-old female with juvenile neuronal ceroid-lipofuscinosis (NCL) accompanied by hypertrophic cardiomyopathy (HCM) and left ventricular noncompaction (LVNC). Within our knowledge, this is the first reported case of juvenile NCL with LVNC, and the youngest case of HCM diagnosed by ultrasound. Juvenile NCL is a progressive hereditary disease involving multi-organ accumulation of ceroid-lipofuscin; its resulting complications require prompt attention. Due to its relative rarity, its cardiac involvement is not well known. Based on findings from this patient and related juvenile NCL cases, the risk of cardiac involvement tends to increase with age; a high frequency of ventricular hypertrophy has been reported in patients aged older than 20 years of age. Medical progress and comprehensive care have led to longer survival in patients with juvenile NCL, which likely increases the incidence of cardiac involvement. In relation to HCM in other metabolic disorders, attention should be paid to arrhythmias, including repolarization disturbances, sinus node dysfunction and ventricular tachycardia. LVNC is a cardiomyopathy characterized by prominent left ventricular trabeculae and deep intratrabecular recesses, which are associated with diastolic or systolic dysfunction, thromboembolic complications and arrhythmias. From ours and other case reports, we recommend regular follow-up of NCL patients as follows: echocardiography to estimate cardiomyopathy, Holter monitoring to identify arrhythmias, and computed tomography to detect thrombosis from both ventricles. The mechanism of the HCM and LVNC associated with juvenile NCL remains unclear. Our case requires careful follow-up. Prospective studies of the cardiac involvement in juvenile NCL are necessary to further elucidate its pathomechanism.",adolescent;article;case report;echocardiography;electrocardiogram;female;heart arrhythmia;heart ventricle tachycardia;Holter monitoring;human;hypertrophic cardiomyopathy;neuronal ceroid lipofuscinosis;sinus node disease;ultrasound;ventricular noncompaction,"Murata, S.;Kasiwagi, M.;Tanabe, T.;Ashida, A.;Ozaki, N.;Tamai, H.",2014,,,0,
3100,Cognitive impairment in elderly patients with type 2 diabetes mellitus: prevalence and related clinical factors,"Aim: Diabetes mellitus is reported to be a risk factor for dementia. We evaluated the cognitive function in elderly diabetic patients and estimated the prevalence of patients with cognitive impairment and looked for any related clinical factors. Subjects and methods: Using 281 elderly (65 years of age or older) Japanese patients with type 2 diabetes mellitus who were free of clinically evident cognitive impairment, we evaluated their cognitive function with the Mini Mental State Examination (MMSE). Results: The MMSE score of all the participants was 27.3 ± 2.4 with 31.3% of them being in the abnormal range (tentatively defined normal range as having an MMSE score of 27–30). Multiple regression analysis disclosed that fasting serum non-esterified fatty acid (NEFA), estimated glomerular filtration ratio (eGFR) and insulin treatment were significantly related factors for the MMSE score, in addition to age and schooling history, which are extremely strong factors. Conclusions: We revealed that approximately one-third of elderly type 2 diabetic patients who were free of clinically evident cognitive impairment had impaired cognitive function, demonstrating that the MMSE score was significantly correlated with fasting NEFA level, renal function, insulin treatment, age and schooling history.",fatty acid;glucagon like peptide 1;hemoglobin A1c;high density lipoprotein cholesterol;insulin;low density lipoprotein cholesterol;oral antidiabetic agent;triacylglycerol;age;aged;alcohol consumption;article;body mass;cognition;cognitive defect;controlled study;dementia;diabetic patient;disease association;estimated glomerular filtration rate;fatty acid blood level;female;geriatric patient;human;hypoglycemia;insulin treatment;ischemic heart disease;Japanese (people);kidney function;major clinical study;male;mild cognitive impairment;Mini Mental State Examination;non insulin dependent diabetes mellitus;priority journal;retinopathy;school,"Murata, Y.;Kadoya, Y.;Yamada, S.;Sanke, T.",2017,,10.1007/s13340-016-0292-9,0,
3101,Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care,"DESIGNFollow up of a randomised controlled trial by postal questionnaires and review of case notes and national datasets.SETTINGStratified, random sample of 19 general practices in north east Scotland.PARTICIPANTS1343 patients (673 intervention and 670 control) under 80 years with a working diagnosis of coronary heart disease but without terminal illness or dementia and not housebound.INTERVENTIONNurse led secondary prevention clinics promoted medical and lifestyle components of secondary prevention and offered regular follow up for one year.MAIN OUTCOME MEASURESComponents of secondary prevention (aspirin, blood pressure management, lipid management, healthy diet, exercise, non-smoking), total mortality, and coronary events (non-fatal myocardial infarctions and coronary deaths).RESULTSMean follow up was at 4.7 years. Significant improvements were shown in the intervention group in all components of secondary prevention except smoking at one year, and these were sustained after four years except for exercise. The control group, most of whom attended clinics after the initial year, caught up before final follow up, and differences between groups were no longer significant. At 4.7 years, 100 patients in the intervention group and 128 in the control group had died: cumulative death rates were 14.5% and 18.9%, respectively (P=0.038). 100 coronary events occurred in the intervention group and 125 in the control group: cumulative event rates were 14.2% and 18.2%, respectively (P=0.052). Adjusting for age, sex, general practice, and baseline secondary prevention, proportional hazard ratios were 0.75 for all deaths (95% confidence intervals 0.58 to 0.98; P=0.036) and 0.76 for coronary events (0.58 to 1.00; P=0.049) CONCLUSIONS: Nurse led secondary prevention improved medical and lifestyle components of secondary prevention and this seemed to lead to significantly fewer total deaths and probably fewer coronary events. Secondary prevention clinics should be started sooner rather than later.OBJECTIVESTo evaluate the effects of nurse led clinics in primary care on secondary prevention, total mortality, and coronary event rates after four years.",Ambulatory Care [organization & administration];Coronary Disease [nursing] [prevention & control];Exercise;Family Practice [organization & administration];Follow-Up Studies;Health Promotion;Life Style;Nurse Practitioners;Primary Health Care [organization & administration];Proportional Hazards Models;Scotland;Smoking Cessation;Survival Analysis;Adult[checkword];Aged[checkword];Humans[checkword];Middle Aged[checkword];Sr-epoc: sr-tobacco: sr-vasc,"Murchie, P;Campbell, Nc;Ritchie, Ld;Simpson, Ja;Thain, J",2003,,,0,3102
3102,Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care,"OBJECTIVES: To evaluate the effects of nurse led clinics in primary care on secondary prevention, total mortality, and coronary event rates after four years. DESIGN: Follow up of a randomised controlled trial by postal questionnaires and review of case notes and national datasets. SETTING: Stratified, random sample of 19 general practices in north east Scotland. PARTICIPANTS: 1343 patients (673 intervention and 670 control) under 80 years with a working diagnosis of coronary heart disease but without terminal illness or dementia and not housebound. Intervention: Nurse led secondary prevention clinics promoted medical and lifestyle components of secondary prevention and offered regular follow up for one year. MAIN OUTCOME MEASURES: Components of secondary prevention (aspirin, blood pressure management, lipid management, healthy diet, exercise, non-smoking), total mortality, and coronary events (non-fatal myocardial infarctions and coronary deaths). RESULTS: Mean follow up was at 4.7 years. Significant improvements were shown in the intervention group in all components of secondary prevention except smoking at one year, and these were sustained after four years except for exercise. The control group, most of whom attended clinics after the initial year, caught up before final follow up, and differences between groups were no longer significant. At 4.7 years, 100 patients in the intervention group and 128 in the control group had died: cumulative death rates were 14.5% and 18.9%, respectively (P=0.038). 100 coronary events occurred in the intervention group and 125 in the control group: cumulative event rates were 14.2% and 18.2%, respectively (P=0.052). Adjusting for age, sex, general practice, and baseline secondary prevention, proportional hazard ratios were 0.75 for all deaths (95% confidence intervals 0.58 to 0.98; P=0.036) and 0.76 for coronary events (0.58 to 1.00; P=0.049) CONCLUSIONS: Nurse led secondary prevention improved medical and lifestyle components of secondary prevention and this seemed to lead to significantly fewer total deaths and probably fewer coronary events. Secondary prevention clinics should be started sooner rather than later.",Ambulatory Care [organization & administration];Coronary Disease [nursing] [prevention & control];Exercise;Family Practice [organization & administration];Follow-Up Studies;Health Promotion;Life Style;Nurse Practitioners;Primary Health Care [organization & administration];Proportional Hazards Models;Scotland;Smoking Cessation;Survival Analysis;Adult[checkword];Aged[checkword];Humans[checkword];Middle Aged[checkword];Sr-epoc: sr-tobacco: sr-vasc,"Murchie, P.;Campbell, N. C.;Ritchie, L. D.;Simpson, J. A.;Thain, J.",2003,,,0,
3103,"KIAA1462, a coronary artery disease associated gene, is a candidate gene for late onset Alzheimer disease in APOE carriers","Alzheimer disease (AD) is a devastating neurodegenerative disease affecting more than five million Americans. In this study, we have used updated genetic linkage data from chromosome 10 in combination with expression data from serial analysis of gene expression to choose a new set of thirteen candidate genes for genetic analysis in late onset Alzheimer disease (LOAD). Results in this study identify the KIAA1462 locus as a candidate locus for LOAD in APOE4 carriers. Two genes exist at this locus, KIAA1462, a gene associated with coronary artery disease, and ""rokimi"", encoding an untranslated spliced RNA The genetic architecture at this locus suggests that the gene product important in this association is either ""rokimi"", or a different isoform of KIAA1462 than the isoform that is important in cardiovascular disease. Expression data suggests that isoform f of KIAA1462 is a more attractive candidate for association with LOAD in APOE4 carriers than ""rokimi"" which had no detectable expression in brain.","Alleles;Alzheimer Disease/*genetics;Apolipoprotein E4/*genetics;Brain/metabolism/pathology;Cell Adhesion Molecules/*genetics;Chromosomes, Human, Pair 10/genetics;Coronary Artery Disease/*genetics;Databases, Genetic;Exons/genetics;Female;Gene Expression Regulation;*Genetic Association Studies;Genetic Loci;*Genetic Predisposition to Disease;Genome, Human/genetics;Heterozygote;Humans;Introns/genetics;Linkage Disequilibrium/genetics;Lod Score;Male;Polymorphism, Single Nucleotide/genetics;RNA/isolation & purification;Real-Time Polymerase Chain Reaction","Murdock, D. G.;Bradford, Y.;Schnetz-Boutaud, N.;Mayo, P.;Allen, M. J.;D'Aoust, L. N.;Liang, X.;Mitchell, S. L.;Zuchner, S.;Small, G. W.;Gilbert, J. R.;Pericak-Vance, M. A.;Haines, J. L.",2013,,10.1371/journal.pone.0082194,0,
3104,What has happened to clinical leadership in futile care discussions?,"Treating clinicians need to make and own decisions about withholding futile treatment, instead of delegating them to patients' families who are usually ill equipped to do so.",aged;amputation;article;cardiomyopathy;case report;clinical practice;dementia;disease severity;hemodialysis;human;kidney failure;leadership;male;medical decision making;microangiopathy;non insulin dependent diabetes mellitus;treatment contraindication;treatment indication;vascular access;visual disorder,"Murphy, B. F.",2008,,,0,
3105,Continuation and adherence rates on initially-prescribed intensive secondary prevention therapy after Rapid Access Stroke Prevention (RASP) service assessment,"Introduction Consistent adherence to treatment is essential for effective secondary prevention following TIA/ischaemic stroke. Representative data on long-term treatment continuation and adherence rates are limited. Methods This single centre study recruited patients attending our Rapid Access Stroke Prevention clinic in Ireland from 07/09/2006 → 30/11/2009. Demographic and clinical data, and prescribed medication regimens at initial assessment were recorded. All patients received copies of clinical correspondence containing clear 'goal-directed treatment advice' sent to their general practitioner or referring physician. Patients were subsequently interviewed with a standardised pro-forma to assess continuation and adherence rates; overall adherence rates with secondary prevention therapy were also assessed with a validated self-reporting tool (Morisky Scale). Recurrent vascular events during follow-up were recorded. Results One hundred and fourteen patients were recruited; mean age: 64.5 ± 13.8 years; median duration of follow-up: 630 days. Patients were prescribed aspirin (69.3%), alone (17.5%) or in combination with dipyridamole MR (51.8%), clopidogrel (18.2%), warfarin (16.7%), statins (76.3%) and anti-hypertensives (51.8%). During follow-up, the percentages of patients continuing treatment prescribed at the initial visit were: Aspirin (93.7%), dipyridamole MR (72.9%), clopidogrel (81%), warfarin (94.7%), statins (87.9%) and anti-hypertensives (89.8%). Overall, 99.1% reported taking their medication the preceding day. Morisky scale scores for all treatments revealed that 41.2% (N = 47) were high, 36.8% (N = 42) medium, and 12.3% (N = 14) low adherers; 9.7% (N = 11) had incomplete data. Two patients (1.8%) had recurrent cerebrovascular events, and two (1.8%) had myocardial infarctions. Discussion This novel study in European TIA/ischaemic stroke patients, who were provided with a goal-directed secondary prevention plan, showed high rates of medication-continuation and self-reported adherence with prescribed treatment, associated with a low incidence of recurrent vascular events during a median follow up of 1.7 years.",acetylsalicylic acid;antihypertensive agent;atorvastatin;clopidogrel;dipeptidyl carboxypeptidase inhibitor;dipyridamole;hydroxymethylglutaryl coenzyme A reductase inhibitor;warfarin;adult;aged;article;brain ischemia;cerebrovascular accident;female;heart infarction;human;incidence;Ireland;major clinical study;male;medication compliance;Morisky Scale;patient compliance;prescription;priority journal;rating scale;recurrent disease;transient ischemic attack,"Murphy, S. J. X.;Coughlan, C. A.;Tobin, O.;Kinsella, J.;Lonergan, R.;Gutkin, M.;McCabe, D. J. H.",2016,,,0,
3106,"The State of US health, 1990-2010: Burden of diseases, injuries, and risk factors","IMPORTANCE: Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. OBJECTIVES: To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. DESIGN: We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. RESULTS: US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. CONCLUSIONS AND RELEVANCE: From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.",cholesterol;glucose;lead;radon;acquired immune deficiency syndrome;aged;air pollution;alcohol consumption;Alzheimer disease;anxiety disorder;article;asthma;automutilation;bipolar disorder;birth;body mass;bone density;brain cancer;breast cancer;cardiomyopathy;cerebrovascular accident;cholesterol blood level;chronic kidney disease;chronic obstructive lung disease;colorectal cancer;congenital malformation;controlled study;diabetes mellitus;diarrhea;diet;disability;disability adjusted life years;dysthymia;eczema;epilepsy;falling;female;glucose blood level;health status;healthy life expectancy;hearing impairment;human;hypertension;intoxication;ischemic heart disease;kidney cancer;leukemia;life;life expectancy;liver cancer;liver cirrhosis;low back pain;lower respiratory tract infection;lung cancer;major depression;male;migraine;mortality;musculoskeletal disease;neck pain;nonhodgkin lymphoma;occupational hazard;osteoarthritis;pancreas cancer;particulate matter;partner violence;periodontal disease;physical disability;premature labor;priority journal;prostate cancer;prostate hypertrophy;rheumatoid arthritis;risk factor;schizophrenia;sexual abuse;sickle cell anemia;smoking;traffic accident;United States;visual impairment;years lived with disability;years of life lost,"Murray, C. J. L.;Abraham, J.;Ali, M. K.;Alvarado, M.;Atkinson, C.;Baddour, L. M.;Bartels, D. H.;Benjamin, E. J.;Bhalla, K.;Birbeck, G.;Bolliger, I.;Burstein, R.;Carnahan, E.;Chen, H.;Chou, D.;Chugh, S. S.;Cohen, A.;Colson, K. E.;Cooper, L. T.;Couser, W.;Criqui, M. H.;Dabhadkar, K. C.;Dahodwala, N.;Danaei, G.;Dellavalle, R. P.;Des Jarlais, D. C.;Dicker, D.;Ding, E. L.;Dorsey, E. R.;Duber, H.;Ebel, B. E.;Engell, R. E.;Ezzati, M.;Felson, D. T.;Finucane, M. M.;Flaxman, S.;Flaxman, A. D.;Fleming, T.;Forouzanfar, M. H.;Freedman, G.;Freeman, M. K.;Gabriel, S. E.;Gakidou, E.;Gillum, R. F.;Gonzalez-Medina, D.;Gosselin, R.;Grant, B.;Gutierrez, H. R.;Hagan, H.;Havmoeller, R.;Hoffman, H.;Jacobsen, K. H.;James, S. L.;Jasrasaria, R.;Jayaraman, S.;Johns, N.;Kassebaum, N.;Khatibzadeh, S.;Knowlton, L. M.;Lan, Q.;Leasher, J. L.;Lim, S.;Lin, J. K.;Lipshultz, S. E.;London, S.;Lozano, R.;Lu, Y.;MacIntyre, M. F.;Mallinger, L.;McDermott, M. M.;Meltzer, M.;Mensah, G. A.;Michaud, C.;Miller, T. R.;Mock, C.;Moffitt, T. E.;Mokdad, A. A.;Mokdad, A. H.;Moran, A. E.;Mozaffarian, D.;Murphy, T.;Naghavi, M.;Narayan, K. M. V.;Nelson, R. G.;Olives, C.;Omer, S. B.;Ortblad, K.;Ostro, B.;Pelizzari, P. M.;Phillips, D.;Pope, C. A.;Raju, M.;Ranganathan, D.;Razavi, H.;Ritz, B.;Rivara, F. P.;Roberts, T.;Sacco, R. L.;Salomon, J. A.;Sampson, U.;Sanman, E.;Sapkota, A.;Schwebel, D. C.;Shahraz, S.;Shibuya, K.;Shivakoti, R.;Silberberg, D.;Singh, G. M.;Singh, D.;Singh, J. A.;Sleet, D. A.;Steenland, K.;Tavakkoli, M.;Taylor, J. A.;Thurston, G. D.;Towbin, J. A.;Vavilala, M. S.;Vos, T.;Wagner, G. R.;Weinstock, M. A.;Weisskopf, M. G.;Wilkinson, J. D.;Wulf, S.;Zabetian, A.;Lopez, A. D.",2013,,,0,
3107,"Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: Quantifying the epidemiological transition","Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively cons ant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition - in which increasing sociodemographic status brings structured change in disease burden - is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.",adult;aged;Alzheimer disease;article;automutilation;brain disease;cardiovascular disease;cerebrovascular accident;cerebrovascular disease;chronic kidney disease;chronic obstructive lung disease;chronic respiratory tract disease;congenital malformation;dengue;depression;diabetes mellitus;diarrhea;disability;disability adjusted life year;drowning;educational status;endocrine disease;female;fertility;health status;hematologic disease;human;Human immunodeficiency virus infection;income;iron deficiency anemia;ischemic heart disease;leishmaniasis;life expectancy;liver cirrhosis;low back pain;major clinical study;malaria;male;malignant neoplastic disease;maternal disease;measles;meningitis;mental disease;mortality;musculoskeletal disease;neck pain;neurologic disease;newborn disease;non communicable disease;nutritional deficiency;nutritional disorder;premature mortality;priority journal;protein calorie malnutrition;respiratory tract infection;substance abuse;tetanus;traffic accident;tuberculosis;urogenital tract disease;violence,"Murray, C. J. L.;Barber, R. M.;Foreman, K. J.;Ozgoren, A. A.;Abd-Allah, F.;Abera, S. F.;Aboyans, V.;Abraham, J. P.;Abubakar, I.;Abu-Raddad, L. J.;Abu-Rmeileh, N. M.;Achoki, T.;Ackerman, I. N.;Ademi, Z.;Adou, A. K.;Adsuar, J. C.;Afshin, A.;Agardh, E. E.;Alam, S. S.;Alasfoor, D.;Albittar, M. I.;Alegretti, M. A.;Alemu, Z. A.;Alfonso-Cristancho, R.;Alhabib, S.;Ali, R.;Alla, F.;Allebeck, P.;Almazroa, M. A.;Alsharif, U.;Alvarez, E.;Alvis-Guzman, N.;Amare, A. T.;Ameh, E. A.;Amini, H.;Ammar, W.;Anderson, H. R.;Anderson, B. O.;Antonio, C. A. T.;Anwari, P.;Arnlöv, J.;Arsenijevic, V. S. A.;Artaman, A.;Asghar, R. J.;Assadi, R.;Atkins, L. S.;Avila, M. A.;Awuah, B.;Bachman, V. F.;Badawi, A.;Bahit, M. C.;Balakrishnan, K.;Banerjee, A.;Barker-Collo, S. L.;Barquera, S.;Barregard, L.;Barrero, L. H.;Basu, A.;Basu, S.;Basulaiman, M. O.;Beardsley, J.;Bedi, N.;Beghi, E.;Bekele, T.;Bell, M. L.;Benjet, C.;Bennett, D. A.;Bensenor, I. M.;Benzian, H.;Bernabé, E.;Bertozzi-Villa, A.;Beyene, T. J.;Bhala, N.;Bhalla, A.;Bhutta, Z. A.;Bienhoff, K.;Bikbov, B.;Biryukov, S.;Blore, J. D.;Blosser, C. D.;Blyth, F. M.;Bohensky, M. A.;Bolliger, I. W.;Başara, B. B.;Bornstein, N. M.;Bose, D.;Boufous, S.;Bourne, R. R. A.;Boyers, L. N.;Brainin, M.;Brayne, C. E.;Brazinova, A.;Breitborde, N. J. K.;Brenner, H.;Briggs, A. D.;Brooks, P. M.;Brown, J. C.;Brugha, T. S.;Buchbinder, R.;Buckle, G. C.;Budke, C. M.;Bulchis, A.;Bulloch, A. G.;Campos-Nonato, I. R.;Carabin, H.;Carapetis, J. R.;Cárdenas, R.;Carpenter, D. O.;Caso, V.;Castañeda-Orjuela, C. A.;Castro, R. E.;Catalá-López, F.;Cavalleri, F.;Çavlin, A.;Chadha, V. K.;Chang, J. C.;Charlson, F. J.;Chen, H.;Chen, W.;Chiang, P. P.;Chimed-Ochir, O.;Chowdhury, R.;Christensen, H.;Christophi, C. A.;Cirillo, M.;Coates, M. M.;Coffeng, L. E.;Coggeshall, M. S.;Colistro, V.;Colquhoun, S. M.;Cooke, G. S.;Cooper, C.;Cooper, L. T.;Coppola, L. M.;Cortinovis, M.;Criqui, M. H.;Crump, J. A.;Cuevas-Nasu, L.;Danawi, H.;Dandona, L.;Dandona, R.;Dansereau, E.;Dargan, P. I.;Davey, G.;Davis, A.;Davitoiu, D. V.;Dayama, A.;De Leo, D.;Degenhardt, L.;Del Pozo-Cruz, B.;Dellavalle, R. P.;Deribe, K.;Derrett, S.;Des Jarlais, D. C.;Dessalegn, M.;Dharmaratne, S. D.;Dherani, M. K.;Diaz-Torné, C.;Dicker, D.;Ding, E. L.;Dokova, K.;Dorsey, E. R.;Driscoll, T. R.;Duan, L.;Duber, H. C.;Ebel, B. E.;Edmond, K. M.;Elshrek, Y. M.;Endres, M.;Ermakov, S. P.;Erskine, H. E.;Eshrati, B.;Esteghamati, A.;Estep, K.;Faraon, E. J. A.;Farzadfar, F.;Fay, D. F.;Feigin, V. L.;Felson, D. T.;Fereshtehnejad, S. M.;Fernandes, J. G.;Ferrari, A. J.;Fitzmaurice, C.;Flaxman, A. D.;Fleming, T. D.;Foigt, N.;Forouzanfar, M. H.;Fowkes, F. G. R.;Paleo, U. F.;Franklin, R. C.;Fürst, T.;Gabbe, B.;Gaffikin, L.;Gankpé, F. G.;Geleijnse, J. M.;Gessner, B. D.;Gething, P.;Gibney, K. B.;Giroud, M.;Giussani, G.;Dantes, H. G.;Gona, P.;González-Medina, D.;Gosselin, R. A.;Gotay, C. C.;Goto, A.;Gouda, H. N.;Graetz, N.;Gugnani, H. C.;Gupta, R.;Gupta, R.;Gutiérrez, R. A.;Haagsma, J.;Hafezi-Nejad, N.;Hagan, H.;Halasa, Y. A.;Hamadeh, R. R.;Hamavid, H.;Hammami, M.;Hancock, J.;Hankey, G. J.;Hansen, G. M.;Hao, Y.;Harb, H. L.;Haro, J. M.;Havmoeller, R.;Hay, S. I.;Hay, R. J.;Heredia-Pi, I. B.;Heuton, K. R.;Heydarpour, P.;Higashi, H.;Hijar, M.;Hoek, H. W.;Hoffman, H. J.;Hosgood, H. D.;Hossain, M.;Hotez, P. J.;Hoy, D. G.;Hsairi, M.;Hu, G.;Huang, C.;Huang, J. J.;Husseini, A.;Huynh, C.;Iannarone, M. L.;Iburg, K. M.;Innos, K.;Inoue, M.;Islami, F.;Jacobsen, K. H.;Jarvis, D. L.;Jassal, S. K.;Jee, S. H.;Jeemon, P.;Jensen, P. N.;Jha, V.;Jiang, G.;Jiang, Y.;Jonas, J. B.;Juel, K.;Kan, H.;Karch, A.;Karema, C. K.;Karimkhani, C.;Karthikeyan, G.;Kassebaum, N. J.;Kaul, A.;Kawakami, N.;Kazanjan, K.;Kemp, A. H.;Kengne, A. P.;Keren, A.;Khader, Y. S.;Khalifa, S. E. A.;Khan, E. A.;Khan, G.;Khang, Y. H.;Kieling, C.;Kim, D.;Kim, S.;Kim, Y.;Kinfu, Y.;Kinge, J. M.;Kivipelto, M.;Knibbs, L. D.;Knudsen, A. K.;Kokubo, Y.;Kosen, S.;Krishnaswami, S.;Defo, B. K.;Bicer, B. K.;Kuipers, E. J.;Kulkarni, C.;Kulkarni, V. S.;Kumar, G. A.;Kyu, H. H.;Lai, T.;Lalloo, R.;Lallukka, T.;Lam, H.;Lan, Q.;Lansingh, V. C.;Larsson, A.;Lawrynowicz, A. E. B.;Leasher, J. L.;Leigh, J.;Leung, R.;Levitz, C. E.;Li, B.;Li, Y.;Li, Y.;Lim, S. S.;Lind, M.;Lipshultz, S. E.;Liu, S.;Liu, Y.;Lloyd, B. K.;Lofgren, K. T.;Logroscino, G.;Looker, K. J.;Lortet-Tieulent, J.;Lotufo, P. A.;Lozano, R.;Lucas, R. M.;Lunevicius, R.;Lyons, R. A.;Ma, S.;Macintyre, M. F.;Mackay, M. T.;Majdan, M.;Malekzadeh, R.;Marcenes, W.;Margolis, D. J.;Margono, C.;Marzan, M. B.;Masci, J. R.;Mashal, M. T.;Matzopoulos, R.;Mayosi, B. M.;Mazorodze, T. T.;McGill, N. W.;McGrath, J. J.;McKee, M.;McLain, A.;Meaney, P. A.;Medina, C.;Mehndiratta, M. M.;Mekonnen, W.;Melaku, Y. A.;Meltzer, M.;Memish, Z. A.;Mensah, G. A.;Meretoja, A.;Mhimbira, F. A.;Micha, R.;Miller, T. R.;Mills, E. J.;Mitchell, P. B.;Mock, C. N.;Ibrahim, N. M.;Mohammad, K. A.;Mokdad, A. H.;Mola, G. L. D.;Monasta, L.;Hernandez, J. C. M.;Montico, M.;Montine, T. J.;Mooney, M. D.;Moore, A. R.;Moradi-Lakeh, M.;Moran, A. E.;Mori, R.;Moschandreas, J.;Moturi, W. N.;Moyer, M. L.;Mozaffarian, D.;Msemburi, W. T.;Mueller, U. O.;Mukaigawara, M.;Mullany, E. C.;Murdoch, M. E.;Murray, J.;Murthy, K. S.;Naghavi, M.;Naheed, A.;Naidoo, K. S.;Naldi, L.;Nand, D.;Nangia, V.;Narayan, K. M. V.;Nejjari, C.;Neupane, S. P.;Newton, C. R.;Ng, M.;Ngalesoni, F. N.;Nguyen, G.;Nisar, M. I.;Nolte, S.;Norheim, O. F.;Norman, R. E.;Norrving, B.;Nyakarahuka, L.;Oh, I. H.;Ohkubo, T.;Ohno, S. L.;Olusanya, B. O.;Opio, J. N.;Ortblad, K.;Ortiz, A.;Pain, A. W.;Pandian, J. D.;Panelo, C. I. A.;Papachristou, C.;Park, E. K.;Park, J. H.;Patten, S. B.;Patton, G. C.;Paul, V. K.;Pavlin, B. I.;Pearce, N.;Pereira, D. M.;Perez-Padilla, R.;Perez-Ruiz, F.;Perico, N.;Pervaiz, A.;Pesudovs, K.;Peterson, C. B.;Petzold, M.;Phillips, M. R.;Phillips, B. K.;Phillips, D. E.;Piel, F. B.;Plass, D.;Poenaru, D.;Polinder, S.;Pope, D.;Popova, S.;Poulton, R. G.;Pourmalek, F.;Prabhakaran, D.;Prasad, N. M.;Pullan, R. L.;Qato, D. M.;Quistberg, D. A.;Rafay, A.;Rahimi, K.;Rahman, S. U.;Raju, M.;Rana, S. M.;Razavi, H.;Reddy, K. S.;Refaat, A.;Remuzzi, G.;Resnikoff, S.;Ribeiro, A. L.;Richardson, L.;Richardus, J. H.;Roberts, D. A.;Rojas-Rueda, D.;Ronfani, L.;Roth, G. A.;Rothenbacher, D.;Rothstein, D. H.;Rowley, J. T.;Roy, N.;Ruhago, G. M.;Saeedi, M. Y.;Saha, S.;Sahraian, M. A.;Sampson, U. K. A.;Sanabria, J. R.;Sandar, L.;Santos, I. S.;Satpathy, M.;Sawhney, M.;Scarborough, P.;Schneider, I. J.;Schöttker, B.;Schumacher, A. E.;Schwebel, D. C.;Scott, J. G.;Seedat, S.;Sepanlou, S. G.;Serina, P. T.;Servan-Mori, E. E.;Shackelford, K. A.;Shaheen, A.;Shahraz, S.;Levy, T. S.;Shangguan, S.;She, J.;Sheikhbahaei, S.;Shi, P.;Shibuya, K.;Shinohara, Y.;Shiri, R.;Shishani, K.;Shiue, I.;Shrime, M. G.;Sigfusdottir, I. D.;Silberberg, D. H.;Simard, E. P.;Sindi, S.;Singh, A.;Singh, J. A.;Singh, L.;Skirbekk, V.;Slepak, E. L.;Sliwa, K.;Soneji, S.;Søreide, K.;Soshnikov, S.;Sposato, L. A.;Sreeramareddy, C. T.;Stanaway, J. D.;Stathopoulou, V.;Stein, D. J.;Stein, M. B.;Steiner, C.;Steiner, T. J.;Stevens, A.;Stewart, A.;Stovner, L. J.;Stroumpoulis, K.;Sunguya, B. F.;Swaminathan, S.;Swaroop, M.;Sykes, B. L.;Tabb, K. M.;Takahashi, K.;Tandon, N.;Tanne, D.;Tanner, M.;Tavakkoli, M.;Taylor, H. R.;Te Ao, B. J.;Tediosi, F.;Temesgen, A. M.;Templin, T.;Ten Have, M.;Tenkorang, E. Y.;Terkawi, A. S.;Thomson, B.;Thorne-Lyman, A. L.;Thrift, A. G.;Thurston, G. D.;Tillmann, T.;Tonelli, M.;Topouzis, F.;Toyoshima, H.;Traebert, J.;Tran, B. X.;Trillini, M.;Truelsen, T.;Tsilimbaris, M.;Tuzcu, E. M.;Uchendu, U. S.;Ukwaja, K. N.;Undurraga, E. A.;Uzun, S. B.;Van Brakel, W. H.;Van De Vijver, S.;Van Gool, C. H.;Van Os, J.;Vasankari, T. J.;Venketasubramanian, N.;Violante, F. S.;Vlassov, V. V.;Vollset, S. E.;Wagner, G. R.;Wagner, J.;Waller, S. G.;Wan, X.;Wang, H.;Wang, J.;Wang, L.;Warouw, T. S.;Weichenthal, S.;Weiderpass, E.;Weintraub, R. G.;Wenzhi, W.;Werdecker, A.;Westerman, R.;Whiteford, H. A.;Wilkinson, J. D.;Williams, T. N.;Wolfe, C. D.;Wolock, T. M.;Woolf, A. D.;Wulf, S.;Wurtz, B.;Xu, G.;Yan, L. L.;Yano, Y.;Ye, P.;Yentür, G. K.;Yip, P.;Yonemoto, N.;Yoon, S. J.;Younis, M. Z.;Yu, C.;Zaki, M. E.;Zhao, Y.;Zheng, Y.;Zonies, D.;Zou, X.;Salomon, J. A.;Lopez, A. D.;Vos, T.",2015,,,0,
3108,UK health performance: Findings of the Global Burden of Disease Study 2010,"Background The UK has had universal free health care and public health programmes for more than six decades. Several policy initiatives and structural reforms of the health system have been undertaken. Health expenditure has increased substantially since 1990, albeit from relatively low levels compared with other countries. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to examine the patterns of health loss in the UK, the leading preventable risks that explain some of these patterns, and how UK outcomes compare with a set of comparable countries in the European Union and elsewhere in 1990 and 2010. Methods We used results of GBD 2010 for 1990 and 2010 for the UK and 18 other comparator nations (the original 15 members of the European Union, Australia, Canada, Norway, and the USA; henceforth EU15+). We present analyses of trends and relative performance for mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 259 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to the UK. We assessed the UK's rank for age-standardised YLLs and DALYs for their leading causes compared with EU15+ in 1990 and 2010. We estimated 95% uncertainty intervals (UIs) for all measures. Findings For both mortality and disability, overall health has improved substantially in absolute terms in the UK from 1990 to 2010. Life expectancy in the UK increased by 4•2 years (95% UI 4•2-4•3) from 1990 to 2010. However, the UK performed significantly worse than the EU15+ for age-standardised death rates, age-standardised YLL rates, and life expectancy in 1990, and its relative position had worsened by 2010. Although in most age groups, there have been reductions in age-specific mortality, for men aged 30-34 years, mortality rates have hardly changed (reduction of 3•7%, 95% UI 2•7-4•9). In terms of premature mortality, worsening ranks are most notable for men and women aged 20-54 years. For all age groups, the contributions of Alzheimer's disease (increase of 137%, 16-277), cirrhosis (65%, -15 to 107), and drug use disorders (577%, 71-942) to premature mortality rose from 1990 to 2010. In 2010, compared with EU15+, the UK had significantly lower rates of age-standardised YLLs for road injury, diabetes, liver cancer, and chronic kidney disease, but significantly greater rates for ischaemic heart disease, chronic obstructive pulmonary disease, lower respiratory infections, breast cancer, other cardiovascular and circulatory disorders, oesophageal cancer, preterm birth complications, congenital anomalies, and aortic aneurysm. Because YLDs per person by age and sex have not changed substantially from 1990 to 2010 but age-specific mortality has been falling, the importance of chronic disability is rising. The major causes of YLDs in 2010 were mental and behavioural disorders (including substance abuse; 21•5% [95 UI 17•2-26•3] of YLDs), and musculoskeletal disorders (30•5% [25•5-35•7]). The leading risk factor in the UK was tobacco (11•8% [10•5-13•3] of DALYs), followed by increased blood pressure (9•0 % [7•5-10•5]), and high body-mass index (8•6% [7•4-9•8]). Diet and physical inactivity accounted for 14•3% (95% UI 12•8-15•9) of UK DALYs in 2010. Interpretation The performance of the UK in terms of premature mortality is persistently and significantly below the mean of EU15+ and requires additional concerted action. Further progress in premature mortality from several major causes, such as cardiovascular diseases and cancers, will probably require improved public health, prevention, early intervention, and treatment activities. The growing burden of disability, particularly from mental disorders, substance use, musculoskeletal disorders, and falls deserves an integrated and strategic response. Funding Bill &Melinda Gates Foundation.",adult;Alzheimer disease;aorta aneurysm;article;behavior disorder;blood pressure;body mass;breast cancer;cardiovascular disease;chronic kidney disease;chronic obstructive lung disease;congenital malformation;diabetes mellitus;disability;early intervention;esophagus cancer;falling;female;health care quality;health program;human;immobilization;ischemic heart disease;life expectancy;liver cancer;liver cirrhosis;lower respiratory tract infection;male;musculoskeletal disease;premature labor;premature mortality;priority journal;quality adjusted life year;quality control;risk factor;substance abuse,"Murray, C. J. L.;Richards, M. A.;Newton, J. N.;Fenton, K. A.;Anderson, H. R.;Atkinson, C.;Bennett, D.;Bernabé, E.;Blencowe, H.;Bourne, R.;Braithwaite, T.;Brayne, C.;Bruce, N. G.;Brugha, T. S.;Burney, P.;Dherani, M.;Dolk, H.;Edmond, K.;Ezzati, M.;Flaxman, A. D.;Fleming, T. D.;Freedman, G.;Gunnell, D.;Hay, R. J.;Hutchings, S. J.;Ohno, S. L.;Lozano, R.;Lyons, R. A.;Marcenes, W.;Naghavi, M.;Newton, C. R.;Pearce, N.;Pope, D.;Rushton, L.;Salomon, J. A.;Shibuya, K.;Vos, T.;Wang, H.;Williams, H. C.;Woolf, A. D.;Lopez, A. D.;Davis, A.",2013,,,0,
3109,Preservation of cognitive function with antihypertensive medications: a longitudinal analysis of a community-based sample of African Americans,"BACKGROUND: Results of previous studies of white older adults suggest that antihypertensive medications preserve cognition. We assessed the long-term effect of antihypertensive medications on cognitive function in a community sample of African American older adults. METHODS: We conducted longitudinal surveys and clinical assessment of cognitive function in a random sample of 2212 community-dwelling African Americans 65 years and older. We identified 1900 participants without evidence of cognitive impairment at baseline, 1617 of whom had subsequent follow-up information, and 946 of whom had blood pressure measurements. Cognitive function was measured at baseline and at 2 and 5 years by means of scores on the Community Screening Instrument for Dementia and neuropsychological and clinical assessment for dementia and cognitive impairment. Prescription and nonprescription medication use was derived from in-home inspection of medications and participant and informant reports. RESULTS: Of 1900 participants, 288 (15.2%) developed incident cognitive impairment. Using logistic regression to control for the effects of age, sex, education, baseline cognitive scores, and hypertension and angina or myocardial infarction, we found that antihypertensive medications reduced the odds of incident cognitive impairment by 38% (odds ratio, 0.62; 95% confidence interval, 0.45-0.84). Corresponding analysis using blood pressure measurements on the subset of participants was inconclusive. CONCLUSION: Antihypertensive medication use is associated with preservation of cognitive function in older African American adults.","*African Americans;Aged;Aged, 80 and over;Angina Pectoris/drug therapy/epidemiology;Antihypertensive Agents/administration & dosage/*therapeutic use;*Cognition/drug effects;Cognition Disorders/diagnosis/drug therapy/epidemiology/*prevention & control;Dementia/diagnosis/drug therapy/epidemiology/*prevention & control;Female;Humans;Hypertension/drug therapy/epidemiology;Incidence;Indiana/epidemiology;Logistic Models;Longitudinal Studies;Male;Myocardial Infarction/drug therapy/epidemiology;Neuropsychological Tests;Residence Characteristics;Risk Assessment;Risk Factors","Murray, M. D.;Lane, K. A.;Gao, S.;Evans, R. M.;Unverzagt, F. W.;Hall, K. S.;Hendrie, H.",2002,Oct 14,,0,
3110,Risk of mortality (including sudden cardiac death) and major cardiovascular events in atypical and typical antipsychotic users: a study with the general practice research database,"Objective. Antipsychotics have been associated with increased cardiac events including mortality. This study assessed cardiac events including mortality among antipsychotic users relative to nonusers. Methods. The General Practice Research Database (GPRD) was used to identify antipsychotic users, matched general population controls, and psychiatric diseased nonusers. Outcomes included cardiac mortality, sudden cardiac death (SCD), all-cause mortality (excluding suicide), coronary heart disease (CHD), and ventricular arrhythmias (VA). Sensitivity analyses were conducted for age, dose, duration, antipsychotic type, and psychiatric disease. Results. 183,392 antipsychotic users (115,491 typical and 67,901 atypical), 544,726 general population controls, and 193,920 psychiatric nonusers were identified. Nonusers with schizophrenia, dementia, or bipolar disorder had increased risks of all-cause mortality compared to general population controls, while nonusers with major depression had comparable risks. Relative to psychiatric nonusers, the adjusted relative ratios (aRR) of all-cause mortality in antipsychotic users was 1.75 (95% CI: 1.64-1.87); cardiac mortality 1.72 (95% CI: 1.42-2.07); SCD primary definition 5.76 (95% CI: 2.90-11.45); SCD secondary definition 2.15 (95% CI: 1.64-2.81); CHD 1.16 (95% CI: 0.94-1.44); and VA 1.16 (95% CI: 1.02-1.31). aRRs of the various outcomes were lower for atypical versus typical antipsychotics (all-cause mortality 0.83 (95% CI: 0.80-0.85); cardiac mortality 0.89 (95% CI: 0.82-0.97); and SCD secondary definition 0.76 (95% CI: 0.55-1.04). Conclusions. Antipsychotic users had an increased risk of cardiac mortality, all-cause mortality, and SCD compared to a psychiatric nonuser cohort.",,"Murray-Thomas, T.;Jones, M. E.;Patel, D.;Brunner, E.;Shatapathy, C. C.;Motsko, S.;Van Staa, T. P.",2013,,10.1155/2013/247486,0,
3111,How many people need palliative care? A study developing and comparing methods for population-based estimates,"Background: Understanding the need for palliative care is essential in planning services. Aim: To refine existing methods of estimating population-based need for palliative care and to compare these methods to better inform their use. Design: (1) Refinement of existing population-based methods, based on the views of an expert panel, and (2) application/comparison of existing and refined approaches in an example dataset. Existing methods vary in approach and in data sources. (a) Higginson used cause of death/symptom prevalence, and using pain prevalence, estimates that 60.28% (95% confidence interval = 60.20%-60.36%) of all deaths need palliative care, (b) Rosenwax used the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) causes of death/hospital-use data, and estimates that 37.01% (95% confidence interval = 36.94%-37.07%) to 96.61% (95% confidence interval = 96.58%-96.64%) of deaths need palliative care, and (c) Gómez-Batiste used percentage of deaths plus chronic disease data, and estimates that 75% of deaths need palliative care. Setting/participants: All deaths in England, January 2006-December 2008, using linked mortality and hospital episode data. Results: Expert panel review identified changing practice (e.g. extension of palliative care to more non-cancer conditions), changing patterns of hospital/home care and multiple, rather than single, causes of death as important. We therefore refined methods (using updated ICD-10 causes of death, underlying/contributory causes, and hospital use) to estimate a minimum of 63.03% (95% confidence interval = 62.95%-63.11%) of all deaths needing palliative care, with lower and upper mid-range estimates between 69.10% (95% confidence interval = 69.02%-69.17%) and 81.87% (95% confidence interval = 81.81%-81.93%). Conclusions: Death registration data using both underlying and contributory causes can give reliable estimates of the populationbasedneed for palliative care, without needing symptom or hospital activity data. In high-income countries, 69%-82% of those who die need palliative care. © 2013 The Author(s).",Alzheimer disease;article;breast cancer;cause of death;chronic liver disease;chronic obstructive lung disease;colorectal cancer;health service;heart failure;human;Huntington chorea;ICD-10;kidney failure;kidney ischemia;lung cancer;multiple sclerosis;needs assessment;pain;palliative therapy;Parkinson disease;prostate cancer;terminal care;United Kingdom,"Murtagh, F. E. M.;Bausewein, C.;Verne, J.;Iris Groeneveld, E.;Kaloki, Y. E.;Higginson, I. J.",2014,,,0,
3112,Does diabetes mellitus alter the onset and clinical course of vascular dementia?,"Background: Vascular dementia (VaD) is the second most common dementing illness. Multiple risk factors are associated with VaD, but the individual contribution of each to disease onset and progression is unclear. We examined the relationship between diabetes mellitus type 2 (DM) and the clinical variables of VaD. Methods: Data from 593 patients evaluated between June, 2003 and June, 2008 for cognitive impairment were prospectively entered into a database. We retrospectively reviewed the charts of 63 patients who fit the NINDS-AIREN criteria for VaD. The patients were divided into those with DM (VaD-DM, n=29) and those without DM (VaD, n=34). The groups were compared with regard to multiple variables. Results: Patients with DM had a significantly earlier onset of VaD (71.9 ± 6.54 vs. 77.2 ± 6.03, p< 0.001), a faster rate of decline per year on the mini mental state examination (MMSE; 3.60 ± 1.82 vs. 2.54 ± 1.60 points, p= 0.02), and a greater prevalence of neuropsychiatric symptoms at the time of diagnosis (62% vs. 21%, p=0.02). Conclusions: A history of pre-morbid DM was associated with an earlier onset and faster cognitive deterioration in VaD. Moreover, DM was associated with neuropsychiatric symptoms in patients with VaD. A larger study is needed to verify these associations. It will be important to investigate whether better glycemic control will mitigate the potential effects of DM on VaD. © 2010 - IOS Press and the authors. All rights reserved.",aged;alcohol abuse;anxiety disorder;article;clinical assessment;comorbidity;congestive heart failure;controlled study;correlation analysis;depression;disease association;disease course;dyslipidemia;female;hallucination;atrial fibrillation;human;hypertension;ischemic heart disease;major clinical study;male;medical record review;Mini Mental State Examination;multiinfarct dementia;non insulin dependent diabetes mellitus;onset age;priority journal;psychiatric diagnosis;risk factor;smoking;cerebrovascular accident;valvular heart disease,"Murthy, S. B.;Jawaid, A.;Qureshi, S. U.;Kalkonde, Y.;Wilson, A. M.;Johnson, M. L.;Kunik, M. E.;Schulz, P. E.",2010,,,0,
3113,The role of patient navigators: Case studies in Singapore,"In 2014, a patient navigator (PN) program was initiated in a healthcare cluster in Singapore. The program was set up to improve care coordination and facilitate continuity of care of patients. PNs are trained nurses who act as a clinical liaison between the patients, family, staff and the healthcare system to coordinate patients’ treatment plans and ensure continuity of care provision from the acute to the community setting. PNs care for patients with chronic diseases and their role includes resolving caregiver disputes, eliminating barriers to treatment, exploring financial assistance options, facilitating terminal discharge and providing end-of-life counseling. This article describes the activities performed by PNs in the acute care setting. The case studies demonstrate the depth and breadth of navigation activities and illustrate how hospital-based navigators help patients seek treatment earlier, access resources and receive care at the appropriate healthcare setting.",antibiotic agent;Alzheimer disease;article;aspiration pneumonia;auscultation;case study;congestive heart failure;consultation;coughing;crackle;diabetes mellitus;dysphagia;dyspnea;follow up;health care personnel;health care system;health program;hospital readmission;hospitalization;human;hyperlipidemia;liver cell carcinoma;oxygen supply;patient care;patient navigator;refeeding syndrome;Singapore;terminal care,"Mustapha, N. Z. B.;Yi, X.;Mohd Razali, M. R. B.;Najumudin, N. B.;Barman, H. B.",2016,,,0,
3114,Heterologous expression and purification systems for structural proteomics of mammalian membrane proteins,"Membrane proteins (MPs) are responsible for the interface between the exterior and the interior of the cell. These proteins are implicated in numerous diseases, such as cancer, cystic fibrosis, epilepsy, hyperinsulinism, heart failure, hypertension and Alzheimer's disease. However, studies on these disorders are hampered by a lack of structural information about the proteins involved. Structural analysis requires large quantities of pure and active proteins. The majority of medically and pharmaceutically relevant MPs are present in tissues at very low concentration, which makes heterologous expression in large-scale production-adapted cells a prerequisite for structural studies. Obtaining mammalian MP structural data depends on the development of methods that allow the production of large quantities of MPs. This review focuses on the different heterologous expression systems, and the purification strategies, used to produce large amounts of pure mammalian MPs for structural proteomics.",,"Mus-Veteau, I.",2002,,10.1002/cfg.218,0,
3115,Heterologous expression of membrane proteins for structural analysis,"Membrane proteins (MPs) are responsible for the interface between the exterior and the interior of the cell. These proteins are involved in numerous diseases, like cancer, cystic fibrosis, epilepsy, hyperinsulinism, heart failure, hypertension and Alzheimer disease. However, studies of these disorders are hampered by a lack of structural information about the proteins involved. Structural analysis requires large quantities of pure and active proteins. The majority of medically and pharmaceutically relevant MPs are present in tissues at low concentration, which makes heterologous expression in large-scale production-adapted cells a prerequisite for structural studies. Obtaining mammalian MP structural data depends on the development of methods that allow the production of large quantities of MPs. This review focuses on the heterologous expression systems now available to produce large amounts of MPs for structural proteomics, and describes the strategies that allowed the determination of the structure of the first heterologously expressed mammalian MPs.",Animals;Baculoviridae/genetics;Crystallization;Drosophila/genetics;Escherichia coli/genetics;Eukaryota/metabolism;*Gene Expression;Humans;Insects/cytology/genetics/virology;Lactococcus lactis/genetics;Mammals/genetics;Membrane Proteins/biosynthesis/*chemistry/*genetics/isolation & purification;Prokaryotic Cells/metabolism;Protein Conformation;Protein Stability;Proteomics/methods;Solubility;Yeasts/genetics,"Mus-Veteau, I.",2010,,10.1007/978-1-60761-344-2_1,0,
3116,Factors associated with mortality among elderly patients with hypothermia,,albumin;antibiotic agent;creatine kinase;creatinine;glucose;hydrocortisone;potassium;sodium;thyroid hormone;age;aged;albumin blood level;article;bacterial infection;blood pH;comorbidity;controlled study;creatinine blood level;dementia;diabetes mellitus;electrocardiogram;endotracheal intubation;female;Glasgow coma scale;heart failure;hormone substitution;hospitalization;human;hypothermia;hypothyroidism;kidney failure;laboratory test;liothyronine blood level;major clinical study;male;malnutrition;medical record;mortality;potassium blood level;priority journal;rhabdomyolysis;risk assessment;risk factor;sex difference;cerebrovascular accident;systolic blood pressure;temperature measurement;urinalysis,"Muszkat, M.;Durst, R. M.;Ben-Yehuda, A.",2002,,,0,
3117,Dementia and depression with ischemic heart disease: a population-based longitudinal study comparing interventional approaches to medical management,"BACKGROUND: We compared the proportion of ischemic heart disease (IHD) patients newly diagnosed with dementia and depression across three treatment groups: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical management alone (IHD-medical). METHODS AND FINDINGS: De-identified, individual-level administrative records of health service use for the population of Manitoba, Canada (approximately 1.1 million) were examined. From April 1, 1993 to March 31, 1998, patients were identified with a diagnosis of IHD (ICD-9-CM codes). Index events of CABG or PCI were identified from April 1, 1998 to March 31, 2003. Outcomes were depression or dementia after the index event. Patients were followed forward to March 31, 2006 or until censored. Proportional hazards regression analysis was undertaken. Independent variables examined were age, sex, diabetes, hypertension and income quintile, medical management alone for IHD, or intervention by PCI or CABG. Age, sex, diabetes, and presence of hypertension were all strongly associated with the diagnosis of depression and dementia. There was no association with income quintile. Dementia was less frequent with PCI compared to medical management; (HR = 0.65; p = 0.017). CABG did not provide the same protective effect compared to medical management (HR = 0.90; p = 0.372). New diagnosis depression was more frequent with interventional approaches: PCI (n = 626; hazard ratio = 1.25; p = 0.028) and CABG (n = 1124, HR = 1.32; p = 0.0001) than non-interventional patients (n = 34,508). Subsequent CABG was nearly 16-fold higher (p<0.0001) and subsequent PCI was 22-fold higher (p<0.0001) for PCI-managed than CABG-managed patients. CONCLUSIONS: Patients managed with PCI had the lowest likelihood of dementia-only 65% of the risk for medical management alone. Both interventional approaches were associated with a higher risk of new diagnosed depression compared to medical management. Long-term myocardial revascularization was superior with CABG. These findings suggest that PCI may confer a long-term protective effect from dementia. The mechanism(s) of dementia protection requires elucidation.","Aged;Algorithms;*Angioplasty, Balloon, Coronary/statistics & numerical data;*Coronary Artery Bypass/statistics & numerical data;Dementia/complications/epidemiology/etiology/*therapy;Depressive Disorder/complications/epidemiology/etiology/*therapy;*Drug Therapy/methods/statistics & numerical data;Female;Humans;Hypertension/complications/epidemiology;Male;Middle Aged;Myocardial Ischemia/complications/epidemiology/rehabilitation/*therapy;Risk Factors;Treatment Outcome","Mutch, W. A.;Fransoo, R. R.;Campbell, B. I.;Chateau, D. G.;Sirski, M.;Warrian, R. K.",2011,Feb 28,10.1371/journal.pone.0017457,0,
3118,Sinus arrest as a result of rivastigmine in an elderly dementia with Lewy bodies patient,,furosemide;prednisolone;rivastigmine;aged;arterial oxygen tension;cardiomegaly;case report;continuous hemodiafiltration;diffuse Lewy body disease;drug withdrawal;echocardiography;electrocardiography;electrocardiography monitoring;female;heart failure;heart left bundle branch block;human;hypoxia;intubation;kidney failure;laboratory test;letter;lung congestion;priority journal;pulse oximetry;rheumatic polymyalgia;sinus arrest;sinus rhythm;thorax radiography;treatment outcome;very elderly,"Muto, S.;Kawano, H.;Nakatomi, D.;Yamasa, T.;Maemura, K.",2015,,,0,
3119,Regulation of the activity of caspases by L-carnitine and palmitoylcarnitine,"L-Carnitine facilitates the transport of fatty acids into the mitochondrial matrix where they are used for energy production. Recent studies have shown that L-carnitine is capable of protecting the heart against ischemia/reperfusion injury and has beneficial effects against Alzheimer's disease and AIDS. The mechanism of action, however, is not yet understood. In the present study, we found that in Jurkat cells, L-carnitine inhibited apoptosis induced by Fas ligation. In addition, 5 mM carnitine potently inhibited the activity of recombinant caspases 3, 7 and 8, whereas its long-chain fatty acid derivative palmitoylcarnitine stimulated the activity of all the caspases. Palmitoylcarnitine reversed the inhibition mediated by carnitine. Levels of carnitine and palmitoyl-CoA decreased significantly during Fas-mediated apoptosis, while palmitoylcarnitine formation increased. These alterations may be due to inactivation of β-oxidation or to an increase in the activity of the enzyme that converts carnitine to palmitoylcarnitine, carnitine palmitoyltransferase I (CPT I). In support of the latter possibility, fibroblasts deficient in CPT I activity were relatively resistant to staurosporine-induced apoptosis. These observations suggest that caspase activity may be regulated in part by the balance of carnitine and palmitoylcarnitine. Copyright (C) 2000 Federation of European Biochemical Societies.",acetylcarnitine;carnitine;carnitine palmitoyltransferase;carnitine palmitoyltransferase I;caspase;caspase 3;caspase 7;caspase 8;Fas ligand;palmitoyl coenzyme A;palmitoylcarnitine;recombinant enzyme;staurosporine;unclassified drug;acquired immune deficiency syndrome;Alzheimer disease;apoptosis;article;cell fractionation;cell protection;concentration response;controlled study;drug antagonism;drug mechanism;energy metabolism;enzyme activity;enzyme regulation;fatty acid oxidation;fibroblast;heart muscle ischemia;human;human cell;leukemia cell line;mitochondrion;polyacrylamide gel electrophoresis;priority journal;reperfusion injury,"Mutomba, M. C.;Yuan, H.;Konyavko, M.;Adachi, S.;Yokoyama, C. B.;Esser, V.;McGarry, J. D.;Babior, B. M.;Gottlieb, R. A.",2000,,,0,
3120,Acute humanin therapy attenuates myocardial ischemia and reperfusion injury in mice,"OBJECTIVE: Humanin (HN), an endogenous antiapoptotic peptide, has previously been shown to protect against Alzheimer's disease and a variety of cellular insults. We evaluated the effects of a potent analog of HN (HNG) in an in vivo murine model of myocardial ischemia and reperfusion. METHODS AND RESULTS: Male C57BL6/J mice (8 to 10 week old) were subjected to 45 minutes of left coronary artery occlusion followed by a 24-hour reperfusion. HNG or vehicle was administered IP 1 hour prior or at the time of reperfusion. The extent of myocardial infarction per area-at-risk was evaluated at 24 hours using Evans Blue dye and 2-3-5-triphenyl tetrazolium chloride staining. Left ventricular function was evaluated at 1 week after ischemia using high-resolution, 2D echocardiography (VisualSonics Vevo 770). Myocardial cell signaling pathways and apoptotic markers were assessed at various time points (0 to 24 hours) following reperfusion. Cardiomyocyte survival and apoptosis in response to HNG were assessed in vitro. HNG reduced infarct size relative to the area-at-risk in a dose-dependent fashion, with a maximal reduction at the dose of 2 mg/kg. HNG therapy enhanced left ventricular ejection fraction and preserved postischemic left ventricular dimensions (end-diastolic and end-systolic), resulting in improved cardiac function. Treatment with HNG significantly increased phosphorylation of AMPK and phosphorylation of endothelial nitric oxide synthase in the heart and attenuated Bcl-2-associated X protein and B-cell lymphoma-2 levels following myocardial ischemia and reperfusion. HNG improved cardiomyocyte survival and decreased apoptosis in response to daunorubicin in vitro. CONCLUSIONS: These data show that HNG provides cardioprotection in a mouse model of myocardial ischemia and reperfusion potentially through activation of AMPK-endothelial nitric oxide synthase-mediated signaling and regulation of apoptotic factors. HNG may represent a novel agent for the treatment of acute myocardial infarction.","AMP-Activated Protein Kinases/metabolism;Animals;Apoptosis/drug effects;Cell Survival/drug effects;Intracellular Signaling Peptides and Proteins/metabolism;Male;Mice;Mice, Inbred C57BL;Myocardial Ischemia/*drug therapy/pathology/physiopathology;Myocardial Reperfusion Injury/*drug therapy/pathology/physiopathology;Myocytes, Cardiac/drug effects/pathology;Nitric Oxide Synthase Type III/metabolism;Peptides/*therapeutic use;Signal Transduction/drug effects;bcl-2-Associated X Protein/metabolism","Muzumdar, R. H.;Huffman, D. M.;Calvert, J. W.;Jha, S.;Weinberg, Y.;Cui, L.;Nemkal, A.;Atzmon, G.;Klein, L.;Gundewar, S.;Ji, S. Y.;Lavu, M.;Predmore, B. L.;Lefer, D. J.",2010,Oct,10.1161/atvbaha.110.205997,0,
3121,Atrial fibrillation and cognitive function in patients with heart failure: a systematic review and meta-analysis,"Cognitive impairment and dementia are established complications of heart failure (HF) in adult patients and impair medication adherence and self-care. Atrial fibrillation (AF) is suggested to play an independent role in the cognitive decline in patients with HF. The objective of this systematic review was to assess the effect of AF on cognitive function in these patients. Medline (PubMed), Scopus, and the CENTRAL databases were queried from their inception up to April 30, 2016. The search included primary research articles evaluating the effect of AF on cognition in HF patients. There were five eligible studies, including a total of 1670 patients with HF; of these, 449 (26.9%) had AF. Different AF types were studied, including persistent, paroxysmal, or permanent. Four cognitive tests were used to assess cognitive function (Mini-Mental State Examination, Short Portable Mental Status Questionnaire, Modified Mini-Mental Examination, and Montreal cognitive assessment tool). Using the inverse variance method and a random effects model, we observed that presence of AF was significantly associated with increased risk of cognitive impairment in HF patients (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.30-2.87), although with significant heterogeneity (I 2 = 39%). This heterogeneity can be attributed to the different populations and types of AF studied as well as to varying cognitive assessment methods. Concomitant AF may exacerbate cognitive dysfunction in HF patients. However, data are sparse and heterogeneous. Well-designed, prospective studies are needed to (a) establish a causative link and (b) identify the underlying mechanism in order to design appropriate interventions to attenuate risk of cognitive impairment in patients with HF.",Atrial fibrillation;Cognitive impairment;Heart failure;Meta-analysis;Systematic review,"Myserlis, P. G.;Malli, A.;Kalaitzoglou, D. K.;Kalaitzidis, G.;Miligkos, M.;Kokkinidis, D. G.;Kalogeropoulos, A. P.",2017,Jan,,0,
3122,Phenomenological aspects of depressive disorder in patients with cerebrovascular disease,,article;cardiovascular risk;cerebrovascular disease;cognition;dementia;depression;Diagnostic and Statistical Manual of Mental Disorders;disease association;follow up;heart function;heart infarction;high risk population;human;multiinfarct dementia;phenomenology;cerebrovascular accident,"Naarding, P.",2007,,,0,
3123,Diabetes in the United Kingdom: A personal series,"A personal series of 6780 patients with diabetes mellitus is reported. Of these 1410 were thought to have insulin-dependent (Type 1) diabetes and 4926 non-insulin-dependent (Type 2) diabetes. Among the former, 128 patients were only diagnosed when in severe ketoacidosis or coma. In 116 patients the diabetes was diagnosed in pregnancy. Chronic alcoholism was an aetiological factor in 75 patients; in 52 it led to the diagnosis being made, and it complicated treatment in 129 additional patients. In the patients with Type 2 diabetes whose treatment was stabilized 23.5% were having insulin injections, 44.5% tablets, and 32.0% diet only. Sight-threatening retinopathy developed in 21.3% of patients with Type 1 and 7.9 % of those with Type 2 diabetes. The rate of developing sight-threatening retinopathy was 1.1% of patients per year. Blindness occurred in 0.28% of patients with Type 1 diabetes per year and 0.097% per year in Type 2 diabetes. If the mean survival of patients with retinopathy going blind is 7.5 years, this would mean 7500 people in the UK blind from diabetic retinopathy. There was a striking drop in the annual incidence of blindness after 1970 coinciding with the introduction of specific treatment for diabetic retinopathy. Juvenile cataract developed in 1.7% of patients who developed Type 1 diabetes before 30 years of age. Clinically important diabetic neuropathy developed in 17.4% of patients with Type 1 and 11.6% of those with Type 2 diabetes. The main features were paraesthesiae and numbness (49%), neuropathic ulceration (37%), pain (5%), autonomic symptoms (5%), and amyotrophy (4%). Oculomotor palsies and mononeuropathies were noted. Foot ulceration occurred in 81 patients with Type 1 and 279 of those with Type 2 diabetes. Charcot changes in the feet were noted in 21 patients. Major amputations were needed in 18 patients with Type 1 and 60 with Type 2 diabetes. Proteinuria believed to be due to diabetic nephropathy developed in 12.8% of patients with Type 1 and 4.7% of those with Type 2 diabetes. The prevalence of early renal failure was 4.6% and 1.4%, respectively. Coronary artery disease was noted in 9% of patients with Type 1 diabetes, and was more common in those who developed diabetes after 20 years of age. Myocardial infarction was as common in women as in men. In Type 2 diabetes coronary artery disease gave rise to symptoms in 19.1%, and myocardial infarction was more common in men. Cerebrovascular disease occurred in 2.6% of patients with Type 1 diabetes, and in 10 patients led to the development of multi-infarct dementia after 24-52 years. It developed in 7.7% of patients with Type 2 diabetes and in three it presented with hemiplegia noted on recovery from anaesthesia for surgery. One hundred and twenty-nine patients with Type 1 diabetes are known to have died, 46 from coronary artery disease and 28 from renal failure. Of the patients with Type 2 diabetes 574 are known to have died, 291 from coronary artery disease, 97 from malignant disease, 79 from cerebrovascular disease and 22 from renal failure.",adolescent;adult;aged;article;child;diabetic nephropathy;diabetic neuropathy;female;human;insulin dependent diabetes mellitus;major clinical study;male;mortality;non insulin dependent diabetes mellitus;priority journal;United Kingdom,"Nabarro, J. D. N.",1991,,,0,
3124,Neurotoxicity of general anaesthesia is hypothetical,,acute kidney tubule necrosis;Alzheimer disease;anesthesist;cerebrovascular accident;coronary artery disease;follow up;general anesthesia;heart infarction;heart surgery;inflammation;neurotoxicity;off pump coronary surgery;oximetry;pain;percutaneous coronary intervention;perioperative period;postoperative cognitive dysfunction;postoperative delirium;postoperative period;priority journal;quality of life;randomized controlled trial (topic);regional anesthesia;stress,"Nadelson, M. R.;Sanders, R. D.;Avidan, M. S.",2015,,,0,
3125,Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke: Pushing the boundaries,"BACKGROUND AND PURPOSE - : If magnetic resonance imaging (MRI) is to compete with computed tomography for evaluation of patients with acute ischemic stroke, there is a need for further improvements in acquisition speed. METHODS - : Inclusion criteria for this prospective, single institutional study were symptoms of acute ischemic stroke within 24 hours onset, National Institutes of Health Stroke Scale ≥3, and absence of MRI contraindications. A combination of echo-planar imaging (EPI) and a parallel acquisition technique were used on a 3T magnetic resonance (MR) scanner to accelerate the acquisition time. Image analysis was performed independently by 2 neuroradiologists. RESULTS - : A total of 62 patients met inclusion criteria. A repeat MRI scan was performed in 22 patients resulting in a total of 84 MRIs available for analysis. Diagnostic image quality was achieved in 100% of diffusion-weighted imaging, 100% EPI-fluid attenuation inversion recovery imaging, 98% EPI-gradient recalled echo, 90% neck MR angiography and 96% of brain MR angiography, and 94% of dynamic susceptibility contrast perfusion scans with interobserver agreements (k) ranging from 0.64 to 0.84. Fifty-nine patients (95%) had acute infarction. There was good interobserver agreement for EPI-fluid attenuation inversion recovery imaging findings (k=0.78; 95% confidence interval, 0.66-0.87) and for detection of mismatch classification using dynamic susceptibility contrast-Tmax (k=0.92; 95% confidence interval, 0.87-0.94). Thirteen acute intracranial hemorrhages were detected on EPI-gradient recalled echo by both observers. A total of 68 and 72 segmental arterial stenoses were detected on contrast-enhanced MR angiography of the neck and brain with k=0.93, 95% confidence interval, 0.84 to 0.96 and 0.87, 95% confidence interval, 0.80 to 0.90, respectively. CONCLUSIONS - : A 6-minute multimodal MR protocol with good diagnostic quality is feasible for the evaluation of patients with acute ischemic stroke and can result in significant reduction in scan time rivaling that of the multimodal computed tomographic protocol. © 2014 American Heart Association, Inc.",tissue plasminogen activator;adult;aged;artery occlusion;article;brain hemorrhage;brain ischemia;clinical protocol;contrast enhancement;diffusion weighted imaging;echo planar imaging;endovascular surgery;evaluation study;female;follow up;human;image analysis;image quality;magnetic resonance angiography;major clinical study;male;mental deterioration;National Institutes of Health Stroke Scale;neuroimaging;neurologist;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;priority journal;prospective study;radiologist;recanalization,"Nael, K.;Khan, R.;Choudhary, G.;Meshksar, A.;Villablanca, P.;Tay, J.;Drake, K.;Coull, B. M.;Kidwell, C. S.",2014,,,0,
3126,"Visit-to-visit blood pressure variability, silent cerebral injury, and risk of stroke","Apart from the well-known role of hypertension in cerebrovascular disease, visit-to-visit blood pressure (BP) variability is emerging as an independent risk factor for stroke. Although the underlying mechanism is not fully understood, artery remodeling is thought to be closely involved in the relationship between visit-to-visit BP variability and stroke. This review article summarizes the recent literature on these topics. Silent cerebral injury is considered to serve as a common pathophysiology in the relationship of visit-to-visit BP variability with cognitive impairment and stroke. Here we review visit-to-visit BP variability, some comparisons of the effects of antihypertensive agents on visit-to-visit BP variability, and an issue regarding the impact of these agents on stroke. © American Journal of Hypertension, Ltd 2013.",acetylsalicylic acid;amlodipine;angiotensin receptor antagonist;antihypertensive agent;atenolol;beta adrenergic receptor blocking agent;calcium channel blocking agent;cilostazol;dipeptidyl carboxypeptidase inhibitor;diuretic agent;lacidipine;placebo;algorithm;ankle brachial index;antihypertensive therapy;arterial stiffness;article;atherosclerosis;blood pressure measurement;blood pressure monitor;blood pressure variability;brain blood flow;brain hemorrhage;brain injury;brain ischemia;brain size;cardiovascular disease;cardiovascular mortality;cardiovascular risk;carotid atherosclerosis;cerebrovascular accident;cognitive defect;dementia;diastolic blood pressure;drug efficacy;heart failure;heart infarction;high risk patient;hypertension;ischemic heart disease;meta analysis (topic);multiinfarct dementia;neuroimaging;nuclear magnetic resonance imaging;outcome assessment;pathophysiology;priority journal;prognosis;randomized controlled trial (topic);risk assessment;risk reduction;secondary prevention;systematic review (topic);systolic blood pressure;transient ischemic attack;white matter lesion;aspirin,"Nagai, M.;Kario, K.",2013,,,0,
3127,Design of novel anti-oxidative nanomedicine for ischemia-reperfusion injury,"Reactive oxygen species (ROS) are highly reactive molecules containing oxygen, which cause strong oxidative damage to lipid, protein, nucleic acid, etc. Excessive generation of ROS in the biological system leads to an increase in oxidative stress, which is a possible risk factor for systemic diseases such as arteriosclerosis, diabetes, renal failure, Alzheimer's disease, and myocardial infarction. ROS scavenging activity has become important to suppress the aggravation of local inflammation, as well as to prevent the progression of systemic diseases via penetration of ROS from the site of inflammation. Nitroxide radical compounds such as 2,2,6,6-tetramethylpiperidine-N-oxyl (TEMPO) catalytically scavenge ROS such as superoxide anion and hydroxyl radical and prevent the propagation of an ROS-dependent reaction. However, the diffusion of low-molecular-weight (LMW) compounds in the entire body is one of the most important factors that cause various adverse effects. For example, normal ATP-based energy would not be obtained if the mitochondrial electron transport chain is inhibited by LMW antioxidants such as TEMPO. To address these issues, we have focused on redox polymer therapeutics as a key form of nanomedicine, viz., we have developed a nitroxide-radical-containing nanoparticle (RNPN), a core-shell type of self-assembling polymeric micelle using poly(ethylene glycol)-b-poly[4-(2,2,6,6-tetramethylpiperidine-N-oxyl)aminomethylstyrene] (PEG-b-PMNT) diblock copolymer in aqueous media. The developed RNPN had a suppressive effect on oxidative stress in an in vitro study, and showed a therapeutic effect against cerebral and myocardial ischemia reperfusion injuries and intracerebral hemorrhage after intravenous administration. It should be noted that RNPN tends to avoid non-specific diffusion of nitroxide radicals to the entire body, especially important electron-transporting systems in the mitochondria.",reactive oxygen metabolite;tempol;Alzheimer disease;arteriosclerosis;article;brain hemorrhage;diabetes mellitus;disease course;electron transport;heart infarction;human;inflammation;kidney failure;nanomedicine;oxidative stress;reperfusion injury;risk factor,"Nagasaki, Y.",2015,,,0,
3128,Health-related factors associated with hospitalization for old people: Comparisons of elderly aged 85 in a population cohort study,"The aim of this population-based study was to (1) describe living conditions and actual health care utilization among 85 year olds; (2) determine factors that affect hospital admissions in this age. The study was conducted on 85-year-old residents in Linköping municipality, Sweden. The data collected included medical records, health care utilization during the preceding 12 months and a postal questionnaire on assistance, assistive technology, functional impairment, feelings of loneliness, worries and health-related quality of life measured by the EQ-5D. Out of 650 eligible individuals, 496 (78% of those alive) participated. Despite the prevalence of multi-morbidity (68%) and mental discomfort, the majority managed self-care (85%), usual activities (74%) and had high (>60/100) self-rated health evaluated by a visual analog scale (VAS). The non-hospitalized group reported a better health status than the hospitalized group in terms of medical aspects, living conditions and subjective estimation. Factors associated with in-patient care were an increased number of general practitioner visits, more assistive technology, community assistance, multimorbidity and/or diagnosed congestive heart failure and arrhythmia. © 2011 Elsevier Ireland Ltd.",diuretic agent;glyceryl trinitrate;warfarin;aged;aging;anxiety;article;assistive technology device;asthma;attitude to illness;chronic disease;chronic obstructive lung disease;cohort analysis;community living;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;emergency ward;exercise;fear;female;general practitioner;health care utilization;health service;health status;hearing impairment;heart arrhythmia;hospital admission;hospital care;hospitalization;human;hyperlipidemia;hypertension;hypothyroidism;insomnia;loneliness;major clinical study;male;mental health;mood disorder;morbidity;neoplasm;osteoarthritis;osteoporosis;pain;population research;prescription;prevalence;primary medical care;priority journal;quality of life;self care;self concept;social support;social welfare;cerebrovascular accident;Sweden;technical aid;urine incontinence;visual analog scale;visual impairment,"Nägga, K.;Dong, H. J.;Marcusson, J.;Skoglund, S. O.;Wressle, E.",2012,,,0,
3129,QnAs with Bruce M. Spiegelman,,peroxisome proliferator activated receptor gamma;peroxisome proliferator activated receptor gamma coactivator 1alpha;pioglitazone;Prdm16 protein;rosiglitazone;transcription factor;unclassified drug;adipocyte;biogenesis;brown adipose tissue;cell function;cell transformation;degenerative disease;diabetes mellitus;drug safety;drug use;drug withdrawal;energy balance;Europe;fibroblast;gene inactivation;heart infarction;human;Huntington chorea;knockout gene;lipid metabolism;muscle cell;neuroprotection;note;obesity;Parkinson disease;priority journal;protein phosphorylation;tissue engineering;United States;white adipose tissue;actos;avandia,"Nair, P.",2011,,,0,
3130,Clinical significance of lung iodine-123 metaiodobenzylguanidine uptake assessment in Parkinson's and heart diseases,"Objective: Decreased heart iodine-123 metaiodobenzylguanidine ( 123I-MIBG) uptake [heart-to-mediastinum count ratio (H/M)] is reported in heart disease (HD) or Lewy body disease (LBD). When LBD is merged, therefore, information regarding HD severity may be ambiguous. We aimed to examine whether lung 123I-MIBG uptake [lung-to-mediastinum count ratio (L/M)] assessment might be useful for differentiating two clinical conditions of HD and LBD, and to investigate whether L/M could reflect the grade of left ventricular (LV) dysfunction. Methods: Three groups were examined: LBD (patient group with Parkinson's disease or dementia with Lewy bodies, n = 33), PS (group with other Parkinsonian syndromes, n = 20) and HD (group with heart disease). HD consisted of 4 subgroups: HD(I) [H/M(<2.30)-matched group with LBD, n = 34), HD(II) [H/M(≥2.30)-matched group with PS, n = 33], HD(III) [group for functional analysis, LV ejection fraction, first-third and peak filling rates (1/3FR and PFR) and time to PFR were calculated using gated SPECT, n = 35] and HD(IV) (group for examining cardiac prognosis, follow-up period of 1283 ± 506 days, n = 54). Using Doppler echocardiography, a diastolic parameter E/e′ and pulmonary artery pressure (ePAP) were estimated. Results: H/Ms did not differ between HD(I) and LBD, or between PS and HD(II). However, L/Ms were increased in the order of LBD, PS, HD(II) and HD(I) groups. In combined LBD, PS, HD(I) and HD(II), L/Ms correlated positively with a diastolic parameter E/e′. L/Ms correlated with ePAP, while H/Ms did not. H/Ms correlated with a systolic parameter EF (r = 0.56) and diastolic parameters 1/3FR (r = 0.51) and PFR (r = 0.51), and L/Ms correlated with diastolic parameters 1/3FR (r = -0.36) and PFR (r = -0.36) but not with EF in HD(III). Kaplan-Meier analysis showed earlier cardiac death in patients with decreased H/Ms, but not in patients with increased L/Ms in HD(IV). Conclusions: Our study suggest that increased lung 123I-MIBG uptake is useful as a reference marker for differentiating two clinical conditions of HD and LBD, and can reflect the degree of LV diastolic dysfunction. Elevated ePAP caused by LV diastolic dysfunction may be involved in the mechanism(s) of increased lung uptake. © 2013 The Japanese Society of Nuclear Medicine.",(3 iodobenzyl)guanidine i 123;aged;article;diastolic dysfunction;diffuse Lewy body disease;Doppler echocardiography;female;follow up;gated single photon emission computed tomography;heart disease;heart function;heart left ventricle ejection fraction;human;Kaplan Meier method;lung artery pressure;major clinical study;male;Parkinson disease;parkinsonism;priority journal;radiological parameters;single photon emission computer tomography,"Nakae, I.;Hayashi, H.;Mitsunami, K.;Horie, M.",2013,,,0,
3131,Long-term effect of galantamine on cognitive function in patients with Alzheimer’s disease versus a simulated disease trajectory: An observational study in the clinical setting,"Background: Long-term maintenance of cognitive function is an important goal of treatment for Alzheimer’s disease (AD), but evidence about the long-term efficacy of cholinesterase inhibitors is sparse. To evaluate the long-term efficacy and safety of galantamine for AD in routine clinical practice, we conducted a 72-week post-marketing surveillance study. The effect of galantamine on cognitive function was estimated in comparison with a simulated disease trajectory. Patients and methods: Patients with mild-to-moderate AD received flexible dosing of galantamine (16–24 mg/day) during this study. Cognitive function was assessed by the mini mental state examination (MMSE) and the clinical status was determined by the Clinical Global Impression-Improvement (CGI-I). Changes of the MMSE score without treatment were estimated in each patient using Mendiondo’s model. Generalized linear mixed model analysis was performed to compare the simulated MMSE scores with the actual scores. Results: Of the 661 patients who were enrolled, 642 were evaluable for safety and 554 were assessed for efficacy. The discontinuation rate was 46.73%. Cognitive decline indicated by the mean change of actual MMSE scores was significantly smaller than the simulated decline. Individual analysis demonstrated that >70% of patients had better actual MMSE scores than their simulated scores. Significant improvement of CGI-I was also observed during the observation period. Adverse events occurred in 28.5% of patients and were serious in 8.41%. The reported events generally corresponded with the safety profile of galantamine in previous studies. Conclusion: These findings support the long-term efficacy of galantamine for maintaining cognitive function and the clinical state in AD patients. Treatment with galantamine was generally safe. Importantly, this study revealed that galantamine improved cognitive function above the predicted level in >70% of the patients.",galantamine;acute heart infarction;acute kidney failure;adult;aged;Alzheimer disease;article;bronchopneumonia;cognition;female;human;major clinical study;male;Mini Mental State Examination;multicenter study;observational study;postmarketing surveillance;stomach cancer,"Nakagawa, R.;Ohnishi, T.;Kobayashi, H.;Yamaoka, T.;Yajima, T.;Tanimura, A.;Kato, T.;Yoshizawa, K.",2017,,10.2147/ndt.s133145,0,
3132,Early catheter removal following transurethral prostatectomy: A study of 431 patients,"Objectives: To assess and review catheter removal on the first day after transurethral prostatectomy. Subjects and Methods: The study included 431 consecutive patients who underwent transurethral prostatectomy between 2000 and 2003 at a Scarborough General Hospital, Toronto, Canada. The equipment used was a standard resectoscope with a regular loop. No roller ball or other gadget was used. The cutting and coagulation electrical variables were standard at 160 and 60 W for the generator used. The decision to remove the catheters was based on normal vital signs, adequate urine output, absence of clots and acceptable color of the catheter effluent. Results: Catheters were removed in 415 (96.3%) patients on postoperative day 1. Of the 415 patients 332 (80.0%) were discharged on the same day. The criteria for catheter removal on postoperative day 1 were not met in 16 (3.7%) patients and the mean indwelling catheter time was 4.8 ± 2.4 days and the mean length of hospital stay after surgery was 6.2 ± 3.3 days. For the entire group, the mean indwelling catheter time was 1.1 ± 0.8 days and the mean length of hospital stay after surgery was 1.6 ± 1.5 days. Risk factors which predicted delayed removal were age, postoperative bleeding and several comorbidities, that is coronary heart disease, renal insufficiency and Alzheimer's disease. Conclusions: Removal of the catheter on the first postoperative day after transurethral prostatectomy seems to be feasible, safe and cost-effective without increasing significant morbidity in selected patients. Copyright © 2006 S. Karger AG.",aged;article;bleeding;Canada;catheter removal;comorbidity;cost effectiveness analysis;hospital discharge;hospitalization;human;indwelling catheter;ischemic heart disease;major clinical study;male;morbidity;postoperative period;prostatectomy;safety;time series analysis;transurethral resection,"Nakagawa, T.;Toguri, A. G.",2006,,,0,
3133,Overview of Regular Dialysis Treatment in Japan (as of 31 December 2009),"A nationwide statistical survey of 4196 dialysis facilities was conducted at the end of 2009, and 4133 facilities (98.5%) responded. The number of patients undergoing dialysis at the end of 2009 was determined to be 290661, an increase of 7240 patients (2.6%) compared with that of 2008. The number of dialysis patients per million at the end of 2009 was 2279.5. The crude death rate of dialysis patients from the end of 2008 to the end of 2009 was 9.6%. The mean age of the new patients introduced into dialysis was 67.3years old and the mean age of the entire dialysis patient population was 65.8years old. Primary diseases such as diabetic nephropathy and chronic glomerulonephritis for new dialysis patients, showed a percentage of 44.5% and 21.9%, respectively. Based on the facilities surveyed, 84.2% of the facilities that responded to the questionnaire satisfied the microbiological quality standard for dialysis fluids for the Japanese Society for Dialysis Therapy (JSDT), with an endotoxin concentration of less than 0.05EU/mL in the dialysis fluid. Similarly, 98.2% of the facilities surveyed satisfied another standard of the society of a bacterial count of less than 100cfu/mL in the dialysis fluid. The facility survey indicated that the number of patients who were treated by blood purification by both peritoneal dialysis and extracorporeal circulation, such as hemodialysis, was 1720. Among the total number of patients, 24.8% were satisfied with the management target recommended in the treatment guidelines for secondary hyperparathyroidism. These standards are set by the JSDT, based on the three parameters, i.e. serum calcium concentration, serum phosphorus concentration, and serum intact parathyroid hormone concentration. According to the questionnaire, 9.8% of the patients were considered to have a complication of dementia. © 2012 The Authors. Therapeutic Apheresis and Dialysis © 2012 International Society for Apheresis.",calcium;calcium carbonate;cinacalcet;dialysis fluid;endotoxin;lanthanum carbonate;parathyroid hormone;phosphate binding agent;phosphorus;sevelamer;vitamin D;article;bacterial count;bleeding;body height;cachexia;calcium blood level;cause of death;cerebrovascular disease;chronic glomerulonephritis;chronic hepatitis;chronic pyelonephritis;daily life activity;dementia;diabetic nephropathy;extracorporeal circulation;health survey;heart failure;heart infarction;hemodialysis;human;infection;intestine obstruction;intoxication;Japan;kidney disease;kidney failure;kidney hypoplasia;kidney polycystic disease;kidney tuberculosis;kidney tumor;liver cirrhosis;lung embolism;lupus erythematosus nephritis;malignant hypertension;malignant neoplastic disease;mortality;myeloma;nephrolithiasis;nephrosclerosis;parathyroid hormone blood level;patient satisfaction;peritoneal dialysis;pregnancy toxemia;priority journal;questionnaire;secondary hyperparathyroidism;survival rate;uremia;urinary tract disease;urinary tract tumor;urogenital tuberculosis;urolithiasis,"Nakai, S.;Iseki, K.;Itami, N.;Ogata, S.;Kazama, J. J.;Kimata, N.;Shigematsu, T.;Shinoda, T.;Shoji, T.;Suzuki, K.;Taniguchi, M.;Tsuchida, K.;Nakamoto, H.;Nishi, H.;Hashimoto, S.;Hasegawa, T.;Hanafusa, N.;Hamano, T.;Fujii, N.;Masakane, I.;Marubayashi, S.;Morita, O.;Yamagata, K.;Wakai, K.;Wada, A.;Watanabe, Y.;Tsubakihara, Y.",2012,,,0,
3134,Standardization of nuclear medicine images and data analysis,"In nuclear medicine, standardization of quantitative evaluation is important for providing reliable and stable results, and a number of quantitative parameters have been used to evaluate physiology and pathophysiology of organ functions. As a quantitative measure of hot spots in bone scintigraphy, bone scan index (BSI) was introduced and has been increasingly used as a biomarker of the amount of bone metastasis. In nuclear cardiology, standardization among software programs is particularly important, since a number of parameters including myocardial perfusion defect and cardiac function such as ejection fraction, ventricular volumes, and diastolic function are calculated. Recently phase analysis is introduced in various software programs to quantify dyssynchrony of contraction timing, and its characteristics and usefulness have been under investigation. 123I-meta-iodobenzylguanidine (MIBG) sympathetic imaging and parameters have also been standardized and applied to neurology for Lewy-body diseases and to chronic heart failure for prognostication.",(3 iodobenzyl)guanidine i 123;article;bone metastasis;bone scintiscanning;data analysis;diffuse Lewy body disease;heart ejection fraction;heart failure;heart muscle perfusion;heart ventricle volume;nuclear medicine;quantitative analysis;software;standardization,"Nakajima, K.",2016,,,0,
3135,Cross calibration of 123I-meta-iodobenzylguanidine heart-to-mediastinum ratio with D-SPECT planogram and Anger camera,"Background: Cardiac 123I-meta-iodobenzylguanidine (MIBG) uptake is quantified using the heart-to-mediastinum ratio (HMR) with an Anger camera. The relationship between HMR determined using D-SPECT with a cadmium–zinc–telluride detector and an Anger camera is not fully understood. Therefore, the present study aimed to define this relationship using images derived from a phantom and from patients. Methods: Cross-calibration phantom studies using an Anger camera with a low-energy high-resolution (LEHR) collimator and D-SPECT, and clinical 123I-MIBG studies proceeded in 40 consecutive patients (80 studies). In the phantom study, a conversion coefficient (CC) was defined based on phantom experiments and applied to the Anger camera and the D-SPECT detector. The HMR was calculated using anterior images with the Anger camera and anterior planograms with D-SPECT. First, the HMR from D-SPECT was cross-calibrated to the Anger camera, and then, the HMR from both cameras were converted to the medium-energy general-purpose collimator condition (CC 0.88; ME88 condition). The relationship between HMR and corrected and uncorrected methods was examined. A 123I-MIBG washout rate was calculated using both methods with and without background subtraction. Results: Based on the phantom experiments, the CC of the Anger camera with an LEHR collimator and of D-SPECT using an anterior planogram was 0.55 and 0.63, respectively. The original HMR from the Anger camera and D-SPECT was 1.76 ± 0.42 and 1.86 ± 0.55, respectively (p < 0.0001). After D-SPECT HMR was converted to the Anger camera condition, the corrected D-SPECT HMR became comparable to the values under the Anger camera condition (1.75 ± 0.48, p = n. s.). When the HMR measured using the two cameras were converted under the ME88 condition, the average standardized HMR from the Anger camera and D-SPECT became comparable (2.21 ± 0.65 vs. 2.20 ± 0.75, p = n. s.). After standardization to the ME88 condition, a systematic difference in the linear regression lines disappeared, and the HMR from both the Anger (StdHMRAnger) and D-SPECT (StdHMRDSPECT) became comparable. Additional correction using a regression line further improved the relationship between both HMR [StdHMRDSPECT = 0.09 + 0.98 × StdHMRAnger (R2 = 0.91)]. The washout rate closely correlated with and without background correction between both methods (R2 = 0.83 and 0.65, respectively). Conclusion: The phantom-based conversion method is applicable to D-SPECT and enables the common application of HMR irrespective of D-SPECT and the Anger camera.",(3 iodobenzyl)guanidine i 123;myomibg;aged;anger camera;article;calibration;cardiovascular parameters;clinical article;clinical study;collimator;diffuse Lewy body disease;female;heart failure;heart to mediastinum ratio;human;image quality;male;phantom;priority journal;retrospective study;single photon emission computed tomography;standardization,"Nakajima, K.;Okuda, K.;Yokoyama, K.;Yoneyama, T.;Tsuji, S.;Oda, H.;Yoshita, M.;Kubota, K.",2017,,10.1007/s12149-017-1191-2,0,
3136,Quetiapine-induced Bradycardia and Hypotension in the Elderly-A Case Report,"Quetiapine is increasingly used for the treatment of behavioral and psychological symptoms of dementia in elderly patients. Among the many potential side effects of second-generation antipsychotics, the sudden onset of cardiac abnormality is a particularly important side effect to consider due its fatal implications. Elderly patients may be particularly vulnerable to these cardiac-related side effects due to the likelihood that they have multiple existing health conditions (e.g., heart disease, high blood pressure, diabetes) as well as age-related changes in their pharmacokinetics and pharmacodynamics and differences in their receptor binding profiles. We present a case of an elderly man with a history of heart disease who developed symptomatic bradycardia and hypotension simultaneously while taking quetiapine. After dose reduction and withdrawal of quetiapine, a time sequential improvement of bradycardia and hypotension monitored by repeated electrocardiogram and blood pressure checks suggests a relationship between the higher dosage of quetiapine and cardiac abnormalities. Other factors such as aging itself and chronic heart failure might be associated with cardiac distress. Elderly patients on quetiapine, particularly at higher dosages, should be continually and closely monitored for any symptoms of cardiac distress.",Quetiapine;bradycardia;hypotension;second generation antipsychotic,"Nakamura, M.;Seki, M.;Sato, Y.;Nagamine, T.",2016,Jan-Feb,,0,3137
3137,Quetiapine-Induced bradycardia and hypotension in the elderly—a case report,"Quetiapine is increasingly used for the treatment of behavioral and psychological symptoms of dementia in elderly patients. Among the many potential side effects of secondgeneration antipsychotics, the sudden onset of cardiac abnormality is a particularly important side effect to consider due its fatal implications. Elderly patients may be particularly vulnerable to these cardiac-related side effects due to the likelihood that they have multiple existing health conditions (e.g., heart disease, high blood pressure, diabetes) as well as age-related changes in their pharmacokinetics and pharmacodynamics and differences in their receptor binding profiles. We present a case of an elderly man with a history of heart disease who developed symptomatic bradycardia and hypotension simultaneously while taking quetiapine. After dose reduction and withdrawal of quetiapine, a time sequential improvement of bradycardia and hypotension monitored by repeated electrocardiogram and blood pressure checks suggests a relationship between the higher dosage of quetiapine and cardiac abnormalities. Other factors such as aging itself and chronic heart failure might be associated with cardiac distress. Elderly patients on quetiapine, particularly at higher dosages, should be continually and closely monitored for any symptoms of cardiac distress.",brotizolam;furosemide;neuroleptic agent;quetiapine;spironolactone;valproic acid;aged;article;behavior;blood pressure;bradycardia;case report;congenital heart disease;dementia;disorientation;drug dose escalation;drug withdrawal;electrocardiogram;heart failure;heart ventricle extrasystole;human;hypotension;insomnia;laboratory test;male;Mini Mental State Examination;physical examination;pulse rate;QTc interval;receptor binding;sinus rhythm;somnolence;thorax radiography,"Nakamura, M.;Seki, M.;Sato, Y.;Nagamine, T.",2016,,,0,
3138,Feasibility and outcomes of surgical therapy in very elderly patients with colorectal cancer,"PURPOSE: Short-term and midterm outcomes of surgery remain unclear in very elderly patients (≥85 y) with colorectal cancer. This study was designed to clarify the safety and therapeutic usefulness of surgery for colorectal cancer in this subgroup of patients. We compared postoperative short-term and midterm outcomes between laparoscopic surgery and open surgery to evaluate the feasibility of laparoscopic surgery in very elderly patients. MATERIALS AND METHODS: The study group comprised 80 patients [38 men (48%) and 42 women (52%)] aged 85 years or older who had colorectal cancer and were treated in our department from 1987 to 2010. The mean age was 87.3±2.3 years, and the median follow-up was 45 months (range, 4 to 252 mo). Sixty-nine patients (86%) were 85 to 89 years old, and 11 (14%) were aged 90 years or older. The American Society of Anesthesiologists' (ASA) risk class was I in 2 patients (2%), II in 44 (55%), and III in 34 (43%). Open surgery was performed in 46 patients (58%), and laparoscopic surgery was performed in 34 patients (42%). RESULTS: The ASA risk class was II or III in 78 patients (98%). Postoperative complications occurred in 21 patients (26%), including ileus in 8 patients (10%), wound infection in 7 (9%), and anastomotic leakage in 3 (4%). As compared with open surgery, laparoscopic surgery had significantly lower intraoperative blood loss (P<0.0001) and a significantly shorter postoperative hospital stay (P=0.0001) but required a significantly longer operation time (P=0.0017). Clinicopathologically, laparoscopic surgery was associated with a significantly smaller tumor size (P=0.0371), significantly fewer dissected lymph nodes (P=0.0181), and significantly fewer patients with stage II or III disease (P=0.0090). Postoperative complications occurred in 14 patients (30%) in the open surgery group and 6 (18%) in the laparoscopic surgery group, but this difference was not significant. As for midterm outcomes, the disease-free survival rate and the overall survival rate were, respectively, 90.9% and 100% in stage I disease, 89.7% and 100% in stage II disease, and 68.4% and 75.9% in stage III disease. CONCLUSIONS: Colorectal surgery was safe, therapeutically useful, and had good short-term and midterm outcomes in very elderly patients with colorectal cancer. As compared with open surgery, laparoscopic surgery was associated with lower intraoperative blood loss and a shorter postoperative hospital stay. These results suggest that laparoscopic surgery is suitable for very elderly patients with colorectal cancer because it is less invasive than open surgery. © 2014 by Lippincott Williams & Wilkins.",carcinoembryonic antigen;aged;anastomosis leakage;article;bleeding;brain infarction;cancer patient;cancer recurrence;cancer surgery;chronic obstructive lung disease;colon resection;colorectal cancer;dementia;diabetes mellitus;disease free survival;feasibility study;female;follow up;heart failure;hospitalization;human;ileus;ischemic heart disease;kidney failure;laparoscopic surgery;liver metastasis;lymph node dissection;major clinical study;male;operation duration;outcome assessment;overall survival;peroperative care;postoperative care;postoperative complication;preoperative complication;priority journal;rectum anterior resection;rectum resection;short course therapy;survival rate;treatment outcome;tumor localization;tumor volume;very elderly;wound infection,"Nakamura, T.;Sato, T.;Miura, H.;Ikeda, A.;Tsutsui, A.;Naito, M.;Ogura, N.;Watanabe, M.",2014,,,0,
3139,Asymptomatic pyuria in diabetic women,"The aim of the present study was to determine the prevalence of and the host factors for asymptomatic pyuria (ASP) in women with type 2 diabetes. The study included 179 type 2 diabetic women and consecutive 455 non-diabetic women attending as out-patients in 1996. Patients with symptoms of a urinary tract infection were excluded. ASP was defined as the presence of more than 10 leukocytes/high-power field in a random urine sample. Diabetic women more often had ASP than non-diabetic women (27.9 vs. 15.8%, P<0.001). The prevalence of ASP was significantly increased in patients with a duration of diabetes exceeding 15 years (0 approximately 4 years; 20.3%, 5 approximately 9 years; 24.3%, 10 approximately 14 years; 23.8%, and > or =15 years; 46.3%). No differences were evident in HbA(1C) between diabetic patients without ASP and those with ASP. Diabetic women with ASP more often had diabetic retinopathy, neuropathy, nephropathy, cerebrovascular disease, ischemic heart disease, and hyperlipidemia than those without ASP. However, no statistically significant differences were evident in the prevalence of hypertension, constipation, or dementia. As the degree of neuropathy increases, it is accompanied by an increasing prevalence of ASP (none, 21.4%; blunt tendon reflexes, 24.5%; symptomatic, 50.0%; and gangrene, 66.6%). The prevalence of ASP was significantly increased in the patients with proliferative diabetic retinopathy (none, 23.2%; background, 29.4%; pre-proliferative, 18.2%; and proliferative, 50.0%). As the degree of nephropathy increases, it is accompanied by an increasing prevalence of ASP (none, 20.0%; microalbuminuria, 31.9%; macroalbuminuria, 37.0%; and renal failure, 60.0%). Thus, the prevalence of ASP is increased in women with diabetes and increased with longer duration of diabetes but was not affected by glucose control. The incidence of ASP increases significantly as diabetic microangiopathy becomes severer.",aged;article;female;human;middle aged;non insulin dependent diabetes mellitus;pyuria,"Nakano, H.;Oba, K.;Saito, Y.;Ouchi, M.;Yamashita, N.;Okamura, K.;Takai, E.;Mizuno, S.;Matsumura, N.;Inuzuka, Y.;Suzuki, T.",2001,,,0,
3140,Relationship between SPECT and pathological alterations in Alzheimer's disease--a study of a case with left-hemisphere dominant lesions,"123I-IMP SPECT (SPECT) has been widely used in clinical neuropsychiatry for establishing the clinical diagnosis, and evaluating the course of the disease. However, little is known about the significance of alterations in SPECT. In this paper, we present comparative study between alterations in SPECT and neuropathological findings in the case of Alzheimer's disease (AD). The patient, a 59-year-old female, began to show memory disturbance and the left hemisphere disturbances, non-fluent aphasia, but right hemisphere disturbances, constructional apraxia, visuo-spatial dysfunctions were not notable at the early stage. The neuroimaging also revealed left-side dominant cerebral atrophy in MRI and left-side dominant hypoactive regions in SPECT (especially in parietal lobe). Memory disturbance and non-fluent aphasia gradually progressed after admission. Then, mirror phenomenon and Bálint's syndrome appeared at the age of 63 years. In the advanced stage, hypoactive regions in SPECT were expanded into temporal and frontal areas. The laterality observed at the early stage became unremarkable. The patient died from heart failure at 64 years. Pathological diagnosis was AD. Eleven ROI (region of interests) were determined on each hemisphere in transverse SPECT image. We calculated ROI% (each ROI count/ROI count at central cerebellum). Neuronal cell count (NCC) and amyloid beta protein deposited areas (BDA) were estimated using 3 serial sections stained with Nissl's method and immunostained for amyloid using monoclonal antibody raised against synthetic A beta, mcAb 90/12. Digitized images based on photographs were analyzed with NIH-image 1.45. NCC decreased in number in frontal, temporal, and parietal lobes. Significant asymmetrical reduction of NCC (lt. < rt.) was observed in orbital, superior temporal and angular gyri (p < 0.01). BDA in superior parietal lobule, superior temporal gyrus and superior, middle, inferior frontal gyri were larger than those in precentral gyrus and visual cortex. Asymmetry of BDA (lt. > rt.) was significant in middle temporal gyrus (p < 0.01). ROI% at the early stage was correlated with corresponding NCC (r = 0.49, p < 0.05) and BDA (r = -0.55, p < 0.01), but at the advanced stage was not significantly correlated with corresponding NCC (r = 0.26) and BDA (r = -0.20). It is evident that SPECT shows good correlation with clinical features and pathological alterations during the course of AD. Our observations imply that the changes in SPECT usually precede the appearance of the clinical symptoms. SPECT is very sensitive in detecting the functional decline in certain regions of the CNS. In the case of AD, the hypoactive regions in SPECT at the early stage may indicate functional decline of the neuronal cells, and at the advanced stage, these may indicate the degree of pathological changes, especially neuronal loss and amyloid beta protein deposition.",Alzheimer disease;article;brain;case report;comparative study;female;human;middle aged;pathology;scintiscanning;single photon emission computer tomography,"Nakano, N.;Fukatsu, R.;Fujii, M.;Miyazawa, J.;Utsumi, K.;Hayashi, S.;Midorikawa, Y.;Tsuzuki, K.;Takahata, N.",1996,,,0,
3141,Are Hospital/ED Transfers Less Likely Among Nursing Home Residents With Do-Not-Hospitalize Orders?,"Objectives This study aims to examine whether an advance directive “Do Not Hospitalize” (DNH) would be effective in reducing hospital/emergency department (ED) transfers. Similar effects in residents with dementia were also examined. Design Cross-sectional study. Setting/subjects New York State (NYS) nursing home residents (n = 43,024). Measurements and analysis The Minimum Data Set 2.0 was used to address the study aims. Advance directives with an indication of DNH and Alzheimer disease/dementia other than Alzheimer disease were coded (yes vs no). Logistic regression analyses were performed to quantify the relationship between DNH orders and hospital/ED transfers while adjusting for confounders. Results Our results show that 61% of nursing home residents had do-not-resuscitate orders, 12% had feeding restrictions, and only 6% had DNH orders. Residents with DNH orders had significantly fewer hospital stays (3.0% vs 6.8%, P <.0001) and ED visits (2.8% vs 3.6%, P = .03) in the last 90 days than those without DNH orders. Dementia residents with DNH orders had significantly fewer hospital stays (2.7% vs 6.3%, P < .0001) but not ED visits (2.8% vs 3.5%, P = .11) than those without DNH orders. After adjusting for covariates in the model, the results show that for residents without DNH orders, the odds of being transferred to a hospital was significantly higher (odds ratio = 2.23, 95% confidence interval = 1.77–2.81) than those with DNH orders. Conclusion Residents with DNH orders had significantly fewer transfers. This suggests that residents' end-of-life care decisions were respected and honored. Efforts should be made to encourage nursing home residents to complete DNH orders to promote integration of the resident's values and goals in guiding care provision toward the end of life.",advance care planning;aged;Alzheimer disease;arthritis;article;asthma;chronic obstructive lung disease;clinical assessment;controlled study;cross-sectional study;depression;diet restriction;emergency ward;female;health care personnel;heart failure;hospitalization;human;hypertension;living will;major clinical study;male;nursing home patient;patient transport;prevalence;very elderly,"Nakashima, T.;Young, Y.;Nakashima, T.;Hsu, W. H.",2017,,10.1016/j.jamda.2016.12.004,0,
3142,Fournier's gangrene in elderly patient: Report of a case,"Fournier's gangrene (FG) is rapidly progressing acute gangrenous infection of the anorectal and urogenital area. FG needs precocious diagnosis and aggressive treatment with the use of wide spectrum antibioticus and surgical debridement. In our case, a 91-year-old Japanese female who had rehabilitation after treatment of pneumonia and her past history was rheumatoid arthritis treated with steroid and chronic heart failure. Her activities of daily living was bedridden with dementia. Necrotic skin was observed in urogenital and anorectal area and skin redness enlarged to the hip with high fever. Surgical debridement was performed. Both Peptostreptococcus Sp. and Fusobacterium Sp. was cultured from resected necrotic tissue. We used antibioticus, PAPM and PIPC, which had sensitivity for them. But unfortunately, disseminated intravascular coagulation occurred after 4th day of operation, and finally she died after 10th day of operation. We discussed the treatment for FG in patient with complication.",dopamine;noradrenalin;panipenem;piperacillin;aged;antibiotic sensitivity;article;bacterium culture;bed rest;case report;computer assisted tomography;death;debridement;dementia;disseminated intravascular clotting;female;fever;Fournier gangrene;Fusobacterium;human;human tissue;hypotension;Japanese (people);Peptostreptococcus;postoperative period;skin necrosis;skin redness,"Nakatani, H.;Hamada, S.;Okanoue, T.;Kawamura, A.;Chikai, T.;Yamamoto, S.;Inoue, Y.;Hanazaki, K.",2011,,,0,
3143,Editor’s Choice-Clinical impact of delirium and antipsychotic therapy: 10-Year experience from a referral coronary care unit,"Background: Little is known about safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. Methods and results: Pre-study Confusion Assessment Method-Intensive Care Unit (CAM–ICU) criteria were implemented in screening consecutive patients admitted to a referral CCU from 2004–2013. Death status was prospectively ascertained. Of 11,079 study patients, the incidence of delirium was 8.3% (n=925). Delirium was associated with an increased risk of in-hospital mortality (adjusted odds ratio (OR) 1.49; 95% confidence interval (CI), 1.08–2.08; p=0.02) and one-year mortality among patients who survived from CCU admission (adjusted hazard ratio (HR) 1.46; 95% CI, 1.12–1.87; p=0.005). A total of 792 doses of haloperidol (5 mg/day; interquartile range (IQR) 3–10) or quetiapine (25 mg/day; IQR 13–50) were given to 244 patients with delirium. The clinical characteristics of patients with delirium who did and did not receive antipsychotic therapy were not different (baseline corrected QT (QTc) interval 457±58 ms vs 459±60 ms, respectively; p=0.65). In comparison to baseline, mean QTc intervals after the first and third doses of the antipsychotics were not significantly prolonged in haloperidol (448±56, 458±57 and 450±50 ms, respectively) or quetiapine groups (470±66, 467±68 and 462±46 ms, respectively) (p>0.05 for all). Additionally, in-hospital mortality (adjusted OR 0.67; 95% CI, 0.42–1.04; p=0.07), ventricular arrhythmia (adjusted OR 0.87; 95% CI, 0.17–3.62; p=0.85) and one-year mortality among the hospital survivors (adjusted HR 0.86; 95% CI 0.62–1.17; p=0.34) were not different in patients with delirium irrespective of whether or not they received antipsychotics. Conclusion: In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.",haloperidol;inotropic agent;quetiapine;acute coronary syndrome;aged;article;cardiogenic shock;cerebrovascular accident;Charlson Comorbidity Index;chronic kidney failure;coronary care unit;delirium;dementia;electrocardiography;female;heart arrest;heart death;heart ventricle arrhythmia;hospital mortality;hospitalization;human;intraaortic balloon pump;low drug dose;major clinical study;male;mechanical ventilator;outcome assessment;priority journal;psychotherapy;QTc interval,"Naksuk, N.;Thongprayoon, C.;Park, J. Y.;Sharma, S.;Gaba, P.;Rosenbaum, A. N.;Peeraphatdit, T.;Hu, T. Y.;Bell, M. R.;Herasevich, V.;Brady, P. A.;Kapa, S.;Asirvatham, S. J.",2017,,10.1177/2048872615592232,0,
3144,Global gene profiling of VCP-associated inclusion body myopathy,"Inclusion body myopathy associated with Paget's disease of bone and frontotemporal dementia (IBMPFD) is an autosomal dominant disorder caused by mutations in the Valosin-containing protein (VCP) gene on chromosome 9p12-13. Patients demonstrate limb girdle muscle weakness, which eventually progresses to involve respiratory muscles, and death from respiratory and cardiac failure. This is the first investigation to analyze key molecular mediators and signaling cascades in skeletal muscle causing myopathy by global gene microarray in hopes of understanding the dysregulated genes and molecular mechanisms underlying IBMPFD and the hope of finding novel therapeutic targets. We determined expression profiles using Human Genome Array microarray technology in Vastus lateralis muscles from patients and their first-degree relatives. We analyzed gene annotations by Database for Annotation, Visualization and Integration Discovery and identified differentially dysregulated genes with roles in several novel biological pathways, including regulation of actin cytoskeleton, ErbB signaling, cancer, in addition to regulation of autophagy, and lysosomal signaling, known disrupted pathways in VCP disease. In this report, we present data from the first global microarray analyzing IBMPFD patient muscles and elucidating dysregulated pathways to further understand the pathogenesis of the disease and discover potential therapeutics.","Adenosine Triphosphatases/genetics/metabolism;Adult;Case-Control Studies;Cell Cycle Proteins/genetics/metabolism;Female;*Gene Expression Profiling;Gene Regulatory Networks/genetics;Humans;Male;Middle Aged;Myositis, Inclusion Body/*genetics;Oligonucleotide Array Sequence Analysis;Reproducibility of Results;Reverse Transcriptase Polymerase Chain Reaction;Signal Transduction/genetics","Nalbandian, A.;Ghimbovschi, S.;Radom-Aizik, S.;Dec, E.;Vesa, J.;Martin, B.;Knoblach, S.;Smith, C.;Hoffman, E.;Kimonis, V. E.",2012,Jun,10.1111/j.1752-8062.2012.00407.x,0,
3145,"A review of TTS-development, types and preparations","Transdermal Therapeutic Systems (TTS) are elastic multi-layer patches applied to the skin in order to deliver active substances into the bloodstream. One advantage of a transdermal drug delivery route over other types of medication delivery is that the patch provides a noninvasive therapy, longer duration of drug activity, and improves most of bioavailability. TTS consist of a backing layer, a drug, an adhesive, and a release liner. TTS can be divided into five basic types of systems: reservoir, matrix, microreservoir, single-layer drug in adhesive, and multi-layer drug in adhesive. In order to improve the penetration of drugs through the skin, passive and active methods are used. The researchers are constantly developing new methods of improving the delivery of drugs applied by transdermal route.",analgesic agent;buprenorphine;capsaicin;clonidine;contraceptive agent;diclofenac epolamine;estradiol;ethinylestradiol plus norelgestromin;fentanyl;flurbiprofen;glyceryl trinitrate;granisetron;insulin;levonorgestrel;lidocaine;methylphenidate;narcotic analgesic agent;nicotine;nonsteroid antiinflammatory agent;opiate;oxybutynin;paroxetine;penetration enhancing agent;rivastigmine;scopolamine;selegiline;sumatriptan;testosterone;tulobuterol;unindexed drug;Alzheimer disease;analgesia;angina pectoris;ankle sprain;antihypertensive therapy;arthralgia;article;asthma;attention deficit disorder;cancer chemotherapy;cancer pain;chemotherapy induced nausea and vomiting;chronic pain;clinical practice;dementia;depression;diabetes mellitus;drug delivery device;drug delivery system;drug dosage form comparison;drug formulation;drug indication;drug penetration;drug release;drug safety;epicondylitis;estrogen deficiency;estrogen therapy;gastrointestinal hemorrhage;hormonal contraception;hormonal therapy;human;hypertension;hypogonadism;insulin treatment;lipophilicity;major depression;medical technology;menopausal syndrome;migraine;molecular weight;myalgia;nausea;neurologic disease;neuropathic pain;overactive bladder;Parkinson disease;pharmaceutical engineering;postherpetic neuralgia;postmenopause osteoporosis;skin;skin penetration;tobacco dependence;transdermal drug administration;urine incontinence;vagina atrophy;vasomotor disorder;venous thromboembolism;vomiting;withdrawal syndrome;wound care,"Nalesniak, M.;Iwaniak, K.;Kasperek, R.;Poleszak, E.",2013,,,0,
3146,"The Most Prevalent Causes of Deaths, DALYs, and Geriatric Syndromes in Iranian Elderly People Between 1990 and 2010: findings from the Global Burden of Disease study 2010","BACKGROUND: The substantial increase in life expectancy during recent decades has left all countries with a high number of elderly people that have particular health needs. Health policy-makers must be aware of the most prevalent causes of deaths and DALYs in this age group, as well as geriatric syndromes, in order to provide appropriate care and allocate resources in an equitable manner. METHODS: The Global Burden of Disease study 2010 (GBD 2010), conducted by the institute for Health Metrics and Evaluation team, estimated the worldwide burden of diseases from 1990 to 2010. Its estimations were conducted on the basis of the proportion of deaths, the duration of symptoms and disability weights for sequelae, years lived with disability (YLDs), years of life lost (YLLs), and disability adjusted life years (DALYs) attributable to different diseases. In the present study, we extracted the data regarding the top five most prevalent causes of deaths, DALYs, and geriatric syndromes in the elderly based on the aforementioned GBD 2010, discussed the results using some tables and figures, reviewed the results, described the limitations of GBD 2010, and finally provided some recommendations as potential solutions. RESULTS: According to GBD 2010, the total number of deaths in Iran in 1990 was 321,627, of which 116,100 were in elderly people (those aged 60 years and above), meaning that 36.10% of all deaths occurred in the elderly. Among all diseases in this year, the first to third ranked causes of death were ischemic heart disease (IHD; 29.44%), neoplasms (13.52%), and stroke (7.24%). In comparison, the total number of deaths in Iran increased to 351,814 in 2010, with 213,116 of these occurring in the elderly (60.58% of deaths), but the most prevalent causes of death remained the same as in 1990. The highest 1990 DALYs rates were the result of IHD (21.56%), neoplasms (10.70%), and stroke (4.85%). IHD (22.77%), neoplasms (9.48%), and low back pain (LBP; 5.72%) were the most prevalent causes of DALYs in older Iranian adults in 2010. The fourth and fifth ranked causes of deaths and DALYs in both 1990 and 2010, both in Iran and globally, were different diseases and geriatric syndromes in the elderly Iranian population. CONCLUSION: The aged population of Iran is growing steadily, and there is a need for health policy-makers to create appropriate programs to meet the health needs of elderly people. Although GBD 2010 results are useful in providing burden estimations at regional and national levels, each individual country should estimate its burden of diseases, injuries, and risk factors at a sub-national level to obtain further details regarding the health status of its people. As no comprehensive study regarding elderly people in Iran has previously been conducted, our study will be a major source for identifying the important causes of deaths, DALYs, and geriatric syndromes among this population.","Accidental Falls/mortality;Aged;Aged, 80 and over;*Cause of Death;Dementia/mortality;Diabetes Mellitus/mortality;Disabled Persons/*statistics & numerical data;Female;Health Surveys;Humans;Iran/epidemiology;Low Back Pain/epidemiology;Male;Middle Aged;Myocardial Ischemia/mortality;Neoplasms/mortality;Pulmonary Disease, Chronic Obstructive/mortality;Stroke/mortality","Namazi Shabestari, A.;Saeedi Moghaddam, S.;Sharifi, F.;Fadayevatan, R.;Nabavizadeh, F.;Delavari, A.;Jamshidi, H. R.;Naderimagham, S.",2015,Aug,015188/aim.003,0,
3147,Anesthetic management of a 137-year-old patient fracture of neck femur,,acetylsalicylic acid;adrenalin;atorvastatin;bupivacaine;enoxaparin;fentanyl;isosorbide mononitrate;lidocaine;ramipril;aged;airway obstruction;anesthesia induction;bone density;case report;cataract;catheterization;dementia;diastolic dysfunction;dose response;drug dose titration;echocardiography;edentulousness;electrocardiogram;epidural anesthesia;femur neck fracture;heart infarction;heart left ventricle ejection fraction;hip surgery;human;hypokinesia;ischemic heart disease;letter;lung emphysema;lung function test;male;muscle mass;obstruction;oxygen therapy;poor general condition;presbyopia;systolic dysfunction;thorax radiography;visual acuity,"Nanda, S.;Gupta, A.;Kulshreshtha, A.;Kalra, P.;Sharma, M.",2012,,,0,
3148,Impact of Drug–Drug and Drug–Disease Interactions on Gait Speed in Community-Dwelling Older Adults,"Background: Gait speed decline, an early marker of functional impairment, is a sensitive predictor of adverse health outcomes in older adults. The effect of potentially inappropriate medications, including drug-disease and drug-drug interactions, on gait speed decline is not well known. Objective: The aim of this study was to determine if drug interactions impair functional status as measured by gait speed. Methods: The sample included 2402 older adults with medication and gait speed data from the Health, Aging and Body Composition study. The independent variable was the frequency of drug–disease and/or drug–drug interactions at baseline and 3 additional years. The main outcome was a clinically meaningful gait speed decline of ≥0.1 m/s the year following drug interaction assessment. Adjusted odds ratios and 95 % confidence intervals (CIs) were calculated using multivariate generalized estimating equations for both the overall sample and a sample stratified by gait speed at time of drug interaction assessment. Results: The prevalence of drug–disease and drug–drug interactions ranged from 7.6 to 9.3 and 10.5 to 12.3 %, respectively, with few participants (3.8–5.7 %) having multiple drug interactions. At least 22 % of participants had a gait speed decline of ≥0.1 m/s annually. Drug interactions were not significantly associated with gait speed decline overall or in the stratified sample of fast walkers. There was some evidence, however, that drug interactions increased the risk of gait speed decline among those participants with slower gait speeds, though p values did not reach statistical significance (adjusted odds ratio 1.22; 95 % CIs 0.96–1.56; p = 0.11). Moreover, a marginally significant dose–response relationship was seen with multiple drug interactions and gait speed decline (adjusted odds ratio 1.40; 95 % CIs 0.95–2.04; p = 0.08). Conclusions: Drug interactions may increase the likelihood of gait speed decline among older adults with evidence of preexisting debility. Future studies should focus on frail elders with less physiological reserve who may be more susceptible to the harms associated with potentially inappropriate medications.",benzodiazepine receptor stimulating agent;dipeptidyl carboxypeptidase inhibitor;non prescription drug;opiate agonist;serotonin uptake inhibitor;aged;article;body composition;cerebrovascular accident;cognitive defect;community living;comorbidity;dementia;depression;diabetes mellitus;drug interaction;drug use;faintness;falling;female;functional status;gait;health status;heart failure;human;ischemic heart disease;kidney failure;longitudinal study;lung disease;major clinical study;male;osteoarthritis;osteoporosis;Parkinson disease;peripheral occlusive artery disease;potentially inappropriate medication;prescription;prevalence;priority journal;walking difficulty;walking speed,"Naples, J. G.;Marcum, Z. A.;Perera, S.;Newman, A. B.;Greenspan, S. L.;Gray, S. L.;Bauer, D. C.;Simonsick, E. M.;Shorr, R. I.;Hanlon, J. T.",2016,,,0,
3149,"Ginkgo biloba special extract in dementia with neuropsychiatric features: A randomised, placebo-controlled, double-blind clinical trial","Background: In previous trials of the Ginkgo biloba special extract EGb 761® improvements in cognitive functioning and behavioural symptoms were found in patients with aging-associated cognitive impairment or dementia. This trial was undertaken to assess the efficacy of EGb 761 in mild to moderate dementia with neuropsychiatric features. Methods: Double-blind trial including 400 patients aged 50 years or above with Alzheimer's disease (AD) or vascular dementia (VaD), randomized to receive EGb 761 or placebo for 22 weeks. Patients scored below 36 on the Test for the Early Detection of Dementia with Discrimination from Depression (TE4D), between 9 and 23 on the SKT test battery and at least 5 on the Neuropsychiatric Inventory (NPI). Results: There was a mean -3.2-point improvement in the SKT upon EGb 761 treatment and an average deterioration by +1.3 points on placebo (p < 0.001, two-sided, ANOVA). EGb 761 was significantly superior to placebo on all secondary outcome measures, including the NPI and an activities-of-daily-living scale. Treatment results were essentially similar for AD and VaD subgroups. The drug was well tolerated; adverse events were no more frequent under drug than under placebo treatment. Conclusion: The data add further evidence on the safety and efficacy of EGb 761 in the treatment of cognitive and non-cognitive symptoms of dementia. © ECV Editio Cantor Verlag.",anxiolytic agent;betahistine;Ginkgo biloba extract;hypnotic agent;placebo;psychostimulant agent;sedative agent;adult;aged;aging;Alzheimer disease;angina pectoris;article;backache;clinical trial;cognitive defect;controlled clinical trial;controlled study;coughing;daily life activity;dementia;diarrhea;disease severity;dizziness;double blind procedure;female;Ginkgo biloba;headache;human;hypertension;hypertensive crisis;influenza;major clinical study;male;multiinfarct dementia;neuropsychiatry;outcome assessment;randomized controlled trial;scoring system;therapy;tinnitus;unspecified side effect;upper respiratory tract infection;egb 761,"Napryeyenko, O.;Borzenko, I.",2007,,,0,
3150,Efficacy and tolerability of Ginkgo biloba extract EGb 761® by type of dementia: Analyses of a randomised controlled trial,"Secondary analyses of a randomised controlled trial were performed to find out whether treatment effects of Ginkgo biloba extract EGb 761® differed by type of dementia. Three hundred ninety-five patients aged 50 years or above, with dementia with neuropsychiatric features were treated with EGb 761® (240 mg/day) or placebo for 22 weeks. Patients scored between 9 and 23 on the Short Syndrome Test (SKT), a cross-culturally validated cognitive test battery. Their total score on the Neuropsychiatric Inventory (NPI) was at least 5. Efficacy was assessed by the SKT test battery (primary outcome measure), the Verbal Fluency Test, the Clock-Drawing Test, the NPI, the Hamilton Rating Scale for Depression (HAMD), and the Gottfries-Bråne-Steen Scale (GBS). Applying standard research diagnostic criteria 214 patients were diagnosed with Alzheimer's disease (probable AD or possible AD with cerebrovascular disease) and 181 with probable vascular dementia (VaD). Under EGb 761® treatment the SKT total score improved by - 3.0 ± 2.3 and - 3.4 ± 2.3 points in patients with AD and VaD, respectively, whereas the patients on placebo deteriorated by + 1.2 ± 2.5 and + 1.5 ± 2.2 points, respectively (p < 0.01 for both drug-placebo differences). Significant drug-placebo differences were found for all secondary outcome variables with no major differences between AD and VaD subgroups. The rate of adverse events tended to be higher for the placebo group. © 2009 Elsevier B.V. All rights reserved.",Ginkgo biloba extract;placebo;abdominal pain;adult;aged;Alzheimer disease;angina pectoris;arthralgia;article;backache;blood pressure;clinical feature;clinical trial;controlled clinical trial;controlled study;coughing;dementia;diarrhea;dizziness;drug efficacy;drug safety;drug tolerability;dysgeusia;female;Ginkgo biloba;Hamilton Depression Rating Scale;headache;human;hypertensive crisis;influenza;major clinical study;male;mental disease;multicenter study;multiinfarct dementia;nausea;neurologic disease;neuropsychological test;priority journal;randomized controlled trial;side effect;tinnitus;treatment outcome;upper respiratory tract infection;egb 761,"Napryeyenko, O.;Sonnik, G.;Tartakovsky, I.",2009,,,0,
3151,The prognostic effects of poststroke cognitive impairment no dementia and domain-specific cognitive impairments in nondisabled ischemic stroke patients,"Background and Purpose- There is some evidence that poststroke dementia, cognitive impairment no dementia (CIND), and mild cognitive impairment predict for poor outcomes such as dementia, death, and institutionalization. However, few studies have examined the prognostic value of CIND, CIND severity, and domain impairments in a poststroke cohort. Methods- A cohort of ischemic stroke patients with baseline cognitive assessments 3 months poststroke were followed up annually for outcomes of dependency, vascular events, and death for up to 5 years. Univariate and multivariate Cox proportional regression was performed to determine the ability CIND, CIND severity, and domain impairments to predict dependency, vascular outcomes, and death. Results- Four-hundred nineteen patients without dementia (mean age 60±11 years, 32% female) were followed for a mean of 3.2 years. Older age, diabetes, more severe strokes, CIND-mild, and CIND-moderate were independently predictive of dependency. There were no independent predictors of recurrent vascular events. Older age, diabetes, and CIND-moderate were independently predictive of death. In analyses of individual cognitive domains, impairments in visuomotor speed were independently predictive of dependency. Conclusions- In poststroke patients, CIND predicts dependency and death, while CIND severity discriminates patients with poor survival. Impairments in visuomotor speed independently predict dependency. © 2011 American Heart Association. All rights reserved.",NCT00161070;adult;aged;article;attention;brain hemorrhage;brain ischemia;cognitive defect;cognitive impairment no dementia;cohort analysis;death;diabetes mellitus;disease severity;female;follow up;heart muscle ischemia;human;hyperlipidemia;hypertension;language;major clinical study;male;mild cognitive impairment;neuropsychological test;peripheral occlusive artery disease;priority journal;prognosis;proportional hazards model;psychologic assessment;Rankin scale;recurrent disease;risk factor;smoking;stroke patient;survival;transient ischemic attack;verbal memory;visual memory;visuomotor coordination;word list recall,"Narasimhalu, K.;Ang, S.;De Silva, D. A.;Wong, M. C.;Chang, H. M.;Chia, K. S.;Auchus, A. P.;Chen, C. P.",2011,,,0,
3152,Frequency and determinants of implantable cardioverter defibrillator deployment among primary prevention candidates with subsequent sudden cardiac arrest in the community,"BACKGROUND-: The prevalence rates and influencing factors for deployment of primary prevention implantable cardioverter defibrillators (ICDs) among subjects who eventually experience sudden cardiac arrest in the general population have not been evaluated. METHODS AND RESULTS-: Cases of adult sudden cardiac arrest with echocardiographic evaluation before the event were identified from the ongoing Oregon Sudden Unexpected Death Study (population approximately 1 million). Eligibility for primary ICD implantation was determined from medical records based on established guidelines. The frequency of prior primary ICD implantation in eligible subjects was evaluated, and ICD nonrecipients were characterized. Of 2093 cases (2003-2012), 448 had appropriate pre-sudden cardiac arrest left ventricular ejection fraction information available. Of these, 92 (20.5%) were eligible for primary ICD implantation, 304 (67.9%) were ineligible because of left ventricular ejection fraction >35%, and the remainder (52, 11.6%) had left ventricular ejection fraction ≤35% but were ineligible on the basis of clinical guideline criteria. Among eligible subjects, only 12 (13.0%; 95% confidence interval, 6.1%-19.9%) received a primary ICD. Compared with recipients, primary ICD nonrecipients were older (age at ejection fraction assessment, 67.1±13.6 versus 58.5±14.8 years, P=0.05), with 20% aged ≥80 years (versus 0% among recipients, P=0.11). Additionally, a subgroup (26%) had either a clinical history of dementia or were undergoing chronic dialysis. CONCLUSIONS-: Only one fifth of the sudden cardiac arrest cases in the community were eligible for a primary prevention ICD before the event, but among these, a small proportion (13%) were actually implanted. Although older age and comorbidity may explain nondeployment in a subgroup of these cases, other determinants such as socioeconomic factors, health insurance, patient preference, and clinical practice patterns warrant further detailed investigation. © 2013 American Heart Association, Inc.",adult;age;aged;article;comorbidity;controlled study;female;heart left ventricle ejection fraction;human;implantable cardioverter defibrillator;implantation;major clinical study;male;prevalence;priority journal;recipient;sudden cardiac death,"Narayanan, K.;Reinier, K.;Uy-Evanado, A.;Teodorescu, C.;Chugh, H.;Marijon, E.;Gunson, K.;Jui, J.;Chugh, S. S.",2013,,,0,
3153,OTC statins: Panacea or Pandora's box?,,C reactive protein;generic drug;hydroxymethylglutaryl coenzyme A reductase inhibitor;non prescription drug;simvastatin;allergy;Alzheimer disease;cardiovascular disease;cardiovascular risk;congestive heart failure;doctor patient relation;drug contraindication;drug cost;fracture;heart protection;human;liver disease;national health service;patient compliance;pregnancy;rheumatoid arthritis;risk reduction;short survey;United Kingdom;United States,"Nash, D. T.",2007,,,0,
3154,Inhibition of lipid peroxidation mediated by indolizines,"Esters, ethers, carbonates and carbamates of 1-indolizinols and azaindolizinols exhibit a profound inhibition of lipid peroxidation in vitro. The antioxidants were prepared by cyclization of pyridines and diazines with diphenylcyclopropenone followed by introduction of the O-substituent.",indolizine derivative;Alzheimer disease;antioxidant activity;article;heart infarction;lipid peroxidation;rheumatoid arthritis;cerebrovascular accident,"Nasir, A. I.;Gundersen, L. L.;Rise, F.;Antonsen, Ø;Kristensen, T.;Langhelle, B.;Bast, A.;Custers, I.;Haenen, G. R. M. M.;Wikström, H.",1998,,,0,
3155,"Relation between butyrylcholinesterase K variant, paraoxonase 1 (PON1) Q and R and apolipoprotein E epsilon 4 genes in early-onset coronary artery disease","OBJECTIVES: The common K variant of butyrylcholinesterase (BChE-K), an enzyme which metabolizes acetylcholine and organophosphates, has been associated with Alzheimer's disease, especially in the presence of the apolipoprotein E epsilon 4 allele (APOE-epsilon 4). Although APOE-epsilon 4 has been associated with the development of coronary artery disease (CAD), an association between the BChE-K variant and CAD has not been explored. Paraoxonase 1 (PON1), located within HDL, is an enzyme which also metabolizes organophosphates and may be antiatherogenic. The R192 variant of PON1 (PON1-R) has been associated with CAD. DESIGN AND METHODS: To determine whether BChE-K is also associated with premature CAD, we examined the frequency of BChE-K among patients with early-onset CAD (n = 150; < 50 yr) vs. late-onset CAD (n = 150; > 65 yr) by molecular analysis. We also examined the frequency of the PON1-R allele in both groups, and explored whether there was synergism between BChE-K and APOE-epsilon 4, BChE-K and PON1-R or PON1-R and APOE-epsilon 4. RESULTS: The frequency of the BChE-K allele tended to be greater among early-onset CAD patients compared to late-onset CAD patients (41.3% vs. 31.3%; p = 0.07), but without any significant difference between males and females. There was no difference in the prevalence of the PON1-R allele between those with early- or late-onset CAD (46.0% vs. 52.7%; p = 0.25). Twenty-two patients with early-onset CAD had both the BChE-K plus APOE-epsilon 4 alleles (14.7%) compared to 11 late-onset CAD patients (7.3%) (p = 0.04). There was no such association between BChE-K and PON1-R, nor PON1-R and APOE-epsilon 4. CONCLUSIONS: Our study suggests that there is a minor association between BChE-K and early-onset CAD, especially in the presence of the APOE-epsilon 4 allele.",Age of Onset;Aged;Alleles;Alzheimer Disease/genetics;Apolipoprotein E4;Apolipoproteins E/*genetics;Aryldialkylphosphatase;Butyrylcholinesterase/*genetics;Coronary Artery Disease/*genetics;Esterases/*genetics;Female;Heterozygote;Humans;Male;Middle Aged,"Nassar, B. A.;Darvesh, S.;Bevin, L. D.;Rockwood, K.;Kirkland, S. A.;O'Neill, B. J.;Bata, I. R.;Johnstone, D. E.;Title, L. M.",2002,May,,0,
3156,A new marker of primary care utilization - annual accumulated duration of time of visits,"Background: Most of the research on primary care workload has focused on the number of visits or the average duration of visits to a primary care physician (PCP) and their effect on the quality of medical care. However, the accumulated annual visit duration has yet to be examined. This measure could also have implications for the allocation of resources among health plans and across regions.In this study we aimed to define and characterize the concept of ""Accumulated Annual Duration of Time"" (AADT) spent with a PCP. Method: A cross-sectional study based on a national random sample of 77,247 adults aged 20 and over. The study's variables included annual number of visits and AADT with a PCP, demographic characteristics and chronic diseases. The time period was the entire year of 2012. Results: For patients older than 20years, the average annual number of visits to a PCP was 8.8±9.1, and the median 6±10 IQR (Interquartile Range). The mean AADT was 65.8±75.7min, and the median AADT was 43±75 IQR minutes. The main characteristics of patients with a higher annual number of visits and a higher AADT with a PCP were: female, older in age, a higher Charlson index and a low socio-economic status. Chronic diseases were also found to increase the number of annual visits to a PCP as well as the AADT, patients with chronic heart failure had highest AADT in comparison to others (23.1±15.5 vs. 8.6±8.9 visits; and 165.3±128.8 vs. 64.5±74min). It was also found that the relationship between AADT and age was very similar to the relationship between visits and age. Conclusion: While facing the ongoing increase in a PCP's work load and shortening of visit length, the concept of AADT provides a new measure to compare between different healthcare systems that allocate different time frames for a single primary care visit. For Israel, the analysis of the AADT data provides support for continued use of the number of visits in the capitation formula, as a reliable and readily-accessible indicator of primary care usage.",adult;anxiety;article;asthma;cerebrovascular accident;Charlson Comorbidity Index;chronic obstructive lung disease;cross-sectional study;dementia;drug abuse;epilepsy;female;general practitioner;health care utilization;heart failure;human;hyperlipidemia;hypertension;immigrant;ischemic heart disease;major clinical study;male;primary medical care;priority journal;social status;visiting nursing service,"Nathan, T. A.;Cohen, A. D.;Vinker, S.",2017,,10.1186/s13584-017-0159-y,0,
3157,Prenatal diagnosis versus preimplantation diagnosis (2),,fertilization in vitro;genetic disorder;human;Huntington chorea;medical ethics;muscle atrophy;note;preimplantation embryo;prenatal diagnosis;syndrome X,"Nau, J. Y.",2003,,,0,
3158,The SAH score: A comprehensive communication tool,"The Hunt and Hess grade and World Federation of Neurological Surgeons (WFNS) scale are commonly used to predict mortality after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to improve the accuracy of mortality prediction compared with the aforementioned scales by creating the ""SAH score."" Methods: The aSAH database at our institution was analyzed for factors affecting in-hospital mortality using multiple logistic regression analysis. Scores were weighted based on relative risk of mortality after stratification of each of these variables. Glasgow Coma Scale (GCS) was subdivided into groups of 3-4 (score = 1), 5-8 (score = 2), 9-13 (score = 3), and 14-15 (score = 4). Age was categorized into 4 subgroups: 18-49 (score = 1), 50-69 (score = 2), 70-79 (score = 3), and 80 years or more (score = 4). Medical comorbidities were subdivided into none (score = 1), 1 (score = 2), or 2 or more (score = 3). Results: In total, 1134 patients were included; all-cause SAH hospital mortality was 18.3%. Admission GCS, age, and medical comorbidities significantly affected mortality after multivariate analysis (P <.05). Summated scores ranged from 0 to 8 with escalating mortality at higher scores (0 = 2%, 1 = 6%, 2 = 8%, 3 = 15%, 4 = 30%, 5 = 58%, 6 = 79%, 7 = 87%, and 8 = 100%). Positive predictive value (PPV) for scores in the range 7-8 was 88.5%, whereas 6-8 was 83%. Negative predictive value (NPV) was 94% for range 0-2 and 92% for 0-3. The area under the curve (AUC) for the SAH score was.821 (good accuracy), compared with the WFNS scale (AUC.777, fair accuracy) and the Hunt and Hess grade (AUC.771, fair accuracy). Conclusions: The SAH score was found to be more accurate in predicting aSAH mortality compared with the Hunt and Hess grade and WFNS scale. © 2014 by National Stroke Association.",acquired immune deficiency syndrome;adult;aged;area under the curve;article;cerebrovascular accident;chronic kidney failure;chronic obstructive lung disease;clinical assessment tool;comorbidity;comparative study;congestive heart failure;controlled study;coronary artery disease;dementia;diabetes mellitus;diagnostic test accuracy study;Glasgow coma scale;human;Human immunodeficiency virus infection;hunt and hess grade;hypertension;liver cirrhosis;major clinical study;medical history;mortality;neoplasm;predictive value;priority journal;retrospective study;risk assessment;risk factor;subarachnoid hemorrhage,"Naval, N. S.;Kowalski, R. G.;Chang, T. R.;Caserta, F.;Carhuapoma, J. R.;Tamargo, R. J.",2014,,,0,
3159,"Letter by naylor regarding article, guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association",,atherosclerosis;carotid artery stenting;carotid endarterectomy;conventional angiography;dementia;health care personnel;heart infarction;human;internal carotid artery;letter;medical society;nuclear magnetic resonance imaging;practice guideline;priority journal;cerebrovascular accident;transient ischemic attack,"Naylor, A. R.",2011,,,0,
3160,The PROGRESS study: Rationale and design,"Rationale: Patients with a history of cerebrovascular disease have a very high risk of stroke, and usual levels of both systolic and diastolic blood pressure are directly and continuously associated with this risk. Trials of blood pressure lowering in patients with transient ischaemic attacks or stroke have been too small to reliably detect the effects on stroke risk of the modest blood pressure reductions achieved. Objectives: The primary objective of PROGRESS is to determine precisely the effects of blood pressure reduction with an angiotensin converting enzyme (ACE) inhibitor-based regimen on the stroke risk in patients with a history of transient ischaemic attacks or minor stroke. Design: The study is a randomized, double-blind, placebo-controlled clinical trial. Before randomization, there is a 4-week run-in phase on open-label ACE inhibitor treatment. The scheduled duration of treatment and follow-up is 4-5 years. Setting: The study will be conducted in collaborating clinical centres in Australia, Belgium, the People's Republic of China, France, Italy, Japan, New Zealand, Sweden and the United Kingdom. Patients: The study will involve 6000 patients with a history of transient ischaemic attacks or stroke (ischaemic or haemorrhagic) in the past 5 years. To be eligible patients should have no definite indication for or contra-indication to treatment with an ACE inhibitor and no disability likely to prevent regular attendance at study clinics. Interventions: Study treatment will comprise perindopril and indapamide or matching placebos for patients without an indication for or contra-indication to treatment with a diuretic, perindopril alone or matching placebo for all other patients. Study outcomes: The primary study outcome is total strokes and secondary outcomes include fatal or disabling strokes, total major cardiovascular events, cardiovascular deaths, cognitive function and dementia, and disability and dependency.",antihypertensive agent;dipeptidyl carboxypeptidase inhibitor;indapamide;perindopril;antihypertensive therapy;article;cerebrovascular disease;clinical protocol;clinical trial;controlled study;diastolic blood pressure;double blind procedure;human;ischemic heart disease;multicenter study;priority journal;randomized controlled trial;cerebrovascular accident;systolic blood pressure;treatment outcome,"Neal, B.;MacMahon, S.",1995,,,0,
3161,VAC® therapy for wound management in patients with contraindications to surgical treatment,"The treatment of complex wounds often requires multiple surgical debridement and eventually reconstruction with skin grafts or flaps, under local or general anesthesia. When the patient's general conditions contraindicate surgical procedures, topical negative pressure with Vacuum Assisted Closure (VAC ®) device can achieve wound healing with reduction of healing time and simpler management. We treated with VAC ® device four patients with complex wounds and important contraindications to surgery. In all the patients, we used VAC ® device with common protocol of topical negative pressure. The healing was obtained in a period variable between 18 and 40 days; the results were satisfactory in three cases, one patient developed an aesthetically unpleasant scar. We present our experience to propose VAC ® when surgical procedures are contraindicated. © 2012 Wiley Periodicals, Inc.",connettivina;hyaluronic acid;meropenem;silver;tobramycin;unclassified drug;vancomycin;achilles tendinitis;acute myeloblastic leukemia;acute heart infarction;adult;aged;Alzheimer disease;article;case report;debridement;extensor muscle;female;foam;hand burn;human;infant;leg injury;leg ulcer;male;necrotizing fasciitis;peripheral vascular disease;Pseudomonas aeruginosa;skin graft;skin ulcer;cerebrovascular accident;vacuum assisted closure;wound dressing;wound healing;Aquacell;Condress;VAC,"Negosanti, L.;Sgarzani, R.;Nejad, P.;Pinto, V.;Tavaniello, B.;Palo, S.;Oranges, C. M.;Fabbri, E.;Michelina, V. V.;Zannetti, G.;Morselli, P. G.;Cipriani, R.",2012,,,0,
3162,Hip fracture as risk factor for mortality in patients over 65 years of age. Case-control study,"INTRODUCTION: Hip fracture among older patients is a devastating injury in most cases. It profoundly affects the physical, mental, functional and social balance that patients used to have and, beyond the orthopedic injury, it reflects the aging process and its dire consequences. Some reports show that up to 50% of patients with hip fracture die within six months and many of those who survive do not recover their baseline independence and function. In recent decades the increase in life expectancy after 60 years of age has led to an exponential growth in hip fractures. This is why it is essential to determine the patient-related and environmental factors leading to the increased mortality rates seen in patients with hip fracture, to improve the survival and quality of life of older adults. The objective was to determine the association between hip fracture and mortality in patients over 65 years of age. MATERIAL AND METHODS: An observational, longitudinal, retrospective, descriptive, comparative case-control study was conducted. The clinical records of all patients over 65 years of age admitted to the Orthopedics Service, Hospital Regional <<Lic. Adolfo Lopez Mateos>>, ISSSTE, with a diagnosis of hip fracture during the previous 12 months were analyzed, regardless of the type of fracture and treatment they received. A group of patients without hip fracture was used as control group. Total sample size was 50 patients with hip fracture and 50 patients without hip fracture. The following data were collected in data collection forms: age, sex, time elapsed since the fracture, survival at one year and, in the case of deceased patients, the cause of death (pneumonia, sepsis, arrhythmia, hydroelectrolytic imbalance, heart failure and others). The results obtained are shown as tables and charts to facilitate their visual understanding. RESULTS: Patient demographics show that there were 40 (80%) female patients and 10 (20%) male patients with a diagnosis of hip fracture. The control group included 35 (70%) females and 15 (30) males. An association between hip fracture and increased mortality was found, with a significant p value of 0.001. The main cause of death among hip fracture patients in our study was sepsis in 7 (35%), while among the control group it was myocardial infarction in 3 (15%). Time wise, mortality was found to be higher within the first six months, with 10 deaths (50%), and within the first year, with six deaths (30%). DISCUSSION: Hip fracture is in fact a risk factor associated with mortality among patients over 65 years of age. Females are the group most prone to sustaining a hip fracture and, therefore, to increased mortality rates. The major cause of death among our patient population was sepsis, apparently caused by mismanagement of soft tissues, a poor aseptic technique during the surgical procedure, a long hospital stay or a poor family support network, and dementia, which is related to poor surgical wound care. The highest mortality rates were found in ages over 90 years, and they were associated with preexisting chronic-degenerative conditions. The age group at highest risk of hip fracture was 80-89 years. Patients with hip fracture should always be managed together with the internist and the geriatrician and they should be considered as orthopedic emergencies, as a long hospital stay and delayed surgical treatment are associated with major complications and increased mortality rates.","Aged;Aged, 80 and over;Case-Control Studies;Female;Hip Fractures/*mortality;Humans;Longitudinal Studies;Male;Retrospective Studies;Risk Factors","Negrete-Corona, J.;Alvarado-Soriano, J. C.;Reyes-Santiago, L. A.",2014,Nov-Dec,,0,
3163,Review: Risks and benefits of HRT comparing various sources of evidence,,estrogen;gestagen;breast cancer;cholecystitis;clinical trial;Cochrane Library;colon cancer;data analysis;dementia;hormone substitution;human;intermethod comparison;ischemic heart disease;Medline;meta analysis;outcomes research;risk benefit analysis;short survey;cerebrovascular accident;thromboembolism;treatment outcome;spine fracture;wrist fracture,"Nelson, H. D.;Humphrey, L. L.;Nygren, P.",2003,,,0,
3164,Choosing and using screening criteria for palliative care consultation in the ICU: A report from the improving palliative care in the ICU (IPAL-ICU) advisory board,"Objective: To review the use of screening criteria (also known as ""triggers"") as a mechanism for engaging palliative care consultants to assist with care of critically ill patients and their families in the ICU. Data Sources: We searched the MEDLINE database from inception to December 2012 for all English-language articles using the terms ""trigger,"" ""screen,"" ""referral,"" ""tool,"" ""triage,"" ""case-finding,"" ""assessment,"" ""checklist,"" ""proactive,"" or ""consultation,"" together with ""intensive care"" or ""critical care"" and ""palliative care,"" ""supportive care,"" ""end-of-life care,"" or ""ethics."" We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website. Study Selection: Two members (a physician and a nurse with expertise in clinical research, intensive care, and palliative care) of the interdisciplinary Improving Palliative Care in the ICU Project Advisory Board presented studies and tools to the full Board, which made final selections by consensus. Data Extraction: We critically reviewed the existing data and tools to identify screening criteria for palliative care consultation, to describe methods for selecting, implementing, and evaluating such criteria, and to consider alternative strategies for increasing access of ICU patients and families to high-quality palliative care. Data Synthesis: The Improving Palliative Care in the ICU Advisory Board used data and experience to address key questions relating to: existing screening criteria; optimal methods for selection, implementation, and evaluation of such criteria; and appropriateness of the screening approach for a particular ICU. Conclusions: Use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Existing data and resources can be used in developing such criteria, which should be tailored for a specific ICU, implemented through an organized process involving key stakeholders, and evaluated by appropriate measures. In some settings, other strategies for increasing access to palliative care may be more appropriate. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.",article;artificial ventilation;brain hemorrhage;brain ischemia;cerebrovascular accident;clinical research;comorbidity;consultation;critically ill patient;dementia;ethics;Glasgow coma scale;heart arrest;hospital admission;hospital management;hospitalization;human;intensive care;intensive care unit;length of stay;living will;mortality;nurse;nursing staff;palliative therapy;patient;patient referral;physician;priority journal;resuscitation;risk management;screening;social work;tracheotomy;traumatic brain injury,"Nelson, J. E.;Curtis, J. R.;Mulkerin, C.;Campbell, M.;Lustbader, D. R.;Mosenthal, A. C.;Puntillo, K.;Ray, D. E.;Bassett, R.;Boss, R. D.;Brasel, K. J.;Frontera, J. A.;Hays, R. M.;Weissman, D. E.",2013,,,0,
3165,Rationale for a Trial of Low-Dose Aspirin for the Primary Prevention of Major Adverse Cardiovascular Events and Vascular Dementia in the Elderly: Aspirin in Reducing Events in the Elderly (ASPREE),"Low-dose aspirin (acetylsalicylic acid) therapy has been shown to reduce the risk of vascular events and there is increasing evidence of its potential to reduce the rate of cognitive decline in the elderly. Adverse effects including gastrointestinal and intracranial haemorrhage may offset these benefits. The balance of risks versus benefits of aspirin for the primary prevention of cardiovascular disease and vascular dementia has not been established in the elderly. There is clearly a need to conduct a study in family practice to investigate whether routine use of low-dose aspirin for the primary prevention of cardiovascular disease and vascular dementia in the elderly is beneficial or harmful. Aspirin in reducing events in the elderly (ASPREE) is a placebo-controlled trial of low-dose aspirin for the primary prevention of major adverse cardiovascular events and vascular dementia. It will follow 15 000 subjects aged 70 years or more for an average of 5 years. This sample size has a power of 87% to detect a 15% reduction in primary events in the aspirin group, with an anticipated combined primary event rate of 20 per 1000 patient years.",acetylsalicylic acid;hemoglobin;nonsteroid antiinflammatory agent;prostaglandin synthase;aged;article;brain hemorrhage;cardiovascular disease;clinical trial;computer assisted tomography;controlled clinical trial;controlled study;gastrointestinal hemorrhage;heart infarction;human;meta analysis;multiinfarct dementia;nuclear magnetic resonance imaging;primary prevention;priority journal;quality of life;randomized controlled trial;cerebrovascular accident;subarachnoid hemorrhage;subdural hematoma,"Nelson, M. R.;Reid, C. M.;Beilin, L. J.;Donnan, G. A.;Johnston, C. I.;Krum, H.;Storey, E.;Tonkin, A.;McNeil, J. J.",2003,,,0,
3166,Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study,"OBJECTIVES: Patient management in emergency departments (EDs) is often based on management protocols developed for specific complaints like dyspnea, chest pain, or syncope. To the best of our knowledge, to date no protocols exist for patients with nonspecific complaints (NSCs) such as ""weakness,""""dizziness,"" or ""feeling unwell."" The objectives of this study were to provide a framework for research and a description of patients with NSCs presenting to EDs. METHODS: Nonspecific complaints were defined as the entity of complaints not part of the set of specific complaints for which evidence-based management protocols for emergency physicians (EPs) exist. ""Serious conditions"" were defined as potentially life-threatening or those requiring early intervention to prevent health status deterioration. During a 6-month period, all adult nontrauma patients with an Emergency Severity Index (ESI) of 2 or 3 were prospectively enrolled, and serious conditions were identified within a 30-day period. RESULTS: The authors screened 18,261 patients for inclusion. A total of 218 of 1,611 (13.5%) nontrauma ESI 2 and 3 patients presented with NSCs. Median age was 82 years (interquartile range [IQR]=72 to 87), and 24 of 218 (11%) were nursing home inhabitants. A median of 4 (IQR=3 to 5) comorbidities were recorded, most often chronic hypertension, coronary artery disease, and dementia. During the 30-day follow-up period a serious condition was diagnosed in 128 of 218 patients (59%). The 30-day mortality rate was 6%. CONCLUSIONS: Patients with NSC presenting to the ED are at high risk of suffering from serious conditions. Sensitive risk stratification tools are needed to identify patients with potentially adverse health outcomes.","Accidental Falls/statistics & numerical data;Aged;Aged, 80 and over;Algorithms;Analysis of Variance;Clinical Protocols;Comorbidity;Cross-Sectional Studies;Diagnosis, Differential;Emergency Service, Hospital/statistics & numerical data;Emergency Treatment/*methods;Fatigue/*diagnosis/epidemiology/etiology;Female;Geriatric Assessment/*methods;Hospitals, University;Humans;Logistic Models;Male;Muscle Weakness/*diagnosis/epidemiology/etiology;Predictive Value of Tests;Prospective Studies;Risk Assessment/*methods;Severity of Illness Index;Switzerland/epidemiology;Triage/methods","Nemec, M.;Koller, M. T.;Nickel, C. H.;Maile, S.;Winterhalder, C.;Karrer, C.;Laifer, G.;Bingisser, R.",2010,Mar,10.1111/j.1553-2712.2009.00658.x,0,
3167,Making a decision about ERT/HRT. Evidence to consider in initiating and continuing protective therapy,"Alzheimer's disease, CAD, and osteoporosis significantly affect the health and well-being of senior citizens in the United States. The fact that women have a longer life expectancy than men has led to the hypothesis that estrogen in some way imparts protection against these disease processes. Available data on the possible negative effect of estrogen on the development and progression of Alzheimer's disease are provocative but inconclusive. Thus, for the time being, they must remain no more than the basis of an attractive hypothesis. In contrast, available data suggest that ERT and HRT can reduce the risk of CAD, but this effect seems more preventive than therapeutic. Addition of a progestational agent to an estrogen regimen may blunt this effect. Although the medical literature contains very few data that address the issue of duration of therapy, logic would suggest that cessation of therapy would result in the loss of a protective effect. With regard to osteoporosis, ERT and HRT have clear beneficial effects in that they increase BMD and decrease fracture risk. There is good evidence that duration of therapy may be more important than dosage and that these effects rapidly dissipate with cessation of therapy. Finally, as with all medical interventions, ERT or HRT must be individualized for each patient. Although actual health hazards are few, adverse effects are common and the emotion-charged, ever-evolving issue of the negative impact of ERT and HRT on breast cancer risk must always be considered before such therapy is instituted.","Aged;Alzheimer Disease/epidemiology/etiology/prevention & control;Coronary Disease/epidemiology/etiology/metabolism/prevention & control;*Decision Making;*Estrogen Replacement Therapy/adverse effects/psychology;*Evidence-Based Medicine;Female;Humans;Life Expectancy;Middle Aged;Osteoporosis, Postmenopausal/epidemiology/etiology/prevention & control;Patient Compliance/psychology;*Patient Selection;Risk Factors;Time Factors;Treatment Outcome;United States/epidemiology","Nerhood, R. C.",2001,Mar,10.3810/pgm.2001.03.1770,0,
3168,Impact of vascular diseases on the progression of mild cognitive impairment to Alzheimer's disease,"Introduction: Mild cognitive impairment does not meet the criteria for the diagnosis of dementia, but reaching this diagnosis raises concern about the future state of a patient due to the possibility of the conversion to Alzheimer's disease. Although the aetiology of Alzheimer's disease is neurodegenerative, the impact of vascular diseases is also taken into consideration. The aim of this study was to assess the impact of vascular diseases in patients diagnosed with mild cognitive impairment on the conversion to Alzheimer's disease. Material and methods: In each of 101 patients with a diagnosis of mild cognitive impairment, a detailed medical history was taken, taking into account: hypertension, ischaemic heart disease, arrhythmias, myocardial infarction, stroke, diabetes as well as thyroid diseases, head injuries, alcohol abuse, smoking, exposure to toxic substances, surgery under general anaesthesia and the family character of dementia. Clinical follow-ups were scheduled after 6, 12 and 24 months. Results: Amongst 101 patients with mild cognitive impairment, 17 (16.8%) converted to Alzheimer's disease within two years of observation. The analysis of the distribution of independence tests showed that the conversion is significant for two variables: ischaemic heart disease and myocardial infarction.",toxic substance;adult;age;aged;alcohol abuse;Alzheimer disease;article;cerebrovascular accident;clinical observation;controlled study;diabetes mellitus;disease association;disease course;environmental exposure;family history;follow up;general anesthesia;head injury;heart arrhythmia;heart infarction;human;hypertension;ischemic heart disease;major clinical study;mild cognitive impairment;smoking;thyroid disease;vascular disease,"Nesteruk, M.;Nesteruk, T.;Styczyńska, M.;Barcikowska, M.",2015,,,1,
3169,Free radicals and antioxidants 20,,allopurinol;antimalarial agent;antioxidant;artemisinin;creatine kinase;free radical;hypoxanthine;oxygen;oxygen radical;reactive oxygen metabolite;xanthine oxidase;Alzheimer disease;fibrinolytic therapy;heart infarction;human;hyperbaric oxygen;hypoxemia;letter;nerve degeneration;oxidative stress;priority journal;reoxygenation;reperfusion injury,"Neubauer, R. A.;James, P. B.;Evans, P. H.;Klinowski, J.;Meshnick, S. R.;Saugstad, O. D.;Aasen, A. O.",1994,,,0,
3170,What are the factors influencing outcome among patients admitted to a hospital with a proximal humeral fracture?,"BACKGROUND: Fracture of the proximal humerus is common in older patients during the decline of their physical health. QUESTIONS/PURPOSES: Our purpose was to evaluate the association between specific risk factors in patients with fractures of the proximal humerus and any inpatient adverse events, mortality, and discharge to a short-term or long-term care facility. METHODS: The National Hospital Discharge Survey (NHDS) provided estimates of all adult patients who were admitted to hospitals after fractures of the proximal humerus in the United States between 1990 and 2007. The influences of sex, age, days of care, diagnosis and procedures (based on ICD-9 codes) on inpatient adverse events and death, and discharge to a short-term or long-term care facility, were studied in bivariate and multivariable analyses. RESULTS: Among an estimated 867,282 patients admitted for proximal humerus fractures, 20% experienced adverse events, and 2.3% died in the hospital. Older age, concomitant femur and femoral neck fractures or head trauma, operative fracture care, congestive heart failure, and chronic alcoholism were associated with inpatient adverse events. Intubation, acute myocardial infarctions, malignancies, and skull fractures were associated with inpatient deaths. Older age, lower limb fractures, specific comorbidities (obesity, congestive heart failure, dementia), and inpatient adverse events (pneumonia, anemia treated with transfusion) were associated with discharges to short-term or long-term care facilities. CONCLUSIONS: Knowledge of risk factors for inpatient adverse events, mortality, and discharge to facilities can help make treatment decisions, improve overall care, discharge planning, and resource utilization for patients with proximal humeral fractures.","Aged;Aged, 80 and over;Chi-Square Distribution;Comorbidity;Female;Health Care Surveys;Hospital Mortality;*Hospitalization;Humans;Logistic Models;Long-Term Care;Male;Middle Aged;Multivariate Analysis;Odds Ratio;Patient Discharge;Retrospective Studies;Risk Factors;Shoulder Fractures/complications/diagnosis/mortality/*therapy;Time Factors;Treatment Outcome;United States","Neuhaus, V.;Swellengrebel, C. H.;Bossen, J. K.;Ring, D.",2013,May,10.1007/s11999-013-2876-z,0,
3171,The benefits of physical activity,,"Aged;Alzheimer Disease/etiology/*prevention & control;Cerebral Infarction/etiology/*prevention & control;Depressive Disorder/etiology/*prevention & control;*Exercise;Food Habits;Humans;Life Style;Myocardial Infarction/etiology/*prevention & control;Risk Factors;Stress, Psychological/complications","Neumann, N. U.;Frasch, K.",2008,Sep 11,,0,
3172,Identifying subgroups of complex patients with cluster analysis,"Objective: To illustrate the use of cluster analysis for identifying sub-populations of complex patients who may benefit from targeted care management strategies. Study Design: Retrospective cohort analysis. Methods: We identified a cohort of adult members of an integrated health maintenance organization who had 2 or more of 17 common chronic medical conditions and were categorized in the top 20% of total cost of care for 2 consecutive years (n = 15,480). We used agglomerative hierarchical clustering methods to identify clinically relevant subgroups based on groupings of coexisting conditions. Ward's minimum variance algorithm provided the most parsimonious solution. Results: Ward's algorithm identified 10 clinically relevant clusters grouped around single or multiple ""anchoring conditions."" The clusters revealed distinct groups of patients including: coexisting chronic pain and mental illness, obesity and mental illness, frail elderly, cancer, specific surgical procedures, cardiac disease, chronic lung disease, gastrointestinal bleeding, diabetes, and renal disease. These conditions co-occurred with multiple other chronic conditions. Mental health diagnoses were prevalent (range 28% to 100%) in all clusters. Conclusions: Data mining procedures such as cluster analysis can be used to identify discrete groups of patients with specific combinations of comorbid conditions. These clusters suggest the need for a range of care management strategies. Although several of our clusters lend themselves to existing care and disease management protocols, care management for other subgroups is less well-defined. Cluster analysis methods can be leveraged to develop targeted care management interventions designed to improve health outcomes.",abdominal surgery;adult;aged;algorithm;article;body mass;cardiovascular disease;chronic disease;chronic lung disease;chronic pain;cluster analysis;cohort analysis;comorbidity;congestive heart failure;coronary artery disease;cost effectiveness analysis;dementia;depression;diabetes mellitus;falling;female;frail elderly;gastrointestinal hemorrhage;health care cost;health care utilization;hip fracture;human;integrated health care system;kidney disease;major clinical study;male;managed care;managed care organization;mental disease;obesity;orthopedic surgery;outcome assessment;patient care;patient identification;priority journal;retrospective study;skin ulcer;cerebrovascular accident,"Newcomer, S. R.;Steiner, J. F.;Bayliss, E. A.",2011,,,0,
3173,Dementia and Alzheimer's disease incidence in relationship to cardiovascular disease in the cardiovascular health study cohort,"OBJECTIVES: To determine whether coronary artery disease, peripheral arterial disease (PAD), or noninvasive markers of cardiovascular disease (CVD) predict the onset of dementia and Alzheimer's disease (AD). DESIGN: Longitudinal cohort study. SETTING: Four U.S. communities. PARTICIPANTS: Men and women (N = 3,602) with a brain magnetic resonance imaging (MRI) scan but no dementia were followed for 5.4 years. Participants with stroke were excluded. MEASUREMENTS: Neurologists and psychiatrists classified incident cases of dementia and subtype using neuropsychological tests, examination, medical records and informant interviews. CVD was defined at the time of the MRI scan. Noninvasive tests of CVD were assessed within 1 year of the MRI. Apolipoprotein E allele status, age, race, sex, education, Mini-Mental State Examination score, and income were assessed as potential confounders. RESULTS: The incidence of dementia was higher in those with prevalent CVD, particularly in the subgroup with PAD. The rate of AD was 34.4 per 1,000 person-years for those with a history of CVD, versus 22.2 per 1,000 person-years without a history of CVD (adjusted hazard ratio (HR) = 1.3, 95% confidence interval (CI) = 1.0-1.7). Rates of AD were highest in those with PAD (57.4 vs 23.7 per 100 person-years, adjusted HR = 2.4, 95% CI= 1.4-4.2). Resuits were similar with further exclusion of those with vascular dementia from the AD group. A gradient of increasing risk was noted with the extent of vascular disease. CONCLUSION: Older adults with CVD other than stroke had a higher risk of dementia and AD than did those without CVD. The risk was highest in people with PAD, suggesting that extensive peripheral atherosclerosis is a risk factor for AD. © by the American Geriatrics Society.",apolipoprotein E;aged;Alzheimer disease;article;atherosclerosis;cohort analysis;controlled study;coronary artery disease;dementia;demography;disease association;female;follow up;human;interview;major clinical study;male;medical record;Mini Mental State Examination;neuropsychological test;nuclear magnetic resonance imaging;prediction;risk factor,"Newman, A. B.;Fitzpatrick, A. L.;Lopez, O.;Jackson, S.;Lyketsos, C.;Jagust, W.;Ives, D.;DeKosky, S. T.;Kuller, L. H.",2005,,,0,
3174,Atherosclerosis and incident depression in late life,"CONTEXT: Depression is a prominent concern for older adults; therefore, it is important to identify causal mechanisms so that prevention and treatment strategies can be developed. The vascular depression hypothesis proposes that vascular factors precede the onset of depression in older adults. However, although cross-sectional associations have been established, owing to a lack of objective assessments and longitudinal data, the validity and temporal nature of this relationship is unclear. OBJECTIVE: To examine whether atherosclerosis, an asymptomatic subclinical indicator of vascular burden, increases the risk of developing depression in older adults. DESIGN: Prospective, population-based study. SETTING: Set within the Rotterdam study, participants were assessed on objective measures of generalized atherosclerosis at baseline (1997-1999) and followed up for an average of 6 years for incident depression. PARTICIPANTS: The baseline sample consisted of 3564 participants (56% female) with a mean age of 72 years who initially did not have depression or dementia. MAIN OUTCOME MEASURES: Depression was categorized into symptoms or syndromes and assessed in a multidimensional manner from physician and mental health specialist reports, pharmacy records (antidepressant usage), a clinical interview, and self-report. RESULTS: During 21 083 person-years, 429 incidents of depressive symptoms and 197 incidents of depressive syndromes occurred. Individual atherosclerotic measures and a composite measure were not predictive of incident depressive symptoms (composite measure hazard ratio, 0.93; 95% confidence interval, 0.83-1.05) or incident depressive syndromes (composite measure hazard ratio, 0.97; 95% confidence interval, 0.81-1.16). An a priori power analysis indicated a sufficient sample size (alpha = .05; 0.95 power). CONCLUSIONS: Atherosclerosis does not appear to increase the risk of incident depression in older adults. These findings do not support the vascular depression hypothesis and, alternatively, taking findings from prior studies into account, suggest either that depression contributes to vascular burden or that both result from an underlying biological substrate.","Aged;Atherosclerosis/diagnosis/*epidemiology;Carotid Artery Diseases/diagnosis/epidemiology;Chronic Disease;Cohort Studies;Comorbidity;Coronary Artery Disease/diagnosis/epidemiology;Depressive Disorder/diagnosis/*epidemiology;Depressive Disorder, Major/diagnosis/epidemiology;Female;Follow-Up Studies;Humans;Longitudinal Studies;Male;Prospective Studies;Psychiatric Status Rating Scales;Risk Factors;Tomography, X-Ray Computed","Newson, R. S.;Hek, K.;Luijendijk, H. J.;Hofman, A.;Witteman, J. C.;Tiemeier, H.",2010,Nov,10.1001/archgenpsychiatry.2010.142,0,
3175,Predicting survival and morbidity-free survival to very old age,"As life expectancy continually increases, it is imperative to identify determinants of survival to the extreme end of the lifespan and more importantly to identify factors that increase the chance of survival free of major morbidities. As such, the current study assessed 45 common disease factors as predictors of survival and morbidity-free survival to age 85 years. Within the Rotterdam Study, a population-based cohort, we evaluated morbidity-free participants who were able to attain age 85 within the study duration (n = 2,008). Risk factors were assessed at baseline (1990-1993), and mortality and morbidities were then collected continuously until mortality or the occurrence of their 85th birthday (average time of 7.9 years). Risk factors included demographic and lifestyle variables, health and morbidity indicators and physiological makers. Major morbidities examined included dementia, cancer, cerebrovascular accident, heart failure and myocardial infarction. Logistic regression analyses demonstrated that many of the variables were independently predictive for survival and for morbidity-free ageing to 85 years. These included being female, absence of left ventricular abnormalities, stable body weight, unimpaired instrumental activities of daily living, lower C-RP levels and higher levels of femoral neck bone mineral density and albumin. Relative to non-survival, predictors were stronger for morbidity-free survival than for total survival or survival with morbidity. This suggests that lifespan and healthy survival to older age can be relatively well predicted. Understanding predictors of a long and healthy lifespan is vital for developing primary and secondary preventions to help improve the quality of life of older adults and for reducing the financial burden of the rapidly escalating ageing population.","Aged;Aged, 80 and over;*Aging/blood;Albumins/metabolism;Biomarkers/blood;Bone Density;C-Reactive Protein/metabolism;Dementia/epidemiology;Disease-Free Survival;Female;Femur Neck/radiography;Heart Failure/epidemiology;Humans;*Life Expectancy;Life Style;Logistic Models;Longevity;Male;Middle Aged;Myocardial Infarction/epidemiology;Neoplasms/epidemiology;Netherlands/epidemiology;Predictive Value of Tests;Prospective Studies;Quality of Life;Risk Factors;Stroke/epidemiology;*Survival Rate","Newson, R. S.;Witteman, J. C.;Franco, O. H.;Stricker, B. H.;Breteler, M. M.;Hofman, A.;Tiemeier, H.",2010,Dec,10.1007/s11357-010-9154-8,0,
3176,An agenda for personalized medicine,,apolipoprotein E;clopidogrel;DNA base;tamoxifen;age distribution;Alzheimer disease;breast cancer;consumer;ethnicity;gene frequency;gene linkage disequilibrium;genetic analysis;genetic marker;genetic variability;genotype;heart infarction;non insulin dependent diabetes mellitus;note;online system;priority journal;psoriasis;sex difference;cerebrovascular accident,"Ng, P. C.;Murray, S. S.;Levy, S.;Venter, J. C.",2009,,,0,
3177,Mental disorders and asthma in the elderly: A population-based study,"Background: Clinical studies have mostly linked anxiety disorders with asthma in young patients, but the data are inconsistent for depression. Few population-based studies have investigated the co-morbid diagnoses of mental disorders with asthma in older adults. Method: Cross-sectional study of a population sample of older adults aged 60 and above (n = 1092). The diagnoses of recent depression and anxiety were made using the Geriatric Mental State (GMS) Schedule. The presence of asthma was ascertained by self-reports of physician-diagnosed asthma. Results: Asthma was associated with a higher prevalence of depressive disorders, with odds ratio of 2.45 (95% CI, 1.06-5.69) when compared against non-asthmatic controls; and 2.42 (95% CI, 1.04-5.64) when compared against controls with other chronic illnesses, after adjusting for psychosocial factors, physical co-morbidity and use of depression-causing drugs. Odds ratios were elevated but statistically insignificant for anxiety disorders and dementia. Conclusion: We observed that asthma in the elderly was more evidently associated co-morbidly with depression, rather than anxiety disorder. However, possible associations with anxiety and dementia are not excluded, and should be further investigated. Copyright © 2006 John Wiley & Sons, Ltd.",benzodiazepine;chloral hydrate;cimetidine;digitalis;haloperidol;levodopa;methyldopa;naproxen;prednisolone;propranolol;reserpine;risperidone;thiazide diuretic agent;tramadol;trihexyphenidyl;adult;aged;anxiety disorder;arthritis;article;asthma;neoplasm;cataract;chronic obstructive lung disease;comorbidity;confidence interval;controlled study;dementia;depression;diabetes mellitus;disease duration;dyslipidemia;geriatric care;heart failure;hip fracture;human;hypertension;ischemic heart disease;major clinical study;mental disease;population research;self report;semi structured interview;social psychology;cerebrovascular accident,"Ng, T. P.;Chiam, P. C.;Kua, E. H.",2007,,,0,
3178,Comparison of the Charlson Comorbidity Index derived from self-report and medical record review in Asian patients with rheumatic diseases,"Abstract: The aim of the study was to compare the agreement between self-report Charlson Comorbidity Index (SR-CCI) and the medical record-based CCI (MR-CCI) and to examine the impact of both instruments on health-related quality of life (HRQoL) amongst Asian patients with rheumatic diseases. This cross-sectional study surveyed a convenience sample of patients seen at rheumatology specialty outpatient clinics. Patients completed the SR-CCI and Short Form 36, while two research assistants completed the MR-CCI. Item-level agreement between the SR-CCI and MR-CCI was evaluated using kappa coefficients. Adjusted linear regression models evaluated the independent effect of the SR-CCI/MR-CCI on HRQoL. The study included 301 patients (median age 51, range 21–79, 61.5 % female, 68.8 % Chinese, 17.6 % Indian, 6.0 % Malay). Kappa statistics for cerebrovascular disease (0.433), chronic pulmonary disease (0.509), connective tissue disease/rheumatoid arthritis (0.506), ulcer disease (0.461), and tumour (0.541) reflected moderate agreement between the SR-CCI and MR-CCI (all p < 0.0001). There was substantial agreement in the reporting of diabetes (0.764, p < 0.0001) but poor/fair agreement for that of myocardial infarction (0.359, p < 0.0001) and diabetes with end-organ damage (0.189, p = 0.0002). Increases in SR-CCI were associated with significant reductions in both physical (β coefficient −2.56, p < 0.0001) and mental HRQoL (β coefficient −1.24, p = 0.044). However, such associations were not observed with the MR-CCI. The SR-CCI demonstrated moderate concordance with the MR-CCI, and the SR-CCI but not MR-CCI scores were associated with lower HRQoL. Assessment of comorbidities amongst rheumatology patients remains complex, and more efficient methods of quantifying these conditions are needed for clinical and research purposes.",acquired immune deficiency syndrome;adult;aged;article;Asian;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;comparative study;congestive heart failure;connective tissue disease;convenience sample;cross-sectional study;dementia;diabetes mellitus;disease severity;female;heart infarction;hemiplegia;human;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;medical record review;neoplasm;peripheral vascular disease;priority journal;quality of life;rheumatic disease;rheumatoid arthritis;Short Form 36;solid tumor;ulcer,"Ng, X.;Low, A. H. L.;Thumboo, J.",2015,,,0,
3179,Not so simple: Situating postgenomics personalized medicine in the regional context in Africa for global and women's health,,acquired immune deficiency syndrome;Africa;albinism;Alzheimer disease;article;asthma;diabetes mellitus;Down syndrome;fetal alcohol syndrome;genetic screening;genomics;health care facility;health care system;heart infarction;human;Human immunodeficiency virus infection;medical literature;midwife;neural tube defect;pharmacogenetics;traditional medicine;vertical transmission;women's health;world health organization,"Ngueng-Feze, I.;Borda-Rodriguez, A.;Huzair, F.",2011,,,0,
3180,A regenerative label-free fiber optic sensor using surface plasmon resonance for clinical diagnosis of fibrinogen,"PURPOSE: We present the regenerative label-free fiber optical biosensor that exploits surface plasmon resonance for quantitative detection of fibrinogen (Fbg) extracted from human blood plasma. MATERIALS AND METHODS: The sensor head was made up of a multimode optical fiber with its polymer cladding replaced by metal composite of nanometer thickness made of silver, aluminum, and nickel. The Ni layer coated allowed a direct immobilization of histidine-tagged peptide (HP) on its metal surface without an additional cross-linker in between. On the coated HP layer, immunoglobulin G was then immobilized for specific capturing of Fbg. RESULTS: We demonstrated a real-time quantitative detection of Fbg concentrations with limit of detection of ~10 ng/mL. The fact that the HP layer could be removed by imidazole with acid also permitted us to demonstrate the regeneration of the outermost metal surface of the sensor head for the sensor reusability. CONCLUSION: The sensor detection limit was estimated to be ~10 pM, which was believed to be sensitive enough for detecting Fbg during the clinical diagnosis of cardiovascular diseases, myocardial infarction, strokes, and Alzheimer's diseases.",Fibrinogen/*analysis;Humans;Limit of Detection;*Optical Fibers;Surface Plasmon Resonance/*instrumentation/*methods;Spr;histidine-tagged peptide;protein sensing;real-time assay,"Nguyen, T. T.;Bea, S. O.;Kim, D. M.;Yoon, W. J.;Park, J. W.;An, S. S.;Ju, H.",2015,,10.2147/ijn.s88963,0,
3181,Comorbidity and survival of Danish prostate cancer patients from 2000-2011: A population-based cohort study,"Objective: We investigated temporal changes in overall survival among prostate cancer (PC) patients and the impact of comorbidity on all-cause mortality. Methods: We conducted a population-based cohort study in the Central Denmark Region (1.2 million inhabitants). Using medical registries, we identified 7,654 PC patients with first-time PC diagnosis within the period 2000-2011 and their corresponding comorbidities within 10 years prior to the PC diagnosis. We estimated 1- and 5-year survival in four consecutive calendar periods using a hybrid analysis and plotted Kaplan-Meier survival curves. We used Cox proportional hazards regression to compute 1- and 5-year age-adjusted mortality rate ratios (MRRs) for different comorbidity levels. All estimates are reported with their corresponding 95% confidence intervals (CI). Results: The annual number of PC cases doubled over the 12-year study period. Men aged <70 years accounted for the largest proportional increase (from 33% to 47%). The proportion of patients within each comorbidity category remained constant over time. One-year survival increased from 82% (CI: 80%-84%) in 2000-2002 to 92% (CI: 90%-93%) in 2009-2011, while 5-year survival increased from 43% (CI: 40%-46%) to 65% (CI: 62%-67%) during the same time intervals. Improvements in 5-year survival were most prominent among patients aged <80 years and among those with no comorbidity (from 51% to 73%) and medium comorbidity (from 32% to 54%). Improvements in survival were much smaller for those with high comorbidity (from 33% to 39%). The 1-year age-adjusted MRR for patients with high comorbidity (relative to patients with no comorbidity) increased over time from 1.84 (CI: 1.19-2.84) to 3.67 (CI: 2.49-5.41), while the 5-year age-adjusted MRR increased from 1.73 (CI: 1.34-2.23) to 2.38 (CI: 1.93-2.94). Conclusion: Overall survival of PC improved substantially during 2000-2011, although primarily among men with low comorbidity. All-cause mortality was highest among PC patients with high comorbidity, and their relative 1- and 5-year mortality increased over time compared to those without comorbidity. © 2013 Nguyen-Nielsen et al, publisher and licensee Dove Medical Press Ltd.",acquired immune deficiency syndrome;aged;article;cancer mortality;cancer patient;cancer registry;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;dementia;Denmark;diabetes mellitus;disease severity;heart infarction;hemiplegia;human;Human immunodeficiency virus infection;Kaplan Meier method;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;overall survival;peripheral vascular disease;proportional hazards model;prostate cancer;risk assessment;solid tumor;ulcer,"Nguyen-Nielsen, M.;Nørgaard, M.;Jacobsen, J. B.;Borre, M.;Thomsen, R. W.;Søgaard, M.",2013,,,0,
3182,Drug utilisation in the geriatric population in the nursing homes and central hospitals of urban Harare,"This paper outlines the pattern of drug utilisation in the elderly inpatient population in the nursing homes, Bumhudzo and BS Leon Trust and the two central hospitals, Harare and Parirenyatwa, in urban Harare, during the period, February to September 1990. The total population of elderly patients in the four institutions was calculated at 324 (52 pc) 170 of which were males and 48 pc were females. Of these patients 273 (84 pc) were Black, 44 (14 pc) were White and seven (2 pc) were Asians. Drug use pattern was estimated using the defined daily dose (DDD) system. The pattern of drug use was matched with the disease pattern to detect any discrepancies in drug utilisation. Of the 324 patients interviewed 114 (35 pc) were not on medication. The total number of drug formulations taken by the studied population was 1,117 with a mean of 3.45 drugs per individual at any one moment. Polypharmacology seems rife. The study indicated irrational and over utilisation of centrally acting drugs and vitamins and minerals. The most utilised group of drugs are the cardiovasculars (22 pc of the total) The most common disease conditions encountered in the elderly were hypertension, 7 pc, congestive heart failure, 7 pc, epigastric pain, 6 pc, senile dementia, 5 pc and pneumonia, 5 pc. The responses on sources of drug information available for the elderly revealed that pharmacists are totally unknown to the elderly in this respect. Measures that could be taken to improve elderly drug use are suggested.","Age Factors;Aged;Aged, 80 and over;Drug Therapy/*utilization;Drug Utilization;Female;*Homes for the Aged;*Hospitals, Urban;Humans;Male;Middle Aged;Morbidity;*Nursing Homes;*Urban Population;Zimbabwe/epidemiology","Nhachi, C. F.;Zvaraya, P.;Kasilo, J.",1994,May,,0,
3183,Factors influencing deprescribing habits among geriatricians,"Background: deprescribing habits among physicians managing older, frailer, cognitively impaired patients have not been well investigated. Methods: an anonymised electronic survey was disseminated to all members of an international geriatric society/local advanced trainee network (N = 930). This comprised a Likert-scale analysis of factors influencing desprescribing, and five case vignettes, detailing a patient with progressive cognitive impairment and dependency, on a background of ischaemic heart disease and hypertension. Results: among 134 respondents (response rate 14.4%), 47.4% were female, 48.9% aged 36-50 years and 84.1% specialists (15.9% trainees). Respondents commonly rated limited life expectancy (96.2%) and cognitive impairment (84.1%) as very/extremely important to deprescribing practices. On multivariable analysis, older respondents less commonly rated functional dependency (odds ratio [OR] 0.22 per change in age category; P < 0.001) and limited life expectancy (OR 0.09, P = 0.04) important when deprescribing, while female participants (OR 3.03, P < 0.001) and trainees (versus specialists OR 14.29, P < 0.001) more often rated adherence to evidence-based guidelines important. As vignettes described increasing dependency and cognitive impairment, physicians were more likely to stop donepezil, aspirin, atorvastatin and antihypertensives (all P < 0.001 for trend). Aspirin (93.6%) and ramipril (94.1%) were most commonly deprescribed. Commonest reasons cited for deprescribing medications were 'dementia severity', followed by pill burden. Conclusion: in this exploratory analysis, geriatricians rated limited life expectancy and cognitive impairment very important in driving deprescribing practices. Geriatricians more often deprescribed multiple medications in the setting of advancing dependency and cognitive impairment, driven by dementia severity and pill burden concerns. Physician characteristics also influence deprescribing practices. Further exploration of factors influencing deprescribing patterns, and patient outcomes, is needed.",acetylsalicylic acid;antihypertensive agent;atorvastatin;donepezil;ramipril;adult;aged;article;cognitive defect;dementia;deprescribing habit;disease severity;female;functional disease;geriatrician;human;hypertension;ischemic heart disease;life expectancy;male;medical specialist;polypharmacy;prescription;priority journal;protocol compliance,"Ní Chróinín, D.;Ní Chróinín, C.;Beveridge, A.",2015,,,0,
3184,Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly,"BACKGROUND: Upper respiratory tract illnesses have been associated with an increased risk of ischemic heart disease and stroke. During two influenza seasons, we assessed the influence of vaccination against influenza on the risk of hospitalization for heart disease and stroke, hospitalization for pneumonia and influenza, and death from all causes. METHODS: Cohorts of community-dwelling members of three large managed-care organizations who were at least 65 years old were studied during the 1998-1999 and 1999-2000 influenza seasons. Administrative and clinical data were used to evaluate outcomes, with multivariable logistic regression to control for base-line demographic and health characteristics of the subjects. RESULTS: There were 140,055 subjects in the 1998-1999 cohort and 146,328 in the 1999-2000 cohort, of which 55.5 percent and 59.7 percent, respectively, were immunized. At base line, vaccinated subjects were on average sicker, having higher rates of most coexisting conditions, outpatient care, and prior hospitalization for pneumonia than unvaccinated subjects. Unvaccinated subjects, however, were more likely to have been given a prior diagnosis of dementia or stroke. Vaccination against influenza was associated with a reduction in the risk of hospitalization for cardiac disease (reduction of 19 percent during both seasons [P<0.001]), cerebrovascular disease (reduction of 16 percent during the 1998-1999 season [P<0.018] and 23 percent during the 1999-2000 season [P<0.001]), and pneumonia or influenza (reduction of 32 percent during the 1998-1999 season [P<0.001] and 29 percent during the 1999-2000 season [P<0.001]) and a reduction in the risk of death from all causes (reduction of 48 percent during the 1998-1999 season [P<0.001] and 50 percent during the 1999-2000 season [P<0.001]). In analyses according to age, the presence or absence of major medical conditions at base line, and study site, the findings were consistent across all subgroups. CONCLUSIONS: In the elderly, vaccination against influenza is associated with reductions in the risk of hospitalization for heart disease, cerebrovascular disease, and pneumonia or influenza as well as the risk of death from all causes during influenza seasons. These findings highlight the benefits of vaccination and support efforts to increase the rates of vaccination among the elderly.",aged;aging;article;cerebrovascular disease;controlled study;death;dementia;disease association;female;heart disease;hospitalization;human;influenza;influenza vaccination;ischemic heart disease;major clinical study;male;outpatient care;pneumonia;priority journal;risk assessment;cerebrovascular accident;upper respiratory tract infection,"Nichol, K. L.;Nordin, J.;Mullooly, J.;Lask, R.;Fillbrandt, K.;Iwane, M.",2003,,,0,
3185,"Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens","BACKGROUND: Vaccination rates for healthy senior citizens are lower than those for senior citizens with underlying medical conditions such as chronic heart or lung disease. Uncertainty about the benefits of influenza vaccination for healthy senior citizens may contribute to lower rates of utilization in this group. OBJECTIVE: To clarify the benefits of influenza vaccination among low-risk senior citizens while concurrently assessing the benefits for intermediate- and high-risk senior citizens. METHODS: All elderly members of a large health maintenance organization were included in each of 6 consecutive study cohorts. Subjects were grouped according to risk status: high risk (having heart or lung disease), intermediate risk (having diabetes, renal disease, stroke and/or dementia, or rheumatologic disease), and low risk. Outcomes were compared between vaccinated and unvaccinated subjects after controlling for baseline demographic and health characteristics. RESULTS: There were more than 20000 subjects in each of the 6 cohorts who provided 147551 person-periods of observation. The pooled vaccination rate was 60%. There were 101 619 person-periods of observation for low-risk subjects, 15 482 for intermediate-risk, and 30 450 for high-risk subjects. Vaccination over the 6 seasons was associated with an overall reduction of 39% for pneumonia hospitalizations (P<.001), a 32% decrease in hospitalizations for all respiratory conditions (P<.001), and a 27% decrease in hospitalizations for congestive heart failure (P<.001). Immunization was also associated with a 50% reduction in all-cause mortality (P<.001). Within the risk subgroups, vaccine effectiveness was 29%, 32%, and 49% for high-, intermediate-, and low-risk senior citizens for reducing hospitalizations for pneumonia and influenza (for high and low risk, P< or =.002; for intermediate risk, P = .11). Effectiveness was 19%, 39%, and 33% (for each, P< or =.008), respectively, for reducing hospitalizations for all respiratory conditions and 49%, 64%, and 55% for reducing deaths from all causes (for each, P<.001). Vaccination was also associated with direct medical care cost savings of $73 per individual vaccinated for all subjects combined (P = .002). Estimates of cost savings within each risk group suggest that vaccination would be cost saving for each subgroup (range of cost savings of $171 per individual vaccinated for high risk to $7 for low risk), although within the subgroups these findings did not reach statistical significance (for each, P> or =.05). CONCLUSIONS: This study confirms that healthy senior citizens as well as senior citizens with underlying medical conditions are at risk for the serious complications of influenza and benefit from vaccination. All individuals 65 years or older should be immunized with this vaccine.","Aged;Aged, 80 and over;Female;Humans;Influenza Vaccines/*therapeutic use;Influenza, Human/*prevention & control;Male;Risk;Risk Factors;Seasons;Treatment Outcome","Nichol, K. L.;Wuorenma, J.;von Sternberg, T.",1998,Sep 14,,0,
3186,Preventable hospitalization among elderly medicare beneficiaries with type 2 diabetes,"OBJECTIVE - To examine the impact of comorbid conditions on preventable hospitalizations among Medicare beneficiaries aged ≥65 years with type 2 diabetes. RESEARCH DESIGN AND METHODS - Data were drawn from the 1999 Medicare Standard Analytic Files, a 5% nationally representative random sample of Medicare beneficiaries. The analysis sample included 193,556 Medicare beneficiaries aged ≥65 years with type 2 diabetes (ICD-9-CM codes 250.xx) who were enrolled in fee-for-service Medicare. Preventable hospitalization was assessed by measuring ambulatory care-sensitive conditions, an accepted measure of hospitalizations that could have been prevented with appropriate outpatient care. Multivariable analyses controlled for demographics; mortality; renal, ophthalmic, of neurological manifestations of diabetes; type of physician providing the outpatient care; and per capita community-level indicators of income and hospital beds. RESULTS - Ninety-six percent of beneficiaries in the sample had a comorbidity, and 46% had five or more comorbidities. Among beneficiaries with type 2 diabetes, cardiovascular-related comorbidities were common and accounted for increased odds of preventable hospitalization, controlling for other factors. The likelihood of a preventable hospitalization increased in the presence of a claim for comorbid congestive heart failure, cardiomyopathy, coronary atherosclerosis, hypertension, or cardiac dysrythmias. Noncardiovascular comorbidities associated with a greater likelihood of preventable hospitalization included chronic obstructive pulmonary disease, asthma and lower respiratory disorders, Alzheimer's disease/dementia, personality/anxiety disorders, depression, and osteoporosis. Our data suggest that nearly 7% of all hospitalizations could be avoided. CONCLUSIONS - These findings support the need for improved outpatient care strategies to reduce the impact of comorbidity on unnecessary hospitalization in patients aged >65 years with type 2 diabetes.",aged;Alzheimer disease;ambulatory care;article;asthma;cardiomyopathy;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;dementia;depression;elderly care;female;health care cost;hospital bed;human;income;major clinical study;male;medical fee;medical service;medicare;non insulin dependent diabetes mellitus;osteoporosis;outpatient care,"Niefeld, M. R.;Braunstein, J. B.;Wu, A. W.;Saudek, C. D.;Weller, W. E.;Anderson, G. F.",2003,,,0,
3187,Intensified prehospital treatment of heart arrest increases the number of survivors with good cerebral function,"Psychological assessment in the form of a test for dementia was carried out in 69 individuals. Thirty of these were survivors of cardiac arrest outside hospital. Seven of these were brought to hospital in ordinary emergency ambulances, 14 in heart ambulances and nine in medically staffed ambulances. In addition, 28 patients with acute myocardial infarction (AMI) and 11 control persons were examined. The result of the investigation demonstrates that the more intensive the prehospital treatment of cardiac arrest, the more patients survive with good cerebral function. In particular, the percentage of cerebral damage was least in cases where a medically staffed ambulance was employed.","Brain Damage, Chronic/etiology/*mortality/prevention & control;Denmark;Heart Arrest/complications/mortality/*therapy;Humans;Psychological Tests;Resuscitation;Survival Rate","Nielsen, J. R.;Gram, L.;Larsen, C. F.;Lybecker, H.;Andersen, C.;Frandsen, F.;Jorgensen, H. R.;Haghfelt, T.",1990,Jun 25,,0,
3188,Intellectual and social function of patients surviving cardiac arrest outside the hospital,"Thirteen survivors of cardiac arrest outside the hospital were examined by clinical and psychological tests 1-3 years after the incidence, and compared to a matched control group of 13 patients with acute myocardial infarction without cardiac arrest. Psychological tests revealed that 7 patients with previous cardiac arrest and 4 control patients had mild-moderate to moderate-severe dementia. The demential symptoms were not detectable by a clinical interview. Four patients in each group exhibited pronounced anxiety symptoms. There were no clear differences between the two groups in respect of changes in cardiac function and social status after the incidence.",central nervous system;clinical article;diagnosis;heart;heart arrest;human;intellect;psychological aspect;social aspect;social status;survival;therapy,"Nielsen, J. R.;Gram, L.;Rasmussen, L. P.",1983,,,0,
3189,Factors affecting in-hospital mortality in patients with lower gastrointestinal tract bleeding: a retrospective study using a national database in Japan,"Background: Bleeding of the lower gastrointestinal tract requires hospitalization and can cause in-hospital death in the most serious cases; however, only a few studies have evaluated in-hospital death from bleeding of the lower gastrointestinal tract. The aim of this study was to investigate the in-hospital mortality of patients with bleeding of the lower gastrointestinal tract and elucidate the factors associated with it using a large-scale database. Methods: We analyzed a nationwide database in Japan retrospectively. From the Diagnosis Procedure Combination database, we extracted data on patients who were admitted with visible blood in stool between July 1, 2010 and March 31, 2012. We assessed age, sex, comorbidity, cause of bleeding, type of hospital, medications, body mass index (BMI), and need for blood transfusion and treatments. A multivariable logistic regression model was used to examine factors associated with blood transfusion and in-hospital death. Results: A total of 30,846 patients were identified. The median age was 74 years, and 52.0 % of patients were male. A total of 782 patients died in hospital (2.5 %), and 8,060 patients (26.1 %) needed blood transfusion. In a multivariate analysis, in-hospital death was significantly associated with being older or male; comorbidities, including congestive heart failure, renal disease, and mild to severe liver disease; the cause of bleeding; a nonacademic hospital; nonsteroidal anti-inflammatory drug use; lower BMI; and requirements for blood transfusion, interventional radiology, and surgery. Most factors were similarly associated with blood transfusion. Conclusions: In-hospital mortality was 2.5 % and was associated with age, sex, comorbidities, cause of bleeding, type of hospital, nonsteroidal anti-inflammatory drug use, BMI, blood transfusion, and requirements for treatments.",acemetacin;acetylsalicylic acid;anticoagulant agent;beraprost;cilostazol;clopidogrel;dabigatran etexilate;dalteparin;danaparoid;dilazep;dipyridamole;enoxaparin;etodolac;flurbiprofen axetil;fondaparinux;heparin;ibuprofen;indometacin;indometacin farnesil;ketoprofen;limaprost;mefenamic acid;mofezolac;nabumetone;nonsteroid antiinflammatory agent;ozagrel;sarpogrelate;sulindac;ticlopidine;warfarin;aged;article;blood transfusion;body mass;chronic lung disease;comorbidity;congestive heart failure;conservative treatment;dementia;diabetes mellitus;female;gastrointestinal hemorrhage;heart infarction;hospital patient;hospitalization;human;ischemic colitis;Japan;kidney disease;liver disease;lower gastrointestinal tract bleeding;major clinical study;male;melena;mortality;occult blood;peripheral vascular disease;priority journal;rectum disease;rectum hemorrhage;retrospective study;rheumatic disease;aspirin,"Niikura, R.;Yasunaga, H.;Yamaji, Y.;Horiguchi, H.;Fushimi, K.;Yamada, A.;Hirata, Y.;Koike, K.",2015,,,0,
3190,The early rehospitalization of elderly patients. Causes and prevention,"The causes of early rehospitalization (within 3 weeks) of very elderly patients, its possible avoidance and appropriate preventive measures were analysed retrospectively in patients of a geriatric hospital. Included were all those patients who had been admitted to the hospital from their home several (mean: five) times between 1987 and 1990 (48 women, 19 men; mean age 81.3 +/- 7.2 years--a total of 331 re-admissions). The most frequent diagnoses were heart failure (38.8%), acute cerebrovascular accident or its sequelae (31.3%), dementia (23.9%), fall or its sequelae (22.3%) and diabetes (20.9%). Of the 331 re-admissions 87 (26.3%) occurred during the first 3 weeks after discharge. The most important reasons of this early re-admissions were inadequate home care (41.4%), undesirable drug effects and non-compliance (25.3%), as well as rapid progression of the basic disease (14.9%). In the judgement of the hospital team more than 40% of the early re-admissions were avoidable, among those re-admitted because of inadequate home care and those in connection with drug intake even more than half. Early hospitalization is frequently avoidable, if individual geriatric assessment is undertaken and discharge carefully planned.","Acute Disease;Aged;Aged, 80 and over;Drug-Related Side Effects and Adverse Reactions;Female;Germany, West;Humans;Male;*Patient Readmission/statistics & numerical data;Retrospective Studies;Time Factors;Treatment Refusal","Nikolaus, T.;Specht-Leible, N.;Kruse, W.;Oster, P.;Schlierf, G.",1992,Mar 13,10.1055/s-2008-1062325,0,
3191,Can we identify risk factors for postoperative delirium in cardiac coronary patients? Our experience,"Introduction: Delirium is a temporary mental disorder that frequently occurs among elderly hospitalized patients. Patients who undergo cardiac operations have an increased risk of postoperative delirium, which is associated with higher mortality and morbidity rates, a prolonged hospital stay, and reduced cognitive and functional recovery. Patients and Methods: In our prospective study, we included 370 consecutive adult patients who underwent on-pump coronary artery surgery between January 1, 2011, and July 1, 2011. We selected 21 potential risk factors and divided them into preoperative, intraoperative, and postoperative groups. Delirium was diagnosed with the Confusion Assessment Method. Results: Postoperative delirium was diagnosed in 74 patients (20%). Four predictive factors were associated with postoperative delirium: diabetes mellitus, cerebrovascular disease, peripheral vascular disease, and prolonged intubation (P < .05). Conclusion: Three of the four predictive factors significantly associated with delirium are preoperative. They are relatively easy to measure and can be used to identify patients at higher risk. Fast extubation of these patients and preventive interventions can be taken to prevent negative consequences of this postoperative complication. © 2012 Forum Multimedia Publishing, LLC.",fentanyl;opiate;adult;alcohol consumption;anesthesia;article;cerebrovascular disease;cognition;coronary artery surgery;dementia;depression;diabetes mellitus;female;functional status;hearing impairment;heart arrest;atrial fibrillation;heart left ventricle function;hospitalization;human;hypertension;intraoperative period;intubation;kidney function;major clinical study;male;morbidity;mortality;neurologic disease;operation duration;peripheral vascular disease;postoperative delirium;postoperative period;predictive validity;preoperative period;priority journal;prospective study;risk assessment;risk factor;visual impairment,"Nikolić, B. D.;Putnik, S. M.;Lazovic, D. M.;Vranes, M. D.",2012,,,0,
3192,Electroencephalographic and histopathological changes resembling Jakob-Creutzfeldt disease after transient cerebral ischemia due to cardiac arrest,,aged;article;autopsy;brain;Creutzfeldt Jakob disease;differential diagnosis;electroencephalography;female;heart arrest;heart muscle;human;male;metabolism;pathology;transient ischemic attack,"Nilsson, B. Y.;Olsson, Y.;Sourander, P.",1972,,,0,
3193,Plasma homocysteine concentration and its relation to symptoms of vascular disease in psychogeriatric patients,"BACKGROUND: There is a high frequency of elevated plasma total homocysteine (tHcy) concentrations in elderly patients with mental disorders. Psychogeriatric patients with a history of vascular disease exhibit a significantly higher plasma tHcy concentration than patients without vascular disease. METHOD: The main reason for the present study is to further investigate the association between plasma tHcy concentration and vascular disease in psychogeriatric patients. We therefore investigated 152 psychogeriatric patients and determined plasma tHcy and its most important determinants (serum folate and serum cobalamin, serum cystatin C and serum creatinine). The patients were divided into two groups according to the presence of vascular disease. Eighty-seven patients had concomitant vascular disease. We also analysed the natriuretic peptide N-terminal pro brain natriuretic peptide (NT-proBNP) and protein S-100B in serum. NT-proBNP is a marker for congestive heart failure, whereas protein S-100B is a marker for brain damage. RESULTS: The plasma tHcy concentration is elevated in the presence of dementia or vascular disease in psychogeriatric patients. The presence of dementia or vascular disease is also associated with higher age, renal impairment and lower serum folate concentration than in patients without dementia or vascular disease. Furthermore, we observed elevated serum concentrations of NT-proBNP in patients with dementia or vascular disease as a sign of poorer cardiovascular status. Likewise, protein S-100B concentrations were elevated in patients with dementia or vascular disease, possibly indicating brain damage in these groups of patients. CONCLUSION: The high frequency of comorbidity of vascular disease and mental illness indicates a possibility to prevent and treat psychogeriatric disease by actively counteracting vascular disease in patients with psychogeriatric symptoms. Routine determination of NT-proBNP is valuable for obtaining information about cardiovascular status.","Aged;Aged, 80 and over;Alzheimer Disease/epidemiology;Creatinine/blood;Cystatin C;Cystatins/blood;Female;Folic Acid/blood;Homocysteine/*blood;Humans;Male;Middle Aged;Natriuretic Peptide, Brain/blood;Peptide Fragments/blood;Protein S/metabolism;Vascular Diseases/*blood/epidemiology;Vitamin B 12/blood","Nilsson, K.;Gustafson, L.;Hultberg, B.",2005,,10.1159/000085072,0,
3194,Plasma homocysteine levels and different forms of vascular disease in patients with dementia and other psychogeriatric diseases,"Background: Total plasma homocysteine (tHcy) concentration is elevated in patients with psychogeriatric disease. There are many different determinants of plasma tHcy concentration, including the presence of vascular disease. Method: We investigated plasma tHcy levels in several different subgroups of vascular disease and also the relation between plasma tHcy and renal function in patients with psychogeriatric disease. Results: All different groups of patients with vascular disease exhibited an elevated level of plasma tHcy compared to patients without vascular disease even after exclusion of patients with folate/cobalamin deficiency. Patients with elevated serum creatinine with or without vascular disease exhibited significantly increased plasma tHcy compared to the respective groups of patients without elevated serum creatinine. Patients with vascular dementia and Alzheimer's disease with concomitant vascular disease exhibited significantly increased plasma tHcy levels compared to patients without vascular disease. Conclusion: The presence of vascular disease increases the level of plasma tHcy and renal impairment further increases the elevated plasma tHcy level. Furthermore, the findings suggest similar influence on plasma tHcy turnover irrespective of whether the vascular disease is of cerebral or extracerebral origin or only manifests itself as arrhythmia or hypertension. Copyright © 2009 S. Karger AG.",cobalamin;creatinine;folic acid;homocysteine;adult;aged;Alzheimer disease;amino acid blood level;angina pectoris;article;blood sampling;confusion;controlled study;creatinine blood level;delirium;depression;female;folic acid deficiency;frontotemporal dementia;gerontopsychiatry;heart arrhythmia;heart failure;heart infarction;human;hypertension;kidney disease;kidney function;major clinical study;male;mental disease;mild cognitive impairment;multiinfarct dementia;priority journal;vascular disease,"Nilsson, K.;Gustafson, L.;Hultberg, B.",2009,,,0,
3195,"Plasma homocysteine, apolipoprotein e status and vascular disease in elderly patients with mental illness","Background: Total plasma homocysteine (tHcy) concentration is increased in elderly patients with mental illness. Also, patients with vascular disease have significantly higher plasma tHcy concentration compared with patients without vascular disease. Apolipoprotein E (apoE) status is associated with cardiovascular disease and a major genetic risk factor is inheritance of the e4 allele. In the present study, we investigated the association between plasma tHcy and apoE status. Methods: The relation between apoE status, plasma tHcy and vascular disease was investigated in a cohort of consecutively enrolled elderly patients with mental illness (n=328). Results: Plasma tHcy concentrations were increased (p<0.01) in carriers of APOE4 (13.6 μmol/L; 9.2-21.7 μmol/L) compared to non-carriers (12.4 μmol/L; 8.3-19.9 μmol/L). The proportion of patients with vascular disease was significantly (p<0.001) increased among carriers (61%) compared to non-carriers (42%). An increased percentage (p<0.001) of APOE4 carriers was observed in patients with Alzheimer's disease (AD) with (71%) or without vascular disease (42%), and in patients with vascular dementia (VaD) (54%) compared to a reference group (34%). Conclusions: Since carriers of APOE4 showed an increased likelihood of vascular disease, these patients need more intensive control of other modifiable vascular risk factors. Furthermore, the association between plasma tHcy and the presence of APOE4 might be attributed to an increased proportion of vascular disease in APOE4 carriers. © 2010 by Walter de Gruyter Berlin New York.",apolipoprotein E;apolipoprotein E4;homocysteine;adult;aged;Alzheimer disease;amino acid blood level;angina pectoris;article;brain infarction;cohort analysis;controlled study;Diagnostic and Statistical Manual of Mental Disorders;female;groups by age;atrial fibrillation;heart infarction;human;hypertension;major clinical study;male;multiinfarct dementia;peripheral vascular disease;priority journal;protein blood level;risk factor;transient ischemic attack,"Nilsson, K.;Gustafson, L.;Nornholm, M.;Hultberg, B.",2010,,,0,
3196,Low systolic blood pressure is associated with impaired cognitive function in the oldest old: longitudinal observations in a population-based sample 80 years and older,"BACKGROUND AND AIMS: The primary aim of the present study was to examine whether there is an association between blood pressure and the risk of subsequent cognitive decline in the oldest old. Various factors associated with blood pressure and cognitive function were considered. METHODS: The study comprised 599 individuals of a population-based sample, 199 men (mean age at baseline 82.8 years, range 80-95) and 400 women (mean age at baseline 83.3 years, range 80-100). Cognitive function was evaluated by the Mini Mental State Examination (MMSE). For a subgroup of 385 subjects (130 men, 255 women), data were available on blood pressure and MMSE at baseline and two followups at two-year intervals. Baseline blood pressure was studied in one group with reduced cognition and in another group with intact cognition across the following four years. The association of systolic blood pressure (SBP) with the MMSE score through the follow-up period was analysed controlling for frailty (time to death), age, gender, apoprotein E, homocysteine, hypertension, congestive heart failure, and stroke. RESULTS: A medical history of arterial hypertension was associated with lower MMSE scores and a higher prevalence of dementia and cognitive decline at baseline. However, intact cognition through the observation period was associated with higher baseline SBP. This relationship also remained when the frailty of aging subjects, indicated by remaining time to death, was taken into account. CONCLUSIONS: Lower SBP in the oldest old is associated with an increased risk of cognitive impairment even after adjustment for compromised vitality. In late life, the risk of cognitive decline needs to be considered in clinical practice.","Aged, 80 and over;Antihypertensive Agents/therapeutic use;*Blood Pressure;Cognition Disorders/*epidemiology/*physiopathology;Female;Follow-Up Studies;Humans;Hypertension/drug therapy/epidemiology;Hypotension/*epidemiology;Logistic Models;Longitudinal Studies;Male;Mental Status Schedule;Prevalence;Risk Factors","Nilsson, S. E.;Read, S.;Berg, S.;Johansson, B.;Melander, A.;Lindblad, U.",2007,Feb,,0,
3197,Association of biochemical values with morbidity in the elderly: a population-based Swedish study of persons aged 82 or more years,"BACKGROUND: Various inter-dependent factors influence serum biochemical values. In the elderly, the impact of these factors may differ compared with younger age groups and therefore population-based studies among older people are needed. The specific morbidity in old age, including also various types of drug therapy, should be observed. METHODS: Various biochemical tests in 349 females and 186 males over 81 years of age were carried out and the associations of biochemical values with morbidity, drug therapy, anthropometry and gender were estimated. RESULTS: Biochemical serum values deviate in various diseases, characterized by increased frequency in the elderly, i.e. congestive heart failure, osteoporosis, hip fractures, depression and dementia. All of these diseases present a tendency to increased homocysteine, usually combined with low folate. Cases with intact cognitive function throughout the six years after sampling are characterized by low homocysteine, which is the opposite of what is found in dementia. Furthermore, congestive heart failure is associated with impaired creatinine clearance and increased urea and urate, and osteoporosis and hip fractures are characterized by low albumin and cholesterol. Increased values for urate and impaired creatinine clearance are found in coronary diseases. In gout, multiple biochemical changes take place. For cases with a history of diabetes, arterial hypertension, peptic ulcer and malignancy, few changes are found compared with the values of the total sample. Furosemide therapy is associated with the same pattern as congestive heart failure, and laxative treatment is characterized by low folate and high homocysteine values.","Aged;Aged, 80 and over;Biomarkers/*blood;Blood Chemical Analysis;Body Mass Index;Cholesterol/blood;Creatine/blood;Data Interpretation, Statistical;Female;Furosemide/therapeutic use;Gout/blood/epidemiology;Heart Failure/blood/epidemiology;Hip Fractures/blood/epidemiology;Homocysteine/blood;Humans;Linear Models;Male;*Morbidity;Osteoporosis/blood/epidemiology;Peptic Ulcer/blood;Serum Albumin/analysis;Sex Factors;Sweden/epidemiology;Twins/statistics & numerical data;Urea/blood;Uric Acid/blood;gamma-Glutamyltransferase/blood","Nilsson, S. E.;Takkinen, S.;Tryding, N.;Evrin, P. E.;Berg, S.;McClearn, G.;Johansson, B.",2003,,,0,
3198,Effects of anti-depression and anti-anxiety on blood sugar level of senile diabetic patients,"Aim: To explore the effects of anti-depression and anti-anxiety on blood sugar level of senile diabetic patients companied with anxiety and depression. Methods: A total of 43 senile type 2 diabetic patients accompanied with anxiety or depression were selected. Including criterion: The patients were coincided to type 2 diabetes mellitus combined with depression and anxiety according to diagnostic standard of WHO. Excluding criterion: Severe hepatorenal disease, heart failure above III degree, conduction dysfunction of the heart and other disease induced by psychonosema were excluded. A total of 43 patients were divided into control group (n = 23) and treatment group (n = 20). Patients in the control group were treated as normal, but in the treatment group, patients were treated by normal method and drug of anti-depression and anti-anxiety, which was the mixture of microdosage dihydrochloride flupenthixol and microdosage hydrochloric melitracene. Changes of self-rating depression scale (SDS) score, self-rating anxiety scale (SAS) score and blood sugar level were evaluated in the two groups before and 3 weeks after treatment. Results: 1 SDS and SAS scores in the control group were lower after treatment (P > 0.05), and fasting blood-glucose (FBG) and 2-hour postprandial blood glucose (PBG2h) were decreased obviously after treatment (t = 2.102 to 2.197, P < 0.05). 2 SDS and SAS scores in the treatment group were lower after treatment(t = 2.491 to 2.507, P < 0.05), and FBG and PBG2h were decreased obviously after treatment [(4.15 ± 2.91), (4.48 ± 3.19) mmol/L], and there were significant differences(t = 2.528 to 2.540, P < 0.05). 3 SDS, SAS scores, FBG and PBG2h in the treatment group were decreased obviously 3 weeks after treatment compared with the control group(t = 2.973 to 3.074, P < 0.01; t = 2.370 to 2.396, P < 0.05) respectively. Conclusion: Senile diabetic patients companied with anxiety and depression are treated with anti-anxiety, anti-depression drug and usual treatment together, and the effect of the combination is better than simple usual treatment, besides anxiety, depression and blood sugar value are improved.",antidepressant agent;anxiolytic agent;flupentixol;glucose;melitracen;aged;anxiety disorder;article;clinical article;controlled study;depression;Diagnostic and Statistical Manual of Mental Disorders;diet restriction;disease association;dose response;drug mechanism;female;glucose blood level;human;male;non insulin dependent diabetes mellitus;postprandial state;rating scale;scoring system;self evaluation;senility,"Ning, L. R.;Sun, S. L.;Li, P.",2004,,,0,
3199,Pain management in hematological patients with major organ dysfunctions and comorbid illnesses,"Background: Organ dysfunctions and medical complications, such as renal failure, liver impairment, coagulation disorders, cardiovascular and respiratory illnesses, may hamper an adequate pain management in haematological patients. Aim: To summarize current knowledge on pain management in hematological patients presenting major organ dysfunctions and comorbidity. We also attempted to provide recommendations to optimize analgesia and to minimize side effects in the setting of medically compromised and frail haematological patients. Methods: A systematic search of the literature, using relevant key words, was conducted in PubMed. Results and conclusions: Pain in hematological patients is a common symptom and is often multi-factorial. Most pharmacotherapeutic measures, including causal therapies, analgesics and adjuvant agents routinely applied in pain management, may also be used in the setting of clinical frailty and medical comorbidities; however, comprehensive clinical and functional patient's evaluations and a careful consideration of expected benefits and potential adverse events are required. © 2012 Bentham Science Publishers.",alfentanil;buprenorphine;clodronic acid;codeine;dextropropoxyphene;fentanyl;hydromorphone;ketamine;methadone;morphine;naloxone;nonsteroid antiinflammatory agent;opiate;oxycodone;pamidronic acid;paracetamol;pethidine;remifentanil;sufentanil;tapentadol;tramadol;acute disease;analgesia;appendicitis;article;cancer pain;cellulitis;cerebrovascular disease;cholelithiasis;chronic disease;chronic obstructive lung disease;common bile duct stone;comorbidity;dementia;drug dose reduction;heart failure;hematologic malignancy;hemochromatosis;herpes zoster;human;hypertension;immunocompromized patient;kidney dysfunction;leg ulcer;liver cirrhosis;liver dysfunction;liver toxicity;lung cancer;medical literature;Medline;mental disease;muscle atrophy;muscle hematoma;muscle spasm;musculoskeletal pain;osteoarthritis;pain;pancreatitis;peptic ulcer;respiration depression;sickle cell anemia;sleep disordered breathing;spleen infarction;thalassemia,"Niscola, P.;Tendas, A.;Giovannini, M.;Scaramucci, L.;Cupelli, L.;Ferrannini, M.;Brunetti, G. A.;Bondanini, F.;Palumbo, R.;Perrotti, A.;Romani, C.;Cartoni, C.;Efficace, F.;de Fabritiis, P.",2012,,,0,
3200,Palliative care in patients without cancer: Impact of the end-of-life care team,"Palliative care improves the quality of life of patients and their families facing problems associated with life-threatening illnesses by promoting the prevention and relief of suffering. Palliative care in Japan has been developed mainly for cancer patients. At the National Center for Geriatrics and Gerontology, an end-of-life care team (EOLCT) has been developed to promote palliative care for patients without cancer. In the first 6 months of its operation, 109 requests were received by the team, 40% of which were for patients without cancer or related disease, including dementia, frailty due to advanced age, chronic respiratory failure, chronic heart failure, and intractable neurologic diseases. The main purpose of the EOLCT is to alleviate suffering. The relevant activities of the team include the use of opioids, providing family care, and giving support in decision-making (advance care planning) regarding withholding; enforcement; and withdrawal of mechanical ventilators, gastric feeding tubes, and artificial alimentation. The EOLCT is also involved in ongoing discussions of ethical problems. The team is actively engaged in the activities of the Japanese Geriatric Society and contributes to the development of decision-making guidelines for end-of-life by the Ministry of Health, Labour and Welfare. The EOLCT can be helpful in promoting palliative care for patients with diseases other than cancer. The team offers support during times of difficulty and decision-making. © 2013 The Japan Geriatrics Society.",aged;article;human;palliative therapy;patient care;standard;terminal care;very elderly,"Nishikawa, M.;Yokoe, Y.;Kubokawa, N.;Hukuda, K.;Hattori, H.;Hong, Y. J.;Miura, H.;Shibasaki, M.;Endo, H.;Takeda, J.;Odate, M.;Senda, K.;Nakashima, K.",2013,,,0,
3201,A mitochondrial encephalomyopathy with cardiomyopathy. A case revealing a defect of complex I in the respiratory chain,"We describe a 16-year-old Japanese girl with a mitochondrial encephalomyopathy who presented with progressive dementia, limb weakness and atrophy, episodic vomiting, generalized convulsions, myoclonic seizures, and hypertrophic cardiomyopathy. CT scan revealed transient focal low density areas in her occipital and parietal lobes, and cerebellar atrophy. The clinical features were consistent with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS). Microscopically, most of muscle fibers in the skeletal muscles and heart were occupied by markedly increased mitochondria. Polarographic studies on mitochondria isolated from postmortem heart muscle showed severe impairment of oxidation of NADH-linked substrates in contrast to normal succinate oxidation. The rotenone-sensitive NADH-coenzyme Q reductase activity was markedly decreased in heart, skeletal muscle and liver mitochondria. The biochemical investigations have led to the identification of a defect of complex I in the respiratory chain. Reported cases of a defect of complex I have revealed pure myopathy, encephalopathy or encephalomyopathy. The reason for a varied clinical expression of a single defect remains to be clarified.",reduced nicotinamide adenine dinucleotide dehydrogenase (ubiquinone);brain disease;cardiomyopathy;case report;central nervous system;computer assisted tomography;diagnosis;heart;human;Japan;mitochondrion;muscle;myopathy;priority journal,"Nishizawa, M.;Tanaka, K.;Shinozawa, K.",1987,,,0,
3202,Residential medication management reviews of antithrombotic therapy in aged care residents with atrial fibrillation: Assessment of stroke and bleeding risk,"What is known and objective Antithrombotics reduce the risk of stroke in individuals with atrial fibrillation (AF). However, optimal prescribing of antithrombotics in older people remains a challenge. The objective of this study was to assess the risk of stroke for aged care home residents with AF and to examine the pharmacist-led medication reviews on the utilization of antithrombotic therapy. Methods This retrospective study included a random sample of de-identified residential medication management reviews (RMMRs) conducted by accredited pharmacists in aged care homes in Sydney, Australia, between August 2011 and December 2012. The study participants were 146 residents aged 65 years and older with AF living in low- and high-care residential aged care facilities. Antithrombotic therapy was examined among the residents, before and after medication review. CHADS2, CHA2DS2-VASc, and HEMORR2HAGES scoring tools were used to assess the risk of stroke and bleeding and indicate the appropriateness of antithrombotic therapy. Results and discussion The mean age (±SD) of individuals was 88·4 (7·5) years, and 63·7% (n = 93) were female. The majority of residents (n = 99, 67·8%) were aged between 85 and 99 years. The mean (±SD) CHADS2 score was 3·1 (1·1), CHA2DS2-VASc was 4·6 (1·5), and HEMORR2HAGES was 2·3 (1·0). All residents were classified as being at high risk of developing stroke. A total of 115 of 146 (78·8%) residents with AF were prescribed antithrombotics. There was a relatively low usage of anticoagulation (28·1%), and few recommendations from the medication review pharmacists to alter the thromboprophylactic therapy in AF. Application of the CHA2DS2-VASc risk tool indicated that 146 residents were eligible for antithrombotic treatments; of these, 74 (50·7%) were prescribed antiplatelets and 41 (28·1%) were prescribed anticoagulants. Of the 31 (21·2%) residents with AF were not prescribed antithrombotics, 21 (67·7%) had relative contraindications for anticoagulant treatments. What is new and conclusion Although there was a high overall use of antithrombotic agents, the study found a reluctance to prescribe or recommend anticoagulants in eligible older people with AF, potentially due to associated contraindications and multimorbidity. The use of guideline-recommended stroke risk tools could assist medication review pharmacists in optimizing antithrombotic therapy in older adults with AF. The study assessed the risk of stroke for aged care home residents with atrial fibrillation (AF) and examined Residential Medication Management (RMMR) reviews on the utilization of antithrombotic therapy. This study found anticoagulants were underutilized in eligible older people with AF. Guideline-recommended stroke scoring systems, in combination with bleeding risk assessment, may assist RMMR service providers in determining the net clinical benefit of antithrombotic therapy in older adults with AF.",acetylsalicylic acid;acetylsalicylic acid plus clopidogrel;acetylsalicylic acid plus dipyridamole;clopidogrel;creatinine;dabigatran;warfarin;aged;aging;alcohol consumption;allergy;anemia;angina pectoris;anticoagulant therapy;article;atrial fibrillation;Australia;bleeding;cerebrovascular accident;CHADS2 score;cognitive defect;controlled study;creatinine blood level;deep vein thrombosis;dementia;depression;diabetes mellitus;drug utilization;falling;female;general practitioner;health care cost;health care facility;heart arrhythmia;heart failure;heart infarction;human;hypertension;impaired glucose tolerance;ischemic heart disease;kidney failure;liver failure;major clinical study;male;medication therapy management;morbidity;mortality;nursing home patient;peptic ulcer;polypharmacy;prescription;prevalence;residential care;retrospective study;risk assessment;risk factor;thromboembolism;transient ischemic attack;vascular disease;very elderly,"Nishtala, P. S.;Castelino, R. L.;Peterson, G. M.;Hannan, P. J.;Salahudeen, M. S.",2016,,,0,
3203,Multimodal MRI in cerebral small vessel disease: Its relationship with cognition and sensitivity to change over time,"BACKGROUND AND PURPOSE-Cerebral small vessel disease is the most common cause of vascular dementia. Interest in using MRI parameters as surrogate markers of disease to assess therapies is increasing. In patients with symptomatic sporadic small vessel disease, we determined which MRI parameters best correlated with cognitive function on cross-sectional analysis and which changed over a period of 1 year. METHODS-Thirty-five patients with lacunar stroke and leukoaraiosis were recruited. They underwent multimodal MRI (brain volume, fluid-attenuated inversion recovery lesion load, lacunar infarct number, fractional anisotropy, and mean diffusivity from diffusion tensor imaging) and neuropsychological testing. Twenty-seven agreed to reattend for repeat MRI and neuropsychology at 1 year. RESULTS-An executive function score correlated most strongly with diffusion tensor imaging (fractional anisotropy histogram, r≤'0.640, P≤0.004) and brain volume (r≤0.501, P≤0.034). Associations with diffusion tensor imaging were stronger than with all other MRI parameters. On multiple regression of all imaging parameters, a model that contained brain volume and fractional anisotropy, together with age, gender, and premorbid IQ, explained 74% of the variance of the executive function score (P≤0.0001). Changes in mean diffusivity and fractional anisotropy were detectable over the 1-year follow-up; in contrast, no change in other MRI parameters was detectable over this time period. CONCLUSION-A multimodal MRI model explains a large proportion of the variation in executive function in cerebral small vessel disease. In particular, diffusion tensor imaging correlates best with executive function and is the most sensitive to change. This supports the use of MRI, in particular diffusion tensor imaging, as a surrogate marker in treatment trials. © 2008 American Heart Association, Inc.",aged;anisotropy;article;brain blood vessel;brain function;brain infarction;brain size;clinical article;cognition;controlled study;cross-sectional study;diffusion tensor imaging;female;follow up;functional assessment;gender;histogram;human;intelligence quotient;lacunar stroke;leukoaraiosis;male;multiple regression;neuropsychological test;neuropsychology;nuclear magnetic resonance imaging;priority journal;scoring system;cerebrovascular accident,"Nitkunan, A.;Barrick, T. R.;Charlton, R. A.;Clark, C. A.;Markus, H. S.",2008,,,0,
3204,Mortality from dementia in a community-dwelling Brazilian population,"BACKGROUND: The influence of dementia on mortality has not yet been reported for a Latin American country. OBJECTIVES: To evaluate the influence of dementia on mortality of a community-dwelling elderly population in Brazil, and to verify the extent to which the diagnosis of dementia is reported on death certificates. METHODS: A cohort of 1,656 individuals, aged 65 and over, was screened for dementia at their domiciles, in 1997. The same population was re-evaluated in 2000, and information on deaths was obtained from relatives and from the municipal obituary service. Kaplan-Meier curves were used for the survival analysis, and the mortality risk ratio (MMR) was calculated using Cox proportional hazards models. RESULTS: We obtained data from 1,393 subjects, corresponding to 84.1% of the target population. The number of deaths was 58 (51.3%) among the patients with dementia and 163 (12.7%) among those without dementia in 1997 (p <0.0001). Dementia and Alzheimer's disease (AD) decreased survival, with hazards ratios of 5.16 [95% Confidence Interval (CI): 3.74-7.12] for dementia and 4.76 (95% CI: 3.16-7.18) for AD. The Cox proportional hazards model identified dementia (MMR=3.92, 95% CI: 2.80-5.48) as the most significant predictor of death, followed by age, history of stroke, complaints of visual impairment and heart failure and by severe arterial hypertension in the baseline evaluation. Dementia and/or AD were mentioned in only 12.5% of the death certificates of individuals with dementia. CONCLUSIONS: Dementia causes a significant decrease in survival, and the diagnosis of dementia is rarely reported on death certificates in Brazil.","Activities of Daily Living;Aged;Aged, 80 and over;Alzheimer Disease/mortality;Brazil/epidemiology;Cause of Death;Comorbidity;Death Certificates;Dementia/*mortality;Epidemiologic Methods;Female;Geriatric Assessment/methods;Humans;Male","Nitrini, R.;Caramelli, P.;Herrera, E., Jr.;de Castro, I.;Bahia, V. S.;Anghinah, R.;Caixeta, L. F.;Radanovic, M.;Charchat-Fichman, H.;Porto, C. S.;Teresa Carthery, M.;Hartmann, A. P.;Huang, N.;Smid, J.;Lima, E. P.;Takahashi, D. Y.;Takada, L. T.",2005,Mar,10.1002/gps.1274,0,
3205,Bipolar disorder in the elderly: A cohort study comparing older and younger patients,"Objective: The purpose of this study was to analyze differences in clinical and socio-demographic characteristics between older and younger bipolar outpatients paying special attention to depressive symptoms in a large, naturalistic cohort. Method: Five hundred and ninety-three DSM-IV-TR bipolar outpatients were enrolled. Clinical characteristics were assessed according to DSM-IV-TR (SCID-I). Subjects were categorized into two groups according to current age (older OBD: age > 65 years; younger-YBD: age < 65 years). Results: About 80% of patients were younger (N = 470), and a fifth were older (N = 123), with a mean age of 77.30 years in OBD. Older patients were more likely to be married, not qualified, bipolar II, with depressive polarity of first episode, higher age at illness onset, higher age at first hospitalization. They were more likely to present with depressive predominant polarity, with lifetime history of catatonic, psychotic and melancholic features, age at illness onset >40 years, as well as suffering from more medical comorbidities when compared to younger bipolars. Conclusion: The clinical presentation of bipolar disorder in late life would be defined more frequently by melancholic depressive features and a predominantly depressive polarity. These results suggest that treatment strategies for elderly bipolar patients should focus in the prevention of depressive episodes.",acute heart infarction;adult;age;aged;Alzheimer disease;article;atherosclerosis;bipolar depression;bipolar disorder;bipolar II disorder;bipolar mania;brain ischemia;catatonia;chronic kidney failure;chronic lung disease;clinical feature;cognitive defect;comorbidity;controlled study;dyslipidemia;epilepsy;family history;female;heart failure;hospitalization;human;hypertension;hypomania;insulin dependent diabetes mellitus;ischemic heart disease;major clinical study;male;married person;medical history;melancholia;mixed mania and depression;motor dysfunction;multiinfarct dementia;neoplasm;non insulin dependent diabetes mellitus;obesity;onset age;osteoporosis;outpatient;Parkinson disease;priority journal;psychosis;suicide attempt;vein insufficiency,"Nivoli, A. M. A.;Murru, A.;Pacchiarotti, I.;Valenti, M.;Rosa, A. R.;Hidalgo, D.;Virdis, V.;Strejilevich, S.;Vieta, E.;Colom, F.",2014,,,0,
3206,Incidence of dementia: evidence for an effect modification by gender. The ILSA Study,"BACKGROUND: Gender differences for incidence of dementia among elderly people have been usually investigated considering gender as a predictor and not as a stratification variable. METHODS: Analyses were based on data collected by the Italian Longitudinal Study on Aging (ILSA), which enrolled 5,632 participants aged 65-84 years between 1992 and 2000. During a median follow-up of 7.8 years, there were 194 cases of incident dementia in the participants with complete data. Cox proportional hazard models for competing risks, stratified by sex, were defined to determine risk factors in relation to developing dementia. RESULTS: The incidence rate of dementia increased from 5.57/1,000 person-years at 65-69 years of age to 30.06/1,000 person-years at 80-84 years. Cox proportional hazard models for competing risks of incidence of dementia and death revealed that, among men, significant risk factors were heart failure, Parkinson's disease, family history of dementia, mild depressive symptomatology and age, while triglycerides were associated with a lower risk of developing dementia. Significant risk factors in women were age, both mild and severe depressive symptomatology, glycemia >/=109 mg/dL, and a BMI < 24.1 kg/m(2). Even as little as three years of schooling was found to be a significant protective factor against the incidence of dementia only for women. CONCLUSIONS: Our results suggest that there is an effect modification by gender in our study population in relation to the association between low education level, lipid profile, BMI, and glycemia and dementia.","Age Factors;Aged;Aged, 80 and over;Body Mass Index;Dementia/*epidemiology/etiology;Depression/complications;Educational Status;Female;Humans;Incidence;Longitudinal Studies;Male;Proportional Hazards Models;Risk Factors;Sex Factors","Noale, M.;Limongi, F.;Zambon, S.;Crepaldi, G.;Maggi, S.",2013,Nov,10.1017/s1041610213001300,1,
3207,Dementia and disability: impact on mortality. The Italian Longitudinal Study on Aging,"Dementia is known to be associated with excess mortality. Physical disability, as a marker of dementia severity, is often considered the last step on the way from disease to death. The objective of this study was to investigate the direct effect of dementia on mortality in a population-based study, carried out in Italy, with a sample of 5,632 individuals aged 65-84 years. At 4-year follow-up, 998 participants had died. The independent predictors of death were: age (75-84 years; HR 2.63, CI = 2.11-3.27), male sex (HR 1.45, CI = 1.22-1.74), coronary heart disease (HR 1.61, CI = 1.34-1.94), moderate and severe instrumental activities of daily living disability (HR 1.98, CI = 1.30-3.03 and HR 3.26, CI = 2.09-5.09, respectively), diabetes in subjects with a survival time greater than 23 months (HR 0.68, CI = 0.43-1.08) and dementia (HR 2.07, CI = 1.62-2.66). These data provide evidence that dementia per se, independently from physical disability, is a strong predictor of death in the elderly.","Activities of Daily Living;Aged;Aged, 80 and over;Dementia/*mortality;Disability Evaluation;Disabled Persons/*statistics & numerical data;Humans;Italy/epidemiology;Longitudinal Studies;Risk Factors;Sex Distribution;Survival Analysis","Noale, M.;Maggi, S.;Minicuci, N.;Marzari, C.;Destro, C.;Farchi, G.;Scafato, E.;Baldereschi, M.;Di Carlo, A.;Crepaldi, G.",2003,,69987,0,
3208,Association between clusters of diseases and polypharmacy in hospitalized elderly patients: results from the REPOSI study,"BACKGROUND: Although the association between multimorbidity and polypharmacy has been clearly documented, no study has analyzed whether or not specific combinations of diseases influence the prescription of polypharmacy in older persons. We assessed which clusters of diseases are associated with polypharmacy in acute-care elderly in-patients. METHODS: This cross-sectional study was held in 38 Italian internal medicine and geriatric wards participating in the Registro Politerapie SIMI (REPOSI) study during 2008. The study sample included 1155 in-patients aged 65 years or older. Clusters of diseases, defined as two or more co-occurring specific chronic diseases, were identified using the odds ratio (OR) for the associations between pairs of diseases followed by cluster analysis. Polypharmacy was defined as the prescription of five or more different medications at hospital discharge. Logistic regression models were run to analyze the association between clusters of diseases and polypharmacy. RESULTS: Among clusters of diseases, the highest mean number of drugs (>8) was found in patients affected by heart failure (HF) plus chronic obstructive pulmonary disease (COPD), HF plus chronic renal failure (CRF), COPD plus coronary heart disease (CHD), diabetes mellitus plus CRF, and diabetes mellitus plus CHD plus cerebrovascular disease (CVD). The strongest association between clusters of diseases and polypharmacy was found for diabetes mellitus plus CHD plus CVD, diabetes plus CHD, and HF plus atrial fibrillation (AF). CONCLUSIONS: The observed knowledge of the relationship among co-occurring diseases and polypharmacy should help to identify and monitor older in-patients at risk of polypharmacy.","Aged;Aged, 80 and over;Cardiovascular Diseases/*epidemiology;Cluster Analysis;Comorbidity;Cross-Sectional Studies;Dementia/epidemiology;Diabetes Mellitus/*epidemiology;Endocrine System Diseases/epidemiology;Female;Gastrointestinal Diseases/epidemiology;Geriatrics;Hospitalization/*statistics & numerical data;Humans;Internal Medicine;Logistic Models;Lung Diseases/epidemiology;Male;Morbidity;Neoplasms/epidemiology;*Polypharmacy;Prevalence;Risk Factors","Nobili, A.;Marengoni, A.;Tettamanti, M.;Salerno, F.;Pasina, L.;Franchi, C.;Iorio, A.;Marcucci, M.;Corrao, S.;Licata, G.;Mannucci, P. M.",2011,Dec,10.1016/j.ejim.2011.08.029,0,
3209,"Old disease, new look? A first report of parkinsonism due to scurvy, and of refeeding-induced worsening of scurvy",,ascorbic acid;folic acid;furosemide;infusion fluid;olanzapine;osmolite;thiamine;zinc;aged;anemia;article;aspiration pneumonia;blood cell count;case report;diabetes mellitus;diet supplementation;gingiva bleeding;hand tremor;heart failure;hematoma;hospital admission;human;hypertension;male;multiinfarct dementia;outcome assessment;parkinsonism;paroxysmal atrial fibrillation;petechia;prostate hypertrophy;refeeding;rigidity;scurvy;shuffling gait;transient ischemic attack;treatment response;vitamin blood level;zinc blood level,"Noble, M.;Healey, C. S.;McDougal-Chukwumah, L. D.;Brown, T. M.",2013,,,0,
3210,The future spectrum of diseases. What the experts think,,acquired immune deficiency syndrome;Alzheimer disease;article;cause of death;eradication therapy;general aspects of disease;heart infarction;hepatitis;Human immunodeficiency virus;non insulin dependent diabetes mellitus;obesity;prevention;prognosis;therapy effect;treatment indication;tuberculosis,"Nocon, M.;Witt, C.;Willich, S. N.",2007,,,0,
3211,A new clinically applicable age-specific comorbidity index for preoperative risk assessment of ovarian cancer patients,"Objective To develop and validate a new feasible comorbidity index based on self-reported information suited for preoperative risk assessment of ovarian cancer patients. Methods The study was based on patient self-reported data from ovarian cancer patients registered in the Danish Gynecological Cancer Database between January 1, 2005 and December 31, 2012. The study population was divided into a development cohort (n = 2020) and a validation cohort (n = 1975). Age-stratified multivariate Cox regression analyses were conducted to identify comorbidities significantly impacting five-year overall survival in the development cohort, and regression coefficients were used to construct a new weighted comorbidity index. The index was applied to the validation cohort, and its predictive ability in regard to overall and cancer-specific five-year-survival was investigated. Finally, the performance of the new index was compared to that of the Charlson Comorbidity Index. Results Regression coefficients of age and five comorbidities (atherosclerotic cardiac disease, chronic obstructive pulmonary disease, diabetes, dementia and hypertension) were included in the new comorbidity index. The validation study found the new index to be significantly associated to both overall survival (HR 1.44, p = 0.013) and cancer-specific survival (HR 1.51, p = 0.017) in multivariate analyses adjusted for other prognostic factors. The index was a significantly better predictor than the Charlson Comorbidity Index. Conclusion This new age-specific comorbidity index based on self-reported information is a significant predictor of overall and cancer-specific survival in ovarian cancer. It can be used to quickly identify those ovarian cancer patients requiring special attention in terms of preoperative optimization and postoperative care.",adolescent;adult;age;aged;alcohol abuse;alcohol liver disease;anemia;angina pectoris;article;asthma;cancer patient;cancer prognosis;cancer specific survival;cancer staging;Charlson Comorbidity Index;chronic obstructive lung disease;clear cell carcinoma;cohort analysis;comorbidity;congestive heart failure;constipation;coronary artery atherosclerosis;dementia;depression;diabetes mellitus;endometrium carcinoma;enteritis;epilepsy;female;heart arrhythmia;heart infarction;human;human tissue;hydronephrosis;hypertension;hyperthyroidism;irritable colon;kidney failure;major clinical study;middle aged;minimal residual disease;nutritional status;obesity;osteoarthritis;outcome assessment;ovary cancer;overall survival;peripheral vascular disease;peritoneum cancer;population research;postoperative care;preoperative evaluation;priority journal;rheumatoid arthritis;risk assessment;self report;underweight;uterine tube tumor,"Noer, M. C.;Sperling, C. D.;Antonsen, S. L.;Ottesen, B.;Christensen, I. J.;Høgdall, C.",2016,,10.1016/j.ygyno.2016.03.034,0,
3212,A patient with possible dementia with Lewy bodies (DLB) who presented with Takotsubo cardiomyopathy,,"Depressive Disorder, Major/complications;Female;Humans;Lewy Body Disease/*complications;Middle Aged;Takotsubo Cardiomyopathy/*complications/*diagnosis","Noguchi, M.;Yamaga, K.",2010,Apr,10.1111/j.1440-1819.2010.02068.x,0,
3213,Swallowing disorders in nursing home residents: How can the problem be explained?,"Background: The swallowing mechanism changes significantly as people age, even in the absence of chronic diseases. Presbyphagia, a term that refers to aging-related changes in the swallowing mechanism, may be linked to many health conditions and presents itself in distinct ways. Swallowing disorders are also identified as a major problem amongst the elderly population living in nursing homes. Methods: The study sought to determine the prevalence of swallowing disorders in nursing home residents, to identify the relationship between self-perceived swallowing disorders, cognitive functions, autonomy, and depression, and also to analyze which variables explain the score of the Dysphagia Self-Test (DST). For this purpose, the researchers chose to apply a survey conveying questions on demographic aspects, general health, eating and feeding, as well as instruments to assess functional performance and the 3 ounce Water Swallow Test. Results: The sample consisted of 272 elderly people living in eight nursing homes in Portugal. Six did not sign the informed consent form. Of the total, 29% were totally dependent, 33% were depressed, 45% had cognitive impairment, and 38% needed help with feeding. About 43% of the individuals reported having problems related to eating. Regarding the DST, 40% showed signs of dysphagia. With respect to the 3 ounce Water Swallow Test, 38% revealed at least one of the symptoms, wet voice being the most prevalent. Correlation measures showed that age had no linear association with the DST score although correlation with the Barthel Index and Mini Mental State Examination was found to be significant. A linear regression model was estimated with the DST score as the dependent variable and the MMSE and BI scores, gender, age, education, the Geriatric Depression Scale score, 3 ounce Water Swallow Test, and diagnosed conditions (such as neurological disorder, dementia, and cardiorespiratory problems) as explaining variables. Conclusion: Results showed a high prevalence of dysphagia signs amongst a nursing home population. For the purpose of the present study, both a subjective and an objective assessment were applied. Results pointed to a significant statistical relation between objective and subjective measures, thus indicating that a self-perception test should be included in the assessment of swallowing disorders in a nursing home population. Notwithstanding, it should not be used as a single or principal measure as it is influenced by the individuals' cognitive condition. © 2013 Nogueira and Reis, publisher and licensee Dove Medical Press Ltd.",age distribution;aged;article;cardiopulmonary insufficiency;cognitive defect;cross-sectional study;depression;dysphagia;eating disorder;educational status;female;human;major clinical study;male;nursing home patient;Portugal;prevalence;questionnaire;risk assessment;risk factor;scoring system;self concept;sex difference,"Nogueira, D.;Reis, E.",2013,,,0,
3214,Loss-of-function mutation in ABCA1 and risk of Alzheimer's disease and cerebrovascular disease,"Introduction The adenosine triphosphate-binding cassette transporter A1 (ABCA1) is a major cholesterol transporter highly expressed in the liver and brain. In the brain, ABCA1 lipidates apolipoprotein E (apoE), facilitates clearance of amyloid-β, and may be involved in maintenance of the blood-brain barrier via apoE-mediated pathways. Methods We tested whether a loss-of-function mutation in ABCA1, N1800H, is associated with plasma levels of apoE and with risk of Alzheimer's disease (AD) in 92,726 individuals and with risk of cerebrovascular disease in 64,181 individuals. Results N1800H AC (0.2%) versus AA (99.8%) was associated with a 13% lower plasma level of apoE (P = 1 × 10-11). Multifactorially adjusted hazard ratios for N1800H AC versus AA were 4.13 (95% confidence interval, 1.32-12.9) for AD, 2.46 (1.10-5.50) for cerebrovascular disease, and 8.28 (2.03-33.7) for the hemorrhagic stroke subtype. Discussion A loss-of-function mutation in ABCA1, present in 1:500 individuals, was associated with low plasma levels of apoE and with high risk of AD and cerebrovascular disease in the general population.",ABC transporter A1;apoenzyme;apolipoprotein A;apolipoprotein B;high density lipoprotein cholesterol;low density lipoprotein;low density lipoprotein cholesterol;triacylglycerol;adult;aged;Alzheimer disease;article;blood sampling;body mass;brain hemorrhage;brain ischemia;cerebrospinal fluid analysis;cerebrovascular disease;cholesterol blood level;computer assisted tomography;Denmark;disease association;disease registry;female;follow up;heart infarction;human;loss of function mutation;major clinical study;male;nuclear magnetic resonance imaging;physical examination;priority journal;risk factor;triacylglycerol blood level,"Nordestgaard, L. T.;Tybjærg-Hansen, A.;Nordestgaard, B. G.;Frikke-Schmidt, R.",2015,,,0,
3215,Predicting the outcome of hip fracture patients by using N-terminal fragment of pro-B-type natriuretic peptide,"Objective: To examine the prognostic value of perioperative N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in hip fracture patients. Design: Blinded prospective cohort study. Setting: Single centre trial at Turku University Hospital in Finland. Participants: Inclusion criterion was admittance to the study hospital due to hip fracture during the trial period of October 2009-May 2010. Exclusion criteria were the patient's refusal and inadequate laboratory tests. The final study population consisted of 182 patients. Primary and secondary outcome measures: NT-proBNP was assessed once during the perioperative period and later if clinically indicated, and troponin T (TnT) and ECG recordings were evaluated repeatedly. The short-term (30-day) and long-term (1000 days) mortalities were studied. Results: Median (IQR) follow-up time was 3.1 (0.3) years. The median (IQR) NT-proBNP level was 1260 (2298) ng/L in preoperative and 1600 (3971) ng/L in postoperative samples (p=0.001). TnT was elevated in 66 (36%) patients, and was significantly more common in patients with higher NT-proBNP. Patients with high (>2370 ng/L) and intermediate (806-2370 ng/L) NT-proBNP level had significantly higher short-term mortality compared with patients having a low (<806 ng/L) NT-proBNP level (15 vs 11 vs 2%, p=0.04), and the long-term mortality remained higher in these patients (69% vs 49% vs 27%, p<0.001). Intermediate or high NT-proBNP level (HR 7.8, 95% CI 1.03 to 59.14, p<0.05) was the only independent predictor of short-term mortality, while intermediate or high NT-proBNP level (HR 2.27, 95% CI 1.30 to 3.96, p=0.004), the presence of dementia (HR 1.74, 95% CI 1.13 to 2.66, p=0.01) and higher preoperative American Society of Anesthesiologists' (ASA) classification (HR 1.59, 95% CI 1.06 to 2.38, p=0.02) were independent predictors of long-term mortality. Conclusion: An elevated perioperative NT-proBNP level is common in hip fracture patients, and it is an independent predictor of short-term and long-term mortality superior to the commonly used clinical risk scores.",NCT01015105;brain natriuretic peptide;troponin T;age distribution;aged;amino terminal sequence;article;clinical trial;congestive heart failure;dyspnea;electrocardiogram;female;follow up;high risk patient;hip fracture;human;major clinical study;male;morbidity;outcome assessment;perioperative period;prognosis;thorax pain;very elderly,"Nordling, P.;Kiviniemi, T.;Strandberg, M.;Strandberg, N.;Airaksinen, J.",2016,,,0,
3216,Frequent mild cognitive deficits in several functional domains in elderly patients with heart failure without known cognitive disorders,"BACKGROUND: The objective of the present study was to investigate whether mild cognitive deficits are present in patients with heart failure (HF) despite absence of any known cognitive disorder. METHODS AND RESULTS: A well defined group of patients (n = 40) with heart failure completed a cognitive screening check list, a depression screening questionnaire, and a battery consisting of neuropsychological tests assessing 5 different cognitive domains: speed/attention, episodic memory, visuospatial functions, language, and executive functions. The neuropsychological results were compared with those from a group of healthy control subjects (n = 41). The patients with HF displayed cognitive impairment compared with the control group within the domains speed and attention, episodic memory, visuospatial functions, and language. Among them, 34 HF patients (85%) could be classified with mild cognitive impairment (MCI), the majority as nonamnestic MCI, ie, with no memory impairment. CONCLUSIONS: Considering the high occurrence of mild cognitive deficits among HF patients without known cognitive disorders, closer attention should be paid to their self-care and compliance. Inadequate self-care and compliance could lead to more frequent hospitalizations. Furthermore, the HF patients may be at increased risk of dementia.","Aged;Aged, 80 and over;Attention/*physiology;Cognition/*physiology;Executive Function;Female;Follow-Up Studies;Heart Failure/*complications/psychology;Humans;Male;Middle Aged;Mild Cognitive Impairment/diagnosis/*etiology/psychology;Neuropsychological Tests;Retrospective Studies;Heart failure;cognition;compliance;dementia;mild cognitive impairment;self-care","Nordlund, A.;Berggren, J.;Holmstrom, A.;Fu, M.;Wallin, A.",2015,Sep,10.1016/j.cardfail.2015.04.006,0,
3217,The use of cholinesterase inhibitors and the risk of myocardial infarction and death: a nationwide cohort study in subjects with Alzheimer's disease,"AIMS: Cholinesterase inhibitors (ChEIs) are used for symptomatic treatment of Alzheimer's disease. These drugs have vagotonic and anti-inflammatory properties that could be of interest also with respect to cardiovascular disease. This study evaluated the use of ChEIs and the later risk of myocardial infarction and death. METHODS AND RESULTS: The cohort consisted of 7073 subjects (mean age 79 years) from the Swedish Dementia Registry with the diagnoses of Alzheimer's dementia or Alzheimer's mixed dementia since 2007. Cholinesterase inhibitor use was linked to diagnosed myocardial infarctions (MIs) and death using national registers. During a mean follow-up period of 503 (range 0-2009) days, 831 subjects in the cohort suffered MI or died. After adjustment for confounders, subjects who used ChEIs had a 34% lower risk for this composite endpoint during the follow-up than those who did not [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.56-0.78]. Cholinesterase inhibitor use was also associated with a lower risk of death (HR: 0.64, 95% CI: 0.54-0.76) and MI (HR: 0.62, 95% CI: 0.40-0.95) when analysed separately. Subjects taking the highest recommended ChEI doses (donepezil 10 mg, rivastigmine >6 mg, galantamine 24 mg) had the lowest risk of MI (HR: 0.35, 95% CI: 0.19-0.64), or death (HR: 0.54, 95% CI: 0.43-0.67) compared with those who had never used ChEIs. CONCLUSION: Cholinesterase inhibitor use was associated with a reduced risk of MI and death in a nationwide cohort of subjects diagnosed with Alzheimer's dementia. These associations were stronger with increasing ChEI dose.","Adult;Aged;Aged, 80 and over;Alzheimer Disease/*drug therapy/mortality;Cholinesterase Inhibitors/*therapeutic use;Cohort Studies;Female;Humans;Male;Middle Aged;Myocardial Infarction/mortality/*prevention & control;Risk Factors;Survival Analysis;Alzheimer's dementia;Choline esterase inhibitors;Myocardial infarction","Nordstrom, P.;Religa, D.;Wimo, A.;Winblad, B.;Eriksdotter, M.",2013,Sep,10.1093/eurheartj/eht182,0,
3218,Urinary methylmalonic acid test may have greater value than the total homocysteine assay for screening elderly individuals for cobalamin deficiency 8,,cobalamin;homocysteine;methylmalonic acid;aged;Alzheimer disease;anemia;cardiovascular disease;circadian rhythm;cobalamin deficiency;comparative study;cyanocobalamin deficiency;diagnostic accuracy;heart infarction;human;intermethod comparison;kidney failure;letter;neurologic disease;stress;cerebrovascular accident;vascular disease;vitamin deficiency,"Norman, E. J.",2004,,,0,
3219,"Merck & Co., Inc.: Analysis of patenting 1998 - 2002",This article complements an earlier (1997) review of the patenting policy of Merck and indicates how the company continues to file extensively. It compares the patenting activity across each major therapeutic area with the company's 2001 revenues from these therapeutic areas.,"4 aminobutyric acid A receptor blocking agent;5 (2,4 dioxo 5 thiazolidinylmethyl) 2 methoxy n [4 (trifluoromethyl)benzyl]benzamide;alendronic acid;antihypertensive agent;antiinfective agent;antineoplastic agent;antiobesity agent;caspase 3 inhibitor;cyclooxygenase 2 inhibitor;ertapenem;finasteride;gonadorelin antagonist;integrase inhibitor;l 104132;l 685458;l 73135;n [4 [2 [[2 hydroxy 2 (3 pyridinyl)ethyl]amino]ethyl]phenyl] 4 [4 [4 (trifluoromethyl)phenyl] 2 thiazolyl]benzenesulfonamide;l 826791;losartan;losartan potassium;mitogen activated protein kinase inhibitor;montelukast;n (4 fluorobenzyl) 8 hydroxy 5 (tetrahydro 2h 1,2 thiazin 2 yl) 1,6 naphthyridine 7 carboxamide s,s dioxide;n methyl dextro aspartic acid receptor blocking agent;neurokinin 1 receptor antagonist;peptide derivative;protein farnesyltransferase inhibitor;protein tyrosine kinase inhibitor;rofecoxib;simvastatin;unclassified drug;unindexed drug;Alzheimer disease;article;atherosclerosis;cardiovascular disease;central nervous system disease;clinical trial;degenerative disease;depression;diabetes mellitus;drug industry;drug marketing;drug mechanism;drug research;economic aspect;endocrine disease;health care policy;heart failure;human;Human immunodeficiency virus infection;hypertension;inflammation;metabolic disorder;migraine;musculoskeletal disease;obesity;osteoporosis;patent;prostate hypertrophy;respiratory tract disease;rheumatoid arthritis;cerebrovascular accident;vomiting;cozaar;fosamax;invanz;krp 297;l 796568;l 870810;singulair;vioxx;zocor","Norman, P.",2003,,,0,
3220,Huntington's disease: Clinical presentation and treatment,"Huntington's disease (HD) is a devastating inherited neurodegenerative disease characterized primarily by progressive motor, cognitive, and psychiatric symptoms. It is caused by autosomal dominant inheritance of an expanded CAG repeat within the Huntington's gene on chromosome 4. In this chapter, we characterize the typical and variant motor phenotypes of the disease and then proceed to describe the cognitive and psychiatric profile. We then give an overview of a suggested multidisciplinary approach to the management of HD, emphasizing the fact that it is a disease which impacts on entire families rather than affecting individuals in isolation. We then describe the pharmacological and nonpharmacological options available for management of specific symptoms. © 2011 Elsevier Inc.",amantadine;antidepressant agent;aripiprazole;baclofen;benzodiazepine;botulinum toxin;carbamazepine;citalopram;clonazepam;clozapine;etiracetam;fluoxetine;haloperidol;huntingtin;lamotrigine;levodopa;mirtazapine;olanzapine;paroxetine;quetiapine;risperidone;sertraline;sulpiride;tetrabenazine;tizanidine;valproic acid;venlafaxine;zopiclone;agitation;agranulocytosis;akathisia;amnesia;ankle edema;anxiety disorder;apathy;ataxia;blood dyscrasia;blurred vision;book;bruxism;CAG repeat;cardiomyopathy;chorea;chorea minor;clinical feature;cognitive defect;confusion;constipation;depression;disease classification;disease course;dizziness;dose response;drowsiness;drug efficacy;drug hypersensitivity;dysphagia;dystonia;edema;endocrine disease;evidence based medicine;frontotemporal dementia;gastrointestinal symptom;genetic association;genetic risk;genetic screening;headache;heart palpitation;hepatitis;human;huntingtin gene;Huntington chorea;hyperammonemia;hypercholesterolemia;hyperlipidemia;hypersexuality;hypertension;hyponatremia;hypotension;inappropriate vasopressin secretion;insomnia;interpersonal communication;learning disorder;livedo reticularis;low drug dose;memory disorder;mental disease;metabolic disorder;mood change;mood disorder;muscle rigidity;mutator gene;myalgia;myocarditis;myoclonus;nutritional requirement;obsessive compulsive disorder;orthostatic hypotension;parkinsonism;phenotype;physiotherapy;prenatal diagnosis;priority journal;psychomotor disorder;psychosis;psychotherapy;rash;sedation;seizure;side effect;sleep arousal disorder;sleep disorder;spasticity;suicidal ideation;tardive dyskinesia;terminal care;tic;tremor;weight gain;xerostomia,"Novak, M. J. U.;Tabrizi, S. J.",2011,,,0,
3221,Association between apolipoprotein E alleles and calcific valvular heart disease,"BACKGROUND: Studies on apolipoprotein E (apoE) alleles have reported an increased risk of coronary heart disease in patients with the apoE4 allele. Given the risk factor and histological similarities between coronary and calcific valvular heart disease (aortic stenosis [AS] and mitral annular calcification [MAC]), we postulated that apoE alleles might be associated with the development of these valvular lesions. METHODS AND RESULTS: We evaluated the association between apoE alleles and calcific valvular lesions in 802 patients undergoing transthoracic echocardiography using logistic regression analyses. No difference was noted in genotype distribution (P=0.59) or prevalence of apoE4 between those with or without MAC (30% versus 27%, respectively; P=0.57). Compared with patients without AS, the genotype distribution of patients with AS differed significantly (P=0.03), with increasing prevalences of the apoE 4 allele (27% in those without versus 40% in those with AS; P=0.01). In multivariate analyses adjusting for age, gender, low-density lipoprotein cholesterol levels, and coronary artery disease, increasing age and the apoE4 allele were significant independent predictors of AS (odds ratio, 1.94; 95% confidence interval, 1.01 to 3.71; P=0.046), whereas the apoE4 allele was not predictive of MAC. CONCLUSIONS: These findings support extension of the importance of the apoE4 allele beyond atherosclerosis and Alzheimer's disease to calcific AS.",Aged;Alleles;Aortic Valve Stenosis/epidemiology/*genetics;Apolipoprotein E4;Apolipoproteins E/*genetics;Calcinosis/epidemiology/*genetics;Cohort Studies;Comorbidity;Diabetes Mellitus/epidemiology;Female;Genetic Predisposition to Disease;Genotype;Humans;Hyperlipidemias/epidemiology;Hypertension/epidemiology;Male;Middle Aged;Mitral Valve Stenosis/epidemiology/genetics;Prevalence;Risk Factors;Smoking/epidemiology,"Novaro, G. M.;Sachar, R.;Pearce, G. L.;Sprecher, D. L.;Griffin, B. P.",2003,Oct 14,10.1161/01.cir.0000097560.96431.3e,0,
3222,Dementia in a retired world boxing champion: Case report and literature review,"Objective: Dementia in retired boxers, also referred to as ""dementia pugilistica"" (DP), is usually attributed to repeated concussive and subconcussive blows to the head. We report the case of a former world boxing champion whose progressive cognitive decline could be ascribed to DP, cerebral infarcts and Wernicke-Korsakoff syndrome. This case demonstrates that dementia in retired boxers may be caused and/or exacerbated by etiologic factors other than DP. Materials and methods: We correlated the clinical features with the histochemical and immunohistochemical changes observed on autopsy brain material from a retired boxer, reviewed the literature on boxing-related dementia, and compared our findings with previous reports on DP. Results: Neuropathologic examination revealed numerous neurofibrillary tangles (NFTs), rare neuritic plaques (NPs), multiple cerebral infarcts, fenestrated septum pellucidum, atrophic and gliotic mamillary bodies, and pale substantia nigra and locus ceruleus. Conclusions: Our neuropathologic data confirmed the notion that dementia in retired boxers could be due to several factors such as DP, multiple cerebral infarcts and Wernicke-Korsakoff syndrome. Our findings illustrate the need to comprehensively examine former boxers with dementia as well as carefully evaluate the neuropathologic changes that may cause or contribute to the patient's cognitive and behavioral symptoms. Such an approach is crucial in order to provide prompt and more definitive therapies. © 2009 Dustri-Verlag Dr. K. Feistle.",apolipoprotein E;aged;alcohol consumption;article;artificial heart pacemaker;autopsy;boxing;brain atrophy;brain infarction;case report;congestive heart failure;coronary artery disease;dementia;genotype;gliosis;heart arrhythmia;human;human tissue;hypertension;insulin dependent diabetes mellitus;locus ceruleus;male;mammillary body;neurofibrillary tangle;occupational disease;pneumonia;priority journal;retirement;senile plaque;septum pellucidum;substantia nigra,"Nowak, L. A.;Smith, G. G.;Reyes, P. F.",2009,,,0,
3223,"Medicare capitation model, functional status, and multiple comorbidities: model accuracy","OBJECTIVE: To examine financial implications of the Centers for Medicare & Medicaid Services Hierarchical Condition Categories (CMS-HCC) risk-adjustment model on Medicare payments for individuals with comorbid chronic conditions. STUDY DESIGN: The study used 1992-2000 data from the Medicare Current Beneficiary Survey and corresponding Medicare claims. Pairs of comorbidities were formed based on prior evidence about possible synergy between these conditions and activities of daily living (ADLs) deficiencies, and included heart disease and cancer, lung disease and cancer, stroke and hypertension, stroke and arthritis, congestive heart failure (CHF) and osteoporosis, diabetes and coronary artery disease, and CHF and dementia. METHODS: For each beneficiary, we calculated the actual Medicare cost ratio as the ratio of the individual's annualized costs to the mean annual Medicare cost for all people in the study. The actual Medicare cost ratios, by ADLs, were compared with HCC ratios under the CMS-HCC payment model. Using multivariate regression models, we tested whether having the identified pairs of comorbidities affected the accuracy of CMS-HCC model predictions. RESULTS: The CMS-HCC model underpredicted Medicare capitation payments for patients with hypertension, lung disease, CHF, and dementia. The difference between the actual costs and predicted payments was partially explained by beneficiary functional status and less-than-optimal adjustment for these chronic conditions. CONCLUSION: Information about beneficiary functional status should be incorporated in reimbursement models. Underpaying providers who care for populations with multiple comorbidities may provide severe disincentives for managed care plans to enroll such individuals and to appropriately manage their complex and costly conditions.","*Activities of Daily Living;Aged;Aged, 80 and over;*Capitation Fee;Chronic Disease/*economics;*Comorbidity;Costs and Cost Analysis;Female;Humans;Male;Managed Care Programs/*economics;Medicare/*economics;Models, Economic;United States","Noyes, K.;Liu, H.;Temkin-Greener, H.",2008,Oct,,0,
3224,"External validation of the CURSI criteria (confusion, urea, respiratory rate and shock index) in adults hospitalised for community-acquired pneumonia","BACKGROUND: For patients hospitalised due to community-acquired pneumonia (CAP), mortality risk is usually estimated with prognostic scores such as CRB-65 or CURB-65. For elderly patients, a new score referred to as CURSI has been proposed which uses shock index (SI) instead of the blood pressure (B) and age (65) criteria. The new score has not been externally validated to date. METHODS: We used data from a hospital-based CAP registry to compare the ability of CURSI, CURB-65 and CRB-65 to predict mortality at day 30 after hospital admission. Patients were stratified by score points as well as score-point-based risk categories, and mortality for each group was assessed. To compare test performance, receiver-operating characteristic (ROC) curves were constructed, and the areas under the curve (AUROC) were calculated with 95% confidence intervals (CI). RESULTS: We analysed 553 inpatients (45% females, median age 78 years) hospitalised between 2005 and 2009 for CAP. Overall, mortality at day 30 was 11% (59/553). The study sample was characterised by advanced comorbidity (chronic heart failure: 22%, chronic kidney failure: 27%) and functional impairment (nursing home residency: 26%, dementia: 31%). All risk scores were significantly associated with 30-day mortality. The AUROC values with 95% CI using score points for risk prediction were as follows: 0.63 [0.56-0.71] for CRB-65, 0.68 [0.61-0.75] for CURB-65 and 0.68 [0.61-0.75] for CURSI. The CURSI-defined low-risk group (0 or 1 score point) had a higher mortality (8%) than the low-risk groups defined by CURB-65 and CRB-65 (4% and 3%, respectively). Lowering the cut-off for the CURSI-defined low-risk group (0 point only) would lower the mortality to 4%, making it comparable to the CURB-65-defined low-risk group. CONCLUSIONS: In our study, the CURSI-defined low-risk group had a higher 30-day mortality than the low-risk groups defined by CURB-65 and CRB-65. Lowering the cut-off value for the CURSI low-risk group would result in a mortality comparable to the CURB-65-defined low risk group. Even then, however, CURSI does not perform better than the established risk scores.","Adolescent;Adult;Aged;Aged, 80 and over;Community-Acquired Infections/complications/diagnosis/*mortality;Comorbidity;Confusion/etiology;Female;Germany/epidemiology;Hospitalization;Hospitals;Humans;Inpatients;Male;Middle Aged;Pneumonia/complications/diagnosis/*mortality;Prognosis;ROC Curve;Respiratory Rate;Retrospective Studies;*Severity of Illness Index;Shock/etiology;Urea/blood;Young Adult","Nullmann, H.;Pflug, M. A.;Wesemann, T.;Heppner, H. J.;Pientka, L.;Thiem, U.",2014,Jan 22,10.1186/1471-2334-14-39,0,
3225,BACE1 levels are elevated in congestive heart failure,"Cardiovascular (CV) diseases are known to have a negative impact on the brain and neurocognition, and contribute to the development of vascular dementia and neurodegenerative diseases such as Alzheimer's disease (AD). Among CV diseases, congestive heart failure (CHF) after myocardial infarction (MI) is a condition where the ability of the left ventricle to eject blood to the circulation is impaired. As a consequence, CHF triggers inflammation and results in reduced cerebral blood flow which are considered among the risk factors for development of AD. However, biochemical alterations in the brain following MI and CHF remain unknown. To address this issue, we investigated microglia activation; levels of BACE1, the key rate-limiting enzyme involved in the pathogenesis of AD; and VEGF levels in the hippocampus and cortex following MI. We created MI by the ligation of the left anterior descending coronary artery in Sprague-Dawley male rats and collected brains either 3 days after MI (AMI) or 21 days after MI (CHF). We investigated microglia activation in AMI and CHF brains by immunohistochemistry and immunoblotting using macrophage/microglia marker Ionized calcium binding adaptor molecule 1 (Iba-1), and observed activated morphology of microglia in the cortex of rats in both AMI and CHF. We also showed the levels of BACE1 were increased in the cortex and hippocampus of CHF rats. To determine whether hypoxia occurs in the CHF brain, we assessed levels of VEGF in the hippocampus and cortex. Western blotting analysis showed up-regulation of VEGF in the hippocampus of CHF brains. These results suggest that neuroinflammation takes place secondary to myocardial infarction. In addition, CHF-induced hypoxia might play a role in the elevation of BACE1 and VEGF levels.","Amyloid Precursor Protein Secretases/*metabolism;Animals;Aspartic Acid Endopeptidases/*metabolism;Cerebral Cortex/metabolism/pathology;Heart Failure/*metabolism/pathology/physiopathology;Hippocampus/metabolism/pathology;Male;Microglia/metabolism;Myocardial Infarction/metabolism/physiopathology;Rats;Rats, Sprague-Dawley;Vascular Endothelial Growth Factor A/metabolism;Ventricular Function, Left","Nural-Guvener, H. F.;Mutlu, N.;Gaballa, M. A.",2013,Jan 4,10.1016/j.neulet.2012.10.051,0,
3226,Variable course of disease of rheumatoid arthritis-associated usual interstitial pneumonia compared to other subtypes,"Background: In rheumatoid arthritis-associated interstitial lung disease (RA-ILD), occurring in 10 % of patients with patients with RA, usual interstitial pattern (UIP) has shown to associate with poor prognosis but more detailed data about the course of the disease in different subtypes is limited. Our aim was to compare the disease course of patients with RA-ILD categorized into either UIP or other types of ILDs. Methods: Clinical and radiological information of 59 patients with RA-ILD were re-assessed and re-classified into UIP or non-UIP groups, followed by a between-group comparison of demographic data, lung function, survival, cause of death and comorbidities. Results: The majority of patients (n = 35/59.3 %) showed a radiological UIP-like pattern in high resolution computed tomography. The median survival was 92 months (95 % CI 62.8-121.2) in the UIP-group and 137 months (95 % CI 31.0-243.0) in the non-UIP-group (p = 0.417). Differences in course of disease were found in the number of hospitalizations for respiratory reasons (mean 1.9 ± 2.6 in UIP vs. 0.5 ± 0.9 in non-UIP group, p = 0.004), the use of oxygen therapy (8/22.9 % UIP patients vs. 0 non-UIP patients, p = 0.016), number of deaths (23/65.7 % vs. 10/41.7 %, p = 0.046) and decline in diffusion capacity (56 ± 20.6 vs. 69 ± 20.2, p = 0.021). Dyspnea and inspiratory crackles were detected more often in the UIP group. RA-ILD was the most common primary cause of death (39.4 % of cases). Hypertension, coronary artery disease, chronic obstructive pulmonary disease, heart insufficiency, diabetes and asthma were common comorbidities. ILD preceded RA diagnosis in 13.6 % of patients. Conclusions: The course of the disease in RA-UIP patients is different from the other RA-ILD subtypes. Several comorbidities associated commonly with RA-ILD, although ILD was the predominant primary cause of death.",abatacept;adalimumab;aurothiomalate;azathioprine;chlorambucil;cyclophosphamide;cyclosporin;etanercept;golimumab;hydroxychloroquine;infliximab;leflunomide;methotrexate;mycophenolate mofetil;penicillamine;podophyllotoxin;prednisolone;rituximab;salazosulfapyridine;steroid;tocilizumab;acute pancreatitis;adult;aged;Alzheimer disease;amyloidosis;article;asthma;atherosclerosis;basal cell carcinoma;bladder carcinoma;bleeding;carcinoma;cause of death;chronic obstructive lung disease;colon adenocarcinoma;comorbidity;computer assisted tomography;controlled study;coronary artery disease;coughing;crackle;diabetes mellitus;disease course;drug megadose;dyspnea;female;Finland;forced vital capacity;gastroenteritis;gastroesophageal reflux;heart failure;hospitalization;human;hypertension;hypothyroidism;interstitial pneumonia;intestine tuberculosis;large cell lymphoma;leg ischemia;lip squamous cell carcinoma;lung cancer;lung diffusion capacity;lung function;major clinical study;male;oxygen therapy;rheumatoid arthritis;rheumatoid arthritis associated usual interstitial pneumonia;sex difference;smoking;squamous cell carcinoma;survival;survival time;tongue carcinoma;ventricle carcinoma;virus infection,"Nurmi, H. M.;Purokivi, M. K.;Kärkkäinen, M. S.;Kettunen, H. P.;Selander, T. A.;Kaarteenaho, R. L.",2016,,,0,
3227,Alcohol alternatives - A goal for psychopharmacology?,,4 aminobutyric acid A receptor stimulating agent;4 hydroxybutyric acid;alcohol;anxiolytic agent;benzodiazepine;buprenorphine;clomethiazole;flumazenil;glutamate receptor;partial agonist;alcohol consumption;alcohol intoxication;alcohol withdrawal;alcoholism;beer;cardiomyopathy;coma;dementia;drug absorption;drug dependence;drug overdose;drug targeting;human;law;liver cirrhosis;priority journal;psychopharmacology;sedation;short survey;stomach irritation;wine,"Nutt, D. J.",2006,,,0,
3228,"A phase Ib multiple ascending dose study of the safety, tolerability, and central nervous system availability of AZD0530 (saracatinib) in Alzheimer's disease","INTRODUCTION: Despite significant progress, a disease-modifying therapy for Alzheimer's disease (AD) has not yet been developed. Recent findings implicate soluble oligomeric amyloid beta as the most relevant protein conformation in AD pathogenesis. We recently described a signaling cascade whereby oligomeric amyloid beta binds to cellular prion protein on the neuronal cell surface, activating intracellular Fyn kinase to mediate synaptotoxicity. Fyn kinase has been implicated in AD pathophysiology both in in vitro models and in human subjects, and is a promising new therapeutic target for AD. Herein, we present a Phase Ib trial of the repurposed investigational drug AZD0530, a Src family kinase inhibitor specific for Fyn and Src kinase, for the treatment of patients with mild-to-moderate AD. METHODS: The study was a 4-week Phase Ib multiple ascending dose, randomized, double-blind, placebo-controlled trial of AZD0530 in AD patients with Mini-Mental State Examination (MMSE) scores ranging from 16 to 26. A total of 24 subjects were recruited in three sequential groups, with each randomized to receive oral AZD0530 at doses of 50 mg, 100 mg, 125 mg, or placebo daily for 4 weeks. The drug:placebo ratio was 3:1. Primary endpoints were safety, tolerability, and cerebrospinal fluid (CSF) penetration of AZD0530. Secondary endpoints included changes in clinical efficacy measures (Alzheimer's Disease Assessment Scale - cognitive subscale, MMSE, Alzheimer's Disease Cooperative Study - Activities of Daily Living Inventory, Neuropsychiatric Inventory, and Clinical Dementia Rating Scale - Sum of Boxes) and regional cerebral glucose metabolism measured by fluorodeoxyglucose positron emission tomography. RESULTS: AZD0530 was generally safe and well tolerated across doses. One subject receiving 125 mg of AZD0530 was discontinued from the study due to the development of congestive heart failure and atypical pneumonia, which were considered possibly related to the study drug. Plasma/CSF ratio of AZD0530 was 0.4. The 100 mg and 125 mg doses achieved CSF drug levels corresponding to brain levels that rescued memory deficits in transgenic mouse models. One-month treatment with AZD0530 had no significant effect on clinical efficacy measures or regional cerebral glucose metabolism. CONCLUSIONS: AZD0530 is reasonably safe and well tolerated in patients with mild-to-moderate AD, achieving substantial central nervous system penetration with oral dosing at 100-125 mg. Targeting Fyn kinase may be a promising therapeutic approach in AD, and a larger Phase IIa clinical trial of AZD0530 for the treatment of patients with AD has recently launched. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01864655. Registered 12 June 2014.",,"Nygaard, H. B.;Wagner, A. F.;Bowen, G. S.;Good, S. P.;MacAvoy, M. G.;Strittmatter, K. A.;Kaufman, A. C.;Rosenberg, B. J.;Sekine-Konno, T.;Varma, P.;Chen, K.;Koleske, A. J.;Reiman, E. M.;Strittmatter, S. M.;van Dyck, C. H.",2015,,10.1186/s13195-015-0119-0,0,
3229,Global prevention of all folic acid-preventable spina bifida and anencephaly by 2010,"Folic acid-preventable spina bifida and anencephaly are pandemic, affecting 225,000 children a year. These birth defects are as preventable as polio. As we near the eradication of polio, it is time to make the commitment to global prevention of all folic acid-preventable spina bifida and anencephaly (FA-P SBA) by 2010. Folic acid fortification of centrally processed foods, such as wheat and corn flour, could immediately prevent all of these birth defects for much of the world's population. These fortification programs will also help adults by increasing serum folate concentration, eradicating folate deficiency anemia, providing human genome stability and reducing homocysteine serum concentration, which will probably prevent heart attacks and strokes, and may prevent colon cancer and Alzheimer's disease. Where there is no centrally processed and distributed food to fortify, intense efforts must be made to increase consumption of synthetic folic acid through vitamin supplements. Geneticists can play a major role in preventing FA-P SBA by helping to create the political will in each country to implement fortification and supplement programs to eliminate disease caused by the current pandemic of folate deficiency. Copyright © 2002 S. Karger AG, Basel.",folic acid;homocysteine;Alzheimer disease;anemia;anencephalus;article;colon cancer;maize;DNA synthesis;drug effect;folic acid blood level;folic acid deficiency;food and drug administration;food intake;gene structure;heart infarction;human;priority journal;risk assessment;spinal dysraphism;cerebrovascular accident;vitamin supplementation;wheat,"Oakley Jr, G. P.",2002,,,0,
3230,Life expectancy of Alzheimer's disease patients,,adult;Alzheimer disease;comorbidity;demography;diabetes mellitus;diagnostic procedure;disease severity;extrapyramidal symptom;heart failure;human;ischemic heart disease;life expectancy;major clinical study;Mini Mental State Examination;mortality;note;prospective study;risk factor;survival;symptomatology;United States,"Oasi, C.;Belmin, J.",2005,,,0,
3231,Adverse drug reactions in Nigerian children: a retrospective review of reports submitted to the Nigerian Pharmacovigilance Centre from 2005 to 2012,"Background: Adverse drug reactions (ADRs) in children recorded in national pharmacovigilance databases in high-income countries have been analysed. Nigeria has a population of 31 million children and became a member of the WHO Programme for International Drug Monitoring in 2004 since when it has been submitting reports of suspected ADRs to the WHO Global Individual Case Safety Report database, VigiBase. Objective: To gain information on reported ADRs in Nigerian children aged 0–17 years in VigiBase from 2005 to 2012. Methods: The data were analysed for annual reports, age and sex of patients, type of reporters, suspected drugs and adverse reactions. The most commonly reported ADRs and suspected drugs were ranked, and drugs associated with the fatalities were evaluated. Results: A total of 297 reports of 473 ADRs in 297 children were received from doctors, pharmacists, other health-care professionals and consumers during the period. ADRs were most frequently reported for anti-retrovirals (74, 24%), antibiotics (71, 23%) and anti-malarials (60, 20%). The most frequently reported ADRs were rash (15.2%), fever (10.3%) and pruritus (6.8%). Anti-infective agents were responsible for more than half of the reports. Twenty-one children (7%) died, eight from acute renal failure. Seven of the cases of acute renal failure were associated with contaminated paracetamol/diphenhydramine hydrochloride and herbal medicines used for teething problems. In the majority of cases, the products were contaminated with diethylene glycol. There were 14 cases of Stevens–Johnson syndrome, three of which were fatal. Conclusion: Anti-infective agents (antibiotics, anti-malarials and anti-retrovirals) were associated with a majority of the ADRs. Stevens–Johnson syndrome was the most frequent severe ADR. Some of the fatalities were associated with sub-standard and herbal medications.",amodiaquine;antibiotic agent;antiinfective agent;antimalarial agent;antiretrovirus agent;artemether;carbamazepine;ceftazidime;ceftriaxone;chlorproguanil plus dapsone;cloxacillin;cotrimoxazole;dactinomycin;diazepam;diclofenac;diethylene glycol;diphenhydramine;dipyrone;herbaceous agent;meropenem;methotrexate;nevirapine;paracetamol;pentazocine;phenytoin;pyrimethamine plus sulfadoxine;sodium carbonate;stavudine;unindexed drug;yellow fever vaccine;abdominal pain;acute kidney failure;adolescent;adverse drug reaction;aggression;anaphylaxis;angioneurotic edema;anuria;article;asthenia;child;controlled study;convulsion;coughing;dementia;diarrhea;drug contamination;drug fatality;drug surveillance program;dyskinesia;epidermolysis;face edema;fever;gastrointestinal hemorrhage;headache;health practitioner;heart arrest;hemolysis;hemolytic uremic syndrome;human;hyperkinesia;infant;injection site pain;jaundice;major clinical study;melena;mouth edema;multiple organ failure;newborn;Nigerian;peripheral neuropathy;pharmacist;physician;pruritus;rash;retrospective study;rigor;side effect;skin ulcer;Stevens Johnson syndrome;thrombocytopenia;unspecified side effect;vomiting,"Obebi Cliff-Eribo, K.;Sammons, H.;Star, K.;Ralph Edwards, I.;Osakwe, A.;Choonara, I.",2016,,10.1179/2046905515y.0000000059,0,
3232,Characteristics of clinical aspects of myocardial infarct in old age,,"Age Factors;*Aged;Angina Pectoris/complications;Arrhythmias, Cardiac/complications;Dementia/complications;Digestive System/physiopathology;Female;Heart Aneurysm/complications;Humans;Male;Myocardial Infarction/*complications/physiopathology;Shock, Cardiogenic/complications","Oberemchenko Ia, V.",1973,Jul,,0,
3233,Familial Creutzfeldt-Jakob disease initially presenting with alien hand syndrome 4,,prion protein;protein 14 3 3;tau protein;aged;autopsy;cardiopulmonary arrest;case report;cause of death;clinical feature;Creutzfeldt Jakob disease;diagnostic procedure;disease course;familial disease;family history;female;genetic analysis;human;laboratory test;letter;neurologic examination;priority journal;time of death,"Oberndorfer, S.;Urbanits, S.;Lahrmann, H.;Jarius, C.;Albrecht, G.;Grisold, W.",2002,,,0,
3234,A promising new treatment for Alzheimer's disease?,,dimebon;donepezil;galantamine;memantine;placebo;rivastigmine;Alzheimer disease;angina pectoris;bilirubin blood level;clinical trial;cognition;confidence interval;disease course;drug efficacy;drug mechanism;health economics;heart atrium flutter;human;hyperhidrosis;letter;Lewy body;Mini Mental State Examination;mood disorder;neuroprotection;prevalence;priority journal;side effect;xerostomia,"O'Brien, J. T.",2008,,,0,
3235,Vascular dementia,"Vascular dementia is one of the most common causes of dementia after Alzheimer's disease, causing around 15% of cases. However, unlike Alzheimer's disease, there are no licensed treatments for vascular dementia. Progress in the specialty has been difficult because of uncertainties over disease classification and diagnostic criteria, controversy over the exact nature of the relation between cerebrovascular pathology and cognitive impairment, and the paucity of identifiable tractable treatment targets. Although there is an established relation between vascular and degenerative Alzheimer's pathology, the mechanistic link between the two has not yet been identified. This Series paper critiques some of the key areas and controversies, summarises treatment trials so far, and makes suggestions for what progress is needed to advance our understanding of pathogenesis and thus maximise opportunities for the search for new and effective management approaches.",albumin;apolipoprotein E4;biological marker;calcium channel blocking agent;cholesterol;cholinesterase inhibitor;donepezil;galantamine;homocysteine;memantine;metalloproteinase;nimodipine;nitrendipine;pravastatin;rivastigmine;simvastatin;age;allele;Alzheimer disease;apathy;article;atrial fibrillation;cerebrovascular accident;chromosome 19;clinical feature;cognitive defect;computer assisted tomography;delusion;diabetes mellitus;educational status;executive function;frameshift mutation;functional disease;gender;genetic association;hallucination;hippocampal sclerosis;human;hypertension;ischemic heart disease;late life depression;memory disorder;mild cognitive impairment;Mini Mental State Examination;Montreal cognitive assessment;multiinfarct dementia;neuroimaging;nuclear magnetic resonance imaging;obesity;priority journal;risk factor;single nucleotide polymorphism;smoking;white matter lesion;X chromosome,"O'Brien, J. T.;Thomas, A.",2015,,,0,
3236,Diffuse T-wave inversions associated with electroconvulsive therapy,"Electroconvulsive therapy (ECT) can lead to ST depression and arrhythmias in patients with coronary artery disease, most likely secondary to increased myocardial oxygen demand. This report describes a case of ECT-associated, global T-wave inversions in a patient with chronic atrial fibrillation treated with digoxin. Laboratory evaluation and echocardiography were normal. These T-wave changes may result from increased sympathetic activity associated with ECT. Prospective studies suggest that this finding may be seen in up to 4% of patients undergoing ECT. © 2004 by Excerpta Medica, Inc.",acetylsalicylic acid;alpha tocopherol;digoxin;donepezil;esmolol;fluoxetine;levothyroxine;methohexital;olanzapine;suxamethonium;aged;article;case report;chronic disease;clinical feature;dementia;depression;disease association;echocardiography;electrocardiography;electroconvulsive therapy;atrial fibrillation;heart muscle conduction disturbance;hospital admission;hospitalization;human;hypothyroidism;laboratory test;male;medical examination;neurologic examination;patient;priority journal,"O'Brien, K. E.;Pastis, N.;Conti, J. B.",2004,,,0,
3237,Use of angiotensin-converting enzyme inhibitors for Alzheimer's disease: An update,,amyloid beta protein;captopril;cholinesterase inhibitor;dipeptidyl carboxypeptidase inhibitor;donepezil;enalapril;galantamine;lisinopril;memantine;perindopril;ramipril;rivastigmine;Alzheimer disease;antihypertensive therapy;blood brain barrier;cognition;cognitive defect;comorbidity;congestive heart failure;daily life activity;drug penetration;exercise tolerance;heart infarction;human;hypertension;mild cognitive impairment;multiinfarct dementia;muscle strength;note;observational study;prevalence;priority journal;renin angiotensin aldosterone system,"O'Caoimh, R.;Kehoe, P. G.;Kennedy, P.;Molloy, W.",2013,,,0,
3238,Atypical manifestation of myocardial ischemia in the elderly,,antidepressant agent;aged;atherosclerosis;dementia;depression;diabetes mellitus;fibromyalgia;human;memory disorder;note;silent myocardial ischemia,"Ochiai, M. E.;Lopes, N. H.;Buzo, C. G.;Pierri, H.",2014,,,0,
3239,The pattern of plasma sodium abnormalities in an acute elderly care ward: A cross-sectional study,"Introduction: The combination of ageing, illness, and medications can lead to hyponatraemia or hypernatraemia. Aims: To describe the distribution of plasma sodium levels in older patients admitted to hospital. Methods: We carried out a hospital based cross-sectional study examining 1,511 serum sodium concentrations ([Na+]) among 336 elderly patients and attempted to elucidate the cause(s) of the abnormal serum [Na+]. Results: The study population had a mean age of 81.4. Ninety-two (27.4%) patients had hyponatraemia and seven patients (2.1%) had hypernatraemia during their hospitalisation. The distribution of [Na+] results was towards the lower end of the normal range. The mortality rate of patients with hyponatraemia was 14.1% and that of patients with normal serum [Na+] was 8.9%. Six patients with hypernatraemia died in hospital. Lower respiratory tract infection and medication accounted for the majority of cases. Conclusions: Deranged [Na+] is common among elderly patients admitted to hospital.",carbamazepine;serotonin uptake inhibitor;sodium;thiazide diuretic agent;aged;article;bronchus tumor;concentration (parameters);controlled study;dementia;diarrhea;disease association;drug use;dysphagia;elderly care;fluid resuscitation;functional disease;heart failure;hospital admission;hospitalization;human;hypernatremia;hyponatremia;hypothyroidism;kidney failure;lower respiratory tract infection;major clinical study;middle cerebral artery occlusion;mortality;paraproteinemia;sodium blood level;statistical significance;cerebrovascular accident,"O'Connor, K. A.;Cotter, P. E.;Kingston, M.;Twomey, C.;O'Mahony, D.",2006,,,0,
3240,Patient Characteristics Predicting Readmission among Individuals Hospitalized for Heart Failure,"Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variation in hospital readmission rates. Database searches yielded 950 potential articles, of which 34 studies met inclusion criteria. Patient characteristics generally have a very modest effect on all-cause or heart failure-related readmission within 7 to 180 days of index hospital discharge. A range of cardiac diseases and other comorbidities only minimally increase readmission rates. No single patient characteristic stands out as a key contributor across multiple studies underscoring the challenge of developing successful interventions to reduce readmissions. Interventions may need to be general in design with the specific intervention depending on each patient's unique clinical profile.",article;biliary tract disease;comorbidity;conceptual framework;data base;dementia;demography;depression;disease predisposition;electrolyte disturbance;financial management;gastrointestinal disease;health behavior;health belief;health care utilization;heart disease;heart failure;hospital discharge;hospital patient;hospital readmission;human;hypothyroidism;length of stay;mental disease;neoplasm;organization;peptic ulcer;protein calorie malnutrition;screening;social aspect;urinary tract disease,"O'Connor, M.;Murtaugh, C. M.;Shah, S.;Barrón-Vaya, Y.;Bowles, K. H.;Peng, T. R.;Zhu, C. W.;Feldman, P. H.",2016,,,0,
3241,How will NICE's budget impact test affect new drug availability?,"NICE's budget impact test – in which new drugs that will have a net impact of £20 million or more in any one of their first three years of use will trigger commercial negotiations between NHS England and the drug company – was introduced in April, amid much controversy. Many argue the threshold is too low and will have an unacceptable impact on the availability of new medicines.",abiraterone acetate;aflibercept;antivirus agent;ezetimibe;new drug;pembrolizumab;ranibizumab;sacubitril plus valsartan;tumor necrosis factor inhibitor;article;budget;dementia;diabetic retinopathy;drug cost;drug industry;funding;health care access;health care availability;health care financing;heart disease;heart failure;hepatitis C;human;national health service;prostate cancer;quality adjusted life year;rheumatic disease;skin cancer;United Kingdom;entresto;eylea;ezetrol;keytruda;lucentis;zytiga,"Ogden, J.",2017,,10.1002/psb.1598,0,
3242,Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury,"Purpose: The definition of ""early"" in terms of continuous renal replacement therapy (CRRT) initiation has not been uniformly used. Therefore, we tried to elucidate whether the timing of CRRT application, based on the interval between the start time of vasopressors infusion and CRRT initiation, was an independent predictor of mortality in the patients with septic acute kidney injury (AKI). Materials and Methods: Progressive septic AKI patients, in whom the infusion doses of vasopressors were increased compared with the initial dose during the first 6 hours of vasopressor treatment and CRRT was performed, between 2009 and 2011, were collected and divided into 2 groups based on the median interval between the 2 points. Results: A total of 210 patients were included. The mean age was 62.4 years, and 126 patients (60.0%) were male. The most common comorbid disease was malignancy (53.8%), followed by hypertension (35.7%) and diabetes mellitus (29.0%). The median interval between the start time of vasopressor infusion and CRRT commencement was 2.0 days. During the study period, 156 patients (74.3%) died within 28 days of CRRT application. The interval between 2 points was significantly shorter in the survivor compared with the death group (P < .001). Moreover, 28-day overall mortality rates in the early CRRT group were significantly lower than those in the late CRRT group (P = .034). Furthermore, early CRRT treatment was independently associated with a lower mortality rate even after adjustment for age, sex, causative organisms, and infection sites (P = .032). Conclusions: This retrospective cohort study suggests that early initiation of CRRT may be of benefit. Given the complex nature of this intervention, the ongoing controversies regarding early vs late initiation of therapy in acute and chronic situation, there is an urgent need to develop well-designed clinical trials to answer the question definitely. © 2012 Elsevier Inc.",hypertensive factor;acute kidney failure;adult;age;article;cerebrovascular accident;chronic obstructive lung disease;cohort analysis;congestive heart failure;continuous renal replacement therapy;controlled study;critically ill patient;dementia;diabetes mellitus;disease severity;early intervention;Escherichia coli;female;heart infarction;human;hypertension;lung;major clinical study;male;malignant neoplastic disease;mortality;patient survival;peritoneal cavity;pneumonia;progressive septic acute kidney injury;retrospective study;sex;Streptococcus pneumoniae;survival;survivor;urinary tract,"Oh, H. J.;Shin, D. H.;Lee, M. J.;Koo, H. M.;Doh, F. M.;Kim, H. R.;Han, J. H.;Park, J. T.;Han, S. H.;Yoo, T. H.;Choi, K. H.;Kang, S. W.",2012,,,0,
3243,Effect of cardiac function on cognition and brain structural changes in dementia,"BACKGROUND AND PURPOSE: Cardiovascular risk factors are considered to also be risk factors for dementia. Recent studies have shown that the prevalence of cognitive dysfunction is high in patients with cardiac diseases. However, few studies have investigated the influence of cardiac function on cognition and brain structural changes in dementia. The aims of this study were to determine the relationship between cardiac and cognitive function, and to characterize any structural changes in the brain that could be caused by cardiac function in patients with dementia. METHODS: Dementia patients (n=93) were recruited prospectively with checking for the presence of vascular risk factors such as hypertension. Cognitive function was measured by the Mini-Mental State Examination, modified Mini-Mental State test, and Korean version of the Dementia Rating Scale. Brain magnetic resonance imaging was conducted to evaluate the cerebral white-matter changes (WMC), ventricular dilation, and cortical and hippocampal atrophy. Cardiac function was evaluated using two-dimensional echocardiography. We divided the patients into two groups according to the presence (+) or absence (-) of WMC. RESULTS: In the entire cohort, the size of the left atrium (LA) was positively correlated with the degree of WMC, irrespective of age (p<0.05). The LA was larger in the WMC (+) group (n=42) than in the WMC (-) group. General cognitive function was significantly lower in the WMC (+) group than in the WMC (-) group. Subjects with an enlarged LA tended to exhibit lower cognitive function and more-severe cerebral WMC. CONCLUSIONS: Cardiac dysfunction represented by LA enlargement could be related to cognitive decline and WMC of the brain resulting from impairment of the cerebral hemodynamic process in dementia.",brain structural changes;cardiac function;cognitive function;dementia,"Oh, J. E.;Shin, J. W.;Sohn, E. H.;Jung, J. O.;Jeong, S. H.;Song, H. J.;Kim, J. M.;Lee, A. Y.",2012,Jun,10.3988/jcn.2012.8.2.123,0,
3244,Corneal endothelium in a case of mitochondrial encephalomyopathy (Kearns-Sayre syndrome),"A case of mitochondrial encephalomyopathy (Kearns-Sayre syndrome) with corneal endothelial abnormality is reported. A 22-year-old woman had retinitis pigmentosa, external ophthalmoplegia, complete heart block, ataxia, muscle weakness, dementia, sensorineural hearing loss, and was of short stature. Renal dysfunction, diabetes mellitus, and amenorrhea were also observed. Biopsy revealed decreased cytochrome c oxidase (complex IV) activity in muscle mitochondria. The corneal endothelium examined by specular microscope showed decreased cell density, severe polymegathism, and pleomorphism in both eyes. To our knowledge, this is the first report concerning primary corneal endothelial abnormality in a case with mitochondrial encephalomyopathy. The corneal endothelium is one of the tissues that could be affected by the enzyme deficiency present in this disease.",case report;cornea endothelium;female;human;Kearns Sayre syndrome;mitochondrion,"Ohkoshi, K.;Ishida, N.;Yamaguchi, T.;Kanki, K.",1989,,,0,
3245,Genetic deficiency of a mitochondrial aldehyde dehydrogenase increases serum lipid peroxides in community-dwelling females,"Mitochondrial aldehyde dehydrogenase 2 (ALDH2) plays a major role in acetaldehyde detoxification. The alcohol sensitivity is associated with a genetic deficiency of ALDH2. We and others have previously reported that such a deficiency influences the risk for late-onset Alzheimer's disease (LOAD), hypertension, and myocardial infarction. Then we tried to find phenotypes to which the ALDH2 polymorphism contributes by conducting several evaluations including biochemical and functional analyses of various tissues in a community-dwelling population. Several serum proteins, lipids, and lipid peroxides (LPO) levels showed differences between the nondefective (ALDH2*1/1) and defective (ALDH2*1/2 and ALDH2*2/2) ALDH2 individuals. However, alcohol-drinking behavior is known to affect these evaluations. Thus, we excluded the effects of alcohol-drinking behavior from the association with the ALDH2-deficient genotype through correction and found that the concentration of LPO was significantly lower in the nondefective ALDH2 females than the defective females. The effect of frequent alcohol-drinking behavior in males seems to override the phenotype of the high serum LPO level. These results indicate that the ALDH2 deficiency may enhance oxidative stress in vivo. Thus, these findings suggest that ALDH2 functions as a protector against oxidative stress and the decrease in protection may influence the onset of AD, hypertension, and myocardial infarction.",Adult;Aged;Female;Humans;Lipid Peroxides/blood;Male;Middle Aged;Mitochondria/enzymology/*genetics;Mitochondrial Diseases/enzymology/*genetics,"Ohsawa, I.;Kamino, K.;Nagasaka, K.;Ando, F.;Niino, N.;Shimokata, H.;Ohta, S.",2003,,10.1007/s10038-003-0046-y,0,
3246,"Effects of music therapy on autonomic nervous system activity, incidence of heart failure events, and plasma cytokine and catecholamine levels in elderly patients with cerebrovascular disease and dementia","Music therapy (MT) has been used in geriatric nursing hospitals, but there has been no extensive research into whether it actually has beneficial effects on elderly patients with cerebrovascular disease (CVD) and dementia. We investigated the effects of MT on the autonomic nervous system and plasma cytokine and catecholamine levels in elderly patients with CVD and dementia, since these are related to aging and chronic geriatric disease. We also investigated the effects of MT on congestive heart failure (CHF) events.Eighty-seven patients with pre-existing CVD were enrolled in the study. We assigned patients into an MT group (n = 55) and non-MT group (n = 32). The MT group received MT at least once per week for 45 minutes over 10 times. Cardiac autonomic activity was assessed by heart rate variability (HRV). We measured plasma cytokine and catecholamine levels in both the MT group and non-MT group. We compared the incidence of CHF events between these two groups. In the MT group, rMSSD, pNN50, and HF were significantly increased by MT, whereas LF/HF was slightly decreased. In the non-MT group, there were no significant changes in any HRV parameters. Among cytokines, plasma interleukin-6 (IL-6) in the MT group was significantly lower than those in the non-MT group. Plasma adrenaline and noradrenaline levels were significantly lower in the MT group than in the non-MT group. CHF events were less frequent in the MT group than in the non-MT group (P < 0.05). These findings suggest that MT enhanced parasympathetic activities and decreased CHF by reducing plasma cytokine and catecholamine levels.","Aged, 80 and over;Autonomic Nervous System/*physiopathology;Catecholamines/*blood;Cerebrovascular Disorders/complications/physiopathology/*therapy;Cytokines/*blood;Dementia/complications/physiopathology/*therapy;Enzyme-Linked Immunosorbent Assay;Female;Follow-Up Studies;Heart Failure/*epidemiology/etiology/prevention & control;Heart Rate/physiology;Humans;Incidence;Male;Music Therapy/*methods;Treatment Outcome","Okada, K.;Kurita, A.;Takase, B.;Otsuka, T.;Kodani, E.;Kusama, Y.;Atarashi, H.;Mizuno, K.",2009,Jan,,0,
3247,Effects of Yokukansan on behavioral and psychological symptoms of dementia in regular treatment for Alzheimer's disease,"Yokukansan (YKS) is used frequently against behavioral and psychological symptoms of dementia (BPSD) together with donepezil in patients with Alzheimer's disease (AD). Here, we investigated the efficacy and safety of YKS in patients with AD in a non-blinded, randomized, parallel-group comparison study. Patients who had at least one symptom score of four or more on the Neuropsychiatric Inventory (NPI) subscales were enrolled in the study. The subjects were randomly assigned to the YKS-treated group (YKS/donepezil combination therapy group) and the non-YKS-treated group (donepezil monotherapy group). TSUMURA Yokukansan (TJ-54, 7.5. g, t.i.d.) was administered in a four-week study treatment period. The subjects were evaluated twice at the start (Week 0) and completion (Week 4) of the study treatment in terms of NPI, Mini-Mental Status Examination (MMSE), Disability Assessment for Dementia (DAD), Zarit Burden Interview, and Self-rating Depression Scale (SDS). The efficacy analysis was performed in 29 patients (YKS-treated group) and 32 patients (non-YKS-treated group). The NPI total score improved significantly more in the YKS-treated group than in the non-YKS-treated group. In the NPI subscales of agitation/aggression and irritability/lability, the YKS-treated group showed significantly greater improvement than the non-YKS-treated group, but no statistically significant improvement was seen with YKS in the other subscales. There were no significant differences between the YKS-treated group and the non-YKS-treated group in MMSE, DAD, Zarit Burden Interview and SDS. No adverse reactions were noted in either group. The results of this study showed that YKS is safe and effective in the treatment of BPSD in AD patients. © 2010 Elsevier Inc.",donepezil;herbaceous agent;risperidone;tj 54;unclassified drug;yokukansan;aged;aggression;agitation;Alzheimer disease;angina pectoris;article;behavioral and psychological symptoms of dementia;brain infarction;brain tumor;chronic bronchitis;clinical trial;combination chemotherapy;controlled clinical trial;controlled study;diabetes mellitus;drug efficacy;drug safety;edema;female;atrial fibrillation;heart infarction;human;hyperlipidemia;hypertension;hyperuricemia;hypokalemia;insomnia;interview;irritability;knee osteoarthritis;major clinical study;male;mental disease;mental instability;Mini Mental State Examination;monotherapy;neurogenic bladder;parallel design;parkinsonism;peripheral neuropathy;prostate hypertrophy;randomized controlled trial;Self-rating Depression Scale;tension headache;vertigo,"Okahara, K.;Ishida, Y.;Hayashi, Y.;Inoue, T.;Tsuruta, K.;Takeuchi, K.;Yoshimuta, H.;Kiue, K.;Ninomiya, Y.;Kawano, J.;Yoshida, K.;Noda, S.;Tomita, S.;Fujimoto, M.;Hosomi, J.;Mitsuyama, Y.",2010,,,0,
3248,Senile changes in the human olfactory bulbs,"The olfactory bulbs were investigated in 58 routine autopsy cases from 33 to 91 years with the mean 72 years. The major pathologically confirmed diseases included 15 cases of cerebral infarctions, 8 intracranial hemorrhages, 9 malignant neoplasms and 9 heart diseases. Paraffin-embedded horizontal sections of the olfactory bulbs were examined for senile changes by means of Bielschowsky methods and Congo red polarizing microscopy. Neurofibrillary tangles were observed in 21 cases (36%), and the incidence rose with age, and also they showed approximately positive correlation in quantity of the senile changes in the hippocampal areas examined by thioflavine fluorescence microscopy. Neurofibrillary tangles were found mainly within the neurons of the anterior olfactory nuclei, and rarely within the relatively large neurons in the mitral and granular cell layers in the cases with abundant tangles. Eosinophilic old neurofibrillary tangles were rarely seen. On the other hand, senile plaques were seen in only 3 cases out of 58 cases, and they were primitive types without amyloid cores within the anterior olfactory nuclei. Amyloid angiopathy was not seen in the olfactory bulbs in contrast to 11 cases with amyloid angiopathy in the hippocampal areas. Electron microscopic examination in the case of Alzheimer's disease disclosed that neurofibrillary tangles in the anterior olfactory nuclei consisted of a mixture of straight and twisted tubules. Granulovacuolar bodies and Hirano bodies were observed in the olfactory bulbs for the first time.",aging;autopsy;central nervous system;clinical article;electron microscopy;histology;human;olfactory bulb;olfactory system,"Okamoto, K.;Morimatsu, M.;Shoji, M.",1986,,,0,
3249,Clinical outcomes of patients 80 years of age and older with soft tissue sarcoma,"Objectives Although soft tissue sarcoma (STS) is rare, its incidence is increasing among older patients. Few studies have compared the outcomes between conservative and surgical treatments for STS patients aged ≥80 years. We assessed the outcomes of both treatments in this population and the association between older age and surgical outcome. Methods We recruited consecutive patients with STS aged ≥80 years treated at our institution between January 2006 and May 2014. We recommended surgical resection for all patients without multiple distant metastases. Overall survival and sarcoma-specific survival were assessed using the Kaplan–Meier method. Results Of the 39 patients with STS who presented at our institution, 37 were included in this analysis (19 men and 18 women with a median age of 85 [range 80–94] years). Tumors were classified as Stage IB (n = 3), IIA (n = 6), IIB (n = 3) or III (n = 24). Four patients underwent conservative therapy and 33 underwent surgical resection. The most common tumor site was the lower extremity, and the majority of tumors were classified as undifferentiated pleomorphic sarcoma. The follow-up rate was 100%. One-year sarcoma-specific survival rates were 25.0% in the conservative therapy group and 90.9% in the surgical resection group. No associations were found between age ≥85 years and perioperative complications or clinical outcome. Conclusions Surgical resection had relatively few complications, given the age group, and improved the prognosis of older patients with STS. Surgical resection of STS with curative intent should be considered in older patients.",aged;article;cancer specific survival;cancer surgery;clinical article;clinical outcome;comorbidity;conservative treatment;dementia;diabetes mellitus;disease severity;distant metastasis;female;geriatric assessment;geriatric patient;heart arrhythmia;human;human tissue;hypertension;ischemic heart disease;leiomyosarcoma;liposarcoma;male;overall survival;peroperative complication;primary tumor;prostate hypertrophy;sarcoma;soft tissue sarcoma;survival rate;tumor volume;very elderly,"Okamoto, M.;Yoshimura, Y.;Aoki, K.;Kito, M.;Tanaka, A.;Suzuki, S.;Takazawa, A.;Isobe, K.;Kato, H.",2017,,10.1016/j.jos.2017.06.011,0,
3250,"Association Between Comorbidities, Nutritional Status, and Anticlotting Drugs and Neurologic Outcomes in Geriatric Patients with Traumatic Brain Injury","Background Several studies using trauma data banks and registers showed that age, Glasgow Coma Scale (GCS), Injury Severity Score, and intraventricular hemorrhage were independent factors for neurologic outcomes in geriatric patients with traumatic brain injury (TBI). However, these analyses did not comprehensively evaluate factors particularly associated with geriatric patients. We aimed to identify factors particularly associated with geriatric patients that affect neurologic outcomes in TBI. Methods Patients aged ≥65 years who were hospitalized consecutively in Kagawa University Hospital with severe TBI between 1 January 2008 and 31 October 2015 were retrospectively reviewed. We evaluated background factors particularly associated with geriatric patients, including comorbidities (Charlson Comorbidity Index [CCI]), nutritional status (serum albumin level), and presence/absence of antiplatelet and anticoagulant drugs, in addition to baseline characteristics. Multivariate analyses were performed to identify independent predictors of unfavorable neurologic outcomes (UO), as defined as a Glasgow Outcome Scale score of 1–3 at discharge from hospital. The association between CCI and UO was evaluated in a subgroup analysis. Results UO occurred in 65.0% of 140 patients. Multivariate analyses showed that the CCI (odds ratio, 1.91; 95% confidence interval, 1.21–3.29; P = 0.011), age, and GCS were independent predictors of UO. In subgroup analyses of patients with an initial GCS score of 13–15, the rate of UO significantly increased with CCI score (CCI 0, 35.5%; CCI 1 or 2, 39.4%; CCI >2, 83.3%; P < 0.01). Conclusions CCI was an independent predictor of UO in geriatric patients with severe TBI.",albumin;anticoagulant agent;acquired immune deficiency syndrome;age;aged;albumin blood level;anticoagulant therapy;article;brain hemorrhage;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;convalescence;correlational study;dementia;diabetes mellitus;disability;female;gender;geriatric patient;Glasgow outcome scale;heart infarction;hemiplegia;hemorrhagic hypotension;human;injury scale;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;metastasis;neoplasm;nutritional status;outcome assessment;peripheral vascular disease;persistent vegetative state;retrospective study;traumatic brain injury;ulcer,"Okazaki, T.;Hifumi, T.;Kawakita, K.;Nakashima, R.;Matsumoto, A.;Shishido, H.;Ogawa, D.;Okauchi, M.;Shindo, A.;Kawanishi, M.;Tamiya, T.;Kuroda, Y.",2016,,,0,
3251,An autopsy case of Fabry disease with neuropathological investigation of the pathogenesis of associated dementia,"The pathogenesis of dementia associated with Fabry disease was examined neuropathologically in an autopsy case. The patient was a 47-year-old computer programmer who developed renal failure at the age of 36, necessitating peritoneal dialysis, and thereafter suffered in succession episodic pulmonary congestion, bradyacusia, heart failure, and dementia, before dying of acute myocardial infarction. MRI of the brain demonstrated leuko-araiosis. The CNS parenchyma showed widespread segmental hydropic swelling of axons in the bilateral cerebral and cerebellar deep white matter in addition to neuronal ballooning due to glycolipid storage in a few restricted nuclei and multiple tiny lacunae. Hydropic axonal swelling was also sparsely distributed in the pyramidal tract, pedunculus cerebellaris superior and brachium colliculi inferioris, but wallerian degeneration of these tracts was absent. Additional features included angiopathy of the subarachnoidal arteries due to Fabry disease, such as medial thickening resulting from glycolipid deposition in smooth muscle cells (SMCs) and adventitial fibrosis with lymphocytic infiltration, together with widespread subtotal or total replacement of medial SMCs by fibrosis, associated with prominent intimal fibrous thickening and undulation of the internal elastic membrane of medium-sized (1000-100 μm diameter) arteries. The findings in this case suggest that axonopathic leukoencephalopathy due to multisegmental hydropic swelling of axons in the bilateral cerebral deep white matter is responsible for the dementia associated with Fabry disease, and may be caused by ischemia resulting from widespread narrowing and stiffening of medium-sized subarachnoidal arteries and progressive heart failure. © 2008 Japanese Society of Neuropathology.",alpha galactosidase;glycolipid;acute heart infarction;adult;artery compliance;artery diameter;artery intima proliferation;article;autopsy;bradyacusia;brain artery;brain region;case report;cell nucleus;cell swelling;central nervous system;cerebellum;cerebrovascular disease;dementia;disease association;enzyme replacement;Fabry disease;hearing disorder;heart failure;human;inferior colliculus brachium;kidney failure;leukoaraiosis;lipid storage;lung congestion;lymphocytic infiltration;male;nerve degeneration;neuroimaging;neurologic examination;neuropathology;nuclear magnetic resonance imaging;parenchyma;pedunculus cerebellaris superior;peritoneal dialysis;priority journal;pyramidal tract;smooth muscle fiber;subarachnoid space;vascular fibrosis;white matter,"Okeda, R.;Nisihara, M.",2008,,,0,
3252,Palliative care for cardiac failure in Ireland,"Studies of Irish people suggest a preference for a palliative approach, with an emphasis on symptom relief, dying at home and on quality rather than duration of life, when they are severely ill with no hope of recovery. People dying from non-malignant conditions such as severe heart failure can have equal and sometimes greater palliative care needs than people dying from malignant conditions. Currently, specialist palliative care services are unevenly distributed in Ireland: only a quarter of acute hospitals have a full specialist service, while 19 % of palliative services limit in some way the services they provide for people with conditions other than cancer. The last decade in particular has seen a strong focus by professionals, activists and government in Ireland on improving and integrating palliative care for chronic, non-malignant conditions. © 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.",acquired immune deficiency syndrome;article;chronic obstructive lung disease;comorbidity;convalescence;dementia;dying;European Union;funding;general practitioner;government;heart failure;human;Human immunodeficiency virus infection;Ireland;malignant neoplastic disease;medical audit;medical decision making;medical ethics;medical specialist;motor neuron disease;palliative therapy;primary medical care;quality of life;terminal disease;United Kingdom;wellbeing,"O'Keeffe, S. T.;Canavan, M.",2011,,,0,
3253,Assessment of cancer pain in a patient with communication difficulties: A case report,"Background: The number of patients who have difficulty with mutual understanding has been increasing recently due to an aging society. This emerging issue needs to be addressed. We report an instructive case of a patient who had communication difficulties due to dementia and sequelae of alcoholic encephalopathy. Case presentation: A 66-year-old man of Mongolian race presented with coronary arteriosclerosis, spinal canal stenosis, transverse colon cancer, and alcoholic encephalopathy. We had been requested to remove wires that had been used for the closure of his chest in a coronary artery bypass grafting procedure. However, on admission, a tortured expression and abdominal distention were observed, along with emaciation. We diagnosed terminal stage cancer, and palliative care was offered. An abdominal computed tomographic scan revealed rectal cancer with stenosis and invasion to the adjacent tissues. A metallic stent was inserted, leading to reduction of the abdominal distention and an improvement of tachycardia. However, the patient's tortured expression was not completely relieved; therefore, an assessment of cancer pain was considered. The Abbey Pain Scale was applied. On the basis of the patient's score, analgesics and an opioid, among other medications, were administered. These led to relief of the patient's tortured expression and reduced his Abbey Pain Scale score. Following this, the patient's vital signs continued to be stable, and he was transferred to the referral institution. Conclusions: Management of cancer pain in elderly patients with mutual understanding difficulties must be performed carefully. In the case of our patient, staff at the referral institution informed us of the patient's latent torture, and we applied the Abbey Pain Scale. There was some confusion and uncertainty regarding clinical management throughout the patient's care; however, his condition eventually stabilized. We believe the application of the Abbey Pain Scale assists in the relief of cancer pain. However, accumulation of further cases and experiences to verify this assessment is required.",diclofenac;fentanyl;morphine;paracetamol;Abbey Pain Scale score;abdominal distension;aged;alcoholic encephalopathy;article;brain disease;cancer pain;cancer palliative therapy;cancer staging;case report;colon cancer;communication disorder;computer assisted tomography;coronary artery atherosclerosis;coronary artery bypass graft;dementia;disease severity;hospital admission;human;male;metal stent;Mongolian (people);pain assessment;priority journal;rectum cancer;tachycardia;tumor invasion;vertebral canal stenosis;voltaren,"Okimasa, S.;Saito, Y.;Okuda, H.;Fukuda, T.;Yano, M.;Okamoto, Y.;Ono, E.;Ohdan, H.",2016,,,0,
3254,Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: A case report,"Introduction: Sleep-related hypoventilation should be considered in patients with chronic obstructive pulmonary disease, because appropriate respiratory management during sleep is important for preventing elevation of PaCO2 levels. A nasal high-flow oxygen therapy system using a special nasal cannula can deliver suitably heated and humidified oxygen at up to 60 L/min. Since the oxygen concentration remains a constant independent of minute ventilation, this system is particularly useful in patients with chronic obstructive pulmonary disease who have hypercapnia. This is the first report of sleep-related hypoventilation with chronic obstructive pulmonary disease improving using a nasal high-flow oxygen therapy system. Case presentation: We report the case of a 73-year-old Japanese female who started noninvasive positive-pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease and CO2 narcosis due to respiratory infection. Since she became agitated as her level of consciousness improved, she was switched to a nasal high-flow oxygen therapy system. When a repeat polysomnography was performed while using the nasal high-flow oxygen therapy system, the Apnea Hypopnea Index was 3.7 times/h, her mean SpO2 had increased from 89 to 93%, percentage time with SpO2 ≤ 90% had decreased dramatically from 30.8 to 2.5%, and sleep stage 4 was now detected for 38.5 minutes. As these findings indicated marked improvements in sleep-related hypoventilation, nasal high-flow oxygen therapy was continued at home. She has since experienced no recurrences of CO2 narcosis and has been able to continue home treatment. Conclusions: Use of a nasal high-flow oxygen therapy system proved effective in delivering a prescribed concentration of oxygen from the time of acute exacerbation until returning home in a patient with chronic obstructive pulmonary disease, dementia and sleep-related hypoventilation. The nasal high-flow oxygen therapy system is currently used as a device to administer high concentrations of oxygen in many patients with type I respiratory failure, but may also be useful instead of a Venturi mask in patients like ours with type II respiratory failure, additionally providing some positive end-expiratory pressure.",clarithromycin;diuretic agent;nitrite;oxygen;aged;apnea hypopnea index;arterial gas;article;cardiomegaly;case report;chronic obstructive lung disease;common cold;consciousness level;dementia;depression;echocardiography;emphysema;female;flu like syndrome;forced expiratory volume;Glasgow coma scale;heart atrium enlargement;heart failure;heart left ventricle ejection fraction;heart right ventricle hypertrophy;human;hypercapnia;hypertension;hypoventilation;hypoxemia;influenza;insomnia;Japanese (people);nasal high flow oxygen therapy system;non invasive positive pressure ventilation;non invasive procedure;polysomnography;positive end expiratory pressure;priority journal;pulmonary hypertension;radiography;sleep disordered breathing;sleep related hypoventilation;ventilator;Vivo 30,"Okuda, M.;Kashio, M.;Tanaka, N.;Matsumoto, T.;Ishihara, S.;Nozoe, T.;Fujii, T.;Okuda, Y.;Kawahara, T.;Miyata, K.",2014,,,0,
3255,Increased homocysteine in a patient diagnosed with Marfan syndrome,,homocysteine;methionine;adult;aorta root;article;cardiomyopathy;case report;dementia;face deformity;female;atrial fibrillation;heart left ventricle failure;human;hyperlipidemia;hypothyroidism;lens disease;Marfan syndrome;mitral valve prolapse;newborn screening;non insulin dependent diabetes mellitus;palate malformation;paresthesia;thyroid cancer;thyroidectomy;tooth malformation,"Oladipo, O.;Spreitsma, L.;Dietzen, D. J.;Shinawi, M.",2010,,,0,
3256,Pattern of and risk factors for brain microbleeds in neurodegenerative dementia,"Objective: A cross-sectional study was conducted to describe the prevalence, locations, and risk factors for brain microbleeds (BMBs) in neurodegenerative dementia. Methods: The database of the Alzheimer Center Reina Sofia Foundation was searched, BMBs were described, and the potential associations of BMBs were investigated using univariate statistics. Results: A total of 148 patients (age 81.6 [standard deviation 6.7], 79.1% female) were studied. Prevalence of BMBs was 44.6%. A group of patients with unusually high (ie,≥4) number of BMBs were identified, which displayed higher number of vascular risk factors and vascular diseases. Brain microbleeds were also associated with ischemic lesions in the basal ganglia (r =.39), clinical diagnosis of Alzheimer's disease (AD) and cerebrovascular disease (r =.33), cortical infarction (r = .20), and antiaggregant or anticoagulant treatment duration (r =.20). Conclusions: Brain microbleeds are associated with vascular burden and AD diagnosis in old patients with neurodegenerative dementia. More research is warranted regarding the mechanisms and potential clinical implications of these results. © The Author(s) 2013.",aged;aging;Alzheimer disease;anticoagulant therapy;article;basal ganglion;brain hemorrhage;brain infarction;brain microbleed;cerebrovascular disease;cross-sectional study;dementia;diabetes mellitus;dyslipidemia;female;atrial fibrillation;human;hypertension;ischemic heart disease;major clinical study;male;prevalence;risk factor;tobacco use;treatment duration;vascular disease,"Olazarán, J.;Ramos, A.;Boyano, I.;Alfayate, E.;Valentí, M.;Rábano, A.;Álvarez-Linera, J.",2014,,,0,
3257,Donepezil therapy in patients with vascular and post-traumatic cognitive impairment: Some clinical observations,"Introduction. Donepezil is a procholinergic drug that slows down cognitive and functional impairment in patients with Alzheimer's disease. Little research has been carried out to study its effect in other types of neurobehavioural disorders. Aims. The purpose of this study was to describe the response to donepezil therapy in patients with neurobehavioural disorders due to vascular and post-traumatic causes. Case reports. Donepezil was administered to four patients with mild cognitive impairment due to vascular causes, to two patients with vascular dementia and to two patients with post-traumatic dementia. Following an average time of four months, the effects exerted on the cognitive, functional and behavioural areas were evaluated. One patient did not tolerate the drug and another suffered an episode of congestive heart failure that gave rise to a moderate neurobehavioural exacerbation. Two patients underwent a moderate improvement, three patients showed a slight improvement and no changes were observed in one patient. In general, memory, attention, depression, apathy and psychotic traits tended to improve. Aggressiveness/irritability tended to get worse. The functional repercussions of these changes were negligible or inexistent. Conclusions. Treatment with donepezil improved cognition and conduct in patients with neurobehavioural disorders due to vascular or post-traumatic causes. These results will have to be confirmed and expanded by means of controlled studies, and research must continue into the characteristics of responding patients and the relevance of their responses.",cholinergic receptor stimulating agent;donepezil;adult;aged;aggressiveness;Alzheimer disease;apathy;article;attention;behavior;case report;cognition;cognitive defect;congestive heart failure;depression;disease exacerbation;drug tolerability;female;functional disease;human;irritability;male;memory;multiinfarct dementia;treatment outcome;aricept,"Olazarán-Rodríguez, J.;Cruz-Orduña, I.;Jiménez-Martín, I.",2004,,,0,
3258,"Tolerability and safety of souvenaid in patients with mild Alzheimer's disease: Results of multi-center, 24-week, open-label extension study","Background: The medical food Souvenaid, containing the specific nutrient combination Fortasyn Connect, is designed to improve synapse formation and function in patients with Alzheimer's disease (AD). Two double-blind randomized controlled trials (RCT) with Souvenaid of 12 and 24 week duration (Souvenir I and Souvenir II) showed that memory performance was improved in drug-naïve mild AD patients, whereas no effects on cognition were observed in a 24-week RCT (S-Connect) in mild to moderate AD patients using AD medication. Souvenaid was well-tolerated in all RCTs. Objective: In this 24-week open-label extension (OLE) study to the 24-week Souvenir II RCT, long-term safety and intake adherence of the medical food Souvenaid was evaluated. Methods: Patients with mild AD (n = 201) received Souvenaid once-daily during the OLE. Main outcome parameters were safety and product intake adherence. The memory domain z-score from a revised neuropsychological test battery was continued as exploratory parameter. Results: Compared to the RCT, a similar (low) incidence and type of adverse events was observed, being mainly (68.3%) of mild intensity. Pooled data (RCT and OLE) showed that 48-week use of Souvenaid was well tolerated with high intake adherence (96.1%). Furthermore, a significant increase in the exploratory memory outcome was observed in both the active-active and control-active groups during Souvenaid intervention. Conclusion: Souvenaid use for up to 48-weeks was well tolerated with a favorable safety profile and high intake adherence. The findings in this OLE study warrant further investigation toward the long-term safety and efficacy of Souvenaid in a well-controlled, double-blind RCT.",NTR1975;NTR2571;alpha tocopherol;ascorbic acid;choline;cyanocobalamin;docosahexaenoic acid;folic acid;icosapentaenoic acid;mineral;phospholipid;pyridoxine;selenium;trace element;uridine phosphate;vitamin;aged;aggression;Alzheimer disease;angina pectoris;anorexia;anxiety;article;backache;bone pain;bronchitis;cognition;constipation;controlled study;depression;diarrhea;diet therapy;disease severity;dizziness;double blind procedure;dyspepsia;faintness;fatigue;female;flatulence;food;food intake;food safety;fracture;gastrointestinal symptom;headache;human;hypercholesterolemia;hypertension;long term care;macronutrient;major clinical study;male;memory;mental disease;mental performance;multicenter study;myalgia;neuropsychological test;nutrient;nutrient content;open study;outcome assessment;patient compliance;pharyngitis;priority journal;randomized controlled trial;respiratory tract disease;souvenaid;treatment duration;vertigo;weight gain;weight reduction,"Olde Rikkert, M. G. M.;Verhey, F. R.;Blesa, R.;Von Arnim, C. A. F.;Bongers, A.;Harrison, J.;Sijben, J.;Scarpini, E.;Vandewoude, M. F. J.;Vellas, B.;Witkamp, R.;Kamphuis, P. J. G. H.;Scheltens, P.",2015,,,0,
3259,Association between severe cerebral amyloid angiopathy and cerebrovascular lesions in Alzheimer disease is not a spurious one attributable to apolipoprotein E4,"Background: We have previously reported an association between severe cerebral amyloid angiopathy (CAA) and cerebrovascular lesions in Alzheimer disease (AD), which is particularly strong for microinfarcts, hemorrhages, and multiple lesion types. Cerebral amyloid angiopathy has also been associated with the apolipoprotein E4 (APOE4) genotype, which is in turn associated with premature coronary artery disease and atherosclerosis. Objective: To test whether severe CAA would be more strongly associated with cerebrovascular lesions than would APOE4 genotype. Methods: We reviewed 306 cases of autopsy-confirmed AD (from the University of California, San Diego, brain autopsy series) to assess whether APOE genotype and other clinical risk factors were predictive of vascular lesions (VLs) in AD. Cerebral amyloid angiopathy severity was assessed using a semiquantitative scale in 4 brain regions (ie, hippocampus, midfrontal cortex, inferior parietal cortex, and superior temporal cortex) and an average score was computed for each case. Results: We found that severe CAA was associated with an increased frequency of VLs (33% of the cases of severe CAA had VLs vs 19% of the cases of mild or absent CAA; P = .02). While the APOE4/4 genotype was associated with an increased severity of CAA, there was no significant relationship between APOE genotype and frequency of VLs. Logistic regression models showed that severe CAA, advanced age, atherosclerosis, and Hachinski Ischemia Scale score of 7 or more were all significantly associated with VLs, but the number of APOE4 alleles, history of hypertension, coronary artery disease, sex, and serum cholesterol levels had nonsignificant effects. Within strata of APOE genotype, the presence of severe CAA was associated with increased frequency of VLs (eg, within APOE4/4 homozygotes, VLs were present within 47% of the cases of severe CAA vs 9.5% of the cases of mild or absent CAA; P = .01). Conclusions: Severe CAA confers a greater risk of VLs in AD, even within strata of APOE genotype. Therefore, the association between severe CAA and VLs in AD is not a spurious one owing to APOE4. Overall, our cases of AD with APOE4 do not seem to be a more 'vasculopathic' subtype of AD. The mechanisms by which CAA produces VLs of various types need to be further elucidated, as these are probably important in producing the common entity of 'mixed' AD/vascular dementia.",apolipoprotein E;adult;aged;aging;Alzheimer disease;article;atherosclerosis;brain ischemia;cerebrovascular disease;disease association;disease severity;female;genotype;human;human tissue;major clinical study;male;neuropathology;priority journal;regression analysis;risk factor;vascular amyloidosis,"Olichney, J. M.;Hansen, L. A.;Hofstetter, C. R.;Lee, J. H.;Katzman, R.;Thal, L. J.",2000,,,0,
3260,The impact of apolipoprotein E4 on cause of death in Alzheimer's disease,"Objective: We tested the hypothesis that the apolipoprotein E ε4 (apoE4) allele is associated with an increased proportion of vascular- related mortality in Alzheimer's disease (AD). Background: ApoE4 is associated with an increased risk of developing AD, with an earlier onset, and may predispose to vascular dementia as well. In the general population, apoE4 has been associated with increased coronary artery disease and shorter lifespan. There is a paucity of data regarding the effect of the apolipoprotein E (apoE) genotype upon the contributing causes of death in AD. Methods: Death certificates of 114 AD cases were reviewed blind to apoE genotype. Deaths due to ischemic heart disease (IHD), cerebrovascular disease (CVD), vascular disease (either IHD or CVD), pneumonia, and other causes were analyzed as a function of apoE genotype. Logistic regression analyses were employed to control for age and gender effects. Results: The likelihood of vascular disease contributing to death increased in association with the ε4 allele (29% in cases without an ε4 allele, 43% in cases with one ε4 allele, 53% in ε4/4 homozygous cases; p = 0.035 after corrections for age and gender). This increase appeared largely due to an increase in ischemic heart disease, which was reported more frequently on death certificates of cases with one or more ε4 allele (adjusted odds ratio [OR] = 1.85 per ε4 allele; p < 0.05). There were nonsignificant trends for apoE4 to be associated with increased mortality related to cerebrovascular disease (OR = 1.45) and decreased mortality related to pneumonia (OR = 0.77) and AD itself (OR = 0.72). The ε4/4 cases had significantly earlier age of onset (mean = 64.5 yr), earlier death, and longer duration of disease (mean = 10.1 yr). Cases with one or more ε4 allele tended to have lower mean MMSE scores prior to death (6.6 versus 9.5) and were more often female (54% versus 45%). Conclusions: The apoE4 allele appears to increase the risk of vascular and ischemic heart disease-related death in patients with AD.",apolipoprotein E;adult;aged;allele;Alzheimer disease;article;coronary artery disease;female;genetic analysis;genetic susceptibility;human;ischemic heart disease;lifespan;major clinical study;male;onset age;priority journal;risk factor;sex difference,"Olichney, J. M.;Sabbagh, M. N.;Hofstetter, C. R.;Galasko, D.;Grundman, M.;Katzman, R.;Thal, L. J.",1997,,,0,
3261,"Safety and tolerability of rivastigmine capsule with memantine in patients with probable Alzheimer's disease: A 26-week, open-label, prospective trial (Study ENA713B US32)","Objective: Rivastigmine, a dual cholinesterase inhibitor (ChEI), is widely approved for the symptomatic treatment of both mild-to-moderate Alzheimer's disease (AD) and Parkinson's disease dementia. Orally administered ChEIs may be associated with gastrointestinal (GI) side effects and add-on therapy with memantine, an N-methyl-D-aspartate receptor antagonist, approved for moderate-to-severe AD, may ameliorate such side effects.Thiswas a 26-week,prospective,multicenter, single-arm,open-label pilot study to assess the safety and tolerability of rivastigmine capsules plus memantine in patients withmoderate AD. Methods: The primary objective was to assess the safety and tolerability of rivastigmine capsules 6-12 mg/day plus memantine (5-20 mg/day) as measured by the incidences of vomiting and nausea compared with those reported in the rivastigmine United States Prescribing Information (US PI). A total of 117 patients were enrolled with 116 receiving at least one dose of study medication. Results: The incidences of nausea and vomiting (30% and 13%, respectively) observed in patients who received 6-12 mg/day rivastigmine plus memantine were lower than those stated in the US PI for rivastigmine monotherapy 6-12 mg/day (47% and 31%, respectively). The most common adverse events were nausea, vomiting, and dizziness. Conclusion: Results from this study suggest the combination of rivastigmine capsule and memantine in patients with moderate AD is safe and tolerable. Improved GI tolerability of rivastigmine has been established with rivastigmine transdermal patch. Copyright © 2009 John Wiley & Sons, Ltd.",memantine;rivastigmine;acute heart infarction;add on therapy;adult;aged;agitation;Alzheimer disease;anxiety;article;asthenia;bronchitis;cardiogenic shock;chronic obstructive lung disease;clinical trial;cognition;confusion;controlled clinical trial;controlled study;daily life activity;decreased appetite;depression;diarrhea;dizziness;drug capsule;drug dose increase;drug dose reduction;drug dose titration;drug efficacy;drug fatality;drug safety;drug tolerability;evening dosage;falling;female;functional assessment;human;insomnia;lethargy;major clinical study;male;mental health;monotherapy;morning dosage;multicenter study;nausea;open study;patient compliance;pilot study;pneumonia;prescription;prospective study;side effect;single blind procedure;somnolence;United States;urinary tract infection;vomiting;weight reduction;exelon,"Olin, J. T.;Bhatnagar, V.;Reyes, P.;Koumaras, B.;Meng, X.;Brannan, S.",2010,,,0,
3262,Predictors of Cognitive and Functional Decline in Patients With Alzheimer Disease Dementia From Brazil,"Little is known on how risk factors for Alzheimer disease (AD) dementia affect disease progression, much less for populations with low mean schooling, whereas the transcription of APOE may be regulated by nongenetic factors. In this 44-month cohort study, 214 consecutive outpatients with late-onset AD were assessed for rates of cognitive and functional decline by way of Clinical Dementia Rating and Mini-Mental State Examination (MMSE) scores, keeping blinded assessment of APOE haplotypes. Subjects were evaluated for sex, schooling, age of dementia onset, and cerebrovascular risk factors (including Framingham risk scores). Of the 214 patients, there were 146 (68.2%) women and 113 (52.8%) APOE4+ carriers. The mean age of AD onset was 73.4+/-6.5 years-old, negatively correlated with time to Clinical Dementia Rating >1.0 (beta=-0.132; rho<0.001), MMSE=20 (beta=-0.105; rho<0.001), and MMSE=15 (beta=-0.124; rho=0.003), more significantly for women and APOE4+ carriers. Mean schooling was 4.18+/-3.7 years, correlated with time to MMSE=20 and MMSE=15 for women and APOE4+ carriers. Body mass index was correlated with time to MMSE=20 only for men (rho=0.006). The 10-year coronary heart disease risk was correlated with time to MMSE=20 only for APOE4+ carriers (rho=0.015). These outcomes suggest interactions among genomic effects of cognitive reserve, cerebral perfusion, and hormonal changes over mechanisms of neurodegeneration.",,"Oliveira, F. F.;Chen, E. S.;Smith, M. C.;Bertolucci, P. H.",2016,Jul-Sep,10.1097/wad.0000000000000117,0,
3263,Effects of APOE haplotypes and measures of cardiovascular risk over gender-dependent cognitive and functional changes in one year in Alzheimer's disease,"BACKGROUND: Illiteracy, high cerebrovascular risk and copies of APOE-4 are risk factors for Alzheimer's disease dementia (AD). We aimed to investigate the impacts of gender, education, coronary heart disease (CHD) risk and creatinine clearance variations, body mass index (BMI) and APOE haplotypes over the rates of cognitive and functional decline of AD in one year. METHODS: Consecutive outpatients with late-onset AD were assessed for gender, schooling, BMI and APOE haplotypes, variations in one year of creatinine clearance and Framingham projections of the 10-year absolute CHD risk, and prospective scores of the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating Sum-of-Boxes (CDR-SOB), the Index of Independence in Activities of Daily Living (ADL) and Lawton's Scale for Instrumental Activities of Daily Living (IADL). RESULTS: For 191 patients, mean age at AD onset was 73.26 +/- 6.4 years-old, earlier for APOE-4/4 carriers (p = 0.0039). For women, higher BMI led to improvements in CDR-SOB (beta = -0.091;p = 0.037) and MMSE (beta = 0.126;p = 0.017) scores, while increased creatinine clearance was associated with improvements in ADL (beta = 0.028;p = 0.012) and MMSE (beta = 0.043;p = 0.039) scores, and higher schooling led to faster worsening of IADL (beta = -0.195;p = 0.022) scores. No variables impacted cognitive or functional decline for men, whereas copies of APOE-4 and the CHD risk had no significant effects whatsoever. CONCLUSIONS: Higher BMI and creatinine clearance are protective regarding cognitive and functional decline for women, whereas higher cognitive reserve may lead to faster decline in instrumental functionality. APOE haplotypes affected the age at AD onset, but not cognitive or functional decline.",Activities of daily living;Alzheimer disease;cognition;educational status;risk factors,"Oliveira, F. F.;Pereira, F. V.;Pivi, G. A. K.;Smith, M. C.;Bertolucci, P. H. F.",2017,Oct 24,,0,
3264,Chagas disease is independently associated with brain atrophy,"Chagas disease (CD) remains a major cause of cardiomyopathy and stroke in developing countries. Brain involvement in CD has been attributed to left ventricular dysfunction, resulting in chronic brain ischemia due to hypoperfusion and/or embolic infarcts. However, cognitive impairment in CD may occur independently of cardiac disease. Therefore, we aimed to investigate head computed tomography (CT) findings in patients with Chagas disease cardiomyopathy (CDC) in comparison with other cardiomyopathies (OC). We studied 73 patients with CDC (n = 41) or OC (n = 32) matched for age and gender. These patients underwent head CT, rated by an investigator blinded to all clinical information. Head CT was rated for the presence of lacunar or territorial infarcts, as well as for measuring the total volumes of the brain, cerebellum and ventricles. Total brain volume was smaller in CDC as compared to OC patients (1,135 ± 150 vs. 1,332 ± 198 cm3, P < 0.001). Cerebellar and ventricular volumes did not differ between the groups. The prevalence of brain infarcts did not differ significantly between the groups. Chagas disease was the only independent predictor of brain atrophy in the multivariable analysis (OR = 1.38; 95% CI = 1.06-1.79, P = 0.017). Chagas disease is associated with brain atrophy independent of structural cardiac disease related to cardiomyopathy. Brain atrophy, rather than multiple infarcts, may represent the main anatomical substrate of cognitive impairment in Chagas disease. © 2009 Springer-Verlag.",adult;article;brain atrophy;brain infarction;brain size;brain ventricle;cardiomyopathy;cerebellum;Chagas disease;computer assisted tomography;controlled study;diastole;disease association;disease duration;female;heart ejection fraction;heart left ventricle contraction;human;major clinical study;male;priority journal,"Oliveira-Filho, J.;Vieira-De-Melo, R. M.;Reis, P. S. O.;Lacerda, A. M.;Neville, I. S.;Cincura, C.;Menezes, D. F.;Viana, L. C.;Jesus, P. A. P.;Lopes, A. A.;Reis, F. J. F. B.;Furie, K. L.",2009,,,0,
3265,Impact on mortality of systolic and/or diastolic heart failure in the elderly - 10 years of follow-up,"Background/purpose There is a lack of long-term follow-up studies for elderly patients with heart failure (HF) in primary health care. There is conflicting information on prognostic differences between systolic or diastolic HF in elderly patients. Our aims were, first, to study the association between overall HF or types of HF and all-cause and cardiovascular mortality, and second, to explore the impact of N-terminal prohormone of brain natriuretic peptide (NTproBNP) and comorbidities. Methods A longitudinal, prognostic, observational primary health care study with 10 years of follow-up comparing an elderly patient population with HF (systolic and/or diastolic HF) to patients without HF was conducted. HF was diagnosed with echocardiography according to the European Society of Cardiology guidelines. Results Seventy-seven of 144 patients (102 women and 42 men; mean age, 77 years) had systolic and/or diastolic HF and were compared with 67 patients without HF (Reference group). During the 10-year follow-up, 71 (49%) patients died (women, 68%; men, 32%). In univariate Cox regression analysis, significant associations were found for overall HF [hazard ratio (HR), 1.86; 95% confidence interval (CI), 1.15-3.01], isolated systolic HF (HR, 1.95; 95% CI, 1.06-3.61), and combined (systolic and diastolic) HF (HR, 3.28; 95% CI, 1.74-6.14) with all-cause mortality, but not for isolated diastolic HF. Similar results were found for cardiovascular mortality. In multivariate analysis, age (HR, 1.11; 95% CI, 1.06-1.17), kidney dysfunction (HR, 1.91; 95% CI, 1.11-3.29), smoking (HR, 3.70; 95% CI, 2.02-6.77), and NTproBNP (HR, 1.01; 95% CI, 1.00-1.02) significantly predicted all-cause mortality, but not any type of HF. Conclusion Patients diagnosed with systolic HF had a worse prognosis for mortality compared to the reference group, but in patients with diastolic HF the prognosis for mortality was similar with that in the reference group. NTproBNP was a valuable prognostic factor in elderly patients. Emphasis should be placed on kidney dysfunction and smoking/having smoked.",amino terminal pro brain natriuretic peptide;angiotensin 2 receptor antagonist;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;aged;aging;article;blood sampling;cardiovascular mortality;cerebrovascular accident;comorbidity;controlled study;dementia;diastolic heart failure;echocardiography;female;atrial fibrillation;heart ejection fraction;heart infarction;human;hypertension;kidney dysfunction;longitudinal study;lung disease;major clinical study;male;mortality;observational study;practice guideline;prevalence;primary health care;priority journal;prognosis;smoking;sudden cardiac death;survival rate;systolic heart failure;valvular heart disease;very elderly,"Olofsson, M.;Boman, K.",2015,,,0,
3266,Centenarians in the county of Funen. Morbidity and functional capacity,"The aim was to examine the feasibility of a study of centenarians and to describe morbidity and functional capacity of centenarians in the County of Funen. A total of 51 out of 58 centenarians on Funen born on May 1, 1894 or before participated. An interview could be carried out almost completely in 80.4% of the 51 participants, cognitive testing (MMSE) in 78.4% and physical performance test (PPT) in 49%. Additional information on morbidity and activities of daily living (ADL) was collected on all 51 centenarians from family members, nursing staff, GP's, hospital registries and the National Cancer Registry. Almost 3/4 were women and 58.8% were in an old people's home. Osteoarthrosis, urinary incontinence, heart failure, dizziness and eye diseases were found to be frequently prevalent, while hypertension, diabetes, cancer and stroke were found to be rare. Based on Katz' ADL index approx. 1/3 could be considered to be independent of help, while almost everybody was dependent on help for the instrumental activities (IADL). A low average score was found at the PPT, especially the walking speed was found to be very slow. Only 32.5% scored over 23 points at the MMSE, but allowing for severe impairment of vision and hearing more than 1/3 were found to be cognitively well-functioning. Severe dementia was found among 15.7%. Dependency on help for the ADL-functions was not found to be associated with health measurement, but strongly associated with visual function, PPT and MMSE (p < 0.001). The characterization of centenarians as described in a number of foreign studies as being an homogeneous, relatively healthy and independent group could therefore not be confirmed. On the contrary, they were found to be very heterogeneous and characterized by multi-morbidity. By far the great part of them were in addition dependent on help in their activities of daily life. Approx. 1/3, however, were found to be relatively independent of help for basic functions, more than 1/3 were cognitively well-functioning, and a very small number could even manage a few outdoor functions by themselves.","*Activities of Daily Living;Aged;*Aged, 80 and over/physiology/psychology;Cross-Sectional Studies;Denmark/epidemiology;Female;Humans;Male;*Morbidity","Olsen, H.;Jeune, B.;Andersen-Ranberg, K.",1996,Dec 16,,0,
3267,Loss of Female Sex Hormones Exacerbates Cerebrovascular and Cognitive Dysfunction in Aortic Banded Miniswine Through a Neuropeptide Y-Ca2+-Activated Potassium Channel-Nitric Oxide Mediated Mechanism,"BACKGROUND: Postmenopausal women represent the largest cohort of patients with heart failure with preserved ejection fraction, and vascular dementia represents the most common form of dementia in patients with heart failure with preserved ejection fraction. Therefore, we tested the hypotheses that the combination of cardiac pressure overload (aortic banding [AB]) and the loss of female sex hormones (ovariectomy [OVX]) impairs cerebrovascular control and spatial memory. METHODS AND RESULTS: Female Yucatan miniswine were separated into 4 groups (n=7 per group): (1) control, (2) AB, (3) OVX, and (4) AB-OVX. Pigs underwent OVX and AB at 7 and 8 months of age, respectively. At 14 months, cerebral blood flow velocity and spatial memory (spatial hole-board task) were lower in the OVX groups (P<0.05), with significant impairments in the AB-OVX group (P<0.05). Resting carotid artery beta stiffness and vascular resistance during central hypovolemia were increased in the AB-OVX group (P<0.05), and blood flow recovery after central hypovolemia was reduced in both OVX groups (P<0.05). Isolated pial artery (pressure myography) vasoconstriction to neuropeptide Y was greatest in the AB-OVX group (P<0.05), and vasodilation to the Ca2+-activated potassium channel alpha-subunit agonist NS-1619 was impaired in both AB groups (P<0.05). The ratio of phosphorylated endothelial nitric oxide synthase:total endothelial nitric oxide synthase was depressed and Ca2+-activated potassium channel alpha-subunit protein was increased in AB groups (P<0.05). CONCLUSIONS: Mechanistically, impaired cerebral blood flow control in experimental heart failure may be the result of heightened neuropeptide Y-induced vasoconstriction along with reduced vasodilation associated with decreased Ca2+-activated potassium channel function and impaired nitric oxide signaling, the effects of which are exacerbated in the absence of female sex hormones.",cerebral blood flow;cognition;female sex hormones;heart failure;heart-brain relationships;vascular biology;vascular cognitive impairment,"Olver, T. D.;Hiemstra, J. A.;Edwards, J. C.;Schachtman, T. R.;Heesch, C. M.;Fadel, P. J.;Laughlin, M. H.;Emter, C. A.",2017,Oct 31,,0,
3268,Diseases and causes of death in the aged--based on the Hisayama Study,,Adult;Aged;Aging;Body Weight;Cerebral Infarction/*mortality;Dementia/mortality;Female;Humans;Japan;Male;Middle Aged;Myocardial Infarction/*mortality;Neoplasms/mortality;Organ Size,"Omae, T.;Ueda, K.",1985,May,,0,
3269,Emerging histomorphologic phenotypes of chronic traumatic encephalopathy in american athletes,"BACKGROUND: We define chronic traumatic encephalopathy (CTE) as a progressive neurodegenerative syndrome caused by single, episodic, or repetitive blunt force impacts to the head and transfer of acceleration-deceleration forces to the brain. OBJECTIVE: We present emerging histomorphologic phenotypes of CTE that we identified in our cohort of CTE cases with apolipoprotein E genotyping and causes and manners of death. METHODS: Autopsy brain tissue of 14 professional athletes and 3 high school football players was examined after unexpected deaths. Histochemical and immunohistochemical tissue staining was performed with apolipoprotein E genotyping. RESULTS: Ten of 14 professional athletes (71%) were positive for CTE: 7 of 8 football players, 2 of 4 wrestlers, and 1 boxer. One of 3 high school players manifested incipient CTE. The age range of those with CTE was 18 to 52 years; they were all male athletes. In all cases of CTE, Alzheimer-type cerebral cortical atrophy was absent; negligible to mild neocortical neuronal dropout was present. The fundamental neuropathologic feature of CTE was the topographic distribution of sparse, moderate, and frequent band-shaped, flame-shaped, small and large globose neurofibrillary tangles and neuritic threads in the cerebral cortex, subcortical nuclei/basal ganglia, hippocampus, and brainstem nuclei. Sparse to frequent diffuse amyloid plaques may accompany tauopathy and was seen in only 2 CTE cases. No α-synucleinopathy was present. All 7 CTE-positive professional athletes with known apolipoprotein E genotypes had at least 1 E3 allele comprising 5 E3/E3 (71%) and 2 E3/E4 (29%). Alcohol- and drug-related deaths, suicides, and accidental deaths were overrepresented in our CTE cohort. CONCLUSION: The emerging histomorphologic features of our CTE cohort may specify histologic criteria for CTE diagnosis, may identify emerging histologic variants of CTE and may facilitate more objective surveillance and accurate identification of sentinel CTE cases. Copyright © by the Congress of Neurological Surgeons.",alcohol;apolipoprotein E;carisoprodol;cocaine;diamorphine;diazepam;methadone;nordazepam;oxycodone;quetiapine;acute pancreatitis;adolescent;adult;article;asphyxia;asthma;athlete;autopsy;basal ganglion;boxing;brain cortex;brain stem;brain tissue;brain vasculitis;cause of death;chronic pancreatitis;chronic traumatic encephalopathy;clinical article;clinical feature;congestive cardiomyopathy;coronary artery atherosclerosis;football;genotype;gunshot injury;head injury;heart death;hippocampus;histochemistry;histology;human;human tissue;immunohistochemistry;intoxication;male;morphology;mortality;neurofibrillary tangle;nucleus accumbens;phenotype;priority journal;staining;traumatic brain injury;Western Hemisphere;wrestling,"Omalu, B.;Bailes, J.;Hamilton, R. L.;Kamboh, M. I.;Hammers, J.;Case, M.;Fitzsimmons, R.",2011,,,0,
3270,Chronic traumatic encephalopathy in a National Football League player,"OBJECTIVE: We present the results of the autopsy of a retired professional football player that revealed neuropathological changes consistent with long-term repetitive concussive brain injury. This case draws attention to the need for further studies in the cohort of retired National Football League players to elucidate the neuropathological sequelae of repeated mild traumatic brain injury in professional football. METHODS: The patient's premortem medical history included symptoms of cognitive impairment, a mood disorder, and parkinsonian symptoms. There was no family history of Alzheimer's disease or any other head trauma outside football. A complete autopsy with a comprehensive neuropathological examination was performed on the retired National Football League player approximately 12 years after retirement. He died suddenly as a result of coronary atherosclerotic disease. Studies included determination of apolipoprotein E genotype. RESULTS: Autopsy confirmed the presence of coronary atherosclerotic disease with dilated cardiomyopathy. The brain demonstrated no cortical atrophy, cortical contusion, hemorrhage, or infarcts. The sabstantia nigra revealed mild pallor with mild dropout of pigmented neurons. There was mild neuronal dropout in the frontal, parietal, and temporal neocortex. Chronic traumatic encephlopathy was evident with many diffuse amyloid plaques as well as sparse neurofibrillary tangles and τ-positive neuritic threads in neocortical areas. There were no neurofibrillary tangles or neuropil threads in the hippocampus or entorhinal cortex. Lewy bodies were absent. The apolipoprotein E genotype was E3/E3. CONCLUSION: This case highlights potential long-term neurodegenerative outcomes in retired professional National Football League players subjected to repeated mild traumatic brain injury. The prevalence and pathoetiological mechanisms of these possible adverse long-term outcomes and their relation to duration of years of playing football have not been sufficiently studied. We recommend comprehensive clinical and forensic approaches to understand and further elucidate this emergent professional sport hazard.",adult;Alzheimer disease;anamnesis;article;autopsy;brain disease;brain injury;cardiomyopathy;case report;cognitive defect;coronary artery atherosclerosis;football;head injury;human;human tissue;Lewy body;male;mood disorder;neurofibrillary tangle;neuropathology;Parkinson disease;priority journal;substantia nigra,"Omalu, B. I.;DeKosky, S. T.;Minster, R. L.;Kamboh, M. I.;Hamilton, R. L.;Wecht, C. H.",2005,,,0,
3271,Lead as an environmental cardiovascular risk factor,,lead;air pollution;Alzheimer disease;article;cardiotoxicity;cardiovascular disease;cardiovascular risk;smoking;coronary artery atherosclerosis;diabetes mellitus;disease course;electrocardiography;environmental exposure;environmental factor;exhaust gas;food contamination;health hazard;heart failure;heart infarction;human;hypertension;incidence;lead blood level;lead poisoning;mental deficiency;mortality;neurotoxicity;obesity;pathophysiology;reference value;risk assessment;soil pollution;symptom;water contamination,"Omelchenko, A.",2009,,,0,
3272,Cholesterol synthesis is the trigger and isoprenoid dependent interleukin-6 mediated inflammation is the common causative factor and therapeutic target for atherosclerotic vascular disease and age-related disorders including osteoporosis and type 2 diabetes,"This is a unifying theory that cholesterol metabolites (isoprenoids) are an integral component of the signaling pathway for interleukin-6 (IL-6) mediated inflammation. IL-6 inflammation is the common causative origin for atherosclerosis, peripheral vascular disease, coronary artery disease, and age-related disorders including osteoporosis, dementia, Alzheimer's disease and type 2 diabetes. Therapeutic effects of bisphosphonates and statins are mediated by isoprenoid depletion. Statins and bisphosphonates act in the cholesterol pathway to deplete isoprenoids. Anti-inflammatory properties of statins and bisphosphonates are due to isoprenoid depletion with subsequent inhibition of IL-6 mediated inflammation. Therapeutic targets for the prevention and control of all the above diseases should focus on cholesterol metabolites and IL-6 mediated inflammation. Prevention of atherosclerotic vascular disease and age-related disorders will be by utilization of cholesterol lowering agents or techniques and/or treatment with statins and/or bisphosphonates to inhibit IL-6 inflammation through regulation of cholesterol metabolism.","Aging/immunology/*metabolism/pathology;Arteriosclerosis/*immunology/metabolism/pathology/therapy;Cholesterol/adverse effects/*biosynthesis;Diabetes Mellitus, Type 2/*immunology/metabolism/pathology/therapy;Humans;Inflammation Mediators/*physiology;Interleukin-6/*physiology;Osteoporosis/*immunology/metabolism/pathology/therapy","Omoigui, S.",2005,,10.1016/j.mehy.2005.03.012,0,
3273,"The Interleukin-6 inflammation pathway from cholesterol to aging--role of statins, bisphosphonates and plant polyphenols in aging and age-related diseases","We describe the inflammation pathway from Cholesterol to Aging. Interleukin 6 mediated inflammation is implicated in age-related disorders including Atherosclerosis, Peripheral Vascular Disease, Coronary Artery Disease, Osteoporosis, Type 2 Diabetes, Dementia and Alzheimer's disease and some forms of Arthritis and Cancer. Statins and Bisphosphonates inhibit Interleukin 6 mediated inflammation indirectly through regulation of endogenous cholesterol synthesis and isoprenoid depletion. Polyphenolic compounds found in plants, fruits and vegetables inhibit Interleukin 6 mediated inflammation by direct inhibition of the signal transduction pathway. Therapeutic targets for the control of all the above diseases should include inhibition of Interleukin-6 mediated inflammation.",,"Omoigui, S.",2007,Mar 20,10.1186/1742-4933-4-1,0,3274
3274,"The Interleukin-6 inflammation pathway from cholesterol to aging - Role of statins, bisphosphonates and plant polyphenols in aging and age-related diseases","We describe the inflammation pathway from Cholesterol to Aging. Interleukin 6 mediated inflammation is implicated in age-related disorders including Atherosclerosis, Peripheral Vascular Disease, Coronary Artery Disease, Osteoporosis, Type 2 Diabetes, Dementia and Alzheimer's disease and some forms of Arthritis and Cancer. Statins and Bisphosphonates inhibit Interleukin 6 mediated inflammation indirectly through regulation of endogenous cholesterol synthesis and isoprenoid depletion. Polyphenolic compounds found in plants, fruits and vegetables inhibit Interleukin 6 mediated inflammation by direct inhibition of the signal transduction pathway. Therapeutic targets for the control of all the above diseases should include inhibition of Interleukin-6 mediated inflammation. © 2007 Omoigui; licensee BioMed Central Ltd.",alendronic acid;apigenin;bisphosphonic acid derivative;caffeic acid;chlorogenic acid;cholesterol;compactin;epicatechin;etidronic acid;ferulic acid;flavonoid;gallocatechin;hydrocinnamic acid;hydroxybenzoic acid;hydroxymethylglutaryl coenzyme A reductase inhibitor;interleukin 6;lignan;luteolin;mevinolin;pamidronic acid;para coumaric acid;pelargonidin;polyphenol;pravastatin;quinic acid;risedronic acid;simvastatin;sinapic acid;stilbene derivative;unindexed drug;aging;Alzheimer disease;arthritis;article;atherosclerosis;neoplasm;cholesterol synthesis;coronary artery disease;dementia;drug mechanism;drug targeting;fruit;geriatric disorder;human;inflammation;non insulin dependent diabetes mellitus;osteoporosis;peripheral vascular disease;priority journal;signal transduction;vegetable,"Omoigui, S.",2007,,,0,
3275,A ten year study of the pharmacotherapy of hypertension at a tertiary hospital in south western Nigeria,"This study was carried out at the University College Hospital, (U.C.H) Ibadan. Its primary purpose was to assess the Pharmaco-therapeutic approach to the management of Hypertension by comparing the antihypertensives prescribed at the U.C.H during a period of 10 years (1997-2006) with the British ABCD aligorithm. Two hundred and thirty (230) patients were selected randomly for the study with age bracket 25 to 85 years. Age, gender, history of hypertension, general health status and regimen on which the patients were placed were used for data collection. Average age of hypertensive patients was 51 ± 14.561 years. The modal age was 52 ± 14.561 years. One hundred and thirty six (136) (59%) of the studied population were males while (94) (40.9%) were females. Seventy four (74) (37.2%) of the hypertensive patients had heart failure as comorbidity, followed by 59 (29.6%) with renal failure while 14 (7%) had diabetics mellitus. One hundred and thirty nine (139) (21.3%) were on monotherapy of calcium channel blockers being the commonest. This is followed by 122 (18.7%) on ACEIs, 120 (18.3%) on diuretics and 41 (6.3%) on beta-blockers. Twenty two (22) (6.9%) were on biotherapy of ACEIs + beta-blockers, 67 (21.2%) on ACEIs + calcium channel blockers, 74 (23.4%) on ACEIs + diuretics, 74 (23.4%) on calcium channel blockers + diuretics. Eighteen (18) (5.7%) were on triple therapy while 6 (1.9%) were on quadruple therapy. The study indicated a close correlation in the choice of anti hypertensives prescribed and the British ABCD algorithm.",acetylsalicylic acid;amiloride plus hydrochlorothiazide;amlodipine;antihypertensive agent;anxiolytic agent;atenolol;beta adrenergic receptor blocking agent;briserin;calcium channel blocking agent;digoxin;dipeptidyl carboxypeptidase inhibitor;felodipine;furosemide;hydralazine;isosorbide dinitrate;lisinopril;methyldopa;nifedipine;propranolol;ramipril;spironolactone;thiazide diuretic agent;adult;age determination;aged;anemia;article;asthma;chronic obstructive lung disease;comorbidity;controlled study;dementia;diabetes mellitus;female;health status;atrial fibrillation;heart failure;heart left ventricle hypertrophy;hepatitis B;human;hypertension;kidney failure;liver disease;major clinical study;male;medical history;monotherapy;Nigeria;parkinsonism;prescription;retinopathy;seizure;sex difference;cerebrovascular accident;tertiary health care,"Omole, M. K.;Oke, G. O.",2012,,,0,
3276,Early and Late Outcomes of Operation for Acute Type A Aortic Dissection in Patients Aged 80 Years and Older,"Background The number of elderly patients undergoing emergency operation for acute type A aortic dissection is increasing in the aging society. We examined the early and late outcomes of operation for acute type A aortic dissection in elderly patients (≥80 years old). Methods From January 2001 to December 2015, 345 consecutive patients underwent surgical treatment for acute type A aortic dissection at our institution. Of these, 63 elderly patients (≥80 years old; 28 men; mean age, 83.7 ± 3.0 years) were reviewed and compared with nonelderly patients (≤79 years old). Results The hospital death was 9/63 (14.3%) and 25/282 (8.9%) in patients 80 years and older but 79 years or younger, respectively (p = 0.28). Multivariate analysis showed age 80 years or older was a significant risk factor for hospital mortality (odds ratio 3.27, 95% confidence interval: 1.22 to 8.76, p = 0.02). During follow-up period (mean, 51.3 ± 40.9 months; range, 1 to 162 months), the 5-year survival of the elderly patients discharged from the hospital was 58.6% ± 8.7%. At postoperative 6 months and the latest follow-up (mean, 44.3 ± 25.6 months) of the elderly patients excluding late death, 90.2% (46/51) and 88% (22/25) of elderly patients had totally or almost independent daily life, respectively. Conclusions Although age 80 years or older was the risk factor for hospital mortality in operation for acute type A aortic dissection, the long-term survival of the hospital survivors and the level of activity of daily life were acceptable. Aggressive surgical treatment could be a reasonable option for selected elderly patients.",adult;aged;aortic arch;aortic dissection;aortic surgery;aortic regurgitation;article;artificial ventilation;ascending aorta;body surface;brain perfusion;cardiogenic shock;cardiopulmonary bypass;comatose patient;controlled study;coronary artery bypass graft;critically ill patient;daily life activity;dementia;female;follow up;geriatric surgery;health status;heart arrest;heart index;hospital mortality;human;immobility;intensive care unit;life expectancy;long term survival;major clinical study;male;mortality risk;neurologic disease;operation duration;outcome assessment;priority journal;resuscitation;surgical mortality;surgical technique;survival rate;survivor;systolic blood pressure;very elderly,"Omura, A.;Matsuda, H.;Minami, H.;Nakai, H.;Henmi, S.;Murakami, H.;Yoshida, M.;Mukohara, N.",2017,,10.1016/j.athoracsur.2016.05.046,0,
3277,Comorbidity as predictor poor prognosis for patients with advanced head and neck cancer treated with major surgery,"Background The impact of comorbidities on patients with advanced head and neck cancer treated with major surgery has not been reported before. Methods We retrospectively reviewed clinical charts between 2004 and 2011 at our institution and identified 185 patients with clinical stage III to IV head and neck cancer treated with major surgery. Comorbidities were scored using the Adult Comorbidity Evaluation-27 (ACE-27) index manual. Results Patients with ACE-27 ≥2 had significantly worse overall survival (OS) and disease-specific survival (DSS) than those with ACE-27 ≤1 (p <.0001 and p =.0047, respectively). Multivariate analyses revealed that ACE-27 ≥2 and extracapsular spread (ECS) were independently significant adverse prognostic factors for OS and DSS. In addition, patients with ACE-27 ≥2 had a higher incidence of distant metastases (p =.0057). Conclusion The current study suggests that comorbidities may predict poor prognosis and development of distant metastases for patients with advanced head and neck cancer treated with major surgery.",acquired immune deficiency syndrome;adult;Adult Comorbidity Evaluation 27 index;advanced cancer;age;aged;angina pectoris;article;cancer localization;cancer patient;cancer prognosis;cancer surgery;cancer survival;cerebrovascular accident;comorbidity;comorbidity assessment;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;disease severity;disease specific survival;distant metastasis;female;head and neck cancer;heart arrhythmia;heart infarction;human;hypertension;leukemia;lymphoma;major clinical study;major surgery;male;medical record review;myeloma;neuromuscular disease;obesity;overall survival;paralysis;peripheral occlusive artery disease;priority journal;retrospective study;solid tumor;substance abuse;tumor differentiation;vein disease,"Omura, G.;Ando, M.;Saito, Y.;Kobayashi, K.;Yamasoba, T.;Asakage, T.",2016,,,0,
3278,Hand ischaemia after radial artery cannulation,Arterial cannulation for haemodynamic monitoring has become a routine procedure in the clinical management of critically ill adults. Thrombosis is the most common complication of this procedure. We report the case of a patient with multiple traumatic injuries in which radial artery cannulation was associated with compartment syndrome of the forearm and hand.,enoxaparin;hypertensive factor;inotropic agent;aged;Alzheimer disease;anticoagulant therapy;artery catheterization;article;case report;cause of death;cerebrovascular accident;compartment syndrome;conservative treatment;device removal;Doppler flowmetry;drug treatment failure;follow up;hand amputation;hand disease;hand ischemia;hand necrosis;heart arrest;heat treatment;human;hypotension;injury;intensive care unit;international normalized ratio;ischemia;male;medical history;necrosis;outcome assessment;partial thromboplastin time;pneumonia;priority journal;prothrombin time;radial artery;resuscitation;septic shock;clexane,"Onal, O.;Salman, E.;Yetisir, F.;Kilic, M.",2015,,,0,
3279,Recommendations to prescribe in complex older adults: Results of the criteria to assess appropriate medication use among elderly complex patients (CRIME) project,"The occurrence of several geriatric conditions may influence the efficacy and limit the use of drugs prescribed to treat chronic conditions. Functional and cognitive impairment, geriatric syndromes (i.e. falls or malnutrition) and limited life expectancy are common features of old age, which may limit the efficacy of pharmacological treatments and question the appropriateness of treatment. However, the assessment of these geriatric conditions is rarely incorporated into clinical trials and treatment guidelines. The CRIME (CRIteria to assess appropriate Medication use among Elderly complex patients) project is aimed at producing recommendations to guide pharmacologic prescription in older complex patients with a limited life expectancy, functional and cognitive impairment, and geriatric syndromes, and providing physicians with a tool to improve the quality of prescribing, independent of setting and nationality. To achieve these aims, we performed the following: (i) Existing diseasespecific guidelines on pharmacological prescription for the treatment of diabetes, hypertension, congestive heart failure, atrial fibrillation and coronary heart disease were reviewed to assess whether they include specific indications for complex patients; (ii) a literature search was performed to identify relevant articles assessing the pharmacological treatment of complex patients; (iii) A total of 19 new recommendations were developed based on the results of the literature search and expert consensus. In conclusion, the new recommendations evaluate the appropriateness of pharmacological prescription in older complex patients, translating the recommendations of clinical guidelines to patients with a limited life expectancy, functional and cognitive impairment, and geriatric syndromes. These recommendations cannot represent substitutes for careful clinical consideration and deliberation by physicians; the recommendations are not meant to replace existing clinical guidelines, but they may be used to help physicians in the prescribing process © Springer International Publishing Switzerland 2013.",anticoagulant agent;antihypertensive agent;digoxin;diuretic agent;furosemide;hemoglobin A1c;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;loop diuretic agent;metformin;potassium sparing diuretic agent;prescription drug;sulfonylurea;warfarin;aged;antihypertensive therapy;article;blood pressure regulation;caregiver;cerebrovascular accident;cognitive defect;congestive heart failure;dementia;diabetes mellitus;eating habit;falling;fracture;functional disease;geriatric disorder;geriatric patient;glycemic control;atrial fibrillation;high risk population;human;hypertension;hypoglycemia;inappropriate prescribing;international normalized ratio;ischemic heart disease;life expectancy;malnutrition;medical literature;orthostatic hypotension;physician;practice guideline;prescription;priority journal;secondary prevention;self care;systolic blood pressure,"Onder, G.;Landi, F.;Fusco, D.;Corsonello, A.;Tosato, M.;Battaglia, M.;Mastropaolo, S.;Settanni, S.;Antocicco, M.;Lattanzio, F.",2014,,,0,
3280,Neurologic diseases in women: Five new things,"This review highlights some of the new epidemiologic information concerning sex differences involving combined oral contraceptives and stroke, depression and selective serotonin reuptake inhibitors use during pregnancy, emerging knowledge of the teratogenicity and cognitive effects of anticonvulsants during pregnancy, demyelinating disorders in pregnancy, and the influence of timing of hormonal exposure on the risk of Alzheimer disease. © 2013 American Academy of Neurology.",acetylsalicylic acid;anticonvulsive agent;drospirenone;estradiol;ethinylestradiol;etonogestrel;gestagen;levonorgestrel;medroxyprogesterone acetate;norelgestromin;oral contraceptive agent;serotonin uptake inhibitor;simvastatin;Alzheimer disease;article;autoimmune disease;birth control;cerebrovascular accident;cognition;computed tomographic angiography;demyelinating disease;depression;diabetes mellitus;diplopia;female;gait disorder;heart infarction;hormonal contraception;hormonal therapy;human;hypertension;intrauterine contraceptive device;migraine;neuroimaging;neurologic disease;nuclear magnetic resonance imaging;pregnancy;priority journal;risk factor;sex difference;synapse;teratogenicity,"O'Neal, M. A.",2013,,,0,
3281,An integrated approach for vascular health: A call to action,"Vascular diseases such as stroke, myocardial infarction, most causes of heart failure, dementia, peripheral arterial disease, certain kidney, and many lung and eye conditions are a result of disorders in the blood vessels (large and small) throughout the entire human body. Vascular diseases are the leading cause of preventable death and disability in Canada. Most vascular diseases share common risk factors (high blood pressure, diabetes, dyslipidemia, and obesity), which can be influenced by modifiable health behaviours such as unhealthy diet, smoking, lack of physical activity, and stress. Ninety percent of Canadians face an increased risk, which could be modified by managing these health behaviours and risk factors. Canada's aging population, combined with alarming trends in obesity, physical inactivity, high blood pressure, and diabetes are expected to further increase the social and economic effect of vascular diseases in the coming decades, unless there are major changes in health policy. Even more concerning is the increase in vascular risk factors among Canada's youth, and ethnically diverse populations. Vascular diseases affect not only the patient, but also place burdens on their spouses, families, friends, and communities. Tremendous potential exists to reduce the effects of vascular diseases through healthy public policy, supporting Canadians to make healthy lifestyle changes, and coordinating efforts across the continuum of care in a patient-focused manner. Vascular health requires partnerships for action across many sectors including government, health care practitioners, academia, not-for-profit organizations, and the private sector. The health sector alone cannot solve this problem.",aging;article;cardiovascular risk;diabetes mellitus;dyslipidemia;government regulation;health behavior;health care cost;health care personnel;health care policy;health economics;human;hypertension;lifestyle modification;obesity;physical activity;physical inactivity;risk factor;stress;vascular disease,"O'Neill, B. J.;Rana, S. N.;Bowman, V.",2015,,,0,
3282,Main medical conditions of frail elderly patients that require intensive care under the Japanese Long-Term Care Insurance (LTCI) system: a comparison with German LTCI,"BACKGROUND: Although the number of frail elderly individuals has rapidly increased with global aging, few studies have assessed the main medical conditions that are covered by Long-Term Care Insurance (LTCI) systems. OBJECTIVES AND METHODS: To improve preventive care strategies, the author researched data from 553 frail elderly individuals above 65 years of age in the Osaka central area. Logistic regression analysis was used to identify severe diseases associated with levels of care higher than level 3 (3+) under the Japanese LTCI system, which is equivalent to the care standards of the German LTCI system. The main medical conditions were also compared between the LTCI systems of both countries. RESULTS: Diseases significantly associated with Japanese level of care 3+ were renal failure (odds ratio 6.3), fracture (5.3), dementia (4.4), and cerebrovascular disease (CVD; 2.5) in males and fracture (7.5), heart failure (3.6), dementia (3.3), CVD (2.9), and depression (2.8) in females. Main medical conditions in Japanese patients by gender were dementia (males 29%, females 21%), CVD (males 27%, females 22%), neoplasm (males 11%), and fracture or fracture sequelae (females 24%). Among German LTCI recipients, the main medical conditions by gender were diseases of the circulatory system (males 23%, females 19%) and mental and behavioral disorders (males 17%, females 20%). CONCLUSION: Dementia and diseases of the circulatory system, especially CVD, were the most common main recipients. Intensive blood pressure control and thorough diabetes treatment are the top preventive healthcare strategies for both diseases of the circulatory system and dementia to avoid disease progression and accumulation. Early detection and treatment of cancer in males and prevention of fractures in females are of particular importance.","Aged, 80 and over;*Critical Care;Female;Frail Elderly;*Geriatric Assessment;Germany;Humans;Insurance Coverage;*Insurance, Long-Term Care;Japan;Logistic Models;Male;Primary Prevention/methods","Onishi, K.",2011,Jul,,0,
3283,"Letter regarding article by Hylek et al, ""Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation"" 3",,acetylsalicylic acid;warfarin;ximelagatran;bleeding;clinical practice;dementia;drug tolerability;embolism;atrial fibrillation;heart infarction;human;letter;priority journal;risk factor;cerebrovascular accident;thromboembolism;aspirin,"Ono, A.;Kawamura, I.;Fujita, T.",2007,,,0,
3284,What is the life expectancy in frontotemporal lobar degeneration?,,accidental death;airway obstruction;Alzheimer disease;aphasia;behavior;cachexia;cause of death;cognition;diagnostic test;disease severity;educational status;frontotemporal dementia;heart failure;human;life expectancy;neoplasm;note;onset age;phenotype;pneumonia;sex difference;sudden death,"Onyike, C. U.",2011,,,0,
3285,Penile strangulation: Report of two unusual cases,"We report two cases of penile strangulation that presented to our emergency department. In the first case, a 60-year-old man, the object of strangulation was a metallic ring that was extricated using an orthopaedic cutter in the operating theatre. The patient recovered uneventfully. In the second case, a 77-year-old man, the object of strangulation was a plastic bottle, which was extricated using surgical instruments in the emergency department, but the patient sub subsequently developed postobstructive diuresis. The first case illustrates the difficulty that may be encountered in this delicate yet urgent situation, while the second case reports a rare complication.",potassium;adult;aged;article;case report;cause of death;death;dementia;depressive psychosis;devices;diuresis;emergency ward;grief;hematuria;human;hypokalemia;ischemic heart disease;male;metallic ring;micturition disorder;operating room;orthopedic cutter;orthopedic equipment;penile strangulation;penile swelling;penis injury;plastic bottle;resuscitation;surgical equipment,"Ooi, C. K.;Goh, H. K.;Chong, K. T.;Lim, G. H.",2009,,,0,
3286,Sy 11-3 Hypertension in Women: More Dangerous Than in Men?,"Heart disease, stroke, and kidney failure are leading causes of death worldwide, and hypertension is a significant risk factor for each. Hypertension is less common in women, compared to men, in those younger than 45 years of age. This trend is reversed in those 65 years and older. In the US between 2011-2014, the prevalence of hypertension in women and men by age group was 6% vs 8% (18-39 years), 30% vs 35% (40-59 years), and 67% vs 63% (60 years and over). Awareness, treatment, and control rates differ between genders with women being more aware of their diagnosis (85% vs 80%), more likely to take their medications (81% vs 71%) and more frequently having controlled hypertension (55% vs 49%). Analysis of >12,000 patient visits with primary care physicians in the US showed no gender difference in the number of anti-hypertensive medications, but did reveal women were more commonly prescribed diuretics and less frequently prescribed ACE-inhibitors.Data on blood pressure (BP) and hypertension prevalence have traditionally been based on manual/automated sphygmomanometer measurements in office. However, extensive epidemiologic data indicate that up to 30% of persons diagnosed with hypertension in office are normotensive outside of clinic. Multiple large population based meta-analyses have shown the superiority of ambulatory blood pressure monitoring (ABPM) and home BP monitoring (or self-monitoring) to in-clinic BP measurements in predicting cardiovascular outcomes (cardiovascular death, stroke, and cardiac/coronary events). Further, night-time BP recorded by ABPM has emerged as a better predictor of total mortality, stroke, and cardiovascular death in patients with hypertension and a history cardiovascular disease (CVD) than either day-time ABPM or in-clinic BP measurements. Importantly, the United States Preventive Services Task Force is now recommending ABPM in all patients prior to initiation of anti-hypertensive treatment as a Grade-A recommendation. ABPM data show a higher percentage of women (43%) than men (34%) have white coat hypertension (elevated in clinic BP, normal out of clinic BP). White coat hypertension has been associated with development of sustained hypertension and increased stroke risk on long term follow-up. In contrast, masked hypertension (elevated out of clinic BP, normal in clinic BP), which has been associated with increased cardiovascular risk, is less common in women compared to men. The prevalence of masked hypertension in women increases with body mass index (adjusted OR = 1.65 for BMI>/=27, 95% CI = 1.14-2.39) and alcohol intake (adjusted OR = 2.12 for at least six drinks per week, 95% CI = 1.34-3.35), perhaps accounting for the increased rate of cardiovascular outcomes in this patient group.Randomized controlled trials (RCTs) with CVD outcomes have provided definitive evidence that BP lowering medications benefit hypertensive women. While these trials have largely shown similar CVD outcome benefits in both genders, some differences in response to therapy have been reported. In the ALLHAT study, amlodipine, compared to lisinopril, was associated with a greater reduction in BP, as well as a decreased stroke rate in women. In the VALUE study, cardiovascular morbidity/mortality was higher with valsartan than with amlodipine in women. In the LIFE study, a lower primary composite endpoint (CVD death, stroke, and myocardial infarction) was seen in women treated with losartan. The BP Lowering Treatment Trialists' Collaboration overview of 31 RCTs included comparisons of active agents with placebos, intensive vs less intensive anti-hypertensive medications, and one active agent versus another. In all cases, average baseline BP was higher for women than men, but BP reduction was comparable between genders. No differences in the effects of various anti-hypertensive regimens on CVD outcomes by gender were identified. However, clinically significant gender specific adverse effects of various anti-hypertensive drug classes have been identified. Women more commonly develop hyponatremia/hypokalemia fro diuretic therapy; men more frequently develop gout. Women are 3 times more likely to develop an ACE-inhibitor related cough, and more commonly experience CCB-related peripheral edema and minoxidil-induced hirsutism. Importantly, ACEIs/ARBs, direct renin inhibitors, and mineralocorticoid antagonists are contraindicated in women of reproductive age due to the potential of developing fetal abnormalities. Thiazide type diuretics are preferred for the use in elderly women because of decreased risk of hip fractures.Several forms of hypertension, including post-menopausal, oral contraceptive (OCP) induced, and pregnancy related hypertension occur only in women. Following menopause, there is an age independent increase in systolic BP thought to be secondary to the withdrawal of endogenous estrogen, increased salt sensitivity, diminished endothelial nitric oxide production, and increased angiotensin II receptor expression. OCP use is associated with increases in both BP and risk of cardiovascular events, which are reversible with cessation of OCP use. Hypertension in pregnancy (including chronic hypertension, gestational hypertension, preeclampsia, and eclampsia) is associated with increased maternal and fetal cardiovascular and non-cardiovascular risk during pregnancy and long-term mortality risk, particularly for Alzheimer disease, stroke, diabetes, and ischemic heart disease.",,"Oparil, S.",2016,Sep,10.1097/01.hjh.0000500943.95477.bd,0,
3287,Genome-wide genotyping demonstrates a polygenic risk score associated with white matter hyperintensity volume in CADASIL,"BACKGROUND AND PURPOSE - : White matter hyperintensities (WMH) on MRI are a quantitative marker for sporadic cerebral small vessel disease and are highly heritable. To date, large-scale genetic studies have identified only a single locus influencing WMH burden. This might in part relate to biological heterogeneity of sporadic WMH. The current study searched for genetic modifiers of WMH volume in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a monogenic small vessel disease. METHODS - : We performed a genome-wide association study to identify quantitative trait loci for WMH volume by combining data from 517 CADASIL patients collected through 7 centers across Europe. WMH volumes were centrally analyzed and quantified on fluid attenuated inversion recovery images. Genotyping was performed using the Affymetrix 6.0 platform. Individuals were assigned to 2 distinct genetic clusters (cluster 1 and cluster 2) based on their genetic background. RESULTS - : Four hundred sixty-six patients entered the final genome-wide association study analysis. The phenotypic variance of WMH burden in CADASIL explained by all single nucleotide polymorphisms in cluster 1 was 0.85 (SE=0.21), suggesting a substantial genetic contribution. Using cluster 1 as derivation and cluster 2 as a validation sample, a polygenic score was significantly associated with WMH burden (P=0.001) after correction for age, sex, and vascular risk factors. No single nucleotide polymorphism reached genome-wide significance. CONCLUSIONS - : We found a polygenic score to be associated with WMH volume in CADASIL subjects. Our findings suggest that multiple variants with small effects influence WMH burden in CADASIL. The identification of these variants and the biological pathways involved will provide insights into the pathophysiology of white matter disease in CADASIL and possibly small vessel disease in general. © 2014 American Heart Association, Inc.",adult;aged;article;brain size;CADASIL;Europe;female;gene linkage disequilibrium;genetic association;genetic risk;genetic variability;genotype;heritability;human;human tissue;major clinical study;male;middle aged;nuclear magnetic resonance imaging;priority journal;quantitative trait locus;single nucleotide polymorphism;white matter;white matter hyperintensity volume;young adult,"Opherk, C.;Gonik, M.;Duering, M.;Malik, R.;Jouvent, E.;Hervé, D.;Adib-Samii, P.;Bevan, S.;Pianese, L.;Silvestri, S.;Dotti, M. T.;De Stefano, N.;Liem, M.;Boon, E. M. J.;Pescini, F.;Pachai, C.;Bracoud, L.;Müller-Myhsok, B.;Meitinger, T.;Rost, N.;Pantoni, L.;Lesnik Oberstein, S.;Federico, A.;Ragno, M.;Markus, H. S.;Tournier-Lasserve, E.;Rosand, J.;Chabriat, H.;Dichgans, M.",2014,,,0,
3288,Heritability of MRI lesion volume in CADASIL: Evidence for genetic modifiers,"BACKGROUND AND PURPOSE - The phenotypic expressivity shows striking variability among individuals with CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), a small vessel disease caused by mutations in NOTCH3. However, little is known about the factors that underlie this variability. We sought to quantify the contribution of modifying genetic effects to individual differences in the volume of cerebral ischemic lesions. METHODS - One hundred and fifty-one affected individuals (mean age±SD=45.7±10.4) from 95 unrelated families with CADASIL underwent MRI. The volume of lesions visible on T2-weighted images and the intracranial volume (ICV) were quantified and vascular risk factors were assessed. Because of a skewed distribution, lesion volume measures were square-root transformed. Variance component methods were used to estimate the heritability of lesion volumes (ie, the proportion of variation caused by additive genetic factors) after adjusting for covariates. RESULTS - In multivariate analyses, higher age, a larger ICV, and a higher diastolic blood pressure were independently associated with a larger volume of T2-visible lesions (all P<0.05). After adjustment for age the point estimate for the heritability of the square-root-transformed measure of T2 lesion volume was 0.634 (SE=±0.286). Adjustment for age, sex, ICV, and diastolic blood pressure increased the estimated heritability to 0.738 (SE±0.255). CONCLUSIONS - Heritability estimates in CADASIL suggest a strong modifying influence of genetic factors distinct from the causative NOTCH3 mutation on the amount of ischemic brain lesions. These findings justify a systematic search for genetic variants that modify disease progression. © 2006 American Heart Association, Inc.",adult;age;devices;article;CADASIL;calculation;diastolic blood pressure;DNA modification;female;gene;gene mutation;genetic variability;heredity;heritability;human;human tissue;image analysis;major clinical study;male;multivariate analysis;notch3 gene;nuclear magnetic resonance imaging;phenotype;priority journal;quantitative analysis;variance;white matter;Magnetom Vision,"Opherk, C.;Peters, N.;Holtmannspötter, M.;Gschwendtner, A.;Müller-Myhsok, B.;Dichgans, M.",2006,,,0,
3289,Comorbidity and survival of Danish breast cancer patients from 2000-2011: A population-based cohort study,"Objective: Previous studies have suggested that breast cancer survival in Denmark has improved, primarily in cancer patients without comorbidity. We therefore conducted a population- based cohort study to examine recent temporal changes in survival and mortality among breast cancer patients with different extents of comorbidity. Methods: We used population-based medical and administrative registries to identify breast cancer patients diagnosed between 2000 and 2011 in the Central Denmark Region. We defined comorbid diseases according to the Charlson Comorbidity Index (CCI), including a history of hospitalization for comorbid disease up to 10 years before breast cancer diagnosis. We studied the impact of comorbidities on overall 1- and 5-year survival in different calendar time periods, using a hybrid analysis for survival prediction in the most recent calendar periods. Results: We included 9,329 breast cancer patients. The proportion of patients within different comorbidity categories remained stable from 2000 to 2011. One-year survival improved from 91% in 2000-2002 to 95% in 2009-2011, while 5-year survival improved from 72% to a predicted 78%. During the entire study period, comorbidity was a strong predictor of the survival of breast cancer patients. However, we observed improvements over time in 1- and 5-year survival for all comorbidity groups. During the 12-year study period, the estimated 5-year survival for patients with a high comorbidity disease burden (CCI score ≥3) increased from 25% to a predicted 50%, and their 5-year age-adjusted mortality hazard ratio (HR) fell from 4.0 (95% confidence interval [CI]: 3.0, 5.4) to 2.7 (95% CI: 2.0, 3.6), respectively, compared with patients with no comorbid disease. Conclusion: Survival of breast cancer patients diagnosed in the Central Denmark Region improved from 2000 to 2011, regardless of the extent of comorbid disease. © 2013 Ording et al, publisher and licensee Dove Medical Press Ltd.",acquired immune deficiency syndrome;adult;aged;article;breast cancer;cancer patient;cancer prognosis;cancer registry;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;dementia;Denmark;diabetes mellitus;female;heart infarction;hemiplegia;hospitalization;human;Human immunodeficiency virus infection;Kaplan Meier method;kidney disease;liver disease;major clinical study;mortality;overall survival;peripheral vascular disease;predictor variable;prevalence;proportional hazards model;ulcer,"Ording, A. G.;Cronin-Fenton, D. P.;Jacobsen, J. B.;Nørgaard, M.;Thomsen, R. W.;Christiansen, P.;Søgaard, M.",2013,,,0,
3290,Hospital Recorded Morbidity and Breast Cancer Incidence: A Nationwide Population-Based Case-Control Study,"Introduction: Chronic diseases and their complications may increase breast cancer risk through known or still unknown mechanisms, or by shared causes. The association between morbidities and breast cancer risk has not been studied in depth. Methods: Data on all Danish women aged 45 to 85 years, diagnosed with breast cancer between 1994 and 2008 and data on preceding morbidities were retrieved from nationwide medical registries. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression associating the Charlson comorbidity score (measured using both the original and an updated Charlson Comorbidity Index (CCI)) with incident breast cancer. Furthermore, we estimated associations between 202 morbidity categories and incident breast cancer, adjusting for multiple comparisons using empirical Bayes (EB) methods. Results: The study included 46,324 cases and 463,240 population controls. Increasing CCI score, up to a score of six, was associated with slightly increased breast cancer risk. Among the Charlson diseases, preceding moderate to severe renal disease (OR = 1.25, 95% CI: 1.06, 1.48), any tumor (OR = 1.17, 95% CI: 1.10, 1.25), moderate to severe liver disease (OR = 1.86, 95% CI: 1.32, 2.62), and metastatic solid tumors (OR = 1.49, 95% CI: 1.17, 1.89), were most strongly associated with subsequent breast cancer. Preceding myocardial infarction (OR = 0.89, 95% CI: 0.81, 0.99), connective tissue disease (OR = 0.87, 95% CI: 0.80, 0.94), and ulcer disease (OR = 0.91, 95% CI: 0.83, 0.99) were most strongly inversely associated with subsequent breast cancer. A history of breast disorders was associated with breast cancer after EB adjustment. Anemias were inversely associated with breast cancer, but the association was near null after EB adjustment. Conclusions: There was no substantial association between morbidity measured with the CCI and breast cancer risk. © 2012 Ording et al.",adult;aged;article;breast cancer;cancer incidence;cancer registry;cancer risk;cerebrovascular disease;chronic obstructive lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;disease association;disease severity;female;heart infarction;hemiplegia;human;insulin dependent diabetes mellitus;kidney disease;leukemia;liver disease;lymphoma;major clinical study;medical record;morbidity;non insulin dependent diabetes mellitus;peripheral vascular disease;population research;solid tumor;ulcer,"Ording, A. G.;Garne, J. P.;Nyström, P. M. W.;Cronin-Fenton, D.;Tarp, M.;Sørensen, H. T.;Lash, T. L.",2012,,,0,
3291,Comorbid Diseases Interact with Breast Cancer to Affect Mortality in the First Year after Diagnosis-A Danish Nationwide Matched Cohort Study,"Background:Survival of breast cancer patients with comorbidity, compared to those without comorbidity, has been well characterized. The interaction between comorbid diseases and breast cancer, however, has not been well-studied.Methods:From Danish nationwide medical registries, we identified all breast cancer patients between 45 and 85 years of age diagnosed from 1994 to 2008. Women without breast cancer were matched to the breast cancer patients on specific comorbid diseases included in the Charlson comorbidity Index (CCI). Interaction contrasts were calculated as a measure of synergistic effect on mortality between comorbidity and breast cancer.Results:The study included 47,904 breast cancer patients and 237,938 matched comparison women. In the first year, the strongest interaction between comorbidity and breast cancer was observed in breast cancer patients with a CCI score of ≥4, which accounted for 29 deaths per 1000 person-years. Among individual comorbidities, dementia interacted strongly with breast cancer and accounted for 148 deaths per 1000 person-years within one year of follow-up. There was little interaction between comorbidity and breast cancer during one to five years of follow-up.Conclusions:There was substantial interaction between comorbid diseases and breast cancer, affecting mortality. Successful treatment of the comorbid diseases or the breast cancer can delay mortality caused by this interaction in breast cancer patients. © 2013 Ording et al.",acquired immune deficiency syndrome;adult;aged;article;breast cancer;cancer mortality;cancer patient;cancer registry;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;controlled study;Danish;dementia;ethnic group;female;follow up;heart infarction;human;insulin dependent diabetes mellitus;leukemia;liver disease;lymphoma;major clinical study;metastasis;non insulin dependent diabetes mellitus;peripheral vascular disease;population research;prevalence;scoring system;ulcer,"Ording, A. G.;Garne, J. P.;Nyström, P. M. W.;Frøslev, T.;Sørensen, H. T.;Lash, T. L.",2013,,,0,
3292,Does comorbidity interact with prostate cancer to increase mortality? A Danish cohort study of 45 326 prostate cancer patients diagnosed during 1995–2011,"Abstract: Background: Many prostate cancer patients die of other causes, but it remains unknown whether comorbidity interacts synergistically with prostate cancer to increase the mortality rate beyond that explained by the individual risks of comorbidity and prostate cancer. Methods: A nationwide cohort study of 45 326 Danish prostate cancer patients diagnosed during 1995–2011, each matched to approximately five men from the general population on age and individual comorbidities in the Charlson Comorbidity Index (CCI). We calculated five-year mortality rates and interaction contrasts as a measure of the excess mortality rate explained by synergy between prostate cancer and comorbidity. Results: Five-year mortality was 46.8% in prostate cancer patients and 25.8% in matched men from the general population. For prostate cancer patients with a CCI score of 2–3, the mortality rate was 250 per 1000 person-years [95% confidence interval (CI): 236, 263], and interaction between comorbidity and prostate cancer accounted for 20% of the total mortality rate (50 deaths per 1000 person-years, 95% CI 35, 65) in the first year following cancer diagnosis. The interaction was mainly present for patients with metastatic disease and those not treated with prostatectomy. Conclusion: Up to 20% of all deaths among men who had both prostate cancer and comorbidities could be explained by the comorbidity-prostate cancer interaction. The mortality attributable to comorbidity itself and the mortality attributable to the interaction may be reduced by successful treatment of the comorbidity.",acquired immune deficiency syndrome;aged;androgen deprivation therapy;article;cancer incidence;cancer mortality;cancer patient;cancer staging;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;controlled study;Dane (people);dementia;Denmark;diabetes mellitus;follow up;Gleason score;heart infarction;hemiplegia;high risk population;human;kidney disease;leukemia;liver disease;low risk population;lymphoma;major clinical study;male;metastasis;mortality rate;orchiectomy;peripheral vascular disease;priority journal;prostate cancer;prostatectomy;solid tumor;ulcer;very elderly,"Ording, A. G.;Horváth-Puhó, E.;Lash, T. L.;Ehrenstein, V.;Borre, M.;Vyberg, M.;Sørensen, H. T.",2016,,,0,
3293,New medicinal action of native hormone,"Estrogen is involved in the growth and development of female organs such as uterus and mammary gland. On the other hand, from clinical point of view, it is recently suggested that estrogen is effective to protect postmenopausal women from osteoporosis, coronary heart disease and Alzheimer disease. In order to study the molecular mechanism of estrogen action, we have identified an estrogen responsive gene, efp (estrogen-responsive finger protein), which might mediate estrogen action in various target organs at diverse stages and targeted mutagenesis of efp gene could help clarify physiologic actions of estrogen.",estrogen;estrogen receptor;estrogen responsive finger protein;unclassified drug;zinc finger protein;Alzheimer disease;article;histochemistry;immunoblotting;in situ hybridization;ischemic heart disease;menstrual cycle;mutagenesis;osteoporosis;protein analysis,"Orimo, A.;Inoue, S.;Minowa, O.;Ikeda, K.;Hiroi, H.;Ogawa, S.;Watanabe, T.;Kuno, J.;Noda, T.;Muramatsu, M.",1997,,,0,
3294,The prevalence of chronic diseases and multimorbidity in primary care practice: A PPRNet report,"Introduction: Multimorbidity (multiple chronic illnesses) greatly affects the delivery of health care and assessment of health care quality. There is a lack of basic epidemiologic data on multimorbidity in the United States. This article addresses the prevalence of 24 chronic illnesses and multimorbidity from primary care practices across the United States. Methods: This cross-sectional study was conducted in the PPRNet, a practice-based research network among 226 practices in 43 states that maintains a clinical database derived from a common electronic health record. Practices providing data as of October 1, 2011, and their active adult patients comprised the population used for analyses. The prevalence of each chronic illness and multimorbidity were calculated. Results: Included in these analyses were 148 practices with 667,379 active patients. Median prevalence across practices ranged from 35.8% for hypertension to 0.23% for Parkinson disease, with wide variability among practices for all conditions. Multimorbidity increased steeply with age, leveling off at age 80; overall, 45.2% of patients had more than one chronic illness. Conclusion: Multimorbidity is a prevalent problem in primary care practice, a finding with implications for health care delivery and payment, quality assessment, and research.",adult;aged;alcohol use disorder;article;asthma;atherosclerosis;cerebrovascular disease;chronic disease;chronic kidney disease;chronic liver disease;chronic obstructive lung disease;clinical practice;comorbidity;coronary artery disease;cross-sectional study;data base;dementia;depression;diabetes mellitus;electronic medical record;epilepsy;female;gastroesophageal reflux;health care delivery;atrial fibrillation;heart failure;human;hyperlipidemia;hypertension;major clinical study;male;migraine;obesity;osteoarthritis;osteopenia;osteoporosis;Parkinson disease;peptic ulcer;prevalence;primary medical care;quality control;rheumatoid arthritis;United States,"Ornstein, S. M.;Nietert, P. J.;Jenkins, R. G.;Litvin, C. B.",2013,,,0,
3295,The Cardiovascular Continuum extended: Aging effects on the aorta and microvasculature,"The 'Cardiovascular Continuum' was described by Dzau and colleagues in 2006 to explain the development over many years of coronary disease with its complications, then end-stage heart failure. The Continuum identified different points along the way where the process could be interrupted by drug therapies or interventions, then described the trials that have been undertaken over the last three decades to establish their value. The approach summarized the major steps in cardiology through modern times, but it had an emphasis on coronary atherosclerosis in prosperous nations, and did not account fully for the problems of aging, which occur in all societies. Aging of the aorta and elastic arteries causes arterial stiffening and leads to development of cardiac failure and microvascular disease in highly perfused organs such as the brain and kidneys. The 'Vascular Aging Continuum' which we introduce, dovetails with the late phases of the Cardiovascular Continuum and provides a more comprehensive explanation, especially for vascular diseases in nations with little atherosclerosis. It will become more common in the Western World where attention to risk factors and widespread use of statins are responsible for a decrease in atherosclerotic disease, prolongation of life, and dominance of macrovascular and microvascular arterial disease, as well as of cardiac failure. © 2010 The Author(s).",aging;article;atherosclerosis;blood pressure;coronary artery blood flow;coronary artery obstruction;heart failure;heart muscle ischemia;human;kidney failure;microvasculature;priority journal;pulse wave,"O'Rourke, M. F.;Safar, M. E.;Dzau, V.",2010,,,0,
3296,"Hormone therapy in perimenopause and postmenopause (HT): Interdisciplinary S3 guideline, Association of the Scientific Medical Societies in Germany AWMF 015/062-short version","This short version of the interdisciplinary S3 guideline on hormone therapy in peri- and postmenopause (HT) is intended as a decision-making instrument for physicians and women considering HT. It is designed to assist daily practice. This short version summarises the long version that contains detailed information about the development of the guideline, particularly about establishing the evidence levels. The statements and recommendations, quoted completely, are marked with the relevant levels of evidence (LoE) and grades of recommendation. The classification system from the Centre for Evidence-based Medicine in Oxford was used in this guideline (see ""Attachment""). © The Author(s) 2011.",chlormadinone acetate;Cimicifuga racemosa extract;conjugated estrogen;conjugated estrogen plus medroxyprogesterone acetate;cyproterone acetate;dienogest;drospirenone;estradiol;estrogen;gestagen;isoflavone;placebo;tibolone;alternative medicine;Alzheimer disease;article;bile duct disease;bone metabolism;breast cancer;cancer combination chemotherapy;cancer hormone therapy;cancer prevention;cancer risk;cerebrovascular disease;clinical effectiveness;cognitive defect;colorectal cancer;dementia;dose response;drug efficacy;early menopause;endometrium cancer;evidence based medicine;fragility fracture;gallbladder disease;Germany;hormonal therapy;hot flush;human;ischemic heart disease;low drug dose;medical decision making;menopausal syndrome;mild cognitive impairment;osteoporosis;ovary cancer;practice guideline;recurrent infection;risk assessment;skin disease;thromboembolism;urinary tract infection;urine incontinence;vagina atrophy,"Ortmann, O.;Dören, M.;Windler, E.",2011,,,0,
3297,Critical illness and long-term cognitive impairment,"EVALUATION OF: Pandharipande PP, Girard TD, Jackson JC et al. Long-term cognitive impairment after critical illness. N. Engl. J. Med. 369(14), 1306-1316 (2013). This study reports the association between long-term cognitive impairment and survivors of critical illness in adult intensive care patients. As part of the BRAIN-ICU study, 821 patients with respiratory failure or shock were enrolled from the medical and surgical intensive care units. Their global cognition and executive function were assessed at 3 and 12 months following discharge using the Repeatable Battery for the Assessment of Neuropsychological status and the Trail Making Test, Part B. A significant number of both older and younger patients were found to have cognitive deficits below the population mean at 3 months (40%), and in 24% of them it persisted at 12 months. This association was stronger in patients with longer duration of delirium, which was independently associated with worse outcomes, for both global cognition and executive functioning. This study provides further evidence that patients with delirium are at a higher risk of developing long-term cognitive impairment and dementia, and their worse cognitive functioning is related to the length of their delirium episode. © 2014 Future Medicine Ltd.",analgesic agent;benzodiazepine derivative;neuroleptic agent;sedative agent;Alzheimer disease;APACHE;article;cardiogenic shock;cognitive defect;critical illness;critically ill patient;delirium;dementia;executive function;human;hypoxemia;intensive care;mild cognitive impairment;neuropsychological test;priority journal;prognosis;psychologic test;Repeatable Battery for the Assessment of Neuropsychological Status;respiratory failure;Richmond Agitation Sedation Scale;septic shock;traumatic brain injury,"Oruganti, P.;Mukaetova-Ladinska, E. B.",2014,,,0,
3298,A case of asystole from periorbital laceration manipulation and oculocardiac reflex in an acute trauma setting,,adrenalin;atropine;blood clotting factor 7;fresh frozen plasma;hydrogen peroxide;hypertensive factor;microcrystalline collagen;povidone iodine;sodium chloride;abnormal respiratory sound;aged;arterial gas;article;artificial ventilation;heart arrest;bleeding;blood clotting disorder;case report;compression;computer assisted tomography;crystalloid;debridement;defibrillation;echography;emergency care;erythrocyte concentrate;erythrocyte transfusion;face injury;female;Glasgow coma scale;heart ventricle fibrillation;heart ventricle tachycardia;hemodynamics;human;hypertension;hypotension;intensive care;international normalized ratio;intubation;kidney injury;laceration;laparotomy;life sustaining treatment;mental deterioration;nephrectomy;nose fracture;oculocardiac reflex;orbit fracture;priority journal;resuscitation;retroperitoneal hematoma;scalp;sinus rhythm;skin flap;splenectomy;subarachnoid hemorrhage;systolic blood pressure;traffic accident;treatment failure;treatment response;tube;avitene,"Osborn, T. M.;Ueeck, B. A.;Ham, L. B.;Assael, L. A.",2008,,,0,
3299,Long-term outcomes of cervical laminoplasty in the elderly,"Incidences of cervical laminoplasty in the elderly are increasing; the influence of other age-related complications and neurological status must be considered for justifying surgery. This study identified the aforementioned influence on long-term outcomes of cervical laminoplasty in patients aged ≥75 years. Thirty-seven of 38 consecutive patients aged ≥75 years who underwent cervical laminoplasty were retrospectively evaluated. Minimum 5-year follow-up was acceptable if patients were complication-free. Follow-up was terminated when neurological evaluation was not possible, owing to death or other serious complications affecting activities of daily living (ADL). Postoperative neurological changes and newly developed severe complications were investigated. Postoperatively, one patient died of acute pneumonia, one remained nonambulatory owing to cerebral infarction, and 35 were ambulatory and were discharged. At a mean follow-up of 78 months, three patients died and nine developed serious complications severely affecting ADL. Of the 25 remaining patients, 23 remained ambulatory at mean follow-up of 105 months. Cox proportional hazard analysis revealed that postoperative motor upper and lower extremities JOA scores of ≤2 and ≤1, respectively, were risk factors for mortality or other severe complications. Postoperative neurological status can be maintained in the elderly if they remain complication-free. Poorer neurological status significantly affected their ADL and mortality.",acute heart failure;aged;article;brain infarction;cause of death;cervical laminoplasty;clinical article;Cobb angle;daily life activity;delirium;dementia;depression;female;follow up;geriatric patient;geriatric surgery;hospital discharge;human;hypertension;Japanese Orthopaedic Association score;laminoplasty;lobar pneumonia;long term care;male;motor activity;neurologic examination;outcome assessment;paralysis;parkinsonism;patient mobility;peroperative complication;postoperative complication;postoperative period;range of motion;risk factor;schizophrenia;spine surgery;subarachnoid hemorrhage;surgical infection;surgical mortality;transient ischemic attack;urinary tract infection,"Oshima, Y.;Miyoshi, K.;Mikami, Y.;Nakamoto, H.;Tanaka, S.",2015,,,0,
3300,Probing the safety of medications in the frail elderly: Evidence from a randomized clinical trial of sertraline and venlafaxine in depressed nursing home residents,"Background: In nursing home residents and other frail elderly patients, old age and potential drug-drug and drug-disease interactions may affect the relative safety and efficacy of medications. The purpose of this study was to examine the efficacy and tolerability of venlafaxine and sertraline for the treatment of depression among nursing home residents. Method: The study was a 10-week randomized, double-blind, controlled trial of venlafaxine (doses up to 150 mg/day) versus sertraline (doses up to 100 mg/day) among 52 elderly nursing home residents with a DSM-IV depressive disorder and, at most, moderate dementia. The primary measure of outcome was the Hamilton Rating Scale for Depression (HAM-D). Adverse events were monitored and recorded systematically during the trial. Results: Twelve subjects were discontinued due to serious adverse events (SAE), 5 were discontinued due to other significant side effects, and 2 withdrew consent. Tolerability estimated by the time to termination was lower for venlafaxine than sertraline for serious adverse events (log rank statistic = 5.28, p = .022), for serious adverse events or side effects (log rank statistic = 8.08, p = .005), or for serious adverse events, side effects, or withdrawal of consent (log rank statistic = 10.04, p = .002). Mean (SD) HAM-D scores at baseline were 20.2 (3.4) for sertraline and 20.3 (3.7) for venlafaxine; intent-to-treat endpoint HAM-D scores were 12.2 (5.1) and 15.7 (6.2) (F = 3.45; p =.069). There were no differences in categorical responses for the intent-to-treat sample or completers. Conclusion: In this frail elderly population, venlafaxine was less well tolerated and, possibly, less safe than sertraline without evidence for an increase in efficacy, This unexpected finding demonstrates the need for systematic research on the safety of drugs in the frail elderly.",antidepressant agent;sertraline;venlafaxine;adult;age;aged;agitation;anemia;anxiety;article;bradycardia;cerebrovascular accident;clinical trial;congestive heart failure;controlled clinical trial;controlled study;delirium;dementia;depression;disease exacerbation;disease severity;double blind procedure;drug efficacy;drug safety;drug tolerability;ECG abnormality;falling;fatigue;female;fracture;Hamilton Depression Rating Scale;atrial fibrillation;human;hypertension;hyponatremia;informed consent;interstitial lung disease;irritability;kidney dysfunction;knee fracture;major clinical study;male;nausea;nursing home;outcomes research;pneumonia;priority journal;psychosis;randomized controlled trial;sepsis;side effect;T wave inversion;thorax pain;thrombocytopenia;United States;urinary tract infection;urosepsis,"Oslin, D. W.;Ten Have, T. R.;Streim, J. E.;Datto, C. J.;Weintraub, D.;DiFilippo, S.;Katz, I. R.",2003,,,0,
3301,Anticholinesterase-induced symptoms improved by pacemaker implantation in patients with Alzheimer's disease: Analysis of 6 cases,"Herein we describe 6 cases of patients with Alzheimer's disease presented with syncope, dizziness, and dyspnea soon after the initiation of cholinesterase inhibitor therapy. All patients had bradyarrhythmia on electrocardiogram (ECG). Two patients had complete atrioventricular block, 2 pateints had 2/1 type atrioventricular block, 1 patient had sinus bradycardia and hypersensitive carotid sinus syndrome, and 1 had sick sinus syndrome. All these patients were treated with pacemaker implantation and the cholinesterase inhibitor therapy continued. At 13-month follow-up, no syncope, dizziness, or dyspnea was reported. © The Author(s) 2012.",acetylsalicylic acid;atenolol;atropine;cholinesterase inhibitor;donepezil;galantamine;isosorbide mononitrate;memantine;metformin;metoprolol;nifedipine;perindopril;ramipril;rivastigmine;trandolapril;trimetazidine;aged;Alzheimer disease;article;atrioventricular block;bradycardia;carotid sinus massage;carotid sinus syndrome;chronic kidney failure;clinical article;complete heart block;diabetes mellitus;dizziness;drug dose increase;dyspnea;echocardiography;electrocardiogram;female;human;hypertension;implantation;ischemic heart disease;male;Mini Mental State Examination;pacemaker;sick sinus syndrome;sinus bradycardia;faintness;treatment outcome,"Osmonov, D.;Özcan, K. S.;Erdinler, I.;Altay, S.;Turkkan, C.;Yildirim, E.;Gurkan, K.",2012,,,0,
3302,Cardiac involvement in juvenile neuronal ceroid lipofuscinosis (Batten disease),"Objective: To explore the onset and progression of cardiac involvement in juvenile neuronal ceroid lipofuscinosis (JNCL). Methods: The study population comprised an unselected group of 29 children and adolescents with genetically verified JNCL. We focused on T-wave abnormalities on an EKG, cardiac hypertrophy, and left ventricular systolic function on echocardiography, and heart rates and heart rate variability (HRV) on 24-hour EKG recordings. The surviving patients were observed for 71/2 years. The 24-hour EKG recording was repeated after 3 years. Results: Abnormally deeply inverted T waves were present in one-third of the initial EKG recordings and were reported as early as 14 years of age. We found coherence between the presence of repolarization disturbances of the ventricular myocardium at the initial recordings and risk of death during the observation period. At increasing age, heart rate and HRV, expressed as the vagal index (number of adjacent RR intervals deviating more than 6%), were significantly reduced, suggesting an age-dependent bidirectional effect of JNCL on heart rate: one through decreasing parasympathetic activity on the heart and the other through a direct negative influence on sinus node automaticity. Coherence between bradycardia and arrhythmia and occurrence of sinus arrests and atrial flutter with increasing age indicated an age-dependent decrease in sinus node activity also. In the early 20s, a high frequency of ventricular hypertrophy occurred. Conclusions: Progressive cardiac involvement with repolarization disturbances, ventricular hypertrophy, and sinus node dysfunction occur in JNCL. We recommend that the attention on heart involvement in JNCL and other neuronal ceroid lipofuscinosis subtypes should be intensified. © 2011 by AAN Enterprises, Inc. All rights reserved.",anticonvulsive agent;baclofen;chlorprothixene;clobazam;creatine kinase MB;etiracetam;gabapentin;lamotrigine;nitrazepam;oxcarbazepine;phenobarbital;quetiapine;topiramate;troponin T;valproic acid;verapamil;adolescent;anticonvulsant therapy;article;atrioventricular block;bradycardia;child;clinical article;disease course;echocardiography;electrocardiogram;female;heart arrhythmia;heart atrium flutter;heart disease;heart left ventricle contraction;heart rate;heart rate variability;heart ventricle hypertrophy;human;male;monotherapy;neuronal ceroid lipofuscinosis;parasympathetic tone;priority journal;school child;seizure;sinus arrest;sinus node;T wave,"Østergaard, J. R.;Rasmussen, T. B.;Mølgaard, H.",2011,,,0,
3303,Non-cancer patients in specialized palliative care in Germany: What are the problems?,"To determine the role of non-cancer palliative care in inpatient services in Germany, data from the Hospice and Palliative Care Evaluation (HOPE) were analysed. Since 1999, a three-month census has been conducted annually in German palliative care units. Pooled data from 2002-2005 were tested for differences between non-cancer patients (NCs) and cancer patients (Cs). A total of 4182 patients (NC: 3.5%; C: 96.5%) were documented; functional status (using Eastern Cooperative Oncology Group (ECOG) measures) in NCs was lower compared to Cs (p=0.009). NCs suffered more often from dyspnoea (40%; C: 29%; p=0.004), weakness (92,3%; C: 84,5%; p=0.011) and tiredness (75.4%; C: 66.7%; p=0.03) and less from nausea (17.1%; C: 28.9%; p=0.002), vomiting (8.2%; C: 19.4%; p=0.001) or loss of appetite (55.5%; C: 67.9%; p=0.002). There were no differences in pain and constipation. Other problems (nursing, psychological) were more frequent for NCs, in particular the need for support in the activities of daily life (90.3%; C: 72.8%; p<0.001) and disorientation/confusion (32.1%; C: 17.2%; p<0.001). There were no differences in social problems. NCs are still rare in specialized inpatient palliative care institutions in Germany. The palliative care needs in patients with nonmalignant disease will challenge the health care system as the workload for these services will grow over proportionally. © The Author(s) 2010.",adult;aged;appetite disorder;artery occlusion;article;cancer patient;cerebrovascular accident;chronic obstructive lung disease;confusion;constipation;daily life activity;dementia;depression;digestive system disease;disorientation;dyspnea;fatigue;female;Germany;heart failure;heart infarction;human;kidney failure;liver disease;major clinical study;male;motor neuron disease;multiple sclerosis;nausea;osteoporosis;pain;palliative therapy;pneumonia;social support;spine disease;vomiting;weakness,"Ostgathe, C.;Alt-Epping, B.;Golla, H.;Gaertner, J.;Lindena, G.;Radbruch, L.;Voltz, R.",2011,,,0,
3304,Psychotic symptoms in the elderly,"Psychotic symptoms may be underrated in traditional epidemiological studies. We assessed psychotic symptoms, physical disorders, disability in daily life and sensory impairments with psychiatric and physical examinations, key informant interviews and medical record reviews in non-demented 85-year-olds living in Gothenburg, Sweden (n=347). The sample was followed for three years regarding mortality and incident dementia. Results: The prevalence of psychotic symptoms was 10.1% and the prevalence of paranoid ideation was 6.9%. Hallucinations were associated with depression, disability in daily life and visual deficits. Delusions were associated with disability in daily life. Paranoid ideation was associated with visual deficits and myocardial infarction. Hallucinations, delusions, and paranoid ideation were each related to increased incidence of dementia. Hallucinations and paranoid ideation were associated with increased 3-year mortality in women but not in men. Conclusions: Psychotic symptoms and paranoid ideation are common in the very old and associated with a poor prognosis.",article;daily life activity;dementia;depression;disability;disease association;elderly care;female;hallucination;heart infarction;human;interview;major clinical study;male;medical record;mortality;paranoia;physical disease;physical examination;prevalence;psychosis;sensory dysfunction;Sweden;visual field defect,"Östling, S.",2003,,,0,
3305,Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old,"BACKGROUND: Psychotic symptoms are reported to be uncommon in the elderly, and may be underrated in traditional epidemiological studies. METHODS: Psychotic symptoms, physical disorders, disability in daily life, and sensory impairments were assessed using results of psychiatric and physical examinations, key-informant interviews, and medical record reviews in a representative sample of nondemented individuals aged 85 years living in the community or in institutions in Goteborg, Sweden (n = 347). The sample was observed for 3 years regarding psychotic symptoms, mortality, and incident dementia. RESULTS: The prevalence of any psychotic symptom was 10.1% (95% confidence interval [CI], 7.1%-13.7%); hallucinations, 6.9% (95% CI, 4.5%-10.1%); and delusions, 5.5% (95% CI, 3.3%-8.4%). The prevalence of paranoid ideation was 6.9% (95% CI, 4.5%-10.1%). Stepwise logistic regression analyses showed that hallucinations were associated with major depressive syndrome (odds ratio [OR], 3.9; 95% CI, 1.3-11.9), disability in daily life (OR, 5.2; 95% CI, 1.8-14.9), and visual deficits (OR, 3.4; 95% CI, 1.0-11.1). Delusions were associated with disability in daily life (OR, 4.9; 95% CI, 1.8-13.3). Paranoid ideation was associated with visual deficits (OR, 3.6; 95% CI, 1.2-10.5) and myocardial infarction (OR, 4.6; 95% CI, 1.7-12.6). Hallucinations (OR, 3.1; 95% CI, 1.4-6.8), delusions (OR, 2.9; 95% CI, 1.2-6.9), and paranoid ideation (OR, 2.7; 95% CI, 1.2-6.2) were each related to increased incidence of dementia from 85 to 88 years of age. Hallucinations and paranoid ideation were associated with increased 3-year mortality in women but not in men. CONCLUSIONS: We found a higher prevalence of psychotic symptoms and paranoid ideation in the elderly than previously reported, and these symptoms were associated with a poor prognosis.","Aged;Aged, 80 and over;Cross-Sectional Studies;Dementia/diagnosis/epidemiology/psychology;Depressive Disorder, Major/diagnosis/epidemiology/psychology;Female;Frail Elderly/*psychology/statistics & numerical data;Geriatric Assessment/*statistics & numerical data;Humans;Incidence;Male;Paranoid Disorders/diagnosis/*epidemiology/psychology;Psychotic Disorders/diagnosis/*epidemiology/psychology;Sampling Studies;Survival Analysis;Sweden","Ostling, S.;Skoog, I.",2002,Jan,,0,
3306,Is this the worst outcome of metabolic syndrome? Hypophosphatemia and resulting cardiac arrest during the treatment of diabetic ketoacidosis with hypertriglyceridemia,"We report a case of diabetic ketoacidosis (DKA) and severe hypertriglyceridemia who developed cardiac arrest due to hypophosphatemia. He was diagnosed with diabetes and hyperlipidemia, indicating metabolic syndrome. Hypophosphatemia was caused by large insulin doses received while treating DKA, which were required because of insulin resistance owing to hypertriglyceridemia. Metabolic syndrome may have accelerated serum phosphate depletion. We suggest frequent monitoring of serum phosphate and phosphate replacement for patients with DKA and severe hypertriglyceridemia. Although such a critical condition has not been reported, it may occur during treatment of patients with poorly controlled type 2 diabetes with DKA. © 2009 The Japanese Society of Internal Medicine.",creatine kinase;glutamate decarboxylase antibody;insulin;pancreas islet cell antibody;phosphate;abdominal circumference;adult;alcohol consumption;anamnesis;anthropometric parameters;anuria;article;body height;body mass;body weight;bradycardia;case report;computer assisted tomography;creatine kinase blood level;decompression surgery;diabetes mellitus;diabetic ketoacidosis;diet;disease duration;fatty liver;fluid therapy;glucose blood level;heart arrest;hemodialysis;human;hyperglycemia;hyperlipidemia;hypertriglyceridemia;hypophosphatemia;insulin resistance;insulin treatment;ketonuria;liver dysfunction;male;mental deterioration;metabolic acidosis;metabolic syndrome X;neuroimaging;non insulin dependent diabetes mellitus;outcome assessment;pancreatitis;plasmapheresis;substitution therapy,"Osuka, A.;Matsuoka, T.;Idoguchi, K.",2009,,,0,
3307,Analysis of dietary factors in Alzheimer's disease: clinical use of nutritional intervention for prevention and treatment of dementia,"To determine dietary factors involved in the pathological process of Alzheimer's disease (AD), we analyzed food consumption and intake of nutrients using Self-administered Diet History Questionnaire (DHQ) developed for Japanese. Sixty four AD patients and 80 age-matched healthy subjects were enrolled in this study. AD was diagnosed according to the criteria of DSM-IV. Dietary behaviors of AD patients was markedly deviated from those of age-matched healthy elderly. AD patients disliked fish and green-yellow vegetables and took more meats than controls. Energy-adjusted analysis of nutrients revealed that AD patients took less vitamin C and carotene. Most conspicuously, AD patients took significantly smaller amount of n-3 polyunsaturated fatty acid (PUFA) reflecting low consumption of fish, and their n-6/n-3 ratio was significantly increased. These habits started from 3 months to 44 years before the onset of dementia, suggesting these dietary abnormalities are not merely the consequence of dementia. Rather, it implies that AD might be a life style-related disease such as coronary heart disease, western style diet-associated cancer and hyperallergy. To see if cognitive function was improved by correcting the n-6/n-3 ratio, we prescribed eicossapentaenoic acid (EPA), one type of n-3 PUFA, for AD patients. Cognitive function was evaluated using MMSE. Administration of EPA (900 mg/day) improved MMSE significantly with maximal effects at 3 months and the effects lasted 6 months. However, the score of MMSE decreased after 6 months. The present study showed that nutritional intervention is useful for the prevention of AD, and also for the therapy of dementia, though it has some limitation.","Aged;Aged, 80 and over;Alzheimer Disease/diet therapy/*prevention & control/*therapy;*Diet;Eating;Female;Food Habits;Humans;Male;*Nutritional Physiological Phenomena","Otsuka, M.",2000,Dec,,0,
3308,Effect of smoking on global cognitive function in nondemented elderly,"BACKGROUND: Contrary to early case-control studies that suggested smoking protects against Alzheimer disease (AD), recent prospective studies have shown that elderly who smoke may be at increased risk for dementia. OBJECTIVE: To examine prospectively the effect of smoking on cognition in nondemented elderly. METHOD: In a multicenter cohort, the European Community Concerted Action Epidemiology of Dementia (EURODEM), including the Odense, Personnes Agees Quid (Paquid), Rotterdam, and Medical Research Council: Ageing in Liverpool Project-Health Aspects (MRC ALPHA) Studies, 17,610 persons aged 65 and over were screened and examined for dementia. After an average 2.3 years of follow-up, 11,003 nondemented participants were retested. Excluding incident dementia cases and those without baseline information on smoking gave an analytical sample of 9,209 persons. Average yearly decline in Mini-Mental State Examination (MMSE) score was compared among groups, adjusting for age, sex, baseline MMSE, education, type of residence, and history of myocardial infarction or stroke. RESULTS: MMSE score of persons who never smoked on average declined 0.03 point/year. The adjusted decline of former smokers was 0.03 point greater and of current smokers 0.13 point greater than never smokers (p < 0.001). Higher rates of decline by smoking were found in men and women, persons with and without family history of dementia, and in three of four participating studies. Higher cigarette pack-year exposure was correlated with a significantly higher rate of decline. CONCLUSION: Smoking may accelerate cognitive decline in nondemented elderly.","Age Distribution;Aged;Aged, 80 and over;Cognition Disorders/*diagnosis/*epidemiology;Cohort Studies;Comorbidity;Dementia/*diagnosis/*epidemiology;Denmark/epidemiology;Disease Progression;Female;Follow-Up Studies;France/epidemiology;Great Britain/epidemiology;Humans;Male;Netherlands/epidemiology;Neuropsychological Tests/statistics & numerical data;Sex Distribution;Smoking/*epidemiology","Ott, A.;Andersen, K.;Dewey, M. E.;Letenneur, L.;Brayne, C.;Copeland, J. R.;Dartigues, J. F.;Kragh-Sorensen, P.;Lobo, A.;Martinez-Lage, J. M.;Stijnen, T.;Hofman, A.;Launer, L. J.",2004,Mar 23,,0,
3309,Atrial fibrillation and dementia in a population-based study. The Rotterdam Study,"BACKGROUND AND PURPOSE: Atrial fibrillation is a frequent disorder in the elderly and a known risk factor for cerebrovascular stroke. We investigated the association of atrial fibrillation with dementia and cognitive impairment in a large cross-sectional, population-based study in the elderly. METHODS: Of the 6584 participants in the Rotterdam Study aged 55 to 106 years, detailed information on dementia status and ECG abnormalities was available. Dementia was diagnosed in three phases. First, participants were screened. Screen-positive subjects were tested further. Those with possible dementia underwent an extensive diagnostic workup. Dementia and dementia subtypes were diagnosed according to prevailing criteria. Cognitive impairment was defined as a Mini-Mental State Examination test score of < 26 points for a nondemented subject. RESULTS: Atrial fibrillation was diagnosed in 195, dementia in 276, and cognitive impairment in 635 subjects. We found significant positive associations of atrial fibrillation with both dementia and impaired cognitive function (age- and sex-adjusted odds ratios, 2.3 [95% confidence interval, 1.4 to 3.7] and 1.7 [95% confidence interval, 1.2 to 2.5]), respectively). The strongest association was found not for vascular dementia but rather for Alzheimer's disease with cerebrovascular disease. The associations were stronger in women, and the relation with dementia was more pronounced in the relatively younger elderly. A history of stroke in subjects with atrial fibrillation could not account for these associations. CONCLUSIONS: Dementia and subtypes Alzheimer's disease and vascular dementia may be related to atrial fibrillation even if no clinical stokes have occurred.","Age Factors;Aged;Aged, 80 and over;Anti-Arrhythmia Agents;Atrial Fibrillation/drug therapy/*epidemiology;Cardiac Output, Low;Cardiovascular Agents/therapeutic use;Cerebrovascular Circulation;Cognition Disorders/epidemiology;Comorbidity;Cross-Sectional Studies;Dementia/*epidemiology;Dementia, Vascular/epidemiology;Electrocardiography;Female;Humans;Male;Middle Aged;Netherlands/epidemiology;Prevalence;Risk Factors","Ott, A.;Breteler, M. M.;de Bruyne, M. C.;van Harskamp, F.;Grobbee, D. E.;Hofman, A.",1997,Feb,,0,
3310,"Open label, multicenter, 28-week extension study of the safety and tolerability of memantine in patients with mild to moderate Alzheimer's disease","Background: Memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to be safe and to have beneficial effects on cognition, function, behavior, and global patient status in patients with Alzheimer's disease (AD) in studies lasting 3-6 months. It is approved in the U.S. and Europe for the treatment of moderate to severe AD and is currently under investigation for mild to moderate AD. Objective: To evaluate the long-term safety of memantine in patients with mild to moderate AD and to investigate the tolerability of once-daily dose administration. Methods: This 28-week study enrolled 314 patients with mild to moderate AD who had completed a 24-week, double-blind, placebo-controlled lead-in clinical trial of memantine in AD. Following an 8-week double-blind dose titration phase (used to assess the tolerability of different dosing regimens), subjects were assigned to continuous open label memantine (10 mg, bi.d.) treatment for 20 weeks. Safety outcome measures included treatment-emergent adverse events (AEs), deaths, vital signs, electrocardiograms, and laboratory parameters. Results: During the 28-week study (Phase A + Phase B), the most common AEs were falls and other injuries (both 10.8%). AEs resulted in treatment discontinuation in 6.7% of patients. Discontinuations due to AEs were similar in the once-daily dosing groups compared to the twice-daily dosing groups. During dose titration, completion rates were greater than 90% for both groups. Conversion to once-daily dosing in patients already receiving twice-daily doses of memantine was also well tolerated. Conclusions: Memantine monotherapy in patients with mild to moderate AD is safe and well tolerated for at least one year. Once-daily dosing during titration and short-term maintenance therapy is safe and well tolerated. © 2007 Steinkopff Verlag.",memantine;placebo;adult;aged;agitation;Alzheimer disease;article;clinical trial;confusion;controlled clinical trial;controlled study;depression;diarrhea;dizziness;double blind procedure;drug dose regimen;drug dose titration;drug induced headache;drug safety;drug tolerability;drug withdrawal;electrocardiogram;falling;fatality;female;flu like syndrome;heart infarction;human;hypertension;inflicted injury;major clinical study;male;multicenter study;outcome assessment;peripheral edema;priority journal;randomized controlled trial;side effect;somnolence;thorax pain;treatment outcome;upper respiratory tract infection;urinary tract infection,"Ott, B. R.;Blake, L. M.;Kagan, E.;Resnick, M.",2007,,,0,
3311,Clinical and haemodynamic findings in multiple cerebral infarction,"A total of 56 patients who had been admitted for an acute or chronic cerebrovascular insufficiency (CVI) were examined; the average age was 61 years. Computer tomography showed multiple cerebral infarction (MCI) in all patients. Fifty percent of the patients had one or several previous cerebrovascular episodes, 73% had focal neurological disorders at the time of admission, particularly in the carotid area. Nineteen patients (34%) showed notable psychiatric features in the sense of a multiple infarction dementia (MID). The most important risk factors were: arterial hypertension, diabetes mellitus, coronary heart-disease, hypertriglyceridemia; almost half the patients had a hyperviscosity syndrome. Depending on the severity of the MCI, hemispheric blood-flow was reduced; there was a significant correlation with the degree to which intellectual performance had been impaired. In 72% of the patients there was good agreement between focal rCBF changes and computer-tomography findings. It was decided that the MCI should be viewed as a special form of CVI; its diagnosis requires the combination of all findings together with anamnestic data.",radioisotope;xenon 133;attention;central nervous system;cerebrovascular accident;computer analysis;computer assisted tomography;dementia;diagnosis;etiology;major clinical study;memory;multiple infarction;peripheral vascular system,"Ott, E.;Bertha, G.;Marguc, K.",1982,,,0,
3312,Intensive statin regimens for reducing risk of cardiovascular diseases among human immunodeficiency virus-infected population: A nation-wide longitudinal cohort study 2000-2011,"OBJECTIVE: This study evaluated the risk of cardiovascular diseases (CVD) in a statin-treated HIV-infected population and the effects of intensive statin regimens (i.e., high-dose or potency) on CVD risks. METHODS: 945 HIV-infected patients newly on statin treatment (144, 15.7% with CVD history) were identified from Taiwan's national HIV cohort. Using the median of the first year cumulative statin dosage as a cut-off point, patients were classified into either a high-dose or low-dose group. Patients were also classified as high-potency (i.e., atorvastatin) or low-potency (i.e., pravastatin) statin users. CVD, including ischemic stroke, coronary artery diseases, and heart failure, were identified after statin use to the end of 2011. Cox hazards regression was applied to assess the time-to-event hazards of CVD in association with intensive statin regimens. RESULTS: In the HIV-infected population with CVD history, the high-dose group had a lower CVD risk compared to that of the low-dose group (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.39-1.99). The high-potency group showed a lower CVD risk compared to that of the low-potency group (HR: 0.42, 95% CI: 0.06-3.13). For those without CVD history, the corresponding figures were HR: 0.64 (95% CI: 0.30-1.35) and HR: 0.67 (95% CI: 0.16-2.87). The event rate of new-onset diabetes in high-dose statin group was higher than that in low-dose statin group (15.28% vs. 8.33%), while no muscle complications (i.e., myalgia, myositis, rhabdomyolysis) and dementia were observed in statin users. CONCLUSIONS: There appears a trend showing a lower CVD risk in HIV patients receiving intensive statin therapy.",Cardiovascular diseases;Dose-response;Human immunodeficiency virus (HIV);Intensive regimens;Statin,"Ou, H. T.;Chang, K. C.;Li, C. Y.;Yang, C. Y.;Ko, N. Y.",2017,Mar 01,,0,
3313,The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients: A population-based cohort study,"Background: Our aim in the present study was to assess the mortality impact of hospital-acquired post-operative sepsis up to 1 year after hospital discharge among adult non-short-stay elective surgical patients. Methods: We conducted a population-based, retrospective cohort study of all elective surgical patients admitted to 82 public acute hospitals between 1 January 2007 and 31 December 2012 in New South Wales, Australia. All adult elective surgical admission patients who stayed in hospital for ≥4 days and survived to discharge after post-operative sepsis were identified using the Admitted Patient Data Collection records linked with the Registry of Births, Deaths, and Marriages. We assessed post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year and compared them with those of patients without post-operative sepsis. Results: We studied 144,503 survivors to discharge. Of these, 1857 (1.3%) had experienced post-operative sepsis. Their post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year were 4.6%, 6.7%, 8.1% and 13.5% (vs 0.7%, 1.2%, 1.5% and 3.8% in the non-sepsis cohort), respectively (P < 0.0001 for all). After adjustment for patient and hospital characteristics, post-operative sepsis remained independently associated with a higher mortality risk (30-day mortality HR 2.75, 95% CI 2.14-3.53; 60-day mortality HR 2.45, 95% CI 1.94-3.10; 90-day mortality HR 2.31, 95% CI 1.85-2.87; 1-year mortality HR 1.71, 95% CI 1.46-2.00). Being older than 75 years of age (HR 3.50, 95% CI 1.56-7.87) and presence of severe/very severe co-morbidities as defined by Charlson co-morbidity index (severe vs normal HR 2.05, 95% CI 1.45-2.89; very severe vs normal HR 2.17, 95% CI 1.49-3.17) were the only other significant independent predictors of increased 1-year mortality. Conclusions: Among elective surgical patients, post-operative sepsis is independently associated with increased post-discharge mortality up to 1 year after hospital discharge. This risk is particularly high in the first month, in older age patients and in the presence of severe/very severe co-morbidities. This high-risk population can be targeted for interventions.",adult;age distribution;aged;article;Australia;cerebrovascular disease;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;disease severity;elective surgery;female;heart infarction;hemiplegia;high risk patient;hospital discharge;human;kidney disease;length of stay;leukemia;liver disease;lymphoma;major clinical study;male;mortality rate;mortality risk;paraplegia;peptic ulcer;peripheral vascular disease;population based case control study;postoperative infection;retrospective study;rheumatic disease;sepsis;survival rate,"Ou, L.;Chen, J.;Hillman, K.;Flabouris, A.;Parr, M.;Assareh, H.;Bellomo, R.",2017,,10.1186/s13054-016-1596-7,0,
3314,Homocysteine as a predictor of cognitive decline in Alzheimer's disease,"Objective: Moderately elevated levels of plasma total homocysteine are associated with an increased risk of developing Alzheimer's disease. We have tested whether baseline concentrations of homocysteine relate to the subsequent rate of cognitive decline in patients with established Alzheimer's disease (AD). Methods: In 97 patients with AD, 73 pathologically-confirmed, we analysed the decline of global cognitive test scores (CAMCOG) over time from the first assessment for at least three 6-monthly visits up to a maximum of 9.5 years (in total 689 assessments). Non-linear mixed-effects statistical models were used. Results: Baseline homocysteine levels showed a concentration-response relationship with the subsequent rate of decline in CAMCOG scores: the higher the homocysteine, the faster the decline. The relationship was significant in patients aged <75 years who had not suffered a prior stroke. For example, in patients aged 65 years with a baseline homocysteine of 14 μmol/L, the decline from a CAMCOG score of 88 to a score of 44 occurred 19.2 (95% CI 6.8, 31.6) months earlier than in patients with a baseline homocysteine of 10 μmol/L. Conclusions: Raised homocysteine concentrations within the normal range among the elderly strongly relate to the rate of global cognitive decline in patients with Alzheimer disease. Plasma homocysteine can readily be lowered by B-vitamin treatment and trials should be carried out to see if such treatments can slow the rate of cognitive decline in relatively young patients with Alzheimer disease. Copyright © 2009 John Wiley & Sons, Ltd.",antidiabetic agent;apolipoprotein E4;creatinine;cyanocobalamin;folic acid;homocysteine;aged;Alzheimer disease;amino acid blood level;antihypertensive therapy;article;smoking;clinical assessment;cognition;cognitive defect;concentration response;creatinine blood level;diabetes mellitus;diastolic blood pressure;female;folic acid blood level;groups by age;heart infarction;heterozygosity;homozygosity;human;major clinical study;male;mental patient;onset age;prediction;statistical model;cerebrovascular accident;systolic blood pressure;vitamin blood level,"Oulhaj, A.;Refsum, H.;Beaumont, H.;Williams, J.;King, E.;Jacoby, R.;Smith, A. D.",2010,,,0,
3315,Reducing unnecessary hospitalizations of nursing home residents,,infusion fluid;aged;Alzheimer disease;antibiotic therapy;case report;cell infiltration;chronic pain;clinical evaluation;congestive heart failure;continuing education;coughing;disease course;disease severity;female;fever;fluid intake;health care cost;health care need;health care personnel;health program;heart left ventricle failure;hospital care;hospitalization;human;insurance;leukocyte count;nursing home patient;osteoarthritis;priority journal;risk benefit analysis;risk factor;short survey;treatment planning;unnecessary procedure,"Ouslander, J. G.;Berenson, R. A.",2011,,,0,
3316,Frequency and determinants of pneumonia and urinary tract infection during stroke hospitalization,"BACKGROUND: Patients with acute stroke are at risk for pneumonia and urinary tract infection (UTI). Identifying patients with stroke at high risk for common infections could enhance timely treatment and improve clinical outcomes. We aimed to identify risk factors associated with the occurrence of pneumonia and UTI during stroke hospitalization. METHODS: We analyzed the frequency of pneumonia and UTI and their influence on outcomes during hospitalization in patients diagnosed with ischemic stroke in the California Acute Stroke Prototype Registry. Generalized estimating equations were used to identify factors and outcomes independently associated with pneumonia and UTI. RESULTS: Overall, 663 patients were admitted with acute ischemic stroke at 11 hospitals. Pneumonia occurred in 66 (10%) and UTI in 84 (13%). Older age, atrial fibrillation, and congestive heart failure were independently associated with greater risk for developing pneumonia, whereas a history of dementia was associated with lesser risk. Women and patients with a history of cerebrovascular events were significantly more likely to experience a UTI. Both pneumonia and UTI were associated with significantly greater length of stay, but only pneumonia was independently associated with higher inpatient mortality and poorer discharge ambulatory status. CONCLUSIONS: Several factors are associated with an increased risk of developing pneumonia and UTI during ischemic stroke hospitalization. Early identification and treatment of these patients may improve clinical outcomes.",,"Ovbiagele, B.;Hills, N. K.;Saver, J. L.;Johnston, S. C.",2006,Sep-Oct,10.1016/j.jstrokecerebrovasdis.2006.05.004,0,
3317,"Diseased, demented, depressed: Serious illness in heads of state",,adrenal insufficiency;Alzheimer disease;arteriosclerosis;article;neoplasm;decision making;dementia;depression;frontotemporal dementia;heart infarction;human;hypertension;leukemia;mental disease;occupational health;physician attitude;political system;politics;priority journal;responsibility;retina injury;cerebrovascular accident;work disability,"Owen, L.",2003,,,0,
3318,Neprilysin Inhibitors: Emerging Therapy for Heart Failure,"Biologically active natriuretic peptides (NPs) are an integral part of cardiac homeostasis as they help to maintain sodium and fluid balance. When homeostasis is perturbed by neurohormonal activation in heart failure, levels of NPs rise in response. Neprilysin (NEP) is a naturally occuring enzyme that breaks down NPs. Scientists have recently discovered a novel pharmacologic agent that combines a NEP inhibitor and an angiotensin receptor blocker. In a large clinical trial, this new drug was found to reduce hospitalization and mortality in systolic heart failure. The challenges of implementing this therapy include patient selection, cost, and risk of side effects including angioedema and Alzheimer's disease. Expected final online publication date for the Annual Review of Medicine Volume 68 is January 14, 2017. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.",,"Owens, A. T.;Brozena, S.;Jessup, M.",2016,Sep 21,10.1146/annurev-med-052915-015509,0,
3319,,"Biologically active natriuretic peptides (NPs) are an integral part of cardiac homeostasis as they help to maintain sodium and fluid balance. When homeostasis is perturbed by neurohormonal activation in heart failure, levels of NPs rise in response. Neprilysin (NEP) is a naturally occuring enzyme that breaks down NPs. Scientists have recently discovered a novel pharmacologic agent that combines a NEP inhibitor and an angiotensin receptor blocker. In a large clinical trial, this new drug was found to reduce hospitalization and mortality in systolic heart failure. The challenges of implementing this therapy include patient selection, cost, and risk of side effects including angioedema and Alzheimer's disease.",ISRCTN11958993;NCT01922089;adrenomedullin;angiotensin receptor antagonist;atrial natriuretic factor;bradykinin;brain natriuretic peptide;dipeptidyl carboxypeptidase;enkephalinase inhibitor;membrane metalloendopeptidase;natriuretic peptide type C;substance P;vasoactive intestinal polypeptide;Alzheimer disease;angioneurotic edema;article;cardiovascular system;drug cost;enzyme inhibition;heart failure;human;patient selection;priority journal;randomized controlled trial (topic);renin angiotensin aldosterone system,"Owens, A. T.;Brozena, S.;Jessup, M.",2017,,10.1146/annurev-med-052915-015509,0,
3320,The content of nucleic acids in the nerve cells of the cerebral cortex in senile dementia (Russian),"A study was made of the RNA content in the cytoplasm mentally of neurons in the 10th cortical field in 10 cases of senile dementia and in 5 metally normal elderly individuals. The cause of death in senile dementia was progressive asthenia, and in the control group it was cancer, peritonitis and myocardial infarction. A statistically significant drop in the RNA content was found in the nerve cells in senile dementia. It is inferred that the decrease in the amount of cytoplasmatic RNA in senile dementia is conditioned by the intracellular metabolism and is related to a drop in its synthesis. This is considered as one of the links in the pathogenesis of the disease.",RNA;age;autopsy;brain;brain cortex;major clinical study;nerve cell;senile dementia,"Oxova, E. E.",1973,,,0,
3321,"The 8,344 mutation in mitochondrial DNA: A comparison between the proportion of mutant DNA and clinicopathologic findings","Ten patients, two men and eight women with mitochondrial encephalomyopathy, had an A-G mutation at nucleotide pair 8,344 in the mitochondrial DNA, the most common genetic defect in myoclonus epilepsy with ragged-red fibers (MERRF). Eight patients had the clinical and pathologic characteristics of MERRF including myoclonus, seizures, cerebellar ataxia and myopathy with ragged-red fibers. Two patients had atypical symptoms such as early onset of fatal cardiac failure and late onset of rapid mental deterioration, respectively. The striking feature in our patients with the 8,344 mutation was that four of 10 patients had cardiac involvement and two developed progressive heart failure. In the typical MERRF patients, the proportion of mutant mitochondrial DNA in their skeletal muscles, quantified by a single strand conformation polymorphism analysis, was above 85%. However, there was no significant correlation between clinical severity, histopathological findings and the proportion of mutant mtDNA in muscle biopsy samples, suggesting that non-ragged-red fibers play an important role in the phenotypic expression of the mutants.",mitochondrial DNA;nucleotide;adolescent;adult;aged;article;cerebellar ataxia;child;clinical article;encephalomyopathy;female;heart failure;histopathology;human;human tissue;male;mental deterioration;mitochondrial myopathy;muscle biopsy;mutation;myoclonus epilepsy;myoclonus seizure;myopathy;nucleotide sequence;phenotype;priority journal;single strand conformation polymorphism;skeletal muscle,"Ozawa, M.;Goto, Y. I.;Sakuta, R.;Tanno, Y.;Tsuji, S.;Nonaka, I.",1995,,,0,
3322,Six common but underrecognized drug interactions and adverse effects,"Medical problems and symptoms related to the use of medications are commonly encountered in primary care. In some cases, these are direct adverse effects (AEs) of the medications, while in other cases they are a result of drug interactions. It is difficult for health care providers to know and recognize the vast number of clinically significant drug interactions and AEs that occur with the use of medications. This article highlights the potential drug interactions and AEs of 6 commonly prescribed medications or classes of medications-warfarin, selective serotonin-reuptake inhibitors, fluoroquinolones, cholinesterase inhibitors, trimethoprim-sulfamethoxazole, and nonsteroidal anti-inflammatory drugs- and points out the clinical circumstances in which patients' risk of experiencing these problems is greatest.",amiodarone;cholinesterase inhibitor;cotrimoxazole;creatinine;dipeptidyl carboxypeptidase inhibitor;donepezil;erythromycin;fluconazole;itraconazole;ketoconazole;metronidazole;nonsteroid antiinflammatory agent;paracetamol;potassium;prednisone;quinolone derivative;serotonin uptake inhibitor;warfarin;article;bleeding;bradycardia;coronary artery disease;creatinine blood level;dementia;diarrhea;disease severity;drug contraindication;drug effect;drug potentiation;drug safety;drug tolerability;drug withdrawal;faintness;food and drug administration;gastrointestinal hemorrhage;health hazard;heart failure;high risk patient;hospital admission;human;international normalized ratio;nausea;nephrotoxicity;neuropathy;potassium blood level;prescription;priority journal;risk assessment;side effect;urine incontinence;vomiting;weight reduction,"Paauw, D.",2017,,,0,
3323,"Causes of death after total hip arthroplasty: A nationwide cohort study with 24,638 patients","Based on the nationwide registration of the total hip arthroplasties (THAs) in Finland since 1980, a cohort of 24,638 patients with primary THA was gathered and followed for causes of death until December 31, 1996. The causes of death were divided into 20 main categories according to the classification of diseases ICD-10. The number of person-years was 153,410, and the mean length of follow-up of a person was 6.2 years. During the follow-up, 4,626 patients died; the expected number was 6,746. The standardized mortality ratio (SMR) was 0.69 (95% confidence interval; 0.67-0.70), without any difference between men and women. The total risk increased during the follow-up, with the highest being 0.84 (95% confidence interval, 0.81-0.87). Among the ICD categories, there were significantly low SMRs for cancers (0.54), accidents (0.74), cardiovascular diseases (0.70), and respiratory diseases (0.46). Among the diseases, there was a constant and significant decline of the SMR for dementia and Alzheimer's disease (0.50), diabetes (0.40), myocardial infarction (0.73), hypertension (0.68), other ischemic diseases (0.70), other heart diseases (0.57), and cerebrovascular diseases (0.70). The explanation for the decreased SMRs seems to be attributed to factors other than the THA per se, such as preoperative patient selection, more active lifestyle after THA, and possibly the use of anti-inflammatory drugs.",antiinflammatory agent;metal;polyethylene;accident;adolescent;adult;aged;Alzheimer disease;article;neoplasm;cardiovascular disease;cause of death;cerebrovascular disease;cohort analysis;controlled study;coxitis;dementia;diabetes mellitus;female;Finland;follow up;heart infarction;human;hypertension;ischemic heart disease;lifestyle;major clinical study;male;patient selection;respiratory tract disease;surgical mortality;total hip prosthesis,"Paavolainen, P.;Pukkala, E.;Pulkkinen, P.;Visuri, T.",2002,,,0,
3324,Run-in periods in randomized trials: implications for the application of results in clinical practice,"Prerandomization run-in periods are being used to select or exclude patients in an increasing number of clinical trials, but the implications of run-in periods for interpreting the results of clinical trials and applying these results in clinical practice have not been systematically examined. We analyzed illustrative examples of reports of clinical trials in which run-in periods were used to exclude noncompliant subjects, placebo responders, or subjects who could not tolerate or did not respond to active drug. The Physicians' Health Study exemplifies the use of a prerandomization run-in period to exclude subjects who are nonadherent, while recent trials of tacrine for Alzheimer disease and carvedilol for congestive heart failure typify the use of run-in periods to exclude patients who do not tolerate or do not respond to the study drug. The reported results of these studies are valid. However, because the reported results apply to subgroups of patients who cannot be defined readily based on demographic or clinical characteristics, the applicability of the results in clinical practice is diluted. Compared with results that would have been observed without the run-in period, the reported results overestimate the benefits and underestimate the risks of treatment, underestimate the number needed to treat, and yield a smaller P value. The Cardiac Arrhythmia Suppression Trial exemplifies the use of an active-drug run-in period that enhances clinical applicability by selecting a group of study subjects who closely resembled patients undergoing active clinical management for this problem. Run-in periods can dilute or enhance the clinical applicability of the results of a clinical trial, depending on the patient group to whom the results will be applied. Reports of clinical trials using run-in periods should indicate how this aspect of their design affects the application of the results to clinical practice.","Clinical Protocols;Data Interpretation, Statistical;Patient Selection;*Randomized Controlled Trials as Topic;Research Design;Statistics as Topic","Pablos-Mendez, A.;Barr, R. G.;Shea, S.",1998,Jan 21,,0,
3325,Vitamin B12 deficiency: Serious consequences,,aminosalicylic acid;antacid agent;chloramphenicol;colchicine;colestyramine;cyanocobalamin;histamine H2 receptor antagonist;homocysteine;hydroxocobalamin;metformin;methionine;neomycin;nitrous oxide;potassium;proton pump inhibitor;achlorhydria;acquired immune deficiency syndrome;adverse outcome;alcoholism;anemia;atrophic gastritis;autoimmune disease;bacterial overgrowth;balance disorder;blood vessel occlusion;bone marrow depression;cancer chemotherapy;celiac disease;cerebrovascular accident;Crohn disease;cyanocobalamin deficiency;deep vein thrombosis;dementia;demyelinating disease;diet;differential diagnosis;disability;dizziness;drug cost;drug megadose;early diagnosis;eating disorder;emergency ward;falling;gastrointestinal surgery;general practitioner;health care personnel;health care quality;heart infarction;Helicobacter infection;human;hyperhomocysteinemia;immune deficiency;liver disease;lung embolism;malabsorption;medicaid;medicare;medication error;mental disease;neurological complication;note;nutritional deficiency;orthostatic hypotension;paresthesia;pharmacist;prevalence;radiation;stomach acid secretion;stomach bypass;treatment indication;vegetarian diet;visual disorder;vitamin deficiency;weakness,"Pacholok, S. M.",2013,,,0,
3326,Determinants of noninvasive ventilation outcomes during an episode of acute hypercapnic respiratory failure in chronic obstructive pulmonary disease: The effects of comorbidities and causes of respiratory failure,"Objectives. To investigate the effect of the cause of acute respiratory failure and the role of comorbidities both acute and chronic on the outcome of COPD patients admitted to Respiratory Intensive Care Unit (RICU) with acute respiratory failure and treated with NIV. Design. Observational prospective study. Patients and Methods. 176 COPD patients consecutively admitted to our RICU over a period of 3 years and treated with NIV were evaluated. In all patients demographic, clinical, and functional parameters were recorded including the cause of acute respiratory failure, SAPS II score, Charlson comorbidity index, and further comorbidities not listed in the Charlson index. NIV success was defined as clinical improvement leading to discharge to regular ward, while exitus or need for endotracheal intubation was considered failure. Results. NIV outcome was successful in 134 patients while 42 underwent failure. Univariate analysis showed significantly higher SAP II score, Charlson index, prevalence of pneumonia, and lower serum albumin level in the failure group. Multivariate analysis confirmed a significant predictive value for pneumonia and albumin. Conclusions. The most important determinants of NIV outcome in COPD patients are the presence of pneumonia and the level of serum albumin as an indicator of the patient nutritional status. © 2014 Angela Maria Grazia Pacilli et al.",serum albumin;acute respiratory failure;aged;article;cardiogenic pulmonary edema;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;chronic obstructive lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled clinical trial;controlled study;dementia;diabetes mellitus;diaphragm paralysis;face mask;female;fibrothorax;general condition improvement;helmet;hemiplegia;hospital admission;hospital discharge;human;hyperglycemia;intensive care unit;kidney disease;kyphoscoliosis;leukemia;lung disease;lung edema;lung embolism;lymphoma;major clinical study;male;malignant neoplastic disease;myasthenia;noninvasive ventilation;nutritional status;obesity;observational study;outcome assessment;peptic ulcer;peripheral vascular disease;pneumonia;pneumothorax;predictive value;pressure support ventilation;prevalence;prospective study;Simplified Acute Physiology Score;sleep disordered breathing;solid tumor;very elderly,"Pacilli, A. M. G.;Valentini, I.;Carbonara, P.;Marchetti, A.;Nava, S.",2014,,,0,
3327,In reply,,sacubitril;valsartan;adverse drug reaction;cardiologist;cardiovascular mortality;dementia;drug safety;health care management;heart failure;human;letter;malignant neoplasm;medical practice;oncologist;priority journal;risk,"Packer, M.",2017,,10.1001/jamacardio.2017.0426,0,
3328,The comorbidity conundrum: A focus on the role of noncardiovascular chronic conditions in the heart failure patient,"The rapid aging of the US population combined with improvements in modern medicine has created a new public health concern of comorbidity, a chronic condition that co-exists with a primary illness. Over 141 million Americans suffer from one or more comorbid conditions. In the heart failure (HF) patient, this comorbidity burden is particularly high, with over 40% of patients having five or more chronic conditions. These comorbidities can vary from being a risk factor to a cause of HF progression or even a precipitating factor for decompensation. Comorbidities, particularly the noncardiovascular conditions, have been associated with greater health resource utilization, poor health outcomes, and increased mortality. To minimize the negative impact that these comorbidities have on patient outcomes, appropriate attention should be paid to identifying, prioritizing, and managing each condition; minimizing medication complexity and polypharmacy; and improving overall coordination of care between providers and patients. © Springer Science+Business Media, LLC 2012.",amiodarone;beta 2 adrenergic receptor stimulating agent;beta adrenergic receptor blocking agent;bisoprolol;dipeptidyl carboxypeptidase inhibitor;doxorubicin;escitalopram;glitazone derivative;loop diuretic agent;memantine;metoprolol succinate;placebo;prostaglandin synthase inhibitor;sertraline;trastuzumab;tricyclic antidepressant agent;acute kidney failure;aging;Alzheimer disease;article;breast cancer;cardiovascular risk;chronic disease;chronic obstructive lung disease;comorbidity;depression;diabetes mellitus;disease association;disease course;fracture;gout;health care cost;health care utilization;health status;heart failure;hospitalization;human;low drug dose;medicare;mortality;osteolysis;outpatient care;pathophysiology;prescription;prevalence;prognosis;randomized controlled trial (topic);rheumatoid arthritis;risk factor;side effect;thyroid disease;herceptin,"Page Ii, R. L.;Lindenfeld, J.",2012,,,0,
3329,Update on the NAS-NRC Twin Registry,"The National Academy of Sciences-National Research Council (NAS-NRC) Twin Registry is one of the oldest, national population-based twin registries in the United States. It consists of 15,924 white male twin pairs born in the years 1917 to 1927 (inclusive), both of whom served in the armed forces, mostly during World War II. This article updates activity in this registry since the earlier 2002 article in Twin Research. The results of clinically based studies on dementia, Parkinson's disease, age-related macular degeneration, and primary osteoarthritis were published, as well as articles based on previously collected questionnaire data on chronic fatigue syndrome, functional limitations, and healthy aging. In addition, risk factor studies are being planned to merge clinical data with earlier collected risk factor data from questionnaires. Examination data from the subset of National Heart, Lung, and Blood Institute (NHLBI) twins resulted in a number of articles, including the relationship of endogenous sex hormones to coronary heart disease and morphological changes in aging brain structures. The NEO Five-Factor Personality Inventory (a paper-and-pencil self-administered questionnaire) has been fielded for the first time. A push to consolidate the various data holdings of the registry is being made.",Adult;Aged;Cardiovascular Diseases/etiology/genetics;Female;Humans;Longitudinal Studies;Male;Middle Aged;*Registries;Risk Factors;Surveys and Questionnaires;*Twin Studies as Topic;United States,"Page, W. F.",2006,Dec,10.1375/183242706779462417,0,
3330,Role of coenzyme Q10 in human life,"Coenzymes are organic protein molecules enhance the action of enzyme. Being a Coenzyme now a day Co Q10 is used in different purposes like stress, Congestive heart failure, hypertension, parkinsonism etc. Ubiquinone and Ubiquinol are the effective Constituents of Co Q10. Ubiquinone and Ubiquinol are very useful as antioxidant Compound. Free radicals may be formed through natural human physiological processes as well as from the environment. They may be the result of diet, stress, smoking, alCohol, exercise, inflammation, drugs or exposure to sunlight and air pollutants Co Q10 has the remarkable effectiveness as vital intermediate on electron transport chain at Mitochondria. Coenzyme Q10 is Synthesized in intercellular region in the human body using tyrosine as fundamental building blocks. Q10 is a 1,4benzoquinone, where Q refers to the quinone chemical group, and 10 refers to the number of isoprenyl chemical subunits in its tail. General dose of Co Q10 is 150 mg/day. Gastrointestinal disturbances have been reported as major adverse effect of this molecule till date. Current development in the production of Co Q10 is going on Continuously from plant, reCombinant Escherichia Coli andmetabolically engineered Escherichia Coli sources. Lots of research work is already going on this matter. In future if some research is needed on this Co-enzyme Q10 then this survey will stand as an informative document to researcher.",free radical;placebo;ubidecarenone;angina pectoris;article;biochemistry;chemical structure;congestive heart failure;disorders of mitochondrial functions;dizziness;drug absorption;drug bioavailability;drug mechanism;drug safety;electron transport;Escherichia coli;fatigue;headache;heart failure;heartburn;human;Huntington chorea;hypertension;immunity;inflammation;insomnia;migraine;nausea;neuroprotection;oxidative stress;Parkinson disease;pharmacodynamics;rash;stress;time to maximum plasma concentration;tooth disease;upper abdominal pain,"Pahari, S. K.;Ghosh, S.;Halder, S.;Jana, M.",2016,,,0,
3331,Recent advances. Geriatric medicine,,acetylsalicylic acid;antihypertensive agent;beta carotene;ibuprofen;indometacin;naproxen;nonsteroid antiinflammatory agent;piroxicam;aged;breast cancer;cancer risk;congestive heart failure;dementia;geriatrics;home care;hospital admission;human;hypertension;inflammation;oxidative stress;priority journal;short survey;cerebrovascular accident;systolic blood pressure,"Pahor, M.;Applegate, W. B.",1997,,,0,
3332,The prevalence and associates of depressive disorders in the oldest-old Finns,"AIM: To describe the prevalence and associates of major depression and minor depression among the Finnish non-demented population aged 85 years and older (n = 339). METHODS: DSM-III-R criteria were used in diagnosing major depression and dementia. Minor depression was diagnosed by the physician in those who did not fulfil the DSM-III-R criteria for major depression, but had still at least two depressive symptoms. In the first phase, cross-tabulation was used to determine relative risks (RR) and their 95% confidential intervals (95% CI). An additive logistic regression model was then used to find the independent associates of depressive disorders. RESULTS: The prevalence of major depression was 8.1% in men and 4.9% in women, and that of minor depression 18.9% in men and 18.5% in women. In men major depression was associated independently with poor physical health and in women with rare contact with family or friends and poor physical health. Minor depression was associated independently with poor physical health and previous myocardial infarction in men and with poor physical health, a poor ability to walk, and smoking in women. CONCLUSIONS: The prevalence of depressive disorders is quite high among the oldest-old Finns. The factors associated with major and minor depression are largely similar. Although the results suggest that psychosocial stress factors affect the development of both major and minor depression in the oldest-old, no conclusions about causality can be made.","Aged;Aged, 80 and over/*psychology;Depressive Disorder/*epidemiology/psychology;Female;Finland/epidemiology;Humans;Logistic Models;Male;Multivariate Analysis;Prevalence;Risk Factors;Statistics, Nonparametric","Paivarinta, A.;Verkkoniemi, A.;Niinisto, L.;Kivela, S. L.;Sulkava, R.",1999,Jul,,0,
3333,The case of malignant peripheral nerve sheath tumor of the cheek,"Introduction Malignant peripheral nerve sheath tumor (MPNST), formerly known as neurogenic sarcoma or malignant neuroblastoma, rarely occurs in the head and neck area and can mimic benign proliferative lesions. The tumor develops from the peripheral nerve cells and can occur on the surface of the skin neurofibromas in von Recklinghausen disease or de Novo. Aim The aim of this paper was to present the case of the 86-year-old female patient with MPNST in the soft tissues of the right cheek. Case study 86-year-old female patient was admitted due to the right cheek tumor growing for about a month of the size 5 × 5 cm that caused significant asymmetry of the face. Results and discussion The patient was diagnosed on the basis of the history, craniofacial visualization, histopathological examination of the tumor sample and referred for surgical treatment and possible adjuvant radiotherapy. Extensive resection of the tumor was followed by a reconstruction of buccal defect with regional lobes. The postoperative course was uneventful. Adjuvant radiotherapy was not performed due to a number of aggravating systemic illness and old age of the patient. She is the subject of constant surgical-oncological follow-up medical care. No local recurrence or distant metastases were observed during follow-up. Conclusions MPNST rarely occurs in the head and neck region. This kind of sarcoma can cause problems in the process of diagnosis and therapy. Resection is the primary treatment in case of MPNST. Due to high incidence of local recurrence and distant metastases, the patients treated for MPNST require continuous outpatient follow-up after the treatment.",CD31 antigen;Ki 67 antigen;protein S 100;vimentin;aged;anamnesis;article;cancer patient;cancer surgery;case report;cheek mucosa;clinical examination;face asymmetry;female;fine needle aspiration biopsy;follow up;heart failure;histopathology;hospital admission;human;human tissue;hypertension;immunohistochemistry;lymph node biopsy;malignant peripheral nerve sheath tumor;medical care;medical history;neurofibromatosis;neuroimaging;non insulin dependent diabetes mellitus;nuclear magnetic resonance imaging;postoperative period;preoperative care;priority journal;senile dementia;tumor volume;very elderly,"Pakla, P.;Lewandowski, B.",2016,,,0,
3334,Time trends in incidence and outcomes of hospitalizations for aspiration pneumonia among elderly people in Spain (2003 − 2013),"Background Aspiration pneumonia (AP) is an infectious process causing high rates of mortality. The purpose of this study was: 1, to describe the incidence from 2003 to 2013 of AP hospitalizations; 2, to assess time trends in hospital outcomes variables, and; 3, to identify the factors independently associated with in-hospital mortality (IHM). Methods A retrospective observational study using the Spanish National Hospital Database, with patients discharged between January 2003 and December 2013 was conducted. Inclusion criteria were: Subjects aged 75 years or older whose medical diagnosis included AP events code according to the ICD-9-CM: 507.x in the primary diagnosis field. Patient variables, up to 14 discharge diagnoses per patient, and up to 20 procedures performed during the hospital stay (ICD-9-CM), Charlson Comorbidity Index, readmission, length of hospital stay (LOHS), and IHM were analyzed. Results We included 111,319 admissions (53.13% women). LOHS decreased in both sexes (P < 0.001) and was significantly higher in men (10.4 ± 10.31 vs. 9.56 ± 10.02 days). Readmissions increased significantly in women during the study (13.94% in 2003 to 16.41% in 2013, P < 0.001). In both sex, IHM was significantly higher in > 94 years old subjects (OR: 1.43, 95%CI 1.36–1.51) and in those with readmissions (OR: 1.20, 95%CI 1.15–1.23). For the entire population, time trend analyses showed a significant decrease in mortality from 2003 to 2013 (OR: 0.96, 95%CI 0.95–0.97). Conclusions Patients with AP are older, male, and have more comorbidities than those without AP. Over time, LOHS and IHM decreased in both sexes, but readmissions increased significantly in women.",acquired immune deficiency syndrome;aged;article;aspiration pneumonia;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;chronic obstructive lung disease;comorbidity;congestive heart failure;dementia;diabetes mellitus;female;groups by age;heart infarction;hemiplegia;hospital discharge;hospital mortality;hospital readmission;hospitalization;human;Human immunodeficiency virus infection;ICD-9-CM;incidence;kidney disease;length of stay;leukemia;liver disease;lymphoma;major clinical study;male;observational study;outcome assessment;paraplegia;peptic ulcer;peripheral vascular disease;retrospective study;rheumatic disease;sex difference;solid malignant neoplasm;Spain;trend study;very elderly,"Palacios-Ceña, D.;Hernández-Barrera, V.;López-de-Andrés, A.;Fernández-de-las-Peñas, C.;Palacios-Ceña, M.;de Miguel-Díez, J.;Carrasco-Garrido, P.;Jiménez-García, R.",2017,,10.1016/j.ejim.2016.12.022,0,
3335,Differential prognostic effect of revascularization according to a simple comorbidity index in high-risk non-ST-segment elevation acute coronary syndrome,"BACKGROUND: Data on the effect of revascularization on outcome in patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTEACS) and significant comorbidities are scarce. Recently, a simple comorbidity index (SCI) including 5 comorbidities (renal failure, dementia, peripheral artery disease, heart failure, and prior myocardial infarction [MI]) has shown to be a useful tool for risk stratification. Nevertheless, therapeutic implications have not been derived. HYPOTHESIS: We sought to evaluate the prognostic effect attributable to revascularization in NSTEACS according the SCI score. METHODS: We included 1017 consecutive patients with NSTEACS. The effect of revascularization on a combined end point of all-cause mortality or nonfatal MI was evaluated by Cox regression according to SCI categories. RESULTS: A total of 560 (55.1%), 236 (23.2%), and 221 (21.7%) patients showed 0, 1, and >/=2 points according to the SCI, respectively. Coronary angiography was performed in 725 patients (71.5%), and 450 patients (44.3%) underwent revascularization. During a median follow-up of 16 months (interquartile range, 12-36 months), 305 (30%) patients experienced the combined end point (202 deaths [19.9%] and 170 MIs [16.7%]). In multivariate analysis, a differential prognostic effect of revascularization was observed comparing SCI >/=2 vs 0 (P for interaction = 0.008). Thus, revascularization was associated with a greater prognostic benefit in patients with SCI >/=2 (hazard ratio [HR]: 0.51, 95% confidence interval [CI]: 0.29-0.89), P = 0.018), whereas no significant benefit was observed in those with 0 and 1 point (HR: 1.31, 95% CI: 0.88-1.94, P = 0.171 and HR: 1.11, 95% CI: 0.70-1.76, P = 0.651, respectively). CONCLUSIONS: In NSTEACS, the SCI score appears to be a useful tool for identifying a subset of patients with a significant long-term death/MI risk reduction attributable to revascularization.",Acute Coronary Syndrome/drug therapy/mortality/*pathology;Aged;Comorbidity;Confidence Intervals;Decision Making;Female;Health Status Indicators;Humans;Kaplan-Meier Estimate;Male;Middle Aged;Prognosis;Propensity Score;Proportional Hazards Models;Prospective Studies;Risk Assessment;Spain;Statistics as Topic;Time Factors;Troponin/blood,"Palau, P.;Nunez, J.;Sanchis, J.;Husser, O.;Bodi, V.;Nunez, E.;Minana, G.;Boesen, L.;Ventura, S.;Llacer, A.",2012,Apr,10.1002/clc.20996,0,
3336,"Levodopa-carbidopa intestinal gel (LCIG) treatment in routine care of patients with advanced Parkinson's disease: An open-label prospective observational study of effectiveness, tolerability and healthcare costs","Background Continuous infusion of levodopa-carbidopa intestinal gel (LCIG) can effectively manage motor and non-motor complications in advanced Parkinson's disease (PD). Healthcare costs, quality of life (QoL), effectiveness, and tolerability were assessed in routine care treatment with LCIG. Methods The seventy-seven patients enrolled in this prospective, open-label, 3-year study in routine medical care were LCIG-naïve (N = 37), or had previous LCIG treatment for <2 (N = 22), or ≥2 (N = 18) years. Healthcare costs were collected monthly. PD symptoms and QoL were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS), 39-item Parkinson's Disease Questionnaire (PDQ-39), and EuroQoL 5-Dimension Visual Analog Scale (EQ-5D VAS); LCIG dose, safety, and tolerability were monitored. Results Mean monthly costs per patient (€8226 ± 5952) were similar across cohorts, remained steady during 3-year follow-up, and increased with PD severity and QoL impairment. In LCIG-naïve patients, significant improvements compared to baseline were observed on the UPDRS total score and PDQ-39 summary index score through 18 months (n = 24; UPDRS, p = 0.033; PDQ-39, p = 0.049). Symptom control was maintained during 3-year follow-up in LCIG-experienced cohorts. Small changes in mean daily LCIG dose were observed. Adverse events were common and generally related to the device, procedure, levodopa, or laboratory evaluations. Conclusions Costs in LCIG-treated patients were stable over 3 years. LCIG treatment led to significant improvements in motor function and QoL over 18 months in LCIG-naïve patients and no worsening was observed in LCIG-experienced patients over 3 years despite natural PD progression over time. The long-term safety was consistent with the established LCIG profile.",carbidopa plus levodopa;codeine;cyanocobalamin;mirtazapine;paracetamol;zopiclone;39 item Parkinson Disease Questionnaire;adult;anxiety;article;cause of death;cohort analysis;controlled clinical trial;controlled study;delusion;dementia;depression;device infection;device removal;disease severity;dose response;drug absorption;drug administration route;drug cost;drug efficacy;drug exposure;drug monitoring;drug safety;drug tolerability;EuroQoL 5 Dimension;follow up;gastrointestinal disease;gel;granulation tissue;health care cost;heart arrest;human;infection;intestinal gel;intraintestinal drug administration;major clinical study;medical care;medical device complication;mental disease;motor performance;open study;pain;Parkinson disease;polyneuropathy;priority journal;prospective study;quality of life;questionnaire;side effect;stoma site infection;symptomatology;treatment duration;tubal occlusion;tube dislocation;Unified Parkinson Disease Rating Scale;visual analog scale,"Pålhagen, S. E.;Sydow, O.;Johansson, A.;Nyholm, D.;Holmberg, B.;Widner, H.;Dizdar, N.;Linder, J.;Hauge, T.;Jansson, R.;Bergmann, L.;Kjellander, S.;Marshall, T. S.",2016,,,0,
3337,Thyroid disease in old age,"The average life expectancy of women and men has nearly doubled within the last hundred years. There are quite a few studies about thyroid diseases in advanced age. But while these are mostly focused on people in the age between 65 and 75 data of people over the age of 75 is rare. The kind of thyroid disorder in advanced age is, at least to some extent, depending on the iodine supply of the country where people live. In countries with insufficient iodine supply hyperthyroid disorders are playing a major role. In contrast older people in those countries where iodine intake is sufficient develop hypothyroidism more often. Thyroid function disorders differ regarding their clinical symptoms depending on the age of the patient. Hypo- as well as hyperthyroidism can evolve with relatively few symptoms. Hypothyroidism of older people can result in alterations of the lipid profile in combination with an enhanced risk of atherosclerosis, in cardiac dysfunction and neurophysiological alterations. The therapy of age-related hypothyroidism comprises a slow dose adjustment of levothyroxine depending on TSH values and clinical symptoms. Potential sequelae of age-related hyperthyroidism are frailty, cardiac arrhythmias and heart failure. In older people with a preexisting heart disease especially significantly lowered TSH values can lead to an increased mortality and should therefore be treated. Antithyroid drug therapy, radioactive iodine therapy and thyroid surgery are reasonable methods for the treatment of hyperthyroidism. Due to improved anaesthesiological procedures and an optimized perioperative management surgery of the thyroid can also be performed in older patients. While it formerly has been assumed that hypothyroidism in older people leads to a restriction of their cognitive functions or to dementia, hyperthyroidism is obviously playing a decisive role. Although there is a rising prevalence of thyroid nodules with increasing age the incidence of thyroid malignancies declines with age. A general screening for thyroid nodules is currently not recommended for older people. Nevertheless thyroid nodules in older patients should be controlled by ultrasound. In case of tumor suspicion these findings should be examined by fine needle aspiration biopsy.",antithyroid agent;levothyroxine;lipid;radioactive iodine;thyrotropin;aged;aging;anesthesiological procedure;article;atherosclerosis;cancer incidence;cancer patient;disease association;echography;fine needle aspiration biopsy;frailty;heart arrhythmia;heart disease;heart failure;human;hyperthyroidism;hypothyroidism;life expectancy;lipid analysis;lipid blood level;mortality;perioperative period;risk factor;screening test;thyroid cancer;thyroid disease;thyroid nodule;thyroid surgery;thyrotropin blood level,"Palitzsch, K. D.",2017,,,0,
3338,Myocardial ischemia due to a large coronary-pulmonary fistula with plexus-like morphology,"Congenital coronary-pulmonary artery fistula is a rare anomaly. We report the case of a coronary-pulmonary artery fistula with plexus-like morphology connecting the left main stem and proximal segments of the left anterior descending and circumflex coronary arteries to the main pulmonary artery in a 69-year-old woman. It caused inducible ischemia as revealed by myocardial perfusion tetrafosmin scintigraphy (Tc-99m SPECT). To our knowledge, no case of a large plexus-like coronary-pulmonary artery fistula from the very proximal left coronary artery has been reported. Furthermore, only a few cases report scintigraphic demonstration of severe ischemia in such a coronary anomaly. © 2008 Italian Federation of Cardiology.",insulin;levothyroxine;tetrofosmin tc 99m;aged;angiocardiography;article;case report;coronary artery circumflex branch;coronary artery fistula;dementia;electrocardiogram;exercise test;female;follow up;Hashimoto disease;heart muscle ischemia;heart muscle perfusion;heart scintiscanning;human;hypothyroidism;left anterior descending coronary artery;morphology;physical examination;pulmonary artery;single photon emission computer tomography;transthoracic echocardiography,"Palloshi, A.;Aprigliano, G.",2008,,,0,
3339,Distinct distal myopathy phenotype caused by VCP gene mutation in a Finnish family,"Inclusion body myopathy with Paget disease and frontotemporal dementia (IBMPFD) is caused by mutations in the valosin-containing protein (VCP) gene. We report a new distal phenotype caused by VCP gene mutation in a Finnish family with nine affected members in three generations. Patients had onset of distal leg muscle weakness and atrophy in the anterior compartment muscles after age 35, which caused a foot drop at age 50. None of the siblings had scapular winging, proximal myopathy, cardiomyopathy or respiratory problems during long-term follow-up. Three distal myopathy patients developed rapidly progressive dementia, became bedridden and died of cachexia and pneumonia and VCP gene mutation P137L (c.410C>T) was then identified in the family. Late onset autosomal dominant distal myopathy with rimmed vacuolar muscle pathology was not sufficient for exact diagnosis in this family until late-occurring dementia provided the clue for molecular diagnosis. VCP needs to be considered in the differential diagnostic work-up in patients with distal myopathy phenotype.","Adenosine Triphosphatases/*genetics;Adult;Cell Cycle Proteins/*genetics;Diagnosis, Differential;Distal Myopathies/diagnosis/*ethnology/*genetics;Female;Finland;Humans;Male;Middle Aged;Muscular Dystrophies/diagnosis;Mutation/*genetics;Pedigree;*Phenotype","Palmio, J.;Sandell, S.;Suominen, T.;Penttila, S.;Raheem, O.;Hackman, P.;Huovinen, S.;Haapasalo, H.;Udd, B.",2011,Aug,10.1016/j.nmd.2011.05.008,0,
3340,Coronary artery bypass surgery provokes alzheimer's disease-like changes in the cerebrospinal fluid,"Several biomarkers are used in confirming the diagnosis of cognitive disorders. This study evaluates whether the level of these markers after heart surgery correlates with the development of cognitive dysfunction, which is a frequent complication of cardiac interventions. Concentrations of amyloid-β peptide, tau, and S100β in the cerebro-spinal fluid were assessed, as well as cognitive functions were evaluated before and after coronary artery bypass grafting, utilizing immuno-assays and psychometric tests, respectively. A drastic rise in the level of S100β was observed one week after the surgery, a mark of a severe generalized cerebral injury. The level of amyloid-β peptide significantly decreased, whereas the concentration of tau markedly increased six months postoperatively. Gradual cognitive decline was also present. These findings clearly demonstrate post-surgical cognitive impairment associated with changes in biomarkers similar to that seen in Alzheimer's disease, suggesting a unifying pathognomic factor between the two disorders. A holistic approach to coronary heart disease and Alzheimer's-type dementia is proposed. © 2010 IOS Press and the authors. All rights reserved.",amyloid beta protein;biological marker;protein S 100;protein s 100 beta;tau protein;unclassified drug;adult;aged;Alzheimer disease;article;brain injury;cerebrospinal fluid analysis;cognitive defect;controlled study;coronary artery bypass surgery;disease association;female;human;major clinical study;male;neuropsychological test;postoperative period;priority journal,"Palotás, A.;Reis, H. J.;Bogáts, G.;Babik, B.;Racsmány, M.;Engvau, L.;Kecskeméti, E.;Juhász, A.;Vieira, L. B.;Teixeira, A. L.;Mukhamedyarov, M. A.;Rizvanov, A. A.;Yalvaç, M. E.;Guimarêes, M. M.;Ferreira, C. N.;Zefirov, A. L.;Kiyasov, A. P.;Wang, L.;Janka, Z.;Kálmán, J.",2010,,,0,
3341,The 2013 British Menopause Society & Women's health concern recommendations on hormone replacement therapy,,androgen;bisphosphonic acid derivative;conjugated estrogen;drospirenone;dydrogesterone;estradiol;estrogen;fluoxetine;gabapentin;gestagen;levonorgestrel;medroxyprogesterone acetate;oral contraceptive agent;paroxetine;phytoestrogen;placebo;progesterone;progesterone receptor;sex hormone;testosterone;tibolone;venlafaxine;acne;androgen therapy;article;breast cancer;cancer risk;cerebrovascular accident;climacterium;cognition;colorectal cancer;dementia;depression;drowsiness;drug megadose;dyspareunia;early menopause;endometrium biopsy;endometrium cancer;endometrium hyperplasia;estrogen deficiency;estrogen therapy;hirsutism;hormone substitution;hot flush;human;ischemic heart disease;lifestyle;low drug dose;medical society;menstrual cycle;metrorrhagia;mood disorder;nausea;osteoporosis;ovary cancer;postmenopause;premature ovarian failure;sexual function;somnolence;unspecified side effect;urinary frequency;uterine cervix cancer;vaginal dryness;vasomotor disorder;venous thromboembolism;women's health,"Panay, N.;Hamoda, H.;Arya, R.;Savvas, M.",2013,,,0,
3342,Insulin therapy--role beyond glucose control,"Larger studies had shown improved patient outcome and lower probability of coronary artery disease in insulin treated groups. The classical lipid abnormalities associated with type 2 diabetes are low HDL-cholesterol concentration and high triglyceride concentration. Insulin usage leads to a decrease in triglyceride concentration, primarily by its effect on the enzyme adipose tissue lipoprotein lipase. Insulin suppresses the enzyme, thereby controlling lipolysis in uncontrolled diabetes. Insulins therapy also improves the endothelial dysfunction especially in people with evident macrovascular complications. Though insulin is noted to increase adrenergic tone and may cause elevation of blood pressure, still patients with insulinoma do not have high blood pressure. Some studies suggest weight gain with insulin therapy, others contradict it. One study suggests that insulin does not affect treatment satisfaction. Insulin is known to improve the glycaemic scenario and also the insulin secretory pattern by reducing the glucotoxicity.","Alzheimer Disease/drug therapy;Blood Glucose/drug effects/metabolism;Cholesterol, HDL/blood/drug effects/metabolism;Cholesterol, LDL/blood/drug effects/metabolism;Diabetes Mellitus, Type 2/blood/*drug therapy;Diabetes, Gestational/drug therapy;Endothelium/drug effects/metabolism;Female;Humans;Hypoglycemic Agents/metabolism/pharmacology/*therapeutic use;Insulin/metabolism/pharmacology/*therapeutic use;Lipoproteins/blood/drug effects/metabolism;Memory Disorders/drug therapy;Pregnancy;Prognosis;Sepsis/drug therapy;Treatment Outcome","Pandit, K.;Mukhopadhyay, P.",2004,Oct,,0,
3343,Computational studies on Alzheimer's disease associated pathways and regulatory patterns using microarray gene expression and network data: Revealed association with aging and other diseases,"Alzheimer's disease (AD), which is one of the most common age-associated neurodegenerative disorders, affects millions of people worldwide. Due to its polygenic nature, AD is believed to be caused not by defects in single genes, but by variations in a large number of genes and their complex interactions, which ultimately contribute to the broad spectrum of disease phenotypes. Extraction of insights and knowledge from microarray and network data will lead to a better understanding of complex diseases. The present study aimed to identify genes with differential topology and their further association with other biological processes that regulate causative factors for AD, ageing (AG) and other diseases. Our analysis revealed a common sharing of important biological processes and putative candidate genes among AD and AG. Some significant novel genes and other variants for various biological processes have been reported as being associated with AD, AG, and other diseases, and these could be implicated in biochemical events leading to AD from AG through pathways, interactions, and associations. Novel information for network motifs such as BiFan, MIM (multiple input module), and SIM (single input module) and their close variants has also been discovered and this implicit information will help to improve research into AD and AG. Ten major classes for TFs (transcription factors) have been identified in our data, where hundreds of TFBS patterns are being found associated with AD, and other disease. Structural and physico-chemical properties analysis for these TFBS classes revealed association of biological processes involved with other severe human disease. Nucleosomes and linkers positional information could provide insights into key cellular processes. Unique miRNA (micro RNA) targets were identified as another regulatory process for AD. The association of novel genes and variants of existing genes have also been explored for their interaction and association with other diseases that are either directly or indirectly implicated through AG and AD. © 2013 Elsevier Ltd.",microRNA;transcription factor;aging;Alzheimer disease;article;autosomal dominant optic atrophy;binding site;brain mapping;brain region;carcinoma;diabetes mellitus;Gaucher disease;gene expression;gene identification;genetic association;genetic variability;human;ischemic heart disease;liver cirrhosis;microarray analysis;nucleosome;physical chemistry;priority journal;structure analysis;sudden cardiac death;systems biology;transcription factor binding site,"Panigrahi, P. P.;Singh, T. R.",2013,,,0,
3344,Under-recognition of delirium in older adults by nurses in the intensive care unit setting,"Background: Nurses have the key roles to detect delirium in hospitalized older patients but under-recognition of delirium among nurses is prevalent. The objectives of this study were to identify the under-recognition rate of delirium by intensive care nurses (ICU) using Confusion Assessment Method for the ICU (CAM–ICU) and factors associated with under-recognition. Methods: Participants were older patients aged ≥65 years who were admitted to the ICU of Srinagarind Medical School, Khon Kaen, Thailand from May 2013 to August 2014. Baseline characteristics were collected. Delirium was rated by a trained clinical researcher using the CAM–ICU. Demographic data were analyzed using descriptive statistics. Univariate and multiple logistic regressions were used to analyze the outcomes. Results: Delirium occurred in 44 of 99 patients (44.4 %). Nurses could not identify delirium in 29.6 % of patients compared with researchers. Pre-existing dementia and depression were found in 47.7 % of patients. Pneumonia or other causes of respiratory failure were the most common causes of admission to ICU (47.7 %). Independent factors associated with under-recognition by nurses were identified—heart failure [adjusted odds ratio (OR), 77.8; 95 % confidence interval (CI) 2.5–2,543, p = 0.01] and pre-existing taking treatment with benzodiazepines (adjusted OR, 22.6; 95 % CI 1.8–85, p = 0.01). Discussion: Under-recognition of delirium is a frequent issue. New independent factors associated with under-recognition were identified. Awareness of delirium in the patients with these factors is recommended. Conclusions: This study supports the finding of high under-recognition rates of delirium among hospitalized older adults in ICU. Patients with heart failure and receiving benzodiazepines were identified as barriers of recognition of delirium.",benzodiazepine derivative;aged;article;asymptomatic disease;clinical article;Confusion Assessment Method for the Intensive Care Unit;controlled study;delirium;dementia;female;heart failure;human;intensive care;intensive care unit;male;nurse;nursing assessment;pneumonia;rating scale;respiratory failure;Thailand,"Panitchote, A.;Tangvoraphonkchai, K.;Suebsoh, N.;Eamma, W.;Chanthonglarng, B.;Tiamkao, S.;Limpawattana, P.",2015,,,0,
3345,Efficacy and safety of nimodipine in subcortical vascular dementia: A randomized placebo-controlled trial,"Background and Purpose-Evidence of drug efficacy in vascular dementia (VaD) is scanty. Therapeutic trials should address VaD subtypes. We studied the efficacy and safety of the calcium antagonist nimodipine in subcortical VaD. Methods-242 patients defined as affected by subcortical VaD based on clinical (ICD-10) and computed tomography criteria were randomized to oral nimodipine 90 mg/d or placebo. Results-230 patients (121 nimodipine, mean age 75.2±6.1; 109 placebo, 75.4±6.0) were valid for the intention-to-treat analysis. At 52 weeks, the Sandoz Clinical Assessment Geriatric scale 5-point variation (primary outcome measure) did not differ significantly between the 2 groups. However, patients on nimodipine performed better than placebo patients in lexical production (P<0.01) and less frequently showed deterioration (3 or more point-drop versus baseline) on a Mini-Mental State Examination (28.1% versus 50.5%; χ2 P<0.01) and Global Deterioration Scale (P<0.05). Dropouts and adverse events were all significantly more common among placebo than nimodipine patients, particularly cardiovascular (30 versus 13; RR, 2.26; 95% CI, 1.11 to 4.60) and cerebrovascular events (28 versus 10; RR, 2.48; 95% CI, 1.23 to 4.98), and behavioral disturbances requiring intervention (22 versus 5; RR, 3.88; 95% CI, 1.49 to 10.12). A worst-rank analysis, performed to correct for the effect of the high dropout rate in the placebo group, showed additional significant differences in favor of nimodipine in Set Test and MMSE total scores. Conclusions-Nimodipine may be of some benefit in subcortical VaD. Confirming previous results, the safety analysis of this study shows that in this high-risk population, nimodipine might protect against cardiovascular comorbidities. © 2005 American Heart Association, Inc.",calcium antagonist;nimodipine;placebo;adult;article;behavior disorder;cardiovascular disease;cerebrovascular disease;clinical trial;cognition;computer assisted tomography;controlled clinical trial;controlled study;double blind procedure;drug efficacy;drug safety;female;global deterioration scale;heart infarction;high risk population;human;hypertension;major clinical study;male;mental disease;Mini Mental State Examination;multicenter study;multiinfarct dementia;neurologic disease;priority journal;randomized controlled trial;rating scale;risk reduction;cerebrovascular accident;transient ischemic attack;treatment outcome,"Pantoni, L.;Del Ser, T.;Soglian, A. G.;Amigoni, S.;Spadari, G.;Binelli, D.;Inzitari, D.",2005,,,0,
3346,Differences in allele frequencies of ACE I/D polymorphism between Northern and Southern Europe at different ages,,"Adult;Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/*genetics;Europe;Female;Gene Frequency;Humans;Male;Middle Aged;Myocardial Infarction/*genetics;Peptidyl-Dipeptidase A/*genetics;Polymorphism, Genetic","Panza, F.;Capurso, C.;D'Introno, A.;Colacicco, A. M.;Kehoe, P. G.;Seripa, D.;Pilotto, A.;Capurso, A.;Solfrizzi, V.",2007,Aug,10.1016/j.atherosclerosis.2006.08.040,0,
3347,Vascular risk and genetics of sporadic late-onset Alzheimer's disease,"In recent years, it is becoming apparent that genes may play an important role in the development of late-onset Alzheimer's disease (LOAD), and genetic studies could unravel new clues. Based on a growing vascular hypothesis for the pathogenesis of LOAD and other dementias, there is increasing interest for environmental and genetic vascular factors. Polymorphisms in different susceptibility genes already implicated in vascular disease risk are now also being suggested as possible genetic markers for increased risk of developing LOAD; however, many of these studies have shown conflicting results. Thus far, the apolipoprotein E (APOE) gene seems to be the only vascular susceptibility factor that is agreed to play a role in the multifactorial pathogenesis of AD although emerging genetic and biological evidence is now strengthening the case for additional inclusion of angiotensin I-converting enzyme 1 (ACE1) into this category. This review will focus on the current knowledge on genetic and nongenetic vascular factors likely to be involved in LOAD, with special emphasis placed on the APOE and ACE1 genes.","5,10 methylenetetrahydrofolate reductase (FADH2);apolipoprotein E;aryldialkylphosphatase;dipeptidyl carboxypeptidase;endothelial nitric oxide synthase;low density lipoprotein receptor related protein;oxidized low density lipoprotein;oxidoreductase;Alzheimer disease;article;atherosclerosis;atherosclerotic plaque;cardiovascular risk;cerebrospinal fluid;cognitive defect;coronary artery disease;diabetes mellitus;disease course;DNA polymorphism;enzyme activity;enzyme blood level;gene deletion;gene frequency;gene insertion;gene location;gene sequence;genetic analysis;genetic risk;genetic screening;genetic susceptibility;genetic transcription;genetic variability;genotype;atrial fibrillation;heart infarction;heart left ventricle hypertrophy;heredity;human;hypertension;linkage analysis;memory disorder;neuropathology;onset age;phenotype;population distribution;prediction;priority journal;promoter region;protein binding;protein expression;protein localization;protein protein interaction;race difference;renin angiotensin aldosterone system;restenosis;sensitivity and specificity;sex difference;single nucleotide polymorphism;cerebrovascular accident;vascular disease","Panza, F.;D'Introno, A.;Colacicco, A. M.;Basile, A. M.;Capurso, C.;Kehoe, P. G.;Capurso, A.;Solfrizzi, V.",2004,,,0,
3348,Shifts in angiotensin I converting enzyme insertion allele frequency across Europe: implications for Alzheimer's disease risk,,"Aged;Aged, 80 and over;*Alleles;Alzheimer Disease/*genetics;Apolipoprotein E4;Apolipoproteins E/genetics;Coronary Disease/genetics;Europe;Female;Gene Frequency/*genetics;Genetic Predisposition to Disease/genetics;Genetics, Population;Humans;Male;Middle Aged;Mutagenesis, Insertional/*genetics;Peptidyl-Dipeptidase A/*genetics;Polymorphism, Genetic/*genetics;Topography, Medical","Panza, F.;Solfrizzi, V.;D'Introno, A.;Colacicco, A. M.;Capurso, C.;Capurso, A.;Kehoe, P. G.",2003,Aug,,0,
3349,Symptoms management at the end of life,"Numerous, well-defined symptoms are associated with end of life when death is caused by a chronic or debilitating illness (or both) such as cancer, HIV/AIDS, Alzheimer's dementia, and congestive heart failure. These symptoms, if unrelieved, are distressing to both the patients and their families and preclude any possibility of relieving psychological, social, and spiritual suffering, improving quality of life, or completing life closure. Therefore, the objective of this article is to identify some common symptoms at end of life and various management strategies for each.",Adult;Aged;*Attitude to Death;Female;Humans;Life Support Care/methods/*standards;Male;Middle Aged;Palliative Care/methods/*standards;Right to Die;Sensitivity and Specificity;Terminal Care/methods/standards;Terminally Ill,"Paolini, C. A.",2001,Oct,,0,
3350,Authors' reply to: The effects of vascular disease on late onset of Parkinson's disease (Jellinger) 2,,amyloid beta protein;apolipoprotein E4;Alzheimer disease;atherosclerosis;cerebrovascular disease;clinical feature;coronary artery disease;disease association;disease severity;atrial fibrillation;human;hypertension;ischemic heart disease;letter;multiinfarct dementia;neuropathology;Parkinson disease;priority journal;risk factor,"Papapetropoulos, S.",2006,,,0,
3351,Can Alzheimer's type pathology influence the clinical phenotype of Parkinson's disease?,"Objectives - Patients with clinical and pathological diagnosis of Parkinson's disease (PD) may, at death, also be found to have the pathological changes of Alzheimer's disease (AD). With this study we aim to determine the influence of AD pathology on the clinical phenotype of PD. Methods - We studied 64 patients who donated their brains to the University of Miami Brain Endowment Bank™ and fulfilled the clinical and pathological criteria for PD. For the evaluation of AD pathology we used the CERAD criteria. Dementia was diagnosed, in life, also using standard criteria. Case histories were abstracted and reviewed by one investigator (SP) who then made comparisons between patients. Results - Patients with AD pathology (PD-AD) were older both at the time of diagnosis and death. The presence of AD pathology did not seem to influence disease duration in our cohort of PD patients. As expected there was a clear relation between AD pathology and dementia but not all PD-AD patients were demented. Psychosis and depression were also found to be more prevalent in the PD-AD patients. In the comparison between demented and non-demented PD-AD patients dementia was more likely to appear in patients with PD and definite criteria for AD. Conclusion - Apart from dementia AD pathology seems to be associated with a number of other clinical characteristics of PD. © Blackwell Munksgaard 2005.",amantadine;antidepressant agent;benzodiazepine;catechol methyltransferase inhibitor;cholinergic receptor blocking agent;dopamine receptor stimulating agent;levodopa;neuroleptic agent;selegiline;adult;aged;Alzheimer disease;article;aspiration pneumonia;brain;neoplasm;controlled study;death;depression;disease duration;female;heart failure;human;infection;ischemic heart disease;major clinical study;male;organ donor;Parkinson disease;phenotype;pneumonia;psychosis;respiratory failure;cerebrovascular accident,"Papapetropoulos, S.;Lieberman, A.;Gonzalez, J.;Mash, D. C.",2005,,,0,
3352,Clinical heterogeneity of the LRRK2 G2019S mutation,"Background: Several pathogenic mutations have been reported in the leucine-rich repeat kinase 2 gene (LRRK2) that cause parkinsonism. The ""common"" LRRK2 G2019S kinase domain substitution has been reported to account for approximately 5% of familial and 1% of sporadic Parkinson disease. Objective: To observe the clinical heterogeneity presented by LRRK2 kinase mutation carriers. Design, Setting, and Participants: We screened 130 patients with pathologically confirmed Parkinson disease and 85 controls for 3 LRRK2 kinase domain pathogenic substitutions: I2012T, G2019S, and I2020T. Main Outcome Measures: Detailed clinical phenotypes for individuals who screened positive for LRRK2 mutations. Results: Five LRRK2 G2019S carriers were identified, of whom 4 had Parkinson disease (clinically and pathologically confirmed), and the fifth was a control subject who died at age 68 years after an acute myocardial infarction with no evidence of neurodegenerative abnormalities. There was no evidence of the I2012T or I2020T mutation in these participants. Conclusions: The underlying disease mechanisms of LRRK2 G2019S-associated parkinsonism are similar to those of typical Parkinson disease. The identification of a control subject raises important questions concerning genetic diagnosis and counseling. © 2006 American Medical Association. All rights reserved.",amantadine;amitriptyline;antidepressant agent;bromocriptine mesilate;cholinergic receptor blocking agent;entacapone;leucine rich repeat kinase 2;levodopa;pergolide;pramipexole;protein kinase;selegiline;unclassified drug;venlafaxine;acute heart infarction;adult;aged;amino acid substitution;article;case report;clinical feature;controlled study;degenerative disease;depression;diffuse Lewy body disease;drug dose regimen;dyskinesia;female;gene mutation;genetic heterogeneity;genetic screening;heterozygote;human;male;motor dysfunction;on off phenomenon;Parkinson disease;phenotype;priority journal;protein domain,"Papapetropoulos, S.;Singer, C.;Ross, O. A.;Toft, M.;Johnson, J. L.;Farrer, M. J.;Mash, D. C.",2006,,,0,
3353,Application of neural networks in medicine - A review,"The main aim of research in medical diagnostics is to develop more exact, cost-effective and easy-to-use systems, procedures and methods for supporting clinicians. In this paper the authors introduce a new method that recently came into the focus referred to as computer generated neural networks. Based on the literature of the past 5-6 years they give a brief review - highlighting the most important articles - showing the idea behind neural networks and where they are used in the medical field. The definition, structure and operation of neural networks are discussed. In the application section they discuss examples in order to give an insight into neural network application research. It is emphasized that in the near future completely new diagnostic equipment can be developed based on this new technology in the field of ECG, EEG and macroscopic and microscopic image analysis systems.",article;artificial neural network;breast cancer;computer analysis;cornea;dementia;electrocardiogram;electroencephalogram;hearing;heart infarction;human;intensive care;liver resection;lung nodule;nerve cell network;neurophysiology;signal processing;simulation,"Papik, K.;Molnar, B.;Schaefer, R.;Dombovari, Z.;Tulassay, Z.;Feher, J.",1998,,,0,
3354,A complex elder care simulation using improvisational actors,"Complex simulations can facilitate students' synthesis of knowledge. Simulations of cognitively impaired elders provide nursing students the opportunity to use critical thinking and clinical decision-making skills in complex patient care situations. The authors report their experiences in designing, implementing, and evaluating a simulation on cognitive problems in elders using actors. This simulation required third-year baccalaureate nursing students to differentiate delirium from dementia, identify symptoms of heart failure, and address a family member's concerns.","Clinical Competence;Cognition Disorders;Decision Making;Education, Nursing, Baccalaureate/*methods;Geriatric Nursing/*education/methods;Humans;*Patient Care Planning;*Patient Simulation;Program Development;*Students, Nursing","Paquette, M.;Bull, M.;Wilson, S.;Dreyfus, L.",2010,Nov-Dec,10.1097/NNE.0b013e3181f7f197,0,
3355,The interaction of injury and disease in the elderly: A case report of fatal elder abuse,"We report a case of an elderly demented woman who died of a mitral rheumatic valvular disease in the context of multiple injuries and from elder abuse. History from police investigation indicated that the deceased was found collapsed on the floor in her bedroom for several days prior to death by her son who did not initiate medical care. Autopsy revealed a frail elderly woman with Alzheimer's disease and evidence of multiple healing sublethal blunt impact injuries of the face, mouth, neck, upper chest, and extremities. In addition, there was unwashed dirt encrusted skin, urine/fecal staining of skin and clothing, dirty overgrown toenails, and matting of the hair. This constellation of findings supports the medical diagnosis of elder abuse with neglect. However, the immediate cause of death was the left-sided congestive heart failure from mitral rheumatic valvular disease. Although the underlying cause of death was related to the chronic cardiac condition, the physical abuse and neglect was considered significant contributing factors to death, since physiologically the injuries and lack of medical treatment was thought to have hastened death by exacerbating the underlying heart disease. This case underscores the need for the forensic pathologist to consider contextual variables and sublethal injuries in cases were the causal interpretations benefit from a more holistic approach. Otherwise, cases like such as the one reported can go unnoticed and certified as a simple natural death. © 2009 Elsevier Ltd and Faculty of Forensic and Legal Medicine.",abuse;aged;Alzheimer disease;article;autopsy;case report;cause of death;congestive heart failure;disease exacerbation;fatality;female;forensic pathology;human;mitral valve disease;multiple trauma;neglect;rheumatic heart disease;wound healing,"Paranitharan, P.;Pollanen, M. S.",2009,,,0,
3356,Exercise as a Polypill for Chronic Diseases,"Exercise may be described as a polypill to prevent and/or treat almost every chronic disease, with obvious benefits such as its low cost and practical lack of adverse effects. Implementing physical activity interventions in public health is therefore a goal at the medical, social, and economic levels. This chapter describes the importance of health promotion through physical activity and discusses the impacts of exercise on the most prevalent chronic diseases, namely metabolic syndrome-related disorders, cardiovascular diseases, cancer, and Alzheimer's disease. For each of these chronic conditions, we discuss the epidemiological evidence supporting a beneficial role of exercise, provide guidelines for exercise prescription, and describe the biological mechanisms whereby exercise exerts its modulatory effects.",Alzheimer's disease;Cancer;Chronic diseases;Coronary heart disease;Dyslipidemia;Hypertension;Metabolic syndrome;Obesity;Physical activity;Type 2 diabetes,"Pareja-Galeano, H.;Garatachea, N.;Lucia, A.",2015,,10.1016/bs.pmbts.2015.07.019,0,
3357,Simvastatin treatment enhances NMDAR-mediated synaptic transmission by upregulating the surface distribution of the GluN2B subunit,"The ramifications of statins on plasma cholesterol and coronary heart disease have been well documented. However, there is increasing evidence that inhibition of the mevalonate pathway may provide independent neuroprotective and procognitive pleiotropic effects, most likely via inhibition of isoprenoids, mainly farnesyl pyrophosphate (FPP) and geranylgeranyl pyrophosphate (GGPP). FPP and GGPP are the major donors of prenyl groups for protein prenylation. Modulation of isoprenoid availability impacts a slew of cellular processes including synaptic plasticity in the hippocampus. Our previous work has demonstrated that simvastatin (SV) administration improves hippocampus-dependent spatial memory, rescuing memory deficits in a mouse model of Alzheimer's disease. Treatment of hippocampal slices with SV enhances long-term potentiation (LTP), and this effect is dependent on the activation of Akt (protein kinase B). Further studies showed that SV-induced enhancement of hippocampal LTP is driven by depletion of FPP and inhibition of farnesylation. In the present study, we report the functional consequences of exposure to SV at cellular/synaptic and molecular levels. While application of SV has no effect on intrinsic membrane properties of CA1 pyramidal neurons, including hyperpolarization-activated cyclic-nucleotide channel-mediated sag potentials, the afterhyperpolarization (AHP), and excitability, SV application potentiates the N-methyl D-aspartate receptor (NMDAR)-mediated contribution to synaptic transmission. In mouse hippocampal slices and human neuronal cells, SV treatment increases the surface distribution of the GluN2B subunit of the NMDAR without affecting cellular cholesterol content. We conclude that SV-induced enhancement of synaptic plasticity in the hippocampus is likely mediated by augmentation of synaptic NMDAR components that are largely responsible for driving synaptic plasticity in the CA1 region.","Animals;Cell Line, Tumor;Cell Membrane/drug effects/*metabolism;Hippocampus/drug effects/metabolism;Humans;Male;Mice;Mice, Inbred C57BL;Organ Culture Techniques;Protein Subunits/*biosynthesis;Receptors, N-Methyl-D-Aspartate/*biosynthesis/physiology;Simvastatin/*pharmacology;Synaptic Transmission/drug effects/*physiology;Up-Regulation/drug effects/*physiology","Parent, M. A.;Hottman, D. A.;Cheng, S.;Zhang, W.;McMahon, L. L.;Yuan, L. L.;Li, L.",2014,Jul,10.1007/s10571-014-0051-z,0,
3358,Gastric dilation due to a neuroleptic agent in an elderly patient: A case report,"Neuroleptics may cause side effects, some of which are little known. We describe here a case of gastric dilation related to treatment with a neuroleptic in an elderly man. To our knowledge, such a case has never been reported in the literature. A 76-year-old man, living in a nursing home, was hospitalized for general weakness and abdominal pain. He had dementia with behavioral disorders treated with cyamemazine, a sedative and anxiolytic neuroleptic. Given a clinical suspicion of intestinal occlusion, an abdominopelvic computerized tomography scan was performed before the patient was admitted to our hospital. This computerized tomography scan did not show intestinal occlusion and there was no mention of gastric dilation in the computerized tomography scan report. Thus, acute gastroenteritis was suspected. The usual medications were stopped and symptomatic treatment for gastroenteritis was started. Quickly, his clinical state and biological parameters returned to normal and his usual treatment, including cyamemazine, was started again. The next day, the digestive symptoms, except for obstipation, reappeared. The abdominal X-ray showed gastric dilation without intestinal occlusion. The neuroleptic was stopped again and symptoms vanished the next day. This report underlines all of the necessary precautions and surveillance around drug prescription, especially in elderly persons.",alanine aminotransferase;aspartate aminotransferase;atorvastatin;C reactive protein;creatinine;cyamemazine;glucose;glycosylated hemoglobin;hydroxyzine;insulin;paracetamol;tamsulosin;urea;abdominal distension;abdominal pain;abdominal radiography;acute gastroenteritis;aged;alanine aminotransferase blood level;article;aspartate aminotransferase blood level;auscultation;behavior disorder;case report;chronic kidney failure;clinical examination;computer assisted tomography;constipation;creatinine blood level;dementia;diet restriction;drug withdrawal;dyslipidemia;fatty liver;gastric dilation;gastroenteritis;glucose blood level;health status;heart failure;hemoglobin blood level;hospitalization;human;hypertension;intestine obstruction;intestine sound;male;medical history;neutrophil count;non insulin dependent diabetes mellitus;palliative therapy;priority journal;prostate adenoma;protein blood level;sleep disordered breathing;stomach disease;urea blood level;vomiting;weakness,"Parent, V.;Popitean, L.;Loctin, A.;Camus, A.;Manckoundia, P.",2015,,,0,
3359,The factors in decreased blood flow in the carotid arteries,"The circulation volume (CV) in the carotid arteries (CA) has been studied at ultrasonic duplex scanning in 219 patients with a history of acute cerebral circulation disturbance (ACCD), 26 patients with vascular dementia (VD) and in 54 healthy controls. Reduced CV in CA was registered both in ACCD and VD patients who had or were of CA stenosis. More severe fall of CV in CA for VD patients was not associated with increasing occlusion of CA. In the absence of obvious cardiac affection (fibrillation, myocardial infarction) in ACCD and VD patients echocardiography recorded insignificant reduction of myocardial contractility and cardiac output. The majority of these patients without cardiac disease or CA stenosis had arterial hypertension which is supposed to be an essential factor of CV lowering in CA.","Acute Disease;Blood Volume;Carotid Artery, Common/*physiopathology/ultrasonography;Carotid Stenosis/physiopathology/ultrasonography;*Cerebrovascular Circulation;Cerebrovascular Disorders/physiopathology/ultrasonography;Dementia, Vascular/physiopathology/ultrasonography;Female;Hemodynamics;Humans;Hypertension/physiopathology/ultrasonography;Male;Middle Aged;Ultrasonography, Doppler, Transcranial","Parfenov, V. A.;Gorbacheva, F. E.",1994,,,0,
3360,"A phase I study of a new polyamine bioosynthesis inhibitor, SAM486A, in cancer patients with solid tumours","Because tumour cell proliferation is highly dependent upon up-regulation of de-novo polyamine synthesis, inhibition of the polyamine synthesis pathway represents a potential target for anticancer therapy. SAM486A (CGP 48664) is a new inhibitor of the polyamine biosynthetic enzyme S-adenosylmethionine decarboxylase (SAMDC), more potent and specific than the first-generation SAMDC inhibitor methylglyoxal (bis) guanylhydrazone (MGBG). Preclinical testing confirmed promising antiproliferative activity. In this phase I study, SAM486A was given 4-weekly as a 120 h infusion. 39 adult cancer patients were enrolled with advanced/refractory disease not amenable to established treatments, PS ≤ 2, adequate marrow, liver, renal and cardiac function. Doses were escalated in 100% increments without toxicity in 24 pts from 3 mg m-2 cycle-1 up to 400 mg m-2 cycle-1. At 550 and 700 mg m-2 cycle-1 reversible dose-limiting neutropenia occurred. Other toxicities included mild fatigue, nausea and vomiting. No objective remission was seen. Pharmakokinetic analysis showed a terminal half-life of approximately 2 days. AUC and Cmax were related to dose; neutropenia correlated with AUC. The recommended dose for further phase II studies on this schedule is 400 mg m-2 cycle-1. (C) 2000 Cancer Research Campaign.",sardomozide;adenosylmethionine decarboxylase;antiemetic agent;fluorouracil;mitoguazone;polyamine;adult;aged;anorexia;antineoplastic activity;article;asthenia;blood toxicity;bone marrow;cancer staging;clinical article;clinical trial;dementia;drug efficacy;drug half life;drug infusion;drug safety;drug tolerance;drug toxicity;fatigue;female;granulocytopenia;heart function;human;kidney function;liver disease;liver function;male;mucosa inflammation;nausea;neutropenia;phase 1 clinical trial;polyamine synthesis;priority journal;rash;solid tumor;somnolence;vomiting;cgp 48664;sam 486a,"Paridaens, R.;Uges, D. R. A.;Barbet, N.;Choi, L.;Seeghers, M.;Van Der Graaf, W. T. A.;Groen, H. J. M.;Dumez, H.;Van Buuren, I.;Muskiet, F.;Capdeville, R.;Van Oosterom, A. T.;De Vries, E. G. E.",2000,,,0,
3361,Study findings hard to interpret: Reply 2,,antidepressant agent;anxiolytic agent;atypical antipsychotic agent;cholinesterase inhibitor;neuroleptic agent;clinical research;dementia;drug tolerability;external validity;heart death;heart infarction;human;note;patient compliance;priority journal,"Pariente, A.;Fourrier-Reáglat, A.;Moride, Y.",2012,,,0,
3362,Antipsychotic use and myocardial infarction in older patients with treated dementia,"BACKGROUND: Antipsychotic agents (APs) are commonly prescribed to older patients with dementia. Antipsychotic use is associated with an increased risk of ischemic stroke in this population. Our study aimed to investigate the association of AP use with the risk of acute myocardial infarction (MI). METHODS: A retrospective cohort of community-dwelling older patients who initiated cholinesterase inhibitor treatment was identified between January 1, 2000, and December 31, 2009, using the Quebec, Canada, prescription claims database. From this source cohort, all new AP users during the study period were matched with a random sample of AP nonusers. The risk of MI was evaluated using Cox proportional hazards models, adjusting for age, sex, cardiovascular risk factors, psychotropic drug use, and propensity scores. In addition, a self-controlled case series study using conditional Poisson regression modeling was conducted. RESULTS: Among the source cohort of 37,138 cholinesterase inhibitor users, 10,969 (29.5%) initiated AP treatment. Within 1 year of initiating AP treatment, 1.3% of them had an incident MI. Hazard ratios for the risk of MI after initiation of AP treatment were 2.19 (95% CI, 1.11-4.32) for the first 30 days, 1.62 (95% CI, 0.99-2.65) for the first 60 days, 1.36 (95% CI, 0.89-2.08) for the first 90 days, and 1.15 (95% CI, 0.89-1.47) for the first 365 days. The self-controlled case series study conducted among 804 incident cases of MI among new AP users yielded incidence rate ratios of 1.78 (95% CI, 1.26-2.52) for the 1- to 30-day period, 1.67 (95% CI, 1.09-2.56) for the 31- to 60-day period, and 1.37 (95% CI, 0.82-2.28) for the 61- to 90-day period. CONCLUSION: Antipsychotic use is associated with a modest and time-limited increase in the risk of MI among community-dwelling older patients treated with cholinesterase inhibitors.","Aged;Aged, 80 and over;Antipsychotic Agents/*therapeutic use;Case-Control Studies;Cholinesterase Inhibitors/*therapeutic use;Cohort Studies;Confounding Factors (Epidemiology);Dementia/*drug therapy;Drug Prescriptions/statistics & numerical data;Female;Humans;Male;Myocardial Infarction/*chemically induced/*epidemiology;Poisson Distribution;Proportional Hazards Models;Quebec/epidemiology;Residence Characteristics;Retrospective Studies;Risk Assessment;Risk Factors;Time Factors","Pariente, A.;Fourrier-Reglat, A.;Ducruet, T.;Farrington, P.;Beland, S. G.;Dartigues, J. F.;Moore, N.;Moride, Y.",2012,Apr 23,10.1001/archinternmed.2012.28,0,
3363,Gender-related differences in patients with acute heart failure: Management and predictors of in-hospital mortality,"Aim and methods: Gender-related differences in clinical phenotype, in-hospital management and prognosis of acute heart failure (AHF) patients have been previously reported in European and US registries. The ALARM-HF survey is the first to include a cohort of 4953 patients hospitalized for AHF in 666 hospitals in 6 European countries, Mexico and Australia. Results: Women accounted for 37% of the study population, were older and had higher rates of de novo heart failure (45% vs 36%, p < 0.001) than men. An acute coronary syndrome (ACS) was the predominant precipitating factor in both genders, but to a lesser extent in females (30% vs 42%, p < 0.001). Between genders comparison showed higher incidence of atrial fibrillation, valvular heart disease, diabetes, obesity, anemia and depression in women (p < 0.05). Similarly, women had higher left ventricular ejection fraction (LVEF) on admission (42 ± 15% vs 36 ± 13%, p < 0.001) and systolic blood pressure (135 ± 40 mm Hg vs 131 ± 39 mm Hg, p = 0.001) than men. On the other hand, men had more often coronary artery disease, renal failure and chronic obstructive pulmonary disease (p < 0.05). Importantly, in-hospital mortality was similar in both genders (11.1% in females vs 10.5% in males, p = 0.475), and its common predictors were: systolic blood pressure at admission, creatinine > 1.5 mg/dL and diabetes. Furthermore, recent ACS, valvular heart disease and dementia contributed to prognosis in women, while LVEF, hypertension and anemia were independent predictors in men. Conclusion: Among patients with AHF, there are significant differences in co-morbidities, precipitating factors and predictors of in-hospital mortality between genders. Nevertheless, in-hospital mortality remains similar between genders. © 2012 Elsevier Ireland Ltd. All rights reserved.",acetylsalicylic acid;adrenalin;amiodarone;antivitamin K;beta adrenergic receptor blocking agent;calcium channel blocking agent;clopidogrel;creatinine;digitalis;diuretic agent;dobutamine;dopamine;levosimendan;natriuretic factor;nitrate;nitric acid derivative;noradrenalin;sodium;troponin;uric acid;acute coronary syndrome;acute heart failure;adult;aged;anemia;article;artificial ventilation;Australia;body mass;cardiovascular mortality;chronic obstructive lung disease;cohort analysis;comorbidity;controlled study;coronary artery bypass graft;coronary artery disease;coronary care unit;dementia;depression;diabetes mellitus;Europe;female;health survey;atrial fibrillation;heart atrium pacemaker;heart left ventricle ejection fraction;heart rate;hemodynamics;hospital admission;hospitalization;human;hypertension;incidence;intensive care;intensive care unit;intraaortic balloon pump;kidney failure;major clinical study;male;Mexico;multivariate analysis;obesity;outcome assessment;phenotype;positive end expiratory pressure;prediction;priority journal;prognosis;sex difference;sodium blood level;systolic blood pressure;treatment indication;uric acid blood level;valvular heart disease,"Parissis, J. T.;Mantziari, L.;Kaldoglou, N.;Ikonomidis, I.;Nikolaou, M.;Mebazaa, A.;Altenberger, J.;Delgado, J.;Vilas-Boas, F.;Paraskevaidis, I.;Anastasiou-Nana, M.;Follath, F.",2013,,,0,
3364,The association between polypharmacy and dementia: A nested case-control study based on a 12-year longitudinal cohort database in South Korea,"Dementia is a major concern among growing chronic diseases in the aging society and its association with polypharmacy has not been adequately assessed. The objective of this study was to determine the association between polypharmacy and dementia through multiple statistical approaches. We conducted a nested case-control study for newly diagnosed dementia cases using the South Korean National Health Insurance Service sample cohort database (2002±2013, n = 1,025,340). Interactions between polypharmacy (an average use of <5 prescription drugs daily) and comorbidities or potentially inappropriate medications (PIMs) were tested. The odds ratios (ORs) for dementia were analyzed according to the presence of comorbidities, PIM uses, the average number of prescribed daily drugs, and significant interactions with polypharmacy using univariate and multiple logistic regression analyses. A higher prevalence of comorbidities, history of PIM use, higher PIM exposure, and higher proportion of polypharmacy were noted among cases than in controls. In the univariate analysis, the OR for dementia increased significantly with the increase in the number of prescribed drugs [1±<5 drugs: 1.72, 95% confidence interval (CI): 1.56±1.88; 5±<10 drugs: 2.64, 95% CI: 2.32±3.05; <10 drugs: 3.35, 95% CI: 2.38±4.71; <1 drug used as reference]. Polypharmacy was correlated with comorbidities and PIM use, and significant interactions were observed between polypharmacy and anticholinergics; H2-receptor antagonists; and comorbidities such as hypertension, peripheral or cerebrovascular disease, congestive heart failure, hemiplegia, diabetes, depression, all other mental disorders, chronic obstructive pulmonary disease, peptic ulcer disease, and chronic liver disease (p<0.001). In the multiple regression analysis, most cases exhibited increasing ORs for dementia with increasing polypharmacy levels. Moreover, the increase in OR was more evident in the absence of drugs or comorbidities that showed significant interactions with polypharmacy than in their presence. Polypharmacy increases the risk of PIM administration, and as some PIMs may have cognition-impairing effects, prolonged polypharmacy may result in dementia. Therefore, efforts are needed to limit or decrease the prescription of medications that have been associated with risk of dementia in the elderly.",aged;article;chronic liver disease;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;disease association;exposure;female;hemiplegia;human;hypertension;longitudinal study;major clinical study;male;mental disease;peptic ulcer;polypharmacy;South Korea,"Park, H. Y.;Park, J. W.;Song, H. J.;Sohn, H. S.;Kwon, J. W.",2017,,10.1371/journal.pone.0169463,0,
3365,Levels of Soluble Receptor for Advanced Glycation End Products in Acute Ischemic Stroke without a Source of Cardioembolism,"BACKGROUND AND PURPOSE: Low levels of soluble receptor for advanced glycation end products (sRAGE) are associated with three conventional vascular risk factors (3Fs: diabetes, hypertension, and hypercholesterolemia), nondiabetic coronary artery disease, and Alzheimer's disease. However, the association between sRAGE and acute ischemic stroke (AS), especially AS without a source of cardioembolism, has not yet been established. METHODS: Patients with AS without a source of cardioembolism (n=259) and age-matched controls (n=300) were grouped according to the presence of 3Fs: AS patients with and without 3Fs (3Fs+ AS and 3Fs- AS, respectively) and controls with and without 3Fs (3Fs+ control and 3Fs- control, respectively). Levels of sRAGE were analyzed among the four groups. RESULTS: sRAGE was significantly higher in the controls than in the AS patients (855 pg/mL vs. 690 pg/mL, p<0.01). sRAGE was significantly higher in 3Fs- controls (996 pg/mL, p<0.05) than in 3Fs+ controls (721 pg/mL), and in AS group regardless of the 3Fs (629 pg/mL in 3Fs- and 705 pg/mL in 3Fs+). The lowest tertile of sRAGE was associated with an increased risk of AS in the 3Fs- group [adjusted odds ratio (OR) 4.0, 95% confidence interval (CI) 1.6-10.3, p<0.01] but not in the 3Fs+ group. The level of sRAGE was also correlated with neurological severity in the 3Fs- AS group (r=-0.32, p<0.05) but not in the 3Fs+ AS group. CONCLUSIONS: Low plasma levels of sRAGE is a potential biomarker for the risk of AS and may reflect the neurological severity of the condition, especially in subjects without identifiable conventional risk factors.",diabetes;hypercholesterolemia;hypertension;soluble receptor for advanced glycation end products;stroke,"Park, H. Y.;Yun, K. H.;Park, D. S.",2009,Sep,10.3988/jcn.2009.5.3.126,0,
3366,The impact of cellular networks on disease comorbidity,"The impact of disease-causing defects is often not limited to the products of a mutated gene but, thanks to interactions between the molecular components, may also affect other cellular functions, resulting in potential comorbidity effects. By combining information on cellular interactions, disease - gene associations, and population-level disease patterns extracted from Medicare data, we find statistically significant correlations between the underlying structure of cellular networks and disease comorbidity patterns in the human population. Our results indicate that such a combination of population-level data and cellular network information could help build novel hypotheses about disease mechanisms. © 2009 EMBO and Macmillan Publishers Limited.",Alzheimer disease;article;autonomic neuropathy;bacterial gene;breast cancer;carpal tunnel syndrome;cell function;cell interaction;comorbidity;data base;disease association;genetic disorder;heart infarction;heredity;human;hypothesis;International Classification of Diseases;medicare;population;priority journal;statistical significance,"Park, J.;Lee, D. S.;Christakis, N. A.;Barabási, A. L.",2009,,,0,
3367,SPECT myocardial perfusion in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,"ABSTRACT: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare hereditary small vessel disease. Although the symptoms are exclusively neurological, arteriopathy is generalized. We performed cardiac evaluation using myocardial perfusion single photon emission computed tomography (SPECT), dual-source 128-channel multidetector computed tomography (MDCT) angiogram, echocardiogram, and electrocardiogram (ECG) in a 46-year-old woman with CADASIL. No abnormal findings were observed on MDCT angiogram, echocardiogram, or ECG. However, SPECT demonstrated reversible perfusion defects in the left anterior descending artery territory. We suggest that myocardial perfusion SPECT is a valuable tool to identify risk from cardiovascular accident in CADASIL patients. Copyright © 2013 Lippincott Williams & Wilkins.",adult;article;CADASIL;cardiac imaging;case report;computed tomographic angiography;echocardiography;electrocardiogram;evaluation study;female;heart muscle perfusion;human;left anterior descending coronary artery;multidetector computed tomography;single photon emission computer tomography,"Park, S. A.;Cho, K. H.;Kim, N. H.;Yang, C. Y.;Park, S. H.",2013,,,0,
3368,Kearns-Sayre syndrome -3 case reports and review of clinical feature,"Kearns-Sayre syndrome, first described by Kearns and Sayre in 1958, is a rare disorder consisting of ptosis, limited movement of both eyes and atypical retinal pigmentary change (salt-pepper like appearance). Most cases have shown an increase in the concentration of mitochondria and ragged-red fiber under Gomori-trichrome staining on muscle biopsy. Occasionally, it is combined with other neurologic and endocrinologic symptoms such as ataxia, dementia, diabetes, and hyperaldosteronism. We recently experienced three cases of male teenaged patients who expressed the clinical features of Kearns-Sayre syndrome.",ubidecarenone;adolescent;adult;anamnesis;article;ataxia;case report;clinical feature;dementia;diabetes mellitus;disorders of mitochondrial functions;eye movement disorder;heart right bundle branch block;heart ventricle extrasystole;histopathology;Holter monitoring;human;human tissue;hyperaldosteronism;Kearns Sayre syndrome;male;mitochondrion;muscle biopsy;ptosis;rare disease;retina pigment degeneration;strabismus;visual system examination,"Park, S. B.;Ma, K. T.;Kook, K. H.;Lee, S. Y.",2004,,,0,
3369,Cyclooxygenase-2 Inhibitors and Cardivascular Risk,"Serious concerns about the cardiovascular safety of rofecoxib had been present since the VIOXX(R) Gastrointestinal Outcomes Research (VIGOR) study first suggested that the drug may increase the risk of myocardial infarction. Subsequent data from major observational studies further implicated the association of rofecoxib with arterial thromboembolic disease. In September 2004, rofecoxib was withdrawn from the worldwide market based on the safety findings of the Adenomatous Polyp Prevention on VIOXX (APPROVe) study, which indicated an increase risk of myocardial infarction and stroke among subjects randomized to rofecoxib. In December 2004, the results of the Adenoma Prevention with Celecoxib (APC) study demonstrated a dose-related increase in the risk of cardiovascular events among patients randomized to celecoxib when compared with placebo. Two other large prospective prevention studies of celecoxib, the Prevention of Spontaneous Adenomatous Polyps (Pre SAP) trial and the Alzheimer's Disease Antiinflammatory Prevention Trial (ADAPT) did not show any sign of increased cardiovascular risk. None of the reported randomized trials studying any COX-2 selective imhibitor, thus far, has been specifically designed to examine cardiovascular outcomes. Hence, no cardiovascular hypotheses have yet been formally tested. Long-term and adequately powered prospective randomized clinical trials in relevant patient populations with clinically appropriate pre-specified cardiovascular end-points, ideally comparing COX-2 selective inhibitors with traditional NSAIDs, are required. Until these trials are completed, careful risk:benefit analysis of any putative increase in cardiovascular risk versus known gastrointestinal benefit for individual agents needs to be undertaken. [By kind permission, KoreaMed, Korean Association of Medical Journal Editors.]",Hs-handsrch: hs-acc: hs-koreamed,"Park, Yb",2005,,,0,
3370,Cyclooxygenase-2 Inhibitors and Cardivascular Risk,"Serious concerns about the cardiovascular safety of rofecoxib had been present since the VIOXX(R) Gastrointestinal Outcomes Research (VIGOR) study first suggested that the drug may increase the risk of myocardial infarction. Subsequent data from major observational studies further implicated the association of rofecoxib with arterial thromboembolic disease. In September 2004, rofecoxib was withdrawn from the worldwide market based on the safety findings of the Adenomatous Polyp Prevention on VIOXX (APPROVe) study, which indicated an increase risk of myocardial infarction and stroke among subjects randomized to rofecoxib. In December 2004, the results of the Adenoma Prevention with Celecoxib (APC) study demonstrated a dose-related increase in the risk of cardiovascular events among patients randomized to celecoxib when compared with placebo. Two other large prospective prevention studies of celecoxib, the Prevention of Spontaneous Adenomatous Polyps (Pre SAP) trial and the Alzheimer's Disease Antiinflammatory Prevention Trial (ADAPT) did not show any sign of increased cardiovascular risk. None of the reported randomized trials studying any COX-2 selective imhibitor, thus far, has been specifically designed to examine cardiovascular outcomes. Hence, no cardiovascular hypotheses have yet been formally tested. Long-term and adequately powered prospective randomized clinical trials in relevant patient populations with clinically appropriate pre-specified cardiovascular end-points, ideally comparing COX-2 selective inhibitors with traditional NSAIDs, are required. Until these trials are completed, careful risk:benefit analysis of any putative increase in cardiovascular risk versus known gastrointestinal benefit for individual agents needs to be undertaken. [By kind permission, KoreaMed, Korean Association of Medical Journal Editors.]",Hs-handsrch: hs-acc: hs-koreamed,"Park, Y. B.",2005,,,0,3369
3371,Fatal rhabdomyolysis in a patient with head injury,"Rhabdomyolysis is a rare but potentially life-threatening disorder caused by the release of injured skeletal muscle components into the circulation. The authors report a case of severe head injury, in which a hyperosmolar state and continuous seizure complicated by severe rhabdomyolysis and acute renal failure evolved during the course of treatment resulted in a fatal outcome despite intensive supportive treatment. Our bitter experience suggests that rhabdomyolysis should be born in mind in patients with severe head injury who may develop hyperosmolar state and continuous seizure. © 2013 The Korean Neurosurgical Society.",anticonvulsive agent;creatinine;mannitol;myoglobin;potassium;sodium;acute kidney failure;adult;anticonvulsant therapy;anuria;article;brain contusion;brain edema;cardiopulmonary insufficiency;case report;comatose patient;computer assisted tomography;creatinine blood level;decerebration;disease activity;disease severity;diuresis;emergency health service;emergency ward;epidural hematoma;fatality;fluid therapy;Glasgow coma scale;head injury;hemodialysis;human;hydration;hyperosmolarity;hyperventilation;intensive care unit;intracranial pressure;male;mental deterioration;mydriasis;myoglobinuria;osmolarity;potassium blood level;protein blood level;rhabdomyolysis;seizure;sodium blood level;tonic clonic seizure;traffic accident,"Park, Y. J.;Kim, S. W.",2013,,,0,
3372,The burden of common chronic disease on healthrelated quality of life in an elderly communitydwelling population in the UK,"Background. Given the high prevalence of chronic conditions and multimorbidity in the elderly, there is a need to determine which chronic conditions have the greatest impact on health-related quality of life (HRQL) and identify where additional intervention may be required. Objective. To explore the impact of a range of common chronic conditions on HRQL in a community- based population aged 65 years or more in the UK. Methods. Secondary analysis of data derived from a large (n = 5849) cross-sectional study. HRQL was assessed using the EuroQoL EQ-5D. Multivariable models were used to estimate the relative effect of 15 individual common chronic conditions and combinations of these conditions on HRQL. Results. Mean age of participants was 74.6 years, 49.2% were male. The mean EQ-5D index score was 0.78 (standard deviation 0.2), range -0.43 to 1.00. Overall, 53% (n = 3078) of the cohort reported problems with pain, 39% (n = 2273) with mobility and 9% (n = 529) with self-care. Multivariate modelling demonstrated that impaired HRQL was significantly associated with 13 of the 15 common chronic conditions studied. Clinically meaningful reductions in EQ-5D index scores were observed for osteoarthritis (-0.081, P = 0.0006), neurological disease (-0.172, P < 0.0001) and depression (-0.269, P < 0.001). Conclusions. This study quantifies the relative impact of 13 common chronic conditions on HRQL in a UK-based community-dwelling ageing population. Findings indicate that osteoarthritis, depression and neurological disease have a strong clinically important negative effect on HRQL. These findings may help clinical decision making and priority setting for management of individuals with multimorbidity.",aged;anxiety;article;cerebrovascular accident;chronic disease;cross-sectional study;dementia;depression;diabetes mellitus;elderly care;female;heart arrhythmia;heart failure;human;hypertension;ischemic heart disease;kidney disease;lung disease;major clinical study;male;neurologic disease;osteoarthritis;pain;physical mobility;quality of life;rheumatoid arthritis;self care;transient ischemic attack;United Kingdom;vascular disease,"Parker, L.;Moran, G. M.;Roberts, L. M.;Calvert, M.;McCahon, D.",2014,,,0,
3373,New Horizons in Comprehensive Geriatric Assessment,"In this article, we discuss the emergence of new models for delivery of Comprehensive Geriatric Assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home and institutionalisation. Traditionally It is delivered by specialised multidisciplinary teams, often in dedicated wards, but in recent years has begun to be taken up and developed quite early in the admission process (at the 'front door'), across traditional ward boundaries and in specialty settings such as surgical and preoperative care, and oncology. We have scanned recent literature, including observational studies of service evaluations, and service descriptions presented as abstracts of conference presentations to provide an overview of an emerging landscape of innovation and development in CGA services for hospital inpatients.",article;delirium;dementia;emergency care;frailty;functional status;geriatric assessment;health care cost;health care delivery;heart failure;hospital patient;hospital readmission;human;mild cognitive impairment;palliative therapy;preoperative care;priority journal;survival rate,"Parker, S. G.;McLeod, A.;McCue, P.;Phelps, K.;Bardsley, M.;Roberts, H. C.;Conroy, S. P.",2017,,10.1093/ageing/afx104,0,
3374,Bilateral Oophorectomy versus Ovarian Conservation: Effects on Long-term Women's Health,"Bilateral oophorectomy at the time of hysterectomy for benign disease is commonly practiced to prevent the subsequent development of ovarian cancer. Currently, bilateral oophorectomy is performed in 55% of all U.S. women having a hysterectomy, with approximately 300 000 prophylactic oophorectomies performed every year. Observational studies show that estrogen deficiency, resulting from premenopausal or postmenopausal oophorectomy, is associated with higher risks of coronary artery disease, stroke, hip fracture, Parkinsonism, dementia, cognitive impairment, depression, and anxiety. These studies suggest that bilateral oophorectomy may do more harm than good. In women not at high risk for development of ovarian or breast cancer, removing the ovaries at the time of hysterectomy should be approached with caution. © 2010.",adnexa disease;anxiety;article;breast cancer;cancer mortality;cancer risk;cognitive defect;coronary artery disease;dementia;depression;estrogen deficiency;gynecologic surgery;hip fracture;human;hysterectomy;intermethod comparison;mood change;osteoporosis;ovarian conservation;ovariectomy;ovary cancer;parkinsonism;postmenopause;premenopause;quality of life;reoperation;sexuality;cerebrovascular accident,"Parker, W. H.",2010,,,0,
3375,Stroke: Classification and diagnosis,"Stroke is a major cause of morbidity and mortality in the UK, yet about 80% of strokes are preventable. Factors that are known to increase the risk of stroke include age, gender, hypertension, atrial fibrillation, diabetes and cigarette smoking. Broadly, a stroke can be classified as either ischaemic (caused by a thrombus) or haemorrhagic (caused by the rupture of blood vessels). Stroke is a medical emergency and the sooner that it is diagnosed and treated the better the outcome.",cholesterol;electrolyte;glucose;urea;age;arm weakness;artery dissection;blood cell count;brain hemorrhage;brain ischemia;cardiovascular risk;carotid artery disease;carotid duplex ultrasonograpy;cholesterol blood level;smoking;computer assisted tomography;delirium;dementia;diabetes mellitus;diet;disease classification;disorders of mitochondrial functions;drug overdose;electrocardiography;electrolyte blood level;erythrocyte sedimentation rate;ethnicity;Fabry disease;family history;fibromuscular dysplasia;gender;glucose blood level;health care personnel;atrial fibrillation;hematologic disease;heredity;homocystinuria;hormonal contraception;human;hyperlipidemia;hypertension;hypoxia;infection;injury;intravascular ultrasound;ischemic heart disease;migraine;moyamoya disease;nuclear magnetic resonance imaging;obesity;paradoxical embolism;peripheral occlusive artery disease;pregnancy;seizure;sepsis;short survey;sleep disordered breathing;slurred speech;Sneddon syndrome;spinal cord lesion;cerebrovascular accident;stroke patient;thyroid function test;urea blood level;urinalysis;vasculitis;vestibular disorder,"Parmar, P.;Sumaria, S.;Hashi, S.",2011,,,0,
3376,Role of homocysteine in age-related vascular and non-vascular diseases,"Homocysteine (Hcy) may represent a metabolic link in the pathogenesis of atherosclerotic vascular diseases and old-age dementias. Hyperhomocysteinemia is an independent risk factor for coronary artery disease and peripheral vascular disease, and is also associated with cerebrovascular disease; specifically, the risk of extracranial carotid atherosclerosis significantly increases in relation to Hcy levels. Hcy is a reliable marker of vitamin B12 deficiency, a common condition in the elderly which is known to induce neurological deficits including cognitive impairment; a high prevalence of folate deficiency has been reported in psychogeriatric patients suffering from depression and dementia. Both these vitamins occupy a key position in the remethylation and synthesis of S-adenosylmethionine (SAMe), a major methyl donor in CNS; therefore, deficiencies in either of these vitamins lead to a decrease in SAMe and increase in Hey, which can be critical in the aging brain. Another pathogenetic mechanism linking high Hey levels to reduced cognitive performances in the elderly might be represented by excitotoxicity, since hyperhymocysteinemia may lead to an excessive production of homocysteic acid and cysteine sulphinic acid, which act as endogenous agonists of NMDA receptors. Considering the reasonably high prevalence in the general population of a genetic predisposition to a thermolabile form of the enzyme 5,10-methylenetetrahydrofolate reductase (MTHFR), hyperhomocysteinemia can be seen as the result of multiple genetic and environmental factors leading to vascular and/or neurodegenerative disorders where age-related involutive phenomena represent a common pathogenetic ground. Systematic studies in different psychogeriatric conditions monitoring Hey levels and clinical features before and after vitamin supplementation are therefore highly recommended.",cyanocobalamin;folic acid;homocysteic acid;homocysteine;aged;article;clinical feature;coronary artery disease;dementia;depression;diet supplementation;etiology;folic acid deficiency;genetic predisposition;gerontopsychiatry;human;hyperhomocysteinemia;patient monitoring;peripheral vascular disease;risk factor;vascular disease;vitamin deficiency,"Parnetti, L.;Bottiglieri, T.;Lowenthal, D.",1997,,,0,
3377,Hypothyroidism and risk of mild cognitive impairment in elderly persons: a population-based study,"OBJECTIVE: To evaluate the association of clinical and subclinical hypothyroidism with MCI in a large population-based cohort.DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, population-based study was conducted in Olmsted County, Minnesota. Randomly selected participants were aged 70 to 89 years on October 1, 2004, and were without documented prevalent dementia [CORRECTED]. A total of 2050 participants were evaluated and underwent in-person interview, neurologic evaluation, and neuropsychological testing to assess performance in memory, attention/executive function, and visuospatial and language domains. Participants were categorized by consensus as being cognitively normal, having MCI, or having dementia according to published criteria. Clinical and subclinical hypothyroidism were ascertained from a medical records linkage system.MAIN OUTCOMES AND MEASURES: Association of clinical and subclinical hypothyroidism with MCI.RESULTS: Among 1904 eligible participants, the frequency of MCI was 16% in 1450 individuals with normal thyroid function, 17% in 313 persons with clinical hypothyroidism, and 18% in 141 individuals with subclinical hypothyroidism. After adjusting for covariates (age, educational level, sex, apolipoprotein E ?4, depression, diabetes mellitus, hypertension, stroke, body mass index, and coronary artery disease) we found no significant association between clinical or subclinical hypothyroidism and MCI (odds ratio [OR], 0.99 [95% CI, 0.66-1.48] and 0.88 [0.38-2.03], respectively). No effect of sex interaction was seen on these effects. In stratified analysis, the odds of MCI with clinical and subclinical hypothyroidism among men was 1.02 (95% CI, 0.57-1.82) and 1.29 (0.68-2.44) and, among women, was 1.04 (0.66-1.66) and 0.86 (0.37-2.02), respectively.CONCLUSIONS AND RELEVANCE: In this population-based cohort of elderly people, neither clinical nor subclinical hypothyroidism was associated with MCI. Our findings need to be validated in a separate setting using the published criteria for MCI and confirmed in a longitudinal study.IMPORTANCE: An association of clinical and subclinical hypothyroidism with mild cognitive impairment (MCI) has not been established.","Cognitive Dysfunction [diagnosis] [epidemiology] [psychology];Cohort Studies;Cross-Sectional Studies;Hypothyroidism [diagnosis] [epidemiology] [psychology];Population Surveillance [methods];Registries;Risk Factors;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword]","Parsaik, Ak;Singh, B;Roberts, Ro;Pankratz, S;Edwards, Kk;Geda, Ye;Gharib, H;Boeve, Bf;Knopman, Ds;Petersen, Rc",2014,,10.1001/jamaneurol.2013.5402,0,3378
3378,Hypothyroidism and risk of mild cognitive impairment in elderly persons: a population-based study,"IMPORTANCE: An association of clinical and subclinical hypothyroidism with mild cognitive impairment (MCI) has not been established. OBJECTIVE: To evaluate the association of clinical and subclinical hypothyroidism with MCI in a large population-based cohort. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, population-based study was conducted in Olmsted County, Minnesota. Randomly selected participants were aged 70 to 89 years on October 1, 2004, and were without documented prevalent dementia [CORRECTED]. A total of 2050 participants were evaluated and underwent in-person interview, neurologic evaluation, and neuropsychological testing to assess performance in memory, attention/executive function, and visuospatial and language domains. Participants were categorized by consensus as being cognitively normal, having MCI, or having dementia according to published criteria. Clinical and subclinical hypothyroidism were ascertained from a medical records linkage system. MAIN OUTCOMES AND MEASURES: Association of clinical and subclinical hypothyroidism with MCI. RESULTS: Among 1904 eligible participants, the frequency of MCI was 16% in 1450 individuals with normal thyroid function, 17% in 313 persons with clinical hypothyroidism, and 18% in 141 individuals with subclinical hypothyroidism. After adjusting for covariates (age, educational level, sex, apolipoprotein E ?4, depression, diabetes mellitus, hypertension, stroke, body mass index, and coronary artery disease) we found no significant association between clinical or subclinical hypothyroidism and MCI (odds ratio [OR], 0.99 [95% CI, 0.66-1.48] and 0.88 [0.38-2.03], respectively). No effect of sex interaction was seen on these effects. In stratified analysis, the odds of MCI with clinical and subclinical hypothyroidism among men was 1.02 (95% CI, 0.57-1.82) and 1.29 (0.68-2.44) and, among women, was 1.04 (0.66-1.66) and 0.86 (0.37-2.02), respectively. CONCLUSIONS AND RELEVANCE: In this population-based cohort of elderly people, neither clinical nor subclinical hypothyroidism was associated with MCI. Our findings need to be validated in a separate setting using the published criteria for MCI and confirmed in a longitudinal study.","Cohort Studies;Cross-Sectional Studies;Hypothyroidism [diagnosis] [epidemiology] [psychology];Mild Cognitive Impairment [diagnosis] [epidemiology] [psychology];Population Surveillance [methods];Registries;Risk Factors;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword]","Parsaik, A. K.;Singh, B.;Roberts, R. O.;Pankratz, S.;Edwards, K. K.;Geda, Y. E.;Gharib, H.;Boeve, B. F.;Knopman, D. S.;Petersen, R. C.",2014,,10.1001/jamaneurol.2013.5402,0,
3379,The frequencies of apolipoprotein E genotypes in health and disease in the Croatian population--an overview of expectations and real results,"The aim of the overview is to show the distribution of common apolipoprotein E (APOE) genotypes in the Croatian population, and to test whether it could serve as a new molecular biomarker in some clinical entities. The study included the following groups: patients with angiographically confirmed coronary artery disease, myocardial infarction, Alzheimer's dementia, vascular dementia, hyperlipidemias, diabetes mellitus, pancreatitis, and healthy subjects. Group comparisons of different clinical entities and control group were performed using Pearson's Chi2-test. There was no difference in APOE genotype frequencies between coronary artery disease neither myocardial infarction and control group. The ApoE genotype frequencies in patients with Alzheimer's disease were significantly different from those in the control group. APOE-4 allele tends to be a risk factor for the development of Alzheimer's disease. The frequencies were only marginally different in vascular dementia. Patients with hypercholesterolemia, those with inherited familial hypercholesterolemia, children with diabetes mellitus, and patients with pancreatitis of different etiology showed distributions of APOE genotypes that differed from the control group. It is concluded that the frequencies of APOE genotypes yielded no statistically significant result to confirm the association between APOE genotypes and any specific disease with the exception of Alzheimer's disease; APO-epsilon4 allell has become one of the important biomarkers in diagnosis of Alzheimer's dementia.","Apolipoproteins E/*genetics;Cardiovascular Diseases/genetics;Croatia;Dementia/genetics;Diabetes Mellitus/genetics;*Gene Frequency;Genotype;Humans;Hypercholesterolemia/genetics;Pancreatitis/genetics;Polymorphism, Genetic","Pasalic, D.;Ferencak, G.;Grskovic, B.;Stavljenic-Rukavina, A.",2006,Dec,,0,
3380,Interarm differences in systolic blood pressure and the risk of dementia and subclinical brain injury,"INTRODUCTION: This study examined whether interarm differences in systolic blood pressure (IDSBP) >/=10 mm Hg were associated with the risk of incident dementia and subclinical brain injury. METHODS: Between 1992 and 1998, 2063 participants of the Framingham Heart Study underwent assessment of IDSBP with results related to the 10-year risk of incident dementia including clinically characterized Alzheimer's disease. Secondary outcomes included markers of subclinical brain injury on magnetic resonance imaging. RESULTS: High IDSBP were associated with a greater risk of incident dementia (hazard ratio [HR] 1.92; 95% confidence interval [CI], 1.09-3.40) and Alzheimer's disease (HR, 2.32; 95% CI, 1.29-4.18), but only in those who carried an apolipoprotein E (APOE) epsilon4 allele. IDSBP also predicted lower total brain volumes and more prevalent silent brain infarcts in those who were APOE epsilon4 positive. DISCUSSION: High IDSBP were associated with an increased risk of dementia, including clinical Alzheimer's disease, and subclinical brain injury in those who were APOE epsilon4 positive.",Abi;Alzheimer's disease;Ankle-brachial index;Atherosclerosis;Blood pressure;Cerebrovascular disease;Dementia;Framingham Heart Study;Interarm differences in systolic blood pressure;Magnetic resonance imaging;Peripheral vascular disease,"Pase, M. P.;Beiser, A.;Aparicio, H.;DeCarli, C.;Vasan, R. S.;Murabito, J.;Seshadri, S.",2016,Apr,10.1016/j.jalz.2015.09.006,0,
3381,Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: Results from the REPOSI Study,"What is known and objective Inappropriate prescribing is highly prevalent for older people and has become a global healthcare concern because of its association with negative health outcomes including ADEs, hospitalization and resource utilization. Beers' criteria are widely utilized for evaluating the appropriateness of medications, and an up-to-date version has recently been published. To assess the prevalence of patients exposed to PIMs at hospital discharge according to the 2003 and 2012 versions of Beers' criteria and to evaluate the risk of adverse clinical events, re-hospitalization and all-cause mortality at 3-month follow-up. Methods This cross-sectional study was held in 66 Italian internal medicine and geriatric wards. The sample included 1380 inpatients aged 65 years or older. Prescriptions of PIM were analysed at hospital discharge. We considered all patients with complete 3-month follow-up. Results and discussion The prevalence of patients receiving at least one PIM was 20·1% and 23·5% according to the 2003 and 2012 versions of the Beers' criteria, respectively. The 2012 Beers' criteria identified more patients with at least one PIM than the 2003 version, although a high percentage of those patients (72·2%) were also identified by the criteria updated in 2003. The main difference in the prevalence of patients receiving a PIM according to the two versions of Beers' criteria involved prescriptions of benzodiazepines for insomnia or agitation, chronic use of non-benzodiazepine hypnotics, prescription of antipsychotics in people with dementia and oral iron at dosage higher than 325 mg/day. Prescription of PIMs was not associated with a higher risk of adverse clinical events, re-hospitalization and all-cause mortality at 3-month follow-up in both univariate and multivariate analysis, after adjusting for age, sex and CIRS comorbidity index. What is New and Conclusions This study found no significant effect of inappropriate drug use according to Beers' criteria on health outcomes among older adults 3 month after discharge. Even though these criteria have been suggested as helpful in promoting appropriate prescribing, reducing drug-related adverse events and associated healthcare costs, to date there is no clear evidence that their application can achieve objective and quantifiable improvements in clinical outcomes. A possible explanation is that both versions of the Beers' criteria have several recognized limitations, one of the main ones being the restricted availability of some drugs in Europe or their limited prescription in everyday clinical practice. © 2014 John Wiley & Sons Ltd.",amiodarone;amitriptyline;antihistaminic agent;barbituric acid derivative;benzodiazepine derivative;bisoprolol;chlorpropamide;clonidine;digoxin;doxazosin;fluoxetine;flurazepam;hypnotic agent;indometacin;iron;ketorolac;muscle relaxant agent;neuroleptic agent;nitrofurantoin;ticlopidine;adverse outcome;aged;aged hospital patient;agitation;article;cause of death;cohort analysis;comorbidity;cross-sectional study;dementia;female;follow up;geriatric hospital;heart arrest;hospital discharge;hospital readmission;human;inappropriate prescribing;insomnia;internist;Italian (citizen);long term care;major clinical study;male;medication error;mortality;potentially inappropriate medication;prescription;risk factor,"Pasina, L.;Djade, C. D.;Tettamanti, M.;Franchi, C.;Salerno, F.;Corrao, S.;Marengoni, A.;Marcucci, M.;Mannucci, P. M.;Nobili, A.",2014,,,0,
3382,Roles of resveratrol and other grape-derived polyphenols in Alzheimer's disease prevention and treatment,"Alzheimer's disease (AD) is a devastating disorder that strikes 1 in 10 Americans over the age of 65, and almost half of all Americans over 85. years old. The odds of an individual developing AD double every five years after the age of 65. While it has become increasingly common to meet heart attack or cancer survivors, there are no AD survivors. There is mounting evidence that dietary polyphenols, including resveratrol, may beneficially influence AD. Based on this consideration, several studies reported in the last few years were designed to validate sensitive and reliable translational tools to mechanistically characterize brain bioavailable polyphenols as disease-modifying agents to help prevent the onset of AD dementia and other neurodegenerative disorders. Several research groups worldwide with expertise in AD, plant biology, nutritional sciences, and botanical sciences have reported very high quality studies that ultimately provided the necessary information showing that polyphenols and their metabolites, which come from several dietary sources, including grapes, cocoa etc., are capable of preventing AD. The ultimate goal of these studies was to provide novel strategies to prevent the disease even before the onset of clinical symptoms. The studies discussed in this review article provide support that the information gathered in the last few years of research will have a major impact on AD prevention by providing vital knowledge on the protective roles of polyphenols, including resveratrol. This article is part of a Special Issue entitled: Resveratrol: Challenges in translating pre-clinical findings to improve patient outcomes.",Alzheimer disease;American;brain;cacao;cancer survivor;dementia;diseases;grape;heart infarction;human;metabolite;nutritional science;patient;plant;prevention;prophylaxis;survivor;polyphenol;resveratrol,"Pasinetti, G. M.;Wang, J.;Ho, L.;Zhao, W.;Dubner, L.",2015,,,0,
3383,Concept of unbearable suffering in context of ungranted requests for euthanasia: Qualitative interviews with patients and physicians,"Objective: To obtain in-depth information about the views of patients and physicians on suffering in patients who requested euthanasia in whom the request was not granted or granted but not performed. Design: In-depth interviews with a topic list. Setting: Patients' homes and physicians' offices. Participants: 10 patients who explicitly requested euthanasia but whose request was not granted or performed and eight physicians of these patients; and eight physicians of patients who had requested euthanasia but had died before the request had been granted or performed or had died after the request was refused by the physician or after the patient had withdrawn his or her request. Results: Not all patients who requested euthanasia thought their suffering was unbearable, although they had a lasting wish to die. Patients and physicians seemed to agree about this. In cases in which patients said they suffered unbearably there was less agreement about what constitutes unbearable suffering; patients put more emphasis on psychosocial suffering, such as dependence and deterioration, whereas physicians referred more often to physical suffering. In some cases the physician thought that the suffering was not unbearable because the patient's behaviour seemed incompatible with unbearable suffering - for instance, because the patient was still reading books. Conclusions: Patients do not always think that their suffering is unbearable, even if they have a lasting wish to die. Physicians seem to have a narrower perspective on unbearable suffering than patients and than case law suggests. In an attempt to solve the problem of different perspectives, physicians should take into account the different aspects of suffering as described in the literature and a framework for assessing the suffering of patients who ask for euthanasia.",adenocarcinoma;adult;aged;Alzheimer disease;article;asthma;clinical article;colon cancer;constipation;critically ill patient;Crohn disease;death;depression;euthanasia;female;general practitioner;heart failure;human;law;lung cancer;male;Meniere disease;pancreas cancer;paralysis;Parkinson disease;patient attitude;physician;priority journal;rheumatic disease;social psychology;stroke patient,"Pasman, H. R. W.;Rurup, M. L.;Willems, D. L.;Onwuteaka-Philipsen, B. D.",2009,,,0,
3384,Osteoporotic hip fractures in non-elderly patients: relevance of associated co-morbidities,"Osteoporotic hip fractures (OHF) are not limited to elderly; however, studies in non-elderly are scarce. Thus, the aim of this study was to evaluate co-morbidities in non-elderly patients with OHF in a Community Teaching Hospital. All hospitalizations due to OHF during a 3-year period in a Community Teaching Hospital were retrospectively evaluated for co-morbidities, and patients 18-64 years old were compared with those >/=65 years old. Of all hospitalizations, 232 (0.73%) were due to hip fractures, and 120/232 (51.7%) patients had OHF. The comparison of the 13 (10.8%) OHF patients <65 years old (47.3 +/- 9.7 years) with 107 (89.2%) >/=65 years old (80.4 +/- 7.7 years) revealed a male predominance (61.5 vs. 27.1%, P = 0.022) and a distinct ethnic distribution with a lower proportion of Caucasians in the former (61.5 vs. 86.9%, P = 0.033). Moreover, non-elderly OHF patients had higher frequencies of insulin-dependent DM (38.5 vs. 3.7%, P = 0.001) and alcoholism (38.5 vs. 4.7%, P = 0.001) than aged patients. In contrast, rates of age-related co-morbidities such as stroke (7.7 vs. 18.7%, P = 0.461), heart failure (23.1 vs. 14.0%, P = 0.411), and dementia (7.7 vs. 15.9%, P = 0.689) were comparable in both groups. Logistic regression analysis demonstrated that insulin-dependent DM (OR = 25.4, 95% CI = 4.7-136.8, P < 0.001) and alcoholism (OR = 20.3, 95% CI = 3.9-103.3, P < 0.001) remained as independent risk factors for OHF in non-elderly patients. Osteoporosis is an important cause of HF in Community Hospital. Non-elderly patients with OHF have a peculiar demographic profile and associated co-morbidities. These findings reinforce the need of early osteoporosis diagnosis and rigorous fracture prevention in patients with DM and alcoholism.","Adolescent;Adult;Age Factors;Aged;Aged, 80 and over;Alcoholism/epidemiology;Brazil/epidemiology;Cardiovascular Diseases/epidemiology;Chi-Square Distribution;Comorbidity;Dementia/epidemiology;Diabetes Mellitus/epidemiology;Female;Hip Fractures/*epidemiology/ethnology;Hospitals, Community;Hospitals, Teaching;Humans;Logistic Models;Male;Middle Aged;Odds Ratio;Osteoporosis/*epidemiology/ethnology;Retrospective Studies;Risk Assessment;Risk Factors;Young Adult","Pasoto, S. G.;Yoshihara, L. A.;Maeda, L. C.;Bernik, M. M.;Lotufo, P. A.;Bonfa, E.;Pereira, R. M.",2012,Oct,10.1007/s00296-011-2154-x,0,
3385,Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope,"It is difficult to distinguish unexplained falls (UFs) from accidental falls (AFs) or syncope in older people. This study was designed to compare patients referred to the emergency department (ED) for AFs, UFs or syncope. Data from a longitudinal study on adverse drug events diagnosed at the ED (ANCESTRAL-ED) in older people were analyzed in order to select cases of AF, syncope, or UF. A total of 724 patients (median age: 81.0 [65–105] years, 66.3% female) were consecutively admitted to the ED (403 AF, 210 syncope, and 111 UF). The number of psychotropic drugs was the only significant difference in patients with AF versus those with UF (odds ratio [OR] 1.44; 95% confidence interval 1.17–1.77). When comparing AF with syncope, female gender, musculoskeletal diseases, dementia, and systolic blood pressure >110 mmHg emerged as significantly associated with AF (OR 0.40 [0.27–0.58], 0.40 [0.24–0.68], 0.35 [0.14–0.82], and 0.31 [0.20–0.49], respectively), while valvulopathy and the number of antihypertensive drugs were significantly related to syncope (OR 2.51 [1.07–5.90] and 1.24 [1.07–1.44], respectively). Upon comparison of UF and syncope, the number of central nervous system drugs, female gender, musculoskeletal diseases, and SBP >110 mmHg were associated with UF (OR 0.65 [0.50–0.84], 0.52 [0.30–0.89], 0.40 [0.20–0.77], and 0.26 [0.13–0.55]), respectively. These results indicate specific differences, in terms of demographics, medical/pharmacological history, and vital signs, among older patients admitted to the ED for AF and syncope. UF was associated with higher use of psychotropic drugs than AF. Our findings could be helpful in supporting a proper diagnostic process when evaluating older patients after a fall.",alpha adrenergic receptor blocking agent;angiotensin receptor antagonist;antiarrhythmic agent;anticonvulsive agent;antidepressant agent;antidiabetic agent;antihistaminic agent;antihypertensive agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;central nervous system agents;cholinergic receptor blocking agent;cholinesterase inhibitor;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hypnotic sedative agent;neuroleptic agent;nitric acid derivative;psychotropic agent;accidental falling;aged;article;clinical evaluation;dementia;demography;disease association;elderly care;emergency ward;faintness;falling;female;hospital admission;human;hypertension;longitudinal study;major clinical study;male;medical history;musculoskeletal disease;patient referral;sex difference;side effect;systolic blood pressure;unexplained falling;valvular heart disease;very elderly;vital sign,"Pasqualetti, G.;Calsolaro, V.;Bini, G.;Dell’Agnello, U.;Tuccori, M.;Marino, A.;Capogrosso-Sansone, A.;Rafanelli, M.;Santini, M.;Orsitto, E.;Ungar, A.;Blandizzi, C.;Monzani, F.",2017,,10.2147/cia.s127824,0,
3386,Cognitive function and the ageing process: The peculiar role of mild thyroid failure,"Background: Over the last decades an increasing body of evidence suggested a possible relationship between thyroid hormone (TH) and the ageing process, and several efforts have been made to determine the actual role of TH dynamic during human life. It is still unclear whether the serum level shift of Thyroid Stimulating Hormone toward higher value, observed during ageing, is a normal adaptive response associated with senescence or an actual mild thyroid dysfunction. A growing body of evidence supports the hypothesis of a reset of the hypothalamus-pituitary-thyroid axis in order to contrast the catabolic status of the ageing process. On the other hand, several meta-analyses showed a direct link between subclinical hypothyroidism (sHT) and cardiovascular events (both ischemic heart disease and stroke), although mainly in individuals younger than 65 years. Similarly, a recent meta-analysis documented consistent data on a positive relationship between sHT and cognitive impairment, but only in individuals younger than 75 years. Conclusion: The available data suggest a complex relationship between mild thyroid failure and the ageing process as well as the development and progression of several cardiovascular and neurological diseases. In this paper, we reviewed the scientific English literature on sHT and the ageing process focusing on experimental evidences related to cognitive impairment and dementia. Moreover, we focused on new patents of treatments potentially able to improve the care of sHT patients, especially in the elderly, where treatment drawbacks may have negative impact on the long term outcome.",thyroid hormone;thyrotropin;aging;article;cardiovascular disease;cerebrovascular accident;cognition;human;hypothalamus hypophysis system;hypothyroidism;ischemic heart disease;priority journal;subclinical hypothyroidism;thyroid disease;thyroid function;thyrotropin blood level,"Pasqualetti, G.;Caraccio, N.;Dell’Agnello, U.;Monzani, F.",2016,,,0,
3387,Two phase 2 multiple ascending-dose studies of vanutide cridificar (ACC-001) and QS-21 adjuvant in mild-to-moderate Alzheimer's disease,"Vanutide cridificar (ACC-001), an immunotherapeutic vaccine, is a potentially disease-modifying therapy that aims to reduce brain amyloid-β (Aβ) plaques in patients with Alzheimer's disease (AD). ACC-001 was evaluated in two phase 2a, multicenter, randomized, third party-unblinded, placebo-controlled, multiple ascending-dose studies of ACC-001 (3μg, 10μg, 30μg) with and without QS-21 adjuvant that enrolled patients with mild-to-moderate AD (n=245). Patients were treated with up to five doses of study vaccine or placebo and followed for safety and tolerability (primary objective) and anti-Aβ IgG immunogenicity (secondary objective) up to 12 months after the last vaccination. Exploratory assessments included cognitive/functional measures, brain magnetic resonance imaging (MRI) volumetry, and pharmacodynamic markers in plasma and cerebrospinal fluid (CSF). The most frequent treatment-emergent adverse events (≥10) were local injection reactions and headache. Amyloid-related imaging abnormalities with vasogenic edema occurred in two (0.8) patients (ACC-001 30μg QS-21; ACC-001 10μg). ACC-001 QS-21 elicited consistently higher peak and sustained anti-Aβ IgG titers compared with ACC-001 alone. Plasma Aβx-40 was significantly higher in all ACC-001 QS-21 groups versus placebo (weeks 16-56), with no evidence of dose response. Exploratory cognitive evaluations, volumetric brain MRI, and CSF biomarkers did not show differences or trends between treatment groups and placebo. ACC-001 with or without QS-21 adjuvant has an acceptable safety profile in patients with mild-to-moderate AD.",2006-002061-39;NCT00479557;immunoglobulin G1;placebo;qs 21;vanutide cridificar;adult;aged;Alzheimer disease;antibody titer;article;brain edema;cerebrospinal fluid;cognition;cohort analysis;controlled study;depression;diarrhea;disease severity;drug efficacy;drug safety;drug tolerability;female;follow up;headache;heart arrest;heart infarction;human;immunogenicity;injection site erythema;injection site pain;injection site swelling;lung cancer;major clinical study;male;nuclear magnetic resonance imaging;outcome assessment;pharmacodynamics;phase 2 clinical trial;priority journal;randomized controlled trial;treatment response;vaccination;vasculitis;volumetry;acc 001,"Pasquier, F.;Sadowsky, C.;Holstein, A.;Leterme, G. L. P.;Peng, Y.;Jackson, N.;Fox, N. C.;Ketter, N.;Liu, E.;Ryan, J. M.",2016,,,0,
3388,Drug use and low blood pressure in the elderly. A study of data from the Kungsholmen Project,"The aim of the present study was to examine the prevalence of low blood pressure in an older population with respect to medication with drugs with potential hypotensive effects. Data from the Kungsholmen Project was used, a population-based study of elderly people aged 75 years and over in Stockholm, Sweden. Among the 1810 participants, 1748 with documentation on blood pressure and drug use were included in the study. Low systolic blood pressure, defined as < 125 mmHg, was found in 157 subjects. Low diastolic blood pressure, defined as < 65 mmHg, was found in 124 subjects. The association between drug use and low blood pressure was examined for drugs with known potential hypotensive effects (sympatholytic drugs, diuretics, β-receptor blocking drugs, calcium antagonists. angiotensin-converting enzyme inhibiting drugs, nitrates, antiparkinsonian drugs, neuroleptics, anxiolytics, sedatives-hypnotics and antidepressant drugs) in a logistic regression model controlling for the possible confounders age, gender, housing, dementia status, cardiovascular disease, body mass index and dehydration. The use of potassium-sparing diuretics, dopaminergic antiparkinsonian drugs and neuroleptics showed a significant association with low systolic blood pressure. Dopaminergic antiparkinsonian drugs were significantly associated with low diastolic blood pressure. This may imply a risk in the elderly, where some of these drugs are commonly used, considering results from previous studies suggesting that low blood pressure may cause, for example, falls and fractures, accelerated dementia, myocardial ischaemia, cerebral ischaemia, and increased mortality in this age group.",antiparkinson agent;neuroleptic agent;potassium sparing diuretic agent;aged;article;brain ischemia;dementia;diastolic blood pressure;drug use;falling;female;fracture;heart muscle ischemia;human;hypotension;major clinical study;male;mortality;priority journal;regression analysis;Sweden;systolic blood pressure,"Passare, G.;Guo, Z.;Winblad, B.;Fastbom, J.",1998,,,0,
3389,Overnight pulse oximetry in nursing home residents with behavior problems: Case reports,,acetylsalicylic acid;alprazolam;buspirone;celecoxib;digoxin;donepezil;fluoxetine;fosinopril;furosemide;glibenclamide;glipizide;insulin;levothyroxine;lisinopril;lorazepam;metolazone;metoprolol;multivitamin;oxygen;potassium chloride;ranitidine;risperidone;rivastigmine;sertraline;simvastatin;terazosin;trazodone;affective neurosis;aged;arterial gas;article;behavior disorder;case report;cerebrovascular accident;controlled study;dementia;depression;electrocardiogram;heart left ventricle hypertrophy;human;hypothyroidism;hypoxia;male;non insulin dependent diabetes mellitus;nuclear magnetic resonance imaging;nursing home;oxygen saturation;oxygen therapy;pulse oximetry;resident;sleep disordered breathing;aspirin,"Passehl, D.;Langer, E.;Vebrick, J.;Drinka, P. J.",2002,,,0,
3390,Methods of cognitive function investigation in the longitudinal study on adult health (ELSA-Brasil),"Context And Objective: Many uncertainties concerning risk factors and evolution of cognitive disorders remain. We describe the methods and preliminary results from the investigation of the cognitive function in the Longitudinal Study on Adult Health (ELSA-Brasil). Design And Setting: Multicenter cohort study on public employees at six public teaching and research institutions. METHODS: The participants were interviewed and examined to obtain a broad range of social, clinical and environmental characteristics. The following standardized tools were used to assess memory, language and visuospatial and executive functions: words or figure memory test; semantic (animals) and phonemic (letter F) verbal fluency tests; and trail test B. Results: 15,101 out of 15,105 participants took the cognitive tests: 54% were women; the mean age was 51 years; and 52% had a university degree. 14,965 participants (99%) did the word test and 136 (1%) did the figure test due to low schooling level. The scores from the semantic verbal fluency tests (mean = 18.42 ± 5.29; median = 18 words) were greater than the scores from the phonemic verbal fluency tests (mean = 12.46 ± 4.5; median = 12 words). The median time taken to perform the trail test was 1.6 minutes. Conclusion: The large cohort size, of young age, and the extensive amount of clinical and epidemiological data available will make it possible to investigate the prognostic value of biological, behavioral, environmental, occupational and psychosocial variables over the short and medium terms in relation to cognitive decline, among adults and elderly people.",adult;aged;article;cognition;dementia;depression;depth perception;experimental cognitive test;female;follow up;heart infarction;hospitalization;human;language;learning and memory test;longitudinal study;male;memory;mortality;neuropsychological test;non insulin dependent diabetes mellitus;questionnaire;risk factor;telephone interview;weight reduction,"Passos, V. M. A.;Caramelli, P.;Benseñor, I.;Giatti, L.;Barreto, S. M.",2014,,,0,
3391,Neuroanesthesiology update,"We review topics pertinent to the perioperative care of patients with neurological disorders. Our review addresses topics not only in the anesthesiology literature, but also in basic neurosciences, critical care medicine, neurology, neurosurgery, radiology, and internal medicine literature. We include literature published or available online up through December 8, 2013. As our review is not able to include all manuscripts, we focus on recurring themes and unique and pivotal investigations. We address the broad topics of general neuroanesthesia, stroke, traumatic brain injury, anesthetic neurotoxicity, neuroprotection, pharmacology, physiology, and nervous system monitoring. Copyright © 2014 by Lippincott Williams & Wilkins.",adenosine;anesthetic agent;anticonvulsive agent;antihypertensive agent;atenolol;carvedilol;cyclopropane;dexamethasone;dexmedetomidine;esmolol;etomidate;fentanyl;glucocorticoid;hydroxymethylglutaryl coenzyme A reductase inhibitor;hypertensive factor;isoflurane;mepivacaine;methoxyflurane;metoprolol;midazolam;morphine;nadolol;placebo;propofol;propranolol;remifentanil;rocuronium;ropivacaine;sevoflurane;unindexed drug;aerosol;Alzheimer disease;analgesia;anesthesia level;anesthesia mechanism;anesthesiology;article;brain circulation;brain cortex;brain electrophysiology;brain hemorrhage;brain ischemia;brain tumor;capnometry;carotid artery disease;carotid artery obstruction;carotid artery stenting;carotid endarterectomy;cerebrovascular accident;cognition;cognitive defect;coronary artery disease;coronary artery spasm;craniotomy;digital subtraction angiography;endothelial dysfunction;evoked muscle response;external auditory canal;follow up;functional magnetic resonance imaging;general anesthesia;health care system;heart muscle ischemia;hemodynamics;hippocampal sclerosis;human;hydrocephalus;hypoxemia;intensive care;mechanical thrombectomy;meningitis;National Institutes of Health Stroke Scale;neurologic disease;neuromonitoring;neuroprotection;neuroradiology;neurotoxicity;perioperative period;postoperative cognitive dysfunction;priority journal;self report;spine surgery;subarachnoid hemorrhage;temporal lobe epilepsy;temporal lobectomy;traumatic brain injury,"Pasternak, J. J.;Lanier, W. L.",2014,,,0,
3392,Cerebrotendinous xanthomatosis,"Cerebrotendinous xanthomatosis is a rare disease showing normal or low serum cholesterol levels associated with high serum cholestanol levels. Three afflicted sisters are presented whose predominant radiologic findings were related to tendon involvement. One patient, in addition, showed osteopetrosis.",cholestanol;cholesterol;achilles tendon;Albers Schoenberg disease;ataxia;atherosclerosis;cerebrotendinous xanthomatosis;cholesterol blood level;dementia;demyelination;diagnosis;etiology;gliosis;heart infarction;methodology;radiography;serum;skeleton;skeleton radiography;spine;tachycardia;xanthoma;xanthomatosis,"Pastershank, S. P.;Yip, S.;Sodhi, H. S.",1974,,,0,
3393,"Flavanols, mild cognitive impairment, and Alzheimer's dementia","Alzheimer's disease (AD) is a dementing neurological disorder that results in progressive memory loss and cognitive decline thought to be associated with buildup of amyloid plaques and neurofibrillary tangles in the brain. Vascular Dementia (VaD) is another common dementing disorder characterized by decreased brain perfusion. Together, AD and VaD constitute mixed dementia, an extremely common type of dementia associated with aging. Neuroimaging research suggests that brain vascular atrophy results in mild cognitive impairment (MCI), a possible precursor for AD. Additionally, literature suggests that attention to cardiovascular risk factors such as hypertension could reduce or delay the incidence of mixed dementia. Furthermore, foods and beverages rich in natural antioxidant flavanoids (i.e. epicatechin and catechin) are currently being advocated as possible preventative agents for a number of pathological conditions ranging from coronary heart disease to dementia. Experimental evidence is mounting that oxidative stress is involved in the pathophysiology of AD, and numerous studies are indicating that polyphenolic antioxidants found in fruits and vegetables can be useful in countering this and blocking neuronal death. More specifically, several cocoa studies suggest that daily intake of cocoa flavanols leads to cardiovascular benefits including vasodilatation via a nitric oxide mechanism and increased brain perfusion. The following text will consider an important question that thus arises regarding the potential of flavanols as effective agents for the prevention and delay of the onset of brain vascular atrophy and subsequently MCI and AD. It will also review the molecular mechanisms through which flavanols operate to accomplish their protective effects.",Alzheimer's disease;Brain vascular atrophy;antioxidants;flavanols;mild cognitive impairment;oxidative stress,"Patel, A. K.;Rogers, J. T.;Huang, X.",2008,,,0,
3394,Adverse effects of acetylcholinesterase inhibitors,,cholinesterase inhibitor;donepezil;galantamine;rivastigmine;abdominal pain;abnormal dreaming;aggression;agitation;anorexia;article;asthenia;blood chemistry;bradycardia;brain ischemia;chill;colonoscopy;computer assisted tomography;dementia;diarrhea;diastolic dysfunction;diverticulosis;dizziness;drug cost;drug dose increase;drug dose reduction;drug dose titration;drug fever;drug induced headache;drug safety;drug tolerability;drug use;drug withdrawal;esophagus rupture;extrapyramidal symptom;fatigue;follow up;gastrointestinal hemorrhage;hallucination;health care cost;heart arrhythmia;hepatitis;human;insomnia;leg cramp;liver dysfunction;medical history;myasthenia;nausea;orthostatic hypotension;rhinitis;rhinorrhea;second degree atrioventricular block;seizure;side effect;faintness;systole;thyroid hormone blood level;treatment planning;tremor;urine incontinence;vomiting,"Patel, B. B.;Holland, N. W.",2011,,,0,
3395,Growing old with HIV,"The intersection of chronic HIV infection, its treatment, and lifestyle with aging has become a topic of considerable fascination during this, the third decade of the AIDS epidemic. An understanding of the pathophysiology of this intersection may provide valuable insights into our general understanding of human aging. This review summarizes the results of recent publications that may have considerable impact on screening and management strategies in the aging HIV-infected population. © 2010 Springer Science+Business Media, LLC.",abacavir;antiretrovirus agent;C reactive protein;CD4 antigen;CD8 antigen;D dimer;didanosine;Human immunodeficiency virus proteinase inhibitor;interleukin 1beta;interleukin 2;interleukin 6;tumor necrosis factor alpha;aging;Alzheimer disease;article;bone density;cardiovascular disease;CD4 CD8 ratio;cognitive defect;comorbidity;cytokine production;dyslipidemia;elderly care;heart infarction;highly active antiretroviral therapy;human;Human immunodeficiency virus;Human immunodeficiency virus infection;immune deficiency;immune response;Kaposi sarcoma;life expectancy;mortality;nonhodgkin lymphoma;osteoporosis;patient compliance;side effect;uterine cervix cancer,"Patel, D.;Crane, L. R.",2011,,,0,
3396,A Cross-Sectional Study Comparing the Frequency of Drug Interactions After Adding Simeprevir- or Sofosbuvir-Containing Therapy to Medication Profiles of Hepatitis C Monoinfected Patients,"Introduction: This study compares the expected occurrence of contraindicated drug–drug interactions (XDDIs) when simeprevir (SIM)- or sofosbuvir (SOF)-containing therapy is added to medication profiles of patients with hepatitis C (HCV) monoinfection to quantify, in relative terms, the population-based risk of XDDIs. Second, this study identified the predictors of XDDIs when HCV therapies are added to medication profiles. Methods: A cross-sectional study was performed among Veterans’ Affairs patients. Inclusion criteria were: (1) age ≥18 years, (2) HCV infection, and (3) availability of a medication list. Patients with human immunodeficiency virus were excluded. Demographics, comorbidities, year of HCV diagnosis, and most recent medication list were collected from medical records. The primary outcome was the presence of XDDIs involving HCV therapy and the medications in the patient’s home medication list after the addition of either SIM- or SOF-containing regimens. To define XDDIs, Lexi-Interact drug interaction software was used. Results: 4,251 patients were included. The prevalence of XDDIs involving SIM- or SOF-containing therapy were 12.6% and 4.7% (p < 0.001), respectively. In multivariable analyses examining the predictors of XDDIs involving SIM-containing therapy, the only medication-related predictor was use of ≥6 home medications (odds ratio OR 4.58, 95% confidence interval CI 3.54–5.20, p < 0.001). Similarly, use of ≥6 home medications was also the only variable associated with an increased probability of XDDI involving SOF-containing therapy (OR 3.83, 95% CI 2.57–5.70, p < 0.001). Conclusions: Sofosbuvir-containing therapy had a lower frequency of XDDIs than SIM-containing therapy. Polypharmacy with various classes of home medications predicted XDDIs involving SIM- or SOF-containing therapy.",antiarrhythmic agent;antidepressant agent;calcium channel blocking agent;central depressant agent;corticosteroid;hydroxymethylglutaryl coenzyme A reductase inhibitor;neuroleptic agent;peginterferon;ribavirin;simeprevir;sofosbuvir;adult;alcoholism;anemia;article;chronic kidney disease;chronic obstructive lung disease;comorbidity;cross-sectional study;dementia;drug effect;drug interaction;female;heart arrhythmia;heart disease;heart failure;hepatitis C;human;hypertension;major clinical study;male;middle aged;neoplasm;neuropathy;organ transplantation;priority journal;seizure,"Patel, N.;Nasiri, M.;Koroglu, A.;Bliss, S.;Davis, M.;McNutt, L. A.;Miller, C.",2015,,,0,
3397,Does left ventricular hypertrophy affect cognition and brain structural integrity in type 2 diabetes? Study design and rationale of the Diabetes and Dementia (D2) study,"Background: Cognitive impairment is common in type 2 diabetes mellitus, and there is a strong association between type 2 diabetes and Alzheimer's disease. However, we do not know which type 2 diabetes patients will dement or which biomarkers predict cognitive decline. Left ventricular hypertrophy (LVH) is potentially such a marker. LVH is highly prevalent in type 2 diabetes and is a strong, independent predictor of cardiovascular events. To date, no studies have investigated the association between LVH and cognitive decline in type 2 diabetes. The Diabetes and Dementia (D2) study is designed to establish whether patients with type 2 diabetes and LVH have increased rates of brain atrophy and cognitive decline. Methods: The D2 study is a single centre, observational, longitudinal case control study that will follow 168 adult patients aged >50 years with type 2 diabetes: 50% with LVH (case) and 50% without LVH (control). It will assess change in cardiovascular risk, brain imaging and neuropsychological testing between two time-points, baseline (0 months) and 24 months. The primary outcome is brain volume change at 24 months. The co-primary outcome is the presence of cognitive decline at 24 months. The secondary outcome is change in left ventricular mass associated with brain atrophy and cognitive decline at 24 months. Discussion: The D2 study will test the hypothesis that patients with type 2 diabetes and LVH will exhibit greater brain atrophy than those without LVH. An understanding of whether LVH contributes to cognitive decline, and in which patients, will allow us to identify patients at particular risk. Trial registration: Australian New Zealand Clinical Trials Registry ( ACTRN12616000546459 ), date registered, 28/04/2016",12616000546459;apolipoprotein E;adult;article;blood pressure measurement;brain atrophy;brain size;cardiovascular risk;case control study;cognitive defect;controlled study;dementia;Doppler flowmetry;female;functional neuroimaging;heart left ventricle hypertrophy;heart left ventricle mass;human;hypothesis;internal carotid artery;longitudinal study;major clinical study;male;medical record review;neuropsychological test;non insulin dependent diabetes mellitus;nuclear magnetic resonance imaging;observational study;physical activity;questionnaire;risk assessment;sample size;study design;transthoracic echocardiography,"Patel, S. K.;Restrepo, C.;Werden, E.;Churilov, L.;Ekinci, E. I.;Srivastava, P. M.;Ramchand, J.;Wai, B.;Chambers, B.;O'Callaghan, C. J.;Darby, D.;Hachinski, V.;Cumming, T.;Donnan, G.;Burrell, L. M.;Brodtmann, A.",2017,,10.1186/s12902-017-0173-7,0,
3398,Adverse drug reactions related to drugs used in orthostatic hypotension: A prospective and systematic pharmacovigilance study in France,"Objective: The aim of the present study was to investigate and characterise adverse drug reactions (ADRs) to drugs used in France for orthostatic hypotension (OH). Methods: In this prospective and systematic study, 121 consecutive out-patients suffering from primary (Parkinson's disease, pure autonomic failure, multiple system atrophy, Lewy bodies disease) or secondary (diabetic and non-diabetic peripheral neuropathies) autonomie failure with symptomatic OH requiring pharmacological treatment with at least one drug marketed in France for OH were included together with six patients with refractory neurocardiogenic syncope. Results: Of the patients, 85 received a monotherapy-mainly with midodrine (49.4%)-and 42 received various combinations, the association of midodrine and fludrocortisone being the most frequent (66.6%). Of all the 127 patients, 88 suffered from a total of 141 ADRs (1.60 per patient) with no statistical difference in ADR frequency between monotherapy and drug combinations (P > 0.05). Among ADRs, 24 (17.0%) were considered as ""serious"" and 16 (11.3%) were considered as ""unexpected"", most of them observed with heptaminol. Conclusions: This study shows a high frequency of ADRs (especially serious and unexpected ADRs) with antihypotensive drugs. It strongly suggests the need for a better evaluation of the safety profile of antihypotensive drugs and improvement in summary of product characteristics. © Springer-Verlag 2005.",cafedrine plus theodrenaline;dihydroergotamine;fludrocortisone;heptaminol;hypertensive agent;midodrine;yohimbine;adult;aged;article;autonomic dysfunction;brain hemorrhage;constipation;controlled study;diabetic neuropathy;diarrhea;diffuse Lewy body disease;drug safety;drug surveillance program;eczema;falling;female;France;heart arrhythmia;atrial fibrillation;heart failure;human;hypertension;ileus;intestine obstruction;major clinical study;male;monotherapy;nausea;orthostatic hypotension;Parkinson disease;priority journal;prospective study;Shy Drager syndrome;side effect;sleep disorder;cerebrovascular accident;faintness;tachycardia;vein thrombosis,"Pathak, A.;Raoul, V.;Montastruc, J. L.;Senard, J. M.",2005,,,0,
3399,A review on novel approach pulsatile drug delivery system,"Pulsatile drug delivery which releases drug in a programmed pattern i.e. at appropriate time and/or at appropriate site of action. It refers to treatment method in which drug in vivo bioavailability is matches with rhythms of disease, in order to optimize therapeutic outcomes and minimise side effects. Currently, it is gaining increasing attention as it offers a more sophisticated approach to the traditional sustained drug delivery system i.e. a constant amount of drug released per unit time. Pulsatile drug delivery system (PDDS) delivers the drug at specific time as per the patho-physiological need of the disease, resulting in improved therapeutic efficacy and patient compliance. Diseases wherein PDDS are promising include asthma, peptic ulcer, cardiovascular diseases, arthritis, attention deficit syndrome in children, and hypercholesterolemia. Various technologies such as time-controlled, pulsed, triggered and programmed drug delivery devices have been developed and extensively studied in recent years for chronopharmaceutical drug delivery. Various types of formulation such as bilayer tablet, coated tablet, pellets, tablet in capsule can be prepared to deliver drug in a pulsatile manner.",amphetamine;antiangina pectoris agent;anticonvulsive agent;antihistaminic agent;beta 2 adrenergic receptor stimulating agent;cardiovascular agent;corticosteroid;diltiazem;dofetilide;egalet;famotidine;fluorouracil;glucocorticoid;histamine H2 receptor antagonist;hydrocortisone;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;ivermectin;lipral;local anesthetic agent;methylphenidate;nifedipine;nonsteroid antiinflammatory agent;propranolol;simvastatin;sotalol;sulfonylurea;theophylline;timer (drug);tricyclic antidepressant agent;unclassified drug;verapamil;allergic rhinitis;Alzheimer disease;angina pectoris;article;asthma;bilayer tablet;biological rhythm;blood clotting disorder;chronology;circadian rhythm;diabetes mellitus;drug absorption;drug bioavailability;drug capsule;drug delivery system;drug efficacy;drug formulation;drug manufacture;drug metabolism;drug pellet;drug stability;drug tolerance;duodenum ulcer;enteric coated tablet;epilepsy;heart infarction;hormone deficiency;hypercholesterolemia;inflammation;infradian rhythm;malignant neoplastic disease;membrane permeability;osteoarthritis;pain;Parkinson disease;patent;peptic ulcer;pH;process optimization;pulsatile drug release;reservoir;rheumatoid arthritis;seasonal affective disorder;seasonal variation;stomach acid secretion;stomach irritation;stomach juice;suprachiasmatic nucleus;sustained release preparation;thrombosis;ultradian rhythm;covera hs;innopran xl;verelan,"Patil, N. D.;Bari, M. M.;Barhate, S. D.",2013,,,0,
3400,Study of the consumptpion of innpropiate medicaments in elder hospitalized in the internal medicine service,"background: The elderlypatients are characterized by the high degree of polymedication. This factor is the most important in the appearance of adverse effects (EAD). The study of the medicaments helps to establish which are inappropriate and therefore they must move back, diminishing of this form EAD's possibility. Pients and Mthod: pective and observacional Study. Criterion of incorporation: patients of > 64 years old, hospitalized in an Internal Medicine Service. There were defined as inappropriate medicament the medicines of low therapeutic utility, them not indicated, and the inadequate ones for the elder. By means of the SPSS 11.5 program the possible variables related with the consumption were analyzed. Results: 172 elders were included in the study. The average of medicines for person and day belonged to 534 (0-15.52.5% was consuming an inappropriate medicament (366% inadequate for the elder, '5% not indicated and 12% UTBs). The analysis multivariant associates the consumption of these medicaments with a major number of diseases (p < 0.012), to a major consumption of medicines (p < 0.001) and to the origin of the nursing residences (p < 0.00'). only the consumption of medicaments not adapted for the elder is associated with increase of EAD. Conclusion: The half of the elders takes at least a medicament of unnecessary form, and the majority ofthese medicaments favors appearance of the EAD. Copyright © 2008 Aran Ediciones, s.l.",acetylsalicylic acid;alpha adrenergic receptor blocking agent;benzodiazepine derivative;beta adrenergic receptor blocking agent;calcium antagonist;chlorpheniramine;chlorpromazine;chlorpropamide;clozapine;corticosteroid;dextropropoxyphene;diphenhydramine;dipyridamole;ergotamine;haloperidol;methyldopa;narcotic agent;oral antidiabetic agent;pentazocine;pentobarbital;pentoxifylline;pethidine;promethazine;propranolol;reserpine;secobarbital;thioridazine;ticlopidine;tricyclic antidepressant agent;unindexed drug;aged;article;asthma;convulsion;dementia;diabetes mellitus;drug misuse;drug utilization;elderly care;glaucoma;heart failure;hospital patient;human;insomnia;internal medicine;major clinical study;orthostatic hypotension;peptic ulcer;Raynaud phenomenon;faintness;urine incontinence,"Patiño, F. B.;Maestu, R. P.;De Letona, J. M. L.;Jiménez, A. I.;Navarro, M. J. G.",2008,,,0,
3401,The influence of comorbidities on overall survival among older women diagnosed with breast cancer,"BackgroundPrevious studies have shown that summary measures of comorbid conditions are associated with decreased overall survival in breast cancer patients. However, less is known about associations between specific comorbid conditions on the survival of breast cancer patients.MethodsThe Surveillance, Epidemiology, and End Results-Medicare database was used to identify primary breast cancers diagnosed from 1992 to 2000 among women aged 66 years or older. Inpatient, outpatient, and physician visits within the Medicare system were searched to determine the presence of 13 comorbid conditions present at the time of diagnosis. Overall survival was estimated using age-specific Kaplan-Meier curves, and mortality was estimated using Cox proportional hazards models adjusted for age, race and/or ethnicity, tumor stage, cancer prognostic markers, and treatment. All statistical tests were two-sided.ResultsThe study population included 64034 patients with breast cancer diagnosed at a median age of 75 years. None of the selected comorbid conditions were identified in 37306 (58%) of the 64034 patients in the study population. Each of the 13 comorbid conditions examined was associated with decreased overall survival and increased mortality (from prior myocardial infarction, adjusted hazard ratio [HR] of death = 1.11, 95% CI = 1.03 to 1.19, P =. 006; to liver disease, adjusted HR of death = 2.32, 95% CI = 1.97 to 2.73, P <. 001). When patients of age 66-74 years were stratified by stage and individual comorbidity status, patients with each comorbid condition and a stage I tumor had similar or poorer overall survival compared with patients who had no comorbid conditions and stage II tumors.ConclusionsIn a US population of older breast cancer patients, 13 individual comorbid conditions were associated with decreased overall survival and increased mortality. © 2011 The Author.",tumor marker;aged;article;breast cancer;cancer mortality;cancer registry;cancer staging;cancer survival;cerebrovascular disease;chronic kidney failure;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;data base;dementia;diabetes mellitus;disease association;ethnicity;female;hazard ratio;heart infarction;hospital patient;human;Kaplan Meier method;liver disease;major clinical study;outpatient care;overall survival;paralysis;peripheral vascular disease;priority journal;proportional hazards model;race;rheumatoid arthritis;stomach ulcer,"Patnaik, J. L.;Byers, T.;Diguiseppi, C.;Denberg, T. D.;Dabelea, D.",2011,,,0,
3402,Bland and broken hearted: A case of hyponatremia induced Tako-tsubo cardiomyopathy,,acetylsalicylic acid;beta adrenergic receptor blocking agent;creatinine;desmopressin;heparin;hydroxymethylglutaryl coenzyme A reductase inhibitor;sodium;troponin I;aged;blood pressure;case report;confusion;dementia;disease duration;electrocardiogram;female;heart muscle ischemia;heart rate;human;hyponatremia;lethargy;letter;leukocytosis;lung nodule;nausea;non ST segment elevation myocardial infarction;oxygen saturation;priority journal;QTc interval;serum osmolality;sinus rhythm;sodium blood level,"Patnaik, S.;Punjabi, C.;Nathan, R.;Khurram, I.;Witzke, C.;Lai, Y. K.",2015,,,0,
3403,An open-label multicenter study to assess the safety of dextromethorphan/quinidine in patients with pseudobulbar affect associated with a range of underlying neurological conditions,"Background: Pseudobulbar affect (PBA) is associated with neurological disorders or injury affecting the brain, and characterized by frequent, uncontrollable episodes of crying and/or laughing that are exaggerated or unrelated to the patient's emotional state. Clinical trials establishing dextromethorphan and quinidine (DM/Q) as PBA treatment were conducted in patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). This trial evaluated DM/Q safety in patients with PBA secondary to any neurological condition affecting the brain. Objective: To evaluate the safety and tolerability of DM/Q during long-term administration to patients with PBA associated with multiple neurological conditions. Methods: Fifty-two-week open-label study of DM/Q 30/30mg twice daily. Safety measures included adverse events (AEs), laboratory tests, electrocardiograms (ECGs), vital signs, and physical examinations. Clinical trial registration: #NCT00056524. Results: A total of 553 PBA patients with >30 different neurological conditions enrolled; 296 (53.5%) completed. The most frequently reported treatment-related AEs (TRAEs) were nausea (11.8%), dizziness (10.5%), headache (9.9%), somnolence (7.2%), fatigue (7.1%), diarrhea (6.5%), and dry mouth (5.1%). TRAEs were mostly mild/moderate, generally transient, and consistent with previous controlled trials. Serious AEs (SAEs) were reported in 126 patients (22.8%), including 47 deaths, mostly due to ALS progression and respiratory failure. No SAEs were deemed related to DM/Q treatment by investigators. ECG results suggested no clinically meaningful effect of DM/Q on myocardial repolarization. Differences in AEs across neurological disease groups appeared consistent with the known morbidity of the primary neurological conditions. Study interpretation is limited by the small size of some disease groups, the lack of a specific efficacy measure and the use of a DM/Q dose higher than the eventually approved dose. Conclusions: DM/Q was generally well tolerated over this 52 week trial in patients with PBA associated with a wide range of neurological conditions.",NCT00056524;fampridine;acetylsalicylic acid;antimigraine agent;antithyroid agent;beta 2 adrenergic receptor stimulating agent;beta carotene;beta interferon;calcium channel blocking agent;carbamazepine;central muscle relaxant;cholinesterase inhibitor;clopidogrel;creatine;dextromethorphan plus quinidine;glatiramer;glucocorticoid;glycopyrronium bromide;immunosuppressive agent;memantine;mitoxantrone;oxcarbazepine;placebo;psychostimulant agent;quinine;retinol;riluzole;topiramate;ubidecarenone;unindexed drug;urinary tract spasmolytic agent;acute coronary syndrome;acute myelomonocytic leukemia;adult;aged;Alzheimer disease;amyotrophic lateral sclerosis;anxiety disorder;arthralgia;article;backache;cardiopulmonary insufficiency;Caucasian;cerebrovascular accident;cerebrovascular disease;clinical laboratory;constipation;controlled clinical trial;controlled study;coughing;death;dementia;diarrhea;disease association;disease course;dizziness;drug blood level;drug induced headache;drug safety;drug tolerability;drug withdrawal;dysphagia;dyspnea;ecchymosis;electrocardiogram;electrocardiography;epistaxis;falling;fatigue;female;fever;flu like syndrome;hallucination;heart arrest;heart infarction;heart repolarization;human;hypertension;incidence;insomnia;Israel;joint stiffness;laboratory test;laceration;leg edema;lethargy;limb pain;major clinical study;male;Montenegro (republic);morbidity;motor dysfunction;motor neuron disease;multicenter study;multiple sclerosis;muscle spasm;nausea;neurologic disease;nose obstruction;open study;Parkinson disease;physical examination;pneumonia;primary lateral sclerosis;pseudobulbar affect;reactive depression;recurrent disease;respiratory failure;rhinopharyngitis;Serbia;side effect;somnolence;sore throat;spinocerebellar degeneration;suicide;traumatic brain injury;United States;urinary tract infection;very elderly;vital sign;vomiting;weakness;xerostomia,"Pattee, G. L.;Wymer, J. P.;Lomen-Hoerth, C.;Appel, S. H.;Formella, A. E.;Pope, L. E.",2014,,,0,
3404,A 6-month open-label study of the effectiveness and tolerability of galantamine in patients with Alzheimer's disease,"The objective of this study was to assess the effectiveness and tolerability of galantamine in patients with mild-to-moderate Alzheimer's disease (AD) in everyday clinical practice. Patient selection was made on 36 sequential patients attending Belfast City Hospital Memory Clinic between December 2000 and June 2001. Patients were treated with galantamine for 6 months, starting from 4 mg twice daily increasing to 8 mg twice daily and then to 12 mg twice daily at 4-weekly intervals. Patients (25 females, 11 males), mean age 78 years (59-90), were diagnosed with probable AD and had a mini-mental state examination (MMSE) score of 10-26. Efficacy was assessed using the MMSE, neuropsychiatric inventory (NPI), neuropsychiatric inventory caregiver distress (NPI-D) scale and the Bristol activities of daily living (B-ADL) scale at baseline and after 3 and 6 months of treatment. Mean improvements were noted on all four measures of efficacy at 3 and 6 months; improvements were significant on the MMSE, NPI and NPI-D at 3 months and on the NPI-D at 6 months. Galantamine was overall well tolerated. The most common adverse events were gastrointestinal, particularly nausea. Four patients stopped treatment due to adverse events, and seven were stabilised on 8 mg twice daily as they were unable to tolerate the target dose. This naturalistic study confirms clinical trial data, which shows galantamine improves cognition and behavioural symptoms and is overall well tolerated. © 2004 Blackwell Publishing Ltd.",analgesic agent;antidepressant agent;cardiovascular agent;central nervous system agents;galantamine;hormone;risperidone;abdominal cramp;acute psychosis;adult;aged;agitation;Alzheimer disease;angina pectoris;article;behavior;caregiver;clinical article;clinical practice;clinical study;cognition;constipation;controlled study;daily life activity;diagnostic procedure;diarrhea;disease exacerbation;disease severity;distress syndrome;drug dose regimen;drug efficacy;drug tolerability;drug withdrawal;dysphagia;falling;female;gastrointestinal symptom;headache;human;male;Mini Mental State Examination;motor dysfunction;nausea;neuropsychiatry;nightmare;open study;patient selection;priority journal;rating scale;scoring system;side effect;statistical significance;symptomatology;thorax pain;treatment outcome;United Kingdom;urinary frequency;vomiting,"Patterson, C. E.;Passmore, A. P.;Crawford, V. L. S.",2004,,,0,
3405,Microencapsulated stem cells for tissue repairing: implications in cell-based myocardial therapy,"Stem cells have the unique properties of self-renewal, pluripotency and a high proliferative capability, which contributes to a large biomass potential. Hence, these cells act as a useful source for acquiring renewable adult cell lines. This, in turn, acts as a potent therapeutic tool to treat various diseases related to the heart, liver and kidney, as well as neurodegenerative diseases such as Parkinson's and Alzheimer's disease. However, a major problem that must be overcome before it can be effectively implemented into the clinical setting is a suitable delivery system that can retain an optimal quantity of the cells at the targeted site for a maximal clinical benefit; a system that will give a mechanical as well as an immune protection to the foreign cells, while at the same time enhancing the yields of differentiated cells, maintaining cell microenvironments and sustaining the differentiated cell functions. To address this issue we opted for a novel delivery system, termed the 'artificial cells', which are semipermeable microcapsules with strong and thin multilayer membrane components with specific mass transport properties. Here, we briefly introduce the concept of artificial cells for encapsulation of stem cells and investigate the application of microencapsulation technology as an ideal tool for all stem transplantations and relate their role to the emerging field of cellular cardiomyoplasty.",Animals;Cardiac Surgical Procedures;Cell Culture Techniques;Drug Compounding;Humans;Myocardial Infarction/surgery;Myocardium/cytology;Rats;Stem Cell Transplantation/*methods;*Stem Cells/immunology,"Paul, A.;Ge, Y.;Prakash, S.;Shum-Tim, D.",2009,Sep,10.2217/rme.09.43,0,
3406,Funding embryonic stem-cell research: Will commerce counteract collaboration?,,Alzheimer disease;biotechnology;brain injury;cell line;cell proliferation;diabetes mellitus;heart failure;human;immunophenotyping;in vitro study;karyotype;medical research;multiple sclerosis;mutation;neurologic disease;Parkinson disease;short survey;spine injury;stem cell;stem cell transplantation,"Paul, G.;Brundin, P.",2002,,,0,
3407,Potential cardiotoxic reaction involving rivastigmine and beta-blockers: A case report and review of the literature,"We report a case of potential cardiovascular toxicity including syncope, bradycardia, and ECG pauses associated with the use of rivastigmine and atenolol. A 65-year-old African American female with a medical history of dementia, hypertension, seizure disorder, stroke, and peripheral vascular disease was admitted to the hospital with shortness of breath and syncope. She was witnessed to have experienced a presyncopal episode followed by a true syncopal episode in which she was unresponsive for 20-30 s. On day two of hospital stay, the patient's ECG showed a sinus bradycardia with a heart rate in the 40 s and sinus pauses greater than 2 s in duration. Atenolol was immediately discontinued, with a continuance of the bradycardia despite one missed dose. The potentially toxic combination of rivastigmine and atenolol was then identified as a plausible causative factor of this patient's syncope and was subsequently discontinued. This patient's Naranjo adverse reaction probability score was five, which indicates a probable association between syncope and bradycardia with the combination of rivastigmine and atenolol [13]. Following the discontinuation of rivastigmine, the ECG pauses resolved and the patient's heart rate returned to normal levels. The patient did not experience any further dizziness or syncope. A 65-year-old female developed syncope and subsequent ECG pauses with sinus bradycardia after being treated with rivastigmine for dementia. Atenolol may have further compounded this toxic effect by its pharmacodynamic mechanisms. © 2010 Springer Science+Business Media, LLC.",atenolol;rivastigmine;aged;anamnesis;article;case report;dementia;drug withdrawal;dyspnea;ECG abnormality;female;heart left ventricle hypertrophy;heart rate;hospital admission;human;hypertension;peripheral vascular disease;priority journal;seizure;sinus bradycardia;cerebrovascular accident;faintness;exelon;tenormin,"Paulison, B.;Léos, C. L.",2010,,,0,
3408,Home-based physical therapy may reduce functional decline among moderately frail elderly adults: Commentary,,cognition;dementia;exercise;geriatric care;heart infarction;hip fracture;home care;human;life expectancy;Mini Mental State Examination;muscle strength;note;patient education;physical disease;physiotherapy;priority journal;cerebrovascular accident,"Paw, M. C. A.;Gill, T. M.",2003,,,0,
3409,Effects of hormonal replacement therapy on the cardiovascular system,"Hormonal replacement therapy becomes frequently used in peri- and postmenopausal women. It causally affects the climacteric syndrome, positively stimulates psychics, improves quality of the skin, decreases dryness of mucous membranes and frequency of recurrent inflammations of eyes and vagina. The positive influence on the bone metabolism and therefore on the incidence of osteoporosis highly dominates among its long-term effects. Long lasting hormonal replacement reduces also the incidence of Alzheimer disease, colorectal carcinoma and it has particularly favourable effect on the cardiovascular system. Estrogens positive affect the lipid spectrum, however, more than 50 % of their beneficial influence comes from their direct vasodilatory effect. Estrogene replacement becomes in many countries indicated for the primary prevention of the ischemic heart disease. The question of its application for the secondary prevention remains still open.",estrogen;gestagen;lipid;Alzheimer disease;arteriosclerosis;bone metabolism;climacterium;colorectal carcinoma;drug effect;drug indication;estrogen therapy;eye inflammation;human;incidence;ischemic heart disease;lipid blood level;long term care;mucosa;osteoporosis;postmenopause;secondary prevention;short survey;skin;vaginitis;vasodilatation,"Payer, J.",2001,,,0,
3410,Interventions for fatigue and weight loss in adults with advanced progressive illness,"Background: Fatigue and unintentional weight loss are two of the commonest symptoms experienced by people with advanced progressive illness. Appropriate interventions may bring considerable improvements in function and quality of life to seriously ill people and their families, reducing physical, psychological and spiritual distress.Objectives: To conduct an overview of the evidence available on the efficacy of interventions used in the management of fatigue and/or unintentional weight loss in adults with advanced progressive illness by reviewing the evidence contained within Cochrane reviews.Methods: We searched the Cochrane Database of Systematic Reviews (CDSR) for all systematic reviews evaluating any interventions for the management of fatigue and/or unintentional weight loss in adults with advanced progressive illness (The Cochrane Library 2010, Issue 8). We reviewed titles of interest by abstract. Where the relevance of a review remained unclear we reached a consensus regarding the relevance of the participant group and the outcome measures to the overview. Two overview authors extracted the data independently using a data extraction form. We used the measurement tool AMSTAR (Assessment of Multiple SysTemAtic Reviews) to assess the methodological quality of each systematic review.Main results: We included 27 systematic reviews (302 studies with 31,833 participants) in the overview. None of the included systematic reviews reported quantitative data on the efficacy of interventions to manage fatigue or weight loss specific to people with advanced progressive illness. All of the included reviews apart from one were deemed of high methodological quality. For the remaining review we were unable to ascertain the methodological quality of the research strategy as it was described. None of the systematic reviews adequately described whether conflict of interests were present within the included studies. Management of fatigueAmyotrophic lateral sclerosis/motor neuron disease (ALS/MND) - we identified one systematic review (two studies and 52 participants); the intervention was exercise.Cancer - we identified five systematic reviews (116 studies with 17,342 participants); the pharmacological interventions were eicosapentaenoic acid (EPA) and any drug therapy for the management of cancer-related fatigue and the non pharmacological interventions were exercise, interventions by breast care nurses and psychosocial interventions.Chronic obstructive pulmonary disease (COPD) - we identified three systematic reviews (59 studies and 4048 participants); the interventions were self management education programmes, nutritional support and pulmonary rehabilitation.Cystic fibrosis - we identified one systematic review (nine studies and 833 participants); the intervention was physical training.Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) - we identified two systematic reviews (21 studies and 748 participants); the interventions were progressive resistive exercise and aerobic exercise.Multiple sclerosis (MS) - we identified five systematic reviews (23 studies and 1502 participants); the pharmacological interventions were amantadine and carnitine. The non pharmacological interventions were diet, exercise and occupational therapy.Mixed conditions in advanced stages of illness - we identified one systematic review (five studies and 453 participants); the intervention was medically assisted hydration. Management of weight lossALS/MND - we identified one systematic review but no studies met the inclusion criteria for the systematic review; the intervention was enteral tube feeding.Cancer - we identified three systematic reviews with a fourth systematic review also containing extractable data on cancer (66 studies and 5601 participants); the pharmacological interventions were megestrol acetate and eicosapentaenoic acid (EPA) (this systematic review is also included in the cancer fatigue section above). The non pharmacological interventions were enteral tube feeding and non invasive interventions for patients i h lung cancer.COPD - we identified one systematic review (59 studies and 4048 participants); the intervention was nutritional support. This systematic review is also included in the COPD fatigue section.Cystic fibrosis - we identified two systematic reviews (three studies and 131 participants); the interventions were enteral tube feeding and oral calorie supplements.HIV/AIDS - we identified four systematic reviews (42 studies and 2071 participants); the pharmacological intervention was anabolic steroids. The non pharmacological interventions were nutritional interventions, progressive resistive exercise and aerobic exercise. Both of the systematic reviews on exercise interventions were also included in the HIV/AIDS fatigue section.MS - we found no systematic reviews which considered interventions to manage unintentional weight loss for people with a clinical diagnosis of multiple sclerosis at any stage of illness.Mixed conditions in advanced stages of illness - we identified two systematic reviews (32 studies and 4826 participants); the interventions were megestrol acetate and medically assisted nutrition.Authors' conclusions: There is a lack of robust evidence for interventions to manage fatigue and/or unintentional weight loss in the advanced stage of progressive illnesses such as advanced cancer, heart failure, lung failure, cystic fibrosis, multiple sclerosis, motor neuron disease, Parkinson's disease, dementia and AIDS. The evidence contained within this overview provides some insight into interventions which may prove of benefit within this population such as exercise, some pharmacological treatments and support for self management.Researchers could improve the methodological quality of future studies by blinding of outcome assessors. Adopting uniform reporting mechanisms for fatigue and weight loss outcome measures would also allow the opportunity for meta-analysis of small studies.Researchers could also improve the applicability of recommendations for interventions to manage fatigue and unintentional weight loss in advanced progressive illness by including subgroup analysis of this population within systematic reviews of applicable interventions.More research is required to ascertain the best interventions to manage fatigue and/or weight loss in advanced illness. There is a need for standardised reporting of these symptoms and agreement amongst researchers of the minimum duration of studies and minimum percentage change in symptom experience that proves the benefits of an intervention. There are, however, challenges in providing meaningful outcome measurements against a background of deteriorating health through disease progression. Interventions to manage these symptoms must also be mindful of the impact on quality of life and should be focused on patient-orientated rather than purely disease-orientated experiences for patients. Systematic reviews and primary intervention studies should include the impact of the interventions on standardised validated quality of life measures.","Weight Loss;Amyotrophic Lateral Sclerosis [complications];Cystic Fibrosis [complications];Disease Progression;Emaciation [etiology] [therapy];Fatigue [etiology] [therapy];HIV Infections [complications];Multiple Sclerosis [complications];Neoplasms [complications];Pulmonary Disease, Chronic Obstructive [complications];Review Literature as Topic;Adult[checkword];Humans[checkword];Sympt","Payne, C.;Wiffen Philip, J.;Martin, S.",2012,,10.1002/14651858.CD008427.pub2,0,
3411,Comparison of in-hospital mortality from acute myocardial infarction in HIV sero-positive versus sero-negative individuals,"Few studies have explored hospitalization outcome differences between patients who are seropositive for human immunodeficiency virus (HIV) compared to HIV-seronegative patients with acute myocardial infarctions (AMIs). The aim of this study was to explore in-hospital AMI mortality risk in seropositive and seronegative patients. A secondary analysis of the Nationwide Inpatient Sample from 1997 to 2006 was conducted. This sample allows the approximation of all United States hospitalizations. All AMI encounters with and without co-occurring HIV were identified using appropriate International Classification of Diseases and procedure codes. Descriptive and Cox proportional-hazards analyses were then conducted to estimate mortality differences between seropositive and seronegative patients while adjusting for demographic, clinical, hospital, and care factors. The results demonstrated higher AMI hospitalization mortality hazard in seropositive compared to seronegative patients after adjustment for age, gender, ethnicity, medical co-morbidities, hospital type, and number of in-hospital procedures (HR 1.38, 95% confidence interval 1.01 to 1.87, p = 0.04). Stratified analysis demonstrated greater although not statistically significant mortality hazard for non-ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction in seropositive compared to seronegative patients. Typical AMI care procedures occurred at significantly lower rates in seropositive versus seronegative patients, including thrombolytic and anticoagulant agents (18% vs 22%), coronary arteriography (48% vs 63%), left cardiac catheterization (52% vs 66%), and coronary artery bypass graft (6% vs 14%). In conclusion, additional mortality burden and lower procedure rates occur for HIV-seropositive patients receiving AMI care. Health care providers should be alert to the increased mortality burden when treating seropositive patients with AMI. © 2012 Elsevier Inc.",anticoagulant agent;fibrinolytic agent;acute heart infarction;adult;angiocardiography;article;cardiovascular mortality;cerebrovascular disease;comorbidity;confidence interval;connective tissue disease;controlled study;coronary artery bypass graft;coronary stent;dementia;demography;diabetes mellitus;drug eluting stent;ethnicity;female;gender;hazard;health care personnel;atrial fibrillation;heart atrium flutter;heart catheterization;hemiplegia;hospitalization;human;Human immunodeficiency virus infected patient;Human immunodeficiency virus infection;ICD-9;kidney disease;liver disease;major clinical study;male;metastasis;non ST segment elevation myocardial infarction;paraplegia;patient care;peptic ulcer;peripheral vascular disease;priority journal;proportional hazards model;serodiagnosis,"Pearce, D.;Ani, C.;Espinosa-Silva, Y.;Clark, R.;Fatima, K.;Rahman, M.;Diebolt, E.;Ovbiagele, B.",2012,,,0,
3412,Management of Hypertension and Cerebrovascular Disease in the Elderly,"Cardiovascular disease and stroke disproportionately affect the elderly. The risk for stroke and transient ischemic attack increases exponentially with age. Blood pressure is a potent modifiable target for reducing the risk for stroke in the elderly. In elderly patients with isolated systolic hypertension and those with intracranial atherosclerotic disease, blood pressure lowering has consistently been shown to be well tolerated and effective in reducing the risk for stroke and its complications. Evidence suggests that ambulatory blood pressure monitoring may provide a more sensitive means of detecting patients at risk and monitoring therapeutic effect. Agents that modify the renin-angiotensin system, particularly angiotensin receptor blockers, may confer additional benefit in stroke protection beyond blood pressure lowering. Several clinical trials currently in progress promise to provide guidance regarding the optimal choice of agent and degree of blood pressure lowering for prevention of stroke and cognitive decline in elderly patients. © 2008 Elsevier Inc. All rights reserved.",acetylsalicylic acid;angiotensin receptor antagonist;atenolol;beta adrenergic receptor blocking agent;calcium channel blocking agent;candesartan;clopidogrel;dihydropyridine derivative;dipeptidyl carboxypeptidase inhibitor;dipyridamole;diuretic agent;enalapril;eprosartan;hydrochlorothiazide;indapamide;losartan;nitrendipine;perindopril;placebo;ramipril;telmisartan;thiazide diuretic agent;add on therapy;aging;antihypertensive therapy;article;blood pressure monitoring;blood pressure regulation;brain atherosclerosis;cardiovascular disease;cardiovascular risk;cerebrovascular disease;clinical trial;cognition;cognitive defect;combination chemotherapy;dementia;diastolic blood pressure;drug effect;drug efficacy;drug tolerability;geriatric patient;heart left ventricle hypertrophy;human;hypertension;learning;low drug dose;memory;monotherapy;neuroprotection;orthostatic hypertension;patient monitoring;priority journal;renin angiotensin aldosterone system;risk assessment;risk reduction;cerebrovascular accident;systolic blood pressure;systolic hypertension;transient ischemic attack;treatment outcome;aspirin,"Pedelty, L.;Gorelick, P. B.",2008,,,0,
3413,[Treatment of chronic diseases in patients with dementia],"Comorbidity is common in patients with dementia, and due to the nature of the dementia disease, patients with dementia have special challenges in relation to comorbidity. This article is about dementia and heart failure, chronic obstructive pulmonary disease, urinary incontinence, falls, polypharmacy and chronic pain. Ongoing goal setting is important, and advance care planning is recommended. In general, comorbidity must be carefully and holistic assessed and managed according to each patient's general status of health and stage of dementia. As the dementia develops, focus should primarily be on symptom control and comfort.",,"Pedersen, H.;Klinkby, K. S.;Waldorff, F. B.",2017,Mar 20,,0,
3414,Pre implantation psychological functioning preserved in majority of implantable cardioverter defibrillator patients 12 months post implantation,"Background: The impact of ICD therapy on patient well being has typically focused on mean differences between groups, thereby neglecting changes within individuals. Using an intra-individual approach, we examined (i) the prevalence of implantable cardioverter defibrillator (ICD) patients maintaining their pre implantation level of psychological functioning at 12 months, and (ii) factors associated with deterioration in functioning. Methods: Consecutively implanted ICD patients (n = 332) completed a set of standardized and validated patient reported measures at baseline and at 12 months post implantation. Results: The majority of patients (72.8% to 81.7%) preserved their pre implantation level of psychological functioning 12 months post implantation. In adjusted analysis, ICD shock (all ps <.001) and Type D personality (all ps <.05) were independent predictors of deterioration in psychological functioning at 12 months across all domains, while baseline psychological status was associated with an improvement (all ps <.05). Patients with a primary prevention indication experienced a decrease in ICD concerns (p =.03) and anxiety (p =.006), and older patients (p =.04) a decrease in anxiety symptoms during the follow-up period. By contrast, patients with left ventricular dysfunction (p =.007) and atrial fibrillation (p =.02) were more likely to experience an increase in anxiety. Conclusions: The majority of ICD patients maintained their pre implantation level of psychological functioning at 12 months. A subset of patients was at risk of poor psychological adaptation, attributable to ICD shocks, Type D personality, atrial fibrillation, and left ventricular dysfunction, while primary prevention indication and older age had a protective effect against deterioration in functioning. © 2011 Elsevier Ireland Ltd.",adaptive behavior;adult;age;anxiety;article;attitude to illness;cardiac resynchronization therapy;controlled study;coronary artery disease;depression;female;follow up;functional status;atrial fibrillation;heart left ventricle ejection fraction;heart left ventricle failure;Hospital Anxiety and Depression Scale;human;implantable cardioverter defibrillator;major clinical study;male;mental deterioration;mental health;primary prevention;priority journal;psychological aspect,"Pedersen, S. S.;Hoogwegt, M. T.;Jordaens, L.;Theuns, D. A. M. J.",2013,,,0,
3415,Dramatic pressure ulcers,,aged;aging;body mass;case report;cause of death;comorbidity;congestive heart failure;decubitus;dysphagia;dyspnea;female;food intake;hip arthroplasty;human;ischemic heart disease;letter;malnutrition;multiinfarct dementia;non insulin dependent diabetes mellitus;nursing home;nutritional status;sepsis;cerebrovascular accident;weight reduction;wound care,"Pedrolli, C.;Cereda, E.",2010,,,0,
3416,"Chronic diseases, cognition, functional decline, and the Charlson index in elderly people with dementia","Objective: To assess the association between chronic degenerative diseases and functional decline, cognition, and mortality prediction. Methods: A cross-sectional study was conducted in a geriatrics service in Belo Horizonte, Brazil, involving 424 patients subdivided into two groups: control and dementia. The study analyzed socio-demographic and environmental data, chronic degenerative diseases, the Charlson index, and data on functional and cognitive dementia. Results: After a univariate analysis, there was a greater frequency of cerebrovascular accident (CVA), urinary incontinence, constipation, and sleep disorder in the dementia group, while the multivariate analysis showed a greater number of environmental factors and sleep disorder. Regarding the Mini Mental State Examination (MMSE), patients with chronic obstructive pulmonary disease (COPD), CVA, and heart failure presented lower scores. There was a greater score in the dementia group with regarding the Charlson index. Conclusion: These comorbidities were associated with the functional decline in elderly people with dementia. © 2013 Elsevier Editora Ltda. All rights reserved.",aged;article;Brazil;cerebrovascular accident;Charlson Comorbidity Index;chronic disease;chronic obstructive lung disease;cognitive defect;constipation;controlled study;cross-sectional study;degenerative disease;dementia;environmental factor;functional disease;geriatric patient;heart failure;human;major clinical study;Mini Mental State Examination;mortality;prediction and forecasting;scoring system;sleep disorder;urine incontinence,"Pedrosa Pimenta, F. A.;Bicalho, M. A. C.;Romano-Silva, M. A.;De Moraes, E. N.;De Rezende, N. A.",2013,,,0,
3417,Sleep disorders in cerebellar ataxias,"Cerebellar ataxias comprise a wide range of etiologies leading to central nervous system-related motor and non-motor symptoms. Recently, a large body of evidence has demonstrated a high frequency of non-motor manifestations in cerebellar ataxias, specially in autosomal dominant spinocerebellar ataxias (SCA). Among these non-motor dysfunctions, sleep disorders have been recognized, although still under or even misdiagnosed. In this review, we highlight the main sleep disorders related to cerebellar ataxias focusing on REM sleep behavior disorder (RBD), restless legs syndrome (RLS), periodic limb movement in sleep (PLMS), excessive daytime sleepiness (EDS), insomnia and sleep apnea.",fragile X mental retardation protein;Alexander disease;amnesia;areflexia;article;ataxia telangiectasia;autosomal dominant disorder;autosomal recessive disorder;Babinski reflex;cardiomyopathy;cell loss;cerebellar ataxia;controlled clinical trial;controlled study;daytime somnolence;disease association;dysarthria;dysphagia;dysphonia;dystonia;eye movement;fasciculation;Friedreich ataxia;gliosis;human;insomnia;Joubert syndrome;Machado Joseph disease;molar tooth;motor neuron disease;muscle atonia;muscle atrophy;myoclonus;nerve degeneration;olfactory nerve disease;parkinsonism;periodic limb movement disorder;peripheral neuropathy;polysomnography;randomized controlled trial;REM sleep deprivation;respiratory failure;restless legs syndrome;scoliosis;Shy Drager syndrome;sleep disordered breathing;sleep disorder;spinocerebellar degeneration;sporadic Creutzfeldt Jakob disease,"Pedroso, J. L.;Braga-Neto, P.;Felício, A. C.;Aquino, C. C. H.;do Prado, L. F. B.;do Prado, G. F.;Barsottini, O. G. P.",2011,,,0,
3418,Hypoxic regulation of ion channel function and expression,"Acute hypoxia regulates the activity of specific ion channels in a rapid and reversible manner. Such effects underlie appropriate cellular responses to hypoxia which are designed to initiate cardiorespiratory reflexes and contribute importantly to other tissue responses, all of which are designed to improve tissue O2 supply. These responses include excitation of chemoreceptors as well as pulmonary vasoconstriction and systemic vasodilatation. However, such responses may also contribute to the adverse responses to hypoxia, such as excitotoxicity in the central nervous system. Whilst numerous ion channel types are known to be modulated by acute hypoxia, the nature of the O2 sensor in most tissues remains to be identified. Prolonged (chronic) hypoxia regulates functional expression of ion channels, and so remodels excitability of various cell types. Whilst this may contribute to adaptive responses such as high-altitude acclimatization, such altered channel expression may also contribute to the onset of pathological disorders, including Alzheimer's disease. Indeed, evidence is emerging that production of pathological peptides associated with Alzheimer's disease is increased during prolonged hypoxia. Such effects may account for the known increased incidence of this disease in patients who have previously endured hypoxic episodes, such as congestive heart failure and stroke. Identification of the mechanisms coupling hypoxia to the increased production of these peptides is likely to be of therapeutic benefit.",ion channel;oxygen;peptide;adaptation;altitude acclimatization;Alzheimer disease;article;breathing reflex;cells by body anatomy;central nervous system;chemoreceptor;congestive heart failure;controlled study;excitability;human;human cell;hypoxia;incidence;lung vasoconstriction;neurotoxicity;oxygen supply;peptide synthesis;protein expression;protein function;sensor;cerebrovascular accident;tissue reaction;vasodilatation,"Peers, C.",2002,,,0,
3419,Relational machine learning for electronic health record-driven phenotyping,"Objective: Electronic health records (EHR) offer medical and pharmacogenomics research unprecedented opportunities to identify and classify patients at risk. EHRs are collections of highly inter-dependent records that include biological, anatomical, physiological, and behavioral observations. They comprise a patient's clinical phenome, where each patient has thousands of date-stamped records distributed across many relational tables. Development of EHR computer-based phenotyping algorithms require time and medical insight from clinical experts, who most often can only review a small patient subset representative of the total EHR records, to identify phenotype features. In this research we evaluate whether relational machine learning (ML) using inductive logic programming (ILP) can contribute to addressing these issues as a viable approach for EHR-based phenotyping. Methods: Two relational learning ILP approaches and three well-known WEKA (Waikato Environment for Knowledge Analysis) implementations of non-relational approaches (PART, J48, and JRIP) were used to develop models for nine phenotypes. International Classification of Diseases, Ninth Revision (ICD-9) coded EHR data were used to select training cohorts for the development of each phenotypic model. Accuracy, precision, recall, F-Measure, and Area Under the Receiver Operating Characteristic (AUROC) curve statistics were measured for each phenotypic model based on independent manually verified test cohorts. A two-sided binomial distribution test (sign test) compared the five ML approaches across phenotypes for statistical significance. Results: We developed an approach to automatically label training examples using ICD-9 diagnosis codes for the ML approaches being evaluated. Nine phenotypic models for each ML approach were evaluated, resulting in better overall model performance in AUROC using ILP when compared to PART (p= 0.039), J48 (p= 0.003) and JRIP (p= 0.003). Discussion: ILP has the potential to improve phenotyping by independently delivering clinically expert interpretable rules for phenotype definitions, or intuitive phenotypes to assist experts. Conclusion: Relational learning using ILP offers a viable approach to EHR-driven phenotyping.",acute heart infarction;algorithm;article;binomial distribution;cataract;computer aided design;congestive heart failure;controlled study;deep vein thrombosis;dementia;diabetic retinopathy;electronic medical record;atrial fibrillation;ICD-9;liver injury;machine learning;measurement accuracy;non insulin dependent diabetes mellitus;phenotype;receiver operating characteristic,"Peissig, P. L.;Santos Costa, V.;Caldwell, M. D.;Rottscheit, C.;Berg, R. L.;Mendonca, E. A.;Page, D.",2014,,,0,
3420,"Magnetic resonance imaging for verifying hip fracture diagnosis why, when and how?","Introduction Hip fractures are commonly diagnosed by plain radiography. When a patient presents with negative radiographs and high clinical suspicion of fracture, guidelines recommend proceeding with magnetic resonance imaging (MRI) to diagnose the patient. The aim of this study was to assess the use of MRI in diagnosing hip fractures following trauma to the hip and describe clinical outcome after MRI-diagnosed hip fractures. The perspective was to develop new recommendations for MRI use. Materials and methods 616 patients at a university hospital fulfilled the inclusion criteria of having an MRI scan of the hip following trauma between the years of 2005 and 2014. Data was collected from the patients’ medical records. Results The annual number of MRIs increased over the ten-year period. Out of 616 MRI scans 228 (37%) showed fracture of the hip with a dominance of trochanteric fractures, 185 (30%) revealed pelvic fracture and 183 (29%) were negative. No patient with acute pelvic fracture had associated fracture of the hip. The main reason to proceed with MRI was a strong clinical suspicion of fracture in patients with negative initial radiographs. Amongst the 228 patients with fracture, 187 (82%) were treated operatively. Of patients with hip fracture, 90 (39%) patients suffered a general complication and 11 (5%) had hip complications. The complication rate of patients with fracture on MRI was compared to that of a cohort of general hip fracture patients at our hospital. No significant difference in twelve months’ survival or general complications could be found, but the MRI group had a significantly lower hip complication rate. Conclusion The diagnosis set by MRI, with high share of pelvic fractures or no fracture, reflects the difficulty in differential diagnosing this group of patients. The rate of occult hip fractures was low and patients with pelvic fractures already known from X-ray did not have additional hip fractures. We found an increase in the annual number of MRIs during the 10–year-period. MRI-diagnosed hip fracture patients do not suffer more complications than the regular hip fracture patient.",aged;article;brain ischemia;controlled study;dementia;differential diagnosis;female;femur trochanteric fracture;follow up;heart infarction;hip fracture;human;length of stay;lung embolism;major clinical study;mortality;nuclear magnetic resonance imaging;pelvis fracture;pneumonia;radiography;thrombosis;wound infection;X ray analysis,"Pejic, A.;Hansson, S.;Rogmark, C.",2017,,10.1016/j.injury.2017.01.025,0,
3421,Migraine and cognitive function: Baseline findings from the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil,"Background The association between migraine and cognitive performance is unclear. We analyzed whether migraine is associated with cognitive performance among participants of the Brazilian Longitudinal Study of Adult Health, ELSA-Brasil. Methods Cross-sectional analysis, including participants with complete information about migraine and aura at baseline. Headache status (no headaches, non-migraine headaches, migraine without aura and migraine with aura), based on the International Headache Society classification, was used as the dependent variable in the multilinear regression models, using the category ""no headache"" as reference. Cognitive performance was measured with the Consortium to Establish a Registry for Alzheimer's Disease word list memory test (CERAD-WLMT), the semantic fluency test (SFT), and the Trail Making Test version B (TMTB). Z-scores for each cognitive test and a composite global score were created and analyzed as dependent variables. Multivariate models were adjusted for age, gender, education, race, coronary heart disease, heart failure, hypertension, diabetes, dyslipidemia, body mass index, smoking, alcohol use, physical activity, depression, and anxiety. In women, the models were further adjusted for hormone replacement therapy. Results We analyzed 4208 participants. Of these, 19% presented migraine without aura and 10.3% presented migraine with aura. All migraine headaches were associated with poor cognitive performance (linear coefficient beta; 95% CI) at TMTB -0.083 (-0.160; -0.008) and poorer global z-score -0.077 (-0.152; -0.002). Also, migraine without aura was associated with poor cognitive performance at TMTB -0.084 (-0.160, -0.008 and global z-score -0.077 (-0.152; -0.002). Conclusion In participants of the ELSA-study, all migraine headaches and migraine without aura were significantly and independently associated with poorer cognitive performance.",Headache;cognition;cognitive performance;executive function;migraine headaches,"Pellegrino Baena, C.;Goulart, A. C.;Santos, I. S.;Suemoto, C. K.;Lotufo, P. A.;Bensenor, I. J.",2017,Jan 01,,0,
3422,"Association of low-frequency and rare coding-sequence variants with blood lipids and coronary heart disease in 56,000 whites and blacks","Low-frequency coding DNA sequence variants in the proprotein convertase subtilisin/kexin type 9 gene (PCSK9) lower plasma low-density lipoprotein cholesterol (LDL-C), protect against risk of coronary heart disease (CHD), and have prompted the development of a new class of therapeutics. It is uncertain whether the PCSK9 example represents a paradigm or an isolated exception. We used the ""Exome Array"" to genotype >200,000 low-frequency and rare coding sequence variants across the genome in 56,538 individuals (42,208 European ancestry [EA] and 14,330 African ancestry [AA]) and tested these variants for association with LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides. Although we did not identify new genes associated with LDL-C, we did identify four low-frequency (frequencies between 0.1% and 2%) variants (ANGPTL8 rs145464906 [c.361C>T; p.Gln121-], PAFAH1B2 rs186808413 [c.482C>T; p.Ser161Leu], COL18A1 rs114139997 [c.331G>A; p.Gly111Arg], and PCSK7 rs142953140 [c.1511G>A; p.Arg504His]) with large effects on HDL-C and/or triglycerides. None of these four variants was associated with risk for CHD, suggesting that examples of low-frequency coding variants with robust effects on both lipids and CHD will be limited. © 2014 The American Society of Human Genetics.",1 alkyl 2 acetylglycerophosphocholine esterase;collagen type 18;glucose;high density lipoprotein cholesterol;low density lipoprotein cholesterol;proteoglycan;triacylglycerol;allele;article;Caucasian;cholesterol blood level;chromosome 19;exome;female;gene frequency;genetic association;genotype;glucose tolerance;human;human tissue;ischemic heart disease;lipid blood level;major clinical study;male;Black person;open reading frame;phenotype;priority journal;stop codon;triacylglycerol blood level,"Peloso, G. M.;Auer, P. L.;Bis, J. C.;Voorman, A.;Morrison, A. C.;Stitziel, N. O.;Brody, J. A.;Khetarpal, S. A.;Crosby, J. R.;Fornage, M.;Isaacs, A.;Jakobsdottir, J.;Feitosa, M. F.;Davies, G.;Huffman, J. E.;Manichaikul, A.;Davis, B.;Lohman, K.;Joon, A. Y.;Smith, A. V.;Grove, M. L.;Zanoni, P.;Redon, V.;Demissie, S.;Lawson, K.;Peters, U.;Carlson, C.;Jackson, R. D.;Ryckman, K. K.;MacKey, R. H.;Robinson, J. G.;Siscovick, D. S.;Schreiner, P. J.;Mychaleckyj, J. C.;Pankow, J. S.;Hofman, A.;Uitterlinden, A. G.;Harris, T. B.;Taylor, K. D.;Stafford, J. M.;Reynolds, L. M.;Marioni, R. E.;Dehghan, A.;Franco, O. H.;Patel, A. P.;Lu, Y.;Hindy, G.;Gottesman, O.;Bottinger, E. P.;Melander, O.;Orho-Melander, M.;Loos, R. J. F.;Duga, S.;Merlini, P. A.;Farrall, M.;Goel, A.;Asselta, R.;Girelli, D.;Martinelli, N.;Shah, S. H.;Kraus, W. E.;Li, M.;Rader, D. J.;Reilly, M. P.;McPherson, R.;Watkins, H.;Ardissino, D.;Zhang, Q.;Wang, J.;Tsai, M. Y.;Taylor, H. A.;Correa, A.;Griswold, M. E.;Lange, L. A.;Starr, J. M.;Rudan, I.;Eiriksdottir, G.;Launer, L. J.;Ordovas, J. M.;Levy, D.;Chen, Y. D. I.;Reiner, A. P.;Hayward, C.;Polasek, O.;Deary, I. J.;Borecki, I. B.;Liu, Y.;Gudnason, V.;Wilson, J. G.;Van Duijn, C. M.;Kooperberg, C.;Rich, S. S.;Psaty, B. M.;Rotter, J. I.;O'Donnell, C. J.;Rice, K.;Boerwinkle, E.;Kathiresan, S.;Cupples, L. A.",2014,,,0,
3423,Estimating lifetime risk of developing high serum total cholesterol: Adjustment for baseline prevalence and single-occasion measurements,"The lifetime risk statistic is a powerful tool in epidemiology. It has been successfully applied to estimate and highlight the risks of numerous diseases, including breast cancer, Alzheimer's disease, stroke, and coronary heart disease and some of its risk factors. Application of this method to health-related conditions that may have an onset early in young adulthood or to measurements that can fluctuate over time introduces problems of under- or overestimation of risk. To correctly quantify the long-term risk of developing high serum total cholesterol (≥240 mg/dl or use of lipid-lowering medication), the authors propose a key modification of the lifetime risk statistic: adjustment for baseline prevalence. It accounts for the fact that many people already have the condition at a young age (an age often chosen as baseline). The authors derive point estimators and confidence intervals and supply a SAS macro (SAS Institute, Inc., Cary, North Carolina). For assessment of the risk inflation due to single-occasion measurement, the authors suggest two diagnostic tools, one requiring the condition to be present on two consecutive occasions and the other taking into account intrasubject variability. As an illustration, the authors calculate risk estimates for US Caucasians based on hypercholesterolemia incidence (1971-early 2001) from the Framingham Heart Study and prevalence data from the 1999-2000 National Health and Nutrition Examination Survey. Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved.",antilipemic agent;cholesterol;adult;article;Caucasian;cholesterol blood level;confidence interval;devices;diagnostic procedure;disease free survival;female;health survey;human;hypercholesterolemia;male;prevalence;risk assessment;statistical analysis;survival rate;time series analysis;United States,"Pencina, M. J.;D'Agostino, R. B.;Beiser, A. S.;Cobain, M. R.;Vasan, R. S.",2007,,,0,
3424,"Risk of recurrent stroke, other vascular events and dementia after transient ischaemic attack and stroke","The early risk of recurrence after transient ischaemic attack (TIA) or minor stroke is high, ranging from 11% at 7 days in population-based studies, where patients are seen non-urgently, to 3% at 7 days in studies where patients are seen urgently in specialist services. In long-term (up to 10 years) studies of vascular risks after TIA and stroke, the risk of stroke is highest early after the event, and then falls, whereas the risk of coronary events is constant over the follow-up period at around 2% per year. In contrast to the early risk after TIA and stroke, the long-term risks are more dependent on the underlying vascular risk factors than the characteristics of the event itself. Stroke is also associated with an increased risk of dementia. Prevalence of post-stroke dementia varies between studies but is around 28% at 3 months in hospital-based studies where pre-stroke dementia was not excluded and 18% in hospital-based studies excluding pre-stroke dementia. Risk factors for post-stroke dementia include low education, prior or recurrent stroke, and older age. In conclusion, available data suggest that the risk of recurrent vascular events is considerable after TIA and stroke, even in the longer term, and that there is also a high risk of dementia after stroke. However, more studies are required to determine medium- and long-term outcomes in the current era of aggressive secondary preventive therapy. © 2009 S. Karger AG, Basel.",Alzheimer disease;article;cardiovascular risk;cognitive defect;dementia;heart death;heart infarction;human;prevalence;priority journal;prognosis;recurrent disease;cerebrovascular accident;transient ischemic attack,"Pendlebury, S. T.;Rothwell, P. M.",2009,,,0,
3425,Transient cognitive impairment in TIA and minor stroke,"BACKGROUND AND PURPOSE-: Acute cognitive impairment and delirium occur after major stroke and are associated with poor cognitive outcome. We conducted a population-based study to determine whether transient cognitive impairment (TCI) is seen acutely after cerebral transient ischemic attack (TIA) or minor stroke, and whether it predicts long-term cognitive decline. METHODS-: Mini-mental-state examination was performed in consecutive testable patients with TIA or minor stroke (National Institutes of Health Stroke Scale ≤3) seen acutely (1-7 days) in the Oxford Vascular Study (2002-2005) versus after 7 days, and in referrals seen acutely who had a subsequent noncerebrovascular diagnosis. We defined TCI as a baseline Mini-mental-state examination score ≥2 points below the 1-month follow-up score, and identified cognitive impairment (Montreal Cognitive Assessment [MoCA] <26/30) and severe dementia at 1-, 2-, and 5-year follow-up. RESULTS-: In 280 TIA and minor stroke patients (mean age/SD 73.5/11.8 years), TCI was more frequent in those seen at 1 to 7 days (80/206; 38.9%) versus later (14/74; 19%; P=0.002) or in noncerebrovascular patients (10/47; 21%; P=0.004). TCI was associated with acute confusion (OR, 5.5; 95% CI, 2.5-11.7; P<0.0001), acute infarct on computed tomography (OR, 2.0; 1.2-3.5; P=0.01), and with residual focal deficits (OR,1.94; 1.13-3.34; P=0.01). However, it was still seen acutely in those whose focal deficits had resolved by time of assessment (41/120; 34%). Although patients with TCI had similar Mini-mental-state examination score by 1 month compared with those without TCI, their 5-year risks of cognitive impairment (OR, 4.3; 1.2-15.7; P=0.03) and severe dementia (OR, 4.9; 1.0-25.8; P=0.05) were increased. CONCLUSIONS-: TCI is a manifestation of TIA and minor stroke, and may persist beyond resolution of focal symptoms. Our findings have implications for definitions in TIA and minor stroke and suggest that cognitive fragility may be revealed by minor cerebrovascular events. © 2011 American Heart Association, Inc.",acute confusion;aged;article;brain infarction;cognitive defect;computer assisted tomography;controlled study;dementia;female;follow up;human;major clinical study;male;Mini Mental State Examination;National Institutes of Health Stroke Scale;neuroimaging;patient referral;prediction;priority journal;scoring system;cerebrovascular accident;transient ischemic attack,"Pendlebury, S. T.;Wadling, S.;Silver, L. E.;Mehta, Z.;Rothwell, P. M.",2011,,,0,
3426,Multiple-time scales analysis of physiological time series under neural control,"We discuss multiple-time scale properties of neurophysiological control mechanisms, using heart rate and gait regulation as model systems. We find that scaling exponents can be used as prognostic indicators. Furthermore, detection of more subtle degradation of scaling properties may provide a novel early warning system in subjects with a variety of pathologies including those at high risk of sudden death.","Adult;Aged;Aged, 80 and over;Autonomic Nervous System/*physiology;Data Interpretation, Statistical;Female;*Fractals;Gait/*physiology;Heart Failure/physiopathology;Heart Rate/*physiology;Humans;Huntington Disease/physiopathology;Male;Time Factors;NASA Discipline Cardiopulmonary;Non-NASA Center","Peng, C. K.;Hausdorff, J. M.;Havlin, S.;Mietus, J. E.;Stanley, H. E.;Goldberger, A. L.",1998,,,0,
3427,Increased risk of dementia among patients with pulmonary tuberculosis: A retrospective population-based cohort study,"Objective: We investigated and compared the risk of dementia development in a cohort of patients with tuberculosis (TB). Methods: The study involved 6473 patient with newly diagnosed TB, and each patient was randomly frequency matched with 4 people without TB based on age, sex, and index year. The risk of dementia development was analyzed using Cox proportional hazards regression. Results: Among the patients with TB, the overall risk of developing dementia was 1.21-fold significantly higher than the non-TB cohort. In the stratified analysis of dementia risks, only the patients with TB who were male or 50 to 64 years of age exhibited a significantly higher risk of dementia development compared with those without TB. An analysis of the follow-up duration revealed that patients with TB had a 1.78-fold increased risk within 1 year of follow-up. Conclusion: Patients with TB have a significantly higher risk of developing dementia than that of the general population.",aged;article;atrial fibrillation;cardiometabolic risk;cerebrovascular accident;cohort analysis;comorbidity;controlled study;dementia;depression;diabetes mellitus;disease predisposition;female;follow up;head injury;heart failure;human;hyperlipidemia;hypertension;lung tuberculosis;major clinical study;male;proportional hazards model;retrospective study;risk assessment,"Peng, Y. H.;Chen, C. Y.;Su, C. H.;Muo, C. H.;Chen, K. F.;Liao, W. C.;Kao, C. H.",2015,,,0,
3428,Long-term warfarin use to prevent both stroke and dementia in subjects with atrial fibrillation?,,warfarin;anticoagulant therapy;anticoagulation;artery occlusion;atherosclerotic plaque;brain embolism;brain infarction;brain ischemia;cardiovascular risk;clinical feature;clinical observation;cognitive defect;dementia;disease association;heart atrium enlargement;atrial fibrillation;heart ventricle function;human;hypertension;hypothesis;long term care;note;occlusive cerebrovascular disease;pathophysiology;perfusion;priority journal;recanalization;risk assessment;risk reduction;cerebrovascular accident;transesophageal echocardiography;venous stasis,"Pengo, V.",2004,,,0,
3429,Iatrogenic demential and extrapyramidal syndrome: rare adverse effect of valproic acid-aspirin combination,,acetylsalicylic acid;allopurinol;valproic acid;fluoxetine;tamsulosin;unclassified drug;aged;case report;consultation;dementia;epilepsy;extrapyramidal symptom;heart failure;hospitalization;human;hypertrophic cardiomyopathy;iatrogenic disease;letter;lung infection;male;prescription;symptom;depakine chrono,"Penot, J. P.;Pradeau, F.",2010,,,0,
3430,"The association of race, gender, and comorbidity with mortality and function after hip fracture","Background. Few studies of hip fracture have large enough samples of men, minorities, and persons with specific comorbidities to examine differences in their mortality and functional outcomes. To address this problem, we combined three cohorts of hip fracture patients to produce a sample of 2692 patients followed for 6 months. Method. Data on mortality, mobility, and other activities of daily living (ADLs) were available from all three cohorts. We used multiple regression to examine the association of race, gender, and comorbidity with 6-month survival and function, controlling for prefracture mobility and ADLs, age, fracture type, cohort, and admission year. Results. The mortality rate at 6 months was 12%: 9% for women and 19% for men. Whites and women were more likely than were nonwhites and men to survive to 6 months, after adjusting for age, comorbidities, and prefracture mobility and function. Whites were more likely than were nonwhites to walk independently or with help at 6 months compared to not walking, after adjusting for age, comorbidities, and prefracture mobility and function. Dementia had a negative impact on survival, mobility, and ADLs at 6 months. The odds of survival to 6 months were significantly lower for people with chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and/or cancer. Parkinson's disease and stroke had negative impacts on mobility and ADLs, respectively, among survivors at 6 months. Conclusions. The finding of higher mortality and worse mobility for nonwhite patients with hip fractures highlights the need for more research on race/ethnicity disparities in hip fracture care. Copyright 2008 by The Gerontological Society of America.",aged;angina pectoris;article;asthma;cerebrovascular accident;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;daily life activity;dementia;diabetes mellitus;European American;female;functional status;heart arrhythmia;heart infarction;hip fracture;hospital admission;human;hypertension;major clinical study;male;mortality;neoplasm;Parkinson disease;physical mobility;priority journal;race difference;sex difference;survival;walking,"Penrod, J. D.;Litke, A.;Hawkes, W. G.;Magaziner, J.;Doucette, J. T.;Koval, K. J.;Silberzweig, S. B.;Egol, K. A.;Siu, A. L.",2008,,,0,
3431,Three Trillion and Counting,,Alzheimer disease;article;attention deficit disorder;comorbidity;emergency care;emergency ward;gross national product;health care cost;health care policy;human;ischemic heart disease;musculoskeletal disease;osteoarthritis;public health,"Pentecost, M. J.",2017,,10.1016/j.jacr.2017.03.002,0,
3432,Clinical relevance of thiamine status amongst hospitalized elderly patients,"BACKGROUND: The prevalence and the consequences of thiamine deficiency among elderly patients admitted to acute geriatric wards are not known. OBJECTIVES: (1) To assess the prevalence of thiamine deficiency in patients admitted to a geriatric ward compared to age-matched ambulatory outpatients; (2) to identify their diseases and problems associated with thiamine deficiency, and (3) to determine the relationship between the thiamine status and the cognitive and functional status of these patients. MATERIALS AND METHODS: 118 aged hospitalized patients (83 +/- 7 years; mean age +/- SD) were prospectively enrolled on admission to the geriatric ward. Their cognitive status was assessed using the Mini-Mental State Examination (MMSE) and their ability to perform their activities of daily living (ADL) using ADL scales. The effect of exogenous thiamine pyrophosphate (TPP) addition on the blood transketolase (TK) activity (TPP TK effect) served to estimate thiamine deficiency. Socioeconomic data, diseases and treatment were identified as potential associated risk factors. This group of hospitalized patients was divided according to their thiamine status to characterize the conditions associated with thiamine deficiency. Thirty-five outpatients without any functional or cognitive impairment served as a control group. RESULTS: Of 118 inpatients, 46 (39%) presented with a TPP TK effect of >15%, and 6 with values of >22%, indicating moderate and severe thiamine deficiency, respectively. Only 6 of 30 outpatients (20%) exhibited a TPP TK effect of >15% and none of them reached values of >18%. Although it tended to be lower in outpatients, the mean TPP TK effect did not statistically differ from the mean of inpatients. Thiamine-deficient inpatients comprised a larger proportion of institutionalized subjects than nondeficient inpatients (87 versus 47%, p < 0.001). Functional status, cognitive functions and the occurrence of delirium did not differ according to their thiamine status. By contrast, thiamine-deficient inpatients exhibited a higher proportion of Alzheimer's disease, depression, cardiac failure and falls. Furosemide was more frequently taken by thiamine-deficient patients. CONCLUSIONS: Severe thiamine deficiency remained quite low among the hospitalized elderly. The prevalence of moderate thiamine deficiency approached 40%. Institutionalized subjects were at particular risk of developing thiamine deficiency. Its clinical relevance on functional status and on cognitive function remained not significant. By contrast, a high proportion of falls, Alzheimer's disease, depression, cardiac failure and furosemide use could have been related to thiamine deficiency.","*Activities of Daily Living;Aged;Aged, 80 and over;*Aging;Cognition Disorders/epidemiology/etiology/rehabilitation;Delirium/epidemiology/etiology/rehabilitation;Enzyme Activation/drug effects;Female;Humans;Inpatients/*statistics & numerical data;Male;Outpatients/statistics & numerical data;Social Class;Thiamine Deficiency/complications/*epidemiology/*rehabilitation;Transketolase/blood","Pepersack, T.;Garbusinski, J.;Robberecht, J.;Beyer, I.;Willems, D.;Fuss, M.",1999,,22070,0,
3433,Measuring the presence of chronic diseases 10,,Charlson Comorbidity Index;chronic disease;chronic obstructive lung disease;Peptoclostridium difficile;comorbidity;dementia;diabetes mellitus;hospital admission;human;ischemic heart disease;letter;peripheral vascular disease,"Pépin, J.",2006,,,0,
3434,A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Treatment Strategy for Patients with Coronary Artery Disease the International Verapamil-Trandolapril Study (INVEST): A Randomized Controlled Trial,"Context Despite evidence of efficacy of antihypertensive agents in treating hypertensive patients, safety and efficacy of antihypertensive agents for coronary artery disease (CAD) have been discerned only from subgroup analyses in large trials. Objective To compare mortality and morbidity outcomes in patients with hypertension and CAD treated with a calcium antagonist strategy (CAS) or a non-calcium antagonist strategy (NCAS). Design, Setting, and Participants Randomized, open label, blinded end point study of 22576 hypertensive CAD patients aged 50 years or older, which was conducted September 1997 to February 2003 at 862 sites in 14 countries. Interventions Patients were randomly assigned to either CAS (verapamil sustained release) or NCAS (atenolol). Strategies specified dose and additional drug regimens. Trandolapril and/or hydrochlorothiazide was administered to achieve blood pressure goals according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) of less than 140 mm Hg (systolic) and less than 90 mm Hg (diastolic); and less than 130 mm Hg (systolic) and less than 85 mm Hg (diastolic) if diabetes or renal impairment was present. Trandolapril was also recommended for patients with heart failure, diabetes, or renal impairment. Main Outcome Measures Primary: first occurrence of death (all cause), nonfatal myocardial infarction, or nonfatal stroke; other: cardiovascular death, angina, adverse experiences, hospitalizations, and blood pressure control at 24 months. Results At 24 months, in the CAS group, 6391 patients (81.5%) were taking verapamil sustained release; 4934 (62.9%) were taking trandolapril; and 3430 (43.7%) were taking hydrochlorothiazide. In the NCAS group, 6083 patients (77.5%) were taking atenolol; 4733 (60.3%) were taking hydrochlorothiazide; and 4113 (52.4%) were taking trandolapril. After a follow-up of 61835 patient-years (mean, 2.7 years per patient), 2269 patients had a primary outcome event with no statistically significant difference between treatment strategies (9.93% in CAS and 10.17% in NCAS; relative risk [RR], 0.98; 95% confidence interval [CI], 0.90-1.06). Two-year blood pressure control was similar between groups. The JNC VI blood pressure goals were achieved by 65.0% (systolic) and 88.5% (diastolic) of CAS and 64.0% (systolic) and 88.1% (diastolic) of NCAS patients. A total of 71.7% of CAS and 70.7% of NCAS patients achieved a systolic blood pressure of less than 140 mm Hg and diastolic blood pressure of less than 90 mm Hg. Conclusion The verapamil-trandolapril-based strategy was as clinically effective as the atenolol-hydrochlorothiazide-based strategy in hypertensive CAD patients.",atenolol;calcium antagonist;hydrochlorothiazide;trandolapril;verapamil;aged;Alzheimer disease;angina pectoris;article;atrioventricular block;blood pressure regulation;bradycardia;neoplasm;cause of death;clinical trial;constipation;controlled clinical trial;controlled study;coronary artery disease;coughing;diabetes mellitus;diastolic blood pressure;drug efficacy;drug indication;drug safety;dyspnea;female;follow up;gastrointestinal hemorrhage;gout;headache;heart failure;heart infarction;hospitalization;human;hyperkalemia;hypertension;hypokalemia;kidney dysfunction;kidney failure;major clinical study;male;morbidity;mortality;multicenter study;Parkinson disease;peripheral edema;peripheral vascular disease;priority journal;randomized controlled trial;side effect;cerebrovascular accident;systolic blood pressure;transient ischemic attack;treatment outcome;unstable angina pectoris;vertigo;wheezing,"Pepine, C. J.;Handberg, E. M.;Cooper-DeHoff, R. M.;Marks, R. G.;Kowey, P.;Messerli, F. H.;Mancia, G.;Cangiano, J. L.;Garcia-Barreto, D.;Keltai, M.;Erdine, S.;Bristol, H. A.;Kolb, H. R.;Bakris, G. L.;Cohen, J. D.;Parmley, W. W.",2003,,,0,
3435,High Level of Depressive Symptoms at Repeated Study Visits and Risk of Coronary Heart Disease and Stroke over 10 Years in Older Adults: The Three-City Study,"BACKROUND: Baseline depressive symptoms have been consistently associated with the onset of cardiovascular disease (CVD). OBJECTIVES: Since depressive symptoms vary over time in elderly persons, and to help clarify whether or not depression is an etiological factor for CVD, we quantified the association between the course of depressive symptoms and occurrence of first coronary heart disease (CHD) and stroke events in older adults. DESIGN: A population-based prospective observational study. SETTING: Participants were randomly selected from the electoral rolls of three large French cities. PARTICIPANTS: A total of 9,294 participants were examined at baseline between 1999 and 2001, and thereafter at repeated study visits over 10 years. MEASUREMENTS: High levels of depressive symptoms (HLDS) were defined as a score>/=16 on the 20-item Center for Epidemiologic Studies Depression Scale. The number of study visits with HLDS was used as a time dependent variable in Cox proportional hazard models. RESULTS: There were 7,313 participants (36.6% males) aged 73.8+/-5.4 years with no history of CHD, stroke or dementia at baseline. After a median follow-up of 8.4 years (SD 2.3 years), 629 first CHD or stroke events occurred. After adjustment for sociodemographic characteristics and vascular risk factors, the risk of CHD and stroke combined increased 1.15-fold (95% CI: 1.06 to 1.25) per each additional study visit with HLDS. The results remained unchanged when accounting for the presence of disability and antidepressant intake at baseline and during follow-up. CONCLUSION: Elderly persons exposed to HLDS at several occasions over 10 years showed substantial increased risk of coronary heart disease and stroke events.",Aged;Coronary Artery Disease/epidemiology/*etiology;Depression/*complications/epidemiology/therapy;Female;*Forecasting;France/epidemiology;Humans;Incidence;Male;*Office Visits;*Population Surveillance;Prospective Studies;Risk Assessment/*methods;Risk Factors;Stroke/epidemiology/*etiology;cardiovascular disease;depressive disorders;elderly;epidemiology,"Pequignot, R.;Dufouil, C.;Prugger, C.;Peres, K.;Artero, S.;Tzourio, C.;Empana, J. P.",2016,Jan,10.1111/jgs.13872,0,
3436,"Depressive symptoms, antidepressants and disability and future coronary heart disease and stroke events in older adults: the Three City Study","To investigate the association between baseline depressive symptoms and first fatal and non fatal coronary heart disease (CHD) and stroke in older adults, taking antidepressants and disability into account. In the Three City Study, a community-based prospective multicentric observational study cohort, 7,308 non-institutionalized men and women aged >/=65 years with no reported history of CHD, stroke or dementia, completed the 20-item Center for Epidemiologic Studies depression scale (CESD) questionnaire. First CHD and stroke events during follow-up were adjudicated by an independent expert committee. Hazard ratios (HRs) were estimated by Cox proportional hazard model. After a median follow-up of 5.3 years, 338 subjects had suffered a first non-fatal CHD or stroke event, and 82 had died from a CHD or stroke. After adjustment for study center, baseline socio-demographic characteristics, and conventional risk factors, depressive symptoms (CESD >/= 16) were associated with fatal events only: fatal CHD plus stroke (HR = 2.50; 95% CI 1.57-3.97), fatal CHD alone (n = 57; HR = 2.21 ; 95%CI 1.27-3.87), and fatal stroke alone (n = 25; HR = 3.27; 95% CI 1.42-7.52). These associations were even stronger in depressed subjects receiving antidepressants (HR = 4.17; 95% CI 1.84-9.46) and in depressed subjects with impaired Instrumental Activities of Daily Living (HR = 8.93; 95% CI 4.60-17.34). By contrast, there was no significant association with non fatal events (HR for non-fatal CHD or stroke = 0.94; 95% CI 0.66-1.33). In non-institutionalized elderly subjects without overt CHD, stroke or dementia, depressive symptoms were selectively and robustly associated with first fatal CHD or stroke events.",Adult;Aging/psychology;Antidepressive Agents/*therapeutic use;Coronary Disease/*epidemiology/etiology;Depression/*drug therapy;Disabled Persons/psychology/*statistics & numerical data;Female;France/epidemiology;Humans;Incidence;Male;Proportional Hazards Models;Prospective Studies;Psychiatric Status Rating Scales;Risk Factors;Socioeconomic Factors;Stroke/*epidemiology/etiology;Surveys and Questionnaires,"Pequignot, R.;Tzourio, C.;Peres, K.;Ancellin, M. L.;Perier, M. C.;Ducimetiere, P.;Empana, J. P.",2013,Mar,10.1007/s10654-013-9765-3,0,
3437,Performance of the fixed pressure valve with antisiphon device SPHERA® in the treatment of normal pressure hydrocephalus and prevention of overdrainage,"Normal pressure hydrocephalus (NPH) is characterized by the triad of gait apraxia, dementia and urinary incontinence associated with ventriculomegaly and normal pressure of cerebrospinal fluid. Treatment is accomplished through the implantation of a ventricular shunt (VPS), however some complications are still frequent, like overdrainage due to siphon effect. This study analyses the performance of a valve with anti-siphon device (SPHERA®) in the treatment of patients with NPH and compares it with another group of patients with NPH who underwent the same procedure without anti-siphon mechanism (PS Medical® valve). 30 patients were consecutively enrolled in two groups with 15 patients each and followed clinically and radiologically for 1 year. Patients submitted to VPS with SPHERA® valve had the same clinical improvement as patients submitted to VPS with PS Medical®. However, complications and symptomatology due to overdrainage were significantly lower in SPHERA® group, suggesting it as a safe tool to treat NPH.",ventriculoatrial shunt;adult;article;behavior change;clinical article;clinical evaluation;dizziness;female;headache;heart left ventricle hypertrophy;human;male;medical device complication;Mini Mental State Examination;normotensive hydrocephalus;pressure relief valve;reoperation;shunt overdrainage;subdural hematoma;symptomatology;vomiting,"Pereira, R. M.;Suguimoto, M. T.;de Oliveira, M. F.;Tornai, J. B.;Amaral, R. A.;Teixeira, M. J.;Pinto, F. C. G.",2016,,,0,
3438,Assessment of long-term cognitive impairment after off-pump coronary-artery bypass grafting and related risk factors,"Objectives: To assess cognitive impairment after off-pump coronary-artery bypass grafting, with a particular emphasis on long-term follow-up and related risk factors. Design: Prospective study. Setting: Virgen de la Victoria University Hospital, Málaga, Spain. Participants: Participants were 36 patients undergoing off-pump coronary-artery bypass grafting. Measurements: Changes in the neuropsychological test battery administered from before to after surgery (1, 6, and 12months). Postoperative cognitive impairment was defined by a significant decrease. Results: A significantly multidomain (attention-executive functions, P<.01; immediate and delayed memory, P<.001; and verbal fluency, P<.05) postoperative cognitive impairment was shown, being maximum at 6months (more than 50% of patients) and still presented at 12months (more than 30% of patients), but partially recovered. Related risk factors as smoking (P<.01), diabetes mellitus (P<.01), peripheral arteriopathy (P<.01), obesity (P<.05), lower hematocrit (P<.01), and hemoglobin (P<.05) levels and diastolic blood pressure (P<.05) were identified as predictors of cognitive impairment. Better New York Heart Association class (P<.01) and less severity of angina (P<.01) were associated with partial postoperative recovering. Conclusion: A multidomain long-term postoperative cognitive impairment and a partial neurocognitive recovering were detected after off-pump coronary-artery bypass grafting and were associated with several nonspecific surgery factors. These findings may be useful when counseling patients before surgery and suggest the importance of long-term neurocognitive evaluation.",hemoglobin;aged;anemia;angina pectoris;article;attention;cardiovascular risk;clinical article;cognition;cognitive defect;comparative study;controlled study;convalescence;coronary artery disease;diabetes mellitus;diastolic blood pressure;disease duration;disease severity;executive function;female;follow up;hematocrit;hemoglobin blood level;human;male;mild cognitive impairment;neuropsychological test;New York Heart Association class;obesity;off pump coronary surgery;outcome assessment;perioperative period;peripheral vascular disease;postoperative period;preoperative period;prospective study;recall;scoring system;short term memory;smoking;verbalization,"Pérez-Belmonte, L. M.;San Román-Terán, C. M.;Jiménez-Navarro, M.;Barbancho, M. A.;García-Alberca, J. M.;Lara, J. P.",2015,,,0,
3439,Co-morbidity in Gaucher's disease results of a nationwide enquiry in Spain,"SHORT INTRODUCTION: Gaucher's disease (GD) is an autosomal recessive disease produced by mutations of the Glucocerebrosidase gene. Carriers are considered to be healthy subjects because there is no manifestation of the disease, but they show signs of macrophage disfunction. The aim of the study was to determine if GD patients and non affected carriers risk suffering other diseases when compared to healthy non-carrier relatives. MATERIAL AND METHODS: DESIGN: Epidemiologic study of historic cohorts. The fact that they have one or two mutated alleles has been considered to be the risk factor leading to other conditions (Dementia, Parkinson disease, Ischemic stroke, Ischemic heart disease, Non rheumatic valvular disease, Cancer hematological and non-hematological, Pulmonary fibrosis, Tuberculosis, Gallstones and Schizophrenia). All people, patients, carriers and healthy controls shared the same genetical background and environmental influence. - Patients and relatives enrolled on the Spanish Gaucher Disease Registry were evaluated. STATISTICS: For the Relative-Risk calculation the Mantel-Haenszel test was applied. Yates' correction was used when size sample was too small. A value of p <0.05 was accepted for statistical significance. RESULTS: 370 people, from 79 different families, were surveyed. We received evaluable information from 45 families (56%), totalling 258 people (69%): 59 healthy subjects (Mean age 32. 20, RANGE: 10-85; M 57.63%/F 42.37%), 132 carriers (Mean age 35.91, RANGE: 1-79; M 56.82%/F 43.18%) and 67 patients (Mean age 32.16, Range: 1-76; M 44.78%/F 55.22%. - Relative Risk of suffering any disease with regard to Gaucher's status: Patient vs Healthy 9.69 (95% Confidence interval [CI] 2.00-63.99; p 0.0006). Patient vs Carrier 3.74 (CI 1.53-9.27; p 0.001); Carrier vs Healthy 2.59 (CI 0. 52-12.50; p 0.21). Relative Risk of suffering any disease with regard to sex was 3.96 for female patients (CI 1.01-16.75; p 0.02) and 1.34 for female carriers (CI 0.27-6.75; p = 0.68). CONCLUSION: As a group, Gaucher's patients seem to have a greater risk of suffering other common unrelated diseases than carriers or healthy relatives. This excess of risk is particularly higher among female patients and can not be explained in terms of differences in age. Carrier status doesn't seem to highten the risk of suffering other diseases.",glucosylceramidase;adolescent;adult;aged;allele;article;child;cohort analysis;female;Gaucher disease;genetic predisposition;genetics;heterozygote;human;male;middle aged;mutation;risk factor;Spain,"Pérez-Calvo, J.;Bernal, M.;Giraldo, P.;Torralba, M. A.;Civeira, F.;Giralt, M.;Pocovi, M.",2000,,,0,
3440,Missed opportunities for advance care planning,,acquired immune deficiency syndrome;adult;aged;cardiovascular mortality;chronic kidney disease;chronic obstructive lung disease;comorbidity;connective tissue disease;dementia;diabetes mellitus;female;health care planning;atrial fibrillation;heart ejection fraction;heart failure;hospital readmission;human;hyperlipidemia;hypertension;ischemic heart disease;letter;leukemia;liver disease;lymphoma;major clinical study;male;peptic ulcer;peripheral occlusive artery disease;prognosis;cerebrovascular accident,"Pérez-Calvo, J. I.;Montero-Pérez-Barquero, M.;Formiga, F.",2012,,,0,
3441,"Cerebral folate deficiency syndromes in childhood: Clinical, analytical, and etiologic aspects","Background: Cerebral folate deficiency may be amenable to therapeutic supplementation. Diverse metabolic pathways and unrelated processes can lead to cerebrospinal fluid 5-methyltetrahydrofolate (5-MTHF) depletion, the hallmark of cerebral folate deficiency. Objective: To analyze cerebral folate abundance in a large prospective series of children diagnosed with any neurologic disorder for which a diagnostic lumbar puncture was indicated. Design: We studied the spectrum and frequency of disorders associated with cerebral folate deficiency by measuring cerebrospinal fluid 5-MTHF, biogenic amines, and pterins. Direct sequencing of the FOLR1 transporter gene was also performed in some patients. Setting: Academic pediatric medical center. Participants: We studied 134 individuals free of neurometabolic disease and 584 patients with any of several diseases of the central nervous system. Results: Of 584 patients, 71 (12%) exhibited 5-MTHF deficiency. Mild to moderate deficiency (n=63; range, 19-63 nmol/L) was associated with perinatal asphyxia, central nervous system infection, or diseases of probable genetic origin (inborn errors of metabolism, white matter disorders, Rett syndrome, or epileptic encephalopathies). Severe 5-MTHF depletion (n=8; range, 0.6-13 nmol/L) was detected in severe MTHF reductase deficiency, Kearns-Sayre syndrome, biotin-responsive striatal necrosis, acute necrotizing encephalitis of Hurst, and FOLR1 defect. A strong correlation was observed between cerebrospinal fluid and plasma folate levels in cerebral folate deficiency. Conclusions: Of the 2 main forms of cerebral folate deficiency identified, mild to moderate 5-MTHF deficiency was most commonly associated with disorders bearing no primary relation to folate metabolism, whereas profound 5-MTHF depletion was associated with specific mitochondrial disorders, metabolic and transporter defects, or cerebral degenerations. The results suggest that 5-MTHF can serve either as the hallmark of inborn disorders of folate transport and metabolism or, more frequently, as an indicator of neurologic dysfunction. ©2011 American Medical Association. All rights reserved.",5 methyltetrahydrofolic acid;biogenic amine;dihydrofolate reductase;pterin derivative;adolescent;adult;article;biotin responsive striatal necrosis;brain disease;brain level;brain metabolism;brain necrosis;central nervous system infection;cerebral folic acid deficiency syndrome;cerebrospinal fluid level;child;controlled study;disease association;disease severity;folic acid deficiency;FOLRI transporter gene;gene;gene sequence;human;inborn error of metabolism;infant;Kearns Sayre syndrome;Leigh disease;Lennox Gastaut syndrome;lumbar puncture;major clinical study;perinatal asphyxia;preschool child;priority journal;Rett syndrome;school child;vitamin blood level;white matter,"Pérez-Dueñas, B.;Ormazábal, A.;Toma, C.;Torrico, B.;Cormand, B.;Serrano, M.;Sierra, C.;De Grandis, E.;Marfa, M. P.;García-Cazorla, A.;Campistol, J.;Pascual, J. M.;Artuch, R.",2011,,,0,
3442,Case report: Myocarditis in West Nile virus infection,West Nile virus (WNV) myocarditis has been documented pathologically in birds and mammals but has rarely been reported in human clinical syndromes. We describe myocarditis associated with WNV. Copyright © 2006 by The American Society of Tropical Medicine and Hygiene.,ampicillin;ceftriaxone;creatine kinase;immunoglobulin G;immunoglobulin M;troponin;abnormally high substrate concentration in blood;aged;article;assisted ventilation;case report;creatine kinase blood level;erythema;fever;atrial fibrillation;heart atrium flutter;heart infarction;heart muscle ischemia;heart ventricle extrasystole;human;hypokinesia;hypoxia;male;mental deterioration;myocarditis;paresis;protein blood level;rash;respiratory failure;serodiagnosis,"Pergam, S. A.;Delong, C. E.;Echevarria, L.;Scully, G.;Goade, D. E.",2006,,,0,
3443,Energy and nutrient intake of elderly hospitalized patients in a steady metabolic status versus catabolic status,"Protein undernutrition enhances frailty and aggravates intercurrent diseases generally observed in elderly patients. Undernutrition results from insufficient food intake and catabolic status. Daily nutrient intakes were explored for hospitalized geriatric patients. Nutrient intake (carbohydrates, lipids, proteins, and calcium) was determined in randomly selected geriatric patients (n=49) over five consecutive days by weighting food in the plate before and after meals. For each geriatric patient, catabolic status and risk factors of undernutrition were considered. Results were compared between patients in a steady status or catabolic status. In steady status patients, protein, lipid and carbohydrate intake but not calcium intake, met recommended dietary allowances (total caloric intake:1535 ± 370 Cal/day; protein: 1 ± 0.4 g/kg/day; carbohydrates: 55 ± 7.7%; lipids: 30 ± 6.3%; calcium: 918 ± 341 mg/day). Patients in catabolic status (cardiopulmonary deficiency, neurologic disease, inflammatory process) had lower total caloric intake, lower protein intake and dramatically lower calcium intake (total caloric intake: 1375 ± 500 Cal/day; protein: 0.9 ± 0.4 g/kg/day; carbohydrates: 54 ± 8.3 %; lipids: 31 ± 6.2%; calcium: 866 ± 379 mg/day). Nutrient intake was lower in elderly patients hospitalized in short stay care units, perhaps due to failure to recognize suitable nutrient requirements. Protein-caloric undernutrition should be diagnosed early during hospitalization in order to allow appropriate dietary supplementation. However the incidence of protein undernutrition among elderly patients as a cause or a consequence of adverse pathophysiological processes remains a cause of debate.",calcium;carbohydrate;lipid;protein;aged;aging;article;calcium intake;caloric intake;carbohydrate intake;cardiopulmonary insufficiency;chronic disease;clinical article;dementia;depression;dysphagia;fat intake;female;hospital patient;human;inflammation;length of stay;male;neurologic disease;priority journal;protein intake;kwashiorkor;risk factor,"Perier, C.;Triouleyre, P.;Terrat, C.;Chomette, M. C.;Beauchet, O.;Gonthier, R.",2004,,,0,
3444,Outcomes among HIV-1 infected individuals first starting antiretroviral therapy with concurrent active TB or other AIDS-defining disease,"Background: Tuberculosis (TB) is common among HIV-infected individuals in many resource-limited countries and has been associated with poor survival. We evaluated morbidity and mortality among individuals first starting antiretroviral therapy (ART) with concurrent active TB or other AIDS-defining disease using data from the ""Prospective Evaluation of Antiretrovirals in Resource-Limited Settings"" (PEARLS) study. Methods: Participants were categorized retrospectively into three groups according to presence of active confirmed or presumptive disease at ART initiation: those with pulmonary and/or extrapulmonary TB (""TB"" group), those with other non-TB AIDS-defining disease (""other disease""), or those without concurrent TB or other AIDS-defining disease (""no disease""). Primary outcome was time to the first of virologic failure, HIV disease progression or death. Since the groups differed in characteristics, proportional hazard models were used to compare the hazard of the primary outcome among study groups, adjusting for age, sex, country, screening CD4 count, baseline viral load and ART regimen. Results: 31 of 102 participants (30%) in the ""TB"" group, 11 of 56 (20%) in the ""other disease"" group, and 287 of 1413 (20%) in the ""no disease"" group experienced a primary outcome event (p = 0.042). This difference reflected higher mortality in the TB group: 15 (15%), 0 (0%) and 41 (3%) participants died, respectively (p<0.001). The adjusted hazard ratio comparing the ""TB"" and ""no disease"" groups was 1.39 (95% confidence interval: 0.93-2.10; p = 0.11) for the primary outcome and 3.41 (1.72-6.75; p<0.001) for death. Conclusions: Active TB at ART initiation was associated with increased risk of mortality in HIV-1 infected patients. © 2013 Périssé et al.",NCT00084136;antiretrovirus agent;atazanavir plus didanosine plus emtricitabine;efavirenz plus emtricitabine plus tenofovir;efavirenz plus lamivudine plus zidovudine;Human immunodeficiency virus proteinase inhibitor;nonnucleoside reverse transcriptase inhibitor;unclassified drug;acquired immune deficiency syndrome;acute heart infarction;adult;AIDS defining disease;antimicrobial therapy;antiretroviral therapy;article;atypical mycobacteriosis;brain hemorrhage;CD4 lymphocyte count;cerebrovascular accident;chronic gastroenteritis;concurrent infection;controlled clinical trial;controlled study;cryptococcal meningitis;Cytomegalovirus retinitis;disease course;drug efficacy;esophagus candidiasis;ethnicity;extrapulmonary tuberculosis;female;gastroenteritis;hepatitis;HIV associated dementia;human;Human immunodeficiency virus 1 infection;hydrocephalus;infection risk;intracranial tuberculoma;Kaposi sarcoma;major clinical study;male;middle aged;miliary tuberculosis;morbidity;mortality;mucocutaneous herpes simplex;nonhodgkin lymphoma;open study;phase 4 clinical trial;randomized controlled trial;retrospective study;risk assessment;stab wound;suicide;systemic mycosis;toxoplasmic encephalitis;tuberculosis;virus load;wasting syndrome,"Périssé, A. R. S.;Smeaton, L.;Chen, Y.;La Rosa, A.;Walawander, A.;Nair, A.;Grinsztejn, B.;Santos, B.;Kanyama, C.;Hakim, J.;Nyirenda, M.;Kumarasamy, N.;Lalloo, U. G.;Flanigan, T.;Campbell, T. B.;Hughes, M. D.",2013,,,0,
3445,Genetics and Alzheimer's disease: notes of an environment watcher (with apologies to L. Thomas),"Support has recently been voiced for the genetic hypothesis of Alzheimer's disease; frequently at the expense of considerations of environmental factors. In the adult, genetic diseases rarely exist without modification by environment forces. Atherosclerosis leading to myocardial infarction may provide a useful model to consider genetic and environmental factors in Alzheimer's disease. Familial hypercholesterolemia produces a premature inherited form of myocardial infarction, whereas, atherosclerosis with myocardial infarction, seen in advanced age, relates more closely to environmental factors such as smoking, diet, etc.",Alzheimer Disease/*chemically induced/genetics;Environmental Pollutants/*toxicity;Humans,"Perl, D. P.",1989,Sep-Oct,,0,
3446,Systemic light chain amyloidosis and Sjogren syndrome: An uncommon association,"Sjogren syndrome is associated with lymphoproliferative disease in 7 of cases; however, association with AL amyloidosis is uncommon. We present a patient who presented simultaneously with Sjogren syndrome supported by dry mouth, positive Schirmer's test, anti-RoSSA antibodies, and a lower lip salivary gland biopsy and AL amyloidosis revealed by heart failure without myeloma. Although is it know that amyloidosis can masquerade as Sjogren syndrome, the occurrence of simultaneous AL amyloidosis and primary Sjogren syndrome has been reported rarely.",amyloid;cyclophosphamide;dexamethasone;gadolinium chloride;melphalan;thalidomide;aged;amyloidosis;article;bone marrow biopsy;bradycardia;case report;chronic wasting disease;claudication;disease association;disease severity;dyspnea;echography;electrocardiogram;female;glossodynia;atrial fibrillation;heart atrium flutter;heart ejection fraction;heart failure;heart muscle biopsy;heart muscle fibrosis;hospital admission;human;hypokinesia;immunophenotyping;light chain;lower lip;macroglossia;monoclonal immunoglobulinemia;myocarditis;nuclear magnetic resonance imaging;pericardial effusion;plasma cell;priority journal;radiofrequency ablation;salivary gland biopsy;Schirmer test;Sjoegren syndrome;systemic light chain amyloidosis;treatment outcome;xerostomia,"Perlat, A.;Decaux, O.;Gervais, R.;Rioux, N.;Grosbois, B.",2009,,,0,
3447,Apolipoprotein E e4 and Cognitive Function: A Modifiable Association Results from Two Independent Cohort Studies,"BACKGROUND: The apolipoprotein E (APOE) e4 genetic polymorphism is a major risk factor for Alzheimer' s disease, hence the possible prevention of its detrimental effects on cognition is of high relevance. METHODS: We used linear regression models to assess associations of APOE e4 with cognitive performance in a population-based cohort study (n = 1,434) and in a cohort of patients with coronary heart disease (n = 366), and restricted cubic splines to explore dose-response relationships between serum cholesterol levels and cognition depending on APOE polymorphism. RESULTS: The association of APOE e4 with cognitive function was strongly amplified in the presence of hypercholesterolemia and cardiovascular disease in both independent cohorts; hypercholesterolemia was associated with cognitive function only among APOE e4 carriers in the presence of cardiovascular disease. The interaction effect between APOE genotype and hypercholesterolemia was statistically significant in both cohorts. CONCLUSIONS: The detrimental effects of APOE e4 polymorphism on cognition may strongly depend on modifiable risk factors.","Aged;Aged, 80 and over;Alzheimer Disease/etiology/*genetics;Apolipoprotein E4/blood/*genetics;Cardiovascular Diseases/*complications;Cholesterol/blood/genetics;Cognition/*physiology;Cohort Studies;Female;*Genetic Predisposition to Disease;Genotype;Humans;Hypercholesterolemia/*complications;Linear Models;Male;Middle Aged;Neuropsychological Tests;Polymorphism, Genetic;Risk Factors","Perna, L.;Mons, U.;Rujescu, D.;Kliegel, M.;Brenner, H.",2016,,10.1159/000440697,0,
3448,Pipeline 2011,,aclidinium bromide;recombinant human insulin;albiglutide;antiasthmatic agent;antidepressant agent;apixaban;betrixaban;cariprazine;clopidogrel;dapagliflozin;edoxaban;elinogrel;generic drug;glucagon like peptide 1 derivative;indacaterol;glycopyrronium bromide plus indacaterol;insulin;lixisenatide;dulaglutide;placebo;fluticasone furoate plus vilanterol;respiratory tract agent;rivaroxaban;roflumilast;dexmecamylamine;telcagepant;thrombin receptor antagonist;ticagrelor;unclassified drug;unindexed drug;vilazodone;vorapaxar;acute coronary syndrome;add on therapy;Alzheimer disease;artery thrombosis;asthma;bipolar mania;bleeding;cerebrovascular accident;chronic obstructive lung disease;cystic fibrosis;depression;diabetes mellitus;drug cost;drug industry;drug legislation;drug marketing;genital tract infection;atrial fibrillation;heart infarction;hepatitis C;human;insulin dependent diabetes mellitus;licensing;major depression;migraine;multiple sclerosis;non insulin dependent diabetes mellitus;note;patent;prescription;schizophrenia;systemic lupus erythematosus;thromboembolism;thrombosis;urinary tract infection;venous thromboembolism;afrezza;brilinta;daxas;ly 2189265;qab 149;relovair;tc 5214;xarelto,"Perry, L. E.",2011,,,0,
3449,Turning theory into practice: The development of modern transdermal drug delivery systems and future trends,"Despite its remarkable barrier function, the skin remains an attractive site for systemic drug delivery given its easy accessibility, large surface area and the possibility to bypass the gastrointestinal tract and the liver and so modify drug absorption kinetics. The pioneering work of Scheuplein, Higuchi and others in the 1960s helped to explain the processes involved in passive percutaneous absorption and led to the development of mathematical models to describe transdermal drug delivery. The intervening years have seen these theories turned to practice and a significant number of transdermal systems are now available including some that employ active drug delivery. This review briefly discusses the evolution of transdermal therapeutic systems over the years and the potential of newer transdermal technologies to deliver hydrophilic drugs and macromolecules through the skin.",buprenorphine;clonidine;estradiol;fentanyl;glyceryl trinitrate;granisetron;levonorgestrel;methylphenidate;nicotine;norelgestromin;norethisterone acetate;oxybutynin;rivastigmine;rotigotine;scopolamine;selegiline;testosterone;angina pectoris;article;attention deficit disorder;chemotherapy induced nausea and vomiting;chronic pain;dementia;drug absorption;drug delivery system;heat activated drug delivery system;human;hypertension;kinetics;macromolecule;mathematical model;menopausal syndrome;microneedle;motion sickness;overactive bladder;Parkinson disease;priority journal;skin;skin absorption;temperature;theory;transdermal drug delivery system,"Perumal, O.;Murthy, S. N.;Kalia, Y. N.",2013,,,0,
3450,A Non-classical Presentation of Tangier Disease with Three ABCA1 Mutations,"Tangier disease is a very rare autosomal recessive inherited disorder characterized by markedly reduced high-density lipoprotein (HDL) levels, characteristic large, yellow-orange tonsils, and enlarged liver, spleen and lymph nodes. It is caused by mutations in the ABCA1 gene. There is no specific treatment, and medications traditionally used to increase HDL are ineffective. A number of patients with non-classical Tangier disease have been described in the literature, who presented with low HDL levels, corneal lesions, hepatosplenomegaly, and thrombocytopenia. We report here about a 45-year-old female with a past medical history of early coronary artery disease, myocardial infarction, multiple episodes of angina, immeasurable HDL, and a history of idiopathic thrombocytopenia purpura. She had a tonsillectomy performed previously, but did not remember if the tonsils were of any unusual color. There was no history of peripheral neuropathy. Her family history is significant for her father and mother having Alzheimer disease and hypertension, respectively. On physical examination she did not have any hepatosplenomegaly or corneal opacities. She was found to have three mutations in the ABCA1 gene. These were designated A1046D (c.3137C>A) in exon 22; Y1532C (c.4595A>G) in exon 34, and W1699C (c.5097G>T) in exon 37. All three have been reported to be deleterious in functional studies. The patient has immeasurable HDL, which leads us to assume that two mutations are on one allele and one mutation on the other. We suspect that this condition is under-diagnosed, and as more patients are reported in the literature, the phenotype of Tangier disease will be elucidated further.",,"Pervaiz, M. A.;Gau, G.;Jaffe, A. S.;Saenger, A. K.;Baudhuin, L.;Ellison, J.",2012,,10.1007/8904_2011_81,0,
3451,Bone marrow-derived progenitor cells in cérébral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,"Background and Purpose-Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited disease due to cérébral microangiopathy presenting with variable pictures, including stroke, progressive cognitive impairment, and disability. Mechanisms leading from vessel structural changes to parenchymal damage and eventually to clinical expression are not fully understood. Among pathogenic processes, endothelial dysfunction has been hypothesized. Endothelial progenitor cells and circulating progenitor cells (CPCs) derived from bone marrow participate in endothelium structure and function maintenance and contribute to ischemic area revascularization. No data are available about these cells in CADASIL. Our objective in this study was to evaluate endothelial progenitor cells and CPCs role in CADASIL. Methods-Twenty-nine patients with CADASIL and 29 sex-and age-matched control subjects were enrolled. Cells were measured in peripheral blood using flow cytometry. Endothelial progenitor cells were defined as positive for CD34/KDR, CD133/KDR, and CD34/CD133/KDR; and CPCs as positive for CD34, CD133, and CD34/CD133. Results-Endothelial progenitor cells were significantly lower in patients with CADASIL than in control subjects (CD34/KDR: 0.05 versus 0.1 cells/μL, P=0.005; CD133/KDR: 0.07 versus 0.1 cells/μL, P=0.006; CD34/CD133/KDR: 0.05 versus 0.1 cells/μL, P=0.001). The difference remained significant after adjusting for age, sex, and statin use. CPCs were not significantly lower in CADASIL, but patients with stroke or dementia had significantly reduced CPC levels than patients without (CD34: 1.68 versus 2.95 cells/μL, P=0.007; CD133: 1.40 versus 2.82 cells/μL, P=0.004; CD34/CD133: 1.44 versus 2.75 cells/μL, P=0.004). CPC levels significantly correlated with cognitive and motor performance measures. Conclusions-We have documented an association between endothelial progenitor cells and CPCs and CADASIL, extending previous data about the presence of endothelial dysfunction in this disease and its potential role in modulating phenotype. Copyright © 2010 American Heart Association. All rights reserved.",CD133 antigen;CD34 antigen;hydroxymethylglutaryl coenzyme A reductase inhibitor;vasculotropin receptor 2;adult;aged;article;autosomal dominant inheritance;B lymphocyte;CADASIL;clinical article;controlled study;dementia;disease association;endothelial dysfunction;endothelium cell;female;flow cytometry;human;male;motor performance;phenotype;priority journal;revascularization;stem cell;cerebrovascular accident,"Pescini, F.;Cesari, F.;Giusti, B.;Sarti, C.;Zicari, E.;Bianchi, S.;Dotti, M. T.;Federico, A.;Balestrino, M.;Enrico, A.;Gandolfo, C.;Gori, A. M.;Abbate, R.;Pantoni, L.;Inzitari, D.",2010,,,0,
3452,The cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) scale: A screening tool to select patients for NOTCH3 gene analysis,"Background and Purpose-Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) phenotype is highly variable, and, although the full clinical-neuroimaging picture may be suggestive of the disease, no characteristic is pathognomonic. Thus, a genetic test remains the diagnostic gold standard, but because it is costly and time-consuming, a pregenetic screening appears desirable. We aimed at developing the CADASIL scale, a screening tool to be applied in the clinical setting. Methods-A preliminary scale was created assigning weighted scores to common disease features based on their frequencies obtained in a pooled analysis of selected international CADASIL series. The accuracy of the scale versus the genetic diagnosis was tested with receiver operating characteristic analysis after the application of this scale to 61 CADASIL and 54 NOTCH3-negative patients (no pathogenic mutation on exons 2-23 of the NOTCH3 gene). To improve the scale accuracy, we then developed an ad hoc optimization algorithm to detect the definitive scale. A third group of 39 patients affected by sporadic small-vessel disease was finally included in the algorithm to evaluate the stability of the scale. Results-The cutoff score of the definitive CADASIL scale had a sensitivity of 96.7% and a specificity of 74.2%. This scale was robust to contamination of patients with sporadic small-vessel disease. Conclusions-The CADASIL scale is a simple and sufficiently accurate screening tool to select patients with a high probability to be affected by the disease and therefore to be subjected to the genetic testing. © 2012 American Heart Association, Inc.",Notch3 receptor;adult;article;CADASIL;CADASIL scale;cerebrovascular accident;clinical feature;diagnostic accuracy;family history;female;gene mutation;genetic analysis;human;human tissue;leukoencephalopathy;major clinical study;male;migraine;migraine with aura;priority journal;screening test;sensitivity and specificity;skin biopsy;transient ischemic attack,"Pescini, F.;Nannucci, S.;Bertaccini, B.;Salvadori, E.;Bianchi, S.;Ragno, M.;Sarti, C.;Valenti, R.;Zicari, E.;Moretti, M.;Chiti, S.;Stromillo, M. L.;De Stefano, N.;Dotti, M. T.;Federico, A.;Inzitari, D.;Pantoni, L.",2012,,,0,
3453,"Memantine treatment in mild to moderate Alzheimer disease: A 24-week randomized, controlled trial","Objective: The objective of this study was to compare the efficacy and safety of the moderate-affinity, uncompetitive N-methyl-d-aspartate receptor antagonist, memantine, versus placebo in patients with mild to moderate Alzheimer disease (AD). Method: This was a randomized, double-blind, placebo-controlled clinical trial conducted at 42 U.S. sites. Participants were 403 outpatients with mild to moderate AD and Mini-Mental State Examination scores of 10-22 randomized to memantine (20 mg/day; N = 201) or placebo (N = 202) for 24 weeks. Primary outcomes were change from baseline at 24 weeks on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), a measure of cognition, and on the Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus), a global measure. Secondary outcomes included change on the Neuropsychiatric Inventory (NPI) and the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL23), measures of behavior and function, respectively. Results: Most (82.4%) participants completed the trial. Memantine resulted in significantly better outcomes than placebo on measures of cognition, global status, and behavior when based on the protocol-specified primary last observation carried forward imputation as well as a mixed-models repeated-measures approach applied to the continuous outcomes. Treatment discontinuations because of adverse events for memantine versus placebo were 19 (9.5%) and 10 (5.0%), respectively. Conclusions: These results support the safety and efficacy of memantine for the treatment of mild to moderate AD. © 2006 American Association for Geriatric Psychiatry.",antidepressant agent;antihypertensive agent;antiinflammatory agent;cholinesterase inhibitor;diuretic agent;donepezil;Ginkgo biloba extract;ginseng extract;memantine;n methyl dextro aspartic acid receptor blocking agent;olanzapine;placebo;risperidone;tocopherol;adult;agitation;Alzheimer disease;Alzheimer disease assessment scale cognitive subscale;Alzheimer disease cooperative study activities of daily living inventory;article;behavior;clinical trial;Clinician interview based impression of change plus caregiver input;cognition;confusion;controlled clinical trial;controlled study;daily life activity;depression;diverticulitis;dizziness;double blind procedure;drug efficacy;drug safety;falling;female;flu like syndrome;functional status;headache;atrial fibrillation;heart infarction;human;hypertension;injury;major clinical study;male;Mini Mental State Examination;multicenter study;Neuropsychiatric Inventory;non invasive measurement;outpatient;randomized controlled trial;scoring system;side effect;somnolence;faintness;United States;upper respiratory tract infection;urinary tract infection,"Peskind, E. R.;Potkin, S. G.;Pomara, N.;Ott, B. R.;Graham, S. M.;Olin, J. T.;McDonald, S.",2006,,,0,
3454,Demographic change and disease rates: a projection until 2050,"Demographic change and its impact on the German healthcare system is a subject of great debate. The purpose of this paper is to make projections on disease rates based on the 11th coordinated demographic prediction and population-based data which take into consideration demographic developments. The German population will decrease by approximately 16% until 2050, while at the same time the number of persons aged over 65 years will increase by 38% and the number of individuals aged over 80 years will increase by 156%. Baby boomers cause a vertical wave in the population pyramid. The population pyramid itself will lead to an overproportional increase in the number of elderly persons. Assuming that disease probability stays the same, the incidence of diseases due to advanced age will rise dramatically. Especially diseases, such as community-acquired pneumonia, age-related macula degeneration, dementia, fracture of the femur neck, and myocardial infarction, will by then occur more often. By 2050, some of the most frequent diseases will be hypertension and arthrosis. Thus, the continuous cutting of resources seems rather short minded. It is highly recommended to reconsider the long-run effects before setting a health policy course. A proper social discourse about primary care and prioritization appears to be urgently needed.","Adult;Aged;Aged, 80 and over;Birth Rate/trends;Cross-Sectional Studies;Forecasting;Germany;Health Services Needs and Demand/trends;Health Services Research/trends;Humans;Middle Aged;Morbidity/*trends;National Health Programs/*trends;*Population Dynamics;Population Surveillance/methods;Young Adult","Peters, E.;Pritzkuleit, R.;Beske, F.;Katalinic, A.",2010,May,10.1007/s00103-010-1050-y,0,
3455,Cardiovascular and biochemical risk factors for incident dementia in the hypertension in the very elderly trial,"OBJECTIVES: Several cardiovascular and biochemical factors including hypertension have been associated with cognitive decline and dementia, although both epidemiological and intervention evidence is mixed with the majority of studies examining those in midlife or younger elderly and the recent Hypertension in the Very Elderly Trial showing no significant association between blood pressure lowering and incident dementia. It has also been suggested that risk factors may differ in the very elderly. The aim of these analyses was to examine the impact of baseline cardiovascular and biochemical factors upon incident dementia and cognitive decline in a very elderly hypertensive group. METHODS: Participants of the Hypertension in the Very Elderly Trial were aged at least 80 years and hypertensive. Cognitive function was assessed at baseline and annually with diagnostic information collected for dementia and relationships between baseline total and high-density lipoprotein cholesterol, creatinine, glucose, haemoglobin, heart failure, atrial fibrillation, diabetes, previous stroke and later dementia/cognitive decline were examined. RESULTS: There were 3336 participants with longitudinal cognitive function data. In multivariate analyses higher creatinine was associated with a lower risk of incident dementia and cognitive decline. Higher total and lower high-density lipoprotein cholesterol were associated with lower risk of cognitive decline. Other variables were not significant. CONCLUSIONS: In very elderly hypertensive patients heart failure, diabetes, atrial fibrillation, prior stroke, glucose and haemoglobin levels did not demonstrate a relationship with cognitive decline or dementia. Higher creatinine (excluding moderate renal impairment) was associated with a lower risk of dementia and cognitive decline. The findings for total and high-density lipoprotein cholesterol add to the varied literature in this area and together these findings may add weight to the suggestion that risk factor profiles differ in the very elderly. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.",creatinine;glucose;hemoglobin;high density lipoprotein cholesterol;indapamide;low density lipoprotein cholesterol;perindopril;add on therapy;aged;antihypertensive therapy;article;cardiovascular risk;chemical parameters;cholesterol blood level;cognition;cognitive defect;creatinine blood level;dementia;diabetes mellitus;glucose blood level;atrial fibrillation;heart failure;hemoglobin blood level;human;hypertension;major clinical study;priority journal;cerebrovascular accident,"Peters, R.;Poulter, R.;Beckett, N.;Forette, F.;Fagard, R.;Potter, J.;Swift, C.;Anderson, C.;Fletcher, A.;Bulpitt, C. J.",2009,,,0,
3456,Outcome of myocardial infarction in Veterans Health Administration patients as compared with medicare patients,"BACKGROUND: Some have the opinion that patients cared for in Veterans Health Administration (VHA) hospitals receive care of poorer quality than those cared for in non-VHA institutions. To assess the quality of care in VHA hospitals, we compared the outcome of acute myocardial infarction among patients in VHA and non-VHA institutions while controlling for potential confounders, including coexisting conditions and severity of illness. METHODS: We studied 2486 veterans discharged from 81 VHA hospitals and 29,249 Medicare patients discharged from 1530 non-VHA hospitals, restricting our samples to men at least 65 years of age who were discharged with confirmed acute myocardial infarction. We compared coexisting conditions, severity of illness, and 30-day and 1-year mortality in the two samples. RESULTS: VHA patients were significantly more likely than Medicare patients to have a recorded history of hypertension (64.3 percent vs. 57.3 percent), chronic obstructive pulmonary disease or asthma (30.9 percent vs. 23.5 percent), diabetes (34.8 percent vs. 29.0 percent), stroke (20.4 percent vs. 14.2 percent), or dementia (7.2 percent vs. 4.8 percent) (P<0.001 for all comparisons). According to both multivariate logistic regression and an analysis using 2265 matched pairs of VHA and Medicare patients, there were no significant differences in 30-day or 1-year mortality. The matched-pairs analysis found that the difference in mortality at 30 days (the mortality rate among Medicare patients minus the mortality rate among VHA patients), averaged over the 5-year age groups, was -0.8 percent (95 percent confidence interval, -2.8 percent to 1.3 percent), and the difference in mortality at 1 year was -1.3 percent (95 percent confidence interval, -3.9 percent to 1.3 percent). CONCLUSIONS: VHA patients had more coexisting conditions than Medicare patients. Nevertheless, we found no significant difference in mortality between VHA and Medicare patients, a result that suggests a similar quality of care for acute myocardial infarction.","Aged;Cohort Studies;Comorbidity;Health Services Research;*Hospitals, Veterans/standards;Humans;Logistic Models;Male;Matched-Pair Analysis;*Medicare;Multivariate Analysis;Myocardial Infarction/classification/*mortality/therapy;*Outcome Assessment (Health Care);*Quality of Health Care;Retrospective Studies;Severity of Illness Index;United States/epidemiology","Petersen, L. A.;Normand, S. L.;Daley, J.;McNeil, B. J.",2000,Dec 28,10.1056/nejm200012283432606,0,
3457,"Association between extending carefirst's medical home program to medicare patients and quality of care, utilization, and spending","IMPORTANCE CareFirst, the largest commercial insurer in the mid-Atlantic Region of the United States, runs a medical home program focusing on financial incentives for primary care practices and care coordination for high-risk patients. From 2013 to 2015, CareFirst extended the program to Medicare fee-for-service (FFS) beneficiaries in participating practices. If the model extension improved quality while reducing spending, the Centers for Medicare and Medicaid Services could expand the program to Medicare beneficiaries broadly. OBJECTIVE To test whether extending CareFirst's program to Medicare FFS patients improves care processes and reduces hospitalizations, emergency department visits, and spending. DESIGN, SETTING, AND PARTICIPANTS This difference-in-differences analysis compared outcomes for roughly 35 000 Medicare FFS patients attributed to 52 intervention practices (grouped by CareFirst into 14 ""medical panels"") to outcomes for 69 000 Medicare patients attributed to 42 matched comparison panels during a 1-year baseline period and 2.5-year intervention at Maryland primary care practices. MAIN OUTCOMES AND MEASURES Hospitalizations (all-cause and ambulatory-care sensitive), emergency department visits, Medicare Part A and B spending, and 3 quality-of-care process measures: ambulatory care within 14 days of a hospital stay, cholesterol testing for those with ischemic vascular disease, and a composite measure for those with diabetes. INTERVENTIONS CareFirst hired nurses who worked with patients' usual primary care practitioners to coordinate care for 3656 high-risk Medicare patients. CareFirst paid panels rewards for meeting cost and quality targets for their Medicare patients and advised panels on how to meet these targets based on analyses of claims data. RESULTS On average, each of the 14 intervention panels had 9.3 primary care practitioners and was attributed 2202 Medicare FFS patients in the baseline period. The panels' attributed Medicare patients were, on average, 73.8 years old, 59.2%female, and 85.1%white. The extension of CareFirst's program to Medicare patients was not statistically associated with improvements in any outcomes, either for the full Medicare population or for a high-risk subgroup in which impacts were expected to be largest. For the full population, the difference-in-differences estimates were 1.4 hospitalizations per 1000 patients per quarter (P = .54; 90% CI, -2.1 to 5.0), -2.5 outpatient ED visits per 1000 patients per quarter (P = .26; 90% CI, -6.2 to 1.1), and -$1 per patient per month in Medicare Part A and B spending (P = .98; 90% CI, -$40 to $39). For hospitalizations and Medicare spending, the 90% CIs did not span CareFirst's expected impacts. Hospitalizations for the intervention group declined by 10% from baseline year to the final 18 months of the intervention, but this was matched by similar declines in the comparison group. CONCLUSION AND RELEVANCE The extension of CareFirst's program to Medicare did not measurably improve quality-of-care processes or reduce service use or spending for Medicare patients. Further program refinement and testing would be needed to support scaling the program more broadly to Medicare patients.",cholesterol;aged;Alzheimer disease;ambulatory care;article;asthma;benchmarking;billing and claims;bipolar disorder;breast cancer;cerebrovascular accident;chronic kidney failure;chronic obstructive lung disease;colorectal cancer;congestive heart failure;controlled study;depression;diabetes mellitus;emergency ward;endometrium cancer;female;general practitioner;health care cost;health care quality;health care utilization;health insurance;high risk patient;hip fracture;hospitalization;human;hyperlipidemia;hypertension;intervention study;ischemic heart disease;length of stay;major clinical study;male;Maryland;medicare;outpatient care;priority journal;prostate cancer;reward;rheumatoid arthritis;schizophrenia;teamwork,"Peterson, G. G.;Geonnotti, K. L.;Hula, L.;Day, T.;Blue, L.;Kranker, K.;Gilman, B.;Stewart, K.;Hoag, S.;Moreno, L.",2017,,10.1001/jamainternmed.2017.2775,0,
3458,Hormone therapy: Making decisions in the face of uncertainty,,clonidine;estrogen;gestagen;isoflavone;medroxyprogesterone acetate;placebo;Alzheimer disease;atherosclerotic plaque;breast cancer;cancer risk;cardiovascular risk;clinical trial;colorectal cancer;decision making;diabetes mellitus;endometrium cancer;heart reinfarction;hip fracture;hormonal therapy;human;ischemic heart disease;lung embolism;menopause;note;priority journal;quality of life;cerebrovascular accident,"Peterson, H. B.;Thacker, S. B.;Corso, P. S.;Marchbanks, P. A.;Koplan, J. P.",2004,,,0,
3459,Trends in physician house calls to medicare beneficiaries,"Objective: House calls (HCs) to older adults seemed to be headed for extinction in recent decades. HCs may be a tool to ensure access and reduce institutionalization of the elderly population. This study determines the number and distribution of HCs by physician specialty over time and analyzes associations of providing HCs with physician and area-level characteristics. Methods: This study was a cross-sectional analysis of 3 complete Medicare Part B claims data for national state-representative samples of physicians in 2000, 2003, and 2006. Multilevel logistic regression determined associations between physician and area-level characteristics and provision of HCs in 2006. Results: Physicians made 478,088 HCs in 2000; 700,661 in 2003; and 995,294 in 2006. Over the same period, the proportion of physicians making HCs decreased from 7.22 (standard error, ±0.20) to 5.26 (±0.19). Physicians in the top decile of HC volume made an increasing number of HCs (median, 56 in 2000 and 86 in 2006). In 2006, physicians who made HCs were more likely to be older, geriatricians, and osteopaths, be in solo practice, and reside in rural areas compared with those who did not make HCs. Conclusions: Between 2000 and 2006, the number of physician HCs to Medicare beneficiaries more than doubled, whereas the number of physicians making HCs declined.",adult;Alzheimer disease;article;cerumen impaction;chronic obstructive lung disease;congestive heart failure;cross-sectional study;debridement;diabetes mellitus;family medicine;female;general practice;general practitioner;geriatric care;health care delivery;human;hypertension;institutionalization;internal medicine;male;medical practice;medicare;osteopathic medicine;phlebotomy;rural area,"Peterson, L. E.;Landers, S. H.;Bazemore, A.",2012,,,0,
3460,Invited commentary: How far can epidemiologists get with statistical adjustment?,,hormone;cardiovascular risk;conflict;dementia;education;epidemiology;health hazard;human;incidence;ischemic heart disease;note;social status;statistics;cerebrovascular accident;venous thromboembolism,"Petitti, D. B.;Freedman, D. A.;Prentice, R. L.;Langer, R.;Anderson, G.;Barad, D.",2005,,,0,
3461,Neuroprotection among the Bulgarian pharmacy patients,"The literary data shows that more than 600 disorders affect the nervous system. Neurodegenerative diseases are defined as hereditary and sporadic conditions that can be characterized by progressive nervous system dysfunction. These disorders are often associated with malfunction of the affected central or peripheral structures of the nervous system. They include diseases such as Alzheimer's Disease and other dementias, Brain Cancer, Degenerative Nerve Diseases, Encephalitis, Epilepsy, Genetic Brain Disorders, Head and Brain Malformations, Hydrocephalus, Stroke, Parkinson's Disease, Multiple Sclerosis, Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's Disease), Huntington's Disease, Prion Diseases, and others. Defects in antioxidant systems result in oxidative stress and cellular damage. Parkinson's, Alzheimer''s and Huntington's diseases, Multiple Sclerosis, familial ALS, and post-traumatic epilepsy are diseases which are now proved to be at least pardy caused by oxidative stress and free-radical damage. The first antioxidants to be discovered were vitamin C, vitamin E and beta carotene. More recent research has revealed powerful antioxidant properties in numerous other substances, including many of the carotenoids, numerous bioflavonoids, Co-enzyme Q10 and resveratrol, and selenium and grapeseed extract. Effective neuroprotection requires absorbing a broad spectrum of all those antioxidants. The aim of the study is to analyze the results from a questionnaire applied to Bulgarian pharmacy patients above 65 years of age in order to assess their level of neuroprotection. Copyright © 2011 CELSIUS.",vitamin B complex;aged;article;Bulgaria;dementia;diabetes mellitus;disease duration;female;Ginkgo biloba;human;hypertension;influenza;ischemic heart disease;male;neuroprotection;pharmacy,"Petkova, V.;Dimitrov, M.;Ibrahim, A.;Andreevska, K.;Karamancheva, L.",2011,,,0,
3462,Turning It Off,,haloperidol;lorazepam;morphine;article;congestive heart failure;delirium;dementia;family;fever;geriatrician;health care personnel;health care system;home;hospice care;human;memory;nurse;palliative therapy;suicide;symptom;terminal care,"Petrone, K.",2014,,,0,
3463,Omega-3 fatty acids and stress,"In psychology, a state of bodily or mental tension resulting from factors that tend to alter an existent equilibrium. Stress is an unavoidable effect of living and is an especially complex phenomenon in modem technological society. It has been linked to coronary heart disease, psychosomatic disorders, and various other mental and physical problems. Treatment usually consists of a combination of counseling or psychotherapy and medication. Stress and tension are normal reactions to events that threaten us are used to describe it. Such threats can come from accidents, financial troubles and problems on the job or with family and through our emotional and physical reactions to the given situations, we become what is termed 'stressed'. Stress is not a diagnosis but a process happening over time. Stress is an unavoidable fact of everyday life and is associated with significant morbidity and even mortality.. In addition to lifestyle considerations - good diet, exercise, meditation, etc.- a number of nutrients and botanicals can provide support for stress-related conditions. Nowadays much attention is paid to the omega fatty acids and their beneficiaries to health. The object of this work is to analyses the effect of omega-3 fatty acids on stress.",antidepressant agent;essential fatty acid;fish oil;omega 3 fatty acid;placebo;polyunsaturated fatty acid;anger;article;attention deficit disorder;bipolar disorder;cognitive defect;depression;diet supplementation;human;mental deterioration;mental stress;mood disorder;prescription;rapid cycling bipolar disorder;schizophrenia;sleep disorder;stress,"Petrov, G.;Peikova, L.;Obreshkova, D.;Bojkova, M.;Tsvetkova, B.",2013,,,0,
3464,"Influence of myocardial infarction, coronary artery bypass surgery, and stroke on cognitive impairment in late life","Relations between cognitive test scores in later life and prior myocardial infarction (MI), coronary artery bypass graft surgery (CABG), and stroke were examined for this study. Subjects were 3,734 Japanese-American men (80% of surviving Honolulu Heart Program cohort) aged 71 to 93 years at the time of cognitive testing. Impairment was defined as scoring below the 16th percentile on a validated cognitive assessment scale. Prior MI, stroke, and CABG were established using hospital surveillance, history, and record review. After adjustment for age, years of education, and years of childhood spent in Japan, men with prior stroke were significantly more likely than others to have poor cognitive performance (odds ratio 4.4, 95% confidence limits 3.0 to 6.7). History of > 1 stroke was associated with an odds ratio of 50 (95% confidence limits 10.5 to 238.3). There was no significant association between cognitive performance and ≤1 prior MI or history of CABG. Time between events and cognitive function testing did not affect results. Analyses support a significant association between clinical stroke and persistent cognitive impairment, but fail to implicate CABG or MI.",aged;aging;Alzheimer disease;article;clinical feature;cognition;cognitive defect;cohort analysis;coronary artery bypass graft;disease association;heart infarction;human;major clinical study;male;priority journal;scoring system;statistical analysis;cerebrovascular accident;survival rate,"Petrovitch, H.;White, L.;Masaki, K. H.;Ross, G. W.;Abbott, R. D.;Rodriguez, B. L.;Lu, G.;Burchfiel, C. M.;Blanchette, P. L.;Curb, J. D.",1998,,,0,
3465,Pharmacological and non-pharmacological treatment of atrial fibrillation - A current view,"Atrial fibrillation (AF) is the most common cardiac arrhythmia in developed countries. The presence of AF increases the risk of stroke, heart failure, dementia and death. Although antiarrhythmic drugs have an important role in the treatment of AF, catheter ablation in most aspects provides better treatment results and in some cases may lead to a cure. This article summarises the current view on the treatment of AF, with special emphasis on catheter ablation.",antiarrhythmic agent;antiarrhythmic activity;article;atrial fibrillation;catheter ablation,"Petrů, J.",2015,,,0,
3466,The next epidemic,,rofecoxib;aging;Alzheimer disease;amyotrophic lateral sclerosis;arthritis;neoplasm;cerebrovascular accident;degenerative disease;diagnostic accuracy;disease course;disease predisposition;drug safety;drug withdrawal;early diagnosis;epidemic;genetic risk;genetic screening;geriatric disorder;health care cost;heart infarction;human;Huntington chorea;incidence;microarray analysis;molecular evolution;note;osteoporosis;Parkinson disease;pneumonia;prevalence;preventive health service;risk assessment;risk factor;symptom;vioxx,"Petsko, G. A.",2006,,,0,
3467,"Leflunomide, a Reversible Monoamine Oxidase Inhibitor","A screening study aimed at identifying inhibitors of the enzyme, monoamine oxidase (MAO), among clinically used drugs have indicated that the antirheumatic drug, leflunomide, is an inhibitor of both MAO isoforms. Leflunomide inhibits human MAO-A and MAO-B and exhibits IC&lt;sub&gt;50&lt;/sub&gt; values of 19.1 muM and 13.7 muM, respectively. The corresponding K&lt;sub&gt;i&lt;/sub&gt; values are 17.7 muM (MAO-A) and 10.1 muM (MAO-B). Dialyses of mixtures of the MAO enzymes and leflunomide show that inhibition of the MAOs by leflunomide is reversible. The principal metabolite of leflunomide, teriflunomide (A77 1726), in contrast is not an MAO inhibitor. This study concludes that, although leflunomide is only moderately potent as an MAO inhibitor, isoxazole derivatives may represent a general class of MAO inhibitors and this heterocycle may find application in MAO inhibitor design. In this respect, MAO inhibitors are used in the clinic for the treatment of depressive illness and Parkinson's disease, and are under investigation as therapy for certain types of cancer, Alzheimer's disease and age-related impairment of cardiac function.",,"Petzer, J. P.;Petzer, A.",2016,,,0,
3468,Novel valosin containing protein mutation in a Swiss family with hereditary inclusion body myopathy and dementia,"Inclusion body myopathy associated with Paget's disease of the bone and frontotemporal dementia is a rare but highly penetrant autosomal dominant progressive disorder linked to mutations in valosin containing protein (VCP). Here, we characterize a novel mutation in the linker 1 domain of VCP leading to inclusion body myopathy and/or frontotemporal dementia in 3 generations of a Swiss family. A detailed history of several years of clinical follow-up and electrophysiological, radiological and pathological findings are presented. Five out of 6 individuals suffered from progressive myopathy and 2 out of 6 from frontotemporal dementia, respectively. A radiologically suspected Paget's disease of the bone could not been confirmed at autopsy. This case study illustrates that only a subset of individuals shows the full triad of the disease complex and that clinicopathological findings are - when interpreted apart from familial history - hard to distinguish from sporadic inclusion body myositis. © 2012 Elsevier B.V.",butedronate technetium tc 99m;creatine kinase;immunoglobulin;steroid;TAR DNA binding protein;valosin containing protein;adult;amino acid substitution;article;bone scintiscanning;brain atrophy;bronchopneumonia;clinical article;computer assisted tomography;creatine kinase blood level;echocardiography;electromyography;follow up;frontotemporal dementia;heart left ventricle hypertrophy;hereditary inclusion body myopathy;heterozygote;histopathology;human;human tissue;immunohistochemistry;male;missense mutation;muscle atrophy;muscle weakness;myopathy;nuclear magnetic resonance imaging;Paget bone disease;paraplegia;peroneus nerve paralysis;priority journal;protein domain;respiratory failure;sequence analysis;Switzerland;VCP gene;walking difficulty,"Peyer, A. K.;Kinter, J.;Hench, J.;Frank, S.;Fuhr, P.;Thomann, S.;Fischmann, A.;Kneifel, S.;Camaño, P.;Munain, A. L. D.;Sinnreich, M.;Renaud, S.",2013,,,0,
3469,Trends in incidence and medical resource utilisation in patients with chronic lymphocytic leukaemia: insights from the UK Clinical Practice Research Datalink (CPRD),"Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in European adults. We aimed to evaluate time trends in CLL incidence and medical resource utilisation of CLL patients in the UK. We conducted a retrospective, observational cohort analysis using the UK Clinical Practice Research Datalink (CPRD) comprising mainly primary care data. We included adult patients with newly diagnosed CLL between January 2000 and June 2012. Descriptive and trend analyses of CLL incidence and medical resource utilisation were performed. A total of 2576 patients with CLL met the eligibility criteria. At diagnosis, the majority of patients (71.7 %) were above 65 years of age. The European age-standardised CLL incidence rate in the CPRD was 6.2/100,000 (95 % confidence interval [CI] 6.0, 6.5/100,000) person-years. There was no statistically significant increase over time. The CLL patients had on average 74.6 general practitioner visits during a median follow-up of 3.3 years. Between 2000 and 2012, the average number of recorded hospitalisations and referrals per year corrected for duration of follow-up significantly (p < 0.001) increased by 8.1 % (95 % CI 6.8 %, 9.3 %) and 16.4 % (95 % CI 15.4 %, 17.3 %), respectively. Referrals and hospitalisations in the second year compared to the first year following the CLL diagnosis significantly decreased. CLL incidence rates in the CPRD were stable over the period from 2000 to 2012. Medical resource utilisation in UK primary care was well documented, but further research is needed to describe secondary and tertiary care medical resource utilisation e.g. chemotherapy administration, which is inadequately captured in the CPRD.",antibiotic agent;antidepressant agent;antiemetic agent;antifungal agent;antivirus agent;chlorambucil;cyclophosphamide;fludarabine;immunosuppressive agent;prednisolone;adult;aged;ambulatory care;article;blood transfusion;cancer chemotherapy;cancer incidence;cancer mortality;cancer radiotherapy;cancer survival;Charlson Comorbidity Index;chronic lymphatic leukemia;chronic obstructive lung disease;clinical practice;clinical research;cohort analysis;comorbidity;congestive heart failure;dementia;female;follow up;health care utilization;hospitalization;human;hypertension;major clinical study;male;medical specialist;observational study;overall survival;patient referral;prescription;primary medical care;priority journal;retrospective study;sex difference;United Kingdom,"Pfeil, A. M.;Imfeld, P.;Pettengell, R.;Jick, S. S.;Szucs, T. D.;Meier, C. R.;Schwenkglenks, M.",2014,,,0,
3470,Bisphosphonate use and femoral fractures in older women 4,,antidepressant agent;bisphosphonic acid derivative;opiate;proton pump inhibitor;age;congestive heart failure;dementia;drug use;falling;femur fracture;femur subtrochanteric fracture;gender;human;letter;long term care;medical history;priority journal;risk;short course therapy;treatment duration,"Pfister, A. K.;Trotter, C. C.",2011,,,0,
3471,Palliative care in geriatrics,,Alzheimer Disease/mortality/*therapy;Analgesics/therapeutic use;Cooperative Behavior;*Geriatrics;Germany;Health Services Needs and Demand;Heart Failure/mortality/*therapy;Hospice Care;Humans;Interdisciplinary Communication;Neoplasms/mortality/*therapy;Pain Management/*methods;*Palliative Care;Patient Participation;Physician-Patient Relations;Pregabalin;Professional-Family Relations;Pruritus/mortality/therapy;*Terminal Care;Uremia/mortality/therapy;gamma-Aminobutyric Acid/analogs & derivatives/therapeutic use,"Pfisterer, M.",2013,Jun,10.1055/s-0033-1343184,0,
3472,Kearns sayre syndrome - Case report with review of literature,"Kearns-Sayre Syndrome is form of rare mitochondrial cytopathy, first described by Thomas P. Kearns and George Pomeroy Sayre in 1958 and is characterized by progressive external opthalmoplegia, cardiac conduction block, pigmentary retinal degeneration, variable number of red ragged fibers on muscle biopsy. It presents before the child reaches the age of twenty. Kearns-Sayre syndrome may affect many organ systems and additional features may include myopathy, dystonia, bulbar symptoms in the formof dysarthria and nasal regurgitation and bilateral facial weakness. Endocrine abnormalities (e.g., diabetes, growth retardation/short stature, and hypoparathyroidism), bilateral sensorineural deafness, dementia, cataracts, and proximal renal tubular acidosis, skeletal muscle weakness (proximal more than distal) and exercise intolerance are additional features. Kearns Sayre Syndrome occurs as a result of large-scale single deletions (or rearrangements) of mitochondrial DNA (mtDNA), which is usually not inherited but occurs spontaneously, probably at the germ-cell level or very early in embryonic development. No disease-modifying therapy is available for Kearns-Sayre syndrome (KSS). Management is supportive vigilance for detection of associated problems. In the future, potential treatment in patients with Kearns-Sayre syndrome may attempt to inhibit mutant mtDNA replication or encourage replication of wild-type mtDNA. © 2011 Dr. K C Chaudhuri Foundation.",adolescent;article;brain atrophy;brain infarction;case report;clinical examination;clinical feature;computer assisted tomography;dysarthria;electroretinography;eye disease;histopathology;human;human tissue;Kearns Sayre syndrome;laboratory test;limb weakness;male;muscle biopsy;muscle weakness;night blindness;nuclear magnetic resonance imaging;obesity;retina degeneration;retinitis pigmentosa;sensory dysfunction;speech disorder;walking difficulty,"Phadke, M.;Lokeshwar, M. R.;Bhutada, S.;Tampi, C.;Saxena, R.;Kohli, S.;Shah, K. N.",2012,,,0,
3473,Minimizing adverse drug events in older patients,"Adverse drug events are common in older patients, particularly in those taking at least five medications, but such events are predictable and often preventable. A rational approach to prescribing in older adults integrates physiologic changes of aging with knowledge of pharmacology. Focusing on specific outcomes, such as the prompt recognition of adverse drug events, allows the family physician to approach prescribing cautiously and confidently. Physicians need to find ways to streamline the medical regimen, such as periodically reviewing all medications in relation to the Beers criteria and avoiding new prescriptions to counteract adverse drug reactions. The incorporation of computerized alerts and a multidisciplinary approach can reduce adverse drug events. Copyright © 2007 American Academy of Family Physicians.",alprazolam;amiodarone;amitriptyline;amphetamine derivative;anorexigenic agent;barbituric acid derivative;chlordiazepoxide;chlorpheniramine;chlorpheniramine maleate;chlorpropamide;cyproheptadine;dexchlorpheniramine maleate;diazepam;dicycloverine;digoxin;diphenhydramine;disopyramide phosphate;doxepin;fluoxetine;flurazepam;guanadrel sulfate;guanethidine;hydroxyzine embonate;hyoscyamine;lorazepam;oxazepam;promethazine;temazepam;triazolam;tripelennamine;unclassified drug;unindexed drug;vaginex;aging;allergic reaction;angina pectoris;article;clinical practice;delirium;delusional disorder;dementia;depression;drug dependence;falling;fracture;Gilles de la Tourette syndrome;health service;heart failure;heart infarction;human;Huntington chorea;hypertension;hypoglycemia;mania;orthostatic hypertension;patient care;practice guideline;prescription;psychosis,"Pham, C. B.;Dickman, R. L.",2007,,,0,
3474,"Changes in pattern of use, clinical characteristics and persistence rate of hormone replacement therapy among postmenopausal women after the WHI publication","The WHI was stopped prematurely because of an increased risk of breast cancer, stroke and cardiovascular diseases (CVD) in the hormone replacement therapy (HRT) arm of the trial. Changes in the use of HRT are expected. Objective: To assess the impact of the Women's Health Initiative (WHI) publication on the rate of HRT prescription, and the clinical characteristics and persistence rate of new users and its determinants. Methods: From the RAMQ databases, the total numbers of HRT prescriptions, and of new HRT's users were calculated between 2 January 1998 and 31 May 2003. To assess the clinical characteristics of women, two retrospective cohorts of new HRT's users were constructed before (pre-WHI) and after (post-WHI) the WHI study publication. The persistence rate after 1 year of follow-up was estimated using a Kaplan-Meier analysis. Cox regression models were used to estimate the rate ratio of HRT cessation. Results: The total numbers of HRT users and of new users declined respectively by 28% and 50% in post-WHI. The standard dosage of HRT was significantly less used, while the proportion of women with risk factors of CVD or at very high risk of coronary artery disease (CAD) did not change. The rate of persistence in the pre-WHI cohort was 59% compared to 45% in the post-WHI (p < 0.0001), and women with risk factors of CVD or at very high risk of CAD were less likely to cease their HRT. Conclusion: One year after publication, significant changes had already occurred in the trends of use, women's characteristics and estrogen dosage. No change in the proportion of new users with CVD risk factors or at very high risk of CAD was seen. Copyright © 2006 John Wiley & Sons, Ltd.",antidepressant agent;anxiolytic agent;conjugated estrogen;conjugated estrogen plus medroxyprogesterone acetate;corticosteroid;estradiol;estrogen;hormone derivative;piperazine estrone sulfate;adult;Alzheimer disease;article;behavior change;breast cancer;cardiovascular disease;cardiovascular risk;controlled study;coronary artery disease;drug use;drug withdrawal;female;follow up;hormone substitution;human;Kaplan Meier method;major clinical study;menopausal syndrome;osteoporosis;postmenopause;prescription;priority journal;proportional hazards model;risk factor;cerebrovascular accident;women's health,"Pharm, M. P. G. B.;Dragomir, A.;Pilon, D.;Moride, Y.;Perreault, S.",2007,,,0,
3475,Effect of β-Adrenergic Antagonists on In-Hospital Mortality after Ischemic Stroke,"Background Ischemic stroke accounts for 85%-90% of all strokes and currently has very limited therapeutic options. Recent studies of β-adrenergic antagonists suggest they may have neuroprotective effects that lead to improved functional outcomes in rodent models of ischemic stroke; however, there are limited data in patients. We aimed to determine whether there was an improvement in mortality rates among patients who were taking β-blockers during the acute phase of their ischemic stroke. Methods A retrospective analysis of a prospectively collected database of ischemic stroke patients was performed. Patients who were on β-adrenergic antagonists both at home and during the first 3 days of hospitalization were compared with patients who were not on β-adrenergic antagonists to determine the association with patient mortality rates. Results The study included a patient population of 2804 patients. In univariate analysis, use of β-adrenergic antagonists was associated with older age, atrial fibrillation, hypertension, and more-severe initial stroke presentation. Despite this, multivariable analysis revealed a reduction in in-hospital mortality among patients who were treated with β-adrenergic antagonists (odds ratio,.657; 95% confidence interval,.655-.658). Conclusions The continuation of home β-adrenergic antagonist medication during the first 3 days of hospitalization after an ischemic stroke is associated with a decrease in patient mortality. This supports the work done in rodent models suggesting neuroprotective effects of β-blockers after ischemic stroke.",anticoagulant agent;antithrombocytic agent;beta adrenergic receptor blocking agent;plasminogen activator;age;aged;article;atrial fibrillation;brain ischemia;cerebrovascular accident;congestive heart failure;dementia;diabetes mellitus;disease severity;drug effect;drug use;female;fibrinolytic therapy;heart disease;home care;hospitalization;human;hypertension;international normalized ratio;major clinical study;male;medical history;mortality;National Institutes of Health Stroke Scale;priority journal;retrospective study;sex difference;stroke patient,"Phelan, C.;Alaigh, V.;Fortunato, G.;Staff, I.;Sansing, L.",2015,,,0,
3476,Association of incident dementia with hospitalizations,"Context: Dementia is associated with increased rates and often poorer outcomes of hospitalization, including worsening cognitive status. New evidence is needed to determine whether some admissions of persons with dementia might be potentially preventable. Objective: To determine whether dementia onset is associated with higher rates of or different reasons for hospitalization, particularly for ambulatory care-sensitive conditions (ACSCs), for which proactive outpatient care might prevent the need for a hospital stay. Design, Setting, and Participants: Retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of adults aged 65 years or older enrolled in an integrated health care system. All participants had no dementia at baseline and those who had a dementia diagnosis during biennial screening contributed nondementia hospitalizations until diagnosis. Automated data were used to identify all hospitalizations of all participants from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first. The study period spanned February 1, 1994, to December 31, 2007. Main OutcomeMeasures: Hospital admission rates for patients with and without dementia, for all causes, by type of admission, and for ACSCs. Results: Four hundred ninety-four individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained free of dementia and 1478 (59%) of those were admitted at least once. The unadjusted all-cause admission rate in the dementia group was 419 admissions per 1000 person-years vs 200 admissions per 1000 person-years in the dementia-free group. After adjustment for age, sex, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23-1.61; P<.001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38-2.31; P<.001). Adjusted admission rates classified by body system were significantly higher in the dementia group for most categories. Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia. Conclusion: Among our cohort aged 65 years or older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ACSCs. ©2012 American Medical Association. All rights reserved.",age;aged;ambulatory care;ambulatory care sensitive conditions;article;bacterial pneumonia;cohort analysis;congestive heart failure;controlled study;dehydration;dementia;disease association;duodenum ulcer;female;hospital admission;hospitalization;human;incidence;integrated health care system;length of stay;longitudinal study;major clinical study;male;mortality;onset age;priority journal;retrospective study;sex;urinary tract infection,"Phelan, E. A.;Borson, S.;Grothaus, L.;Balch, S.;Larson, E. B.",2012,,,0,
3477,The Polycomb group protein EED couples TNF receptor 1 to neutral sphingomyelinase,"The phospholipase neutral sphingomyelinase (N-SMase) has been recognized as a major mediator of processes such as inflammation, development and growth, differentiation and death of cells, as well as in diseases such as Alzheimer's, atherosclerosis, heart failure, ischemia/reperfusion damage, or combined pituitary hormone deficiency. Although activation of N-SMase by the proinflammatory cytokine TNF was described almost two decades ago, the underlying signaling pathway is unresolved. Here, we identify the Polycomb group protein EED (embryonic ectodermal development) as an interaction partner of nSMase2. In yeast, the N terminus of EED binds to the catalytic domain of nSMase2 as well as to RACK1, a protein that modulates the activation of nSMase2 by TNF in concert with the TNF receptor 1 (TNF-R1)-associated protein FAN. In mammalian cells, TNF causes endogenous EED to translocate from the nucleus and to colocalize and physically interact with both endogenous nSMase2 and RACK1. As a consequence, EED and nSMase2 are recruited to the TNF-R1.FAN.RACK1-complex in a timeframe concurrent with activation of nSMase2. After knockdown of EED by RNA interference, the TNF-dependent activation of nSMase2 is completely abrogated, identifying EED as a protein that both physically and functionally couples TNF-R1 to nSMase2, and which therefore represents the ""missing link"" that completes one of the last unresolved signaling pathways of TNF-R1.","Enzyme Activation;HeLa Cells;Humans;Polycomb Repressive Complex 2;Receptors, Tumor Necrosis Factor/*metabolism;Repressor Proteins/*metabolism;Sphingomyelin Phosphodiesterase/*metabolism","Philipp, S.;Puchert, M.;Adam-Klages, S.;Tchikov, V.;Winoto-Morbach, S.;Mathieu, S.;Deerberg, A.;Kolker, L.;Marchesini, N.;Kabelitz, D.;Hannun, Y. A.;Schutze, S.;Adam, D.",2010,Jan 19,10.1073/pnas.0908486107,0,
3478,Postmenopausal hormone therapy: Critical reappraisal and a unified hypothesis. Editorial comment,,conjugated estrogen;estrogen;medroxyprogesterone acetate;progesterone;adult;aged;atherosclerosis;breast cancer;cancer risk;castration;cause of death;climacterium;clinical trial;cognition;colorectal cancer;controlled study;dementia;female;fragility fracture;hormonal therapy;human;ischemic heart disease;lung embolism;major clinical study;Haplorhini;note;postmenopause;prevalence;prophylaxis;randomized controlled trial;risk benefit analysis;venous thromboembolism,"Phillips, L. S.;Langer, R. D.",2005,,,0,
3479,Cognitive deficits in peripheral vascular disease: A comparison of mild stroke patients and normal control subjects,"Background and Purpose: Evidence indicates that peripheral vascular disease (PVD) and cerebrovascular disease (CVD) coexist and therefore reflect a generalized pattern of atherosclerotic disease in an individual. Given the known deleterious effects of CVD on cognitive function, it was hypothesized that patients with PVD may have impaired cerebral function due to concomitant but clinically unrecognized CVD. The purpose of this study was to determine whether neuropsychological tests would reveal this potential dysfunction. Methods: Neuropsychological test scores (n=25) were compared across three groups: (1) 29 PVD patients (13 amputees, 16 nonamputees), (2) 29 age- and education-matched patients with atherothrombotic brain infarcts (ie, CVD), and (3) 30 age and education-matched control subjects. Results: PVD patients performed significantly worse (P<.002) than control subjects on eight neuropsychological measures of executive function, attention, and visuospatial function. The pattern and, in certain instances, the magnitude of impairment was highly similar between PVD and CVD subjects. Regression analyses revealed that PVD severity and ischemic heart disease were significant negative predictors of test performance. Depression and atherosclerotic risk factors did not explain neuropsychological deficits after the effects of PVD and ischemic heart disease were considered. Conclusions: PVD patients exhibit neuropsychological deficits that suggest the presence of mild vascular-related brain dysfunction. Patients with multiple manifestations of generalized atherosclerosis (ie, severe PVD, ischemic heart disease) appear to be particularly at risk. Clinicians should be alert to these potential deficits and to the possibility of further vascular-related cognitive decline.",adult;aged;article;atherosclerosis;brain infarction;cerebrovascular disease;clinical article;cognitive defect;controlled study;depression;depth perception;female;human;male;multiinfarct dementia;neuropsychological test;peripheral vascular disease;priority journal;risk factor;cerebrovascular accident,"Phillips, N. A.;Mate-Kole, C. C.",1997,,,0,
3480,Diabetes and dementia,Concern about memory loss does not always point to a diagnosis of dementia. Hypoglycaemia in the elderly may present with subtle changes and may be missed. Nonmixed insulins are preferable to premixed insulins in most elderly people with diabetes. Postprandial hyperglycaemia may be improved by using a very short acting aspart insulin of lispro insulin or a short acting insulin secretagogue such as repaglinide. Metformin should be used cautiously in the elderly because of decreased renal function and therefore increased risk of lastic acidosis. The glitazones may be the drugs of choice in elderly people with diabetes because of low risk of hypoglycaemia. The risk of an adverse drug reaction increases linearly with increasing number of medications. Medications that can be given daily are preferable to those that need to be given thrice daily. NSAIDs and diabetes do not mix.,acarbose;acetylsalicylic acid;amitriptyline;antidepressant agent;antilipemic agent;biguanide derivative;captopril;clonazepam;metformin;digoxin;gemfibrozil;glibenclamide;gliclazide;glimepiride;glipizide;glitazone derivative;glitinide derivative;glyade;insulin lispro;human insulin;insulin aspart;insulin derivative;isophane insulin;metformin bc;neutral insulin;nidem;nonsteroid antiinflammatory agent;oral antidiabetic agent;pioglitazone;repaglinide;rosiglitazone;sulfonylurea;tricyclic antidepressant agent;unclassified drug;unindexed drug;aged;amnesia;anticholinergic effect;article;case report;cognitive defect;combination chemotherapy;controlled study;dementia;depression;diabetes mellitus;diabetic foot;disease association;drug half life;drug indication;female;glucose blood level;heart failure;human;hyperkalemia;hypoglycemia;hypotension;kidney function;lactic acidosis;male;polypharmacy;rhabdomyolysis;risk assessment;side effect;actos;actrapid;amaryl;aspirin;avandia;daonil;diabex;diaformin;diamicron;glimel;glucobay;glucohexal;glucomet;glucophage;humalog mix25;humulin r;humulin;melizide;minidiab;mixtard;novomix 30;novonorm;novorapid,"Phillips, P. J.;Popplewell, P. Y.",2002,,,0,
3481,Singapore's burden of disease and injury 2004,"Introduction: The Singapore Burden of Disease (SBoD) Study 2004 provides a comprehensive and detailed assessment of the size and distribution of health problems in Singapore. It is the first local study to use disability-adjusted life years (DALYs) to quantify the total disease burden. Methods: The SBoD study applied the methods developed for the original Global Burden of Disease study to data specific to Singapore to compute the DALYs. DALY is a summary measure of population health that combines time lost due to premature mortality (years of life lost [YLL]) with time spent in ill-health (broadly-termed disability) arising from incident cases of disease or injury (years of life lost due to disability [YLD]). DALYs, stratified by gender and age group, were calculated for more than 130 specific health conditions for the Singapore resident population for the year 2004. Results: In 2004, diabetes mellitus, ischaemic heart disease and stroke were the top three leading causes of premature death and ill-health in Singapore, and together accounted for more than one-quarter (28 percent) of the total disease burden (in DALYs). Morbidity burden (YLD) was responsible for 52 percent of the total DALYs, with diabetes mellitus, anxiety and depression, and Alzheimer's disease and other dementias being the main sources of the total YLDs. Ischaemic heart disease, stroke and lung cancer were the major contributors to the premature mortality burden (YLL). Conclusion: This study provides an objective and systematic assessment of the fatal and nonfatal health conditions in Singapore to support priority setting in public health policies and research.",age distribution;article;cause of death;daily life activity;diabetes mellitus;disability;disease control;disease registry;fatality;health;health care policy;human;ischemic heart disease;lung cancer;medical research;morbidity;mortality;population research;public health problem;Singapore;statistical analysis;cerebrovascular accident;world health organization,"Phua, H. P.;Chua, A. V. L.;Ma, S.;Heng, D.;Chew, S. K.",2009,,,0,
3482,Bullous pemphigoid and antecedent neurological diseases: An association with dementia,"Background: Bullous pemphigoid is the most common subepidermal immunobullous disorder. Studies have reported the association between bullous pemphigoid and various neurological diseases. Aims: The aim of this study was to evaluate whether bullous pemphigoid is associated with pre-existent neurological diseases and whether specific diseases exhibit this association. Methods: All dermatology inpatients from January 2010 to May 2015 were analyzed. Bullous pemphigoid cases were identified based on clinical features and consistent histopathologic and direct immunofluorescence findings. Patients with other autoimmune bullous skin disorders were excluded. An equal number of inpatients with other skin conditions were selected randomly as age- and sex- matched controls. Results: Out of 3015 inpatients, 103 cases of bullous pemphigoid and 103 age- and sex-matched controls were included. Seventy six patients with bullous pemphigoid had a history of at least one neurological disease. After adjusting for age, gender, race, functional status and neuro-psychiatric medications, patients with bullous pemphigoid were found to be approximately thrice as likely to have a history of at least one neurological disease than were controls (odds ratio: 2.88; 95% confidence interval: 1.32-6.26; P = 0.008). Amongst the pre-existing neurological diseases, only dementia was statistically more prevalent in bullous pemphigoid cases compared to controls (adjusted odds ratio: 2.61; 95% confidence interval: 1.19-5.75; P = 0.017). Parkinson disease and psychiatric disorders demonstrated a higher adjusted risk among bullous pemphigoid patients but the difference was not statistically significant. Limitations: The limitations were potential referral and selection bias, as the patients were inpatients. There is a possible misclassification as the diagnosis of neurological diseases was performed using medical records. The duration from the diagnosis of neurological diseases to bullous pemphigoid could not be accurately determined as it was a retrospective review of records and most neurological diseases have a prolonged course. Conclusions: Pre-existent neurological disease, specifically dementia, was found to be associated with bullous pemphigoid.",aged;Alzheimer disease;article;bullous pemphigoid;case control study;comparative study;controlled study;dementia;diabetes mellitus;epilepsy;female;human;human tissue;immunofluorescence;ischemic heart disease;major clinical study;male;medical record;mental disease;neurologic disease;Parkinson disease;retrospective study,"Phuan, C. Z. Y.;Yew, Y. W.;Tey, H. L.",2017,,10.4103/0378-6323.198451,0,
3483,"Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007","BACKGROUND: Atrial fibrillation (AF) is a common and costly problem among older persons. The frequency of AF increases with age, but representative national data about incidence and prevalence are limited. We examined the annual incidence, prevalence, and mortality associated with AF among older persons. METHODS AND RESULTS: In a retrospective cohort study of Medicare beneficiaries 65 years and older diagnosed with AF between 1993 and 2007, we measured annual age- and sex-adjusted incidence and prevalence of AF and mortality following an AF diagnosis. Among 433,123 patients with incident AF, the mean age was 80 years, 55% were women, and 92% were white. The incidence of AF remained steady during the 14-year study period, ranging from 27.3 to 28.3 per 1000 person-years. Incidence rates were consistently higher among men and white beneficiaries. The prevalence of AF increased across the study period (mean, 5% per year) and was robust to sensitivity analyses. Among beneficiaries with incident AF in 2007, 36% had heart failure, 84% had hypertension, 30% had cerebrovascular disease, and 8% had dementia. Mortality after AF diagnosis declined slightly over time but remained high. In 2007, the age- and sex-adjusted mortality rates were 11% at 30 days and 25% at 1 year. CONCLUSIONS: Among older Medicare beneficiaries, incident AF is common and has remained relatively stable for more than a decade. Incident AF is associated with significant comorbidity and mortality; death occurs in one-quarter of beneficiaries within 1 year.","Aged;Aged, 80 and over;Atrial Fibrillation/diagnosis/*epidemiology/mortality;Female;Humans;Incidence;Male;*Medicare;Prevalence;Retrospective Studies;Sex Factors;Survival Analysis;Treatment Outcome;United States","Piccini, J. P.;Hammill, B. G.;Sinner, M. F.;Jensen, P. N.;Hernandez, A. F.;Heckbert, S. R.;Benjamin, E. J.;Curtis, L. H.",2012,Jan,10.1161/circoutcomes.111.962688,0,
3484,Increased QT variability in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,"BACKGROUND AND PURPOSE: Although sudden death (SD) accounts for numerous cases of premature mortality in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the risk factors responsible for this dramatic event remain unclear. We sought possible differences in the QT variability index (QTVI) -- a well-known index of temporal dispersion in myocardial repolarization strongly associated with the risk of SD -- between a group of patients with CADASIL and healthy controls. METHODS: A total of 13 patients with CADASIL and 13 healthy volunteers underwent a 5-min electrocardiogram recording to calculate the QTVI. All the patients also underwent a clinical assessment, including functional status by Rankin score, and a magnetic resonance imaging (MRI) brain scan for quantitative analysis of T2-weighted (T2-W) and T1-weighted (T1-W) lesion volume (LV). RESULTS: Short-term QT-interval analysis showed significantly higher QTVI (P = 0.029) in patients than in controls. In patients, notwithstanding the limitations of the small sample size, QTVI also well correlated with T1-W LV (r = 0.747, P = 0.003) and T2-W LV (r = 0.731, P = 0.005). CONCLUSION: Because patients with CADASIL have increased temporal cardiac repolarization variability as assessed by QTVI, this mechanism could underlie these patients' risk of SD. Whether this easily assessed, non-invasive marker could be used to stratify the risk of malignant ventricular arrhythmias in patients with CADASIL and, possibly, to guide their therapeutic management warrants confirmation from larger prospective studies.","Adult;Aged;Arrhythmias, Cardiac/diagnosis/*etiology/physiopathology;Brain/blood supply/pathology/physiopathology;CADASIL/*complications;Cerebral Arteries/pathology;Death, Sudden, Cardiac/*etiology;Electrocardiography;Female;Heart Conduction System/physiopathology;Heart Rate/physiology;Heart Ventricles/innervation/physiopathology;Humans;Magnetic Resonance Imaging;Male;Middle Aged;Pilot Projects;Predictive Value of Tests","Piccirillo, G.;Magri, D.;Mitra, M.;Rufa, A.;Zicari, E.;Stromillo, M. L.;De Stefano, N.;Dotti, M. T.",2008,Nov,10.1111/j.1468-1331.2008.02300.x,0,
3485,The changing prevalence of comorbidity across the age spectrum,"The purpose of the research was to demonstrate that comorbid health conditions disproportionately affect elderly cancer patients. Descriptive analyses and stacked area charts were used to examine the prevalence and severity of comorbid ailments by age of 27,506 newly diagnosed patients treated at one of eight cancer centers between 1998 and 2003. Hypertension was the most common ailment in all patients, diabetes was the second most prevalent ailment in middle-aged patients, and previous solid tumor(s) were the second most prevalent ailment in patients aged 74 and older. Although the prevalence and severity of comorbid ailments including dementia and congestive heart failure increased with age, some comorbidities such as HIV/AIDS and obesity decreased. Advances in cancer interventions have increased survivorship, but the impact of the changing prevalence and severity of comorbidities at different ages has implications for targeted research into targeted clinical and psychosocial interventions.","Adolescent;Adult;Age Factors;Aged;Aged, 80 and over;Cognition Disorders/epidemiology;Comorbidity;Female;Humans;Hypertension/epidemiology;Male;Middle Aged;Neoplasms/*epidemiology;Prevalence","Piccirillo, J. F.;Vlahiotis, A.;Barrett, L. B.;Flood, K. L.;Spitznagel, E. L.;Steyerberg, E. W.",2008,Aug,10.1016/j.critrevonc.2008.01.013,0,
3486,Interpretation of neuropathological lesions: Its limitations in medico-legal experts' reports,"Aggressive or paradoxical behaviour may reflect an organic dementia. The most frequent is Alzheimer's disease, which results from an abnormal structural conformation of tubulin-associated protein (tau) and beta-amyloid protein that, respectively, aggregate in certain neurons as intracellular neurofibrillary tangles (NFTs) and in the extracellular environment as senile plaques. These lesions progress in the brain tissue according to the stages described by Braak and Braak. Staging of neurofibrillary pathology has proven anatomical and clinical correlation, which can be used in a medico-legal procedure. We report two cases demonstrating discrepancies between anatomical and clinical features, which should encourage medical expert to prudence when interpreting neuropathological reports. © 2009 Elsevier Ireland Ltd. All rights reserved.",alpha synuclein;amyloid beta protein;aged;Alzheimer disease;antigen retrieval;arteriosclerosis;article;autopsy;brain atrophy;brain contusion;brain ventricle dilatation;brain weight;bronchopneumonia;cardiomegaly;case report;female;head injury;heart left ventricle hypertrophy;human;human tissue;hypertension;immunohistochemistry;medicolegal aspect;mental deterioration;microscopic anatomy;nephrosclerosis;neurofibrillary tangle;neuropathology;neuropil thread;priority journal;senile plaque;vascular amyloidosis,"Piercecchi-Marti, M. D.;De Paula, A. M.;Gavaudan, G.;Bartoli, C.;Pelissier-Alicot, A. L.;Leonetti, G.;Pellissier, J. F.",2010,,,0,
3487,Single photon emission computed tomography,"Single photon emission computed tomography (SPECT) is becoming an increasingly important part of routine clinical nuclear medicine. By providing tomographic reconstructions in multiple planes through the patient, SPECT expands the clinical applications in nuclear medicine as well as providing better contrast, edge definition and separation of target from background activities. Imaging techniques have been developed for the evaluation of regional cerebral blood flow using radiolabeled amines. Thus cerebral functional imaging can be used in the diagnosis of acute cerebral infarction, cerebral vascular disease, dementia and epilepsy. SPECT plays a complementary role in the evaluation of coronary artery disease, particularly when it is coupled with thallium-201 and exercise testing. SPECT extends our diagnostic capabilities in additional areas, such as liver and bone scintigraphy as well as tumor imaging with gallium-67.","Brain/radionuclide imaging;Cerebral Infarction/radionuclide imaging;Diphosphates;Heart/radionuclide imaging;Image Enhancement;Liver/radionuclide imaging;Myocardial Infarction/radionuclide imaging;Radioisotopes;Technetium;Technetium Tc 99m Pyrophosphate;Thallium;*Tomography, Emission-Computed/methods","Piez, C. W., Jr.;Holman, B. L.",1985,Jul-Aug,,0,
3488,Positron emission tomography (PET) utilizing Pittsburgh compound B (PIB) for detection of amyloid heart deposits in hereditary transthyretin amyloidosis (ATTR),"BACKGROUND: DPD scintigraphy has been advocated for imaging cardiac amyloid in ATTR amyloidosis. PET utilizing 11C-Pittsburgh compound B (PIB) is the gold standard for imaging brain amyloid in Alzheimer's disease. PIB was recently shown to identify cardiac amyloidosis in both AL and ATTR amyloidosis. In the ATTR population, two types of amyloid fibrils exist, one containing fragmented and full-length TTR (type A) and the other only full-length TTR (type B). The aim of this study was to further evaluate PIB-PET in patients with hereditary ATTR amyloidosis. METHODS: Ten patients with biopsy-proven V30M ATTR amyloidosis and discrete or no signs of cardiac involvement were included. Patients were grouped according to TTR-fragmentation. All underwent DPD scintigraphy, echocardiography, and PIB-PET. A left ventricular PIB-retention index (PIB-RI) was established and compared to five normal volunteers. RESULTS: PIB-RI was increased in all patients (P < 0.001), but was significantly higher in type B than in type A (0.129 +/- 0.041 vs 0.040 +/- 0.006 min-1, P = 0.009). Cardiac DPD uptake was elevated in group A and absent in group B. CONCLUSION: PIB-PET, in contrast to DPD scintigraphy, has the potential to specifically identify cardiac amyloid depositions irrespective of amyloid fibril composition. The heart appears to be a target organ for amyloid deposition in ATTR amyloidosis.",Cardiomyopathy;Pittsburgh compound B;amyloidosis,"Pilebro, B.;Arvidsson, S.;Lindqvist, P.;Sundstrom, T.;Westermark, P.;Antoni, G.;Suhr, O.;Sorensen, J.",2016,Sep 19,10.1007/s12350-016-0638-5,0,
3489,"Human longevity is influenced by many genetic variants: evidence from 75,000 UK Biobank participants","Variation in human lifespan is 20 to 30% heritable in twins but few genetic variants have been identified. We undertook a Genome Wide Association Study (GWAS) using age at death of parents of middle-aged UK Biobank participants of European decent (n=75,244 with father's and/or mother's data, excluding early deaths). Genetic risk scores for 19 phenotypes (n=777 proven variants) were also tested. In GWAS, a nicotine receptor locus(CHRNA3, previously associated with increased smoking and lung cancer) was associated with fathers' survival. Less common variants requiring further confirmation were also identified. Offspring of longer lived parents had more protective alleles for coronary artery disease, systolic blood pressure, body mass index, cholesterol and triglyceride levels, type-1 diabetes, inflammatory bowel disease and Alzheimer's disease. In candidate analyses, variants in the TOMM40/APOE locus were associated with longevity, but FOXO variants were not. Associations between extreme longevity (mother >=98 years, fathers >=95 years, n=1,339) and disease alleles were similar, with an additional association with HDL cholesterol (p=5.7x10-3). These results support a multiple protective factors model influencing lifespan and longevity (top 1% survival) in humans, with prominent roles for cardiovascular-related pathways. Several of these genetically influenced risks, including blood pressure and tobacco exposure, are potentially modifiable.",Gwas;aging;genetic;human;longevity,"Pilling, L. C.;Atkins, J. L.;Bowman, K.;Jones, S. E.;Tyrrell, J.;Beaumont, R. N.;Ruth, K. S.;Tuke, M. A.;Yaghootkar, H.;Wood, A. R.;Freathy, R. M.;Murray, A.;Weedon, M. N.;Xue, L.;Lunetta, K.;Murabito, J. M.;Harries, L. W.;Robine, J. M.;Brayne, C.;Kuchel, G. A.;Ferrucci, L.;Frayling, T. M.;Melzer, D.",2016,Mar,10.18632/aging.100930,0,3490
3490,"Human longevity is influenced by many genetic variants: evidence from 75,000 UK Biobank participants","Variation in human lifespan is 20 to 30% heritable in twins but few genetic variants have been identified. We undertook a Genome Wide Association Study (GWAS) using age at death of parents of middle-aged UK Biobank participants of European decent (n=75,244 with father's and/or mother's data, excluding early deaths). Genetic risk scores for 19 phenotypes (n=777 proven variants) were also tested. In GWAS, a nicotine receptor locus(CHRNA3, previously associated with increased smoking and lung cancer) was associated with fathers' survival. Less common variants requiring further confirmation were also identified. Offspring of longer lived parents had more protective alleles for coronary artery disease, systolic blood pressure, body mass index, cholesterol and triglyceride levels, type-1 diabetes, inflammatory bowel disease and Alzheimer's disease. In candidate analyses, variants in the TOMM40/APOE locus were associated with longevity, but FOXO variants were not. Associations between extreme longevity (mother >=98 years, fathers >=95 years, n=1,339) and disease alleles were similar, with an additional association with HDL cholesterol (p=5.7x10-3). These results support a multiple protective factors model influencing lifespan and longevity (top 1% survival) in humans, with prominent roles for cardiovascular-related pathways. Several of these genetically influenced risks, including blood pressure and tobacco exposure, are potentially modifiable.",aged;female;genetic database;genetic polymorphism;genetics;genome-wide association study;human;longevity;male;middle aged;smoking;United Kingdom;very elderly,"Pilling, L. C.;Atkins, J. L.;Bowman, K.;Jones, S. E.;Tyrrell, J.;Beaumont, R. N.;Ruth, K. S.;Tuke, M. A.;Yaghootkar, H.;Wood, A. R.;Freathy, R. M.;Murray, A.;Weedon, M. N.;Xue, L.;Lunetta, K.;Murabito, J. M.;Harries, L. W.;Robine, J. M.;Brayne, C.;Kuchel, G. A.;Ferrucci, L.;Frayling, T. M.;Melzer, D.",2016,,,0,
3491,"Red blood cell distribution width: Genetic evidence for aging pathways in 116,666 volunteers","INTRODUCTION: Variability in red blood cell volumes (distribution width, RDW) increases with age and is strongly predictive of mortality, incident coronary heart disease and cancer. We investigated inherited genetic variation associated with RDW in 116,666 UK Biobank human volunteers. RESULTS: A large proportion RDW is explained by genetic variants (29%), especially in the older group (60+ year olds, 33.8%, <50 year olds, 28.4%). RDW was associated with 194 independent genetic signals; 71 are known for conditions including autoimmune disease, certain cancers, BMI, Alzheimer's disease, longevity, age at menopause, bone density, myositis, Parkinson's disease, and age-related macular degeneration. Exclusion of anemic participants did not affect the overall findings. Pathways analysis showed enrichment for telomere maintenance, ribosomal RNA, and apoptosis. The majority of RDW-associated signals were intronic (119 of 194), including SNP rs6602909 located in an intron of oncogene GAS6, an eQTL in whole blood. CONCLUSIONS: Although increased RDW is predictive of cardiovascular outcomes, this was not explained by known CVD or related lipid genetic risks, and a RDW genetic score was not predictive of incident disease. The predictive value of RDW for a range of negative health outcomes may in part be due to variants influencing fundamental pathways of aging.",Adult;Aged;Aging/ blood/ genetics;Biological Specimen Banks;Erythrocyte Indices/ genetics;Female;Gene Ontology;Genetic Predisposition to Disease;Genetic Variation;Genome-Wide Association Study;Genotype;Healthy Volunteers;Humans;Male;Middle Aged;Signal Transduction/ genetics;United Kingdom,"Pilling, L. C.;Atkins, J. L.;Duff, M. O.;Beaumont, R. N.;Jones, S. E.;Tyrrell, J.;Kuo, C. L.;Ruth, K. S.;Tuke, M. A.;Yaghootkar, H.;Wood, A. R.;Murray, A.;Weedon, M. N.;Harries, L. W.;Kuchel, G. A.;Ferrucci, L.;Frayling, T. M.;Melzer, D.",2017,,,0,
3492,A multidimensional prognostic index in common conditions leading to death in older patients,,acute disease;adverse outcome;aged;aged hospital patient;chronic disease;chronic kidney disease;clinical assessment tool;cohort analysis;coitus;community acquired pneumonia;congestive heart failure;dementia;follow up;human;liver cirrhosis;mental health;mortality;multidimensional prognostic index;note;nutritional status;patient assessment;prediction;priority journal;prognosis;questionnaire;relapse;risk,"Pilotto, A.;Panza, F.;Ferrucci, L.",2012,,,0,
3493,Influence of Incipient Dementia on Hospitalization for Primary Care Sensitive Conditions: A Population-Based Cohort Study,"BACKGROUND: Studies have reported that moderate/severe stages of dementia are linked to increased hospitalization rates, but little is known about the influence of incipient dementia on hospitalizations for primary care sensitive conditions (PCSCs). OBJECTIVE: To examine the associations between incipient dementia and hospitalization outcomes, including all-cause and PCSC hospitalization. METHODS: A total of 2,268 dementia-free participants in the Swedish National study on Aging and Care-Kungsholmen were interviewed and clinically examined at baseline. Participants aged >/=78 years were followed for 3 years, and those aged 60-72 years, for 6 years. Number of hospitalizations was retrieved from the National Patient Register. Dementia was diagnosed in accordance with Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Hospitalization outcomes were compared in participants who did and did not develop dementia. Zero-inflated Poisson regressions and logistic regressions were used in data analysis. RESULTS: During the follow-up, 175 participants developed dementia. The unadjusted PCSC admission rate was 88.2 per 1000 person-years in those who developed dementia and 25.6 per 1000 person-years in those who did not. In the fully adjusted logistic regression model, incipient dementia was associated with an increased risk of hospitalization for PCSCs (OR = 2.3, 95% CI 1.3-3.9) but not with the number of hospitalizations or with all-cause hospitalization. Risks for hospitalization for diabetes, congestive heart failure, and pyelonephritis were higher in those who developed dementia than in those who did not. About 10% participants had a PCSC hospitalization attributable to incipient dementia. CONCLUSION: People with incipient dementia are more prone to hospitalization for PCSCs but not to all-cause hospitalization.",Dementia;hospitalization longitudinal follow-up;population based study,"Pimouguet, C.;Rizzuto, D.;Fastbom, J.;Lagergren, M.;Fratiglioni, L.;Xu, W.",2016,Mar 8,10.3233/jad-150853,0,
3494,Sex and gender factors in medical studies: Implications for health and clinical practice,,cytochrome P450;Alzheimer disease;anorexia nervosa;anxiety disorder;bipolar disorder;bulimia;clinical research;depression;dysthymia;epilepsy;female;gender;health care policy;heart disease;heredity;human;ischemic heart disease;male;medical research;menstrual cycle;non insulin dependent diabetes mellitus;pain;phenotype;priority journal;regulatory mechanism;schizophrenia;sex difference;short survey;torsade des pointes;United States;urine incontinence,"Pinn, V. W.",2003,,,0,
3495,Research on Women's Health: Progress and opportunities,,acetylsalicylic acid;alpha tocopherol;estrogen;progesterone;unclassified drug;virus vaccine;Wart virus vaccine;behavioral research;breast cancer;cardiovascular disease;clinical research;clinical trial;dementia;drug efficacy;drug mechanism;female infertility;genetics;health care organization;heart infarction;hormonal therapy;hormone deficiency;human;lung cancer;medical research;menarche;menopausal syndrome;menopause;note;ovary cancer;phenotype;pregnancy;premature ovarian failure;priority journal;reproductive health;sex difference;cerebrovascular accident;uterine cervix cancer;aspirin,"Pinn, V. W.",2005,,,0,
3496,Hypertension in the elderly,"Introduction: There is a high prevalence of hypertension in the elderly, as evidenced by clinical and health behavioral policies. Still, there are uncertainties on the treatment of hypertension, especially treatment of the very elderly. These considerations have largely been ignored in clinical trials due to concern regarding contamination by other pathologies that are difficult to frame and manage. Methods: We performed an effective and ample literature review and provided reflections on the Consensus Conference ACCF/AHA 2011 on the principle types of hypertension found in the elderly. We also considered the associated principle pathologies for various treatments and related organs. Discussion: Even if the goal of treatment of elevated blood pressure in the elderly is same as in younger population, it is no longer certain that a target systolic blood pressure (SBP) <140 mmHg should be persistently reached in the very elderly. It is important to note that for all studies these values have never been reached. In the treatment of isolated systolic hypertension (ISH) the preferred target is a SBP >160 mmHg. Treating hypertension in the elderly and very elderly reduces the risk of stroke and heart failure, though the evidence is inconclusive for all-cause mortality. Conclusion: Hypertension in the elderly is very common and needs to be treated with criteria that consider the patient's age, comorbidities, lifestyle and adherence. Above all, in the very elderly, therapeutic treatment should be personalized according to the above criteria. Where possible pharmaceutical therapy should be limited at the preference of healthy lifestyle changes (physical activity, diet, etc.). © 2012 Elsevier Srl. All rights reserved.",alpha adrenergic receptor blocking agent;angiotensin receptor antagonist;beta adrenergic receptor blocking agent;blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;renin inhibitor;aged;article;blood pressure regulation;cardiovascular risk;cerebrovascular accident;cerebrovascular disease;coronary artery disease;dementia;edema;geriatric patient;glucose metabolism;gout;health care policy;atrial fibrillation;heart failure;high risk patient;human;hyperglycemia;hypertension;hyponatremia;obesity;osteoarthritis;quality of life;risk;risk reduction;social status;systolic blood pressure;systolic hypertension;vascular resistance;very elderly,"Pinna, G.;Pascale, C.;La Regina, M.;Orlandini, F.",2012,,,0,
3497,Termination of refractory focal status epilepticus by the P-glycoprotein inhibitor verapamil,,acetylsalicylic acid;carbamazepine;clobazam;digitoxin;etiracetam;lamotrigine;lorazepam;midazolam;phenytoin;prothipendyl;valproic acid;verapamil;basal cell carcinoma;brain ischemia;cancer surgery;chronic kidney failure;clonic seizure;colon carcinoma;consciousness disorder;decubitus;dementia;depression;drug dose increase;epileptic state;face;focal epilepsy;atrial fibrillation;heart failure;heel;human;hypertension;intensive care unit;ischemic heart disease;letter;middle cerebral artery;posterior cerebral artery;priority journal;sacrum;shoulder;stomach tube,"Pirker, S.;Baumgartner, C.",2011,,,0,
3498,Association of change in depression and anxiety symptoms with functional outcomes in pulmonary rehabilitation patients,"Objective: Pulmonary rehabilitation (PR) has emerged over the last decade as an essential component of an integrated approach to managing patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). We sought to examine how depression and anxiety symptom changes relate to disease-specific quality of life outcomes following PR. Methods: We performed a cohort study of 81 patients with COPD who completed PR at a Veterans Administration Medical Center. Pulmonary rehabilitation consisted of supervised exercise training and education twice weekly for 8 weeks. Beck Depression and Anxiety Inventories (BDI and BAI) assessed symptom burden at baseline and completion of PR. We measured change in disease-specific quality of life using the dyspnea, mastery, emotion and fatigue domains of the Chronic Respiratory Questionnaire Self-Reported (CRQ-SR) from baseline to completion of PR. Results: Participants were 69.8±9.1 years old and all male. Forced expiratory volume in 1 s (FEV1) was 1.23±0.39 L. The CRQ-SR scores improved significantly: dyspnea (P<.0001), mastery (P=.015) and fatigue (P=.017). The BDI scores improved significantly (13.1±10.5 to 10.8±9.9, P=.003; BAI: 13.1±10.1 to 12.1±11.7). Multivariate regression models controlling for age, FEV1, depression treatment and anxiety treatment showed that improvement in depressive symptoms were associated with improvement in fatigue (P=.003), emotion (P=.003) and mastery (P=.01). Anxiety symptom change was not significantly associated with change in disease-specific quality of life domains. Conclusion: Addressing anxiety symptoms in PR patients may be indicated because disease-specific quality of life improvement appears to be associated with mood. © 2011.",adult;aged;anxiety disorder;article;asthma;Beck Anxiety Inventory;Beck Depression Inventory;bladder cancer;chronic obstructive lung disease;chronic respiratory questionnaire self reported;congestive heart failure;correlational study;dementia;depression;diabetes mellitus;digestive system ulcer;dyspnea;emotion;exercise;fatigue;forced expiratory volume;gastroesophageal reflux;human;hyperlipidemia;hypertension;lung cancer;lung fibrosis;major clinical study;male;mood;musculoskeletal disease;patient education;prostate cancer;pulmonary rehabilitation;quality of life;questionnaire;sleep disordered breathing;treatment duration;vascular disease;veteran,"Pirraglia, P. A.;Casserly, B.;Velasco, R.;Borgia, M. L.;Nici, L.",2011,,,0,
3499,Predicting AIDS-related events using CD4 percentage or CD4 absolute counts,"Background: The extent of immunosuppression and the probability of developing an AIDS-related complication in HIV-infected people is usually measured by the absolute number of CD4 positive T-cells. The percentage of CD4 positive cells is a more easily measured and less variable number. We analyzed sequential CD4 and CD8 numbers, percentages and ratios in 218 of our HIV infected patients to determine the most reliable predictor of an AIDS-related event. Results: The CD4 percentage was an unsurpassed predictor of the occurrence of AIDS-related events when all subsets of patients are considered. The CD4 absolute count was the next most reliable, followed by the ratio of CD4/CD8 percentages. The value of CD4 percentage over the CD4 absolute count was seen even after the introduction of highly effective HIV therapy. Conclusion: The CD4 percentage is unsurpassed as a parameter for predicting the onset of HIV-related diseases. The extra time and expense of measuring the CD4 absolute count may be unnecessary. © 2006 Pirzada et al; licensee BioMed Central Ltd.",anti human immunodeficiency virus agent;CD4 antigen;CD8 antigen;acquired immune deficiency syndrome;adult;aged;AIDS related complex;article;aspergillosis;Aspergillus;bacterial pneumonia;Candida;cardiomyopathy;CD4+ T lymphocyte;CD8+ T lymphocyte;colitis;controlled study;Filobasidiella;Cryptosporidium;Cytomegalovirus;dementia;drug efficacy;enteritis;esophagitis;esophagus candidiasis;female;fungal meningitis;herpes simplex;Herpes simplex virus;human;Human immunodeficiency virus;immune deficiency;Kaposi sarcoma;lymphocyte count;major clinical study;male;Microsporidia;mycobacteriosis;Mycobacterium avium;Mycobacterium tuberculosis;nonhodgkin lymphoma;pancytopenia;Pneumocystis carinii;Pneumocystis pneumonia;prediction;priority journal;probability;progressive multifocal leukoencephalopathy;reliability;retinitis;spinal cord disease;time;Toxoplasma;toxoplasmosis;treatment outcome;tuberculosis;unnecessary procedure;virus pneumonia;wasting syndrome,"Pirzada, Y.;Khuder, S.;Donabedian, H.",2006,,,0,
3500,Managing the menopause: British Menopause Society Council consensus statement on hormone replacement therapy,"The British Menopause Society Council aims to help health professionals inform and advise women about the menopause. This guidance regarding estrogen-based hormone replacement therapy (HRT), including tibolone, which is classified in the British National Formulary as HRT, responds to the results and analysis of the randomized Women's Health Initiative studies and the observational Million Women Study. Treatment choice should be based on up-to-date information and targeted to individual women's needs. HRT still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination. © 2006 Ingenta.",conjugated estrogen;estrogen;tibolone;Alzheimer disease;article;breast cancer;clinical observation;clinical trial;consensus;data analysis;dementia;drug classification;drug dose regimen;endometrium cancer;female;gallbladder disease;health practitioner;hormonal therapy;human;ischemic heart disease;medical society;menopausal syndrome;ovary cancer;patient care;patient counseling;practice guideline;quality of life;risk benefit analysis;cerebrovascular accident;United Kingdom;venous thromboembolism,"Pitkin, J.;Rees, M. C. P.;Gray, S.;Lumsden, M. A.;Marsden, J.;Stevenson, J.;Williamson, J.",2005,,,0,
3501,Effects of insulinic therapy on cognitive impairment in patients with Alzheimer disease and Diabetes Mellitus type-2,"Background: Type-2 Diabetes Mellitus (DM-2) is an important risk factor for Alzheimer disease (AD) and vascular dementia (VD). The role of insulinic therapy on cognitive decline is controversial. Objective: To evaluate cognitive impairment in patients with AD and DM-2 treated with either oral antidiabetic drugs or combination of insulin with other diabetes medications. Methods: 104 patients with mild-to-moderate AD and DM-2 were divided into two groups, according to antidiabetic pharmacotherapy: group A, patients treated with oral antidiabetic drugs and group B, patients treated with insulin combined with other oral antidiabetic medications. Cognitive functions were assessed by the Mini Mental State Examination (MMSE) and the Clinician's Global Impression (CGI), with a follow-up of 12 months. Results: At the end of the study, the MMSE scores showed a significant worsening in 56.5% patients of group A and in 23.2% patients of group B, compared to baseline MMSE scores (P = .001). Also CGI-C scores showed a significant worsening for all domains after 12 months in group A vs group B (P = .001). The two groups were matched for body mass index, serum lipids, triglycerides, Apo ε4 allele and smoke habit. Conversely, ischemic heart disease and hypertension were significantly higher in group B (P = .002). After adjustment for this risk variables, our results remained significant (P = .001). Conclusions: Our study suggests that insulinic therapy could be effective in slowing cognitive decline in patients with AD. © 2009 Elsevier B.V. All rights reserved.",antidiabetic agent;apolipoprotein E4;insulin;lipid;triacylglycerol;adult;aged;Alzheimer disease;article;body mass;clinical article;cognition;cognitive defect;controlled study;drug effect;female;heart muscle ischemia;human;hypertension;male;Mini Mental State Examination;non insulin dependent diabetes mellitus;priority journal;smoking,"Plastino, M.;Fava, A.;Pirritano, D.;Cotronei, P.;Sacco, N.;Sperlì, T.;Spanò, A.;Gallo, D.;Mungari, P.;Consoli, D.;Bosco, D.",2010,,,0,
3502,"Cigarette smoking, nicotine addiction and its pharmacologic treatment","From antiquity, in the human societies were used psychoactive substances, which in the modern society are widely used, with a purpose of euphoria. Some of these substances are acceptable from the society, when their use don't exceed the measure, such as alcohol, caffeine and tobacco, while some others, because of their guidance in dependence of a human from these substances and in uncontrollable antisocial behavior, are considered illicit substances, such as narcotic substances. Tobacco smoking is the most prevalent modifiable risk factor for increased morbidity and mortality in the World. These risks have been shown to be related to the nicotine, the addictive component of tobacco smoke. Lang cancer and chronic obstructive pulmonary disease are obvious health hazards to the smoker. In addition, respiratory diseases are increased in smokers; these include emphysema and chronic bronchitis as well as pulmonary tuberculosis, influenza and bacterial bronchitis and pneumonia. Smokers have a higher incidence of cardiovascular disease, such as coronary artery disease, hypertension, aortic aneurysm, arterial thrombosis and stroke. Furthermore, smokers have a higher incidence of peptic ulcer disease, Alzheimer's disease, osteoporosis, and wrinkling. In passive smokers, studies have shown an increased incidence of lung cancer, exacerbations of asthma, coronary artery disease, nasal carcinoma, brain tumor and breast cancer. In children, exposure to parental smoking clearly increases the incidence of acute respiratory diseases. The direct role of nicotine in the pathogenesis of disease has not been completely defined. Its effects on cardiovascular disease may be mediated by direct increases in heart rate and blood pressure, depression of the magnitude of the increase in coronary blood flow that occurs in response to increased metabolic demand, including coronary artery spasm in susceptible people, causing platelet hyperaggregability and relative hypercoagulability and producing endothelial damage. In cancer pathogenesis, nicotine is not carcinogenic, but, when burned, may produce nicotine-derived nitrosoamines in amounts sufficient to contribute to cancer. In pregnancy, nicotine blocks the cholinergic receptor and blocks the acetylcholine-facilitated amino acid transport; however, more importantly, placental hypoxia induced by carbon monoxide and other tobacco gases depress energy-dependent processes such as transport of amino acids and other nutrients. Once absorbed, nicotine readily crosses the blood-brain barrier and is distributed throughout the brain within seconds. Experimentally, nicotine in low doses causes ganglionic stimulation and, therefore, causes a centrally mediated cardiovascular stimulation, while high doses cause ganglionic blockade with subsequent hypotension, bradycardia, nausea, vomiting and pallor. However, tolerance to these effects, although not complete, develops within 1 day. Cigarette smoking and tobacco use meet the criteria for drug dependence. Considerable behavioral and pharmacologic evidence show that nicotine is dependence-producing constituent of tobacco. Nicotine produces an euphoriant effect and provides the reinforcement for the smoking of cigarettes. Following abrupt smoking cessation or attempts to reduce consumption, withdrawal symptoms occur within hours. The symptoms include restlessness, irritability, anxiety, tension, stress intolerance, drowsiness, frequent awakenings from sleep, fatigue, depression, impatience, confusion, impaired concentration, and gastrointestinal disturbances. Effective treatments for tobacco dependence exist and all tobacco users should be offered those treatments. Five first-line pharmacotherapies for tobacco dependence (sustained-release bupropion hydrochloride, nicotine gum, nicotine inhaler, nicotine nasal spray and nicotine patch) are effective and at least 1 of these medications should be prescribed in the absence of contraindications.",acetylcholine;alcohol;amfebutamone;amino acid;caffeine;nicotine;nicotine gum;nitrosamine;tobacco smoke;Alzheimer disease;amino acid transport;antisocial behavior;aorta aneurysm;artery thrombosis;article;asthma;blood brain barrier;brain tumor;breast cancer;bronchitis;carcinogenesis;carcinogenicity;cardiovascular disease;cholinergic receptor blocking;chronic bronchitis;chronic obstructive lung disease;smoking;coronary artery blood flow;coronary artery disease;depression;dose response;drug contraindication;drug dependence;drug tolerance;emphysema;endothelium injury;ganglion block;health hazard;heart rate;human;hypertension;hypotension;incidence;influenza;lung cancer;lung tuberculosis;metabolic disorder;morbidity;mortality;nose carcinoma;osteoporosis;passive smoking;pathogenesis;peptic ulcer;pneumonia;respiratory tract disease;risk assessment;risk factor;cerebrovascular accident;sustained release preparation;thrombocyte aggregation;tobacco;tobacco dependence,"Plessas, C. T.;Tsaoula, E.;Violaki, N.;Plessas, S. T.",2002,,,0,
3503,Use of vitamin K antagonist therapy in geriatrics: A french national survey from the french society of geriatrics and gerontology (SFGG),"Objective We aimed to evaluate the quality and determinants of vitamin K antagonists (VKA) control among very elderly patients in geriatric settings. Methods A national cross-sectional survey was conducted among patients aged 80≥ years who were hospitalized in rehabilitation care or institutionalized in a nursing home and who were treated by VKA. Time in therapeutic range (TTR) was computed according to Rosendaal's method. Results A total of 2,633 patients were included. Mean [± standard deviation (SD)] age was 87.2 ± 4.4 years and 72.9 % were women. The main indication for VKA therapy was atrial fibrillation (AF; 71.4 %). Mean (±SD) TTR was 57.9 ± 40.4 %. After backward logistic regression, poorer VKA control (TTR<50 vs. ≥50 %) was associated with being hospitalized in rehabilitation care [odds ratio (OR)rehab. vs. nursing home = 1.41; 95 % CI 1.11-1.80], the indication for VKA treatment (ORprosthetic heart valve vs. AF = 4.76; 95 % CI 2.83-8.02), a recent VKA prescription (OR1vs. [12 months = 1.70; 95 % CI 1.08-2.67), the type of VKA (ORfluindione vs. warfarin = 1.22; 95 % CI 1.00-1.49), a history of international normalized ratio [4.5 (OR = 1.50; 95 % CI 1.21-1.84), a history of major bleeding (OR = 1.88; 95 % CI 1.00-3.53), antibiotic use (OR = 1.83; 95 % CI 1.24-2.70), and falls (OR≥2 falls during the past year vs. 2 = 1.26; 95 % CI 1.01-1.56) ©Springer International Publishing Switzerland 2013.",acenocoumarol;antibiotic agent;antivitamin K;fluindione;paracetamol;proton pump inhibitor;serotonin uptake inhibitor;warfarin;aged;article;bleeding;comorbidity;cross-sectional study;dementia;depression;drug use;falling;female;geriatric patient;atrial fibrillation;heart failure;heart valve prosthesis;human;international normalized ratio;major clinical study;male;medical history;medical society;nursing home;prescription;priority journal;rehabilitation care;treatment indication;very elderly,"Plichart, M.;Berrut, G.;Maubourguet, N.;Jeandel, C.;Emeriau, J. P.;Ankri, J.;Bouvier, H.;Ruault, G.;Hanon, O.",2013,,,0,
3504,Oliguric acute kidney injury as a main symptom of bradycardia and arteriosclerosis resolved by pacemaker implantation: A case report,"Introduction. Cardiovascular comorbidities regularly determine renal function. We report a case of acute kidney injury (Acute Kidney Injury Network stage 3) due to an intermittent third-degree atrioventricular block, which had not been diagnosed before. Case presentation. A 76-year-old Caucasian man with liver cirrhosis due to non-alcoholic fatty liver disease, and type-2 diabetes was cognitively impaired and had reduced vigilance presumably caused by hepatic encephalopathy and/or Alzheimer dementia. Within 2 years, two hospitalizations occurred for syncope attributed to orthostatic failure and hypovolemia. During the last hospitalization, oliguric acute kidney injury occurred. Sonography ruled out a post-renal cause. His renal resistive index was 1.0; his heart rate was below 50 beats per minute. After cessation of beta-blocker therapy, Holter electrocardiogram showed a new intermittent third-degree atrioventricular block with pauses for less than 3 seconds. Pacemaker insertion resolved his acute kidney injury, despite resumption of beta-blocker therapy. During four months of follow-up, syncope has not occurred, and vigilance was stable. However, his renal resistive index of 1.0 remained. Conclusions: Here, typical neurologic symptoms of bradycardia were misclassified. Diagnostic work-up of oliguric acute kidney injury revealed intermittent third-degree heart block. The pathomechanism of acute kidney injury relates to relevant bradycardia and increased vascular stiffness attenuating arterial diastolic renal blood flow.",acetylsalicylic acid;albumin;amlodipine;aspartate aminotransferase;beta adrenergic receptor blocking agent;bicarbonate;creatinine;donepezil;gamma glutamyltransferase;insulin;pantoprazole;propranolol;ramipril;simvastatin;sitagliptin;spironolactone;torasemide;urea;acute kidney failure;aged;albumin blood level;alkalosis;Alzheimer disease;arteriosclerosis;artery perfusion;article;aspartate aminotransferase blood level;attention disturbance;bicarbonate blood level;blood carbon dioxide tension;blood oxygen tension;blood pH;bradycardia;case report;cognitive defect;comorbidity;complete heart block;creatinine blood level;creatinine clearance;dementia;diastolic dysfunction;dizziness;drug withdrawal;echocardiography;echography;electrocardiogram;faintness;first degree atrioventricular block;follow up;gamma glutamyl transferase blood level;gastroscopy;glomerulus filtration rate;heart infarction;heart left ventricle hypertrophy;heart rate;hematuria;hepatic encephalopathy;Holter monitoring;hospital admission;hospital discharge;hospitalization;human;hypertension;hypoglycemia;hypotension;hypovolemia;insulin treatment;international normalized ratio;kidney perfusion;leukocyturia;liver cirrhosis;male;metabolic acidosis;microalbuminuria;Mini Mental State Examination;mitral valve regurgitation;nausea and vomiting;non insulin dependent diabetes mellitus;nonalcoholic fatty liver;oliguria;pacemaker implantation;physical examination;rehabilitation care;rehydration;resistive index;respiratory failure;sinus rhythm;standing;transient ischemic attack;urea blood level;urinalysis;urinary tract infection;urine volume;walking aid,"Pliquett, R. U.;Radler, D.;Tamm, A.;Greinert, D.;Greinert, R.;Girndt, M.",2014,,,0,
3505,Clinical and anatomo-pathologic characteristics of vascular changes in Pick's disease,,"Adult;Aged;Aortic Diseases/complications;Arteriosclerosis/complications;Coronary Disease/complications;Dementia/complications/*diagnosis/*pathology;Diagnosis, Differential;Euphoria;Eye Manifestations;Female;Humans;Intracranial Arteriosclerosis/*diagnosis;Libido;Male;Memory;Middle Aged;Nephrosclerosis/complications;Orientation;Reflex, Abnormal;Speech Disorders/etiology","Pliuiko, K. S.;Bazanova, A. N.;Kornemova, I. V.;Usik, V. D.",1967,,,0,
3506,Severe mental illness and mortality of hospitalized ACS patients in the VHA,"BACKGROUND: Severe mental illness (SMI) has been associated with more medical co-morbidity and less cardiovascular procedure use for older patients with myocardial infarction. However, it is unknown whether SMI is associated with increased long term mortality risk among patients presenting with acute coronary syndromes (ACS). We tested the hypothesis that SMI is associated with higher one-year mortality following ACS hospitalization. METHODS: All ACS patients (n = 14,194) presenting to Veterans Health Administration (VHA) hospitals between October 2003 and September 2005 were included. Survival analysis evaluated the association between SMI and one-year all-cause mortality, adjusting for demographics, co-morbidities, in-hospital treatment, and discharge medications. RESULTS: Overall, 18.4 % of ACS patients had SMI. Patients with SMI were more likely female, younger, Caucasian race, have a history of alcohol abuse, liver disease, dementia, hypertension and more likely to be a current smoker; however, prior cardiac history was similar between the 2 groups. There were no significant differences in cardiac procedure use, including coronary angiogram (38.7% vs. 40.3%, p = 0.14) or coronary revascularization (31.0% vs. 32.3%, p = 0.19), and discharge medications between those with and without SMI. One-year mortality was lower for patients with SMI (15.8% vs. 19.1%, p < 0.001). However, in multivariable analysis, there were no significant differences in mortality (HR 0.91; 95% CI 0.81-1.02) between patients with and without SMI. CONCLUSION: Among ACS patients in the VHA, SMI is prevalent, affecting almost 1 in 5 patients. However, patients with SMI were as likely to undergo coronary revascularization and be prescribed evidence-based medications at hospital discharge, and were not at elevated risk of adverse 1-year outcomes compared to patients without SMI.","Acute Coronary Syndrome/diagnosis/*mortality/therapy;Aged;Aged, 80 and over;Comorbidity;Female;Health Services Research;Hospital Mortality;Hospitals, Veterans/*standards/statistics & numerical data;Humans;Male;Mental Disorders/diagnosis/*epidemiology/therapy;Middle Aged;Myocardial Infarction/diagnosis/mortality/therapy;Risk Factors;Survival Analysis;United States/epidemiology;United States Department of Veterans Affairs","Plomondon, M. E.;Ho, P. M.;Wang, L.;Greiner, G. T.;Shore, J. H.;Sakai, J. T.;Fihn, S. D.;Rumsfeld, J. S.",2007,Sep 18,10.1186/1472-6963-7-146,0,
3507,Depression and severe heart failure: Benefits of cardiac resynchronization therapy,"Background: The relationship between depression and heart failure is neither coincidental nor trivial, since depression is a powerful predictor of re-hospitalization and mortality. We prospectively studied the prevalence and impact of depression on the clinical outcomes of patients attending for cardiac resynchronization therapy (CRT). We specifically examined whether patients with depression have a different rate of response to CRT and whether CRT has an effect on depressive symptoms. Methods: Sixty-eight recipients ofCRTsystems were included. The depressive status was evaluated before implant and after 6 months by a structured diagnostic interview measuring Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria of major depression and by a self-report questionnaire (Center for Epidemiological Studies Depression Scale, CES-D). The CRT response was assessed at 6 months by a clinical composite score. Results: At inclusion, DSM-IV criteria of major depression were identified in 41% of the population, while using the self-report questionnaire 65% were observed to have mild to major depressive symptoms (CES-D ≥ 16). Only 4 patients were taking antidepressants. At 6 months, 75% were considered responders to CRT. Response to CRT did not differ between those with and without depression at baseline. The rate of patients with depression at 6 months was significantly lower in responders to CRT compared with nonresponders. Conclusions: We found a high prevalence of depressive symptoms in patients receiving CRT systems. Patients with depression should not be excluded from CRT, because they demonstrate a similar rate of response than the persons without depression and the responders are less likely to be depressed at 6 months.",antidepressant agent;adult;aged;article;cardiac resynchronization therapy;Center for Epidemiological Studies Depression Scale;comorbidity;comparative study;defibrillator;dementia;depression;device therapy;disease association;disease course;disease severity;DSM-IV;female;follow up;heart failure;heart transplantation;human;major clinical study;major depression;male;mental function;outcome assessment;prevalence;priority journal;Structured Clinical Interview for DSM Disorders;treatment indication;treatment response,"Ploux, S.;Verdoux, H.;Whinnett, Z.;Ritter, P.;Dos Santos, P.;Picard, F.;Clementy, J.;Haïssaguerre, M.;Bordachar, P.",2012,,,0,
3508,Comorbidity of dementia: a cross-sectional study of primary care older patients,"BACKGROUND: The epidemiologic study of comorbidities of an index health problem represents a methodological challenge. This study cross-sectionally describes and analyzes the comorbidities associated with dementia in older patients and reviews the existing similarities and differences between identified comorbid diseases using the statistical methods most frequently applied in current research. METHODS: Cross-sectional study of 72,815 patients over 64 seen in 19 Spanish primary care centers during 2008. Chronic diseases were extracted from electronic health records and grouped into Expanded Diagnostic Clusters(R). Three different statistical methods were applied (i.e., analysis of prevalence data, multiple regression and factor analysis), stratifying by sex. RESULTS: The two most frequent comorbidities both for men and women with dementia were hypertension and diabetes. Yet, logistic regression and factor analysis demonstrated that the comorbidities significantly associated with dementia were Parkinson's disease, congestive heart failure, cerebrovascular disease, anemia, cardiac arrhythmia, chronic skin ulcers, osteoporosis, thyroid disease, retinal disorders, prostatic hypertrophy, insomnia and anxiety and neurosis. CONCLUSIONS: The analysis of the comorbidities associated with an index disease (e.g., dementia) must not be exclusively based on prevalence rates, but rather on methodologies that allow the discovery of non-random associations between diseases. A deep and reliable knowledge about how different diseases are grouped and associated around an index disease such as dementia may orient future longitudinal studies aimed at unraveling causal associations.","Aged;Aged, 80 and over;Anxiety Disorders/epidemiology;Cerebrovascular Disorders/epidemiology;Chronic Disease;Comorbidity;Cross-Sectional Studies;Dementia/*diagnosis/*epidemiology;Diabetes Mellitus/epidemiology;Electronic Health Records/statistics & numerical data;Female;Humans;Hypertension/epidemiology;Logistic Models;Longitudinal Studies;Male;Middle Aged;Prevalence;Primary Health Care/*statistics & numerical data;*Severity of Illness Index;Sleep Initiation and Maintenance Disorders/epidemiology;Spain/epidemiology","Poblador-Plou, B.;Calderon-Larranaga, A.;Marta-Moreno, J.;Hancco-Saavedra, J.;Sicras-Mainar, A.;Soljak, M.;Prados-Torres, A.",2014,Mar 20,10.1186/1471-244x-14-84,0,
3509,Association of apolipoprotein E but not B with Alzheimer's disease,"In our studies apolipoprotein E4 (APOE4) is associated with both early- and late-onset Alzheimer's disease. Alzheimer's patients from West Texas were screened for the APOE4 allele, which was found at frequencies of 0.43 and 0.59 in familial late- and early-onset cases. Sporadic cases had lower frequencies, but they still were 2-4 times higher than control spouses. To determine whether the APOE association may be a risk factor for coronary disease as well, we examined two APOB gene restriction sites that have previously been found to be associated with coronary artery disease, especially myocardial infarctions. The APOB alleles were found at similar frequencies in Alzheimer's patients and control spouses.",Aged;Alzheimer Disease/*genetics;Apolipoproteins B/*genetics;Apolipoproteins E/*genetics;Female;Humans;Male;Middle Aged;Time Factors,"Poduslo, S. E.;Riggs, D.;Schwankhaus, J.;Osborne, A.;Crawford, F.;Mullan, M.",1995,Nov,,0,
3510,"Arterial stiffness, cognitive decline, and risk of dementia: The Rotterdam study","BACKGROUND AND PURPOSE - Arterial stiffness is associated with an increased risk of myocardial infarction and stroke, independent of classical vascular risk factors. Vascular factors and stroke are associated with cognitive function and dementia. We examined whether arterial stiffness was independently associated with cognitive function and dementia. METHODS - The present study was based on the Rotterdam Study, a prospective population-based cohort study ongoing since 1990. During the third examination (1997-1999) arterial stiffness was measured by assessment of pulse wave velocity and carotid distensibility. Cognitive function was assessed during the third and fourth examination (2002-2004) with a neuropsychological test battery. We used linear and logistic regression to estimate the association of arterial stiffness with cognitive function and cognitive decline. From the third examination until January 1, 2005, we identified 156 incident dementia cases. Cox proportional hazard models were used to estimate the association between arterial stiffness and the risk of dementia. RESULTS - After adjustment for cardiovascular risk factors we found an association of increased pulse wave velocity with poorer performance on the Stroop test (adjusted β-coefficient [95% confidence interval] 1.13 [0.26 to 1.99] per standard deviation increase in pulse wave velocity) but not with performance on other cognitive tests. No associations were found between measures of arterial stiffness and cognitive decline or risk of dementia after adjustment for cardiovascular factors. CONCLUSIONS - We did not identify arterial stiffness as an independent risk factor of cognitive decline or risk of dementia. © 2007 American Heart Association, Inc.",aged;arterial stiffness;article;cardiovascular disease;cardiovascular risk;carotid artery;carotid artery pulse;cognition;cognitive defect;cohort analysis;confidence interval;controlled study;dementia;disease association;female;human;logistic regression analysis;major clinical study;male;priority journal;prospective study;pulse wave;rigidity,"Poels, M. M. F.;Van Oijen, M.;Mattace-Raso, F. U. S.;Hofman, A.;Koudstaal, P. J.;Witteman, J. C. M.;Breteler, M. M. B.",2007,,,0,
3511,Hiding behind confusion: Pleural empyema caused by parvimonas micra,,amoxicillin plus clavulanic acid;C reactive protein;ofloxacin;streptokinase;aged;Alzheimer disease;amnesia;antibiotic therapy;artificial heart pacemaker;blood culture;body temperature;case report;complete heart block;computer assisted tomography;confusion;congestive heart failure;heart atrium flutter;hospital admission;human;hypertension;intensive care unit;leukocyte count;loss of appetite;lung infiltrate;male;medical history;New York Heart Association class;note;Parvimonas micra;periodontal disease;periodontitis;peripheral occlusive artery disease;pleura empyema;pleural catheter;priority journal;respiratory failure;somnolence;thorax radiography;very elderly,"Poetter, C.;Pithois, C.;Caty, S.;Petit, V.;Combier, J. P.;Mourtialon, P.;Mattner, F.",2014,,,0,
3512,Long-term benefits of rivastigmine in dementia associated with Parkinson's Disease: An active treatment extension study,"In patients with dementia associated with Parkinson's disease (PD), the efficacy and safety of rivastigmine, an inhibitor of acetylcholinesterase and butyrylcholinesterase, were previously demonstrated in a 24-week double-blind placebo-controlled trial. Our objective was to determine whether benefits were sustained over the long term. Following the double-blind trial, all patients were permitted to enter an active treatment extension study, during which they received rivastigmine 3-12 mg/day. Standard safety assessments were performed. Efficacy assessments included the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog) and other measures of cognition, daily function, neuropsychiatric symptoms, and executive function. Of 433 patients who completed the double-blind trial, 334 entered and 273 completed the active treatment extension. At 48 weeks, the mean ADAS-cog score for the whole group improved by 2 points above baseline. Placebo patients switching to rivastigmine for the active treatment extension experienced a mean cognitive improvement similar to that of the original rivastigmine group during the double-blind trial. The adverse event profile was comparable to that seen in the double-blind trial. Long-term rivastigmine treatment appeared well tolerated and may provide sustained benefits in dementia associated with PD patients who remain on treatment for up to 48 weeks. © 2005 Movement Disorder Society.",dopamine receptor stimulating agent;neuroleptic agent;placebo;rivastigmine;aged;article;brain function;cardiopulmonary insufficiency;cerebrovascular accident;clinical trial;cognition;confusion;controlled clinical trial;controlled study;daily life activity;dementia;Diagnostic and Statistical Manual of Mental Disorders;disease association;dose response;double blind procedure;drug efficacy;drug fatality;drug safety;drug substitution;drug tolerance;falling;female;functional assessment;hallucination;heart failure;heart infarction;human;long term care;major clinical study;male;maximum tolerated dose;nausea and vomiting;neuropsychiatry;open study;Parkinson disease;pneumonia;priority journal;side effect;symptom;treatment duration;treatment withdrawal;tremor;exelon,"Poewe, W.;Wolters, E.;Emre, M.;Onofrj, M.;Hsu, C.;Tekin, S.;Lane, R.",2006,,,0,
3513,"Energy and protein intake, anthropometrics, and disease burden in elderly home-care receivers - A cross-sectional study in Germany (ErnSIPP study)","Objective: To date, no study has examined the nutritional status and disease burden of elderly home-care receivers living in Germany. Aim of this cross-sectional study was, first, to assess disease burden and nutritional status, denoted in anthropometrics, and, second, to investigate associations between anthropometrics and disease burden. Design: Cross-sectional multi-centre study. Setting: Home-care receivers living in three urban areas of Germany in 2010. Participants: 353 elderly (>64 years) in home care (128 males aged 79.1 ±7.8 years, 225 females aged 82.0 ±7.5 years). Measurements: Nutritional status was assessed by body mass index (BMI), mid upper arm circumference (MUAC) and calf circumference (CC). Medical conditions were assessed in personal interviews. A 3-day prospective nutrition diary was kept. Metric data are reported as mean±SD or median (interquartile range), p<0.05 was considered significant. Results: Most participants were substantially (59%), and 11% severest in need of care. The seniors suffered from 5 (4–7) chronic diseases; dementia, depression, stroke, and respiratory illness were most prevalent (each 20–40%). More than one-third of participants had only moderate or poor appetite, nearly half were unable to eat independently. Chewing problems were reported for 52% of study participants, and more than one quarter of elderly had swallowing problems. Daily mean energy intake was 2017±528 kcal in men (n=123) and 1731±451 kcal in women (n=216; p<0.001). Mean protein intake amounted to 1.0 g/kg body weight. Mean BMI was 28.2±6.2 kg/m2 (n=341), 14% of seniors had a BMI <22 kg/m2 (including 4% with BMI <20 kg/m2). Critical MUAC (<22 cm) was indicated in 6% of subjects; and CC <31 cm in 11% of men, 21% of women (p<0.05). After adjusting for sex and age, BMI, MUAC and CC were negatively associated with high care level, hospitalization in the previous year, nausea/vomiting, prevalence of dementia, poor appetite, and eating difficulties like dependency, chewing and swallowing problems. Conclusion: We recommend to pay special attention to the nutritional status of elderly persons in home-care exhibiting named disease burden.",prescription drug;aged;anthropometry;appetite disorder;arm circumference;article;body mass;body weight;calf circumference;caloric intake;cerebrovascular accident;chronic kidney disease;constipation;cross-sectional study;decubitus;dementia;depression;diabetes mellitus;diarrhea;dysphagia;eating disorder;female;gastritis;Germany;heart failure;home care;hospitalization;human;hypertension;interview;major clinical study;male;mastication;mid upper arm circumference;multicenter study;nausea and vomiting;nutritional status;osteoporosis;prevalence;priority journal;protein intake;respiratory tract disease;underweight;urban area;xerostomia,"Pohlhausen, S.;Uhlig, K.;Kiesswetter, E.;Diekmann, R.;Heseker, H.;Volkert, D.;Stehle, P.;Lesser, S.",2016,,,0,
3514,"Chronicity of HIV infections, a persistent evolution",,"AIDS Dementia Complex/virology;AIDS-Related Opportunistic Infections/virology;Aging, Premature/virology;Anti-HIV Agents/*adverse effects;Chronic Disease;Cognition Disorders/virology;Disease Progression;HIV Infections/*complications/epidemiology/*therapy;HIV-Associated Lipodystrophy Syndrome/virology;Hepatitis C/virology;Humans;Myocardial Infarction/etiology;Neoplasms/virology;Nurse's Role","Poizot-Martin, I.",2009,Apr,,0,
3515,Risk factors for suicide attempts in elderly and old elderly patients,"The aim of the study was to assess the phenomenon of suicide attempt in the elderly inhabitants of Krakow. Special attention has been paid to the group of ""seniors""--aged 75 years or over. The authors have analyzed all the 136 cases of suicide attempts by individuals aged over 60 years, selected from the cases of suicide attempts by self-intoxications by patients hospitalized in the Department of Clinical Toxicology, CMUJ in Krakow in the years 2000-2002. The group concerned included 45 males and 91 females. A large number of subjects (over a half of the total) ranged in age from 60 to 65 years. The group of seniors comprised 35 individuals (aged 75 years or over), including 7 males and 28 females. On the basis of the data from medical documentation, the subjects were analysed from the point of view of their health condition and in the psycho-social context. In the majority of cases the subjects are pensioners residing in Krakow, often living alone. In the case of 98% of the subjects, it was their first suicide attempt. Pharmaceuticals used for self-poisoning were most frequently psychotropic, or mixed-type drugs. The assessment of the severity of poisoning indicates that in about 20% patients poisoning was severe. 70% of the subjects suffered from depressive, reactive, or situational disorders, affective depression or organic brain disorders, often with dementive signs. A significant number of subjects suffered from hypertension, coronary artery disease, arteriosclerosis, or alimentary tract diseases. In the group of the seniors, the most conspicuous problems included serious somatic diseases (malignant diseases and chronic respiratory system diseases), depression, organic dementia, loneliness, and bad family situation. Taking into consideration the scantiness of research into attempted and completed suicide in the elderly and in the old elderly, the present authors stress the importance of the continuation of the research to prevent suicide in the aforesaid age group.","Age Distribution;Aged;Aged, 80 and over;Female;Humans;Male;Middle Aged;Poland/epidemiology;Retrospective Studies;Risk Factors;Sex Distribution;Suicide, Attempted/*statistics & numerical data","Polewka, A.;Chrostek Maj, J.;Kroch, S.;Szkolnicka, B.;Mikolaszek-Boba, M.;Groszek, B.;Zieba, A.",2004,,,0,
3516,Apolipoprotein E haplotyping by denaturing high-performance liquid chromatography,"The apolipoprotein E (APOE) gene in humans contains two single-base polymorphisms in exon 4, which result in three common alleles, conventionally named ε2, ε3 and ε4. Numerous studies have shown an important association between the ε4 variant and an increased risk of Alzheimer's disease; other data suggest a possible linkage of APOE genetic heterogeneity with lipid profile and an increased risk of atherothrombotic stroke and coronary heart disease. APOE genotyping is therefore an increasingly common assay in laboratory medicine. The most widely used technique for APOE genotyping is based upon restriction isotyping, i.e., amplification of the fragment of exon 4 containing the most common sequence variations, followed by enzymatic digestion of the amplicon and fragments analysis by gel electrophoresis. We developed a novel, reliable and fast method that exploits the sensitivity and specificity of denaturing high-performance liquid chromatography in detecting single-nucleotide polymorphisms. We show that, in most cases, with a single chromatographic separation it is possible to correctly identify the six different APOE allelic patterns, without any manipulation after the polymerase chain reaction amplification. When compared to restriction isotyping, our method is much faster, less labor intensive and similarly inexpensive. © 2005 by Walter de Gruyter.",apolipoprotein E;apolipoprotein E2;apolipoprotein E3;apolipoprotein E4;DNA;accuracy;allele;Alzheimer disease;amplicon;article;cerebrovascular accident;controlled study;cost effectiveness analysis;denaturing high performance liquid chromatography;DNA sequence;enzyme degradation;exon;gel electrophoresis;gene amplification;genetic heterogeneity;genetic manipulation;genetic risk;genotype;haplotype;human;intermethod comparison;ischemic heart disease;lipid metabolism;nucleotide sequence;polymerase chain reaction;priority journal;reliability;restriction mapping;sensitivity and specificity;sequence analysis;single nucleotide polymorphism;site directed mutagenesis,"Poli, M.;Gatta, L. B.;Dominici, R.;Lovati, C.;Mariani, C.;Albertini, A.;Finazzi, D.",2005,,,0,
3517,Changes in drug utilization during a gap in insurance coverage: An examination of the medicare part d coverage gap,"Background: Nations are struggling to expand access to essential medications while curbing rising health and drug spending. While the US government's Medicare Part D drug insurance benefit expanded elderly citizens' access to drugs, it also includes a controversial period called the ""coverage gap"" during which beneficiaries are fully responsible for drug costs. We examined the impact of entering the coverage gap on drug discontinuation, switching to another drug for the same indication, and drug adherence. While increased discontinuation of and adherence to essential medications is a regrettable response, increased switching to less expensive but therapeutically interchangeable medications is a positive response to minimize costs. Methods and Findings: We followed 663,850 Medicare beneficiaries enrolled in Part D or retiree drug plans with prescription and health claims in 2006 and/or 2007 to determine who reached the gap spending threshold, n = 217,131 (33%). In multivariate Cox proportional hazards models, we compared drug discontinuation and switching rates in selected drug classes after reaching the threshold between all 1,993 who had no financial assistance during the coverage gap (exposed) versus 9,965 multivariate propensity score-matched comparators with financial assistance (unexposed). Multivariate logistic regressions compared drug adherence (≤80% versus >80% of days covered). Beneficiaries reached the gap spending threshold on average 222 d ±79. At the drug level, exposed beneficiaries were twice as likely to discontinue (hazard ratio [HR] = 2.00, 95% confidence interval [CI] 1.64-2.43) but less likely to switch a drug (HR = 0.60, 0.46-0.78) after reaching the threshold. Gap-exposed beneficiaries were slightly more likely to have reduced adherence (OR = 1.07, 0.98-1.18). Conclusions: A lack of financial assistance after reaching the gap spending threshold was associated with a doubling in discontinuing essential medications but not switching drugs in 2006 and 2007. Blunt cost-containment features such as the coverage gap have an adverse impact on drug utilization that may conceivably affect health outcomes. Please see later in the article for the Editors' Summary. © 2011 Polinski et al.",cardiovascular agent;generic drug;oral antidiabetic agent;aged;anemia;article;cardiovascular disease;controlled study;coronary artery atherosclerosis;dementia;depression;diabetes mellitus;drug substitution;drug utilization;drug withdrawal;dyspnea;fatigue;female;financial management;hazard ratio;health insurance;human;hypercholesterolemia;hyperlipidemia;hypertension;insurance;major clinical study;malaise;male;malignant neoplastic disease;medicare;musculoskeletal pain;pensioner;prescription;prevalence;propensity score;rheumatoid arthritis;sensitivity analysis;thorax pain,"Polinski, J. M.;Shrank, W. H.;Huskamp, H. A.;Glynn, R. J.;Liberman, J. N.;Schneeweiss, S.",2011,,,0,
3518,Endovascular Therapy for Acute Stroke,"Stroke is the most common cause of permanent disability, the second most common cause of dementia, and the fourth most common cause of death in the Western world. Recently, based on positive multicenter randomized clinical trials, endovascular therapy for acute stroke has undergone a revolution. Routine mechanical thrombectomy in addition to intravenous thrombolysis has been shown to provide excellent outcomes for patients with proximal anterior circulation occlusions. This procedure reduces disability and benefits are seen across a wide range of age and initial stroke severity. Important features that affect treatment decisions include time of presentation, the patient's clinical status, imaging characteristics, and lab tests. Under optimal conditions, it should be available to patients 24/7, similar to systems offering prompt percutaneous coronary interventions to patients with acute ST-segment elevation myocardial infarctions. Copyright © 2017 Elsevier Inc.",cerebral artery disease;cerebrovascular accident;clinical study;clinical trial;controlled clinical trial;controlled study;disability;human;imaging;mechanical thrombectomy;occlusion;percutaneous coronary intervention;randomized controlled trial;ST segment elevation myocardial infarction,"Politi, M;Kastrup, A;Marmagkiolis, K;Grunwald, Iq;Papanagiotou, P",2017,,10.1016/j.pcad.2017.03.004,0,
3519,Pisa syndrome due to donepezil: Pharmacokinetic interactions to blame?,"We report a case of Pisa syndrome (PS) due to the acetylcholinesterase inhibitor donepezil which may have been precipitated by pharmacokinetic interactions with commonly used medications. PS is defined as a reversible lateral bending of the trunk with a tendency to lean to one side. This is a rare but very distressing complication with this commonly used medication which was not initially recognised, leading to increasing disability for the patient and significant carer stress. Cessation of donepezil and modulation of potential interacting medications resulted in complete resolution.",citalopram;donepezil;lamotrigine;lorazepam;losartan;memantine;omeprazole;simvastatin;adverse drug reaction;aged;agitation;Alzheimer disease;article;Barrett esophagus;case report;coronary artery bypass graft;drug dose reduction;drug withdrawal;focal epilepsy;human;hypertension;ischemic heart disease;male;medical history;pacemaker implantation;patient worry;Pisa syndrome;priority journal;prostate hypertrophy;restlessness;stress;very elderly,"Pollock, D.;Cunningham, E.;McGuinness, B.;Passmore, A. P.",2017,,10.1093/ageing/afw253,0,
3520,Does phase angle correlate with hyperhomocysteinemia? A study of patients with classical homocystinuria,"The role of the phase angle in hyperhomocysteinemia has yet to be assessed. Classical homocystinuria is a rare genetic disease characterized by severe hyperhomocysteinemia, as well as increased levels of methionine and reduced levels of cysteine. The objective of this study was to investigate the potential relationship between phase angle and homocysteine, cysteine, and methionine levels in patients with classical homocystinuria. Eight patients were included in the study. Phase angle was measured with a tetrapolar bioimpedance analyzer. Serum homocysteine, cysteine, and methionine levels were measured by HPLC. Only three patients had adequate metabolic control of their disease. Median phase angle was 5.9° (range = 5.4°-8.5°). There was a significant correlation between phase angle and levels of homocysteine (r = -0.807, p = 0.015), methionine (r = -0.711, p = 0.048), and cysteine (r = 0.836, p = 0.010). Was also positively correlated with BMI and arm muscle circumference (p < 0.05). Two patients had phase angles below the 5th percentile, and only one above the 50th percentile. Our findings suggest that cellular integrity is affected in patients with high homocysteine levels, thus indicating that phase angle could be a valuable indicator of prognosis and classical homocystinuria. It also suggests a role for this indicator in other forms of hyperhomocysteinemia and other inborn errors of metabolism. © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.",cysteine;homocysteine;methionine;adolescent;adult;Alzheimer disease;anthropometry;arm circumference;arm muscle;article;body mass;cerebrovascular accident;chronic disease;clinical article;controlled study;dementia;disease association;disease severity;female;fracture;heart failure;high performance liquid chromatography;homocystinuria;human;hyperhomocysteinemia;impedance;inborn error of metabolism;incidence;life expectancy;male;metabolic regulation;morbidity;mortality;phase angle;phenotype;physics;prognosis;survival;tetrapolar bioimpedance analyzer,"Poloni, S.;Schweigert Perry, I. D.;D'Almeida, V.;Schwartz, I. V. D.",2013,,,0,
3521,A novel adjustable automated system for inducing chronic intermittent hypoxia in mice,"BACKGROUND: Sleep apnea is a chronic, widely underdiagnosed condition characterized by disruption of sleep architecture and intermittent hypoxia due to short cessations of breathing. It is a major independent risk factor for myocardial infarction, congestive heart failure and stroke as well as one of the rare modifiable risk factors for Alzheimer's Dementia. Reliable animal disease models are needed to understand the link between sleep apnea and the various clinically linked disorders. NEW METHOD: An automated system for inducing hypoxia was developed, in which the major improvement was the possibility to efficiently adjust the length and intensity of hypoxia in two different periods. The chamber used a small volume of gas allowing for fast exchanges of different oxygen levels. The mice were kept in their cages adapted with the system on the cage lid. As a proof of principle, they were exposed to a three week period of intermittent hypoxia for 8 hours a day, with 90 s intervals of 5, 7% and 21% oxygen to validate the model. Treated (n = 8) and control mice (no hypoxia, n = 7) were handled in the same manner and their hippocampal brain regions compared by histology. RESULTS: The chamber provided a fast, reliable and precise intermittent hypoxia, without inducing noticeable side effects to the animals. The validation experiment showed that apoptotic neurons in the hippocampus were more numerous in the mice exposed to intermittent hypoxia than in the control group, in all tested hippocampal regions (cornu ammonis 1 (CA1) P <0.001; cornu ammonis 3 (CA3) P <0.001; and dentate gyrus (DG) P = 0.023). In both, control and hypoxic conditions, there was a significantly higher number of apoptotic neurons in the DG compared to the CA1 and CA3 subfields (P <0.001). CONCLUSION: The new design of a hypoxic chamber provides a fast, adjustable and reliable model of obstructive sleep apnea, which was validated by apoptosis of hippocampal neurons.","Animals;Apoptosis/physiology;Brain/cytology/metabolism;CA1 Region, Hippocampal/cytology/metabolism;Dentate Gyrus/cytology/metabolism;Disease Models, Animal;Hippocampus/ cytology/ metabolism;Hypoxia/ metabolism;Male;Mice;Mice, Inbred C57BL;Neurons/cytology/metabolism;Sleep Apnea, Obstructive/metabolism/pathology","Polsek, D.;Bago, M.;Zivaljic, M.;Rosenzweig, I.;Lacza, Z.;Gajovic, S.",2017,,,0,
3522,Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power,"Introduction Several models for predicting mortality have been developed for patients with burns, and the most commonly used are based on age and total body surface area (TBSA%). They often show good predictive precision as depicted by high values for area under the receiver operating characteristic curves (AUC). However the effect of coexisting morbidity on such prediction models has not to our knowledge been thoroughly examined. We hypothesised that adding it to a previously published model (based on age, TBSA%, full thickness burns, gender, and need for mechanical ventilation) would further improve its predictive power. Methods We studied 772 patients admitted during the period 1997-2008 to the Linköping University Hospital, National Burn Centre with any type of burns. We defined coexisting morbidity as any of the medical conditions listed in the Charlson list, as well as psychiatric disorders or drug or alcohol misuse. We added coexisting medical conditions to the model for predicting mortality (age, TBSA%, and need for mechanical ventilation) to determine whether it improved the model as assessed by changes in deviances between the models. Results Mean (SD) age and TBSA% was 35 (26) years and 13 (17) %, respectively. Among 725 patients who survived, 105 (14%) had one or more coexisting condition, compared with 28 (60%) among those 47 who died. The presence of coexisting conditions increased with age (p < 0.001) among patients with burns. The AUC of the mortality prediction model in this study, based on the variables age, TBSA%, and need for mechanical ventilation was 0.980 (n = 772); after inclusion of coexisting morbidity in the model, the AUC improved only marginally, to 0.986. The model was not significantly better either. Conclusion Adding coexisting morbidity to a model for prediction of mortality after a burn based on age, TBSA%, and the need for mechanical ventilation did not significantly improve its predictive value. This is probably because coexisting morbidity is automatically adjusted for by age in the original model.",acquired immune deficiency syndrome;adolescent;adult;age distribution;aged;alcohol abuse;article;artificial ventilation;body surface;burn;cerebrovascular disease;child;chronic lung disease;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;drug abuse;female;heart infarction;hemiplegia;human;Human immunodeficiency virus infection;kidney disease;liver disease;major clinical study;male;mental disease;morbidity;mortality;paraplegia;peripheral vascular disease;predictive value;receiver operating characteristic;total body surface area;ulcer;very elderly,"Pompermaier, L.;Steinvall, I.;Fredrikson, M.;Sjöberg, F.",2015,,,0,
3523,"Inclusion body myositis, Paget's disease of the bone and frontotemporal dementia: Early involvement of the heart and respiratory muscles","Since valosin-containing protein mutations were reported as a cause of hereditary inclusion body myositis associated with Paget's disease of the bone and frontotemporal dementia, many new mutations have been described in the last decade. We report on a 46-year-old German male with a progressive tetraparesis and autosomal dominant inheritance pattern. Echocardiography revealed a beginning dilated cardiomyopathy and laboratory analyses showed increased alkaline phosphatase. Decreased verbal memory and an impairment of concept building were observed on neuropsychological examination. Muscle biopsy demonstrated a myopathic pattern, rimmed vacuoles, CD8 + T-cell infiltrates and positive MHC1-muscle fibres. We found a heterozygote mutation in exon 5 of the valosin-containing protein gene (c.464G > T p.Arg155Leu), which until now has been described only in an Australian family. We describe here the first German case with the above-mentioned mutation causing inclusion-body myositis associated with Paget's disease of the bone and fronto-temporal dementia. Here, we recommend regular controls of cardiac and respiratory functions. © Georg Thieme Verlag KG · Stuttgart · New York.",alkaline phosphatase;valosin containing protein;adult;alkaline phosphatase blood level;article;Australia;autosomal dominant disorder;breathing muscle;cardiomyopathy;case report;CD8+ T lymphocyte;echocardiography;frontotemporal dementia;Germany;heart muscle;heterozygote;human;male;muscle biopsy;mutation;myositis;neuropsychology;Paget bone disease;quadriplegia;respiratory function;verbal memory,"Ponfick, M.;Ludolph, A. C.;Dekomien, G.;Uttner, I.;Kassubek, J.;Gdynia, H. J.",2012,,,0,
3524,Non-pharmacological strategies of behavioural symptoms associated with dementia management,"Behavioural and psychological symptoms of dementia (BPSD) are common among demented patients and constitute a serious problem not only because of additional care-related issues and increased caregivers' burden, but also due to considerable consequences for the patients, including faster progression of cognitive disorder, increased care need and earlier institutionalization, risk of falls and injuries as well as increased mortality. Commonly used drugs (antipsychotics, antidepressants, antiepileptic) have limited efficacy and tolerability. Moreover, antipsychotics use in dementia has been linked to increased risk of cerebrovascular events (like stroke and myocardial infarct) and premature mortality. Non-pharmacological interventions have been proposed as an alternative to drug use. Their efficacy, although also limited, is not inferior to drugs while the risk of side effects is minimal as compared to any drug. Four different theoretical models (genetic-biological, behavioural, stress hypersensitivity and frustrated needs) are used for the development of different management approaches. The resulting, clinically confirmed methods include sensory interventions, structured activities and social activities potentialization. The commonly used behavioural methods, although popular, are surprisingly insufficiently examined in clinical trials. Wider use of non-pharmacological methods for dementia (including BPSD) is compromised by mental barriers of health professionals (including beliefs and habits), low level of knowledge among professionals and caregivers as well as barriers related to health care system and costs of care.",neuroleptic agent;alternative medicine;article;behavior disorder;caregiver burden;cerebrovascular disease;dementia;drug efficacy;drug tolerability;falling;health care cost;health practitioner;human;injury;institutionalization;mental disease;premature mortality;professional knowledge;risk factor;social behavior,"Ponichtera-Kasprzykowska, M.;Pȩkala, K.;Sobów, T.",2013,,,0,
3525,Racial/ethnic disparities in medication use among veterans with hypertension and dementia: A national cohort study,"BACKGROUND: Hypertension and comorbid dementia are common illnesses affecting older adults disproportionally. Medication adherence is vital in achieving therapeutic outcomes. Use of antihypertensive and dementia medications may vary by race/ethnicity and has not been well explored. OBJECTIVE: To evaluate the utilization of antihypertensive and dementia drugs and adherence in a national cohort of veterans aged 65 years or older with a diagnosis of both hypertension and dementia across different racial/ethnic groups. METHODS: This was a retrospective cohort study that used 2 national databases of the Veterans Health Administration to estimate medication utilization and adherence rates among whites, African Americans, and Hispanics from 2000 to 2005. A medication possession ratio of 0.8 or greater defined adherence. The association between race/ethnicity and adherence was analyzed using multivariate logistic regression analyse. RESULTS: A total of 56,561 patients (70.5% white, 15.6% African American, 6.6% Hispanic) aged 65 years or older had diagnoses of dementia and hypertension. African Americans were less likely than whites to receive angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β-blockers, acetylcholinesterase inhibitors, and memantine (p < 0.05). Hispanics were more likely than whites to be prescribed an ACE inhibitor and less likely to be prescribed an ARB, β-blocker, nondihydropyridine calcium-channel blocker (CCB), loop diuretic, α-agonist, or potassium-sparing diuretic (PSD) (p < 0.05). Medication adherence was significantly lower in African Americans than whites in all classes except for ARBs, loop diuretics, and PSDs (p < 0.05), Being Hispanic was associated with significantly lower adherence rates than whites for dihydropyridine CCBs and acetylcholinesterase inhibitors (p < 0.05). CONCLUSIONS: Racial/ethnic differences exist in antihypertensive and dementia medication use in a cohort of older adults with hypertension and dementia. Adherence rates for a number of antihypertensive and dementia drugs are lower for minorities compared with whites. Healthcare providers should make special efforts to improve medication adherence among minorities.",alpha adrenergic receptor stimulating agent;amlodipine;angiotensin receptor antagonist;antihypertensive agent;beta adrenergic receptor blocking agent;cholinesterase inhibitor;diltiazem;dipeptidyl carboxypeptidase inhibitor;felodipine;loop diuretic agent;memantine;nicardipine;nifedipine;nisoldipine;nootropic agent;potassium sparing diuretic agent;thiazide diuretic agent;verapamil;African American;aged;article;cerebrovascular disease;chronic kidney disease;cohort analysis;controlled study;dementia;diabetes mellitus;drug use;ethnic difference;ethnicity;female;health care management;health care utilization;heart failure;Hispanic;human;hypertension;ischemic heart disease;major clinical study;male;patient compliance;priority journal;race difference;retrospective study;veteran,"Poon, I.;Lal, L. S.;Ford, M. E.;Braun, U. K.",2009,,,0,
3526,Differences in mortality and use of revascularization in black and white patients with acute MI admitted to hospitals with and without revascularization services,"Context: Racial differences in the use of coronary revascularization after acute myocardial infarction (AMI) have been widely reported. However, few studies have examined patterns of care for AMI patients admitted to hospitals with and without revascularization services. Objective: To compare rates of hospital transfer, coronary revascularization, and mortality after AMI for black and white patients admitted to hospitals with and without revascularization services. Design, Setting, and Participants: Retrospective cohort study of 1 215 924 black and white Medicare beneficiaries aged 68 years and older, admitted with AMI between January 1, 2000, and June 30, 2005, to 4627 US hospitals with and without revascularization services. Main Outcome Measures: For patients admitted to nonrevascularization hospitals, transfer to another hospital with revascularization services; for all patients, risk-adjusted rates of 30-day coronary revascularization and 1-year mortality. Results: Black patients admitted to hospitals without revascularization were less likely (25.2% vs 31.0%; P<.001) to be transferred. Black patients admitted to hospitals with or without revascularization services were less likely to undergo revascularization than white patients (34.3% vs 50.2% and 18.3% vs 25.9%; P<.001) and had higher 1-year mortality (35.3% vs 30.2% and 39.7% vs 37.6%; P<.001). After adjustment for sociodemographics, comorbidity, and illness severity, blacks remained less likely to be transferred (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.75-0.81; P<.001) and undergo revascularization (HR, 0.71; 95% CI, 0.69-0.74; P<.001; and HR, 0.68; 95% CI, 0.65-0.70; P<.001 in hospitals with and without revascularization, respectively). Risk-adjusted mortality was lower for blacks during the first 30 days after admission (HR, 0.91; 95% CI, 0.88-0.93; P<.001; and HR, 0.90; 95% CI, 0.87-0.92; P<.001 in hospitals with and without revascularization, respectively) but was higher (P<.001) thereafter. Conclusions: Black patients admitted to hospitals with and without coronary revascularization services are less likely to receive coronary revascularization. The higher long-term mortality of black patients may reflect the lower use of revascularization or other aspects of AMI care. ©2007 American Medical Association. All rights reserved.",acute heart infarction;age distribution;aged;article;Caucasian;chronic obstructive lung disease;comorbidity;confidence interval;congestive heart failure;controlled study;dementia;demography;diabetes mellitus;disease severity;electrolyte disturbance;female;health service;heart arrhythmia;heart muscle revascularization;hospital admission;human;kidney failure;major clinical study;male;medicare;metastasis;mortality;Black person;neurologic disease;outcome assessment;paralysis;peripheral vascular disease;priority journal;race difference;valvular heart disease;weight reduction,"Popescu, I.;Vaughan-Sarrazin, M. S.;Rosenthal, G. E.",2007,,,0,
3527,"Distribution of SLC10A4, a synaptic vesicle protein in the human brain, and the association of this protein with alzheimer's disease-related neuronal degeneration","Member 4 of the sodium/bile acid co-transporter family of proteins (SLC10A4) was discovered as a synaptic vesicle protein. The distribution of Slc10a4 protein in the brain has only so far been assessed in adult rats. Here, we assessed the regional distribution of SLC10A4 in aged human brain by immunohistochemistry. The protein was ubiquitously expressed, particularly in the cholinergic and monoaminergic neurons and in the lateral geniculate body. The protein expression was not influenced by the postmortem delay or fixation time. Synaptic alterations are reported to be seen in Alzheimer's disease (AD) and the suggested function of SLC10A4 as a vesicular transporter for cholinergic neurotransmitters proposes a link between this protein and AD. With increased severity of AD-related pathology, depletion of SLC10A4 expression was noted in the transentorhinal cortex. Intriguingly, in the most severely affected cases (Braak V), two patterns were noted, i.e., those with severe depletion of SLC10A4 and those with numerous neurons displaying SLC10A4. In conclusion, assessment of the expression of SLC10A4 by means of immunohistochemistry is feasible. The observed depletion of SLC10A4 with increase in the severity of AD-related neuronal degeneration is interesting and the observation that some subjects in Braak V displayed none and some displayed numerous SLC10A4 immunoreactive neurons is intriguing. Assessment of the SLC10A4 protein in neurodegenerative diseases or diseases affecting lateral geniculate body should be carried out to investigate whether alterations in the expression of SLC10A4 in synaptic vesicles might be used as a marker of transmitter deficits (cholinergic, monoaminorgic) or other synaptic pathology. © 2013-IOS Press and the authors. All rights reserved.",dopamine;serotonin;sodium bile acid cotransporter;sodium bile acid cotransporter family 10 member 4 protein;unclassified drug;vesicular transport protein;aged;Alzheimer disease;amygdaloid nucleus;article;autopsy;brain tissue;caudate nucleus;cause of death;cholinergic nerve cell;clinical article;dentate hilus;disease severity;entorhinal cortex;female;fusiform gyrus;granular cell;gray matter;heart arrest;hippocampal CA1 region;hippocampal CA2 region;hippocampal CA3 region;human;human tissue;hypothalamic paraventricular nucleus;immunohistochemistry;immunoreactivity;lateral geniculate body;mammillary body;Meynert basal nucleus;monoamine nerve cell;nerve cell;nerve cell degeneration;neuropathology;neuropil;oculomotor nucleus;olivary nucleus;parahippocampal gyrus;priority journal;protein expression;raphe nucleus;staining;subiculum;synapse vesicle;thalamus nucleus;tissue microarray;transentorhinal cortex;very elderly;white matter,"Popova, S. N.;Alafuzoff, I.",2013,,,0,
3528,Predicting death in the nursing home: development and validation of the 6-month Minimum Data Set mortality risk index,"BACKGROUND: Currently, 24% of all deaths nationally occur in nursing homes making this an important focus of care. However, many residents are not identified as dying and thus do not receive appropriate care in the last weeks and months of life. The aim of our study was to develop and validate a predictive model of 6-month mortality risk using functional, emotional, cognitive, and disease variables found in the Minimum Data Set. METHODS: This retrospective cohort study developed and validated a clinical prediction model using stepwise logistic regression analysis. Our study sample included all Missouri long-term-care residents (43,510) who had a full Minimum Data Set assessment transmitted to the Federal database in calendar year 1999. Death was confirmed by death certificate data. RESULTS: The validated predictive model with a c-statistic of.75 included the following predictors: a) demographics (age and male sex); b) diseases (cancer, congestive heart failure, renal failure, and dementia/Alzheimer's disease); c) clinical signs and symptoms (shortness of breath, deteriorating condition, weight loss, poor appetite, dehydration, increasing number of activities of daily living requiring assistance, and poor score on the cognitive performance scale); and d) adverse events (recent admission to the nursing home). A simple point system derived from the regression equation can be totaled to aid in predicting mortality. CONCLUSIONS: A reasonably accurate, validated model has been produced, with clinical application through a scored point system, to assist clinicians, residents, and family members in defining good goals of care around end-of-life care.","Activities of Daily Living;Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/epidemiology;Cognition Disorders/epidemiology;Cohort Studies;Death Certificates;Dyspnea/epidemiology;Feeding and Eating Disorders/epidemiology;Female;Forecasting;Heart Failure/epidemiology;Humans;Male;Missouri/epidemiology;*Mortality;Neoplasms/epidemiology;*Nursing Homes;Renal Insufficiency/epidemiology;Retrospective Studies;Risk Assessment;Sex Factors;Terminal Care","Porock, D.;Oliver, D. P.;Zweig, S.;Rantz, M.;Mehr, D.;Madsen, R.;Petroski, G.",2005,Apr,,0,
3529,Valproate therapy for agitation in dementia: Open-label extension of a double-blind trial,"Objective: The authors describe an open-label extension of a double-blind, randomized, placebo-controlled study of divalproex sodium in 56 nursing home patients with agitation and dementia. Methods: Participants (N = 46) were treated for 6 weeks in an open fashion with clinically optimal doses of divalproex sodium (range: 250 mg/day-1,500 mg/day; mean: 851 mg/day). Behavior was assessed with the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression of Change (CGI) by new raters. Safety, tolerability, and laboratory data were obtained regularly. Results: The mean BPRS Agitation Factor decreased by 3.1 points from baseline; 86% of those completing the open phase were rated as improved on the CGI. These changes were mirrored by changes in other behavior rating scales. Sixty percent of subjects had no side effects; 33% had side effects that were rated as mild. There were no clinically significant changes in laboratory values. Conclusion: Ongoing open-label treatment with divalproex was associated with improvement in measures of agitation. Doses, levels, and tolerability were similar to those in the blinded phase of the study. These findings help confirm and extend the results from the placebo-controlled phase of the trial and suggest that divalproex may be beneficial for some patients with this clinical problem.",placebo;valproate semisodium;agitation;arthropathy;article;ataxia;behavior;cardiovascular disease;cerebrovascular accident;chronic kidney failure;chronic obstructive lung disease;clinical article;clinical trial;controlled clinical trial;controlled study;dementia;diarrhea;dose response;drug effect;drug fatality;drug safety;drug tolerability;edema;female;fever;gastrointestinal disease;heart infarction;human;infection;male;multicenter study;muscle weakness;nausea;pneumonia;randomized controlled trial;rating scale;respiratory tract infection;sedation;seizure;side effect;skin disease;treatment outcome;urinary tract infection;vomiting,"Porsteinsson, A. P.;Tariot, P. N.;Jakimovich, L. J.;Kowalski, N.;Holt, C.;Erb, R.;Cox, C.",2003,,,0,
3530,Association between physical performance and sense of autonomy in outdoor activities and life-space mobility in community-dwelling older people,"Objectives To study the relationship between physical performance and sense of autonomy in outdoor activities with life-space mobility - the spatial area a person purposefully moves through in daily life - in community-dwelling older people. Design Cross-sectional analyses of baseline data of the Life-Space Mobility in Old Age cohort study. Setting Structured interviews in participants' homes. Participants Community-dwelling people aged 75 to 90 (N = 848). Measurements Sense of autonomy outdoors (Impact on Participation and Autonomy questionnaire subscale), life-space mobility (Life-Space Assessment; University of Alabama, Birmingham Study of Aging), and Short Physical Performance Battery. Results The median score for life-space mobility was 64.0. In linear regression models, poorer physical performance and more-limited sense of autonomy were independently associated with more restrictions in life-space mobility, explaining approximately one-third of the variation in life-space mobility. Physical performance also had an indirect effect on life-space mobility through sense of autonomy outdoors. Subgroup analyses of 5-year age groups and sex revealed that the associations were somewhat stronger in women and the oldest age group. Conclusion Physical performance and sense of autonomy in outdoor activities explained a substantial portion of the variation in life-space mobility in healthy older people, indicating that physical and psychosocial factors play a role in maintaining mobility in old age. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.",aged;Alzheimer disease;article;chronic disease;chronic obstructive lung disease;cohort analysis;community living;cross-sectional study;elderly care;female;groups by age;heart infarction;human;human activities;ischemic heart disease;leisure;life space mobility;major clinical study;male;neighborhood;outdoor activity;personal autonomy;physical capacity;physical mobility;physical performance;questionnaire;senescence;social psychology;structured interview;travel;walking;walking difficulty;walking speed,"Portegijs, E.;Rantakokko, M.;Mikkola, T. M.;Viljanen, A.;Rantanen, T.",2014,,,0,
3531,Association between vitamin D deficiency and heart failure risk in the elderly,"AIMS: The aim of this study was to evaluate the association between vitamin D deficiency and risk of heart failure in elderly patients of cardiology outpatient clinics. METHODS AND RESULTS: A cross-sectional study with an analytical approach was employed. Clinical data were collected from the elderly from August 2015 to February 2016. The dependent variable was the risk of heart failure; the independent variable was vitamin D deficiency; and intervening factors were age, gender, education, ethnicity, hypertension, diabetes mellitus, hypothyroidism, renal failure, dementia, stroke, dyslipidaemia, depression, smoking, alcoholism, obesity, andropause, and cardiac arrhythmia. To analyse the association between vitamin D deficiency and risk of heart failure, we used the bivariate logistic analysis, followed by analysis through the multivariate logistic regression model. Of the 137 elderly, the study found the following: women (75.9%); overweight (48.2%); obese (30.6%); increase in the index waist/hip (88.3%); dyslipidaemia (94.2%) and hypertension (91.2%); coronary artery disease (35.0%); and 27.7% with cardiac arrhythmia or left ventricular hypertrophy. Sixty-five per cent of the elderly were deficient in vitamin D. The risk of heart failure was significantly associated with vitamin D deficiency [odds ratio (OR): 12.19; 95% confidence interval (CI) = 4.23-35.16; P = 0.000], male gender (OR: 15.32; 95% CI = 3.39-69.20, P = 0.000), obesity (OR: 4.17; 95% CI = 1.36-12.81; P = 0.012), and cardiac arrhythmia (OR: 3.69; 95% CI = 1.23-11.11; P = 0.020). CONCLUSIONS: There was a high prevalence of vitamin D deficiency in the elderly, and the evidence shows a strong association between vitamin D deficiency and increased risk of heart failure in this population.",Elderly;Heart failure;Risk;Vitamin D,"Porto, C. M.;Silva, V. L.;da Luz, J. S. B.;Filho, B. M.;da Silveira, V. M.",2017,Aug 17,,0,
3532,"Location, location, location: Characteristics and services of long-stay home care recipients in retirement homes compared to others in private homes and long-term care homes","We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients.",age;aged;aggression;anxiety disorder;article;cerebrovascular accident;chronic patient;cognitive defect;dementia;depression;female;frailty;health care delivery;heart failure;home care;home environment;human;long term care;major clinical study;male;nursing;occupational therapy;physical disease;physiotherapy;residential care;retirement;urine incontinence;wandering behavior,"Poss, J. W.;Sinn, C. L. J.;Grinchenko, G.;Blums, J.;Peirce, T.;Hirdes, J.",2017,,,0,
3533,Aneurysmal coronary artery disease in cerebrotendinous xanthomatosis,"Cerebrotendinous xanthomatosis (CTX), first described by van Bogaert et al in 1937, is a rare (<100 cases reported), autosomal recessive disease characteristized by accumulation of cholesterol and cholestanol in tissues. Its clinical features can include tendon xanthomas, cataracts, neurologic dysfunction (dementia, ataxia, paresis and peripheral neuropathy) and accelerated arterial atherosclerosis. CTX results from a deficiency of a hepatic microsomal enzyme necessary for primary bile acid synthesis from cholesterol. Because bile acid synthesis is impaired, chenodeoxycholic acid in bile is reduced or absent, biliary cholesterol secretion is reduced, and, for reasons uncertain, the hepatic conversion of cholesterol to cholestanol is markedly increased and blood, biliary and tissue cholestanol levels are markedly elevated. Cholestanol appears to be highly atherogenic and has been demonstrated in most tissues, including the coronary arteries. Although accelerated coronary atherosclerosis is believed to be characteristic of this lipid disorder, coronary angiographic findings have not been reported in CTX. Herein, we describe such findings.",adult;angiography;case report;cerebrotendinous xanthomatosis;human;ischemic heart disease;priority journal,"Potkin, B. N.;Hoeg, J. M.;Connor, W. E.;Salen, G.;Quyyumi, A. A.;Brush Jr, J. E.;Roberts, W. C.;Brewer Jr, H. B.",1988,,,0,
3534,End of life treatment decisions in people with dementia: Carers' views and the factors which influence them,"Objective. Treatment decisions in life threatening situations (TD) are poorly studied in people with dementia. Method. The carers of people with dementia were asked four TD questions, pertaining to cardiac resuscitation, intravenous fluids, oral antibiotics and intravenous antibiotics. The impact of key variables (age, dementia severity, psychiatric co-morbidity, physical illness, family relationship of carer) on TD were evaluated. Results. Fifty carers participated, 46% wanted cardiac resuscitation, 60% wanted treatment with intravenous fluids, 52% wanted treatment with intravenous antibiotics and 60% wanted treatment with oral antibiotics. Agreement between questions was high (76-89%), suggesting that relatives were either for or against intervention. There was an association between more severe dementia and a reduced wish for intravenous antibiotics. None of the variables significantly influenced other TD. Conclusion. The 'global' view of carers, was not influenced greatly by key disease variables. There are potential implications for the way in which carers are used as proxy decision makers. Copyright (C) 2000 John Wiley and Sons, Ltd.",antibiotic agent;aged;article;caregiver;clinical article;dementia;disease severity;evaluation study;female;heart arrest;human;long term care;male;medical decision making;physical disease;questionnaire;resuscitation,"Potkins, D.;Bradley, S.;Shrimanker, J.;O'Brien, J.;Swann, A.;Ballard, C.",2000,,,0,
3535,Accuracy of administrative data to assess comorbidity in patients with heart disease. an Australian perspective,"The objective of this study was to determine the accuracy of administrative data (by use of hospital discharge codes) for measuring comorbidity in patients with heart disease. One thousand seven hundred and sixty-five medical records of subjects admitted to hospital for AMI, unstable angina, angina pectoris, chronic IHD or heart failure were reviewed. The number and types of comorbidities were determined from the medical records (regarded as the ""gold standard""). These were compared with the 10 discharge codes obtained from the hospital administrative records (referred to as the ""administrative data""). The rate of false-negative and false-positive comorbidity diagnoses were determined. Twenty of the 21 comorbidities studied were underreported in the administrative data. For these 20 comorbidities, the median false-negative rate was 49.5% and ranged from 11% for diabetes to 100% for dementia. False-positive rates were low, less than 1.5%, except for chronic arrythmia (4.8%) and hypertension (4.2%). Mean percent agreement was high, ranging from 88% for hypertension to 100% for AIDS/HIV. Administrative data based on hospital discharge codes consistently underestimate the presence of comorbid conditions in our population. This has implications for administrators when estimating mortality, length of stay and disability. Researchers also need to be aware when using administrative data based on hospital discharge codes to assess subject's comorbidities that they may be widely underreported.",Aged;Australia/epidemiology;*Comorbidity;Epidemiologic Methods;Female;Heart Diseases/*complications;*Hospital Records;Humans;Male;Prevalence;Quality of Life;Reproducibility of Results,"Powell, H.;Lim, L. L.;Heller, R. F.",2001,Jul,,0,
3536,Genome-wide Association for Major Depression Through Age at Onset Stratification: Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium,"BACKGROUND: Major depressive disorder (MDD) is a disabling mood disorder, and despite a known heritable component, a large meta-analysis of genome-wide association studies revealed no replicable genetic risk variants. Given prior evidence of heterogeneity by age at onset in MDD, we tested whether genome-wide significant risk variants for MDD could be identified in cases subdivided by age at onset. METHODS: Discovery case-control genome-wide association studies were performed where cases were stratified using increasing/decreasing age-at-onset cutoffs; significant single nucleotide polymorphisms were tested in nine independent replication samples, giving a total sample of 22,158 cases and 133,749 control subjects for subsetting. Polygenic score analysis was used to examine whether differences in shared genetic risk exists between earlier and adult-onset MDD with commonly comorbid disorders of schizophrenia, bipolar disorder, Alzheimer's disease, and coronary artery disease. RESULTS: We identified one replicated genome-wide significant locus associated with adult-onset (>27 years) MDD (rs7647854, odds ratio: 1.16, 95% confidence interval: 1.11-1.21, p = 5.2 x 10-11). Using polygenic score analyses, we show that earlier-onset MDD is genetically more similar to schizophrenia and bipolar disorder than adult-onset MDD. CONCLUSIONS: We demonstrate that using additional phenotype data previously collected by genetic studies to tackle phenotypic heterogeneity in MDD can successfully lead to the discovery of genetic risk factor despite reduced sample size. Furthermore, our results suggest that the genetic susceptibility to MDD differs between adult- and earlier-onset MDD, with earlier-onset cases having a greater genetic overlap with schizophrenia and bipolar disorder.",Age at onset;Gwas;Heterogeneity;Major depressive disorder;Polygenic scoring;Stratification,"Power, R. A.;Tansey, K. E.;Buttenschon, H. N.;Cohen-Woods, S.;Bigdeli, T.;Hall, L. S.;Kutalik, Z.;Lee, S. H.;Ripke, S.;Steinberg, S.;Teumer, A.;Viktorin, A.;Wray, N. R.;Arolt, V.;Baune, B. T.;Boomsma, D. I.;Borglum, A. D.;Byrne, E. M.;Castelao, E.;Craddock, N.;Craig, I. W.;Dannlowski, U.;Deary, I. J.;Degenhardt, F.;Forstner, A. J.;Gordon, S. D.;Grabe, H. J.;Grove, J.;Hamilton, S. P.;Hayward, C.;Heath, A. C.;Hocking, L. J.;Homuth, G.;Hottenga, J. J.;Kloiber, S.;Krogh, J.;Landen, M.;Lang, M.;Levinson, D. F.;Lichtenstein, P.;Lucae, S.;MacIntyre, D. J.;Madden, P.;Magnusson, P. K.;Martin, N. G.;McIntosh, A. M.;Middeldorp, C. M.;Milaneschi, Y.;Montgomery, G. W.;Mors, O.;Muller-Myhsok, B.;Nyholt, D. R.;Oskarsson, H.;Owen, M. J.;Padmanabhan, S.;Penninx, B. W.;Pergadia, M. L.;Porteous, D. J.;Potash, J. B.;Preisig, M.;Rivera, M.;Shi, J.;Shyn, S. I.;Sigurdsson, E.;Smit, J. H.;Smith, B. H.;Stefansson, H.;Stefansson, K.;Strohmaier, J.;Sullivan, P. F.;Thomson, P.;Thorgeirsson, T. E.;Van der Auwera, S.;Weissman, M. M.;Breen, G.;Lewis, C. M.",2016,May 24,10.1016/j.biopsych.2016.05.010,0,
3537,Genome-wide Association for Major Depression Through Age at Onset Stratification: Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium,"Background Major depressive disorder (MDD) is a disabling mood disorder, and despite a known heritable component, a large meta-analysis of genome-wide association studies revealed no replicable genetic risk variants. Given prior evidence of heterogeneity by age at onset in MDD, we tested whether genome-wide significant risk variants for MDD could be identified in cases subdivided by age at onset. Methods Discovery case-control genome-wide association studies were performed where cases were stratified using increasing/decreasing age-at-onset cutoffs; significant single nucleotide polymorphisms were tested in nine independent replication samples, giving a total sample of 22,158 cases and 133,749 control subjects for subsetting. Polygenic score analysis was used to examine whether differences in shared genetic risk exists between earlier and adult-onset MDD with commonly comorbid disorders of schizophrenia, bipolar disorder, Alzheimer's disease, and coronary artery disease. Results We identified one replicated genome-wide significant locus associated with adult-onset (>27 years) MDD (rs7647854, odds ratio: 1.16, 95% confidence interval: 1.11–1.21, p = 5.2 × 10-11). Using polygenic score analyses, we show that earlier-onset MDD is genetically more similar to schizophrenia and bipolar disorder than adult-onset MDD. Conclusions We demonstrate that using additional phenotype data previously collected by genetic studies to tackle phenotypic heterogeneity in MDD can successfully lead to the discovery of genetic risk factor despite reduced sample size. Furthermore, our results suggest that the genetic susceptibility to MDD differs between adult- and earlier-onset MDD, with earlier-onset cases having a greater genetic overlap with schizophrenia and bipolar disorder.",adult;Alzheimer disease;article;bipolar disorder;comorbidity;controlled study;coronary artery disease;female;genetic association;genetic risk;genome-wide association study;genomics;human;major clinical study;major depression;male;onset age;population based case control study;priority journal;schizophrenia;single nucleotide polymorphism,"Power, R. A.;Tansey, K. E.;Buttenschøn, H. N.;Cohen-Woods, S.;Bigdeli, T.;Hall, L. S.;Kutalik, Z.;Lee, S. H.;Ripke, S.;Steinberg, S.;Teumer, A.;Viktorin, A.;Wray, N. R.;Arolt, V.;Baune, B. T.;Boomsma, D. I.;Børglum, A. D.;Byrne, E. M.;Castelao, E.;Craddock, N.;Craig, I. W.;Dannlowski, U.;Deary, I. J.;Degenhardt, F.;Forstner, A. J.;Gordon, S. D.;Grabe, H. J.;Grove, J.;Hamilton, S. P.;Hayward, C.;Heath, A. C.;Hocking, L. J.;Homuth, G.;Hottenga, J. J.;Kloiber, S.;Krogh, J.;Landén, M.;Lang, M.;Levinson, D. F.;Lichtenstein, P.;Lucae, S.;MacIntyre, D. J.;Madden, P.;Magnusson, P. K. E.;Martin, N. G.;McIntosh, A. M.;Middeldorp, C. M.;Milaneschi, Y.;Montgomery, G. W.;Mors, O.;Müller-Myhsok, B.;Nyholt, D. R.;Oskarsson, H.;Owen, M. J.;Padmanabhan, S.;Penninx, B. W. J. H.;Pergadia, M. L.;Porteous, D. J.;Potash, J. B.;Preisig, M.;Rivera, M.;Shi, J.;Shyn, S. I.;Sigurdsson, E.;Smit, J. H.;Smith, B. H.;Stefansson, H.;Stefansson, K.;Strohmaier, J.;Sullivan, P. F.;Thomson, P.;Thorgeirsson, T. E.;Van der Auwera, S.;Weissman, M. M.;Breen, G.;Lewis, C. M.",2017,,10.1016/j.biopsych.2016.05.010,0,
3538,Coding issues in critical care patients with an emphasis on encephalopathy,,antidepressant agent;acute kidney failure;acute kidney tubule necrosis;article;brain disease;brain toxicity;chronic kidney disease;coma;Current Procedural Terminology;cyanocobalamin deficiency;dementia;diabetes mellitus;diabetic ketoacidosis;drug induced encephalopathy;glucose metabolism;heart arrest;hepatic coma;hepatic encephalopathy;hyperglycemia;hypernatremia;hyperosmolarity;hypertension encephalopathy;hyperthyroidism;hypoglycemia;hyponatremia;hypothyroidism;hypoxic ischemic encephalopathy;ICD-10-CM;ICD-9-CM;intensive care;metabolic encephalopathy;neurologic disease;neurologic examination;nicotinic acid deficiency;patient assessment;patient care;posterior reversible encephalopathy syndrome;sepsis;thyrotoxicosis;uremia;Wernicke encephalopathy,"Powers, L. B.",2012,,,0,
3539,The contribution of leading diseases and risk factors to excess losses of healthy life in eastern Europe: Burden of disease study,"Background: The East/West gradient in health across Europe has been described often, but not using metrics as comprehensive and comparable as those of the Global Burden of Disease 2000 and Comparative Risk Assessment studies. Methods: Comparisons are made across 3 epidemiological subregions of the WHO region for Europe - A (very low child and adult mortality), B (low child and low adult mortality) and C (low child and high adult mortality) - with populations in 2000 of 412, 218 and 243 millions respectively, and using the following measures: 1. Probabilities of death by sex and causal group across 7 age intervals; 2. Loss of healthy life (DALYs) to diseases and injuries per thousand population; 3. Loss of healthy life (DALYs) attributable to selected risk factors across 3 age ranges. Results: Absolute differences in mortality are most marked in males and in younger adults, and for deaths from vascular diseases and from injuries. Dominant contributions to east-west differences come from the nutritional/physiological group of risk factors (blood pressure, cholesterol concentration, body mass index, low fruit and vegetable consumption and inactivity) contributing to vascular disease and from the legal drugs - tobacco and alcohol. Conclusion: The main requirements for reducing excess health losses in the east of Europe are: 1) favorable shifts in all amenable vascular risk factors (irrespective of their current levels) by population-wide and personal measures; 2) intensified tobacco control; 3) reduced alcohol consumption and injury control strategies (for example, for road traffic injuries). Cost effective strategies are broadly known but local institutional support for them needs strengthening. © 2005 Powles et al; licensee BioMed Central Ltd.",alcohol;cholesterol;adult;alcohol consumption;Alzheimer disease;article;automutilation;blood pressure;body burden;body mass;cardiovascular risk;cerebrovascular disease;child;chronic obstructive lung disease;comparative study;controlled study;cost effectiveness analysis;dementia;depression;Eastern Europe;female;food intake;food preservation;fruit;gastrointestinal disease;groups by age;health care need;health center;hearing impairment;heart disease;human;immobilization;injury;ischemic heart disease;life;lower respiratory tract infection;lung cancer;male;metric system;mortality;nutrition;osteoarthritis;patient selection;population;probability;risk assessment;sex;smoking;social support;tobacco;traffic accident;vascular disease;vegetable;world health organization,"Powles, J. W.;Zatonski, W.;Vander Hoorn, S.;Ezzati, M.",2005,,,0,
3540,Evaluation of efficacy and efficiency of a pragmatic intervention by a social worker to support informal caregivers of elderly patients (The ICE Study): study protocol for a randomized controlled trial,"BACKGROUND: Medical progress and the lifestyle modification have prolonged life expectancy, despite the development of chronic diseases. Support and care for older subjects are often provided by a network of informal caregivers composed of family, friends and neighbors, who are essential in helping older persons to continue living at home. It has been shown that the extent and diversity of informal tasks may jeopardize the physical, mental and social wellbeing of caregivers. METHODS/DESIGN: The aim of the Informal Carers of Elderly cohort is to define, through a longitudinal study, profiles of caregivers of older patients with a diagnosis of one of the following diseases: cancer (breast, prostate, colorectal), neurodegenerative diseases (Parkinson's disease, Alzheimer's disease and similar diseases), neurovascular diseases (stroke), sensory diseases (age-related macular degeneration (AMD)) and heart disease (heart failure). Patients must be at least 60 years old and living in the region of Burgundy-Franche-Comte (France). By following the different phases of the caregiving relationship from the announcement of the diagnosis, it will be possible to assess the quality of life of caregivers, coping strategies, levels of anxiety and depression, social support and the extent of their burden. We will also evaluate the efficacy and efficiency of the implementation of a pragmatic intervention by a social worker to help informal caregivers, through a randomized interventional trial nested in the cohort. Qualitative approaches aimed at studying the caregiver/patient relationship, and situations leading to breakdown of the caregiver relationship will be also undertaken. DISCUSSION: Through an analytical and longitudinal definition of profiles of informal caregivers, this study will gather detailed information on their life courses and their health trajectory by identifying consequences associated with the concept of their role as carers. In addition, the randomized interventional trial will explore the relevance of the implementation of a supportive intervention by a social worker to help caregivers. These data will help to identify strategies that could be used to improve the existing sources of aid and to propose new approaches to help caregivers. This study will provide the opportunity to identify the most relevant means of support adapted to caregivers, and provide an impulse for new health care policies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02626377 . Retrospectively registered on 9 December 2015. Protocol date/version: 23 October 2014/version 2.",Cancer;Chronic disease;Cost-utility;Elderly;Health-related quality of life;Informal caregivers;Longitudinal cohort study;Randomized study,"Pozet, A.;Lejeune, C.;Bonnet, M.;Dabakuyo, S.;Dion, M.;Fagnoni, P.;Gaimard, M.;Imbert, G.;Nerich, V.;Foubert, A.;Chotard, M.;Bonin, M.;Anota, A.;Bonnetain, F.",2016,Nov 03,,0,
3541,Caution when prescribing cholinesterase inhibitors,,cholinergic receptor blocking agent;cholinesterase inhibitor;aspiration pneumonia;bradycardia;bronchospasm;cholinergic activity;cost effectiveness analysis;coughing;dementia;diarrhea;drug efficacy;elderly care;emphysema;gastroesophageal reflux;heart failure;human;hypersalivation;letter;nausea;patient care;prescription;faintness;urine incontinence;vomiting,"Praisoody, A.",2012,,,0,
3542,Etiology-based classification - the way forward for psychiatry,,benzodiazepine derivative;Alzheimer disease;asymptomatic disease;bipolar disorder;catatonia;chronic obstructive lung disease;cognition;dementia;disease classification;DSM-5;dyspnea;electroconvulsive therapy;etiology based classification;human;ischemic heart disease;letter;medical research;mental disease;mild cognitive impairment;neuropathology;neuropsychiatry;prion disease;priority journal;psychiatrist;schizophrenia,"Prakash, S.;Mandal, P.",2015,,,0,
3543,Clinical factors associated with initiation of and persistence with ADP receptor-inhibiting oral antiplatelet treatment after acute coronary syndrome: a nationwide cohort study from Finland,"OBJECTIVES: To study patient selection for and persistence with ADP receptor-inhibiting oral antiplatelet (OAP) treatment after acute coronary syndrome (ACS). DESIGN: Observational, retrospective, cohort study linking real-life patient-level register data. SETTING: Nationwide drug usage study using data of patients with ACS discharged from hospitals in Finland. PARTICIPANTS: The study population consisted of 54 416 patients (aged >/=18 years) following hospital admission for unstable angina pectoris or myocardial infarction during 2009-2013. Patients were classified as either OAP or non-OAP users based on drug purchases within 7 days of discharge. OUTCOME MEASURES: Initiation of and a 12-month persistence with OAP medication. RESULTS: In total, 49% of patients with ACS received OAP treatment after hospital discharge. Women represented 40% of the population, but only 32% of them became OAP users (adjusted OR for initiation compared with men 0.8; p<0.001). Patients not treated with percutaneous coronary intervention (PCI), elderly and patients with dementia/Alzheimer's disease, atrial fibrillation or warfarin treatment were less likely to be treated with OAP. If initiated, they were less likely to complete the recommended 12 months' medication (adjusted risk increment >38% and p<0.001 for all). The OAP users showed good compliance with immediate initiation (92% within 1 day of discharge) and high mean medication possession rate (99%). Among OAP users, the usage of other secondary prevention drugs after ACS was more common than in non-OAP-treated patients (difference >20 percentage points for each). CONCLUSIONS: Only half of the patients with ACS received guideline-recommended ADP receptor-inhibiting OAP treatment after hospital discharge, suggesting suboptimal treatment practices. Non-PCI-treated patients and patients with increased age, unstable angina, dementia or atrial fibrillation appear to have the highest risk of deficient treatment with OAPs. OAP users, however, showed good compliance during drug usage.","drug utilization;oral antiplatelet;persistence;unstable angina pectoris;organisation. EPID Research performs commissioned pharmacoepidemiological;studies, and thus its employees have been and currently are working in;collaboration with several pharmaceutical companies. VK, ER and JA have received;fees from pharmaceutical industry for consultancy regarding educational or;advisory activities. AD and PH are employees of the sponsor, AstraZeneca;Nordic-Baltic.","Prami, T.;Khanfir, H.;Deleskog, A.;Hasvold, P.;Kyto, V.;Reissell, E.;Airaksinen, J.",2016,Nov 22,,0,
3544,Clinical factors associated with initiation of and persistence with ADP receptor-inhibiting oral antiplatelet treatment after acute coronary syndrome: A nationwide cohort study from Finland,"Objectives To study patient selection for and persistence with ADP receptor-inhibiting oral antiplatelet (OAP) treatment after acute coronary syndrome (ACS). Design Observational, retrospective, cohort study linking real-life patient-level register data. Setting Nationwide drug usage study using data of patients with ACS discharged from hospitals in Finland. Participants The study population consisted of 54â €..416 patients (aged ≥18â €..years) following hospital admission for unstable angina pectoris or myocardial infarction during 2009-2013. Patients were classified as either OAP or non-OAP users based on drug purchases within 7â €..days of discharge. Outcome measures Initiation of and a 12-month persistence with OAP medication. Results In total, 49% of patients with ACS received OAP treatment after hospital discharge. Women represented 40% of the population, but only 32% of them became OAP users (adjusted OR for initiation compared with men 0.8; p<0.001). Patients not treated with percutaneous coronary intervention (PCI), elderly and patients with dementia/Alzheimer's disease, atrial fibrillation or warfarin treatment were less likely to be treated with OAP. If initiated, they were less likely to complete the recommended 12 months' medication (adjusted risk increment >38% and p<0.001 for all). The OAP users showed good compliance with immediate initiation (92% within 1 day of discharge) and high mean medication possession rate (99%). Among OAP users, the usage of other secondary prevention drugs after ACS was more common than in non-OAP-Treated patients (difference >20 percentage points for each). Conclusions Only half of the patients with ACS received guideline-recommended ADP receptor-inhibiting OAP treatment after hospital discharge, suggesting suboptimal treatment practices. Non-PCI-Treated patients and patients with increased age, unstable angina, dementia or atrial fibrillation appear to have the highest risk of deficient treatment with OAPs. OAP users, however, showed good compliance during drug usage.",adenosine diphosphate;adenosine diphosphate receptor;angiotensin receptor antagonist;beta adrenergic receptor blocking agent;clopidogrel;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;prasugrel;ticagrelor;unclassified drug;warfarin;acute coronary syndrome;aged;Alzheimer disease;article;atrial fibrillation;cohort analysis;coronary artery bypass graft;dementia;drug use;female;Finland;groups by age;hospital admission;hospital discharge;human;hypertension;major clinical study;male;medication compliance;non ST segment elevation myocardial infarction;observational study;patient compliance;patient selection;percutaneous coronary intervention;retrospective study;secondary prevention;ST segment elevation myocardial infarction;treatment duration;unstable angina pectoris;very elderly,"Prami, T.;Khanfir, H.;Deleskog, A.;Hasvold, P.;Kytö, V.;Reissell, E.;Airaksinen, J.",2016,,10.1136/bmjopen-2016-012604,0,
3545,MELAS: A multigenerational impact of the MTTL1 A3243G MELAS mutation,"Background: the maternally inherited MTTL1 A3243G mutation in the mitochondrial genome causes MelaS (Mitochondrial encephalopathy lactic acidosis with Stroke-like episodes), a condition that is multisystemic but affects primarily the nervous system. Significant intra-familial variation in phenotype and severity of disease is well recognized. Methods: retrospective and ongoing study of an extended family carrying the MTTL1 A3243G mutation with multiple symptomatic individuals. tissue heteroplasmy is reviewed based on the clinical presentations, imaging studies, laboratory findings in affected individuals and pathological material obtained at autopsy in two of the family members. Results: there were seven affected individuals out of thirteen members in this three generation family who each carried the MTTL1 A3243G mutation. the clinical presentations were varied with symptoms ranging from hearing loss, migraines, dementia, seizures, diabetes, visual manifestations, and stroke like episodes. three of the family members are deceased from MelaS or to complications related to MelaS. Conclusions: the results of the clinical, pathological and radiological findings in this family provide strong support to the current concepts of maternal inheritance, tissue heteroplasmy and molecular pathogenesis in MelaS. neurologists (both adult and paediatric) are the most likely to encounter patients with MelaS in their practice. genetic counselling is complex in view of maternal inheritance and heteroplasmy. newer therapeutic options such as arginine are being used for acute and preventative management of stroke like episodes. © 2014 Canadian Journal of neurologiCal sciences inc.",alpha tocopherol;arginine;ascorbic acid;carnitine;clobazam;dichloroacetic acid;gliclazide;mitochondrial protein;MTTL1 protein;oxybutynin;riboflavin;risperidone;succinic acid;thiamine;topiramate;ubidecarenone;unclassified drug;valproic acid;vitamin K group;adult;Alzheimer disease;article;aspiration pneumonia;autopsy;blindness;cerebrovascular accident;clinical article;dementia;diabetes mellitus;extended family;extrachromosomal inheritance;extraocular muscle;family history;female;focal epilepsy;gene mutation;genetic counseling;hand tremor;hearing impairment;heart arrest;heart atrium enlargement;heteroplasmy;human;hyporeflexia;intractable epilepsy;lactic acidosis;learning disorder;lymphocyte;MELAS syndrome;migraine;mitochondrial genome;mitochondrial myopathy;muscle biopsy;nerve conduction;neurologist;periventricular heterotopia;polymerase chain reaction;premature aging;priority journal;retrospective study;seizure;tonic clonic seizure;visual disorder;visual field defect;weakness;wrist injury;young adult,"Prasad, M.;Narayan, B.;Prasad, A. N.;Rupar, C. A.;Levin, S.;Kronick, J.;Ramsay, D.;Tay, K. Y.;Prasad, C.",2014,,,0,
3546,Factors associated with choice of antipsychotic treatment in elderly veterans: potential confounders for observational studies,"BACKGROUND: Antipsychotics are commonly used in the elderly despite limited efficacy and safety data from randomised controlled trials. Observational comparative safety studies of antipsychotics vary, which may be due to confounding. OBJECTIVE: To compare the characteristics of typical and atypical antipsychotic initiators. METHODS: Using the Australian Government Department of Veterans' Affairs claims dataset, we compared patient and prescribing physician characteristics and health care utilisation between atypical and typical antipsychotic initiators. Significant independent predictors of use were calculated using a multivariate log-binomial model. RESULTS: Compared to patients initiated on typical antipsychotics (n=10,966), patients initiated on atypical antipsychotics (n=9,239) were less likely to be male (Relative Risk (RR)=0.91, 95% CI 0.89-0.94) and have prior dispensing of morphine (RR=0.53, 95% CI 0.49-0.57) and oral corticosteroids (RR=0.86, 95% CI 0.81-0.91) and to have been hospitalised for myocardial infarction or pneumonia. Patients initiated on atypical antipsychotics were more likely to be in aged care (RR=1.08, 95% CI 1.05-1.12), to be prescribed the medicine by their usual doctor (RR=1.12, 95% CI 1.09-1.16) and have prior dispensing of anticholinesterases (RR=1.19, 95% CI 1.15-1.23), antidepressants (RR=1.18 95% CI 1.15-1.22) and anti-parkinson medications (RR=1.30, 95% CI 1.25-1.36). CONCLUSIONS: Differences between typical and atypical antipsychotic initiators indicate the potential for confounding in observational studies. Future pharmacoepidemiogical research in Australia, investigating the adverse events of antipsychotics, should consider the variables identified in this study to control for confounding.","Aged;Aged, 80 and over;Antipsychotic Agents/*therapeutic use;Australia;Choice Behavior;Dementia/diagnosis/*drug therapy;Drug Utilization/statistics & numerical data;Female;Humans;Male;Models, Statistical;Piperazines/*therapeutic use;Practice Patterns, Physicians'/statistics & numerical data;Risk Factors;Sex Distribution;Veterans/*psychology/statistics & numerical data","Pratt, N.;Roughead, E.;Salter, A.;Ryan, P.",2010,Dec,10.1111/j.1753-6405.2010.00613.x,0,
3547,Nutrition and physical activity and chronic disease prevention: Research strategies and recommendations,"A shortage of credible information exists on practical dietary and physical activity patterns that have potential to reverse the national obesity epidemic and reduce the risk of major cancers and other chronic diseases. Securing such information is a challenging task, and there is considerable diversity of opinion concerning related research designs and priorities. Here, we put forward some perspectives on useful methodology and infrastructure developments for progress in this important area, and we list high-priority research topics in the areas of 1) assessment of nutrient intake and energy expenditure; 2) development of intermediate outcome biomarkers; 3) enhancement of cohort and cross-cultural studies; and 4) criteria for and development of full-scale nutrition and physical activity intervention trials. © Oxford University Press 2004, all rights reserved.",acetylsalicylic acid;alpha tocopherol;antihypertensive agent;antiinflammatory agent;antineoplastic agent;biological marker;calcium;chondroitin sulfate;estrogen;finasteride;genomic DNA;gestagen;glucosamine sulfate;hydroxymethylglutaryl coenzyme A reductase inhibitor;messenger RNA;metformin;potassium;selenium;sodium;tamoxifen;vitamin D;arthritis;article;behavior modification;breast cancer;cancer prevention;chronic disease;clinical observation;clinical trial;cohort analysis;colon adenoma;colorectal cancer;cultural factor;diabetes mellitus;dietary intake;energy expenditure;epidemic;experimental design;food and drug administration;fracture;human;hypothesis;ischemic heart disease;lifestyle;low fat diet;measurement;medical research;menopausal syndrome;methodology;nephrolithiasis;nutrient;nutritional status;obesity;outcomes research;physical activity;population research;priority journal;prostate cancer;rectum adenoma;risk reduction;workshop;aspirin,"Prentice, R. L.;Willet, W. C.;Greenwald, P.;Alberts, D.;Bernstein, L.;Boyd, N. F.;Byers, T.;Clinton, S. K.;Fraser, G.;Freedman, L.;Hunter, D.;Kipnis, V.;Kolonel, L. N.;Kristal, B. S.;Kristal, A.;Lampe, J. W.;McTiernan, A.;Milner, J.;Patterson, R. E.;Potter, J. D.;Riboli, E.;Schatzkin, A.;Yates, A.;Yetley, E.",2004,,,0,
3548,The impact of comorbid disease and injuries on resource use and expenditures in parkinsonism,"Background: Persons with parkinsonism have high rates of both associated and unrelated prevalent comorbid conditions. A better understanding of patterns of care and expenditures may aid in designing programs to enhance functioning, lengthen independent living, and manage costs. Methods: The authors linked national survey data of 24,831 elderly to nearly 1.9 million Medicare claims. Persons with parkinsonism (n = 791) were identified from survey or Medicare encounters for paralysis agitans. Comorbid disease risk was measured using age-adjusted OR with 95% CI. Comorbidity cost ratios (ratio of average per person per year charges for parkinsonism alone vs with comorbid conditions) were developed to describe incremental costs of comorbidities. Results: Patients with parkinsonism were older (78.5 ± 7.6 vs 75.1 ± 8.3 years, p < 0.0001) and had more injuries resulting in broken bones (35.6% vs 19.5%, p < 0.0001), including broken hips (15.9% vs 5.8%, p < 0.0001), during the 5-year study. Broken hips were more prevalent among men (OR 3.4, 95% CI 2.5 to 4.8) and women (OR 2.5, 95% CI 2.1 to 3.1) with than without parkinsonism. Among those with parkinsonism, comorbidity cost ratios demonstrated two- to threefold higher charges for dementia, broken bones, broken hip, and diabetes. Conclusions: Comorbidity associated with parkinsonism is an under-recognized contribution to higher resource use and expenditures. Further study of injuries, dementia, and diabetes is required to assess whether public health interventions could reduce excess morbidity and expenditures associated with parkinsonism.",aged;arthritis;article;neoplasm;comorbidity;dementia;diabetes mellitus;female;fracture;health care cost;health care utilization;hip fracture;human;hypertension;injury;ischemic heart disease;major clinical study;male;medicare;Parkinson disease;parkinsonism;priority journal;cerebrovascular accident,"Pressley, J. C.;Louis, E. D.;Tang, M. X.;Cote, L.;Cohen, P. D.;Glied, S.;Mayeux, R.",2003,,,0,
3549,Diagnostic correlates of Alzheimer dementia in a U.S. nationwide inpatient sample,"Introduction: Alzheimer dementia (ALZ-D) is among the most frequent diseases in the elderly. Several somatic and psychiatric disorders have been suggested to be related to this diagnosis. The aim of this analysis of a large and representative U.S. nationwide inpatient sample (NIS) was to identify diagnostic correlates of ALZ-D in subjects aged 60 years and older. Methods: Of the total sample of 800,457 inpatient subjects (∼2% of all inpatients in 2004), 315,244 individuals were 60 years or older. Of these, 9,572 (3.03%) received a diagnosis of ALZ-D, whereas 33,367 (10.59%) were diagnosed with osteoarthritis (OA) and served as a comparison group. Comparisons of potential somatic and psychiatric diagnostic correlates were conducted. Results: As determined by both univariate comparison and multivariate logistic regression analysis, after controlling for age and gender, subjects with ALZ-D (versus OA) had an overall higher rate of diagnoses of diseases of the vascular system (stroke: odds ratio 1.69; 95% confidence interval: 1.25-2.30) and psychotic and affective disorders (bipolar: 2.78 [1.26-6.12]; schizoaffective: 3.06 [2.10-4.47]). Increasing age and male gender were positively associated with the diagnosis of ALZ-D. Discussion: Many somatic diagnoses related to ALZ-D were confirmed by these analyses of the NIS. However, psychotic and affective disorders were identified to be equally significant correlates of ALZ-D, even in the presence of all other disorders. Prospective and longitudinal data are needed to investigate potential causal and temporal relationships between ALZ-D with somatic and psychiatric disorders. © 2010 American Association for Geriatric Psychiatry.",adult;aged;alcoholism;Alzheimer disease;article;atherosclerosis;bipolar depression;clinical trial;confidence interval;controlled clinical trial;controlled study;correlation analysis;depression;diabetes mellitus;disease association;female;generalized anxiety disorder;heart infarction;human;hypertension;major clinical study;male;multivariate logistic regression analysis;nationwide inpatient sample;obesity;obsessive compulsive disorder;osteoarthritis;panic;patient selection;phobia;posttraumatic stress disorder;random sample;randomized controlled trial;risk factor;schizoaffective psychosis;schizophrenia;sex difference;cerebrovascular accident;tobacco dependence;transient ischemic attack;United States;univariate analysis,"Preuss, U. W.;Watzke, S.;Choi, J. H.",2010,,,0,
3550,Bilateral striopallidodentate calcification (Fahr's syndrome) and multiple system atrophy in a patient with longstanding hypoparathyroidism,"Recently, a family with idiopathic brain calcification was reported, in which one family member was diagnosed with multiple system atrophy (MSA) at autopsy. We report here a case showing similar neuropathological features in a patient with longstanding hypoparathyroidism. Our female patient had a history of hypoparathyroidism with hypocalcaemia and tetany since the age of 9 years. In her 50s she developed dementia and parkinsonism. She died of myocardial infarction aged 65 years. Neuropathology showed severe brain calcifications of the Fahr type in the basal ganglia, thalami, cerebral and cerebellar white matter and dentate nuclei. Additionally, there was prominent alpha-synucleinopathy of the multiple system atrophy type (MSA). The patient has a healthy identical twin and there is no family history of hypoparathyroidism or neurological disease. Data on alpha-synuclein accumulation in various cases of Fahr's syndrome are needed to establish the correlation between alpha-synucleinopathy and bilateral striopallidodentate calcification. © 2007 Japanese Society of Neuropathology.",alpha synuclein;aged;alpha synucleinopathy;anamnesis;article;basal ganglion;brain calcification;brain disease;case report;correlation analysis;dementia;dentate nucleus;Fahr disease;female;heart infarction;human;hypocalcemia;hypoparathyroidism;monozygotic twins;neuropathology;parkinsonism;priority journal;Shy Drager syndrome;tetany;thalamus;white matter,"Preusser, M.;Kitzwoegerer, M.;Budka, H.;Brugger, S.",2007,,,0,
3551,Assessment of the completeness and accuracy of computer medical records in four practices committed to recording data on computer,"Background. General practice computer databases are being increasingly seen as a source of data for public health monitoring and commissioning. Such ambitions depend on routine clinical data being recorded with acceptable completeness and accuracy. Aim. The aim of this study was to assess the completeness and accuracy of the computer medical records in four high-recording general practices. Method. Four general practices in the Trent Region that use the EMIS computer system, and were known to be high recorders of clinical data on their computer databases, were selected. A retrospective analysis of the computer records, a prospective comparison of a sample of computer records with manual records, and a prospective comparison between videorecorded consultations and their manual and computer records were undertaken. Results. Checks for completeness in computer recording of diabetes mellitus and glaucoma showed high levels of accurate recording, 97% and 92% respectively. Prevalence rates between practices were reasonably comparable. No practice consistently, across 10 diagnoses, recorded prevalences higher or lower than the other practices; those diagnoses with recognized objective diagnostic criteria were recorded with a more consistent prevalence than those without. Lifestyle data recording was low; overall, smoking habits and alcohol consumption were recorded for 52% and 38% of patients aged over 16 years, respectively. Comparison of the manual records with the computer records showed that the computer records were sufficiently complete with regard to diagnoses (82% of all items recorded), prescriptions (100%) and referrals (67%), but missed most of the remaining data that a manual record captured. The videorecorded validation study showed that there were no important lapses in the recording of diagnoses, prescriptions or referrals when the computer recording was compared to the actual process of the consultations. Conclusion. In these four high-recording practices the data in computer records were of sufficient completeness and accuracy to allow meaningful data aggregation for some diagnoses, prescriptions and referrals. Standardized protocols for defining which patients are included and excluded from major disease groups are required.",accuracy;alcohol consumption;article;asthma;computer system;data base;dementia;depression;diabetes mellitus;general practice;glaucoma;human;hypertension;ischemic heart disease;knee osteoarthritis;lifestyle;medical record;multiple sclerosis;patient referral;prescription;prospective study;public health;retrospective study;smoking habit;cerebrovascular accident,"Pringle, M.;Ward, P.;Chilvers, C.",1995,,,0,
3552,Lack of prion infectivity in fixed heart tissue from patients with Creutzfeldt-Jakob disease or amyloid heart disease,"In most forms of prion disease, infectivity is present primarily in the central nervous system or immune system organs such as spleen and lymph node. However, a transgenic mouse model of prion disease has demonstrated that prion infectivity can also be present as amyloid deposits in heart tissue. Deposition of infectious prions as amyloid in human heart tissue would be a significant public health concern. Although abnormal disease-associated prion protein (PrP(Sc)) has not been detected in heart tissue from several amyloid heart disease patients, it has been observed in the heart tissue of a patient with sporadic Creutzfeldt-Jakob Disease (sCJD), the most common form of human prion disease. In order to determine whether prion infectivity can be found in heart tissue, we have inoculated formaldehyde fixed brain and heart tissue from two sCJD patients, as well as prion protein positive fixed heart tissue from two amyloid heart disease patients, into transgenic mice overexpressing the human prion protein. Although the sCJD brain samples led to clinical or subclinical prion infection and deposition of PrP(Sc) in the brain, none of the inoculated heart samples resulted in disease or the accumulation of PrP(Sc). Thus, our results suggest that prion infectivity is not likely present in cardiac tissue from sCJD or amyloid heart disease patients.","Amyloidosis/*metabolism/*pathology;Animals;Brain/metabolism/pathology;Cardiomyopathies/*metabolism/*pathology;Creutzfeldt-Jakob Syndrome/*metabolism/*pathology/transmission;Cricetinae;Disease Models, Animal;Humans;Immunohistochemistry;Mice;Mice, Transgenic;Myocardium/*metabolism/*pathology;PrPSc Proteins/*metabolism/*pathogenicity","Priola, S. A.;Ward, A. E.;McCall, S. A.;Trifilo, M.;Choi, Y. P.;Solforosi, L.;Williamson, R. A.;Cruite, J. T.;Oldstone, M. B.",2013,Sep,10.1128/jvi.00692-13,0,
3553,The Association between Perceived Stress and Mortality among People with Multimorbidity: A Prospective Population-Based Cohort Study,"Multimorbidity is common and is associated with poor mental health and high mortality. Nevertheless, no studies have evaluated whether mental health may affect the survival of people with multimorbidity. We investigated the association between perceived stress and mortality in people with multimorbidity by following a population-based cohort of 118,410 participants from the Danish National Health Survey 2010 for up to 4 years. Information on perceived stress and lifestyle was obtained from the survey. We assessed multimorbidity using nationwide register data on 39 conditions and identified 4,229 deaths for the 453,648 person-years at risk. Mortality rates rose with increasing levels of stress in a dose-response relationship (P-trend < 0.0001), independently of multimorbidity status. Mortality hazard ratios (highest stress quintile vs. lowest) were 1.51 (95% confidence interval (CI): 1.25, 1.84) among persons without multimorbidity, 1.39 (95% CI: 1.18, 1.64) among those with 2 or 3 conditions, and 1.43 (95% CI: 1.18, 1.73) among those with 4 or more conditions, when adjusted for disease severities, lifestyle, and socioeconomic status. The numbers of excess deaths associated with high stress were 69 among persons without multimorbidity, 128 among those with 2 or 3 conditions, and 255 among those with 4 or more conditions. Our findings suggested that perceived stress contributes significantly to higher mortality rates in a dose-response pattern, and more stress-associated deaths occurred in people with multimorbidity.",alcohol;adult;aged;alcohol consumption;allergy;anemia;anorexia;anxiety disorder;article;atrial fibrillation;bipolar disorder;body mass;bulimia;cerebrovascular accident;chronic gastritis;chronic kidney disease;chronic liver disease;chronic lung disease;cohabitation;cohort analysis;comorbidity;connective tissue disease;controlled study;dementia;disease severity;distress syndrome;dyslipidemia;employment status;epilepsy;female;follow up;gout;hearing disorder;heart failure;human;Human immunodeficiency virus infection;hypertension;inflammatory bowel disease;insulin dependent diabetes mellitus;intestine diverticulosis;ischemic heart disease;lifestyle;major clinical study;male;middle aged;migraine;mood disorder;mortality;mortality rate;multiple sclerosis;neuropathy;non insulin dependent diabetes mellitus;osteoporosis;Parkinson disease;Perceived Stress Scale;peripheral occlusive artery disease;physical activity;physical inactivity;population based case control study;prospective study;prostate disease;public health;schizoaffective psychosis;schizophrenia;smoking;social status;stress;thyroid disease;visual disorder,"Prior, A.;Fenger-Grøn, M.;Larsen, K. K.;Larsen, F. B.;Robinson, K. M.;Nielsen, M. G.;Christensen, K. S.;Mercer, S. W.;Vestergaard, M.",2016,,,0,
3554,"Health practices and illness cognition in young, middle aged, and elderly adults","The present paper examines reported frequencies of 21 health practices, beliefs that these health practices can prevent six different illnesses, and beliefs about those illnesses in a community sample of 396 people: 173 young (20 to 39 years), 111 middle-aged (40 to 59 years), and 112 elderly adults (60 to 89 years). Elderly respondents report higher frequencies of health-promoting actions (e.g., regular medical check-ups, avoidance of salt, regular sleep, and eating a balanced diet) than younger respondents. Health practices aimed at reinterpreting stress and controlling emotions (e.g., avoiding emotional stress, staying mentally alert and active) also increased with age. Belief that these 21 practices prevent specific illnesses was consistent across the three age groups. Beliefs about the six illnesses were consistent across age with three exceptions: Elderly people considered themselves more vulnerable to disease, saw it as more serious for them, and were less likely to use chronic mild symptoms, like weakness and aches, as illness warnings.","Adult;Age Factors;Aged;Aging;*Attitude to Health;*Behavior;*Cognition;Colonic Neoplasms/prevention & control/psychology;Common Cold/prevention & control/psychology;Dementia/prevention & control/psychology;Diet, Sodium-Restricted;Emotions;Female;*Health;Health Promotion;Humans;Hypertension/prevention & control/psychology;Lung Neoplasms/prevention & control/psychology;Male;Middle Aged;Myocardial Infarction/prevention & control/psychology;Physical Exertion;Rectal Neoplasms/prevention & control/psychology;Sex Factors","Prohaska, T. R.;Leventhal, E. A.;Leventhal, H.;Keller, M. L.",1985,Sep,,0,
3555,An aspirated partial denture as a complication in status epilepticus,,lorazepam;phenytoin;aged;aspirated partial denture;case report;comorbidity;coronary artery disease;dementia;dental surgeon;diabetes mellitus;dysphagia;emergency ward;endoscopy;epileptic state;fiber optics;follow up;forceps;foreign body;heart failure;heart valve prosthesis;human;laryngoscope;male;partial denture;psychosis;remission;short survey,"Prokopakis, E.;Ioannidis, D.;Georgopoulos, D.;Velegrakis, G.",2014,,,0,
3556,Patients receiving lithium therapy have a reduced prevalence of neurological and cardiovascular disorders,"A variety of evidence from laboratory and animal studies suggests that lithium has neurotrophic and cytoprotective properties, and may ameliorate or prevent some disease states. We investigated whether such a protective effect can be observed in human psychiatric patients receiving lithium therapy. We carried out a retrospective chart review of 1028 adult psychiatric male and female outpatients attending four lithium clinics in metropolitan New York City. Patients were divided into two groups based on lithium usage, and the prevalence of neurological and cardiovascular disorders was compared. The main outcome measures were the occurrence in the two patient groups of a variety of neurological disorders and myocardial infarction. Odds ratios were calculated to assess the risk of having a disorder for patients receiving lithium compared to patients not receiving lithium: for seizures, the odds ratio was 0.097; for amyotrophic lateral sclerosis, the odds ratio was 0.112; for dementia not otherwise specified, the odds ratio was 0.112; and for myocardial infarction, the odds ratio was 0.30. Logistical regression analysis showed that lithium treatment is a significant negative predictive factor in the prevalence of each of these disease states, when age, duration of clinic attendance, and use of anti-psychotic medications are taken into account. Our results show that patients receiving regular lithium treatment have a reduced prevalence of some neurological disorders and myocardial infarctions. One possible explanation of these results is that a protective effect of lithium observed in laboratory and animal studies may also be present in human patients receiving regular lithium therapy.",Amyotrophic lateral sclerosis;Dementia;Lithium;Myocardial infarction;Outpatients;Seizures,"Prosser, J. M.;Fieve, R. R.",2016,Nov 3,10.1016/j.pnpbp.2016.06.006,0,
3557,Cigarette smokers differ in their handling of natural (RRR) and synthetic (all rac) alpha-tocopherol: a biokinetic study in apoE4 male subjects,"We have compared the biokinetics of deuterated natural (RRR) and synthetic (all rac) alpha-tocopherol in male apoE4-carrying smokers and nonsmokers. In a randomized, crossover study subjects underwent two 4-week treatments (400 mg/day) with undeuterated RRR- and all rac-alpha-tocopheryl acetate around a 12-week washout. Before and after each supplementation period subjects underwent a biokinetic protocol (48 h) with 150 mg deuterated RRR- or all rac-alpha-tocopheryl acetate. During the biokinetic protocols, the elimination of endogenous plasma alpha-tocopherol was significantly faster in smokers (P < 0.05). However, smokers had a lower uptake of deuterated RRR than nonsmokers, but there was no difference in uptake of deuterated all rac. The supplementation regimes significantly raised plasma alpha-tocopherol (P < 0.001) with no differences in response between smokers and nonsmokers or between alpha-tocopherol forms. Smokers had significantly lower excretion of alpha-carboxyethyl-hydroxychroman than nonsmokers following supplementation (P < 0.05). Nonsmokers excreted more alpha-carboxyethyl-hydroxychroman following RRR than all rac; however, smokers did not differ in excretion between forms. At baseline, smokers had significantly lower ascorbate (P < 0.01) and higher F(2)-isoprostanes (P < 0.05). F(2)-isoprostanes in smokers remained unchanged during the study, but increased in nonsmokers following alpha-tocopherol supplementation. These data suggest that apoE4-carrying smokers and nonsmokers differ in their handling of natural and synthetic alpha-tocopherol.",Adult;Alzheimer Disease/genetics;Apolipoprotein E4;Apolipoproteins E/*genetics;Ascorbic Acid/blood;Chromans/urine;Coronary Disease/genetics;F2-Isoprostanes/blood;Genetic Predisposition to Disease;Humans;Hyperlipoproteinemia Type V/*genetics;Male;Middle Aged;Smoking/*metabolism;Tocopherols;alpha-Tocopherol/administration & dosage/*analogs &;derivatives/blood/pharmacokinetics,"Proteggente, A. R.;Rota, C.;Majewicz, J.;Rimbach, G.;Minihane, A. M.;Kraemer, K.;Lodge, J. K.",2006,Jun 15,10.1016/j.freeradbiomed.2006.02.006,0,
3558,"Increased morbidity, mortality and length of in-hospital stay for patients with acute coronary syndrome with pre-morbid psychiatric diagnoses","Background: Psychiatric and cardiac comorbidities form the top two budget categories for health systems in high-income countries with evidence that psychiatric pre-morbidities lead to worse outcomes in patients with acute coronary syndrome (ACS). There are no studies examining this relationship in a national multicentre population level study in the UK, and no studies examining their impact on length of in-hospital stay (LoS) in ACS. Recognizing at-risk populations and reducing LoS in ACS is an essential part of improving patient care and cost-effectiveness. Methods: We investigated the impact of psychiatric diagnoses on morbidity, all-cause mortality and LoS amongst 57,668 ACS patients between Jan-2004 and Dec-2014 using the Secure-Anonymized-Information-Linkage (SAIL) databank. Demographics, admissions, cardiac and psychiatric comorbidities were identified using coded data. Results: There were a total of 3857 out of 57,668 patients who had a pre-morbid psychiatric diagnosis. The mean LoS in patients without psychiatric comorbidities was 9.78. days (95% CI: 9.66-9.91). This was higher (p <. 0.01) in the presence of any psychiatric diagnosis (14.72), dementia (20.87), schizophrenia (15.67), and mood disorders (13.41). Patients with psychiatric comorbidities had worse net adverse cardiac events (HR 1.18, 95% CI: 1.16-1.21) and mortality rates (HR 1.26, 95% CI: 1.23-1.30). Conclusions: Our results demonstrate that psychiatric comorbidities have a significant and clinically important impact on morbidity, mortality and LoS in ACS patients in Wales, UK. Clinicians' awareness and active management of psychiatric conditions amongst ACS patients is needed to reduce poor outcomes and LoS and ultimately the risk for patients and financial burden for the health-service. Copyright © 2017.",acute coronary syndrome;awareness;clinical trial;comorbidity;controlled clinical trial;controlled study;cost effectiveness analysis;doctor patient relation;heart disease;hospitalization;human;length of stay;major clinical study;mood disorder;morbidity;mortality rate;multicenter study;patient care;psychiatric diagnosis;schizophrenia;Wales,"Protty, Mb;Lacey, A;Smith, D;Hannoodee, S;Freeman, P",2017,,10.1016/j.ijcard.2017.01.067,0,3559
3559,"Increased morbidity, mortality and length of in-hospital stay for patients with acute coronary syndrome with pre-morbid psychiatric diagnoses","BACKGROUND: Psychiatric and cardiac comorbidities form the top two budget categories for health systems in high-income countries with evidence that psychiatric pre-morbidities lead to worse outcomes in patients with acute coronary syndrome (ACS). There are no studies examining this relationship in a national multicentre population level study in the UK, and no studies examining their impact on length of in-hospital stay (LoS) in ACS. Recognizing at-risk populations and reducing LoS in ACS is an essential part of improving patient care and cost-effectiveness. METHODS: We investigated the impact of psychiatric diagnoses on morbidity, all-cause mortality and LoS amongst 57,668 ACS patients between Jan-2004 and Dec-2014 using the Secure-Anonymized-Information-Linkage (SAIL) databank. Demographics, admissions, cardiac and psychiatric comorbidities were identified using coded data. RESULTS: There were a total of 3857 out of 57,668 patients who had a pre-morbid psychiatric diagnosis. The mean LoS in patients without psychiatric comorbidities was 9.78days (95% CI: 9.66-9.91). This was higher (p<0.01) in the presence of any psychiatric diagnosis (14.72), dementia (20.87), schizophrenia (15.67), and mood disorders (13.41). Patients with psychiatric comorbidities had worse net adverse cardiac events (HR 1.18, 95% CI: 1.16-1.21) and mortality rates (HR 1.26, 95% CI: 1.23-1.30). CONCLUSIONS: Our results demonstrate that psychiatric comorbidities have a significant and clinically important impact on morbidity, mortality and LoS in ACS patients in Wales, UK. Clinicians' awareness and active management of psychiatric conditions amongst ACS patients is needed to reduce poor outcomes and LoS and ultimately the risk for patients and financial burden for the health-service.",Acute coronary syndrome;Length of stay;Mortality;Population;Psychiatric,"Protty, M. B.;Lacey, A.;Smith, D.;Hannoodee, S.;Freeman, P.",2017,Jun 01,,0,
3560,Palliative care in neurology,"Palliative care in neurology is characterized by the need of taking into account some distinguishing features which supplement and often differ from the general palliative approach to cancer or to severe organ failures. Such position is emphasized by a new concept of palliative assistance which is not limited to the ""end of life"" stage, as it was the traditional one, but is applied along the entire course of progressive, life-limiting, and disabling conditions. There are various reasons accounting for a differentiation of palliative care in neurology and for the development of specific expertise; the long duration of the advanced stages of many neurological diseases and the distinguishing features of some clinical problems (cognitive disorders, psychic disorders, etc.), in addition to the deterioration of some general aspects (nutrition, etc.), make the general criteria adopted for cancer, severe respiratory, hepatic or renal failures and heart failure inadequate. The neurological diseases which could benefit from the development of a specific palliative approach are dementia, cerebrovascular diseases, movement disorders, neuromuscular diseases, severe traumatic brain injury, brain cancers and multiple sclerosis, as well as less frequent conditions. The growing literature on palliative care in neurology provides evidence of the neurological community's increasing interest in taking care of the advanced and terminal stages of nervous system diseases, thus encouraging research, training and updating in such direction. This document aims to underline the specific neurological requirements concerning the palliative assistance.",Humans;Nervous System Diseases/physiopathology/*therapy;Neurology/*methods;Palliative Care/*methods,"Provinciali, L.;Tarquini, D.;De Falco, F. A.;Carlini, G.;Zappia, M.;Toni, D.",2015,Jul,10.1701/1940.21086,0,
3561,Diagnosing neurosyphilis: A case of confusion,"A Pakistani man aged 60 years presented with personality change, aggression, paranoid delusions and sexual disinhibition while being treated for severe chest sepsis in intensive care. Collateral history confirmed that these personality changes had been developing over the course of the previous 2 years. He was found to have positive syphilis serology during a routine confusion screen, and the possibility of neurosyphilis was raised. Cerebrospinal fluid examination revealed elevated protein but negative syphilis testing. Following multidisciplinary discussion, the decision was made to treat as neurosyphilis, which resulted in a significant improvement in symptoms. The genitourinary department was able to carry out thorough contact tracing. This case demonstrates the importance of including syphilis in a confusion screen as this patient was diagnosed following a low clinical suspicion. It also highlights some potential pitfalls and difficulties in the diagnosis of neurosyphilis and the importance of the use of a multidisciplinary team.",lorazepam;penicillin G;reaginic antibody;risperidone;acute kidney failure;adult;aggression;antibiotic therapy;article;ataxic gait;behavior change;case report;cerebrospinal fluid analysis;comorbidity;confusion;delirium;delusion;differential diagnosis;disease severity;disruptive behavior;drowsiness;drug efficacy;family relation;frontotemporal dementia;hospital admission;hospital discharge;hospital readmission;human;hypoglycemia;leukocyte count;low drug dose;lumbar puncture;male;medical history;Montreal cognitive assessment;neurosyphilis;non ST segment elevation myocardial infarction;paranoia;persecutory delusion;priority journal;psychiatric treatment;short term memory;treatment duration,"Prynn, J.;Hussain, A.;Winnett, A.",2016,,10.1136/bcr-2016-216582,0,
3562,"Cardiovascular profile in critically ill elderly medical patients: Prevalence, mortality and length of stay","Purpose Data are demonstrating the increase in utilization of critical care by the elderly. Around 11% of ICU patients are ≥80 years-old. Methods An observational retrospective study was conducted between 2003 and 2011, including elderly patients (≥80 years old) admitted from medical services to the intensive care unit (ICU) in a tertiary university hospital. The final sample size was N = 202. Results Mortality rates were: ICU 34.1%, in-hospital 44% and 1-year cumulative mortality 55.4% (20.4% for hospital survivors). Multivariate analysis showed that APACHE II score: OR 1.10, 95% CI (1.03-1.18), SAPS II score: OR 1.03, 95% CI (1.01-1.06), a score < 3 on the Cruz Roja Hospital mental scale: 0.51 OR, 95% CI (0.01-0.57) and ICU admission for cardiovascular disease: OR 5.05, 95% CI (1.98-12.84) were independently associated with mortality ICU. Factors independently associated with 1-year mortality were: dyslipidemia OR 7.25 (1.47-35.60), chronic kidney failure OR 13.23, 95% CI (2.28-76.6), stroke OR 10.44, 95% CI (2.26-48.25) and antihypertensive treatment OR 0.08, 95% CI (0.01-0.48). In multiple linear regression, ICU length of stay was associated with mechanical ventilation B coefficient 6.41, 95% CI (1.18-11.64) and in-hospital length of stay was related to age: B coefficient - 2.17, 95% CI (- 4.02 to - 0.33). Conclusions Prevalence of cardiovascular risk factors and cardiovascular disease was high, and basal cardiovascular treatment was underused. Primary diagnosis for cardiovascular disease at ICU admission should be assessed as predictor of ICU mortality. Intensifying cardiovascular basal treatment could decrease 1-year mortality. Cardiovascular profile did not show an effect on in-hospital mortality and length of stay.",antihypertensive agent;aged;airway obstruction;antihypertensive therapy;APACHE;article;artificial ventilation;cardiovascular disease;cardiovascular risk;cerebrovascular accident;cerebrovascular disease;Charlson Comorbidity Index;chronic kidney failure;critically ill patient;dementia;diabetes mellitus;disease association;dyslipidemia;female;functional disease;heart failure;heart muscle ischemia;hospital admission;human;intensive care;intensive care unit;length of stay;major clinical study;male;medical service;mental deficiency;mortality;observational study;peripheral occlusive artery disease;prevalence;retrospective study;Simplified Acute Physiology Score,"Puchades, R.;González, B.;Contreras, M.;Gullón, A.;De Miguel, R.;Martín, D.;Gutiérrez, C.;Navarro, R.",2015,,,0,
3563,Impact of comorbidity and basal health status on coronary care unit admission and clinical profile in nonagenarians with acute myocardial infarction,,acute heart infarction;aged;article;cerebrovascular disease;chronic kidney failure;clinical feature;comorbidity;controlled study;coronary artery disease;coronary care unit;dementia;diabetes mellitus;disease association;dyslipidemia;dyspnea;female;health status;human;hypertension;major clinical study;male;observational study;priority journal;retrospective study;thorax pain,"Puchades, R.;González, B.;De La Cuesta, V.;Galván, J. M.;De Oca, R. M.;Gutierrez, C.;Navarro, R.;Jiménez-Borreguero, L. J.",2016,,,0,
3564,Non compaction cardiomyopathy and Antiphospholipid syndrome: A catastrophic thromboembolic association,"We described a massive non compaction cardiomyopathy associated with Antiphospholipid syndrome in a 53-year-old male with many episodes of ischemic cerebral stroke complicated by functional disability, cognitive decline and vascular dementia. In our case, the association of massive non compaction cardiomyopathy and severe left ventricular dysfunction added to Antiphospholipid syndrome has showed a dramatic thromboembolic manifestation. © 2007 Elsevier Ireland Ltd. All rights reserved.",anticoagulant agent;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;immunoglobulin G;immunoglobulin M;ticlopidine;adult;anamnesis;antiphospholipid syndrome;article;blood pressure measurement;brain ischemia;cardiomyopathy;cardiovascular risk;case report;cognitive defect;disease association;functional disease;heart auscultation;heart left ventricle failure;hospital admission;human;immunoglobulin blood level;laboratory test;low drug dose;lung auscultation;male;multiinfarct dementia;neurologic examination;ventricular noncompaction;priority journal;risk factor;cerebrovascular accident;thromboembolism;transthoracic echocardiography,"Pugliatti, P.;Di Bella, G.;Recupero, A.;Patanè, S.;Coglitore, S.",2008,,,0,
3565,Inhaled corticosteroids and the risk of fracture in chronic obstructive pulmonary disease,"Background: Inhaled corticosteroids are used increasingly to treat people with COPD, but the extent to which these drugs increase the risk of fracture is unclear. Aim: To quantify the dose-response relationship between fracture risk and inhaled corticosteroids in people with COPD, independent of the effects of percent predicted FEV1 and oral corticosteroids. Design: Nested case-control study. Methods: Cases and controls were COPD patients aged ≥40 years or more at diagnosis, with a FEV1 measurement recorded in The Health Improvement Network database, up to 5 July 2005. Cases (people with a fracture event after 1 January 1998, n=1235) were assigned up to four controls (n=4598), matched by gender and general practice. Results: Mean FEV1 was 57.5% in cases, and 58.5% in controls. Inhaled corticosteroids had been prescribed in 69% of cases (median dose 269 mcg/day) and 66% (226 mcg/day) of controls. Oral corticosteroids had been prescribed in 60% of cases (median annual prescription rate 0.6) and 56% of controls (also 0.6 per year). Risk of fracture increased with increasing mean daily doses of inhaled corticosteroid (p for trend 0.007), and was most marked in those whose daily dose was 51600 mcg (OR 1.80, 95% CI 1.04-3.11). This effect was virtually unchanged by adjustment for mean percent predicted FEV1 and annual prescription rate for oral corticosteroids (OR for highest dose exposure 1.74, 95% CI 1.00-3.01). Discussion: Our findings add to the evidence that the use of inhaled corticosteroids is associated with a small increase in fracture risk, particularly at higher doses. © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.",antidepressant agent;antiparkinson agent;anxiolytic agent;beclometasone dipropionate;bisphosphonic acid derivative;budesonide;calcitonin;calcium;corticosteroid;estrogen;fluticasone propionate;hypnotic agent;neuroleptic agent;nonsteroid antiinflammatory agent;thiazide diuretic agent;vitamin D;aged;article;case control study;cerebrovascular disease;chronic obstructive lung disease;smoking;comorbidity;controlled study;dementia;disease association;dose response;drug dose comparison;epilepsy;female;forced expiratory volume;general practice;hip fracture;human;hyperthyroidism;ischemic heart disease;major clinical study;male;malignant neoplastic disease;osteoporosis;prediction;prescription;priority journal;quantitative analysis;rheumatoid arthritis;risk assessment;sex difference;spirometry;treatment duration;wrist fracture,"Pujades-Rodríguez, M.;Smith, C. J. P.;Hubbard, R. B.",2007,,,0,
3566,Geriatric treatment concept reduces the cost of hospital,,"Acute Disease/*therapy;Alzheimer Disease/*drug therapy;Cholinesterase Inhibitors/*therapeutic use;Clinical Trials as Topic/*methods;Diabetes Mellitus, Type 2/*therapy;Female;Health Services for the Aged/*economics/*statistics & numerical data;*Hospital Units;Humans;Male;Myocardial Infarction/*prevention & control;Patient Readmission/*economics/*statistics & numerical data;*Patient Selection;Registries/*statistics & numerical data","Pullen, R.;Dovjak, P.",2013,Dec,10.1007/s00391-013-0549-x,0,
3567,A women's health track for internal medicine residents using evidence-based medicine,"OBJECTIVES: Evidenced-based medicine has established itself as an integral part of medical education and practice. The explosion of new knowledge in women's health and the need to teach this to internal medicine residents in an evidence-based fashion have presented a challenge to medical educators. To address this need, we developed and implemented an evidence-based women's health curriculum to be used in addition to clinical training in a women's health center for internal medicine residents. The objectives of the curriculum are to (1) define and utilize basic evidence-based medicine concepts to critically analyze women's health literature, (2) understand recent innovations in women's health from an evidence-based viewpoint, (3) gain clinical experience in women's health, and (4) apply evidence-based medicine to the clinical practice of women's health. DESCRIPTION: We designed our curriculum based on recommendations from the National Academy of Women's Health Medical Education, the American Board of Internal Medicine, the Fifth Report of the Council on Graduate Medical Education, and the results of needs assessments of internal medicine residents at our institution. Using Medline to create a women's health bibliography, an extensive literature search was performed on the following topics: osteoporosis, breast cancer, hormone replacement therapy, domestic violence, coronary artery disease in women, menopause, headaches, substance abuse in women, urinary incontinence, dementia, sexual dysfunction, and evidence-based medicine. Peer-reviewed journal articles were compiled by subject matter for placement in our clinic's resource center and were entered into a computerized database that will link with online journals and be available for electronic access. Most articles were selected based on the criteria of data published since 1990, and randomized, double-blinded, placebo-controlled studies were given preference. Weekly 45-minute sessions preceding the resident clinic in the women's health center are held in a journal-club format to review literature in a systematic fashion. Faculty and residents review and analyze one to two articles weekly. Content experts provide context and clinical expertise to resident discussions. Clinical questions, such as ""Should I prescribe hormone replacement therapy to my postmenopausal patient?"" are addressed in each session. Evidence-based medicine core concepts are reviewed and applied; these core concepts include the number needed to treat, absolute risk reduction, and relative risk. DISCUSSION: The women's health curriculum, weekly conferences, and clinical experience serve to update residents and clinicians in women's health literature, to exchange ideas for the improvement of women's health as it is taught in internal medicine, and to further elucidate the evidence behind what we practice and teach. The curriculum equips physicians to provide patients with solid, evidence-based interpretations of new scientific knowledge to discern truth from fallacy.","Curriculum;Education, Medical, Graduate;Evidence-Based Medicine/*education;Female;Humans;Internal Medicine/*education;*Internship and Residency;Kentucky;*Women's Health","Pursley, H. G.;Kwolek, D. S.",2002,Jul,,0,
3568,Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment,"Background: About half of out-of-hospital cardiac arrest survivors experience secondary anoxic brain damage. Neurological outcome can be influenced by rehabilitative treatment approaches, but the nature and severity of persistent disabilities remain unclear. The aim of the study was to explore persistent neuropsychiatric symptoms, global function and life situation of these patients, and to evaluate quality of life in families. Methods: 25 months after inpatient rehabilitation, 12 individuals (mean age=51 years; ten M: two F) attended a cross-sectional interdisciplinary follow-up assessment with their carers. Function was investigated by clinical rating scales, neuropsychological standard tests, and clinical psychological inventories. Family members were asked about quality of life and satisfaction with social support. Results: All patients had deficits in at least one or more cognitive areas such as orientation, memory, alertness, and awareness. Three different clinical syndromes were observed: very severe intellectual and physical impairment, (two), mild to moderate dementia, (five), and amnesic syndrome, (five). Prevalence of multiple disabilities, was high. A striking discrepancy was found between self and proxy rating of disabilities (P<0.01). Family members faced dramatically altered life situations after CA; 60% of spouses suffered from psychosomatic problems, 50% complained of lack of social support. Conclusion: Despite optimal in-hospital treatment, severe anoxic brain damage resulted in permanent cognitive decline, impaired awareness and self care ability. Families felt isolated, and more than half need more support to prevent burn out. Copyright (C) 2000 Elsevier Science Ireland Ltd.",adolescent;aged;amnesia;anoxia;article;brain injury;clinical article;dementia;depression;family;female;follow up;heart arrest;human;male;neuropsychiatry;priority journal;quality of life;rehabilitation;resuscitation;treatment outcome,"Pußwald, G.;Fertl, E.;Faltl, M.;Auff, E.",2000,,,0,
3569,Medicare cost in matched hospice and non-hospice cohorts,"Hospice care is perceived as enhancing life quality for patients with advanced, incurable illness, but cost comparisons to non-hospice patients are difficult to make. The very large Medicare expenditures for care given during the end of life, combined with the pressure on Medicare spending, make this information important. We sought to identify cost differences between patients who do and do not elect to receive Medicare-paid hospice benefits. We introduce an innovative prospective/retrospective case-control method that we used to study 8,700 patients from a sample of 5% of the entire Medicare beneficiary population for 1999-2000 associated with 16 narrowly defined indicative markers. For the majority of cohorts, mean and median Medicare costs were lower for patients enrolled in hospice care. The lower costs were not associated with shorter duration until death. For important terminal medical conditions, including non-cancers, costs are lower for patients receiving hospice care. The lower cost is not associated with shorter time until death, and appears to be associated with longer mean time until death.","Aged;Aged, 80 and over;Alzheimer Disease/economics/mortality/therapy;Case-Control Studies;Cohort Studies;Female;*Health Care Costs;Heart Failure/economics/mortality/therapy;Hospice Care/*economics;Humans;Male;Medicare/*economics;Middle Aged;Neoplasms/economics/mortality/therapy;Stroke/economics/mortality/therapy;Survival Rate","Pyenson, B.;Connor, S.;Fitch, K.;Kinzbrunner, B.",2004,Sep,10.1016/j.jpainsymman.2004.05.003,0,
3570,Vitamin D deficiency is unrelated to type of atrial fibrillation and its complications,"INTRODUCTION: Vitamin D plays an important role in a broad range of organ functions, including the cardiovascular system. Only one study has tested the association between vitamin D deficiency and arrhythmia and it found no association. The aim of the present study was to evaluate the association between vitamin D deficiency and the type of atrial fibrillation (AF) and complications to AF. MATERIAL AND METHODS: In total, 258 patients were consecutively included from March 2009 to February 2011. All in- and out-patients in the Department of Cardiology at Hvid ovre Hospital were invited to participate, provided they had electrocardiographically documented AF. Patients with dementia or terminal illness were excluded. 25 hydroxyvitamin D (25 OHD) was measured with a chemiluminescence assay (Liaison from DiaSorin, Stillwater, Minnesota, USA). RESULTS: No association between vitamin D level and type of AF was found. Furthermore, no association between vitamin D deficiency and ischaemic heart disease, stroke or acute myocardial infarction was found. Vitamin D deficiency was significantly associated with low age (p = 0.02) and gender with a higher proportion of females having the optimal level of 25 OHD (p = 0.0005). CONCLUSION: Other studies have found a beneficial effect of vitamin D on cardiovascular diseases, but we found no association between vitamin D deficiency and the type of AF or complications to AF. Further investigation is necessary to determine whether vitamin D supplementation improves cardiovascular outcomes in patients with AF. FUNDING: The study has received financial support from several private and one public fund. TRIAL REGISTRATION: The study was approved by the National Ethics Committee (Project-ID: H-C-2009-014).",25 hydroxyvitamin D;alkaline phosphatase;creatinine;parathyroid hormone;thyrotropin;acute heart infarction;adult;age;aged;article;cerebrovascular accident;chemoluminescence;disease association;electrocardiography;female;gender;atrial fibrillation;human;ischemic heart disease;major clinical study;male;questionnaire;season;vitamin D deficiency,"Qayyum, F.;Landex, N. L.;Agner, B. R.;Rasmussen, M.;Jøns, C.;Dixen, U.",2012,,,0,
3571,"The studies on clinical manifestations, histopathology and imaging of MELAS","Objective. To investigate the clinical manifestions, neuropathology and imaging in the patients with MELAS type of mitochondrial encephalomyopathy for exploring the diagnostic method of the disease. Methods. Systemic study was performed on the clinical features, imaging of four MELAS patients. Muscle biopsy and 2 brain biopsies of 3 cases were examined. Results. The main clinical features were characterized by intolerance to exercise, recurrent headache and vomit, focal or generalized seizures, dementia, stroke-like episodes, sensorineural deafness, hypertrophic cardiomyopathy, endocrine dysfunction, short stature, lactic acidosis and so on. Electromyography showed myopathic damage. CT showed calcification in basal ganglia. CT showed multiple low density lesion primarily in gray matter of occipital, parietal and temporal cortex, which was expressed by the abnormal longer T1 and T2-weighted signals on MRI. Muscle biopsy showed red ragged fiber and abnormal mitochondria. Brain biopsy showed laminar necrosis of cortex, astrocytosis, diffused microvascular proliferation and calcification. Four cases were diagnosed as MELAS type. Conclusion According to clinical manifestations and neuroimage features, MELAS is possibly early defined in combination with muscle or/and brain biopsy.",adult;article;brain biopsy;case report;clinical feature;computer assisted tomography;diagnostic imaging;electromyography;encephalomyopathy;female;histopathology;human;human tissue;male;MELAS syndrome;muscle biopsy,"Qi, X.;Qian, H.;Guo, Y.",2001,,,0,
3572,In reply 4,,antihypertensive agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;diuretic agent;uric acid;Alzheimer disease;antihypertensive activity;cardiovascular disease;cardiovascular risk;cerebrovascular accident;dementia;heart failure;human;hypertension;hyperuricemia;letter;obesity;prescription;priority journal;uric acid blood level,"Qiu, C.;Winblad, B.;Fratiglioni, L.",2006,,,0,
3573,Heart failure and risk of dementia and Alzheimer disease: a population-based cohort study,"BACKGROUND: Heart failure has been linked to cognitive impairment in several previous studies, but to our knowledge, no investigations have explored the relationship between heart failure and the risk of dementia. We sought to examine the hypothesis that heart failure is a risk factor for dementia and Alzheimer disease. METHODS: A community-based cohort of 1301 individuals 75 years or older and without dementia in Stockholm, Sweden, was examined 3 times over a 9-year period to detect patients with dementia and Alzheimer disease using the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Heart failure was defined according to the guidelines of the Task Force on Heart Failure of the European Society of Cardiology by integrating clinical symptoms and signs with inpatient register entries and use of cardiac medications. Data were analyzed using Cox proportional hazards models with adjustment for major potential confounders. RESULTS: During the 6534 person-years of follow-up (mean, 5.02 years per person), 440 subjects were diagnosed as having dementia, including 333 with Alzheimer disease. At baseline, heart failure was identified in 205 subjects. Heart failure was associated with a multi-adjusted hazard ratio (HR) of 1.84 (95% confidence interval [CI], 1.35-2.51) for dementia and 1.80 (95% CI, 1.25-2.61) for Alzheimer disease. Use of antihypertensive drugs (83% of which are diuretics) seemed to reduce dementia risk due to heart failure (HR, 1.38; 95% CI, 0.99-1.94). Heart failure and low diastolic pressure (< 70 mm Hg) had an additive effect on the risk for dementia (HR, 3.07; 95% CI, 1.67-5.61). CONCLUSIONS: Heart failure is associated with an increased risk of dementia and Alzheimer disease in older adults. Antihypertensive drug therapy may partially counteract the risk effect of heart failure on dementia disorders.","Aged;Aged, 80 and over;Alzheimer Disease/epidemiology/etiology;Antihypertensive Agents/*therapeutic use;Cohort Studies;Dementia/diagnosis/*epidemiology/*etiology;Female;Follow-Up Studies;Heart Failure/*complications/drug therapy/epidemiology;Humans;Male;Odds Ratio;Risk Assessment;Risk Factors;Sweden/epidemiology","Qiu, C.;Winblad, B.;Marengoni, A.;Klarin, I.;Fastbom, J.;Fratiglioni, L.",2006,May 8,10.1001/archinte.166.9.1003,1,
3574,Vascular risk profiles for dementia and Alzheimer's disease in very old people: a population-based longitudinal study,"Numerous studies have linked individual vascular factors to dementia including Alzheimer's disease (AD). We investigated different vascular risk profiles in relation to dementia and AD among very old people. A standardized follow-up procedure was applied three times to a dementia-free cohort (n=1270, age >or= 75) over a nine-year period to detect dementia and AD cases using the DSM-III-R criteria. We examined two vascular risk profiles, which were scored by counting the number of corresponding vascular factors: 1) atherosclerotic profile included systolic pressure >or= 160 mmHg, diabetes/prediabetes, and stroke; and 2) cerebral hypoperfusion profile constituted diastolic pressure < 70 mmHg, pulse pressure < 70 mmHg, and heart failure. Data were analyzed with Cox proportional-hazards models controlling for major potential confounders. During the 6406 person-years of follow-up, 428 subjects developed dementia, including 328 AD cases. All components of vascular profiles were significantly or marginally associated with increased dementia risk. The risk of dementias was increased with increasing score of both risk profiles (p for trend <or= 0.001); subjects with a score >or= 2 in either profile had an approximately twofold-increased risk for dementia and AD. These data suggest that aggregation of atherosclerotic- and hypoperfusion-related vascular factors increases the risk of dementia in very old people. Severe cerebral atherosclerosis and insufficient perfusion are involved in the development of dementia including AD.","Aged;Aged, 80 and over;*Alzheimer Disease/diagnosis/epidemiology/etiology;Blood Pressure/physiology;Community Health Planning;*Dementia/diagnosis/epidemiology/etiology;Female;*Geriatric Assessment;Heart Rate/physiology;Humans;Longitudinal Studies;Male;Neuropsychological Tests;Proportional Hazards Models;Risk Factors;Vascular Diseases/*complications/epidemiology","Qiu, C.;Xu, W.;Winblad, B.;Fratiglioni, L.",2010,,10.3233/jad-2010-1361,0,
3575,"Risk factors for dementia and Alzheimer' s disease-findings from a community-based cohort study in Stockholm, Sweden","OBJECTIVE: It is known that dementia is a multi-factorial disorder, but the etiological factors other than aging remain to be explored, hence we sought to investigate the risk factors of dementia and Alzheimer's disease (AD). METHODS: We followed a community-based dementia-free cohort (n = 1301) aged 75 years and over in Stockholm, Sweden. Baseline data were obtained through a structured interview and extensive clinical examination, or by reviewing the inpatient register database. We used the DSM-III-R criteria to define dementia and AD cases. RESULTS: Over six years of a follow-up program,350 subjects were diagnosed as dementia, including 260 Alzheimer cases. Multiple Cox regression analysis suggested that older age,low education (< 8 years), cognitive impairment, functional disability (ADL > or = 1), low diastolic pressure (< 70 mm Hg), diabetes mellitus, coronary heart disease, and APOEepsilon4 allele were significantly or marginally associated with subsequent development of dementia and AD. Dementia was related also to stroke and atrial fibrillation. Antihypertensive drug use was associated with a lower risk of AD and dementia. CONCLUSIONS: Our study revealed that some sociodemographic features, cognitive and physical dysfunctions, vascular disorders, and genetic susceptibility were major risk factors for dementia and AD. Use of antihypertensive drugs might protect against the dementing disorders in a very old population.",aged;Alzheimer disease;article;cohort analysis;demography;female;follow up;human;male;risk factor;statistical model;Sweden,"Qiu, C. X.;Winblad, B.;Fratiglioni, L.",2005,,,1,
3576,Does midlife obesity really lower dementia risk? - Authors' reply,,age distribution;body mass;cardiovascular disease;cardiovascular risk;cerebrovascular accident;dementia;disease association;evidence based practice;follow up;heart infarction;human;letter;malignant neoplastic disease;mortality;obesity;priority journal;risk factor;weight change;weight reduction,"Qizilbash, N.;Gregson, J.;Pocock, S.",2015,,,0,
3577,Modifiable risk factors for nursing home-acquired pneumonia,"Background. This study sought to identify modifiable risk factors for pneumonia in elderly nursing home residents. Methods. A cohort of 613 elderly residents (age, >65 years) of 5 nursing homes in the New Haven, Connecticut, area was followed-up prospectively from February 2001 through March 2003. The primary outcome was radiographically documented pneumonia within a 12-month surveillance period. Baseline modifiable risk factors were evaluated for their independent association with pneumonia. Results. Of 613 elderly nursing home residents, 131 (21%) died, and an additional 112 (18%) developed a radiographically documented case of pneumonia during the 12-month surveillance period. Among the 9 candidate modifiable risk factors that were evaluated individually in Cox proportional hazards models adjusting for covariates (i.e., nursing home facility, age, race, coexisting conditions, and immobility), inadequate oral care (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.06-2.35; P = .024) and swallowing difficulty (HR, 1.65; 95% CI, 1.04-2.62; P = .033) were associated with pneumonia. When modifiable risk factors were evaluated simultaneously in the same Cox proportional hazards model, inadequate oral care (HR, 1.55; 95% CI, 1.04-2.30; P = .030) and swallowing difficulty (HR, 1.61; 95% CI, 1.02-2.55; P = .043) remained independently associated with pneumonia, adjusting for the same covariates. Calculation of population-based attributable fractions showed that 21% of all cases of pneumonia in our cohort could have been avoided if inadequate oral care and swallowing difficulty were not present. Conclusions. Two biologically plausible and modifiable risk factors increased the risk of pneumonia in elderly nursing home residents. These results provide a framework for the development and testing of a targeted pneumonia prevention strategy.",antacid agent;dipeptidyl carboxypeptidase inhibitor;sedative agent;aged;aging;article;aspiration pneumonia;neoplasm;cohort analysis;comorbidity;congestive heart failure;daily life activity;dementia;dental procedure;depression;diabetes mellitus;dysphagia;female;geriatric patient;human;immobilization;influenza vaccination;kidney disease;Klebsiella pneumoniae;liver disease;major clinical study;male;malnutrition;mouth hygiene;nursing home;pneumonia;priority journal;risk factor;Staphylococcus aureus;cerebrovascular accident;feeding apparatus,"Quagliarello, V.;Ginter, S.;Han, L.;Van Ness, P.;Allore, H.;Tinetti, M.",2005,,,0,
3578,Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries,"With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson comorbidity index to mortality is likely to have changed since development of the index in 1984. The authors reevaluated the Charlson index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data. © The Author 2011.",acquired immune deficiency syndrome;aged;article;Australia;Canada;cerebrovascular disease;Charlson Comorbidity Index;chronic disease;chronic lung disease;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;female;France;health care quality;heart infarction;hemiplegia;hospital discharge;human;Human immunodeficiency virus infection;Japanese (people);kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;metastasis;mortality;New Zealand;nonparametric test;paraplegia;peptic ulcer;peripheral vascular disease;prediction;rheumatic disease;risk assessment;scoring system;solid tumor;Switzerland;validation process,"Quan, H.;Li, B.;Couris, C. M.;Fushimi, K.;Graham, P.;Hider, P.;Januel, J. M.;Sundararajan, V.",2011,,,0,
3579,Atherosclerosis and central adiposity in a pediatric patient with AIDS treated with HAART: Autopsy findings,"Several types of cardiovascular lesions may develop in pediatric human immunodeficiency virus-positive (HIV+)/ acquired immunodeficiency syndrome (AIDS) patients, namely myocarditis, dilated cardiomyopathy, pericardial effusion, pericarditis, left ventricle hypertrophy, fibrocalcific arteriopathy, and aneurysms. Additional lesions may be discovered by histological examination. These include fibrocalcific lesions in medium-sized arteries and small vessels, mainly of the heart and brain, and vasculitis. In the large arteries the vasa vasorum may present chronic inflammatory infiltrates or leukocytoclastic vasculitis, resulting in aneurysms. We are reporting the case of a 14-year-old girl with mother-to-infant HIV transmission with a long history of several central nervous system infections and AIDS dementia, who received treatment with the HAART protocol (including a protease inhibitor) for 3 years. A year after beginning this treatment, cholesterol serum levels were 2.8 g/L and 3.8 g/L. Autopsy findings showed gross and microscopic features of adult-type atherosclerosis involving the whole thoracic aorta, its main branches, and the coronary arteries. Remarkably, the abdominal aorta and all its branches were almost completely devoid of these lesions. At the same time, although the body presented extreme cachexia, there were obvious subepericardial, periadrenal, and peripancreatic fat deposits. The referred findings may have resulted from the well-known metabolic-dyslipemic syndrome induced by the HAART therapy and have not been specifically mentioned previously in the literature in the particular setting observed in the case of this patient. © 2006 Society for Pediatric Pathology.",cholesterol;didanosine;lamivudine;proteinase inhibitor;ritonavir;zidovudine;acquired immune deficiency syndrome;adolescent;article;atherosclerosis;autopsy;case report;cerebrospinal fluid analysis;cholesterol blood level;clinical feature;computer assisted tomography;cryptococcosis;disease association;female;highly active antiretroviral therapy;histopathology;human;Human immunodeficiency virus infected patient;meningoencephalitis;obesity;priority journal,"Quijano, G.;Drut, R.",2006,,,0,
3580,Obesity in the elderly,"Our population is ageing, and obesity is increasing in the elderly. BMI value associated with the lowest relative mortality is slightly higher in older than in younger (between 25 and 32kg/m2). Nevertheless, the combined effect of aging and obesity increases the risk of comorbidities, including type 2 diabetes mellitus, cardiovascular risk, respiratory insufficiency, obstructive sleep apneas, cancer, urinary incontinence and dementia. The medical consequences of obesity are alleviated by modest, achievable weight loss (5-10kg) with an evidence-based maintenance strategy. A combination of exercise and modest calorie restriction appears to be the optimal method of reducing fat mass and preserving muscle mass. The clinical outcomes have been evaluated in diabetes mellitus and in cardiovascular diseases, showing favorable effects on the morbidity and probably on the mortality. Very-low-energy diets have to be avoided for elderly patients. The risk of muscle loss increases with the level of diet restriction. In older people, the risks of laparoscopic bariatric surgery are not higher than in younger but the benefits have not been evaluated. The sarcopenic obesity (excess in body fat and loss of muscle mass and function) burdens the functional consequences of obesity in older people. Since sarcopenia is frequent in the elderly, a screening should be done in obese patients for whom a restrictive diet is not recommended. In renal or cardiac insufficiency, only physical activity can be recommended. In elderly people, weight management interventions using moderate calorie restriction and physical activity exercise are recommended. Daily protein intake must be maintained. Health benefits and risks from long-term weight management in obese elderly have to be studied in randomized controlled studies. © 2013 Elsevier Masson SAS.",aging;article;bariatric surgery;caloric restriction;cardiovascular risk;comorbidity;dementia;disease association;elderly care;evidence based medicine;fat mass;functional status;heart failure;human;kinesiotherapy;laparoscopic surgery;low calory diet;muscle atrophy;muscle mass;neoplasm;non insulin dependent diabetes mellitus;obesity;protein intake;respiratory failure;risk benefit analysis;risk factor;sarcopenia;sleep disordered breathing;surgical risk;treatment planning;urine incontinence;weight reduction,"Quilliot, D.;Böhme, P.;Malgras, A.;Ziegler, O.",2013,,,0,
3581,Comorbidities alone do not explain the undertreatment of colorectal cancer in older adults: A French population-based study,"OBJECTIVES: To investigate the influence of comorbidities on treatment modalities of colorectal cancer according to the age of patients and French recommendations. DESIGN: Population-based study SETTING: French Digestive Cancer Registry, Burgundy. PARTICIPANTS: Two thousand nine hundred twenty-one incident colorectal cancers diagnosed between 2004 and 2007. MEASUREMENTS: The independent influence of comorbidities (recorded according to the Charlson index) on treatment was analyzed using multivariate logistic regressions controlling for age, sex, and their interaction. RESULTS: The association between comorbidities and resection for cure was significant only in patients younger than 75 (P interaction=.008). For Stage III colon cancer, 40.4% of the patients aged 75 and older had adjuvant chemotherapy, versus 90.5% of those younger than 75 (P<.001). The association between comorbidities and adjuvant chemotherapy for Stage III colon cancer was significant only in patients younger than 75 (P interaction=.004). Patients aged 75 and older were less likely to receive chemotherapy, even when they had few or no comorbidities. Overall, 29.3% of patients aged 75 and older with advanced colorectal cancer had palliative chemotherapy, versus 77.1% of those younger than 75 (P<.001). Whatever the age, palliative chemotherapy was less frequent for a Charlson comorbidity index of 2 or greater (P interaction=.16). Radiotherapy was administered in 59.0% of patients aged 75 and older with rectal cancer, versus 85.3% of those younger than 75 (P<.001). Whatever the age, patients with a Charlson score of 2 or greater were less likely to receive radiotherapy for rectal cancer than were patients without comorbidities (P interaction=.86). CONCLUSION: Further studies are warranted to identify more precisely the reasons for lower treatment rates for colorectal cancer in the older population. © 2011, The American Geriatrics Society.",antineoplastic agent;adjuvant chemotherapy;aged;article;cancer chemotherapy;cancer palliative therapy;cancer radiotherapy;cancer staging;cerebrovascular disease;colon cancer;colorectal cancer;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;disease association;geriatric disorder;heart infarction;hemiplegia;human;kidney disease;leukemia;liver disease;lymphoma;major clinical study;peptic ulcer;peripheral vascular disease;rectum cancer,"Quipourt, V.;Jooste, V.;Cottet, V.;Faivre, J.;Bouvier, A. M.",2011,,,0,
3582,First line chemotherapy with gemcitabine in advanced non-small cell lung cancer elderly patients: A randomized phase II study of 3-week versus 4-week schedule,"Purpose: This randomized phase II multicenter trial aimed at evaluating the efficacy and safety of the 4-week versus 3-week schedules of gemcitabine monotherapy in previously untreated elderly patients with advanced non-small cell lung cancer (NSCLC). Patients and methods: Chemonaive patients with stage IIIB or IV NSCLC, and age between 70 and 90 years, were randomized to receive gemcitabine dose of either 1000 mg/m2 on days 1, 8, 15, every 28 days (arm Q4W), or 1125 mg/m2 on days 1 and 8, every 21 days (arm Q3W). Results: From June 1999 to January 2001, 81 patients (42 on arm Q4W; 39 on arm Q3W) were included. The median age was 75 on both arms; most patients (82.7%) were male, and had a Karnofsky performance status of 80 or 90 (76.5%). For arms Q4W and Q3W, respectively, the median time to treatment failure was 83 days (95% CI, 69-98 days) versus 92 days (95% CI, 63-113), and the median survival was 154 days (95% CI, 108-227) versus 205 days (95% CI, 125-344). The objective response rate was higher on arm Q3W (28.2%) than on arm Q4W (14.3%). Total number of cycles administered was 132 on arm Q4W (median 3, range 1-10 cycles) and 169 on arm Q3W (median 4, range 1-9 cycles). Patients on arm Q4W and Q3W, respectively, received 100.1 and 99.8% of the planned weekly mean dose. The most common grade, three to four toxicities, was neutropenia (17.1% on arm Q4W versus 18.9% on arm Q3W) and thrombocytopenia (12.2% on arm Q4W versus 2.6% on arm Q3W). Conclusion: Although both 3- and 4-week gemcitabine regimens were safely and effectively administered in chemonaive elderly patients with advanced NSCLC, the 3-week schedule appears to be the more convenient for this population. Moreover, even if this is only a phase II study this 3-week schedule appears to be at least as efficient as the 4-week regimen. © 2004 Elsevier Ireland Ltd. All rights reserved.",alkaline phosphatase;creatinine;gemcitabine;kidney enzyme;liver enzyme;acute heart infarction;advanced cancer;aged;alopecia;anemia;article;bleeding;blood toxicity;bone marrow suppression;cancer chemotherapy;cancer survival;clinical trial;colic;confidence interval;controlled clinical trial;controlled study;diarrhea;digestive system hemorrhage;disease course;drug dose regimen;drug efficacy;drug fatality;drug safety;drug screening;drug tolerance;enzyme defect;febrile neutropenia;female;heart failure;human;infection;intestine necrosis;leukopenia;lung edema;non small cell lung cancer;lung toxicity;major clinical study;male;monotherapy;mucosa inflammation;multicenter study;multiinfarct dementia;nausea;neutropenia;peritonitis;phase 2 clinical trial;postoperative complication;primary health care;priority journal;prognosis;randomized controlled trial;respiratory failure;septic shock;thrombocytopenia;treatment failure;treatment outcome;treatment planning;vomiting;gemzar,"Quoix, E.;Breton, J. L.;Ducoloné, A.;Mennecier, B.;Depierre, A.;Lemarié, E.;Moro-Sibilot, D.;Germa, C.;Neidhardt, A. C.",2005,,,0,
3583,Clinical trials in stroke in 2002,,amlodipine;antihypertensive agent;antilipemic agent;calcium channel blocking agent;chlortalidone;dipeptidyl carboxypeptidase inhibitor;diuretic agent;donepezil;hydroxymethylglutaryl coenzyme A reductase inhibitor;lisinopril;placebo;pravastatin;simvastatin;Alzheimer disease;clinical trial;drug induced cancer;heart death;heart infarction;heart protection;human;hypertension;ischemic heart disease;multiinfarct dementia;note;risk benefit analysis;cerebrovascular accident,"Rabadi, M. H.;Blass, J.",2003,,,0,
3584,Sedentarity--sedentary lifestyle and physical activity,"Physical inactivity is the most important planetary reason for non-transmissible mortality. Technical developments have allowed a sedentary lifestyle. This causes health problems such as insulin resistance, atherosclerosis, heart failure and obesity. In addition, disturbances of bones and muscles as well as dementia of the Alzheimer type are associated with sedentarity. Assessing this risk factor and attempting to increase physical activity should be a very important part of any general practitioner's measures.",Cardiovascular Diseases/*epidemiology/*prevention & control;Causality;*Health Behavior;*Life Style;Mortality;*Motor Activity;*Physical Fitness;Risk Assessment/*methods;Risk Factors;Risk Reduction Behavior,"Rabaeus, M.",2005,Sep,10.1024/0040-5930.62.9.651,0,
3585,Intensive lowering of blood pressure: Should we SPRINT?,,blood pressure measurement;blood pressure monitoring;cardiovascular risk;cerebrovascular accident;chronic kidney failure;dementia;disease association;Framingham risk score;glomerulus filtration rate;heart failure;heart infarction;high risk population;human;incidence;ischemic heart disease;life expectancy;mortality;note;numbers needed to treat;risk reduction;systolic blood pressure;Systolic Blood Pressure Intervention Trial,"Rabi, D. M.;Padwal, R.",2016,,10.1503/cmaj.160147,0,
3586,Evidence for reduction of pro-atherosclerotic properties in platelets from healthy centenarians,"The aim of the present study was to investigate if aging is associated with platelet membrane modifications possibly related with cellular activation and hyperaggregability and if platelets from centenarians show different properties which might play a role in successful aging and longevity. Platelet plasma membranes were obtained from 60 healthy subjects, divided into four groups according to the age range: (1) 21-39 years; (2) 40-59 years; (3) 60-79 years; (4) centenarians (>/=100 years). Both centenarians and control subjects were submitted to the following inclusion criteria: liver, kidney, and thyroid function tests within the normal range; absence of history of diabetes, hypertension or coronary heart disease; no signs of edema or dehydration; no drug or vitamin supplement in the 4 weeks before the study; absence of Alzheimer's disease or secondary dementia. The following determinations were performed: lipid peroxide levels (Lp) evaluated by the measurement of thiobarbituric acid (TBA) reactivity, fluidity studied by the fluorescence anisotropy of the probe 1-(4-trimethylaminophenyl)-6-phenyl-1,3,5-hexatriene (TMA-DPH), Na(+)/K(+)-ATPase activity measured by the method of Kitao and Hattori, and sialic acid (SA) content evaluated by the periodate-thiobarbituric acid method. Centenarians showed: (i) Lp concentrations lower than elderly subjects; (ii) increased Na(+)/K(+)-ATPase activity compared with adult and elderly subjects; (iii) higher TMA-DPH anisotropy than elderly subjects; (iv) SA content similar to the young and adult groups.The present work found deep platelet membrane modifications in centenarians compared with elderly subjects. These changes are likely associated with a decreased platelet activation and therefore might exert a protective role against cardiovascular accidents, as platelet activation is a key event in the initiation and progression of arteriosclerosis.",Adult;Aged;Aging/*physiology;Arteriosclerosis/blood;Blood Platelets/*physiology;Humans;Kidney Function Tests;Liver Function Tests;*Membrane Fluidity;Middle Aged;N-Acetylneuraminic Acid/analysis;Platelet Function Tests;Sodium-Potassium-Exchanging ATPase/analysis;Thiobarbituric Acid Reactive Substances/metabolism;Thyroid Function Tests,"Rabini, R. A.;Vignini, A.;Martarelli, D.;Nanetti, L.;Salvolini, E.;Rizzo, M. R.;Ragno, E.;Paolisso, G.;Franceschi, C.;Mazzanti, L.",2003,Apr,,0,
3587,Centenarian patients attended at a general hospital,"BACKGROUND: To report the social and medical situation of centenarian patients who required emergency hospital care during the last 8 years. METHOD: Retrospective study of patients aged over 100 years attended at the Emergency Department of a general hospital. The percentages of admissions and mortality rates were then compared with those among patients aged over 65. RESULTS: A total of 51 consultations from 41 patients were recorded, with a mean age of 101.2 years. The number of consultations increased gradually with time (p = 0.008). Ninety-three percent of patients lived with their families, predominantly in the rural setting. The most prevalent conditions included the prostatic syndrome (among males), heart failure and chronic obstruction to the airflow. Only 20% of patients had dementia. Sixty-four percent of consultations required hospital admission, with a mortality rate of 20.5% in this group of patients. The most common discharge diagnoses were heart failure and acute cerebrovascular accident. CONCLUSIONS: A gradual increase in hospital care is likely to be excepted among centenarians, who have an acceptable health status, although with a high risk of mortality during hospital admission.","Aged;Aged, 80 and over/*statistics & numerical data;Female;Geriatrics/statistics & numerical data;Health Services for the Aged/*utilization;Hospital Mortality;Hospitals, General/*utilization;Humans;Male;Patient Admission/*statistics & numerical data;Retrospective Studies;Spain","Rabunal Rey, R.;Monte Secades, R.;Rigueiro Veloso, M. T.;Casariego Vales, E. J.;Ibanez Alonso, M. D.;Garcia Pais, M. J.",2002,Jun,,0,
3588,Molecular basis of human CD36 gene mutations,"CD36 is a transmembrane glycoprotein of the class B scavenger receptor family. The CD36 gene is located on chromosome 7 q11.2 and is encoded by 15 exons. Defective CD36 is a likely candidate gene for impaired fatty acid metabolism, glucose intolerance, atherosclerosis, arterial hypertension, diabetes, cardiomyopathy, Alzheimer disease, and modification of the clinical course of malaria. Contradictory data concerning the effects of antiatherosclerotic drugs on CD36 expression indicate that further investigation of the role of CD36 in the development of atherosclerosis may be important for the prevention and treatment of this disease. This review summarizes current knowledge of CD36 gene structure, splicing, and mutations and the molecular, metabolic, and clinical consequences of these phenomena.","Alternative Splicing/genetics;Amino Acid Sequence;Antigens, CD36/chemistry/*genetics/metabolism;Base Sequence;Humans;Molecular Sequence Data;Mutation/*genetics;Protein Processing, Post-Translational/genetics","Rac, M. E.;Safranow, K.;Poncyljusz, W.",2007,May-Jun,10.2119/2006-00088.Raae,0,
3589,Effects of oestrogen deprivation on interleukin-6 production by peripheral blood mononuclear cells of postmenopausal women,"Various hormones can influence the expression of interleukin-6 (IL-6) and oestrogens are the most extensively studied. There is, however, controversy about the nature of the IL-6 secreted by human cells and its regulation by 17beta-oestradiol. The aim of this work was to clarify whether oestrogen deprivation after menopause may contribute to an enhanced IL-6 production by peripheral blood mononuclear cells (PBMC) in postmenopausal women. Twenty-two healthy postmenopausal women, age range 45-63 years, with clinical symptoms of oestrogen deficiency were enrolled in the study. The control group consisted of 16 healthy young women, age range 22-31 years, with regular menses and who were not taking oral contraceptives. Levels of IL-6 in the sera and PBMC culture supernatants were measured by the biological B9 cell-proliferation assay and expression of the IL-6 gene in non-stimulated PBMC was detected by RT-PCR. The effect of 17beta-oestradiol on spontaneous IL-6 production by the PBMC of postmenopausal women was also studied in vitro and in vivo. Seventeen out of the twenty-two postmenopausal women were given hormonal replacement therapy of 50 microg 17beta-oestradiol/day transdermally and the spontaneous production of IL-6 by the PBMC was analysed after 6 and 12 months of treatment. The postmenopausal women had significantly higher serum levels of IL-6 than the young controls. The spontaneous production of IL-6 by non-stimulated PBMC into the culture supernatants was also significantly higher in the postmenopausal women compared with the young. We also found that IL-6 gene expression was present in the non-stimulated PBMC isolated directly from the venous blood of the majority of the postmenopausal women. Women with IL-6 gene expression in the non-stimulated PBMC had significantly lower serum levels of 17beta-oestradiol compared with those where the IL-6 gene was not expressed in the PBMC. Our in vitro experiments showed that 17beta-oestradiol at concentrations of 10(-9) M and 10(-10) M decreased spontaneous IL-6 production by the PBMC of postmenopausal women. In vivo treatment with 17beta-oestradiol transdermally also significantly decreased spontaneous IL-6 production by the PBMC of postmenopausal women after 12 months of the therapy. Our results indicate that oestrogen deprivation after menopause may enhance IL-6 production by the PBMC of postmenopausal women. We suspect that the late complications of oestrogen deficiency, such as osteoporosis, coronary heart disease and Alzheimer's disease, may be mediated by an exaggerated production of IL-6 - a cytokine which seems to play a pivotal role in the pathogenesis of these age-related diseases.","Administration, Cutaneous;Adult;Alzheimer Disease/metabolism;Biological Assay;Case-Control Studies;Coronary Disease/metabolism;Estradiol/blood/*deficiency/therapeutic use;Female;Follicle Stimulating Hormone/blood;Humans;Interleukin-6/*biosynthesis;Leukocytes, Mononuclear/drug effects/*metabolism;Middle Aged;Osteoporosis, Postmenopausal/metabolism;Postmenopause/*metabolism","Rachon, D.;Mysliwska, J.;Suchecka-Rachon, K.;Wieckiewicz, J.;Mysliwski, A.",2002,Feb,,0,
3590,Comorbidity affects all domains of physical function and quality of life in patients with rheumatoid arthritis,"Objective: Comorbidities have been reported to influence physical function, but it is not clear which activities are predominantly impaired, or which other domains of health status are affected in addition to physical function. In this study, we investigated the impact of comorbidities on individual activities of daily living, and other aspects of quality of live in patients with RA. Methods: In 380 patients with established RA, we quantified comorbidity levels according to the age-adjusted Charlson Comorbidity Index (CCIA) and functional disability by serial measures of the HAQ over 1 year. In a subset of 185 patients, we assessed quality of life using Short Form-36 (SF-36). To analyse the relationship between comorbidities, different activities of daily living and health status, we divided patients into four subgroups of CCIA and performed analysis of variance (ANOVA) and multivariable general linear regression models adjusted for gender, disease duration and disease activity. Results: ANOVA showed significant (P<0.03) increase of disability within each domain of HAQ with increasing level of comorbidity. Similar results were observed using the physical component score (P = 0.003) of the SF-36 and its domains, whereas mental component score (P = 0.31) and its domains were unaffected by comorbidities. In a sub-analysis stratifying patients into different levels of disease activity, we found increase in almost all domains of HAQ within respective groups of CCIA. Conclusions: Activities of daily living represented by HAQ are equally affected by comorbidities. More generally, health status was only affected with respect to its physical but not its mental domains. © The Author 2010. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.",acquired immune deficiency syndrome;adult;aged;analysis of variance;article;cerebrovascular disease;chronic lung disease;comorbidity;congestive heart failure;daily life activity;dementia;diabetes mellitus;disease activity;disease duration;female;functional disease;gender;health status;heart infarction;hemiplegia;human;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;mortality;multiple linear regression analysis;paraplegia;peptic ulcer;peripheral vascular disease;priority journal;quality of life;rheumatic disease;rheumatoid arthritis;scoring system;Short Form 36;solid tumor,"Radner, H.;Smolen, J. S.;Aletaha, D.",2011,,,0,
3591,Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002-2012,"Objective This study aimed to assess the impact of individual comorbid conditions as well as the weight assignment, predictive properties and discriminating power of the Charlson Comorbidity Index (CCI) on outcome in patients with acute coronary syndrome (ACS). Methods A prospective multicentre observational study (AMIS Plus Registry) from 69 Swiss hospitals with 29 620 ACS patients enrolled from 2002 to 2012. The main outcome measures were in-hospital and 1-year follow-up mortality. Results Of the patients, 27% were female (age 72.1 ±12.6 years) and 73% were male (64.2±12.9 years). 46.8% had comorbidities and they were less likely to receive guideline-recommended drug therapy and reperfusion. Heart failure (adjusted OR 1.88; 95% CI 1.57 to 2.25), metastatic tumours (OR 2.25; 95% CI 1.60 to 3.19), renal diseases (OR 1.84; 95% CI 1.60 to 2.11) and diabetes (OR 1.35; 95% CI 1.19 to 1.54) were strong predictors of in-hospital mortality. In this population, CCI weighted the history of prior myocardial infarction higher (1 instead of -0.4, 95% CI -1.2 to 0.3 points) but heart failure (1 instead of 3.7, 95% CI 2.6 to 4.7) and renal disease (2 instead of 3.5, 95% CI 2.7 to 4.4) lower than the benchmark, where all comorbidities, age and gender were used as predictors. However, the model with CCI and age has an identical discrimination to this benchmark (areas under the receiver operating characteristic curves were both 0.76). Conclusions Comorbidities greatly influenced clinical presentation, therapies received and the outcome of patients admitted with ACS. Heart failure, diabetes, renal disease or metastatic tumours had a major impact on mortality. CCI seems to be an appropriate prognostic indicator for in-hospital and 1-year outcomes in ACS patients. ClinicalTrials.gov Identifier NCT01305785.",NCT01305785;acetylsalicylic acid;angiotensin receptor antagonist;clopidogrel;dipeptidyl carboxypeptidase inhibitor;heparin;low molecular weight heparin;prasugrel;ticagrelor;acquired immune deficiency syndrome;acute coronary syndrome;adult;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;connective tissue disease;controlled study;dementia;diabetes mellitus;female;follow up;heart failure;heart infarction;hemiplegia;hospital admission;hospital patient;human;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;malignant neoplastic disease;mortality;multicenter study;observational study;outcome assessment;peptic ulcer;peripheral vascular disease;priority journal;prospective study;validation study,"Radovanovic, D.;Seifert, B.;Urban, P.;Eberli, F. R.;Rickli, H.;Bertel, O.;Puhan, M. A.;Erne, P.",2014,,,0,
3592,Mortality patterns in Kuwait: inferences from death certificate data,"Two main features of the mortality pattern in Kuwait are very low crude death rates, not exceeding 2.3 per 1,000, and a high frequency of traffic accidents, ranking as the second leading cause of death. In quantitative terms, mortality statistics in Kuwait have reached their objectives in that coverage approaches 100%. However, quality of data still suffers from apparent shortcomings, as exemplified by senility (without mention of psychosis) as the sixth leading cause of death. Huge oscillations in the frequency of some conditions from one year to the next one are even more indicative of the dubious reliability of the information on the death certificate. These variations occur across the board and do not characterize only a pre-war/post-war comparison. Coding inconsistencies are not restricted to the same group of diseases (e.g., cardiovascular disorders) but appear to comprise shifts in coding between different groups of diseases (e.g., pneumonia and disorders related to short gestation). Socially undesirable causes of death are, in particular, an area where reliability of data may be easily challenged on logical grounds. If raw mortality data were taken for granted, they could be very misleading. Providing for a cautious interpretation, however, these data may still be fairly informative. PIP: This study examines the mortality patterns of Kuwaitis and non-Kuwaitis during 1987-92. Population in Kuwait declined from about 2 million in the late 1980s, of which about 28% were nationals, to 1.4 million in June 1992. The war in 1990-91 contributed to the departures of both Kuwaitis and non-Kuwaitis. Crude mortality rates, with the exception of the war years, are estimated to be 2.2 and 2.3 per 1000, and 2.5 for males and 2.0 for females. Standardized rates are three times higher (7 per 1000 for both Kuwaitis and non-Kuwaitis). Differences in causes of death are apparent between nationals and others. Three patterns are considered characteristic for Kuwait: 1) crude death rates are low; 2) the leading causes of death are ranked peculiarly; 3) the number of certified causes of death in a very short time period shows major changes. Kuwait has very high fertility and a very young population. Non-Kuwaitis are described as being healthy due to pre-employment requirements, having a high turnover of expatriates, and not having any retired expatriates. Traffic accidents are given as the second leading cause of death. External causes, which include traffic accidents, constitute 16% of all causes in 1986 and 18% in 1992. Cardiovascular diseases are 31-35% of total deaths, and malignant neoplasms are 10-12% of deaths. The high number of traffic accidents is attributed to the lack of technical experience of motorists and the dense network of highways. Death certificates and recorded causes of death are considered unreliable. The example is given of the high frequency of senility as an underlying cause. Frequency changes can be considerable from one year to the next. For example, acute myocardial infarction rates declined by almost half during 1988-92. Ischemic heart disease by 1992 became a leading cause of death from a fourth-ranked position in 1988. Coding consistencies appear to be within the same group of illnesses. Unlikely patterns are also evident for diabetes mellitus rates. The ratio of male/female cause-specific mortality rates is 7:1. eng","Accidents, Traffic/mortality;Aging;Cardiovascular Diseases/mortality;*Death Certificates;Dementia/mortality;Female;Fetal Death/epidemiology;Forms and Records Control;Humans;Infant Mortality;Infant, Newborn;Kuwait/epidemiology;Male;Mental Disorders/mortality;*Mortality;Pneumonia/mortality;Pregnancy;Psychotic Disorders/mortality;Reproducibility of Results;Suicide/statistics & numerical data;*Accidental Deaths;Arab Countries;Asia;*Causes Of Death;*Death Records;Demographic Factors;Developing Countries;Kuwait;Political Factors;Population;Population Dynamics;Population Statistics;Research Methodology;Vital Statistics;*War;Western Asia","Radovanovic, Z.",1994,Dec,,0,
3593,Tympanoplasty in geriatric patients: surgical considerations,"The outcomes of tympanoplasty in the elderly are generally no different from those in the young. Although some reports suggest that hearing results were not as good in patients older than 60, the instance of graft failure in these patients did not differ greatly by age. Patients older than 65 do have the highest incidence of perioperative death or complications, with elderly men being at a greater risk than elderly women. The risk is also higher in patients who have concomitant diseases, such as coronary artery disease, congestive heart failure, myocardial infarction, diabetes mellitus, hypertension, renal disease, chronic obstructive pulmonary disease, cerebral vascular disease, dementia, and peripheral vascular disease. The presence of coexisting disease is more important than age itself, although physiologic age is more important than chronological age.","Aged;Aged, 80 and over;Female;Health Status;Humans;Male;Middle Aged;*Postoperative Complications;Risk Factors;Tympanic Membrane/*surgery;*Tympanoplasty","Radpour, S.",1999,Jul,,0,
3594,Homocysteine measurements in geriatric patients,"OBJECTIVE: Homocysteine measurements may be relevant in geriatric medicine as homocysteine has been identified as an independent risk factor for prevalent disorders such as occlusive arterial vascular disease, cognitive impairment and dementia. The aim of the present study was to study diagnostic correlates of plasma total homocysteine (tHcy) in geriatric in-patients. MATERIAL AND METHODS: Blood samples for the analysis of tHcy and related factors like serum vitamin B12, serum folate, red blood cell folate and clinical data were collected from geriatric patients (n=114) in stable clinical condition. RESULTS: Almost 40% of the patients had tHcy values above 20 micromol/L. tHcy correlated significantly with serum folate, serum vitamin B12, serum creatinine and congestive heart failure, but not with red blood cell folate, cerebrovascular disease, coronary heart disease or cognitive impairment. CONCLUSIONS: Hyperhomocysteinaemia seems to be frequent in geriatric patients and might primarily be an indicator of low folate and high creatinine values.","Aged;Aged, 80 and over;Diagnosis, Differential;Female;Folic Acid Deficiency/diagnosis;Heart Failure/diagnosis;Homocysteine/*blood;Humans;Hyperhomocysteinemia/*diagnosis/etiology;Male;Reference Values;Regression Analysis;Risk Factors;Vitamin B 12 Deficiency/diagnosis","Raeder, S.;Landaas, S.;Laake, K.;Lyberg, T.;Engedal, K.",2006,,10.1080/00365510600615972,0,
3595,Oxidative stress and the paradoxical effects of antioxidants,,alpha tocopherol;antioxidant;ascorbic acid;catalase;glutathione;retinol;superoxide dismutase;altitude disease;Alzheimer disease;atherosclerosis;diet supplementation;heart failure;heart infarction;ischemic heart disease;kidney failure;letter;neoplasm;oxidative stress,"Rafieian-Kopaei, M.;Baradaran, A.;Rafieian, M.",2013,,,0,
3596,Peripheral arterial disease and cognitive function,"As a marker of generalized atherosclerosis, peripheral arterial disease (PAD) has implications not only for the affected lower extremity but also to overall cardiovascular health. It confers an increased risk of non-fatal and fatal vascular events which increases with the severity of the disease. Patient-based studies have shown that individuals with advanced PAD tend to perform poorly on cognitive tests compared to controls. In population studies, PAD is associated with an increased cognitive decline independently of previous cerebrovascular disease and cardiovascular risk factors. A low ankle-brachial index (ABI) may be an early predictor of cognitive decline and of potential value in identifying individuals at increased risk of cognitive impairment. In patients with PAD, secondary preventive measures directed at decreasing the long-term systemic vascular complications may also be important to the preservation of cognitive health. However, evidence suggests that PAD patients may be undertreated with regard to atherosclerotic risk factors, as demonstrated by an undue emphasis on symptom relief rather than essential risk factor reduction. More research needs to be carried out to determine the predictors of cognitive function in PAD patients, whether subtle cognitive disturbances are related to activities of daily living, including medical treatment compliance, and whether neuroprotective strategies and atherosclerotic risk factor control positively influence cognitive function in these high-risk patients. © 2009 SAGE Publications.",antihypertensive agent;antilipemic agent;antioxidant;antithrombocytic agent;dipeptidyl carboxypeptidase inhibitor;ankle brachial index;article;brain atherosclerosis;brain cortex lesion;brain infarction;brain protection;cardiovascular disease;cardiovascular risk;cerebrovascular accident;clinical trial;cognitive defect;disease association;human;intermittent claudication;ischemic heart disease;leg amputation;memory disorder;mental deterioration;mental performance;neuropathology;peripheral vascular disease;priority journal;psychometry;risk factor;risk reduction;secondary prevention;smoking cessation;verbal memory,"Rafnsson, S. B.;Deary, I. J.;Fowkes, F. G. R.",2009,,,0,
3597,Cardiovascular diseases and decline in cognitive function in an elderly community population: The Edinburgh Artery Study,"OBJECTIVE: To investigate cognitive performance and 4-year change in cognitive function in relation to different clinical manifestations of atherosclerotic disease in an elderly community population. METHODS: The Edinburgh Artery Study is a population cohort study of men and women who were recruited to a baseline survey in 1987 and 1988. From the time of study entry, the participants have been invited to two follow-up clinical examinations and continuously monitored for major fatal and nonfatal vascular events. All alive and eligible subjects were invited for cognitive testing in two study years when the mean age of the sample was 73.1 (standard deviation = 5.0) years. A follow-up cognitive assessment was performed in 2002 and 2003 on 452 survivors. RESULTS: In multivariate analyses controlling for demographic characteristics, depression, and major atherosclerotic risk factors, stroke was associated with a significantly worse performance on tests of verbal memory (p = .02) and letter fluency (p = .002). In addition, stroke was related to a significantly steeper 4-year decline in verbal memory performance (p = .04). Among the subjects who had not had an overt stroke, those with symptomatic peripheral arterial disease experienced a significantly greater 4-year decline in verbal memory functioning (p = .04). CONCLUSIONS: In older people, stroke is associated with both worse performance on cognitive tests and progressive verbal memory decline. Elderly individuals with vascular diseases other than stroke may also be vulnerable to a greater decline in verbal memory function. A relationship between vascular diseases and verbal memory decline may exist independently of depressed mood and major atherosclerotic risk factors. Copyright © 2007 by American Psychosomatic Society.",adult;aged;article;cardiovascular disease;clinical examination;clinical feature;cohort analysis;community assessment;community sample;coronary artery atherosclerosis;demography;edinburgh artery study;female;follow up;geriatric patient;health survey;human;major clinical study;male;memory consolidation;mental deterioration;methodology;multivariate analysis;priority journal;psychologic assessment;risk factor;sample size;cerebrovascular accident;survivor;task performance;verbal memory;word recognition,"Rafnsson, S. B.;Deary, I. J.;Smith, F. B.;Whiteman, M. C.;Fowkes, F. G. R.",2007,,,0,
3598,Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial,"DESIGNCost effectiveness analysis.SETTING19 general practices in north east Scotland.PARTICIPANTS1343 patients (673 in intervention group and 670 in control group, as originally randomised) aged under 80 years with a diagnosis of coronary heart disease but without terminal illness or dementia and not housebound.INTERVENTIONNurse led clinics to promote medical and lifestyle components of secondary prevention.MAIN OUTCOME MEASURESCosts of clinics; overall costs to health service; and cost per life year and per quality adjusted life year (QALY) gained, expressed as incremental gain in intervention group compared with control group.RESULTSThe cost of the intervention (clinics and drugs) was 136 pounds sterling (254 dollars; 195 euros) per patient higher (1998-9 prices) in the intervention group, but the difference in other NHS costs, although lower for the intervention group, was not statistically significant. Overall, 28 fewer deaths occurred in the intervention group leading to a gain in mean life years per patient of 0.110 and of 0.124 QALYs. The incremental cost per life year saved was 1236 pounds sterling and that per QALY was 1097 pounds sterling.CONCLUSIONNurse led clinics for the secondary prevention of coronary heart disease in primary care seem to be cost effective compared with most interventions in health care, with the main gains in life years saved.OBJECTIVETo establish the cost effectiveness of nurse led secondary prevention clinics for coronary heart disease based on four years' follow up of a randomised controlled trial.",Coronary Disease [economics] [nursing] [prevention & control];Cost of Illness;Cost-Benefit Analysis;Family Practice [economics];Follow-Up Studies;Hospitalization [economics];Quality-Adjusted Life Years;Scotland;Adult[checkword];Aged[checkword];Humans[checkword];Middle Aged[checkword];Sr-commun: sr-vasc: sr-epoc,"Raftery, Jp;Yao, Gl;Murchie, P;Campbell, Nc;Ritchie, Ld",2005,,10.1136/bmj.38342.665417.8F,0,3599
3599,Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial,"OBJECTIVE: To establish the cost effectiveness of nurse led secondary prevention clinics for coronary heart disease based on four years' follow up of a randomised controlled trial. DESIGN: Cost effectiveness analysis. SETTING: 19 general practices in north east Scotland. PARTICIPANTS: 1343 patients (673 in intervention group and 670 in control group, as originally randomised) aged under 80 years with a diagnosis of coronary heart disease but without terminal illness or dementia and not housebound. INTERVENTION: Nurse led clinics to promote medical and lifestyle components of secondary prevention. MAIN OUTCOME MEASURES: Costs of clinics; overall costs to health service; and cost per life year and per quality adjusted life year (QALY) gained, expressed as incremental gain in intervention group compared with control group. RESULTS: The cost of the intervention (clinics and drugs) was 136 pounds sterling (254 dollars; 195 euros) per patient higher (1998-9 prices) in the intervention group, but the difference in other NHS costs, although lower for the intervention group, was not statistically significant. Overall, 28 fewer deaths occurred in the intervention group leading to a gain in mean life years per patient of 0.110 and of 0.124 QALYs. The incremental cost per life year saved was 1236 pounds sterling and that per QALY was 1097 pounds sterling. CONCLUSION: Nurse led clinics for the secondary prevention of coronary heart disease in primary care seem to be cost effective compared with most interventions in health care, with the main gains in life years saved.",Coronary Disease [economics] [nursing] [prevention & control];Cost of Illness;Cost-Benefit Analysis;Family Practice [economics];Follow-Up Studies;Hospitalization [economics];Quality-Adjusted Life Years;Scotland;Adult[checkword];Aged[checkword];Humans[checkword];Middle Aged[checkword];Sr-commun: sr-vasc: sr-epoc,"Raftery, J. P.;Yao, G. L.;Murchie, P.;Campbell, N. C.;Ritchie, L. D.",2005,,10.1136/bmj.38342.665417.8F,0,
3600,"Parkinsonism is a late, not rare, feature of CADASIL: a study on Italian patients carrying the R1006C mutation","BACKGROUND AND PURPOSE: To describe parkinsonism as a clinical manifestation of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. METHODS: We report 5 patients carrying the R1006C mutation in the exon 19 of NOTCH3 gene. All cases presented late onset, slowly progressive parkinsonism, not responsive to l-dopa. We performed brain MRI and (123)I-FP-CIT SPECT in all and in 3 additional patients carrying the same mutation but without parkinsonism. Four patients with parkinsonism underwent myocardial (123)I-meta-iodobenzylguanidine scintigraphy. RESULTS: In all patients, brain MRI showed widespread ischemic lesions in the periventricular white matter, the internal and external capsules, the basal ganglia, and thalami. (123)I-FP-CIT SPECT showed symmetrical or asymmetrical reduction of tracer uptake in the putamen, with inconstant caudate involvement. Myocardial (123)I-meta-iodobenzylguanidine scintigraphy resulted normal. Nigrostriatal denervation was also demonstrated in 2 patients without parkinsonism. CONCLUSIONS: In cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, parkinsonism may be a not rare, late onset manifestation. The clinical picture, the lack of response to dopaminergic treatment, and MRI findings suggest a vascular parkinsonism, which may be preceded by a protracted presymptomatic phase.","Aged;Brain/pathology;CADASIL/*complications/genetics/*physiopathology;Exons;Female;Genetic Predisposition to Disease;Humans;Italy;Leukoencephalopathies/genetics;Levodopa/pharmacology;Magnetic Resonance Imaging/methods;Male;*Mutation;Parkinsonian Disorders/*complications/*genetics;Receptors, Notch/*genetics;Tomography, Emission-Computed, Single-Photon/methods","Ragno, M.;Berbellini, A.;Cacchio, G.;Manca, A.;Di Marzio, F.;Pianese, L.;De Rosa, A.;Silvestri, S.;Scarcella, M.;De Michele, G.",2013,Apr,10.1161/strokeaha.111.000458,0,
3601,Multi-organ investigation in 16 CADASIL families from central Italy sharing the same R1006C mutation,"Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) may involve many target organs with relevant variability among affected individuals. We performed a multi-organ assessment tapping nervous system, skeletal muscle and cardiovascular system in thirty-nine individuals belonging to 16 families from Central Italy sharing the same R1006C CADASIL mutation. Stroke prevalence was larger in female patients (66.7%) than in males (23.8%); high levels of CKemia were quite frequent (21.6%) and were related to a myopathy without mitochondrial alterations; several individuals had atrial septal aneurysm (10.3%). No specific relationships between common cardiovascular risk factors and clinical manifestations were found. The present systematic study thus identified several gender-related, myopathic and cardiovascular peculiarities of R1006C mutation. This kind of comprehensive approach is necessary to define clinical course, prognosis and treatment options for a multi-organ disease such as CADASIL. © 2011 Elsevier Ireland Ltd.",creatine kinase;hydroxymethylglutaryl coenzyme A reductase inhibitor;Notch3 receptor;abnormally low substrate concentration in blood;adult;aged;article;CADASIL;cardiovascular risk;carotid artery obstruction;cognitive defect;contrast enhancement;creatine kinase blood level;demyelinating sensory motor polineuropathy;disease severity;Doppler echocardiography;drug withdrawal;electromyography;female;gene mutation;heart atrium septal aneurysm;heart atrium septum defect;heart infarction;heart left ventricle hypertrophy;heart muscle conduction disturbance;human;hyperCKemia;hypertension;Italy;major clinical study;male;memory disorder;migraine;multiinfarct dementia;muscle biopsy;myalgia;myopathy;neuroimaging;neurologic examination;neurophysiological recruitment;nuclear magnetic resonance imaging;polyneuropathy;priority journal;prognosis;risk factor;seizure;sensory neuropathy;sex difference;side effect;skeletal muscle;cerebrovascular accident;transesophageal echocardiography;two dimensional echocardiography,"Ragno, M.;Pianese, L.;Cacchiò, G.;Manca, A.;Scarcella, M.;Silvestri, S.;Di Marzio, F.;Caiazzo, A. R.;Silvaggio, F.;Tasca, G.;Mirabella, M.;Trojano, L.",2012,,,0,
3602,Early evaluation of neurological prognosis and therapy after cardiopulmonary resuscitation. Current opportunities and clinical implications,"The developments of cardiopulmonary resuscitation and intensive care medicine have made possible survival after cardiac arrest. However, only 10-30% of patients with initially successful resuscitation later reach a state without severe neurological impairment. Ethical and socioeconomic reasons therefore make early prognosis important for certain patients. There are no reliable parameters for predictions of good clinical outcome. If clinical information is consistent with severe hypoxic brain damage, cortical somatosensory evoked potentials are absent, and neuron-specific enolase values exceed 33-65 μg/l, recovery of consciousness can be excluded. The same result can be predicted if brain imaging shows severe hypoxemic changes or if a myoclonic status occurs on the first day. In summary, the prognosis in patients with cerebral anoxy and cardiopulmonary resuscitation remains poor. Treatment with hypothermia for 24 h is recommended. © 2007 Springer Medizin Verlag.",biological marker;corticosteroid;lidoflazine;neuron specific enolase;nimodipine;thiopental;article;brain disease;brain hypoxia;coma;consciousness;convalescence;disease severity;evoked cortical response;evoked somatosensory response;Glasgow coma scale;heart arrest;human;hypoxemia;intensive care;Kluver Bucy syndrome;laboratory test;lance adams syndrome;medical ethics;neuroimaging;neurologic disease;neurologic examination;persistent vegetative state;prognosis;resuscitation;socioeconomics;survival;Wernicke Korsakoff syndrome,"Ragoschke-Schumm, A.;Pfeifer, R.;Marx, G.;Knoepffler, N.;Witte, O. W.;Isenmann, S.",2007,,,0,
3603,"Dual eligibility, selection of skilled nursing facility, and length of Medicare paid postacute stay","Medicare and Medicaid dual-eligible beneficiaries use more medical care and experience worse health outcomes than Medicare-only beneficiaries. This article points to a possible inefficiency in the skilled nursing facility (SNF) admission process, specifically that patients and SNFs are partially matched based on dual-eligibility status, and investigates its influence on patients' SNF length of stay. Using a set of fee-for-service beneficiaries newly admitted for Medicare-paid SNF care, we document two findings: (1) compared with Medicare-only patients, dual-eligibles are more likely to be discharged to SNFs with low nurse-to-patient ratios and (2) dual-eligibles are more likely to become long-stay nursing home residents than Medicare-only beneficiaries if treated in SNFs with low nurse-to-patient ratios. We conclude that changes in the current SNF care referral process have the potential to reduce excess SNF utilization by dual-eligible beneficiaries and could help reduce spending by both Medicare and Medicaid. © The Author(s) 2014.",aged;Alzheimer disease;article;bipolar disorder;cerebrovascular accident;Charlson Comorbidity Index;comorbidity;conceptual framework;congestive heart failure;controlled study;daily life activity;dementia;diabetes mellitus;Elixhauser comorbidity index;emphysema;female;health care utilization;health insurance eligibility;health status;hip fracture;hospital admission;hospital discharge;hospital readmission;hospitalization;human;hypothesis;intensive care;length of stay;lowest income group;major clinical study;male;malignant neoplastic disease;married person;medicaid;medicare;nurse patient ratio;nursing care;nursing home;nursing home patient;nursing staff;patient referral;poverty;registered nurse;sample size;schizophrenia,"Rahman, M.;Gozalo, P.;Tyler, D.;Grabowski, D. C.;Trivedi, A.;Mor, V.",2014,,,0,
3604,Relationship between vascular factors and white matter low attenuation of the brain,"To study the relationship between vascular factors and white matter low attenuation of the brain (WMLA), computer tomography findings of 251 patients were re-interpreted. Clinical data on patients were collected from the hospital records. It was possible to obtain sufficient clinical data on 204 patients who were included in the study. WMLA changes, on computer tomography, were found in 51.5% of patients. WMLA was most commonly present in patients with vascular (69.8%) and combined (69.2%) dementia. The occurrence of WMLA did not differ between patients with Alzheimer's disease (26.7%) and those without dementia (35.9%). Arterial hypertension, coronary heart disease, or diabetes were not associated with WMLA. Heart failure and orthostatic hypotension, were found to be more commonly present in patients with than in those without WMLA (34.0% vs 14.3%, p = 0.0012; 10.0% vs 2.0%, p = 0.036). Both systolic and diastolic low blood pressure values were associated with WMLA unlike hypertensive blood pressure values. Atrial fibrillation in electrocardiography was associated with WMLA, while neither left ventricular hypertrophy nor myocardial infarction was. When several explanatory variables were adjusted by logistic regression analysis, age, heart failure, and systolic blood pressure below 130 predicted WMLA. In conclusion, the association between WMLA and vascular factors with hemodynamic significance suggests that cerebral hypoperfusion may contribute to the genesis of WMLA.","Adult;Age Factors;Aged;Alzheimer Disease/etiology/physiopathology/*radiography;Arrhythmias, Cardiac/epidemiology;Blood Pressure;Brain/*radiography;*Cerebrovascular Circulation;Comorbidity;Coronary Disease/epidemiology;Dementia, Vascular/etiology/physiopathology/*radiography;Diabetes Mellitus/epidemiology;Electrocardiography;Electroencephalography;Female;Heart Failure/epidemiology;Humans;Hypertension/epidemiology;Hypotension, Orthostatic/epidemiology;Male;Middle Aged;*Tomography, X-Ray Computed","Raiha, I.;Tarvonen, S.;Kurki, T.;Rajala, T.;Sourander, L.",1993,Apr,,0,
3605,Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: A mixed-methods study,"Objective: Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions. Methods: We undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the 'Team Climate Inventory' and skill mix) on the implementation of MDT treatment plans. Results: The adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good 'Team Climate' (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91). Conclusions: Greater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to ensure the equitable provision of care.",adult;aged;article;clinical decision making;cohort analysis;community mental health;controlled study;dementia;female;female genital tract cancer;health behavior;heart failure;hematologic malignancy;human;major clinical study;male;medical record;multidisciplinary team;non participant observation;observational study;patient care;patient preference;prospective study;psychosis;quantitative analysis;semi structured interview;skin cancer;teamwork;treatment planning,"Raine, R.;Xanthopoulou, P.;Wallace, I.;A'Bháird, C. N.;Lanceley, A.;Clarke, A.;Livingston, G.;Prentice, A.;Ardron, D.;Harris, M.;King, M.;Michie, S.;Blazeby, J. M.;Austin-Parsons, N.;Gibbs, S.;Barber, J.",2014,,,0,
3606,Hypertension guidelines in need of guidance,,aldosterone antagonist;antihypertensive agent;beta adrenergic receptor blocking agent;diuretic agent;thiazide diuretic agent;valsartan;article;blood pressure monitoring;blood pressure regulation;cardiovascular mortality;cerebrovascular accident;cerebrovascular disease;chronic kidney disease;clinical trial (topic);coronary artery disease;dementia;diabetes mellitus;evidence based medicine;health care policy;heart failure;human;hyperlipidemia;hypertension;hypotension;microalbuminuria;morbidity;national health organization;patient compliance;physical disability;practice guideline;priority journal;resistant hypertension;sleep disordered breathing;systolic blood pressure;systolic hypertension;white coat hypertension,"Ram, C. V. S.",2014,,,0,
3607,Artifactual broadcomplex tachycardia due to parkinsonian tremor,,sotalol;aged;article;artifact;case report;clinical feature;dementia;ECG abnormality;electrocardiography;atrial fibrillation;hospitalization;human;hypertension;ischemic heart disease;male;Parkinson disease;pneumonia;priority journal;pseudoarrhythmia;symptom;telemetry;tremor,"Ramakrishnan, N.;Schneiderman, H.",2007,,,0,
3608,"The A's, G's, C's, and T's of health disparities","In order to eliminate health disparities in the United States, more efforts are needed to address the breadth of social issues directly contributing to the healthy divide observed across racial and ethnic groups. Socioeconomic status, education, and the environment are intimately linked to health outcomes. However, with the tremendous advances in technology and increased investigation into human genetic variation, genomics is poised to play a valuable role in bolstering efforts to find new treatments and preventions for chronic conditions and diseases that disparately affect certain ethnic groups. Promising studies focused on understanding the genetic underpinnings of diseases such as prostate cancer or beta-blocker treatments for heart failure are illustrative of the positive contribution that genomics can have on improving minority health. © 2009 Ramos and Rotimi; licensee BioMed Central Ltd.",beta adrenergic receptor blocking agent;DNA;G protein coupled receptor kinase 5;American Indian;amino acid substitution;article;Asian;attributable risk;breast cancer;cancer risk;cardiovascular disease;cause of death;chronic disease;cystic fibrosis;diabetes mellitus;drug efficacy;ethnic group;European American;fragile X syndrome;gene mutation;genetic disorder;genetic polymorphism;genetic variability;genomics;geographic distribution;health disparity;heart failure;heart infarction;Hispanic;human;human genome;Human immunodeficiency virus infection;Huntington chorea;hypertension;liver disease;medical technology;migration;minority health;mortality;Pacific Islander;population genetics;population risk;priority journal;prostate cancer;race difference;risk factor;sickle cell anemia;single nucleotide polymorphism;social status;socioeconomics;cerebrovascular accident;survival rate;United States,"Ramos, E.;Rotimi, C.",2009,,,0,
3609,Electroconvulsive therapy: Is there a role for treating older patients?,"Electroconvulsive therapy (ECT) is a powerful acute treatment for severe and resistant depression. We review literature related to the efficacy, safety and tolerability of ECT in older people, with an emphasis on research studies and reviews published in the last 25 years. In general ECT has been considered a very effective and safe treatment for depression and other psychiatric and non-psychiatric disorders in older people. Amnesia is commonly attributed to ECT treatment, but studies suggest that the negative effects of ECT on cognition are probably small in older patients. Currently the balance of risks and benefits of ECT justify its use for severe depression in older patients, both with and without dementia. Copyright © Cambridge University Press 2013.",antidepressant agent;benzodiazepine derivative;venlafaxine;aged;anterograde amnesia;article;bilateral stimulation;catatonia;clinical effectiveness;cognitive defect;confusion;delirium;depression;depressive psychosis;diffuse Lewy body disease;disorientation;electroconvulsive therapy;electrostimulation;elevated blood pressure;euphoria;follow up;headache;heart infarction;heart muscle oxygen consumption;human;hypomania;maintenance therapy;major depression;mania;mortality;myalgia;Parkinson disease;patient safety;pneumonia;pulse rate;rapid cycling bipolar disorder;relapse;remission;schizophrenia;seizure threshold;treatment response,"Ramos-Garcia, M. I.;González-Salazar, C. F.",2013,,,0,
3610,Intermittent oxygen deficiency as the cause of dementia,"It is well known that peroxidic materials can be expected to accumulate in simple molecules such as ethers or complex organic systems. Most such peroxides are stable at body temperature for long periods of time. However, when the supply of oxygen is depleted, certain metallic substances, e.g. iron, initiate a rapid chain reaction. This process, the rapid chain reaction of peroxide decomposition catalyzed by ferrous iron, is to be expected in any part of living tissue as an immediate result of oxygen deprivation. Dementia, it is postulated, is the result of limited, but repeated, oxygen deprivation in parts of the brain. The particular form of dementia will depend upon the specific part of the brain affected. Since tiny clots are the most likely source of blood and hence oxygen deficiency, it should not be surprising that various parts of the brain may be are affected. Dementia prevention would then require action to avoid even the smallest clots in the bloodstream. In general, actions which prevent coronary disease are indicated.","*Anoxia;Brain/*physiopathology;Coronary Disease/prevention & control;Dementia/*etiology/physiopathology/prevention & control;Free Radicals/metabolism;Humans;Models, Neurological;Models, Psychological;Peroxides/metabolism","Ramp, F. L.",1999,Sep,10.1054/mehy.1997.0707,0,
3611,Fatal streptokinase-induced intracerebral haemorrhage in cerebral amyloid angiopathy,"A fatal intracerebral haemorrhage (ICH) associated with streptokinase (SK) treatment of an acute myocardial infarction is described. Autopsy examination showed a lobar ICH and severe cerebral amyloid angiopathy (CAA). The close temporal relationship between SK administration and intracranial haemorrhage, the absence of pretreatment risk factors for ICH, and the presence of CAA suggests that these are related phenomena. Accordingly: 1. There may be a synergistic relationship between CAA and intracranial haemorrhage induced by fibrinolytic agents; 2. Thrombolytic agents may induce more frequent than expected intracranial haemorrhage in conditions associated with a high incidence of CAA, notably old age and Alzheimer's disease; 3. A regional defect in haemostasis other than vessel fragility may contribute to the intracranial haemorrhagic predisposition of CAA; 4. Autopsy examination of cases of ICH is an essential part of the audit of clinical trials of fibrinolytic agents.",streptokinase;adult;amyloidosis;article;autopsy;brain hemorrhage;case report;computer analysis;computer assisted tomography;fatality;heart infarction;histology;human;intravenous drug administration;male;priority journal;vascular disease;streptase,"Ramsay, D. A.;Penswick, J. L.;Robertson, D. M.",1990,,,0,
3612,"Blood component recalls and market withdrawals: Frequency, reasons, and management in the United States","In a previous article, we reviewed the management of blood component recalls and withdrawals (G. Ramsey. Transfusion Med Rev 2004;18:36-45). Since then, US rates of recall and biological product deviation for blood components have improved significantly, particularly with regard to reduced recalls for donor infectious disease risks or testing. However, analysis of the current data from the US Food and Drug Administration suggests that 1 (0.4%) in 250 blood components is involved in market withdrawals and quarantines, with 1 in 5800 components formally recalled. Most of these units, unfortunately, had already have been transfused. The US Food and Drug Administration has issued several recent guidances that address transfusion service actions for dealing with specific infectious disease problems. This present article updates our 2004 recommendations as to when to notify physicians about transfused nonconforming blood components. © 2013 Elsevier Inc.",etretin;etretinate;fresh frozen plasma;hepatitis B surface antigen;antigen detection;article;bacterium contamination;blood bank;blood component;blood donor;blood transfusion;blood transfusion reaction;Chagas disease;Creutzfeldt Jakob disease;erythrocyte;food and drug administration;Hepatitis C virus;human;Human immunodeficiency virus;infection;malaria;marketing;medicaid;medicare;physician;piroplasmosis;product recall;radioimmunoprecipitation;recall;United States;West Nile virus,"Ramsey, G.",2013,,,0,
3613,"Age dependence of tissue plasminogen activator concentrations in plasma, as studied by an improved enzyme-linked immunosorbent assay","A procedure for improving the specificity of enzyme-linked immunosorbent assays (ELISA) was devised, based on addition of antigen-specific or non-immune immunoglobulins to the citrated plasma sample and defining the difference in assay response between these two mixtures as the antigen-specific part of the response. When applied to measurement of tissue plasminogen activator (t-PA; EC 3.4.21.31) antigen in plasma, this procedure resulted in elimination of the overestimates obtained in a large proportion (10-20%) of patients' samples when assayed according to the conventional ELISA technique. Basal t-PA concentrations in plasma were found to be highly age-dependent, normal values being about 3 μg/L for adults near 30 years of age and about 10 μg/L for those over 60. Patients with gallbladder stone disease had increased mass concentrations of t-PA in plasma, even when corrected for the age effect; patients with multi-infarct dementia did not.",tissue plasminogen activator;age;cholelithiasis;enzyme linked immunosorbent assay;gallbladder;heart;heart infarction;human;human cell;plasma;priority journal,"Ranby, M.;Bergsdorf, N.;Nilsson, T.",1986,,,0,
3614,"Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep","The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a ""marker"" of disease severity or a ""mediator"" of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.",acetazolamide;carbon dioxide;oxybate sodium;theophylline;triazolam;zolpidem;acid maltase deficiency;acromegaly;acute respiratory failure;adaptive servoventilation;algorithm;altitude;Alzheimer disease;amyotrophic lateral sclerosis;apnea hypopnea index;article;artificial ventilation;bilevel positive airway pressure;cardiovascular mortality;cardiovascular risk;central sleep apnea syndrome;cerebrovascular accident;chronic obstructive lung disease;clinical feature;comorbidity;diabetes mellitus;disease association;disease severity;Duchenne muscular dystrophy;end stage renal disease;enzyme deficiency;heart failure with preserved ejection fraction;heart failure with reduced ejection fraction;heart ventricle arrhythmia;human;hypoventilation;hypoxemia;hypoxia;interstitial lung disease;kyphoscoliosis;lung disease;myotonic dystrophy;neuromuscular disease;noninvasive ventilation;obesity;oxygen therapy;Parkinson disease;pathophysiology;positive end expiratory pressure;prevalence;priority journal;prognosis;pulmonary hypertension;respiratory drive;stroke patient;thorax disease;treatment indication,"Randerath, W.;Verbraecken, J.;Andreas, S.;Arzt, M.;Bloch, K. E.;Brack, T.;Buyse, B.;De Backer, W.;Eckert, D. J.;Grote, L.;Hagmeyer, L.;Hedner, J.;Jennum, P.;La Rovere, M. T.;Miltz, C.;McNicholas, W. T.;Montserrat, J.;Naughton, M.;Pepin, J. L.;Pevernagie, D.;Sanner, B.;Testelmans, D.;Tonia, T.;Vrijsen, B.;Wijkstra, P.;Levy, P.",2017,,10.1183/13993003.00959-2016,0,
3615,A study of the accuracy of telephone orders in nursing homes in southern California,"Objectives: To examine the nature and accuracy of physician telephone orders in nursing homes. We hoped to identify the types of orders given, and to measure the accuracy of transfer of a given verbal order from the clinician to the licensed nurse. We wanted to reveal the possible magnitude of error until the time the order is implemented, as well as the potential for adverse clinical outcomes that might result. We hypothesized that error rates for verbal orders given in skilled nursing facilities (SNFs) would not exceed error rates found in other settings. Design: Verbal orders given by five clinicians to the nursing staff in several nursing homes were carefully recorded by clinicians and nurses. The orders were compared for accuracy and categorized by type and facility of origin. The medical record was later audited to verify whether orders were accurately transcribed to the treatment plans. Setting: Seven 99-bed SNFs in southern California. Patients: In each of the facilities, the clinicians actively cared for approximately 15 to 20 frail elderly, for a total of 100 patients. Common clinical problems encountered included dementia (mostly due to Alzheimer's disease), congestive heart failure, hypertension, pressure ulcers, respiratory and urinary tract infections, depression and other behavioral disorders associated with dementia, and diabetes. Most of the patients were insured with a combination of Medicare and Medicaid. Main Results: Over a 10-month period, approximately 820 verbal orders were assessed. The types of telephone orders were: medication (34%); laboratory testing (21%); dietary, such as water, supplements, or minerals (9%); symptom monitoring, bladder training, or other nursing procedures (9%); professional consultants or services (6%); durable medical equipment or safety aids (4%); wound care (4%); vital sign monitoring (3%); x-ray/electrocardiogram/pulse oximetry (3%); disposition, such as admission, discharge, or transfer (2%); and mobility (2%). The significant error rate noted was 6.1 per 1000. Conclusions: The telephone order significant error rate did not exceed the error rates for written orders cited in previous studies of orders entered into a computer or written into the patient chart. In all cases, the order error was not identified in routine physician phone order review (where the clinician has an opportunity to compare the transmitted order with his or her memory of the actual order). The current method of mailing telephone treatment orders for physician signature within five days does not appear to identify significant errors. Certain types of orders and facilities seemed more prone to error. More frequent review of certain types of telephone orders by the medical director, a pharmacy consultant, or a licensed nursing staff member may be helpful in determining effective methods to ensure patient safety. Adopting a standard procedure for verbal orders may reduce significant errors.",accuracy;analytical error;article;competence;health care quality;nursing home;telephone;treatment planning;United States,"Randolph, J. F.;Magro, J.;Stalmach, D.;Cermak, B.;Wilson, B.",1999,,,0,
3616,When should nursing home residents be transferred to hospital?,"Background. Nursing home residents are old persons with chronic diseases, functional impairment and often dementia. Acute illness is common and nursing home staff often has to consider transfer to hospital. Material and methods. The aim was to find why nursing home residents are transferred to hospital and to discuss when such transfers are appropriate. The results are taken from the literature. Results. No studies are reporting the reasons why nursing home residents in Norway are transferred to hospital. Hip fracture, pneumonia, stroke, chest pain, cardiac failure and anaemia are the most common causes of hospital admissions among the very oldest, in our experience also from nursing homes. Hospital transfer can be appropriate for: 1) diagnostic work up, 2) medical treatment to avoid death and functional impairment, and 3) palliative care. Admission for hip fracture and serious anaemia will improve survival and function if the patient is not dying from other diseases. Admission for pneumonia, stroke and acute coronary syndrome may improve survival and function for patients without advanced dementia and with some life expectancy. Transfer for palliative care will benefit the patient only if nursing home care is insufficient. Medical services and knowledge about palliative care should be increased; guidelines for hospitalisation and end-of-life decisions are recommended.",acute heart infarction;anemia;elderly care;health care personnel;heart failure;hip fracture;hospital admission;hospital care;hospitalization;human;life expectancy;medical decision making;medical service;nursing home;palliative therapy;patient transport;pneumonia;practice guideline;short survey;cerebrovascular accident;survival;terminal care;thorax pain,"Ranhoff, A. H.;Linnsund, J. M.",2005,,,0,
3617,Cardiovascular risk factors and glucose tolerance in midlife and risk of cognitive disorders in old age up to a 49-year follow-up of the Helsinki businessmen study,"Purpose: The purpose of this study is to compare midlife predictors of old age dementia with or without concomitant atherosclerotic cardiovascular disease (ASCVD). Design: In the Helsinki Businessmen Study (men born in 1919–1934, n = 3309), death certificates (n = 1885) during up to 49-year follow-up (through 31 December 2013) were screened for dementia (n = 365) and ASCVD, and categorized as (1) AD without ASCVD (“pure” AD, n = 93), (2) AD + ASCVD (n = 126), (3) vascular dementia (VD, n = 82), (4) other or undefined etiology (n = 64). Using Cox analyses, death without dementia and dementia types were compared for the prediction by midlife ASCVD risk factors. Men without diagnosed dementia during follow-up were used as reference. Results: ASCVD risk factors predicted death without dementia during follow-up. Midlife cholesterol was higher in AD + ASCVD and VD as compared with men surviving to old age without known dementia. None of the midlife factors including cholesterol and glucose tolerance predicted pure AD, but midlife cholesterol predicted AD + ASCVD, both as a continuous (hazard ratio [HR] per SD 1.24, 95% CI, 1.04–1.47), and dichotomous variable (cutpoint 6.5 mmol/L; HR 1.67, 95% CI, 1.16–2.40). Conclusion: Midlife cholesterol predicted dementia with vascular features, but midlife vascular risk factors and glucose intolerance were not related to pure Alzheimer disease without concomitant atherosclerotic cardiovascular disease.Key messages Heterogenous etiology of dementia, which in old age is usually a clinical diagnosis, may confound the role of long-term risk factors. In a longitudinal study with autopsy records, midlife cholesterol predicted dementia with features of atherosclerotic cardiovascular disease but not “pure“ Alzheimer disease Glucose tolerance in midlife was not associated with pure Alzheimer’s disease.",NCT02526082;antidiabetic agent;antihypertensive agent;apolipoprotein E;cholesterol;glucose;nootropic agent;triacylglycerol;adult;Alzheimer disease;antihypertensive therapy;article;autopsy;cardiovascular mortality;cardiovascular risk;cause of death;cholesterol blood level;comparative study;controlled study;coronary artery atherosclerosis;death certificate;dementia;diabetes mellitus;diffuse Lewy body disease;follow up;glucose intolerance;glucose tolerance;human;hypertension;longitudinal study;major clinical study;male;middle aged;Mini Mental State Examination;multiinfarct dementia;prediction;priority journal;reimbursement;senescence;triacylglycerol blood level,"Rantanen, K.;Strandberg, A. Y.;Salomaa, V.;Pitkälä, K.;Tilvis, R. S.;Tienari, P.;Strandberg, T.",2017,,10.1080/07853890.2017.1290821,0,
3618,Midlife fitness predicts less burden of chronic disease in later life,"OBJECTIVE: To investigate the relationship between midlife fitness in healthy adults and the development of nonfatal chronic conditions (CCs) in older age. DESIGN: Cohort study. SETTING: Data on participants were drawn from the Cooper Center Longitudinal Study and linked with US Medicare claims made in the years 1999 through 2009. PARTICIPANTS: The cohort included 18 670 participants (median age, 49 years; 21% women) who had received a comprehensive clinical examination between 1970 and 2009 at the Cooper Center, were >/=65 years of age and covered by Medicare between 1999 and 2009, and who reported no baseline history of CCs such as cardiovascular disease, diabetes, and cancer. The participants tended to be from upper educational and socioeconomic strata. ASSESSMENT OF RISK FACTORS: Fitness was assessed by maximal treadmill effort using the modified Balke protocol. The participants' treadmill times were classified into age- and sex-specific quintiles (Q) of fitness (Q1, least fit) and converted into metabolic equivalents (MET). Clinical and anthropometric variables and physical activity were measured. MAIN OUTCOME MEASURES: The main outcome measure was the association between level of fitness in midlife (ie, at study entry) and the development of chronic conditions (specifically, congestive heart failure, ischemic heart disease, stroke, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, Alzheimer's disease, and colon or lung cancer), recorded by Medicare. The conditions were each assigned a value of 1, and those present were summed for survivors at ages 70, 75, 80, and 85 years. Death was an additional outcome. Total follow-up was 120 780 person-years. MAIN RESULTS: At study entry the participants had, overall, low levels of traditional risk factors for CCs, with the less fit having somewhat less healthy risk factor profiles. The highest level of midlife fitness (Q5) was associated with developing fewer CCs compared with low midlife fitness (Q1) in men (15.6; 95% confidence interval [CI], 15.0-16.2 vs 28.2; 95% CI, 27.4-29.0 per 100 person-years) and women (11.4; 95% CI, 10.5-12.3 vs 20.1; 95% CI, 18.7-21.6 per 100 person-years). After multivariate adjustment, higher fitness remained associated with a lower risk of developing CCs (men: hazard ratio [HR], 0.95; 95% CI, 0.94-0.96 per MET; and women: HR, 0.94; 95% CI, 0.91-0.96 per MET). Level of fitness was similarly associated with the development of CCs in younger and older participants. Among the 2406 participants who died during the study period, the number of CCs among the more fit persons was significantly lower than that among the less fit; thus, in their final 5 years of life, 58.3% of fitness Q4 and Q5 versus 43.5% of Q1 had </=1 CC and 9.5% of Q4 and Q5 versus 18.3% of Q1 had >/=4 CCs. CONCLUSIONS: Healthy, fit, middle-aged adults developed fewer chronic conditions in later life than unfit persons and had a lesser burden of chronic disease before death.",,"Rantanen, T.",2013,Nov,10.1097/jsm.0000000000000039,0,
3619,Very urgent carotid endarterectomy does not increase the procedural risk,"Objectives The timing of CEA for symptomatic internal carotid artery (ICA) stenosis remains a matter of controversy. Recent registry data showed a significantly increased risk, especially in the very early days after the onset of symptoms. In this study the outcome of CEA in the hyperacute phase has been investigated. Methods The outcome of CEA for symptomatic ICA stenosis between January 2004 and December 2013 has been retrospectively analyzed. Patients were divided into four timing groups: surgery within 0 and 2 days, between 3 and 7 days, 8 and 14 days, and thereafter. The post-operative 30 day stroke and death rates were assessed. Results A total of 761 symptomatic patients (40.1% with transient ischemic attack [TIA], 21.3% with amaurosis fugax, and 38.6% with ischemic stroke) were included, with an overall peri-operative stroke and death rate of 3.3%. A stroke and death rate of 4.4% (9/206) for surgery within 0 and 2 days, 1.8% (4/219) between 3 and 7 days, 4.4% (6/136) between 8 and 14 days, and 2.5% (5/200) in the period thereafter (p =.25 for the difference between the groups) was observed. The timing of surgery did not influence the peri-operative outcome in a multivariate regression analysis (OR 0.93 [0.63-1.36], p =.71). Conclusions These data show that very urgent surgery in symptomatic patients can be performed without increased procedural risk. Given the fact that ruptured plaques with neurological symptoms carry the highest risk of a recurrent ischemic event in the first 2 days, treating patients as soon as possible to offer the highest benefit in stroke prevention is recommended.",aged;artery embolism;article;blood clot lysis;brain hemorrhage;brain ischemia;carotid endarterectomy;cerebrovascular accident;cerebrovascular disease;clinical feature;comparative study;computer assisted tomography;congestive heart failure;controlled study;disease duration;early intervention;female;heart failure;heart infarction;human;hyperperfusion syndrome;internal carotid artery occlusion;major clinical study;male;mental deterioration;neurological complication;operation duration;outcome assessment;patient safety;perioperative period;peroperative complication;postoperative period;priority journal;Rankin scale;retrospective study;stroke unit;surgical mortality;surgical risk;time to treatment;transient ischemic attack;transitional blindness,"Rantner, B.;Schmidauer, C.;Knoflach, M.;Fraedrich, G.",2015,,,0,
3620,Sequence Analysis of Long-Term Readmissions among High-Impact Users of Cerebrovascular Patients,"Objective. Understanding the chronological order of the causes of readmissions may help us assess any repeated chain of events among high-impact users, those with high readmission rate. We aim to perform sequence analysis of administrative data to identify distinct sequences of emergency readmissions among the high-impact users. Methods. A retrospective cohort of all cerebrovascular patients identified through national administrative data and followed for 4 years. Results. Common discriminating subsequences in chronic high-impact users (n=2863) of ischaemic stroke (n=34208) were ""urological conditions-chest infection,"" ""chest infection-urological conditions,"" ""injury-urological conditions,"" ""chest infection-ambulatory condition,"" and ""ambulatory condition-chest infection"" (p<0.01). Among TIA patients (n=20549), common discriminating (p<0.01) subsequences among chronic high-impact users were ""injury-urological conditions,"" ""urological conditions-chest infection,"" ""urological conditions-injury,"" ""ambulatory condition-urological conditions,"" and ""ambulatory condition-chest infection."" Among the chronic high-impact group of intracranial haemorrhage (n=2605) common discriminating subsequences (p<0.01) were ""dementia-injury,"" ""chest infection-dementia,"" ""dementia-dementia-injury,"" ""dementia-urine infection,"" and ""injury-urine infection."" Conclusion. Although common causes of readmission are the same in different subgroups, the high-impact users had a higher proportion of patients with distinct common sequences of multiple readmissions as identified by the sequence analysis. Most of these causes are potentially preventable and can be avoided in the community.",aged;anemia;article;atrial fibrillation;brain hemorrhage;brain ischemia;cerebrovascular disease;Charlson Comorbidity Index;chest infection;dementia;emergency care;epilepsy;female;hearing impairment;heart muscle ischemia;home care;hospital readmission;human;injury;kidney failure;length of stay;major clinical study;male;paralysis;retrospective study;transient ischemic attack;urinary tract disease;urine incontinence;visual impairment,"Rao, A.;Bottle, A.;Darzi, A.;Aylin, P.",2017,,10.1155/2017/7062146,0,
3621,Alzheimer: Stem cell therapies for neurodegenerative disease: How should we push ahead?,,adulthood;Alzheimer disease;bone marrow cell;brain nerve cell;brain region;cell differentiation;cell division;cell function;cells by body anatomy;degenerative disease;embryonic stem cell;heart muscle cell;heart muscle ischemia;hematopoietic stem cell;hippocampus;human;nervous system development;note;phenotype;pluripotent stem cell;priority journal;signal transduction;stem cell transplantation;totipotent stem cell;trophoblast,"Rao, M.;Martin, G.;Snider, J.;Loring, J.;Freudenberger, D.;Kinoshita, J.;Brewer, G.;Townsend, K.;Mueller, F. J.;Angela, B.",2005,,,0,
3622,Vein of galen aneurysmal malformation presented by dementia and impotence in an adult: Case report,"Background:: Vein of Galen aneurysmal malformations are a rare entity of vascular malformations that present themselves in neonates and infants by congestive heart failure in early days of life or later on by hydrocephalus and macrocephaly; very few reports exist on their presentation in adulthood. Case Presentation:: In this case report, we review a case of an adult suffering from vein of Galen aneurysmal malformation that was not diagnosed until the early thirties of his life. His main clinical symptoms were dementia and impotence. Conclusions:: Vein of Galen aneurysmal malformation is extremely rare in adult. We present this case for better understanding of the pathophysiological process of such a rare disorder. Copyright © 2013 by Lippincott Williams & Wilkins.",adult;apathy;article;artificial embolism;blurred vision;case report;computed tomographic angiography;computer assisted tomography;delayed diagnosis;dementia;human;hypertension;impotence;limb weakness;male;memory disorder;nuclear magnetic resonance imaging;papilledema;paraplegia;priority journal;quadrigeminal cistern;short term memory;shunting;vein of Galen malformation,"Rashad, S.;Hassan, T.",2013,,,0,
3623,Primary nonadherence to overactive bladder medications in an integrated managed care health care system,"BACKGROUND: Treatment for overactive bladder (OAB) remains suboptimal, in part because of patient nonadherence to medications. Primary nonadherence is when patients fail to pick up their initial prescriptions. OBJECTIVE: To measure primary nonadherence to OAB medications within 30 days of a first OAB prescription order using electronic medical records from a U.S. managed care health care system METHODS: A retrospective cohort study was conducted using electronic medical records from the Kaiser Permanente Southern California (KPSC) database to identify patients with new OAB prescriptions between January 1, 2007, and December 31, 2013. The index date was defined as the first order of an OAB prescription. Patients had to be aged = 18 years on the index date and were required to have 12 months of continuous membership with drug benefit eligibility before, during, and after the index date. Patients were defined as primary nonadherent if they did not pick up their new OAB prescriptions within 30 days of the order date. Descriptive statistics and a multivariable logistic regression analysis with backward selection were conducted to identify factors associated with patients who were primary nonadherent versus adherent. RESULTS: There were 9,050 patients with a new OAB prescription order; 1,662 (18[%]) of these were primary nonadherent. Patients with primary nonadherence were younger in age (56.9 [[]SD &#177; 16.0] years vs. 63.9 [[]SD &#177; 14.8] years; P &lt; 0.001) and more likely to have commercial insurance (65.9[%] vs. 46.2[%]; P &lt; 0.001). They also had lower mean Charlson Comorbidity Index (CCI) scores (1.99 vs. 2.70; P &lt; 0.001), fewer OAB-related comorbidities, fewer concomitant medications (P &lt; 0.005), and fewer overall prescriptions dispensed in the previous 12 months (P &lt; 0.001) compared with adherent patients. Significant factors such as commercial insurance (P = 0.013), race other than white (P = 0.020), CCI = 0 versus CCI = 2 (P = 0.001), urinary tract infections (P &lt; 0.001), and falls (P = 0.047) were associated with a higher likelihood of primary nonadherence versus adherence. CONCLUSIONS: Nearly 1 in 5 patients did not pick up their new OAB medications within 30 days of the order date. Knowledge of factors associated with primary nonadherence may inform strategies for improving management of OAB.",darifenacin;fesoterodine;mirabegron;oxybutynin;solifenacin;tolterodine;trospium chloride;urinary tract spasmolytic agent;adult;aged;Alzheimer disease;article;cerebrovascular accident;Charlson Comorbidity Index;cohort analysis;comorbidity;congestive heart failure;controlled study;depression;diabetes mellitus;electronic medical record;female;health insurance;human;hypertension;integrated health care system;ischemic heart disease;major clinical study;male;medication compliance;multiple sclerosis;overactive bladder;Parkinson disease;patient compliance;polypharmacy;prescription;prostate hypertrophy;race;retrospective study;risk factor;skin infection;treatment refusal;urinary tract infection;gelnique;oxytrol,"Rashid, N.;Vassilakis, M.;Lin, K. J.;Kristy, R.;Ng, D. B.",2017,,10.18553/jmcp.2017.23.4.484,0,
3624,Duloxetine versus routine care in the long-term management of diabetic peripheral neuropathic pain,"Introduction: Duloxetine hydrochloride is a dual reuptake inhibitor of both serotonin and norepinephrine. In the present open-label study, the safety of duloxetine at a fixed-dose of 60 mg twice daily (BID) for up to 52 weeks was evaluated and compared to routine care in the therapy of patients diagnosed with diabetic peripheral neuropathic pain (DPNP). Methods: Patients who completed a 13-week, double-blind, duloxetine and placebo acute therapy period were rerandomly assigned in a 2:1 ratio to therapy with duloxetine 60 mg BID (N = 161) or routine care (N = 76) for an additional 52 weeks. Routine care consisted primarily of gabapentin, amitriptyline, and venlafaxine. The study included male or female outpatients 18 years of age or older with a diagnosis of DPNP caused by type 1 or type 2 diabetes. Results: A higher percentage of routine care-treated patients experienced 1 or more serious adverse events. No statistically significant therapy-group difference was observed in the overall incidence of treatment-emergent adverse events (TEAEs). The TEAEs reported by 10% or more of duloxetine 60 mg BID-treated patients were nausea, and by the routine care-treated patients were peripheral edema, pain in the extremity, somnolence, and dizziness. Duloxetine did not appear to adversely affect glycemic control, lipid profiles, nerve function, or the course of DPNP. There were no statistically significant therapy-group differences observed in the 36-item Short-Form Health Survey subscales or in the EuroQol 5-Dimension Questionnaire. Conclusions: In this study, duloxetine was safe and well tolerated compared to routine care in the long-term management of patients with DPNP. © Mary Ann Liebert, Inc.",acetylsalicylic acid;alpha tocopherol;amitriptyline;amlodipine besylate;atenolol;atorvastatin;azithromycin;calcium;carbamazepine;clopidogrel;duloxetine;esomeprazole;furosemide;gabapentin;glibenclamide plus metformin;glimepiride;glipizide;glucose;hydrochlorothiazide;insulin glargine;insulin lispro;lansoprazole;lipid;lisinopril;metformin;metoprolol succinate;multivitamin;noradrenalin uptake inhibitor;pantoprazole;paracetamol;pioglitazone;placebo;quinapril;ramipril;rosiglitazone;serotonin uptake inhibitor;sildenafil;simvastatin;synthoid;tamsulosin;unindexed drug;valsartan;venlafaxine;acute heart infarction;adult;aged;agitation;article;balance disorder;clinical trial;congestive heart failure;controlled clinical trial;controlled study;coronary artery disease;dementia;diabetic ketoacidosis;diabetic neuropathy;disease severity;dizziness;double blind procedure;drug efficacy;drug safety;drug tolerability;dyskinesia;dyspnea;erythema;European Quality of Life 5 Dimension Questionnaire;falling;female;glucose blood level;heart infarction;human;hypercalcemia;incidence;infection;insulin dependent diabetes mellitus;intestinal dysmotility;long term care;lung embolism;male;nausea;nerve function;non insulin dependent diabetes mellitus;outpatient;pain;Parkinson disease;peripheral edema;peripheral neuropathy;pruritus;questionnaire;randomized controlled trial;Short Form 36;side effect;somnolence;thorax pain;treatment outcome;urine retention;vomiting;accupril;actos;altace;amaryl;avandia;effexor xr;elavil;flomax;glucophage;glucotrol;glucovance;humalog;lantus;lasix;lipitor;neurontin;nexium;norvasc;plavix;prevacid;protonix;toprol xl;tylenol;viagra;zithromax;zocor,"Raskin, J.;Smith, T. R.;Wong, K.;Pritchett, Y. L.;D'Souza, D. N.;Iyengar, S.;Wernicke, J. F.",2006,,,0,
3625,Psychiatric co-morbidities in patients with dilated cardiomyopathy,,adult;African Caribbean;anxiety disorder;article;bipolar disorder;Caucasian;cohort analysis;comorbidity;congestive cardiomyopathy;controlled study;dementia;depression;ethnicity;female;human;major clinical study;male;mental disease;obsessive compulsive disorder;phobia;prevalence;priority journal;schizoaffective psychosis;schizophrenia;South Asian;substance abuse;suicide attempt;United Kingdom,"Rasoul, D.;Potluri, S.;Wong, S. C. H.;Gorantla, R. S.;Aziz, A.;Chandran, S.;Uppal, H.;Potluri, R.",2015,,,0,
3626,"Simultaneously assessing intended and unintended treatment effects of multiple treatment options: A pragmatic ""matrix design""","Purpose: A key aspect of comparative effectiveness research is the assessment of competing treatment options and multiple outcomes rather than a single treatment option and a single benefit or harm. In this commentary, we describe a methodological framework that supports the simultaneous examination of a ""matrix"" of treatments and outcomes in non-randomized data. Methods: We outline the methodological challenges to a matrix-type study (matrix design). We consider propensity score matching with multiple treatment groups, statistical analysis, and choice of association measure when evaluating multiple outcomes. We also discuss multiple testing, use of high-dimensional propensity scores for covariate balancing in light of multiple outcomes, and suitability of available software. Conclusion: The matrix design study methods facilitate examination of the comparative benefits and harms of competing treatment choices, and also provides the input required for calculating the numbers needed to treat and for a broader benefit/harm assessment that weighs endpoints of varying severity. © 2011 John Wiley & Sons, Ltd.",analgesic agent;angiotensin receptor antagonist;anticoagulant agent;anticonvulsive agent;benzodiazepine;beta adrenergic receptor blocking agent;cardiovascular agent;corticosteroid;cyclooxygenase 2 inhibitor;dipeptidyl carboxypeptidase inhibitor;histamine H2 receptor antagonist;loop diuretic agent;nonsteroid antiinflammatory agent;opiate;proton pump inhibitor;serotonin uptake inhibitor;thiazide diuretic agent;Alzheimer disease;angina pectoris;anticonvulsant therapy;backache;bone density;chronic liver disease;comparative effectiveness;computer program;diabetes mellitus;drug efficacy;drug safety;falling;fracture;gastrointestinal disease;gastrointestinal hemorrhage;gout;heart death;heart failure;heart infarction;heart muscle revascularization;hip fracture;human;humerus fracture;hyperlipidemia;hypertension;methodology;mortality;note;osteoporosis;outcome assessment;Parkinson disease;pelvis fracture;priority journal;propensity score;radius fracture;research;risk;statistical analysis;cerebrovascular accident;therapy effect;treatment outcome;unstable angina pectoris,"Rassen, J. A.;Solomon, D. H.;Glynn, R. J.;Schneeweiss, S.",2011,,,0,
3627,Association between blood pressure and survival over 9 years in a general population aged 85 and older,"OBJECTIVES: To investigate the association between blood pressure and mortality in people aged 85 and older. DESIGN: Population-based prospective study with 9-year follow-up. SETTING: Department of Neuroscience and Neurology and Department of Public Health and General Practice, University of Kuopio, and Department of Clinical Neurosciences, Helsinki University Hospital. PARTICIPANTS: Of all 601 people living in the city of Vantaa born before April 1, 1906, whether living at home or in institutions and alive on April 1, 1991, 521 were clinically examined and underwent blood pressure measurement. MEASUREMENTS: Blood pressure was measured using a standardized method in the right arm of the subject after resting for at least 5 minutes. Information on medical history for each participant was verified from a computerized database containing all primary care health records. Death certificates were obtained from the National Register; the collection of death certificates was complete. RESULTS: After adjusting for age, sex, functional status, and coexisting diseases (earlier-diagnosed myocardial infarction, congestive heart failure, dementia, cancer, stroke, or hypertension), low systolic blood pressure (BP) was associated with risk of death. CONCLUSION: Low systolic BP may be partially related to poor general health and poor vitality, but the very old may represent a select group of individuals, and the use of BP-lowering medications needs to be evaluated in this group.","Activities of Daily Living;Age Factors;Aged, 80 and over;Aging/*physiology;*Blood Pressure;Blood Pressure Monitoring, Ambulatory;Female;Finland/epidemiology;Follow-Up Studies;Humans;Male;Prospective Studies;Risk Factors;Sex Distribution;Surveys and Questionnaires;Survival Rate/trends;Urban Population/statistics & numerical data","Rastas, S.;Pirttila, T.;Viramo, P.;Verkkoniemi, A.;Halonen, P.;Juva, K.;Niinisto, L.;Mattila, K.;Lansimies, E.;Sulkava, R.",2006,Jun,10.1111/j.1532-5415.2006.00742.x,0,
3628,"Atrial fibrillation, stroke, and cognition: A longitudinal population-based study of people aged 85 and older","BACKGROUND AND PURPOSE - The aim of this study was to investigate the association between atrial fibrillation (AF), stroke, dementia, and their correlation with brain pathology in subjects aged 85 years or older. METHODS - This is a prospective 9-year follow-up population based study in Vantaa, a town in Southern Finland; 553 subjects (92% of the total population) aged 85 years or older were clinically examined by a neurologist. The presence of AF was collected from the medical records or examined by ECG or ambulatory ECG. Neuropathological examination was conducted in more than half of the clinically examined subjects. RESULTS - AF was significantly associated with stroke at baseline; 32% of patients with AF had clinical evidence of stroke compared with 16.7% of those without such evidence (P<0.001). Dementia at baseline was significantly associated with age, clinical stroke, and the presence of apolipoprotein E ε4 allele, but not with sex, education, or vascular risk factors. Multiple regression analysis including neuropathological results showed that dementia was significantly associated with education (OR, 0.89; 95% CI, 0.80 to 0.98; P=0.019), the β-amyloid load in the brain (OR, 1.26; 95% CI, 1.13 to 1.39; P<0.001) and with the vascular pathology (OR, 2.03; 95% CI, 1.14 to 3.62; P=0.016), but not with sex, age at death, apolipoprotein E ε4 allele, or vascular risk factors. CONCLUSIONS - AF is a significant and preventable risk factor for stroke but not for dementia in the very old. The etiology of dementia syndrome in the very old is multifactorial. Both Alzheimer disease pathology and vascular pathology, particularly multiple small infarcts, contribute to cognitive decline. © 2007 American Heart Association, Inc.",amyloid beta protein;apolipoprotein E;apolipoprotein e epsilon4;unclassified drug;aged;allele;ambulatory care;article;cognition;comparative study;controlled study;correlation analysis;dementia;disease association;electrocardiogram;female;Finland;follow up;atrial fibrillation;human;human tissue;longitudinal study;major clinical study;male;medical record;multiple regression;neurologic examination;patient education;population based case control study;priority journal;prospective study;risk factor;cerebrovascular accident;vascular disease,"Rastas, S.;Verkkoniemi, A.;Polvikoski, T.;Juva, K.;Niinistö, L.;Mattila, K.;Länsimies, E.;Pirttilä, T.;Sulkava, R.",2007,,,0,
3629,Cerebrovascular disease in dementia: the importance of atrial fibrillation,The relationship between cardiovascular disease and cerebral infarction was analysed in a prospectively assessed post mortem series of 48 demented patients. Hypertension was rare in this group of patients whose mean age was 82.7 y. Atrial fibrillation was the most important underlying cardiac abnormality. It is suggested that atrial fibrillation is more important than hypertension in the aetiology of cerebral infarction in the very aged and that this may be relevant to the pathogenesis of cerebrovascular dementia.,Aged;Atrial Fibrillation/*complications;Cerebral Infarction/*etiology/pathology;Circle of Willis/pathology;Coronary Disease/complications;Dementia/*etiology/pathology;Female;Humans;Hypertension/complications;Male;Prospective Studies,"Ratcliffe, P. J.;Wilcock, G. K.",1985,Mar,,0,
3630,Expanding the spectrum of γ-secretase gene mutation-associated phenotypes: Two novel mutations segregating with familial hidradenitis suppurativa (acne inversa) and acne conglobata,,gamma secretase;Notch receptor;acne conglobata;acne inversa;Alzheimer disease;amino acid sequence;autoinflammatory disease;breast cancer;complex formation;congestive cardiomyopathy;epigenetics;exon;frameshift mutation;frontotemporal dementia;gene;gene identification;gene segregation;genetic association;genetic code;genetic transcription;genetic variability;human;letter;NCSTN gene;nonsense mutation;pathogenesis;phenotype;protein binding;protein degradation;protein function;pseudoangiomatous stromal hyperplasia;sequence analysis;signal transduction;suppurative hidradenitis,"Ratnamala, U.;Jhala, D.;Jain, N. K.;Saiyed, N. M.;Raveendrababu, M.;Rao, M. V.;Mehta, T. Y.;Al-Ali, F. M.;Raval, K.;Nair, S.;Chandramohan, N. K.;Kuracha, M. R.;Nath, S. K.;Radhakrishna, U.",2016,,,0,
3631,Accuracy of ICD-10 coding system for identifying comorbidities and infectious conditions using data from a Thai university hospital administrative database,"Objective: To determine the accuracy of International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system in identifying comorbidities and infectious conditions using data from a Thai university hospital administrative database. Material and Method: A retrospective cross-sectional study was conducted among patients hospitalized in six general medicine wards at Siriraj Hospital. ICD-10 code data was identified and retrieved directly from the hospital administrative database. Patient comorbidities were captured using the ICD-10 coding algorithm for the Charlson comorbidity index. Infectious conditions were captured using the groups of ICD-10 diagnostic codes that were carefully prepared by two independent infectious disease specialists. Accuracy of ICD-10 codes combined with microbiological data for diagnosis of urinary tract infection (UTI) and bloodstream infection (BSI) was evaluated. Clinical data gathered from chart review was considered the gold standard in this study. Results: Between February 1 and May 31, 2013, a chart review of 546 hospitalization records was conducted. The mean age of hospitalized patients was 62.8±17.8 years and 65.9% of patients were female. Median length of stay [range] was 10.0 [1.0-353.0] days and hospital mortality was 21.8%. Conditions with ICD-10 codes that had good sensitivity (90% or higher) were diabetes mellitus and HIV infection. Conditions with ICD-10 codes that had good specificity (90% or higher) were cerebrovascular disease, chronic lung disease, diabetes mellitus, cancer, HIV infection, and all infectious conditions. By combining ICD-10 codes with microbiological results, sensitivity increased from 49.5 to 66% for UTI and from 78.3 to 92.8% for BSI. Conclusion: The ICD-10 coding algorithm is reliable only in some selected conditions, including underlying diabetes mellitus and HIV infection. Combining microbiological results with ICD-10 codes increased sensitivity of ICD-10 codes for identifying BSI. Future research is needed to improve the accuracy of hospital administrative coding system in Thailand.",adolescent;adult;aged;article;bloodstream infection;cerebrovascular disease;chronic lung disease;comorbidity;congestive heart failure;controlled study;cross-sectional study;data base;dementia;diabetes mellitus;diagnostic accuracy;diagnostic test accuracy study;female;gastrointestinal infection;heart infarction;hemiplegia;hospital management;human;ICD-10-CM;infection;kidney disease;length of stay;liver disease;lower respiratory tract infection;major clinical study;male;mortality;paraplegia;peptic ulcer;peripheral vascular disease;predictive value;retrospective study;rheumatic disease;sensitivity and specificity;skin infection;urinary tract infection,"Rattanaumpawan, P.;Wongkamhla, T.;Thamlikitkul, V.",2016,,,0,
3632,The effect of dementia on medication use and adherence among Medicare beneficiaries with chronic heart failure,"BACKGROUND: Alzheimer's disease and related disorders (ADRD) are prevalent in older adults, increase the costs of chronic heart failure (CHF) management, and may be associated with undertreatment of cardiovascular disease. OBJECTIVE: The purpose of our study was to determine the relationship between comorbid ADRD and CHF medication use and adherence among Medicare beneficiaries with CHF. METHODS: This 2-year (1/1/2006-12/31/2007) cross-sectional study used data from the Chronic Condition Data Warehouse of the Centers for Medicare and Medicaid Services. Medicare beneficiaries with evidence of CHF who had systolic dysfunction and Medicare Parts A, B, and D coverage during the entire study period were included. ADRD was identified based on diagnostic codes using the Chronic Condition Data Warehouse algorithm. CHF evidence-based medications (EBMs) were selected based on published guidelines: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, selected beta-blockers, aldosterone antagonists, and selected vasodilators. Measures of EBMs included a binary indicator of EBM use and medication possession ratio among users. RESULTS: Of 9827 beneficiaries with CHF and systolic dysfunction, 24.2% had a diagnosis of ADRD. Beneficiaries with ADRD were older (80.8 vs 73.6 years; P < 0.0001) and more likely to be female (69.3% vs 58.1%; P < 0.0001). Overall EBM use was lower in patients with CHF and ADRD compared with patients with CHF but no ADRD (85.3% vs 91.2%; P < 0.0001). Lower use among those with ADRD was consistent across all EBM classes except vasodilators. Among beneficiaries receiving EBM, those with ADRD had a slightly higher mean medication possession ratio for EBM compared with those without ADRD (0.86 vs 0.84; P = 0.0001). CONCLUSIONS: EBM medication adherence was high in this population, regardless of ADRD status. However, patients with ADRD had lower EBM use compared with those without ADRD. Low use of specific EBM medications such as beta-blockers was found in both groups. Therefore, interventions targeting increased treatment with specific EBMs for CHF, even among patients with ADRD, may be of benefit and could help reduce CHF-related hospitalizations.","Adult;Age Distribution;Aged;Aged, 80 and over;Alzheimer Disease/complications;Chronic Disease;Comorbidity;Cross-Sectional Studies;Dementia/*complications;Female;Health Care Costs;Heart Failure/*drug therapy/economics;Humans;Male;Medicare;Middle Aged;Multivariate Analysis;Patient Compliance/*statistics & numerical data;United States","Rattinger, G. B.;Dutcher, S. K.;Chhabra, P. T.;Franey, C. S.;Simoni-Wastila, L.;Gottlieb, S. S.;Stuart, B.;Zuckerman, I. H.",2012,Feb,10.1016/j.amjopharm.2011.11.003,0,
3633,Dementia Mortality: Estimates of survival after the onset of dementia range from 4 to 12 years,,age distribution;aging;Alzheimer disease;caregiver;cause of death;comorbidity;dementia;dementia mortality;diabetes mellitus;disease course;disease duration;disease severity;epilepsy;heart infarction;hip fracture;home care;human;hypertension;letter;medical specialist;mortality;multiinfarct dementia;neurologist;pneumonia;sample size;social psychology;cerebrovascular accident;survival time;thyroid disease,"Ravi, S.",2011,,,0,
3634,"Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality >80 Years of Age: Cohort Study Using Electronic Health Records","Background: Clinical trials show benefit from lowering systolic blood pressure (SBP) in people ≥80 years of age, but nonrandomized epidemiological studies suggest lower SBP may be associated with higher mortality. This study aimed to evaluate associations of SBP with all-cause mortality by frailty category >80 years of age and to evaluate SBP trajectories before death. Methods: A population-based cohort study was conducted using electronic health records of 144 403 participants ≥80 years of age registered with family practices in the United Kingdom from 2001 to 2014. Participants were followed for ≤5 years. Clinical records of SBP were analyzed. Frailty status was classified using the e-Frailty Index into the categories of fit, mild, moderate, and severe. All-cause mortality was evaluated by frailty status and mean SBP in Cox proportional-hazards models. SBP trajectories were evaluated using person months as observations, with mean SBP and antihypertensive treatment status estimated for each person month. Fractional polynomial models were used to estimate SBP trajectories over 5 years before death. Results: During follow-up, 51 808 deaths occurred. Mortality rates increased with frailty level and were greatest at SBP <110 mm Hg. In fit women, mortality was 7.7 per 100 person years at SBP 120 to 139 mm Hg, 15.2 at SBP 110 to 119 mm Hg, and 22.7 at SBP <110 mm Hg. For women with severe frailty, rates were 16.8, 25.2, and 39.6, respectively. SBP trajectories showed an accelerated decline in the last 2 years of life. The relative odds of SBP <120 mm Hg were higher in the last 3 months of life than 5 years previously in both treated (odds ratio, 6.06; 95% confidence interval, 5.40-6.81) and untreated (odds ratio, 6.31; 95% confidence interval, 5.30-7.52) patients. There was no evidence of intensification of antihypertensive therapy in the final 2 years of life. Conclusions: A terminal decline of SBP in the final 2 years of life suggests that nonrandomized epidemiological associations of low SBP with higher mortality may be accounted for by reverse causation if participants with lower blood pressure values are closer, on average, to the end of life.",angiotensin receptor antagonist;beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;thiazide diuretic agent;age;aged;antihypertensive therapy;article;blood pressure measurement;body mass;cause of death;cerebrovascular accident;cholesterol blood level;cohort analysis;comorbidity;dementia;electronic health record;female;follow up;frailty;general practice;geriatric care;human;hypertension;illness trajectory;ischemic heart disease;major clinical study;male;mortality rate;obesity;prescription;prevalence;primary medical care;priority journal;sex;smoking;systolic blood pressure;underweight;United Kingdom;very elderly,"Ravindrarajah, R.;Hazra, N. C.;Hamada, S.;Charlton, J.;Jackson, S. H. D.;Dregan, A.;Gulliford, M. C.",2017,,10.1161/circulationaha.116.026687,0,
3635,Repetitive Thinking as a Psychological Cognitive Style in Midlife Is Associated with Lower Risk for Dementia Three Decades Later,"Aims: To examine the association of a reported tendency toward repetitive thinking (RT) in midlife when confronting difficulties in family and work settings with dementia many years later. Methods: A tendency toward RT was assessed in approximately 9,000 male participants in the Israeli Ischemic Heart Disease study in 1965. The subjects were categorized according to their tendency toward RT in familial and work settings as: 1 = always forget; 2 = tend to forget; 3 = tend to think repetitively, and 4 = usually think repetitively. Dementia was assessed over 3 decades later in 1,889 participants among 2,604 survivors of the original cohort. Results: The prevalence rates of dementia were 24, 19, 15 and 14% in the 4 groups of tendency toward RT in stressful work situations with superiors (p for trend < 0.0002), respectively. The prevalence rates of dementia were 21, 18, 14 and 14% in the 4 groups of tendency toward RT in familial situations (p for trend < 0.004), respectively. These associations held after multivariate analysis. Conclusions: The tendency toward RT when confronting distress is associated with a lower risk for dementia. Future studies should assess possible mechanisms and potentials for intervention and modification. Copyright © 2009 S. Karger AG, Basel.",dementia;risk;prevalence;multivariate analysis;ischemic heart disease;survivor;male,"Ravona-Springer, R.;Beeri, M. S.;Goldbourt, U.",2009,,,0,
3636,Exposure to the holocaust and world war II concentration camps during late adolescence and adulthood is not associated with increased risk for dementia at old age,"Holocaust and Nazi concentration camp survivors were subjects to prolonged and multi-dimensional trauma and stress. The aim of the present study was to assess the association between exposure to such trauma during late adolescence and adulthood with dementia at old age. In 1963, approximately 10,000 male civil servants aged 40-71 participated in the Israel Ischemic Heart Disease (IIHD) study. Of them, 691 reported having survived Nazi concentration camps [concentration Camp Survivors (CCS)]. Additional 2316 participants were holocaust survivors but not concentration camp survivors (HSNCC) and 1688 were born in European countries but not exposed to the Holocaust (NH). Dementia was assessed in 1999-2000, over three decades later, in 1889 survivors of the original IIHD cohort; 139 of whom were CCS, 435 were HSNCC, and 236 were NH. Dementia prevalence was 11.5% in CCS, 12.6% in HSNCC, and 15.7% in NH. The odds ratio of dementia prevalence, estimated by age adjusted logistic regression, for CCS as compared to HSNCC was 0.97 (95% CI: 0.53-1.77), approximate Z =-0.10; p = 0.92. Further adjustment for socioeconomic status, diabetes mellitus, and other co-morbidity at midlife (coronary heart disease, lung, and kidney disease), and height did not change the results substantially. Thus, in subjects who survived until old age, late adolescence and adulthood exposure to extreme stress, as reflected by experiencing holocaust and Nazi concentration camps, was not associated with increased prevalence of dementia. Individuals who survived concentration camps and then lived into old age may carry survival advantages that are associated with protection from dementia and mortality. © 2011 - IOS Press and the authors. All rights reserved.",adult;aged;article;comorbidity;dementia;diabetes mellitus;Europe;holocaust;human;mortality;prevalence;priority journal;socioeconomics;survivor;war,"Ravona-Springer, R.;Beeri, M. S.;Goldbourt, U.",2011,,,0,
3637,Younger age at crisis following parental death in male children and adolescents is associated with higher risk for dementia at old age,"Aims: To examine the association of midlife report of crisis following parental death (CFPD) during childhood and adolescence, with dementia at old age. Methods: In 1965, 9362 male participants of the Israel Ischemic Heart Disease study were asked whether they have experienced CFPD (paternal or maternal) during the following ages: 0 to 6, 7 to 12, 13 to 18, or >18 years. Dementia was assessed over 3 decades later in 1889 survivors of the original cohort, 1652 of whom were assessed for CFPD in 1965. Results: Controlling for age, the estimated odds ratios for dementia relative to individuals who reported crisis following paternal parental death (CFPD-P) at the age of 18 years and above were 3.06 (95% CI: 1.42-6.61), 2.15 (95% CI: 0.87-5.31), and 2.35 (95% CI: 1.05-5.28) for those who reported CFPD-P at the ages of 0 to 6, 7 to 12, and 13 to 18 years, respectively. Odds ratios for dementia were 0.60 (95% CI: 0.32-1.11) for participants who reported CFPD-P at ages of 18 and above compared with participants who did not report such a crisis. Similar results were obtained for the association of crisis reported following maternal parental death (CFPD-M) at different age groups and dementia. Conclusions: CFPD during childhood is associated with an increased risk for dementia in men who survived until old age. Copyright © 2012 by Lippincott Williams & Wilkins.",adolescent;adult;age;anxiety disorder;article;child;child behavior;controlled study;death;dementia;disease association;emotional stress;high risk population;human;infant;life event;major clinical study;male;mortality;parental deprivation;preschool child;priority journal;psychologic assessment;risk assessment;school child;social status;survival,"Ravona-Springer, R.;Beeri, M. S.;Goldbourt, U.",2012,,,0,
3638,Satisfaction with current status at work and lack of motivation to improve it during midlife is associated with increased risk for dementia in subjects who survived thirty-seven years later,"The present study aimed to assess the relationship of midlife Motivation to Improve Status at work (MIS) with dementia more than three decades later. In 1963, 9,920 out of 10,059 male participants of the Israel Ischemic Heart disease (IIHD) study, aged 40-65 years, were questioned about their MIS as follows: ""Do you want to improve your status at work and do you believe it is possible?"". One of four answers was possible: trying to change status and believe it is possible (MIS1) (n = 3,060); trying but unsure of success (MIS2) (n = 2,618); not trying, unlikely to succeed (MIS3) (n = 2,020); not trying, satisfied (MIS4) (n = 2,222). Dementia was assessed over three decades later in 1,714 survivors of the original cohort, including 1,691 who responded in 1963 to the questionnaire regarding MIS. Controlling for age, the estimated odds for dementia relative to MIS1 were 1.45 (95% CI 1.06-2.01) in MIS2, 1.52 (95% CI 1.04-2.23) in MIS3, and 1.96 (95% CI 1.38-2.81) in MIS4. Further adjustment for age and socioeconomic status index resulted in adjusted estimated odds for dementia relative to MIS1 were 1.26 (95% CI 0.90-1.75) in MIS2, 1.10 (95% CI 0.74-1.64) in MIS3, and 1.78 (95% CI 1.23-2.56) in MIS4. These results were not attenuated when midlife diabetes, blood pressure values, serum-cholesterol levels, and coronary heart disease were controlled for in the analysis. Among tenured working men, lack of MIS together with satisfaction with current status was associated with higher risk for dementia among survivors several decades later. This association was partially attenuated by socioeconomic status.",Adult;Aged;Cohort Studies;Dementia/diagnosis/*epidemiology/*psychology;Follow-Up Studies;Humans;Israel/epidemiology;*Job Satisfaction;Male;Middle Aged;*Motivation/physiology;*Personal Satisfaction;Risk Factors;*Surveys and Questionnaires;Survival Rate/trends,"Ravona-Springer, R.;Beeri, M. S.;Goldbourt, U.",2013,,10.3233/jad-122422,0,
3639,Body weight variability in midlife and risk for dementia in old age,"Objective: To analyze the relationship between body weight variability and dementia more than 3 decades later. Methods: The measurement of body weight variability was based on 3 successive weight recordings taken from over 10,000 apparently healthy tenured working men participating in the Israel Ischemic Heart Disease study, in which cardiovascular risk factors and clinical status were assessed in 1963, 1965, and 1968, when subjects were 40-70 years of age. Groups of men were stratified according to quartiles of SD of weight change among 3 measurements (1963/1965/1968): ≤1.15 kg, 1.16-1.73 kg, 1.74-2.65 kg, and $2.66 kg. The prevalence of dementia was assessed more than 36 years later in approximately one-sixth of them who survived until 1999/2000 (minimum age 76 years) and underwent cognitive evaluation (n = 1,620). Results: Survivors' dementia prevalence rates were 13.4%, 18.4%, 20.1%, and 19.2% in the first to fourth quartiles ofweight change SD, respectively (p for trend5 0.034). Compared to the first quartile of weight change SD and adjusted for diabetes mellitus, body height, and socioeconomic status, a multivariate analysis demonstrated that the odds ratio for dementia was 1.42 (95% confidence interval [CI] 0.95-2.13), 1.59 (95% CI 1.05-2.37), and 1.74 (95% CI 1.14-2.64) in quartiles 2-4 of weight change SD respectively. This relationship was independent of the direction of weight changes. Conclusion: Midlife variations in weight may antecede late-life dementia. © 2013 American Academy of Neurology.",adult;aged;article;body height;body mass;body weight;cardiovascular risk;cognition;dementia;diabetes mellitus;human;Israel;male;prevalence;priority journal;risk assessment;senescence;social status;survivor;weight change,"Ravona-Springer, R.;Schnaider-Beeri, M.;Goldbourt, U.",2013,,,0,
3640,A Pathogenic Mechanism Potentially Operative in Multiple Progressive Diseases and Its Therapeutic Implications,"A variety of peptide signaling moieties that we have termed intracrines can act in the interiors of their cells of synthesis or of target cells after internalization. These intracrine factors are known to be upregulated in such disorders as diabetic nephropathy, systolic heart failure, and age-related macular degeneration. Indeed, a similar set of intracrines is upregulated in each of these disorders, suggesting a commonality of mechanism. In addition, several chronic neurodegenerative disorders such as Alzheimer disease and Parkinson disease involve intercellular trafficking of intracellular disease-causing proteins. These disorders can be considered intracrine-like. Here the mechanistic and therapeutic implications of these observations, and of the relevant modes of intracrine action, are discussed, including the possibility that similar therapeutic approaches could be effective in multiple progressive disorders and the implications of these observations for intracrine pharmacology in general.",age related macular degeneration;Alzheimer disease;chronic kidney failure;diabetic nephropathy;internalization;Parkinson disease;renin angiotensin aldosterone system;synthesis;systolic heart failure;target cell;peptide,"Re, R. N.",2017,,10.1002/jcph.997,0,
3641,"Despite hype, not all statins are the same, experts say",,C reactive protein;cerivastatin;hydroxymethylglutaryl coenzyme A reductase inhibitor;rosuvastatin;Alzheimer disease;neoplasm;coronary artery disease;drug marketing;food and drug administration;heart infarction;high risk patient;human;hypercholesterolemia;multiple sclerosis;note;osteoporosis;priority journal;rhabdomyolysis,"Ready, T.",2004,,,0,
3642,Oestrogen alone in postmenopausal women: Data from the WHI,,conjugated estrogen;gestagen;breast cancer;clinical trial;cognitive defect;dementia;drug use;estrogen deficiency;hip fracture;hormone substitution;human;hysterectomy;ischemic heart disease;menopausal syndrome;monotherapy;note;prescription;risk assessment;risk benefit analysis;statistical significance;cerebrovascular accident;venous thromboembolism,"Rebar, R. W.",2005,,,0,
3643,"First systematic experience of preimplantation genetic diagnosis for single-gene disorders, and/or preimplantation human leukocyte antigen typing, combined with 24-chromosome aneuploidy testing","Objective To study the feasibility, accuracy, and reproductive outcome of 24-chromosome aneuploidy testing (24-AT), combined with preimplantation genetic diagnosis (PGD) for single-gene disorders (SGDs) or human leukocyte antigen (HLA) typing in the same biopsy sample. Design Retrospective study. Setting Preimplantation genetic diagnosis center. Patient(s) A total of 238 PGD patients, average age 36.8 years, for whom 317 combined PGD cycles were performed, involving 105 different conditions, with or without HLA typing. Intervention(s) Whole-genome amplification product, obtained in 24-AT, was used for PGD and/or HLA typing in the same blastomere or blastocyst biopsy samples. Main Outcome Measure(s) Proportion of the embryos suitable for transfer detected in these blastomere or blastocyst samples, and the resulting pregnancy and spontaneous abortion rates. Result(s) Embryos suitable for transfer were detected in 42% blastocyst and 25.1% blastomere samples, with a total of 280 unaffected, HLA-matched euploid embryos detected for transfer in 212 cycles (1.3 embryos per transfer), resulting in 145 (68.4%) unaffected pregnancies and birth of 149 healthy, HLA-matched children. This outcome is significantly different from that of our 2,064 PGD cycle series without concomitant 24-AT, including improved pregnancy (68.4% vs. 45.4%) and 3-fold spontaneous abortion reduction (5.5% vs. 15%) rates. Conclusion(s) The introduced combined approach is a potential universal PGD test, which in addition to achieving extremely high diagnostic accuracy, significantly improves reproductive outcomes of PGD for SGDs and HLA typing in patients of advanced reproductive age.",cystic fibrosis transmembrane conductance regulator;hemoglobin beta chain;protein S;24 chromosome aneuploidy testing;achondroplasia;adrenoleukodystrophy;adult;Aicardi Goutieres syndrome;Alpers disease;alpha 1 antitrypsin deficiency;Alzheimer disease;arthrogryposis;article;Becker muscular dystrophy;beta thalassemia;blastocyst;blastoma;breast cancer;carnitine deficiency;carnitine palmitoyltransferase II deficiency;centronuclear myopathy;chromosome analysis;chromosome fragile site;colon polyposis;congenital adrenal hyperplasia;congenital disorder of glycosylation type 1a;controlled study;Creutzfeldt Jakob disease;Crouzon syndrome;cystic fibrosis;diagnostic accuracy;Duchenne muscular dystrophy;dyschondrosteosis;Ehlers Danlos syndrome;embryo;embryo transfer;Emery Dreifuss muscular dystrophy;epidermolysis bullosa dystrophica;facioscapulohumeral muscular dystrophy;familial cold autoinflammatory syndrome;familial hypertrophic cardiomyopathy;Fanconi anemia;feasibility study;female;Friedreich ataxia;Gaucher disease;gene amplification;genetic disorder;glycogen storage disease;GM1 gangliosidosis;hemophagocytic syndrome;hemophilia A;hereditary motor sensory neuropathy;hereditary multiple exostosis;hereditary nonpolyposis colorectal cancer;HLA typing;Holt Oram syndrome;human;Huntington chorea;hypohidrotic ectodermal dysplasia;Joubert syndrome;kidney polycystic disease;long QT syndrome 2;Machado Joseph disease;major clinical study;maple syrup urine disease;Marfan syndrome;medium chain acyl coenzyme A dehydrogenase deficiency;microarray analysis;mosaicism;multiple endocrine neoplasia;myotonic dystrophy;nail patella syndrome;nemaline myopathy;neurofibromatosis;neuronal ceroid lipofuscinosis;Niemann Pick disease;Noonan syndrome;Norrie disease;oculocutaneous albinism;ornithine transcarbamylase deficiency;osteogenesis imperfecta;outcome assessment;pemphigus vulgaris;perception deafness;phenylketonuria;pregnancy outcome;preimplantation genetic diagnosis;prenatal diagnosis;priority journal;propionic acidemia;protein S deficiency;retinoblastoma;retinoschisis;retrospective study;Rieger syndrome;Sandhoff disease;sickle cell anemia;single gene disorder;single nucleotide polymorphism;spastic paraplegia;spinal muscular atrophy;spontaneous abortion;telangiectasia;thrombophilia;tooth development;torsion dystonia;tuberous sclerosis;von Hippel Lindau disease;Waardenburg syndrome;Wiskott Aldrich syndrome,"Rechitsky, S.;Pakhalchuk, T.;San Ramos, G.;Goodman, A.;Zlatopolsky, Z.;Kuliev, A.",2015,,,0,
3644,Tai chi intervention may lead to improved cognitive function associated with reduced depression symptoms in heart failure patients,"Individuals with heart failure (HF) have elevated risk of cognitive impairment, with 70% or more scoring below clinical cut-points on cognitive screening tests. In addition, almost a third of HF patients exhibit clinical levels of depression symptoms, which are also related to moderate cognitive deficits. Combined, reduced cerebral blood flow associated with HF and elevated depression symptoms may put HF patients at an even greater risk for cognitive impairment. This may be important information, since even mild cognitive decrements are often a precursor to further cognitive impairment and increase dementia risk, especially among individuals with vascular pathology. Meanwhile, exercise programs including Tai Chi are beneficial in HF patients with a range of depression symptom levels. However, it is unknown whether reductions in depression symptoms associated with Tai chi are related to improved cognitive function. The present study sought to examine the relationships among Tai Chi practice, depression and cognitive function. Methods: Forty HF patients (mean age=66.4 +/- 10.8, and left ventricular ejection fraction (LVEF%) = 46.0 +/- 13.9) were randomly assigned to 16-weeks of Tai Chi, Resistance Band (RB) training or Standard of Care (SOC). The Montreal Cognitive Assessment (MoCA) (mean = 23.5 +/- 4.1) and the Beck Depression Inventory (BDI) (mean = 10.2 +/- 6.8) were administered to all participants before and after the 16-week intervention period. Results: A repeated measures ANOVA controlling for LVEF% and age revealed a group X time interaction for scores on the MoCA (F = 3.89, p = .032, partial eta2 = .21), with individuals in the Tai Chi group and the RB group demonstrating greater improvement in overall MoCA scores compared with the SOC group who showed a decline in MoCA scores . Multiple regression analyses controlling for LVEF% and age revealed that changes in MoCA were significantly negatively related to alterations in BDI (change R2 = .113, t = -2.69, p = .011). Conclusions: Our findings provide the initial evidence of the efficacy of Tai Chi practice as an additional potential exercise option for improving neuropsychological functioning in heart failure patients.",Tai Chi;cognition;heart failure;patient;human;psychosomatics;society;cognitive defect;risk;exercise;screening test;Beck Depression Inventory;health care quality;brain blood flow;heart left ventricle ejection fraction;vascular disease;dementia;multiple regression;precursor;analysis of variance;Sr-compmed,"Redwine, Ls;Pung, Ms;Hong, Ss;Wilson, Ks;Chinh, Ks;Iqbal, Fs;Mills, Pj",2014,,10.1097/PSY.0000000000000057,0,3645
3645,Tai chi intervention may lead to improved cognitive function associated with reduced depression symptoms in heart failure patients,"Individuals with heart failure (HF) have elevated risk of cognitive impairment, with 70% or more scoring below clinical cut-points on cognitive screening tests. In addition, almost a third of HF patients exhibit clinical levels of depression symptoms, which are also related to moderate cognitive deficits. Combined, reduced cerebral blood flow associated with HF and elevated depression symptoms may put HF patients at an even greater risk for cognitive impairment. This may be important information, since even mild cognitive decrements are often a precursor to further cognitive impairment and increase dementia risk, especially among individuals with vascular pathology. Meanwhile, exercise programs including Tai Chi are beneficial in HF patients with a range of depression symptom levels. However, it is unknown whether reductions in depression symptoms associated with Tai chi are related to improved cognitive function. The present study sought to examine the relationships among Tai Chi practice, depression and cognitive function. Methods: Forty HF patients (mean age=66.4 +/- 10.8, and left ventricular ejection fraction (LVEF%) = 46.0 +/- 13.9) were randomly assigned to 16-weeks of Tai Chi, Resistance Band (RB) training or Standard of Care (SOC). The Montreal Cognitive Assessment (MoCA) (mean = 23.5 +/- 4.1) and the Beck Depression Inventory (BDI) (mean = 10.2 +/- 6.8) were administered to all participants before and after the 16-week intervention period. Results: A repeated measures ANOVA controlling for LVEF% and age revealed a group X time interaction for scores on the MoCA (F = 3.89, p = .032, partial eta2 = .21), with individuals in the Tai Chi group and the RB group demonstrating greater improvement in overall MoCA scores compared with the SOC group who showed a decline in MoCA scores . Multiple regression analyses controlling for LVEF% and age revealed that changes in MoCA were significantly negatively related to alterations in BDI (change R2 = .113, t = -2.69, p = .011). Conclusions: Our findings provide the initial evidence of the efficacy of Tai Chi practice as an additional potential exercise option for improving neuropsychological functioning in heart failure patients.",Tai Chi;cognition;heart failure;patient;human;psychosomatics;society;cognitive defect;risk;exercise;screening test;Beck Depression Inventory;health care quality;brain blood flow;heart left ventricle ejection fraction;vascular disease;dementia;multiple regression;precursor;analysis of variance;Sr-compmed,"Redwine, L. S.;Pung, M. S.;Hong, S. S.;Wilson, K. S.;Chinh, K. S.;Iqbal, F. S.;Mills, P. J.",2014,,10.1097/psy.0000000000000057,0,
3646,Associations between serum cholesterol levels and cerebral amyloidosis,"IMPORTANCE: Because deposition of cerebral beta-amyloid (Abeta) seems to be a key initiating event in Alzheimer disease (AD), factors associated with increased deposition are of great interest. Whether elevated serum cholesterol levels act as such a factor is unknown. OBJECTIVE: To investigate the association between serum cholesterol levels and cerebral Abeta during life early in the AD process. DESIGN, SETTING, AND PARTICIPANTS: A multisite, university medical center-based, cross-sectional analysis of potential associations between contemporaneously assayed total serum cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and cerebral Abeta, measured with carbon C11-labeled Pittsburgh Compound B (PIB) positron emission tomography. Seventy-four persons (mean age, 78 years) were recruited via direct outreach in stroke clinics and community senior facilities following a protocol designed to obtain a cohort enriched for cerebrovascular disease and elevated vascular risk. Three patients had mild dementia. All others were clinically normal (n = 33) or had mild cognitive impairment (n = 38). RESULTS: Cerebral Abeta was quantified using a Global PIB Index, which averages PIB retention in cortical areas prone to amyloidosis. Statistical models that controlled for age and the apolipoprotein E epsilon4 allele revealed independent associations among the levels of LDL-C, HDL-C, and PIB index. Higher LDL-C and lower HDL-C levels were both associated with a higher PIB index. No association was found between the total cholesterol level and PIB index. No association was found between statin use and PIB index, and controlling for cholesterol treatment in the statistical models did not alter the basic findings. CONCLUSIONS AND RELEVANCE: Elevated cerebral Abeta level was associated with cholesterol fractions in a pattern analogous to that found in coronary artery disease. This finding, in living humans, is consistent with prior autopsy reports, epidemiologic findings, and animal and in vitro work, suggesting an important role for cholesterol in Abeta processing. Because cholesterol levels are modifiable, understanding their link to Abeta deposition could potentially and eventually have an effect on retarding the pathologic cascade of AD. These findings suggest that understanding the mechanisms through which serum lipids modulate Abeta could offer new approaches to slowing Abeta deposition and thus to reducing the incidence of AD.","Aged;Aged, 80 and over;Alzheimer Disease/*blood/radionuclide imaging;Amyloid beta-Peptides/*blood;Amyloidosis/*blood/radionuclide imaging;Cerebral Cortex/metabolism/*radionuclide imaging;Cholesterol/*blood;Cohort Studies;Cross-Sectional Studies;Female;Humans;Male","Reed, B.;Villeneuve, S.;Mack, W.;DeCarli, C.;Chui, H. C.;Jagust, W.",2014,Feb,10.1001/jamaneurol.2013.5390,0,
3647,Lower cognitive performance in normal older adult male twins carrying the apolipoprotein E epsilon 4 allele,"OBJECTIVE: Given the strong association of the apolipoprotein E (apoE) allele epsilon 4 with late-onset Alzheimer dementia or multi-infarct dementia, we tested whether normal older adult men with at least one epsilon 4 allele demonstrate subclinical changes in cognition and perform more poorly on tests of cognitive function compared with subjects without the epsilon 4 allele. DESIGN: Matched-pair design of normal adult male (average age, 63 years) fraternal twins. SETTING: Subjects voluntarily participated on an outpatient basis at a research or medical center facility. PARTICIPANTS: Members of the National Heart, Lung, and Blood Institute twin panel third examination previously genotyped for apoE. MAIN OUTCOME MEASURE: Education-adjusted scores on several neuropsychological tests were compared in twins discordant for the apoE epsilon 4 allele. Subjects with documented cerebrovascular disease were excluded. RESULTS: Among 20 fraternal twin pairs discordant for the presence of epsilon 4, twins with the epsilon 4 allele demonstrated poorer mean performance than their co-twins without the epsilon 4 allele. This relationship was also noted cross-sectionally where age- and education-adjusted scores of 50 individual twin subjects with at least one epsilon 4 allele demonstrated poorer performance compared with 138 individual twins without an epsilon 4 allele. CONCLUSIONS: The apoE epsilon 4 allele may be associated with decreased cognitive function in discordant twin pairs. Our results suggest that epsilon 4 may represent a potential marker for accelerated cognitive aging and such individuals may be at greater risk for development of late-onset Alzheimer dementia or multi-infarct dementia.","Alleles;Alzheimer Disease/genetics/psychology;Apolipoproteins E/*genetics;*Cognition;Cognition Disorders/genetics/psychology;Dementia, Multi-Infarct/genetics/psychology;Diseases in Twins;Humans;Male;Middle Aged;Neuropsychological Tests;Twins","Reed, T.;Carmelli, D.;Swan, G. E.;Breitner, J. C.;Welsh, K. A.;Jarvik, G. P.;Deeb, S.;Auwerx, J.",1994,Dec,,0,
3648,Long term outcomes following pretibial injury: Mortality and effects on social care,"Introduction: Pretibial injuries are common, and those patients requiring hospital admission are often elderly with significant comorbidity. The long term impact on social care and associated mortality seen in this patient group has not been reported previously. It was our impression that pretibial injury is often a marker of increasing social and/or medical needs of the patient, and that a significant proportion of these patients underwent long term changes in social circumstances following injury. Methods: A review of 109 patients with pretibial injuries over a 3-year period admitted to the Plastic Surgery Unit at Derriford Hospital, Plymouth, UK. Overall mortality and changes in social circumstances within a 6-month period following discharge from hospital were recorded. Results: The overall mortality was 11%. Twenty-five percent of patients underwent an escalation of their social care requirements immediately on discharge from hospital. At 6 months only 78% of patients who were living independently at home prior to admission had returned home. Increasing age, cardiovascular comorbidities, length of time to operation were significantly associated with deterioration in social circumstances and death. Conclusions: Mortality following pretibial injury is higher than that expected for the population. A sizeable proportion of patients with pretibial injuries can be expected to need significant long term changes in social input after injury. Whether this change is directly due to injury, or is a reflection of underlying medical and social deterioration identified by the hospital admission process is unclear. In either respect, close liaison with medical and social care teams is essential to facilitate optimum care in this patient group. © 2007 Elsevier Ltd. All rights reserved.",acetylsalicylic acid;anticoagulant agent;antithrombocytic agent;clopidogrel;steroid;warfarin;aged;anamnesis;angina pectoris;article;cause of death;chi square test;chronic obstructive lung disease;comorbidity;confidence interval;dementia;female;Fisher exact test;follow up;atrial fibrillation;heart disease;heart infarction;hospitalization;human;hypertension;length of stay;logistic regression analysis;long term care;major clinical study;male;mortality;muscle injury;neurological complication;operation duration;pneumonia;priority journal;rank sum test;respiratory tract disease;risk;social care;statistical significance;cerebrovascular accident;Student t test;tibialis anterior muscle,"Rees, L. S.;Chapman, T.;Yarrow, J.;Wharton, S.",2008,,,0,
3649,The age of menarche,"PIP: In females, the first menstrual period, menarche, signals the beginning of the capacity to reproduce and is associated with the development of secondary sexual characteristics. Menarche is one of the most significant milestones in a woman's life. The first cycles tend to be anovulatory and vary widely in length. They are usually painless and occur without warning. Menarche occurs between the ages of 10 and 16 years in most girls in developed countries. Although the precise determinants of menarcheal age remain to be understood, genetic influences, socioeconomic conditions, general health and well-being, nutritional status, certain types of exercise, seasonality, and family size possibly play a role. Over the past century the age at menarche has fallen in industrialized countries, but that trend has stopped and may even be reversing. The average age at menarche in 1840 was 16.5 years, now it is 13. The age at menopause, however, has remained relatively constant at approximately 50 years. The length of time during which women are exposed to endogenous estrogen has therefore been increasing. Reasons for the fall in menarcheal age remain unclear, but one interpretation considers it to be a reflection of the improvement in health and environmental conditions. The decline in menarcheal age appears to be leveling off in many countries such as Britain, Iceland, Italy, Poland, and Sweden, but continues in Germany and some other countries. Late menarche is associated with a decreased risk of developing breast cancer in later life, a decreased frequency of coronary heart disease, later first pregnancy, and reduction in teen pregnancy. Late menarche may, however, be positively associated with the risk of developing Alzheimer's disease. eng","*Adolescent;*Age Factors;Demography;*Menarche;Menstruation;Population;Population Characteristics;Reproduction;Adolescents;*Adolescents, Female;Demographic Factors;*Menarche--determinants;Youth","Rees, M.",1995,,,0,
3650,Rehabilitation in the elderly,"The prerequisites for effective rehabilitation programmes in elderly patients are described, taking into account the specific social, physiological and psychological changes associated with senescence. The special problems facing elderly patients admitted to hospital are discussed and how their needs can be met. The importance of dementia as a factor influencing rehabilitation is considered and the various forms of residential and non-residential care described. Similarly, the paramount importance of accurate diagnosis of the causes of confusional states is emphasized and principles of management described. The fruitfulness of effective liaison between the psychiatrist and geriatrician is underlined and various ways by which this can be achieved, including the place of psychogeriatric assessment unit, and the role of the acute geriatric ward and geriatric rehabilitation unit. The principles of management of the elderly mentally ill in hospital are outlined. As specific examples of the principles and problems of rehabilitation programmes for disorders in the elderly, a detailed description is presented of the rehabilitation of the patient with myocardial infarction and the patient who has developed a hemiplegia following a cerebrovascular accident.",Aged;Cerebrovascular Disorders/*rehabilitation;Confusion/rehabilitation;Dementia/*rehabilitation;Depression/rehabilitation;Geriatric Nursing;Humans;Interprofessional Relations;Mental Disorders/*rehabilitation;*Rehabilitation,"Rees, W. L.",1979,,,0,
3651,Better off living-the ethics of the new UNOS proposal for allocating kidneys for transplantation,,article;comorbidity;dementia;graft recipient;graft survival;heart failure;hospital admission;human;intensive care unit;kidney transplantation;living donor;medical ethics;neoplasm;prediction,"Reese, P. P.;Caplan, A. L.",2011,,,0,
3652,Representativeness of the get with the guidelines-stroke registry: Comparison of patient and hospital characteristics among medicare beneficiaries hospitalized with ischemic stroke,"Background and Purpose-: Get With The Guidelines (GWTG)-Stroke is a large quality improvement-based registry of acute stroke; however, its generalizability is unclear. We used fee-for-service Medicare claims to ascertain the representativeness of ischemic stroke admissions in GWTG-Stroke. Methods-: All 228 815 ischemic stroke admissions aged ≥65 years enrolled in GWTG-Stroke between April 2003 and December 2007 were linked to 926 756 unique fee-for-service Medicare patients with ischemic stroke (primary International Classification of Diseases, 9th Revision discharge code 434 or 436) from the same period. Patient characteristics and in-hospital outcomes were compared between the linked GWTG-Stroke Medicare cohort and the remaining unlinked Medicare cohort. Characteristics of GWTG-Stroke hospitals were compared with non-GWTG-Stroke hospitals. Results-: A total of 144 344 of the 228,815 GWTG-Stroke admissions (63.1%) were successfully linked to the 926 756 Medicare ischemic stroke beneficiaries, leaving 782 412 unlinked Medicare patients. Differences in patient characteristics, including age, race, gender, and comorbidities, between the linked and unlinked Medicare cohorts were minimal. Length of stay and rate of discharge home were almost identical between the linked and unlinked groups; however, in-hospital mortality was slightly lower in the linked Medicare cohort (6.3%) compared with the unlinked cohort (7.0%). There were large differences in hospital characteristics between GWTG-Stroke and non-GWTG-Stroke hospitals; GWTG-Stroke hospitals tended to be larger, urban, teaching centers. Conclusions-: Despite substantial differences between GWTG-Stroke and non-GWTG-Stroke hospitals, Medicare beneficiaries with acute ischemic stroke entered in the GWTG-Stroke program were similar to other Medicare beneficiaries. These data suggest that the Medicare-aged GWTG-Stroke ischemic stroke admissions are generally representative of the national fee-for-service Medicare ischemic stroke population. © 2011 American Heart Association. All rights reserved.",acute heart infarction;adult;aged;American Indian;article;Asian;brain ischemia;carotid artery obstruction;Caucasian;chronic obstructive lung disease;comorbidity;coronary artery disease;dementia;diabetes mellitus;disease registry;female;gender;Hispanic;hospital admission;hospital discharge;hospitalization;human;hypertension;length of stay;major clinical study;male;medicare;Black person;outcome assessment;peripheral vascular disease;pneumonia;practice guideline;priority journal;race;cerebrovascular accident,"Reeves, M. J.;Fonarow, G. C.;Smith, E. E.;Pan, W.;Olson, D.;Hernandez, A. F.;Peterson, E. D.;Schwamm, L. H.",2012,,,0,
3653,Misinterpreted neuropsychiatric presentations of medical problems in demented patients 1,,behavior disorder;brain disease;cerebrovascular accident;comorbidity;congestive heart failure;dementia;diabetic ketoacidosis;diagnostic error;drug intoxication;drug overdose;elderly care;encephalitis;human;hyperthyroidism;hypoglycemia;letter;medical practice;mental disease;mental health;neuroleptic malignant syndrome;neuropsychiatry;subdural hematoma;withdrawal syndrome,"Reeves, R. R.;Ladner, M. E.",2006,,,0,
3654,Orally Disintegrating for the Treatment of Psychotic and Behavioral Disturbances Associated with Dementia,Orally disintegrating olanzapine is a recently marketed form of olanzapine that dissolves rapidly on contact with saliva. We describe six demented patients resistant to treatment with common oral antipsychotic medications who were successfully treated with the formulation. The importance of these case reports is to make physicians aware that orally disintegrating olanzapine may be useful for the management of psychobehavioral disturbances in demented patients who resist or have difficulty taking standard oral medications.,acetylsalicylic acid;clonidine;donepezil;haloperidol;isosorbide;neuroleptic agent;olanzapine;salbutamol;terazosin;ticlopidine;valproic acid;verapamil;aged;Alzheimer disease;article;behavior disorder;chronic obstructive lung disease;clinical article;clinical feature;clinical medicine;dementia;drug formulation;drug solubility;female;human;hypertension;ischemic heart disease;male;multiinfarct dementia;prostate hypertrophy;psychosis;saliva;treatment outcome,"Reeves, R. R.;Torres, R. A.",2003,,,0,
3655,Primary angioplasty in acute myocardial infarction: Does age or race matter?,"Purpose: Recent data suggest substantial variations in the treatment of acute myocardial infarction based on age, race, gender and socioeconomic status. We evaluated the use of primary angioplasty (PA) in acute myocardial infarction (AMI) in elderly and minority patients treated at an urban, teaching hospital. Subjects and methods: We reviewed the records of 322 patients with AMI admitted to an urban, teaching hospital from 1997-2000. Our main outcome was PA in AMI. Secondary outcomes included use of post-infarction therapies. Univariate analysis was performed on the variables of interest, age and race, as well as all candidate variables. Results: Unadjusted analysis revealed that elderly and African-American patients were significantly less likely to receive PA for AMI, and post-infarction beta-blockers, (all p < .05). Other factors that had a significant negative impact on use of PA included do-not-resuscitate status, increasing acuity of presenting signs and symptoms, severity of illness, dementia and subendocardial infarcts (all p < .05). After adjustment for these potential confounders, increasing age remained inversely associated with both PA (p < .001), and use of standard post-myocardial infarction beta-blockers, (p < .05). Additionally, African-American patients in our study were less likely to undergo PA as initial AMI (p < .01). Conclusions: Our results indicate differences in the use of PA in the elderly and African-Americans. These differences are not explained by severity of illness and suggest that interventions and standard therapies may be withheld from those who may benefit most.",beta adrenergic receptor blocking agent;acute heart infarction;adult;age;aged;angioplasty;article;clinical feature;dementia;disease severity;elderly care;factorial analysis;female;geriatric patient;hospital admission;human;major clinical study;male;medical record;Black person;outcomes research;priority journal;race;resuscitation;standard;statistical analysis;teaching hospital;urban area,"Regueiro, C. R.;Gill, N.;Hart, A.;Crawshaw, L.;Hentosz, T.;Shannon, R. P.",2003,,,0,
3656,Self-reported exercise tolerance and the risk of serious perioperative complications,"Background: Impaired exercise tolerance during formal testing is predictive of perioperative complications. However, for most patients, formal exercise testing is not indicated, and exercise tolerance is assessed by history. Objective: To determine the relationship between self-reported exercise tolerance and serious perioperative complications. Methods: Our study group consisted of 600 consecutive outpatients referred to a medical consultation clinic at a tertiary care medical center for preoperative evaluation before undergoing 612 major noncardiac procedures. Patients were asked to estimate the number of blocks they could walk and flights of stairs they could climb without experiencing symptomatic limitation. Patients who could not walk 4 blocks and climb 2 flights of stairs were considered to have poor exercise tolerance. All patients were evaluated for the development of 26 serious complications that occurred during hospitalization. Results: Patients reporting poor exercise tolerance had more perioperative complications (20.4% vs 10.4%; P<.001). Specifically, they had more myocardial ischemia (P = .02) and more cardiovascular (P = .04) and neurologic (P = .03) events. Poor exercise tolerance predicted risk for serious complications independent of all other patient characteristics, including age (adjusted odds ratio, 1.94; 95% confidence interval, 1.19- 3.17). The likelihood of a serious complication occurring was inversely related to the number blocks that could be walked (P = .006) or flights of stairs that could be climbed (P = .01). Other patient characteristics predicting serious complications in multivariable regression analysis included history of congestive heart failure, dementia, Parkinson disease, and smoking greater than or equal to 20 pack-years. Conclusion: Self-reported exercise tolerance can be used to predict in-hospital perioperative risk, even when using relatively simple and familiar measures.",adult;article;cardiovascular disease;smoking;congestive cardiomyopathy;dementia;exercise tolerance;hospitalization;human;major clinical study;Parkinson disease;patient referral;perioperative period;prediction;preoperative evaluation;priority journal;regression analysis;risk assessment;risk factor;self report,"Reilly, D. F.;McNeely, M. J.;Doerner, D.;Greenberg, D. L.;Staiger, T. O.;Geist, M. J.;Vedovatti, P. A.;Coffey, J. E.;Mora, M. W.;Johnson, T. R.;Guray, E. D.;Van Norman, G. A.;Fihn, S. D.",1999,,,0,
3657,Inequalities in physical comorbidity: A longitudinal comparative cohort study of people with severe mental illness in the UK,"Objectives: Little is known about the prevalence of comorbidity rates in people with severe mental illness (SMI) in UK primary care. We calculated the prevalence of SMI by UK country, English region and deprivation quintile, antipsychotic and antidepressant medication prescription rates for people with SMI, and prevalence rates of common comorbidities in people with SMI compared with people without SMI. Design: Retrospective cohort study from 2000 to 2012. Setting: 627 general practices contributing to the Clinical Practice Research Datalink, a UK primary care database. Participants: Each identified case (346 551) was matched for age, sex and general practice with 5 randomly selected control cases (1 732 755) with no diagnosis of SMI in each yearly time point. Outcome measures: Prevalence rates were calculated for 16 conditions. Results: SMI rates were highest in Scotland and in more deprived areas. Rates increased in England, Wales and Northern Ireland over time, with the largest increase in Northern Ireland (0.48% in 2000/2001 to 0.69% in 2011/2012). Annual prevalence rates of all conditions were higher in people with SMI compared with those without SMI. The discrepancy between the prevalence of those with and without SMI increased over time for most conditions. A greater increase in the mean number of additional conditions was observed in the SMI population over the study period (0.6 in 2000/ 2001 to 1.0 in 2011/2012) compared with those without SMI (0.5 in 2000/2001 to 0.6 in 2011/2012). For both groups, most conditions were more prevalent in more deprived areas, whereas for the SMI group conditions such as hypothyroidism, chronic kidney disease and cancer were more prevalent in more affluent areas. Conclusions: Our findings highlight the health inequalities faced by people with SMI. The provision of appropriate timely health prevention, promotion and monitoring activities to reduce these health inequalities are needed, especially in deprived areas.",neuroleptic agent;serotonin uptake inhibitor;tricyclic antidepressant agent;adult;affective psychosis;article;asthma;bipolar disorder;cerebrovascular accident;chronic kidney disease;chronic obstructive lung disease;cohort analysis;comorbidity;comparative study;controlled study;dementia;depression;epilepsy;female;general practice;heart failure;human;hypertension;hypothyroidism;insulin dependent diabetes mellitus;ischemic heart disease;learning disorder;longitudinal study;major clinical study;male;mental disease;middle aged;neoplasm;non insulin dependent diabetes mellitus;osteoarthritis;prescription;prevalence;primary medical care;psoriasis;retrospective study;rheumatoid arthritis;schizophrenia;severe mental illness;United Kingdom,"Reilly, S.;Olier, I.;Planner, C.;Doran, T.;Reeves, D.;Ashcroft, D. M.;Gask, L.;Kontopantelis, E.",2015,,,0,
3658,Rofecoxib did not slow progression of dementia in patients with established Alzheimer's disease,,cyclooxygenase 2 inhibitor;naproxen;nonsteroid antiinflammatory agent;placebo;rofecoxib;Alzheimer disease;caregiver;clinical trial;cognition;cognitive defect;disease course;drug cost;drug selectivity;encephalitis;enzyme inhibition;evidence based medicine;gastrointestinal disease;heart failure;hospital admission;human;interview;pathophysiology;rating scale;risk benefit analysis;risk reduction;scoring system;short survey,"Reines, S. A.;Block, G. A.;Morris, J. C.;Lines, C.;Riggs, G.;Holloway, R.",2004,,,0,
3659,Central nervous system angioendotheliosis. A treatable multiple infarct dementia,"Neoplastic angioendotheliosis is a rare disorder of blood vessels characterized by a bizarre array of neurologic symptoms associated with dementia, strokelike syndrome, and dermatologic involvement. There is widespread vascular endothelial cell proliferation contained within the blood vessels throughout the body. This condition has been referred to as 'angioendotheliomastosis proliferans, systemisata' and 'diffuse malignant proliferation of the vascular endothelium'. This neoplastic angioendotheliosis is a treatable primary proliferative disorder of the endothelial cells of blood vessels characterized by a clinical neurologic picture of multiple infarct dementia and an inordinate amount of local cerebral edema, so striking that it may simulate a primary or metastatic solid tumor. The malignant cells remain within the lumen of the vessels and rarely if ever metastasize or occur in peripheral blood. Improvement can be obtained by high doses of steroids. Antimetabolites and irradiation are suggested means of additional treatment. General autopsy revealed neoplastic proliferation of the endothelial cells of the heart, liver, pancreas, adrenals, kidneys, bladder, ovaries, uterus, lungs, and gastrointestinal tract. The skin showed no change.",corticosteroid;autopsy;brain edema;brain infarction;brain tumor;dementia;diagnosis;hemangioendothelioma;histology;major clinical study;therapy,"Reinglass, J. L.;Muller, J.;Wissman, S.;Wellman, H.",1977,,,0,
3660,Subclinical atherosclerotic calcification and cognitive functioning in middle-aged adults: the CARDIA study,"OBJECTIVE: Cardiovascular risk factors in middle-age are associated with cognitive impairment and dementia in older age. Less is known about the burden of calcified subclinical atherosclerosis and cognition, especially in midlife. We examined the association of coronary artery and abdominal aortic calcified plaque (CAC and AAC, respectively) with cognitive functioning in middle-aged adults. METHODS: This cross-sectional study included 2510 black and white adults (age: 43-55 years) without heart disease or stroke who completed a year 25 follow-up exam (2010-11) as part of the Coronary Artery Risk Development in Young Adults Study. CAC and AAC were measured with non-contrast computed tomography. Cognition was assessed with the Digit Symbol Substitution Test (DSST) (psychomotor speed), Stroop Test (executive function), and Rey Auditory Verbal Learning Test (RAVLT) (verbal memory). RESULTS: A greater amount of CAC and AAC was associated with worse performance on each test of cognitive function after adjustment for age, sex, race, education, and study center. Associations were attenuated, but remained significant for the DSST and RAVLT following additional adjustment for vascular risk factors, including adiposity, smoking, alcohol use, dyslipidemia, hypertension, and diabetes. Compared to participants without CAC or AAC, those with both CAC and AAC, but not CAC or AAC alone was associated with lower DSST scores (p < 0.05). CONCLUSIONS: In this community-based sample, greater subclinical atherosclerotic calcification was associated with worse psychomotor speed and memory in midlife. These findings underscore the importance of a life course approach to the study of cognitive impairment with aging.","Aorta, Abdominal/pathology;Atherosclerosis/radiography;Calcinosis/*complications/radiography;Cognition Disorders/*etiology/pathology;Coronary Artery Disease/pathology/radiography;Coronary Vessels/pathology;Female;Humans;Longitudinal Studies;Male;Middle Aged;Plaque, Atherosclerotic/*pathology;Tomography, X-Ray Computed;Atherosclerosis;Cognition;Risk factors;Subclinical disease","Reis, J. P.;Launer, L. J.;Terry, J. G.;Loria, C. M.;Zeki Al Hazzouri, A.;Sidney, S.;Yaffe, K.;Jacobs, D. R., Jr.;Whitlow, C. T.;Zhu, N.;Carr, J. J.",2013,Nov,10.1016/j.atherosclerosis.2013.08.038,0,
3661,Personal view: What are coroners and pathologists for?,,death certificate;dementia;dyspnea;edema;heart disease;heart failure;heart muscle fibrosis;human;medical service;patient care;priority journal;short survey,"Reisner, C.",2009,,,0,
3662,"Validity of self-reported stroke in elderly African Americans, Caribbean Hispanics, and Whites","BACKGROUND: The validity of a self-reported stroke remains inconclusive. OBJECTIVE: To validate the diagnosis of self-reported stroke using stroke identified by magnetic resonance imaging (MRI) as the standard. DESIGN, SETTING, AND PARTICIPANTS: Community-based cohort study of nondemented, ethnically diverse elderly persons in northern Manhattan. METHODS: High-resolution quantitative MRIs were acquired for 717 participants without dementia. Sensitivity and specificity of stroke by self-report were examined using cross-sectional analyses and the chi(2) test. Putative relationships between factors potentially influencing the reporting of stroke, including memory performance, cognitive function, and vascular risk factors, were assessed using logistic regression models. Subsequently, all analyses were repeated, stratified by age, sex, ethnic group, and level of education. RESULTS: In analyses of the whole sample, sensitivity of stroke self-report for a diagnosis of stroke on MRI was 32.4%, and specificity was 78.9%. In analyses stratified by median age (80.1 years), the validity between reported stroke and detection of stroke on MRI was significantly better in the younger than the older age group (for all vascular territories: sensitivity and specificity, 36.7% and 81.3% vs 27.6% and 26.2%; P = .02). Impaired memory, cognitive skills, or language ability and the presence of hypertension or myocardial infarction were associated with higher rates of false-negative results. CONCLUSIONS: Using brain MRI as the standard, specificity and sensitivity of stroke self-report are low. Accuracy of self-report is influenced by age, presence of vascular disease, and cognitive function. In stroke research, sensitive neuroimaging techniques rather than stroke self-report should be used to determine stroke history.","African Americans/ethnology;Aged;Aged, 80 and over;Cohort Studies;*Ethnic Groups;European Continental Ancestry Group/ethnology;Female;*Geriatric Assessment;Hispanic Americans/ethnology;Humans;Logistic Models;Magnetic Resonance Imaging;Male;Neurologic Examination;Neuropsychological Tests;Residence Characteristics;*Self Concept;Sensitivity and Specificity;Stroke/*diagnosis/*ethnology/psychology;Surveys and Questionnaires","Reitz, C.;Schupf, N.;Luchsinger, J. A.;Brickman, A. M.;Manly, J. J.;Andrews, H.;Tang, M. X.;DeCarli, C.;Brown, T. R.;Mayeux, R.",2009,Jul,10.1001/archneurol.2009.83,0,
3663,"Hospitalization, inpatient burden and comorbidities associated with bullous pemphigoid in the U.S.A","Background: Bullous pemphigoid (BP) is associated with significant disability and comorbid health disorders that may lead to or result from hospitalization. However, little is known about the inpatient burden and comorbidities of BP. Objectives: To obtain data on the inpatient burden and comorbidities of BP in the U.S.A. Methods: We analysed data from the 2002 to 2012 National Inpatient Sample, including a representative 20% sample of all hospitalizations in the U.S.A. (72 108 077 adults). Results: The prevalence of hospitalization for BP increased from 25·84 to 32·60 cases per million inpatients from 2002 to 2012. In multivariate logistic regression models with stepwise selection, increasing age, nonwhite ethnicity, higher median household income, being insured with Medicare or Medicaid, and increasing number of chronic conditions were all associated with hospitalization for BP (P < 0·05 for all). The top three primary discharge diagnoses for patients with a secondary diagnosis of BP were septicaemia (prevalence 5·51%, 95% confidence interval 5·03–5·99), pneumonia (4·60%, 4·19–5·01) and urinary tract infection (3·52%, 3·15–3·89). Patients with BP also had numerous autoimmune, infectious, cardiovascular and other comorbidities. Interestingly, BP was associated with multiple neuropsychiatric disorders, including demyelinating disorders, dementias (presenile, senile, vascular and other), paralysis, neuropathy (diabetic, other polyneuropathy), Parkinson disease, epilepsy, psychoses and depression. The mean annual age- and sex-adjusted in-hospital mortality rate was significantly higher in patients with a secondary diagnosis of BP compared with no BP (2·9%, range 2·8–3·9% vs. 2·1%, range 1·9–2·2%). Significant predictors of mortality in patients with BP included increasing age, nonwhite ethnicity and insurance with Medicaid or other payment status (P < 0·05 for all). Conclusions: Hospitalization for BP increased significantly between 2002 and 2012. Moreover, there were significant ethnic and healthcare disparities with respect to hospitalization and inpatient mortality from BP.",acute kidney failure;acute respiratory failure;adult;age;aged;American Indian;article;Asian;atrial fibrillation;autoimmune disease;Black person;bullous pemphigoid;cardiovascular risk;celiac disease;cellulitis;chronic obstructive lung disease;collapse;comorbidity;congestive heart failure;coronary artery disease;Cushing syndrome;dehydration;demyelinating disease;depression;diabetic neuropathy;epilepsy;faintness;female;gastrointestinal hemorrhage;health care cost;heart infarction;hematologic malignancy;hospital discharge;hospital mortality;hospital patient;hospitalization;household income;human;hypertension;hypothyroidism;income;inpatient burden;land use;length of stay;lung embolism;major clinical study;male;medicaid;medicare;methicillin susceptible Staphylococcus aureus;metropolitan area;micropolitan area;middle aged;multiinfarct dementia;multiple chronic conditions;multiple sclerosis;mycosis;myocarditis;neurologic disease;non insulin dependent diabetes mellitus;obesity;occlusive cerebrovascular disease;osteomyelitis;paralysis;Parkinson disease;peripheral vascular disease;pneumonia;polyneuropathy;presenile dementia;prevalence;priority journal;psychosis;pulmonary vascular disease;rheumatoid arthritis;seasonal variation;senile dementia;septicemia;skin infection;spring;Staphylococcus infection;Streptococcus infection;summer;suppurative hidradenitis;systemic lupus erythematosus;teaching hospital;United States;urinary tract infection;very elderly;virus infection;volume depletion disorder;young adult,"Ren, Z.;Hsu, D. Y.;Brieva, J.;Silverberg, N. B.;Langan, S. M.;Silverberg, J. I.",2017,,10.1111/bjd.14821,0,
3664,"Hazards of hospitalization: More than just ""never events""",,acute heart infarction;anemia;bleeding;bloodstream infection;catheter infection;decubitus;dementia;environmental factor;functional disease;health care cost;health care quality;health care system;health hazard;hospital acquired pneumonia;hospital infection;hospitalization;hospitalization cost;human;length of stay;medication error;note;patient safety;phlebotomy;polypharmacy;priority journal;reimbursement;sensory dysfunction;surgical error;venous thromboembolism;ventilator associated pneumonia,"Rennke, S.;Fang, M. C.",2011,,,0,
3665,Depression in old age—the first step to dementia?,,antidepressant agent;age;alcohol consumption;Alzheimer disease;body mass;cognition assessment;dementia;depression;diabetes mellitus;heart infarction;human;meta analysis (topic);multiinfarct dementia;note;obesity;physical disease;physical inactivity;priority journal;proportional hazards model;risk factor;smoking;systematic review (topic),"Reppermund, S.",2016,,10.1016/s2215-0366(16)30022-0,0,
3666,Clinical endocrinologists' perception of the deleterious effects of TSH suppressive therapy in patients with differentiated thyroid carcinoma,"Objective: To explore the opinion of clinical endocrinologists as to the deleterious effects of thyrotropin (TSH) suppressive therapy in patients with differentiated thyroid carcinoma (DTC). Materials and methods: A self-administered survey was sent by e-mail to a group of endocrinologists with expertise in the treatment of patients with differentiated thyroid carcinoma. The questionnaire consisted of three questions related to: 1) the possible adverse effects of this therapy on different organ systems, 2) the clinical significance of these effects and 3) the usefulness of treatment guidelines for DTC. Results: A total of 91 endocrinologists responded with a wide divergence of opinions. No question had more than 80% of answers in a particular option. Of the possible side effects of suppressive therapy, a high degree of ignorance to three of them (increased left ventricular mass, reentrant tachycardia and diastolic dysfunction). Most respondents felt that the seven items, dementia and Alzheimer, decreased quality of life, decreased bone mineral density (BMD) in premenopausal women and men, thromboembolic disease, signs and symptoms of hyperthyroidism and increased risk of fractures were not affected by suppressive therapy, while most responded positively to two items (increased heart rate and decreased BMD in postmenopausal women). Eighty percent of the respondents felt that in any case these effects were not clinically significant and 33% considered that treatment guidelines should be reviewed. Conclusions: Clinical endocrinologists seem to have a very heterogeneous opinion regarding the potential harmful effects of TSH-suppressive therapy for DTC. © 2010 SEEN.",thyrotropin;Alzheimer disease;article;bone density;dementia;diastolic dysfunction;fracture;heart left ventricle mass;heart rate;hyperthyroidism;practice guideline;quality of life;questionnaire;tachycardia;thromboembolism;thyroid carcinoma,"Reverter, J. L.;Colomé, E.;Puig Domingo, M.;Julián, T.;Halperin, I.;Sanmartí, A.",2010,,,0,
3667,"Heart failure, dementia, and diuretics: is uric acid involved?",,"Aged;Aged, 80 and over;Alzheimer Disease/epidemiology/etiology;Antihypertensive Agents/*therapeutic use;Cohort Studies;Dementia/diagnosis/*epidemiology/*etiology;Female;Follow-Up Studies;Heart Failure/*complications/drug therapy/epidemiology;Humans;Male;Risk Assessment;Risk Factors;Sweden/epidemiology;Uric Acid/*blood","Reyes, A. J.",2006,Nov 13,10.1001/archinte.166.20.2286,0,
3668,"Heart failure, dementia, and diuretics: Is uric acid involved? 3",,antihypertensive agent;diuretic agent;uric acid;add on therapy;Alzheimer disease;cardiovascular risk;dementia;heart failure;heart left ventricle failure;human;letter;medical research;oxidative stress;priority journal;prognosis;sodium intake;cerebrovascular accident;uric acid blood level;urinary excretion,"Reyes, A. J.",2006,,,0,
3669,Local formularies,"The widespread availability of authoritative guidance on prescribing from a wide variety of international and national bodies calls into question the need for additional local formulary advice. This article describes contemporary local formulary management in the United Kingdom and discusses the areas where local decision making remains valuable. Local formularies can fulfil important roles which justify their continued existence, including ensuring local ownership and acceptance of advice, rapid dissemination of information, responsiveness to local circumstances and service design, sensitivity to local pricing arrangements and close professional links with commissioners, pharmacists and prescribers. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.",antibiotic agent;fibrinogen receptor;ibandronic acid;methotrexate;pamidronic acid;rivastigmine;somatostatin;vancomycin;acromegaly;acute coronary syndrome;Alzheimer disease;article;bone metastasis;breast cancer;cancer patient;Clostridium difficile infection;cost effectiveness analysis;decision making;drug formulary;dysphagia;health care organization;healthcare associated infection;human;medical education;organization and management;percutaneous coronary intervention;pharmacist;prescription;primary medical care;priority journal;rheumatoid arthritis;United States,"Reynolds, D. J. M.;Fajemisin, O.;Wilds, S.",2012,,,0,
3670,Systemic transthyretin amyloidosis in a patient with bent spine syndrome,"Wild-type and mutant transthyretin (TTR) are implicated in systemic amyloidosis (ATTR). Myopathy is a rare complication of ATTR amyloidosis, however no patient with bent spine syndrome secondary to ATTR amyloidosis has been reported so far. We present the first case of bent spine syndrome in a patient with wild-type ATTR amyloidosis who also had concomitant Alzheimer's disease. © 2013 Informa UK Ltd. All rights reserved.",congo red;prealbumin;aged;Alzheimer disease;amyloidosis;article;bent spine syndrome;cardiovascular magnetic resonance;case report;congestive cardiomyopathy;electromyography;heart atrium enlargement;human;human tissue;immunohistochemistry;male;memory disorder;myopathy;priority journal;spine disease;systemic transthyretin amyloidosis,"Rezania, K.;Pytel, P.;Smit, L. J.;Mastrianni, J.;Dina, M. A.;Highsmith, W. E.;Dogan, A.",2013,,,0,
3671,Mechanical embolectomy for ischemic stroke in a pediatric ventricular assist device patient,"The reported incidence of cerebral embolic or hemorrhagic complications related to mechanical circulatory support in children is high, even while subjects are managed with aggressive antithrombotic therapy. The safety and utility of endovascular treatment for stroke in the pediatric VAD population has not been established in the published literature. We describe a nine-yr-old patient on BiVAD support who experienced threatened AIS on two separate occasions. He was treated successfully via mechanical embolectomy on both occasions and survived to transplantation with minimal neurologic deficits. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",acetylsalicylic acid;blood clotting factor 10a;dipyridamole;heparin;mycophenolic acid;prednisolone;anesthesia induction;aphasia;arm weakness;article;bradycardia;brain ischemia;brain perfusion;cardiac graft rejection;case report;child;chronic graft rejection;computer assisted tomography;congestive cardiomyopathy;consciousness disorder;drug dose titration;extracorporeal oxygenation;gastrointestinal hemorrhage;general anesthesia;heart arrest;heart catheterization;heart failure;heart transplantation;heart ventricle fibrillation;hemiparesis;human;immunosuppressive treatment;intracardiac thrombosis;language disability;limb weakness;male;mechanical thrombectomy;mental deterioration;neuroimaging;neurologic disease;orthotopic transplantation;pediatric anesthesia;postoperative complication;rectum hemorrhage;rehabilitation care;resuscitation;retransplantation;school child;thrombocyte aggregation;transesophageal echocardiography;ventricular assist device;aspirin;BiVAD,"Rhee, E.;Hurst, R.;Pukenas, B.;Ichord, R.;Cahill, A. M.;Rossano, J.;Fuller, S.;Lin, K.",2014,,,0,
3672,Takotsubo Cardiomyopathy Associated with Severe Hypocalcemia Secondary to Idiopathic Hypoparathyroidism,The etiology and pathophysiology of takotsubo cardiomyopathy have not yet been fully clarified. We report a case of takotsubo cardiomyopathy associated with severe hypocalcemia secondary to hypoparathyroidism. A 69-year-old woman presented with acute pulmonary edema caused by severe left ventricular dysfunction with apical ballooning compatible with takotsubo cardiomyopathy. Laboratory tests revealed severe hypocalcemia secondary to idiopathic hypoparathyroidism. Coronary angiography showed normal coronary artery function. Her symptoms and signs of heart failure improved dramatically with the correction of hypocalcemia through calcium and calcitriol replacement. Copyright © 2013 The Korean Society of Cardiology.,angiotensin receptor antagonist;calcitriol;calcium ion;calcium lactate;furosemide;gluconate calcium;spironolactone;aged;amnesia;article;calcium blood level;cardiomegaly;case report;cognitive defect;crackle;disease association;disease duration;disease severity;dyspnea;electrocardiogram;emergency ward;female;hand paresthesia;heart left ventricle failure;heart ventriculography;hospital admission;human;hypocalcemia;hypotension;idiopathic hypoparathyroidism;leg cramp;lung auscultation;lung congestion;lung edema;physical examination;pleura effusion,"Rhee, H. S.;Lee, S. W.;Jung, Y. K.;Jeon, U.;Park, S. H.;Lee, S. J.;Sin, W. Y.;Jin, D. K.",2013,,,0,
3673,Investigating silent strokes in hypertensives: a magnetic resonance imaging study (ISSYS): rationale and protocol design,"METHODS/DESIGNCohort study in a randomly selected sample of 1000 participants, hypertensive aged 50 to 70 years old, with no history of previous stroke or dementia.On baseline all participants will undergo a brain MRI to determine the presence of brain infarcts and other cerebrovascular lesions (brain microbleeds, white matter changes and enlarged perivascular spaces) and will be also tested to determine other than brain organ damage (heart-left ventricular hypertrophy, kidney-urine albumin to creatinine ratio, vessels-pulse wave velocity, ankle brachial index), in order to establish the contribution of other subclinical conditions to the risk of further vascular events. Several sub-studies assessing the role of 24 hour ambulatory BP monitoring and plasma or genetic biomarkers will be performed.Follow-up will last for at least 3 years, to assess the rate of further stroke/transient ischemic attack, other cardiovascular events and cognitive decline, and their predictors.DISCUSSIONImproving the knowledge on the frequency and determinants of these lesions in our setting might help in the future to optimize treatments or establish new preventive strategies to minimize clinical and socioeconomic consequences of stroke and cognitive decline.BACKGROUNDSilent brain infarcts are detected by neuroimaging in up to 20% of asymptomatic patients based on population studies. They are five times more frequent than stroke in general population, and increase significantly both with advancing age and hypertension. Moreover, they are independently associated with the risk of future stroke and cognitive decline.Despite these numbers and the clinical consequences of silent brain infarcts, their prevalence in Mediterranean populations is not well known and their role as predictors of future cerebrovascular and cardiovascular events in hypertensive remains to be determined.ISSYS (Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study) is an observational cross-sectional and longitudinal study aimed to: 1- determine the prevalence of silent cerebrovascular infarcts in a large cohort of 1000 hypertensives and to study their associated factors and 2-to study their relationship with the risk of future stroke and cognitive decline.",Analysis of Variance;Blood Pressure [physiology];Brain Infarction [pathology];Cognition Disorders [diagnosis] [etiology];Cohort Studies;Hypertension [complications] [epidemiology];Magnetic Resonance Imaging;Physical Examination;Risk Factors;Stroke [complications] [diagnosis] [epidemiology] [prevention & control];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword],"Riba-Llena, I;Jarca, Ci;Mundet, X;Tovar, Jl;Orfila, F;López-Rueda, A;Nafría, C;Fernández, Jl;Castañé, X;Domingo, M;Alvarez-Sabín, J;Fernández-Cortiñas, I;Maisterra, O;Montaner, J;Delgado, P",2013,,10.1186/1471-2377-13-130,0,3674
3674,Investigating silent strokes in hypertensives: a magnetic resonance imaging study (ISSYS): rationale and protocol design,"BACKGROUND: Silent brain infarcts are detected by neuroimaging in up to 20% of asymptomatic patients based on population studies. They are five times more frequent than stroke in general population, and increase significantly both with advancing age and hypertension. Moreover, they are independently associated with the risk of future stroke and cognitive decline.Despite these numbers and the clinical consequences of silent brain infarcts, their prevalence in Mediterranean populations is not well known and their role as predictors of future cerebrovascular and cardiovascular events in hypertensive remains to be determined.ISSYS (Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study) is an observational cross-sectional and longitudinal study aimed to: 1- determine the prevalence of silent cerebrovascular infarcts in a large cohort of 1000 hypertensives and to study their associated factors and 2-to study their relationship with the risk of future stroke and cognitive decline. METHODS/DESIGN: Cohort study in a randomly selected sample of 1000 participants, hypertensive aged 50 to 70 years old, with no history of previous stroke or dementia.On baseline all participants will undergo a brain MRI to determine the presence of brain infarcts and other cerebrovascular lesions (brain microbleeds, white matter changes and enlarged perivascular spaces) and will be also tested to determine other than brain organ damage (heart-left ventricular hypertrophy, kidney-urine albumin to creatinine ratio, vessels-pulse wave velocity, ankle brachial index), in order to establish the contribution of other subclinical conditions to the risk of further vascular events. Several sub-studies assessing the role of 24 hour ambulatory BP monitoring and plasma or genetic biomarkers will be performed.Follow-up will last for at least 3 years, to assess the rate of further stroke/transient ischemic attack, other cardiovascular events and cognitive decline, and their predictors. DISCUSSION: Improving the knowledge on the frequency and determinants of these lesions in our setting might help in the future to optimize treatments or establish new preventive strategies to minimize clinical and socioeconomic consequences of stroke and cognitive decline.",Analysis of Variance;Blood Pressure [physiology];Brain Infarction [pathology];Cognition Disorders [diagnosis] [etiology];Cohort Studies;Hypertension [complications] [epidemiology];Magnetic Resonance Imaging;Physical Examination;Risk Factors;Stroke [complications] [diagnosis] [epidemiology] [prevention & control];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword],"Riba-Llena, I.;Jarca, C. I.;Mundet, X.;Tovar, J. L.;Orfila, F.;López-Rueda, A.;Nafría, C.;Fernández, J. L.;Castañé, X.;Domingo, M.;Alvarez-Sabín, J.;Fernández-Cortiñas, I.;Maisterra, O.;Montaner, J.;Delgado, P.",2013,,10.1186/1471-2377-13-130,0,
3675,Long-term risk of dementia in persons with schizophrenia: A danish population-based cohort study,"IMPORTANCE Although schizophrenia is associated with several age-related disorders and considerable cognitive impairment, it remains unclear whether the risk of dementia is higher among persons with schizophrenia compared with those without schizophrenia. OBJECTIVE To determine the risk of dementia among persons with schizophrenia compared with those without schizophrenia in a large nationwide cohort study with up to 18 years of follow-up, taking age and established risk factors for dementia into account. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study of more than 2.8 million persons aged 50 years or older used individual data from 6 nationwide registers in Denmark. A total of 20 683 individuals had schizophrenia. Follow-up started on January 1, 1995, and ended on January 1, 2013. Analysis was conducted from January 1, 2015, to April 30, 2015. MAIN OUTCOMES AND MEASURES Incidence rate ratios (IRRs) and cumulative incidence proportions (CIPs) of dementia for persons with schizophrenia compared with persons without schizophrenia. RESULTS During 18 years of follow-up, 136 012 individuals, including 944 individuals with a history of schizophrenia, developed dementia. Schizophrenia was associated with a more than 2-fold higher risk of all-cause dementia (IRR, 2.13; 95%CI, 2.00-2.27) after adjusting for age, sex, and calendar period. The estimates (reported as IRR; 95%CI) did not change substantially when adjusting for medical comorbidities, such as cardiovascular diseases and diabetes mellitus (2.01; 1.89-2.15) but decreased slightly when adjusting for substance abuse (1.71; 1.60-1.82). The association between schizophrenia and dementia risk was stable when evaluated in subgroups characterized by demographics and comorbidities, although the IRR was higher among individuals younger than 65 years (3.77; 3.29-4.33), men (2.38; 2.13-2.66), individuals living with a partner (3.16; 2.71-3.69), those without cerebrovascular disease (2.23; 2.08-2.39), and those without substance abuse (1.96; 1.82-2.11). The CIPs (95%CIs) of developing dementia by the age of 65 years were 1.8%(1.5%-2.2%) for persons with schizophrenia and 0.6%(0.6%-0.7%) for persons without schizophrenia. The respective CIPs for persons with and without schizophrenia were 7.4%(6.8%-8.1%) and 5.8% (5.8%-5.9%) by the age of 80 years. CONCLUSIONS AND RELEVANCE Individuals with schizophrenia, especially those younger than 65 years, had a markedly increased relative risk of dementia that could not be explained by established dementia risk factors.",adult;aged;article;atrial fibrillation;cardiovascular disease;cerebrovascular disease;cohort analysis;comorbidity;congestive heart failure;controlled study;daily life activity;dementia;diabetes mellitus;disease association;female;follow up;high risk population;human;ischemic heart disease;major clinical study;male;peripheral vascular disease;risk assessment;risk factor;schizophrenia;substance abuse,"Ribe, A. R.;Laursen, T. M.;Charles, M.;Katon, W.;Fenger-Grøn, M.;Davydow, D.;Chwastiak, L.;Cerimele, J. M.;Vestergaard, M.",2015,,,0,
3676,Vascular care in patients with Alzheimer disease with cerebrovascular lesions slows progression of white matter lesions on MRI: The evaluation of vascular care in Alzheimer's disease (EVA) study,"Background and Purpose:White matter lesions (WMLs) and cerebral infarcts are common findings in Alzheimer disease and may contribute to dementia severity. WMLs and lacunar infarcts may provide a potential target for intervention strategies. This study assessed whether multicomponent vascular care in patients with Alzheimer disease with cerebrovascular lesions slows progression of WMLs and prevents occurrence of new infarcts. Methods: A randomized controlled clinical trial, including 123 subjects, compared vascular care with standard care in patients with Alzheimer disease with cerebrovascular lesions on MRI. Progression of WMLs, lacunes, medial temporal lobe atrophy, and global cortical atrophy were semiquantitatively scored after 2-year follow-up. Results-Sixty-five subjects (36 vascular care, 29 standard care) had a baseline and a follow-up MRI and in 58 subjects, a follow-up scan could not be obtained due to advanced dementia or death. Subjects in the vascular care group had less progression of WMLs as measured with the WML change score (1.4 versus 2.3, P=0.03). There was no difference in the number of new lacunes or change in global cortical atrophy or medial temporal lobe atrophy between the 2 groups. Conclusions:s:Vascular care in patients with Alzheimer disease with cerebrovascular lesions slows progression of WMLs. Treatment aimed at vascular risk factors in patients with early Alzheimer disease may be beneficial, possibly in an even earlier stage of the disease. © 2010 American Heart Association, Inc.",acetylsalicylic acid;beta adrenergic receptor blocking agent;calcium antagonist;folic acid;pravastatin;pyridoxine;aged;Alzheimer disease;article;brain atrophy;brain cortex;brain damage;brain infarction;cerebrovascular disease;clinical trial;controlled clinical trial;controlled study;dementia;disease course;female;human;hypercholesterolemia;hypertension;major clinical study;male;nuclear magnetic resonance imaging;patient care;priority journal;randomized controlled trial;risk factor;temporal lobe;white matter,"Richard, E.;Gouw, A. A.;Scheltens, P.;Van Gool, W. A.",2010,,,0,
3677,Methodological issues in a cluster-randomized trial to prevent dementia by intensive vascular care,"DESIGN, SETTING AND PARTICIPANTSMulti-center, open, cluster-randomized controlled clinical trial (preDIVA) including 3535 non-demented subjects aged 70-78, executed in primary practice and coordinated from one academic hospital. General practices are randomized to standard care or intensive vascular care.INTERVENTIONVascular care consists of 4-monthly visits to a practice nurse who monitors all cardiovascular risk factors. Hypertension, hypercholesterolemia, overweight, lack of physical exercise and diabetes are strictly controlled according to a protocol and treated in a way, tailored to the characteristics of individual participants.MEASUREMENTSPrimary outcomes are incident dementia and disability; secondary outcomes are mortality, vascular events (stroke, myocardial infarction, peripheral vascular disease), cognitive decline and depression.RESULTSBetween May 2006 and February 2009, 3535 subjects from 115 general practices have been included. The clusters have an average size of 31 (SD 22, range 2-114). 1658 Patients from 52 practices were randomized to the standard care condition and 1877 patients in 63 practices to the vascular care condition.DISCUSSIONWhen designing a cluster-randomized trial, clustering of patient data within GP practices leads to a loss of power. This should be adjusted for in the power calculation. Since intensive vascular care will probably lead to a reduction in cardiovascular mortality, the competing risks of mortality and dementia should be taken into account.OBJECTIVESDescription of methodological issues in a trial designed to evaluate if a multi-component intervention aimed at vascular risk factors can prevent dementia.",Cardiovascular Diseases [mortality] [prevention & control];Cluster Analysis;Dementia [prevention & control];Depression;Disease Progression;Randomized Controlled Trials as Topic [methods];Reference Values;Risk Factors;Treatment Outcome;Aged[checkword];Humans[checkword];Sr-dementia: sr-htn,"Richard, E;Ligthart, Sa;Moll, van Charante Ep;Gool, Wa",2010,,,0,3678
3678,Methodological issues in a cluster-randomized trial to prevent dementia by intensive vascular care,"OBJECTIVES: Description of methodological issues in a trial designed to evaluate if a multi-component intervention aimed at vascular risk factors can prevent dementia. DESIGN, SETTING AND PARTICIPANTS: Multi-center, open, cluster-randomized controlled clinical trial (preDIVA) including 3535 non-demented subjects aged 70-78, executed in primary practice and coordinated from one academic hospital. General practices are randomized to standard care or intensive vascular care. INTERVENTION: Vascular care consists of 4-monthly visits to a practice nurse who monitors all cardiovascular risk factors. Hypertension, hypercholesterolemia, overweight, lack of physical exercise and diabetes are strictly controlled according to a protocol and treated in a way, tailored to the characteristics of individual participants. MEASUREMENTS: Primary outcomes are incident dementia and disability; secondary outcomes are mortality, vascular events (stroke, myocardial infarction, peripheral vascular disease), cognitive decline and depression. RESULTS: Between May 2006 and February 2009, 3535 subjects from 115 general practices have been included. The clusters have an average size of 31 (SD 22, range 2-114). 1658 Patients from 52 practices were randomized to the standard care condition and 1877 patients in 63 practices to the vascular care condition. DISCUSSION: When designing a cluster-randomized trial, clustering of patient data within GP practices leads to a loss of power. This should be adjusted for in the power calculation. Since intensive vascular care will probably lead to a reduction in cardiovascular mortality, the competing risks of mortality and dementia should be taken into account.",Cardiovascular Diseases [mortality] [prevention & control];Cluster Analysis;Dementia [prevention & control];Depression;Disease Progression;Randomized Controlled Trials as Topic [methods];Reference Values;Risk Factors;Treatment Outcome;Aged[checkword];Humans[checkword];Sr-dementia: sr-htn,"Richard, E.;Ligthart, S. A.;Moll van Charante, E. P.;Gool, W. A.",2010,,,0,
3679,The neuropathology of vascular disease in the medical research council cognitive function and ageing study (MRC CFAS),"Background: Vascular disease is associated with increased risk of dementia. Vascular health worsens with age. We investigated the relationship between self-reported vascular disease and brain pathology. Methods: Brain donations to the population-based MRC Cognitive Function and Ageing Study (n=456, age range 66-103 years) were assessed using a standard protocol for Alzheimer's Disease (AD) and cerebrovascular pathology. History of stroke, angina, diabetes, medicated hypertension and heart attack were identified from self-and proxy-report interviews, retrospective informant interviews and death certificates. Logistic regression was used to estimate associations between each health condition and dichotomised neuropathological variables adjusted for age and sex. Results: Stroke (36%), angina (23%), diabetes (12%), medicated hypertension (35%) and heart attack (22%) were frequently reported. Self-reported stroke was strongly associated with vascular, but not AD pathology. Medicated hypertension was associated with increased microinfarcts (OR=2.1, 95%CI=1.3-3.7) and less severe neocortical tangles (OR=0.5, 95%CI=0.3-0.8) and cerebral amyloid angiopathy (OR=0.5, 95%CI=0.3-0.8). Heart attack was associated with increased microinfarcts (OR=2.1, 95%CI=1.2-3.9). Conclusions: Vascular risk factors were not associated with an increased burden of AD pathology at death in old age. A positive association between indices of systemic cardiovascular health (treated hypertension and ischaemic heart disease) and cerebral microinfarcts emerged. The findings support the view that cerebral small vessel disease and cardiovascular disease are interrelated. Microinfarcts are emerging as an important correlate of age-related vascular cognitive impairment and the findings add weight to the argument for strategies to improve general cardiovascular health as a potential preventative strategy against cognitive decline in later life. © 2012 Bentham Science Publishers.",apolipoprotein E;aging;Alzheimer disease;angina pectoris;article;cerebrovascular disease;cognition;dementia;diabetes control;disease association;genotype;heart infarction;human;hypertension;medical research;neocortex;neuropathology;population research;priority journal;self report;cerebrovascular accident;vascular amyloidosis;vascular disease,"Richardson, K.;Stephan, B. C. M.;Ince, P. G.;Brayne, C.;Matthews, F. E.;Esiri, M. M.",2012,,,0,
3680,"Doctors' authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany","Objectives-The study was performed in order to investigate how end-of-life decisions are influenced by cultural and sociopolitical circumstances and to explore the compliance of doctors with patient wishes Participants and measurement-Five hundred and thirty-five physicians were surveyed in Sweden (Umeå), Germany (Rostock and Neubrandenburg), and in Russia (Arkhangelsk) by a questionnaire. The participants were recruited according to availability and are not representative. The questionnaire is based on the one developed by Molloy and co-workers in Canada which contains three case vignettes about an 82-year-old Alzheimer patient with an acute life-threatening condition; the questionnaire includes different levels of information about his treatment wishes. We have added various questions about attitudes determining doctors' decision making process (legal and ethical concerns, patient's and family wishes, hospital costs, patient's age and level of dementia and physician's religion). Results-Swedish physicians chose fewer life-prolonging interventions as compared with the Russian and the German doctors. Swedish physicians would perform cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest less frequently, followed by the German doctors. More than half the Russian physicians decided to perform CPR irrespective of the available information about the patient's wishes. Level of dementia emerged as the most powerful determining attitude-variable for the decision making in all three countries. Conclusions-The lack of compliance with patient wishes among a substantial number of doctors points to the necessity of emphasising ethical aspects both in medical education and clinical practice. The inconsistency in the treatment decisions of doctors from different countries calls for social consensus in this matter.",adult;age;aged;Alzheimer disease;article;authority;clinical practice;comparative study;controlled study;dementia;euthanasia;family;female;Germany;heart arrest;hospital cost;human;legal aspect;male;medical decision making;medical ethics;patient information;physician attitude;questionnaire;religion;resuscitation;Russian Federation;Sweden,"Richter, J.;Eisemann, M.;Zgonnikova, E.",2001,,,0,
3681,The ageing male and the socio-medical aspects,"The potential for good health is largely dependent on the prevention and reduction of early onset of fatal disease and death. The male population, in particular, is at risk from early onset of fatal disease and death. Prevention strategies must be developed in order to reduce the risk factors leading to the currently most common causes of death (heart disease, cancer, accidents). Due to the increase in life expectancy, however, other illnesses generally affecting the elderly population (osteoporosis, dementia, cancer, heart attack, incontinence etc.) are gaining in significance. The above average reduction in life expectancy in men can be counteracted particularly through preventative measures and the active promotion of good health. In particular risk factors, such as, smoking, overweight, high blood pressure and metabolic disease, are responsible for the high mortality rate in men. New research areas must be defined for the male population, which particularly focus on the ageing male. In the field of age related illness, gender specific investigations are definitely required. The main focus has to be on therapy and prevention of those diseases and their subsequent debilitating effects, that commonly effect the elderly. Particularly with men there is still a deficit of information with regards the role of hormones and their relationship with andropause and ageing.",accident;aging;article;neoplasm;dementia;health status;heart disease;heart infarction;human;hypertension;incontinence;life expectancy;metabolic disorder;mortality;obesity;onset age;osteoporosis;risk factor;smoking;social aspect,"Rieder, A.",2001,,,0,
3682,Clinical relevance of apolipoproteins,"Apolipoproteins play an important role as transport proteins of lipids, receptor binding proteins, activators of lipolytic enzymes and as mediators of other important physiological functions. With respect to clinical relevance, apo B and A-I have to be mentioned above all. Several studies indicate that these apolipoproteins are of similar validity in predicting the risk of coronary heart disease as LDL and HDL, of which they represent the major protein components. Apart from apo B and A-I, lipoprotein(a), is a potent predictor of atherosclerotic disease. Lp(a) is atherogenic and potentially thrombogenic since it consists of one molecule of LDL and one molecule of apo(a) and displays a great structural homology to plasminogen. Lp(a) has been shown to be an independent risk factor for coronary heart disease. Also of potential clinical importance is apo E, which occurs in three allelic forms. These isoforms play an important role in cholesterol homeostasis and possibly also in the pathogenesis of Alzheimer's disease.",apolipoprotein;apolipoprotein A1;apolipoprotein B;apolipoprotein E;binding protein;carrier protein;cholesterol;enzyme;high density lipoprotein;lipid;lipoprotein A;low density lipoprotein;plasminogen;Alzheimer disease;atherogenesis;atherosclerosis;coronary risk;enzyme activation;homeostasis;human;ischemic heart disease;lipolysis;lipoprotein metabolism;pathogenesis;physiology;prediction;protein structure;receptor binding;short survey;blood clotting,"Riesen, W. F.;Engler, H.",1996,,,0,
3683,Role of cardiovascular insufficiency in intellectual deterioration in senium,,"Aged;Aged, 80 and over;*Aging;*Dementia;*Heart Failure;Humans;*Mental Disorders;*Psychotic Disorders;*HEART FAILURE, CONGESTIVE/in old age;*MENTAL DISORDERS/in old age;*Psychoses, senile","Riggs, H. E.;Wahal, K. M.",1962,Jan,,0,
3684,Colorectal cancer patients: What do they die of?,,antineoplastic agent;anemia;artery disease;article;cancer epidemiology;tumor invasion;cancer patient;cancer survival;chronic disease;cohort analysis;colorectal cancer;controlled study;dementia;diabetes mellitus;falling;female;gastrointestinal disease;heart failure;heart infarction;human;hypertension;International Classification of Diseases;ischemic heart disease;lower respiratory tract infection;male;mental disease;neurologic disease;pneumonia;priority journal;retrospective study;suicide;Sweden;traffic accident;urogenital tract disease,"Riihimäki, M.;Thomsen, H.;Sundquist, K.;Hemminki, K.",2012,,,0,
3685,Evolution of chronic renal impairment and long-term mortality after de novo acute kidney injury in the critically ill; a Swedish multi-centre cohort study,"Acute Kidney Injury (AKI) is common in critical ill populations and its association with high short-term mortality is well established. However, long-term risks of death and renal dysfunction are poorly understood and few studies exclude patients with pre-existing renal disease, meaning outcome for de novo AKI has been difficult to elicit. We aimed to compare the long-term risk of Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD) and mortality in critically ill patients with and without severe de novo AKI. Method: This cohort study was conducted between 2005 and 2011 in Swedish intensive care units (ICU). Data from 130134 adult patients listed on the Swedish intensive care register-database was linked with other national registries. Patients with pre-existing CKD (4192) and ESRD (1389) were excluded, as were cases (26771) with incomplete data. Patients were classified according to AKI exposure during ICU admission. Outcome in the de novo AKI group was compared to the non-exposed (no-AKI) intensive care control group. Primary outcome was all-cause mortality. Follow-up ranged from one to seven years (median 2.1 years). Secondary outcomes were incidence of CKD and ESRD and median follow-up was 1.3 years. Results: Of 97 782 patients, 5273 (5.4%) had de novo AKI. These patients had significantly higher crude mortality at one (48.4% vs. 24.6%) and five years (61.8% vs. 39.1%) compared to the control group. The first 30% of deaths in AKI patients occurred within 11 days of ICU admission whilst the 30-centile in the no-AKI group died by 748 days. CKD was significantly more common in AKI survivors at one year (6.0% vs. 0.44%) than in no-AKI group (adjusted incidence rate ratio (IRR) 7.6). AKI patients also had significantly higher rates of ESRD at one (2.0% vs. 0.08%) and at five years (3.9% vs. 0.3%) than those in the comparison group (adjusted IRR 22.5). Conclusion: This large cohort study demonstrated that de novo AKI is associated with increased short and long-term risk of death. AKI is independently associated with increased risk of CKD and ESRD as compared to an ICU control population. Severe de novo AKI survivors should be routinely followed-up and their renal function monitored.",acute kidney failure;adult;aged;article;Charlson Comorbidity Index;chronic kidney failure;cohort analysis;comorbidity;controlled study;critically ill patient;dementia;diabetes mellitus;disease association;disease predisposition;end stage renal disease;female;heart infarction;high risk patient;human;intensive care unit;long term mortality;major clinical study;male;mortality;outcome assessment;predictive value;priority journal;prognosis;risk assessment;survival prediction;survival rate;survival time;Swedish citizen,"Rimes-Stigare, C.;Frumento, P.;Bottai, M.;Mårtensson, J.;Martling, C. R.;Walther, S. M.;Karlström, G.;Bell, M.",2015,,,0,
3686,A novel method for continuous environmental surveillance for carbon monoxide exposure to protect emergency medical service providers and patients,"Background: Carbon monoxide exposure is an important, but frequently undiagnosed, cause for Emergency Medical Services (EMS) response. Its elusive characteristics and non-specific symptoms make detection difficult without monitoring devices. Consequently, both patients and EMS providers are at increased risk of harm from such exposures. Case Series: We report a series of five cases of carbon monoxide encounters, in which carbon monoxide exposure was not suspected, whereby portable (pager-sized) environmental carbon monoxide detectors, that provide continuous surveillance of the ambient air, were utilized. These devices were carried within, or attached to, the first-in medical jump bags, alerting EMS crews to potentially harmful levels of carbon monoxide. Conclusion: This case series highlights the importance of environmental surveillance for carbon monoxide by EMS providers, particularly in such cases where its presence is not suspected. This was, in fact, the case in all the encounters presented herein. © 2013 Elsevier Inc.",azithromycin;carbon monoxide;donepezil;ibuprofen;salbutamol;abdominal pain;adult;aged;ambient air;analytical equipment;article;asthma;backache;bacterial infection;biosurveillance;blood pressure;blurred vision;bradycardia;breathing rate;carbon monoxide detector;carbon monoxide intoxication;clinical article;confusion;death;dementia;dyspnea;emergency health service;emergency patient;emergency ward;environmental exposure;environmental monitoring;eye disease;faintness;female;furnace;heart arrest;heart rate;hospital discharge;human;hyperbaric chamber;hyperbaric oxygen;hypercholesterolemia;hypertension;hypotension;male;medical history;nausea and vomiting;neck pain;oxygen therapy;paramedical personnel;patient transport;priority journal;pulse oximetry;urine incontinence;virus infection;aricept,"Risavi, B. L.;Wadas Jr, R. J.;Thomas, C.;Kupas, D. F.",2013,,,0,
3687,Efficacy of rosiglitazone in a genetically defined population with mild-to-moderate Alzheimer's disease,"Mild-to-moderate AD patients were randomized to placebo or rosiglitazone (RSG) 2, 4 or 8 mg. Primary end points at Week 24 were mean change from baseline in AD Assessment Scale-Cognitive (ADAS-Cog) and Clinician's Interview-Based Impression of Change Plus Caregiver Input global scores in the intention-to-treat population (N=511), and results were also stratified by apolipoprotein E (APOE) genotype (n=323). No statistically significant differences on primary end points were detected between placebo and any RSG dose. There was a significant interaction between APOE ε4 allele status and ADAS-Cog (P=0.014). Exploratory analyses demonstrated significant improvement in ADAS-Cog in APOE ε4-negative patients on 8 mg RSG (P=0.024; not corrected for multiplicity). APOE ε4-positive patients did not show improvement and showed a decline at the lowest RSG dose (P=0.012; not corrected for multiplicity). Exploratory analyses suggested that APOE ε4 non-carriers exhibited cognitive and functional improvement in response to RSG, whereas APOE ε4 allele carriers showed no improvement and some decline was noted. These preliminary findings require confirmation in appropriate clinical studies.",apolipoprotein E4;placebo;rosiglitazone;aged;Alzheimer disease;anxiety disorder;article;asthenia;backache;bronchitis;clinical trial;cognition;constipation;controlled clinical trial;controlled study;contusion;coughing;cystitis;diarrhea;disease severity;dizziness;double blind procedure;drug dose regimen;drug fatality;drug induced headache;edema;female;genetic trait;genotype;heart failure;heterozygote;human;insomnia;interview;major clinical study;male;mental deterioration;outcome assessment;peripheral edema;priority journal;randomized controlled trial;rating scale;rhinopharyngitis;scoring system;statistical significance,"Risner, M. E.;Saunders, A. M.;Altman, J. F. B.;Ormandy, G. C.;Craft, S.;Foley, I. M.;Zvartau-Hind, M. E.;Hosford, D. A.;Roses, A. D.",2006,,,0,
3688,The significance of carotid sinus hypersensitivity in the elderly,"The carotid sinus stimulation test was performed under electrocardiographic control in 100 consecutive patients admitted to a psychogeriatric assessment unit. An abnormal cardioinhibitory response was obtained in two patients, and a borderline response in 13 patients. The incidence of carotid sinus hypersensitivity was no higher in those with dementia, coronary artery disease, and arteriosclerosis, nor in the very elderly. The increased frequency in males was significant. It is suggested that age alone is not a predisposing factor. Further studies are needed to determine the importance of a hypersensitive reflex as a clinical entity in the elderly.",Age Factors;Aged;Arteriosclerosis/physiopathology;*Blood Pressure;Carotid Sinus/*physiopathology;Coronary Disease/physiopathology;Dementia/physiopathology;Female;*Geriatrics;*Heart Rate;Humans;Male;*Reflex;Sex Factors,"Ritch, A. E.",1975,,,0,
3689,Ocular and systemic manifestations of exfoliation syndrome,"Exfoliation syndrome is an age-related disease characterized by the production and progressive accumulation of a fibrillar extracellular material in many ocular tissues. It leads to the most common identifiable cause of open-angle glaucoma worldwide, comprising the majority of glaucoma in some countries. The material in the eye appears as white deposits on the anterior lens surface and/or pupillary border. During pupillary movement, the iris scrapes exfoliation material from the lens surface, while the material on the lens causes rupture of iris pigment epithelial cells, with concomitant pigment dispersion into the anterior chamber and its deposition on anterior chamber structures. Exfoliation material can be found in many different organs. It is an ischemic disease and is associated with elevated serum homocysteine. Systemic associations include transient ischemic attacks, hypertension, angina, myocardial infarction, cerebrovascular and cardiovascular disease, aortic aneurysm, Alzheimer disease, and hearing loss. The discovery in 2007 of nonsynonymous single nucleotide polymorphisms in the LOXL1 (lysyl oxidase-like 1) gene are expected to make a major impact not only in understanding exfoliation syndrome, but in leading to new avenues of therapy.",dorzolamide plus timolol;latanoprost;pilocarpine;argon laser trabeculoplasty;article;disease course;exfoliative glaucoma;eye disease;gene expression;genetic risk;genetics;glaucoma;heredity;human;incidence;intraocular pressure;molecular pathology;open angle glaucoma;pathogenesis;prevalence;priority journal;prognosis;pseudoexfoliation;risk factor;systemic disease;trabecular meshwork;trabeculectomy;trabeculoplasty;ultrastructure;vascular disease,"Ritch, R.",2014,,,0,
3690,Adverse childhood environment and late-life cognitive functioning,"Objective: Clinical studies suggest that childhood maltreatment may cause nervous system changes and consequent cognitive disorder. The persistence of this association in late-life is examined. Methods: Cognitive functioning and childhood events were examined in 1282 persons over 65 years, taking into account proximal competing causes of poor cognitive performance. Results: Ninety one per cent experienced at least one adverse childhood event, of these 14.7% severe events. Sharing of parental problems and, for women, loss of a parent were associated with poorer verbal retrieval whereas being sent to a foster home or mistreatment by schoolmates was associated with poorer visuospatial memory. Severe abuse was associated with a lower risk of cognitive impairment on some tests suggesting a resilience factor. Positive childhood environment was protective although only for non-carriers of the ApoE e4 allele on the central executive task. Conclusions: Some adverse childhood events continue to have a negative effect on later-life cognitive performance, while some more severe acute events may have the opposite effect, underlying the necessity to consider events individually and not as global test scores. Copyright © 2010 John Wiley & Sons, Ltd.",apolipoprotein E4;aged;allele;angina pectoris;arteritis;article;asthma;blood sampling;child abuse;child parent relation;childhood;clinical assessment;cognition;cognitive defect;dementia;diabetes mellitus;Diagnostic and Statistical Manual of Mental Disorders;family conflict;family history;female;foster care;genotype;heart arrhythmia;heart failure;heart infarction;heterozygote;human;hypercholesterolemia;hypertension;life event;major clinical study;male;memory consolidation;mental disease;neglect;neurologic examination;parental deprivation;poverty;questionnaire;cerebrovascular accident;thyroid disease;verbal memory;visual memory,"Ritchie, K.;Jaussent, I.;Stewart, R.;Dupuy, A. M.;Courtet, P.;Malafosse, A.;Ancelin, M. L.",2011,,,0,
3691,Cause and mechanisms of intracranial atherosclerosis,,apolipoprotein A1;catalase;copper zinc superoxide dismutase;high density lipoprotein cholesterol;low density lipoprotein cholesterol;manganese superoxide dismutase;article;autopsy;brain atherosclerosis;brain ischemia;cerebrovascular accident;computed tomographic angiography;diabetes mellitus;dyslipidemia;human;hypercholesterolemia;hypertension;internal carotid artery;metabolic syndrome X;neuroimaging;nuclear magnetic resonance imaging;priority journal;race;risk factor;silent myocardial ischemia;subarachnoid hemorrhage;vasa vasorum,"Ritz, K.;Denswil, N. P.;Stam, O. C. G.;Van Lieshout, J. J.;Daemen, M. J. A. P.",2014,,,0,
3692,Prognostic value and risk factors of delirium in emergency patients with decompensated heart failure,"OBJECTIVE: Patients with heart failure (HF) seen at the emergency department (ED) are increasingly older and more likely to present delirium. Little is known, however, about the impact of this syndrome on outcome in these patients. We aimed to investigate the prognostic value and risk factors of delirium at admission (prevalent delirium) in ED patients with decompensated HF. METHODS AND RESULTS: We performed a prospective, observational study, analyzing the presence of prevalent delirium in decompensated HF patients attended at the ED in 2 hospitals in Spain in the context of the Epidemiology Acute Heart Failure Emergency project. We used the brief Confusion Assessment Method to assess the presence of delirium. Patients were followed for 1 month after discharge. Of 239 enrolled patients (81.7 +/- 9.4 years, women 61.1%, long-term care [LTC] 11%), 35 (14.6%) had prevalent delirium (20% LTC vs 9.4% in-home, P = .078). The factors associated with delirium in the multivariate analysis were functional dependence (P = .001) and dementia (P = .005). Prevalent delirium was an independent risk factor of death within 30 days (OR 3.532; 95% CI 1.422-8.769, P = .007) whereas autonomy in basic activities of daily living was a protective factor (OR 0.971; 95% CI 0.956-0.986, P = .001). The area under the ROC curve for our 30-day mortality model was 0.802 (95% CI 0.721-0.883, P = .001). CONCLUSION: Prevalent delirium in patients with decompensated HF was a predictor of short-term mortality. Routine identification of delirium in patients at risk, particularly those with greater functional dependence, can help emergency physicians in decision-making and enhance care in patients with decompensated HF.",Aged;Delirium/diagnosis/*epidemiology/mortality;Female;Geriatric Assessment;Heart Failure/*epidemiology/mortality;Humans;Male;Prevalence;Prognosis;Prospective Studies;Risk Factors;Spain/epidemiology;Delirium;comprehensive geriatric assessment;emergency department;heart failure,"Rizzi, M. A.;Torres Bonafonte, O. H.;Alquezar, A.;Herrera Mateo, S.;Pinera, P.;Puig, M.;Benito, S.;Ruiz, D.",2015,Sep 1,10.1016/j.jamda.2015.06.006,0,
3693,Effect of the Interplay Between Genetic and Behavioral Risks on Survival After Age 75,"Objectives: To explore the association between genes that may be related to human mortality, taking into account the possible contribution of morbidity, and investigate whether lifestyle behaviors may attenuate genetic risk. Design: Twenty-five-year population-based cohort study. Setting: Kungsholmen cohort, Stockholm, Sweden. Participants: Individuals aged 75 and older (N = 1,229). Measurements: The associations between single-nucleotide variations in 14 genes (previously associated with mortality or to diseases linked to mortality), relevant lifestyle risk behaviors (smoking; mental, physical, or social inactivity; moderate or poor social network), and mortality were estimated using Cox regression. Results: People with allelic variation in four genes related to cardiovascular diseases and metabolism were more likely to die: apolipoprotein (APO)C1 GG and AG carriers, APOE ɛ4 carriers, insulin-degrading enzyme (IDE) TC carriers, and phosphatidylinositol 3-kinase (PI3KCB) GG carriers. Individuals with multiple adverse alleles had 62% higher mortality rate than those with none. In contrast, people with no risk behaviors (low-risk profile) had 65% lower mortality rate than people with all examined risk behaviors (high-risk profile). Combining the genetic and environmental factors, it was found that, independent of genetic profile, individuals with a low-risk profile had up to 64% lower mortality rate than those with a moderate high– or high-risk profile and at least one genetic risk factor. Conclusion: This study supports and expands evidence that genetic variations in APOE, IDE, and PI3KCB are associated with lower mortality rate, although lifestyle behaviors can modulate their effects.",apolipoprotein C1;apolipoprotein E4;insulinase;phosphatidylinositol 3 kinase;aged;allele;article;cerebrovascular disease;cohort analysis;dementia;diabetes mellitus;environmental factor;female;genetic risk;genetic variation;high risk behavior;human;ischemic heart disease;lifestyle;long term survival;low risk population;major clinical study;male;mortality rate;population research;single nucleotide polymorphism;smoking;social network;Sweden;very elderly,"Rizzuto, D.;Keller, L.;Orsini, N.;Graff, C.;Bäckman, L.;Bellocco, R.;Wang, H. X.;Fratiglioni, L.",2016,,10.1111/jgs.14391,0,
3694,Acute painless progressive quadriplegia associated with warfarin use 1,,corticosteroid;dexamethasone;fresh frozen plasma;warfarin;aged;blood clotting disorder;case report;chronic obstructive lung disease;clinical feature;computer assisted tomography;congestive heart failure;dementia;disease course;disease exacerbation;atrial fibrillation;human;hyperlipidemia;hypertension;letter;male;nuclear magnetic resonance imaging;quadriplegia;spinal cord hemorrhage,"Robbins, M.;Verghese, J.",2007,,,0,
3695,Age-related diseases,,age;arteriosclerosis;article;atherosclerosis;cognitive defect;dementia;emphysema;heart failure;metabolic syndrome X;non insulin dependent diabetes mellitus;osteoarthritis;osteoporosis;prostate cancer,"Robert, L.",2005,,,0,
3696,Measurement of total homocysteine concentrations in acidic citrate using an enzymatic cycling method,,adenosylhomocysteinase;citric acid;homocysteine;reduced nicotinamide adenine dinucleotide;Alzheimer disease;analytic method;article;atherosclerosis;cardiovascular risk;dilution;enyzmatic cycling method;enzyme immunoassay;enzyme mechanism;high performance liquid chromatography;human;ischemic heart disease;linear regression analysis;peripheral vascular disease;pH;priority journal;cerebrovascular accident,"Roberts, E. L.;Davies, R. A.",2009,,,0,
3697,Minimally invasive autopsy employing post-mortem CT and targeted coronary angiography: Evaluation of its application to a routine Coronial service,"Aims: Post-mortem imaging is a potential alternative to traditional medicolegal autopsy. We investigate the reduction in number of invasive autopsies required by use of post-mortem CT ± coronary angiography. Methods and results: A total of 120 adult deaths referred to the Coroner were investigated by CT, with coronary angiography employed only for the second series of 60 cases, in order to determine the added value of angiography. The confidence of imaging cause of death was classified as definite (no autopsy), probable, possible or unascertained. Invasive autopsy was not required in 38% of cases without coronary angiography and 70% of cases with angiography. Full autopsy, including brain dissection, was required in only 9% of cases. There was complete agreement between autopsy and radiological causes of death in the cases with a 'probable' imaging cause of death, indicating that cases for which imaging provides an accurate cause of death without autopsy were identified correctly. In two patients, CT demonstrated unsuspected fractures, not detected at subsequent autopsy. Conclusions: A two-thirds reduction in the number of invasive coronial autopsies can be achieved by use of post-mortem CT plus coronary angiography. At the same time, use of post-mortem CT may improve accuracy of diagnosis, particularly for traumatic deaths. © 2013 John Wiley & Sons Ltd.",acute pyelonephritis;aged;alcohol abuse;alcohol liver disease;aorta dissection;aorta rupture;article;asphyxia;autopsy;brain hemorrhage;brain infarction;brain surgery;bronchopneumonia;cause of death;computed tomographic angiography;coronary artery calcification;coronary artery obstruction;coroner;dementia;fatty liver;female;hanging;heart arrest;atrial fibrillation;heart infarction;hemopericardium;human;hypoglycemia;ischemic heart disease;ketoacidosis;lung carcinoma;lung embolism;lung hemorrhage;major clinical study;male;multiple trauma;pneumonia;priority journal;subarachnoid hemorrhage;sudden cardiac death;thorax pain;unstable angina pectoris;validation study,"Roberts, I. S. D.;Traill, Z. C.",2014,,,0,
3698,The predictive capacity of personal genome sequencing,"New DNA sequencing methods will soon make it possible to identify all germline variants in any individual at a reasonable cost. However, the ability of whole-genome sequencing to predict predisposition to common diseases in the general population is unknown. To estimate this predictive capacity, we use the concept of a ""genometype."" A specific genometype represents the genomes in the population conferring a specific level of genetic risk for a specified disease. Using this concept, we estimated the maximum capacity of whole-genome sequencing to identify individuals at clinically significant risk for 24 different diseases. Our estimates were derived from the analysis of large numbers of monozygotic twin pairs; twins of a pair share the same genometype and therefore identical genetic risk factors. Our analyses indicate that (i) for 23 of the 24 diseases, most of the individuals will receive negative test results; (ii) these negative test results will, in general, not be very informative, because the risk of developing 19 of the 24 diseases in those who test negative will still be, at minimum, 50 to 80% of that in the general population; and (iii) on the positive side, in the best-case scenario, more than 90% of tested individuals might be alerted to a clinically significant predisposition to at least one disease. These results have important implications for the valuation of genetic testing by industry, health insurance companies, public policy-makers, and consumers.",Alzheimer disease;article;autoimmune thyroiditis;bladder cancer;breast cancer;cancer risk;cholelithiasis;chronic fatigue syndrome;colorectal cancer;dementia;dystocia;female;gastroesophageal reflux;genetic procedures;genetic risk;genome;genometype;heritability;human;insulin dependent diabetes mellitus;irritable colon;ischemic heart disease;leukemia;lung cancer;male;mastectomy;mathematical model;monozygotic twins;mortality;ovary cancer;pancreas cancer;Parkinson disease;pelvic organ prolapse;population research;priority journal;prostate cancer;risk factor;stomach cancer;stress incontinence;cerebrovascular accident;whole genome sequencing,"Roberts, N. J.;Vogelstein, J. T.;Parmigiani, G.;Kinzler, K. W.;Vogelstein, B.;Velculescu, V. E.",2012,,,0,
3699,Cardiac disease associated with increased risk of nonamnestic cognitive impairment,"Objective: To investigate the association of cardiac disease with amnestic and nonamnestic mild cognitive impairment (aMCI and naMCI, respectively). Nonamnestic mild cognitive impairment, a putative precursor of vascular and other non-Alzheimer dementias, is hypothesized to have a vascular etiology. Design: A prospective, population-based, cohort study with a median 4.0 years of follow-up. Setting: Olmsted County, Minnesota. Participants: A total of 2719 participants were evaluated at baseline and every 15 months using the Clinical Dementia Rating scale, a neurological evaluation, and neuropsychological testing. A diagnosis of normal cognition, MCI, or dementia was made by consensus. Cardiac disease at baseline was assessed from the participant's medical records. Main Outcome Measures: Incident MCI, aMCI, or naMCI. Results: Of 1450 participants without MCI or dementia at baseline, 366 developed MCI. Cardiac disease was associated with an increased risk of naMCI (hazard ratio, 1.77 [95% CI, 1.16-2.72]). However, the association varied by sex (P=.02 for interaction). Cardiac disease was associated with an increased risk of naMCI (hazard ratio, 3.07 [95% CI, 1.58-5.99]) for women but not for men (hazard ratio, 1.16 [95% CI, 0.68-1.99]). Cardiac disease was not associated with any type of MCI or with aMCI. Conclusions: Cardiac disease is an independent risk factor for naMCI; within-sex comparisons showed a stronger association for women. Prevention and management of cardiac disease and vascular risk factors may reduce the risk of naMCI. © 2013 American Medical Association. All rights reserved.",aged;article;Clinical Dementia Rating Scale;cohort analysis;congestive heart failure;coronary artery disease;dementia;disease association;female;follow up;atrial fibrillation;heart disease;heart infarction;human;ischemic heart disease;major clinical study;male;mild cognitive impairment;neuropsychological test;population research;priority journal;prospective study;rating scale;sex difference;United States,"Roberts, R. O.;Geda, Y. E.;Knopman, D. S.;Cha, R. H.;Pankratz, V. S.;Boeve, B. F.;Tangalos, E. G.;Ivnik, R. J.;Mielke, M. M.;Petersen, R. C.",2013,,,0,
3700,Coronary heart disease is associated with non-amnestic mild cognitive impairment,"The progression of amnestic mild cognitive impairment (a-MCI) to Alzheimer's disease and hypothesized progression of non-amnestic mild cognitive impairment (na-MCI) to non-degenerative or vascular dementias suggest etiologic differences. We examined the association between coronary heart disease (CHD) and mild cognitive impairment (MCI) subtypes in a population-based cohort. Participants (n=1969; aged 70-89 years) were evaluated using the Clinical Dementia Rating Scale, a neurological examination, and neuropsychological testing for diagnoses of normal cognition, MCI, or dementia. CHD was defined as a history of myocardial infarction, angina, angiographic coronary stenosis, or coronary revascularization and ascertained by participant interview and from medical records. CHD was significantly associated with na-MCI (OR=1.93; 95% CI=1.22-3.06) but not with a-MCI (OR=0.94; 95% CI=0.69-1.28). In contrast, ApoE varepsilon4 allele was significantly associated with a-MCI (OR=1.75; 95% CI=1.28-2.41), but not with na-MCI (OR=1.17; 95% CI=0.69-2.00). The association of CHD with prevalent na-MCI but not with a-MCI suggests that CHD and na-MCI may have similar underlying etiologies.","Aged;Aged, 80 and over;Amnesia/*epidemiology/metabolism;Apolipoprotein E4/*metabolism;Case-Control Studies;Cognition Disorders/*epidemiology/metabolism;Cohort Studies;Comorbidity;Coronary Disease/*epidemiology/metabolism;Cross-Sectional Studies;Dementia/*epidemiology/metabolism;Female;Humans;Longitudinal Studies;Male;Minnesota/epidemiology;Reference Values","Roberts, R. O.;Knopman, D. S.;Geda, Y. E.;Cha, R. H.;Roger, V. L.;Petersen, R. C.",2010,Nov,10.1016/j.neurobiolaging.2008.10.018,0,
3701,What's the best vasopressor in septic shock?,,adrenalin;catecholamine;dobutamine;dopamine;hypertensive factor;noradrenalin;placebo;terlipressin;vasopressin;aged;anuria;article;blood pressure measurement;case report;clinical trial;emergency ward;febrile bone marrow aplasia;female;heart arrhythmia;heart index;heart infarction;human;information retrieval;inotropism;intensive care unit;limb injury;limb ischemia;Medline;mental deterioration;mortality;nursing home;observational study;outcome assessment;pneumonia;priority journal;randomized controlled trial;septic shock;cerebrovascular accident;survival rate;tachycardia;tachypnea,"Robinson, A.",2010,,,0,
3702,Vitamin D supplementation-clarity required regarding treatment regimens and target plasma levels,,25 hydroxyvitamin D;calcium;cathelicidin;colecalciferol;ergocalciferol;insulin;renin;vitamin D;vitamin D receptor;Alzheimer disease;antiangiogenic activity;breast cancer;calcium homeostasis;calcium intake;cardiovascular mortality;cell differentiation;cell growth;cell proliferation;colon cancer;controlled clinical trial (topic);depression;diabetes mellitus;disease association;falling;fracture;gastrointestinal symptom;heart muscle ischemia;hip fracture;human;hypercalcemia;hyperphosphatemia;hypertension;infection prevention;influenza;insulin release;macrophage;medication compliance;meta analysis (topic);mortality;multiple sclerosis;myopathy;nephrolithiasis;note;Parkinson disease;postmenopause;primary prevention;priority journal;prostate cancer;randomized controlled trial (topic);risk reduction;sarcopenia;sun exposure;taste disorder;vitamin blood level;vitamin D deficiency;vitamin D intoxication;vitamin supplementation,"Robinson, S.;Canavan, M.;O'Donnell, M. J.;Mulkerrin, E.",2014,,,0,
3703,Can a beverage cart help improve hydration?,"The purpose of this study was to determine the effectiveness of a hydration program to improve hydration and prevent conditions associated with dehydration (delirium, urinary tract infections, respiratory infections, falls, skin breakdown, and constipation). Data showed a significant increase in fluid in each body compartment, significant decrease in the number of laxatives, increase in the number of bowel movements, decline in the number of falls, and decrease in cost during the hydration period.",diuretic agent;laxative;psychotropic agent;steroid;water;aged;article;beverage;body fluid compartment;cerebrovascular accident;chronic kidney disease;constipation;controlled study;cost control;defecation;dehydration;delirium;dementia;depression;diabetes mellitus;disease association;elderly care;falling;female;fluid intake;health care cost;health program;heart failure;human;hydration;major clinical study;male;malnutrition;prophylaxis;respiratory tract infection;risk factor;skin disease;total body water;urinary tract infection,"Robinson, S. B.;Rosher, R. B.",2002,,,0,
3704,Accelerated Accumulation of Multimorbidity After Bilateral Oophorectomy: A Population-Based Cohort Study,"Objective To study the association between bilateral oophorectomy and the rate of accumulation of multimorbidity. Patients and Methods In this historical cohort study, the Rochester Epidemiology Project records-linkage system was used to identify all premenopausal women who underwent bilateral oophorectomy before age 50 years between January 1, 1988, and December 31, 2007, in Olmsted County, Minnesota. Each woman was randomly matched to a referent woman born in the same year (±1 year) who had not undergone bilateral oophorectomy. We studied the rate of accumulation of 18 common chronic conditions over a median of approximately 14 years of follow-up. Results Although women who underwent bilateral oophorectomy already had a higher multimorbidity burden at the time of oophorectomy, they also experienced an increased risk of subsequent multimorbidity. After adjustments for 18 chronic conditions present at baseline, race/ethnicity, education, body mass index, smoking, age at baseline, and calendar year at baseline, women who underwent oophorectomy before age 46 years experienced an increased risk of depression, hyperlipidemia, cardiac arrhythmias, coronary artery disease, arthritis, asthma, chronic obstructive pulmonary disease, and osteoporosis. In addition, they experienced an accelerated rate of accumulation of the 18 chronic conditions considered together (hazard ratio, 1.22; 95% CI, 1.14-1.31; P<.001). Several of these associations were reduced in women who received estrogen therapy. Conclusion Bilateral oophorectomy is associated with a higher risk of multimorbidity, even after adjustment for conditions present at baseline and for several possible confounders. However, several of these associations were reduced in women who received estrogen therapy.",adult;age distribution;anxiety;arthritis;article;asthma;body mass;cerebrovascular accident;chronic kidney failure;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;controlled study;coronary artery disease;dementia;depression;diabetes mellitus;educational status;estrogen therapy;ethnic difference;female;follow up;heart arrhythmia;human;hyperlipidemia;hypertension;major clinical study;malignant neoplasm;osteoporosis;ovariectomy;population research;premenopause;randomized controlled trial;risk assessment;risk factor;schizophrenia;smoking habit;substance abuse,"Rocca, W. A.;Gazzuola-Rocca, L.;Smith, C. Y.;Grossardt, B. R.;Faubion, S. S.;Shuster, L. T.;Kirkland, J. L.;Stewart, E. A.;Miller, V. M.",2016,,10.1016/j.mayocp.2016.08.002,0,
3705,Long-term mortality analysis in Parkinson's disease treated with deep brain stimulation,"Background. Few data have been published regarding long-term mortality in patients with Parkinson's disease treated with DBS. Methods. This study analyzed long-term mortality rates, causes, and correlates in PD patients treated with DBS. Results. 184 consecutive patients were included; mean follow-up was 50 months. Fifteen deaths occurred (total 8.15%, annual mortality rate 1.94%). Mean age at disease onset and at surgery was 48±2.4 and 63±1.6 years, respectively. Mean disease duration until death was 21±7.8 years. Most deaths related to stroke, myocardial infarction, other vascular/heart disorders, or severe infection; one suicide was recorded. Deceased PD patients were mostly male and had lower motor benefit after DBS, but univariate analysis failed to show significant differences regarding gender and motor benefit. Survival was 99% and 94% at 3 and 5 years. Conclusions. Long-term survival is to be expected in PD patients treated with DBS, possibly higher than previously expected. Death usually supervenes due to vascular events or infection. © 2014 Sofia Rocha et al.",levodopa;adult;article;brain depth stimulation;brain hemorrhage;brain ischemia;cardiomyopathy;cause of death;cerebrovascular accident;colon cancer;comorbidity;dementia;depression;diabetes mellitus;disease duration;dyslipidemia;female;follow up;gender;heart disease;heart infarction;human;hypertension;infection;intervertebral disk hernia;kidney cancer;long term survival;major clinical study;male;metastasis;middle aged;mortality;motor performance;onset age;Parkinson disease;peritonitis;phenotype;pneumonia;priority journal;prostate cancer;prostate hypertrophy;respiratory tract infection;sepsis;subdural hematoma;suicide;thrombosis;time of death;traumatic brain injury;treatment response;Unified Parkinson Disease Rating Scale;urolithiasis;vascular disease;young adult,"Rocha, S.;Monteiro, A.;Linhares, P.;Chamadoira, C.;Basto, M. A.;Reis, C.;Sousa, C.;Lima, J.;Rosas, M. J.;Massano, J.;Vaz, R.",2014,,,0,
3706,Amyloid and amyloidoses,"Amyloid is a pathologic fibrillar aggregation of polypeptides in a cross-β-sheet conformation. Amyloidoses are caused by the deposition of amyloid and may occur as cerebral and extracerebral disease. More than 29 different amyloid proteins have been identified. Analysis of a Congo red-stained tissue section by polarization microscopy is the gold standard for diagnosing amyloid. Subsequent classification of the amyloid is mandatory and is increasingly supported by molecular biological analyses. In Germany, this recently led to the discovery of several hereditary amyloid diseases. The correct classification of amyloid is of paramount importance. This helps to asses the prognosis and plan patient treatment. © 2009 Springer Medizin Verlag.",amyloid;amyloid beta protein;amyloid precursor protein;apolipoprotein A1;apolipoprotein A2;apolipoprotein A4;atrial natriuretic factor;beta 2 microglobulin;congo red;cystatin C;dysferlin;fibrinogen;gelsolin;immunoglobulin;insulin;lactadherin;lactoferrin;lysozyme;oncostatin M;polypeptide;prealbumin;prion protein;procalcitonin;prolactin;serum amyloid A;tau protein;Alzheimer disease;amyloidosis;article;diabetes mellitus;disease classification;familial amyloid polyneuropathy;familial amyloidosis;gene mutation;genetic disorder;gold standard;heart amyloidosis;human;immunohistochemistry;kidney amyloidosis;molecular biology;multiple myeloma;polarization microscopy;prognosis;senile dementia;vascular amyloidosis,"Röcken, C.;Eriksson, M.",2009,,,0,
3707,Hyponatremia in the prognosis of acute ischemic stroke,"BACKGROUND: Hyponatremia is a risk factor for stroke and cardiovascular disease. Even mild hyponatremia is associated with increased 30-day mortality after myocardial infarction, and it has recently shown to increase the 3-year mortality after a stroke. In this work, we investigated both acute and chronic clinical outcomes after a stroke in hyponatremic patients. METHODS: We reviewed all patients admitted between 2004 and 2011 with the diagnosis of acute ischemic stroke. Hyponatremia was defined as serum sodium level less than 135 mmol/L and recorded on admission. All hemorrhagic strokes were excluded. Data were analyzed using multivariate logistic regression. RESULTS: A total of 3585 patients with stroke were identified. Hyponatremia was observed in 565 (16%) patients. Baseline characteristics were similar between groups except heart failure (P = .015), cancer (P = .038), diabetes (P < .001), and dementia (P = .015). Hyponatremic patients had higher National Institutes of Health Stroke Scale (NIHSS) score on admission (P = .032) and at discharge (P = .02). Despite similar modified Barthel Index (mBI) preadmission, patients with hyponatremia had worse mBI on admission (P = .049). Hyponatremia was associated with higher mortality in hospital (P = .039) and at 3-month (P = .001) and 12-month follow-ups (P = .001). A poorer discharge disposition was seen in the hyponatremia group (P = .004). Complications during admission were similar between groups except for urinary infection (P = .008). Patients with hyponatremia had worse NIHSS and mBI values on admission, and their deficits worsened during their hospitalization. CONCLUSIONS: This is the first study to demonstrate that hyponatremia is associated with acute mortality and poorer discharge dispositions and to confirm that higher mortality occurs in these patients, even after 12 months after a stroke.","Aged;Aged, 80 and over;Biomarkers/blood;Brain Ischemia/*complications/diagnosis/mortality/therapy;Comorbidity;Disability Evaluation;Female;Humans;Hyponatremia/blood/*complications/diagnosis/mortality/therapy;Logistic Models;Male;Middle Aged;Multivariate Analysis;Patient Admission;Patient Discharge;Prognosis;Risk Factors;Sodium/blood;Stroke/*complications/diagnosis/mortality/therapy;Time Factors;Hyponatremia;acute ischemic stroke;disposition;epidemiology;mortality","Rodrigues, B.;Staff, I.;Fortunato, G.;McCullough, L. D.",2014,May-Jun,10.1016/j.jstrokecerebrovasdis.2013.07.011,0,
3708,Secondary hemosiderosis on kidney biopsy in a patient with a left ventricular assist device,,ferric ferrocyanide;ferritin;haptoglobin;hemosiderin;immunoglobulin A;immunoglobulin G;immunoglobulin M;lactate dehydrogenase;novel erythropoiesis stimulating protein;warfarin;acute kidney failure;acute kidney tubule necrosis;adult;anemia;blood culture;blood smear;blood transfusion;capillary wall;cardiogenic shock;case report;compartment syndrome;continuous renal replacement therapy;Coombs test;disseminated intravascular clotting;echocardiography;erythrocyte;Escherichia coli;fasciotomy;female;focal glomerulosclerosis;heart assist device;heart ejection fraction;heart failure;heart left ventricle;heart muscle biopsy;heart transplantation;hemodialysis;hemosiderosis;histopathology;hospitalization;human;immunofluorescence;influenza A;kidney biopsy;kidney cell;kidney dysfunction;kidney failure;kidney function;kidney parenchyma;kidney scintiscanning;kidney transplantation;Klebsiella pneumoniae;left ventricular assist device;letter;lung artery pressure;medical care;mental deterioration;mitral valve repair;myocarditis;partial nephrectomy;partial thromboplastin time;proliferative glomerulonephritis;proteinuria;prothrombin time;rhabdomyolysis;shear stress;squamous cell;systemic vascular resistance;tonic clonic seizure;urinalysis;urine culture;young adult;Impella;Thoratec Corporation,"Rodrigues, J.;Alam, A.;Bernard, C.;Giannetti, N.;Podymow, T.",2014,,,0,
3709,Association of annular calcification and aortic valve sclerosis with brain findings on magnetic resonance imaging in community dwelling older adults: The cardiovascular health study,"Objectives: The objective of this study was to investigate the associations of mitral annular calcification, aortic annular calcification, and aortic valve sclerosis with covert magnetic resonance imaging (MRI)defined brain infarcts. Background: Clinically silent brain infarcts defined by MRI are associated with increased risk for cognitive decline, dementia, and future overt stroke. Left-sided cardiac valvular and annular calcifications are suspected as risk factors for clinical ischemic stroke. Methods: A total of 2,680 CHS (Cardiovascular Health Study) participants without clinical histories of stroke or transient ischemic attack underwent brain MRI in 1992 and 1993, 1 to 2 years before echocardiographic exams (1994 to 1995). Results: The mean age of the participants was 74.5 ± 4.8 years, and 39.3% were men. The presence of any annular or valvular calcification (mitral annular calcification, aortic annular calcification, or aortic valve sclerosis), mitral annular calcification alone, or aortic annular calcification alone was significantly associated with a higher prevalence of covert brain infarcts in unadjusted analyses (p < 0.01 for all). In models adjusted for age, sex, race, body mass index, physical activity, creatinine, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking, diabetes, coronary heart disease, and congestive heart failure, the presence of any annular or valve calcification remained associated with covert brain infarcts (risk ratio: 1.24; 95% confidence interval: 1.05 to 1.47). The degree of annular or valvular calcification severity showed a direct relation with the presence of covert MRI findings. Conclusions: Left-sided cardiac annular and valvular calcifications are associated with covert MRI-defined brain infarcts. Further study is warranted to identify mechanisms and determine whether intervening in the progression of annular and valvular calcification could reduce the incidence of covert brain infarcts as well as the associated risk for cognitive impairment and future stroke. © 2011 American College of Cardiology Foundation.",creatinine;high density lipoprotein cholesterol;aged;aorta atherosclerosis;artery calcification;article;body mass;brain infarction;cholesterol blood level;congestive heart failure;controlled study;diabetes mellitus;disease association;female;human;ischemic heart disease;major clinical study;male;nuclear magnetic resonance imaging;physical activity;prevalence;priority journal;smoking;systolic blood pressure,"Rodriguez, C. J.;Bartz, T. M.;Longstreth Jr, W. T.;Kizer, J. R.;Barasch, E.;Lloyd-Jones, D. M.;Gottdiener, J. S.",2011,,,0,
3710,Clinical significance of homocysteine in elderly hospitalized patients,"Serum homocysteine levels, which increase with age, are now recognized as a vascular risk factor and are related to the development of heart failure and dementia in the elderly. However, relatively low serum homocysteine levels have also been reported to be an adverse prognostic factor in dialysis patients. The objective of the study was to analyze the prevalence, clinical significance, and prognostic value of serum homocysteine levels in patients older than 65 years, admitted to a general internal medicine hospitalization unit. We studied 337 hospitalized patients, 184 males and 153 females, aged 77.2+/-0.4 years, whose admission was not determined by an acute vascular event. We recorded past vascular events and vascular risk factors. We determined the body mass index (weight in kilograms divided by the square of height in meters), and cholesterol, triglyceride, folate, vitamin B12, and homocysteine levels. We also studied 36 control subjects (18 males and 18 females) of similar age. After discharge, we assessed the survival status of 301 patients by telephone recall. Survival curves were plotted by the method of Kaplan and Meier. Median survival was 1186 days. The 15th (9.6 micromol/L) and 50th (14.4 micromol/L) percentiles, as the lowest and highest cut-off points, were empirically defined as those related to a shorter survival. Serum homocysteine concentration was significantly positively correlated with age and serum creatinine and albumin concentrations, and negatively correlated with serum cobalamin and folate concentrations. The average serum homocysteine concentration for the patients group, as a whole, was 16.5+/-0.5 micromol/L, not significantly different from the control group, but with a much greater dispersion, as patients with congestive heart failure or cognitive impairment had higher serum homocysteine concentrations, and patients with sepsis, leukocytosis, and hypoalbuminemia had lower concentrations. Malnutrition was associated both with abnormally high and low homocysteine concentrations, and abnormally low and abnormally high homocysteine concentrations were both associated with higher mortality. In conclusion, low homocysteine levels in elderly non-vitamin-supplemented hospitalized patients should not be interpreted as a protective factor in some individuals. Instead, it may be considered as an effect of an inflammatory-malnutrition process associated with a poor prognosis.","Aged;Aged, 80 and over;Cardiovascular Diseases/*blood/diagnosis;Creatinine/blood;Female;Hemoglobins/analysis;Homocysteine/*blood;Humans;Lymphocyte Count;Male;Neutrophils;Nutritional Status;Predictive Value of Tests;Risk Factors;Serum Albumin/metabolism;Statistics, Nonparametric;Survival Analysis;Triazoles/blood;Vitamin B 12/blood","Rodriguez, J. J.;Santolaria, F.;Martinez-Riera, A.;Gonzalez-Reimers, E.;de la Vega Prieto, M. J.;Valls, M. R.;Gaspar, M. R.",2006,May,10.1016/j.metabol.2005.12.009,0,
3711,"Associations between chronic conditions, body functions, activity limitations and participation restrictions: A cross-sectional approach in Spanish non-clinical populations","Objectives To analyse the relationships between chronic conditions, body functions, activity limitations and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) framework. Design A cross-sectional study. Setting 2 geographical areas in the Autonomous Region of Aragon, Spain, namely, a rural area, Cinco Villas, and an urban area in the city of Zaragoza. Participants 864 individuals selected by simple random sampling from the register of Social Security card holders, aged 50 years and over, positive to disability screening. Main outcome measures ICF Checklist-body function domains, WHO Disability Assessment Schedule 2.0 (WHODAS 2.0, 36-item (WHODAS-36)) global scores and medical diagnoses (chronic conditions) from primary care records. Results Mild disability (WHODAS-36 level 5-24%) was present in 51.5% of the sample. In the adjusted ordinal regression model with WHODAS-36 as the dependent variable, disability was substantially associated with moderate-to-complete impairment in the following functions: mental, OR 212.8 (95% CI 72 to 628.9); neuromusculoskeletal, OR 44.8 (24.2 to 82.8); and sensory and pain, OR 6.3 (3.5 to 11.2). In the relationship between health conditions and body function impairments, the strongest links were seen for: dementia with mental functions, OR 50.6 (25.1 to 102.1); cerebrovascular disease with neuromusculoskeletal function, OR 5.8 (3.5 to 9.7); and chronic renal failure with sensory function and pain, OR 3.0 (1.49 to 6.4). Dementia, OR 8.1 (4.4 to 14.7) and cerebrovascular disease, OR 4.1 (2.7 to 6.4) were associated with WHODAS-36 scores. Conclusions Body functions are heterogeneously linked to limitations in activities and restrictions on participation, with the highest impact being due to mental and musculoskeletal functions. This may be relevant for disability assessment and intervention design, particularly if defined on a body function basis. Control of specific health conditions, such as dementia and cerebrovascular disease, appears to be paramount in reducing disability among persons aged 50 years and over.","adult;aged;anemia;anxiety disorder;article;asthma;cerebrovascular disease;chronic disease;chronic kidney failure;chronic liver disease;chronic obstructive lung disease;cognitive defect;cross-sectional study;degenerative disease;dementia;depression;diabetes mellitus;disability;dystrophy;female;functional disease;heart arrhythmia;heart failure;hip fracture;human;hypertension;International Classification of Functioning, Disability and Health;ischemic heart disease;major clinical study;male;marriage;mental deficiency;mental function;middle aged;neoplasm;neuromuscular disease;pain;patient participation;peripheral occlusive artery disease;physical activity;physical disability;rural area;sensory dysfunction;Spain;Spaniard;thyroid disease;urban area;urine incontinence;very elderly;visual impairment;WHO Disability Assessment Schedule 2.0","Rodríguez-Blázquez, C.;Damián, J.;Andrés-Prado, M. J.;Almazán-Isla, J.;Alcalde-Cabero, E.;Forjaz, M. J.;Castellote, J. M.;González-Enríquez, J.;Martínez-Martín, P.;Comín, M.;De Pedro-Cuesta, J.",2016,,,0,
3712,Potentially inappropriate use of furosemide in a very elderly population: An observational study,"Objective: Little is known about furosemide prescription modalities in elderly people. We describe furosemide prescription in ambulatory elderly patients. Methods: All patients aged over 80 years, affiliated to Mutualité Sociale Agricole de Bourgogne, a French regional health insurance plan, with a medical prescription delivered in March 2015, were retrospectively included. Results: Among 15 141 patients with a median age of 86 years, comprising 61.3% of women, 3937 patients (26%) had a prescription for furosemide. Severe heart failure was the most common chronic comorbidity (27.7%). Furosemide was considered a long-term therapy for almost all patients (98.7% with prescriptions for 3 months or more). Recommended indications for long-term furosemide therapy included severe heart failure (50.9%), chronic nephropathy (3%) and cirrhosis (0.1%). The furosemide prescription rate increased with age (81-85: 20.4%, 86-90: 28.5%, 91-95: 35.6%, >95: 42.7%, P<.001), and the increase was associated with a decrease in recommended heart failure therapeutics (beta-blockers, angiotensin-conversion-enzyme-inhibitors or angiotensin-receptor-blockers). Prescribers were mostly general practitioners (81.3%). Plasma electrolytes were controlled in less than a half of the patients with furosemide. Conclusions: In this large study, long-course furosemide was prescribed in a quarter of ambulatory patients. Half of those taking furosemide suffered from severe heart failure. Age was associated with a linear increase in furosemide use and a decrease in recommended heart failure therapeutic prescriptions. A large part of these prescriptions do not seem to be in accordance with recommendations.",angiotensin receptor antagonist;anticoagulant agent;antithrombocytic agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;furosemide;hydroxymethylglutaryl coenzyme A reductase inhibitor;nitric acid derivative;age;aged;Alzheimer disease;article;cerebrovascular accident;chronic disease;chronic kidney failure;chronic liver disease;chronic respiratory failure;comorbidity;controlled study;coronary artery disease;dementia;diabetes mellitus;drug indication;electrolyte blood level;female;France;general practitioner;heart failure;hematologic malignancy;human;hypertension;liver cirrhosis;major clinical study;male;mental deficiency;neoplasm;observational study;Parkinson disease;peripheral occlusive artery disease;potentially inappropriate medication;priority journal;psychosis;retrospective study;rheumatoid arthritis;treatment duration;very elderly,"Rodriguez-Cillero, C.;Menu, D.;d'Athis, P.;Perrin, S.;Dipanda, M.;Asgassou, S.;Guepet, H.;Mazen, E.;Manckoundia, P.;Putot, A.",2017,,10.1111/ijcp.12975,0,
3713,Clinical profile and outcomes in octogenarians with atrial fibrillation: A community-based study in a specific European health care area,"BACKGROUND: Age increases risk of stroke and bleeding. Clinical trial data have had relatively low proportions of elderly subjects. We sought to study a Spanish population of octogenarians with atrial fibrillation (AF) by combining different sources of electronic clinical records from an area where all medical centres utilized electronic health record systems. METHODS: Data was derived from the Galician Healthcare Service information system. RESULTS: From 383,000 subjects, AF was coded in 7990 (2.08%), 3640 (45.6%) of whom were >/=80 and 4350 (54.4%)<80. All CHA2DS2-VASc's components were more prevalent in the elderly except for diabetes. Of those >/=80, 2178 (59.8%) were women. Mean CHA2DS2-VASc was 4.2+/-1.1. Distribution of CHA2DS2-VASc components varied between genders. 2600 (71.4%) were on oral anticoagulant (OA). During a median follow up of 696days (124.23), all-cause mortality was higher in >/=80 (1011/3640 (27.8%) vs 350/4350 (8.05%) (p<0.001). There were differences in rate of thromboembolic (TE) and haemorrhagic events (2.3% vs 0.9%, p<0.01 and 2.5% vs 1.7%, p=0.01 respectively). In octogenarian, differences between genders were observed with regard to TE, but not in haemorrhagic or all-cause mortality rates. Age, heart failure, non-valvular AF, dementia, and OA were independent predictors of all-cause mortality. In regard to TE, female gender, hypertension, previous TE and OA were independent predictive factors. CONCLUSIONS: Octogenarians with AF had very different characteristics and outcomes from their younger counterparts. These results also provide reassurance about the effectiveness of OA in preventing TE events and maintaining a reasonable haemorrhagic event rate in the extremely elderly.",Atrial fibrillation;Dementia;Octogenarian;Stroke,"Rodriguez-Manero, M.;Lopez-Pardo, E.;Cordero, A.;Kredieh, O.;Pereira-Vazquez, M.;Martinez-Sande, J. L.;Martinez-Gomez, A.;Pena-Gil, C.;Novo-Platas, J.;Garcia-Seara, J.;Mazon, P.;Laje, R.;Moscoso, I.;Varela-Roman, A.;Garcia-Acuna, J. M.;Gonzalez-Juanatey, J. R.",2017,Sep 15,,0,
3714,A disease management program intervention in elderly patients with high comorbidity: results of a randomized-controlled trial (HF-GERIATRICS),"Objective.- To assess the efficacy of a disease management programme (DMP) for very old patients with heart failure (HF) and significant comorbidity. Methods.- A multicentre randomized trial in 630 patients with HF, aged over 75 years, admitted to the acute-care units of the Geriatrics Departments in 6 hospitals. Patients were randomly allocated to a DMP or to usual care. The DMP was conducted by a case manager, and included three main components: - patient education to improve disease' knowledge and self-care; - monitoring of clinical status; - therapeutic adherence. Main statistical analyses was performed according to the intentionto- treat principle, and used Cox regression models to examine the association of a DMP with hospital readmission, quality-of-life, and mortality over 12 months. Results.- Mean age was 85.6 + 5 years with a 63% of women. Intervention group included 279 and control group 351 patients. There was no differences between groups in relation to age, gender, functional or cognitive status, presence of different co-morbidities, including depression and dementia, NYHA functional class, aetiology, HF drugs at discharge, previous admissions due to HF. Educational intervention significantly improved disease knowledge and shelf care behaviour in patients allocated to intervention group in relation to control group. There was no significant differences between intervention and control group in one-year survival, any cause or HF readmissions and quality of life. Conclusion.- A DMP that included an educational interventional program did not improved survival, readmissions or health-related quality of life in very elderly patients with high comorbidity.",human;geriatrics;comorbidity;society;randomized controlled trial;European Union;aged;disease management;patient;hospital readmission;control group;quality of life;survival;very elderly;emergency care;heart failure;statistical analysis;dementia;proportional hazards model;monitoring;gender;self care;mortality;patient education;female;case manager;model;morbidity;etiology;hospital;New York Heart Association class;Sr-dementia,"Rodriguez-Pascual, C;Paredes-Galan, E;Ferrero-Martinez, Al;Gonzalez-Guerrero, Jl;Hornillos, M;Abizanda, P",2013,,10.1016/j.eurger.2013.07.034,0,
3715,Cancer linked to Alzheimer disease but not vascular dementia,"Objective: To investigate whether cancer is associated with Alzheimer disease (AD) and vascular dementia (VaD). METHODS: Cox proportional hazards models were used to test associations between prevalent dementia and risk of future cancer hospitalization, and associations between prevalent cancer and risk of subsequent dementia. Participants in the Cardiovascular Health Study-Cognition Substudy, a prospective cohort study, aged 65 years or older (n = 3,020) were followed a mean of 5.4 years for dementia and 8.3 years for cancer. RESULTS: The presence of any AD (pure AD + mixed AD/VaD; hazard ratio [HR] = 0.41, 95% confidence interval [CI] = 0.20-0.84) and pure AD (HR = 0.31, 95% CI = 0.12-0.86) was associated with a reduced risk of future cancer hospitalization, adjusted for demographic factors, smoking, obesity, and physical activity. No significant associations were found between dementia at baseline and rate of cancer hospitalizations for participants with diagnoses of VaD. Prevalent cancer was associated with reduced risk of any AD (HR = 0.72; 95% CI = 0.52-0.997) and pure AD (HR = 0.57; 95% CI = 0.36-0.90) among white subjects after adjustment for demographics, number of APOE ε4 alleles, hypertension, diabetes, and coronary heart disease; the opposite association was found among minorities, but the sample size was too small to provide stable estimates. No significant association was found between cancer and subsequent development of VaD. CONCLUSIONS: In white older adults, prevalent Alzheimer disease (AD) was longitudinally associated with a reduced risk of cancer, and a history of cancer was associated with a reduced risk of AD. Together with other work showing associations between cancer and Parkinson disease, these findings suggest the possibility that cancer is linked to neurodegeneration. © 2010 by AAN Enterprises, Inc. All rights reserved.",aged;Alzheimer disease;article;cancer risk;disease association;European American;female;follow up;human;major clinical study;male;minority group;multiinfarct dementia;neoplasm;nerve degeneration;priority journal;race difference;risk assessment;sample size,"Roe, C. M.;Fitzpatrick, A. L.;Xiong, C.;Sieh, W.;Kuller, L.;Miller, J. P.;Williams, M. M.;Kopan, R.;Behrens, M. I.;Morris, J. C.",2010,,,0,
3716,"Association of Plasma Abeta40 Peptides, But Not Abeta42, with Coronary Artery Disease and Diabetes Mellitus","BACKGROUND/OBJECTIVE: Plasma levels of amyloid-beta (Abeta) 1-40 peptide have been proposed to be associated with cardiovascular mortality in patients with coronary artery disease (CAD). Therefore, we aimed to investigate the association of plasma Abeta levels with CAD, cardiovascular risk factors (CVRF), and APOE genotype in non-demented elderly individuals. METHODS: Plasma Abeta1 - 40 and Abeta1 - 42 levels of 526 individuals (mean age of 63.0+/-7.3 years) were quantified with the INNO-BIA plasma Abeta forms assay based on multiplextrademark technique. APOE genotype was determined with an established protocol. Presence of CAD and CVRFs were ascertained using a questionnaire and/or medical records. RESULTS: Plasma Abeta1 - 40 levels were significantly higher in individuals with CAD (p = 0.043) and, independently, in individuals with diabetes mellitus (DM) type 2 (p = 0.001) while accounting for age- and gender-effects. Plasma Abeta1 - 42 levels were higher in APOEvarepsilon4 carriers (p = 0.004), but were neither relevantly associated with CAD nor with any CVRF. Plasma Abeta1 - 40 showed no association with APOE genotype. DISCUSSION: Our findings argue for an association of circulating plasma Abeta1 - 40 peptides with incident CAD and DM. Further investigations are needed to entangle the role of Abeta1 - 40 role in the pathophysiology of cardiovascular disease independent of its known role in Alzheimer's disease.",APOE genotype;Alzheimer's disease;amyloid-beta;coronary artery disease;diabetes mellitus;vascular,"Roeben, B.;Maetzler, W.;Vanmechelen, E.;Schulte, C.;Heinzel, S.;Stellos, K.;Godau, J.;Huber, H.;Brockmann, K.;Wurster, I.;Gaenslen, A.;Gruner, E.;Niebler, R.;Eschweiler, G. W.;Berg, D.",2016,Mar 16,10.3233/jad-150575,0,
3717,Carotid plaque in alzheimer caregivers and the role of sympathoadrenal arousal,"Objectives: To test the hypothesis that those who provide care for a spouse diagnosed with Alzheimer's disease would have increased prevalence of carotid artery plaque compared with noncaregiving controls and that prolonged sympathoadrenal arousal to acute stress would relate to this difference. Providing care for a spouse with Alzheimer's disease has been associated with an increased risk of coronary heart disease, potentially due to the impact of caregiving stress on the atherosclerotic disease process. Methods: Participants were 111 spousal caregivers (74 ± 8 years of age; 69% women) to patients with Alzheimer's disease and 51 noncaregiving controls (75 ± 6 years of age; 69% women). Inhome assessment of carotid artery plaque via B-mode ultrasonography was conducted. Plasma catecholamine response to an acute speech stressor task was also measured. Results: Logistic regression indicated that caregiving status (i.e., caregiver versus noncaregiver) was associated significantly with a 2.2 times greater odds for the presence of plaque independent of other risk factors of atherosclerosis (95% confidence interval, 1.01-4.73, p = .048). Decreased recovery to basal levels of epinephrine after a psychological stress task was associated significantly with the presence of plaque in caregivers, but not in noncaregivers. Norepinephrine recovery post stressor was not associated with plaque in either group. Conclusions: Caregivers had a higher frequency of carotid plaque compared with noncaregivers. Poorer epinephrine recovery after acute stress was associated with the presence of plaque in caregivers but not in noncaregivers. A prolonged sympathoadrenal response to acute stress might enhance the development of atherosclerosis in chronically stressed Alzheimer caregivers. Copyright © 2011 by the American Psychosomatic Society.",adrenalin;antihypertensive agent;hypocholesterolemic agent;noradrenalin;adrenalin blood level;adrenergic system;adult;Alzheimer disease;antihypertensive therapy;article;blood pressure;cardiovascular risk;caregiver;caregiver burden;carotid atherosclerosis;controlled study;echography;female;human;ischemic heart disease;major clinical study;male;mental stress;noradrenalin blood level;obesity;priority journal,"Roepke, S. K.;Chattillion, E. A.;Von Känel, R.;Allison, M.;Ziegler, M. G.;Dimsdale, J. E.;Mills, P. J.;Patterson, T. L.;Ancoli-Israel, S.;Calleran, S.;Harmell, A. L.;Grant, I.",2011,,,0,
3718,Heart disease and stroke statistics-2012 update: A report from the American heart association,"Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on disease morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited more than 8700 times in the literature (including citations of all annual versions). In 2010 alone, the various Statistical Updates were cited 1600 times (data from ISI Web of Science). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year and added a new chapter detailing various disorders of heart rhythm. Also, the 2012 Statistical Update is a major source for monitoring both cardiovascular health and disease in the population, with a focus on progress toward achievement of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update. © 2011 American Heart Association, Inc.",cystatin C;high density lipoprotein cholesterol;low density lipoprotein cholesterol;triacylglycerol;acute coronary syndrome;African American;Alzheimer disease;ambulatory care;American Indian;angina pectoris;aorta aneurysm;aorta valve disease;arterial wall thickness;article;Asian;atherosclerosis;atrioventricular block;awareness;bacterial endocarditis;behavioral risk factor surveillance system;blood pressure;body mass;bradycardia;Brugada syndrome;cancer mortality;cardiomyopathy;cardiovascular disease;cardiovascular procedure;cardiovascular risk;cardiovascular surgery;carotid artery obstruction;carotid endarterectomy;Caucasian;cause of death;childhood disease;cholesterol blood level;chronic kidney disease;chronic liver disease;computed tomographic angiography;congenital heart disease;congestive heart failure;coronary artery calcification;coronary artery disease;deep vein thrombosis;defibrillator;diabetes mellitus;diastolic blood pressure;diet supplementation;dietary intake;disease association;disease classification;disease course;disease free survival;dyslipidemia;educational status;energy balance;ethnicity;family history;glucose blood level;glucose tolerance;health care cost;health care quality;health statistics;heart arrest;heart arrhythmia;atrial fibrillation;heart catheterization;heart disease;heart failure;heart infarction;heart left ventricle function;heart preexcitation;heart rhythm;heart transplantation;heart ventricle flutter;heritability;Hispanic;home care;hormonal therapy;hospital discharge;hospitalization;human;hypercholesterolemia;hyperlipidemia;hypertension;hypertrophic cardiomyopathy;hypoglycemia;immobilization;insulin dependent diabetes mellitus;ischemic heart disease;kidney failure;length of stay;lifestyle;long QT syndrome;lung embolism;macronutrient;medical society;meta analysis (topic);metabolic syndrome X;mitral valve disease;morbidity;mortality;mucocutaneous lymph node syndrome;Black person;nutritional health;obesity;open heart surgery;oral contraception;out of hospital cardiac arrest;overall survival;passive smoking;percutaneous coronary intervention;peripheral occlusive artery disease;physical activity;polymorphic ventricular tachycardia;postmenopause;prevalence;priority journal;pulmonary valve disease;race;revascularization;rheumatic fever;rheumatic heart disease;secondary prevention;sex difference;short QT syndrome;sickle cell;sinus node disease;sleep disordered breathing;smoking;cerebrovascular accident;sudden death;systolic blood pressure;tachycardia;tonometry;torsade des pointes;triacylglycerol blood level;tricuspid valve disease;United States;unstable angina pectoris;valvular heart disease;venous thromboembolism;Wolff Parkinson White syndrome,"Roger, V. L.;Go, A. S.;Lloyd-Jones, D. M.;Benjamin, E. J.;Berry, J. D.;Borden, W. B.;Bravata, D. M.;Dai, S.;Ford, E. S.;Fox, C. S.;Fullerton, H. J.;Gillespie, C.;Hailpern, S. M.;Heit, J. A.;Howard, V. J.;Kissela, B. M.;Kittner, S. J.;Lackland, D. T.;Lichtman, J. H.;Lisabeth, L. D.;Makuc, D. M.;Marcus, G. M.;Marelli, A.;Matchar, D. B.;Moy, C. S.;Mozaffarian, D.;Mussolino, M. E.;Nichol, G.;Paynter, N. P.;Soliman, E. Z.;Sorlie, P. D.;Sotoodehnia, N.;Turan, T. N.;Virani, S. S.;Wong, N. D.;Woo, D.;Turner, M. B.",2012,,,0,
3719,Paramedics’ perceptions and educational needs with respect to palliative care,"Introduction In recent years the scope of palliative care has been redefined to include patients earlier in the course of their illness, and those suffering from life-limiting conditions. Paramedics may be involved in the care of these patients, especially in situations of carer distress, sudden deterioration and imminent death, as well as in non-emergent situations such as inter-facility transfers. In these scenarios, clinical decisions regarding patient care initiated by paramedics may set the trajectory for subsequent care. Objective To identify and measure paramedics’ perspectives and educational needs regarding palliative care provision, as well as their understanding of the common causes of death. Methods All St John Ambulance Western Australia paramedics were invited to complete a mixed methods qualitative and quantitative survey using a tool previously validated in studies involving other emergency care providers. Quantitative results are reported using descriptive statistics, while Likert-type scales were converted to ordinal variables and expressed as means +/- SD. Qualitative data was analysed using content analysis techniques and reported as themes. Results Twenty-nine paramedics returned completed surveys. They considered palliative care to be strongly focused on end-of-life care, symptom control and holistic care. The dominant educational needs identified were ethical issues, end-of-life communication and the use of structured patient care pathways. Cancer diagnoses were overrepresented as conditions considered most suitable for palliative care, compared with their frequency as a cause of death. Conditions often experienced in ambulance practice, such as heart failure, trauma and cardiac arrhythmias were overestimated in their frequency as causes of death. Conclusions Paramedics have a sound grasp of some important aspects of palliative care including symptom control and the holistic nature of the palliative approach. They did, however, tend to equate palliative care with care occurring in the terminal phase and saw it as being particularly applied to cancer diagnoses. Paramedic palliative care educational efforts should be focused on: ethical issues, end-of-life communication, increasing understanding of the common causes of death, and education regarding those illnesses where a palliative approach might be beneficial.",accident;adult;Alzheimer disease;ambulance;anus cancer;article;Australia;automutilation;breast cancer;bronchus cancer;cause of death;cerebrovascular disease;chronic respiratory tract disease;colon cancer;content analysis;control;controlled study;dementia;diabetes mellitus;dying;emergency health service;female;heart arrhythmia;heart failure;holistic care;human;hypertension;influenza;injury;ischemic heart disease;Likert scale;liver cirrhosis;lung cancer;male;medical ethics;palliative therapy;pancreas cancer;paramedical education;paramedical personnel;patient care;perception;pneumonia;prostate cancer;qualitative research;quantitative study;rectum cancer;skin cancer;terminal care;trachea cancer;urinary tract disease,"Rogers, I. R.;Shearer, F. M.;Rogers, J. R.;Ross-Adjie, G.;Monterosso, L.;Finn, J.",2015,,,0,
3720,Elevated plasma homocysteine levels in patients treated with levodopa: association with vascular disease,"BACKGROUND: Hyperhomocysteinemia is a risk factor for vascular disease and potentially for dementia and depression. The most common cause of elevated homocysteine levels is deficiency of folate or vitamin B(12). However, patients with Parkinson disease (PD) may have elevated homocysteine levels resulting from methylation of levodopa and dopamine by catechol O-methyltransferase, an enzyme that uses S-adenosylmethionine as a methyl donor and yields S-adenosylhomocysteine. Since S-adenosylhomocysteine is rapidly converted to homocysteine, levodopa therapy may put patients at increased risk for vascular disease by raising homocysteine levels. OBJECTIVES: To determine whether elevations in plasma homocysteine levels caused by levodopa use are associated with increased prevalence of coronary artery disease (CAD), and to determine what role folate and vitamin B(12) have in levodopa-induced hyperhomocysteinemia. DESIGN/METHODS: Subjects included 235 patients with PD followed up in a movement disorders clinic. Of these, 201 had been treated with levodopa, and 34 had not. Blood samples were collected for the measurement of homocysteine, folate, cobalamin, and methylmalonic acid levels. A history of CAD (prior myocardial infarctions, coronary artery bypass grafting, or coronary angioplasty procedures) was prospectively elicited. We analyzed parametric data by means of 1-way analysis of variance or the t test, and categorical data by means of the Fisher exact test or chi(2) test. RESULTS: Mean +/- SD plasma homocysteine levels were significantly higher in patients treated with levodopa (16.1 +/- 6.2 micro mol/L), compared with levodopa-naive patients (12.2 +/- 4.2 micro mol/L; P<.001). We found no difference in the plasma concentration of folate, cobalamin, or methylmalonic acid between the 2 groups. Patients whose homocysteine levels were in the higher quartile (>or=17.7 micro mol/L) had increased prevalence of CAD (relative risk, 1.75; 95% confidence interval, 1.08-2.70;P=.04). CONCLUSIONS: Levodopa therapy, rather than PD, is a cause of hyperhomocysteinemia in patients with PD. Deficiency of folate or vitamin B(12) levels does not explain the elevated homocysteine levels in these patients. To our knowledge, this is the first report that levodopa-related hyperhomocysteinemia is associated with increased risk for CAD. These findings have implications for the treatment of PD in patients at risk for vascular disease, and potentially for those at risk for dementia and depression.","Aged;Aged, 80 and over;Antiparkinson Agents/*adverse effects;Coronary Artery Disease/blood/epidemiology;Female;Folic Acid/blood;Homocysteine/*blood;Humans;Hyperhomocysteinemia/*chemically induced;Levodopa/*adverse effects;Male;Middle Aged;Parkinson Disease/*drug therapy;Risk Factors;Vitamin B 12/blood","Rogers, J. D.;Sanchez-Saffon, A.;Frol, A. B.;Diaz-Arrastia, R.",2003,Jan,,0,
3721,The importance of cognitive assessment before ventricular device placement: A teachable moment,,aged;attention;behavior disorder;cardiac resynchronization therapy;case report;clinical assessment;cognition;dementia;distress syndrome;family;health service;heart assist device;human;left ventricular assist device;male;memory;neuropsychiatry;note;priority journal;risk benefit analysis;systolic heart failure;treatment failure;wandering behavior,"Rogers, S. E.;Klein, L.;Perissinotto, C. M.",2015,,,0,
3722,Cognitive impairment associated with beta-blockade in the elderly,"We report the cases of three elderly patients presenting with insidious mental impairment whilst receiving both lipophilic and hydrophilic beta-adrenoceptor blocking agents (propranolol and atenolol respectively). In each case marked improvement occurred on drug withdrawal. Two of our cases probably had early senile dementia of the Alzheimer's type and continued to exhibit signs of mild mental impairment, but the third was restored to normal functioning. We found no evidence of impaired perfusion to suggest a vascular basis for the effect or of depression. We believe that beta-blockade may cause or exacerbate mental impairment in the elderly.",atenolol;propranolol;aged;article;case report;cognitive defect;heart infarction;human;hypertension;male;oral drug administration;priority journal,"Rogers, T. K.;Bowman, C. E.",1990,,,0,
3723,An association with great implications: vascular pathology and Alzheimer disease,,"Alzheimer Disease/*pathology;Brain Ischemia/*pathology;Cerebral Amyloid Angiopathy/*pathology;Cerebral Arteries/*pathology;Circle of Willis/pathology;Humans;Intracranial Arteriosclerosis/*pathology;Myocardial Infarction/pathology;Plaque, Amyloid/*pathology;Risk Factors;Statistics as Topic","Roher, A. E.;Kokjohn, T. A.;Beach, T. G.",2006,Jan-Mar,10.1097/01.wad.0000201855.39246.2d,0,
3724,Neuropathology and amyloid-β spectrum in a bapineuzumab immunotherapy recipient,"The field of Alzheimer's disease (AD) research eagerly awaits the results of a large number of Phase III clinical trials that are underway to investigate the effectiveness of anti-amyloid-β (Aβ) immunotherapy for AD. In this case report, we review the pertinent clinical history, examine the neuropathology, and characterize the Aβ profile of an AD patient who received bapineuzumab immunotherapy. The patient received four bapineuzumab infusions over a 39 week period. During the course of this treatment, there was no remarkable change in cognitive impairment as determined by MMSE scores. Forty-eight days after the fourth bapineuzumab infusion was given, MRI revealed that the patient had developed lacunar infarcts and possible vasogenic edema, probably related to immunotherapy, but a subsequent MRI scan 38 days later demonstrated resolution of vasogenic edema. The patient expired due to acute congestive heart failure complicated by progressive AD and cerebrovascular accident 378 days after the first bapineuzumab infusion and 107 days after the end of therapy. Neuropathological and biochemical analysis did not produce evidence of lasting plaque regression or clearance of Aβ due to immunotherapy. The Aβ species profile of this case was compared with non-immunized AD cases and non-demented controls and found to be similar to non-immunized AD cases. SELDI-TOF mass spectrometric analysis revealed the presence of full-length Aβ1-42 and truncated Aβ peptides demonstrating species with and without bapineuzumab specific epitopes. These results suggest that, in this particular case, bapineuzumab immunotherapy neither resulted in detectable clearance of amyloid plaques nor prevented further cognitive impairment. © 2011 - IOS Press and the authors. All rights reserved.",amyloid beta protein;amyloid beta protein[1-42];apolipoprotein E;bapineuzumab;dexamethasone;donepezil;epitope;placebo;rivastigmine;tumor necrosis factor alpha;acute heart infarction;aged;Alzheimer disease;amyloid plaque;article;asthma;ataxia;basal ganglion;brain atherosclerosis;brain circulus arteriosus;brain edema;brain infarction;brain weight;case report;caudate nucleus;cause of death;cerebrospinal fluid analysis;cerebrovascular accident;chemical analysis;cognitive defect;computer assisted tomography;congestive heart failure;consciousness disorder;controlled study;coronary artery atherosclerosis;coronary stent;dementia;depigmentation;depression;drug clearance;drug substitution;drug withdrawal;electroencephalography;entorhinal cortex;epileptic discharge;family history;fast protein liquid chromatography;female;gait disorder;gastrointestinal reflux;gliosis;globus pallidus;high performance liquid chromatography;hippocampus;histopathology;human;human tissue;hypercholesterolemia;hypertension;immunoreactivity;immunotherapy;leptomeninx;leukocyte;male;mammillary body;medical history;Mini Mental State Examination;neurofibrillary tangle;neuropathology;nuclear magnetic resonance imaging;priority journal;protein blood level;Purkinje cell;putamen;substantia nigra;subthalamus;surface enhanced laser desorption ionization time of flight mass spectrometry;white matter;aricept;exelon,"Roher, A. E.;Maarouf, C. L.;Daugs, I. D.;Kokjohn, T. A.;Hunter, J. M.;Sabbagh, M. N.;Beach, T. G.",2011,,,0,
3725,An interdisciplinary memory clinic: a novel practice setting for pharmacists in primary care,"Pharmacists have developed innovative practices in various settings as singular providers or as members of multidisciplinary or interdisciplinary teams. Examples include pharmacists practicing in heart failure, hypertension, or hyperlipidemia clinics. There is a paucity of literature describing pharmacists in interdisciplinary memory clinics and specifically pharmacists practicing in interdisciplinary, primary care-based memory clinics. New practice models should be disseminated to guide others in the development of similar models given the complexity of this population. Patients with dementia are more difficult to manage because of cognitive impairment, behavioral and psychological symptoms, the common presence of multiple comorbidities, and related polypharmacy and caregiver issues. These challenges require expertise in neurodegenerative disorders and geriatrics. The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting. Patients are assessed using an interdisciplinary approach, with team consensus for assessment and planning of care. Pharmacists' activities include assessment of (1) appropriateness of medications based on frailty, (2) medications that can impair cognition and/or function, (3) medication adherence and management skills, and (4) vascular risk factor control. Pharmacists provide education regarding medications and diseases, ensure appropriate transitions in care, and conduct home visits. Pharmacist participation in this clinic represents a novel opportunity to advance pharmacy practice in primary care, interdisciplinary models. Work is ongoing to describe outcomes attributable to pharmacist participation in this clinic.",Ambulatory Care Facilities;Humans;Medication Adherence;Memory Disorders/*drug therapy;Patient Care Team;*Pharmacists;Primary Health Care/*organization & administration;Professional Role;Alzheimer disease;aging;ambulatory care;clinical pharmacy;geriatrics,"Rojas-Fernandez, C. H.;Patel, T.;Lee, L.",2014,Jun,10.1177/1060028014526857,0,
3726,Acute cerebrovascular disease in the young: The stroke in young fabry patients study,"BACKGROUND AND PURPOSE - : Strokes have especially devastating implications if they occur early in life; however, only limited information exists on the characteristics of acute cerebrovascular disease in young adults. Although risk factors and manifestation of atherosclerosis are commonly associated with stroke in the elderly, recent data suggests different causes for stroke in the young. We initiated the prospective, multinational European study Stroke in Young Fabry Patients (sifap) to characterize a cohort of young stroke patients. METHODS - : Overall, 5023 patients aged 18 to 55 years with the diagnosis of ischemic stroke (3396), hemorrhagic stroke (271), transient ischemic attack (1071) were enrolled in 15 European countries and 47 centers between April 2007 and January 2010 undergoing a detailed, standardized, clinical, laboratory, and radiological protocol. RESULTS - : Median age in the overall cohort was 46 years. Definite Fabry disease was diagnosed in 0.5% (95% confidence interval, 0.4%-0.8%; n=27) of all patients; and probable Fabry disease in additional 18 patients. Males dominated the study population (2962/59%) whereas females outnumbered men (65.3%) among the youngest patients (18-24 years). About 80.5% of the patients had a first stroke. Silent infarcts on magnetic resonance imaging were seen in 20% of patients with a first-ever stroke, and in 11.4% of patients with transient ischemic attack and no history of a previous cerebrovascular event. The most common causes of ischemic stroke were large artery atherosclerosis (18.6%) and dissection (9.9%). CONCLUSIONS - : Definite Fabry disease occurs in 0.5% and probable Fabry disease in further 0.4% of young stroke patients. Silent infarcts, white matter intensities, and classical risk factors were highly prevalent, emphasizing the need for new early preventive strategies. © 2013 American Heart Association, Inc.",NCT00414583;adult;age;aphasia;artery dissection;article;ataxia;atherosclerosis;brain hemorrhage;brain infarction;brain ischemia;coma;comorbidity;congestive heart failure;diabetes mellitus;diplopia;dysarthria;dysphasia;Fabry disease;family history;female;gender;headache;atrial fibrillation;hemianopia;human;hyperlipidemia;hypertension;major clinical study;male;medical history;National Institutes of Health Stroke Scale;nausea and vomiting;neuroimaging;nuclear magnetic resonance imaging;paresis;priority journal;prospective study;Rankin scale;somatosensory disorder;stroke patient;stupor;transient ischemic attack;transitional blindness;unconsciousness;vertigo,"Rolfs, A.;Fazekas, F.;Grittner, U.;Dichgans, M.;Martus, P.;Holzhausen, M.;Böttcher, T.;Heuschmann, P. U.;Tatlisumak, T.;Tanislav, C.;Jungehulsing, G. J.;Giese, A. K.;Putaala, J.;Huber, R.;Bodechtel, U.;Lichy, C.;Enzinger, C.;Schmidt, R.;Hennerici, M. G.;Kaps, M.;Kessler, C.;Lackner, K.;Paschke, E.;Meyer, W.;Mascher, H.;Riess, O.;Kolodny, E.;Norrving, B.",2013,,,0,
3727,Adverse drug reactions,,antacid agent;anticonvulsive agent;antihypertensive agent;antiparkinson agent;anxiolytic agent;barbituric acid derivative;benzodiazepine;beta adrenergic receptor blocking agent;butyrophenone;cholinergic receptor blocking agent;cimetidine;corticosteroid;cotrimoxazole;diazepam;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;levodopa;methyldopa;narcotic analgesic agent;nonsteroid antiinflammatory agent;opiate;phenothiazine;prazosin;psychotropic agent;quinoline derived antiinfective agent;theophylline;tricyclic antidepressant agent;unindexed drug;verapamil;adverse drug reaction;adverse outcome;anticholinergic effect;blurred vision;bradycardia;confusion;constipation;delirium;dementia;depression;disease classification;disease severity;dizziness;dose response;driving ability;drug metabolism;drug safety;drug surveillance program;dyspnea;enzyme activity;extrapyramidal symptom;falling;fatigue;gait disorder;gastrointestinal symptom;general practitioner;genetic variability;heart failure;human;hypertension;hypotension;hypothermia;incontinence;mortality;orthostatic hypotension;pharmacy;polypharmacy;prescription,"Roller, L.;Gowan, J.",2012,,,0,
3728,Senile dementia of the Binswanger type. A vascular form of dementia in the elderly,"Computed tomography and magnetic resonance imaging in the elderly have demonstrated the common occurrence of deep white-matter lesions in the aging brain. These radiologic lesions (leukoaraiosis) may represent an early marker of dementia. At autopsy, an ischemic periventricular leukoencephalopathy (Binswanger's disease) has been found in most cases. The clinical spectrum of Binswanger's disease appears to range from asymptomatic radiologic lesions to dementia with focal deficits, frontal signs, pseudobulbar palsy, gait difficulties, and urinary incontinence. The name senile dementia of the Binswanger type (SDBT) is proposed for this poorly recognized, vascular form of subcortical dementia. The SDBT probably results from cortical disconnection most likely caused by hypoperfusion. In contrast, multi-infarct dementia is correlated with multiple large and small strokes that cause a loss of over 50 to 100 mL of brain volume. The periventricular white matter is a watershed area irrigated by long, penetrating medullary arteries. Risk factors for SDBT are small-artery diseases, such as hypertension and amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension. The SDBT may be a potentially preventable and treatable form of dementia.","Aged;Cerebral Arterial Diseases/*complications/pathology;Dementia/*diagnosis/etiology/physiopathology;Humans;Magnetic Resonance Spectroscopy;Tomography, X-Ray Computed","Roman, G. C.",1987,Oct 2,,0,
3729,"A diagnostic dilemma: Is ""Alzheimer's dementia"" Alzheimer's disease, vascular dementia, or both?",,Alzheimer disease;amnesia;amygdaloid nucleus;CADASIL;cerebrovascular disease;cognitive defect;comorbidity;cytoskeleton;diagnostic value;differential diagnosis;entorhinal cortex;hippocampus;human;ischemic heart disease;multiinfarct dementia;neocortex;neurofibrillary tangle;onset age;parietal lobe;priority journal;short survey;cerebrovascular accident;temporal lobe,"Román, G. C.;Royall, D. R.",2004,,,0,
3730,Dying in an acute care hospital. An analysis of the last-days situation,"Objective: to know the symptoms and symptomatic treatment preceding the death of patients in medical services, except in Oncology. Method: we studied all deaths in medical services, except in Oncology, for 11 weeks. We collected the clinical data of agony by reviewing medical and nursing records, by interviewing responsible teams, and by reviewing the medication administered. The relationship between the signs and symptoms that define the proximity of agony and death was analyzed. Results: we included 38 patients (68.4% women) with a mean age of 82 (64-97); 31 (82%) of them were admitted to Internal Medicine. The primary diagnosis was dementia in 9 cases (24%), stroke in 7 (18%), chronic obstructive pulmonary disease in 4 (11%), and heart failure in 3 cases (8%). During the last five days before death, 34 patients (89%) had maximum weakness, 33 (87%) inability to ingest, 30 (79%) respiratory distress, 26 (68%) decreased level of consciousness, 18 (47 %) fever, 16 (42%) respiratory rales, 15 (39%) dry mouth, 13 (34%) poor peripheral perfusion, and 8 (21%) episodes of agitation. Decreased level of consciousness, inability to ingest, respiratory distress, rales, and poor peripheral perfusion were related to death in the next 4 days. The risk of death increased over 3 times when two or more symptoms were present. In all, 69% of patients with respiratory rales and 43% of those with agitation received no specific treatment. Conclusions: most deaths studied were preceded by a period of agony, often unrecognized and untreated. It would be desirable that protocols be designed for these patients in medical services. Copyright © 2010 Arán Ediciones, S.L.",adult;aged;agitation;article;chronic obstructive lung disease;clinical article;dementia;dysphagia;female;fever;heart failure;hospital care;hospital service;human;interview;male;medical record review;mortality;perfusion;physical disease by body function;respiratory distress;respiratory tract disease;cerebrovascular accident;unconsciousness;weakness;xerostomia,"Romaní Costa, V.;Expósito López, A.;Rodríguez Carballeira, M.;Almagro Mena, P.",2010,,,0,
3731,Left Ventricular global longitudinal strain predicts heart failure readmission in acute decompensated heart failure,"BACKGROUND: The goal of this study was to determine if left ventricular (LV) global longitudinal strain (GLS) predicts heart failure (HF) readmission in patients with acute decompensated heart failure. METHODS AND RESULTS: Two hundred ninety one patients were enrolled at the time of admission for acute decompensated heart failure between January 2011 and September 2013. Left ventricle global longitudinal strain (LV GLS) by velocity vector imaging averaged from 2, 3 and 4-chamber views could be assessed in 204 out of 291 (70%) patients. Mean age was 63.8 +/- 15.2 years, 42% of the patients were males and 78% were African American or Hispanic. Patients were followed until the first HF hospital readmission up to 44 months. Patients were grouped into quartiles on the basis of LV GLS. Kaplan-Meier curves showed significantly higher readmission rates in patients with worse LV GLS (log-rank p < 0.001). After adjusting for age, sex, history of ischemic heart disease, dementia, New York Heart Association class, LV ejection fraction, use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, systolic and diastolic blood pressure on admission and sodium level on admission, worse LV GLS was the strongest predictor of recurrent HF readmission (p < 0.001). The ejection fraction was predictive of readmission in univariate, but not in multivariate analysis. CONCLUSION: LV GLS is an independent predictor of HF readmission after acute decompensated heart failure with a higher risk of readmission in case of progressive worsening of LV GLS, independent of the ejection fraction.","Acute Disease;Aged;Echocardiography/ methods;Female;Follow-Up Studies;Heart Failure/diagnosis/ physiopathology;Heart Ventricles/diagnostic imaging/ physiopathology;Humans;Male;Middle Aged;Patient Readmission/ trends;Predictive Value of Tests;Retrospective Studies;Stroke Volume;Ventricular Function, Left/ physiology;Echocardiography;Heart failure;Strain analysis","Romano, S.;Mansour, I. N.;Kansal, M.;Gheith, H.;Dowdy, Z.;Dickens, C. A.;Buto-Colletti, C.;Chae, J. M.;Saleh, H. H.;Stamos, T. D.",2017,Mar 15,,0,
3732,What lies beneath: Fabry nephropathy in a female patient with severe cerebrovascular disease,"Fabry disease is an X-linked inborn error of metabolism, which is caused by the deficiency of α-galactosidase A, leading to progressive accumulation of neutral glycosphingolipids and α-galactosyl breakdown products in most body fluids and several tissues, resulting in the clinical manifestations. The onset of Fabry disease symptoms in females is not observed as early as in males. We report a novel presentation of Fabry disease in a female patient with medical history of relapsing strokes and brain magnetic resonance angiography showing signs of microangiopathy and multiple lacunar strokes that were first diagnosed as Moyamoya disease (a chronic progressive cerebrovascular disease). The patient subsequently displayed increased levels of serum creatinine and proteinuria. Diagnosis of Fabry disease was made by a renal biopsy and wasconfirmed by molecular studies showing a missense mutation: c1066C > T (het) [R356W]. The diagnosis was delayed by 21 years with respect to her first symptom (stroke), probably because her initial clinical presentation was neurological and diagnosed as Moyamoya disease. Other factors that contributed to the delay of the diagnosis were the lack of acute or chronic pain (neuropathic pain) and angiokeratomas. Some similarities in the pathogenic aspects of the patient's vascular lesions lead us to speculate that this patient has Fabry disease, with a phenotype that had not yet been described. It is necessary to be aware of this possibility to avoid misdiagnosis of Fabry disease as Moyamoya disease. © 2013 Dustri-Verlag Dr.K.Feistle.",creatinine;hemoglobin;adult;aorta aneurysm;arteriole;article;atrophy;case report;cerebrovascular accident;chronic obstructive lung disease;computer assisted tomography;creatinine blood level;dementia;disease severity;dysphasia;echography;electrocardiography;Fabry disease;female;fibrosing alveolitis;follow up;frozen section;glomerulus epithelium;heart left ventricle hypertrophy;hemoglobin blood level;human;human tissue;hypertension;kidney biopsy;kidney cortex;kidney medulla;kidney parenchyma;kidney tubule;lacunar stroke;lipid storage;magnetic resonance angiography;medical history;microangiopathy;microscopy;missense mutation;moyamoya disease;nephrologist;neurogenic bladder;neuroimaging;neuropsychological test;physical examination;proteinuria;quadriplegia;renal replacement therapy;sinus bradycardia;spasticity;thorax examination,"Romão, E. A.;Lourenço, C. M.;Marques Júnior, W.;Rolfs, A.;Muñoz, V.;Vieira Neto, O. M.;Dantas, M.;Silva, G. E. B.;Costa, R. S.",2013,,,0,
3733,"APOE genotype, plasma lipids, lipoproteins, and AD in community elderly","Background: Genetic variation at the APOE locus has a major influence on both plasma lipid levels and the risk of AD. The relationship between APOE genotype and plasma lipids may influence the risk of AD. Objective: In a community-based study of white, African American, and Caribbean Hispanic elderly in New York City, we investigated the relationship between plasma lipids and AD as well as the possible influence of APOE genotype on this relationship. Methods: Total plasma cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were investigated in a cross-sectional study of nondemented elderly and patients with AD and in a prospective study of incident AD. Analyses included APOE genotype, gender, ethnicity, body mass index, and other potential confounders such as a history of hypertension, smoking, aspirin use, previous stroke, or ischemic heart disease. Results: Compared with nondemented elderly, decreased TC level had a weak but significant inverse association with incident AD, independent of APOE genotype. No other lipoprotein fragment was associated with either prevalent or incident AD. Conclusion: Our results suggest that no consistent relationship exists between APOE genotype, plasma lipoproteins, and AD.",apolipoprotein E;high density lipoprotein cholesterol;low density lipoprotein cholesterol;triacylglycerol;aged;Alzheimer disease;article;controlled study;disease association;elderly care;ethnic difference;female;gene locus;genetic variability;genotype;human;human cell;human tissue;lipid blood level;major clinical study;male;prevalence;priority journal;United States,"Romas, S. N.;Tang, M. X.;Berglund, L.;Mayeux, R.",1999,,,0,
3734,Management of painful wounds in advanced disease,,antibiotic agent;fentanyl;hydromorphone;ibuprofen;methadone;metronidazole;morphine;opiate;quetiapine;sufentanil;aged;case report;chronic kidney failure;clinical feature;clinical trial;comorbidity;congestive heart failure;decubitus;dementia;drug choice;drug dose reduction;drug dose titration;drug effect;drug efficacy;female;human;pain;sepsis;short survey;wound;wound infection,"Romayne, G.",2010,,,0,
3735,"Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment: The framingham study","Background and Purpose-: Carotid atherosclerosis has been associated with increased risk of stroke and poorer cognitive performance in older adults. The relation of carotid atherosclerosis to cognitive impairment and MRI indices of ischemia and aging in midlife is less clear. Methods-: We studied 1975 Framingham Offspring Study participants free of stroke and dementia with available carotid ultrasound, brain MRI, and neuropsychological testing. We related common and internal carotid artery intima-media thickness and internal carotid stenosis to large white matter hyperintensity (>1 SD above age-specific mean), total brain volume, hippocampal volume, silent cerebral infarcts, and neuropsychological measures of verbal memory, executive function, and nonverbal memory measures. Results-: We observed that internal carotid artery intima-media thickness, but not common carotid artery intima-media thickness, was associated with higher prevalence of silent cerebral infarcts (OR, 1.21; 95% CI, 1.03-1.43; P<0.05), large white matter hyperintensity (OR, 1.19; 95% CI, 1.03-1.38; P<0.05), lower total brain volume (-0.05 per SD; P<0.05), and poorer performance in verbal memory (-0.06 per SD; P<0.05) and nonverbal memory measures (-0.08 per SD; P<0.01), but not with hippocampal volume. Internal carotid stenosis =25% was associated with a higher prevalence of large white matter hyperintensity (adjusted OR, 1.77; 95% CI, 1.25-2.53) and lower total brain volume (-0.11 per SD; P=0.042) but not with silent cerebral infarcts or hippocampal volume. Internal carotid stenosis =50% was associated with higher prevalence of silent cerebral infarcts (OR, 2.53; 95% CI, 1.17-5.44), large white matter hyperintensity (OR, 2.35; 95% CI, 1.08-5.13), and poorer performance on executive function (-0.39 per SD; P<0.05), but not with total brain volume or hippocampal volume. Conclusions-: Carotid atherosclerosis markers were associated with MRI indices of brain ischemia and aging and with cognitive impairment in a community-based sample of middle-aged adults. Our data suggest that internal carotid artery intima-media thickness may be a better marker for cognitive impairment than common carotid artery intima-media thickness. © 2009 American Heart Association, Inc.",adult;aging;artery intima proliferation;article;atherosclerosis;brain infarction;brain ischemia;brain size;carotid artery obstruction;cognitive defect;controlled study;dementia;disease marker;female;hippocampus;human;internal carotid artery;major clinical study;male;neuropsychology;nuclear magnetic resonance imaging;prevalence;priority journal;ultrasound;verbal memory;white matter,"Romero, J. R.;Beiser, A.;Seshadri, S.;Benjamin, E. J.;Polak, J. F.;Vasan, R. S.;Au, R.;Decarli, C.;Wolf, P. A.",2009,,,0,
3736,Framingham coronary heart disease risk score can be predicted from structural brain images in elderly subjects,"Recent literature has presented evidence that cardiovascular risk factors (CVRF) play an important role on cognitive performance in elderly individuals, both those who are asymptomatic and those who suffer from symptoms of neurodegenerative disorders. Findings from studies applying neuroimaging methods have increasingly reinforced such notion. Studies addressing the impact of CVRF on brain anatomy changes have gained increasing importance, as recent papers have reported gray matter loss predominantly in regions traditionally affected in Alzheimer's disease (AD) and vascular dementia in the presence of a high degree of cardiovascular risk. In the present paper, we explore the association between CVRF and brain changes using pattern recognition techniques applied to structural MRI and the Framingham score (a composite measure of cardiovascular risk largely used in epidemiological studies) in a sample of healthy elderly individuals. We aim to answer the following questions: Is it possible to decode (i.e., to learn information regarding cardiovascular risk from structural brain images) enabling individual predictions? Among clinical measures comprising the Framingham score, are there particular risk factors that stand as more predictable from patterns of brain changes? Our main findings are threefold: i) we verified that structural changes in spatially distributed patterns in the brain enable statistically significant prediction of Framingham scores. This result is still significant when controlling for the presence of the APOE 4 allele (an important genetic risk factor for both AD and cardiovascular disease). ii) When considering each risk factor singly, we found different levels of correlation between real and predicted factors; however, single factors were not significantly predictable from brain images when considering APOE4 allele presence as covariate. iii) We found important gender differences, and the possible causes of that finding are discussed.",aged;allele;Alzheimer disease;apoe 4 gene;article;cardiovascular risk;female;Framingham risk score;gene;genetic risk;human;ischemic heart disease;male;neuroimaging;nuclear magnetic resonance imaging;pattern recognition;sex difference,"Rondina, J. M.;Squarzoni, P.;Souza-Duran, F. L.;Scazufca, M.;Menezes, P. R.;Vallada, H.;Lotufo, P. A.;de Toledo Ferraz Alves, T. C.;Filho, G. B.",2014,,,0,
3737,Males With MECP2 C-terminal-Related Atypical Rett Syndromes and Their Carrier Mothers,"Background This communication examines the expanding phenotypes of the MECP2 C-terminal atypical Rett syndromes in males and their affected carrier mothers. Descriptions We describe three males with normal karyotypes who presented with congenital evolving complex neurodevelopmental encephalopathies with multifaceted symptomatology of hypotonia, epilepsy, ataxia, spasticity, movement disorders, behavioral issues, severe intellectual impairment, and communication skills, and a protracted regression phase followed by stabilization. These phenotypes did not prompt us to identify atypical Rett syndrome early in childhood. Results Genetic analysis identified the two brothers with C-terminal truncation and the third male with C-terminal missense mutations. These mutations were inherited from their mothers, both of whom had incompletely characterized modest intellectual, mental health, social, and gastrointestinal impairments. Neither was independently able to care properly for their son(s). Conclusions Mutations of the MECP2 gene should be considered early in males with hypotonia, developmental delay, profound intellectual impairment, and seizures, associated with a mother with psychosocial, cognitive, and gastrointestinal impairments. Counseling and supporting mildly affected mothers requires both medical and social efforts.",chloral hydrate;DNA;methyl CpG binding protein 2;tetrabenazine;acute pancreatitis;adolescent;adult;article;ataxia;carboxy terminal sequence;case report;cerebellum atrophy;child;choreoathetosis;communication skill;depression;DNA determination;electroencephalography;exon;family history;female;frameshift mutation;gallstone;gastrointestinal symptom;gene mutation;genetic analysis;head circumference;heart arrest;heart arrhythmia;heterozygote;human;intellectual impairment;karyotype;learning disorder;male;mental health;missense mutation;muscle hypotonia;myoclonus;neuroimaging;nonalcoholic fatty liver;nuclear magnetic resonance imaging;pathologic fracture;phenotype;pneumonia;priority journal;Rett syndrome;Sanger sequencing;spasticity;stop codon;tonic clonic seizure;white matter;young adult,"Ronen, G. M.;Brady, L. I.;Tarnopolsky, M. A.",2017,,10.1016/j.pediatrneurol.2016.10.012,0,
3738,"Scleromyxedema: A multicenter study of characteristics, comorbidities, course, and therapy in 30 patients","Background: Scleromyxedema is associated with a monoclonal gammopathy and other comorbidities. Its prognostic and therapeutic features are poorly documented because most reports deal with single cases or small series. Objective: We sought to describe the characteristics of patients with scleromyxedema regarding demographics, clinical characteristics, comorbidities, therapeutic interventions, and course. Methods: We conducted a retrospective and prospective multicenter study. Results: We identified 30 patients with scleromyxedema (17 men and 13 women). The mean age at diagnosis was 59 years. The mean delay between disease onset and diagnosis was 9 months. Monoclonal gammopathy was detected in 27 patients. Extracutaneous manifestations were present in 19 patients including neurologic (30%), rheumatologic (23.3%), and cardiac (20%) manifestations. Two patients developed hematologic malignancies. The most common therapies included oral steroids and intravenous immunoglobulins. Although corticosteroids were ineffective, intravenous immunoglobulins (alone or in combination with other drugs) induced complete remission in 4 and partial remission in 9 patients with a mean treatment duration of 2 years. In all, 21 patients were followed up for a mean period of 33.5 months, at which time 16 patients were alive, 12 with and 4 without skin disease. Five patients died: 2 with dermatoneuro syndrome and 1 each with myeloid leukemia, Hodgkin lymphoma, and myocardial insufficiency. Limitations: This is mainly a retrospective study. Conclusions: Our study confirms that scleromyxedema is a chronic and unpredictable disease with severe systemic manifestations leading to a guarded prognosis. There is no specific definitive treatment. Our data support the contention that intravenous immunoglobulin is a relatively effective and safe treatment. The response is not permanent and maintenance infusions are required. © 2012 by the American Academy of Dermatology, Inc.",alpha2b interferon;azathioprine;chloroquine;corticosteroid;cyclophosphamide;cyclosporin;etretin;etretinate;hydroxychloroquine;immunoglobulin;isotretinoin;lenalidomide;melphalan;methotrexate;methylprednisolone;mucin;mycophenolate mofetil;prednisolone;prednisone;steroid;thalidomide;adult;aged;Alzheimer disease;arthralgia;arthritis;article;cardiomyopathy;carpal tunnel syndrome;clinical article;coma;comorbidity;congestive cardiomyopathy;demography;disease course;disease severity;drug megadose;drug withdrawal;esophagus function disorder;female;fibromyalgia;follow up;heart failure;heart muscle ischemia;hematologic malignancy;Hodgkin disease;human;human tissue;lung fibrosis;male;medical record review;monoclonal immunoglobulinemia;motor neuropathy;multiple cycle treatment;myelodysplastic syndrome;myeloid leukemia;myositis;neurodermatitis;outcome assessment;phototherapy;priority journal;prospective study;PUVA;Raynaud phenomenon;remission;macular edema;retrospective study;scleromyxedema;sensorimotor neuropathy;sensory neuropathy;Sjoegren syndrome;skin manifestation;steroid therapy;systemic therapy;treatment duration;treatment response;unspecified side effect,"Rongioletti, F.;Merlo, G.;Cinotti, E.;Fausti, V.;Cozzani, E.;Cribier, B.;Metze, D.;Calonje, E.;Kanitakis, J.;Kempf, W.;Stefanato, C. M.;Marinho, E.;Parodi, A.",2013,,,0,
3739,A qualitative study on changes in local brain pH due to discrete cerebral microembolism,"In this work autoradiography of 14C-5,5-dimethyl-2,4-oxazolidinedione (14C-DMO) was used to trace changes in local cerebral pH in embolized awake rabbits. One hour after i.v. injection of 14C-DMO small cerebral ischemic foci were produced in rabbits by injecting plastic beads into the left heart ventricle under short-acting anaesthesia, and after another hour the animals were put to death and their brains processed for autoradiography of 14C-DMO. Evidence of acidosis was in general not found in the microischemic regions, though there were a few possible exceptions. However in the hippocampus a diffuse acidosis involving a large part of the structure, could be found in 2 of the 4 experiments. This hippocampal phenomenon probably reflected the same process as has been observed using autoradiography of 2-deoxyglucose (reflecting cellular glucose uptake) on the same ischemic model increased 2-deoxyglucose phosphorylation. Because the hippocampus is involved in the memory function and the fact that small infarcts are coupled to dementia, this phenomenon should be drawn into focus for further studies.",Animals;Autoradiography;Brain/*metabolism;Carbon Radioisotopes;Dimethadione;Female;Hippocampus/metabolism;Hydrogen/*metabolism;Hydrogen-Ion Concentration;Intracranial Embolism/*metabolism;Male;Rabbits,"Roos, M. W.",1999,,,0,
3740,An experimental model of cerebral microischemia in rabbits,"Multiinfarct dementia is the second most common form of dementia in the elderly. An animal model of microischemia may provide information about the pathophysiology relevant when searching for prevention or treatment of microinfarctions in humans. The purpose of the present study was to develop an experimental model useful for studying discrete microischemic foci. In order to achieve single cerebral microischemic foci plastic beads with diameters of about 100 microns were injected into the left heart ventricle of anesthetized rabbits. 2-Deoxy-[14C]glucose (2-DG) and autoradiography were used to detect regions with disturbed metabolism. The tissue sections were inspected for impacted beads. Foci with markedly increased 2-DG accumulation and with diameters of about 1 mm were detected in all parts of the brain, indicating hypoxic regions with enhanced glycolysis. In some foci, located mainly in the basal ganglia, a central dip in the 2-DG profile was seen, suggesting poor glucose supply to the central ischemic region. The ratio foci/beads was about 1 in the brain stem (diencephalon included) and about 0.5 in the cortex. Twenty-four hours after embolization, infarctions, mainly in the deeper brain regions, were seen. There were still foci with increased 2-DG uptake, which were mainly located in the cortex. The results suggest that microemboli reaching the deeper brain regions give rise to metabolic disturbances more often than emboli reaching the cortex and that the ischemic foci in deeper brain regions are more prone to develop further into infarctions.","Animals;Autoradiography;Brain Ischemia/metabolism/*pathology;Cerebral Cortex/metabolism/pathology;Deoxyglucose/metabolism;Disease Models, Animal;Female;Hippocampus/metabolism/pathology;Male;Rabbits","Roos, M. W.;Sperber, G. O.;Johansson, A.;Bill, A.",1996,Jan,10.1006/exnr.1996.0008,0,
3741,"Stroke-independent association between metabolic syndrome and functional dependence, depression, and low quality of life in elderly community-dwelling Brazilian people","OBJECTIVES: Metabolic syndrome (Met.S) is a risk factor for stroke, dementia, and ischemic heart disease (IHD). It is unclear whether Met.S is an independent risk factor for functional dependence, depression, cognitive impairment, and low health-related quality of life (HRQoL) in a population free of clinical stroke. DESIGN: Cross-sectional. SETTING: Two communities in southern Brazil. PARTICIPANTS: Four hundred twenty people aged 60 and older. MEASUREMENTS: An adapted (body mass index ≥30 kg/m2 and blood pressure ≥140/90) Adult Treatment Panel III definition was used in diagnosing Met.S. Depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised) and Mini-Mental State Examination were evaluated along with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). HRQoL was measured using a visual analogue scale (0-10). All values were adjusted for age, sex, and presence of IHD. RESULTS: Forty (9.5%) subjects had a stroke and were excluded from the final analysis. Met.S was present in 37.4% of the stroke-free population. Met.S was significantly and independently associated with 2.24 times as much ADL dependence, 2.39 times as much IADL dependence, a 2.12 times higher risk of depression, a 2.27 times higher likelihood of cognitive impairment, and a 1.62 times higher chance of low self-perceived HRQoL (all P<0.05). Adjustment for its own components reduced the strength of the above associations but did not eliminate their statistical significance. If Met.S were removed from this population, dependence, depression, cognitive impairment, and low QoL would be reduced 15.0% to 21.4%. CONCLUSION: Met.S was significantly associated with functional dependence, depression, cognitive impairment, and low HRQoL, and its effects were independent of clinical stroke, IHD, and its own individual components. © 2007, The American Geriatrics Society.",adult;aged;article;blood pressure;body mass;Brazil;cognitive defect;community sample;comorbidity;controlled study;cross-sectional study;daily life activity;depression;Diagnostic and Statistical Manual of Mental Disorders;disease association;female;functional disease;gender;groups by age;human;ischemic heart disease;major clinical study;male;metabolic syndrome X;Mini Mental State Examination;quality of life;risk assessment;risk factor;self evaluation;statistical significance;cerebrovascular accident;visual analog scale,"Roriz-Cruz, M.;Rosset, I.;Wada, T.;Sakagami, T.;Ishine, M.;Roriz-Filho, J. S.;Cruz, T. R. S.;Rodrigues, R. P.;Resmini, I.;Sudoh, S.;Wakatsuki, Y.;Nakagawa, M.;Souza, A. C.;Kita, T.;Matsubayashi, K.",2007,,,0,
3742,High blood pressure accelerates gait slowing inwell-functioning older adults over 18-years of follow-up,"OBJECTIVES: To examine whether the association between hypertension and decline in gait speed is significant in well-functioning older adults and whether other health-related factors, such as brain, kidney, and heart function, can explain it. DESIGN: Longitudinal cohort study. SETTING: Cardiovascular Health Study. PARTICIPANTS: Of 2,733 potential participants with a brain magnetic resonance imaging (MRI) scan, measures of mobility and systolic blood pressure (BP), no self-reported disability in 1992 to 1994 (baseline), and with at least 1 follow-up gait speed measurement through 1997 to 1999, 643 (aged 73.6, 57% female, 15% black) who had received a second MRI in 1997 to 1999 and an additional gait speed measure in 2005 to 2006 were included. MEASUREMENTS: Mixed models with random slopes and intercepts were adjusted for age, race, and sex. Main explanatory factors included white matter hyperintensity progression, baseline cystatin-C, and left cardiac ventricular mass. Incidence of stroke and dementia, BP trajectories, and intake of antihypertensive medications during follow-up were tested as other potential explanatory factors. RESULTS: Higher systolic BP was associated with faster rate of gait speed decline in this selected group of 643 participants, and results were similar in the parent cohort (N=2,733). Participants with high BP (n=293) had a significantly faster rate of gait speed decline than those with baseline BP less than 140/90mmHg and no history of hypertension (n = 350). Rates were similar for those with history of hypertension who were uncontrolled (n = 110) or controlled (n = 87) at baseline and for those who were newly diagnosed (n = 96) at baseline. Adjustment for explanatory factors or for other covariates (education, prevalent cardiovascular disease, physical activity, vision, mood, cognition, muscle strength, body mass index, osteoporosis) did not change the results. CONCLUSION: High BP accelerates gait slowing in well-functioning older adults over a long period of time, even for those who control their BP or develop hypertension later in life. Health-related measurements did not explain these associations. Future studies to investigate the mechanisms linking hypertension to slowing gait in older adults are warranted. © 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.",antihypertensive agent;cystatin C;aged;article;body mass;brain function;cardiovascular disease;cognition;cohort analysis;controlled study;dementia;disease association;disease control;drug use;educational status;elderly care;female;follow up;heart function;heart left ventricle mass;human;hypertension;image analysis;kidney function;longitudinal study;major clinical study;male;mood;muscle strength;nuclear magnetic resonance imaging;osteoporosis;patient mobility;physical activity;protein blood level;cerebrovascular accident;systolic blood pressure;vision;walking difficulty;walking speed;white matter,"Rosano, C.;Longstreth Jr, W. T.;Boudreau, R.;Taylor, C. A.;Du, Y.;Kuller, L. H.;Newman, A. B.",2011,,,0,
3743,Coronary artery calcium: Associations with brain magnetic resonance imaging abnormalities and cognitive status,"OBJECTIVES: To evaluate the association between coronary atherosclerosis and subclinical brain magnetic resonance imaging (MRI) abnormalities and between coronary atherosclerosis and abnormal cognitive function (dementia/ mild cognitive impairment). DESIGN: Cross-sectional. SETTING: The Cardiovascular Health Study (CHS), an epidemiological study of risk factors for cardiovascular disease in older adults. PARTICIPANTS: Four hundred nine men and women, mean age 79, recruited from the Pittsburgh center of the CHS. MEASUREMENTS: Coronary atherosclerosis was defined according to the level of coronary artery calcification (CAC), as measured using electronic beam tomography. Subclinical brain MRI abnormalities included ventricular enlargement, white matter hyperintensities, and number of subcortical brain infarcts. Brain MRI and CAC measurements were performed between 1998 and 2000 at the Pittsburgh center of the CHS. Prevalence of brain MRI abnormalities and abnormal cognitive status were examined across quartiles of the CAC score, before and after controlling for age. Multivariate logistic regression models were used to assess whether CAC level was associated with abnormalities of brain MRI or abnormal cognitive status. RESULTS: Older adults with high CAC scores were more likely to have more-severe brain MRI abnormalities, including subcortical infarction and high white matter hyperintensities. The associations between CAC and ventricular enlargement showed a similar but not significant trend. The presence of any of the MRI abnormalities attenuated the association between CAC and abnormal cognitive status. CONCLUSION: Older adults with higher levels of CAC were more likely to have more-severe brain MRI abnormalities and abnormal cognitive status. © 2005 by the American Geriatrics Society.",aged;artery calcification;article;brain infarction;calcium blood level;cardiovascular risk;cognition;cognitive defect;controlled study;coronary artery atherosclerosis;dementia;female;human;major clinical study;male;neuroimaging;nuclear magnetic resonance imaging,"Rosano, C.;Naydeck, B.;Kuller, L. H.;Longstreth Jr, W. T.;Newman, A. B.",2005,,,0,
3744,Is hypertension overtreatment a silent epidemic?,,acute kidney failure;antihypertensive therapy;brain ischemia;cardiovascular mortality;chronic kidney failure;dementia;heart infarction;heart muscle ischemia;hemodialysis;human;hypertension;intensive care;morbidity;note;orthostatic hypotension;priority journal;systolic blood pressure,"Rosansky, S.",2012,,,0,
3745,Do not resuscitate?,,case report;dementia;heart arrest;human;letter;male;resuscitation,"Rosansky, S. J.",1991,,,0,
3746,Risk-Adjusted percent time in therapeutic range as a quality indicator for outpatient oral anticoagulation results of the veterans affairs study to improve anticoagulation (varia),"Background-Oral anticoagulation is safer and more effective when patients receive high-quality care. However, there have been no prior efforts to measure quality of oral anticoagulation care or to risk adjust it to ensure credible comparisons. Our objective was to profile site performance in the Veterans Health Administration (VA) using risk-adjusted percent time in therapeutic range (TTR). Methods and Results-We included 124 551 patients who received outpatient oral anticoagulation from 100 VA sites of care for indications other than valvular heart disease from October 1, 2006, to September 30, 2008. We calculated TTR for each patient and mean TTR for each site of care. Expected TTR was calculated for each patient and each site based on the variables in the risk adjustment model, which included demographics, comorbid conditions, medications, and hospitalizations. Mean TTR for the entire sample was 58%. Site-observed TTR varied from 38% to 69% or from poor to excellent. Site-expected TTR varied from 54% to 62%. Site risk-adjusted performance ranged from 18% below expected to 12% above expected. Risk adjustment did not alter performance rankings for many sites, but for other sites, it made an important difference. For example, the site ranked 27th of 100 before risk adjustment was one of the best (risk-adjusted rank, 7). Risk-adjusted site rankings were consistent from year to year (correlation between years, 0.89). Conclusions-Risk-adjusted TTR can be used to profile the quality of outpatient oral anticoagulation in a large, integrated health system. This measure can serve as the basis for quality measurement and quality improvement efforts. © 2011 American Heart Association, Inc.",warfarin;adult;aged;alcohol abuse;anticoagulant therapy;article;bipolar disorder;cardiomyopathy;chronic kidney disease;chronic liver disease;chronic lung disease;dementia;demography;diabetes mellitus;epilepsy;female;health care quality;atrial fibrillation;heart failure;hospitalization;human;hyperlipidemia;hypertension;major clinical study;major depression;male;mural thrombus;neoplasm;outpatient care;priority journal;pulmonary hypertension;race difference;risk assessment;sex difference;substance abuse;thrombus;treatment indication;treatment outcome;valvular heart disease;venous thromboembolism;veteran,"Rose, A. J.;Hylek, E. M.;Ozonof, A.;Ash, A. S.;Reisman, J. I.;Berlowitz, D. R.",2011,,,0,
3747,Inoperable patients with acute type A dissection: Are they candidates for endovascular repair?,"OBJECTIVES: The objectives are to (i) report characteristics and outcomes of patients with inoperable acute type A aortic dissection, (ii) describe proximal aortic morphology and (iii) identify potential for endovascular treatment of the entry tear. METHODS: Fifty-three (7.7%) of 686 patients with acute type A dissection between 2005 and 2015 were deemed inoperable. Chart review and active follow-up were performed for clinical characteristics and outcomes. Specific attention was directed at determining the reasons for inoperability. Twenty-four patients had computed tomography scans available for 3D reconstruction and imaging analysis. Measurements included diameter and cross-sectional area at multiple levels; plus lengths along the centreline, greater and lesser curves and outer wall of dissection. The entry tear location was identified. Entry tears between the sinotubular junction and innominate artery, or distal to the left subclavian artery, were considered amenable to endovascular repair. RESULTS: The reasons for inoperability were characterized as very high-risk 35 (66%) or prohibitive 18 (34%). Prohibitive risk factors included dementia, severe stroke, malperfusion and advanced malignancy. Thirty-day mortality occurred in 35 (66%). On imaging analysis, the sinotubular junction was <45 mm in 18 (75%). The false lumen was located along the greater curve in 16 (67%), lesser curve 2 (8%), anteriorly in 5 (21%) and posteriorly in 1 (4%). The entry tear was potentially amenable to coverage in 19 (79%) patients - between the sinotubular junction and innominate artery in 18 patients and distal to the left subclavian artery in 1 patient. The entry tear was in the aortic root and arch in 1 patient (4%) each and not visible in 3 patients (13%). CONCLUSIONS: Only one-third of inoperable patients are prohibitive risk for any intervention. The entry tears in most patients are potentially coverable with endovascular devices. Additional imaging and engineering analysis will guide the design of disease specific devices.",acute kidney failure;adult;aged;aortic arch;aortic dissection;aortic root;article;artificial ventilation;brachiocephalic trunk;cerebrovascular accident;computer assisted tomography;controlled study;dementia;endovascular surgery;female;follow up;heart arrest;heart infarction;heart tamponade;hospice care;human;hypotension;major clinical study;male;mesenteric ischemia;multiple organ failure;neurologic disease;priority journal;resuscitation;retrospective study;subclavian artery;surgical mortality;surgical risk;three dimensional imaging;type A aortic dissection,"Roselli, E. E.;Hasan, S. M.;Idrees, J. J.;Aftab, M.;Eagleton, M. J.;Menon, V.;Svensson, L. G.",2017,,10.1093/icvts/ivx193,0,
3748,Headache and mitochondrial disorders,,calcium;CADASIL;cerebrovascular accident;clinical feature;disease association;disease transmission;electron transport;extrachromosomal inheritance;familial hemiplegic migraine;headache;human;Kearns Sayre syndrome;lactic acidemia;lactic acidosis;MELAS syndrome;MERRF syndrome;migraine;mitochondrial encephalopathy;mitochondrial myopathy;muscle biopsy;note;prevalence;priority journal;sodium channelopathy,"Rosen, N.",2008,,,0,
3749,Mortality and Reoperations following lower limb amputations,"Background: Above-the-knee amputations (AKA) and below-the-knee amputations (BKA) are commonly indicated in patients with ischemia, extensive tissue loss, or infection. AKA were previously reported to have better wound-healing rates but poorer rehabilitation rates than BKA. Objectives: To compare the outcomes of AKA and BKA and to identify risk factors for poor outcome following leg amputation. methods: This retrospective cohort study comprised 188 consecutive patients (mean age 72 years, range 25-103, 71% males) who underwent 198 amputations (91 AKA, 107 BKA, 10 bilateral procedures) between February 2007 and May 2010. Included were male and female adults who underwent amputations for ischemic, infected or gangrenotic foot. Excluded were patients whose surgery was performed for other indications (trauma, tumors). Mortality and reoperations (wound debridement or need for conversion to a higher level of amputation) were evaluated as outcomes. Patient- and surgery-related risk factors were studied in relation to these primary outcomes. Results: The risk factors for mortality were dementia [hazard ratio (HR) 2.769], non-ambulatory status preoperatively (HR 2.281), heart failure (HR 2.013) and renal failure (HR 1.87). Resistant bacterial infection (HR 3.083) emerged as a risk factor for reoperation. Neither AKA nor BKA was found to be an independent predictor of mortality or reoperation. Conclusions: Both AKA and BKA are associated with very high mortality rates. Mortality is most probably related to serious comorbidities (renal and heart disease) and to reduced functional status and dementia. Resistant bacterial infections are associated with high rates of reoperation. The risk factors identified can aid surgeons and patients to better anticipate and possibly prevent severe complications.",creatinine;above knee amputation;adult;age;aged;article;below knee amputation;cardiovascular disease;cohort analysis;dementia;female;gangrene;gastrointestinal disease;gender;heart failure;human;kidney failure;leg ischemia;major clinical study;male;pneumonia;reoperation;retrospective study;risk factor;surgical mortality;treatment outcome;urinary tract infection;wound infection,"Rosen, N.;Gigi, R.;Haim, A.;Salai, M.;Chechik, O.",2014,,,0,
3750,Survival in elderly patients supported with continuous flow left ventricular assist device as bridge to transplantation or destination therapy,"Background Published data on mechanical circulatory support for elderly patients in continuous flow devices are sparse and suggest relatively poor survival. This study investigated whether LVADs can be implanted in selected patients over the age of 65 years with acceptable survival compared with published outcomes. Methods and Results A single-center retrospective analysis was conducted in 64 consecutive patients ≥65 years of age implanted with a continuous-flow left ventricular assist device (CF-LVAD) as either bridge to transplantation or destination therapy from August 2005 to January 2012. Baseline laboratory and hemodynamic characteristics and follow-up data were obtained. Median survival was 1,090 days. Survival was 85%, 74%, 55%, and 45% at 6 months and 1, 2, and 3 years, respectively. Our cohort had a baseline mean Seattle Heart Failure Model (SHFM) score of 2.6 ± 0.9. Observed survival was significantly better than SHFM-predicted medical survival. Stratification by age subsets, renal function, SHFM, implantation intention, or etiology did not reveal significant differences in survival. The most common cause of death was sepsis and nonlethalcomplication was bleeding. Conclusions Our experience with patients over the age of 65 receiving CF-LVADs suggests that this group demonstrates excellent survival. Further research is needed to discern the specific criteria for risk stratification for LVAD support in the elderly. © 2014 Elsevier Inc. All rights reserved.",beta adrenergic receptor blocking agent;cholesterol;diuretic agent;dobutamine;hemoglobin;sodium;uric acid;vasodilator agent;acidosis;aged;article;bleeding;cause of death;clinical assessment tool;continuous flow left ventricular assist device;follow up;heart arrest;heart left ventricle ejection fraction;heart right ventricle failure;human;kidney function;liver failure;major clinical study;mental deterioration;multiple organ failure;outcome assessment;overall survival;pancreas adenocarcinoma;priority journal;respiratory failure;retrospective study;scoring system;Seattle Heart Failure Model;sepsis;survival rate;very elderly,"Rosenbaum, A. N.;John, R.;Liao, K. K.;Adatya, S.;Colvin-Adams, M. M.;Pritzker, M.;Eckman, P. M.",2014,,,0,
3751,Pleuroparenchymal fibroelastosis: A pattern of chronic lung injury,"Pleuroparenchymal fibroelastosis (PPFE) is a rare condition currently described as an upper lobe subpleural and interstitial proliferation of predominantly elastic fibers. The etiology is unknown, and no specific diagnostic criteria have been reported. Here we report 5 cases of PPFE, 1 man and 4 women, 3 of them diagnosed at the time autopsy, 1 diagnosed in an explanted lung, and 1 diagnosed on a surgical wedge biopsy. The average age of diagnosis among this series is 73 years, and the duration of pulmonary symptoms ranged from 14 months to at least 9 years. Two patients had been exposed to specific medications (daptomycin and dapsone) preceding the development of pulmonary symptoms, and 1 patient developed eosinophilic pneumonia in the course of the disease. Four patients had clinical evidence of fibrous interstitial pneumonia. We found evidence of diffuse parenchymal fibroelastosis involving both upper and lower lobes in all 5 cases, suggesting that the disease may be a more diffuse condition than previously reported. PPFE may actually represent a pattern of chronic lung injury rather than a specific entity and may be seen in association with a variety of clinicoradiologic conditions. Based on our findings in this series and the most recent publications of the subject, we propose the following set of diagnostic criteria for PPFE: multilobar subpleural and/or centrilobular fibrous interstitial pneumonia characterized by an extensive (>80%) proliferation of elastic fibers in nonatelectatic lung, along with absent to mild chronic inflammation, and absent to rare granulomas.",corticosteroid;cotrimoxazole;dapsone;daptomycin;doxycycline;acid fast bacterium;acute lung injury;adult;aged;aorta stenosis;article;asthma;autopsy;case report;chronic inflammation;computer assisted tomography;congestive heart failure;daptomycin induced eosinophilic pneumonia;dementia;depression;diastolic heart failure;disease association;disease duration;drug withdrawal;dyslipidemia;eczema;elastic fiber;electron microscopy;emergency ward;eosinophilia;Epstein Barr virus;failure to thrive;family history;female;fever;fibromyalgia;fibrosing alveolitis;gastroesophageal reflux;atrial fibrillation;high resolution chest computed tomography;human;hypertension;hypothyroidism;interstitial lung disease;interstitial pneumonia;invasive aspergillosis;knee arthroplasty;Loeffler pneumonia;long term care;lung aspergillosis;lung development;lung fibrosis;lung function test;lung infiltrate;lung injury;lung parenchyma;male;medical history;methicillin resistant Staphylococcus aureus;microscopy;middle aged;non insulin dependent diabetes mellitus;obesity;osteoarthritis;osteopenia;osteoporosis;oxygen therapy;pacemaker;peripheral eosinophilia;pleuroparenchymal fibroelastosis;psoriasis;publication;pulmonary hypertension;pulse oximeter;pyrexia idiopathica;radiology;rare disease;Raynaud phenomenon;respiratory failure;rheumatic fever;sick sinus syndrome;tissue section;very elderly;weakness,"Rosenbaum, J. N.;Butt, Y. M.;Johnson, K. A.;Meyer, K.;Batra, K.;Kanne, J. P.;Torrealba, J. R.",2015,,,0,
3752,Hearing one's voice in your speech: An unusual case of palinacousis due to acute intracerebral hemorrhage,"Introduction: Palinacousis or auditory perseveration is a form of acquired auditory perceptual disorder that occurs rarely due to an acute intracranial process. The condition mimics psychotic hallucination, seizure, or other behavioral disorders, potentially causing management delay. We describe an unusual form of palinacousis resulting from acute lobar intracerebral hemorrhage. Case Report: A 70-year-old right-handed white man with history of hypertension, ischemic cardiomyopathy, and atrial fibrillation on anticoagulation developed a rare form of palinacousis, on which he hears the previous speaker's voice on the current speaker's speech due to right parietal intracranial hemorrhage. Cranial imaging revealed right parietal intracranial hemorrhage likely secondary to cerebral amyloid angiopathy or hypertension. Extensive workup and thorough clinical examination ruled out dementia, psychosis, seizure, or other behavioral disorders. The condition gradually improved without any specific intervention. Conclusions: Abnormality in auditory processing due to intracranial lesions affecting auditory cortical projections causes a variety of symptoms that mimic other conditions such as psychotic hallucinations, and ictal and postictal behavioral changes. Thorough characterization with detailed examination and workup may help in distinguishing one from the other. A rare form of palinacousis may occur after unilateral nondominant parietal lesion. The condition is self-limiting and requires no specific management. Ruling out seizure disorder or psychiatric condition may prevent unnecessary workup and treatment.",acetylsalicylic acid;warfarin;acute disease;aged;anticoagulant therapy;article;atrial fibrillation;auditory processing disorder;brain edema;brain hemorrhage;case report;clinical examination;computer assisted tomography;congestive heart failure;coronary artery disease;emergency ward;heart palpitation;human;hypertension;ischemic cardiomyopathy;male;medical history;neuroimaging;nuclear magnetic resonance imaging;palinacousis;perception disorder;perseveration;physiotherapy;priority journal;revascularization;speech;vascular amyloidosis;voice;aspirin,"Rosenberg, D.;Latorre, J. G. S.",2016,,,0,
3753,"Safety and efficacy of methylphenidate for apathy in Alzheimer's Disease: A randomized, placebo-controlled trial","Objective: In a recent crossover trial, methylphenidate treatment decreased apathy in Alzheimer's disease. We further assessed this finding in the Apathy in Dementia Methylphenidate Trial (ADMET). Method: Six-week, randomized, double-blind, placebocontrolled multicenter trial enrolling Alzheimer's disease participants (NINCDS-ADRDA criteria) with apathy assigned to methylphenidate 20 mg daily or placebo, conducted from June 2010 to December 2011. Primary outcomes were change in Apathy Evaluation Scale (AES) score and modified Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGI-C). Secondary outcomes included change in Neuropsychiatric Inventory (NPI) apathy score, Mini-Mental State Examination (MMSE) score, and safety. Results: 60 participants were randomly assigned (29 methylphenidate, 31 placebo). At baseline, mean (SD) age = 76 (8) years, MMSE score = 20 (5), AES score = 51 (12), NPI total score = 16 (8), and 62% of the participants (n = 37) were female. After 6 weeks' treatment, mean (SD) change in AES score was -1.9 (1.5) for methylphenidate and 0.6 (1.4) for placebo (P = .23). Odds ratio for improvement in ADCS-CGI-C was 3.7 (95% CI, 1.3 to 10.8) (P = .02), with 21% of methylphenidate versus 3% of placebo rated as moderately or markedly improved. NPI apathy score improvement was 1.8 points (95% CI, 0.3 to 3.4) greater on methylphenidate than on placebo (P = .02). MMSE trended toward improvement on methylphenidate (P = .06). There were trends toward greater anxiety and weight loss > 2% in the methylphenidate-treated group. Conclusions: Methylphenidate treatment of apathy in Alzheimer's disease was associated with significant improvement in 2 of 3 efficacy outcomes and a trend toward improved global cognition with minimal adverse events, supporting the safety and efficacy of methylphenidate treatment for apathy in Alzheimer's disease. © Copyright 2013 Physicians Postgraduate Press, Inc.",NCT01117181;cholinesterase inhibitor;memantine;methylphenidate;placebo;serotonin uptake inhibitor;abdominal pain;aged;aggression;agitation;Alzheimer disease;Alzheimer Disease Cooperative Study Clinical Global Impression scale;anemia;angina pectoris;anorexia;anxiety;Apathy Evaluation Scale;apathy syndrome;arthralgia;article;bleeding disorder;blood pressure;blurred vision;Clinical Global Impression scale;controlled study;decreased appetite;delusion;depression;dermatitis;distractibility;dizziness;drowsiness;drug dose increase;drug efficacy;drug eruption;drug fatality;drug fever;drug induced headache;drug safety;dyskinesia;ECG abnormality;female;hair loss;hallucination;heart atrium enlargement;heart palpitation;hostility;human;hyperactivity;hypertension;impulsiveness;insomnia;learning disorder;liver function;major clinical study;male;Mini Mental State Examination;mood disorder;motor activity;multicenter study;nausea;nervousness;Neuropsychiatric Inventory;priority journal;pulse pressure,"Rosenberg, P. B.;Lanctôt, K. L.;Drye, L. T.;Herrmann, N.;Scherer, R. W.;Bachman, D. L.;Mintzer, J. E.",2013,,,0,
3754,"Body mass index, other cardiovascular risk factors, and hospitalization for dementia","Background: Previous studies have shown that risk factors commonly associated with coronary disease, stroke, and other vascular disorders also predict dementia. We investigated the longitudinal relationship between body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and risk of hospital discharge or death certificate diagnosis of dementia. Methods: A total of 7402 men who were 47 to 55 years old in 1970 to 1973, without prior stroke or myocardial infarction, derived from a population sample of 9998 men were prospectively followed up until 1998. Two hundred fifty-four men (3.4%) had a hospital discharge diagnosis or a death certificate diagnosis of dementia: 176 with a primary diagnosis or cause of death and 78 with a secondary diagnosis. Results: The relationship between BMI and dementia as a primary diagnosis was J-shaped, and men with a BMI between 20.00 and 22.49 had the lowest risk. Subsequently, after adjustment for smoking, blood pressure, serum cholesterol level, diabetes mellitus, and social class, the risk increased linearly in men who had a BMI of 22.50 to 24.99 (multiple-adjusted hazard ratio [HR], 1.73; 95% confidence interval [CI], 0.92-3.25), 25.00 to 27.49 (HR, 1.93; 95% CI, 1.03-3.63), 27.50 to 29.99 (HR, 2.30; 95% CI, 1.18-4.47), and 30.00 or greater (HR, 2.54; 95% CI, 1.20-5.36) (P for linear trend = .03). Men with a BMI less than 20.00 had a nonsignificantly elevated risk (HR, 2.19; 95% CI, 0.77-6.25). Conclusions: A J-shaped relationship was observed between BMI and dementia, such that a BMI less than 20 and an increasing BMI of 22.5 or greater were associated with increased risk from midlife to old age of a primary hospital diagnosis of dementia. Overweight and obesity could be major preventable factors in the development of dementia.",cholesterol;acute heart infarction;adult;Alzheimer disease;article;blood pressure measurement;body height;body mass;body weight;cardiovascular risk;cause of death;cholesterol blood level;confidence interval;controlled study;death certificate;diabetes mellitus;female;hazard assessment;hospital discharge;hospitalization;human;major clinical study;male;multiinfarct dementia;priority journal;risk factor;sample size;smoking;social class;cerebrovascular accident,"Rosengren, A.;Skoog, I.;Gustafson, D.;Wilhelmsen, L.",2005,,,0,
3755,Heterozygous familial hypercholesterolemia presenting as chylomicronemia syndrome,"Heterozygous familial hypercholesterolemia (HeFH) is characterized by a twofold elevation in low-density lipoprotein cholesterol. Severe elevations in triglycerides are an uncommon manifestation. In this case report, we discuss an atypical presentation of the chylomicronemia syndrome in a patient with HeFH. Genetic analyses of the low-density lipoprotein receptor mutation and single nucleotide polymorphisms that elevate triglycerides provide confirmation for this atypical presentation of HeFH.",acetylsalicylic acid;allopurinol;apolipoprotein B;apolipoprotein E2;apolipoprotein E3;atorvastatin;carbohydrate;cholesterol;evolocumab;ezetimibe;hemoglobin A1c;high density lipoprotein cholesterol;low density lipoprotein cholesterol;omega 3 acid ethyl ester;prasugrel;rosuvastatin;simvastatin;triacylglycerol;abdominal pain;acute coronary syndrome;adult;Alzheimer disease;article;blurred vision;carbohydrate diet;case report;cholesterol blood level;coronary artery disease;coronary stent;coronary stenting;familial hypercholesterolemia;fatigue;gout;hemoglobin blood level;hospitalization;human;hyperlipidemia;hypertension;lipoprotein blood level;low back pain;male;memory disorder;middle aged;myalgia;myopathy;paresthesia;patient history of surgery;percutaneous coronary intervention;physical examination;priority journal;sedentary lifestyle;triacylglycerol blood level;xanthoma,"Rosenson, R. S.;Najera, S. D.;Hegele, R. A.",2017,,10.1016/j.jacl.2016.12.005,0,
3756,Differences in the treatment of patients with acute myocardial infarction according to patient age,"OBJECTIVE: To identify age-related differences in the treatment of patients with acute myocardial infarction. DESIGN: Retrospective cohort study. SETTING: Two university-affiliated medical centers with integrated clinical programs. PATIENTS: 329 patients admitted with acute myocardial infarction in 1988-1990 for whom complete medical records were available. Study exclusions included patients transferred from other hospitals specifically to undergo angiography or other cardiac procedures, nursing home residents, patients with metastatic cancer or dementia, and patients in whom 'do not resuscitate' orders were written during the first 2 hospital days. MEASUREMENTS: Medical records were reviewed to determine socio-demographic data, comorbidity, admission severity of illness, medications, the use of specific diagnostic and therapeutic modalities during and after hospitalization, treatment limitations, and patient outcomes. MAIN RESULTS: Chronological age of patients was related to the use of several diagnostic and therapeutic modalities. Using logistic regression to adjust for comorbidity, severity, infarct size and location, and other covariates, patients 75 years and older were 12 times less likely to receive thrombolytic therapy, 8 times less likely to undergo coronary angiography, and 7 times less likely to undergo coronary angioplasty than patients less than 65 years of age. However, age was not related to the use of other modalities, including echocardiography or gated blood pool scanning, pulmonary artery catheterization, and transvenous pacing. Finally, in a logistic regression model, the risk of in-hospital death was 4 times greater for patients 75 years and older than patients less than 65 years. CONCLUSIONS: Physicians' management of patients with acute myocardial infarction differed greatly according to patient age for some diagnostic and therapeutic modalities, but not for others. These findings indicate that generalizations about age- related practice variations should not be based on analysis of a single procedure. Moreover, judgments about the appropriateness of age-related differences in management require knowledge of the relative effectiveness of management strategies in older and younger patients.",antiangina pectoris agent;antiarrhythmic agent;anticoagulant agent;antihypertensive agent;antilipemic agent;antithrombocytic agent;creatine kinase;digitalis;diuretic agent;fibrinolytic agent;streptokinase;tissue plasminogen activator;acute heart infarction;adult;aged;aging;angiocardiography;article;artificial heart pacemaker;cardiovascular disease;coronary artery dilatation;disease severity;echocardiography;female;fibrinolytic therapy;heart catheterization;human;major clinical study;male;prognosis;scoring system;treatment planning,"Rosenthal, G. E.;Fortinsky, R. H.",1994,,,0,
3757,Rheumatic polymyalgia and giant cell arteritis syndrome,"The relations between rheumatic polymyalgia (RP) and giant cell arteritis (GCA), especially temporal arteritis (TA), are still obscure. The muscle disease has been called by a number of names, until in 1957 Barber cointed the term 'rheumatic polymyalgia'. It is relatively frequent in Europe and the USA and affects the white race particularly. Familial incidence was described by Liang (1974) in 4 cases (females) out of 250 patients with RP and GCA. The sex distribution (in 647 cases) was 2:1. The average age (289 cases) was 65.2 yr. Persons younger than 50 yr were rarely affected. In 40% of 92 patients the disease had a sudden onset: The tracheo cervical and caudal musculature was painful in 64% and the dorsal musculature in 1% while affection of all muscles occurred in 1%. The joints most often affected were the knees and the small joints of the feet and hands. The incidence of synovitis varied between 10 and 50%. In approx. 50% of all patients with RP, TA was demonstrable at least in the anamnesis. In most cases, systemic manifestations such as fever, depression and behavior disorders occurred in early stages. Association with LE or scleroderma was present in 5% of 247 patients. Muscle biopsies revealed only mild chronic inflammation in 15%. Myositis or vasculitis were not observed. The prognosis was favorable when RP was not associated with another disease. GCA was first described by Sir. J. Hutchinson in 1890. Subsequently, this disease was practically forgotten until TA was described anew in 1932 by Horton. The reported incidence of this disease varies from 2 to 10 patients per 100,000 of the population/yr. The age and sex distributions are the same as for RP, although GCA is occassionally observed in younger patients. The early stage of GCA is characterized by systemic manifestations, which render early diagnosis very difficult and may precede TA by months or years. In 109 patients, in whom the diagnosis was confirmed by biopsy, only 60% exhibited symptoms of arteritis. The presenting syndrome of GCA is headache, with fever in 80% of cases. The most frequent clinical finding is reduced or absent arterial pulsation, followed by pressure tenderness and nodular swelling of arteries. Claudication of the masticatory musculature occurs almost exclusively in TA. The incidence of ocular symptoms varies from 6 to 60%. In patients with histologically confirmed TA, ocular symptoms are demonstrable in almost 40%, the ultimate result being optic nerve atrophy. Involvement of the aortic arch and its main branches can be demonstrated histologically in a large proportion of cases, but mostly, however, it remains asymptomatic. Stenosis occurs in 15 to 20% of patients and causes absence of pulsations, which is hard to distinguish from Takayasu arteritis; it is due to aneurysms of the aorta or its branches. Takayasu's arteritis predominantly affects young women. Distinction of the 2 diseases is mainly made by the patient's age. In two thirds of the cases Takayasu's arteritis also shows systemic manifestations, and the 2 diseases may well be closely related. In many cases, autopsy reveals GCA of the coronary vessels. In patients with myocardial infarction, the diagnosis of GCA is often overlooked. Autopsy may reveal involvement of the vertebral and intracerebral arteries and of the carotid artery. Hemipareses and subarachnoid hematomas are frequent. Early dementia, confusion, hallucinations or coma also occur. A definite diagnosis can only be based on histologic examination. At biopsy an arterial tract, a few cm long, should be excised and examined in serial sections. The mortality rate of GCA is low, and the disease responds excellently to corticosteroids. In series in which GCA was diagnosed on the basis of the symptoms of arteritis, the frequency of RP was 52%. Conversely, 164 patients from 5 different series with RP yielded 49% of TA cases. RP responds well to anti inflammatory agents such as phenylbutazone, indocid and small doses of steroids. Such treatment does not reduce the risk of blindness, however.",article;blindness;blood vessel biopsy;diagnosis;giant cell arteritis;histology;major clinical study;muscle biopsy;myalgia;rheumatic polymyalgia;temporal arteritis;therapy,"Rosenthal, M.",1975,,,0,
3758,Managing hypertension in the elderly in light of the changes during aging,"The natural rise in systolic blood pressure with age is often complicated by other co-morbidities. Pharmacokinetics and pharmacodynamics of antihypertensive drugs are altered during aging, resulting in decrease in absorption and function of the kidney and liver, as well as interactions and adverse reactions of antihypertensives with the often large number of medications taken by the elderly. The problem of compliance in the elderly that may be disrupted by depression, loss of memory, vascular dementia and other conditions that compromise cognition is also of concern. Despite the many issues facing healthcare providers in managing hypertension in the elderly, the benefits are extensively documented and warrant overcoming therapeutic inertia, especially in view of current access to well documented therapeutic options.",aldosterone antagonist;amiloride;amlodipine plus atorvastatin;angiotensin receptor antagonist;atenolol;beta adrenergic receptor blocking agent;calcium channel blocking agent;captopril;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydrochlorothiazide;indapamide;losartan;nitrendipine;nonsteroid antiinflammatory agent;perindoprilat;placebo;potassium;psychotropic agent;spironolactone;verapamil;aging;apathy;brain protection;breast tenderness;cardiovascular risk;cerebrovascular accident;clinical trial;cognitive defect;delirium;depression;drowsiness;drug blood level;drug excretion;drug metabolism;drug safety;drug tolerability;extrapyramidal symptom;gastrointestinal toxicity;geriatric patient;heart arrhythmia;human;hyperkalemia;hypertension;ischemic heart disease;kidney disease;kidney function;lifestyle modification;liver toxicity;memory disorder;multiinfarct dementia;nephrotoxicity;orthostatic hypotension;patient compliance;polypharmacy;priority journal;risk reduction;short survey;side effect;systolic blood pressure;systolic hypertension;unspecified side effect,"Rosenthal, T.;Nussinovitch, N.",2008,,,0,
3759,A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?,"BACKGROUND: Historically, specialist palliative care has been accessed by a greater proportion of people dying with cancer compared to people with other life-limiting conditions. More recently, a variety of measures to improve access to palliative care for people dying from non-cancer conditions have been implemented. There are few rigorous population-based studies that document changes in palliative care service delivery relative to the number of patients who could benefit from such services. METHOD: A retrospective cohort study of the last year of life of persons with an underlying cause of death in 2009-10 from cancer, heart failure, renal failure, liver failure, chronic obstructive pulmonary disease, Alzheimer's disease, motor neurone disease, Parkinson's disease, Huntington's disease and/or HIV/AIDS. The proportion of decedents receiving specialist palliative care was compared to a 2000-02 cohort. Logistic regression models were used identify social and demographic factors associated with accessing specialist palliative care. RESULTS: There were 12,817 deaths included into the cohort; 7166 (56 %) from cancer, 527 (4 %) from both cancer and non-cancer conditions and 5124 (40 %) from non-cancer conditions. Overall, 46.3 % of decedents received community and/or hospital based specialist palliative care; a 3.5 % (95 % CI 2.3-4.7) increase on specialist palliative care access reported ten years earlier. The majority (69 %; n = 4928) of decedents with cancer accessed palliative care during the last year of life. Only 14 % (n = 729) of decedents with non-cancer conditions accessed specialist palliative care, however, this represented a 6.1 % (95 % CI 4.9-7.3) increase on the specialist palliative care access reported for the same decedent group ten years earlier. Compared to decedents with heart failure, increased odds of palliative care access was observed for decedents with cancer (OR 10.5; 95 % CI 9.1-12.2), renal failure (OR 1.5; 95 % CI 1.3-1.9), liver failure (OR 2.3; 95 % CI 1.7-3.3) or motor neurone disease (OR 4.5; 95 % CI 3.1-6.6). Living in major cities, being female, having a partner and living in a private residence was associated with increased odds of access to specialist palliative care. CONCLUSION: There is small but significant increase in access to specialist palliative care services in Western Australia, specifically in patients dying with non-cancer conditions.",Cancer;Community based palliative care;Hospital-based palliative care;Life limiting illness;Non-cancer conditions;Palliative care;Population-based study,"Rosenwax, L.;Spilsbury, K.;McNamara, B. A.;Semmens, J. B.",2016,May 10,10.1186/s12904-016-0119-2,0,
3760,Estimating the size of a potential palliative care population,"Objectives: To develop a method for estimating the population who could potentially benefit from receiving palliative care in the last year of their lives, and then apply the estimates to the Western Australian population to ascertain characteristics of these people. Methods: Three estimates of the potential palliative care population, Minimal, Mid-range and Maximal, were developed through focus groups, interviews and the literature. These estimates were applied to the cohort of people who died in Western Australia between 1 July 2000 and 31 December 2002 by linking death records with hospital morbidity data through the Western Australian Data Linkage System. Results: Between 0.28% and 0.50% of people in the Western Australian population in any one year could potentially benefit from palliative care, many of whom die from conditions other than neoplasms. While neoplasms accounted for 59.5% of all underlying causes of deaths in the Minimal Estimate, heart failure (21.0%), renal failure (9.8%), chronic obstructive pulmonary disease (9.6%), Alzheimer's disease (4.0%), liver failure (3.2%), Parkinson's disease (1.3%), motor neurone disease (0.9%), HIV/AIDS (<0.01%) and Huntington's disease (<0.01%) accounted for other conditions in this estimate. The study was expanded to include Mid-range and Maximal Estimates. Characteristics of the Western Australian population in these three estimates are described. Conclusions: Unlike traditional palliative care estimates that focus on malignant disease, this study included nonmalignant conditions in a set of three estimates of a potential palliative care population. By using population-based data to describe characteristics of people who compose palliative care populations, these results offer a tool for planning equitable healthcare services. © 2005 Edward Arnold (Publishers) Ltd.",acquired immune deficiency syndrome;adolescent;adult;aged;Alzheimer disease;analytic method;article;Australia;cause of death;child;chronic obstructive lung disease;cohort analysis;death certificate;female;health care planning;heart failure;human;Human immunodeficiency virus infection;Huntington chorea;infant;interview;kidney failure;liver failure;male;morbidity;motor neuron disease;palliative therapy;Parkinson disease;population research;terminal care,"Rosenwax, L. K.;McNamara, B.;Blackmore, A. M.;Holman, C. D. J.",2005,,,0,
3761,Hospital and emergency department use in the last year of life: A baseline for future modifications to end-of-life care,"Objectives: To describe hospital and emergency department use in the last year of life by people for whom death from cancer or one of another nine conditions was an expected outcome. Design, participants and setting: Retrospective cross-sectional study based on death registrations and morbidity data for 1071 Western Australians who died between 1 August 2005 and 30 June 2006. Decedents had an informal primary carer, did not live in residential aged care and died of a condition amenable to palliative care. Main outcome measures: Total number of hospital admissions; emergency presentations (with and without hospital admission); days spent in hospital by age group at death, sex, metropolitan or rural place of residence and cancer versus non-cancer diagnosis; proportion in hospital on any day in the last 365 days of life; time points of change in the last 365 days of life at which there was an increasing proportion of hospital admissions for those with cancer and non-cancer conditions. Results: All but 4% of the decedents spent time in hospital with a marked increase in hospitalisations in the last 108 days of life for people who died of cancer and the last 83 days of life for people who died of non-cancer conditions. Those with cancer spent less time in hospital than those with other diagnoses. Seventy per cent of the cohort had at least one emergency presentation. On the last day of life, 61.5% of people were in hospital and 4.0% had been seen in emergency departments. Conclusions: Western Australian hospitals currently provide extensive and progressively greater care at the end of life. Identifying patterns of emergency and inpatient use for various disease trajectories will assist in the planning of appropriate services for people where death is an expected outcome.",acquired immune deficiency syndrome;age distribution;aged;Alzheimer disease;amyotrophic lateral sclerosis;article;Australia;cause of death;chronic kidney failure;chronic liver failure;chronic obstructive lung disease;controlled study;cross-sectional study;emergency care;emergency ward;female;heart failure;hospital admission;hospital care;hospital department;human;Human immunodeficiency virus infection;Huntington chorea;length of stay;major clinical study;male;motor neuron disease;neoplasm;palliative therapy;Parkinson disease;retrospective study;sex difference;terminal care;terminal disease;urban rural difference,"Rosenwax, L. K.;McNamara, B. A.;Murray, K.;McCabe, R. J.;Aoun, S. M.;Currow, D. C.",2011,,,0,
3762,Application of NMR spectroscopy in medicinal chemistry and drug discovery,"We describe the details of the magnetic resonance spectroscopy and chemical shift imaging techniques for the human brain which have been developed over the last two decades. With these non-invasive tools, it is now readily possible to repeatedly assay up to 20 common brain metabolites. From the perspective of drug discovery, each of these metabolites could fulfill a number of useful functions: disease biomarker, surrogate marker of drug delivery, surrogate marker of drug efficacy and so on. To facilitate the possible utility of clinical magnetic resonance spectroscopy in future drug discovery, the major portion of the review is devoted to a detailed description of the well-validated neurochemical profiles of many common human brain disorders, for which MRS data now exists. Beyond proton, MRS, the commonest tool provided by the manufacturers of clinical MRI equipment, lays the world of heteronuclear NMR more familiar to chemists. Here too, with relatively little effort it has been possible to define neurochemical profiles of human brain disorders using 13C MRS. The future for drug discovery scientists is discussed. Finally, recognizing that a known feature of MR is the lack of sensitivity, we describe new efforts to harness hyperpolarization, with its 50,000 signal amplification, to conventional MRS. © 2011 Bentham Science Publishers Ltd.",4 aminobutyric acid;acetic acid;alanine;biological marker;choline;creatine;creatine phosphate;glucose;glutamic acid;glutamine;inositol;lactic acid;lipid;n acetylaspartic acid;phenylalanine;succinic acid;taurine;Alzheimer disease;aminoaciduria;article;blood brain barrier;brain;brain development;brain disease;brain infection;brain ischemia;brain lymphoma;Canavan disease;clinical assessment;clinical chemistry;dementia;diabetes mellitus;diagnostic value;Down syndrome;drug activity;drug dependence;drug development;endocrine disease;genetic disorder;glycogen storage disease type 5;head injury;heart arrest;hepatic encephalopathy;histochemistry;HIV associated dementia;human;Human immunodeficiency virus infection;Huntington chorea;hyperpolarization;metabolite;metabolomics;neurobiology;neurochemistry;neurofibromatosis;newborn hypoxia;non invasive measurement;nuclear magnetic resonance spectroscopy;ornithine transcarbamylase deficiency;progressive multifocal leukoencephalopathy;substance abuse;toxoplasmosis;urea cycle disorder,"Ross, B.;Tran, T.;Bhattacharya, P.;Watterson, D. M.;Sailasuta, N.",2011,,,0,
3763,Characterization of risk factors for vascular dementia: the Honolulu-Asia Aging Study,"BACKGROUND: The Honolulu Heart Program (HHP) is a prospective study of heart disease and stroke that has accumulated risk factor data on a cohort of 8,006 Japanese American men since the study began in 1965. A recent examination of the cohort identified all patients with vascular dementia (VaD) using the criteria of the California Alzheimer's Disease Diagnostic and Treatment Center. OBJECTIVE: To characterize patients with VaD by stroke subtype and to investigate risk factors for VaD in a cohort of Japanese American men, aged 71 to 93, living in Hawaii and participating in the HHP. METHODS: Sixty-eight men with VaD were compared with 3,335 men without dementia or stroke (NSND). Men with VaD were also compared with 106 men with stroke who were not demented (SND). Candidate risk factors were measured prospectively. RESULTS: Of the 68 men with VaD there were 34 (50%) whose VaD was attributed to small vessel infarcts, 16 (23%) whose VaD was related to large vessel infarcts, and 11 (16%) with both large and small vessel infarcts. The remainder could not be classified. In a multivariate logistic regression model for VaD compared with NSND containing variables found to be associated with VaD in a univariate analysis, age (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.13 to 1.27), coronary heart disease (OR 2.50, 95% CI 1.35 to 4.62), and 1-hour postprandial glucose (OR 1.41, 95% CI 1.06 to 1.88) remained significantly predictive of VaD, whereas preference for a Western diet (OR 0.54, 95% CI 0.30 to 0.98) as opposed to an Oriental or mixed diet and use of supplementary vitamin E (OR 0.32, 95% CI 0.12 to 0.82) were protective. A similar model for the comparison of men with VaD and SND revealed age (OR 1.24, 95% CI 1.14 to 1.35) was predictive of VaD, whereas preference for a Western diet (OR 0.43, 95% CI 0.22 to 0.86) was protective. CONCLUSIONS: The most common stroke subtype associated with VaD was lacunar stroke. Age and traditional vascular risk factors are important contributors to the development of VaD in late life. The antioxidant vitamin E and presently unknown factors related to a Western diet as opposed to an Oriental diet may be protective against developing VaD.","Aged;Aged, 80 and over;Asia;Cerebrovascular Disorders/*epidemiology;Dementia, Vascular/*epidemiology;Hawaii;Humans;Male;Odds Ratio;Prospective Studies;Risk Factors","Ross, G. W.;Petrovitch, H.;White, L. R.;Masaki, K. H.;Li, C. Y.;Curb, J. D.;Yano, K.;Rodriguez, B. L.;Foley, D. J.;Blanchette, P. L.;Havlik, R.",1999,Jul 22,,0,
3764,"CHF5074 reduces biomarkers of neuroinflammation in patients with mild cognitive impairment: A 12-week, double-blind, placebo-controlled study","As neuroinflammation is an early event in the pathogenesis of Alzheimer's disease, new selective antiinflammatory drugs could lead to promising preventive strategies. We evaluated the safety, tolerability, pharmacokinetics and pharmacodynamics of CHF5074, a new microglial modulator, in a 12-week, double-blind, placebo-controlled, parallel groups, ascending dose study involving 96 MCI patients. Subjects were allocated into three successive study cohorts to receive ascending, titrated doses of CHF5074 (200, 400 or 600 mg/day) or placebo. Vital signs, cardiac safety, neuropsychological performance and safety clinical laboratory parameters were assessed on all subjects. Plasma samples were collected throughout the study for measuring drug concentrations, soluble CD40 ligand (sCD40L) and TNF-α. At the end of treatment, cerebrospinal fluid (CSF) samples were optionally collected after the last dose to measure drug levels, β-amyloid1-42 (Aβ42), tau, phospho-tau181, sCD40L and TNF-α. Ten patients did not complete the study: one in the placebo group (consent withdrawn), two in the 200-mg/day treatment group (consent withdrawn and unable to comply) and seven in the 400-mg/day treatment group (five AEs, one consent withdrawn and one unable to comply). The most frequent treatment-emergent adverse events were diarrhea, dizziness and back pain. There were no clinically significant treatment-related clinical laboratory, vital sign or ECG abnormalities. CHF5074 total body clearance depended by gender, age and glomerular filtration rate. CHF5074 CSF concentrations increased in a dose-dependent manner. At the end of treatment, mean sCD40L and TNF-α levels in CSF were found to be inversely related to the CHF5074 dose (p=0.037 and p=0.001, respectively). Plasma levels of sCD40L in the 600-mg/day group were significantly lower than those measured in the placebo group (p=0.010). No significant differences between treatment groups were found in neuropsychological tests but a positive dose-response trend was found on executive function in APOE4 carriers. This study shows that CHF5074 is well tolerated in MCI patients after a 12-week titrated treatment up to 600 mg/day and dose-dependently affects central nervous system biomarkers of neuroinflammation. © 2013 Bentham Science Publishers.",amyloid beta protein[1-42];biological marker;CD40 ligand;chf 5074;gamma secretase inhibitor;placebo;tumor necrosis factor alpha;unclassified drug;abdominal pain;adult;aged;area under the curve;article;backache;blood level;cerebrospinal fluid;cerebrovascular accident;clinical laboratory;connective tissue disease;constipation;controlled study;diarrhea;dizziness;dose response;double blind procedure;drug absorption;drug bioavailability;drug clearance;drug distribution;drug dose titration;drug safety;drug tolerability;ECG abnormality;executive function;female;gastrointestinal disease;glomerulus filtration rate;human;major clinical study;male;maximum plasma concentration;mild cognitive impairment;musculoskeletal disease;nausea;nervous system inflammation;neuropsychological test;priority journal;sciatica;takotsubo cardiomyopathy;vital sign;vomiting,"Ross, J.;Sharma, S.;Winston, J.;Nunez, M.;Bottini, G.;Franceschi, M.;Scarpini, E.;Frigerio, E.;Fiorentini, F.;Fernandez, M.;Sivilia, S.;Giardino, L.;Calzà, L.;Norris, D.;Cicirello, H.;Casula, D.;Imbimbo, B. P.",2013,,,0,
3765,Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement from the American Heart Association,"Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals.",age;Alzheimer disease;article;awareness;cardiorespiratory fitness;cardiovascular mortality;cardiovascular risk;cerebrovascular accident;clinical classification;clinical outcome;clinical practice;dementia;disability;dose response;exercise;exercise test;health practitioner;heart failure;human;impaired glucose tolerance;lifestyle;malignant neoplasm;medical society;mental stress;metabolic syndrome X;non insulin dependent diabetes mellitus;patient care;physical activity;population;priority journal;sex;surgical risk;vital sign,"Ross, R.;Blair, S. N.;Arena, R.;Church, T. S.;Després, J. P.;Franklin, B. A.;Haskell, W. L.;Kaminsky, L. A.;Levine, B. D.;Lavie, C. J.;Myers, J.;Niebauer, J.;Sallis, R.;Sawada, S. S.;Sui, X.;Wisløff, U.",2016,,10.1161/cir.0000000000000461,0,
3766,Care of the adult patient with down syndrome,"Individuals with Down syndrome have an increased risk formany conditions, including cardiovascular disease, cancer, infections, and osteoporosis, and endocrine, neurological, orthopedic, auditory, and ophthalmic disorders.They also are at increased risk for abuse and human rights violations and receive fewer screenings and interventions than the population without Down syndrome. In this literature review, the most common health conditions associated with Down syndrome are examined, along with the topics of sexual abuse, menstrual hygiene, contraception, and human rights. Clinical guidelines for this population are summarized in an effort to assist practicing physicians in improving their provision of health care to the adult patient with Down syndrome.",acute lymphoblastic leukemia;adult;Alzheimer disease;article;coronary artery atherosclerosis;congenital heart disease;contraception;diabetes mellitus;digestive system function disorder;Down syndrome;early menopause;eye disease;gynecologic disease;hearing disorder;human;human rights;hygiene;infection;intellectual impairment;ischemic heart disease;life expectancy;menstruation;myeloid leukemia;orthopedics;patient care;practice guideline;screening;seizure;sexual abuse;thyroid disease,"Ross, W. T.;Olsen, M.",2014,,,0,
3767,Hyperammonemia after blood transfusion,,acetylsalicylic acid;ammonia;atorvastatin;bicarbonate;calcium acetate;cetirizine;clopidogrel;colecalciferol;heparin;hydromorphone;lactulose;metoprolol;midodrine;ondansetron;pantoprazole;rocuronium;vitamin K group;adult;anemia;blood transfusion;case report;coronary artery disease;end stage renal disease;faintness;health hazard;hemodialysis;human;hyperammonemia;international normalized ratio;lethargy;letter;liver cirrhosis;male;mental deterioration;middle aged;non insulin dependent diabetes mellitus;non ST segment elevation myocardial infarction;nonalcoholic fatty liver;priority journal;single drug dose;thorax pain,"Rossfeld, Z. M.;Wright, N. R.",2017,,10.7326/l17-0093,0,
3768,Slowing gait and risk for cognitive impairment,"Objective: To identify the shared neuroimaging signature of gait slowing and cognitive impairment. Methods: We assessed a cohort of older adults (n = 175, mean age 73 years, 57% female, 65% white) with repeated measures of gait speed over 14 years, MRI for gray matter volume (GMV) at year 10 or 11, and adjudicated cognitive status at year 14. Gait slowing was calculated by bayesian slopes corrected for intercepts, with higher values indicating faster decline. GMV was normalized to intracranial volume, with lower values indicating greater atrophy for 10 regions of interest (hippocampus, anterior and posterior cingulate, primary and supplementary motor cortices, posterior parietal lobe, middle frontal lobe, caudate, putamen, pallidum). Nonparametric correlations adjusted for demographics, comorbidities, muscle strength, and knee pain assessed associations of time to walk with GMV. Logistic regression models calculated odds ratios (ORs) of gait slowing with dementia or mild cognitive impairment with and without adjustment for GMV. Results: Gait slowing was associated with cognitive impairment at year 14 (OR per 0.1 s/y slowing 1.47; 95% confidence interval 1.04-2.07). The right hippocampus was the only region that was related to both gait slowing (ρ = -0.16, p = 0.03) and cognitive impairment (OR 0.17, p = 0.009). Adjustment for right hippocampal volume attenuated the association of gait slowing with cognitive impairment by 23%. Conclusions: The association between gait slowing and cognitive impairment is supported by a shared neural substrate that includes a smaller right hippocampus. This finding underscores the value of long-term gait slowing as an early indicator of dementia risk.",aged;anterior cingulate;article;brain atrophy;brain size;caudate nucleus;cognitive defect;cohort analysis;comorbidity;controlled study;dementia;diabetes mellitus;disease association;dorsal striatum;female;frontal lobe;gait;gait slowing;gray matter;hippocampus;human;hypertension;ischemic heart disease;knee pain;left hippocampus;major clinical study;male;mild cognitive impairment;muscle strength;neuroimaging;nuclear magnetic resonance imaging;parietal lobe;posterior cingulate;primary motor cortex;priority journal;prospective study;putamen;quadriceps femoris muscle;right hippocampus;risk factor;supplementary motor area;walking speed,"Rosso, A. L.;Verghese, J.;Metti, A. L.;Boudreau, R. M.;Aizenstein, H. J.;Kritchevsky, S.;Harris, T.;Yaffe, K.;Satterfield, S.;Studenski, S.;Rosano, C.",2017,,10.1212/wnl.0000000000004153,0,
3769,Beer and wine in antiquity: beneficial remedy or punishment imposed by the Gods?,"Different types of alcoholic beverages such as wine and beer were used in ancient times for various medicinal purposes. Being the oldest and probably the most widely used drugs, they were known to have some therapeutic value, in addition to the vital part they played in the daily life of people. Ethanol is produced by fermentation of a variety of plants and consumed either in a diluted form or concentrated by distillation to concoct alcoholic beverages. Beer made of fermented barley is an alcoholic drink that was believed to contain a spirit or a god. It is a drink of relatively low alcohol content with supernatural properties. The same was believed for wine. Considered to be divine, these beverages were the long sought elixirs of life and appeared in religious ceremonies, in mythology, and in social meals, such as the Greek symposia. In addition, these alcoholic drinks were considered to be a remedy for practically every disease and, therefore, were a common ingredient in ancient prescriptions. They were used as anaesthetics that dull the pain, as stimulants, as analgesics, as antiseptics to cleanse wounds and relieve pain, as emetics, as digestives, as antidotes for plant poisoning, for bites and stings, and as purifiers. However, we should not overlook the harmful effects of alcohol abuse such as drunkenness, chronic liver disease and, in modern terminology, infirmities that included pancreatitis, cardiomyopathy, peripheral neuropathy, dementia, and central nervous system disorders.","Beer/*history;Egypt;Greek World;History, Ancient;Humans;Wine/*history","Rosso, A. M.",2012,,,0,
3770,"Executive function, but not memory, associates with incident coronary heart disease and stroke","OBJECTIVE: To evaluate the association of performance in cognitive domains executive function and memory with incident coronary heart disease and stroke in older participants without dementia. METHODS: We included 3,926 participants (mean age 75 years, 44% male) at risk for cardiovascular diseases from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) with Mini-Mental State Examination score >/=24 points. Scores on the Stroop Color-Word Test (selective attention) and the Letter Digit Substitution Test (processing speed) were converted to Z scores and averaged into a composite executive function score. Likewise, scores of the Picture Learning Test (immediate and delayed memory) were transformed into a composite memory score. Associations of executive function and memory were longitudinally assessed with risk of coronary heart disease and stroke using multivariable Cox regression models. RESULTS: During 3.2 years of follow-up, incidence rates of coronary heart disease and stroke were 30.5 and 12.4 per 1,000 person-years, respectively. In multivariable models, participants in the lowest third of executive function, as compared to participants in the highest third, had 1.85-fold (95% confidence interval [CI] 1.39-2.45) higher risk of coronary heart disease and 1.51-fold (95% CI 0.99-2.30) higher risk of stroke. Participants in the lowest third of memory had no increased risk of coronary heart disease (hazard ratio 0.99, 95% CI 0.74-1.32) or stroke (hazard ratio 0.87, 95% CI 0.57-1.32). CONCLUSION: Lower executive function, but not memory, is associated with higher risk of coronary heart disease and stroke. Lower executive function, as an independent risk indicator, might better reflect brain vascular pathologies.","Aged;Aged, 80 and over;Coronary Disease/*epidemiology/*psychology;*Executive Function;Female;Follow-Up Studies;Humans;Incidence;Longitudinal Studies;Male;*Memory;Mental Status Schedule;Multicenter Studies as Topic;Multivariate Analysis;Neuropsychological Tests;Proportional Hazards Models;Randomized Controlled Trials as Topic;Stroke/*epidemiology/*psychology","Rostamian, S.;van Buchem, M. A.;Westendorp, R. G.;Jukema, J. W.;Mooijaart, S. P.;Sabayan, B.;de Craen, A. J.",2015,Sep 1,10.1212/wnl.0000000000001895,0,
3771,"APOE-related mortality: Effect of dementia, cardiovascular disease and gender","Allele-frequency comparisons between younger and older populations suggest an effect of apolipoprotein E gene (APOE) on mortality, not consistently confirmed by longitudinal data. Our aim was to assess the effect of APOE on survival taking into account the possible contribution of Alzheimer's disease, other dementias, ischemic heart- and cerebrovascular disease (IHCD). In a community-based longitudinal study, the Kungsholmen Project, 75+ year-old individuals (n = 1094) were examined, and followed for 18 years. An increased mortality-risk of 22% in those with the ε4 allele was detected; whereas a 28% decreased mortality-risk was detected in those with the ε2 allele compared to those with the ε3ε3 genotype. IHCD adjustment did not change the mortality-risk in those with the ε4 allele or the ε2 allele. Dementia accounted for the majority of the increased mortality-risk associated with the ε4 allele, but the protective effect of the ε2 allele remained. Both effects of the ε4 allele and the ε2 allele were strongly modified by gender. A 49% elevated risk for death in men was related to the ε4 allele, and a 36% decreased mortality-risk was found in women with the ε2 allele. These findings suggest different roles for the APOE alleles in survival by gender in old age. © 2007 Elsevier Inc. All rights reserved.",apolipoprotein E;aged;Alzheimer disease;article;cardiovascular disease;cerebrovascular disease;dementia;female;gene frequency;genotype;human;ischemic heart disease;major clinical study;male;mortality;priority journal;prognosis;risk assessment;risk factor;sex difference;survival rate,"Rosvall, L.;Rizzuto, D.;Wang, H. X.;Winblad, B.;Graff, C.;Fratiglioni, L.",2009,,,0,
3772,Clopidogrel use and early outcomes among older patients receiving a drug-eluting coronary artery stent,"BACKGROUND: Clopidogrel use after drug-eluting stent (DES) coronary artery implantation is essential for the prevention of early in-stent thrombosis, but clopidogrel use among older DES recipients has not been widely studied. We sought to identify characteristics associated with failure to fill a clopidogrel prescription and to examine the relationship between a clopidogrel prescription fill and hospitalization for acute myocardial infarction (AMI) or death. METHODS AND RESULTS: This study was a retrospective analysis of administrative data (20% sample) of 15 996 Medicare Part D enrollees who received a DES in 2006 to 2007. We modeled the adjusted probability and odds of clopidogrel prescription fill within 7 and 90 days of discharge and its association with AMI hospitalization or death. Of the study sample, 19.7% did not fill a clopidogrel prescription within 7 days of discharge, falling to 13.3% by day 90. The adjusted probability of filling a clopidogrel prescription within 7 or 90 days of discharge was lower for patients with dementia (20.2% less likely; 95% CI, 10.4%-30.1%), depression (10.7% less likely; 95% CI, 6.9%-14.5%), age >84 years compared to age 65 to 69 years (10.6% less likely; 95% CI, 8.6%-12.7%), black race (6.6% less likely; 95% CI, 4.2%-9.0%), intermediate levels of medication cost share (5.2% less likely; 95% CI, 2.9%-7.6%), and female sex (3.3% less likely; 95% CI, 2.1%-4.5%). It was higher for patients initially hospitalized for an AMI (12.5% more likely; 95% CI, 11.3%-13.6%). Failure to fill a clopidogrel prescription within 7 days of discharge was associated with a higher adjusted odds ratio of death during days 8 to 90 (2.44; 95% CI, 1.76-3.38) but was not associated with an increased risk of hospitalization for AMI. CONCLUSIONS: One in 5 patients failed to fill a prescription for clopidogrel at 7 days after DES placement, and 1 in 7 failed to do so by 3 months. Individual characteristics available at the time of hospital discharge were associated with a clopidogrel prescription fill. Those characteristics most strongly associated with nonadherence, including age >84 years, not having an AMI, depression, and dementia, may guide clinicians and health systems seeking to target this high-risk population and improve health outcomes after percutaneous coronary intervention.","Age Factors;Aged;Aged, 80 and over;*Blood Vessel Prosthesis Implantation;Coronary Artery Disease/complications/*epidemiology/mortality/*therapy;Coronary Vessels/drug effects/surgery;Dementia/*epidemiology;Drug-Eluting Stents;Female;Humans;Male;Medicare Part D;Medication Adherence;Platelet Aggregation Inhibitors/*administration & dosage/adverse effects;Retrospective Studies;Survival Analysis;Thrombosis/etiology/prevention & control;Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives;United States","Roth, G. A.;Morden, N. E.;Zhou, W.;Malenka, D. J.;Skinner, J.",2012,Jan,10.1161/circoutcomes.111.962704,0,
3773,Curbing unnecessary use of antipsychotic medication,,aripiprazole;neuroleptic agent;olanzapine;placebo;abnormal behavior;article;bipolar disorder;cerebrovascular accident;dementia;drug misuse;epilepsy;geriatric care;heart failure;human;intervention study;long term care;mortality;off label drug use;prescription;schizophrenia,"Rothe, J.;Gold, J. A.",2013,,,0,
3774,Depression and Health Service Utilization From Age 70 to 85: The Jerusalem Longitudinal Study,"Background: Health service utilization rises with age, and yet, its determinants are poorly understood. Our objective was to examine the association between depression and health service utilization from age 70-85. Methods: A representative sample (born 1920-1921) from the Jerusalem Longitudinal Cohort Study (1990-2010) was assessed at age 70, 78, and 85 for depression (using the Brief Symptoms Inventory); emergency room (ER) visits, and hospitalization in the previous year; social, functional, and medical domains. Results: We examined 414, 674, and 1118 subjects at ages 70, 78, and 85, among whom prevalence of depression was 16.2%, 21.1%, and 36.7%, respectively. ER visits and hospitalization were higher among depressed subjects. We adjusted for sex as well as financial status (social model); physical activity, going outdoors, functional status (functional model); and diabetes, ischemic heart disease, hypertension, cancer, dementia, chronic pain, and smoking (medical model). Depressed subjects were more likely to report increased ER visits, after adjustment in social, functional or medical models at age 78 (odds ratio [OR], 2.1, 95% confidence interval [CI], 1.3-3.3; OR, 1.8, 95% CI, 1.1-2.9; OR, 2.0, 95% CI, 1.26-3.26), and at age 85 (OR, 1.7, 95% CI, 1.33-2.3; OR, 1.4, 95% CI, 1.04-1.81; and OR, 1.4, 95% CI, 1.1-1.94), respectively. Aside from the social model at age 85 (OR, 1.5, 95% CI, 1.1-2.0), depression was not associated with increased likelihood of hospitalization. Conclusions: Depression at ages 78 and 85 is consistently associated with increased ER visits and should be considered among older people presenting to the ER. © 2013 American Medical Directors Association, Inc.",aged;article;Brief Symptom Inventory;chronic pain;daily life activity;dementia;depression;diabetes mellitus;disease association;emergency ward;female;functional status;health care utilization;hospital admission;hospitalization;human;hypertension;ischemic heart disease;longitudinal study;major clinical study;male;neoplasm;physical activity;smoking;survival rate,"Rottenberg, Y.;Jacobs, J. M.;Stessman, J.",2013,,,0,
3775,Hospice care 3,,adult;amyotrophic lateral sclerosis;chronic disease;congestive heart failure;cost effectiveness analysis;death;dementia;dying;health care system;human;letter;major clinical study;palliative therapy;priority journal;terminal care,"Rousseau, P.",1994,,,0,
3776,We'll Be Takin' Him Home,,African American;decubitus;dementia;diabetes mellitus;enteric feeding;family attitude;heart failure;home care;human;kidney failure;note;nurse;patient care;pneumonia;primary medical care;swallowing;wound care,"Rousseau, P.",2016,,,0,
3777,Physical and transcription map in the region 14q24.3: Identification of six novel transcripts,"The region of chromosome 14q24 has been of particular interest as it is known to contain one of the early-onset Alzheimer disease genes (AD3). Other genes of medical interest, such as arrhythmogenic right ventricular cardiomyopathy, have been mapped to this region by linkage analysis or chromosome rearrangements. We have focused on the region of a balanced translocation (2;14)(p25;q24). Members of a family with this translocation all have anterior polar cataracts, suggesting the presence of a gene involved in lens integrity at the vicinity of the breakpoint. The chromosome 14 breakpoint has been defined between the short tandem repeats D14S289 and D14S277, a region of overlap for yeast artificial chromosomes (YACs) 88862 and 934d4. We have extended the study of the region to 2 Mb on chromosome 14 and present a physical map of this region, including several sequence-tagged sites. New probes were generated using several end clones and inter-Alu PCR fragments from YACs. cDNA selection was used to identify transcribed sequences. Mapping and alignment of 17 nonoverlapping cDNAs completed by sequence and expression pattern analysis suggested that a minimum of eight putative transcription units is present in this region: six of these units correspond to five new genes and one member of a new gene family.",article;cataract;chromosome 14q;chromosome translocation;DNA transcription;gene expression;gene mapping;human;human cell;nucleotide sequence;priority journal,"Roux, A. F.;Rommens, J. M.;Read, L.;Duncan, A. M. V.;Cox, D. W.",1997,,,0,
3778,Incidental venous thromboembolism diagnosed in patients admitted with a first venous thromboembolism: Frequency and clinical significance (an observational study),,adult;advanced cancer;age;aged;autoimmune disease;brain disease;computer assisted tomography;congestive heart failure;dementia;disease association;female;follow up;gastrointestinal hemorrhage;human;incidental finding;infection;inflammatory disease;letter;liver cirrhosis;lung embolism;major clinical study;male;metabolic disorder;middle aged;mood disorder;mortality rate;neoplasm;observational study;priority journal;venous thromboembolism;walking difficulty,"Rouzaud, D.;Alexandra, J. F.;Chauchard, M.;Delon, M.;Dossier, A.;Chauveheid, M. P.;Perozziello, A.;Papo, T.;Sacre, K.",2016,,,0,
3779,Association of Cognitive Impairment in Patients on 3-Hydroxy-3-Methyl-Glutaryl-CoA Reductase Inhibitors,"BACKGROUND: Atherosclerotic cardiovascular diseases are the leading cause of death in the United States. A reduction in cholesterol with 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statin) significantly reduces mortality and morbidity. Statins may be associated with cognitive impairment or dementia. Our aim was to study the association of cognitive impairment or dementia in patients who were on a statin. METHODS: Electronic medical records of 3,500 adult patients in our suburban internal medicine office were reviewed. RESULTS: There were 720 (20.6%) patients in the statin treatment group. Dementia or cognitive impairment was an associated comorbid condition in 7.9% patients in the statin treatment group compared to 3.1% patients in the non-statin group (P < 0.001). Analysis of all of the patients with cognitive impairment or dementia showed that among the age ranges of 51 years through 100 years, the patients in the statin treatment group had a higher prevalence of cognitive impairment or dementia compared to the non-statin group. In the statin treatment group, we found significantly higher prevalence of hyperlipidemia (86.3%), hypertension (69.6%), diabetes mellitus (36.0%), osteoarthritis (31.5%), coronary artery disease (26.1%), hypothyroidism (21.5%) and depression (19.3%) compared to the non-statin group (P < 0.001). About 39.9% of the patients with dementia or cognitive impairment were on statin therapy compared to 18.9% patients who had no dementia or cognitive impairment and were on statin therapy (P < 0.001). Among the patients with cognitive deficit or dementia in the statin treatment group, the majority of the patients were either on atorvastatin (43.9%) or simvastatin (35.1%), followed by rosuvastatin (12.2%) and pravastatin (8.8%). We found greater odds of dementia or cognitive impairment with each year increase in age (1.3 times), in women (2.2 times), African American race (2.7 times), non-consumption of moderate amount of alcohol (two times), diabetes mellitus (1.6 times), hypothyroidism (1.7 times), cerebrovascular accident (3.2 times), and other rheumatological diseases (1.8 times). CONCLUSIONS: The association of dementia or cognitive impairment was significantly higher in the patients who were on statin therapy compared to the patients who were not on a statin.",Cognitive function;Cognitive impairment;Dementia;HMG-CoA reductase inhibitor therapy;Statin therapy,"Roy, S.;Weinstock, J. L.;Ishino, A. S.;Benites, J. F.;Pop, S. R.;Perez, C. D.;Gumbs, E. A.;Rosenbaum, J. A.;Roccato, M. K.;Shah, H.;Contino, G.;Hunter, K.",2017,Jul,,0,
3780,Hip fracture and depression in elderly patients: Is there a sex effect? 9,,albumin;age distribution;aged;chronic obstructive lung disease;cognitive defect;comorbidity;controlled study;dementia;depression;education;female;health status;hip fracture;hospital admission;human;ischemic heart disease;letter;major clinical study;male;musculoskeletal disease;nursing home;parkinsonism;sex,"Rozzini, R.;Morandi, A.;Sleiman, I.;Trabucchi, M.",2007,,,0,
3781,Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness,"OBJECTIVE: This hospital-based prospective study tests the hypothesis that, in a large group of hospitalized elderly patients, those who report functional decline between pre-illness baseline and hospital admission have a higher risk of death. METHODS: Nine hundred fifty elderly ambulant patients (F = 69.3%; mean age 78.3 +/- 8.5 years) were consecutively admitted to a geriatric ward (Poliambulanza Hospital, Brescia, Italy) during a 15-month period. Number and severity of somatic diseases, Charlson Index score, APACHE II score, level of serum albumin, cognitive status (by Mini-Mental State Examination), and depression score (by Geriatric Depression Scale), were assessed on admission and evaluated as potential prognostic factors. Functional status (by Barthel Index) was assessed by self-report on admission. Preadmission function was also assessed by self-report at the time of admission. Impairment of function due to an acute event is measured as the difference between performances on admission and 2 weeks before the acute event. Six-month survival was the main outcome variable. RESULTS: Factors related to mortality in bivariate analysis were: male sex, age over 80, cancer, congestive heart failure, pulmonary diseases, elevated Charlson Index score, and (independently) dementia (Mini-Mental State Examination < 18), APACHE-Acute Physiology Score , albumin level <3.5 g/dL, and anemia. After controlling for these variables and for Barthel Index score 2 weeks before the acute event, change in function due to the acute disease is independently related to 6-month mortality (minor functional change [<30 Barthel Index Point] relative risk: 1.3, 95% confidence interval, 0.6-3.0 and major functional change [major functional decrement] relative risk: 2.8, 95% confidence interval, 1.3-5.7). CONCLUSIONS: Disease-induced disability may reflect a condition of biological inability to react to acute diseases (i.e., frailty), and should be assessed as a relevant prognostic indicator.","*Activities of Daily Living;Aged;Aged, 80 and over;*Disability Evaluation;Female;*Frail Elderly;Hospital Mortality/*trends;Humans;Male;Middle Aged;Patient Admission/*statistics & numerical data;Retrospective Studies;Risk Factors;Survival Rate/trends","Rozzini, R.;Sabatini, T.;Cassinadri, A.;Boffelli, S.;Ferri, M.;Barbisoni, P.;Frisoni, G. B.;Trabucchi, M.",2005,Sep,,0,
3782,Frailty is a strong modulator of heart failure-associated mortality 2 (multiple letters),,advanced cancer;comorbidity;confidence interval;dementia;disease classification;geriatric patient;heart failure;hospitalization;human;laboratory test;letter;liver cirrhosis;medical assessment;Mini Mental State Examination;mortality;practice guideline;priority journal;prognosis;risk factor;survival time,"Rozzini, R.;Sabatini, T.;Frisoni, G. B.;Trabucchi, M.;Jong, P.;Tu, J. V.",2003,,,0,
3783,Medical treatment of acute illnesses in end-stage dementia 2 (multiple letters),,antibiotic agent;acute disease;antibiotic therapy;dehydration;delirium;dementia;gastrointestinal hemorrhage;heart failure;human;letter;medical decision making;Mini Mental State Examination;mortality;palliative therapy;pneumonia;priority journal;prognosis;quality of life;cerebrovascular accident;survival,"Rozzini, R.;Sabatini, T.;Trabucchi, M.;Van der Steen, J. T.;Ooms, M. E.;Adèr, H. J.;Ribbe, M. W.;Van Der Wal, G.",2003,,,0,
3784,A Report of Accelerated Coronary Artery Disease Associated with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy,"Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia and it is caused by mutations in the NOTCH3 gene. The neurologic manifestations of CADASIL syndrome have been well characterized; however, here we report one of the first de novo cases of CADASIL-associated coronary artery disease. A 45-year-old woman with a history of CADASIL and remote tobacco use presented with unstable angina. She was found to have diffuse and irregular narrowing of the left anterior descending artery and a drug eluting stent was deployed. Months later, she developed two subsequent episodes of unstable angina, requiring stent placement in the distal left anterior descending artery and the right coronary artery. Though the neurologic manifestations of CADASIL have been well described, these patients may also be predisposed to developing premature coronary artery disease. Patients with CADASIL and their physicians should be aware of this possible association because these patients may not be identified as high risk by traditional cardiovascular risk estimators. These patients may benefit from more aggressive interventions to reduce cardiac risk.",,"Rubin, C. B.;Hahn, V.;Kobayashi, T.;Litwack, A.",2015,,10.1155/2015/167513,0,
3785,To drink or not to drink: That is the question,,amyloid;cholesterol;alcohol abuse;alcohol blood level;alcohol consumption;alcoholic beverage;alcoholism;Alzheimer disease;article;atherosclerosis;beer;binge drinking;blood clotting;bone density;breast cancer;cancer mortality;cancer risk;cardiovascular mortality;cerebrovascular accident;cholesterol blood level;coronary artery atherosclerosis;coronary artery disease;dementia;drinking behavior;fracture;human;lifespan;lifestyle modification;lung cancer;motor performance;non insulin dependent diabetes mellitus;obesity;osteoporosis;priority journal;public health;rheumatoid arthritis;skin cancer;smoking;sudden cardiac death;sun exposure;Wart virus;wine,"Rubin, E.",2014,,,0,
3786,States worse than death among hospitalized patients with serious illnesses,,acute disease;cohort analysis;congestive heart failure;death;decision making;dementia;electronic medical record;health care system;health status;hospital patient;human;letter;life sustaining treatment;major clinical study;mortality;oligophrenia;outcome assessment;outpatient care;priority journal;structured interview;urine incontinence,"Rubin, E. B.;Buehler, A. E.;Halpern, S. D.",2016,,10.1001/jamainternmed.2016.4362,0,
3787,A register-based 13-year to 43-year follow-up of 70 patients with obsessive-compulsive disorder treated with capsulotomy,"Objectives Little is known about the long-term medical status of patients with severe obsessive-compulsive disorder (OCD) undergoing capsulotomy, a neurosurgical last-resort treatment. The present study used national registers to identify all operated patients with OCD in Sweden and evaluated their long-term medical status, including mortality, hospital admissions and psychotropic medication after capsulotomy for OCD. Design Register-based long-term follow-up cohort study. Participants We used the procedural and diagnostic codes in the Swedish National Patient Register to define the study population between 1970 and March 2013. Verification by manual review of medical records of the indication for surgery in those identified by the register yielded the final study cohort of 70 patients, followed 13-43 years after surgery. The sensitivity of the case selection method was 86%. Outcome measures We studied hospitalisation 5 years before and after surgery. Mortality data were derived from the Causes of Death Register. The Prescribed Drug Register was used to study psychotropic drug utilisation. Results By March 2013, 29 of the 70 patients were deceased. Their mean age at the time of death was 68 years (SD=14). Two patients had committed suicide and one had died of suspected suicide. Seventy per cent had been admitted to a psychiatric ward in the 5 years preceding surgery, and 84% in the first five postoperative years. Seventy-five per cent of those alive in 2012 were prescribed at least two psychotropic medications, often at high doses, the most common being antidepressants. Conclusions Malignant OCD has a poor long-term prognosis. Patients who are candidates for surgery should be informed that, while OCD symptoms may be ameliorated with surgery, they should not expect long-term freedom from medication and psychiatric care.",amitriptyline;citalopram;clomipramine;duloxetine;fluoxetine;oxazepam;sertraline;venlafaxine;zopiclone;adolescent;adult;alcohol liver cirrhosis;Alzheimer disease;article;atrial fibrillation;brain ischemia;capsulotomy;cardiomegaly;cerebrovascular accident;cohort analysis;controlled study;female;follow up;gamma knife radiosurgery;hospital admission;hospital patient;human;influenza;ischemic heart disease;leukemia;lung edema;major clinical study;male;malignant neoplasm;medical record;myocarditis;obsessive compulsive disorder;population based case control study;psychiatric department;sensitivity analysis;suicide;suicide attempt;surgical mortality;thermocapsulotomy;time of death,"Rück, C.;Larsson, J. K.;Mataix-Cols, D.;Ljung, R.",2017,,10.1136/bmjopen-2016-013133,0,
3788,Predictors for quality of life of patients with a portable out-of-centre-implanted extracorporeal membrane oxygenation device,"Objectives: Despite progress in the treatment of cardiopulmonary organ failure, the mortality rate for patients with acute respiratory distress syndrome (ARDS) and cardiogenic shock remains high. Extracorporeal membrane oxygenation (ECMO) is a promising treatment option, but long-term outcomes and health-related quality of life (HRQOL) are unknown. Methods: Detailed information related to pre- and post-device data and outcomes from a consecutive sample of 71 patients treated with ECMO was analysed. Long-term survivors were given a detailed follow-up examination after a median time of 31 months that included multiple scoring systems for HRQOL assessment. Results: Seventy-one patients received a portable out-of-centre-implanted ECMO system. The survival rate at hospital discharge was 48%. Median HRQOL scores were 80% on the Karnofsky index (normal >/=80%), 80% on the Euroqol-5D (normal >/=75%) and 73.1% on the quality-of-life index (normal >/=70%). Mental scores were 96.7% on the Mini-Mental State Examination (normal >/=90.0%), 77.8% on the DemTect (normal >/=72.0%), 87.0% on the test for early detection of dementia with depression demarcation (TFDD; normal >/=74.0%) and confirmed good mental state and HRQOL for patients at follow-up. Univariate analysis for in-hospital mortality indicated that ventilation time before device implantation, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, higher lactate level at the time of ECMO implantation and female gender were associated with adverse outcomes. Conclusions: In our cohort of patients, survivors of out-of-hospital ECMO implantation demonstrated good mental and quality-of-life conditions with well-recovered cardiopulmonary function during long-term follow-up. The indicators for adverse outcomes, pre-implantation lactate levels, pre-ventilation time and APACHE II score, should be considered before implantation of an ECMO device. Clinical trial: This study is registered at DRKS (Deutsches Register Klinischer Studien) under the code DRKS00009735 and was submitted to the WHO.","Adult;Aged;Extracorporeal Membrane Oxygenation;Female;Follow-Up Studies;Hospital Mortality;Humans;Male;Middle Aged;Quality of Life;Respiratory Distress Syndrome, Adult/mortality/ therapy;Shock, Cardiogenic/mortality/ therapy;Survival Rate;Treatment Outcome;Health-related quality of life;Out-of-centre;Outcome assessment;Survival","Ruckert, F.;Steinke, T.;Flother, L.;Bucher, M.;Metz, D.;Frantz, S.;Charitos, E. I.;Treede, H.;Raspe, C.",2017,Apr 01,,0,
3789,Hyponatremia in tube-fed elderly men,"Previous reports have described 5-20% prevalence of hyponatremia in extended care facilities, due largely to drugs or inappropriate antidiuretic hormone secretion. In our 400 bed VA extended care facility, 15 men with organic brain syndrome (Alzheimer's, multi-infarct dementia, anoxic encephalopathy or alcoholism) currently receive Isocal via gastrostomy as the sole source of nutrition. We noted intermittent hyponatremia in about half of these patients, and conducted a chart review to investigate the cause. Mean age was 68 yr (range 46-92); tube feeding duration was 3 mo.-3 yr; 266 Na concentrations were obtained from the charts. Simultaneous with these Na analyses, one of three diets prevailed: (A) mixed foods (3-6 g Na/day) orally before gastrostomy; (B) Isocal supplemented with NaCl to give 2 g Na/day; (C) unsupplemented Isocal providing 1 g Na/day. (B) and (C) had been randomly varied by rotating physicians. Serum Na was directly related to Na intake. On (A), Na was within normal range (135-145 mEq/l) in all men. One patient was hyponatremic during diet (B). During (C), eight patients were hyponatremic. Na was less than 135 mEq/l in 40% of all samples during diet (C) and less than 130 mEq/l in 14%. Changing from diet (A) or (B) to diet (C) caused nearly equivalent declines in Na and Cl; K and HCO-3 were unaffected. No hyponatremic patient took drugs known to cause hyponatremia, or had congestive heart failure, hypoalbuminemia, lipemia or fasting hyperglycemia. At the end of the study, four hyponatremic men were changed from (C) to (B); serum Na became normal in all four patients, without edema or hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)",Bicarbonates [blood];Chlorides [blood];Diet [adverse effects];Electrolytes [blood];Enteral Nutrition [adverse effects];Hyponatremia [etiology];Potassium [blood];Sodium [blood];Aged[checkword];Humans[checkword];Male[checkword],"Rudman, D;Racette, D;Rudman, Iw;Mattson, De;Erve, Pr",1986,,,0,
3790,Hyponatremia in tube-fed elderly men,"Previous reports have described 5-20% prevalence of hyponatremia in extended care facilities, due largely to drugs or inappropriate antidiuretic hormone secretion. In our 400 bed VA extended care facility, 15 men with organic brain syndrome (Alzheimer's, multi-infarct dementia, anoxic encephalopathy or alcoholism) currently receive Isocal via gastrostomy as the sole source of nutrition. We noted intermittent hyponatremia in about half of these patients, and conducted a chart review to investigate the cause. Mean age was 68 yr (range 46-92); tube feeding duration was 3 mo.-3 yr; 266 Na concentrations were obtained from the charts. Simultaneous with these Na analyses, one of three diets prevailed: (A) mixed foods (3-6 g Na/day) orally before gastrostomy; (B) Isocal supplemented with NaCl to give 2 g Na/day; (C) unsupplemented Isocal providing 1 g Na/day. (B) and (C) had been randomly varied by rotating physicians. Serum Na was directly related to Na intake. On (A), Na was within normal range(135-145 mEq/l) in all men. One patient was hyponatremic during diet (B). During (C), eight patients were hyponatremic. Na was < 135 mEq/l in 40% of all samples during diet (C) and < 130 mEq/l in 14%. Changing from diet (A) or (B) to diet (C) caused nearly equivalent declines in Na and Cl; K and HCO-3 were unaffected. No hyponatremic patient took drugs known to cause hyponatremia, or had congestive heart failure, hypoalbuminemia, lipemia or fasting hyperglycemia. At the end of the study, four hyponatremic men were changed from (C) to (B); serum Na became normal in all four patients,without edema or hypertension. In about half of elderly men with advanced organic brain syndrome, therefore, the minimum daily requirement for Na appears to be about 2g/day, which is at least 10 times higher than the requirement in healthy populations.",aged;central nervous system;clinical article;diagnosis;human;hyponatremia;organic brain syndrome;prevention;priority journal;therapy;feeding apparatus,"Rudman, D.;Racette, D.;Rudman, I. W.",1986,,,0,
3791,Hospitalization in community-dwelling persons with Alzheimer's disease: frequency and causes,"OBJECTIVES: To examine the rates of and risk factors for acute hospitalization in a prospective cohort of older community-dwelling patients with Alzheimer's disease (AD). DESIGN: Longitudinal patient registry. SETTING: AD research center. PARTICIPANTS: Eight hundred twenty-seven older persons with AD. MEASUREMENTS: Acute hospitalization after AD research center visit was determined from a Medicare database. Risk factor variables included demographics, dementia-related, comorbidity and diagnoses and were measured in interviews and according to Medicare data. RESULTS: Of the 827 eligible patients seen at the ADRC during 1991 to 2006 (median follow-up 3.0 years), 542 (66%) were hospitalized at least once, and 389 (47%) were hospitalized two or more times, with a median of 3 days spent in the hospital per person-year. Leading reasons for admission were syncope or falls (26%), ischemic heart disease (17%), gastrointestinal disease (9%), pneumonia (6%), and delirium (5%). Five significant independent risk factors for hospitalization were higher comorbidity (hazard ratio (HR)=1.87, 95% confidence interval (CI)=1.57-2.23), previous acute hospitalization (HR=1.65, 95% CI=1.37-1.99), older age (HR=1.51, 95% CI=1.26-1.81), male sex (HR=1.27, 95% CI=1.04-1.54), and shorter duration of dementia symptoms (HR=1.26, 95% CI=1.02-1.56). Cumulative risk of hospitalization increased with number of risk factors present at baseline: 38% with zero factors, 57% with one factor, 70% with two or three factors, and 85% with four or five factors (P(trend) <.001). CONCLUSION: In a community-dwelling population with generally mild AD, hospitalization is frequent, occurring in two-thirds of participants over a median follow-up time of 3 years. With these results, clinicians may be able to identify dementia patients at high risk for hospitalization.",Accidental Falls/statistics & numerical data;Age Factors;Aged;Alzheimer Disease/*epidemiology;Comorbidity;Delirium/epidemiology;Female;Gastrointestinal Diseases/epidemiology;Hospitalization/*statistics & numerical data;Humans;Longitudinal Studies;Male;Massachusetts/epidemiology;Myocardial Ischemia/epidemiology;Pneumonia/epidemiology;Prospective Studies;Registries;Risk Factors;Sex Factors;Syncope/epidemiology,"Rudolph, J. L.;Zanin, N. M.;Jones, R. N.;Marcantonio, E. R.;Fong, T. G.;Yang, F. M.;Yap, L.;Inouye, S. K.",2010,Aug,10.1111/j.1532-5415.2010.02924.x,0,
3792,Probabilistic models of mortality for patients admitted in conventional hospital units,"Background: We have developed a tool to measure disease severity of patients hospitalized in conventional units in order to evaluate and compare the effectiveness and quality of health care in our setting. Patients and method: A total of 2,274 adult patients admitted consecutively to inpatient units from the Medicine, Surgery and Orthopaedic Surgery, and Trauma Departments of the Corporació Sanitària Parc Taulí of Sabadell, Spain, between November 1, 1997 and September 30, 1998 were included. The following variables were collected: demographic data, previous health state, substance abuse, comorbidity prior to admission, characteristics of the admission, clinical parameters within the first 24 hours of admission, laboratory results and data from the Basic Minimum Data Set of hospital discharges. Multiple logistic regression analysis was used to develop mortality probability models during the hospital stay. Results: The mortality probability model at admission (MPMHOS-0) contained 7 variables associated with mortality during hospital stay: age, urgent admission, chronic cardiac insufficiency, chronic respiratory insufficiency, chronic liver disease, neoplasm, and dementia syndrome. The mortality probability model at 24-48 hours from admission (MPMHOS-24) contained 9 variables: those included in the MPMHOS-0 plus two statistically significant laboratory variables: hemoglobin and creatinine. Conclusions: Severity measures, in particular those presented in this study, can be helpful for the interpretation of hospital mortality rates and can guide mortality or quality committees at the time of investigating health care-related problems.",creatinine;hemoglobin;adult;age;article;chronic disease;chronic liver disease;comorbidity;comparative study;controlled study;dementia;demography;disease severity;evaluation study;female;health care quality;health status;heart failure;hospital admission;hospital discharge;human;laboratory test;major clinical study;male;medicine;mortality;neoplasm;orthopedic surgery;probability;regression analysis;respiratory failure;Spain;substance abuse;surgical ward;traumatology,"Rué, M.;Roqué, M.;Solà, J.;Macià, M.;Casanovas, A.;Conesa, D.;De Nadal, J.;Elias, J.;Martos, A.;Maldonado, R.;Noguerasy Montserrat Sala, A.;Font, J.;Moreno, C.;Planell, J.;Moreno, C.;Gispert, R.",2001,,,0,
3793,Systemic blood pressure profile in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,"Background and Purpose - Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic form of subcortical ischemic vascular dementia (SIVD). The most common vascular risk factors are unremarkable in CADASIL; however, studies on systemic blood pressure (BP) changes over time are substantially lacking. Because BP instability is a relevant risk factor for developing or worsening white matter changes in sporadic SIVD, we aimed to study the BP profile of CADASIL to investigate its relationship with cognitive decline and white matter injury. Methods - Twenty-four-hour ambulatory BP monitoring was performed in a group of 14 CADASIL patients (12 males and 2 females) and in a group of 15 healthy age-matched control subjects. The following BP variables were compared between the 2 groups: mean daytime and nighttime systolic, diastolic, and mean arterial BP (SABP day, DABPday, and MABPday, and SABP night, DABPnight, and MABPnight) and nocturnal percentage decline in arterial BP (%MABP reduction). Cognitive performances were tested by mini mental status examination (MMSE), and brain MRI was performed to extrapolate the T2-weighted lesion volume (LV) in each CADASIL patient. The 24-hour arterial BP variables were compared between CADASIL and controls. In addition, for CADASIL patients only, MMSE, LV, and age were compared with each pressure variable. Results - Patients with CADASIL showed a significant reduction (P<0.05) of SABPday, DABPday, MABPday and %MABP decline with respect to controls. In addition, MMSE of CADASIL subjects correlated significantly (P<0.0001) with daytime MABP. Conclusions - The low systemic BP profile observed in CADASIL patients was specifically attributable to reduced diurnal BP values. This may further affect cerebral hemodynamics and increase the risk of cognitive impairment in these patients. The pathogenesis of abnormal BP profile in CADASIL remains to be clarified. It is likely that central and peripheral mechanisms controlling BP variations are involved. © 2005 American Heart Association, Inc.",adult;aged;article;blood pressure measurement;blood pressure monitoring;brain injury;CADASIL;circadian rhythm;clinical article;cognition;cognitive defect;controlled study;diastolic blood pressure;disease association;disease exacerbation;female;hemodynamics;human;male;multiinfarct dementia;night;nuclear magnetic resonance imaging;pathogenesis;priority journal;risk factor;systolic blood pressure;white matter,"Rufa, A.;Dotti, M. T.;Franchi, M.;Stromillo, M. L.;Cevenini, G.;Bianchi, S.;De Stefano, N.;Federico, A.",2005,,,0,
3794,Cardiac autonomic nervous system and risk of arrhythmias in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL),"BACKGROUND AND PURPOSE - Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited systemic microangiopathy with prevalently cerebral manifestations. Among the causes of death, sudden unexpected death seems to occur in a significant number of CADASIL patients. Because potential causes of sudden unexpected death may include cardiac arrhythmias and myocardial infarction, we evaluated risk factors for life-threatening arrhythmias, such as reduced heart rate variability, sympathetic overactivity and QT interval (QTc) prolongation, in 23 CADASIL patients. The relationship of these changes with brain MRI pattern was also investigated. METHODS - Frequency domain measures of heart rate variability (10 minutes recordings) and QTc interval were recorded in 23 CADASIL patients (17 males, 6 females) and 22 healthy age- and sex-matched control subjects. The following heart rate variability spectral parameters were considered at rest during spontaneous and controlled breathing (Cb): total power, very-low-frequency component, low-frequency component, high-frequency component, low-frequency/high-frequency ratio, and Cb-total power, Cb-very-low-frequency component, Cb-low-frequency component, Cb-high-frequency component, Cb-low-frequency/high-frequency ratio. R-to-R wave and QTc interval were also analyzed. All data were statistically compared between CADASIL and control subjects. Conventional brain MRI was performed in patients with CADASIL and T1-weighted and T2-weighted lesion volumes, and were compared with each spectral component of the tachogram. RESULTS - During spontaneous and controlled breathing, total power spectrum and all spectral components (very low frequency component, high-frequency component, low-frequency component) of heart rate variability were significantly reduced in CADASIL patients with respect to controls (P<0.05). The low-frequency/high-frequency component ratio was significantly higher in CADASIL patients than in controls. No significant correlation between heart rate variability spectral parameters and other variables including total brain T2-weighted and T1-weighted lesion volumes were observed in CADASIL subjects. CONCLUSIONS - We found a statistically significant reduction in all frequency domain parameters of heart rate variability associated with a higher low frequency/high frequency ratio for CADASIL patients with respect to normal subjects. These data are consistent with autonomic derangement and suggests that CADASIL patients may be at risk for life-threatening arrhythmias. This could at least in part explain their higher recurrence of sudden unexpected death and should be taken into account in planning therapy. © 2007 American Heart Association, Inc.",adult;aged;article;autonomic nervous system;brain damage;breathing;CADASIL;clinical article;controlled study;correlation analysis;disease association;female;heart arrhythmia;heart rate variability;human;male;nuclear magnetic resonance imaging;priority journal,"Rufa, A.;Guideri, F.;Acampa, M.;Cevenini, G.;Bianchi, S.;De Stefano, N.;Stromillo, M. L.;Federico, A.;Dotti, M. T.",2007,,,0,
3795,Anaemia is associated with development of acute heart failure in patients with acute coronary syndrome: propensity-score matched study,"Introduction: Anaemia is a prevalent comorbidity in patients with heart failure (HF), associated with worse prognosis as highlighted by 2016 ESC guidelines of HF, which reinforced the importance of its treatment to improve HF patients' outcomes. However, the role of anaemia in the development of acute HF in patients with acute coronary syndrome (ACS) is not well characterized. Purpose: Authors pretend to evaluate if anaemia at admission for ACS is associated with in-hospital development of acute HF. Methods: Observational retrospective study, with a sample of 594 consecutive patients admitted for ACS. Patients were divided in two groups: with anaemia, defined as haemoglobin at admission less than 12 g/dL, and without anaemia. Propensity-score was calculated to each patients taking into account age, sex, previous history of smoking, arterial hypertension, diabetes mellitus, hyperlipidaemia, myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, heart failure, significant valvular disease, stroke, peripheral artery disease, cancer, chronic obstructive pulmonary disease, dementia, family history of coronary artery disease, type of acute coronary syndrome justifying admission, severity of coronary artery disease, degree of revascularization and value of creatinine at admission. Each patient with anaemia was matched with a patient without anaemia with similar propensity-score. Outcome of acute HF was defined as evolution in Killip-Kimball classes 3 (acute pulmonary oedema) and 4 (cardiogenic shock) during hospitalization. The association of anaemia with acute HF was accessed in the matched-pairs with logistic regression and p<0.05 was considered statistically significant. Results: From the study sample of 594 patients, 120 (20.2%) patients had anaemia at admission. Matching each patient with anaemia with a patient without anaemia with similar propensity-score resulted in 120 matched-pairs of patients and a study sample of 202 patients, due to multiple matching of controls. Matched-pairs on propensity-score were similar in every variable used in the construction of the propensity-score, proving the correct pseudo-randomization. Anaemia at admission was associated with the development of in-hospital acute HF with an odds ratio (OR) of 1.11 (95% CI 1.04 - 1.19, p=0.003). Conclusion: Patients with anaemia at admission for ACS had in our propensity-score matched study a 11% greater probability of developing acute HF during hospitalization.",acute coronary syndrome;acute heart failure;anemia;cancer epidemiology;cardiogenic shock;cerebrovascular accident;chronic obstructive lung disease;clinical trial;controlled clinical trial;controlled study;coronary artery bypass graft;dementia;diabetes mellitus;family study;female;heart infarction;hospitalization;human;human tissue;hyperlipidemia;hypertension;logistic regression analysis;lung edema;major clinical study;male;odds ratio;percutaneous coronary intervention;peripheral occlusive artery disease;population based case control study;probability;propensity score;randomization;randomized controlled trial;retrospective study;revascularization;smoking;valvular heart disease;creatinine;endogenous compound;hemoglobin,"Rui, Azevedo Guerreiro Ra;Pais, J;Congo, K;Bras, D;Carvalho, J;Carrington, M;Neves, D;Santos, Ar;Picarra, B;Caeiro, A;Aguiar, J",2017,,10.1002/ejhf.833,0,
3796,Alcohol consumption and risk of dementia: The Rotterdam Study,"Background: Light-to-moderate alcohol consumption reduces the risk of coronary heart disease and stroke. Because vascular disease is associated with cognitive impairment and dementia, we hypothesised that alcohol consumption might also affect the risk of dementia. Methods: We examined the relation between alcohol consumption and risk of dementia in individuals taking part in the Rotterdam Study - a prospective population-based study of 7983 individuals aged 55 years and older. We studied all participants who did not have dementia at baseline (1990-93) and who had complete data on alcohol consumption (n=5395). Through follow-up examinations in 1993-94 and 1997-99 and an extensive monitoring system, we obtained nearly complete follow-up (99.7%) until the end of 1999. We used proportional hazards regression analysis, adjusted for age, sex, systolic blood pressure, education, smoking, and body-mass index, to compare the risk of developing dementia between individuals who regularly consumed alcohol and individuals who did not consume alcohol. Findings: The average follow-up was 6.0 years. During this period, 197 individuals developed dementia (146 Alzheimer's disease, 29 vascular dementia, 22 other dementia). The median alcohol consumption was 0.29 drinks per day. Light-to-moderate drinking (one to three drinks per day) was significantly associated with a lower risk of any dementia (hazard ratio 0.58 [95% Cl 0.38-0.90]) and vascular dementia (hazard ratio 0.29 [0.09-0.93]). We found no evidence that the relation between alcohol and dementia varied by type of alcoholic beverage. Interpretation: These findings suggest that light-to-moderate alcohol consumption is associated with a reduced risk of dementia in individuals aged 55 years or older. The effect seems to be unchanged by the source of alcohol.",alcohol;adult;age;aged;alcohol consumption;alcoholic beverage;Alzheimer disease;article;body mass;controlled study;dementia;disease association;education;female;follow up;health hazard;human;major clinical study;male;multiinfarct dementia;nonbiological model;population research;priority journal;regression analysis;risk assessment;risk factor;sex difference;smoking;systolic blood pressure,"Ruitenberg, A.;Van Swieten, J. C.;Witteman, J. C. M.;Mehta, K. M.;Van Duijn, C. M.;Hofman, A.;Breteler, M. M. B.",2002,,,0,
3797,Behavioural problems in patients with acute myocardinal infarction admitted to ICU,"The clinician should understand the etiology of acute brain dysfunction and correct the medical problem, should provide supportive interventions and order medications to decrease paranoia and agitation. Objective. To study the incidence and epidemiological features of delirium with a non-specified etiology in patients with acute myocardial infarction (AMI) admitted to an Intensive Care Unit (ICU), in order to design the main aspects of a prospective study on this matter and to explore the possible influence of two different architectural settings. Method. A descriptive, retrospective review of problem-oriented medical records (POMR) of 60 consecutively admitted survivors of an AMI and without a background of psychotic disorder, dementia, alcohol or drugs dependency, without language problems during the ICU-stay. The sample comprised two groups of 30 eligible patients belonging to 2 architectural orientations of the ICU, i.e. exterior (with daylight) or interior (artificial light). Results. The rate of delirium in the whole sample was 16%. When we considered only those patients over 70 years, this rate increased to 38%. Advanced age and haemodynamic and cardiac rhythm unstability appear to be the most important risk factors; CK serum levels, infarcted area, treatment with lidocaine and fibrinolysis are also important variables. The length of ICU-stay was longer in patients who became agitated than in their counterparts. Semiopen architectural settings with a mean length of ICU-stay inferior to 4 days were not associated to the development of these alterations in our study. Conclusion. The incidence of acute confusional states in patients diagnosed of AMI in ICU is high, and the interventions based on risk factors could reduce the length of stay. The design of a prospective study about delirium of a non-specified cause in ICU would provide preventive and therapeutic interventions in other pathologies.",creatine kinase;lidocaine;acute heart infarction;adult;age;aged;agitation;article;behavior disorder;brain dysfunction;confusion;creatine kinase blood level;delirium;female;fibrinolysis;heart arrhythmia;heart infarction size;heart rhythm;hemodynamics;human;intensive care;length of stay;major clinical study;male;medical record;paranoia;retrospective study;risk factor,"Ruiz Del Fresno, L.;De La Torre Prados, M. V.;Daga Ruiz, D.;Toro Sánchez, R.;García Alcántara, A.;Carpintero Avellaneda, J. L.",1998,,,0,
3798,"APOE gene polymorphism analysis in Barranquilla, Colombia","INTRODUCTION: The genetic variability present in the APOE gene polymorphism is considered an important factor associated with predisposition to diseases affecting lipid metabolism, as well as heart diseases and Alzheimer's disease, among others. Understanding it as a risk factor in different populations and ethnic groups is a useful tool. OBJECTIVE: To analyze the APOE gene polymorphism and determine allelic and genotypic frequencies of a representative sample of population from Barranquilla, Colombia. MATERIALS AND METHODS: We performed a descriptive and comparative study. The sample size was 227 unrelated individuals from Barranquilla, Colombia. RESULTS: The most frequent allele was the epsilon3, with 85%, followed by the epsilon4 allele (13%) and epsilon2 (1.8%). The genotypes found were: epsilon3/epsilon3: 71.8%, epsilon3/epsilon4: 24.2%, epsilon2/epsilon3: 2.2%, epsilon2/epsilon4: 1.3% and epsilon4/epsilon4: 0.4%. The epsilon2/epsilon2 genotype was not found in this study. The sample exhibited the Hardy-Weinberg equilibrium. CONCLUSION: The frequency of the epsilon3 allele and the epsilon3/epsilon3 genotype was similar to that reported in the literature in countries like Brazil, Mexico, Colombia, and in some Colombian Amerindian ethnic groups. The epsilon2/epsilon2 genotype was absent. This result is consistent with those found in other population groups worldwide. The frequency of the epsilon4 allele and the genotypes associated in this population could be related to the presence of diseases such as hypercholesterolemia, myocardial infarction and Alzheimer.",Apolipoproteins E;Colombia;alleles;genetic;polymorphism;population,"Ruiz, M.;Arias, I.;Rolon, G.;Hernandez, E.;Garavito, P.;Silvera-Redondo, C.",2016,Mar 03,10.7705/biomedica.v36i1.2612,0,
3799,Comorbidity in heart failure. Results of the Spanish RICA Registry,"BACKGROUND: We sought to identify the comorbidities associated with heart failure (HF) in a non-selected cohort of patients, and its influence on mortality and rehospitalization. DESIGN AND METHODS: Data were obtained from the 'Registro de Insuficiencia Cardiaca' (RICA) of the Spanish Society of Internal Medicine. The registry includes patients prospectively admitted in Internal Medicine units for acute HF. Variables included in Charlson Index (ChI) were collected and analysed according to age, gender, left ventricular ejection fraction (LVEF) and Barthel Index. The primary end point of study was the likelihood of rehospitalization and death for any cause during the year after discharge. RESULTS: We included 2051 patients, mean age 78 and 53% females. LVEF was 50% in 59.1% of the cohort. There was a high degree of dependency as measured by Barthel Index (14.8 % had an index </= 60). Mean ChI was 2.91 (SD +/- 2.4). The most frequent comorbidities included in ChI were diabetes mellitus (44.3%), chronic renal impairment (30.8%) and chronic obstructive pulmonary disease (COPD) (27.4%). Age, myocardial infarction, peripheral artery disease, dementia, COPD, chronic renal impairment and diabetes with target-organ damage were all identified as independent prognostic factors for the combined end point of rehospitalization and death at 1 year. However, if multivariate analysis was done including ChI, only this remained as an independent prognostic factor for the combined end point (P < 0.001). CONCLUSIONS: HF is a comorbid condition. ChI is a simple and feasible tool for estimating the burden of comorbidities in such population. We believe that a holistic approach to HF would improve prognosis and the relief the pressure exerted on public health services.","Aged;Aged, 80 and over;Comorbidity;Female;Heart Failure/*epidemiology/therapy;Hospitalization/statistics & numerical data;Humans;Male;Registries;Retreatment/statistics & numerical data;Spain/epidemiology","Ruiz-Laiglesia, F. J.;Sanchez-Marteles, M.;Perez-Calvo, J. I.;Formiga, F.;Bartolome-Satue, J. A.;Armengou-Arxe, A.;Lopez-Quiros, R.;Perez-Silvestre, J.;Serrado-Iglesias, A.;Montero-Perez-Barquero, M.",2014,Dec,10.1093/qjmed/hcu127,0,
3800,New possible role of statins in age-related diseases,,"Animals;Apoptosis/drug effects;Blood Proteins/antagonists & inhibitors;Coronary Disease/drug therapy;Dementia/drug therapy;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*pharmacology/therapeutic use;In Vitro Techniques;Rats;Rats, Sprague-Dawley;Serpins;Stroke/drug therapy","Ruocco, A.;Postiglione, A.;Santillo, M.;Seru, R.;Avvedimento, E. V.;Cuda, G.;Paterno, R.",2002,Dec,,0,
3801,Heart diseases and long-term risk of dementia and Alzheimer's disease: a population-based CAIDE study,"BACKGROUND: Many cardiovascular risk factors are shown to increase the risk of dementia and Alzheimer's disease (AD), but the impact of heart disease on later development of dementia is still unclear. OBJECTIVE: The aim of the study was to investigate the long-term risk of dementia and Alzheimer's disease (AD) related to midlife and late-life atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD) in a population-based study with a follow-up of over 25 years. METHODS: Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study includes 2000 participants who were randomly selected from four separate, population-based samples originally studied in midlife (1972, 1977, 1982, or 1987). Re-examinations were carried out in 1998 and 2005-2008. Altogether 1,510 (75.5%) persons participated in at least one re-examination, and 127 (8.4%) persons were diagnosed with dementia (of which 102 had AD). RESULTS: AF in late-life was an independent risk factor for dementia (HR 2.61, 95% CI 1.05-6.47; p = 0.039) and AD (HR 2.54, 95% CI 1.04-6.16; p = 0.040) in the fully adjusted analyses. The association was even stronger among the apolipoprotein E (APOE) epsilon4 non-carriers. Late-life HF, but not CAD, tended to increase the risks as well. Heart diseases diagnosed at midlife did not increase the risk of later dementia and AD. CONCLUSION: Late-life heart diseases increase the subsequent risk of dementia and AD. Prevention and effective treatment of heart diseases may be important also from the perspective of brain health and cognitive functioning.",Age Factors;Aged;Alzheimer Disease/*epidemiology/genetics;Apolipoprotein E4/genetics;Atrial Fibrillation/*epidemiology/genetics;Cohort Studies;Coronary Artery Disease/*epidemiology/genetics;Dementia/*epidemiology/genetics;Female;Finland/epidemiology;Follow-Up Studies;Heart Failure/*epidemiology/genetics;Humans;Male;Risk;Risk Factors;Socioeconomic Factors;Alzheimer disease;atrial fibrillation;coronary artery disease;dementia;heart failure,"Rusanen, M.;Kivipelto, M.;Levalahti, E.;Laatikainen, T.;Tuomilehto, J.;Soininen, H.;Ngandu, T.",2014,,10.3233/jad-132363,1,
3802,Treating the elderly is more complex,,glipizide;glucose;insulin;cerebrovascular disease;comorbidity;delirium;dementia;depression;diabetes mellitus;drug metabolism;elderly care;glucose blood level;heart infarction;human;hyperlipidemia;hypertension;hypoglycemia;ischemic heart disease;kidney metabolism;life expectancy;lifestyle;liver metabolism;non insulin dependent diabetes mellitus;obesity;patient compliance;patient counseling;patient education;patient information;polypharmacy;practice guideline;risk benefit analysis;risk factor;seizure;short survey;sitting;sleep disorder;treatment planning,"Rusnak, D.",2003,,,0,
3803,"Does the Framingham cardiovascular disease risk score also have predictive utility for dementia death? An individual participant meta-analysis of 11,887 men and women","Objective: Individual cardiovascular disease (CVD) risk factors are associated with dementia. For the first time, we investigated whether the Framingham CVD risk score-which comprises these multiple risk factors-was also associated with future dementia risk. Methods: Individual participant meta-analysis of two large, general population cohort studies (N = 11,887). For the purposes of comparison of the dementia results, we also examined the association between the Framingham CVD risk score and CVD-related death. Results: Framingham CVD risk score was associated with dementia death (hazard ratio per 10% increased risk, 95% confidence interval: 4.00, 2.44-6.56). Adjusting for age eliminated this association (1.04, 0.53-2.01); similarly, age explained 88% of the ability of the Framingham CVD risk score to predict CVD death. Conclusions: The Framingham CVD risk score was no more strongly associated with future dementia than age. It therefore offers no added value in predicting dementia. © 2013 Elsevier Ireland Ltd.",adult;aged;Alzheimer disease;article;atherosclerosis;cardiovascular disease;cardiovascular risk;cohort analysis;controlled study;dementia;disease association;female;Framingham risk score;frontotemporal dementia;hazard ratio;heart failure;human;ischemic heart disease;major clinical study;male;meta analysis (topic);mortality;multicenter study;peripheral vascular disease;population based case control study;predictive value;priority journal;risk factor,"Russ, T. C.;Hamer, M.;Stamatakis, E.;Starr, J. M.;Batty, G. D.;Kivimäki, M.",2013,,,0,
3804,Frequency and Risk Factors for Live Discharge from Hospice,"Objectives: To report frequencies and associated risk factors for 4 distinct causes of live discharge from hospice. Design: Retrospective cohort study using electronic medical records of hospice patients who received care from a large urban not-for-profit hospice agency in New York City during a 3-year period between 2013 and 2015 (n = 9,190). Results: Roughly one in five hospice patients were discharged alive (21%; n = 1911). Acute hospitalization was the most frequent reason for live discharge (42% of all live discharges; n = 802). Additional reasons included elective revocation to resume disease-directed treatments (18%; n = 343), disqualification (14%; n = 271), and service transfers or moves (26%; n = 495). Multinomial logistic regression analyses revealed that risk for acute hospitalization was higher among younger patients (age AOR = 0.98 [95% CI = 0.98–0.99] P <.01), racial/ethnic minorities (Hispanic AOR = 2.23 [CI = 1.82–2.73] P <.001; African American OR = 2.46 [CI = 2.00–3.03] P <.001; Asian/other OR = 1.63 [CI = 1.25–2.11] P <.001), and patients without advance directives (AOR = 1.41 [95% CI = 0.98–0.99] P <.001). Disqualification occurred much more frequently among patients with non-cancer diagnoses, including dementia (AOR = 13.14 [95% CI = 7.96–21.61] P <.001) and pulmonary disease (AOR = 11.68 [95% CI = 6.58–20.74] P <.001). Transfers and service moves were more common among Hispanics (AOR = 1.56 [95% CI = 1.45–2.34] P <.001), African Americans (AOR = 1.35 [95% CI = 1.03–1.79] P <.05), patients without a primary caregiver (AOR = 1.35 [95% CI = 1.09–1.67] P <.001), and those without advance directives (AOR = 1.30 [95% CI = 1.07–1.58] P <.01). Conclusion: Further research into factors that underlie live discharge events, especially acute hospitalization, is warranted given their cost and burden for patients/families. Hospices should develop strategies to address acute medical crises and thoroughly evaluate patients’ suitability, unmet needs, and knowledge about end-of-life issues at the time of hospice enrollment, especially for those with non-cancer diagnoses.",adult;African American;aged;article;Asian;caregiver;cerebrovascular accident;Charlson Comorbidity Index;cohort analysis;dementia;ethnic difference;female;groups by age;heart failure;Hispanic;hospice;hospice patient;hospital discharge;hospitalization;human;length of stay;live discharge;living will;lung disease;major clinical study;male;malignant neoplasm;medical record review;New York;patient transport;race difference;risk factor;very elderly,"Russell, D.;Diamond, E. L.;Lauder, B.;Dignam, R. R.;Dowding, D. W.;Peng, T. R.;Prigerson, H. G.;Bowles, K. H.",2017,,10.1111/jgs.14859,0,
3805,Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group,"The purpose of the present study was to assess the prevalence of orthostatic hypotension and its associations with demographic characteristics, cardiovascular risk factors and symptomatology, prevalent cardiovascular disease, and selected clinical measurements in the Cardiovascular Health Study, a multicenter, observational, longitudinal study enrolling 5,201 men and women aged 65 years and older at initial examination. Blood pressure measurements were obtained with the subjects in a supine position and after they had been standing for 3 minutes. The prevalence of asymptomatic orthostatic hypotension, defined as 20 mm Hg or greater decrease in systolic or 10 mm Hg or greater decrease in diastolic blood pressure, was 16.2%. This prevalence increased to 18.2% when the definition also included those in whom the procedure was aborted due to dizziness upon standing. The prevalence was higher at successive ages. Orthostatic hypotension was associated significantly with difficulty walking (odds ratio, 1.23; 95% confidence interval, 1.02, 1.46), frequent falls (odds ratio, 1.52; confidence interval, 1.04, 2.22), and histories of myocardial infarction (odds ratio, 1.24; confidence interval, 1.02, 1.50) and transient ischemic attacks (odds ratio, 1.68; confidence interval, 1.12, 2.51). History of stroke, angina pectoris, and diabetes mellitus were not associated significantly with orthostatic hypotension. In addition, orthostatic hypotension was associated with isolated systolic hypertension (odds ratio, 1.35; confidence interval, 1.09, 1.68), major electrocardiographic abnormalities (odds ratio, 1.21; confidence interval, 1.03, 1.42), and the presence of carotid artery stenosis based on ultrasonography (odds ratio, 1.67; confidence interval, 1.23, 2.26). Orthostatic hypotension was negatively associated with weight. We conclude that orthostatic hypotension is common in the elderly and increases with advancing age. It is associated with cardiovascular disease, particularly those manifestations measured objectively, such as carotid stenosis. It is associated also with general neurological symptoms, but this link may not be causal. Differences in prevalence of and associations with orthostatic hypotension in the present study compared with others are largely attributed to differences in population characteristics and methodology.","Aged;Aging/*physiology;Dementia/complications;Demography;Female;Health Status;Humans;Hypotension, Orthostatic/complications/epidemiology/*physiopathology;Male;Multivariate Analysis;Nervous System Diseases/complications;Prevalence;Risk Factors","Rutan, G. H.;Hermanson, B.;Bild, D. E.;Kittner, S. J.;LaBaw, F.;Tell, G. S.",1992,Jun,,0,
3806,Depression in physical illness,"Symptoms of depression occur commonly in medical illness, yet it is not always clear at which point such symptoms merit clinical attention. There is a common misperception that all depression is an 'understandable' psychological reaction to a serious illness. This belief may result in patients being denied appropriate treatment. Depression in the physically ill has been shown to have a significant impact, with increased symptom burden, impaired functioning and reduced quality of life. Treatment may lead not only to an improvement in depressive symptoms but also improvement in somatic symptoms, functional abilities, and a reduction in healthcare costs. © 2006 Elsevier Ltd. All rights reserved.",alpha interferon;amantadine;anabolic agent;antiarrhythmic agent;antihypertensive agent;antiparkinson agent;antivirus agent;barbituric acid derivative;carbamazepine;cimetidine;clonidine;corticosteroid;digoxin;efavirenz;histamine H2 receptor antagonist;interferon;levodopa;nevirapine;nifedipine;oral contraceptive agent;procainamide;propranolol;reserpine;ribavirin;serotonin uptake inhibitor;sertraline;tricyclic antidepressant agent;unindexed drug;vigabatrin;vincristine;acquired immune deficiency syndrome;anxiety;arthritis;article;asthma;backache;bradykinesia;neoplasm;cerebrovascular disease;chronic disease;chronic obstructive lung disease;circadian rhythm;clinical trial;Crohn disease;depression;diabetes mellitus;Diagnostic and Statistical Manual of Mental Disorders;disease association;electroconvulsive therapy;emphysema;endocrine disease;epilepsy;fatigue;guilt;heart disease;heart infarction;heart muscle ischemia;hepatitis B;hepatitis C;human;Huntington chorea;mononucleosis;insomnia;ischemic heart disease;kidney disease;major clinical study;migraine;mood;multiple sclerosis;Parkinson disease;physical disease;prevalence;priority journal;psychosocial withdrawal;questionnaire;rheumatic disease;statistical significance;cerebrovascular accident;suicide;symptom,"Ruttley, A.;Reid, S.",2006,,,0,
3807,"The relation between age, sex, comorbidity, and pharmacotherapy and the risk of syncope: A Danish nationwide study","AimsSyncope is a common cause for hospitalization and may be related to comorbidity and concurrent medication. The objective of this study was to determine the incidence, comorbidity, and pharmacotherapy in a nationwide cohort of patients hospitalized with syncope.Methods and resultsAn observational study including patients with the diagnosis of syncope identified from the Danish National Patient Register in the period 19972009. All patients were matched on sex and age with five controls from the Danish population. We estimated the incidence of syncope and the association with comorbidities and pharmacotherapy by conditional logistic regression analyses. We identified 127 508 patients with a first-time diagnosis of syncope [median age 65 years (interquartile range 4981), 52.6 female]. The age distribution of the patients showed three peaks around 20, 60, and 80 years of age with the third peak occurring 57 years earlier in males. Cardiovascular disease and cardiovascular drug therapy was present in 28 and 48 of the patients, respectively. We found significant association between cardiovascular disease and the risk of admission for syncope increasing with younger age; age 029 years [odds ratio (OR) 5.8, confidence interval (CI): 5.26.4), age 3049 (OR 4.4, CI: 4.24.6), age 5079 (OR 2.9, CI: 2.83.0), and age above 80 (OR 2.0, CI: 1.92.0). Cardiovascular pharmacotherapy associated with age and risk of syncope was similar.ConclusionIn a nationwide cohort of patients hospitalized for first syncope we found significant association between cardiovascular comorbidity and pharmacotherapy and the risk of syncope. The occurrence of syncope displayed an age distribution with important gender-specific differences and higher incidence rates than previously reported. © The Author 2012.",amiodarone;antiarrhythmic agent;anticonvulsive agent;antidepressant agent;anxiolytic agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;clopidogrel;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;morphine;sotalol;spironolactone;thiazide diuretic agent;verapamil;adult;aged;article;cardiovascular disease;chronic obstructive lung disease;cohort analysis;comorbidity;controlled study;dementia;diabetes mellitus;disease association;disease registry;faintness;female;heart arrhythmia;heart failure;heart infarction;hospital admission;hospital patient;human;incidence;ischemic heart disease;liver disease;major clinical study;male;observational study;outpatient care;peptic ulcer;peripheral vascular disease;priority journal;risk assessment;sex difference,"Ruwald, M. H.;Hansen, M. L.;Lamberts, M.;Hansen, C. M.;Hojgaard, M. V.;Kober, L.;Torp-Pedersen, C.;Hansen, J.;Gislason, G. H.",2012,,,0,
3808,A Scottish record linkage study of risk factors in medical history and dementia outcome in hospital patients,"The relative risk (RR) of acquiring a hospital diagnosis of dementia was estimated in 101,104 patients (1 in 25 fraction) randomly selected from total admissions to Scottish general hospitals between 1968 and 1977. The patients were allocated to putative at-risk groups according to main diagnosis at time of index admission, and RR of dementia (ICD 9 290) was contrasted between ten risk groups and a reference group. Record linkage was used to reduce admission episodes to individual cases, to link general and psychiatric Scottish Morbidity Records (SMR 1 and SMR 4), to identify subsequent admission diagnoses of dementia, and to establish person-years-at-risk for each case by linking to the Registrar General's mortality file. For males, RR was significantly increased in the 'hypertensive' risk group (RR 3.88:95% CI 2.18-9.89: p < 0.05) and was significantly reduced in the 'arterial disease' risk group (RR 0.57:95% CI 0.34-0.95: p < 0.05). There was a trend towards increased risk in the cerebrovascular category. For females, RR was significantly reduced in the 'cancer' risk group (RR 0.46:95% CI 0.34-0.63: p < 0.05). There was no evidence of significant alteration in RR in a number of other possible risk groups (endocrine, head injury, CNS/NS disease, ischaemic heart disease, peptic ulcer). Morbidity registers provide access to large data sets of low reliability. No attempt was made to distinguish between Alzheimer's disease and multi-infarct dementia cases, which limited scope for comparison with studies focused on Alzheimer's disease. Previous reports of positive associations between head injury, thyroid disorder, and subsequent Alzheimer's disease were not replicated.",adult;aged;anamnesis;artery disease;article;neoplasm;dementia;disease classification;female;high risk population;hospital admission;hospital patient;human;hypertension;male;medical record;morbidity;mortality;priority journal;reliability;risk factor;sex difference;statistics;United Kingdom,"Ryan, D. H.",1994,,,0,
3809,Drinking patterns of older adults with chronic medical conditions,"BACKGROUND: Understanding alcohol consumption patterns of older adults with chronic illness is important given the aging baby boomer generation, the increase in prevalence of chronic conditions and associated medication use, and the potential consequences of excessive drinking in this population. OBJECTIVES: To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic conditions. DESIGN/METHODS: This descriptive study used the nationally representative 2005 Medicare Current Beneficiary Survey linked with Medicare claims. The sample included community-dwelling, fee-for-service beneficiaries 65 years and older with one or more of seven chronic conditions (Alzheimer's disease and other senile dementia, chronic obstructive pulmonary disease, depression, diabetes, heart failure, hypertension, and stroke; n = 7,422). Based on self-reported alcohol consumption, individuals were categorized as nondrinkers, within-guidelines drinkers, or at-risk drinkers (exceeds guidelines). RESULTS: Overall, 30.9 % (CI 28.0-34.1 %) of older adults with at least one of seven chronic conditions reported alcohol consumption in a typical month in the past year, and 6.9 % (CI 6.0-7.8 %) reported at-risk drinking. Older adults with higher chronic disease burdens were less likely to report alcohol consumption and at-risk drinking. CONCLUSIONS: Nearly one-third of older adults with selected chronic illnesses report drinking alcohol and almost 7 % drink in excess of National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. It is important for physicians and patients to discuss alcohol consumption as a component of chronic illness management. In cases of at-risk drinking, providers have an opportunity to provide brief intervention or to offer referrals if needed. © 2013 Society of General Internal Medicine.",alcohol;aged;aging;alcohol consumption;Alzheimer disease;article;cerebrovascular accident;chronic disease;chronic obstructive lung disease;community;controlled study;demography;depression;diabetes mellitus;drinking behavior;female;functional status;health service;health survey;heart failure;human;hypertension;major clinical study;male;medical fee;medicare;patient selection;practice guideline;prevalence;risk factor;senile dementia,"Ryan, M.;Merrick, E. L.;Hodgkin, D.;Horgan, C. M.;Garnick, D. W.;Panas, L.;Ritter, G.;Blow, F. C.;Saitz, R.",2013,,,0,
3810,Early Morbidity and Mortality in 50 Very Elderly Patients after Posterior Atlantoaxial Fusion for Traumatic Odontoid Fractures,"Background Traumatic odontoid fractures (tOFs) in the very elderly are associated with high morbidity and mortality. The best treatment strategy (conservative vs. surgery) is still unclear. Methods Between April 2008 and April 2014, fifty (17 male, 33 female) patients (mean age 87.2 ± 4.4 years; range: 80-99) were included in this retrospective cohort study. All patients underwent posterior fusion surgery for tOF. Early outcome, morbidity and mortality, length of hospital and intensive care unit (ICU) stay, comorbidities, and perioperative complications were assessed. Results The mean age-adjusted Charlson Comorbidity Index (CCI) was 5.8 ± 3.9 (range: 0-13), and the mean American Society of Anesthesiologists score was 3 ± 0.5 (range: 2-4). Surgery was delayed in 48% of patients. Thirty percent of patients had preoperative complications (72.4% severe), of which a leading cause was dysphagia with subsequent pneumonia, and 18% required preoperative assessment or improvement of health status. Surgery-related complications were experienced in 14% with no neurovascular lesion. Postoperative medical complications occurred in 52% of patients (67.3% severe). Major complications were mostly respiratory/pulmonary (66.7%), of which postoperative pneumonia (36.4%) was leading. Twenty-four percent of patients were ICU monitored. Mean length of ICU stay was 9 ± 6.6 days (1-20). Mean length of hospital stay was 15 ± 8.6 days (4-56). There was no in-hospital mortality, and 30-day mortality was 6%. Conclusions Posterior fusion for tOF in patients 80 years or older seems to be a feasible treatment option in these high-risk patients. Despite a high incidence of severe comorbidities and perioperative complications, outcome was satisfactory. Level of Evidence Our research was a retrospective cohort study, Level III.",aged;anemia;arm weakness;article;aspiration pneumonia;ataxia;brain ischemia;Charlson Comorbidity Index;clinical article;cognitive defect;cohort analysis;comorbidity;delirium;dementia;dysphagia;erythrocyte transfusion;feasibility study;female;geriatric patient;hemorrhagic shock;high risk patient;human;hypothermia;incidence;intensive care;length of stay;lung disease;male;morbidity;mortality;multiple trauma;neck pain;non ST segment elevation myocardial infarction;odontoid process fracture;operative blood loss;peroperative complication;pleura effusion;pneumonia;posterior atlantoaxial fusion;postoperative complication;preoperative complication;preoperative evaluation;retrospective study;spine fusion;tracheotomy;traffic accident;traumatic odontoid fracture;treatment outcome;upper gastrointestinal bleeding;urinary tract infection;urogenital tract infection;very elderly,"Ryang, Y. M.;Török, E.;Janssen, I.;Reinke, A.;Buchmann, N.;Gempt, J.;Ringel, F.;Meyer, B.",2016,,,0,
3811,Reversible Cerebral Metabolism Changes Using Proton Magnetic Resonance Spectroscopy in a Patient with Intracranial Dural Arteriovenous Fistula: A Case Report,"BACKGROUND: Cerebral metabolism can be disrupted by venous congestion in patients with intracranial dural arteriovenous fistula (DAVF), which may lead to adverse neurological outcomes. However, there are no clear indicators to guide cerebral evaluation and treatment selection in cases of DAVF. We describe a patient with a DAVF whose proton magnetic resonance spectroscopy ((1)H-MRS) findings were associated with improvements in clinical status. CASE DESCRIPTION: An elderly woman with a history of myocardial infarction presented with progressive dementia, aphasia, and a severe headache. We detected a transverse-sigmoid sinus DAVF, as well as abnormal levels of lactate and N-acetylaspartic acid (NAA) in the (1)H-MRS, and successfully treated the patient using surgical sinus skeletonization. However, follow-up (1)H-MRS revealed inconsistent reversals in the levels of lactate and NAA. In addition, we calculated the NAA/creatinine ratios from before and after surgery, which revealed postoperative increases in the ratios for the left temporal, right parietal, and left parietal regions. These increases occurred concurrently with improvements in the patient's cognitive function. CONCLUSIONS: (1)H-MRS may be useful for pretreatment detection of increased lactate levels, decreased NAA levels, and/or decreased NAA/creatinine ratios. These findings may indicate poorer cerebral metabolism, and show a need for more aggressive treatment. Furthermore, (1)H-MRS may be useful for evaluating the effect of conservative treatment and for indicating conversion to a more aggressive treatment.",Cerebral metabolism;Dural arteriovenous fistula;N-acetylaspartic acid;Proton magnetic resonance spectroscopy,"Ryu, B.;Kawamata, T.;Wakai, T.;Shimizu, M.;Yagi, S.;Shimizu, T.",2016,Aug,10.1016/j.wneu.2016.05.058,0,
3812,Evaluating the cause of death in obese individuals: A ten-year medical autopsy study,"Background. Obesity is a growing public health problem associated with increased morbidity and rate of death. Postmortem examination is imperative to determine the cause of death, to detect clinically unsuspected disease entities, and consequently to determine the actual impact of obesity on patient mortality. Methods. A total of 849 adult autopsies were retrospectively reviewed. Obese (BMI ≥ 30 kg/m2) and nonobese patients were separately studied. The primary cause of death in each group was categorized into malignancy, infection, stroke, ischemic and nonischemic heart disease, pulmonary embolism, hemorrhage, and primary nonneoplastic diseases of different organ systems. Results. Of 849 autopsies, 32.3% were obese. The leading causes of death in the obese population were malignancy (31.4%), infection (25.9%), ischemic heart disease (12.8%), and pulmonary embolism (6.2%). Obese individuals were statistically more likely to die from pulmonary embolism and liver disease and less likely to die from neurologic diseases and nonischemic heart disease. Conclusion. Autopsies on obese individuals constitute a third of all adult medical autopsies in our center. Increased death rates in the obese due to pulmonary embolism and liver disease should receive special clinical attention. Autopsy findings in the obese population should contribute to overall premortem disease detection, prevention, and management.",adrenal cortex adenoma;adult;article;autopsy;bacterial endocarditis;bacterial peritonitis;bleeding;breast carcinoma;cause of death;cerebral palsy;cerebrovascular accident;colon carcinoma;congenital heart disease;congestive cardiomyopathy;congestive heart failure;coronary artery recanalization;diabetes mellitus;diffuse Lewy body disease;esophagus varices;female;gangrene;heart disease;heart infarction;heart left bundle branch block;heart right ventricle dysplasia;hemangioendothelioma;hepatic encephalopathy;hepatorenal syndrome;hernia strangulation;human;hydrocephalus;hypertension;infection;ischemic heart disease;kidney carcinoma;liver disease;lung carcinoma;lung embolism;major clinical study;male;medical record review;mesothelioma;metabolic syndrome X;mixed Mullerian tumor;multiple organ failure;neurologic disease;obesity;pancreas carcinoma;pneumonia;priority journal;retrospective study;sarcoidosis;sudden cardiac death;systemic mycosis;urinary tract infection,"Saab, J.;Salvatore, S. P.",2015,,,0,
3813,The benefit of revascularization in nonagenarians with lower limb ischemia is limited by high mortality,"OBJECTIVE/BACKGROUND: Owing to the increased life expectancy of the population the number of very old patients referred to vascular surgical units has increased. Advanced age is a well known risk factor in patients undergoing surgical interventions for lower limb ischemia. However, amputation performed on an elderly person living independently will lead to permanent institutional care. The aim of this study was to evaluate the outcome of patients aged 90 years and older with lower limb ischemia undergoing surgical or endovascular revascularization. METHODS: Two hundred and thirty-three nonagenarians with either chronic critical limb ischemia (CLI) or acute limb ischemia (ALI) who underwent revascularization at the authors' institution between 2002 and 2013 were included in this retrospective study. Risk factors were evaluated and survival, limb salvage, and amputation free survival (AFS) assessed. RESULTS: The median age of the study population was 92 years (range 90-100 years). The majority (81.1%) of the patients were female. One in four (24.5%) patients had diabetes, and the incidence of coronary artery disease was 79.8%. Seventy-three percent of the patients had CLI and 27% of had ALI. Seventy percent of the patients underwent surgical revascularization and 30% were treated endovascularly. The majority (72.5%) of the patients maintained their independent living status; 27.5% ended up in institutional care post-operatively. Similarly, the majority (82.0%) of the patients maintained their walking ability, while 18% were not able to ambulate independently after revascularization. One year survival, limb salvage, and AFS rates were 50.9% versus 48.6% (p = .505), 85.1% versus 87.0% (p = .259), and 45.7% versus 44.4% (p = .309) in the surgical versus endovascular group, respectively. Dementia was an independent risk factor of poor AFS (odds ratio: 1.56; 95% confidence interval: 1.077-2.272; p = .019). CONCLUSION: Good limb salvage can be achieved by both surgical and endovascular revascularization, and independent living can be maintained in the majority of the patients. However, the benefit of revascularization is limited owing to high mortality, especially in patients with dementia.","Aged, 80 and over;Endovascular Procedures;Female;Humans;Ischemia/*mortality/*surgery;Limb Salvage/*mortality;Lower Extremity/blood supply/*surgery;Male;Retrospective Studies;Risk Assessment;Risk Factors;Treatment Outcome;*Vascular Grafting;Lower limb ischemia;Nonagenarians;Outcome;Revascularization","Saarinen, E.;Vuorisalo, S.;Kauhanen, P.;Alback, A.;Venermo, M.",2015,Apr,10.1016/j.ejvs.2014.12.027,0,
3814,"Cardiac hemodynamics are linked with structural and functional features of brain aging: the age, gene/environment susceptibility (AGES)-Reykjavik Study","BACKGROUND: Advanced heart failure is linked with structural and functional alterations in the brain. It is unclear whether a graded decrease in cardiac function puts older subjects at risk for brain aging. We investigated the association between cardiac hemodynamics and features of brain aging in community-dwelling older subjects. METHODS AND RESULTS: With data from a sub-study (n=931 subjects, mean age 75.9 years, 47.7% male) of the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, we investigated the association of MRI measures of cardiac hemodynamics, including left ventricular stroke volume (LVSV) and cardiac output (CO) to brain characteristics. In multivariable analyses, each 10 mL lower LVSV was associated with 4.4 mL (95% CI 1.9 to 6.9) lower total parenchymal brain volume (TBV) and 3.7 mL (95% CI 1.8 to 5.7) lower gray matter volume (GMV). Likewise, each unit (L/min) lower CO was associated with 3.9 mL (95% CI 0.4 to 7.4) lower TBV and 3.9 mL (95% CI 0.4 to 7.4) lower GMV. Lower LVSV was associated with worse performance in processing speed (P=0.043) and executive function (P<0.001). Lower CO was associated with worse performance in processing speed (P=0.015) and executive function (P=0.003). Each 10 mL lower LVSV and each unit lower CO associated with a higher risk of mild cognitive impairment or dementia (odds ratio: 1.24, 95% CI 0.99 to 1.57 and odds ratio: 1.40, 95% CI 0.99 to 2.00, respectively). CONCLUSIONS: A graded decrease in cardiac functioning is associated with features of brain aging. Older persons with cardiac or cognitive signs and symptoms may have both cardiac and cerebral diseases and should be evaluated accordingly.","Age Factors;Aged;Aged, 80 and over;Aging/*physiology;Brain Diseases/diagnosis/*epidemiology;Cardiac Output, Low/diagnosis/epidemiology;Cognition Disorders/diagnosis/epidemiology;Cohort Studies;Comorbidity;Depression/diagnosis/epidemiology;Female;Geriatric Assessment/methods;Heart Failure/diagnosis/*epidemiology;Heart Function Tests;Hemodynamics/*physiology;Humans;Iceland;Independent Living;Linear Models;Magnetic Resonance Imaging, Cine/methods;Male;Neuropsychological Tests;Prognosis;Risk Assessment;Sex Factors;Stroke Volume/physiology;brain aging;cardiac output;cognitive impairment;stroke volume","Sabayan, B.;van Buchem, M. A.;Sigurdsson, S.;Zhang, Q.;Harris, T. B.;Gudnason, V.;Arai, A. E.;Launer, L. J.",2015,Jan 27,10.1161/jaha.114.001294,0,
3815,Is there a characteristic lipid profile in Alzheimer's disease?,"OBJECTIVE: To characterize the lipid profile in Alzheimer's Disease (AD) and to determine whether it differs from the cardiac risk profile. BACKGROUND: Links between hypercholesterolemia and AD development continue to grow. Presently, limited information exists about the lipid profile characteristics in AD. METHODS: We examined the lipid profiles (total cholesterol (TC), high-density lipoprotein (HDL), lower-density lipoprotein (LDL), TC/HDL ratio, and triglyceride (TG) levels) of 153 subjects with probable/possible AD (mean age 77.2 +/- 8.6 years, mean MMSE 19.9 +/- 5.6) and 25 non-demented subjects with atherosclerotic heart disease (ASHD) (mean age 73.8 +/- 7.2 years); neither on lipid lowering therapy. RESULTS: Subjects with TC > 200 mg/dl composed 69% of AD and 72% of ASHD groups. Mean TC was 218.9 +/- 38.9 mg/dl and 218.5 +/- 9.2 mg/dl for AD and ASHD subjects respectively. AD subjects exhibited significantly higher HDL and lower TG and TC/HDL ratios. MMSE did not correlate with any lipid parameters in AD. DISCUSSION: Elevated TC, LDL and TG with normal HDL and TC/HDL ratio characterize the lipid profile in AD, which somewhat overlaps with but may be distinct from the cardiac risk profile. MMSE does not correlate with lipid parameters suggesting no interaction between cholesterol and cognition in AD.","Aged;Aged, 80 and over;Alzheimer Disease/*blood/*complications/diagnosis;Cholesterol, HDL/blood;Cholesterol, LDL/blood;Coronary Artery Disease/blood/complications;Female;Humans;Hypercholesterolemia/blood/*complications/epidemiology;Lipids/*blood;Male;Middle Aged;Neuropsychological Tests;Severity of Illness Index;Triglycerides/blood","Sabbagh, M.;Zahiri, H. R.;Ceimo, J.;Cooper, K.;Gaul, W.;Connor, D.;Sparks, D. L.",2004,Dec,,0,
3816,Statins to treat Alzheimer's disease: an incomplete story,"The link between cholesterol and Alzheimer's disease (AD) has been explored for almost two decades. The link stems from the observation that atherosclerotic heart disease increases the risk for AD and that people expiring from coronary artery disease had AD changes in their brains. Cholesterol is a cofactor of amyloid deposition, with substantial evidence showing that high cholesterol diets in animal models can accelerate amyloidogenesis. This link led investigators to posit the use of cholesterol-lowering agents as treatments for AD and cognitive decline. Indeed, the epidemiological data suggest that cholesterol-lowering agents may reduce the risk of developing AD. Early pilot studies suggested that statins may be useful as treatments for AD because of a reduction in the rates of decline. Recent reports of simvastatin and atorvastatin assessed in large randomized, double-blind, placebo-controlled multicenter trials have not confirmed a clinically demonstrable cognitive benefit for statins in the treatment of AD. This article will discuss the results of one of these trials and explore the reasons behind why the multicenter trials may not have been positive and the growing disparity between preclinical/epidemiological benefit and a lack of clinical efficacy.",,"Sabbagh, M. N.;Sparks, D. L.",2012,Jan,10.1586/ern.11.171,0,
3817,Achieving ideal cardiovascular and brain health: Opportunity amid crisis: Presidential address at the American Heart Association 2010 Scientific Sessions,,cholesterol;Alzheimer disease;article;blood pressure;cardiovascular disease;cardiovascular risk;cognition;death;dementia;diabetes mellitus;health care cost;heart infarction;human;lifestyle;physical activity;priority journal;race;smoking;cerebrovascular accident;waist circumference,"Sacco, R. L.",2011,,,0,
3818,Imaging in systemic amyloidosis,"Background: Diagnosis of systemic amyloidosis remains challenging. Histology, the current gold standard for diagnosis of amyloidosis provides limited information on the extent of the disease and is not useful for monitoring. Non-invasive imaging modalities offer an easy way to evaluate whole-body amyloid burden, accurately identify organ involvement, quantify and monitor disease progression and response to treatment. Sources of data: A literature search was performed using PubMed on the subjects of 'amyloid imaging', 'SAP scintigraphy', 'imaging in cardiac amyloidosis', 'cardiac MRI', 'PET and amyloidosis' and 'nuclear imaging in amyloidosis'. Areas of agreement: 123I-SAP scintigraphy is the best and the only modality in routine clinical use for assessing the extent and distribution of visceral amyloid deposition in all types of amyloidosis. Echocardiography remains the most important tool for assessing cardiac amyloidosis but cardiac magnetic resonance imaging is becoming increasingly valuable. Bone-seeking tracers like 99mTc-DPD and pyrophosphate are beginning to have a role in imaging transthyretin cardiac amyloidosis. Limitations: Specificity of each of the imaging modalities limits the utility of any one imaging method for all types of amyloidosis for all organs. Growing points and further research: 99mTc-DPD has a high sensitivity and specificity to cardiac transthyretin amyloid deposits and its role in early diagnosis of this condition is under investigation. Further studies are needed with 123I-mIBG to assess its utility in patients with early cardiac autonomic neuropathy. Positron emission tomography with tracers used for Alzheimer's disease imaging is an area of increasing interest in systemic amyloid imaging. © The Author 2013. Published by Oxford University Press. All rights reserved.",(3 iodobenzyl)guanidine i 123;amyloid;aprotinin tc 99m;butedronate technetium tc 99m;fluorodeoxyglucose f 18;gadolinium;medronate technetium tc 99m;Pittsburgh compound B;prealbumin;radiopharmaceutical agent;serum amyloid P;serum amyloid P i 123;thioflavine;unclassified drug;amyloidosis;article;autonomic neuropathy;cardiovascular magnetic resonance;computer assisted tomography;diagnostic imaging;differential diagnosis;drug uptake;early diagnosis;echocardiography;heart amyloidosis;heart left ventricle ejection fraction;heart scintiscanning;human;phase 1 clinical trial (topic);positron emission tomography;priority journal;prognosis;scintigraphy;sensitivity and specificity;serum amyloid P scintigraphy;treatment response,"Sachchithanantham, S.;Wechalekar, A. D.",2013,,,0,
3819,Depressive symptoms and risk of dementia: the Framingham Heart Study,"OBJECTIVES: Depression may be associated with an increased risk for dementia, although results from population-based samples have been inconsistent. We examined the association between depressive symptoms and incident dementia over a 17-year follow-up period. METHODS: In 949 Framingham original cohort participants (63.6% women, mean age = 79), depressive symptoms were assessed at baseline (1990-1994) using the 60-point Center for Epidemiologic Studies Depression Scale (CES-D). A cutpoint of > or = 16 was used to define depression, which was present in 13.2% of the sample. Cox proportional hazards models adjusting for age, sex, education, homocysteine, and APOE epsilon4 examined the association between baseline depressive symptoms and the risk of dementia and Alzheimer disease (AD). RESULTS: During the 17-year follow-up period, 164 participants developed dementia; 136 of these cases were AD. A total of 21.6% of participants who were depressed at baseline developed dementia compared with 16.6% of those who were not depressed. Depressed participants (CES-D >/=16) had more than a 50% increased risk for dementia (hazard ratio [HR] 1.72, 95% confidence interval [CI] 1.04-2.84, p = 0.035) and AD (HR 1.76, 95% CI 1.03-3.01, p = 0.039). Results were similar when we included subjects taking antidepressant medications as depressed. For each 10-point increase on the CES-D, there was significant increase in the risk of dementia (HR 1.46, 95% CI 1.18-1.79, p < 0.001) and AD (HR 1.39, 95% CI 1.11-1.75, p = 0.005). Results were similar when we excluded persons with possible mild cognitive impairment. CONCLUSIONS: Depression is associated with an increased risk of dementia and AD in older men and women over 17 years of follow-up.","Aged;Aged, 80 and over;Alzheimer Disease/epidemiology/etiology/psychology;Cohort Studies;Coronary Disease/epidemiology/psychology;Dementia/epidemiology/*etiology/*psychology;Depression/*complications/epidemiology/*psychology;Female;Follow-Up Studies;Humans;Longitudinal Studies;Male;Middle Aged;Risk Factors","Saczynski, J. S.;Beiser, A.;Seshadri, S.;Auerbach, S.;Wolf, P. A.;Au, R.",2010,Jul 6,10.1212/WNL.0b013e3181e62138,0,
3820,Patterns of comorbidity in older adults with heart failure: The cardiovascular research network PRESERVE study,"Objectives: To examine whether the total burden of comorbidity and pattern of co-occurring conditions varies in individuals with heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HF-P) or HF with reduced LVEF (HF-R). Design: Cross-sectional cohort study. Setting: Four participating health plans within the National Heart, Lung, and Blood Institute-sponsored Cardiovascular Research Network. Participants: All members aged 65 and older with HF based on hospital discharge and ambulatory visit diagnoses. Measurements: Participants with a LVEF of 50% or greater were classified as having HF-P. Presence of cardiac and noncardiac comorbidities was obtained from health plan administrative databases. Results: Of 23,435 individuals identified with HF and LVEF information, 53% (12,407) had confirmed HF-P (mean age 79.6; 60% female). More than three-quarters of the sample had three or more co-occurring conditions in addition to HF, and half had five or more cooccurring conditions. Participants with HF-P had a slightly higher burden of comorbidity than those with HF-R (mean 4.5 vs 4.4, P =.002). Patterns of how specific conditions co-occurred did not vary in participants with preserved or reduced systolic function. Conclusion: There is a high degree of comorbidity and multiple morbidity in individuals with HF. The burden and pattern of comorbidity varies only slightly in individuals with preserved or reduced LVEF. © 2013 The American Geriatrics Society.",aged;anemia;aorta valve disease;article;brain ischemia;cardiovascular risk;cerebrovascular disease;clinical assessment;comorbidity;cross-sectional study;dementia;depression;diabetes mellitus;dyslipidemia;echocardiography;female;gastrointestinal hemorrhage;hearing disorder;atrial fibrillation;heart failure;heart infarction;heart left ventricle ejection fraction;heart ventricle fibrillation;heart ventriculography;hospital discharge;human;hypertension;lung disease;major clinical study;male;neoplasm;nuclear medicine;outpatient care;peripheral occlusive artery disease;risk assessment;tachycardia;thromboembolism;transient ischemic attack;unstable angina pectoris;visual disorder,"Saczynski, J. S.;Go, A. S.;Magid, D. J.;Smith, D. H.;McManus, D. D.;Allen, L.;Ogarek, J.;Goldberg, R. J.;Gurwitz, J. H.",2013,,,0,
3821,Prehospital period in patients with myocardial infarction in Turkey,"Objectives: To identify the causes that affect the time from the onset of symptoms to admission to the hospital, in patients with a diagnosis of acute myocardial infarction (MI). Methods: The study was carried out between January 2004 and January 2005 in the Emergency Room of the Uludag University Faculty of Medicine (UUFM) Hospital Turkey. A total of 180 patients were included. Residents of the UUFM Department of Cardiology distributed a questionnaire to all patients. Socioeconomic level was determined by scoring the socioeconomic factors. For statistical analyses we used the SPSS 13.0 statistical software. Results: Of the 180 patients, 79.4% (n=143) were admitted to the hospital within 6 hours of onset of symptoms and 20.6% (n=37) the time exceeded 6 hours of which 10% (n=18) admitted in more than 12 hours. Male patients seemed to present earlier than females (p<0.05 and p<0.05). The time to admission decreased as the socioeconomic level improved and the level of education increased. Patients with a history of MI, who had coronary angioplasty and had undergone coronary by-pass surgery admitted to the hospital earlier than those who did not have these factors p=0.042, p=0.005, p=0.026. Subjects who had anginal symptoms prior to acute MI (p<0.001) and patients with diabetes (p<0.001) had a significantly longer admission time. Conclusions: It is essential to inform individuals with a low level of education and socioeconomic status; patients with anginal complaints and diabetic persons; particularly females, on the symptoms of MI and the importance of early hospitalization on the outcome.",creatine kinase MB;fibrinolytic agent;myoglobin;nitrate;troponin I;acute heart infarction;adult;aged;angina pectoris;article;chronic obstructive lung disease;smoking;comorbidity;controlled study;coronary artery bypass surgery;dementia;diabetes mellitus;educational status;electrocardiography;emergency care;emergency ward;family history;female;hospital admission;human;hypertension;kidney disease;major clinical study;male;questionnaire;scoring system;sex ratio;social status;statistical analysis;symptom;time;transluminal coronary angioplasty;Turkey (republic);university hospital,"Sadikoglu, G.;Mehmetoglu, H. C.;Mehmetoglu, E.;Yesilbursa, D.",2006,,,0,
3822,"Elevated Aβ42 in aged, non-demented individuals with cerebral atherosclerosis","The β-secretase, BACE1, generates β-amyloid (Aβ), a major hallmark of Alzheimer's disease (AD) pathology. The elevation of BACE1 levels in brains of AD patients may play a role in initiating or propagating disease. BACE1 levels are increased under low energy or low oxygen conditions, which may occur in individuals with impaired circulation in the brain. We compared levels of BACE1 in the brains of aged, non-demented individuals with high or low levels of atherosclerosis in the circle of Willis, and found that while there is no change in BACE1, Aβ42 levels are elevated in the high atherosclerosis group. © 2013 Bentham Science Publishers.",amyloid beta protein[1-42];apolipoprotein E4;beta secretase 1;insulinase;membrane metalloendopeptidase;oxygen;aged;Alzheimer disease;article;brain atherosclerosis;brain circulation;brain circulus arteriosus;brain homogenate;cerebrovascular disease;clinical article;controlled study;disease course;energy;female;frontal cortex;heart infarction;heterozygote;human;human tissue;male;mental health;priority journal;protein content,"Sadleir, K. R.;Bennett, D. A.;Schneider, J. A.;Vassar, R.",2013,,,0,
3823,Switching from donepezil tablets to rivastigmine transdermal patch in alzheimer's disease,"Objective: Evaluate safety and tolerability of switching from donepezil to rivastigmine transdermal patch in patients with mild to moderate Alzheimer's disease. Methods: Prospective, parallel-group, open-label study to evaluate immediate or delayed switch from 5-10 mg/day donepezil to 4.6 mg/24 h rivastigmine following a 4-week treatment period. Results: Rates of discontinuation due to any reason or adverse events were similar between groups. Incidences of gastrointestinal adverse events were 3.8% in the immediate and 0.8% in the delayed switch group. No patients discontinued secondary to nausea and vomiting. Discontinuations due to application site reactions were low (2.3%). Asymptomatic bradycardia was more common following the immediate switch (2.3% vs 0%); however, these patients had coexisting cardiac comorbidities. Conclusion: Both switch strategies were safe and well tolerated. The majority of patients may be able to switch directly to rivastigmine patches without a withdrawal period. Appropriate clinical judgment should be used for patients with existing bradycardia or receiving 2 blockers.",donepezil;memantine;metoprolol;rivastigmine;adult;aged;agitation;Alzheimer disease;application site reaction;article;atrioventricular block;body weight;bradycardia;clinical trial;comorbidity;constipation;control group;controlled clinical trial;controlled study;decreased appetite;diarrhea;disease severity;drug fatality;drug safety;drug substitution;drug tolerability;drug withdrawal;ECG abnormality;female;hallucination;hearing impairment;heart bundle branch block;heart right bundle branch block;heart right ventricle hypertrophy;human;hypertension;incidence;major clinical study;male;multicenter study;nausea;prospective study;randomized controlled trial;restlessness;side effect;somnolence;stupor;T wave;treatment duration;vagina tumor;vomiting,"Sadowsky, C. H.;Dengiz, A.;Olin, J. T.;Koumaras, B.;Meng, X.;Brannan, S.",2009,,,0,
3824,Organization of TeleHomeCare at the Home Setting: different approaches to specific phenotypes,"Introduction.- The demographic rising of population implies a wider range of old people needing from increasing aid, mainly affecting the non-robust layer of old community-dwelling people. Stated in the Fried model we can roughly distinguish three theoretical phenotypes: frailty, disability and chronical disease. For this, alternatives to traditional attention and care are needed, and telemedicine appears as a feasible and sustainable alternative. Text.- Telehealth brings health care services, expertise, and information to patients at their homes. It is known that telehomecare implies great opportunities for improving both quality of health care and health outcomes. Different experiences in tele-monitoring on non-robust old people living in community will be presented. The examples fit exactly with the three main phenotypes. The HOMESWEETHOME project is a platform focused and tested exclu sively and specifically on frail people. It sets out as randomized controlled trial to investigate implementation, use and clinical impact of economically sustainable comprehensive set of homeassistance services. ALADDIN project is focused on patients with dementia as an example of disability and need of continuing care of caregivers. It aims to develop an integrated platform with the objective of health promotion, prevention and early detection on dementia patients, as well as relieving burden in caregivers. Experiences like CARME project focused in Heart failure or with COPD patients exemplifies the need of an innovative specialised care in patient with chronic illnesses. Similarities and specificities of each of the initiatives will be presented as new approaches for the telemedicine in the home setting.",European Union;geriatrics;society;phenotype;human;patient;telemedicine;disability;community;dementia;caregiver;health service;telehealth;model;health promotion;population;randomized controlled trial;monitoring;health;health care quality;prevention;heart failure;hospital patient;chronic disease,"Saeza, I;Masa, Ma;Santaeugenia, S",2012,,10.1016/j.eurger.2012.07.318,0,3825
3825,Organization of TeleHomeCare at the Home Setting: Different approaches to specific phenotypes,"Introduction.- The demographic rising of population implies a wider range of old people needing from increasing aid, mainly affecting the non-robust layer of old community-dwelling people. Stated in the Fried model we can roughly distinguish three theoretical phenotypes: frailty, disability and chronical disease. For this, alternatives to traditional attention and care are needed, and telemedicine appears as a feasible and sustainable alternative. Text.- Telehealth brings health care services, expertise, and information to patients at their homes. It is known that telehomecare implies great opportunities for improving both quality of health care and health outcomes. Different experiences in tele-monitoring on non-robust old people living in community will be presented. The examples fit exactly with the three main phenotypes. The HOMESWEETHOME project is a platform focused and tested exclu sively and specifically on frail people. It sets out as randomized controlled trial to investigate implementation, use and clinical impact of economically sustainable comprehensive set of homeassistance services. ALADDIN project is focused on patients with dementia as an example of disability and need of continuing care of caregivers. It aims to develop an integrated platform with the objective of health promotion, prevention and early detection on dementia patients, as well as relieving burden in caregivers. Experiences like CARME project focused in Heart failure or with COPD patients exemplifies the need of an innovative specialised care in patient with chronic illnesses. Similarities and specificities of each of the initiatives will be presented as new approaches for the telemedicine in the home setting.",European Union;geriatrics;society;phenotype;human;patient;telemedicine;disability;community;dementia;caregiver;health service;telehealth;model;health promotion;population;randomized controlled trial;monitoring;health;health care quality;prevention;heart failure;hospital patient;chronic disease,"Saeza, I.;Masa, M. A.;Santaeugenia, S.",2012,,10.1016/j.eurger.2012.07.318,0,
3826,Rivastigmine and concomitant memantine in alzheimer's disease: Safety and tolerability,"Background: Investigate the safety and tolerability of rivastigmine capsules and transdermal patch in patients with moderate Alzheimer's disease receiving concomitant memantine. Methods: Safety data from two prospective, open-label, multicenter trials were analyzed. Study US32: patients received rivastigmine capsules (3-12 mg/day) plus memantine (20 mg/day). Study US38: patients switched from donepezil to rivastigmine patches (4.6 mg/24 hours) immediately or following 7 days' withdrawal; ~50% received concomitant memantine (20 mg/day). Results: The rivastigmine patch demonstrated more favorable tolerability than rivastigmine capsules, being associated with fewer adverse events (AEs) (73% versus 83%), serious AEs (10% versus 23%) and gastrointestinal symptoms (4% versus 26% for nausea; 4% versus 11% for vomiting). Application site reactions occurred in 17% of patients. Conclusion: Concomitant memantine treatment with rivastigmine patch and capsule is generally well tolerated. The favorable tolerability and safety profile of rivastigmine transdermal patch is not further improved with concomitant memantine. Recommendations to minimize application site reactions are provided. © MBL Communications Inc.",donepezil;memantine;rivastigmine;abdominal pain;adult;aged;agitation;Alzheimer disease;angina pectoris;anxiety;application site reaction;article;asthenia;bradycardia;cardiogenic shock;chronic obstructive lung disease;clinical trial;confusion;controlled clinical trial;controlled study;decreased appetite;dehydration;depression;diarrhea;dizziness;drug capsule;drug dosage form comparison;drug dose titration;drug safety;drug tolerability;drug withdrawal;ECG abnormality;falling;female;gastrointestinal symptom;heart infarction;human;insomnia;lethargy;major clinical study;male;mental disease;multicenter study;nausea;open study;pancreatitis;pneumonia;priority journal;prospective study;side effect;faintness;transdermal patch;unconsciousness;unspecified side effect;urinary tract infection;vital sign;vomiting;weight reduction,"Safirstein, B.;Meng, X.;Olin, J. T.",2010,,,0,
3827,Effects of postmenopausal hormone replacement therapy on insulin resistance,"Postmenopausal hormone replacement therapy (HRT) protects women from the risk of cardiovascular system disease, osteoporosis, and dementia. There are conflicting reports about the effects of HRT on insulin resistance. The purpose of this study was to investigate the effects of HRT on insulin resistance with the hyperinsulinemic euglycemic clamp technique, the most sensitive technique measuring insulin resistance. Conjugated estrogen (0.625 mg/d) and medroxyprogesterone acetate (5 mg/d) were given to 15 postmenopausal women with insulin resistance. After 3 mo of HRT, the M value (total glucose consumption) increased 28% (p < 0.001), low-density lipoprotein (LDL) cholesterol decreased 12.9% (p < 0.044), high-density lipoprotein (HDL) cholesterol increased 17% (p < 0.009), total cholesterol decreased 9.1% (p < 0.016), and serum insulin decreased 33% (p < 0.022) compared to baseline values before HRT was started. No significant changes in glucose, C-peptide, and triglyceride levels were observed. Whereas there were no differences regarding glucose, total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels between the insulin-resistant (n = 15) and non-insulin-resistantwomen (n = 24) (p > 0.05), there were significant differences in M value, insulin, and C-peptide levels between these groups (p < 0.05). We believe that HRT with this combination may protect postmenopausal women from coronary artery disease (CAD) through its beneficial effects on insulin resistance, hyperinsulinemia, and lipid levels, which are considered to be important factors in CAD pathogenesis.","C-Peptide/blood;Cholesterol, HDL/blood;Cholesterol, LDL/blood;*Estrogen Replacement Therapy;Estrogens, Conjugated (USP)/therapeutic use;Female;Glucose Clamp Technique;Humans;Insulin/blood;Insulin Resistance/*physiology;Medroxyprogesterone Acetate/therapeutic use;Middle Aged;Reference Values;Triglycerides/blood","Saglam, K.;Polat, Z.;Yilmaz, M. I.;Gulec, M.;Akinci, S. B.",2002,Aug,10.1385/endo:18:3:211,0,
3828,Central nervous system relapse in a patient with acute promyelocytic leukaemia: Does the risk stratification matter?,"Extramedullary relapse is an uncommon complication of acute promyelocytic leukaemia (APL). The most common site of extramedullary relapse is the central nervous system (CNS), and the majority of CNS relapses occur in patients with high-risk disease in which white blood cell count at presentation is greater than 10×103/μL. The best management of such patients is still controversial. We describe a 47-year-old man with APL who developed two CNS relapses which were diagnosed through the presence of t(15;17)(q22;q21) on PCR of the cerebrospinal fluid (CSF), despite presenting initially with intermediate-risk disease. We conclude that the intermediate risk group is very heterogeneous and these patients sometimes may behave like high-risk patients. Also, clinicians should take into account symptoms that can be related to CNS relapse in patients with APL and consider lumbar puncture even if radiological imaging does not reveal anything. Copyright 2013 BMJ Publishing Group. All rights reserved.",arsenic trioxide;CD33 antigen;cytarabine;daunorubicin;dexamethasone;lactate dehydrogenase;mercaptopurine;methotrexate;microsomal aminopeptidase;myeloperoxidase;retinoic acid;adult;anterior myocardial infarction;article;autologous peripheral blood stem cell transplantation;bone marrow examination;brain radiography;cancer recurrence;cardiopulmonary arrest;case report;central nervous system relapse;cerebrospinal fluid analysis;chromosome 15;chromosome 17;chromosome 21q;chromosome 22q;chromosome aberration;chromosome analysis;confusion;consolidation chemotherapy;contrast enhancement;death;electrocardiography;flow cytometry;hematologic relapse;hemoglobin blood level;herpes zoster;human;induction chemotherapy;lactate dehydrogenase blood level;leukocyte count;lumbar puncture;male;mental deterioration;multiple cycle treatment;nuclear magnetic resonance imaging;pancytopenia;priority journal;promyelocyte;promyelocytic leukemia;real time polymerase chain reaction;relapse;thorax pain,"Sahin, D. G.;Gunduz, E.;Akay, O. M.;Gulbas, Z.",2013,,,0,
3829,Association of selected antipsychotic agents with major adverse cardiovascular events and noncardiovascular mortality in elderly persons,"Background-Data from observational studies have raised concerns about the safety of treatment with antipsychotic agents (APs) in elderly patients with dementia, but this area has been insufficiently investigated. We performed a head-to-head comparison of the risk of major adverse cardiovascular events and noncardiovascular mortality associated with individual APs (ziprasidone, olanzapine, risperidone, quetiapine, levomepromazine, chlorprothixen, flupentixol, and haloperidol) in Danish treatment-naïive patients aged =70 years. Methods and Results-We followed all treatment-näive Danish citizens aged >70 years that initiated treatment with APs for the first time between 1997 and 2011 (n=91 774, mean age 82±7 years, 35 474 [39%] were men). Incidence rate ratios associated with use of different APs were assessed by multivariable time-dependent Poisson regression models. For the first 30 days of treatment, compared with risperidone, incidence rate ratios of major adverse cardiovascular events were higher with use of levomepromazine (3.80, 95% CI 3.43 to 4.21) and haloperidol (1.85, 95% CI 1.67 to 2.05) and lower for treatment with flupentixol (0.54, 95% CI 0.45 to 0.66), ziprasidone (0.31, 95% CI 0.10 to 0.97), chlorprothixen (0.76, 95% CI 0.61 to 0.95), and quetiapine (0.68, 95% CI 0.58 to 0.80). Relationships were generally similar for long-term treatment. The majority of agents were associated with higher risks among patients with cardiovascular disease compared with patients without cardiovascular disease (P for interaction <0.0001). Similar results were observed for noncardiovascular mortality, although differences in associations between patients with and without cardiovascular disease were small. Conclusions-Our study suggested some diversity in risks associated with individual APs but no systematic difference between first- and second-generation APs. Randomized placebo-controlled studies are warranted to confirm our findings and to identify the safest agents.",chlorprothixene;flupentixol;haloperidol;levomepromazine;olanzapine;quetiapine;risperidone;ziprasidone;acute heart infarction;aged;article;brain ischemia;cardiovascular disease;cardiovascular risk;controlled study;Danish citizen;disease association;drug safety;female;high risk patient;human;incidence;major clinical study;male;malignant neoplastic disease;mortality rate;prevalence;priority journal;treatment duration,"Sahlberg, M.;Holm, E.;Gislason, G. H.;Køber, L.;Torp-Pedersen, C.;Andersson, C.",2015,,,0,
3830,The first genetically confirmed Japanese patient with mucolipidosis type IV,Key Clinical Message: Mucolipidosis type IV (MLIV) is a rare neurodegenerative disorder characterized by severe psychomotor delay and visual impairment. We report the brain pathology in the first Japanese patient of MLIV with a novel homozygous missense mutation in MCOLN1. We detected the localized increase in p62-reactive astrocytes in the basal ganglia. Mucolipidosis type IV (MLIV) is a rare neurodegenerative disorder characterized by severe psychomotor delay and visual impairment. We report the brain pathology in the first Japanese patient of MLIV with a novel homozygous missense mutation in MCOLN1. We detected the localized increase in p62-reactive astrocytes in the basal ganglia.,transient receptor potential channel 1;trihexyphenidyl;aged;ankle clonus;article;astrocyte;Babinski reflex;blindness;brain atrophy;case report;cataract;cerebellum atrophy;chronic kidney disease;chronic kidney failure;clonus;dysarthria;electrocardiography;exome;gene;gene sequence;heart ventricle hypertrophy;histology;human;human tissue;hypertension;liver dysfunction;male;MCOLN1 gene;mental deficiency;missense mutation;mucolipidosis type 4;nerve biopsy;neuronal ceroid lipofuscinosis;nuclear magnetic resonance imaging;oromandibular dystonia;priority journal;retina dystrophy;spastic gait,"Saijo, H.;Hayashi, M.;Ezoe, T.;Ohba, C.;Saitsu, H.;Kurata, K.;Matsumoto, N.",2016,,,0,
3831,Molecular associations of Primary Open-Angle Glaucoma with potential comorbid diseases (POAG-Associome),"Glaucoma is the leading cause of irreversible vision loss, which is caused by death of the retinal ganglion cells. Currently, glaucoma affects over 60 million people worldwide with primary open-Angle glaucoma (POAG) being one of the most common forms of the disease. Despite the large amount of research devoted to glaucoma, molecular and genetic mechanisms of its development are still poorly understood. Thus, the aim of the present study was prediction of new potentially comorbid diseases of POAG, based on analysis of associative gene networks describing disease-disease interactions. Application of enrichment analysis to associative networks, constructed with the ANDSystem for 31 diseases that are comorbid to POAG according to the literature data, revealed that 10 diseases had a statistically significant overlap of proteins/genes with the POAG associative network (p-value < 0.01). Comparison of POAG with over 4000 diseases with the aid of the ANDSystem showed that there was a statistically significant overrepresentation of proteins/genes in the POAG associative network for more than 100 diseases. Analysis of Gene Ontology (GO) biological processes showed the importance of apoptosis-related and endothelium-related processes for the formation of comorbid conditions of POAG with cancer and cardiovascular diseases, among others.",anxiety disorder;apoptosis;article;asthma;cataract;cerebrovascular accident;chronic obstructive lung disease;comorbidity assessment;congestive heart failure;dementia;depression;diabetes mellitus;diabetic retinopathy;disease association;endothelium;epilepsy;gene ontology;genetic analysis;headache;hepatitis B;human;hyperlipidemia;hypertension;hypothyroidism;ischemic heart disease;kidney failure;liver disease;macular degeneration;malignant neoplasm;migraine;myopia;neurologic disease;open angle glaucoma;pathogenesis;peptic ulcer;peripheral vascular disease;psychosis;rheumatoid arthritis;sleep disorder;systemic lupus erythematosus;tuberculosis,"Saik, O. V.;Konovalova, N. A.;Demenkov, P. S.;Ivanisenko, T. V.;Petrovskiy, E. D.;Ivanisenko, N. V.;Ivanoshchuk, D. E.;Ponomareva, M. N.;Konovalova, O. S.;Lavrik, I. N.;Kolchanov, N. A.;Ivanisenk, V. A.",2016,,,0,
3832,Silent stroke: Not listened to rather than silent,"Background and Purpose-The prevalence of silent brain infarcts varies from 8% to 28% in the general elderly population. Silent brain infarcts are associated with increased risk of subsequent stroke and cognitive dysfunction. By definition, silent strokes lack clinically overt stroke-like symptoms and fail to come to clinical attention; however, impaired recall of symptoms may be a potential confounder. Our aim is to report a series of patients with incidentally detected acute and subacute strokes and examine whether they were truly asymptomatic. Methods-Subjects included in this study were drawn from ongoing dementia research studies at the Memory Ageing and Cognition Center, in which all participants underwent a cranial MRI. Incidental hyperintense lesions on diffusion-weighted imaging with corresponding apparent diffusion coefficient defects indicative of acute/subacute silent stroke were identified. Clinical data for individuals with incidental hyperintense lesions on diffusion-weighted imaging were collated. Results-Six of 649 subjects had incidental hyperintense lesions on diffusion-weighted imaging; on retrospective questioning, 3 recalled symptoms temporally correlated with MRI lesions, which had been reported to but ignored by family members. Two subjects had focal neurological signs. A majority of the subjects with incidental hyperintense lesions on diffusion-weighted imaging had significant cognitive impairment. Conclusions-A significant number of strokes may be ""silent"" due to lack of awareness of stroke-like symptoms in the elderly and their families. Enhanced stroke prevention education strategies are needed for the elderly population and, in particular, for their families. © 2012 American Heart Association, Inc.",aged;article;asymptomatic disease;cerebrovascular accident;cognitive defect;diffusion coefficient;diffusion weighted imaging;female;human;major clinical study;male;nuclear magnetic resonance imaging;priority journal,"Saini, M.;Ikram, K.;Hilal, S.;Qiu, A.;Venketasubramanian, N.;Chen, C.",2012,,,0,
3833,Re: Trends in physician house calls to medicare beneficiaries,,age distribution;Alzheimer disease;chronic obstructive lung disease;competence;congestive heart failure;curriculum;diabetes mellitus;experience;family medicine;human;hypertension;learning;letter;medical society;medicare;Medline;physician;professional practice;quality of life;resident;satisfaction;skill;social support,"Sairenji, T.",2014,,,0,
3834,A letter of greeting for the inaugural issue of biogenic amines,,acetylcholine;biogenic amine;catecholamine;serotonin;Alzheimer disease;angina pectoris;Asia;autonomic nervous system;defecation disorder;depression;drug research;esophagitis;heart arrhythmia;human;hypertension;hypotension;irritable colon;Japan;letter;medical information;medical research;micturition disorder;migraine;neurogenic bladder;neurology;Parkinson disease;pathophysiology;patient care;peptic ulcer;rumination;schizophrenia;scientific literature;stress;cerebrovascular accident,"Saito, H.;Minami, M.",2006,,,0,
3835,"Fabry disease, do we think enough about this multisystemic disorder? - A presentation of three cases in a Serbian family","Background. Fabry Disease is a rare, X-chromosomal inherited lysosomal storage disease with a consequent intracellular accumulation of neutral glycosphingolipids in various tissues. This can cause skin and ocular lessions, progressive renal, cardiac or cerebrovascular disorders. If a person in a family has Fabry disease, other family members including even extended relatives, may also be at risk. Case report. We presented three cases pointed out various manifestation of Fabry disease, that illustrate a possible cause for otherwise unexplained cardiac hypertrophy and various rhythm and conduction abnormalities. Conclusion. Although most symptoms begin in childhood, various manifestations often lead to misdiagnosis and clinical diagnosis is frequently delayed for many years, even decades. Enzyme replacement therapy has become available, pointing out the importance of early diagnosis so that treatment can be initiated before irreversible organ damage.",alpha galactosidase;ceramide dihexoside;ceramide trihexoside;glycolipid;unclassified drug;abdominal pain;adolescent;adult;alph galactosidase A gene;amino acid substitution;article;birefringence;brain biopsy;case report;diarrhea;electrocardiography;enzyme activity;ergometry;Fabry disease;female;gene;genetic screening;atrial fibrillation;heart palpitation;heart ventricle hypertrophy;human;human tissue;laboratory test;lethargy;male;memory disorder;mental deterioration;nuclear magnetic resonance imaging;paresthesia;pedigree analysis;periodic acid Schiff stain;polymerase chain reaction;proteinuria;Serbia;urinalysis,"Sakač, D.;Koraćević, G.;Pavlica, T.;Sekulić, S.",2012,,,0,
3836,Coexistence of transthyretin- and Aβ-type cerebral amyloid angiopathy in a patient with hereditary transthyretin V30M amyloidosis,,Vectastain ABC kit;diflunisal;prealbumin;tafamidis;transthyretin v30m;unclassified drug;aged;anhidrosis;ATTR amyloidosis;autonomic dysfunction;autopsy;case report;clinical article;constipation;death;dementia;deterioration;dysesthesia;familial amyloidosis;genetic analysis;hallucination;heart disease;heart failure;human;human tissue;immunohistochemistry;letter;limb weakness;locus ceruleus;male;memory disorder;mutation;priority journal;substantia nigra;sural nerve;vascular amyloidosis;very elderly,"Sakai, K.;Asakawa, M.;Takahashi, R.;Ishida, C.;Nakamura, R.;Hamaguchi, T.;Ono, K.;Iwasa, K.;Yamada, M.",2017,,10.1016/j.jns.2017.08.3240,0,
3837,A family with adult type ceroid lipofuscinosis (Kufs' disease) and heart muscle disease: report of two autopsy cases,"Two cases in a family with Kufs' disease had lethal arrhythmias and heart muscle disease. Autopsy findings showed an abundant accumulation of lipofuscin-like lipopigments in most neurons in the central nervous system (CNS). The heart showed a slight increase in the accumulation of the lipofuscin-like lipopigments in the myocardial fibers, slight to severe fibrosis and infiltration of fat cells in the myocardium. The lipopigments both in the heart and in neurons of the CNS had curvilinear profiles on electron microscope and reacted immunohistochemically to polyclonal antibodies against subunit c of mitochondrial adenosine triphosphate (ATP) synthase. The degenerative process in this heart muscle disease might be attributable to the same metabolic abnormality as seen in the neuronal degeneration associated with Kufs' disease.",article;cardiomyopathy;case report;fatality;heart arrhythmia;human;male;middle aged;neuronal ceroid lipofuscinosis;nuclear family;pathology;pathophysiology,"Sakajiri, K.;Matsubara, N.;Nakajima, T.;Fukuhara, N.;Makifuchi, T.;Wakabayashi, M.;Oyanagi, S.;Kominami, E.",1995,,,0,
3838,Colocalization of apolipoprotein AI in various kinds of systemic amyloidosis,"Apolipoprotein AI (apoAI), a major component of high-density lipoproteins, is one of the major amyloid fibril proteins and a minor constituent of the senile plaques observed in Alzheimer's disease. We examined colocalization of apoAI in various kinds of systemic amyloidosis in this study. Forty-three of 48 formalin-fixed paraffin-embedded heart specimens with various forms of systemic amyloidosis reacted immunohistochemically with anti-human apoAI antibody. ApoAI was also detected in water-extracted amyloid material by immunoblotting. In addition, we observed colocalization of apoAI and murine amyloid A (AA) amyloidosis in human apoAI transgenic mice. This is the first report of colocalization of apoAI with amyloid deposits in various forms of human systemic amyloidosis and murine AA amyloidosis in human apoAI transgenic mice. ApoAI may not always be a major component of amyloid fibrils, even when it is present in systemic amyloid deposits.","Amyloidosis/*metabolism;Animals;Apolipoprotein A-I/genetics/*metabolism;Cardiomyopathies/metabolism;Humans;Immunoblotting;Immunohistochemistry;Mice;Mice, Transgenic;Myocardium/metabolism;Serum Amyloid A Protein/metabolism","Sakata, N.;Hoshii, Y.;Nakamura, T.;Kiyama, M.;Arai, H.;Omoto, M.;Morimatsu, M.;Ishihara, T.",2005,Feb,10.1369/jhc.4A6387.2005,0,
3839,Recognizing a hidden cause of bowel obstruction: The abdominal cocoon,,abdominal cocoon syndrome;abdominal pain;aged;article;case report;computer assisted tomography;congestive heart failure;dementia;emergency ward;gastroesophageal reflux;hospital discharge;human;hypertension;laparotomy;male;nausea and vomiting;peritonitis;physical examination;small intestine obstruction;stomach tube;very elderly,"Sakharpe, A. K.;Wilhelm, J.;Bui, R.;Colon, B. S.;Ibrahim, G.;Baccaro, L.;McBride, N.;Boonswang, P.",2014,,,0,
3840,Prevalence and in-hospital mortality of gastrostomy and jejunostomy in Japan: a retrospective study with a national administrative database,"BACKGROUND: PEG is widely used; however, large-scale data for PEG have been lacking. OBJECTIVE: To estimate the prevalence of placement of gastrostomy and jejunostomy tubes and to elucidate the patient background characteristics and their associations with in-hospital mortality. DESIGN: A retrospective analysis of the Japanese administrative claims database. SETTING: Japanese acute-care hospitals. PATIENTS: A total of 64,219 patients who underwent gastrostomy or jejunostomy tube insertion between July and December, 2007 to 2010, were identified among 11.6 million discharge records. INTERVENTION: Placement of gastrostomy and jejunostomy tubes. MAIN OUTCOME MEASUREMENTS: In-hospital mortality and the associated risk factors. RESULTS: The mean age was 77.4 years; >90% of patients were aged >60 years. Cerebrovascular disease and pneumonia were the most frequently recorded diagnoses, followed by neuromuscular disease and dementia. The estimated annual number of gastrostomy and jejunostomy placements in Japan ranged from 96,000 to 119,000. The in-hospital mortality was 11.9%, and the significantly associated risk factors were male sex, older age, placement of a jejunostomy tube, urgent admission, hospital with lower bed capacity, the presence of malignancy, miscellaneous diseases, pneumonia, heart failure, renal failure, chronic liver diseases, pressure sores and sepsis, and occurrence of peritonitis and/or GI perforation, GI hemorrhage, and intra-abdominal hemorrhage. LIMITATIONS: Retrospective investigation of administrative database. CONCLUSION: Our large-scale data revealed the current status of gastrostomy tube placement in Japan. This can contribute to individual decision-making and the public consensus regarding artificial nutritional support in the elderly.","Adolescent;Adult;Aged;Aged, 80 and over;Child;Child, Preschool;Databases, Factual;Female;Gastrostomy/mortality/statistics & numerical data/*utilization;*Hospital Mortality;Humans;Infant;Infant, Newborn;Japan/epidemiology;Jejunostomy/mortality/statistics & numerical data/*utilization;Logistic Models;Male;Middle Aged;Multivariate Analysis;Retrospective Studies;Risk Factors;Young Adult","Sako, A.;Yasunaga, H.;Horiguchi, H.;Fushimi, K.;Yanai, H.;Uemura, N.",2014,Jul,10.1016/j.gie.2013.12.006,0,
3841,"Hospitalization with hypoglycemia in patients without diabetes mellitus: A retrospective study using a national inpatient database in Japan, 2008-2012","We aimed to examine prevalence, patient characteristics, etiology, and clinical outcomes of hospitalized patients who had hypoglycemia without a diagnosis of diabetes mellitus, using a Japanese nationwide database. This was a retrospective observational study using a national database of acute-care inpatients in Japan. Nondiabetic patients aged ≥15 years who were hospitalized for hypoglycemia were eligible. We estimated the annual numbers of hospitalized cases in Japan. We also investigated the patient characteristics, and risk factors of in-hospital mortality. We identified 8684 eligible patients out of 22.7 million discharge records between July 2008 and March 2013. The average age was 70.0 years and the average body mass index (BMI) was 19.9kg/m2. Most frequently recorded underlying diseases were malignancies, cerebrovascular diseases, pneumonia, renal failure, and heart failure. The estimated annual numbers of hospitalizations because of hypoglycemia in nondiabetic patients were 5000 to 7000. In-hospital mortality was 14.9%, and predictive factors for poor survival included older age, community hospital, low BMI, coma at admission, urgent admission, renal failure, heart failure, pneumonia, sepsis, chronic liver diseases, and malignancies. Patients without diabetes mellitus but with hypoglycemia had multiple comorbidities and high in-hospital mortality. Clinicians should carefully investigate the etiology of hypoglycemia in nondiabetic patients, and treat the underlying diseases.",adolescent;adrenal cortex insufficiency;adult;aged;alcoholism;article;autoimmune disease;body mass;cerebrovascular disease;chronic liver disease;chronic lung disease;clinical outcome;coma;community hospital;dementia;diabetes mellitus;diabetic patient;diseases;dumping syndrome;eating disorder;emergency care;female;fracture;head injury;heart failure;hospital admission;hospital discharge;hospital mortality;hospital patient;hospitalization;human;hypoglycemia;hypopituitarism;hypothyroidism;iatrogenic disease;insulin autoimmune syndrome;insulinoma;intracranial injury;ischemic heart disease;Japan;Japanese (people);kidney failure;major clinical study;male;malignant neoplasm;medical record;middle aged;observational study;pneumonia;prevalence;priority journal;retrospective study;risk factor;sepsis;urinary tract infection,"Sako, A.;Yasunaga, H.;Matsui, H.;Fushimi, K.;Hamasaki, H.;Katsuyama, H.;Tsujimoto, T.;Goto, A.;Yanai, H.;Patel, S.",2017,,10.1097/md.0000000000007271,0,
3842,Cognitive dysfunction following cardiovascular surgery,"OBJECTIVE: The aim of this study was the evaluation of perioperative cognitive dysfunction in patients undergoing cardiovascular surgery with or without cardiopulmonary bypass (CPB) and identification of the risk factors. SUBJECTS AND METHODS: Between July 2001 and October 2003, we performed cognitive examinations in 192 patients (mean age 65.5 +/- 7.6 years) who underwent elective cardiovascular surgery with or without CPB. The cognitive examinations (Hasegawa dementia scale) were done both pre- and postoperatively. Forty-six patients who had developed cognitive dysfunction postoperatively were included in Group A. The remaining 146 patients were placed in the control group (Group B). RESULTS: The patients in Group A were noted to be significantly older than those in Group B (69.8 +/- 7.4 vs. 64.1 +/- 7.2, p < 0.05). The number of patients who at risk for cerebrovascular disease was significantly higher in Group A than in Group B (p < 0.05). Among intraoperative variables, there were no significant differences between the two groups concerning the presence or absence of CPB, CPB duration, and operation duration. The length of postoperative hospitalization of the Group A patients was greater. Age was identified as the only predictor of postoperative cognitive dysfunction in multivariate analysis. CONCLUSION: In the present study, it is possible that CPB did not play a significant role in the genesis of cognitive dysfunction after cardiovascular surgery. Age appears to be the only significant predictor of postoperative cognitive dysfunction.",Age Factors;Aged;Cardiac Surgical Procedures/*adverse effects;Cardiopulmonary Bypass;Cognition Disorders/*etiology;Coronary Artery Bypass/adverse effects;Coronary Disease/surgery;Female;Heart Valve Diseases/surgery;Humans;Male;Middle Aged;Multivariate Analysis,"Sakurai, M.;Takahara, Y.;Takeuchi, S.;Mogi, K.",2005,May,10.1007/s11748-005-0034-6,0,
3843,Cardiac effects of cholinesterase inhibitors: A reason for restraint?,"Cholinesterase inhibitors are prescribed in the treatment of mild to moderate Alzheimer's dementia. Little is known about the cardiac safety of these drugs. We present two different cases in which cardiac events occurred during the use of a cholinesterase inhibitor. The pathophysiology, the effects of these drugs on the heart, information about the reports of side effects in pharmacovigilance databases and known literature are discussed. Although cardiac risks of cholinesterase inhibitors seem small, we advise to monitor cardiac effects of cholinesterase inhibitors carefully in patients with existing cardiac disease, especially in those using concomitant drugs known to interact with the cardiac risks of cholinesterase inhibitors.",amiodarone;beta adrenergic receptor blocking agent;calcium channel blocking agent;cholinesterase inhibitor;cisapride;clarithromycin;diclofenac;digoxin;diltiazem;domperidone;erythromycin;fluconazole;galantamine;hydrochlorothiazide;itraconazole;ketoconazole;lactulose;losartan;metoprolol;pantoprazole;papaverine;paracetamol;phentolamine;rivastigmine;rosuvastatin;spironolactone;temazepam;terbinafine;unindexed drug;verapamil;acute heart infarction;aged;Alzheimer disease;angina pectoris;article;atrioventricular block;bradycardia;cardiotoxicity;cardiovascular disease;cardiovascular risk;case report;drug dose escalation;drug effect;drug safety;drug surveillance program;electrocardiogram;food drug interaction;heart arrhythmia;heart atrium arrhythmia;heart infarction;human;hypertension;male;pathophysiology;patient monitoring;faintness;reminyl,"Salarbaks, A. M.;Boomkamp-Snoeren, C. M.;Van Puijenbroek, E.;Jansen, P. A. F.;Van Marum, R. J.",2009,,,0,
3844,Workshop on DHA as a required nutrient: Overview,"Early recognition of the importance of docosahexaenoic acid (DHA) in brain, neural, and visual development, prompted professional bodies to establish dietary recommendations for pregnant women and term and preterm infants. More recent studies show that supplemental DHA can play an important role in reducing the risk for certain age-related diseases. Data from nationwide surveys suggest that the average intake of DHA by US adults is considerably lower than levels suggested by researchers to sustain baseline nutritional status and to achieve the beneficial and protective effects of DHA. The Workshop on DHA as a Required Nutrient provided a forum for scientists to present and debate the research in support of more universal dietary recommendations for DHA as an essential nutrient throughout life. © 2009 Elsevier Ltd. All rights reserved.",docosahexaenoic acid;fish oil;icosapentaenoic acid;lipid emulsion;omega 3 fatty acid;Alzheimer disease;antiinflammatory activity;article;cardiovascular disease;child development;clinical trial;diet supplementation;essential fatty acid deficiency;fatty acid synthesis;human;ischemic heart disease;nervous system development;nutritional requirement;nutritional status;nutritional value;parenteral nutrition;phenylketonuria;pregnant woman;prematurity;priority journal;risk reduction,"Saldanha, L. G.;Salem Jr, N.;Brenna, J. T.",2009,,,0,
3845,Subcortical gray matter N-acetylaspartate reduction in two cases of vascular dementia,"Many of the previous studies of vascular dementia using proton magnetic resonance (MR) spectroscopy had been carried out on white matter. However, no proton spectroscopic data of the subcortical gray matter are available in such disease. We report two cases suffering from vascular dementia, with an unilateral N-acetylaspartate (NAA) decrease on subcortical gray matter. This significant reduction in NAA ratios was associated with an increase of choline on the ipsilateral centrum semiovale. We discuss the pathophysiology of these cases. © 2002 Elsevier Science Inc. All rights reserved.",captopril;choline;clopidogrel;glibenclamide;glyceryl trinitrate;n acetylaspartic acid;adult;aged;aphasia;arteriosclerosis;article;aspiration pneumonia;Binswanger encephalopathy;cardiovascular risk;carotid artery obstruction;case report;clinical feature;computer assisted tomography;diagnostic imaging;dysgraphia;dyslexia;female;gray matter;hemiparesis;human;hyperlipidemia;hypertension;ischemic heart disease;lifestyle;male;memory disorder;multiinfarct dementia;neurologic examination;non insulin dependent diabetes mellitus;pons;priority journal;proton nuclear magnetic resonance;pseudobulbar palsy,"Salem, D. B.;Walker, P. M.;Osseby, G. V.;Krausé, D.;Giroud, M.;Brunotte, F.",2003,,,0,
3846,Cooler biologically compatible core body temperatures may prolong longevity and combat neurodegenerative disorders,"Scientific evidence suggests the critical role of temperature in regulating three mechanisms contributing to cellular damage: Oxidative stress, oxygen demand overload and inflammation. In this article, we propose that the Arrhenius rate law has a profound impact on aging and a variety of neurodegenerative disorders including Alzheimer's disease, and we review the supporting evidence. Published studies suggest empirical correlations between temperature and lifespan of various organisms, bolstering the hypothesis that variations in lifespan may stem from differences in the mitochondrial production rates of radicals - a process also influenced by temperature. Given the exponential temperature dependency of all biochemical factors, cooler body temperatures may promote longevity and combat neurodegenerative disorders. This promises to offer extraordinary yet unexplored weapons against two formidable enemies of the human body: aging and neurodegenerative disorders. Stated in the form of a thesis referred to as Salerian and Saleri Temperature Thesis (SSTT): ""Cooler biologically compatible core body temperatures prolong lifespan and are of value to combat illness"". Double blind studies of SSTT in therapeutic strategies against amyotrophic lateral sclerosis (ALS) or early-stage Alzheimer's disease may offer a reasonable first stage to validate SSTT. In view of the known rapid progressive neurodegeneration associated with ALS, minute variations in core body temperature may, in fact, demonstrate statistically significant differences in disease progression.","Animals;Body Temperature;Caloric Restriction;Humans;Inflammation;Models, Biological;Models, Theoretical;Myocardial Infarction/therapy;Neurodegenerative Diseases/pathology/*therapy;Oxidative Stress;Risk Factors;Stroke/therapy","Salerian, A. J.;Saleri, N. G.",2006,,10.1016/j.mehy.2005.07.021,0,
3847,Quality indicators for the management of medical conditions in nursing home residents,"PURPOSE: The purpose of this study was to develop a set of specific care processes associated with better outcomes for general medical conditions identified as quality improvement targets for institutionalized vulnerable elders. METHODS: A national panel of nursing home experts used a modified-Delphi process to rate the validity (process linked to improved outcomes) and feasibility (of implementation and measurement) of candidate measures for depression, diabetes, hearing impairment, heart failure, hypertension, ischemic heart disease, osteoarthritis, osteoporosis, pneumonia, stroke, and vision impairment. Each quality indicator was written as an ""if"" statement, describing persons to whom the quality indicator applied followed by a ""then"" statement identifying the care process to be provided. A separate clinical committee reviewed the resulting set of indicators. RESULTS: One hundred fourteen quality indicators were identified across the 11 medical conditions. The quality indicators capture a broad range of medical care addressing assessment, management, and follow up. Fifty-five indicators (48%) were identical to quality measures for community-dwelling vulnerable elders. A limited number were rated as questionably feasible to implement or measure (6 and 2, respectively). Thirty-eight (33%) would not be applied to measures of care quality for persons with advanced dementia or poor prognosis. CONCLUSIONS: Explicit care processes linked to improved nursing home outcomes for general medical conditions can be identified. Most of these care processes can be measured by medical records or interview. Nursing home quality measures for medical conditions must account for exclusions related to poor prognosis and advanced dementia.","Aged;Delphi Technique;Disabled Persons;Feasibility Studies;Health Services for the Aged/standards;Homes for the Aged/*standards/statistics & numerical data;Humans;Nursing Homes/*standards/statistics & numerical data;Quality Assurance, Health Care/*methods;*Quality Indicators, Health Care;Quality of Life;Reproducibility of Results;United States;Vulnerable Populations/*statistics & numerical data","Saliba, D.;Solomon, D.;Rubenstein, L.;Young, R.;Schnelle, J.;Roth, C.;Wenger, N.",2004,Sep-Oct,10.1097/01.jam.0000136960.25327.61,0,3848
3848,Quality indicators for the management of medical conditions in nursing home residents,"PURPOSE: The purpose of this study was to develop a set of specific care processes associated with better outcomes for general medical conditions identified as quality improvement targets for institutionalized vulnerable elders. METHODS: A national panel of nursing home experts used a modified-Delphi process to rate the validity (process linked to improved outcomes) and feasibility (of implementation and measurement) of candidate measures for depression, diabetes, hearing impairment, heart failure, hypertension, ischemic heart disease, osteoarthritis, osteoporosis, pneumonia, stroke, and vision impairment. Each quality indicator was written as an ""if"" statement, describing persons to whom the quality indicator applied followed by a ""then"" statement identifying the care process to be provided. A separate clinical committee reviewed the resulting set of indicators. RESULTS: One hundred fourteen quality indicators were identified across the 11 medical conditions. The quality indicators capture a broad range of medical care addressing assessment, management, and follow up. Fifty-five indicators (48%) were identical to quality measures for community-dwelling vulnerable elders. A limited number were rated as questionably feasible to implement or measure (6 and 2, respectively). Thirty-eight (33%) would not be applied to measures of care quality for persons with advanced dementia or poor prognosis. CONCLUSIONS: Explicit care processes linked to improved nursing home outcomes for general medical conditions can be identified. Most of these care processes can be measured by medical records or interview. Nursing home quality measures for medical conditions must account for exclusions related to poor prognosis and advanced dementia.","Aged;Cardiovascular Diseases/diagnosis/therapy;Delphi Technique;Depressive Disorder/diagnosis/drug therapy;Diabetes Mellitus/diagnosis/drug therapy;Feasibility Studies;Homes for the Aged/*standards;Humans;Nursing Homes/*standards;Osteoarthritis/diagnosis/therapy;Osteoporosis/diagnosis/therapy;Outcome and Process Assessment (Health Care)/*methods;*Quality Indicators, Health Care;Reproducibility of Results;Respiratory Tract Infections/diagnosis/therapy;Sensation Disorders/diagnosis/therapy;United States","Saliba, D.;Solomon, D.;Rubenstein, L.;Young, R.;Schnelle, J.;Roth, C.;Wenger, N.",2005,May-Jun,10.1016/j.jamda.2005.03.022,0,
3849,Epidemiology and impact of multimorbidity in primary care: A retrospective cohort study,"Background: In developed countries, primary health care increasingly involves the care of patients with multiple chronic conditions, referred to as multimorbidity. Aim: To describe the epidemiology of multimorbidity and relationships between multimorbidity and primary care consultation rates and continuity of care. Design of study: Retrospective cohort study. Setting: Random sample of 99 997 people aged 18 years or over registered with 182 general practices in England contributing data to the General Practice Research Database. Method: Multimorbidity was defined using two approaches: people with multiple chronic conditions included in the Quality and Outcomes Framework, and people identified using the Johns Hopkins University Adjusted Clinical Groups (ACG®) Case-Mix System. The determinants of multimorbidity (age, sex, area deprivation) and relationships with consultation rate and continuity of care were examined using regression models. Results: Sixteen per cent of patients had more than one chronic condition included in the Quality and Outcomes Framework, but these people accounted for 32% of all consultations. Using the wider ACG list of conditions, 58% of people had multimorbidity and they accounted for 78% of consultations. Multimorbidity was strongly related to age and deprivation. People with multimorbidity had higher consultation rates and less continuity of care compared with people without multimorbidity. Conclusion: Multimorbidity is common in the population and most consultations in primary care involve people with multimorbidity. These people are less likely to receive continuity of care, although they may be more likely to gain from it. ©British Journal of General Practice.",adult;article;asthma;bipolar disorder;chronic disease;chronic kidney disease;chronic obstructive lung disease;clinical assessment tool;cohort analysis;consultation;controlled study;data base;dementia;depression;diabetes mellitus;epidemiological data;epilepsy;female;general practice;groups by age;atrial fibrillation;heart failure;human;hypertension;ischemic heart disease;Johns Hopkins University Adjusted Clinical Groups Case Mix System;learning disorder;longitudinal study;major clinical study;male;mental disease;morbidity;multicenter study;multimorbidity;neoplasm;obesity;outcome assessment;patient care;prevalence;primary medical care;psychosis;Quality and Outcomes Framework;retrospective study;schizophrenia;cerebrovascular accident;thyroid disease;United Kingdom,"Salisbury, C.;Johnson, L.;Purdy, S.;Valderas, J. M.;Montgomery, A. A.",2011,,,0,
3850,Futility in transcatheter aortic valve implantation: result from the Italian multicenter OBSERVANT Study,"BACKGROUND Transcatheter Aortic Valve Implantation (TAVI) is a valid treatment in high-risk patients with severe aortic valve stenosis. Recent trials demonstrated similar short-term outcomes compared to surgery also in low-risk patients. To date, there is no agreement regarding the profile of patient in whom TAVI is likely to be beneficial, especially in compromised and so called ""inoperable"" patients. Objective of the study is to identify those patients who do not benefit from TAVI, regardless by the excellent periprocedural-result (and we defined as ""futile"" procedure). METHODS All patients that underwent TAVI between December 2010 and June 2012 and were enrolled in the OBservational Study of Effectiveness of AVR-TAVI procedures for severe Aortic steNosis Treatment (OBSERVANT) were included in the analysis. Futility was defined as 1-year mortality in patients survived at 30 days. Multivariable analysis was performed to assess pre-operative independent predictors of futility. RESULTS A total of 1911 patients that underwent TAVI were enrolled in the OBSERVANT. Only the data from 1728 patients that survive 30 days after TAVI were analyzed. One-year mortality was 13.5% (233 patients). The independent pre-operative predictors of futility, corrected for major post-procedural complications, were: male gender (HR 1.38; 95% CI 1.00-1.90); serum creatinine (every 1 mg/dL increase of HR 1.18; 95% CI 1.03-1.35); frailty score (grade 1: HR 1.94; 95% CI 1.34-2.79; grade 2:HR 1.72; 95% CI 1.17-2.52; grade 3:HR 6.28; 95% CI 3.54-11.14); previous procedures on the aorta (HR 1.89; 95% CI 1.15- 3.09); percutaneous transluminal coronary angioplasty (PTCA) at the time of TAVI (HR 1.98; 95% CI 1.07-3.63). CONCLUSION Male gender, kidney dysfunction, low- and mid-grade of frailty, previous procedures on the aorta and PTCA concomitant with TAVI are independent predictors of one-year mortality in patients undergoing successful TAVI. In these subgroups a proper and careful patient selection is needed to avoid ""futile"" procedures. For sure patients with high grade of frailty (dementia, patient totally dependent in shifts or day-by-day activities) should be excluded from a TAVI program.",aorta stenosis;clinical trial;controlled clinical trial;controlled study;creatinine blood level;dementia;female;Frailty;gender;human;human tissue;kidney dysfunction;major clinical study;male;mortality;multicenter study;observational study;patient selection;surgery;transcatheter aortic valve implantation;transluminal coronary angioplasty,"Salizzoni, S;D'Errigo, P;Barbero, C;Ferrigno, L;Rosato, S;Barbanti, M;Tamburino, C;Rinaldi, M;Seccareccia, F",2016,,,0,
3851,Cilostazol in the management of atherosclerosis,"The burden of atherosclerosis is particularly high in western countries in terms of mortality and disability. The cerebral arteries (stroke or transient ischemic attack [TIA]), coronary arteries (myocardial infarction [MI]) and peripheral arteries (intermittent claudication [IC], ischemic limb) can be affected. Atherosclerosis may involve different mechanisms such as inflammation, platelet activation, endothelial damage, balance between proliferation and apoptosis of smooth muscle cells and oxidative stress. Research is focused to counteract each of these aspects. Many antithrombotic drugs are currently available and most of them act as inhibitors of platelet function. Aspirin, ticlopidine, clopidogrel and the combi- nation of aspirin plus dipyridamole are widely used for primary (in high-risk patients) and secondary prevention of athero- sclerotic diseases. Research of new pharmacological strategies is driven by the need to reduce the risk of bleeding associ- ated with the use of antiplatelet drugs. In this context cilostazol, a type III phosphodiesterase inhibitor, has demonstrated antiplatelet and vasodilator effects with low rate of bleeding complications. This review will focus on the pharmacological properties of cilostazol and its use in the management of atherothrombotic vascular diseases. © 2010 Bentham Science Publishers Ltd.",acetylsalicylic acid;adenosine;anticoagulant agent;atenolol;C reactive protein;caspase;cilostazol;clopidogrel;cyclic AMP;dipyridamole;high density lipoprotein cholesterol;interleukin 1beta;low density lipoprotein cholesterol;monocyte chemotactic protein 1;nifedipine;p21 activated kinase;pentoxifylline;phosphodiesterase inhibitor;placebo;protein Bax;protein p53;ticlopidine;tumor necrosis factor alpha;vascular cell adhesion molecule 1;von Willebrand factor;apoptosis;artery disease;artery occlusion;article;atherosclerosis;bleeding;brain blood flow;brain hemorrhage;brain infarction;brain ischemia;calcium cell level;cardiovascular risk;cause of death;cell activation;cell proliferation;cholesterol blood level;smoking;clinical practice;congestive heart failure;coronary artery bypass graft;coronary artery disease;coronary stent;dementia;diabetes mellitus;diarrhea;drug activity;drug indication;drug mechanism;drug safety;endothelium cell;endothelium injury;enzyme activation;feces;follow up;headache;heart infarction;heart muscle revascularization;heart palpitation;heart protection;high risk patient;hospitalization;human;hyperhomocysteinemia;hyperlipidemia;hypertension;inflammation;intermittent claudication;middle cerebral artery;neuroprotection;nuclear magnetic resonance imaging;oxidative stress;percutaneous coronary intervention;peripheral edema;pulse rate;restenosis;risk assessment;risk benefit analysis;risk management;risk reduction;secondary prevention;side effect;smooth muscle fiber;subarachnoid hemorrhage;thrombocyte activation;thrombocyte aggregation;transluminal coronary angioplasty;treatment contraindication;upregulation;vasodilatation;aspirin,"Sallustio, F.;Rotondo, F.;Legge, S. D.;Stanzione, P.",2010,,,0,
3852,Deriving comorbidities from medical records using natural language processing,"Extracting comorbidity information is crucial for phenotypic studies because of the confounding effect of comorbidities. We developed an automated method that accurately determines comorbidities from electronic medical records. Using a modified version of the Charlson comorbidity index (CCI), two physicians created a reference standard of comorbidities by manual review of 100 admission notes. We processed the notes using the MedLEE natural language processing system, and wrote queries to extract comorbidities automatically from its structured output. Interrater agreement for the reference set was very high (97.7%). Our method yielded an F1 score of 0.761 and the summed CCI score was not different from the reference standard (p=0.329, power 80.4%). In comparison, obtaining comorbidities from claims data yielded an F1 score of 0.741, due to lower sensitivity (66.1%). Because CCI has previously been validated as a predictor of mortality and readmission, our method could allow automated prediction of these outcomes.",acquired immune deficiency syndrome;adolescent;adult;aged;article;billing and claims;cancer staging;cerebrovascular disease;Charlson Comorbidity Index;child;chronic lung disease;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetic foot;diabetic ketoacidosis;diabetic nephropathy;diabetic neuropathy;diabetic retinopathy;electronic medical record;female;heart infarction;hemiplegia;hospital admission;hospital readmission;human;Human immunodeficiency virus infection;ICD-9;infant;insulin dependent diabetes mellitus;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;mortality;natural language processing;peptic ulcer;peripheral vascular disease;physician;preschool child;school child;scoring system;sensitivity and specificity;ulcer;Unified Medical Language System,"Salmasian, H.;Freedberg, D. E.;Friedman, C.",2013,,,0,
3853,Mortality Caused by Surgery for Degenerative Lumbar Spine,"Study Design. Register study. Objective. The purpose of this study was to assess the safety of lumbar spine surgery for degenerative disorders and to assess the predictive factors for mortality and causes of death. Summary of Background Data. Growing numbers and relative indications of spine surgery emphasize the importance of patient safety. We assessed the incidence of mortality related to surgery, overall case fatality and factors predicting mortality in elective spinal surgery. Methods. A national database was utilized to assess patient characteristics, surgical procedures, and outcomes of degenerative spinal surgery in Finland. Patients were classified into four diagnostic categories: Disc herniation, spinal stenosis, degenerative disc disease, and spondylolysis and spondylolisthesis. The mortality related to surgery and overall mortality in each diagnostic group was analyzed at 7 days, 30 days, 90 days, and 1 year after surgery. We categorized the deaths into medical errors, sequelae of surgery, surgery probably a contributing factor, and deaths not associated with surgery. Age, sex, comorbid conditions, and hospital characteristics were considered as potential risk factors for mortality. Results. Out of 408 deaths (0.67% of total of 61,166 patients) deaths that occurred during the 1-year follow up, 49 deaths (12% of deaths, 0.08% of patients) were classified as having an association with surgery: Two deaths by medical errors, 28 deaths by complications after surgery and 19 deaths related to the surgery. The surgery-related 1-year mortality was 0.08%. Age >75 years, male sex, diabetes, and hypertension showed an association with increased risk of death related to surgery. Conclusion. Mortality caused by elective spinal surgery is rare. Cardiovascular incidents are the most common reasons for deaths occurring soon after surgery. Consideration of expected gains and risks of surgery, prevention of unintended errors during surgery and recognition and treatment of complications once they occur are recommended.",adult;aged;alcoholism;article;asthma;atherosclerosis;atrial fibrillation;brain hemorrhage;cause of death;chronic obstructive lung disease;comorbidity;dementia;depression;diabetes mellitus;discectomy;epilepsy;esophagus hemorrhage;female;Finland;follow up;groups by age;heart failure;heart infarction;human;hypercholesterolemia;hypertension;intervertebral disk hernia;intoxication;ischemic heart disease;liver cirrhosis;lumbar spine;lung embolism;major clinical study;male;medical error;middle aged;multiple sclerosis;outcome assessment;Parkinson disease;patient safety;pneumonia;postoperative complication;postoperative hemorrhage;postoperative infection;priority journal;psychosis;sepsis;sex difference;spinal cord atrophy;spinal cord decompression;spine fusion;spine surgery;spondylolisthesis;spondylolysis;surgical mortality;uremia;vertebral canal stenosis,"Salmenkivi, J.;Sund, R.;Paavola, M.;Ruuth, I.;Malmivaara, A.",2017,,10.1097/brs.0000000000002188,0,
3854,Prognostic factors of functional status improvement in individuals admitted to convalescence care units,"Convalescence care strives to achieve functional recovery of individuals, reducing likelihood of institutionalisation or re-hospitalisation. This work assesses the efficacy of convalescence units in Catalonia, and identifies prognostic factors related to functional improvement. Design and setting: Retrospective analysis of information system data for 11,945 stays in convalescence units with admission and discharge within 2009. Measurements: Main outcome is functional improvement, defined as the reduction of the number of dependent activities of daily life (ADL) between admission and discharge. Other outcomes were functional and cognitive status, Resource Utilization Groups III (RUG III) resource use categories, coverage and intensity of therapies, diagnosis, comorbidities and medical procedures. Logistic regression analyses were performed to identify factors related to functional improvement. Results: Functional improvement was reached in 5618 individuals (47.0%). It was more likely in patients admitted from acute care hospitals (49.5%) than for other procedences (41.6%). Less than two thirds of the sample (63.5%) were able to return to their usual residence. Median length of stay was 35 days, and 93% of patients were discharged at three months. Identified negative factors that decreased the likelihood of functional improvement: cognition and alertness outcomes, complexity, RUG III categories, functional status and therapies received. Positive factors were: less than 9 dependent ADL, and intensity of training in walking skills and dressing/grooming. Conclusion: Based on the identified prognostic factors for functional improvement, convalescence unit users may be classified by rehabilitative expectatives according to their diagnosis and degree of functional and cognitive impairment at admission.",adult;aged;alertness;amputation stump;article;behavior disorder;cognition;cognitive defect;comorbidity;convalescence;dementia;emergency care;female;foot orthosis;functional disease;functional status;general condition improvement;heart failure;hospital admission;human;length of stay;major clinical study;male;mood disorder;nursing home;patient care;priority journal;prognosis;respiratory tract infection;skin ulcer;urinary tract infection;walking,"Salvà, A.;Roqué, M.;Vallès, E.;Bustins, M.;Bullich, I.;Sanchez, P.",2015,,,0,
3855,A geriatric emergency service for acutely ill elderly patients: Pattern of use and comparison with a conventional emergency department in Italy,"The current disease-oriented, episodic model of emergency care does not adequately address the complex needs of older adults presenting to emergency departments (EDs). Dedicated ED facilities with a specific organization (e.g., geriatric EDs (GEDs)) have been advocated. One of the few GED experiences in the world is described and its outcomes compared with those of a conventional ED (CED). In a secondary analysis of a prospective observational cohort of 200 acutely ill elderly patients presenting to two urban EDs in Ancona, Italy, identifiers and triage, clinical, and social data were collected and the following outcomes considered: early (30-day) and late (6-month) ED revisit, frequent ED return, hospital admission, and functional decline. Death, functional decline, any ED revisit and any hospital admission were also considered as a composite outcome. Odds ratios and 95% confidence intervals (CIs) were calculated. Overall, GED patients were older and frailer than CED patients. The two EDs did not differ in terms of early, late, or frequent ED return or in 6-month hospital admission or functional decline. The mortality rate was slightly but significantly lower in the GED patients (hazard ratio=0.47, 95% CI=0.22-0.99, P=.047). The data suggest noninferiority and, indirectly, a slight superiority for the GED system in the acute care of elderly people, supporting the hypothesis that ED facilities specially designed for older adults may provide better care. © 2008, Copyright the Authors.",acute coronary syndrome;acute disease;aged;article;chronic obstructive lung disease;cognitive defect;comorbidity;controlled study;dementia;diagnostic procedure;emergency care;emergency health service;emergency ward;female;geriatric care;heart arrhythmia;heart failure;hospital admission;human;Italy;long term care;major clinical study;male;mortality;pneumonia;risk factor;transient ischemic attack,"Salvi, F.;Morichi, V.;Grilli, A.;Giorgi, R.;Spazzafumo, L.;Polonara, S.;De Tommaso, G.;Rappelli, A.;Dessí-Fulgheri, P.",2008,,,0,
3856,The only certain measure of the effectiveness of multiple sclerosis therapy is cerebrospinal neurofilament level - YES,,rituximab;acute heart infarction;amyotrophic lateral sclerosis;cerebrospinal fluid analysis;cytoskeleton;degenerative disease;dementia;enzyme linked immunosorbent assay;human;lumbar puncture;multiple sclerosis;neurofilament;neurologic disease;nuclear magnetic resonance imaging;paresthesia;short survey;vascular disease,"Salzer, J.",2015,,,0,
3857,Assessing Hospital Performance for Acute Myocardial Infarction: How should emergency department transfers be attributed,"Background: The Centers for Medicare and Medicaid Services publicly reports risk-standardized mortality rates (RSMRs) to assess quality of care for hospitals that treat acute myocardial infarction patients, and the outcomes for inpatient transfers are attributed to transferring hospitals. However, emergency department (ED) transfers are currently ignored and therefore attributed to receiving hospitals. Methods: New York State administrative data were used to develop a statistical model similar to the one used by Centers for Medicare and Medicaid Services to risk-adjust hospital 30-day mortality rates. RSMRs were calculated and outliers were identified when ED transfers were attributed to: (1) the transferring hospital and (2) the receiving hospital. Differences in hospital outlier status and RSMR tertile between the 2 attribution methods were noted for hospitals performing and not performing percutaneous coronary interventions (PCIs). Results: Although both methods of attribution identified 3 high outlier non-PCI hospitals, only 2 of those hospitals were identified by both methods, and each method identified a different hospital as a third outlier. Also, when transfers were attributed to the referring hospital, 1 non-PCI hospital was identified as a low outlier, and no non-PCI hospitals were identified as a low outlier with the other attribution method. About one sixth of all hospitals changed their tertile status. Most PCI hospitals (89%) that changed status moved to a higher (worse RSMR) tertile, whereas the majority of non-PCI hospitals (68%) that changed status were moved to a lower (better) RSMR tertile when ED transfers were attributed to the referring hospital. Conclusions: Hospital quality assessments for acute myocardial infarction are affected by whether ED transfers are assigned to the transferring or receiving hospital. The pros and cons of this choice should be considered.",acute heart infarction;acute leukemia;article;atherosclerosis;cardiovascular mortality;cerebrovascular accident;chronic obstructive lung disease;comorbidity;congestive heart failure;dementia;emergency care;emergency ward;fibrosis;heart catheterization;hospital service;hospitalization;human;Huntington chorea;hypertension;liver disease;medicaid;medicare;metastasis;Parkinson disease;patient transport;percutaneous coronary intervention;peripheral vascular disease;pneumonia;priority journal;protein calorie malnutrition;revascularization;seizure;spine fracture,"Samadashvili, Z.;Hannan, E. L.;Cozzens, K.;Walford, G.;Jacobs, A. K.;Berger, P. B.;Holmes, D. R.;Venditti, F. J.;Curtis, J.",2015,,,0,
3858,The value of the metabolic syndrome concept in elderly adults: Is it worth less than the sum of its parts?,"Objectives To determine whether the metabolic syndrome (MetS) or its components were more closely associated with disease states and inflammation in elderly adults. Design Sydney Memory and Ageing Study. Cross-sectional, observational cohort. Setting Population-derived, community-dwelling elderly adults. Participants Nine hundred thirty individuals aged 70 to 90. Measurements Age- and sex-adjusted odds ratios (ORs) for disease states; fasting circulating inflammatory markers and oxidative metabolism byproducts. Results MetS was associated with diabetes mellitus (OR = 4.1, P <.001) and bowel cancer (OR = 9.1, P =.03) but not in analyses that controlled for component conditions. Models containing component conditions had the strongest associations with heart disease. Disease associations were improved after addition of component conditions to the MetS model. The reverse did not hold: disease associations were not improved when MetS was added to the components model. Low high-density lipoprotein cholesterol (HDL-C) was independently associated with myocardial infarction (OR = 2.32) and angina pectoris (OR = 2.59) (both P <.008). Waist circumference was independently associated with cancer (OR = 1.82, P =.008). Although MetS was associated with higher C-reactive protein, vascular cell adhesion molecule, interleukin-6, amyloid A, homocysteine, and malondialdehyde, it explained less than half of the variance of models containing its components. Conclusion The observation that MetS is associated with disease states and markers of circulating inflammation in the elderly is explained mainly by abdominal obesity and low HDL-C. Longitudinal data will further clarify these cross-sectional findings that MetS appears to be less than the sum of its parts in elderly adults. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.",amyloid A protein;C reactive protein;cell adhesion molecule;creatinine;high density lipoprotein cholesterol;homocysteine;interleukin 6;malonaldehyde;abdominal obesity;aerobic metabolism;aged;angina pectoris;article;cohort analysis;controlled study;diabetes mellitus;disease association;disease marker;female;heart infarction;human;inflammation;intestine cancer;major clinical study;male;metabolic syndrome X;observational study,"Samaras, K.;Crawford, J.;Baune, B. T.;Campbell, L. V.;Smith, E.;Lux, O.;Brodaty, H.;Trollor, J. N.;Sachdev, P.",2012,,,0,
3859,Metabolic burden and disease and mortality risk associated with impaired fasting glucose in elderly adults,"Objectives To examine whether impaired fasting glucose (IFG) represents an intermediary condition between normal fasting glucose and diabetes mellitus and, specifically, whether elderly adults with IFG have higher disease burden, cardiovascular risk, and systemic inflammation and higher 2-year mortality and incident disease. Design Prospective observational study. Setting Population-derived cohort. Participants Individuals with a mean age of 78.6 ± 4.7 (N = 945). Measurements Disease was ascertained using a standardized questionnaire at baseline and 2 years. Fasting metabolic, inflammatory, and oxidative metabolism markers were measured. Disease prevalence, cardiovascular risk, and biochemical markers were compared to determine disease burden and metabolic disturbances in IFG. Adjusted odds ratios (ORs) for 2-year all-cause mortality and incident disease were determined. Results IFG prevalence was 41%. Individuals with IFG had higher baseline rates of heart disease than those with normal fasting glucose (NFG), similar to that in individuals with diabetes mellitus. IFG was characterized by higher inflammatory markers and oxidative metabolism end products and was an intermediary between NFG and diabetes mellitus for triglycerides and malondialdehyde. Discriminant analysis showed that IFG was independently associated with stroke and higher triglycerides and oxidative stress. Two-year all-cause mortality was 3.9%. The 2-year adjusted ORs for all-cause mortality, incident cardiac disease, stroke, and cancer were similar between IFG and NFG, using both American Diabetes Association and World Health Organization IFG criteria. IFG did not predict secondary cardiac events, stroke, or cancer. Conclusion IFG was an intermediary condition for heart disease, inflammation, and oxidative stress in elderly adults but not for 2-year incident disease or all-cause mortality. Longer-term prospective studies are needed to clarify whether IFG in elderly adults portends greater morbidity and mortality.",alpha tocopherol;C reactive protein;carotene;cholesterol;creatinine;cyanocobalamin;glucose;high density lipoprotein cholesterol;homocysteine;insulin;interleukin 10;interleukin 12p70;interleukin 1beta;interleukin 6;interleukin 8;low density lipoprotein cholesterol;malonaldehyde;retinol;serum amyloid A;triacylglycerol;tumor necrosis factor alpha;urate;vascular cell adhesion molecule 1;acute heart infarction;aerobic metabolism;aged;alcohol consumption;angina pectoris;article;body mass;body weight;breast cancer;cardiovascular risk;cerebrovascular accident;cholesterol blood level;claudication;colon cancer;controlled study;creatinine blood level;depression;diabetes mellitus;diabetic patient;diastolic blood pressure;diet restriction;discriminant analysis;disorders of carbohydrate metabolism;education;female;glucose blood level;halfway house;heart arrhythmia;heart disease;high school;human;hyperlipidemia;hypertension;impaired fasting glucose;incidence;inflammation;insulin blood level;kidney disease;lung cancer;major clinical study;male;metabolic disorder;mortality;neoplasm;observational study;oxidative stress;pensioner;physical disability;population research;prevalence;prospective study;prostate cancer;questionnaire;smoking;systolic blood pressure;transient ischemic attack;triacylglycerol blood level;uric acid blood level,"Samaras, K.;Crawford, J.;Lutgers, H. L.;Campbell, L. V.;Baune, B. T.;Lux, O.;Brodaty, H.;Trollor, J. N.;Sachdev, P.",2015,,,0,
3860,To the editor,,aorta valve prosthesis;aorta stenosis;aorta valve regurgitation;cerebrovascular accident;clinical effectiveness;coronary artery disease;dementia;disease association;high risk patient;human;letter;mitral valve regurgitation;prevalence;priority journal;silent myocardial infarction;transcatheter aortic valve implantation;treatment indication,"Samarendra, P.",2016,,,0,
3861,Reply 10,,aged;cause of death;death certificate;dementia;health care quality;heart arrest;hospice care;human;letter;palliative therapy;pneumonia;priority journal,"Sampson, E. L.",2006,,,0,
3862,ICD-9 diagnosis codes have poor sensitivity for identification of preexisting comorbidities in traumatic fracture patients: A study of the National Trauma Data Bank,"BACKGROUND: The use of large national databases for clinical research has increased recently in the field of trauma care as they allow study of rare events without the logistical difficulties of a prospective study. However, many of these databases use administrative billing codes, such as International Classification of Disease - 9th Rev. (ICD-9) codes, to identify preexisting patient comorbidities. While the accuracy of these billing codes for research purposes has previously been called into question, this has not been studied in a trauma population. METHODS: All patients with proximal tibia fractures in the 2011 and 2012 American College of Surgeons' National Trauma Data Bank were reviewed. Rates of 12 individual comorbidities in this population were computed using both ICD-9 diagnosis codes and also National Trauma Data Bank chart-abstracted variables. The sensitivity was computed for ICD-9 coding of each comorbidity taking chartabstracted data elements as criterion standard. With the use of multivariate logistic regression, controlling for age and Injury Severity Score (ISS), the odds ratio for mortalitywas computed for each comorbidity, using both ICD-9 diagnoses and chart-abstracted diagnoses. RESULTS: A total of 32,441 patients with proximal tibia fractures were identified. The sensitivities of ICD-9 billing codes for the comorbidities analyzed ranged from 18.8% for previous myocardial infarction to 2.4% for alcoholism. In individual multivariate analyses of each comorbidity, there was a change in the statistical significance of the odds ratio for mortality for 6 of 12 comorbidities analyzed. CONCLUSION: Researchers and those evaluating research in the field of trauma should carefully consider the accuracy of data elements in future studies, especially ICD-9-coded comorbidity diagnoses.",adult;alcoholism;article;bleeding disorder;comorbidity;congestive heart failure;dementia;diabetes mellitus;female;heart infarction;human;hypertension;ICD-9;injury scale;kidney failure;length of stay;liver cirrhosis;major clinical study;male;metastasis;mortality;obesity;peripheral vascular disease;priority journal;proximal tibia fracture;respiratory tract disease;smoking;traffic accident,"Samuel, A. M.;Lukasiewicz, A. M.;Webb, M. L.;Bohl, D. D.;Basques, B. A.;Davis, K. A.;Grauer, J. N.",2015,,,0,
3863,Comorbidity is a prognostic factor in elderly patients with head and neck cancer,"Background: The number of aged patients with head and neck cancer is increasing. Comorbidities are common in this population. It is necessary to evaluate the effect of comorbidities as measured with the ACE-27 index on recurrence and survival of elderly patients with head and neck cancer, adjusting by other prognostic factors as age, clinical stage and functional status index. Patients: Three hundred and ten patients greater than 70 years of age with head and neck cancer in a referral cancer center were studied. Comorbidity measured with the ACE-27 index was the main independent variable. The outcomes were recurrence and survival. Results: Comorbidities were present in 75% of patients. Five-year disease-free survival, overall survival and cancer-specific survival were 63.1, 42.8 and 55.8%, respectively. Advanced clinical stage and Karnofsky index ≤70 were associated with recurrence. Age >80 years, male gender, Karnofsky index ≤80, advanced clinical stage, and ACE value ≥2 were independently associated with overall survival. The ACE-27 value was not associated with cancer-specific survival. The Karnofsky performance index was associated with overall survival and mortality and acted as a confounding factor on multivariable analysis on overall and cancer-specific survival. Conclusions: Comorbidity measured with ACE-27 was a prognostic factor for overall survival in patients older than 70 years with head and neck cancer. The Karnofsky performance index could be included in multivariable analysis of survival for older patients with head and neck cancer. © 2007 Society of Surgical Oncology.",platinum derivative;taxane derivative;acquired immune deficiency syndrome;age distribution;aged;alcohol abuse;angina pectoris;artery disease;article;cancer center;cancer chemotherapy;cancer radiotherapy;cancer staging;cancer surgery;cancer survival;comorbidity;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;disease severity;elderly care;female;gastrointestinal disease;head and neck cancer;heart arrhythmia;human;hypertension;Karnofsky Performance Status;kidney failure;leukemia;liver disease;lymphoma;major clinical study;male;mental disease;multivariate analysis;myeloma;neuromuscular disease;obesity;pancreas disease;paralysis;prognosis;respiratory tract disease;cerebrovascular accident;survival rate;vein disease,"Sanabria, A.;Carvalho, A. L.;Vartanian, J. G.;Magrin, J.;Ikeda, M. K.;Kowalski, L. P.",2007,,,0,
3864,Coventina's column,,cholinesterase inhibitor;donepezil;memantine;placebo;Alzheimer disease;breast endoprosthesis;carcinogenicity;cardiomyopathy;disability;foreign body;heart infarction;heart left ventricle ejection fraction;heart muscle biopsy;human;medical literature;metal implantation;Mini Mental State Examination;note;nuclear magnetic resonance imaging;patient assessment;total hip prosthesis,"Sanai, L.",2012,,,0,
3865,Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series,"BACKGROUND: The management of unstable osteoporotic intertrochantric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure secondary to osteoporosis. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study is to analyze the role of primary hemiarthroplasty in cases of unstable osteoporotic intertrochanteric femur fractures. MATERIALS AND METHODS: We retrospectively analyzed 37 cases of primary hemiarthroplasty performed for osteoporotic unstable intertrochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3 and Evans type III or IV fractures). There were 27 females and 10 males with a mean age of 77.1 years (range, 62-89 years). RESULTS: Two patients died due to unrelated cause (myocardial infarction) within 6 months of surgery and remaining 35 patients were followed up to an average of 24.5 months (range,18-39 months). The average surgery time was 71 min (range, 55-88 min) with an average intraoperative blood loss of 350 ml (range, 175-500 ml). Six patients needed blood transfusion postoperatively. The patients walked on an average 3.2 days after surgery (range, 2-8 days). One patient had superficial skin infection and one had bed sore with no other significant postoperative complications. One patient of Alzheimer's disease refused to walk and had a poor result. A total of 32 out of 35 patients (91%) had excellent to fair functional results and 2 had poor result with respect to the Harris hip score (mean 84.8+/-9.72, range 58-97). One patient who had neurological comorbidity refused to walk post operatively and was labeled as failed result. CONCLUSION: Hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in elderly results in early ambulation and good functional results although further prospective randomized trials are required before reaching to conclusion.",Hemiarthroplasty;osteoporotic fractures;unstable intertrochanteric fractures,"Sancheti, K.;Sancheti, P.;Shyam, A.;Patil, S.;Dhariwal, Q.;Joshi, R.",2010,Oct,10.4103/0019-5413.67122,0,
3866,Circulating aminopeptidase activities in men and women with essential hypertension,"Essential hypertension is one of the major contributors to premature morbidity and mortality due to the incresased risk for coronary heart disease, stroke, renal disease, peripheral vascular disease and vascular dementia for both men and women. However, its basic causes remain unknown. In the present work we studied the activity of several proteolytic regulatory enzymes related to renin-angiotensin-system (RAS) (aminopeptidase A, APA; aminopeptidase N, APN; aminopeptidase B, APB; and insulin-regulated aminopeptidase, IRAP); with oxytocin regulation (oxytocinase); with the metabolism of GnRH and TRH (pyrrolidone carboxypeptidase, Pcp); and with enkephalins metabolism (enkephalindegrading activity, EDA), to elucidate their role in the mechanisms responsible of essential hypertension and to discuss the possible gender differences. Serum samples of 53 individuals with essential hypertension and 60 healthy volunteers were collected and used to assay enzyme activities, gonad hormones testosterone and estradiol, TSH and free thyroxin (fT4). Differences were observed in APA, APN, Pcp and EDA specific activities, and in serum gonad hormone levels between hypertensive and control groups. Only Pcp activity showed gender differences. Regarding the RAS, APA is reduced while APN is increased, suggesting increased levels of angiotensin II and a facilitation of the conversion of angiotensin III in angiotensin IV. Thus, the changes in several RAS-regulating specific activities and other enzyme activities involved in the neuroendocrine modulation of gonad and stress-related functions are related to essential hypertension with minor gender differences. Therefore, aminopeptidases constitute new elements for the knowledge of the causes of essential hypertension and an alternative as therapeutic targets against the illness. © 2013 Bentham Science Publishers.",aminopeptidase;aminopeptidase B;angiotensin II;angiotensin II [3-8];angiotensin III;cystyl aminopeptidase;enkephalin;estradiol;glutamyl aminopeptidase;gonadorelin;insulin;insulin regulated aminopeptidase;microsomal aminopeptidase;protirelin;testosterone;thyrotropin;unclassified drug;adolescent;adult;article;chemiluminescence immunoassay;circulation;controlled study;enzyme activity;enzyme regulation;essential hypertension;female;fluoroimmunoassay;fluorometry;free thyroxine index;gonad;hormone blood level;human;major clinical study;male;protein metabolism;renin angiotensin aldosterone system;sex difference,"Sánchez-Agesta Ortega, R.;Arias De Saavedra-Alías, J. M.;Liébana-Cañada, A.;Sánchez-Muñoz, B.;Martínez-Martos, J. M.;Ramírez-Expósito, M. J.",2013,,,0,
3867,"Three measures of physical rehabilitation effectiveness in elderly patients: a prospective, longitudinal, comparative analysis","BACKGROUND: Rehabilitation success is measured by instruments that assess performance of activities of daily living. Guidelines on the use and choice of these instruments are lacking. The present study aimed to analyse prognostic indicators of physical rehabilitation effectiveness in elderly patients according to three rehabilitation impact indices. METHODS: Prospective, longitudinal study in a post-acute care unit. The study included rehabilitation-eligible deconditioned elderly in-patients prospectively admitted to post-acute care (n = 685, aged 83.2 +/- 8.3 years, mean length of stay 15 +/- 9.2 days). DATA COLLECTION: Premorbid health status variables (PHSV): age, sex, comorbidity (Charlson index), medical history (heart failure, pulmonary disease, cerebrovascular disease, dementia), previous living situation and pre-admission functional status (premorbid Lawton and Barthel indices). Admission health status variables (AHSV): main diagnoses, referral source, physical (Barthel-adm) and cognitive function (Pfeiffer test), undernutrition and dysphagia. OUTCOME MEASURES: Absolute functional gain (AFG, admission-to-discharge Barthel change), relative functional gain (RFG, achieved percentage of potential gain) and rehabilitation efficiency index (REI, AFG over length of stay). Univariate analysis considered these parameters, along with PHSV and AHSV. Multivariate logistic regression analysis was performed for AFG >/=20, RFG >/=35 % and REI >/= 0.50. RESULTS: Greater AFG was associated with 14 variables, 8 PHSV (57.1 %) and 6 AHSV (42.8 %); greater RFG with 9 variables, 3 PHSV (33.3 %) and 6 AHSV (66.6 %); and REI with 9 variables, 4 PHSV (44.4 %) and 5 AHSV (55.5 %). Mean AFG value was 34.5 +/- 15.8 in patients who achieved complete recovery (RFG 100 %, n = 189, 27.5 %) and 35.3 +/- 15.0 (p = 0.593) in the remaining patients (n = 311, 45.4 %). In multivariate analysis, only Barthel-adm was related to all three rehabilitation impact indices. CONCLUSIONS: Both premorbid and acute-process variables have a greater impact on AFG and REI, compared to RFG. Although AFG gives information about the degree of reduction in dependence, it does not provide clinical information about post-rehabilitation functional status (mean AFG values did not differ between patients with and without complete recovery). A future implication for evaluating rehabilitation effectiveness in elderly patients is to recommend RFG corrected by premorbid Barthel score, which is less affected by previous health conditions, as the optimum method to assess the degree to which maximum potential improvement was achieved.","*Activities of Daily Living;Aged;Aged, 80 and over;Comorbidity;Critical Care/*methods;Female;Health Status Disparities;Hospitalization/statistics & numerical data;Humans;Longitudinal Studies;Male;Multivariate Analysis;Outcome Assessment (Health Care)/*methods;Patient Acuity;Patient Discharge;Prognosis;Prospective Studies;*Recovery of Function;Spain;Treatment Outcome","Sanchez-Rodriguez, D.;Miralles, R.;Muniesa, J. M.;Mojal, S.;Abadia-Escartin, A.;Vazquez-Ibar, O.",2015,Oct 29,10.1186/s12877-015-0138-5,0,
3868,"Three measures of physical rehabilitation effectiveness in elderly patients: a prospective, longitudinal, comparative analysis","BACKGROUND: Rehabilitation success is measured by instruments that assess performance of activities of daily living. Guidelines on the use and choice of these instruments are lacking. The present study aimed to analyse prognostic indicators of physical rehabilitation effectiveness in elderly patients according to three rehabilitation impact indices. METHODS: Prospective, longitudinal study in a post-acute care unit. The study included rehabilitation-eligible deconditioned elderly in-patients prospectively admitted to post-acute care (n = 685, aged 83.2 ± 8.3 years, mean length of stay 15 ± 9.2 days). DATA COLLECTION: Premorbid health status variables (PHSV): age, sex, comorbidity (Charlson index), medical history (heart failure, pulmonary disease, cerebrovascular disease, dementia), previous living situation and pre-admission functional status (premorbid Lawton and Barthel indices). Admission health status variables (AHSV): main diagnoses, referral source, physical (Barthel-adm) and cognitive function (Pfeiffer test), undernutrition and dysphagia. OUTCOME MEASURES: Absolute functional gain (AFG, admission-to-discharge Barthel change), relative functional gain (RFG, achieved percentage of potential gain) and rehabilitation efficiency index (REI, AFG over length of stay). Univariate analysis considered these parameters, along with PHSV and AHSV. Multivariate logistic regression analysis was performed for AFG ≥20, RFG ≥35 % and REI ≥ 0.50. RESULTS: Greater AFG was associated with 14 variables, 8 PHSV (57.1 %) and 6 AHSV (42.8 %); greater RFG with 9 variables, 3 PHSV (33.3 %) and 6 AHSV (66.6 %); and REI with 9 variables, 4 PHSV (44.4 %) and 5 AHSV (55.5 %). Mean AFG value was 34.5 ± 15.8 in patients who achieved complete recovery (RFG 100 %, n = 189, 27.5 %) and 35.3 ± 15.0 (p = 0.593) in the remaining patients (n = 311, 45.4 %). In multivariate analysis, only Barthel-adm was related to all three rehabilitation impact indices. CONCLUSIONS: Both premorbid and acute-process variables have a greater impact on AFG and REI, compared to RFG. Although AFG gives information about the degree of reduction in dependence, it does not provide clinical information about post-rehabilitation functional status (mean AFG values did not differ between patients with and without complete recovery). A future implication for evaluating rehabilitation effectiveness in elderly patients is to recommend RFG corrected by premorbid Barthel score, which is less affected by previous health conditions, as the optimum method to assess the degree to which maximum potential improvement was achieved.",aged;comorbidity;convalescence;daily life activity;female;health disparity;hospital discharge;hospitalization;human;intensive care;longitudinal study;male;multivariate analysis;outcome assessment;patient acuity;procedures;prognosis;prospective study;Spain;statistics and numerical data;treatment outcome;very elderly,"Sánchez-Rodríguez, D.;Miralles, R.;Muniesa, J. M.;Mojal, S.;Abadía-Escartín, A.;Vázquez-Ibar, O.",2015,,10.1186/s12877-015-0138-5,0,
3869,Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction,"Background Comorbid elderly patients with non-ST-elevation myocardial infarction (non-STEMI) are underrepresented in randomized trials and undergo fewer cardiac catheterizations according to registries. Our aim was to compare the conservative and invasive strategies in these patients. Methods Randomized multicenter study, including 106 patients (January 2012-March 2014) with non-STEMI, over 70 years and with comorbidities defined by at least two of the following: peripheral artery disease, cerebral vascular disease, dementia, chronic pulmonary disease, chronic renal failure or anemia. Patients were randomized to invasive (routine coronary angiogram, n = 52) or conservative (coronary angiogram only if recurrent ischemia or heart failure, n = 54) strategy. Medical treatment was identical. The main endpoint was the composite of all-cause mortality, reinfarction and readmission for cardiac cause (postdischarge revascularization or heart failure), at long-term (2.5-year follow-up). Analysis of cumulative event rate (incidence rate ratio = IRR) and time to first event (hazard ratio = HR), were performed. Results Cardiac catheterization/revascularization rates were 100%/58% in the invasive versus 20%/9% in the conservative arm. There were no differences between groups in the main endpoint (invasive vs conservative: IRR = 0.946, 95% CI 0.466-1.918, p = 0.877) at long-term. The invasive strategy, however, tended to improve 3-month outcomes in terms of mortality (HR = 0.348, 95% CI 0.122-0.991, p = 0.048), and of mortality or ischemic events (reinfarction or postdischarge revascularization) (HR = 0.432, 95% CI 0.190-0.984, p = 0.046). This benefit declined during follow-up. Conclusions Invasive management did not modify long-term outcome in comorbid elderly patients with non-STEMI. The finding of a tendency towards an improvement in the short-term needs confirmation in larger studies (clinicaltrials.govNCT1645943). Copyright © 2016 European Federation of Internal Medicine.",aged;anemia;article;cerebrovascular disease;chronic kidney failure;chronic lung disease;comorbidity;comparative study;conservative treatment;controlled study;coronary angiography;dementia;female;heart catheterization;heart failure;heart muscle revascularization;heart reinfarction;hospital readmission;human;major clinical study;male;mortality;multicenter study;non ST segment elevation myocardial infarction/dt [Drug Therapy];non ST segment elevation myocardial infarction/th [Therapy];non ST segment elevation myocardial infarction/dt [Drug Therapy];peripheral occlusive artery disease;randomized controlled trial;very elderly;acetylsalicylic acid/dt [Drug Therapy];anticoagulant agent/dt [Drug Therapy];beta adrenergic receptor blocking agent/dt [Drug Therapy];clopidogrel/dt [Drug Therapy];dipeptidyl carboxypeptidase inhibitor/dt [Drug Therapy];hydroxymethylglutaryl coenzyme A reductase inhibitor/dt [Drug Therapy];ticagrelor/dt [Drug Therapy];clinical trial;comorbidity;controlled clinical trial;follow up;hazard ratio;heart catheterization;heart muscle ischemia;incidence;non ST segment elevation myocardial infarction;revascularization;treatment failure,"Sanchis, J;Nunez, E;Barrabes, Ja;Marin, F;Consuegra-Sanchez, L;Ventura, S;Valero, E;Roque, M;Bayes-Genis, A;Blanco, Bg;Degano, I;Nunez, J",2016,,10.1016/j.ejim.2016.07.003,0,
3870,Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction,"BACKGROUND: Comorbid elderly patients with non-ST-elevation myocardial infarction (non-STEMI) are underrepresented in randomized trials and undergo fewer cardiac catheterizations according to registries. Our aim was to compare the conservative and invasive strategies in these patients. METHODS: Randomized multicenter study, including 106 patients (January 2012-March 2014) with non-STEMI, over 70years and with comorbidities defined by at least two of the following: peripheral artery disease, cerebral vascular disease, dementia, chronic pulmonary disease, chronic renal failure or anemia. Patients were randomized to invasive (routine coronary angiogram, n=52) or conservative (coronary angiogram only if recurrent ischemia or heart failure, n=54) strategy. Medical treatment was identical. The main endpoint was the composite of all-cause mortality, reinfarction and readmission for cardiac cause (postdischarge revascularization or heart failure), at long-term (2.5-year follow-up). Analysis of cumulative event rate (incidence rate ratio=IRR) and time to first event (hazard ratio=HR), were performed. RESULTS: Cardiac catheterization/revascularization rates were 100%/58% in the invasive versus 20%/9% in the conservative arm. There were no differences between groups in the main endpoint (invasive vs conservative: IRR=0.946, 95% CI 0.466-1.918, p=0.877) at long-term. The invasive strategy, however, tended to improve 3-month outcomes in terms of mortality (HR=0.348, 95% CI 0.122-0.991, p=0.048), and of mortality or ischemic events (reinfarction or postdischarge revascularization) (HR=0.432, 95% CI 0.190-0.984, p=0.046). This benefit declined during follow-up. CONCLUSIONS: Invasive management did not modify long-term outcome in comorbid elderly patients with non-STEMI. The finding of a tendency towards an improvement in the short-term needs confirmation in larger studies (clinicaltrials.govNCT1645943).",Comorbidities;Elderly;Invasive management;Non-ST elevation myocardial infarction,"Sanchis, J.;Nunez, E.;Barrabes, J. A.;Marin, F.;Consuegra-Sanchez, L.;Ventura, S.;Valero, E.;Roque, M.;Bayes-Genis, A.;Del Blanco, B. G.;Degano, I.;Nunez, J.",2016,Jul 13,10.1016/j.ejim.2016.07.003,0,
3871,Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction,"Background Comorbid elderly patients with non-ST-elevation myocardial infarction (non-STEMI) are underrepresented in randomized trials and undergo fewer cardiac catheterizations according to registries. Our aim was to compare the conservative and invasive strategies in these patients. Methods Randomized multicenter study, including 106 patients (January 2012–March 2014) with non-STEMI, over 70 years and with comorbidities defined by at least two of the following: peripheral artery disease, cerebral vascular disease, dementia, chronic pulmonary disease, chronic renal failure or anemia. Patients were randomized to invasive (routine coronary angiogram, n = 52) or conservative (coronary angiogram only if recurrent ischemia or heart failure, n = 54) strategy. Medical treatment was identical. The main endpoint was the composite of all-cause mortality, reinfarction and readmission for cardiac cause (postdischarge revascularization or heart failure), at long-term (2.5-year follow-up). Analysis of cumulative event rate (incidence rate ratio = IRR) and time to first event (hazard ratio = HR), were performed. Results Cardiac catheterization/revascularization rates were 100%/58% in the invasive versus 20%/9% in the conservative arm. There were no differences between groups in the main endpoint (invasive vs conservative: IRR = 0.946, 95% CI 0.466–1.918, p = 0.877) at long-term. The invasive strategy, however, tended to improve 3-month outcomes in terms of mortality (HR = 0.348, 95% CI 0.122–0.991, p = 0.048), and of mortality or ischemic events (reinfarction or postdischarge revascularization) (HR = 0.432, 95% CI 0.190–0.984, p = 0.046). This benefit declined during follow-up. Conclusions Invasive management did not modify long-term outcome in comorbid elderly patients with non-STEMI. The finding of a tendency towards an improvement in the short-term needs confirmation in larger studies (clinicaltrials.govNCT1645943).",NCT1645943;acetylsalicylic acid;anticoagulant agent;beta adrenergic receptor blocking agent;clopidogrel;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;ticagrelor;aged;anemia;article;cerebrovascular disease;chronic kidney failure;chronic lung disease;comorbidity;comparative study;conservative treatment;controlled study;coronary angiography;dementia;female;heart catheterization;heart failure;heart muscle revascularization;heart reinfarction;hospital readmission;human;major clinical study;male;mortality;multicenter study;non ST segment elevation myocardial infarction;peripheral occlusive artery disease;randomized controlled trial;very elderly,"Sanchis, J.;Núñez, E.;Barrabés, J. A.;Marín, F.;Consuegra-Sánchez, L.;Ventura, S.;Valero, E.;Roqué, M.;Bayés-Genís, A.;del Blanco, B. G.;Dégano, I.;Núñez, J.",2016,,10.1016/j.ejim.2016.07.003,0,
3872,Influence of comorbid conditions on one-year outcomes in non-ST-segment elevation acute coronary syndrome,"OBJECTIVE: To investigate comorbid conditions with prognostic influence in non-ST-segment elevation acute coronary syndrome (NSTEACS). PATIENTS AND METHODS: The study group consisted of a derivation cohort of 1017 patients (admitted from October 1, 2002, through October 1, 2008) and an external validation cohort of 652 patients (admitted from February 1, 2006, through September 30, 2009). Comorbid conditions, including risk factors and components of the Charlson comorbidity index (ChCI) and coronary artery disease-specific index, were recorded. The main outcome was one-year mortality. RESULTS: During follow-up, 103 patients died. After adjusting for variables associated with NSTEACS characteristics (base model), 5 comorbid conditions predicted mortality: severe or mild renal failure (hazard ratio [HR], 2.9 and HR, 1.6, respectively), dementia (HR, 3.1), peripheral artery disease (HR, 2.0), previous heart failure (HR, 2.6), and previous myocardial infarction (HR, 1.4). A simple comorbidity index (SCI) was developed using these variables, (per point: HR, 1.6; 95% confidence interval, 1.4-1.8; P = .0001). Adding the SCI, Charlson comorbidity index, or coronary artery disease-specific index to the base model resulted in a gain of 6.58%, 5.00%, and 4.04%, respectively, in discriminative ability (P = .001), without significant differences among the 3 indices. In patients with comorbid conditions, the highest risk period was in the first weeks after NSTEACS. The strength of the association between SCI and mortality rate was similar in the external validation cohort (HR, 1.3; 95% confidence interval, 1.1-1.6; P = .001). CONCLUSION: Renal dysfunction, dementia, peripheral artery disease, previous heart failure, and previous myocardial infarction are the comorbid conditions that predict mortality in NSTEACS. A simple index using these variables proved to be as accurate as the more complex comorbidity indices for risk stratification. In-hospital management of patients with comorbid conditions merits further investigation.","Acute Coronary Syndrome/*epidemiology/mortality;Aged;Aged, 80 and over;Comorbidity;Female;Humans;Male;Middle Aged;Multivariate Analysis;Myocardial Infarction/epidemiology;Prognosis;Prospective Studies;Risk Assessment;Stroke Volume;Survival Analysis;Ventricular Dysfunction, Left/epidemiology","Sanchis, J.;Nunez, J.;Bodi, V.;Nunez, E.;Garcia-Alvarez, A.;Bonanad, C.;Regueiro, A.;Bosch, X.;Heras, M.;Sala, J.;Bielsa, O.;Llacer, A.",2011,Apr,10.4065/mcp.2010.0702,0,
3873,Erythropoietin receptor (EpoR) agonism is used to treat a wide range of disease,"The erythropoietin receptor (EpoR) was discovered and described in red blood cells (RBCs), stimulating its proliferation and survival. The target in humans for EpoR agonists drugs appears clear-to treat anemia. However, there is evidence of the pleitropic actions of erythropoietin (Epo). For that reason, rhEpo therapy was suggested as a reliable approach for treating a broad range of pathologies, including heart and cardiovascular diseases, neurodegenerative disorders (Parkinson's and Alzheimer's disease), spinal cord injury, stroke, diabetic retinopathy and rare diseases (Friedreich ataxia). Unfortunately, the side effects of rhEpo are also evident. A new generation of nonhematopoietic EpoR agonists drugs (asialoEpo, Cepo and ARA 290) have been investigated and further developed. These EpoR agonists, without the erythropoietic activity of Epo, while preserving its tissue-protective properties, will provide better outcomes in ongoing clinical trials. Nonhematopoietic EpoR agonists represent safer and more effective surrogates for the treatment of several diseases such as brain and peripheral nerve injury, diabetic complications, renal ischemia, rare diseases, myocardial infarction, chronic heart disease and others.","Animals;Asialoglycoproteins/pharmacology/therapeutic use;Brain Diseases/drug therapy;Cardiovascular Diseases/drug therapy;Diabetes Complications/drug therapy;Erythropoietin/analogs & derivatives/pharmacology/therapeutic use;Humans;Oligopeptides/pharmacology/therapeutic use;Receptors, Erythropoietin/*agonists","Sanchis-Gomar, F.;Perez-Quilis, C.;Lippi, G.",2013,Apr 30,10.2119/molmed.2013.00025,0,
3874,Carotid- intima media thickness is independently associated with cognitive decline. The INVADE study,"Objectives: Increased carotid intima-media thickness (C-IMT) is a non-invasive marker of atherosclerosis and predicts vascular events. Moreover, increasing evidence suggests an association between carotid atherosclerosis and cognitive decline. The purpose of this study is to investigate the relationship between C-IMT and the development of cognitive impairment in a large population-based sample. Methods: This study was based on the data of the participants of the INVADE (Intervention project on cerebrovascular diseases and dementia in the district of Ebersberg, Bavaria) project. Vascular risk factors, Geriatric depression scale (GDS) and ""6 Item Cognitive Impairment Test"" (6CIT) were evaluated at baseline and after 2 years. The relationship between C-IMT and cognitive impairment was analysed using multivariate logistic regression. Results: Complete baseline data were available in 3386 subjects (mean age 67.7 [95% confidence interval (CI): 67.5, 68.0] years, 41% male). During follow-up, 174 subjects developed a new cognitive impairment. In the subgroup without cognitive impairment at baseline a significant association between cognitive decline after 2 years and elevated C-IMT at baseline could be detected with a significantly higher baseline C-IMT in those with cognitive decline (0.87mm vs. 0.78 mm; p < 0.0001). After adjustment for various risk factors only age, GDS baseline 6CIT and C-IMT were independently associated with the development of a new cognitive impairment. Conclusions: Our data indicate that an increased carotid intima-media thickness predicts a cognitive decline in an elderly population without prevalent cognitive impairment. Copyright © 2009 John Wiley & Sons, Ltd.",aged;arterial wall thickness;artery media;article;cardiovascular risk;carotid artery;cognitive defect;dementia;depression;diabetes mellitus;disease association;disease course;female;Geriatric Depression Scale;human;intima;ischemic heart disease;major clinical study;male;prediction;prospective study;rating scale,"Sander, K.;Bickel, H.;Förstl, H.;Etgen, T.;Briesenick, C.;Poppert, H.;Sander, D.",2010,,,0,
3875,Significant reduction of vascular risk factors after two years of follow-up in the population-based intervention project INVADE,"Background: The INVADE project (Intervention project of cerebrovascular diseases and dementia in the district of Ebersberg) analyzes the effect of risk factor evaluation and modification on the incidence of stroke and dementia. Here we evaluated the changes of risk factors after two years in the INVADE population, particularly in participants with diabetes mellitus and coronary heart disease (CHD). Patients and Methods: Baseline data of 3909 participants were available. In addition to common risk factors and new risk indicators, various social demographic data and life style parameters were analyzed. A guideline-based therapy was proposed for each participant based on an individual risk profile. The differences between baseline and the 2-year follow-up data were analyzed using the paired t-test and the McNemar test. Results: Complete follow-up data were available in 3185 participants (1288 men; mean age 69.5 years). For the overall project population the reduction of traditional risk factors was effective, particularly in subjects with hypertension or diabetes. The prevalence of hypertension was 76%, including 19% newly diagnosed subjects. In this subgroup, the systolic blood pressure could be reduced by 4.7 mmHg. 20.3% of the participants showed a diabetes mellitus, blood glucose level decreased about 8%. Additionally an improvement in hypertension therapy and lipid levels was seen. Comparable results were achieved in the CHD subgroup. Additionally, in the overall study population treatment with antihypertensives and statins increased significantly. Discussion: Even after two years, the INVADE project was able to reduce vascular risk factors particularly in high risk patients with diabetes and CHD. Based on these findings, the primary aim of the project, the reduction of stroke and dementia incidence, can be achieved. © Georg Thieme Verlag KG Stuttgart.",acetylsalicylic acid;anticoagulant agent;antihypertensive agent;clopidogrel;hydroxymethylglutaryl coenzyme A reductase inhibitor;aged;article;cardiovascular risk;cerebrovascular disease;controlled study;dementia;demography;diabetes mellitus;female;follow up;glucose blood level;human;hyperlipidemia;hypertension;ischemic heart disease;lifestyle;major clinical study;male;population based case control study;prevalence;cerebrovascular accident;systolic blood pressure,"Sander, K.;Horn, C. S.;Briesenick, C.;Sander, D.",2006,,,0,
3876,High-sensitivity C-reactive protein is independently associated with early carotid artery progression in women but not in men: The INVADE study,"BACKGROUND AND PURPOSE - High-sensitivity C-reactive protein (hsCRP) is known to be associated with atherosclerosis and cardiovascular events. Limited information exists regarding the importance of sex differences for the association between hsCRP and the progression of early stages of atherosclerosis. Therefore, we investigated the effect of hsCRP on early carotid atherosclerosis progression and major vascular risk factors in men and women. METHODS - We analyzed the data of INVADE (intervention project on cerebrovascular diseases and dementia in the community of Ebersberg, Bavaria), a prospective, population-based study. In addition to common risk factors, measurements of carotid intima-media-thickness and hsCRP were performed at baseline and after 2 years. RESULTS - Complete baseline data were available for 3387 subjects including 2001 women, and complete follow-up data were available for 2346 subjects. Within this study population, women were older and had higher systolic blood pressure and cholesterol levels. The prevalence of smoking and ischemic heart disease was more frequent in men. The baseline carotid intima-media-thickness was significantly higher in men compared with women (0.82 mm; 95% CI, 0.812 to 0.834 mm versus 0.77 mm; 95% CI, 0.763 to 0.779 mm; P<0.0001). Carotid intima-media-thickness progression after risk factor adjustment was significantly associated with hsCRP in women (P=0.006) but not in men (P=0.39). CONCLUSIONS - The association between hsCRP and progression of early carotid atherosclerosis shows sex differences. In further studies analyzing the role of inflammation for cardiovascular diseases and atherosclerosis, these sex differences should be considered. © 2007 American Heart Association, Inc.",C reactive protein;cholesterol;adult;aged;artery intima proliferation;artery media;article;carotid artery disease;cerebrovascular disease;cholesterol bile level;confidence interval;dementia;disease course;female;follow up;human;ischemic heart disease;major clinical study;male;population research;priority journal;prospective study;risk assessment;risk factor;sensitivity and specificity;sex difference;smoking;systolic blood pressure,"Sander, K.;Horn, C. S.;Briesenick, C.;Sander, D.",2007,,,0,
3877,Co-morbidity associated with dementia,"Purpose: The purpose of this study, was to identify, common co-morbid conditions associated with dementia subtypes and to evaluate the association of hypertension, diabetes mellitus, atrial fibrillation, congestive heart failure, and anemia with dementia subtypes relative to controls. Methods: Hospital discharge data were used to identify 15,013 subjects from South Carolina with a diagnosis of dementia between 1998 and 1999. A control group of 15,013 persons without dementia was randomly sampled from hospital discharge records and matched to persons with dementia on the basis of age, race, and gender. Multiple hospitalizations for each patient were merged, and repeated diagnoses during separate hospitalizations were counted once. Results: After adjusting for age, race, and gender, persons with Alzheimer's disease and dementia associated with medical conditions were less likely to be diagnosed with hypertension, diabetes, congestive heart failure, and atrial fibrillation than were controls. Patients with multi-infarct dementia were also less likely to have congestive heart failure, but were more likely to have diabetes. Anemia was not associated with any dementia subtype. Conclusions: There are distinct differences in comorbid conditions among dementia subtypes. Our research does not support previous studies that suggest a circulatory component to the development of Alzheimer's disease.",adult;age;aged;anemia;article;comorbidity;congestive heart failure;dementia;diabetes mellitus;disease association;female;gender;atrial fibrillation;hospital discharge;hospitalization;human;Huntington chorea;hypertension;major clinical study;male;medical record;multiinfarct dementia;race;senile dementia;United States,"Sanderson, M.;Wang, J.;Davis, D. R.;Lane, M. J.;Cornman, C. B.;Fadden, M. K.",2002,,,0,
3878,STEP--standardized assessment of elderly people in primary care,"BACKGROUND: There is a need for a standard preventive assessment scheme, which is effective, feasible and acceptable throughout European primary care. METHODS: A consensus based guideline including systematic reviews of the evidence was done by an expert panel of general practitioners (core group) and epidemiologists / geriatricians from seven European countries. RESULTS: The Step group identified 8 health domains to be considered in a preventive assessment; client's perspective and attitudes. physical state, functional state, significant symptoms, mental function, social circumstances, medication and primary preventive issues. To select the health areas with a proven preventive potential the strength of scientific evidence and the relevance to primary preventive care was assessed. The final recommendations graded as the preventive primary care impact factor as follows: A1=strongly recommended were hypertension, symptomatic heart failure, urinary incontinence, hearing impairment, vision impairment, falls, breathlessness, depression, dementia, medication review, functional status, activity and physical exercise. A2=recommended: Hypertension over the age of 80, history of myocardial infarction, symptomatic coronary heart disease, atrial fibrillation, history of TIA or stroke, peripheral vascular disease, diabetes, thyroid dysfunction, osteoporosis, lipids, faecal incontinence, weight status, foot problems, oral heath, osteoarthritis, sleeplessness, pain, social circumstances, tobacco and alcohol use, psychological support for patients with chronic disease and (national) immunization & cancer programs. CONCLUSIONS: The rising population of elderly people in Europe gives cause for health care professionals and policy makers to consider optimal ways to preserve health and function in old age. An Evidence based, proactive preventive geriatric assessment can help to promote heath and function in older people.","Age Factors;Aged;Aged, 80 and over;Consensus;Europe;*Evidence-Based Medicine;Female;Geriatric Assessment/*methods;Humans;Male;Middle Aged;Practice Guidelines as Topic;*Preventive Medicine;*Primary Health Care;Reference Standards;Risk Factors","Sandholzer, H.;Hellenbrand, W.;Renteln-Kruse, W.;Van Weel, C.;Walker, P.",2004,Dec 10,10.1055/s-2004-836107,0,
3879,Caution of overdependence on formulas while treating hyponatremia,"Use of online formulas to treat hyponatremia is a common practice. We report here that while using the same goal of correction and type of infusate to treat a patient with hyponatremia, a large discrepancy in infusion rate is obtained from using the 2 commonly available online equations. When the therapy fluid is less concentrated saline (0.9%), Adrogue's formula poses the risk of large amount of volume being administered for only a small change in serum sodium concentration. This may be detrimental especially in patients with congestive heart failure. When the therapy fluid is hypertonic saline (3%), these formulas may result in overly rapid correction. We should, thus, never use these formulas blindly in the management of patients with hyponatremia. © 2012 Elsevier Inc. All rights reserved.",adrogue formula;hydrochlorothiazide;infusion fluid;sodium;unclassified drug;aged;article;case report;congestive heart failure;decreased appetite;dementia;falling;female;fluid therapy;human;hypertension;hyponatremia;hypothyroidism;hypovolemia;infusion rate;mucosal dryness;priority journal;serum osmolality;skin turgor;sodium blood level;solute;wrist fracture,"Sandhu, G.;Zouain, E.;Chan, G.",2012,,,0,
3880,Management of elderly patients with troponin positive chest pain in a district general hospital,"Background: The number of elderly patients that present with an acute coronary syndrome (ACS) is increasing, reflecting the growing number of people in the general population in this age group. The various guidelines do not generally specify a management strategy in this elderly group and the management is often at the discretion of the treating physician. We conducted an audit within our Cardiology Department to compare our practice of management of ACS in the elderly population based on the European Society of Cardiology guidelines. Methods: We conducted a retrospective analysis of the management of patients aged 80 and above that were admitted with troponin positive chest pain from 1st January to 31st December 2010. Patient information was primarily obtained from our computer data base system that includes blood results, ECHOs, diagnostic angiograms, discharge and clinic letters. If the information was inadequate we obtained patient files or contacted the relevant general practitioner. Results: Octo-nonagenarians represented just over a third (35%) of all patients that were admitted with a troponin positive event during the study period. We noted a 10% mortality rate observed in our study population over a 12 month period. Atrial fibrillation was an incidental finding in 22% of patients. Nearly half of these patients (49%) were managed by the cardiologists. 68% of these patients underwent diagnostic coronary angiography, of which 32% went on to have percutaneous coronary intervention and 7% underwent surgical intervention. Majority (80%) of patients that underwent angioplasty had more than 1 stent and 74% of patients required more than one coronary vessel to be stented. The length of stay in hospital was double for patients who were under the care of the general medical teams rather than the cardiology team. This group also had a higher number of other comorbidities such as dementia, malignancy, a history of gastro intestinal bleeds and chronic renal impairment. Conclusions: Octo and nonagenarians represent a significant proportion of our ACS patients. They have high mortality, greater number of comorbidities, diseased coronary vessels and if intervention was undertaken required more than one stent. Therefore, octo-nonagenarians represent a very complex group of patients. Guidelines and risk stratification are of limited value in this group as clinical trial data is currently lacking. Quality of life and risk to benefit assessments are of paramount importance in this group. © 2012 Via Medica.",troponin;aged;angiocardiography;angioplasty;article;cardiogenic shock;cardiovascular mortality;comorbidity;coronary artery bypass graft;coronary artery obstruction;coronary stent;dementia;female;gastrointestinal hemorrhage;general hospital;geriatric care;geriatric patient;heart arrest;atrial fibrillation;heart palpitation;human;hypertension;incidental finding;kidney disease;length of stay;major clinical study;male;non st segment elevation acute coronary syndrome;non ST segment elevation myocardial infarction;percutaneous coronary intervention;pneumonia;practice guideline;prevalence;repeat procedure;retrospective study;sex ratio,"Sandhu, K. S.;Singh, A.;Nadar, S. K.",2012,,,0,
3881,Influence of T-786C polymorphism on the promoter activity of eNOS,,endothelial nitric oxide synthase;messenger RNA;allele;Alzheimer disease;cell isolation;endothelium cell;genetic association;genetic polymorphism;genetic variability;genotype;heart infarction;human;letter;linkage analysis;peripheral blood mononuclear cell;priority journal;promoter region;protein expression;shear stress;umbilicus,"Sandrim, V. C.",2006,,,0,
3882,Predicting change in functional status over quarterly intervals for older adults enrolled in the PACE community-based long-term care program,"BACKGROUND AND AIMS: Many frail older adults experience multiple changes in activities of daily living (ADL) functioning over the course of a year. Accurate predictions of ADL status over quarterly intervals may improve the precision of care planning for older adults who seek long-term care in the community. The study sought to develop and validate a model that predicts older adults' ADL status over quarterly intervals. METHODS: The study included 3127 enrollees from 11 Program of All Inclusive Care for the Elderly (PACE) sites. Nurses assessed ADL status quarterly. Potential predictors included baseline assessment of age, sex, race, and living situation and quarterly assessments of prior functioning, co-morbidities, prior hospitalizations, and mental status. RESULTS: Change in level of functioning occurred for 30% of quarterly observations. Predictors of functioning at the end of a quarter were prior ADL change, prior hospitalization, living with others, impaired mental status, cancer, dementia, coronary artery disease, congestive heart failure and chronic obstructive pulmonary disease. When the model was applied to the validation observations, 93% of predictions were within one level and 72% of the predictions were the same level of ADL functioning observed at the end of the quarter. CONCLUSIONS: In a sample of community-living ADL-disabled older adults, changes in functional status over a quarter were common and associated with functional and health status at the beginning of the quarter. Further validation of the model may result in an index that helps clinicians better predict future ADL needs of community-living older adults who need long-term care.","*Activities of Daily Living;Adult;Aged;Aged, 80 and over;Cohort Studies;Female;*Frail Elderly;*Geriatric Assessment;Housing for the Elderly;Humans;Male;Predictive Value of Tests;Skilled Nursing Facilities","Sands, L. P.;Xu, H.;Craig, B. A.;Eng, C.;Covinsky, K. E.",2008,Oct,,0,
3883,Psychotic and senile patients with ischemic heart disease,,"Aged;Aged, 80 and over;*Dementia;*Heart Diseases;Humans;*Mental Disorders;*Myocardial Ischemia;*Psychotic Disorders;*HEART DISEASES/in old age;*Psychoses, senile","Sanen, F. J.",1960,Jun,,0,
3884,Difficult cases in heart failure: the challenge of neurocognitive dysfunction in severe heart failure,"Often ignored, neurocognitive dysfunction in chronic heart failure represents a daunting morbidity progressing to loss of self-reliance. Although the precise mechanisms arbitrating the development of this disorder remain elusive, microembolization and cerebral hypoperfusion are implicated. Other causes of cognitive decline may include prior cardiac surgery, chronic hypertension, sleep disordered breathing, hyperhomocysteinemia, dementia of aging, and more traditional causes such as Alzheimer's disease. The discovery of neurocognitive defects in heart failure must prompt a well-constructed diagnostic evaluation to search for the underlying causes since this process may be at least partially reversible in many cases. Copyright 2002 CHF, Inc",article;case report;cognitive defect;congestive heart failure;dementia;female;human;middle aged,"Sangha, S. S.;Uber, P. A.;Park, M. H.;Scott, R. L.;Mehra, M. R.",2002,,,0,
3885,Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing,"Purpose: This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. Methods: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75 years and olderwere randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteriawere used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicatorswere used. An analysis to assess factors associated with IP was performed. Results: 672 patients [median age (Q1Q3) 82 (7986) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1Q3 713). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria thanwith the Beers criteria (p < 0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p < 0.001) was observed. Polypharmacy (≥10 medicines) was the strongest predictor of IP [OR = 11.34 95% confidence interval (CI) 4.9625.94], PIMs [OR = 14.16, 95% CI 6.4431.12], Beers-listed PIMs [OR = 8.19, 95% CI 3.0122.28] and STOPP-listed PIMs [OR = 8.21, 95% CI 3.4719.44]. PIMs was the strongest predictor of PPOs [OR = 2.79, 95% CI 1.814.28]. Conclusions: A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.",angiotensin receptor antagonist;anticoagulant agent;benzodiazepine derivative;dipeptidyl carboxypeptidase inhibitor;diuretic agent;furosemide;omeprazole;paracetamol;tricyclic antidepressant agent;aged;article;assessing care of vulnerable elders;Barthel index;cerebrovascular disease;chronic obstructive lung disease;cognition;cohort analysis;comparative study;controlled study;daily life activity;dementia;diabetes mellitus;female;geriatric patient;heart failure;hospital admission;hospitalization;human;hypertension;inappropriate prescribing;major clinical study;male;assessment of humans;observational study;polypharmacy;Potentially Inappropriate Medicine;prospective study;screening tool of older person's prescription;screening tool to alert doctors to right treatment,"San-José, A.;Agustí, A.;Vidal, X.;Formiga, F.;López-Soto, A.;Fernández-Moyano, A.;García, J.;Ramírez-Duque, N.;Torres, O. H.;Barbé, J.",2014,,,0,
3886,"Mortality, material deprivation and urbanization: Exploring the social patterns of a metropolitan area","Introduction: Socioeconomic inequalities affecting health are of major importance in Europe. The literature enhances the role of social determinants of health, such as socioeconomic characteristics and urbanization, to achieve health equity. Yet, there is still much to know, mainly concerning the association between cause-specific mortality and several social determinants, especially in metropolitan areas. This study aims to describe the geographical pattern of cause-specific mortality in the Lisbon Metropolitan Area (LMA), at small area level (parishes), and analyses the statistical association between mortality risk and health determinants (material deprivation and urbanization level). Fourteen causes have been selected, representing almost 60 % of total mortality between 1995 and 2008, particularly those associated with urbanization and material deprivation. Methods: A cross-sectional ecological study was carried out. Using a hierarchical Bayesian spatial model, we estimated sex-specific smoothed Standardized Mortality Ratios (sSMR) and measured the relative risks (RR), and 95 % credible intervals, for cause-specific mortality relative to 1. urbanization level, 2. material deprivation and 3. material deprivation adjusted by urbanization. Results: The statistical association between mortality and material deprivation and between mortality and urbanization changes by cause of death and sex. Dementia and MN larynx, trachea, bronchus and lung are the causes of death showing higher relative risk associated with urbanization. Infectious and parasitic diseases, Chronic liver disease and Diabetes are the causes of death presenting higher relative risk associated with material deprivation. Ischemic heart disease was the only cause with a statistical association with both determinants, and MN female breast was the only without any statistical association. Urbanization level reduces the impact of material deprivation for most of the causes of death. Men face a higher impact of material deprivation and urbanization level, than women, in most cause-specific mortality, even when considering the adjusted model. Conclusions: Our findings explore the specific pattern of fourteen causes of death in LMA and reveals small areas with an excess risk of mortality associated with material deprivation, thereby identifying problematic areas that could potentially benefit from public policies effecting social inequalities.",adolescent;adult;aged;article;Bayes theorem;bronchus disease;cause of death;chronic liver disease;cross-sectional study;dementia;diabetes mellitus;disease association;ecological study;female;geographic distribution;health care policy;high risk population;human;infection;ischemic heart disease;larynx disorder;lung disease;major clinical study;male;material deprivation;mortality;parasitosis;Portugal;priority journal;risk factor;sex difference;social determinants of health;social status;standardized mortality ratio;study design;trachea disease;trend study;urban area;urbanization,"Santana, P.;Costa, C.;Marí-Dell'Olmo, M.;Gotsens, M.;Borrell, C.",2015,,,0,
3887,Donepezil in the treatment of mild to moderate Alzheimer's disease: Report of a Belgian multicenter study,"In this report the results of a Belgian multicenter 24-week open-label study with donepezil in the treatment of mild to moderate Alzheimer's disease are described. Efficacy and safety were evaluated in a sample of 200 patients recruited in 25 Belgian centers. No significant changes could be found in cognition and behaviour over this 6-month period. Changes in daily functioning were small. Safety data were comparable to those reported in international trials. These results suggest that the findings of more robust double-blind, placebo-controlled studies can be confirmed in real life situations.",cholinesterase inhibitor;donepezil;abdominal pain;accident;aged;Alzheimer disease;angina pectoris;anorexia;anxiety disorder;article;behavior;Belgium;bronchitis;bronchopneumonia;cardiovascular disease;clinical trial;cognition;confusion;controlled clinical trial;controlled study;daily life activity;dehydration;depression;diarrhea;disease severity;diverticulitis;drug efficacy;drug fatality;drug safety;dyspepsia;extrapyramidal syndrome;female;fracture;headache;hostility;human;hyperventilation;injury;lung edema;major clinical study;malaise;male;multicenter study;nausea;nervousness;osteoarthritis;pain;peptic ulcer;restlessness;skin ulcer;subdural hematoma;suicide attempt;faintness;vertigo;xerostomia,"Santens, P.;Ventura, M.",2003,,,0,
3888,Subcortical hyperintensities in the cholinergic system are associated with improvements in executive function in older adults with coronary artery disease undergoing cardiac rehabilitation,"OBJECTIVE: Coronary artery disease (CAD) is frequently accompanied by white matter hyperintensities and executive dysfunction. Because acetylcholine is important in executive function, these symptoms may be exacerbated by subcortical hyperintensities (SH) located in cholinergic (CH) tracts. This study investigated the effects of SH on cognitive changes in CAD patients undergoing a 48-week cardiac rehabilitation program. METHODS: Fifty patients (age 66.5 +/- 7.1 years, 84% male) underwent the National Institute of Neurological Disorders and Stroke - Canadian Stroke Network neurocognitive battery at baseline and 48 weeks. Patients underwent a 48-week cardiac program and completed neuroimaging at baseline. Subcortical hyperintensities in CH tracts were measured using Lesion Explorer. Repeated measures general linear models were used to examine interactions between SH and longitudinal cognitive outcomes, controlling for age, education, and max VO2 change as a measure of fitness. RESULTS: In patients with SH in CH tracts, there was a significant interaction with the Trail Making Test (TMT) part A and part B over time. Patients without SH improved on average 16.6 and 15.0% on the TMT-A and TMT-B, respectively. Patients with SH on average showed no improvements in either TMT-A or TMT-B over time. There were no significant differences in other cognitive measures. CONCLUSION: These results suggest that CAD patients with SH in CH tracts improve less than those without SH in CH tracts, over 48 weeks of cardiac rehabilitation. Thus, SH in CH tracts may contribute to longitudinal cognitive decline following a cardiac event and may represent a vascular risk factor of cognitive decline. (c) 2017 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.",cerebrovascular disease;cognition;executive function;neuroimaging;vascular dementia;white matter disease,"Santiago, C.;Herrmann, N.;Swardfager, W.;Saleem, M.;Oh, P. I.;Black, S. E.;Bradley, J.;Lanctot, K. L.",2017,May 05,,0,
3889,White Matter Microstructural Integrity Is Associated with Executive Function and Processing Speed in Older Adults with Coronary Artery Disease,"OBJECTIVE: Coronary artery disease (CAD) is associated with an increased risk of cognitive decline. Although cerebral white matter (WM) damage predicts cognitive function in CAD, conventional neuroimaging measures only partially explain the effect of CAD on cognition. The purpose of this study was to determine if WM microstructural integrity and CAD using diffusion tensor imaging (DTI) correlates with cognitive function in older adults with CAD. METHODS: Forty-nine CAD patients (66 +/- 7 years old, 86% male) underwent neurocognitive assessments using the cognitive battery recommended by the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network for the study of vascular cognitive impairment. Composite scores for each cognitive domain were calculated. Microstructural integrity in normal-appearing WM was quantified as fractional anisotropy (FA) using DTI in nine bilateral and two interhemispheric WM tracts from the Johns Hopkins University WM Tractography Atlas. Linear regression models examined associations between FA and cognitive performance, controlling for age, sex, and education, with correction for multiple comparisons using a false discovery rate of 5%. RESULTS: Executive function was most significantly associated with FA in the left parahippocampal cingulum (beta = 0.471, t = 3.381, df = 44, p = 0.002) and left inferior fronto-occipital fasciculus (beta = 0.430, t = 2.984, df = 44, p = 0.005). FA was not associated with memory in any of the WM tracts examined. CONCLUSION: These results suggest that WM microstructural integrity may be an important neural correlate of executive function even in cognitively intact CAD patients. This study suggests WM damage may be relevant to subtle cognitive decline in a population that may have early neural risk for dementia.","Aged;Aged, 80 and over;Anisotropy;Canada;Cognition/*physiology;Coronary Artery Disease/*physiopathology/psychology;Cross-Sectional Studies;Diffusion Tensor Imaging;Executive Function/*physiology;Female;Humans;Imaging, Three-Dimensional;Linear Models;Magnetic Resonance Imaging;Male;Middle Aged;Neuropsychological Tests;White Matter/*ultrastructure;Cerebrovascular disease;cognition;executive function;vascular dementia;white matter disease","Santiago, C.;Herrmann, N.;Swardfager, W.;Saleem, M.;Oh, P. I.;Black, S. E.;Lanctot, K. L.",2015,Jul,10.1016/j.jagp.2014.09.008,0,
3890,Autonomic Cardiac Function in Preclinical Alzheimer's Disease,"To explore early autonomic cardiac changes in pre-clinical Alzheimer's disease (AD), we have evaluated electrocardiologic measures of vagal tone for 63 adults (ages 55-75) at rest, during cognitive testing, and then again at rest. All subjects had multiple risk factors for AD, and all completed amyloid PET scans (18F-Florbetapir) to determine amyloid positivity (Abeta+). No change in electrocardiographic measures were observed for Abeta+ participants under each testing condition, whereas Abeta-subjects showed an expected increase in vagal tone during the cognitive stress condition. These findings suggest an early relationship between cortical Abeta accumulation, a precursor to AD development, and autonomic cardiac function.",Aging;Alzheimer's disease;cardiac;heart rate variability;resting sinus arrhythmia;vagal tone,"Santos, C. Y.;Machan, J. T.;Wu, W. C.;Snyder, P. J.",2017,,,0,
3891,Delirium in elderly patients,"It is estimated that the 'number of elderly in the population' of Brazil will result in an unprecedented increase to 32 million by 2025. Delirium affects the geriatric population 3-4 times more commonly than in other population groups. Until now, little has been written about the factors responsible for the altered mental status seen in delirium. Given the frequency of delirium and the increase in the vulnerable population of elders, it is incumbent on the medical community to improve understanding of the pathogenesis of this condition. At times, delirium is the first symptom or signal of an acute illness or drug intoxication. The phathophysiology continues to be uncertain. Delirium can present with mental status changes varying from hyper-alert hyperactive, hyperalert-hypoactive and mixed states. The condition should be in the differential diagnosis of any geriatric patient presenting with new onset mental status changes or functional psychosis. Diagnosis is based on the clinical history, physical examination and search for an acute illness especially changes in breathig and cardiac function that lead to cerebral ischemia, or impaired oxygenation of the brain. Treatment is based on recognition of an underlying illness and its appropriate treatment. Clearly prevention is the best treatment. Much can be done to decrease the incidence of this devastating change in brain function by insuring adequate brain oxygenation and providing appropriate supportive care.",acetophenazine;antiparkinson agent;chlorpromazine;chlorprothixene;cholinergic receptor blocking agent;clozapine;fluphenazine;haloperidol;histamine H2 receptor antagonist;hypnotic sedative agent;loxapine;molindone;narcotic analgesic agent;neuroleptic agent;promazine;risperidone;thioridazine;tiotixene;trifluoperazine;aged;anticholinergic effect;article;clinical feature;delirium;dementia;differential diagnosis;drug activity;geriatric patient;human;hypotension;incidence;intraoperative period;laboratory diagnosis;neuropathology;postoperative period;preoperative period;prognosis;psychosis;sedation,"Santos, F. S.;Babichak, A. C.;Amaral, A.",2000,,,0,
3892,Allelic frequencies at the ACE and LRPAP1 loci suggest age-related relationships in a northern Italian population,"The present work attempts to determine the distribution of ACE and LRPAP1 genotypes and allele frequencies in a sample of the population of north-western Italy and to examine the age-related association of these polymorphisms. ACE D allele frequency found in this work further confirms data obtained in previous studies of Northern Italian populations. Regarding the LRPAP1 gene, high frequencies of the deleted allele in European populations were also confirmed. In order to analyse the relationship between ACE and LRPAP1 gene polymorphisms and age, the sample was subdivided into four age groups: 1-30 (n= 99), 31-50 (n= 165), 51-79 (n= 146) and 80-100 years old (n= 57). For the ACE gene, significant difference in D/D genotype frequency was found only between the younger and the 51-79 age groups (p<0.05), the latter showing the lower frequency value. Significant differences were found, for both the I/D and D/D LRPAP1 genotypes, between the first and the second age group (p < 0.02) and between the first and the third age group (p < 0.01), with the 51-79 age group showing the higher D/D and the lower I/D genotype frequency values.","Adolescent;Adult;Aged;Aged, 80 and over;Aging/*genetics;Alzheimer Disease/genetics;Child;Child, Preschool;Coronary Artery Disease/genetics;European Continental Ancestry Group;Female;*Gene Frequency;Genotype;Humans;Infant;Italy;LDL-Receptor Related Protein-Associated Protein/*genetics;Male;Middle Aged;Peptidyl-Dipeptidase A/*genetics;*Polymorphism, Genetic","Santovito, A.;Bulgarello, C.;Cervella, P.;Bigatti, M. P.;Delpero, M.",2007,Jan-Feb,,0,
3893,Diabetes is associated with a slower rate of cognitive decline in Alzheimer disease,"BACKGROUND: Previous epidemiologic studies indicate that diabetes mellitus (DM) is associated with cognitive decline and an increased risk of developing Alzheimer disease (AD) in people who do not have dementia. However, little is known about the effect of DM on the rate of cognitive decline in established AD. Our objective was to determine whether DM influences the rate of cognitive decline in patients with AD. METHODS: A total of 608 patients with a probable diagnosis of AD and a Mini-Mental State Examination (MMSE) score between 10 and 26 were enrolled in a prospective multicenter study. Participants were followed up to 52 (mean 26) months. DM was assessed at baseline (history of DM or antidiabetic medication use). Cognitive function was assessed twice yearly with the MMSE. RESULTS: Sixty-three participants (10.4%) had DM at baseline. In a mixed model adjusted for sex, age, educational level, dementia severity, cholinesterase inhibitor use, and vascular factors (hypertension, atrial fibrillation, coronary heart disease, and hypercholesterolemia), there were no differences between the groups in MMSE baseline scores (-0.75, p = 0.20), but cognitive decline was slower in the group with DM (0.38, p = 0.01). CONCLUSIONS: In a cohort of community-dwelling patients with Alzheimer disease (AD), the presence of diabetes mellitus (DM) was associated with a lower rate of cognitive decline. Future studies will need to address the potential impact of DM in the cerebral aging process and to assess the neuropathologic variations in patients with AD with DM.","Aged;Aged, 80 and over;Alzheimer Disease/*complications/diagnosis/*epidemiology;Cognition Disorders/diagnosis/*epidemiology;Diabetes Complications/*epidemiology;Diabetes Mellitus/diagnosis/drug therapy/*epidemiology;Disease Progression;Female;Follow-Up Studies;France/epidemiology;Humans;Hypoglycemic Agents/therapeutic use;Male;Neuropsychological Tests;Prognosis;Prospective Studies;Severity of Illness Index;Time Factors","Sanz, C.;Andrieu, S.;Sinclair, A.;Hanaire, H.;Vellas, B.",2009,Oct 27,10.1212/WNL.0b013e3181bd80e9,0,
3894,IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke,"BACKGROUND: A predictive model of stroke mortality may be useful for clinicians to improve communication with and care of hospitalized patients. Our aim was to identify predictors of mortality and to develop and validate a risk score model using information available at hospital presentation. METHODS AND RESULTS: This retrospective study included 12 262 community-based patients presenting with an acute ischemic stroke at multiple hospitals in Ontario, Canada, between 2003 and 2008 who had been identified from the Registry of the Canadian Stroke Network (8223 patients in the derivation cohort, 4039 in the internal validation cohort) and the Ontario Stroke Audit (3720 for the external validation cohort). The mortality rates for the derivation and internal validation cohorts were 12.2% and 12.6%, respectively, at 30 days and 22.5% and 22.9% at 1 year. Multivariable predictors of 30-day and 1-year mortality included older age, male sex, severe stroke, nonlacunar stroke subtype, glucose >/=7.5 mmol/L (135 mg/dL), history of atrial fibrillation, coronary artery disease, congestive heart failure, cancer, dementia, kidney disease on dialysis, and dependency before the stroke. A risk score index stratified the risk of death and identified low- and high- risk individuals. The c statistic was 0.850 for 30-day mortality and 0.823 for 1-year mortality for the derivation cohort, 0.851 for the 30-day model and 0.840 for the 1-year mortality model in the internal validation set, and 0.790 for the 30-day model and 0.782 for the 1-year model in the external validation set. CONCLUSION: Among patients with ischemic stroke, factors identifiable within hours of hospital presentation predicted mortality risk at 30 days and 1 year. The predictive score may assist clinicians in estimating stroke mortality risk and policymakers in providing a quantitative tool to compare facilities.","Acute Disease;Aged;Aged, 80 and over;Brain Ischemia/diagnosis/*mortality;Female;Hospitalization/statistics & numerical data;Humans;Male;Middle Aged;*Models, Statistical;Ontario/epidemiology;Patient Discharge/*statistics & numerical data;Predictive Value of Tests;Reproducibility of Results;Retrospective Studies;Risk Adjustment/methods;Risk Factors;*Severity of Illness Index;Stroke/diagnosis/*mortality","Saposnik, G.;Kapral, M. K.;Liu, Y.;Hall, R.;O'Donnell, M.;Raptis, S.;Tu, J. V.;Mamdani, M.;Austin, P. C.",2011,Feb 22,10.1161/circulationaha.110.983353,0,
3895,Hematologic complications of the elderly,"Hematologic complications in older patients present a many-faceted management problem. The etiology of anemia alone - the most common blood disorder in the geriatric population - encompasses a maze of possibilities. The clinician must discover, classify, and treat the anemia, and search out underlying causes. Anemia may herald other serious hematologic complications and may exacerbate such concomitant disorders as chronic obstructive pulmonary disease (COPD), congestive heart failure, angina pectoris, and cerebrovascular insufficiency. In addition, confusion resulting from the effects of anemia is easy to misdiagnose as dementia. This discussion covers basic management concepts to bear in mind in managing anemia and other important hematologic disorders in older patients.",alcohol;chloramphenicol;isoniazid;lead;acute myeloblastic leukemia;aged;blood and hemopoietic system;human;neutropenia;preleukemia;short survey;sideroblastic anemia;thrombocytopenia,"Sapra, R.;Armentrout, S. A.",1984,,,0,
3896,Functional Status is a Predictor of Postoperative Complications After Cancer Surgery in the Very Old,"Background: The association between preoperative functional status and postoperative complications after cancer surgery is very well described in the ‘youngest old’ population; however, limited information is available for the very old (i.e. those aged 80 years and older). Objective: Our aim was to evaluate whether functional status, expressed as metabolic equivalents (METs), is a predictor of adverse postoperative outcomes in very old patients. Methods: In a retrospective cohort study, we included all patients aged 80 years or older who underwent elective oncological surgery at a tertiary hospital in Brazil in 2011. The primary outcome was postoperative complications up to 30 days after surgery. Functional status was evaluated using a simple questionnaire, which classified participants into three groups based on METs. We used logistic regression models to investigate the association between functional status and the occurrence of complications, adjusted for possible confounders. Results: We analyzed data from 138 patients aged 80 years or older. The mean age of the sample was 84.2 ± 4.2 years and 52% were female; 65% of the procedures were classified as low risk and 35% were classified as intermediate risk. Regarding functional status, 72% of the sample had a performance equivalent to fewer than 4 METs, 27% had 4–6 METs, and 1% had more than 6 METs. Postoperative complications were observed in 25%, and the mortality rate was 2%. Better functional status was associated with reduced odds of postoperative complications in multivariate analysis (odds ratio 0.11, 95% confidence interval 0.02–0.85; p = 0.034). Conclusion: Functional status seems to be related to surgical morbidity in the very old.",abdominal surgery;aged;anemia;article;bladder cancer;Brazil;cancer surgery;cardiovascular disease;cohort analysis;comorbidity;controlled study;creatinine clearance;dementia;diabetes mellitus;digestive system cancer;female;functional status;general anesthesia;head and neck cancer;heart failure;hospitalization;human;hypertension;length of stay;major clinical study;male;metabolic equivalent;mortality rate;neurosurgery;operation duration;orchiectomy;orthopedic surgery;postoperative complication;prediction;prostate cancer;questionnaire;retrospective study;skin surgery;spinal anesthesia;surgical risk;tertiary care center;transurethral resection;urogenital tract cancer;very elderly,"Saraiva, M. D.;Karnakis, T.;Gil-Junior, L. A.;Oliveira, J. C.;Suemoto, C. K.;Jacob-Filho, W.",2017,,10.1245/s10434-017-5783-9,0,
3897,The correlation between chronic diseases and quality of life among the elderly,"Introduction and objective: Increased life expectancy is one of the achievements of the 21st century accompanied by the growing trend of chronic diseases. This study attempted to investigate the relationship between chronic diseases and quality of life among the elderly living in South East of Iran in 2015. Materials and methods: This was a cross-sectional, descriptive and analytical study on 425 people aged 60 years and older living in South-East of Iran. The sampling was multi-stage, while the research tool involved the abridged Persian version ofSF-36 questionnaire and the history of chronic diseases checklist. Data were analyzed through descriptive statistics, t-test, chi-square and Pearson correlation coefficient. Findings: The mean age of the elderly under study was 70.17±7.56. Moreover, %82.4 of the elderly suffered from at least one chronic disease. There was a significant statistical difference between the mean scores of the quality of life of patients with chronic diseases and healthy elderly (p<001.0). The quality of jobs was significantly correlated in most of the dimensions with education level, income and economic situation (p<05.0). Conclusions: The findings suggested that the increasing number of chronic illnesses reduces quality of life. Proper training in order to encourage the elderly can be effective in adopting healthy behaviors aimed at promoting health.",aged;Alzheimer disease;arthritis;article;cardiovascular disease;chi square test;chronic disease;consciousness;controlled study;correlation coefficient;cross-sectional study;dementia;demography;depression;diabetes mellitus;digestive system function disorder;education;female;health behavior;health promotion;health status;hearing impairment;heart infarction;human;hypertension;income;Iran;life expectancy;Likert scale;lipid blood level;low back pain;major clinical study;male;neoplasm;osteoporosis;quality of life;questionnaire;respiratory tract disease;sample size;scoring system;Short Form 36;Social Functioning Scale;social interaction;speech disorder;Student t test,"Sarani, M.;Karimzaei, T.;Mohseni, M.;Ahmadi-Pour, H.;Tabatabaei, V. A.;Saravani, S.;Shahrakivahed, A.",2016,,,0,
3898,Cancer-specific administrative data-based comorbidity indices provided valid alternative to Charlson and National Cancer Institute Indices,"Objective We aimed to develop and validate administrative data-based comorbidity indices for a range of cancer types that included all relevant concomitant conditions. Study Design and Settings Patients diagnosed with colorectal, breast, gynecological, upper gastrointestinal, or urological cancers identified from the National Cancer Registry between July 1, 2006 and June 30, 2008 for the development cohort (n = 14,096) and July 1, 2008 to December 31, 2009 for the validation cohort (n = 11,014) were identified. A total of 50 conditions were identified using hospital discharge data before cancer diagnosis. Five site-specific indices and a combined site index were developed, with conditions weighted according to their log hazard ratios from age- and stage-adjusted Cox regression models with noncancer death as the outcome. We compared the performance of these indices (the C3 indices) with the Charlson and National Cancer Institute (NCI) comorbidity indices. Results The correlation between the Charlson and C3 index scores ranged between 0.61 and 0.78. The C3 index outperformed the Charlson and NCI indices for all sites combined, colorectal, and upper gastrointestinal cancer, performing similarly for urological, breast, and gynecological cancers. Conclusion The C3 indices provide a valid alternative to measuring comorbidity in cancer populations, in some cases providing a modest improvement over other indices. © 2014 Elsevier Inc. All rights reserved.",adult;aged;alcohol abuse;anemia;angina pectoris;anxiety disorder;article;asthma;behavior disorder;bladder cancer;blood clotting disorder;bone disease;breast cancer;cancer diagnosis;cancer patient;cancer registry;cerebrovascular disease;Charlson Comorbidity Index;chronic obstructive lung disease;colorectal cancer;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;endocrine disease;endometrium cancer;enteropathy;epilepsy;ethnicity;eye disease;female;follow up;gastrointestinal disease;heart arrhythmia;heart infarction;hepatitis;hospital discharge;hospitalization;human;hypertension;inner ear disease;kidney cancer;liver cancer;liver disease;major clinical study;male;malnutrition;metabolic disorder;middle aged;national health organization;neurologic disease;obesity;osteoporosis;ovary cancer;priority journal;spine disease;stomach cancer;urinary tract disease;valvular heart disease;vein insufficiency,"Sarfati, D.;Gurney, J.;Stanley, J.;Salmond, C.;Crampton, P.;Dennett, E.;Koea, J.;Pearce, N.",2014,,,0,
3899,Comorbidity among patients with colon cancer in New Zealand,"Aims To identify patient factors that are associated with a higher risk of comorbidity, and to assess the impact of comorbidity on risk of in-hospital death, length of stay and 5-year all-cause survival among a large cohort of patients with colon cancer in New Zealand. Methods Comorbidity data were collected from patients who were diagnosed with colon cancer and admitted to public hospitals during 1996-2003. The comorbidity measures included all conditions listed in the Charlson Comorbidity Index, as well as a predetermined list of additional conditions. We examined predictors of higher comorbidity scores. We also measured the impact of comorbidity on in-hospital death, length of stay and 5-year all-cause survival using logistic, linear and Cox proportional hazard regression models to adjust for confounding by sex, age, ethnicity, extent of disease and area level deprivation. Results There were 11,524 patients included in the study. 7.5% of females and 10.3% of men had Charlson scores of three or more. Higher comorbidity scores were associated with increasing age, and were more common among males, Maori and Pacific people, those with unknown extent of disease and those living in the most deprived quintile of New Zealand. Those with Charlson scores _3 had a higher risk of in-hospital death (OR=4.8; 95% CI 3.5-6.6), longer lengths of hospital stay (0.14 days 95% CI 0.08-0.2) and lower 5-year survival HR=2.0; 95%CI=1.8-2.3) compared with those with a score of 0. Conclusion This study confirms that comorbidity is common among colon cancer patients in New Zealand, and has an adverse and independent effect on outcomes related to mortality and length of hospital stay. © NZMA.",acquired immune deficiency syndrome;adult;age;aged;angina pectoris;article;cancer patient;chronic respiratory tract disease;colon cancer;comorbidity;congestive heart failure;connective tissue disease;dementia;enteritis;essential hypertension;ethnicity;female;heart arrhythmia;heart infarction;hemiplegia;hospital admission;human;kidney disease;length of stay;liver disease;lung embolism;major clinical study;male;mental disease;mortality;New Zealand;outcome assessment;paraplegia;peripheral vascular disease;scoring system;sex,"Sarfati, D.;Tan, L.;Blakely, T.;Pearce, N.",2011,,,0,
3900,Recent patterns and predictors of neurological mortality among hospitalized patients in Central Ghana,"Background Although neurological disorders are projected to escalate globally in the coming decades, there is a paucity of enumerated data on the burden, spectrum and determinants of outcomes of adult neurological admissions in resource-limited settings, especially within sub-Saharan Africa. Objective To evaluate the diversity, demography, and determinants of mortality among adult patients presenting with neurological disorders over a 6-year period in a tertiary medical referral institution in the Central belt of Ghana. Methods A retrospective analysis of data on neurological admissions and in-patient outcomes between 2008 and 2013 was undertaken. Data collected for analyses included age, gender, neurological diagnosis, documented comorbidities, duration of admission and vital status at discharge. Predictors of in-patient mortality were evaluated using Kaplan-Meier survival curves and Cox Proportional Hazards regression models. Results The 6494 admissions with neurological disorders represented 15.0% of all adult medical admissions over the study period. Male-to-female ratio of admissions was 1.6:1.0 with a mean ± SD age of 52.9 ± 20 years. The commonest neurological disorders were Cerebrovascular, Infectious, Seizures/epilepsy, Alcohol-use and Spinal cord disorders representing 54.0%, 26.7%, 10.3%, 4.0% and 2.3% of admissions respectively. Despite the low national HIV prevalence of 2.0%, the frequency of HIV infection among patients with infectious disorders of the nervous system was 40.9%. Overall crude mortality rate for neurologic admissions was 30.6% being 39.1% and 33.9% for Infectious affectations of the nervous system and stroke respectively and 7.4% for seizure disorders. Probability of death was higher for females than males aHR (95% CI) of 1.53 (1.40-1.68) and increasing age aHR (95% CI) of 1.11 (1.06-1.17) for each 20-year increase in age. Conclusion Almost one in three patients admitted with neurological disease to a tertiary care center in Ghana died in the hospital, and the majority of these deaths were due to non-communicable conditions. Enhanced multi-dimensional public health disease prevention strategies and neurological inpatient care processes are warranted.",acoustic neurinoma;adult;alcohol consumption;alcohol intoxication;alcoholism;Alzheimer disease;arachnoid cyst;article;aspiration pneumonia;atrial fibrillation;bacterial infection;Bell palsy;brain atrophy;brain damage;brain hemorrhage;brain ischemia;brain tumor;breast metastasis;bulbar paralysis;cavernous sinus thrombosis;cellulitis;cerebral palsy;cerebrovascular accident;cerebrovascular disease;chronic kidney disease;congestive heart failure;degenerative disease;demography;diabetes mellitus;dysglycemia;encephalomalacia;epilepsy;female;gastroenteritis;glioma;Guillain Barre syndrome;hospital admission;hospital patient;hospital readmission;human;Human immunodeficiency virus infection;Human immunodeficiency virus prevalence;hypertension;hypophysis adenoma;idiopathic intracranial hypertension;infection;major clinical study;male;mortality;mortality rate;motor neuron disease;multiinfarct dementia;myelitis;neurofibromatosis;neuroleptic malignant syndrome;neurologic disease;normotensive hydrocephalus;outcome assessment;paraplegia;Parkinson disease;pneumonia;priority journal;recurrent disease;retrospective study;seizure;sepsis;sex difference;spinal cord disease;subdural hematoma;symptomatic epilepsy;toxoplasmosis;transient ischemic attack;urinary tract infection;urosepsis;Wernicke Korsakoff syndrome;withdrawal syndrome,"Sarfo, F. S.;Awuah, D. O.;Nkyi, C.;Akassi, J.;Opare-Sem, O. K.;Ovbiagele, B.",2016,,,0,
3901,Protein sumoylation and human diseases,"The covalent attachment of SUMO polypeptides, or sumoylation, is an important regulator of the functional properties of many proteins. Among these are many proteins implicated in human diseases including cancer, Huntington's, Alzheimer's, and Parkinson's Diseases, as well as spinocerebellar ataxia 1, and amyotrophic lateral sclerosis. Two more recent additions to the list of human disease-associated proteins that are sumoylated are amyloid precursor protein and lamin A. APP sumoylation modulates A-beta peptide levels, suggesting a potential role in Alzheimer's Disease, and decreased lamin A sumoylation due to mutations near its SUMO site has been implicated in causing some forms of familial dilated cardiomyopathy. The findings of involvement of sumoylation in human diseases have sparked significant interest in finding pharmacologic and other mechanisms for altering the sumoylation of proteins in the cell, with the goal of developing new therapeutic interventions for combating these diseases. © 2012 Elsevier Masson SAS. All rights reserved.",lamin;synuclein;SUMO 1 protein;protein;lamin A;amyloid precursor protein;amyloid beta protein;polypeptide;sumoylation;human;neoplasm;amyotrophic lateral sclerosis;laminopathy;diseases;heart;mutation;spinocerebellar degeneration;congestive cardiomyopathy;Alzheimer disease;Parkinson disease,"Sarge, K. D.;Park-Sarge, O. K.",2012,,,0,
3902,Effect of tracheostomy with imipramine on apneusis attacks in a girl with Rett syndrome,"A girl with Rett syndrome was suffered from severe apneusis attacks, resulting in cardiopulmonary arrest, which required resuscitation. Her apneusis attacks did not respond at all to diazepam, magnesium citrare or tricyclic antidepressants but ceased by tracheostomy with oral imipramine. The breathing abnormality appeared to involve difficulty in terminating inspiration. This supports the idea that a lack of serotonin may cause her apneusis attacks.",diazepam;imipramine;magnesium citrate;serotonin;tricyclic antidepressant agent;apnea attack;article;cardiopulmonary arrest;case report;female;human;resuscitation;Rett syndrome;tracheostomy,"Sasaki, K.",2012,,,0,
3903,Chronic kidney disease: A risk factor for dementia onset: A population-based study. the Osaki-Tajiri project,"OBJECTIVES: To examine the relationship between the incidence of dementia and chronic kidney disease (CKD). DESIGN: Longitudinal data analyses. SETTING: Baseline data and follow-up data from the Osaki-Tajiri Project. PARTICIPANTS: The Tajiri Project dementia prevalence study in 1998 involved 497 community-dwelling, older men and women (346 with Clinical Dementia Rating score (CDR) of 0 (healthy), 119 with a CDR of 0.5 (questionable dementia), and 32 with a CDR of 1 or greater (dementia)). Two hundred fifty-four participants with CDR of 0 and 0.5 who were reclassified as converters (n=28) or nonconverters (n=230) to dementia in the incidence study in 2003 were followed. MEASUREMENTS: The prevalence of CKD and the onset of dementia were retrospectively analyzed, and the effects of other vascular risk factors on converters and CKD were analyzed. RESULTS: Weighted logistic regression showed CKD to be significantly associated with incident dementia after adjustment for age, sex, education, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, and anemia. The odds ratio for conversion to dementia for those with CKD compared to those without was 5.3 (95% confidence interval=1.7, 16.2). Apart from dyslipidemia, there were no associations between dementia and the other vascular risk factors. CONCLUSION: CKD was strongly associated with the incidence of dementia independent of age, sex, education, and other vascular risk factors. © 2011, The American Geriatrics Society.",aged;anemia;article;chronic kidney disease;controlled study;dementia;diabetes mellitus;disease association;dyslipidemia;educational status;female;human;hypertension;ischemic heart disease;longitudinal study;major clinical study;male;retrospective study;risk factor,"Sasaki, Y.;Marioni, R.;Kasai, M.;Ishii, H.;Yamaguchi, S.;Meguro, K.",2011,,,0,
3904,Case-control study of associated conditions at the time of death in patients with epilepsy,"Analysis of mortality data based on underlying cause of death in epileptic patients is of limited value in view of the low case-fatality ratio of epilepsy. Recently the National Center for Health Statistics has made available all conditions mentioned on each death certificate for the entire US population. Using a case-control study design, we have analyzed all the associated conditions at the time of death in patients with epilepsy for the year 1978. Association between epilepsy and the following conditions reached statistical significance: mental retardation, cerebral palsy, cerebrovascular disease, myocardial ischemia, dementia, foreign body in pharynx and larynx, pneumonia, alcoholism and cirrhosis of liver. Early recognition and proper management of some of these factors could significantly reduce the mortality and morbidity in epileptic patients.",Death Certificates;Epidemiologic Methods;Epilepsy/*complications/mortality;Female;Humans;Male,"Satishchandra, P.;Chandra, V.;Schoenberg, B. S.",1988,,,0,
3905,Incidence of Dementia over Three Decades in the Framingham Heart Study,"BACKGROUND: The prevalence of dementia is expected to soar as the average life expectancy increases, but recent estimates suggest that the age-specific incidence of dementia is declining in high-income countries. Temporal trends are best derived through continuous monitoring of a population over a long period with the use of consistent diagnostic criteria. We describe temporal trends in the incidence of dementia over three decades among participants in the Framingham Heart Study. METHODS: Participants in the Framingham Heart Study have been under surveillance for incident dementia since 1975. In this analysis, which included 5205 persons 60 years of age or older, we used Cox proportional-hazards models adjusted for age and sex to determine the 5-year incidence of dementia during each of four epochs. We also explored the interactions between epoch and age, sex, apolipoprotein E epsilon4 status, and educational level, and we examined the effects of these interactions, as well as the effects of vascular risk factors and cardiovascular disease, on temporal trends. RESULTS: The 5-year age- and sex-adjusted cumulative hazard rates for dementia were 3.6 per 100 persons during the first epoch (late 1970s and early 1980s), 2.8 per 100 persons during the second epoch (late 1980s and early 1990s), 2.2 per 100 persons during the third epoch (late 1990s and early 2000s), and 2.0 per 100 persons during the fourth epoch (late 2000s and early 2010s). Relative to the incidence during the first epoch, the incidence declined by 22%, 38%, and 44% during the second, third, and fourth epochs, respectively. This risk reduction was observed only among persons who had at least a high school diploma (hazard ratio, 0.77; 95% confidence interval, 0.67 to 0.88). The prevalence of most vascular risk factors (except obesity and diabetes) and the risk of dementia associated with stroke, atrial fibrillation, or heart failure have decreased over time, but none of these trends completely explain the decrease in the incidence of dementia. CONCLUSIONS: Among participants in the Framingham Heart Study, the incidence of dementia has declined over the course of three decades. The factors contributing to this decline have not been completely identified. (Funded by the National Institutes of Health.).","Aged;Aged, 80 and over;Atrial Fibrillation/complications;Dementia/*epidemiology/etiology;Dementia, Vascular/epidemiology;Educational Status;Female;Heart Failure/complications;Humans;Incidence;Longitudinal Studies;Male;Massachusetts/epidemiology;Middle Aged;Proportional Hazards Models;Risk Factors;Stroke/complications","Satizabal, C. L.;Beiser, A. S.;Chouraki, V.;Chene, G.;Dufouil, C.;Seshadri, S.",2016,Feb 11,10.1056/NEJMoa1504327,1,
3906,"The impact of delirium on outcomes in acute, non-intubated cardiac patients","Background: Because of progress in cardiovascular management, many critically ill geriatric patients undergo various procedures and intensive cardiovascular care treatments. Although delirium frequently affects geriatric patients post-procedurally and after intensive cardiovascular care, the impact of delirium on acute cardiac patients has not been well understood. The objective of this study was to investigate the impact of delirium on outcomes in acute, non-intubated cardiac patients. Methods: This was a prospective cohort study including non-surgical cardiac patients aged 65 years or older admitted to the intensive care unit or intensive cardiac care unit. We excluded mechanically ventilated patients. Delirium was evaluated using the confusion assessment method for the intensive care unit. The primary outcome analysed was 60-day mortality. The secondary outcomes analysed were risk and precipitating factors for delirium development. Results: Of 163 patients, 35 (21.5%) developed delirium. Patients with delirium had higher 60-day mortality rates than those without delirium (22.9% versus 3.9%, P<0.001) and spent an average of 10 days longer in the hospital (32±20 versus 22±16 days, P=0.002). On the multivariable Cox analysis, delirium was independently associated with 60-day mortality (adjusted hazard ratio 3.91; 95% confidence interval 1.06−17.36; P=0.04), which was also confirmed by the propensity score-matched analysis. Dementia, history of cerebrovascular disease, and higher sequential organ failure assessment score were significantly associated with delirium development. Conclusions: Acute delirium is common and predicts mortality in non-intubated cardiac patients. Cardiac critical care providers should be aware of this neurological condition.",angiotensin receptor antagonist;antithrombocytic agent;beta adrenergic receptor blocking agent;C reactive protein;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;acute coronary syndrome;acute heart failure;aged;article;cardiac patient;cerebrovascular disease;clinical article;controlled study;delirium;female;heart arrhythmia;hospital admission;human;intensive care unit;male;mortality rate;multiple organ failure;outcome assessment;priority journal;prospective study;scoring system;Sequential Organ Failure Assessment Score,"Sato, K.;Kubota, K.;Oda, H.;Taniguchi, T.",2017,,10.1177/2048872615624239,0,
3907,The effect of donepezil treatment on cardiovascular mortality,"The acetylcholinesterase inhibitor donepezil hydrochloride improves cognitive function in patients with Alzheimer's disease and vascular dementia. Given acetylcholine's important actions on the heart, we undertook a retrospective cohort investigation to assess whether donepezil usage affects cardiovascular mortality. In patients treated with donepezil, hazard ratios for total and cardiovascular mortality were 0.68 (P = 0.045, 95% confidence interval 0.46-0.99) and 0.54 (P = 0.042, 95% confidence interval 0.30-0.98), respectively. The apparent survival benefit in donepezil-treated patients should not be overinterpreted. Prospective clinical trials are warranted. © 2010 American Society for Clinical Pharmacology and Therapeutics.",donepezil;aged;Alzheimer disease;article;brain disease;cardiovascular disease;cerebrovascular disease;chronic obstructive lung disease;chronic respiratory tract disease;dementia;diabetes mellitus;drug effect;drug mechanism;female;follow up;gastrointestinal hemorrhage;hazard ratio;heart disease;human;ischemic heart disease;lipid disorder;liver disease;major clinical study;male;malignant neoplastic disease;metabolic disorder;mortality;multiinfarct dementia;pneumonia;priority journal;side effect;solid tumor;survival rate;treatment outcome;Unified Parkinson Disease Rating Scale;unspecified dementia;urinary tract infection;volume depletion,"Sato, K.;Urbano, R. R.;Yu, C.;Yamasaki, F.;Sato, T.;Jordan, J.;Robertson, D.;Diedrich, A.",2010,,,0,
3908,Highly cooperative dependence of sarco/endoplasmic reticulum calcium ATPase SERCA2a pump activity on cytosolic calcium in living cells,"Sarco/endoplasmic reticulum (SR/ER) Ca(2+)-ATPase (SERCA) is an intracellular Ca(2+) pump localized on the SR/ER membrane. The role of SERCA in refilling intracellular Ca(2+) stores is pivotal for maintaining intracellular Ca(2+) homeostasis, and disturbed SERCA activity causes many disease phenotypes, including heart failure, diabetes, cancer, and Alzheimer disease. Although SERCA activity has been described using a simple enzyme activity equation, the dynamics of SERCA activity in living cells is still unknown. To monitor SERCA activity in living cells, we constructed an enhanced CFP (ECFP)- and FlAsH-tagged SERCA2a, designated F-L577, which retains the ATP-dependent Ca(2+) pump activity. The FRET efficiency between ECFP and FlAsH of F-L577 is dependent on the conformational state of the molecule. ER luminal Ca(2+) imaging confirmed that the FRET signal changes directly reflect the Ca(2+) pump activity. Dual imaging of cytosolic Ca(2+) and the FRET signals of F-L577 in intact COS7 cells revealed that SERCA2a activity is coincident with the oscillatory cytosolic Ca(2+) concentration changes evoked by ATP stimulation. The Ca(2+) pump activity of SERCA2a in intact cells can be expressed by the Hill equation with an apparent affinity for Ca(2+) of 0.41 +/- 0.0095 mum and a Hill coefficient of 5.7 +/- 0.73. These results indicate that in the cellular environment the Ca(2+) dependence of ATPase activation is highly cooperative and that SERCA2a acts as a rapid switch to refill Ca(2+) stores in living cells for shaping the intracellular Ca(2+) dynamics. F-L577 will be useful for future studies on Ca(2+) signaling involving SERCA2a activity.",Animals;COS Cells;Calcium/*metabolism;Calcium Signaling/*physiology;Cercopithecus aethiops;Cytosol/*metabolism;Green Fluorescent Proteins/genetics/metabolism;Humans;Recombinant Fusion Proteins/genetics/metabolism;Sarcoplasmic Reticulum Calcium-Transporting ATPases/genetics/*metabolism;Spodoptera,"Satoh, K.;Matsu-Ura, T.;Enomoto, M.;Nakamura, H.;Michikawa, T.;Mikoshiba, K.",2011,Jun 10,10.1074/jbc.M110.204685,0,
3909,Medication (Re)fill adherence measures derived from pharmacy claims data in older Americans: A review of the literature,"Medication nonadherence is a significant public health problem that affects the health and well-being of older Americans while burdening the US healthcare system. Pharmacy claims data have gained importance in deriving objective medication (re)fill adherence measures; however, little is known about application of such measures in older Americans. The objective of this study was to assess the types and characteristics of pharmacy claims-derived medication (re)fill adherence measures used in older Americans. A comprehensive literature search strategy was employed to identify all articles using pharmacy claims data to measure (re)fill adherence to prescription medications in older Americans aged 65+ years. Included were articles reporting original research studies conducted and published in the USA in English between 1 January 2000 and 1 November 2012. The basic search used multiple key terms indicating adherence, combined with the term ""medication"" and the term ""pharmacy claims or administrative claims."" Due to the variety of measure names used in the literature, a more specific search was added to repeat the basic search for 29 previously used medication (re)fill adherence measure names. Articles identified through the database search were manually reviewed to select only articles meeting the inclusion criteria. The search resulted in a total of 36 articles. Information on medication (re)fill measurements were extracted and summarized. The 36 articles used 20 differently named measures under the three main concepts: medication adherence, persistence, and discontinuation. Measures of medication adherence cumulatively assessed the proportion of time at which medications were (not) filled over a predefined observation period (e.g., medication possession ratio). Measures of medication persistence assessed the continuity of medication filling over a specified time period, while medication discontinuation measures focused on termination of medication (re)fills. Overall, almost two thirds of all identified articles used a single medication (re)fill adherence measure. Among them, 77 % used a medication possession measure. The term ""medication possession ratio"" (MPR) was used most frequently (65 %), followed by the ""proportion of days covered"" (PDC; 30 %). No single measure can be generally recommended for the use in older Americans. The challenges in using pharmacy claims-based medication (re)fill adherence measures in older Americans include a lack of consensus terminology and algorithms among measures of the same concepts, insufficient transparency of individual measure operationalization, and inadequate consideration of unique characteristics of the older population, such as temporary nursing home care. Although medication (re)fill adherence measures may be well suited for measuring medication adherence in older Americans, little guidance is available on how to use them in this population. Further efforts need to be given to the development and standardization of pharmacy claims-based medication (re)fill measures that are specifically tailored toward use in older Americans. © 2013 Springer International Publishing Switzerland.",alendronic acid;amlodipine plus benazepril;angiotensin receptor antagonist;anticonvulsive agent;antiglaucoma agent;antihypertensive agent;antilipemic agent;antiparkinson agent;beta adrenergic receptor blocking agent;bisphosphonic acid derivative;calcitonin;calcium channel blocking agent;corticosteroid;digoxin;dipeptidyl carboxypeptidase inhibitor;donepezil;galantamine;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;muscarinic receptor blocking agent;nonsteroid antiinflammatory agent;oral antidiabetic agent;paroxetine;phenobarbital;phenytoin;proton pump inhibitor;raloxifene;risedronic acid;rivastigmine;unindexed drug;Alzheimer disease;anxiety disorder;article;billing and claims;chronic lung disease;corticosteroid therapy;drug withdrawal;dyslipidemia;epilepsy;heart failure;heart infarction;hormonal therapy;human;hypertension;medicare;medication compliance;non insulin dependent diabetes mellitus;open angle glaucoma;osteoporosis;overactive bladder;Parkinson disease;patient compliance;pharmacy;priority journal;senescence;treatment refusal,"Sattler, E. L. P.;Lee, J. S.;Perri Iii, M.",2013,,,0,
3910,Incidence and risk conditions of ischemic stroke in older adults,"Objective: The objective of this study was to investigate incidence and mortality from ischemic stroke in older adults with specific underlying chronic conditions, evaluating the influence of these conditions in developing stroke. Materials & methods: Population-based cohort study involving 27,204 individuals ≥60 years old in Southern Catalonia, Spain. All cases of hospitalization from ischemic stroke (confirmed by neuro-imaging) were collected from 01/12/2008 until 30/11/2011. Incidence rates and 30-day mortality were estimated according to age, sex, chronic illnesses, and underlying conditions. Multivariable Cox regression analysis was used to calculate Hazards Ratio (HR) and estimate the association between baseline conditions and risk of developing stroke. Results: Mean incidence rate reached 453 cases per 100,000 person-years. Maximum rates appeared among individuals with history of prior stroke (2926 per 100,000), atrial fibrillation (1815 per 100,000), coronary artery disease (1104 per 100,000), nursing-home residence (1014 per 100,000), and advanced age ≥80 years (1006 per 100,000). Thirty-day mortality was 13% overall, reaching 21% among patients over 80 years. Age [HR: 1.06; 95% confidence interval (CI): 1.04–1.07], history of prior stroke (HR: 5.08; 95% CI: 3.96–6.51), history of coronary artery disease (HR: 1.65; 95% CI: 1.21–2.25), atrial fibrillation (HR: 2.96; 95% CI: 2.30–3.81), diabetes mellitus (HR: 1.55; 95% CI: 1.23–1.95), and smoking (HR: 1.64; 95% CI: 1.15–2.34) emerged independently associated with an increased risk of ischemic stroke. Conclusion: Incidence and mortality from ischemic stroke remains considerable. Apart from age and history of atherosclerosis (prior stroke or coronary artery disease), atrial fibrillation, diabetes, and smoking were the underlying conditions most strongly associated with an increased risk.",adult;aged;anticoagulant therapy;article;atrial fibrillation;brain ischemia;chronic kidney failure;chronic lung disease;cohort analysis;coronary artery disease;dementia;diabetes mellitus;female;human;hypercholesterolemia;hypertension;incidence;major clinical study;male;middle aged;neoplasm;outcome assessment;prevalence;priority journal;risk factor,"Satue, E.;Vila-Corcoles, A.;Ochoa-Gondar, O.;de Diego, C.;Forcadell, M. J.;Rodriguez-Blanco, T.;Barnes, L.;Jariod, M.",2016,,10.1111/ane.12535,0,
3911,Chronotherapeutical approach: Circadian rhythm in human and its role in occurrence and severity of diseases,"Mammalians circadian pacemaker resides in the paired suprachiasmatic nuclei (SCN) and influences a multitude of biological processes, including the sleep-wake rhythm. Clock genes are the genes that control the circadian rhythms in physiology and behaviour. Due to that that pathophysiology several diseases like allergic rhinitis, arthritis, asthma, myocardial infarction; congestive heart failure, stroke, and peptic ulcer disease etc. give rise to day-night patterns in onset and symptoms exacerbation. The scientific study of biological rhythms and their underlying mechanisms is known as chronobiology and treatment using this concept is known as chronotherapy. The effectiveness and toxicity of many drugs vary depending on dosing time. Such chronophamacological phenomena are influenced by not only the pharmacodynamics but also pharmacokinetics of medication. Chronopharmacokinetics deals with the study of the temporal changes in absorption, distribution, metabolism and elimination of several drugs and thus takes into account the influence of time of administration on these. The role of circadian rhythms in the mechanisms of disease and the pharmacokinetics and pharmacodynamics of medications constitute a challenge to drug-discovery and drug-delivery scientists. This review represents the basic concept of circadian rhythm, mechanism and its synchronization with severity and occurrence of various diseases from viewpoint of chronopharmacology and chronotherapy.",barbituric acid derivative;benzodiazepine;beta adrenergic receptor stimulating agent;cimetidine;cisplatin;clemastine;cyproheptadine;dihydrocodeine;etomidate;etoposide;famotidine;fluorouracil;indometacin;ketamine;ketoprofen;lidocaine;mepivacaine;mequitazine;methotrexate;nifedipine;nizatidine;pethidine;propranolol;ranitidine;ropivacaine;roxatidine;terfenadine;theophylline;tramadol;unindexed drug;allergic rhinitis;Alzheimer disease;article;asthma;blood clotting disorder;cardiovascular disease;chronotherapy;circadian rhythm;disease exacerbation;disease severity;drug bioavailability;drug sensitivity;duodenum ulcer;epilepsy;human;hypercholesterolemia;hypertension;infection;inflammation;neoplasm;pain;Parkinson disease;pathophysiology;sleep disorder;suprachiasmatic nucleus;thrombosis;ulcer;ultradian rhythm,"Satwara Rohan, S.;Patel Parul, K.;Farhatjahan, S.",2012,,,0,
3912,Pharmaceutical care: Missions and visions,,asthma;blood pressure;dementia;diabetes mellitus;heart failure;medicine;osteoporosis;pharmaceutical care;pharmacy;short survey;skin disease,"Sauer, B.",2010,,,0,
3913,The central role of comorbidity in predicting ambulatory care sensitive hospitalizations,"Ambulatory care sensitive hospitalizations (ACSHs) are commonly used as measures of access to and quality of care. They are defined as hospitalizations for certain acute and chronic conditions; yet, they are most commonly used in analyses comparing different groups without adjustment for individual-level comorbidity. We present an exploration of their roles in predicting ACSHs for acute and chronic conditions. Using 1998-99 US Medicare claims for 1 06 930 SEER-Medicare control subjects and 1999 Area Resource File data, we modelled occurrence of acute and chronic ACSHs with logistic regression, examining effects of different predictors on model discriminatory power. Flags for the presence of a few comorbid conditions-congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension and, for acute ACSHs, dementia-contributed virtually all of the discriminative ability for predicting ACSHs. C-statistics were up to 0.96 for models predicting chronic ACSHs and up to 0.87 for predicting acute ACSHs. C-statistics for models lacking comorbidity flags were lower, at best 0.73, for both acute and chronic ACSHs. Comorbidity is far more important in predicting ACSH risk than any other factor, both for acute and chronic ACSHs. Imputations about quality and access should not be made from analyses that do not control for presence of important comorbid conditions. Acute and chronic ACSHs differ enough that they should be modelled separately. Unaggregated models restricted to persons with the relevant diagnoses are most appropriate for chronic ACSHs.",acute disease;aged;ambulatory care;article;chronic disease;comorbidity;female;health care delivery;hospitalization;human;male;medicare;risk factor;statistical model;statistics;United States;very elderly,"Saver, B. G.;Wang, C. Y.;Dobie, S. A.;Green, P. K.;Baldwin, L. M.",2014,,,0,
3914,Poor outcome associated with probable bilateral extracranial ICA vasospasm,"We describe a woman with bilateral extracranial internal carotid artery (ICA) vasospasm. Initial MRI of the brain showed multiple areas of high-signal intensity in the white matter of both the frontoparietal lobes. She was alert, and the muscle strength of the four extremities was moderately decreased. Cranial CT on day 3 showed increased numbers of low-density areas in both the anterior cerebral arteries (ACA) and middle cerebral arteries (MCA), accompanied by neurological deterioration. Cranial and cervical CT angiography on day 9 showed that all areas of both the ACA and MCA had become low density. Both ICAs were markedly narrowed along their entire length and tapered. On day 16, the patient died. Three patients with bilateral extracranial ICA spasms have been described previously. To our knowledge, this is the first time to document bilateral ICA spasm causing elongated narrowing of the carotid arteries, leading to an unfortunate outcome. Copyright 2013 BMJ Publishing Group. All rights reserved.",argatroban;dexamethasone;heparin;norphenazone;aged;anterior cerebral artery;article;artificial ventilation;Babinski reflex;brain vasospasm;cardiopulmonary arrest;carotid artery obstruction;case report;clinical feature;coma;computed tomographic angiography;contrast enhancement;differential diagnosis;electrocardiography;female;follow up;Holter monitoring;human;internal carotid artery;mental deterioration;neuroimaging;nuclear magnetic resonance imaging;outcome assessment;priority journal;resuscitation;sinus tachycardia;vasculitis,"Sawa, N. N.;Kataoka, H.;Ueno, S.",2013,,,0,
3915,Contralateral hip fractures - Can predisposing factors be determined?,"A case control study was carried out in the Orthopaedic Department of Bradford Royal Infirmary in an attempt to see if certain medical conditions, which can affect balance and stability, are more common in those who sustain a second proximal femoral fracture. Medical conditions included in the study were: late effects of cerebro-vascular accident, blindness, syncope and collapse, alcoholism, Alzheimer's disease, epilepsy, Parkinsonism, ischaemic heart disease and senile dementia. The study group comprised 53 patients admitted to hospital between 1992 and 1998 with two separate proximal femoral fractures each on a different side. The control group comprised 530 patients selected from a general pool of 2080 proximal femoral fracture patients admitted to hospital during the same period. The control group patients were matched to the study group for age, sex, and time of occurrence of the first fracture. Results show significantly higher association of late effects of cerebro-vascular accident, blindness, syncope and collapse, and Alzheimer's disease with subsequent contralateral proximal femoral fractures. This study supports a causal relationship between the above medical conditions and subsequent contralateral proximal femoral fractures. It may therefore be possible to identify patients who are at risk of returning with a second fracture. Copyright (C) 2000 Elsevier Science Ltd.",adult;aged;alcoholism;Alzheimer disease;article;blindness;case control study;cerebrovascular accident;collapse;controlled study;epilepsy;hip fracture;human;ischemic heart disease;major clinical study;Parkinson disease;priority journal;risk factor;senile dementia;faintness;X ray,"Saxena, P.;Shankar, J.",2000,,,0,
3916,Lipoprotein Lipase HindIII Intronic Polymorphism in a Subset of Iranian Patients with Late-Onset Alzheimer's Disease,"OBJECTIVE: Lipid metabolism is involved in the pathogenesis of late-onset Alzheimer's disease (LOAD). Lipoprotein lipase (LPL) is a multifunctional enzyme that plays a major role in lipid metabolism; its abnormal function seems to be related, either directly or indirectly, to the pathogenesis of many diseases such as atherosclerosis, coronary artery disease (CAD) and Alzheimer's disease (AD) . HindIII polymorphism is a common LPL genetic variant shown to increase the risk of LOAD. The present research investigates whether this polymorphism is involved in the pathogenesis of Iranian LOAD patients. MATERIALS AND METHODS: In this case control study ,allele and genotype frequencies for the HindIII polymorphism of the LPL gene in 100 patients affected with LOAD and 100 healthy controls were determined by reaction-restriction fragment length polymorphism (PCR-RFLP) and compared using the chi-square and Fisher's exact tests. RESULTS: LPL H+H+ genotype frequency in LOAD patients was 58%, which was significantly higher than controls (44%). There was a 1.75-fold increased risk for the development of LOAD in carriers of the H+H+ genotype compared to non-carriers (OR=1.75; 95%CI: 1.00-3.07; p=0.048). When adjusted for sex, the H+H+ genotype was more frequent in patients than controls; this difference was more remarkable in males (OR: 1.90; 95% CI: 1.08-3.34; p=0.024). The mean age of disease onset did not differ in patients with the LPL H+H+ genotype compared to unaffected individuals. CONCLUSION: This study confirms the association between the H+H+ genotype with LOAD and supports the correlation of this genotype of the LPL gene with risk of developing LOAD in Iranian patients with AD.",Alzheimer's Disease;Association Study;HindIII Polymorphism;LPL Gene,"Sayad, A.;Noruzinia, M.;Zamani, M.;Harirchian, M. H.;Kazemnejad, A.",2012,Spring,,0,
3917,"Pacing extremely old patients: Who decides - The doctor, the patient, or the relatives?","Decision making competence is not necessarily present or absent. In many cases it is partial or compromised. This applies especially to those over 80 years old, in whom the prevalence of dementia is high. Three patients who presented with indications for permanent pacemaker insertion are considered. One was apparently competent, one had partial competence, and one was clearly incompetent. In all three cases the closest relatives were opposed to decisions made by either the patient or the doctors. The three cases reflect the tension between doctors, patients, and relatives in situations where medical interests, individual interests, and familial interests conflict. The cases illustrate the type of problems encountered in clinical practice. The current legal position is reviewed.",aged;Alzheimer disease;article;artificial heart pacemaker;cardiovascular risk;case report;clinical feature;clinical practice;cognitive defect;collapse;competence;death;doctor patient relation;falling;female;heart block;heart disease;heart failure;heart pacing;hospital admission;hospital discharge;human;informed consent;medical decision making;medicolegal aspect;mental test;patient;physician;priority journal;quality of life;relative;risk assessment;scoring system;senescence;faintness;treatment indication;validation process,"Sayers, G. M.;Bethell, H. W. L.",2004,,,0,
3918,C-338A polymorphism of the endothelin-converting enzyme (ECE-1) gene and the susceptibility to sporadic late-onset Alzheimer's disease and coronary artery disease,"The human endothelin-converting enzyme (ECE) is involved in beta-amyloid synthesis and regulation of the endothelin-1 (ET-1) vasoconstricting peptide. We investigated the distribution of the C-338A polymorphism of the ECE-1b gene in sporadic late-onset Alzheimer's disease (LOAD) and in coronary artery disease (CAD) to verify its role in the onset of these two complex diseases. Two cohorts of 458 Italian Caucasian LOAD patients and 165 CAD patients were examined for the C-338A polymorphism and compared with respective control samples (260 and 106 subjects, respectively) . The A allele was less present in LOAD patients than in controls, but an at limits statistically significant difference was achieved only in subjects aged less than 80 years, where only the AA genotypes appeared to have a protective role against the onset of the sporadic LOAD. For the overall CAD sample the pattern was similar and significant differences were observed only in subjects non carrying the apolipoprotein E (APOE) e*4 allele, where the A allele carrying genotypes had a protective role against the onset of the disease.","Age of Onset;Aged;Aged, 80 and over;Alzheimer Disease/enzymology/*genetics;Aspartic Acid Endopeptidases/*genetics;Cohort Studies;Coronary Artery Disease/enzymology/*genetics;Female;*Genetic Predisposition to Disease;Humans;Male;Metalloendopeptidases/*genetics;Middle Aged;*Polymorphism, Genetic","Scacchi, R.;Gambina, G.;Broggio, E.;Ruggeri, M.;Corbo, R. M.",2008,,,0,
3919,Different pattern of association of paraoxonase Gln192-->Arg polymorphism with sporadic late-onset Alzheimer's disease and coronary artery disease,"The paraoxonase (PON1) Gln192-->Arg polymorphism was examined in a group of sporadic late-onset Alzheimer's disease (AD) patients, in a group of coronary artery disease (CAD) patients, and in normal subjects. The AD sample showed a PON1*R allele frequency significantly lower than the control group (0.225 vs. 0.281, P=0.049). In the CAD patients the *R allele was more frequent than in the controls (0.230 vs. 0.213), though not significantly (P=0.28). The odds ratios (OR) adjusted for age, gender, and APOE polymorphism by logistic regression analysis highlighted that in AD the PON1 RR genotype was significantly protective (OR=0.41, 95% CI=0.19-0.90; P=0.025), whereas in CAD it appeared to be a significant risk factor (OR=5.11, 95% CI=1.09-23.9; P=0.038) limited to younger patients.","Adult;Aged;Aged, 80 and over;Alzheimer Disease/*genetics;Aryldialkylphosphatase;Coronary Artery Disease/*genetics;Esterases/blood/*genetics;Genotype;Humans;Middle Aged;Polymorphism, Genetic","Scacchi, R.;Gambina, G.;Martini, M. C.;Broggio, E.;Vilardo, T.;Corbo, R. M.",2003,Mar 13,,0,
3920,Evaluation of the Yale New Haven Readmission Risk Score for Pneumonia in a General Hospital Population,"Background The Yale New Haven Readmission Risk Score (YNHRRS) for pneumonia is a clinical prediction tool developed to assess risk for 30-day readmission. This tool was validated in a cohort of Medicare patients; generalizability to a broader patient population has not been evaluated. In addition, it lacks indicators of functional status or social support, which have been shown in other studies to be predictors of readmission. The objective of this study was to evaluate the generalizability of the YNHRRS for pneumonia in a general population of hospitalized patients, and assess the impact of incorporating measures of functional status and social support on its predictive value. Methods This retrospective chart review comprised all patients admitted to a 563-bed academic medical center with a primary diagnosis of pneumonia between March 2014 and March 2015. Abstraction of clinical variables allowed calculation of the YNHRRS and additional indicators of functional status and social support. The primary outcome was 30-day readmission rate. We created a logistic regression model to predict readmission using the YNHRRS, functional status, and social support as covariates. Results Among 270 discharges with pneumonia, the observed readmission rate was 23%. The YNHRRS was a significant predictor of readmission in our multivariate model, with an odds ratio of 2.20 (95% confidence interval, 1.29-3.73) for each 10% increase in calculated risk. Indicators of functional status and social support were not significant predictors of readmission. Conclusions The YNHRRS can be applied to an unselected population as a tool to predict patients with pneumonia at risk for readmission.",immunosuppressive agent;aged;article;chronic lung disease;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;female;functional status;general hospital;hospital discharge;hospital patient;hospital readmission;human;kidney disease;liver disease;major clinical study;male;malignant neoplasm;medical record review;pleura effusion;pneumonia;predictive value;priority journal;risk assessment;social support;Yale New Haven Readmission Risk Score,"Schaefer, G.;El-Kareh, R.;Quartarolo, J.;Seymann, G.",2017,,10.1016/j.amjmed.2017.04.039,0,
3921,Quantification of GDF11 and Myostatin in Human Aging and Cardiovascular Disease,"Growth and differentiation factor 11 (GDF11) is a transforming growth factor β superfamily member with a controversial role in aging processes. We have developed a highly specific LC-MS/MS assay to quantify GDF11, resolved from its homolog, myostatin (MSTN), based on unique amino acid sequence features. Here, we demonstrate that MSTN, but not GDF11, declines in healthy men throughout aging. Neither GDF11 nor MSTN levels differ as a function of age in healthy women. In an independent cohort of older adults with severe aortic stenosis, we show that individuals with higher GDF11 were more likely to be frail and have diabetes or prior cardiac conditions. Following valve replacement surgery, higher GDF11 at surgical baseline was associated with rehospitalization and multiple adverse events. Cumulatively, our results show that GDF11 levels do not decline throughout aging but are associated with comorbidity, frailty, and greater operative risk in older adults with cardiovascular disease.",biological marker;growth differentiation factor;growth differentiation factor 11;myostatin;unclassified drug;aged;aging;amino acid sequence;aorta stenosis;article;bradycardia;cardiovascular disease;comorbidity;controlled study;deep vein thrombosis;dementia;deterioration;diabetes mellitus;disease severity;female;functional status;heart arrhythmia;heart infarction;heart valve replacement;hospitalization;human;hyperlipidemia;hypertension;hypotension;kidney failure;liquid chromatography;lung embolism;major clinical study;male;mass spectrometry;morbidity;pleura effusion;pneumonia;priority journal;seizure;surgical risk;tachycardia;urinary tract infection;very elderly,"Schafer, M. J.;Atkinson, E. J.;Vanderboom, P. M.;Kotajarvi, B.;White, T. A.;Moore, M. M.;Bruce, C. J.;Greason, K. L.;Suri, R. M.;Khosla, S.;Miller, J. D.;Bergen, H. R.;LeBrasseur, N. K.",2016,,,0,
3922,Fever - Useful or noxious symptom that should be treated?,"Fever is a phylogenetically ancient host reaction to invading microorganisms and other noxious stimuli. Poikylathermic organisms can reach febrile temperatures by seeking a hot environment in response to a higher set point in their thermoregulatory center. Endothermic organisms produce febrile temperatures through endogenous heat production at the expenditure of a higher metabolic rate. Nevertheless, fever has been conserved during evolution through millennia, obviously because of its advantage for host defense. Despite of these arguments most doctors, nurses and patients treat fever with antipyretics. The role of fever for the recovery from low risk infections is marginal at best. A large study of ibuprofen in patients with severe sepsis could not establish a positive or negative role on the course or final outcome of the infection in an intensive care setting. These clinical observations seemingly contradict findings in severe experimental bacterial infections in rodents but it has to be taken into consideration that these animals, in contrast to patients, received no antibiotic treatment. In patients with influenza-like illnesses non-steroidal antirhumatics (NSAR) improve fever and wellbeing with little or no evidence for undesired side-effects. It therefore appears appropriate to treat patients with these and similar infections with NSAR. Antipyretic therapy in special patient groups such as brain injury victims, patients with cardiac or respiratory failure or dementia has not been established to be indicated to overcome a worsening of these organs to fail during infections. In children with a history of fever convulsions prevention or lowering of fever does not reduce recurrence. In patients with strokes it appears advisable however to use antipyretics in case of fever despite of a present lack of a proven beneficial effect. In conclusion symptomatic antipyretic therapy should be considered for low risk infections if patient suffering from fever. For more severe infections antipyretic therapy can be applied on an individual basis without too much hope to improve outcome or cause a severe worsening of prognosis. © 2006 by Verlag Hans Huber.",antipyretic agent;antirheumatic agent;ibuprofen;nonsteroidal antirheumatic agent;unclassified drug;absence of side effects;antibiotic therapy;article;bacterial infection;brain injury;convulsion;dementia;fever;heart failure;host resistance;human;immune response;intensive care;metabolic rate;prognosis;respiratory failure;sepsis;cerebrovascular accident;thermogenesis;thermoregulation,"Schaffner, A.",2006,,,0,
3923,Megaesophagus and possible mechanisms of sudden death,"Achalasia is a neurodegenerative condition characterized by esophageal dysmotility and megaesophagus. Two cases are reported that demonstrate unexpected deaths associated with previously unsuspected achalasia. Case 1: A 66-year-old woman was found dead at her home. At autopsy significant stenosing coronary artery atherosclerosis was found with cardiac failure. In addition, a striking finding was narrowing of the distal esophagus with marked proximal dilatation. The esophagus was completely filled with a large amount of soft masticated food and was bulging anteriorly, compressing the left atrium. Death was attributed to ischemic heart disease complicated by previously unsuspected achalasia. Case 2: An 84-year-old man collapsed and suffered a respiratory arrest while eating. Internal examination revealed narrowing of the cardioesophageal junction with marked proximal dilatation of the esophagus that contained approximately 50 mL of soft semi-fluid masticated yellow food paste. Fragments of yellow masticated food remnants were present in upper and lower airways but not within the stomach. There was a history of dementia with symmetrical cerebral ventricular dilatation found at autopsy. Death was attributed to food asphyxia complicating previously unsuspected achalasia with dementia. Megaesophagus may, therefore, be a significant finding at autopsy that may either be a primary cause of unexpected death or else may exacerbate or compound the effects of pre-existing underlying disease. © 2008 American Academy of Forensic Sciences.",anamnesis;article;autopsy;chronic inflammation;coronary artery atherosclerosis;coronary artery obstruction;esophagus achalasia;esophagus dilatation;foot edema;heart failure;histopathology;human;ischemic heart disease;masticatory muscle;megaesophagus;nerve cell;physical examination;priority journal;sudden death,"Schalinski, S.;Guddat, S. S.;Tsokos, M.;Byard, R. W.",2009,,,0,
3924,"Influenza-attributable deaths, Canada 1990-1999","The number of deaths attributable to influenza is believed to be considerably higher than the number certified by vital statistics registration as due to influenza. Weekly mortality data for Canada from the 1989/1990 to the 1998/1999 influenza seasons were analysed by cause of death, age group, and place of death to estimate the impact of influenza on mortality. A Poisson regression model was found to accurately predict all-cause, as well as cause-specific mortality, as a function of influenza-certified deaths, after controlling for seasonality, and trend. Influenza-attributable deaths were calculated as predicted less baseline-predicted deaths. In summary, throughout the 1990s there were on average just under 4000 deaths attributable to influenza annually (for an influenza-attributable mortality rate of 13/100 000 persons), varying from no detectable excess mortality for the 1990/1991 influenza season, to 6000-8000 influenza-attributable deaths for the more severe influenza seasons of 1997/1998 and 1998/1999. On average, 8% (95% CI 7-10) of influenza-attributable deaths were certified as influenza, although this percentage varied from 4% to 12% from year to year. Only 15% of the influenza-attributable deaths were certified as pneumonia, and for all respiratory causes, 40%. Deaths were distributed over most causes. The weekly pattern of influenza-certified deaths was a good predictor of excess all-cause mortality. © 2007 Cambridge University Press.",accident;acute respiratory tract disease;adult;age distribution;aged;article;Canada;neoplasm;cardiovascular disease;cause of death;central nervous system disease;cerebrovascular accident;chronic obstructive lung disease;dementia;gastrointestinal disease;health statistics;human;infection;influenza;intoxication;ischemic heart disease;kidney disease;major clinical study;mathematical analysis;mental disease;metabolic disorder;mortality;pneumonia;prediction;respiratory tract disease;seasonal variation,"Schanzer, D. L.;Tam, T. W. S.;Langley, J. M.;Winchester, B. T.",2007,,,0,
3925,Mitochondrial myopathies and encephalomyopathies,"Defects of mitochondrial metabolism result in a wide variety of human disorders, which can present at any time from infancy to late adulthood and involve virtually any tissue either alone or in combination. Abnormalities of the electron transport and oxidative phosphorylation (OXPHOS) system are probably the most common cause of mitochondrial diseases. Thirteen of the protein subunits of OXPHOS are encoded by mitochondrial DNA (mtDNA) and mutations of this genome are important causes of OXPHOS deficiency. The link between genotype and phenotype with respect to mtDNA mutations is not clear: the same mutation may result in a variety of phenotypes, and the same phenotype may be seen with a variety of different mtDNA mutations. The pathogenesis of mtDNA mutations is unclear although OXPHOS and ATP deficiency, and free radical generation, are thought to contribute to tissue dysfunction. There is now strong evidence for mitochondrial dysfunction in neurodegenerative disorders. In some cases, e.g. Friedreich's ataxia, hereditary spastic paraplegia, this is a result of a mutation of a nuclear gene encoding a mitochondrial protein, whilst in others, e.g. Huntington's disease, amyotrophic lateral sclerosis, the OXPHOS defect is secondary to events induced by a mutation in a nuclear gene encoding a non-mitochondrial protein. In yet a third group, e.g. Parkinson's disease, Alzheimer's disease, the relationship of the mitochondrial defect to aetiology and pathogenesis is unclear.",adenosine triphosphate;cell nucleus DNA;free radical;mitochondrial DNA;protein subunit;Alzheimer disease;amyotrophic lateral sclerosis;article;base pairing;degenerative disease;electron transport;encephalomyopathy;Friedreich ataxia;gene mutation;genotype;hereditary motor sensory neuropathy;hereditary optic atrophy;human;human cell;Huntington chorea;Kearns Sayre syndrome;Leigh disease;mitochondrial myopathy;mitochondrial respiration;myoclonus epilepsy;ophthalmoplegia;oxidative phosphorylation;Parkinson disease;phenotype;point mutation;priority journal,"Schapira, A. H. V.;Cock, H. R.",1999,,,0,
3926,One-week dose titration of extended release galantamine in patients with Alzheimer's disease,"Background: Our purpose was to assess the safety and tolerability of extended-release galantamine (GAL-ER), using a 1-week dose titration in Alzheimer's patients. Methods: An open-label, 12-week, multicenter study was performed (n = 82). Results were compared with findings from a placebo-controlled trial using a 4-week titration of GAL-ER and immediate-release galantamine. The primary analysis compared incidences of adverse events (AEs). Results: Although not statistically significant, more patients in the 1-week titration study experienced an AE. More patients with a 1-week titration had at least one prespecified gastrointestinal (GI) AE. These findings correlated with a higher baseline incidence of GI disturbances. Four patients experienced serious AEs; no deaths occurred. Mean Mini-Mental State Examination scores improved by 1.8 and 1.9 points at weeks 4 and 12, respectively. Conclusions: A 1-week titration of GAL-ER was generally safe and well tolerated, with a potential risk of more GI side effects. A 1-week titration may permit dosing flexibility and promote increased adherence to medication regimens. © 2008 The Alzheimer's Association.",antidiarrheal agent;antiinfective agent;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;galantamine;hydroxymethylglutaryl coenzyme A reductase inhibitor;placebo;proton pump inhibitor;salicylic acid derivative;thyroid hormone;adult;aged;Alzheimer disease;article;bradycardia;clinical trial;cognition;correlation analysis;decreased appetite;diarrhea;dose response;drug dose escalation;drug dose titration;drug efficacy;drug induced headache;drug response;drug safety;drug tolerability;drug withdrawal;female;flank pain;gastroenteritis;gastrointestinal symptom;heart infarction;human;hyponatremia;incidence;major clinical study;male;Mini Mental State Examination;multicenter study;nausea;open study;paresthesia;patient compliance;priority journal;scoring system;side effect;sustained release formulation;vomiting;weight reduction,"Scharre, D. W.;Shiovitz, T.;Zhu, Y.;Amatniek, J.",2008,,,0,
3927,Zoonosis in the Nursing Home,,albumin;C reactive protein;doxycycline;immunoglobulin G;immunoglobulin M;aged;albumin blood level;blood pressure;case report;dementia;depression;diabetes mellitus;electrocardiography;female;fever;heart infarction;human;hypertransaminasemia;letter;loneliness;mortality;neutrophilia;nursing home;organization and management;Q fever;thorax radiography;zoonosis,"Schattner, A.;Huber, R.",2016,,,0,
3928,Ventilatory capacity and risk for dementia,"BACKGROUND: Previous studies have found a relationship between single indicators of ventilatory capacity and measures of cognitive function, but have not addressed dementia specifically. This study examined the relationship between different indicators of ventilatory capacity and dementia, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, controlling for important confounding factors. METHODS: Cross-sectional data on participants (n = 437) of the Berlin Aging Study (BASE), which are representative of former West Berlin's living population aged 70 years and older, were analyzed. Ventilatory capacity was measured by spirometry as peak expiratory flow rate (PEF-R), forced expiratory volume in 1 second (FEV-1), maximal expiratory flow at 50% of forced vital capacity (MEF50%FVC), and maximal expiratory flow at 25% of forced vital capacity (MEF25%FVC). Odds ratios (OR) for dementia associated with ventilatory capacity were obtained by logistic regression, adjusting for age, gender, education, ApoE4 status, chronic obstructive pulmonary disease, smoking, heart failure, visual and auditory functioning, grip strength, and former physical activity. RESULTS: Separate analyses for PEF-R, FEV-1, MEF50%FVC, and MEF25%FVC revealed significantly increased odds for dementia among subjects in the lowest compared with the best functioning group in ventilatory testing. The OR associated with PEF-R > or = 2 l/s was found to be 20.4 (confidence interval [CI] 5.1-82.7). For FEV-1, MEF50%FVC, and MEF25%FVC ORs of 7.5 (CI 2.1-27.9), 4.3 (CI 1.5-12.5), and 4.7 (CI 1.3-17) were obtained, respectively. CONCLUSIONS: Ventilatory capacity, measured by spirometry in a representative sample of very elderly people, is cross-sectionally related to dementia. Taking evidence from longitudinal studies into account, this result suggests that decreased respiratory function may increase the risk for dementia, independent from already known risk factors.","Aged;Aged, 80 and over;Cross-Sectional Studies;Dementia/*etiology;Female;Humans;Male;Regression Analysis;*Respiration;Risk Factors","Schaub, R. T.;Munzberg, H.;Borchelt, M.;Nieczaj, R.;Hillen, T.;Reischies, F. M.;Schlattmann, P.;Geiselmann, B.;Steinhagen-Thiessen, E.",2000,Nov,,0,
3929,Statin for the brain: update in 2008,"Statins are essential drugs for the prevention of coronary artery disease. There is now evidence that they can also prevent ischemic stroke. The protective effect is related to the reduction in total and LDL cholesterol levels and the clinical benefit is especially high in secondary prevention patients with previous stroke and/or transient ischemic accident. The favourable role of statins is less well documented during an acute stroke than during an acute coronary syndrome, and certainly deserves further studies. Besides their specific cholesterol-lowering effect, statins exert various pleiotropic effects, which probably contribute to vascular protection. Furthermore, statins are able to reduce the formation of beta-amyloid peptide, which plays a key-role in the pathogenesis of Alzheimer disease. However, currently available results are heterogeneous and could not firmly support a protective effect of statins in dementia in general, neither in Alzheimer disease more specifically, nor in the reduction of cognitive function in the elderly. Several ongoing trials should confirm or not confirm this new potential indication of statins in a near future.",Alzheimer Disease/*prevention & control;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use;Stroke/*prevention & control,"Scheen, A. J.;Radermecker, R. P.;Sadzot, B.",2008,May-Jun,,0,
3930,Patient Self-Defined Goals,"This research, a descriptive qualitative analysis of self-defined serious illness goals, expands the knowledge of what goals are important beyond the physical-making existing disease-specific guidelines more holistic. Integration of goals of care discussions and documentation is standard for quality palliative care but not consistently executed into general and specialty practice. Over 14 months, lay health-care workers (care guides) provided monthly supportive visits for 160 patients with advanced heart failure, cancer, and dementia expected to die in 2 to 3 years. Care guides explored what was most important to patients and documented their self-defined goals on a medical record flow sheet. Using definitions of an expanded set of whole-person domains adapted from the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, 999 goals and their associated plans were deductively coded and examined. Four themes were identified-medical, nonmedical, multiple, and global. Forty percent of goals were coded into the medical domain; 40% were coded to nonmedical domains-social (9%), ethical (7%), family (6%), financial/legal (5%), psychological (5%), housing (3%), legacy/bereavement (3%), spiritual (1%), and end-of-life care (1%). Sixteen percent of the goals were complex and reflected a mix of medical and nonmedical domains, ""multiple"" goals. The remaining goals (4%) were too global to attribute to an NCP domain. Self-defined serious illness goals express experiences beyond physical health and extend into all aspects of whole person. It is feasible to elicit and record serious illness goals. This approach to goals can support meaningful person-centered care, decision-making, and planning that accords with individual preferences of late life.",decision-making;goal-oriented;palliative care;patient preferences;patient-centered care;serious illness,"Schellinger, S. E.;Anderson, E. W.;Frazer, M. S.;Cain, C. L.",2017,Jan 01,,0,
3931,"High mortality rates, distressing symptoms, and burdensome interventions for nursing home residents with advanced dementia","Objective. To describe the clinical course of nursing home residents with advanced dementia. Design. Multicenter, prospective cohort study. Setting and participants. Study subjects were recruited between 2003 and 2007 from 22 nursing homes in the Boston area. Inclusion criteria were age 60 years or older; length of stay more than 30 days; and score of 5 or 6 on the Cognitive Performance Scale. The Cognitive Performance Scale is a validated measure that uses 5 variables from the Minimum Data Set to categorize residents by cognition, ranging from intact (score of 0) to very severe impairment (score of 6). Residents meeting these inclusion criteria were evaluated for the following additional requirements: cognitive impairment due to dementia, as documented in the chart; stage 7 on the Global Deterioration Scale, as determined by the resident's nurse (range, 1 through 7; at stage 7, patients have profound cognitive deficits, minimal verbal communication, total functional dependence, incontinence of urine and stool, and inability to ambulate independently); and the availability of an appointed health care proxy who could communicate in English. Main outcome measures. Data collected included functional status (quantified by nurses using the Bedford Alzheimer's Nursing Severity Subscale; range of scores 7-to28, with higher scores indicating greater functional disability), cognitive status (evaluated by the Test for Severe Impairment; range of scores 0-to24, with lower scores indicating greater impairment), clinical complications (including suspected pneumonia, febrile episodes, eating problems, and other sentinel events), interventions (including parenteral therapy, hospitalizations, emergency room visits, and tube feedings), and signs of pain and dyspnea (as observed and documented by the residents' care provider and dichotomized as ""none"" or ""rarely"" versus ""sometimes,"" ""often,"" or ""almost daily""). Aspiration, agitated behavior, and pressure ulcers were ascertained through interviews with nurses. Data collected from health care proxies at baseline included whether the proxy understood the type of clinical complications expected in advanced dementia and whether a nursing home physician had informed the proxy of the prognosis or the clinical complications expected. At quarterly assessments, the health care proxy was asked whether he or she thought the resident had less than 6 months to live. Main results. Of the 572 residents with advanced dementia who met all eligibility criteria, 323 residents and their health care proxies were enrolled (56.5%). The mean age of residents was 85.3 years; 85.4% were women; and 89.5% were white. The median length of nursing home stay was 3.0 years, and the median time since diagnosis of dementia was 6.0 years. Alzheimer's disease was the leading cause of dementia (72.4%). Residents had severe functional disability (mean score of the Bedford Alzheimer's Nursing Severity Subscale, 21.0) and cognitive disability (72.7% scored 0 on the Test for Severe Impairment). Over half (54.8%) died over the 18-month study period. The probability of death within 6 months was 24.7%. During the 18-month study period, the probability of at least 1 episode of pneumonia was 41.1%; a febrile episode, 52.6%; and an eating problem, 85.8%. Adjusted 6-month mortality rates after the development of pneumonia, a febrile episode, and eating problems were 46.7%, 44.5%, and 38.6%, respectively. A total of 42 sentinel events (including seizures, gastrointestinal bleeding, hip fractures, other fractures, stroke, pulmonary embolus, and myocardial infarction) occurred in 31 of 323 residents (9.6%). Sentinel events rarely precipitated death - only 7 events occurred during the last 3 months of life among residents who died. The proportion of residents who had distressing symptoms were as follows: dyspnea, 46%; pain, 39.1%; pressure ulcers, 38.7%; agitation, 53.6%; and aspiration, 40.6%. Among residents who died, the proportion who had dyspnea, pain, pressure ulcers, and aspiration increased as the end of life approached. In th last 3 months of life, 40.7% of residents underwent at least 1 burdensome intervention (hospitalization, emergency room visit, parenteral therapy, or tube feeding). Residents whose health care proxies believed that the resident had less than 6 months to live and understood the clinical complications expected in advanced dementia were less likely to undergo a burdensome intervention during the final 3 months of life than were residents whose health care proxies did not have this understanding (adjusted odds ratio, 0.12 [95% confidence interval, 0.04-0.37]). Receipt of physician counseling was not associated with the likelihood of interventions. Conclusion. Nursing home residents with advanced dementia have a high mortality rate. Infections and eating problems are likely to develop and are associated with decreased survival. Distressing symptoms are common and increase as death approaches. Many residents undergo burdensome interventions in the final months of life. Residents were less likely to undergo these interventions when health care proxies were aware of the poor prognosis and expected clinical complications. Copyright 2009 by Turner White Communications Inc. All rights reserved.",adult;aged;agitation;Alzheimer disease;article;aspiration;cognition;cognitive defect;cohort analysis;decubitus;dementia;disease severity;distress syndrome;dyspnea;eating;eating disorder;emergency ward;female;fever;functional disease;functional status;hospitalization;human;length of stay;life expectancy;major clinical study;male;mortality;nurse;nursing home;nursing home patient;pain;parenteral nutrition;pneumonia;prognosis;prospective study;rating scale;feeding apparatus;United States;validation process;verbal communication,"Schenker, Y.",2009,,,0,
3932,"Efficacy and tolerability of saxagliptin compared with glimepiride in elderly patients with type 2 diabetes: A randomized, controlled study (GENERATION)","Aims: To assess the efficacy and safety of adjunctive saxagliptin vs glimepiride in elderly patients with type 2 diabetes (T2D) and inadequate glycaemic control. Methods: In this multinational, randomized, double-blind, phase IIIb/IV study (GENERATION; NCT01006603), patients aged≥65years were randomized (1:1) to receive saxagliptin 5mg/day or glimepiride ≤6mg/day, added to metformin, during a 52-week treatment period. The primary endpoint was achievement of glycated haemoglobin (HbA1c)<7.0% at week52 without confirmed/severe hypoglycaemia. The key secondary endpoint was incidence of confirmed/severe hypoglycaemia. Safety and tolerability were also assessed. Results: Of 720 patients randomized (360 in each treatment group; mean age 72.6years; mean T2D duration 7.6years), 574 (79.8%) completed the study (saxagliptin 80.3%; glimepiride 79.2%). Similar proportions of patients achieved the primary endpoint with saxagliptin and glimepiride (37.9 vs 38.2%; odds ratio 0.99, 95% confidence interval 0.73, 1.34; p=0.9415); however, a significant treatment-by-age interaction effect was detected (p=0.0389): saxagliptin was numerically (but not significantly) superior to glimepiride for patients aged<75years (39.2 vs 33.3%) and numerically inferior for patients aged≥75years (35.9 vs 45.5%). The incidence of confirmed/severe hypoglycaemia was lower with saxagliptin vs glimepiride (1.1 vs 15.3%; nominal p<0.0001). Saxagliptin was generally well tolerated, with similar incidences of adverse events compared with glimepiride. Conclusion: As avoiding hypoglycaemia is a key clinical objective in elderly patients, saxagliptin is a suitable alternative to glimepiride in patients with T2D aged≥65years.",NCT01006603;glimepiride;glucose;glycosylated hemoglobin;metformin;saxagliptin;add on therapy;age;aged;arthralgia;article;backache;bladder stone;blood sampling;bronchitis;cardiovascular disease;cholecystitis;colon cancer;controlled study;coughing;dementia;diarrhea;dizziness;double blind procedure;drug dose titration;drug efficacy;drug fatality;drug safety;drug tolerability;drug withdrawal;epilepsy;faintness;female;fracture;glucose blood level;glycemic control;headache;heart failure;heart infarction;human;hypoglycemia;incidence;lethargy;liver cell carcinoma;liver tumor;lymphoma;major clinical study;male;migraine;multicenter study;neoplasm;neurologic disease;non insulin dependent diabetes mellitus;opportunistic infection;phase 3 clinical trial;phase 4 clinical trial;randomized controlled trial;rhinopharyngitis;skin defect;skin edema;transitional cell carcinoma;treatment duration;upper respiratory tract infection;urinary tract infection,"Schernthaner, G.;Durán-Garcia, S.;Hanefeld, M.;Langslet, G.;Niskanen, L.;Östgren, C. J.;Malvolti, E.;Hardy, E.",2015,,,0,
3933,Statins and the elderly: Recent evidence and current indications,"Cardiovascular disease (CVD) is estimated to remain as the main cause of death in developed nations over the next 30 years, with increased prevalence in the older population. This is because the observed decline in the incidence of CVD owing to improvements in prevention has now been counterbalanced by the increased shift toward an older and thus more fragile population. Statin treatment reduces cardiovascular morbidity and mortality in middle-aged adults. However, few studies have included older individuals, particularly those aged 80 years or over. The adverse effects associated with high doses of statins and their interactions with other drugs may give rise to more problems in the elderly population. Evidence remains limited regarding the overall benefit of starting statin therapy in adults aged 80 and over; so that clinical judgment remains necessary in making the decision to use them. In this review, we present available evidence from randomized clinical trials, as well as relative community and post-approval data directly applicable to the management of CVD in the elderly, in both primary and secondary prevention. Also discussed is the latest evidence regarding the putative protective effects of statins on senile dementia and the relationship betwen statin treatment and cancer. © 2012, Editrice Kurtis.",atorvastatin;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;mevinolin;placebo;pravastatin;rosuvastatin;Alzheimer disease;article;cerebrovascular accident;clinical decision making;cost effectiveness analysis;dementia;disease association;elderly care;genotype;heart infarction;human;ischemic heart disease;liver disease;muscle weakness;primary prevention;prospective study;risk reduction;secondary prevention;senile dementia;treatment indication;unstable angina pectoris,"Schiattarella, G. G.;Perrino, C.;Magliulo, F.;Ilardi, F.;Serino, F.;Trimarco, V.;Izzo, R.;Amato, B.;Terranova, C.;Cardin, F.;Militello, C.;Leosco, D.;Trimarco, B.;Esposito, G.",2012,,,0,
3934,Small renal masses managed with active surveillance: Predictors of tumor growth rate after long-term follow-up,"Background The purpose of the study was to evaluate the relationships between the patients' clinical characteristics and the growth pattern of SRMs, and to investigate the predictive factors of tumor growth rates in patients initially managed with AS. Materials and Methods We retrospectively reviewed data from our prospectively collected database of 70 patients diagnosed with 72 SRMs between 1996 and 2013. Clinical and demographic data, and linear and volumetric growth rates were recorded for each patient. A Pearson correlation test was used to evaluate initial tumor size and linear or volumetric growth rate. Logistic regression models were used to evaluate the predictive factors affecting tumor growth kinetics. Results The mean age was 76 ± 6.8 years, and 47 (67.1%) of patients were male. The mean (± SD) and the median (interquartile range [IQR]) tumor size at presentation were 2.1 ± 1.3 and 2.7 (1.8-3.7) cm, respectively. The mean (± SD) and the median (IQR) linear growth rate were 0.5 ± 0.3 and 0.6 (0.4-1.5) cm per year, respectively. Patients treated with delayed surgery experienced a significantly greater mean linear growth rate (1.4 vs. 0.3 cm per year) than those observed in the AS group (P <.001). Male sex (HR, 1.70; P =.04) and symptomatic presentation (HR, 1.85; P =.02) were found to be significant predictors of tumor growth rates during AS. Conversely, age, Charlson Comorbidity Index, and initial tumor size failed to predict growth kinetics. Conclusion Male sex and symptomatic presentation are associated with faster growth rates in patients managed with AS after long-term follow-up.",aged;angiomyolipoma;article;backache;cancer patient;cancer surgery;cause of death;Charlson Comorbidity Index;chronic kidney failure;cohort analysis;comorbidity;computer assisted tomography;congestive heart failure;coronary artery disease;dementia;female;follow up;human;human tissue;image guided biopsy;kidney biopsy;kidney tumor;liver metastasis;long term care;lung embolism;lung metastasis;major clinical study;male;nephron sparing surgery;oncocytoma;partial nephrectomy;prediction;prospective study;respiratory failure;retrospective study;tumor growth;tumor volume;very elderly;volumetry,"Schiavina, R.;Borghesi, M.;Dababneh, H.;Bianchi, L.;Longhi, B.;Diazzi, D.;Monti, C.;La Manna, G.;Martorana, G.;Brunocilla, E.",2015,,,0,
3935,Apolipoprotein E polymorphism: Survival and neurological outcome after cardiopulmonary resuscitation,"Background and Purpose - The apolipoprotein E 3/3 (apoE 3/3) genotype is associated with a reduced risk of developing Alzheimer's disease and with a favorable neurological outcome after traumatic head injury. In vitro studies suggest that the most common genotype, apoE 3/3, may be involved in neuroprotective and neuroregenerative mechanisms. The aim of this study was to determine whether the apoE 3/3 genotype has an impact on survival and neurological outcome after cardiopulmonary resuscitation. Methods - Eighty patients with cardiac arrest were investigated prospectively for their apoE genotype. Epidemiological data were assessed according to recommended guidelines. Patients were divided into 2 groups, ie, with the apoE 3/3 genotype present or absent, and tested for differences in survival and neurological outcome. Further statistical analysis with respect to survival and neurological outcome was performed by using a stepwise logistic regression analysis. Results - Patients with the apoE 3/3 genotype had a significantly higher survival rate (64% versus 33%, P=0.007) and more often a favorable neurological outcome (55% versus 27%, P=0.013) compared with patients with other apoE genotypes. The apoE 3/3 genotype was shown to be a substantial predictive factor for a favorable neurological outcome (odds ratio 3.2) and was, apart from other essential factors, predictive for survival (odds ratio 4.4) after cardiopulmonary resuscitation. Conclusions - These data give evidence that patients with the apoE 3/3 genotype have a better chance of recovery after cardiopulmonary resuscitation than do patients with apoE genotypes other than 3/3.",apolipoprotein E3;adult;aged;Alzheimer disease;article;female;genetic polymorphism;genotype;heart arrest;human;major clinical study;male;priority journal;resuscitation;risk assessment;cerebrovascular accident,"Schiefermeier, M.;Kollegger, H.;Madl, C.;Schwarz, C.;Holzer, M.;Kofler, J.;Sterz, F.",2000,,,0,
3936,"Functional, cognitive and emotional long-term outcome of patients with ischemic stroke requiring mechanical ventilation","Prognosis of patients with ischemic stroke requiring mechanical ventilation (MV) has been reported to be poor. However, longterm survival and functional outcome have scarcely been studied and nothing is known about the prevalence of cognitive impairment or depression in survivors and their quality of life (QoL). We identified all patients treated for acute ischemic stroke on a Neurological Intensive Care Unit during 3.5 years who required MV for more than 24 hours. Early mortality rate at 2 months and survival rates at 1 and 2 years were determined. Survivors were examined for functional outcome (modified Rankin Scale (mRS), Barthel Index), cognitive impairment (Mini Mental State Examination (MMSE)), depression (Beck Depression Inventory, BDI) and QoL (Short Form-36). Clinical characteristics on admission were analyzed for prognostic significance. Of 101 consecutive patients, 44% died within 60 days. Survival rates at 1 and 2 years were 40% and 33%, respectively. Age > 60 years (p = 0.002) and Glasgow Coma Scale score < 10 on admission (p = 0.002) were independent predictors of early and late mortality. History of myocardial infarction (p = 0.007) independently predicted late mortality at 2 years. Of 33 surviving patients, nine (27%) had a good functional outcome (mRS 0-2). Of 27 survivors who could be interviewed, 17 (63%) had no cognitive impairment (MMSE > 24) and 20 (74%) did not suffer from relevant depression (BDI < 19). In conclusion, longer-term survival of patients with ischemic stroke requiring MV was 33% and every fourth survivor resumed an independent life without dementia or depression. Older patients comatose on admission and with concomitant cardiovascular disease had the lowest probability of a favorable outcome.","Aged;Analysis of Variance;Chi-Square Distribution;Cognition/*physiology;Emotions/*physiology;Female;Glasgow Coma Scale;Humans;Longitudinal Studies;Male;Middle Aged;*Outcome Assessment (Health Care);*Quality of Life;Respiration, Artificial/*methods;Retrospective Studies;*Stroke/physiopathology/psychology/rehabilitation;Survival Rate","Schielke, E.;Busch, M. A.;Hildenhagen, T.;Holtkamp, M.;Kuchler, I.;Harms, L.;Masuhr, F.",2005,Jun,10.1007/s00415-005-0711-5,0,
3937,Cognitive changes in prevalent and incident cardiovascular disease: a 12-year follow-up in the Maastricht Aging Study (MAAS),"Aims: Cardiovascular disease (CVD) has been suggested to accelerate cognitive decline and to be a risk factor for dementia, but still little is known about the cognitive course after a first cardiovascular event. Therefore, the present study aims to investigate the cognitive trajectories in both prevalent and incident CVD over a 12-year time period in the general population. Methods and results: Cognitively healthy participants (age 24-82 years, n = 1823) of a prospective cohort study were serially assessed at baseline, 6 and 12 years. Verbal memory, executive function, and information processing speed were analysed in adults with prevalent, incident, and no CVD. Random effects models were used to test the association between CVD and change in cognitive function over time. At baseline, participants with prevalent CVD showed more decline in memory and information processing speed than healthy controls. Participants with incident CVD also showed more decline in these cognitive domains, but this was only significant in the follow-up period from 6 to 12 years. Associations were more pronounced in participants aged younger than 65 years at baseline, and in sub-analyses with angina pectoris or myocardial infarction as the most prevalent CVD conditions. Conclusion: Prevalent and incident CVD predict cognitive decline in middle-aged individuals. Findings for incident CVD suggest that the onset of decline is linked in time with the vascular event itself. Timely CVD management may delay the onset of decline.",Cardiovascular disease;Cognition;Dementia;Epidemiology;Neuropsychology;Risk factors,"Schievink, S. H. J.;van Boxtel, M. P. J.;Deckers, K.;van Oostenbrugge, R. J.;Verhey, F. R. J.;Kohler, S.",2017,Jul 22,,0,
3938,High sensitivity of laser-induced fluorescence detection in capillary gel electrophoresis for accurate apolipoprotein E genotyping,"Human apolipoprotein E (apoE) is a product of a polymorphic gene. In the general population, it shows tow major mutations, which lead to the appearance of three common alleles encoding for three protein isoforms. This polymorphism is important in the regulation of lipid metabolism. Accurate apoE phenotyping or genotyping has become essential in clinical laboratories, since the ε4 allele has been associated with cardiovascular and Alzheimer's diseases. Endonuclease restriction isotyping, followed by slab gel electrophoresis, is a rapid and convenient method for the investigation of common apoE genotypes. However, during the large-scale apoE genotyping of the STANISLAS cohort, we were confronted with a partial lack of sensitivity and resolution power of this traditional method, which sometimes leads to the misclassification of the genotypes ε2/2 and ε3/2. We have overcome this difficulty by separating the restriction fragments with capillary gel electrophoresis linked to laser-induced fluorescence detection. The baseline resolution was 2 pb, and the sensitivity limit attainable was similar to that by radioactive detection. The distinction between the ε3/2 and the ε2/2 genotypes became unequivocal, even when only low amounts of DNA were available for amplification.",apolipoprotein E;accuracy;allele;Alzheimer disease;article;DNA polymorphism;fluorescence;gel electrophoresis;gene mutation;human;hypercholesterolemia;ischemic heart disease;laser;lipid metabolism,"Schlenck, A.;Bohnet, K.;Aguillon, D.;Lafaurie, C.;Siest, G.;Visvikis, S.",1997,,,0,
3939,Does Polypharmacy in Nursing Homes Affect Long-Term Mortality?,"Objectives: To investigate the association between polypharmacy and mortality in nursing home (NH) residents. Design: Prospective observational cohort study. Settings: Six NHs in central Israel. Participants: Mobile with dementia and fully dependent residents (N = 764; n = 558 (73%) fully dependent, n = 206 (27%) mobile residents with dementia requiring institutional care; mean age 82.2 ± 5.9). Measurements: Two-year mortality and its association with number of drugs that individual residents were taking at baseline, controlled for multiple confounders. Results: At baseline, 268 residents were taking five or fewer drugs per day, 202 were taking six or seven, and 294 were taking eight or more. In the multivariate analysis, the likelihood of dying within 2 years in the group taking six or seven drugs per day (odds ratio (OR = 0.95, 95% CI = 0.63–1.43) and in those taking eight or more (OR = 1.20, 95% CI = 0.78–1.84) was similar to that of those taking five or fewer. Variables at baseline independently associated with greater mortality were male sex (OR = 1.75, 95% CI = 1.24–2.46), older age (OR = 1.07, 95% CI = 1.04–1.10), higher Charlson Comorbidity Index (OR = 1.17, 95% CI = 1.04–1.30), and taking anticoagulant (OR = 1.78, 95% CI = 1.01–3.13) or antihyperglycemic medication (OR = 1.69, 95% CI = 1.12–2.53). Variables at baseline independently associated with lower mortality were higher body mass index (OR = 0.99, 95% CI = 0.93–0.99) and taking lipid-lowering medication (OR = 0.54, 95% CI = 0.36–0.80) and selective serotonin reuptake inhibitors or serotonin–norepinephrine reuptake inhibitors (OR = 0.52, 95% CI = 0.37–0.75). Conclusion: Polypharmacy, defined quantitatively according to number of drugs, was not associated with mortality in these NH residents.",antiarrhythmic agent;anticoagulant agent;antidiabetic agent;antilipemic agent;serotonin noradrenalin reuptake inhibitor;serotonin uptake inhibitor;age;aged;article;body mass;cerebrovascular accident;Charlson Comorbidity Index;chronic kidney disease;cohort analysis;congestive heart failure;dementia;depression;diabetes mellitus;dying;dyslipidemia;enteric feeding;extrapyramidal syndrome;feeding apparatus;female;functional status;gender;heart arrhythmia;hematologic disease;human;hypothyroidism;institutional care;length of stay;lung disease;major clinical study;male;medical history;mortality;nursing home;nursing home patient;observational study;polypharmacy;prediction;prospective study,"Schlesinger, A.;Weiss, A.;Nenaydenko, O.;Adunsky, A.;Beloosesky, Y.",2016,,,0,
3940,Ocular and Systemic Pseudoexfoliation Syndrome,"Purpose: To provide an update on most recent developments regarding ocular and systemic manifestations and complications, clinical diagnosis and management, and molecular pathophysiology of pseudoexfoliation (PEX) syndrome, and to discuss future tasks and challenges in this field. Design: Perspective. Methods: Review of recent literature and authors' own clinical and laboratory studies. Results: PEX syndrome is a common age-related generalized fibrotic matrix process of worldwide significance, which may not only cause severe chronic open-angle glaucoma and cataract, but also a spectrum of other serious spontaneous and surgical intraocular complications. Recent progress and advances have led to (1) improvements in clinical management by understanding the effects of the PEX process on ocular tissues, by refining diagnostic criteria, by applying new treatment regimes, and by developing preventive strategies to reduce surgical complications; (2) increasing evidence for systemic associations of PEX with cardiovascular and cerebrovascular morbidity; and (3) new insights into the molecular pathophysiology by analyzing the composition of PEX material, the differential gene expression of affected tissues, and key factors involved in pathogenesis. The current pathogenetic concept describes PEX syndrome as an elastic microfibrillopathy involving transforming growth factor-β1, oxidative stress, and impaired cellular protection mechanisms as key pathogenetic factors. Conclusions: Future tasks and challenges comprise epidemiologic prevalence and genetic studies of PEX syndrome, prospective randomized clinical and histopathological screening studies on its systemic manifestations and associations, and intensified basic research on differential protein and gene expression, animal and in vitro models, as well as potential biomarkers for PEX syndrome and its associated glaucoma. © 2006 Elsevier Inc. All rights reserved.",antiinflammatory agent;biological marker;cyanocobalamin;eye protein;folic acid;latanoprost;melanin;pyridoxine;timolol;transforming growth factor beta1;abdominal aorta aneurysm;aging;Alzheimer disease;angina pectoris;article;brain ischemia;capsulotomy;cardiovascular disease;cataract;cataract extraction;ciliary body;clinical trial;closed angle glaucoma;cornea;disease severity;eye disease;eye synechia;gene expression;genetic risk;heart infarction;human;hyperhomocysteinemia;hypertension;hyphema;intraocular hypertension;iris;keratopathy;laser surgery;lens;lens implant;lens subluxation;miosis;mydriasis;myocardial disease;occlusive cerebrovascular disease;open angle glaucoma;oxidative stress;pathogenesis;pathophysiology;perception deafness;postoperative care;postoperative inflammation;priority journal;pseudoexfoliation;pseudoexfoliation syndrome;retina vein occlusion;risk assessment;risk reduction;senile dementia;cerebrovascular accident;surgical risk;systemic disease;trabecular meshwork;trabeculectomy;trabeculoplasty;treatment indication;uveitis;vitamin blood level,"Schlötzer-Schrehardt, U.;Naumann, G. O. H.",2006,,,0,
3941,Antipsychotic drug use and the risk of venous thromboembolism in elderly patients with dementia,"The aim of this study was to investigate the association between the use of antipsychotics and the risk of venous thromboembolism (VTE) in elderly patients with dementia. Based on data from the German Pharmacoepidemiological Research Database, a nested case-control study was conducted within a cohort of 72,591 patients with dementia aged at least 65 years at cohort entry. Cases were patients with a hospitalization due to VTE. Up to 4 controls were matched to each case according to age, sex, health insurance, and calendar time of the VTE. Users of antipsychotics were classified into current or former users, and in addition, all current users were categorized as prevalent or new users. For a further analysis, we distinguished between users of either conventional or atypical antipsychotics or concurrent users of both conventional and atypical antipsychotics. Multivariate conditional logistic regression was applied to calculate odds ratios (ORs) of VTE for all user groups compared with nonusers. The case-control data set comprised 1028 VTE cases and 4109 controls. An increased risk of VTE was found for current users (OR, 1.23; 95% confidence interval [CI], 1.01-1.50) and for users of a combination of atypical and conventional antipsychotics (OR, 1.62; 95% CI, 1.15-2.27). In current users, only new use was associated with an increased risk (OR, 1.63; 95% CI, 1.10-2.40). Increased attention to clinical signs of VTE should be paid during the first 3 months of treatment with antipsychotics and in patients receiving both conventional and atypical agents, especially if other risk factors for VTE exist. © 2013 by Lippincott Williams & Wilkins.",amisulpride;aripiprazole;atypical antipsychotic agent;benperidol;chlorprothixene;flupentixol;fluphenazine;fluspirilene;haloperidol;levomepromazine;melperone;neuroleptic agent;olanzapine;perphenazine;pipamperone;promethazine;prothipendyl;quetiapine;risperidone;sulpiride;thioridazine;tiapride;ziprasidone;zuclopenthixol;aged;article;bipolar disorder;case control study;controlled study;data base;deep vein thrombosis;dementia;diabetes mellitus;drug exposure;dyslipidemia;female;follow up;health insurance;heart failure;hospitalization;human;hypertension;incidence;ischemic heart disease;lung embolism;major clinical study;male;neoplasm;obesity;priority journal;risk factor;schizophrenia;varicosis;vein insufficiency;venous thromboembolism,"Schmedt, N.;Garbe, E.",2013,,,0,
3942,Genetic variants of the NOTCH3 gene in the elderly and magnetic resonance imaging correlates of age-related cerebral small vessel disease,"Cerebral small vessel disease-related brain lesions such as white matter lesions and lacunes are common findings of magnetic resonance imaging in the elderly. These lesions are thought to be major contributors to disability in old age, and risk factors that include age and hypertension have been established. The radiological, histopathologic and clinical phenotypes of age-related cerebral small vessel disease remarkably resemble autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy, which is caused by mutations in NOTCH3. We hypothesized that genetic variations in NOTCH3 also play a role in age-related cerebral small vessel disease. We directly sequenced all 33 exons, the promoter and 3′-untranslated region of NOTCH3 in 195 participants with either coalescent white matter lesions or lacunes and compared the results to 82 randomly selected participants with no focal changes on magnetic resonance images in the Austrian Stroke Prevention Study. We detected nine common and 33 rare single nucleotide polymorphisms, of which 20 were novel. All common single nucleotide polymorphisms were genotyped in the entire cohort (n=888), and four of them, rs1043994, rs10404382, rs10423702 and rs1043997, were associated significantly with both the presence and progression of white matter lesions. The association was confined to hypertensives, a result which we replicated in the Cohorts for Heart and Ageing Research in Genomic Epidemiology Consortium on an independent sample of 4773 stroke-free hypertensive elderly individuals of European descent (P=0.04). The 33 rare single nucleotide polymorphisms were scattered over the NOTCH3 gene with three being located in the promoter region, 24 in exons (18 non-synonymous), three in introns and three in the 3′-untranslated region. None of the single nucleotide polymorphisms affected a cysteine residue. Sorting Intolerant From Tolerant, PolyPhen2 analyses and protein structure simulation consistently predicted six of the non-synonymous single nucleotide polymorphisms (H170R, P496L, V1183M, L1518M, D1823N and V1952M) to be functional, with four being exclusively or mainly detected in subjects with severe white matter lesions. In four individuals with rare non-synonymous single nucleotide polymorphisms, we noted anterior temporal lobe hyperintensity, hyperintensity in the external capsule, lacunar infarcts or subcortical lacunar lesions. None of the observed abnormalities were specific to cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy. This is the first comprehensive study investigating (i) the frequency of NOTCH3 variations in community-dwelling elderly and (ii) their effect on cerebral small vessel disease related magnetic resonance imaging phenotypes. We show that the NOTCH3 gene is highly variable with both common and rare single nucleotide polymorphisms spreading across the gene, and that common variants at the NOTCH3 gene increase the risk of age-related white matter lesions in hypertensives. Additional investigations are required to explore the biological mechanisms underlying the observed association. © 2011 The Author.",cysteine;Notch2 receptor;3' untranslated region;adult;aged;arteriography;article;autosomal dominant disorder;brain damage;CADASIL;cerebrovascular disease;clinical assessment;controlled study;disease association;disease course;exon;external capsule;gene sequence;genetic variability;histopathology;human;hypertension;major clinical study;nuclear magnetic resonance imaging;priority journal;promoter region;protein structure;radiodiagnosis;risk factor;single nucleotide polymorphism;white matter,"Schmidt, H.;Zeginigg, M.;Wiltgen, M.;Freudenberger, P.;Petrovic, K.;Cavalieri, M.;Gider, P.;Enzinger, C.;Fornage, M.;Debette, S.;Rotter, J. I.;Ikram, M. A.;Launer, L. J.;Schmidt, R.",2011,,,0,
3943,Eighteen-year trends in stroke mortality and the prognostic influence of comorbidity,"Objectives: To examine 18-year trends in short-term and long-term stroke mortality and the prognostic influence of comorbidity. Methods: We conducted a nationwide population-based cohort study. Using the Danish National Registry of Patients, covering all Danish hospitals, we identified all 219,354 patients with a firsttime hospitalization for stroke during 1994-2011. We computed standardized 30-day, 1-year, and 5-year mortality by sex. Comorbidity categories were defined by Charlson Comorbidity Index scores of 0 (none), 1 (moderate), 2 (severe), and 3 or more (very severe). Calendar periods of diagnosis (1994-1998, 1999-2003, 2004-2008, and 2009-2011) and comorbidity categories were compared by means of mortality rate ratios based on Cox regression. Results: Over time, the 30-day mortality rate ratio adjusted for age, sex, and comorbidity decreased by approximately 45% for ischemic stroke (standardized risk decreased from 17.2% in 1994-1998 to 10.6% in 2009-2011) and by 35% for intracerebral hemorrhage (from 43.2% to 33.8%). The absolute mortality reduction occurred for all levels of comorbidity. Five-year mortality risk decreased from 56.4% in 1994-1998 to 46.1% in 2004-2008 for ischemic stroke and from 66.1% to 61.0% for intracerebral hemorrhage. Comparing very severe comorbidity with no comorbidity, 30-day and 5-year mortality rate ratios were both approximately 2.5-fold increased for ischemic stroke and 1.7-fold increased for intracerebral hemorrhage. Conclusions: Short- and long-term mortality improved considerably between 1994 and 2011 for all types of stroke. Short-term mortality improved regardless of comorbidity burden. However, comorbidity burden was a strong prognostic factor for both short- and long-term mortality. © 2014 American Academy of Neurology.",adolescent;adult;aged;article;brain hemorrhage;brain ischemia;cerebrovascular accident;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;dementia;Denmark;diabetes mellitus;diagnostic test accuracy study;disease severity;female;atrial fibrillation;heart atrium flutter;heart infarction;human;kidney disease;liver disease;major clinical study;male;middle aged;mortality;peripheral vascular disease;priority journal;prognosis;solid tumor;stroke patient;trend study;ulcer;very elderly;young adult,"Schmidt, M.;Jacobsen, J. B.;Johnsen, S. P.;Boøtker, H. E.;Soørensen, H. T.",2014,,,0,
3944,"25 Year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: A Danish nationwide cohort study","Objectives: To examine 25 year trends in first time hospitalisation for acute myocardial infarction in Denmark, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity. Design: Nationwide population based cohort study using medical registries. Setting: All hospitals in Denmark. Subjects: 234 331 patients with a first time hospitalisation for myocardial infarction from 1984 through 2008. Main outcome measures: Standardised incidence rate of myocardial infarction and 30 day and 31-365 day mortality by sex. Comorbidity categories were defined as normal, moderate, severe, and very severe according to the Charlson comorbidity index, and were compared by means of mortality rate ratios based on Cox regression. Results: The standardised incidence rate per 100 000 people decreased in the 25 year period by 37% for women (from 209 to 131) and by 48% for men (from 410 to 213). The 30 day, 31-365 day, and one year mortality declined from 31.4%, 15.6%, and 42.1% in 1984-8 to 14.8%, 11.1%, and 24.2% in 2004-8, respectively. After adjustment for age at time of myocardial infarction, men and women had the same one year risk of dying. The mortality reduction was independent of comorbidity category. Comparing patients with very severe versus normal comorbidity during 2004-8, the mortality rate ratio, adjusted for age and sex, was 1.96 (95% CI 1.83 to 2.11) within 30 days and 3.89 (3.58 to 4.24) within 31-365 days. Conclusions: The rate of first time hospitalisation for myocardial infarction and subsequent short term mortality both declined by nearly half between 1984 and 2008. The reduction in mortality occurred for all patients, independent of sex and comorbidity. However, comorbidity burden was a strong prognostic factor for short and long term mortality, while sex was not.",acquired immune deficiency syndrome;acute heart infarction;adult;age distribution;aged;article;cerebrovascular disease;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;disease severity;ethnic group;female;hemiplegia;hospitalization;human;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;metastasis;mortality;multiple organ failure;onset age;peripheral vascular disease;population research;primary medical care;priority journal;prognosis;sex ratio;trend study;ulcer,"Schmidt, M.;Jacobsen, J. B.;Lash, T. L.;Bøtker, H. E.;Sørensen, H. T.",2012,,,0,
3945,Diabetes mellitus in midlife and the risk of dementia three decades later,"Objective: To examine the association between diabetes in midlife (1963-1968) and dementia more than three decades later (1999-2001). Methods: The authors characterized dementia using standard methods for 1,892 participants among 2,606 survivors of 10,059 participants in the Israeli Ischemic Heart Disease study, a longitudinal investigation of the incidence of and risk factors for cardiovascular disease among Jewish male civil servants in Israel. Face to face interviews were conducted with the 652 subjects identified as possibly demented by the Modified Telephone Interview for Cognitive Status. Logistic regression analysis was performed to assess the association of diabetes with dementia controlling for sociodemographic and cardiovascular variables compared to those with no cognitive impairment. Results: Of 1,892 assessed subjects (mean age 82 at assessment), 309 (16.3%) had dementia. Diabetic subjects had significantly more dementia than non-diabetic subjects (χ2 = 7.54, df = 1, p = 0.006, OR 2.83 [95% CI = 1.40 to 5.71]). Those who survived to the time of this study were younger and healthier than those who died. Conclusions: Evidence for diabetes as a risk factor for dementia was found, similar to other epidemiologic studies. In contrast to the earlier studies, however, the authors linked diabetes in midlife to dementia more than three decades later in the very old survivors of a large male cohort.",adult;aged;article;cardiovascular risk;cognition;cognitive defect;dementia;demography;diabetes mellitus;disease association;human;interview;Jew;logistic regression analysis;major clinical study;male;priority journal;risk factor,"Schnaider Beeri, M.;Goldbourt, U.;Silverman, J. M.;Noy, S.;Schmeidler, J.;Ravona-Springer, R.;Sverdlick, A.;Davidson, M.",2004,,,0,
3946,Reply from the authors 2,,smooth muscle actin;Alzheimer disease;aorta valve disease;cardiovascular function;cognitive defect;coronary artery atherosclerosis;disease association;disease severity;genetic association;heterozygote;human;letter;mitral valve disease;neuropathology;priority journal,"Schnaider Beeri, M.;Rapp, M.;Silverman, J. M.;Schmeidler, J.;Grossman, H. T.;Fallon, J. T.;Purohit, D. P.;Perl, D. P.;Siddiqui, A.;Lesser, G.;Rosendorff, C.;Haroutunian, V.",2007,,,0,
3947,High-sensitivity cardiac troponin T and cognitive function and dementia risk: the atherosclerosis risk in communities study,"AIM: Clinical cardiovascular disease is a major risk factor for cognitive impairment and dementia. However, less is known about the association of subclinical myocardial damage with cognition and dementia. We sought to examine the associations of high-sensitivity cardiac troponin T (hs-cTnT) with cognition and dementia. METHODS AND RESULTS: Cross-sectional analysis of cognition (baseline 1996-98) and prospective analysis of dementia (follow-up through 2010) in 9472 participants in the Atherosclerosis Risk in Communities study. High-sensitivity cardiac troponin T was measured using a novel highly sensitive assay with a lower limit of the blank of 3 ng/L. Cognitive function was assessed by three tests: the delayed word recall test (DWRT), the digit symbol substitution test (DSST), and the word fluency test (WFT). Dementia was defined using ICD-9 codes. Linear regression and Cox models were adjusted for traditional cardiovascular risk factors. The mean age of participants was 63 years, 59% were female, 21% were black, and 66% had hs-cTnT >/=3 ng/L. In cross-sectional analyses, higher hs-cTnT was associated with lower scores on the DSST (P-trend < 0.001) and the WFT (P-trend = 0.002), but not on the DWRT (P-trend = 0.089). Over a median of 13 years, there were 455 incident dementia hospitalizations. In prospective analyses, higher baseline concentrations of hs-cTnT were associated with an increased risk for dementia hospitalizations overall (P-trend < 0.001) and for vascular dementia (P-trend = 0.029), but not for Alzheimer's dementia (P-trend = 0.212). CONCLUSION: Elevations in baseline concentrations of hs-cTnT were associated with lower cognitive test scores at baseline and increased dementia hospitalization risk during the follow-up. Our results suggest that subclinical myocardial injury is associated with cognition and dementia.",Atherosclerosis/blood/*complications;Cardiomyopathies/complications;Cognition Disorders/blood/*etiology;Cross-Sectional Studies;Dementia/blood/*etiology;Female;Hospitalization/statistics & numerical data;Humans;Male;Middle Aged;Prospective Studies;Psychological Tests;Risk Factors;Troponin T/*metabolism;Cognition;Dementia;High-sensitivity Troponin T,"Schneider, A. L.;Rawlings, A. M.;Sharrett, A. R.;Alonso, A.;Mosley, T. H.;Hoogeveen, R. C.;Ballantyne, C. M.;Gottesman, R. F.;Selvin, E.",2014,Jul 14,10.1093/eurheartj/ehu124,0,
3948,The apolipoprotein E ε4 allele increases the odds of chronic cerebral infection detected at autopsy in older persons,"Background and Purpose - Studies investigating the relation of the apolipoprotein E (apoE) ε4 allele to clinical stroke and to vascular changes on magnetic resonance imaging have been conflicting. Little data are available regarding the relation of apoE ε4 to cerebral infarctions documented on postmortem examination. Methods - We studied the apoE ε4 allele in 214 deceased members of the Religious Orders Study, a longitudinal clinical-pathologic study of aging and Alzheimer disease. The apoE genotype was determined using DNA from lymphocytes. Brains were removed a median of 5 hours (interquartile range, 5.5) after death. At postmortem examination, age, location, and size of macroscopic chronic cerebral infarctions were recorded from 1-cm coronal slabs after paraformaldehyde fixation. We also examined 20-μm paraffin-embedded sections of midfrontal and calcarine cortex for amyloid angiopathy on a scale of 1 to 4. Results - Subjects included 96 males and 118 females with a mean age at death of 86 years (SD, 7). Sixty-five subjects (30.4%) had at least 1 apoE ε4 allele and 76 (35.5%) exhibited cerebral infarctions. More than 74% of the subjects exhibited amyloid angiopathy with a mean score of 1.4 ± 1.2. After controlling for age and sex, apoE ε4 increased the odds of cerebral infarction by 2.3-fold (95% CI, 1.2 to 4.2). apoE ε4 increased the odds of cortical 3.2-fold (95% CI, 1.3 to 7.7) and subcortical infarctions 2.3-fold (95% CI, 1.2 to 4.5). The effect was unchanged after accounting for amyloid angiopathy. Conclusions - apoE ε4 increases the odds of chronic cerebral infarction detected at autopsy in older persons. © 2005 American Heart Association, Inc.",apolipoprotein E;apolipoprotein e epsilon 4;unclassified drug;aged;allele;Alzheimer disease;article;autopsy;brain infarction;brain infection;chronic disease;controlled study;DNA determination;female;genotype;human;major clinical study;male;priority journal;vascular amyloidosis,"Schneider, J. A.;Bienias, J. L.;Wilson, R. S.;Berry-Kravis, E.;Evans, D. A.;Bennett, D. A.",2005,,,0,
3949,Recruitment methods for united states alzheimer disease prevention trials,"There are no substantially effective treatments or preventatives for Alzheimer disease. The few prevention trials that were undertaken did not shown efficacy for the drugs tested; but, nevertheless, advanced prevention trials methods. We review past recruitment methods and discuss areas for improvement. improvements in recruitment methods can enhance the likelihood for accurately demonstrating the efficacy of an effective drug. effective therapeutics to prevent Ad await discovery and proof.",acetylsalicylic acid;alpha tocopherol;amyloid beta protein;celecoxib;estrogen;naproxen;selenium;simvastatin;tau protein;Alzheimer disease;article;cardiovascular risk;clinical trial (topic);dementia;disease course;disease marker;disease registry;drug efficacy;follow up;Ginkgo biloba;health insurance;heart infarction;heart protection;human;medicare;mild cognitive impairment;neuropathology;neurophysiological recruitment;primary prevention;priority journal;sample size;cerebrovascular accident;United States;women's health;aspirin,"Schneider, L. S.",2012,,,0,
3950,Reduce vascular risk to prevent dementia?,,apolipoprotein E4;glucose;academic achievement;age;allele;Alzheimer disease;arteriolosclerosis;brain hemorrhage;brain infarction;brain injury;cardiovascular mortality;cardiovascular risk;dementia;depression;heart infarction;hippocampal sclerosis;human;hypertension;incidence;lacunar stroke;lifestyle;medical practice;mental deterioration;Netherlands;neurofibrillary tangle;neuropathology;neuroprotection;non insulin dependent diabetes mellitus;note;nurse attitude;obesity;outcome assessment;peripheral occlusive artery disease;physical inactivity;prevalence;priority journal;protein aggregation;risk assessment;risk factor;risk reduction;smoking;symptom;vascular amyloidosis,"Schneider, L. S.",2016,,10.1016/s0140-6736(16)31129-1,0,
3951,Evolution of Cognitive Function after Transcatheter Aortic Valve Implantation,"Background - This study aimed to assess the evolution of cognitive function after transcatheter aortic valve implantation (TAVI). Previous smaller studies reported conflicting results on the evolution of cognitive function after TAVI. Methods and Results - In this prospective cohort, cognitive function was measured in 229 patients ≥70 years using the Mini Mental State Examination before and 6 months after TAVI. Cognitive deterioration or improvement was defined as change of ≥3 points decrease or increase in the Mini Mental State Examination score between baseline and follow-up. Cognitive deterioration was found in 29 patients (12.7%). Predictive analysis using logistic regression did not identify any statistically significant predictor of cognitive deterioration. A review of individual medical records in 8 patients with a major Mini Mental State Examination score decrease of ≥5 points revealed specific causes in 6 cases (postinterventional delirium in 2; postinterventional stroke, progressive renal failure, progressive heart failure, or combination of preexisting cerebrovascular disease and mild cognitive impairment in 1 each). Among 48 patients with impaired baseline cognition (Mini Mental State Examination score <26 points), 18 patients (37.5%) cognitively improved. The preinterventional aortic valve area was lower in patients who cognitively improved (median aortic valve area 0.60 cm 2) as compared with patients who did not improve (median aortic valve area 0.70 cm 2; P=0.01). Conclusions - This is the first study providing evidence that TAVI results in cognitive improvement among patients who had impaired preprocedural cognitive function, possibly related to hemodynamic improvement in patients with severe aortic stenosis. Our results confirm that some patients experience cognitive deterioration after TAVI.",aorta valve stenosis;cerebrovascular accident;cognition;controlled study;delirium;follow up;geriatric assessment;heart failure;hemodynamics;human;kidney failure;logistic regression analysis;major clinical study;medical record;mental deterioration;mild cognitive impairment;Mini Mental State Examination;transcatheter aortic valve implantation,"Schoenenberger, A. W.;Zuber, C.;Moser, A.;Zwahlen, M.;Wenaweser, P.;Windecker, S.;Carrel, T.;Stuck, A. E.;Stortecky, S.",2016,,,0,3952
3952,Evolution of Cognitive Function after Transcatheter Aortic Valve Implantation,"Background - This study aimed to assess the evolution of cognitive function after transcatheter aortic valve implantation (TAVI). Previous smaller studies reported conflicting results on the evolution of cognitive function after TAVI. Methods and Results - In this prospective cohort, cognitive function was measured in 229 patients ≥70 years using the Mini Mental State Examination before and 6 months after TAVI. Cognitive deterioration or improvement was defined as change of ≥3 points decrease or increase in the Mini Mental State Examination score between baseline and follow-up. Cognitive deterioration was found in 29 patients (12.7%). Predictive analysis using logistic regression did not identify any statistically significant predictor of cognitive deterioration. A review of individual medical records in 8 patients with a major Mini Mental State Examination score decrease of ≥5 points revealed specific causes in 6 cases (postinterventional delirium in 2; postinterventional stroke, progressive renal failure, progressive heart failure, or combination of preexisting cerebrovascular disease and mild cognitive impairment in 1 each). Among 48 patients with impaired baseline cognition (Mini Mental State Examination score <26 points), 18 patients (37.5%) cognitively improved. The preinterventional aortic valve area was lower in patients who cognitively improved (median aortic valve area 0.60 cm 2) as compared with patients who did not improve (median aortic valve area 0.70 cm 2; P=0.01). Conclusions - This is the first study providing evidence that TAVI results in cognitive improvement among patients who had impaired preprocedural cognitive function, possibly related to hemodynamic improvement in patients with severe aortic stenosis. Our results confirm that some patients experience cognitive deterioration after TAVI.",aged;aortic valve stenosis;article;brain embolism;cerebrovascular accident;cognition;female;follow up;heart failure;human;kidney failure;major clinical study;male;medical record review;mental deterioration;mild cognitive impairment;Mini Mental State Examination;postoperative delirium;postoperative period;priority journal;prospective study;transcatheter aortic valve implantation;very elderly,"Schoenenberger, A. W.;Zuber, C.;Moser, A.;Zwahlen, M.;Wenaweser, P.;Windecker, S.;Carrel, T.;Stuck, A. E.;Stortecky, S.",2016,,10.1161/circinterventions.116.003590,0,
3953,Anxiety disorders and physical comorbidity: increased prevalence but reduced relevance of specific risk factors for hospital-based mortality during a 12.5-year observation period in general hospital admissions,"Anxiety disorders (AD) are associated with an increase in physical comorbidities, but the effects of these diseases on hospital-based mortality are unclear. Consequently, we investigated whether the burden of physical comorbidity and its relevance on hospital-based mortality differed between individuals with and without AD during a 12.5-year observation period in general hospital admissions. During 1 January 2000 and 30 June 2012, 11,481 AD individuals were admitted to seven General Manchester Hospitals. All comorbidities with a prevalence ≥1 % were compared with those of 114,810 randomly selected and group-matched hospital controls of the same age and gender, regardless of priority of diagnoses or specialized treatments. Comorbidities that increased the risk of hospital-based mortality (but not mortality outside of the hospital) were identified using multivariate logistic regression analyses. AD individuals compared to controls had a substantial excess comorbidity, but a reduced hospital-based mortality rate. Twenty-two physical comorbidities were increased in AD individuals compared with controls, which included cardiovascular diseases and their risk factors. The most frequent physical comorbidities in AD individuals were hypertension, asthma, cataract, and ischaemic heart disease. Risk factors for hospital-based mortality in AD individuals were lung cancer, alcoholic liver disease, respiratory failure, heart failure, pneumonia, bronchitis, non-specific dementia, breast cancer, COPD, gallbladder calculus, atrial fibrillation, and angina. The impact of atrial fibrillation, angina, and gallbladder calculus on hospital-based mortality was higher in AD individuals than in controls. In contrast, other mortality risk factors had an equal or lower impact on hospital-based mortality in sample comparisons. Therefore AD individuals have a higher burden of physical comorbidity that is associated with a reduced risk of general hospital-based mortality. Atrial fibrillation, angina, and gallbladder calculus are major risk factors for general hospital-based mortality in AD individuals.",adult;alcohol liver disease;anxiety disorder;article;asthma;atrial fibrillation;breast cancer;bronchitis;cataract;cholelithiasis;comorbidity;comparative study;dementia;disease course;female;general hospital;heart failure;hospital admission;hospital readmission;hospitalization;human;hypertension;ICD-10;ischemic heart disease;lung cancer;major clinical study;male;middle aged;mortality;patient information;physical disease;pneumonia;prevalence;priority journal;respiratory failure;risk factor,"Schoepf, D.;Heun, R.",2015,,,0,
3954,Physical comorbidity and its relevance on mortality in schizophrenia: A naturalistic 12-year follow-up in general hospital admissions,"Schizophrenia is a major psychotic disorder with significant comorbidity and mortality. Patients with schizophrenia are said to suffer more type-2 diabetes mellitus (T2DM) and diabetogenic complications. However, there is little consistent evidence that comorbidity with physical diseases leads to excess mortality in schizophrenic patients. Consequently, we investigated whether the burden of physical comorbidity and its relevance on hospital mortality differed between patients with and without schizophrenia in a 12-year follow-up in general hospital admissions. During 1 January 2000 and 31 June 2012, 1418 adult patients with schizophrenia were admitted to three General Manchester NHS Hospitals. All comorbid diseases with a prevalemce ≥1 % were compared with those of 14,180 age- and gender-matched hospital controls. Risk factors, i.e. comorbid diseases that were predictors for general hospital mortality were identified using multivariate logistic regression analyses. Compared with controls, schizophrenic patients had a higher proportion of emergency admissions (69.8 vs. 43.0 %), an extended average length of stay at index hospitalization (8.1 vs. 3.4 days), a higher number of hospital admissions (11.5 vs. 6.3), a shorter length of survival (1895 vs. 2161 days), and a nearly twofold increased mortality rate (18.0 vs. 9.7 %). Schizophrenic patients suffered more depression, T2DM, alcohol abuse, asthma, COPD, and twenty-three more diseases, many of them diabetic-related complications or other environmentally influenced conditions. In contrast, hypertension, cataract, angina, and hyperlipidaemia were less prevalent in the schizophrenia population compared to the control population. In deceased schizophrenic patients, T2DM was the most frequently recorded comorbidity, contributing to 31.4 % of hospital deaths (only 14.4 % of schizophrenic patients with comorbid T2DM survived the study period). Further predictors of general hospital mortality in schizophrenia were found to be alcoholic liver disease (OR = 10.3), parkinsonism (OR = 5.0), T1DM (OR = 3.8), non-specific renal failure (OR = 3.5), ischaemic stroke (OR = 3.3), pneumonia (OR = 3.0), iron-deficiency anaemia (OR = 2.8), COPD (OR = 2.8), and bronchitis (OR = 2.6). There were no significant differences in their impact on hospital mortality compared to control subjects with the same diseases except parkinsonism which was associated with higher mortality in the schizophrenia population compared with the control population. The prevalence of parkinsonism was significantly elevated in the 255 deceased schizophrenic patients (5.5 %) than in those 1,163 surviving the study period (0.8 %, OR = 5.0) and deceased schizophrenic patients had significantly more suffered extrapyramidal symptoms than deceased control subjects (5.5 vs. 1.5 %). Therefore patients with schizophrenia have a higher burden of physical comorbidity that is associated with a worse outcome in a 12-year follow-up of mortality in general hospitals compared with hospital controls. However, schizophrenic patients die of the same physical diseases as their peers without schizophrenia. The most relevant physical risk factors of general hospital mortality are T2DM, COPD and infectious respiratory complications, iron-deficiency anaemia, T1DM, unspecific renal failure, ischaemic stroke, and alcoholic liver disease. Additionally, parkinsonism is a major risk factor for general hospital mortality in schizophrenia. Thus, optimal monitoring and management of acute T2DM and COPD with its infectious respiratory complications, as well as the accurate detection and management of iron-deficiency anaemia, of diabetic-related long-term micro- and macrovascular complications, of alcoholic liver disease, and of extrapyramidal symptoms are of utmost relevance in schizophrenia. © 2013 Springer-Verlag Berlin Heidelberg.",adult;adult disease;alcohol abuse;alcohol liver disease;angina pectoris;anxiety disorder;article;asthma;bipolar disorder;brain ischemia;bronchitis;cannabis addiction;case control study;cataract;cellulitis;cholelithiasis;chronic kidney disease;chronic obstructive lung disease;comorbidity;constipation;controlled study;dementia;depression;diabetogenesis;diverticulosis;epilepsy;esophagus ulcer;extrapyramidal symptom;female;femur neck fracture;follow up;gastritis;gastroesophageal reflux;general hospital;atrial fibrillation;heart failure;heart infarction;hospital admission;hospitalization;human;hyperlipidemia;hypertension;hypothyroidism;iron deficiency anemia;kidney failure;length of stay;major clinical study;male;middle aged;mortality;non insulin dependent diabetes mellitus;opiate addiction;parkinsonism;peripheral vascular disease;pneumonia;prevalence;priority journal;respiratory failure;risk factor;schizophrenia;suicide;suicide attempt;survival,"Schoepf, D.;Uppal, H.;Potluri, R.;Heun, R.",2014,,,0,
3955,Genotype-based risk and pharmacogenetic sampling in clinical trials,"A number of recent genome-wide association (GWA) studies have identified unequivocal statistical associations between inherited genetic variations, mostly single-nucleotide polymorphisms (SNPs), and common complex diseases such as diabetes, cardiovascular disease, and obesity. Genotyping individuals for these variations has the potential to help redefine how pharmacologic agents undergo clinical development. By identifying carriers of known genomic variants that contribute to susceptibility, a high-risk population can be defined, as well as individuals with potential for a better response to a drug. We evaluated the potential utility that selecting individuals for a trial on the basis of genotypes identified in contemporary GWA studies would have had on recently described clinical trials. We pursued this by constraining both the risks of a disease outcome associated with particular genotypes and overall drug responses to those actually observed in genetic association and clinical trial studies, respectively. We pursued these evaluations in the context of clinical trials investigating drugs for macular degeneration, obesity, heart disease, type II diabetes, prostate cancer, and Alzheimer's disease. We show that the increase in incidence of outcomes in trials restricted to individuals with specific genotypic profiles can result in substantial reductions in requisite sample sizes for such trials. In addition, we also derive realistic bounds for samples sizes for clinical trials investigating pharmacogenetic effects that leverage genetic variations identified in recent association studies. Copyright © Taylor & Francis Group, LLC.",abciximab;acetylsalicylic acid;antioxidant;atorvastatin;clopidogrel;fibrinolytic agent;finasteride;hydroxymethylglutaryl coenzyme A reductase inhibitor;metformin;ramipril;simvastatin;Alzheimer disease;article;behavior therapy;clinical study;clinical trial;disease association;drug efficacy;genetic association;genetic risk;genetic susceptibility;genetic variability;genotype;heart disease;heart infarction;human;multilocus sequence typing;non insulin dependent diabetes mellitus;obesity;patient selection;pharmacogenetics;priority journal;prophylaxis;prostate cancer;macular degeneration;single nucleotide polymorphism;treatment response;aspirin,"Schork, N. J.;Topol, E. J.",2010,,,0,
3956,Results of noninvasive ventilation in very old patients,"Background: Noninvasive ventilation (NIV) is frequently used for the management of acute respiratory failure (ARF) in very old patients (> 80 years), often in the context of a do-not-intubate order (DNI). We aimed to determine its efficacy and long-term outcome. Methods: Prospective cohort of all patients admitted to the medical ICU of a tertiary hospital during a 2-year period and managed using NIV. Characteristics of patients, context of NIV, and treatment intensity were compared for very old and younger patients. Six-month survival and functional status were assessed in very old patients. Results: During the study period, 1,019 patients needed ventilatory support and 376 (37%) received NIV. Among them, 163 (16%) very old patients received ventilatory support with 60% of them managed using NIV compared with 32% of younger patients (p < 0.0001). Very old patients received NIV more frequently with DNI than in younger patients (40% vs. 8%). Such cases were associated with high mortality for both very old and younger patients. Hospital mortality was higher in very old than in younger patients but did not differ when NIV was used for cardiogenic pulmonary edema or acute-on-chronic respiratory failure (20% vs. 15%) and in postextubation (15% vs. 17%) out of a context of DNI. Six-month mortality was 51% in very old patients, 67% for DNI patients, and 77% in case of NIV failure and endotracheal intubation. Of the 30 hospital survivors, 22 lived at home and 13 remained independent for activities of daily living. Conclusions: Very old patients managed using NIV have an overall satisfactory 6-month survival and functional status, except for endotracheal intubation after NIV failure. © 2012 Schortgen et al.",aged;article;cardiogenic pulmonary edema;clinical examination;comorbidity;controlled study;daily life activity;dementia;endotracheal intubation;female;follow up;functional assessment;heart failure;human;intensive care unit;length of stay;lung disease;major clinical study;male;mortality;neoplasm;noninvasive ventilation;outcome assessment;peripheral occlusive artery disease;priority journal;respiratory failure;survival;very elderly,"Schortgen, F.;Follin, A.;Piccari, L.;Roche-Campo, F.;Carteaux, G.;Taillandier-Heriche, E.;Krypciak, S.;Thille, A. W.;Paillaud, E.;Brochard, L.",2012,,,0,
3957,Amyloidosis in the bladder: Three cases with different appearance,"Amyloidosis refers to a number of diseases characterized by extracellular deposition of misfolded proteins, called amyloid fibrils, in the tissues and organs of the body. Amyloidosis in the bladder is a generally localized, rare condition, with approximately 200 cases reported in the literature. This report presents three cases of amyloidosis in the bladder, two of which had coexisting transitional cell carcinoma. Evaluation for systemic disease is recommended in patients with newly discovered amyloidosis, even if first recognized in an area with the localized form, as in the bladder.",azathioprine;aged;Alzheimer disease;amyloidosis;aorta stenosis;article;bladder amyloidosis;bladder disease;bladder papilloma;bladder tumor;case report;cerebrovascular accident;chronic kidney disease;computer assisted tomography;cystoscopy;disease severity;follow up;atrial fibrillation;heart failure;hematuria;histopathology;human;hyperlipidemia;hypertension;lung disease;male;non insulin dependent diabetes mellitus;palliative therapy;pleura thickening;rectum biopsy;retroperitoneal fibrosis;transitional cell carcinoma;transurethral resection;urge incontinence;very elderly;imurel,"Schou-Jensen, K. S.;Dahl, C.;Pilt, A. P.;Azawi, N. H.",2014,,,0,
3958,Causes of failure to reactivate aged patients with cerebrovascular accident,,Aged;Aphasia;Brain Neoplasms/diagnosis;Cerebrovascular Disorders/*rehabilitation;Contracture;Deafness;Dementia;Femoral Neck Fractures/complications;Hemianopsia;Humans;Humeral Fractures/complications;Motivation;Myocardial Infarction/complications,"Schouten, J.",1975,Jul 12,,0,
3959,Stroke and hypertension,"Arterial hypertension is the most important risk factor for stroke. Many interventional trials have unambiguously proven the benefit of antihypertensive therapy in both primary and secondary prevention for all age categories. No recommendation for any single antihypertensive substance for the primary prevention of stroke exists. Achieving the therapeutic goal (normotension) is the crucial factor. In most patients, multiple combinations of antihypertensive drugs are required to do this. For high-risk patients and in secondary prevention, substances inhibiting the renin-angiotensin-system, especially combined with calcium antagonists and indapamid, may be advantageous, while beta-blockers appear to be less well suited. In patients suffering from left-ventricular hypertrophy or atrial fibrillation, sartanes are the best-documented drug class. As TIA or stroke will often disturb the normal circadian rhythm of blood pressure and eliminate the usual night-time drop, monitoring of the therapeutic results must include ambulatory 24h measurements. The interrelation between vascular dementia and hypertension is by now also considered proven. An early start of antihypertensive treatment can prevent the development of dementia and impaired cognitive function. © 2009 Springer Medizin Verlag.",amlodipine;angiotensin 1 receptor antagonist;antihypertensive agent;atenolol;benazepril;beta adrenergic receptor blocking agent;calcium antagonist;dipeptidyl carboxypeptidase inhibitor;diuretic agent;eprosartan;hydrochlorothiazide;indapamide;losartan;nitrendipine;perindopril;placebo;telmisartan;thiazide diuretic agent;ambulatory monitoring;antihypertensive therapy;article;clinical trial;cognition;atrial fibrillation;heart left ventricle hypertrophy;high risk patient;human;hypertension;multiinfarct dementia;primary prevention;renin angiotensin aldosterone system;risk factor;secondary prevention;cerebrovascular accident;transient ischemic attack,"Schrader, J.",2009,,,0,
3960,Plasma clusterin and the risk of Alzheimer disease,"CONTEXT: Variants in the clusterin gene are associated with the risk of Alzheimer disease (AD) and clusterin levels have been found to be increased in brain and cerebrospinal fluid of patients with AD. Plasma clusterin was reported to be associated with brain atrophy, baseline disease severity, and rapid clinical progression in patients with AD. OBJECTIVE: To evaluate the potential of plasma clusterin as a biomarker of the presence, severity, and risk of AD. DESIGN, SETTING, AND PARTICIPANTS: A case-cohort study nested within the Rotterdam Study, a prospective population-based cohort study conducted in Rotterdam, The Netherlands. Plasma levels of clusterin were measured at baseline (1997-1999) in 60 individuals with prevalent AD, a random subcohort of 926 participants, and an additional 156 participants diagnosed with AD during follow-up until January 1, 2007 (mean [SD], 7.2 [2.3] years). MAIN OUTCOME MEASURES: Prevalent AD, severity of AD measured by the Mini-Mental State Examination (MMSE) score, and the risk of developing AD during follow-up. RESULTS: The likelihood of prevalent AD increased with increasing plasma levels of clusterin (odds ratio [OR] per SD increase of plasma clusterin level, 1.63; 95% confidence interval [CI], 1.21-2.20; adjusted for age, sex, education level, apolipoprotein E status, diabetes, smoking, coronary heart disease, and hypertension). Among patients with AD, higher clusterin levels were associated with more severe disease (adjusted difference in MMSE score per SD increase in clusterin levels, -1.36; 95% CI, -2.70 to -0.02; P = .047). Plasma clusterin levels were not related to the risk of incident AD during total follow-up (adjusted HR, 1.00; 95% CI, 0.85-1.17; P for trend = .77) or within 3 years of baseline (adjusted HR, 1.09; 95% CI, 0.84-1.42; P for trend = .65). CONCLUSION: Plasma clusterin levels were significantly associated with baseline prevalence and severity of AD, but not with incidence of AD.","Aged;Aged, 80 and over;Alzheimer Disease/*blood/epidemiology/genetics;Biomarkers/blood;Case-Control Studies;Clusterin/*blood/genetics;Cohort Studies;Female;Genetic Predisposition to Disease;Humans;Incidence;Male;Mental Status Schedule;Middle Aged;Netherlands/epidemiology;Odds Ratio;Prevalence;Risk;Severity of Illness Index","Schrijvers, E. M.;Koudstaal, P. J.;Hofman, A.;Breteler, M. M.",2011,Apr 6,10.1001/jama.2011.381,0,
3961,Cardiac Dysfunction in the BACHD Mouse Model of Huntington's Disease,"While Huntington's disease (HD) is classified as a neurological disorder, HD patients exhibit a high incidence of cardiovascular events leading to heart failure and death. In this study, we sought to better understand the cardiovascular phenotype of HD using the BACHD mouse model. The age-related decline in cardiovascular function was assessed by echocardiograms, electrocardiograms, histological and microarray analysis. We found that structural and functional differences between WT and BACHD hearts start at 3 months of age and continue throughout life. The aged BACHD mice develop cardiac fibrosis and ultimately apoptosis. The BACHD mice exhibited adaptive physiological changes to chronic isoproterenol treatment; however, the medication exacerbated fibrotic lesions in the heart. Gene expression analysis indicated a strong tilt toward apoptosis in the young mutant heart as well as changes in genes involved in cellular metabolism and proliferation. With age, the number of genes with altered expression increased with the large changes occurring in the cardiovascular disease, cellular metabolism, and cellular transport clusters. The BACHD model of HD exhibits a number of changes in cardiovascular function that start early in the disease progress and may provide an explanation for the higher cardiovascular risk in HD.","Adrenergic beta-Agonists/pharmacology/therapeutic use;Aging;Animals;Apoptosis/genetics;Cardiomegaly/genetics/*physiopathology/ultrasonography;*Disease Models, Animal;Fibrosis;Gene Expression Profiling;Heart Ventricles/metabolism/pathology;Huntington Disease/genetics/metabolism/*physiopathology;Isoproterenol/pharmacology;Mice;Mice, Inbred C57BL;Mice, Transgenic;Multiplex Polymerase Chain Reaction;Myocardial Contraction/drug effects/physiology;Nerve Tissue Proteins/genetics;Real-Time Polymerase Chain Reaction;Tissue Array Analysis;Trinucleotide Repeat Expansion;Ventricular Dysfunction, Left/drug;therapy/genetics/*physiopathology/ultrasonography","Schroeder, A. M.;Wang, H. B.;Park, S.;Jordan, M. C.;Gao, F.;Coppola, G.;Fishbein, M. C.;Roos, K. P.;Ghiani, C. A.;Colwell, C. S.",2016,,10.1371/journal.pone.0147269,0,3962
3962,Cardiac Dysfunction in the BACHD Mouse Model of Huntington's Disease,"While Huntington's disease (HD) is classified as a neurological disorder, HD patients exhibit a high incidence of cardiovascular events leading to heart failure and death. In this study, we sought to better understand the cardiovascular phenotype of HD using the BACHD mouse model. The age-related decline in cardiovascular function was assessed by echocardiograms, electrocardiograms, histological and microarray analysis. We found that structural and functional differences between WT and BACHD hearts start at 3 months of age and continue throughout life. The aged BACHD mice develop cardiac fibrosis and ultimately apoptosis. The BACHD mice exhibited adaptive physiological changes to chronic isoproterenol treatment; however, the medication exacerbated fibrotic lesions in the heart. Gene expression analysis indicated a strong tilt toward apoptosis in the young mutant heart as well as changes in genes involved in cellular metabolism and proliferation. With age, the number of genes with altered expression increased with the large changes occurring in the cardiovascular disease, cellular metabolism, and cellular transport clusters. The BACHD model of HD exhibits a number of changes in cardiovascular function that start early in the disease progress and may provide an explanation for the higher cardiovascular risk in HD.","beta adrenergic receptor stimulating agent;HTT protein, human;huntingtin;isoprenaline;nerve protein;aging;animal;apoptosis;C57BL mouse;cardiomegaly;diagnostic imaging;disease model;drug effects;drug therapy;echography;fibrosis;gene expression profiling;genetics;heart contraction;heart left ventricle function;heart ventricle;Huntington chorea;metabolism;mouse;multiplex polymerase chain reaction;pathology;pathophysiology;physiology;real time polymerase chain reaction;tissue microarray;transgenic mouse;trinucleotide repeat","Schroeder, A. M.;Wang, H. B.;Park, S.;Jordan, M. C.;Gao, F.;Coppola, G.;Fishbein, M. C.;Roos, K. P.;Ghiani, C. A.;Colwell, C. S.",2016,,10.1371/journal.pone.0147269,0,
3963,Internal confirmation of diagnoses in routine statutory health insurance data: concept with examples and case definitions,"Over the course of the last few decades, statutory health insurance data have become increasingly important for health services research. Of particular interest in this context are diagnoses. Since all health insurance data are originally collected for billing purposes, secondary analyses should examine the completeness, plausibility, and validity of the information provided. While an external validation through, for example, a comparison with the physician's records or a second independent medical examination can be seen as a gold standard, this is often not feasible. For this reason, internal validation approaches are recommended for studies based upon diagnoses drawn from routine data. For such approaches, no established standards are currently available. The aim of this contribution is to introduce a generic internal validation concept for chronic diseases. Data employed in the present contribution stem from the health insuree sample of the AOK health insurance fund Hesse. Criteria for assessing the validity of diagnoses (e.g., repetitions, codes assigned by various physicians, prescriptions) are presented for three chronic diseases - heart failure, dementia, and tuberculosis. Building upon these criteria, algorithms for the definition of epidemiologically certain cases are developed and prevalence estimates formed on the basis of these algorithms are compared with other data sources (registers and surveys). Internal confirmation of the diagnoses of heart failure and dementia was possible in 97% and 80% of cases, respectively. The difference between the two diagnoses is due to the low rate of treatment with specific pharmaceuticals in the case of dementia. Prevalence estimates are comparable with those based on other sources. Inpatient discharge diagnoses of tuberculosis were internally confirmed in 100% and outpatient diagnoses in 40% of cases. For this reason, outpatient diagnoses were not considered for the case definition of tuberculosis. A comparison with tuberculosis surveillance data reveals a somewhat higher incidence in the insuree sample. In selecting and weighting criteria as well as employing a case definition, the research aim of the respective investigation must be taken into account. The adopted procedure is to be presented in a transparent manner. Georg Thieme Verlag KG Stuttgart * New York.",article;chronic disease;classification;diagnosis;factual database;Germany;human;public health;statistical analysis;utilization review;validation study,"Schubert, I.;Ihle, P.;Köster, I.",2010,,,0,
3964,Gastric acid secretion,"PURPOSE OF REVIEW: The present review summarizes the past year's literature, both clinical and basic science, regarding neuroendocrine and intracellular regulation of gastric acid secretion and proper use of antisecretory medications. RECENT FINDINGS: Gastric acid kills microorganisms, modulates the gut microbiome, assists in digestion of protein, and facilitates absorption of iron, calcium, and vitamin B12. The main stimulants of acid secretion are gastrin, released from antral G cells; histamine, released from oxyntic enterochromaffin-like cells; and acetylcholine, released from antral and oxyntic intramural neurons. Other stimulants include ghrelin, motilin, and hydrogen sulfide. The main inhibitor of acid secretion is somatostatin, released from oxyntic and antral D cells. Glucagon-like peptide-1 also inhibits acid secretion. Proton pump inhibitors (PPIs) reduce acid secretion and, as a result, decrease somatostatin and thus stimulate gastrin secretion. Although considered well tolerated drugs, concerns have been raised this past year regarding associations between PPI use and kidney disease, dementia, and myocardial infarction; the quality of evidence, however, is very low. SUMMARY: Our understanding of the physiology of gastric secretion and proper use of PPIs continues to advance. Such knowledge is crucial for improved management of acid-peptic disorders.",,"Schubert, M. L.",2016,Nov,10.1097/mog.0000000000000308,0,
3965,"Physiologic, pathophysiologic, and pharmacologic regulation of gastric acid secretion","PURPOSE OF REVIEW: The present review summarizes the past year's literature, both clinical and basic science, regarding physiologic and pharmacologic regulation of gastric acid secretion in health and disease. RECENT FINDINGS: Gastric acid kills microorganisms, assists digestion, and facilitates absorption of iron, calcium, and vitamin B12. The main stimulants of acid secretion are the hormone gastrin, released from antral G cells; paracrine agent histamine, released from oxyntic enterochromaffin-like cells; and neuropeptide acetylcholine, released from antral and oxyntic intramural neurons. Gastrin is also a trophic hormone that participates in carcinogenesis. Helicobacter pylori may increase or decrease acid secretion depending upon the acuity and predominant anatomic focus of infection; most patients manifest hypochlorhydria. Despite the fact that proton pump inhibitors (PPIs) are amongst the most widely prescribed drugs, they are underutilized in patients at high risk for UGI bleeding. Although generally considered well tolerated, concerns have been raised regarding associations between PPI use and dementia, kidney disease, myocardial infarction, pneumonia, osteoporosis, dysbiosis, small bowel injury, micronutrient deficiency, and fundic gland polyps. SUMMARY: Our understanding of the physiologic, pathophysiologic, and pharmacologic regulation of gastric secretion continues to advance. Such knowledge is crucial for improved and safe management of acid-peptic disorders.",,"Schubert, M. L.",2017,Nov,,0,
3966,Dementia and amputation,"OBJECTIVES: To our experience dementia seems to play an increasing role for major amputation in patients suffering from peripheral arterial disease (PAD). To confirm our impression, we analysed the rate of dementia associated with different surgical procedures using the information of the federal statistics in Germany. PATIENTS AND METHODS: Detailed lists of cases hospitalized with the principal diagnosis (PAD), abdominal aortic aneurysm (AAA), myocardial infarction (MI) and hip fracture (HF), and of the procedures minor or major amputation, endovascular aortic repair (EVAR), total endoprosthesis for hip replacement (THR) and coronary aortic bypass graft (CABG) in Germany in the years 2008 to 2010 were provided by the Federal Statistical Office. RESULTS: Dementia is documented as additional diagnosis in approximately one fourth of cases having the principal diagnosis HF, 5% to 6% of cases with the principal diagnosis MI and PAD, but only in approximately 2% of AAA cases. Dementia is documented as principal or additional diagnosis in one fourth of amputation procedures (major amputation approximately 18% and minor amputation approximately 8%), in approximately 5% THR, 2% of EVAR and only 0.3% of CABG. The rate of documentation of dementia is higher in patients treated by major amputation than in the hospitalized PAD population. Vice versa, the rate of documentation of dementia is lower in patients getting THR than in the hospitalized HF population. CONCLUSION: The presented analysis supports the assumption that dementia plays a relevant role in older patients suffering from PAD receiving major amputation in Germany.",DRG statistics;abdominal aortic aneurysm amputation;endovascular aortic repair;hip fracture;peripheral arterial disease;total hip replacement,"Schuch, V.;Moysidis, T.;Weiland, D.;Santosa, F.;Kroger, K.",2012,Dec,10.1556/imas.4.2012.4.1,0,
3967,"Selective hemapheresis, an effective new approach in the therapeutic management of disorders associated with rheological impairment: mode of action and possible clinical indications","The in vitro measurement of whole-blood viscosity, plasma viscosity, and erythrocyte aggregability is easy to perform, but they only allow a partial insight into the complexity of blood flow characteristics; however, they permit definition of the rheological properties of new hemorheological therapeutic modalities such as extracorporeal plasma therapy as described in this paper. Under more theoretical aspects, it becomes obvious that such hemorheological approaches should either improve the vasomotoric properties of blood vessels, reduce the circulating red blood cell concentration, or improve the viscosity by reducing the concentration of hemorheologically relevant plasma proteins. In this review, the rheological effect of a single apheresis treatment with different devices was compared. Due to their differences in selectivity, the extracorporeal methods have different effects on the rheologically relevant plasma proteins, and, therefore, their rheological effectiveness differs remarkably. Today, the classical blood letting and plasma exchange treatment have been replaced by erythrapheresis and selective devices for extracorporeal plasma treatment, respectively. For more than 10 years, the following 5 more-or-less selective apheresis procedures are commercially available: immunoadsorption, differential filtration, polyanion adsorption by dextrane sulfate as well as by polyacrylate, and polyanion precipitation by heparin as polyanion. The last three procedures are semiselective and, therefore, relatively unspecific whereas immunoadsorption only affects the plasma lipoprotein concentration. Several studies have shown the effective use of extracorporeal hemorheotherapy for the treatment of various diseases including macro- and cryoglobulinemia, Raynaud's disease, hyperlipoproteinemia (often characterized by premature atherosclerosis and coronary heart disease and peripheral arterial occlusive disease), cerebral multi-infarct demention and acute ischemic stroke, sudden hearing loss, and acute occlusion of the central retinal artery.","Arterial Occlusive Diseases/therapy;Blood Viscosity;Cholesterol, LDL/blood;Coronary Disease/therapy;Dementia, Multi-Infarct/therapy;Hearing Disorders/therapy;Hemofiltration;*Hemorheology;Humans;Immunosorbent Techniques;Immunosorbents;Plasma Exchange;Plasmapheresis/*methods;Stroke/therapy","Schuff-Werner, P.;Holdt, B.",2002,Feb,,0,
3968,Methylphenidate in a patient with Alzheimer's disease : Increase in drive and cardiac performance,"The administration of methylphenidate (Ritalin(R)) to a patient with Alzheimer's disease who was in a critical condition (i.e. refusal of food, apathy and congestive heart failure) resulted in recovery to a stable health condition and stabilization of dementia. In this article various aspects of methylphenidate therapy in patients with Alzheimer's disease are presented.",Apathy;Attention;Dopamine;Heart failure;N-terminal pro-BNP,"Schuhfried, G.;Schuhfried, G.",2016,Apr 13,10.1007/s00391-016-1043-z,0,
3969,Case report: Acute unintentional carbachol intoxication,"Introduction: Intoxications with carbachol, a muscarinic cholinergic receptor agonist are rare. We report an interesting case investigating a (near) fatal poisoning. Methods: The son of an 84-year-old male discovered a newspaper report stating clinical success with plant extracts in Alzheimer's disease. The mode of action was said to be comparable to that of the synthetic compound 'carbamylcholin'; that is, carbachol. He bought 25 g of carbachol as pure substance in a pharmacy, and the father was administered 400 to 500 mg. Carbachol concentrations in serum and urine on day 1 and 2 of hospital admission were analysed by HPLC-mass spectrometry. Results: Minutes after oral administration, the patient developed nausea, sweating and hypotension, and finally collapsed. Bradycardia, cholinergic symptoms and asystole occurred. Initial cardiopulmonary resuscitation and immediate treatment with adrenaline (epinephrine), atropine and furosemide was successful. On hospital admission, blood pressure of the intubated, bradyarrhythmic patient was 100/65 mmHg. Further signs were hyperhidrosis, hypersalivation, bronchorrhoea, and severe miosis; the electrocardiographic finding was atrio-ventricular dissociation. High doses of atropine (up to 50 mg per 24 hours), adrenaline and dopamine were necessary. The patient was extubated 1 week later. However, increased dyspnoea and bronchospasm necessitated reintubation. Respiratory insufficiency was further worsened by Proteus mirabilis infection and severe bronchoconstriction. One week later, the patient was again extubated and 3 days later was transferred to a peripheral ward. On the next day he died, probably as a result of heart failure. Serum samples from the first and second days contained 3.6 and 1.9 mg/l carbachol, respectively. The corresponding urine concentrations amounted to 374 and 554 mg/l. Conclusion: This case started with a media report in a popular newspaper, initiated by published, peer-reviewed research on herbals, and involved human failure in a case history, medical examination and clinical treatment. For the first time, an analytical method for the determination of carbachol in plasma and urine has been developed. The analysed carbachol concentration exceeded the supposed serum level resulting from a therapeutic dose by a factor of 130 to 260. Especially in old patients, intensivists should consider intoxications (with cholinergics) as a cause of acute cardiovascular failure. © 2006 Schulz et al.; licensee BioMed Central Ltd.",activated carbon;adrenalin;atropine;carbachol;dopamine;furosemide;lactulose;prednisolone;salbutamol;sultamicillin;theophylline;aged;Alzheimer disease;article;heart arrest;atrioventricular dissociation;bradycardia;bronchospasm;carbachol intoxication;cardiovascular disease;case report;collapse;drug blood level;drug dose reduction;drug intoxication;drug megadose;drug urine level;dyspnea;electrocardiography;extubation;Gram negative infection;heart failure;high performance liquid chromatography;human;hyperhidrosis;hypersalivation;hypotension;lung hemorrhage;male;mass spectrometry;miosis;nausea;priority journal;Proteus mirabilis;respiratory failure;resuscitation,"Schulz, M.;Graefe, T.;Stuby, K.;Andresen, H.;Kupfermann, N.;Schmoldt, A.",2006,,,0,
3970,Impact of a medication management system on nursing home admission rate in a community-dwelling nursing home-eligible medicaid population,"Background: Community-dwelling frail elderly have an increased need for effective medication management to reside in their homes and delay or avoid admission to nursing homes. Objective: The objective of this study was to examine the impact of a medication management system on nursing home admission within the community-dwelling frail elderly. Methods: This prospective cohort study compared nursing home admission rates in intervention and control clients of a state Medicaid home and community-based waiver program. Groups were matched on age (±5 years), race, gender, and waiver program start date (±120 days). The medication management service consisted of 2 parts: 1) prescription medicines dispensed from the client's local pharmacy in a calendar card, and 2) a coordinating service by a health educator to address medication-related problems as they arose. The primary dependent variable was admission to a nursing home. Results: A total of 273 clients agreed to participate, enrolled, and had at least 1 prescription dispensed. The matched control group was composed of 800 other clients. The client sample was 72 years of age, 73% (785/1073) non-white, 75% (804/1073) female, and enrolled in the waiver program approximately 50 months. The 2 groups were similar on all demographic variables examined. Six clients (2.2%) in the intervention group and 40 clients (5.0%) in the control group were admitted to a nursing home at least once during the study period. Logistic regression was used to test the model predicting at least 1 nursing home admission. Control group clients were 2.94 times more likely to be admitted to a nursing home than clients in the intervention group. Conclusions: The medication management service implemented within this study was effective in reducing nursing home admissions in a group of frail community-dwelling elderly.",aged;Alzheimer disease;anemia;arthritis;article;bath;bladder disease;caregiver;cerebrovascular accident;cognition;congestive heart failure;controlled study;daily life activity;dementia;depression;diabetes mellitus;diet supplementation;eating;emphysema;feces incontinence;female;frail elderly;health educator;health insurance;health service;heart infarction;human;hypertension;kidney failure;locomotion;long term memory;major clinical study;male;medicaid;neoplasm;nursing home;Parkinson disease;peripheral vascular disease;pharmacy;pneumonia;prescription;priority journal;prospective study;seizure;weight gain;weight reduction,"Schulz, R. M.;Porter, C.;Lane, M.;Cornman, C.;Branham, L.",2011,,,0,
3971,The LDL receptor-related protein (LRP1/A2MR) and coronary atherosclerosis--novel genomic variants and functional consequences,"The LDL receptor-related protein/alpha 2-macroglobulin receptor (LRP1/A2MR) is a multifunctional cell-surface glycoprotein that endocytoses several structurally and functionally distinct ligands. In clinical studies different genomic variants of the LRP1/A2MR and its role in the development of degenerative diseases like atherosclerosis or Alzheimer's disease were studied. We screened for novel genomic variants of LRP1/A2MR and investigated the importance of these variants in 214 coronary patients suffering from myocardial infarction as well as in 224 healthy controls. We detected a novel C>G polymorphism at position -25 in the functionally important promoter region of LRP1/A2MR. This polymorphism (c.1-25C>G) leads to the creation of a new GC-box, recognized by the constitutively expressed SP 1 transcription factor. Investigating the LRP1/A2MR gene expression with respect to this polymorphism, carriers of the mutant G-allele were found to have a higher mRNA expression level. A novel polymorphism in exon 22 (c.4012C>T), and two novel polymorphisms in intron 24 (IVS24+123C>A and IVS24+690G>A) associated with a previously described polymorphism in exon 61 (c.10249G>A), were related to the development of myocardial infarction. Two novel rare genetic variants of exon 88 (c.13933C>T) and intron 88 (IVS88+15G>A) were identified in four patients with severe coronary symptoms. However, the LRP1/A2MR gene expression was found to be independent of all identified novel genomic variants as well as other previously described changes (A217V, A775P, D2080N, D2632E, G4379S) except the promoter polymorphism. Copyright 2002 Wiley-Liss, Inc.",low density lipoprotein receptor related protein;messenger RNA;adult;article;biosynthesis;coronary artery atherosclerosis;female;genetic polymorphism;genetic predisposition;genetic variability;genetics;genome;heart infarction;human;male;metabolism;monocyte;physiology;promoter region,"Schulz, S.;Schagdarsurengin, U.;Greiser, P.;Birkenmeier, G.;Müller-Werdan, U.;Hagemann, M.;Riemann, D.;Werdan, K.;Gläser, C.",2002,,,0,
3972,Febuxostat in the treatment of gout: 5-yr findings of the FOCUS efficacy and safety study,"Objectives. This 5-yr study assessed urate-lowering and clinical efficacy and safety of long-term febuxostat therapy in subjects with gout. The primary efficacy end-point was reduction to and maintenance of serum urate (sUA) levels <6.0 mg/dl. Methods. Subjects who completed a previous 28-day study were entered into an open-label extension study and initially received febuxostat 80 mg daily. Between Weeks 4 and 24, dosing could be adjusted to febuxostat 40 or 120 mg. All subjects received gout flare prophylaxis during the first 4 weeks. Gout flares were recorded and treated throughout the study, and sUA, baseline tophi and safety were monitored. Results. Among 116 subjects initially enrolled, dose adjustments were made for 44 (38%) subjects. As a result, 8 subjects received febuxostat 40 mg, 79 received 80 mg, and 29 received 120 mg daily maintenance dose. At 5 yrs, 93% (54/58) of the remaining subjects had sUA <6.0 mg/dl. Fifty-eight subjects (50%) discontinued prematurely; 38 did so in the first year. Thirteen subjects withdrew due to an adverse event. Sustained reduction of sUA was associated with nearly complete elimination of gout flares. In 26 subjects with a tophus at baseline, resolution was achieved in 69% (18/26) by last visit on study drug at any point during the study (Final Visit). There were no deaths reported during the study. Conclusions. Long-term treatment with febuxostat resulted in durable maintenance of sUA <6.0 mg/dl for most subjects. There was nearly complete abolition of gout flares in patients completing the study. Baseline tophi resolved in a majority of subjects. © The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.",NCT00174949;analgesic agent;antiinflammatory agent;antilipemic agent;colchicine;diuretic agent;febuxostat;uric acid;abdominal pain;adult;aged;Alzheimer disease;appendix perforation;arthropathy;article;atrioventricular block;basal cell carcinoma;cholecystitis;clinical trial;concussion;connective tissue disease;creatinine blood level;depression;diarrhea;disease exacerbation;diverticulitis;diverticulosis;double blind procedure;drug dose titration;drug efficacy;drug eruption;drug fatality;drug induced cancer;drug induced headache;drug safety;drug tolerability;drug withdrawal;dysesthesia;edema;female;fracture;fragility fracture;gastrointestinal pain;gastrointestinal symptom;gout;atrial fibrillation;heart disease;heart infarction;hepatobiliary disease;human;hyperlipidemia;hypertension;infection;influenza;intervertebral disk degeneration;kidney dysfunction;limb injury;liver function test;long term care;lower respiratory tract infection;lung infection;lung tumor;maintenance therapy;major clinical study;male;mental disease;multicenter study;musculoskeletal disease;nephrotoxicity;open study;osteoarthritis;osteoarthropathy;outcome assessment;pain;paresthesia;phase 2 clinical trial;pneumonia;priority journal;prostate cancer;rash;rotator cuff injury;side effect;skin injury;small intestine obstruction;spinal cord disease;tendon disease;thorax pain;tongue cancer;upper respiratory tract infection;uric acid blood level;urinary tract disease;urinary tract infection;urine retention;vertebral canal stenosis,"Schumacher Jr, H. R.;Becker, M. A.;Lloyd, E.;MacDonald, P. A.;Lademacher, C.",2009,,,0,
3973,Ventricular asystole during vagal nerve stimulation,,clonazepam;etiracetam;gabapentin;valproic acid;heart arrest;brain surgery;complex partial seizure;electrocardiogram;epilepsy;human;letter;mental deterioration;nerve stimulation;priority journal;vagus nerve,"Schuurman, P. R.;Beukers, R. J.",2009,,,0,
3974,High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease,"Background Little is known regarding the contemporary outcomes of older patients with peripheral artery disease (PAD) undergoing major lower extremity (LE) amputation in the United States. We sought to characterize clinical outcomes and factors associated with outcomes after LE amputation in patients with PAD. Methods Using data from the Centers for Medicare and Medicaid Services from January 1, 2000, to December 31, 2008, we examined the national patterns of mortality after major LE amputation among patients 65 years or older with PAD. Cox proportional hazards models were used to investigate the association between clinical variables, comorbid conditions, year of index amputation, geographic variation, and major LE amputation. Results Among 186,338 older patients with identified PAD who underwent major LE amputation, the mortality rate was 13.5% at 30 days, 48.3% at 1 year, and 70.9% at 3 years. Age per 5-year increase (hazard ratio [HR] 1.29, 95% CI 1.29-1.29), history of heart failure (HR 1.71, 95% CI 1.71-1.72), renal disease (HR 1.84. 95% CI 1.83-1.85), cancer (HR 1.71, 95% CI 1.70-1.72), and chronic obstructive pulmonary disease (HR 1.33, 95% CI, 1.32-1.33) were all independently associated with death after major LE amputation. Subjects who underwent above knee amputation had a statistically higher hazard of death when compared with subjects who underwent LE amputation at more distal locations (HR with above the knee amputation 1.31, 95% CI 1.25-1.36). Conclusions Older patients with PAD undergoing major LE amputation still face a slightly high mortality risk, with almost half of all patients with PAD dying within a year of major LE amputation. © 2013, Mosby, Inc. All rights reserved.",above knee amputation;aged;article;below knee amputation;cerebrovascular accident;cerebrovascular disease;chronic obstructive lung disease;comorbidity;congestive heart failure;dementia;diabetes mellitus;female;heart failure;human;kidney disease;knee amputation;leg amputation;length of stay;major clinical study;male;medicaid;medical history;medicare;mortality;neoplasm;outcome assessment;peripheral occlusive artery disease;priority journal;renovascular hypertension;United States,"Schuyler Jones, W.;Patel, M. R.;Dai, D.;Vemulapalli, S.;Subherwal, S.;Stafford, J.;Peterson, E. D.",2013,,,0,
3975,Optimizing glycemic control and minimizing the risk of hypoglycemia in patients with type 2 diabetes,"Diabetic microvascular and macrovascular complications arise from hyperglycemia, presenting an increasing healthcare burden as the diabetic population continues to grow. Clinical trial evidence indicates that antihyperglycemic medications are beneficial with regard to microvascular disease (retinopathy, renal impairment, and perhaps neuropathy); however, the benefit of aggressive use of these medications with regard to cardiovascular risk has been less clear in recent studies. These studies were confounded by the propensity of the antihyperglycemic medications involved to cause hypoglycemia, which itself presents cardiovascular risk. This article presents additional context for these seemingly discordant results and maintains that the achievement of glycemic targets is warranted in most patients and provides cardiovascular benefit, provided that hypoglycemia is avoided and the treatment regimen is tailored to the needs of the individual patient. A treatment approach that is driven by these principles and emphasizes diet and exercise, a combination of noninsulin antidiabetic agents, not including sulfonylureas and glinides, and judicious use of insulin is also presented. © 2013 Schwartz SS.",adrenalin;alpha glucosidase inhibitor;antidiabetic agent;biguanide derivative;bromocriptine;colesevelam;dipeptidyl peptidase IV inhibitor;gliclazide;glucagon;glucagon like peptide 1 receptor agonist;glucose;hemoglobin A1c;human insulin;incretin;indapamide plus perindopril;insulin;isophane insulin;metformin;pioglitazone;placebo;sulfonylurea;sulfonylurea derivative;adrenalin blood level;article;body weight;cardiovascular disease;cardiovascular risk;cerebrovascular accident;clinical trial (topic);dementia;diabetic patient;diet therapy;disease severity;drug efficacy;drug safety;electrocardiogram;electrocardiography;exercise;glucagon blood level;glucose blood level;glycemic control;hazard ratio;heart infarction;hemoglobin blood level;hospitalization;human;hypoglycemia;incidence;insulin synthesis;insulin treatment;mortality;non insulin dependent diabetes mellitus;obesity;outcome assessment;risk benefit analysis;risk factor;risk reduction;side effect;symptom;weight gain,"Schwartz, S. S.",2013,,,0,
3976,Zika Virus Meningoencephalitis in an Immunocompromised Patient,"The World Health Organization considers the Zika virus (ZIKV) outbreak in the Americas a global public health emergency. The neurologic complications due to ZIKV infection comprise microcephaly, meningoencephalitis, and Guillain-Barré syndrome. We describe a fatal case of an adult patient receiving an immunosuppressive regimen following heart transplant. The patient was admitted with acute neurologic impairment and experienced progressive hemodynamic instability and mental deterioration that finally culminated in death. At autopsy, a pseudotumoral form of ZIKV meningoencephalitis was confirmed. Zika virus infection was documented by reverse trancriptase–polymerase chain reaction, immunohistochemistry, and immunofluorescence and electron microscopy of the brain parenchyma and cerebral spinal fluid. The sequencing of the viral genome in this patient confirmed a Brazilian ZIKV strain. In this case, central nervous system involvement and ZIKV propagation to other organs in a disseminated pattern is quite similar to that observed in other fatal Flaviviridae viral infections.",aciclovir;amiodarone;antibiotic agent;dobutamine;gadoterate meglumine;lamotrigine;meropenem;methylprednisolone;mycophenolate mofetil;noradrenalin;prednisone;tacrolimus;valproic acid;vancomycin;adult;article;autopsy;brain tissue;cardiac graft rejection;cardiogenic shock;case report;cerebrospinal fluid analysis;Chagas cardiomyopathy;contrast enhancement;death;drug megadose;drug withdrawal;electron microscopy;fever;headache;heart transplantation;hospital admission;human;immunocompromised patient;immunofluorescence;immunohistochemistry;lumbar puncture;malaise;male;meningoencephalitis;mental deterioration;neurologic disease;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;reverse transcription polymerase chain reaction;seizure;sequence analysis;shock;virus genome;virus strain;Zika virus;Achieva X-Series,"Schwartzmann, P. V.;Ramalho, L. N. Z.;Neder, L.;Vilar, F. C.;Ayub-Ferreira, S. M.;Romeiro, M. F.;Takayanagui, O. M.;dos Santos, A. C.;Schmidt, A.;Figueiredo, L. T. M.;Arena, R.;Simões, M. V.",2017,,10.1016/j.mayocp.2016.12.019,0,
3977,Amyloidogenic and anti-amyloidogenic properties of recombinant transthyretin variants,"Most transthyretin (TTR) mutations lead to TTR amyloid depositions in patients with familial amyloidotic polyneuropathy and familial amyloidotic cardiomyopathy. However, though an amyloidogenic protein itself, TTR inhibits aggregation of Alzheimer's amyloid beta protein (A beta) in vitro and in vivo. The pathogenic relationship between two amyloidogenic processes remains unclear. To understand how TTR mutations influence the ability of TTR to inhibit A beta amyloidosis, forty-seven recombinant TTR variants were produced and analyzed. We showed that all recombinant proteins formed tetramers and were functional in thyroxine binding. Acid denaturation at pH 3.8 resulted in aggregation and fibril formation of all TTR variants. However, only TTR G42 and TTR P55 formed fibrils at pH 6.8. Most TTR variants bound to A beta and inhibited A beta aggregation in vitro. TTR variants S64, A71, Q89, V107, H114 and I122 revealed decreased binding to A beta and decreased inhibition of A beta aggregation. Only TTR G42 and TTR P55 completely failed to bind A beta and to inhibit A beta aggregation. We suggest that TTR variants characterized by decreased binding to A beta or by decreased inhibition of A beta aggregation in vitro may contribute to A beta amyloid formation in vivo. These TTR variants might be important targets for epidemiological studies in Alzheimer's disease.","Alzheimer Disease/genetics/metabolism;Amino Acid Substitution;Amyloid Neuropathies, Familial/genetics/metabolism;Amyloid beta-Peptides/*chemistry/genetics/metabolism/ultrastructure;Cardiomyopathies/genetics/metabolism;Humans;Macromolecular Substances;Mutagenesis, Site-Directed;Prealbumin/*chemistry/genetics/metabolism/ultrastructure;Protein Binding/genetics;Recombinant Proteins/*chemistry/genetics/metabolism","Schwarzman, A. L.;Tsiper, M.;Wente, H.;Wang, A.;Vitek, M. P.;Vasiliev, V.;Goldgaber, D.",2004,Mar,,0,
3978,How urine analysis reflects oxidative stress - Nitrotyrosine as a potential marker,"Enhanced oxidant stress involved in the pathogenesis of cardiovascular (heart failure, atherosclerosis, ischemia-reperfusion injury), neurodegenerative (M. Alzheimer), metabolic (hypercholesterolemia, diabetes) and inflammatory disorders is mimicked by non-intermittent therapy with nitrovasodilators. We used this latter therapy model to study urinary 3- nitrotyrosine (n-tyr) excretion as a potential biomarker that may reflect the enhanced generation of reactive oxygen species. Namely, free or protein-bound n-tyr is formed in the organism by nitration of tyrosine (residues) via peroxynitrite (reaction product of NO and O<sub>2</sub>/<sup>-</sup>). Free n-tyr content was analyzed by gas chromatography in urine obtained from healthy human subjects under a nitrite-limited diet during a two-day non-intermittent transdermal administration of glyceroltrinitrate (GTN; 0.4 mg/h) with or without vitamin C (Vit-C; 55 mug/kg/min) as antioxidant. Concomitant with the development of complete vascular tolerance (loss of dilator action), a progressive increase in urinary n-tyr excretion (up to 186+9 mug/day) was demonstrated in volunteers given GTN only. In contrast, when Vit-C was added, the GTN-induced increases in urinary n-tyr content were significantly suppressed (up to 130.20+6.91 mug/day), whereas Vit-C alone even decreased urinary n-tyr content (down to 34.00+5.66 mug/day), which was below control values (56.0+3.4 mug/day). Thus, urinary n-tyr may serve as a biomarker to detect changes in oxidant stress and thereby to evaluate the efficacy of therapeutic interventions aimed at reducing oxidant stress under various pathophysiological conditions. (C) 2000 Elsevier Science B.V.",adult // antioxidant activity // article // clinical trial // controlled clinical trial // controlled study // drug efficacy // female // gas chromatography // human // human experiment // male // nitration // normal human // oxidative stress // priorit,"Schwemmer, M.;Fink, B.;Kockerbauer, R.;Bassenge, E.",2000,,10.1016/s0009-8981%2800%2900247-3,0,3979
3979,How urine analysis reflects oxidative stress - Nitrotyrosine as a potential marker,"Enhanced oxidant stress involved in the pathogenesis of cardiovascular (heart failure, atherosclerosis, ischemia-reperfusion injury), neurodegenerative (M. Alzheimer), metabolic (hypercholesterolemia, diabetes) and inflammatory disorders is mimicked by non-intermittent therapy with nitrovasodilators. We used this latter therapy model to study urinary 3- nitrotyrosine (n-tyr) excretion as a potential biomarker that may reflect the enhanced generation of reactive oxygen species. Namely, free or protein-bound n-tyr is formed in the organism by nitration of tyrosine (residues) via peroxynitrite (reaction product of NO. and O<inf>2</inf>/<sup>-</sup>.). Free n-tyr content was analyzed by gas chromatography in urine obtained from healthy human subjects under a nitrite-limited diet during a two-day non-intermittent transdermal administration of glyceroltrinitrate (GTN; 0.4 mg/h) with or without vitamin C (Vit-C; 55 mug/kg/min) as antioxidant. Concomitant with the development of complete vascular tolerance (loss of dilator action), a progressive increase in urinary n-tyr excretion (up to 186+/-9 mug/day) was demonstrated in volunteers given GTN only. In contrast, when Vit-C was added, the GTN-induced increases in urinary n-tyr content were significantly suppressed (up to 130.20+/-6.91 mug/day), whereas Vit-C alone even decreased urinary n-tyr content (down to 34.00+/-5.66 mug/day), which was below control values (56.0+/-3.4 mug/day). Thus, urinary n-tyr may serve as a biomarker to detect changes in oxidant stress and thereby to evaluate the efficacy of therapeutic interventions aimed at reducing oxidant stress under various pathophysiological conditions. (C) 2000 Elsevier Science B.V.",adult;antioxidant activity;article;clinical trial;controlled clinical trial;controlled study;drug efficacy;female;gas chromatography;human;human experiment;male;nitration;normal human;oxidative stress;priority journal;randomized controlled trial;urinalysis;urinary excretion;urine level;3 nitrotyrosine/ec [Endogenous Compound];antioxidant;ascorbic acid/ct [Clinical Trial];ascorbic acid/iv [Intravenous Drug Administration];biological marker/ec [Endogenous Compound];glyceryl trinitrate/ct [Clinical Trial];glyceryl trinitrate/dl [Intradermal Drug Administration];peroxynitrite/ec [Endogenous Compound];reactive oxygen metabolite/ec [Endogenous Compound];tyrosine/ec [Endogenous Compound],"Schwemmer, M;Fink, B;Kockerbauer, R;Bassenge, E",2000,,10.1016/S0009-8981%2800%2900247-3,0,
3980,Selective application of cardiopulmonary resuscitation improves survival rates,"This study is a retrospective review of all patients who died without cardiopulmonary resuscitation (CPR) or who sustained a sudden cardiopulmonary arrest in the hospital and received CPR during a 2-yr period at a large medical center. Based on a review of Current Procedural Terminology codes, patients were classified into one of the ten disease categories: multiple medical problems, acute disease, procedure-related, congenital disease, neoplasm, metastatic neoplasm, trauma, burn, acquired immunodeficiency syndrome, and dementia. A total of 1206 patient deaths without a CPR effort were identified. CPR was administered to another 550 patients who had a sudden cardiopulmonary arrest, of which 71% survived the resuscitative attempt initially, but only 25% survived CPR until discharge from the hospital. CPR was applied less frequently than the mean in the metastatic neoplasm (P < 0.0001), trauma (P = 0.013), and dementia (P = 0.0003) groups and more frequently in the acute disease (P < 0.0001) and procedure-related (P < 0.0001) groups. Survival to discharge from the hospital was more frequent than the mean in the congenital disease group (P = 0.0004) and less frequent in the neoplasm group (P = 0.0425). The other groups had survival rates comparable to the mean. Patients 70 yr of age and older were less likely to receive CPR than those younger than 70 (P < 0.0001). However, if they did receive CPR, they were just as likely to survive to discharge from the hospital as the younger patients (P = 0.3404). In conclusion, the high survival rate demonstrated in most diagnostic groups reflects prior decisions to withhold CPR in many patients in whom it would be ineffective. Additionally, CPR in selected patients with multiple medical problems and in patients of advanced age was associated with reasonable chance of survival to discharge.",acute disease;adolescent;adult;age;aged;article;cardiopulmonary arrest;child;congenital disorder;death;dementia;disease classification;hospital discharge;human;infant;injury;major clinical study;metastasis;priority journal;resuscitation;survival,"Schwenzer, K. J.;Smith, W. T.;Durbin Jr, C. G.",1993,,,0,
3981,New avenues to prevent sudden unexpected death in nocturnal frontal lobe epilepsy: Follow the route established by omega-3 polyunsaturated fatty acids,,omega 3 fatty acid;asthma;autonomic nervous system;cardiovascular disease;cerebrovascular accident;dementia;disease duration;food intake;frontal lobe epilepsy;heart arrhythmia;heart muscle ischemia;human;hypertension;incidence;letter;nocturnal frontal lobe epilepsy;positive end expiratory pressure;priority journal;respiratory tract disease;risk factor;sleep disordered breathing;sudden death;supplementation;tonic clonic seizure,"Scorza, F. A.;Cavalheiro, E. A.;Tufik, S.;Scorza, C. A.;Andersen, M. L.",2015,,,0,
3982,Quality of care factors associated with unplanned readmissions of older medical patients: A case-control study,"Background: Unplanned readmissions befall up to 25% of acutely hospitalised older patients, and many may be potentially preventable. Aim: To assess the type and prevalence of quality of care factors associated with potentially preventable readmissions to a tertiary hospital general medicine service. Methods: A retrospective case-control study was undertaken of hospital records of patients 65 years or older admitted acutely between 1 January 2005 and 31 December 2010. Readmissions up to 30 days postdischarge (cases) were purposively sampled according to frequencies of primary discharge diagnoses coded during the study period. Non-readmitted patients (controls), matched according to age, sex and primary discharge diagnosis on index admission, were selected in a 1.7:1 ratio. Results: One hundred and thirteen cases and 198 controls were analysed, the former demonstrating a significantly higher comorbidity burden (mean (±standard deviation) comorbidity score 6.6 (±2.2) vs 5.6 (±2.4), P = 0.003) and a higher proportion of individuals with one or more hospitalisations over the preceding 6 months (55.7% vs 8.1%, P < 0.001). Among readmitted patients, 50 (44.3%) were associated with one or more quality factors versus 23 (11.6%) controls (P < 0.001). The most common were: failure to develop/activate an advance care plan (18, 15.9% vs 2, 1.0%; P < 0.001); suboptimal management of presenting illness (13, 11.4% vs 0, 0%; P < 0.001); inadequate assessment of functional limitations (11, 9.7% vs 0, 0%; P < 0.001); and potentially preventable complication of therapy (8, 7.1% vs 1, 0.5%, P = 0.002). Conclusions: Quality of care factors are more common among readmitted than among non-readmitted older patients suggesting potential for remedial strategies. Such strategies may still have limited effects as older, frail patients with advanced diseases and multimorbidity will likely retain a high propensity for readmission despite optimal care. © 2013 Royal Australasian College of Physicians.",acute coronary syndrome;aged;anamnesis;article;case control study;cellulitis;chronic obstructive lung disease;collapse;comorbidity;controlled study;delirium;dementia;diagnostic error;diagnostic test;faintness;female;follow up;functional disease;geriatric patient;health care planning;health care quality;heart failure;hospital discharge;hospital readmission;human;length of stay;lower respiratory tract infection;major clinical study;male;marriage;medical record;nursing home;patient care;physical disease;physical examination;pneumonia;prevalence;priority journal;retrospective study;sepsis;thorax pain;unplanned readmission;urinary tract infection;very elderly,"Scott, I. A.;Shohag, H.;Ahmed, M.",2014,,,0,
3983,Thromboprophylaxis of elderly patients with AF in the UK: an analysis using the General Practice Research Database (GPRD) 2000-2009,"OBJECTIVE: To assess use of thromboprophylaxis in UK general practise among patients with atrial fibrillation (AF); to investigate whether elderly patients are less likely to receive anticoagulation therapy than younger patients. DESIGN: Retrospective cohort study SETTING: UK General Practice Research Database (GPRD) PATIENTS: Aged >/=60 years with a new diagnosis of AF (2000-2009). INTERVENTIONS: None. MAIN OUTCOME MEASURES: The main outcome measure was initiation of warfarin in the first year following diagnosis. Patients were categorised by stroke risk (CHADS(2) score) and bleeding risk (HAS-BLED score). RESULTS: 81 381 patients were identified (21% aged 60-69 years, 37% aged 70-79 years, 42% aged 80+ years). Patients aged 80+ years were significantly less likely to be initiated on warfarin than younger patients, adjusted for gender, practice and comorbidities; 32% of patients aged 80+ years received warfarin compared with 57% aged 60-69 years (p<0.0001), and 55% aged 70-79 years (p<0.0001). For all strata of CHADS(2)/HASBLED scores, patients aged 80+ years were significantly less likely to be treated with warfarin than younger patients. Logistic regression showed that female sex, low Basal Metabolic Index (BMI), age over 80 years, increasing HAS-BLED score and dementia were independently associated with reduced use of warfarin. Stroke/Transient Ischaemic Attack (TIA), hypertension, heart failure and left ventricular systolic dysfunction were associated with increased use. Patients with HAS-BLED>CHADS(2) were less likely to be initiated on warfarin. Higher CHADS(2) scores were associated with increased anticoagulation use. CONCLUSIONS: Anticoagulation is being under-used in patients with AF aged 80+ years, even after taking into account increased bleeding risk in this age group.","Age Factors;Aged;Aged, 80 and over;Anticoagulants/*therapeutic use;Atrial Fibrillation/*complications;Databases, Factual;Female;Follow-Up Studies;General Practice/*statistics & numerical data;Great Britain/epidemiology;Humans;Incidence;Male;Middle Aged;*Registries;Retrospective Studies;Risk Assessment;Risk Factors;Thrombosis/epidemiology/etiology/*prevention & control;Treatment Outcome","Scowcroft, A. C.;Lee, S.;Mant, J.",2013,Jan,10.1136/heartjnl-2012-302843,0,
3984,Left ventricular mass increase is associated with cognitive decline and dementia in the elderly independently of blood pressure,"AIMS: Left ventricular (LV) mass increase is considered part of composite target organ damage in hypertension and an independent risk factor for cardiovascular (CV) events. This study was designed to explore whether left ventricular mass index (LVMI) is associated with cognitive decline and dementia in elderly subjects, independently of blood pressure (BP) levels. METHODS AND RESULTS: Four hundred subjects (mean age 79 +/- 6 years) were studied. Left ventricular mass was measured echocardiographically in accordance with American Society of Echocardiography and normalized for body height to the 2.7 (LVMI). Global cognitive function was evaluated with the mini-mental state examination (MMSE) (maximum score 30). Dementia was defined as an MMSE score <21. Arterial stiffness was evaluated as carotid-femoral pulse wave velocity by Complior. Prevalence of hypertension was 70% and diabetes mellitus was diagnosed in 25%. No significant differences in traditional CV risk factors were observed across LVMI quartiles. Mini-mental state examination showed an inverse trend across LVMI quartiles (the higher the LVMI, the lower the MMSE, P for trend <0.05); systolic and diastolic BP levels were not different across LVMI quartiles. In multivariable logistic regression models, including age, sex, BP levels, and use of antihypertensive drugs as covariates, the highest LVMI was found to be independently associated with a two-fold higher likelihood of having dementia. The association persisted significant even after adjustment for arterial stiffness. CONCLUSION: In elderly subjects, LVMI is associated with a progressive cognitive decline. This association is independent of BP levels and/or large artery stiffness.","Aged;Aged, 80 and over;Antihypertensive Agents/therapeutic use;Blood Flow Velocity/physiology;Blood Pressure/physiology;Carotid Arteries/physiopathology;Carotid Artery Diseases/physiopathology/ultrasonography;Cognition Disorders/*etiology;Dementia/*etiology/physiopathology;Diabetes Mellitus/physiopathology;Elasticity;Female;Humans;Hypertension/*complications/drug therapy;Hypertrophy, Left Ventricular/*complications/physiopathology/ultrasonography;Logistic Models;Male;Middle Aged;Prevalence;Pulse","Scuteri, A.;Coluccia, R.;Castello, L.;Nevola, E.;Brancati, A. M.;Volpe, M.",2009,Jun,10.1093/eurheartj/ehp133,0,
3985,Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults,"B vitamin deficiency is a leading cause of neurological impairment and disability throughout the world. Multiple B vitamin deficiencies often coexist, and thus an understanding of the complex relationships between the different biochemical pathways regulated in the brain by these vitamins may facilitate prompter diagnosis and improved treatment. Particular populations at risk for multiple B vitamin deficiencies include the elderly, people with alcoholism, patients with heart failure, patients with recent obesity surgery, and vegetarians/vegans. Recently, new clinical settings that predispose individuals to B vitamin deficiency have been highlighted. Moreover, other data indicate a possible pathogenetic role of subclinical chronic B vitamin deficiency in neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. In light of these findings, this review examines the clinical manifestations of B vitamin deficiency and the effect of B vitamin deficiency on the adult nervous system. The interrelationships of multiple B vitamin deficiencies are emphasized, along with the clinical phenotypes related to B vitamin deficiencies. Recent advances in the clinical determinants and diagnostic clues of B vitamin deficiency, as well as the suggested therapies for B vitamin disorders, are described.",biotin;pantothenic acid;alcoholism;Alzheimer disease;amyotrophic lateral sclerosis;article;bariatric surgery;biochemical analysis;chronic disease;clinical assessment;clinical feature;cyanocobalamin deficiency;diagnostic procedure;folic acid deficiency;heart failure;high risk population;human;Korsakoff psychosis;neurologic disease;neuropathy;nicotinic acid deficiency;Parkinson disease;pathogenesis;pathophysiology;phenotype;pyridoxine deficiency;riboflavin deficiency;thiamine deficiency;treatment planning;vegetarian;vitamin deficiency;Wernicke encephalopathy,"Sechi, G. P.;Sechi, E.;Fois, C.;Kumar, N.",2016,,,0,
3986,Cholesterol homeostasis failure in the brain: Implications for synaptic dysfunction and cognitive decline,"Cholesterol is one of the most important molecules in cell physiology because of its involvement in several biological processes: for instance, it determines both physical and biochemical properties of cell membranes and proteins. Disruption to cholesterol homeostasis leads to coronary heart disease, atherosclerosis and metabolic syndrome. Strong evidence suggests that cholesterol also has a crucial role in the brain as various neurological and neurodegenerative disorders, including Alzheimer's, Huntington's and Parkinson diseases are associated with disruptions to cholesterol homeostasis. Here, we summarize the current knowledge about the role cholesterol plays at synaptic junctions and the pathological consequences caused by disruptions in the homeostatic maintenance of this compound. © 2014 Bentham Science Publishers.",cholesterol;lipoprotein receptor;Alzheimer disease;article;central nervous system;central nervous system disease;central nervous system function;cholesterol homeostasis;cholesterol metabolism;cognitive defect;homeostasis;human;Huntington chorea;nerve cell plasticity;neurotransmission;Niemann Pick disease;Parkinson disease;Smith Lemli Opitz syndrome;synapse;synaptic dysfunction;synaptogenesis,"Segatto, M.;Leboffe, L.;Trapani, L.;Pallottini, V.",2014,,,0,
3987,"Adult polyglucosan body disease masquerading as ""ALS with dementia of the Alzheimer type"": An exceptional phenotype in a rare pathology","We describe an exceptional clinical picture, namely, cognitive impairment of the Alzheimer disease type in a man who later developed manifestations typical of amyotrophic lateral sclerosis and who was subsequently found to have adult polyglucosan body disease (APGBD) upon postmortem neuropathologic explorations. The combined occurrence of amyotrophic lateral sclerosis and cognitive impairment of the Alzheimer disease type in APGBD has not been reported before. This case also underlines the diverse clinical presentation of this rare clinicopathologic entity (namely APGBD) and highlights the importance of recognizing the unusual association of clinical features in making the diagnosis. Copyright © 2012 by Lippincott Williams & Wilkins.",cholesterol;creatine kinase;lisinopril;myoglobin;riluzole;rivastigmine;simvastatin;adult polyglucosan body disease;aged;Alzheimer disease;amyotrophic lateral sclerosis;anterior horn cell;apathy;apraxia;article;autopsy;Babinski reflex;brain cortex atrophy;brain hemorrhage;brain spongiosis;bronchopneumonia;cardiopulmonary insufficiency;case report;cholesterol blood level;clinical feature;cognitive defect;creatine kinase blood level;disease association;disease duration;disorientation;electrophysiology;fasciculation;fluency disorder;glossopharyngeal nerve;hearing impairment;human;human tissue;hypercholesterolemia;hyperreflexia;loading drug dose;lung edema;male;memory disorder;Mini Mental State Examination;mortality;muscle atrophy;neuroimaging;neurologic disease;neurologic examination;neuropathology;neuropil;nuclear magnetic resonance imaging;phenotype;priority journal;prostatectomy;protein blood level;rare disease;weight reduction;white matter,"Segers, K.;Kadhim, H.;Colson, C.;Duttmann, R.;Glibert, G.",2012,,,0,
3988,Local delivery of protease-resistant stromal cell derived factor-1 for stem cell recruitment after myocardial infarction,"BACKGROUND: Local delivery of chemotactic factors represents a novel approach to tissue regeneration. However, successful chemokine protein delivery is challenged by barriers including the rapid diffusion of chemokines and cleavage of chemokines by proteases that are activated in injured tissues. Stromal cell-derived factor-1 (SDF-1) is a well-characterized chemokine for attracting stem cells and thus a strong candidate for promoting regeneration. However, SDF-1 is cleaved by exopeptidases and matrix metalloproteinase-2, generating a neurotoxin implicated in some forms of dementia. METHODS AND RESULTS: We designed a new chemokine called S-SDF-1(S4V) that is resistant to matrix metalloproteinase-2 and exopeptidase cleavage but retains chemotactic bioactivity, reducing the neurotoxic potential of native SDF-1. To deliver S-SDF-1(S4V), we expressed and purified fusion proteins to tether the chemokine to self-assembling peptides, which form nanofibers and allow local delivery. Intramyocardial delivery of S-SDF-1(S4V) after myocardial infarction recruited CXCR4+/c-Kit+ stem cells (46+/-7 to 119+/-18 cells per section) and increased capillary density (from 169+/-42 to 283+/-27 per 1 mm2). Furthermore, in a randomized, blinded study of 176 rats with myocardial infarction, nanofiber delivery of the protease-resistant S-SDF-1(S4V) improved cardiac function (ejection fraction increased from 34.0+/-2.5% to 50.7+/-3.1%), whereas native SDF-1 had no beneficial effects. CONCLUSIONS: The combined advances of a new, protease-resistant SDF-1 and nanofiber-mediated delivery promoted recruitment of stem cells and improved cardiac function after myocardial infarction. These data demonstrate that driving chemotaxis of stem cells by local chemokine delivery is a promising new strategy for tissue regeneration.","Animals;Blood Pressure;Carotid Arteries/physiology;Chemokine CXCL12;Chemokines, CXC/*genetics/isolation & purification/pharmacology;Dipeptidyl Peptidase 4/metabolism;Drug Resistance;Hematopoietic Stem Cell Mobilization;Male;Matrix Metalloproteinase 2/*metabolism;Mutation;Myocardial Infarction/*physiopathology;*Neovascularization, Physiologic;Peptide Hydrolases/metabolism;Plasmids;Rats;Rats, Sprague-Dawley;Regeneration;Stem Cells/*physiology","Segers, V. F.;Tokunou, T.;Higgins, L. J.;MacGillivray, C.;Gannon, J.;Lee, R. T.",2007,Oct 9,10.1161/circulationaha.107.718718,0,
3989,Bidil: Recontextualizing the race debate,,atorvastatin;bazedoxifene;bifidil;coronary vasodilating agent;veliflapon;donepezil;entecavir;herpes vaccine;herpevac;hydralazine plus isosorbide dinitrate;motavizumab;nebivolol;numax tm;rosuvastatin;African American;Alzheimer disease;article;clinical trial;drug cost;drug efficacy;drug formulation;drug marketing;ethnopharmacology;evidence based medicine;food and drug administration;health care access;health care policy;health care quality;heart failure;hepatitis B;herpes simplex;high risk population;human;hypercholesterolemia;hypertension;menopausal syndrome;minority group;pharmacogenomics;priority journal;reimbursement;Human respiratory syncytial virus;virus infection;aricept;dg 031;medi 524,"Séguin, B.;Hardy, B.;Singer, P. A.;Daar, A. S.",2008,,,0,
3990,Is coronary artery bypass surgery a risk factor for the development of Alzheimer's disease?,"The occurrence of late cognitive decline in some patients after coronary artery bypass grafting (CABG) is now well documented. The fact that not all studies have found evidence of late decline suggests that it may not be inevitable. The cause of the late cognitive decline after CABG remains controversial, because most studies did not include appropriate control subjects. Some have suggested that the late cognitive decline may be due to a combination of normal aging and progression of underlying cerebrovascular disease. The pattern of the late cognitive changes, with prominent psychomotor slowing and modest or no decline in memory, may be consistent with this hypothesis. One recent epidemiological study concluded that the late cognitive changes might be due to Alzheimer's disease, but another case-control study did not find support for this interpretation. There is evidence from both neuropathological and cognitive studies that candidates for cardiac surgery may have mild AD-type changes preoperatively, thus raising the possibility that for some patients, the surgery is not a direct cause of the late cognitive decline. Rather, the surgery may uncover or accelerate a pre-existing cognitive impairment. In order to determine whether it is the severity of pre-existing cardio- and cerebrovascular disease or the use of cardiopulmonary bypass that confers an increased risk of postoperative dementia, future studies should include controls with a degree of coronary artery disease similar to that of the patients undergoing CABG.",aging;Alzheimer disease;cardiopulmonary bypass;case control study;cerebrovascular disease;cognitive defect;coronary artery bypass graft;coronary artery bypass surgery;coronary artery disease;dementia;epidemiology;heart surgery;human;hypothesis;memory;patient;risk;risk factor;surgery,"Seines, O. A.",2006,,,0,
3991,Perioperative haloperidol to prevent postoperative delirium 7,,haloperidol;lorazepam;neuroleptic agent;alcohol withdrawal;clinical trial;cognitive defect;delirium;dementia;disease exacerbation;drug efficacy;drug safety;heart muscle ischemia;human;incidence;letter;low drug dose;mortality;orthopedic surgery;perioperative period;postoperative complication,"Seitz, D.;Gill, S. S.",2006,,,0,
3992,Risk of perioperative blood transfusions and postoperative complications associated with serotonergic antidepressants in older adults undergoing hip fracture surgery,"Serotonergic antidepressants (SAds) are associated with bleeding-related adverse events. An increased risk of bleeding with SAds may have important implications in surgical settings. Our study evaluates the risk of red blood cell (RBC) transfusions and postoperative complications associated with SAds among older adults undergoing hip fracture surgery. We conducted a retrospective cohort study of individuals 66 years or older who underwent hip fracture surgery in Ontario, Canada. The risk of RBC transfusion among current users of SAds and nonserotonergic antidepressants (NSAds) was compared with recent former SAd users. Secondary outcomes included measures of postoperative morbidity and mortality. Subgroup analyses were undertaken in groups who were coprescribed other medications known to effect bleeding. Multivariable logistic regression was utilized to determine the odds ratios (ORs) for antidepressants and postoperative outcomes. A total 11,384 individuals were included in the study sample. Current SAd users had an increased risk of RBC transfusion compared with recent former users of SAds (OR, 1.28; 95% confidence interval, 1.14-1.43) as did current NSAd users (OR, 1.17; 95% confidence interval, 1.03-1.33). The risk of RBC transfusion with SAds or NSAds was further increased among individuals receiving antiplatelet agents. However, postoperative morbidity and mortality were not increased among either group of antidepressant users. In conclusion, SAds are associated with an increased risk of RBC transfusions, although this does not appear to result in major postoperative complications. Clinicians should be aware of this increased risk, although routine discontinuation of antidepressants before surgery is likely unwarranted in most cases. © 2013 by Lippincott Williams & Wilkins.",amfebutamone;antidepressant agent;citalopram;escitalopram;fluoxetine;fluvoxamine;heparin;mirtazapine;paroxetine;proton pump inhibitor;serotonergic antidepressant;sertraline;steroid;trazodone;tricyclic antidepressant agent;unclassified drug;warfarin;acute heart infarction;adult;anemia;angina pectoris;article;blood transfusion;cardiovascular mortality;cerebrovascular accident;Charlson Comorbidity Index;chronic kidney disease;chronic obstructive lung disease;cohort analysis;congestive heart failure;controlled study;deep vein thrombosis;dementia;diabetes mellitus;erythrocyte;erythrocyte transfusion;female;health care utilization;atrial fibrillation;hip fracture;hospital admission;human;lung embolism;major clinical study;male;morbidity;Parkinson disease;perioperative period;pneumonia;postoperative complication;postoperative hemorrhage;priority journal;retrospective study,"Seitz, D. P.;Bell, C. M.;Gill, S. S.;Reimer, C. L.;Herrmann, N.;Anderson, G. M.;Newman, A.;Rochon, P. A.",2013,,,0,
3993,Postoperative Medical Complications Associated with Anesthesia in Older Adults with Dementia,"Objectives To examine the association between anesthetic technique and postoperative complications in older adults with dementia undergoing hip fracture surgery. Design Population-based, retrospective cohort study. Setting Ontario, Canada. Participants All older adults with dementia who underwent surgery for hip fracture repair in Ontario, Canada, between April 1, 2003 and March 31, 2011. Measurements The baseline characteristics of individuals who received general anesthesia (GA) and regional anesthesia (RA) were compared. Individuals who received GA were matched to similar individuals who received RA using propensity scores to control for confounding, and their outcomes compared, including 30-day mortality, intensive care unit (ICU) admissions, specific postoperative medical complications, and hospital length of stay (LOS). Results In the 6,135 matched pairs, there was no statistically significant difference in postoperative 30-day mortality (GA, 11.3%; RA, 10.8%, P =.44). There were no statistically significant differences in the rates of specific postoperative medical complications or LOS in the two anesthetic groups, but GA was associated with higher rates of ICU admissions (6.1% vs 4.2%, P <.001). Conclusion For older adults with dementia undergoing hip fracture surgery, GA and RA are associated with similar rates of most perioperative adverse events. Further studies are required to determine the optimal methods of providing anesthesia and perioperative care for older adults with dementia undergoing surgical procedures.",anesthetic agent;aged;anesthesia;anesthesia complication;article;congestive heart failure;deep vein thrombosis;dementia;female;general anesthesia;heart infarction;hip fracture;hip surgery;human;intensive care unit;length of stay;lung embolism;major clinical study;male;outcome assessment;pneumonia;population research;regional anesthesia;retrospective study;shock;surgical mortality,"Seitz, D. P.;Gill, S. S.;Bell, C. M.;Austin, P. C.;Gruneir, A.;Anderson, G. M.;Rochon, P. A.",2014,,,0,
3994,Sympathetic nerve fibers in human cervical and thoracic vagus nerves,"Background Vagus nerve stimulation (VNS) therapy has been used for chronic heart failure and is believed to improve imbalance of autonomic control by increasing parasympathetic activity. Although it is known that there is neural communication between the VN and the cervical sympathetic trunk, there are few data regarding the quantity and/or distribution of the sympathetic components within the vagus nerve (VN). Objective To examine the sympathetic components within the human VN and correlate them with the presence of cardiac and neurologic diseases. Methods We performed immunohistochemistry on 31 human cervical and thoracic VNs (total 104 VNs) from autopsies and reviewed the patients' records. We correlated the quantity of sympathetic nerve fibers within the VNs with cardiovascular and neurologic disease states. Results All 104 VNs contain tyrosine hydroxylase (TH)-positive (sympathetic) nerve fibers; the mean TH-positive areas were 5.47% in the right cervical VN, 3.97% in the left cervical VN, 5.11% in the right thoracic VN, and 4.20% in the left thoracic VN. The distribution of TH-positive nerve fibers varied from case to case: central, peripheral, or scattered throughout nerve bundles. No statistically significant differences in nerve morphology were seen between diseases in which VNS is considered effective (depression and chronic heart failure) and other cardiovascular diseases or neurodegenerative disease. Conclusion Human VNs contain sympathetic nerve fibers. The sympathetic component within the VN could play a role in physiologic effects reported with VNS. The recognition of sympathetic nerve fibers in the VNs may lead to better understanding of the therapeutic mechanisms of VNS. © 2014 Heart Rhythm Society. All right sreserved.",tyrosine 3 monooxygenase;adult;age;aged;Alzheimer disease;article;autopsy;cardiovascular disease;cervical vagus nerve;controlled study;coronary artery disease;degenerative disease;depression;ethnic difference;female;atrial fibrillation;heart failure;heart infarction;heart ventricle tachycardia;human;human tissue;Huntington chorea;hypertension;immunohistochemistry;male;Parkinson disease;priority journal;sex;Shy Drager syndrome;sudden cardiac death;sympathetic nerve;thoracic vagus nerve;vagus nerve;vagus nerve stimulation,"Seki, A.;Green, H. R.;Lee, T. D.;Hong, L.;Tan, J.;Vinters, H. V.;Chen, P. S.;Fishbein, M. C.",2014,,,0,
3995,Early detection of twiddler syndrome due a congestion alert by remote monitoring,"There are often false-positive alerts of thoracic impedance monitoring; however, the “false-positive alerts” might indicate any clinical problem of patient. In the present case, an alert for a drop in intrathoracic impedance, which generally indicates exacerbation of heart failure, enabled early detection of twiddler syndrome.",aged;article;cardiac resynchronization therapy;cardiovascular monitoring device;case report;congestive cardiomyopathy;dementia;device migration;electrocardiography;false positive result;female;heart failure;heart left bundle branch block;heart ventricle tachycardia;human;impedance cardiography;implantable cardioverter defibrillator;New York Heart Association class;priority journal;prosthetic replacement;QRS interval;telemonitoring;twiddler syndrome;very elderly;CorVue;Merlin net;UnifyT CRT D,"Sekimoto, S.;Wakamatsu, M.;Morino, A.;Yoshida, T.;Saeki, T.;Murakami, Y.",2017,,10.1002/ccr3.979,0,
3996,Neurocognitive outcomes 3 years after coronary artery bypass graft surgery: a controlled study,"BACKGROUND: Cardiopulmonary bypass has been implicated in the late cognitive decline that has been reported after coronary artery bypass graft (CABG) surgery. Because most studies did not include a control group, a causal link of such decline with the use of cardiopulmonary bypass has not been established. METHODS: We compared changes in cognitive performance from baseline to 3 years in patients undergoing on-pump CABG (n = 152) with those of three control groups: patients with off-pump surgery (n = 75); with diagnosed coronary artery disease but no surgery (n = 99); and without coronary artery disease risk factors (n = 69). Neuropsychological performance was assessed by standardized tests of attention, language, verbal and visual memory, visuospatial, executive function, and psychomotor and motor speed. RESULTS: Relative to their baseline performance, no group had significantly lower performance at 36 months for any of the cognitive domains. From 12 to 36 months, there were no statistically significant differences in the degree of change between the on- and off-pump surgery groups. There was a trend toward mild decline in some cognitive domains, but overall differences among groups in degree of change over time were not statistically significant. CONCLUSIONS: We found a mild but nonsignificant trend toward late postoperative cognitive decline for all study groups with coronary artery disease, but no significant differences in the degree of late postoperative cognitive decline after on-pump compared with off-pump surgery. These findings suggest that previously reported late decline after bypass surgery is not specific to use of cardiopulmonary bypass.","Aged;Alzheimer Disease/etiology;Apolipoprotein E4/genetics;Cardiopulmonary Bypass/adverse effects;Cerebrovascular Disorders/psychology;Cognition Disorders/*etiology;Coronary Artery Bypass/*adverse effects;Coronary Artery Bypass, Off-Pump/*adverse effects;Coronary Disease/psychology;Female;Follow-Up Studies;Genotype;Humans;Male;Middle Aged;Neuropsychological Tests;Psychomotor Performance;Treatment Outcome","Selnes, O. A.;Grega, M. A.;Bailey, M. M.;Pham, L.;Zeger, S.;Baumgartner, W. A.;McKhann, G. M.",2007,Dec,10.1016/j.athoracsur.2007.06.054,0,
3997,Clinical applications of positron emission tomography,"After several decades of the exclusive use of positron emission tomography (PET) for clinical research, the success of metabolic imaging using fluorodeoxyglucose (FDG) has lead to the routine use of PET in oncology, cardiology and neurology. In oncology, because of modified tumour metabolism in many malignancies, PET is frequently used for tissue characterisation, staging and follow-up of therapy. In cardiology, PET is useful in the diagnosis of coronary artery disease and for assessment of myocardial viability. The presurgical evaluation of patients with medically refractory partial epilepsy is one of the most clinical relevant use for clinical PET in neurology, and the evaluation of patients with dementia is now under evaluation.",fluorodeoxyglucose;cancer staging;cardiology;cell viability;clinical research;coronary artery disease;dementia;heart muscle;neurology;oncology;positron emission tomography;short survey,"Semah, F.;Tamas, C.;Syrota, A.",2004,,,0,
3998,Cerebral White Matter Lesions as a Clinically Relevant Intermediate Target of Cerebrovascular Prevention,,arterial stiffness;attention;blood pressure regulation;brain blood flow;cardiovascular risk;cognition;cognitive defect;computer assisted tomography;dementia;executive function;heart failure;heart stroke volume;hemodynamics;human;hypertension;hypotension;leukoaraiosis;note;nuclear magnetic resonance imaging;perfusion;priority journal;pulse pressure;risk assessment;white matter;white matter change;white matter lesion,"Semplicini, A.",2015,,,0,
3999,A clinical approach to genetic testing for non-specialists,,Alzheimer disease;article;autopsy;consumer;coronary artery disease;genetic counseling;genetic disorder;genetic screening;genetic variability;health insurance;hemochromatosis;human;hypertrophic cardiomyopathy;medical decision making;medical education;Mendelian disease;next generation sequencing;nurse;patient care;phenotype;priority journal;risk factor;sudden death,"Semsarian, C.;Ingles, J.",2017,,10.1136/bmj.j4101,0,
4000,Sudden cardiac death in familial hypertrophic cardiomyopathy: An Australian experience,,Alzheimer disease;article;exercise;familial disease;female;heart left ventricle hypertrophy;human;hypertension;hypertrophic cardiomyopathy;major clinical study;male;sudden death;valvular heart disease,"Semsarian, C.;Richmond, D. R.",1999,,,0,
4001,Case 36-2011: A 93-year-old woman with shortness of breath and chest pain,,acetylsalicylic acid;amlodipine;atorvastatin;clonidine;clopidogrel;creatine kinase MB;dihydropyridine;dipeptidyl carboxypeptidase inhibitor;eptifibatide;glyceryl trinitrate;heparin;hydrochlorothiazide;irbesartan;labetalol;metoprolol;omeprazole;aged;angiocardiography;aorta dissection;article;case report;cataract extraction;cholelithiasis;chronic kidney failure;clinical evaluation;clinical examination;colon adenocarcinoma;colon resection;dementia;differential diagnosis;disease association;drug hypersensitivity;drug substitution;drug withdrawal;dyspnea;echocardiography;electrocardiogram;enzyme blood level;female;gastroesophageal reflux;health status;heart catheterization;heart infarction;heart left ventricle aneurysm;heart repolarization;human;hypercholesterolemia;hypertension;hyponatremia;hysterectomy;kidney artery stenosis;kidney dysfunction;lung embolism;lung volume;medical history;myocarditis;osteoarthritis;osteoporosis;pain assessment;pericarditis;postoperative complication;variant angina pectoris;priority journal;Q wave,"Senecal, E. L.;Rosenfield, K.;Caldera, A. E.;Passeri, J. J.",2011,,,0,
4002,Derivation and Internal Validation of a Clinical Prediction Tool for 30-Day Mortality in Lower Gastrointestinal Bleeding,"Background There are limited data to predict which patients with lower gastrointestinal bleeding are at risk for adverse outcomes. We aimed to develop a clinical tool based on admission variables to predict 30-day mortality in lower gastrointestinal bleeding. Methods We used a validated machine learning algorithm to identify adult patients hospitalized with lower gastrointestinal bleeding at an academic medical center between 2008 and 2015. The cohort was split randomly into derivation and validation cohorts. In the derivation cohort, we used multiple logistic regression on all candidate admission variables to create a prediction model for 30-day mortality, using area under the receiving operator characteristic curve and misclassification rate to estimate prediction accuracy. Regression coefficients were used to derive an integer score, and mortality risk associated with point totals was assessed. Results In the derivation cohort (n = 4044), 8 variables were most associated with 30-day mortality: age, dementia, metastatic cancer, chronic kidney disease, chronic pulmonary disease, anticoagulant use, admission hematocrit, and albumin. The model yielded a misclassification rate of 0.06 and area under the curve of 0.81. The integer score ranged from −10 to 26 in the derivation cohort, with a misclassification rate of 0.11 and area under the curve of 0.74. In the validation cohort (n = 2060), the score had an area under the curve of 0.72 with a misclassification rate of 0.12. After dividing the score into 4 quartiles of risk, 30-day mortality in the derivation and validation sets was 3.6% and 4.4% in quartile 1, 4.9% and 7.3% in quartile 2, 9.9% and 9.1% in quartile 3, and 24% and 26% in quartile 4, respectively. Conclusions A clinical tool can be used to predict 30-day mortality in patients hospitalized with lower gastrointestinal bleeding.",acetylsalicylic acid;albumin;anticoagulant agent;nonsteroid antiinflammatory agent;thienopyridine derivative;warfarin;acute kidney failure;adult;albumin blood level;anticoagulant therapy;article;atrial fibrillation;blood transfusion;cerebrovascular disease;chronic kidney failure;chronic lung disease;colorectal cancer;congestive heart failure;coronary artery disease;dementia;disease association;disease classification;diverticulosis;end stage renal disease;female;gastrointestinal hemorrhage;hematocrit;hemorrhoid;human;international normalized ratio;intestine ischemia;machine learning;major clinical study;male;metastasis;mortality;mortality risk;peripheral vascular disease;priority journal;retrospective study;scoring system;validation study,"Sengupta, N.;Tapper, E. B.",2017,,10.1016/j.amjmed.2016.12.009,0,
4003,COX-2 inhibitors: Cancer prevention or cardiovascular risk?,,celecoxib;cyclooxygenase 2 inhibitor;nitric oxide;nonsteroid antiinflammatory agent;placebo;rofecoxib;adenoma;adenomatous polyp;arthritis;breast cancer;neoplasm;cancer prevention;cardiovascular disease;cardiovascular risk;clinical trial;colorectal cancer;dementia;dose response;drug design;drug research;drug withdrawal;heart infarction;human;note;priority journal;thrombosis,"Senior, K.",2005,,,0,
4004,"Plasma Abeta42 and Abeta40 as markers of cognitive change in follow-up: a prospective, longitudinal, population-based cohort study","BACKGROUND: Single measurements of plasma Abeta are not useful in the diagnostics of Alzheimer's disease (AD). However, changes in plasma Abeta levels during repeated testing may be helpful in the prediction and evaluation of progression of the incipient AD or mild cognitive impairment. OBJECTIVE: To examine the relation of baseline and serial plasma Abeta levels to cognitive change in follow-up. METHODS: 269 subjects (52 cognitively impaired and 217 controls) from a population-based cohort were clinically followed up from 3 to 6 years. Serial plasma samples were available from 70 subjects who were followed up for 3 years and 43 subjects followed for 6 years. The plasma Abeta levels were measured using ELISA. RESULTS: Subjects who declined cognitively during the follow-up had lower levels of plasma Abeta42 at the baseline. Plasma Abeta42 and the Abeta42/Abeta40 ratio decreased (-2.4 pg/ml for Abeta42 in 6 years) in those who declined in follow-up, whereas Abeta42 and the Abeta42/Abeta40 ratio increased in the subjects who remained cognitively stable or improved in follow-up. Subjects using acetylsalicylic acid, dipyridamole, antidiabetic or anticoagulant drugs as well as subjects with coronary heart disease had higher levels of Abeta40. CONCLUSIONS: Low or decreasing plasma Abeta42 during the follow-up is associated with cognitive decline. Serial measurement of plasma Abeta42 may be useful in the detection of the subjects who are at risk for cognitive decline.",Aged;Alzheimer Disease/blood/*diagnosis;Amyloid beta-Peptides/*blood;Biomarkers/*blood;Cognition Disorders/blood/*diagnosis;Cohort Studies;Female;Humans;Male;Middle Aged;Peptide Fragments/*blood,"Seppala, T. T.;Herukka, S. K.;Hanninen, T.;Tervo, S.;Hallikainen, M.;Soininen, H.;Pirttila, T.",2010,Oct,10.1136/jnnp.2010.205757,0,
4005,An adequate threshold for body mass index to detect underweight condition in elderly persons: The Italian Longitudinal Study on Aging (ILSA),"Background. The present study aims at defining a body mass index (BMI) threshold for risk of being underweight in elderly persons on the basis of the BMI distribution in a large Italian population-based sample and on its ability to predict short-term mortality. Methods. At baseline (1992), BMI was obtained for 3110 (1663 males and 1447 females) persons aged 65-84 participating in the Italian Longitudinal Study on Aging (ILSA). BMI and risk factors (age, sex, education, smoking status, disability, and disease status) have been considered for their potential association with 4-year all-cause mortality. Information on vital status at 1995 was obtained for 2551 participants. Results. The fifth centile of BMI was well approximated by a value of 20 for both sexes. Also in both sexes, at a BMI value of 24 the a posteriori probability of death started to increase, doubling at a value of 22 for men and 20 for women. Crude mortality was 14.6% for men and 9.8% for women. The hazard ratios and confidence intervals (CIs) comparing mortality for each BMI two-unit class to the 26-28 class, after adjusting for confounding variables, showed significantly higher rates only for BMI values below 20 (2.9; 95% CI, 1.2-7.0), although a consistent increase in hazard ratio (1.6; 95% CI, 0.9-3.0) already appeared for the 20-22 BMI group. Conclusions. Our study confirms that low BMI is an independent predictive factor of short-term mortality in elderly persons. A BMI value of 20 kg/m2 seems to be a reliable threshold for defining underweight elderly persons at high risk. Nevertheless, more careful clinical and nutritional management should also be applied to elderly persons with higher BMI values. Copyright 2005 by The Gerontological Society of America.",aged;aging;article;body mass;congestive heart failure;dementia;female;human;longitudinal study;major clinical study;male;malnutrition;mortality;nutritional status;parkinsonism;peripheral vascular disease;priority journal;sex difference;survival rate,"Sergi, G.;Perissinotto, E.;Pisent, C.;Buja, A.;Maggi, S.;Coin, A.;Grigoletto, F.;Enzi, G.",2005,,,0,
4006,Age- and gender-related peculiarities of patients with delirium in the cardiac intensive care unit,"BACKGROUND: The overall evidence base regarding delirium has been growing steadily over the past few decades. There has been considerable analysis of delirium concerning, for example, mechanically ventilated patients, patients in the general intensive care unit (ICU) setting, and patients with exclusively postoperative delirium. Nevertheless, there are few studies regarding delirium in a cardiovascular ICU (ICCU) setting and especially scarce literature about the particular features of delirium relating to patient age and gender. AIM: We aimed to determine particular features of delirium not induced by alcohol or other psychoactive substances, relating to patient age and gender in an ICCU setting. METHODS: An observational cross-sectional study was conducted to evaluate patients with delirium in a Lithuanian ICCU. From a sample of 19,007 ICCU admissions, 337 (1.8%) had documented delirium diagnosed through liaison and consultation with a psychiatrist and were included in the final analysis. The obtained data was then evaluated and analysed according to patients' gender and four categorised age groups: < 65 years, 65-74 years, 75-84 years, and >/= 85 years. RESULTS: Female patients who experienced delirium demonstrated a higher prevalence of hypertension, hyponatraemia, heart failure, cardiac rhythm and conduction disorders, myocardial infarction (MI), and dementia. The men, who were on average seven years younger than the women, significantly more often had hypokalaemia, double- or triple-vessel coronary artery disease, and sepsis. Furthermore, MI, ST-segment elevated MI, and Killip class 4 were most frequent amongst patients less than 65 years of age. Moreover, the youngest patient group demonstrated the highest mortality. CONCLUSIONS: Our investigation presented a number of associated peculiarities related to gender and age. It was shown that delirium is a severe complication that more often affects men amongst patients < 65 years old and more frequently affects women in the age group of >/= 85 years. Male patients < 65 years old, who develop delirium should be treated with more caution because they tend to have more serious forms of disorder and a poorer prognosis.",age;cardiac care;cardiovascular intensive care unit (ICCU);delirium;gender,"Serpytis, P.;Navickas, P.;Navickas, A.;Serpytis, R.;Navickas, G.;Glaveckaite, S.",2017,,,0,
4007,Nutritional and cultural aspects of the mediterranean diet,"The recent recognition by United Nations Educational, Scientific and Cultural Organization (UNESCO) of the Mediterranean diet as an Intangible Cultural Heritage of Humanity reinforces, together with the scientific evidence, the Mediterranean diet as a cultural and health model. The Mediterranean diet has numerous beneficial effects on among others the immune system, against allergies, on the psyche, or even on quality of life, topics that are currently fields of research. The Mediterranean diet has an international projection; it is regarded as the healthiest and the most sustainable eating pattern on the planet and is a key player in the public health nutrition field globally, but especially in the Mediterranean area. Moreover, this ancient cultural heritage should be preserved and promoted from different areas: public health, agriculture, culture, politics, and economic development. © 2012 Hans Huber Publishers, Hogrefe AG, Bern.",olive oil;acute heart infarction;Alzheimer disease;article;asthma;breast cancer;caloric intake;cancer risk;cardiovascular mortality;cognition;colorectal cancer;cultural factor;diabetes mellitus;economic development;energy expenditure;human;ischemic heart disease;life expectancy;low fat diet;Mediterranean diet;metabolic syndrome X;multiinfarct dementia;nutritional parameters;obesity;Parkinson disease;physical activity;quality of life;weight gain,"Serra-Majem, L.;Bach-Faig, A.;Raidó-Quintana, B.",2012,,,0,
4008,Physiologic role and therapeutic indications of the l-carnitine,"L-carnitine is an essential cofactor in the β-oxidation of long-chain fatty acids. It is endogenous synthesized and it can also be obtained from dietary sources. Although the physiologic role of carnitine is well known, its therapeutic role is less clear. Carnitine is indicated in the treatment of primary deficiency states, and it can also be useful in the management of secondary deficiency states. In clinical trials with ischaemic heart disease patients, the treatment with l-carnitine has shown to produce beneficial effects on metabolism and myocardial function, and an exercise tolerance improvement in patients with angina pectoris. Moreover, carnitine seems to protect against induced toxicity from drugs like anthracycline antibiotics and valproic acid. In some studies carnitine has caused an improvement in athletic performance. At present it is being tested in patients with Alzheimer's disease. The tolerance to exogen administration of l-carnitine is good.",anthracycline antibiotic agent;carnitine;daunorubicin;Alzheimer disease;carnitine deficiency;diarrhea;drug indication;drug mechanism;gastrointestinal toxicity;heart function;heart protection;human;ischemic heart disease;metabolism;oral drug administration;short survey,"Serrano Zuneda, B.;Salva, P.",1994,,,0,
4009,Homocysteine and the brain: Vascular risk factor or neurotoxin?,,cyanocobalamin;homocysteine;low density lipoprotein receptor;n methyl dextro aspartic acid receptor;neurotoxin;pyridoxine;Alzheimer disease;amino acid blood level;atherosclerosis;atherosclerotic plaque;cardiovascular risk;smoking;cognitive defect;dietary intake;disease association;epidemiological data;heart infarction;heredity;homocysteine urine level;human;lifestyle;metabolic disorder;multiinfarct dementia;neurotoxicity;nutritional deficiency;Parkinson disease;priority journal;risk factor;secondary prevention;short survey;cerebrovascular accident;thrombosis;vitamin deficiency;vitamin supplementation,"Seshadri, S.;Wolf, P. A.",2003,,,0,
4010,"Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham Study","The main neurological causes of morbidity and mortality are stroke and dementia. We contend that the most relevant and readily communicated risk estimate for stroke and dementia is lifetime risk, which is the probability of someone of a given age and sex developing a condition during their remaining lifespan. Lifetime risk estimates describe the population burden; however, they can be refined with risk-stratified models to enable individual risk prediction. Community-based data on a group of North Americans of European descent indicate that the lifetime risk of stroke for a middle-aged woman is 1 in 5 and for a middle-aged man is 1 in 6. The lifetime risk of stroke was equal to the lifetime risk of dementia and equal to or greater than the lifetime risk of Alzheimer's disease (1 in 5 and 1 in 10 for women and men, respectively), and the lifetime risk of stroke or dementia was greater than 1 in 3. Thus, the lifetime burden attributable to common neurological disease is immense. © 2007 Elsevier Ltd. All rights reserved.",age distribution;Alzheimer disease;article;breast cancer;cardiovascular disease;congestive heart failure;data analysis;dementia;disease association;atrial fibrillation;high risk population;hip fracture;human;hypertension;ischemic heart disease;life expectancy;lifespan;lung cancer;morbidity;mortality;neurologic disease;non insulin dependent diabetes mellitus;obesity;Parkinson disease;parkinsonism;prediction;priority journal;prostate cancer;risk factor;sex difference;cerebrovascular accident;United States,"Seshadri, S.;Wolf, P. A.",2007,,,0,
4011,Chlamydia pneumoniae in PBMC: Reproducibility of the ompA nested touchdown PCR,"The aim of our study was to evaluate whether the replicate PCR testing may provide more accurate estimates of C. pneumoniae DNA prevalence in PBMC of patients undergoing carotid endarterectomy. Clinical sensitivity and reproducibility of ompA nested touchdown PCR was also performed. Clinical sensitivity and reproducibility was examined by testing C. pneumoniae-negative PBMC spiked with serial dilutions of semipurified C. pneumoniae elementary bodies (from 8 to 0.002 IFU/ml). Detection of C. pneumoniae DNA was performed by ompA nested touchdown PCR. Each clinical and spiked PBMC DNA specimen was analyzed in replicates of 1,3,5 and 10. PCR results of serial dilutions of C. pneumoniae DNA performed in replicates of 10 were analysed by probit analysis. C. pneumoniae DNA was detected in 14 of the 30 (46.7%) PBMC clinical specimens examined when 10 replicates were tested. When we analyzed 1, 3 and 5 replicates, 4 (13.3%), 7(23.3%), 12(40%) of the 30 specimens were positive, respectively. The limit of detection of ompA nested PCR touchdown was 0.008 IFU/ml when 10 replicates were tested. The ompA nested PCR had reproducibility scores of 10 for 10 from 8 to 4 IFU/ml concentration, but scores decreased for smaller numbers of IFU/ml. Our results showed that repeat testing of the same specimen increased clinical sensitivity as well as reproducibility of the ompA nested touchdown PCR. In conclusion the replicate PCR testing improves the performance of ompA nested touchdown PCR and provides a more accurate estimates of the prevalence of C. pneumoniae in PBMC of patients with atherosclerotic cardiovascular disease.",bacterial DNA;Alzheimer disease;article;atherosclerosis;carotid endarterectomy;Chlamydia pneumoniae;community acquired pneumonia;controlled study;DNA determination;HEp 2 cell line;human;human cell;immunofluorescence test;ischemic heart disease;multiple sclerosis;peripheral blood mononuclear cell;polymerase chain reaction;priority journal;reproducibility;statistical analysis,"Sessa, R.;Schiavoni, G.;Di Pietro, M.;Petrucca, A.;Cipriani, P.;Puopolo, M.;Zagaglia, C.;Fallucca, S.;Del Piano, M.",2005,,,0,
4012,"Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer","Background: Advances in heart failure (HF) treatments have prolonged survival, but more patients die of HF than of any type of cancer. Little is known about the current practice in end-of-life (EOL) care in HF. Methods: Two EOL cohorts (HF and cancer) were identified using Medicare data linked with pharmacy and cancer registry data. We assessed use of hospice, opiates, and acute care services (hospitalizations, emergency department [ED] visits, intensive care unit [ICU] admissions, and death in acute care). Time trends and predictors of use were assessed using multivariate regression including demographics and cardiovascular and noncardiovasuclar comorbidities. Results: Among 5,836 HF patients with median age of 85, 77% female and 4% black, 20% were referred to hospice compared to 51% of 7,565 cancer patients. A modest rise in hospice use over time was parallel in the 2 groups. Twenty-two percent of HF patients filled opiate prescriptions during 60 days before death compared to 46% of cancer patients. Use of acute care services in the 30 days before death was higher for HF (64% vs 39% for ED visits, 60% vs 45% for hospitalizations, and 19% vs 7% for ICU admission). More HF patients died during acute hospitalizations than cancer patients (39% vs 21%). Conclusion: Patients dying of HF were less likely to be supported by hospice and opiates but more likely to die in hospitals than patients with cancer. Our study suggests that opportunities may exist to improve hospice and opiate use in HF patients. © 2010, Mosby, Inc. All rights reserved.",opiate;aged;article;cerebrovascular disease;chronic kidney disease;chronic lung disease;clinical assessment;comorbidity;coronary artery disease;death;dementia;depression;diabetes mellitus;dialysis;emergency ward;female;health care quality;health care utilization;atrial fibrillation;heart failure;heart infarction;hospice care;hospitalization;human;hypertension;intensive care unit;major clinical study;male;neoplasm;nursing home;peripheral vascular disease;prescription;priority journal;trend study,"Setoguchi, S.;Glynn, R. J.;Stedman, M.;Flavell, C. M.;Levin, R.;Stevenson, L. W.",2010,,,0,
4013,Maximum potential benefit of implantable defibrillators in preventing sudden death after hospital admission because of heart failure,"Background: Implantable defibrillators are recommended for the prevention of sudden cardiac death in patients with heart failure. However, criteria to identify those who would benefit most from this therapy are lacking. We assessed the maximum potential benefit of preventing sudden death in patients with repeated hospital admissions because of heart failure. Methods: Using a cohort assembled from an administrative database, we identified 14 374 patients admitted to hospital for the first time because of heart failure between Jan. 1, 2000, and Dec. 31, 2004. We followed subsequent admissions related to heart failure as well as mortality and causes of death to Mar. 31, 2006. We regarded all out-of-hospital cardiac deaths as sudden deaths. We calculated the maximum potential benefit of preventing sudden death by subtracting the observed survival after each hospital admission from the hypothetical survival whereby all out-of-hospital cardiac deaths were assumed to be preventable. Results: The mean age of the cohort was 77 years, 45% were women, 11% had cerebrovascular disease, and 21% had chronic kidney disease. Out-of-hospital cardiac deaths constituted 13.7% (1226/8967) of all deaths during 32 055 person-years of follow-up. The median survival declined with each subsequent hospital admission related to heart failure. The hypothetical prevention of all out-of-hospital deaths prolonged life by 0.63 (95% confidence interval [CI] 0.49 to 0.77) years after the first hospital admission. This potential benefit dropped to 0.28 (95% CI 0.10 to 0.46) years after 3 hospital admissions related to heart failure. Among patients less than 65 years old, and older patients without kidney disease, dementia or cancer, more than 50% survived longer than 2 years until they had 2 or 3 hospital admissions related to heart failure. Interpretation: The use of implantable defibrillators to prevent sudden death would provide limited benefit among older patients with comorbidities and among patients with multiple hospital admissions related to heart failure. © 2009 Canadian Medical Association or its licensors.",adult;aged;article;cause of death;chronic kidney disease;chronic obstructive lung disease;cohort analysis;comorbidity;defibrillator;dementia;diabetes mellitus;dialysis;female;heart arrest;heart arrhythmia;atrial fibrillation;heart atrium flutter;heart failure;heart infarction;heart ventricle fibrillation;heart ventricle tachycardia;home;hospice patient;hospital admission;hospital patient;human;hypertension;major clinical study;male;neoplasm;nursing home patient;rheumatoid arthritis;sudden death;survival rate;treatment outcome,"Setoguchi, S.;Nohria, A.;Rassen, J. A.;Schneeweiss, S.;Stevenson, L. W.",2009,,,0,
4014,Potential causes of higher mortality in elderly users of conventional and atypical antipsychotic medications,"OBJECTIVES: To investigate the potential mechanisms through which conventional antipsychotic medication (APM) might act, the specific causes of death in elderly patients newly started on conventional APM were compared with those of patients taking atypical APM. DESIGN: Cohort study. SETTING: Community. PARTICIPANTS: All British Columbia residents aged 65 and older who initiated a conventional or atypical APM between 1996 and 2004. MEASUREMENTS: Cox proportional hazards models were used to compare risks of developing a specific cause of death within 180 days of APM initiation. Potential confounders were adjusted for using traditional multivariable, propensity-score, and instrumental-variable adjustments. RESULTS: The study cohort included 12,882 initiators of conventional APM and 24,359 initiators of atypical APM. Of 3,821 total deaths within the first 180 day of use, cardiovascular (CV) deaths accounted for 49% of deaths. Initiators of conventional APM had a significantly higher adjusted risk of all CV death (hazard ratio (HR)=1.23, 95% confidence interval (CI)=1.10-1.36) and out-of-hospital CV death (HR=1.36, 95% CI=1.19-1.56) than initiators of atypical APM. Initiators of conventional APM also had a higher risk of death due to respiratory diseases, nervous system diseases, and other causes. CONCLUSION: These data suggest that greater risk of CV deaths might explain approximately half of the excess mortality in initiators of conventional APM. The risk of death due to respiratory causes was also significantly higher in conventional APM use. © 2008, Copyright the Authors.",acetophenazine;antidepressant agent;aripiprazole;atypical antipsychotic agent;chlorpromazine;chlorprothixene;clozapine;fluphenazine;haloperidol;loxapine;mesoridazine;molindone;neuroleptic agent;olanzapine;perphenazine;pimozide;promazine;quetiapine;risperidone;thioridazine;tiotixene;trifluoperazine;triflupromazine;ziprasidone;aged;article;Canada;cardiovascular disease;cause of death;cerebrovascular disease;cohort analysis;comorbidity;delirium;dementia;diabetes mellitus;drug megadose;drug safety;female;food and drug administration;heart arrest;heart arrhythmia;heart failure;hospitalization;human;Human immunodeficiency virus infection;ischemic heart disease;low drug dose;major clinical study;male;mood disorder;mortality;neurologic disease;nursing home patient;pneumonia;proportional hazards model;psychosis;respiratory tract disease;sudden death,"Setoguchi, S.;Wang, P. S.;Alan Brookhart, M.;Canning, C. F.;Kaci, L.;Schneeweiss, S.",2008,,,0,
4015,Do cholesterol-lowering drugs influence on bone metabolism?,"Statins, without any doubt, belong to the most effective lipid-lowering drugs. For almost 30 years they have been successfully administered to hypercholesterolemic patients. A large number of clinical trials confirm that statin treatment significantly improves the prognosis for patients after myocardial infarction. The results of research from the last decade show that administration of this class of drugs is highly beneficial, causing versatile effects. They have antiaggregational, fibrinolytic and anti-inflammatory effects. Due to the inhibition of blood-vessel constriction, they cause vasodilatation. Statins influence angiogenesis and work as antineoplastic agents. By synapto- and neurogenesis stimulation, they inhibit neurodegeneration and development of dementia. Do HMG-CoA inhibitors influence bone metabolism? Is it a beneficial effect? Results of experimental research suggest that, due to inducing higher bone formation, statins prevent diseases caused by bone mass losing. A large number of clinical trials confirm this information. In observational studies, the usage of statins diminishes the risk of hip fracture, providing bone mass increase in the hip. According to the present data, this class of drugs has no effect on either spine mineral density or on the risk of its fracture. These could be regarded as additional clinical implications for hypercholesterolemic patients but further, large population-based, randomized, controlled trials are needed to confirm the presented results.",antilipemic agent;antineoplastic agent;atorvastatin;cerivastatin;compactin;fluindostatin;hydroxymethylglutaryl coenzyme A reductase inhibitor;hypocholesterolemic agent;mevinolin;pitavastatin;pravastatin;rosuvastatin;simvastatin;angiogenesis;antiinflammatory activity;article;bone density;bone metabolism;bone mineral;bone mineralization;clinical trial;dementia;drug efficacy;drug research;fibrinolysis;heart infarction;hip fracture;human;hypercholesterolemia;nerve degeneration;nervous system development;ossification;osteoporosis;prognosis;risk reduction;spine fracture;synaptogenesis;thrombocyte aggregation inhibition;vasodilatation,"Sewerynek, E.;Stuss, M.",2006,,,0,
4016,Relationship between nitric oxide levels and delirium in patients with coronary bypass operation,"Objective: Delirium is an acute brain failure which is related to various pathological conditions. Although there are some ideas about etiopathogenesis of delirium, some points have not been cleared yet. We aimed to investigate relationship between nitric oxide (NO) levels and delirium prospectively in patients with in coronary bypass operation. Methods: We included 50 (37 males, 13 females, ages: 37-75, mean±sd= 59.8±10.6) patients with coronary illnesses who will undergo bypass operation. Patients with dementia and any systemic disease, except hypertension and coronary artery disease, were excluded from study. Smoking was not allowed at least 7 days prior to operation. We diagnosed delirium using DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) criteria. Delirium Rating Scale was used to estimate delirium severity. Blood samples were taken pre-operationally and post operationally. Patients were divided into two groups as delirium group and nondelirium group. We compared the two groups according to NO levels. Results: 12 of the 50 patients had delirium. While there was no significant difference among blood NO levels pre-operationally between two groups, the NO levels were statistically higher in the delirium group than the nondelirium group. Conclusion: Our study is important since it is first study that investigated the relationship between NO and delirium. Blood NO levels become higher in patients who developed post operationally delirium. These findings can be explained by increased NO production in brain tissue due to increased cerebral ischemia and/or increased response to oxidative stress during operation.",nitric oxide;adult;aged;article;clinical article;controlled study;coronary artery bypass surgery;delirium;Diagnostic and Statistical Manual of Mental Disorders;disease severity;female;human;male;prospective study;rating scale,"Sezer, Ö;Karlidaǧ, R.;Karabulut, A. B.;Özcan, C.;Nisanoǧlu, V.;Türköz, Y.;But, A.;Ünal, S.",2004,,,0,
4017,The ticking of the epigenetic clock: Antipsychotic drugs in old age,"Background: Exposed to antipsychotic drugs (APDs), older individuals with dementing illness are at risk of cerebrovascular adverse effects (CVAE), including sudden death. Transient microvascular dysfunctions are known to occur in younger persons exposed to APDs; however, they seldom progress to CVAE, suggesting that APDs alone are insufficient for engendering this untoward effect. It is, therefore, believed that a preexistent microvascular damage is necessary for CVAE to take place, but the exact nature of this lesion remains unclear. CNS small vessel disease (SVD) is a well-known age-related risk factor for strokes, dementia, and sudden death, which may constitute the initial CVAE-predisposing pathology. Therefore, we propose the two strikes CVAE paradigm, in which SVD represents the first strike, while exposure to APDs, the second. In this model, both strikes must be present for CVAE to take place, and the neuroimaging load of white matter hyperintensities may be directly proportional with the CVAE risk. To investigate this hypothesis at the molecular level, we focused on a seemingly unrelated phenomenon: both APDs and SVD were found protective against a similar repertoire of cancers and their spread to the brain (1-4). Since microRNA-29 has shown efficacy against the same malignancies and has been associated with small vessels pathology, we narrowed our search down to this miR, hypothesizing that the APDs mechanism of action includes miR-29 upregulation, which in turn facilitates the development of SVD. Aim: To assess whether miR-29 can be utilized as a peripheral blood biomarker for SVD and CVAE risk. Method: We conducted a search of experimentally verified miR-29 target genes utilizing the public domain tools miRanda, RNA22 and Weizemann Institute of Science miRNA Analysis. We identified in total 67 experimentally verified target genes for miR-29 family, 18 of which correlate with microvascular integrity and may be relevant for CVAE. Conclusion: Upregulated microRNA-29 silences the expression of 18 genes connected with capillary stability, engendering a major vulnerability for SVD (first strike) which in turn increases the risk for CVAE after exposure to APDs (second strike).",biological marker;melatonin receptor;microRNA 29;neuroleptic agent;sirtuin;vasculotropin;aged;article;brain ischemia;cerebrovascular accident;dementia;DNA methylation;epigenetics;gene expression regulation;gene silencing;human;malignant neoplastic disease;metabolic disorder;microvascular ischemia;non insulin dependent diabetes mellitus;nuclear magnetic resonance imaging;sudden cardiac death;wound healing,"Sfera, A.;Osorio, C.;Inderias, L.;Cummings, M.",2016,,,0,
4018,Cognitive function and sleep related breathing disorders in a healthy elderly population: the SYNAPSE study,"STUDY OBJECTIVES: Sleep related breathing disorders (SRBD) are risk factors for cognitive dysfunction in middle-aged subjects, but this association has not been observed in the elderly. We assess the impact of SRBD on cognitive performance in a large cohort of healthy elderly subjects. DESIGN: Cross-sectional study examining the association between subjective memory test, neuropsychological battery testing and SRBD in the elderly. SETTING: Community-based sample in home and research clinical settings. PARTICIPANTS: 827 subjects, 58.5% women, aged 68 y at study entry, participated in the study. All were free of previously diagnosed SRBD, coronary heart disease, and neurological disorders, including stroke and dementia. Clinical interview, neurological assessment, polygraphy, and extensive cognitive testing were conducted for all participants. INTERVENTION: N/A. MEASUREMENT AND RESULTS: SRBD (apnea-hypopnea index [AHI] > 15 events/h) was diagnosed in 445 (53%) subjects, 167 (37%) of them with AHI > 30. Minimal daytime sleepiness was found in the group; 9.2% of the population had an Epworth Sleepiness Scale score > 10. No significant association was found between AHI, nocturnal hypoxemia, and cognitive scores. Comparison of mild vs severe cases showed a trend toward lower cognitive scores with AHI > 30, affecting delayed recall and Stroop test. CONCLUSIONS: The impact of undiagnosed SRBD on cognitive function appeared quite limited in a generally older healthy population, and only slightly affected severe cases. The implication of undiagnosed SRBD on the cognitive impairment in elderly subjects remains hypothetical and needs to be prospectively studied.",Aged;Aging;Cognition;Cognition Disorders/*epidemiology;Cohort Studies;Comorbidity;Cross-Sectional Studies;Female;France/epidemiology;Humans;Male;Memory;Neuropsychological Tests/statistics & numerical data;Severity of Illness Index;Sleep Apnea Syndromes/diagnosis/*epidemiology,"Sforza, E.;Roche, F.;Thomas-Anterion, C.;Kerleroux, J.;Beauchet, O.;Celle, S.;Maudoux, D.;Pichot, V.;Laurent, B.;Barthelemy, J. C.",2010,Apr,,0,
4019,Impact of hospitalization on modification of drug regimens: Results of the criteria to assess appropriate medication use among elderly complex patients study,"Aim: To assess the impact of hospitalization on modification of drug burden among elderly patients. Methods: The present prospective cohort study was carried out in acute care hospitals in Italy. The difference in the number of drugs used before hospital admission and those prescribed at discharge was calculated. The prevalence of (i) any increase (1 or more drugs); and (ii) an increase >50% in the number of drugs from admission to discharge was calculated, and the factors associated with these conditions were identified. Results: The mean age of 1082 participants was 81.2±7.3 years and 606 were women (56.0%), an increase in the number of drugs (1 or more drugs) between admission and discharge was observed in 672 participants (62.1% of study sample) and an ""increase >50%"" was observed in 372 participants (34.3%). ""Any increase"" was inversely associated with age and the number of drugs used before hospitalization, and it was positively associated with length of stay and diagnoses, including chronic obstructive pulmonary disease, ischemic heart disease and diabetes. ""Increase >50%"" was inversely associated with female sex, the number of drugs before hospitalization, involuntary loss of weight and intact cognitive status, and was positively associated with length of stay, chronic obstructive pulmonary disease, heart failure and diabetes. Conclusions: Not only disease, but also demographic factors (age and gender) and geriatric syndromes (weight loss and cognitive status) might influence pharmacological burden. These data might be useful in order to target interventions aimed at improving drug use and reducing iatrogenic illness.",age;aged;article;cerebrovascular accident;chronic obstructive lung disease;cohort analysis;controlled study;daily life activity;delirium;dementia;diabetes mellitus;drug dose regimen;drug use;falling;female;gender;heart failure;hospital admission;hospital discharge;hospitalization;human;hypertension;iatrogenic disease;ischemic heart disease;Italy;length of stay;major clinical study;male;Mini Mental State Examination;pain;Parkinson disease;polypharmacy;prescription;prevalence;priority journal;prospective study;very elderly;weight reduction,"Sganga, F.;Landi, F.;Vetrano, D. L.;Corsonello, A.;Lattanzio, F.;Bernabei, R.;Onder, G.",2016,,,0,
4020,Predictors of rehospitalization among older adults: Results of the CRIME Study,"Aim: To assess the predictors of readmission among older adults hospitalized in acute care wards. Methods: A prospective cohort study was carried out among 921 hospitalized older adults participating in the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) project. The primary outcome of the study was rehospitalization within 1 year after discharge from acute care hospitals. We assessed the participants with a questionnaire including 350 items about demographic, social and clinical characteristics. We analyzed all factors at discharge that could be considered predictors of readmission. Results: The mean age of the participants was 81.2 years (SD 7.4 years), and 509 were women (55.3%). Overall, 280 of 921 patients (30.4%) were rehospitalized during the 1-year follow up of the study. Patients with a Mini-Mental State Examination score equal to or higher than 24 had a higher probability of rehospitalization, as compared with those who performed lower than 24 (OR 1.76, 95% CI 1.04-2.83). In addition, heart failure (OR 1.77, 95% CI 1.14-2.24), the number of falls during 1-year follow up (OR 1.15, 95% CI 1.05-1.28) and the number of drugs during first hospitalization (OR 1.15, 95% CI 1.01-1.07) were significantly associated with rehospitalization, whereas no significant association was shown for age, sex and walking speed for minimum size (OR 1.15, 95% CI 0.99-2.00). Conclusions: Predictors of readmission in older people are an intact cognitive status; the presence of a geriatric condition, such as heart failure and falls; and a high number of drugs during first hospitalization. Further studies are required to assess the impact of home care for avoiding readmission in patients with an intact cognitive status, and supporting and treating patients with dementia.",adult;aged;cohort analysis;controlled study;crime;dementia;emergency care;female;follow up;heart failure;home care;hospital readmission;hospitalization;human;major clinical study;Mini Mental State Examination;probability;questionnaire;very elderly;walking speed,"Sganga, F.;Landi, F.;Volpato, S.;Cherubini, A.;Ruggiero, C.;Corsonello, A.;Fabbietti, P.;Lattanzio, F.;Gravina, E. M.;Bernabei, R.;Onder, G.",2016,,10.1111/ggi.12938,0,
4021,Predictors of rehospitalization among older adults: Results of the CRIME Study,"AIM: To assess the predictors of readmission among older adults hospitalized in acute care wards. METHODS: A prospective cohort study was carried out among 921 hospitalized older adults participating in the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) project. The primary outcome of the study was rehospitalization within 1 year after discharge from acute care hospitals. We assessed the participants with a questionnaire including 350 items about demographic, social and clinical characteristics. We analyzed all factors at discharge that could be considered predictors of readmission. RESULTS: The mean age of the participants was 81.2 years (SD 7.4 years), and 509 were women (55.3%). Overall, 280 of 921 patients (30.4%) were rehospitalized during the 1-year follow up of the study. Patients with a Mini-Mental State Examination score equal to or higher than 24 had a higher probability of rehospitalization, as compared with those who performed lower than 24 (OR 1.76, 95% CI 1.04-2.83). In addition, heart failure (OR 1.77, 95% CI 1.14-2.24), the number of falls during 1-year follow up (OR 1.15, 95% CI 1.05-1.28) and the number of drugs during first hospitalization (OR 1.15, 95% CI 1.01-1.07) were significantly associated with rehospitalization, whereas no significant association was shown for age, sex and walking speed for minimum size (OR 1.15, 95% CI 0.99-2.00). CONCLUSIONS: Predictors of readmission in older people are an intact cognitive status; the presence of a geriatric condition, such as heart failure and falls; and a high number of drugs during first hospitalization. Further studies are required to assess the impact of home care for avoiding readmission in patients with an intact cognitive status, and supporting and treating patients with dementia. Geriatr Gerontol Int 2017; 17: 1588-1592.",elderly;readmission;rehospitalization,"Sganga, F.;Landi, F.;Volpato, S.;Cherubini, A.;Ruggiero, C.;Corsonello, A.;Fabbietti, P.;Lattanzio, F.;Gravina, E. M.;Bernabei, R.;Onder, G.",2017,Oct,,0,4020
4022,Physical performance measures and polypharmacy among hospitalized older adults: Results from the crime study,"Objective: To investigate the association of polypharmacy and physical performance measures in a sample of elderly patients aged ≥65 years admitted to acute care hospitals. Design, setting and participants: Prospective study conducted among 1123 hospitalized older adults participating to the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) project. Measurements: Physical performance was measured at hospital admission by the 4-meter walking speed (WS) and the grip strength (GS). Polypharmacy was defined as the use of ≥10 drugs during hospital stay. Results: Mean age of 1123 participants was 81.5±7.4 years and 576 (51.3%) were on polypharmacy. Prevalence of polypharmacy was higher in patients with low WS and GS. After adjusting for potential confounders, participants in the highest tertile of WS were less likely to be on polypharmacy as compared with those in the lowest tertile (OR 0.58; 95% CI 0.35-0.96). Similarly, participants in the highest tertile of GS had a significantly lower likelihood of polypharmacy as compared with those in the lowest tertile (OR 0.55; 95% CI 0.36-0.84). When examined as continuous variables, WS and GS were inversely associated with polypharmacy (WS: OR 0.77 per 1 SD increment; 95% CI 0.60-0.98; GS: OR 0.71 per 1 SD increment; 95% CI 0.56-0.90). Conclusion: Among hospitalized older adults WS and GS are inversely related to polypharmacy. These measures should be incorporated in standard assessment of in-hospital patients.",analgesic agent;anticoagulant agent;antiinfective agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;corticosteroid;diuretic agent;laxative;neuroleptic agent;aged;aged hospital patient;article;cognition;dementia;diabetes mellitus;drug use;emergency care;emergency ward;falling;female;functional status;grip strength;grip strength test;heart failure;hospital admission;human;ischemic heart disease;length of stay;major clinical study;male;Mini Mental State Examination;pain;physical performance;polypharmacy;priority journal;prospective study;renin angiotensin aldosterone system;walking speed,"Sganga, F.;Vetrano, D. L.;Volpato, S.;Cherubini, A.;Ruggiero, C.;Corsonello, A.;Fabbietti, P.;Lattanzio, F.;Bernabei, R.;Onder, G.",2014,,,0,
4023,Natural history of newly diagnosed Alzheimer's disease,"Objective: To investigate predictors of Alzheimer's disease survival. Design: Prospective study. Setting: Population-based Alzheimer's Registry. Patients: 521 persons with Alzheimer's from 1987-1996. Measurements: Demographics, Mini-Mental State Exam (MMSE), Blessed Dementia Rating Scale (DRS), dementia symptoms, co-morbid conditions, and physical signs. Results: The median survival from initial diagnosis was 4.2 years for males and 5.7 years for females. At older ages, the survival difference between Alzheimer's patients and the US population diminished. Predictors of mortality included baseline MMSE ≤ 17; baseline DRS = >5.0; frontal lobe release signs, extrapyramidal signs, gait disturbance, history of falls, congestive heart failure, ischemic heart disease and diabetes. Conclusions: Survival after initial recognition of Alzheimer's disease was less than survival in the US population. Measures of disease severity that can be obtained at an initial clinic visit were strongly associated with survival. These results should be useful to patients and clinicians when planning for future care.",aged;Alzheimer disease;article;clinical feature;comorbidity;congestive heart failure;controlled study;dementia;demography;diabetes mellitus;epilepsy;extrapyramidal system;female;frontal lobe;gait disorder;history;human;ischemic heart disease;major clinical study;male;mental health;mental test;physical examination;population research;survival,"Shadlen, M. F.;Larson, E. B.",2005,,,0,
4024,Alzheimer's disease symptom severity in blacks and whites,"OBJECTIVE: In order to determine whether there are racial differences in Alzheimer's Disease (AD) symptom severity and vascular comorbidities, we compared African-American (black) and Caucasian (white) patients with AD from similar socioeconomic backgrounds at the time the disease was first recognized. DESIGN: Cross-sectional observational study from a population- based dementia registry. PARTICIPANTS: Patients were enrolled from an HMO base population of 23,000 persons more than age 60 in Seattle, Washington. This study examines 453 subjects with probable AD (38 blacks (mean age 76.5, SD 6.4), and 415 whites (mean age 79.7, SD 6.7)). MEASUREMENTS: Measured were patient demographics, age at onset of AD, AD symptom duration, Mini-Mental State Exam (MMSE) score, Blessed Dementia Rating Scale, presence of psychiatric symptoms, and vascular comorbidities. RESULTS: Blacks had significantly lower mean cognitive scores (MMSE = 17.2, SD 5.6) compared with whites (MMSE = 20.2, SD 5.2, unpaired t test P < .01). The significant racial difference in MMSE scores persisted after controlling for education, duration of AD symptoms, age, and ADL impairment. Blacks and whites did not differ significantly regarding gender distribution, education level, income, or percent with early age of onset of AD. No statistically significant race- related differences were found in impairments in activities of daily living or symptoms of paranoia, hallucinations, or agitation. Blacks had significantly higher rates of hypertension (56%) compared with whites (34%) (Fisher's exact test, P = .013), but the rates of stroke and ischemic heart disease were similar. CONCLUSIONS: Despite uniform detection methods and controlling for reported duration of dementia symptoms, measured cognitive impairment is significantly more severe when AD is recognized in blacks compared with whites. The significantly higher prevalence of hypertension among black AD cases was not associated with excess cerebrovascular disease comorbidity. This study highlights a need for normative measurements of cognitive function in minority AD groups in order to distinguish differential cognitive symptom severity from possible measurement bias.",aged;Alzheimer disease;article;clinical feature;cognitive defect;comorbidity;controlled study;disease association;disease duration;disease severity;ethnic difference;female;human;ischemic heart disease;major clinical study;male;neuropsychological test;cerebrovascular accident,"Shadlen, M. F.;Larson, E. B.;Gibbons, L.;McCormick, W. C.;Teri, L.",1999,,,0,
4025,Quality of chronic disease care for older people in care homes and the community in a primary care pay for performance system: Retrospective study,"Objective: To describe the quality of care for chronic diseases among older people in care homes (nursing and residential) compared with the community in a pay for performance system. Design: Retrospective analysis of The Health Improvement Network (THIN), a large primary care database. Setting: 326 English and Welsh general practices, 2008-9. Participants: 10 387 residents of care homes and 403 259 residents in the community aged 65 to 104 and registered for 90 or more days with their general practitioner. Main outcome measure: 16 process quality indicators for chronic disease management appropriate for vulnerable older people for conditions included in the UK Quality and Outcomes Framework. Results: After adjustment for age, sex, dementia, and length of registration, attainment of quality indicators was significantly lower for residents of care homes than for those in the community for 14 of 16 indicators. The largest differences were for prescribing in heart disease (β blockers in coronary heart disease, relative risk 0.70,95% confidence interval 0.65 to 0.75) and monitoring of diabetes (retinal screening, 0.75, 0.71 to 0.80). Monitoring hypothyroidism (0.93, 0.90 to 0.95), blood pressure in people with stroke (0.92, 0.90 to 0.95), and electrolytes for those receiving loop diuretics (0.89, 0.87 to 0.92) showed smaller differences. Attainment was lower in nursing homes than in residential homes. Residents of care homes were more likely to be identified by their doctor as unsuitable or non-consenting for all Quality and Outcomes Framework indicators for a condition allowing their exclusion from targets; 33.7% for stroke and 34.5% for diabetes. Conclusion: There is scope for improving the management of chronic diseases in care homes, but high attainment of some indicators shows that pay for performance systems do not invariably disadvantage residents of care homes compared with those living in the community. High use of exception reporting may compromise care for vulnerable patient groups. The Quality and Outcomes Framework, and other pay for performance systems, should monitor attainment and exception reporting in vulnerable populations such as residents of care homes and consider measures that deal with the specific needs of older people.",acetylsalicylic acid;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;electrolyte;loop diuretic agent;aged;article;blood pressure monitoring;cerebrovascular accident;chronic disease;community care;diabetes mellitus;elderly care;female;health care quality;health care system;atrial fibrillation;heart disease;heart failure;heart infarction;human;hypothyroidism;ischemic heart disease;major clinical study;male;nursing home;patient monitoring;pay for performance system;physician attitude;prescription;primary medical care;priority journal;residential home;retina examination;retrospective study,"Shah, S. M.;Carey, I. M.;Harris, T.;DeWilde, S.;Cook, D. G.",2011,,,0,
4026,Clinical diagnosis of dementia with Lewy bodies 8,,cholinesterase inhibitor;adult;Alzheimer disease;chronic obstructive lung disease;dementia;hallucination;heart failure;human;letter;Lewy body;multiinfarct dementia;Parkinson disease;subdural hematoma;symptomatology,"Shaji, K. S.;Iype, T.;Anandan, K. R.",2002,,,0,
4027,Cognitive impairment common after critical illness,,Alzheimer disease;cardiogenic shock;cognitive defect;critical illness;delirium;follow up;hospital patient;hospitalization;human;intensive care unit;note;respiratory failure;risk factor;septic shock;traumatic brain injury,"Shalshin, A.",2014,,,0,
4028,Carconoid heart disease arising from an ovarian teratoma 6,,antibiotic agent;octreotide;abdomen;aged;alertness;anamnesis;autopsy;cannula;carcinoid;carcinoid syndrome;cardiomegaly;case report;cerebrovascular accident;computer assisted tomography;cyanosis;dementia;diarrhea;echocardiography;edema;electrocardiogram;female;fibrosis;hematocrit;human;immunohistochemistry;jugular vein;Klebsiella pneumoniae;laboratory test;leg;letter;leukocyte count;lung auscultation;medical examination;muscle weakness;neurologic examination;nursing home;ovary;ovary teratoma;patient;pelvis;physical examination;priority journal;pulmonary valve;recumbency;sepsis;systolic heart murmur;tricuspid valve;umbilical hernia;urea nitrogen blood level;vein dilatation;wakefulness,"Shapiro, M. D.;Hanon, S.",2005,,,0,
4029,Poor outcome after first-ever stroke,,Age Factors;Atrial Fibrillation/epidemiology;Cohort Studies;Comorbidity;Dementia/epidemiology;Heart Failure/epidemiology;Humans;*Outcome Assessment (Health Care);Prognosis;Recurrence;Risk Factors;Severity of Illness Index;Stroke/*diagnosis/*mortality,"Sharma, J. C.",2003,Aug,10.1161/01.str.0000083467.23040.4b,0,
4030,Undiagnosed subclinical hypothyroidism associated with Chilaiditi's syndrome affecting anesthetic management,"Chilaiditi's syndrome, comprising internal herniation of intestine into sub-diaphragmatic space, may cause acute intestinal obstruction necessitating emergency laparotomy. It is associated with several co-morbidities. In our case its association with subclinical hypothyroidism was detected on the fourth post-operative day, which affected anesthetic management by markedly delaying recovery from general anesthesia.",atropine;halothane;neostigmine methyl sulfate;nitrous oxide;pethidine;suxamethonium;thiopental;vecuronium;adult;anesthesia induction;anesthetic recovery;angina pectoris;article;case report;Chilaiditis syndrome;comorbidity;emergency surgery;female;general anesthesia;hernia;human;hypothyroidism;intestine obstruction;intestine perforation;laparotomy;liothyronine blood level;mental deficiency;neuromuscular blocking;obesity;preoperative evaluation;Rett syndrome;schizophrenia;thyrotropin blood level;thyroxine blood level,"Sharma, S. M.",2010,,,0,
4031,Neuroleptic Malignant Syndrome Caused by Quetiapine in an Elderly Man with Lewy Body Dementia,,citalopram;clonazepam;donepezil;quetiapine;valproic acid;aged;case report;consciousness level;diffuse Lewy body disease;drug withdrawal;dysphagia;enteric feeding;fever;human;hydration;hyperlipidemia;hypertension;ischemic heart disease;letter;leukocytosis;limb movement;male;memory disorder;myoclonus;neuroleptic malignant syndrome;parasomnia;parkinsonism;personality disorder;short term memory;tachycardia;tremor;visual hallucination,"Shea, Y. F.;Chu, L. W.",2016,,,0,
4032,Continuing pharmacyeducation series-risk factors and complications of diabetes,"Diabetic is a complex metabolic condition that requires meticulous management and a global approach. Poor management and control of diabetes often lead to poor disease outcomes. The management of diabetes and its complications presents an increasing challenge to health care systems throughout the world. New findings regarding complications of diabetes, their prevalence and incidence, and risk factors involved were discussed in this paper. Various risk factors associated with diabetes include-diabetic neuropathy, diabetic retinopathy, hypoglycemia, metabolic syndrome, T.B musculoskeletal disease, hypoglycemia, Chronic liver disease and coronary heart disease, Foot ulcers and amputations, mental function and dementia, infections, depression and changes in bone quality1. So, prevention of diabetes will need deeper understanding by the patients and their surroundings before medical advancements throw up a magical cure to it. Pharmacist can play an important role by screening patients at higher risk for diabetes, assessing patient health status and adherence to standards of care, patient education referring patients to other health care professionals as appropriate for other complications monitoring the outcomes2. A buildup of awareness and high motivation levels among society as a whole will ensure active co-operation of every individual for a healthy living.",alendronic acid;amitriptyline;carbamazepine;gabapentin;nortriptyline;protein kinase;reactive oxygen metabolite;risedronic acid;thiazide diuretic agent;article;bone density;cardiovascular disease;continuing education;dementia;depression;diabetes control;diabetes mellitus;diabetic foot;diabetic ketoacidosis;diabetic nephropathy;diabetic neuropathy;diabetic retinopathy;diabetogenesis;differential diagnosis;disease association;disease classification;foot amputation;functional assessment;glycemic control;human;hypoglycemia;insulin dependent diabetes mellitus;kidney biopsy;kidney function;mental function;microalbuminuria;neuropathic pain;non insulin dependent diabetes mellitus;patient assessment;patient education;patient monitoring;pharmacist attitude;physiotherapy;protein restriction;respiratory tract infection;risk assessment;risk factor;symptom;treatment indication;urinalysis;urinary tract infection,"Sheejav, S.;Reddym, H.;Joseph, J. C.;Krishna Raj, R.",2010,,,0,
4033,Survival and functional independence after implantation of a permanent pacemaker in octogenarians and nonagenarians. A population-based study,"BACKGROUND: The number of very elderly persons who are candidates for implantation of a permanent pacemaker is increasing, but the effect of cardiac pacing on long-term survival and functional variables has not been determined. OBJECTIVE: To determine long-term survival after implantation of a permanent pacemaker in octogenarians and nonagenarians and to assess functional independence after such implantation. DESIGN: Retrospective, population-based cohort study. SETTING: Epidemiologic setting from an unselected population. PATIENTS: 157 octogenarians and nonagenarians who initially received a pacemaker between 1962 and 1988 and were followed through 1992. MAIN OUTCOME MEASURES: Overall mortality rate, functional capabilities, and placement in a nursing home. RESULTS: Observed survival in patients with heart disease was significantly worse than that in age-and sex-matched controls (P < 0.001). Observed survival in community residents without heart disease was similar to that in controls (P > 0.2). Multivariable analysis identified congestive heart failure, chronic obstructive pulmonary disease, old age, syncope, cancer, and atrioventricular block as independent predictors of increased mortality. Symptoms decreased in 118 patients (75%) after pacemaker implantation. After implantation, 70 patients (45%) were permanently placed in nursing homes; this number is similar to the estimated probability of lifetime use of nursing homes from the National Mortality Followback Survey. Dementia developed or worsened in 51 patients (32%), and orthopedic disability occurred in 41 patients (26%). CONCLUSIONS: Normal relative survival in octogenarians and nonagenarians without heart disease is reassuring; the poor prognosis in patients with heart disease warrants careful evaluation of the methods and indications for cardiac pacing. Permanent pacing alleviates bradycardia-related symptoms. Placement in a nursing home and development or worsening of cardiac, neurologic, or orthopedic disabilities frequently occur after implantation of a permanent pacemaker in the very elderly.","*Activities of Daily Living;Aged;Aged, 80 and over;Arrhythmias, Cardiac/mortality/therapy;*Cardiac Pacing, Artificial;Female;Follow-Up Studies;Heart Diseases/*mortality/*therapy;Homes for the Aged;Humans;Male;Multivariate Analysis;Nursing Homes;Survival Analysis","Shen, W. K.;Hayes, D. L.;Hammill, S. C.;Bailey, K. R.;Ballard, D. J.;Gersh, B. J.",1996,Sep 15,,0,
4034,Systems Pharmacology Based Study of the Molecular Mechanism of SiNiSan Formula for Application in Nervous and Mental Diseases,"Background. Mental disorder is a group of systemic diseases characterized by a variety of physical and mental discomfort, which has become the rising threat to human life. Herbal medicines were used to treat mental disorders for thousand years in China in which the molecular mechanism is not yet clear. Objective. To systematically explain the mechanisms of SiNiSan (SNS) formula on the treatment of mental disorders. Method. A systems pharmacology method, with ADME screening, targets prediction, and DAVID enrichment analysis, was employed as the principal approach in our study. Results. 60 active ingredients of SNS formula and 187 mental disorders related targets were discovered to have interactions with them. Furthermore, the enrichment analysis of drug-target network showed that SNS probably acts through ""multi-ingredient, multitarget, and multisystems"" holistic coordination in different organs pattern by indirectly regulating the nutritional and metabolic pathway even their serial complications. Conclusions. Our research provides a reference for the molecular mechanism of medicinal herbs in the treatment of mental disease on a systematic level. Hopefully, it will also provide a theoretical basis for the discovery of lead compounds of natural medicines for other diseases based on traditional medicine.",androgen receptor;APC protein;breast cancer resistance protein;bungarotoxin receptor;cholecystokinin;colecalciferol 24 hydroxylase;cytochrome P450 1A1;cytochrome P450 1A2;cytochrome P450 2A6;cytochrome P450 2C9;cytochrome P450 2D6;cytochrome P450 3A4;DHCR7 protein;DRD3 protein;estrogen receptor alpha;gelatinase B;glycogen synthase kinase 3beta;herbaceous agent;HTR2A protein;HTR3A protein;multidrug resistance associated protein 1;nicotinic receptor alpha4;OXTR protein;radix paeoniae;peptides and proteins;PRF1 protein;RANTES;sinisan formula;toll like receptor 4;unclassified drug;XDH protein;algorithm;Alzheimer disease;article;atherosclerosis;autism;blood brain barrier;radix bupleuri;central nervous system disease;drug absorption;drug bioavailability;drug distribution;drug efficacy;drug excretion;drug mechanism;drug metabolism;epilepsy;ethnopharmacology;gene expression;Glycyrrhiza;heart disease;heart failure;heart infarction;herbal medicine;human;hyperalgesia;hypertension;mental disease;metabolic disorder;metabolic regulation;neurologic disease;non insulin dependent diabetes mellitus;nutrition;obesity;pain;peripheral neuropathy;pharmacology;prediction;psychopharmacotherapy;schizophrenia;seizure;sour orange;systems pharmacology;vascular disease,"Shen, X.;Zhao, Z.;Luo, X.;Wang, H.;Hu, B.;Guo, Z.",2016,,10.1155/2016/9146378,0,
4035,"Subcortical vascular cognitive impairment, no dementia: EEG global power independently predicts vascular impairment and brain symmetry index reflects severity of cognitive decline","Background and Purpose: Vascular cognitive impairment, no dementia (vCIND) is a prevalent and potentially preventable disorder. Clinical presentation of the small-vessel subcortical subtype may be insidious, and differential difficulties can arise with mild cognitive impairment. We investigated EEG parameters in subcortical vCIND in comparison with amnestic multidomain mild cognitive impairment to determine the additional diagnostic value of quantitative EEG in this setting. Methods: Fifty-seven community-residing patients with an uneventful central neurologic history and first presentation of cognitive decline without dementia were included. Neuropsychological test results were correlated with EEG parameters. Predictive values for vCIND and amnestic multidomain mild cognitive impairment were calculated using receiver operating characteristic curves and logistic regression modeling. Results: Vascular cognitive impairment, no dementia and amnestic multidomain mild cognitive impairment differed with regard to the EEG (delta 1 theta)/(alpha + beta) ratio (DTABR) and pairwise derived brain symmetry index. We found statistically significant correlations between pairwise derived brain symmetry index and immediate verbal memory, immediate global memory, verbal recognition, working memory, and mean memory score in vCIND. Verbal fluency (odds ratio: 1.54, 95% confidence interval: 1.04-2.28, P = 0.033) and (delta 1 theta)/(alpha + beta) ratio (odds ratio: 2.28, 95% confidence interval: 1.06-4.94, P = 0.036) emerged as independent diagnostic predictors for vCIND with an overall correct classification rate of 95.0%. Conclusion: Our data indicate that EEG is of additional value in the differential diagnosis and follow-up of patients presenting with cognitive decline. These findings may have an impact on memory care.",anticoagulant agent;antithrombocytic agent;adult;aged;article;carotid artery obstruction;cognitive defect;congestive heart failure;coronary artery disease;diabetes mellitus;diagnostic accuracy;diagnostic test accuracy study;diagnostic value;disease severity;dyslipidemia;electroencephalogram;female;heart arrhythmia;human;hypertension;major clinical study;male;mild cognitive impairment;neuropsychological test;predictive value;psychologic test;sensitivity and specificity;vascular cognitive impairment no dementia;verbal memory;working memory,"Sheorajpanday, R. V. A.;Mariën, P.;Nagels, G.;Weeren, A. J. T. M.;Saerens, J.;Van Putten, M. J. A. M.;De Deyn, P. P.",2014,,,0,
4036,Online health: The end of family medicine?,,advanced cancer;Alzheimer disease;amyotrophic lateral sclerosis;cystic fibrosis;family medicine;general practitioner;health care;heart infarction;human;letter;leukemia;medical student;multiple sclerosis;osteoarthritis;Parkinson disease;physician,"Shepherd, R. W.",2013,,,0,
4037,Cognitive functions in patients with chronic heart failure,"Objective. To evaluate cognitive functions in patients with different stages of chronic heart failure (CHF) and different degrees of stenosis of precerebral arteries. Material and methods. Authors examined 148 patients with CHF and 21 patients without CHF (controls). Neuropsychological assessment (NINDS-Canadian Stroke Standards - 30 minutes protocol), ultrasound scanning of the main cranial arteries and transcranial dopplerography and echocardiogram were made. Results and conclusion. Patients with CHF more frequently had combined (multifocal) cognitive impairment. Patients with systolic heart failure performed significantly worse on neuropsychological tests, in particular, functional domains within the frontal lobes and «executive» dysfunction, than those with diastolic heart failure. Cognitive impairment in patients with CHF was associated with the lower left ventricular ejection fraction and deterioration in indices of diastolic function but not with carotid artery stenosis.",artery occlusion;article;brain artery;cognition;cognitive defect;controlled study;diastolic heart failure;echography;frontal lobe;heart failure;heart left ventricle ejection fraction;human;major clinical study;mental deterioration;neuropsychological test;precerebral artery;systolic heart failure;transcranial doppler;transcranial dopplerography,"Shestakova, M. V.;Vasilenko, A. F.;Grigoricheva, E. A.;Karpova, M. I.;Shamurov, Y. S.;Epaneshnikova, N. V.;Istomina, V. V.",2014,,,0,
4038,Acupuncture for Vascular Dementia: A Pragmatic Randomized Clinical Trial,"In this trial, patients who agreed to random assignment were allocated to a randomized acupuncture group (R-acupuncture group) or control group. Those who declined randomization were assigned to a nonrandomized acupuncture group (NR-acupuncture group). Patients in the R-acupuncture group and NR-acupuncture group received up to 21 acupuncture sessions during a period of 6 weeks plus routine care, while the control group received routine care alone. Cognitive function, activities of daily living, and quality of life were assessed by mini-mental state examination (MMSE), Activities of Daily Living Scale (ADL), and dementia quality of life questionnaire (DEMQOL), respectively. All the data were collected at baseline, after 6-week treatment, and after 4-week follow-up. No significant differences of MMSE scores were observed among the three groups but pooled-acupuncture group had significant higher score than control group. Compared to control group, ADL score significantly decreased in NR-acupuncture group and pooled-acupuncture group. For DEMQOL scores, no significant differences were observed among the three groups, as well as between pooled-acupuncture group and control group. Additional acupuncture to routine care may have beneficial effects on the improvements of cognitive status and activities of daily living but have limited efficacy on health-related quality of life in VaD patients.",acupuncture;aged;article;cognition;controlled study;daily life activity;diabetes mellitus;female;follow up;human;hypertension;ischemic heart disease;major clinical study;male;Mini Mental State Examination;multiinfarct dementia;quality of life;randomization;randomized controlled trial;risk assessment,"Shi, G. X.;Li, Q. Q.;Yang, B. F.;Liu, Y.;Guan, L. P.;Wu, M. M.;Wang, L. P.;Liu, C. Z.",2015,,,0,
4039,Clinical characteristics and laboratory findings of 252 Chinese patients with anti-phospholipid syndrome: comparison with Euro-Phospholipid cohort,"This study aims to characterize the Chinese Han patients with anti-phospholipid syndrome (APS) and compare the data with those of the Euro-Phospholipid cohort. We conducted a single center study consisting of 252 patients with definite APS from 2000 to 2015. We analyzed the clinical and laboratory characteristics of our cohort and compared the data with those of the Euro-Phospholipid cohort. Our cohort consisted of 216 females and 36 males, with a mean age at entry into this study of 41 years (range 11–74 years). Of these patients, 69 (27.4%) patients had primary APS, and 183 (72.6%) had secondary APS (SAPS), including 163 (64.7%) patients had systemic lupus erythematosus (SLE). Thrombotic events occurred in 190 (75.4%) patients, and the most common ones were deep vein thrombosis (40.1%) and stroke (23.8%), which were similar to the reports of the Euro-Phospholipid cohort. In contrast, our cohort had less pulmonary embolism (6.7%). Among 93 females with 299 pregnancy episodes, the rates of early (<10 weeks) and late fetal loss (≥10 weeks) were, respectively, 37.8% and 24.4%. The latter was significantly higher than that of the Euro-Phospholipid cohort. Moreover, 7 APS nephropathy patients (characterized histopathologically by thrombotic microangiopathy) and 8 catastrophic APS patients were found in our cohort. Anti-cardiolipin antibodies (aCL) were detected in 169 (67.1%) patients, lupus anti-coagulant (LA) was detected in 83 (32.9%), and anti-β2 glycoprotein I antibodies (anti-β2GPI) in 148 (58.7%) patients. These results show that some clinical manifestations of APS may vary among different racial groups.",antinuclear antibody;beta 2 glycoprotein i antibody;cardiolipin antibody;double stranded DNA antibody;immunoglobulin G;immunoglobulin M;La antibody;lupus anticoagulant;protein antibody;Ro antibody;Sm antibody;unclassified drug;acute brain disease;Addison disease;adolescent;adult;adult respiratory distress syndrome;aged;amnesia;angina pectoris;antiphospholipid syndrome;artery thrombosis;arthralgia;arthritis;article;avascular necrosis;bleeding;Budd Chiari syndrome;cardiomyopathy;cerebellar ataxia;cerebral sinus thrombosis;cerebrovascular accident;child;Chinese;chorea;controlled study;coronary bypass rethrombosis;deep vein thrombosis;disease association;epilepsy;esophageal ischemia;esophagus disease;female;fetus wastage;fibrosing alveolitis;gangrene;glomerular thrombosis;heart infarction;hemiballism;hemolytic anemia;histopathology;human;human tissue;incidence;intra cardiac thrombus;jugular vein thrombosis;kidney biopsy;kidney disease;kidney infarction;kidney vein thrombosis;laboratory;leg ulcer;livedo reticularis;liver vein;liver vein thrombosis;lung embolism;lung hemorrhage;lupus like syndrome;major clinical study;male;mesenteric ischemia;microthrombus;migraine;multiinfarct dementia;nose septum perforation;optic nerve disease;pancreas disease;pancreatic infarction;prematurity;priority journal;pseudovasculitic lesion;pseudovasculitic skin lesion;pulmonary artery thrombosis;pulmonary hypertension;pulmonary microthrombosis;pulmonary vascular disease;renal artery thrombosis;retinal artery thrombosis;retinal vein thrombosis;Sjoegren syndrome;skin defect;skin necrosis;skin ulcer;small hepatic vein thrombosis;spinal cord disease;spleen infarction;superficial thrombophlebitis;systemic lupus erythematosus;thrombocytopenia;thrombotic thrombocytopenic purpura;transient amnesia;transient ischemic attack;transitional blindness;transverse myelopathy;upper extremity deep vein thrombosis;vascular lesion;vein thrombosis,"Shi, H.;Teng, J. L.;Sun, Y.;Wu, X. Y.;Hu, Q. Y.;Liu, H. L.;Cheng, X. B.;Yin, Y. F.;Ye, J. N.;Chen, P. P.;Yang, C. D.",2017,,10.1007/s10067-017-3549-1,0,
4040,An autopsy case of atypical senile dementia with atrophy of the temporal lobes. A clinical and histopathological report,"A man aged 70, descendant of an apparently healthy family, showed disorientation, delusional ideas and rages at 66. Later there was slowly advancing deterioration with muteness, disorientation and dysphagia. He died of cardiac failure. There was diffuse atrophy of the cerebrum, which was remarkably accentuated on both temporal lobes (poles, T2 and T3), where the loss of nerve cells and proliferation of astrocytes were found in the cortex and pallor and conspicuous fibrillary gliosis were noted in the white matter. These findings fundamentally suggest Pick's disease. On the one hand, numerous senile plaques and Alzheimer's neurofibrillary changes, suggestive of Alzheimer's disease (senile dementia), were observed throughout the cerebral cortex. On the other hand, a few inflated cells were also seen in the cingulate, superior frontal gyri and temporal poles. The basilar artery was moderately atherosclerotic and cerebrovascular disorders were distributed throughout the cerebral cortex and basal ganglia, especially in the field of supply of middle cerebral artery. This case is similar to rare cases reported by Berlin (1949), Neumann (1949) and Oyanagi et al. (1975). The nosological situation as a disease entity remains to be determined.",autopsy;brain atrophy;brain cortex;case report;central nervous system;histology;neurofilament;pick disease (arnold);senile dementia,"Shibayama, H.;Hoshino, T.;Kobayashi, H.",1978,,,0,
4041,Electron microscopic structure of the Alzheimer's neurofibrillary changes in case of atypical senile dementia,"A man aged 70, showed early disorientation, memory defects, delusions and rages at 66, later mental deterioration with muteness and dysphagia. He died of cardiac failure. The postmortem examination revealed macroscopically and light microscopically the neuropathological findings of atypical senile dementia. Moreover, it is the interesting characteristic in the presented case that there are electron microscopically two types of filaments making the neurofibrillary tangles. One showed the so-called 'paired helical filaments', which were observed in the cerebral cortex. The other showed parallel 'straight filaments'. These 'straight filaments' were found in the bilateral hippocampi.",aged;Alzheimer disease;autopsy;brain;case report;central nervous system;electron microscopy;presenile dementia,"Shibayama, H.;Kitoh, J.",1978,,,0,
4042,An increased risk of reversible dementia may occur after zolpidem derivative use in the elderly population a population-based case-control study,"We evaluate the effects of zolpidem use to develop dementia or Alzheimer disease from the Taiwan National Health Insurance Research Database (NHIRD). A retrospective population-based nested case-control study. Newly diagnosed dementia patients 65 years and older and controls were sampled. A total of 8406 dementia and 16,812 control subjects were enrolled from Taiwan NHIRD during 2006 to 2010. The relationships between zolpidem use and dementia were measured using odds and adjusted odds ratios. The relationship between the average cumulative doses for zolpidem and dementia was also analyzed. Zolpidem alone or with other underlying diseases, such as hypertension, diabetes, and stroke, was significantly associated with dementia after controlling for potential confounders, such as age, sex, coronary artery disease, diabetes, anti-hypertension drugs, stroke, anticholesterol statin drugs, depression, anxiety, benzodiazepine, anti-psychotic, and anti-depressant agents' use (Adjusted OR=1.33, 95% CI 1.24-1.41). Zolpidem use also has significant dose-response effects for most of the types of dementia. In patient with Alzheimer diseases, the effects of zolpidem among patients with Alzheimer's disease remained obscure. The adjusted OR for patients whose cumulative exposure doses were between 170 and 819 mg/year (adjusted OR: 1.65, 95% CI 1.08-2.51, P=0.0199) was significant; however, the effects for lower and higher cumulative dose were not significant. Zolpidem used might be associated with increased risk for dementia in elderly population. Increased accumulative dose might have higher risk to develop dementia, especially in patients with underlying diseases such as hypertension, diabetes, and stroke.",antihypertensive agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;zolpidem;zopiclone;aged;anxiety disorder;article;cerebrovascular accident;controlled study;coronary artery disease;dementia;depression;diabetes mellitus;disease association;drug use;female;geriatric disorder;human;hyperlipidemia;hypertension;major clinical study;male;population based case control study;priority journal;retrospective study;risk factor;Taiwan;very elderly,"Shih, H. I.;Lin, C. C.;Tu, Y. F.;Chang, C. M.;Hsu, H. C.;Chi, C. H.;Kao, C. H.",2015,,,0,
4043,GWAB: A web server for the network-based boosting of human genome-wide association data,"During the last decade, genome-wide association studies (GWAS) have represented a major approach to dissect complex human genetic diseases. Due in part to limited statistical power, most studies identify only small numbers of candidate genes that pass the conventional significance thresholds (e.g. P ≤ 5 × 10 â '8). This limitation can be partly overcome by increasing the sample size, but this comes at a higher cost. Alternatively, weak association signals can be boosted by incorporating independent data. Previously, we demonstrated the feasibility of boosting GWAS disease associations using gene networks. Here, we present a web server, GWAB (www.inetbio.org/gwab), for the network-based boosting of human GWAS data. Using GWAS summary statistics (P-values) for SNPs along with reference genes for a disease of interest, GWAB reprioritizes candidate disease genes by integrating the GWAS and network data. We found that GWAB could more effectively retrieve disease-associated reference genes than GWAS could alone. As an example, we describe GWAB-boosted candidate genes for coronary artery disease and supporting data in the literature. These results highlight the inherent value in sub-threshold GWAS associations, which are often not publicly released. GWAB offers a feasible general approach to boost such associations for human disease genetics.",Alzheimer disease;area under the curve;article;benchmarking;coronary artery disease;Crohn disease;disease associated gene;disease association;false positive rate;feasibility study;gene;genetic association;genetic database;genome-wide association study;human;information retrieval;non insulin dependent diabetes mellitus;online system;parameters;priority journal;probability;process design;receiver operating characteristic;reference value;rheumatoid arthritis;schizophrenia;single nucleotide polymorphism;software;ulcerative colitis;validation process;web based service design;web server;GWAB,"Shim, J. E.;Bang, C.;Yang, S.;Lee, T.;Hwang, S.;Kim, C. Y.;Singh-Blom, U. M.;Marcotte, E. M.;Lee, I.",2017,,10.1093/nar/gkx284,0,
4044,Cognitive correlates of cerebral vasoreactivity on transcranial doppler in older adults,"Background This study was performed to explore the possible contributions of cerebral hemodynamic changes to the cognitive impairment in patients with Alzheimer's disease (AD). Methods A total of 194 participants were included: 52 controls, 75 patients with mild cognitive impairment (MCI), and 67 patients with AD. Demographic characteristics, vascular risks, mini-mental state examination (MMSE), and clinical dementia rating (CDR) were assessed, and magnetic resonance imaging of the brain was performed to evaluate white matter hyperintensities (WMHs). Using transcranial Doppler (TCD) ultrasonography, cerebrovascular reactivity (CVR) was evaluated with a breath-holding test, in addition to the mean blood flow velocity (MFV), pulsatility index (PI), and resistance index (RI) of the middle cerebral artery. Results After adjusting for covariates such as age, education, WMH severity, and vascular risks, TCD parameters such as MFV, PI, and RI did not differ between the 3 groups. However, CVR was significantly reduced in the AD group (45.33 ± 11.49%), compared with the other groups (56.36 ± 14.65%, controls; 53.84 ± 15.47%, MCI group; P <.001). Multiple regression analyses also showed that CVR was associated with MMSE scores. CVR differed according to the CDR scores (P <.001). Conclusions Our finding may be suggestive of an underlying microangiopathic mechanism in AD patients. Furthermore, there was an association between the impaired function of cerebral microvessels and cognitive impairment. Further research is needed to fully establish whether altered cerebral hemodynamics may be considered an independent factor in predicting cognitive decline or an effect of pathologic processes involved in AD.",age;aged;Alzheimer disease;article;blood flow velocity;brain blood flow;breath holding;cardiovascular risk;cerebrovascular reactivity;Clinical Dementia Rating;cognition;cognitive defect;controlled study;demography;diabetes mellitus;disease severity;Doppler echography;dyslipidemia;educational status;female;human;hypertension;ischemic heart disease;major clinical study;male;middle cerebral artery;mild cognitive impairment;Mini Mental State Examination;nervous system parameters;nuclear magnetic resonance imaging;observational study;priority journal;pulsatility index;resistance index;smoking;transcranial doppler;vascular resistance;white matter hyperintensity;white matter lesion,"Shim, Y.;Yoon, B.;Shim, D. S.;Kim, W.;An, J. Y.;Yang, D. W.",2015,,,0,
4045,Clinicopathologic study of Alzheimer's disease: Alzheimer mimics,"A definite diagnosis of Alzheimer's disease (AD) can only be made at autopsy. Even at expert research centers, diagnostic accuracy is relatively low. We conducted this study to examine the accuracy of clinical diagnosis of AD and present a list of clinical and neuropsychological findings that could render the clinical diagnosis difficult. Using the National Alzheimer's Coordinating Center database, the records of 533 patients who had been diagnosed clinically with AD, and later underwent autopsy, were reviewed retrospectively. Since the pathologic results of 119 subjects did not meet the criteria for definite AD, we labeled them as Alzheimer ""mimics"". The neuropathological diagnoses of Alzheimer mimics consisted of dementia with Lewy bodies (n = 35, 29%), insufficient AD (n = 22, 18%), vascular disease (n = 15, 13%), frontotemporal lobar degeneration (n = 14, 12%), and hippocampal sclerosis (n = 10, 8%). History of pacemaker insertion (10.92% versus 4.11%, p = 0.005), congestive heart failure (13.45% versus 6.04%, p = 0.007), hypertension (56.30% versus 47.83%, p = 0.037), and resting tremor (14.29% versus 10.87%, p = 0.170) was more prevalent in Alzheimer mimics. Clinical Dementia Rating score and frequency of Neuropsychiatric Inventory Questionnaire items reflecting delusions, agitation, depression, and motor disturbance were more severe in confirmed AD. In addition to Mini-Mental State Examination (16.97 +/- 8.29 versus 12.74 +/- 15.26, p < 0.001), Logical Memory, Animal Fluency, Boston Naming Test, and Digit Span scores showed more severe impairment in confirmed AD. Continuing systematic comparisons of the current criteria for the clinical and pathological dementia diagnoses are essential to clinical practice and research, and may also lead to further improvement of the diagnostic procedure.","Aged;Aged, 80 and over;Alzheimer Disease/*diagnosis/pathology/psychology;Autopsy;Brain/pathology;Databases, Factual;Female;Follow-Up Studies;Humans;Immunohistochemistry;Lewy Body Disease/pathology/psychology;Male;*Neuropsychological Tests;Psychomotor Performance/physiology;Reproducibility of Results","Shim, Y. S.;Roe, C. M.;Buckles, V. D.;Morris, J. C.",2013,,10.3233/jad-121594,0,
4046,"Cyclic AMP phosphodiesterase inhibitor, phthalazinol (EG626), in the treatment of digitalis resistant heart failure, hemiplegia, late corticocerebellar atrophy, olivo ponto cerebellar atrophy, senile dementia, dystrophia musculorum progressiva",,acetylsalicylic acid;adenosine diphosphate;adrenalin;collagen;cyclic AMP;oxagrelate;phosphodiesterase;cerebellum cortex atrophy;drug comparison;heart failure;hemiplegia;ischemic heart disease;senile dementia;therapy;aspirin;eg 626,"Shimamoto, T.;Murase, H.;Yamasaki, H.",1976,,,0,
4047,Mental states of AMI patients in a CCU,"Abnormal mental states of the CCU patients exert some negative influence upon cardiac intensive therapies in a CCU. Therefore, it is quite important for the CCU staff to understand mental states of the patients in order to offer accurate care to them. A research was conducted with the patients suffering from acute myocardial infarction (AMI) regarding their mental states. Of 135 AMI patients admitted to our CCU 105 patients (75 males and 30 females, aged 29 to 84) were studied. Diagnostic procedure of mental states included psychiatric interviews and psychological tests during the patient's fstay in the CCU. Through these examinations, 105 patients with AMI were classified as follows: 37 patients were in anxiety states, 15 in depressive states, 9 in manic states, 9 in demented states, 2 with problematic behavior, 1 in a hypochondriacal state, 1 in a postcardiotomy delirium-like state, 1 in a delirious state (nocturnal delirium), and 30 others in a normal condition. The purposes of this report are to elucidate the mental states of patients with AMI in the CCu and to classify mental states and case-histories of these CCU patients. It is emphasized that psychiatric intervention should be available in order to carry out adequate cardiac treatment for the AMI patients in the CCU.",anxiety;central nervous system;coronary care unit;dementia;depression;heart;heart infarction;major clinical study,"Shimizu, Y.;Kurosawa, H.;Hirose, S.",1981,,,0,
4048,B-type natriuretic peptide is predictive of hospitalization in community-dwelling elderly without heart diseases,"AIM: To examine prospectively the relationship between plasma B-type natriuretic peptide (BNP) levels in community-dwelling elderly and their hospitalization. METHODS: A total number of 644 subjects aged 65 years or older were recruited from the annual community health examinations. Those with a history of stroke or neurological findings were not included. After excluding those with old myocardial infarction, left ventricular dysfunction, moderate or severe valvular disorders, atrial fibrillation, renal insufficiency, and history of hospitalization within 1 year, 602 participants (226 men, 376 women; mean age, 80.3 +/- 6.2 years) remained eligible for this study. Antihypertensive medications, activities of daily living (ADL) score and history of hospitalization were assessed by annual interview. Measurement of casual blood pressure, Mini-Mental State Examination, electrocardiography and echocardiography were performed. Plasma BNP, serum creatinine, total cholesterol, albumin and hemoglobin A1c levels were also examined. A follow-up survey was performed for the occurrence and reasons for hospitalization. RESULTS: During a median follow up of 37 months, 112 subjects were hospitalized. After adjustment for conventional risk factors of hospitalization using the Cox proportional hazard model, each increment of 1 standard deviation in log BNP levels was associated with a 36% increase in the risk of hospitalization (P = 0.02). Plasma BNP levels were significantly higher in the hospitalized subjects due to stroke, heart diseases, dementia, pneumonia and also difficulty to live alone than those of the subjects without hospitalization. CONCLUSION: Plasma BNP level is a very useful biochemical marker predictive of future hospitalization in community-dwelling independent elderly people without apparent heart diseases.","Aged;Aged, 80 and over;Biomarkers/*blood;Female;Follow-Up Studies;Geriatric Assessment;Heart Diseases/blood/*diagnosis;Hospitalization/*statistics & numerical data;Humans;Japan;Male;Natriuretic Peptide, Brain/*blood;Predictive Value of Tests;Prospective Studies;Residence Characteristics","Shimizu, Y.;Nishinaga, M.;Takata, J.;Miyano, I.;Okumiya, K.;Matsubayashi, K.;Ozawa, T.;Yasuda, N.;Doi, Y.",2009,Jun,10.1111/j.1447-0594.2009.00514.x,0,
4049,Aging differentially alters the expression of angiogenic genes in a tissue-dependent manner,"Organ functions are altered and impaired during aging, thereby resulting in increased morbidity of age-related diseases such as Alzheimer's disease, diabetes, and heart failure in the elderly. Angiogenesis plays a crucial role in the maintenance of tissue homeostasis, and aging is known to reduce the angiogenic capacity in many tissues. Here, we report the differential effects of aging on the expression of angiogenic factors in different tissues, representing a potentially causes for age-related metabolic disorders. PCR-array analysis revealed that many of angiogenic genes were down-regulated in the white adipose tissue (WAT) of aged mice, whereas they were largely up-regulated in the skeletal muscle (SM) of aged mice compared to that in young mice. Consistently, blood vessel density was substantially reduced and hypoxia was exacerbated in WAT of aged mice compared to that in young mice. In contrast, blood vessel density in SM of aged mice was well preserved and was not different from that in young mice. Moreover, we identified that endoplasmic reticulum (ER) stress was strongly induced in both WAT and SM during aging in vivo. We also found that ER stress significantly reduced the expression of angiogenic genes in 3T3-L1 adipocytes, whereas it increased their expression in C2C12 myotubes in vitro. These results collectively indicate that aging differentially affects the expression of angiogenic genes in different tissues, and that aging-associated down-regulation of angiogenic genes in WAT, at least in part through ER stress, is potentially involved in the age-related adipose tissue dysfunction.","3T3-L1 Cells;Adipose Tissue, White/*blood supply/*physiology;*Aging;Angiogenesis Inducing Agents/metabolism;Animals;Cell Hypoxia;Cell Line;Endoplasmic Reticulum Stress;*Gene Expression Regulation;Mice;Mice, Inbred C57BL;Muscle, Skeletal/blood supply/physiology;*Neovascularization, Physiologic;Age-related disease;Aging;Angiogenesis;Metabolic disorder;White adipose tissue","Shimoda, Y.;Matsuo, K.;Ono, K.;Soma, Y.;Ueyama, T.;Matoba, S.;Yamada, H.;Ikeda, K.",2014,Apr 18,10.1016/j.bbrc.2014.03.098,0,
4050,The elevation of serum creatine kinase in the course of Parkinson disease. In relation to malignant syndrome,"In the long course of Parkinson disease, we encounter the elevation of serum creatine kinase (CK) occasionally. Such elevation was not necessarily accompanied by severe symptoms as malignant syndrome. To delineate the basis of its situation, we selected the patients showing CK-elevation from 697 cases of Parkinson disease who had entered our hospital and their serum CK level had been measured. The cases with common cause of CK-elevation like trauma or myocardial infarction were excluded in advance. Those patients with CK-elevation were investigated with reference to age, gender, severity, duration of illness, dementia, and psychiatric symptoms retrospectively. High CK level was observed in 95 cases who were composed predominantly of advanced male patients. No obvious anticipatory cause of CK-elevation like a modification of anti-parkinson drug was recognized in 65 cases. On the other hand, CK-elevation caused by the modification of anti-parkinson drug was recognized in 10 cases. CK-elevation was observed in patients with dementia, delirium, and hallucination at higher rate. Most of these patients with CK- elevation did not show high fever and did not necessarily meet the criteria of malignant syndrome. However, 9 cases who showed marked increase of CK level over 10 times of upper limit of normal value contained some cases who had features of malignant syndrome. In Parkinson disease, especially in advanced cases dopamine may be ustably controlled in a few locations of their brain. Some situation of the disease may elicit imbalance of dopamine in patients' brain and induce CK elevation as in the similar condition in which neuroleptics are administrated.",antiparkinson agent;creatine kinase;dopamine;neuroleptic agent;adult;aged;article;clinical article;creatine kinase blood level;delirium;dementia;dopamine release;female;fever;gender;hallucination;human;male;neuroleptic malignant syndrome;Parkinson disease,"Shimoda-Matsubayashi, S.;Yagi, K.;Tanabe, H.",1996,,,0,
4051,Cataract: Window for systemic disorders,"Cataract is the leading cause of visual handicap throughout the world, and almost all elderly individuals develop lens opacities. Epidemiological studies have shown that nuclear cataracts in young adults are associated with higher mortality. Many cataractogenic stressors induce endoplasmic reticulum (ER) stress, which in turn induces the unfolded protein response (UPR). The UPR can damage or kill a wide range of cell types and may be involved in many human diseases. We hypothesize that a cataract can be considered a window that can indicate the presence of systemic disorders. This is important because cataract is easily detected during a routine ocular examination. The slightest opacity in any region of the lenses, especially in younger patients, may be a sign of systemic disorders. Earlier detection of systemic disorders can save the lives of patients. If our hypothesis is correct, then elimination of known ER/cataractogenic stressors from individuals with cataracts should be the one of the first steps for treatments of the systemic disorders. We discuss the potential risk factors and beneficial effects of removal of such risk factors in patients with early cataracts. All patients with cataract should be referred for comprehensive medical examination. © 2007.",alcohol;amino acid;antioxidant;calcium ion;homocysteine;nicotine;riboflavin;selenium;vitamin;alcohol consumption;Alzheimer disease;amino acid deficiency;article;calcium balance;cataract;cataractogenesis;cause of death;cell death;cholesterol metabolism;dehydration;diabetes mellitus;diarrhea;disease association;disease marker;endoplasmic reticulum stress;heart infarction;human;hyperhomocysteinemia;hypertension;hypothesis;mortality;oxidative stress;priority journal;riboflavin deficiency;risk factor;risk reduction;selenium deficiency;smoking;cerebrovascular accident;virus infection;vitamin deficiency,"Shinohara, T.;White, H.;Mulhern, M. L.;Maisel, H.",2007,,,0,
4052,Ultra-sensitive measurement of protein and nucleic acid biomarkers may enable earlier disease detection and more effective therapies,"The pharmaceutical industry is striving to develop effective new therapies for diseases, ranging from cancers to cardiovascular and neurodegenerative disorders to a host of metabolic, infectious and genetic conditions, and is placing emphasis on treatments related to the early detection of disease. The development of new molecular diagnostic methods capable of detecting disease at the molecular level in blood, cerebrospinal fluid, and other body specimens lies at the core of an emerging revolution in disease diagnosis. Using specific and targeted protein and nucleic acid (ie, DNA and RNA) biomarkers, clinicians will be able to detect diseases and confirm diagnoses very early on. Ideally, clinicians might be able to diagnose even before patients present with clinical signs and symptoms - when a disease is most amenable to successful treatment.",activin;amyloid beta protein;biological marker,"Shipp, G.",2007,,,0,
4053,Effect of a Whole-Person Model of Care on Patient Experience in Patients With Complex Chronic Illness in Late Life,"BACKGROUND: Patients with serious chronic illness are at a greater risk of depersonalized, overmedicalized care as they move into later life. Existing intervention research on person-focused care for persons in this transitional period is limited. OBJECTIVE: To test the effects of LifeCourse, a team-based, whole-person intervention emphasizing listening to and knowing patients, on patient experience at 6 months. DESIGN: This is a quasi-experimental study with patients allocated to LifeCourse and comparison groups based on 2 geographic locations. Robust change-score regression models adjusted for baseline differences and confounding. SETTING/PARTICIPANTS: Patients (113 intervention, 99 comparison in analyses) were individuals with heart failure or other serious chronic illness, cancer, or dementia who had visits to hospitals at a large multipractice health system in the United States Midwest. MEASUREMENTS: Primary outcome was 6-month change in patient experience measured via a novel, validated 21-item patient experience tool developed specifically for this intervention. Covariates included demographics, comorbidity score, and primary diagnosis. RESULTS: At 6 months, LifeCourse was associated with a moderate improvement in overall patient experience versus usual care. Individual domain subscales for care team, communication, and patient goals were not individually significant but trended positively in the direction of effect. CONCLUSION: Person-focused, team-based interventions can improve patient experience with care at a stage fraught with overmedicalization and many care needs. Improvement in patient experience in LifeCourse represents the sum effect of small improvements across different domains/aspects of care such as relationships with and work by the care team.",late-life care;patient experience;quasi-experiment;serious chronic illness;team-based care;whole-person care,"Shippee, N. D.;Shippee, T. P.;Mobley, P. D.;Fernstrom, K. M.;Britt, H. R.",2017,Jan 01,,0,
4054,"Role of birthplace in chronic disease in adults and very old individuals: National cohorts in the UK and USA, 2009-2010","Objectives: To understand the role of birthplace in chronic disease in adults and very old individuals. Study design: Two national and population-based studies (UK Longitudinal Household Survey and US National Health and Nutrition Examination Surveys) in 2009-2010 were included. Method: Information on demographics, lifestyle factors and self-reported chronic diseases was obtained by household interview. Analyses included Chi-squared test, t-test and logistic regression modelling. Results: In the UK, there were more cases of heart failure and myocardial infarction in adults (aged 20-79 years) born in Scotland, and more cases of coronary heart disease in adults born in Northern Ireland. There were fewer cases of asthma, depression and hypothyroidism in adults born in Northern Ireland and not born in the UK, and fewer cases of cancer, chronic bronchitis and epilepsy in adults not born in the UK. In USA, there were fewer cases of asthma, cancer, chronic bronchitis, heart failure and heart attack, but more cases of liver disease in adults born in Mexico. Similarly, there were fewer cases of asthma, cancer and chronic bronchitis in adults born in other Spanish or non-Spanish countries, although there were more cases of liver disease in other Spanish-born adults and more cases of diabetes in other non-Spanish-born adults. In very old (≥80 years) individuals, there were more cases of chronic bronchitis in those born in Wales, more cases of myocardial infarction in those born in Northern Ireland, and more cases of diabetes and liver disease in those not born in the UK. Overall, diabetes was more common in foreign-born adults, and respiratory illness and cancer were more common in native-born adults. Conclusions: It is suggested that future health policy and public health programmes should consider birthplace. © 2013 The Royal Society for Public Health.",adult;age distribution;aged;article;asthma;birthplace;chronic bronchitis;chronic disease;cohort analysis;demography;depression;diabetes mellitus;disease association;epilepsy;female;geographic distribution;health care policy;health survey;heart failure;heart infarction;household;human;hypothyroidism;indigenous people;Ireland;ischemic heart disease;lifestyle;liver disease;longitudinal study;major clinical study;male;malignant neoplastic disease;Mexico;population research;public health;respiratory tract disease;self report;United Kingdom;United States,"Shiue, I.",2014,,,0,
4055,"Chronic diseases and life events accounted for 2–18 % population attributable risks for adult hearing loss: UK Adult Psychiatric Morbidity Survey, 2007","Links between chronic diseases and hearing loss in adults have emerged. However, previous investigations were not complete, and the role of life events was unclear. Therefore, it was aimed to examine the relationships of common chronic diseases and life events and adult hearing loss in a country-wide and population-based study. Data were retrieved from UK Adult Psychiatric Morbidity Survey, 2007, being cross-sectional, including demographics, self-reported prior health conditions and hearing loss (ever and in the last 12 months), and several major life events. Analyses included Chi square test, t test, logistic regression model, and population attributable risk estimation. People who had prior health conditions including cancer, migraine, dementia, depression, cataracts, chronic bronchitis, allergy, bowel problem, bladder problem, arthritis, muscle problem or skin problem tended to report hearing loss than their counterparts. People who have experienced major life events including post-traumatic stress disorder, serious illness of close relatives, death of family, serious problems with friends, major financial crisis, valuables stolen, being bullied, violence at home, sexual abuse or running away from home were also more likely to experience ever hearing loss problem or that in the last 12 months. 2.0–13.1 % adult hearing loss could be delayed or prevented by managing chronic diseases while 4.1–18.1 % might be delayed or prevented by minimizing the negative effects of life events. Chronic diseases and life events were associated with hearing loss in adults. Better managing lifestyle to minimize detrimental impacts in future health and nursing programs would be suggested.",adolescent;adult;aged;allergy;angina pectoris;arthritis;article;asthma;attributable risk;bladder disease;cataract;cerebrovascular accident;chi square test;chronic bronchitis;chronic disease;cross-sectional study;death;dementia;demography;depression;diabetes mellitus;enteropathy;epilepsy;female;health survey;hearing impairment;human;infection;life event;lifestyle modification;liver disease;logistic regression analysis;major clinical study;male;middle aged;migraine;muscle disease;neoplasm;population research;posttraumatic stress disorder;priority journal;self report;sexual abuse;skin disease;Student t test,"Shiue, I.",2016,,,0,
4056,"Risks of atrial fibrillation and death at discharge after thrombolysis in stroke patients: Northumbrian Sentinel Stroke Audit, 2013-2015","Background: The aim of this study was to examine risks of atrial fibrillation and death at discharge in stroke patients treated with thrombolysis in a subregional setting covering full calendar years with a clear study catchment drawn serving as a confirmatory statistical analysis from the northeast of England in the last 2 years. Methods: Data between 16 June, 2013 and 15 June, 2015 were extracted from Sentinel Stroke National Audit Programme in Northumbria Healthcare NHS Foundation Trust that has covered health service for Northumberland and North Tyneside. Results: The very old people aged 80 and above were less likely to have thrombolysis treatment, while there was no sex difference observed. Moreover, thrombolysis treatment was more likely to be given in ischemic patients with severe stroke symptoms. There was no difference in comorbidities including atrial fibrillation, congestive heart failure, diabetes, hypertension, and stroke/TIA as well. Those who received thrombolysis treatment were more likely to have atrial fibrillation or die at discharge. The ORs were higher after additionally adjusting for comorbidities. Similarly, these patients also had poorer scoring in modified Rankin scale than those who did not receive thrombolysis treatment. However, there was no difference at 6 months after survival. Conclusion: For future research, clinical outcomes in addition to atrial fibrillation and quality of life both at discharge and 6 months after thrombolysis treatment should be included for examination as well. For clinical practice, giving thrombolysis treatment in hospitals might need to be reconsidered if clinical outcomes were actually worse than not.",aged;atrial fibrillation;blood clot lysis;catchment;cerebrovascular accident;clinical practice;clinical study;comorbidity;congestive heart failure;death;diabetes mellitus;hospital;human;hypertension;quality of life;Rankin scale;sex difference;statistical analysis;stroke patient;symptom;trust;United Kingdom;very elderly,"Shiue, I.",2016,,,0,
4057,Gender and outcome from acute myocardial infarction and secondary stroke,,acute heart infarction;brain ischemia;Canadian;cardiovascular mortality;cardiovascular risk;cerebrovascular accident;comorbidity;coronary artery bypass graft;depression;evidence based practice;follow up;atrial fibrillation;heart ventricle fibrillation;heart ventricle tachycardia;human;letter;observational study;outcome assessment;percutaneous coronary intervention;pharmaceutical care;prognosis;sex difference;social psychology;social support,"Shiue, I.;Hristova, K.",2014,,,0,
4058,Association between inflammatory potential of diet and mortality in the Iowa Women's Health study,"PURPOSE: Chronic diseases such as cancer and cardiovascular disease (CVD) are well-established causes of disability and premature deaths. Dietary components that are known to affect chronic inflammation have been implicated in the etiology and prognosis of these chronic diseases. We examined the ability of the dietary inflammatory index (DII) to predict overall, cancer and CVD mortality in the Iowa Women's Health study. METHODS: The DII was computed from baseline dietary intake assessed in this cohort of 37,525 women, who were aged 55-69 years when enrolled starting in 1986. During the follow-up period, through December 31, 2010, in a total of 17,793 deaths, 5044 cancer- and 6528 CVD-related deaths were identified through mortality record linkage. Cox proportional hazards regression was used to estimate hazard ratios (HR) with DII expressed both as a continuous variable and as quartiles. RESULTS: Comparing subjects in DII Quartile 4 versus Quartile 1, modest positive associations were noted for all-cause mortality (HRQ4vsQ1 1.07; 95 % CI 1.01-1.13; p-trend = 0.006), digestive cancer mortality (HRQ4vsQ1 1.19; 95 % CI 1.00-1.43; p-trend = 0.05), CVD mortality (HRQ4vsQ1 1.09; 95 % CI 1.01-1.18; p-trend = 0.08), non-cancer/non-CVD/non-acute mortality (HRQ4vsQ1 1.09; 95 % CI 1.00-1.19; p-trend = 0.19), coronary heart disease (CHD) mortality (HRQ4vsQ1 1.17; 95 % CI 1.05-1.30; p-trend = 0.001) and chronic obstructive pulmonary disease (COPD) mortality (HRQ4vsQ1 1.43; 95 % CI 1.18-1.75; p-trend = 0.0006). No substantial associations were observed for mortality from stroke, Alzheimer's disease or unspecified dementia. CONCLUSION: These results indicate that a pro-inflammatory diet, as evidenced by higher DII scores, may be associated with total mortality as well as mortality from digestive cancer, CVD, CHD and COPD.",Cohort;Diet;Inflammation;Mortality;Women,"Shivappa, N.;Blair, C. K.;Prizment, A. E.;Jacobs, D. R., Jr.;Steck, S. E.;Hebert, J. R.",2016,Jun,10.1007/s00394-015-0967-1,0,
4059,Post-stroke vascular dementia: risk factors and clinical neuro-imaging features,"To analyze the status of risk factors for post-stroke vascular dementia, 128 patients with post-stroke dementia, aged from 50-79 years, have been studied. A control group included 125 patients, aged 50-79 years, with moderate cognitive impairment after stroke. A coronary heart disease was a significant risk factor for the patients aged from 50-59; coronary heart disease, diabetes mellitus, overweight and hyperlipidemia were significant risk factors for the aged 60-69, diabetes mellitus, overweight and hyperlipidemia were significant risk factors for the aged 70-79. The stroke-related factors were cerebral infarction in left hemisphere, frontal and temporo-occipital infarction, thalamic, basal ganglion; cerebral white-matter lesions. The mathematical model of post-stroke dementia prediction was created for patients with post-stroke moderate cognitive impairment.","Aged;Brain/*pathology;Case-Control Studies;Data Interpretation, Statistical;Dementia, Vascular/*etiology/*pathology;Female;Humans;Magnetic Resonance Imaging;Male;Middle Aged;Models, Neurological;Neuropsychological Tests;Prognosis;Risk Factors;Severity of Illness Index;Stroke/*complications/*pathology","Shprakh, V. V.;Suvorova, I. A.",2010,,,0,
4060,Risk factors and prediction of poststroke dementia,"To study the status of risk factors for poststroke dementia, 128 patients, aged 50-79 years, with poststroke dementia have been examined. A control group included 125 patients with moderate cognitive impairment after stroke. Coronary heart disease was a significant factor at the age from 50 to 59; coronary heart disease, diabetes mellitus, overweight and hyperlipidemia were significant risk factors at the age from 60 to 69 and diabetes mellitus, overweight and hyperlipidemia were significant risk factors at the age from 70 to 79. The neuroimaging study revealed that the development of dementia in patients with moderate cognitive impairment was related to the localization of focal poststroke changes in the left hemisphere, frontal and temporal-occipital areas, frontal white matter, thalamus, basal ganglia as well as to the prevalence and severity of subcortical leukoareosis in the frontal areas, basal ganglia and thalamus. An individual prediction model for poststroke dementia in patients with moderate cognitive impairment has been worked out.","Aged;Brain/pathology;Cognition Disorders/*epidemiology/*etiology/pathology;Dementia, Vascular/*epidemiology/*etiology/pathology;Diabetes Mellitus/epidemiology;Female;Humans;Hyperlipidemias/epidemiology;Male;Middle Aged;Myocardial Ischemia/epidemiology;Overweight/epidemiology;Prognosis;Risk Factors;Stroke/*complications/*epidemiology/pathology","Shprakh, V. V.;Suvorova, I. A.",2010,,,0,
4061,Standards of medical care in diabetes—2017 abridged for primary care providers,,acetylsalicylic acid;antithrombocytic agent;clopidogrel;antidiabetic activity;anxiety disorder;article;autoimmune disease;behavior therapy;blood pressure regulation;cancer risk;cognitive defect;dementia;depression;diabetes mellitus;diabetic nephropathy;diet;diet therapy;dual antiplatelet therapy;exercise;fatty liver;feeding behavior;foot care;glycemic control;health care delivery;health care personnel;health care practice;hearing impairment;hip fracture;human;hypertension;hypoglycemia;ischemic heart disease;lifestyle;malignant neoplasm;microangiopathy;neuropathy;non insulin dependent diabetes mellitus;nursing home;obesity;periodontal disease;pregnancy;primary medical care;retinopathy;sleep disordered breathing;smoking cessation,"Shubrook, J.;Butts, A.;Chamberlain, J. J.;Johnson, E. L.;Leal, S.;Rhinehart, A. S.;Skolnik, N.;Bradley, S.;Jaffa, F. M.;Herman, W. H.;Kalyani, R. R.;Cherrington, A. L.;Coustan, D. R.;De Boer, I.;James, R.;Feldman, H.;Florez, H. J.;Koliwad, S.;Maryniuk, M.;Neumiller, J. J.;Wolfsdorf, J.;Berg, E. G.;McAuliffe-Fogarty, A. H.;Ratner, R.",2017,,10.2337/cd16-0067,0,
4062,"ISMP adverse drug reactions: Clarithromycin helps patient with dementia; eosinophilic fasciitis and dermatomyositis with ""statins"" arrhythmia caused by caffeine in health foods; CHF and itraconazole",,amiodarone;atorvastatin;caffeine;clarithromycin;guarana;hydroxymethylglutaryl coenzyme A reductase inhibitor;itraconazole;race 2005 energy blast with guarana and ginseng;simvastatin;unclassified drug;adult;aged;congestive heart failure;dementia;dermatomyositis;drug effect;drug response;eosinophilic fasciitis;female;ginseng;health food;heart arrhythmia;herb;human;male;neutropenia;short survey;biaxin;lipitor;sporanox;zocor,"Shuster, J.",2001,,,0,
4063,ISMP adverse drug reactions: Unrecognized neuroleptic malignant syndrome caused by risperidone; cerebral hemorrhage due to ginkgo biloba? Abnormal movements due to donepezil? Febrile pancytopenia associated with clopidogrel colon perforation due to clozapine; steroid psychosis after intra-articular administration,,acetylsalicylic acid;alendronic acid;amantadine;amlodipine;C reactive protein;cephalosporin;cholinesterase inhibitor;clopidogrel;clozapine;cotrimoxazole;digoxin;donepezil;Ginkgo biloba extract;methylprednisolone;neuroleptic agent;omeprazole;risperidone;selegiline;steroid;unindexed drug;ziprasidone;acute kidney failure;adrenal insufficiency;Alzheimer disease;amnesia;brain hematoma;brain hemorrhage;colon perforation;delirium;dementia;heart failure;human;mental health;motor dysfunction;neuroleptic malignant syndrome;pancytopenia;Parkinson disease;psychosis;restless legs syndrome;short survey;urinary tract infection;aricept;geodon;plavix,"Shuster, J.",2001,,,0,
4064,"Heart failure with sunitinib: Prolonged QT interval, syncope, and delirium with galantamine - Memantine-induced hepatitis. Cabergoline-associated erythema nodosum: ""Sleep driving"" and the use of nonbenzodiazepine hypnotics - Atypical fractures in postmenopausal women taking alendronate. Drug-related problems in patients with human immunodeficiency virus",,alendronic acid;alprazolam;cabergoline;digoxin;donepezil;galantamine;haloperidol;hypnotic agent;lisinopril;memantine;promazine;sunitinib;tiapride;unclassified drug;zaleplon;zolpidem tartrate;amnesia;ankle edema;ankle pain;car driving;cholestatic hepatitis;delirium;dementia;drug dose increase;drug withdrawal;erythema nodosum;fracture;heart failure;human;Human immunodeficiency virus infected patient;hyperprolactinemia;hypotension;iatrogenic disease;jaundice;kidney carcinoma;metastasis;nausea;postmenopause,"Shuster, J.",2008,,,0,
4065,ISMP Adverse Drug Reactions - Agranulocytosis Induced by Proton Pump Inhibitors; Two Cases of Fatal Antimalarial-Induced Cardiomyopathy; Oxaliplatin-Induced Thrombotic Thrombocytopenic Purpura; Unique Skin Eruption Caused by Telaprevir; Acute-Onset Opioid-Induced Hyperalgesia in a Child; Risk of Sharing a Pill Cutter; Dementia and Risk of Adverse Warfarin-Related Events in Nursing Homes,,bevacizumab;celecoxib;chloroquine;cytochrome P450 2C19;esomeprazole;etanercept;fluorouracil;folinic acid;hydrocortisone;hydromorphone;hydroxychloroquine;iron dextran;iron saccharate;ketorolac;lorazepam;meropenem;methotrexate;morphine;naproxen;omeprazole;oxaliplatin;peginterferon alpha2a plus ribavirin;prednisone;ranitidine;sorafenib;teicoplanin;telaprevir;tobramycin;warfarin;add on therapy;adrenal insufficiency;adverse drug reaction;agitation;agranulocytosis;antibiotic therapy;arthralgia;article;awareness;cardiogenic shock;cardiomyopathy;childhood disease;comparative study;congestive cardiomyopathy;cryotherapy;cystic fibrosis;dementia;discoid lupus erythematosus;drug formulation;drug induced disease;drug withdrawal;echocardiography;electromyography;eosinophil count;hepatitis C;hip pain;home;home care;human;hyperalgesia;ileostomy;implantable cardioverter defibrillator;international normalized ratio;joint sw;juvenile rheumatoid arthritis;leukocyte count;liver metastasis;lung metastasis;multiple cycle treatment;neutrophil count;patient controlled analgesia;pityriasis rubra pilaris;plasmapheresis;rash;rectum carcinoma;respiratory tract infection;septic shock;skin biopsy;thorax pain;thrombotic thrombocytopenic purpura;treatment duration;incivek;infed;nexium;venofer,"Shuster, J.",2013,,,0,
4066,Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia,"Background and objective Current guidelines recommend empirical treatment against Pseudomonas aeruginosa in community-acquired pneumonia (CAP) patients with specific risk factors. However, evidence to support these recommendations is limited. We evaluate the risk factors and the impact of antimicrobial therapy in patients hospitalized with CAP due to P. aeruginosa. Methods We performed a retrospective population-based study of >150 hospitals. Patients were included if they had a diagnosis of CAP and P. aeruginosa was identified as the causative pathogen. Univariate and multivariate analyses were performed using the presence of risk factors and 30-day mortality as the dependent measures. Results Seven hundred eighty-one patients with P. aeruginosa pneumonia were identified in a cohort of 62 689 patients with pneumonia (1.1%). Of these, 402 patients (0.6%) were included in the study and 379 (0.5%) were excluded due to health care-associated pneumonia or immunosuppression. In patients with CAP due to P. aeruginosa, 272 (67.8%) had no documented risk factors. These patients had higher rates of dementia and cerebrovascular disease. Empirical antibiotic therapy against P. aeruginosa within the first 48 h of presentation was independently associated with lower 30-day mortality in patients with CAP due to P. aeruginosa (hazard ratio (HR) 0.42, 95% confidence interval (CI): 0.23-0.76) and in patients without risk factors for P. aeruginosa CAP (HR 0.40, 95% CI: 0.21-0.76). Conclusions Risk factor recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Risk factors did not define the whole benefit observed due to empirical therapy covering P. aeruginosa. Risk factors recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Not administrating antibiotics active against P. aeruginosa in the first 48 h increases 30-day mortality.",amikacin;antibiotic agent;aztreonam;cefepime;ceftazidime;ciprofloxacin;gentamicin;hypertensive factor;imipenem;levofloxacin;meropenem;piperacillin;tobramycin;aged;antibiotic therapy;article;artificial ventilation;cerebrovascular disease;Charlson Comorbidity Index;chronic obstructive lung disease;cohort analysis;community acquired pneumonia;controlled study;dementia;diabetes mellitus;disease duration;female;heart failure;heart infarction;human;ICD-9-CM;length of stay;major clinical study;male;metastasis;mortality;peripheral vascular disease;practice guideline;priority journal;Pseudomonas aeruginosa;retrospective study;risk factor;treatment duration,"Sibila, O.;Laserna, E.;Maselli, D. J.;Fernandez, J. F.;Mortensen, E. M.;Anzueto, A.;Waterer, G.;Restrepo, M. I.",2015,,,0,
4067,Consumption of oral analgesics and dosage forms in elderly patients: Population based study,"The objective of the study was to describe the consumption of oral analgesics (OA) in people aged ≥ 65 years, and distinguish between easy-to-swallow (ETS) formulations and solid forms. Real data study with a cross sectional design. Electronic anonymous medical records of one year of primary care activity (July 2007-June 2008) were retrospectively reviewed. Inclusion criteria: patients aged ≥ 65 years receiving OA. Subgroups: institutionalized/non institutionalized. It was considered the oral analgesics use as a principal variable. Study variables: socio-demographic, pharmaceutical formulations (solid and ETS), co morbidities, type of analgesics, geriatric scales (Minimental, Barthel) and poly-medication. Multiple logistic regression analysis models were applied. Program SPSSWIN, statistical signification p < 0.05. Overall 78 % patients regularly consumed OA. 11,344 patients were studied; mean age 75.1 ± 7 years; female 61.5 %. Two percent of patients were institutionalized and were older (OR = 1.2), predominantly female (OR = 1.3), had more co morbidity (OR = 3.5; p < 0.001) and lower geriatric scale scores. OA were 13.8 % of total drug consumption (CI 95 %, 13.2-14.4 %); NSAIDs 69.5 % and opioids 17.6 %. Poly-medication 90.6 % (96 % institutionalized vs. 90.5 % non institutionalized; p = 0.019). 31.1 % of patients used ETS whose use was associated with stroke (OR = 2.7), neuropathy (OR = 2.4; p < 0.001) and urinary incontinence. Institutionalized patients consumption of paracetamol, tramadol and aceclofenac was higher (54.3 %, 19 % and 7.6 %, respectively). The use of OA was high, particularly in institutionalized patients. NSAIDs use was higher than expected compared to opioids that were lower than expected. The use of ETS analgesics was lower than expected given the reduced swallowing capacity of elderly patients. © 2009 Sociedad Española de Farmacia Hospitalaria.",aceclofenac;acetylsalicylic acid;analgesic agent;celecoxib;codeine;diclofenac;dihydrocodeine;dipyrone;fentanyl;gabapentin;ibuprofen;methadone;morphine;naproxen;nonsteroid antiinflammatory agent;opiate;paracetamol;pethidine;piroxicam;pregabalin;salicylic acid derivative;tramadol;age distribution;aged;alcoholism;article;asthma;Barthel index;cerebrovascular accident;comorbidity;controlled study;cross-sectional study;dementia;demography;depression;diabetes mellitus;drug dosage form;drug use;dyslipidemia;dysphagia;electronic medical record;female;fibromyalgia;fracture;gastroesophageal reflux;human;hypertension;ischemic heart disease;major clinical study;male;malignant neoplastic disease;medical record review;Mini Mental State Examination;multivariate logistic regression analysis;neuropathy;obesity;osteoporosis;peptic ulcer;polypharmacy;population research;primary medical care;retrospective study;sex difference;swallowing;urine incontinence,"Sicras-Mainar, A.;De Cambra-Florensa, S.;Navarro-Artieda, R.",2009,,,0,
4068,Impact of Loss of Work Productivity in Patients with Overactive Bladder Treated with Antimuscarinics in Spain: Study in Routine Clinical Practice Conditions,"Background: Overactive bladder (OAB) is a syndrome characterized by presenting symptoms of urgency, with or without urge incontinence, and normally accompanied by day and night frequency. Objective: The aim of this study was to evaluate the impact of lost work productivity [number of days of sick leave] in patients treated with fesoterodine versus tolterodine and solifenacin to treat OAB in Spain. Methods: A retrospective, observational study was carried out using the records (digital databases) of actively working patients (2008–2013). The study population comprised of patients from two autonomous communities; 31 primary care centres agreed to participate. Patients who began first treatment with antimuscarinics (fesoterodine, solifenacin or tolterodine) and who met certain inclusion/exclusion criteria were included in the study. Follow-up lasted for 1 year. The main outcome measures were comorbidity, medication possession ratio (MPR), treatment persistence, and number of days of sick leave and associated costs. Indirect costs were considered to be those related to lost work productivity (number of days of sick leave, exclusively), (1) due to OAB and (2) overall total. The cost was expressed as the average cost per patient (cost/unit). Multivariate analyses (Cox, ANCOVA) were used to correct the models. Results: A total of 3094 patients were recruited into the study; 43.0 % were treated with solifenacin, 29.2 % with tolterodine, and 27.8 % with fesoterodine. The average age of patients was 54 years (standard deviation 9.2), and 62.2 % were women. The comparison of fesoterodine versus solifenacin and tolterodine showed a higher MPR (90.0 vs. 87.0 and 86.1 %, respectively), higher treatment persistence (40.2 vs. 34.7 and 33.6 %), lower use of sick leave (22.8 vs. 52.9 and 36.7 %), total number of days of sick leave (5.1 vs. 9.7 and 9.3 days) and costs corrected for covariates (€371 vs. €703 and €683); p < 0.05. Conclusions: Despite the possible limitations of this study, active patients who began treatment with fesoterodine to treat OAB (compared with solifenacin or tolterodine) had fewer days of sick leave, resulting in lower costs due to lost productivity.",antibiotic agent;antiinfective agent;dermatological agent;fesoterodine;solifenacin;tolterodine;adult;article;asthma;cerebrovascular accident;chronic obstructive lung disease;cost of illness;dementia;depression;diabetes mellitus;dyslipidemia;female;follow up;human;hypertension;ischemic cardiomyopathy;longitudinal study;major clinical study;male;malignant neoplastic disease;medical leave;middle aged;multicenter study;observational study;outcome assessment;overactive bladder;patient compliance;phase 4 clinical trial;priority journal;productivity;retrospective study;urine incontinence,"Sicras-Mainar, A.;Navarro-Artieda, R.;Ruiz-Torrejón, A.;Sáez-Zafra, M.;Coll-de Tuero, G.",2015,,,0,
4069,Effect of smoking status on healthcare costs and resource utilization in patients with type 2 diabetes in routine clinical practice: A retrospective nested case-control economic study,"Aim: To compare healthcare resource utilization and costs according to smoking status in patients with type 2 diabetes in clinical practice. Methods: A retrospective cohort nested case-control study was designed. Cases were current smokers, while 2 types of controls (former smokers and never smokers) were matched (2 controls per case) for age, sex, duration of diabetes and burden of comorbidity using data from medical records. Noninstitutionalized diabetics of both genders, aged >18 years and seen consecutively over a 5-year period before the index date, were enrolled. Analysis compared healthcare resource utilization, loss of productivity due to sick leave and corresponding costs. Results: In total, 2,490 medical records were analyzed, i.e. 498 cases, 996 former smokers and 996 never smokers. Mean age was 63.4 years (64.9% male). Smokers had higher glycosylated hemoglobin levels (7.4 vs. 7.2 and 7.2%, respectively; p = 0.013) and a lower degree of metabolic control (49.2 vs. 54.7 and 55.8%; p = 0.036). Smokers had higher average annual costs (EUR 3,583) than former smokers (EUR 2,885; p < 0.001) and never smokers (EUR 2,183; p < 0.001). Conclusions: Diabetic smoker patients had lower metabolic control, higher health resource utilization and more sick leave, resulting in higher healthcare costs and lost productivity compared with both former and never smoker diabetics. © 2013 S. Karger AG, Basel.",acarbose;exendin 4;glibenclamide;gliclazide;glimepiride;glimepiride plus rosiglitazone;glipentide;glipizide;hemoglobin A1c;human insulin;insulin aspart;insulin detemir;insulin glargine;insulin glulisine;insulin lispro;metformin;metformin plus pioglitazone;metformin plus sitagliptin;metformin plus vildagliptin;miglitol;pioglitazone;repaglinide;sitagliptin;vildagliptin;adult;aged;alcoholism;ambulatory care;article;asthma;cardiovascular disease;case control study;chronic obstructive lung disease;clinical practice;cohort analysis;comorbidity;controlled study;dementia;depression;diabetic nephropathy;diabetic neuropathy;diabetic patient;diabetic retinopathy;disease duration;dyslipidemia;female;health care cost;health care utilization;hemoglobin blood level;hospitalization;human;hypertension;ischemic heart disease;laboratory test;major clinical study;male;malignant neoplastic disease;medical leave;medical record review;metabolic regulation;microalbuminuria;middle aged;neuropathy;non insulin dependent diabetes mellitus;obesity;primary medical care;priority journal;productivity;radiology;retrospective study;smoking;Spain,"Sicras-Mainar, A.;Rejas-Gutiérrez, J.;Navarro-Artieda, R.;Ibánez-Nolla, J.",2014,,,0,
4070,Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity,"To analyze the effect of loss of exclusivity of data on the cost of treatment of peripheral neuropathic pain (PNP) with pregabalin or gabapentin in routine clinical practice. A retrospective observational study, with electronic medical records for patients enrolled at primary care centers managed by the health care provider Badalona Serveis Assistencials, who initiated treatment of PNP with pregabalin or gabapentin. The analysis used drugs and resources prices for year 2015. The 1163 electronic medical records (pregabalin; N = 764, gabapentin; N = 399) for patients (62.2% women) with a mean (standard deviation) age of 59.2 (14.7) years were analyzed. Treatment duration was slightly shorter with pregabalin than with gabapentin (5.2 vs 5.5 months; P = 0.124), with mean doses of 227.4 (178.6) mg and 900.0 (443.4) mg, respectively. The average study drug cost per patient was higher for pregabalin than for gabapentin; €214.6 (206.3) vs €157.4 (181.9), P < 0.001, although the cost of concomitant analgesic medication was lower; €176.5 (271.8) vs €306.7 (529.2), P < 0.001. The adjusted average total cost per patient was lower in those treated with pregabalin than in those treated with gabapentin; €2,413 (2119-2708) vs €3201 (2806–3.597); P = 0.002, owing to significantly lower health care costs; €1307 (1247-1367) vs €1538 (1458-1618), P < 0.001, and also non-health care costs; €1106 (819-1393) vs €1663 (1279-2048), P = 0.023, that was caused by a significantly lower use of concomitant medication, fewer medical visits to primary care, and fewer days of sick leave. After loss of exclusivity of both drugs, pregabalin continued to show lower health care and non-health care costs than gabapentin in the treatment of PNP in routine clinical practice.",gabapentin;pregabalin;adult;aged;alcoholism;analysis of covariance;article;asthma;cerebrovascular accident;Charlson Comorbidity Index;chronic obstructive lung disease;clinical practice;comorbidity;controlled study;dementia;demyelinating polyneuropathy;depression;diabetic neuropathy;dyslipidemia;electronic medical record;epilepsy;female;health care cost;health care planning;hospitalization;human;hypertension;ischemic cardiomyopathy;major clinical study;male;malignant neoplasm;meralgia paresthetica;middle aged;multiple sclerosis;neuralgia;neuropathic pain;non insulin dependent diabetes mellitus;obesity;observational study;Parkinson disease;peripheral neuropathic pain;primary medical care;radiculopathy;retrospective study;sensory polyneuropathy;smoking;smoking habit;treatment duration;young adult,"Sicras-Mainar, A.;Rejas-Gutiérrez, J.;Pérez-Páramo, M.;Navarro-Artieda, R.",2017,,10.1111/jep.12634,0,
4071,HDL and glucose metabolism: Current evidence and therapeutic potential,"High-density lipoprotein (HDL) and its principal apolipoprotein A-I (ApoA-I) have now been convincingly shown to influence glucose metabolism through multiple mechanisms. The key clinically relevant observations are that both acute HDL elevation via short-term reconstituted HDL (rHDL) infusion and chronically raising HDL via a cholesteryl ester transfer protein (CETP) inhibitor reduce blood glucose in individuals with type 2 diabetes mellitus (T2DM). HDL may mediate effects on glucose metabolism through actions in multiple organs (e.g., pancreas, skeletal muscle, heart, adipose, liver, brain) by three distinct mechanisms: (i) Insulin secretion from pancreatic beta cells, (ii) Insulin-independent glucose uptake, (iii) Insulin sensitivity. The molecular mechanisms appear to involve both direct HDL signaling actions as well as effects secondary to lipid removal from cells. The implications of glucoregulatory mechanisms linked to HDL extend from glycemic control to potential anti-ischemic actions via increased tissue glucose uptake and utilization. Such effects not only have implications for the prevention and management of diabetes, but also for ischemic vascular diseases including angina pectoris, intermittent claudication, cerebral ischemia and even some forms of dementia. This review will discuss the growing evidence for a role of HDL in glucose metabolism and outline related potential for HDL therapies.",ABC transporter A1;ABC transporter G1;apolipoprotein A1;apolipoprotein E;calcium calmodulin dependent protein kinase kinase;cholesterol ester transfer protein inhibitor;glucose;glucose transporter 4;high density lipoprotein;hydroxymethylglutaryl coenzyme A reductase kinase;recombinant high density lipoprotein;recombinant protein;unclassified drug;acute coronary syndrome;Alzheimer disease;apoptosis;blood brain barrier;brain blood flow;cerebrovascular disease;coronary artery bypass graft;disease association;drug effect;endoplasmic reticulum stress;glucose blood level;glucose homeostasis;glucose metabolism;glucose oxidation;glucose transport;glucose utilization;glycemic control;heart protection;insulin release;insulin sensitivity;ischemic heart disease;lipid storage;metabolic regulation;mild cognitive impairment;neuroprotection;non insulin dependent diabetes mellitus;pancreas islet beta cell;protein function;short survey;skeletal muscle,"Siebel, A. L.;Heywood, S. E.;Kingwell, B. A.",2015,,,0,
4072,Absent MicroRNAs in Different Tissues of Patients with Acquired Cardiomyopathy,"MicroRNAs (miRNAs) can be found in a wide range of tissues and body fluids, and their specific signatures can be used to determine diseases or predict clinical courses. The miRNA profiles in biological samples (tissue, serum, peripheral blood mononuclear cells or other body fluids) differ significantly even in the same patient and therefore have their own specificity for the presented condition. Complex profiles of deregulated miRNAs are of high interest, whereas the importance of non-expressed miRNAs was ignored. Since miRNAs regulate gene expression rather negatively, absent miRNAs could indicate genes with unaltered expression that therefore are normally expressed in specific compartments or under specific disease situations. For the first time, non-detectable miRNAs in different tissues and body fluids from patients with different diseases (cardiomyopathies, Alzheimer's disease, bladder cancer, and ocular cancer) were analyzed and compared in this study. miRNA expression data were generated by microarray or TaqMan PCR-based platforms. Lists of absent miRNAs of primarily cardiac patients (myocardium, blood cells, and serum) were clustered and analyzed for potentially involved pathways using two prediction platforms, i.e., miRNA enrichment analysis and annotation tool (miEAA) and DIANA miRPath. Extensive search in biomedical publication databases for the relevance of non-expressed miRNAs in predicted pathways revealed no evidence for their involvement in heart-related pathways as indicated by software tools, confirming proposed approach.",Absent miRNAs;Cardiomyopathy;Heart muscle biopsy;Peripheral blood mononuclear cell;Serum,"Siegismund, C. S.;Rohde, M.;Kuhl, U.;Escher, F.;Schultheiss, H. P.;Lassner, D.",2016,Aug,10.1016/j.gpb.2016.04.005,0,
4073,"Commentary on ""A roadmap for the prevention of dementia: The inaugural Leon Thal Symposium""",,acetylsalicylic acid;amyloid beta protein;amyloid beta protein antibody;beta secretase inhibitor;clopidogrel;gamma secretase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;hypocholesterolemic agent;nootropic agent;rofecoxib;rosiglitazone;Alzheimer disease;article;clinical research;cognitive defect;coronary artery disease;cost control;dementia;disease course;disease severity;drug efficacy;drug research;drug safety;drug targeting;health care cost;heart infarction;high risk population;human;hypothesis;nerve degeneration;pathophysiology;positron emission tomography;primary prevention;priority journal;senile plaque;symposium;aspirin;avandia;vioxx,"Siemers, E. R.;Paul, S. M.",2008,,,0,
4074,Phase 3 solanezumab trials: Secondary outcomes in mild Alzheimer's disease patients,"Introduction EXPEDITION and EXPEDITION2 were identically designed placebo-controlled phase 3 studies assessing effects of solanezumab, an antiamyloid monoclonal antibody binding soluble amyloid-β peptide, on cognitive and functional decline over 80 weeks in patients with mild-to-moderate Alzheimer's disease (AD). Primary findings for both studies have been published. Methods Secondary analyses of efficacy, biomarker, and safety endpoints in the pooled (EXPEDTION + EXPEDITION2) mild AD population were performed. Results In the mild AD population, less cognitive and functional decline was observed with solanezumab (n = 659) versus placebo (n = 663), measured by Alzheimer's Disease Assessment Scale Cognitive subscale, Mini-Mental State Examination, and Alzheimer's Disease Cooperative Study-Activities of Daily Living functional scale Instrumental ADLs. Baseline-to-endpoint changes did not differ between treatment groups for Alzheimer's Disease Cooperative Study-Activities of Daily Living functional scale, basic items of the ADCS-ADL, and Clinical Dementia Rating Sum of Boxes. Plasma/cerebrospinal fluid biomarker findings indicated target engagement by solanezumab. Solanezumab demonstrated acceptable safety. Efficacy findings for the moderate AD population are also provided. Discussion These findings describe solanezumab effects on efficacy/safety measures in a mild AD population. Another phase 3 study, EXPEDITION3, will investigate solanezumab's effects in a mild AD population.",solanezumab;acute heart infarction;adult;aged;Alzheimer disease;Alzheimer Disease Assessment Scale;article;B cell lymphoma;brain hemorrhage;cardiogenic shock;cerebrospinal fluid;Clinical Dementia Rating;controlled study;drug efficacy;drug eruption;drug safety;drug withdrawal;emphysema;female;heart arrest;heart arrhythmia;heart failure;heart muscle ischemia;human;lower respiratory tract infection;major clinical study;male;Mini Mental State Examination;noncardiac chest pain;phase 3 clinical trial;pneumonia;priority journal;randomized controlled trial;respiratory failure;septic shock,"Siemers, E. R.;Sundell, K. L.;Carlson, C.;Case, M.;Sethuraman, G.;Liu-Seifert, H.;Dowsett, S. A.;Pontecorvo, M. J.;Dean, R. A.;DeMattos, R.",2016,,,0,
4075,"Early brain damage in essential hypertension: ""to have and have not""--is it important?",,"Blood Pressure;Brain/blood supply;Brain Ischemia/etiology/physiopathology;Cerebrovascular Circulation;Dementia, Vascular/*etiology/physiopathology;Humans;Hypertension/*complications/physiopathology;Hypertrophy, Left Ventricular/complications/etiology/physiopathology;Stroke/*etiology/physiopathology;Time Factors","Sierra, C.",2006,Aug,,0,
4076,"Health care consequences of demographic changes in Mecklenburg-West Pomerania: projected case numbers for age-related diseases up to the year 2020, based on the Study of Health in Pomerania (SHIP)","BACKGROUND: The population in the German federal state of Mecklenburg-West Pomerania is growing older. A resulting rise in age-related diseases will likely lead to a greater need for medical care, even though the population as a whole is declining. The predicted number of patients affected by these diseases varies from one district to another because of local differences in demographic trends. METHODS: Case numbers were forecasted on the basis of representative data on the morbidity from chronic diseases, which were derived from the Study of Health in Pomerania (SHIP), the conjoint cancer registry of the East German federal states (GKR), and a study on dementia morbidity. These data were combined with demographic prognoses for Mecklenburg-West Pomerania and its rural and urban districts up to the year 2020. RESULTS: The largest increases in case numbers are predicted for dementia (+91.1%), myocardial infarction (+28.3%), diabetes mellitus (+21.4%), and incident colon carcinoma (+31.0%; all figures are expressed in relation to the year 2005 as a baseline). The predicted changes in case numbers vary widely from one district to another. CONCLUSION: All of the German federal states located in the former East Germany are likely to experience similar developments to those predicted for Mecklenburg-West Pomerania, as will many rural areas of the former West Germany, in which a demographic transition is already evident. Because of the predicted rise in the number of patients, new health care concepts will have to be rapidly developed, implemented, and evaluated in order to ensure that comprehensive medical care will be delivered where it is needed.","Adult;Age Distribution;Aged;Aged, 80 and over;Comorbidity;Dementia/*epidemiology;Diabetes Mellitus/*epidemiology;Female;Germany/epidemiology;Humans;Incidence;Male;Middle Aged;Myocardial Infarction/*epidemiology;Neoplasms/*epidemiology;Registries/*statistics & numerical data;Risk Assessment;Sex Distribution","Siewert, U.;Fendrich, K.;Doblhammer-Reiter, G.;Scholz, R. D.;Schuff-Werner, P.;Hoffmann, W.",2010,May,10.3238/arztebl.2010.0328,0,
4077,Clinical impact of methodological issues in the diagnosis of deficiencies and abnormalities of essential fats,"The essential fats (EFs) ω3 and ω6 are two families of polyunsaturated fatty acids (PUFAs) consisting of the essential fatty acids (EFAs) and their derivatives. The EFAs linoleic acid (ω6) and alpha-linolenic acid (ω3) have long been known to be essential nutrients. EFs are essential for membrane-based reactions, transport mechanisms, and receptor-mediated functions. Research points to EF abnormalities as primary nutritional factors in cardiovascular disease, old age dementia, behavioral problems and low IQ in children, and a wide range of other disorders. Diagnosis of EFA abnormalities improved dramatically with the use of high resolution capillary gas liquid chromatography in the 1980s. Initially, only the most severe cases of EFA deficiency (EFAD) could be diagnosed - equivalent to only detecting cholesterol over 2,000 mg/dL. A commonly used measure of EFAD is the ratio 20:3 ω9/20:4 ω6 - the ratio of the concentrations of triene (Mead acid, 20:3 ω9) to tetraene (Arachidonic acid, 20:4 ω6) (T/T). A ratio of T/T greater than 0.4 was considered a marker of EFAD until the 1980s, when it as reduced to 0.2. This cutoff was still only suitable for detecting severe EFAD found in a few rare patients with severe fat malabsorption or on diets severely restricted in EFAs. Today's upper normal limit of T/T is ~ 0.025. This 10x increase in sensitivity helps identify EFAD in patients with cardiovascular disease, immune disorders, gastrointestinal disease, and other conditions characterized by abnormal EFA metabolism. The same methodology allows us to test which forms of EFA food supplements are best to prevent or correct EFA abnormalities. We can test the effects of new foods or oils on essential fat metabolism by measuring small changes they produce in markers like 20:3 ω9. More than 25% of adults are deficient in essential fats. Over 90% of patients with chronic intestinal malabsorption, and more than 50% of patients with coronary artery disease (CAD) or at high risk for heart disease as indicated by elevated total/HDL cholesterol ratios (TC/HDLC), have biochemical evidence of EFAD. Fatty acid profiles are complex assays because they measure over 50 interacting variables. Understanding the methodologies, flaws, and pitfalls involved in their measurement and in deciphering test results is critical to effective clinical applications. EF abnormalities which cannot be diagnosed on clinical examination or by other tests need to be treated by identifying their nature through proper analysis. Fatty acid analysis identifies both the problem and the optimal treatment to correct it.",arachidonic acid;cholesterol;essential fatty acid;high density lipoprotein cholesterol;linoleic acid;linolenic acid;omega 3 fatty acid;omega 6 fatty acid;polyunsaturated fatty acid;article;behavior disorder;cardiovascular disease;cholesterol blood level;coronary artery disease;coronary risk;dementia;diet supplementation;essential fatty acid deficiency;heart disease;human;hypercholesterolemia;intellectual impairment;lipoprotein blood level;liquid chromatography;malabsorption;nutrient,"Siguel, E.",2000,,,0,
4078,Clinical magnetic resonance spectroscopy,,"2,3 diphosphoglyceric acid;adenosine triphosphate;alanine;choline;creatine;creatine kinase;creatine phosphate;fluorouracil;fructose;glycerophosphoethanolamine;glycerophosphorylcholine;n acetylaspartic acid;phosphate;phosphoethanolamine;phospholipid;phosphorylcholine;silicon;tumor necrosis factor alpha;water;Alzheimer disease;brain infarction;brain metabolism;brain metastasis;brain tumor;breast endoprosthesis;neoplasm;cancer chemotherapy;cancer radiotherapy;carbon nuclear magnetic resonance;cardiovascular disease;cerebrovascular disease;clinical practice;energy metabolism;epilepsy;exercise tolerance;follow up;glycogen storage disease;glycogen storage disease type 5;heart failure;heart muscle ischemia;heart muscle metabolism;heart transplantation;human;hyperthermic therapy;limb tumor;liver disease;liver function test;liver metabolism;migraine;mitochondrial myopathy;multiple sclerosis;muscle fatigue;newborn disease;nuclear magnetic resonance spectroscopy;Parkinson disease;peripheral vascular disease;pH;phosphorus nuclear magnetic resonance;priority journal;proton nuclear magnetic resonance;sarcoma;short survey;skeletal muscle;cerebrovascular accident;white matter","Sijens, P. E.;Oudkerk, M.",2005,,,0,
4079,Cognitive impairments in patients with cerebrovascular risk factors: A comparison of Mini Mental Status Exam and Montreal Cognitive Assessment,"Objective and background: Recent evidence suggests that cerebrovascular risk factors are contributing factors, not only to vascular cognitive decline, but also for Alzheimer's disease. The study aim was to compare Montreal Cognitive Assessment (MoCA) and MMSE tests in subjects with cerebrovascular risk factors. Patients and methods: Fifty patients with cerebrovascular risk factors were administrated the MMSE and MoCA tests. Data collected for all subjects and the results were compared. Results: Cognitive impairments revealed on both tests were more frequent in females, and correlated with the level of education (for MoCA r = 0.75, p = 0.001 and for MMSE r = 0.662, p = 0.001). Mean values of MoCA score were significantly lower in patients with two or more cerebrovascular risk factors compared with those with only one risk factor (19.92 ± 5.99 versus 23.81 ± 4.06; p = 0.049), a finding that was not evidenced by MMSE. Conclusions: The most frequent impaired domain in MMSE (for scores both less and more than 26) was attention; but in MoCA the most frequent impaired domains were delayed recall (for scores above 26), and visuo-executive (for scores ≤26), which is a common domain involved in vascular cognitive decline. MoCA may be superior to MMSE in early detection of cognitive decline in patients with vascular risk factors. © 2012 Elsevier B.V.",adult;article;body mass;cerebrovascular risk factor;cognitive defect;coronary artery disease;diabetes mellitus;education;female;atrial fibrillation;heart failure;human;hypercholesterolemia;hypertension;intermethod comparison;ischemic heart disease;major clinical study;male;Mini Mental State Examination;Montreal cognitive assessment;psychologic test;risk factor;sex difference;smoking,"Sikaroodi, H.;Yadegari, S.;Miri, S. R.",2013,,,0,
4080,Antibodies against phosphorylcholine are not altered in plasma of patients with Alzheimer's disease,"Background: Phosphorylcholine is one of the major epitopes of oxidised low density lipoprotein. Low levels of IgM antibodies against phosphorylcholine (anti-PC) are associated with development of myocardial infarction and stroke. It has been shown that patients with Alzheimer's disease and other dementias have significantly lower serum anti-PC levels compared to controls, suggesting that low levels of atheroprotective anti-PC may play a role in AD and dementia. Methods: We quantified levels of anti-PC levels using an ELISA in plasma from 176 controls, 125 patients with Alzheimer's disease, 19 patients with vascular dementia and 63 patients with other dementias. Results: We observed similar plasma anti-PC levels in controls, patients with Alzheimer's disease, and other dementias. Conclusions: Our data suggests that anti-PC is not useful as a biomarker for Alzheimer's disease.",albumin;apolipoprotein E4;immunoglobulin M antibody;phosphorylcholine;tau protein;adult;aged;Alzheimer disease;antibody blood level;article;blood analysis;clinical assessment;comparative study;controlled study;diffuse Lewy body disease;disease association;enzyme linked immunosorbent assay;female;frontotemporal dementia;genotype;human;major clinical study;male;multiinfarct dementia;Parkinson disease,"Silajdžić, E.;Björkqvist, M.;Hansson, O.",2015,,,0,
4081,Substance use-related outpatient consultations in specialized health care: An underestimated entity,"Background: To study the occurrence and documentation of substance use related outpatient visits in specialized health care. Methods: The diagnosis recorded in retrospective discharge data in Tampere University Hospital for 6 years was compared with the prospective data gathered from separately completed forms added during an 8-week period to every outpatient's discharge data. In this form, the relation of substance use and the actual reason for the consultation were specifically elicited. Results: On the basis of diagnoses, retrospectively, 0.4% (6,666 of 1,555,898) of outpatient visits were caused by substance use. In the prospective part of the study, 5.6% of visits (1,401/25,014) were related to substance use. Retrospective study demonstrated 2% prevalence of substance use, whereas prospective study showed 36% substance use-related visits at the emergency room. According to the retrospective discharge data, alcohol-related organ damages were the major reason for substance use-related outpatient visits. In the prospective study, the proportion of acute traumas was most prevalent. Conclusions: Our study indicates that substance use-related visits often remain undetected in specialized health care. Substance use-related visits were underdocumented/undetected in the emergency room. Using a simple separate form could dramatically increase the detection of substance use-related visits.",adult;alcohol intoxication;alcohol liver cirrhosis;alcohol liver disease;alcohol withdrawal;article;cardiomyopathy;consultation;dementia;emergency treatment;fatty liver;female;fetal alcohol syndrome;gastritis;hospital discharge;human;major clinical study;male;neuropathy;outpatient care;pancreatitis;prevalence;priority journal;retrospective study;statistical analysis;substance abuse,"Sillanaukee, P.;Kääriäinen, J.;Sillanaukee, P.;Poutanen, P.;Seppä, K.",2002,,,0,
4082,"Food, polyphenols and neuroprotection",,curcumin;cytochrome c;DNA methyltransferase;epigallocatechin gallate;flavonoid;histone acetyltransferase;histone deacetylase;phosphatidylethanolamine;polyphenol;protein Bax;resveratrol;stilbene;antioxidant activity;autophagy;bioavailability;degenerative disease;deglycosylation;dementia;drug transformation;food;genetic regulation;ischemic heart disease;nerve degeneration;nervous system inflammation;neuroprotection;note;oxidative stress,"Silva, R. F. M.;Pogačnik, L.",2017,,10.4103/1673-5374.205096,0,
4083,Varicella zoster virus vasculopathy: A treatable form of rapidly progressive multi-infarct dementia after 2 years' duration,"We describe an extraordinarily protracted case of varicella zoster virus (VZV) multifocal vasculopathy in a man who presented initially with ischemic optic neuropathy and then suffered 4 episodes of stroke manifesting as multi-infarct dementia over a 2-year period. Brain magnetic resonance imaging (MRI) and angiography (MRA) revealed cortical and subcortical infarctions as well as vasculitic occlusion and stenosis. The patient was treated with corticosteroids and later with cyclophosphamide. More than 2 years after the onset of neurological disease, two cerebrospinal fluid (CSF) examinations revealed the presence of anti-VZV IgG antibody with reduced serum-to-CSF ratios of anti-VZV IgG compared with ratios for total IgG and albumin, indicative of intrathecal synthesis of anti-VZV IgG. After definitive diagnosis, immunosuppressive drugs were discontinued and he was treated with intravenous acyclovir; both mental status and gait improved and no further episodes of neurological dysfunction ensued. The favorable outcome in this patient indicates that VZV vasculopathy can be treated successfully even after 26 months. VZV must be considered as a possible cause of neurological disease in any patient with idiopathic multifocal vasculopathy. © 2012 Elsevier B.V. All rights reserved.",acetylsalicylic acid;aciclovir;albumin;atorvastatin;clopidogrel;corticosteroid;cyclophosphamide;immunoglobulin G antibody;low density lipoprotein;methylprednisolone sodium succinate;valaciclovir;aged;amnesia;article;ataxia;brain angiography;brain biopsy;brain dysfunction;brain infarction;cardiomyopathy;carotid artery obstruction;case report;cerebrospinal fluid analysis;cerebrovascular accident;cerebrovascular disease;dizziness;drug dose increase;dysarthria;herpes zoster;human;hypercholesterolemia;immunohistochemistry;ischemic optic neuropathy;leukocyte;lipoprotein blood level;magnetic resonance angiography;male;multiinfarct dementia;neuroimaging;polymerase chain reaction;priority journal;Purkinje cell;vascular disease;vertebral artery stenosis;West Nile virus;aspirin,"Silver, B.;Nagel, M. A.;Mahalingam, R.;Cohrs, R.;Schmid, D. S.;Gilden, D.",2012,,,0,
4084,30-Day Readmissions After an Acute Kidney Injury Hospitalization,"Background The risk of hospital readmission in acute kidney injury survivors is not well understood. We estimated the proportion of acute kidney injury patients who were rehospitalized within 30 days and identified characteristics associated with hospital readmission. Methods We conducted a population-based study of patients who survived a hospitalization complicated by acute kidney injury from 2003-2013 in Ontario, Canada. The primary outcome was 30-day hospital readmission. We used a propensity score model to match patients with and without acute kidney injury, and a Cox proportional hazards model with death as a competing risk to identify predictors of 30-day readmission. Results We identified 156,690 patients who were discharged from 197 hospitals after an episode of acute kidney injury. In the subsequent 30 days, 27,457 (18%) patients were readmitted; 15,988 (10%) visited the emergency department and 7480 (5%) died. We successfully matched 111,778 patients with acute kidney injury 1:1 to patients without acute kidney injury. The likelihood of 30-day readmission was higher in acute kidney injury patients than those without acute kidney injury (hazard ratio [HR] 1.53; 95% confidence interval [CI], 1.50-1.57). Factors most strongly associated with 30-day rehospitalization were the number of hospitalizations in the preceding year (adjusted HR 1.45 for ≥2 hospitalizations; 95% CI, 1.40-1.51) and receipt of inpatient chemotherapy (adjusted HR 1.44; 95% CI, 1.32-1.58). Conclusions One in 5 patients who survive a hospitalization complicated by acute kidney injury is readmitted in the next 30 days. Better strategies are needed to identify and care for acute kidney injury survivors in the community.",creatinine;abdominal pain;acute kidney failure;adult;aged;article;Canada;cerebrovascular disease;chronic kidney failure;chronic liver disease;chronic lung disease;chronic obstructive lung disease;comorbidity;congestive heart failure;coronary artery disease;creatinine blood level;dementia;diabetes mellitus;emergency ward;female;gastrointestinal hemorrhage;health care cost;health care utilization;heart failure;heart infarction;high risk patient;hospital discharge;hospital readmission;hospitalization;human;Human immunodeficiency virus infection;hypertension;major clinical study;male;malignant neoplasm;middle aged;multicenter study;outcome assessment;palliative therapy;peripheral vascular disease;population research;priority journal;propensity score;thorax pain;urinary tract infection;urine retention;very elderly,"Silver, S. A.;Harel, Z.;McArthur, E.;Nash, D. M.;Acedillo, R.;Kitchlu, A.;Garg, A. X.;Chertow, G. M.;Bell, C. M.;Wald, R.",2017,,10.1016/j.amjmed.2016.09.016,0,
4085,Atypical presentations of depression,"Depression is common in older adults. This condition is often under-recognized and undertreated in this patient segment as it may present differently than in younger individuals. A number of risk factors for depression have been identified and may help increase recognition. Altered presentations include generalized anxiety/worry, somatisation, presence of a disability gap, subjective but not objective memory complaints, pseudodementia, hopelessness, change in adherence to medical regimens or change in function not otherwise explained. For individuals with dementia syndromes, excess disability may indicate depression. A high index of suspicion, recognition of risk factors, and asking about specific aspects of depression may increase diagnosis.",antiparkinson agent;benzodiazepine;beta adrenergic receptor blocking agent;digoxin;steroid;anxiety;article;cardiovascular disease;cerebrovascular disease;depression;disease association;endocrine disease;fatigue;guilt;heart infarction;hopelessness;human;insomnia;memory disorder;mental concentration;mood disorder;patient attitude;physical disability;physical disease;pseudodementia;restlessness;risk factor;social psychology;cerebrovascular accident;suicide;weight gain;weight reduction,"Silvius, J. L.",2006,,,0,
4086,Multimorbidity in bullous pemphigoid: a case–control analysis of bullous pemphigoid patients with age- and gender-matched controls,"Background: Bullous pemphigoid (BP) is the most common autoimmune blistering disease in the elderly and is associated with increased mortality. The extent of multimorbidity in patients with BP and its impact on survival are unclear. Objectives: To describe the extent and spectrum of multimorbidity in patients with BP and to ascertain its impact on survival. Methodology: This was a case–control study conducted in the setting of an academic medical centre. Cases defined as newly diagnosed BP patients referred to the inpatient dermatology service between 2005 and 2014. For every case, three age- and gender-matched controls were randomly selected. Retrospective review of medical records was performed. Univariate and multivariate comparisons of cases and controls were performed using conditional logistic regression. Results: A total of 105 cases and 315 controls were included in this study. Eighty-eight cases (84%) were multimorbid (≥2 chronic diseases) as compared to 205 controls (65%) (P < 0.001), while the mean number of comorbid conditions was 3.2 ± 1.6 in cases compared to 2.4 ± 1.6 in controls (P < 0.001). 43% of cases had ≥4 comorbidities compared to 27% in controls (P = 0.003). On multivariate analysis (adjusting for age, gender and comorbidities), neurological disease (OR 10.93; CI: 5.74, 20.79) and hypertension (OR 2.38; CI: 1.18, 4.77) were positively associated with BP. Charlson comorbidity index was 6.0 ± 2.5 in cases compared to 5.0 ± 2.1 in controls (P = 0.002), and the 1-year mortality of cases and controls was 32.4% and 17.8%, respectively. Conclusion: Our study has shown that a significant proportion of patients with BP are multimorbid and individually have a higher number of comorbidities compared to matched controls. Disease burden and multimorbidity may well impact the prognosis of patients with BP.",age;aged;article;bipolar disorder;bullous pemphigoid;case control study;cerebrovascular accident;Charlson Comorbidity Index;chronic disease;comorbidity;controlled study;dementia;depression;dermatology;diabetes mellitus;epilepsy;female;gastrointestinal disease;gender;gout;human;hyperlipidemia;hypertension;ischemic heart disease;kidney disease;lung disease;major clinical study;male;medical record review;mortality;multiple chronic conditions;neurologic disease;Parkinson disease;priority journal;prognosis;schizophrenia,"Sim, B.;Fook-Chong, S.;Phoon, Y. W.;Koh, H. Y.;Thirumoorthy, T.;Pang, S. M.;Lee, H. Y.",2017,,10.1111/jdv.14312,0,
4087,Cerebral biopsy in the investigation of presenile dementia. I. Clinical aspects,,Adult;Aged;Aging;Biopsy/pathology;Brain/*epidemiology;Cardiomegaly;Dementia/epidemiology/pathology;Electroencephalography;Female;Humans;Intelligence Tests;Male;Memory;Middle Aged;Neurologic Manifestations;Personality;Psychophysiology;Psychotic Disorders/*pathology;Seizures;Speech;Urinary Incontinence,"Sim, M.;Turner, E.;Smith, W. T.",1966,Feb,,0,
4088,New use of atypical antipsychotics was linked to acute kidney injury and all-cause mortality at 90 days,,atypical antipsychotic agent;creatinine;olanzapine;quetiapine;risperidone;acute heart infarction;acute kidney failure;adverse outcome;agitation;behavior disorder;caregiver;cohort analysis;creatinine blood level;dementia;end stage renal disease;follow up;heart ventricle arrhythmia;hospital discharge;hospitalization;human;ICD-10;morbidity;mortality;neuroleptic malignant syndrome;note;off label drug use;outcome assessment;pneumonia;practice guideline;prescription;priority journal;randomized controlled trial (topic);rhabdomyolysis;risk assessment;urine retention,"Simon, G.",2015,,,0,
4089,HIV in older adults,"The prevalence of HIV/AIDS in older adults continues to increase, and in 2005, 25% of those infected with HIV were older than 50. Successful treatment regimens allow people to live longer with HIV, but the incidence is also increasing, with older adults accounting for 15% of new HIV cases in 2005. Prevention, diagnosis, and management of HIV/AIDS in older adults are complex issues. The aging immune system may impact response to treatment with highly active antiretroviral therapy (HAART), and there is greater potential for drug-drug interactions and toxicities due to comorbidities and polypharmacy. Patients living longer with HIV are more likely to develop diseases associated with aging, and at an earlier age, than those without HIV. These include coronary artery disease, dyslipidemia, metabolic syndrome, diabetes, osteoporosis, and dementia. Geriatricians and primary care providers are increasingly responsible for managing these complex issues.","Acquired Immunodeficiency Syndrome/epidemiology/prevention & control;Aged;*Aging;Antiretroviral Therapy, Highly Active/*methods;Comorbidity;Drug Interactions;HIV Infections/diagnosis/drug therapy/*epidemiology/*prevention & control;Humans;Incidence;Polypharmacy;Prevalence;Prognosis;Risk Factors;United States/epidemiology","Simone, M. J.;Appelbaum, J.",2008,Dec,,0,
4090,Economic hardship and biological weathering: The epigenetics of aging in a U.S. sample of black women,"Background: Past research has linked low socio-economic status (SES) to inflammation, metabolic dysregulation, and various chronic and age-related diseases such as type 2 diabetes, coronary heart disease, stroke, and dementia. These studies suggest that the challenges and adversities associated with low SES may result in premature aging and increased risk of morbidity and mortality. Objective: Building upon this research, the present study investigates various avenues whereby low income might accelerate biological aging. Methods: Structural equation modeling and longitudinal data from a sample of 100 Black, middle-aged women residing in the United States was used to investigate the effect of income on a recently developed epigenetic measure of biological aging. This measure can be used as a ""biological clock"" to assess, at any point during adulthood, the extent to which an individual is experiencing accelerated or decelerated biological aging. Results: Low income displayed a robust association with accelerated aging that was unaffected after controlling for other SES-related factors such as education, marital status, and childhood adversity. Further, our analyses indicated that the association between income and biological aging was not explained by health-related behaviors such as diet, exercise, smoking, alcohol consumption, or having health insurance. Rather, in large measure, it was financial pressure (difficulty paying bills, buying necessities, or meeting daily expenses) that accounted for the association between low income and accelerated aging. Conclusions: These findings support the view that chronic financial pressures associated with low income exert a weathering effect that results in premature aging.",adult;adulthood;aging;alcohol consumption;article;biological rhythm;Black person;childhood;controlled study;CpG island;diet;disease association;DNA methylation;economic aspect;education;epigenetics;exercise;female;financial pressure;health behavior;health insurance;human;human cell;lowest income group;major clinical study;marriage;middle aged;premature aging;smoking;social status;United States,"Simons, R. L.;Lei, M. K.;Beach, S. R. H.;Philibert, R. A.;Cutrona, C. E.;Gibbons, F. X.;Barr, A.",2016,,,0,
4091,Physical and mental health comorbidity is common in people with multiple sclerosis: Nationally representative cross-sectional population database analysis,"Background: Comorbidity in Multiple Sclerosis (MS) is associated with worse health and higher mortality. This study aims to describe clinician recorded comorbidities in people with MS.Methods: 39 comorbidities in 3826 people with MS aged ≥25 years were compared against 1,268,859 controls. Results were analysed by age, gender, and socioeconomic status, with unadjusted and adjusted Odds Ratios (ORs) calculated using logistic regression.Results: People with MS were more likely to have one (OR 2.44; 95% CI 2.26-2.64), two (OR 1.49; 95% CI 1.38-1.62), three (OR 1.86; 95% CI 1.69-2.04), four or more (OR 1.61; 95% CI 1.47-1.77) non-MS chronic conditions than controls, and greater mental health comorbidity (OR 2.94; 95% CI 2.75-3.14), which increased as the number of physical comorbidities rose. Cardiovascular conditions, including atrial fibrillation (OR 0.49; 95% CI 0.36-0.67), chronic kidney disease (OR 0.51; 95% CI 0.40-0.65), heart failure (OR 0.62; 95% CI 0.45-0.85), coronary heart disease (OR 0.64; 95% CI 0.52-0.71), and hypertension (OR 0.65; 95% CI 0.59-0.72) were significantly less common in people with MS.Conclusion: People with MS have excess multiple chronic conditions, with associated increased mental health comorbidity. The low recorded cardiovascular comorbidity warrants further investigation. © 2014 Simpson et al.; licensee BioMed Central Ltd.",adult;age;aged;anxiety disorder;article;bipolar disorder;chronic kidney disease;chronic pain;comorbidity;constipation;controlled study;cross-sectional study;dementia;depression;eating disorder;epilepsy;female;atrial fibrillation;heart failure;human;hypertension;ischemic heart disease;learning disorder;major clinical study;male;mental health;migraine;mortality;multiple sclerosis;prevalence;schizophrenia;sex difference;social status;visual impairment,"Simpson, R. J.;McLean, G.;Guthrie, B.;Mair, F.;Mercer, S. W.",2014,,,0,
4092,"Pioglitazone in early Parkinson's disease: A phase 2, multicentre, double-blind, randomised trial","Background: A systematic assessment of potential disease-modifying compounds for Parkinson's disease concluded that pioglitazone could hold promise for the treatment of patients with this disease. We assessed the effect of pioglitazone on the progression of Parkinson's disease in a multicentre, double-blind, placebo-controlled, futility clinical trial. Methods: Participants with the diagnosis of early Parkinson's disease on a stable regimen of 1 mg/day rasagiline or 10 mg/day selegiline were randomly assigned (1:1:1) to 15 mg/day pioglitazone, 45 mg/day pioglitazone, or placebo. Investigators were masked to the treatment assignment. Only the statistical centre and the central pharmacy knew the treatment name associated with the randomisation number. The primary outcome was the change in the total Unified Parkinson's Disease Rating Scale (UPDRS) score between the baseline and 44 weeks, analysed by intention to treat. The primary null hypothesis for each dose group was that the mean change in UPDRS was 3 points less than the mean change in the placebo group. The alternative hypothesis (of futility) was that pioglitazone is not meaningfully different from placebo. We rejected the null if there was significant evidence of futility at the one-sided alpha level of 0·10. The study is registered at ClinicalTrials.gov, number NCT01280123. Findings: 210 patients from 35 sites in the USA were enrolled between May 10, 2011, and July 31, 2013. The primary analysis included 72 patients in the 15 mg group, 67 in the 45 mg group, and 71 in the placebo group. The mean total UPDRS change at 44 weeks was 4·42 (95% CI 2·55-6·28) for 15 mg pioglitazone, 5·13 (95% CI 3·17-7·08) for 45 mg pioglitazone, and 6·25 (95% CI 4·35-8·15) for placebo (higher change scores are worse). The mean difference between the 15 mg and placebo groups was -1·83 (80% CI -3·56 to -0·10) and the null hypothesis could not be rejected (p=0·19). The mean difference between the 45 mg and placebo groups was -1·12 (80% CI -2·93 to 0·69) and the null hypothesis was rejected in favour of futility (p=0·09). Planned sensitivity analyses of the primary outcome, using last value carried forward (LVCF) to handle missing data and using the completers' only sample, suggested that the 15 mg dose is also futile (p=0·09 for LVCF, p=0·09 for completers) but failed to reject the null hypothesis for the 45 mg dose (p=0·12 for LVCF, p=0·19 for completers). Six serious adverse events occurred in the 15 mg group, nine in the 45 mg group, and three in the placebo group; none were thought to be definitely or probably related to the study interventions. Interpretation: These findings suggest that pioglitazone at the doses studied here is unlikely to modify progression in early Parkinson's disease. Further study of pioglitazone in a larger trial in patients with Parkinson's disease is not recommended. Funding: National Institute of Neurological Disorders and Stroke.",NCT01280123;creatine kinase;pioglitazone;placebo;rasagiline;selegiline;adult;ankle fracture;article;cardiovascular disease;Clinical Dementia Rating;confusion;controlled study;cyst rupture;dehydration;depression;diarrhea;dose response;double blind procedure;drug dose titration;drug safety;drug tolerability;dyspnea;edema;fatigue;female;Geriatric Depression Scale;heart atrium flutter;heart infarction;human;hypoxia;intention to treat analysis;intervertebral disk degeneration;intestine obstruction;major clinical study;male;middle aged;multicenter study;nausea;null hypothesis;osteoarthritis;Parkinson disease;Parkinson Disease Questionnaire 39;phase 2 clinical trial;priority journal;questionnaire;randomized controlled trial;respiratory failure;side effect;spondylolisthesis;transient ischemic attack;treatment outcome;Unified Parkinson Disease Rating Scale;United States,"Simuni, T.;Kieburtz, K.;Tilley, B.;J Elm, J.;Ravina, B.;Babcock, D.;Emborg, M.;Hauser, R.;Kamp, C.;Morgan, J. C.;Webster Ross, G.;K Simon, D.;Bainbridge, J.;Baker, L.;Bodis-Wollner, I.;Boyd, J.;Cambi, F.;Carter, J.;Chou, K.;Dahodwala, N.;Dewey, R. B.;Dhall, R.;Fang, J.;Farrow, B.;Feigin, A.;Glazman, S.;Goudreau, J.;LeBlanc, P.;Lee, S.;Leehey, M.;Lew, M. F.;Lowenhaupt, S.;Luo, S.;Pahwa, R.;Perez, A.;Schneider, J.;Scott, B.;Shah, B.;Shannon, K. M.;Sharma, S.;Singer, C.;Truong, D.;Wagner, R.;Williams, K.;Marie Wills, A.;Shieen Wong, P.;Zadikoff, C.;Zweig, R.",2015,,,0,
4093,Midlife work-related stress is associated with late-life cognition,"To investigate the associations between midlife work-related stress and late-life cognition in individuals without dementia from the general population. The Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study population (n = 2000) was randomly selected from independent Finnish population-based surveys (baseline mean age 50 years). Participants underwent two re-examinations in late life (mean age 71 and 78 years, respectively). 1511 subjects participated in at least one re-examination (mean total follow-up 25 years). Work-related stress was measured using two questions on work demands administered in midlife. Multiple cognitive domains were assessed. Analyses were adjusted for several potential confounders. Higher levels of midlife work-related stress were associated with poorer performance on global cognition [β-coefficient, −0.02; 95% confidence interval (CI), −0.05 to −0.00], and processing speed [β −0.03, CI −0.05 to −0.01]. Results remained significant after adjusting for potential confounders. Work-related stress was not significantly associated with episodic memory, executive functioning, verbal fluency or manual dexterity. This study shows that global cognition and processing speed may be particularly susceptible to the effects of midlife work-related stress.",apolipoprotein E4;biological marker;adult;aged;aging;article;asthma;atrial fibrillation;blood sampling;cardiac patient;cardiovascular risk;cerebrovascular accident;chronic obstructive lung disease;clinical article;cognition;coronary artery disease;diabetes mellitus;disease association;episodic memory;female;follow up;health status;heart failure;heart infarction;human;job stress;late life cognition;Likert scale;male;medical history;middle aged;mild cognitive impairment;Mini Mental State Examination;practice guideline;priority journal;Purdue pegboard test;Stroop test;word recognition;world health organization,"Sindi, S.;Kåreholt, I.;Solomon, A.;Hooshmand, B.;Soininen, H.;Kivipelto, M.",2017,,10.1007/s00415-017-8571-3,0,
4094,Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review,"IMPORTANCE: Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes. OBJECTIVE: To inform how payers and providers should identify patients with ""advanced illness"" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system. EVIDENCE REVIEW: Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015). RESULTS: Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10). CONCLUSIONS: Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.",,"Singer, A. E.;Goebel, J. R.;Kim, Y. S.;Dy, S. M.;Ahluwalia, S. C.;Clifford, M.;Dzeng, E.;O'Hanlon, C. E.;Motala, A.;Walling, A. M.;Goldberg, J.;Meeker, D.;Ochotorena, C.;Shanman, R.;Cui, M.;Lorenz, K. A.",2016,Sep,10.1089/jpm.2015.0367,0,
4095,The Association between Pulse Wave Velocity and Cognitive Function: The Sydney Memory and Ageing Study,"Objectives:Pulse wave velocity (PWV) is a measure of arterial stiffness and its increase with ageing has been associated with damage to cerebral microvessels and cognitive impairment. This study examined the relationship between carotid-femoral PWV and specific domains of cognitive function in a non-demented elderly sample.Method:Data were drawn from the Sydney Memory and Ageing Study, a cohort study of non-demented community-dwelling individuals aged 70-90 years, assessed in successive waves two years apart. In Wave 2, PWV and cognitive function were measured in 319 participants. Linear regression was used to analyse the cross-sectional relationship between arterial stiffness and cognitive function in the whole sample, and separately for men and women. Analysis of covariance was used to assess potential differences in cognition between subjects with PWV measurements in the top and bottom tertiles of the cohort. Covariates were age, education, body mass index, pulse rate, systolic blood pressure, cholesterol, depression, alcohol, smoking, hormone replacement therapy, apolipoprotein E ε4 genotype, use of anti-hypertensive medications, history of stroke, transient ischemic attack, myocardial infarction, angina, diabetes, and also sex for the whole sample analyses.Results:There was no association between PWV and cognition after Bonferroni correction for multiple testing. When examining this association for males and females separately, an association was found in males, with higher PWV being associated with lower global cognition and memory, however, a significant difference between PWV and cognition between males and females was not found.Conclusion:A higher level of PWV was not associated with lower cognitive function in the whole sample. © 2013 Singer et al.",apolipoprotein E4;cholesterol;aged;alcohol consumption;arterial stiffness;article;body mass;cholesterol blood level;cognition;cohort analysis;controlled study;depression;educational status;executive function;female;genotype;geriatric assessment;human;major clinical study;male;medical history;memory;pulse rate;pulse wave;renal replacement therapy;sex difference;smoking;systolic blood pressure,"Singer, J.;Trollor, J. N.;Crawford, J.;O'Rourke, M. F.;Baune, B. T.;Brodaty, H.;Samaras, K.;Kochan, N. A.;Campbell, L.;Sachdev, P. S.;Smith, E.",2013,,,0,
4096,Mortality derived from 5-year survival in patients with Alzheimer disease,"OBJECTIVE: The objective of the authors of the source article was to investigate survival and course of the disease in a registry of patients with Alzheimer disease diagnosed from 1987-1996. The objective of this article is to derive expected mortality, age/sex-matched as closely as possible to data available in the article, and to derive comparative mortality from the survival results at 5 years. METHODS: The cohort of 521 patients with newly recognized senile dementia (Alzheimer disease) was drawn from a health organization in western Washington with an enrollment of 23,000 members age 60 years and older. After initial selection, a careful evaluation was made to confirm the diagnosis. The cohort was followed to death or 2001, with follow-up (FU) ranging from 0.2 to 14 years (mean 5.2 years). The authors used elaborate statistical methods in their analysis of results. A detailed description is given in the text of this article on the derivation of both observed and expected mean annual mortality rates to obtain excess death rates (EDR) and mortality ratios (MR) as indices of excess mortality averaged over 5 years of FU. RESULTS: All patients were age 60 or older, mean age was 80.2 years, and females outnumbered males, 66% to 34%. The overall EDR, all patients combined, was 37 extra deaths per 1000 per year. For all males EDR was 52; and for all females, EDR was 33 per 1000 per year. The corresponding MR values were 142%, 149% and 141%. EDR and MR increased with test scores measuring severity of cognitive impairment, with physical features of the severity of the dementia, and especially with the presence of comorbid diseases such as stroke, coronary heart disease (CHD) and congestive heart failure (CHF). With a mean age of 80 years, MR values are relatively low in comparison with EDR, owing to the high mean expected mortality. CONCLUSION: An approximate pattern of increased mortality has been found in a cohort of senile dementia patients in the Group Health Cooperative, in the area of Seattle, Washington, despite some uncertainty attributable to absence of sex and race distribution data within each of the 4 individual age groups.","Aged;Aged, 80 and over;Alzheimer Disease/*mortality;Cohort Studies;Female;Humans;Male;Middle Aged;Registries;*Survival Analysis;United States/epidemiology;Washington","Singer, R. B.",2005,,,0,
4097,Managing anemia in dialysis patients: Hemoglobin cycling and overshoot,,acetylsalicylic acid;albumin;alkaline phosphatase;aminotransferase;amiodarone;bicarbonate;bilirubin;chloride;creatinine;diltiazem;dobutamine;esomeprazole;ferritin;ferrous gluconate;glucose;hemoglobin;metoprolol;paricalcitol;potassium;recombinant erythropoietin;salmeterol;sevelamer;sodium;transferrin;African American;aged;albumin blood level;anamnesis;anemia;angioplasty;article;bicarbonate blood level;blood pressure;blood vessel graft;breathing rate;caregiver;case report;cephalic vein;chloride blood level;clinical protocol;cranial nerve;creatinine blood level;dementia;depression;diastolic heart failure;disease duration;disease severity;dyspnea;family history;female;ferritin blood level;gastroesophageal reflux;glaucoma;Graves disease;atrial fibrillation;heart rate;hematocrit;hemodialysis;hemodialysis patient;hospital admission;human;hypoglycemia;iatrogenic disease;internal jugular vein;kidney artery stenosis;kidney failure;kidney ischemia;laboratory test;leukocyte count;liver function test;medical record;neurologic examination;outpatient care;patient assessment;peripheral vascular disease;pharmacologic stress testing;polycythemia;potassium blood level;priority journal;sensorimotor function;sodium blood level;somnolence;thrombosis;urea nitrogen blood level;vein catheterization;vein disease;aspirin,"Singh, A. K.;Milford, E.;Fishbane, S.;Keithi-Reddy, S. R.",2008,,,0,
4098,Chronic obstructive pulmonary disease and association with mild cognitive impairment: the Mayo Clinic Study of Aging,"OBJECTIVE: To investigate the association of chronic obstructive pulmonary disease (COPD) with mild cognitive impairment (MCI) and MCI subtype: amnestic MCI and nonamnestic MCI, in a population-based study of elderly patients. PATIENTS AND METHODS: Participants included 1927 individuals aged 70 to 89 years enrolled in the population-based Mayo Clinic Study of Aging. Participants were evaluated by using a nurse assessment, neurological evaluation, and neuropsychological testing, and the diagnosis of MCI was made by a consensus panel according to the standardized criteria. Chronic obstructive pulmonary disease was identified by the review of medical records. The study was conducted from October 1, 2004, through July 31, 2007. The associations of COPD and disease duration with MCI and its subtypes were evaluated by using logistic regression models adjusted for potential covariates. RESULTS: Of 1927 participants, 288 had COPD (men vs women: 18% vs 12%; P<.001). As compared with patients without COPD, patients with COPD had a higher prevalence of MCI (27% vs 15%; P<.001). The odds ratio (OR) for MCI was almost 2 times higher in patients with COPD than in those without (OR, 1.87; 95% CI, 1.34-2.61), with a similar effect in men and women. The OR for MCI increased from 1.60 (95% CI, 0.97-2.57) in patients with a COPD duration of 5 years or less to 2.10 (95% CI, 1.38-3.14) in patients with a COPD duration of more than 5 years. CONCLUSION: This population-based study suggests that COPD is associated with increased odds of having MCI and its subtypes. There was a dose-response relationship with the duration of COPD after controlling for the potential covariates.","Aged;Aged, 80 and over;Aging;Dementia/diagnosis/epidemiology;Female;Humans;Logistic Models;Male;Mild Cognitive Impairment/diagnosis/*epidemiology;Prevalence;Pulmonary Disease, Chronic Obstructive/*epidemiology;Risk Factors;United States;Apoe;Bmi;Cad;Copd;Emr;Icd-9;International Classification of Diseases, Ninth Revision;Mci;Mcsa;Mayo Clinic Study of Aging;Omc;Or;Olmsted Medical Center;Rep;Rochester Epidemiology Project;a-MCI;amnestic mild cognitive impairment;apolipoprotein E;body mass index;chronic obstructive pulmonary disease;coronary artery disease;electronic medical record;mild cognitive impairment;na-MCI;nonamnestic mild cognitive impairment;odds ratio","Singh, B.;Parsaik, A. K.;Mielke, M. M.;Roberts, R. O.;Scanlon, P. D.;Geda, Y. E.;Pankratz, V. S.;Christianson, T.;Yawn, B. P.;Petersen, R. C.",2013,Nov,10.1016/j.mayocp.2013.08.012,0,
4099,Derivation and validation of automated electronic search strategies to extract Charlson comorbidities from electronic medical records,"OBJECTIVE: To develop and validate automated electronic note search strategies (automated digital algorithm) to identify Charlson comorbidities. PATIENTS AND METHODS: The automated digital algorithm was built by a series of programmatic queries applied to an institutional electronic medical record database. The automated digital algorithm was derived from secondary analysis of an observational cohort study of 1447 patients admitted to the intensive care unit from January 1 through December 31, 2006, and validated in an independent cohort of 240 patients. The sensitivity, specificity, and positive and negative predictive values of the automated digital algorithm and International Classification of Diseases, Ninth Revision (ICD-9) codes were compared with comprehensive medical record review (reference standard) for the Charlson comorbidities. RESULTS: In the derivation cohort, the automated digital algorithm achieved a median sensitivity of 100% (range, 99%-100%) and a median specificity of 99.7% (range, 99%-100%). In the validation cohort, the sensitivity of the automated digital algorithm ranged from 91% to 100%, and the specificity ranged from 98% to 100%. The sensitivity of the ICD-9 codes ranged from 8% for dementia to 100% for leukemia, whereas specificity ranged from 86% for congestive heart failure to 100% for leukemia, dementia, and AIDS. CONCLUSION: Our results suggest that search strategies that use automated electronic search strategies to extract Charlson comorbidities from the clinical notes contained within the electronic medical record are feasible and reliable. Automated digital algorithm outperformed ICD-9 codes in all the Charlson variables except leukemia, with greater sensitivity, specificity, and positive and negative predictive values.",*Algorithms;*Comorbidity;Confidence Intervals;*Electronic Health Records;Humans;Information Storage and Retrieval/*methods;International Classification of Diseases,"Singh, B.;Singh, A.;Ahmed, A.;Wilson, G. A.;Pickering, B. W.;Herasevich, V.;Gajic, O.;Li, G.",2012,Sep,10.1016/j.mayocp.2012.04.015,0,
4100,"Catatonia, major depression and Takotsubo cardiomyopathy in an elderly patient",,escitalopram;lorazepam;moclobemide;olanzapine;troponin;acute coronary syndrome;aged;agitation;akinesia;case report;catatonia;clinical feature;confusion;coronary care unit;delusion;drug dose titration;echocardiography;electrocardiogram;electroconvulsive therapy;evening dosage;female;follow up;geriatric patient;guilt;heart left ventricle contractility;human;hypertension;hyponatremia;letter;liaison psychiatry;major depression;mental deterioration;nasogastric tube;nutrition;persecutory delusion;psychomotor retardation;psychosis;relapse,"Singh, D.;Williams, O.",2013,,,0,
4101,Depression in primary TKA and higher medical comorbidities in revision TKA are associated with suboptimal subjective improvement in knee function,"Background: To characterize whether medical comorbidities, depression and anxiety predict patient-reported functional improvement after total knee arthroplasty (TKA). Methods. We analyzed the prospectively collected data from the Mayo Clinic Total Joint Registry for patients who underwent primary or revision TKA between 1993-2005. Using multivariable-adjusted logistic regression analyses, we examined whether medical comorbidities, depression and anxiety were associated with patient-reported subjective improvement in knee function 2- or 5-years after primary or revision TKA. Odds ratios (OR), along with 95% confidence intervals (CI) and p-value are presented. Results: We studied 7,139 primary TKAs at 2- and 4,234 at 5-years; and, 1,533 revision TKAs at 2-years and 881 at 5-years. In multivariable-adjusted analyses, we found that depression was associated with significantly lower odds of 0.5 (95% confidence interval [CI]: 0.3 to 0.9; p = 0.02) of 'much better' knee functional status (relative to same or worse status) 2 years after primary TKA. Higher Deyo-Charlson index was significantly associated with lower odds of 0.5 (95% CI: 0.2 to 1.0; p = 0.05) of 'much better' knee functional status after revision TKA for every 5-point increase in score. Conclusions: Depression in primary TKA and higher medical comorbidity in revision TKA cohorts were associated with suboptimal improvement in index knee function. It remains to be seen whether strategies focused at optimization of medical comorbidities and depression pre- and peri-operatively may help to improve TKA outcomes. Study limitations include non-response bias and the use of diagnostic codes, which may be associated with under-diagnosis of conditions. © 2014 Singh and Lewallen; licensee BioMed Central Ltd.",acquired immune deficiency syndrome;adult;aged;anxiety disorder;article;cerebrovascular disease;chronic obstructive lung disease;congestive heart failure;controlled study;dementia;depression;Deyo Charlson index;diabetes mellitus;disease association;diseases;female;follow up;heart infarction;hemiplegia;human;kidney disease;knee function;liver disease;major clinical study;male;malignant neoplastic disease;assessment of humans;outcome assessment;peripheral vascular disease;prospective study;total knee replacement;ulcer,"Singh, J. A.;Lewallen, D. G.",2014,,,0,
4102,"ECG of the Month. Unexpected Atrioventricular Conduction in High-Grade Atrioventricular Block. DIAGNOSIS: Sinus rhythm; high-grade second-degree atrioventricular block with a junctional escape rhythm and three capture complexes, each with right bundle branch block aberration; possible septal myocardial infarct of indeterminate age; ST-T and U wave changes suggesting hypokalemia","A 90-year-old man with a history of high blood pressure, a cerebrovascular accident without focal residua, dementia, and stage 3 chronic kidney disease went to the emergency department because of dizziness and near syncope. His medications were aspirin 81 mg qd, clopidogrel 75 mg qod, escitalopram oxalate 10 mg qd, quetiapine fumarate 25 mg qd, and memantine hydrochloride 10 mg qd. He had orthrostatic hypotension with supine blood pressure of 173/77 mmHg falling to 116/68 on standing, while pulse increased from 66 to 84 beats/min. He received IV fluid and returned home. Two days later, he saw his primary care physician because of episodes of dizziness and confusion. The Figure shows an electrocardiogram recorded during that visit.",,"Singh, M.;LeLorier, P. A.;Celebi, M. M.;Glancy, D. L.",2014,Mar-Apr,,0,4103
4103,"ECG of the Month. Unexpected Atrioventricular Conduction in High-Grade Atrioventricular Block. DIAGNOSIS: Sinus rhythm; high-grade second-degree atrioventricular block with a junctional escape rhythm and three capture complexes, each with right bundle branch block aberration; possible septal myocardial infarct of indeterminate age; ST-T and U wave changes suggesting hypokalemia","A 90-year-old man with a history of high blood pressure, a cerebrovascular accident without focal residua, dementia, and stage 3 chronic kidney disease went to the emergency department because of dizziness and near syncope. His medications were aspirin 81 mg qd, clopidogrel 75 mg qod, escitalopram oxalate 10 mg qd, quetiapine fumarate 25 mg qd, and memantine hydrochloride 10 mg qd. He had orthrostatic hypotension with supine blood pressure of 173/77 mmHg falling to 116/68 on standing, while pulse increased from 66 to 84 beats/min. He received IV fluid and returned home. Two days later, he saw his primary care physician because of episodes of dizziness and confusion. The Figure shows an electrocardiogram recorded during that visit.",atrioventricular block;blood;case report;complication;electrocardiography;human;hypokalemia;hypotension;male;heart infarction;pathophysiology;chronic kidney failure;very elderly,"Singh, M.;LeLorier, P. A.;Celebi, M. M.;Glancy, D. L.",2014,,,0,
4104,"ECG Case of the Month: Unexpected Atrioventricular Conduction in High-Grade Atrioventricular Block. Sinus rhythm; high-grade second degree atrioventricular block with a junctional escape rhythm and three capture complexes, each with right bundle branch block aberration; possible septal myocardial infarct of indeterminate age; ST-T and U wave changes suggesting hypokalemia","A 90-year-old man with a history of high blood pressure, a cerebrovascular accident without focal residua, dementia, and stage 3 chronic kidney disease went to the emergency department because of dizziness and near syncope. His medications were aspirin 81 mg qd, clopidogrel 75 mg qod, escitalopram oxalate 10 mg qd, Seroquel 25 mg qd, and memantine hydrochloride 10 mg qd. He had orthostatic hypotension with supine blood pressure of 173/77 mm Hg falling to 116/68 on standing, while pulse increased from 66 to 84 beats/ min. He received IV fluid and returned home. Two days later he saw his primary care physician because of episodes of dizziness and confusion. The figure shows an electrocardiogram recorded during that visit.",,"Singh, M.;LeLorier, P. A.;Celebi, M. M.;Glancy, D. L.",2015,Mar-Apr,,0,4105
4105,"ECG Case of the Month: Unexpected Atrioventricular Conduction in High-Grade Atrioventricular Block. Sinus rhythm; high-grade second degree atrioventricular block with a junctional escape rhythm and three capture complexes, each with right bundle branch block aberration; possible septal myocardial infarct of indeterminate age; ST-T and U wave changes suggesting hypokalemia","A 90-year-old man with a history of high blood pressure, a cerebrovascular accident without focal residua, dementia, and stage 3 chronic kidney disease went to the emergency department because of dizziness and near syncope. His medications were aspirin 81 mg qd, clopidogrel 75 mg qod, escitalopram oxalate 10 mg qd, Seroquel 25 mg qd, and memantine hydrochloride 10 mg qd. He had orthostatic hypotension with supine blood pressure of 173/77 mm Hg falling to 116/68 on standing, while pulse increased from 66 to 84 beats/ min. He received IV fluid and returned home. Two days later he saw his primary care physician because of episodes of dizziness and confusion. The figure shows an electrocardiogram recorded during that visit.",atrioventricular block;blood;case report;electrocardiography;heart atrioventricular node;heart infarction;human;hypokalemia;male;pathophysiology;sinus arrhythmia;very elderly,"Singh, M.;LeLorier, P. A.;Celebi, M. M.;Glancy, D. L.",2015,,,0,
4106,Can wine and moderate alcohol intake work as functional food nutraceuticals? A tribute to Dr. Serge C. renaud,,"adverse drug reaction;aging;alcohol consumption;alcohol liver cirrhosis;alcoholic beverage;alcoholism;brain;cacao;cardiomyopathy;cell membrane;coenzyme;dementia;diet;diseases;dose response;drinking;fatty liver;fish;France;functional food;gene;human;hypertriglyceridemia;hyperuricemia;inflammation;insulin resistance;mitochondrion;morbidity;mortality;neoplasm;non insulin dependent diabetes mellitus;oxidative stress;patient;physical activity;platelet reactivity;protection;psychosis;risk;Russian Federation;vodka;whiskey;wine;1,1 diphenyl 2 picrylhydrazyl;alcohol;amino acid;antioxidant;beta carotene;C reactive protein;calcium;carnitine;chromium;copper;cyanocobalamin;fish oil;flavonoid;folic acid;high density lipoprotein;interleukin 6;linolenic acid;magnesium;marker;mineral;nutraceutical;omega 3 fatty acid;plasminogen activator;potassium;selenium;tumor necrosis factor alpha;vitamin;zinc","Singh, R. B.;Meester, F. D.;Wilkzynska, A.;Wilson, D. W.;Lanzmann, D.;Abramova, M.;Shastun, S. A.;Sergey, C.;Khochunsky, P.;Velangi, P. S.;Awori, E.;Sharma, A.;Jain, M.;Buttar, H. S.",2014,,,0,
4107,End of life decision in Indian Armed Forces hospitals,,army;attitude to death;chronic liver disease;chronic obstructive lung disease;clinical assessment;coma;congestive heart failure;dementia;disease severity;dyspnea;functional status;human;intensive care;intensive care unit;interstitial lung disease;letter;malignant neoplastic disease;medical decision making;metastasis;multiple organ failure;oxygen therapy;palliative therapy;patient decision making;persistent vegetative state;public hospital;quadriplegia;quality of life;respiratory arrest;terminally ill patient;treatment failure;treatment refusal;treatment response,"Singhal, S.;Banerji, A.",2012,,,0,
4108,Persistent depressive symptoms and cognitive function in late midlife: The Whitehall II study,"Objective: Depression has been widely linked to poor cognition and dementia in the elderly. However, comorbidity at older ages does not allow an assessment of the role of mental health as a risk factor for cognitive outcomes. We examined the association between depressive symptoms, measured 6 times over an 18-year period, and cognitive deficits in late midlife. Method: Of the 10,308 participants in the Whitehall II study, 4,271 men and women (aged 35-55 years at baseline) were followed up for 18 years, during which depressive symptoms were assessed 6 times using the General Health Questionnaire depression subscale. The follow-up was from 1985-1988 to 2002-2004. Cognition was assessed at the most recent wave (2002-2004, mean age 61 years, range 50-74 years) using 6 tests: memory, reasoning, vocabulary, 2 tests of verbal fluency, and the MMSE (Mini Mental State Examination). Cognitive deficit was defined as MMSE score < 28 and performance in the worst sex-specific quintile for the other tests. Results: History of depressive symptoms, once or more in the 6 times assessed, had a weak association with some of the cognitive tests. However, in analysis adjusted for sociodemographic variables, diabetes, coronary heart disease, hypertension, stroke, and antidepressant use, persistent depressive symptoms (4-6 times) were associated with cognitive deficits on all tests: memory (OR = 1.91; 95% CI, 1.36-2.67), reasoning (OR = 1.60; 95% CI, 1.15-2.20), vocabulary (OR = 1.75; 95% CI, 1.27-2.41), phonemic fluency (OR = 1.40; 95% CI, 1.00-1.94), semantic fluency (OR = 1.68; 95% CI, 1.20-2.35), and the MMSE (OR = 1.76; 95% CI, 1.25-2.50). Conclusions: Our data show that depressive episodes tend to persist in some individuals, and these individuals are at a greater risk of cognitive deficits in late midlife. © Copyright 2010 Physicians Postgraduate Press, Inc.",adult;aged;article;cognition;cognitive defect;depression;diabetes mellitus;disease association;female;follow up;General Health Questionnaire;human;hypertension;ischemic heart disease;linguistics;major clinical study;male;memory;Mini Mental State Examination;priority journal;cerebrovascular accident,"Singh-Manoux, A.;Akbaraly, T. N.;Marmot, M.;Melchior, M.;Ankri, J.;Sabia, S.;Ferrie, J. E.",2010,,,0,
4109,Interleukin-6 and C-reactive protein as predictors of cognitive decline in late midlife,"OBJECTIVE: Peripheral inflammatory markers are elevated in patients with dementia. In order to assess their etiologic role, we examined whether interleukin-6 (IL-6) and C-reactive protein (CRP) measured in midlife predict concurrently assessed cognition and subsequent cognitive decline. METHODS: Mean value of IL-6 and CRP, assessed on 5,217 persons (27.9% women) in 1991-1993 and 1997-1999 in the Whitehall II longitudinal cohort study, were categorized into tertiles to examine 10-year decline (assessments in 1997-1999, 2002-2004, and 2007-2009) in standardized scores (mean = 0, SD = 1) of memory, reasoning, and verbal fluency using mixed models. Mini-Mental State Examination (MMSE) was administered in 2002-2004 and 2007-2009; decline >/=3 points was modeled with logistic regression. Analyses were adjusted for baseline age, sex, education, and ethnicity; further analyses were also adjusted for smoking, obesity, Framingham cardiovascular risk score, and chronic diseases (cancer, coronary heart disease, stroke, diabetes, and depression). RESULTS: In cross-sectional analysis, reasoning was 0.08 SD (95% confidence interval [CI] -0.14, -0.03) lower in participants with high compared to low IL-6. In longitudinal analysis, 10-year decline in reasoning was greater (ptrend = 0.01) among participants with high IL-6 (-0.35; 95% CI -0.37, -0.33) than those with low IL-6 (-0.29; 95% CI -0.31, -0.27). In addition, participants with high IL-6 had 1.81 times greater odds ratio of decline in MMSE (95% CI 1.20, 2.71). CRP was not associated with decline in any test. CONCLUSIONS: Elevated IL-6 but not CRP in midlife predicts cognitive decline; the combined cross-sectional and longitudinal effects over the 10-year observation period corresponded to an age effect of 3.9 years.",Adult;Biomarkers/metabolism;C-Reactive Protein/*physiology;Cognition Disorders/*diagnosis/*metabolism;Cohort Studies;Cross-Sectional Studies;Female;Humans;Interleukin-6/*physiology;Longitudinal Studies;Male;Middle Aged;Predictive Value of Tests,"Singh-Manoux, A.;Dugravot, A.;Brunner, E.;Kumari, M.;Shipley, M.;Elbaz, A.;Kivimaki, M.",2014,Aug 5,10.1212/wnl.0000000000000665,0,
4110,Atrial fibrillation as a risk factor for cognitive decline and dementia,"Aims: To assess whether AF is a risk factor for cognitive dysfunction we used prospective data on AF, repeat cognitive scores, and dementia incidence in adults followed over 45 to 85 years. Methods and results: Data are drawn from the Whitehall II study, N = 10 308 at study recruitment in 1985. A battery of cognitive tests was administered four times (1997-2013) to 7428 participants (414 cases of AF), aged 45-69 years in 1997. Compared with AF-free participants, those with longer exposure to AF (5, 10, or 15 years) experienced faster cognitive decline after adjustment for sociodemographic, behavioural, and chronic diseases (P for trend = 0.01). Incident stroke or coronary heart disease individually did not explain the excess cognitive decline; however, this relationship was impacted when considering them together (P for trend 0.09). Analysis of incident dementia (N = 274/9302 without AF; N = 50/912 with AF) showed AF was associated with higher risk of dementia in Cox regression adjusted for sociodemographic factors, health behaviours and chronic diseases [hazard ratio (HR): 1.87; 95% confidence interval (CI): 1.37, 2.55]. Multistate models showed AF to increase risk of dementia in those free of stroke (HR: 1.67; 95% CI: 1.17, 2.38) but not those free of stroke and coronary heart disease (HR: 1.29; 95% CI: 0.74, 2.24) over the follow-up. Conclusion: In adults aged 45-85 years AF is associated with accelerated cognitive decline and higher risk of dementia even at ages when AF incidence is low. At least in part, this was explained by incident cardiovascular disease in patients with AF.",Ageing;Atrial fibrillation;Cognitive decline;Dementia,"Singh-Manoux, A.;Fayosse, A.;Sabia, S.;Canonico, M.;Bobak, M.;Elbaz, A.;Kivimaki, M.;Dugravot, A.",2017,Sep 07,,0,
4111,McLeod syndrome resulting from a novel XK mutation,"McLeod Syndrome (MLS) is a rare X-linked disorder characterized by haemopoietic abnormalities and late-onset neurological and muscular defects. The McLeod blood group phenotype is typically associated with erythrocyte acanthocytosis, absence of the Kx antigen and reduced expression of Kell system antigens. MLS is caused by hemizygosity for mutations in the XK gene. We describe a patient with MLS who first showed symptoms in 1989 (aged 51 years). As the disease progressed, the patient developed a slight dementia, aggressive behaviour and choreatic movements. A cardiomyopathy was also diagnosed. An electroneuromyography showed neuropathic and myopathic changes. Liver enzymes were elevated and a blood smear showed acanthocytes. MLS was confirmed by serological analysis of the Kell antigens. Analysis of red blood cells by flow cytometry revealed the patient and his grandson to have reduced Kell antigen expression. The patient's daughters had two populations of red cells, consistent with them being heterozygous for an XK0 allele. The molecular basis of MLS in this family is a novel mutation consisting of a 7453-bp deletion that includes exon 2 of the XK gene. This confirms that the patient's 7-year-old grandson, who is currently asymptomatic, also has the XK0 allele and is therefore likely to develop MLS.",alanine aminotransferase;antigen;aspartate aminotransferase;creatine kinase;genomic DNA;Kx antigen;lactate dehydrogenase;liver enzyme;unclassified drug;acanthocytosis;adult;aggression;allele;antigen expression;article;hematologic disease;blood group;blood group Kell system;blood smear;cardiomyopathy;case report;cell assay;chorea;clinical feature;dementia;disease association;disease course;electromyography;electroneurography;enzyme blood level;erythrocyte;exon;flow cytometry;gene deletion;gene location;gene mutation;hemizygosity;heterozygote;human;hypertranslucent lung;male;muscle disease;neurologic disease;nucleotide sequence;onset age;phenotype;polymerase chain reaction;priority journal;sequence analysis;serodiagnosis;symptom;X chromosome linked disorder,"Singleton, B. K.;Green, C. A.;Renaud, S.;Fuhr, P.;Poole, J.;Daniels, G. L.",2003,,,0,
4112,Calcified Amorphous Tumor Causing Shower Embolism to the Brain: A Case Report with Serial Echocardiographic and Neuroradiologic Images and a Review of the Literature,"An 89-year-old woman with chronic atrial fibrillation, hypertension, chronic heart failure, and dementia was admitted to our hospital due to multiple small cerebral and cerebellar infarctions. Transthoracic echocardiogram revealed a floating calcified mass lesion arising from the endocardium of the posterior portion of the mitral annulus with mitral annular calcification. Furthermore, the mass had a heterogeneity of the echogenicity. The mass was diagnosed as a calcified amorphous tumor based on specific echocardiographic features. Serial echocardiograms showed shrinkage and disappearance of the mass, and magnetic resonance image revealed new infarction in the left occipital lobe. Embolization of the mass appeared to cause systemic embolism.",Embolic stroke;calcified amorphous tumor;mitral annular calcification;shower emboli,"Singu, T.;Inatomi, Y.;Yonehara, T.;Ando, Y.",2017,May,,0,
4113,Veiled bacterial endocarditis: Case study,We report two case of infective endocarditis (IE) who were admitted and treated for other medical and surgical complications in the hospital. The first case was admitted for abdominal infection following seven month amenorrhea and the second case was admitted for bleeding esophageal varices. The risk factor in the first case was vaginal hysterectomy and mitral valve prolapse while in the second it was variceal sclerotherapy. Both patients developed infective endocarditis (IE) while being managed for their respective diseases. IE prophylaxis was not undertaken as the cardiac status at the time of admission was not available. Echocardiography played an important role in the diagnosis and management of both cases. We conclude that greater emphasis has to be placed in managing patients with cardiac condition undergoing any high risk upper gastrointestinal procedure/genitourinary procedure/abdominal surgeries.,ampicillin;antimalarial agent;cephalosporin;diuretic agent;gentamicin;hemoglobin;heparin;metronidazole;quinolone derivative;vancomycin;abdominal pain;acute kidney failure;adult;amenorrhea;amniotomy;anemia;article;assisted ventilation;bacterial endocarditis;bleeding;case report;chill;congestive heart failure;crackle;disease duration;drowsiness;echography;elevated blood pressure;erythrocyte transfusion;esophagus varices;female;fetus death;fever;foot edema;heart atrium enlargement;hemiparesis;hospital admission;human;hypoxic ischemic encephalopathy;hysterectomy;male;maternal hypertension;medical history;mental deterioration;middle aged;mitral valve prolapse;mitral valve regurgitation;mitral valve stenosis;oligohydramnios;placenta disorder;plasma transfusion;primigravida;restlessness;retro placental clot;sclerotherapy;septicemia;sinus tachycardia;splenomegaly;Staphylococcus aureus;tachycardia;thorax radiography;transthoracic echocardiography;vagina bleeding;vaginal delivery;young adult,"Sinha, A.;Shetkar, U. B.;Tewari, S. C.;Chandurkar, M. B.;Sinha, N. K.",2013,,,0,
4114,Angiotensin-converting enzyme inhibitors and cognitive decline in older adults with hypertension: Results from the cardiovascular health study,"Background: Hypertension (HTN) is a risk factor for dementia, and animal studies suggest that centrally active angiotensin-converting enzyme (ACE) inhibitors (those that cross the blood-brain barrier) may protect against dementia beyond HTN control. Methods: Participants in the Cardiovascular Health Study Cognition Substudy with treated HTN and no diagnosis of congestive heart failure (n=1054; mean age, 75 years) were followed up for a median of 6 years to determine whether cumulative exposure to ACE inhibitors (as a class and by central activity), compared with other anti-HTN agents, was associated with a lower risk of incident dementia, cognitive decline (by Modified Mini-Mental State Examination [3MSE]), or incident disability in instrumental activities of daily living (IADLs). Results: Among 414 participants who were exposed to ACEinhibitors and 640 who were not, there were 158 cases of incident dementia. Compared with other anti-HTN drugs, there was no association between exposure to all ACE inhibitors and risk of dementia (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.88-1.15), difference in 3MSE scores (-0.32 points per year; P=.15), or odds of disability in IADLs (odds ratio [OR], 1.06; 95% CI, 0.99-1.14). Adjusted results were similar. However, centrally activeACE inhibitors were associated with 65% less decline in 3MSE scores per year of exposure (P=.01), and noncentrally active ACE inhibitors were associated with a greater risk of incident dementia (adjusted HR, 1.20; 95% CI, 1.00-1.43 per year of exposure) and greater odds of disability in IADLs (adjusted OR, 1.16; 95% CI, 1.03-1.30 per year of exposure) compared with other anti-HTN drugs. Conclusions: While ACE inhibitors as a class do not appear to be independently associated with dementia risk or cognitive decline in older hypertensive adults, there may be within-class differences in regard to these outcomes. These results should be confirmed with a randomized clinical trial of a centrally active ACE inhibitor in the prevention of cognitive decline and dementia. ©2009 American Medical Association. All rights reserved.",acetylsalicylic acid;antihypertensive agent;benazepril;candesartan;captopril;dipeptidyl carboxypeptidase inhibitor;enalapril;fosinopril;lisinopril;moexipril;perindopril;quinapril;ramipril;trandolapril;ADL disability;aged;aging;antihypertensive therapy;article;cardiovascular disease;cognitive defect;congestive heart failure;dementia;female;follow up;geriatric patient;human;hypertension;major clinical study;male;Mini Mental State Examination;priority journal;treatment outcome,"Sink, K. M.;Leng, X.;Williamson, J.;Kritchevsky, S. B.;Yaffe, K.;Kuller, L.;Yasar, S.;Atkinson, H.;Robbins, M.;Psaty, B.;Goff Jr, D. C.",2009,,,0,
4115,Multimorbidity patterns in a primary care population aged 55 years and over,"BACKGROUND: To support the management of multimorbid patients in primary care, evidence is needed on prevalent multimorbidity patterns. OBJECTIVE: To identify the common and distinctive multimorbidity patterns. METHODS: Clinical data of 120480 patients (>/=55 years) were extracted from 158 general practices in 2002-11. Prevalence rates of multimorbidity were analyzed (overall, and for 24 chronic diseases), adjusted for practice, number of diseases and patients' registration period; differentiated between patients 55-69 and >/=70 years. To investigate multimorbidity patterns, prevalence ratios (prevalence rate index-disease group divided by that in the non-index-disease group) were calculated for patients with heart failure, diabetes mellitus, migraine or dementia. RESULTS: Multiple membership multilevel models showed that the overall adjusted multimorbidity rate was 86% in patients with >/=1 chronic condition, varying from 70% (migraine) to 98% (heart failure), 38% had >/=4 chronic diseases. In patients 55-69 years, 83% had multimorbidity. Numerous significant prevalence ratios were found for disease patterns in heart failure patients, ranging from 1.2 to 7.7, highest ratio for chronic obstructive pulmonary disease-cardiac dysrhythmia. For diabetes mellitus, dementia or migraine patients highest ratios were for heart failure-visual disorder (2.1), heart failure-depression (3.9) and depression-back/neck disorder (2.1), respectively (all P-values<0.001). CONCLUSIONS: Multimorbidity management in general practice can be reinforced by knowledge on the clinical implications of the presence of the comprehensive disease patterns among the elderly patients, and those between 55 and 69 years. Guideline developers should be aware of the complexity of multimorbidity. As a consequence of this complexity, it is even more important to focus on what matters to a patient with multimorbidity in general practice.","Aged;Arrhythmias, Cardiac/epidemiology;Back Pain/epidemiology;Chronic Disease;Comorbidity;Coronary Artery Disease/epidemiology;Dementia/*epidemiology;Depression/epidemiology;Diabetes Mellitus/*epidemiology;Female;General Practice/statistics & numerical data;Heart Failure/*epidemiology;Humans;Hypertension/epidemiology;Male;Middle Aged;Migraine Disorders/*epidemiology;Neck Pain/epidemiology;Osteoporosis/epidemiology;Prevalence;Pulmonary Disease, Chronic Obstructive/epidemiology;Stroke/epidemiology;Vision Disorders/epidemiology;general practice;multimorbidity;primary health care.","Sinnige, J.;Korevaar, J. C.;Westert, G. P.;Spreeuwenberg, P.;Schellevis, F. G.;Braspenning, J. C.",2015,Oct,10.1093/fampra/cmv037,0,
4116,Amyloid fibril protein nomenclature: 2012 recommendations from the Nomenclature Committee of the International Society of Amyloidosis,"The Nomenclature Committee of the International Society of Amyloidosis (ISA) met during the XIIIth International Symposium, May 610, 2012, Groningen, The Netherlands, to formulate recommendations on amyloid fibril protein nomenclature and to consider newly identified candidate amyloid fibril proteins for inclusion in the ISA Amyloid Fibril Protein Nomenclature List. The need to promote utilization of consistent and up to date terminology for both fibril chemistry and clinical classification of the resultant disease syndrome was emphasized. Amyloid fibril nomenclature is based on the chemical identity of the amyloid fibril forming protein; clinical classification of the amyloidosis should be as well. Although the importance of fibril chemistry to the disease process has been recognized for more than 40 years, to this day the literature contains clinical and histochemical designations that were used when the chemical diversity of amyloid diseases was poorly understood. Thus, the continued use of disease classifications such as familial amyloid neuropathy and familial amyloid cardiomyopathy generates confusion. An amyloid fibril protein is defined as follows: the protein must occur in body tissue deposits and exhibit both affinity for Congo red and green birefringence when Congo red stained deposits are viewed by polarization microscopy. Furthermore, the chemical identity of the protein must have been unambiguously characterized by protein sequence analysis when so is practically possible. Thus, in nearly all cases, it is insufficient to demonstrate mutation in the gene of a candidate amyloid protein; the protein itself must be identified as an amyloid fibril protein. Current ISA Amyloid Fibril Protein Nomenclature Lists of 30 human and 10 animal fibril proteins are provided together with a list of inclusion bodies that, although intracellular, exhibit some or all of the properties of the mainly extracellular amyloid fibrils. © 2012 Informa UK, Ltd.",actin;alpha synuclein;amylin;amyloid;amyloid precursor protein;amyloid protein;apolipoprotein A1;apolipoprotein A2;apolipoprotein A4;atrial natriuretic factor;beta 2 microglobulin;casein;congo red;cystatin C;fibrinogen;galectin 7;gelsolin;huntingtin;immunoglobulin heavy chain;immunoglobulin light chain;insulin;lactadherin;lactoferrin;lung surfactant;lysozyme;prealbumin;prion protein;procalcitonin;prolactin;serum amyloid A;Alzheimer disease;amyloidosis;article;birefringence;cardiomyopathy;cell inclusion;clinical classification;disease classification;familial amyloid polyneuropathy;familial amyloidosis;gene mutation;human;interstitial lung disease;medical society;medical terminology;melanosome;nomenclature;polarization microscopy;priority journal;protein analysis;secretory vesicle;sequence analysis,"Sipe, J. D.;Benson, M. D.;Buxbaum, J. N.;Ikeda, S. I.;Merlini, G.;Saraiva, M. J. M.;Westermark, P.",2012,,,0,
4117,Comparative effectiveness of cardioprotective drugs in elderly individuals with type 2 diabetes,"Summary Aims Although many elderly individuals suffer from type 2 diabetes, the effectiveness of cardioprotective drugs in primary prevention of cardiovascular events in clinical practice in this population has rarely been evaluated. We aimed to assess the effectiveness of, (i) angiotensin converting enzyme inhibitors or angiotensin receptor blockers, (ii) statins, (iii) antiplatelet drugs and (iv) the combination of these three drugs, in the prevention of myocardial infarction (MI) and stroke in elderly individuals with type 2 diabetes. Methods Using Quebec administrative databases, we conducted nested case-control analyses among a cohort of 17,384 individuals without a history of cardiovascular disease. Individuals were aged ≥ 66 years, newly treated with oral antidiabetes drugs and had not used any of the three above classes of cardioprotective drugs in the year before cohort entry. For each case (MI/stroke during follow-up), five controls were matched for age, year of cohort entry and sex. Use of each drug and of their combination was defined as current, past or no use. We calculated adjusted odds ratios (AOR) of MI/stroke. Results We observed no reduction in the MI/stroke risk for users of ACEI/ARB nor for users of the three drugs combination. Longer exposure to statins was associated with a lower risk (AOR for every 30 days of therapy: 0.97; 95% CI: 0.96-0.99). By contrast, current use of antiplatelet drugs was associated with an increased risk of MI/stroke (1.40; 1.12-1.75). Conclusion The benefit of cardioprotective drugs in primary prevention was not clear in this cohort of elderly individuals with type 2 diabetes. A short duration of exposure to these drugs might explain the lack of benefit.",angiotensin receptor antagonist;antilipemic agent;antithrombocytic agent;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;oral antidiabetic agent;aged;aging;Alzheimer disease;article;Canada;cardiovascular disease;cerebrovascular accident;chronic obstructive lung disease;clinical practice;cohort analysis;controlled study;depression;drug efficacy;female;heart infarction;heart protection;human;hypertension;ICD-9;kidney disease;liver cirrhosis;major clinical study;male;non insulin dependent diabetes mellitus;obesity;primary prevention;priority journal;rural area;treatment duration;urban area;very elderly,"Sirois, C.;Moisan, J.;Poirier, P.;Grégoire, J. P.",2015,,,0,
4118,Characteristics of acute kidney injury of senile patients and evaluation of blood purification treatment,"Objective: To investigate the characteristics and treatment of acute kidney injury (AKI) of senile patients. Methods: A total of 150 cases of AKI treated from January 2009 to December 2014 were retrospectively analyzed. All cases accorded with the diagnosis criteria of AKI of KDIGO. Accompanied diseases, severity of diseases, and 60-day fatality rate of patients older than 80 years and younger than 60 years were compared. Biochemical indexes and blood pressure of patients before and after blood purification were monitored and risk factors of mortality of two groups were analyzed. Results: Among 150 patients, 91 of them were older than 80 years (senile group) with average age of (88.6±5.0) years and 59 of them were younger than 60 years (adult group) with average age of (44.3±12.6) years. Accompanied diseases of the senile group were primary hypertension, coronary heart disease, and diabetes mellitus, while those of the adult group were acute or chronic nephritis, malignant tumor, systemic autoimmunity disease, and obstructive nephropathy. And 27.1% of patients of the adult group did not have any accompanied diseases. Diseases of the senile group were severer than those of the adult group. APACHE III scores, rate of medical ventilation, and the incidence of sepsis, hypotension, and MODS of the senile group were significantly higher than those of the adult group (P<0.001). In the senile group, 94.5% of patients underwent bedside slow low-efficiency daily dialfiltration (SLEDD-f) therapy, while 93.2% of patients of the adult group accepted intermediate hemodialysis (IHD). The differences of systolic and diastolic pressures between two groups before treatment were statistically significant, but after blood purification, the differences between two groups were not statistically significant. The serum creatinine and HCO-3 levels within the group before and after treatment were significantly different. The 60-day fatality rate of the senile group was 65.9%, which was significantly higher than that of the adult group (30.5%, P<0.01). The risk factors of mortality of two groups were APPECH III scores, MODS, and age. Conclusion: Diseases of senile patients with AKI were severer than those of the adult patients and the fatality rate of senile patients was higher due to decreased renal function and more accompanied diseases. Comprehensive treatment is more suitable for senile patients with complications and unstable hemodynamic indexes.",acute kidney failure;adult;aged;APACHE;article;artificial ventilation;autoimmune disease;blood pressure;blood purification;chronic kidney disease;comparative study;controlled study;diabetes mellitus;disease severity;hematological procedure;hemodialysis patient;human;hypertension;hypotension;ischemic heart disease;major clinical study;malignant neoplastic disease;mortality;retrospective study;risk factor;senility;sepsis;very elderly,"Situ, B. Y.;Yan, J. L.;Sun, J. S.;Ye, Z. B.",2015,,,0,
4119,Vascular risk factors and intensity of cognitive dysfunction in MCI,"Patients with Mild Cognitive Impairment (MCI) have a greater risk of developing dementia than general population. Lots of evidence suggests that cardiovascular risk factors appear more often in the MCI than in general population The aim of this study was to evaluate association between cardiovascular risk factors and intensity of cognitive impairment in MCI patients. We evaluated 24 MCI patients (9 women and 15 men) fulfilling Mayo Clinic Group Criteria. Taking under consideration presence of cardiovascular diseases patients were divided into two groups: first group (n=16) MCI with cardiovascular diseases and second group (n=8) MCI without cardiovascular disorders. Cognitive functions were assessed by neuropsychological tests battery including MMSE, Clock Drawing Test, Trail Making Test (TMT), Verbal Fluency Test with letters FAS, Auditory Verbal Learning Test (AVLT). In the MCI group with vascular risk factors we have found more distinct dysfunction of learning new information, recall and short-term memory than in MCI patients without vascular pathology. In conclusion we may suggest that more distinct cognitive deficit may indicate higher risk of developing dementia, that is why patients with MCI should be under special supervision, with at least annual neuropsychological evaluation.",Aged;Cerebrovascular Disorders/epidemiology/physiopathology/psychology;Cognition Disorders/diagnosis/*epidemiology/physiopathology;Comorbidity/trends;Coronary Artery Disease/epidemiology/physiopathology/psychology;Dementia/diagnosis/*epidemiology/physiopathology;Female;Humans;Hyperlipidemias/epidemiology/physiopathology/psychology;Hypertension/epidemiology/physiopathology/psychology;Male;Memory Disorders/diagnosis/epidemiology/physiopathology;Neuropsychological Tests;Predictive Value of Tests;Prognosis;Risk Factors;Smoking/epidemiology;Vascular Diseases/*epidemiology/physiopathology/*psychology,"Siuda, J.;Gorzkowska, A.;Opala, G.;Ochudlo, S.",2007,Jun 15,10.1016/j.jns.2007.01.034,0,
4120,"Designation, diligence and drift: understanding laboratory expenditure increases in British Columbia, 1996/97 to 2005/06","Laboratory testing is one of the fastest growing areas of health services spending in Canada. We examine the extent to which increases in laboratory expenditures might be explained by testing that is consistent with guidelines for the management of chronic conditions, by analyzing fee-for-service physician payment data in British Columbia from 1996/97 and 2005/06. We used direct standardization to quantify the effect on laboratory expenditures from changes in: fee levels; population growth; population aging; treatment prevalence; expenditure on recommended tests for those conditions; and expenditure on other tests. The chronic conditions selected were those with guidelines containing laboratory recommendations developed by the BC Guidelines and Protocol Advisory Committee: diabetes, hypertension, congestive heart failure, renal failure, liver disease, rheumatoid arthritis, osteoarthritis and dementia. Laboratory service expenditures increased by $98 million in 2005/06 compared to 1996/97, or 3.6% per year after controlling for population growth and aging. Testing consistent with guideline-recommended care for chronic conditions explained one-third (1.2% per year) of this growth. Changes in treatment prevalence were just as important, contributing 1.5% per year. Hypertension was the most common condition, but renal failure and dementia showed the largest changes in prevalence over time. Changes in other laboratory expenditure including for those without chronic conditions accounted for the remaining 0.9% growth per year. Increases in treatment prevalence were the largest driver of laboratory cost increases between 1996/97 and 2005/06. There are several possible contributors to increasing treatment prevalence, all of which can be expected to continue to put pressure on health care expenditures.",adolescent;adult;aged;article;Canada;child;chronic disease;diagnostic test;economics;health care cost;human;infant;medical fee;middle aged;population growth;practice guideline;preschool child;public health;very elderly,"Sivananthan, S. N.;Peterson, S.;Lavergne, R.;Barer, M. L.;McGrail, K. M.",2012,,,0,
4121,Role of reactive oxygen species and antioxidants in atopic dermatitis,"BACKGROUND: In humans, oxidative stress is involved in many diseases such as atherosclerosis, Parkinson's disease, heart failure, myocardial infarction, Alzheimer's disease, Fragile X syndrome and chronic fatigue syndrome. Atopic dermatitis (AD), also known as atopic eczema, is a non-contagious, relapsing inflammatory skin disease which is characterized by eczema and pruritus. The skin reacts abnormally to irritants, food and environmental allergens and it becomes very itchy, which leads to scratching, redness and flaky skin. Very little study has been done to find out the relationship between oxidative stress and Atopic dermatitis. AIM: The aim of our work was to evaluate the status of oxidative stress in patients of Atopic dermatitis in comparison with healthy control subjects. MATERIAL AND METHODS: Twenty five patients of known Atopic dermatitis and 25 normal healthy controls of same age group were included in the study. Estimations of oxidants like Malondialdehyde (MDA), enzymatic antioxidants like Superoxide dismutase (SOD), Catalase, Glutathione peroxidase (GPX) and non-enzymatic antioxidants like reduced Glutathione (GSH), Vitamin A, Vitamin E and Vitamin C were done to assess the oxidative stress. RESULTS: Atopic dermatitis patients were more prone to damage caused by Reactive Oxygen Species (ROS) or Oxidants, than controls, which was evident from an increase of Malondialdehyde and a decrease of enzymatic and non enzymatic Antioxidants. CONCLUSION: Antioxidants may possibly be beneficial in the treatment of Atopic dermatitis, which must be substantiated by further studies.",Antioxidants;Atopic dermatitis;Oxidative stress;Reactive oxygen species (ROS),"Sivaranjani, N.;Rao, S. V.;Rajeev, G.",2013,Dec,10.7860/jcdr/2013/6635.3732,0,
4122,Functional limitations of upper limbs in older diabetic individuals. The Italian longitudinal study on aging,"Background and aims: This study aimed at assessing the prevalence rate of symptoms of shoulder osteoarthritis in diabetic subjects and their possible associations, as part of the prospective study called ILSA (Italian Longitudinal Study on Aging). Methods: The study examined 5632 individuals aged 65-84 years, living either independently or in institutions. Of the above number, 2109 subjects were examined in the 1996 follow-up, with evaluation of the diabetic status and osteoarthritis symptoms (at least one of the following sites: hand, knee, shoulder, hip). Associations between diabetes and osteoarthritis symptoms were examined by means of the X2 test or the non-parametric Wilcoxon rank-sum test. Relationships of diagnoses of osteoarthritis and possible risk factors were analysed by multinomial logistic regression, adjusting for significant interactions. Results: Only for shoulders did osteoarthritis symptoms reveal a significant association with diabetes (p=0.0107). Significant risk factors for shoulder osteoarthritis were gender, age, completed years of schooling, BMI and diabetes. A woman of ≤76 years was 3.3 times more likely to have definite osteoarthritis and almost 2 times more likely to have possible osteoarthritis than a man of similar age. A man of over 76 years was estimated to be 3.5 times as likely to have definite osteoarthritis and almost 1.6 times more likely to have possible osteoarthritis than a younger man. Conclusions: It was concluded that the high prevalence rates of osteoarthritis symptoms in diabetic patients should be a major concern when planning treatment, because they might lead to a reduction in physical exercise, due to joint pain. Common pathophysiological pathways should be identified, such as RANKL/OPG and inflammation markers, to explain the independent association of these disabling conditions. ©2009, Editrice Kurtis.",biological marker;osteoclast differentiation factor;aged;aging;angina pectoris;arm movement;arthralgia;article;body mass;coxitis;dementia;diabetes mellitus;diabetic patient;disease association;educational status;exercise;female;follow up;functional disease;gender;hand;heart failure;heart infarction;human;hypertension;inflammation;knee arthritis;major clinical study;male;neuropathy;osteoarthritis;Parkinson disease;pathophysiology;prevalence;prospective study;risk assessment;risk factor;shoulder disease;cerebrovascular accident,"Siviero, P.;Tonin, P.;Maggi, S.",2009,,,0,
4123,A follow-up study of five cases of aluminosis,"Five men were investigated after having pulmonary aluminosis due to exposure to aluminium pyrotechnic flake powder during the late 1940s. Two of the men had died 6 years and 20 years after exposure respectively, due to their lung disease. One man had died from heart failure 34 years after the end of exposure. Today, more than 40 years after exposure, two men were available for investigation. They had no respiratory symptoms and their vital lung capacities had not deteriorated during these years. One of the two survivors had developed a dementia with motor disturbances, which is not consistent with Alzheimer's dementia. This man had a very high concentration of aluminium in his cerebrospinal fluid. The other survivor had a normal concentration and was not demented.",aluminum;adult;aged;aluminosis;article;cerebrospinal fluid level;clinical article;dementia;follow up;heart failure;human;lung capacity;lung disease;male;motor dysfunction;occupational exposure;patient;symptom,"Sjögren, B.;Ljunggren, K. G.;Almkvist, O.;Frech, W.;Basun, H.",1996,,,0,
4124,Lifetime social stresses cause disease 2,,hydrocortisone;Alzheimer disease;avoidance behavior;chronic fatigue syndrome;dementia;depression;doctor patient relation;exercise;fear;fibromyalgia;hippocampus;human;hydrocortisone blood level;ischemic heart disease;letter;lifespan;low back pain;massage;mental disease;muscle fatigue;myalgia;neurochemistry;physiotherapy;priority journal;psychology;schizophrenia;social aspect;social problem;symptom,"Skelly, M.",2001,,,0,
4125,Diagnostic errors in older patients: a systematic review of incidence and potential causes in seven prevalent diseases,"BACKGROUND: Misdiagnosis, either over- or underdiagnosis, exposes older patients to increased risk of inappropriate or omitted investigations and treatments, psychological distress, and financial burden. OBJECTIVE: To evaluate the frequency and nature of diagnostic errors in 16 conditions prevalent in older patients by undertaking a systematic literature review. DATA SOURCES AND STUDY SELECTION: Cohort studies, cross-sectional studies, or systematic reviews of such studies published in Medline between September 1993 and May 2014 were searched using key search terms of ""diagnostic error"", ""misdiagnosis"", ""accuracy"", ""validity"", or ""diagnosis"" and terms relating to each disease. DATA SYNTHESIS: A total of 938 articles were retrieved. Diagnostic error rates of >10% for both over- and underdiagnosis were seen in chronic obstructive pulmonary disease, dementia, Parkinson's disease, heart failure, stroke/transient ischemic attack, and acute myocardial infarction. Diabetes was overdiagnosed in <5% of cases. CONCLUSION: Over- and underdiagnosis are common in older patients. Explanations for over-diagnosis include subjective diagnostic criteria and the use of criteria not validated in older patients. Underdiagnosis was associated with long preclinical phases of disease or lack of sensitive diagnostic criteria. Factors that predispose to misdiagnosis in older patients must be emphasized in education and clinical guidelines.",elderly;misdiagnosis;older patient;overdiagnosis;underdiagnosis,"Skinner, T. R.;Scott, I. A.;Martin, J. H.",2016,,10.2147/ijgm.s96741,0,
4126,Hypertension and related factors in the etiology of Alzheimer's disease,"The prevalence of hypertension is estimated to approach 50% in individuals above age 70. The consequences of hypertension include cerebrovascular disease, coronary heart disease, and general atherosclerosis. Several recent studies suggest that there may be an association also between hypertension and Alzheimer's disease (AD). This review will examine the evidence for this association and possible pathways between hypertension, Alzheimer encephalopathy, and clinical dementia.",Aged;Aging;Alzheimer Disease/*etiology/pathology/prevention & control;Antihypertensive Agents/therapeutic use;Arteriosclerosis/etiology;Brain/*blood supply/*pathology;Coronary Disease/etiology;Humans;Hypertension/*complications/drug therapy/physiopathology;Prevalence;Stroke/etiology,"Skoog, I.;Gustafson, D.",2002,Nov,,0,
4127,Update on hypertension and Alzheimer's disease,"Several studies report that blood pressure is increased in victims of Alzheimer's disease (AD) decades before the onset of the disease. Years before onset of Alzheimer's disease, blood pressure start to decrease and continues to decrease during the disease process. High blood pressure has also been related to pathological manifestations of Alzheimer's disease (senile plaques, neurofibrillary tangles, hippocampal atrophy). The exact mechanism behind these associations is not clear. Hypertension is also a risk factor for stroke, ischemic white matter lesions, silent infarcts, general atherosclerosis, myocardial infarction and cardiovascular diseases, and often clusters with other vascular risk factors, including diabetes mellitus, obesity and hypercholesterolemia. Also these risk factors have been related to Alzheimer's disease. Hypertension may thus cause cerebrovascular disease that may increase the possibility for individuals with AD encephalopathy to express a dementia syndrome. Hypertension may also lead to vessel wall changes in the brain, leading to hypoperfusion, ischemia and hypoxia which may initiate the pathological process of AD. Finally, subclinical AD may lead to increased blood pressure, and similar biological mechanisms may be involved in the pathogenesis of both disorders. Hypertension is a common disorder and often untreated. Several observational studies have reported that use of antihypertensives decreases risk of AD. Even though hypertension only results in a moderately increased risk of AD, or overall dementia, better treatment of hypertension may have an immense effect on the total number of demented individuals. © 2006 W. S. Maney & Son Ltd.",angiotensin receptor antagonist;antihypertensive agent;apolipoprotein E4;atenolol;beta adrenergic receptor blocking agent;calcium channel blocking agent;candesartan hexetil;chlortalidone;cholinesterase inhibitor;dipeptidyl carboxypeptidase inhibitor;diuretic agent;indapamide;nitrendipine;perindopril;placebo;adult;aged;Alzheimer disease;antihypertensive therapy;article;blood pressure;brain atrophy;brain blood flow;brain blood vessel;cerebrovascular disease;cognitive defect;controlled study;dementia;disease association;disease severity;hippocampus;human;hypertension;major clinical study;neurofibrillary tangle;neuroimaging;neuropathology;nuclear magnetic resonance imaging;pathogenesis;risk factor;cerebrovascular accident;treatment outcome,"Skoog, I.;Gustafson, D.",2006,,,0,
4128,Increased mortality in partners of female myocardial infarction patients,"BACKGROUND: Many studies have been performed on the impact of Alzheimer's disease, stroke and cancer on carers. Information on the influence of a myocardial infarction in a patient on the health of the partner is still scarce. METHODS: Exposed and non-exposed partners were compared with respect to the occurrence of mortality and predefined diseases, using Cox proportional hazards survival analysis. RESULTS: None of the disease incidence rates differed between exposed partners and control partners. Over 12 times as many male partners of (female) heart patients died as compared to their male control partners, when they had a low educational level. CONCLUSION: When exposed to myocardial infarction in a patient, the risk of dying in low educated male partners was over 12 times as large as for male low educated unexposed partners.",*Caregivers;Female;Humans;Male;Middle Aged;Mortality/*trends;*Myocardial Infarction;National Health Programs;Netherlands;Proportional Hazards Models;Survival Analysis,"Skrotzki, T. M.;van den Akker, M.;Kester, A. D.;Buntinx, F.",2005,Dec,10.1093/fampra/cmi070,0,
4129,Multiple protective functions of sigma1 receptor,"The Sigma Receptor 1 (sig-1R) is a protein present in numerous normal tissues, such as brain, retina, lens, liver, lung, heart, but also in many tumor lines. Its amino acid sequence is homologous to fungal C-8,7 sterol isomerase, but it has no known homology with mammalian proteins and does not possess sterol isomerase activity. It is localized in plasma and ER membranes, and its exact function is not clarified as of yet. Last reports point to its participation in regulation of ionic channels activity, particularly calcium channels. Application of numerous synthetic ligands of sigma1 receptor provided means to study its protective effects and metabolic functions in different tissues. This review describes influence of sigma1 receptor on various aspects of cellular metabolism, such as calcium signalling, mitochondrial functions, oxidative stress, survival and apoptotic pathways, and tumor cells proliferation.",acid sensing ion channel;calcium;calcium channel;complement component C7;complement component C8;epidermal growth factor;glucose regulated protein;immunoglobulin enhancer binding protein;isomerase;manganese superoxide dismutase;mitogen activated protein kinase;n methyl dextro aspartic acid receptor;protein kinase B;pyruvate dehydrogenase;reactive oxygen metabolite;reduced nicotinamide adenine dinucleotide phosphate;sigma 1 opiate receptor;sodium channel;voltage dependent anion channel;Alzheimer disease;amino acid sequence;antiarrhythmic activity;antiinflammatory activity;antineoplastic activity;apoptosis;article;brain injury;brain ischemia;calcium metabolism;calcium signaling;cardiovascular system;cell metabolism;cell survival;central nervous system;dopamine uptake;endoplasmic reticulum membrane;eye protection;heart ventricle hypertrophy;human;lens;liver;liver protection;mitochondrion;neuroprotection;oxidative stress;protein expression;protein function;retina;sequence homology;tissue injury;tumor growth,"Skrzycki, M.;Czeczot, H.",2014,,,0,
4130,Criteria of death and time of death--do Norwegian physicians follow laws and regulations?,"In Norway, death is defined as total and irreversible damage of the whole central nervous system. This means that the time of death is some minutes after circulatory arrest. The time lapse may vary from about five minutes up to 45 minutes, depending on the temperature in the brain when the circulation ceased. Five cases of spontaneous circulation after cessation of resuscitation are described. All the patients had asystoly, diagnosed on ECG by anaesthesiologists. The resuscitation had lasted for 30 minutes when the crew of the ambulance, which included a doctor, gave up. Two of the patients left the hospital alive, three died after some hours. One of the patients had no cerebral sequelae, the other developed dementia. Circulation may also start spontaneously after the doctor has diagnosed circulatory arrest in patients suffering from suffocation and exsanguination.",aged;article;brain death;case report;death;death certificate;female;heart arrest;human;legal aspect;male;middle aged;Norway;pathophysiology;resuscitation;time,"Skulberg, A.",1991,,,0,
4131,Diagnostic value of MIBG cardiac scintigraphy for differential dementia diagnosis,"Objective Iodine-123 metaiodobenzylguanidine (MIBG) cardiac scintigraphy has shown the potential to discriminate dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). However, these studies did not reflect clinical practice, as patients with ischemic heart disease, heart failure, diabetes mellitus, arterial hypertension, and hyperlipidemia and patients treated with antidepressants like trazodone were excluded. Methods This study aimed to evaluate the use of MIBG cardiac scintigraphy to diagnose DLB in clinical practice. Moreover, the potential diagnostic value of MIBG cardiac scintigraphy in patients with clinically ambiguous dementia diagnosis (DLB versus AD) was tested. Eighty-five patients with a possible clinical diagnosis of DLB entered the study. MIBG uptake was determined by calculating the heart-to-mediastinum-uptake ratio (H/M). Results The average H/M ratio was 1.42 ± 0.35. The number of core features for DLB and the H/M ratio were negatively correlated (p = 0.001; r = -0.360). With an H/M ratio cutoff of 1.68 in 20 patients with clinically ambiguous dementia diagnoses (DLB versus AD) at the moment of MIBG cardiac scintigraphy, 95% (19/20) of the patients were correctly classified as compared with clinical or definite diagnosis at follow-up, with sensitivity and specificity values for diagnosing DLB of 100% (16/16) and 75% (3/4), respectively. The H/M ratio was influenced only by age (p = 0.046; r = -0.217) and gender (p = 0.024) and not by any other variable studied. Conclusions The MIBG cardiac scintigraphy H/M ratio is a possible diagnostic biomarker for DLB in routine clinical practice and might have an added diagnostic value in case of doubt between DLB and AD.",(3 iodobenzyl)guanidine i 123;haloperidol;trazodone;aged;Alzheimer disease;article;clinical practice;collimator;computed tomography scanner;controlled study;diagnostic accuracy;diagnostic test accuracy study;diagnostic value;diffuse Lewy body disease;female;heart scintiscanning;human;hyperlipidemia;hypertension;ischemic heart disease;major clinical study;male;mediastinum;non insulin dependent diabetes mellitus;sensitivity and specificity;thyroid disease;very elderly;Philips XCT scanner;Varicam scanner,"Slaets, S.;Van Acker, F.;Versijpt, J.;Hauth, L.;Goeman, J.;Martin, J. J.;De Deyn, P. P.;Engelborghs, S.",2015,,,0,
4132,Anecortave acetate (15 milligrams) versus photodynamic therapy for treatment of subfoveal neovascularization in age-related macular degeneration,"Purpose: To compare 1-year safety and efficacy of anecortave acetate 15 mg with photodynamic therapy (PDT) with verteporfin in patients eligible for initial PDT treatment. Design: Prospective, masked, randomized, multicenter, parallel group, active control, noninferiority clinical trial. Participants: Five hundred thirty patients with predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration were randomized to treatment with either anecortave acetate 15 mg or PDT. Methods: In the anecortave acetate group, the drug was administered under the Tenon's capsule as a periocular posterior juxtascleral depot (PJD) at the beginning of the study and at month 6. Before the first administration of anecortave acetate, patients in this treatment group received a sham PDT treatment, and sham PDT treatments were repeated every 3 months if there was evidence of leakage on fluorescein angiography (FA). Patients assigned to PDT received up to 4 PDT treatments at 3-month intervals, as needed based upon FA, and a sham PJD procedure at the beginning of the study and at month 6. Best-corrected visual acuity was determined at baseline and all follow-up visits. Safety data were regularly reviewed by an independent safety committee. Main Outcome Measure: Percent responders (patients losing <3 lines of vision) at month 12. Results: Percent responders in the anecortave acetate and PDT groups were 45% and 49%, respectively (not statistically different, P = 0.43). The confidence interval (CI) for the difference ranged from -13.2% favoring PDT to +5.6% favoring anecortave acetate. The month 12 clinical outcome for anecortave acetate was improved in patients for whom reflux was controlled and who were treated within the 6-month treatment window (57% vs. 49%; 95% CI, -4.3% favoring PDT to +21.7% favoring anecortave acetate). No serious adverse events related to the study drug were reported in either treatment group. Conclusions: The safety and efficacy outcomes in this study demonstrate that the benefits of anecortave acetate for the treatment of choroidal neovascularization outweigh the risks associated with either the drug or the PJD administration procedure. © 2006 by the American Academy of Ophthalmology.",anecortave;benzoporphyrin derivative;acute kidney failure;acute respiratory failure;adult;apnea;arthritis;article;backache;bipolar disorder;brain infarction;cerebrovascular accident;chronic obstructive lung disease;clinical trial;comparative study;confidence interval;controlled clinical trial;controlled study;dementia;drug efficacy;drug safety;emphysema;female;fever;fluorescence angiography;follow up;gastrointestinal carcinoma;gastrointestinal hemorrhage;heart arrest;heart arrhythmia;heart failure;heart infarction;heart muscle ischemia;human;infection;leukemia;liver cell carcinoma;lung carcinoma;lung edema;lung embolism;major clinical study;male;multicenter study;neovascularization (pathology);optic neuritis;outcome assessment;pathologic fracture;photodynamic therapy;pneumonia;priority journal;prospective study;randomized controlled trial;retina hemorrhage;age related macular degeneration;risk assessment;statistical analysis;thorax pain;tuberculosis;vision;visual acuity;visual disorder;vitreous hemorrhage,"Slakter, J. S.;Bochow, T.;D'Amico, D. J.;Marks, B.;Jerdan, J.;Sullivan, E. K.",2006,,,0,
4133,Heart failure treatment: the state of Austrian clinical practice--the Cor survey. Cor Survey Study Group,"The aim of this observational study was to evaluate how patients with heart failure (HF) are treated in Austria and which variables may influence usage and dosage of angiotensin-converting enzyme (ACE) inhibitors. One hundred fifty-five hospital departments throughout Austria took part by responding to questionnaires on 4331 patients with a primary or secondary diagnosis of HF who were discharged during November 1996. A total of 1896 patients (44%) were taking an ACE inhibitor at admission, 868 (20%) patients were started on ACE inhibitor therapy in the hospital, and 64% were discharged while taking an ACE inhibitor. Triple therapy (ACE inhibitor, glycoside, and diuretic) was used in 34% of the patients. Conditions favoring ACE inhibitor therapy were hypertension (77%), diabetes (75% insulin-dependent, 70% non-insulin dependent), and age below 75 years (71%). Functional stage, gender, presence of chronic obstructive pulmonary disease or atrial fibrillation, and a history of stroke had little influence on the prescription of ACE inhibitors. They were used infrequently and, if so, in low doses in patients with a serum creatinine levels above 2.0 mg/dL, the aged, or those with dementia. Geographic location also affected medication use. More educational efforts and more scientific evidence on the issue of adequacy of different doses will be needed in order to take full advantage of the beneficial potential of ACE inhibitors in the therapy of patients with HF in the future.","Aged;Aged, 80 and over;Angiotensin-Converting Enzyme Inhibitors/administration & dosage/*therapeutic use;Austria/epidemiology;Cross-Sectional Studies;Female;Health Care Surveys;Heart Failure/*drug therapy/epidemiology;Humans;Male;Middle Aged","Slany, J.",1998,May,,0,
4134,The Impact of MRI white matter hyperintensities on dementia in parkinson's disease in relation to the homocysteine level and other vascular risk factors,"Background: The role of white matter hyperintensities (WMH) and homocysteine (Hcy) and other vascular risk factors in the pathogenesis of Parkinson's disease (PD) dementia (PDD) remains unclear. Objective: The aim of the study was to assess the impact of WMH, Hcy and other biochemical and vascular risk factors on PDD. Methods: A total of 192 patients with PD and 184 age-and sex-matched healthy controls were included. A semistructured interview was used to assess demographic and clinical variables with respect to vascular risk factors (arterial hypertension, diabetes mellitus, atrial fibrillation, ischemic heart disease, obliterative atherosclerosis, hypercholesterolemia, smoking, alcohol intake). Unified Parkinson's Disease Rating Scale score, Hoehn-Yahr staging and the Schwab-England activities of daily living scale were used to assess motor abilities and activities of daily living. A complex neuropsychological examination with a battery of tests was used to classify patients into a group with dementia (PDD) and a group without dementia (PD). Neuroradiological examination of MRI scans included visual rating scales for WMH (according to the Wahlund and Erkinjunntti rating scales) and the Scheltens scale for hippocampal atrophy. Blood samples for Hcy, folate, vitamin B12, fibrinogen, lipids, glucose, creatinine, transaminases and thyroid stimulating hormone (TSH) were examined. Results: Among all patients, 57 (29.7%) fulfilled the diagnostic criteria for dementia. Significantly higher Hcy plasma levels were noted in PD and PDD groups compared to controls (p < 0.05) and in PDD when compared to PD (p < 0.05). According to multivariate regression analysis, WMH (Erkinjuntti scale), high Hcy, low vitamin B12 and folate plasma levels were independent risk factors for PDD. Vascular risk factors did not play any role in the pathogenesis of PDD and WMH. Conclusions: WMH along with Hcy, folate and vitamin B12 may impact cognition in PD. Therapy with vitamin B12, folate and catechol-O-methyltransferase inhibitors may play a potential protective role against PDD.",aminotransferase;catechol methyltransferase inhibitor;creatinine;cyanocobalamin;fibrinogen;folic acid;glucose;homocysteine;levodopa;lipid;thyrotropin;activity of daily living assessment;adult;aged;alcohol consumption;article;atherosclerosis;Beck Depression Inventory;blood sampling;brain atrophy;controlled study;dementia;diabetes mellitus;female;atrial fibrillation;hippocampus;human;hypercholesterolemia;hypertension;ischemic heart disease;major clinical study;male;Mini Mental State Examination;motor performance;neuroradiology;nuclear magnetic resonance imaging;Parkinson disease;priority journal;rating scale;risk factor;semi structured interview;smoking;Unified Parkinson Disease Rating Scale;white matter,"Sławek, J.;Roszmann, A.;Robowski, P.;Dubaniewicz, M.;Sitek, E. J.;Honczarenko, K.;Gorzkowska, A.;Budrewicz, S.;Mak, M.;Gołąb-Janowska, M.;Koziorowska-Gawron, E.;Droździk, M.;Kurzawski, M.;Bandurski, T.;Białecka, M.",2014,,,0,
4135,Vascular risk factors do not contribute to motor and cognitive impairment in Parkinson's disease,,levodopa;adult;aged;alcohol consumption;arterial wall thickness;carotid artery;cerebrovascular disease;cognitive defect;controlled study;dementia;diabetes mellitus;echoencephalography;female;atrial fibrillation;heart failure;human;hypertension;letter;major clinical study;male;mild cognitive impairment;motor dysfunction;Parkinson disease;priority journal;risk factor;smoking;transient ischemic attack,"Sławek, J.;Wieczorek, D.;Derejko, M.;Dubaniewicz, M.;Brockhuis, B.;Sitek, E.;Wilczewska, L.;Roszmann, A.;Lass, P.",2010,,,0,
4136,Underutilization of aspirin for secondary prophylaxis of cardiovascular disease in a long-term-care facility 2,,acetylsalicylic acid;adult;aged;Alzheimer disease;angina pectoris;cardiovascular disease;health care facility;heart infarction;high risk population;human;letter;long term care;major clinical study;mortality;nursing home;priority journal;prophylaxis;cerebrovascular accident;transient ischemic attack,"Sleeper, R. B.;Rojas-Fernandez, C.",2002,,,0,
4137,Short-term survival in elderly patients hospitalized for heart failure: The role of diabetes mellitus and newly recognized hyperglycemia: Letters to the editor,,aged;aged hospital patient;dementia;diabetes mellitus;disease association;female;heart failure;human;hyperglycemia;letter;major clinical study;male;mortality;prediction;prognosis;risk assessment;survival,"Sleiman, I.;Rozzini, R.;Giordano, A.;Trabucchi, M.",2009,,,0,
4138,Psychiatric and somatic complications and pharmacological treatment in patients with dementia,"One hundred and one patients with dementia, treated at Psychiatric department of GH Bjelovar were studied regarding the sort and frequency of complications, the evidence of other psychiatric or physical illnesses and psychopharmacological therapy. Of all the patients diagnosed with dementia, 21.78% were diagnosed with primary dementia, 70.3% with secondary dementia and 7.92%0 with combined (both primary and secondary) dementia. The number of patients diagnosed with vascular and primary dementia and the number of the registered complications vs. the so called other psychiatric diagnoses accompanying dementia reflects the difficulties in diagnosing Alzheimer's disease and the complications of dementia. The results of therapy are thoroughly discussed. © Medicinska naklada - Zagreb, Croatia.",anticonvulsive agent;antidepressant agent;atypical antipsychotic agent;benzodiazepine derivative;cholinesterase inhibitor;haloperidol;hypnotic agent;maprotiline;neuroleptic agent;oxazepam;promazine;risperidone;serotonin uptake inhibitor;Alzheimer disease;article;cardiovascular disease;cerebrovascular disease;chronic obstructive lung disease;controlled study;Croatia;delirium;dementia;depression;gastrointestinal disease;heart arrhythmia;heart failure;human;hypertension;kidney disease;lung disease;major clinical study;mental disease;multiinfarct dementia;neurologic disease;physical disease;psychiatric department;psychosis,"Slijepčević, M. K.;Čatipović, V.",2004,,,0,
4139,Effect of Alzheimer disease on the cost of treating other diseases,"The authors' objective is to determine the effect of diagnosed Alzheimer disease (AD) on cost to Medicare of treating other diseases. Using the 1994 National Long-Term Care Survey merged with Medicare claims and death data, the authors assessed the relative cost to Medicare of covering beneficiaries over 1994-1995 with diagnosed AD relative to other elderly population. They focused on hospitalizations during 1994-1995 for hip fracture, stroke, coronary heart disease, congestive heart failure, and pneumonia. The authors determined whether differences in Medicare payments by AD status mainly reflected differences in rates of occurrence of hospitalizations for the five primary diagnoses, other primary diagnoses, or death during 1994-1995 or in spending given the adverse events. During 1994-1995, an average of $15,700 was spent by Medicare, per person, for those with diagnosed AD, nearly twice the amount spent on others. The difference in Medicare payments was attributable to more adverse events occurring to AD group. Such persons had higher death rates than other elderly population (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.07-1.62), higher hospitalization rates for hip fracture (OR, 1.96; 95% CI, 1.34-2.87), stroke (OR, 1.71; 95% CI, 1.10-2.68), pneumonia (OR, 1.46; 95% CI, 1.07-1.99), and for other reasons than the five conditions (OR, 1.65; 95% CI, 1.38-1.98), but they also had lower hospitalization rates for the cardiac diseases. There were no differences in Medicare payments according to AD diagnosis, controlling for frequency of deaths, hospitalizations, and other factors. Persons with diagnosed AD cost Medicare more because of more adverse health events rather than in intensity of care, given event occurrence.",nootropic agent;aged;Alzheimer disease;article;confidence interval;congestive heart failure;elderly care;female;health care cost;health survey;heart disease;hip fracture;hospitalization;human;ischemic heart disease;long term care;major clinical study;male;medicare;mortality;pneumonia;priority journal;risk factor;side effect;cerebrovascular accident,"Sloan, F. A.;Taylor Jr, D. H.",2002,,,0,
4140,The effect of dementia on outcomes and process of care for Medicare beneficiaries admitted with acute myocardial infarction,"OBJECTIVES: To determine differences in mortality after admission for acute myocardial infarction (AMI) and in use of noninvasive and invasive treatments for AMI between patients with and without dementia. DESIGN: Retrospective chart review. SETTING: Cooperative Cardiovascular Project. PATIENTS: Medicare patients admitted for AMI (N=129,092) in 1994 and 1995. MEASUREMENTS: Dementia noted on medical chart as history of dementia, Alzheimer's disease, chronic confusion, or senility. Outcome measures included mortality at 30 days and 1-year postadmission; use of aspirin, beta-blocker, angiotensin-converting enzyme (ACE) inhibitor, thrombolytic therapy, cardiac catheterization, coronary angioplasty, and cardiac bypass surgery compared by dementia status. RESULTS: Dementia was associated with higher mortality at 30 days (relative risk (RR)=1.16, 95% confidence interval (CI)=1.09-1.22) and at 1-year postadmission (RR=1.18, 95% CI=1.13-1.23). There were few to no differences in the use of aspirin and beta-blockers between patients with and without a history of dementia. Patients with a history of dementia were less likely to receive ACE inhibitors during the stay (RR=0.89, 95% CI=0.86-0.93) or at discharge (RR=0.90, 95% CI=0.86-0.95), thrombolytic therapy (RR=0.82, 95% CI=0.74-0.90), catheterization (RR=0.51, 95% CI=0.47-0.55), coronary angioplasty (RR=0.58, 95% CI=0.51-0.66), and cardiac bypass surgery (RR=0.41, 95% CI=0.33-0.50) than patients without a history of dementia. CONCLUSION: The results imply that the presence of dementia had a major effect on mortality and care patterns for this condition.","Aged;Aged, 80 and over;Cardiac Catheterization/utilization;Cardiovascular Agents/therapeutic use;*Decision Making;Dementia/*complications;Female;Humans;Logistic Models;Male;*Medical Audit;Medicare/statistics & numerical data;Multivariate Analysis;Myocardial Infarction/complications/*mortality/*therapy;Myocardial Revascularization/utilization;*Outcome and Process Assessment (Health Care);Retrospective Studies;Socioeconomic Factors;United States/epidemiology;Empirical Approach;Health Care and Public Health;Mental Health Therapies","Sloan, F. A.;Trogdon, J. G.;Curtis, L. H.;Schulman, K. A.",2004,Feb,,0,
4141,"The impact of APOE on myocardial infarction, stroke, and dementia: the Rotterdam Study","It is unclear how the APOE genotype contributes to the incidence of vascular diseases and dementia. In a population-based sample (n = 6,852) with complete follow-up, APOE was weakly associated with myocardial infarction and not related with stroke. In the absence of epsilon4, the incidence of dementia would be 25.8% lower; in the absence of epsilon2/epsilon3, 2.8% higher. Risk estimates of dementia, specified for age, sex, and APOE, are provided for counseling. APOE is not strongly related to vascular diseases, but contributes substantially to dementia incidence.",Age Distribution;Aged;Apolipoproteins E/*genetics;Cohort Studies;Dementia/epidemiology/*genetics;European Continental Ancestry Group/genetics;Female;Genotype;Humans;Incidence;Male;Middle Aged;Myocardial Infarction/epidemiology/*genetics;Netherlands/epidemiology;Proportional Hazards Models;Risk;Risk Assessment;Sex Distribution;Stroke/epidemiology/*genetics,"Slooter, A. J.;Cruts, M.;Hofman, A.;Koudstaal, P. J.;van der Kuip, D.;de Ridder, M. A.;Witteman, J. C.;Breteler, M. M.;Van Broeckhoven, C.;van Duijn, C. M.",2004,Apr 13,,0,
4142,Selecting target conditions for quality of care improvement in vulnerable older adults,"OBJECTIVE: To identify a set of geriatric conditions as optimal targets for quality improvement to be used in a quality measurement system for vulnerable older adults. DESIGN: Discussion and two rounds of ranking of conditions by a panel of geriatric clinical experts informed by literature reviews. METHODS: A list of 78 conditions common among vulnerable older people was reduced to 35 on the basis of their (1) prevalence, (2) impact on health and quality of life, (3) effectiveness of interventions in improving mortality and quality of life, (4) disparity in the quality of care across providers and geographic areas, and (5) feasibility of obtaining the data needed to test compliance with quality indicators. A panel of 12 experts in geriatric care discussed and then ranked the 35 conditions on the basis of the same five criteria. We then selected 21 conditions, based on panelists' iterative rankings. Using available national data, we compiled information about prevalence of the selected conditions for community-dwelling older people and older nursing home residents and estimated the proportion of inpatient and outpatient care attributable to the selected conditions. RESULTS: The 21 conditions selected as targets for quality improvement among vulnerable older adults include (in rank order): pharmacologic management; depression; dementia; heart failure; stroke (and atrial fibrillation); hospitalization and surgery; falls and mobility disorders; diabetes mellitus; end-of-life care; ischemic heart disease; hypertension; pressure ulcers; osteoporosis; urinary incontinence; pain management; preventive services; hearing impairment; pneumonia and influenza; vision impairment; malnutrition; and osteoarthritis. The selected conditions had mean rank scores from 1.2 to 3.8, and those excluded from 4.6 to 6.9, on a scale from 1 (highest ranking) to 7 (lowest ranking). Prevalence of the selected conditions ranges from 10 to 50% among community-dwelling older adults and from 25 to 80% in nursing home residents for the six most common selected conditions. The 21 target conditions account for at least 43% of all acute hospital discharges and 33% of physician office visits among persons 65 years of age and older. Actual figures must be higher because several of the selected conditions (e.g., end-of-life care) are not recorded as diagnoses. CONCLUSIONS: Twenty-one conditions were selected as targets for quality improvement in vulnerable older people for use in a quality measurement system. The 21 geriatric conditions selected are highly prevalent in this group and likely account for more than half of the care provided to this group in hospital and ambulatory settings.","Aged;Evaluation Studies as Topic;Female;*Geriatrics;Health Services for the Aged/*standards/statistics & numerical data;Homes for the Aged;Humans;Long-Term Care;Male;Prevalence;Quality Assurance, Health Care/*methods;Therapeutics/*standards;United States","Sloss, E. M.;Solomon, D. H.;Shekelle, P. G.;Young, R. T.;Saliba, D.;MacLean, C. H.;Rubenstein, L. Z.;Schnelle, J. F.;Kamberg, C. J.;Wenger, N. S.",2000,Apr,,0,
4143,Effect of statins on a wide range of health outcomes: a cohort study validated by comparison with randomized trials,"AIMS: To assess the effect of statins on a range of health outcomes. METHODS: We undertook a population-based cohort study to assess the effect of statins on a range of health outcomes using a propensity score-based method to control for differences between people prescribed and not prescribed statins. We validated our design by comparing our results for vascular outcomes with the effects established in large randomized trials. The study was based on the United Kingdom Health Improvement Network database that includes the computerized medical records of over four and a half million patients. RESULTS: People who initiated treatment with a statin (n = 129,288) were compared with a matched sample of 600,241 people who did not initiate treatment, with a median follow-up period of 4.4 years. Statin use was not associated with an effect on a wide range of outcomes, including infections, fractures, venous thromboembolism, gastrointestinal haemorrhage, or on specific eye, neurological or autoimmune diseases. A protective effect against dementia was observed (hazard ratio 0.80, 99% confidence interval 0.68, 0.95). There was no effect on the risk of cancer even after > or =8 years of follow-up. The effect sizes for statins on vascular end-points and mortality were comparable to those observed in large randomized trials, suggesting bias and confounding had been well controlled for. CONCLUSIONS: We found little evidence to support wide-ranging effects of statins on health outcomes beyond their established beneficial effect on vascular disease.","Adult;Aged;Aged, 80 and over;Cohort Studies;Female;Great Britain/epidemiology;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use;Incidence;Male;Medical Records;Middle Aged;Multivariate Analysis;Myocardial Infarction/mortality;Outcome Assessment (Health Care);Randomized Controlled Trials as Topic;Reproducibility of Results;Stroke/mortality;Vascular Diseases/*drug therapy/mortality","Smeeth, L.;Douglas, I.;Hall, A. J.;Hubbard, R.;Evans, S.",2009,Jan,10.1111/j.1365-2125.2008.03308.x,0,
4144,Clinical characterization of vascular dementia: retrospective evaluation of an outpatient sample,"OBJECTIVE: to analyze the clinical features and associated morbidity in a group of patients with vascular dementia (VD). METHODS: we retrospectively evaluated 25 patients with diagnosis of VD, based on the State of California Alzheimers Disease Diagnostic and Treatment Centers (ADDTC) criteria. Clinical and neuroimaging data and laboratory test results were obtained for the characterization of the sample. RESULTS: the mean age was 68.7 +/- 14.6 years (64.0% men), with mean educational level of 5.2 +/- 4.4 years. Sudden onset of symptoms was observed in 48.0% of patients and stepwise deteriorating and fluctuating courses being observed in 4.0% and 16% respectively. Focal neurologic deficits were the first symptom in 48.0%, with focal deficits being observed in 80% on examination. The main morbidity were: hypertension (92.0%); hypercholesterolemia (64.0%); coronary heart disease (40.0%); smoking (40.0%); hypertriglyceridemia (36.0%); diabetes mellitus (32.0%); Chagas' disease (8.0%). CONCLUSIONS: we observed strong association between VD and hypertension and hypercholesterolemia. The observation of two patients presenting Chagas' disease suggests that this endemic condition may be considered a possible regional risk factor.","Aged;Aged, 80 and over;Ambulatory Care;Comorbidity;Dementia, Vascular/epidemiology/*physiopathology;Female;Humans;Male;Middle Aged;Retrospective Studies;Risk Factors","Smid, J.;Nitrini, R.;Bahia, V. S.;Caramelli, P.",2001,Jun,,0,
4145,Effect of comorbidity on risk of venous thromboembolism in patients with renal cell carcinoma,"Purpose: Venous thromboembolism (VTE) is associated with renal cell carcinoma (RCC), but data on the effect of comorbidities are limited. Therefore, our purpose was to determine the effect of comorbidity on VTE risk among patients with RCC. Materials and methods: A population-based cohort of all patients with RCC (n = 8,633) diagnosed in Denmark between 1995 and 2010 and a comparison cohort selected from the general population and matched on age, sex, and comorbidities (n = 83,055) were identified. Risk of subsequent VTE was estimated with 95% CI for the first 3 months, 1 year, and 5 years following cancer diagnosis. We stratified by Charlson comorbidity index (CCI) scores to estimate excess risk in patients with RCC vs. the comparison cohort within comorbidity strata. We also performed subanalyses for postoperative VTE and metastases. Results: VTE risk was higher in the RCC compared with comparison cohort, particularly during the initial year following diagnosis (risk difference = 9.9 per 1,000 persons [95% CI: 7.7-12.2]). After stratifying by CCI, excess risk declined with increasing comorbidities. The risk difference was 12.3 per 1,000 persons (95% CI: 9.1-15.5) for CCI = 0 and 0.5 (95% CI: 6.0-7.0) for CCI = 4. Excess risk also declined with increasing comorbidities among patients with postoperative VTE and among those with metastases. Conclusions: RCC is associated with increased risk of VTE when compared with a matched general population cohort. Risk did not appear to increase with added comorbidity burden. Clinical attention to VTE risk in patients with RCC is appropriate regardless of the presence or absence of comorbidities. © 2014 Elsevier Inc.",acquired immune deficiency syndrome;adult;aged;article;attributable risk;cancer diagnosis;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;chronic obstructive lung disease;cohort analysis;comorbidity;comparative study;congestive heart failure;connective tissue disease;controlled study;deep vein thrombosis;dementia;Denmark;female;heart infarction;hemiplegia;human;insulin dependent diabetes mellitus;kidney carcinoma;kidney disease;leukemia;liver disease;lung embolism;lymphoma;major clinical study;male;non insulin dependent diabetes mellitus;patient history of surgery;peripheral vascular disease;priority journal;solid tumor;ulcer;very elderly,"Smith, A. B.;Horvath-Puhó, E.;Nielsen, M. E.;Lash, T. L.;Baron, J. A.;Sørensen, H. T.",2014,,,0,
4146,Prevention of Stroke in Patients with Silent Cerebrovascular Disease: a Scientific Statement for Healthcare Professionals from the American Heart Association/American Stroke Association,"Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians. Copyright © 2016 American Heart Association, Inc.",aging;anticoagulation;article;blood clot lysis;brain hemorrhage;brain infarction;brain ischemia;cerebrovascular accident/pc [Prevention];cerebrovascular disease/di [Diagnosis];human;medical society;nuclear magnetic resonance imaging;primary prevention;priority journal;research;risk factor;silent cerebrovascular disease/di [Diagnosis];white matter;adoption;brain hemorrhage;brain infarction;brain scintiscanning;cardiovascular risk;clinical study;consensus development;controlled study;dementia;diagnosis;doctor patient relation;incidental finding;medical society;prevention;radiologist;randomized controlled trial;white matter;writing;anticoagulant agent,"Smith, Ee;Saposnik, G;Biessels, Gj;Doubal, Fn;Fornage, M;Gorelick, Pb;Greenberg, Sm;Higashida, Rt;Kasner, Se;Seshadri, S",2017,,10.1161/STR.0000000000000116,0,4147
4147,Prevention of Stroke in Patients with Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals from the American Heart Association/American Stroke Association,"Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians.",aging;anticoagulation;article;blood clot lysis;brain hemorrhage;brain infarction;brain ischemia;cerebrovascular accident;cerebrovascular disease;human;medical society;nuclear magnetic resonance imaging;primary prevention;priority journal;research;risk factor;silent cerebrovascular disease;white matter,"Smith, E. E.;Saposnik, G.;Biessels, G. J.;Doubal, F. N.;Fornage, M.;Gorelick, P. B.;Greenberg, S. M.;Higashida, R. T.;Kasner, S. E.;Seshadri, S.",2017,,10.1161/str.0000000000000116,0,
4148,Brief communication: National quality-of-care standards in home-based primary care,"Background: Home-based primary care for homebound seniors is complex, and practice constraints are unique. No quality-of-care standards exist. Objective: To identify process quality indicators that are essential to high-quality, home-based primary care. Design: An expert development panel reviewed established and new quality indicators for applicability to home-based primary care. A separate national evaluation panel used a modified Delphi process to rate the validity and importance of the potential quality indicators. Participants: Two national panels whose members varied in practice type, location, and setting. Results: The panels considered 260 quality indicators and endorsed 200 quality indicators that cover 23 geriatric conditions. Twenty-one (10.5%) quality indicators were newly created, 52 (26%) were modified, and 127 (63.5%) were unchanged. The quality indicators have decreased emphasis on interventions and have placed greater emphasis on quality of life. Limitations: The quality indicator set may not apply to all home-bound seniors and might be difficult to implement for a typical home-based primary care program. Conclusions: The quality indicator set provides a comprehensive home-based primary care quality framework and will allow for future comparative research. Provision of these evidence-based measures could improve patient quality of life and longevity. © 2007 American College of Physicians.",article;constipation;decubitus;Delphi study;dementia;depression;diabetes mellitus;expert system;falling;follow up;geriatric care;geriatric disorder;health care delivery;health care quality;health program;hearing impairment;atrial fibrillation;heart failure;home care;hypertension;influenza;insomnia;intervention study;ischemic heart disease;malnutrition;medical practice;osteoarthritis;osteoporosis;pneumonia;preventive medicine;primary medical care;priority journal;screening;standard;cerebrovascular accident;terminal care;urine incontinence;validity;visual impairment,"Smith, K. L.;Soriano, T. A.;Boal, J.",2007,,,0,
4149,Canadian society takes position on long-term hormone therapy,,Breast Neoplasms/chemically induced;Canada;Dementia/chemically induced;Double-Blind Method;Estrogen Replacement Therapy/*adverse effects;Female;Humans;Myocardial Infarction/chemically induced;Randomized Controlled Trials as Topic;Stroke/chemically induced;Thrombosis/chemically induced;Women's Health,"Smith, M.",2004,Mar 3,,0,
4150,Estrogen Replacement and Risk of Alzheimer Disease 1 (multiple letters),,calcium;estrogen;follitropin;gestagen;gonadotropin;luteinizing hormone;multivitamin;testosterone;vitamin;age;allele;Alzheimer disease;brain function;cardiovascular risk;clinical trial;disease association;drug efficacy;drug use;estrogen therapy;gonadotropin blood level;hormone synthesis;human;ischemic heart disease;letter;long term care;medical decision making;neurologic disease;outcomes research;postmenopause;prevalence;priority journal;risk assessment;side effect;vitamin supplementation,"Smith, M. A.;Perry, G.;Atwood, C. S.;Bowen, R. L.;Lahad, A.;Ishay, L.;Buckwalter, J. G.;Petitti, D. B.;Crooks, V. C.;Rosenberg, L.;Zandi, P. P.;Breitner, J. C. S.;Resnick, S. M.;Henderson, V. W.",2003,,,0,
4151,Effect of walking distance on 8-year incident depressive symptoms in elderly men with and without chronic disease: the Honolulu-Asia Aging Study,"OBJECTIVES: To determine the effect of walking on incident depressive symptoms in elderly Japanese-American men with and without chronic disease. DESIGN: Prospective cohort study. SETTING: The Honolulu-Asia Aging Study. PARTICIPANTS: Japanese-American men aged 71 to 93 at baseline. MEASUREMENTS: Physical activity was assessed according to self-reported distance walked per day. Depressive symptoms were measured using an 11-question version of the Centers for Epidemiologic Studies Depression Scale (CES-D 11) at the fourth examination (n=3,196) and at the seventh examination 8 years later (1999/00, n=1,417). Presence of incident depressive symptoms was defined as a CES-D 11 score of 9 or greater or taking antidepressants at Examination 7. Subjects with prevalent depressive symptoms at baseline were excluded. RESULTS: Age-adjusted 8-year incident depressive symptoms were 13.6%, 7.6%, and 8.5% for low (<0.25 miles/day), intermediate (0.25-1.5 miles/day), and high (>1.5 miles/day) walking groups at baseline (P=0.008). Multiple logistic regression analyses, adjusted for age, education, marital status, cardiovascular risk factors, prevalent diseases, and functional impairment, showed that those in the intermediate and highest walking groups had significantly lower odds of developing 8-year incident depressive symptoms (odds ratio (OR)=0.52, 95% confidence interval (CI)=0.32-0.83, P=.006 and OR=0.61, 95% CI= 0.39-0.97, P=.04, respectively). Analysis found that this association was significant only in participants without chronic diseases (coronary heart disease, cerebrovascular accident, cancer, Parkinson's disease, dementia, or cognitive impairment) at baseline. CONCLUSION: Daily physical activity (>/=0.25 mile/day) is significantly associated with lower risk of 8-year incident depressive symptoms in elderly Japanese-American men without chronic disease at baseline.","Aged;Aged, 80 and over;Depression/diagnosis/*epidemiology;Hawaii/epidemiology;Health Status;Humans;Incidence;Japan/ethnology;Male;Multivariate Analysis;Prospective Studies;*Walking","Smith, T. L.;Masaki, K. H.;Fong, K.;Abbott, R. D.;Ross, G. W.;Petrovitch, H.;Blanchette, P. L.;White, L. R.",2010,Aug,10.1111/j.1532-5415.2010.02981.x,0,
4152,CO intoxication: what to do after the acute episode?,,"Brain/pathology/physiopathology;Brain Damage, Chronic/*diagnosis/physiopathology;Carbon Monoxide/blood;Carbon Monoxide Poisoning/*complications/diagnosis/physiopathology/*therapy;Cardiomyopathies/*diagnosis/physiopathology;Dementia/diagnosis/physiopathology;Follow-Up Studies;Humans;*Hyperbaric Oxygenation;Lipid Peroxidation/physiology;Magnetic Resonance Imaging;Malondialdehyde/metabolism;Neurodegenerative Diseases/diagnosis/physiopathology;Neurologic Examination;Prognosis;Risk Factors;Tomography, X-Ray Computed","Smolle-Juttner, F. M.",2014,Dec,10.1055/s-0034-1387437,0,
4153,Hospice and the continuum of primary care,"Continuity of care, attention to both the patient as an individual and the family as a unit, integrating attention to physical needs with psychological and spiritual care, are all core values of primary care - and are also central values of palliative care. Primary care physicians are well positioned to improve palliative care and the use of hospice services, particularly for patients with end-stage chronic disease and dementia. A continuous primary care relationship allows physicians to work with patients over time, listen to their unique needs and concerns, facilitate greater understanding of what might be anticipated as the disease worsens, and advocate for the best care options to meet the patients and families' goals for end-of-life care. Key tasks for primary care physicians to improve palliative care and to pave the way for timely, appropriate access of hospice care for patients with terminal conditions include: (1) carefully considering and communicating disease prognosis without extinguishing hope; (2) understanding patients' values and goals of care while assisting them with advance care planning; (3) integrating palliative care measures with disease-oriented care early in the course of worsening disease; and (4) explaining and advocating the timely use of hospice services when appropriate for patients with terminal illness (see Fig. 1). As a partner with the patient and family in this dynamic process, the primary care physician is then best positioned to recognize when referral to hospice may be appropriate.",dipeptidyl carboxypeptidase inhibitor;diuretic agent;inotropic agent;article;chronic disease;chronic obstructive lung disease;dementia;disease course;doctor patient relation;family counseling;health care access;health care delivery;health care planning;health care quality;heart failure;hospice care;human;palliative therapy;patient care;patient referral;primary medical care;prognosis;psychological aspect;religion;terminal disease,"Smucker, D. R.",2004,,,0,
4154,Depression in physical illness,"Depressive illnesses are common in the general population and are significantly more common in those with physical illnesses. The symptoms of depression may go unrecognised in medical patients, with consequent under-diagnosis and under-treatment. Co-morbid depression is associated with increased morbidity, poorer function, increased healthcare costs and increased mortality. Depressive illnesses are amenable to treatment by both pharmacological and psychological means. Successful treatment can result in improved quality of life as well as improved function, mortality and overall outcome in the physical disorder. It is therefore important that medical doctors are aware of the symptoms, diagnosis and management of depressive illness. © 2009 Royal College of Physicians of Edinburgh.",alpha interferon;aminophylline;amitriptyline;anticonvulsive agent;antidepressant agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;cimetidine;citalopram;corticosteroid;cytotoxic agent;digoxin;fluoxetine;imipramine;isotretinoin;levodopa;metoclopramide;mirtazapine;moclobemide;monoamine oxidase inhibitor;nonsteroid antiinflammatory agent;paracetamol;phenelzine;serotonin uptake inhibitor;tricyclic antidepressant agent;venlafaxine;Addison disease;agitation;alcohol abuse;anorexia;Beck Depression Inventory;chronic pain;cognitive therapy;comorbidity;concentration loss;Cushing disease;depression;Diagnostic and Statistical Manual of Mental Disorders;differential diagnosis;disease exacerbation;drug misuse;drug overdose;dynamic therapy;fatigue;functional status;Geriatric Depression Scale;group therapy;head injury;health care cost;heart disease;heart infarction;hepatic encephalopathy;hepatitis C;Hospital Anxiety and Depression Scale;human;Human immunodeficiency virus infection;Huntington chorea;hypoglycemia;hypothyroidism;mononucleosis;insomnia;insulin dependent diabetes mellitus;International Classification of Diseases;interpersonal therapy;kidney disease;libido disorder;liver disease;liver failure;low drug dose;memory disorder;mental deficiency;mood;morbidity;mortality;multiple sclerosis;neoplasm;neuropathy;non insulin dependent diabetes mellitus;outcome assessment;parathyroid disease;Parkinson disease;patient education;physical disease;physician;physiotherapy;prevalence;prophylaxis;psychiatric treatment;quality of life;rheumatoid arthritis;short survey;side effect;social support;stress;cerebrovascular accident;suicidal ideation;symptom;systemic lupus erythematosus;weight gain;weight reduction,"Smyth, R.",2009,,,0,
4155,Economic burden of community-based disease-associated malnutrition in the United States,"BACKGROUND: The burden imposed by disease-associated malnutrition (DAM) on patients and the healthcare system in food-abundant industrialized countries is often underappreciated. This study measured the economic burden of community-based DAM in the United States. METHODS: The burden of DAM was quantified in terms of direct medical costs, quality-adjusted life years lost, and mortality across 8 diseases (breast cancer, chronic obstructive pulmonary disease [COPD], colorectal cancer [CRC], coronary heart disease [CHD], dementia, depression, musculoskeletal disorders, and stroke). To estimate the total economic burden, the morbidity and mortality burden was monetized using a standard value of a life year and combined with direct medical costs of treating DAM. Disease-specific prevalence and malnutrition estimates were taken from the National Health Interview Survey and the National Health and Nutrition Examination Survey. Deaths by disease were taken from the Center for Disease Control and Prevention. Estimates of costs and morbidity were taken from the literature. RESULTS: The annual burden of DAM across the 8 diseases was $156.7 billion, or $508 per U.S. resident. Nearly 80% of this burden was derived from morbidity associated with DAM; around 16% derived from mortality and the remainder from direct medical costs of treating DAM. The total burden was highest in COPD and depression, while the burden per malnourished individual was highest in CRC and CHD. CONCLUSION: DAM exacts a large burden on American society. Therefore, improved diagnosis and management of community-based DAM to alleviate this burden are needed.","Cardiovascular Diseases/*complications;Colorectal Neoplasms/complications;Coronary Disease/complications;Depression/complications;Developed Countries;*Health Care Costs;Health Services Needs and Demand;Humans;Malnutrition/complications/*economics;Mental Disorders/*complications;Musculoskeletal Diseases/*complications;Neoplasms/*complications;Pulmonary Disease, Chronic Obstructive/*complications;United States;burden of disease;community-based;disease-associated malnutrition;malnutrition;quality of life;quality-adjusted life year","Snider, J. T.;Linthicum, M. T.;Wu, Y.;LaVallee, C.;Lakdawalla, D. N.;Hegazi, R.;Matarese, L.",2014,Nov,10.1177/0148607114550000,0,
4156,Descriptive analysis of medication administration during inpatient cardiopulmonary arrest resuscitation (from the Mayo Registry for Telemetry Efficacy in Arrest Study),"Advanced cardiovascular life support guidelines exist, yet there are variations in clinical practice. Our study aims to describe the utilization of medications during resuscitation from in-hospital cardiopulmonary arrest. A retrospective review of patients who suffered a cardiopulmonary arrest from May 2008 to June 2014 was performed. Clinical and resuscitation data, including timing and dose of medications used, were extracted from the electronic medical record and comparisons made. A total of 94 patients were included in the study. Patients were divided into different groups based on the medication combination used during resuscitation: (1) epinephrine; (2) epinephrine and bicarbonate; (3) epinephrine, bicarbonate, and calcium; (4) epinephrine, bicarbonate, and epinephrine drip; and (5) epinephrine, bicarbonate, calcium, and epinephrine drip. No difference in baseline demographics or clinical data was present, apart from history of dementia and the use of calcium channel blockers. The number of medications given was correlated with resuscitation duration (Spearman's rank correlation = 0.50, p <0.001). The proportion of patients who died during the arrest was 12.5% in those who received epinephrine alone, 30.0% in those who received only epinephrine and bicarbonate, and 46.7% to 57.9% in the remaining groups. Patients receiving only epinephrine had shorter resuscitation durations compared to that of the other groups (p <0.001) and improved survival (p = 0.003). In conclusion, providers frequently use nonguideline medications in resuscitation efforts for in-hospital cardiopulmonary arrests. Increased duration and mortality rates were found in those resuscitations compared with epinephrine alone, likely due to the longer resuscitation duration in the former groups.",adrenalin;bicarbonate;calcium;adult;aged;article;cardiopulmonary arrest;cohort analysis;comparative study;controlled study;electronic medical record;female;heart rhythm;hospital patient;human;infusion;major clinical study;male;priority journal;resuscitation;retrospective study;telemetry;treatment duration,"Snipelisky, D.;Ray, J.;Matcha, G.;Roy, A.;Dumitrascu, A.;Harris, D.;Bosworth, V.;Clark, B.;Thomas, C. S.;Heckman, M. G.;Vadeboncoeur, T.;Kusumoto, F.;Burton, M. C.",2016,,,0,
4157,Ginkgo biloba for preventing cognitive decline in older adults a randomized trial,"Context: The herbal product Ginkgo biloba is taken frequently with the intention of improving cognitive health in aging. However, evidence from adequately powered clinical trials is lacking regarding its effect on long-term cognitive functioning. Objective: To determine whether G biloba slows the rates of global or domain-specific cognitive decline in older adults. Design, Setting, and Participants: The Ginkgo Evaluation of Memory (GEM) study, a randomized, double-blind, placebo-controlled clinical trial of 3069 community-dwelling participants aged 72 to 96 years, conducted in 6 academic medical centers in the United States between 2000 and 2008, with a median follow-up of 6.1 years. Intervention Twice-daily dose of 120-mg extract of G biloba (n=1545) or identical-appearing placebo (n=1524). Main Outcome Measures: Rates of change over time in the Modified Mini-Mental State Examination (3MSE), in the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog), and in neuropsychological domains of memory, attention, visual-spatial construction, language, and executive functions, based on sums of z scores of individual tests. Results: Annual rates of decline in z scores did not differ between G biloba and placebo groups in any domains, including memory (0.043; 95% confidence interval [CI], 0.034-0.051 vs 0.041; 95% CI, 0.032-0.050), attention (0.043; 95% CI, 0.037-0.050 vs 0.048; 95% CI, 0.041-0.054), visuospatial abilities (0.107; 95% CI, 0.097-0.117 vs 0.118; 95% CI, 0.108-0.128), language (0.045; 95% CI, 0.037-0.054 vs 0.041; 95% CI, 0.033-0.048), and executive functions (0.092; 95% CI, 0.086-0.099 vs 0.089; 95% CI, 0.082-0.096). For the 3MSE and ADAS-Cog, rates of change varied by baseline cognitive status (mild cognitive impairment), but there were no differences in rates of change between treatment groups (for 3MSE, P=.71; for ADAS-Cog, P=.97). There was no significant effect modification of treatment on rate of decline by age, sex, race, education, APOE*E4 allele, or baseline mild cognitive impairment (P>.05). Conclusion: Compared with placebo, the use of G biloba, 120 mg twice daily, did not result in less cognitive decline in older adults with normal cognition or with mild cognitive impairment. Trial Registration: clinicaltrials.gov Identifier: NCT00010803. ©2009 American Medical Association. All rights reserved.",NCT00010803;Ginkgo biloba extract;aged;article;bleeding;clinical trial;cognitive defect;controlled clinical trial;drug effect;drug efficacy;female;human;ischemic heart disease;major clinical study;male;mild cognitive impairment;mortality;priority journal;side effect;cerebrovascular accident;treatment outcome;United States,"Snitz, B. E.;O'Meara, E. S.;Carlson, M. C.;Arnold, A. M.;Ives, D. G.;Rapp, S. R.;Saxton, J.;Lopez, O. L.;Dunn, L. O.;Sink, K. M.;DeKosky, S. T.",2009,,,0,
4158,Longitudinal association of dementia and depression,"Objectives: Depression is an important precursor to dementia, but less is known about the role dementia plays in altering the course of depression. We examined whether depression prevalence, incidence, and severity are higher in those with dementia versus those with mild cognitive impairment (MCI), or normal cognition. Design: Prospective cohort study using the longitudinal Uniform Data Set of the National Alzheimer's Coordinating Center (2005-2013). Setting: 34 Alzheimer Disease research centers. Participants: 27,776 subjects with dementia, MCI, or normal cognition. Measurements: Depression status was determined by a clinical diagnosis of depression within the prior 2 years and by a Geriatric Depression Scale-Short Form score >5. Results: Rates of depression were significantly higher in subjects with MCI and dementia compared with those with normal cognition at index visit. Controlling for demographics and common chronic conditions, logistic regression analysis revealed elevated depression in those with MCI (OR: 2.40 [95% CI: 2.25, 2.56]) or dementia (OR: 2.64 [95% CI: 2.43, 2.86]) relative to those with normal cognition. In the subjects without depression at the index visit (N = 18,842), those with MCI and dementia had higher probabilities of depression diagnosis 2 years post index visit than those with normal cognition: MCI = 21.7%, dementia = 24.7%, normal cognition = 10.5%. Conclusion: MCI and dementia were associated with significantly higher rates of depression in concurrent as well as prospective analyses. These findings suggest that efforts to effectively engage and treat older adults with dementia will need also to address co-occurring depression.",aged;Alzheimer disease;article;cerebrovascular accident;cognition;cohort analysis;congestive heart failure;dementia;depression;diabetes mellitus;disease association;disease severity;educational status;female;functional status;Geriatric Depression Scale;heart infarction;human;hypertension;longitudinal study;major clinical study;male;mild cognitive impairment;prospective study;race,"Snowden, M. B.;Atkins, D. C.;Steinman, L. E.;Bell, J. F.;Bryant, L. L.;Copeland, C.;Fitzpatrick, A. L.",2015,,,0,
4159,Redistribution of heart failure as the cause of death: The Atherosclerosis Risk in Communities Study,"Background: Heart failure is sometimes incorrectly listed as the underlying cause of death (UCD) on death certificates, thus compromising the accuracy and comparability of mortality statistics. Statistical redistribution of the UCD has been used to examine the effect of misclassification of the UCD attributed to heart failure, but sex- and race-specific redistribution of deaths on coronary heart disease (CHD) mortality in the United States has not been examined.Methods: We used coarsened exact matching to infer the UCD of vital records with heart failure as the UCD from 1999 to 2010 for decedents 55 years old and older from states encompassing regions under surveillance by the Atherosclerosis Risk in Communities (ARIC) Study (Maryland, Minnesota, Mississippi, and North Carolina). Records with heart failure as the UCD were matched on decedent characteristics (five-year age groups, sex, race, education, year of death, and state) to records with heart failure listed among the multiple causes of death. Each heart failure death was then redistributed to plausible UCDs proportional to the frequency among matched records.Results: After redistribution the proportion of deaths increased for CHD, chronic obstructive pulmonary disease, diabetes, hypertensive heart disease, and cardiomyopathy, P < 0.001. The percent increase in CHD mortality after redistribution was the highest in Mississippi (12%) and lowest in Maryland (1.6%), with variations by year, race, and sex. Redistribution proportions for CHD were similar to CHD death classification by a panel of expert reviewers in the ARIC study.Conclusions: Redistribution of ill-defined UCD would improve the accuracy and comparability of mortality statistics used to allocate public health resources and monitor mortality trends. © 2014 Snyder et al.; licensee BioMed Central Ltd.",adult;African American;aged;Alzheimer disease;article;cardiomyopathy;cause of death;cerebrovascular disease;chronic obstructive lung disease;controlled study;dementia;diabetes mellitus;education;female;gastrointestinal disease;gender;groups by age;heart failure;human;hypertension;ischemic heart disease;kidney disease;lower respiratory tract infection;major clinical study;male;medical record;medical research;middle aged;mortality;neoplasm;priority journal;race;Redistribution;statistical parameters;trend study;United States;very elderly,"Snyder, M. L.;Love, S. A.;Sorlie, P. D.;Rosamond, W. D.;Antini, C.;Metcalf, P. A.;Hardy, S.;Suchindran, C. M.;Shahar, E.;Heiss, G.",2014,,,0,
4160,Evaluating the heritability explained by known susceptibility variants: a survey of ten complex diseases,"Recently, an increasing number of susceptibility variants have been identified for complex diseases. At the same time, the concern of ""missing heritability"" has also emerged. There is however no unified way to assess the heritability explained by individual genetic variants for binary outcomes. A systemic and quantitative assessment of the degree of ""missing heritability"" for complex diseases is lacking. In this study, we measure the variance in liability explained by individual variants, which can be directly interpreted as the locus-specific heritability. The method is extended to deal with haplotypes, multi-allelic markers, multi-locus genotypes, and markers in linkage disequilibrium. Methods to estimate the standard error and confidence interval are proposed. To assess our current level of understanding of the genetic basis of complex diseases, we conducted a survey of 10 diseases, evaluating the total variance explained by the known variants. The diseases under evaluation included Alzheimer's disease, bipolar disorder, breast cancer, coronary artery disease, Crohn's disease, prostate cancer, schizophrenia, systemic lupus erythematosus (SLE), type 1 diabetes and type 2 diabetes. The median total variance explained across the 10 diseases was 9.81%, while the median variance explained per associated SNP was around 0.25%. Our results suggest that a substantial proportion of heritability remains unexplained for the diseases under study. Programs to implement the methodologies described in this paper are available at http://sites.google.com/site/honcheongso/software/varexp.","Alleles;Female;Genetic Markers;*Genetic Predisposition to Disease;*Genetic Variation;Genome-Wide Association Study/statistics & numerical data;Genotype;Haplotypes;Humans;Linkage Disequilibrium;Male;*Models, Genetic;Models, Statistical;Statistics, Nonparametric","So, H. C.;Gui, A. H.;Cherny, S. S.;Sham, P. C.",2011,Jul,10.1002/gepi.20579,0,
4161,A safe anaesthetic in Huntington's disease 26,,alfentanil;atracurium besilate;glycopyrronium bromide;neostigmine;pethidine;propofol;ranitidine;adult;angina pectoris;blood pressure;case report;dental surgery;depression;endotracheal intubation;female;gastroesophageal reflux;general anesthesia;heart infarction;human;Huntington chorea;letter;premedication;priority journal,"Soar, J.;Matheson, K. H.",1993,,,0,
4162,Risk of Major Cardiovascular Events in People with Down Syndrome,"BACKGROUND: Improved medical care over more than five decades has markedly increased life expectancy, from 12 years to approximately 60 years, in people with Down syndrome (DS). With increased survival into late adulthood, there is now a greater need for the medical care of people with DS to prevent and treat aging-related disorders. In the wider population, acquired cardiovascular diseases such as stroke and coronary heart disease are common with increasing age, but the risks of these diseases in people with DS are unknown. There are no population-level data on the incidence of acquired major cerebrovascular and coronary diseases in DS, and no data examining how cardiovascular comorbidities or risk factors in DS might impact on cardiovascular event incidence. Such data would be also valuable to inform health care planning for people with DS. Our objective was therefore to conduct a population-level matched cohort study to quantify the risk of incident major cardiovascular events in DS. METHODS AND FINDINGS: A population-level matched cohort study compared the risk of incident cardiovascular events between hospitalized patients with and without DS, adjusting for sex, and vascular risk factors. The sample was derived from hospitalization data within the Australian state of Victoria from 1993-2010. For each DS admission, 4 exact age-matched non-DS admissions were randomly selected from all hospitalizations within a week of the relevant DS admission to form the comparison cohort. There were 4,081 people with DS and 16,324 without DS, with a total of 212,539 person-years of observation. Compared to the group without DS, there was a higher prevalence in the DS group of congenital heart disease, cardiac arrhythmia, dementia, pulmonary hypertension, diabetes and sleep apnea, and a lower prevalence of ever-smoking. DS was associated with a greater risk of incident cerebrovascular events (Risk Ratio, RR 2.70, 95% CI 2.08, 3.53) especially among females (RR 3.31, 95% CI 2.21, 4.94) and patients aged </= 50 years old. The association of DS with ischemic strokes was substantially attenuated on adjustment for cardioembolic risk (RR 1.93, 95% CI 1.04, 3.20), but unaffected by adjustment for atherosclerotic risk. DS was associated with a 40-70% reduced risk of any coronary event in males (RR 0.58, 95% CI 0.40, 0.84) but not in females (RR 1.14, 95% CI 0.73, 1.77). CONCLUSIONS: DS is associated with a high risk of stroke, expressed across all ages. Ischemic stroke risk in DS appears mostly driven by cardioembolic risk. The greater risk of hemorrhagic stroke and lower risk of coronary events (in males) in DS remain unexplained.","Adolescent;Adult;Aged;Aged, 80 and over;Cardiovascular Diseases/*epidemiology/*etiology;Child;Child, Preschool;Cohort Studies;Comorbidity;Down Syndrome/*complications;Female;Humans;Incidence;Infant;Infant, Newborn;Male;Middle Aged;Patient Outcome Assessment;Population Surveillance;Risk;Young Adult","Sobey, C. G.;Judkins, C. P.;Sundararajan, V.;Phan, T. G.;Drummond, G. R.;Srikanth, V. K.",2015,,10.1371/journal.pone.0137093,0,
4163,"Cholinesterase inhibitors in the ""real world"" setting: Rivastigmine versus donepezil tolerability and effectiveness study","Introduction: Comparative tolerability and effectiveness of donepezil and rivastigmine in clinical practice using a ""real life"" sample of patients diagnosed as having mild to moderate Alzheimer's disease and treated in the memory clinic setting have not been properly studied to date. Material and methods: A retrospective, case records analysis of all patients (N = 183) who had been prescribed either drug over the period of 3 years (1998-2000) and were seen for at least 6 months afterwards. Main outcome estimates were: for tolerability the likelihood to achieve recommended doses for both drugs and side effects profiles, for effectiveness clinical global impression of change (CGI) rating at 6 months after dose titration finished. Results: Numerically, more subjects on rivastigmine than on donepezil dropped out early due to side effects (14.6% vs 11.9%). A maximum approved dose (10 mg for donepezil and 12 mg for rivastigmine) has been achieved by significantly more patients on donepezil than on rivastigmine (p < 0.001). Side effects profiles of both drugs were similar and equally contributed to the drop-out rate. The response rate defined as at least no change on CGI did not differ between the groups. Conclusions: Donepezil and rivastigmine are comparably tolerated and of similar clinical benefits in the ""real life"" population of non-selected patients with mild to moderate AD. The differences in tolerability reported in the randomized controlled trials might be attributed to the fixed schedules of reaching the target dose of rivastigmine. Copyright © Termedia & Banach.",cholinesterase inhibitor;donepezil;rivastigmine;aged;agitation;alertness;Alzheimer disease;article;clinical practice;congestive heart failure;constipation;controlled study;diarrhea;dose response;drug efficacy;drug response;drug tolerability;drug withdrawal;extrapyramidal symptom;female;gastrointestinal symptom;headache;heart arrhythmia;human;limb weakness;major clinical study;male;medical care;medical record;muscle cramp;nausea;prescription;sensory system;side effect;sleep disorder;treatment outcome;vertigo;vomiting,"Sobow, T.;Kloszewska, I.",2006,,,0,
4164,"Serum antioxidant capacity in neurological, psychiatric, renal diseases and cardiomyopathy","The role of free radicals (FR) in the pathogenesis and in the progression of many diseases has been often discussed, but not widely investigated. However, the total antioxidant capacity in the serum seems to be of great evidence. Total antioxidant capacity was determined using oxygen absorbance capacity assay (ORAC) in serum of patients suffering from depression, schizophrenia, Alzheimer's disease (AD), anorexia nervosa, Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), Aids-encephalopathy, diabetic polyneuropathy (PNP), cardiomyopathy (CM), renal disease, and healthy individuals as controls (C). The results showed that the total antioxidant capacity in serum decreased significantly (p < 0.01) by 24, 20, 13, and 17% for anorexia nervosa, Aids-encephalopathy, PNP and CM respectively. In serum of patients with renal disease significantly elevated antioxidant capacity was found. The data indicated that increased oxidative stress can be involved in the pathogenesis or in the progression of PNP and CM. Decrease of serum antioxidant capacity in patients with anorexia nervosa and Aids-encephalopathy are probably due primarily to malnutrition and secondly to insufficient antioxidant and immune system. In renal disease, the accumulation of urea in serum seems to be responsible for high antioxidant capacity. In contrast, there were no changes in PD, AD, depression syndrome and schizophrenia.",Adult;Aged;Antioxidants/*metabolism;Cardiomyopathies/*blood;Female;Humans;Kidney Diseases/*blood;Male;Mental Disorders/*blood;Middle Aged;Nervous System Diseases/*blood;Reference Values,"Sofic, E.;Rustembegovic, A.;Kroyer, G.;Cao, G.",2002,May,10.1007/s007020200059,0,
4165,Predictive factors for early hospital readmission and 1-year mortality in elder patients following surgical treatment of a hip fracture,"BACKGROUND: Early hospital readmission after surgically treated hip fracture is a common entity, often involving an adverse event and causing strains on an already overburdened healthcare system. The main purposes of the present study were to determine the 30-day readmission rate, analyze the predictive factors for early hospital readmissions, and assess 1-year mortality following surgical treatment of hip fracture in elderly patients. Retrospective case-control study. METHODS: In total, 517 patients with a mean age of 74 years were evaluated. The rate of early readmission, age, gender, body mass index, fracture type, pre-fracture mobility status, preoperative time to surgery, American Society of Anesthesiologists score, implant type, postoperative intensive care unit stay, total length of postoperative hospital stay, comorbidities, and the main reasons for readmission were the criteria for data collection. Multivariate analysis was performed to determine the main predictors of early hospital readmission. Mortality within the first year after surgery was also assessed. RESULTS: A higher prevalence of chronic obstructive pulmonary disease, cardiac arrhythmia or ischemic heart disease, diabetes, and dementia or Parkinson’s disease was detected in readmitted patients. Advanced age, American Society of Anesthesiologists (ASA) grade ≥3, postoperative intensive care unit (ICU) stay, and pre-existing cardiac arrhythmia or ischemic heart disease were identified as the main predictors. The 1-year mortality rate for the readmitted group was 53.9%, whereas it was 24% for those patients who were not readmitted. CONCLUSION: The readmission rate following surgical treatment of hip fracture in elder patients was 12%, and its main predictive factors were advanced age, ASA grade ≥3, postoperative ICU stay, and pre-existing cardiac arrhythmia or ischemic heart disease. Hospital readmission within the first 30-day period following initial discharge was significantly correlated with an increased 1-year mortality rate.",adult;aged;American Society of Anesthesiologists score;article;body mass;cannulated screw;case control study;cerebrovascular accident;chronic obstructive lung disease;constipation;controlled study;delirium;dementia;diabetes mellitus;evaluation and follow up;female;femoral neck fracture;femur subtrochanteric fracture;heart arrhythmia;hematoma;hemiarthroplasty;hip fracture;hospital readmission;hospitalization;human;intensive care unit;ischemic heart disease;major clinical study;male;middle aged;mortality;multivariate analysis;osteosynthesis;pain;Parkinson disease;pneumonia;preoperative care;prevalence;prosthesis dislocation;retrospective study;scoring system;surgical infection;total hip prosthesis;urinary tract infection;very elderly,"Sofu, H.;Üçpunar, H.;Çamurcu, Y.;Duman, S.;Konya, M. N.;Gürsu, S.;Şahin, V.",2017,,10.5505/tjtes.2016.84404,0,
4166,Biomechanical evaluation of the ventral and lateral surface shear strain distributions in central compared with dorsolateral placement of cages for lumbar interbody fusion,"Object. The purpose of this study was to measure and compare the ventral and lateral surface strain distributions and stiffness for two types of interbody cage placement: 1) central placement for anterior lumbar interbody fusion (ALIF); and 2) dorsolateral placement for extraforaminal lumbar interbody fusion (ELIF). Methods. Two functional spine units were obtained for testing in each of 13 cadaveric spines, yielding 26 segments (three of which were not used because of bone abnormalities). Bilateral strain gauges were mounted adjacent to the endplate on the lateral and ventral walls of each vertebral body in the 23 motion segments. Each segment was cyclically tested in compression, flexion, and extension in the following conditions: while intact, postdiscectomy, and instrumented with interbody fusion cages placed using both insertion techniques. No significant differences were observed between ALIF and ELIF in compressive stiffness, bending stiffness in flexion and extension (p ≥ 0.1), ventral and lateral strain distribution during the intact tests (p ≥ 0.24), and during the flexion tests after fusion (p ≥ 0.22). In compression, higher ventral and lower lateral strain was observed in the ALIF than in the ELIF group (ventral, p = 0.05; lateral, p = 0.04), and in extension, higher ventral (p = 0.01) and higher lateral strain (p = 0.002) was observed in the ELIF than in the ALIF group. Conclusions. Preservation of the ventral anulus and dorsolateral placement of the interbody cages during ELIF allow alternate load transfer pathways through the dorsolateral vertebral wall and ventral anulus that are not observed following ALIF. These may be associated with a lower incidence of subsidence and a higher rate of fusion due to a more concentrated application of bone healing-enhancing compression forces during the fusion and healing process.",Alzheimer disease;article;cardiogenic shock;compression;congestive heart failure;demography;gastrointestinal hemorrhage;heart disease;heart infarction;human;hypertension;implant;intermethod comparison;kidney failure;lung cancer;rigidity;sepsis;spine fusion;strain gauge transducer,"Sohn, M. J.;Kayanja, M. M.;Kilinçer, C.;Ferrara, L. A.;Benzel, E. C.",2006,,,0,
4167,Clinical and etiological aspects of senile dementia,"Some clinical and etiological aspects of senile dementia of the Alzheimer type (SDA) were elucidated in a case control study of 63 SDA patients and 91 controls. The SDA patients had significantly more commonly both senile and presenile dementia in parents and sibs than the controls. The occurrence of senile dementia in parents or sibs increased the risk for SDA by about 900% when all other relevant factors were taken into account in multiple logistic risk function analysis. The increase of the risk for SDA associated with the occurrence of presenile dementia in sibs was even greater but not statistically significant because of other factors and sample size. There was a negative correlation between the occurrence of hypertension and angina pectoris and SDA, which may be partly due to selective diagnostic criteria of SDA. The β-globulin fraction of cerebrospinal fluid was significantly reduced in the electrophoresis in the SDA patients compared with the controls.",beta globulin;age;central nervous system;cerebrospinal fluid;dementia;etiology;major clinical study;senile dementia,"Soininen, H.;Heinonen, O. P.",1982,,,0,
4168,Long-term efficacy and safety of celecoxib in Alzheimer's disease,"Background/Aims: Cyclooxygenase-2 (COX-2) may play an important role in the neuropathology of Alzheimer's disease (AD). The efficacy and safety of celecoxib (200 mg bid), a COX-2 selective inhibitor, were assessed in patients ≥50 years with established mild-to-moderate AD to determine whether treatment was effective in retarding deterioration of cognitive function. Methods: This was a 52-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. The primary efficacy end points were the change from baseline to week 52 in the Alzheimer's Disease Assessment Scale-Cognitive Behavior (ADAS-cog) composite score and the week 52 Clinician's Interview-Based Impression of Change Plus (CIBIC+). Results: At 52 weeks, change in ADAS-cog scores from baseline was similar for placebo and celecoxib 200 mg bid groups (5.00 and 4.39, respectively). CIBIC+ scores were also similar (4.83 and 4.92). Two extension studies were conducted but were terminated early based on these efficacy results. Safety data from all 3 studies indicated that celecoxib was generally well-tolerated. Conclusion: Celecoxib 200 mg bid did not slow the progression of AD in this study, and the occurrence of adverse events was as expected for an elderly population with a complex chronic medical condition. Copyright © 2007 S. Karger AG.",acetylsalicylic acid;celecoxib;paracetamol;placebo;abdominal pain;abscess;accidental injury;aged;aggression;agitation;Alzheimer disease;alzheimer disease assessment scale cognitive behavior;anemia;aneurysm;angina pectoris;aorta stenosis;aphasia;arthralgia;article;atrioventricular block;backache;bleeding;bone metastasis;brain concussion;brain hemorrhage;carcinoma;cataract;cerebrovascular disease;clinical trial;clinician interview based impression of change plus;cognition;confusion;constipation;controlled clinical trial;controlled study;convulsion;coronary artery disease;dehydration;dementia;diarrhea;dizziness;double blind procedure;drug efficacy;drug fatality;drug induced headache;drug safety;drug tolerability;drug withdrawal;dyspepsia;dyspnea;ecchymosis;emphysema;epistaxis;female;fracture;heart arrest;atrial fibrillation;heart block;heart failure;heart infarction;heart ventricle tachycardia;human;hyponatremia;infection;insomnia;liver cell carcinoma;long term care;lung embolism;lung fibrosis;lung infection;male;medical assessment;nausea;pathologic fracture;peptic ulcer;pneumonia;priority journal;prostate disease;psychologic assessment;randomized controlled trial;rating scale;rectum carcinoma;rectum hemorrhage;respiratory failure;respite care;scoring system;sick sinus syndrome;side effect;subdural hematoma;faintness;systolic blood pressure;therapy effect;thorax pain;thromboembolism;treatment outcome;treatment response;tremor;upper respiratory tract infection;urea nitrogen blood level;uremia;urinary tract infection;urine incontinence;urine retention;vomiting;aspirin,"Soininen, H.;West, C.;Robbins, J.;Niculescu, L.",2007,,,0,
4169,Whole-diet approach and risk of chronic disease: Limits and advantages 11,,alcohol consumption;Alzheimer disease;neoplasm;cancer mortality;cardiovascular risk;chronic disease;dementia;diet therapy;human;ischemic heart disease;letter;Mediterranean diet;mortality;outcome assessment;risk assessment;scoring system,"Solfrizzi, V.;Capurso, C.;D'Introno, A.;Colacicco, A. M.;Capurso, A.;Panza, F.",2006,,,0,
4170,"Vascular risk factors, incidence of MCI, and rates of progression to dementia","Objective: To estimate prevalence, incidence, and rate of progression of mild cognitive impairment (MCI) to dementia and correlated vascular risk factors with incident MCI and its progression to dementia. Methods: The authors evaluated 2,963 individuals from the population-based sample of 5,632 subjects 65 to 84 years old, at the first (1992 to 1993) and second survey (1995 to 1996) of the Italian Longitudinal Study on Aging (ILSA), with a 3.5-year follow-up. Dementia, Alzheimer disease (AD), vascular dementia (VaD), other types of dementia, and MCI were classified using current clinical criteria. Results: Among the 2,963 participants, 139 MCI patients were diagnosed at the first ILSA survey. During the 3.5-year follow-up, 113 new events of MCI were diagnosed with an estimated incidence rate of 21.5 per 1,000 person-years. We found a progression rate to dementia (all causes) of 3.8/100 person-years. Specific progression rates for AD, VaD, and other types of dementia were 2.3, 1.3, and 0.3/100 person-years. Furthermore, age was a risk factor for incident MCI (RR: 5.93, 95% CI: 3.17 to 11.10), while education was protective (RR: 0.06, 95% CI: 0.03 to 0.10), and serum total cholesterol evidenced a borderline nonsignificant trend for a protective effect. There was a nonsignificant trend for stroke as a risk factor of progression of MCI to dementia. Conclusions: In this population, among those who progressed to dementia, 60% progressed to AD and 33% to VaD. Vascular risk factors influence incident mild cognitive impairment and the rate of progression to dementia.",,"Solfrizzi, V.;Panza, F.;Colacicco, A. M.;D’Introno, A.;Capurso, C.;Torres, F.;Grigoletto, F.;Maggi, S.;Del Parigi, A.;Reiman, E. M.;Caselli, R. J.;Scafato, E.;Farchi, G.;Capurso, A.",2004,,10.1212/01.Wnl.0000144281.38555.E3,1,
4171,Angiotensin-converting enzyme inhibitors and incidence of mild cognitive impairment. the Italian Longitudinal Study on Aging,"Midlife elevated blood pressure and hypertension contribute to the development of Alzheimer's disease (AD) and overall dementia. We sought to estimate whether angiotensin-converting enzyme inhibitors (ACE-Is) reduced the risk of developing mild cognitive impairment (MCI) in cognitively normal individuals. In the Italian Longitudinal Study on Aging, we evaluated 1,445 cognitively normal individuals treated for hypertension but without congestive heart failure from a population-based sample from eight Italian municipalities with a 3.5-year follow-up. MCI was diagnosed with current clinical criteria. Dementia, AD, and vascular dementia were diagnosed based on DSM-IIIR criteria, NINCDS-ADRDA criteria, and ICD-10 codes. Among 873 hypertension-treated cognitively normal subjects, there was no significant association between continuous exposure to all ACE-Is and risk of incident MCI compared with other antihypertensive drugs [hazard ratio (HR), 0.45, 95% confidence interval (CI), 0.16-1.28]. Captopril exposure alone did not significantly modify the risk of incident MCI (HR, 1.80, 95% CI, 0.39-8.37). However, the enalapril sub-group alone (HR, 0.17, 95% CI, 0.04 -0.84) or combined with the lisinopril sub-group (HR, 0.27, 95% CI, 0.08-0.96), another ACE-I structurally related to enalapril and with similar potency, were associated with a reduced risk of incident MCI. Study duration exposure to ACE-Is as a ""class"" was not associated with incident MCI in older hypertensive adults. However, within-class differences linked to different chemical structures and/or drug potencies may exist, with a possible effect of the enalapril and lisinopril sub-groups in reducing the risk of incident MCI. © 2011 American Aging Association.",benazepril;captopril;cilazapril;dipeptidyl carboxypeptidase inhibitor;enalapril;fosinopril;lisinopril;perindopril;quinapril;ramipril;aged;aging;article;drug exposure;drug potency;female;follow up;human;hypertension;Italy;longitudinal study;major clinical study;male;mild cognitive impairment;morbidity;population research;risk reduction;treatment duration,"Solfrizzi, V.;Scafato, E.;Frisardi, V.;Seripa, D.;Logroscino, G.;Kehoe, P. G.;Imbimbo, B. P.;Baldereschi, M.;Crepaldi, G.;Di Carlo, A.;Galluzzo, L.;Gandin, C.;Inzitari, D.;Maggi, S.;Pilotto, A.;Panza, F.",2013,,,0,
4172,Primary angiitis of the CNS (PACNS) with predominant cranial neuropathy and spinal cord involvement,"We describe a 70-year old man with a history of repeated epidural injections for chronic low back pain, presenting with headache, cranial nerve palsies and progressive myelopathy. Meningeal enhancement was initially seen in the posterior epidural space of the T10-T12 spine on MRI. Extensive laboratory investigation showed normal or negative results except for persistent pleocytosis, elevated protein and absence of demonstrable microorganisms on CSF studies. Despite conventional and empirical treatments, the patient developed progressive neurological deterioration leading to death. Autopsy showed Primary angiitis of the CNS (PACNS) with predominant cranial neuropathy, spinal cord involvement and extensive myelomalacia. © 2009 Japanese Society of Neuropathology.",aciclovir;ampicillin;ethambutol;fluconazole;isoniazid;meropenem;moxifloxacin;pyrazinamide;rifampicin;steroid;aged;article;autopsy;brain vasculitis;cardiopulmonary arrest;case report;central nervous system disease;central nervous system infection;cerebrospinal fluid examination;cerebrovascular accident;clinical feature;cranial nerve paralysis;cranial neuropathy;differential diagnosis;disease exacerbation;disease severity;electromyography;epileptic state;flow cytometry;headache;herpes simplex encephalitis;human;human tissue;hypertension;hyponatremia;listeriosis;low back pain;male;meningitis;mental deterioration;mortality;mycosis;nerve conduction;nuclear magnetic resonance imaging;pleocytosis;polyneuropathy;priority journal;radiculopathy;repeat procedure;respiratory distress;spinal cord disease;xanthochromia,"Solis, O. E.;Mehta, R. I.;Kalanithi, S.;Bordelon, Y.;Salamon, N.;Yong, W. H.;Vinters, H. V.",2010,,,0,
4173,Serum cholesterol changes after midlife and late-life cognition: twenty-one-year follow-up study,"BACKGROUND: Longitudinal studies have shown that high serum total cholesterol (TC) at midlife is a risk factor for dementia/Alzheimer disease. The significance of TC later in life is unclear. OBJECTIVE: To investigate changes in serum TC from midlife to late life and their relationship with late-life cognition. METHODS: Participants of the Cardiovascular Risk Factors, Aging and Dementia study were derived from random, population-based samples previously studied in a survey in 1972, 1977, 1982, or 1987. After an average follow-up of 21 years, 1,449 individuals aged 65 to 79 were reexamined in 1998. RESULTS: Serum TC levels decreased in most individuals. High midlife TC represented a risk factor for more severe cognitive impairment later in life, and the values were significantly different between the control, mild cognitive impairment, and dementia groups. There were no significant differences in serum TC at reexamination. A moderate decrease in serum TC from midlife to late life (0.5 to 2 mmol/L) was significantly associated with the risk of a more impaired late-life cognitive status, even after adjusting for age, follow-up time, sex, years of formal education, midlife cholesterol, changes in body mass index, APOE epsilon4 genotype, history of myocardial infarction/stroke/diabetes, and lipid-lowering treatment. CONCLUSIONS: The relationship between serum total cholesterol (TC) and dementia seems to be bidirectional. High midlife serum TC is a risk factor for subsequent dementia/Alzheimer disease, but decreasing serum TC after midlife may reflect ongoing disease processes and may represent a risk marker for late-life cognitive impairment.",Aged;Apolipoproteins E/genetics;Cholesterol/*blood;Cognition Disorders/*blood/genetics;Dementia/blood/genetics;Female;Humans;Longitudinal Studies;Male;Risk Factors,"Solomon, A.;Kareholt, I.;Ngandu, T.;Winblad, B.;Nissinen, A.;Tuomilehto, J.;Soininen, H.;Kivipelto, M.",2007,Mar 6,10.1212/01.wnl.0000256368.57375.b7,0,
4174,Cardiovascular risk of celecoxib in 6 randomized placebo-controlled trials: The cross trial safety analysis,"BACKGROUND - Observational studies and randomized trials have reported increased cardiovascular risk associated with cyclooxygenase-2 inhibitors. Prior placebo-controlled randomized studies had limited ability to assess the relationship of either celecoxib dose or pretreatment cardiovascular status to risk associated with celecoxib. Our aim was to assess the cardiovascular risk associated with celecoxib in 3 dose regimens and to assess the relationship between baseline cardiovascular risk and effect of celecoxib on cardiovascular events. METHODS AND RESULTS - We performed a patient-level pooled analysis of adjudicated data from 7950 patients in 6 placebo-controlled trials comparing celecoxib with placebo for conditions other than arthritis with a planned follow-up of at least 3 years. Patients were administered celecoxib in 3 dose regimens: 400 mg QD, 200 mg BID, or 400 mg BID. From the pooled data, we calculated a hazard ratio for all dose regimens combined and individual hazard ratios for each dose regimen and examined whether celecoxib-related risk was associated with baseline cardiovascular risk. The primary end point was the combination of cardiovascular death, myocardial infarction, stroke, heart failure, or thromboembolic event. With 16 070 patient-years of follow-up, the hazard ratio for the composite end point combining the tested doses was 1.6 (95% CI, 1.1 to 2.3). The risk, which increased with dose regimen (P=0.0005), was lowest for the 400-mg-QD dose (hazard ratio, 1.1; 95% CI, 0.6 to 2.0), intermediate for the 200-mg-BID dose (hazard ratio, 1.8; 95% CI, 1.1 to 3.1), and highest for the 400-mg-BID dose (hazard ratio, 3.1; 95% CI, 1.5 to 6.1). Patients at highest baseline risk demonstrated disproportionately greater risk of celecoxib-related adverse events (P for interaction=0.034). CONCLUSIONS - We observed evidence of differential cardiovascular risk as a function of celecoxib dose regimen and baseline cardiovascular risk. By further clarifying the extent of celecoxib-related cardiovascular risk, these findings may help guide treatment decisions for patients who derive clinical benefit from selective cyclooxygenase-2 inhibition. © 2008 American Heart Association, Inc.",NCT00007189;NCT00050479;NCT00078897;NCT00090974;NCT00141193;anastrozole;celecoxib;cyclooxygenase 2;exemestane;naproxen;placebo;selenium;adult;aged;Alzheimer disease;arthritis;article;breast cancer;calculation;cardiovascular disease;cardiovascular risk;clinical decision making;clinical trial;colon polyp;colorectal adenoma;confidence interval;controlled clinical trial;controlled study;double blind procedure;drug effect;female;follow up;hazard ratio;heart death;heart failure;heart infarction;human;major clinical study;male;priority journal;randomized controlled trial;risk assessment;risk factor;cerebrovascular accident;thromboembolism,"Solomon, S. D.;Wittes, J.;Finn, P. V.;Fowler, R.;Viner, J.;Bertagnolli, M. M.;Arber, N.;Levin, B.;Meinert, C. L.;Martin, B.;Pater, J. L.;Goss, P. E.;Lance, P.;Obara, S.;Chew, E. Y.;Kim, J.;Arndt, G.;Hawk, E.",2008,,,0,
4175,"Apoptosis: Concept, mechanisms and clinical implications","Tissue homeostasis mainly depends on the balance between cell proliferation and cell death. Programmed cell death or apoptosis is an intrinsic death program that occurs in various physiological and pathological situations which is highly conserved throughout evolution. Apoptosis or self destruction is necessary for normal development and homeostasis of multicellular organisms. Apoptosis plays a major role in many diseases like cancer, AIDS and neurodegenerative disorders. It differs from necrosis in many ways. Activated death receptors induced and mitochondria induced are the two basic pathways proposed for initiating apoptosis. This process is regulated by many intracellular and extracellular signals. Cellular disruption results from the activation of a family of cysteine proteases known as caspases (CASP). Caspases are synthesized as inactive proenzymes, which upon activation cleave various substrates in the cytoplasm or nucleus leading to changes in morphological and cell death. Dysregulation of controlling mechanisms results indisease. Hence clinically many diseases are the ultimate result of either deficient apoptosis or excessive apoptosis. Since cell death by apoptosis plays a key role in the regulation of tissue homeostasis, any defect in this intrinsic death program may result in tumor formation.",apoptotic protease activating factor 1;caspase;Fas associated death domain protein;Fas ligand;protein bcl 2;protein p53;tumor necrosis factor receptor;tumor necrosis factor related apoptosis inducing ligand;acquired immune deficiency syndrome;Alzheimer disease;apoptosis;article;autoimmune disease;CD4+ T lymphocyte;cell death;cell destruction;degenerative disease;DNA fragmentation;gastrointestinal disease;heart muscle ischemia;Human immunodeficiency virus infection;kidney polycystic disease;mitochondrion;neoplasm;Parkinson disease;protein degradation,"Somani, R.;Kalantri, P.;Kadam, V.",2010,,,0,
4176,Apolipoprotein E and angiotensin converting enzyme gen polymorphism in stroke patients,"It was found that there was a relationship between ApoE and ACE polymorphism and the risk of morbidity and mortality in cardiovascular diseases. In nowadays, atherosclerosis, Alzheimer Disease and Cerebrovascular diseases have also such an accordance with ApoE and ACE as significant risk factors. ACE genotype groups were looked for basic specialty like DD, ID, II and ApoE for Epsilon 2 (E2), Epsilon 3 (E3), Epsilon 4 (E4) allels as 3 major isophorms. In this study, we investigated ApoE and ACE polymorphism in ischemic and hemorrhagic stroke and evaluated the relationship of risk factors. We compared prospectively 29 ischemic and 20 hemorrhagic stroke with the same group of 20 control people. Patients were between 45 and 88 years old, ischemic group mean age 67.62±10.34 and hemorrhagic group was 65.80±10.92. Of hemorrhagic patients 50% were women and 50% men, ischemic patients 51.7% women and 48.3% men. We couldn't find any significant importance compared to age and sexes. There was no meaningful difference between hemorrhagic and ischemic group and control group in comparison with genotype group of ACE gen poymorphism (X2=0.49, p>0.05). After making groups of E2/E2, E2/E3, E3/E3, E3/E4 and comparing them with control group, there was no significant difference (X2=3.45, p>0.05). Also, there was no significant difference between ischemic and hemorrhagic group as compared with risk factors of hypertension, diabetes mellitus, myocardial infarctus, hyperlipidemi and coronary heart disease.",apolipoprotein E;dipeptidyl carboxypeptidase;adult;aged;Alzheimer disease;article;atherosclerosis;cardiovascular risk;cerebrovascular disease;controlled study;diabetes mellitus;genetic polymorphism;heart infarction;human;hyperlipidemia;hypertension;ischemic heart disease;major clinical study;prospective study;cerebrovascular accident,"Somay, G.;Misirli, H.;Güler, M.;Çalişkan, T.;Sayhan, N.;Erenoǧlu, Y. N.",2002,,,0,
4177,Severe cardiovascular disease and Alzheimer's disease: senile plaque formation in cortical areas,"The main objectives of this study were to analyze the distribution of senile plaques (SP) and neurofibrillary tangles (NFT) in different cortical areas of patients suffering from severe cardiovascular diseases (CVD) and to compare them with Alzheimer's disease (AD) cases. Forty brains were divided into three groups: an AD group (n = 12), a CVD group (n = 17), and a nonheart disease control group (n = 11). The cortical areas examined were the middle frontal gyrus, the superior and inferior watershed areas, the hippocampal formation with the transentorhinal cortex, and the primary visual cortex. SP and NFT were counted in Bielschowsky-stained sections from all cortical areas and from the hippocampal formation and the transentorhinal cortex, respectively. Patients with severe CVD occupied an intermediate position in the spectrum of SP formation between AD and nonheart disease patients. The CVD group showed a higher prevalence of SP than the control group, and SP counts were significantly larger in the inferior watershed area, dentate gyrus, subiculum, and transentorhinal cortex. The distribution of SP was similar in CVD and AD patients. Control and CVD patients showed no difference regarding the number of NFT. The existence of a possible cardiovascular component in the genesis of SP is discussed.","Aged;Aged, 80 and over;Alzheimer Disease/complications/*pathology;Brain/*pathology;Coronary Disease/complications/*pathology;Female;Humans;Male;Middle Aged;Neurofibrillary Tangles/*pathology","Soneira, C. F.;Scott, T. M.",1996,,10.1002/(sici)1098-2353(1996)9:2<118::aid-ca4>3.0.co;2-d,0,
4178,Comparison of machine learning techniques with classical statistical models in predicting health outcomes,"Several machine learning techniques (multilayer and single layer perceptron, logistic regression, least square linear separation and support vector machines) are applied to calculate the risk of death from two biomedical data sets, one from patient care records, and another from a population survey. Each dataset contained multiple sources of information: history of related symptoms and other illnesses, physical examination findings, laboratory tests, medications (patient records dataset), health attitudes, and disabilities in activities of daily living (survey dataset). Each technique showed very good mortality prediction in the acute patients data sample (AUC up to 0.89) and fair prediction accuracy for six year mortality (AUC from 0.70 to 0.76) in individuals from epidemiological database surveys. The results suggest that the nature of data is of primary importance rather than the learning technique. However, the consistently superior performance of the artificial neural network (multi-layer perceptron) indicates that nonlinear relationships (which cannot be discerned by linear separation techniques) can provide additional improvement in correctly predicting health outcomes.",aged;area under the curve;article;artificial intelligence;artificial neural network;Canada;comparative study;dementia;female;health status;heart infarction;human;male;mortality;prognosis;receiver operating characteristic;statistical model;treatment outcome,"Song, X.;Mitnitski, A.;Cox, J.;Rockwood, K.",2004,,,0,
4179,MRI features in dengue encephalitis: A case series in South Indian tertiary care hospital,"Dengue virus, a RNA virus of family Flaviviradae is considered non-neurotropic. Increasing studies and case reports reveal neurological manifestations of dengue virus. In our case series, we have evaluated magnetic resonance imaging (MRI) findings of 3 patients with dengue fever diagnosed by positive dengue NS1 antigen with neurological symptoms, which revealed nonspecific imaging features of dengue encephalitis in two cases and dengue meningoencephalitis in one case. Autopsy findings are also correlated in 2 patients who succumbed to their disease. This case series underlines the consideration of dengue encephalitis in patients of dengue fever with neurological symptoms and relevant imaging findings.",nonstructural protein 1;adult;article;autopsy;Babinski reflex;brain edema;brain hernia;case report;cerebrospinal fluid;chill;clinical evaluation;clinical examination;clinical feature;computer assisted tomography;consciousness;decompressive craniectomy;dengue;dengue encephalitis;dengue meningoencephalitis;diastolic blood pressure;diffusion weighted imaging;disease association;disease duration;dizziness;drowsiness;emergency ward;encephalitis;female;fever;frontal lobe;Glasgow coma scale;headache;heart arrest;heart rate;hospital discharge;human;hypotension;hypoventilation;image analysis;lymphocytosis;male;medical history;meningoencephalitis;mental deterioration;mesencephalon;neuroimaging;neurologic disease;nuclear magnetic resonance imaging;physical examination;pons;pulse rate;resuscitation;rigor;seizure;serology;slurred speech;subarachnoid hemorrhage;systolic blood pressure;temporal lobe;tertiary health care;thalamus;unsteady gait;virus meningitis;vomiting;white matter;young adult,"Soni, B. K.;Das, D. S. R.;George, R. A.;Aggarwal, R.;Sivasankar, R.",2017,,10.4103/ijri.IJRI_322_16,0,
4180,Approaches to ascertaining comorbidity information: validation of routine hospital episode data with clinician-based case note review,"BACKGROUND: In clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease. METHODS: A validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed. RESULTS: Median age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions. CONCLUSIONS: This study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was significant under-recording of some other comorbid conditions, and particularly common risk factors.",adolescent;adult;aged;cerebrovascular disease;comorbidity;diabetes mellitus;electronic medical record;female;human;information processing;male;middle aged;heart muscle ischemia;procedures;chronic kidney failure;severity of illness index;standards;United Kingdom;validation study;very elderly,"Soo, M.;Robertson, L. M.;Ali, T.;Clark, L. E.;Fluck, N.;Johnston, M.;Marks, A.;Prescott, G. J.;Smith, W. C.;Black, C.",2014,,,0,
4181,EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia,"Background and objectives: The last version of the EFNS dementia guidelines is from 2007. In 2010, the revised guidelines for Alzheimer's disease (AD) were published. The current guidelines involve the revision of the dementia syndromes outside of AD, notably vascular cognitive impairment, frontotemporal lobar degeneration, dementia with Lewy bodies, corticobasal syndrome, progressive supranuclear palsy, Parkinson's disease dementia, Huntington's disease, prion diseases, normal-pressure hydrocephalus, limbic encephalitis and other toxic and metabolic disorders. The aim is to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists and other specialist physicians responsible for the care of patients with dementing disorders. It represents a statement of minimum desirable standards for practice guidance. Methods: The task force working group reviewed evidence from original research articles, meta-analyses and systematic reviews, published by June 2011. The evidence was classified (I, II, III, IV) and consensus recommendations graded (A, B, or C) according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. Results and conclusions: New recommendations and good practice points are made for clinical diagnosis, blood tests, neuropsychology, neuroimaging, electroencephalography, cerebrospinal fluid (CSF) analysis, genetic testing, disclosure of diagnosis, treatment of behavioural and psychological symptoms in dementia, legal issues, counselling and support for caregivers. All recommendations were revised as compared with the previous EFNS guidelines. The specialist neurologist together with primary care physicians play an important role in the assessment, interpretation and treatment of symptoms, disability and needs of dementia patients. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.",alpha tocopherol;antioxidant;atypical antipsychotic agent;baclofen;bromocriptine;cholinesterase inhibitor;creatine;donepezil;idebenone;lamotrigine;levodopa;memantine;mepacrine;placebo;remacemide;rivastigmine;ubidecarenone;anterograde amnesia;anxiety;article;ataxia;behavior disorder;brain biopsy;bronchopneumonia;caregiver;cerebrospinal fluid analysis;cerebrospinal fluid shunting;Cochrane Library;cognitive defect;comorbidity;computer assisted tomography;corticobasal degeneration;counseling;Creutzfeldt Jakob disease;daily life activity;decision making;dementia;diffuse Lewy body disease;driving ability;dysarthria;dysgraphia;dyslexia;electroencephalography;emphysema;episodic memory;executive function;frontal variant frontotemporal dementia;gene mutation;genetic screening;Geriatric Depression Scale;Gerstmann Straussler Scheinker syndrome;heart infarction;human;Huntington chorea;lung embolism;Medline;meta analysis (topic);Mini Mental State Examination;multiinfarct dementia;neuroimaging;neurologic examination;neuropsychology;normotensive hydrocephalus;nuclear magnetic resonance imaging;paraneoplastic neuropathy;Parkinson disease;peer review;positron emission tomography;practice guideline;prion disease;priority journal;progressive nonfluent aphasia;progressive supranuclear palsy;psychologic test;semantic dementia;single photon emission computer tomography;systematic review (topic),"Sorbi, S.;Hort, J.;Erkinjuntti, T.;Fladby, T.;Gainotti, G.;Gurvit, H.;Nacmias, B.;Pasquier, F.;Popescu, B. O.;Rektorova, I.;Religa, D.;Rusina, R.;Rossor, M.;Schmidt, R.;Stefanova, E.;Warren, J. D.;Scheltens, P.",2012,,,0,
4182,The microcirculation: a key player in obesity-associated cardiovascular disease,"It is increasingly recognized that obesity is a risk factor for microvascular disease, involving both structural and functional changes in the microvasculature. This review aims to describe how obesity impacts the microvasculature of a variety of tissues, including visceral adipose tissue, skeletal muscle, heart, brain, kidneys, and lungs. These changes involve endothelial dysfunction, which in turn (i) impacts control of vascular tone, (ii) contributes to development of microvascular insulin resistance, (iii) alters secretion of paracrine factors like nitric oxide and endothelin, but (iv) also influences vascular structure and perivascular inflammation. In concert, these changes impair organ perfusion and organ function thereby contributing to altered release and clearance of neurohumoral factors, such as adipokines and inflammatory cytokines. Global microvascular dysfunction in obese subjects is therefore a common pathway that not only explains exercise-intolerance but also predisposes to development of chronic kidney disease, microvascular dementia, coronary microvascular angina, heart failure with preserved ejection fraction, chronic obstructive pulmonary disease, and pulmonary hypertension.",Adipose tissue;Endothelial dysfunction;Insulin resistance;Microvascular disease;Obesity,"Sorop, O.;Olver, T. D.;van de Wouw, J.;Heinonen, I.;van Duin, R. W.;Duncker, D. J.;Merkus, D.",2017,Jul 01,,0,
4183,Systemic disease after hip replacement: Aeromedical implications of arthroprosthetic cobaltism,"Background: A multisystem illness recently reported in recipients of the newest generation of metal-on-metal hip prostheses has been ascribed to toxic effects of cobalt and possibly chromium. Case Report: We present a case of insidiously developing neurologic illness that occurred in a physically active professional. Discussion: This case illustrates the potential for a hip prosthesis to occultly impair safe functioning of aviators. Based on this case and others, we suggest modifications to aeromedical policy relating to waiver requests after hip replacement, including routine monitoring of serum cobalt and chromium levels in recipients of metal-on-metal hip prostheses. The evaluation of aviators having an elevated cobalt level is also discussed. © by the Aerospace Medical Association, Alexandria, VA.",cobalt;aerospace medicine;article;blood;case report;cognitive defect;hip arthroplasty;hip osteoarthritis;human;male;metal on metal joint prosthesis;middle aged;sensory dysfunction,"Sotos, J. G.;Tower, S. S.",2013,,,0,
4184,Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey,"Background: Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability. Methods: We undertook cross-sectional surveys of residents aged older than 65 years (n=15 022) in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Disability was assessed with the 12-item WHO disability assessment schedule 2.0. Dementia, depression, hypertension, and chronic obstructive pulmonary disease were ascertained by clinical assessment; diabetes, stroke, and heart disease by self-reported diagnosis; and sensory, gastrointestinal, skin, limb, and arthritic disorders by self-reported impairment. Independent contributions to disability scores were assessed by zero-inflated negative binomial regression and Poisson regression to generate population-attributable prevalence fractions (PAPF). Findings: In regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25·1% [IQR 19·2-43·6]). Other substantial contributors were stroke (11·4% [1·8-21·4]), limb impairment (10·5% [5·7-33·8]), arthritis (9·9% [3·2-34·8]), depression (8·3% [0·5-23·0]), eyesight problems (6·8% [1·7-17·6]), and gastrointestinal impairments (6·5% [0·3-23·1]). Associations with chronic diseases accounted for around two-thirds of prevalent disability. When zero inflation was taken into account, between-site differences in disability scores were largely attributable to compositional differences in health and sociodemographic characteristics. Interpretation: On the basis of empirical research, dementia, not blindness, is overwhelmingly the most important independent contributor to disability for elderly people in countries with low and middle incomes. Chronic diseases of the brain and mind deserve increased prioritisation. Besides disability, they lead to dependency and present stressful, complex, long-term challenges to carers. Societal costs are enormous. Funding: Wellcome Trust; WHO; US Alzheimer's Association; Fondo Nacional de Ciencia Y Tecnologia, Consejo de Desarrollo Cientifico Y Humanistico, Universidad Central de Venezuela. © 2009 Elsevier Ltd. All rights reserved.",aged;angina pectoris;arthritis;article;asthma;China;chronic disease;chronic obstructive lung disease;clinical assessment;clinical research;controlled study;coughing;cross-sectional study;Cuba;dementia;demography;depression;diabetes mellitus;disability;Dominican Republic;dyspnea;enteropathy;eye disease;female;gastrointestinal disease;health;health care cost;hearing impairment;heart disease;heart infarction;human;hypertension;India;limb disease;limb weakness;lowest income group;male;Mexico;paralysis;Peru;population;prevalence;priority journal;regression analysis;rheumatic disease;rural area;scoring system;sensory dysfunction;skin disease;stomach disease;cerebrovascular accident;faintness;Venezuela;world health organization,"Sousa, M.;Ferri, C. P.;Acosta, D.;Albanese, E.;Guerra, M.;Huang, Y.;Jacob, K. S.;Jotheeswaran, A. T.;Rodriguez, J. J. L.;Pichardo, G. R.;Rodriguez, M. C.;Salas, A.;Sosa, A. L.;Williams, J.;Zuniga, T.;Prince, M.",2009,,,0,
4185,Neurologic adverse effects of ranolazine in an elderly patient with renal impairment,"Ranolazine, an antianginal agent, has activity at muscle and neuronal sodium channels. Congenital genetic mutations to sodium channels in humans and supratherapeutic ranolazine concentrations in animal models have produced similar neurologic adverse reactions. We describe a case of neurologic adverse effects in an 81-year-old woman with coronary artery disease, renal impairment, and mild neurologic disease who received ranolazine for symptomatic control of a non-ST-segment elevation myocardial infarction. Just over 48 hours after a dose increase, she experienced new-onset dysarthia, dysmetria, hallucinations, worse tremors, and difficulty with word finding. Her workup for acute stroke and infectious causes was negative. Her symptoms abated 2 days after ranolazine was discontinued. The patient was at risk for ranolazine adverse effects due to the high dose administered and her advanced age, renal impairment, and baseline mild neurologic disease. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient's neurologic adverse events and the ranolazine therapy. To our knowledge, this is the first case report illustrating rare but debilitating neurologic adverse effects of ranolazine. Health care practitioners should be aware of the adverse effects of ranolazine and avoid doses greater than 500 mg twice/day in patients older than 80 years or those with a creatinine clearance of less than 30 ml/minute. Copyright © 2013 Pharmacotherapy Publications, Inc.",acetylsalicylic acid;ceftriaxone;cotrimoxazole;glyceryl trinitrate;heparin;isosorbide dinitrate;ranolazine;abdominal pain;aged;agitation;angiocardiography;article;case report;chill;confusion;continuous infusion;coronary artery bypass graft;coronary artery disease;coronary artery obstruction;dementia;drug dose increase;drug megadose;drug withdrawal;dysarthria;dysmetria;female;fever;hallucination;heart catheterization;high risk patient;human;kidney disease;nausea;neurologic disease;non ST segment elevation myocardial infarction;side effect;thorax pain;tremor;urinary tract infection;vomiting,"Southard, R. A.;Blum, R. M.;Bui, A. H.;Blankstein, R.",2013,,,0,
4186,Nonvertebral fractures due to post-menopausal osteoporosis: Evaluation of effective preventive interventions,,alendronic acid;bisphosphonic acid derivative;calcium;estrogen;gestagen;ibandronic acid;pamidronic acid;parathyroid hormone[1-34];placebo;raloxifene;risedronic acid;salcatonin;vitamin D;zoledronic acid;accident prevention;age distribution;anxiety;article;bone densitometry;bone density;breast cancer;calcium intake;smoking;clavicle fracture;clinical trial;dementia;depression;disease course;drug approval;drug contraindication;drug efficacy;drug withdrawal;environmental factor;falling;female;food and drug administration;fragility fracture;hip fracture;hormone substitution;human;immobilization;incidence;ischemic heart disease;morbidity;mortality;muscle exercise;osteopenia;osteosarcoma;pelvis fracture;postmenopause osteoporosis;prevalence;quality of life;risk assessment;risk factor;risk reduction;sex difference;cerebrovascular accident;survival rate;United States;venous thromboembolism;vitamin intake;weight bearing;wrist fracture,"South-Paul, J. E.",2005,,,0,
4187,A genomewide exploration suggests a new candidate gene at chromosome 11q23 as the major determinant of plasma homocysteine levels: results from the GAIT project,"Homocysteine (Hcy) plasma level is an independent risk marker for venous thrombosis, myocardial infarction, stroke, congestive heart failure, osteoporotic fractures, and Alzheimer disease. Hcy levels are determined by the interaction of genetic and environmental factors. The genetic basis is still poorly understood, since only the MTHFR 677 C-->T polymorphism has been consistently associated with plasma Hcy levels. We conducted a genomewide linkage scan for genes affecting variation in plasma Hcy levels in 398 subjects from 21 extended Spanish families. A variance-components linkage method was used to analyze the data. The strongest linkage signal (LOD score of 3.01; genomewide P = .035) was found on chromosome 11q23, near marker D11S908, where a candidate gene involved in the metabolism of Hcy (the nicotinamide N-methyltransferase gene [NNMT]) is mapped. Haplotype analyses of 10 single-nucleotide polymorphisms within this gene found one haplotype associated with plasma Hcy levels (P = .0003). Our results, to our knowledge, represent the first genomic scan for quantitative variation in Hcy plasma levels. They strongly suggest that the NNMT gene could be a major genetic determinant of plasma Hcy levels in Spanish families. Since this gene encodes an enzyme involved in Hcy synthesis, this finding would be consistent with known biochemical pathways. These data could be relevant in determining the relationships between Hcy level, cardiovascular disease, osteoporosis, and Alzheimer disease.","Chromosome Mapping;*Chromosomes, Human, Pair 11;Gene Expression Regulation, Enzymologic;Genetic Linkage;Genetic Markers/genetics;Genetic Variation;*Genome, Human;Haplotypes;Heterozygote;Homocysteine/*blood/*genetics;Humans;Lod Score;Methyltransferases/genetics;Models, Biological;Nicotinamide N-Methyltransferase;Polymorphism, Single Nucleotide;Risk Factors;Spain;Thrombophilia/blood/*genetics","Souto, J. C.;Blanco-Vaca, F.;Soria, J. M.;Buil, A.;Almasy, L.;Ordonez-Llanos, J.;Martin-Campos, J. M.;Lathrop, M.;Stone, W.;Blangero, J.;Fontcuberta, J.",2005,Jun,10.1086/430409,0,
4188,A comparison of end-stage renal disease and Alzheimer's disease in the elderly through a comprehensive geriatric assessment,"PURPOSE: The percentage of patients receiving haemodialysis (HD) treatment and of patients with Alzheimer's disease (AD) within the elderly population is increasing day by day. Functional dependence, malnutrition, cognitive impairment or depression impairs the quality of life and increases mortality in both diseases. This study aims to assess HD and AD patients through comprehensive geriatric assessment (CGA) and compare their results. METHOD: A total of 579 patients (121 HD, 188 AD patients and 270 control subjects) over the age of 65, who were followed at geriatric and nephrology departments between January 2011 and July 2012, were included in this prospective cross-sectional study. Mini-Mental State Examination, Mini-Nutritional Assessment, Geriatric Depression Scale and basic and Instrumental Activities of Daily Living indexes were applied to all patients. The results obtained were compared among the patient groups. RESULTS: The mean age of the participants was 72.6 +/- 8.2. Based on the CGA findings, the results for both groups were considerably different from control group. While depression scores were observed higher in HD patients than in AD patients, cognition, nutrition and functional capacity were mostly affected in AD patients. CONCLUSION: The management of geriatric HD patients is substantially complex. Depression, cognitive impairment and decrease in functional capacity can often be overlooked, so findings may be ascribed to underlying kidney impairment. Therefore, comprehensive geriatric assessment should be regularly performed in HD patients in order to detect problems at an early stage, to take necessary preventative measures, to initiate treatment as soon as possible and to enhance quality of life.","Activities of Daily Living;Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology/*psychology;Cognition;Comorbidity;Cross-Sectional Studies;Depression/etiology;Diabetes Mellitus/epidemiology;Female;*Geriatric Assessment;Heart Failure/epidemiology;Humans;Hypertension/epidemiology;Kidney Failure, Chronic/*epidemiology/*psychology/therapy;Male;Middle Aged;Nutrition Assessment;Nutritional Status;Prospective Studies;Renal Dialysis/psychology","Soysal, P.;Isik, A. T.;Buyukaydin, B.;Kazancioglu, R.",2014,Aug,10.1007/s11255-014-0739-5,0,
4189,Physical activity and depression predict event-free survival in heart transplant candidates,"Objective: This study prospectively evaluated the relationship of physical activity (PA), depression, and anxiety to event-free survival during waiting time for heart transplantation in ambulatory patients enrolled in the Waiting for a New Heart Study. Method: Data from 227 ambulatory patients newly listed for heart transplantation were analyzed. Everyday PA (number of activities, caloric expenditure), depression, and anxiety at time of listing were assessed via questionnaires. Events were defined as death, high-urgency transplantation, delisting due to clinical deterioration, and mechanical circulatory support device implantation. Associations of PA scores, depression, and anxiety with event-free survival were analyzed using Cox proportional hazards models. Covariates included age, sex, body mass index, and objective indicators of disease severity. Results: After a median follow-up of 478 days (6-1,849 days), 132 events occurred (46 deaths, 20 mechanical circulatory support device implantations, 54 high-urgency transplantations, 12 delistings). A higher number of activities was significantly associated with a reduced hazard ratio (HR) to experience an event (HR = 0.88, 95% CI [0.81, 0.96]), and depression increased this risk (HR = 1.64, 95% CI [1.16, 2.32]). Both effects remained significant in multivariate analyses (HR = 0.91, 95% CI [0.83, 0.99]; HR = 1.60, 95% CI [1.12, 2.29], ps < .02). No significant interactions between PA scores and emotions were observed and anxiety was unrelated to survival. Conclusion: Both everyday PA and the absence of depression prolonged event-free survival in ambulatory heart transplant candidates. These findings were independent of objective measures of disease severity. Patients waiting for cardiac transplantation may benefit from interventions focused on increasing their everyday PA and reducing depressive symptoms.",adult;age;anxiety disorder;article;assessment of humans;body mass;depression;disease severity;emotion;energy expenditure;event free survival;female;follow up;Heart Failure Survival Score;heart index;heart transplantation;Hospital Anxiety and Depression Scale;human;major clinical study;male;mental deterioration;physical activity;prediction;prospective study;sex,"Spaderna, H.;Vögele, C.;Barten, M. J.;Smits, J. M. A.;Bunyamin, V.;Weidner, G.",2014,,,0,
4190,HMG-CoA reductase inhibitors (statins) in the treatment of Alzheimer's disease and why it would be ill-advise to use one that crosses the blood-brain barrier,"Increased circulating cholesterol has been long linked to an increased risk of coronary artery disease (CAD), and is now linked to an increased risk of developing Alzheimer s disease (AD). We first showed the neuropathologic link between CAD and AD as increased incidence of cerebral senile plaques in both disorders. We then showed that AD-like neuropathology occurred in the brains of cholesterol-fed rabbits; including increased -amyloid (Ab). Currently there are a number of transgenic mouse models of AD that exhibit enhanced Ab pathology if cholesterol diet is administered. Culture studies clearly show that excess cholesterol enhances beta-metabolism of amyloid precursor protein (APP) and production of -amyloidogenic peptides, and that sufficiently reducing cholesterol levels by inhibition of synthesis completely inhibits all beta-metabolism of APP. Our finding that the elevated levels of Ab in rabbits fed cholesterol diet could be cleared from the brain by resuming a control diet prompted the hypothesis that lowering cholesterol levels in the blood of AD patients may be of some clinical benefit. Pilot data suggests that therapeutically lowering circulating cholesterol may attenuate Ab production in the cholesterol-fed rabbit brain, may stabilize cognitive performance in mildly impaired AD patients, and may reduce the risk of developing AD. Accordingly, we have initiated a double-blind treatment trial evaluating Atorvastatin Na+ among 120 mild-to-moderately impaired AD subjects randomized to one of two groups receiving placebo or active drug once a day. Atorvastatin is one of a general class of HMG-CoA reductase inhibitor drugs called statins that lower cholesterol by inhibition of synthesis. We chose to use Atorvastatin in this AD Treatment Trial because it does not cross the blood-brain-barrier, and believe it would be ill-advised to use a statin that does. This position stems from the observations that excess cholesterol inhibits cholesterol synthesis and increases Ab production, that Ab kills cells in part by inhibiting cholesterol synthesis, and that statins acting at the neuronal level could further exacerbate degeneration in AD by further inhibition of necessary cholesterol synthesis.",Hs-handsrch: sr-compmed: sr-dementia,"Sparks, Dl;Connor, Dj;Browne, Pj;Lopez, Je;Sabbagh, Mn",2002,,,0,4194
4191,Intraneuronal beta-amyloid immunoreactivity in the CNS,"The high degree of overlap in the neuropathologic outcome of Alzheimer's disease (AD), Down's Syndrome (DS), and coronary heart disease suggest a possible interrelationship. The pattern of hippocampal and cortical intraneuronal beta A4 immunoreactivity is strikingly similar in AD, DS, coronary heart disease, and two separate animal models of coronary heart disease. Cells in fascia dentata and large cortical neurons were beta A4 immunodecorated in half the AD and DS subjects studied. Similar neuronal staining occurred in half the age-matched coronary heart disease subjects, but was absent in each nonheart disease control investigated. Analogous accumulations of neuronal beta A4 immunoreactivity were induced in rabbit brain by dietary administration of high cholesterol, and this effect could be reversed by regression of the experimental diet. Decreased density (p < 0.05) and cellular staining intensity occurred after 2 weeks of control diet following 8 weeks of high cholesterol. Microgliosis accompanied the accumulation of beta A4 immunoreactivity in the cholesterol-fed rabbits and persisted after regression of the diet and decreases in neuronal beta A4 immunoreactivity. An identical pattern of neuronal beta A4 immunoreactivity was induced in the brains of adolescent pigs after acute ligation of the left anterior descending coronary artery (LAD) compared to surgical and anesthetic controls. The mean number of beta A4 immunoreactive neurons was significantly increased (p < 0.05) in the cortex and hippocampus of pigs with a ligated LAD compared to both control groups. Increased density and intensity of neuronal beta A4 immunoreactivity induced by ligation of the LAD was commensurate with the severity of the decreased cardiac output in the LAD group, but not in the anesthetic control groups with decreased cardiac output. The incidence of ALZ-50 (A68) immunoreactive neurons also increased in the ligated pigs compared to both control groups. The data suggest a neuronal origin of beta A4 immunoreactive peptide(s), which can be cleared from the brain by microglia after severe accumulation is induced. This could indicate that reduced clearance of beta-APP metabolic by-products could contribute to a metabolic backlog and redirection of peptide processing by microglia to extracellular deposition. Neuronal accumulation of beta A4 immunoreactivity could be due to the effect of circulating factors on brain function in both animals models. It is likely that animal models of coronary heart disease may be useful in disclosing the mechanism of SP formation and induction of ALZ-50 immunoreactivity irrespective of their pathoclinical significance.","Aged;Alzheimer Disease/pathology;Amyloid beta-Peptides/*metabolism;Animals;Cell Count;Central Nervous System/*metabolism/pathology;Coronary Disease/pathology;Coronary Vessels/physiology;Dentate Gyrus/metabolism/pathology;Disease Models, Animal;Down Syndrome/metabolism/pathology;Gliosis/metabolism/pathology;Hemodynamics/physiology;Humans;Immunohistochemistry;Interneurons/*metabolism;Microglia/metabolism/ultrastructure;Middle Aged;Neurons/metabolism;Rabbits;Swine","Sparks, D. L.",1996,Mar-Apr,,0,
4192,"Coronary artery disease, hypertension, ApoE, and cholesterol: a link to Alzheimer's disease?","The premature presence of senile plaques (SP) in coronary artery disease (CAD), and neurofibrillary tangles (NFT) as well as SP in hypertension (HyperT), suggest a neuropathologic link between CAD, HyperT, and AD. Previous MI, CAD and HyperT often occur in and may increase the risk of AD. Expression of Apo-E4 likely increases risk of CAD by elevating blood cholesterol and the risk of AD via proposed interactions with beta-amyloid and/or free radicals (FRs). Any Apo-E4 effect is vague, but FRs probably mediate vascular damage in HyperT. Increasing FR content in the blood is related to increasing CAD severity, while the severity of elevated FR level correlates with how deep into a blood vessel there is activation of the FR scavenger enzyme, superoxide dismutase (SOD). The ApoE genotype and SP/NFT areal densities were determined in a large population of non-demented CAD, HyperT and non-heart disease (non-HD) control subjects, and compared to findings in a similar number of AD patients. ApoE immunoreactivity was determined in many individuals. Cholesterol content in cortex was determined by HPLC in a small, loosely age-matched group of Apo-E4 genotype-matched AD, CAD and non-HD subjects. SOD immunoreactivity was also assessed in a number of subjects. The Apo-E4 genotype frequency was increased in CAD, HyperT and AD compared to non-HD controls. Dose of Apo-E4 correlated with SP densities, but not NFT, and only in the non-demented groups. Essentially all SP in CAD, HyperT and non-HD subjects were ApoE-immunoreactive. Cortical cholesterol was increased in CAD and AD compared to controls. SOD immunoreactivity was similar in HyperT and AD; SP were immunodecorated in both. AD, CAD and HyperT may be linked, while CAD and HyperT subjects may die of heart disease before showing cognitive change.","Aged;Aged, 80 and over;Alleles;Alzheimer Disease/complications/*metabolism/pathology;Apolipoprotein E4;Apolipoproteins E/genetics/*metabolism;Cholesterol/*metabolism;Coronary Disease/*metabolism/pathology;Genotype;Humans;Hypertension/*metabolism;Middle Aged;Neurofibrillary Tangles/pathology;Plaque, Amyloid/pathology;Superoxide Dismutase/analysis","Sparks, D. L.",1997,Sep 26,,0,
4193,Should the guidelines for monitoring serum cholesterol levels in the elderly be re-evaluated?,"Elevated circulating cholesterol can have profound effects on the health of an individual. Such excess cholesterol can promote coronary artery disease, production and accumulation of beta-amyloid in the brain, and possibly Alzheimer's disease (AD). In a clinical trial evaluating the benefit of a cholesterol-lowering drug in the treatment of AD, mean cholesterol levels at baseline among individuals participating in the trial were found to be relatively high. Based on this observation we suggest that cholesterol levels should be actively monitored in the elderly, as many individuals with AD are over 65 years of age and therefore excluded by currently accepted guidelines.","Aged;Alzheimer Disease/blood/*drug therapy/*etiology;Anticholesteremic Agents/*therapeutic use;Cholesterol/*blood;Cholesterol, HDL/blood;Humans;Hypercholesterolemia/blood/*complications;Practice Guidelines as Topic/standards;Triglycerides/blood","Sparks, D. L.;Connor, D. J.;Browne, P.;Sabbagh, M. N.",2002,Aug-Oct,,0,
4194,HMG-CoA reductase inhibitors (statins) in the treatment of Alzheimer's disease and why it would be ill-advise to use one that crosses the blood-brain barrier,"Increased circulating cholesterol has been long linked to an increased risk of coronary artery disease (CAD), and is now linked to an increased risk of developing Alzheimer s disease (AD). We first showed the neuropathologic link between CAD and AD as increased incidence of cerebral senile plaques in both disorders. We then showed that AD-like neuropathology occurred in the brains of cholesterol-fed rabbits; including increased -amyloid (Ab). Currently there are a number of transgenic mouse models of AD that exhibit enhanced Ab pathology if cholesterol diet is administered. Culture studies clearly show that excess cholesterol enhances beta-metabolism of amyloid precursor protein (APP) and production of -amyloidogenic peptides, and that sufficiently reducing cholesterol levels by inhibition of synthesis completely inhibits all beta-metabolism of APP. Our finding that the elevated levels of Ab in rabbits fed cholesterol diet could be cleared from the brain by resuming a control diet prompted the hypothesis that lowering cholesterol levels in the blood of AD patients may be of some clinical benefit. Pilot data suggests that therapeutically lowering circulating cholesterol may attenuate Ab production in the cholesterol-fed rabbit brain, may stabilize cognitive performance in mildly impaired AD patients, and may reduce the risk of developing AD. Accordingly, we have initiated a double-blind treatment trial evaluating Atorvastatin Na+ among 120 mild-to-moderately impaired AD subjects randomized to one of two groups receiving placebo or active drug once a day. Atorvastatin is one of a general class of HMG-CoA reductase inhibitor drugs called statins that lower cholesterol by inhibition of synthesis. We chose to use Atorvastatin in this AD Treatment Trial because it does not cross the blood-brain-barrier, and believe it would be ill-advised to use a statin that does. This position stems from the observations that excess cholesterol inhibits cholesterol synthesis and increases Ab production, that Ab kills cells in part by inhibiting cholesterol synthesis, and that statins acting at the neuronal level could further exacerbate degeneration in AD by further inhibition of necessary cholesterol synthesis.",Hs-handsrch: sr-compmed: sr-dementia,"Sparks, D. L.;Connor, D. J.;Browne, P. J.;Lopez, J. E.;Sabbagh, M. N.",2002,,,0,
4195,Neurochemical and histopathologic alterations characteristic of Pick's disease in a non-demented individual,"In the course of investigating a large number of non-demented subjects, a 68 year old female dying of coronary artery disease was found to have Pick bodies in her grossly normal brain. Although only mild subcortical gliosis and no neuron loss were observed, Pick bodies were found throughout the brain and occasional balloon cells were noted. Pick bodies and numerous neurons were also ALZ-50 and Tau-1 immunoreactive. Retrospective studies indicated a lack of overt intellectual decline or depression in this individual. Frontal, temporal and occipital poles, amygdala, hypothalamus and nucleus basalis of Meynert (nbM) were analyzed for ChAT, AChE and MAO-A and -B enzymatic activities and for the binding of 5HT and imipramine. Cholinergic decreases were found only in subcortical structures. Serotonin binding decreases were widespread, excluding the nbM. Altered MAO-B activity was regionally variable, and no differences in MAO-A activity or imipramine binding were observed. Few differences in neurochemical alterations were observed in the current non-demented subject with abundant Pick bodies compared to previous studies of demented Pick's patients. This case strongly suggests that chemical dysfunction and neuropathological features of Pick's disease occur in advance of overt clinical manifestations of the disorder.",acetylcholinesterase;amine oxidase (flavin containing) isoenzyme A;amine oxidase (flavin containing) isoenzyme B;choline acetyltransferase;imipramine;monoclonal antibody Alz 50;serotonin;tau protein;aged;article;case report;controlled study;enzyme activity;female;histopathology;human;human tissue;neurochemistry;Pick presenile dementia;priority journal,"Sparks, D. L.;Danner, F. W.;Davis, D. G.;Hackney, C.;Landers, T.;Coyne, C. M.",1994,,,0,
4196,Neuropathology of mitral valve prolapse in man and cardiopulmonary bypass (CPB) surgery in adolescent Yorkshire pigs,"We investigated the brains of non-demented individuals with mitral valve prolapse (MVP) and found evidence of Alzheimer-like lesions. This neuropathology consisted of premature presence of beta-amyloid-containing senile plaques (SP) without increased prevalence of neurofibrillary tangles. Low levels of SP occurred in 20 to 45- year-old subjects with MVP, and much greater densities were observed in subjects between 45 and 62 years of age. We also investigated the brains of adolescent Yorkshire pigs undergoing cardiopulmonary bypass surgery and likewise found evidence of Alzheimer-like neuropathology. This took the form of intraneuronal accumulation of beta-amyloid immunoreactivity and increasing numbers of Alz-50 immunoreactive neurons with reduced recovery of cardiac efficiency after the surgery. Based on prevailing concepts in Alzheimer's disease, it is feasible to hypothesize that cognitive dysfunction occurring after cardiopulmonary bypass surgery with coronary artery grafting or valve repair/replacement is a functional sequela of AD-like neuropathology. This postulate is based on the premise that an individual seeking such surgery would have pre-existing, elevated AD-like neuropathology to start with. It is further coupled with the probability that these forms of cardiovascular surgery exacerbate the extent and progression of AD-like neuropathology.","Adult;Amyloid beta-Peptides/metabolism;Animals;Antigens/metabolism;Brain/*pathology;Brain Chemistry/physiology;Cardiopulmonary Bypass/*adverse effects;Cognition Disorders/pathology;Coronary Disease/pathology;Female;Humans;Immunohistochemistry;Male;Middle Aged;Mitral Valve Prolapse/*pathology;Myocardium/pathology;Neurofibrillary Tangles/pathology;Plaque, Amyloid/pathology;Swine","Sparks, D. L.;Gross, D. R.;Hunsaker, J. C.",2000,Mar-Apr,,0,
4197,"Cortical senile plaques in coronary artery disease, aging and Alzheimer's disease","Mild alterations in cognitive function are present in normal aging and severe cognitive alterations are a hallmark of Alzheimer's disease (AD). The cognitive change in AD has been correlated to the characteristic pathologic lesions in the brain, senile plaques (SP) and neurofibrillary tangles. Senile plaques are the most consistent correlative marker in AD. We present preliminary data indicating that abundant SP are found in the brains of nondemented patients dying with or as a result of critical coronary artery disease (cCAD) compared to nonheart disease (non-HD) subjects; 15 of 20 cCAD patients contained SP and only two of 16 non-HD patients contained SP.",adult;aged;Alzheimer disease;article;controlled study;coronary artery disease;female;heart disease;human;major clinical study;male;neuropathology;senile plaque,"Sparks, D. L.;Hunsaker Iii, J. C.;Scheff, S. W.;Kryscio, R. J.;Henson, J. L.;Markesbery, W. R.",1990,,,0,
4198,Monoaminergic and cholinergic synaptic markers in the nucleus basalis of Meynert (nbM): normal age-related changes and the effect of heart disease and Alzheimer's disease,"Neurotransmitter markers for acetylcholine, serotonin (5-HT), and dopamine (DA) were measured in autopsied human nucleus basalis of Meynert (nbM) from nondemented individuals without heart disease (non-HD) (age range, 4-84 years; n = 77), nondemented individuals with heart disease (HD) (age range, 57-92 years; n = 23), and individuals with Alzheimer's disease (AD) (age range, 59-92 years; n = 22). No significant differences in any chemical marker were found between age-matched HD and non-HD individuals. The activities of choline acetyltransferase (ChAT) and acetylcholinesterase (AChE), and [3H]spiperone binding were regionally distributed within the nbM in control (non-HD) subjects less than 54 years of age. The activity of AChE, 5-[3H]HT binding, and the content of homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and 5-HT were regionally distributed in the nbM in non-HD, HD, and AD subjects more than 54 years of age. The binding of [3H]spiperone was regionally distributed in the nbM in HD and AD subjects more than 54 years of age, only. Activity of ChAT and AChE, content of 5-HT, 5-HIAA, and DA, binding of 5-[3H]HT, and the turnover number for DA (ratio of HVA/DA) all decreased with increasing age in the non-HD control population. The content of HVA, binding of [3H]spiperone, and the turnover number for 5-HT (ratio of 5-HIAA/5-HT) did not change with increasing age. Significant reductions in ChAT and AChE activities were found in AD nbM compared with postmortem interval- and age-matched HD and non-HD individuals. The reduction of 5-HT and 5-HIAA content and [3H]spiperone binding in individuals with AD of all ages suggests a loss of functional serotonergic innervation of the nbM. Dopaminergic synaptic markers were less affected in AD nbM, although turnover numbers for both DA and 5-HT were increased in AD. Receptor upregulation in response to presynaptic deficits did not occur for DA or 5-HT.","Acetylcholinesterase/*analysis;Adolescent;Adult;Aged;Aged, 80 and over;Aging/*metabolism;Alzheimer Disease/*metabolism;Biomarkers;Child;Child, Preschool;Choline O-Acetyltransferase/*analysis;Coronary Disease/*metabolism;Dopamine/metabolism;Humans;Middle Aged;Nerve Tissue Proteins/*analysis;Neurotransmitter Agents/*metabolism;Serotonin/metabolism;Substantia Innominata/*chemistry","Sparks, D. L.;Hunsaker, J. C., 3rd;Slevin, J. T.;DeKosky, S. T.;Kryscio, R. J.;Markesbery, W. R.",1992,Jun,10.1002/ana.410310608,0,
4199,Temporal sequence of plaque formation in the cerebral cortex of non- demented individuals,"One of the hallmarks of Alzheimer's disease is the presence of argyrophilic plaques (arg-P) accompanying dementia and other forms of cognitive alterations. In the present investigation 195 non-demented, cognitively normal patients were grouped according to the presence or absence of critical coronary artery disease (cCAD), defined as a 75% or greater stenosis of one of the epicardial arteries. None of the subjects had significant cerebral vascular disease. The parahippocampal gyrus (PHG) and frontal pole were analyzed for the presence of arg-P, A4 deposition, ALZ-50 immunoreactive (IR) neurons and neuropil threads (NT). Individuals with cCAD have a significantly greater incidence of plaques than non-heart disease (non-HD) subjects. Every cCAD subject had ALZ-50 IR neurons in the PHG and a greater incidence of NT as compared to the non-HD subjects. Every subject with plaques also had IR neurons and NT in the PHG. Based on the presumption that early neurodegeneration labeled by ALZ-50 antibody and amyloid deposition are in some way linked, then the sequence of plaque formation is initiated by the presence of ALZ-50 IR neurons followed in order by NT, A4 deposition and diffuse form arg-P.",amyloid;adult;aged;Alzheimer disease;argyrophilia;article;brain cortex;controlled study;coronary artery disease;frontal cortex;human;human tissue;immunoreactivity;neuropil;priority journal;senile plaque;subiculum,"Sparks, D. L.;Liu, H.;Scheff, S. W.;Coyne, C. M.;Hunsaker Iii, J. C.",1993,,,0,
4200,Water quality has a pronounced effect on cholesterol-induced accumulation of Alzheimer amyloid beta (Abeta) in rabbit brain,"Increased circulating cholesterol is known to promote risk of coronary artery disease. It is now emerging that cholesterol promotes production and accumulation of amyloid beta (Abeta) deposited in the hallmark pathologic lesion of Alzheimer's disease (AD), the senile plaque, perhaps by shifting away from normal metabolism of amyloid beta protein precursor (AbetaPP) to beta. Previous studies employing the cholesterol-fed rabbit model of AD demonstrated that induction of AD-like Abeta accumulation in brain could be reversed by co-administration of cholesterol lowering drugs or removing cholesterol, prompted initiation of an AD Cholesterol-Lowering (Statin) Treatment Trial. We now present data that identify a previously unrecognized role for dietary water quality on the severity of neuropathology induced by elevated cholesterol. Neuronal accumulation of Abeta induced by increased circulating concentrations of cholesterol in the New Zealand white rabbit is attenuated when distilled drinking water is administered compared to use of tap water. The numbers of neurons in cholesterol-fed rabbits that exhibited Abeta immunoreactivity, relative to normal chow-fed controls, increased approximately 2.5 fold among animals on tap water but only approximately 1.9 fold among animals on distilled water. This yielded a statistically significant approximately 28% reduction due to the use of distilled water. In addition, the subjectively assessed intensity of neuronal Abeta immunoreactivity was consistently reduced among cholesterol-fed rabbits allowed distilled drinking water compared to cholesterol-fed rabbits on tap water. As intensity of antibody immunoreactivity is likely related to concentration of antigen, the identified difference among cholesterol-fed rabbits allowed distilled drinking water may hold greater importance than a significant reduction in numbers of affected neurons. The effect on neuronal Abeta immunoreactivity intensity was observable among cholesterol-fed rabbits reared and allowed tap water when performing studies in three distinct locales. Pilot data suggest the possibility of increased clearance of Abeta from the brain, identified as increased blood levels, among cholesterol-fed rabbits administered distilled water compared to animals on tap water. The agent(s) occurring in tap water, excluded by distillation, promoting accumulation of neuronal Abeta immunoreactivity is(are) yet undisclosed, but arsenic, manganese, aluminum, zinc, mercury, iron and nitrate have tentatively been excluded because they were not identifiable (below detection limits) in the tap water of the three locales where the cholesterol-induced neuropathologic difference was observable. These findings suggest that water quality may impact on human health in the setting of increased circulating cholesterol levels, and could illustrate a truly simple life-style change that could be of benefit in AD.","Alzheimer Disease/*pathology;Amyloid beta-Peptides/*metabolism;Animals;Brain/*pathology;Cholesterol/*blood;Humans;Hypercholesterolemia/pathology;Male;Rabbits;Risk Factors;Water Pollution, Chemical/*adverse effects;*Water Purification","Sparks, D. L.;Lochhead, J.;Horstman, D.;Wagoner, T.;Martin, T.",2002,Dec,,0,
4201,A position paper: based on observational data indicating an increased rate of altered blood chemistry requiring withdrawal from the Alzheimer's Disease Cholesterol-Lowering Treatment Trial (ADCLT),"Recruitment for the inaugural double-blind placebo-controlled trial investigating a cholesterol-lowering treatment for benefit in Alzheimer's disease (AD) (ADCLT) ended after obtaining 98 informed consents. Suspension of recruitment of the ADCLT occurred in concert with initiation of two separate multicenter trials testing similar hypotheses. Although occurring at very low rates (<2%), altered-chemistry adverse events requiring discontinuation of therapy (withdrawal AEs) are not unexpected with use of cholesterol-lowering statins. We suggest that exceptionally close monitoring for altered chemistry among individuals with AD should be undertaken in future statin treatment trials, as limited data from the ADCLT indicate that chemically based withdrawal AEs could be more prevalent among female AD patients. There was no apparent correlation between the occurrence of withdrawal-AE incidence and lower body mass among the female AD trial subjects and, therefore, probably was not a dose-related resultant. This might indicate that cognitively intact elderly women at risk for heart disease and those with clinically documented AD should not be presumed to be pharmocodynamically equivalent. Lipid profiles obtained at screening in the ADCLT are consistent with a possible difference between patients with current AD and those at risk for heart disease. Elevated cholesterol, increased cholesterol/high-density lipid (HDL) ratios, and elevated triglycerides are routinely observed among those at risk for heart disease; however, among ADCLT study participants, only cholesterol levels were increased while cholesterol/HDL ratio and triglyceride levels remained within normal limits.","Alzheimer Disease/*drug therapy/*etiology/metabolism;Blood/*drug effects/metabolism;Blood Chemical Analysis;Coronary Disease/complications/drug therapy/metabolism;Dose-Response Relationship, Drug;Female;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/*adverse effects;Hypercholesterolemia/*complications/*drug therapy/metabolism;Hyperlipidemias/complications/drug therapy/metabolism;Male;Monitoring, Physiologic;Patient Dropouts/statistics & numerical data;Risk Factors;Sex Characteristics","Sparks, D. L.;Lopez, J.;Connor, D.;Sabbagh, M.;Seward, J.;Browne, P.",2003,,10.1385/jmn:20:3:407,0,
4202,"Increased density of senile plaques (SP), but not neurofibrillary tangles (NFT), in non-demented individuals with the apolipoprotein E4 allele: Comparison to confirmed Alzheimer's disease patients","The apolipoprotein E genotype and cortical senile plaque (SP) and cortical and hippocampal neurofibrillary tangle (NFT) densities were determined in non-demented individuals and neuropathologically confirmed AD patients. The non-demented population was further subdivided according to presence or absence of pathologically established critical coronary artery disease (cCAD), hypertension (HyperT), or neither (non-heart disease; non-HD). The apolipoprotein EA (APOE4) allele incidence and dose frequencies were increased in the AD, cCAD and HyperT groups compared to the non-HD controls. The mean number of SP and NFT was significantly increased with the presence of the APOE4 allele within the entire population. After grouping the non-demented subjects according to cardiac status, SP but not NFT density was increased among those individuals with the APOE4 genotype. In HyperT, the increased density of SP also correlated to the APOE4 allele dose frequency. The density of SP and NFT was increased in all regions of AD brain compared to all other non-demented groups, but no significant difference was found between AD patients with or without an APOE4 allele. These two AD groups were age-matched, but could not be matched for disease duration. The data suggest a relationship between heart disease, APOE4 genotype and the presence of SP regardless of cognitive status.",apolipoprotein E;adult;aged;Alzheimer disease;article;controlled study;dementia;female;histology;human;human tissue;hypertension;major clinical study;male;neurofibrillary tangle;priority journal;senile plaque,"Sparks, D. L.;Scheff, S. W.;Liu, H.;Landers, T.;Danner, F.;Coyne, C. M.;Hunsaker Iii, J. C.",1996,,,0,
4203,Increased incidence of neurofibrillary tangles (NFT) in non-demented individuals with hypertension,"The incidence rates and numerical densities of argyrophilic neurofibrillary tangles (NFT) and senile plaques (SP) were determined in non-demented individuals and subjects with Alzheimer's disease (AD). The non-AD subjects were grouped according to cardiac status; those individuals with critical coronary artery disease (cCAD), those hypertensive individuals without cCAD (HyperT), and those without heart disease (non-HD). The incidence and densities of SP and NFT were significantly greater in AD than any of the non-demented groups. The prevalence of SP was increased in both HyperT and cCAD compared to non-HD controls, while NFT occurrence was accentuated in non-demented HyperT subjects only. The densities of SP and NFT in HyperT were elevated compared to cCAD or both cCAD and non-HD controls; NFT densities were similar in cCAD and non-HD. NFT density increased with increasing age in only the non-HD and cCAD groups, suggesting a possible relationship between disease process and NFT formation in the AD and HyperT populations.",adult;aged;Alzheimer disease;article;controlled study;female;human;human tissue;hypertension;major clinical study;male;neurofibrillary tangle;priority journal;senile plaque,"Sparks, D. L.;Scheff, S. W.;Liu, H.;Landers, T. M.;Coyne, C. M.;Hunsaker Iii, J. C.",1995,,,0,
4204,Palliative care for heart failure in Greece,"While few palliative care units are available for cancer patients in big cities of Greece, this specialized care is generally unavailable for non-cancer patients. No protocols are in use and the use of advance directives and discussions around euthanasia still represents a taboo subject for Greek families. Patients will receive standard hospital care but not necessarily psychological or social support. Terminal patients will rather finish their life in a hospital bed, a tendency that has accentuated these last decades. The family is generally present and regulates hospital admittance, home care and end-of-life decisions. The presence of well-trained and multi-professional teams is very scarce and expensive. Informal carers guided by the family often assume the basic care while medical care is provided in hospitals on an outpatient base or through house calls of privately installed doctors of different specialties. Very few geriatricians are available in Greece. © 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.",diuretic agent;haloperidol;milrinone;risperidone;Alzheimer disease;article;cancer patient;cardiac patient;conflict of interest;delirium;euthanasia;financial management;follow up;Greece;health care quality;health personnel attitude;heart failure;home care;hospital admission;hospital bed;hospital discharge;human;income;medical decision making;medical education;nurse attitude;outpatient care;oxygen therapy;palliative therapy;Parkinson disease;physician attitude;practice guideline;psychological aspect;social support;taboo;terminally ill patient,"Spatharakis, G.",2011,,,0,
4205,Costs and implications of discarded medication in hospice,"Symptom control for hospice patients frequently involves the use of pharmacologic agents for control of pain, dyspnea, and anxiety. Other troubling symptoms that will often require pharmacologic agents include nausea, vomiting, constipation, and delirium. While the Medicare requirement for hospice is a prognosis of six months or less, accurately predicting prognosis is very difficult. Because of this, medications for symptom control will often have to be prescribed and refilled without knowing exactly how much the hospice patient may require. The objective of the current study was to determine the amount of medication discarded at death. Additionally we wanted to estimate the cost related to discarded medication. We reviewed the records of 296 patients over a three-year period in a community hospice to characterize the medications that were discarded at death. Seventeen patients were not eligible for evaluation because of lack of complete information, leaving 279 study subjects. Cost calculations were used using a website cost calculator (HealthTrans.com). Fifty-six percent of the decedents were female and the majority were Hispanic (62%). The five most common diagnoses were cancer (36%); dementia (22%); and COPD, CVA, and congestive heart failure (CHF) (8%). The median length of stay in hospice was 16 days. The most frequent medication unused at the time of death was morphine solution followed by lorazepam. The cost of discarded morphine including tablets as well as solution totaled over $6,000 for the study period. The next highest medication cost was lorazepam for both solution and tablets, which came to over $1,600. The total estimated cost for all medications for the study period amounted to $14,980. The results of this study indicate that hospice patients have variable amounts of discarded medication at the time of death and that the cost involved of these unused medications can be significant. Hospice organizations should investigate creative ways to reduce the amount of discarded medications. © 2013, Mary Ann Liebert, Inc.",lorazepam;morphine;article;cerebrovascular accident;chronic obstructive lung disease;congestive heart failure;dementia;drug cost;female;hospice;hospice patient;human;length of stay;major clinical study;male;medical record review;neoplasm;time of death,"Speer, N. D.;Dioso, J.;Casner, P. R.",2013,,,0,
4206,Sacubitril-valsartan in heart failure,,membrane metalloendopeptidase;sacubitril plus valsartan;Alzheimer disease;amyloid plaque;cost effectiveness analysis;drug cost;health care cost;health care delivery;heart failure;human;letter;managed care;medicare;prescription;priority journal;private health insurance;purchasing;United States,"Spellberg, B.",2017,,10.7326/l17-0047,0,
4207,Comorbidity is an independent prognostic factor for the survival of ovarian cancer: A Danish register-based cohort study from a clinical database,"Objective The aim of the study was to examine whether comorbidity is an independent prognostic factor for 3129 women diagnosed with ovarian cancer from 2005 to 2011. As Performance status (PS) might capture the impact of comorbidity we addressed whether comorbidity can be explained by PS or whether comorbidity has an independent impact on survival. Methods The Danish Gynecological Cancer Database (DGCD) is a national clinical database including information on comorbidity and a large number of tumor-related and patient-related factors. The Charlson Comorbidity Index was used to measure the patients' comorbidity based on the registration in DGCD. The overall mortality (OS) from the date of surgery to death or censoring was the outcome measure. Results The hazard ratio (HR) for patients with comorbidity was 3.31 (1.14-1.50) compared to patients without comorbidity after adjustment for age, stage, residual tumor, histology and grade. After including PS in the model, comorbidity remained significant for OS. Age, stage, residual tumor, histology and PS prove to be independent prognostic factors as well. No association is found between comorbidity and receiving surgery or not. Conclusion Comorbidity is an independent prognostic factor, and has a negative impact on the survival of ovarian cancer patients. However, comorbidity has a smaller impact on survival compared with the other prognostic factors considered. © 2013 Elsevier Inc.",acquired immune deficiency syndrome;adolescent;adult;aged;article;cancer mortality;cancer prognosis;cancer survival;cerebrovascular accident;Charlson Comorbidity Index;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;dementia;female;heart infarction;histopathology;human;human tissue;insulin dependent diabetes mellitus;liver disease;major clinical study;non insulin dependent diabetes mellitus;outcome assessment;ovary cancer;overall survival;peripheral vascular disease;priority journal;solid tumor,"Sperling, C.;Noer, M. C.;Christensen, I. J.;Nielsen, M. L. S.;Lidegaard, O.;Høgdall, C.",2013,,,0,
4208,The case for postmenopausal hormone therapy,"Because randomized trials of the impact of hormone therapy on women's health are lacking, clinicians can only point out the benefits established in observational studies, discuss the potential risks, and allow each patient to decide for herself. Informed decision making is time-consuming, however. Ample educational materials and a counselor may facilitate the process.",conjugated estrogen;estradiol;estrogen;gestagen;high density lipoprotein cholesterol;low density lipoprotein cholesterol;medroxyprogesterone acetate;norethisterone;progesterone;Alzheimer disease;article;bone density;breast cancer;clinical trial;colorectal cancer;controlled clinical trial;coronary artery disease;dyspareunia;female;heart infarction;hormonal therapy;human;hypertension;oral drug administration;osteoporosis;ovary cancer;patient education;postmenopause;randomized controlled trial;cerebrovascular accident;urine incontinence;urogenital tract disease,"Speroff, L.",1996,,,0,
4209,HT: A clinician demurs,The ongoing challenge to clinicians is to make medical judgments that are suitable for patients as individuals with unique combinations of medical needs. The cancellation of the WHI study's estrogen/progestin arm leaves unanswered questions that will affect clinicians' medical decisions. © 2003 American Society for Reproductive Medicine Published by Elsevier Inc.,acetylsalicylic acid;bisphosphonic acid derivative;estrogen;gestagen;hydroxymethylglutaryl coenzyme A reductase inhibitor;placebo;raloxifene;Alzheimer disease;article;behavior modification;breast cancer;cancer risk;cancer staging;cardiovascular disease;cardiovascular risk;clinical practice;clinical trial;colorectal cancer;doctor patient relation;female;health care need;health care organization;hormonal therapy;human;ischemic heart disease;lifestyle;lung cancer;medical decision making;patient care;physician;postmenopause;postmenopause osteoporosis;priority journal;quality of life;risk benefit analysis;risk reduction;smoking cessation;survival rate;treatment outcome;treatment planning;venous thromboembolism;aspirin,"Speroff, L.",2003,,,0,
4210,WHI estrogen-only arm is canceled,,conjugated estrogen;estrogen;gestagen;placebo;breast cancer;cancer risk;clinical trial;cognitive defect;coronary risk;dementia;drug effect;estrogen therapy;follow up;health care organization;heart infarction;hip fracture;hormone substitution;human;hysterectomy;ischemic heart disease;menopausal syndrome;menopause;note;postmenopause;primary prevention;risk benefit analysis;risk reduction;side effect;statistical significance;cerebrovascular accident,"Speroff, L.",2004,,,0,
4211,Trace elements in human brain: Special reference to copper in Alzheimer's disease,"Objective: In the literature on trace element determination in the normal and diseased human brain, some experimental findings highlight that the results obtained are affected by several variability factors. The examination of the published data, considering the influencing variables, helps to identify which values can be correctly confronted to obtain a truthful picture. Results: We first report, all together, the cited findings. With attention to the influencing variables, we then reviewed the available data on Cu determination in various brain areas of patients suffering from Alzheimer's disease (AD) and controls, in order to plausibly identify possible Cu variations in AD and to check whether the changes affected certain regions. Regarding the cortex, we came to a different conclusion than that deriving from a hasty comparison of the published values. Conclusions: From all the retrieved information, we stress the importance of some variables not widely considered, giving suggestions for future investigations; this could help optimize the utilization of the results, rendering easier the comparison of the outcomes of different studies. ©2013 Dustri-Verlag Dr. K. Feistle.",copper;rubidium ion;selenium;trace element;zinc;age distribution;Alzheimer disease;amygdaloid nucleus;article;brain cortex;brain level;cause of death;contamination;disease duration;frontal cortex;frontal lobe;gray matter;heart infarction;hippocampus;human;left hemisphere;locus ceruleus;onset age;Parkinson disease;priority journal;putamen;quality control;reliability;right hemisphere;sampling;sex difference;sex ratio;substantia nigra;temporal gyrus;water content;white matter,"Speziali, M.;Di Casa, M.;Bettinelli, M.",2013,,,0,
4212,Memory identity and capacity,,aged;case report;decision making;ethics;female;heart failure;human;interpersonal communication;memory;mental capacity;multiinfarct dementia;note;personal autonomy;resuscitation;social behavior;verbal communication,"Spike, J. P.",2007,,,0,
4213,Eprosartan - dual blocker of AT1 receptors,"AII antagonists were first recommended for the treatment of hypertension for diabetics and patients with microalbuminuria. Ten years ago, the results of four major clinical studies with AIIA were presented and published. These studies demonstrated a significant renoprotective effect of these medicaments in comparison with a placebo (RENAAL and IRMA) and amlodipine (MARVAL and IDNT). In 2002, the results of two major comparative studies into hypertension -Losartan Intervention For Endpoints (LIFE) and the Study on COgnition and Prognosis in Elderly hypertensives (SCOPE). The year 2005 saw the publication of the results of the Morbidity and mortality after strokes, eprosartan compared with nitrendipine for secondary prevention (MOSES), which brought new indicators for sartans - systolic hypertension and the secondary prevention of strokes. The ONTARGET study into the secondary prevention of ischemic heart disease was published in 2008, the same year that the OSCAR study shows the significance of the treatment of systolic blood pressure using eprosartan in the prevention of dementia. The MOSES study compared eprosartan with nitrendipine in 1,405 patients for the secondary prevention of strokes. Randomisation was successful, with minimal differences shown in basic characteristics. Blood pressure was lowered to a comparable level, without significant differences between either group over the entire duration of the monitored period (150.7/84 mmHg and 152.0/87.2 mmHg, with a reduction to 137.5/80.8 mmHg and 136.0/80.2 mmHg respectively following the administration of eprosartan and nitrendipine). Furthermore, average normotensive values were achieved after as little as 3 months and 75.5% of cases achieved values of < 140/90 mmHg following the administration of eprosartan and 77.7% following the administration of nitrendipine. During the subsequent period, a total of 461 primary incidents occurred: 206 in patients with eprosartan and 255 in patients with nitrendipine (95% CI, 0.66-0.96; p = 0.014), with the following instance of cardiovascular events: 77 for eprosartan and 101 for nitrendipine (95% CI, 0.55-1.02; p = 0.06), cerebrovascular events: 102 for eprosartan and 134 for nitrendipine (95% CI, 0.58-0.97; p = 0.03).",amlodipine;angiotensin 1 receptor;eprosartan;nitrendipine;placebo;sartan derivative;article;cardiovascular disease;cerebrovascular disease;dementia;diabetic hypertension;geriatric disorder;human;ischemic heart disease;microalbuminuria;monitoring;morbidity;mortality;prognosis;publication;publishing;randomization;cerebrovascular accident;systolic blood pressure;systolic hypertension,"Špinar, J.;Vítovec, J.;Špinarová, L.",2012,,,0,
4214,Pellagra. An analysis of 18 patients and a review of the literature,"The clinical and laboratory features of 18 adult pellagrins are reviewed. Only four patients (22%) had the full triad of dermatitis, diarrhea and dementia. Dermatitis alone occurred in six (33%), dementia in five (28%) and dermatitis and diarrhea in three (17%). In one patient, dementia was the initial sign of a relapse. Steatorrhea was found in six patients and was usually associated with marked alopecia. Edema without evidence of cardiac failure was present in seven patients. A diffuse increase in slow wave activity on the electroencephalogram was characteristic in patients with dementia. Fever occurred in 14 patients, and an infection was documented in 10 of these. Common laboratory abnormalities included a normochromic, normocytic anemia, lymphopenia, eosinopenia, hyperuricemia, and low serum levels of albumin, urea, cholesterol, carotene, potassium, calcium, and magnesium. Adrenal and thyroid function were normal, but a low serum T4, high serum free T4, and an elevated T3 resin uptake were frequently observed. These abnormalities were corrected with treatment of the underlying nutritional disorder. In two patients initially treated with thiamine alone, and in one who received inadequate amounts of niacin and protein, there was marked deterioration of mental function, which responded to administration of niacin and proper diet.",albumin cr 51;alcohol;amino acid;ampicillin;antibiotic agent;cyanocobalamin;diazepam;folic acid;multivitamin;nicotinamide;nicotinic acid;pancreas enzyme;pyridoxine;thiamine;unclassified drug;xylose;alcoholism;article;clinical study;dermatitis;diarrhea;drug therapy;electroencephalography;major clinical study;mental capacity;pellagra;steatorrhea;therapy;thyroid gland,"Spivak, J. L.;Jackson, D. L.",1977,,,0,
4215,Clinical vignettes in geriatric depression,"The diagnosis of depression in older patients is often complicated by comorbid conditions, such as cerebrovascular disease or dementia. Tools specific for this age group, such as the Geriatric Depression Scale or the Cornell Scale for Depression in Dementia, may assist in making the diagnosis. Treatment decisions should consider risks associated with medications, such as serotonin syndrome, hyponatremia, falls, fractures, and gastrointestinal bleeding. Older white men with depression are at high risk of suicide. Depression is common after stroke or myocardial infarction, and response to antidepressant treatment has been linked to vascular outcomes. Depression care management is an important adjunct to the use of antidepressant medications. Structured psychotherapy and exercise programs are useful treatments for select patients. © 2011 American Academy of Family Physicians.",amfebutamone;antidepressant agent;cardiovascular agent;central nervous system agents;cholinergic receptor blocking agent;citalopram;cyclobenzaprine;desipramine;dextromethorphan;duloxetine;escitalopram;fluoxetine;herbaceous agent;lithium;methylphenidate;mirtazapine;nortriptyline;paroxetine;pethidine;phenelzine;sedative agent;serotonin noradrenalin reuptake inhibitor;serotonin uptake inhibitor;sertraline;sumatriptan succinate;tramadol;trazodone;tricyclic antidepressant agent;unindexed drug;venlafaxine;article;bedtime dosage;cerebrovascular accident;cerebrovascular disease;clinical feature;cognitive therapy;comorbidity;Cornell Scale for Depression in Dementia;dementia;depression;disease association;drug induced headache;drug safety;electroconvulsive therapy;exercise;extrapyramidal symptom;falling;fracture;gastrointestinal hemorrhage;gastrointestinal symptom;Geriatric Depression Scale;geriatric disorder;health program;heart infarction;high risk patient;human;hypertension;hyponatremia;hypotension;insomnia;Mini Mental State Examination;morning dosage;psychological rating scale;psychosis;psychotherapy;risk assessment;risk factor;sedation;seizure;serotonin syndrome;sexual dysfunction;side effect;suicidal ideation;symptom;treatment response;urinary hesitancy;weight gain;withdrawal syndrome;xerostomia;celexa;cymbalta;demerol;effexor;flexeril;imitrex;lexapro;nardil;norpramin;pamelor;prozac;remeron;ritalin;ultram;wellbutrin;zoloft,"Spoelhof, G. D.;Davis, G. L.;Licari, A.",2011,,,0,
4216,Strategies for old people,,beta adrenergic receptor blocking agent;flupirtine;aging;Alzheimer disease;comorbidity;Creutzfeldt Jakob disease;heart infarction;neuroprotection;note;patient compliance;katadolon,"Spohrer, B.",1999,,,0,
4217,Milder Alzheimer's disease pathology in heart failure and atrial fibrillation,"INTRODUCTION: Heart failure (HF) and atrial fibrillation (AF) have been associated with a higher risk of Alzheimer's disease (AD). Whether HF and AF are related to AD by enhancing AD neuropathological changes is unknown. METHODS: We applied network analyses and multiple logistic regression models to assess the association between HF and AF with severity of AD neuropathology in patients from the National Alzheimer's Coordinating Center database with primary neuropathological diagnosis of AD. RESULTS: We included 1593 patients, of whom 129 had HF and 250 had AF. HF and AF patients were older and had milder AD pathology. In the network analyses, HF and AF were associated with milder AD neuropathology. In the regression analyses, age (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.93-0.95 per 1-year increase in age, P < .001) and the interaction term HF x AF (OR 0.61, 95% CI 0.40-0.91, P = .014) were inversely related to severe AD pathology, whereas APOE epsilon4 genotype showed a direct association (OR 1.68, 95% CI 1.31-2.16). Vascular neuropathology was more frequent in patient with HF and AF patients than in those without. DISCUSSION: HF and AF had milder AD neuropathology. Patients with milder AD lived longer and had more exposure to vascular risk factors. HF and AF patients showed a higher frequency of vascular neuropathology, which could have contributed to lower the threshold for clinically evident dementia.",Alzheimer's disease;Atrial fibrillation;Dementia;Heart failure;Neuropathology;Vascular dementia,"Sposato, L. A.;Ruiz Vargas, E.;Riccio, P. M.;Toledo, J. B.;Trojanowski, J. Q.;Kukull, W. A.;Cipriano, L. E.;Nucera, A.;Whitehead, S. N.;Hachinski, V.",2017,Jul,,0,
4218,Mild cognitive impairment and exposure to general anesthesia for surgeries and procedures: A population-based case-control study,"Background: To examine whether exposure to general anesthesia for procedures at age ≥40 years is associated with prevalent mild cognitive impairment (MCI) in the elderly. Methods: A case-control study nested within a population-based cohort. Olmsted County, Minnesota, residents, aged 70-91 years, underwent baseline evaluations that included the Clinical Dementia Rating scale, a neurologic evaluation, and neuropsychologic testing. Individuals identified with MCI (cases) at enrollment were matched 1:2 on age, sex, education, and apolipoprotein genotype with participants who were cognitively normal at the time of the index visit. Medical records from age 40 years until the index visit were reviewed to determine exposures to general anesthesia. Conditional logistic regression, taking into account the matched set study design and adjusting for MCI risk factors, was used to assess whether exposure to anesthesia after the age of 40 years was associated with prevalent MCI. Results: A total of 387 Mayo Clinic Study of Aging participants (219 males, 168 females) were diagnosed with MCI at enrollment with mean age of 81 ± 5 years. Exposure to general anesthesia after the age of 40 years was not significantly associated with prevalent MCI when analyzed as a dichotomous variable (any versus none, adjusted odds ratio, 0.97 [95% confidence interval, 0.68-1.40]) or the number of exposures (odds ratio, 1.13 [0.74-1.72], 0.81 [0.53-1.22], and 1.03 [0.67-1.58] for 1, 2-3, and ≥4 exposures, respectively, with no exposure as the reference). Similar results were obtained for exposure to anesthesia after the age of 60 years and during 5, 10, and 20 years before the first visit. Conclusions: Exposure to general anesthesia for procedures at age ≥40 years was not associated with prevalent MCI in the elderly.",inhalation anesthetic agent;nitrous oxide;propofol;thiopental;aged;anesthesia induction;article;atrial fibrillation;cardiovascular disease;cerebrovascular accident;Clinical Dementia Rating;cognitive defect;congestive heart failure;controlled study;coronary artery disease;dementia;depth perception;diabetes mellitus;dyslipidemia;executive function;exposure;female;general anesthesia;general surgery;genotype;human;hypertension;language;major clinical study;male;marriage;mild cognitive impairment;orthopedic surgery;patient history of surgery;population based case control study;priority journal;risk factor;smoking;very elderly,"Sprung, J.;Roberts, R. O.;Knopman, D. S.;Price, L. L.;Schulz, H. P.;Tatsuyama, C. L.;Weingarten, T. N.;Schroeder, D. R.;Hanson, A. C.;Petersen, R. C.;Warner, D. O.",2017,,10.1213/ane.0000000000001725,0,
4219,Orally Dosing Furosemide to Approximate Continuous Infusion,,furosemide;aged;Alzheimer disease;article;body weight;cardiomegaly;case report;congestive heart failure;continuous infusion;diabetes mellitus;diuresis;foot edema;human;hypertension;hypotension;kidney failure;male;pleura effusion;priority journal;thorax radiography;weight reduction,"Spyropoulos, E. M.;Simms, N.;Clark, C.;Greco, F. A.",2017,,10.1016/j.amjmed.2017.03.052,0,
4220,A 'bridging' (safety/tolerance) study of besipirdine hydrochloride in patients with Alzheimer's disease,"Besipirdine hydrochloride is a novel compound with cholinergic and adrenergic activity being investigated as a treatment for Alzheimer's disease (AD). The pharmacodynamics of some anti-dementia drugs are known to differ in patients with AD as compared with elderly normals. The present study was designed to determine the maximum tolerated dose (MTD) of multiple oral doses of besipirdine in AD patients. Twelve AD patients (NINCDS/ADRDA criteria; 7M, 5F, ages 58-75, mean age 65) were randomized to besipirdine (n=9) or placebo (n=3) in a double-blind, parallel-group, rising-dose design. Doses were 10, 20 , 30, and 40 mg bid for 2 days each, followed by 50 and 60 mg bid for 5 days each. The most common adverse events were asymptomatic postural hypotension and asymptomatic bradycardia. Two patients on active drug developed severe adverse events: 1 after 3 days at 50 mg bid (nausea and vomiting); 1 after 3 days at 60 mg bid (angina). Due to the anginal episode, the study was terminated on Day 17. Plasma concentrations increased linearly with dose for besipirdine and its major metabolite. The two patients who developed severe adverse events had the highest plasma concentrations measured. Besipirdine 50 mg bid was considered the maximum tolerated dose (MTD).",besipirdine;cholinergic receptor stimulating agent;drug metabolite;new drug;placebo;adult;aged;Alzheimer disease;angina pectoris;article;asthenia;bradycardia;clinical article;clinical trial;controlled clinical trial;controlled study;double blind procedure;drug blood level;female;human;hypertension;male;nausea;oral drug administration;orthostatic hypotension;phase 1 clinical trial;randomized controlled trial;rash;vomiting,"Sramek, J. J.;Viereck, C.;Huff, F. J.;Wardle, T.;Hourani, J.;Stewart, J. A.;Cutler, N. R.",1995,,,0,
4221,Cardiovascular risk factors associated with smaller brain volumes in regions identified as early predictors of cognitive decline,"Purpose: To determine in a large multiethnic cohort the cardiovascular and genetic risk factors associated with smaller volume in the hippocampus, precuneus, and posterior cingulate, and their association with preclinical deficits in cognitive performance in patients younger and older than 50 years. Materials and Methods: The institutional review board approved the study and all participants provided written informed consent. Eligible for this study were 1629 participants (700 men and 929 women; mean age, 50.0 years 6 10.2 [standard deviation]) drawn from the population-based Dallas Heart Study who underwent laboratory and clinical analysis in an initial baseline visit and approximately 7 years later underwent brain magnetic resonance imaging with automated volumetry and cognitive assessment with the Montreal Cognitive Assessment (MoCA). Regression analysis showed associations between risk factors and segmental volumes, and associations between these volumes with cognitive performance in participants younger and older than 50 years. Results: Lower hippocampal volume was associated with previous alcohol consumption (standardized estimate, 20.04; P = .039) and smoking (standardized estimate, 20.04; P = .048). Several risk factors correlated with lower total brain, posterior cingulate, and precuneus volumes. Higher total (standardized estimate, 0.06; P = .050), high-density lipoprotein (standardized estimate, 0.07; P = .003), and lowdensity lipoprotein (standardized estimate, 0.04; P = .037) cholesterol levels were associated with larger posterior cingulate volume, and higher triglyceride levels (standardized estimate, 0.06; P = .004) were associated with larger precuneus volume. Total MoCA score was associated with posterior cingulate volume (standardized estimate, 0.13; P = .001) in younger individuals and with hippocampal (standardized estimate, 0.06; P , .05) and precuneus (standardized estimate, 0.08; P , .023) volumes in older adults. Conclusion: Smaller volumes in specific brain regions considered to be early markers of dementia risk were associated with specific cardiovascular disease risk factors and cognitive deficits in a predominantly midlife multiethnic populationbased sample. Additionally, the risk factors most associated with these brain volumes differed in participants younger and older than 50 years, as did the association between brain volume and MoCA score.",cholesterol;high density lipoprotein cholesterol;low density lipoprotein cholesterol;triacylglycerol;very low density lipoprotein cholesterol;adult;aged;alcohol consumption;article;brain size;cardiovascular risk;cognitive defect;controlled study;female;genetic risk;heart left ventricle hypertrophy;hippocampus;human;hypertension;image analysis;major clinical study;male;Montreal cognitive assessment;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;posterior cingulate;precuneus;priority journal;regression analysis;volumetry;Achieva,"Srinivasa, R. N.;Rossetti, H. C.;Gupta, M. K.;Rosenberg, R. N.;Weiner, M. F.;Peshock, R. M.;McColl, R. W.;Hynan, L. S.;Lucarelli, R. T.;King, K. S.",2016,,,0,
4222,Risk of developing multimorbidity across all ages in an historical cohort study: Differences by sex and ethnicity,"Objective: To study the incidence of de novo multimorbidity across all ages in a geographically defined population with an emphasis on sex and ethnic differences. Design: Historical cohort study. Setting: All persons residing in Olmsted County, Minnesota, USA on 1 January 2000 who had granted permission for their records to be used for research (n=123 716). Participants: We used the Rochester Epidemiology Project medical records-linkage system to identify all of the county residents. We identified and removed from the cohort all persons who had developed multimorbidity before 1 January 2000 (baseline date), and we followed the cohort over 14 years (1 January 2000 through 31 December 2013). Main outcome measures: Incident multimorbidity was defined as the development of the second of 2 conditions (dyads) from among the 20 chronic conditions selected by the US Department of Health and Human Services. We also studied the incidence of the third of 3 conditions (triads) from among the 20 chronic conditions. Results: The incidence of multimorbidity increased steeply with older age; however, the number of people with incident multimorbidity was substantially greater in people younger than 65 years compared to people age 65 years or older (28 378 vs 6214). The overall risk was similar in men and women; however, the combinations of conditions (dyads and triads) differed extensively by age and by sex. Compared to Whites, the incidence of multimorbidity was higher in Blacks and lower in Asians. Conclusions: The risk of developing de novo multimorbidity increases steeply with older age, varies by ethnicity and is similar in men and women overall. However, as expected, the combinations of conditions vary extensively by age and sex. These data represent an important first step toward identifying the causes and the consequences of multimorbidity.",adolescent;adult;age distribution;aged;arthritis;article;Asian;asthma;autism;Black person;Caucasian;cerebrovascular accident;child;chronic kidney disease;chronic obstructive lung disease;cohort analysis;comorbidity;comorbidity assessment;congestive heart failure;coronary artery disease;dementia;depression;diabetes mellitus;ethnic difference;female;heart arrhythmia;hepatitis;human;Human immunodeficiency virus infection;hyperlipidemia;hypertension;incidence;major clinical study;male;medical record review;multimorbidity;neoplasm;osteoporosis;population;risk assessment;schizophrenia;sex difference;substance abuse;United States;very elderly,"St Sauver, J. L.;Boyd, C. M.;Grossardt, B. R.;Bobo, W. V.;Rutten, L. J. F.;Roger, V. L.;Ebbert, J. O.;Therneau, T. M.;Yawn, B. P.;Rocca, W. A.",2015,,,0,
4223,Contribution to the therapy of the failing heart in the aged and postapoplectic dementia,,"*Alzheimer Disease;*Cerebral Hemorrhage;*Crataegus;*Dementia;*Heart Failure;Humans;*Plant Extracts;*Psychotic Disorders;*Heart failure, congestive;*Psychoses, senile","Stabenow, U.",1962,Aug 31,,0,
4224,Cognitive symptoms of chronic disorders of cerebral circulation in patients with atrial fibrillation,"Atrial fibrillation is a heart rhythm disorder, accompanied by numerous systemic disorders. One of them accounting for changes in the central nervous system is of great importance. Reduction of cardiac output and contractile function of the heart cause a deterioration of cerebral blood flow, thus contributing to the formation and progression of cognitive disorders that subsequently can lead to dementia. The objective of this study was to investigate clinical manifestations of chronic cerebrovascular pathology in patients with different clinical forms of atrial fibrillation based on neuropsychological studies. Eighty two patients with atrial fibrillation nonvalvular etiology, developed due to coronary heart disease, were examined. The comparison group consisted of 30 patients with ischemic heart disease without any cardiac rhythm and conduction. Patients in both groups underwent a computed tomography examination of the brain. The study established that cognitive disorders in patients with atrial fibrillation were manifested in attention deficit, reduced rate of speech and mental activity, impaired visual-spatial functions and secondary memory disorders. The permanent form of atrial fibrillation showed accelerated decrease in the speed of psychomotor reactions, visual-spatial disorders and memory loss, whereas deterioration of cognitive functions occurs regardless of age, duration of hypertension, and predictors of dyslipidemic disorders. The presence of atrial fibrillation is associated with a higher incidence of diffuse lesions of the white matter of the brain. The most pronounced changes in patients with atrial fibrillation are detected in the periventricular matter and perivascular spaces. The progression of diffuse changes of the white matter of the brain associated with the increase of memory disorders, attention and mental speed. Thus, early manifestations of chronic disorders of cerebral circulation in patients with atrial fibrillation in the absence of severe focal neurological symptoms may be mild cognitive disorders, whose identification is necessary due to the increased risk of progression to the stage of severe cognitive deficits.",adult;aged;amnesia;article;atrial fibrillation;attention deficit disorder;cerebrovascular disease;chronic disease;cognitive defect;computer assisted tomography;controlled study;disease duration;dyslipidemia;female;human;hypertension;ischemic heart disease;major clinical study;male;memory disorder;mental performance;middle aged;psychomotor disorder;speech;white matter lesion,"Stadnik, S. N.",2015,,,0,
4225,Progression of mild cognitive impairment to dementia contribution of cerebrovascular disease compared with medial temporal lobe atrophy,"Background and Purpose - We sought to determine the predictive value of magnetic resonance imaging measures of vascular disease (white matter hyperintensities [WMHs], lacunes, microbleeds, and infarcts) compared with atrophy on the progression of mild cognitive impairment to dementia. Methods - We included 152 consecutive patients with mild cognitive impairment. Baseline magnetic resonance imaging was used to determine the presence of medial temporal lobe atrophy and vascular disease (presence of lacunes, microbleeds, and infarcts was determined, and WMHs were rated on a semiquantitative scale). Patients were followed up for 2± 1 years. Results - Seventy-two (47%) patients progressed to dementia during follow-up. Of these, 56 (37%) patients were diagnosed with Alzheimer's disease, and 16 (10%) patients were diagnosed with a non-Alzheimer dementia (including vascular dementia, frontotemporal lobar degeneration, and Parkinson dementia). Converters were older and had a lower Mini-Mental State Examination score at baseline. On baseline magnetic resonance imaging, patients who progressed to a non-Alzheimer dementia showed more severe WMHs and had a higher prevalence of lacunes in the basal ganglia and microbleeds compared with nonconverters. Cox proportional-hazard models showed that, adjusted for age and sex, baseline medial temporal lobe atrophy (hazard ratio=2.9; 95% CI, 1.7 to 5.3), but not vascular disease, was associated with progression to Alzheimer's disease. By contrast, deep WMHs (hazard ratio=5.7; 95% CI, 1.2 to 26.7) and periventricular hyperintensities (hazard ratio=6.5; 95% CI, 1.4 to 29.8) predicted progression to non-Alzheimer dementia. Furthermore, microbleeds (hazard ratio=2.6; 95% CI, 0.9 to 7.5) yielded a >2-fold increased, though nonsignificant, risk of non-Alzheimer dementia. Conclusion - Medial temporal lobe atrophy and markers of cerebrovascular disease predict the development of different types of dementia in mild cognitive impairment patients. © 2009 American Heart Association, Inc.",adult;aged;Alzheimer disease;article;basal ganglion;brain atrophy;brain ventricle;cerebrovascular accident;controlled study;dementia;disease course;female;follow up;frontotemporal dementia;human;infarction;major clinical study;male;medial temporal lobe atrophy;mild cognitive impairment;Mini Mental State Examination;multiinfarct dementia;nuclear magnetic resonance imaging;Parkinson disease;predictive validity;prevalence;priority journal;temporal lobe;vascular disease;white matter,"Staekenborg, S. S.;Koedam, E. L. G. E.;Henneman, W. J. P.;Stokman, P.;Barkhof, F.;Scheltens, P.;Van Der Flier, W. M.",2009,,,0,
4226,Neurological signs in relation to type of cerebrovascular disease in vascular dementia,"BACKGROUND AND PURPOSE - The aim of this study was to describe the prevalence of a number of neurological signs in a large population of patients with vascular dementia (VaD) and to compare the relative frequency of specific neurological signs dependent on type of cerebrovascular disease. METHODS - Seven hundred six patients with VaD (NINDS-AIREN) were included from a large multicenter clinical trial (registration number NCT00099216). At baseline neurological examination, the presence of 16 neurological signs was assessed. Based on MRI, patients were classified as having large vessel VaD (18%; large territorial or strategical infarcts on MRI), small vessel VaD (74%; white matter hyperintensities [WMH], multiple lacunes, bilateral thalamic lesions on MRI), or a combination of both (8%). RESULTS - A median number of 4.5 signs per patient was presented (maximum 16). Reflex asymmetry was the most prevalent symptom (49%), hemianopia was most seldom presented (10%). Measures of small vessel disease were associated with an increased prevalence of dysarthria, dysphagia, parkinsonian gait disorder, rigidity, and hypokinesia and as well to hemimotor dysfunction. By contrast, in the presence of a cerebral infarct, aphasia, hemianopia, hemimotor dysfunction, hemisensory dysfunction, reflex asymmetry, and hemiplegic gait disorder were more often observed. CONCLUSIONS - The specific neurological signs demonstrated by patients with VaD differ according to type of imaged cerebrovascular disease. Even in people who meet restrictive VaD criteria, small vessel disease is often seen with more subtle signs, including extrapyramidal signs, whereas large vessel disease is more often related to lateralized sensorimotor changes and aphasia. © 2008 American Heart Association, Inc.",adult;aged;aphasia;article;Babinski reflex;brain damage;brain infarction;cerebrovascular disease;clinical feature;controlled study;disease association;dysarthria;dysphagia;female;gait disorder;hemianopia;human;hypokinesia;major clinical study;male;motor dysfunction;multiinfarct dementia;neurologic disease;neurologic examination;nuclear magnetic resonance imaging;patient coding;prevalence;priority journal;reflex asymmetry;reflex disorder;rigidity;sensory dysfunction;tendon reflex;thalamus;tremor,"Staekenborg, S. S.;Van Der Flier, W. M.;Van Straaten, E. C. W.;Lane, R.;Barkhof, F.;Scheltens, P.",2008,,,0,
4227,Inappropriate prescribing in older residents of Australian care homes,"What is known and objective: The incidence of inappropriate prescribing is higher amongst the older age group than the younger population. Inappropriate prescribing potentially leads to drug-related problems such as adverse drug reactions. We aimed to determine the prevalence of inappropriate prescribing in residents of Tasmanian (Australia) residential care homes using Beers and McLeod criteria. Methods: Patient demographics, medical conditions and medications were collected from medical records. The patients who fulfilled either Beers or McLeod criteria were identified and the characteristics of these patients were then compared. Results: Data for 2345 residents were collected between 2006 and 2007. There were 1027 (43·8%) patients prescribed at least one inappropriate medication. Beers criteria identified more patients (828 patients, 35·3%) as being prescribed inappropriate medication compared with McLeod criteria (438 patients, 18·7%). Patients taking psychotropic medication/s, more than six medications or diagnosed with five or more medical conditions were more likely to be prescribed an inappropriate medication (P < 0·001). The most frequently identified inappropriate medications included benzodiazepines, amitriptyline, oxybutynin and non-steroidal anti-inflammatory drugs. What is new and conclusion: Inappropriate prescribing, as defined by either Beers criteria or McLeod criteria, is relatively common in Australian nursing homes. The prevalence of inappropriate prescribing, and factors influencing it, are consistent with other countries. Both Beers and McLeod criteria are a general guide to prescribing, and do not substitute for professional judgment. © 2010 Blackwell Publishing Ltd.",alprazolam;amiodarone;amitriptyline;anticoagulant agent;antipyretic agent;benzodiazepine derivative;carvedilol;celecoxib;diazepam;diltiazem;dipyridamole;estradiol;meloxicam;metoprolol;nonsteroid antiinflammatory agent;omeprazole;oxazepam;oxybutynin;prednisolone;psychotropic agent;temazepam;aged;anxiety disorder;article;Australia;cerebrovascular accident;controlled study;dementia;demography;depression;drug megadose;female;heart failure;human;hypertension;incidence;ischemic heart disease;low drug dose;major clinical study;male;medical record;medication error;nursing home;osteoarthritis;prescription;prevalence;residential home;sex difference;urine incontinence,"Stafford, A. C.;Alswayan, M. S.;Tenni, P. C.",2011,,,0,
4228,Amyloid-beta (1-40) and the risk of death from cardiovascular causes in patients with coronary heart disease,"BACKGROUND: The amyloid beta peptide is the major protein constituent of neuritic plaques in Alzheimer disease and appears to play a central role in vascular inflammation pathophysiology. OBJECTIVES: This study sought to determine the clinical value of amyloid-beta 1-40 (Abeta40) measurement in predicting cardiovascular (CV) mortality in patients with coronary heart disease (CHD) and arterial stiffness progression in young healthy subjects. METHODS: Abeta40 was retrospectively measured in blood samples collected from 3 independent prospective cohorts and 2 case-control cohorts (total N = 1,464). Major adverse cardiac events (MACE) were assessed in the 2 prospective cohorts (n = 877) followed for a median of 4.4 years. To look at effects on subclinical disease, arterial stiffness was evaluated at baseline and after 5-year follow-up (n = 107) in young healthy subjects. The primary endpoint was the predictive value of Abeta40 for CV mortality and outcomes in patients with CHD. RESULTS: In Cox proportional hazards models adjusted for age, sex, estimated glomerular filtration rate, left ventricular ejection fraction, high-sensitivity C-reactive protein, and high-sensitivity troponin T, Abeta40 independently predicted CV death and MACE in patients with CHD (p < 0.05 for all). After multivariate adjustment, Abeta40 levels conferred a substantial enhancement of net reclassification index and integrated discrimination improvement of individuals at risk in the total combined CHD cohort over the best predictive model. Further cohort-based analysis revealed that Abeta40 levels were significantly and independently associated with arterial stiffness progression, incident subclinical atherosclerosis, and incident CHD. CONCLUSIONS: Measuring blood levels of Abeta40 identified patients at high risk for CV death.","Age Factors;Aged;Amyloid beta-Peptides/*blood;Ankle Brachial Index;Biomarkers/blood;C-Reactive Protein/analysis;Carotid Intima-Media Thickness;Cause of Death;Coronary Disease/*blood/*mortality;Female;Follow-Up Studies;Glomerular Filtration Rate;Humans;Male;Middle Aged;Myocardial Infarction/blood/epidemiology;Peptide Fragments/*blood;Plaque, Atherosclerotic;Proportional Hazards Models;Retrospective Studies;Stroke Volume;Troponin T/blood;Vascular Stiffness;arterial stiffness;biomarker;risk stratification;subclinical atherosclerosis","Stamatelopoulos, K.;Sibbing, D.;Rallidis, L. S.;Georgiopoulos, G.;Stakos, D.;Braun, S.;Gatsiou, A.;Sopova, K.;Kotakos, C.;Varounis, C.;Tellis, C. C.;Kastritis, E.;Alevizaki, M.;Tselepis, A. D.;Alexopoulos, P.;Laske, C.;Keller, T.;Kastrati, A.;Dimmeler, S.;Zeiher, A. M.;Stellos, K.",2015,Mar 10,10.1016/j.jacc.2014.12.035,0,
4229,Longitudinal cognitive performance in older adults with cardiovascular disease: evidence for improvement in heart failure,"BACKGROUND: Cardiovascular disease (CVD) and particularly heart failure (HF) have been associated with cognitive impairment in cross-sectional studies, but it is unclear how cognitive impairment progresses over time in older adults with these conditions. OBJECTIVE: The aim of this study was to prospectively examine cognitive function in patients with HF versus other forms of CVD. METHOD: Seventy-five older adults (aged 53-84 years) with CVD underwent Doppler echocardiogram to evaluate cardiac status and 2 administrations of the Dementia Rating Scale (DRS), a test of global cognitive functioning, 12 months apart. RESULTS: Although DRS performance did not statistically differ between groups at either administration, a significant between-group difference in the rate of cognitive change emerged (lambda = 0.87; F = 10.50; P = .002; omega 2 = 0.11). Follow-up analyses revealed that patients with HF improved significantly on global DRS performance, whereas patients with other forms of CVD remained stable. More specifically, patients with HF showed improvement on subscales of attention, initiation/perseveration, and conceptualization. Exploratory analyses indicated that higher diastolic blood pressure at baseline was associated with improved DRS performance in patients with HF (r = 0.38; P = .02). CONCLUSIONS: Patients with HF exhibited modest cognitive improvements during 12 months, particularly in attention and executive functioning. Higher diastolic blood pressure at baseline was associated with improvement. These results suggest that cognitive impairment in patients with HF may be modifiable and that improved blood pressure control may be an important contributor to improved function. Further prospective studies are needed to replicate results and determine underlying mechanisms.",aged;article;blood pressure;cardiovascular disease;cognitive defect;diastole;echography;female;geriatric assessment;heart failure;hospitalization;human;male;mental health;middle aged;pathophysiology;prospective study;psychological rating scale;risk factor;single blind procedure;transesophageal echocardiography,"Stanek, K. M.;Gunstad, J.;Paul, R. H.;Poppas, A.;Jefferson, A. L.;Sweet, L. H.;Hoth, K. F.;Haley, A. P.;Forman, D. E.;Cohen, R. A.",2009,,,0,
4230,Change in circulating C-reactive protein is not associated with atorvastatin treatment in Alzheimer's disease,"Amyloid containing senile plaques (SP) and neurofibrillary tangles (NFT) are histologic hallmarks of Alzheimer's disease (AD). Interestingly the SP and NFT found in non-demented, age-matched individuals with ischemic heart disease and/or hypertension are morphologically and topographically identical to those in AD. Cholesterol plays a significant role in production and accumulation of amyloid beta (Abeta) and progression of AD. Cholesterol is also a major contributor in atherosclerotic changes and cardiovascular disease. Numerous studies acknowledged benefits of cholesterol-lowering statins in slowing down the progression of AD, improving cognitive status and significantly reducing risk of cardiovascular events. Accumulating evidence suggests that there is a chronic inflammatory reaction in the areas of the brain affected by AD and C-reactive protein (CRP) is identified as a key molecule of acute phase of inflammation. CRP is also a very sensitive marker for cardiovascular events and excellent prognostic tool in post-heart attack and post-coronary artery bypass surgery recovery. Here we report that cholesterol lowering with atorvastatin produces no significant change in CRP levels in treating AD patients who participated in ADCLT (AD cholesterol lowering trial).",Aged;Alzheimer Disease/*drug therapy/*metabolism/pathology;Anticholesteremic Agents/*administration & dosage;Atorvastatin Calcium;C-Reactive Protein/*metabolism;Cognition/drug effects;Coronary Artery Disease/drug therapy/metabolism/pathology;Heptanoic Acids/*administration & dosage;Humans;Middle Aged;Neuropsychological Tests;Placebos;Prognosis;Pyrroles/*administration & dosage;Vasculitis/drug therapy/metabolism/pathology,"Stankovic, G.;Sparks, D. L.",2006,Sep,10.1179/016164106x130452,0,
4231,The application of IMPACT prognostic models to elderly adults with traumatic brain injury: A population-based observational cohort study,"Objective: To examine the performance of the International Mission for Prognosis and Clinical Trial Design in Traumatic Brain Injury (IMPACT) prognostic models in older patients. Methods: Using data from the National Study on Costs and Outcomes of Trauma (NSCOT), this study identified adult patients presenting to US hospitals in 2001 and 2002 with non-penetrating moderate or severe traumatic brain injury (GCS ≤ 12). IMPACT model calibration and discrimination in the older stratum (65–84 years) was compared to that in the younger stratum (18–64 years). Results: IMPACT model discrimination did not differ significantly between the older (n = 202; weighted n = 268) and younger strata (n = 613; weighted n = 1632) and was generally adequate (c-statistic for the core-death model = 0.81 [0.77–0.84] vs 0.75 [0.66–0.84], respectively; p = 0.26). IMPACT model calibration was poor for both older and younger strata (Hosmer-Lemeshow p-value for the core-death model = 0.01 vs < 0.0001, respectively). Pre-specified qualitative graphical evaluation suggested substantial under-prediction of mortality in the oldest decades of life, but not among younger patients. Conclusions: The examined IMPACT prognostic models demonstrated adequate discrimination and poor calibration in both older and younger patients, yet particular caution may be required when applying these models to the elderly.",anticoagulant agent;antithrombocytic agent;adult;aged;alcoholism;article;cerebrovascular disease;cohort analysis;computer assisted tomography;congestive heart failure;dementia;diabetes mellitus;disease severity;epidural hematoma;female;heart disease;heart infarction;human;liver disease;major clinical study;male;mortality;observational study;prediction;qualitative analysis;sensitivity analysis;solid tumor;subdural hematoma;traffic accident;traumatic brain injury;very elderly,"Staples, J. A.;Wang, J.;Zaros, M. C.;Jurkovich, G. J.;Rivara, F. P.",2016,,,0,
4232,Single-dose cefuroxime with gentamicin reduces Clostridium difficile-associated disease in hip-fracture patients,"Antibiotic-associated Clostridium difficile diarrhoea may complicate recovery from surgery for proximal femoral fracture. We undertook a four-year case-control study to evaluate a change in antibiotic prophylaxis in our department. During the period January 2003 to January 2005, patients received three doses of prophylactic cefuroxime (1.5 g). We then introduced a new regimen, comprising of one single dose of cefuroxime (1.5 g) with gentamicin (240 mg) at induction. Prior to the change in prophylaxis, 912 patients underwent surgery for neck of femur fracture, and from March 2005 to March 2007, 899 patients had surgery under the new regimen. Thirty-eight patients developed C. difficile infection (4.2%) in the initial group, compared with 14 patients (1.6%) in the group with the new regimen (P = 0.009). The incidence of C. difficile infection increased throughout the rest of the hospital over the same time period. Patients with C. difficile infection had a statistically significant increase in antibiotic exposure, inpatient stay, morbidity and inpatient mortality. The main challenges regarding prophylactic antibiotic selection are infection due to meticillin-resistant Staphylococcus aureus (MRSA) and C. difficile-associated diarrhoea. We advocate the use of the new regimen as an alternative to multiple-dose cephalosporin antibiotics for the prevention of C. difficile infection in this group of high-risk patients. © 2008 The Hospital Infection Society.",amoxicillin plus clavulanic acid;cefalexin;ceftazidime;cefuroxime;cephalosporin;cephalosporin derivative;flucloxacillin;gentamicin;levofloxacin;meticillin;moxifloxacin;ofloxacin;penicillin G;aged;antibiotic prophylaxis;article;asthma;case control study;cerebrovascular accident;chronic obstructive lung disease;Peptoclostridium difficile;comorbidity;controlled study;deep vein thrombosis;dementia;diabetes mellitus;diarrhea;dosage schedule comparison;drug use;female;femur neck fracture;fracture treatment;gastrointestinal disease;atrial fibrillation;high risk patient;hip fracture;hip surgery;hospital department;human;hypertension;incidence;ischemic heart disease;kidney dysfunction;length of stay;lung embolism;major clinical study;male;malignant neoplastic disease;medical decision making;methicillin resistant Staphylococcus aureus;morbidity;mortality;postoperative infection;respiratory tract infection;single drug dose;time;treatment duration;urinary tract infection;wound infection,"Starks, I.;Ayub, G.;Walley, G.;Orendi, J.;Roberts, P.;Maffulli, N.",2008,,,0,
4233,Assessment of energy requirements in elderly populations,"The daily energy requirements of older adults are unclear. Aging results in a decline in daily energy expenditure and intake, which are associated with greater gains in body fatness and a subsequently higher risk of morbidity and mortality. Understanding the energy requirements of older populations, therefore, has important clinical implications. Current world-wide recommendations suggest that energy needs of individuals above 50 y are of 1.51 times resting energy expenditure. Limited data suggest that this may be an underestimation of energy needs in older Caucasian women and men. In contrast, current energy requirement recommendations may be appropriate for older African-American women, because of their low rate of daily energy expenditure for their metabolic size. Aging is also associated with Alzheimer's and Parkinson's and recent data suggest that individuals with these chronic diseases actually have energy requirements that are at or below current recommendations. Physical activity is the most modifiable and varible component of daily energy expenditure and, therefore, energy requirements. Current data suggest that an inexpensive and simple measurement of physical activity is difficult in older adults, which limits our ability to accurately determine energy needs. Overall, current data suggest that energy needs of older adults may be higher than current world-wide recommendations, although future prospective data are needed in healthy, ethnic, and diseased populations. Accurate, unobtrusive, and inexpensive methods to measure physical activity are also needed to assess energy requirements.",aged;aging;Alzheimer disease;article;caloric intake;Caucasian;chronic disease;controlled study;energy expenditure;ethnic group;female;gender;heart failure;human;male;metabolic rate;Parkinson disease;physical activity,"Starling, R. D.;Poehlman, E. T.",2000,,,0,
4234,Vascular parkinsonism and vascular dementia are associated with an increased risk of vascular events or death,"INTRODUCTION: The natural course of vascular parkinsonism (VaP) and dementia (VaD) due to cerebral small vessel disease (SVD) is not well known. The aim of this single-center study was to evaluate the long-term risk of vascular events, death and dependency in patients with VaP or VaD and to compare it with patients without cerebrovascular disease but with high atherothrombotic risk. MATERIAL AND METHODS: Seventy-eight consecutive, functionally independent patients with MRI features of SVD and with recently diagnosed VaD (n = 50) and VaP (n = 28) and 55 controls (control group - CG) with high 10-year risk of total cardiovascular disease (SCORE >/= 5%) were prospectively recruited and followed for 24 months. RESULTS: Patients with SVD had lower prevalence of coronary artery disease compared with the CG (20.5% vs. 40%; p = 0.02) but similar prevalence of other atherothrombotic risk factors including mean age (73.7 +/-7.3 vs. 72 +/-5.9 years, p = 0.09). All outcomes were worse in SVD patients than controls. Thirty-one percent of SVD patients (34% of VaD vs. 25% of VaP, p = 0.45) experienced vascular events or died compared to 6% of controls (p < 0.01). After adjustments for potential confounders (age, sex, vascular risk factors), patients with VaP (HR = 7.5; 95% CI: 1.6-33; p < 0.01) and VaD (HR = 8.7; 95% CI: 2.1-35; p < 0.01) had higher risk of vascular events or death and death or dependency (respectively; HR = 3.9; 95% CI: 0.83-18.8; p = 0.07 and HR = 4.7, 95% CI: 1.1-19.7; p = 0.03). CONCLUSIONS: Patients with VaP or VaD due to SVD had significantly higher risk of vascular events, death and dependency compared to controls with high cardiovascular risk and without cerebrovascular disease.",cerebral small vessel disease;mortality;prognosis;vascular dementia;vascular events;vascular parkinsonism,"Staszewski, J.;Piusinska-Macoch, R.;Brodacki, B.;Skrobowska, E.;Macek, K.;Stepien, A.",2017,,,0,
4235,The transitionalist: Optimizing inpatient-to-outpatient transitions of care - Reply,,advanced practice nurse;caregiver;chronic disease;cost effectiveness analysis;delirium;dementia;health care cost;health care personnel;health care system;heart failure;hospital discharge;hospital patient;human;note;nursing home;outpatient;patient care;patient participation;physician;priority journal,"Stauffer, B. D.",2012,,,0,
4236,Gray matter atrophy in patients with ischemic stroke with cognitive impairment,"BACKGROUND AND PURPOSE - Patients with ischemic stroke are at risk for developing vascular cognitive impairment ranging from mild impairments to dementia. MRI findings of infarction, white matter hyperintensities, and global cerebral atrophy have been implicated in the development of vascular cognitive impairment. The present study investigated regional gray matter volume differences between patients with ischemic stroke with no cognitive impairment and those with impairment in at least one domain of cognitive function. METHODS - Ninety-one patients with ischemic stroke participated. Detailed neuropsychological testing was used to characterize cognitive functioning in 7 domains: orientation, attention, working memory, language, visuospatial ability, psychomotor speed, and memory. High-resolution T1-weighted 3-dimensional fast-spoiled gradient recalled structural MRIs were processed using optimized voxel-based morphometry techniques while controlling for lesions. Whole brain voxelwise regional differences in gray matter volume were assessed between patients with stroke with no impaired cognitive domains and patients with stroke with at least one impaired cognitive domain. Logistic regression models were used to assess the contribution of demographic variables, stroke-related variables, and voxel-based morphometry results to classification of cognitive impairment group membership. RESULTS - Fifty-one patients had no impairments in any cognitive domain and 40 patients were impaired in at least one cognitive domain. Logistic regression identified significant contributions to cognitive impairment groups for demographic variables, stroke-related variables, and cognitive domain performance. Voxel-based morphology results demonstrated significant gray matter volume reductions in patients with stroke with one or more cognitive domain impairment compared with patients with stroke without cognitive impairment that was seen mostly in the thalamus with smaller reductions found in the cingulate gyrus and frontal, temporal, parietal, and occipital lobes. These reductions were present after controlling for group differences in age, education, stroke volume, and laterality of stroke. The addition of voxel-based morphometry-derived thalamic volume significantly improved a logistic regression model predicting cognitive impairment group membership when added to demographic variables, stroke-related variables, and cognitive domain performance. CONCLUSIONS - These results suggest a central role for the thalamus and lesser roles for other cortical regions in the development of cognitive impairment after ischemic stroke. Indeed, consideration of thalamic volumes adds significant information to the classification of cognitive impaired versus nonimpaired groups beyond information provided by demographic, stroke-related, and cognitive performance measures. © 2008 American Heart Association, Inc.",adult;aged;article;attention;brain atrophy;brain infarction;brain region;brain size;cerebrovascular accident;cingulate gyrus;cognition;cognitive defect;controlled study;demography;disease severity;female;frontal cortex;gray matter;human;logistic regression analysis;major clinical study;male;memory;morphometrics;neuropsychological test;nuclear magnetic resonance imaging;occipital lobe;orientation;parietal lobe;priority journal;psychomotor development;temporal cortex;thalamus;white matter,"Stebbins, G. T.;Nyenhuis, D. L.;Wang, C.;Cox, J. L.;Freels, S.;Bangen, K.;Detoledo-Morrell, L.;Sripathirathan, K.;Moseley, M.;Turner, D. A.;Gabrieli, J. D. E.;Gorelick, P. B.",2008,,,0,
4237,AT2 receptor agonists: hypertension and beyond,"PURPOSE OF REVIEW: Research about the angiotensin AT2 receptor (AT2R) has been hampered in the past by the lack of a specific and selective agonist with in-vivo stability. Such an eagerly awaited agonist, compound 21, has recently become available, giving momentum to AT2R research which so far has resulted in 14 original publications. This article is intending to review those publications which address AT2R function by direct in-vivo stimulation instead of indirect approaches such as receptor blockade or genetic alteration of AT2R expression. RECENT FINDINGS: Studies reviewed in this article looked at the effect of AT2R stimulation in disease models of hypertension, renal disease, stroke, Alzheimer's disease and myocardial infarction. AT2R stimulation does not have an antihypertensive effect, but promoted tissue protection in all models in which it was tested. Antiinflammation and antiapoptosis seem important features of the AT2R underlying improved outcome in experimental disease models. SUMMARY: Availability of nonpeptidic, orally active AT2R agonists will facilitate future AT2R research and hopefully contribute to the clarification of many still open questions regarding AT2R signalling and function. Furthermore, AT2R agonists represent a potential novel class of drugs and are expected to enter a phase I clinical study in 2012.","Animals;Antihypertensive Agents/*pharmacology/therapeutic use;Blood Vessels/*drug effects/pathology;Brain Ischemia/drug therapy;Cognition/drug effects;Hypertension/complications/*physiopathology;Inflammation/physiopathology;Kidney Diseases/complications/drug therapy;Myocardial Infarction/drug therapy;Receptor, Angiotensin, Type 2/*agonists/*physiology;Signal Transduction","Steckelings, U. M.;Paulis, L.;Namsolleck, P.;Unger, T.",2012,Mar,10.1097/MNH.0b013e328350261b,0,
4238,Invited Commentary,,xenon;aortic arch surgery;brain atrophy;brain blood flow;brain blood vessel;brain circulation;brain injury;brain perfusion;carotid artery disease;cell loss;computer assisted tomography;dementia;disease duration;disease marker;disease predisposition;Doppler flowmetry;heart arrest;heart surgery;hippocampus;human;ischemia;leukoaraiosis;neuroimaging;neurologic disease;neurological complication;note;nuclear magnetic resonance imaging;outcome assessment;perioperative period;positron emission tomography;priority journal;risk factor;single photon emission computer tomography;cerebrovascular accident;white matter,"Stecker, M. M.",2009,,,0,
4239,Case 3-2013: A 72-year-old woman with abdominal pain and distention after peritoneal dialysis,,acetylsalicylic acid;allopurinol;amlodipine;carvedilol;ceftazidime;cephalosporin;clopidogrel;docusate sodium;gentamicin;insulin;isosorbide mononitrate;lisinopril;nicotinic acid;quinolone;recombinant erythropoietin;sertraline;simvastatin;vancomycin;vitamin;abdominal discomfort;abdominal distension;abdominal pain;abnormal laboratory result;aged;anemia;aorta valve regurgitation;article;atelectasis;bare metal stent;cardiomegaly;case report;catheter occlusion;catheter removal;clinical feature;computer assisted tomography;constipation;coronary artery disease;dementia;depression;diabetic nephropathy;dyslipidemia;electrocardiogram;female;heart left ventricle hypertrophy;hemodialysis;hemoperitoneum;human;human tissue;hypertension;insulin dependent diabetes mellitus;ischemic cardiomyopathy;kidney failure;lung edema;lung nodule;mitral valve regurgitation;nausea;outcome assessment;percutaneous transluminal angioplasty;peritoneal dialysis;peritoneal fibrosis;peritonitis;physical examination;priority journal;pulmonary hypertension;pyelonephritis;sinus rhythm;thorax radiography;tuberculous peritonitis;unstable angina pectoris;urinalysis;urinary tract infection;vomiting,"Steele, D. J. R.;Kasmar, A. G.;Guimaraes, A. R.;Dekker, J. P.",2013,,,0,
4240,"WHI hormone trials: A window to the future, a view from the past",,C reactive protein;conjugated estrogen;docetaxel;estrogen;gestagen;low density lipoprotein cholesterol;medroxyprogesterone acetate;placebo;progesterone;age distribution;article;breast cancer;cancer incidence;clinical trial;colorectal cancer;coronary artery disease;deep vein thrombosis;dementia;diabetes mellitus;drug withdrawal;health care personnel;heart infarction;heart protection;hip fracture;hormone substitution;human;hypercholesterolemia;hypertension;intervention study;ischemic heart disease;lung embolism;menopausal syndrome;menopause;mild cognitive impairment;obesity;prescription;prevalence;priority journal;risk benefit analysis;risk factor;cerebrovascular accident;venous thromboembolism;women's health,"Stefanick, M. L.",2009,,,0,
4241,Hormone replacement therapy in prevention of morbidity and mortality in the older woman: part III: potential adverse effects of hormone replacement therapy,"OBJECTIVES: The objective of this four part series is to review for the practicing clinician the extensive and sometimes contradictory literature on the effects of estrogen replacement therapy (ERT) and hormone replacement therapy (HRT) in the postmenopausal woman. This third article reviews HRT and the potential excess morbidity from breast cancer, endometrial cancer, venous thromboembolism (VTE), and coronary heart disease (CHD). DESIGN: Studies reviewed were obtained through Medline searches, examination of citations in the articles reviewed from those searches,interviews with local experts in geriatrics, cardiology, and women's health. CONCLUSIONS: Long-term HRT seems to be associated with a small increased risk for breast cancer. The risk of endometrial cancer in women with a uterus using ERT can be eliminated completely with the use of combination estrogen and progestin. HRT may be associated with a small increased risk for VTE; however, the absolute morbidity and mortality attributable to VTE is small and unlikely to impact the net benefit of HRT significantly. Although there is considerable data favoring a beneficial effect of HRT on CHD, initiation of HRT in women with established CHD may be associated with increased risk of adverse cardiac events in the first year after initiation. In counseling patients about the use of long-term HRT, the balance of these risks and the effect of co-morbid illness in the geriatric population should be addressed. Discussion of HRT and the aging brain (stroke, dementia), the net benefit of long-term HRT, and decision-making for the individual patient is forthcoming in the final article of this four-part series.",,"Steffen, K. A.;Carnes, M.",2000,May-Jun,,0,
4242,"Hormone replacement therapy in prevention of morbidity and mortality in the older woman. Part IV: HRT and the aging brain, overall mortality, and individual decision-making","OBJECTIVES: The objective of this four part series is to review for the practicing clinician the extensive and sometimes contradictory literature on the effects of estrogen replacement therapy and hormone replacement therapy (HRT) in the postmenopausal woman. This final article reviews the role of long-term HRT in stroke, Alzheimer's disease (AD), and overall mortality as well as strategies to guide decision-making for the individual patient. DESIGN: Studies reviewed were obtained through Medline searches, examination of citations in the articles reviewed from those searches, interviews with local experts in geriatrics, cardiology, and women's health. CONCLUSIONS: Evidence for benefit from HRT in delaying onset of and preventing AD in aging women is inconclusive. No consistent trend for beneficial or harmful effect of HRT on stroke risk has been demonstrated. HRT does seem to be beneficial in decreasing overall mortality risk, especially in women with coronary heart disease risk factors. The overall health and functioning of the geriatric patient and the presence of co-morbid conditions must be factored into clinical decisions. The decision to initiate HRT is complex, requires thoughtful assessment of net benefit and risk for the individual patient, and should accommodate the individual's personal preferences. Forthcoming results from the Women's Health Initiative HRT trial and observational study will help resolve some of the ambiguities in this decision-making process.",,"Steffen, K. A.;Carnes, M.",2000,Jul-Aug,,0,
4243,The effect of major depression on functional status in patients with coronary artery disease,"OBJECTIVE: To examine the effect of major depression on reported functional status in a group of patients with coronary artery disease (CAD). SETTING: An inpatient cardiology service. PARTICIPANTS: Three hundred thirty- five inpatients with coronary artery disease who were free of dementia, Parkinson's disease, and other primary neurological illnesses. MEASUREMENTS: Duke Depression Evaluation Schedule, a structured psychiatric interview which included the Diagnostic Interview Schedule depression subscale, the Cumulative Illness Rating Scale, and two scales for measuring instrumental and self-maintenance activities of daily living. RESULTS: Twenty-seven subjects met DSM-IV criteria for major depression. Compared with subjects without major depression, depressed subjects were more than twice as likely to report a self-maintenance ADL deficit and were significantly more likely to report an IADL deficit than were nondepressed subjects (93 vs 71%). In regression models, female gender, older age, greater medical illness severity, and pressence of major depression were significant predictors of self-maintenance ADL disability; and female gender, older age, greater medical severity, and presence of major depression significantly predicted greater IADL impairment. CONCLUSION: The presence of major depression was associated with functional disability in patients with CAD. Further research is needed to clarify whether antidepressant treatment significantly impacts both affective symptoms and functional status in patients with coronary heart disease.",adult;aged;article;coronary artery disease;depression;disability;disease association;disease severity;female;health service;health status;human;maintenance therapy;major clinical study;male;rating scale;regression analysis;self report,"Steffens, D. C.;O'Connor, C. M.;Jiang, W. J.;Pieper, C. F.;Kuchibhatla, M. N.;Arias, R. M.;Look, A.;Davenport, C.;Gonzalez, M. B.;Krishnan, K. R. R.",1999,,,0,
4244,,"The transdermal delivery of drugs to the systemic circulation is an established route of drug administration for a variety of small molecules. Transdermal drug delivery is characterized by constant plasma profiles through zero-order drug release for up to several days, the circumvention of the first-pass metabolism as well as its noninvasive alternative to oral dosing. Several drugs have been developed for chronic or acute conditions affecting older adults like for example pain, M. Alzheimer and M. Parkinson. Transdermal drug delivery offers some key advantages for the treatment of older adults, but also requires special attention when prescribed to older patients taking into account the individual risk– benefit profile. This chapter is intended to provide a short overview on transdermal drug delivery with the focus on older patients and reviews the major transdermal drug delivery products.",buprenorphine;estradiol;fentanyl;glyceryl trinitrate;nicotine patch;norbuprenorphine;opiate;rivastigmine;rotigotine;Alzheimer disease;analgesia;angina pectoris;area under the curve;article;clinical trial (topic);cutaneous parameters;drug dependence;drug release;drug solubility;drug transport;erythema;first pass effect;human;maximum plasma concentration;priority journal;skin manifestation;smoking cessation;time to maximum plasma concentration;topical drug administration;transdermal drug delivery system;transdermal patch;estraderm;exelon,"Stegemann, S.",2016,,10.1007/978-3-319-43099-7_17,0,
4245,Comment on ASH position article on central blood pressure and waveform analysis,,antihypertensive agent;antihypertensive therapy;aorta pressure;central aortic waveform analysis;cognitive defect;congestive heart failure;dementia;exercise;human;hypertension;letter;lifestyle modification;priority journal;pulse wave;systolic blood pressure;waveform,"Steigerwalt, S. P.",2016,,,0,
4246,New products for pharmacists 09-10-2015,,alirocumab;aripiprazole;brentuximab vedotin;cetirizine;eltrombopag;empagliflozin plus metformin;entecavir;eslicarbazepine acetate;esomeprazole;etiracetam;evolocumab;flibanserin;inositol;lidocaine;memantine;new drug;oxycodone;pramipexole;sonidegib;allergy;basal cell carcinoma;classical Hodgkin lymphoma;coronary artery atherosclerosis;dementia;drug approval;epilepsy;familial hypercholesterolemia;gastroesophageal reflux;hepatitis B;human;hypoactive sexual desire disorder;large cell lymphoma;neuralgia;non insulin dependent diabetes mellitus;note;pain;Parkinson disease;pharmacist;pollen allergy;seizure;thrombocytopenia;adcetris;addyi;aptiom;baraclude;lidoderm;mirapex er;namenda;nexium;odomzo;oxycontin;promacta;repatha Injection;spritam;synjardy;zyrtec,"Stein, J.",2015,,,0,
4247,Treatment of unstable pulmonary embolism in the elderly and those with comorbid conditions,"Background: Although the in-hospital case fatality rate is lower in unstable patients with pulmonary embolism who receive thrombolytic therapy, less than one third receive it. The purpose of this investigation is to try to assess why most unstable patients fail to receive thrombolytic therapy and whether evidence might support a more aggressive approach. Methods: Data were obtained from the Nationwide Inpatient Sample 1999-2008. Results: Fewer unstable patients with pulmonary embolism accompanied by comorbid conditions received thrombolytic therapy than patients with no comorbid conditions, 11,670 of 60,100 (19.4%) vs 9710 of 12,130 (80.0%) (P <.0001). Fewer patients aged > 60 years received thrombolytic therapy than patients aged ≤ 60 years, both among those with comorbid conditions, 6330 of 37,320 (17.0%) vs 5340 of 22,780 (23.4%) (P <.0001), and among those without comorbid conditions, 3560 of 5060 (70.4%) vs 6150 of 7070 (87.0%) (P <.0001). However, even among elderly patients and those with comorbid conditions, the case fatality rate was lower with thrombolytic therapy. The odds ratio of in-hospital death (0.11-0.62) favored thrombolytic therapy irrespective of age or comorbidity. Conclusion: Unstable patients with pulmonary embolism were less likely to receive thrombolytic therapy if they were elderly or had comorbid conditions, but those who received thrombolytic therapy had a lower in-hospital case fatality rate irrespective of age or comorbid conditions. The cautious approach of withholding thrombolytic therapy in those who might have major bleeding might not be the safest approach in terms of mortality and needs to be prospectively evaluated. © 2013 Elsevier Inc.",fibrinolytic agent;acquired immune deficiency syndrome;adult;aged;article;bleeding;cerebrovascular accident;chronic obstructive lung disease;comorbidity;dementia;fatality;fibrinolytic therapy;heart failure;heart infarction;hemiplegia;human;Human immunodeficiency virus infection;kidney disease;leukemia;liver disease;lung embolism;major clinical study;mortality;priority journal,"Stein, P. D.;Matta, F.",2013,,,0,
4248,Obesity and pulmonary embolism: The mounting evidence of risk and the mortality paradox,"Purpose: To determine the prevalence of pulmonary embolism in obese patients according to age, gender and comorbid conditions and explore the relation of obesity to mortality. Methods: The number of patients discharged from short-stay hospitals throughout the United States from 1998-2008 with pulmonary embolism who were obese or not obese, and in-hospital all-cause mortality were determined from the Nationwide Inpatient Sample. Results: From 1998-2008, 203,500 of 17,979,200 (1.1%) obese patients were diagnosed with pulmonary embolism compared with 2,034,100 of 346,049,800 (0.6%) non-obese patients [relative risk (RR) = 2.03]. Relative risk for pulmonary embolism was highest among obese patients aged 11-20 years (RR = 5.80) and was higher in obese women (RR = 2.08) than in obese men (RR = 1.74). Mortality was 4.3% in obese patients with pulmonary embolism compared with 9.5% in non-obese patients (RR = 0.45). Obesity had the greatest effect on mortality in older patients and little effect in teenagers and young adults. Among stable patients who did not receive thrombolytic therapy, mortality was 3.8% in obese patients and 8.4% in non-obese patients (RR = 0.45). Among unstable patients, obesity had little effect on mortality. Conclusions: The prevalence of pulmonary embolism in hospitalized patients was higher in obese patients than in non-obese patients. Mortality in patients with pulmonary embolism was lower in obese patients than in non-obese patients, with the greatest effects in women, older patients and stable patients. © 2011 Elsevier Ltd. All rights reserved.",fibrinolytic agent;acquired immune deficiency syndrome;acute heart infarction;adolescent;adult;aged;article;cerebrovascular accident;child;chronic obstructive lung disease;comorbidity;dementia;diabetes mellitus;female;fibrinolytic therapy;heart failure;hemiparesis;hemiplegia;hospital patient;hospitalization;human;Human immunodeficiency virus infection;infant;kidney disease;length of stay;leukemia;liver disease;lung embolism;lymphoma;major clinical study;male;metastasis;mortality;obesity;paraplegia;peripheral vascular disease;preschool child;priority journal;school child;shock;ulcer;United States,"Stein, P. D.;Matta, F.;Goldman, J.",2011,,,0,
4249,Inferior Vena Cava Filters in Elderly Patients with Stable Acute Pulmonary Embolism,"Background Patients aged >60 years with pulmonary embolism who were stable and did not require thrombolytic therapy were shown to have a somewhat lower in-hospital all-cause mortality with vena cava filters. In this investigation we further assess mortality with filters in stable elderly patients. Methods In-hospital all-cause mortality according to use of inferior vena cava filters was assessed from the National (Nationwide) Inpatient Sample, 2003-2012, in: 1) All patients with pulmonary embolism; 2) All with pulmonary embolism who had none of the comorbid conditions listed in the Charlson Comorbidity Index; 3) Patients with a primary (first-listed) diagnosis of pulmonary embolism, and 4) Patients with a primary diagnosis of pulmonary embolism and none of the comorbid conditions listed in the Charlson Comorbidity Index. Results From 2003-2012, 2,621,575 stable patients with pulmonary embolism were hospitalized in the US. Patients aged >80 years showed lower mortality with vena cava filters (all pulmonary embolism, 6.1% vs 10.5%; all pulmonary embolism with no comorbid conditions, 3.3% vs 6.3%; primary pulmonary embolism, 4.1% vs 5.7%; primary pulmonary embolism with no comorbid conditions, 2.1% vs 3.7%; all P <.0001). In the all-patient category, patients aged 71-80 years showed somewhat lower mortality with filters, 6.3% vs 7.4% (P <.0001), and those without comorbid conditions, 2.5% vs 2.8% (P =.04). Those aged 71-80 years with primary pulmonary embolism, irrespective of comorbid conditions, did not show lower mortality with filters. Conclusion At present, in the absence of a randomized controlled trial, it seems prudent to consider a vena cava filter in very elderly (aged >80 years) stable patients with acute pulmonary embolism.",acute heart infarction;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic obstructive lung disease;comorbidity;controlled study;dementia;female;fibrinolytic therapy;heart failure;hospital mortality;human;lung embolism;major clinical study;male;peripheral vascular disease;priority journal;vena cava filter,"Stein, P. D.;Matta, F.;Hughes, M. J.",2017,,10.1016/j.amjmed.2016.09.033,0,
4250,Home Treatment of Deep Venous Thrombosis in the Era of New Oral Anticoagulants,"This is a retrospective cohort study of adults with a primary diagnosis of deep venous thrombosis (DVT) unaccompanied by pulmonary embolism (PE), seen in 4 emergency departments in 2013 and part of 2014. The purpose was to assess the prevalence of home treatment of DVT in the present era of new oral anticoagulants. Among 96 patients with DVT and no PE, 85 (88.5%) were hospitalized and 11 (11.5%) were discharged to home. Most of the patients discharged to home received low-molecular-weight heparin, 9 (81.8%) of 11. None were prescribed new oral anticoagulants. Early discharge in ≤2 days occurred 28 (32.9%) of 85 patients. Most (64.3%) received enoxaparin and/or warfarin at early discharge. Rivaroxaban was prescribed in 7 (25.0%) of those discharged in ≤2 days. We conclude that in some emergency departments, patients with DVT are uncommonly discharged to home even though new oral anticoagulants are available.",anticoagulant agent;enoxaparin;low molecular weight heparin;rivaroxaban;warfarin;acute heart infarction;adult;aged;anticoagulant therapy;article;atrial fibrillation;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;deep vein thrombosis;dementia;diabetes mellitus;female;hemiplegia;home care;human;liver disease;lymphoma;major clinical study;male;malignant neoplastic disease;metastasis;paraplegia;prescription;priority journal;retrospective study;solid tumor;vena cava filter,"Stein, P. D.;Matta, F.;Hughes, P. G.;Ghiardi, M.;Marsh, J. H.;Khwarg, J.;Brandon, M. S.;Fowkes, H. A. N.;Kazan, V.;Wiepking, M.;Keyes, D. C.;Kakish, E. J.;Hughes, M. J.",2015,,,0,
4251,Contraindications to anticoagulation therapy and eligibility for novel anticoagulants in older patients with atrial fibrillation,"AIMS: Oral anticoagulation therapy prevents stroke and improves survival in patients with atrial fibrillation, but the therapy is underutilized. We sought to identify the prevalence of contraindications for oral anticoagulation and the proportion of patients potentially eligible for different agents. METHODS: We identified patients with nonacute atrial fibrillation in a nationally representative 5% sample of 2009 Medicare data. We divided the population into patients ineligible for any oral anticoagulant, patients eligible for warfarin only, and patients eligible for any anticoagulant. We compared patient characteristics and the use of anticoagulation among the subgroups. RESULTS: Among 86,671 patients with atrial fibrillation, 1872 (2.2%) were ineligible for anticoagulation because of an absolute contraindication, most frequently a history of intracranial hemorrhage (60%). Patients ineligible for any anticoagulant were the same age as the overall group (mean age, 80.5 vs. 80.4 years). However, they had higher rates of dementia (19% vs. 8.6%) and heart failure (59% vs. 43%) and higher mean CHADS2 scores (3.8 vs. 2.8). Of the remaining 84,799 patients eligible for anticoagulation, 7146 (8.4%) were eligible for warfarin only (most commonly because of mechanical heart valves [66%] and end-stage renal disease [12%]). Sixty-five percent of patients eligible for anticoagulation received warfarin, and the proportion was similar for patients with a relatively high risk of bleeding. CONCLUSIONS: Older adults with atrial fibrillation rarely have absolute contraindications to oral anticoagulation therapy. Among patients without contraindications, most appeared to be eligible for any anticoagulant, and relatively high-risk features appeared not to influence warfarin use.","Administration, Oral;Age Factors;Aged;Aged, 80 and over;Anticoagulants/administration & dosage/*contraindications;Atrial Fibrillation/blood/diagnosis/*drug therapy/epidemiology;Blood Coagulation/*drug effects;Comorbidity;*Eligibility Determination;Female;Hemorrhage/chemically induced;Humans;Male;Medicare;*Patient Selection;Risk Assessment;Risk Factors;Stroke/blood/diagnosis/epidemiology/*prevention & control;Treatment Outcome;United States/epidemiology;Warfarin/administration & dosage/*contraindications;Atrial fibrillation;Contraindications;Medicarex;Older patients;Oral anticoagulation","Steinberg, B. A.;Greiner, M. A.;Hammill, B. G.;Curtis, L. H.;Benjamin, E. J.;Heckbert, S. R.;Piccini, J. P.",2015,Aug,10.1111/1755-5922.12129,0,
4252,Vascular risk factors and neuropsychiatric symptoms in Alzheimer's disease: the Cache County Study,"OBJECTIVE: Knowledge of potentially modifiable risk factors for neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) is important. This study longitudinally explores modifiable vascular risk factors for NPS in AD. METHODS: Participants enrolled in the Cache County Study on Memory in Aging with no dementia at baseline were subsequently assessed over three additional waves, and those with incident (new onset) dementia were invited to join the Dementia Progression Study for longitudinal follow-up. A total of 327 participants with incident AD were identified and assessed for the following vascular factors: atrial fibrillation, hypertension, diabetes mellitus, angina, coronary artery bypass surgery, myocardial infarction, cerebrovascular accident, and use of antihypertensive or diabetes medicines. A vascular index (VI) was also calculated. NPS were assessed over time using the Neuropsychiatric Inventory (NPI). Affective and Psychotic symptom clusters were assessed separately. The association between vascular factors and change in NPI total score was analyzed using linear mixed model and in symptom clusters using a random effects model. RESULTS: No individual vascular risk factors or the VI significantly predicted change in any individual NPS. The use of antihypertensive medications more than four times per week was associated with higher total NPI and Affective cluster scores. CONCLUSIONS: Use of antihypertensive medication was associated with higher total NPI and Affective cluster scores. The results of this study do not otherwise support vascular risk factors as modifiers of longitudinal change in NPS in AD.","Aged;Aged, 80 and over;Alzheimer Disease/*complications;Antihypertensive Agents/therapeutic use;Cardiovascular Diseases/*complications;Disease Progression;Female;Humans;Longitudinal Studies;Male;Mental Disorders/*complications;Neuropsychological Tests;Risk Factors;Alzheimer's disease;dementia;neuropsychiatric;vascular","Steinberg, M.;Hess, K.;Corcoran, C.;Mielke, M. M.;Norton, M.;Breitner, J.;Green, R.;Leoutsakos, J.;Welsh-Bohmer, K.;Lyketsos, C.;Tschanz, J.",2014,Feb,10.1002/gps.3980,0,
4253,A novel C2orf37 mutation causes the first Italian cases of Woodhouse Sakati syndrome,,levodopa;adolescence;adult;alopecia;arm;article;autopsy;autosomal recessive disorder;bradykinesia;C2orf37 gene;cardiovascular risk;case report;cause of death;cognitive defect;complete heart block;dysarthria;dystonia;ear lobe;ECG abnormality;exon;extrapyramidal symptom;face dysmorphia;family;female;gene;gene insertion;gene mutation;gene sequence;heart infarction;heart ventricle septum;heart ventricle wall;homozygosity;human;hypodontia;hypogonadism;incontinence;insulin dependent diabetes mellitus;Italy;laparoscopy;leg;limb tremor;male;male genital tract malformation;mental deterioration;mitral valve prolapse;muscle rigidity;neuroendocrine disease;non insulin dependent diabetes mellitus;open reading frame;parkinsonism;polyneuropathy;primary amenorrhea;priority journal;pyramidal sign,"Steindl, K. L.;Alazami, A. M.;Bhatia, K. P.;Wuerfel, J. T.;Petersen, D.;Cartolari, R.;Neri, G.;Klein, C.;Mongiardo, B.;Alkuraya, F. S.;Schneider, S. A.",2010,,,0,
4254,"Association of beta-Blockers With Functional Outcomes, Death, and Rehospitalization in Older Nursing Home Residents After Acute Myocardial Infarction","Importance: Although beta-blockers are a mainstay of treatment after acute myocardial infarction (AMI), these medications are commonly not prescribed for older nursing home residents after AMI, in part owing to concerns about potential functional harms and uncertainty of benefit. Objective: To study the association of beta-blockers after AMI with functional decline, mortality, and rehospitalization among long-stay nursing home residents 65 years or older. Design, Setting, and Participants: This cohort study of nursing home residents with AMI from May 1, 2007, to March 31, 2010, used national data from the Minimum Data Set, version 2.0, and Medicare Parts A and D. Individuals with beta-blocker use before AMI were excluded. Propensity score-based methods were used to compare outcomes in people who did vs did not initiate beta-blocker therapy after AMI hospitalization. Main Outcomes and Measures: Functional decline, death, and rehospitalization in the first 90 days after AMI. Functional status was measured using the Morris scale of independence in activities of daily living. Results: The initial cohort of 15720 patients (11140 women [70.9%] and 4580 men [29.1%]; mean [SD] age, 83 [8] years) included 8953 new beta-blocker users and 6767 nonusers. The propensity-matched cohort included 5496 new users of beta-blockers and an equal number of nonusers for a total cohort of 10992 participants (7788 women [70.9%]; 3204 men [29.1%]; mean [SD] age, 84 [8] years). Users of beta-blockers were more likely than nonusers to experience functional decline (odds ratio [OR], 1.14; 95% CI, 1.02-1.28), with a number needed to harm of 52 (95% CI, 32-141). Conversely, beta-blocker users were less likely than nonusers to die (hazard ratio [HR], 0.74; 95% CI, 0.67-0.83) and had similar rates of rehospitalization (HR, 1.06; 95% CI, 0.98-1.14). Nursing home residents with moderate or severe cognitive impairment or severe functional dependency were particularly likely to experience functional decline from beta-blockers (OR, 1.34; 95% CI, 1.11-1.61 and OR, 1.32; 95% CI, 1.10-1.59, respectively). In contrast, little evidence of functional decline due to beta-blockers was found in participants with intact cognition or mild dementia (OR, 1.03; 95% CI, 0.89-1.20; P = .03 for effect modification) or in those in the best (OR, 0.99; 95% CI, 0.77-1.26) and intermediate (OR, 1.05; 95% CI, 0.86-1.27) tertiles of functional independence (P = .06 for effect modification). Mortality benefits of beta-blockers were similar across all subgroups. Conclusions and Relevance: Use of beta-blockers after AMI is associated with functional decline in older nursing home residents with substantial cognitive or functional impairment, but not in those with relatively preserved mental and functional abilities. Use of beta-blockers yielded a considerable mortality benefit in all groups.","0 (Adrenergic beta-Antagonists);Activities of Daily Living;Adrenergic beta-Antagonists/adverse effects/ therapeutic use;Aged, 80 and over;Disease Progression;Female;Hospitalization/ statistics & numerical data;Humans;Male;Medicare;Myocardial Infarction/ drug therapy/ mortality;Nursing Homes;Treatment Outcome;United States","Steinman, M. A.;Zullo, A. R.;Lee, Y.;Daiello, L. A.;Boscardin, W. J.;Dore, D. D.;Gan, S.;Fung, K.;Lee, S. J.;Komaiko, K. D.;Mor, V.",2017,Feb 01,,0,
4255,"Association of ?-blockers with functional outcomes, death, and rehospitalization in older nursing home residents after acute myocardial infarction","IMPORTANCE Although ?-blockers are a mainstay of treatment after acutemyocardial infarction (AMI), these medications are commonly not prescribed for older nursing home residents after AMI, in part owing to concerns about potential functional harms and uncertainty of benefit. OBJECTIVE To study the association of ?-blockers after AMI with functional decline, mortality, and rehospitalization among long-stay nursing home residents 65 years or older. DESIGN, SETTING, AND PARTICIPANTS This cohort study of nursing home residents with AMI from May 1, 2007, to March 31, 2010, used national data from the Minimum Data Set, version 2.0, and Medicare Parts A and D. Individuals with ?-blocker use before AMI were excluded. Propensity score-based methods were used to compare outcomes in people who did vs did not initiate ?-blocker therapy after AMI hospitalization. MAIN OUTCOMES AND MEASURES Functional decline, death, and rehospitalization in the first 90 days after AMI. Functional status was measured using the Morris scale of independence in activities of daily living. RESULTS The initial cohort of 15 720 patients (11 140 women [70.9%] and 4580 men [29.1%]; mean [SD] age, 83 [8] years) included 8953 new ?-blocker users and 6767 nonusers. The propensity-matched cohort included 5496 new users of ?-blockers and an equal number of nonusers for a total cohort of 10 992 participants (7788 women [70.9%]; 3204 men [29.1%]; mean [SD] age, 84 [8] years). Users of ?-blockers were more likely than nonusers to experience functional decline (odds ratio [OR], 1.14; 95%CI, 1.02-1.28), with a number needed to harm of 52 (95%CI, 32-141). Conversely, ?-blocker users were less likely than nonusers to die (hazard ratio [HR], 0.74; 95%CI, 0.67-0.83) and had similar rates of rehospitalization (HR, 1.06; 95%CI, 0.98-1.14). Nursing home residents with moderate or severe cognitive impairment or severe functional dependency were particularly likely to experience functional decline from ?-blockers (OR, 1.34; 95%CI, 1.11-1.61 and OR, 1.32; 95%CI, 1.10-1.59, respectively). In contrast, little evidence of functional decline due to ?-blockers was found in participants with intact cognition or mild dementia (OR, 1.03; 95%CI, 0.89-1.20; P = .03 for effect modification) or in those in the best (OR, 0.99; 95%CI, 0.77-1.26) and intermediate (OR, 1.05; 95%CI, 0.86-1.27) tertiles of functional independence (P = .06 for effect modification). Mortality benefits of ?-blockers were similar across all subgroups. CONCLUSIONS AND RELEVANCE Use of ?-blockers after AMI is associated with functional decline in older nursing home residents with substantial cognitive or functional impairment, but not in those with relatively preserved mental and functional abilities. Use of ?-blockers yielded a considerable mortality benefit in all groups.",beta adrenergic receptor blocking agent;acute heart infarction;aged;article;cardiac patient;cardiovascular mortality;clinical outcome;cognition;cognitive defect;cohort analysis;comparative study;daily life activity;dementia;disease severity;female;functional assessment;functional disease;functional status;hospital discharge;hospital readmission;human;intensive care unit;major clinical study;male;Morris scale;nursing home patient;pharmaceutical care;priority journal;side effect;very elderly,"Steinman, M. A.;Zullo, A. R.;Lee, Y.;Daiello, L. A.;Boscardin, W. J.;Dore, D. D.;Gan, S.;Fung, K.;Lee, S. J.;Komaiko, K. D. R.;Mor, V.",2017,,10.1001/jamainternmed.2016.7701,0,
4256,Association of platelet activation with vascular cognitive impairment: Implications in dementia development?,"Cardiovascular risk factors are associated with coronary artery disease (CAD) and with cognitive dysfunction. However, the precise pathogenic mechanisms responsible for this association remain elusive. In the present study, CAD patients with cognitive impairment showed significantly higher platelet activation compared with CAD patients without cognitive impairment. In addition, we identified platelet activity to be a significant independent predictor for the severity of cognitive impairment in these patients. We discuss the link between platelet hyperactivity and dementia (including Alzheimer's disease) based on the literature and our findings. We also discuss the potential mechanisms involved. This link may become a therapeutic option. © 2014 Bentham Science Publishers.",amyloid beta protein;glycoprotein Ib alpha;PADGEM protein;article;clinical article;cognitive defect;coronary artery disease;dementia;disease course;flow cytometry;human;protein expression;scoring system;thrombocyte activation;vascular disease,"Stellos, K.;Katsiki, N.;Tatsidou, P.;Bigalke, B.;Laske, C.",2014,,,0,
4257,Impaired endothelial function of forearm resistance arteries in CADASIL patients,"BACKGROUND AND PURPOSE - Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary arteriopathy, which mainly involves the brain causing stroke and dementia. Mice expressing the mutated protein display early dysfunction in vasoreactivity in resistance arteries, but studies of patients have been inconclusive so far. METHODS - We examined peripheral endothelium-dependent vasodilatation in 10 CADASIL-patients and 20 controls using 3 methods: venous occlusion plethysmography of forearm blood flow with intraarterial acetylcholine and sodium nitroprusside infusions for evaluation of resistance arteries, ultrasound with flow mediated vasodilatation (FMD) of the brachial artery for evaluation of a conduit artery, and the pulse wave method with measurements before and after terbutaline for evaluation of systemic endothelium-dependent vasodilation. RESULTS - The CADASIL patients displayed reductions in both basal (P=0.034) and stimulated blood flow (P=0.023 for the highest dose of acetylcholine) and an impaired endothelium-dependent vasodilation when investigated in forearm resistance arteries (P=0.019). The FMD and the pulse wave method did not show any reduction in endothelium-dependent vasodilation in the patients. CONCLUSIONS - Endothelium-dependent vasodilation was impaired in resistance arteries, but not in a conduit artery, in the forearm of CADASIL patients. © 2007 American Heart Association, Inc.",acetylcholine;nitroprusside sodium;terbutaline;adult;aged;artery endothelium;article;blood vessel reactivity;brachial artery;CADASIL;clinical article;drug megadose;female;forearm blood flow;human;male;priority journal;protein expression;pulse wave;resistance blood vessel;statistical analysis;tissue level;vasodilatation;vein occlusion plethysmography;nitropress,"Stenborg, A.;Kalimo, H.;Viitanen, M.;Terent, A.;Lind, L.",2007,,,0,
4258,Hypomagnesaemia in alcohol encephalopathies,"Two groups of patients were examined for serum magnesium concentrations: 18 male patients with acute delirium tremens (Material I); 14 male patients with the diagnosis of alcohol encephalopathy (4 newly admitted and 10, hospitalized for 5 mth to 3 yr) (Material II). The term alcohol encephalopathy (AE) is introduced in this paper as a common diagnostic denominator to designate Korsakoff's psychosis, Wernicke's encephalopathy, dementia alcoholica and intellectual reduction of a degree which makes social readjustment impossible. Out of 10 patients admitted with the diagnosis of delirium tremens and normal serum magnesium concentration (Material I), none developed an AE as a sequel, whereas out of 11 patients admitted with acute delirium tremens (10 patients) or predelirium (1 patient) and found to have hypomagnesaemia, 6 patients developed an AE as a sequel (Material I, II). The difference is statistically significant (P<0.05). The serum Mg concentration mean value of the AE group (Material II) was significantly lower than that of the delirium tremens group (Material I P<0.05), and also lower than that of the chronic alcoholic patients (P<0.05) or that of the schizophrenics with no known alcoholic addiction serving as controls (P<0.001). The lowest serum magnesium concentrations were found in the AE cases of a very recent onset. Four newly admitted AE patients were treated with mistura magnesii hydroxidi (Nordic Pharmacopoeia). A follow up of the results was carried out 5 yr later. AE was shown to be reversible in those cases in which adequate magnesium treatment was given at the onset of the illness. AE patients not treated with magnesium or treated for too short a period of time had low serum magnesium concentrations, independently of the length of hospitalization and the length of abstinence from alcohol. The combinaion of hypomagnesaemia with delirium/predelirium tremens appears to be of aetiological significance for the occurrence of AE, which develops as a sequel to delirium/predelirium tremens.",alcohol;anvenit;magnesium;magnesium carbonate;magnesium hydroxide;unclassified drug;alcohol encephalopathy;alcoholism;article;brain disease;delirium tremens;diagnosis;electrocardiography;electroencephalography;etiology;heart failure;hypomagnesemia;intellect;kidney injury;Korsakoff psychosis;magnesium blood level;memory;novalucol forte;oral drug administration;schizophrenia;therapy;Wernicke encephalopathy,"Stendig Lindberg, G.",1974,,,0,
4259,Both deterioration and improvement in activities of daily living are related to falls: a 6-year follow-up of the general elderly population study Good Aging in Skane,"OBJECTIVES: To determine the relationship between long-term change in activities of daily living (ADL) and falls in the elderly and to identify characteristics of groups at risk for falls. METHODS: This was a 6-year, prospective cohort study using data from the Good Aging in Skane study in southern Sweden, involving 1,540 elderly subjects, including the oldest-old (age, 60-93 years). The subjects were recruited from the general population. ADL was measured at a baseline and follow-up assessment, using Sonn and Asberg's revised scale and the ADL staircase. Falls were recorded in a period of 6 months before the follow-up assessment. The association between falls and change in ADL was calculated using adjusted, multiple logistic regression analysis and presented in odds ratios (ORs). RESULTS: Thirteen percent of the study population reported one or several falls in the measured period. Over the course of 6 years, one in four participants changed their ADL status, and parts of this category had an increased risk for falls compared with those who stayed independent in ADL or who had no change in the ADL staircase. Groups with different characteristics had a prominent risk for falls: those with a reduction of two to eight steps in the ADL staircase (OR, 4.05; 95% confidence interval [CI], 1.62-10.11) and those becoming independent from dependency in instrumental ADL (OR, 4.13; 95% CI, 1.89-9.00). The former group had advanced age with a greater burden of cognitive impairment, gait disability, arrhythmia, and fall risk medications. The latter group had a higher prevalence of ischemic heart disease and low walking speed. CONCLUSION: Both deterioration and improvement in ADL over the course of 6 years increased the risk for falls in a general elderly population. Interventional efforts may require different strategies, as groups with different characteristics were at risk. Those at risk with improved ADL function may have a history of sufficient burden of comorbidity combined with obtained mobility for exposure to a fall event.","Accidental Falls/prevention & control/*statistics & numerical data;Activities of Daily Living/*classification;Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/epidemiology;Arrhythmias, Cardiac/epidemiology;Cohort Studies;Comorbidity;Female;Gait;Gait Apraxia/epidemiology;Humans;Longitudinal Studies;Male;Middle Aged;Myocardial Ischemia/epidemiology;Prospective Studies;Risk Factors;accidental falls;activities of daily living;elderly;general population;prospective","Stenhagen, M.;Ekstrom, H.;Nordell, E.;Elmstahl, S.",2014,,10.2147/cia.s70075,0,
4260,Alzheimer and vascular neuropathological changes associated with different cognitive states in a non-demented sample,"The state between aging with no cognitive impairment and dementia has become a major focus for intervention. The neuropathological and neurobiological correlates of this intermediate state are therefore of considerable interest, particularly from population representative samples. Here we investigate the neuropathological profile associated with different cognitive ability levels measured using strata defined by Mini Mental State Examination (MMSE) scores. One hundred and fifty one individuals were stratified into three cognitive groups including: non-, mildly, and moderately impaired at death. Alzheimer's disease, atrophy, and vascular pathologies were investigated. Mild impairment was associated with an increased risk of vascular pathologies including small vessel disease and lacunes. In contrast, the moderately impaired group showed a more extensive pattern of pathology, including tangles and neuritic plaques (entorhinal/hippocampus), atrophy (cortical and hippocampal), and vascular disease (small vessel disease, lacunes, and infarcts). In a population-based sample of older people, MMSE score defined strata are associated with multiple pathologies. The profile of AD and vascular changes becomes more complex with increased cognitive impairment and these changes are likely to constitute a major substrate for age associated cognitive impairment. The results highlight the need for rigorous investigation of both neurodegenerative and vascular risks factors in old age. © 2012-IOS Press and the authors. All rights reserved.",apolipoprotein E;aged;aging;Alzheimer disease;angina pectoris;article;autopsy;cerebrovascular disease;cognitive defect;comorbidity;dementia;diabetes mellitus;disease association;disease severity;female;genotype;health status;heart infarction;human;hypertension;immunohistochemistry;major clinical study;male;mild cognitive impairment;Mini Mental State Examination;neuropathology;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;priority journal;risk factor;cerebrovascular accident,"Stephan, B. C. M.;Matthews, F. E.;Ma, B.;Muniz, G.;Hunter, S.;Davis, D.;McKeith, I. G.;Foster, G.;Ince, P. G.;Brayne, C.",2012,,,0,
4261,Neuropsychological profiles of vascular disease and risk of dementia: implications for defining vascular cognitive impairment no dementia (VCI-ND),"Background: vascular cognitive impairment no dementia (VCI-ND) defines a preclinical phase of cognitive decline associated with vascular disorders. The neuropsychological profile of VCI-ND may vary according to different vascular conditions. Objective: to determine the neuropsychological profile of individuals with no dementia and vascular disorders, including hypertension, peripheral vascular disease (PVD), coronary heart disease (CHD), diabetes and stroke. Risk of 2-year incident dementia in individuals with disease and cognitive impairment was also tested. Methods: participants were from the Cognitive Function and Ageing Study. At baseline, 13,004 individuals aged >/=65 years were enrolled into the study. Individuals were grouped by baseline disorder status (present, absent) for each condition. Cognitive performance was assessed using the Mini Mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAMCOG). Dementia was assessed at 2 years. Results: in the cross-sectional analysis, hypertension, PVD and CHD were not associated with cognitive impairment. Stroke was associated with impaired global (MMSE) and CAMCOG sub-scale (including memory and non-memory) scores. Diabetes was associated with impairments in global cognitive function (MMSE) and abstract thinking. In the longitudinal analysis, cognitive impairments were associated with incident dementia in all groups. Conclusion: the neuropsychological profile in individuals with vascular disorders depends on the specific condition investigated. In all conditions cognitive impairment is a risk factor for dementia. A better understanding of which cognitive domains are affected in different disease groups could help improve operationalisation of the neuropsychological criteria for VCI-ND and could also aid with the development of dementia risk prediction models in persons with vascular disease.",cognition;dementia risk;epidemiology;older people;vascular cognitive impairment no dementia;vascular disease,"Stephan, B. C. M.;Minett, T.;Muniz-Terrera, G.;Harrison, S. L.;Matthews, F. E.;Brayne, C.",2017,Sep 01,,0,
4262,The effects of cognitive impairment on nursing home residents' emergency department visits and hospitalizations,"Background Little is known about the relationship of cognitive impairment (CI) in nursing home (NH) residents and their use of emergency department (ED) and subsequent hospital services. Methods We analyzed 2006 Medicare claims and resident assessment data for 112,412 Medicare beneficiaries aged >65 years residing in US nursing facilities. We estimated the effect of resident characteristics and severity of CI on rates of total ED visits per year, then estimated the odds of hospitalization after ED evaluation. Results Mild CI predicted higher rates of ED visits relative to no CI, and ED visit rates decreased as severity of CI increased. In unadjusted models, mild CI and very severe CI predicted higher odds of hospitalization after ED evaluation; however, after adjusting for other factors, severity of CI was not significant. Conclusions Higher rates of ED visits among those with mild CI may represent a unique marker in the presentation of acute illness and warrant further investigation.",psychotropic agent;acute disease;ADL disability;aged;article;Black person;chronic obstructive lung disease;cognitive defect;cohort analysis;depression;diabetes mellitus;disease severity;emergency care;emergency ward;emphysema;falling;female;heart failure;hospitalization;human;major clinical study;male;marriage;medicare;nursing home patient;priority journal;relative;retrospective study,"Stephens, C. E.;Newcomer, R.;Blegen, M.;Miller, B.;Harrington, C.",2014,,,0,
4263,Prescribing of antipsychotics in people with dementia in acute general hospitals in England: 2010-2012,"Purpose: Antipsychotics are believed to be over-used in the control, the behavioural and psychological symptoms of dementia. Hospitals are encouraged to audit antipsychotic use in people with dementia. The objectives of this study are to describe antipsychotic use in inpatients with dementia between 2010 and 2012 and to understand the impact of clinical and socio-demographic factors on their use. Design: Retrospective and longitudinal analysis of antipsychotics dispensed to people with dementia in 34 English hospitals between January 2010 and October 2012. The unit of analysis was the period during which an inpatient was under the continuous care of one or more hospitals. Results: Among the inpatients, 16.6% (10,440/63,079) with dementia received an antipsychotic in 13.9% of periods of care (13,643/97,902). Antipsychotic use was higher in inpatients with dementia and schizophrenia (57%) and in those inpatients with dementia and the symptoms and signs involving emotional state (38.2%). Antipsychotic use decreased between 2010 and 2012 (15.9% versus 12.1%, P < 0.001). In people with dementia without schizophrenia, the absence of cerebrovascular or ischaemic heart disease (OR 1.16 [1.12-1.21]), the presence of signs or symptoms of emotional state (OR 3.71 [3.29-4.19]), increasing deprivation (OR 1.02 [1.01-1.03]) and male gender (OR 1.10 [1.06-1.15]) were significantly associated with increased antipsychotic use (P < 0.001 in all cases). Increasing age (OR 0.88 [0.87-0.89]) was significantly associated with decreased antipsychotic use (P < 0.001). Conclusion: Antipsychotic use in inpatients with dementia is declining but still more than one in eight periods of care are associated with use of an antipsychotic.",neuroleptic agent;adult;aged;article;cerebrovascular disease;dementia;drug use;emotionality;female;gender;general hospital;hospital patient;human;inappropriate prescribing;ischemic heart disease;major clinical study;male;pharmacoepidemiology;schizophrenia;social status;symptomatology;United Kingdom;very elderly,"Stephens, P.;Chikh, K.;Leufkens, H.",2014,,,0,
4264,A role for mitochondria in age-related disorders?,,mitochondrial DNA;aging;Alzheimer disease;gene mutation;heart failure;hereditary optic atrophy;human;mitochondrial respiration;note;oxidative phosphorylation;Parkinson disease;pathogenesis;priority journal,"Stephenson, J.",1996,,,0,
4265,Medicare hospice care in US nursing homes: A 2006 update,"Introduction: This research examines 2006 population-based data on persons who died in US nursing homes (NHs) and received hospice in the NH. Methods: We compared dying persons characteristics and lengths of hospice stay in five US states between 1992 and 1996 and in 2006. We also compared characteristics of dying persons in 2006 by whether they first entered hospice in the community (i.e. 'community-NH', N=12,950) or the NH (i.e. 'NH-only', N=159,065).Results: In five US states, dying persons who received NH hospice in 2006, compared to 1992-1996, were older, had more short hospice stays (≤7 days), and were less frequently diagnosed with cancer. Also, in 2006, dying persons receiving 'NH-only' versus 'community-NH' hospice were older, had more short stays, and were less frequently diagnosed with cancer.Discussion: Persons in 2006 who received hospice in the community and in the NH (vs. 'NH-only') were strikingly similar to hospice participants in 1992-1996. 2006 'NH-only' vs. 'community-NH' dying persons, more closely resemble U.S. NH residents. © The Author(s) 2011.",aged;Alzheimer disease;article;breast cancer;chronic obstructive lung disease;colorectal cancer;dementia;dying;failure to thrive;female;heart disease;heart failure;hospice care;human;kidney failure;length of stay;lung cancer;major clinical study;male;medicare;metastasis;neoplasm;nursing home;Parkinson disease;United States,"Sterns, S.;Miller, S. C.",2011,,,0,
4266,"Aging, resting pulse rate, and longevity","OBJECTIVES: To examine the relationship between resting pulse rate (RPR) and longevity in individuals aged 70 to 90. DESIGN: The Jerusalem Longitudinal Cohort Study (1990-2010) is a prospective longitudinal study of a representative cohort born in 1920-21. SETTING: Home-based comprehensive assessment in 1990, 1998, and 2005. PARTICIPANTS: Individuals aged 70 (n = 453), 78 (n = 856), and 85 (n = 1,044), with follow-up to age 90. MEASUREMENTS: Comprehensive assessment included average RPR, beta-blocker usage, and physical activity level. Mortality data were collected from the Ministry of Interior from 1990 to 2010. METHODS: Cox proportional hazards ratios (HRs) were determined for RPR (continuous variable), adjusting for sex, education, diabetes mellitus, ischemic heart disease, congestive heart failure, hypertension, kidney disease, anemia, physical activity, body mass index, self-rated health, dementia, beta-blocker use, and an interaction term for RPR by beta-blocker use. RESULTS: Mean RPR was 75.1 +/- 9.9 at 70, 74.5 +/- 10.9 at 78, and 68.5 +/- 10.5 at 85 in women and 74.3 +/- 10.7 at 70, 73.1 +/- 11.2 at 78, and 65.2 +/- 10.5 at 85 in men, with a significant decline from 78 to 85 for both sexes. In participants not taking beta-blockers followed up from 70 to 77, 78 to 84, and 85 to 90, mean RPR was lower in survivors than nonsurvivors for women (75.8 +/- 9.2 vs 83.5 +/- 10.9, P < .001; 75.2 +/- 9.8 vs 79.9 +/- 12.6, P = .004; 71.5 +/- 9.9 vs 74.6 +/- 10.7, P = .02, respectively) and men (75.2 +/- 10.3 vs 75.2 +/- 10.9, P = .98; 73.5 +/- 10.1 vs 77.2 +/- 12.1, P = .005; 67.1 +/- 9.5 vs 70.4 +/- 11.7, P = .01, respectively). Adjusted HRs for mortality per 10-beat increase in RPR during follow-up were 1.13 (95% confidence interval (CI) = 0.87-1.47) for 70 to 77, 1.35 (95% CI = 1.11-1.65) for 78 to 84, and 1.17 (95% CI = 1.01-1.37) for 85 to 90. CONCLUSION: RPR declines in the oldest old, and this decline is associated with greater longevity. It may serve as a simple prognostic marker in the oldest old.","Aged;Aged, 80 and over;Aging/*physiology;Female;Follow-Up Studies;Heart Rate/*physiology;Humans;Longevity/*physiology;Male;Motor Activity/*physiology;Prospective Studies;Rest/*physiology;Time Factors","Stessman, J.;Jacobs, J. M.;Stessman-Lande, I.;Gilon, D.;Leibowitz, D.",2013,Jan,10.1111/jgs.12060,0,
4267,Depression and hypothalamic-pituitary-adrenal activation: A quantitative summary of four decades of research,"Objectives: To summarize quantitatively the literature comparing hypothalamic-pituitary-adrenal (HPA) axis function between depressed and nondepressed individuals and to describe the important sources of variability in this literature. These sources include methodological differences between studies, as well as demographic or clinical differences between depressed samples. Methods: The current study used meta-analytic techniques to compare 671 effect sizes (cortisol, adrenocorticotropic hormone, or corticotropin-releasing hormone) across 361 studies, including 18,454 individuals. Results: Although depressed individuals tended to display increased cortisol (d = 0.60; 95% confidence interval [CI], 0.54-0.66) and adrenocorticotropic hormone levels (d = 0.28; 95% CI, 0.16-0.41), they did not display elevations in corticotropin-releasing hormone (d = 0.02; 95% CI, -0.47-0.51). The magnitude of the cortisol effect was reduced by almost half (d = 0.33; 95% CI, 0.21-0.45) when analyses were limited to studies that met minimal methodological standards. Gender did not significantly modify any HPA outcome. Studies that included older hospitalized individuals reported significantly greater cortisol differences between depressed and nondepressed groups compared with studies with younger outpatient samples. Important cortisol differences also emerged for atypical, endogenous, melancholic, and psychotic forms of depression. Conclusions: The current study suggests that the degree of HPA hyperactivity can vary considerably across patient groups. Results are consistent with HPA hyperactivity as a link between depression and increased risk for conditions, such as diabetes, dementia, coronary heart disease, and osteoporosis. Such a link is strongest among older inpatients who display melancholic or psychotic features of depression. Copyright © 2011 by the American Psychosomatic Society.",corticotropin;corticotropin releasing factor;dexamethasone;hydrocortisone;prednisolone;adolescent;adult;aged;article;atypical depression;Beck Depression Inventory;blood cerebrospinal fluid barrier;center for epidemiologic studies depression scale;child;circadian rhythm;demography;depression;depressive psychosis;endogenous depression;female;gender;Hamilton Depression Rating Scale;hospitalization;human;hydrocortisone blood level;hypothalamus hypophysis adrenal system;major clinical study;male;melancholic depression;meta analysis;Montgomery Asberg Depression Rating Scale;outpatient;priority journal;psychologic test;saliva level;school child;Zung Depression Scale,"Stetler, C.;Miller, G. E.",2011,,,0,
4268,Gender differences in seeking care for falls in the aged medicare population,"Background: One third of adults aged <65 years fall annually, and women are more likely than men to be treated for fall injuries in hospitals and emergency departments. Purpose: The aim of this study was to examine how men and women differed in seeking medical care for falls and in the information about falls they received from healthcare providers. Methods: This study, undertaken in 2010, analyzed population-based data from the 2005 Medicare Current Beneficiary Survey (MBCS), the most recent data available in 2010 from this survey. A sample of 12,052 community-dwelling Medicare beneficiaries aged <65 years was used to examine male-female differences among 2794 who reported falling in the previous year, sought medical care for falls and/or discussed fall prevention with a healthcare provider. Multivariable logistic regression analyses were conducted to determine the factors associated with falling for men and women. P-values ≤0.05 were considered significant. Results: Nationally, an estimated seven million Medicare beneficiaries (22%) fell in the previous year. Among those who fell, significantly more women than men talked with a healthcare provider about falls and also discussed fall prevention (31.2% [95% CI=28.8%, 33.6%] vs 24.3% [95% CI=21.6%, 27.0%]). For both genders, falls were most strongly associated with two or more limitations in activities of daily living and often feeling sad or depressed. Conclusions: Women were significantly more likely than men to report falls, seek medical care, and/or discuss falls and fall prevention with a healthcare provider. Providers should consider asking all older patients about previous falls, especially older male patients who are least likely to seek medical attention or discuss falls with their doctors. ©2012 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.",article;daily life activity;dementia;depression;doctor patient relation;falling;female;health care personnel;human;ischemic heart disease;major clinical study;male;medical care;medicare;sadism;sex difference;cerebrovascular accident,"Stevens, J. A.;Ballesteros, M. F.;Mack, K. A.;Rudd, R. A.;DeCaro, E.;Adler, G.",2012,,,0,
4269,Seizures and X-linked intellectual disability,"Intellectual disability occurs as an isolated X-linked trait and as a component of recognizable X-linked syndromes in the company of somatic, metabolic, neuromuscular, or behavioral abnormalities. Seizures accompany intellectual disability in almost half of these X-linked disorders. The spectrum of seizures found in the X-linked intellectual disability syndromes is broad, varying in time of onset, type of seizure, and response to anticonvulsant therapy. The majority of the genes associated with XLID and seizures have now been identified. © 2012 Elsevier Masson SAS.",agyria;Aicardi syndrome;anophthalmia;article;brain malformation;cardiomyopathy;centronuclear myopathy;cerebellum agenesis;cerebellum hypoplasia;chondrodysplasia;coloboma;cyst;Dandy Walker syndrome;de Lange syndrome;developmental disorder;Duchenne muscular dystrophy;dyskeratosis congenita;Fahr disease;fragile X syndrome;Goltz syndrome;happy puppet syndrome;hydranencephaly;hydrocephalus;incontinentia pigmenti;infantile spasm;nystagmus;Opitz syndrome;Pallister Hall syndrome;periventricular heterotopia;Rett syndrome;rolandic epilepsy;seizure;Simpson Golabi Behmel syndrome;telecanthus;tonic clonic seizure;X linked mental retardation,"Stevenson, R. E.;Holden, K. R.;Rogers, R. C.;Schwartz, C. E.",2012,,,0,
4270,The effect on risk estimates of excluding cases from a case-control study of ischemic stroke,"There is limited information about the effect on stroke risk estimates of excluding cases who are unable to respond to interviews. A case-control study of ischemic stroke between 1988 and 1990 in Shreveport, La., USA, provided a basis for studying this question. Of 197 consecutively admitted cases of ischemic stroke, 77 were excluded due to dementia, aphasia or impaired consciousness. Information about risk factors and stroke characteristics was obtained from hospital records. Excluded cases had more left hemispheric (52 versus 19%) and fewer vertebrobasilar (12 versus 29%) and lacunar (5 versus 13%) infarcts than included cases. Excluded cases were also older (p < 0.01), and they had larger infarcts (p < 0.01), multiple strokes (p < 0.01) and congestive heart failure (p < 0.01) more often than included cases. Cases were matched to hospital controls by age, sex, race, and date of admission. Odds ratios (ORs) were higher for excluded cases for 5 of 6 exposures with a significantly higher OR for congestive heart failure (p < 0.01). The ORs changed by as much as 63% when excluded cases were added. These results emphasize the importance of acquiring information about excluded cases and considering selection bias when interpreting stroke studies that exclude cases who are unable to respond to interviews.",Adult;Age Distribution;Brain Ischemia/complications/*epidemiology/pathology;Case-Control Studies;Chi-Square Distribution;Cognition Disorders/etiology/pathology;*Communication Barriers;Communication Disorders/etiology/pathology;Confidence Intervals;Cross-Sectional Studies;Humans;Likelihood Functions;Logistic Models;Louisiana/epidemiology;Male;Odds Ratio;Retrospective Studies;Risk Factors;Selection Bias;Severity of Illness Index,"Stewart, A.;Davis, P.;Kittner, S.;Langenberg, P.",1997,,,0,
4271,Drug-induced bradycardia,Drug-induced bradycardia is a common adverse effect as well as a desired effect of therapeutic treatment. Interactions between drugs in patients who may be taking many agents are also an important factor. Both cardiac and noncardiac drugs have been shown to cause bradycardia. Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.,alpha adrenergic receptor blocking agent;amisulpride;amlodipine;atenolol;beta adrenergic receptor blocking agent;calcium channel blocking agent;carvedilol;cholinesterase inhibitor;citalopram;digoxin;diltiazem;donepezil;doxazosin;fluoxetine;glucocorticoid;labetalol;lithium;metoprolol;metrifonate;neostigmine;nifedipine;prazosin;propranolol;risperidone;rivastigmine;serotonin uptake inhibitor;tamsulosin;timolol;unindexed drug;verapamil;Alzheimer disease;angina pectoris;article;bipolar disorder;bradycardia;dose response;drug induced bradycardia;drug induced disease;drug mechanism;drug megadose;drug overdose;drug safety;drug withdrawal;epidural anesthesia;general anesthesia;heart arrhythmia;human;hypertension;inflammation;local anesthesia;myasthenia gravis;prostate hypertrophy;psychopharmacotherapy;sinus bradycardia;spinal anesthesia,"Stewart, K.",2011,,,0,
4272,Associations between oral health and risk of dementia in a 37-year follow-up study: the prospective population study of women in Gothenburg,"OBJECTIVES: To investigate the association between incident dementia and previous number of teeth measured over a long interval. DESIGN: Retrospective analysis of a 37-year cohort study. SETTING: Prospective Population Study of Women in Gothenburg. PARTICIPANTS: Women with (n = 158) and without (n = 539) dementia in 2000 to 2005. MEASUREMENTS: Tooth counts in 1968-69, 1980-81, and 1992-93. Covariates included age, education, stroke, myocardial infarction, diabetes mellitus, smoking status, blood pressure, body mass index, and cholesterol level. RESULTS: After adjustment for age, odds ratios (ORs) for dementia in 2000-05, comparing first with fourth tooth count quartiles, were 1.81 (95% confidence interval (CI) = 1.03-3.19) for tooth counts measured in 1968, 2.25 (95% CI = 1.18-4.32) for those in 1980, and 1.99 (0.92-4.30) for those in 1992. After further adjustment for education, ORs were 1.40 (95% CI = 1.03-3.19) for 1968, 1.96 (95% CI = 0.98-3.95) for 1980, and 1.59 (95% CI = 0.71-3.53) for 1992, and after additional adjustment for vascular risk factors, ORs were 1.38 (95% CI = 0.74-2.58) for 1968, 2.09 (95% CI = 1.01-4.32) for 1980, and 1.61 (95% CI = 0.70-3.68) for 1992. CONCLUSION: In most of the analyses, lower tooth count was not associated with dementia, although a significant association was found for one of the three examinations. Further research may benefit from more-direct measures of dental and periodontal disease.","Aged;Aged, 80 and over;Comorbidity;Dementia/*epidemiology;Demography;Female;Follow-Up Studies;Humans;*Oral Health;Prospective Studies;Retrospective Studies;Risk;Social Class;Sweden/epidemiology;cohort study;dementia;oral health;periodontal disease;tooth loss","Stewart, R.;Stenman, U.;Hakeberg, M.;Hagglin, C.;Gustafson, D.;Skoog, I.",2015,Jan,10.1111/jgs.13194,0,
4273,Pharmacotherapy in multimorbid patients: An art of the general practitioners par excellence,,beta adrenergic receptor blocking agent;digitalis;neuroleptic agent;biometry;chronic obstructive lung disease;clinical feature;clinical practice;dementia;depression;diabetes mellitus;general practitioner;health care quality;heart failure;human;hypercholesterolemia;hypertension;incidence;medical specialist;medical staff;morbidity;observational study;osteoarthritis;osteoporosis;patient monitoring;short survey,"Stiefelhagen, P.",2007,,,0,
4274,Polypharmacotherapy in the older and multimorbid patients: When guidelines hit the wall,,phenprocoumon;chronic obstructive lung disease;comorbidity;dementia;depression;diabetes mellitus;elderly care;health care cost;heart failure;human;hypercholesterolemia;hypertension;mortality;osteoporosis;patient compliance;polypharmacy;practice guideline;quality of life;short survey,"Stiefelhagen, P.",2010,,,0,
4275,Sacubitril/Valsartan,"Pharmacotherapy of chronic left heart failure has progressed throughout the past years, resulting in a threefold increase of survival compared to a solely symptomatically oriented therapy. Despite these advances, there remains a need for new therapeutic principles, particularly with regard to the poor prognosis of this disease in advanced stages. Such a new drug is the combination of sacubitril and valsarían (Entresto®). Results of the study PARADIGM-HF were surprisingly positive regarding risk of death and hospitalization due to heart failure, but there remain open questions, especially regarding a possible risk of dementia with long-term therapy.",new drug;sacubitril plus valsartan;dementia;heart death;heart left ventricle failure;hospitalization;human;long term care;prognosis;short survey;entresto,"Stiefelhagen, P.",2016,,,0,
4276,Recognition and management of hypertension in older persons: Focus on African Americans,"Hypertension is the most commonly diagnosed condition in persons aged 60 and older and is the single most important risk factor for cardiovascular disease (ischemic heart disease, heart failure, and stroke), kidney disease, and dementia. More than half of individuals with hypertension in the United States are aged 60 and older. Hypertension disproportionately affects African Americans, with all age groups, including elderly adults, having a higher burden of hypertension-related complications than other U.S. populations. Multiple clinical trials have demonstrated the beneficial effects of blood pressure (BP) reduction on cardiovascular morbidity and mortality, with most of the evidence in individuals aged 60 and older. Several guidelines have recently been published on the specific management of hypertension in individuals aged 60 and older, including in high-risk groups such as African Americans. Most recommend careful evaluation, thiazide diuretics and calcium-channel blockers for initial drug therapy in most African Americans, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in those with chronic kidney disease or heart failure. Among the areas of controversy is the recommended target BP in African Americans aged 60 and older. A recent U.S. guideline recommended raising the systolic BP target from less than 140 mmHg to less than 150 mmHg in this population. This article will review the evidence and current guideline recommendations for hypertension treatment in older African Americans, including the rationale for continuing to recommend a SBP target of less than 140 mmHg in this population.",angiotensin receptor antagonist;calcium;calcium channel blocking agent;creatinine;dipeptidyl carboxypeptidase inhibitor;glucose;glycosylated hemoglobin;lipid;thiazide diuretic agent;African American;article;blood pressure monitoring;cardiovascular mortality;clinical assessment;clinical effectiveness;clinical evaluation;clinical feature;clinical trial (topic);conservative treatment;diagnostic test;early intervention;epidemiological data;evidence based practice;genetic susceptibility;groups by age;human;hypertension;lifestyle modification;managed care;outcome assessment;pathogenesis;patient compliance;population;practice guideline;systolic blood pressure;systolic hypertension,"Still, C. H.;Ferdinand, K. C.;Ogedegbe, G.;Wright, J. T.",2015,,,0,
4277,Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery,"Background: We evaluated the role of the Charlson age-comorbidity index (CACI), a weighted comorbidity index that reflects cumulative increased likelihood of 1-year mortality, in predicting perioperative outcomes in an emergency general surgery population at a large Canadian teaching hospital. Methods: A retrospective chart review of emergency general surgery admissions in 2010 was conducted. Patients who had surgery were identified. Mode of surgery and CACI were recorded, as well as measures of outcome, including 30-day mortality and intensive care unit (ICU) admission. A multivariate stepwise logistic regression model was created to assess the effect of age-adjusted Charlson comorbidity index on postoperative outcomeswhile controlling for the effect of possible confounders. The prediction ability of CACI for mortality was assessed using receiver operating characteristic analyses considering the area under the curve and its 95% confidence intervals (CIs). Results: of the 529 admissions to general surgery from the emergency department, 257 patients underwent a surgical intervention. The CACI scores ranged from 0 to 16. We described a total of 11 deaths (4.3%) and 30 ICU admissions (11.7%). CACI was associated with an increased risk of 30-day mortality (adjusted odds ratio,1.39; 95% CI, 1.11-1.73; p = 0.0034). Receiver operating characteristic analysis was consistent with high accuracy of CACI for mortality prediction alone, resulting in area under the curve or c statistic of 0.90 (95% CI, 0.84-0.95). CACI was similar in predicting mortality to a multivariate model. CACI was also found to be associated with ICU admission (adjusted odds ratio, 1.17; 95% CI, 1.01-1.37; p G 0.0382). CACI is not as good a predictor for ICU admission when compared with the multivariate model. Conclusion: We have shown that the CACI is a valid tool for 30-day mortality prediction in the context of emergency general surgery. Level of Evidence: Prognostic study, level III.",acquired immune deficiency syndrome;adult;age;aged;area under the curve;article;Charlson age comorbidity index;Charlson Comorbidity Index;chronic obstructive lung disease;comorbidity;congestive heart failure;connective tissue disease;controlled study;coronary artery disease;dementia;diabetes mellitus;emergency surgery;endocrine disease;female;general surgery;glomerulus filtration rate;heart infarction;hemiplegia;hospital admission;human;hypertension;intensive care unit;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;medical record review;peripheral vascular disease;postoperative complication;prediction;priority journal;receiver operating characteristic;solid tumor;surgical mortality;treatment outcome;ulcer,"St-Louis, E.;Iqbal, S.;Feldman, L. S.;Sudarshan, M.;Deckelbaum, D. L.;Razek, T. S.;Khwaja, K.",2015,,,0,
4278,A high-throughput screening strategy identifies cardiotonic steroids as alternative splicing modulators,"Alternative splicing has emerged as a promising therapeutic target in a number of human disorders. However, the discovery of compounds that target the splicing reaction has been hindered by the lack of suitable high-throughput screening assays. Conversely, the effects of known drugs on the splicing reaction are mostly unclear and not routinely assessed. We have developed a two-color fluorescent reporter for cellular assays of exon inclusion that can accommodate nearly any cassette exon and minimizes interfering effects from changes in transcription and translation. We used microtubule-associated protein tau (MAPT) exon 10, whose missplicing causes frontotemporal dementia, to test the reporter in screening libraries of known bioactive compounds. These screens yielded several compounds that alter the splicing of the exon, both in the reporter and in the endogenous MAPT mRNA. One compound, digoxin, has long been used in the treatment of heart failure, but was not known to modulate splicing. The positive compounds target different signal transduction pathways, and microarray analysis shows that each compound affects the splicing of a different set of exons in addition to MAPT exon 10. Our results identify currently prescribed cardiotonic steroids as modulators of alternative splicing and demonstrate the feasibility of screening for drugs that alter exon inclusion.","Alternative Splicing/*drug effects/genetics;Cardiotonic Agents/*pharmacology;Cell Line;Dementia/genetics/metabolism;Digoxin/*pharmacology;Drug Evaluation, Preclinical/methods;*Exons/genetics;Gene Expression Profiling/methods;Genes, Reporter/genetics;Heart Failure/drug therapy/genetics/metabolism;Humans;Oligonucleotide Array Sequence Analysis/methods;RNA, Messenger/*biosynthesis/genetics;Signal Transduction/drug effects/genetics;tau Proteins/*biosynthesis/genetics","Stoilov, P.;Lin, C. H.;Damoiseaux, R.;Nikolic, J.;Black, D. L.",2008,Aug 12,10.1073/pnas.0801661105,0,
4279,Paying for the greying of society,A recent US report has highlighted how all Western governments may need to work with insurers to make biotech-based drugs affordable for an ageing population.,abciximab;alteplase;eptifibatide;human insulin;insulin;insulin lispro;interleukin 2 receptor antibody;OKT 3;recombinant erythropoietin;recombinant granulocyte colony stimulating factor;recombinant granulocyte macrophage colony stimulating factor;reteplase;sevelamer;trastuzumab;aging;Alzheimer disease;biotechnology;neoplasm;chronic kidney failure;cost control;diabetes mellitus;drug cost;drug research;elderly care;health care cost;home care;hospitalization;human;ischemic heart disease;length of stay;osteoporosis;Parkinson disease;quality of life;short survey;cerebrovascular accident;activase;epogen;herceptin;humalog;humulin;integrelin;leukine;neupogen;novolin;orthoclone okt3;procrit;renagel;reopro;retavase;simulect;zenapax,"Stokes, R.",2001,,,0,
4280,Effects of Silymarin on Diabetes Mellitus Complications: a Review,"Diabetes mellitus is a common metabolic disorder that is caused by a deficit in the production of (type 1) or response to (type 2) insulin. Diabetes mellitus is characterized by a state of chronic hyperglycemia and such symptoms as weight loss, thirst, polyuria, and blurred vision. These disturbances represent one of the major causes of morbidity and mortality nowadays, despite available treatments, such as insulin, insulin secretagogues, insulin sensitizers, and oral hypoglycemic agents. However, many efforts have been made to discover new drugs for diabetes treatment, including medicinal plant extracts. Silymarin is a powder extract of the seeds from Silybum marianum, a plant from the Asteraceae family. The major active ingredients include four isomers: silybin, isosilybin, silychristin, and silydianin. Silymarin is indicated for the treatment of hepatic disorders, such as cirrhosis, chronic hepatitis, and gallstones. Moreover, several studies of other pathologies, including diabetes, sepsis, osteoporosis, arthritis, hypercholesterolemia, cancer, viral infections, and Alzheimer's and Parkinson's diseases, have tested the effects of silymarin and reported promising results. This article reviews data from clinical, in vivo, and in vitro studies on the use of silymarin, with a focus on the complications of diabetes, including nephropathy, neuropathy, healing delays, oxidative stress, hepatotoxicity, and cardiomyopathy. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.",Asteraceae;blurred vision;cardiomyopathy/co [Complication];chronic hepatitis/dt [Drug Therapy];controlled study;diabetic nephropathy/co [Complication];diabetic neuropathy/co [Complication];diabetic retinopathy/co [Complication];double blind procedure;drug elimination;gallbladder disease/dt [Drug Therapy];gluconeogenesis;glycogenolysis;human;hyperglycemia;in vitro study;in vivo study;insulin dependent diabetes mellitus/dt [Drug Therapy];insulin dependent diabetes mellitus/dt [Drug Therapy];liver cirrhosis/dt [Drug Therapy];liver disease/dt [Drug Therapy];liver toxicity/co [Complication];metabolic disorder;morbidity;mortality;mouse;non insulin dependent diabetes mellitus/dt [Drug Therapy];non insulin dependent diabetes mellitus/dt [Drug Therapy];nonhuman;oxidative stress;polyuria;randomized controlled trial;rat;review;Silybum marianum;single drug dose;symptomatology;thirst;weight reduction;wound healing/co [Complication];creatinine/ec [Endogenous Compound];insulin derivative/dt [Drug Therapy];insulin derivative/pd [Pharmacology];insulin sensitizing agent/dt [Drug Therapy];insulin sensitizing agent/pd [Pharmacology];interleukin 1beta/ec [Endogenous Compound];interleukin 6/ec [Endogenous Compound];isosilybin/ec [Endogenous Compound];oral antidiabetic agent/dt [Drug Therapy];oral antidiabetic agent/po [Oral Drug Administration];oral antidiabetic agent/pd [Pharmacology];reactive oxygen metabolite/ec [Endogenous Compound];silibinin/ec [Endogenous Compound];silicristin/ec [Endogenous Compound];silidianin/ec [Endogenous Compound];Silybum marianum extract/an [Drug Analysis];Silybum marianum extract/dt [Drug Therapy];Silybum marianum extract/po [Oral Drug Administration];Silybum marianum extract/pd [Pharmacology];silymarin/an [Drug Analysis];silymarin/dt [Drug Therapy];silymarin/po [Oral Drug Administration];silymarin/pd [Pharmacology];tumor necrosis factor/ec [Endogenous Compound];unclassified drug;urea/ec [Endogenous Compound];Alzheimer disease;arthritis;cardiomyopathy;chronic hepatitis;diabetes mellitus;extract;family;gallstone;hypercholesterolemia;isomer;kidney disease;liver cirrhosis;liver toxicity;malignant neoplasm;neuropathy;osteoporosis;Parkinson disease;plant seed;powder;sensitization;sepsis;symptom;virus infection;insulin;new drug;oral antidiabetic agent;silibinin;silicristin;silidianin;silymarin,"Stolf, Am;Cardoso, Cc;Acco, A",2017,,10.1002/ptr.5768,0,
4281,Antithrombotic therapy for atrial fibrillation and additional risk factors for stroke/embolism,"Objectives: To evaluate 1) how many patients with atrial fibrillation (AF) and heart failure were discharged from Austrian hospitals with antithrombotic therapy, 2) if the presence of risk factors for stroke/embolism (age > 65 years, arterial hypertension, diabetes, and previous stroke) influence the choice of antithrombotic therapy and if the presence of contraindications for oral anticoagulation (dementia, alcohol abuse) influence the choice of antithrombotic therapy, and 3) if there are differences among the types of departments in the use of antithrombotic therapy. Patients: Included were 1566 patients (841 female, 725 male, mean age 76 years) with AF and heart failure. Methods: At discharge, a questionnaire was completed including risk factors, contraindications for antithrombotic therapy, and antithrombotic medication. Results: Oral anticoagulants (OAC) had 26 % of the cases, acetyl salicylic acid (ASA) 31 %, a combination of OAC and ASA 2 %, and no antithrombotic therapy 41 %. The risk factors age > 65 years, arterial hypertension, diabetes, and previous stroke did not influence the choice of antithrombotic therapy. Dementia but not alcohol abuse influenced the choice against OAC. The rate of OAC was higher in cardiological or cardiovascular rehabilitation clinics than in other departments. Conclusion: The results of this survey show that in medical practice the recommendations regarding antithrombotic therapy in atrial fibrillation are rarely considered, especially when additional risk factors are present.",acetylsalicylic acid;aged;alcohol abuse;anticoagulant therapy;article;cardiovascular risk;clinical trial;dementia;diabetes mellitus;embolism;female;atrial fibrillation;heart failure;human;hypertension;major clinical study;male;oral drug administration;cerebrovascular accident,"Stöllberger, C.;Finsterer, J.;Slany, J.",1999,,,0,
4282,Transcatheter aortic valve replacement: Clinical aspects and ethical considerations,,aged;aorta stenosis;article;case report;clinical assessment;dementia;disease severity;dyspnea;female;health care cost;heart failure;hemiplegia;high risk patient;human;immobilization;medical ethics;mortality;outcome assessment;prediction;priority journal;survival rate;transcatheter aortic valve implantation,"Stone, M. L.;Kern, J. A.;Sade, R. M.",2012,,,0,
4283,Cerebrovascular reactivity to acetazolamide in (senile) dementia of Alzheimer's type: Relationship to disease severity,"Neuropathological reports about denervation and amyloid angiopathy in dementia of Alzheimer's type (DAT) as well as signs of selective incomplete white matter infarctions point to a vascular involvement within the degenerative process. In order to investigate potential alterations of cerebrovascular function we performed cerebral blood flow measurements before and after intravenous injection of 1 g acetazolamide using technetium-99m hexamethylpropyleneamine oxime and single photon emission tomography in 12 patients (6 female, 6 male; mean age 70.8 ± 9.6 years) with probable (senile) dementia of Alzheimer's type (SDAT) and 9 controls (7 female, 2 male; mean age 71.2 ± 8.6 years). SDAT patients revealed significantly reduced cerebrovascular reactivity with lower values with increasing cognitive impairment. We discuss possible underlying mechanisms.",acetazolamide;acetylsalicylic acid;benzodiazepine derivative;hexamethylpropylene amine oxime technetium tc 99m;neuroleptic agent;adult;aged;Alzheimer disease;article;blood vessel reactivity;brain blood flow;brain blood vessel;brain infarction;clinical article;cognitive defect;controlled study;denervation;depression;disease severity;female;heart infarction;human;male;neuropathology;photon emission tomography;priority journal;senile dementia;vascular amyloidosis;white matter,"Stoppe, G.;Schutze, R.;Kogler, A.;Staedt, J.;Munz, D. L.;Emrich, D.;Ruther, E.",1995,,,0,
4284,Life-style and hypertension - Hypertension and life-style,"There are three connections between our life-style and our arterial blood pressure: 1.) ""Bad"" life-style may cause or increase arterial hypertension. 2.) ""Good"" life-style may decrease or even abolish arterial hypertension. 3.) Diseases caused by arterial hypertension (particularly stroke, heart failure, myocardial infarction, nephropathy, peripheral arterial occlusive disease, retinopathy, aortic dissection and dementia) may force the patient to change his life-style drastically - Independent on whether or not he or she is willing-to do so. Thus, the primary objective of medicine should be prevention of the consequences of arterial hypertension mentioned above which are irreversible in most cases. Therefore, primary prevention, including changes in life-style, should always be the first step, even before the very first onset of arterial hypertension. Whenever arterial hypertension has already occurred, ""amelioration"" of life-style should be applied in all patients since its potential in decreasing elevated arterial blood pressure has been unequivocally shown. The most important elements of life-style in its relation to arterial hypertension are obesity, smoking, stress, excessive salt intake, ethanol and caffeine, which can be found on the one hand as causes of elevated blood pressure, and on the other hand their reversal may be useful in the treatment of arterial hypertension.",caffeine;alcohol consumption;aorta dissection;dementia;heart failure;heart infarction;human;hypertension;kidney disease;lifestyle;obesity;peripheral occlusive artery disease;retinopathy;risk factor;salt intake;short survey;smoking;stress;cerebrovascular accident,"Stoschitzky, K.;Zweiker, R.",2002,,,0,
4285,Haemostasis in ischaemic stroke and vascular dementia,"Abnormalities of coagulation and fibrinolysis may play an important role in the pathogenesis of ischaemic stroke and vascular dementia. We aimed to determine whether haemostatic function is altered in acute recent-onset or chronic ischaemic cerebrovascular disease. We studied consecutive patients with ischaemic stroke (n = 74) and vascular dementia (n = 42) compared with healthy controls (n = 40) in a case-control study. The ischaemic stroke group was assessed twice, 3-10 days after the acute stroke and at 1-3 months. Fibrinogen, fibrin D-dimer (marker of fibrin turnover) and von Willebrand factor (vWF) (marker of endothelial disturbance) were elevated acutely (P < 0.0001) and in the convalescent phase after ischaemic stroke (P < 0.0001, P < 0.0001, and P < 0.01 respectively, compared with controls). Similar results were seen in the vascular dementia group. Stepwise multivariate regression analyses showed that cerebrovascular disease correlated independently with fibrinogen (P < 0.001) and fibrin D-dimer levels (P < 0.001), while vWF correlated independently with electrocardiograph evidence of ischaemic heart disease (P = 0.004). Changes between acute and convalescent phases in were slightly inconsistent. However, in the acute stage there were tendencies for fibrinogen, D-dimer and vWF to be increased, and factor VIII was significantly higher. Abnormalities of haemostasis, including increased fibrin turnover and endothelial disturbance, are found in both acute and chronic cerebral ischaemia. Many of these patients have co-existent ischaemic heart disease and this may contribute to some of these changes. Acute ischaemic stroke is associated with transient changes in haemostatic factors; however, most abnormalities persist into the convalescent phase, and are also demonstrable in subjects with vascular dementia. © 2001 Lippincott Williams & Wilkins.",blood clotting factor 8;D dimer;fibrinogen;von Willebrand factor;adult;aged;article;blood clotting;brain ischemia;cerebrovascular accident;controlled study;convalescence;female;fibrin metabolism;fibrinolysis;hemostasis;human;ischemic heart disease;major clinical study;male;multiinfarct dementia;priority journal,"Stott, D. J.;Spilg, E.;Campbell, A. M.;Rumley, A.;Mansoor, M. A.;Lowe, G. D. O.",2001,,,0,
4286,Appreciation - WO Williams OBE MD FRCGP,,acetylsalicylic acid;Alzheimer disease;asthma;Coxsackie virus infection;general practice;general practitioner;heart infarction;human;influenza;measles;medical research;note;postgraduate education;publication;university;workload;aspirin,"Stott, N. C. H.",2004,,,0,
4287,Blood conservation techniques: Where to begin,Blood conservation techniques are used to reduce the need for allogeneic blood transfusion. One of the most important blood conservation techniques is the optimization of blood counts prior to invasive procedures with anticipated blood loss. Infusion nurses need to understand the importance of treating patients who require the use of parenteral iron to attempt to optimize their blood counts before procedures. Infusion nurses provide a vital link to patient safety and treatment. This article will also discuss other methods of blood conservation frequently used to protect a scarce resource and reduce inappropriate transfusions. Copyright © 2013 Infusion Nurses Society.,cyanocobalamin;dexamethasone;diphenhydramine;erythropoietin;famotidine;ferric gluconate;ferumoxytol;folic acid;hemoglobin;iron;iron dextran;iron saccharate;lisinopril;novel erythropoiesis stimulating protein;recombinant erythropoietin;acquired immune deficiency syndrome;acute lung injury;adjuvant chemotherapy;anaphylaxis;anemia;aplastic anemia;article;bleeding;blood cell count;blood compatibility;blood conservation;blood donor;blood transfusion;body temperature;bone marrow suppression;celiac disease;Chagas disease;chronic inflammation;chronic kidney disease;colon cancer;colon polyp;colon ulcer;colonoscopy;colorectal carcinoma;cost benefit analysis;Creutzfeldt Jakob disease;diarrhea;drug dosage form comparison;drug hypersensitivity;endocrine disease;enteritis;erythrocyte disorder;erythropoiesis;folic acid blood level;gastrointestinal absorption;headache;hematocrit;hemoglobin blood level;hemolytic anemia;hemorrhoid;hepatitis C;human;Human immunodeficiency virus infection;hypertension;hypervolemia;hypotension;inflammation;injury;iron binding capacity;iron blood level;iron deficiency;iron deficiency anemia;iron intake;leukocyte count;lung hemosiderosis;malaria;mean corpuscular volume;medical history;menorrhagia;morbid obesity;myalgia;neoplasm;non insulin dependent diabetes mellitus;patient safety;phlebotomy;priority journal;rash;religion;risk assessment;risk factor;sickle cell anemia;sickle cell trait;stomach bypass;surgery;thalassemia;thrombocyte count;thrombocyte transfusion;thyroid disease;vitamin intake;weakness,"Stover, J. C.;Broomer, B. W.",2013,,,0,
4288,Cognitive impairment and infectious burden in the elderly,"Infectious agents have been suspected as contributing factors to dementia, especially in Alzheimer disease. We intended to test whether viral or bacterial seropositivity is associated with cognitive impairment among home-dwelling elderly. Viral burden (seropositivity for herpes simplex type 1 (HSVI), type 2 (HSV2), or cytomegalovirus (CMV), and bacterial burden (Chlamydia pneumoniae and Mycoplasma pneumoniae) were tested among 383 home-dwelling individuals with vascular disease (mainly coronary heart disease) in the ongoing DEBATE study (mean age 80 years). Mini-mental state examination (MMSE) and its changes were used to define cognitive impairment. At baseline, 0-1, 2, and 3 positive titers toward viruses were found in 48 (12.5 %), 229 (59.8 %), and 106 (27.7 %) individuals,respectively. MMSE points decreased with increasing viral burden (p = 0.03). At baseline,58 individuals (15.1 %) had cognitive impairment (MMSE < 24 points) which after adjustments was significantly associated with seropositivity for 3 viruses (risk ratio 2.5, 95%confidence interval 1.3 to 4.7). MMSE score decreased in 150 cases (43%) during 12-month follow-up. After adjustment for MMSE score at baseline and with 0-1 seropositivities as reference (1.0), the risk ratios were 1.8 (95 % confidence interval 0.9 to 3.6) and 2.3 (95% confidence interval 1.1 to 5.0) for 2 and 3 seropositivities, respectively. No significant associations were observed between bacterial burden and cognition. Viral burden of herpes virus and cytomegalovirus was associated with cognitive impairment in home-dwelling elderly. The association may offer a preventable cause of cognitive decline.","Alzheimer Disease [epidemiology];Bacterial Infections [epidemiology] [microbiology];Chlamydophila pneumoniae [isolation & purification];Cognition Disorders [diagnosis] [epidemiology] [prevention & control];Comorbidity;Cost of Illness;Herpesviridae Infections [epidemiology] [virology];Mycoplasma pneumoniae [isolation & purification];Neuropsychological Tests;Severity of Illness Index;Virus Diseases [epidemiology] [virology];Aged[checkword];Aged, 80 and over[checkword];Humans[checkword]","Strandberg, Te;Pitkala, Kh;Linnavuori, K;Tilvis, Rs",2004,,10.1016/j.archger.2004.04.053,0,4289
4289,Cognitive impairment and infectious burden in the elderly,"Infectious agents have been suspected as contributing factors to dementia, especially in Alzheimer disease. We intended to test whether viral or bacterial seropositivity is associated with cognitive impairment among home-dwelling elderly. Viral burden (seropositivity for herpes simplex type 1 (HSVI), type 2 (HSV2), or cytomegalovirus (CMV), and bacterial burden (Chlamydia pneumoniae and Mycoplasma pneumoniae) were tested among 383 home-dwelling individuals with vascular disease (mainly coronary heart disease) in the ongoing DEBATE study (mean age 80 years). Mini-mental state examination (MMSE) and its changes were used to define cognitive impairment. At baseline, 0-1, 2, and 3 positive titers toward viruses were found in 48 (12.5 %), 229 (59.8 %), and 106 (27.7 %) individuals,respectively. MMSE points decreased with increasing viral burden (p = 0.03). At baseline,58 individuals (15.1 %) had cognitive impairment (MMSE < 24 points) which after adjustments was significantly associated with seropositivity for 3 viruses (risk ratio 2.5, 95%confidence interval 1.3 to 4.7). MMSE score decreased in 150 cases (43%) during 12-month follow-up. After adjustment for MMSE score at baseline and with 0-1 seropositivities as reference (1.0), the risk ratios were 1.8 (95 % confidence interval 0.9 to 3.6) and 2.3 (95% confidence interval 1.1 to 5.0) for 2 and 3 seropositivities, respectively. No significant associations were observed between bacterial burden and cognition. Viral burden of herpes virus and cytomegalovirus was associated with cognitive impairment in home-dwelling elderly. The association may offer a preventable cause of cognitive decline.","Alzheimer Disease [epidemiology];Bacterial Infections [epidemiology] [microbiology];Chlamydophila pneumoniae [isolation & purification];Cognition Disorders [diagnosis] [epidemiology] [prevention & control];Comorbidity;Cost of Illness;Herpesviridae Infections [epidemiology] [virology];Mycoplasma pneumoniae [isolation & purification];Neuropsychological Tests;Severity of Illness Index;Virus Diseases [epidemiology] [virology];Aged[checkword];Aged, 80 and over[checkword];Humans[checkword]","Strandberg, T. E.;Pitkala, K. H.;Linnavuori, K.;Tilvis, R. S.",2004,,10.1016/j.archger.2004.04.053,0,
4290,Predictors of mortality in home-dwelling patients with cardiovascular disease aged 75 and older,"OBJECTIVES: To compare the predictive value of biomarkers commonly measured in older patients with cardiovascular disease (CVD) with an indicator of cognitive function. DESIGN: Prospective cohort study. SETTING: Helsinki, Finland. PARTICIPANTS: Three hundred ninety-eight home-dwelling older persons (261 women, mean age 80) with stable CVD and without a diagnosis of clinical dementia. MEASUREMENTS: Simple laboratory and clinical measurements (including the Mini Mental State Examination (MMSE, maximum score 30 points) and New York Heart Association (NYHA) classification) were used to predict mortality. A MMSE score between 18 and 24 points was considered to indicate cognitive impairment. RESULTS: At baseline, median MMSE score was 27 (interquartile range 25-28), with 59 individuals having a score below 24 points. During a mean follow-up of 6.0 years, 129 participants died. In the fully adjusted Cox proportional hazards model, low MMSE score was the strongest predictor of mortality, with a relative hazard of 2.38 (95% confidence interval=1.52-3.74; P<.001). Of the various clinical and laboratory variables, only creatinine, C-reactive protein, and history of congestive heart failure were significant independent predictors, whereas conventional risk factors were not. CONCLUSION: Only a few clinical variables independently predicted 6-year mortality in older home-living patients with CVD. The strongest predictor was impaired cognitive function assessed using MMSE.",Aged;Cardiovascular Diseases/*mortality;Cognition Disorders/*complications;Female;Humans;Male;Mental Status Schedule,"Strandberg, T. E.;Pitkala, K. H.;Tilvis, R. S.",2009,Feb,10.1111/j.1532-5415.2008.02112.x,0,
4291,Neurology 2007,,acetylsalicylic acid;anticoagulant agent;clopidogrel;folic acid;homocysteine;irbesartan;rituximab;rivastigmine;vitamin;vitamin B group;anticoagulation;brain depth stimulation;cardiovascular disease;carotid artery obstruction;coronary stent;dementia;diffuse Lewy body disease;genetic polymorphism;atrial fibrillation;heart infarction;heart right left shunt;high risk patient;human;migraine;multiple sclerosis;myelooptic neuropathy;neuromodulation;note;Parkinson disease;secondary prevention;transient ischemic attack;vitamin supplementation,"Straube, A.",2007,,,0,
4292,Psychotropic medication use in older adults,,amfebutamone;amitriptyline;chlorpromazine;citalopram;clomipramine;desipramine;desvenlafaxine;doxepin;duloxetine;enflurane;escitalopram;fluoxetine;fluphenazine;fluvoxamine;haloperidol;imipramine;mirtazapine;monoamine oxidase inhibitor;neuroleptic agent;nortriptyline;paroxetine;pethidine;phenelzine;psychotropic agent;serotonin uptake inhibitor;sertraline;thioridazine;tricyclic antidepressant agent;unindexed drug;venlafaxine;Alzheimer disease;anxiety disorder;article;bipolar disorder;constipation;depression;diarrhea;diffuse Lewy body disease;dizziness;dry eye;electroconvulsive therapy;gastrointestinal symptom;geriatric anesthesia;gerontopsychiatry;headache;heart arrhythmia;heart ventricle fibrillation;human;malaise;mental disease;multiinfarct dementia;nausea;orthostatic hypotension;perioperative period;priority journal;psychosis;seizure;sleep disorder;sudden cardiac death;suicide;transcranial magnetic stimulation;urine retention;xerostomia;celexa;cymbalta;effexor;haldol;luvox;mellaril;paxil;prestiq;prolixin;prozac;remeron;risperdal;thorazine;wellbutrin;zoloft,"Strauss, J.",2014,,,0,
4293,Polypharmacy and excessive polypharmacy in octogenarians and older acutely hospitalized patients,"AIM: The aim of this study was to assess the occurrence of polypharmacy and excessive polypharmacy in very old hospitalized patients based on their comorbidities. METHODS: The documentation of patients aged 80 years or older admitted to our department in the year 2010 was analyzed. Based on the Charlson index of comorbidity, a multiple logistic regression model with stepwise backward elimination was performed. Patients were stratified by gender and four age-groups, and factors of a change in the number of medications during the hospital stay were assessed. RESULTS: Chronic pulmonary disease [odds ratio (OR): 2.40], diabetes mellitus with (OR: 4.65) or without (OR: 1.65) microvascular complications, congestive heart failure (OR: 2.37), connective tissue disease (OR: 3.02), and peripheral vascular disease (OR: 2.30) were statistically significantly associated with polypharmacy, while some of these diseases were also associated with excessive polypharmacy. The number of medications showed a gradual decrease with age, which was concordant with a decrease in total Charlson index score. ""Admission for myocardial infarction"" was associated with an increase in pharmaceuticals during hospital stay, whereas a known diagnosis of dementia or metastatic malignant disease was protective against a further increase in medications. CONCLUSIONS: Several medical conditions seem to predispose to polypharmacy in very old patients. To attain old age seems to be associated with few comorbidities, which reduces the need for a high number of pharmaceuticals. Physicians should pay attention to the identified predictors in very old patients, as polypharmacy may lead to adverse events and unnecessary hospitalization.","Acute Disease;Age Distribution;Aged, 80 and over;Austria/epidemiology;Cardiovascular Diseases/*drug therapy/epidemiology;Chronic Disease;Comorbidity;Diabetes Mellitus/*drug therapy/epidemiology;Drug Prescriptions/*statistics & numerical data;Drug Utilization Review;Female;Humans;Inappropriate Prescribing/*statistics & numerical data;Incidence;Length of Stay/*statistics & numerical data;Lung Diseases/*drug therapy/epidemiology;Male;*Polypharmacy;Risk Factors;Sex Distribution","Strehblow, C.;Smeikal, M.;Fasching, P.",2014,Apr,10.1007/s00508-013-0485-1,0,
4294,Presence of severe neuroinflammation does not intensify neurofibrillary degeneration in human brain,"This study investigated the allegedly causal relationship between microglial activation and neurofibrillary degeneration (NFD) typical of Alzheimer's disease (AD) by determining if presence of extreme microglial activation coincides with intensified NFD. We performed comparative histopathological analyses of NFD and microglial reactivity in 18 primary subjects ranging from 4 to 51 years of age. Ten of these subjects (median age 34) died from infectious disease (HIV, sepsis) and CNS trauma, while eight subjects (median age 32.5) died from non-infectious conditions (controls). Second, we also examined two 52-year-old subjects with Down syndrome where one had comorbid sepsis and the other one did not. We found that all 10 subjects with infectious/traumatic diagnoses showed severe neuroinflammation, while the 8 control subjects completely lacked neuroinflammatory changes. However, all 18 primary subjects were found to show the same early-stage, pretangle neuropathology of Braak stage 1a and 1b, that is, they exhibited primarily subcortical NFD in the locus coeruleus and sporadic lesions in the transentorhinal cortex. Similarly, the two subjects with Down syndrome showed the same high levels of NFD (Braak stage VI) irrespective of the comorbid sepsis-related neuroinflammation present in one of these individuals. Collectively, our findings show that despite rampant microglial activation in all subjects with neuroinflammatory conditions the extent of NFD is at the same level as seen in non-inflamed controls. These findings demonstrate that microglial activation does not initiate or exacerbate NFD, and we conclude that CNS inflammation is unlikely to be causally involved in the development of NFD characteristic of AD dementia. © 2013 Wiley Periodicals, Inc.",acquired immune deficiency syndrome;adult;aorta valve disease;article;asthmatic state;cell activation;central nervous system disease;central nervous system tumor;child;clinical article;coma;controlled study;cytomegalovirus infection;disease association;Down syndrome;entorhinal cortex;female;heart arrest;histopathology;human;Human immunodeficiency virus infection;human tissue;infection;Kaposi sarcoma;locus ceruleus;male;malignant neoplastic disease;microglial activation;nerve degeneration;nervous system inflammation;neurofibrillary degeneration;neuropathology;peptic ulcer;preschool child;priority journal;school child;sepsis;soft tissue sarcoma;subcortex;toxoplasmosis;traumatic brain injury,"Streit, W. J.;Xue, Q. S.;Braak, H.;del Tredici, K.",2014,,,0,
4295,Mortality after distal femur fractures in elderly patients,"Background: Hip fractures in the elderly are associated with high 1-year mortality rates, but whether patients with other lower extremity fractures are exposed to a similar mortality risk is not clear. Questions/purposes: We evaluated the mortality of elderly patients after distal femur fractures; determined predictors for mortality; analyzed the effect of surgical delay; and compared survivorship of elderly patients with distal femur fractures with subjects in a matched hip fracture group. Patients and Methods: We included 92 consecutive patients older than 60 years with low-energy supracondylar femur fractures treated between 1999 and 2009. Patient, fracture, and treatment characteristics were extracted from operative records, charts, and radiographs. Data regarding mortality were obtained from the Social Security Death Index. Results: Age-adjusted Charlson Comorbidity Index and a previous TKA were independent predictors for decreased survival. Congestive heart failure, dementia, renal disease, and history of malignant tumor led to shorter survival times. Patients who underwent surgery more than 4 days versus 48 hours after admission had greater 6-month and 1-year mortality risks. No differences in mortality were found comparing patients with native distal femur fractures with patients in a hip fracture control group. Conclusions: Periprosthetic fractures and fractures in patients with dementia, heart failure, advanced renal disease, and metastasis lead to reduced survival. The ageadjusted Charlson Comorbidity Index may serve as a useful tool to predict survival after distal femur fractures. Surgical delay greater than 4 days increases the 6-month and 1-year mortality risks. Mortality after native fractures of the distal femur in the geriatric population is high and similar to mortality after hip fractures. Level of Evidence: Level II, prognostic study. See the guidelines online for a complete description of evidence. © The Association of Bone and Joint Surgeons1® 2010.",adult;age adjusted Charlson Comorbidity Index;aged;article;clinical assessment tool;congestive heart failure;controlled study;dementia;female;femur fracture;foot radiography;geriatric patient;hip fracture;human;kidney disease;major clinical study;male;malignant neoplastic disease;medical record review;metastasis;mortality;periprosthetic fracture;priority journal;survival time;survivor;therapy delay,"Streubel, P. N.;Ricci, W. M.;Wong, A.;Gardner, M. J.",2011,,,0,
4296,Vascular dementia,"Many cases of age-related cognitive dementia are caused by cerebrovascular lesions, and various vascular syndromes can lead to cognitive impairment and dementia. Repeated cortical infarcts due to embolic disease of the heart or major cerebral vessels can cause progressive deterioration towards dementia and incapacitation. In classic multi-infarct dementia, cognitive deterioration is stepwise rather than smoothly progressive. While diagnostic technologies have vastly improved and added to general knowledge of the pathology of cerebrovascular disease, MRI, PET, and transcranial Doppler scans have demonstrated that significant white matter change is possible without clinically recognized TIA or completed stroke. In addition, patients may have initial complaints that are not serious enough to produce changes on mental status examination. Many patients have mixed dementia, exhibiting aspects of both degenerative brain disease and clinical evidence of strokes or significant changes on MRI scan. The overlap between vascular and degenerative disease is significant, yet the exact interaction of the pathophysiology of the vascular lesions and the degenerative changes is not known. The treatment of vascular or mixed dementia involves control of the risk factors for continued vascular events and treatment with the cholinesterase inhibitors.",,"Strub, R. L.",2003,Winter,,0,
4297,Advanced cancer and comorbid conditions: Prognosis and treatment,"Background: Nonmalignant comorbid medical conditions, such as heart failure and emphysema, may complicate cancer treatment. Methods: Guidelines from the National Hospice Organization for cancer and selected nonmalignant diseases are outlined, and treatment principles for end-stage heart failure and emphysema are reviewed. Results: Estimates by clinicians of survivability in advanced cancer and nonmalignant disease are important in order to allow patients and family members to begin realistic advance planning. As disease progresses through its end stages to death, optimal management may include both disease-modifying and symptom-relieving interventions. Conclusions: A well-managed end of life is an important therapeutic option in informed consent discussions with seriously ill patients and their families.",bronchodilating agent;carvedilol;digoxin;dipeptidyl carboxypeptidase inhibitor;furosemide;ipratropium bromide;prednisone;theophylline;Alzheimer disease;article;cancer palliative therapy;cancer survival;cancer therapy;chronic obstructive lung disease;comorbidity;disease course;emphysema;heart failure;human;informed consent;practice guideline;prognosis;treatment planning,"Stuart, B.",1999,,,0,
4298,Ischemic infarct involving all arterial territories of the thalamus,Ischemic infarcts of the thalamus involve one or two of its four arterial territories that are usually supplied by the posterior cerebral (PCA) and the posterior communicating (PCoA) arteries. We report a patient who suffered ischemic infarcts in all arterial territories of the right thalamus. Magnetic resonance (MR) angiography showed an occlusion of the right PCA and failed to visualize a PCoA. We assume that the absence of a relevant thalamic blood supply deriving from the PCoA enabled PCA occlusion to cause infarcts in all thalamic territories.,acetylsalicylic acid;cholesterol;high density lipoprotein cholesterol;adult;anxiety;aorta;apathy;artery occlusion;article;ataxia;atherosclerotic plaque;blood analysis;brain artery;brain blood flow;brain infarction;brain ischemia;brain region;case report;cerebral artery disease;cholesterol blood level;smoking;cognitive defect;depression;diet;Doppler echography;electrocardiogram;error;heart left ventricle hypertrophy;Holter monitoring;homonymous hemianopia;human;hypesthesia;hypoalgesia;learning;lipid analysis;magnetic resonance angiography;male;medial geniculate body;neurologic examination;nuclear magnetic resonance imaging;paresthesia;perimetry;posterior cerebral artery;pulvinar;recall;right hemisphere;cerebrovascular accident;thalamus;thalamus dorsomedial nucleus;thinking;thorax radiography;transesophageal echocardiography;transthoracic echocardiography;verbal behavior;vision;aspirin,"Studer, A.;Georgiadis, D.;Baumgartner, R. W.",2003,,,0,
4299,Treatment of symptoms of the menopause: An endocrine society clinical practice guideline,"Objective: The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause. Participants: The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society. Evidence: The Task Force developed this evidenced-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews of published data and considered several other existing meta-analyses and trials. Consensus Process: Multiple e-mail communications, conference calls, and one face-to-face meeting determined consensus. Committees of The Endocrine Society, representatives from endorsing societies, and members of The Endocrine Society reviewed and commented on the drafts of the guidelines. The Australasian Menopause Society, the British Menopause Society, European Menopause and Andropause Society, the European Society of Endocrinology, and the International Menopause Society (co-sponsors of the guideline) reviewed and commented on the draft. Conclusions: Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause. Health care professionals should individualize therapy based on clinical factors and patient preference. They should screenwomenbefore initiatingMHTfor cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use ofMHTto prevent coronary heart disease, breast cancer, or dementia. Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have contraindications because these patients should not useMHT.Low-dose vaginal estrogen and ospemifene provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and lubricants are available for those not choosing hormonal therapy. All postmenopausal women should embrace appropriate lifestyle measures.",bazedoxifene plus conjugated estrogen;chlormadinone acetate;clonidine;conjugated estrogen plus medroxyprogesterone acetate;drospirenone plus estradiol;dydrogesterone;dydrogesterone plus estradiol;estradiol;estradiol acetate;estradiol plus levonorgestrel;estradiol plus norethisterone acetate;estradiol valerate;estrogen;follitropin;gabapentin;gestagen;levonorgestrel;medrogestone;medroxyprogesterone acetate;megestrol acetate;nomegestrol acetate;ospemifene;placebo;pregabalin;progesterone;promegestone;serotonin noradrenalin reuptake inhibitor;serotonin uptake inhibitor;tibolone;unindexed drug;anxiety disorder;arthralgia;article;bedtime dosage;breast cancer;cardiovascular disease;cardiovascular risk;cerebrovascular accident;colorectal cancer;dementia;depression;drug dose escalation;drug safety;dyspareunia;dysuria;endometrium cancer;estrogen therapy;evidence based practice;fracture;gallbladder disease;hormonal therapy;hot flush;human;ischemic heart disease;low drug dose;lung cancer;menopausal syndrome;metabolic syndrome X;mortality;non insulin dependent diabetes mellitus;ovary cancer;overactive bladder;patient preference;personalized medicine;postmenopause;practice guideline;priority journal;quality of life;risk assessment;sleep disorder;urge incontinence;urinary tract infection;urine incontinence;vagina atrophy;vaginal dryness;vasomotor disorder;venous thromboembolism,"Stuenkel, C. A.;Davis, S. R.;Gompel, A.;Lumsden, M. A.;Murad, M. H.;Pinkerton, J. A. V.;Santen, R. J.",2015,,,0,
4300,Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty,"BACKGROUND AND OBJECTIVES: The influence of the type of anesthesia on perioperative outcomes after bilateral total knee arthroplasty (BTKA) remains unknown. Therefore, we examined a large sample of BTKA recipients, hypothesizing that neuraxial anesthesia would favorably impact on outcomes. METHODS: We identified patient entries indicating elective BTKA between 2006 and 2010 in a national database; subgrouped them by type of anesthesia: general (G), neuraxial (N), or combined neuraxial-general (NG); and analyzed differences in demographics and perioperative outcomes. RESULTS: Of 15,687 identified procedures, 6.8% (n = 1066) were performed under N, 80.1% (n = 12,567) under G, and 13.1% (n = 2054) under NG. Comparing N to G and NG, patients in group N were, on average, younger (63.9, 64.6, and 64.8 years; P = 0.030) but did not differ in overall comorbidity burden. Patients in group N required blood product transfusions significantly less frequently (28.5%, 44.7%, 38.0%; P < 0.0001). In-hospital mortality, 30-day mortality, and complication rates tended to be lower in group N, without reaching statistical significance. After adjusting for covariates, N and NG were associated with 16.0% and 6.0% reduction in major complications compared with G, but only the reduced odds for the requirement of blood transfusions associated with N reached statistical significance (N vs G: odds ratio, 0.52 [95% CI, 0.45-0.61], P < 0.0001; NG vs G: odds ratio, 0.77 [95% CI, 0.69-0.86], P < 0.0001). CONCLUSIONS: Neuraxial anesthesia for BTKA is associated with significantly lower rates of blood transfusions and, by trend, decreased morbidity. Although by itself the effect may be limited, N might be used within a multimodal approach to reduce complications after BTKA. © 2012 American Society of Regional Anesthesia and Pain Medicine.",acute heart infarction;acute kidney failure;adult;aged;article;artificial ventilation;blood transfusion;cerebrovascular disease;chronic obstructive lung disease;comparative study;dementia;diabetes mellitus;female;gastrointestinal disease;general anesthesia;heart disease;heart infarction;human;infection;lung disease;lung embolism;major clinical study;male;mortality;neoplasm;neuraxial anesthesia;outcome assessment;perioperative period;peripheral vascular disease;pneumonia;priority journal;regional anesthesia;total knee replacement;wound infection,"Stundner, O.;Chiu, Y. L.;Sun, X.;Mazumdar, M.;Fleischut, P.;Poultsides, L.;Gerner, P.;Fritsch, G.;Memtsoudis, S. G.",2012,,,0,
4301,Caring for people with chronic disease: Is 'muddling through' the best way to handle the multiple complexities?,"It is stated everywhere that chronic care poses one of the biggest challenges for the future of medicine. Critical analysis however suggests that these statements are oversimplistic and based on limited, and at times, spurious assumptions. This paper highlights some basic realities: epidemiology shows that at any time, 80% of people experience 'good enough health', and that only 0.8% require tertiary medical care; most people with chronic conditions experience a stable illness trajectory; 'true' multi-morbidity is a pattern of advanced age; ageing and the physiological decline of our organ systems is a slow and steady process starting at the age of 30; and, as our health declines in a variety of patterns with disease and ageing, our psycho-socio-semiotic care needs increase dramatically. I argue that managing the complexities associated with chronic disease care successfully requires an equally complex management approach, 'muddling through', defined by Lindblom as making decisions based on successive limited comparisons. Our patients - rightly - expect that we make these decisions in their best interest. Individual health care professionals and health care policy makers firmly need to put the patient at the centre of the health care system. © 2012 Blackwell Publishing Ltd.",aging;anxiety;article;asthma;bipolar disorder;cerebrovascular accident;chronic disease;chronic obstructive lung disease;dementia;depression;diabetes mellitus;epilepsy;health care policy;health care system;atrial fibrillation;heart failure;human;hypertension;ischemic heart disease;medical decision making;neoplasm;patient care;politics;priority journal;schizophrenia;symptom;tertiary health care;transient ischemic attack,"Sturmberg, J. P.",2012,,,0,
4302,Hormone replacement therapy,"The potential absolute risks for the use of hormone therapy (HT) are rare meaning that less than or equal to 10 events per 10000 users per year occur; except for stroke. Especially for women younger than age 50 or those at low risk of CHD, stroke, osteoporosis, or breast cancer the absolute risk or benefit from HT is likely to be neglectable. Studies so far have suggested a different benefit-risk-ratio for each type of estrogen and progestogen, route of administration, and timing of therapy. However, this hypothesis still needs to be proven by further research.",antidepressant agent;estradiol;estrogen;gestagen;medroxyprogesterone;progesterone;Alzheimer disease;article;body mass;breast cancer;breast carcinoma;cerebrovascular accident;cognition;cost benefit analysis;depression;estrogen therapy;hormone substitution;human;ischemic heart disease;menopausal syndrome;menopause;non insulin dependent diabetes mellitus;osteoporosis;risk benefit analysis;vein thrombosis,"Stute, P.;Kiesel, L.",2009,,,0,
4303,Risk factors for depressive symptoms in glaucoma patients: a nationwide case-control study,"Purpose: The purpose was to investigate the risk factors for depressive symptoms in glaucoma patients. Methods: From the Longitudinal Health Insurance Database in Taiwan, we included 1190 glaucoma patients with subsequent depression diagnoses in the case group and randomly selected 4673 glaucoma patients without depression diagnoses as the control group, matched by age, sex, and time of glaucoma diagnosis. The age-adjusted Charlson comorbidity index (ACCI) score was used to compute the burden of comorbidity for each patient. Current use (past 6 months) of topical antiglaucoma medications and systemic medications was identified. Multivariate regression was used to analyze the risk factors for depression. Results: The mean age for glaucoma patients was 61.88 years. Patients with depressive symptoms had significantly higher ACCI scores (P <.0001). The current use of any topical antiglaucoma medications was not associated with an increased risk for depression. However, higher ACCI scores (P <.0001), cerebrovascular diseases (odds ratio [OR] = 1.324, 95 % confidence interval [CI] = 1.118--1.568), dementia (OR = 2.647, 95 % CI = 2.142–3.270), thyroid diseases (OR = 1.720, 95 % CI = 1.366–2.165), headaches (OR = 1.299, 95 % CI = 1.112–1.518), and current use of systemic β-blockers (OR = 1.782, 95 % CI = 1.538–2.065) and calcium channel blockers (OR = 1.396, 95 % CI, 1.197–1.629) were found to increase the risk of depression in glaucoma patients. Conclusions: In this study, a comorbidity burden was a significant risk factor for depression in glaucoma patients, particularly for those currently using systemic β-blockers and calcium channel blockers.",adrenergic receptor stimulating agent;antiglaucoma agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;carbonate dehydratase inhibitor;cholinergic receptor stimulating agent;prostaglandin derivative;adult;age adjusted charlson comorbidity index;article;cerebrovascular disease;Charlson Comorbidity Index;chronic kidney disease;chronic obstructive lung disease;comorbidity;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;drug use;female;glaucoma;headache;human;hypertension;major clinical study;male;middle aged;peripheral vascular disease;population based case control study;priority journal;risk factor;systemic therapy;thyroid disease;topical treatment,"Su, C. C.;Chen, J. Y. C.;Wang, T. H.;Huang, J. Y.;Yang, C. M.;Wang, I. J.",2015,,,0,
4304,Age-related hearing loss and dementia: a 10-year national population-based study,"Age-related hearing loss (ARHL) is postulated to affect dementia. Our study aims to investigate the relationship between ARHL and the prevalence, and 10-year incidence of dementia in the Taiwan National Health Insurance Research Database (NHIRD). We selected patients diagnosed with ARHL from the NHIRD. A comparison cohort comprising of patients without ARHL was frequency-matched by age, sex, and co-morbidities, and the occurrence of dementia was evaluated in both cohorts. The ARHL cohort consisted of 4108 patients with ARHL and the control cohort consisted of 4013 frequency-matched patients without ARHL. The incidence of dementia [hazard ratio (HR), 1.30; 95% confidence interval (CI 1.14-1.49); P = 0.002] was higher among ARHL patients. Cox models showed that being female (HR, 1.34; 95% CI 1.07-1.68), as well as having co-morbidities, including chronic liver disease and cirrhosis, rheumatoid arthritis, hypertension, diabetes mellitus, stroke, head injury, chronic kidney disease, coronary artery disease, alcohol abuse/dependence, and tobacco abuse/dependence (HR, 1.27; 95% CI 1.11-1.45), were independent risk factors for dementia in ARHL patients. We found ARHL may be one of the early characteristics of dementia, and patients with hearing loss were at a higher risk of subsequent dementia. Clinicians should be more sensitive to dementia symptoms within the first 2 years following ARHL diagnosis. Further clinical studies of the relationship between dementia and ARHL may be necessary.",Aged;Cohort Studies;Comorbidity;Dementia/diagnosis/epidemiology;Diabetes Mellitus/epidemiology;Female;Humans;Hypertension/epidemiology;Incidence;Male;Middle Aged;Presbycusis/diagnosis/epidemiology;Prevalence;Proportional Hazards Models;Risk Factors;Taiwan/epidemiology;Age-related hearing loss;Dementia;Nhird;Presbycusis;Sensory hearing loss,"Su, P.;Hsu, C. C.;Lin, H. C.;Huang, W. S.;Yang, T. L.;Hsu, W. T.;Lin, C. L.;Hsu, C. Y.;Chang, K. H.;Hsu, Y. C.",2017,May,,0,
4305,Effects of Shenmai Injection on blood SOD activity and MDA level in senile patients in coronary heart disease,"In order to approach the effects of Shenmai Injection on SOD activity and MDA level in the senile patients with coronary heart disease, 48 cases, who had stenosis of over 70% in more than one branches of the coronary arteries, were assigned randomly into a treatment group (given Shenmai Injection plus the routine treatment) and a control group (given the routine treatment only). The superoxide dismutase (SOD) activity and malondialdehyde (MDA) level were determined before treatment and at the end of a 3-week treatment. The results showed that in the treatment group, the SOD activity was significantly increased (P<0.05) and the MDA level markedly decreased (P<0.01) in the treatment group. It can be concluded that Shenmai Injection may enhance the antioxidant ability of the senile patients with coronary heart disease.",antioxidant;beta adrenergic receptor blocking agent;calcium;glyceryl trinitrate;malonaldehyde;shenmai;superoxide dismutase;unclassified drug;adult;aged;antioxidant activity;article;Chinese medicine;clinical article;clinical trial;controlled clinical trial;controlled study;coronary artery obstruction;drug mechanism;enzyme activity;female;human;ischemic heart disease;male;randomized controlled trial;senility;treatment outcome,"Su, X.;Ma, Y.;Huang, R.;Wang, X.;Wang, Y.",2005,,,0,
4306,Frequency of apolipoprotein E in a Nahua population,"The presence of different ethnic groups in Mexico may give rise to genetic diversity between the native Indian population and the Mestizos. It is therefore of medical and anthropological interest to analyze the genotypes of disease-associated loci, such as polymorphism in the apolipoprotein E gene, whose 4/4 allele increases the risk of Alzheimer's disease and coronary heart disease in other populations. We studied a Nahua Indian-population in the State of Morelos (Santo Domingo Ocotitlan). The ABO blood type of all individuals was determined and compared with the findings of other Nahua group from the State of Puebla. Without statistical significant differences in O, A and AB groups between both populations (p > 0.5). The allelic and genotypic frequency of apolipoprotein E was similar to that observed in other Mexican indian (Mazatecans, Mayans) and Mestizo populations, however there was a statistically significant difference when the results were compared to the allelic frequencies of other Amerinds: The Cayapa (Ecuador) for the ε3 and ε4 alleles (p < 0.002); the Nuuk (Greenland) for ε3 and ε4 alleles (p < 0.0001 and p < 0.002 respectively); and the Ammssalik (Greenland) for both alleles with p < 0.0001 and p = 0.04 respectively. In the case of the genotypes, there was statistically significant difference for the 4/3 genotypes, but a non significant difference for the 4/4 genotype. This is a descriptive study which contributes to the knowledge of the genetic structure of Mexican population.",apolipoprotein E;allele;Alzheimer disease;article;blood group A;blood group AB;blood group ABO system;blood group O;controlled study;Ecuador;ethnic group;gene frequency;gene locus;gene structure;genetic polymorphism;genetic risk;genetic variability;genotype;Greenland;human;Indian;ischemic heart disease;Mexico;population genetics;statistical significance,"Suástegui Román, R. A.;Gómez, P. Y.;Guerrero Camacho, J. L.;Ochoa Morales, A.;Granados, J.;Prado, A. J.;López-Caro, O. A.;Villetela, M. E. A.",2002,,,0,
4307,Sodium thiosulfate protects brain in rat model of adenine induced vascular calcification,"Vascular bed calcification is a common feature of ends stage renal disease that may lead to a complication in cardiovascular and cerebrovascular beds, which is a promoting cause of myocardial infarction, stroke, dementia and aneurysms. Sodium thiosulfate (STS) due to its multiple properties such as antioxidant and calcium chelation has been reported to prevent vascular calcification in uremic rats, without mentioning its impact on cerebral function. Moreover, the previous studies have not explored the effect of STS on the mitochondrial dysfunction, one of the main pathophysiological features associated with the disease and the main site for STS metabolism. The present study addresses this limitation by using a rat model where 0.75% adenine was administered to induce vascular calcification and 400 mg/kg b wt. of STS was given as preventive and curative agent. The blood and urine chemistries along with histopathology of aorta confirms the renal protective effect of STS in two modes of administration. The brain oxidative stress assessment was made through TBARS level, catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities, found to be in the near normal level. STS administration not only reduced the mitochondrial oxidative stress (measured by TBARS, SOD, GPx and CAT) but also preserved the mitochondrial respiratory enzyme activities (NADH dehydrogenase, Succinate dehydrogenase and Malate dehydrogenase) and its physiology (measured by P/O ratio and RCR). In fact, the protective effect of STS was prominent, when it was administered as a curative agent, where low H2S and high thiosulfate level was observed along with low cystathionine beta synthase activity, confirms thiosulfate mediated renal protection. In conclusion, STS when given after induction of calcification is protective to the brain by preserving its mitochondria, compared to the treatment given concomitantly.","Adenine/*metabolism;Animals;Antioxidants/pharmacology;Brain/*drug effects/*metabolism;Catalase/metabolism;Disease Models, Animal;Glutathione Peroxidase/metabolism;Kidney/drug effects/physiology;Male;Oxidation-Reduction/drug effects;Oxidative Stress/*drug effects;Rats, Wistar;Thiosulfates/*pharmacology;Vascular Calcification/chemically induced/*drug therapy;Cystathionine beta synthase;Hydrogen sulfide;Mitochondria;Rhodanese;Sodium thiosulfate;Vascular calcification","Subhash, N.;Sriram, R.;Kurian, G. A.",2015,Nov,10.1016/j.neuint.2015.09.004,0,
4308,Low serum n-3 polyunsaturated fatty acid/n-6 polyunsaturated fatty acid ratio predicts neurological deterioration in Japanese patients with acute ischemic stroke,"Background: Epidemiological and clinical trials have shown that n-3 polyunsaturated fatty acids (PUFAs) reduce the incidence of coronary heart disease or stroke. However, the association between PUFAs and acute-phase stroke has not yet been thoroughly studied. We investigated the impact of serum PUFAs on early neurological deterioration (END) in patients with acute ischemic stroke. Methods: In this retrospective study, we enrolled 281 Japanese patients (mean age: 75 ± 13 years; 165 males) with acute ischemic stroke diagnosed within 24 h of onset. General blood examinations, including PUFAs (n-3 PUFAs: eicosapentaenoic acid, EPA, and docosahexaenoic acid, DHA, and n-6 PUFAs: arachidonic acid, AA), were performed on admission. Other risk factors and comorbidities were also examined. END was defined as a ≥2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within a 72-hour period. Statistical significance between the END and non-END group was assessed using Wilcoxon rank sum tests or Student's t tests for categorical variables. Multiple logistic regression analyses were performed to identify predictors of END. Results: END was observed in 75 patients (26.7%). Diabetes mellitus (p = 0.003), high-sensitivity C-reactive protein (hs-CRP) level (p < 0.001), prior stroke (p = 0.035), ischemic heart disease (p = 0.029), EPA/AA ratio (p = 0.003), DHA/AA ratio (p = 0.002), EPA+DHA/AA ratio (p = 0.002), diagnosis of small vessel disease (p = 0.004) and admission NIHSS score (p < 0.001) were significantly associated with END. We used separate multiple logistic regression analyses for the EPA/AA, DHA/AA and EPA+DHA/AA ratios, because EPA and DHA are considered covariant factors (r = 0.544; p < 0.0001). Multiple logistic regression analyses showed that END was positively associated with diabetes mellitus, hs-CRP level and NIHSS score on admission, and negatively associated with the EPA/AA ratio (odds ratio, OR: 0.18; 95% confidence interval, CI: 0.05-0.58; p = 0.003), DHA/AA ratio (OR: 0.045; 95% CI: 0.006-0.30; p = 0.001), EPA+DHA/AA ratio (OR: 0.45; 95% CI: 0.26-0.74; p = 0.002) and diagnosis of small vessel disease. Conclusions: Our data suggest that a low serum n-3 PUFA/n-6 PUFA ratio on admission may predict neurological deterioration in Japanese patients with acute ischemic stroke. Large-scale prospective studies are further required to clarify the role of PUFAs in the acute phase of ischemic stroke.",arachidonic acid;C reactive protein;docosahexaenoic acid;icosapentaenoic acid;aged;article;brain ischemia;brain region;capillary gas chromatography;computer assisted tomography;diabetes mellitus;diffusion weighted imaging;fatty acid blood level;female;human;ischemic heart disease;Japanese (people);major clinical study;male;mental deterioration;National Institutes of Health Stroke Scale;neuroimaging;nuclear magnetic resonance imaging;prediction;priority journal;retrospective study,"Suda, S.;Katsumata, T.;Okubo, S.;Kanamaru, T.;Suzuki, K.;Watanabe, Y.;Katsura, K. I.;Katayama, Y.",2013,,,0,
4309,Validation of the Readmission Risk Score in Heart Failure Patients at a Tertiary Hospital,"Background The Readmission Risk score (RR score) is a software application developed to identify patients at increased risk for readmission. This score was developed to improve on the methodology for 30-day risk-standardized all-cause readmission rates (RSRRs) used by the Centers for Medicare and Medicaid Services for its quality reporting system. However, the utility of the RR score in clinical practice has not been independently validated. Methods and Results We included patients admitted with the primary discharge diagnosis of congestive heart failure (CHF) from September 2011 to August 2013. Data on individual components of the RR score were obtained by means of detailed chart review. We calculated the RR score of all admissions and examined its ability to predict 30-day all-cause readmission. We repeated the analysis by randomly selecting 1 admission per patient and also by including only those ≥65 years old. A total of 1,046 admissions met the inclusion criteria. Of these, 369 (35.28%) were readmitted within 30 days of discharge. The performance of the RR score was poor, with an area under the receiver operating characteristic curve (AUC) of 0.61 (95% confidence interval [CI] 0.57-0.64) for all age groups and 0.59 (95% CI 0.53-0.64) for patients aged ≥65 years. The AUC for the RR score was 0.58 (95% CI 0.50-0.65) in a randomly selected patient-level model. However, patients in the highest quartile of RR score were twice as likely to be readmitted as those in the lowest quartile (47.24% vs 24.69%; P <.001). The sensitivity and specificity of the RR score in predicting all cause readmissions were poor. Conclusion Based on our single-institution data, patients with CHF readmitted within 30 days had a higher RR score than those not readmitted. The ability of the RR score to predict future all-cause readmission was modest at best.",glucose;aged;aorta stenosis;article;cardiovascular risk;cerebrovascular accident;chronic obstructive lung disease;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;female;glucose blood level;groups by age;heart failure;heart left ventricle ejection fraction;hospital readmission;human;major clinical study;male;medical record review;prediction;predictive value;priority journal;quality control;sensitivity and specificity;systolic blood pressure;teaching hospital;tertiary care center;validation study,"Sudhakar, S.;Zhang, W.;Kuo, Y. F.;Alghrouz, M.;Barbajelata, A.;Sharma, G.",2015,,,0,
4310,Pulsatile cardiopulmonary bypass failed to prevent neuropsychological dysfunction,"To prevent neurological complications during cardiopulmonary bypass, cerebrovascular screenings by magnetic resonance angiography and computed tomographic scan of the brain were performed preoperatively in patients who had ischemic heart disease and all patients aged 60 years or older. From 1996 to 1999, 173 adult patients (mean age 65.1+/-7.7 y) were evaluated. Forty-one patients were considered to be at high risk from the screening tests and pulsatile cardiopulmonary bypass was applied. The remaining 132 patients were placed in the control group. Postoperative cerebral infarction caused by embolism was encountered in three patients (3/173, 1.7%), two in the high-risk group (2/41, 4.8%) and one in the control group (1/132, 0.8%), but the difference between these incidences was not statistically significant. Cerebral infarctions caused by brain hypoperfusion did not occur in this series. A neuropsychological test (Hasegawa's dementia scale, HDS) was done pre- and postoperatively. No one was diagnosed with dementia preoperatively, whereas 7 patients were diagnosed with dementia postoperatively. Among these 7 patients, 6 patients were in the high-risk group (17.1%, 6/35) and one patient was in the control group (0.9%, 1/113). Under these circumstances, using cerebrovascular screening and pulsatile cardiopulmonary bypass, cerebral infarction due to hypoperfusion did not occur, but cerebral infarction due to embolism was encountered, and neuropsychological dysfunction was not prevented.",Cardiopulmonary Bypass [adverse effects] [methods] [mortality];Cerebral Infarction [diagnosis] [etiology];Dementia [classification] [diagnosis] [etiology];Diabetes Complications;Hospital Mortality;Hypertension [complications];Intensive Care Units;Intracranial Embolism [diagnosis] [etiology];Length of Stay [statistics & numerical data];Mass Screening [methods];Neuropsychological Tests;Preoperative Care [methods];Pulsatile Flow;Regression Analysis;Risk Factors;Severity of Illness Index;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-endoc: sr-vasc,"Sudo, Y.;Takahara, Y.;Nakajima, N.",2001,,,0,4311
4311,Pulsatile cardiopulmonary bypass failed to prevent neuropsychological dysfunction,"To prevent neurological complications during cardiopulmonary bypass, cerebrovascular screenings by magnetic resonance angiography and computed tomographic scan of the brain were performed preoperatively in patients who had ischemic heart disease and all patients aged 60 years or older. From 1996 to 1999, 173 adult patients (mean age 65.1+/-7.7 y) were evaluated. Forty-one patients were considered to be at high risk from the screening tests and pulsatile cardiopulmonary bypass was applied. The remaining 132 patients were placed in the control group. Postoperative cerebral infarction caused by embolism was encountered in three patients (3/173, 1.7%), two in the high-risk group (2/41, 4.8%) and one in the control group (1/132, 0.8%), but the difference between these incidences was not statistically significant. Cerebral infarctions caused by brain hypoperfusion did not occur in this series. A neuropsychological test (Hasegawa's dementia scale, HDS) was done pre- and postoperatively. No one was diagnosed with dementia preoperatively, whereas 7 patients were diagnosed with dementia postoperatively. Among these 7 patients, 6 patients were in the high-risk group (17.1%, 6/35) and one patient was in the control group (0.9%, 1/113). Under these circumstances, using cerebrovascular screening and pulsatile cardiopulmonary bypass, cerebral infarction due to hypoperfusion did not occur, but cerebral infarction due to embolism was encountered, and neuropsychological dysfunction was not prevented.",Cardiopulmonary Bypass [adverse effects] [methods] [mortality];Cerebral Infarction [diagnosis] [etiology];Dementia [classification] [diagnosis] [etiology];Diabetes Complications;Hospital Mortality;Hypertension [complications];Intensive Care Units;Intracranial Embolism [diagnosis] [etiology];Length of Stay [statistics & numerical data];Mass Screening [methods];Neuropsychological Tests;Preoperative Care [methods];Pulsatile Flow;Regression Analysis;Risk Factors;Severity of Illness Index;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-endoc: sr-vasc,"Sudo, Y;Takahara, Y;Nakajima, N",2001,,,0,
4312,Report of five rare or previously unknown amyloidogenic transthyretin mutations disclosed in Sweden,"The number of amyloidogenic transthyretin (TTR) mutations described in the literature is more than 100. However, for several mutations, the phenotype has been described in a few individuals only; thus, the knowledge of the clinical course and the outcome after therapeutical interventions such as liver transplantation is limited. We describe the phenotype associated with five rare amyloidogenic TTR mutations that lately were discovered in Sweden: ATTR Val30Leu, Ala45Ser, Leu55Gln, Gly57Arg and Tyr69His of which ATTR Gly57Arg is previously unknown. The symptoms at onset differed, but cardiomyopathy and peripheral neuropathy were observed in all except the ATTR Tyr69His mutation. Likewise, carpal tunnel syndrome was found or had been present in all cases except the case with the ATTR Val30Leu mutation. The phenotype of the ATTR Tyr69His mutation was characterised by oculo-meningeal symptoms with seizures and a steadily progressing dementia, symptoms rarely found in ATTR amyloidosis, but similar to those previously described for this mutation, where all cases appear to originate from one Swedish family. Two patients with the ATTR Leu55Gln and Ala45Ser mutations have been subjected to liver transplantation, but echocardiographic examination has revealed an increasing cardiomyopathy after transplantation in both cases, the ATTR Leu55Gln patient succumbed 2 years after transplantation from progressive disease.",Adult;Amyloidosis/etiology/*genetics;Cardiomyopathies/etiology/genetics;European Continental Ancestry Group;Female;Humans;Liver Transplantation;Middle Aged;*Mutation;Peripheral Nervous System Diseases/etiology/genetics;Phenotype;Prealbumin/*genetics;Sweden;Young Adult,"Suhr, O. B.;Andersen, O.;Aronsson, T.;Jonasson, J.;Kalimo, H.;Lundahl, C.;Lundgren, H. E.;Melberg, A.;Nyberg, J.;Olsson, M.;Sandberg, A.;Westermark, P.",2009,Dec,10.3109/13506120903421587,0,
4313,Non-steroidal anti-inflammatory drugs and the risk of Clostridium difficile-associated disease,"AIM Several case reports have linked diclofenac, a non-steroidal anti-inflammatory drug (NSAID), with Clostridium difficile associated disease (CDAD). We assessed whether NSAID use in general, and diclofenac use in particular, is associated with an increased risk of CDAD. METHODS We used the United Kingdom's General Practice Research Database (GPRD) to conduct a population-based case-control study. All cases of CDAD occurring between 1994 and 2005 were identified and were matched to 10 controls each. Conditional logistic regression was used to estimate the odds ratio of CDAD associated with current NSAID use, adjusting for covariates. RESULTS We identified 1360 CDAD cases and 13072 controls. We found an increased risk of CDAD associated with diclofenac (adjusted odds ratio (RR) 1.35, 95% confidence interval (CI) 1.10, 1.67). We did not observe an increased risk of CDAD with use of any other NSAID. No dose-response for diclofenac exposure was found. When we analyzed only patients who were not hospitalized in the year before the index date, we found diclofenac to have a similar effect on CDAD risk (adjusted RR 1.43, 95% CI 1.11, 1.84). CONCLUSION Diclofenac use is associated with a modest increase in the risk of CDAD. In patients at risk of CDAD, other NSAIDs could be prescribed. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.",acetylsalicylic acid;cyclooxygenase 2 inhibitor;diclofenac;ibuprofen;naproxen;nonsteroid antiinflammatory agent;adult;alcohol consumption;article;chronic obstructive lung disease;Clostridium difficile infection;congestive heart failure;dementia;diabetes mellitus;disease association;diverticulosis;dose response;drug use;enteritis;female;gastrointestinal hemorrhage;gastrointestinal reflux;heart infarction;human;infection risk;kidney failure;liver failure;major clinical study;male;neoplasm;peptic ulcer;population based case control study;priority journal;cerebrovascular accident;United Kingdom,"Suissa, D.;Delaney, J. A. C.;Dial, S.;Brassard, P.",2012,,,0,
4314,Omega-3 fatty acids: A review of its wide range of applications and possible mechanisms of action,"Consumption of fish/fish oil has been reported to modulate the symptoms in cardiovascular disease, inflammatory responses, cancer, and neurological disorders. The objective of this review is to provide therapeutic role of polyunsaturated fatty acids (PUFA) with practical evidences carried out in recent years. Literature studies were selected using the Google, Pub Med and Medline database on the basis of the following criteria: (1) significance of omega-3-fatty acid in nutrition and disease (2) randomized controlled design, placebo controlled studies using Eicosapentaenoic acid and Docosahexaenoic acid. Imbalance in fatty acid composition is thought to be the major risk factor for the development and progression of various diseases. Omega-3 fatty acid up regulates anti-inflammatory and anti-apoptotic gene expression. It also competes with enzymes essential for ω-6 PUFA derived proinflammatory eicosanoid mediators. In addition, it reduces blood pressure, angiogenesis process. Interactions of PUFA with signal transduction pathways reverse the symptoms associated with depression whereas transcription factors modulates tumor metabolism. Consumption of fatty fish/ fish oil is associated with reduced risk for cardiovascular disease, inflammatory responses, cancer and neurological disorders.",apolipoprotein E;docosahexaenoic acid;icosapentaenoic acid;immunoglobulin enhancer binding protein;interleukin 1alpha;interleukin 1beta;matrix metalloproteinase;neuroprotectin d1;omega 3 fatty acid;placebo;polyunsaturated fatty acid;prostaglandin;protein p53;reactive oxygen metabolite;syndecan 1;triacylglycerol;tumor necrosis factor alpha;unclassified drug;vascular cell adhesion molecule 1;Alzheimer disease;angiogenesis;article;blood pressure;cardiovascular disease;cell proliferation;depression;drug mechanism;estrogen metabolism;gene expression;heart infarction;human;multicenter study (topic);neoplasm;protein polymorphism;randomized controlled trial (topic);rheumatoid arthritis;sea food;upregulation,"Sukrutha, S. K.;Janakiraman, S.",2014,,,0,
4315,A confused and febrile elderly man,,ampicillin;antibiotic agent;gentamicin;metformin;nitrite;paracetamol;perindopril;tamsulosin;warfarin;abdominal radiography;aged;article;atelectasis;atrial fibrillation;case report;confusion;delirium;dementia;electrocardiogram;feces;fever;gallbladder scintiscanning;general practitioner;heart muscle ischemia;history;human;hypertension;male;mild renal impairment;non insulin dependent diabetes mellitus;osteoarthritis;physical examination;prostate hypertrophy;sepsis;single drug dose;tachypnea;thorax radiography;toileting;urinalysis;urinary tract infection;very elderly,"Sullivan, R.;Cranney, J.;Fulde, G.",2017,,,0,
4316,I was sick and you came to visit me: Time spent at the bedsides of seriously ill patients with poor prognoses,"PURPOSE: To learn how much time hospital staff and families spend at the bedsides of seriously ill patients with poor prognoses. SUBJECTS AND METHODS: An observational study was made of 58 inpatients with cancer, acquired immunodeficiency syndrome, heart failure, obstructive lung disease, or advanced dementia, along with their families and the physicians and nurses working on the medical floors of a university hospital, using direct videotape surveillance of patients' doorways. RESULTS: The mean (±SD) total visitor-minutes spent in the rooms of these patients was 321±297 minutes per day. On average, patients spent 18 hours 39 minutes per day alone. Mean visit durations were 3±3 minutes for attending physicians (including consultants), 3±2 minutes for house officers, 2±1 minutes for nurses, and 24±51 minutes for family. The total person-visits per patient per day were 3±3 for attending physicians, 9±8 for house officers, 45±23 for nurses, and 13±21 for family. Patient sex and age were not significantly associated with total visitor-minutes. In a repeated-measures analysis of variance model, nonwhite patients received fewer total visitor-minutes than did white patients, and patients with dementia received fewer total visitor-minutes than did patients with other diagnoses, especially those with malignancy. Do-not-resuscitate orders were associated with slightly more total visitor-minutes. CONCLUSIONS: These seriously ill patients with poor prognoses spent most of their time in the hospital alone. Staff visits were frequent but brief. These data do not confirm anecdotal reports that staff members spend less time at the bedsides of patients with do-not-resuscitate orders. Patients with advanced dementia and minority patients appear to have less bedside contact. Further study is required to confirm these findings and to understand optimal visit time for medical inpatients with poor prognoses. © 2001 by Excerpta Medica, Inc.",acquired immune deficiency syndrome;adult;article;carcinoma;chronic obstructive lung disease;consultation;controlled study;dementia;female;health care facility;health visitor;heart failure;hospital;hospital patient;hospital personnel;human;major clinical study;male;minority group;nurse;patient;physician;priority journal;prognosis;race;resuscitation;statistical analysis;time;videotape,"Sulmasy, D. P.;Rahn, M.",2001,,,0,
4317,The accuracy of substituted judgments in patients with terminal diagnoses,"BACKGROUND: Patients' loved ones often make end-of-life treatment decisions, but the accuracy of their substituted judgments and the factors associated with accuracy are poorly understood. OBJECTIVE: To assess the accuracy of judgments made by surrogate decision makers; ascertain the beliefs, practices, and clinical and sociodemographic factors associated with accuracy of surrogates' decisions; assess the preferences of patients for life-sustaining treatments; and compare differences in accuracy across diagnoses. DESIGN: Cross-sectional paired interviews. SETTING: Outpatient practices of three university hospitals. PATIENTS: 250 patients with terminal diagnoses of congestive heart failure, AIDS, amyotrophic lateral sclerosis, lung cancer, and chronic obstructive pulmonary disease (50 patient-surrogate pairs in each group) and 50 general medical patients and their surrogates. MEASUREMENTS: The accuracy of surrogate predictions was measured by using scales based on 10 potential treatments in each of three hypothetical clinical scenarios. RESULTS: Preferences varied according to mode of treatment and scenario. On average, surrogates made correct predictions in 66% of instances. Accuracy was better for the permanent coma scenario than for the scenarios of severe dementia or coma with a small chance of recovery (P < 0.001). In a binary logit model, the accuracy of substituted judgments was positively associated with the patient having spoken with the surrogate about end-of-life issues (odds ratio [OR], 1.9 [95% CI, 1.6 to 2.3]), the patient having private insurance (OR, 1.4 [CI, 1.1 to 1.7]), the surrogate's level of education (OR, 1.5 [CI, 1.2 to 1.9]), and the patient's level of education (OR, 1.7 [CI, 1.4 to 2.2]). Accuracy was negatively associated with the patient's belief that he or she would live longer than 10 years (OR, 0.6 [CI, 0.5 to 0.7]), surrogate experience with life-sustaining treatment (OR, 0.4 [CI, 0.3 to 0.5]), surrogate participation in religious services (OR, 0.67 [CI, 0.50 to 0.91]), and a diagnosis of heart failure (OR, 0.6 [CI, 0.5 to 0.8]). Age, ethnicity, marital status, religion, and advance directives were not associated with accuracy. CONCLUSIONS: The accuracy of substituted judgments is associated with multiple clinically apparent patient and surrogate factors. This information can help clinicians identify conditions under which substituted judgments are likely to be accurate or inaccurate and can help target populations for education designed to improve the accuracy of surrogate decision making.","Adult;*Advance Directives;Aged;Aged, 80 and over;*Consensus;Cross-Sectional Studies;*Decision Making;Demography;Female;Humans;Interviews as Topic;Judgment;Logistic Models;Male;Middle Aged;Religion;Resuscitation Orders;Socioeconomic Factors;Statistics as Topic;Terminally Ill/*psychology;Death and Euthanasia;Empirical Approach","Sulmasy, D. P.;Terry, P. B.;Weisman, C. S.;Miller, D. J.;Stallings, R. Y.;Vettese, M. A.;Haller, K. B.",1998,Apr 15,,0,
4318,How voter turnout varies between different chronic conditions? A population-based register study,"BACKGROUND: While poor self-rated health is known to decrease an individual's propensity to vote, disaggregation of the components of health on turnout has thus far received only little attention. This study deepens on the understanding of such relationships by examining the association between chronic diseases and voting. METHODS: The study uses an individual-level register-based data set that contains an 11% random sample of the entire electorate in the 1999 Finnish parliamentary elections. With information on hospital discharge diagnoses and reimbursements for drugs prescribed, we identify persons with chronic hospital-treated diseases (coronary heart disease, chronic obstructive pulmonary disease (COPD) and asthma, depression, cancer, psychotic mental disease, diabetes, cerebrovascular disease, rheumatic disease, epilepsy, arthrosis, alcoholism, dementia, atherosclerosis, Parkinson's disease, other degenerative brain diseases, multiple sclerosis and kidney disease). RESULTS: After adjusting for gender, age, education, occupational class, income, partnership status, cohabitation with underaged children and hospitalisation during Election Day, neurodegenerative brain diseases had the strongest negative relationship with voting (dementia OR=0.20, 95% CI 0.18 to 0.22; others up to OR=0.70). Alcoholism (OR=0.66) and mental disorders also had a negative association (depression OR=0.91; psychotic mental disease OR=0.79), whereas cancer and COPD/asthma had a positive association (both OR=1.05). Having more than one condition at a time further decreased voting probability. CONCLUSIONS: By showing how different health conditions are related to voter turnout, this study provides essential information for identifying gaps in the potential for political participation and for further inquiries aiming to develop models that explain the link between health and voting probability.",Epidemiology of chronic diseases;Policy;Registers;Social capital;Social activities,"Sund, R.;Lahtinen, H.;Wass, H.;Mattila, M.;Martikainen, P.",2017,May,,0,
4319,Comorbidities of psoriasis - Exploring the links by network approach,"Increasing epidemiological studies in patients with psoriasis report the frequent occurrence of one or more associated disorders. Psoriasis is associated with multiple comorbidities including autoimmune disease, neurological disorders, cardiometabolic diseases and inflammatorybowel disease. An integrated system biology approach is utilized to decipher the molecular alliance of psoriasis with its comorbidities. An unbiased integrative network medicine methodology is adopted for the investigation of diseasome, biological process and pathways of five most common psoriasis associated comorbidities. A significant overlap was observed between genes acting in similar direction in psoriasis and its comorbidities proving the mandatory occurrence of either one of its comorbidities. The biological processes involved in inflammatory response and cell signaling formed a common basis between psoriasis and its associated comorbidities. The pathway analysis revealed the presence of few common pathways such as angiogenesis and few uncommon pathways which includes CCKR signaling map and gonadotrophin-realising hormone receptor pathway overlapping in all the comorbidities. The work shed light on few common genes and pathways that were previously overlooked. These fruitful targetsmay serve as a starting point for diagnosis and/or treatment of psoriasis comorbidities. The current research provides an evidence for the existence of shared component hypothesis between psoriasis and its comorbidities.",Alzheimer disease;angiogenesis;article;biological functions;comorbidity;disease association;evidence based medicine;heart infarction;human;methodology;molecular genetics;non insulin dependent diabetes mellitus;obesity;psoriasis;rheumatoid arthritis;signal transduction;systems biology,"Sundarrajan, S.;Arumugam, M.",2016,,,0,
4320,Higher Risk of Vascular Dementia in Myocardial Infarction Survivors,"Background -Increased risk of dementia after myocardial infarction (MI) may be mediated by shared risk factors (e.g., atherosclerosis) and post-MI stroke. We examined risk of dementia in 1-year survivors of MI. Methods -Using Danish medical registries, we conducted a nationwide population-based cohort study of all patients with first-time MI and a sex-, birth year-, and calendar year-matched general population comparison cohort without MI (1980-2012). Cox regression analysis was used to compute 1-35 year adjusted hazard ratios (aHRs) for dementia, controlled for matching factors and adjusted for comorbidities and socioeconomic status. Results -We identified 314,911 patients with MI and 1,573,193 matched comparison cohort members randomly sampled from the general population (median age 70 years, 63% male). After 35 years of follow-up, the cumulative incidence of all-cause dementia in the MI cohort was 9% (2.8% for Alzheimer's disease, 1.6% for vascular dementia, and 4.5% for other dementias). Compared with the general population cohort, MI was not associated with all-cause dementia (aHR = 1.01, 95% confidence interval (CI): 0.98-1.03). Risk of Alzheimer's disease (aHR = 0.92, 95% CI: 0.88-0.95) and other dementias (aHR = 0.98, 95% CI: 0.95-1.01) also approximated unity. However, MI was associated with higher risk of vascular dementia (aHR = 1.35, 95% CI: 1.28-1.43), which was substantially strengthened for patients experiencing stroke after MI (aHR = 4.48, 95% CI: 3.29-6.12). Conclusions -MI was associated with higher risk of vascular dementia throughout follow-up and this asssociation was stronger in patients suffering stroke. The risk of Alzheimer's disease and other dementias was not higher in MI patients.",dementia;epidemiology;myocardial infarction;risk factor,"Sundboll, J.;Hovath-Puho, E.;Adelborg, K.;Schmidt, M.;Pedersen, L.;Botker, H. E.;Henderson, V. W.;Sorensen, H. T.",2017,Oct 12,,1,
4321,Gender differences in predictors of survival in elderly nursing-home residents: a 3-year follow up,"This study focus on predicting factors of survival possible to modify by nursing care, and the incidence and mortality rate of nursing-home-acquired pneumonia, allocated to 1, 2 and 3 years of follow ups. The residents consisted of 156 women and 78 men living in special housing for the elderly. Data on chronic disease and medication were obtained at baseline, and activities of daily living (ADL) status, nutritional status and body temperature were assessed. The incidence of pneumonia was noted prospectively for 1 year and retrospectively for the following 2 years. Predictive factors for survival were explored by Cox hazard regression analysis. The results showed that age, functional and cognitive impairment were predictors of mortality irrespective of gender, while poor nutritional status in women and chronic obstructive pulmonary disease, heart disease and medication with sedatives in men were gender-specific predictors. ADL correlated positively with dementia and negatively with S-albumin irrespective of gender, while malnutrition correlated positively with ADL in women and positively with chronic obstructive pulmonary disease in men. To promote the quality of daily living in elderly individuals, it is of importance to improve the capabilities in daily functions and nutritional status, especially in women with functional impairment, and to prevent anxiety particularly in men. The findings also clarify that pneumonia is as common as cerebral vascular insult and heart failure as cause of death in this population.","Aged;Aged, 80 and over;Female;Humans;*Inpatients;Male;*Nursing Homes;*Sex Factors;*Survival Analysis","Sund-Levander, M.;Grodzinsky, E.;Wahren, L. K.",2007,Mar,10.1111/j.1471-6712.2007.00431.x,0,
4322,"Which hospitalisations are ambulatory care-sensitive, to what degree, and how could the rates be reduced? Results of a group consensus study in Germany","Background: Much has been written lately regarding hospitalisations for ambulatory care-sensitive conditions (ACSH) and their strengths and weaknesses as a quality management indicator. The idea underlying ambulatory care-sensitive conditions (ACSC) is that effective treatment of acute conditions, good management of chronic illnesses and immunisation against infectious diseases can reduce the risk of a specified set of hospitalisations. Methods: The present paper applies group consensus methods to synthesise available evidence with expert opinion, thus identifying relevant ACSC. It contributes to the literature by evaluating the degree of preventability of ACSH and surveying the medical and systemic changes needed to increase quality for each diagnosis group. Forty physicians proportionally selected from all medical disciplines relevant to the treatment of ACSC participated in the three round Delphi survey. The setting of the study is Germany. Results: The proposed core list is a subset of 22 ACSC diagnosis groups, covering 90% of all consented ACSH and conditions with a higher than 85% estimated degree of preventability. Of all 18.6 million German hospital cases in the year 2012, the panelists considered 5.04 million hospitalisations (27%) to be sensitive to ambulatory care, of which 3.72 (20%) were estimated to be actually preventable. If only emergencies are considered, the ACSH share reduces to less than 8%. The geographic distribution of ACSH indicates significant regional variation with particularly high rates and potential for improvement in the North Rhine region, in Thuringia, Saxony-Anhalt, northern and eastern Bavaria and the Saarland.The average degree of preventability was 75% across all diagnosis groups. By far the most often mentioned strategy for reducing ACSH was 'improving continuous care'. Conclusion: There are several good reasons why process indicators prevail in the assessment of ambulatory care. ACSH rates can however provide a more complete picture by adding useful information related to the overall patient outcome. The results of our analysis should be used to encourage debate and as a basis for further confirmatory work.",alcohol liver disease;ambulatory care;article;asthma;backache;bleeding;bronchitis;chronic disease;chronic obstructive lung disease;consensus development;convulsion;decubitus;Delphi study;dementia;depression;diabetes mellitus;duodenitis;eye disease;gastritis;geographic distribution;Germany;headache;heart failure;hospitalization;human;hypertension;infection;influenza;intestine infection;ischemic heart disease;male genital system disease;malnutrition;melanoma;metabolic disorder;migraine;nutritional deficiency;obesity;parasitosis;pelvic inflammatory disease;pneumonia;polyneuropathy;pregnancy disorder;rare disease;skin cancer;skin disease;sleep disorder;thyroid disease;tooth disease;tuberculosis,"Sundmacher, L.;Fischbach, D.;Schuettig, W.;Naumann, C.;Augustin, U.;Faisst, C.",2015,,,0,
4323,Neoplastic angioendotheliosis of the central nervous system,"The patient, a male aged 56, first noticed incomplete urinary retention about 9 months before admission to the hospital. Subsequently he had progressive paresis and hypesthesia of lower extremities. About 7.5 months before admission, he had complete urinary retention, disturbance of all forms of sensation below Th. 6 on the right and Th. 8 on the left. On admission (November 10, 1979), general examination showed no abnormalities. Neurologically, observed were equivocal paresis of the right facial muscle, bilateral hyperactive orbicuralis oris and pharyngeal reflexes, paralysis of lower extremities with diffuse muscular wasting, and severe involvement of all modalities of sensation below the level of Th. 8 on both sides and hyperesthesia in the regions of Th. 6-8 on the right and of L. 2 on the left. After then he showed recurrent aphasia, dysgraphia and dyslexia with sudden onset. These symptoms were improved by steroid therapy, and worsened by decreasing dosage of steroid. Since June 2, 1980, when agraphia and aphasia, without effect of steroid therapy, rapidly occurred, he gradually became drowsy and less responsive. He became completely unresponsive in August and died of bilateral bronchopneumonia on October 6, 1980. On laboratory examination, erythrocyte sedimentation rates, serum urea nitrogens and creatinins were normal throughout the hospitalization. Examinations of CRP showed 1+ to 4+, and CSF proteins were elevated. CT scan in May, 1980, disclosed a large irregular area of lucency in the white matter of the left parietal lobe, and diffuse low density areas in the white matter of the left temporal and bilateral occipital lobes. CT scan in April, 1980, revealed diffuse low density areas in bilateral frontal, occipital, temporal and parietal regions, mainly in the white matter. EEG revealed transient periodic lateralized epileptiform discharges, that is, the periodic sharp waves on the left parietal region. The postmortem examination showed diffuse or scattered numerous necrotic and demyelinating lesions in the spinal cord, and the both cerebral hemispheres in particular bilateral occipital lobes. In these lesions there were extensive proliferations of vessels and demonstrable intravascular proliferations of atypical cell with a large, rounded nuclei and scanty cytoplasm. These findings couldn't be recognized in the other organs including muscles, liver, spleen, bone marrow, lungs, kidneys, heart, adrenals, bladder, pancreas, thyroid gland, prostate, testis and gastrointestinal tract. The proliferation of vessels was dissimilar from increase in number of capillaries after cerebral infarction, because the proliferating vessels were larger than capillaries and were present even in non-necrotic areas. The proliferation of vessels was considered to be an important finding of neoplastic angioendotheliosis as described by Bots (1974) and Strouth et al. (1965).",angioendotheliosis;autopsy;case report;central nervous system;dementia;diagnosis;histology;muscle atrophy;peripheral vascular system;neoplasm,"Sunohara, N.;Mukoyama, M.;Satoyoshi, E.",1982,,,0,
4324,Influence of apolipoprotein E gene polymorphism on the risk for breast cancer,"Apolipoprotein E (APO E) is a polymorphic gene involved in lipid metabolism with three common alleles ε2, ε3 and ε4.The ε4 allele has been associated with elevated levels of cholesterol as well as greater risk for coronary heart disease and Alzheimer's disease. In the present study 110 cases of breast cancer and control were studied for APOE genotype distribution using PCR-RFLP (Polymerase chain reaction-Restriction fragment length polymorphism) technique. Significant association of APOE 3/4 with breast cancer (17.3%) was observed. Higher frequency of Breast cancer patients with steroid hormone receptor positive status (18%) were found to be of 3/4 genotype. The elevation in 3/4 genotype frequencies was also found in premenopausal group (21.6%) and in patients with advanced tumor (77.7%). Body mass index (BMI) and familial incidence did not show association with APOE genotype. The results suggest the influence of APOE genotype on development of breast cancer. © Kamla-Raj 2008.",apolipoprotein E;steroid receptor;adult;advanced cancer;article;body mass;breast cancer;cancer risk;cancer staging;cancer susceptibility;controlled study;correlation analysis;familial incidence;female;gene frequency;genetic polymorphism;genetic risk;genetic susceptibility;genotype;human;human tissue;major clinical study;male;polymerase chain reaction;premenopause;restriction fragment length polymorphism,"Surekha, D.;Vishnupriya, S.;Sailaja, K.;Nageswara Rao, D.;Raghunadharao, D.",2008,,,0,
4325,Progressive supranuclear palsy. Report of 14 cases with special reference to unusual features,"The clinical features and course of 14 patients with progressive supranuclear palsy (PSP) were analysed. PSP formed 2.3 percent of the parkinsonian population. Blepharospasm, hypersomnia, athetosis, action dystonia, action myoclonus and family history of dementia were the unusual features. Half of the patients had dementia at presentation. Drug therapy was uniformly disappointing. The mean duration from onset to death in 4 patients who died was 4.5 years. The histopathological features in a patient with the disease for one year and who died of acute myocardial infarction showed moderately severe changes characteristic of the disease.","Brain/pathology;Female;Humans;India/epidemiology;Male;Middle Aged;*Supranuclear Palsy, Progressive/diagnosis/epidemiology;Time Factors","Suresh, T. G.;Rao, T. V.",1991,Jun,,0,
4326,Prevalence of Intracranial Atherosclerotic Stenosis Using High-Resolution Magnetic Resonance Angiography in the General Population: The Atherosclerosis Risk in Communities Study,"Background and Purpose - Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke, but little is known about its epidemiology. We studied the prevalence of ICAS and its association with vascular risk factors using high-resolution magnetic resonance angiography in a US cardiovascular cohort. Methods - The Atherosclerosis Risk in Communities (ARIC) study recruited participants from 4 US communities from 1987 to 1989. Using stratified sampling, we selected 1980 participants from visit 5 (2011-2013) for high-resolution 3T-magnetic resonance angiography. All images were analyzed in a centralized laboratory, and ICAS was graded as: no stenosis, <50% stenosis, 50% to 69% stenosis, 70% to 99% stenosis, and complete occlusion. We calculated per-vessel and per-person prevalence of ICAS (weighted for n=6538 visit 5 participants) and also estimated the US prevalence. We used multivariable logistic regression to identify variables independently associated with ICAS. Results - Subjects who had an adequate magnetic resonance angiography (n=1765) were aged 67 to 90 years, 41% were men, 70% were white, and 29% were black. ICAS was prevalent in 31% of participants and 9% had ICAS ≥50%. Estimated US prevalence of ICAS ≥50% for 65 to 90 years old was 8% for whites and 12% for blacks. Older age, black race, higher systolic blood pressure, and higher low-density lipoprotein cholesterol levels were associated with increased odds of ICAS, whereas higher levels of high-density lipoprotein cholesterol and use of cholesterol-lowering medications were associated with decreased odds of ICAS. Body mass index and smoking were not associated with ICAS. Conclusions - The prevalence of ICAS in older adults is high, and it could be a target for primary prevention of stroke and dementia in this population.",high density lipoprotein;high density lipoprotein cholesterol;hypocholesterolemic agent;low density lipoprotein cholesterol;triacylglycerol;age;aged;article;atherosclerosis;Black person;body mass;cardiovascular risk;cerebrovascular accident;cholesterol blood level;cohort analysis;comorbidity;controlled study;cross-sectional study;diabetes mellitus;disease association;female;heart infarction;high resolution magnetic resonance angiography;human;hypertension;intracranial atherosclerotic stenosis;lipoprotein blood level;magnetic resonance angiography;major clinical study;male;medical history;neuroimaging;occlusive cerebrovascular disease;prevalence;priority journal;race difference;randomized controlled trial;risk assessment;systolic blood pressure;triacylglycerol blood level,"Suri, M. F. K.;Qiao, Y.;Ma, X.;Guallar, E.;Zhou, J.;Zhang, Y.;Liu, L.;Chu, H.;Qureshi, A. I.;Alonso, A.;Folsom, A. R.;Wasserman, B. A.",2016,,,0,
4327,Lipid Peroxidation Markers in Coronary Artery Disease Patients with Possible Vascular Mild Cognitive Impairment,"This study examined associations between lipid peroxidation markers and cognition, and associations between these markers and cognitive response to an exercise intervention program, in adults with coronary artery disease at risk of dementia. Lipid peroxidation products were measured in serum in 118 patients (29 possible vascular mild cognitive impairment and 89 controls). Ratios of early- (lipid hydroperoxides, LPH) to late-stage (8-isoprostane, 8-ISO; 4-hydroxy-2-nonenal, 4-HNE) lipid peroxidation products were calculated. Cognitive performance was assessed before and at completion of a 24-week exercise intervention program. A global effect of group on lipid peroxidation markers was observed, adjusting for sex, years of education, and cardiopulmonary fitness (main effect of group F (3,102) = 2.957, p = 0.036). Lower lipid peroxidation at baseline, as determined by lower 8-ISO concentration, was associated with greater improvement in verbal memory (F (1, 64) = 4.738, p = 0.03) and executive function (F (1, 64) = 5.219, p = 0.026) performance. Similarly, higher ratios of 8-ISO/LPH (F (1, 65) = 6.592, p = 0.013) and (8-ISO+4-HNE) to LPH (F (1, 65) = 3.857, p = 0.054), were associated with less improvement in executive function performance over a 24-week exercise intervention. Lipid peroxidation may be a biomarker of early vascular cognitive impairment, and elevated lipid peroxidation might limit the cognitive benefits of exercise in this high-risk population.",Cardiovascular;coronary artery disease;exercise;heart disease;hydroperoxide;hydroxynonenal;isoprostane;lipid peroxidation;oxidative stress;vascular cognitive impairment,"Suridjan, I.;Herrmann, N.;Adibfar, A.;Saleem, M.;Andreazza, A.;Oh, P. I.;Lanctot, K. L.",2017,,,0,
4328,Significance of triphasic waves in patients with acute encephalopathy: a nine-year cohort study,"OBJECTIVE: Triphasic waves (TWs) are a frequent electroencephalography (EEG) finding in encephalopathy, yet their origin and prognostic significance are not well understood. The aim of this study was to determine the clinical and EEG characteristics in encephalopathic patients with TWs. We hypothesized that specific EEG characteristics are predictive of outcome. METHODS: Consecutive adult encephalopathic patients with TWs on EEG and neuroimaging were included. EEG analysis included semiquantitative evaluation of TWs, background activity, and EEG reactivity. The study endpoint was death. RESULTS: Over a nine-year period, 105 patients with TWs were included. Common abnormalities on neuroimaging were white matter lesions (60%) and cerebral atrophy (59%). Pathologic conditions included infections (56%), renal (50%) and liver insufficiency (12%), and respiratory failure (20%). Mortality was 20%. Absent EEG background reactivity and respiratory failure were independently associated with death (OR 3.73, 95%CI 1.08-12.80, p=0.037 and OR 6.47, 95%CI 1.98-21.12, p=0.02). CONCLUSIONS: These results suggest that TWs are a marker of structural brain disease coupled with toxic-metabolic perturbations, and that etiologies or underlying pathologies were not predictive for outcome while non-reactive EEG was independently associated with death. SIGNIFICANCE: In contrast to clinical, EEG and neuroimaging findings, non-reactive EEG patterns predicted death in encephalopathic patients with TWs.","Aged;Brain Diseases/*diagnosis/epidemiology;Cohort Studies;Comorbidity;Coronary Disease/epidemiology;Dementia/epidemiology;Diabetes Mellitus, Type 2/epidemiology;*Electroencephalography;Female;Humans;Hypertension/epidemiology;Length of Stay;Male;*Neuroimaging;Postoperative Complications/*diagnosis;Predictive Value of Tests;Prognosis;Stroke/epidemiology;Behavioral disorder;EEG patterns;Encephalopathy;Neurocritical care;Outcome;Triphasic waves","Sutter, R.;Stevens, R. D.;Kaplan, P. W.",2013,Oct,10.1016/j.clinph.2013.03.031,0,
4329,Clinical features of diabetes mellitus with the mitochondrial DNA 3243 (A-G) mutation in Japanese: Maternal inheritance and mitochondria-related complications,"Diabetes mellitus with the mitochondrial DNA 3243(A-G) mutation is reported to represent 0.5-2.8% of the general diabetic population. Since the characterization of diabetes with the mutation is still incomplete, we undertook a nation-wide case-finding study of genetically defined patients using questionnaires in Japan. One hundred and thirteen Japanese diabetic patients with the mutation were registered and analyzed. The patients had a high prevalence of maternal inheritance of diabetes and deafness, short and thin stature, and showed an early middle-aged onset of diabetes and deafness. Eighty-six percent of the patients required insulin therapy due to the progressive insulin secretory defect. Glucose intolerance of the mothers was associated with an early middle-aged onset of diabetes, reduction in the insulin secretory capacity, early requirement of insulin therapy, and increases in the daily insulin dose. The heteroplasmic concentrations of the 3243 mutation in leukocytes were low and declined with aging. The patients had advanced microvascular complications, and mitochondria-related complications such as cardiomyopathy, cardiac conductance disorders, neuromuscular symptoms, neuropsychiatric disturbance, and macular pattern dystrophy. Thus, this study has revealed that: (1) diabetes mellitus with the 3243 mutation is a subtype of diabetes mellitus with mitochondria-related complications; and (2) insulin secretory ability is more severely impaired in the patients whose mothers were glucose intolerance. © 2002 Elsevier Science Ireland Ltd. All rights reserved.",insulin;mitochondrial DNA;adult;aging;article;body build;cardiomyopathy;case finding;clinical feature;controlled study;dementia;depression;diabetes mellitus;diabetic microangiopathy;diabetic neuropathy;diabetic retinopathy;disorders of mitochondrial functions;encephalomyopathy;extrachromosomal inheritance;female;gene mutation;glucose intolerance;hearing impairment;heart muscle conduction disturbance;human;human cell;insulin release;insulin treatment;leukocyte;major clinical study;male;maternally inherited diabetes mellitus and deafness;mental deficiency;neuromuscular disease;neuropsychiatry;onset age;ophthalmoplegia;prevalence;macular degeneration;short stature;sick sinus syndrome;Wolff Parkinson White syndrome,"Suzuki, S.;Oka, Y.;Kadowaki, T.;Kanatsuka, A.;Kuzuya, T.;Kobayashi, M.;Sanke, T.;Seino, Y.;Nanjo, K.",2003,,,0,
4330,Coronary artery calcification a canary in the cognitive coalmine,,NCT02085265;amyloid beta protein;amyloid beta protein[1-40];angiotensin receptor antagonist;dipeptidyl carboxypeptidase inhibitor;perindopril;telmisartan;Alzheimer disease;brain atrophy;brain hemorrhage;brain infarction;cerebrovascular accident;chemoprophylaxis;cognition;cognitive defect;coronary artery atherosclerosis;coronary artery calcification;coronary artery disease;dementia;disease association;drug effect;human;hypertension;mortality;neurofibrillary tangle;note;prediction;priority journal;risk factor;senile plaque,"Swardfager, W.;Black, S. E.",2016,,,0,
4331,Independent cognitive effects of atrophy and diffuse subcortical and thalamico-cortical cerebrovascular disease in dementia,"BACKGROUND AND PURPOSE - Brain atrophy, cortical infarction, and subcortical ischemic vasculopathy have all been associated with cognitive dysfunction. The interrelationships between these pathologies and their independent contributions to cognitive function remain unclear. Despite the high frequency of Alzheimer disease (AD) in those with clinically diagnosed vascular dementia, and the frequent findings of vascular disease in those with clinically diagnosed AD, many studies of brain-behavior relationships in dementia consider these populations separately. The present study sought to identify the correlates of independent domains of cognitive impairment in an unselected sample across a large range of severity and overlap of AD and VaD. METHODS - Two hundred five individuals from the Sunnybrook Dementia Study recruited from a university Memory clinic had detailed neuropsychological testing and MRI quantification using a multi-step postprocessing algorithm. A factor analysis of the cognitive protocol yielded a 3-factor solution, provisionally labeled: (1) short-term memory and language, (2) attention and working memory, and (3) mental flexibility. RESULTS - A factor analysis of brain measures identified 3 independent factors with measures of (1) brain atrophy, (2) subcortical vascular disease, and (3) strategic infarcts (anterior-medial thalamus and cortical infarcts). After accounting for the effects of age and education, measures of brain atrophy were the strongest correlates of all cognitive domains. Small vessel disease was independently associated with general severity, impaired short-term memory/language, and reduced mental flexibility, but not with poor working memory, presumably through disruption of frontal-subcortical connections. In contrast, strategic infarcts to anterior-medial thalamus and cortical gray matter were associated with poor short-term and working memory, but not with impairments in mental flexibility or global severity measures. CONCLUSIONS - These data support the hypothesis that the thalamico-cortical network subserves both short-term and working memory. The findings also suggest that each type of pathology (atrophy, small vessel disease, and strategic infarcts) contribute independently to the pattern of cognitive disabilities associated with dementia. Particular attention to cerebrovascular disease in deep white or gray matter structures of the thalamico-cortical system is certainly warranted. © 2008 American Heart Association, Inc.",adult;age;aged;algorithm;Alzheimer disease;article;attention;brain atrophy;brain cortex;brain infarction;cerebrovascular disease;cognition;cognitive defect;controlled study;dementia;disease severity;education;factorial analysis;female;frontal cortex;gray matter;human;language;major clinical study;male;mental function;multiinfarct dementia;neuropsychological test;nuclear magnetic resonance imaging;priority journal;quantitative analysis;short term memory;thalamus;working memory,"Swartz, R. H.;Stuss, D. T.;Gao, F.;Black, S. E.",2008,,,0,
4332,PCSK9 inhibitors and neurocognitive adverse events: exploring the FDA directive and a proposal for N-of-1 trials,"Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are a novel class of medications that greatly lower low-density lipoprotein cholesterol (LDL-C) by upregulating LDL receptor availability. In early 2014, the US Food and Drug Administration (FDA) directed developers of PCSK9 inhibitors to monitor neurocognitive adverse effects and consider neurocognitive testing in at least a subset of participants in ongoing late-stage trials. Available trial evidence indicates that neurocognitive adverse events may occur more commonly in individuals receiving an antibody to PCSK9, but these events are uncommon and have not been associated with on-treatment LDL-C levels. Moreover, it is unclear to what extent closer monitoring of trial participants allocated to PCSK9 inhibitors has led to an ascertainment bias. Regardless, further trial data are needed, and long-term outcomes trials are ongoing, with at least one including a neurocognitive substudy. Considering lessons learned from the statin experience, high-quality prospective cohort studies and randomized trials may not be enough to allay concerns or settle debate since the focus of effect in these studies is the group average. Therefore, we suggest that n-of-1 trials could be considered to bring the focus to the individual while retaining the benefits of blinding and randomization in evidence generation. Ultimately, any neurocognitive adverse effects that might exist with PCSK9 inhibition and lipid lowering must be weighed against potential benefits of therapy, including avoidance of myocardial infarction and stroke, and a reduced risk of dementia due to neurovascular benefits from long-term lipid lowering.","Anticholesteremic Agents/*adverse effects/therapeutic use;Cholesterol, LDL/blood;Clinical Trials as Topic/*methods;Cognition Disorders/chemically induced;Drug Design;Humans;Proprotein Convertases/*antagonists & inhibitors;Serine Endopeptidases;United States;United States Food and Drug Administration","Swiger, K. J.;Martin, S. S.",2015,Jun,10.1007/s40264-015-0296-6,0,
4333,Stem cell therapy market,,acute heart infarction;allogeneic hematopoietic stem cell transplantation;Alzheimer disease;angina pectoris;anus fistula;article;autologous hematopoietic stem cell transplantation;bone marrow transplantation;cancer therapy;embryonic stem cell;graft versus host reaction;hematologic disease;human;mesenchymal stem cell transplantation;minimally invasive procedure;multipotent stem cell;pancreas islet beta cell;pluripotent stem cell;priority journal;age related macular degeneration,"Syed, B. A.;Evans, J. B.",2013,,,0,
4334,Statin therapy in the elderly: A review,"Cardiovascular morbidity is the leading cause of mortality in the developed nations. Elevated serum cholesterol is a major risk factor for ischemic heart disease, one of the common cardiovascular morbidity in older adults, statins have been shown to be effective in reducing serum cholesterol and improving outcomes. Hypercholesterolemia is common in older adults and is one of the major modifiable risk factors. Yet, these patients have often been excluded from major clinical trials of statins and evidence suggests of their underuse. Data from recent clinical trials of statins indicate that the elderly patients with the highest cardiovascular risk are likely to derive the most benefits from cholesterol lowering. With the aging of the population, the prevalence of hypercholesterolemia and cardiovascular morbidity is likely to increase. In this review we evaluate the evidence for the use of statins in older adults. © 2008 Elsevier Ireland Ltd. All rights reserved.",amiodarone;antifungal agent;atorvastatin;cerivastatin;cholesterol;coumarin;creatine kinase;cyclosporin;fibric acid derivative;fluindostatin;gemfibrozil;hydroxymethylglutaryl coenzyme A reductase inhibitor;isoconazole;ketoconazole;macrolide;mevinolin;nefazodone;nicotinic acid;placebo;pravastatin;proteinase inhibitor;rosuvastatin;simvastatin;verapamil;aged;allergic rash;aminotransferase blood level;cardiovascular disease;cardiovascular risk;cholesterol blood level;clinical trial;coronary artery atherosclerosis;creatine kinase blood level;drug absorption;drug bioavailability;drug blood level;drug dose comparison;drug efficacy;drug indication;drug induced headache;drug megadose;drug metabolism;drug safety;drug tolerability;food drug interaction;gastrointestinal symptom;grapefruit juice;heart failure;human;hypercholesterolemia;insomnia;ischemic heart disease;life expectancy;low drug dose;mental deterioration;morbidity;mortality;myopathy;neoplasm;patient compliance;polyneuropathy;prescription;priority journal;rhabdomyolysis;risk factor;risk reduction;short survey;side effect;unspecified side effect;lescol,"Szadkowska, I.;Stanczyk, A.;Aronow, W. S.;Kowalski, J.;Pawlicki, L.;Ahmed, A.;Banach, M.",2010,,,0,
4335,"A time sequence analysis of the relationship between cardiovascular risk factors, vascular diseases and restless legs syndrome in the general population","Previous cross-sectional studies regarding the association of restless legs syndrome (RLS) with cardiovascular morbidity are controversial. Our aim was to evaluate prospectively the relationship of cardiovascular risk factors and vascular diseases with incident RLS in the general population. The results are from two prospective population-based cohort studies: the Dortmund Health Study (n = 1312, median follow-up of 2.1 years) and the Study of Health in Pomerania (n = 4308, median follow-up of 5.0 years). RLS status was assessed twice according to the minimal criteria. Diabetes, hypertension, myocardial infarction and stroke, as well as currently taken medications, were assessed as self-reports. Body mass index and serum total cholesterol were also measured. The independent risks associated with each outcome were estimated by multivariable logistic regression models adjusted for comorbidities and behavioural factors. Obesity was an independent risk factor of incident RLS in the Dortmund Health Study, and higher body mass index was an independent risk factor in both studies. Diabetes, hypertension and hypercholesterolaemia were independent predictors of incident RLS in the Study of Health in Pomerania. The vascular comorbidity index, defined by the number of concurrent cardiovascular risk factors and vascular diseases, showed a positive association with incident RLS in both studies. RLS at baseline was not a significant predictor of any subsequent cardiovascular risk factors and/or vascular diseases in any of the studies. Cardiovascular risk factors and diseases predict the subsequent development of RLS in the general population. The presence of RLS is not a significant risk factor of cardiovascular morbidity. © 2013 European Sleep Research Society.",cholesterol;glucose;hemoglobin;adult;aged;alcohol consumption;article;body mass;cardiovascular risk;cerebrovascular accident;cholesterol blood level;chronic disease;cohort analysis;diabetes mellitus;diastolic blood pressure;female;follow up;glucose blood level;headache;heart infarction;hemoglobin blood level;human;hypercholesterolemia;hypertension;incidence;leg cramp;major clinical study;male;morbidity;obesity;physical activity;priority journal;prospective study;questionnaire;restless legs syndrome;sequence analysis;smoking;systolic blood pressure;vascular disease,"Szentkirályi, A.;Völzke, H.;Hoffmann, W.;Happe, S.;Berger, K.",2013,,,0,
4336,Restless legs syndrome and all-cause mortality in four prospective cohort studies,"Objectives: To evaluate the association between restless legs syndrome (RLS) and all-cause mortality. Design: Four prospective cohort studies. Setting: The Dortmund Health Study (DHS) and the Study of Health in Pomerania (SHIP) from Germany. The Women's Health Study (WHS) and the Physicians' Health Study (PHS) from the USA. Participants: In DHS: a random sample (n=1 299) from the population of Dortmund; in SHIP: a sample (n=4 291) from residents living in West Pomerania were drawn by multistage random sampling design; in WHS: female healthcare professionals (n=31 370); in PHS: male physicians (n=22 926) Main outcome measures: All-cause mortality. Results: The prevalence of RLS ranged between 7.4% and 11.9% at baseline. During follow-up (ranging between 6 and 11 years) RLS was not associated with increased risk of all-cause mortality in any of the four cohorts. The multivariable-adjusted HRs (95% CI) for all-cause mortality ranged from 0.21 (0.03 to 1.53) to 1.07 (0.93 to 1.23) across the four studies. The HRs for all-cause mortality did not differ according to gender. Conclusions: In these four independently conducted large prospective cohort studies from Germany and the USA, RLS did not increase the risk of all-cause mortality. These findings do not support the hypothesis that RLS is a risk factor for mortality of any cause.",adult;aged;article;cardiovascular risk;cerebrovascular accident;cohort analysis;diabetes mellitus;female;follow up;Germany;health care personnel;heart infarction;human;hypertension;lifestyle;major clinical study;male;mortality;neoplasm;prospective study;quality of life;resident;restless legs syndrome;United States,"Szentkirályi, A.;Winter, A. C.;Schürks, M.;Völzke, H.;Hoffmann, W.;Buring, J. E.;Gaziano, J. M.;Kurth, T.;Berger, K.",2012,,,0,
4337,Mildly elevated blood pressure is a marker for better health status in Polish centenarians,"The number of centenarians is projected to rise rapidly. However, knowledge of evidence-based health care in this group is still poor. Hypertension is the most common condition that leads to multiple organ complications, disability, and premature death. No guidelines for the management of high blood pressure (BP) in centenarians are available. We have performed a cross-sectional study to characterize clinical and functional state of Polish centenarians, with a special focus on BP. The study comprised 86 consecutive 100.9 ± 1.2 years old (mean ± SD) subjects (70 women and 16 men). The assessment included structured interview, physical examination, geriatric functional assessment, resting electrocardiography, and blood and urine sampling. The subjects were followed-up on the phone. Subjects who survived 180 days (83 %) as compared to non-survivors had higher systolic BP (SBP), diastolic BP (DPB), mean arterial pressure (MAP), pulse pressure (PP), higher mini-mental state examination, Barthel Index of Activities of Daily Living and Lawton Instrumental Activities of Daily Living Scale scores, higher serum albumin and calcium levels, and total iron-binding capacity, while lower serum creatinine, cystatin C, folate, and C-reactive protein levels. SBP ≥140 mm Hg, DBP ≥90 mm Hg, MAP ≥100 mm Hg, and PP ≥40 mm Hg were associated with higher 180-day survival probability. Results suggest that mildly elevated blood pressure is a marker for better health status in Polish centenarians.",C reactive protein;calcium;creatinine;cystatin C;folic acid;serum albumin;aged;article;Barthel index;blood pressure;blood sampling;creatinine blood level;cross-sectional study;dementia;diastolic blood pressure;electrocardiography;falling;female;follow up;functional assessment;health status;heart failure;human;iron binding capacity;Lawton instrumental activities of daily living scale;major clinical study;male;mean arterial pressure;memory disorder;Mini Mental State Examination;osteoarthritis;pain;physical examination;Polish citizen;pulse pressure;structured interview;systolic blood pressure;urinalysis;very elderly,"Szewieczek, J.;Dulawa, J.;Francuz, T.;Legierska, K.;Hornik, B.;Włodarczyk-Sporek, I.;Janusz-Jenczeń, M.;Batko-Szwaczka, A.",2015,,,0,
4338,Impact of pharmacy student and resident-led discharge counseling on heart failure patients,"Purpose: Many health systems have implemented interventions to reduce the rate of heart failure readmissions. Pharmacists have the training and expertise to provide effective medication-related education. However, few studies have examined the impact of discharge education provided by pharmacy students and residents on patients hospitalized with heart failure exacerbations. Methods: This was a nonrandomized intervention study evaluating the impact of a pharmacy student and resident-led discharge counseling program on heart failure readmissions. The primary end point was the 30-day heart failure readmission rate. Secondary end points included self-reported patient understanding of medications, number of medication errors documented, and estimated associated cost avoidance. Results: A total of 86 and 94 patients were enrolled into the intervention and control groups, respectively. No statistically significant difference in readmission rates was detected between the intervention and the control groups. Thirty-four medication errors and discrepancies were documented, or 1 for every 2.5 patients counseled, resulting in an estimated cost avoidance of $4241 for the institution. Eighty-nine percent of patients who received discharge counseling agreed they had a better understanding of their medications after speaking with a pharmacy resident or student. Conclusions: There was no statistically significant difference in readmission rates; however, several medication errors were prevented, and a large percentage of patients expressed an improved understanding of their medications. © The Author(s) 2013.",aged;aorta stenosis;article;cerebrovascular accident;chronic obstructive lung disease;controlled clinical trial;controlled study;coronary artery disease;dementia;diabetes mellitus;health care cost;heart arrest;heart failure;heart left ventricle ejection fraction;hospital discharge;hospital readmission;human;major clinical study;medication error;patient counseling;patient satisfaction;percutaneous coronary intervention;pharmacist;pharmacy student;resident;self report,"Szkiladz, A.;Carey, K.;Ackerbauer, K.;Heelon, M.;Friderici, J.;Kopcza, K.",2013,,,0,
4339,Inflammatory cerebral amyloid angiopathy: The overlap of perivascular (PAN-like) with vasculitic (Aβ-related angiitis) form: An autopsy case,"Beside advanced age, cerebral amyloid angiopathy (CAA) and hypertension (HTA) are the two most important risk factors for haemorrhagic stroke. Inflammatory changes of amyloid-laden vessels have been reported only in rare sporadic CAA cases. We present the case of a 78-year-old woman with a history of hypertension, dementia and haemorrhagic stroke of the right frontal lobe 2 years before admission. She was admitted with recurrence of symptoms of transient aphasia and central, right-side facial paresis that occurred an hour before her arrival at the hospital. In the admission unit, she was only slightly confused, with no other neurological deficits. An urgent CT scan revealed a recent haemorrhagic stroke in the left frontal lobe. In an hour her condition suddenly deteriorated. After a generalized seizure she presented with right-side hemiparesis with signs of uncal herniation and remained unconscious. A control CT scan showed a large haemorrhagic expansion that comprised the whole left brain hemisphere with 2 cm midline shift. She died about 10 hours after the onset of symptoms. At autopsy chronic inflammation of the thyroid gland, bronchopneumonia, fibrous and fatty heart degeneration and kidney haemorrhagic infarcts were documented. Amyloid deposition and systemic immune disorders in the inner organs were not demonstrated. In neuropathological examination we diagnosed inflammatory form of CAA with coexistence (the overlap) of two, perivascular and vascular, subtypes of CAA-related inflammation.",amyloid protein;collagen fiber;fibrin;aphasia;article;autopsy;brain hemorrhage;brain hernia;cardiovascular inflammation;clinical feature;computer assisted tomography;dementia;disease classification;facial nerve paralysis;frontal lobe;hemiparesis;human;hypertension;left hemisphere;neuropathology;perivascular inflammation;vascular amyloidosis;vasculitis,"Szpak, G. M.;Lewandowska, E.;Śliwińska, A.;Stȩpień, T.;Tarka, S.;Mendel, T.;Rafałowska, J.",2011,,,0,
4340,Cost-effectiveness of antihypertensive treatment in patients 80 years of age or older in Switzerland: an analysis of the HYVET study from a Swiss perspective,"This analysis shows the economic benefit of antihypertensive treatment in patients 80 years of age or older from the perspective of the Swiss healthcare system. The cost-effectiveness analysis of antihypertensive treatment in the elderly was carried out applying the results of the Hypertension in the Very Elderly Trial study to the Swiss healthcare system. The analysis shows that hypertension treatment provides, compared with placebo, an additional life expectancy of 0.0457 years per patient, over a follow-up period of 2 years. The medication cost was covered by the reduction of costs related to the treatment of strokes, myocardial infarctions and heart failure: the total cost per patient in the active group resulted in a dominant strategy of savings compared with the placebo group. Sensitivity analysis yielded a stable estimate after varying the costs of medication, stroke, myocardial infarction, heart failure and life expectancy, confirming the robustness of these results. Moreover, considering that antihypertensive treatment also positively affects the incidence of dementia, those net benefits might even be underestimated.","Age Factors;Aged, 80 and over;Antihypertensive Agents/*economics/*therapeutic use;Cost Savings;Cost-Benefit Analysis;Double-Blind Method;*Drug Costs;Female;*Health Care Costs;Health Services for the Aged/*economics;Heart Failure/economics/etiology/prevention & control;Humans;Hypertension/complications/*drug therapy/*economics;Life Expectancy;Male;Models, Economic;Multicenter Studies as Topic;Myocardial Infarction/economics/etiology/prevention & control;National Health Programs/*economics;Randomized Controlled Trials as Topic;Retrospective Studies;Stroke/economics/etiology/prevention & control;Switzerland;Time Factors;Treatment Outcome","Szucs, T. D.;Waeber, B.;Tomonaga, Y.",2010,Feb,10.1038/jhh.2009.47,0,
4341,Cardiac involvement in neuronal ceroid lipofuscinosis,"We present a case of a 58-year-old female with neuropsychiatric symptoms, followed by recurrent episodes of atrial flagellation and symptoms of heart failure. Based on intraoperative myocardial biopsy, neuronal ceroid lipofuscinosis was diagnosed. Copyright © Polskie Towarzystwo Kardiologiczne.",adult;article;case report;female;heart disease;heart failure;heart muscle biopsy;human;neuronal ceroid lipofuscinosis;recurrent disease,"Szwoch, M.;Wojtowicz, D.;Dorniak, K.;Walczak, E.;Raczak, G.;Fidziańska, A.",2013,,,0,
4342,Health characteristics of heart transplant recipients surviving into their 80s,"Background Heart transplantation (HTx) is the preferred treatment for patients with end-stage heart failure and has been successful for >30 y. The clinical course of recipients at the extreme of age is unknown. We reviewed our experience to determine the overall health and prevalence of Tx-related medical problems for recipients in their ninth decade. Methods We reviewed the UCTP experience from 1985 to present to identify patients who survived into their 80s and matched (1:1) with other recipients for gender and age at HTx, but did not survive to ≥80 y. The end point was the prevalence of medical problems. Results Since 1985, 1129 adult HTx have been performed and 14 patients (1.2%) survived to ≥80 y old. The mean age at HTx was 63 ± 4 y. Of octogenarians, the majority were males with ischemic cardiomyopathy. The average survival after transplant was 19 ± 5 y in the octogenarians and 5 ± 5 y in the controls (P < 0.01). Over time, the prevalence of comorbidities increased. Compared with nonoctogenarians, we observed higher prevalence of dyslipidemia (P = 0.02), and chronic renal insufficiency (P = 0.02) during follow-up. Cardiac function was normal (ejection fraction > 55%) for all octogenarians at age 80 y. Conclusions Despite improvements in posttransplant care, survival of HTx patients into the ninth decade is rare (1%). For those surviving into their 80s, cardiac function is preserved but dyslipidemia, renal insufficiency, and skin cancers are common. As the age of Htx patients continues to increase, posttransplant care should be tailored to minimize post-HTx complications and further extend survival.",antiarrhythmic agent;beta adrenergic receptor blocking agent;donepezil;hydroxymethylglutaryl coenzyme A reductase inhibitor;memantine;thyroid hormone;warfarin;aged;article;artificial heart pacemaker;aspiration pneumonia;bradycardia;brain hemorrhage;brain tumor;cause of death;chronic kidney failure;clinical article;comorbidity;controlled study;deep vein thrombosis;dementia;diabetes mellitus;disease course;dyslipidemia;falling;female;follow up;graft recipient;heart atrium arrhythmia;heart failure;heart function;heart transplantation;human;hypertension;hypothyroidism;ischemic cardiomyopathy;kidney failure;left ventricular assist device;male;malignant neoplasm;non small cell lung cancer;pneumonia;priority journal;prostate cancer;sepsis;skin cancer;sudden death;survival time;very elderly,"Tabachnick, D. R.;Bowen, M. E.;Stehlik, J.;Kfoury, A. G.;Caine, W. T.;Selzman, C. H.;McKellar, S. H.",2017,,10.1016/j.jss.2017.04.021,0,
4343,"Mutation in twinkle in a large Iranian family with progressive external ophthalmoplegia, myopathy, dysphagia and dysphonia, and behavior change","Background: TWINKLE (c10orf2) gene is responsible for autosomal dominant progressive external ophthalmoplegia (PEO). In rare cases, additional features such as muscle weakness, peripheral neuropathy, ataxia, cardiomyopathy, dysphagia, dysphonia, cataracts, depression, dementia, parkinsonism, and hearing loss have been reported in association with heterozygous mutations of the TWINKLE gene. Methods: We have studied a large Iranian family with myopathy, dysphonia, dysphagia, and behavior change in addition to PEO in affected members. Results: We identified a missense mutation C.1121G > A in the c10orf2 gene in all affected members. Early death is a novel feature seen in affected members of this family that has not been reported to date. Conclusion: The association of PEO, myopathy, dysphonia, dysphagia, behavior change and early death has not been previously reported in the literature or other patients with this mutation.",adult;article;behavior change;chronic progressive external ophthalmoplegia;clinical article;controlled study;death;differential diagnosis;dysphagia;dysphonia;echocardiography;electrocardiogram;electromyography;gene;gene sequence;genotype;human;Iranian people;linkage analysis;missense mutation;myopathy;nerve conduction velocity;single nucleotide polymorphism;twinkle gene,"Tafakhori, A.;Yu Jin Ng, A.;Tohari, S.;Venkatesh, B.;Lee, H.;Eskin, A.;Nelson, S. F.;Bonnard, C.;Reversade, B.;Kariminejad, A.",2016,,,0,
4344,Cell-based therapy for patients with vascular dementia,"The homeostasis of neuronal cells is maintained by the cerebral circulation and blood-brain barrier. Circulating bone marrow-derived immature cells, including CD34-positive (CD34+) cells, have been implicated in homeostasis of the cerebral microvasculature. Decreased levels of circulating CD34+ cells, associated with ageing and/or cardiovascular risk factors, correlate with poor clinical outcomes in patients with cerebrovascular and cardiovascular diseases. Clinical trials with local transplantation of bone marrow-derived immature cells for patients with limb ischaemia, including Buerger's disease and arteriosclerosis obliterans, have been shown to improve impaired microcirculation. In the present review, current findings about the correlation between circulating immature cells and microcirculation are reviewed, and the possibility of novel cell-based therapy in patients with vascular dementia is discussed. © 2011 The Author; Psychogeriatrics © 2011 Japanese Psychogeriatric Society.",NCT01028794;Alzheimer disease;B lymphocyte;blood brain barrier;brain circulation;cardiovascular disease;cardiovascular risk;CD34 selection;cell therapy;cerebrovascular disease;heart infarction;human;moyamoya disease;multiinfarct dementia;neovascularization (pathology);patient safety;priority journal;short survey;stroke patient;treatment outcome,"Taguchi, A.",2011,,,0,
4345,Falling mortality when adjusted for comorbidity in upper gastrointestinal bleeding: Relevance of multi-disciplinary care,"Objectives: The understanding of changes in comorbidity might improve the management of upper gastrointestinal bleeding (UGIB); such changes might not be detectable in short-term studies. We aimed to study UGIB mortality as adjusted for comorbidity and the trends in risk scores over a 14-year period. Methods: Patients presenting with UGIB to a single institution, 1996-2010, were assessed. Those with multiple comorbidities were managed in a multi-disciplinary care unit since 2000. Trends with time were assessed using logistic regression, including those for Charlson comorbidity score, the complete Rockall score and 30-day mortality. Results: 2669 patients were included. The Charlson comorbidity score increased significantly with time: the odds of a high (3+) score increasing at a relative rate of 4.4% a year (OR 1.044; p<0.001). The overall 30-day mortality was 4.9% and inpatient mortality was 7.1%; these showed no relationship with time. When adjusted for the increasing comorbidity, the odds of death decreased significantly at a relative rate of 4.5% per year (p=0.038). After the introduction of multi-disciplinary care, the raw mortality OR was 0.680 (p=0.08), and adjusted for comorbidity it was 0.566 (p=0.013). Conclusions: 30-day mortality decreased when adjusted for the rising comorbidity in UGIB; whether this is related to the introduction of multi-disciplinary care needs to be considered.",acquired immune deficiency syndrome;adult;article;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;comorbidity;complete rockall score;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;heart infarction;hemiplegia;human;kidney disease;leukemia;liver disease;lymphoma;major clinical study;mortality;assessment of humans;observational study;patient assessment;peripheral vascular disease;retrospective study;ulcer;upper gastrointestinal bleeding,"Taha, A. S.;Saffouri, E.;McCloskey, C.;Craigen, T.;Angerson, W. J.",2014,,,0,
4346,Clinical developments in 2010: A review,,amiodarone;amitriptyline;beta adrenergic receptor blocking agent;bevacizumab;ticagrelor;cyklo f;dabigatran;dipeptidyl carboxypeptidase inhibitor;dodecyl sulfate sodium;donepezil;dronedarone;eltrombopag;epidermal growth factor receptor;febuxostat;flomax relief;galantamine;gefitinib;hemoglobin A1c;indacaterol;prednisone;low molecular weight heparin;metformin plus rosiglitazone;mixtard 30;movetis;opiate;pazopanib;prednisolone;pregabalin;prucalopride;rivaroxaban;rivastigmine;roflumilast;rosiglitazone;tamsulosin;tranexamic acid;unclassified drug;add on therapy;advanced cancer;Alzheimer disease;analgesia;anticoagulant therapy;aqueous solution;hematologic disease;cardiovascular risk;chronic obstructive lung disease;clinical decision making;constipation;cream;diabetes control;diabetes mellitus;diabetic patient;drug research;drug safety;wet macular degeneration;gene mutation;atrial fibrillation;heart failure;hemoglobin blood level;hepatitis B;hepatitis C;human;hyperuricemia;insulin treatment;kidney cancer;non small cell lung cancer;menstruation disorder;neuropathic pain;pain;patient safety;pharmacy;prostate hypertrophy;age related macular degeneration;rheumatoid arthritis;short survey;side effect;cerebrovascular accident;unspecified side effect;virus detection;adenuric;avandamet;avandia;avastin;brilique;daxas;lodotra;multaq;onbrez breezhaler;revolade;votrient,"Taheri, L.",2011,,,0,
4347,Cilostazol Use Is Associated with Reduced Risk of Dementia: A Nationwide Cohort Study,"Whether antiplatelet agents have a preventive effect on cognitive function remains unknown. We examined the potential association between the use of cilostazol, an antiplatelet agent and cyclic adenosine monophosphate phosphodiesterase 3 inhibitor, and the risk of dementia in an Asian population. Patients initiating cilostazol therapy between 1 January 2004 and 31 December 2009 without a prior history of dementia were identified from Taiwan's National Health Insurance database. Participants were stratified by age, sex, comorbidities, and comedication. The outcome of interest was all-cause dementia (ICD-9-CM codes 290.0, 290.4, 294.1, 331.0). Cox regression models were used to estimate the hazard ratio (HR) of dementia. The cumulative cilostazol dosage was stratified by quartile of defined daily doses using no cilostazol use as a reference. A total of 9148 participants 40 years of age or older and free of dementia at baseline were analyzed. Patients using cilostazol (n = 2287) had a significantly decreased risk of incident dementia compared with patients not using the drug [n = 6861; adjusted HR (aHR) 0.75; 95% confidence interval (CI) 0.61–0.92]. Notably, cilostazol use was found to have a dose-dependent association with reduced rate of dementia emergence (p for trend = 0.001). Subgroup analysis identified a decline of dementia in cilostazol users with diagnosed ischemic heart disease (aHR 0.44, 95% CI 0.24–0.83) and cerebral vascular disease (aHR 0.34, 95% CI 0.21–0.54). These observations suggest that cilostazol use may reduce the risk to develop dementia, and a high cumulative dose further decreases the risk of dementia. These findings should be examined further in randomized clinical trials.",cilostazol;age distribution;aged;article;cerebrovascular disease;cohort analysis;controlled study;dementia;disease association;drug megadose;drug use;female;follow up;human;ICD-9-CM;ischemic heart disease;low drug dose;major clinical study;male;outcome assessment;priority journal;sex difference,"Tai, S. Y.;Chien, C. Y.;Chang, Y. H.;Yang, Y. H.",2017,,10.1007/s13311-017-0512-4,0,
4348,Risk of dementia from proton pump inhibitor use in Asian population: A nationwide cohort study in Taiwan,"INTRODUCTION: Concerns have been raised regarding the potential association between proton pump inhibitor (PPI) use and dementia. OBJECTIVE: This study aimed to examine this association in an Asian population. METHODS: Patients initiating PPI therapy between January 1, 2000 and December 31, 2003 without a prior history of dementia were identified from Taiwan's National Health Insurance Research Database. The outcome of interest was all-cause dementia. Cox regression models were applied to estimate the hazard ratio (HR) of dementia. The cumulative PPI dosage stratified by quartiles of defined daily doses and adjusted for baseline disease risk score served as the primary variables compared against no PPI use. RESULTS: We analyzed the data of 15726 participants aged 40 years or older and free of dementia at baseline. PPI users (n = 7863; average follow-up 8.44 years) had a significantly increased risk of dementia over non-PPI users (n = 7863; average follow-up 9.55 years) (adjusted HR [aHR] 1.22; 95% confidence interval: 1.05-1.42). A significant association was observed between cumulative PPI use and risk of dementia (P for trend = .013). Subgroup analysis showed excess frequency of dementia in PPI users diagnosed with depression (aHR 2.73 [1.91-3.89]), hyperlipidemia (aHR 1.81 [1.38-2.38]), ischemic heart disease (aHR 1.55 [1.12-2.14]), and hypertension (aHR 1.54 [1.21-1.95]). CONCLUSIONS: An increased risk for dementia was identified among the Asian PPI users. Cumulative PPI use was significantly associated with dementia. Further investigation into the possible biological mechanisms underlying the relationship between dementia and PPI use is warranted.","0 (Proton Pump Inhibitors);Adult;Aged;Asian Continental Ancestry Group;Databases, Factual;Dementia/ chemically induced/ epidemiology;Depression/drug therapy/epidemiology;Female;Follow-Up Studies;Humans;Hyperlipidemias/drug therapy/epidemiology;Hypertension/drug therapy/epidemiology;Male;Middle Aged;Myocardial Ischemia/drug therapy/epidemiology;Proton Pump Inhibitors/administration & dosage/ adverse effects;Taiwan/epidemiology","Tai, S. Y.;Chien, C. Y.;Wu, D. C.;Lin, K. D.;Ho, B. L.;Chang, Y. H.;Chang, Y. P.",2017,,,0,
4349,Long-term use of benzodiazepines and related drugs among community-dwelling individuals with and without Alzheimer's disease,"The aim of this study was to investigate the prevalence of benzodiazepine and related drug (BZDR) use, especially long-term use, and associated factors among community-dwelling individuals with and without Alzheimer's disease (AD). We utilized data from the MEDALZ-2005 cohort, which includes all community-dwelling individuals diagnosed with AD in Finland at the end of 2005 and matched comparison individuals without AD. Register-based data included prescription drug purchases, comorbidities, and hospital discharge diagnoses. In this study, 24,966 individuals with AD and 24,985 individuals without AD were included. During the 4-year follow-up, we found that 45% (N = 11,312) of individuals with AD and 38% (N = 9534) of individuals without AD used BZDRs. The prevalence of long-term (>/= 180 days) BZDR use was more common among individuals with AD (30%) than individuals without AD (26%). The median durations of the first long-term use periods of BZDRs were 1.5 and 2 years for individuals with and without AD, respectively. Factors associated with long-term BZDR use included female sex, AD, schizophrenia, bipolar disorder, depression, coronary artery disease, and asthma/chronic obstructive pulmonary disease. The high prevalence of long-term BZDR use among individuals with AD is especially a cause for concern because long-term use may further impair cognition and may be associated with serious adverse events.","Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/diagnosis/epidemiology/*psychology;Benzodiazepines/*administration & dosage/adverse effects;Case-Control Studies;*Cognition/drug effects;Comorbidity;Drug Administration Schedule;Drug Prescriptions;Drug Utilization Review;Female;Finland/epidemiology;Humans;Inappropriate Prescribing;*Independent Living;Male;*Practice Patterns, Physicians';Prevalence;Registries;Risk Assessment;Risk Factors;Sex Factors;Time Factors;Treatment Outcome","Taipale, H.;Koponen, M.;Tanskanen, A.;Tolppanen, A. M.;Tiihonen, J.;Hartikainen, S.",2015,Jul,10.1097/yic.0000000000000080,0,
4350,Contribution of the long-term care insurance certificate for predicting 1-year all-cause readmission compared with validated risk scores in elderly patients with heart failure,"Objectives Readmission is a common and serious problem associated with heart failure (HF). Unfortunately, conventional risk models have limited predictive value for predicting readmission. The recipients of long-term care insurance (LTCI) are frail and have mental and physical impairments. We hypothesised that adjustment of the conventional risk score with an LTCI certificate enables a more accurate appreciation of readmission for HF. Methods We investigated 452 patients with HF who were followed up for 1 year to determine all-cause readmission. We obtained their clinical and socioeconomic data, including LTCI. The three clinical risk scores used in our evaluation were Keenan (2008), Krumholz (2000) and Charlson (1994). We used net reclassification improvement (NRI) to assess the incremental benefit. Results Patients with LTCI were significantly older, and had a higher prevalence of cerebrovascular disease and dementia than those without LTCI. One-year all-cause readmission (n=193, 43%) was significantly associated with all risk scores, receiving LTCI and the category of LTCI. Receiving LTCI was associated with readmission independent of all risk scores (HR, 1.59 to 1.63; all p<0.01). Adding LTCI to all risk scores led to a significantly improved reclassification, which was observed in the subgroup of patients with HF with preserved ejection fraction (≥50%) but not in the subgroup with reduced ejection fraction (<50%). Conclusions Possession of an LTCI certificate was independently associated with 1-year all-cause readmission after adjusting for validated clinical risk scores in patients with HF. Adding LTCI status significantly improved the model performance for readmission risk, particularly in patients with HF and preserved ejection fraction.",albumin;nonsteroid antiinflammatory agent;adult;albumin blood level;article;cerebrovascular disease;cognitive defect;drug use;female;frail elderly;health insurance;heart ejection fraction;heart failure;heart function;hospital readmission;human;long term care;major clinical study;male;prediction;predictive value;prevalence;priority journal;risk assessment;risk factor;scoring system,"Takahashi, K.;Saito, M.;Inaba, S.;Morofuji, T.;Aisu, H.;Sumimoto, T.;Ogimoto, A.;Ikeda, S.;Higaki, J.",2016,,10.1136/openhrt-2016-000501,0,
4351,Clinical experience of hyperbaric oxygen therapy (Japanese),,carbon monoxide;oxygen;Alzheimer disease;brain edema;brain embolism;Buerger disease;carbon monoxide intoxication;coma;decompression sickness;heart failure;hyperbaric oxygen;intraarterial drug administration;leg ulcer;major clinical study;resuscitation;therapy,"Takahashi, K.;Shiozawa, S.;Iwatsuki, K.",1974,,,0,
4352,Six-month mortality risks in long-term care residents with chronic ulcers,"Chronic ulcers are a common problem in long-term care. Residents with ongoing ulcers are often frail and at risk for mortality. This study evaluated the relationship between wound characteristics and other health predictors with 6-month mortality in nursing home residents. The subjects included were nursing home residents seen by the wound consult service from 1998 to 2007 with an ongoing chronic ulcer. This was a retrospective cohort study. Data were manually and electronically abstracted for each resident. Six-month mortality was collected as the primary outcome. Statistical comparisons were made using logistic regression with a final multivariant model. Four hundred and forty residents were seen with 411 records reviewed. Ulcer area was not associated with mortality; however, chronic ulcer number was associated with 6-month mortality with an odds ratio of 1.32 (95% CI 1.07-1.63). Other significant risk factors included heart failure, dementia, cancer, depression and blindness with all factors having an odds ratio greater than 1.75. Higher haemoglobin and venous insufficiency were protective of 6-month mortality. Ulcer number is an important predictor for 6-month mortality. The presence of multiple ulcers and comorbid health concerns may influence discussion of prognosis for healing and for potential end of life discussions. © 2008 The Authors.",aged;article;blindness;decubitus;dementia;depression;female;heart failure;human;long term care;major clinical study;male;medical record review;mortality;neoplasm;nursing home patient;priority journal;risk factor;ulcer;vein insufficiency;wound care,"Takahashi, P. Y.;Cha, S. S.;Kiemele, L. J.",2008,,,0,
4353,A Cross-sectional Evaluation of the Association Between Lower Extremity Venous Ulceration and Predictive Risk Factors,"Objective. This study sought to identify the association between a history of venous ulceration and demographic, vascular, and nonvascular risk factors in a healthy cohort of older adults. PATIENTS: All patients older than 60 years impanelled within a primary care practice residing in Olmsted County, Minnesota on January 1, 2005 were enrolled. METHODS: This was a cross-sectional study utilizing administrative data from an outpatient practice. The primary outcome was a previous history of venous ulceration. The predictor risk variables included demographic risk factors and comorbid health conditions. Data analysis involved univariable comparison between venous ulceration and the risk variables. The significant variables were placed in a final multivariable model. RESULTS: The authors reviewed the records of 12,650 patients and identified 581 (4.6%) who had a history of venous ulceration. Venous insufficiency had the highest association with venous ulceration with an odds ratio of more than 900. Decubitus ulceration also had a high association with an odds ratio of 2.66 [95% CI: 1.74-4.07]. Older age, female gender, previous hospitalization, diabetes, renal insufficiency, peripheral vascular disease, congestive heart failure, depression, degenerative arthritis, peripheral neuropathy, hypothyroidism, and falls were associated with venous ulceration. Marital status, hyperlipidemia, hip fracture, chronic obstructive pulmonary disease, cancer, and dementia were not associated with venous ulceration. CONCLUSION: The relationship between venous insufficiency and venous ulceration appears to be very strong, as expected, given the etiology of disease. Conditions such as vascular disease and vascular risk factors were also highly associated with ulceration. Interestingly, decubitus ulceration as a risk was a novel finding.",,"Takahashi, P. Y.;Kiemele, L.;Cha, S. S.;Chandra, A.",2009,Nov,,0,
4354,Sudden collapse after minor head injury in an elderly man; association with cardiocerebral decompensation and fat embolism syndrome,"An 86-year-old man suffering from right hemiparesis and dementia fell from a stretcher and sustained laceration and bruising to his right eyebrow. He was brought to an emergency room, and his wounds were treated. Shortly after discharge, his respiratory and mental status dramatically declined. Despite supportive care, he died about three hours after re-admission. Autopsy revealed a minor laceration to the eyebrow with minor intracranial injuries, mild cardiomegaly (370 g) with right atrial dilatation, pericardial effusion (170 ml) and marked pulmonary edema. Microscopically, fatty droplets were observed in the lung capillaries, the glomeruli and the intracerebral vessels. Although the extent of the original injuries seemed insufficient to cause systemic fat embolism syndrome (FES), the patient's decreased cardiac reserves and stress associated with this event likely contributed to his death consistent with the physiochemical model of FES pathogenesis. © 2007 Elsevier Ltd and FFLM.",aged;article;autopsy;brain blood vessel;brain damage;brain dysfunction;cardiomegaly;case report;collapse;computer assisted tomography;congestive heart failure;dementia;disease association;emergency ward;eyebrow;fat embolism;glomerulus;head injury;heart atrium enlargement;heart disease;heart stress;hemiparesis;histopathology;hospital discharge;hospital readmission;human;laceration;lung capillary;lung edema;male;mental disease;pathogenesis;pericardial effusion;physicochemical model;respiratory tract disease;skin bruising;sudden death;suturing method;thorax radiography,"Takahashi, S.;Kanetake, J.;Kanawaku, Y.;Funayama, M.",2008,,,0,
4355,Treatment of hypertension in the elderly,"Hypertension guideline has been revised as JSH2014. Because the elderly show marked individual differences in the physiological function, the therapeutic strategies should be individually selected, considering their QOL. As to general guidelines, drug therapy should be indicated for patients with a blood pressure of </= 140/90mmHg on principle. However, treatment indication must be individually assessed in persons, aged over 75 years, with a systolic blood pressure of 140-149 mmHg or frail elderly. Target blood pressure in persons aged 65-74 years should be < 140/90mmHg and that in those aged over 75 years should be < 150/90 mmHg. If treatment is well tolerated, more aggressive blood pressure control < 140/90mmHg may further improve the outcome. In patients with coronary artery disease, the risk of cardiac events may increase if diastolic blood pressure is < 70mmHg. Therefore, blood pressure control should be performed while monitoring the ischemic findings.",Aged;Blood Pressure Monitors;Dementia;Humans;Hypertension/diagnosis/physiopathology/*therapy;Life Style;*Practice Guidelines as Topic;Risk Factors,"Takami, Y.;Rakugi, H.",2015,Apr,,0,
4356,Detrimental Effects of Centrally Administered Angiotensin II are Enhanced in a Mouse Model of Alzheimer Disease Independently of Blood Pressure,"BACKGROUND: The significance of brain angiotensin II in Alzheimer disease (AD) is unclear. METHODS AND RESULTS: To examine the role of brain angiotensin II in AD, intracerebroventricular angiotensin II infusion was performed on 5XFAD mice, a mouse model of AD, and wild-type mice, and the detrimental effects of brain angiotensin II was compared between the 2 strains of mice. Intracerebroventricular angiotensin II infusion significantly impaired cognitive function in 5XFAD mice but not in wild-type mice. This vulnerability of 5XFAD mice to brain angiotensin II was associated with enhancement of hippocampal inflammation and oxidative stress and with increased cerebrovascular amyloid beta deposition. We also compared the effect of brain angiotensin II on the heart and skeletal muscle between the 2 strains because AD is associated with heart failure and sarcopenia. We found that cardiac compensatory response of 5XFAD mice to brain angiotensin II-induced hypertension was less than that of wild-type mice. Brain angiotensin II caused skeletal muscle atrophy and injury in 5XFAD mice more than in wild-type mice. CONCLUSIONS: Brain angiotensin II seems to be involved in cognitive impairment and brain injury in AD, which is associated with oxidative stress, inflammation, and cerebral amyloid angiopathy. Further, brain angiotensin II may participate in cardiac disease and sarcopenia observed in AD.",Alzheimer disease;angiotensin II;cerebrovascular disease;cognitive impairment;dementia;sarcopenia,"Takane, K.;Hasegawa, Y.;Lin, B.;Koibuchi, N.;Cao, C.;Yokoo, T.;Kim-Mitsuyama, S.",2017,Apr 20,,0,
4357,Synchronous tumor with diffuse large B-cell lymphoma and ameboma,,C reactive protein;cyclophosphamide;insulin;interleukin 2 receptor;lactate dehydrogenase;metronidazole;prednisolone;rituximab;vincristine;abdominal pain;aged;ameboma;article;case report;colonoscopy;computer assisted tomography;dementia;diarrhea;Entamoeba histolytica;fatigue;fever;heart infarction;hemoglobin blood level;human;Human immunodeficiency virus;hypertension;large cell lymphoma;leukocyte count;lymphadenopathy;male;non insulin dependent diabetes mellitus;priority journal;protein blood level;thrombocyte count;weight reduction,"Takashima, M.;Kakimoto, T.;Saito, H.;Misaki, S.;Onishi, Y.;Kasugai, T.;Akuta, K.;Kasahara, H.;Yamamoto, K.;Doi, Y.;Ujiie, H.;Sugahara, H.;Hoshida, Y.;Sakoda, H.",2011,,,0,
4358,Alteration of fatal 1:1 conducted atrial flutter to less conducted ratio by landiolol infusion,"An 84-year-old male patient with a past history of atrial-flutter-fibrillation and dementia underwent an urgent femoral neck fracture surgery. Preoperative electrocardiography demonstrated atrial flutter (AFL) with ventricular conduction at a ratio of 2:1–4:1, and transthoracic echocardiography showed severe left ventricular dysfunction with Ejection Fraction of 14.6 %. Femoral nerve block and Lateral femoral cutaneous nerve block with sedation was planned for the surgery. Upon entry to the operating room, ECG showed 2:1 conducted AFL at the rate of 128 beats min−1. Due to the stimulation of urethral catheter insertion, it has altered to 1:1 conducted AFL. Loading dose of landiolol hydrochloride 7.5 mg followed by 1.5–3 μg/kg/min continuous administration was given, which had decreased the conduction ratio to 2:1 without causing hypotension. A further episode of 1:1 conducted AFL occurred when the pin was inserted to the thighbone, which caused circulatory collapse. Additional bolus dose of landiolol immediately altered it to 2:1 before operating cardioversion and stabilized the hemodynamics. He maintained AFL with 2:1 conduction thereafter, and 1:1 conduction was never seen postoperatively even after discontinuation of landiolol.",donepezil;enalapril maleate;landiolol;propofol;sevoflurane;spironolactone;tiapride;warfarin;aged;article;atrial fibrillation;cardioversion;case report;continuous infusion;dementia;drug infusion;drug withdrawal;echography;electrocardiography;extubation;femoral nerve;femur neck fracture;fracture fixation;heart atrium flutter;heart left ventricle failure;heart ventricle conduction;hip pain;human;loading drug dose;male;medical history;mitral valve regurgitation;nerve block;operating room;operation duration;preoperative evaluation;sedation;shock;supraglottic airway device;transthoracic echocardiography;urethral catheter;urethral catheterization;very elderly,"Takata, J.;Haruyama, N.;Arashi, T.;Mae, T.",2016,,,0,
4359,Torsades de Pointes with QT prolongation related to donepezil use,"An 83-year-old female, who had a history of anterior myocardial infarction, was treated for Alzheimer's disease with donepezil. She suffered from repeated diarrhea and vomiting, and experienced syncope. She was admitted to our hospital and was diagnosed with acute colitis and syncope. On admission, her heart rate was 54 beats/min with regular rhythm. Laboratory data showed a low plasma potassium level. Electrocardiogram (ECG) showed poor R progression, ST elevation, negative T in precordial leads, and marked QT prolongation. Transthoracic echocardiogram showed the enlargement of the left atrium and aneurysmal area at the apex. Torsades de Pointes (TdP) with syncope and convulsion were confirmed on ECG monitoring twice after admission. We treated her with potassium chloride and started magnesium sulfate and lidocaine, and then added isoprenaline injection. After these treatments, her heart rate increased and we did not detect TdP again. With the aging population in Japan, prescriptions for donepezil are increasing. We have to be vigilant for syncope in patients taking donepezil, which is possibly related to QT prolongation and TdP. © 2009 Japanese College of Cardiology.",alanine aminotransferase;aspartate aminotransferase;bisoprolol;brain natriuretic peptide;cilostazol;donepezil;isoprenaline;lidocaine;magnesium sulfate;orciprenaline;potassium;potassium chloride;urea;aged;alanine aminotransferase blood level;Alzheimer disease;angiocardiography;article;artificial heart pacemaker;aspartate aminotransferase blood level;case report;colitis;convulsion;coronary artery circumflex branch;coronary artery obstruction;diabetes mellitus;diarrhea;drug dose reduction;drug withdrawal;electrocardiography;electrostimulation;female;heart aneurysm;heart atrium enlargement;atrial fibrillation;heart ejection fraction;heart electrophysiology;heart infarction;heart murmur;heart rate;heart rhythm;heart ventricle enddiastolic pressure;human;hypertension;hypovolemia;left anterior descending coronary artery;leukocyte count;pallor;potassium blood level,"Takaya, T.;Okamoto, M.;Yodoi, K.;Hata, K.;Kijima, Y.;Nakajima, H.;Nishikawa, Y.;Kita, T.;Ito, M.;Seo, T.;Kawashima, S.",2009,,,0,
4360,QT prolongation associated with memantine in Alzheimer's disease,,acetylsalicylic acid;benidipine;carvedilol;clopidogrel;furosemide;iron;lansoprazole;memantine;pitavastatin;potassium;spironolactone;trichlormethiazide;warfarin;acute heart infarction;aged;Alzheimer disease;case report;disease exacerbation;drug dose increase;drug dose reduction;drug withdrawal;electrocardiography;female;heart failure;heart hypertrophy;human;kidney dysfunction;letter;lung congestion,"Takehara, H.;Suzuki, Y.;Someya, T.",2015,,,0,
4361,Terminal-stage prognostic analysis in candidemia,"Background: Candidemia has an extremely high mortality rate but is not always the direct cause of death. Therefore, determining the effect of candidemia on death is extremely difficult. Methods: We investigated prognostic factors in patients with culture-proven candidemia at 2 Japanese university teaching hospitals from April 2009 through May 2013. To examine the effects of comorbid conditions, the Charlson comorbidity index was determined, and patients were subjectively classified into 3 clinical prognostic stages (terminal [death expected within 1 month], semiterminal [death expected within 6 months], and nonterminal [expected to live more than 6 months]). The Cox proportional hazard model was used for univariate and multivariate analyses of factors possibly affecting survival. Results: On univariate analysis, factors identified as associated with an increased mortality rate were: admission to an internal medicine department, Candida glabrata, immunosuppression, hypotension, hypoxemia, and a terminal prognostic stage. Factors associated with a decreased mortality rate were: serum albumin, endophthalmitis investigation, and nonterminal prognostic stage. The mortality rate was significantly related to the prognostic stage on multivariate analysis (P<0.0001), was increased by age (P=0.0014), and was decreased by a delayed start of antifungal therapy (P=0.0374). Conclusion: In contrast to earlier studies, the present study has found that later antifungal usage is associated with a decreased mortality rate in cases of candidemia. More important than candidemia in causing the deaths of patients with candidemia were the patients' background and comorbidity status. Therefore, rigorous methods should be used when investigating causes of death in terminally ill patients with candidemia.",antifungal agent;serum albumin;acquired immune deficiency syndrome;adolescent;adult;aged;article;Candida albicans;Candida glabrata;candidemia;catheter infection;central venous catheter;cerebrovascular disease;Charlson Comorbidity Index;child;chronic lung disease;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;endophthalmitis;female;gastrointestinal infection;heart infarction;hemiplegia;human;hypotension;hypoxemia;immunosuppressive treatment;infant;investigative procedures;liver disease;lymphoma;major clinical study;male;mortality;newborn;peripheral vascular disease;prognosis;retrospective study;terminal disease;terminally ill patient;ulcer;urinary tract infection,"Takuma, T.;Shoji, H.;Niki, Y.",2015,,,0,
4362,Are patients with cognitive impairment after stroke at increased risk for developing Alzheimer disease? 2 (multiple letters),,academic achievement;adult;aged;alcohol consumption;Alzheimer disease;anamnesis;cognitive defect;confidence interval;data analysis;demography;diabetes mellitus;female;follow up;atrial fibrillation;human;hypertension;ischemic heart disease;letter;major clinical study;male;Mini Mental State Examination;priority journal;risk assessment;risk factor;smoking;cerebrovascular accident,"Talelli, P.;Ellul, J.;Honig, L. S.;Mayeux, R.",2004,,,0,
4363,Cardiovascular risk in cognitively preserved elderlies is associated with glucose hypometabolism in the posterior cingulate cortex and precuneus regardless of brain atrophy and apolipoprotein gene variations,"Cardiovascular risk factors (CVRF) possibly contribute to the emergence of Alzheimer's disease (AD). Fluorodeoxyglucose-positron emission tomography (FDG-PET) has been widely used to demonstrate specific patterns of reduced cerebral metabolic rates of glucose (CMRgl) in subjects with AD and in non-demented carriers of the apolipoprotein epsilon4 (APOE epsilon4) allele, the major genetic risk factor for AD. However, functional neuroimaging studies investigating the impact of CVRF on cerebral metabolism have been scarce to date. The present FDG-PET study investigated 59 cognitively preserved elderlies divided into three groups according to their cardiovascular risk based on the Framingham 10-year risk Coronary Heart Disease Risk Profile (low-, medium-, and high-risk) to examine whether different levels of CVRF would be associated with reduced CMRgl, involving the same brain regions affected in early stages of AD. Functional imaging data were corrected for partial volume effects to avoid confounding effects due to regional brain atrophy, and all analyses included the presence of the APOE epsilon4 allele as a confounding covariate. Significant cerebral metabolism reductions were detected in the high-risk group when compared to the low-risk group in the left precuneus and posterior cingulate gyrus. This suggests that findings of brain hypometabolism similar to those seen in subjects with AD can be detected in association with the severity of cardiovascular risk in cognitively preserved individuals. Thus, a greater knowledge about how such factors influence brain functioning in healthy subjects over time may provide important insigths for the future development of strategies aimed at delaying or preventing the vascular-related triggering of pathologic brain changes in the AD.",Aged;Alleles;Apolipoprotein E4/*genetics/metabolism;Apolipoproteins/genetics/metabolism;Atrophy/genetics/metabolism/pathology;Brain/metabolism/*pathology/radionuclide imaging;Cardiovascular Diseases/etiology/*genetics/physiopathology;*Cognition;DNA/genetics;Female;Genetic Predisposition to Disease;Genetic Variation;Genotype;Glucose/*metabolism;Gyrus Cinguli/*metabolism/pathology/radionuclide imaging;Humans;Hypoglycemia/*complications/genetics/metabolism;Magnetic Resonance Imaging;Male;Positron-Emission Tomography;Risk Factors,"Tamashiro-Duran, J. H.;Squarzoni, P.;de Souza Duran, F. L.;Curiati, P. K.;Vallada, H. P.;Buchpiguel, C. A.;Lotufo, P. A.;Wajngarten, M.;Menezes, P. R.;Scazufca, M.;de Toledo Ferraz Alves, T. C.;Busatto, G. F.",2013,Jun,10.1007/s11357-012-9413-y,0,
4364,Compliance with recommendations in secondary prevention of stroke in primary care,"Objective: Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance. Design: Multi-centre cross-sectional. Setting: Health primary care centres in a metropolitan area (944,280 inhabitants). Participants: Patients aged 18. years and over with ischemic brain disease diagnosis prior to 6. months before the study. Main measurements: Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event. Good adherence was considered when BP <. 140/90 mmHg, LDL-cholesterol <. 100 mg/dL, smoking abstention and preventive drugs prescription (anti-platelet/anticoagulants, statins and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-antagonists or diuretics) during the last 18. months. Results: A total of 21,976 patients, mean age 73.12 years (SD: 12.13), 48% women, 72.7% with stroke. Co-morbidity: hypertension 70.8%, dyslipidemia 55.1%, DM 30.9%, atrial fibrillation 14.1%, ischemic heart disease 13.5%, chronic renal failure 12.5%, heart failure 8.8%, peripheral arterial disease 6.2%, dementia 7.8%. No record was found for smoking in 3.7%, for BP in 3.5% and for LDL in 6.5%. Optimal control: abstention smoking in 3.7%, BP <. 140/90 in 65.7% and LDL <. 100 mg/dL in 41.0%. Treatment: 86.2% anti-platelet/anticoagulants, 61.3% statins and 61.8% angiotensin-converting-enzyme inhibitors, angiotensin-receptor-antagonists or diuretic. Registration and risk factors control was higher in 66-79. years aged and lower in 18-40. years aged. Conclusions: The implementation of clinical guidelines recommendations for stroke prevention in primary care must be improved, especially among younger population. Organizational changes and more active involvement by professionals and strategies against therapeutic inertia must be taken. Copyright © 2016 Elsevier Espana, S.L.U.",adult;aged;atrial fibrillation;blood pressure monitoring;brain infarction;brain ischemia;cardiovascular system;chronic kidney failure;clinical trial;comorbidity;consensus development;controlled clinical trial;controlled study;dementia;diagnosis;dyslipidemia;female;heart failure;human;hypertension;information processing;ischemic heart disease;major clinical study;male;multicenter study;nurse;prescription;prevention;primary health care;registration;risk factor;secondary prevention;smoking;thrombocyte;young adult;angiotensin receptor antagonist;anticoagulant agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;endogenous compound;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein;low density lipoprotein cholesterol,"Tamayo-Ojeda, C;Parellada-Esquius, N;Salvador-Gonzalez, B;Oriol-Toron, Pa;Rodriguez-Garrido, Md;Munoz-Segura, D",2016,,10.1016/j.aprim.2016.07.004,0,
4365,Compliance with recommendations in secondary prevention of stroke in primary care,"Objective Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance. Design Multi-centre cross-sectional. Setting Health primary care centres in a metropolitan area (944,280 inhabitants). Participants Patients aged 18 years and over with ischemic brain disease diagnosis prior to 6 months before the study. Main measurements Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event. Good adherence was considered when BP < 140/90 mmHg, LDL-cholesterol < 100 mg/dL, smoking abstention and preventive drugs prescription (anti-platelet/anticoagulants, statins and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-antagonists or diuretics) during the last 18 months. Results A total of 21,976 patients, mean age 73.12 years (SD: 12.13), 48% women, 72.7% with stroke. Co-morbidity: hypertension 70.8%, dyslipidemia 55.1%, DM 30.9%, atrial fibrillation 14.1%, ischemic heart disease 13.5%, chronic renal failure 12.5%, heart failure 8.8%, peripheral arterial disease 6.2%, dementia 7.8%. No record was found for smoking in 3.7%, for BP in 3.5% and for LDL in 6.5%. Optimal control: abstention smoking in 3.7%, BP < 140/90 in 65.7% and LDL < 100 mg/dL in 41.0%. Treatment: 86.2% anti-platelet/anticoagulants, 61.3% statins and 61.8% angiotensin-converting-enzyme inhibitors, angiotensin-receptor-antagonists or diuretic. Registration and risk factors control was higher in 66-79 years aged and lower in 18-40 years aged. Conclusions The implementation of clinical guidelines recommendations for stroke prevention in primary care must be improved, especially among younger population. Organizational changes and more active involvement by professionals and strategies against therapeutic inertia must be taken.",angiotensin receptor antagonist;anticoagulant agent;antithrombocytic agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;adult;aged;anticoagulant therapy;article;atrial fibrillation;blood pressure measurement;brain ischemia;cardiovascular disease;cholesterol blood level;chronic kidney failure;comorbidity;cross-sectional study;dementia;demography;dyslipidemia;female;groups by age;heart failure;human;hypertension;ischemic heart disease;major clinical study;male;multicenter study;peripheral occlusive artery disease;primary medical care;protocol compliance;risk factor;secondary prevention;smoking;smoking cessation;treatment duration,"Tamayo-Ojeda, C.;Parellada-Esquius, N.;Salvador-González, B.;Oriol-Torón, P. Á;Rodríguez-Garrido, M. D.;Muñoz-Segura, D.",2017,,10.1016/j.aprim.2016.07.004,0,
4366,[Compliance with recommendations in secondary prevention of stroke in primary care] Seguimiento de las recomendaciones en prevencion secundaria cerebrovascular en atencion primaria,"OBJECTIVE: Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance. DESIGN: Multi-centre cross-sectional. SETTING: Health primary care centres in a metropolitan area (944,280 inhabitants). PARTICIPANTS: Patients aged 18years and over with ischemic brain disease diagnosis prior to 6months before the study. MAIN MEASUREMENTS: Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event. Good adherence was considered when BP <140/90 mmHg, LDL-cholesterol <100 mg/dL, smoking abstention and preventive drugs prescription (anti-platelet/anticoagulants, statins and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-antagonists or diuretics) during the last 18months. RESULTS: A total of 21,976 patients, mean age 73.12 years (SD: 12.13), 48% women, 72.7% with stroke. Co-morbidity: hypertension 70.8%, dyslipidemia 55.1%, DM 30.9%, atrial fibrillation 14.1%, ischemic heart disease 13.5%, chronic renal failure 12.5%, heart failure 8.8%, peripheral arterial disease 6.2%, dementia 7.8%. No record was found for smoking in 3.7%, for BP in 3.5% and for LDL in 6.5%. Optimal control: abstention smoking in 3.7%, BP <140/90 in 65.7% and LDL <100 mg/dL in 41.0%. TREATMENT: 86.2% anti-platelet/anticoagulants, 61.3% statins and 61.8% angiotensin-converting-enzyme inhibitors, angiotensin-receptor-antagonists or diuretic. Registration and risk factors control was higher in 66-79years aged and lower in 18-40years aged. CONCLUSIONS: The implementation of clinical guidelines recommendations for stroke prevention in primary care must be improved, especially among younger population. Organizational changes and more active involvement by professionals and strategies against therapeutic inertia must be taken.",Accidente cerebrovascular;Atencion primaria;Cerebral infarction;Ictus;Prevencion secundaria;Primary health care;Secondary prevention;Stroke,"Tamayo-Ojeda, C.;Parellada-Esquius, N.;Salvador-Gonzalez, B.;Oriol-Toron, P. A.;Rodriguez-Garrido, M. D.;Munoz-Segura, D.;en representacion del grupo de investigacion del, proyecto",2017,Jun - Jul,,0,
4367,Impact of stroke care unit on patient outcomes in a community hospital,"Background and Purpose-Geographically distinct multidisciplinary stroke care units (SCUs) have been shown by systematic reviews to have superior patient outcomes compared with conventional care in general medical wards. However, the effectiveness of SCUs in smaller North American community hospitals is less well defined. The objective of this study was to determine the impact of establishing a specialized SCU at a community hospital on patient outcomes. Methods-This is a retrospective cohort study of 805 patients with stroke admitted to 2 community hospitals in Edmonton, Canada, from 2003 to 2009 using an administrative database. Stroke was identified by International Classification of Disease, 10th Edition, codes. One of the community hospitals established a SCU on January 1, 2007. This date was used to subdivide the patient population into 2 cohorts: phase 1 from 2003 to 2006 and phase 2 from 2007 to 2009. Outcomes measured were mortality, discharge disposition, length of stay, and complications and were adjusted for age, sex, and medical comorbidities. Results-Patient mortality decreased significantly from 17.1% to 8.3% (adjusted odds ratio [OR], 0.54; 95% confidence interval [CI], 0.31-0.95) after SCU implementation, whereas it remained 19% at the control hospital. SCU also increased the odds that patients would be discharged home independently (adjusted OR, 2.17; 95% CI, 1.49-3.15; P>0.001] without increasing length of stay. Conclusions-Establishing a SCU in a community hospital not only increases the survival of stroke patients, but also the proportion of patients discharged home to live independently. The benefits of SCU reported in larger tertiary centers extend to smaller community hospitals with more limited resources.© 2013 American Heart Association Inc.",age;aged;article;cerebrovascular accident;Charlson Comorbidity Index;cohort analysis;community hospital;comorbidity;congestive heart failure;controlled study;deep vein thrombosis;dementia;diabetes mellitus;dyslipidemia;falling;female;gender;atrial fibrillation;heart infarction;home care;hospital admission;hospital discharge;hospital personnel;human;hypertension;International Classification of Diseases;kidney disease;length of stay;lung embolism;major clinical study;male;mortality;outcome assessment;patient monitoring;peripheral vascular disease;pneumonia;priority journal;rehabilitation care;retrospective study;stroke patient;stroke unit;tertiary care center;urinary tract infection,"Tamm, A.;Siddiqui, M.;Shuaib, A.;Butcher, K.;Jassal, R.;Muratoglu, M.;Buck, B. H.",2014,,,0,
4368,Impact of comorbidity on lung cancer survival,"Lung cancer is associated with smoking and age, both of which are associated with comorbidity. We evaluated the impact of comorbidity on lung cancer survival. Data on 56 comorbidities were abstracted from the records of a cohort of 1,155 patients. Survival effects were evaluated with Cox regression (outcome crude death). The adjusted R2 statistic was used to compare the survival variation explained by predictive variables. No comorbidity was observed in 11.7% of patients, while 54.3% had 3 or more (mean 2.97) comorbidities. In multivariate analysis, 19 comorbidities were associated with survival: HIV/AIDS, tuberculosis, previous metastatic cancer, thyroid/glandular diseases, electrolyte imbalance, anemia, other blood diseases, dementia, neurologic disease, congestive heart failure, COPD, asthma, pulmonary fibrosis, liver disease, gastrointestinal bleeding, renal disease, connective tissue disease, osteoporosis and peripheral vascular disease. Only the latter was protective. Some of the hazards of comorbidities were explained by more directly acting comorbidities and/or receipt of treatment. Stage explained 25.4% of the survival variation. In addition to stage, the 19 comorbidities explained 6.1%, treatments 9.2%, age 3.7% and histology 1.3%. Thirteen uncommon comorbidities (prevalence <6%) affected 21.2% of patients and explained 3.5% of the survival variation. Comorbidity count and the Charlson index were significant predictors but explained only 2.5% and 2.0% of the survival variation, respectively. Comorbidity has a major impact on survival in early- and late-stage disease, and even infrequent deleterious comorbidities are important collectively. Comorbidity count and the Charlson index failed to capture much information. Clinical practice and trials need to consider the effect of comorbidity in lung cancer patients. © 2002 Wiley-Liss, Inc.",antineoplastic agent;acquired immune deficiency syndrome;adult;anemia;article;hematologic disease;cancer chemotherapy;cancer epidemiology;cancer radiotherapy;cancer staging;cancer surgery;cancer survival;cancer therapy;comorbidity;congestive heart failure;connective tissue disease;controlled study;dementia;electrolyte disturbance;female;gastrointestinal hemorrhage;human;Human immunodeficiency virus infection;kidney disease;liver disease;lung cancer;lung fibrosis;male;metastasis;multivariate analysis;neurologic disease;osteoporosis;peripheral vascular disease;prevalence;priority journal;smoking;survival rate;survival time;thyroid disease;tuberculosis,"Tammemagi, C. M.;Neslund-Dudas, C.;Simoff, M.;Kvale, P.",2003,,,0,
4369,Extra gastrointestinal manifestation of Helicobacter pylori-facts or myth?,"Introduction H. pylori has been associated with several conditions and this has been labelled as the extra-gastrointestinal manifestation of H. pylori. To prove a causal relationship between HP and a particular disease, certain criteria have to be fullfilled. Firstly there has to be a close association between the two; secondly there has to be a biologically plausible mechanism; thirdly HP infection should precede the development of the disease and fourthly, eradication of HP should result in an improvement in the condition or cure of the disease. There are only two conditions that have the most convincing evidence: idiopathic thrombocytopenia purpura (ITP) and unexplained iron deficiency anemia. Many studies had shown a higher prevalence of HP in ITP and unexplained IDA although there are also conflicting reports. H. pylori eradication in these cases have been shown to result in clinical benefit to the patient. There are also potentially plausible mechanisms that explain the link between HP and ITP and IDA. The role of HP in coronary artery disease and stroke was also proposed. The available epidemiological data was controversial. Most of the correlations between HP positivity and vascular risk factors were largely due to chance or publication bias. The proposed mechanism linking H. pylori to ischemic stroke is similar to ischemic heart disease. Cross reacting antibodies to HSP are a risk factor for carotid atherosclerosis. An alternative mechanism is hyperhomocysteinaemia although this was not confirmed by others. CagA positive H. pylori may be an important factor in the association. The role of HP in Parkinson disease, Alzheimer's disease has also been studied. Although there are some exciting data to suggest an association, the studies were small and need to be confirmed in a larger study. Both ghrelin and leptin are important appetite hormones secreted from the stomach. Ghrelin is an important hormone in weight regulation and eating behaviour. As ghrelin is primarily produced and secreted by the gastric mucosa, H. pylori infection may impair gastric ghrelin production and therefore H. pylori eradication may be related to body weight change. Nweneka & Prentice carried out a systematic review and showed lower circulating ghrelin in H. pylori positive patients in 17 studies while 10 studies reported no difference. A meta-analysis of 19 studies involving 1801 patients showed a significantly higher circulating ghrelin concentration in H. pylori negative subjects than in H. pylori positive subjects. However, eradicating H. pylori did not alter the ghrelin levels. In summary, the higher prevalence of H. pylori in obesity is not proven. The evidence supporting the role of HP in plasma ghrelin and leptin is also conflicting and non conclusive. Although there is some changes in plasma leptin and ghrelin level following H. pylori eradication and potentially may explain the association, a larger randomized controlled trial is required. The role of H. pylori infection in chronic urticaria was also proposed. There seems to be a correlation between density of bacteria colonization and cutaneous symptoms, as well as the intensity of inflammation. In addition, 80% of the patient experienced complete remission after receiving H. pylori eradication therapy (Abdou et al., Fukuda et al., Di Campli et al.). However, Hellmig et al. studied 74 urticaria patients with positive H. pylori and found that neither the prevalence nor the eradication therapy had any impact on the clinical course of chronic urticaria. Therefore the cutaneous manifestation of H. pylori remained controversial. Randomized controlled trials with adequate sample size are required before a firm conclusion can be drawn. Helicobacter pylori has also been implicated in cirrhotic patients, hepatic encephalopathy and hepatocellular carcinoma (HCC). Pellicano et al. examined 254 patients with hepatitis C cirrhosis and found a very high prevalence of H. pylori infection in cirrhotic patients. In a case controlled study (Zullo et al.), there was no correlation in bacterial d nsity and cagA prevalence between cirrhotic patients and controls. H. pylori has been found to be more prevalent among patients with HCC than in controls (78% vs 54%, OR 3.02, p < 0.05) (Leone et al., Dasani et al., Chen et al.). However, there were studies that failed to demonstrate a positive association between HP and blood ammonia level and found no difference in H. pylori infected and noninfected subjects. H. pylori eradication was also not associated with a reduction in ammonia level. The incidence of PUD is high in cirrhotic patients. While the underlying reasons may be similar to non-cirrhotic patients, there may be other factors to account for the increase prevalence of peptic ulcer disease in cirrhotic patients. In a case controlled study, Wu and colleagues showed that duodenal ulcers were more common in cirrhotic patients although the prevalence of H. pylori was similar among the compensated, decompensated cirrhotics and normal controls. Lo et al. also demonstrated that the prevalence of H. pylori in cirrhotic patients with duodenal ulcer was only 52% and eradicating H. pylori in cirrhotic patients did not effectively reduce ulcer recurrence. Recurrent ulcers were noted in 44% of persistent H. pylori positive patients and 48% of H. pylori negative patients. This was further reinforced by Tzathas et al. who revealed that H. pylori eradication does not protect cirrhotics from ulcer recurrence. They recommended PPI maintenance therapy to prevent ulcer recurrence. Vergara et al. did a meta-analysis and identified 7 studies with a total of 976 patients with cirrhosis and found that H. pylori in patients with peptic ulcer disease was higher than those without. Kamalaporn et al. studied 130 cirrhotics and by multivariate analysis concluded that H. pylori infection and cirrhosis were independently associated with peptic ulcer disease. Conclusion: Many disease association with H. pylori have been studied but to date, the best available evidence is with ITP and unexplained IDA. There is a continue interest to study the role of H. pylori in extragastrointestinal diseases and the evidence is accumulating. Many diseases have been associated but the available evidence are often conflicting. More good quality studies are needed to confirm such association before we can recommend such strategy in clinical practice.",Helicobacter pylori;Asian;literature;pylorus;human;patient;prevalence;infection;randomized controlled trial (topic);idiopathic thrombocytopenic purpura;peptic ulcer;recurrent peptic ulcer;liver cirrhosis;duodenum ulcer;controlled study;eradication therapy;chronic urticaria;plasma;meta analysis;density;risk factor;hepatic encephalopathy;liver cell carcinoma;hepatitis C;ammonia blood level;coronary artery disease;iron deficiency anemia;Parkinson disease;ischemic heart disease;Alzheimer disease;appetite;brain ischemia;publishing;epidemiological data;stomach;weight;eating;stomach mucosa;weight change;systematic review;ulcer;maintenance therapy;multivariate analysis;obesity;randomized controlled trial;stroke;disease association;clinical practice;bacterium;inflammation;remission;urticaria;disease course;sample size;carotid atherosclerosis;ghrelin;leptin;hormone;ammonia;cross reacting antibody,"Tan, H-J",2012,,10.1111/j.1440-1746.2011.06998.x,0,4370
4370,Extra gastrointestinal manifestation of Helicobacter pylori-facts or myth?,"Introduction H. pylori has been associated with several conditions and this has been labelled as the extra-gastrointestinal manifestation of H. pylori. To prove a causal relationship between HP and a particular disease, certain criteria have to be fullfilled. Firstly there has to be a close association between the two; secondly there has to be a biologically plausible mechanism; thirdly HP infection should precede the development of the disease and fourthly, eradication of HP should result in an improvement in the condition or cure of the disease. There are only two conditions that have the most convincing evidence: idiopathic thrombocytopenia purpura (ITP) and unexplained iron deficiency anemia. Many studies had shown a higher prevalence of HP in ITP and unexplained IDA although there are also conflicting reports. H. pylori eradication in these cases have been shown to result in clinical benefit to the patient. There are also potentially plausible mechanisms that explain the link between HP and ITP and IDA. The role of HP in coronary artery disease and stroke was also proposed. The available epidemiological data was controversial. Most of the correlations between HP positivity and vascular risk factors were largely due to chance or publication bias. The proposed mechanism linking H. pylori to ischemic stroke is similar to ischemic heart disease. Cross reacting antibodies to HSP are a risk factor for carotid atherosclerosis. An alternative mechanism is hyperhomocysteinaemia although this was not confirmed by others. CagA positive H. pylori may be an important factor in the association. The role of HP in Parkinson disease, Alzheimer's disease has also been studied. Although there are some exciting data to suggest an association, the studies were small and need to be confirmed in a larger study. Both ghrelin and leptin are important appetite hormones secreted from the stomach. Ghrelin is an important hormone in weight regulation and eating behaviour. As ghrelin is primarily produced and secreted by the gastric mucosa, H. pylori infection may impair gastric ghrelin production and therefore H. pylori eradication may be related to body weight change. Nweneka & Prentice carried out a systematic review and showed lower circulating ghrelin in H. pylori positive patients in 17 studies while 10 studies reported no difference. A meta-analysis of 19 studies involving 1801 patients showed a significantly higher circulating ghrelin concentration in H. pylori negative subjects than in H. pylori positive subjects. However, eradicating H. pylori did not alter the ghrelin levels. In summary, the higher prevalence of H. pylori in obesity is not proven. The evidence supporting the role of HP in plasma ghrelin and leptin is also conflicting and non conclusive. Although there is some changes in plasma leptin and ghrelin level following H. pylori eradication and potentially may explain the association, a larger randomized controlled trial is required. The role of H. pylori infection in chronic urticaria was also proposed. There seems to be a correlation between density of bacteria colonization and cutaneous symptoms, as well as the intensity of inflammation. In addition, 80% of the patient experienced complete remission after receiving H. pylori eradication therapy (Abdou et al., Fukuda et al., Di Campli et al.). However, Hellmig et al. studied 74 urticaria patients with positive H. pylori and found that neither the prevalence nor the eradication therapy had any impact on the clinical course of chronic urticaria. Therefore the cutaneous manifestation of H. pylori remained controversial. Randomized controlled trials with adequate sample size are required before a firm conclusion can be drawn. Helicobacter pylori has also been implicated in cirrhotic patients, hepatic encephalopathy and hepatocellular carcinoma (HCC). Pellicano et al. examined 254 patients with hepatitis C cirrhosis and found a very high prevalence of H. pylori infection in cirrhotic patients. In a case controlled study (Zullo et al.), there was no correlation in bacterial d nsity and cagA prevalence between cirrhotic patients and controls. H. pylori has been found to be more prevalent among patients with HCC than in controls (78% vs 54%, OR 3.02, p < 0.05) (Leone et al., Dasani et al., Chen et al.). However, there were studies that failed to demonstrate a positive association between HP and blood ammonia level and found no difference in H. pylori infected and noninfected subjects. H. pylori eradication was also not associated with a reduction in ammonia level. The incidence of PUD is high in cirrhotic patients. While the underlying reasons may be similar to non-cirrhotic patients, there may be other factors to account for the increase prevalence of peptic ulcer disease in cirrhotic patients. In a case controlled study, Wu and colleagues showed that duodenal ulcers were more common in cirrhotic patients although the prevalence of H. pylori was similar among the compensated, decompensated cirrhotics and normal controls. Lo et al. also demonstrated that the prevalence of H. pylori in cirrhotic patients with duodenal ulcer was only 52% and eradicating H. pylori in cirrhotic patients did not effectively reduce ulcer recurrence. Recurrent ulcers were noted in 44% of persistent H. pylori positive patients and 48% of H. pylori negative patients. This was further reinforced by Tzathas et al. who revealed that H. pylori eradication does not protect cirrhotics from ulcer recurrence. They recommended PPI maintenance therapy to prevent ulcer recurrence. Vergara et al. did a meta-analysis and identified 7 studies with a total of 976 patients with cirrhosis and found that H. pylori in patients with peptic ulcer disease was higher than those without. Kamalaporn et al. studied 130 cirrhotics and by multivariate analysis concluded that H. pylori infection and cirrhosis were independently associated with peptic ulcer disease. Conclusion: Many disease association with H. pylori have been studied but to date, the best available evidence is with ITP and unexplained IDA. There is a continue interest to study the role of H. pylori in extragastrointestinal diseases and the evidence is accumulating. Many diseases have been associated but the available evidence are often conflicting. More good quality studies are needed to confirm such association before we can recommend such strategy in clinical practice.",Helicobacter pylori;Asian;literature;pylorus;human;patient;prevalence;infection;randomized controlled trial (topic);idiopathic thrombocytopenic purpura;peptic ulcer;recurrent peptic ulcer;liver cirrhosis;duodenum ulcer;controlled study;eradication therapy;chronic urticaria;plasma;meta analysis;density;risk factor;hepatic encephalopathy;liver cell carcinoma;hepatitis C;ammonia blood level;coronary artery disease;iron deficiency anemia;Parkinson disease;ischemic heart disease;Alzheimer disease;appetite;brain ischemia;publishing;epidemiological data;stomach;weight;eating;stomach mucosa;weight change;systematic review;ulcer;maintenance therapy;multivariate analysis;obesity;randomized controlled trial;stroke;disease association;clinical practice;bacterium;inflammation;remission;urticaria;disease course;sample size;carotid atherosclerosis;ghrelin;leptin;hormone;ammonia;cross reacting antibody,"Tan, H. J.",2012,,10.1111/j.1440-1746.2011.06998.x,0,
4371,Differences of vascular factors between Alzheimer's disease and vascular dementia,"Aim: To compare the differences of vascular factors between Alzheimer' s disease (AD) and vascular dementia (VD). Methods: A retrospective study was used to collect the information about demography and concomitant vascular diseases of patients who were clinically diagnosed senile dementia in PLA General Hospital in 1993 - 2002. The concomitant rate of the vascular factors in AD, VD and mixed dementia (MD)were studied for analysis of single and multi factors. Results: The results showed that only the concomitant rates of hypertension and stroke in the VD group (83%, 40%) were significantly higher than those in the AD group (94%, 37%). After controlled gender, ages, occupation, inhabitancy, marriage and survival status, the history of hypertension and brain stroke had significant differences between the AD group and the VD group(P < 0.05, P < 0.001). There were no significant differences among AD, VD, and MD groups in hypotension, diabetes mellitus, coronary heart diseases, arrhythmia, heart block, pacemaker' s cardiac rhythm, transient ischemic attack, chronic obstructive pulmonary diseases, hyperlipemia and anaemia history(P > 0.05). Conclusion: Only the history of hypertension and stroke may predict the diagnosis of VD and MD, while other vascular factors have no significant differences between AD, VD and MD, and correlate with all of them. Vascular factors may participate in the pathological process of AD, and may have important significance to prevention, treatment, and amelioration of prognosis for various kinds of senile dementia.",age;Alzheimer disease;anemia;article;artificial heart pacemaker;cerebrovascular accident;chronic obstructive lung disease;comorbidity;controlled study;correlation analysis;demography;diabetes mellitus;disease association;gender;general hospital;heart arrhythmia;heart block;heart rhythm;human;hyperlipidemia;hypertension;hypotension;information processing;ischemic heart disease;major clinical study;marriage;medical record;multiinfarct dementia;occupation;pathogenesis;prediction;prognosis;retrospective study;risk factor;senile dementia;statistical significance;survival;transient ischemic attack,"Tan, J. P.;Wang, L. N.;Zhang, X. H.;Lin, H. L.;Wang, Y.",2004,,,0,
4372,Diagnosing bacteraemia early in older adults,,urea;adult;age;aged;bacteremia;blood culture;body temperature;cerebrovascular accident;dementia;diabetes mellitus;female;human;hyperlipidemia;hypertension;ischemic heart disease;Klebsiella pneumoniae;letter;major clinical study;male;middle aged;mortality;retrospective study;sepsis;urea blood level,"Tan, L. F.;Tong, K.;Hoe, J. T. M.;Liang, S.;Merchant, R. A.",2015,,,0,
4373,Plasma total cholesterol level as a risk factor for Alzheimer disease: the Framingham Study,"BACKGROUND: Previous studies examining the association of plasma cholesterol levels with the risk for development of Alzheimer disease (AD) have been inconclusive. We examined the impact of baseline and lifetime plasma total cholesterol levels averaged across many years on the risk for AD in a large, population-based cohort. METHODS: Five thousand two hundred nine subjects from the Framingham Study original cohort underwent biennial evaluation for cardiovascular risk factors since 1950, with estimations of serum total cholesterol levels at 19 of these 25 biennial examinations. The study sample consisted of 1026 subjects from this cohort who were alive and free of stroke and dementia at examination cycle 20 (1988-1989) and had undergone apolipoprotein E (APOE) genotyping. The main outcome measure was incident AD diagnosed using standard criteria, according to average total cholesterol levels across biennial examination cycles 1 to 15 and baseline total cholesterol level measured at the 20th biennial examination cycle. RESULTS: Alzheimer disease developed in 77 subjects from 1992 to 2000. After adjustment for age, sex, APOE genotype, smoking, body mass index (calculated as weight in kilograms divided by the square of height in meters), coronary heart disease, and diabetes, we found no significant association between the risk for incident AD and average cholesterol level at biennial examination cycles 1 to 15 (hazard ratio per 10-mg/dL [0.3-mmol/L] rise, 0.95; 95% confidence interval, 0.87-1.04) or baseline total cholesterol level at examination 20 (hazard ratio, 0.97; 95% confidence interval, 0.90-1.05). CONCLUSION: In this large, population-based cohort, baseline and long-term average serum total cholesterol levels were not associated with the risk for incident AD.",Adult;Aged;Alzheimer Disease/*blood/*etiology/genetics;Apolipoproteins E/genetics;Cholesterol/*blood;Female;Genotype;Humans;Hypercholesterolemia/blood/*complications;Longitudinal Studies;Male;Middle Aged;Multivariate Analysis;Proportional Hazards Models;Risk Assessment;Risk Factors,"Tan, Z. S.;Seshadri, S.;Beiser, A.;Wilson, P. W.;Kiel, D. P.;Tocco, M.;D'Agostino, R. B.;Wolf, P. A.",2003,May 12,10.1001/archinte.163.9.1053,0,
4374,Mitochondrial genome single nucleotide polymorphisms and their phenotypes in the Japanese,"Polymorphisms in the human mitochondrial genome have been used for the elucidation of phylogenetic relationships among various ethnic groups. Because analysis by mitochondrial genetics has detected pathogenic mutations causing mitochondrial encephalomyopathy or cardiomyopathy, most of the mitochondrial single nucleotide polymorphisms (mtSNPs) found in control subjects have been regarded as merely normal variants. However, we cannot exclude the possibility that the mitochondrial functional differences among individuals are ascribable at least in part to the mtSNPs of each individual. Human lifespan in ancient history was much shorter than that at the present time. Therefore, it is reasonable to speculate that certain mtSNPs that predispose one toward susceptibility to adult- or elderly-onset diseases, such as Parkinson's disease and Alzheimer's disease, have never been a target for natural selection in the past. Similarly, thrifty mtSNPs that had been advantageous for survival under severe famine or cold climate conditions might turn out to be related to satiation-related diseases, such as diabetes mellitus and obesity. To examine these hypotheses, we have constructed a mtSNP database by sequencing the entire mitochondrial genomes of 672 subjects: 96 in each of seven groups (i.e., centenarians, young obese or non-obese subjects, diabetic patients with or without major vascular involvement, patients with Parkinson's disease, and those with Alzheimer's disease).","Brain/physiology;DNA, Mitochondrial/*genetics;Haplotypes;Humans;Japan;Life Expectancy;Male;Mitochondria/*genetics/metabolism;Mitochondrial Proteins/chemistry/genetics;Nucleic Acid Conformation;Obesity/genetics/metabolism;Phenotype;Phylogeny;*Polymorphism, Single Nucleotide;Protein Conformation","Tanaka, M.;Takeyasu, T.;Fuku, N.;Li-Jun, G.;Kurata, M.",2004,Apr,,0,
4375,Dying at 23 with 1p36 deletion syndrome: Laura’s family story,"Laura was unusual. She had always been different and at times difficult. She was born with a genetic disorder, diagnosed as 1p36 deletion syndrome when she was 21 years old. At 23 she suffered her first cardiac arrest at home and entered the hospital system for the first time apart from infancy. After initially appearing to do well, she suffered a second cardiac arrest 10 weeks after admission. This was followed by an irreversible deterioration and she died 14 weeks after admission. We her family had been with her throughout her traumatic experience. This is our story.",infusion fluid;oxygen;1p36 deletion syndrome;adult;article;cardiomyopathy;case report;central nervous system;chromosome 1;chromosome analysis;clinical feature;communication disorder;developmental delay;disease severity;dying;facies;female;genetic disorder;heart arrest;heart function;holistic care;hospital admission;hospital planning;human;incidence;intellectual impairment;intensive care unit;medical error;medical staff;mental deterioration;nose feeding;nurse consultant;palliative therapy;posttraumatic stress disorder;priority journal;short stature;ventilator;waiting room;written communication;young adult,"Tandy, P. A.",2012,,10.1111/j.1445-5994.2012.02878.x,0,
4376,New approaches of cyclooxygenase-2 inhibitors - Cardiovascular events of coxibs,"Due to an increased risk of cardiovascular events in current users with high- dose rofecoxib among elderly patients. Rofecoxib was voluntarily withdrawn from the market at late 2004. Lately, FDA advises the use of the lowest effective dose of NSAIDs (including coxibs), if physicians determine that continued use is appropriate for individual patients. Two large trials (the CLASS study and the VIGOR study) appeared that coxibs; reduced the risk of GI toxicity (associated with a significantly incidence of upper GI bleeding, perforation or ulceration and symptomatic ulcers), but there were no differences in the risk of myocardial infarction and stroke events, compared with traditional NSAIDs for the treatment of pain and inflammatory conditions. Even coxibs use was associated with a dose- related increase in the composite end point of death from cardiovascular causes, myocardial infarction, stroke, or heart failure. In light of recent reports of cardiovascular harm associated with treatment with other agents in both APPROVe and APC trial. The available data show that coxibs appears to play an important role in the modulation of intestinal polyposis and colorectal carcinogenesis. Additionally, COX-2 expression may be associated with inflammatory responses leading to the occurrence of Alzheimer's disease and potentially, coxibs could be used to retard the progression of this condition.",acetylsalicylic acid;celecoxib;cyclooxygenase 2;cyclooxygenase 2 inhibitor;diclofenac;etoricoxib;ibuprofen;indometacin;ketorolac;lumiracoxib;meloxicam;naproxen;nonsteroid antiinflammatory agent;paracetamol;parecoxib;placebo;rofecoxib;valdecoxib;Alzheimer disease;antiinflammatory activity;article;cardiovascular disease;cardiovascular risk;clinical trial;colorectal cancer;digestive system perforation;digestive system ulcer;disease course;dose response;drug megadose;drug safety;drug withdrawal;food and drug administration;gastrointestinal hemorrhage;gastrointestinal polyposis;gastrointestinal toxicity;heart failure;heart infarction;human;IC50;inflammatory disease;osteoarthritis;pain;protein expression;rheumatoid arthritis;risk reduction;cerebrovascular accident;aleve;arcoxia;aspirin;bextra;celebrex;dynastat;prexige;vioxx,"Tang, C. C.;Chou, L. P.;Chou, C. H.;Hsu, S. Y.",2005,,,0,
4377,Prevalence and risk factor of cognitive impairment were different between urban and rural population: A community-based study,"Background: China is facing a continuously rising numbers of people with cognitive impairment (CI). Objectives: To investigate the prevalence and risk factors of CI among elderly people living in rural and urban communities. Methods: We conducted a face-to-face survey of CI on 7,900 individuals aged 50 years or older meeting inclusion criteria in the Malu (rural community, n = 4,429) andWuliqiao (urban community, n = 3,471) communities of Shanghai. The Mini-Mental State Examination (MMSE) was used to evaluate the cognitive function. Information on demographic features and potential risk factors for CI was collected during the interview. Multivariate logistic regression was performed to identify risk factors associated with CI. Results: Based on the education modified MMSE score, we identified 329 CI cases in rural community and 227 in urban community. The prevalence of CI was 7.43% in rural population and 6.54% in urban population (p = 0.13). In the urban population, risk of having CIwas associated with age (OR = 1.04; 95% CI: 1.01-1.08), lack of physical activities (OR = 2.25; 95% CI: 1.11-4.57), presence of diabetes mellitus (OR = 1.79; 95% CI: 1.04-3.07), and having three or more children (OR = 2.39; 95% CI: 1.27-4.50). In contrast, factors associated with rural populations included female gender (OR = 2.03; 95% CI: 1.08-3.82), age (OR = 1.06; 95% CI: 1.03-1.08), exposure to pesticides (OR = 4.68; 95% CI: 1.27-17.21), history of encephalitis or meningitis (OR = 6.02; 95% CI: 1.92-18.85) and head trauma (OR = 1.89; 95% CI: 1.10-3.24). Conclusions: Urban rural and populations showed different risk factors for CI, suggesting that different preventive strategies in these areas should be performed.",pesticide;adult;aged;Alzheimer disease;article;cerebrovascular accident;cognition;cognitive defect;cross-sectional study;demography;diabetes mellitus;drinking behavior;educational status;encephalitis;environmental exposure;female;gender;head injury;human;hypercholesterolemia;hypertension;interview;ischemic heart disease;major clinical study;male;meningitis;Mini Mental State Examination;prevalence;priority journal;risk factor;rural population;urban population;very elderly,"Tang, H. D.;Zhou, Y.;Gao, X.;Liang, L.;Hou, M. M.;Qiao, Y.;Ma, J. F.;Chen, S. D.",2015,,,0,
4378,Patient-Specific Induced Pluripotent Stem Cells for Disease Modeling and Phenotypic Drug Discovery,"In vitro cell models are invaluable tools for studying diseases and discovering drugs. Human induced pluripotent stem cells, particularly derived from patients, are an advantageous resource for generating ample supplies of cells to create unique platforms that model disease. This manuscript will review recent developments in modeling a variety of diseases (including their cellular phenotypes) with induced pluripotent stem cells derived from patients. It will also describe how researchers have exploited these models to validate drugs as potential therapeutics for these devastating diseases.",Alzheimer disease;amyotrophic lateral sclerosis;article;Barth syndrome;bone disease;catecholaminergic polymorphic ventricular tachycardia;congestive cardiomyopathy;diabetic cardiomyopathy;diseases;dysautonomia;hematologic disease;human;hypertrophic cardiomyopathy;liver disease;long QT syndrome;Machado Joseph disease;Parkinson disease;phenotype;phenotypic drug discovery;pluripotent stem cell;Rett syndrome;schizophrenia;spinal muscular atrophy,"Tang, S.;Xie, M.;Cao, N.;Ding, S.",2016,,,0,
4379,"Genetic associations for activated partial thromboplastin time and prothrombin time, their gene expression profiles, and risk of coronary artery disease","Activated partial thromboplastin time (aPTT) and prothrombin time (PT) are clinical tests commonly used to screen for coagulation-factor deficiencies. One genome-wide association study (GWAS) has been reported previously for aPTT, but no GWAS has been reported for PT. We conducted a GWAS and meta-analysis to identify genetic loci for aPTT and PT. The GWAS for aPTT was conducted in 9,240 individuals of European ancestry from the Atherosclerosis Risk in Communities (ARIC) study, and the GWAS for PT was conducted in 2,583 participants from the Genetic Study of Three Population Microisolates in South Tyrol (MICROS) and the Lothian Birth Cohorts (LBC) of 1921 and 1936. Replication was assessed in 1,041 to 3,467 individuals. For aPTT, previously reported associations with KNG1, HRG, F11, F12, and ABO were confirmed. A second independent association in ABO was identified and replicated (rs8176704, p = 4.26 × 10-24). Pooling the ARIC and replication data yielded two additional loci in F5 (rs6028, p = 3.22 × 10-9) and AGBL1 (rs2469184, p = 3.61 × 10-8). For PT, significant associations were identified and confirmed in F7 (rs561241, p = 3.71 × 10-56) and PROCR/EDEM2 (rs2295888, p = 5.25 × 10-13). Assessment of existing gene expression and coronary artery disease (CAD) databases identified associations of five of the GWAS loci with altered gene expression and two with CAD. In summary, eight genetic loci that account for ∼29% of the variance in aPTT and two loci that account for ∼14% of the variance in PT were detected and supported by functional data. © 2012 The American Society of Human Genetics.",glycoprotein;guanine nucleotide binding protein;histidine;low molecular weight kininogen;adult;aged;article;atherosclerosis;blood group ABO system;cardiovascular risk;clinical assessment;cohort analysis;controlled study;coronary artery disease;data analysis;data base;Europe;female;gene expression;gene expression profiling;gene locus;gene replication;genetic association;genetic risk;genetic variability;human;human tissue;major clinical study;male;meta analysis;partial thromboplastin time;priority journal;prothrombin time,"Tang, W.;Schwienbacher, C.;Lopez, L. M.;Ben-Shlomo, Y.;Oudot-Mellakh, T.;Johnson, A. D.;Samani, N. J.;Basu, S.;Gögele, M.;Davies, G.;Lowe, G. D. O.;Tregouet, D. A.;Tan, A.;Pankow, J. S.;Tenesa, A.;Levy, D.;Volpato, C. B.;Rumley, A.;Gow, A. J.;Minelli, C.;Yarnell, J. W. G.;Porteous, D. J.;Starr, J. M.;Gallacher, J.;Boerwinkle, E.;Visscher, P. M.;Pramstaller, P. P.;Cushman, M.;Emilsson, V.;Plump, A. S.;Matijevic, N.;Morange, P. E.;Deary, I. J.;Hicks, A. A.;Folsom, A. R.",2012,,,0,
4380,Insomnia and health-related quality of life in stroke,"Background: Insomnia is a common complaint in stroke survivors. Insomnia after stroke is correlated with physical disability, dementia, anxiety, depression, and fatigue. However, the influence of insomnia following stroke on health-related quality of life (HRQoL) has not been investigated. Objectives: The current study aimed to examine the effect of insomnia on HRQoL in stroke survivors 3 months after their index stroke over and above confounding variables. Method: Three hundred and thirty-six patients were recruited from the acute stroke unit in a regional hospital in Hong Kong. Insomnia was ascertained by a single item on a locally validated, seven-item insomnia questionnaire. HRQoL was measured by the total score and the 12 domain scores of the Stroke Specific Quality of Life (SSQoL) scale. Demographic and clinical characteristics were obtained using the following scales: National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS). Results: Forty-four percent of stroke survivors reported experiencing insomnia in the past month; they were more likely to be female and to have a higher GDS score. The insomnia group had significantly lower overall SSQoL, energy and thinking scores after adjusting for sex, BI, and GDS scores. Conclusion: The findings show that stroke survivors who experienced insomnia had a reduced overall HRQoL and were impaired in the energy and thinking domains of HRQoL. Early screening for sleep disturbance would be beneficial to prevent later development of post-stroke insomnia. Pharmacological and non-pharmacological interventions are suggested to improve HRQoL in stroke patients with insomnia.",aged;article;Barthel index;cerebrovascular accident;comparative study;controlled study;diabetes mellitus;educational status;female;geriatric assessment;Geriatric Depression Scale;health status;human;hypertension;insomnia;ischemic heart disease;major clinical study;male;medical history;Mini Mental State Examination;mood;National Institutes of Health Stroke Scale;personality;productivity;quality of life;quality of life assessment;scoring system;self report;sex difference;sleep disorder;Stroke Specific Quality of Life scale;thinking,"Tang, W. K.;Lau, C. G.;Mok, V.;Ungvari, G. S.;Wong, K. S.",2015,,,0,
4381,Gait Performance Trajectories and Incident Disabling Dementia Among Community-Dwelling Older Japanese,"Objectives Initial gait speed is a good predictor of dementia in later life. This prospective study used repeated measures analysis to identify potential gait performance trajectory patterns and to determine whether gait performance trajectory patterns were associated with incident disabling dementia among community-dwelling older Japanese. Design A prospective, observational, population-based follow-up study. Setting Japan, 2002 to 2014. Participants A total of 1686 adults without dementia (mean [SD] age, 71.2 [5.6] years; women, 56.3%) aged 65 to 90 years participated in annual geriatric health assessments during the period from June 2002 through July 2014. The average number of follow-up assessments was 3.9, and the total number of observations was 6509. Measurements Gait performance was assessed by measuring gait speed and step length at usual and maximum paces. A review of municipal databases in the Japanese public long-term care insurance system revealed that 196 (11.6%) participants developed disabling dementia through December 2014. Results We identified 3 distinct trajectory patterns (high, middle, and low) in gait speed and step length at usual and maximum paces in adults aged 65 to 90 years; these trajectory patterns showed parallel declines among men and women. After adjusting for important confounders, participants in the low trajectory groups for gait speed and step length at usual pace were 3.46 (95% confidence interval 1.88–6.40) and 2.12 (1.29–3.49) times as likely to develop incident disabling dementia, respectively, as those in the high trajectory group. The respective values for low trajectories of gait speed and step length at maximum pace were 2.05 (1.02–4.14) and 2.80 (1.48–5.28), respectively. Conclusions Regardless of baseline level, the 3 major trajectory patterns for gait speed and step length tended to show similar age-related changes in men and women in later life. Individuals with low trajectories for gait speed and step length had a higher dementia risk, which highlights the importance of interventions for improvements in gait performance, even among older adults with low gait performance.",hemoglobin;aged;angina pectoris;article;body mass;brain hemorrhage;cerebrovascular accident;dementia;diabetes mellitus;educational status;erythrocyte count;female;follow up;gait;geriatric assessment;grip strength;hand grip;heart arrhythmia;heart infarction;hematocrit;hemoglobin blood level;human;hyperlipidemia;hypertension;Japanese (people);long term care;longitudinal study;major clinical study;male;malignant neoplasm;Mini Mental State Examination;observational study;prospective study;subarachnoid hemorrhage;walking speed,"Taniguchi, Y.;Kitamura, A.;Seino, S.;Murayama, H.;Amano, H.;Nofuji, Y.;Nishi, M.;Yokoyama, Y.;Shinozaki, T.;Yokota, I.;Matsuyama, Y.;Fujiwara, Y.;Shinkai, S.",2017,,10.1016/j.jamda.2016.10.015,0,
4382,Veterans' physical health,"How individuals age is affected by life experiences. What we know today about aging has been largely shaped by a generation who experienced the special circumstances of wartime in their formative years. In this review, we investigate the research question, ""What is known about the physical health of Canadian veterans?"" In answering this question, we summarize the literature on Canadian Veterans but also include international literature on the physical health of American and Australian Veterans, along with some information from reports from Great Britain and other parts of Europe. Areas in which veterans perhaps fare worse than civilians of similar age include general health, hearing loss, musculoskeletal disorders, infections, cirrhosis, skin conditions, stomach conditions, neurologic conditions, and cardiovascular disease. The differing effects of combat on female veterans are also summarized. The healthy warrior effect is discussed along with its impact on research findings and the importance of choosing an appropriate control group. © 2013 The Author. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.",corticosteroid derivative;aging;amyotrophic lateral sclerosis;arthritis;article;assault;asthma;coronary artery atherosclerosis;Australia;balance disorder;Canada;cardiovascular disease;cerebrovascular accident;Cochrane Library;cognitive defect;crush syndrome;dementia;dermatitis;duodenum ulcer;eczema;Embase;endemic disease;Europe;female;fibromyalgia;hearing impairment;helminthiasis;hemorrhagic fever;hepatitis A;hepatitis B;hepatitis C;human;hypertension;immunosuppressive treatment;incidence;infection;irritable colon;ischemic heart disease;knee amputation;labor complication;liver cirrhosis;malaria;male;Medline;mental health;migraine;military service;morbidity;mortality;multiple sclerosis;obesity;ovary polycystic disease;parasitosis;pelvis pain syndrome;physical disability;posttraumatic stress disorder;priority journal;prisoner;PsycINFO;public health service;quality of life;rash;rheumatic disease;sexual harassment;smoking;spine disease;stomach ulcer;strongyloidiasis;systematic review (topic);tuberculosis;United Kingdom;uterine cervix cancer;veterans health;visual disorder;Western Hemisphere,"Tansey, C. M.;Raina, P.;Wolfson, C.",2013,,,0,
4383,"Level of Need, Divertibility, and Outcomes of Newly Admitted Nursing Home Residents","Objectives To describe the level of need and divertibility of newly admitted nursing home residents, describe the factors that drive need, and describe the outcomes of residents across different levels of need. Design Retrospective cohort study. Setting A total of 640 publicly funded nursing homes (also known as long-term care facilities) in Ontario, Canada. Participants All newly admitted residents between January 1, 2010 and March 1, 2012. Measurements We categorized residents into 36 groups based on different levels of (1) cognitive impairment, (2) difficulty in activities of daily living (ADL), (3) difficulty in instrumental ADLs, and (4) whether or not they had a caregiver at home. Residents were then categorized as having low, intermediate, or high needs; applying results from previous “Balance of Care” studies, we also captured the proportion who could have been cost-effectively diverted into the community. We then contrasted the characteristics of residents across the needs and divertible groupings, and compared 4 outcomes among these groups: hospital admissions, emergency department visits, mortality, and return to home. Results A population-level cohort of 64,105 incident admissions was captured. About two-thirds had great difficulty performing ADLs (65%) and had mild to severe cognitive impairment (66%); over 90% had great difficulty with instrumental ADLs. Just less than 50% of the new admissions were considered to be residents with high care needs (cognitively impaired with great ADL difficulty), while only 4.5% (2880 residents) had low care needs (cognition and ADL intact). Those with dementia (71.0%) and previous stroke (21.5%) were over-represented in the high needs group. Those that cannot be divertible to anywhere else but an institution with 24 hour nursing care comprised 41.3% (n = 26,502) of residents. Only 5.4% (n = 3483), based on community resources available, could potentially be cost-effectively diverted to the community. Those at higher needs experienced higher rates of mortality, higher total cost across all health sectors, and lower rates of return to home. Conclusions The majority of those admitted into nursing homes have high levels of need (driven largely by dementia and stroke) and could not have their needs met cost-effectively elsewhere, suggesting that the system is at capacity. Caring for the long-term care needs of the aging population should consider the balance of investments in institution and community settings.",acute heart infarction;adult;aged;arthritis;article;assisted living facility;asthma;caregiver;cerebrovascular accident;chronic disease;chronic obstructive lung disease;cognitive defect;cohort analysis;community;congestive heart failure;cost effectiveness analysis;daily life activity;dementia;depression;diabetes mellitus;female;health care availability;health care cost;health care need;health disparity;heart arrhythmia;home care;hospital admission;human;hypertension;kidney disease;major clinical study;male;malignant neoplasm;medical history;middle aged;mild cognitive impairment;mortality;nursing home patient;Ontario;osteoarthritis;osteoporosis;peripheral vascular disease;prognosis;retrospective study;self care;very elderly;young adult,"Tanuseputro, P.;Hsu, A.;Kuluski, K.;Chalifoux, M.;Donskov, M.;Beach, S.;Walker, P.",2017,,10.1016/j.jamda.2017.02.008,0,
4384,Infertility etiologies are genetically and clinically linked with other diseases in single meta-diseases,"The present review aims to ascertain whether different infertility etiologies share particular genes and/or molecular pathways with other pathologies and are associated with distinct and particular risks of later-life morbidity and mortality. In order to reach this aim, we use two different sources of information: (1) a public web server named DiseaseConnect ( http://disease-connect.org ) focused on the analysis of common genes and molecular mechanisms shared by diseases by integrating comprehensive omics and literature data; and (2) a literature search directed to find clinical comorbid relationships of infertility etiologies with only those diseases appearing after infertility is manifested. This literature search is performed because DiseaseConnect web server does not discriminate between pathologies emerging before, concomitantly or after infertility is manifested. Data show that different infertility etiologies not only share particular genes and/or molecular pathways with other pathologies but they have distinct clinical relationships with other diseases appearing after infertility is manifested. In particular, (1) testicular and high-grade prostate cancer in male infertility; (2) non-fatal stroke and endometrial cancer, and likely non-fatal coronary heart disease and ovarian cancer in polycystic ovary syndrome; (3) osteoporosis, psychosexual dysfunction, mood disorders and dementia in premature ovarian failure; (4) breast and ovarian cancer in carriers of BRCA1/2 mutations in diminished ovarian reserve; (5) clear cell and endometrioid histologic subtypes of invasive ovarian cancer, and likely low-grade serous invasive ovarian cancer, melanoma and non-Hodgkin lymphoma in endometriosis; and (6) endometrial and ovarian cancer in idiopathic infertility. The present data endorse the principle that the occurrence of a disease (in our case infertility) is non-random in the population and suggest that different infertility etiologies are genetically and clinically linked with other diseases in single meta-diseases. This finding opens new insights for clinicians and reproductive biologists to treat infertility problems using a phenomic approach instead of considering infertility as an isolated and exclusive disease of the reproductive system/hypothalamic-pituitary-gonadal axis. In agreement with a previous validation analysis of the utility of DiseaseConnect web server, the present study does not show a univocal correspondence between common gene expression and clinical comorbid relationship. Further work is needed to untangle the potential genetic, epigenetic and phenotypic relationships that may be present among different infertility etiologies, morbid conditions and physical/cognitive traits.",breast;cerebrovascular accident;dementia;diseases;endometriosis;endometrium cancer;etiology;gene;gene expression;hypophysis gonad system;infertility;ischemic heart disease;male;male infertility;melanoma;mood disorder;morbidity;mortality;mutation;neoplasm;nonhodgkin lymphoma;osteoporosis;ovarian reserve;ovary cancer;ovary polycystic disease;pathology;population;premature ovarian failure;prostate cancer;psychosexual disorder;risk,"Tarín, J. J.;García-Pérez, M. A.;Hamatani, T.;Cano, A.",2015,,,0,
4385,Diabetes and dementia in long-term care,"OBJECTIVES: To examine the presence or absence of dementia, and the prevalence rates for different dementias, in patients with and without adult onset diabetes (AODM). DESIGN: Chart survey. SETTING: A public long-term care facility in Rochester, New York, chosen to provide an enriched sample with respect to the diseases and demographic variables of interest. PARTICIPANTS: All long-term care residents in the facility aged 50 years or older (n = 476), mean age 74.8 years. Thirty-six (7.6%) had probable Alzheimer's disease (AD), 49 (10.3%) had possible AD, 38 (8.0%) had clinically diagnosed vascular dementia, 84 (17.6%) had unspecified dementias, and 269 (56.5%) were not demented. MEASUREMENTS: Demographic data, dementia and diabetes determined on the basis of extraction of chart data, and hypertension, myocardial infarction, congestive heart failure, and hypercholesterolemia determined on the basis of chart diagnoses. RESULTS: There were 99 residents with AODM in the sample, a prevalence rate of about 21%. The rates of both dementia and AODM were as expected for this age group and setting. Patients with probable or possible AD had the lowest rates of AODM (0 and 6.1%, respectively), and patients with vascular dementia had the highest rates of AODM (47.4%). Age, sex, and race influenced both the risk of having a dementia and the type of dementia. When these variables were adjusted for in multiple logistic regression, however, AODM remained a robust predictive factor because of its significant negative association with AD. Patients with unspecified dementias and no dementia showed rates of AODM (about 20%) that were roughly comparable and intermediate between vascular dementia and AD. CONCLUSIONS: In our study, AD diagnosed clinically and AODM did not co-occur, whereas AODM was associated with vascular dementia diagnosed clinically. Conversely, in non-Alzheimer, nonvascular dementias diagnosed clinically, the rates of AODM were equivalent to those in nondemented patients. These findings are in agreement with some, but not all, previous studies.","Age Distribution;Aged;Aged, 80 and over;Case-Control Studies;Continental Population Groups;Dementia/classification/*etiology;Diabetes Mellitus, Type 2/*complications;Female;Humans;Logistic Models;Long-Term Care/*statistics & numerical data;Male;New York;Predictive Value of Tests;Prevalence;Risk Factors;Sex Distribution;Skilled Nursing Facilities/statistics & numerical data","Tariot, P. N.;Ogden, M. A.;Cox, C.;Williams, T. F.",1999,Apr,,0,
4386,CME Digest Introduction,,anemia;article;continuing education;decubitus;dementia;evidence based medicine;heart arrest;medical education;medical literature;nursing home;pain;policy;United States,"Tarnove, L.",2007,,,0,
4387,The Changing Face of Survival in Rett Syndrome and MECP2-Related Disorders,"Purpose Survival in Rett syndrome remains unclear. Although early estimates were grim, more recent data suggest that survival into adulthood is typical. We aimed to define survival in Rett syndrome more clearly and identify risk factors for early death. Methods Participants with clinical Rett Syndrome or methyl-CpG-binding protein 2 mutations without clinical RTT were recruited through the Rett Syndrome Natural History study from 2006 to 2015. Clinical details were collected, and survival was determined using the Kaplan-Meier estimator. Risk factors were assessed using Cox proportional hazards models. Results Among 1189 valid participants, 51 died (range 3.9-66.6 years) during the 9-year follow-up period. Those who died included 36 (3.9%) classic Rett syndrome females, 5 (5.9%) atypical severe Rett syndrome females, 1 (2.4%) non-Rett syndrome female, the single atypical severe male, 6 (30%) non-Rett syndrome males, and 2 (7.1%) methyl-CpG-binding protein 2 duplication syndrome males. All atypical mild Rett syndrome females, methyl-CpG-binding protein 2 duplication syndrome females, and the single classic Rett syndrome male remain alive. Most deaths were due to cardiorespiratory issues. Only one died from severe malnutrition, scoliosis, and extreme frailty. Survival for classic and atypical Rett syndrome was greater than 70% at 45 years. Overall severity and several modifiable risk factors, including ambulation, weight, and seizures, were associated with mortality in classic Rett syndrome. Conclusions Survival into the fifth decade is typical in Rett syndrome, and death due to extreme frailty has become rare. Although the leading cause of death remains cardiorespiratory compromise, many risk factors for early death are modifiable. Intense therapeutic interventions could further improve the prognosis for individuals with Rett syndrome.",NCT00299312;methyl CpG binding protein 2;adult;aged;article;body weight;cardiopulmonary insufficiency;child;disease severity;female;gene mutation;human;major clinical study;male;mobilization;mortality;priority journal;prognosis;Rett syndrome;risk factor;seizure;survival,"Tarquinio, D. C.;Hou, W.;Neul, J. L.;Kaufmann, W. E.;Glaze, D. G.;Motil, K. J.;Skinner, S. A.;Lee, H. S.;Percy, A. K.",2015,,,0,
4388,Clinical features of leuko-araiosis,"Objective - To study the clinical features of leuko-araiosis. Methods - Age matched groups of patients with a CT finding of pure leuko-araiosis (n = 26) and a control group with a normal CT finding (n = 26) were formed (mean ages 78.6 (SD 3.3) v 76.5 (SD 4.6) years; NS). Results - Dementia, vascular dementia, central brain atrophy on CT, disability in activities of daily living and instrumental activities of daily living, urinary incontinence, gait disorder (assistance needed), personality change, and night time confusion were found to be more commonly present in leuko-araiosis positive patients than in controls, whereas focal neurological symptoms and signs were not associated with leuko-araiosis. The occurrences of heart failure and systolic hypotension - but not hypertension - were higher in the leuko-araiosis positive group than in the controls. Leuko-araiosis was also found to be related to a less sudden onset of symptoms and a lower Hachinski score than true brain infarction(s). Conclusions - Leuko-araiosis on CT in these elderly patients seems to be a vascular disorder aetiologically different from brain infarction, with clinical manifestations of subtle onset and general disabling nature and no prominent focal neurological signs or symptoms.",aged;article;brain atrophy;brain infarction;clinical feature;computer assisted tomography;confusion;daily life activity;dementia;female;gait disorder;heart failure;human;hypertension;hypotension;leukoaraiosis;major clinical study;male;multiinfarct dementia;neurologic disease;personality disorder;priority journal;urine incontinence;vascular disease,"Tarvonen-Schröder, S.;Röyttä, M.;Räihä, I.;Kurki, T.;Rajala, T.;Sourander, L.",1996,,,0,
4389,"Neurologic complications of cancer: Part 2: Vascular, infectious, paraneoplastic, neuromuscular, and treatment-related complications","Neurologic complications related to cancer and its therapy are increasing because of increasing survival and therapeutic modalities in patients with cancer. To deal with such complications requires familiarity with them and knowledge of pathophysiologic events underlying cancer. The vascular, infectious, paraneoplastic, neuromuscular, and treatment-related neurologic complications of cancer are discussed in this article.",aciclovir;alkylating agent;alpha interferon;amphotericin B lipid complex;antibiotic agent;antimetabolite;antineoplastic agent;asparaginase;baclofen;camptothecin;carmustine;chlorambucil;chlormethine;cladribine;colloidal gold;cotrimoxazole;cytarabine;estramustine;fluconazole;flucytosine;fludarabine;gemtuzumab ozogamicin;gyrase inhibitor;heparin;immunosuppressive agent;methotrexate;steroid;unindexed drug;valproic acid;warfarin;antithrombin III deficiency;aphasia;artery thrombosis;article;aseptic meningitis;ataxia;blindness;blood clotting factor deficiency;brain atrophy;brain disease;brain dysfunction;brain hemorrhage;brain infection;brain ischemia;brain metastasis;neoplasm;cancer classification;cancer radiotherapy;cancer surgery;carcinomatosis;cardiomyopathy;cerebral blindness;cerebral sinus thrombosis;cerebrovascular disease;clinical trial;cognitive defect;coma;delirium;dementia;depression;diplopia;disseminated intravascular clotting;drug fatality;fibrinogen defect;hearing impairment;heart infarction;heart ventricle thrombosis;hemiparesis;hemolytic anemia;human;infection sensitivity;insomnia;leukemia;leukoencephalopathy;lymphoma;mania;meningitis;mood disorder;muscle weakness;myopathy;nausea;neurological complication;neuromuscular disease;neurotoxicity;occlusive cerebrovascular disease;ophthalmoplegia;opportunistic infection;ototoxicity;paraneoplastic syndrome;paraplegia;pathophysiology;polycythemia;polyneuropathy;postoperative infection;priority journal;psychosis;radiation injury;radiation necrosis;retina hemorrhage;seizure;sensory neuropathy;spasticity;spinal cord disease;stereotaxic surgery;cerebrovascular accident;suicidal behavior;thrombocytopenia;thrombosis;transient ischemic attack;tremor;urine incontinence;uveitis;vein thrombosis;visual impairment;elspar;mylotarg,"Tasdemiroglu, E.;Kaya, A. H.;Bek, S.;Emir, C. B.;Sengoz, A.;Kilickesmez, O.;Mansuroglu, I.",2004,,,0,
4390,Critical care and the brain,,neuroprotective agent;adult respiratory distress syndrome;Alzheimer disease;artificial ventilation;brain dysfunction;brain injury;clinical protocol;cortical electrode;delirium;drug efficacy;electroencephalography;functional status;general practitioner;hospital admission;human;intensive care;intensive care unit;lung edema;medical specialist;microdialysis;neurocritical care;neuroimaging;oximetry;personalized medicine;physical disability;priority journal;respiratory failure;shock;short survey;takotsubo cardiomyopathy;traumatic brain injury,"Tasker, R. C.;Menon, D. K.",2016,,,0,
4391,"Dementia in stroke survivors in the Stroke Data Bank cohort. Prevalence, incidence, risk factors, and computed tomographic findings","We determined the prevalence of dementia in 927 patients with acute ischemic stroke aged greater than or equal to 60 years in the Stroke Data Bank cohort based on the examining neurologist's best judgment. Diagnostic agreement among examiners was 68% (kappa = 0.34). Of 726 testable patients, 116 (16%) were demented. Prevalence of dementia was related to age but not to sex, race, handedness, educational level, or employment status before the stroke. Previous stroke and previous myocardial infarction were related to prevalence of dementia although hypertension, diabetes mellitus, atrial fibrillation, and previous use of antithrombotic drugs were not. Prevalence of dementia was most frequent in patients with infarcts due to large-artery atherosclerosis and in those with infarcts of unknown cause. Computed tomographic findings related to prevalence of dementia included infarct number, infarct site, and cortical atrophy. Among 610 patients who were not demented at stroke onset, we used methods of survival analysis to determine the incidence of dementia occurring during the 2-year follow-up. Incidence of dementia was related to age but not sex. Based on logistic regression analysis, the probability of new-onset dementia at 1 year was 5.4% for a patient aged 60 years and 10.4% for a patient aged 90 years. With a multivariate proportional hazards model, the most important predictors of incidence of dementia were a previous stroke and the presence of cortical atrophy at stroke onset.","Aged;Dementia/*epidemiology;Dementia, Vascular/epidemiology;Female;Follow-Up Studies;Humans;Ischemic Attack, Transient/*complications/mortality/radiography;Male;Middle Aged;Prevalence;Regression Analysis;Socioeconomic Factors;Tomography, X-Ray Computed","Tatemichi, T. K.;Foulkes, M. A.;Mohr, J. P.;Hewitt, J. R.;Hier, D. B.;Price, T. R.;Wolf, P. A.",1990,Jun,,0,
4392,The possible risk of cancer in claudicants,"The aim of this study was to select a group of patients who had mild intermittent claudication and were undergoing secondary prevention measures, and record all vascular and non-vascular events over a 10-year follow-up. A total of 534 events were recorded in 109 claudicants. 25.7% of the claudicants died, 39% of them due to vascular events, 36% from cancer and 25% from other causes. 17 of the 20 cancer cases could be classified as related to smoking. Cancer occurred relatively early in the study, within the first five years, while severe vascular events occurred mainly during later periods. A clear transformation occurred in the outcome of the claudicants. Mortality was equally attributable to vascular and cancer-related comorbidities. In conclusion, the improvement of vascular outcomes due to secondary prevention measures and technological advances in the management of acute vascular events may result in a relative increase in cancer incidence and deaths. © SAGE Publications 2011.",angiotensin receptor antagonist;anticoagulant agent;beta adrenergic receptor blocking agent;creatinine;dipeptidyl carboxypeptidase inhibitor;hydroxymethylglutaryl coenzyme A reductase inhibitor;adult;aged;Alzheimer disease;angina pectoris;ankle brachial index;anticoagulant therapy;article;bladder carcinoma;body mass;breast carcinoma;cancer incidence;cancer mortality;cancer risk;cardiovascular risk;carotid artery obstruction;cause of death;colon carcinoma;comorbidity;death;diabetes mellitus;diet;disease severity;diverticulitis;duodenum ulcer;erythrocyte sedimentation rate;female;follow up;heart failure;high risk patient;human;hypertension;intermittent claudication;kidney carcinoma;kidney failure;larynx cancer;liver cell carcinoma;lung carcinoma;major clinical study;male;oropharynx cancer;outcome assessment;outpatient care;ovary carcinoma;pancreatitis;prospective study;prostate carcinoma;cancer recurrence;risk assessment;secondary prevention;smoking;venous thromboembolism,"Taute, B. M.;Thommes, S.;Taute, R.;Podhaisky, H.",2011,,,0,
4393,Factors associated with undertreatment of atrial fibrillation in geriatric outpatients with Alzheimer disease,"Background: According to international recommendations [from the American College of Cardiology/American Heart Association/European Society of Cardiology] and those of the Haute Autorite de Sante (HAS) in France, treatment with a vitamin K antagonist is recommended in patients with atrial fibrillation (AF) in the presence of a high thromboembolic risk factor [history of stroke, transient ischemic attack, systemic embolism, or valvular heart disease, or presence of a mechanical heart valve prosthesis] or at least two moderate risk factors (age >75 years, hypertension, congestive heart failure, or diabetes). In patients with a major contraindication, the vitamin K antagonist can be replaced by an antiplatelet agent (APA). These recommendations are not systematically observed in patients with Alzheimer disease (AD). The aim of our study was to determine the factors associated with undertreatment of AF in geriatric outpatients with AD. Methods: Use of oral anticoagulants or APAs was studied in 66 patients with AF who were included in the French Network on Alzheimer Disease (REAL.FR) cohort, consisting of 686 outpatients living at home, supported by an informal caregiver, and suffering from Alzheimer-type dementia, with a Mini Mental Status Examination (MMSE) score between 10 and 26. First, demographic characteristics (age, sex, body mass index [BMI], living arrangements, educational level), medical conditions (comorbidity, number of medications), disability (activities of daily living [ADL], instrumental activities of daily living [IADL]), risk of falls (one-leg balance test), cognitive status (according to MMSE, Alzheimer's Disease Assessment Scale - Cognitive Subscale [ADAS-Cog], and Clinical Dementia Rating [CDR] scores), risk factors for stroke (hypertension, history of stroke, congestive heart failure, diabetes, or age >75 years) and potential contraindications to oral anticoagulants (OACs) or APAs (polypharmacy, risk of falls, renal failure, gastrointestinal diseases) of patients receiving OACs were compared with those of patients receiving APAs and those of patients receiving no treatment for AF. Then the same characteristics were compared between patients receiving no treatment for AF and those receiving OACs or APAs. Results: Only 56 % (n = 37) of patients with AF were receiving OACs or APAs at the baseline visit, of whom 18 (49 %) were receiving OACs and 19 (51 %) were receiving APAs. Bivariate analysis showed that patients receiving OACs or APAs were significantly more likely to have a history of cardiovascular disease (p = 0.005) - in particular, hypertension (p = 0.037) - less likely to be living alone and unaided (p = 0.038), and less likely to be taking nonsteroidal anti-inflammatory drugs [NSAIDs] (p = 0.001). Conclusion: Despite the national and international recommendations, nearly half of AD patients with AF do not receive OACs or APAs. A history of cardiovascular disease - in particular, hypertension - improves access to treatment, but use of NSAIDs and living alone without home care seem to be the main factors associated with non-prescription of OACs or APAs. 2013 Springer International Publishing Switzerland.",ADL disability // aged // Alzheimer disease/dt [Drug Therapy] // anticoagulant therapy // article // body mass // cardiovascular risk // caregiver // cerebrovascular accident // cognition // cohort analysis // comorbidity // congestive heart failure //,"Tavassoli, N.;Perrin, A.;Berard, E.;Gillette, S.;Vellas, B.;Rolland, Y.",2013,,10.1007/s40256-013-0040-5,0,4394
4394,Factors associated with undertreatment of atrial fibrillation in geriatric outpatients with Alzheimer disease,"Background: According to international recommendations [from the American College of Cardiology/American Heart Association/European Society of Cardiology] and those of the Haute Autorite de Sante (HAS) in France, treatment with a vitamin K antagonist is recommended in patients with atrial fibrillation (AF) in the presence of a high thromboembolic risk factor [history of stroke, transient ischemic attack, systemic embolism, or valvular heart disease, or presence of a mechanical heart valve prosthesis] or at least two moderate risk factors (age >75 years, hypertension, congestive heart failure, or diabetes). In patients with a major contraindication, the vitamin K antagonist can be replaced by an antiplatelet agent (APA). These recommendations are not systematically observed in patients with Alzheimer disease (AD). The aim of our study was to determine the factors associated with undertreatment of AF in geriatric outpatients with AD. Methods: Use of oral anticoagulants or APAs was studied in 66 patients with AF who were included in the French Network on Alzheimer Disease (REAL.FR) cohort, consisting of 686 outpatients living at home, supported by an informal caregiver, and suffering from Alzheimer-type dementia, with a Mini Mental Status Examination (MMSE) score between 10 and 26. First, demographic characteristics (age, sex, body mass index [BMI], living arrangements, educational level), medical conditions (comorbidity, number of medications), disability (activities of daily living [ADL], instrumental activities of daily living [IADL]), risk of falls (one-leg balance test), cognitive status (according to MMSE, Alzheimer's Disease Assessment Scale - Cognitive Subscale [ADAS-Cog], and Clinical Dementia Rating [CDR] scores), risk factors for stroke (hypertension, history of stroke, congestive heart failure, diabetes, or age >75 years) and potential contraindications to oral anticoagulants (OACs) or APAs (polypharmacy, risk of falls, renal failure, gastrointestinal diseases) of patients receiving OACs were compared with those of patients receiving APAs and those of patients receiving no treatment for AF. Then the same characteristics were compared between patients receiving no treatment for AF and those receiving OACs or APAs. Results: Only 56 % (n = 37) of patients with AF were receiving OACs or APAs at the baseline visit, of whom 18 (49 %) were receiving OACs and 19 (51 %) were receiving APAs. Bivariate analysis showed that patients receiving OACs or APAs were significantly more likely to have a history of cardiovascular disease (p = 0.005) - in particular, hypertension (p = 0.037) - less likely to be living alone and unaided (p = 0.038), and less likely to be taking nonsteroidal anti-inflammatory drugs [NSAIDs] (p = 0.001). Conclusion: Despite the national and international recommendations, nearly half of AD patients with AF do not receive OACs or APAs. A history of cardiovascular disease - in particular, hypertension - improves access to treatment, but use of NSAIDs and living alone without home care seem to be the main factors associated with non-prescription of OACs or APAs. © 2013 Springer International Publishing Switzerland.",ADL disability;aged;Alzheimer disease/dt [Drug Therapy];Alzheimer disease/dt [Drug Therapy];anticoagulant therapy;article;body mass;cardiovascular risk;caregiver;cerebrovascular accident;cognition;cohort analysis;comorbidity;congestive heart failure;controlled clinical trial;controlled study;demography;diabetes mellitus;disease association;educational status;fall risk assessment;female;gastrointestinal disease;geriatric patient;heart atrium fibrillation/dt [Drug Therapy];heart atrium fibrillation/dt [Drug Therapy];home care;human;hypertension;kidney failure;Lawton instrumental activities of daily living scale;major clinical study;male;medical history;multicenter study;outcome assessment;outpatient;priority journal;rating scale;scoring system;very elderly;anticoagulant agent/ct [Clinical Trial];anticoagulant agent/cb [Drug Combination];anticoagulant agent/cm [Drug Comparison];anticoagulant agent/dt [Drug Therapy];anticoagulant agent/po [Oral Drug Administration];antiinflammatory agent;antithrombocytic agent/ct [Clinical Trial];antithrombocytic agent/cb [Drug Combination];antithrombocytic agent/cm [Drug Comparison];antithrombocytic agent/dt [Drug Therapy];donepezil/dt [Drug Therapy];galantamine/dt [Drug Therapy];rivastigmine/dt [Drug Therapy];Alzheimer disease;Alzheimer Disease Assessment Scale;bivariate analysis;cardiology;cardiovascular disease;Clinical Dementia Rating;college;daily life activity;dementia;disability;drug therapy;embolism;examination;France;heart;heart atrium fibrillation;heart valve prosthesis;human;leg;mechanical heart valve;mental health;Mini Mental State Examination;outpatient;patient;polypharmacy;prescription;risk;risk factor;society;thromboembolism;transient ischemic attack;valvular heart disease;aminosalicylic acid;anticoagulant agent;antithrombocytic agent;antivitamin K;nonsteroid antiinflammatory agent;retinol,"Tavassoli, N;Perrin, A;Berard, E;Gillette, S;Vellas, B;Rolland, Y",2013,,10.1007/s40256-013-0040-5,0,
4395,Re: Comment on: Should functionality and activities of daily living be considered aside from mortality in the management of hip fractures?,,cerebrovascular accident;comorbidity;daily life activity;dementia;hip fracture;human;ischemic heart disease;letter;mobilization;mortality;neoplasm;pneumonia;risk factor;urinary tract infection,"Tay, E.",2016,,10.11622/smedj.2016140,0,
4396,"The relative effect of Alzheimer's disease and related dementias, disability, and comorbidities on cost of care for elderly persons","Objectives. Our primary objectives were (a) to determine the relative impact of Alzheimer's disease and related dementias (ADRD), disability, and common comorbid health conditions on the cost of caring for community-dwelling elderly person and (b) to determine whether ADRD serves as an effect modifier for the effect of disability and common comorbidities on costs. Methods. Participants were drawn from community respondents to the 1994 National Long Term Care Survey. The authors compared total cost of caring for persons without ADRD with that of those who had moderate and severe ADRD. Using regression analysis, the author identified the adjusted effect of ADRD, limitations in activities of daily living (ADLs), and common comorbidities on total costs. Results. Persons with severe ADRD had higher median total costs ($10,234) than did persons with moderate ADRD ($4,318) and those without ADRD ($2,268, p < .001). However, disability measured by ADL limitations was a more important predictor of total cost than was ADRD status in both stratified and multivariate analyses. Comorbidities such as heart attack, stroke, and chronic obstructive pulmonary disease also increased costs. Severe ADRD was an effect modifier for ADL limitations, increasing the positive impact of disability on total costs among persons with severe ADRD, but not for comorbidities. Discussion. Disability, severe ADRD, and comorbidity all had independent effects that increased total costs. Thus, any risk adjustment procedure should account for disability and comorbidity and not just ADRD status.",aged;Alzheimer disease;article;chronic obstructive lung disease;community care;comorbidity;controlled study;daily life activity;dementia;disease severity;elderly care;female;health care cost;health survey;heart infarction;human;major clinical study;male;physical disability;priority journal;regression analysis;risk assessment;cerebrovascular accident,"Taylor D.H, Jr.;Schenkman, M.;Zhou, J.;Sloan, F. A.",2001,,,0,
4397,Clinical course of neuropathologically confirmed frontal-variant Alzheimer's disease,"Background: A 66-year-old man presented with a 3-year history of personality changes marked by increasing apathy, social withdrawal and deficits in complex attention, and a 1-year history of progressive memory problems and difficulties in planning and carrying out complex tasks. Investigations: Three neuropsychological examinations over 2 years, neurological examination, routine laboratory tests, brain MRI, single-photon emission CT scan, genetic analyses, and neuropathological examination. Diagnosis: A clinical diagnosis of frontal-variant frontotemporal dementia was superseded by postmortem neuropathological evidence, which established a diagnosis of frontal-variant Alzheimer's disease. Management: The patient and his spouse were referred for counseling, and the patient was referred for follow-up examinations.",amyloid beta protein;aged;Alzheimer disease;apathy;article;attention deficit disorder;autopsy;brain atherosclerosis;case report;disease course;disease duration;follow up;genetic analysis;Geriatric Depression Scale;heart ventricle hypertrophy;human;image analysis;laboratory test;male;memory disorder;Mini Mental State Examination;neurologic examination;neuropathology;neuropsychological test;nuclear magnetic resonance imaging;patient counseling;patient referral;personality disorder;priority journal;psychosocial withdrawal;single photon emission computer tomography;task performance,"Taylor, K. I.;Probst, A.;Miserez, A. R.;Monsch, A. U.;Tolnay, M.",2008,,,0,
4398,Apolipoprotein E and familial non-insulin-dependent diabetes mellitus 5,,apolipoprotein E2;apolipoprotein E3;apolipoprotein E4;Alzheimer disease;amyloidosis;controlled study;familial disease;female;human;ischemic heart disease;letter;major clinical study;male;non insulin dependent diabetes mellitus;pancreas islet disease;priority journal,"Taylor, R. W.;Stewart, M. W.;Avery, P. J.;Humphriss, D. B.;Alberti, K. G. M. M.;Turnbull, D. M.;Walker, M.",1994,,,0,
4399,Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: an analysis of 553 consecutive patients,"BACKGROUND: Despite being a major determinant of functional independence, ambulation after major limb amputation has not been well studied. The purpose, therefore, of this study was to investigate the relationship between a variety of preoperative clinical characteristics and postoperative functional outcomes in order to formulate treatment recommendations for patients requiring major lower limb amputation. METHODS: From January 1998 through December 2003, 627 major limb amputations (37.6% below knee amputations, 4.3% through knee amputations, 34.5% above knee amputations, and 23.6% bilateral amputations) were performed on 553 patients. Their mean age was 63.7 years; 55% were men, 70.2% had diabetes mellitus, and 91.5% had peripheral vascular disease. A retrospective review was performed correlating various preoperative presenting factors such as age at presentation, race, medical comorbidities, preoperative ambulatory status, and preoperative independent living status, with postoperative functional endpoints of prosthetic usage, survival, maintenance of ambulation, and maintenance of independent living status. Kaplan-Meier survival curves were constructed and compared by using the log-rank test. Odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals were constructed by using multiple logistic regressions and Cox proportional hazards models. RESULTS: Statistically significant preoperative factors independently associated with not wearing a prosthesis in order of greatest to least risk were nonambulatory before amputation (OR, 9.5), above knee amputation (OR, 4.4), age > 60 years (OR, 2.7), homebound but ambulatory status (OR, 3.0), presence of dementia (OR, 2.4), end-stage renal disease (OR, 2.3), and coronary artery disease (OR, 2.0). Statistically significant preoperative factors independently associated with death in decreasing order of influence included age > or = 70 years (HR, 3.1), age 60 to 69 (HR, 2.5), and the presence of coronary artery disease (HR, 1.5). Statistically significant preoperative factors independently associated with failure of ambulation in decreasing order of influence included age > or = 70 years (HR, 2.3), age 60 to 69 (HR, 1.6), bilateral amputation (HR, 1.8), and end-stage renal disease (HR, 1.4). Statistically significant preoperative factors independently associated with failure to maintain independent living status in decreasing order of influence included age > or = 70 years (HR, 4.0), age 60 to 69 (HR, 2.7), level of amputation (HR, 1.8), homebound ambulatory status (HR, 1.6), and the presence of dementia (HR, 1.6). CONCLUSIONS: Patients with limited preoperative ambulatory ability, age > or = 70, dementia, end-stage renal disease, and advanced coronary artery disease perform poorly and should probably be grouped with bedridden patients, who traditionally have been best served with a palliative above knee amputation. Conversely, younger healthy patients with below knee amputations achieved functional outcomes similar to what might be expected after successful lower extremity revascularization. Amputation in these instances should probably not be considered a failure of therapy but another treatment option capable of extending functionality and independent living.",Aged;*Amputation;Arterial Occlusive Diseases/epidemiology/*surgery;Comorbidity;Female;Humans;Leg/*surgery;Male;Middle Aged;Odds Ratio;Prognosis;Proportional Hazards Models;Recovery of Function;Retrospective Studies;Survival Analysis;Treatment Outcome,"Taylor, S. M.;Kalbaugh, C. A.;Blackhurst, D. W.;Hamontree, S. E.;Cull, D. L.;Messich, H. S.;Robertson, R. T.;Langan, E. M., 3rd;York, J. W.;Carsten, C. G., 3rd;Snyder, B. A.;Jackson, M. R.;Youkey, J. R.",2005,Aug,10.1016/j.jvs.2005.04.015,0,
4400,A comparison of percutaneous transluminal angioplasty versus amputation for critical limb ischemia in patients unsuitable for open surgery,"BACKGROUND: Percutaneous transluminal angioplasty (PTA), although not the traditional therapy, seems to be a safe alternative for patients with critical limb ischemia who are believed to be unsuitable candidates for open surgery. However, the efficacy of PTA in this setting has not been analyzed. The purpose of this study was to compare the outcomes of PTA for limb salvage with outcomes of major limb amputation in physiologically impaired patients believed to be unsuitable for open surgery. METHODS: From a prospective vascular registry, 314 patients (183 underwent amputation, and 131 underwent complex PTA for limb salvage) were identified as physiologically impaired or unsuitable for open surgery. This was defined as having at least one of the following: functional impairment (homebound ambulatory or transfer only), mental impairment (dementia), or medical impairment (two of the following: end-stage renal disease, coronary artery disease, and chronic obstructive pulmonary disease). Patients undergoing PTA were compared with patients undergoing amputation by examining the outcome parameters of survival, maintenance of ambulation, and maintenance of independent living status. Parameters were assessed by using Kaplan-Meier life-table curves (log-rank test and 95% confidence intervals [CIs]) and hazard ratios (HRs) from the Cox model. RESULTS: PTA resulted in a 12-month limb salvage rate of 63%. Thirty-day mortality was 4.4% for the amputation group and 3.8% for the PTA group. After adjustment for age, race, diabetes, prior vascular procedure, dementia, and baseline functional status, PTA patients had significantly lower rates of ambulation failure (HR, 0.44; P = .0002) and loss of independence (HR, 0.53; P = .025) but had significantly higher mortality (HR, 1.62; P = .006) than amputees. However, when life tables were examined, the maintenance of ambulation advantage lasted only 12 months (PTA, 68.6%; 95% CI, 59.6%-77.7%; amputation, 48%; 95% CI, 40.4%-55.5%) and was not statistically significant at 2 years (62.2% [95% CI, 48.8%-71.5%] and 44% [95% CI, 35.8%-52.2%], respectively). Maintenance of independent living status advantage lasted only 3 months, with no statistically significant difference at 2 years (PTA, 60.5%; 95% CI, 45.4%-75.6%; amputation, 52.6%; 95% CI, 40.4%-64.9%). Although mortality was high in both cohorts, patients who underwent amputation had a survival advantage for all time intervals examined (at 2 years: PTA, 29%; 95% CI, 19.9%-38.1%; amputation, 48.1%; 95% CI, 39.2%-56.9%). CONCLUSIONS: Patients who present with critical limb ischemia and physiologic impairments that preclude open surgery seem to have comorbidities that blunt any functional advantage achieved after PTA for limb salvage. PTA in this setting affords very little benefit compared with amputation alone.","Activities of Daily Living;Aged;Aged, 80 and over;*Amputation;*Angioplasty, Balloon;Cohort Studies;Female;Follow-Up Studies;Humans;Ischemia/mortality/physiopathology/surgery/*therapy;Kaplan-Meier Estimate;*Limb Salvage/methods;Lower Extremity/*blood supply;Male;Middle Aged;Patient Selection;Proportional Hazards Models;Prospective Studies;Registries;Retrospective Studies;South Carolina;Time Factors;Treatment Outcome;Walking","Taylor, S. M.;Kalbaugh, C. A.;Blackhurst, D. W.;Kellicut, D. C.;Langan, E. M., 3rd;Youkey, J. R.",2007,Feb,10.1016/j.jvs.2006.09.038,0,
4401,"Leukocyte telomere length and prevalence of age-related diseases in semisupercentenarians, centenarians and centenarians' offspring","Centenarians and their offspring are increasingly considered a useful model to study and characterize the mechanisms underlying healthy aging and longevity. The aim of this project is to compare the prevalence of age-related diseases and telomere length (TL), a marker of biological age and mortality, across five groups of subjects: semisupercentenarians (SSCENT) (105-109. years old), centenarians (CENT) (100-104. years old), centenarians' offspring (CO), age- and gender-matched offspring of parents who both died at an age in line with life expectancy (CT) and age- and gender-matched offspring of both non-long-lived parents (NLO). Information was collected on lifestyle, past and current diseases, medical history and medication use. SSCENT displayed a lower prevalence of acute myocardial infarction (p. =. 0.027), angina (p. =. 0.016) and depression (p. =. 0.021) relative to CENT. CO appeared to be healthier compared to CT who, in turn, displayed a lower prevalence of both arrhythmia (p. =. 0.034) and hypertension (p. =. 0.046) than NLO, characterized by the lowest parental longevity. Interestingly, CO and SSCENT exhibited the longest (p. <. 0.001) and the shortest (p. <. 0.001) telomeres respectively while CENT showed no difference in TL compared to the younger CT and NLO. Our results strengthen the hypothesis that the longevity of parents may influence the health status of their offspring. Moreover, our data also suggest that both CENT and their offspring may be characterized by a better TL maintenance which, in turn, may contribute to their longevity and healthy aging. The observation that SSCENT showed considerable shorter telomeres compared to CENT may suggest a progressive impairment of TL maintenance mechanisms over the transition from centenarian to semisupercentenarian age.",acute heart infarction;age distribution;age releted disease;aged;angina pectoris;article;cerebrovascular accident;chronic obstructive lung disease;controlled study;dementia;depression;geriatric disorder;health status;heart arrhythmia;human;hypertension;leukocyte telomere length;life expectancy;longevity;osteoarthritis;prevalence;progeny;telomere;very elderly,"Tedone, E.;Arosio, B.;Gussago, C.;Casati, M.;Ferri, E.;Ogliari, G.;Ronchetti, F.;Porta, A.;Massariello, F.;Nicolini, P.;Mari, D.",2014,,,0,
4402,Invasive strategy in acute coronary syndrome - Authors' reply,,clopidogrel;fibrinogen receptor antagonist;heparin;aged;aging;anticoagulant therapy;bleeding;community hospital;comorbidity;conservative treatment;coronary artery disease;dementia;disease severity;drug efficacy;frail elderly;heart muscle revascularization;human;invasive procedure;letter;life expectancy;non ST segment elevation myocardial infarction;open study;percutaneous coronary intervention;priority journal;quality of life;randomized controlled trial (topic);risk factor;sample size;unstable angina pectoris;very elderly,"Tegn, N.;Abdelnoor, M.;Aaberge, L.;Endresen, K.;Bendz, B.",2016,,,0,
4403,In-hospital mortality and coronary procedure use for individuals with dementia with acute myocardial infarction in the United States,"OBJECTIVES: To determine in-hospital mortality differences in individuals with dementia and acute myocardial infarction (AMI) when using invasive coronary procedures. DESIGN: Retrospective cohort study. SETTING: 2009 Nationwide Inpatient Sample. PARTICIPANTS: Individuals admitted with a primary diagnosis of AMI (N = 631,734) to 1,045 hospitals in 44 states during 2009. MEASUREMENTS: Dementia status and procedural use of diagnostic catheterization, percutaneous intervention (PCI), and coronary artery bypass grafts (CABG) as indicated by International Classification of Diseases, Ninth Revision, codes. The primary outcome was in-hospital mortality. Using multivariable analysis adjusted for covariates, associations were made between coronary procedural use in individuals with dementia and in-hospital mortality. Additional multivariable analysis identified the association between utilization of coronary procedures and in-hospital mortality in AMI patients with dementia. RESULTS: Dementia diagnosis (n = 15,335) was associated with greater likelihood of in-hospital mortality (odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.15-1.29, P < .001) and less use of diagnostic catheterization (OR = 0.37, 95% CI = 0.35-0.40, P < .001), PCI (OR = 0.37, 95% CI = 0.35-0.40, P < .001), and CABG (OR = 0.19, 95% CI = 0.16-0.22, P < .001). There was less likelihood of in-hospital mortality in participants with dementia who received diagnostic catheterization (OR = 0.36, 95% CI = 0.16-0.78, P < .001), PCI (OR = 0.57, 95% CI = 0.47-0.70, P < .001), or CABG (OR = 0.22, 95% CI = 0.08-0.56, P < .001) than in those not receiving respective interventions. CONCLUSION: Dementia is a significant predictor of in-hospital mortality for hospitalized individuals with AMI and is associated with less use of invasive coronary procedures. Beyond differing care patterns for individuals with AMI and dementia, these results indicate that individuals with dementia are at substantially greater risk for in-hospital mortality when they do not receive procedural interventions.","Aged;Aged, 80 and over;*Angioplasty, Balloon, Coronary;*Cardiac Catheterization;Cohort Studies;*Coronary Artery Bypass;Dementia/*complications;Female;*Hospital Mortality;Humans;Male;Myocardial Infarction/*complications/*therapy;Retrospective Studies;United States/epidemiology;acute myocardial infarction;dementia;in-hospital mortality","Tehrani, D. M.;Darki, L.;Erande, A.;Malik, S.",2013,Nov,10.1111/jgs.12497,0,
4404,Enrichment of clinical study populations,"Those who conduct clinical trials enrich study populations in a variety of ways in order to identify a population of patients in whom a drug effect, if present, is more likely to be demonstrable. The principal ways to do this are as follows: (i) practical enrichment, i.e., generally seeking to reduce noise (variability of measurement) and heterogeneity (by avoiding the enrollment of patients with other diseases and individuals in whom the disease disappears spontaneously), (ii) prognostic enrichment, i.e., finding patients who are likely to have the event of interest when enrolling for risk-reduction studies, and (iii) predictive enrichment, i.e., finding the individuals who are more likely to respond. Enrichment fits well into the growing interest in individualization of therapy but creates some tension with another trend, namely, the desire for real-world studies with less restrictive entry criteria and other requirements. © 2010 American Society for clinical Pharmacology and Therapeutics.",angiotensin receptor antagonist;antiarrhythmic agent;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;enalapril;hydroxymethylglutaryl coenzyme A reductase inhibitor;tamoxifen;tetrabenazine;trastuzumab;article;breast cancer;cardiotoxicity;clinical practice;clinical study;clinical trial;drug mechanism;heart arrhythmia;heart failure;human;Huntington chorea;hypercholesterolemia;hypertension;priority journal;prognosis;risk reduction;treatment response;herceptin,"Temple, R.",2010,,,0,
4405,"The complexity of the genotype-phenotype relationship and the limitations of using genetic ""markers"" at the individual level","Many associations have recently been discovered between phenotypic variation and genetic loci, causing some to advocate what Robert Sinsheimer has called ""a new eugenics"" that would treat genetic ""defects"" in individuals prone to a disease. The first premise of this vision is that genetic association studies reveal the biological cause of the phenotypic variation. Once the responsible genes are known, the second premise is that we should focus upon changing ""nature"" rather than ""nurture"" by correcting the ""defective"" genes. The first premise is flawed because associations between genetic markers and phenotypes can be spurious, as shown by an example. Moreover, it is shown that using non-causative but associated genetic markers one at a time (the normal practice) can lead to incorrect predictions of disease risk for many individuals. Going from association to causation is a non-trivial step scientifically that has rarely been done in much of the human genetic research. Even when a particular locus does contribute to the phenotypic variation of interest, the first premise remains flawed because phenotypes in general arise from complex interactions among genes and between genes and environments as shown for genes associations with coronary artery disease (CAD). The ability of current molecular genetic tools to ""fix"" defective genotypes is extremely limited, but even if the technological problems could be overcome, the studies on CAD reveal no obvious ""defective"" gene to fix because the genetic effects are so context dependent (upon both other genes and environmental factors). Contrary to the second premise of the new eugenics, the more we learn about how different genotypes show variable responses to environments, the more important the environment becomes for individual treatment. The paradigm of a ""defective gene"" may work for classical Mendelian genetic diseases that are due to loss-of-function mutations. However, such mutations affect only a small portion of humanity. When the focus is changed to common disease and behavioral phenotypes, the ""defective gene"" paradigm is biologically meaningless and often harmful when applied to individuals. Thus, even when genes clearly do influence common phenotypic variation, the premises of the ""new eugenics"" are biologically indefensible.",apolipoprotein E;Alzheimer disease;article;Biomedical and Behavioral Research;coronary artery atherosclerosis;environment;genetic disorder;genetic marker;genetic predisposition;genetic variability;genetics;Genetics and Reproduction;genotype;human;medical genetics;phenotype;reproducibility,"Templeton, A. R.",1998,,,0,
4406,Do old age psychiatrists miss physical illnesses?,We studied the ability of old age psychiatrists to accurately diagnose physical disorders in elderly patients. A group of 24 psychogeriatric patients who died in hospital were matched for age and sex with 24 elderly patients who died under the care of other specialists in the same hospital. Postmortem findings and premortem diagnoses were compared retrospectively and the two groups showed high but similar levels of diagnostic discrepancies despite the greater prevalence of dementia in the psychogeriatric group. The results show that old age psychiatrists are as successful as other specialists in identifying physical illnesses in their elderly patients.,aged;article;aspiration pneumonia;autopsy;bronchopneumonia;clinical article;colon carcinoma;controlled study;dementia;diagnostic accuracy;duodenum ulcer;emphysema;female;gerontopsychiatry;heart infarction;human;liver disease;lung edema;male;medical audit;medical specialist;morbidity;physical disease;prostate cancer;psychiatrist;sigmoid volvulus;spleen rupture,"Tench, D. W.;Benbow, S. M.;Benbow, E. W.",1992,,,0,
4407,The impact of an acute dialysis start on the mortality attributed to the use of central venous catheters: A retrospective cohort study,"Background: Central venous catheters (CVCs) are associated with early mortality in dialysis patients. However, some patients progress to end stage renal disease after an acute illness, prior to reaching an estimated glomerular filtration rate (eGFR) at which one would expect to establish alternative access (fistula/peritoneal dialysis catheter). The purpose of this study was to determine if exclusion of this acute start patient group alters the association between CVCs and mortality. Methods. We conducted a retrospective cohort study of 406 incident dialysis patients from 1 Jan 2006 to 31 Dec 2009. Patients were classified as acute starts if 1) the eGFR was >25ml/min/1.73m2, ≤3 months prior to dialysis initiation and declined after an acute event (n=45), or 2) in those without prior eGFR measurements, there was no supporting evidence of chronic kidney disease on history or imaging (n=12). Remaining patients were classified as chronic start (n=349). Results: 98% and 52% of acute and chronic starts initiated dialysis with a CVC. There were 148 deaths. The adjusted mortality hazard ratio (HR) for acute vs. chronic start patients was 1.84, (95% CI [1.19-2.85]). The adjusted mortality HR for patients dialyzing with a CVC compared to alternative access was 1.19 (95% CI [0.80-1.77]). After excluding acute start patients, the adjusted HR fell to 1.03 (95% CI [0.67-1.57]). Conclusions: A significant proportion of early dialysis mortality occurs after an acute start. Exclusion of this population attenuates the mortality risk associated with CVCs. © 2012 Tennankore et al.; licensee BioMed Central Ltd.",acute coronary syndrome;adult;aged;article;catheter infection;cause of death;central venous catheterization;cerebrovascular accident;chronic kidney disease;cohort analysis;congestive cardiomyopathy;correlation analysis;delirium;dementia;demyelinating disease;dialysis;disease association;disease severity;female;gastrointestinal hemorrhage;gastrointestinal obstruction;glomerulus filtration rate;heart failure;human;major clinical study;male;mortality;multiple myeloma;outcome assessment;respiratory failure;retrospective study;seizure;valvular heart disease,"Tennankore, K. K.;Soroka, S. D.;Kiberd, B. A.",2012,,,0,
4408,Characteristics of Hospice Programs with Problematic Live Discharges,"Context Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. Objectives To characterize hospices with high rates of problematic patterns of live discharges. Methods Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. Results In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers. Conclusion Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.",aged;article;cerebrovascular accident;congestive heart failure;coronary artery disease;dementia;dying;failure to thrive;female;hospice;hospital management;hospitalization;human;independent variable;liver disease;major clinical study;male;medicare;oligophrenia;organization;Parkinson disease;patient care planning;pneumonia;problematic live discharge;profit,"Teno, J. M.;Bowman, J.;Plotzke, M.;Gozalo, P. L.;Christian, T.;Miller, S. C.;Williams, C.;Mor, V.",2015,,,0,
4409,The burden and trends of psychiatric co-morbidities amongst patients with cardiomyopathy,,adult;alcohol abuse;bipolar disorder;cannabis addiction;cohort analysis;comorbidity;comparative study;congestive cardiomyopathy;dementia;depression;disease association;emotional stress;female;genetic risk;heart failure;human;hypertrophic cardiomyopathy;hypothalamus hypophysis system;ICD-10;intoxication;letter;major clinical study;male;mental disease;obsessive compulsive disorder;phobia;prevalence;priority journal;restrictive cardiomyopathy;risk factor;schizoaffective psychosis;schizophrenia;sudden death;suicide attempt,"Teo, R.;Gollop, N. D.;Baig, M.;Uppal, H.;Chandran, S.;Potluri, R.",2014,,,0,
4410,Adverse effects of interferon on the cardiovascular system in patients with chronic hepatitis C,"The therapeutic effects of interferon in chronic hepatitis C and many of its adverse effects have been well documented. However, there are only a few reports regarding its adverse effects on the cardiovascular system. The aim of this study was to clarify the clinical features of the adverse effects of interferon on the cardiovascular system in patients with chronic hepatitis C. We monitored 295 patients with chronic active hepatitis C during 312 courses of interferon therapy and for 1 year after the end of treatment for the presence of cardiovascular adverse effects. We found 6 patients with cardiovascular adverse effects during interferon therapy and 4 more patients within 1 year after the end of therapy (10/312, 3.2%). The adverse effects of interferon on the cardiovascular system included arrhythmia (n = 4), ischemic heart disease (n = 4) and myocardial disease (n = 2). None of the clinical factors, including history of cardiovascular disease, were related to these cardiovascular adverse effects. In all instances the patient's condition improved after discontinuation of interferon and adequate therapy. The cardiovascular adverse effects of interferon occurred frequently in patients with chronic hepatitis C, even after the end of therapy and they were unpredictable. Thus, all patients undergoing interferon therapy should be monitored not only during but also after the end of treatment.",alpha interferon;antivirus agent;beta interferon;interferon;recombinant alpha2a interferon;recombinant alpha2b interferon;adult;aged;alopecia;article;bone marrow suppression;cholelithiasis;chronic active hepatitis;dementia;fatigue;female;heart arrhythmia;hematuria;herpes zoster;human;intramuscular drug administration;intraocular hemorrhage;intravenous drug administration;ischemic heart disease;major clinical study;male;myocardial disease;pneumonia;priority journal;psychosis;rash;side effect;time;tremor;vertigo,"Teragawa, H.;Hondo, T.;Amano, H.;Hino, F.;Ohbayashi, M.",1996,,,0,
4411,A neuroradiological study on the influence of cerebral atrophy and white matter lesion on cognitive function in the elderly,"We investigated the influence of brain atrophy and white matter lesions on cognitive function in elderly people. We selected 33 subjects (mean age, 79.2 +/- 5.1yrs) with a MMSE score from 14 to 30 who had no previous history of stroke from the outpatients in the Memory Clinic of our hospital. These subjects were divided into four groups on the basis of their MMSE score as follows: 14-20; moderate dementia (Moderate-D, n = 9), 21-23; mild dementia (Mild-D, n = 9), 24-27; mild cognitive impairment (MCI, n = 10), 28-30; normal (Normal, n = 5). Among these four groups, we compared the frequency of the associated risk factors for cerebral infarction (hypertension, diabetes mellitus, hyperlipidemia, heart disease), and the severity of brain atrophy and cerebral white matter lesion which were visually evaluated by MRI technique. Brain atrophy and white matter lesions were assessed by reviewing the cerebral cortex and hippocampus, and deep white matter lesion (DWML) and periventricular hyperintensity (PVH), respectively. Brain atrophy was divided into three grades (mild, moderate, severe) and white matter lesions were classified into four grades (0-3) using Fazekas's criteria. We performed statistical analysis to detect t parameters which correlate with and influence MMSE scores from among the MRI findings. The cases with dementia were all diagnosed as Alzheimer's disease. There were no significant differences among the four groups in mean age, the incidence of individual associated risk factors, the severity of cortical atrophy, or the grade of DWML (< or = 2) and PVH (< or = 2). However, the frequency of hippocampal atrophic change greater than a moderate grade increased in parallel with the exacerbation of reduced cognitive function (Normal; 20%, MCI: 40%, Mild-D; 56%, Moderate-D 89%), and approximately 76% with such a change were AD cases. Statistical analysis showed a significant negative correlation between the grade of hippocampal atrophy and MMSE score (r = -0.518, p < 0.005) and a great influence of hippocampal atrophy on that score (step-wise regression analysis: r = 0.518, p < 0.005). From the above results, it was suggested that more than moderate atrophic change in the hippocampus might possibly be related with cognitive impairment and that both DWML and PVH less than the second grade had little influence on the decline of brain function.","Aged;Aged, 80 and over;Alzheimer Disease/*pathology;Atrophy/psychology;Cerebral Cortex/*pathology;Cognition Disorders/*pathology;Hippocampus/*pathology;Humans;*Magnetic Resonance Imaging;Neuropsychological Tests","Terai, S.",2004,Sep,,0,
4412,Three Dimensional Display in Nuclear Medicine,"Imaging techniques to obtain a tomographic image in nuclear medicine such as PET and SPECT are widely used. It is necessary to interpreting all of the tomographic images obtained in order to accurately evaluate the individual lesion, whereas three dimensional display is often useful in order to overview and evaluate the feature of the entire lesion or disease such as the position, size and abnormal pattern. In Japan, the use of three dimensional image analysis workstation with an application of the co-registration and image fusion between the functional images such as PET or SPECT and anatomical images such as CT or MRI has been generalized. In addition, multimodality imaging system such as a PET/CT and SPECT/CT has been widespread. Therefore, it is expected to improve the diagnostic accuracy using three dimensionally image fusion to functional images with poor anatomical information. In this commentary, as an example of a three dimensional display that are commonly used in nuclear medicine examination in Japan, brain regions, cardiac region and bone and tumor region will be introduced separately.","Alzheimer Disease/diagnosis;Bone Neoplasms/diagnosis;Diagnostic Imaging/*methods;Imaging, Three-Dimensional/*methods;Magnetic Resonance Imaging/methods;Mild Cognitive Impairment/diagnosis;Myocardial Ischemia/diagnosis;Neuroimaging/methods;Positron-Emission Tomography/methods;Software;Tomography, Emission-Computed, Single-Photon/methods;Tomography, X-Ray Computed/methods","Teraoka, S.;Souma, T.",2015,,,0,
4413,Three Dimensional Display in Nuclear Medicine,"Imaging techniques to obtain a tomographic image in nuclear medicine such as PET and SPECT are widely used. It is necessary to interpreting all of the tomographic images obtained in order to accurately evaluate the individual lesion, whereas three dimensional display is often useful in order to overview and evaluate the feature of the entire lesion or disease such as the position, size and abnormal pattern. In Japan, the use of three dimensional image analysis workstation with an application of the co-registration and image fusion between the functional images such as PET or SPECT and anatomical images such as CT or MRI has been generalized. In addition, multimodality imaging system such as a PET/CT and SPECT/CT has been widespread. Therefore, it is expected to improve the diagnostic accuracy using three dimensionally image fusion to functional images with poor anatomical information. In this commentary, as an example of a three dimensional display that are commonly used in nuclear medicine examination in Japan, brain regions, cardiac region and bone and tumor region will be introduced separately.",Alzheimer disease;bone tumor;computer assisted tomography;diagnostic imaging;mild cognitive impairment;heart muscle ischemia;neuroimaging;nuclear magnetic resonance imaging;positron emission tomography;procedures;single photon emission computed tomography;software;three dimensional imaging,"Teraoka, S.;Souma, T.",2015,,,0,4412
4414,The influence of age and chronic medical conditions on neurological outcomes in out of hospital cardiac arrest,"Aim: It is unknown whether older patients with out of hospital cardiac arrest (OHCA) have worse outcomes because of aging itself, or because age can be a marker for overall health status. We aimed to study the prognostic utility of age and pre-arrest comorbidities. Methods: We conducted a retrospective cohort study, reviewing electronic health records of all adults treated for non-traumatic OHCA in the University of Michigan Emergency Department (N= 588). Primary covariates included age, Charlson Comorbidity Index (CCI), and a combined Charlson-age index. The primary dichotomized outcome was favorable neurological outcome (cerebral performance category, 1-2), evaluated by logistic regressions. Results: Dementia ( p= 0.01), witnessed arrest ( p= 0.03), bystander CPR ( p< 0.001), presenting rhythm ( p< 0.001), and mild therapeutic hypothermia ( p< 0.001) were associated with the primary outcome. Increasing age (unadjusted OR for each decade of life, 95% CI: 0.78, 0.70-0.88; adjusted 0.79, 0.67-0.94) was negatively associated with likelihood of a favorable neurological outcome. CCI and combined Charlson-age index significantly predicted outcome in the unadjusted, but not adjusted analysis. Composite variables were stronger predictors in patients with shockable than non-shockable presenting rhythms (interaction terms: age and rhythm [ p= 0.004], CCI and rhythm [ p= 0.01]). Conclusion: Age, but not CCI, was significantly associated with less favorable neurological outcomes in patients with OHCA after adjusting important covariates. Age appears to be an independent predictor of prognosis rather than a marker for comorbidity.",adult;age;aged;article;Charlson Comorbidity Index;chronic disease;cohort analysis;comorbidity;dementia;female;human;induced hypothermia;major clinical study;male;neurologic disease;observational study;out of hospital cardiac arrest;outcome assessment;predictive value;priority journal;prognosis;resuscitation;retrospective study;return of spontaneous circulation,"Terman, S. W.;Shields, T. A.;Hume, B.;Silbergleit, R.",2015,,,0,
4415,Symptomatic and concurrent depressions,"The symptomatic and concurrent depressions description need to resort to comorbidity and symptomatic co-occurrence concepts. Patients with depressive symptoms or in a major depressive episode may also be suffering from another nonmood psychiatric disorders as alcoholism, anxiety or eating disorders. Many general medical conditions which are link with depression are illustrated with the examples of cancer, coronary artery disease, endocrinologic diseases, dementia, stroke and chronic fatigue syndrome. When depression and another psychiatric or medical conditions occur together, it is important to provide to the practitioner guidelines for the decision to treat one of the two disorders. This paper contains an example of decisional algorithm.","Alcoholism/complications;Algorithms;Anxiety Disorders/complications;Cerebrovascular Disorders/complications;Coronary Disease/complications;Decision Support Techniques;Dementia/complications;Depression/*complications/therapy;Depressive Disorder/*complications/therapy;Endocrine System Diseases/complications;Fatigue Syndrome, Chronic/complications;Feeding and Eating Disorders/complications;Guidelines as Topic;Humans;Neoplasms/complications","Terra, J. L.",1999,Apr 1,,0,
4416,A pharmacist's guide to OTC therapy,,acetylsalicylic acid;anticoagulant agent;beta adrenergic receptor blocking agent;bisphosphonic acid derivative;celecoxib;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;ibuprofen;methotrexate;naproxen;non prescription drug;nonsteroid antiinflammatory agent;paracetamol;placebo;sulfonylurea;valproic acid;Alzheimer disease;analgesia;analgesic activity;antiinflammatory activity;antipyretic activity;cancer pain;cardiovascular risk;cognition;dementia;diabetes mellitus;drug absorption;drug activity;drug efficacy;drug formulation;drug metabolism;drug overdose;drug release;drug safety;dysmenorrhea;dyspepsia;epigastric pain;fever;follow up;food and drug administration;gastrointestinal hemorrhage;gastrointestinal symptom;health care personnel;heart failure;heart infarction;heartburn;high risk patient;human;hyperlipidemia;hypertension;incidence;liver failure;liver toxicity;nausea;outcome assessment;pain;patient education;pharmacist;postoperative pain;practice guideline;primary health care;risk factor;self care;self medication;short survey;single drug dose;cerebrovascular accident;tension headache;thromboembolism;aspirin,"Terrie, Y. C.",2009,,,0,
4417,Alzheimer's Disease: Empowering Patients and Caregivers,,aging;Alzheimer disease;article;aspiration pneumonia;awareness;behavior;caregiver;cognition;cognitive defect;coping behavior;disease course;disease severity;empowerment;health care personnel;heart failure;human;incidence;lifestyle;memory disorder;mood change;pharmacist;risk factor;survival rate,"Terrie, Y. C.",2015,,,0,
4418,Association of longer telomeres with better health in centenarians,"Prior animal model studies have demonstrated an association between telomere length and longevity. Our study examines telomere length in centenarians in good health versus poor health. Using DNA from blood lymphocytes, telomere length was measured by quantitative polymerase chain reaction in 38 sex- and age-matched centenarians (ages 97-108). ""Healthy"" centenarians (n = 19) with physical function in the independent range and the absence of hypertension, congestive heart failure, myocardial infarction, peripheral vascular disease, dementia, cancer, stroke, chronic obstructive pulmonary disease, and diabetes were compared to centenarians with physical function limitations and > or =2 of the above conditions (n = 19). Healthy centenarians had significantly longer telomeres than did unhealthy centenarians (p =.0475). Our study demonstrated that investigations of the association between telomere length and exceptional longevity must take into account the health status of the individuals. This raises the possibility that perhaps it is not exceptional longevity but one's function and health that may be associated with telomere length.","Activities of Daily Living;Aged, 80 and over/*physiology;Female;*Health Status;Humans;Longevity/*physiology;Male;*Telomere/ultrastructure","Terry, D. F.;Nolan, V. G.;Andersen, S. L.;Perls, T. T.;Cawthon, R.",2008,Aug,,0,
4419,Health status of 'Ruhr-City' in 2025--predicted disease burden for the metropolitan Ruhr area in North Rhine-Westphalia,"BACKGROUND: Demographic change is a driving force of disease burden. The German population is aging and simultaneously shrinking, due to a rising life expectancy and a declining fertility rate. North Rhine-Westphalia (NRW) is the most populous federal state of Germany including the Ruhr metropolitan area. The NRW population is expected to shrink by 2.5% until 2025, the population of the Ruhr area by 9.5%. At the same time, the population forecast predicts a growth of 30% in the age group > or =55 years for NRW. METHODS: The 'burden of disease' approach of the World Health Organisation (WHO) summarizes the health status of populations. This approach was used to predict the regional disease burden in 2025 by calculating disability adjusted life years (DALY) as the sum of life years lost due to premature death and years lived with disability due to selected diseases. Our projection included selected tumours, myocardial infarction (MI) and dementia. RESULTS: For the Ruhr area, increases in DALYs are expected for all causes studied, i.e. selected tumours (20%), MI (17%) and dementia (36%). The increase in the Ruhr area was estimated to be proportionally lower than in NRW in total, but the disease burden per inhabitant is higher. CONCLUSION: The population shrinking is no cure for 'Ruhr City'. The projection of disease burden shows that health status will decrease due to the demographic change. DALY estimates show the potential health gains, which can be won by implementing measures to reduce premature deaths and to prevent new cases.","Adolescent;Adult;Age Distribution;Aged;Aged, 80 and over;Child;Child, Preschool;Dementia/*epidemiology;Female;Germany/epidemiology;*Health Status;Health Surveys;Humans;Infant;Infant, Newborn;Life Expectancy/trends;Male;Middle Aged;Myocardial Infarction/*epidemiology;Neoplasms/*epidemiology;*Population Dynamics;Sex Distribution;Urban Population/statistics & numerical data;Young Adult","Terschuren, C.;Mekel, O. C.;Samson, R.;Classen, T. K.;Hornberg, C.;Fehr, R.",2009,Oct,10.1093/eurpub/ckp060,0,
4420,Peril beyond the winner's curse: A small sample size is the bane of biomarker discovery,,biological marker;Alzheimer disease;cognition;diabetes mellitus;false positive result;flow injection analysis;gas chromatography;genome-wide association study;heart failure;human;letter;liquid chromatography-mass spectrometry;mild cognitive impairment;priority journal;prostate cancer;respiratory tract disease;sample size;time of flight mass spectrometry,"Thambisetty, M.;Casanova, R.;Varma, S.;Legido Quigley, C.",2017,,10.1016/j.jalz.2017.01.003,0,
4421,Predicting early death among elderly dialysis patients: Development and validation of a risk score to assist shared decision making for dialysis initiation,"Background A shared decision-making tool could help elderly patients with advanced chronic kidney disease decide about initiating dialysis therapy. Because mortality may be high in the first few months after initiating dialysis therapy, incorporating early mortality predictors in such a tool would be important for an informed decision. Our objective is to derive and validate a predictive risk score for early mortality after initiating dialysis therapy. Study Design Retrospective observational cohort, with development and validation cohorts. Setting & Participants US Renal Data System and claims data from the Centers for Medicare & Medicaid Services for 69,441 (aged ≥67 years) patients with end-stage renal disease with a previous 2-year Medicare history who initiated dialysis therapy from January 1, 2009, to December 31, 2010. Candidate Predictors Demographics, predialysis care, laboratory data, functional limitations, and medical history. Outcomes All-cause mortality in the first 3 and 6 months. Analytical Approach Predicted mortality by logistic regression. Results The simple risk score (total score, 0-9) included age (0-3 points), low albumin level, assistance with daily living, nursing home residence, cancer, heart failure, and hospitalization (1 point each), and showed area under the receiver operating characteristic curve (AUROC) = 0.69 in the validation sample. A comprehensive risk score with additional predictors was also developed (with AUROC = 0.72, high concordance between predicted vs observed risk). Mortality probabilities were estimated from these models, with the median score of 3 indicating 12% risk in 3 months and 20% in 6 months, and the highest scores (≥8) indicating 39% risk in 3 months and 55% in 6 months. Limitations Patients who did not choose dialysis therapy and did not have a 2-year Medicare history were excluded. Conclusions Routinely available information can be used by patients with chronic kidney disease, families, and their nephrologists to estimate the risk of early mortality after dialysis therapy initiation, which may facilitate informed decision making regarding treatment options.",albumin;creatinine;aged;albumin blood level;area under the curve;article;Caucasian;Charlson Comorbidity Index;chronic obstructive lung disease;cohort analysis;congestive heart failure;creatinine blood level;decision making;dementia;demography;depression;end stage renal disease;female;health care utilization;heart failure;hemodialysis;hemodialysis patient;hospitalization;human;ischemic heart disease;major clinical study;male;medical history;medicare;mortality;neoplasm;nursing home;observational study;peripheral vascular disease;race difference;receiver operating characteristic;retrospective study;sex difference;shared decision making;treatment duration;very elderly,"Thamer, M.;Kaufman, J. S.;Zhang, Y.;Zhang, Q.;Cotter, D. J.;Bang, H.",2015,,,0,
4422,The 2017 hormone therapy position statement of The North American Menopause Society,"The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the 2012 Hormone Therapy Position Statement of The North American Menopause Society and identifies future research needs. An Advisory Panel of clinicians and researchers expert in the field of women's health and menopause was recruited by NAMS to review the 2012 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees.Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing or discontinuing HT.For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is most favorable for treatment of bothersome VMS and for those at elevated risk for bone loss or fracture. For women who initiate HT more than 10 or 20 years from menopause onset or are aged 60 years or older, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS or bone loss, with shared decision making and periodic reevaluation. For bothersome GSM symptoms not relieved with over-the-counter therapies and without indications for use of systemic HT, low-dose vaginal estrogen therapy or other therapies are recommended.This NAMS position statement has been endorsed by Academy of Women's Health, American Association of Clinical Endocrinologists, American Association of Nurse Practitioners, American Medical Women's Association, American Society for Reproductive Medicine, Asociacion Mexicana para el Estudio del Climaterio, Association of Reproductive Health Professionals, Australasian Menopause Society, Chinese Menopause Society, Colegio Mexicano de Especialistas en Ginecologia y Obstetricia, Czech Menopause and Andropause Society, Dominican Menopause Society, European Menopause and Andropause Society, German Menopause Society, Groupe d'etudes de la menopause et du vieillissement Hormonal, HealthyWomen, Indian Menopause Society, International Menopause Society, International Osteoporosis Foundation, International Society for the Study of Women's Sexual Health, Israeli Menopause Society, Japan Society of Menopause and Women's Health, Korean Society of Menopause, Menopause Research Society of Singapore, National Association of Nurse Practitioners in Women's Health, SOBRAC and FEBRASGO, SIGMA Canadian Menopause Society, Societa Italiana della Menopausa, Society of Obstetricians and Gynaecologists of Canada, South African Menopause Society, Taiwanese Menopause Society, and the Thai Menopause Society. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool, June 2017. The British Menopause Society supports this Position Statement.",,"The, Nams Hormone Therapy Position Statement Advisory Panel",2017,Jul,,0,
4423,All-Cause and Cause-Specific Mortality after Hypertensive Disease of Pregnancy,"OBJECTIVE: To assess whether women with a history of hypertensive disease of pregnancy have increased risk for early adult mortality. METHODS: In this retrospective cohort study, women with one or more singleton pregnancies (1939-2012) with birth certificate information in the Utah Population Database were included. Diagnoses were categorized into gestational hypertension; preeclampsia; hemolysis, elevated liver enzymes, and low platelet count syndrome; and eclampsia. Women with more than one pregnancy with hypertensive disease (exposed) were included only once, assigned to the most severe category. Exposed women were matched one to two to unexposed women by age, year of childbirth, and parity at the time of the index pregnancy. The causes of death were ascertained using Utah death certificates and the fact of death was supplemented with the Social Security Death Index. Hazard ratios for cause-specific mortality among exposed women compared with unexposed women were estimated using Cox regressions adjusting for neonatal sex, parental education, preterm delivery, race-ethnicity, and maternal marital status. RESULTS: A total of 60,580 exposed women were matched to 123,140 unexposed women; 4,520 (7.46%) exposed and 6,776 (5.50%) unexposed women had died by 2012. All-cause mortality was significantly higher among women with hypertensive disease of pregnancy (adjusted hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.57-1.73). Exposed women's greatest excess mortality risks were from Alzheimer disease (adjusted HR 3.44, 95% CI 1.00-11.82), diabetes (adjusted HR 2.80, 95% CI 2.20-3.55), ischemic heart disease (adjusted HR 2.23, 95% CI 1.90-2.63), and stroke (adjusted HR 1.88, 95% CI 1.53-2.32). CONCLUSION: Women with hypertensive disease of pregnancy have increased mortality risk, particularly for Alzheimer disease, diabetes, ischemic heart disease, and stroke.",adult;Alzheimer disease;article;birth certificate;cause of death;cerebrovascular accident;childbirth;cohort analysis;controlled study;data base;death certificate;diabetes mellitus;disease severity;eclampsia;educational status;female;HELLP syndrome;high risk pregnancy;human;ischemic heart disease;major clinical study;marriage;maternal hypertension;mortality;parity;pregnancy;premature labor;priority journal;retrospective study;social security;United States,"Theilen, L. H.;Fraser, A.;Hollingshaus, M. S.;Schliep, K. C.;Varner, M. W.;Smith, K. R.;Esplin, M. S.",2016,,,0,
4424,Effect of pravastatin on plasma sterols and oxysterols in men,"METHODS: A post hoc analysis was performed with plasma material from a clinical trial where 51 healthy men (35+/-4 years) were randomly assigned to receive either pravastatin (40 mg/day) or placebo for 6 months. Cholesterol, its precursor lathosterol, its brain-specific metabolite 24(S)-hydroxycholesterol (24S-OH-chol) and 27-hydroxycholesterol (27-OH-chol) were determined in plasma samples before and after treatment by using gas-liquid chromatography (GC)-flame ionization detection (GC-FID) and GC mass spectrometry (GC-MS).RESULTS: Besides reducing total cholesterol (-20%, P<0.001) and LDL cholesterol (LDL-C; -33%, P<0.001) concentrations, pravastatin treatment resulted in a decrease of the ratio of lathosterol to cholesterol, a surrogate marker of endogenous cholesterol synthesis, by 20% (P<0.05). Absolute concentrations of 24S-OH-chol were not altered, but its ratio to cholesterol slightly increased by 15% (P<0.05). 27-OH-chol concentrations as well as its ratio to cholesterol were both significantly altered due to pravastatin treatment (-7% and +14%, P<0.05 for both, respectively).CONCLUSIONS: The treatment with pravastatin 40 mg once a day for 6 months does not affect brain cholesterol metabolism as judged by plasma concentrations of 24(S)-hydroxycholesterol.OBJECTIVES: The HMG-CoA reductase inhibitors, or statins, are well established in the prevention and treatment of coronary artery disease, mainly by lowering low-density lipoprotein (LDL) cholesterol levels. These compounds are structurally similar, but differ in their lipophilicity. Several studies have indicated a link between cholesterol and Alzheimer's disease (AD), and there is also epidemiological evidence that statin treatment may decrease the prevalence of dementias. In the present study we wanted to investigate whether pravastatin treatment affects brain cholesterol metabolism.",Brain [metabolism];Cholesterol [blood];Hydroxycholesterols [blood];Hydroxymethylglutaryl-CoA Reductase Inhibitors [pharmacology];Pravastatin [pharmacology];Sterols [blood];Adult[checkword];Humans[checkword];Male[checkword],"Thelen, Km;Lütjohann, D;Vesalainen, R;Janatuinen, T;Knuuti, J;Bergmann, K;Lehtimäki, T;Laaksonen, R",2006,,10.1007/s00228-005-0068-9,0,4425
4425,Effect of pravastatin on plasma sterols and oxysterols in men,"OBJECTIVES: The HMG-CoA reductase inhibitors, or statins, are well established in the prevention and treatment of coronary artery disease, mainly by lowering low-density lipoprotein (LDL) cholesterol levels. These compounds are structurally similar, but differ in their lipophilicity. Several studies have indicated a link between cholesterol and Alzheimer's disease (AD), and there is also epidemiological evidence that statin treatment may decrease the prevalence of dementias. In the present study we wanted to investigate whether pravastatin treatment affects brain cholesterol metabolism. METHODS: A post hoc analysis was performed with plasma material from a clinical trial where 51 healthy men (35+/-4 years) were randomly assigned to receive either pravastatin (40 mg/day) or placebo for 6 months. Cholesterol, its precursor lathosterol, its brain-specific metabolite 24(S)-hydroxycholesterol (24S-OH-chol) and 27-hydroxycholesterol (27-OH-chol) were determined in plasma samples before and after treatment by using gas-liquid chromatography (GC)-flame ionization detection (GC-FID) and GC mass spectrometry (GC-MS). RESULTS: Besides reducing total cholesterol (-20%, P<0.001) and LDL cholesterol (LDL-C; -33%, P<0.001) concentrations, pravastatin treatment resulted in a decrease of the ratio of lathosterol to cholesterol, a surrogate marker of endogenous cholesterol synthesis, by 20% (P<0.05). Absolute concentrations of 24S-OH-chol were not altered, but its ratio to cholesterol slightly increased by 15% (P<0.05). 27-OH-chol concentrations as well as its ratio to cholesterol were both significantly altered due to pravastatin treatment (-7% and +14%, P<0.05 for both, respectively). CONCLUSIONS: The treatment with pravastatin 40 mg once a day for 6 months does not affect brain cholesterol metabolism as judged by plasma concentrations of 24(S)-hydroxycholesterol.",Brain [metabolism];Cholesterol [blood];Hydroxycholesterols [blood];Hydroxymethylglutaryl-CoA Reductase Inhibitors [pharmacology];Pravastatin [pharmacology];Sterols [blood];Adult[checkword];Humans[checkword];Male[checkword],"Thelen, K. M.;Lütjohann, D.;Vesalainen, R.;Janatuinen, T.;Knuuti, J.;Bergmann, K.;Lehtimäki, T.;Laaksonen, R.",2006,,10.1007/s00228-005-0068-9,0,
4426,Estrogens and quality of life at the menopause,"The term menopause refers to the final cessation of menstruation, either as a normal part of aging (loss of all follicles and ovarian function) or as the result of surgical removal of both ovaries. The average age at menopause in Western societies is 50-52 years. Menopause is associated with a loss of menstruation hormone levels, leading to potential problems of hot flashes, increased risk for osteoporosis, heart disease, Alzheimer's disease, dry vangina, night sweats, and decreased interest in sex. Hormone therapy improves emotions, decreased vasomotor symptoms, somatic symptoms, depression and reduces the risk of death and disability associated with osteoporosis and coronary heart disease. Quality of life is very important for women at the menopause and estrogen replacement therapy (ERT) offers substantial improvement in many aspects.",amine oxidase (flavin containing);androgen;antidepressant agent;clonidine;conjugated estrogen;estradiol;estrogen;gestagen;placebo;raloxifene;adult;aged;aging;Alzheimer disease;anxiety;article;cardiovascular disease;clinical trial;controlled study;depression;double blind procedure;estrogen deficiency;estrogen therapy;female;hormone deficiency;hormone substitution;human;menopause;meta analysis;postmenopause osteoporosis;quality of life,"Theodosopoulou, E.;Vlachou, E.;Kotrotsiou, E.;Kiayias, J.;Anastassiou, C.",2001,,,0,
4427,Interest of the brain natriuretic peptide as a marker of acute cor pulmonale in acute respiratory distress syndrome,"Objective: The aim of this study was to evaluate the accuracy of the BNP as a marker of acute cor pulmonale in patients with ARDS. Study design: Prospective clinical trial. Patients and methods: At day 2 or 3 after the onset of the ARDS, an echocardiography was performed. Patients with left ventricular dysfunction were excluded. Right ventricular area (RVA) and RVA/LVA ratio were measured. ACP was defined as RVA/LVA > 0.6 associated with septal dyskinesia. Simultaneously, 5 ml of blood was collected for BNP measurement. Results: 26 patients were studied. BNP levels were higher in 10 patients with ACP: 585.5 [189-4830] vs 145.5 [36.5-346] pg/ml (P = 0.01) but in those with creatinine clearance < 90 ml/min: 602 [331-3530] vs 125 [39-189] pg/ml (P = 0.007). BNP was correlated with RVA (r = 0.5; p = 0.01), RVA/LVA ratio (r = 0.61; p = 0.001), sPAP (r = 0.58; p = 0.002) and with age, cardiac index and creatinine clearance (r = 0.61; p = 0.001). In multivariate analysis, BNP was only correlated with creatinine clearance (p = 0.03), and RVA (p = 0.06). Conclusion: In ARDS patients without left ventricular dysfunction, BNP level is more elevated in patients with acute cor pulmonale than patients without cor pulmonale. © 2006 Elsevier SAS. All rights reserved.",brain natriuretic peptide;adult respiratory distress syndrome;article;blood sampling;clinical article;clinical trial;creatinine clearance;dyskinesia;echocardiography;heart index;heart left ventricle failure;heart right ventricle;human;multivariate analysis;prion disease;prospective study,"Thierry, S.;Lecuyer, L.;Brocas, E.;Van de Louw, A.;Hours, S.;Moreau, M. H.;Boiteau, R.;Tenaillon, A.",2006,,,0,
4428,Preoperative consultations for medicare patients undergoing cataract surgery,"IMPORTANCE: Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. OBJECTIVE: To assess temporal trends, explanatory factors, and geographic variation for preoperative consultation in Medicare beneficiaries undergoing cataract surgery, a common low-risk elective procedure. DESIGN, SETTING, AND PARTICIPANTS: Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556 637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. Temporal trends in consultations were evaluated within this entire cohort, whereas explanatory factors and geographic variation were evaluated within the 89 817 individuals who underwent surgery from 2005 to 2006. MAIN OUTCOMES AND MEASURES: Separately billed preoperative consultations (performed by family practitioners, general internists, pulmonologists, endocrinologists, cardiologists, nurse practitioners, or anesthesiologists) within 42 days before index surgery. RESULTS: The frequency of preoperative consultations increased from 11.3%in 1998 to 18.4% in 2006. Among individuals who underwent surgery in 2005 to 2006, hierarchical logistic regression modeling found several factors to be associated with preoperative consultation, including increased age (75-84 years vs 66-74 years: adjusted odds ratio [AOR], 1.09 [95% CI, 1.04-1.13]), race (African American race vs other: AOR, 0.71 [95% CI, 0.65-0.78]), urban residence (urban residence vs isolated rural town: AOR, 1.64 [95% CI, 1.49-1.81]), facility type (outpatient hospital vs ambulatory surgical facility: AOR, 1.10 [95% CI, 1.05-1.15]), anesthesia provider (anesthesiologist vs non-medically directed nurse anesthetist: AOR, 1.16 [95% CI, 1.10-1.24), and geographic region (Northeast vs South: AOR, 3.09 [95% CI, 2.33-4.10]). The burden of comorbidity was associated with consultation, but the effect size was small (<10%). Variation in frequency of consultation across hospital referral regions was substantial (median [range], 12% [0-69%]), even after accounting for differences in patient-level, anesthesia provider-level, and facility-level characteristics. CONCLUSIONS AND RELEVANCE: Between 1995 and 2006, the frequency of preoperative consultation for cataract surgery increased substantially. Referrals for consultation seem to be primarily driven by nonmedical factors, with substantial geographic variation. Copyright 2014 American Medical Association. All rights reserved.",African American;aged;article;cataract;cataract extraction;cerebrovascular disease;chronic kidney failure;chronic lung disease;cohort analysis;comorbidity;consultation;dementia;diabetes mellitus;endocrinologist;female;general practitioner;health service;heart failure;hemiplegia;human;ischemic heart disease;liver disease;major clinical study;male;medicare;nurse anesthetist;outcome assessment;paraplegia;peptic ulcer;peripheral vascular disease;physician;preoperative care;priority journal;pulmonologist;random sample;rheumatic disease;very elderly,"Thilen, S. R.;Treggiari, M. M.;Lange, J. M.;Lowy, E.;Weaver, E. M.;Wijeysundera, D. N.",2014,,,0,
4429,"Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality","Objectives: this study examined the association between medically recognized urinary incontinence and risk of several disease conditions, hospitalization, nursing home admission and mortality. Design: review and abstraction of medical records and computerized data bases from 5986 members, aged 65 years and older, of a large health maintenance organization in northern California. Results: there was an increased risk of newly recognized urinary incontinence following a diagnosis of Parkinson's disease, dementia, stroke, depression and congestive heart failure in both men and women, after adjustment for age and cohort. The risk of hospitalization was 30% higher in women following the diagnosis of incontinence [relative risk (RR) = 1.3, 95% confidence interval (CI) = 1.2-1.5] and 50% higher in men (RR = 1.5, 95% CI = 1.3-l.6) after adjustment for age, cohort and co-morbid conditions. The adjusted risk of admission to a nursing facility was 2.0 times greater for incontinent women 95% CI = 1.7-2.4) and 3.2 times greater for incontinent men (95% CI = 2.7-3.8). In contrast, the adjusted risk of mortality was only slightly greater for women (RR = 1.1, 95% CI = 0.99-1.3) and men (RR = 1.2; 95% CI = 1.1-1.4). Conclusions: urinary incontinence increases the risk of hospitalization and substantially increases the risk of admission to a nursing home, independently of age, gender and the presence of other disease conditions, but has little effect on total mortality.",aged;article;congestive heart failure;dementia;depression;female;hospitalization;human;major clinical study;male;mortality;nursing home;Parkinson disease;priority journal;cerebrovascular accident;urine incontinence,"Thom, D. H.;Haan, M. N.;Van Den Eeden, S. K.",1997,,,0,
4430,Clozapine-induced cardiac failure,"A 73-year-old woman with dementia was given clozapine for treatment-resistant psychotic symptoms. Subsequently, she developed cardiac failure. Caution should be exercised when using clozapine, especially in the elderly.",Dementia;cardiac failure;clozapine;elderly;psychotic symptoms,"Thomas, K.;Susan, S. R.;Jayaprakash, K. K.",2006,Apr,10.4103/0019-5545.31607,0,
4431,Arrhythmia as a cardiac manifestation in MELAS syndrome,"A 44-year-old female with a diagnosis of mitochondrial myopathy, encephalopathy and stroke-like episodes (MELAS) syndrome had progressive left ventricular hypertrophy (LVH) on echocardiogram. A Holter monitor demonstrated episodes of non-sustained atrial tachycardia, a finding not been previously described in this population. This unique case of MELAS syndrome demonstrates the known associated cardiac manifestation of LVH and the new finding of atrial tachycardia which may represent the potential for subclinical arrhythmia in this population.",acetylsalicylic acid;atenolol;brain natriuretic peptide;gadolinium;leucine transfer RNA;adult;article;bilateral ophthalmoplegia;brain atrophy;cardiac imaging;cardiomyopathy;cardiovascular magnetic resonance;case report;cerebellum atrophy;dementia;diabetes mellitus;disease course;female;gene deletion;heart arrhythmia;heart left ventricle hypertrophy;Holter monitoring;human;MELAS syndrome;mitochondrial genome;myopathy;neuroimaging;nuclear magnetic resonance imaging;ophthalmoplegia;perception deafness;ptosis;radiological parameters;seizure;sinus rhythm;supraventricular premature beat,"Thomas, T.;Craigen, W. J.;Moore, R.;Czosek, R.;Jefferies, J. L.",2015,,,0,
4432,Estrogen protects peripheral and cerebral blood vessels from toxicity of Alzheimer peptide amyloid-beta and inflammatory reaction,"Due to increases in life expectancy, women are living 30 years or more beyond menopause. This has led to an increasing interest in the association between postmenopausal estrogen deficiency and degenerative diseases associated with aging such as cardiovascular disease, osteoporosis and dementia. Women are two times more likely to develop late-onset Alzheimer's disease (AD) than age-matched men. A large number of observational reports and a few randomized clinical trials have indicated that estrogen replacement therapy (ERT) may retard the development and severity of dementia in postmenopausal women. The mechanism underlying the protective action of estrogen in AD is under active investigation. A chronic inflammatory reaction mediated by abnormal deposition of proteins such as amyloid-beta (A beta) is central to the pathology of AD. We investigated the effect of low doses of conjugated estrogen (Premarin) in an animal model of A beta-induced vascular disruption and inflammatory reaction. This rodent model allows live videomicroscopic recording and electron microscopic analysis of peripheral vascular disruption and inflammatory reaction triggered by A beta. Estrogen prevented vascular deposition of A beta, endothelial and vessel wall disruption with plasma leakage, platelet and mast cell activation, and characteristic features of an inflammatory reaction: adhesion and transmigration of leukocytes. The beneficial effect was lost when estrogen treatment was discontinued. Estrogen also protected the cerebral blood vessels from endothelial dysfunction induced by A beta. This novel protective effect of estrogen against A beta cytotoxicity in peripheral and cerebral vasculature may contribute to the therapeutic efficacy of estrogen in AD and coronary vascular disease.","Aged;Alzheimer Disease/*drug therapy/metabolism/pathology;Amyloid beta-Peptides/*metabolism;Animals;Blood Vessels/*drug effects/metabolism/pathology;Cerebrovascular Circulation/*drug effects;Coronary Disease/drug therapy;Disease Models, Animal;Estrogen Replacement Therapy;Estrogens/deficiency;Estrogens, Conjugated (USP)/*therapeutic use;Female;Humans;Inflammation/pathology/prevention & control;Male;Microscopy, Electron;Rats;Rats, Sprague-Dawley","Thomas, T.;Rhodin, J. A.;Sutton, E. T.;Bryant, M. W.;Price, J. M.",1999,Oct,,0,
4433,"The effects of preexisting medical comorbidities on mortality and length of hospital stay in acute burn injury: Evidence from a national sample of 31,338 adult patients","OBJECTIVE: To determine whether and to what extent preexisting medical comorbidities influence mortality risk and length of hospitalization in patients with acute burn injury. SUMMARY BACKGROUND DATA: The effects on mortality and length of stay of a number of important medical comorbidities have not been examined in acute burn injury. Existing studies that have investigated the effects of medical comorbidities on outcomes in acute burn injury have produced inconsistent results, chiefly due to the use of relatively small samples from single burn centers. METHODS: Records of 31,338 adults who were admitted with acute burn injury to 70 burn centers from the American Burn Association National Burn Repository, were reviewed. A burn-specific list of medical comorbidities was derived from diagnoses included in the Charlson Index of Comorbidities and the Elixhauser method of comorbidity measurement. Logistic regression was used to assess the effects of preexisting medical conditions on mortality, controlling for demographic and burn injury characteristics. Ordinal least squares regression with a logarithmic transformation of the dependent variable was used to assess the relationship of comorbidities with length of stay. RESULTS: In-hospital mortality was significantly predicted by HIV/AIDS (odds ratio [OR] = 10.2), renal disease (OR = 5.1), liver disease (OR = 4.8), metastatic cancer (OR = 4.6), pulmonary circulation disorders (OR = 2.9), congestive heart failure (OR = 2.4), obesity (OR = 2.1), non-metastatic malignancies (OR = 2.1), peripheral vascular disorders (OR = 1.8), alcohol abuse (OR = 1.8), neurological disorders (OR = 1.6), and cardiac arrhythmias (OR = 1.5). Increased length of hospital stay among survivors was significantly predicted by paralysis (90% increase), dementia (60%), peptic ulcer disease (53%), other neurological disorders (52%), HIV/AIDS (49%), renal disease (44%), a psychiatric diagnosis (42%), cerebrovascular disease (41%), cardiac arrhythmias (40%), peripheral vascular disorders (39%), alcohol abuse (36%), valvular disease (32%), liver disease (30%), diabetes (26%), congestive heart failure (23%), drug abuse (20%), and hypertension (17%). CONCLUSIONS: A number of preexisting medical conditions influence outcomes in acute burn injury. Patients with preburn HIV/AIDS, metastatic cancer, liver disease, and renal disease have particularly poor prognoses. © 2007 Lippincott Williams & Wilkins, Inc.",acquired immune deficiency syndrome;adult;aged;alcohol abuse;article;burn;neoplasm;cerebrovascular disease;comorbidity;congestive heart failure;controlled study;dementia;demography;diabetes mellitus;drug abuse;female;heart arrhythmia;hospital admission;human;Human immunodeficiency virus infection;hypertension;kidney disease;length of stay;liver disease;logistic regression analysis;lung disease;major clinical study;male;medical record;mental disease;metastasis;mortality;neurologic disease;obesity;paralysis;peptic ulcer;peripheral vascular disease;priority journal;regression analysis;risk;valvular heart disease,"Thombs, B. D.;Singh, V. A.;Halonen, J.;Diallo, A.;Milner, S. M.",2007,,,0,
4434,Cardiovascular disease prevention and the rise in dementia,,acetylsalicylic acid;antihypertensive agent;apolipoprotein E4;atorvastatin;folic acid;hydroxymethylglutaryl coenzyme A reductase inhibitor;pravastatin;simvastatin;allele;Alzheimer disease;cardiovascular disease;cardiovascular risk;dementia;genetic susceptibility;genotype;human;hypercholesterolemia;incidence;ischemic heart disease;life expectancy;lifestyle modification;longevity;mortality;note;pathogenesis;pill;prevalence;priority journal;risk factor;cerebrovascular accident;United Kingdom,"Thompson, G. R.",2012,,,0,
4435,Development and validation of the mortality risk for trauma comorbidity index,"OBJECTIVE: The aim of this study was to develop and validate a comorbidity index to predict the risk of mortality associated with chronic health conditions following a traumatic injury. SUMMARY BACKGROUND DATA: Currently available comorbidity adjustment tools do not account for certain chronic conditions, which may influence outcome following traumatic injury or they have not been fully validated for trauma. Controlling for comorbidity in trauma patients is becoming increasingly important as the population ages and elderly patients are more active, as well as to adjust for bias in trauma mortality studies. METHODS: Cohort study using data from the National Study on the Costs and Outcome of Trauma. Subject pool (N = 4644/Weighted Number = 14,069) was randomly divided in half; the first half of subjects was used to derive the risk scale, the second to validate the instrument. To construct the Mortality Risk Score for Trauma (MoRT), univariate analysis and odds ratios were performed to determine relative risk of mortality at hospital discharge comparing those persons with a comorbid condition to those without. Conditions significantly associated with mortality (P < 0.05) were included in the multivariate model. The variables in the final model were used to build the MoRT. The predictive ability of the MoRT and the Charlson Comorbidity Index (CCI) for discharge and 1-year mortality were estimated using the c-statistic in the validation sample. RESULTS: Six comorbidity factors were independently associated with the risk of mortality and formed the basis for the MoRT: severe liver disease, myocardial infarction, cerebrovascular disease, cardiac arrhythmias, dementia, and depression. The MoRT had a similar overall discrimination as the CCI for mortality at hospital discharge in injured adults (c-statistic: 0.56 vs. 0.56) although neither by itself performed well. The addition of age and gender improved the predictive ability of the MoRT (0.59; 95% CI: 0.56, 0.62) and the CCI (0.59; 0.56, 0.62). Similar results were seen at 1-year postinjury. The further addition of Injury Severity Score significantly improved the predictive ability of the MoRT (0.77, 95% CI: 0.74, 0.79) and the CCI (0.77, 95% CI: 0.75, 0.80). CONCLUSIONS: The MoRTs primary advantage over current instruments is its parsimony, containing only 6 items. In the present study, the comorbid conditions found to be predictive of mortality had some overlap with the CCI, but this study identified 2 novel predictors: cardiac arrhythmias and depression. Inclusion and reporting of these items within trauma registries would therefore be an important step to allow further validation and use of the MoRT.",Adult;Chi-Square Distribution;*Comorbidity;Confidence Intervals;Female;Humans;Injury Severity Score;Male;Predictive Value of Tests;Prevalence;Prospective Studies;*Risk Assessment;Risk Factors;United States/epidemiology;Wounds and Injuries/*mortality,"Thompson, H. J.;Rivara, F. P.;Nathens, A.;Wang, J.;Jurkovich, G. J.;Mackenzie, E. J.",2010,Aug,10.1097/SLA.0b013e3181df03d6,0,
4436,A kick in the shins: The financial impact of uncontrolled warfarin use in pre-tibial haematomas,"Warfarin is increasingly prescribed in the elderly population for a number of medical conditions. Pre-tibial haematomas are a common cause of morbidity in this group. The aim of the study was to identify the proficiency of INR monitoring at a primary care level in correlation with their recommended INR range and to study the treatment outcome in this group. A retrospective single-centre study of patients diagnosed with pre-tibial haematomas was conducted over a two-year period. Length of hospital stay, time delay until operative intervention, blood transfusion and warfarin reversal requirements, social care input and cost to the NHS were considered. A total of 62 patients were admitted with pre-tibial haematomas of which 20 were on Warfarin. Females were predominantly more affected (5.6:1). The mechanism of injury was as a result of minor trauma. The mean INR level was 3.8 with a standard deviation of 3.1. Mean length of hospital stay was 11 days with a standard deviation of 13.6. Nine patients required skin grafting. Average cost for the acute episode was £3500 per patient. INR levels were significantly outwith the target range causing substantial patient morbidity and imposing a significant financial burden on the NHS. Tighter regulation at a primary care level should help reduce this risk. © 2012 Elsevier Ltd.",antibiotic agent;hemoglobin;hydroxymethylglutaryl coenzyme A reductase inhibitor;levothyroxine;omeprazole;prothrombin complex;vitamin K group;warfarin;aged;antibiotic therapy;anticoagulant therapy;article;blood transfusion;bone disease;cerebrovascular accident;cerebrovascular disease;chronic liver disease;chronic obstructive lung disease;community care;cost of illness;debridement;delayed diagnosis;dementia;diabetes mellitus;drug use;female;atrial fibrillation;heart failure;hematoma;hemoglobin blood level;hepatic encephalopathy;human;hypertension;injury;international normalized ratio;ischemic heart disease;length of stay;lymphoma;major clinical study;male;nursing home;physiotherapy;pneumonia;pretibial hematoma;priority journal;retrospective study;skin transplantation;social care;split thickness skin graft;therapy delay;thyroid disease;tibia;urinary tract infection;wound complication;wound infection,"Thomson, W. L.;Pujol-Nicolas, A.;Tahir, A.;Siddiqui, H.",2014,,,0,
4437,Aging and sexuality,,amitriptyline;antidepressant agent;antihypertensive agent;atenolol;beta adrenergic receptor blocking agent;calcium channel blocking agent;clofibrate;diazepam;diuretic agent;doxazosin;escitalopram;estrogen;fluphenazine;furosemide;gemfibrozil;haloperidol;hydrochlorothiazide;labetalol;lorazepam;metoprolol;neuroleptic agent;nortriptyline;propranolol;risperidone;serotonin uptake inhibitor;spironolactone;terazosin;testosterone;tricyclic antidepressant agent;unindexed drug;age distribution;aged;aging;alcohol consumption;Alzheimer disease;angina pectoris;anorgasmia;anticholinergic syndrome;anxiety;article;chronic obstructive lung disease;smoking;condom;confusion;depression;divorce;dyspareunia;ejaculation disorder;elderly care;erectile dysfunction;estrogen blood level;family counseling;female sexual dysfunction;hormone response;human;Human immunodeficiency virus infection;hyperprolactinemia;impotence;intimacy;libido;lubrication;menopausal syndrome;orgasm;orgasm disorder;pain;patient education;pharmaceutical care;pharmacist;postmenopause;postoperative pain;prostate cancer;prostatitis;retrograde ejaculation;risk factor;safe sex;scar formation;sedation;sex difference;sexual arousal;sexual arousal disorder;sexual behavior;sexual dysfunction;sexual intercourse;sexuality;sexually transmitted disease;side effect;stress incontinence;testosterone blood level;vaginal dryness;xerostomia,"Thornhill, T. H.;Smith, L. S.",2007,,,0,
4438,Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia,"OBJECTIVE Older adults with diabetes and dementia are at increased risk for hypoglycemia and other adverse events associated with tight glycemic control and are unlikely to experience long-term benefits. We examined risk factors for tight glycemic control in this population and use of medications associated with a high risk of hypoglycemia in the subset with tight control. RESEARCH DESIGN AND METHODS This retrospective cohort study of national Veterans Affairs (VA) administrative/ clinical data and Medicare claims for fiscal years (FYs) 2008-2009 included 15,880 veterans aged ≥65 years with type 2 diabetes and dementia and prescribed antidiabetic medication. Multivariable regression analyses were used to identify sociodemographic and clinical predictors of hemoglobin A1c (HbA1c) control (tight, moderate, poor, or not monitored) and, in patients with tight control, subsequent use ofmedication associated with a high risk of hypoglycemia (sulfonylureas, insulin). RESULTS Fifty-two percent of patients had tight glycemic control (HbA1c <7% [53mmol/mol]). Specific comorbidities, older age, and recent weight loss were associated with greater odds of tight versus moderate control, whereas Hispanic ethnicity and obesity were associated with lower odds of tight control. Among tightly controlled patients, 75% used sulfonylureas and/or insulin, with higher odds in patients who were male, black, or aged ≥75 years; had a hospital or nursing home stay in FY2008; or had congestive heart failure, renal failure, or peripheral vascular disease. CONCLUSIONS Many older veterans with diabetes and dementia are at high risk for hypoglycemia associated with intense diabetes treatment and may be candidates for deintensification or alteration of diabetes medications.",antidiabetic agent;hemoglobin A1c;insulin;sulfonylurea derivative;age distribution;aged;article;Black person;cohort analysis;community living;comorbidity;congestive heart failure;controlled study;dementia;demography;ethnic difference;female;glycemic control;hemoglobin blood level;high risk population;Hispanic;hospital care;human;hypoglycemia;kidney failure;major clinical study;male;non insulin dependent diabetes mellitus;nursing home;obesity;patient monitoring;peripheral vascular disease;retrospective study;risk factor;sex difference;very elderly;veteran;weight reduction,"Thorpe, C. T.;Gellad, W. F.;Good, C. B.;Zhang, S.;Zhao, X.;Mor, M.;Fine, M. J.",2015,,,0,
4439,Comorbidity of other chronic age-dependent diseases in dementia,"This study compares the prevalence rates of 5 common age-dependent diseases in non-demented and demented subjects. Control and dementia populations were approximately age-matched and their numbers also approximated. Prevalence rates for hypertension, myocardial infarction (MI), stroke, cancer and diabetes were determined. The rates of two or more coexisting diseases in the same patient were also compared. Two populations were studied: one was designated the autopsy series, and the other the hospital series. In the autopsy series, the rate of cardiomegaly/hypertension was 1.3 times higher in the control than in the dementia population, and for MI it was 1.7 times higher in the former than in the latter The rate for stroke was higher in the control group by only a factor of 1.1, for cancer by only a factor of 1.2, and for diabetes the rates were almost identical in the two populations. The rate differences were statistically significant only with respect to cardiomegaly and MI. When the non-vascular and vascular dementias were compared, the rates in the latter were higher by only a factor of 1.3 for cardiomegaly, stroke, cancer and diabetes; for MIs, the rates were about the same in the two dementia categories. The data for two or more coexisting diseases were almost identical in control and dementia autopsy populations. In the hospital series, the hypertension rate was 1.6 times higher in the control than in the Alzheimer's disease (AD) group; for MI, the control group was higher by a factor of 1.5. The control group also showed higher rates for cancer and diabetes by factors of 1.7 and 1.5, respectively. Stroke was higher in AD patients by a factor of 1.4. The difference in the hypertension rates was statistically significant only in control females, and for MI only in control males. For stroke and diabetes, the rate differences were not statistically significant; for cancer only AD females showed a significantly lower rate than controls. It is concluded that contrary to anecdotal impression and studies comparing single diseases, these age-dependent diseases are common in demented subjects.",article;neoplasm;dementia;diabetes mellitus;female;heart infarction;human;hypertension;major clinical study;male;morbidity;prevalence;sex difference;cerebrovascular accident,"Thorpe, J.;Widman, L. P.;Wallin, A.;Beiswanger, J.;Blumenthal, H. T.",1994,,,0,
4440,Dual health care system use and high-risk prescribing in patients with dementia: A national cohort study,"Background: Recent federal policy changes attempt to expand veterans' access to providers outside the Department of Veterans Affairs (VA). Receipt of prescription medications across unconnected systems of care may increase the risk for unsafe prescribing, particularly in persons with dementia. Objective: To investigate the association between dual health care system use and potentially unsafe medication (PUM) prescribing. Design: Retrospective cohort study. Setting: National VA outpatient care facilities in 2010. Participants: 75 829 veterans with dementia who were continuously enrolled in Medicare from 2007 to 2010; 80% were VA-only users, and 20% were VA-Medicare Part D (dual) users. Measurements: Augmented inverse propensity weighting was used to estimate the effect of dual-system versus VA-only prescribing on 4 indicators of PUM prescribing in 2010: any exposure to Healthcare Effectiveness Data and Information Set (HEDIS) high-risk medication in older adults (PUM-HEDIS), any daily exposure to prescriptions with a cumulative Anticholinergic Cognitive Burden (ACB) score of 3 or higher (PUM-ACB), any antipsychotic prescription (PUM-antipsychotic), and any PUM exposure (any-PUM). The annual number of days of each PUM exposure was also examined. Results: Compared with VA-only users, dual users had more than double the odds of exposure to any-PUM (odds ratio [OR], 2.2 [95% CI, 2.2 to 2.3]), PUM-HEDIS (OR, 2.4 [CI, 2.2 to 2.8]), and PUM-ACB (OR, 2.1 [CI, 2.0 to 2.2]). The odds of PUM-antipsychotic exposure were also greater in dual users (OR, 1.5 [CI, 1.4 to 1.6]). Dual users had an adjusted average of 44.1 additional days of any-PUM exposure (CI, 37.2 to 45.0 days). Limitation: Observational study design of veteran outpatients only. Conclusion: Among veterans with dementia, rates of PUM prescribing are significantly higher among dual-system users than with VA-only users.",acetylsalicylic acid;amfepramone;benzphetamine;dexamphetamine;dexmethylphenidate;diazepam;diphenhydramine plus pseudoephedrine;flurazepam;hydroxyzine;hydroxyzine embonate;ketorolac;memantine;meprobamate;methamphetamine;methylphenidate;methylphenobarbital;nifedipine;pentobarbital;phendimetrazine;phenobarbital;phentermine;phenylephrine plus promethazine;prescription drug;promethazine;scopolamine;secbutabarbital;secobarbital;thioridazine;trimethobenzamide;unindexed drug;aged;Alzheimer disease;anemia;article;blood clotting disorder;chronic lung disease;cohort analysis;combination drug therapy;confounding variable;congestive heart failure;dementia;diabetes mellitus;diabetic complication;drug exposure;dual eligibility (health insurance);electrolyte disturbance;evidence based practice;female;health care access;high risk patient;human;hypertension;hypothyroidism;independent variable;kidney failure;major clinical study;male;medicare;multiinfarct dementia;neoplasm;neurologic disease;obesity;observational study;outpatient department;paralysis;peripheral vascular disease;potentially inappropriate medication;prevalence;priority journal;pulmonary vascular disease;retrospective study;rheumatoid arthritis;sensitivity analysis;underweight;valvular heart disease;very elderly;veteran,"Thorpe, J. M.;Thorpe, C. T.;Gellad, W. F.;Good, C. B.;Hanlon, J. T.;Mor, M. K.;Pleis, J. R.;Schleiden, L. J.;Van Houtven, C. H.",2017,,10.7326/m16-0551,0,
4441,Tibial shaft fractures treated by rigid internal fixation. The early results in a 4 year series,"Ninety nine fractures of the shaft of the tibia in 98 patients were treated by rigid internal fixation over 4 years. One patient died after operation from myocardial infarction, and one patient went abroad. The healing course of the remaining 97 fractures is described, classified according to the type of fracture and the accuracy of operative reduction. Seventy five fractures had a normal time to union, defined as the lasting achievement of full weight bearing within 4 months. In 7 fractures the healing period was moderately delayed (full weight bearing being achieved in 4-6 months) and in 5 it was seriously delayed, requiring 6-11 months after injury. Nonunion occurred in 4 cases and refracture in 6 cases. Osteitis developed in 2 cases and was sucessfully treated with antibiotics within 6 weeks. A second internal fixation was necessary in 12 patients. In 5 patients a plaster cast was applied to treat delayed union. Amputation was necessary in a 75 year old man with senile dementia who developed infection after a second operation for refracture. One patient still has a pseudarthrosis after 2 years and 2 further operations. In the other 95 fractures union was the end result. Of the 21 comminuted and open fractures only 13 healed within 4 months. We recommend a different approach in the treatment of badly comminuted and open 'high energy' fractures. With this reservation, we find that the method of rigid internal fixation which we employ has given satisfactory early results. The frequency of both delayed healing and infection is reasonably low compared to the results in similar series.",bone plate;fracture healing;injury;major clinical study;methodology;osteitis;osteosynthesis;therapy;tibia fracture,"Thunold, J.;Varhaug, J. E.;Bjerkeset, T.",1975,,,0,
4442,"Community-Dwelling People Screened Positive for Dementia in Primary Care: A Comprehensive, Multivariate Descriptive Analysis Using Data from the DelpHi-Study","Background: Efficient help and care for people with dementia (PWD) is dependent on knowledge about PWD in primary care. Objective:This analysis comprehensively describes community-dwelling PWD in primary care with respect to various dementia care specific variables. Methods: The analyses are based on baseline data of the ongoing general practitioner-based, randomized, controlled intervention trial DelpHi-MV (Dementia: life- and person-centered help). 6,838 patients were screened for dementia in 136 GP practices; 17.1 were screened positive, 54.4 of those agreed to participate and data could be assessed in n = 516 subjects. We assessed age, sex, living situation, cognitive status, functional status, level of impairment, comorbidities, formal diagnosis of dementia, depression, neuropsychiatric symptoms, quality of life, utilization of medical support, and pharmacological therapy. Results: Concerning clinical-, dementia-, and health-related variables, the sample under examination was on average mildly cognitively and functionally impaired (MMSE, m = 22.2; BADL, m = 3.7). A level of care was assigned in 38.0. Depression was identified in 15.4 and other frequent comorbidities were high blood pressure (83.3), coronary heart diseases (37.1), cerebrovascular diseases (22.3), among others. In 48.6, neuropsychiatric symptoms were present in a clinically relevant severity. Pharmacological treatment with antidementia medication was received by 25.8 and antidepressant medication by 14.0. Utilization of services was generally low. Conclusion:The comprehensive description of people screened positive for dementia in primary care reveals a complex and unique population of patients. They are considerably underdiagnosed and in their majority mildly to moderately affected. More in-depth analyses are needed to study relations, associations and interactions between different variables.",antidepressant agent;donepezil;galantamine;memantine;rivastigmine;aged;article;cerebrovascular disease;cognition;cognitive defect;community living;comorbidity;controlled study;Delphi study;dementia;depression;female;functional status;general practitioner;health care utilization;human;hypertension;ischemic heart disease;major clinical study;male;Mini Mental State Examination;primary medical care;priority journal;quality of life,"Thyrian, J. R.;Eichler, T.;Michalowsky, B.;Wucherer, D.;Reimann, M.;Hertel, J.;Richter, S.;Dreier, A.;Hoffmann, W.",2016,,,0,
4443,A polymorphism in the angiotensin 1-converting enzyme gene is associated with damage to cerebral cortical white matter in Alzheimer's disease,"The impact of the insertion (I)/deletion (D) (I/D) polymorphism in the angiotensin 1-converting enzyme (ACE) gene on the extent of white matter myelin loss (ML) was investigated in four regions of the cerebral cortex in an autopsy-confirmed series of 93 patients with Alzheimer's disease (AD). The possible influence of APO E ε4 allele acting in concert with ACE D allele was assessed. The extent of ML did not differ between D/D, I/D and I/I genotype groups when data from all four brain regions were combined. However, separate analysis showed that the frontal and temporal cortex tended to be affected more severely by ML in patients with D/D genotype compared to those with I/D and I/I genotypes. Stratification according to APO E ε4 allele revealed a greater overall ML in patients bearing at least one copy of ACE D allele and one APO E ε4 allele, especially in individuals homozygous for both. The APO E ε4 allele may therefore act synergistically in patients with AD (and other subjects) bearing ACE D/D genotype to increase the risk of ML, perhaps through transient ischaemic episodes consequent upon poor cardiac output associated with coronary atherosclerosis in patients with the APO E ε4 allele. © 2003 Elsevier Ireland Ltd. All rights reserved.",apolipoprotein E;apolipoprotein E 4;apolipoprotein E-4;apolipoprotein E4;dipeptidyl carboxypeptidase;myelin;adult;aged;allele;Alzheimer disease;article;autopsy;brain cortex;brain injury;brain region;controlled study;coronary artery atherosclerosis;data analysis;disease association;disease severity;DNA polymorphism;female;frontal cortex;gene deletion;gene frequency;gene insertion;genetic polymorphism;genetic predisposition;genetic risk;genetics;genotype;homozygosity;human;human tissue;male;metabolism;myelinated nerve;nerve degeneration;pathology;pathophysiology;priority journal;protein depletion;temporal cortex;transient ischemic attack;white matter,"Tian, J.;Shi, J.;Bailey, K.;Harris, J. M.;Pritchard, A.;Lambert, J. C.;Chartier-Harlin, M. C.;Pickering-Brown, S. M.;Lendon, C. L.;Mann, D. M. A.",2004,,,0,
4444,Comorbidity and the risk of anastomotic leak in Chinese patients with colorectal cancer undergoing colorectal surgery,"Purpose: Comorbidities had considerable effects on the prognosis in patients with colorectal cancer (CRC). The primary aim of the present study was to examine the influence of comorbidity on the risk of anastomotic leak (AL) in patients with CRC who underwent surgical resection. Methods: Using the electronic Hospitalization Summary Reports in the top-ranked public hospitals in China, we identified 11,397 patients with CRC undergoing resection surgery from 2013 through 2015. We estimated the risk of AL according to Charlson Comorbidity Index (CCI) score using logistic regression analysis, adjusting for age, sex, and geographic regions. Results: The incidence rate of AL in the study population was 1.8% (204/11,397). Multivariable analyses identified male sex and CCI score as independent risk factors for AL. The CCI score had a positive graded association with the risk of AL (P for trend = 0.006). The risk increased by an estimated 10.2% (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.03–1.18) for each additional 1 point in the CCI score. After adjusting for potential confounders, patients with a CCI score ≥3 had 1.82 times (95% CI, 1.24–2.69) higher risk of AL compared with patients with a CCI score of 0. Conclusion: The findings suggested that CCI score was an independent risk factor for the development of AL in Chinese patients with CRC who underwent surgical resection.",acquired immune deficiency syndrome;adult;anastomosis leakage;article;cerebrovascular disease;Charlson Comorbidity Index;Chinese;chronic lung disease;colorectal cancer;colorectal surgery;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;female;geographic distribution;groups by age;heart infarction;hemiplegia;high risk patient;human;incidence;laparoscopic surgery;length of stay;leukemia;liver disease;lymphoma;major clinical study;male;middle aged;moderate renal impairment;multicenter study;open surgery;peripheral vascular disease;postoperative complication;priority journal;risk factor;severe renal impairment;sex difference;solid malignant neoplasm;ulcer,"Tian, Y.;Xu, B.;Yu, G.;Li, Y.;Liu, H.",2017,,10.1007/s00384-017-2798-4,0,
4445,Derivatization Strategy for the Comprehensive Characterization of Endogenous Fatty Aldehydes Using HPLC-Multiple Reaction Monitoring,"Fatty aldehydes are crucial substances that mediate a wide range of vital physiological functions, particularly lipid peroxidation. Fatty aldehydes such as acrolein and 4-hydroxynonenal (4-HNE) are considered potential biomarkers of myocardial ischemia and dementia, but analytical techniques for fatty aldehydes are lacking. In the present study, a comprehensive characterization strategy with high sensitivity and facility for fatty aldehydes based on derivatization and high-performance liquid chromatography-multiple reaction monitoring (HPLC-MRM) was developed. The fatty aldehydes of a biosample were derivatized using 2,4-bis(diethylamino)-6-hydrazino-1,3,5-triazine under mild and efficient reaction conditions at 37 degrees C for 15 min. The limit of detection (LOD) of the fatty aldehydes varied from 0.1 to 1 pg/mL, depending on the structures of these molecules. General MRM parameters were forged for the analysis of endogenous fatty aldehydes. ""Heavy"" derivatization reagents with 20 deuterium atoms were synthesized for both the discovery and comprehensive characterization of fatty aldehydes. More than 80 fatty aldehydes were detected in the biosamples. The new strategy was successfully implemented in global fatty aldehyde profiling of plasma and brain tissue of the bilateral common carotid artery (2VO) dementia rat model. Dozens of fatty aldehydes were significantly changed between the control and model groups. These findings further highlight the importance of endogenous fatty aldehydes.",,"Tie, C.;Hu, T.;Jia, Z. X.;Zhang, J. L.",2016,Aug 2,10.1021/acs.analchem.6b01756,0,
4446,C-reactive protein in geriatric practice,,"*Alcoholism;*Arteriosclerosis;*C-Reactive Protein;*Dementia;*Diabetes Mellitus;Humans;*Myocardial Infarction;*Paralysis;*Psychotic Disorders;*Myocardial infarct;*Psychoses, senile","Tigano, F.",1962,Jul-Sep,,0,
4447,Incidence and Duration of Cumulative Bisphosphonate Use among Community-Dwelling Persons with or without Alzheimer's Disease,"We studied the incidence and duration of cumulative bisphosphonate use among older Finnish women and men with or without Alzheimer's disease (AD). The MEDALZ-2005 cohort is a nationwide sample of all persons with clinically diagnosed AD on 31 December 2005 and their age-, gender-, and region of residence-matched control persons without AD. Information on bisphosphonate use by persons with an AD diagnosis and their controls without AD during 2002-2009 was obtained from the prescription register database containing reimbursed medications. A total of 6,041 (11.8) persons used bisphosphonates during the 8-year follow-up. Bisphosphonates were more commonly used among persons without AD (n = 3121, 12.3) than among persons with AD (n = 2,920, 11.2) (p = 0.001). The median duration of bisphosphonate use was 743 days (IQR). Among persons with AD, the median duration of use was 777 days (IQR) and among persons without AD, 701 days (IQR) (p = 0.011). People without AD more often used bisphosphonate combination preparations including vitamin D than did people with AD (p < 0.0001). Bisphosphonate use was more common among people without AD who had comorbidities, asthma/COPD, or rheumatoid arthritis compared with users with AD. Short-term users were more likely to be male, at least 80 years old, and not having AD. Although the incidence of bisphosphonate use was slightly higher among persons without AD, the cumulative duration of bisphosphonate use was longer in persons with AD. Short-term use was associated with male gender, older age, and not having AD.",alendronic acid;bisphosphonic acid derivative;clodronic acid;colecalciferol;etidronic acid;ibandronic acid;pamidronic acid;risedronic acid;vitamin D;zoledronic acid;aged;Alzheimer disease;article;asthma;Charlson Comorbidity Index;chronic obstructive lung disease;cohort analysis;controlled study;data base;female;follow up;heart failure;human;incidence;ischemic heart disease;long term care;major clinical study;male;prescription;prevalence;priority journal;rheumatoid arthritis;sex difference;treatment duration;very elderly,"Tiihonen, M.;Taipale, H.;Tanskanen, A.;Tiihonen, J.;Hartikainen, S.",2016,,,0,
4448,Co-morbidities in Finnish patients with rheumatoid arthritis: 15-year follow-up,"Objectives: To study the prevalence and importance of co-morbidities in patients with rheumatoid arthritis (RA) at the time of the diagnosis and after a 15-year follow-up, focusing on the relationship between co-morbidity and disease activity. Method: The study population comprised 87 patients with early RA (mean age 44 years, 79% female, and 65% rheumatoid factor positive) collected from the Helsinki area between 1986 and 1989. Data for co-morbidities were collected at baseline and at a 15-year examination or at the time of death, and the age-weighted Charlson co-morbidity index (CCIa) at baseline was calculated for each patient. The disease activity score based on 28 joints (DAS28) was assessed with three parameters at baseline and during the first year (DAS28 AUC0-12). The relationship between co-morbidity and activity of RA was studied in groups CCIa 0, CCIa 1-2, and CCIa ≥ 3. Results: Adequate data were available in 80 patients with a mean age of 60 years and a mean disease duration of 15.4 years. At baseline, 20% of patients had at least one co-morbid condition (CC). At endpoint, 60% of the patients had some co-morbidity: 34% had one CC, 19% two, 5% three, and 2% four CCs. The most common end-point CCs were hypertension (30%), cardiovascular diseases (14%), and malignancies (11%). DAS28 AUC0-12 and DAS28 at end-point were higher in groups CCIa1-2 and CCIa ≥ 3 than in CCIa 0. Conclusions: Co-morbidities increased during the 15 years of RA and the patients with high baseline CCIa showed higher disease activity both in early disease and at end-point. © 2013 Informa Healthcare on license from Scandinavian Rheumatology Research Foundation.",disease modifying antirheumatic drug;rheumatoid factor;acquired immune deficiency syndrome;adult;article;asthma;brain infarction;cardiovascular disease;cause of death;cerebrovascular accident;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;chronic obstructive lung disease;comorbidity;congestive cardiomyopathy;coronary artery disease;DAS28;dementia;demyelination;depression;diabetes mellitus;disease activity;disease activity score;disease duration;female;Finland;follow up;functional status;heart infarction;hemiplegia;human;hypertension;hypothyroidism;ischemic heart disease;kidney disease;leukemia;liver disease;lung fibrosis;lymphoma;major clinical study;male;morbidity;mortality;osteoporosis;paraplegia;parkinsonism;peptic ulcer;peripheral vascular disease;prevalence;priority journal;rheumatic disease;rheumatoid arthritis;solid tumor;time of death;tuberculosis,"Tiippana-Kinnunen, T.;Kautiainen, H.;Paimela, L.;Leirisalo-Repo, M.",2013,,,0,
4449,"Fatty acids of plasma lipids, red cells and platelets in Alzheimer's disease and vascular dementia","Fatty acids of plasma lipids, red cells and platelets were analyzed from 38 demented patients (age 53-88 years), comprising 11 patients with Alzheimer's disease (AD), 19 with multi-infarct dementia (MID) and 8 with probable vascular dementia (PVD). The mean age, body mass index, duration of dementia and content of triglycerides, total cholesterol and HDL-cholesterol in plasma were similar in AD and MID. The patients with PVD were older. As compared to AD, in MID and PVD the linoleic acid (LA) and other n - 6 and n - 3 polyunsaturated fatty acids (PUFA) were significantly lower in red cells and tended to be lower also in serum triglycerides, cholesterol esters (CHE) and phospholipids (PL), and platelets. The LA content of red cells was significantly correlated with that of serum CHE and PL, and n - 6 PUFA (including arachidonic acid) of red cells. The low LA content of red cells was associated with old age, coronary heart disease and heart failure, but not with the severity of dementia.",cholesterol ester;fatty acid;linoleic acid;phospholipid;triacylglycerol;aged;Alzheimer disease;blood and hemopoietic system;central nervous system;clinical article;etiology;human;lipid blood level;multiinfarct dementia;peripheral vascular system;priority journal,"Tilvis, R. S.;Erkinjuntti, T.;Sulkava, R.;Miettinen, T. A.",1987,,,0,
4450,Predictors of cognitive decline and mortality of aged people over a 10-year period,"BACKGROUND: The search for preventable and remediable risk conditions of cognitive decline is ongoing, but results have thus far been inconsistent. According to the hypothesis of our 10-year prospective study, the predictive values of different risk indicators change over time in a general 75+ population. METHODS: A population-based sample of 75-, 80-, and 85-year-old individuals (n=650) underwent comprehensive clinical examinations in 1990 in Helsinki, Finland. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and/or Clinical Dementia Rating (CDR) at baseline and after 1, 5, and 10 years. RESULTS: At baseline, a low MMSE score was associated with age, history of stroke, apolipoprotein E allele epsilon4 (APOE4), and intermittent claudication. After 1 year, cognitive decline was typical of participants suffering from vascular diseases, e.g., heart failure and intermittent claudication. Five-year decline was predicted by the presence of atrial fibrillation (RR [relative risk] 2.8), APOE4 (RR 2.4), elevated C-reactive protein (CRP) (RR 2.3), diabetes mellitus (RR 2.2), and heart failure (RR 1.8). They also tended to increase 5-year all-cause mortality. At 10 years, the decline associated with APOE4 (RR 3.3), slightly elevated serum ionized calcium (RR 3.3), and feelings of loneliness (RR 3.0). CONCLUSIONS: Long follow-up of a general aged population explains several inconsistencies of earlier reports. In 75+ individuals, general ill health is a strong associate of cognitive deficits. The strongest predictors of both cognitive decline and mortality are age, APOE4, manifest vascular diseases, and diabetes. The role of new potential predictors, feelings of loneliness and hypercalcemia, needs clinical testing.","Aged;Aged, 80 and over;Cognition Disorders/*epidemiology;Female;Follow-Up Studies;*Geriatrics;Humans;Male;Mortality/trends;Prognosis;Prospective Studies;Time Factors","Tilvis, R. S.;Kahonen-Vare, M. H.;Jolkkonen, J.;Valvanne, J.;Pitkala, K. H.;Strandberg, T. E.",2004,Mar,,0,
4451,Invasive strategy in acute coronary syndrome 1,,acute coronary syndrome;angiocardiography;dementia;human;invasive procedure;letter;life expectancy;non ST segment elevation myocardial infarction;priority journal;quality of life,"Timmis, A.",2016,,,0,
4452,Contribution of individual diseases to death in older adults with multiple diseases,"Objectives To determine empirically the diseases contributing most commonly and strongly to death in older adults, accounting for coexisting diseases. Design Longitudinal. Setting United States. Participants Twenty-two thousand eight hundred ninety Medicare Current Beneficiary Survey participants, a national representative sample of Medicare beneficiaries, enrolled during 2002 to 2006. Measurements Information on chronic and acute diseases was ascertained from Medicare claims data. Diseases contributing to death during follow-up were identified empirically using regression models for all diseases with a frequency of 1% or greater and hazard ratio for death of greater than 1. The additive contributions of these diseases, adjusting for coexisting diseases, were calculated using a longitudinal extension of average attributable fraction; 95% confidence intervals were estimated from bootstrapping. Results Fifteen diseases and acute events contributed significantly to death, together accounting for nearly 70% of death. Heart failure (20.0%), dementia (13.6%), chronic lower respiratory disease (12.4%), and pneumonia (5.3%) made the largest contributions to death. Cancer, including lung, colorectal, lymphoma, and head and neck, together contributed to 5.6% of death. Other diseases and events included acute kidney injury, stroke, septicemia, liver disease, myocardial infarction, and unintentional injuries. Conclusion The use of methods that focus on determining a single underlying cause may lead to underestimation of the extent of the contribution of some diseases such as dementia and respiratory disease to death in older adults and overestimation of the contribution of other diseases. Current conceptualization of a single underlying cause may not account adequately for the contribution to death of coexisting diseases that older adults experience. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.",acute kidney failure;aged;article;cause of death;chronic respiratory tract disease;colorectal cancer;comorbidity;dementia;female;follow up;geriatric disorder;head and neck cancer;heart failure;heart infarction;human;liver disease;longitudinal study;lung cancer;lymphoma;major clinical study;male;medicare;mortality;patient information;pneumonia;septicemia;cerebrovascular accident,"Tinetti, M. E.;McAvay, G. J.;Murphy, T. E.;Gross, C. P.;Lin, H.;Allore, H. G.",2012,,,0,
4453,Comparative effectiveness research and patients with multiple chronic conditions,,beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;cerebrovascular accident;chronic disease;chronic obstructive lung disease;comparative effectiveness;dementia;disease severity;health care cost;health care personnel;health care quality;heart failure;human;kidney failure;medicaid;medicare;mental disease;patient care;patient information;priority journal;private health insurance;short survey,"Tinetti, M. E.;Studenski, S. A.",2011,,,0,
4454,Comparative value of -FP-CIT SPECT and -MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and other types of dementia,"Aims: (i) To compare the diagnostic value of FPCIT SPECT and MIBG myocardial scintigraphy in differentiating DLB from other types of dementia, and (ii) to determine inter-rater reliability for visual assessment for each of the two methods. Materials/Methods: Our analyses included 30 patients with a clinical diagnosis of DLB and 29 patients with a clinical diagnosis of non-DLB dementia (AD, n = 16; bvFTD, n = 13), who were consecutively referred to five memory clinics in Lombardy. All patients underwent FP-CIT SPECT and MIBG myocardial scintigraphy within few weeks of clinical diagnosis. All diagnoses were agreed upon by the local clinician and an independent expert (PT), who did not at any time during the study have access to striatal and myocardial images. Diagnostic appropriateness was re-evaluated after 12 months of follow-up. Unlike prior investigations, our study did not exclude patients with concomitant illnesses that might potentially interfere with MIBG uptake. Striatal and myocardial images were visually classified as either normal or abnormal by independent nuclear physicians who were blinded to the patients' clinical data, except for age. Results: The DLB and non-DLB groups were comparable (p > 0.05) for sex, age at onset, and age and global severity of dementia at first visit. As expected, DLB patients showed a greater frequency of all core features, and had lower scores on tests of visuospatial/constructional and attentional abilities (p < 0.05). Overall, sensitivity and specificity to DLB were respectively 93% and 100% for MIBG myocardial scintigraphy, and 90% and 76% for FPCIT SPECT. Lower specificity of striatal compared to myocardial imaging was due to decreased FP-CIT uptake in seven non-DLB patients (three with parkinsonism) who had normal MIBG myocardial uptake. Inter-reader agreement was higher for myocardial (Cohen's kappa between 0.89 and 0.96) than for striatal (Cohen's kappa between 0.82 and 0.86) imaging. Discussion: Striatal and myocardial imaging are equally sensitive to DLB, but the latter method can be more reliable and specific for excluding non-DLB dementias, especially when parkinsonism is the only ""core feature"" exhibited by the patient. Notably, MIBG myocardial uptake in our non-DLB group was invariably normal, despite the concomitance of diabetes and/or cardiomyopathy in about one fourth of the patients, suggesting that the potential confounding effect of these illnesses on MIBG uptake might have been overestimated. Conclusions: Our results on MIBG scintigraphy argue in favour of its upgrade from supportive to suggestive DLB features. This needs to be confirmed in further prospective studies with larger unselected samples.",cardiac muscle;cardiomyopathy;clinical article;clinical trial;controlled clinical trial;controlled study;corpus striatum;diabetes mellitus;diagnosis;diagnostic test accuracy study;diffuse Lewy body disease;follow up;frontal variant frontotemporal dementia;human;memory;myocardial perfusion imaging;onset age;parkinsonism;physician;prospective study;sensitivity and specificity;single blind procedure;single photon emission computed tomography;(3 iodobenzyl)guanidine;(3 iodobenzyl)guanidine i 123;iodine 123;unclassified drug,"Tiraboschi, P;Corso, A;Guerra, U;Nobili, F;Piccardo, A;Calcagni, M;Volterrani, D;Cecchin, D;Vidale, S;Sacco, L;Merello, M;Stefanini, S;Micheli, A;Vai, P;Capitanio, S;Gabanelli, S;Riva, R;Pinto, P;Biffi, A;Muscio, C",2016,,10.3233/JAD-169001,0,
4455,Aetiology of in-hospital cardiac arrest on general wards,"Aim Aetiology of in-hospital cardiac arrests (IHCAs) on general wards has not been studied. We aimed to determine the underlying causes for IHCAs by the means of autopsy records and clinical judgement of the treating consultants. Furthermore, we investigated whether aetiology and preceding vital dysfunctions are associated with long-term survival. Design and setting Prospective observational study between 2009–2011 including 279 adult IHCA patients attended by medical emergency team in a Finnish university hospital's general wards. Results The median age of the patients was 72 (64, 80) years, 185 (66%) were male, 178 (64%) of events were monitored/witnessed, first rhythm was shockable in 42 (15%) cases and 53 (19%) patients survived six months. Aetiology was determined as cardiac in 141 events, 73 of which were due to acute myocardial infarction. There were 138 non-cardiac IHCAs; most common causes were pneumonia (39) and exsanguination (16). No statistical difference was observed in the incidence of objective vital dysfunctions preceding the event between the cardiac and non-cardiac groups (40% vs. 44%, p = 0.448). Subjective antecedents were more common in the cardiac cohort (47% vs. 32%, p = 0.022), chest pain being an example (11% vs. 0.7%, p < 0.001). Reviewing all 279 IHCAs, only shockable primary rhythm, monitored/witnessed event and low comorbidity score were independently associated with 180-day survival. Conclusions Cardiac aetiology underlies half of the IHCAs on general wards. Both objective and subjective antecedents are common. However, neither the cardiac aetiology nor the absence of preceding deterioration of vital signs were factors independently associated with a favourable outcome.",NCT00951704;benzodiazepine derivative;opiate;acute heart infarction;adult;aged;airway obstruction;anaphylaxis;aorta dissection;aorta stenosis;aorta valve regurgitation;article;asthma;atrial fibrillation;brain ischemia;cardiomyopathy;Charlson Comorbidity Index;cholecystitis;chronic obstructive lung disease;cohort analysis;comorbidity;complication;congestive cardiomyopathy;congestive heart failure;cor pulmonale;coronary artery disease;defibrillation;dementia;diabetes mellitus;drug overdose;erysipelas;exsanguination;faintness;female;Finland;heart amyloidosis;heart arrest;heart failure;heart muscle ischemia;heart tamponade;hematologic malignancy;human;hyperkalemia;hypertension;hyponatremia;hypoxia;incidence;kidney failure;liver cirrhosis;long term survival;lung embolism;major clinical study;male;malignant neoplastic disease;mesenteric ischemia;mitral valve regurgitation;myocarditis;observational study;pancreatitis;pericarditis;perimyocarditis;peripheral occlusive artery disease;peritonitis;pneumonia;priority journal;prognosis;prospective study;rapid response team;resuscitation;sepsis;solid tumor;survival time;thorax pain;university hospital;urogenital tract infection;vital sign;ward,"Tirkkonen, J.;Hellevuo, H.;Olkkola, K. T.;Hoppu, S.",2016,,,0,
4456,Co-administration of donepezil and digoxin produces no pharmacokinetic or pharmacodynamic interactions,"Donepezil HCl, is a cholinesterase (ChE) inhibitor that is selective for acetylcholinesterase. It has recently been approved in the US and the UK for treatment of the symptoms of mild to moderate Alzheimer's disease. Digoxin is a cardiac glycoside that is commonly used in the elderly for the treatment of congestive heart failure and atrial fibrillation. Since both inhibition of ChE and digoxin can produce changes in heart rate or cardiac conduction, this study was designed to investigate any pharmacokinetic (PK) and/or pharmacodynamic (PD) interactions that might occur when donepezil and digoxin are administered concurrently. This was a randomized, single-dose, open-label, three-period crossover study. The three treatments administered were: 1) donepezil HCl (5 mg tablet); 2) digoxin (0.25 mg tablet), or 3) the concurrent administration of both drugs. Twelve healthy male volunteers were enrolled into this study. Subjects ranged in age from 19 to 44 years (mean ñ SD: 28 ñ 7.6 years). Characterization of donepezil and/or digoxin PK for each treatment phase (AUC0-120, Cmax, tmax and t1/2) was done by measuring concentrations of each drug in plasma samples collected over a 120-h period following drug administration. Donepezil was quantified by HPLC. Digoxin was measured by RIA. PD was assessed by telemetry (Lead II, ECG), beginning 1 h prior to drug administration, and continuing for 24-h after administration. Lead II rhythm strips were recorded at specified times to measure heart rate and duration of PR, QRS and QTc intervals. Donepezil PK were essentially identical when donepezil was administered alone or concurrently with digoxin. Digoxin PK were likewise unchanged by co-administration of donepezil. No differences in heart rate, PR, QRS, or QTc intervals were observed in any of the subjects, for any of the treatments during the 24 hours of monitoring following drug administration. The concurrent administration of donepezil and digoxin produced no PK or PD interactions.",Hs-handsrch,"Tiseo, Pj;Rogers, Sl;Friedhoff, Lt",1997,,,0,4457
4457,Co-administration of donepezil and digoxin produces no pharmacokinetic or pharmacodynamic interactions,"Donepezil HCl, is a cholinesterase (ChE) inhibitor that is selective for acetylcholinesterase. It has recently been approved in the US and the UK for treatment of the symptoms of mild to moderate Alzheimer's disease. Digoxin is a cardiac glycoside that is commonly used in the elderly for the treatment of congestive heart failure and atrial fibrillation. Since both inhibition of ChE and digoxin can produce changes in heart rate or cardiac conduction, this study was designed to investigate any pharmacokinetic (PK) and/or pharmacodynamic (PD) interactions that might occur when donepezil and digoxin are administered concurrently. This was a randomized, single-dose, open-label, three-period crossover study. The three treatments administered were: 1) donepezil HCl (5 mg tablet); 2) digoxin (0.25 mg tablet), or 3) the concurrent administration of both drugs. Twelve healthy male volunteers were enrolled into this study. Subjects ranged in age from 19 to 44 years (mean ñ SD: 28 ñ 7.6 years). Characterization of donepezil and/or digoxin PK for each treatment phase (AUC0-120, Cmax, tmax and t1/2) was done by measuring concentrations of each drug in plasma samples collected over a 120-h period following drug administration. Donepezil was quantified by HPLC. Digoxin was measured by RIA. PD was assessed by telemetry (Lead II, ECG), beginning 1 h prior to drug administration, and continuing for 24-h after administration. Lead II rhythm strips were recorded at specified times to measure heart rate and duration of PR, QRS and QTc intervals. Donepezil PK were essentially identical when donepezil was administered alone or concurrently with digoxin. Digoxin PK were likewise unchanged by co-administration of donepezil. No differences in heart rate, PR, QRS, or QTc intervals were observed in any of the subjects, for any of the treatments during the 24 hours of monitoring following drug administration. The concurrent administration of donepezil and digoxin produced no PK or PD interactions.",Hs-handsrch,"Tiseo, P. J.;Rogers, S. L.;Friedhoff, L. T.",1997,,,0,
4458,The frequency of osteoporosis diagnosis depending on the site and method of bone examination,"The aim of the study has been to evaluate how often osteoporosis is diagnosed in DEXA examination of the spinal column and proximal epiphysis of the femoral bone as well as in ultrasonography of the heel in a population group. The study comprised 536 post-menopausal women aged 54.36 ±10.91 years. A fracture in history was reported by 158 patients, including 57 fractures characteristic of osteoporosis (spinal column, forearm, proximal epiphysis of the femoral bone). Osteoporosis was diagnosed in 0.4% patients in the greater trochanter, in 1.5% in the neck of femur, in 7.8% in the Ward triangle, in 12.8% in the L1 - L4 segment of the spine, and in as many as 36.2% in the calcaneal bone. Here, no abnormalities were found only in 14.2% of the patients. The frequency of positive osteoporosis diagnosis did not differ significantly between the groups with and without fractures in history. There was a correlation found between measurements results of the spine and the Ward triangle, and between the neck of femur and the greater trochanter. In the remaining DEXA measurements, the statistics values were a little beyond the critical ones. On the other hand, ultrasonographic diagnosis of osteoporosis in the heel did not correlate absolutely with those of DEXA. T-score in each measurement correlated with each other at r from 0.453 to 0.905, with the highest values when in DEXA. Comparing T-score in sonography of the heel with those of DEXA suggests that they have been overrated by one standard deviation. In conclusion, the frequency of osteoporosis diagnosis has been found to differ significantly depending on the method and site of measurement. The measurement discrepancy in various sites is substantial despite a high correlation between them. The paper's results suggest that it is necessary to work out other diagnostic criteria for the ultrasonographic examination of the heel.",cytokine;estrogen;interleukin 6;tumor necrosis factor;adult;aged;Alzheimer disease;anamnesis;article;atherosclerosis;bone examination;calcaneus;controlled study;correlation coefficient;diagnostic procedure;dual energy X ray absorptiometry;echography;female;femur;femur trochanteric fracture;fragility fracture;hormone substitution;human;inflammation;ischemic heart disease;major clinical study;osteoporosis;postmenopause;spine,"Tłustochowicz, M.;Kaliński, A.;Pluskiewicz, W.;Zakrzewska, A.",2005,,,0,
4459,Charles Bonnet syndrome and dementia after traumatic brain injury,"Traumatic brain injury (TBI) is a serious public health problem that may cause permanent disability and death. Charles Bonnet syndrome, uncommon after TBI, is a syndrome manifested by visual hallucinations. We evaluated a patient who developed Charles Bonnet syndrome after TBI in a motor vehicle accident. After the acute hospitalization (43 d), he had visual hallucinations of people or animals in trees, and fish, dogs, and scorpions in his backyard. Neuropsychologic testing showed left-sided brain impairment and major impairment of visual working memory, abstract processing, motor coordination, spatial perception, and reasoning. At 23 months after the injury, neurologic examination showed bradyphrenia, confusion, difficulty following directions, emotional withdrawal, and fear. Positron emission tomography scan showed large, diffuse, symmetrical areas with decreased uptake of 18F-fluorodeoxyglucose in bilateral temporal lobes, parietal lobes, and left frontal lobe; the dorsal portions of bilateral caudate nucleus were poorly visualized. In summary, this patient developed Charles Bonnet syndrome and probable Lewy Body Dementia and Alzheimer disease within two years after TBI, most likely as a result of synergy between family history of synucleinopathy, older age, and TBI.",cisplatin;docetaxel;fluorodeoxyglucose f 18;lorazepam;risperidone;aged;agitation;alcohol abuse;Alzheimer disease;article;bradyphrenia;cancer combination chemotherapy;cancer radiotherapy;case report;caudate nucleus;Charles Bonnet syndrome;computer assisted tomography;confusion;consciousness disorder;dementia;depth perception;diffuse Lewy body disease;emotional disorder;erythrocyte concentrate;esophagus cancer;family history;fear;frontal lobe;gastrointestinal hemorrhage;heart infarction;hematoma;hospitalization;human;hypertension;male;memory disorder;mental disease;motor coordination;multimodality cancer therapy;neuropsychological test;open reduction;osteosynthesis;parietal lobe;positron emission tomography;scalp;temporal lobe;traffic accident;traumatic brain injury;visual discrimination;visual hallucination;visual memory;working memory,"Tobe, E. H.",2014,,,0,
4460,The value of drug repositioning in the current pharmaceutical market,"Drug repositioning is the process of developing new indications for existing drugs or biologics. Increasing interest in drug repositioning has occurred due to sustained high failure rates and costs involved in attempts to bring new drugs to market, It has been estimated that it may cost more than USD 800 million to develop a new drug de novo. In addition, due to regulatory requirements regarding safety, efficacy and quality, the time required to develop a new drug de novo has been estimated to be 10 to 17 years. De novo drug discovery has failed to efficiently supply pharmaceutical company pipelines. A rational approach to drug repositioning may include a cross-disciplinary focus on the elucidation of the mechanisms of disease, allowing matching of disease pathways with appropriately targeted therapeutic agents. Repurposed drugs or biologics have the advantage of decreased development costs and decreased time to Launch due to previously collected pharmacokinetic, toxicology and safety data. For these reasons, repurposing should be a primary strategy in drug discovery for every broadly focused, research-based pharmaceutical company. Copyright © 2009 Prous Science, S.A.U. or its licensors. All rights reserved.",acetylsalicylic acid;amantadine;bevacizumab;botulinum toxin E;chloroquine;corticosteroid;etanercept;finasteride;fluoxetine;hydroxychloroquine;imatinib;lamotrigine;lithium salt;methotrexate;minoxidil;paclitaxel;propranolol;rituximab;rivastigmine;thalidomide;topiramate;zidovudine;alopecia;Alzheimer disease;angina pectoris;ankylosing spondylitis;article;bipolar disorder;blepharospasm;breast cancer;cardiovascular disease;cervical dystonia;chronic myeloid leukemia;colorectal cancer;coronary artery disease;cost control;cost effectiveness analysis;depression;dosage schedule comparison;drug cost;drug design;drug dose regimen;drug efficacy;drug indication;drug industry;drug marketing;drug megadose;drug quality;drug safety;drug treatment failure;epilepsy;erythema nodosum leprosum;essential tremor;food and drug administration;gastrointestinal stromal tumor;heart infarction;human;Human immunodeficiency virus infection;hyperhidrosis;hypertension;in-stent restenosis;influenza;ischialgia;lepromatous leprosy;malaria;malignant neoplastic disease;migraine;multiple myeloma;myasthenia gravis;nausea and vomiting;nonhodgkin lymphoma;Parkinson disease;patent;premenstrual dysphoric disorder;prostate cancer;prostate hypertrophy;psoriasis;psoriatic arthritis;age related macular degeneration;rheumatoid arthritis;salvage therapy;subretinal neovascularization;suppurative hidradenitis;teratogenicity;unspecified side effect,"Tobinick, E. L.",2009,,,0,
4461,Alzheimer's drugs linked to reduced risk of myocardial infarction,,Alzheimer Disease/*drug therapy;Cholinesterase Inhibitors/*adverse effects;Humans;Myocardial Infarction/*chemically induced,"Tofield, A.",2013,Sep,,0,
4462,"Dystonia, mental deterioration and dyschromatosis symmetrica hereditaria in a family with ADAR1 mutation","A family with dystonia associated with dyschromatosis symmetrica hereditaria (DSH), mental deterioration, and tissue calcification is described. The proband possessed an adenosine deaminase acting on the RNA 1 gene (ADARI) mutation Gly1007Arg. This ADARI mutation could disturb RNA editing at Q/R sites of glutamate receptor in the brain and increase Ca2+influx into neurons, which is thought to induce dystonia and mental deterioration. The observations in our family raise the possibility that the ADARI mutation might be a direct cause or a predisposing factor for heredodegenerative dystonia. Further investigation of ADARI mutations will shed light on the genotype-phenotype correlation in DSH. © 2006 Movement Disorder Society.",adenosine deaminase acting on RNA 1;antiparkinson agent;arginine;baclofen;botulinum toxin A;calcium ion;dantrolene;eperisone;glutamate receptor;glycine;levodopa;tizanidine;unclassified drug;adult;aorta valve stenosis;article;brain;brain calcification;brain nerve cell;calcium transport;case report;chondrocalcinosis;clinical examination;clinical feature;computer assisted tomography;controlled study;death;degenerative disease;dystonia;echocardiography;family study;female;gene mutation;genetic analysis;genetic association;genetic predisposition;genotype phenotype correlation;heart failure;human;irritability;knee radiography;male;mental deterioration;mutational analysis;neurologic examination;priority journal;RNA editing;skin disease;skin examination;spasticity;tooth disease;tooth radiography;Wechsler intelligence scale;botox,"Tojo, K.;Sekijima, Y.;Suzuki, T.;Suzuki, N.;Tomita, Y.;Yoshida, K.;Hashimoto, T.;Ikeda, S. I.",2006,,,0,
4463,Paroxysmal atrial fibrillation and related thromboembolism may be a hidden factor in the development of dementia,,Alzheimer disease;cell proliferation;cerebrovascular accident;congestive heart failure;dementia;diabetes mellitus;endothelial dysfunction;human;hypertension;letter;nuclear magnetic resonance imaging;nutritional status;paroxysmal atrial fibrillation;prevalence;priority journal;smooth muscle cell;thromboembolism;transient ischemic attack;vascular disease,"Tokatli, A.;Yiginer, O.;Ozmen, N.;Uzun, M.;Kilicaslan, F.",2016,,10.1111/psyg.12186,0,
4464,Hyponatremia in pediatric patients with HIV-1 infection,"Hyponatremia has been recognized as a complication in adults with acquired immunodeficiency syndrome (AIDS). We did a retrospective study evaluating the medical records of 86 children (age 4 months to 21 years) with human immunodeficiency virus (HIV-1) infection to determine the frequency and clinical associations of hyponatremia. Twenty-two children (26%) developed hyponatremia (serum sodium < 135 mEq/L; range 104 to 134 mEq/L; mean 130 mEq/L). Fourteen were male; 18 of the 22 patients were black and 4 were white. At the time of hyponatremia, the children frequently had comorbid associations, including 8 (35%) with AIDS encephalopathy; 3 (14%) with cardiomyopathy; 3 (14%) using diuretics; 1 (5%) using pentamidine; 3 (14%) with bacterial pneumonia; 2 (9%) requiring gastric lavage feedings; 2 (9%) with tuberculosis meningitis; 2 (9%) with gastroenteritis; 1 (5%) with infection caused by Mycobacterium avium-intracellulare; 1 (5%) each with brain tumor and tumor metastasis to brain. The cause of hyponatremia was attributed to syndrome of inappropriate antidiuretic hormone in 8 children; poor sodium intake and/or excessive diarrheal losses in 5; and the use of diuretics in 3 patients. Mild hyponatremia with no identifiable cause was found in 5 patients.","AIDS Dementia Complex/epidemiology;AIDS-Related Complex/*complications/immunology;Acquired Immunodeficiency Syndrome/*complications/immunology;Adolescent;Adult;Brain Neoplasms/epidemiology;CD4 Lymphocyte Count;Cardiomyopathies/epidemiology;Child;Child, Preschool;Comorbidity;Female;Gastroenteritis/epidemiology;*Hiv-1;Humans;Hyponatremia/*epidemiology/etiology;Incidence;Infant;Intracranial Embolism and Thrombosis/epidemiology;Male;Pneumonia/epidemiology;Retrospective Studies;Tuberculosis, Meningeal/epidemiology","Tolaymat, A.;al-Mousily, F.;Sleasman, J.;Paryani, S.;Neiberger, R.",1995,Oct,,0,
4465,Compliance with and understanding of advance directives among trainee doctors in the United Kingdom,"AIM: To investigate doctors' response to and understanding of the legal status of advance directives. METHODS: A vignette-based study administered at palliative medicine, oncology, general practice, and geriatric medicine specialist registrar meetings (United Kingdom). Respondents determined the treatment to provide for a patient presenting with a myocardial infarction with or without an advance directive requesting maximum therapy. RESULTS: Response rate 77% (43/56). Twenty-five percent (10/40) of respondents increased the care that they would provide in response to the advance directive (p = 0.004); 77% (33/43) support/strongly support use of advance directives; 51% (22/43) did not know the legal status of advance directives; 44% found that their medical school education was not an important influence on their decision making. CONCLUSIONS: Advance directives requesting treatment can increase the level of care provided by the physician, however, most trainees chose a level of care different from that in the advance directive. Confusion exists among doctors about the legal status of advance directives, which limits their usefulness. Medical education needs to be improved to train doctors to deal with advance directives.","Advance Directive Adherence/legislation & jurisprudence/*standards;*Advance Directives/legislation & jurisprudence;Alzheimer Disease/complications;*Attitude of Health Personnel;Clinical Competence/standards;Comprehension;Critical Care/organization & administration;Curriculum/standards;Decision Making;Education, Medical, Graduate;England;Family Practice/education;Geriatrics/education;*Health Knowledge, Attitudes, Practice;Health Services Needs and Demand;Humans;Medical Oncology/education;*Medical Staff/education/psychology;Mental Competency;Myocardial Infarction/etiology/therapy;Palliative Care/organization & administration;Patient Selection;Statistics, Nonparametric;Surveys and Questionnaires","Toller, C. A.;Budge, M. M.",2006,Autumn,,0,
4466,Incident ischaemic heart disease in persons with Alzheimer's disease in a Finnish nationwide exposure-matched cohort,"Background Previous studies on the association between cardiovascular diseases and Alzheimer's disease (AD) have been inconsistent despite the overlapping risk factor profile. We assessed whether the incidence of ischaemic heart disease (IHD) and revascularisation procedures are different in persons with AD than in the matched population without AD. Methods We conducted a nationwide exposure-matched cohort study including all 28,093 community-dwelling individuals with clinically verified diagnosis of AD, residing in Finland and alive on December 31, 2005. Participants were identified from the Special Reimbursement Register. One matched comparison person was identified for each participant with AD. We assessed the associations between AD and any IHD event (diagnosed IHD/revascularisation procedure), diagnosed IHD (myocardial infarctions and other IHD), and revascularisation procedure (angioplasty or bypass). Information on outcomes was extracted from the Hospital Discharge Register. Analyses were restricted to incident events during 2006-2009 and 25,325 AD-comparison person pairs were included in the analysis after excluding events occurring in 2002-2005. Results People with AD were more likely to have incident IHD diagnosis than AD-free comparison persons (adjusted HR, 95% CI 1.16, 1.06-1.28) but less likely to undergo revascularisation procedures (0.12, 0.08-0.20). There were no differences in all incident IHD events (0.95, 0.87-1.04). Conclusions Persons with AD had a higher risk of incident ischaemic heart disease when comorbidities and cardiovascular medication were taken into account, but they were less likely to undergo revascularisation procedures. This was not entirely explained by contraindications. We acknowledge the need for more detailed studies assessing whether this reflects undertreatment of cardiac problems among persons with AD. © 2013 Elsevier Ireland Ltd.",aged;Alzheimer disease;angioplasty;article;cardiovascular risk;community living;controlled study;coronary artery bypass graft;female;Finland;heart infarction;heart muscle revascularization;human;incidence;ischemic heart disease;major clinical study;male;priority journal;risk assessment,"Tolppanen, A. M.;Kettunen, R.;Ahonen, R.;Soininen, H.;Hartikainen, S.",2013,,,0,
4467,Neurosonological markers predicting cognitive deterioration,"Introduction: Vascular brain changes and risk factors play a role in development and progres sion of Alzheimer's disease (AD). The primary aim of our study was to determin. The predictive value of neurosonological bio markers of cerebral microvasculature -resistance index (RI) and breath-holding index (BHI). The development AD dementia i. The older non-demented population. The secondary aim was to compare RI and BHI with other vascular bio markers. Methods: A prospective study with patients with mild cognitive impairment (MCI), subjective memory complaints (SCD) and AD dementia patients as controls. All subjects underwent a detailed neuropsychology examination, brain magnetic resonance imag ing and transcranial colour-coded sonography, includ in. The evaluation of BHI and RI i. The middle cerebral artery (MCA). Results: One hundred and eighty-three patients were enrol led, of which 113 patients with a dia gnosis of MCI (n = 38), SCD (n = 49) and AD (n = 26) were included i. The analysis. Dur in. The fol low-up period (mean 40 months), 23 (26.4%) patients converted to dementia. Patients i. The conversion group had a significantly lower BHI for both hemispheres; there was no significant difference i. The RI values. The ROC analysis showe. The cut-offvalues of BHI = 0.50 for left and BHI = 0.57 for right MCA (Z-score BHI < 0) to b. The best predictive factors for dementia conversion. The hazard ratio (HR) of AD conversion for Z-score BHI < 0 was 5.61 (95%CI 1.66-18.97). The patients with conversion also had a significantly higher age, lower body mass index, higher frequency of ischaemic heart disease, APOE e4 al lele and more severe hippocampal atrophy and vascular white matter lesions. Conclusion: BHI measurement seems to b. The most useful neurosonological marker of AD conversion. In our study, BHI = 0.50 for left MCA and BHI = 0.57 for right MCA sh. The best predictive value for conversion to AD dementia.",apolipoprotein E4;age;allele;Alzheimer disease;article;body mass;brain atrophy;breath holding index;clinical assessment;controlled study;dementia;echoencephalography;follow up;hazard ratio;hippocampal atrophy;human;ischemic heart disease;major clinical study;memory disorder;mental deterioration;middle cerebral artery;mild cognitive impairment;nuclear magnetic resonance imaging;receiver operating characteristic;resistance index;scoring system;subjective memory complaint;white matter lesion;Z score,"Tomek, A.;Urbanová, B.;Magerová, H.;Marková, H.;Paulasová Schwabová, J.;Janský, P.;Růžičková, T.;Mokrišová, I.;Laczó, J.;Vyhnálek, M.;Hort, J.",2017,,10.14735/amcsnn2017409,0,
4468,Summary,"Gateways to Clinical Trials is a guide to the most recent clinical trials in current literature and congresses. The data in the following tables has been retrieved from the Clinical Trials Knowledge Area of Thomson Reuters IntegritySM, the drug discovery and development portal. This issue focuses on the following selection of drugs: Adefovir dipivoxil, Alemtuzumab, Aliskiren fumarate, AMA1-C1/alhydrogel, Amlodipine besylate/atorvastatin calcium, Aripiprazole, Artesunate/amodiaquine, Asenapine maleate; Bosentan, Brivaracetam; Carisbamate, Clevudine, Clofarabine, Corticorelin acetate; Dasatinib; Elinogrel potassium, Entecavir, Erlotinib hydrochloride, Eslicarbazepine acetate, Etazolate; Fampridine, Fluarix, Fondaparinux sodium, Fulvestrant; Gabapentin enacarbil, GDC-0941, GI-5005, Golimumab; Imatinib mesylate, Lacosamide, Lapatinib ditosylate, Levetiracetam, Liraglutide, LOLA; Mecasermin, Morphine hydrochloride; Natalizumab, Nilotinib hydrochloride monohydrate; Olmesartan medoxomil, Omacetaxine mepesuccinate; Paclitaxel-eluting stent, Peginterferon alfa-2a, Peginterferon alfa-2b, Pemetrexed disodium, Poly I:CLC, Pralatrexate, Pregabalin; Ranolazine, Rasagiline mesilate, Retigabine hydrochloride, Rhenium Re-186 etidronate, Rosuvastatin calcium, Rotigotine, RTL-1000, Rufinamide; Sirolimus-eluting coronary stent, Sirolimuseluting stent, Sorafenib, Stiripentol; Tiotropium bromide; Valsartan/amlodipine besylate, Varenicline tartrate; XL-184; Zoledronic acid monohydrate. © 2010 Prous Science, S.A.U. or its licensors.",acetylsalicylic acid;aliskiren;allopurinol;amlodipine;atorvastatin;bosentan;clopidogrel;dexamethasone;elinogrel;enoxaparin;entecavir;fondaparinux;heparin;hydrochlorothiazide;irbesartan;lamivudine;losartan;olmesartan;ornithine aspartate;peginterferon alpha;ramipril;ranolazine;rapamycin;ribavirin;rosuvastatin;sildenafil;thiazide diuretic agent;tirofiban;unindexed drug;valsartan;acute coronary syndrome;acute myeloblastic leukemia;acute lymphoblastic leukemia;alcohol liver cirrhosis;Alzheimer disease;arterial pressure;bleeding;bone pain;brain cancer;brain hemorrhage;brain ischemia;breast cancer;cardiovascular disease;chronic myeloid leukemia;chronic obstructive lung disease;clinical trial (topic);coronary artery disease;diabetes mellitus;drug dose increase;drug dose titration;drug efficacy;drug eluting stent;drug safety;drug tolerance;dyslipidemia;follow up;glioblastoma;glioma;heart failure;heart infarction;heart left ventricle hypertrophy;heart ventricle hypertrophy;heart ventricle tachycardia;hemoglobin blood level;hepatic encephalopathy;hepatitis B;hepatitis C;hip fracture;human;Human immunodeficiency virus infection;hypertension;hyperthyroidism;influenza;kidney failure;leukocyte count;liver cirrhosis;liver fibrosis;non small cell lung cancer;lung vascular resistance;malaria;mental disease;metabolic disorder;multiple sclerosis;myoclonus epilepsy;myopathy;neoplasm;note;nutritional disorder;Parkinson disease;percutaneous coronary intervention;prostate cancer;psoriatic arthritis;pulmonary hypertension;restless legs syndrome;rheumatoid arthritis;schizoaffective psychosis;schizophrenia;side effect;single drug dose;systolic blood pressure;T cell lymphoma;thrombocyte count;thyroid disease;treatment duration;treatment response;trichotillomania;urogenital tract disease;virus load;virus replication;aspirin,"Tomillero, A.;Moral, M. A.",2010,,,0,
4469,Percutaneous endoscopic gastrostomy for aspiration pneumonia: A 10-year single-center experience,"BACKGROUND: The significance of percutaneous endoscopic gastrostomy (PEG) in patients with aspiration pneumonia is unknown. The purpose of this study was to evaluate the clinical characteristics and outcomes of aspiration pneumonia patients who underwent PEG. METHODS: A retrospective cohort study of consecutive patients hospitalized with pneumonia who underwent PEG from 2005 to 2014. RESULTS: Of 2281 cases of pneumonia, 92 patients with aspiration pneumonia underwent PEG during their hospital stay. The rate of PEG insertion significantly decreased after 2011, when Japanese therapeutic guidelines for pneumonia in the elderly were published (5.9% vs. 1.6% before and after guideline publication, respectively; p<0.01). The study population was male dominant (63%), with a mean age of 80.7 years. They had several risk factors for aspiration pneumonia, such as dementia (63.0%), cerebrovascular disorders (37.0%), and neurologic diseases (28.3%). Survival after PEG was 88.0% at day 30, 84.3% at 3 months, 73.8% at 6 months, and 61.1% at 1 year with a median survival of 751 days. Pneumonia was the most common cause of death during the follow-up period (22 of 51 patients, 43.1%). Cox proportional hazard model showed that independent predictors of mortality were older age, male gender, comorbidity of heart failure, and lower serum albumin values before PEG. CONCLUSIONS: The rate of PEG placement is decreasing after the Japanese guidelines were published in 2011. While the overall median survival was approximately 2 years, the most common cause of death was pneumonia and mortality was associated with some significant factors.","Age Factors;Aged;Aged, 80 and over;Cause of Death;Cohort Studies;Female;Follow-Up Studies;Gastrostomy/ methods/ mortality;Humans;Male;Pneumonia, Aspiration/etiology/mortality/ therapy;Retrospective Studies;Risk Factors;Sex Factors;Survival Rate;Time Factors;Aspiration pneumonia;Dysphagia;Nursing- and healthcare-associated pneumonia;Percutaneous endoscopic gastrostomy","Tomioka, H.;Yamashita, S.;Mamesaya, N.;Kaneko, M.",2017,May,,0,
4470,An autopsy case of juvenile neuronal ceroid-lipofuscinosis with dilated cardiomyopathy,"We reported an autopsy case of neuronal ceroid-lipofuscinosis (NCL3) with dilatated cardiomyopathy. A 29-year-old male patient first noticed night-blindness at the age of four years. He was pointed out retinitis pigmentosa at the age of six years and developed ataxia, mental retardation, epilepsy and myoclonus, thereafter. T1 weighted MRI showed diffuse atrophy of the cerebellum, brainstem, and cerebrum, and dilatation of the ventricular system and T2-weighted MRI showed mild high signal intensity in the white matter around the trigones of the lateral ventricles. Autopsy findings showed an abundant accumulation of ceroid-lipofuscin-like lipopigments in most neurons in the central nervous system, and curvilinear bodies and lipofuscin like granules were confirmed by electron microscopy. The heart muscle showed an increase in the accumulation of ceroid-lipofuscin-like lipopigments, severe fibrosis and fatty infiltration in the myocardium. The peculiar point of this case is NCL3 with dilated cardiomyopathy.",ceroid;lipofuscin;adult;article;ataxia;autopsy;brain atrophy;brain stem;brain ventricle dilatation;case report;cerebellum atrophy;clinical feature;electrocardiogram;electron microscopy;epilepsy;genetic analysis;heart dilatation;heart muscle;heart muscle fibrosis;human;lipid storage;male;mental deficiency;myoclonus;neuronal ceroid lipofuscinosis;night blindness;nuclear magnetic resonance imaging;retinitis pigmentosa;white matter,"Tomiyasu, H.;Takahashi, W.;Ohta, T.;Yoshii, F.;Shibuya, M.;Shinohara, Y.",2000,,,0,
4471,Association between LDL-C and risk of myocardial infarction in CKD,"LDL cholesterol (LDL-C) is an important marker of coronary risk in the general population, but its utility in people with CKD is unclear. We studied 836,060 adults from the Alberta Kidney Disease Network with at least one measurement of fasting LDL-C, estimated GFR (eGFR), and proteinuria between 2002 and 2009. All participants were free of stage 5 CKD at cohort entry. We followed participants from first eGFR measurement toMarch 31, 2009; we used validated algorithms applied to administrative data to ascertain primary outcome (hospitalization for myocardial infarction) and Cox regression to calculate adjusted hazard ratios (HRs) for myocardial infarction by LDL-C categories within eGFR strata. During median follow-up of 48 months, 7762 patients were hospitalized for myocardial infarction, with incidence highest among participants with the lowest eGFR. Compared with 2.6-3.39 mmol/L (referent), the risk associated with having LDL-C above 4.9 mmol/L seemed greatest for GFR ≥ 90 ml/min per 1.73 m2 and least for eGFR=15-59.9ml/min per 1.73m2. Specifically, the adjusted HRs (95%confidence intervals) ofmyocardial infarction associated with LDL-C of $4.9 compared with 2.6-3.39 mmol/L in participants with eGFR=15- 59.9, 60-89.9, and $90ml/min per 1.73m2 were 2.06 (1.59, 2.67), 2.30 (2.00, 2.65), and 3.01 (2.46, 3.69). In conclusion, the association between higher LDL-C and risk of myocardial infarction is weaker for people with lower baseline eGFR, despite higher absolute risk of myocardial infarction. Increased LDL-C may be less useful as a marker of coronary risk among people with CKD than the general population. Copyright © 2013 by the American Society of Nephrology.",angiotensin receptor antagonist;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;ezetimibe;fibric acid derivative;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;indigenous people;adult;article;cardiovascular risk;cholesterol blood level;chronic kidney disease;cohort analysis;comorbidity;dementia;diabetes mellitus;disease association;female;follow up;glomerulus filtration rate;hazard ratio;heart infarction;human;hypertension;major clinical study;male;outcome assessment;paraplegia;priority journal;proteinuria;risk assessment;social status,"Tonelli, M.;Muntner, P.;Lloyd, A.;Manns, B.;Klarenbach, S.;Pannu, N.;James, M.;Hemmelgarn, B.",2013,,,0,
4472,Comorbidity as a driver of adverse outcomes in people with chronic kidney disease,"Chronic kidney disease (CKD) is associated with poor outcomes, perhaps due to a high burden of comorbidity. Most studies of CKD populations focus on concordant comorbidities, which cause CKD (such as hypertension and diabetes) or often accompany CKD (such as heart failure or coronary disease). Less is known about the burden of mental health conditions and discordant conditions (those not concordant but still clinically relevant, like dementia or cancer). Here we did a retrospective population-based cohort study of 530,771 adults with CKD residing in Alberta, Canada between 2003 and 2011. Validated algorithms were applied to data from the provincial health ministry to assess the presence/absence of 29 chronic comorbidities. Linkage between comorbidity burden and adverse clinical outcomes (mortality, hospitalization or myocardial infarction) was examined over median follow-up of 48 months. Comorbidities were classified into three categories: concordant, mental health/chronic pain, and discordant. The median number of comorbidities was 1 (range 0-15) but a substantial proportion of participants had 3 and more, or 5 and more comorbidities (25 and 7%, respectively). Concordant comorbidities were associated with excess risk of hospitalization, but so were discordant comorbidities and mental health conditions. Thus, discordant comorbidities and mental health conditions as well as concordant comorbidities are important independent drivers of the adverse outcomes associated with CKD.","Adult;Aged;Aged, 80 and over;Alberta/epidemiology;Databases, Factual;Female;Hospitalization;Humans;Male;Mental Disorders/diagnosis/epidemiology;Middle Aged;Myocardial Infarction/diagnosis/epidemiology;Prognosis;Renal Insufficiency, Chronic/diagnosis/*epidemiology/mortality/therapy;Retrospective Studies;Risk Assessment;Risk Factors;Time Factors;Young Adult","Tonelli, M.;Wiebe, N.;Guthrie, B.;James, M. T.;Quan, H.;Fortin, M.;Klarenbach, S. W.;Sargious, P.;Straus, S.;Lewanczuk, R.;Ronksley, P. E.;Manns, B. J.;Hemmelgarn, B. R.",2015,Oct,10.1038/ki.2015.228,0,
4473,Does lowering blood pressure prevent recurrent stroke?,,dipeptidyl carboxypeptidase inhibitor;diuretic agent;indapamide;perindopril;placebo;adult;anamnesis;antihypertensive activity;Asia;Australia;blood pressure measurement;blood pressure regulation;cerebrovascular accident;clinical trial;cognition;controlled clinical trial;controlled study;dementia;diastolic blood pressure;double blind procedure;drug contraindication;drug efficacy;drug indication;drug tolerability;drug withdrawal;Europe;fatality;follow up;heart infarction;hospital admission;human;hypertension;hypotension;long term care;major clinical study;medical decision making;monotherapy;multicenter study;note;randomized controlled trial;recurrent disease;risk management;screening test;systolic blood pressure;transient ischemic attack,"Tonkin, A. M.",2002,,,0,
4474,"Discovering and Developing Successful Cardiovascular Therapeutics: A Conversation with James N. Topper, MD, PhD",,antiarrhythmic agent;cardiovascular agent;central nervous system agents;Alzheimer disease;biotechnology;cardiovascular disease;congestive heart failure;diabetic nephropathy;drug cost;drug development;drug industry;drug research;Ebola hemorrhagic fever;genomics;health care cost;health care need;human;internal medicine;male;metabolic disorder;note;oncology;postdoctoral education;postgraduate education;priority journal;vascular biology;Zika fever,"Topper, J. N.;Rutherford, J. D.",2016,,10.1161/circulationaha.116.025720,0,
4475,Guidelines for family-centered care in Neuro-ICU populations: Caveats for routine palliative care,,acute disease;artificial ventilation;brain ischemia;coma;consciousness level;consultation;critically ill patient;dementia;do not resuscitate;family centered care;family health;financial management;health care cost;health care quality;heart arrest;holistic care;hospitalization;human;hydrocephalus;hypothermia;length of stay;letter;managed care;medical society;mortality rate;neurological intensive care unit;outcome assessment;palliative therapy;population;practice guideline;priority journal;prognosis;quality of life;resuscitation;risk factor;staff training;subarachnoid hemorrhage;terminal care;ventriculostomy,"Torbey, M. T.;Brophy, G. M.;Varelas, P. N.;Bösel, J.;Manno, E.;Bader, M. K.;Suarez, J. I.;Seder, D.;Freeman, W. D.",2017,,10.1097/ccm.0000000000002344,0,
4476,Study links drugs for Alzheimer's disease with reduced risk of heart attack and death,,Alzheimer Disease/*drug therapy/epidemiology;Cholinesterase Inhibitors/*pharmacology;Coronary Disease/epidemiology/*prevention & control;Cytokines/*drug effects;Female;Humans;Male;Myocardial Infarction/epidemiology/*prevention & control;Risk Assessment;Sweden/epidemiology,"Torjesen, I.",2013,Jun 05,10.1136/bmj.f3669,0,
4477,The potential diagnostic value of vitreous humor analyses at autopsy is not appreciated,,2 propanol;acetone;alcohol;glucose;opiate;abdominal aortic aneurysm;airway obstruction;alcohol intoxication;autopsy;burn;cerebrovascular accident;collapse;dementia;depression;diabetes mellitus;diagnostic value;drowning;drug abuse;epilepsy;falling;hanging;heart arrest;hospice;hospital laboratory;hospital mortality;human;kidney failure;letter;liver failure;lung disease;lung embolism;malignant neoplasm;metastasis;nursing home;pancreatitis;seizure;subarachnoid hemorrhage;subdural hematoma;sudden death;sudden infant death syndrome;suicide;thorax disease;traffic accident;vitreous body,"Tormey, W. P.",2016,,10.1007/s11845-016-1449-z,0,
4478,Delirium,,benzodiazepine derivative;neuroleptic agent;vitamin B group;alcohol withdrawal;alcoholism;Alzheimer disease;artificial ventilation;clinical assessment;delirium;heart failure;human;infection;mental disease;priority journal;psychologic assessment;risk factor;sepsis;short survey,"Torpy, J. M.;Burke, A. E.;Glass, R. M.",2010,,,0,
4479,Pain in patients living in Norwegian nursing homes,"The aims of this study were to describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain. Inpatients (n = 307) older than 64 years from nursing homes were included. Pain was measured with a 4-point verbal rating scale in the self-reported group (SRG) and Doloplus-2 in the proxy-rated group (PRG). The mean age was 86 years (SD, 7), and more than two-thirds were female. A total of 128 (60%) patients were able to self-report their pain. Approximately 50% of the SRG reported 'pain now', and of these, nearly 50% reported moderate or severe pain intensity. Better cognitive function was associated with higher pain and receiving more potent pain medication in the SRG. The pain prevalence in the PRG was higher than in the SRG (67.5% vs 51%), but no variable was associated with proxy-rated pain. Nearly 30% in the SRG and 40% in the PRG did not receive pain medication in spite of pain. Pain is still a huge problem in the nursing homes, and more research is needed on pain management in nursing home residents. © 2009 SAGE Publications.",analgesic agent;antigout agent;muscle relaxant agent;narcotic analgesic agent;nonsteroid antiinflammatory agent;paracetamol;aged;amputation;angina pectoris;arthralgia;arthritis;article;bone pain;cerebrovascular accident;cognition;controlled study;daily life activity;disease severity;drug efficacy;drug use;duodenum ulcer;female;fracture;gastritis;gout;headache;herpes zoster;hip prosthesis;hospital patient;human;knee prosthesis;low back pain;major clinical study;male;malignant neoplastic disease;migraine;myalgia;Norway;nursing home;osteoporosis;pain;pain assessment;prevalence;stomach ulcer,"Torvik, K.;Kaasa, S.;Kirkevold, Ø;Rustøen, T.",2009,,,0,
4480,Concomitant use of acetylcholine esterase inhibitors and urinary antispasmodics among finnish community-dwelling persons with alzheimer disease,"Concomitant use of acetylcholine esterase inhibitors (AChEIs) and anticholinergic drugs, such as urinary antispasmodics (UA), is generally considered as inappropriate because of their opposite pharmacological actions. However, prevalence and the duration or factors associated with concomitant use have not been previously studied among communitydwelling persons with Alzheimer disease (AD). The aim of this study was to examine the prevalence and duration of concomitant use of AChEIs and UAs among community-dwelling persons with AD and factors associated with concomitant use. Register-based data of the MEDALZ-2005 Study included all community-dwelling persons with clinically diagnosed AD at the end of year 2005 in Finland. Persons using AChEI drugs during the 4-year follow-up (2006-2009) were included in the present study (n = 20,442). Among AChEI users, 1576 persons used UA during the follow-up. Prevalence of concomitant use of AChEIs and UAs was 7.3% (n = 1491) during the 4-year follow-up. The median duration of concomitant use was 236 days. Factors associated with concomitant use were age younger than 80 years (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.08-1.34), male sex (OR, 1.16; 95% CI, 1.04-1.30), Parkinson disease (OR, 1.98; 95% CI, 1.55-2.52), diabetes (OR, 1.25; 95% CI, 1.08-1.45), and prostatic cancer (OR, 1.54; 95% CI, 1.13-2.09). Despite their antagonizing action, concomitant use of AChEIs and UAs was quite common among Finnish community-dwelling persons with AD. In addition, duration of concomitant use was comparatively long. It is recommended to consider some other options than UAs to treat urinary incontinence among persons with AD.",cholinesterase inhibitor;donepezil;galantamine;rivastigmine;spasmolytic agent;aged;Alzheimer disease;article;cardiovascular disease;comorbidity;coronary artery disease;diabetes mellitus;female;Finland;Finn (citizen);follow up;heart arrhythmia;heart failure;human;hypertension;major clinical study;male;Parkinson disease;prescription;priority journal;prostate cancer;treatment duration;urine incontinence;very elderly,"Torvinen-Kiiskinen, S.;Taipale, H.;Tanskanen, A.;Tiihonen, J.;Hartikainen, S.",2014,,,0,
4481,New ICD-10 version of the Multipurpose Australian Comorbidity Scoring System outperformed Charlson and Elixhauser comorbidities in an older population,"Objectives To translate, validate, and compare performance of an International Classification of Diseases, 10th revision (ICD-10) version of the Multipurpose Australian Comorbidity Scoring System (MACSS) against commonly used comorbidity measures in the prediction of short- and long-term mortality, 28-day all-cause readmission, and length of stay (LOS). Study Design and Setting Hospitalization and death data were linked for 25,374 New South Wales residents aged 65 years and older, admitted with a hip fracture between 2008 and 2012. Comorbidities were identified according to the MACSS, Charlson, and Elixhauser definitions using ICD-10 coding algorithms. Regression models were fitted and area under the curve (AUC) and Akaike Information Criterion assessed. Results The ICD-10 MACSS had excellent discriminating ability in predicting inhospital mortality (AUC = 0.81) and 30-day mortality (AUC = 0.80), acceptable prediction of 1-year mortality (AUC = 0.76) but poor discrimination for 28-day readmission and LOS. The MACSS algorithm provided better model fit than either Charlson or Elixhauser algorithm for all outcomes. Conclusion This work presents a rigorous translation of the ICD-9 MACSS for use with ICD-10 coded data. The updated ICD-10 MACSS outperformed both Charlson and Elixhauser measures in an older population and is recommended for use with large administrative data sets in predicting mortality outcomes.",aged;article;bacterial infection;cachexia;cerebrovascular accident;Charlson Comorbidity Index;chronic kidney failure;chronic liver disease;chronic lung disease;coding algorithm;comorbidity;comorbidity assessment;comparative study;congestive heart failure;dementia;electrolyte disturbance;Elixhauser comorbidity index;female;health care utilization;heart arrhythmia;heart infarction;hip fracture;hospital readmission;hospitalization;human;ICD-10;ICD-9;ICD-9-CM;incontinence;length of stay;leukemia;lung cancer;lymphoma;major clinical study;male;malnutrition;metastasis;mortality;Multipurpose Australian Comorbidity Scoring System;New South Wales;obesity;osteoporosis;pneumonia;prediction;primary tumor;priority journal;prostate hypertrophy;respiratory tract disease;senility;septicemia;skin ulcer;very elderly;vitamin deficiency,"Toson, B.;Harvey, L. A.;Close, J. C. T.",2016,,10.1016/j.jclinepi.2016.04.004,0,
4482,Cholinesterase inhibitors for Alzheimer's disease and the heart: An update,"Acetylcholinesterase inhibitors (AChEIs) are widely used in the symptomatic treatment of Alzheimer's disease, a disease that is afflicting a major part of our greying population. Their mechanism of action is based upon non-specific cholinergic stimulation, thereby potentially inducing cardiac beneficial or adverse effects. Data of large observational studies demonstrated a small but significant cardiac risk for all registered AChEIs (donepezil, galantamine and rivastigmine) not observed in previous clinical trials. This might be explained by a non-selective approach for prescribing AChEIs, thereby also including older persons with coexisting diseases or using several drugs, opposed to a selective patient recruitment in trials. Although there is no consensus on the management, we recommend attentiveness for cardiac symptoms and heart rhythm in every patient treated with AChEIs, and plea for a vigilant use of AChEIs in elderly patients at increased risk for cardiac adverse effects.",cholinesterase inhibitor;donepezil;galantamine;rivastigmine;Alzheimer disease;article;atrioventricular block;behavior;bradycardia;cardiovascular mortality;cardiovascular risk;cholinergic activity;cholinergic stimulation;chronotropism;clinical effectiveness;drug half life;drug safety;drug tolerability;electrocardiography monitoring;faintness;heart;heart failure;heart rate;heart rate variability;heart rhythm;human;implanted heart pacemaker;plasma protein binding;synapse vesicle,"Tournoy, J.;Van Der Linden, L.",2014,,,0,
4483,"Successes of SPRINT, but Still Some Hurdles to Cross",,NCT01206062;antihypertensive agent;trandolapril plus verapamil;valsartan;acute coronary syndrome;acute kidney failure;adverse outcome;antihypertensive therapy;cardiovascular disease;cardiovascular risk;cerebrovascular accident;chronic kidney disease;cognition;coronary artery disease;dementia;diabetes mellitus;diastolic blood pressure;dizziness;end stage renal disease;evidence based practice;faintness;heart failure;heart infarction;heart left ventricle hypertrophy;high risk patient;human;hypertension;hypokalemia;hyponatremia;hypotension;kidney injury;kidney ischemia;note;practice guideline;priority journal;randomized controlled trial (topic);risk reduction;systolic blood pressure,"Touyz, R. M.;Dominiczak, A. F.",2016,,,0,
4484,Time-varying impact of comorbidities on mortality after liver transplantation: a national cohort study using linked clinical and administrative data,"OBJECTIVE: We assessed the impact of comorbidity on mortality in three periods after liver transplantation (first 90 days, 90 days-5 years and 5-10 years). DESIGN: Prospective cohort study using records from the UK Liver Transplant Audit (UKLTA) linked to Hospital Episode Statistics (HES), an administrative database of hospital admissions in the English National Health Service (NHS). Comorbidities relevant for liver transplantation were identified from the 10th revision of the International Classification of Diseases (ICD-10) codes in HES records of admissions in the year preceding their operation. Multivariable Cox regression was used to estimate HRs for three different time periods after liver transplantation. SETTING: All liver transplant centres in the NHS hospitals in England. PARTICIPANTS: Adults who received a first elective liver transplant between April 1997 and March 2010 in the linked UKLTA-HES database. OUTCOMES: Patient mortality in three different time periods after transplantation. RESULTS: Among 3837 recipients, 45.1% had comorbidities. Recipients with cardiovascular disease had statistically significantly higher mortality in all three periods after transplantation (first 90 days: HR=2.0; 95% CI 1.4 to 2.9, 90 days-5 years: 1.6; 1.2 to 2.2, beyond 5 years: 2.8; 1.7 to 4.4). Prior congestive cardiac failure (3.2; 2.1 to 4.9) significantly increased mortality only in the first 90 days. History of non-hepatic malignancy appeared to increase risk over all periods, but significantly only in the first 90 days (1.9; 1.0 to 3.6). A diagnosis of connective tissue disease, dementia, diabetes, chronic pulmonary and renal disease did not have a significant impact on mortality in any period. CONCLUSIONS: The impact of comorbidities present at the time of transplantation changes with time after transplantation. Renal disease, pulmonary disease and diabetes had no impact on mortality in contrast to previous reports.","Adult;Comorbidity;Databases, Factual;Female;Great Britain/epidemiology;*Hospital Mortality;Humans;Liver Diseases/*mortality;Liver Transplantation/*mortality/statistics & numerical data;Male;Middle Aged;Prospective Studies;State Medicine;Time Factors;Cardiology;Diabetes & endocrinology;Oncology;Transplant medicine;Transplant surgery","Tovikkai, C.;Charman, S. C.;Praseedom, R. K.;Gimson, A. E.;van der Meulen, J.",2015,May 14,10.1136/bmjopen-2014-006971,0,
4485,Prediction of disease-associated single nucleotide polymorphisms using virtual genomes constructed from a public haplotype database,"Objectives: Simultaneous dealing of hundreds of thousands of single nucleotide polymorphisms (SNPs) in genome-wide association studies is labarious. The aim of out study is to develop a method to decrease the number of candidate SNPs prior to the genotyping of study subjects. Methods: We created virtual genotype data on case and control subjects from data of the International HapMap Project by using haplotype-based simulation method. We repeated virtual case-control association studies and selected candidate SNPs. We applied the selected SNPs to previously published genetic case-control studies. Sensitivity to detect association with causative genes using our method was compared to the original studies and results using tag SNPs. Results: We found a discrete distribution pattern of SNPs, which was able to produce significant results in case-control association studies. The number of candidate SNPs that we selected was 24.7% of the number of the original set of SNPs. We applied this method to previously published genetic case-control studies and found that the use of candidate SNPs improved the sensitivity for detecting significant alleles, both compared to the of original studies and to the use of tag SNPs. The results were not affected by the difference of the diseases and genes involved. Conclusions: Our simulation-based approach has advantages vantages of reducing costs and improving performance to detect significant alleles. This method can be used without considering the specific disease and genes involved. © 2008 Schattauer GmbH.",alpha synuclein;aryldialkylphosphatase 1;butyrophilin like 2;carrier protein;complement factor H;contractile protein;dynamin;helicase C domain 1;myosin 9B;purinergic P2X7 receptor;transcription factor 7 like 2;unclassified drug;Alzheimer disease;article;case control study;controlled study;gene frequency;genetic association;genetic database;genome analysis;genotype;haplotype;heart infarction;human;insulin dependent diabetes mellitus;major depression;medical information system;non insulin dependent diabetes mellitus;Parkinson disease;prediction;priority journal;macular degeneration;sarcoidosis;sensitivity analysis;simulation;single nucleotide polymorphism,"Toyabe, S. I.;Miyashita, A.;Kitamura, N.;Kuwano, R.;Akazawa, K.",2008,,,0,
4486,Impact of the 2013 cholesterol guideline on patterns of lipid-lowering treatment in patients with atherosclerotic cardiovascular disease or diabetes after 1 year,"BACKGROUND: The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults emphasizes evidence-based treatment with moderate- to high-dose statins for patients at high risk for atherosclerotic cardiovascular disease (ASCVD). Whether this new guideline influenced patterns of treatment 1 year after its dissemination is unknown. OBJECTIVE: To compare patterns of lipid-lowering treatment before and 1 year after the release of the 2013 cholesterol guideline in 2 high-risk groups: patients with ASCVD and patients with diabetes mellitus. METHODS: Using pharmacy and medical claims from a large U.S. health insurance organization, 610,535 patients with ASCVD (n = 301,440) or diabetes mellitus (n = 309,095) were identified, and statin treatment rates and statin intensity were examined before and 1 year after the dissemination of the 2013 cholesterol guideline. A standardized difference of at least 10[%] was required to declare the effect size meaningful. RESULTS: Overall, there was no change in statin treatment rates for patients with ASCVD (48.0[%] before guideline vs. 47.3[%] after, standardized difference 1.4[%]) or diabetes (50[%] vs. 51.5[%] after, standardized difference 2.4[%]). Statin initiation rates among patients not on statins before the 2013 guideline were 10.1[%] in patients with ASCVD and 14.3[%] in patients with diabetes, but these gains were offset by 13.0[%] and 12.2[%] statin discontinuation rates among ASCVD and diabetes patients, respectively. Among patients taking statins 1 year after the guideline was issued, 80[%] of patients with ASCVD and aged = 75 years were not on guideline-recommended high-intensity statin therapy, whereas most patients with ASCVD and aged &gt; 75 years or patients with diabetes were on moderate- or highintensity statin treatment. CONCLUSIONS: One year after dissemination of the 2013 cholesterol guideline, overall treatment rates with statins among patients with ASCVD and diabetes did not change appreciably, and many patients remained either untreated or undertreated.",cholesterol;ezetimibe;fibric acid derivative;hydroxymethylglutaryl coenzyme A reductase inhibitor;nicotinic acid;acute coronary syndrome;aged;article;cardiovascular risk;cerebrovascular accident;Charlson Comorbidity Index;cholesterol blood level;chronic kidney disease;cohort analysis;coronary artery atherosclerosis;coronary artery bypass surgery;coronary artery disease;dementia;diabetes mellitus;diabetic patient;drug megadose;end stage renal disease;evidence based practice;female;health insurance;heart failure;heart infarction;heart muscle revascularization;high risk patient;human;hypertension;major clinical study;male;outcome assessment;percutaneous coronary intervention;peripheral vascular disease;practice guideline;primary prevention;secondary prevention;sensitivity analysis;unstable angina pectoris,"Tran, J. N.;Kao, T. C.;Caglar, T.;Stockl, K. M.;Spertus, J. A.;Lew, H. C.;Solow, B. K.;Chan, P. S.",2016,,,0,
4487,Treatment of obsessive-compulsive disorder using clomipramine in a very old patient,"OBJECTIVE: TO describe the effect of the tricyclic drug clomipramine in a very old patient with obsessive-compulsive disorder and Alzheimer dementia. CASE SUMMARY: A 93-year-old woman had a history of obsessive-compulsive disorder since early adulthood. The obsession consisted of remembering names of famous people and the compulsion consisted of excessive list making. With the onset of memory loss secondary to Alzheimer disease, she became increasingly anxious and compulsive as a result of a failure to remember. After nine weeks on fluoxetine she became jittery and more confused. After a two-week wash-out period, she was given a nine-week course of clomipramine that was carefully titrated up to a therapeutic concentration. RESULTS: At the completion of clomipramine treatment, the patient no longer felt driven to recall the names of famous people. Her score from the Yale-Brown Obsessive-Compulsive Scale dropped from 29 to 3. Her Folstein Mini-Mental State Examination score increased from 21 to 23. CONCLUSIONS: Clomipramine appeared much more effective and better tolerated than fluoxetine in this very old patient despite its potential anticholinergic effect and the coexistence of Alzheimer disease.",alprazolam;buspirone;clomipramine;digoxin;fluoxetine;furosemide;glyceryl trinitrate;aged;Alzheimer disease;anticholinergic effect;article;case report;comorbidity;compulsion;confusion;congestive heart failure;disease severity;drug effect;drug efficacy;drug tolerability;female;geriatric care;human;neuropsychological test;obsession;priority journal;transdermal drug administration,"Trappler, B.",1999,,,0,
4488,Relistor approved for opioid-related constipation,,17 methylnaltrexone;laxative;morphine;mu opiate receptor antagonist;opiate;abdominal pain;acquired immune deficiency syndrome;advanced cancer;blood brain barrier;cancer palliative therapy;chronic obstructive lung disease;constipation;dementia;diarrhea;dizziness;drug approval;drug indication;drug receptor binding;flatulence;gastrointestinal obstruction;heart failure;human;Human immunodeficiency virus infection;nausea;note;opiate induced constipation;priority journal;recommended drug dose;relistor,"Traynor, K.",2008,,,0,
4489,Vascular factors and risk for neuropsychiatric symptoms in Alzheimer's disease: the Cache County Study,"OBJECTIVE: To examine, in an exploratory analysis, the association between vascular conditions and the occurrence of neuropsychiatric symptoms (NPS) in a population-based sample of incident Alzheimer's disease (AD). METHODS: The sample consisted of 254 participants, identified through two waves of assessment. NPS were assessed using the Neuropsychiatric Inventory. Prior to the onset of AD, data regarding a history of stroke, hypertension, hyperlipidemia, heart attack or coronary artery bypass graft (CABG), and diabetes were recorded. Logistic regression procedures were used to examine the relationship of each vascular condition to individual neuropsychiatric symptoms. Covariates considered were age, gender, education, APOE genotype, dementia severity, and overall health status. RESULTS: One or more NPS were observed in 51% of participants. Depression was most common (25.8%), followed by apathy (18.6%), and irritability (17.7%). Least common were elation (0.8%), hallucinations (5.6%), and disinhibition (6.0%). Stroke prior to the onset of AD was associated with increased risk of delusions (OR = 4.76, p = 0.02), depression (OR = 3.87, p = 0.03), and apathy (OR = 4.48, p = 0.02). Hypertension was associated with increased risk of delusions (OR = 2.34, p = 0.02), anxiety (OR = 4.10, p = 0.002), and agitation/aggression (OR = 2.82, p = 0.01). No associations were observed between NPS and diabetes, hyperlipidemia, heart attack or CABG, or overall health. CONCLUSIONS: Results suggest that a history of stroke and hypertension increase the risk of specific NPS in patients with AD. These conditions may disrupt neural circuitry in brain areas involved in NPS. Findings may provide an avenue for reduction in occurrence of NPS through the treatment or prevention of vascular risk conditions.","Aged;Aged, 80 and over;Aging;Alzheimer Disease/diagnosis/*epidemiology/*physiopathology;Brain/*physiopathology;Catchment Area (Health);Coronary Artery Bypass/statistics & numerical data;Female;Genotype;Humans;Hyperlipidemias/epidemiology;Male;Myocardial Infarction/*epidemiology/*physiopathology/surgery;Prevalence;Psychomotor Agitation/*epidemiology/*physiopathology;Risk Factors;Severity of Illness Index;Stroke/*epidemiology/physiopathology;United States/epidemiology","Treiber, K. A.;Lyketsos, C. G.;Corcoran, C.;Steinberg, M.;Norton, M.;Green, R. C.;Rabins, P.;Stein, D. M.;Welsh-Bohmer, K. A.;Breitner, J. C.;Tschanz, J. T.",2008,Jun,10.1017/s1041610208006704,0,
4490,Reducing cardiovascular morbidity and mortality in the elderly,"Candesartan cilexetil is highly effective at lowering blood pressure, whilst maintaining placebo-like tolerability, in a wide range of patient groups. Although the benefit of lowering blood pressure in elderly patients with moderate hypertension has been demonstrated in several large-scale clinical trials, elderly patients with mild hypertension have rarely been studied. The high incidence of cardiovascular and cerebrovascular mortality and morbidity, including dementia, in the elderly means that control of blood pressure is particularly important in this patient group. A major new international clinical trial - SCOPE (Study on COgnition and Prognosis in the Elderly) - has therefore been initiated. This is a prospective, randomized, double-blind, parallel comparison of the effects of candesartan cilexetil, 8 or 16 mg once daily, and placebo in about 5000 patients who will be followed for a mean of 2.5 years. SCOPE is the first study designed to assess the effect of antihypertensive therapy in elderly patients (70-89 years of age) with mild hypertension (sitting systolic blood pressure of 160-179 mmHg and/or sitting diastolic blood pressure of 90-99 mmHg). The primary objective of the study is to determine the effect of candesartan cilexetil on major cardiovascular events (cardiovascular death, non-fatal stroke and myocardial infarction, and silent myocardial infarction), while an important secondary objective is to determine the effect of such treatment on the prevention of cognitive impairment. SCOPE should provide definitive evidence of the cardiovascular and cerebrovascular benefits of treating mildly hypertensive elderly patients with angiotensin II type 1 receptor blockers, which not only reduce blood pressure, but may also provide significant protection from the negative effects of angiotensin II on target organs.","Angiotensin Receptor Antagonists;Antihypertensive Agents [therapeutic use];Benzimidazoles [therapeutic use];Biphenyl Compounds [therapeutic use];Cognition [drug effects];Double-Blind Method;Hypertension [complications] [drug therapy] [physiopathology];Morbidity;Prognosis;Prospective Studies;Receptor, Angiotensin, Type 1;Receptor, Angiotensin, Type 2;Tetrazoles;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Hs-handsrch: sr-dementia: sr-htn: sr-stroke","Trenkwalder, P.",2000,,,0,
4491,Reducing cardiovascular morbidity and mortality in the elderly,"Candesartan cilexetil is highly effective at lowering blood pressure, whilst maintaining placebo-like tolerability, in a wide range of patient groups. Although the benefit of lowering blood pressure in elderly patients with moderate hypertension has been demonstrated in several large-scale clinical trials, elderly patients with mild hypertension have rarely been studied. The high incidence of cardiovascular and cerebrovascular mortality and morbidity, including dementia, in the elderly means that control of blood pressure is particularly important in this patient group. A major new international clinical trial - SCOPE (Study on COgnition and Prognosis in the Elderly) - has therefore been initiated. This is a prospective, randomized, double-blind, parallel comparison of the effects of candesartan cilexetil, 8 or 16 mg once daily, and placebo in about 5000 patients who will be followed for a mean of 2.5 years. SCOPE is the first study designed to assess the effect of antihypertensive therapy in elderly patients (70-89 years of age) with mild hypertension (sitting systolic blood pressure of 160-179 mmHg and/or sitting diastolic blood pressure of 90-99 mmHg). The primary objective of the study is to determine the effect of candesartan cilexetil on major cardiovascular events (cardiovascular death, non-fatal stroke and myocardial infarction, and silent myocardial infarction), while an important secondary objective is to determine the effect of such treatment on the prevention of cognitive impairment. SCOPE should provide definitive evidence of the cardiovascular and cerebrovascular benefits of treating mildly hypertensive elderly patients with angiotensin II type 1 receptor blockers, which not only reduce blood pressure, but may also provide significant protection from the negative effects of angiotensin II on target organs.","Angiotensin Receptor Antagonists;Antihypertensive Agents [therapeutic use];Benzimidazoles [therapeutic use];Biphenyl Compounds [therapeutic use];Cognition [drug effects];Double-Blind Method;Hypertension [complications] [drug therapy] [physiopathology];Morbidity;Prognosis;Prospective Studies;Receptor, Angiotensin, Type 1;Receptor, Angiotensin, Type 2;Tetrazoles;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Hs-handsrch: sr-dementia: sr-htn: sr-stroke","Trenkwalder, P",2000,,,0,4490
4492,Prevalence and significance of cardiovascular disease and hypertension in elderly patients with dementia and depression,"The prevalence and significance of clinical heart disease and hypertension were compared in three groups of elderly patients. One group was diagnosed as dementia of an Alzheimer's type (AD), another as multiinfarct dementia (MID), and the third as major depression. Clinical heart disease and hypertension were uncommon in the AD group with the prevalence being lower than that reported in most epidemiologic studies. Four percent of the AD patients had a history of myocardial infarction, 5% angina, 1% arrhythmias, and 3% heart failure. Electrocardiographic changes of an old myocardial infarction were present in 9%, atrial fibrillation in 1%, and left ventricular hypertrophy in 3%. A history of hypertension was present in 24% of the AD patients. In comparison, a history of myocardial infarction, angina, and heart failure was five times greater, and electrocardiographic abnormalities were twice as prevalent in the MID group. A history of hypertension was three times more common and actual blood pressure readings were higher. In the depression group heart disease was not uncommon and the prevalence, in general, was comparable with the MID group. However, a history of increased blood pressure and actual increased blood pressure readings were statistically less than in the MID group.",Aged;Alzheimer Disease/*complications;Cardiovascular Diseases/complications/*epidemiology;Dementia/*complications;Depressive Disorder/*complications;Female;Heart Diseases/diagnosis/epidemiology;Humans;Hypertension/diagnosis/epidemiology;Male;Maryland,"Tresch, D. D.;Folstein, M. F.;Rabins, P. V.;Hazzard, W. R.",1985,Aug,,0,
4493,"Male risk factors for hip fracture-a 30-year follow-up study in 7,495 men","SUMMARY: Risk factors for hip fracture were studied in 7,495 randomly selected men during 30 years; 451 men had a hip fracture. High degree of leisure-time, but not work-related, physical activity, high occupational class, and high body mass index (BMI) protected against hip fracture. Smoking, tall stature, interim stroke, and dementia increased the risk. PURPOSE: The purpose was to prospectively study risk factors for hip fracture in men. METHODS: We studied midlife determinants of future hip fractures in 7,495 randomly selected men aged 46-56 years in Gothenburg, Sweden. The subjects were investigated in 1970-1973 and followed for over 30 years. Questionnaires were used regarding lifestyle factors, psychological stress, occupational class, and previous myocardial infarction, stroke, and diabetes mellitus. Alcohol problems were assessed with the aid of registers. Using the Swedish hospital discharge register, data were collected on intercurrent stroke and dementia diagnoses and on first hip fractures (X-ray-verified). RESULTS: Four hundred fifty-one men (6%) had a hip fracture. Age, tall stature, low occupational class, tobacco smoking, alcoholic intemperance, and interim stroke or dementia were independently associated with the risk of hip fracture. There were inverse associations with leisure-time physical activity, BMI, and coffee consumption. The gradient of risk for one standard deviation of multivariable risk decreased with time since measurement yet was a good alternative to dual energy X-ray absorptiometry measurements. CONCLUSIONS: High degree of leisure-time physical activity, high occupational class, and high BMI protected against hip fracture. However, work-related physical activity was not protective. Smoking, tall stature, and interim stroke or dementia increased the risk.","Age Distribution;Aged;Aged, 80 and over;Body Height;Body Mass Index;Dementia/complications/epidemiology;Epidemiologic Methods;Hip Fractures/epidemiology/*etiology;Humans;Male;Middle Aged;Motor Activity;Osteoporotic Fractures/epidemiology/*etiology;Smoking/adverse effects/epidemiology;Social Class;Stroke/complications/epidemiology;Sweden/epidemiology","Trimpou, P.;Landin-Wilhelmsen, K.;Oden, A.;Rosengren, A.;Wilhelmsen, L.",2010,Mar,10.1007/s00198-009-0961-7,0,
4494,Is silent cerebral infarction associated with vascular events in patients undergoing hemodialysis?,,brain hemorrhage;brain infarction;cardiovascular disease;cohort analysis;confidence interval;congestive heart failure;controlled study;coronary artery bypass graft;dementia;diabetes mellitus;disease association;hemodialysis;human;ischemic heart disease;major clinical study;note;outcomes research;priority journal;smoking;cerebrovascular accident;transient ischemic attack;transluminal coronary angioplasty,"Tripepi, G.;Zoccali, C.",2006,,,0,
4495,The association between systemic inflammation and cognitive performance in the elderly: The Sydney Memory and Ageing Study,"Inflammation may contribute to cognitive decline and dementia. This study examined the cross-sectional relationships between markers of systemic inflammation (C-reactive protein, interleukins-1β, -6, -8, -10, -12, plasminogen activator inhibitor, serum amyloid A, tumour necrosis factor-œ and vascular adhesion molecule-1) and cognitive function in 873 non-demented community-dwelling elderly participants aged 70-90 years. Regression analyses were performed to determine the relationships between cognitive domains and inflammatory markers, controlling for age, sex, education, cardiovascular risk factors, obesity and other metabolic factors, smoking, alcohol consumption, depression and presence of the apolipoprotein ε4 genotype. Regression analyses were repeated using four factors derived from a factor analysis of the cognitive tests. After Bonferroni correction for multiple testing, associations remained between raised levels of interleukin-12 and reduced performance in processing speed. Marked sex differences were noted in the abovementioned findings, with only females being significantly affected. Using the four factors derived from the factor analyses of cognitive test as dependent variables, interleukins-12 and -6 were both associated with the processing speed/executive function factor, even after controlling for relevant confounding factors. Thus, markers of systemic inflammation are related to cognitive deficits in a non-clinical community-dwelling elderly population, independent of depression, cardiovascular or metabolic risk factors, or presence of apolipoprotein ε4 genotype. Additional research is required to elucidate the pathophysiology and longitudinal development of these relationships. © American Aging Association 2011.",amyloid A protein;apolipoprotein E4;C reactive protein;glucose;interleukin 10;interleukin 12;interleukin 1beta;interleukin 6;interleukin 8;plasminogen activator inhibitor;triacylglycerol;tumor necrosis factor alpha;vascular cell adhesion molecule 1;acute heart infarction;age;aged;alcohol consumption;angina pectoris;article;cardiometabolic risk;cardiovascular risk;cerebrovascular accident;cognitive defect;controlled study;cross-sectional study;depression;educational status;executive function;factorial analysis;female;genotype;human;inflammation;male;neuropsychological test;obesity;regression analysis;sex;sex difference;smoking;transient ischemic attack,"Trollor, J. N.;Smith, E.;Agars, E.;Kuan, S. A.;Baune, B. T.;Campbell, L.;Samaras, K.;Crawford, J.;Lux, O.;Kochan, N. A.;Brodaty, H.;Sachdev, P.",2012,,,0,
4496,Abeta Amyloid Pathology Affects the Hearts of Patients With Alzheimer's Disease: Mind the Heart,"BACKGROUND: Individually, heart failure (HF) and Alzheimer's disease (AD) are severe threats to population health, and their potential coexistence is an alarming prospect. In addition to sharing analogous epidemiological and genetic profiles, biochemical characteristics, and common triggers, the authors recently recognized common molecular and pathological features between the 2 conditions. Whereas cognitive impairment has been linked to HF through perfusion defects, angiopathy, and inflammation, whether patients with AD present with myocardial dysfunction, and if the 2 conditions bear a common pathogenesis as neglected siblings are unknown. OBJECTIVES: Here, the authors investigated whether amyloid beta (Abeta) protein aggregates are present in the hearts of patients with a primary diagnosis of AD, affecting myocardial function. METHODS: The authors examined myocardial function in a retrospective cross-sectional study from a cohort of AD patients and age-matched controls. Imaging and proteomics approaches were used to identify and quantify Abeta deposits in AD heart and brain specimens compared with controls. Cell shortening and calcium transients were measured on isolated adult cardiomyocytes. RESULTS: Echocardiographic measurements of myocardial function suggest that patients with AD present with an anticipated diastolic dysfunction. As in the brain, Abeta40 and Abeta42 are present in the heart, and their expression is increased in AD. CONCLUSIONS: Here, the authors provide the first report of the presence of compromised myocardial function and intramyocardial deposits of Abeta in AD patients. The findings depict a novel biological framework in which AD may be viewed either as a systemic disease or as a metastatic disorder leading to heart, and possibly multiorgan failure. AD and HF are both debilitating and life-threatening conditions, affecting enormous patient populations. Our findings underline a previously dismissed problem of a magnitude that will require new diagnostic approaches and treatments for brain and heart disease, and their combination.","0 (Amyloid beta-Peptides);Aged;Aged, 80 and over;Aging/metabolism;Alzheimer Disease/ complications/diagnosis/metabolism;Amyloid beta-Peptides/ metabolism;Brain/metabolism/ultrastructure;Cardiomyopathies/diagnosis/ etiology/metabolism;Cross-Sectional Studies;Enzyme-Linked Immunosorbent Assay;Female;Humans;Immunoblotting;Immunohistochemistry;Male;Microscopy, Electron, Transmission;Myocardium/ metabolism/ultrastructure;Retrospective Studies;amyloidosis;cardiomyopathy;dementia;heart failure;protein aggregates","Troncone, L.;Luciani, M.;Coggins, M.;Wilker, E. H.;Ho, C. Y.;Codispoti, K. E.;Frosch, M. P.;Kayed, R.;Del Monte, F.",2016,Dec 06,,0,
4497,"""Natural"" death of a person under the care of a custodian","An ambulance service doctor was called to the death of a 76-year-old woman and attested cardiac arrest and psycho-organic brain syndrome as the cause of death on the death certificate. At the second external examination mandatory before cremation, extensive hematomas were detected on the right thorax and multiple haematomas in the face and on the forehead. The autopsy initially ordered by the public health officer revealed serial rib fractures and a fractured skull. After notifying the prosecutor, a forensic autopsy was ordered and death was found to have been caused by fat embolism following massive blunt force to the thorax with serial rib fractures and haematopneumothorax. After that, the adopted son, who had been appointed care custodian for the woman, and his wife were suspected, because they had given contradictory explanations for the injuries. At first, they were only suspected of failure to render assistance, but in the end they were both charged with murder. Only because of the second external examination prescribed by the law still in force could the errors of the improper first external examination be corrected.",aged;article;autopsy;case report;custodial care;dementia;differential diagnosis;elder abuse;expert witness;female;Germany;heart arrest;homicide;human;legal aspect;multiple trauma;pathology,"Trübner, K.;Kleiber, M.;Heide, S.",2012,,,0,
4498,Heart Failure with Recovered Ejection Fraction in a Cohort of Elderly Patients with Chronic Heart Failure,"OBJECTIVE: The aim of this study was to determine whether patients with heart failure (HF) who recover left ventricular ejection fraction (LVEF), termed here as 'Rec-HF', have a distinct clinical profile and prognosis compared with patients with HF and reduced LVEF (HF-REF) or HF and preserved LVEF (HF-PEF). METHODS: We evaluated and classified patients from the Spanish Heart Failure Registry into three categories based on enrollment/follow-up echocardiograms: HF-PEF (LVEF >/=50%), HF-REF (LVEF persistently <50%) and Rec-HF (LVEF on enrollment <50% but normalized during follow-up). RESULTS: A total of 1,202 patients were included, 1,094 with HF-PEF, 81 with HF-REF and 27 with Rec-HF. The three groups included patients of advanced age (mean age 75 years) with comorbidities. Rec-HF patients were younger, with a better functional status, lower prevalence of diabetes mellitus, dementia and cerebrovascular disease, and higher prevalence of COPD. The etiology of HF was more frequently ischemic and alcoholic and less frequently hypertensive. After a median follow-up of 367 days, the unadjusted hazard ratios for death in the Rec-HF versus HF-PEF and HF-REF groups were 0.11 (95% CI 0.02-080; p = 0.029) and 0.31 (95% CI 0.04-2.5; p = 0.274). Results were statistically nonsignificant in multivariate-adjusted models. CONCLUSION: Rec-HF is also present in elderly patients with HF but it is necessary to further investigate the natural history and optimal pharmacologic management of this 'new HF syndrome'.",,"Trullas, J. C.;Manzano, L.;Formiga, F.;Aramburu-Bodas, O.;Quesada-Simon, M. A.;Arias-Jimenez, J. L.;Garcia-Escriva, D.;Romero-Requena, J. M.;Jordana-Comajuncosa, R.;Montero-Perez-Barquero, M.",2016,,10.1159/000447287,0,
4499,Heart failure with recovered ejection fraction in a cohort of elderly patients with chronic heart failure,"Objective: The aim of this study was to determine whether patients with heart failure (HF) who recover left ventricular ejection fraction (LVEF), termed here as 'Rec-HF', have a distinct clinical profile and prognosis compared with patients with HF and reduced LVEF (HF-REF) or HF and preserved LVEF (HF-PEF). Methods: We evaluated and classified patients from the Spanish Heart Failure Registry into three categories based on enrollment/follow-up echocardiograms: HF-PEF (LVEF ≥50%), HF-REF (LVEF persistently <50%) and Rec-HF (LVEF on enrollment <50% but normalized during follow-up). Results: A total of 1,202 patients were included, 1,094 with HF-PEF, 81 with HF-REF and 27 with Rec-HF. The three groups included patients of advanced age (mean age 75 years) with comorbidities. Rec-HF patients were younger, with a better functional status, lower prevalence of diabetes mellitus, dementia and cerebrovascular disease, and higher prevalence of COPD. The etiology of HF was more frequently ischemic and alcoholic and less frequently hypertensive. After a median follow-up of 367 days, the unadjusted hazard ratios for death in the Rec-HF versus HF-PEF and HF-REF groups were 0.11 (95% CI 0.02-080; p = 0.029) and 0.31 (95% CI 0.04-2.5; p = 0.274). Results were statistically nonsignificant in multivariate-adjusted models. Conclusion: Rec-HF is also present in elderly patients with HF but it is necessary to further investigate the natural history and optimal pharmacologic management of this 'new HF syndrome'.",aged;alcoholism;article;cerebrovascular disease;cohort analysis;comorbidity;dementia;diabetes mellitus;echocardiography;female;follow up;functional status;heart failure;heart failure with recovered ejection fraction;heart left ventricle ejection fraction;heart muscle ischemia;hospital readmission;human;hypertension;major clinical study;male;priority journal,"Trullàs, J. C.;Manzano, L.;Formiga, F.;Aramburu-Bodas, O.;Quesada-Simón, M. A.;Arias-Jiménez, J. L.;García-Escrivá, D.;Romero-Requena, J. M.;Jordana-Comajuncosa, R.;Montero-Pérez-Barquero, M.",2016,,10.1159/000447287,0,
4500,Increased incidence of orthopedic fractures in cirrhotic patients: A nationwide population-based study,"Background & Aims: Hepatic encephalopathy (HE) is a reversible neuropsychiatric disorder in cirrhotic patients. The cognitive dysfunction and increased accidental falls in HE and osteodystrophy in cirrhotic patients may contribute to orthopedic fractures. This study investigated the fracture incidence and risk factors in cirrhotic patients with HE. Methods: In total, 3764 cirrhotic patients with HE were identified from the Taiwan National Health Insurance database between 2000 and 2009. The fracture incidence of the HE patients was compared with that of 3764 age-, sex-, and comorbidity-matched cirrhotic patients without HE and non-cirrhotic controls. Cox proportional hazard models were used to estimate the risk of fracture in the HE patients. Results: Cirrhotic patients with and without HE had comparable increased risks of fracture (p <0.05) and cumulative incidences of fracture than controls (log-rank p <0.001). The estimated fracture rates were 7.09% for the HE group, 7.72% for the cirrhosis without HE group, and 4.05% for the controls, during the 18-month follow-up. The HE group had a higher incidence rate of skull fractures (IRR = 2.61, 95% CI 1.04-6.57), but a lower rate of upper limb fractures (IRR = 0.45, 95% CI 0.29-0.70) than the cirrhosis without HE group. Alcoholism, heart failure, and cerebrovascular disease were associated with increased risk of fracture in HE patients. Conclusions: Cirrhotic patients, with or without HE, are at an increased risk of orthopedic fractures. Skull fractures, rather than fractures in weight-bearing bones, are more frequently observed in HE patients, particularly those with comorbidities. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.",adult;aged;alcoholism;article;cerebrovascular disease;chronic kidney disease;chronic lung disease;cohort analysis;comorbidity;controlled study;data base;dementia;diabetes mellitus;disease association;female;follow up;health care cost;heart failure;heart infarction;hepatic encephalopathy;human;incidence;limb fracture;liver cirrhosis;major clinical study;male;osteoporosis;priority journal;risk factor;skull fracture;spine fracture;Taiwan,"Tsai, C. F.;Liu, C. J.;Chen, T. J.;Chu, C. J.;Lin, H. C.;Lee, F. Y.;Su, T. P.;Lu, C. L.",2013,,,0,
4501,"Susceptibility-weighted imaging, an additional tool to diagnose brain death: Initial experience",We describe findings suggestive of brain death on susceptibility-weighted imaging. We retrospectively reviewed brain magnetic resonance (MR) images of 15 patients who had cardiac arrest and found four cases with evidence of brain death. We then reviewed susceptibility-weighted imaging (SWI) findings on these cases. SWI images in the four cases with brain death showed deoxygenated blood in intracranial arteries. This preliminary result suggests that SWI may be used to diagnose brain death.,acute disseminated encephalomyelitis;acute kidney failure;adult;article;blood oxygenation;brain circulation;brain death;case report;child;coma;drug intoxication;female;head injury;heart arrest;human;magnetic resonance angiography;male;medical record review;mental deterioration;preschool child;resuscitation;susceptibility weighted imaging,"Tsai, F. Y.;Lee, K. W.;Kao, H. W.;Chen, C. Y.",2012,,,0,
4502,Increased risk of dementia in patients hospitalized with acute kidney injury: A nationwide population-based cohort study,"PURPOSE: To determine whether acute kidney injury (AKI) is a risk factor for dementia. METHODS: This nationwide population-based cohort study was based on data from the Taiwan National Health Insurance Research Database for 2000-2011. The incidence and relative risk of dementia were assessed in 207788 patients hospitalized for AKI. The comparison control was selected using the propensity score based on age, sex, index year and comorbidities. RESULTS: During the 12-year follow-up, patients with AKI had a significantly higher incidence for developing dementia than did the controls (8.84 vs 5.75 per 1000 person-y). A 1.88-fold increased risk of dementia (95% confidence interval, 1.76-2.01) was observed after adjustment for age, sex, and several comorbidities (diabetes, hypertension, hyperlipidemia, head injury, depression, stroke, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, atrial fibrillation, cancer, liver disease, chronic infection/inflammation, autoimmune disease, malnutrition). CONCLUSIONS: We found that patients with AKI exhibited a significantly increased risk of developing dementia. This study provides evidence on the association between AKI and long-term adverse outcomes. Additional clinical studies investigating the related pathways are warranted.","Acute Kidney Injury/ epidemiology;Aged;Aged, 80 and over;Cohort Studies;Comorbidity;Dementia/ epidemiology;Female;Hospitalization/ statistics & numerical data;Humans;Incidence;Male;Middle Aged;Population Surveillance/ methods;Propensity Score;Proportional Hazards Models;Risk Assessment/methods/statistics & numerical data;Risk Factors;Taiwan/epidemiology","Tsai, H. H.;Yen, R. F.;Lin, C. L.;Kao, C. H.",2017,,,0,
4503,Comparison of risks factors for unplanned ICU transfer after ED admission in patients with infections and those without infections,"Background. The objectives of this study were to compare the risk factors for unplanned intensive care unit (ICU) transfer after emergency department (ED) admission in patients with infections and those without infections and to explore the feasibility of using risk stratification tools for sepsis to derive a prediction system for such unplanned transfer. Methods. The ICU transfer group included 313 patients, while the control group included 736 patients randomly selected from those who were not transferred to the ICU. Candidate variables were analyzed for association with unplanned ICU transfer in the 1049 study patients. Results. Twenty-four variables were associated with unplanned ICU transfer. Sixteen (66.7%) of these variables displayed association in patients with infections and those without infections. These common risk factors included specific comorbidities, physiological responses, organ dysfunctions, and other serious symptoms and signs. Several common risk factors were statistically independent. Conclusions. The risk factors for unplanned ICU transfer in patients with infections were comparable to those in patients without infections. The risk factors for unplanned ICU transfer included variables from multiple dimensions that could be organized according to the PIRO (predisposition, insult/infection, physiological response, and organ dysfunction) model, providing the basis for the development of a predictive system. © 2014 Jeffrey Che-Hung Tsai et al.",adult;aged;alcohol abuse;article;cerebrovascular disease;comorbidity;comparative study;congestive heart failure;controlled study;coronary artery disease;dementia;diabetes mellitus;disease association;emergency ward;end stage renal disease;feasibility study;female;hematologic disease;hematological parameters;hospital admission;human;hypertension;hypotension;infection;infection risk;intensive care unit;liver disease;major clinical study;male;metabolic disorder;middle aged;observational study;peritonitis;risk;risk factor;stratification;very elderly;young adult,"Tsai, J. C. H.;Cheng, C. W.;Weng, S. J.;Huang, C. Y.;Yen, D. H. T.;Chen, H. L.",2014,,,0,
4504,Infections in the survivors of out-of-hospital cardiac arrest in the first 7 days,"Objective: To evaluate the incidence, risk factors, foci, isolated organisms, and outcomes of infections in the survivors of out-of-hospital cardiac arrest (OHCA) within the first 7 days after resuscitation. Design and setting: Retrospective cohort study in the intensive care unit of a university hospital. Patients and participants: We enrolled 117 survivors of adult nontraumatic OHCA victims who survived more than 24 h between January 1999 and May 2004. We collected patients' demographics, the causes and initial electrocardiographic rhythm of cardiac arrest, and the process of cardiopulmonary resuscitation. The incidence, clinical presentations and outcomes of infections occurring in the first 7 days after resuscitation were evaluated. Variables were compared between the infected and noninfected patients. Measurements and results: Among our OHCA survivors asystole was the most common initial rhythm (66%). Eighty-three patients (71%) were found to have infection. Pneumonia was the most common infection (61%) followed by bacteremia (13%). Although the Gram-negative bacteria were responsible for most infections, the most commonly isolated organism was Staphylococcus aureus. The infection group had more patients with dementia and noncardiac causes of OHCA. The survival curves did not differ significantly between infection and noninfection groups. Conclusions: Infections were common in OHCA survivors during the first 7 days. The most common responsible organisms were Gram-negative bacteria, and the most commonly isolated organism was S. aureus. Infections in the early stage after return of spontaneous circulation did not change the hospital mortality and hospitalization duration. © Springer-Verlag 2005.",antibiotic agent;abdominal infection;aged;article;asphyxia;asthma;heart arrest;bacteremia;bacterium isolation;brain stem infarction;catheter infection;chronic obstructive lung disease;clinical feature;cohort analysis;computer assisted tomography;controlled study;dementia;disease exacerbation;echography;electrocardiography;empyema;female;gastrointestinal hemorrhage;Gram negative bacterium;heart arrhythmia;heart injury;heart muscle ischemia;hospital discharge;hospital infection;hospitalization;human;hyperkalemia;infection risk;intensive care unit;major clinical study;male;medical assessment;mortality;pneumonia;resuscitation;retrospective study;skin infection;Staphylococcus aureus;subarachnoid hemorrhage;survival rate;thorax radiography;treatment outcome;university hospital;urinary tract infection;victim;wound infection,"Tsai, M. S.;Chiang, W. C.;Lee, C. C.;Hsieh, C. C.;Ko, P. C. I.;Hsu, C. Y.;Su, C. P.;Chen, S. Y.;Chang, W. T.;Yuan, A.;Ma, M. H. M.;Chen, S. C.;Chen, W. J.",2005,,,0,
4505,Non-alcoholic Wernicke’s encephalopathy with cortical involvement and polyneuropathy following gastrectomy,"In this study, we present the clinical manifestations, brain magnetic resonance imaging (MRI) and concurrent polyneuropathies in two patients with non-alcoholic Wernicke’s encephalopathy (WE) after gastrojejunostomy (Billroth II) anastomosis procedures. These patients developed sub-acute onset of disorientation and disturbance of consciousness following several weeks of poor intake. Peripheral neuropathy of varying severity was noted before and after the onset of WE. Brain MRI of the patients showed cerebellar vermis and symmetric cortical abnormalities in addition to typical WE changes. Electrophysiological studies demonstrated axonal sensorimotor polyneuropathy. Prompt thiamine supplement therapy was initiated and both patients gradually recovered, however mild amnesia was still noted 6 months later. We reviewed non- alcoholic WE with atypical cortical abnormalities in English language literatures and identified 29 more cases. Eight out of 31 (25.8%) patients died during follow-up. Nine patients with gait disturbance or motor paresis had showed hyporeflexia in neurological examinations. In addition to classic triad, seizure was recorded in seven patients. Dietary deprivation is a risk factor for non-alcoholic WE among elderly patients receiving gastrointestinal surgery. The prognosis is good after thiamine supplement therapy. Recognizing the MRI features and predisposing factors in patients who have undergone gastrectomy can aid in the diagnosis and management.",brain natriuretic peptide;glycosylated hemoglobin;homocysteine;nicotinamide;pantothenic acid;pyridoxine;riboflavin;thiamine;thyroid peroxidase antibody;troponin I;aged;amnesia;article;Babinski reflex;brain cortex;cardiomegaly;case report;cerebellum vermis;clinical article;clinical feature;consciousness disorder;disease severity;disorientation;echocardiography;electromyogram;electrophysiology;emergency ward;female;gastrectomy;gastrectomy Billroth II;gastrojejunostomy;Guillain Barre syndrome;heart ejection fraction;human;hydration;hypotension;hypothyroidism;lethargy;male;mental deterioration;mitral valve regurgitation;muscle weakness;nerve conduction velocity test;nerve potential;neurologic examination;nuclear magnetic resonance imaging;peripheral neuropathy;plasmapheresis;polyneuropathy;prognosis;quadriplegia;respiratory failure;sensorimotor neuropathy;sinus rhythm;tendon reflex;thiamine deficiency;vitamin supplementation;Wernicke encephalopathy,"Tsao, W. C.;Ro, L. S.;Chen, C. M.;Chang, H. C.;Kuo, H. C.",2017,,10.1007/s11011-017-0055-8,0,
4506,Dementia: The leading predictor of death in a defined elderly population: The Cache County Study,"Objective: To examine the relative risk and population attributable risk (PAR) of death with dementia of varying type and severity and other risk factors in a population of exceptional longevity. Methods: Deaths were monitored over 5 years using vital statistics records and newspaper obituaries in 355 individuals with prevalent dementia and 4,328 without in Cache County, UT. Mean age was 83.3 (SD 7.0) years with dementia and 73.7 (SD 6.8) years without. History of coronary artery disease, hypertension, diabetes, and other life-shortening illness was ascertained from interviews. Results: Death certificates implicated dementia as an important cause of death, but other data suggested a stronger association. Adjusted Cox relative hazard and PAR of death were higher with dementia than with any other illness studied. Relative hazard of death with dementia was highest at ages 65 to 74, but the high prevalence of dementia after age 85 resulted in 27% PAR among the oldest old. Mortality increased substantially with severity of dementia. Alzheimer disease shortened survival time most dramatically in younger participants, but vascular dementia posed a greater mortality risk among the oldest old. Conclusion: In this population, dementia was the strongest predictor of mortality, with a risk two to three times those of other life-shortening illnesses.",aged;article;dementia;disease severity;female;geriatric disorder;histopathology;human;incidence;life expectancy;longevity;major clinical study;male;mortality;prediction;prevalence;priority journal;risk factor;survival time;United States,"Tschanz, J. T.;Corcoran, C.;Skoog, I.;Khachaturian, A. S.;Herrick, J.;Hayden, K. M.;Welsh-Bohmer, K. A.;Calvert, T.;Norton, M. C.;Zandi, P.;Breitner, J. C. S.",2004,,,0,
4507,"A population study of Alzheimer's disease: Findings from the Cache County Study on Memory, Health, and Aging","There are several population-base studies of aging, memory, and dementia being conducted worldwide. Of these, the Cache County Study on Memory, Health and Aging is noteworthy for its large number of ""oldest-old"" members. This study, which has been following an initial cohort of 5,092 seniors since 1995, has reported among its major findings the role of the Apolipoprotein E gene on modifying the risk for Alzheimer's disease (AD) in males and females and identifying pharmacologic compounds that may act to reduce AD risk. This article summarizes the major findings of the Cache County study to date, describes ongoing investigations, and reports preliminary analyses on the outcome of the oldest-old in this population, the subgroup of participants who were over age 84 at the study's inception. © 2005 Springer Publishing Company.",acetylsalicylic acid;alpha tocopherol;antioxidant;apolipoprotein E2;apolipoprotein E3;apolipoprotein E4;ascorbic acid;estrogen;gestagen;histamine H2 receptor antagonist;multivitamin;nonsteroid antiinflammatory agent;vitamin;vitamin B complex;age;aged;aging;Alzheimer disease;article;clinical trial;comorbidity;dementia;depression;diabetes mellitus;disease course;female;follow up;genotype;heart infarction;hormone substitution;human;hypertension;incidence;longevity;major clinical study;male;memory;population research;prevalence;risk factor;risk reduction;sex difference;cerebrovascular accident;United States;vitamin supplementation;aspirin,"Tschanz, J. T.;Treiber, K.;Norton, M. C.;Welsh-Bohmer, K. A.;Toone, L.;Zandi, P. P.;Szekely, C. A.;Lyketsos, C.;Breitner, J. C. S.;Anthony, J.;Bigler, E.;Burke, J.;Green, R. C.;Klein, L.;Leslie, C.;Munger, R.;Østbye, T.;Pieper, C.;Plassman, B.;Steffens, D. C.;Townsend, J. T.;Wyse, B. W.;Williams, M.",2005,,,0,
4508,A pulmonary rehabilitation program reduces levels of anxiety and depression in COPD patients,"Background: The presence of anxiety and depressive symptoms in COPD patients has been acknowledged for many years. The preponderance of recent studies supports the utility of pulmonary rehabilitation programs to reduce the levels of depression and anxiety in these patients. The aim of this study is to investigate possible changes in levels of anxiety and depression among patients enrolled in a pulmonary rehabilitation program, along with the role of disease severity in these changes. Methods: In 101 COPD patients, who attended a pulmonary rehabilitation program, levels of trait anxiety (STAI) and depressive symptoms (BDI) were assessed at the beginning and at the end of the program. Age, sex, level of education in years and stage of disease severity were recorded. Results: Our study included 80 male and 21 female patients. Mean age and mean education level were 64.1 ± 8.1 and 11.3 ± 4.1 years, respectively. Regarding COPD staging, 11 patients suffered from mild, 16 from moderate, 47 from severe and 27 from very severe COPD. Significant decreases in anxiety (from 39.7 to 34.0, p < 0.001) and depression rates (from 10.7 to 6.3, p < 0.001) were observed. A statistically significant reduction in anxiety and depression was revealed (p < 0.05)at all stages of COPD. Conclusion: Pulmonary rehabilitation programs should be offered to all COPD patients irrespective of disease severity, since they all lead to improvement in anxiety and depressive symptoms. © 2013 Tselebis et al.; licensee BioMed Central Ltd.",salbutamol;adult;aerobic exercise;angina pectoris;anxiety;article;bicycle ergometry;breathing exercise;breathing muscle;chronic obstructive lung disease;congestive heart failure;dementia;depression;diabetes mellitus;disease severity;educational status;female;forced expiratory volume;forced vital capacity;heart infarction;human;hypoxia;major clinical study;male;muscle training;pulmonary hypertension;pulmonary rehabilitation,"Tselebis, A.;Bratis, D.;Pachi, A.;Moussas, G.;Ilias, I.;Harikiopoulou, M.;Theodorakopoulou, E.;Dumitru, S.;Kosmas, E.;Vgontzas, A.;Siafakas, N.;Tzanakis, N.",2013,,,0,
4509,Increased depression risk among patients with chronic osteomyelitis,"OBJECTIVE: Inflammatory processes, which provoke alternations of neurotransmitter metabolism, neuroendocrine function, and neuroplasticity in the brain, might promote depression. In depression patients who do not exhibit risk factors, including hypertension, diabetes, coronary heart disease, stroke, Parkinson's disease and dementia, particularly in young people, inflammation is a likely risk factor for depression. We explored whether chronic osteomyelitis (COM), a chronic inflammatory disease, increases depression risk. METHODS: A Taiwanese national insurance claims data set of more than 22 million enrollees was used to select 15,529 COM patients without depression history and 62,116 randomly selected age- and gender-matched controls without depression and COM history to trace depression development for an 12-year follow-up period from January 1, 1999 to December 31, 2010. The depression risk was analyzed using the Cox proportional hazards regression model. RESULTS: The above-mentioned risk factors for depression were more frequent in the COM cohort, who exhibited significantly higher depression risk than the control group did. Comparing only those without comorbidities, the COM group exhibited higher depression risk than the control group did (hazard ratio [HR]=3.04, 95% confidence interval [CI]: 2.55-3.62). The younger population carried even greater risk (age<45: HR=6.08, 95% CI: 1.71-7.85; age>65: HR=1.75, 95% CI: 1.39-2.19). CONCLUSIONS: This is the first study connecting COM to increased risk of developing depression. The outcomes suggest that COM is a substantial depression predictor and call for a closer focus on these patients for more rigorous depression prevention, particularly in young people.",Adult;Aged;Chronic Disease;Comorbidity;Coronary Disease/epidemiology;Dementia/epidemiology;Depression/*epidemiology/etiology;Depressive Disorder/*epidemiology/etiology;Diabetes Mellitus/epidemiology;Female;Humans;Hypertension/epidemiology;Incidence;Inflammation/complications/epidemiology;Kaplan-Meier Estimate;Male;Middle Aged;Osteomyelitis/diagnosis/*psychology;Parkinson Disease/epidemiology;Proportional Hazards Models;Risk Assessment;Risk Factors;Chronic osteomyelitis;Depression;Inflammation,"Tseng, C. H.;Huang, W. S.;Muo, C. H.;Chang, Y. J.;Kao, C. H.",2014,Dec,10.1016/j.jpsychores.2014.09.008,0,
4510,Assessing potential glycemic overtreatment in persons at hypoglycemic risk,"IMPORTANCE Although serious hypoglycemia is a common adverse drug event in ambulatory care, current performance measures do not assess potential overtreatment. OBJECTIVE To identify high-risk patients who had evidence of intensive glycemic management and thus were at risk for serious hypoglycemia. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of patients in the Veterans Health Administration receiving insulin and/or sulfonylureas in 2009. MAIN OUTCOMES AND MEASURES Intensive controlwas defined as the last hemoglobin A1c (HbA1c) measured in 2009 that was less than 6.0%, less than 6.5%, or less than 7.0%. The primary outcome measure was an HbA1c less than 7.0% in patients who were aged 75 years or older who had a serum creatinine value greater than 2.0mg/dL or had a diagnosis of cognitive impairment or dementia.We also assessed the rates in patients with other significant medical, neurologic, or mental comorbid illness. Variation in rates of possible glycemic overtreatment was evaluated among 139 Veterans Health Administration facilities grouped within 21 Veteran Integrated Service Networks. RESULTS There were 652 378 patients who received insulin and/or a sulfonylurea with an HbA1c test result. Fifty percent received sulfonylurea therapy without insulin; the remainder received insulin therapy.We identified 205 857 patients (31.5%) as the denominator for the primary outcome measure; 11.3%had a last HbA1c value less than 6.0%, 28.6%less than 6.5%, and 50.0%less than 7.0%. Variation in rates by Veterans Integrated Service Network facility ranged 8.5%to 14.3%, 24.7%to 32.7%, and 46.2%to 53.4%for HbA1c less than 6.0%, less than 6.5%, and less than 7.0%, respectively. The magnitude of variation by facility was larger, with overtreatment rates ranging from 6.1% to 23.0%, 20.4%to 45.9%, and 39.7%to 65.0%for HbA1c less than 6.0%, less than 6.5%, and less than 7.0%, respectively. The maximum rate was nearly 4-fold compared with the minimum rates for HbA1c less than 6.0%, followed by 2.25-fold for HbA1c less than 6.5%and less than 2-fold for HbA1c less than 7.0%. When comorbid conditions were included, 430 178 patients (65.9%) were identified as high risk. Rates of overtreatment were 10.1%for HbA1c less than 6.0%, 25.2%for less than 6.5%, and 44.3%for less than 7.0%. CONCLUSIONS AND RELEVANCE Patients with risk factors for serious hypoglycemia represent a large subset of individuals receiving hypoglycemic agents; approximately one-half had evidence of intensive treatment. A patient safety indicator derived from administrative data can identify high-risk patients for whom reevaluation of glycemic management may be appropriate, consistent with meaningful use criteria for electronic medical records. Copyright © 2014 American Medical Association. All rights reserved.",creatinine;hemoglobin A1c;insulin;sulfonylurea;aged;ambulatory care;aphasia;apraxia;article;cognitive defect;comorbidity;creatinine blood level;cross-sectional study;dementia;diabetes mellitus;dysphasia;end stage liver disease;end stage renal disease;epilepsy;female;glucose blood level;glycemic control;heart failure;heart infarction;hemiplegia;high risk patient;human;hypoglycemia;insulin treatment;kidney function;life expectancy;major clinical study;major depression;male;neoplasm;neurologic disease;Parkinson disease;priority journal;retinopathy;stomach paresis;transient ischemic attack;veterans health,"Tseng, C. L.;Soroka, O.;Maney, M.;Aron, D. C.;Pogach, L. M.",2014,,,0,
4511,Risk factors for clinically diagnosed Alzheimer's disease: A case-control study of a Greek population,"Many efforts have been made to trace the causes of Alzheimer's disease (AD). There are, however, many points of controversy among reports from the same country as well as among reports from different countries. The current study is a case-control study to determine the risk factors in the development of AD in Greece. Sixty-five patients with AD and 69 age-matched controls were examined. All patients with AD fulfilled the DSM-IV criteria for AD and NINCDS-ADRDA criteria for probable AD. Demographic characteristics such as gender, current marital status, who he/she is living with, education, main place of residence in childhood, adulthood, and late life, occupational hazards, patient's medical history (history of diabetes mellitus and hypertension), life habits like alcohol consumption and smoking, and a history of head trauma, heart attack, stroke, parkinsonism, or depression were collected from the subject or from an informant. A family history of selected diseases (hypertension, diabetes mellitus, dementia, Parkinson's disease, Down's syndrome, stroke) was also elicited. Ages of father and mother at birth were also recorded. Chi-square test, Kruskal-Wallis analysis of variance, cluster analysis, and logistic regression analysis were used for statistical analysis. The results (chi-square test) showed a statistically significant difference between patient; with dementia of the Alzheimer type and controls as far as marital status (p = .04), the subject's history of major depressive episode (p = .02), and family history of dementia (p = .002) were concerned. Logistic regression analysis results produced a complex model of family aggregation of dementia, with patients with a history of depression and family history of dementia having an up to seven times higher risk of developing AD. These findings, especially a family history of dementia, are consistent with most of the literature.",academic achievement;aged;alcohol consumption;Alzheimer disease;anamnesis;article;case control study;cluster analysis;controlled study;dementia;demography;depression;diabetes mellitus;Down syndrome;family history;female;gender;Greece;head injury;heart infarction;high risk population;household;human;hypertension;major clinical study;male;marriage;parental age;parkinsonism;regression analysis;risk factor;smoking habit;social environment;statistical analysis;cerebrovascular accident,"Tsolaki, M.;Fountoulakis, K.;Chantzi, E.;Kazis, A.",1997,,,0,
4512,"Nimodipine vs Dihydroergocristine in the Treatment of Old Age Dementias. Blind, Randomized, Cross-over, Placebo-controlled Study CONFERENCE ABSTRACT","The major neutopathological finding in Alzheimer's disease is the death of cholinergic cell bodies originating in the nucleus basalis of Meynert. A pharmacological strategy designed to slow the rate of cholinergic neuronal death should be of palliative value in the progression of the majority of cases of AD. Nimodipine, a dihydropyridine, a calcium antagonist, has been reported to have beneficial effects in the treatment of old age dementias, in acute ischemic infarction, and organic brain syndromes. This agent is capable of enhancing cholinergic tone, neurofilament/microtubular stabilization and regional perfusion rates1. Ergot derivatives can interact with all monoamine systems, by binding the specific receptors for noradrenaline, dopamine and serotonine2. Moreover the role of dopamine receptor stimulation has been stressed in the evaluation of ergot derivatives active on aging brain symptoms3. One of the most important is the well-known hydrogenated ergot alkaloid, dihydroergocristine (DEC) employed in the management of aging brain, characterized by diminished sensitivity to exogenous stimuli or decreased sleep, motor activity, mental alertness, and memory performance (so called organic brain syndrome). It is provided with an a1-antagonist activity, while it stimulates the dopaminergic receptors, according to several in vitro and in vivo experimental studies4 5. In a placebo- controlled, double blind, randomized clinical study in 99 elderly patients with cognitive decline, nimodipine and dihydroegocristine were found to be therapeutically effective agents in the treatment of old age dementias. DSM-IV and NINCD-ADRDA criteria were used for the diagnosis of Alzheimer's Disease. DSM-IV criteria were used for the diagnosis of vascular dementia. Hachinski score was used for the differential diagnosis between Azheimer's Disease and Vascular dementia. MMSE, CAMCOG and FRSSD were used in the assessment before and after treatment. GDS and Hamilton scales were used to exclude patients with depression. CT scan was performed in all patients. Treatment with 45mg of nimodipine administered orally in divided doses, and 6 mg of dihydroergocristine for three months in 32 patients with Alzheimer's Disease, in 35 patients with vascular dementia and 32 patients with Age Associated Memory Impairment Placebo was administered in the same patients for the same duration either before or after treatment with nimodipine or dihydroergocristine. Wilcoxon matched pairs test was used for statistical analysis. Both agents prevented further significant decline in patients with Alzheimer's Disease and Vascular Dementia and were significant superior to an inactive placebo. Both agents improved significantly patients with Age Associated Memory Impairment. Reference: 1 Tollefson GD. Short term effects on the calcium channel blocker nimodipine in the management of primary degenerative dementia. Biol Psychiatry 1990;27:1133. 2 Goldstein M., Lew JY, Hata F., Lieberman A. Binding interactions of ergot alkaloids with monoaminergic receptors in the brain. Gerontology 1978; (Suppl 1); 24:76 3 Suchy IH. Clinical effects of dopamine agonists in elderly patents. In calne DB et al (Eds) LIsuride and other Dopamine Agonists. Raven Press, New York 1983;529 4 Lucchelli A., Zonta F, Grana E, Turba C, Pagella P. Dualism in the alpha-adrenoreceptor blocking action of dihydroergocristine. Pharmacol. Res. Comm 1981;13:23 5 Morpurgo C., Faini D, Falcone A. Effects of phentolamine, dihydroergocristine and isoxuprine on the blood pressure and heart rate in normotensive, hypotensive and hypertensive rats. Naunyn Schmiedeberg's. Arch Pharmacol 1975;290:335",Hs-handsrch: sr-sympt,"Tsolaki, M.;Kazis, A.",1995,,,0,4513
4513,"Nimodipine vs Dihydroergocristine in the Treatment of Old Age Dementias. Blind, Randomized, Cross-over, Placebo-controlled Study CONFERENCE ABSTRACT","The major neutopathological finding in Alzheimer's disease is the death of cholinergic cell bodies originating in the nucleus basalis of Meynert. A pharmacological strategy designed to slow the rate of cholinergic neuronal death should be of palliative value in the progression of the majority of cases of AD. Nimodipine, a dihydropyridine, a calcium antagonist, has been reported to have beneficial effects in the treatment of old age dementias, in acute ischemic infarction, and organic brain syndromes. This agent is capable of enhancing cholinergic tone, neurofilament/microtubular stabilization and regional perfusion rates1. Ergot derivatives can interact with all monoamine systems, by binding the specific receptors for noradrenaline, dopamine and serotonine2. Moreover the role of dopamine receptor stimulation has been stressed in the evaluation of ergot derivatives active on aging brain symptoms3. One of the most important is the well-known hydrogenated ergot alkaloid, dihydroergocristine (DEC) employed in the management of aging brain, characterized by diminished sensitivity to exogenous stimuli or decreased sleep, motor activity, mental alertness, and memory performance (so called organic brain syndrome). It is provided with an a1-antagonist activity, while it stimulates the dopaminergic receptors, according to several in vitro and in vivo experimental studies4 5. In a placebo- controlled, double blind, randomized clinical study in 99 elderly patients with cognitive decline, nimodipine and dihydroegocristine were found to be therapeutically effective agents in the treatment of old age dementias. DSM-IV and NINCD-ADRDA criteria were used for the diagnosis of Alzheimer's Disease. DSM-IV criteria were used for the diagnosis of vascular dementia. Hachinski score was used for the differential diagnosis between Azheimer's Disease and Vascular dementia. MMSE, CAMCOG and FRSSD were used in the assessment before and after treatment. GDS and Hamilton scales were used to exclude patients with depression. CT scan was performed in all patients. Treatment with 45mg of nimodipine administered orally in divided doses, and 6 mg of dihydroergocristine for three months in 32 patients with Alzheimer's Disease, in 35 patients with vascular dementia and 32 patients with Age Associated Memory Impairment Placebo was administered in the same patients for the same duration either before or after treatment with nimodipine or dihydroergocristine. Wilcoxon matched pairs test was used for statistical analysis. Both agents prevented further significant decline in patients with Alzheimer's Disease and Vascular Dementia and were significant superior to an inactive placebo. Both agents improved significantly patients with Age Associated Memory Impairment. Reference: 1 Tollefson GD. Short term effects on the calcium channel blocker nimodipine in the management of primary degenerative dementia. Biol Psychiatry 1990;27:1133. 2 Goldstein M., Lew JY, Hata F., Lieberman A. Binding interactions of ergot alkaloids with monoaminergic receptors in the brain. Gerontology 1978; (Suppl 1); 24:76 3 Suchy IH. Clinical effects of dopamine agonists in elderly patents. In calne DB et al (Eds) LIsuride and other Dopamine Agonists. Raven Press, New York 1983;529 4 Lucchelli A., Zonta F, Grana E, Turba C, Pagella P. Dualism in the alpha-adrenoreceptor blocking action of dihydroergocristine. Pharmacol. Res. Comm 1981;13:23 5 Morpurgo C., Faini D, Falcone A. Effects of phentolamine, dihydroergocristine and isoxuprine on the blood pressure and heart rate in normotensive, hypotensive and hypertensive rats. Naunyn Schmiedeberg's. Arch Pharmacol 1975;290:335",Hs-handsrch: sr-sympt,"Tsolaki, M;Kazis, A",1995,,,0,
4514,Ramelteon for the treatment of delirium in elderly patients: A consecutive case series study,"Objective: Melatonin is effective in the prevention and treatment of delirium. Ramelteon has few adverse effects and higher affinity for MT1 and MT2 receptors than melatonin. The aim of the present study was to determine the efficacy of ramelteon in elderly patients with delirium caused by different primary diseases/conditions. Method: We treated 10 consecutive elderly patients having delirium with ramelteon. Results: Of the 10 patients, six showed improvement, and no marked adverse effects were observed. Conclusions: Our study suggested that ramelteon was a safe and useful alternative to melatonin for the treatment of delirium in elderly patients. Randomized, controlled studies are necessary to confirm the therapeutic benefits of ramelteon. © 2014, Baywood Publishing Co., Inc.",melatonin;mianserin;perospirone;quetiapine;ramelteon;risperidone;trazodone;absence of side effects;aged;article;brain metastasis;bronchitis;cerebrovascular disease;circadian rhythm;clinical article;delirium;dementia;disease severity;drug efficacy;female;geriatric patient;gerontopsychiatry;heart failure;human;insomnia;kidney failure;lung cancer;male;pneumonia;postoperative delirium;very elderly,"Tsuda, A.;Nishimura, K.;Naganawa, E.;Otsubo, T.;Ishigooka, J.",2014,,,0,
4515,"Non-communicable disease epidemic: epidemiology in action (EuroEpi 2013 and NordicEpi 2013): Aarhus, Denmark from 11 August to 14 August 2013",,11beta hydroxysteroid dehydrogenase 2;anti human immunodeficiency virus agent;BCG vaccine;C reactive protein;caffeine;clozapine;corticosteroid;diazepam;diphtheria pertussis tetanus vaccine;endothelial nitric oxide synthase;enterolactone;fibrinogen;hemoglobin A1c;hydrocortisone;hydroxymethylglutaryl coenzyme A reductase inhibitor;immunoglobulin G antibody;maternal antibody;neuronal nitric oxide synthase;nonsteroid antiinflammatory agent;paracetamol;prostaglandin synthase inhibitor;serotonin uptake inhibitor;tamoxifen;temazepam;tissue antigen;tricyclic antidepressant agent;unindexed drug;virus antibody;vitamin D;zopiclone;2009 H1N1 influenza;abortion;absence;absenteeism;academic achievement;accidental death;acquired immune deficiency syndrome;acute heart failure;acute heart infarction;acute kidney failure;acute liver failure;acute lymphoblastic leukemia;adipose tissue;adolescence;adolescent behavior;adolescent disease;adolescent health;adolescent pregnancy;adulthood;adverse outcome;African;air pollution;air quality;air temperature;Albanian (people);alcohol consumption;alcohol intoxication;allele;allergy;allostatic load;alternative medicine;Alzheimer disease;ambient air;ambulance transportation;anorectal malformation;anorexia;antibiotic therapy;antibody blood level;anticoagulant therapy;antihypertensive therapy;anxiety disorder;arterial stiffness;artery thrombosis;article;assessment of humans;asthma;atherosclerosis;atopic dermatitis;attributable risk;Australian Aborigine;autism;automutilation;awareness;axillary lymph node;bacterial load;Bangladeshi;bariatric surgery;Barrett esophagus;BCG vaccination;behavior disorder;benign childhood epilepsy;bereavement;billing and claims;binge drinking;biomechanics;bipolar disorder;birth rate;birth weight;blood pressure;body composition;body fat;body fat distribution;body height;body mass;body size;body weight;Bosnia and Herzegovina;Braden Scale;brain hemorrhage;brain ischemia;Brazil;Brazilian;breast cancer;breast feeding;bronchitis;burn;caloric intake;cancer chemotherapy;cancer diagnosis;cancer epidemiology;cancer incidence;cancer localization;cancer mortality;cancer patient;cancer prevention;cancer prognosis;cancer radiotherapy;cancer recurrence;cancer risk;cancer screening;cancer staging;cancer surgery;cancer survival;cancer survivor;cancer susceptibility;cancer therapy;carbohydrate intake;cardiac patient;cardiometabolic risk;cardiovascular disease;cardiovascular mortality;cardiovascular risk;cardiovascular system;caregiver;carpal tunnel syndrome;Caucasian;cause of death;celiac disease;cellular immunity;central nervous system tumor;cerebral palsy;cerebrovascular accident;cesarean section;child death;child health;child parent relation;child welfare;childbirth;childhood;childhood cancer;childhood disease;childhood injury;childhood leukemia;childhood obesity;cholestatic hepatitis;cholesterol blood level;chronic disease;chronic fatigue syndrome;chronic inflammation;chronic kidney disease;chronic liver disease;chronic obstructive lung disease;chronic stress;chronology;clinical assessment tool;clinical decision making;clinical effectiveness;clinical examination;clinical protocol;clinical research;cognition;cohabitation;cold;colic;colon cancer;colorectal cancer;comorbidity;computer assisted tomography;conduct disorder;congenital diaphragm hernia;congenital heart disease;congenital heart malformation;congenital malformation;consumer;coping behavior;cost effectiveness analysis;Crimean Congo hemorrhagic fever;cubital tunnel syndrome;cutaneous melanoma;cytokine release;cytopathology;daily life activity;daughter;death certificate;decubitus;delivery;dementia;demography;dengue;Denmark;dental caries;dental fluorosis;dental health;depression;developmental disorder;diabetes mellitus;diarrhea;diet supplementation;diet therapy;dietary fiber;dietary intake;dietary recall assessment tool;diphtheria;disability;disease association;disease course;disease exacerbation;disease marker;disease severity;disease surveillance;distress syndrome;diverticulosis;drinking behavior;drug classification;drug efficacy;drug metabolism;drug safety;drug surveillance program;drug transport;drug use;drug utilization;eating disorder;economic aspect;ectopic pregnancy;education;educational status;Egypt;electronic medical record;embryo disposition;emergency ward;emphysema;encephalomyelitis;endocrine tumor;endometrium carcinoma;enteric virus;environmental exposure;environmental factor;environmental temperature;epidemic;epidemiology;ethnicity;evaluation study;exhaust gas;extrapulmonary tuberculosis;family;family history;family planning;family violence;fast food;fat free mass;fat intake;fat mass;fatality;feedback system;feeding behavior;female fertility;female genital mutilation;fertilization in vitro;fetus death;fetus growth;fetus mortality;fetus wastage;fever;fibrinogen blood level;Finland;first degree relative;first trimester pregnancy;fish meat;follow up;food;food intake;food poisoning;food preference;food security;food selectivity;forced expiratory volume;France;fruit;fruit juice;gender;gene interaction;gene locus;General Health Questionnaire;general practice;genetic association;genetic epidemiology;genetic polymorphism;genetic predisposition;genetic variability;genotype;genotype environment interaction;geographic distribution;geriatric patient;germ cell tumor;Germany;gestational age;Giardia intestinalis;giardiasis;Gilles de la Tourette syndrome;glucose blood level;glucose tolerance;groups by age;Guinea-Bissau;pollen allergy;head circumference;health behavior;health care access;health care management;health care planning;health care policy;health care quality;health care system;health care utilization;health disparity;health program;health status;health survey;hearing;hearing impairment;atrial fibrillation;heart contraction;heart failure;heart infarction;heart rate variability;heart rehabilitation;heart transplantation;heatwave;Helicobacter infection;hematologic malignancy;hemoglobin blood level;hemorrhoid;hepatitis A;hepatitis B;hepatitis C;Hepatitis C virus;Hepatitis E virus;hereditary nonpolyposis colorectal cancer;heredity;Herpes simplex virus 1;herpes zoster;high risk population;highly active antiretroviral therapy;hip fracture;HIV test;Hodgkin disease;home accident;honey;hormone blood level;hospital admission;hospital care;hospitalization;household;human;Human immunodeficiency virus infected patient;Human immunodeficiency virus infection;hyperactivity;hyperkinetic disorder;hypertension;hypospadias;Iceland;immigrant;immune response;income;industrial noise;industrial worker;infertility;infertility therapy;inflammatory bowel disease;injury;insomnia;insulin blood level;insulin resistance;intelligence quotient;intensive care unit;Internet;interpregancy interval;intestine flora;intestine parasite;intoxication;intracytoplasmic sperm injection;intravenous drug abuse;ischemia;ischemic heart disease;Italy;Japanese (people);job stress;Kazakhstan;kidney function;kinesiotherapy;larynx cancer;latitude;lean body weight;leisure;Lennox Gastaut syndrome;leukemia;life;lifestyle;lipoprotein blood level;liver cell carcinoma;liver cirrhosis;liver fibrosis;liver transplantation;long term care;long term survival;low back pain;low birth weight;low risk population;lung cancer;lung development;lung function;lymphoma;Madagascar;malignant neoplastic disease;Malmo diet;market;marketing;marriage;maternal age;maternal diabetes mellitus;maternal disease;maternal hypertension;maternal mortality;maternal obesity;maternal serum;maternal smoking;measles;measles vaccination;medical care;medical history;medical information;medical leave;medical school;medical specialist;medical student;medication compliance;melanoma;melanoma skin cancer;menarche;menstrual cycle;mental deterioration;mental disease;mental health;mental patient;mesothelioma;metabolic syndrome X;microcephaly;midwife;migrant;mobilization;modifiable risk factor;mother;motor development;multiple sclerosis;mumps;musculoskeletal disease;musculoskeletal pain;Muslim;myeloid leukemia;myeloma;Namibia;needlestick injury;neighborhood;neonatal hyperbilirubinemia;nerve conduction;neural tube defect;newborn mortality;nicotine replacement therapy;noise;non communicable disease;non insulin dependent diabetes mellitus;nonalcoholic fatty liver;nonhodgkin lymphoma;North African;Norwegian (people);nursery;nutrition;nutritional assessment;nutritional status;obesity;obsessive compulsive disorder;obstetrician;occupation and occupation related phenomena;occupational accident;occupational exposure;occupational hazard;occupational prestige;offender;onset age;organ donor;ovary cancer;overeducation;Pakistani;Papanicolaou test;parent;parental age;parental attitude;parental deprivation;Parkinson disease;patient care;patient compliance;patient counseling;patient information;patient participation;patient satisfaction;pedigree;pedometer;peer group;pension;percutaneous coronary intervention;perinatal care;peritoneal dialysis;personality;pertussis;pet animal;pharmacoepidemiology;physical activity;physical inactivity;physician;physiological process;placenta weight;pneumonia;policy;poliomyelitis;polypharmacy;Portugal;postmenopause;postnatal stress;prediction;predictive value;preeclampsia;pregnancy;pregnancy outcome;premature labor;premature mortality;premenopause;prenatal care;prenatal drug exposure;prenatal exposure;prenatal period;prenatal stress;prescription;primary health care;primary medical care;primary prevention;primary tumor;productivity;progeny;prostate cancer;protection;protein blood level;protein intake;protein polymorphism;psoriasis;psychiatric department;psychodynamics;psychological aspect;psychological well being;psychophysiology;psychosomatic disorder;puberty;public health problem;publication;puerperal depression;puerperium;quality of life;radiation exposure;rapid response team;reading;recreation;recurrence risk;recurrent disease;religion;reproduction;reproductive health;respiratory tract disease;retirement;return to work;reward;rheumatoid arthritis;risk assessment;risk factor;rubella;rural area;rural population;Russian Federation;saliva level;salt intake;sandstorm;sanitation;sarcoidosis;schizophrenia;school;scientist;screening test;season;second trimester pregnancy;Serbia;seroprevalence;sex difference;sexual behavior;sexual intercourse;shoulder impingement syndrome;sibling;single nucleotide polymorphism;skin disease;sleep disordered breathing;sleep pattern;small for date infant;smoking;smoking cessation;social class;social interaction;social norm;social status;social support;socioeconomic inequality;socioeconomics;sodium excretion;soft drink;soft tissue sarcoma;solutio placentae;South Africa;South American;Spain;speech;sperm;spontaneous abortion;sport;spouse;standardization;standing;stillbirth;stomach cancer;Strengths and Difficulties Questionnaire;stress;student;substance abuse;suicidal ideation;suicide;suicide attempt;summer;surgical patient;Sweden;systemic lupus erythematosus;Tanzania;telephone interview;television viewing;temperature related phenomena;testis cancer;tetanus;thalassemia;thorax pain;thorax surgery;thyroid cancer;thyroid disease;time series analysis;time to pregnancy;tobacco;tonsil cancer;topical treatment;total knee replacement;toxoplasmosis;traffic and transport;triacylglycerol blood level;tuberculosis;tumor associated leukocyte;Turk (people);twins;undergraduate student;underweight;United Kingdom;urban area;uric acid blood level;urinalysis;urine incontinence;uterine cervix cancer;uterine cervix carcinoma;uterine cervix small cell neuroendocrine carcinoma;uterus cancer;vaccination;vacuum extraction;vaginitis;vagus reflex;varicosis;vegetable;vegetarian diet;vein thrombosis;venous thromboembolism;veterinary clinic;viral clearance;vitamin blood level;volcano;waist circumference;weather;Wegener granulomatosis;weight change;weight gain;weight reduction;welfare;wild boar;work capacity;work disability;work environment;zoonosis,"Tsukinoki, R.;Murakami, Y.",2013,,,0,
4516,Early prediction of gait ability in patients with hip fracture,"OBJECTIVE: Many elderly patients with hip fracture (HF) present with gait deficits. As such, an HF both indirectly and directly increases the number of elderly people requiring care, making it a major medical and economic problem in an aging society. To facilitate the treatment of HF and attempt to resolve the consequences, we have attempted to derive an equation that would predict gait ability. The prediction equation was developed by multivariate analysis using standard evaluation methods, with inclusion of guaranteed objectivity where possible. We attached greater importance to the prediction of gait ability early in the period of hospitalization, since this allows for early determination of an efficient therapeutic strategy. METHODS: The subjects were 54 HF patients (six men, 48 women; mean age: 78.0 +/- 8.4 years) admitted to general hospitals in Hirosaki, Aomori prefecture, between 1998 and 2007. All were aged 60 years or older and were able to walk immediately before injury; physical therapy was initiated for all individuals during hospitalization. Evaluation items related to physical function, psychological function, and complications that may affect gait were evaluated; these included the manual muscle test, motor age test, Katz's index, dementia (HDS-R), consciousness disturbance, among others. RESULTS: Based on data for 35 patients who could gait at discharge and 19 patients who could not, a model including MAT, HDS-R, and the New York Heart Association classification of cardiac function scores (P < 0.001) was obtained using multiple logistic regression analysis (discriminant hitting ratio: 94.4%). CONCLUSIONS: The effectiveness of the derived model suggests that both physical and psychological functions should be considered for gait prediction.",,"Tsushima, E.;Hada, R.;Iwata, M.;Tsushima, H.",2009,May,10.1007/s12199-009-0079-8,0,
4517,"Paclitaxel, cisplatin and methotrexate combination chemotherapy is active in the treatment of refractory urothelial malignancies","Purpose: We investigated the activity of combination chemotherapy consisting of paclitaxel, cisplatin and methotrexate in patients with advanced urothelial cancers. Materials and Methods: A total of 25 consecutive patients with metastatic refractory urothelial malignancies was treated with a combination of 200 mg./m.2 paclitaxel, 30 mg./m.2 methotrexate and 70 mg./m.2 cisplatin in a pilot study. Results: There were no complete responses. Of 25 patients 10 (40%), including 3 of 7 with liver metastases, bad a partial response. Hematological and nonhematological toxicity was tolerable. Conclusions: The combination chemotherapeutic regimen of paclitaxel, cisplatin and methotrexate is active in patients with advanced urothelial cancer and warrants further study.",cisplatin;methotrexate;paclitaxel;adult;advanced cancer;aged;alopecia;anemia;article;cancer combination chemotherapy;clinical article;clinical trial;dementia;diarrhea;drug induced disease;drug response;female;heart infarction;human;male;metastasis;nephrotoxicity;neutropenia;priority journal;sensory neuropathy;thrombocytopenia;urogenital tract cancer,"Tu, S. M.;Hossan, E.;Amato, R.;Kilbourn, R.;Logothetis, C. J.",1995,,,0,
4518,Geriatric Suicide Attempt and Risk of Subsequent Dementia: A Nationwide Longitudinal Follow-up Study in Taiwan,"Objective It was unclear whether older people without dementia who attempted suicide were at increased risk of subsequently developing dementia. Methods Using the Taiwan National Health Insurance Research Database, 1,189 patients aged ≥ 65 years who attempted suicide and 4,756 age- and sex-matched control subjects were enrolled in our study and followed to the end of 2011. Those who developed dementia during the follow-up were identified. Results Cox regression analysis, after adjusting for demographic data and medical comorbidities, found that geriatric suicide attempt was associated with an increased risk of subsequent dementia (HR: 7.40; 95% CI: 6.11–8.97; Wald χ2 = 414.87, df = 1, p < 0.001). Both patients aged between 65 and 79 years (HR: 7.74; 95% CI: 6.17–9.71; Wald χ2 = 312.62, df = 1, p < 0.001) and patients aged ≥ 80 years (HR: 6.94; 95% CI: 4.73–10.17; Wald χ2 = 97.78, df = 1, p < 0.001) who attempted suicide had an increased risk of developing dementia in later life. Conclusion The elderly who attempted suicide were prone to developing dementia in later life, independent of depression and medical comorbidities. Further studies are necessary to clarify the underlying mechanisms between geriatric suicide and dementia and whether the prompt intervention for geriatric suicide may reduce this risk.",aged;alcoholism;article;cerebrovascular disease;chronic respiratory tract disease;comorbidity;comparative study;controlled study;dementia;depression;diabetes mellitus;disease course;dyslipidemia;female;follow up;geriatric disorder;head injury;health program;human;hypertension;ICD-9-CM;ischemic heart disease;kidney disease;longitudinal study;major clinical study;male;national health insurance;risk factor;suicide attempt;Taiwan,"Tu, Y. A.;Chen, M. H.;Tsai, C. F.;Su, T. P.;Bai, Y. M.;Li, C. T.;Lin, W. C.;Liu, M. E.;Pan, T. L.;Chen, T. J.;Tsai, S. J.",2016,,10.1016/j.jagp.2016.08.016,0,
4519,Editorial,,adenosine;adenosine A1 receptor;adenosine A2 receptor agonist;adenosine A2a receptor;adenosine A2a receptor agonist;adenosine A2a receptor antagonist;adenosine A2b receptor;adenosine A3 receptor;adenosine A3 receptor agonist;adenylate cyclase;cyclic AMP;G protein coupled receptor;inhibitory guanine nucleotide binding protein;regadenoson;unclassified drug;Alzheimer disease;article;atherosclerosis;cardiovascular disease;depression;drug indication;epilepsy;heart protection;human;hypertension;ischemic heart disease;Parkinson disease;cvt 3146;lexiscan,"Tuccinardi, T.;Martinelli, A.",2010,,,0,
4520,Keeping exercise short and intense: What's involved and is it worth it?,,corticotropin releasing factor;article;cardiorespiratory fitness;cardiovascular mortality;cardiovascular risk;dementia;exercise;fitness;follow up;heart disease;heart failure;human;ischemic heart disease;lifestyle;non insulin dependent diabetes mellitus;obesity;physical activity;practice guideline;resistance training;secondary prevention;United Kingdom;United States,"Tucker, R.",2014,,,0,
4521,Diuretic medication use reduces incident dementia risk: A meta-analysis of prospective studies,"Introduction Numerous observational studies suggest that blood pressure management with antihypertensive drugs may be effective in reducing dementia risk. Objective To quantify dementia risk in relation to diuretic medication use. Methods Electronic databases were searched until June 2015. Eligibility criteria: population, adults without dementia at baseline from primary care, community cohort, residential/institutionalized or randomized controlled trial (RCT); exposure, diuretic medication; comparison, no diuretic medication, other or no antihypertensive medication, placebo-control; outcome, incident dementia in accordance with standardized criteria. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled in fixed-effects models with RevMan 5.3. The overall quality and strength of evidence was rated with GRADE criteria. Results Fifteen articles were eligible comprising a pooled sample of 52,599 persons and 3444 incident dementia cases (median age 76.1 years, 40% male) with a median follow-up of 6.1 years. Diuretic use was associated with 17% reduction in dementia risk (HR 0.83; 95% CI 0.75 to 0.90) and a 21% reduction in Alzheimer's disease risk (HR 0.79; 95% CI 0.68 to 0.93). GRADE was rated as moderate. Risk estimates were consistent comparing monotherapy versus combination therapy, study design and follow-up. Metaregression did not suggest that age, gender, systolic blood pressure, attrition, mortality rate, education, cognitive function, stroke, Apolipoprotein E allele, heart failure or diabetes altered the primary results. Conclusions Diuretic medication was associated with a consistent reduction in dementia and Alzheimer's disease risk and the absence of heterogeneity points to the generalizability of these findings.",drug therapy;dementia;risk;meta analysis;human;prospective study;European;psychiatry;follow up;blood pressure;randomized controlled trial;observational study;community;primary medical care;adult;population;therapy;systolic blood pressure;education;exposure;data base;male;Alzheimer disease;model;confidence interval;hazard ratio;monotherapy;diabetes mellitus;study design;gender;heart failure;mortality;cognition;cerebrovascular accident;allele;diuretic agent;antihypertensive agent;isoprenaline;placebo;apolipoprotein E,"Tully, P.;Hanon, O.;Cosh, S.;Tzourio, C.",2016,,10.1016/j.eurpsy.2016.01.044,0,
4522,Diuretic medication use reduces incident dementia risk: a meta-analysis of prospective studies,"Introduction Numerous observational studies suggest that blood pressure management with antihypertensive drugs may be effective in reducing dementia risk. Objective To quantify dementia risk in relation to diuretic medication use. Methods Electronic databases were searched until June 2015. Eligibility criteria: population, adults without dementia at baseline from primary care, community cohort, residential/institutionalized or randomized controlled trial (RCT); exposure, diuretic medication; comparison, no diuretic medication, other or no antihypertensive medication, placebo-control; outcome, incident dementia in accordance with standardized criteria. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled in fixed-effects models with RevMan 5.3. The overall quality and strength of evidence was rated with GRADE criteria. Results Fifteen articles were eligible comprising a pooled sample of 52,599 persons and 3444 incident dementia cases (median age 76.1 years, 40% male) with a median follow-up of 6.1 years. Diuretic use was associated with 17% reduction in dementia risk (HR 0.83; 95% CI 0.75 to 0.90) and a 21% reduction in Alzheimer's disease risk (HR 0.79; 95% CI 0.68 to 0.93). GRADE was rated as moderate. Risk estimates were consistent comparing monotherapy versus combination therapy, study design and follow-up. Metaregression did not suggest that age, gender, systolic blood pressure, attrition, mortality rate, education, cognitive function, stroke, Apolipoprotein E allele, heart failure or diabetes altered the primary results. Conclusions Diuretic medication was associated with a consistent reduction in dementia and Alzheimer's disease risk and the absence of heterogeneity points to the generalizability of these findings.",drug therapy;dementia;risk;meta analysis;human;prospective study;European;psychiatry;follow up;blood pressure;randomized controlled trial;observational study;community;primary medical care;adult;population;therapy;systolic blood pressure;education;exposure;data base;male;Alzheimer disease;model;confidence interval;hazard ratio;monotherapy;diabetes mellitus;study design;gender;heart failure;mortality;cognition;cerebrovascular accident;allele;diuretic agent;antihypertensive agent;isoprenaline;placebo;apolipoprotein E,"Tully, P;Hanon, O;Cosh, S;Tzourio, C",2016,,10.1016/j.eurpsy.2016.01.044,0,4521
4523,"Diuretic antihypertensive drugs and incident dementia risk: a systematic review, meta-analysis and meta-regression of prospective studies","OBJECTIVE: Diuretic drugs have been a mainstay of hypertension treatment in the elderly however their dementia sparing effects are under-reported. The objective was to quantify dementia risk in relation to diuretic antihypertensive drugs. METHODS: Electronic databases were searched until June 2015. ELIGIBILITY CRITERIA: population, adults without dementia from primary care, community cohort, residential/institutionalized, or randomized controlled trial; exposure, diuretic antihypertensive drug; comparison, no diuretic drug, other or no antihypertensive drug, placebo-control; outcome, incident dementia diagnosed by standardized criteria. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled in fixed-effects models with RevMan 5.3 (The Nordic Cochrane Centre, Copenhagen, Denmark) and the findings rated according to The Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS: A total of 15 articles were included (52 599 persons, 3444 dementia cases, median age 76.1 years) and median follow-up was 6.1 years. Diuretics were associated with reduced dementia risk (HR 0.83; 95% CI 0.76-0.91, P < 0.0001, I = 0) and Alzheimer's disease risk (HR 0.82; 95% CI 0.71-0.94, P = 0.004, I = 0). Stratified analysis indicated a difference between potassium sparing, thiazide and loop diuretics (P = 0.01). Risk estimates were generally consistent comparing monotherapy vs. combination therapy, study design and follow-up. Meta-regression showed that demographics, stroke, heart failure, diabetes, liver disease, attrition, mortality rate, cognitive function, and apolipoprotein E allele did not moderate the results. CONCLUSION: Diuretic antihypertensive drugs were associated with a consistent reduction in dementia risk without heterogeneity, pointing to generalizability of these findings. REGISTRATION: PROSPERO [CRD42015023428].",,"Tully, P. J.;Hanon, O.;Cosh, S.;Tzourio, C.",2016,Jun,10.1097/hjh.0000000000000868,0,
4524,Treatment of hypertension in an elderly outpatient population in the Netherlands,"BACKGROUND: The treatment of older patients with hypertension has been controversial-in addition to uncertainty regarding appropriate blood pressure (BP) targets in the very old, there are concerns that excessive BP lowering could result in adverse events such as falls, stroke, and cognitive problems. The Hypertension in the Very Elderly Trial (HYVET), however, found that lowering BP in patients aged > or =80 years was associated with decreased morbidity and mortality. OBJECTIVE: This study compared the findings of HYVET with data from a population of elderly outpatients with hypertension in a clinical practice setting. METHODS: This was a retrospective study of prospectively collected data from patients aged > or =80 years with a history of hypertension who visited a geriatric diagnostic day clinic in the Netherlands in 2004. The data were analyzed to determine how many patients were being prescribed antihypertensive medication, how many would have been eligible for HYVET, how many achieved adequate BP control, and whether reaching BP goals was associated with the number and type of antihypertensive medications received or with eligibility for HYVET. RESULTS: During 2004, 518 patients aged > or =80 years visited the geriatric diagnostic day clinic, of whom 147 met the criteria for inclusion in this study. One hundred forty-one patients (95.9%) were receiving antihypertensive medication, although only 52 (35.4%) would have been eligible for HYVET. Dementia, which was an exclusion criterion in HYVET, was the major reason for ineligibility (70 [47.6%]). Greater proportions of patients in this study had comorbidities compared with the HYVET population (stroke: 22.4% vs 6.7%, respectively; myocardial infarction: 7.5% vs 3.1%; heart failure: 11.6% vs 2.9%; diabetes mellitus: 21.1% vs 6.8%). At the time of the clinic visit, 50.3% of patients had adequate BP control, as defined in HYVET (systolic BP <150 mm Hg and diastolic BP <80 mm Hg). Levels of BP control were similar in patients who would and would not have been ineligible for HYVET. Only the mean (SD) number of antihypertensive medications received was significantly associated with the achievement of BP control compared with failure to achieve adequate BP control (2.2 [1.0] vs 1.8 [1.1], respectively; P < 0.05). CONCLUSIONS: Based on the findings of this study, the benefits of treating elderly patients with hypertension in clinical practice may be lower than those reported by HYVET. The study results support the current recommendation that all patients with hypertension should be treated with >1 antihypertensive medication if adequate control is not achieved at low doses of a single medication.","Age Factors;Aged, 80 and over;Antihypertensive Agents/*adverse effects/*therapeutic use;Blood Pressure/drug effects/physiology;Comorbidity;Creatinine/blood;Female;Humans;Hypertension/complications/*drug therapy/epidemiology;Male;Netherlands/epidemiology;Outpatients;Sex Factors","Tulner, L. R.;Kuper, I. M.;van Campen, J. P.;Koks, C. H.;Mac Gillavry, M. R.;Beijnen, J. H.;Brandjes, D. P.",2009,Aug,10.1016/j.amjopharm.2009.08.002,0,
4525,Changes in under-treatment after comprehensive geriatric assessment: An observational study,"Background: Under-treatment is frequently present in geriatric patients. Because this patient group often suffer from multiple diseases, polypharmacy (defined as the concomitant chronic use of five or more drugs) and contraindications to indicated drugs may also frequently be present. Objective: To describe the prevalence of under-treatment with respect to frequently indicated medications before and after comprehensive geriatric assessment (CGA) and the prevalence of contraindications to thesemedications. Patients and Methods: The geriatric outpatients evaluated in this study had previously been included in a prospective descriptive study conducted in 2004. Demographic data, medical history, co-morbidity and medication use and changes were documented. The absence of drugs indicated for frequently under-treated conditions before and after CGA was compared. Undertreatment was defined as omission of drug therapy indicated for the treatment or prevention of 13 established diseases or conditions known to be frequently under-treated. Co-morbid conditions were independently classified by two geriatricians, who determined whether or not a condition represented a contraindication to use of these drugs. Results: In 2004, 807 geriatric outpatients were referred for CGA. Of these, 548 patients had at least one of the 13 selected diseases or conditions. Thirtytwo of these patients were excluded from the analysis, leaving 516 patients. Before CGA, 170 of these patients were under-treated (32.9%); after CGA, 115 patients (22.3%) were under-treated. Contraindications were present in 102 of the patients (19.8%) and were more frequent in under-treated patients. After CGA, mean drug use and the prevalence of polypharmacy increased. Although 393 drugs were discontinued after CGA, the overall number of drugs used increased from 3177 before CGA to 3424 after CGA. Five times more drugs were initiated for a new diagnosis than for correction of under-treatment. Conclusions: Under-treatment is significantly reduced after CGA. Patients with contraindications to indicated medicines are more frequently undertreated. CGA leads to an increase in polypharmacy, mainly because of new conditions being diagnosed and despite frequent discontinuation of medications. © 2010 Adis Data Information BV. All rights reserved.",antihypertensive agent;beta adrenergic receptor blocking agent;bisphosphonic acid derivative;dipeptidyl carboxypeptidase inhibitor;aged;alcohol abuse;anemia;article;bleeding;bradycardia;brain hemorrhage;chronic obstructive lung disease;comorbidity;controlled study;dementia;demography;descriptive research;drug contraindication;drug indication;falling;female;geriatric assessment;geriatric care;heart failure;heart infarction;human;hypertension;hypotension;kidney failure;major clinical study;male;medical documentation;observational study;osteoporosis;outpatient;polypharmacy;priority journal;prospective study;subdural hematoma;undertreatment,"Tulner, L. R.;Van Campen, J. P. C. M.;Frankfort, S. V.;Koks, C. H. W.;Beijnen, J. H.;Brandjes, D. P. M.;Jansen, P. A. F.",2010,,,0,
4526,"Effects of habitual coffee consumption on cardiometabolic disease, cardiovascular health, and all-cause mortality: O'Keefe JH, Bhatti SK, Patil HR. J Am Coll Cardiol 2013;62:1043-51",,caffeine;cholesterol;low density lipoprotein;Alzheimer disease;anxiety;asthma;brain ischemia;cardiometabolic risk;cardiovascular disease;cerebrovascular accident;cholesterol blood level;coffee;congestive heart failure;depression;diastolic blood pressure;drinking behavior;gallstone;heart arrhythmia;atrial fibrillation;heart infarction;heart palpitation;hospitalization;human;hypertension;insomnia;ischemic heart disease;lipid blood level;mortality;non insulin dependent diabetes mellitus;note;osteolysis;Parkinson disease;priority journal;risk factor;risk reduction;symptom;tremor;urine volume,"Tunson, J.",2014,,,0,
4527,Community-acquired hypernatremia in elderly and very elderly patients admitted to the hospital: Clinical characteristics and outcomes,"Background: The clinical features, outcome and cost burden of community-acquired hypernatremia (CAH) in elderly and very elderly patients are not well known. Our aim was to investigate the etiologies, reasons for admission, clinical courses, outcomes, complications, and cost assessments of the elderly patients with CAH. Material/Methods: We conducted a retrospective study in our tertiary hospital. Elderly and very elderly patients evaluated in the emergency department (ED) from January 1, 2010 to December 31, 2010 (n=4960) were included. Totally, 102 patients older than 65 years and diagnosed with CAH were evaluated. The patients were divided into 2 main groups according to their age: elderly (65-74 years old) (group 1) (n=38), and very elderly (>74 years) (group 2) (n=64). Results: Our overall observed prevalence of CAH was 2.0% (n=102, 102/4960). In particular, the prevalences of CAH in group 1 and group 2 were 1.0% (38/3651) and 4.8% (64/1309), respectively (p<0.001). Totally, 62 patients had been treated by renin-angiotensin system (RAS) blockers (ie, ACE-inhibitors). Alzheimer's disease had been diagnosed in 46.1% of the subjects. The mean Katz scores at the time of admission were 2.4±1.9 and 1.1±1.0 in group 1 and 2, respectively (p<0.001). The mean cost was higher in group 2 than in group 1 (2407.13±734.54 USD, and 2141.12±1387.14 USD, respectively) (p<0.01). The need for intensive care was significantly greater in group 2 as compared to group 1. Conclusions: The important determinants of ""CAH"" in elderly subjects are accompanying Alzheimer's disease, oral intake impairment, and concomitant treatment with RAS blockers. © Med Sci Monit, 2012.",dipeptidyl carboxypeptidase inhibitor;aged;Alzheimer disease;article;artificial ventilation;community acquired hypernatremia;comorbidity;cost benefit analysis;diabetes mellitus;disease course;female;heart failure;hospitalization;human;hypernatremia;hypertension;intensive care;Katz index;laboratory test;length of stay;major clinical study;male;mortality;outcome assessment;prevalence;renin angiotensin aldosterone system;retrospective study,"Turgutalp, K.;Özhan, O.;Oǧuz, E. G.;Yilmaz, A.;Horoz, M.;Helvaci, I.;Kiykim, A.",2012,,,0,
4528,(Dis)organization of Palliative Care as a Potential Quality-of-Life Issue in the Senior Population--Croatian Experiences,"This paper analyses the current situation in the Croatian health-care system, with special emphasis on the (dis)organization of palliative care within the public health, more precisely gerontology context. Namely, population world-wide is getting older, that is both a statistical and an everyday-medical fact. Today we consider citizens after the age of 65 as the elderly, with a tendency to move the age-limit to 75 years. Croatia on the matter swiftly follows global trends, while literature points to the fact that an increase in the elderly population dictates the need for an organized system of palliative care and hospice building. Although we cannot ignore the fact that children can become palliative care patients, we can conclude that these are predominantly elderly patients. In fact, approximately half of patients--users of palliative care--have some type of oncological diagnosis; a significant number of patients suffer from dementia, stroke, or heart failure. As for the Primorsko-goranska county and the City of Rijeka, they show similar trend, as can be illustrated with data from the 2011 census, when the share of citizens over 65 years in the population of the Primorsko-goranska county reached 18.91%, and in the population of the City of Rijeka 19.74%. Thus, one of the main quality-of-life issues in the Croatian senior population is the (dis)function of the palliative medicine/care system. Practice, namely, shows that there has still been no implementation. In particular, palliative medicine is not yet recognized as a speciality or sub-speciality, standards and norms for this activity are not set, palliative care is still not included in the system of obligatory health insurance, and as far as the national strategy of health policy for the area of palliative care, Croatian Government at its meeting held on 27th December 2013 finally adopted the ""Strategic Plan for Palliative Care of the Republic of Croatia for the period from 2014 to 2016"". Exactly because we are a decade behind European standards (Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the organization of palliative care), it is more than legitimate to place this subject at the centre of the current Croatian gerontology interest.",Aged;Croatia;Female;Humans;Palliative Care/*organization & administration;Patient Care Planning;Quality of Health Care;*Quality of Life,"Turina, I. S.;Kresina, H. G.;Babic, S. G.;Jankovic, S.;Kresina, S.;Brkljacic, M.",2015,Jun,,0,
4529,Forensic autopsies of geriatric deaths conducted in elazig,"Introduction: The elderly population is rapidly growing throughout the world due to the increased life span of individuals, parallel to advances in the fields of medicine and technology, improvements in socio-economic conditions, and a decreased reproduction rate. The aim of the present study was to get epidemiological data on forensic deaths and autopsy findings in elderly people. Materials and Method: Of 1439 cases that underwent an autopsy in the Department of Forensic Medicine in Elaz›g Firat University Faculty of Medicine in a five-year period between January 2008 and December 2012, 345 cases (23.9%) aged 65 and over were evaluated for age, gender, and place and cause of death. Results: The mean age of the cases was 73.7±7.6 years; 24 (73.6%) were males and 91 (26.4%) were females. Of these deaths, 207 (60.0%) occurred in the city center. Accidents were the most common cause of death, occurring in 181 cases (52.5%), followed by natural causes occurring in 112 (32.5%) cases. Traffic accidents (54.3%) and falls (21.5%) were found to be the most common causes of unnatural death, and myocardial infarction (72.1%) and cerebrovascular diseases (11.5%) was the most common causes of death from natural causes. 63% (80 cases) of traffic accidents were pedestrian accident. Conclusion: In order to reduce mortality in the elderly population, more emphasis must be placed on personal health checks, which should be performed with higher frequency. More stringent safety measures should be taken in order to reduce the risk of accidents, and public awareness should be raised regarding the safety of elderly people.",aged;article;autopsy;cerebrovascular disease;death;epilepsy;falling;female;forensic medicine;heart infarction;heart rupture;homicide;human;male;pneumonia;retrospective study;senility;suicide;traffic accident;Turkey (republic);very elderly,"Turkoglu, A.;Tokdemir, M.;Bork, T.;Tuncez, F. T.",2014,,,0,
4530,A geriatric diabetic clinic reviewed,"One hundred and seventy-three patients attending geriatric diabetic clinics were reviewed. The mean age was 79.2 years and 25% of patients were on insulin treatment, though most had Type 2 diabetes. A high prevalence of large vessel complications such as stroke and ischaemic heart disease was found. Control of diabetes was poor and the reasons for this are discussed. There was minimal evidence of an association of poor control, history of smoking or hypertension with complications.",chlorpropamide;glibenclamide;gliclazide;insulin;sulfonylurea;aged;article;dementia;diabetes mellitus;geriatric disorder;heart failure;home monitoring;human;hypertension;hypoglycemia;ischemic heart disease;major clinical study;neuropathy;outpatient department;proteinuria;smoking;cerebrovascular accident;vascular disease,"Turnbull, C. J.",1991,,,0,
4531,Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis,"Background: Stroke is a leading cause of death and disability; worldwide it is estimated that 16.9 million people have a first stroke each year. Lipid-lowering, anticoagulant, and antihypertensive drugs can prevent strokes, but may be underused. Methods and Findings: We analysed anonymised electronic primary care records from a United Kingdom (UK) primary care database that covers approximately 6% of the UK population. Patients with first-ever stroke/transient ischaemic attack (TIA), ≥18 y, with diagnosis between 1 January 2009 and 31 December 2013, were included. Drugs were considered under-prescribed when lipid-lowering, anticoagulant, or antihypertensive drugs were clinically indicated but were not prescribed prior to the time of stroke or TIA. The proportions of strokes or TIAs with prevention drugs under-prescribed, when clinically indicated, were calculated. In all, 29,043 stroke/TIA patients met the inclusion criteria; 17,680 had ≥1 prevention drug clinically indicated: 16,028 had lipid-lowering drugs indicated, 3,194 anticoagulant drugs, and 7,008 antihypertensive drugs. At least one prevention drug was not prescribed when clinically indicated in 54% (9,579/17,680) of stroke/TIA patients: 49% (7,836/16,028) were not prescribed lipid-lowering drugs, 52% (1,647/3,194) were not prescribed anticoagulant drugs, and 25% (1,740/7,008) were not prescribed antihypertensive drugs. The limitations of our study are that our definition of under-prescribing of drugs for stroke/TIA prevention did not address patients’ adherence to medication or medication targets, such as blood pressure levels. Conclusions: In our study, over half of people eligible for lipid-lowering, anticoagulant, or antihypertensive drugs were not prescribed them prior to first stroke/TIA. We estimate that approximately 12,000 first strokes could potentially be prevented annually in the UK through optimal prescribing of these drugs. Improving prescription of lipid-lowering, anticoagulant, and antihypertensive drugs is important to reduce the incidence and burden of stroke and TIA.",anticoagulant agent;antihypertensive agent;antilipemic agent;adult;aged;article;asthma;atrial fibrillation;body mass;cerebrovascular accident;CHADS2 score;chronic kidney failure;chronic obstructive lung disease;dementia;deprescription;depression;diabetes mellitus;epilepsy;female;Framingham risk score;human;hypercholesterolemia;hypothyroidism;inappropriate prescribing;ischemic heart disease;major clinical study;male;obesity;odds ratio;osteoporosis;peripheral occlusive artery disease;predictive value;psychosis;retrospective study;rheumatoid arthritis;risk factor;smoking;transient ischemic attack;white coat hypertension,"Turner, G. M.;Calvert, M.;Feltham, M. G.;Ryan, R.;Fitzmaurice, D.;Cheng, K. K.;Marshall, T.",2016,,10.1371/journal.pmed.1002169,0,
4532,Epidural blood patch using manometry for sinking skin flap syndrome,"We describe here a 55-year-old male patient with a medical history significant for chronic back pain and substance abuse with cocaine who sustained a traumatic subarachnoid hemorrhage after a fall from a roof while acutely intoxicated on cocaine requiring decompressive hemicraniectomy and cranioplasty that was complicated by an epidural abscess requiring a repeat craniectomy. He was diagnosed with sinking skin flap syndrome consistent with altered mental status and a sunken skin flap with increased midline shift. Despite treatment with Trendelenburg positioning and appropriate fluid management, the patient continued to decline, and an epidural blood patch was requested for treatment. After placement of the epidural blood patch using manometry in the epidural space, the patient's neurologic status improved allowing him to ultimately receive a cranioplasty. The patient is now able to perform several of his activities of daily living and communicate effectively.",adult;article;backache;blood patch;brain hemorrhage;case report;chronic pain;clinical examination;cocaine dependence;compression fracture;coronary artery disease;craniectomy;cranioplasty;daily life activity;epidural abscess;epidural space;falling;general condition deterioration;hospital admission;human;lung injury;male;manometry;medical history;mental deterioration;mental health;middle aged;non ST segment elevation myocardial infarction;pelvis fracture;physiotherapy;postoperative complication;priority journal;rib fracture;sinking skin flap syndrome;subarachnoid hemorrhage;substance abuse;syndrome,"Turner, J. D.;Farmer, J. L.;Dobson, S. W.",2016,,,0,
4533,Drosophila Neprilysins Are Involved in Middle-Term and Long-Term Memory,"Neprilysins are type II metalloproteinases known to degrade and inactivate a number of small peptides. Neprilysins in particular are the major amyloid-beta peptide-degrading enzymes. In mouse models of Alzheimer's disease, neprilysin overexpression improves learning and memory deficits, whereas neprilysin deficiency aggravates the behavioral phenotypes. However, whether these enzymes are involved in memory in nonpathological conditions is an open question. Drosophila melanogaster is a well suited model system with which to address this issue. Several memory phases have been characterized in this organism and the neuronal circuits involved are well described. The fly genome contains five neprilysin-encoding genes, four of which are expressed in the adult. Using conditional RNA interference, we show here that all four neprilysins are involved in middle-term and long-term memory. Strikingly, all four are required in a single pair of neurons, the dorsal paired medial (DPM) neurons that broadly innervate the mushroom bodies (MBs), the center of olfactory memory. Neprilysins are also required in the MB, reflecting the functional relationship between the DPM neurons and the MB, a circuit believed to stabilize memories. Together, our data establish a role for neprilysins in two specific memory phases and further show that DPM neurons play a critical role in the proper targeting of neuropeptides involved in these processes. SIGNIFICANCE STATEMENT: Neprilysins are endopeptidases known to degrade a number of small peptides. Neprilysin research has essentially focused on their role in Alzheimer's disease and heart failure. Here, we use Drosophila melanogaster to study whether neprilysins are involved in memory. Drosophila can form several types of olfactory memory and the neuronal structures involved are well described. Four neprilysin genes are expressed in adult Drosophila Using conditional RNA interference, we show that all four are specifically involved in middle-term memory (MTM) and long-term memory (LTM) and that their expression is required in the mushroom bodies and also in a single pair of closely connected neurons. The data show that these two neurons play a critical role in targeting neuropeptides essential for MTM and LTM.",Drosophila;dorsal paired medial neurons;long-term memory;mushroom bodies;neprilysin;olfactory conditioning,"Turrel, O.;Lampin-Saint-Amaux, A.;Preat, T.;Goguel, V.",2016,Sep 14,10.1523/jneurosci.3730-15.2016,0,
4534,The renal palliative care program,"A 75-year-old man with a 25-year history of type 2 diabetes presents for long-term treatment options. His estimated glomerular filtration rate is 16 mL per minute per 1.73 m(2) of body-surface area. His history is remarkable for ischemic coronary artery disease, congestive heart failure, peripheral artery disease, mild dementia, and colon cancer. He has been admitted to the hospital 4 times in the last 6 months. How should his case be managed?",aged;article;case report;chronic kidney failure;human;male;methodology;non insulin dependent diabetes mellitus;palliative therapy;standard,"Tuso, P.",2013,,,0,
4535,"Uric acid may be protective against cognitive impairment in older adults, but only in those without cardiovascular risk factors","Uric acid (UA) may not only prevent development of cognitive dysfunction owing to its antioxidant efficacy, but also may worsen cognitive functions by gaining pro-oxidant character. The present study attempts to uncover this paradoxical association between UA and cognitive impairment in elderly. 1374 elderly patients were retrospectively evaluated and included in the study. Participants underwent determination of circulating UA levels and comprehensive geriatric assessment. A serum UA concentration>/=7.0mg/dL in males and >/=5.7mg/dL in females were considered hyperuricemia. The mean age of patients was 76.72+/-8.76years. The prevalence of hyperuricemia was 36.6%. Significant differences was determined between the patients with and without hyperuricemia in terms of age, gender, body mass index, score of Charlson Comorbidity Index (CCI), triglyceride level, and the prevalence of dementia, diabetes, hypertension and Congestive Heart Failure (CHF) (p<0.05). When the effect of diabetes, hypertension and CHF between the groups has been statistically adjusted, the prevalence of dementia was significantly higher in those with lower UA in the absence of effect of DM, HT and CHF (p<0.05). Higher UA is associated with better cognitive performance in the absence of cardiovascular risk factors, and these risk factors may potentially suppress this protective effect of higher UA in the older adults.","268B43MJ25 (Uric Acid);Aged;Aged, 80 and over;Cognitive Dysfunction/ blood;Dementia/ epidemiology;Female;Heart Failure/epidemiology;Humans;Hypertension/epidemiology;Hyperuricemia/ epidemiology;Male;Retrospective Studies;Risk Factors;Turkey;Uric Acid/ blood;Cardiovascular risk factor;Cognitive function;Dementia;Hyperuricemia;Uric acid","Tuven, B.;Soysal, P.;Unutmaz, G.;Kaya, D.;Isik, A. T.",2017,Mar,,0,
4536,Hormone replacement therapy: what is the evidence today?,"Based on the most recent studies, it clearly appears that long-term hormone replacement therapy (HRT) prevents fractures but does not improve established coronary artery disease. In addition, HRT leads to a small increase in breast cancer incidence and to a decrease in colorectal cancer incidence. HRT increases the incidence of venous thrombosis, pulmonary embolisms and strokes. As a consequence, HRT can no longer be recommended for primary or secondary prevention of cardiovascular diseases. In addition, it was also demonstrated that HRT was not able to improve cognitive functions and prevent dementia. Therefore regarding daily clinical practice, HRT certainly remains useful to control the symptoms of oestrogen deficiency in recently menopausal patients, but it should definitively no longer be recommended for long-term treatment.","Aged;*Estrogen Replacement Therapy/adverse effects;Female;Fractures, Spontaneous/epidemiology/prevention & control;Humans;Middle Aged;Neoplasms/chemically induced/epidemiology;Osteoporosis, Postmenopausal/*drug therapy/epidemiology;Randomized Controlled Trials as Topic;Risk Factors;Treatment Outcome","Uebelhart, B.;Frey, D.;Uebelhart, D.",2003,Dec,10.1007/s00393-003-0559-y,0,
4537,Proton pump inhibitor - Side effects and complications of long-term proton pump inhibitor administration,"Proton Pump Inhibitors are among the most common drugs taken. The indication is for treatment of heartburn, reflux disease, prophylaxis and treatment of peptic ulcers, in combination with NSAIDs and steroids as well as H. pylori-eradication. PPI's are widely used, even with non-specific symptoms. This certainly has to do with good tolerability and a previously considered low side effect profile. At the moment, there is growing evidence that the long-term intake of PPI's may not be as safe as assumed. In addition to interactions with some drugs, including platelet aggregation inhibitors, recent studies have shown an increased risk of myocardial infarction, interstitial nephritis, chronic renal injury, infections, vitamin deficiencies and electrolyte shifts as well developing dementia.",antithrombocytic agent;proton pump inhibitor;article;dementia;drug tolerability;electrolyte disturbance;heart infarction;human;infection;interstitial nephritis;kidney injury;long term care;side effect;treatment indication;vitamin deficiency,"Ueberschaer, H.;Allescher, H. D.",2017,,10.1055/s-0042-121265,0,
4538,Clinical spectrum and prognosis of the aged patients with sick sinus syndrome,"The clinical features of 33 aged patients (mean age, 78.1 years) with sick sinus syndrome are described, and the therapeutic responses and mortality rate are reported. Electrocardiographic abnormalities varied from severe sinus bradycardia (Group I, 4 patients), sinoatrial block and/or sinus arrest (Group II, 14 patients) to sinus bradyarrhythmia associated with episodic supraventricular tachyarrhythmias (Group III, 15 patients). Symptoms were produced by both bradycardia and tachycardia, but asymptomatic patients were more frequently encountered among patients in the 9th decade and with senile dementia. Association of electrocardiographic evidence of atrioventricular block and/or bundle branch block was noted in 7 (21.2%), old myocardial infarction in 4 patients (12.2%). Etiologic relation between coronary heart disease and sick sinus syndrome was not demonstrated. Drug therapy was effective in about half of the patients, while the use of temporary cardiac pacing or implantation of a cardiac pacemaker was required in 14 patients (42.4). Cardiac pacing was life-saving in some cases. Survival rate after 3 years of follow-up was 76.2%.",age;aged;electrocardiography;heart arrhythmia;major clinical study;sick sinus syndrome;therapy,"Ueda, K.;Kamata, C.;Mifune, J.",1977,,,0,
4539,Charlson comorbidity index predicts poor outcome in CML patients treated with tyrosine kinase inhibitor,"Although the Sokal and Hasford scoring systems are well-known prognostic models specific to chronic myeloid leukemia (CML), whether they can effectively predict outcomes in elderly CML patients with comorbidities has not been fully elucidated. We evaluated the association between comorbidity at diagnosis with treatment outcome and survival in chronic phase CML patients. A questionnaire was administered to patients diagnosed with CML between 2001 and 2012 and treated with tyrosine kinase inhibitors (TKIs). The Charlson comorbidity index (CCI) was used to determine concomitant diseases. In total, 79 patients (33 females; median age, 57 years) were enrolled. CCI scores at diagnosis were between 2 and 11. At the last follow-up, 46 patients showed a major molecular response. Complete cytogenetic response was achieved in 73.4 % of the cases 12 months after TKI administration. We observed only five deaths during the 55.5-month median follow-up period. The risk categories (low/intermediate/high) associated with Sokal and Hasford scores were 33/27/7 and 21/43/3, respectively. The 27 cases with a CCI score >3 had significantly poorer survival after diagnosis (52 cases had a CCI score <2). CCI scores were inversely associated to overall survival. Concomitant comorbidity at diagnosis is associated with poor outcome in CML patients treated with TKIs.",dasatinib;imatinib;nilotinib;protein tyrosine kinase inhibitor;acquired immune deficiency syndrome;adult;aged;article;cancer chemotherapy;cancer prognosis;cancer survival;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;chronic myeloid leukemia;comorbidity;congestive heart failure;connective tissue disease;cytogenetics;dementia;diabetes mellitus;disease association;female;follow up;heart infarction;hemiplegia;human;kidney disease;lymphoma;major clinical study;male;myelodysplastic syndrome;overall survival;peptic ulcer;peripheral vascular disease;retrospective study;solid malignant neoplasm;treatment outcome;treatment response,"Uemura, M.;Imataki, O.;Kawachi, Y.;Kawakami, K.;Hoshijima, Y.;Matsuoka, A.;Kadowaki, N.",2016,,10.1007/s12185-016-2074-3,0,
4540,Physical complications of dementia: 12 months research in a special ward for the elderly with senile dementia,"Background: The Imaise Branch of Ichinomiya City Hospital proactively accepts patients with behavioral and psychological symptoms of dementia (BPSD). In cases with serious physical complications, we treat them in cooperation with other medical departments. We investigated the physical complications in our Special Ward for Elderly with Senile Dementia (WED) to determine the need to treat them for dementia. Methods: The subjects were 53 patients, who left our WED in the 12 months from April, 2005 to March, 2006. We subdivided physical complications into three categories in this investigation: (i) serious emergencies occurring in WED with a possibly high risk of mortality; (ii) emergency complications arising in WED that required diagnoses and treatment by specialists of other departments; and (iii) chronic diseases related to other more severe diseases requiring treatment. Results: The 53 investigated patients consisted of 28 men (53%) and 25 women (47%). Their average age was 79years (male 76, female 82). There were 35 patients (66%) with Alzheimer's disease, five (9%) with vascular dementia, two (4%) with dementia with Lewy bodies, and 11 with other illnesses. The average hospitalization period was about 8 months. Serious emergencies with a high risk of mortality occurred 22 times for every 15 patients (28%) in total. Six patients (11%) died in the WED. Emergencies requiring diagnoses and treatment by specialists of other departments occurred 23 times in every 18 patients (35%) in total. Patients with chronic diseases related to other more severe diseases numbered 26 (49%). Conclusion: These investigations confirmed the great need to treat physical complications in facilities for patients with dementia. All three categories of physical complications showed high rates, and the kinds of diseases varied. It is necessary to diagnose and treat various physical complications with a high incidence rate, and it is important to cooperate with specialists of other medical departments. © 2007 The Authors; Journal compilation © 2007 Japanese Psychogeriatric Society.",methotrexate;aged;Alzheimer disease;angina pectoris;aorta aneurysm;aorta dissection;article;aspiration pneumonia;bile duct stone;brain hemorrhage;brain infarction;cholecystitis;cholelithiasis;chronic disease;chronic kidney failure;convulsion;diabetes mellitus;diffuse Lewy body disease;disease severity;emergency care;esophagus varices;female;femur neck fracture;genital bleeding;geriatric patient;glaucoma;heart arrhythmia;heart failure;hematemesis;high risk patient;hospitalization;human;hyperkalemia;hypoglycemia;inguinal hernia;intestine obstruction;intoxication;kidney failure;length of stay;liver cancer;liver injury;lung emphysema;major clinical study;male;malignant neoplastic disease;medical specialist;moyamoya disease;multiinfarct dementia;necrotizing fasciitis;physical disease;pneumoconiosis;pneumonia;priority journal;prostate cancer;rheumatoid arthritis;senile dementia;stomach ulcer;subdural hematoma;sudden death;faintness;treatment indication;upper respiratory tract obstruction;spine fracture,"Ukai, K.;Mizuno, Y.;Ozaki, K.;Sekiya, T.;Tomita, K.;Ito, T.",2007,,,0,
4541,Trade-offs between cancer and other diseases: Do they exist and influence longevity?,"Relationships between aging, disease risks, and longevity are not yet well understood. For example, joint increases in cancer risk and total survival observed in many human populations and some experimental aging studies may be linked to a trade-off between cancer and aging as well as to the trade-off(s) between cancer and other diseases, and their relative impact is not clear. While the former trade-off (between cancer and aging) received broad attention in aging research, the latter one lacks respective studies, although its understanding is important for developing optimal strategies of increasing both longevity and healthy life span. In this paper, we explore the possibility of trade-offs between risks of cancer and selected major disorders. First, we review current literature suggesting that the trade-offs between cancer and other diseases may exist and be linked to the differential intensity of apoptosis. Then we select relevant disorders for the analysis (acute coronary heart disease [ACHD], stroke, asthma, and Alzheimer disease [AD]) and calculate the risk of cancer among individuals with each of these disorders, and vice versa, using the Framingham Study (5209 individuals) and the National Long Term Care Survey (NLTCS) (38,214 individuals) data. We found a reduction in cancer risk among old (80+) men with stroke and in risk of ACHD among men (50+) with cancer in the Framingham Study. We also found an increase in ACHD and stroke among individuals with cancer, and a reduction in cancer risk among women with AD in the NLTCS. The manifestation of trade-offs between risks of cancer and other diseases thus depended on sex, age, and study population. We discuss factors modulating the potential trade-offs between major disorders in populations, e.g., disease treatments. Further study is needed to clarify possible impact of such trade-offs on longevity. © 2010, Mary Ann Liebert, Inc.",adult;aged;aging;Alzheimer disease;article;asthma;cancer risk;female;groups by age;human;ischemic heart disease;lifespan;longevity;male;priority journal;risk assessment;cerebrovascular accident;survival,"Ukraintseva, S. V.;Arbeev, K. G.;Akushevich, I.;Kulminski, A.;Arbeeva, L.;Culminskaya, I.;Akushevich, L.;Yashin, A. I.",2010,,,0,
4542,Ethical dilemma in multiple co-morbid respiratory failure patient: Patient autonomy against family wishes?,"An 82 years old patient with background history of severe COPD, heart failure, multiple co-morbidities and poor quality of life was admitted with pneumonia and subsequently developed acute respiratory distress. There was an obvious conflict of opinion among her family members regarding decision making in her case. The patient time and again insisted against being resuscitated if she ever became seriously ill. However, she did not appoint a proxy decision maker or give an advance directive. This created an ethical dilemma, resulting a clash among the family members as well as her treating physicians concerning the withholding of active treatment and DNR orders in case of cardiorespiratory arrest. In the end the clinicians took lead and, with effective communication with the patient and the family members, made a final decision of withholding treatment in respect of the patient's dignity and autonomy.",aged;article;cardiopulmonary insufficiency;case report;chronic obstructive lung disease;comorbidity;decision making;dementia;family conflict;female;heart failure;human;medical ethics;patient autonomy;patient decision making;pneumonia;quality of life;respiratory distress;respiratory failure;rheumatoid arthritis,"Ul Haq, A.",2012,,,0,
4543,Senile plaques and neurofibrillary tangles of the Alzheimer type in nondemented individuals at presenile age,"100 unselected brains of patients dying at the ages of 55--64 years were examined for the presence of Alzheimer type changes. These changes were found in 25 brains. This number is lower than that in a comparable investigation from Japan, but it is clearly above the number found in selected nondemented patients from England. Although none of the patients had suffered from an easily recognizable presenile dementia, an important proportion of them had been noted for unusual psychology. The occurrence of Alzheimer type changes was not dependent on the diseases the patients had suffered from.",Alcoholism/complications;Alzheimer Disease/complications/*pathology/psychology;Brain/*pathology;Brain Neoplasms/complications;Dementia/*pathology;Female;Humans;Hypertension/complications;Lymphoma/complications;Male;Middle Aged;Myocardial Infarction/complications;Neurofibrils/*pathology;Organ Size,"Ulrich, J.",1982,,,0,
4544,Impact of albuminuria on early neurological deterioration and lesion volume expansion in lenticulostriate small infarcts,"Background and Purpose - Albuminuria, a marker of chronic kidney disease, is associated with an increased risk of incident stroke and unfavorable long-term outcomes. However, the association of albuminuria with short-term outcomes and change in infarct volume in patients with acute small subcortical infarction remains unknown. Methods - We retrospectively reviewed 85 consecutive patients with acute small subcortical infarcts in the lenticulostriate artery territory who were admitted to our stroke center within 24 hours of symptom onset and underwent serial diffusionweighted imaging (DWI). Albuminuria was determined based on the urinary albumin-to-creatinine ratio obtained from a first morning spot urine after admission. Infarct volume was measured on axial sections of the initial and follow-up DWI. Early neurological deterioration (END) was defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale score during the first 5 days after admission. Results - Albuminuria (UACR ≥30 mg/g creatinine) was observed in 14 of 18 patients with END (77.8%) and in 25 of 67 patients without END (37.3%), P=0.002. Multivariate logistic regression analysis revealed that albuminuria was associated with END after adjustment for age, low estimated glomerular filtration rate (<60 mL/min per 1.73 m2), and infarct volume on initial DWI (odds ratio, 6.64; 95% confidence interval, 1.62-27.21; P=0.009). In addition, albuminuria was an independent predictor of increase in infarct volume using multivariate linear regression analysis (β coefficient=0.217; P=0.038). Conclusions - Our findings suggest that albuminuria is associated with END and infarct volume expansion in patients with small subcortical infarcts in the lenticulostriate artery territory. © 2013 American Heart Association, Inc.",albumin;creatinine;aged;albumin urine level;albuminuria;article;brain artery;brain infarction size;creatinine urine level;diffusion weighted imaging;disease association;early neurological deterioration;female;follow up;glomerulus filtration rate;human;lenticulostriate artery;major clinical study;male;mental deterioration;National Institutes of Health Stroke Scale;priority journal;retrospective study;urine level,"Umemura, T.;Senda, J.;Fukami, Y.;Mashita, S.;Kawamura, T.;Sakakibara, T.;Sobue, G.",2014,,,0,
4545,Management of older inpatients who refuse nonpsychiatric medication within birmingham and solihull mental health NHS foundation trust,"The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.",aged;anemia;arthritis;article;asthma;breast cancer;candidiasis;clinical article;clinical audit;constipation;consultation;dementia;dry eye;dyspepsia;epilepsy;extrapyramidal symptom;female;glaucoma;heart failure;human;hypertension;hypothyroidism;infection;insomnia;irritable colon;low back pain;male;medication compliance;myalgia;mycosis;non insulin dependent diabetes mellitus;nutritional deficiency;overactive bladder;pharmaceutical care;prescription;rash;treatment indication;treatment refusal;vitamin deficiency,"Umotong, E.",2016,,10.1097/nmd.0000000000000622,0,
4546,Long-term consequences of finasteride vs placebo in the prostate cancer prevention trial,"Background: Finasteride has been found to reduce the risk of low-grade prostate cancer but to have no impact on overall survival. The long-term adverse and beneficial consequences of finasteride have not been examined. Methods: We used a linkage between data from the Prostate Cancer Prevention Trial (PCPT) and Medicare claims. Patients were examined by randomized study arm (finasteride vs placebo for 7 years) for long-term consequences of the intervention, including cardiac, endocrine, and sexual dysfunction, depression, diabetes, and benign prostatic hyperplasia (BPH)-related events. To examine time to events, we used cumulative incidence and Cox regression, adjusting for covariates. All statistical tests were two-sided. Results: A total of 13 935 of 18 880 participants (73.8%) in the PCPT were linked to Medicare claims, withmedianMedicare follow-up assessment time of 16 years fromtrial registration. There were no differences between finasteride and placebo participants with respect to important baseline factors or amount of Medicare follow-up assessment time. Finasteride patients had a 10% higher risk of new claims for depression (hazard ratio [HR] = 1.10, 95% confidence interval [CI] = 1.01 to 1.19, P = .04) and a 6% lower risk of procedures for BPH-related events (primarily lower urinary tract symptoms; HR=0.94, 95% CI=0.89 to 1.00, P = .03). No other differences were found in rates of long-termconsequences of intervention in the two study arms. Conclusions: Finasteride use is associated with reduced need for procedures for relief of BPH-related events and a modest increase in depression. Overall, there is little need to worry about long-termnoncancer consequences of finasteride use in those who use it for treatment of symptomatic BPH, hair growth, or prevention of cancer.",finasteride;placebo;acute heart infarction;adult;adverse outcome;aged;article;cancer patient;cancer prevention;cancer survival;controlled study;dementia;depression;diabetes mellitus;endocrine bone disease;follow up;fracture;human;hypercholesterolemia;incidence;ischemic heart disease;long term survival;lower urinary tract symptom;major clinical study;male;medicare;middle aged;obesity;osteoporosis;priority journal;prostate cancer;prostate hypertrophy;randomized controlled trial;sexual dysfunction;thrombosis;transurethral resection;treatment duration;urinary tract infection,"Unger, J. M.;Till, C.;Thompson, I. M.;Tangen, C. M.;Goodman, P. J.;Wright, J. D.;Barlow, W. E.;Ramsey, S. D.;Minasian, L. M.;Hershman, D. L.",2016,,10.1093/jnci/djw168,0,
4547,Autopsy report on central pontine myelinolysis triggered by vomiting associated with digoxin intoxication,"An 87-year-old male, prescribed digoxin and furosemide for congestive heart failure and Alzheimer disease, had dehydration and anemia due to poor food intake and hemorrhagic cystitis. Repeated vomiting due to an upper respiratory infection caused disturbance of consciousness and hypotension. The patient was admitted to hospital and diagnosed with digoxin intoxication and hypernatremia. The serum sodium (Na+) level was corrected, but the patient died 4 days after admission following uncontrollable seizure. A histologic examination after an autopsy revealed characteristic findings of central pontine myelinolysis (CPM). This is the first autopsy report on CPM triggered by vomiting in association with digoxin administration. © 2009 Elsevier Ireland Ltd. All rights reserved.",digoxin;furosemide;Ringer lactate solution;aged;Alzheimer disease;anemia;article;autopsy;blood chemistry;bradycardia;brain ventricle dilatation;case report;central pontine myelinolysis;computer assisted tomography;congestive heart failure;consciousness disorder;coronary artery disease;dehydration;digoxin blood level;drug intoxication;ECG abnormality;electrocardiogram;hemorrhagic cystitis;histology;human;hypernatremia;hypokalemia;hypoproteinemia;hypotension;kidney failure;male;malnutrition;neurofibrillary tangle;Nissl staining;priority journal;seizure;silver staining;vomiting,"Unuma, K.;Harada, K.;Nakajima, M.;Eguchi, H.;Tsushima, K.;Ito, T.;Shintani-Ishida, K.;Kojima, H.;Yoshida, K. i",2010,,,0,
4548,Risk factors for mortality in Down syndrome,"BACKGROUND: Down syndrome is a genetic condition that contributes to a significantly shorter life expectancy compared with the general population. We investigated the most common comorbidities in a population of acute hospital patients with Down syndrome and further explored what the most common risk factors for mortality are within this population. METHOD: From our database of one million patients admitted to National Health Service (NHS) Trusts in northern England, we identified 558 people who had Down syndrome. We compared this group with an age- and gender-matched control group of 5580 people. RESULTS: The most prevalent comorbid diseases within the Down's population were hypothyroidism (22.9%) and epilepsy (20.3%). However, the conditions that had the highest relative risks (RRs) in the Down's population were septal defects and dementia. Respiratory failure, dementia and pneumonia were the most significantly related comorbidities to mortality in the Down syndrome population. In the control population, respiratory failure, dementia and renal failure were the most significant disease contributors. When these contributors were analysed using multivariate analysis, heart failure, respiratory failure, pneumonia and epilepsy were the identified risk factors for in-hospital mortality in the Down syndrome population. Respiratory failure was the sole risk factor for mortality in the Down syndrome population [RR = 9.791 (1.6-59.9) P </= 0.05], when compared with the risk factors for mortality in the control population. CONCLUSIONS: There is significant medical morbidity in Down syndrome. This morbidity contributes to the lower life expectancy. Respiratory failure is a risk factor for mortality in Down syndrome. We need to thoroughly investigate people with Down syndrome to ensure any treatable illnesses are well managed.",Adult;*Comorbidity;Down Syndrome/epidemiology/*mortality;England/epidemiology;Epilepsy/epidemiology/*mortality;Female;Humans;Hypothyroidism/epidemiology/*mortality;Male;Middle Aged;National Health Programs/statistics & numerical data;Respiratory Insufficiency/epidemiology/*mortality;Risk Factors;Down syndrome;mortality,"Uppal, H.;Chandran, S.;Potluri, R.",2015,Sep,10.1111/jir.12196,0,
4549,Lp(a) lipoprotein in cerebrovascular disease and dementia,"Lp(a) lipoprotein has been considered an independent risk factor in the development of coronary heart disease (CHD). We examined the role of Lp(a) in patients with cerebrovascular disease (CVD) and those with dementia. The Lp(a) concentration in patients with CHD, those with cerebral infarction due to a large artery occlusion and those with vascular dementia (VD) was significantly higher than that of age-matched control subjects. However, the Lp(a) concentration was not high in cerebral infarction due to a small artery occlusion, intracerebral hemorrhage and dementia of the Alzheimer type (DAT). The present results suggest that Lp(a) should cause VD as well as CVD, and that Lp(a) should be one of the indicators that distinguish VD from DAT.",Aged;Cerebral Infarction/blood;Cerebrovascular Disorders/*blood;Coronary Disease/*blood;Dementia/*blood;Female;Humans;Lipoprotein(a);Lipoproteins/*blood;Male;Middle Aged;Myocardial Infarction/blood;Risk Factors,"Urakami, K.;Mura, T.;Takahashi, K.",1987,Dec,,0,
4550,Suppurative parotitis,,C reactive protein;cefepime;metronidazole;vancomycin;aged;antibiotic sensitivity;article;blood culture;body temperature;breathing rate;case report;cellulitis;chill;chronic kidney disease;computer assisted tomography;congestive heart failure;dementia;emergency care;female;fever;heart rate;human;hypertension;lethargy;leukocyte count;medical history;methicillin resistant Staphylococcus aureus;nursing home patient;parotitis;penicillin allergy;polymorphonuclear cell;priority journal;protein blood level;swelling,"Usoltseva, N.;D'Costa, M.;Carlson, A.;Garcia-Montilla, R. J.",2013,,,0,
4551,Usefulness of acute delirium as a predictor of adverse outcomes in patients >65 years of age with acute decompensated heart failure,"Delirium is an acute confusional state that is very prevalent in older patients hospitalized with acute decompensated heart failure (ADHF). The association between delirium and ADHF outcome has not been well described. We analyzed 883 consecutive patients >65 years of age admitted with ADHF. Acute delirium was diagnosed based on the Confusion Assessment Method. Delirious patients (total n = 151) had an increased in-hospital all-cause death compared to nondelirious patients (n = 17, 11%, vs n = 45, 6%; adjusted odds ratio [OR] 1.93, 95% confidence interval [CI] 1.07 to 3.48, p = 0.02). Of those surviving to discharge (n = 821), on multivariable logistic regression analysis, delirium was independently associated with increased risk of 30-day (adjusted OR 4.24, 95% CI 2.77 to 6.47, p <0.001) and 90-day (adjusted OR 3.72, 95% CI 2.51 to 5.54, p <0.001) rehospitalizations for ADHF and higher nursing home placement (adjusted OR 2.70, 95% CI 1.59 to 5.30, p <0.001) after adjusting for age, gender, cardiac risk factors, dementia, activities of daily living, instrumental activities of daily living, coronary artery disease, atrial fibrillation, left ventricular ejection fraction, angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker, β blockers, Charlson co-morbidity index, and other potential confounders. Furthermore, delirium was strongly associated with 90-day all-cause mortality in patients discharged from the hospital (adjusted hazard ratio 2.10, CI 1.53 to 2.88, p <0.0001). In conclusion, acute delirium serves as an important prognostic determinant of in-hospital and posthospital discharge outcomes including increased ADHF readmission risk in older hospitalized patients with ADHF. Thus, delirium plays an important role in the risk stratification and prognosis of patients with ADHF. © 2011 Elsevier Inc.",angiotensin receptor antagonist;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;acute heart failure;adverse outcome;aged;article;cardiovascular risk;coronary artery disease;daily life activity;delirium;dementia;female;groups by age;atrial fibrillation;heart failure;heart left ventricle ejection fraction;hospital readmission;human;major clinical study;male;morbidity;mortality;nursing home;priority journal;risk assessment;sex difference;survival,"Uthamalingam, S.;Gurm, G. S.;Daley, M.;Flynn, J.;Capodilupo, R.",2011,,,0,
4552,Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society,"Objective: To update for both clinicians and the lay public the evidence-based position statement published by The North American Menopause Society (NAMS) in March 2007 regarding its recommendations for menopausal hormone therapy (HT) for postmenopausal women, with consideration for the therapeutic benefit-risk ratio at various times through menopause and beyond. Design: An Advisory Panel of clinicians and researchers expert in the field of women's health was enlisted to review the March 2007 NAMS position statement, evaluate new evidence through an evidence-based analysis, and reach consensus on recommendations. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees as an official NAMS position statement. The document was provided to other interested organizations to seek their endorsement. Results: Current evidence supports a consensus regarding the role of HT in postmenopausal women, when potential therapeutic benefits and risks around the time of menopause are considered. This paper lists all these areas along with explanatory comments. Conclusions that vary from the 2007 position statement are highlighted. Addenda include a discussion of risk concepts, a new component not included in the 2007 paper, and a recommended list of areas for future HT research. A suggested reading list of key references is also provided. Conclusions: Recent data support the initiation of HT around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fractures in select postmenopausal women; or both. The benefit-risk ratio for menopausal HT is favorable close to menopause but decreases with aging and with time since menopause in previously untreated women. Copyright © 2008 The North American Menopause Society.",conjugated estrogen;drospirenone;estradiol;estrogen;gestagen;medroxyprogesterone acetate;norethisterone acetate;progesterone;adult;article;body mass;body weight;bone densitometry;breast cancer;cancer risk;clinical trial;cognitive defect;controlled clinical trial;controlled study;dementia;depression;dyspareunia;early menopause;endometrium cancer;estrogen therapy;evidence based medicine;female;fragility fracture;hormonal therapy;human;ischemic heart disease;libido disorder;low drug dose;major clinical study;mammography;menopausal syndrome;menopause;mood disorder;postmenopause osteoporosis;premature ovarian failure;quality of life;randomized controlled trial;risk benefit analysis;risk reduction;cerebrovascular accident;urge incontinence;urinary tract infection;vagina atrophy;vaginitis;vasomotor disorder,"Utian, W. H.;Archer, D. F.;Bachmann, G. A.;Gallagher, J. C.;Grodstein, F.;Heiman, J. R.;Henderson, V. W.;Hodis, H. N.;Karas, R. H.;Lobo, R. A.;Manson, J. E.;Reid, R. L.;Schmidt, P. J.;Stuenkel, C. A.",2008,,,0,
4553,Study on clinical spectrum of vascular cognitive impairment,Introduction: Vascular dementia is the second most common cause of dementia comprising about 1/3 of all dementia. In India we have increased incidence of stroke and high number of cardiovascular disease burden which have contributed to increasing number of patients with VCI. Aim: To study the clinical spectrum of vascular cognitive impairment. Objectives: To determine the risk factors for VCI To analyze the clinical spectrum and cognitive profiles in VCI Material and Methods: This is a prospective analytic study. 50 Vascular dementia patients fulfilling NINDS - AIREN criteria (probable and possible) were studied for one year (Sep 13 - Aug 14) at Institute of Neurology Chennai. The clinical spectrum of VCI was assessed by MRI and clinical profile. Cognitive functions were assessed by MOCA Addenbrookes test. The significance of score was obtained by using ANOVA test and post HOC test. Results: The risk factors of VCI such as age sex education duration DM SHT dyslipidemia Coronary artery disease atrial fibrillation smoking alcohol were analyzed by chi square and found that all are clinically and statistically significant. This spectrum is broadly classified into large vessel disease (42%) small vessel disease (32%) strategic infarct (10%) dementia due to intracerebral hemorrhage (8%) and minimal cognitive impairment (8%). The executive functions Visuospatial fluency attention memory are most commonly affected in vascular dementia. Conclusion: In our study hypertension diabetes and CAD stays an important risk factor for VCI. In the spectrum of VCI the most common disorder was found to be large vessel disease(42% ) followed by small vessel disease (32%) strategic infarct (10%) hemorrhagic dementia (8%) and MCI (8%). The executive functions are most commonly affected in vascular dementia compared to other dementia.,cognitive defect;Indian;neurology;dementia;multiinfarct dementia;risk factor;executive function;infarction;human;patient;cardiovascular disease;cerebrovascular accident;atrial fibrillation;smoking;India;coronary artery disease;dyslipidemia;diseases;diabetes mellitus;hypertension;memory;sexual education;brain hemorrhage;cognition;analysis of variance;nuclear magnetic resonance imaging;post hoc analysis;alcohol,"Vadivel, S.;Bhanu, K.",2015,,,0,4554
4554,Study on clinical spectrum of vascular cognitive impairment,Introduction: Vascular dementia is the second most common cause of dementia comprising about 1/3 of all dementia. In India we have increased incidence of stroke and high number of cardiovascular disease burden which have contributed to increasing number of patients with VCI. Aim: To study the clinical spectrum of vascular cognitive impairment. Objectives: To determine the risk factors for VCI To analyze the clinical spectrum and cognitive profiles in VCI Material and Methods: This is a prospective analytic study. 50 Vascular dementia patients fulfilling NINDS - AIREN criteria (probable and possible) were studied for one year (Sep 13 - Aug 14) at Institute of Neurology Chennai. The clinical spectrum of VCI was assessed by MRI and clinical profile. Cognitive functions were assessed by MOCA Addenbrookes test. The significance of score was obtained by using ANOVA test and post HOC test. Results: The risk factors of VCI such as age sex education duration DM SHT dyslipidemia Coronary artery disease atrial fibrillation smoking alcohol were analyzed by chi square and found that all are clinically and statistically significant. This spectrum is broadly classified into large vessel disease (42%) small vessel disease (32%) strategic infarct (10%) dementia due to intracerebral hemorrhage (8%) and minimal cognitive impairment (8%). The executive functions Visuospatial fluency attention memory are most commonly affected in vascular dementia. Conclusion: In our study hypertension diabetes and CAD stays an important risk factor for VCI. In the spectrum of VCI the most common disorder was found to be large vessel disease(42% ) followed by small vessel disease (32%) strategic infarct (10%) hemorrhagic dementia (8%) and MCI (8%). The executive functions are most commonly affected in vascular dementia compared to other dementia.,cognitive defect;Indian;neurology;dementia;multiinfarct dementia;risk factor;executive function;infarction;human;patient;cardiovascular disease;cerebrovascular accident;atrial fibrillation;smoking;India;coronary artery disease;dyslipidemia;diseases;diabetes mellitus;hypertension;memory;sexual education;brain hemorrhage;cognition;analysis of variance;nuclear magnetic resonance imaging;post hoc analysis;alcohol,"Vadivel, S;Bhanu, K",2015,,,0,
4555,The BELFRAIL (BFC80+) study: a population-based prospective cohort study of the very elderly in Belgium,"BACKGROUND: In coming decades the proportion of very elderly people living in the Western world will dramatically increase. This forthcoming ""grey epidemic"" will lead to an explosion of chronic diseases. In order to anticipate booming health care expenditures and to assure that social security is funded in the future, research focusing on the relationship between chronic diseases, frailty and disability is needed. The general aim of the BELFRAIL cohort study (BFC80+) is to study the dynamic interaction between health, frailty and disability in a multi-system approach focusing on cardiac dysfunction and chronic heart failure, lung function, sarcopenia, renal insufficiency and immunosenescence. METHODS/DESIGN: The BFC80+ is a prospective, observational, population-based cohort study of subjects aged 80 years and older in three well-circumscribed areas of Belgium. In total, 29 general practitioner (GP) centres were asked to include patients aged 80 and older. Only three exclusion criteria were used: severe dementia, in palliative care and medical emergency. Two sampling methods for the recruitment of patients were used. Between November 2, 2008 and September 15, 2009, 567 subjects were included in the BFC80+ study. Every study participant was invited to undergo four study visits. The GP recorded background variables and medical history and performed a detailed anamnesis and clinical examination. The clinical research assistant performed an extensive examination including performance testing, questionnaires and technical examinations. Echocardiography was performed at home by a cardiologist. A blood sample was collected in the morning. Follow-up reporting of hard outcome measures including mortality, hospitalization and morbidity was organized. A second data collection is planned after 18 months. DISCUSSION: The BFC80+ was designed to acquire a better understanding of the epidemiology and pathophysiology of chronic diseases in the very elderly and to study the dynamic interaction between health, frailty and disability in a multi-system approach. The wide variety of dimensions investigated in the BFC80+ will enable us not only to investigate in depth the relationship between the different physiological systems but also to initiate new research questions based on this unique database of community-dwelling elderly.","Aged, 80 and over;Aging/*blood/*pathology;Belgium/epidemiology;Cardiovascular Diseases/blood/epidemiology;Chronic Disease;Cohort Studies;Disabled Persons/statistics & numerical data;Female;*Frail Elderly/statistics & numerical data;Humans;Male;*Population Surveillance/methods;Prospective Studies","Vaes, B.;Pasquet, A.;Wallemacq, P.;Rezzoug, N.;Mekouar, H.;Olivier, P. A.;Legrand, D.;Mathei, C.;Van Pottelbergh, G.;Degryse, J.",2010,Jun 17,10.1186/1471-2318-10-39,0,
4556,"Frequencies of apolipoprotein E polymorphism in a healthy Kurdish population from Kermanshah, Iran","The molecular polymorphism displayed by apolipoprotein E (APOE) has been listed as a risk factor for susceptibility to various disorders, such as those associated with lipid metabolism, arteriosclerosis, coronary artery disease (CAD), and Alzheimer disease. To evaluate the role of APOE genotypes as risk factors for Alzheimer disease, CAD, and atherosclerosis in the Kurdish population of Kermanshah, Iran, we studied the frequencies of APOE alleles *2, *3, and *4 and genotypes in 914 healthy Kurdish subjects (514 men and 400 women). The highest frequency of APOE in the Kurdish population was found for APOE*3 (87.87%). The APOE*2 and APOE*4 allele frequencies were 6.66% and 5.45%, respectively. Distribution of APOE genotypes and alleles was not significantly different between male and female subjects (p > 0.05). Interestingly, the order of the frequency of APOE alleles (*3-->*2-->*4) in the Kurdish population was quite different from that reported for most populations in the world (*3-->*4-->*2). The findings of the present study can be used to identify individuals with high risk of CAD and atherosclerosis and suggest a preventive measure to reduce their susceptibility.","Adult;Age Distribution;Apolipoproteins E/*genetics;Asian Continental Ancestry Group/*genetics;Ethnic Groups/genetics;Female;Gene Frequency;Genotype;Humans;Iran;Male;*Polymorphism, Genetic;Sex Distribution","Vaisi-Raygani, A.;Kharrazi, H.;Rahimi, Z.;Pourmotabbed, T.",2007,Oct,10.1353/hub.2008.0003,0,
4557,"Commentary: Mediterranean diet and cognitive outcomes: Epidemiological evidence suggestive, randomized trials needed",,Alzheimer disease;cerebrovascular accident;clinical effectiveness;cognition;food intake;human;ischemic heart disease;Mediterranean diet;note;nuclear magnetic resonance imaging;observational study;oxidative stress;priority journal;vegetable,"Valls-Pedret, C.;Ros, E.",2013,,,0,
4558,ApoE and ACE genes: Impact on human longevity,,apolipoprotein E;dipeptidyl carboxypeptidase;Alzheimer disease;cholesterol transport;coronary artery disease;DNA polymorphism;genetic variability;heart infarction;longevity;note;priority journal;renin angiotensin aldosterone system;survival,"Van Bockxmeer, F. M.",1994,,,0,
4559,APOE e4 and the associations of seafood and long-chain omega-3 fatty acids with cognitive decline,"bjective: To examine the association between consumption of seafood and long-chain n-3 fatty acids with change in 5 cognitive domains over an average of 4.9 years. Methods: From an ongoing longitudinal, community-based epidemiologic study of aging and dementia (the Rush Memory and Aging Project), we included 915 participants (age 81.4 6 7.2 years, 25% men) who had completed at least one follow-up cognitive assessment and dietary data. Diet was assessed by semiquantitative food frequency questionnaire. Scores for global cognitive function and 5 cognitive domains (episodic, semantic, and working memory, perceptual speed, and visuospatial ability) were assessed using 19 cognitive tests. Mixed models adjusted for multiple risk factors of cognitive change were used to assess the associations. Results: Consumption of seafood was associated with slower decline in semantic memory (b 5 0.024; p 5 0.03) and perceptual speed (b 5 0.020; p 5 0.05) in separate models adjusted for age, sex, education, participation in cognitive activities, physical activity, alcohol consumption, smoking, and total energy intake. In secondary analyses, APOE e4 carriers demonstrated slower rates of decline in global cognition and in multiple cognitive domains with weekly seafood consumption and with moderate to high long-chain n-3 fatty acid intake from food. These associations were not present in APOE e4 noncarriers. Higher intake levels of a-linolenic acid were associated with slower global cognitive decline, but also only in APOE e4 carriers. Conclusions: These results suggest protective relations of one meal per week of seafood and long-chain n-3 fatty acids against decline in multiple cognitive domains. The role of APOE e4 in this association needs further study.",apolipoprotein E;fish oil;linolenic acid;long chain fatty acid;omega 3 fatty acid;age;aged;alcohol consumption;article;caloric intake;cerebrovascular accident;cognition;cognition assessment;cognitive defect;depth perception;diabetes mellitus;dietary intake;education;episodic memory;female;follow up;food frequency questionnaire;food intake;gender;heart infarction;human;hypertension;major clinical study;male;meal;perception;physical activity;priority journal;risk factor;sea food;semantic memory;smoking;working memory,"Van De Rest, O.;Wang, Y.;Barnes, L. L.;Tangney, C.;Bennett, D. A.;Morris, M. C.",2016,,,0,
4560,Evaluation of Underlying Causes of Death in Patients with Dementia to Support Targeted Advance Care Planning,"Background: Insight in causes of death in demented patients may help physicians in end-of-life care. Objectives: To investigate underlying causes of death (UCD) in demented patients stratified by age, sex, dementia subtype [Alzheimer's disease (AD), vascular dementia (VaD)] and to compare them with UCD in the general population (GP). Methods: A nationwide cohort of 59,201 patients with dementia (admitted to a hospital or visiting a day clinic) was constructed [38.7 men, 81.4 years (SD 7.0)] from 2000 through 2010. UCDs were reported and compared to the GP by calculating relative risks (RRs). Results: During follow up [median follow up time 1.3 years (IQR 0.3- 3.0)], 64.2 of women and 69.3 of men died. Leading UCDs were dementia (17.5 in men and 23.7 in women) and cardiovascular disease (CVD) (18.7 and 19.2, respectively). When compared to the GP, dementia was a more common UCD (RR in men 4.65, 95 CI 4.43-4.88), while CVD (RR in men 0.67, 95 CI 0.65-0.68) and cancer (RR 0.40, 95 CI 0.39-0.41) were less common. These differences were more pronounced in patients aged between 60-69 as compared to those aged≥90 years. Patients with AD died less often of cerebrovascular diseases as compared to VaD (RR in men 0.53, 95 CI 0.47-0.59). Conclusion: UCDs in patients with dementia differs from that of the GP, as dementia is more often and cancer less often an UCD. Although less frequent compared to the GP, CVD also is one of the leading UCDs in patients with dementia. This information is valuable for targeted advance care planning.",adult;age distribution;aged;Alzheimer disease;article;cancer mortality;cardiovascular disease;cardiovascular mortality;cause of death;cerebrovascular disease;chronic respiratory tract disease;clinical evaluation;cohort analysis;controlled study;cross linking;day hospital;dementia;female;follow up;gastrointestinal disease;mortality;hospitalization;human;ischemic heart disease;major clinical study;male;malignant neoplastic disease;middle aged;multiinfarct dementia;Netherlands;patient care;pneumonia;priority journal;terminal care;underlying cause of death;urogenital tract disease,"Van De Vorst, I. E.;Koek, H. L.;Bots, M. L.;Vaartjes, I.",2016,,,0,
4561,Effect of Vascular Risk Factors and Diseases on Mortality in Individuals with Dementia: A Systematic Review and Meta-Analysis,"Objectives To assess the effect of cardiovascular diseases and risk factors on mortality in individuals with dementia. Design Systematic review and meta-analysis. English- and Dutch-language studies in PubMed, EMBASE, and PsycINFO databases were searched in April 2014 with hand-searching of in-text citations and no publication limitations. Inclusion criteria were original studies reporting on cardiovascular risk factors or diseases and their relationship with survival in individuals with dementia. The Quality In Prognosis Studies tool was used to appraise all included articles. Setting Population-, hospital-, and nursing home-based. Participants Community-dwelling, hospitalized individuals and nursing home residents with dementia. Measurements A random-effects meta-analysis was performed to investigate the effect of several cardiovascular diseases and risk factors on overall mortality. Results Twelve studies with 235,865 participants were included. In pooled analyses, male sex (hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.56-1.78), diabetes mellitus (DM) (HR = 1.49, 95% CI = 1.33-1.68), smoking (ever vs never) (HR = 1.37, 95% CI = 1.17-1.61), coronary heart disease (CHD) (HR = 1.21, 95% CI = 1.02-1.44) and congestive heart failure (CHF) (HR = 1.37, 95% CI = 1.18-1.59) were associated with mortality. Stroke, high blood pressure, being overweight, and hypercholesterolemia were not statistically significantly related to mortality. Conclusion Individuals with dementia and DM, smoking, CHD, and CHF have a greater risk of death than individuals with dementia without these risk factors or diseases.",article;body mass;cardiovascular risk;cerebrovascular accident;congestive heart failure;dementia;diabetes mellitus;hazard ratio;heart infarction;human;hypercholesterolemia;hypertension;ischemic heart disease;mortality;obesity;risk assessment;sex;smoking,"Van De Vorst, I. E.;Koek, H. L.;De Vries, R.;Bots, M. L.;Reitsma, J. B.;Vaartjes, I.",2016,,,0,
4562,Prognosis of patients with dementia: Results from a prospective nationwide registry linkage study in the Netherlands,"Objective: To report mortality risks of dementia based on national hospital registry data, and to put these risks into perspective by comparing them with those in the general population and following cardiovascular diseases. Design: Prospective cohort study from 1 January 2000 through 31 December 2010. Setting: Hospital-based cohort. Participants: A nationwide hospital-based cohort of 59 201 patients with clinical diagnosis of dementia (admitted to a hospital or visiting a day clinic) was constructed (38.7% men, 81.4 years (SD 7.0)). Main outcomes and measures: 1-year and 5-year age-specific and sex-specific mortality risks were reported for patients with dementia visiting a day clinic compared with the general population; for patients hospitalised with dementia compared with patients hospitalised for acute myocardial infarction (AMI), heart failure or stroke, these were presented as absolute and relative risks (RRs). Results: 1-year mortality was 38.3% in men and 30.5% in women. 5-year risk was 65.4% and 58.5%, respectively. Mortality risks were significantly higher in patients with dementia admitted to the hospital than in those visiting a day clinic (1-year RR 3.29, 95% CI 3.16 to 3.42; and 5-year RR 1.79, 95% CI 1.76 to 1.83). Compared with the general population, mortality risks were significantly higher among patients visiting a day clinic (1-year RR for women 2.99, 95% CI 2.84 to 3.14; and for men 3.94, 95% CI 3.74 to 4.16). 5-year RRs were somewhat lower, but still significant. Results were more pronounced at younger ages. Mortality risks among admitted patients were comparable or even exceeded those of cardiovascular diseases (1-year RR for women with dementia vs AMI 1.24, 95% CI 1.19 to 1.29; vs heart failure 1.05, 95% CI 1.02 to 1.08; vs stroke 1.07, 95% CI 1.04 to 1.10). 5-year RRs were comparable. For men, RRs were slightly higher. Conclusions: Dementia has a poor prognosis as compared with other diseases and the general population. The risks among admitted patients even exceeded those following cardiovascular diseases.",acute heart infarction;adult;aged;article;cardiovascular disease;cause of death;cerebrovascular accident;cohort analysis;dementia;female;heart failure;human;major clinical study;male;middle aged;mortality;Netherlands;population;prognosis;prospective study;survival time,"Van De Vorst, I. E.;Vaartjes, I.;Geerlings, M. I.;Bots, M. L.;Koek, H. L.",2015,,,0,
4563,The epidemiology of chronic diseases and long-term care: results of a claims data-based study,"BACKGROUND: It is generally assumed that chronic diseases and multimorbidity increase the risk of long-term care. Nevertheless, a systematic study on the nature and the prevalence of those diseases associated with long-term care has not been yet undertaken in Germany. MATERIALS AND METHODS: The study was perfomed using claims data of one nationwide operating statutory health insurance company in 2006. Inclusion criteria were age >/= 65 years, minimum of 1 out of 46 diagnoses in a minimum of three quarters of the year (n = 8,678). A comparison group was formed with n = 114,962. We calculated prevalences and relative risks -using nominal regression- to determine influential factors on long-term care. RESULTS: A small number of diseases (e.g. dementia, urinary incontinence, chronic stroke and cardiac insufficiency) show high prevalences (> 20%) among long-term care users and at the same time great prevalence differences between users and non-users CONCLUSION: These data are important for improving medical and nursing care of long-term care users. Further research is needed with regard to the question by which mechanisms those diseases produce disability and frailty, thus leading to long-term care requirements.","Age Distribution;Aged;Aged, 80 and over;Chronic Disease/*epidemiology;Comorbidity;Dementia/*epidemiology;Female;Germany/epidemiology;Heart Failure/*epidemiology;Humans;Insurance Claim Review/statistics & numerical data;Long-Term Care/*statistics & numerical data;Male;National Health Programs/*statistics & numerical data;Prevalence;Risk Factors;Sex Distribution;Stroke/*epidemiology;Urinary Incontinence/*epidemiology","van den Bussche, H.;Heinen, I.;Koller, D.;Wiese, B.;Hansen, H.;Schafer, I.;Scherer, M.;Glaeske, G.;Schon, G.",2014,Jul,10.1007/s00391-013-0519-3,0,
4564,Reborn after calcium infusion,,alfacalcidol;calcium;aged;anamnesis;apraxia;article;attention disturbance;brain calcification;case report;computer assisted tomography;congestive heart failure;dementia;electrocardiogram;falling;female;globus pallidus;hair loss;hand tremor;human;hypocalcemia;idiopathic hypoparathyroidism;leg edema;leg muscle;memory disorder;mental concentration;mental function;Mini Mental State Examination;muscle cramp;muscle strength;neuroimaging;neurologic examination;outpatient department;paresthesia;Parkinson disease;parkinsonism;pneumonia;priority journal,"Van Den Hanenberg, F.;Kalisvaart, K.",2015,,,0,
4565,Which quality and outcomes framework (QOF) clinical indicators are applicable for British Forces Germany Health Service (BFG HS) primary care?,"OBJECTIVES: To determine which QOF clinical indicators are applicable for BFG HS primary care. METHOD: In depth cross-sectional survey of BFG HS general practitioners. Participants were requested to assess all 19 QOF clinical domains (80 clinical indicators) and to indicate to what extent these were applicable for BFG HS (Likert scale 1-5). Response rate was documented. Cronbach's alpha reliability was calculated and a comparison of the mean responses of training and non-training practices was made. RESULTS: The response rate was 80% (28/35). Cronbach's alpha was 0.91.The mean score for both training practices and non-training practices was 3.9. Based on the mean score the applicable indicators were (in descending order): Hypothyroidism (mean 4.6, 95% confidence interval 4.5-4.8), Hypertension (4.6, 4.5-4.8), Asthma (4.3, 4.2-4.5), Diabetes mellitus (4.3, 4.2-4.3), Obesity (4.1, 4.0-4.2), Chronic Heart Disease (4.1, 3.9-4.2), Epilepsy (4.0, 3.9-4.2) and Smoking (4.0, 3.7-4.2). Problematic were (descending means): Cancer (3.9, 3.6-4.2), Stroke and TIA (3.8, 3.7-4.0), Atrial fibrillation (3.6, 3.3-3.8), Learning disabilities (3.5, 3.1- 4.0), Chronic kidney disease (3.5, 3.3-3.8), Chronic Obstructive Pulmonary Disease (3.5, 3.3-3.7), Mental health (3.5, 3.3-3.6), Heart failure (3.4, 3.1-3.7), Depression (3.2, 2.8-3.5) and Palliative care (3.2, 2.7-3.6). Not applicable was Dementia (2.4, 2.0-2.8). CONCLUSION: This study shows that several but not all QOF clinical indicators are applicable in BFG HS. Therefore QOF cannot be directly transferred to BFH HS and an adapted quality framework is required.","Chronic Disease;Clinical Competence/standards/statistics & numerical data;Confidence Intervals;Cross-Sectional Studies;Germany;Great Britain;Humans;Military Medicine/*standards;Military Personnel/*statistics & numerical data;*Outcome Assessment (Health Care);Primary Health Care/*standards/statistics & numerical data;Quality Indicators, Health Care/*standards","van den Heuvel, H. G.;Simpson, R. G.",2008,Dec,,0,
4566,Risk of left ventricular dysfunction in patients with probable Alzheimer's disease with APOE*4 allele,"OBJECTIVE: To examine the association between the APOE genotype and cardiovascular disease in Alzheimer's disease (AD) patients. DESIGN: Case register study of 100 consecutive referrals to a Memory Clinic where type of dementia and cardiovascular comorbidity were diagnosed and APOE genotype was determined. SETTING: The Memory Clinic, University Hospital Rotterdam Dijkzigt. PARTICIPANTS: One hundred Memory Clinic patients, 59 to 91 years of age, who attended the Memory Clinic in the period between January 1994 and March 1996. MEASUREMENTS: Relative risk of cardiovascular morbidity in probable AD, based on clinical and ECG findings. RESULTS: The diagnosis of probable AD was more frequent in APOE*4 allele-carrying AD patients. When comparing homozygotes for APOE*4 with homozygotes for APOE*3, a nine-fold increase in prevalence of cardiac ischemia on ECG was found in the former. When grouping parameters of left ventricular dysfunction, the prevalence was 7.2 (95% confidence interval 1.2-42.6) times greater in probable Alzheimer patients with APOE4/4. CONCLUSIONS: In patients with probable AD, APOE*4 is associated with cardiac disease indicative of left ventricular dysfunction.","Aged;Aged, 80 and over;*Alleles;Alzheimer Disease/*complications/genetics;Apolipoproteins E/*genetics;Cardiovascular Diseases/complications;Female;Genotype;Humans;Male;Middle Aged;Odds Ratio;Risk Factors;Ventricular Dysfunction, Left/*complications","van der Cammen, T. J.;Verschoor, C. J.;van Loon, C. P.;van Harskamp, F.;de Koning, I.;Schudel, W. J.;Slooter, A. J.;Van Broeckhoven, C.;van Duijn, C. M.",1998,Aug,,0,
4567,"Relating cause of death with place of care and healthcare costs in the last year of life for patients who died from cancer, chronic obstructive pulmonary disease, heart failure and dementia: A descriptive study using registry data","BACKGROUND: The four main diagnostic groups for palliative care provision are cancer, chronic obstructive pulmonary disease, heart failure and dementia. But comparisons of costs and care in the last year of life are mainly directed at cancer versus non-cancer or within cancer patients. AIM: Our aim is to compare the care and expenditures in their last year of life for Dutch patients with cancer, chronic obstructive pulmonary disease, heart failure or dementia. DESIGN: Data from insurance company Achmea (2009-2010) were linked to information on long-term care at home or in an institution, the National Hospital Registration and Causes of Death-Registry from Statistics Netherlands. For patients who died of cancer ( n = 8658), chronic obstructive pulmonary disease ( n = 1637), heart failure ( n = 1505) or dementia ( n = 3586), frequencies and means were calculated, Lorenz curves were drawn up and logistic regression was used to compare patients with high versus low expenditures. RESULTS: For decedents with cancer and chronic obstructive pulmonary disease, the highest costs were for hospital admissions. For decedents with heart failure, the highest costs were for the care home (last 360 days) and hospital admissions (last 30 days). For decedents with dementia, the highest costs were for the nursing home. CONCLUSION: Patients with dementia had the highest expenditures due to nursing home care. The number of dementia patients will double by the year 2030, resulting in even higher economic burdens than presently. Policy regarding patients with chronic conditions should be informed by research on expenditures within the context of preferences and needs of patients and carers.",Healthcare expenditures;Netherlands;costs of dying;end-of-life care;hospital costs;long-term care;population ageing,"van der Plas, A. G.;Oosterveld-Vlug, M. G.;Pasman, H. R.;Onwuteaka-Philipsen, B. D.",2017,Apr,,0,
4568,"Dementia, Lower Respiratory Tract Infection, and Long-Term Mortality","Objective: To examine long-term mortality and its determinants in nursing home residents with dementia diagnosed with a lower respiratory tract infection (LRI). Setting and Patients: US (Missouri) nursing home residents (541) and Dutch residents (403) with dementia who were treated with antibiotics for an LRI. Methods: Prospective studies of nursing home-acquired LRI in the US (Missouri) and in the Netherlands. Measurements included demographics, indicators of acute illness, general health condition, intake problems, and comorbid disease. Six-month mortality rates were calculated and Cox proportional hazards models were developed for mortality up to 2 years after diagnosis. Results: Six-month mortality was 48.8% among Dutch residents and 36.4% among US residents. After multivariable adjustment, Dutch nationality was not associated with higher long-term mortality. Variables most strongly associated with long-term mortality were activity of daily living dependency and male gender. Other variables associated with outcome were diverse: respiratory difficulty, age, dehydration, congestive heart failure, decreased alertness, decubitus ulcers, Parkinson disease, weight loss/poor nutrition, and pulse rate. Conclusion: LRI is followed by substantial mortality in the months after diagnosis, indicating high frailty of nursing home residents with dementia who develop LRI. A variety of patient characteristics, including many not directly related to LRI, were consistently associated with long-term mortality in two cohorts with differing illness severity. The results are relevant for informing families, evaluating poor long-term survival in the context of care and treatment, and balancing the potential burdens and benefits of care. © 2007 American Medical Directors Association.",antibiotic agent;ADL disability;age;aged;article;cohort analysis;comorbidity;congestive heart failure;controlled study;decubitus;dehydration;dementia;demography;disease severity;female;human;lower respiratory tract infection;major clinical study;male;mortality;multivariate analysis;Netherlands;nursing home patient;Parkinson disease;proportional hazards model;prospective study;pulse rate;race difference;sex difference;survival rate;United States;vulnerable population;weight reduction,"van der Steen, J. T.;Mehr, D. R.;Kruse, R. L.;Ribbe, M. W.;van der Wal, G.",2007,,,0,
4569,Hypertensive Target Organ Damage and Longitudinal Changes in Brain Structure and Function: The Second Manifestations of Arterial Disease-Magnetic Resonance Study,"Hypertension has been related to structural and functional brain changes. In high-risk populations, hypertensive target organ damage might better represent exposure to high blood pressure than the blood pressure measurement itself. We examined the association of hypertensive target organ damage with longitudinal changes in brain structure and function within the Second Manifestations of Arterial Disease-Magnetic Resonance (SMART-MR) study. Renal function, albuminuria, and left ventricular hypertrophy on electrocardiography were measured in 663 patients with manifest arterial disease (mean age, 57±9 years; 81% men). Automated brain segmentation was used to quantify progression of global brain atrophy (change in brain parenchymal fraction) and progression of cerebral small vessel disease on 1.5T magnetic resonance imaging, and memory and executive functioning were assessed at baseline and after on average 3.9 years of follow-up. Regression analyses showed that an increasing number of signs of target organ damage was associated with more progression of global brain atrophy and more rapid decline in memory performance. Compared with no target organ damage, mean differences in change in brain parenchymal fraction (95% confidence interval) for 1 and ≥2 signs of organ damage were -0.12 (-0.30; 0.06) and -0.41 (-0.77; -0.05) % intracranial volume, and mean (95% confidence interval) differences in change in memory performance (z score) were -0.15 (-0.29; -0.00) and -0.27 (-0.54; -0.01). Results were independent of blood pressure, antihypertensive treatment, and other confounders. Hypertension target organ damage was not associated with progression of cerebral small vessel disease or change in executive functioning. Routinely assessed signs of hypertensive target organ damage, and in particular impaired renal function, could be used to identify patients at the highest risk of cognitive decline.",adult;aged;albuminuria;article;brain;brain atrophy;brain damage;brain function;brain structure;cerebrovascular disease;disease association;disease course;electrocardiography;executive function;female;follow up;heart left ventricle hypertrophy;human;hypertension;kidney function;major clinical study;male;memory;mental deterioration;nuclear magnetic resonance imaging;priority journal;risk assessment,"Van Der Veen, P. H.;Geerlings, M. I.;Visseren, F. L. J.;Nathoe, H. M.;Mali, W. P. T. M.;Van Der Graaf, Y.;Muller, M.;Algra, A.;Doevendans, P. A.;Grobbee, D. E.;Rutten, G. E. H. M.;Kappelle, L. J.;Moll, F. L.",2015,,,0,
4570,Brain volumes and risk of cardiovascular events and mortality. The SMART-MR study,"Brain atrophy is a strong predictor for cognitive decline and dementia, and these are, in turn, associated with increased mortality in the general population. Patients with cardiovascular disease have more brain atrophy and a higher morbidity and mortality. We investigated if brain volumes on magnetic resonance imaging were associated with the risk of cardiovascular events and mortality in patients with manifest arterial disease (n= 1215; mean age 58years). Automated brain segmentation was used to quantify intracranial volume, and volumes of total brain, sulcal cerebrospinal fluid, and ventricles. After a median follow-up of 8.3years, 184 patients died, 49 patients had an ischemic stroke, and 100 patients had an ischemic cardiac complication. Smaller relative brain volumes increased the risk of all-cause death (hazard ratio [HR] per standard deviation decrease in total brain volume: 1.58, 95% confidence interval [95% CI]: 1.33-1.88), vascular death (HR 1.69, 95% CI: 1.35-2.13), and ischemic stroke (HR 1.96, 95% CI: 1.43-2.69), independent of cardiovascular risk factors. These results suggest that brain volumes are an important determinant of poor outcome in patients with high cardiovascular risk. © 2014 Elsevier Inc.",adult;aged;artery disease;article;brain ischemia;brain size;cardiovascular mortality;cardiovascular risk;cause of death;cerebrospinal fluid;cohort analysis;disease association;female;gray matter;heart ejection fraction;heart muscle ischemia;high risk patient;human;major clinical study;male;nuclear magnetic resonance imaging;priority journal;prognosis;prospective study;risk assessment;systolic blood pressure;white matter;white matter lesion,"van der Veen, P. H.;Muller, M.;Vincken, K. L.;Mali, W. P. T. M.;van der Graaf, Y.;Geerlings, M. I.;Algra, A.;Doevendans, P. A.;Van der Graaf, Y.;Grobbee, D. E.;Rutten, G. E. H. M.;Kappelle, L. J.;Mali, W. P. T. M.;Moll, F. L.;Visseren, F. L. J.",2014,,,0,
4571,Dying from cancer or other chronic diseases in the Netherlands: ten-year trends derived from death certificate data,"BACKGROUND: For the further development of palliative care, it is relevant to gain insight into trends in non-acute mortality. The aim of this article is twofold: (a) to provide insight into ten-year trends in the characteristics of patients who died from cancer or other chronic diseases in the Netherlands; (b) to show how national death statistics, derived from physicians' death certificates, can be used in this type of investigations. METHODS: Secondary analysis of data from 1996 to 2006 on the ""primary"" or ""underlying"" cause of death from official death certificates filled out by physicians and additional data from 2003 to 2006 on the place of death from these certificates. RESULTS: Of the 135,000 people who died in the Netherlands in 2006, 77,000 (or 57%) died from a chronic disease. Cancer was the most frequent cause of death (40,000). Stroke accounted for 10,000 deaths, dementia for 8,000 deaths and COPD and heart failure each accounted for 6,000 deaths. Compared to 1996, the number of people who died from chronic diseases has risen by 6%.Of all non-acute deaths, almost three quarters were at least 70 years old when they died. Almost one third of the people died at home (31%), 28% in a hospital, 25% in a nursing home and 16% somewhere else. CONCLUSION: Further investments to facilitate dying at home are desirable. Death certificate data proved to be useful to describe and monitor trends in non-acute deaths. Advantages of the use of death certificate data concern the reliability of the data, the opportunities for selection on the basis of the ICD-10, and the availability and low cost price of the data.",,"van der Velden, L. F.;Francke, A. L.;Hingstman, L.;Willems, D. L.",2009,Feb 04,10.1186/1472-684x-8-4,0,
4572,Impaired Cardiac Function and Cognitive Brain Aging,"It is well established that patients with heart failure are at a greater risk for dementia. Recent evidence suggests that the heart-brain link goes beyond advanced heart failure, and even suboptimal cardiac function is associated with brain structural and functional changes leading to cognitive impairment. In this review, we address several pathophysiological mechanisms underlying this association, including hemodynamic stress and cerebral hypoperfusion, neuroinflammation, cardiac arrhythmias, and hypercoagulation. The close link between cardiac function and brain health has numerous clinical and public health implications. Cardiac dysfunction and cognitive impairment are both common in older adults. However, in our current clinical practice, these medical conditions are generally evaluated and treated in isolation. Emerging evidence on the significance of the heart-brain link calls for comprehensive cardiovascular risk assessment in patients with cognitive impairment and a neurocognitive workup in patients with impaired cardiac function. A multidisciplinary approach by cardiologists, neurologists, and geriatricians would benefit the diagnostic process and disease management and ultimately improve the quality of life for patients with cardiac and cognitive dysfunction.",aged;aging;brain;cardiologist;cardiovascular risk;clinical practice;cognitive defect;female;geriatrician;heart arrhythmia;heart failure;heart function;hemodynamic stress;human;male;nervous system inflammation;neurologist;perfusion;public health;quality of life;risk assessment;structure activity relation,"van der Velpen, I. F.;Yancy, C. W.;Sorond, F. A.;Sabayan, B.",2017,,10.1016/j.cjca.2017.07.008,0,
4573,Non-cardiovascular co-morbidity in elderly patients with heart failure outnumbers cardiovascular co-morbidity,"BACKGROUND: Patients with heart failure often suffer from multiple co-morbid conditions. However, until now only cardiovascular co-morbidity has been well described. AIMS: To understand heart failure in the context of multi-morbidity, by describing the age and sex specific patterns of non-cardiovascular co-morbidity in elderly patients with heart failure in general practice. METHODS: All patients aged 65 years and over, diagnosed with heart failure in four practices of the Nijmegen Academic Practice-based Research Network (NPBRN) between January 1999 and December 2003 were selected, and the prevalence of 27 cardio- and non-cardiovascular co-morbidities determined. RESULTS: Of the 269 patients identified (mean age 79 years; 57% women), 80.2% had four or more co-morbidities. With increasing age, a significant increase in the prevalence of non-cardiovascular conditions like visual and hearing impairments, osteoarthritis, dementia and urine incontinence; and a decrease in cardiovascular conditions like myocardial infarction and in women, hypertension, was observed. In patients aged 85 years and over, non-cardiovascular disorders predominated over cardiovascular disorders. CONCLUSIONS: In elderly patients with heart failure, the prevalence of non-cardiovascular co-morbidity is very high and exceeds the prevalence of cardiovascular conditions. Diseases such as dementia and osteoarthritis must be taken into account in the management of elderly patients with heart failure.","Aged;Aged, 80 and over;Cardiovascular Diseases/*epidemiology;Comorbidity;Cross-Sectional Studies;Family Practice;Female;Health Status Indicators;Heart Failure/*epidemiology;Humans;Incidence;Male;Netherlands;Registries","van der Wel, M. C.;Jansen, R. W.;Bakx, J. C.;Bor, H. H.;Olderikkert, M. G.;van Weel, C.",2007,Jun-Jul,10.1016/j.ejheart.2007.02.004,0,
4574,The efficacy and safety of ECT in depressed older adults: A literature review,"Background: Although little doubt exists among practising clinicians in old age psychiatry about the efficacy and safety of ECT in depression, opinions about acceptability differ widely. The objectives of this review were to determine the efficacy and safety of ECT based on both randomised and non-randomised evidence in elderly with a major depressive disorder. Methods: Randomised and non-randomised studies on efficacy and safety of ECT in elderly with and without concomitant disorders such as cerebrovascular disorders, Alzheimer's dementia, vascular dementia and Parkinson's disease were selected. Literature was systematically searched in a number of electronic databases. Results: Although 121 studies were included in the review process, only four provided randomised evidence. No negative studies with respect to efficacy were found. ECT is effective in the acute treatment of late life depression. ECT is generally safe, although a number of serious complications possibly related to ECT have been described. Most of the objectives of this review could not be answered or refuted with certainty, because firm randomised evidence on the efficacy and safety of ECT in the depressed elderly is missing. Conclusions: ECT is effective in the acute treatment of late life depression and is generally safe. Important questions such as the relative efficacy of ECT over antidepressants, the long-term efficacy of ECT, morbidity and mortality related to ECT, cost-effectiveness and the efficacy of ECT in subgroups of patients cannot be answered and need to be studied further. Copyright © 2003 John Wiley & Sons, Ltd.",antidepressant agent;aged;Alzheimer disease;anterograde amnesia;article;heart arrest;brain hemorrhage;cardiovascular disease;cerebrovascular disease;clinical trial;cognitive defect;confusion;controlled clinical trial;controlled study;cost effectiveness analysis;data base;dementia;depression;drug efficacy;dyskinesia;electroconvulsive therapy;heart arrhythmia;atrial fibrillation;heart infarction;human;hypertension;intoxication;long term care;major depression;memory disorder;morbidity;mortality;multiinfarct dementia;Parkinson disease;randomized controlled trial;safety;side effect;spinal cord compression;faintness;tachycardia;yawning,"Van Der Wurff, F. B.;Stek, M. L.;Hoogendijk, W. J. G.;Beekman, A. T. F.",2003,,,0,
4575,Cognitive Outcomes Five Years After Not Undergoing Coronary Artery Bypass Graft Surgery,"Background: Patients with coronary artery disease who underwent coronary artery bypass graft surgery have a high risk of cognitive decline 5 years after the procedure. It is conceivable that this is not caused by the operation, but by natural aging. Methods: Psychologists repeatedly administered a battery of seven neuropsychological tests with eight main variables to 112 subjects without known coronary artery disease, with a time interval of 5 years. Cognitive decline was defined as deterioration in performance beyond normal variation in at least two of the eight main variables. The incidence of cognitive decline in the control subjects was compared with the incidence of cognitive decline in the 281 participants of the Octopus Study, who underwent coronary artery bypass graft surgery 5 years earlier. Patients and control subjects were age-matched. Results: After 5 years, cognitive outcome could be determined in 99 of 112 control subjects (88%) and 240 of 281 coronary artery bypass graft surgery patients (85%). Cognitive decline was present in 82 (34.2%) of 240 coronary artery bypass graft surgery patients and in 16 (16.2%) of 99 control subjects (crude odds ratio, 2.69; 95% confidence interval, 1.48 to 4.90). However, after correction for differences in age, sex, education, and baseline comorbidity between the patients and the control subjects, the odds ratio was 1.37 (95% confidence interval, 0.65 to 2.92). Conclusions: We were unable to demonstrate that patients who underwent coronary artery bypass graft surgery have more cognitive decline after 5 years than control subjects without coronary artery disease. © 2008 The Society of Thoracic Surgeons.",adult;age distribution;aged;article;cognition;comorbidity;confidence interval;controlled study;coronary artery bypass graft;coronary artery disease;female;human;major clinical study;male;mental deterioration;neuropsychological test;outcome assessment;priority journal;psychologic assessment;psychologist;sex ratio;surgical patient;treatment refusal,"van Dijk, D.;Moons, K. G. M.;Nathoe, H. M.;van Aarnhem, E. H. L.;Borst, C.;Keizer, A. M. A.;Kalkman, C. J.;Hijman, R.",2008,,,0,
4576,C-reactive protein and cerebral small-vessel disease: The Rotterdam scan study,"Background-Inflammatory processes are involved in the development and consequences of atherosclerosis. Whether these processes are also involved in cerebral small-vessel disease is unknown. Cerebral white matter lesions and lacunar brain infarcts are caused by small-vessel disease and are commonly observed on MRI scans in elderly people. These lesions are associated with an increased risk of stroke and dementia. We assessed whether higher C-reactive protein (CRP) levels were related to white matter lesion and lacunar infarcts. Methods and Results-We based our study on 1033 participants of the population-based Rotterdam Scan Study for whom complete data on CRP levels were available and who underwent brain MRI scanning. Subjects were 60 to 90 years of age and free of dementia at baseline. Six hundred thirty-six subjects had a second MRI scan on average 3.3 years later. We used multivariate regression models to assess the associations between CRP levels and markers of small-vessel disease. Higher CRP levels were associated with presence and progression of white matter lesions, particularly with marked lesion progression (ORs for highest versus lowest quartile of CRP 3.1 [95% CI 1.3 to 7.2] and 2.5 [95% CI 1.1 to 5.6] for periventricular and subcortical white matter lesion progression, respectively). These associations persisted after adjustment for cardiovascular risk factors and carotid atherosclerosis. Persons with higher CRP levels tended to have more prevalent and incident lacunar infarcts. Conclusions-Inflammatory processes may be involved in the pathogenesis of cerebral small-vessel disease, in particular, the development of white matter lesions. © 2005 American Heart Association, Inc.",C reactive protein;aged;aging;article;blood sampling;brain;brain blood vessel;brain infarction;brain ischemia;cardiovascular disease;cerebrovascular disease;diagnostic accuracy;female;human;hypertension;major clinical study;male;microcirculation;Netherlands;neuroimaging;nuclear magnetic resonance imaging;priority journal;protein blood level;risk factor;white matter,"Van Dijk, E. J.;Prins, N. D.;Vermeer, S. E.;Vrooman, H. A.;Hofman, A.;Koudstaal, P. J.;Breteler, M. M. B.",2005,,,0,
4577,Progression of cerebral small vessel disease in relation to risk factors and cognitive consequences: Rotterdam scan study,"Background and Purpose: Cerebral white matter lesions and lacunar infarcts are small vessel disease-related lesions, which are associated with cognitive decline and dementia. We aimed to assess the relationship between risk factors, effect modifiers, and progression of these lesions. Furthermore, we studied the cognitive consequences of lesion progression. Methods: Six hundred sixty-eight people, aged 60 to 90 years, underwent repeated MRI scanning and neuropsychological testing within 3-year follow-up. We rated incident lacunar infarcts and change in periventricular and subcortical white matter lesion severity with a semiquantitative scale. We assessed the relationships between age, sex, baseline lesion load, risk factors, lesion progression, and change in cognitive function by multivariate regression analyses and additional stratified analyses. Results: Baseline lesion load, higher age, high blood pressure, and current smoking were independently associated with progression of white matter lesions. Women had more marked progression of subcortical white matter lesions and incident lacunar infarcts compared with men. Carotid atherosclerosis was associated with incident lacunar infarcts. Higher blood pressure did not contribute to lesion progression in people with already severe lesions at baseline nor in the very old. Lesion progression was associated with a paralleled decline in general cognitive function and in particular with a decreased information processing speed. Conclusions: Higher age, female sex, cigarette smoking, elevated blood pressure, and baseline lesion load were associated with small vessel disease progression. Age and baseline lesion load influenced the risk relations with blood pressure. Progression of small vessel disease was related to a paralleled decline in cognitive function. © 2008 American Heart Association, Inc.",adult;aged;article;atherosclerosis;brain blood vessel;brain infarction;cerebrovascular disease;smoking;cognition;controlled study;disease association;disease course;female;follow up;human;hypertension;major clinical study;male;multivariate analysis;neuropsychological test;nuclear magnetic resonance imaging;priority journal;risk factor;small vessel vasculitis;white matter,"Van Dijk, E. J.;Prins, N. D.;Vrooman, H. A.;Hofman, A.;Koudstaal, P. J.;Breteler, M. M. B.",2008,,,0,
4578,"Arterial oxygen saturation, COPD, and cerebral small vessel disease","Objective: To study whether lower arterial oxygen saturation (SaO 2) and chronic obstructive pulmonary disease (COPD) are associated with cerebral white matter lesions and lacunar infarcts. Methods: We measured SaO2 twice with a pulse oximeter, assessed the presence of COPD, and performed MRI in 1077 non-demented people from a general population (aged 60-90 years). We rated periventricular white matter lesions (on a scale of 0-9) and approximated a total subcortical white matter lesion volume (range 0-29.5 ml). All analyses were adjusted for age and sex and additionally for hypertension, diabetes, body mass index, pack years smoked, cholesterol, haemoglobin, myocardial infarction, and left ventricular hypertrophy. Results: Lower SaO 2 was independent of potential confounders associated with more severe periventricular white matter lesions (score increased by 0.12 per 1% decrease in SaO2 (95% confidence interval 0.01 to 0.23)). Participants with COPD had more severe periventricular white matter lesions than those without (adjusted mean difference in score 0.70 (95% confidence interval 0.23 to 1.16)). Lower SaO2 and COPD were not associated with subcortical white matter lesions or lacunar infarcts. Conclusion: Lower SaO 2 and COPD are associated with more severe periventricular white matter lesions.",adult;age distribution;aged;arterial oxygen saturation;article;body mass;brain infarction;brain injury;chronic obstructive lung disease;smoking;controlled study;dementia;diabetes mellitus;disease severity;female;heart infarction;heart ventricle hypertrophy;hemoglobin determination;human;hypertension;major clinical study;male;mass screening;nuclear magnetic resonance imaging;priority journal;pulse oximetry;scoring system;sex ratio;white matter,"Van Dijk, E. J.;Vermeer, S. E.;De Groot, J. C.;Van De Minkelis, J.;Prins, N. D.;Oudkerk, M.;Hofman, A.;Koudstaal, P. J.;Breteler, M. M. B.",2004,,,0,
4579,Admission From Nursing Home Residence Increases Acute Mortality After Hip Fractures,"Background: Little is known about the effect of preinjury residence on inpatient mortality following hip fracture. This study addressed whether (1) admission from a nursing home residence and (2) admission from another hospital were associated with higher inpatient mortality after a hip fracture. Methods: Using the National Hospital Discharge Survey database, we analyzed an estimated 2 124 388 hip fractures discharges, from 2001 to 2007. Multivariable logistic regression analysis was performed to identify whether admission from a nursing home and admission from another hospital were independent risk factors for inpatient mortality. Our primary null hypothesis is that there is no difference in inpatient mortality rates after hip fracture in patients admitted from a nursing home, compared to other forms of admission. The secondary null hypothesis is that there is no difference in inpatient mortality after hip fracture in patients whose source of admission was another hospital, compared to other sources of admission. Results: Almost 4% of the patients were admitted from a nursing home and 6% from another hospital. The mean age was 79 years and 71% were women. The majority of patients were treated with internal fixation. Admission from a nursing home residence (odds ratio [OR] of 2.1, confidence interval [CI] 1.9-2.3) and prior hospital stay (OR 3.4, CI 3.2-3.7) were associated with a higher risk of inpatient mortality after accounting for other comorbidities and type of treatment. Conclusions: Patients transferred to an acute care hospital from a long-term care facility or another acute care hospital are at particularly high risk of inpatient death. This subset of patients should be considered separately from patients admitted from other sources. Level of Evidence: Prognostic level II.",acute kidney failure;adult;aged;anemia;article;atrial fibrillation;cervical spine fracture;chronic kidney disease;chronic lung disease;congestive heart failure;dementia;diabetes mellitus;female;gender;hip arthroplasty;hip fracture;hospital admission;hospitalization;human;hypertension;lung embolism;lung insufficiency;major clinical study;male;mental disease;mortality;nursing home patient;nutritional deficiency;osteoporosis;osteosynthesis;priority journal;risk factor;transfusion;very elderly,"van Dijk, P. A. D.;Bot, A. G. J.;Neuhaus, V.;Menendez, M. E.;Vrahas, M. S.;Ring, D.",2015,,,0,
4580,The nature of excess mortality in nursing home patients with dementia,"Survival and excess mortality in 606 dementia patients admitted to a psychogeriatric nursing home were analyzed in a historical prospective 8-year follow up. The overall 2-year survival rate after admission was 55%, 60% for women and 39% for men. Patients with senile dementia of the Alzheimer's type had higher 2-year survival rates than those with multi-infarct dementia (57% vs 41%). Physical impairment, inactivity, dependency as measured on an observational scale, and comorbidity had an adverse effect on survival. Diseases with the lowest two-year survival were myocardial infarction, heart failure, atrial fibrillation, parkinsonism, pulmonary infection, anemia, pressure sores, and malignancies. The mortality rates of dementia patients were higher than those of the general population, especially during the first months after admission. This excess mortality of dementia patients was better described by an additive than by a multiplicative factor, suggesting that dementia can primarily be regarded as an independent, competing mortality risk.","Aged;Aged, 80 and over;Comorbidity;Dementia/*mortality;Female;Humans;Male;Netherlands/epidemiology;*Nursing Homes;Survival Analysis","van Dijk, P. T.;van de Sande, H. J.;Dippel, D. W.;Habbema, J. D.",1992,Mar,,0,
4581,Comorbidity and 1-year mortality risks in nursing home residents,"OBJECTIVES: To investigate the effect of chronic diseases and disease combinations on 1-year mortality in nursing home residents. DESIGN: Retrospective cohort study using electronically submitted Minimum Data Set (MDS) information and Missouri death certificate data. SETTING: Five hundred twenty-two nursing homes in Missouri. PARTICIPANTS: Forty-three thousand five hundred ten nursing home residents with a full MDS assessment in 1999. MEASUREMENTS: Information about chronic diseases, age, sex, and performance in activities of daily living (ADLs) available from the first full MDS 2.0 assessment in 1999; death within 1 year after the first full MDS-assessment in 1999. RESULTS: After adjustment for age and sex, eight variables were predictive for 1-year mortality: seven chronic diseases (dementia, cancer, heart failure, renal failure, emphysema/chronic obstructive pulmonary disease, diabetes mellitus, and anemia) and an interaction variable containing age and cancer. Adding terms for disease combinations (e.g., diabetes mellitus and heart failure) did not enhance survival prediction. When there was also adjustment for ADL performance as measured using the MDS-ADL Short Form, dementia and anemia were not included, because they had no prognostic value above that of the other variables. CONCLUSION: Several chronic diseases were associated with 1-year mortality in the institutionalized elderly after adjustment for ADL performance, age, and sex. Evidence of a synergistic effect of disease combinations on mortality is lacking. © 2005 by the American Geriatrics Society.",aged;anemia;article;neoplasm;chronic disease;chronic obstructive lung disease;cohort analysis;comorbidity;controlled study;daily life activity;dementia;diabetes mellitus;emphysema;female;heart failure;human;kidney failure;major clinical study;male;mortality;nursing home;prognosis;retrospective study;survival,"Van Dijk, P. T. M.;Mehr, D. R.;Ooms, M. E.;Madsen, R.;Petroski, G.;Frijters, D. H.;Pot, A. M.;Ribbe, M. W.",2005,,,0,
4582,Outcome after hemi-arthroplasty for displaced intracapsular femoral neck fracture related to mental state,"This study was performed to assess mortality and functional outcome after hemi-arthroplasty for displaced intracapsular femoral neck fractures in relation to mental state. Between 1991 and 1995, 202 consecutive patients over 70 years of age were followed for at least two years or until death. Thirty-nine patients were known with senile dementia at the time of admission. The four-month mortality rate was 11.7% for the mentally normal patients and 33.3% for the mentally impaired patients. After one year the mortality rate was 19.6% for the mentally normal patients and 43.6% for the mentally impaired patients. This difference is statistically significant (p<0.001). Of the 141 surviving mentally normal patients, who had been mobile before operation, 16 (11.3%) were not mobile four months after operation. Of the 24 surviving mentally impaired patients, who had been mobile before operation, 18 (75.0%) were not mobile four months after operation. This difference is statistically significant (p<0.001). The conclusion of our study is that mental state has a statistically significant effect on mortality and functional outcome after hemi-arthroplasty for displaced intracapsular femoral neck fractures. For demented patients, hemi-arthrplasty is a too major operation and less invasive methods of internal fixation should be considered. Copyright (C) 2000 Elsevier Science Ltd.",aged;arthroplasty;article;cardiopulmonary insufficiency;cerebrovascular accident;decubitus;disability;female;femur neck fracture;hematoma;human;major clinical study;male;mental health;mortality;postoperative complication;priority journal;quality of life;risk factor;senile dementia;treatment outcome;urinary tract infection;wound dehiscence;wound infection,"Van Dortmont, L. M. C.;Douw, C. M.;Van Breukelen, A. M. A.;Laurens, D. R.;Mulder, P. G. H.;Wereldsma, J. C. J.;Van Vugt, A. B.",2000,,,0,
4583,Direction on guidelines: Plans for guideline development in the Netherlands,,angina pectoris;asthma;cerebrovascular accident;chronic obstructive lung disease;dementia;diabetes mellitus;disability;evidence based practice;heart failure;heart infarction;human;mortality;Netherlands;note;pneumonia;practice guideline;transient ischemic attack,"Van Everdingen, J. J. E.;Dreesens, D. H. H.;Tuut, M. K.",2010,,,0,
4584,Study findings hard to interpret,,Antipsychotic Agents/*therapeutic use;Cholinesterase Inhibitors/*therapeutic use;Dementia/*drug therapy;Female;Humans;Male;Myocardial Infarction/*chemically induced/*epidemiology,"van Hout, H. P.;van Marwijk, H. W.;van der Wouden, J. C.",2012,Oct 8,10.1001/archinternmed.2012.3764,0,
4585,Male-specific association between a gamma-secretase polymorphism and premature coronary atherosclerosis,"BACKGROUND: Atherosclerosis is a common multifactorial disease resulting from an interaction between susceptibility genes and environmental factors. The causative genes that contribute to atherosclerosis are elusive. Based on recent findings with a Wistar rat model, we speculated that the gamma-secretase pathway may be associated with atherosclerosis. METHODOLOGY/PRINCIPAL FINDINGS: We have tested for association of premature coronary atherosclerosis with a non-synonymous single-nucleotide polymorphism (SNP) in the gamma-secretase component APH1B (Phe217Leu; rs1047552), a SNP previously linked to Alzheimer's disease. Analysis of a Dutch Caucasian cohort (780 cases; 1414 controls) showed a higher prevalence of the risk allele in the patients (odds ratio (OR) = 1.35), albeit not statistically different from the control population. Intriguingly, after gender stratification, the difference was significant in males (OR = 1.63; p = 0.033), but not in females (OR = 0.50; p = 0.20). Since Phe217Leu-mutated APH1B showed reduced gamma-secretase activity in mouse embryonic fibroblasts, the genetic variation is likely functional. CONCLUSION/SIGNIFICANCE: We conclude that, in a male-specific manner, disturbed gamma-secretase signalling may play a role in the susceptibility for premature coronary atherosclerosis.","Adult;Age of Onset;Amino Acid Substitution;Animals;Cell Line;Cohort Studies;Coronary Artery Disease/epidemiology/*genetics;European Continental Ancestry Group/genetics;Female;Fibrinogen/analysis;Fibroblasts/metabolism;Humans;Male;Membrane Proteins/*genetics/metabolism;Mice;Middle Aged;Netherlands/epidemiology;Peptide Hydrolases;*Polymorphism, Single Nucleotide;Prevalence;Recombinant Fusion Proteins/metabolism;Risk Factors;Sex Distribution;Sex Factors;Substrate Specificity","van Loo, K. M.;Dejaegere, T.;van Zweeden, M.;van Schijndel, J. E.;Wijmenga, C.;Trip, M. D.;Martens, G. J.",2008,,10.1371/journal.pone.0003662,0,
4586,Lipoprotein-associated phospholipase A2 is associated with risk of dementia,"OBJECTIVE: High levels of the inflammatory marker lipoprotein-associated phospholipase A2 (Lp-PLA2) have been proposed to be a predictor of coronary heart disease and stroke. Because both inflammation and vascular disease are associated with dementia, the objective of the present study was to examine the association between Lp-PLA2 and the risk of dementia. METHODS: Within the Rotterdam Study, a population-based prospective cohort study, we performed a case-cohort study. Of the 6,713 participants at risk for dementia, a random sample of 1,742 individuals was drawn. During follow-up (mean, 5.7 years), 302 incident dementia cases were identified. Cox proportional hazard models were used to estimate the association of Lp-PLA2 and dementia. RESULTS: We found that subjects with higher levels of Lp-PLA2 had an increased risk of dementia. Compared with the first quartile of Lp-PLA2, age- and sex-adjusted hazard ratios (HRs; 95% confidence interval [CI]) for dementia for the second, third, and fourth quartiles were 1.19 (0.78-1.81), 1.15 (0.74-1.79), and 1.56 (1.03-2.37), respectively (p value for trend 0.04). Additional adjustment for cardiovascular and inflammatory factors did not change the estimates. INTERPRETATION: This is the first study to our knowledge that shows that Lp-PLA2 is associated with the risk of dementia independent of cardiovascular and inflammatory factors and provides evidence for a potential role of Lp-PLA2 in identifying subjects at risk for dementia.",1-Alkyl-2-acetylglycerophosphocholine Esterase;Aged;Cohort Studies;Dementia/*metabolism;Female;Humans;Male;Middle Aged;Phospholipases A/*blood;Phospholipases A2;Proportional Hazards Models;Random Allocation;Risk Factors,"van Oijen, M.;van der Meer, I. M.;Hofman, A.;Witteman, J. C.;Koudstaal, P. J.;Breteler, M. M.",2006,Jan,10.1002/ana.20721,0,
4587,Welcome to Progress in Stem Cell: Editorial,"Welcome to the new open access journal Progress in Stem Cell, edited by Dr. Phuc Van Pham, and Dr. Ngoc Kim Phan, of Vietnam National University, Ho Chi Minh city, Vietnam. Progress in Stem Cell (ISSN 2199-4633) is the Open Access journal that acts as a forum for translational research into stem cell therapies. Progress in Stem Cell is scientific journal that overlays the study of cancer stem cells, stem cell therapy, stem-cell transplantation, human embryonic stem cells, neural stem cells, murine embryonic stem cells, adult stem cell.. Progress in Stem Cell is a peer-reviewed journal that focuses on the areas of established and emerging concepts in stem cell research and their assorted disease therapies.",Alzheimer disease;article;cancer stem cell;cell differentiation;cell proliferation;diabetes mellitus;embryonic stem cell;gene mutation;heart failure;human;Huntington chorea;neural stem cell;nuclear reprogramming;osteoarthritis;Parkinson disease;stem cell;stem cell transplantation;tissue engineering,"Van Pham, P.;Kim Phan, N.",2014,,,0,
4588,Medical conditions of nursing home admissions,"BACKGROUND: As long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Although need factors have a strong impact on nursing home (NH) admission, the diseases causing these functional disabilities are lacking or unclear in the residents' file. We investigated the medical reason (primary diagnosis) of a nursing home admission with respect to the underlying disease. METHODS: This study is based on two independent, descriptive and comparative studies in Belgium and was conducted at two time points (1993 and 2005) to explore the evolution over twelve years. Data from the subjects were extracted from the resident's file; additional information was requested from the general practitioner, nursing home physician or the head nurse in a face-to-face interview. In 1993 we examined 1332 residents from 19 institutions, and in 2005 691 residents from 7 institutions. The diseases at the time of admission were mapped by means of the International Classification of Diseases--9th edition (ICD-9). Longitudinal changes were assessed and compared by a chi-square test. RESULTS: The main chronic medical conditions associated with NH admission were dementia and stroke. Mental disorders represent 48% of all admissions, somatic disorders 43% and social/emotional problems 8%. Of the somatic disorders most frequently are mentioned diseases of the circulatory system (35%) [2/3 sequels of stroke and 1/5 heart failure], followed by diseases of the nervous system (15%) [mainly Parkinson's disease] and the musculoskeletal system (14%) [mainly osteoarthritis]. The most striking evolution from 1993 to 2005 consisted in complicated diabetes mellitus (from 4.3 to 11.4%; p < 0.0001) especially with amputations and blindness. Symptoms (functional limitations without specific disease) like dizziness, impaired vision and frailty are of relevance as an indicator of admission. CONCLUSION: Diseases like stroke, diabetes and mobility problems are only important for institutionalisation if they cause functional disability. Diabetes related complications as cause of admission increased almost three-fold between 1993 and 2005.","Aged;Aged, 80 and over;Belgium/epidemiology;Data Collection/trends;Dementia/complications/*epidemiology;Diabetes Complications/*epidemiology;Female;Homes for the Aged/*trends;Humans;Longitudinal Studies;Male;Nursing Homes/*trends;Patient Admission/*trends;Stroke/complications/*epidemiology","Van Rensbergen, G.;Nawrot, T.",2010,Jul 14,10.1186/1471-2318-10-46,0,
4589,Experimentally induced vitamin E selenium deficiency in the growing dog,,alpha tocopherol;aspartate aminotransferase;creatine kinase;selenium;sodium selenite;cell degeneration;diet;dog;drug deficiency;drug determination;edema;endocardium;heart;heart muscle;heart muscle necrosis;histology;kidney;liver;malnutrition;microscopy;muscle;muscle cell;muscle disease;muscle weakness;neuronal ceroid lipofuscinosis;oral drug administration;plasma;regeneration;subcutaneous tissue;theoretical study,"Van Vleet, J. F.",1975,,,0,
4590,"A delirium? Admission to a general hospital, not to a psychiatric one","Delirium is often not recognized either by psychiatrists or by other physicians. In two men, aged 78 and 70 years, a diagnosis of delirium was not recognized at admission. The first patient had Alzheimer's disease with superimposed delirium caused by pulmonary embolism, which led to cardiopulmonary arrest during his stay in a psychiatric hospital. The other patient had a delirium due to multiple somatic causes (carbon monoxide poisoning with cerebral damage, pulmonary infection, heart attack) which was not recognized leading to an early discharge from the general hospital. The first patient died later on because of complications of a pneumonia and the other patient was transferred to a nursing home on a maintenance dose of haloperidol. Since delirium is a symptom of a medical disorder, delirious patients should be referred primarily to a general hospital.",haloperidol;aged;Alzheimer disease;article;brain injury;carbon monoxide intoxication;case report;delirium;diagnostic error;heart infarction;hospitalization;human;lung embolism;lung infection;male,"Van Waarde, J. A.;Van der Mast, R. C.",2000,,,0,
4591,Reasons for non-response in observational pharmacogenetic research,"Purpose: In epidemiological studies, non-response may introduce bias and limit generalizability. In genetic pharmacoepidemiological research, collection of DNA might be a major reason for non-response.We determined reasons for non-response and compared characteristics of non-responders and responders in a pharmacogenetic case-control study. Methods: Myocardial infarction (MI) cases and controls, who were antihypertensive drug users, were recruited through community pharmacies that participate in the Pharmaco-Morbidity-Record-Linkage- System (PHARMO). The PHARMO database comprises drug dispensing histories of about 2 000 000 subjects from a representative sample of Dutch community pharmacies linked to the national registry of hospital discharges. Independent samples t-test and ANOVA-statistics were used to analyse the differences in continuous variables between responders and non-responders. χ2 statistics and logistic regression were used to compare categorical variables. Results: We approached 1871 cases and 14 102 controls of whom 794 MI cases (42.4%) and 4997 controls (35.4%) responded. We could not approach 2194 patients of whom 63.1% had died and 31.2% moved to another pharmacy. Main reasons for non-response were health problems or hospital stays (16.2%, OR 1.47; 95%CI: 1.00-2.16). Other reasons were old age or dementia (16.9%, OR 1.82; 95%CI: 1.24-2.65). Only a small percentage (1.1%, OR 1.43; 95%CI: 0.41-5.03) mentioned DNA sampling as a reason. About 30% of the non-responders did not give a reason. Women were statistically significantly (p<0.0005) less willing to participate than men (38.8% versus 31.3%). An association with age was also found (mean age 64.6 versus 66.5 yrs) ( p<0.0005). Conclusion: In a pharmacogenetic case-control study fear for genetic screening was not a major reported reason for non-response. Females were less willing to participate than males. Copyright © 2009 John Wiley & Sons, Ltd.",angiotensin 2 receptor antagonist;antihypertensive agent;beta adrenergic receptor blocking agent;calcium antagonist;dipeptidyl carboxypeptidase inhibitor;thiazide diuretic agent;age;aged;article;case control study;controlled study;dementia;DNA determination;drug utilization;fear;female;genetic screening;heart infarction;hospital discharge;hospitalization;human;hypertension;major clinical study;male;medical research;observational study;patient attitude;patient information;pharmacoepidemiology;pharmacogenetics;pharmacy;priority journal;public health problem;research subject;sex difference,"Van Wieren-de Wijer, D. B. M. A.;Maitland-van Der Zee, A. H.;De Boer, A.;Kroon, A. A.;De Leeuw, P. W.;Schiffers, P.;Janssen, R. G. J. H.;Psaty, B. M.;Van Duijn, C. M.;Stricker, B. H. C.;Klungel, O. H.",2009,,,0,
4592,Should we treat mild subclinical/mild hyperthyroidism? No,"The management of a patient with subclinical hyperthyroidism or mild thyroid over-activity is controversial. Subclinical hyperthyroidism is defined as a serum thyrotrophin (TSH) below the reference range but a normal thyroxine (T4) and triiodothyronine (T3) level in a patient who is either asymptomatic or has only non-specific symptoms. Epidemiological studies report an overall prevalence of approximately 3%, with men and women over 65 years and those in iodine deficient regions having the highest prevalence. Approximately 50% of subjects are taking levothyroxine. The aetiology for those with endogenous subclinical hyperthyroidism is Graves' disease, toxic nodular goitre or rarely a solitary toxic adenoma or thyroiditis. Non-thyroidal illness is an important cause of false positive low serum TSH test results. Subjects with low but detectable serum TSH values (0.1-0.4 mU/L) usually recover spontaneously when re-tested. It has been estimated that in those with an undetectable serum TSH (< 0.1 mU/L) conversion to overt hyperthyroidism occurs at a rate up to 5% per year. Advocates of intervening for subclinical hyperthyroidism argue that early treatment might reduce mortality, prevent the later development of atrial fibrillation, osteoporotic fractures, and overt hyperthyroidism but data supporting improvement in outcomes are sparse. No appropriately powered prospective, randomised, controlled, double-blinded trial of intervention for subclinical hyperthyroidism exists. For the vast majority of patients adopting a ""wait and see"" policy rather than intervention may avoid unnecessary treatment or the potential for harm. Any potential benefits of therapy in subclinical hyperthyroidism must be weighed against the significant morbidity associated with the treatment of hyperthyroidism. © 2011 European Federation of Internal Medicine.",antithyroid agent;levothyroxine;liothyronine;radioactive iodine;thionamide derivative;thyroid hormone;thyrotropin;thyroxine;adenoma;Alzheimer disease;angina pectoris;article;cognitive defect;diagnostic accuracy;disease association;disease exacerbation;dose response;drug fatality;drug safety;evidence based medicine;false positive result;fragility fracture;gold standard;Graves disease;atrial fibrillation;heart palpitation;hormonal therapy;hormone substitution;human;hyperthyroidism;hypothyroidism;iodine deficiency;liothyronine blood level;nervousness;nodular goiter;osteoporosis;phase 2 clinical trial;recurrent disease;risk factor;side effect;subclinical hyperthyroidism;subclinical hypethyroidism;surgical technique;therapy delay;thyroiditis;thyrotoxicosis;thyrotropin blood level;thyroxine blood level;toxic goiter;treatment indication,"Vanderpump, M. P. J.",2011,,,0,
4593,"Malnutrition and associated factors in elderly hospital patients: A Belgian cross-sectional, multi-centre study","Background & aims: In Belgium, general data on the prevalence of malnutrition are lacking. Prevalence rates are necessary to gain insight into the magnitude of malnutrition and to establish a nutrition policy that takes the limited health care resources into account. This study aimed to obtain insight into the prevalence of malnutrition in Belgian elderly hospital wards and to identify factors associated with the malnutrition prevalence. Methods: A cross-sectional, multi-centre study in elderly wards of Belgian hospitals. The nutritional status was assessed using the Mini Nutritional Assessment. A standardised questionnaire was used to record demographic data and data on potential factors associated with malnutrition. Results: Out of 2329 elderly patients, 33% suffered from malnutrition. Almost 43% of the patients were at risk of malnutrition and 24% were well-nourished. Having swallowing difficulties, taste difficulties, and being transferred from a nursing home were strongly associated with being malnourished. Conclusion: The malnutrition prevalence in Belgian elderly hospitals wards is similar to international figures. Elderly who have swallowing difficulties, taste difficulties, or coming from a nursing home may need adequate nutritional care. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy. © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.",aged;article;Belgium;controlled study;cross-sectional study;delirium;dementia;demography;depression;diabetes mellitus;dysphagia;elderly care;female;heart failure;hospital patient;human;major clinical study;male;malnutrition;morbidity;mortality;nursing home;nutritional assessment;nutritional health;nutritional status;prevalence;questionnaire;risk assessment;taste disorder,"Vanderwee, K.;Clays, E.;Bocquaert, I.;Gobert, M.;Folens, B.;Defloor, T.",2010,,,0,
4594,Use of metalonin for cardiovascular disease/Myocardial ischemia-reperfusion injury and metatonin 9,,beta adrenergic receptor blocking agent;calcium antagonist;captopril plus hydrochlorothiazide;melatonin;Alzheimer disease;angina pectoris;blood pressure;cardiovascular disease;circadian rhythm;colon cancer;coronary artery;diastolic blood pressure;heart infarction prevention;heart muscle ischemia;human;hypertension;jet lag;letter;myocardial hibernation;prostate cancer;protein synthesis;reperfusion injury;stunned heart muscle;syndrome X;systolic blood pressure,"Vardar, S. A.",2006,,,0,
4595,Response to: Angiotensin receptor blockers in hypertension: The emerging role in diabetes mellitus 3,,angiotensin II;angiotensin receptor antagonist;antihypertensive agent;atenolol;irbesartan;losartan;valsartan;Alzheimer disease;blood pressure regulation;cardiovascular disease;clinical trial;cognitive defect;cost of illness;diabetes mellitus;diabetic nephropathy;diet therapy;electrocardiogram;health care planning;health survey;atrial fibrillation;heart left ventricle hypertrophy;human;hypertension;letter;life expectancy;microalbuminuria;mortality;multiinfarct dementia;pathophysiology;prevalence;priority journal;proteinuria;cerebrovascular accident;treatment outcome;United Kingdom,"Varughese, G. I.;Scarpello, J. H. B.",2006,,,0,
4596,Venous thromboembolism in nonagenarians. Findings from the RIETE Registry,"The balance between the efficacy and safety of anticoagulant therapy in patients aged >/=90 years with venous thromboembolism (VTE) is uncertain. RIETE is an ongoing, prospective registry of consecutive patients with acute, objectively confirmed, symptomatic VTE. We evaluated the efficacy and safety of anticoagulant therapy during the first three months in all patients aged >/=90 years. In addition, we tried to identify those at a higher risk for VTE. Of 21,873 patients enrolled from March 2001 to February 2008, 610 (2.8%) were aged >/=90 years. Of these, 307 (50%) presented with pulmonary embolism (PE), 240 (39%) had immobility >/=4 days, and 271 (44%) had abnormal creatinine levels. During the first three months of therapy, 140 patients aged >/=90 years (23%) died. Of these, 45 (32%) died of PE (34 of the initial episode, 11 of recurrent PE), 18 (13%) had fatal bleeding. Recent immobility >/=4 days was the most common risk factor for VTE (240 of 610 patients, 39%), but only 54 of them (22%) had received thromboprophylaxis. The most frequent causes for immobility were senile dementia, acute infection, trauma or decompensated heart failure. The duration of immobility was <4 weeks in 126 patients (52%), and most of them were bedridden at home. In conclusion, one in every four VTE patients aged >/=90 years died during the first three months of therapy. Of these, one in every three died of PE, one in every eight had fatal bleeding. Identifying at-risk patients may help to prevent some of these deaths.","Adolescent;Adult;*Age Factors;Aged;Aged, 80 and over;Anticoagulants/*administration & dosage/adverse effects;Child;Female;Hemorrhage/chemically induced/mortality/prevention & control;Heparin/*administration & dosage/adverse effects;Humans;Male;Middle Aged;*Registries;Risk Factors;Spain;Survival Rate;Treatment Outcome;Venous Thromboembolism/drug therapy/mortality/*physiopathology;Vitamin K/antagonists & inhibitors","Vasco, B.;Villalba, J. C.;Lopez-Jimenez, L.;Falga, C.;Montes, J.;Trujillo-Santos, J.;Monreal, M.",2009,Jun,,0,
4597,Fatal Hepatitis C in a Renal Transplant Recipient on Immunosuppression,,alanine aminotransferase;alkaline phosphatase;aspartate aminotransferase;azathioprine;bilirubin;corticosteroid;mycophenolate mofetil;tacrolimus;thymocyte antibody;virus RNA;adult;alanine aminotransferase blood level;alkaline phosphatase blood level;aspartate aminotransferase blood level;autopsy;bilirubin blood level;case report;chronic glomerulonephritis;chronic kidney disease;cognitive defect;fatality;feces color;flapping tremor;graft recipient;heart arrest;hepatic encephalopathy;hepatitis C;histopathology;hospital admission;human;hypotension;immunosuppressive treatment;jaundice;kidney transplantation;male;mental deterioration;neurologic examination;note;pallor;priority journal;pruritus;thrombocytopenia;urine color;West Haven criteria,"Vasishta, R.;Kakkar, N.;Duseja, A. K.;Dhiman, R. K.",2012,,,0,
4598,The effectiveness of individual self-control and self-care skills training programs in chronic heart failure patients,"The aim of the study was to evaluate the impact of individual selfcontrol and self-care skill training programs and group learning on frequency and duration of hospitalization in patients with heart failure. Methods: 120 patients with heart failure (NYHA II-IV, mean age 62.8+/- 9.8, ischemic etiology in combination with hypertension) participated in the study. Inclusion criteria were the presence of clinical signs of heart failure II-IV functional class NYHA, drug therapy in accordance with the European standards of heart failure treatment for at least 1 month, and informed consent of the patient. Exclusion criteria were acute coronary syndrome, decompensation of concomitant disease, alcohol dependence, dementia, and inability to carry out therapeutic training. Patients were randomized to three (the 1st, the 2nd and control) groups. In the 1st group patients were trained on the individual programs that took into account the level of patients' health literacy, patients from the 2nd group attended lectures, patients from the control group were not trained. The duration of observation periodwas 6 months. The combined end point for the evaluation of the effectiveness of individual programs and group learning was the rate of heart failure decompensations and hospitalizations associated with them. Duration of hospitalizations was also estimated. Results: Initially groups of patients were comparable on age, sex, severity and duration of heart failure, and presence of comorbidity. During the observation time in the 1st group 6 patients (15% (95% confidence interval (CI): 5.5%-28.0%, p = 0.05)) were hospitalized, in the 2nd - 13 (32.5% (95%CI: 18.7%- 48.1%, p = 0.05)) in the control - 19 (47.5% (95%CI: 31.9%-63.3%, p =0.05)). The statistically significant differences were found between the 1st group and the control (chi<sup>2</sup>=8.9, p=0.012). This suggests that patients who were taught according to the individual programs, were hospitalized rarely compared to the control group. The number of hospitalized patients in the 2nd and control groups was not statistically significantly different (chi<sup>2</sup> = 1.3, p = 0.519). The number of heart failure decompensations in the 1st group was 7, in the 2nd - 15, in the control - 23. The average amount of heart failure decompensations of one patient from the 1st group was significantly less in comparison with the control (p < 0.01). In the 2nd group it did not differ from the control (p > 0.05). The total duration of hospitalizations in the 1st group was 94 days, in the 2nd - 200, in the control - 311. The average duration of one patient hospitalization in the 1st group was significantly less in comparison with the control (p < 0.01). In the 2nd group the average duration of one patient hospitalization did not differ from the control group (p > 0.05). Conclusions: Thus, individual self-control and self-care skill training programs that took into account the level of patients' health literacy in heart failure were more effective than group sessions, and could reduce frequency and duration of hospitalizations.",self care;skill;training;heart failure;patient;human;internal medicine;self control;hospitalization;control group;learning;health literacy;comorbidity;dementia;alcoholism;acute coronary syndrome;hypertension;informed consent;drug therapy;confidence interval;hospital patient;etiology;New York Heart Association class,"Vatutin, Nt;Yeshchenko, Ev",2013,,10.1016/j.ejim.2013.08.048,0,4599
4599,The effectiveness of individual self-control and self-care skills training programs in chronic heart failure patients,"The aim of the study was to evaluate the impact of individual selfcontrol and self-care skill training programs and group learning on frequency and duration of hospitalization in patients with heart failure. Methods: 120 patients with heart failure (NYHA II-IV, mean age 62.8+ 9.8, ischemic etiology in combination with hypertension) participated in the study. Inclusion criteria were the presence of clinical signs of heart failure II-IV functional class NYHA, drug therapy in accordance with the European standards of heart failure treatment for at least 1 month, and informed consent of the patient. Exclusion criteria were acute coronary syndrome, decompensation of concomitant disease, alcohol dependence, dementia, and inability to carry out therapeutic training. Patients were randomized to three (the 1st, the 2nd and control) groups. In the 1st group patients were trained on the individual programs that took into account the level of patients' health literacy, patients from the 2nd group attended lectures, patients from the control group were not trained. The duration of observation periodwas 6 months. The combined end point for the evaluation of the effectiveness of individual programs and group learning was the rate of heart failure decompensations and hospitalizations associated with them. Duration of hospitalizations was also estimated. Results: Initially groups of patients were comparable on age, sex, severity and duration of heart failure, and presence of comorbidity. During the observation time in the 1st group 6 patients (15% (95% confidence interval (CI): 5.5%-28.0%, p = 0.05)) were hospitalized, in the 2nd - 13 (32.5% (95%CI: 18.7%- 48.1%, p = 0.05)) in the control - 19 (47.5% (95%CI: 31.9%-63.3%, p =0.05)). The statistically significant differences were found between the 1st group and the control (chi<sup>2</sup>=8.9, p=0.012). This suggests that patients who were taught according to the individual programs, were hospitalized rarely compared to the control group. The number of hospitalized patients in the 2nd and control groups was not statistically significantly different (chi<sup>2</sup> = 1.3, p = 0.519). The number of heart failure decompensations in the 1st group was 7, in the 2nd - 15, in the control - 23. The average amount of heart failure decompensations of one patient from the 1st group was significantly less in comparison with the control (p < 0.01). In the 2nd group it did not differ from the control (p > 0.05). The total duration of hospitalizations in the 1st group was 94 days, in the 2nd - 200, in the control - 311. The average duration of one patient hospitalization in the 1st group was significantly less in comparison with the control (p < 0.01). In the 2nd group the average duration of one patient hospitalization did not differ from the control group (p > 0.05). Conclusions: Thus, individual self-control and self-care skill training programs that took into account the level of patients' health literacy in heart failure were more effective than group sessions, and could reduce frequency and duration of hospitalizations.",self care;skill;training;heart failure;patient;human;internal medicine;self control;hospitalization;control group;learning;health literacy;comorbidity;dementia;alcoholism;acute coronary syndrome;hypertension;informed consent;drug therapy;confidence interval;hospital patient;etiology;New York Heart Association class,"Vatutin, N. T.;Yeshchenko, E. V.",2013,,10.1016/j.ejim.2013.08.048,0,
4600,Patient perspectives of dabigatran: Analysis of online discussion forums,"Background: In 2010 the US FDA approved dabigatran, the first new anticoagulant for stroke prevention in non-valvular atrial fibrillation (AF) since 1954. To date there is little data that reflects the experiences and perceptions of real-world patients with dabigatran. The abundance of Internet-based discussion forums and support groups related to AF or anticoagulation may provide a low-cost resource for assessing patient experiences. Objective: The aim of this study was to determine patient experiences and perceptions regarding dabigatran through qualitative thematic content analysis of comments posted on publicly accessible virtual discussion forums and Internet support groups. Measurements: Comments posted between January 2011 and September 2012 were downloaded from websites focusing on support of patients with AF or on anticoagulation therapy. Comments were analyzed for thematic content. Results: Five broad thematic categories emerged from the posted comments: general concerns about safety and efficacy, questions about indications and contraindications, questions about proper use and storage, questions about diet and drug restrictions, and experiences with perceived side effects. Our data revealed that a primary concern for patients taking dabigatran is the lack of antidote to reverse the effects of dabigatran if bleeding occurs. Several questions pertaining to the use of dabigatran with other medications or medical conditions were noted, and multiple patients expressed confusion about instructions for using dabigatran before and after medical procedures. An unexpected finding included several criticisms of the medication packaging, which many patients found inconvenient or difficult to open. Finally, several perceived side effects were noted, including some not reported in clinical trials. Conclusions: Online communities may provide information about topics that are a concern to patients and that may not be discernible in clinical trials, such as medication side effects, proper use, and safety. Our data also highlighted potential topics that may not be a priority to researchers but are nevertheless important to patients (e.g. medication convenience or packaging). Despite the growing use of online health-related communities, very little research makes use of this low-cost resource for identifying patient interests regarding therapeutic treatments to guide patient-oriented research. © Springer International Publishing 2013.",acetylsalicylic acid;antacid agent;antidote;dabigatran;proton pump inhibitor;rivaroxaban;warfarin;acute heart infarction;angina pectoris;anticoagulant therapy;anxiety disorder;arthralgia;article;bleeding;blood pressure;cerebrovascular accident;confusion;content analysis;coughing;dementia;depression;diet restriction;dizziness;drug contraindication;drug efficacy;drug indication;drug induced headache;drug information;drug packaging;drug safety;drug storage;drug use;dysphagia;dyspnea;esophagus pain;fatigue;fluid retention;gastrointestinal hemorrhage;hair loss;atrial fibrillation;heartburn;hemorrhoid;human;hyperhidrosis;insomnia;Internet;kidney disease;loss of appetite;major clinical study;metallic taste;myalgia;nausea;patient attitude;priority journal;side effect;stomach pain;support group;thorax pain;tinnitus;transient ischemic attack;valvular heart disease;vomiting;weight gain;weight reduction;aspirin,"Vaughan Sarrazin, M. S.;Cram, P.;Mazur, A.;Ward, M.;Reisinger, H. S.",2014,,,0,
4601,Caspase-1 genetic variation is not associated with Alzheimer's disease risk,"BACKGROUND: Interleukin (IL)-1beta is a potent proinflammatory cytokine markedly overexpressed in the brains of patients with Alzheimer's disease (AD), and also involved in development of atherosclerosis and coronary artery disease. Caspase-1 (CASP1), formerly called IL-1beta converting enzyme (ICE), mediates the cleavage of the inactive precursor of IL-1beta into the biologically active form. CASP1 genetic variation (G+7/in6A, rs501192) has been associated with susceptibility to myocardial infarction and cardiovascular death risk. We examined the contribution of this gene to the susceptibility for AD. METHODS: We examined genetic variations of CASP1 by genotyping haplotype tagging SNPs (htSNPs) (rs501192, rs556205 and rs530537) in a group of 628 Spanish AD cases and 722 controls. RESULTS: There were no differences in the genotypic, allelic or haplotypic distributions between cases and controls in the overall analysis or after stratification by age, gender or APOE epsilon4 allele. CONCLUSION: Our negative findings in the Spanish population argue against the hypothesis that CASP1 genetic variations are causally related to AD risk.","Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/*genetics;Apolipoprotein E4/genetics;Caspase 1/*genetics;Female;Genetic Variation;Genotype;Haplotypes;Humans;Interleukin-1beta/metabolism;Male;Middle Aged;Polymorphism, Single Nucleotide;Risk Factors;Sex Factors","Vazquez-Higuera, J. L.;Rodriguez-Rodriguez, E.;Sanchez-Juan, P.;Mateo, I.;Pozueta, A.;Martinez-Garcia, A.;Frank, A.;Valdivieso, F.;Berciano, J.;Bullido, M. J.;Combarros, O.",2010,Feb 25,10.1186/1471-2350-11-32,0,
4602,Cortical sources of EEG rhythms in congestive heart failure and Alzheimer's disease,"INTRODUCTION: The brain needs continuous oxygen supply even in resting-state. Hypoxia enhances resting-state electroencephalographic (EEG) rhythms in the delta range, and reduces those in the alpha range, with a pattern similar to that observed in Alzheimer's disease (AD). Here we tested whether resting-state cortical EEG rhythms in patients with congestive heart failure (CHF), as a model of acute hypoxia, present frequency similarities with AD patients, comparable by cognitive status revealed by the mini mental state examination (MMSE). METHODS: Eyes-closed EEG data were recorded in 10 CHF patients, 20 AD patients, and 20 healthy elderly subjects (Nold) as controls. LORETA software estimated cortical EEG generators. RESULTS: Compared to Nold, both AD and CHF groups presented higher delta (2-4Hz) and lower alpha (8-13Hz) temporal sources. The highest delta and lowest alpha sources were observed in CHF subjects. In these subjects, the global amplitude of delta sources correlated with brain natriuretic peptide (BNP) level in the blood, as a marker of disease severity. CONCLUSIONS: Resting-state delta and alpha rhythms suggest analogies between the effects of acute hypoxia and AD neurodegeneration on the cortical neurons' synchronization. SIGNIFICANCE: Acute ischemic hypoxia could affect the mechanisms of cortical neural synchronization generating resting state EEG rhythms, inducing the ""slowing"" of EEG rhythms typically observed in AD patients.","Aged;Aged, 80 and over;Alzheimer Disease/*physiopathology/psychology;Cerebral Cortex/*physiopathology;Cognition Disorders/physiopathology/psychology;Educational Status;*Electroencephalography;Female;Heart Failure/*physiopathology/psychology;Humans;Image Processing, Computer-Assisted;Magnetic Resonance Imaging;Male;Natriuretic Peptide, Brain/physiology;Neuropsychological Tests;Pilot Projects","Vecchio, F.;Valeriani, L.;Buffo, P.;Scarpellini, M. G.;Frisoni, G. B.;Mecarelli, O.;Babiloni, C.;Rossini, P. M.",2012,Oct,10.1016/j.ijpsycho.2012.06.053,0,
4603,Differential aspects of nutrition in the elderly diabetic patient,"Elderly diabetic patients are a population at risk for malnutrition, specially in nursing homes and hospitalised patients. They suffer more frequently macrovascular complications of diabetes like cerebrovascular disease and coronary heart disease, as well as other geriatric syndromes like dementia, depression, frailty and falls. These situations can lead to malnutrition and the need for nutritional support in general, and for enteral nutrition in particular. In this article, we show nutritional assessment and guidelines and nutritional recommendations, both for oral diet and for artificial nutrition, in the elderly patient with diabetes.",article;cerebrovascular disease;dementia;depression;diabetes mellitus;diabetic patient;diet therapy;falling;frail elderly;geriatric nutrition;hospital patient;human;ischemic heart disease;malnutrition;nursing home patient,"Vega Piñero, B.",2010,,,0,
4604,Conn's dementia,,aldosterone;atenolol;catecholamine;enalapril;hydrocortisone;adult;anamnesis;article;brain disease;case report;dementia;emergency ward;heart left ventricle hypertrophy;human;hydrocortisone blood level;hypertension;kidney dysfunction;kidney function;laboratory test;male;medical assessment;neurologic examination;neuropsychiatry;neuropsychology;primary hyperaldosteronism;priority journal;psychiatry;white matter,"Velakoulis, D.;Lubman, D. I.;Brett, A.;Russell, D.",2002,,,0,
4605,Reply to turner and Kerber,,estrogen;estrogen receptor;Alzheimer disease;basic research;cells by body anatomy;clinical practice;estrogen activity;estrogen therapy;gene control;health status;human;intracellular signaling;ischemic heart disease;letter;priority journal,"Velarde, M. C.",2013,,,0,
4606,"Distribution of APOE polymorphism in the ""Paisa"" population from northwest Colombia (Antioquia)","BACKGROUND: The apolipoprotein E (APOE) gene plays a pivotal role in cholesterol metabolism. Since the discovery of the APOE*2 and APOE*4 as the major susceptibility alleles for several diseases including dyslipidemia, atherosclerosis, coronary heart disease, late-onset and early Alzheimer's disease, the APOE genotype might be considered as a potential predictive factor for both epidemiological research and diagnosis. AIM: The aim of this study is to report on the polymorphism of the APOE gene in the ""Paisa"" population from northwest Colombia (Antioquia) to obtain a population baseline of the existing variation in this locus. METHOD: One thousand and one healthy voluntaries were genotyped for the APOE polymorphism using polymerase chain reaction-restriction fragment length polymorphism technique. RESULTS: The APOE*3/*3 genotype presented the highest frequency (66.33%) and the APOE*4/*4 had the lowest frequency (1.89%). Genotype frequencies comply with Hardy-Weinberg expectations. Allele frequencies obtained for APOE*2, APOE*3 and APOE*4 were 0.075 +/- 0.005 (95% CI = 0.063-0.086), 0.814 +/- 0.009 (0.797-0.831) and 0.111 +/- 0.007 (0.098-0.125), respectively. CONCLUSION: Although globally the high-to-low APOE frequency follows the E*3 > E*4 > E*2 trend, the present APOE frequency data is in disagreement with some reports from South-American countries.","Apolipoproteins E/*genetics;Colombia;*Gene Frequency;Humans;Polymerase Chain Reaction;*Polymorphism, Genetic;Apoe;apolipoprotein;genetic distance;paisa;polymorphism","Velez-Pardo, C.;Rojas, W.;Jimenez-Del-Rio, M.;Bedoya, G.",2015,Mar,10.3109/03014460.2014.932846,0,
4607,"Left ventricular ""grape-shaped"", mobile thrombi in an elderly patient",,brain natriuretic peptide;furosemide;heparin;metoprolol succinate;ramipril;spironolactone;aged;Alzheimer disease;arterial pressure;article;case report;disease severity;diuretic therapy;dyspnea;electrocardiography;female;heart arrest;heart disease;heart ejection fraction;heart left ventricle thrombus;heart rate;hospital admission;human;hypertension;intensive care unit;lung edema;noninvasive ventilation;Q wave;resuscitation;thorax radiography;thrombus;tricuspid valve regurgitation;very elderly,"Velibey, Y.;Erbay, A.;Usta, E.",2014,,,0,
4608,Pre-operative mild cognitive dysfunction predicts risk for post-operative delirium after elective cardiac surgery,"Background and Aims: To identify pre-operative risk factors for delirium in patients undergoing elective cardiac surgery, using clearly defined diagnostic criteria for delirium, and a thorough clinical assessment. Methods: The incidence of post-operative delirium in 107 patients ≥60 years undergoing elective cardiac surgery was calculated. None of the patients included suffered from dementia. Pre-operative cognitive function in all patients was assessed using the Mini Mental State Examination (MMSE) and post-operative delirium was diagnosed using the Confusion Assessment Method (CAM). Post-operative clinical and cognitive assessments were carried out for all patients. Results: Twenty-five patients (23.4%) developed delirium post-operatively. Clinical parameters, including age, gender, co-morbidities, medications, and peri-operative parameters, were similar in patients with and without post-operative delirium. Patients with pre-operative subjective memory complaints and lower MMSE scores, undergoing valve operation or valve + coronary artery bypass grafting (CABG), exhibited an increased risk of developing post-operative delirium. Additionally, delirious patients had a significant decline in post-operative MMSE score compared with the non-delirious ones. Conclusions: The main pre-operative risk factors for post-operative delirium after elective cardiac operations were subjective memory complaints, mild cognitive impairment, and type of cardiac surgery, such as valve procedures. This study suggests that cognitive evaluation should be included in pre-operative assessment. © 2007, Editrice Kurtis.",opiate;paracetamol;adult;aged;angina pectoris;article;carotid artery obstruction;cerebrovascular disease;chronic obstructive lung disease;clinical evaluation;cognition;cognitive defect;comorbidity;coronary artery bypass graft;delirium;diabetes mellitus;disease severity;elective surgery;heart infarction;heart surgery;heart valve surgery;human;hyperlipidemia;hypertension;incidence;major clinical study;Mini Mental State Examination;postoperative complication;postoperative pain;preoperative evaluation;risk assessment;risk factor,"Veliz-Reissmüller, G.;Torres, H. A.;Van der Linden, J.;Lindblom, D.;Jönhagen, M. E.",2007,,,0,
4609,"Tarenflurbil for Alzheimer's disease: a ""shot on goal"" that missed",,amyloid beta protein;biological marker;cholinesterase inhibitor;fluorodeoxyglucose;gamma secretase;hydroxymethylglutaryl coenzyme A reductase inhibitor;memantine;placebo;tarenflurbil;Alzheimer disease;cerebrospinal fluid;clinical assessment;clinical trial;cognition;coronary artery disease;daily life activity;disease course;drug efficacy;drug withdrawal;enzyme inhibition;heart failure;human;letter;neuroimaging;nuclear magnetic resonance imaging;outcome assessment;positron emission tomography;priority journal;rating scale,"Vellas, B.",2010,,,0,
4610,Long-term use of standardised ginkgo biloba extract for the prevention of Alzheimer's disease (GuidAge): A randomised placebo-controlled trial,"Background: Prevention strategies are urgently needed to tackle the growing burden of Alzheimer's disease. We aimed to assess efficacy of long-term use of standardised ginkgo biloba extract for the reduction of incidence of Alzheimer's disease in elderly adults with memory complaints. Methods: In the randomised, parallel-group, double-blind, placebo-controlled GuidAge clinical trial, we enrolled adults aged 70 years or older who spontaneously reported memory complaints to their primary-care physician in France. We randomly allocated participants in a 1:1 ratio according to a computer-generated sequence to a twice per day dose of 120 mg standardised ginkgo biloba extract (EGb761) or matched placebo. Participants and study investigators and personnel were masked to study group assignment. Participants were followed-up for 5 years by primary-care physicians and in expert memory centres. The primary outcome was conversion to probable Alzheimer's disease in participants who received at least one dose of study drug or placebo, compared by use of the log-rank test. This study is registered with ClinicalTrials.gov, number NCT00276510. Findings: Between March, 2002, and November, 2004, we enrolled and randomly allocated 2854 participants, of whom 1406 received at least one dose of ginkgo biloba extract and 1414 received at least one dose of placebo. By 5 years, 61 participants in the ginkgo group had been diagnosed with probable Alzheimer's disease (1·2 cases per 100 person-years) compared with 73 participants in the placebo group (1·4 cases per 100 person-years; hazard ratio [HR] 0·84, 95% CI 0·60-1·18; p=0·306), but the risk was not proportional over time. Incidence of adverse events was much the same between groups. 76 participants in the ginkgo group died compared with 82 participants in the placebo group (0·94, 0·69-1·28; p=0·68). 65 participants in the ginkgo group had a stroke compared with 60 participants in the placebo group (risk ratio 1·12, 95% CI 0·77-1·63; p=0·57). Incidence of other haemorrhagic or cardiovascular events also did not differ between groups. Interpretation: Long-term use of standardised ginkgo biloba extract in this trial did not reduce the risk of progression to Alzheimer's disease compared with placebo. Funding: Ipsen. © 2012 Elsevier Ltd.",NCT00276510;Ginkgo biloba extract;placebo;aged;Alzheimer disease;angina pectoris;article;brain hemorrhage;brain ischemia;controlled study;death;double blind procedure;drug efficacy;drug safety;female;follow up;France;gastrointestinal symptom;heart failure;heart infarction;human;log rank test;major clinical study;male;memory;primary medical care;priority journal;randomized controlled trial;side effect;transient ischemic attack;treatment duration;treatment outcome;vascular disease,"Vellas, B.;Coley, N.;Ousset, P. J.;Berrut, G.;Dartigues, J. F.;Dubois, B.;Grandjean, H.;Pasquier, F.;Piette, F.;Robert, P.;Touchon, J.;Garnier, P.;Mathiex-Fortunet, H.;Andrieu, S.",2012,,,0,
4611,"Age, vascular health, and Alzheimer disease biomarkers in an elderly sample","OBJECTIVE: To investigate the associations between age, vascular health, and Alzheimer disease (AD) imaging biomarkers in an elderly sample. METHODS: We identified 430 individuals along the cognitive continuum aged >60 years with amyloid positron emission tomography (PET), tau PET, and magnetic resonance imaging (MRI) scans from the population-based Mayo Clinic Study of Aging. A subset of 329 individuals had fluorodeoxyglucose (FDG) PET. We ascertained presently existing cardiovascular and metabolic conditions (CMC) from health care records and used the summation of presence/absence of hypertension, hyperlipidemia, cardiac arrhythmias, coronary artery disease, congestive heart failure, diabetes mellitus, and stroke as a surrogate for vascular health. We used global amyloid from Pittsburgh compound B PET, entorhinal cortex tau uptake (ERC-tau) from tau-PET, and neurodegeneration in AD signature regions from MRI and FDG-PET as surrogates for AD pathophysiology. We dichotomized participants into CMC = 0 (CMC- ) versus CMC > 0 (CMC+ ) and tested for age-adjusted group differences in AD biomarkers. Using structural equation models (SEMs), we assessed the impact of vascular health on AD biomarker cascade (amyloid leads to tau leads to neurodegeneration) after considering the direct and indirect age, sex, and apolipoprotein E effects. RESULTS: CMC+ participants had significantly greater neurodegeneration than CMC- participants but did not differ by amyloid or ERC-tau. The SEMs showed that (1) vascular health had a significant direct and indirect impact on neurodegeneration but not on amyloid; and (2) vascular health, specifically the presence of hyperlipidemia, had a significant direct impact on ERC-tau. INTERPRETATION: Vascular health had quantifiably greater impact on neurodegeneration in AD regions than on amyloid deposition. Longitudinal studies are warranted to clarify the relationship between tau deposition and vascular health. Ann Neurol 2017.",,"Vemuri, P.;Lesnick, T. G.;Przybelski, S. A.;Knopman, D. S.;Lowe, V. J.;Graff-Radford, J.;Roberts, R. O.;Mielke, M. M.;Machulda, M. M.;Petersen, R. C.;Jack, C. R., Jr.",2017,Oct 10,,0,
4612,Comments,,Alzheimer disease;caregiver;cerebrovascular accident;chronic obstructive lung disease;cost benefit analysis;health service;heart failure;home care;human;neoplasm;note;palliative therapy;Parkinson disease,"Ventura, M. M.",2016,,,0,
4613,Hyperhomocysteinemia and related factors in 600 hospitalized elderly subjects,"Hyperhomocysteinemia (HHcy) is a metabolic disorder frequently occurring in the elderly population. Recently several reports have suggested abnormalities in homocysteine (tHcy) metabolism implicating HHcy as a metabolic link in the multifactorial processes characterizing many geriatric illnesses-with special emphasis on atherosclerotic vascular diseases and cognitive impairment. The present study was undertaken in a large sample of elderly hospitalized subjects to determine (1) the prevalence of HHcy, (2) the association of HHcy with vascular and cognitive disorders, and (3) the factors independently predicting Hhcy. Six hundred elderly subjects (264 men and 336 women; mean age, 79 +/- 9 years) were randomly chosen from those admitted as inpatients over a period of 3 years. In all patients, body mass index (BMI), mid-upper arm muscle area (MUAMA), plasma cholesterol, triglycerides, total proteins, albumin, lymphocyte count, creatinine, homocysteine (fasting and 4 hours after methionine oral load), serum vitamin B(6), vitamin B(12), and folate concentrations were measured. The presence of disease or use of medications known to affect homocysteine plasma levels were also recorded. The mean fasting tHcy level was 16.8 +/- 12 micromol/L in the whole sample, 18.18 +/- 13.25 micromol/L in men, and 15.86 +/- 12.14 micromol/L in women (P =.005 men v women). The mean Hcy level 4 hours after methionine load was 37.95 +/- 20.9 in the whole sample. Prevalence of hyperhomocysteinemia (fasting Hcy > or = 15 micromol/L or 4 hours after methionine load > or = 35 micromol/L) was 61% (365/600) (67% in men and 56% in women, P <.05). HHcy was rarely (8%) an isolated disorder; in addition to diabetes (20%), renal failure (48.2%), and malnutrition (20.2%), it was often associated with heart failure (30%), malignancies (20.5%), and the use of diuretics (56%) and anticonvulsant drugs (13%). Plasma homocysteine progressively increases across subjects from those with no diabetes, malnutrition, renal failure, obesity, inflammatory bowel disease, heart failure to those with 1, 2, or more concurrent diseases. Multiple stepwise regression analysis showed that 72% of plasma total fasting tHcy variability was explained by age, serum folate, plasma albumin, use of diuretics, and renal function (measured as plasma creatinine clearance). In conclusion, the present study documents that hyperhomocysteinemia, in elderly hospitalized patients is (1) a common finding, (2) frequently associated with vascular and cognitive disorders, and (3) probably a secondary phenomenon in most cases. The major predictor of high plasma homocysteine levels were age, serum folate, plasma albumin, plasma creatinine clearance, and use of diuretic drugs. These variables explain a large proportion of plasma Hcy variability.","Aged;Aged, 80 and over;*Aging;Dementia/complications;Diabetes Complications;Fasting;Female;Homocysteine/blood;Humans;Hyperhomocysteinemia/complications/*epidemiology;Inflammatory Bowel Diseases/complications;Kinetics;Linear Models;Male;Methionine;Nutrition Disorders/complications;Odds Ratio;Renal Insufficiency/complications;Vascular Diseases/complications","Ventura, P.;Panini, R.;Verlato, C.;Scarpetta, G.;Salvioli, G.",2001,Dec,10.1053/meta.2001.28079,0,
4614,Palliative resection of the primary tumour in stage IV rectal cancer,"AIM: The aim of this study was to investigate the use of resection in a cohort of palliatively treated patients with stage IV rectal cancer. To avoid selection bias, particular attention was paid to correction for comorbidity and extent of disease. METHOD: Patients with stage IV rectal cancer in two hospitals in Groningen were consecutively included over a 5-year period. Comorbidity was defined as major (dementia, cardiac failure or left ventricle ejection fraction <30%, or severe chronic obstructive pulmonary disease), minor (diabetes, hypertension, mild renal disease or mild pulmonary disease) or none. The effect of patient and disease characteristics on survival was assessed using Kaplan-Meier and Cox regression analyses. RESULTS: Of 88 patients, 11 (13%) underwent elective surgical resection without chemotherapy, 15 (17%) received both elective resection and chemotherapy, 21 (24%) underwent palliative chemotherapy only and 41 (47%) had supportive care only. The extent of disease (P<0.01), hospital (P=0.02) and comorbidity (P=0.04) were correlated with worse survival. Patients treated surgically survived for longer than patients treated nonsurgically, when the data were corrected for age, comorbidity, extent of disease and hospital [hazard ratio (HR)=0.4 (95% CI=0.2-0.7)]. Perioperative morbidity was seen in 38% of the patients, and 30-day mortality was 0%. CONCLUSION: In this retrospective cohort, resection was associated with longer survival independently of the extent of distant metastases, age and comorbidity.","Adult;Aged;Aged, 80 and over;Antineoplastic Agents/therapeutic use;Chemotherapy, Adjuvant;Cohort Studies;Female;Humans;Kaplan-Meier Estimate;Male;Middle Aged;Neoplasm Staging;Palliative Care/*methods;Proportional Hazards Models;Rectal Neoplasms/drug therapy/mortality/pathology/*surgery;Rectum/pathology/*surgery;Retrospective Studies;Selection Bias;Severity of Illness Index;Treatment Outcome","Verberne, C. J.;de Bock, G. H.;Pijl, M. E.;Baas, P. C.;Siesling, S.;Wiggers, T.",2012,Mar,10.1111/j.1463-1318.2011.02618.x,0,
4615,Relation between cardiovascular and metabolic disease and cognition in very old age: cross-sectional and longitudinal findings from the berlin aging study,"This study documented findings on the relation between cognitive functioning (perceptual speed, memory, fluency, and knowledge) and cardiovascular and metabolic disease in a sample of very old adults (ages 70 and older), both cross-sectionally (n=516) and longitudinally (n=206) in a 4-year follow-up. After age, SES, sex, and dementia status were controlled for, 4 diagnoses were negatively associated with cognition: congestive heart failure, stroke, coronary heart disease, and diabetes mellitus, with a joint effect of 0.47 standard deviations. The impact of disease status was largest on perceptual speed and fluency, memory was impacted only by diabetes, and knowledge was not related to any somatic diagnosis. There was no differential decline in participants diagnosed with 1 of these 4 diseases and those who were not. The only cardiovascular risk factor associated with cognitive performance was alcohol consumption.","Age Factors;Aged;Aged, 80 and over;Aging/*physiology/*psychology;Alcohol Drinking/epidemiology/psychology;Berlin/epidemiology;Cardiovascular Diseases/diagnosis/epidemiology/*psychology;*Cognition;Cross-Sectional Studies;Diabetes Mellitus/diagnosis/epidemiology/*psychology;Female;Health Status Indicators;Humans;Intelligence;Interviews as Topic;Longitudinal Studies;Male;Regression Analysis;Risk Factors;Socioeconomic Factors","Verhaegen, P.;Borchelt, M.;Smith, J.",2003,Nov,10.1037/0278-6133.22.6.559,0,
4616,Effect of Terminalia arjuna on antioxidant defense system in cancer,"Constant production of reactive oxygen species (ROS) during aerobic metabolism is balanced by antioxidant defense system of an organism. Although low level of ROS is important for various physiological functions, its accumulation has been implicated in the pathogenesis of age-related diseases such as cancer and coronary heart disease and neurodegenerative disorders such as Alzheimer's disease. It is generally assumed that frequent consumption of phytochemicals derived from vegetables, fruits, tea and herbs may contribute to shift the balance towards an adequate antioxidant status. The present study is aimed to investigate the effect of aqueous extract of medicinal plant Terminalia arjuna on antioxidant defense system in lymphoma bearing AKR mice. Antioxidant action of T. arjuna is monitored by the activities of catalase, superoxide dismutase and glutathione S transferase which constitute major antioxidant defense system by scavenging ROS. These enzyme activities are low in lymphoma bearing mice indicating impaired antioxidant defense system. Oral administration of different doses of aqueous extract of T. arjuna causes significant elevation in the activities of catalase, superoxide dismutase and glutathione S transferase. T. arjuna is found to down regulate anaerobic metabolism by inhibiting the activity of lactate dehydrogenase in lymphoma bearing mice, which was elevated in untreated cancerous mice. The results indicate the antioxidant action of aqueous extract of T. arjuna, which may play a role in the anti carcinogenic activity by reducing the oxidative stress along with inhibition of anaerobic metabolism.","Analysis of Variance;Animals;Antioxidants/*pharmacology;Catalase/metabolism;Glutathione Transferase/metabolism;L-Lactate Dehydrogenase/metabolism;Liver/enzymology/metabolism;Lymphoma/*metabolism;Mice;Mice, Inbred AKR;Neoplasm Transplantation;Oxidative Stress/*drug effects;Plant Extracts/*pharmacology;Superoxide Dismutase/metabolism;Terminalia/*chemistry","Verma, N.;Vinayak, M.",2009,Jan,10.1007/s11033-008-9279-3,0,
4617,"Sodium-hydrogen exchanger inhibitory potential of Malus domestica, Musa x paradisiaca, Daucus carota, and Symphytum officinale","BACKGROUND: The involvement of sodium-hydrogen exchangers (NHE) has been described in the pathophysiology of diseases including ischemic heart and brain diseases, cardiomyopathy, congestive heart failure, epilepsy, dementia, and neuropathic pain. Synthetic NHE inhibitors have not achieved much clinical success; therefore, plant-derived phytoconstituents may be explored as NHE inhibitors. METHODS: In the present study, the NHE inhibitory potential of hydroalcoholic and alkaloidal fractions of Malus domestica, Musa x paradisiaca, Daucus carota, and Symphytum officinale was evaluated. The different concentrations of hydroalcoholic and alkaloidal extracts of the selected plants were evaluated for their NHE inhibitory activity in the platelets using the optical swelling assay. RESULTS: Among the hydroalcoholic extracts, the highest NHE inhibitory activity was shown by M. domestica (IC50=2.350 +/- 0.132 mug/mL) followed by Musa x paradisiaca (IC50=7.967 +/- 0.451 mug/mL), D. carota (IC50=37.667 +/- 2.517 mug/mL), and S. officinale (IC50=249.330 +/- 1.155 mug/mL). Among the alkaloidal fractions, the highest NHE inhibitory activity was shown by the alkaloidal fraction of Musa x paradisiacal (IC50=0.010 +/- 0.001 mug/mL) followed by D. carota (IC50=0.024 +/- 0.002 mug/mL), M. domestica (IC50=0.031 +/- 0.005 mug/mL), and S. officinale (IC50=4.233 +/- 0.379 mug/mL). The IC50 of alkaloidal fractions was comparable to the IC50 of synthetic NHE inhibitor, EIPA [5-(N-ethyl-N-isopropyl)amiloride] (IC50=0.033 +/- 0.004 mug/mL). CONCLUSIONS: It may be concluded that the alkaloidal fractions of these plants possess potent NHE inhibitory activity and may be exploited for their therapeutic potential in NHE activation-related pathological complications.",Amiloride/analogs & derivatives/pharmacology;Blood Platelets/drug effects;Comfrey/*chemistry;Daucus carota/*chemistry;Humans;In Vitro Techniques;Inhibitory Concentration 50;Malus/*chemistry;Musa/*chemistry;Plant Extracts/pharmacology;Sodium-Hydrogen Antiporter/*antagonists & inhibitors,"Verma, V.;Singh, N.;Jaggi, A. S.",2014,Feb,10.1515/jbcpp-2013-0088,0,
4618,"Alterations to the frequency and function of peripheral blood monocytes and associations with chronic disease in the advanced-age, frail elderly","Background: Circulating myeloid cells are important mediators of the inflammatory response, acting as a major source of resident tissue antigen presenting cells and serum cytokines. They represent a number of distinct subpopulations whose functional capacity and relative concentrations are known to change with age. Little is known of these changes in the very old and physically frail, a rapidly increasing proportion of the North American population. Design: In the following study the frequency and receptor expression of blood monocytes and dendritic cells (DCs) were characterized in a sample of advanced-age, frail elderly (81-100 yrs), and compared against that of adults (19-59 yrs), and community-dwelling seniors (61-76 yrs). Cytokine responses following TLR stimulation were also investigated, as well as associations between immunophenotyping parameters and chronic diseases. Results: The advanced-age, frail elderly had significantly fewer CD14(++) and CD14(+)CD16(+), but not CD14(++)CD16(+) monocytes, fewer plasmacytoid and myeloid DCs, and a lower frequency of monocytes expressing the chemokine receptors CCR2 and CX 3CR1. At baseline and following stimulation with TLR-2 and -4 agonists, monocytes from the advanced-age, frail elderly produced more TNF than adults, although the overall induction was significantly lower. Finally, monocyte subset frequency and CX3CR1 expression was positively associated with dementia, while negatively associated with anemia and diabetes in the advanced-age, frail elderly. Conclusions: These data demonstrate that blood monocyte frequency and phenotype are altered in the advanced-age, frail elderly and that these changes correlate with certain chronic diseases. Whether these changes contribute to or are caused by these conditions warrants further investigation. © 2014 Verschoor et al.",chemokine receptor CX3CR1;toll like receptor 2;toll like receptor 4;toll like receptor agonist;tumor necrosis factor;adult;aged;anemia;article;asthma;cerebrovascular accident;chronic disease;chronic obstructive lung disease;community;congestive heart failure;controlled study;coronary artery disease;dementia;dendritic cell;diabetes mellitus;female;frail elderly;heart arrhythmia;human;human cell;immunophenotyping;major clinical study;male;monocyte;myeloid dendritic cell;plasmacytoid dendritic cell;very elderly,"Verschoor, C. P.;Johnstone, J.;Millar, J.;Parsons, R.;Lelic, A.;Loeb, M.;Bramson, J. L.;Bowdish, D. M. E.",2014,,,0,
4619,Serum C-reactive protein and congestive heart failure as significant predictors of herpes zoster vaccine response in elderly nursing home residents,"Background. Elderly long-term care residents often exhibit a myriad of risk factors for immune dysfunction, including chronic inflammation and multiple comorbid conditions, which undoubtedly contribute to their enhanced susceptibility to infection. Hence, understanding the factors required for optimal vaccine responsiveness is critical. Methods. We examined 187 elderly nursing home residents (aged 80-102 years) and 50 community-dwelling seniors (aged 60-75 years) immunized with the live-attenuated varicella-zoster virus (VZV) vaccine. Specifically, we examined whether vaccine responsiveness was associated with serum C-reactive protein (CRP), tumor necrosis factor, interleukin 1β, 6, and 10, leukocyte telomere length, chronic disease status, and frailty. Results. Elderly participants had significantly higher levels of CRP, tumor necrosis factor, and interleukin 6 and shorter leukocyte telomere length. Vaccine responsiveness was inversely related to the CRP level in elderly participants, but not seniors, and those with congestive heart failure were less likely to achieve a 2-fold response (odds ratio, 0.08). The latter relationship is probably due to immunosenescence, because heart failure was associated with increased senescent CD4+ T cells, and reduced naive and effector and central memory CD8+ T cells. Conclusions. In summary, these data improve our understanding of vaccine responsiveness for those in long-term care, suggesting that certain risk factors are associated with a greater likelihood of vaccine failure.",NCT01328548;C reactive protein;interleukin 10;interleukin 1beta;interleukin 6;tumor necrosis factor;varicella zoster vaccine;aged;article;Canada;CD4+ T lymphocyte;CD8+ T lymphocyte;chronic disease;chronic lung disease;congestive heart failure;controlled study;dementia;diabetes mellitus;drug response;drug treatment failure;effector cell;female;frailty;hemiplegia;human;human cell;immunosenescence;leukocyte;major clinical study;male;nursing home patient;peripheral vascular disease;prediction;predictor variable;priority journal;protein blood level;risk factor;telomere length;very elderly;zostavax,"Verschoor, C. P.;Lelic, A.;Parsons, R.;Evelegh, C.;Bramson, J. L.;Johnstone, J.;Loeb, M. B.;Bowdish, D. M. E.",2017,,10.1093/infdis/jix257,0,
4620,Apolipoprotein isoform E4 does not increase coronary heart disease risk in carriers of low-density lipoprotein receptor mutations,"BACKGROUND: In humans, the E4 allele of the apolipoprotein E gene is associated with increased coronary heart disease risk. Surprisingly, in rodents, apolipoprotein E4 only accelerates the atherosclerotic process when transgenic for the human low-density lipoprotein receptor (LDLR) protein. We therefore investigated whether the LDLR locus interacted with the apolipoprotein E gene genotype on coronary heart disease risk in patients clinically diagnosed with familial hypercholesterolemia with and without LDLR mutation. We investigated whether the presence of an LDLR mutation diminishing LDLR function was protective in E4/E4 carriers. METHODS AND RESULTS: In a cohort of 2400 patients clinically diagnosed with familial hypercholesterolemia, we found an LDLR gene mutation in 1383 patients, whereas in 1013 patients, such mutation was not present. In 92 patients homozygous for the apolipoprotein E4, the presence of an LDLR mutation conferred lower coronary heart disease risk (hazard ratio, 0.16; 95% CI, 0.05-0.58; P=0.005). Mirroring these results, the apolipoprotein E4/E4 genotype was also associated with lower coronary heart disease risk in patients with familial hypercholesterolemia with an LDLR mutation (hazard ratio, 0.26; hazard ratio, 0.08-0.80; P=0.02). CONCLUSIONS: LDLR function is key to the detrimental effects of apolipoprotein E4 in humans. Kinetic studies in humans are now required to study the consequences of our observation for prevention of both coronary heart disease and Alzheimer disease.","Adult;Aged;Apolipoprotein E4/*genetics/metabolism;Cohort Studies;Coronary Artery Disease/epidemiology/*genetics/metabolism;Female;*Heterozygote;Humans;Hyperlipoproteinemia Type II/genetics;Male;Middle Aged;*Mutation;Receptors, LDL/*genetics/metabolism;Risk Factors","Versmissen, J.;Oosterveer, D. M.;Hoekstra, M.;Out, R.;Berbee, J. F.;Blommesteijn-Touw, A. C.;van Vark-van der Zee, L.;Vongpromek, R.;Vanmierlo, T.;Defesche, J. C.;Mulder, M.;Kastelein, J. J.;Sijbrands, E. J.",2011,Dec,10.1161/circgenetics.111.959858,0,
4621,Homocysteine and cardiovascular risk,"For the past thirty years, homocysteine has been considered a potential cause of atherosclerosis. Mild hyperhomocysteinemia, which is sometimes associated with a low plasma level of vitamin B9, B12 and folic acid, is a proven cardiovascular risk marker, if not factor. Its level is closely related to experimental and clinical events as diverse as acute myocardial infarction, stroke, dementia, and venous thrombo-embolic disease. Its direct incrimination in causing these events remains uncertain and controversal. Indeed, even if vitamin supplementation has clearly proven its efficiency on lowering plasma levels of homocysteine, recent studies do not show any positive effect of vitamin therapy on cardiovascular events. The hypothesis that this therapy is inefficient has been recently reinforced by three randomized trials, two on the arterial effects of vitamin supplementation (the NORVIT and HOPE 2 studies) and one on its effects on thrombo-embolic venous disease (the VITRO study). Several hypotheses still need to be explored: that of total uselessness of vitamin supplementation; the possible need to complete the actual data with further, more powerful studies in order to prove a clinical effect of vitamin therapy; or even the exploration other metabolic paths that could lower homocysteine levels.",cyanocobalamin;folic acid;homocysteine;placebo;pyridoxine;vitamin B group;atherosclerosis;cardiovascular disease;cardiovascular risk;clinical trial;controlled clinical trial;dementia;heart infarction;human;hyperhomocysteinemia;randomized controlled trial;risk assessment;short survey;cerebrovascular accident;thromboembolism;venous thromboembolism;vitamin blood level;vitamin supplementation,"Vesin, C.;Horellou, M. H.;Mairesse, S.;Conard, J.;Safar, M.;Blacher, J.",2007,,,0,
4622,Increased mortality and comorbidity associated with leber’s hereditary optic neuropathy: A nationwide cohort study,"PURPOSE. Leber’s hereditary optic neuropathy (LHON) is a mitochondrial genetic disease in which optic neuropathy is considered a key feature. Several other manifestations of LHON have been reported; however, only little is known of their incidence and the life expectancy in LHON patients. METHODS. This study, based on Danish nationwide health registries, included 141 patients diagnosed with LHON and 297 unaffected family members in the maternal line. The incidence of comorbidities and mortality for patients with LHON and unaffected family members was compared with that in the general population. RESULTS. Having LHON was associated with an almost 2-fold risk of mortality with a rate ratio (RR) of 1.95 (95% confidence interval [CI]: 1.47-2.59; P < 0.001). The incidence of several diseases was increased for LHON patients, but not for family members. The incidence of stroke was 5.73 per 1000 patient-years for LHON patients compared to 2.33 for the general population, and the RR was 2.38 (95% CI: 1.58-3.58; P < 0.001). The incidence of demyelinating disorders was 2.24 compared to 0.21 for the general population; RR was 12.89 (95% CI: 6.70-24.77; P < 0.001). A 4-fold risk of dementia was seen for LHON patients (RR: 4.26, 95% CI: 1.91-9.48; P < 0.001), incidence 1.45 for LHON and 0.37 for the general population. Moreover, LHON patients had an increased risk of epilepsy, atherosclerosis, nerve symptoms, neuropathy, and alcohol-related disorders. CONCLUSIONS. The manifestation of LHON was associated with increased mortality and increased incidence of several disorders including stroke, demyelinating disorder, dementia, and epilepsy.",adult;article;atherosclerosis;cerebrovascular accident;cohort analysis;comorbidity;comparative effectiveness;controlled study;dementia;demyelinating disease;epilepsy;female;gene mutation;headache;hearing impairment;heart arrhythmia;heart failure;heart muscle ischemia;human;incidence;Leber hereditary optic neuropathy;life expectancy;major clinical study;male;migraine;mortality;overall survival;priority journal,"Vestergaard, N.;Rosenberg, T.;Torp-Pedersen, C.;Vorum, H.;Andersen, C. U.;Aasbjerg, K.",2017,,10.1167/iovs.17-21990,0,
4623,Acute admissions to medical departments in Denmark: Diagnoses and patient characteristics,"Background Despite extensive research on individual diseases, population-based knowledge about reasons for acute medical admissions remains limited. Our aim was to examine primary diagnoses, Charlson Comorbidity Index (CCI) score, age, and gender among patients admitted acutely to medical departments in Denmark. Methods In this population-based observational study, 264,265 acute medical patients admitted during 2010 were identified in the Danish National Registry of Patients (DNRP), covering all hospitals in Denmark. Reasons for acute admissions were assessed by primary diagnoses, grouped according to the International Classification of Diseases 10th edition. Additionally, the CCI score, age and gender were presented according to each diagnostic group. Results Two-thirds of the patients had one of the four following reasons for admission: cardiovascular diseases (19.3%), non-specific Z-diagnoses (""Factors influencing health status and contact with health services"") (16.9%), infectious diseases (15.5%), and non-specific R-diagnoses (""Symptoms and abnormal findings, not elsewhere classified"") (11.8%). In total, 45% of the patients had a CCI score of one or more and there was a considerable overlap between the patients' chronic diseases and the reason for admission. The median age of the study population was 64 years (IQR 47-77 years), ranging from 46 years (IQR 27-66) for injury and poisoning to 74 years (IQR 60-83) for hematological diseases. Gender representation varied considerably within the diagnostic groups, for example with male predominance in mental disorders (59.0%) and female predominance in diseases of the musculoskeletal system (57.8%). Conclusion Our study identifies that acute medical patients often present with non-specific symptoms or complications related to their chronic diseases. © 2014 European Federation of Internal Medicine.",acquired immune deficiency syndrome;adult;age;aged;article;behavior disorder;cardiovascular disease;cerebrovascular disease;Charlson Comorbidity Index;chronic disease;chronic lung disease;congenital malformation;congestive heart failure;connective tissue disease;dementia;Denmark;diabetes mellitus;diagnosis related group;digestive system disease;endocrine disease;female;gender;health service;health status;heart infarction;hematologic disease;hemiplegia;hospital admission;hospital department;hospital patient;human;ICD-10;infection;injury;intoxication;kidney disease;length of stay;leukemia;liver disease;lymphoma;major clinical study;male;mental disease;metabolic disorder;metastasis;musculoskeletal disease;neoplasm;neurologic disease;nutritional disorder;observational study;perinatal morbidity;peripheral vascular disease;pneumonia;pregnancy disorder;register;respiratory tract disease;sex ratio;skin disease;solid tumor;symptom;ulcer;urogenital tract disease;very elderly,"Vest-Hansen, B.;Riis, A. H.;Sørensen, H. T.;Christiansen, C. F.",2014,,,0,
4624,Out-of-hours and weekend admissions to Danish medical departments: Admission rates and 30-day mortality for 20 common medical conditions,"Objectives: Knowledge on timing of admissions and mortality for acute medical patients is limited. The aim of the study was to examine hospital admission rates and mortality rates for patients with common medical conditions according to time of admission. Design: Nationwide population-based cohort study. Setting: Population of Denmark. Participants: Using the Danish National Registry of Patients covering all Danish hospitals, we identified all adults with the first acute admission to a medical department in Denmark during 2010. Primary and secondary outcome measures: Hourly admission rates and age-standardised and sex-standardised 30-day mortality rates comparing weekday office hours, weekday out of hours, weekend daytime hours and weekend night-time hours. Results: In total, 174 192 acute medical patients were included in the study. The admission rates (patients per hour) were 38.7 (95% CI 38.4 to 38.9) during weekday office hours, 13.3 (95% CI 13.2 to 13.5) during weekday out of hours, 19.8 (95% CI 19.6 to 20.1) during weekend daytime hours and 7.9 (95% CI 7.8 to 8.0) during weekend night-time hours. Admission rates varied between medical conditions. The proportion of patients admitted to an intensive care unit (ICU) increased outside of office hours. The age-standardised and sex-standardised 30-day mortality rate was 5.1% (95% CI 5.0% to 5.3%) after admission during weekday office hours, 5.7% (95% CI 5.5% to 6.0%) after admission during weekday out of hours, 6.4% (95% CI 6.1% to 6.7%) after admission during weekend daytime hours and 6.3% (95% CI 5.9% to 6.8%) after admission during weekend night-time hours. For the majority of the medical conditions examined, weekend admission was associated with highest mortality. Conclusions: While admission rates decreased from office hours to weekend hours there was an observed increase in mortality. This may reflect differences in severity of illness as the proportion admitted to an ICU increased during the weekend.",acquired immune deficiency syndrome;acute heart infarction;adolescent;adult;aged;alcohol intoxication;anemia;angina pectoris;article;bacteremia;cerebrovascular accident;cerebrovascular disease;chronic lung disease;chronic obstructive lung disease;cohort analysis;congestive heart failure;connective tissue disease;dehydration;dementia;Denmark;diabetes mellitus;disease severity;erysipelas;faintness;female;gastroenteritis;atrial fibrillation;heart failure;heart infarction;hemiplegia;hospital admission;hospital department;human;hypertension;intensive care unit;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;middle aged;mortality;night work;outcome assessment;peripheral vascular disease;pneumonia;respiratory failure;sepsis;solid tumor;transient ischemic attack;ulcer;urinary tract infection;very elderly;working time,"Vest-Hansen, B.;Riis, A. H.;Sørensen, H. T.;Christiansen, C. F.",2015,,,0,
4625,Left ventricle diastolic function and cognitive performance in adults with Down syndrome,,"Adult;Cognition/*physiology;Diastole;Down Syndrome/*complications/physiopathology;Female;Heart Ventricles/*physiopathology;Humans;Male;Ventricular Dysfunction, Left/*complications/physiopathology;Ventricular Function, Left/*physiology;Adults;Alzheimer's disease;Amyloidosis;Diastolic dysfunction;Down syndrome","Vetrano, D. L.;Carfi, A.;Brandi, V.;L'Angiocola, P. D.;Di Tella, S.;Cipriani, M. C.;Antocicco, M.;Zuccala, G.;Palmieri, V.;Silveri, M. C.;Bernabei, R.;Onder, G.",2016,Jan 15,10.1016/j.ijcard.2015.11.041,0,
4626,Chronic diseases and geriatric syndromes: The different weight of comorbidity,"Background Comorbidity is a relevant health determinant in older adults. Co-occurrence of several diseases and other age-associated conditions generates new clinical phenotypes (geriatric syndromes [GS] as falls, delirium etc.). We investigated the association of chronic diseases, alone or in combination, and GS in older adults receiving home care services in 11 European countries and one Canadian province. Methods Participants were cross-sectionally evaluated with the multidimensional assessment instrument RAI HC. We assessed 14 different diagnoses and 8 GS (pain, urinary incontinence, falls, disability, dizziness, weight loss, pressure ulcers and delirium). Adjusted mean number of GS per participant was calculated for groups of participants with each disease when occurring alone or with comorbidity. Results The mean age of the 6903 participants was 82.2 ± 7.4 years and 4750 (69%) were women. Participants presented with an average of 2.6 diseases and 2.0 GS: pain (48%), urinary incontinence (47%) and falls (33%) were the most prevalent. Parkinson's disease, cerebrovascular disease and peripheral artery disease were associated with the highest number of GS (2.5, 2.3 and 2.2, respectively). Conversely, hypertension, diabetes, dementia, cancer and thyroid dysfunction were associated with the lowest number of GS (2.0 on average). For 9/14 examined diseases (hypertension, diabetes, dementia, COPD, heart failure, ischemic heart disease, atrial fibrillation, cancer and thyroid dysfunction) the number of GS increased with the degree of comorbidity. Conclusions Comorbidity and GS are prevalent in older adults receiving home care. Different diseases have a variable impact on occurrence of GS. Comorbidity is not always associated with an increased number of GS.",aged;article;atrial fibrillation;cerebrovascular disease;chronic disease;chronic obstructive lung disease;chronic pain;cognitive defect;cohort analysis;comorbidity;cross-sectional study;decubitus;delirium;dementia;diabetes mellitus;disability;dizziness;evaluation study;falling;female;geriatric disorder;glaucoma;heart failure;home care;human;hypertension;ischemic heart disease;major clinical study;male;neoplasm;Parkinson disease;peripheral occlusive artery disease;retrospective study;thyroid disease;urine incontinence;weight reduction,"Vetrano, D. L.;Foebel, A. D.;Marengoni, A.;Brandi, V.;Collamati, A.;Heckman, G. A.;Hirdes, J.;Bernabei, R.;Onder, G.",2016,,,0,
4627,Polypharmacy in nursing home residents with severe cognitive impairment: Results from the SHELTER Study,"Objective: Pharmacological treatment of older adults with cognitive impairment represents a challenge for prescribing physicians, and polypharmacy is common in these complex patients. The aim of the current study is to assess prevalence and factors related to polypharmacy in a sample of nursing home (nursing home) residents with advanced cognitive impairment. Methods: We conducted a cross-sectional analysis of 1449 nursing home residents with advanced cognitive impairment participating to the Services and Health for Elderly in Long Term Care (SHELTER) project, a study collecting information on residents admitted to 57 nursing home in eight countries. Data were collected using the International Resident Assessment Instrument (InterRAI) for long-term care facilities. Polypharmacy status was categorized into three groups: nonpolypharmacy (zero to four drugs), polypharmacy (five to nine drugs), and excessive polypharmacy (≥10 drugs). Results: Polypharmacy was observed in 735 residents (50.7%) and excessive polypharmacy was seen in 245 (16.9%). Compared with nonpolypharmacy, excessive polypharmacy was associated directly with ischemic heart disease (odds ratio [OR], 3.68; 95% confidence interval [CI], 2.01-6.74), diabetes mellitus (OR, 2.66; 95% CI; 1.46-4.84), Parkinson's disease (OR, 2.84; 95% CI, 1.36-5.85), gastrointestinal symptoms (OR, 1.20; 95% CI, 1.43-3.39), pain (OR, 3.12; 95% CI, 1.99-4.89), dyspnea (OR, 2.57; 95% CI, 1.31-5.07), and recent hospitalization (OR, 2.56; 95% CI, 1.36-5.85). An inverse relation with excessive polypharmacy was shown for age (OR, 0.74; 95% CI, 0.59-0.93), activities of daily living disability (OR, 0.79; 95% CI, 0.63-0.99) and presence of a geriatrician on the nursing home staff (OR, 0.36; 95% CI, 0.20-0.64). Conclusion: Polypharmacy and excessive polypharmacy are common among nursing home residents with advanced cognitive impairment. Determinants of polypharmacy status includes not only comorbidities, but also specific symptoms, age, and functional status. A geriatrician in the facility is associated with lower prevalence of excessive polypharmacy. © 2013 The Alzheimer¢s Association. All rights reserved.",analgesic agent;angiotensin receptor antagonist;antibiotic agent;antidepressant agent;antithrombocytic agent;antiulcer agent;benzodiazepine derivative;beta adrenergic receptor blocking agent;calcium channel blocking agent;corticosteroid;digoxin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;laxative;neuroleptic agent;nootropic agent;oral antidiabetic agent;psychotropic agent;vitamin D;ADL disability;aged;article;cognitive defect;cross-sectional study;disease severity;drug use;dyspnea;female;gastrointestinal symptom;health care facility;hospitalization;human;intermethod comparison;ischemic heart disease;long term care;major clinical study;male;nursing home patient;nursing home personnel;pain;Parkinson disease;polypharmacy;prevalence;priority journal;risk factor;vitamin supplementation,"Vetrano, D. L.;Tosato, M.;Colloca, G.;Topinkova, E.;Fialova, D.;Gindin, J.;Van Der Roest, H. G.;Landi, F.;Liperoti, R.;Bernabei, R.;Onder, G.",2013,,,0,
4628,Is obesity mechanistically linked to the greater risk of cerebral vascular disease?,,adipose tissue;Alzheimer disease;article;blood flow velocity;blood vessel reactivity;cardiovascular risk;cerebrovascular accident;cerebrovascular disease;cognitive defect;coronary artery disease;disease association;heart failure;heart infarction;high risk patient;human;hypercapnia;hypertension;lean body weight;metabolic regulation;middle cerebral artery;non insulin dependent diabetes mellitus;obesity;oxidative stress;prevalence;public health problem;rebreathing;risk assessment;vasodilatation,"Vianna, L. C.",2017,,10.1113/ep086596,0,
4629,Low Serum Insulin-Like Growth Factor-I Predicts Cognitive Decline in Alzheimer's Disease,"Background: The relationship between the insulin-like growth factor-I (IGF-I) system and Alzheimer's disease (AD) is mostly based on transversal studies. It remains, however, to demonstrate whether IGF-I is associated with cognitive decline over time in AD. Objective:The objective of the study was to analyze the course of cognitive decline of AD subjects over a 24-month period in relation to serum IGF-I and insulin-like growth factor binding protein-3 (IGFBP-3) measured at baseline. Methods: Data are from the SIGAL follow-up study. IGF-I and IGFBP-3 were measured in AD subjects who performed a Mini-Mental State Examination (MMSE) every 6 months for 2 years. MMSE course was analyzed using a mixed model with random intercept and slope function. Results: Among the 200 AD participants, 146 (mean age = 81.1 (standard deviation (SD) = 5.9) years, 62.6 of women) had at least one follow-up visit. Mean IGF-I at baseline was 147.8 (74.2) ng/mL. Hundred forty-six participants (62.6) had at least one follow-up visit. Mean MMSE was 21.7 (4.7)/30 and dropped on average by 2.28 points per year. MMSE decline was steeper among participants with lower IGF-I. For each decrease of 1 SD of IGF-I, subjects lost an additional 0.63 points per year in MMSE, e.g., participants with IGF-I level of 74 ng/mL lost 2.91 MMSE points per year whereas participants with IGF-I of 222 ng/mL lost 1.65 MMSE points per year. There was no association between IGFBP-3 and cognitive decline. Conclusion:Lower baseline serum IGF-I was associated with faster cognitive decline in AD over a 2-year period.",antihypertensive agent;C reactive protein;cholinesterase inhibitor;glucose;hemoglobin;memantine;prealbumin;serum albumin;somatomedin binding protein 3;somatomedin C;triacylglycerol;aged;albumin blood level;Alzheimer disease;antihypertensive therapy;article;atrial fibrillation;cardiovascular disease;cognition;depression;diabetes mellitus;diastolic blood pressure;disease association;dyslipidemia;enzyme linked immunosorbent assay;female;follow up;glomerulus filtration rate;glucose blood level;heart failure;hemoglobin blood level;human;hypertension;ischemic heart disease;major clinical study;male;Mini Mental State Examination;priority journal;prospective study;protein blood level;systolic blood pressure;very elderly,"Vidal, J. S.;Hanon, O.;Funalot, B.;Brunel, N.;Viollet, C.;Rigaud, A. S.;Seux, M. L.;Le-Bouc, Y.;Epelbaum, J.;Duron, E.",2016,,,0,
4630,"Coronary artery calcium, brain function and structure: the AGES-Reykjavik Study","BACKGROUND AND PURPOSE: Several cardiovascular risk factors are associated with cognitive disorders in older persons. Little is known about the association of the burden of coronary atherosclerosis with brain structure and function. METHODS: This is a cross-sectional analysis of data from the Age, Gene, Environment Susceptibility (AGES)-Reykjavik Study cohort of men and women born 1907 to 1935. Coronary artery calcification (CAC), a marker of atherosclerotic burden, was measured with CT. Memory, speed of processing, and executive function composites were calculated from a cognitive test battery. Dementia was assessed in a multistep procedure and diagnosed according to international guidelines. Quantitative data on total intracranial and tissue volumes (total, gray matter volume, white matter volume, and white matter lesion volume), cerebral infarcts, and cerebral microbleeds were obtained with brain MRI. The association of CAC with dementia (n=165 cases) and cognitive function in nondemented subjects (n=4085), and separately with MRI outcomes, was examined in multivariate models adjusting for demographic and vascular risk factors. Analyses tested whether brain structure mediated the associations of CAC to cognitive function. RESULTS: Subjects with higher CAC were more likely to have dementia and lower cognitive scores, more likely to have lower white matter volume, gray matter volume, and total brain tissue, and to have more cerebral infarcts, cerebral microbleeds, and white matter lesions. The relations of cognitive performance and dementia to CAC were significantly attenuated when the models were adjusted for brain lesions and volumes. CONCLUSIONS: In a population-based sample, increasing atherosclerotic load assessed by CAC is associated with poorer cognitive performance and dementia, and these relations are mediated by evidence of brain pathology.","Aged;Aged, 80 and over;Aging/genetics/pathology/*physiology;Brain/pathology/*physiology;Calcinosis/*epidemiology/genetics/pathology/physiopathology;Cognition Disorders/epidemiology/genetics/pathology;Cohort Studies;Coronary Artery Disease/*epidemiology/genetics/pathology/physiopathology;Coronary Vessels/pathology/*physiology;Cross-Sectional Studies;*Environment;Female;Genetic Predisposition to Disease/*epidemiology/genetics;Humans;Iceland/epidemiology;Magnetic Resonance Imaging;Male","Vidal, J. S.;Sigurdsson, S.;Jonsdottir, M. K.;Eiriksdottir, G.;Thorgeirsson, G.;Kjartansson, O.;Garcia, M. E.;van Buchem, M. A.;Harris, T. B.;Gudnason, V.;Launer, L. J.",2010,May,10.1161/strokeaha.110.579581,0,
4631,The metabolic syndrome and cognitive performance: The Northern Manhattan Study,"Background: The metabolic syndrome (MetS) is a risk factor for diabetes, stroke, myocardial infarction, and increased mortality, and has been associated with cognition in some populations. We hypothesized that MetS would be associated with lower Mini-Mental State Examination (MMSE) scores in a multi-ethnic population, and that MetS is a better predictor of cognition than its individual components or diabetes. Methods: We conducted a cross-sectional analysis among 3,150 stroke-free participants. MetS was defined by the modified National Cholesterol Education Program guidelines-Adult Treatment Panel III (NCEP-ATPIII) criteria. Linear regression and polytomous logistic regression estimated the association between MMSE score and MetS, its individual components, diabetes, and inflammatory biomarkers. Results: MetS was inversely associated with MMSE score (unadjusted β = -0.67; 95% CI -0.92, -0.41). Adjusting for potential confounders, MetS was associated with lower MMSE score (adjusted β = -0.24; 95% CI -0.47, -0.01), but its individual components and diabetes were not. Those with MetS were more likely to have an MMSE score of <18 than a score of ≥24 (adjusted OR = 1.94; 95% CI 1.26, 3.01). There was an interaction between MetS and race-ethnicity, such that MetS was associated with lower MMSE score among non-Hispanic whites and Hispanics but not non-Hispanic blacks. Conclusions: MetS was associated with lower cognition in a multi-ethnic population. Further studies of the effect of MetS on cognition are warranted, and should account for demographic differences. Copyright © 2011 S. Karger AG, Basel.",C reactive protein;high density lipoprotein;interleukin 6;tumor necrosis factor receptor 1;adult;aged;article;cognition;cohort analysis;cross-sectional study;diabetes mellitus;diastolic blood pressure;female;Hispanic;human;inflammation;major clinical study;male;mental performance;metabolic syndrome X;Mini Mental State Examination;psychologic assessment;race difference;cerebrovascular accident;systolic blood pressure;waist circumference,"Vieira, J. R.;Elkind, M. S. V.;Moon, Y. P.;Rundek, T.;Boden-Albala, B.;Paik, M. C.;Sacco, R. L.;Wright, C. B.",2011,,,0,
4632,An overview: The biologically important quninoline derivatives,"Heterocyclic compounds are widely prevalent in animal kingdom as well as in plant kingdom and they play various roles in metabolic processes. A large number of heterocyclic compounds are in clinical practice as a drug, while many of them find industrial utility and hence the syntheses of heterocyclic compounds and understanding of the biological importance of specific heterocyclic class will be an interesting field of synthetic organic chemists.",1 (6 chloro 2 methyl 4 phenylquinolin 3 yl) 3 (aryl)prop 2 en 1one;2 hydroxyquinoline;2 methyl 4 quinolone;4 hydroxyquinoline;4 methyl 2 quinolone;aablaquine;amodiaquine;antiallergic agent;balaquine;cardiotonic agent;chloroquine;ciprofloxacin;enofloxacin;gatifloxacin;lomefloxacin;medroxyprogesterone acetate;mefloquine;n methyl dextro aspartic acid receptor blocking agent;nalidixic acid;ofloxacin;pamaquine;piperaquine;primaquine;progesterone receptor;quinolin 2(1h) one derivative;quinoline derivative;sparfloxacin;tafenoquine;unclassified drug;Alzheimer disease;antibacterial activity;antibiotic sensitivity;antimalarial activity;antiviral activity;article;birth control;drug synthesis;heart arrest;Huntington chorea;hypogonadism;ischemia;pharmacophore;Pick presenile dementia;quality of life;respiratory arrest;structure activity relation,"Vijayakumar, V.",2016,,,0,
4633,N-terminal pro-brain natriuretic peptide and subclinical brain small vessel disease,"OBJECTIVE: To study the association of N-terminal pro-brain natriuretic peptide (NT-proBNP) with several brain MRI markers of brain vascular disease in a sample of participants free of stroke and dementia. METHODS: NT-proBNP plasma level was determined by means of a sandwich immunoassay method in a cohort study comprising 278 hypertensive patients. The presence of silent brain infarcts, brain microbleeds, enlarged perivascular spaces, and white matter hyperintensity volumes was assessed by brain MRI. We performed univariate and multivariate analyses to determine whether NT-proBNP was independently associated with these imaging markers, individually or combined. RESULTS: Median age was 63 years, and 41.4% were women. NT-proBNP remained independently associated with silent brain infarcts (odds ratio [OR] per 1-SD increase in NT-proBNP 2.11, 95% confidence interval [CI] 1.44-3.10), brain microbleeds (OR 1.79, 95% CI 1.15-2.78), basal ganglia enlarged perivascular spaces (OR 1.55, 95% CI 1.12-2.15), and white matter hyperintensity volumes (beta 1.60, 95% CI 0.47-2.74), even after controlling for vascular risk factors, cardiovascular risk, atrial fibrillation, previous heart disease, duration of hypertension, and preventive treatments. A score combining several imaging markers was also related to NT-proBNP levels (common OR per 1-SD increase 1.74, 95% CI 1.21-2.50). CONCLUSIONS: NT-proBNP is independently associated with silent cerebrovascular lesions and could be a surrogate marker of vascular brain damage in hypertension.","0 (Biomarkers);0 (Peptide Fragments);0 (pro-brain natriuretic peptide (1-76));114471-18-0 (Natriuretic Peptide, Brain);Aged;Biomarkers/ blood;Cerebrovascular Disorders/blood/ diagnosis;Cohort Studies;Female;Humans;Hypertension/diagnosis/epidemiology;Male;Middle Aged;Natriuretic Peptide, Brain/ blood;Peptide Fragments/ blood;Predictive Value of Tests;Risk Assessment;Risk Factors","Vilar-Bergua, A.;Riba-Llena, I.;Penalba, A.;Cruz, L. M.;Jimenez-Balado, J.;Montaner, J.;Delgado, P.",2016,Dec 13,,0,
4634,Sacubitril-valsartan for heart failure: From devil's advocate to evidence-based medicine,,amyloid beta protein;beta adrenergic receptor blocking agent;brain natriuretic peptide;dipeptidyl carboxypeptidase inhibitor;enalapril;ivabradine;membrane metalloendopeptidase;mineralocorticoid antagonist;placebo;sacubitril;sacubitril plus valsartan;adverse outcome;angioneurotic edema;cause of death;clinical practice;cognition;coughing;dementia;drug dose titration;drug tolerability;estimated glomerular filtration rate;evidence based medicine;heart death;heart failure;heart failure with reduced ejection fraction;hospital readmission;hospitalization;human;hyperkalemia;hypotension;kidney function;managed care;note;outcome assessment;patient risk;priority journal;risk factor;sudden cardiac death;lcz 696,"Vinereanu, D.",2017,,10.1097/mjt.0000000000000571,0,
4635,Programs by areas of action,,dementia;health program;heart muscle ischemia;ischemic heart disease;prognosis;short survey;uterine cervix cancer,"Viñes, J. J.",2001,,,0,
4636,Hypertension in the elderly: An evidence-based review,"The progressive ageing of world population, and the increasing prevalence hypertension in elderly people are leading to the consideration that hypertension in the elderly is one of the main topic in hypertension treatment. Multiple mechanisms, including stiffening of large arteries, endothelial dysfunction, cardiac remodeling, autonomic dysregulation, renal aspects, contribute to the great prevalence of hypertension in the elderly and to increased cardiovascular morbidity and mortality. Treatment of hypertension can hardly put back older patients in a low risk category, especially if target organ damage is present. Nevertheless, blood pressure control can successfully prevent stroke, cognitive decline, coronary heart disease and heart failure, and reduce mortality in the elderly, and even in patients >80 years, as recently demonstrated. Blood pressure should be lowered below 140/90 mmHg also in older patients. However the HYVET study suggests that a goal of 150/90 mmHg can be reasonable in patients aged 80 years or more. Drug treatment should be titrated with particular caution to adverse responses and excessive blood pressure lowering. © 2011 Bentham Science Publishers.",arginine;beta adrenergic receptor blocking agent;calcium antagonist;chlortalidone;dipeptidyl carboxypeptidase inhibitor;indapamide;losartan;nitrendipine;nitric oxide;noradrenalin;perindopril;prostaglandin synthase;reactive oxygen metabolite;reduced nicotinamide adenine dinucleotide phosphate oxidase;tetrahydrobiopterin;thiazide diuretic agent;trandolapril;aged;aging;alcohol consumption;antihypertensive therapy;arterial stiffness;artery compliance;artery dilatation;article;autonomic nervous system;brachial artery;brain hemorrhage;brain ischemia;case report;cause of death;chronic kidney disease;cost of illness;dementia;diastolic blood pressure;diastolic dysfunction;evidence based medicine;geriatric care;geriatric disorder;glomerulus filtration rate;heart afterload;atrial fibrillation;heart ejection fraction;heart muscle oxygen consumption;heart output;heart rate;high potassium intake;human;hypertension;mean arterial pressure;meta analysis (topic);monotherapy;orthostatic hypotension;pathophysiology;pressoreceptor reflex;prevalence;priority journal;pseudohypertension;pulse pressure;pulse wave;randomized controlled trial (topic);risk reduction;sex difference;smoking cessation;sodium restriction;cerebrovascular accident;systolic blood pressure;systolic hypertension;vascular resistance;vein insufficiency;weight reduction;white coat hypertension,"Virdis, A.;Bruno, R. M.;Neves, M. F.;Bernini, G.;Taddei, S.;Ghiadoni, L.",2011,,,0,
4637,Depressive symptom clusters and optimistic traits are associated with left ventricular mass increase in older subjects independently of blood pressure levels and hypertension,,aged;angina pectoris;blood pressure measurement;cardiovascular disease;cardiovascular risk;controlled study;dementia;depression;diabetes mellitus;disease association;echocardiography;female;Geriatric Depression Scale;heart arrhythmia;heart infarction;heart left ventricle hypertrophy;heart left ventricle mass;human;hypertension;laboratory test;letter;major clinical study;male;mental disease;physical examination;prevalence;priority journal;risk factor;scoring system;smoking;transient ischemic attack;valvular heart disease,"Viscogliosi, G.;Chiriac, I. M.;Pellegrini, F.;Brutti, F.;Bellomi, C.;Andreozzi, P.;Ettorre, E.",2015,,,0,
4638,Alois Alzheimer (1864-1915) and the Alzheimer syndrome,"Alois Alzheimer is known for his seminal work in recognizing a form of presenile dementia. His early interests were natural history and botany. He started his medical education in Berlin and attended the universities of Wurzburg and Tubingen. Nissl and Alzheimer worked together on extensive investigation of the pathology of the nervous system, especially the anatomy of the cerebral cortex. In 1902 Emil Kraepelin invited Alzheimer to work with him in the university psychiatric clinic in Heidelberg. In 1903 both moved to work in the university psychiatric clinic in Munich. It was during these years that Alzheimer described the Alzheimer's disease. He also described brain changes in arteriosclerosis, loss of nerve cells in Huntington's disease in the corpus striatum and brain changes in epilepsy. Alzheimer presented a preliminary report of his histological findings in 1906 at Tubingen about a 51-year-old lady who had developed presenile dementia and died within four years of onset of the disease. He published his findings in 1907, reporting the atrophic brain with neurofibrillary deposits and areas in the cerebrum resistant to staining. During the later years of his career Alzheimer concentrated on the study of changes in glial cells. His best-known works from this period were on Westphal-Strumpell pseudo-sclerosis of the brain, now assumed to be the same as Wilson's Disease. His death, at age 51, was the result of cardiac failure following endocarditis.","Alzheimer Disease/*history/pathology;Cerebral Cortex/pathology;Eponyms;Germany;History, 19th Century;History, 20th Century;Humans;Pathology/history","Vishal, S.;Sourabh, A.;Harkirat, S.",2011,Feb,10.1258/jmb.2010.010037,0,
4639,Cerebral microhemorrhage,"Background and Purpose - With the advent of modern MRI imaging techniques, cerebral microhemorrhages have been increasingly recognized on gradient-echo (GE) or T2*-weighted MRI sequences in different populations. However, in clinical practice, their diagnostic value, associated risk, and prognostic significance are often unclear. This review summarizes the pathophysiology, differential diagnosis, epidemiology, and clinical significance of cerebral microhemorrhages. Summary of Review - Focal areas of signal loss on GE MRI imaging pathologically represent focal hemosiderin deposition associated with previous hemorrhagic events. Cerebral microhemorrhages have been noted in healthy elderly, ischemic cerebrovascular disease, intracerebral hemorrhage (ICH), cerebral amyloid angiopathy (CAA), and in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Microhemorrhages have been associated with older age, hypertension, smoking, white matter disease, lacunar infarcts, previous ischemic stroke, or ICH. In CAA, microhemorrhages predict both the risk of recurrent lobar ICH and future clinical decline. In patients with ischemic cerebrovascular disease, microhemorrhage number and location may be associated with executive dysfunction and may predict the occurrence of ICH and lacunar infarction. Conclusions - When cerebral microhemorrhages are diagnosed on MRI, conclusions regarding their significance and associated risks should be made based on the population examined. Further studies to characterize the associated risks of cerebral microhemorrhages in different stroke populations are needed to use this new imaging marker in therapeutic decisions. © 2006 American Heart Association, Inc.",hemosiderin;adult;age;aged;article;brain hemorrhage;brain infarction;CADASIL;cerebrovascular accident;cerebrovascular disease;cognitive defect;computer assisted tomography;diagnostic value;differential diagnosis;female;gender;human;hyperlipidemia;hypertension;major clinical study;male;nuclear magnetic resonance imaging;pathophysiology;prevalence;priority journal;prognosis;risk factor;smoking;vascular amyloidosis;white matter,"Viswanathan, A.;Chabriat, H.",2006,,,0,
4640,Cortical neuronal apoptosis in CADASIL,"BACKGROUND AND PURPOSE - Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by mutations of the NOTCH3 gene and is a model of pure vascular dementia. Cortical atrophy has been reported to be associated with cognitive decline in the disease, although the underlying mechanism is unknown. We postulated that apoptosis may be involved in this process. METHODS - We report the clinical history, magnetic resonance imaging findings, and pathologic examinations of 4 patients (2 of whom were demented) who died from complications of the disease. Apoptosis was evaluated in brain tissue using antibodies against activated caspase3 and in situ end labeling assays for DNA fragmentation. RESULTS - Widespread neuronal apoptosis in the cerebral cortex (predominantly in layers 3 and 5) was observed in all patients. This was not seen in 3 non-CADASIL controls. Semiquantitative analysis suggested that apoptosis was more extensive in the presence of larger load of subcortical ischemic lesions and smaller brain volumes. CONCLUSIONS - Neuronal apoptosis may be involved in cortical atrophy in CADASIL and appears related to the burden of subcortical ischemic lesions. These findings may have important implications in other small vessel diseases and may provide a potential target for future therapeutic interventions. © 2006 American Heart Association, Inc.",antibody;caspase 3;DNA fragment;apoptosis;article;brain atrophy;brain size;CADASIL;controlled study;gene;gene mutation;human;human tissue;image analysis;multiinfarct dementia;nerve cell;notch3 gene;nuclear magnetic resonance imaging;priority journal;quantitative analysis;white matter,"Viswanathan, A.;Gray, F.;Bousser, M. G.;Baudrimont, M.;Chabriat, H.",2006,,,0,
4641,The influence of vascular risk factors and stroke on cognition in late life analysis of the NACC cohort,"Objective: Vascular risk factors in mid-life predict late life cognitive decline in previously normal populations. We sought to investigate the contribution of vascular risk factors in late life to cognitive decline in a cohort of normal elderly individuals. Methods: Cognitively normal subjects were identified from the longitudinal cohort of participants in the National Alzheimer Coordinating Center (NACC) database (n=2975). The association between a composite score of vascular risk factors (based on the Framingham Stroke Risk Profile) and cognitive function was tested at baseline visit and estimated in longitudinal analyses using linear mixed-effects models. Results: Total vascular risk factor burden was associated with worse cognitive performance at baseline and faster decline longitudinally in univariate analyses but only with worse WAIS digit symbol performance in cross-sectional (estimate=-0.266 units/1 unit of Framingham Stroke Risk Profile Score; 95% confidence interval,-0.380 to-0.153; P<0.001) and longitudinal (estimate=-0.034 units/1 unit of Framingham Stroke Risk Profile Score/year; 95% confidence interval,-0.055 to-0.012; P=0.002) analyses after adjusting for age, education, and APOE genotype. Individuals with history of stroke performed significantly worse on the trails B, category fluency, and Boston naming tests in cross-sectional analyses and in delayed logical memory and digit span backwards in longitudinal analyses. Conclusions: Although the modified Framingham Stroke Risk Profile in late-life predicts rate of decline on selective neurocognitive measures in previously normal elderly individuals, age appears to be the strongest risk factor for cognitive impairment in this population. History of stroke independently influences rate of cognitive decline in these individuals.",antihypertensive agent;apolipoprotein E4;article;blood pressure measurement;Boston naming test;cardiovascular risk;cerebrovascular accident;cognition;cognitive defect;dementia;education;female;follow up;Framingham risk score;genotype;heart left ventricle hypertrophy;human;major clinical study;male;memory;neurologic examination;physical examination;priority journal;risk factor;systolic blood pressure;transient ischemic attack;Wechsler adult intelligence scale,"Viswanathan, A.;Macklin, E. A.;Betensky, R.;Hyman, B.;Smith, E. E.;Blacker, D.",2015,,,0,
4642,Personalized modeling for prediction with decision-path models,Deriving predictive models in medicine typically relies on a population approach where a single model is developed from a dataset of individuals. In this paper we describe and evaluate a personalized approach in which we construct a new type of decision tree model called decision-path model that takes advantage of the particular features of a given person of interest. We introduce three personalized methods that derive personalized decision-path models. We compared the performance of these methods to that of Classification And Regression Tree (CART) that is a population decision tree to predict seven different outcomes in five medical datasets. Two of the three personalized methods performed statistically significantly better on area under the ROC curve (AUC) and Brier skill score compared to CART. The personalized approach of learning decision path models is a new approach for predictive modeling that can perform better than a population approach.,Alzheimer disease;area under the curve;article;Bayes theorem;Brier skill score;classification and regression tree;clinical decision making;community acquired pneumonia;controlled study;decision path area under the curve method;decision path Bayesian method;decision path information gain method;decision tree;factual database;genetic database;heart failure;heparin induced thrombocytopenia;human;information gain;information processing;intermethod comparison;lazy decision tree;nonbiological model;personalized decision path model;predictive value;probability;process optimization;receiver operating characteristic;scoring system;sepsis;single nucleotide polymorphism;splitting criterion;statistical analysis;statistical parameters,"Visweswaran, S.;Ferreira, A.;Ribeiro, G. A.;Oliveira, A. C.;Cooper, G. F.",2015,,,0,
4643,"Psychological distress, caregiving, and metabolic variables","This study examined relationships between chronic stress and insulin/glucose in two groups of nondiabetics, M age = 69.4: spouse caregivers (CGs) of persons with Alzheimer's disease (n = 73) and age- and gender-matched spouses of nondemented controls (COs) (n = 69). Fasting insulin/glucose and psychological variables were assessed twice (Time 1, Time 2) over a 15-18 month period. CGs had significantly higher insulin levels at Times 1 and 2 than did COs even when obesity, exercise, gender, age, alcoholic drinks, hormone replacement therapy (HRT), lipids, and hypertension (HTN) were considered in the analyses. CGs generally reported significantly more psychological distress (higher burden, depression, hassles, and lower uplifts) than did COs at each time. Differences in psychological distress at Time 1 between CGs and COs did not mediate the insulin difference in the groups at Time 1, but differences in distress at Time 2 between CGs and COs did mediate their difference in insulin at Time 2. Although caregiver status was not associated with glucose at Time 1 or Time 2, psychological distress was positively associated with glucose at Time 2. Moreover, psychological distress at Time 1 was associated with higher glucose at Time 2 after controlling for glucose at Time 1. These data suggest that relationships between psychological and physiological distress exist both cross-sectionally and over time. These results may be important because higher insulin and glucose levels are associated with increased coronary risk and coronary heart disease.","Aged;Blood Glucose/*metabolism;Caregivers/*psychology;Coronary Disease/psychology;Cross-Sectional Studies;Depressive Disorder/psychology;Family Health;Female;Humans;Hypertension;Insulin/blood/*metabolism;Lipids/blood;Male;Obesity;Stress, Psychological/*psychology","Vitaliano, P. P.;Scanlan, J. M.;Krenz, C.;Schwartz, R. S.;Marcovina, S. M.",1996,Sep,,0,
4644,Coronary heart disease moderates the relationship of chronic stress with the metabolic syndrome,"Metabolic syndrome levels (MSLs) were compared in caregivers (CGs) of spouses with Alzheimer's disease who had diagnoses of coronary heart disease (CHD; n = 27) with non CGs with CHD diagnoses (n = 18), and CGs (n = 44) to non CGs (n = 52) free of CHD. MSLs were greater for CGs than non CGs, but only in persons with CHD (CHD, B for CG status = -.41; non CHD, B = .12; p < .05) at study entry (Time 1 = T1) and CHD, B = -.32; non CHD, B = .14; p < .05) 15-18 months later (Time 2 = T2). In the CHD group, MSLs were associated with poorer health habits at T1 (r = .39, p < .01), uplifts (r = -.37, p < .01) at T2, and CG status (p < .05) at T1 and T2. Relationships of CG status and MSLs declined in the presence of poor health habits at T1 and uplifts at T2. Poorer health habits and fewer uplifts may be associated with elevated MSLs in CGs with CHD.","Aged;Alzheimer Disease;Caregivers/*psychology;Coronary Disease/etiology/*psychology;Female;Health Behavior;Health Status;Humans;Male;Metabolic Diseases/*psychology;Middle Aged;*Stress, Psychological;Syndrome","Vitaliano, P. P.;Scanlan, J. M.;Siegler, I. C.;McCormick, W. C.;Knopp, R. H.",1998,Nov,,0,
4645,"A path model of chronic stress, the metabolic syndrome, and coronary heart disease","OBJECTIVE: We tested a theoretical stress model cross-sectionally and prospectively that examined whether relationships of chronic stress, psychophysiology, and coronary heart disease (CHD) varied in older adult men (N = 47), older adult women not using hormone replacement therapy (HRT) (N = 64), and older adult women using HRT (N = 41). METHOD: Structural equations examined relationships of CHD with 1) chronic stress (caring for a spouse with Alzheimer's disease and patient functioning), 2) vulnerability (anger and hostility), 3) social resources (supports), 4) psychological distress (burden, sleep problems, and low uplifts), 5) poor health habits (high-caloric, high-fat diet and limited exercise), and 6) the metabolic syndrome (MS) (blood pressure, obesity, insulin, glucose, and lipids). RESULTS: Caregiver men had a greater prevalence of CHD (13/24) than did noncaregiver men (6/23) (p <.05) 27 to 30 months after study entry. This was influenced by pathways from caregiving to distress, distress to the MS, and the MS to CHD. In men, poor health habits predicted the MS 15 to 18 months later, and the MS predicted new CHD cases over 27 to 30 months. In women, no ""caregiving-CHD"" relationship occurred; however, 15 to 18 months after study entry women not using HRT showed ""distress-MS"" and ""MS-CHD"" relationships. In women using HRT, associations did not occur among distress, the MS, and CHD, but poor health habits and the MS were related. CONCLUSIONS: In older men, pathways occurred from chronic stress to distress to the metabolic syndrome, which in turn predicted CHD. Older women not using HRT showed fewer pathways than men; however, over time, distress, the MS, and CHD were related. No psychophysiological pathways occurred in older women using HRT.","Aged;Caregivers/psychology;Coronary Disease/*psychology;Cross-Sectional Studies;Estrogen Replacement Therapy/psychology;Female;Follow-Up Studies;Geriatric Assessment;Health Behavior;Humans;Life Style;Male;Metabolic Syndrome X/*physiology;*Models, Psychological;Prospective Studies;Risk Factors;Stress, Psychological/*complications","Vitaliano, P. P.;Scanlan, J. M.;Zhang, J.;Savage, M. V.;Hirsch, I. B.;Siegler, I. C.",2002,May-Jun,,0,
4646,Psychophysiological mediators of caregiver stress and differential cognitive decline,"The authors examined relationships between chronic stress and cognitive decline and whether such relationships were mediated by psychophysiological factors. Ninety-six caregivers of spouses with Alzheimer's disease (AD) were compared with 95 similar noncaregiver spouses. All were free of diabetes. Although the groups started similarly, over 2 years caregivers declined by a small but significant amount (1 raw score point and 4 percentile points, each p < .05) on Shipley Vocabulary. In contrast, noncaregivers did not change. Higher hostile attribution (β = -.09;p < .05) and metabolic risk (β = -.10; p < .05) in caregivers mediated the cognitive decline. This is the first study of cognitive decline and mediators in caregivers. This work has implications for caregiver and care-recipient health and for research on cognition, psychophysiology, diabetes, and AD. Copyright 2005 by the American Psychological Association.",antihypertensive agent;beta adrenergic receptor blocking agent;insulin;aged;Alzheimer disease;angina pectoris;article;Beck Depression Inventory;blood pressure;cardiovascular disease;caregiver;cognition;controlled study;coronary artery disease;female;glucose blood level;Hamilton Depression Rating Scale;health status;heart infarction;hormone substitution;hostility;human;hypertension;insulin blood level;major clinical study;major depression;male;psychophysiology;questionnaire;radioimmunoassay;regression analysis;spouse;State Trait Anxiety Inventory;stress,"Vitaliano, P. P.;Yi, J.;Phillips, P. E. M.;Echeverria, D.;Young, H.;Siegler, I. C.",2005,,,0,
4647,To the editor,,membrane metalloendopeptidase;sacubitril plus valsartan;Alzheimer disease;amyloid plaque;cost effectiveness analysis;drug cost;health care delivery;heart failure;human;letter;managed care;medicare;outpatient;priority journal;purchasing;United States,"Vitting, K. E.",2017,,10.7326/l17-0049,0,
4648,Cataract surgery outcome at a rural eye care hospital in India,"We report the final outcomes, based on final visual acuity, of patients who underwent cataract surgery at an outreach rural ophthalmology unit and document the details of the ophthalmic examination, type of surgery, intra- and postoperative complications and the final visual acuity. Of 208 eyes (198 patients), 81.3% had small incision cataract surgery and 18.7% had phacoemulsification. We believe that, with good planning and the proper utilization of available resources, it is possible to achieve a good visual outcome in the great majority of cases.",adult;aged;article;capsule opacification;capsulotomy;cataract;cataract extraction;cornea injury;diabetes mellitus;erbium YAG laser;eye care;eye examination;female;glaucoma;health care delivery;human;hypertension;India;ischemic heart disease;lens capsule rupture;lens implantation;major clinical study;male;outcome assessment;peroperative complication;phacoemulsification;postoperative complication;public-private partnership;retina disease;macular edema;rural health care;senility;treatment outcome;visual acuity;vitreous disease,"Vivekanand, U.;Shetty, A.;Kulkarni, C.",2011,,,0,
4649,Health benefits of physical activity in older patients: A review,"As the number of elderly persons in our country increases, more attention is being given to geriatric health care needs and successful aging is becoming an increasingly important topic in medical literature. The concept of successful aging is in first line on a preventive approach of care for older people. Promotion of regular physical activity is one of the main non-pharmaceutical measures proposed to older subjects since low rate of physical activity is frequently noticed in this age group. Moderate but regular physical activity is associated with a reduction of total mortality among older people, a positive effect on the primary prevention of coronary heart disease and a significant optimization of the lipid profile. Improvement of body composition with a reduction of fat mass, reduction of blood pressure and prevention of stroke as well as type 2 diabetes are also well established. Prevention of some cancers (especially breast and colon), increase in bone density and prevention of falls are also reported. Moreover, some longitudinal studies suggest that physical activity is linked to a reduced risk of developing dementia and Alzheimer disease in particular. © 2013 Springer-Verlag France.",aging;Alzheimer disease;article;blood pressure regulation;body composition;bone density;breast cancer;cancer prevention;cerebrovascular accident;colon cancer;falling;fat mass;geriatric care;human;ischemic heart disease;mortality;physical activity;risk reduction,"Vogel, T.;Lang, P. O.;Schmitt, E.;Kaltenbach, G.;Geny, B.",2013,,,0,
4650,Neuroimaging and correlates of cognitive function among patients with heart failure,"Background/Aims: We purposed to investigate the relationship between cerebral abnormalities detected by magnetic resonance imaging (MRI) and cognitive performance in nondemented outpatients with heart failure (HF). Methods: In 58 patients with HF neuropsychological assessment was performed including tests of mental speed, executive functions, memory, language and visuospatial functions. Deep, periventricular and total white matter hyperintensities (WMH), lacunar and cortical infarcts, global and medial temporal lobe atrophy (MTA) were investigated on MRI of the brain. Correlations between MRI findings and the cognitive measures were calculated. Results: MTA correlated with memory (r = -0.353, p < 0.01), with executive functions (r = -0.383, p < 0.01) and the Mini Mental State Examination (r = -0.343, p < 0.05). Total WMH and deep WMH were found to correlate with depression and anxiety scores, but not with cognitive measures. Age, estimated premorbid intelligence and MTA were independent predictors of diminished cognitive performance. Conclusions: In HF patients, MTA was related to cognitive dysfunction, involving memory impairment and executive dysfunction, whereas WMH was related to depression and anxiety. Copyright © 2007 S. Karger AG.",adult;aged;anxiety;article;cognition;cognitive defect;correlation analysis;depression;female;heart failure;human;language;major clinical study;male;memory;Mini Mental State Examination;neuroimaging;neuropsychological test;nuclear magnetic resonance imaging;priority journal;white matter,"Vogels, R. L. C.;Oosterman, J. M.;Van Harten, B.;Gouw, A. A.;Schroeder-Tanka, J. M.;Scheltens, P.;Van Der Flier, W. M.;Weinstein, H. C.",2007,,,0,
4651,Reduced glucose transporter-1 in brain derived circulating endothelial cells in mild Alzheimer's disease patients,"Patients with Alzheimer's disease (AD) have blood-brain barrier (BBB) dysfunction. Methods to study cells of the BBB in vivo would facilitate analyses of neurovascular damage in early AD. Thus, we conducted a pilot study to investigate if brain-derived endothelial cells (BDCECs) could be identified from a cell population of circulating endothelial cells (CECs). Peripheral blood was sampled from early AD patients (n = 9), patients with vascular diseases (myocardial infarction (n = 8) and ischemic stroke (n = 8)), and healthy controls (n = 8). We enumerated CD34+/CD146+/CD45- cells (CECs) and Glucose transporter-1 (Glut1+ CECs (BDCECs)) by flow cytometry. We found that BDCECs formed a separate, aggregate cell population. Glut1 expression on BDCECs, measured by the median fluorescence intensity, was significantly decreased in patients with AD compared to both the healthy controls and patients with myocardial infarction ((p < 0.05, Kruskal-Wallis, Dunn's post hoc test). We found no significant differences in cell numbers. Our study shows that isolation of BDCECs offers a promising non-invasive tool to investigate cells derived from the BBB. Downregulation of Glut1 at the mild stages of AD suggests that agents that increase Glut1 levels may be therapeutic candidates to improve energy availability to the brain.",Blood-brain barrier;Brain endothelial cells;Facilitated glucose transporter member 1;Glut1;Neurodegeneration;Solute carrier family 2 (SLC2A1),"Vogelsang, P.;Giil, L. M.;Lund, A.;Vedeler, C. A.;Parkar, A. P.;Nordrehaug, J. E.;Kristoffersen, E. K.",2017,Nov 01,,0,
4652,Hypertension in the elderly: Ubiquitous but not innocuous,,angiotensin receptor antagonist;antihypertensive agent;antilipemic agent;beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;losartan;nifedipine;bradycardia;cardiovascular risk;clinical trial;cognitive defect;dementia;drug cost;drug efficacy;drug safety;drug tolerability;elderly care;fatigue;heart infarction;human;hypertension;ischemic heart disease;monotherapy;morbidity;nocturia;note;pathophysiology;prevalence;prophylaxis;stress incontinence;systolic hypertension,"Vokonas, P. S.",2004,,,0,
4653,Change in the Multidimensional Prognostic Index Score during Hospitalization in Older Patients,"We investigated and describe change in the Multidimensional Prognostic Index (MPI) score between admission and discharge in 960 older patients admitted to 20 geriatric units for an acute disease or a relapse of a chronic disease. The MPI was calculated at admission and at discharge. Subjects were divided into three groups of MPI score, low risk (MPI-1 value ≤0.33), moderate risk (MPI-2 value 0.34-0.66), and severe risk of mortality (MPI-3 value ≥0.67), on the basis of previously established cutoffs. Variation of MPI values over length of hospital stay (LOS) was analyzed with a multivariable longitudinal linear model for repeated measurements. At admission, 23.5% subjects had an MPI-1 score, 33.3% had an MPI-2 score, and 43.0% had an MPI-3 score. Overall, for almost 60% of the patients, MPI score at hospital discharge was different compared with the score at admission, although the difference was not statistically significant (-0.003; p = 0.708). Patients with high and intermediate MPI scores at admission had a decrease of MPI score at discharge (delta-MPI -0.026, p < 0.001, and delta-MPI -0.066, p = 0.569, respectively), whereas patients in the MPI-low group, experienced a significant increase in MPI score (delta-MPI 0.041, p < 0.001). The evolution of MPI score as a function of LOS had a curvilinear shape because it significantly decreased for patients with short hospitalization (1-6 days) and tended to increase for those with longer LOS. The MPI, a well-established prognostic tool, is sensitive to change of patient's health status and might be used to objectively track and monitor the clinical evolution of acutely ill geriatric patients admitted to the hospital.",activity of daily living assessment;acute disease;aged;article;chronic disease;chronic obstructive lung disease;cognition;comparative study;comprehensive geriatric assessment;controlled study;dementia;disease severity;Exton Smith scale;female;geriatric assessment;geriatric patient;health status;heart failure;hospital admission;hospital discharge;hospitalization;human;ICD-10;kidney failure;major clinical study;male;mortality;multidimensional prognostic index;pneumonia;priority journal;prognostic assessment;relapse;senescence;Short Portable Mental Status Questionnaire;social status,"Volpato, S.;Daragjati, J.;Simonato, M.;Fontana, A.;Ferrucci, L.;Pilotto, A.",2016,,,0,
4654,Type 2 diabetes and risk for functional decline and disability in older persons,"As older adults make up an increasingly lager proportion of the diabetic population, the spectrum of chronic diabetes complications will change and expand. Aside from the traditional long-term complications, diabetes has been associated with excess risk of a number of clinical conditions typical of the geriatric population, including functional decline, physical disability, falls, fractures, cognitive impairment and depression. These conditions are common and profoundly affect the quality of life of older patients with diabetes. The identification of effective ways of preventing and treating these emerging complications, thus improving quality of life among older diabetic patients, is already a major issue in geriatric medicine. In this narrative review, we describe current epidemiological and clinical evidence supporting the association between diabetes and physical disability in older persons. Furthermore, the potential biological mechanisms underlying such an association are analyzed. © 2010 Bentham Science Publishers Ltd.",acarbose;C reactive protein;hemoglobin A1c;interleukin 6;metformin;rosiglitazone;tetrahydrolipstatin;tumor necrosis factor alpha;aging;article;backache;bone density;cardiovascular disease;chronic pain;climbing;clinical trial;cognitive defect;comorbidity;dementia;depression;diabetes mellitus;disease association;disease severity;falling;fragility fracture;functional disease;functional status;glycemic control;hemoglobin blood level;hip;Hispanic;human;insulin resistance;ischemic heart disease;lifestyle modification;muscle atrophy;non insulin dependent diabetes mellitus;obesity;oxidative stress;physical disability;physical performance;priority journal;protein blood level;quality of life;risk factor;secondary prevention;self report;cerebrovascular accident;United States;walking difficulty,"Volpato, S.;Maraldi, C.;Fellin, R.",2010,,,0,
4655,Dementia with bilateral medial temporal lobe ischemia,"Neuropathologic examination of two patients with dementia showed chronic bilateral medial temporal lobe ischemic damage that included the hippocampus (particularly the CA-1 region), subiculum, and amygdala. Both patients had several myocardial infarctions, and the relatively circumscribed cerebral injury may have resulted from one or more episodes of global hypoxic ischemia. Focal hippocampal injury has been associated with amnesia. The additional damage to medial temporal lobe structures may have caused the dementia.",brain ischemia;case report;central nervous system;dementia;diagnosis;heart;heart infarction;hippocampus;human;priority journal;temporal lobe,"Volpe, B. T.;Petito, C. K.",1985,,,0,
4656,Medicinal chemistry and pharmacology of A2B adenosine receptors,"The low affinity A(2B) adenosine receptor, like any other adenosine receptor subtype, belongs to the super-family of seven transmembrane domain protein-coupled receptors (7TMs GPCR) and is classified by the GPCR database in the family of rhodopsin like receptors (Class A of GPCR). It has been cloned from various species, including rat and human, and its sequences are highly similar across species, ranging from 85% identity between human and mouse and 95% identity between rat and mouse. The A(2B)receptors show a ubiquitous distribution, the highest levels are present in cecum, colon and bladder, followed by blood vessels, lung, eye and mast cells. Through A(2B) receptors adenosine seems to cause mast cells degranulation, vasodilation, cardiac fibroblast proliferation, inhibition of Tumor Necrosis Factor (TNF-alpha), increased synthesis of interleukin-6 (IL-6), stimulation of Cl(-) secretion in intestinal epithelia and hepatic glucose production. Hence, A(2B) adenosine receptor agonists could be useful in the treatment of cardiac diseases like hypertension or myocardial infarction and in the management of septic shock, while antagonists may serve as novel drugs for asthma, Alzheimer's disease, cystic fibrosis and type-II diabetes. No potent and selective A(2B) agonists have been reported so far; 5'-N-ethylcarboxamidoadenosine (NECA) is one of the most active. The monosubstitution on N(6)-position of adenosine is well tolerated and that position appears to be a useful site for increasing A(2B) potency. Among substituents in 2-position of adenosine only 1-alkynyl chains are effective for A(2B) potency. In particular, the (S)-2-hydroxypropynyl substituents brought about the highest activity demonstrating that the A(2B) receptors discriminate between (R) and (S) diastereomers. Hence, (S)-2-phenylhydroxypropynylNECA (PHPNECA), with an EC(50) = 0.22 micro M, proved to be the most potent A(2B) agonist reported so far. Classical antagonists for adenosine receptors are alkylxanthines which show considerable potency at A(2B) receptors. Para substituted 1,3-dialkyl-8-phenylxanthines possess high affinity in binding assays; the 3-unsubstituted 1-alkyl analogues resulted more A(2B) selective with the 8-[4-[(N-(2-hydroxyethyl)carboxamidomethyl)oxy]phenyl]-1-propylxanthine (60) showing the highest affinity (K(i) = 1.2 nM) and selectivity (A(1)/A(2B) = 60, A(2A)/A(2B) = 1,790, A(3)/A(2B) = 360). Among non-xanthine derivatives very promising are substituted purines, in which combination of appropriate substituents in 2-, 8-, and 9-position could lead to very potent and selective A(2B) antagonists.",adenine;adenosine;adenosine A2b receptor;adenosine receptor;drug derivative;xanthine derivative;animal;article;chemistry;drug antagonism;drug design;drug potentiation;human;molecular genetics;sequence homology;structure activity relation,"Volpini, R.;Costanzi, S.;Vittori, S.;Cristalli, G.;Klotz, K. N.",2003,,,0,
4657,"Migraine, Chronic Vasculopathies, and Spreading Depolarization",,collagen type 4;angina pectoris;artery dissection;artery occlusion;atrial fibrillation;blood vessel occlusion;brain ischemia;CADASIL;cardiovascular risk;cerebrovascular accident;cerebrovascular disease;chronic disease;coronary artery disease;depolarization;diabetes mellitus;embolism;endothelial dysfunction;gene mutation;headache;heart atrium septum defect;heart infarction;heart muscle ischemia;hemiparesis;hereditary infantile hemiparesis retinal tortuosity leukoencephalopathy;human;hypercoagulability;hypertension;inflammation;leukodystrophy;leukoencephalopathy;migraine;migraine with aura;migraine without aura;neuroglial spreading depolarization;note;patent foramen ovale;phenotype;priority journal;retinal vasculopathy with cerebral leukodystrophy;thrombocyte dysfunction;vascular disease;vasoconstriction,"Von Bornstädt, D.;Eikermann-Haerter, K.",2016,,,0,
4658,Cachexia as a major underestimated and unmet medical need: facts and numbers,"Cachexia is a serious, however underestimated and underrecognised medical consequence of malignant cancer, chronic heart failure (CHF), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), cystic fibrosis, rheumatoid arthritis, Alzheimer's disease, infectious diseases, and many other chronic illnesses. The prevalence of cachexia is high, ranging from 5% to 15% in CHF or COPD to 60% to 80% in advanced cancer. By population prevalence, the most frequent cachexia subtypes are in order: COPD cachexia, cardiac cachexia (in CHF), cancer cachexia, and CKD cachexia. In industrialized countries (North America, Europe, Japan), the overall prevalence of cachexia (due to any disease) is growing and currently about 1%, i.e., about nine million patients. The relative prevalence of cachexia is somewhat less in Asia, but is a growing problem there as well. In absolute terms, cachexia is, in Asia (due to the larger population), as least as big a problem as in the Western world. Cachexia is also a big medical problem in South America and Africa, but data are scarce. A consensus statement recently proposed to diagnose cachexia in chronic diseases when there is weight loss exceeding 5% within the previous 3-12 months combined with symptoms characteristic for cachexia (e.g., fatigue), loss of skeletal muscle and biochemical abnormalities (e.g., anemia or inflammation). Treatment approaches using anabolics, anti-catabolic therapies, appetite stimulants, and nutritional interventions are under development. A more thorough understanding of the pathophysiology of cachexia development and progression is needed that likely will lead to combination therapies being developed. These efforts are greatly needed as presence of cachexia is always associated with high-mortality and poor-symptom status and dismal quality of life. It is thought that in cancer, more than 30% of patients die due to cachexia and more than 50% of patients with cancer die with cachexia being present. In other chronic illnesses, one can estimate that up to 30% of patients die with some degree of cachexia being present. Mortality rates of patients with cachexia range from 10% to 15% per year (COPD), to 20% to 30% per year (CHF, CKD) to 80% in cancer.",,"von Haehling, S.;Anker, S. D.",2010,Sep,10.1007/s13539-010-0002-6,0,
4659,Exaggerated plasma fibrin formation (D-Dimer) in elderly alzheimer caregivers as compared to noncaregiving controls,"Background: The chronic stress of providing care for a spouse suffering from Alzheimer's disease has been associated with an increased risk for coronary artery disease and overall mortality. Procoagulant changes are kindled by mental stress, and they are prospectively associated with atherothrombotic events. Objective: To examine whether dementia caregivers would show greater coagulation activity and less fibrinolytic capacity than noncaregiving controls. Methods: Subjects were 48 (30 female and 18 male) elderly (mean age ± SD, 72 ± 9 years) community-dwelling spousal Alzheimer caregivers and 20 noncaregiving age- and gender-matched controls. Plasma levels of thrombin-antithrombin III, fibrin D-dimer, von Willebrand factor, tissue-type plasminogen activator, and plasminogen activator inhibitor 1 were measured. Results: D-dimer, a marker of fibrin formation and degradation, was significantly higher in caregivers than in controls (688 ± 575 vs. 406 ± 157 ng/ml, p = 0.021). Plasma levels of the four other hemostasis variables were not significantly different between the two groups. Controlling for the classic cardiovascular risk factors body mass index, hypertension status, smoking status, hypercholesterolemia, type II diabetes, and medication potentially affecting hemostasis did not change results. Conclusion: The findings suggest that Alzheimer caregivers have an increased fibrin turnover as compared to noncaregiving controls independent of common confounders of hemostasis. Such an elevated clotting diathesis might contribute to increased cardiovascular risk and overall mortality with dementia caregiving strain. Copyright © 2005 S. Karger AG, Basel.",antithrombin III;biological marker;D dimer;fibrin;plasminogen activator;plasminogen activator inhibitor 1;thrombin;thrombin antithrombin complex;tissue plasminogen activator;von Willebrand factor;adult;age distribution;aged;Alzheimer disease;article;blood clotting;body mass;cardiovascular risk;caregiver;clinical article;community care;comparative study;controlled study;female;fibrin formation;fibrinolysis;human;hypercholesterolemia;hypertension;male;mental stress;non insulin dependent diabetes mellitus;population risk;priority journal;protein blood level;protein degradation;protein determination;risk assessment;risk factor;sex ratio;smoking;upregulation,"Von Känel, R.;Dimsdale, J. E.;Adler, K. A.;Patterson, T. L.;Mills, P. J.;Granta, I.",2005,,,0,
4660,Effect of acute psychological stress on the hypercoagulable state in subjects (spousal caregivers of patients with Alzheimer's disease) with coronary or cerebrovascular disease and/or systemic hypertension,,"Aged;Aged, 80 and over;Alzheimer Disease/blood/*psychology;Antithrombin III/metabolism;Caregivers/*psychology;Catecholamines/blood;Coronary Thrombosis/blood/*psychology;Female;Fibrin Fibrinogen Degradation Products/metabolism;Hemodynamics/physiology;Humans;Hypertension/blood/*psychology;Intracranial Embolism/blood/*psychology;Male;Middle Aged;Peptide Hydrolases/metabolism;Risk Factors;Stress, Psychological/blood/*complications;Thrombophilia/blood/*psychology;von Willebrand Factor/metabolism","von Kanel, R.;Dimsdale, J. E.;Ziegler, M. G.;Mills, P. J.;Patterson, T. L.;Lee, S. K.;Grant, I.",2001,Jun 15,,0,
4661,Increased Framingham Coronary Heart Disease Risk Score in dementia caregivers relative to non-caregiving controls,"BACKGROUND: Elderly individuals who provide care to a spouse suffering from dementia bear an increased risk of coronary heart disease (CHD). OBJECTIVE: To test the hypothesis that the Framingham CHD Risk Score would be higher in dementia caregivers relative to non-caregiving controls. METHODS: We investigated 64 caregivers providing in-home care for their spouse with Alzheimer's disease and 41 gender-matched non-caregiving controls. All subjects (mean age 70 +/- 8 years, 75% women, 93% Caucasian) had a negative history of CHD and cerebrovascular disease. The original Framingham CHD Risk Score was computed adding up categorical scores for age, blood lipids, blood pressure, diabetes, and smoking with adjustment made for sex. RESULTS: The average CHD risk score was higher in caregivers than in controls even when co-varying for socioeconomic status, health habits, medication, and psychological distress (8.0 +/- 2.9 vs. 6.3 +/- 3.0 points, p = 0.013). The difference showed a medium effect size (Cohen's d = 0.57). A relatively higher blood pressure in caregivers than in controls made the greatest contribution to this difference. The probability (area under the receiver operator curve) that a randomly selected caregiver had a greater CHD risk score than a randomly selected non-caregiver was 65.5%. CONCLUSIONS: Based on the Framingham CHD Risk Score, the potential to develop overt CHD in the following 10 years was predicted to be greater in dementia caregivers than in non-caregiving controls. The magnitude of the difference in the CHD risk between caregivers and controls appears to be clinically relevant. Clinicians may want to monitor caregiving status as a routine part of standard evaluation of their elderly patients' cardiovascular risk.","Aged;*Caregivers/psychology;Case-Control Studies;Coronary Disease/*etiology;Dementia/complications/psychology/*therapy;Female;Health Behavior;Humans;Male;Middle Aged;Risk Assessment;Socioeconomic Factors;Stress, Psychological","von Kanel, R.;Mausbach, B. T.;Patterson, T. L.;Dimsdale, J. E.;Aschbacher, K.;Mills, P. J.;Ziegler, M. G.;Ancoli-Israel, S.;Grant, I.",2008,,10.1159/000113649,0,
4662,Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study,"We aimed to evaluate the criterion validity of the 2015 food-based Dutch dietary guidelines, which were formulated based on evidence on the relation between diet and major chronic diseases. We studied 9701 participants of the Rotterdam Study, a population-based prospective cohort in individuals aged 45 years and over [median 64.1 years (95%-range 49.0-82.8)]. Dietary intake was assessed at baseline with a food-frequency questionnaire. For all participants, we examined adherence (yes/no) to fourteen items of the guidelines: vegetables (>/=200 g/day), fruit (>/=200 g/day), whole-grains (>/=90 g/day), legumes (>/=135 g/week), nuts (>/=15 g/day), dairy (>/=350 g/day), fish (>/=100 g/week), tea (>/=450 mL/day), ratio whole-grains:total grains (>/=50%), ratio unsaturated fats and oils:total fats (>/=50%), red and processed meat (<300 g/week), sugar-containing beverages (</=150 mL/day), alcohol (</=10 g/day) and salt (</=6 g/day). Total adherence was calculated as sum-score of the adherence to the individual items (0-14). Information on disease incidence and all-cause mortality during a median follow-up period of 13.5 years (range 0-27.0) was obtained from data collected at our research center and from medical records. Using Cox proportional-hazards models adjusted for confounders, we observed every additional component adhered to was associated with a 3% lower mortality risk (HR 0.97, 95% CI 0.95; 0.98), lower risk of stroke (HR 0.95, 95% CI 0.92; 0.99), chronic obstructive pulmonary disease (HR 0.94, 95% CI 0.91; 0.98), colorectal cancer (HR 0.90, 95% CI 0.84; 0.96), and depression (HR 0.97, 95% CI 0.95; 0.999), but not with incidence of coronary heart disease, type 2 diabetes, heart failure, lung cancer, breast cancer, or dementia. These associations were not driven by any of the individual dietary components. To conclude, adherence to the Dutch dietary guidelines was associated with a lower mortality risk and a lower risk of developing some but not all of the chronic diseases on which the guidelines were based.",Cancer;Cardiovascular disease;Cohort study;Diet quality;Neurological diseases;Validation,"Voortman, T.;Kiefte-de Jong, J. C.;Ikram, M. A.;Stricker, B. H.;van Rooij, F. J. A.;Lahousse, L.;Tiemeier, H.;Brusselle, G. G.;Franco, O. H.;Schoufour, J. D.",2017,Nov,,0,
4663,Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study,,"Brain/drug effects/metabolism/physiopathology;Cholesterol/deficiency;Clinical Trials as Topic/standards/statistics & numerical data;Cognition Disorders/*drug therapy/epidemiology/prevention & control;Cohort Studies;Data Interpretation, Statistical;Dementia/*drug therapy/epidemiology/prevention & control;Heart Failure/chemically induced/metabolism/mortality;Humans;Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse;effects/*pharmacology/therapeutic use;Hypercholesterolemia/complications/drug therapy/metabolism;Incidence;Neuroprotective Agents/pharmacology/therapeutic use;Risk Assessment","Vos, E.;Nehrlich, H. H.",2009,Aug 4,10.1212/WNL.0b013e3181ab966f,0,
4664,Modifiable risk factors for prevention of dementia in midlife and late life: the libra index,"Background: Recently, the LIfestyle for BRAin health (LIBRA) index was developed to assess an individual's prevention potential for dementia. We investigated the predictive validity of the LIBRA index for incident dementia in midlife and late life. Methods: 7918 non-demented individuals (55-97 years) were recruited from the European multicenter population- based DESCRIPA study, including the following cohorts: Gwomen and GH85 (Sweden), ILSA (Italy), LASA and MAAS (the Netherlands), and PAQUID (France). An individual's LIBRA index was calculated solely using modifiable risk factors: depression, diabetes, physical inactivity, hypertension, obesity, smoking, hypercholesterolemia, coronary heart disease, and mild/moderate alcohol use. Participants were classified in midlife (55-72y) and late life (>72y) based on median age and into low, medium, and high age-specific risk groups for dementia based on LIBRA tertiles. Cox proportional hazards models, adjusted for demographics and center, were used to test the predictive validity of the continuous LIBRA score and the LIBRA risk groups for dementia after up to 16 years (mean 7.4y). Results:3958 individuals were classified in midlife (mean age 67.3; 53% female), of whom 277 (7%) progressed to dementia at follow-up. In midlife, the risk for dementia tended to increase as the LIBRA index became higher (HR=1.07, 95% CI 1.00-1.15, p=0.069). Individuals in the high-risk group had an increased risk of dementia compared to those in the low-risk group (HR=1.46, 1.04-2.04, p=0.029; Table 1). 3960 individuals were classified in late life (mean age 78.8; 56% female), of whom 684 (17%) progressed to dementia. In late life, the LIBRA index did not predict dementia (HR=1.03, 0.98- 1.09, p=0.20). No differences in progression rates to dementia were found between the 3 risk groups. When obesity and hypertension were excluded from the index in late life, the risk for dementia increased as the index became higher (HR=1.08, 1.02- 1.15, p=0.013) and individuals in the high-risk group had an increased risk for dementia compared to those in the low-risk group (HR=1.26, 1.04-1.52, p=0.018; Table 1). Conclusions: Our findings indicate that the LIBRA index might be a useful tool in midlife and, when adjusted, also in late life to identify individuals for primary prevention interventions of dementia and monitor individuals'risk-change over time. (Table Presented).",aged;alcohol consumption;brain;clinical trial;controlled clinical trial;controlled study;dementia;depression;diabetes mellitus;female;follow up;France;health hazard;human;hypercholesterolemia;hypertension;ischemic heart disease;Italy;lifestyle;low risk population;major clinical study;male;multicenter study;Netherlands;obesity;physical inactivity;predictive validity;prevention;primary prevention;proportional hazards model;risk factor;smoking;Sweden,"Vos, Sjb;Boxtel, M;Schiepers, O;Deckers, K;Vugt, M;Carriere, I;Dartigues, J-F;Peres, K;Artero, S;Ritchie, K;Galluzzo, L;Scafato, E;Frisoni, Gb;Huisman, M;Comijs, Hc;Sacuiu, S;Skoog, I;Irving, K;O'Donnell, C;Verhey, Frj;Visser, Pj;Koehler, S",2016,,,0,
4665,"Modifiable Risk Factors for Prevention of Dementia in Midlife, Late Life and the Oldest-Old: Validation of the LIBRA Index","BACKGROUND: Recently, the LIfestyle for BRAin health (LIBRA) index was developed to assess an individual's prevention potential for dementia. OBJECTIVE: We investigated the predictive validity of the LIBRA index for incident dementia in midlife, late life, and the oldest-old. METHODS: 9,387 non-demented individuals were recruited from the European population-based DESCRIPA study. An individual's LIBRA index was calculated solely based on modifiable risk factors: depression, diabetes, physical activity, hypertension, obesity, smoking, hypercholesterolemia, coronary heart disease, and mild/moderate alcohol use. Cox regression was used to test the predictive validity of LIBRA for dementia at follow-up (mean 7.2 y, range 1-16). RESULTS: In midlife (55-69 y, n = 3,256) and late life (70-79 y, n = 4,320), the risk for dementia increased with higher LIBRA scores. Individuals in the intermediate- and high-risk groups had a higher risk of dementia than those in the low-risk group. In the oldest-old (80-97 y, n = 1,811), higher LIBRA scores did not increase the risk for dementia. CONCLUSION: LIBRA might be a useful tool to identify individuals for primary prevention interventions of dementia in midlife, and maybe in late life, but not in the oldest-old.",Aging;dementia;modifiable risk factors;prevention,"Vos, S. J. B.;van Boxtel, M. P. J.;Schiepers, O. J. G.;Deckers, K.;de Vugt, M.;Carriere, I.;Dartigues, J. F.;Peres, K.;Artero, S.;Ritchie, K.;Galluzzo, L.;Scafato, E.;Frisoni, G. B.;Huisman, M.;Comijs, H. C.;Sacuiu, S. F.;Skoog, I.;Irving, K.;O'Donnell, C. A.;Verhey, F. R. J.;Visser, P. J.;Kohler, S.",2017,,,0,
4666,"Coronary heart disease and cortical thickness, gray matter and white matter lesion volumes on MRI","Coronary heart disease (CHD) has been linked with cognitive decline and dementia in several studies. CHD is strongly associated with blood pressure, but it is not clear how blood pressure levels or changes in blood pressure over time affect the relation between CHD and dementia-related pathology. The aim of this study was to investigate relations between CHD and cortical thickness, gray matter volume and white matter lesion (WML) volume on MRI, considering CHD duration and blood pressure levels from midlife to three decades later. The study population included 69 elderly at risk of dementia who participated in the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study. CAIDE participants were examined in midlife, re-examined 21 years later, and then after additionally 7 years (in total up to 30 years follow-up). MRIs from the second re-examination were used to calculate cortical thickness, gray matter and WML volume. CHD diagnoses were obtained from the Finnish Hospital Discharge Register. Linear regression analyses were adjusted for age, sex, follow-up time and scanner type, and additionally total intracranial volume in GM volume analyses. Adding diabetes, cholesterol or smoking to the models did not influence the results. CHD was associated with lower thickness in multiple regions, and lower total gray matter volume, particularly in people with longer disease duration (>10 years). Associations between CHD, cortical thickness and gray matter volume were strongest in people with CHD and hypertension in midlife, and those with CHD and declining blood pressure after midlife. No association was found between CHD and WML volumes. Based on these results, long-term CHD seems to have detrimental effects on brain gray matter tissue, and these effects are influenced by blood pressure levels and their changes over time.","Adult;Aged;Aged, 80 and over;Aging;Cerebral Cortex/*pathology;Coronary Disease/*complications;Dementia/*etiology/pathology;Female;Follow-Up Studies;Gray Matter/*pathology;Humans;Magnetic Resonance Imaging;Male;Middle Aged;Risk Factors;White Matter/*pathology","Vuorinen, M.;Damangir, S.;Niskanen, E.;Miralbell, J.;Rusanen, M.;Spulber, G.;Soininen, H.;Kivipelto, M.;Solomon, A.",2014,,10.1371/journal.pone.0109250,0,
4667,Association of peripheral visfatin levels and visfatin G-948t gene polymorphism with alzheimer's disease in a turkish population,"Introduction: Visfatin is a pleiotropic cytokine implicated in several physiological and pathophysiological processes such as innate immunity, cellular metabolism, longevity, and inflammation. Altered visfatin levels and visfatin gene polymorphisms have been reported in various human diseases, including type 2 diabetes mellitus, rheumatoid arthritis, obesity, coronary artery disease and stroke. Materials and Method: In this study, we investigated whether serum visfatin levels were changed in volunteers with Alzheimer's disease (AD) (n = 40) or healthy controls (n=40) and whether visfatin gene G-948T polymorphism was associated with the disease. Results: Visfatin levels were not significantly different in AD patients compared with healthy aged control subjects. In this relatively small population, we found a significant, but weak association between GT heterozygous genotype at position -948 of visfatin gene and AD. However, there was no association between G-948T polymorphism and visfatin levels, and any demographic, anthropometric or biochemical parameters. Conclusion: Further studies in larger and different populations are needed to fully elaborate the involvement of visfatin gene in AD.",high density lipoprotein;low density lipoprotein;nicotinamide phosphoribosyltransferase;triacylglycerol;allele;Alzheimer disease;article;case control study;cholesterol blood level;clinical article;controlled study;DNA extraction;ELISA kit;female;gene;genetic association;genotype;glucose blood level;human;male;real time polymerase chain reaction;single nucleotide polymorphism;Turkey (republic);visfatin gene,"Vurgun, U.;Şahin, O.;Tüfekcí, K. U.;Keskinoǧlu, P.;Yener, G.;Genç, K. K.;Genç, S.",2013,,,0,
4668,The question not asked: the challenge of pleiotropic genetic tests,"Nearly all of the literature on the ethical, legal, or social issues surrounding genetic tests has proceeded on the assumption that any particular test for a gene mutation yields information about only one disease condition. Even though the phenomenon of pleiotropy, where a single gene has multiple, apparently unrelated phenotypic effects, is widely recognized in genetics, it has not had much significance for genetic testing until recently. In this article, I examine a moral dilemma created by one sort of pleiotropic testing, APOE genotyping, which can yield information about the risk of two different conditions -- coronary heart disease and Alzheimer's disease. A physician administering APOE testing for the beneficial purpose of assessing the risk of heart disease may discover medically useless and socially harmful information about the patient's risk of Alzheimer's disease. I explore how much providers should disclose to patients about pleiotropic test results and whether patients are obligated to know as much about their genetic condition as possible.","*Dementia;*Disclosure;Double Effect Principle;Ethics;Genetic Counseling;*Genetic Diseases, Inborn;Genetic Predisposition to Disease;*Genetic Privacy;*Genetic Testing;*Heart Diseases;Humans;*Incidental Findings;Informed Consent;Intention;Moral Obligations;Motivation;Patients;*Pedigree;Physicians;Policy Making;Prejudice;Risk;Risk Assessment;Social Responsibility;Stress, Psychological;Time Factors;*Truth Disclosure;Analytical Approach;Genetics and Reproduction;Professional Patient Relationship","Wachbroit, R.",1998,Jun,,0,
4669,Patterns of hospice care among military veterans and non-veterans,"Context Historically, hospice use by veterans has lagged behind that of non-veterans. Little is known about hospice use by veterans at a population level. Objectives To determine whether veteran and non-veteran hospice users differ by demographics, primary diagnosis, location of care, and service utilization. Methods Using the 2007 National Home and Hospice Care Survey, we identified 483 veteran and 932 non-veteran male hospice users representing 287,620 hospice enrollees nationally. We used chi-square and t-tests to compare veterans and non-veterans by demographic characteristics, primary diagnosis, and location of hospice care. We used multivariate regression to assess for differences in hospice diagnosis and location of care, adjusting for demographic and clinical factors. We also compared length of stay and number of visits by hospice personnel between veterans and non-veterans using multivariate regression. Results Veteran hospice users were older than non-veterans (77.0 vs. 74.3 years, P = 0.02) but did not differ by other demographics. In adjusted analyses, cancer was a more common primary diagnosis among veterans than non-veterans (56.4% vs. 48.4%; P = 0.02), and veteran hospice users were more likely than non-veterans to receive hospice at home (68.4% vs. 57.6%; P = 0.007). The median adjusted length of stay and number of nurse or social worker visits did not differ by veteran status (all P > 0.10), but veterans received fewer home health aide visits than non-veterans (one every 5.3 days vs. one every 3.7 days; P = 0.002). Conclusion Although veteran and non-veteran hospice users were similar on most demographic measures, important differences in hospice referral patterns and utilization exist. © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All.",adult;aged;army;article;cerebrovascular disease;chronic lung disease;congestive heart failure;controlled study;dementia;demography;geography;health care personnel;health care utilization;health survey;home;hospice;hospice care;hospice patient;hospital;human;length of stay;major clinical study;male;malignant neoplastic disease;middle aged;nurse;nursing home;oligophrenia;patient referral;social worker;very elderly;veterans health,"Wachterman, M. W.;Lipsitz, S. R.;Simon, S. R.;Lorenz, K. A.;Keating, N. L.",2014,,,0,
4670,Quality of End-of-Life Care Provided to Patients With Different Serious Illnesses,"IMPORTANCE: Efforts to improve end-of-life care have focused primarily on patients with cancer. High-quality end-of-life care is also critical for patients with other illnesses. OBJECTIVE: To compare patterns of end-of-life care and family-rated quality of care for patients dying with different serious illnesses. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cross-sectional study was conducted in all 146 inpatient facilities within the Veteran Affairs health system among patients who died in inpatient facilities between October 1, 2009, and September 30, 2012, with clinical diagnoses categorized as end-stage renal disease (ESRD), cancer, cardiopulmonary failure (congestive heart failure or chronic obstructive pulmonary disease), dementia, frailty, or other conditions. Data analysis was conducted from April 1, 2014, to February 10, 2016. MAIN OUTCOMES AND MEASURES: Palliative care consultations, do-not-resuscitate orders, death in inpatient hospices, death in the intensive care unit, and family-reported quality of end-of-life care. RESULTS: Among 57753 decedents, approximately half of the patients with ESRD, cardiopulmonary failure, or frailty received palliative care consultations (adjusted proportions, 50.4%, 46.7%, and 43.7%, respectively) vs 73.5% of patients with cancer and 61.4% of patients with dementia (P < .001). Approximately one-third of patients with ESRD, cardiopulmonary failure, or frailty (adjusted proportions, 32.3%, 34.1%, and 35.2%, respectively) died in the intensive care unit, more than double the rates among patients with cancer and those with dementia (13.4% and 8.9%, respectively) (P < .001). Rates of excellent quality of end-of-life care reported by 34005 decedents' families were similar for patients with cancer and those with dementia (adjusted proportions, 59.2% and 59.3%; P = .61), but lower for patients with ESRD, cardiopulmonary failure, or frailty (54.8%, 54.8%, and 53.7%, respectively; all P </= .02 vs patients with cancer). This quality advantage was mediated by palliative care consultation, setting of death, and a code status of do-not-resuscitate; adjustment for these variables rendered the association between diagnosis and overall end-of-life care quality nonsignificant. CONCLUSIONS AND RELEVANCE: Family-reported quality of end-of-life care was significantly better for patients with cancer and those with dementia than for patients with ESRD, cardiopulmonary failure, or frailty, largely owing to higher rates of palliative care consultation and do-not-resuscitate orders and fewer deaths in the intensive care unit among patients with cancer and those with dementia. Increasing access to palliative care and goals of care discussions that address code status and preferred setting of death, particularly for patients with end-organ failure and frailty, may improve the overall quality of end-of-life care for Americans dying of these illnesses.",,"Wachterman, M. W.;Pilver, C.;Smith, D.;Ersek, M.;Lipsitz, S. R.;Keating, N. L.",2016,Aug 1,10.1001/jamainternmed.2016.1200,0,
4671,What is the mutation of mitochondrial DNA?,,mitochondrial DNA;transfer RNA;ataxia;dementia;DNA determination;eye disease;gene deletion;gene location;gene mutation;glucose intolerance;heart block;human;Kearns Sayre syndrome;MELAS syndrome;MERRF syndrome;myoclonus;ophthalmoplegia;perception deafness;point mutation;retina degeneration;seizure;short stature;short survey;cerebrovascular accident;vomiting,"Wada, Y.;Tamai, M.",2002,,,0,
4672,Advance directives affecting medical treatment choices,"Advance directives theoretically enhance individual autonomy and facilitate treatment decision making at the end of life. There is little empirical evidence to support this, however. Based on a national postal survey of 2172 randomly selected medical practitioners (response rate 73%), this paper examines the effect advance medical directives have on (a) treatment prescribing for terminally ill people and (b) the degree of difficulty practitioners experience in making treatment choices. A hypothetical patient with Alzheimer's disease and an acute life-threatening illness was presented with and without an advance directive. With a directive, respondents were more uniform in their choice of treatment, with 86% choosing as the patient had requested. Difficulty with decision making was also less with the directive, 31% vs 45% with no directive. The data indicate that advance directives do affect practitioners' treatment choices in favor of patient wishes and reduce the difficulty practitioners may experience in making them.","*Advance Directives;Aged;Aged, 80 and over;Alzheimer Disease/complications/therapy;Australia;*Decision Making;Female;Humans;Myocardial Infarction/complications/therapy;*Practice Patterns, Physicians';Death and Euthanasia;Empirical Approach","Waddell, C.;Clarnette, R. M.;Smith, M.;Oldham, L.",1997,Summer,,0,
4673,"Add-on prolonged-release melatonin for cognitive function and sleep in mild to moderate Alzheimer's disease: A 6-month, randomized, placebo-controlled, multicenter trial","Purpose: A link between poor sleep quality and Alzheimer's disease (AD) has recently been suggested. Since endogenous melatonin levels are already reduced at preclinical AD stages, it is important to ask whether replenishing the missing hormone would be beneficial in AD and whether any such effects would be related to the presence of sleep disorder in patients. Patients and methods: The effects of add-on prolonged-release melatonin (PRM) (2 mg) to standard therapy on cognitive functioning and sleep were investigated in 80 patients (men [50.7%], women [49.3%], average age 75.3 years [range, 52-85 years]) diagnosed with mild to moderate AD, with and without insomnia comorbidity, and receiving standard therapy (acetylcholinesterase inhibitors with or without memantine). In this randomized, double-blind, parallel-group study, patients were treated for 2 weeks with placebo and then randomized (1:1) to receive 2 mg of PRM or placebo nightly for 24 weeks, followed by 2 weeks placebo. The AD Assessment Scale-Cognition (ADAS-Cog), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), sleep, as assessed by the Pittsburgh Sleep Quality Index (PSQI) and a daily sleep diary, and safety parameters were measured. Results: Patients treated with PRM (24 weeks) had significantly better cognitive performance than those treated with placebo, as measured by the IADL (P=0.004) and MMSE (P=0.044). Mean ADAS-Cog did not differ between the groups. Sleep efficiency, as measured by the PSQI, component 4, was also better with PRM (P=0.017). In the comorbid insomnia (PSQI ≥6) subgroup, PRM treatment resulted in significant and clinically meaningful effects versus the placebo, in mean IADL (P=0.032), MMSE score (+1.5 versus -3 points) (P=0.0177), and sleep efficiency (P=0.04). Median ADAS-Cog values (-3.5 versus +3 points) (P=0.045) were significantly better with PRM. Differences were more significant at longer treatment duration. PRM was well tolerated, with an adverse event profile similar to that of placebo. Conclusion: Add-on PRM has positive effects on cognitive functioning and sleep maintenance in AD patients compared with placebo, particularly in those with insomnia comorbidity. The results suggest a possible causal link between poor sleep and cognitive decline. © 2014 Wade et al.",cholinesterase inhibitor;creatinine;glucose;melatonin;memantine;placebo;abdominal discomfort;abnormal dreaming;adult;aged;Alzheimer disease;angina pectoris;article;Assessment Scale Cognition;backache;burning feet syndrome;cognition;cognitive defect;comorbidity;controlled study;coughing;creatinine blood level;decreased appetite;delusion;diarrhea;disease severity;drug efficacy;drug safety;drug tolerability;drug withdrawal;fatigue;female;glucose blood level;headache;human;insomnia;instrumental activities of daily living;major clinical study;male;Mini Mental State Examination;multicenter study;nausea;Pittsburgh Sleep Quality Index;randomized controlled trial;rating scale;restlessness;rhinopharyngitis;side effect;sleep quality;somnolence;thyroid tumor;treatment duration;upper respiratory tract infection;urinary tract infection;vomiting;circadin,"Wade, A. G.;Farmer, M.;Harari, G.;Fund, N.;Laudon, M.;Nir, T.;Frydman-Marom, A.;Zisapel, N.",2014,,,0,
4674,Clinical correlates of leukoaraiosis: A study of 175 patients,"Background: In India, the correlates of leukoaraiosis (LA) have not been widely reported. This study was designed to investigate the factors which correlate with LA. Materials and Methods: We included patients with LA who consented for the study and graded their severity on the basis of Fazekas scale. We excluded patients with LA who did not consent/cooperate for the study as also patients with other white matter changes which mimic LA. Results: LA is a common and under-rated cause of disability. Presentations include cognitive decline, gait disturbance, dysarthria, bladder/bowel sphincter disturbances, and increased risk of stroke. The comorbidities include hyperhomocysteinemia, hypertension, dyslipidemia, tobacco use, ischemic heart disease, previous stroke, atrial fibrillation, chronic renal failure, and bariatric surgery.",adult;aged;article;atrial fibrillation;bariatric surgery;bladder disease;chronic kidney failure;clinical examination;comorbidity;digestive system disease;dysarthria;dyslipidemia;female;gait disorder;human;hyperhomocysteinemia;hypertension;India;ischemic heart disease;leukoaraiosis;major clinical study;male;mental deterioration;observational study;patient referral;prospective study;risk factor;tertiary care center;tobacco use;white matter,"Wadia, R.;Ghiya, S.;Singh, J.;Sontakke, S.;Bharadwaj, V.;Sonawane, R.;Bade, Y.;Shrikanth, K.;Goli, N.;Chauhan, R.;Nadkarni, N.",2016,,10.4103/0972-2327.194425,0,
4675,Simple search techniques in PubMed are potentially suitable for evaluating the completeness of systematic reviews,"Objective: The Institute for Quality and Efficiency in Health Care (IQWiG) assesses the added benefit of new drugs by means of company dossiers. The pharmaceutical company performs the information retrieval, which is then assessed by IQWiG. Our aim was to determine whether PubMed's Related Citations (RelCits) and/or a simple-structured Boolean search (SSBS) are efficient and reliable search techniques to assess the completeness of an evidence base consisting of published randomized controlled trials (RCTs). Study Design and Setting: Retrospective analysis of citations included as relevant in systematic reviews (SRs) of drugs. The proportion of relevant citations identified by the above-mentioned search techniques was determined. Relative sensitivity, precision, and the number needed to read (NNR) were then calculated. Results: A total of 19 SRs included 330 relevant PubMed citations. The single techniques yielded either insufficient completeness, reliability, or efficiency. The first 20 RelCits plus SSBS achieved high completeness and reliability (sensitivity: 98.1%, range: 80-100%) and sufficient efficiency (precision: 5.0%, NNR: 25). The first 50 RelCit plus SSBS achieved slightly better completeness and reliability, but slightly worse efficiency. Conclusion: Combining the first 20 RelCits and an SSBS in PubMed is a suitable method to assess the completeness of an evidence base of published RCTs. © 2013 Elsevier Inc. All rights reserved.",accuracy;acute coronary syndrome;Alzheimer disease;article;asthma;calculation;citation analysis;depression;insulin dependent diabetes mellitus;Medline;non insulin dependent diabetes mellitus;priority journal;productivity;randomized controlled trial (topic);reading;retrospective study;sensitivity analysis;systematic review (topic),"Waffenschmidt, S.;Janzen, T.;Hausner, E.;Kaiser, T.",2013,,,0,
4676,Antihypertensive treatment and risk of dementia: A retrospective database study,"Objective: Vascular risk factors play an important role in the pathogenesis of vascular dementia, as well as in Alzheimer disease. The effect of antihypertensive medication on risk of dementia is unclear. The aim was to investigate the association between antihypertensive prescriptions and incident dementia, using a primary care database. Methods: The analysis was based on 575 general and internal practices in Germany (10/2003-09/2008) (Disease analyzer database). Antihypertensive medication (ATC codes) during 3 years before newly diagnosed dementia (ICD codes or specific medication) in 1,297 patients was compared to 1,297 controls without dementia after matching for age (mean age: 80.6 ± 8.6 y), sex (females: 62%) and date of diagnosis. Conditional logistic regression was used to calculate crude and adjusted odds ratios (95% confidence intervals). Results: Betablocker prescriptions (≥ 1 per year over 3 y) showed a significant inverse association with newly diagnosed dementia (Odds ratio, OR: 0.79 95% CI 0.61 - 0.99) after adjusting for demographic covariates, health care use, and cardiovascular and neurological comorbidity. In the fully adjusted model, ACE inhibitors also tended to be inversely associated with incident dementia, but failed statistical significance (OR 0.84 95% CI 0.65 - 1.08). Calcium channel blockers were positively related to cognitive impairment only in the crude analysis. The other drug groups were not significantly related to dementia (diuretics OR: 0.89; 0.67 - 1.19; angiotensin-1-inhibitors OR: 1.04; 0.66 - 1.64). Conclusions: This practice-based case-control study indicated a possible protective effect of some antihypertensive agents (beta-blockers, ACE-inhibitors) on the development of dementia. Randomized controlled trials are required to confirm this finding. ©2012 Dustri-Verlag Dr. K. Feistle.",angiotensin I;beta adrenergic receptor blocking agent;calcium channel blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;aged;article;comorbidity;confidence interval;controlled study;dementia;diabetes mellitus;disease association;drug mechanism;female;health care utilization;heart failure;human;hypertension;incidence;logistic regression analysis;major clinical study;male;medical practice;prescription;primary medical care;retrospective study;risk assessment;cerebrovascular accident,"Wagner, G.;Icks, A.;Abholz, H. H.;Schrod̈er-Bernhardi, D.;Rathmann, W.;Kostev, K.",2012,,,0,
4677,Beverages: Alternative medicine and health benefits,"Since ancient time people consume different beverages and have attributed health benefits without any scientific basis. Beverages or drinks are liquid preparations used for human consumption worldwide in daily life. Beverages are classified as alcoholic and non alcoholic beverages. Alcoholic beverages including beer, wine, cider and sprits; nonalcoholic beverages including soft drinks like soda pop, sparkling water, iced tea, lemonade, root beer, fruit punch, milk, hot chocolate, tea, coffee, milkshakes, energy drinks, juice, and carbohydrate drink, have been part of human culture. Water itself is often not classified as beverage but water is the chief constituent of all the beverages that maintain body electrolyte level and responsible for change in volume of blood circulation. Complete removal of water cause death faster than other substance. Some of these beverages are use as a traditional medicine for the treatment of chronic and acute diseases. Tea contains theobromine, theophylline, caffeine, polyphenols, antioxidants etc. and used in asthma (as bronchodilator), angina pectoris, peripheral vascular disease, coronary artery disease, lowering of blood cholesterol, and as anti cancer agent. Coffee contains psychoactive substance caffeine, having stimulant effect. Coffee also have antioxidant and use in prevention of Alzheimer's disease, dementia, Parkinson's disease, heart disease, diabetes mellitus type 2, non-alcoholic fatty liver disease, cirrhosis, and gout. Moderate consumption of alcoholic beverages decreases the risk of cardiac disease, stroke, hypertension, diabetes, and certain types of cancer, including colon, ovarian, and prostate carcinoma. The long term continuous consumption of heavy alcohol is responsible to risk of developing alcoholism and alcoholic liver disease. Juices are rich in vitamins, phytochemicals, antioxidants, fructose and essential minerals that provide health benefits.",4 hydroxyphenylacetic acid;aliquilphenol derivative;alkaloid;benzoic acid derivative;chalcone derivative;coumaric acid;diterpene;flavanone derivative;flavonol derivative;hydroxyaldehyde;hydroxybenzoic acid derivative;multivitamin;phenol derivative;polyphenol derivative;stilbene derivative;unclassified drug;acute disease;alcoholic beverage;alternative medicine;Alzheimer disease;angina pectoris;article;asthma;beer;beverage;cacao;chronic disease;cider;clinical effectiveness;coffee;coronary artery disease;dementia;diet therapy;drinking;energy drink;food analysis;food composition;fruit juice;gout;health food;human;liver cirrhosis;milk;non insulin dependent diabetes mellitus;nonalcoholic fatty liver;nutritional value;outcome assessment;Parkinson disease;peripheral vascular disease;risk reduction;soft drink;sprit;tea;traditional medicine;wine,"Waheed, A.;Sadhna, D.;Gupta, A.;Patel, P.;Jabin, F.;Rajput, S. K.",2015,,,0,
4678,Principles for safety and efficacy in the development of novel and functional foods,"Functional foods are foods positioned in the market place for particular and identified physiological or health reasons. They may be traditional foods with newly defined significance or altogether newly formulated foods whose ingredients may be novel or whose formulation may be novel. Functional foods may also be ones used to prevent or manage disease, but here they may compete with pharmaceutical products, only to be distinguished by source of active component and the form in which they are ingested, namely one recognised and/or sold as food or medicine. A list of nine health categories, in which new foods requiring risk analysis may be devoloped, is presented in the article.",Alzheimer disease;diet therapy;food industry;food intake;food safety;human;ischemic heart disease;large intestine cancer;obesity;osmolality;osteoporosis;pH;phytochemistry;risk assessment;short survey;water content;wellbeing,"Wahlqvist, M. L.",2000,,,0,
4679,Hospitalizations and skilled nursing facility admissions before and after the implementation of a home-based primary care program,"Objectives: To evaluate the effect of an urban house calls program (HCP) on healthcare utilization. Design: Retrospective chart review with pre/post analysis. Setting: Urban home-based primary care program. Participants: All participants (N=179) in a capitated insurance program enrolled in a HCP between October 2004 and August 2006. INTERVENTION: Enrollment into HCP. Measurements: Hospitalizations and skilled nursing facility (SNF) admissions before and after enrollment. Patients with at least one hospitalization or SNF admission before and after enrollment were compared using the McNemar test. Median number of hospitalizations and SNF placements before and after HCP enrollment were compared using the Wilcoxon signed-rank sum test. Results: Sixty-one percent of patients had one or more hospitalizations before enrollment, whereas only 38% had one or more hospitalizations after enrollment (P<.001). Thirty-eight percent of patients had at least one SNF placement before enrollment, compared with 18% after enrollment (P=.001). The median hospitalization rate decreased from 1 to 0; the median SNF placement rate was 0 (interquartile range 0-1) before enrollment and 0 (interquartile range 0-0) after enrollment (P<.001). Conclusion: A HCP may be associated with fewer hospitalizations and SNF placements. Models of care that reduce morbidity and preserve quality of life are critical to help homebound older adults remain in their communities. © 2010, The American Geriatrics Society.",aged;arthritis;article;asthma;chronic obstructive lung disease;congestive heart failure;controlled study;coronary artery disease;dementia;depression;diabetes mellitus;ethnicity;female;health care quality;health care utilization;health program;hospitalization;human;major clinical study;male;medical record;morbidity;nursing home;primary medical care;retrospective study;urban area,"Wajnberg, A.;Wang, K. H.;Aniff, M.;Kunins, H. V.",2010,,,0,
4680,Recognizing encephalopathy and delirium in the cardiopulmonary rehabilitation setting,"Objective: This article reviews the prevalence, underlying mechanisms, and challenges of treating encephalopathy and delirium in the postsurgical and medically compromised cardiopulmonary patient receiving services on an acute inpatient rehabilitation unit. Additionally, pertinent information is provided on conducting an evaluation to assess for neurocognitive sequelae of the above-mentioned conditions to help achieve better treatment outcomes. Method: Review of the medical and neuropsychology literature is provided along with 2 case reports to illustrate evaluation of a persisting toxicmetabolic encephalopathy and a resolving delirium and the treatment team's effectiveness in producing a more optimal treatment outcome. The unique role of the rehabilitation psychologist, special treatment considerations, and the importance of integrated follow-up neurorehabilitation services for the cardiopulmonary patient and caregivers also are emphasized. Results: Encephalopathy and delirium are 2 related, but somewhat different, conditions that can emerge postoperatively, any time during acute care hospitalization, and often enough, during impatient or subacute-care rehabilitation. Their association with long-term harm and poor outcome warrant early identification and immediate medical intervention. Implications: Encephalopathy and delirium can significantly affect rehabilitation outcomes and, as such, rehabilitation psychologists are encouraged to systematically screen for the presence of delirium and encephalopathy in the cardiopulmonary rehabilitation setting so to enhance treatment efficacy and quality of life in affected individuals.",sotalol;aftercare;aged;Alzheimer disease;anxiety;article;atrial fibrillation;biventricular assist device;brain atherosclerosis;brain disease;brain infarction;cardiopulmonary rehabilitation;caregiver support;case report;cerebrovascular accident;chronic obstructive lung disease;clinical assessment;clinical assessment tool;cognition;cognitive rehabilitation;coma;computer assisted tomography;confusion;Confusion Assessment for delirium;congestive cardiomyopathy;congestive heart failure;coronary artery bypass graft;deep vein thrombosis;dehydration;delirium;dementia;depression;disease exacerbation;electrolyte disturbance;female;heart arrest;heart arrhythmia;heart muscle ischemia;heart rehabilitation;heart ventricle tachycardia;hospital patient;human;hypotension;implantable cardioverter defibrillator;incidence;ischemic heart disease;kidney failure;lethargy;malnutrition;mental disease;mental health;metabolic encephalopathy;microembolism;mild cognitive impairment;Mini Mental State Examination;Montreal cognitive assessment;morbidity;mortality;neuropsychological test;neuropsychology;nuclear magnetic resonance imaging;nutritional deficiency;osmolality;pathophysiology;patient counseling;postoperative period;prevalence;problem solving;psychoeducation;psychologic test;psychologist;pulmonary rehabilitation;quality of life;sepsis;sleep disordered breathing;stupor;thorax pain;toxic metabolic encephalopathy;treatment outcome;treatment planning;uterus cancer;very elderly;vitamin deficiency;Wechsler intelligence scale;Wechsler memory scale,"Waked, W. J.;Gordon, R. M.;Whiteson, J. H.;Baron, E. M.",2015,,,0,
4681,Interactive relations of blood pressure and age to subclinical cerebrovascular disease,"Objective: To examine interactive relations of blood pressure (BP) and age to MRI indices of subclinical cerebrovascular disease in middle-aged to older adults. Methods: One hundred and thirteen stroke-free and dementia-free, community-dwelling adults (ages 54-81 years; 65% men; 91% white) engaged in (1) clinical assessment of resting SBP and DBP; (2) MRI rated for periventricular white matter hyperintensities (WMH) and deep WMH silent brain infarction (SBI) and brain atrophy (i.e. ventricular enlargement and sulcal widening ). Principal components analysis of the MRI ratings yielded a two-component solution-(1) periventricular and deep WMH SBI; and (2) ventricular enlargement, sulcal widening. Results: Relations of SBP, DBP and pulse pressure (PP) (and their interactions with age) to each MRI component were examined in multiple regression analyses adjusted for age, sex, fasting plasma glucose and cholesterol, and antihypertensives. For component 1, results indicated significant interactions of SBP and PP with age (P < 0.05); higher levels of SBP and PP were associated with greater white matter disease and brain infarction at younger ages (≤68 years). Significant interactions of SBP and DBP with age were also noted for component 2 (P < 0.05); higher levels of BP were associated with greater brain atrophy at younger ages (≤63 years). Conclusion: Higher BP and PP are associated with greater subclinical cerebrovascular disease most prominently in the 'young old'. Appropriate management of hypertension and arterial stiffening may be critical to the preservation of brain structure with ageing. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.",adult;age;aged;arterial stiffness;article;blood pressure monitoring;brain atrophy;brain infarction;cerebrovascular disease;diastolic blood pressure;female;heart left ventricle hypertrophy;human;hypertension;major clinical study;male;nuclear magnetic resonance imaging;priority journal;pulse pressure;systolic blood pressure;white matter lesion,"Waldstein, S. R.;Wendell, C. R.;Lefkowitz, D. M.;Siegel, E. L.;Rosenberger, W. F.;Spencer, R. J.;Manukyan, Z.;Katzel, L. I.",2012,,,0,
4682,Identifying wound prevalence using the Mobile Wound Care program,"Measuring the prevalence of wounds within health care systems is a challenging and complex undertaking. This is often compounded by the clinicians' training, the availability of the required data to collect, incomplete documentation and lack of reporting of this type of data across the various health care settings. To date, there is little published data on wound prevalence across regions or states. This study aims to identify the number and types of wounds treated in the Gippsland area using the Mobile Wound Care (MWC™) program. The MWC program has enabled clinicians in Gippsland to collect data on wounds managed by district nurses from four health services. The main outcomes measured were patient characteristics, wound characteristics and treatment characteristics of wounds in Gippsland. These data create several clinical and research opportunities. The identification of predominant wound aetiologies in Gippsland provides a basis on which to determine a regional wound prospective and the impact of the regional epidemiology. Training that incorporates best practice guidelines can be tailored to the most prevalent wound types. Clinical pathways that encompass the Australian and New Zealand clinical practice guidelines for the management of venous leg ulcers can be introduced and the clinical and economical outcomes can be quantitatively measured. The MWC allows healing times (days) to be benchmarked both regionally and against established literature, for example, venous leg ulcers. © 2014 John Wiley & Sons Ltd.",anticoagulant agent;corticosteroid;acute heart infarction;adolescent;adult;age;aged;alcohol consumption;Alzheimer disease;anemia;article;asthma;Australia;cardiovascular disease;cellulitis;cerebrovascular accident;chemotherapy;child;chronic obstructive lung disease;colostomy;comorbidity;congestive heart failure;coronary artery disease;crush trauma;decubitus;deep vein thrombosis;dementia;depression;economic aspect;emphysema;endocrine disease;female;gastroesophageal reflux;gastrointestinal disease;health program;heart arrhythmia;human;hyperlipidemia;hypertension;hypotension;hypothyroidism;incontinence;infant;insulin dependent diabetes mellitus;kidney failure;leg ulcer;limited mobility;liver disease;lymphedema;major clinical study;malabsorption;male;mental health;metabolic disorder;middle aged;mobile wound care;mood disorder;musculoskeletal disease;neoplasm;neurologic disease;New Zealand;newborn;non insulin dependent diabetes mellitus;nurse;nutritional disorder;obesity;osteoarthritis;osteoporosis;outcome assessment;pain;palliative therapy;paraplegia;Parkinson disease;patient compliance;peripheral vascular disease;practice guideline;preschool child;prevalence;priority journal;respiratory tract disease;rheumatoid arthritis;school child;smoking;socioeconomics;surgical wound;transient ischemic attack;urine incontinence;very elderly;wound care;wound healing;young adult,"Walker, J.;Cullen, M.;Chambers, H.;Mitchell, E.;Steers, N.;Khalil, H.",2014,,,0,
4683,Identifying patients at risk of emergency admission for colorectal cancer,"Background: Patients whose colorectal cancer is treated after an emergency admission tend to have late-stage cancer and a poor prognosis. We identified risk factors for an emergency admission by linking data from the National Bowel Cancer Audit (NBCA) and the English Hospital Episode Statistics (HES), an administrative database of all admissions to English National Health Service hospitals, which includes data on mode of admission.Methods:We identified all adults included in the NBCA with a primary diagnosis of bowel cancer, excluding cancer of the appendix, between August 2007 and July 2011 whose record could be linked to HES. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) for an emergency admission for colorectal cancer. All risk factors were adjusted for cancer site and calendar year.Results:97 909 adults were identified with a primary diagnosis of bowel cancer and 82 777 patients could be linked to HES. Patients who were older, female, of a non-white ethnic background, and more socioeconomically deprived, and those with dementia or cardiac, neurologic and liver disease had an increased risk of presenting as an emergency admission. The strongest risk factors were age (90 compared with 70 years: OR 2.99, 95% CI 2.84 to 3.15), dementia (OR 2.46, 2.18 to 2.79), and liver disease (OR 1.87, 1.69 to 2.08).Conclusions:Our study identifies risk factors that may impair health-seeking behaviour and access to healthcare. An earlier recognition of symptoms in patients with these risk factors may contribute to better outcomes. © 2014 Cancer Research UK. All rights reserved.",adult;advanced cancer;aged;article;cancer localization;cerebrovascular disease;chronic kidney disease;chronic lung disease;colorectal cancer;comparative study;congestive heart failure;dementia;diabetes mellitus;emergency care;ethnicity;female;gender;heart infarction;hemiplegia;high risk patient;hospital admission;human;intestine cancer;liver disease;major clinical study;male;paraplegia;patient identification;peripheral vascular disease;priority journal;rheumatic disease;risk factor;senescence;social status;very elderly,"Wallace, D.;Walker, K.;Kuryba, A.;Finan, P.;Scott, N.;Van Der Meulen, J.",2014,,,0,
4684,Mitochondrial genetics: a paradigm for aging and degenerative diseases?,"Studies of diseases caused by mitochondrial DNA mutations suggest that a variety of degenerative processes may be associated with defects in oxidative phosphorylation (OXPHOS). Application of this hypothesis has provided new insights into such diverse clinical problems as ischemic heart disease, late-onset diabetes, Parkinson's disease, Alzheimer's disease, and aging.","Aging/*genetics;Alzheimer Disease/genetics;Base Sequence;Coronary Disease/genetics;DNA, Mitochondrial/chemistry/*genetics;Humans;Huntington Disease/genetics;Molecular Sequence Data;Muscular Diseases/genetics;Mutation;Nervous System Diseases/genetics;*Oxidative Phosphorylation;Parkinson Disease/genetics;RNA, Transfer/genetics","Wallace, D. C.",1992,May 1,,0,
4685,Long-Term Outcomes and Causes of Death in Patients with Renovascular Disease Undergoing Renal Artery Stenting,"Renovascular disease (RVD) can lead to hypertension and chronic kidney disease (CKD). Patients with advanced peripheral arterial disease (PAD) have a 5-year mortality of 1/430%. Rate and causes of death in patients with significant RVD, who share similar risk factors with patients having PAD, are not well defined. We assessed consecutive patients with RVD who underwent renal artery stenting at our institution over 6 years. Specific causes of death were ascertained, and the probability of survival was estimated. Cox models were fit to identify predictors of outcomes. We identified 281 patients with RVD who underwent renal stenting. Follow-up was available for all patients (median 5.1 years). All-cause mortality was 24.2% at 5 years and 33.7% at 7 years (compounded annualized death rate: 5.5%). Of the 68 deaths, 36 (52.9%) were cardiovascular (13.2% acute myocardial infarction, 13.2% stroke, 11.8% sudden death, and 10.3% congestive heart failure) and 32 (47.1%) deaths had noncardiovascular causes. In patients with RVD undergoing stenting, cardiovascular events are the most common causes of death. Compared to patients with advanced PAD, RVD may have a lower 5-year mortality.",acute heart infarction;aged;article;cardiomyopathy;cardiovascular mortality;cause of death;cerebrovascular accident;congestive heart failure;coronary artery disease;dementia;female;follow up;frail elderly;gastrointestinal hemorrhage;human;liver disease;lung disease;major clinical study;male;medical record review;mortality rate;outcome assessment;pancreatitis;peripheral occlusive artery disease;predictor variable;proportional hazards model;renal artery stent;renovascular disease;sudden death;survival rate;thromboembolism;transient ischemic attack;wound infection,"Wallace, E. L.;Tasan, E.;Cook, B. S.;Charnigo, R.;Abdel-Latif, A. K.;Ziada, K. M.",2016,,,0,
4686,Incident atrial fibrillation and the risk of fracture in the cardiovascular health study,"In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture. INTRODUCTION: AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort. METHODS: Of the CHS participants aged >/=65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall. RESULTS: Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 % CI 0.83-1.42) or fracture at any selected site (adjusted HR = 0.97, 95 % CI 0.77-1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 % CI = 0.87-1.16) compared with those without AF. CONCLUSION: In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.",Arrhythmia;Atrial fibrillation;Fracture;Hip fracture,"Wallace, E. R.;Siscovick, D. S.;Sitlani, C. M.;Dublin, S.;Mitchell, P.;Robbins, J. A.;Fink, H. A.;Cauley, J. A.;Buzkova, P.;Carbone, L.;Chen, Z.;Heckbert, S. R.",2016,Oct 7,10.1007/s00198-016-3778-1,0,
4687,Incident atrial fibrillation and the risk of fracture in the cardiovascular health study,"Summary: In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture. Introduction: AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort. Methods: Of the CHS participants aged ≥65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall. Results: Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 % CI 0.83–1.42) or fracture at any selected site (adjusted HR = 0.97, 95 % CI 0.77–1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 % CI = 0.87–1.16) compared with those without AF. Conclusion: In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.",antihypertensive agent;bisphosphonic acid derivative;warfarin;aged;article;atrial fibrillation;diabetes mellitus;disease association;electrocardiogram;female;follow up;hip fracture;hospital discharge;human;hypertension;ischemic heart disease;major clinical study;male;medicare;priority journal;prospective study;risk factor,"Wallace, E. R.;Siscovick, D. S.;Sitlani, C. M.;Dublin, S.;Mitchell, P.;Robbins, J. A.;Fink, H. A.;Cauley, J. A.;Bůžková, P.;Carbone, L.;Chen, Z.;Heckbert, S. R.",2017,,10.1007/s00198-016-3778-1,0,
4688,"Calcium dysregulation, and lithium treatment to forestall Alzheimer's disease - a merging of hypotheses","Intracellular Ca(2+) concentrations are tightly regulated, and elevated levels sustained over periods of time can cause cellular deterioration. The putative role of dysregulated intracellular Ca(2+) in Alzheimer's disease had led to the hypothesis that controlling intracellular Ca(2+) may forestall cognitive decline. Lithium has been shown to reduce intracellular Ca(2+) concentrations. Two well-characterized neuronal targets of lithium that may affect intracellular Ca(2+) levels are N-methyl-d-aspartate (NMDA) receptors and inositol monophosphatase (IMP). Results from a recent single-center placebo-controlled randomized trial suggest that long-term lithium treatment at subtherapeutic doses may have the potential to delay the progression of disease, and observational studies have shown that lithium reduces the prevalence of dementia in subjects with bipolar disorder on long-term lithium therapy. I am advancing the hypothesis that lithium may protect against cognitive decline by stabilizing intracellular Ca(2+) through a dual, synergistic mechanism of targeting both extracellular and intracellular sites, via antagonizing NMDA-receptors and inhibiting IMP. Insights derived from this hypothesis could lead to an improved understanding of the molecular pathology of Alzheimer's disease, and have implications on the evaluation and use of therapeutics that alter intracellular Ca(2+) levels.","Alzheimer Disease/drug therapy/metabolism/pathology;Calcium/metabolism;Calcium Signaling/*drug effects;Glycogen Synthase Kinase 3/antagonists & inhibitors/metabolism;Humans;Lithium/*pharmacology/therapeutic use;*Models, Theoretical;Neuronal Plasticity;Phosphoric Monoester Hydrolases/antagonists & inhibitors/metabolism;Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors/metabolism;Alzheimer's disease;Congestive heart failure Inclusion body myositis Digoxin;Inositol monophosphatase;Inositol trisphosphate;Lithium;NMDA-receptors","Wallace, J.",2014,Mar,10.1016/j.ceca.2014.02.005,0,
4689,"Symptoms, vascular risk factors and blood-brain barrier function in relation to CT white-matter changes in dementia","The aim was to study the frequently found white-matter changes on computerized tomography (CT) in patients with dementia and to relate these changes to clinical regional brain symptomatology, vascular factors, albumin ratio [indicator of blood-brain barrier (BBB) function] and other CT changes. The study included 85 patients, average age 71 ± 8, with Alzheimer's disease (n = 56) and vascular dementia (n = 29), who underwent CT (Siemens Somatome DR 1) of the brain. They were inpatients in a psychiatric department specialized in dementia investigations. The degree of CT white-matter changes (absence, mild-moderate, severe) was the basis for the division of the patients into three groups. As the patients without white-matter changes were significantly younger than those with such changes, all statistical analyses were controlled for age. Subcortical symptomatology was significantly more frequent in the group with severe white-matter changes, whereas the reverse was true for parietal symptomatology. Diabetes mellitus, hypertension, ischemic cardiac disease and lacunas were significantly more common in patients with white-matter changes, whereas the freqeuncy of transient ischemic attack/stroke episodes did not differ significantly between the groups. The albumin ratio was significantly higher in the groups with white-matter changes and highest in the group with severe white-matter changes. The findings indicate that white-matter changes in demented patients are at least partially an age- and stroke-independent disease manifestation of the vascular system and is associated with a specific symptom pattern. BBB dysfunction may be the link between the vasculature and the tissue damage. Copyright (C) 2000 S. Karger AG, Basel.",adult;aged;Alzheimer disease;article;blood brain barrier;blood vessel injury;computer assisted tomography;dementia;diabetes mellitus;female;human;hypertension;ischemic heart disease;major clinical study;male;multiinfarct dementia;priority journal;risk factor;scoring system;statistical analysis;tissue injury;white matter,"Wallin, A.;Sjögren, M.;Edman, Å;Blennow, K.;Regland, B.",2000,,,0,
4690,Isolated brain metastasis from a small renal mass,"The identification of small renal masses is increasing. Active surveillance is a guideline-approved management strategy for select patients with small renal masses. Metastases during the observation of small renal masses are uncommon, and no cases of brain metastasis have been reported. We report the case of a 73-year-old man who presented with tonic-clonic seizures as the result of a brain metastasis from a small renal mass (3.5 cm in maximal dimension). Treatment with whole brain radiotherapy was undertaken successfully. The patient will undergo surveillance with consideration for systemic therapy at the time of progression.",donepezil;lorazepam;phenytoin;warfarin;abdominal radiography;aged;alcohol consumption;article;atrial fibrillation;bone scintiscanning;bradycardia;brain biopsy;brain metastasis;case report;clear cell carcinoma;computer assisted tomography;dementia;forward heart failure;histopathology;human;hypervolemia;immunohistochemistry;intubation;kidney tumor;male;medical history;neurologic examination;pacemaker;patient monitoring;priority journal;sedation;smoking;tonic clonic seizure;transient ischemic attack;tumor vascularization;tumor volume,"Wallis, C. J. D.;Downes, M. R.;Bjarnason, G.;Satkunasivam, R.",2016,,,0,
4691,Ageing and health issues in intellectual disabilities,"PURPOSE OF REVIEW: This review summarizes recent research and evidence-based practice and policy guidelines from 31 articles or books focused on the health of ageing individuals with intellectual disabilities. RECENT FINDINGS: Findings are presented under four headings that correspond to categories of health measures applied in recent EU evidence-based public health documents. Large group studies, notably longitudinal studies, have advanced knowledge of the health-related attributes of the population of older adults with intellectual disabilities and their distinctive health risks, including those linked to aetiologies. Empirical studies applying various research designs and literature reviews presented findings about weight and levels of physical activity, prevalent health problems (e.g. high levels of sensory impairment, risk factors for coronary artery disease) and other aspects of the health status of this population. Efforts to improve assessment methods for dementia continue. Evidence from small group studies in Israel and the USA suggests that interventions to increase physical activity and functioning of older adults may be beneficial. Pharmacological studies consider treatments for dementia as well as widespread prescription of medications to manage challenging behaviours. Health system issues include access to health care, training for health professionals, support for family care givers, end of life care and more cohesive national health policies. SUMMARY: Health-related research in older people with intellectual disabilities has extended our understanding of the characteristics of this population relative to other groups of older individuals and to national populations in terms of health status, determinants of health and priorities for policy and practice.",,"Walsh, P. N.",2005,Sep,10.1097/01.yco.0000179487.85261.6f,0,
4692,Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization,"CONTEXT: For many elderly patients, an acute medical illness requiring hospitalization is followed by a progressive decline, resulting in high rates of mortality in this population during the year following discharge. However, few prognostic indices have focused on predicting posthospital mortality in older adults. OBJECTIVE: To develop and validate a prognostic index for 1 year mortality of older adults after hospital discharge using information readily available at discharge. DESIGN: Data analyses derived from 2 prospective studies with 1-year of follow-up, conducted in 1993 through 1997. SETTING AND PATIENTS: We developed the prognostic index in 1495 patients aged at least 70 years who were discharged from a general medical service at a tertiary care hospital (mean age, 81 years; 67% female) and validated it in 1427 patients discharged from a separate community teaching hospital (mean age, 79 years; 61% female). MAIN OUTCOME MEASURE: Prediction of 1-year mortality using risk factors such as demographic characteristics, activities of daily living (ADL) dependency, comorbid conditions, length of hospital stay, and laboratory measurements. RESULTS: In the derivation cohort, 6 independent risk factors for mortality were identified and weighted using logistic regression: male sex (1 point); number of dependent ADLs at discharge (1-4 ADLs, 2 points; all 5 ADLs, 5 points); congestive heart failure (2 points); cancer (solitary, 3 points; metastatic, 8 points); creatinine level higher than 3.0 mg/dL (265 micromol/L) (2 points); and low albumin level (3.0-3.4 g/dL, 1 point; <3.0 g/dL, 2 points). Several variables associated with 1-year mortality in bivariable analyses, such as age and dementia, were not independently associated with mortality after adjustment for functional status. We calculated risk scores for patients by adding the points of each independent risk factor present. In the derivation cohort, 1-year mortality was 13% in the lowest-risk group (0-1 point), 20% in the group with 2 or 3 points, 37% in the group with 4 to 6 points, and 68% in the highest-risk group (>6 points). In the validation cohort, 1-year mortality was 4% in the lowest-risk group, 19% in the group with 2 or 3 points, 34% in the group with 4 to 6 points, and 64% in the highest-risk group. The area under the receiver operating characteristic curve for the point system was 0.75 in the derivation cohort and 0.79 in the validation cohort. CONCLUSIONS: Our prognostic index, which used 6 risk factors known at discharge and a simple additive point system to stratify medical patients 70 years or older according to 1-year mortality after hospitalization, had good discrimination and calibration and generalized well in an independent sample of patients at a different site. These characteristics suggest that our index may be useful for clinical care and risk adjustment.","Aged;Aged, 80 and over;Female;*Health Status Indicators;Hospitalization/*statistics & numerical data;Humans;Logistic Models;Male;*Mortality;Multivariate Analysis;Prognosis;Risk Assessment;Risk Factors","Walter, L. C.;Brand, R. J.;Counsell, S. R.;Palmer, R. M.;Landefeld, C. S.;Fortinsky, R. H.;Covinsky, K. E.",2001,Jun 20,,0,
4693,"Safety, feasibility, and outcomes of tapering antihypertensive agents in older adults in preparation for clinical trials","Objectives:Wide use of antihypertensive agents limits participation in clinical trials and the ability to assess physiological outcomes of blood pressure (BP) independent of medication effects. The purpose of this study was to evaluate the safety, feasibility, and outcomes of tapering antihypertensives. Methods: Participants 60 years or older with hypertension, taking <2 antihypertensives, and without diabetes mellitus, congestive heart failure, or dementia, were enrolled prospectively (n=26 receiving antihypertensives, mean age 71.3+/-1.3 years, 60% women, 27% African Americans). Antihypertensives were tapered over 3 weeks with close monitoring. Participants were then enrolled in a clinical trial and received one of three antihypertensive regimens (hydrochlorothiazide, candesartan, or lisinopril). Dose adjustments were performed until participants achieved BP <140/90 mmHg.Antihypertensive load was determined by adding the fraction of maximum dosage for each medication. Results: There were no side effects reported, no medical attention required, and no drop-outs due to safety concerns among the 26 tapered participants. All participants achieved blood pressure control after enrollment (systolic BP drop from 148+/-4 to 130+/-1 mmHg, P<0.001). In addition in those who were controlled prior to enrollment, antihypertensive load decreased from 0.54+/-0.11 to 0.34+/-0.07 (P=0.038). Conclusion: Short term medication taper with careful monitoring among older adults taking <2 antihypertensives is likely to be safe and feasible in geriatric clinical trials. Involvement in such trials may lead to improved blood pressure control and decreased antihypertensive load.",adult;clinical trial (topic);geriatrics;society;safety;human;drug therapy;monitoring;blood pressure regulation;diabetes mellitus;blood pressure;hypertension;clinical trial;African American;dementia;side effect;congestive heart failure;female;antihypertensive agent;hydrochlorothiazide;candesartan;lisinopril;Sr-dementia,"Wan, S;Hart, M;Lipsitz, La;Hajjar, I",2010,,10.1111/j.1532-5415.2010.02850.x,0,
4694,Clinical risk prediction by exploring high-order feature correlations,"Clinical risk prediction is one important problem in medical informatics, and logistic regression is one of the most widely used approaches for clinical risk prediction. In many cases, the number of potential risk factors is fairly large and the actual set of factors that contribute to the risk is small. Therefore sparse logistic regression is proposed, which can not only predict the clinical risk but also identify the set of relevant risk factors. The inputs of logistic regression and sparse logistic regression are required to be in vector form. This limits the applicability of these models in the problems when the data cannot be naturally represented vectors (e.g., medical images are two-dimensional matrices). To handle the cases when the data are in the form of multi-dimensional arrays, we propose HOSLR: High-Order Sparse Logistic Regression, which can be viewed as a high order extension of sparse logistic regression. Instead of solving one classification vector as in conventional logistic regression, we solve for K classification vectors in HOSLR (K is the number of modes in the data). A block proximal descent approach is proposed to solve the problem and its convergence is guaranteed. Finally we validate the effectiveness of HOSLR on predicting the onset risk of patients with Alzheimer's disease and heart failure.",Alzheimer Disease/*diagnosis;Heart Failure/*diagnosis;Humans;*Logistic Models;Magnetic Resonance Imaging;Risk Assessment/*methods;Risk Factors,"Wang, F.;Zhang, P.;Wang, X.;Hu, J.",2014,,,0,
4695,Expanded molecular features of carnitine acyl-carnitine translocase (CACT) deficiency by comprehensive molecular analysis,"Carnitine-acylcarnitine translocase (CACT) deficiency is a rare autosomal recessive disease of fatty acid oxidation, mainly affecting long chain fatty acid utilization. The disease usually presents at neonatal period with severe hypoketotic hypoglycemia, hyperammonemia, cardiomyopathy and/or arrhythmia, hepatic dysfunction, skeletal muscle weakness, and encephalopathy. Definitive diagnosis of CACT deficiency by molecular analysis of the SLC25A20 gene has recently become clinically available. In contrast to biochemical analysis, sequence analysis is a more rapid and reliable method for diagnosis of CACT deficiency. In this study, we used Sanger sequencing and target array CGH to identify molecular defects in the SLC25A20 gene of patients with clinical features and an acylcarnitine profile consistent with CACT deficiency. Eight novel mutations, including a large 25.9. kb deletion encompassing exons 5 to 9 of SLC25A20 were found. Review of the published cases revealed that CACT deficiency is a pan-ethnic disorder with a broad mutation spectrum. Mutations are distributed along the entire gene without a hot spot. Two thirds of them are nonsense, frame-shift, or splice site mutations resulting in premature stop codons. This study underscores the importance of comprehensive molecular analysis, including sequencing and targeted array CGH of the SLC25A20 gene when CACT deficiency is suspected. © 2011 Elsevier Inc.",amino acid;carnitine;carnitylacylcarnitine translocase;creatine kinase;DNA;slc25a20 protein;unclassified drug;acidosis;adult;amino acid deficiency;article;autosomal recessive disorder;blood sampling;brain disease;cardiomyopathy;carnitine acyl carnitine translocase deficiency;clinical feature;comparative genomic hybridization;dementia;DNA extraction;female;fetus;gene deletion;gene mutation;gene sequence;genetic analysis;heart arrhythmia;human;hyperammonemia;hypoglycemia;hypokalemia;infant;lethargy;liver failure;major clinical study;male;missense mutation;newborn;priority journal,"Wang, G. L.;Wang, J.;Douglas, G.;Browning, M.;Hahn, S.;Ganesh, J.;Cox, S.;Aleck, K.;Schmitt, E. S.;Zhang, W.;Wong, L. J. C.",2011,,,0,
4696,"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015","Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography–year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4–61·9) in 1980 to 71·8 years (71·5–72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7–17·4), to 62·6 years (56·5–70·2). Total deaths increased by 4·1% (2·6–5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8–18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6–16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9–14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1–44·6), malaria (43·1%, 34·7–51·8), neonatal preterm birth complications (29·8%, 24·8–34·9), and maternal disorders (29·1%, 19·3–37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and dru use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000–183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000–532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Funding Bill & Melinda Gates Foundation.",accidental injury;adult;adverse drug reaction;Africa south of the Sahara;age distribution;Alzheimer disease;anemia;article;assault;automutilation;battle injury;cancer epidemiology;cancer mortality;cardiovascular disease;cardiovascular mortality;cause of death;cerebrovascular accident;child;childhood mortality;chronic liver disease;chronic respiratory tract disease;cold exposure;communicable disease;congenital malformation;controlled study;dementia;diabetes mellitus;diarrhea;drug dependence;drug use;Ebola hemorrhagic fever;endocrine disease;enteritis;female;foreign body;gastrointestinal disease;geographic distribution;gunshot injury;gynecologic disease;hematologic disease;hemoglobinopathy;hemolytic anemia;human;Human immunodeficiency virus infection;immunopathology;injury;ischemic heart disease;life expectancy;liver cirrhosis;lower respiratory tract infection;major clinical study;malaria;male;malignant neoplasm;maternal disease;maternal mortality;mental disease;metabolic disorder;middle aged;Middle East;mortality;mortality rate;musculoskeletal disease;neglected disease;neurologic disease;newborn disease;newborn mortality;non communicable disease;nutritional deficiency;nutritional disorder;pneumococcal meningitis;population growth;population structure;premature labor;premature mortality;priority journal;pulmonary aspiration;Rotavirus infection;sex;sibling;sickle cell anemia;skin disease;Streptococcus pneumonia;sudden infant death syndrome;suffocation;thermal exposure;tropical disease;urinary tract disease;urogenital tract disease;violence;war,"Wang, H.;Naghavi, M.;Allen, C.;Barber, R. M.;Carter, A.;Casey, D. C.;Charlson, F. J.;Chen, A. Z.;Coates, M. M.;Coggeshall, M.;Dandona, L.;Dicker, D. J.;Erskine, H. E.;Ferrari, A. J.;Fitzmaurice, C.;Foreman, K.;Forouzanfar, M. H.;Fraser, M. S.;Fullman, N.;Goldberg, E. M.;Graetz, N.;Haagsma, J. A.;Hay, S. I.;Huynh, C.;Johnson, C. O.;Kassebaum, N. J.;Kulikoff, X. R.;Kutz, M.;Kyu, H. H.;Larson, H. J.;Leung, J.;Lim, S. S.;Lind, M.;Lozano, R.;Marquez, N.;Mikesell, J.;Mokdad, A. H.;Mooney, M. D.;Nguyen, G.;Nsoesie, E.;Pigott, D. M.;Pinho, C.;Roth, G. A.;Sandar, L.;Silpakit, N.;Sligar, A.;Sorensen, R. J. D.;Stanaway, J.;Steiner, C.;Teeple, S.;Thomas, B. A.;Troeger, C.;VanderZanden, A.;Vollset, S. E.;Wanga, V.;Whiteford, H. A.;Wolock, T.;Zoeckler, L.;Achoki, T.;Afshin, A.;Alexander, L. T.;Anderson, G. M.;Bell, B.;Biryukov, S.;Blore, J. D.;Brown, A.;Brown, J.;Cercy, K.;Chew, A.;Cohen, A. J.;Daoud, F.;Dossou, E.;Estep, K.;Flaxman, A.;Friedman, J.;Frostad, J.;Godwin, W. W.;Hancock, J.;Kemmer, L.;Khalil, I. A.;Liu, P. Y.;Masiye, F.;Millear, A.;Mirarefin, M.;Misganaw, A.;Moradi-Lakeh, M.;Morgan, K.;Ng, M.;Pain, A.;Quame-Amaglo, J.;Rao, P.;Reitsma, M. B.;Shackelford, K. A.;Sur, P.;Wagner, J. A.;Vos, T.;Lopez, A. D.;Murray, C. J. L.;Ellenbogen, R. G.;Mock, C. N.;Quistberg, D. A.;Anderson, B. O.;Blosser, C. D.;Futran, N. D.;Heckbert, S. R.;Jensen, P. N.;Montine, T. J.;Tirschwell, D. L.;Watkins, D. A.;Bhutta, Z. A.;Nisar, M. I.;Akseer, N.;Alam, N. K. M.;Knibbs, L. D.;Lalloo, R.;Gouda, H. N.;McGrath, J. J.;Jeemon, P.;Dandona, R.;Kumar, G. A.;Gething, P. W.;Cooper, C.;Darby, S. C.;Deribew, A.;Ali, R.;Bennett, D. A.;Jha, V.;Rahimi, K.;Kinfu, Y.;Faghmous, I. D. A.;Langan, S. M.;McKee, M.;Murthy, G. V. S.;Pearce, N.;Roberts, B.;Campos-Nonato, I. R.;Campuzano, J. C.;Gomez-Dantes, H.;Heredia-Pi, I. B.;Mejia-Rodriguez, F.;Montañez Hernandez, J. C.;Montero, P.;Rios Blancas, M. J.;Servan-Mori, E. E.;Villalpando, S.;Duan, L.;Liu, S.;Wang, L.;Ye, P.;Liang, X.;Yu, S.;Mensah, G. A.;Salomon, J. A.;Thorne-Lyman, A. L.;Ajala, O. N.;Bärnighausen, T.;Ding, E. L.;Farvid, M. S.;Wagner, G. R.;James, P.;Osman, M.;Shrime, M. G.;Fitchett, J. R. A.;Knudsen, A. K.;Ellingsen, C. L.;Krog, N. H.;Savic, M.;Hailu, A. D.;Norheim, O. F.;Abate, K. H.;Gebrehiwot, T. T.;Gebremedhin, A. T.;Abbafati, C.;Abbas, K. M.;Abd-Allah, F.;Abera, S. F.;Melaku, Y. A.;Tesfay, F. H.;Abyu, G. Y.;Aregay, A. F.;Betsu, B. D.;Gebru, A. A.;Hailu, G. B.;Yalew, A. Z.;Yebyo, H. G.;Abreu, D. M. X.;Franca, E. B.;Abu-Raddad, L. J.;Adelekan, A. L.;Akinyemi, R. O.;Ojelabi, F. A.;Ademi, Z.;Fürst, T.;Azzopardi, P.;Cowie, B. C.;Gibney, K. B.;MacLachlan, J. H.;Meretoja, A.;Alam, K.;Borschmann, R.;Colquhoun, S. M.;Patton, G. C.;Weintraub, R. G.;Szoeke, C. E. I.;Vijayakumar, L.;Bohensky, M. A.;Taylor, H. R.;Wijeratne, T.;Adou, A. K.;Adsuar, J. C.;Afanvi, K. A.;Agardh, E. E.;Rehm, J.;Badawi, A.;Lindsay, M. P.;Popova, S.;Agarwal, A.;Agrawal, A.;Hotez, P. J.;Ahmad, A.;Norrving, B.;Akanda, A. S.;Akinyemiju, T. F.;Schwebel, D. C.;Singh, J. A.;Al Lami, F. H.;Alabed, S.;Al-Aly, Z.;Driscoll, T. R.;Kemp, A. H.;Leigh, J.;Mekonnen, A. B.;Alasfoor, D.;Aldhahri, S. F.;Altirkawi, K. A.;Terkawi, A. S.;Aldridge, R. W.;Banerjee, A.;Tillmann, T.;Alegretti, M. A.;Aleman, A. V.;Cavalleri, F.;Colistro, V.;Alemu, Z. A.;Alhabib, S.;Alkerwi, A.;Alla, F.;Allebeck, P.;Carrero, J. J.;Fereshtehnejad, S.;Weiderpass, E.;Havmoeller, R.;Al-Raddadi, R.;Alsharif, U.;Alvarez Martin, E.;Alvis-Guzman, N.;Amare, A. T.;Ciobanu, L. G.;Tessema, G. A.;Amegah, A. K.;Kudom, A. A.;Ameh, E. A.;Amini, H.;Karema, C. K.;Ammar, W.;Harb, H. L.;Amrock, S. M.;Andersen, H. H.;Antonio, C. A. T.;Faraon, E. J. A.;Ärnlöv, J.;Larsson, A.;Arsic Arsenijevic, V. S.;Barac, A.;Artaman, A.;Asayesh, H.;Asghar, R. J.;Atique, S.;Avokpaho, E. F. G. A.;Gankpé, F. G.;Awasthi, A.;Bacha, U.;Bahit, M. C.;Balakrishnan, K.;Barker-Collo, S. L.;Mohammed, S.;Barregard, L.;Petzold, M.;Barrero, L. H.;Basu, A.;Basu, S.;Bayou, Y. T.;Bazargan-Hejazi, S.;Beardsley, J.;Bedi, N.;Beghi, E.;Deribe, K.;Belay, H. A.;Giref, A. Z.;Haile, D.;Jibat, T.;Manamo, W. A. A.;Tefera, W. M.;Yirsaw, B. D.;Sheth, K. N.;Bell, M. L.;Biroscak, B. J.;Bello, A. K.;Santos, I. S.;Bensenor, I. M.;Lotufo, P. A.;Berhane, A.;Wolfe, C. D. A.;Bernabé, E.;Beyene, A. S.;Gishu, M. D.;Bhala, N.;Bhalla, A.;Biadgilign, S.;Bikbov, B.;Bin Abdulhak, A. A.;Bjertness, E.;Htet, A. S.;Bose, D.;Bourne, R. R. A.;Brainin, M.;Brayne, C. E. G.;Brazinova, A.;Majdan, M.;Shen, J.;Breitborde, N. J. K.;Brenner, H.;Schöttker, B.;Brewer, J. D.;Brugha, T. S.;Buckle, G. C.;Gosselin, R. A.;Butt, Z. A.;Calabria, B.;Lal, A.;Lucas, R. M.;Degenhardt, L.;Resnikoff, S.;Carapetis, J. R.;Cárdenas, R.;Carpenter, D. O.;Castañeda-Orjuela, C. A.;Castillo Rivas, J.;Catalá-López, F.;Cerda, J.;Chen, W.;Chiang, P. P.;Chibalabala, M.;Chibueze, C. E.;Mori, R.;Chimed-Ochir, O.;Jiang, Y.;Takahashi, K.;Chisumpa, V. H.;Mapoma, C. C.;Choi, J. J.;Chowdhury, R.;Christensen, H.;Christopher, D. J.;Cirillo, M.;Colomar, M.;Cooper, L. T.;Crump, J. A.;Poulton, R. G.;Damsere-Derry, J.;Danawi, H.;Refaat, A. H.;Dargan, P. I.;das Neves, J.;Massano, J.;Pedro, J. M.;Davey, G.;Davis, A. C.;Greaves, F.;Newton, J. N.;Davitoiu, D. V.;de Castro, E. F.;de Jager, P.;De, D.;Dellavalle, R. P.;Dharmaratne, S. D.;Dhillon, P. K.;Ganguly, P.;Lal, D. K.;Zodpey, S.;Diaz-Torné, C.;dos Santos, K. P. B.;Dubey, M.;Rahman, M. H. U.;Singh, A.;Duncan, B. B.;Kieling, C.;Schmidt, M. I.;Elyazar, I.;Endries, A. Y.;Ermakov, S. P.;Eshrati, B.;Esteghamati, A.;Hafezi-Nejad, N.;Fahimi, S.;Malekzadeh, R.;Roshandel, G.;Sepanlou, S. G.;Farzadfar, F.;Kasaeian, A.;Parsaeian, M.;Heydarpour, P.;Rahimi-Movaghar, V.;Sheikhbahaei, S.;Yaseri, M.;Farid, T. A.;Khan, A. R.;Farinha, C. S. E. S.;Faro, A.;Feigin, V. L.;Te Ao, B. J.;Fernandes, J. G.;Fernandes, J. C.;Fischer, F.;Foigt, N.;Shiue, I.;Fowkes, F. G. R.;Franklin, R. C.;Piel, F. B.;Majeed, A.;Gall, S. L.;Gambashidze, K.;Gamkrelidze, A.;Kereselidze, M.;Shakh-Nazarova, M.;Iyer, V. J.;Gebre, T.;Geleijnse, J. M.;Gessner, B. D.;Ghoshal, A. G.;Gillum, R. F.;Mehari, A.;Gilmour, S.;Inoue, M.;Kawakami, N.;Shibuya, K.;Giroud, M.;Glaser, E.;Halasa, Y. A.;Shepard, D. S.;Undurraga, E. A.;Gona, P.;Goodridge, A.;Gopalani, S. V.;Gotay, C. C.;Kissoon, N.;Kopec, J. A.;Murthy, S.;Pourmalek, F.;Goto, A.;Gugnani, H. C.;Gupta, R.;Gupta, R.;Gupta, V.;Gutiérrez, R. A.;Hamadeh, R. R.;Hamidi, S.;Handal, A. J.;Hankey, G. J.;Norman, P. E.;Hao, Y.;Harikrishnan, S.;Haro, J. M.;Hilderink, H. B.;Hoek, H. W.;Tura, A. K.;Hogg, R. S.;Horino, M.;Horita, N.;Hosgood, H. D.;Hoy, D. G.;Hsairi, M.;Htike, M. M. T.;Hu, G.;Huang, C.;Huang, H.;Huiart, L.;Husseini, A.;Huybrechts, I.;Huynh, G.;Iburg, K. M.;Innos, K.;Jacobs, T. A.;Jacobsen, K. H.;Jahanmehr, N.;Katibeh, M.;Rajavi, Z.;Jakovljevic, M. B.;Javanbakht, M.;Jayaraman, S. P.;Jayatilleke, A. U.;Prabhakaran, D.;Jiang, G.;Jimenez-Corona, A.;Jonas, J. B.;Joshi, T. K.;Kabir, Z.;Kamal, R.;Kesavachandran, C. N.;She, J.;Shen, Z.;Zhang, H.;Kan, H.;Kant, S.;Karch, A.;Karimkhani, C.;Karletsos, D.;Karthikeyan, G.;Naik, N.;Paul, V. K.;Roy, A.;Sagar, R.;Satpathy, M.;Tandon, N.;Kaul, A.;Kayibanda, J. F.;Keiyoro, P. N.;Lyons, R. A.;Parry, C. D.;Kengne, A. P.;Matzopoulos, R.;Wiysonge, C. S.;Stein, D. J.;Mayosi, B. M.;Keren, A.;Khader, Y. S.;Khan, E. A.;Khang, Y. H.;Won, S.;Khera, S.;Tavakkoli, M.;Khoja, T. A. M.;Kim, D.;Kim, Y. J.;Kissela, B. M.;Kokubo, Y.;Kolte, D.;McGarvey, S. T.;Kosen, S.;Koul, P. A.;Koyanagi, A.;Kuate Defo, B.;Kucuk Bicer, B.;Kuipers, E. J.;Kulkarni, V. S.;Kwan, G. F.;Rao, S. R.;Lam, H.;Lam, J. O.;Nachega, J. B.;Tran, B. X.;Lansingh, V. C.;Laryea, D. O.;Latif, A. A.;Lawrynowicz, A. E. B.;Levi, M.;Li, Y.;Lipshultz, S. E.;Wilkinson, J. D.;Simard, E. P.;Liu, Y.;Phillips, M. R.;Xiao, Q.;Lo, L.;Logroscino, G.;Lunevicius, R.;Ma, S.;Machado, V. M.;Mackay, M. T.;Magdy Abd El Razek, H.;Magdy Abd El Razek, M.;Mandisarisa, J.;Mangalam, S.;Marcenes, W.;Meaney, P. A.;Margolis, D. J.;Silberberg, D. H.;Martin, G. R.;Martinez-Raga, J.;Marzan, M. B.;Mason-Jones, A. J.;McMahon, B. J.;Mehndiratta, M. M.;Woldeyohannes, S. M.;Tedla, B. A.;Zeleke, B. M.;Memiah, P.;Memish, Z. A.;Mendoza, W.;Meretoja, T. J.;Lallukka, T.;Mhimbira, F. A.;Micha, R.;Mozaff, D.;Shi, P.;Singh, G. M.;Miller, T. R.;Mohammad, K. A.;Mohammadi, A.;Mohan, V.;Mola, G. L. D.;Monasta, L.;Montico, M.;Ronfani, L.;Morawska, L.;Werdecker, A.;Mueller, U. O.;Westerman, R.;Musa, K. I.;Paternina, A. J.;Seedat, S.;Nagel, G.;Rothenbacher, D.;Naidoo, K. S.;Sartorius, B.;Naldi, L.;Remuzzi, G.;Nangia, V.;Nash, D.;Nejjari, C.;Neupane, S.;Newton, C. R.;Ngalesoni, F. N.;Ngirabega, J. D.;Nguyen, Q. L.;Nkamedjie Pete, P. M.;Nomura, M.;Nyakarahuka, L.;Ogbo, F. A.;Ohkubo, T.;Olivares, P. R.;Olusanya, B. O.;Olusanya, J. O.;Opio, J. N.;Oren, E.;Ortiz, A.;Ota, E.;Ozdemir, R.;Mahesh, P. A.;Pandian, J. D.;Pant, P. R.;Papachristou, C.;Park, E.;Park, J.;Patten, S. B.;Tonelli, M.;Stokic Pejin, L.;Pereira, D. M.;Cortinovis, M.;Giussani, G.;Perico, N.;Pesudovs, K.;Pillay, J. D.;Plass, D.;Platts-Mills, J. A.;Polinder, S.;Pope, C. A.;Qorbani, M.;Rafay, A.;Rana, S. M.;Rahman, M.;Rahman, S. U.;Rai, R. K.;Rajsic, S.;Raju, M.;Rakovac, I.;Ranabhat, C. L.;Rangaswamy, T.;Ribeiro, A. L.;Ricci, S.;Roca, A.;Rojas-Rueda, D.;Roy, N. K.;Ruhago, G. M.;Sunguya, B. F.;Saha, S.;Sahathevan, R.;Saleh, M. M.;Sanabria, J. R.;Sanchez-Niño, M. D.;Sanchez-Riera, L.;Sarmiento-Suarez, R.;Sawhney, M.;Schaub, M. P.;Schneider, I. J. C.;Silva, D. A. S.;Schutte, A. E.;Shaddick, G.;Shaheen, A.;Shahraz, S.;Shaikh, M. A.;Sharma, R.;Shetty, B. P.;Shin, M.;Shiri, R.;Sigfusdottir, I. D.;Silveira, D. G. A.;Silverberg, J. I.;Yano, Y.;Singh, O. P.;Singh, P. K.;Singh, V.;Soneji, S.;Søreide, K.;Soriano, J. B.;Sposato, L. A.;Sreeramareddy, C. T.;Stathopoulou, V.;Stein, M. B.;Stranges, S.;Stroumpoulis, K.;Swaminathan, S.;Sykes, B. L.;Tabarés-Seisdedos, R.;Tabb, K. M.;Takala, J. S.;Talongwa, R. T.;Taye, B.;Ten Have, M.;Tuzcu, E. M.;Thomson, A. J.;Thrift, A. G.;Thurston, G. D.;Topor-Madry, R.;Topouzis, F.;Towbin, J. A.;Traebert, J.;Truelsen, T.;Trujillo, U.;Uchendu, U. S.;Ukwaja, K. N.;Uthman, O. A.;Van Dingenen, R.;van Donkelaar, A.;Vasankari, T.;Vasconcelos, A. M. N.;Venketasubramanian, N.;Vidavalur, R.;Violante, F. S.;Vlassov, V. V.;Wallin, M. T.;Weichenthal, S.;White, R. A.;Williams, H. C.;Wong, J. Q.;Woolf, A. D.;Xavier, D.;Xu, G.;Yakob, B.;Yan, L. L.;Yip, P.;Yonemoto, N.;Yonga, G.;Younis, M. Z.;Zaidi, Z.;Zaki, M. E.;Zannad, F.;Zavala, D. E.;Zeeb, H.;Zonies, D.;Zuhlke, L. J.",2016,,10.1016/s0140-6736(16)31012-1,0,
4697,Effects of early blood pressure lowering on early and long-term outcomes after acute stroke: An updated meta-analysis,"Background: Hypertension is common after acute stroke onset. Previous studies showed controversial effects of early blood pressure (BP) lowering on stroke outcomes. The aim of this study is to assess the effects of early BP lowering on early and long-term outcomes after acute stroke. Methods: A meta-analysis was conducted with prospective randomized controlled trials assessing the effects of early BP lowering on early and long-term outcomes after acute stroke compared with placebo. Literature searching was performed in the databases from inception to December 2013. New evidence from recent trials were included. Outcomes were analyzed as early (within 30 days) and long-term (from 3 to 12 months) endpoints using summary estimates of relative risks (RR) and their 95% confidence intervals (CI) with the fixed-effect model or random-effect model. Results: Seventeen trials providing data from 13236 patients were included. Pooled results showed that early BP lowering after acute stroke onset was associated with more death within 30 days compared with placebo (RR: 1.34 and 95% CI: 1.02, 1.74, p = 0.03). However the results showed that early BP lowering had no evident effect on early neurological deterioration, early death within 7 days, long-term death, early and long-term dependency, early and long-term combination of death or dependency, long-term stroke recurrence, long-term myocardial infarction and long-term CVE. Conclusions: The new results lend no support to early BP lowering after acute stroke. Early BP lowering may increase death within 30 days after acute stroke. © 2014 Wang et al.",antihypertensive agent;placebo;adult;article;blood pressure regulation;cerebrovascular accident;controlled study;death;dependent personality disorder;female;heart infarction;human;hypertension;major clinical study;male;mental deterioration;meta analysis;randomized controlled trial (topic);recurrent disease;treatment outcome,"Wang, H.;Tang, Y.;Rong, X.;Li, H.;Pan, R.;Wang, Y.;Peng, Y.",2014,,,0,
4698,Subdural hematoma in diabetic patients,"Background and purpose: Subdural hematoma (SDH) is associated with a high mortality rate. However, the risk of SDH in diabetic patients has not been well studied. The aim of the study was to examine the risk of SDH in incident diabetic patients. Methods: From a universal insurance claims database of Taiwan, a cohort of 28 045 incident diabetic patients from 2000 to 2005 and a control cohort of 56 090 subjects without diabetes were identified. The incidence and hazard ratio of SDH were measured by the end of 2010. Results: The mean follow-up years were 7.24 years in the diabetes cohort and 7.44 years in the non-diabetes cohort. The incidence of SDH was 1.57-fold higher in the diabetes cohort than in the non-diabetes cohort (2.04 vs. 1.30 per 1000 person-years), with an adjusted hazard ratio of 1.63 [95% confidence interval (CI) 1.43-1.85]. The stratified data showed that adjusted hazard ratios were 1.51 (95% CI 1.28-1.77) for traumatic SDH and 1.89 (95% CI 1.52-2.36) for non-traumatic SDH. The 30-day mortality rate for those who developed SDH in the diabetes cohort was 8.94%. Conclusions: This study demonstrates that incident diabetic patients are at higher risk of SDH than individuals without diabetes. Proper intervention for diabetic patients is necessary for preventing the devastating disorder.",adult;aged;article;cerebrovascular accident;chronic kidney disease;comorbidity;congestive heart failure;controlled study;coronary artery disease;dementia;diabetes mellitus;diabetic patient;female;follow up;atrial fibrillation;human;hyperlipidemia;hypertension;incidence;major clinical study;male;mortality;priority journal;sex ratio;subdural hematoma;Taiwan,"Wang, I. K.;Chen, H. J.;Cheng, Y. K.;Wu, Y. Y.;Lin, S. Y.;Chou, C. Y.;Chang, C. T.;Yen, T. H.;Chuang, F. R.;Sung, F. C.;Hsu, C. Y.",2015,,,0,
4699,Analysis of risk factors for all cause-mortality in Chinese emergency atrial fibrillation patients,"Objective: To explore the independent risk factors associated with one-year mortality in patients with atrial fibrillation (AF). Methods: This study consecutively enrolled AF patients presenting to an emergency department at 20 Chinese hospitals from November 2008 to October 2011. Their baseline data and therapies were recorded. They were followed up for one year. Their major cardiovascular outcomes were recorded. And the predictors of one-year mortality were identified by uni- and multi-variate Cox regression analysis with baseline, therapy variables and follow-up therapy variables. Results: The one-year all-cause mortality was 13.8% among a total of 2016 AF patients. They were divided into mortality group (A, n=279) and survival group (B, n=1737). The baseline data of two groups were analyzed. The group A patients were older ((76.1 ± 11.6) vs (67.2 ± 13.1) years, P < 0.01) and had smaller body mass index compared with group B ((23.7 ± 3.6) vs (22.3 ± 3.4) kg/m2, P < 0.01); the proportion of permanent AF and CHADS2 score ≥ 2 points was higher in the group A (71.8% vs 47.5%, P < 0.01). History of heart failure, previous stroke, left ventricular systolic dysfunction, diabetes, dementia and chronic obstructive pulmonary disease (COPD) were in a higher proportion of group A (51.2% vs 35.1%, 26.3% vs 17.6%, 26.7% vs 17.9%, 21.0% vs 14.6%, 6.0% vs 1.6%, 21.4% vs 10.1%, all P < 0.01). With regards to drug treatment, usage of diuretics, digoxin and other anticoagulants (heparin, etc), the values were greater in group A (50.9% vs 42.2%, 41.3% vs 34.7%, 10.0% vs 5.9%, all P < 0.01). The Kaplan-Meier survival curves showed that the mortality rate increased along with rising CHADS2 score. Multi-variate Cox regression analysis showed that age (HR=1.053, 95% CI: 1.040-1.066), permanent AF (HR=1.374, 95% CI: 1.003-1.883), history of heart failure (HR=1.385, 95% CI: 1.009-1.901), previous stroke (HR=1.345, 95% CI: 1.009-1.795), COPD (HR=1.379, 95% CI: 1.030-1.848), unused angiotensin II receptor blocker (ARB) (HR=1.955, 95% CI: 1.349-2.832), aspirin unused (HR=1.770, 95% CI: 1.375-2.278) and warfarin unused (HR=3.262, 95% CI: 1.824-5.834) were independent risk factors for one-year mortality of AF patients. Conclusion: Age, history of heart failure, previous stroke, COPD history, ARB unused, aspirin and warfarin unused are independent risk factors for one-year all-cause mortality of AF patients. Copyright © 2013 by the Chinese Medical Association.",acetylsalicylic acid;digoxin;diuretic agent;heparin;article;cause of death;cerebrovascular accident;CHADS2 score;Chinese;chronic obstructive lung disease;controlled study;dementia;diabetes mellitus;disease association;emergency ward;follow up;atrial fibrillation;heart failure;human;left ventricular systolic dysfunction;medical history;predictive value;risk assessment;aspirin,"Wang, J.;Yang, Y. M.;Zhu, J.;Zhang, H.;Shao, X. H.;Huang, B.;Tian, L.",2013,,,0,
4700,Predictors of functional change: a longitudinal study of nondemented people aged 65 and older,"DESIGNA population-based prospective cohort study.SETTINGA random sample was selected from the Group Health Cooperative members in the Seattle area from 1994 to 1996 and followed biennially.PARTICIPANTSTwo thousand five hundred eighty-one people aged 65 and older, cognitively intact at baseline.MEASUREMENTSFunctional status was measured by activities of daily living, instrumental activities of daily living, and performance-based physical function testing.RESULTSThe cohort status at the time of these analyses was: deceased, 391; withdrawn, 179; dementia, 152; and on study, 1,873. The mean follow-up time was 3.4 years. Using linear regressions with Generalized Estimating Equation, selected medical conditions (diabetes mellitus, hypertension, coronary heart disease, cerebrovascular disease (CVD), osteoporosis, arthritis, and cancer), low cognitive function, depression, and smoking were associated with worse functional outcomes. Exercise and moderate alcohol use were associated with better functional outcomes. Over the follow-up period, coronary heart disease, CVD, and depression were associated with increased rates of functional decline. Exercise and moderate alcohol consumption were associated with decreased rates of functional decline. Significant interactions were observed between exercise and coronary heart disease, moderate alcohol use and CVD, and cognition and CVD.CONCLUSIONSOur study has identified not only risk factors associated with functional decline but also the interactions among these factors. These observations, along with other published research, add to the growing understanding of the underlying process of functional change and could provide a basis to design effective strategies to delay functional decline.OBJECTIVESTo identify factors associated with functional change in an older population and investigate interactions among selected potential risk factors.","Activities of Daily Living;Alcohol Drinking;Arthritis [physiopathology];Cerebrovascular Disorders [physiopathology];Cognition;Cohort Studies;Coronary Disease [physiopathology];Depression [physiopathology];Diabetes Mellitus [physiopathology];Exercise;Hypertension [physiopathology];Longitudinal Studies;Neoplasms [physiopathology];Osteoporosis [physiopathology];Prospective Studies;Risk Factors;Smoking;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Sr-endoc: sr-muskel","Wang, L;Belle, G;Kukull, Wb;Larson, Eb",2002,,,0,4701
4701,Predictors of functional change: a longitudinal study of nondemented people aged 65 and older,"OBJECTIVES: To identify factors associated with functional change in an older population and investigate interactions among selected potential risk factors. DESIGN: A population-based prospective cohort study. SETTING: A random sample was selected from the Group Health Cooperative members in the Seattle area from 1994 to 1996 and followed biennially. PARTICIPANTS: Two thousand five hundred eighty-one people aged 65 and older, cognitively intact at baseline. MEASUREMENTS: Functional status was measured by activities of daily living, instrumental activities of daily living, and performance-based physical function testing. RESULTS: The cohort status at the time of these analyses was: deceased, 391; withdrawn, 179; dementia, 152; and on study, 1,873. The mean follow-up time was 3.4 years. Using linear regressions with Generalized Estimating Equation, selected medical conditions (diabetes mellitus, hypertension, coronary heart disease, cerebrovascular disease (CVD), osteoporosis, arthritis, and cancer), low cognitive function, depression, and smoking were associated with worse functional outcomes. Exercise and moderate alcohol use were associated with better functional outcomes. Over the follow-up period, coronary heart disease, CVD, and depression were associated with increased rates of functional decline. Exercise and moderate alcohol consumption were associated with decreased rates of functional decline. Significant interactions were observed between exercise and coronary heart disease, moderate alcohol use and CVD, and cognition and CVD. CONCLUSIONS: Our study has identified not only risk factors associated with functional decline but also the interactions among these factors. These observations, along with other published research, add to the growing understanding of the underlying process of functional change and could provide a basis to design effective strategies to delay functional decline.","Activities of Daily Living;Alcohol Drinking;Arthritis [physiopathology];Cerebrovascular Disorders [physiopathology];Cognition;Cohort Studies;Coronary Disease [physiopathology];Depression [physiopathology];Diabetes Mellitus [physiopathology];Exercise;Hypertension [physiopathology];Longitudinal Studies;Neoplasms [physiopathology];Osteoporosis [physiopathology];Prospective Studies;Risk Factors;Smoking;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Sr-endoc: sr-muskel","Wang, L.;Belle, G.;Kukull, W. B.;Larson, E. B.",2002,,,0,
4702,Performance-based physical function and future dementia in older people,"BACKGROUND: The association of physical function with progression to dementia has not been well investigated. We aimed to determine whether physical function is associated with incident dementia and Alzheimer disease (AD). METHODS: We performed a prospective cohort study of 2288 persons 65 years and older without dementia. Patients were enrolled from 1994 to 1996 and followed up through October 2003. Main outcome measures included incident dementia and AD. RESULTS: During follow-up 319 participants developed dementia (221 had AD). The age-specific incidence rate of dementia was 53.1 per 1000 person-years for participants who scored lower on a performance-based physical function test at baseline (< or = 10 points) compared with 17.4 per 1000 person-years for those who scored higher (> 10 points). A 1-point lower performance-based physical function score was associated with an increased risk of dementia (hazard ratio, 1.08; 95% confidence interval, 1.03-1.13; P < .001), an increased risk of AD (hazard ratio, 1.06; 95% confidence interval, 1.01-1.12; P = .01), and an increased rate of decline in the Cognitive Ability Screening Instrument scores (0.11 point per year; 95% confidence interval, 0.08-0.14; P < .001) after adjusting for age, sex, years of education, baseline cognitive function, APOE epsilon4 allele, family history of AD, depression, coronary heart disease, and cerebrovascular disease. CONCLUSIONS: Lower levels of physical performance were associated with an increased risk of dementia and AD. The study suggests that poor physical function may precede the onset of dementia and AD and higher levels of physical function may be associated with a delayed onset.",Aged;Dementia/epidemiology/*physiopathology;Female;Follow-Up Studies;Humans;Incidence;Life Style;Male;Motor Activity/*physiology;Prospective Studies;Risk Factors;Severity of Illness Index;United States/epidemiology,"Wang, L.;Larson, E. B.;Bowen, J. D.;van Belle, G.",2006,May 22,10.1001/archinte.166.10.1115,0,
4703,Cerebral Fat Embolism in a Trauma Patient with Captured Imaging of Echogenic Emboli in the Inferior Vena Cava,The authors present a case of fat embolism syndrome after traumatic long-bone fracture in a patient with rapid neurologic deterioration and multiple cerebral embolic events. Diagnostic workup revealed the neuroradiologic findings classically described with cerebral fat emboli. The authors present hallmark ultrasound imaging of echogenic material actively traveling through the inferior vena cava.,D dimer;fibrinogen;lactic acid;levetiracetam;acute respiratory failure;adult;antibiotic prophylaxis;article;artificial ventilation;case report;cerebral fat embolism;diffusion weighted imaging;Doppler flowmetry;electroencephalography;emergency care;fat embolism;femur subtrochanteric fracture;fever;fibrinogen blood level;fibula fracture;gastrostomy;Glasgow coma scale;heart right ventricle failure;hemodynamic monitoring;human;hypertension;image enhancement;inferior cava vein;international normalized ratio;lactate blood level;loading drug dose;male;mental deterioration;mental disease;open reduction (procedure);osteosynthesis;partial thromboplastin time;postoperative period;prothrombin time;seizure;tachycardia;thrombocytopenia;tracheostomy;ventilator associated pneumonia;x-ray computed tomography;keppra,"Wang, N. N.;Panda, N.;Hyun, J. S.;Barounis, D.;Weiser, T. G.",2016,,10.1016/j.jmu.2016.08.006,0,
4704,Neuroprotective effects of a nanocrystal formulation of sPLA(2) inhibitor PX-18 in cerebral ischemia/reperfusion in gerbils,"The group IIA secretory phospholipase A2 (sPLA(2)-IIA) has been studied extensively because of its involvement in inflammatory processes. Up-regulation of this enzyme has been shown in a number of neurodegenerative diseases including cerebral ischemia and Alzheimer's disease. PX-18 is a selective sPLA(2) inhibitor effective in reducing tissue damage resulting from myocardial infarction. However, its use as a neuroprotective agent has been hampered due to its low solubility. In this study, we test the possible neuroprotective effects of PX-18 formulated as a suspension of nanocrystals. Transient global cerebral ischemia was induced in gerbils by occlusion of both common carotid arteries for 5 min. Four days after ischemia/reperfusion (I/R), extensive delayed neuronal death, DNA damage, and increases in reactive astrocytes and microglial cells were observed in the hippocampal CA1 region. PX-18 nanocrystals (30 and 60 mg/kg body wt) and vehicle controls were injected i.p. immediately after I/R. PX-18 nanocrystal injection significantly reduced delayed neuronal death, DNA damage, as well as glial cell activation. These findings demonstrated the effective neuroprotection of PX-18 in the form of nanocrystal against I/R-induced neuronal damage. The results also suggest that nanocrystals hold promise as an effective strategy for the delivery of compounds with poor solubility that would otherwise be precluded from preclinical development.","Alkanesulfonic Acids/chemistry/*pharmacology/therapeutic use;Animals;Brain/*drug effects/enzymology/physiopathology;Brain Ischemia/*drug therapy/enzymology/physiopathology;Cell Death/drug effects/physiology;Disease Models, Animal;Enzyme Inhibitors/chemistry/*pharmacology/therapeutic use;Gerbillinae;Gliosis/drug therapy/etiology/pathology;Hippocampus/drug effects/enzymology/pathology;Male;Nanoparticles;Nerve Degeneration/drug therapy/etiology/pathology;Neuroglia/drug effects/pathology;Neuroprotective Agents/chemistry/*pharmacology/therapeutic use;Oleic Acids/chemistry/*pharmacology/therapeutic use;Phospholipases A2, Secretory/*antagonists & inhibitors/metabolism;Reperfusion Injury/*drug therapy/enzymology/physiopathology;Treatment Outcome","Wang, Q.;Sun, A. Y.;Pardeike, J.;Muller, R. H.;Simonyi, A.;Sun, G. Y.",2009,Aug 18,10.1016/j.brainres.2009.06.022,0,
4705,Comorbidities and survival in a large cohort of patients with newly diagnosed myelodysplastic syndromes,"Comorbid conditions have rarely been systematically studied among patients with myelodysplastic syndromes (MDS). We conducted a large population-based study to assess the role of comorbidity in the survival of newly diagnosed MDS patients. This study included 1708 MDS patients (age ≥ 66 years) diagnosed in the US during 2001-2002, with follow-up through the end of 2004. Hazard ratios (HRs) were estimated using multivariate Cox proportional hazard models. The median survival time was approximately 18 months. Fifty one percent of MDS patients had comorbid conditions. Patients with comorbid conditions had significantly greater risk of death than those without comorbidities. The HR was 1.19 (95% confidence interval (CI): 1.05-1.36) and 1.77 (95% CI: 1.50-2.08) for those with a Charlson index of 1-2 and ≥ 3, respectively. The risk of death increases with Charlson index. MDS patients who have congestive heart failure or chronic obstructive pulmonary disease had significantly shorter survival than patients without those conditions, whereas diabetes did not appear to have an impact on survival. This study confirms comorbidity as a significant and independent determinant of MDS survival, and the findings underscore the importance to take comorbid conditions into account when assessing the prognosis of MDS. © 2009 Elsevier Ltd. All rights reserved.",aged;article;cerebrovascular accident;chronic kidney failure;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;death;dementia;diabetes mellitus;female;heart infarction;human;liver disease;major clinical study;male;myelodysplastic syndrome;paralysis;peripheral vascular disease;priority journal;prognosis;rheumatoid arthritis;risk assessment;survival rate;survival time;ulcer,"Wang, R.;Gross, C. P.;Halene, S.;Ma, X.",2009,,,0,
4706,Cardiovascular risk and memory in non-demented elderly women,"OBJECTIVE: To determine whether cardiovascular (CV) risk is associated with subtle memory deficits in non-demented, healthy older women with a family history of Alzheimer disease (AD). METHODS: Baseline data of 375 participants from a randomized, double-blind placebo-controlled primary prevention trial to test the efficacy of hormone replacement therapy in delaying AD and cognitive decline were analyzed. All subjects were women over 65 with a family history of AD who had normal cognition and no active heart disease at baseline. A baseline memory composite score was calculated, consisting of immediate and delayed recall of verbal and nonverbal material. Multiple linear regression was performed to examine the association of relative CV risk with memory functioning; age, ethnicity and education level were included as covariates. RESULTS: Mean baseline memory composite score was significantly higher in those with low relative CHD risk than those with high relative CHD risk. CONCLUSION: These findings suggest that subtle elevation of CHD risk may negatively affect memory functioning even in otherwise healthy, non-demented older women without a history of heart disease.",Aged;Cohort Studies;Comorbidity;Coronary Disease/diagnosis/*epidemiology;Double-Blind Method;Estrogen Replacement Therapy/methods;Estrogens/pharmacology/therapeutic use;Female;Humans;Memory/drug effects/*physiology;Memory Disorders/drug therapy/*epidemiology/prevention & control;Mental Recall/drug effects/physiology;Neuroprotective Agents/pharmacology/therapeutic use;Neuropsychological Tests;Progesterone/pharmacology/therapeutic use;Risk Factors,"Wang, S.;Jacobs, D.;Andrews, H.;Tsai, W. Y.;Luo, X.;Bergmann, C.;Sano, M.",2010,Jul,10.1016/j.neurobiolaging.2008.08.007,0,
4707,Physical activity and risk of cognitive impairment among oldest-old women,"Objectives Physical activity may reduce the risk of cognitive decline in the elderly, but its effects among the oldest-old (i.e., those aged 85 years and older) are not well known. Our study assessed the association between very late-life physical activity and 5-year risk of mild cognitive impairment (MCI) or dementia and neuropsychological test performance among oldest-old women. Methods This prospective study was conducted at three sites. Participants included 1,249 women (mean [standard deviation] age: 83.3 [2.8] years). Baseline physical activity was measured by self-reported blocks walked per week and analyzed according to tertile. Five years later, surviving participants who were 85 years and older (oldest-old) completed neuropsychological testing and underwent adjudication of clinical cognitive status (normal, MCI, or dementia). All analyses were adjusted for baseline age, education, cognition, depression, body mass index, hypertension, smoking, and coronary artery disease. Results Compared with women in the lowest tertile, women in the highest tertile were less likely to develop dementia (13.0% versus 23.2%; multivariate adjusted odds ratio: 0.54 [95% confidence interval: 0.36-0.82]). However, risk of MCI was not associated with physical activity. Physical activity was also associated with higher performance 5 years later on tests of global cognition, category fluency, and executive function but not phonemic fluency, memory, or attention. Conclusions Higher level of very late-life physical activity was associated with a lower risk of subsequent dementia in oldest-old women. These findings support future studies for late-life physical activity interventions for the prevention of dementia among oldest-old women.",age;aged;article;attention;body mass;cognition;cognitive defect;controlled study;coronary artery disease;dementia;depression;disease association;education;executive function;female;human;hypertension;major clinical study;memory;mild cognitive impairment;neuropsychological test;physical activity;prospective study;risk;smoking,"Wang, S.;Luo, X.;Barnes, D.;Sano, M.;Yaffe, K.",2014,,10.1016/j.jagp.2013.03.002,0,
4708,Physical activity and risk of cognitive impairment among oldest-old women,"Objectives Physical activity may reduce the risk of cognitive decline in the elderly, but its effects among the oldest-old (i.e., those aged 85 years and older) are not well known. Our study assessed the association between very late-life physical activity and 5-year risk of mild cognitive impairment (MCI) or dementia and neuropsychological test performance among oldest-old women. Methods This prospective study was conducted at three sites. Participants included 1,249 women (mean [standard deviation] age: 83.3 [2.8] years). Baseline physical activity was measured by self-reported blocks walked per week and analyzed according to tertile. Five years later, surviving participants who were 85 years and older (oldest-old) completed neuropsychological testing and underwent adjudication of clinical cognitive status (normal, MCI, or dementia). All analyses were adjusted for baseline age, education, cognition, depression, body mass index, hypertension, smoking, and coronary artery disease. Results Compared with women in the lowest tertile, women in the highest tertile were less likely to develop dementia (13.0% versus 23.2%; multivariate adjusted odds ratio: 0.54 [95% confidence interval: 0.36-0.82]). However, risk of MCI was not associated with physical activity. Physical activity was also associated with higher performance 5 years later on tests of global cognition, category fluency, and executive function but not phonemic fluency, memory, or attention. Conclusions Higher level of very late-life physical activity was associated with a lower risk of subsequent dementia in oldest-old women. These findings support future studies for late-life physical activity interventions for the prevention of dementia among oldest-old women. Copyright © 2014 American Association for Geriatric Psychiatry.",age;aged;article;attention;body mass;cognition;cognitive defect;controlled study;coronary artery disease;dementia;depression;disease association;education;executive function;female;human;hypertension;major clinical study;memory;mild cognitive impairment;neuropsychological test;physical activity;prospective study;risk;smoking;aging;cohort analysis;confidence interval;dementia;female;human;prevention;task performance;tracheobronchial stent,"Wang, S;Luo, X;Barnes, D;Sano, M;Yaffe, K",2014,,10.1016/j.jagp.2013.03.002,0,4707
4709,Glycogen synthase kinase-3β (Gsk-3β) rs334558 polymorphism is not associated with mild cognitive impairment in chinese han type 2 diabetic patients,"Background and objective: Activation of glycogen synthase kinase-3β (GSK-3β) increases the risk of insulin resistance and type 2 diabetes mellitus (T2DM). Considering the association between GSK-3β rs334558 polymorphism and Alzheimer’s disease, we aimed to investigate the association between GSK-3β rs334558 polymorphism and mild cognitive impairment (MCI) in T2DM patients. Methods: This case-control study was performed to evaluate the association between GSK-3β rs334558 polymorphism and MCI in the recruited 88 Chinese Han T2DM patients, 51 of which satisfied the MCI diagnostic criteria and 37 matched individuals with healthy cognition as the control. Results: Genotype and allele distributions of GSK-3β rs334558 polymorphism in the MCI patients were not significantly different from those in healthy-cognition controls (χ2=4.377, df=2, P=0.112 and χ2=0.031, df=1, P=0.859, respectively). There was no significant difference in the serum GSK-3β concentration between the two groups (16.40 ± 16.61 ng/ml vs. 18.63 ± 16.07 ng/ml, P>0.05). Nor difference was found between the two groups in terms of GSK-3β genotypes (CC, TC and TT, all P>0.05). Neuropsychological test scores were not significantly different between genotypic subgroups in either the MCI group or control group (all P>0.05). Conclusions: Our findings failed to identify the association between the GSK-3β rs334558 polymorphism and diabetic MCI. GSK-3β rs334558 polymorphism might not be a stratification marker to predicate the disease risk in China.",cholesterol;glucose;hemoglobin A1c;high density lipoprotein cholesterol;low density lipoprotein cholesterol;triacylglycerol;adult;allele;article;body mass;case control study;clock drawing test;controlled study;Digit Span Test;DNA polymorphism;education;female;gene;genetic association;genotype;Glycogen synthase kinase 3 beta gene;human;hypertension;ischemic heart disease;major clinical study;male;middle aged;mild cognitive impairment;Montreal cognitive assessment;neuropsychological test;non insulin dependent diabetes mellitus;polymerase chain reaction;trail making test;Verbal Fluency Test;Word similarity test,"Wang, S.;Sun, H.;Huang, R.;Wang, P.;Cai, R.;Xia, W.;Sun, J.;Tian, S.;Dong, X.",2017,,,0,
4710,Impact of age and comorbidity on non - Small-cell lung cancer treatment in older veterans,"Purpose: Because comorbidity affects cancer treatment outcomes, guidelines recommend considering comorbidity when making treatment decisions in older patients with lung cancer. Yet, it is unclear whether treatment is targeted to healthier older adults who might reasonably benefit.Patients and Methods: Receipt of first-line guideline-recommended treatment was assessed for 20,511 veterans age ≥ 65 years with non-small-cell lung cancer (NSCLC) in the Veterans Affairs (VA) Central Cancer Registry from 2003 to 2008. Patients were stratified by age (65 to 74, 75 to 84, ≥ 85 years), Charlson comorbidity index score (0, 1 to 3, ≥ 4), and American Joint Committee on Cancer stage (I to II, IIIA to IIIB, IIIB with malignant effusion to IV). Comorbidity and patient characteristics were obtained from VA claims and registry data. Multivariate analysis identified predictors of receipt of guideline-recommended treatment.Results: In all, 51% of patients with local, 35% with regional, and 27% with metastatic disease received guideline-recommended treatment. Treatment rates decreased more with advancing age than with worsening comorbidity for all stages, such that older patients with no comorbidity had lower rates than younger patients with severe comorbidity. For example, 50% of patients with local disease age 75 to 84 years with no comorbidity received surgery compared with 57% of patients age 65 to 74 years with severe comorbidity (P < .001). In multivariate analysis, age and histology remained strong negative predictors of treatment for all stages, whereas comorbidity and nonclinical factors had a minor effect.Conclusion: Advancing age is a much stronger negative predictor of treatment receipt among older veterans with NSCLC than comorbidity. Individualized decisions that go beyond age and include comorbidity are needed to better target NSCLC treatments to older patients who may reasonably benefit. © 2012 by American Society of Clinical Oncology.",aged;aging;article;cancer patient;cancer registry;cancer staging;cerebrovascular disease;chronic lung disease;clinical decision making;cohort analysis;comorbidity;congestive heart failure;controlled study;dementia;diabetes mellitus;disease severity;elderly care;female;heart infarction;histopathology;human;lung adenocarcinoma;lung alveolus cell carcinoma;non small cell lung cancer;major clinical study;male;metastasis;outcome assessment;peripheral vascular disease;pleura effusion;practice guideline;priority journal;smoking;squamous cell carcinoma;veteran,"Wang, S.;Wong, M. L.;Hamilton, N.;Davoren, J. B.;Jahan, T. M.;Walter, L. C.",2012,,,0,
4711,Safety and efficacy of ticagrelor with emergency percutaneous coronary intervention in senile patients with ST-segment elevation myocardial infarction and dementia,"Antiplatelet drug therapy is an important supportive measure for patients undergoing emergency percutaneous coronary intervention (PCI), to promote blood flow and reduce the risk of stent thrombosis. Ticagrelor is a new antiplatelet drug that offers some advantages over older drugs like clopidogrel in general ST-segment elevation myocardial infarction (STEMI) patients. However, its safety and efficacy in STEMI patients who also exhibit dementia and its underlying pathologies is unknown. Here, the application of ticagrelor was assessed in STEMI patients with dementia undergoing PCI. The study included 174 patients with dementia, ages 60 to 79 years, who were hospitalized due to STEMI from July 2014 to June 2015. All patients were treated by PCI. Before PCI, patients were randomly divided into two groups: one receiving ticagrelor and the other receiving clopidogrel to prevent cardiovascular thrombotic events. Patients were followed for 30 days to record cardiovascular events, bleeding, and other adverse reactions. Statistical analysis was performed using t-test, chi-square test and logistic regression analysis. The primary endpoint of vascular causes of death, stroke, and MI was less frequent in patients receiving ticagrelor than those receiving clopidogrel (P<0.05). The incidence of stent thrombosis was also lower in the ticagrelor group (P<0.05). However, some adverse events, i.e., upper gastrointestinal bleeding and dyspnea, were more common with ticagrelor administration (P<0.05). These findings indicate that ticagrelor offers some outcome advantages over clopidgrel in treating STEMI patients with dementia who undergo PCI, as seen for a broader population, as this intervention can reduce vascular-cause mortality, stroke, and recurrent myocardial infarction risks. Although bleeding was more frequent with ticagrelor treatment, it appeared to be less severe than with clopidogrel treatment.",adult;aged;article;atrioventricular block/si [Side Effect];cerebrovascular accident;controlled clinical trial;controlled study;dementia;drug efficacy;drug safety;dyspnea/si [Side Effect];female;heart infarction;heart ventricle arrhythmia/si [Side Effect];human;loading drug dose;major clinical study;male;percutaneous coronary intervention;sinus bradycardia/si [Side Effect],"Wang, S.;Yang, X.;Li, Z.;Zhang, B.;Cheng, Y.",2016,,,0,4712
4712,Safety and efficacy of ticagrelor with emergency percutaneous coronary intervention in senile patients with ST-segment elevation myocardial infarction and dementia,"Antiplatelet drug therapy is an important supportive measure for patients undergoing emergency percutaneous coronary intervention (PCI), to promote blood flow and reduce the risk of stent thrombosis. Ticagrelor is a new antiplatelet drug that offers some advantages over older drugs like clopidogrel in general ST-segment elevation myocardial infarction (STEMI) patients. However, its safety and efficacy in STEMI patients who also exhibit dementia and its underlying pathologies is unknown. Here, the application of ticagrelor was assessed in STEMI patients with dementia undergoing PCI. The study included 174 patients with dementia, ages 60 to 79 years, who were hospitalized due to STEMI from July 2014 to June 2015. All patients were treated by PCI. Before PCI, patients were randomly divided into two groups: one receiving ticagrelor and the other receiving clopidogrel to prevent cardiovascular thrombotic events. Patients were followed for 30 days to record cardiovascular events, bleeding, and other adverse reactions. Statistical analysis was performed using t-test, chi-square test and logistic regression analysis. The primary endpoint of vascular causes of death, stroke, and MI was less frequent in patients receiving ticagrelor than those receiving clopidogrel (P<0.05). The incidence of stent thrombosis was also lower in the ticagrelor group (P<0.05). However, some adverse events, i.e., upper gastrointestinal bleeding and dyspnea, were more common with ticagrelor administration (P<0.05). These findings indicate that ticagrelor offers some outcome advantages over clopidgrel in treating STEMI patients with dementia who undergo PCI, as seen for a broader population, as this intervention can reduce vascular-cause mortality, stroke, and recurrent myocardial infarction risks. Although bleeding was more frequent with ticagrelor treatment, it appeared to be less severe than with clopidogrel treatment. Copyright © 2016, E-Century Publishing Corporation. All rights reserved.",adult;aged;article;atrioventricular block/si [Side Effect];cerebrovascular accident;controlled clinical trial;controlled study;dementia;drug efficacy;drug safety;dyspnea/si [Side Effect];female;heart infarction;heart ventricle arrhythmia/si [Side Effect];human;loading drug dose;major clinical study;male;percutaneous coronary intervention;sinus bradycardia/si [Side Effect];ST segment elevation myocardial infarction;stent thrombosis;treatment outcome;upper gastrointestinal bleeding/si [Side Effect];clopidogrel/ct [Clinical Trial];clopidogrel/cm [Drug Comparison];clopidogrel/po [Oral Drug Administration];ticagrelor/ae [Adverse Drug Reaction];ticagrelor/ct [Clinical Trial];ticagrelor/cm [Drug Comparison];ticagrelor/po [Oral Drug Administration];adverse drug reaction;cardiovascular system;cause of death;chi square test;clinical trial;drug therapy;dyspnea;emergency;logistic regression analysis;pharmacokinetics;prevention;randomized controlled trial;safety;Student t test;upper gastrointestinal bleeding;clopidogrel;ticagrelor,"Wang, S;Yang, X;Li, Z;Zhang, B;Cheng, Y",2016,,,0,
4713,Magnetic fields in noninvasive heart stimulation: Novel approach for anti-atrial fibrillation,,atropine;propranolol;Alzheimer disease;atrial fibrillation;autonomic nervous system;drug resistant epilepsy;heart failure;heart stimulation;heart ventricle arrhythmia;human;letter;magnetotherapy;mental disease;nerve cell plasticity;neurologic disease;neuromodulation;paroxysmal supraventricular tachycardia;priority journal;spinal cord stimulation;supraventricular tachycardia;therapy effect;transcranial magnetic stimulation;vagus nerve stimulation,"Wang, S.;Zhou, X.;Wang, Z.;Huang, B.;Zhou, L.;Chen, M.;Yu, L.;Jiang, H.",2015,,,0,
4714,Disease implication of hyper-Hippo signalling,"The Hippo signalling pathway regulates cellular proliferation, apoptosis and differentiation, thus exerting profound effects on cellular homeostasis. Inhibition of Hippo signalling has been frequently implicated in human cancers, indicating a well-known tumour suppressor function of the Hippo pathway. However, it is less certain whether and how hyperactivation of the Hippo pathway affects biological outcome in living cells. This review describes current knowledge of the regulatory mechanisms of the Hippo pathway, mainly focusing on hyperactivation of the Hippo signalling nexus. The disease implications of hyperactivated Hippo signalling have also been discussed, including arrhythmogenic cardiomyopathy, Sveinsson's chorioretinal atrophy, Alzheimer's disease, amyotrophic lateral sclerosis and diabetes. By highlighting the significance of disease-relevant Hippo signalling activation, this review can offer exciting prospects to address the onset and potential reversal of Hippo-related disorders.",Alzheimer's disease;Hippo pathway;Sveinsson's chorioretinal atrophy;amyotrophic lateral sclerosis;arrhythmogenic cardiomyopathy;diabetes,"Wang, S. P.;Wang, L. H.",2016,Oct,10.1098/rsob.160119,0,
4715,Arg972 insulin receptor substrate-1 polymorphism and risk and severity of Alzheimer's disease,"We explored the association between the Arg972 insulin receptor substrate-1 (IRS1) polymorphism and the risk and severity of Alzheimer's disease (AD). We genotyped the Arg972 IRS1 (rs1801278) polymorphism in 1123 pairs of age, sex, body mass index, residence area and education level-matched Han Chinese AD patients and controls. AD severity was assessed with Mini-Mental State Examination (MMSE) scores. The AA (homozygous Arg972 IRS1) and GA (heterozygous Arg972 IRS1) genotypes were associated with an increased risk of AD after adjustment for comorbidities including type 2 diabetes mellitus, coronary heart disease, and hypertension (p<0.001; adjusted odds ratio [OR] 3.93 and 2.90, respectively). The A allele was associated with an increased risk of AD after adjustment for comorbidities (p<0.001; adjusted OR 2.26; 95% confidence interval 1.92-2.80). The percentage of Arg972 IRS1 AA homozygotes was higher in the MMSE score 14 category than in the MMSE score 15-26 category overall and in each age group (p<0.001), while the wild type IRS1 GG homozygotes were predominantly found in the MMSE score 15-26 category overall and in each age group. The GG homozygote group had higher MMSE score than the GA heterozygote group, which in turn had higher MMSE score than the AA homozygote group overall and in each age group (p<0.05). In conclusion, the Arg972 IRS1 polymorphism is an independent risk factor for AD and the A allele has a gene dosage effect on AD severity in Han Chinese. This study adds fresh insights into the pathogenesis of AD.","Age Factors;Aged;Aged, 80 and over;Alzheimer Disease/epidemiology/ethnology/*genetics;Arginine/*genetics;China;Diabetes Mellitus, Type 2/epidemiology/genetics;Female;Gene Frequency;Genetic Predisposition to Disease/*genetics;Genotype;Humans;Insulin Receptor Substrate Proteins/*genetics;Male;Polymorphism, Single Nucleotide/*genetics;Psychiatric Status Rating Scales;Retrospective Studies;Alzheimer's disease;Case-control study;Cognitive impairment;Gene polymorphism;Insulin receptor substrate-1;Mini-Mental State Examination","Wang, W.;Yang, L.;Tan, L.;Wu, X.;Jiang, B.;Shen, X.",2014,Jul,10.1016/j.jocn.2013.09.028,0,
4716,Genotype-specific effects of smoking on risk of CHD,,apolipoprotein B;apolipoprotein E;cigarette smoke;cytochrome P450;low density lipoprotein;nitric oxide synthase;peroxynitrite;allele;neoplasm;smoking;death;dementia;diabetes mellitus;disease course;disease predisposition;enzyme activity;genetic variability;genetics;genotype;human;hypothesis;intrauterine growth retardation;ischemic heart disease;molecule;note;oxidation;priority journal;protein expression;public health;risk factor;sexual dysfunction;stress,"Wang, X. L.;Mahaney, M. C.",2001,,,0,
4717,Rehabilitation nursing analysis of community senile patients,,adult;aged;brain infarction;community;controlled study;female;health service;health status;health visitor;hospital discharge;human;hypertension;information processing;ischemic heart disease;major clinical study;male;note;nursing;physical examination;psychological aspect;senile dementia;senility;sleep disorder;social problem;social support,"Wang, Y.",2003,,,0,
4718,Insomnia and multimorbidity in the community elderly in China,"Study Objectives: To examine the comorbidity between insomnia and medical conditions. Methods: This cross-sectional study was conducted in community adults, aged > 60 years, who resided in one of four major cities in northern China. Sociodemographic and clinical data were collected simultaneously. A total of 3,176 elderly adults (1,292 male, mean ± standard deviation age 70.2 ± 6.8 years; 1,884 female, 68.8 ± 6.7 years) were interviewed. Results: The prevalence of specific medical conditions in both people with insomnia and people without insomnia was detected. Significantly higher proportions of arrhythmia, hypertension, cerebral hemorrhage, migraine, and hyperlipidemia were observed in people with insomnia than in people without insomnia. Moreover, a significantly higher proportion of insomnia was seen in elderly people with arrhythmia and migraine. We also found that elderly people with insomnia who took sleep medications reported a higher prevalence of coexisting arrhythmia, hypertension, and migraine, even after adjusting for age, sex, and depression. Conclusions: Our results indicate associations between insomnia and medical conditions in the community elderly in China. People who complained of insomnia had poorer physical health conditions. Sleep medication may not be a covariate that influences the comorbidity of some specific physical conditions. Clinical Trial Registration: Trial name: The study of diagnosis and treatment of senile dementia in Hebei Province; URL: http://www.chictr.org.cn/showproj. aspx?proj=8194; Registration number: ChiCTR-RRC-11001345.",ChiCTR-RRC-11001345;hypnotic agent;aged;aging;article;brain hemorrhage;brain infarction;China;chronic obstructive lung disease;clinical study;community;comorbidity;comparative study;controlled study;cross-sectional study;demography;depression;diabetes mellitus;emphysema;female;health status;heart arrhythmia;human;hyperlipidemia;hypertension;insomnia;ischemic heart disease;major clinical study;male;malignant neoplasm;migraine;multiple chronic conditions;narcolepsy;pharmaceutical care;prevalence;sleep disorder;sleep disordered breathing;social status,"Wang, Y. M.;Song, M.;Wang, R.;Shi, L.;He, J.;Fan, T. T.;Chen, W. H.;Wang, L.;Yu, L. L.;Gao, Y. Y.;Zhao, X. C.;Li, N.;Han, Y.;Liu, M. Y.;Lu, L.;Wang, X. Y.",2017,,10.5664/jcsm.6550,0,
4719,Management of complications in endovascular treatment for arteriosclerotic occlusive disease of lower extremities,"Objective To discuss the prevention and treatment of the perioperative complications in endovascular treatment for arteriosclerosis obliterans (ASO) of lower extremities. Methods Endovascular treatment was performed for 210 patients (248 limbs) with ASO of lower extremities,including 28 iliac lesions, 76 femoral-popliteal lesions, 56 inferior genicular lesions and 88 multiple segment lesions.The clinical data and complications were reviewed and analyzed. Results The technical success was achieved in 92.74% (230/248). Perioperative complications occurred in 21 patients(21/210, 10.00%), including hematoma (n=6), pseudoaneurysm (n=1), heart failure (n=2), constrast-induced nephropathy (n=1), artery perforation (n=3), artery section (n=3) and restenosis (n=5). All the complications were relieved after corresponding treatment.Conclusion Endovascular treatment is a safe and effective method for ASO of lower extremities because of its high success rate and few complications.Effective control of systemic diseases,careful operation and regular treatment after operation are all the effective measures to prevent and reduce the occurrence of complications.",artery perforation;article;contrast induced nephropathy;endovascular surgery;false aneurysm;femoral artery;heart failure;hematoma;human;iliac artery;major clinical study;patient safety;peripheral occlusive artery disease;popliteal artery;postoperative period;restenosis;therapy effect,"Wang, Z. H.;Tian, L.;Chen, X. D.;Zhuang, B. X.;Yang, X. D.;Wang, S. H.;Jiang, F. T.;Wang, Y. H.",2011,,,0,
4720,Hip fractures and dementia: Clinical decisions for the future,"Severe dementia is a life-limiting condition; hip fractures are morecommon in patients who have dementia. This study outlines the case of a 92-year-old female with severe dementia who sustained a hip fracture. Despite having a terminal diagnosis (severe dementia and hip fracture) and poor premorbid quality of life, she had a life-prolonging surgery. The report outlines issues around treatment options in such circumstances, informed consent and substitute decision-making. The authors propose a 'goals of care' approach to manage patients in whom the best treatment is unclear, during their attendance to the emergency department. It is suggested that utilization of such a model may help with substitute decision-making and true informed consent.",aged;anemia;article;aspiration pneumonia;case report;decision making;dementia;female;hip fracture;human;non ST segment elevation myocardial infarction;priority journal;transthoracic echocardiography;treatment outcome;very elderly,"Waran, E.;William, L.",2016,,10.1093/omcr/omw001,0,
4721,"Improving access to financial support for heart failure patients: Understanding the claims, process and the doctors' role","Many heart failure patients are eligible to receive financial support (Disability Living Allowance or Attendance Allowance) because of their impaired mobility. Those with a very limited prognosis can gain rapid access to these benefits by claiming under 'special rules' with the support of a report (DS 1500) from their doctor. However, patients rarely submit claims under this scheme, usually for one of two reasons: 1. Patients and/or healthcare professionals are either unaware of these benefits, or misunderstand the claims process; 2. Doctors believe that their report requires them to accurately predict the patient's prognosis but lack the evidence to do this. Information recently provided by senior advisers at the Department of Work and Pensions clarifies the claims process and explains the doctors' role, noting that this does not require prognostic accuracy. Easily accessible routine clinical data are summarised that identify patients whose claims are most likely to succeed.",anemia;article;awareness;chronic obstructive lung disease;clinical study;cognitive defect;comorbidity;dementia;depression;diabetes mellitus;diagnostic accuracy;financial management;health care personnel;atrial fibrillation;heart failure;human;information;kidney dysfunction;kidney failure;patient attitude;patient identification;patient mobility;physician attitude;prognosis;social insurance,"Ward, C.",2007,,,0,
4722,Some developments on the affected-pedigree-member method of linkage analysis,"Some improvements are presented for the affected-pedigree-member method of linkage analysis, which is a generalization of the sib-pair method. The test statistic is extended to include contrasts between affected and unaffected pedigree members, so that it now utilizes marker information from all typed pedigree members rather than just the typed affected members. Computer simulation using a sample pedigree of 14 individuals shows that this modification can substantially increase statistical power where there is a direct association between marker variation and disease and where disease risk is elevated in carriers of the disease allele. Data on Huntington disease in 16 British families, which were analyzed previously using only the affected individuals, are reanalyzed with the unaffected individuals included. Strong rejection of the null hypothesis of no association between Huntington disease and the HindIII polymorphism is confirmed, but the particular families in which the association is significant differs from that obtained through an analysis based only on affected individuals and reflects more closely the results obtained from a lod-score analysis. The test statistic is also modified here to incorporate contrasts between individuals of zero kinship, if needed. This enables contrasts between individuals from different pedigrees, as well as contrasts involving individuals sampled from the general population, to be incorporated into the test of association. For population data, the methodology reduces to a type of contingency-table analysis, in which the rows of the table correspond to different marker-locus genotypes and in which the two columns categorize subjects into an ""affected"" group versus an ""unaffected,"" or control, group. This aspect of the methodology is illustrated using two population data sets, the first relating APO-E genotype to the frequency of individuals undergoing maintenance hemodialysis and the second relating APO-B genotype to the frequency of coronary artery disease. The present methodology confirms the lack of association between marker and disease in the former data set and confirms the presence of association in the latter. Finally, the methodology is formulated here in terms of ordinary, multiperson kinship coefficients rather than in terms of the generalized kinship coefficients originally proposed. This greatly reduces the number of coefficients to be calculated, thereby enhancing the computational efficiency of the computer program.","Apolipoproteins B/genetics;Apolipoproteins E/genetics;Computer Simulation;Coronary Disease/genetics;Deoxyribonuclease HindIII;Female;*Genetic Linkage;Humans;Huntington Disease/genetics;Male;Models, Genetic;Models, Statistical;*Pedigree;Polymorphism, Restriction Fragment Length;Renal Dialysis;Risk Factors","Ward, P. J.",1993,Jun,,0,
4723,Apolipoprotein E and the development of atherosclerosis,"Elevated levels of cholesterol, lipids, and lipoproteins are known to increase the risk of atherosclerosis and coronary artery disease in humans. Apolipoproteins may play a role in the development of premature coronary artery disease because they have metabolic functions that significantly influence lipid metabolism. Apolipoprotein E is a protein component of the atherogenic lipoproteins. The gene that encodes apolipoprotein E is polymorphic with three allelic forms. Two of the three alleles have been associated with increased incidence of cardiovascular disease. It is desirable, therefore, to accurately determine apolipoprotein E phenotypes and genotypes. Methods have been developed to assess both. The best methods, however, appear to be those for assessing apo E genotype using the polymerase chain reaction for DNA amplification and allele-specific oligonucleotides for identification of the specific polymorph.",apolipoprotein E;Alzheimer disease;article;atherogenesis;atherosclerosis;smoking;coronary artery disease;coronary risk;diabetes mellitus;gender;genotype;human;hyperlipidemia;hypertension;lipid blood level;lipoprotein blood level;obesity;risk assessment,"Warden, B. A.;Thompson, E.",1994,,,0,
4724,Cognitive impact of lacunar infarcts and white matter hyperintensity volume,"Background: Subcortical lacunar infarcts and white matter hyperintensities (WMH) are common neuroradiological findings, but few studies associate between these insults and cognition in a community-dwelling population. Methods: The Dallas Heart Study is a populationbased initiative whose assessments included demographic and clinical findings including brain MRI and the Montreal Cognitive Assessment (MoCA). The presence and number of lacunes in subjects aged over 55 years were assessed by study physicians. The WMH volume was measured by an automated method. The association between the presence and number of lacunar infarcts and of WMH volume with the total MoCA score and subdomains was assessed using linear regression with adjustment for age, gender and self-reported ethnicity. Results: In 609 subjects with valid data, both the presence and the increasing number of lacunes were associated with lower MoCA scores, even after adjusting for demographic variables. The presence of lacunes was also associated with lower scores in the memory, executive and attention subdomains. The WMH volume was not significantly associated with the MoCA score. Conclusion: The presence and increasing number of lacunes in midlife is associated with a lower performance in multiple domains of a cognitive screening measure after adjusting for demographic factors.",adult;aged;article;attention;cognition;depth perception;educational status;executive function;female;human;lacunar stroke;language;major clinical study;male;memory;Montreal cognitive assessment;neuroimaging;nuclear magnetic resonance imaging;orientation;priority journal;race difference;radiological parameters;white matter;white matter hyperintensity volume,"Warren, M. W.;Weiner, M. F.;Rossetti, H. C.;McColl, R.;Peshock, R.;King, K. S.",2015,,,0,
4725,Distended bladder presenting with altered mental status and venous obstruction,"Background: New onset or acute worsening of bilateral lower extremity swelling is commonly caused by venous congestion from decompensated heart failure, pulmonary disease, liver dysfunction, or kidney insufficiency. A thromboembolic event, lymphatic obstruction, or even external compression of venous flow can also be the culprit. Case Report: We report the case of an 83-year-old male with a history of myelodysplastic syndrome that progressed to acute myeloid leukemia, bipolar disorder, and benign prostatic hypertrophy. He presented with altered mental status and new onset lower extremity edema caused by acute bladder outflow obstruction. Computed tomography of the abdomen and pelvis showed the patient’s distended bladder compressing bilateral external iliac veins. Conclusion: Insertion of a Foley catheter resulted in several liters of urine output and marked improvement in his lower extremity edema and mental status a few hours later. Our extensive workup failed to reveal a cause of the patient’s acute change in mental status, and we attributed it to a concept known as cystocerebral syndrome.",tamsulosin;abdominal radiography;acute disease;aged;agitation;article;bipolar disorder;bladder distension;bladder obstruction;case report;clinical examination;computer assisted tomography;confusion;dementia;disease association;disease severity;Foley balloon catheter;human;leg edema;male;mental disease;nuclear magnetic resonance imaging;treatment response;urine incontinence;urine retention;urine volume;vein occlusion;very elderly,"Washco, V.;Engel, L.;Smith, D. L.;McCarron, R.",2015,,,0,
4726,Oestrogen plus progestin increases the risk of ischaemic stroke in post-menopausal women,,cell nucleus receptor;Cimicifuga racemosa extract;conjugated estrogen;drospirenone;estrogen;ethinylestradiol;gestagen;isoflavone derivative;medroxyprogesterone acetate;oral contraceptive agent;phytoestrogen;placebo;progesterone;protein bcl 2;serotonin;thioredoxin;adult;age;aged;apoptosis;blood clot;brain function;breast cancer;cardiovascular disease;cerebrovascular accident;clinical trial;cognition;data analysis;decision making;dementia;disease severity;drug mechanism;drug surveillance program;estrogen activity;ethnology;evidence based medicine;female;follow up;hormone substitution;hot flush;human;incidence;ischemic heart disease;menopausal syndrome;Mini Mental State Examination;minor affective disorder;night sweat;osteoporosis;outcomes research;oxidative stress;patient selection;postmenopause;pregnancy;priority journal;randomization;risk assessment;risk factor;short survey;thromboembolism;United States;venous thromboembolism,"Wassertheil-Smoller, S.;Hendrix, S. L.;Limacher, M.;Palferman, T. G.;Chiueh, C. C.",2003,,,0,
4727,The usefulness of carotid artery ultrasonography in patients with Binswanger's encephalopathy,"Carotid artery ultrasonography (B-mode and Duplex method) was conducted in 49 cases of Binswanger's encephalopathy (group B) to compare with 189 cases of lacunar infarction (group L). With B-mode method, there was no significant difference in the amount of plaque between group B and group L, but the inner diameter of the common carotid artery was greater in group B. Using Duplex method, we measured maximum systolic flow velocity (Max), minimum diastolic flow velocity (Min) and time velocity integral (TVI). We found that those data were consistently lower in group B than in group L, with a correlation to the severity of mental impairment. The decrease in Max in group B, which has diffuse arteriosclerosis, indicates a decline in cardiac function, while the decrease in Min indicates an increase of intracranial small vessel resistance. The lower TVI in group B is thought to reflect a loss of velocity in cerebrovascular circulation due to the decrease in Max and Min. Carotid artery ultrasonography thus proved useful in evaluating the pathogenesis and progression of the disease.","Aged;Blood Flow Velocity;Carotid Arteries/*ultrasonography;Cerebral Infarction/physiopathology/ultrasonography;Cerebrovascular Circulation;Dementia, Vascular/physiopathology/ultrasonography;Female;Humans;Intracranial Arteriosclerosis/physiopathology/*ultrasonography;Male;Middle Aged;*Ultrasonography, Interventional","Watanabe, M.;Mano, K.;Watanabe, H.",1998,Sep,,0,
4728,Longer lives and unfinished agendas on child survival,,Pneumococcus vaccine;Alzheimer disease;child;childhood mortality;financial management;health care delivery;human;international cooperation;ischemic heart disease;life expectancy;liver cirrhosis;maternal care;maternal mortality;morbidity;mortality rate;motivation;newborn mortality;note;priority journal;refugee;survival,"Watkins, K.",2016,,10.1016/s0140-6736(16)31744-5,0,
4729,Linking electronic health record-extracted psychosocial data in real-time to risk of readmission for heart failure,"BACKGROUND: Knowledge of psychosocial characteristics that helps to identify patients at increased risk for readmission for heart failure (HF) may facilitate timely and targeted care. OBJECTIVE: We hypothesized that certain psychosocial characteristics extracted from the electronic health record (EHR) would be associated with an increased risk for hospital readmission within the next 30 days. METHODS: We identified 15 psychosocial predictors of readmission. Eleven of these were extracted from the EHR (six from structured data sources and five from unstructured clinical notes). We then analyzed their association with the likelihood of hospital readmission within the next 30 days among 729 patients admitted for HF. Finally, we developed a multivariable predictive model to recognize individuals at high risk for readmission. RESULTS: We found five characteristics-dementia, depression, adherence, declining/refusal of services, and missed clinical appointments-that were associated with an increased risk for hospital readmission: the first four features were captured from unstructured clinical notes, while the last item was captured from a structured data source. CONCLUSIONS: Unstructured clinical notes contain important knowledge on the relationship between psychosocial risk factors and an increased risk of readmission for HF that would otherwise have been missed if only structured data were considered. Gathering this EHR-based knowledge can be automated, thus enabling timely and targeted care.",Aged;Dementia/complications;Depression/complications;Electronic Health Records;Female;Heart Failure/*etiology/psychology/therapy;Humans;Logistic Models;Male;Medical Record Linkage;Patient Compliance/statistics & numerical data;*Patient Readmission/statistics & numerical data;Psychology;Risk Factors;Time Factors;Treatment Refusal/statistics & numerical data,"Watson, A. J.;O'Rourke, J.;Jethwani, K.;Cami, A.;Stern, T. A.;Kvedar, J. C.;Chueh, H. C.;Zai, A. H.",2011,Jul-Aug,10.1016/j.psym.2011.02.007,0,
4730,AESOPS: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care,"OBJECTIVE: To compare the clinical effectiveness and cost-effectiveness of a stepped care intervention against a minimal intervention in the treatment of older hazardous alcohol users in primary care.DESIGN: A multicentre, pragmatic, two-armed randomised controlled trial with an economic evaluation.SETTING: General practices in primary care in England and Scotland between April 2008 and October 2010.PARTICIPANTS: Adults aged ? 55 years scoring ? 8 on the Alcohol Use Disorders Identification Test (10-item) (AUDIT) were eligible. In total, 529 patients were randomised in the study.INTERVENTIONS: The minimal intervention group received a 5-minute brief advice intervention with the practice or research nurse involving feedback of the screening results and discussion regarding the health consequences of continued hazardous alcohol consumption. Those in the stepped care arm initially received a 20-minute session of behavioural change counselling, with referral to step 2 (motivational enhancement therapy) and step 3 (local specialist alcohol services) if indicated. Sessions were recorded and rated to ensure treatment fidelity.MAIN OUTCOME MEASURES: The primary outcome was average drinks per day (ADD) derived from extended AUDIT--Consumption (3-item) (AUDIT-C) at 12 months. Secondary outcomes were AUDIT-C score at 6 and 12 months; alcohol-related problems assessed using the Drinking Problems Index (DPI) at 6 and 12 months; health-related quality of life assessed using the Short Form Questionnaire-12 items (SF-12) at 6 and 12 months; ADD at 6 months; quality-adjusted life-years (QALYs) (for cost-utility analysis derived from European Quality of Life-5 Dimensions); and health and social care resource use associated with the two groups.RESULTS: Both groups reduced alcohol consumption between baseline and 12 months. The difference between groups in log-transformed ADD at 12 months was very small, at 0.025 [95% confidence interval (CI)--0.060 to 0.119], and not statistically significant. At month 6 the stepped care group had a lower ADD, but again the difference was not statistically significant. At months 6 and 12, the stepped care group had a lower DPI score, but this difference was not statistically significant at the 5% level. The stepped care group had a lower SF-12 mental component score and lower physical component score at month 6 and month 12, but these differences were not statistically significant at the 5% level. The overall average cost per patient, taking into account health and social care resource use, was £488 [standard deviation (SD) £826] in the stepped care group and £482 (SD £826) in the minimal intervention group at month 6. The mean QALY gains were slightly greater in the stepped care group than in the minimal intervention group, with a mean difference of 0.0058 (95% CI -0.0018 to 0.0133), generating an incremental cost-effectiveness ratio (ICER) of £1100 per QALY gained. At month 12, participants in the stepped care group incurred fewer costs, with a mean difference of -£194 (95% CI -£585 to £198), and had gained 0.0117 more QALYs (95% CI -0.0084 to 0.0318) than the control group. Therefore, from an economic perspective the minimal intervention was dominated by stepped care but, as would be expected given the effectiveness results, the difference was small and not statistically significant.CONCLUSIONS: Stepped care does not confer an advantage over minimal intervention in terms of reduction in alcohol consumption at 12 months post intervention when compared with a 5-minute brief (minimal) intervention.TRIAL REGISTRATION: This trial is registered as ISRCTN52557360.FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 25. See the HTA programme website for further project information.BACKGROUND: There is clear evidence of the detrimental impact of hazardous alcohol consumption on the physical and mental health of the population. Estimates suggest that hazardous alcohol consumption annually account for 150,000 hospital admissions and between 15,000 and 22,000 deaths in the UK. In the older population, hazardous alcohol consumption is associated with a wide range of physical, psychological and social problems. There is evidence of an association between increased alcohol consumption and increased risk of coronary heart disease, hypertension and haemorrhagic and ischaemic stroke, increased rates of alcohol-related liver disease and increased risk of a range of cancers. Alcohol is identified as one of the three main risk factors for falls. Excessive alcohol consumption in older age can also contribute to the onset of dementia and other age-related cognitive deficits and is implicated in one-third of all suicides in the older population.","Alcoholism [diagnosis] [economics] [therapy];Cost-Benefit Analysis;Health Care Costs [statistics & numerical data];Mass Screening [methods];Primary Health Care [economics] [methods];Risk Factors;Treatment Outcome;United Kingdom;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-addictn","Watson, Jm;Crosby, H;Dale, Vm;Tober, G;Wu, Q;Lang, J;McGovern, R;Newbury-Birch, D;Parrott, S;Bland, Jm;Drummond, C;Godfrey, C;Kaner, E;Coulton, S",2013,,10.3310/hta17250,0,4731
4731,AESOPS: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care,"BACKGROUND: There is clear evidence of the detrimental impact of hazardous alcohol consumption on the physical and mental health of the population. Estimates suggest that hazardous alcohol consumption annually accounts for 150,000 hospital admissions and between 15,000 and 22,000 deaths in the UK. In the older population, hazardous alcohol consumption is associated with a wide range of physical, psychological and social problems. There is evidence of an association between increased alcohol consumption and increased risk of coronary heart disease, hypertension and haemorrhagic and ischaemic stroke, increased rates of alcohol-related liver disease and increased risk of a range of cancers. Alcohol is identified as one of the three main risk factors for falls. Excessive alcohol consumption in older age can also contribute to the onset of dementia and other age-related cognitive deficits and is implicated in one-third of all suicides in the older population. OBJECTIVE: To compare the clinical effectiveness and cost-effectiveness of a stepped care intervention against a minimal intervention in the treatment of older hazardous alcohol users in primary care. DESIGN: A multicentre, pragmatic, two-armed randomised controlled trial with an economic evaluation. SETTING: General practices in primary care in England and Scotland between April 2008 and October 2010. PARTICIPANTS: Adults aged ? 55 years scoring ? 8 on the Alcohol Use Disorders Identification Test (10-item) (AUDIT) were eligible. In total, 529 patients were randomised in the study. INTERVENTIONS: The minimal intervention group received a 5-minute brief advice intervention with the practice or research nurse involving feedback of the screening results and discussion regarding the health consequences of continued hazardous alcohol consumption. Those in the stepped care arm initially received a 20-minute session of behavioural change counselling, with referral to step 2 (motivational enhancement therapy) and step 3 (local specialist alcohol services) if indicated. Sessions were recorded and rated to ensure treatment fidelity. MAIN OUTCOME MEASURES: The primary outcome was average drinks per day (ADD) derived from extended AUDIT--Consumption (3-item) (AUDIT-C) at 12 months. Secondary outcomes were AUDIT-C score at 6 and 12 months; alcohol-related problems assessed using the Drinking Problems Index (DPI) at 6 and 12 months; health-related quality of life assessed using the Short Form Questionnaire-12 items (SF-12) at 6 and 12 months; ADD at 6 months; quality-adjusted life-years (QALYs) (for cost-utility analysis derived from European Quality of Life-5 Dimensions); and health and social care resource use associated with the two groups. RESULTS: Both groups reduced alcohol consumption between baseline and 12 months. The difference between groups in log-transformed ADD at 12 months was very small, at 0.025 [95% confidence interval (CI)--0.060 to 0.119], and not statistically significant. At month 6 the stepped care group had a lower ADD, but again the difference was not statistically significant. At months 6 and 12, the stepped care group had a lower DPI score, but this difference was not statistically significant at the 5% level. The stepped care group had a lower SF-12 mental component score and lower physical component score at month 6 and month 12, but these differences were not statistically significant at the 5% level. The overall average cost per patient, taking into account health and social care resource use, was £488 [standard deviation (SD) £826] in the stepped care group and £482 (SD £826) in the minimal intervention group at month 6. The mean QALY gains were slightly greater in the stepped care group than in the minimal intervention group, with a mean difference of 0.0058 (95% CI -0.0018 to 0.0133), generating an incremental cost-effectiveness ratio (ICER) of £1100 per QALY gained. At month 12, participants in the stepped care group incurred fewer costs, with a mean difference of -£194 (95% CI -£585 to £198), and had gained 0.0117 more QALYs (95% CI - . 084 to 0.0318) than the control group. Therefore, from an economic perspective the minimal intervention was dominated by stepped care but, as would be expected given the effectiveness results, the difference was small and not statistically significant. CONCLUSIONS: Stepped care does not confer an advantage over minimal intervention in terms of reduction in alcohol consumption at 12 months post intervention when compared with a 5-minute brief (minimal) intervention. TRIAL REGISTRATION: This trial is registered as ISRCTN52557360. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 25. See the HTA programme website for further project information.","Alcoholism [diagnosis] [economics] [therapy];Cost-Benefit Analysis;Great Britain;Health Care Costs [statistics & numerical data];Mass Screening [methods];Primary Health Care [economics] [methods];Risk Factors;Treatment Outcome;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];Sr-addictn","Watson, J. M.;Crosby, H.;Dale, V. M.;Tober, G.;Wu, Q.;Lang, J.;McGovern, R.;Newbury-Birch, D.;Parrott, S.;Bland, J. M.;Drummond, C.;Godfrey, C.;Kaner, E.;Coulton, S.",2013,,10.3310/hta17250,0,
4732,Polypharmacy in elderly hospitalised patients in Slovakia,"OBJECTIVE: The aims of the present study were to: analyse the prevalence of polypharmacy in a group of older patients; evaluate the influence of hospital stay on the number of drugs taken; assess the most frequently prescribed pharmacological classes; identify risk factors that predisposed the patient to polypharmacy. Setting The study was carried out in the Department of Internal Medicine of a non-university general hospital. METHOD: In the retrospective study, 600 patients aged 65 years or more were enrolled. They were hospitalised in the period from 1st December 2003 to 31st March 2005. Each person taking six or more medications per day was considered to be a patient with polypharmacy. Particular sociodemographic and clinical characteristics, as well as comorbid conditions, were evaluated as factors potentially influencing the prevalence of polypharmacy. MAIN OUTCOME MEASURE: The number and type of medications taken at the time of hospital admission and discharge were recorded and compared for each patient. RESULTS: Polypharmacy on admission and at discharge was observed in 362 (60.3%) and 374 (62.3%) patients, respectively. Hospitalisation led to a significant increase in the number of medications. The spectrum of medications used corresponded to the proportions of diagnoses in the evaluated group, in which cardiovascular diseases were most prevalent. According to the multivariate analysis using a logistic regression model, diabetes mellitus (odds ratio (OR) 2.40; 95% confidence interval (CI): 1.64-3.50), heart failure (OR 2.14; 95% CI: 1.46-3.14), dementia (OR 2.12; 95% CI: 1.26-3.57), living alone (OR 2.00; 95% CI: 1.28-3.10), arterial hypertension (OR 1.63; 95% CI: 1.08-2.44) and cerebrovascular disease (OR 1.58; 95% CI: 1.03-2.44) significantly increased the risk of the presence of polypharmacy. CONCLUSION: Our study confirmed a relatively high prevalence of polypharmacy in Slovak elderly patients. Polypharmacy risk rose especially with the increased prevalence of diseases of advancing age (diabetes mellitus, heart failure, arterial hypertension, dementia and cerebrovascular diseases). The increasing numbers of medications in inpatients indicate the need for the careful re-evaluation of pharmacotherapy during the stay in hospital.","Aged/*statistics & numerical data;Aged, 80 and over;Comorbidity;*Drug Therapy, Combination;Female;Hospitalization/*statistics & numerical data;Humans;Logistic Models;Male;Retrospective Studies;Risk Factors;Slovakia;Socioeconomic Factors","Wawruch, M.;Zikavska, M.;Wsolova, L.;Kuzelova, M.;Tisonova, J.;Gajdosik, J.;Urbanek, K.;Kristova, V.",2008,Jun,10.1007/s11096-007-9166-3,0,
4733,Medical profile of patients with fractured neck of femur,,"Aged;Aged, 80 and over;Cerebrovascular Disorders/epidemiology;Comorbidity;Dementia/epidemiology;Drug Therapy/statistics & numerical data;Female;Femoral Neck Fractures/*epidemiology;Heart Failure/epidemiology;Humans;Hypertension/epidemiology;Institutionalization/statistics & numerical data;Male;Middle Aged;Myocardial Ischemia/epidemiology;New Zealand/epidemiology","Weatherall, M.",1993,Sep 8,,0,
4734,Efficacy of nasal bridles in avoiding percutaneous endoscopic gastrostomy placement,"Objective: The aim of the study was to report the use of nasogastric tube bridles to avoid dislodging of percutaneous endoscopic gastrostomy tubes. Specifically it was intended to see if they reduced feeding time, medical input and costs. Design and setting: This was a cohort study in a district hospital setting. Patients: 164 patients admitted with conditions causing acutely impaired swallowing. Interventions: 140 of 164 patients referred received a NGT bridle. Results: Of these, 49 (35%) died by 28 days and 68 (48.6%) at 1 year; 73 (52.1%) had regained adequate oral intake at 28 days and 27 (19.2%) had proceeded to PEG. Of those not bridled, nine (37.5%) died by 28 days and 10 (41.7%) at 1 year with the remainder eating. There was no significant difference in mortality between groups. There were no complications attributed to bridles. Conclusion: We conclude that nasogastric bridles are safe and represent an appropriate method to maintain nutrition while seeing if the underlying disease process will stabilise in these critically ill patients. They have the benefits of avoiding unnecessary PEG and the associated complications and cost.",adult;aged;article;brain hypoxia;central nervous system infection;clinical examination;congestive heart failure;degenerative disease;dementia;depression;diabetic stomach paresis;dysphagia;female;hepatic encephalopathy;hospital admission;human;injury;major clinical study;male;mortality;nasogastric tube;nasogastric tube bridle;oncology;Parkinson disease;percutaneous endoscopic gastrostomy;priority journal;risk benefit analysis;safety;sepsis;stomach paresis;cerebrovascular accident;subarachnoid hemorrhage;subdural hematoma;surgery,"Webb, G.;Gupta, P.;Fitchett, J.;Simmons, J.;De Silva, A.",2012,,,0,
4735,Asset of creatine phosphate for cardiocerebral syndrome treatment in acute myocardial infarction in old age,"Background. The objective of the investigation was to compare possibilities how to influence the general neuropsychic symptomatology described as cardiocerebral syndrome during the first three days of an acute myocardial infarction (AIM) in old age by means of creatine phosphate (CP). Methods and Results. The investigation which extended over 8 months comprised 50 subjects admitted to the coronary unit (CU) because of AIM symptomatology, age 65 - 93 years (75.1 ± 5.6 years). Twenty-five subjects were given, using a uniform protocol, during the first three days at the CU, 18 g CP (Neoton, Schiapparelli) by the i.v. route. The control group of 25 subjects (randomized) with AIM of comparable parameters (age, sex, location and course of IM) were not given CP. Evaluation of the dynamics of mental deterioration by means of a test of cognitive functions (MMS) during the first three days after IM by means of simple regression analysis, comparing the two groups, revealed a favourable effect of CP on mental functions as compared with the control group (p = 0.05). In the CP treated group there was, as compared with the control group, on the 1st and 2nd day a lower incidence of stenocardias (statistically not significant; p = NS), ventricular dysrhythmias (p = NS) and cardiac failure (p = NS). Conclusions. Administration of creatine phosphate did not produce any undesirable side effects. Objective evidence was provided of the favourable effect of CP on mental deterioration in cardiocerebral syndrome in AIM in old age.",creatine phosphate;acute heart infarction;aged;angina pectoris;article;cardiocerebral syndrome;clinical article;clinical trial;controlled clinical trial;controlled study;drug efficacy;female;heart failure;heart ventricle arrhythmia;human;intravenous drug administration;male;mental deterioration;randomized controlled trial;neoton,"Weber, P.;Vlasicova, Y.;Labrova, R.;Semrad, B.",1995,,,0,
4736,How and why we should move our geriatric cheese,"Caring for frail, vulnerable elderly patients differs from caring for younger patients and is becoming much more prevalent. The papers in this supplement, derived from the Assessing Care of Vulnerable Elders project, will help all physicians improve our management of the syndromes discussed and evaluate how well we are succeeding.",antiarrhythmic agent;antidepressant agent;antihypertensive agent;antilipemic agent;barbituric acid derivative;beta adrenergic receptor blocking agent;calcium channel blocking agent;chlorpropamide;cholinergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;diuretic agent;nonsteroid antiinflammatory agent;pethidine;warfarin;Alzheimer disease;cognitive defect;depression;elderly care;health care quality;heart failure;human;osteoarthritis;priority journal;short survey,"Webster J.R, Jr.",2001,,,0,
4737,Genetic Risks for Chronic Conditions: Implications for Long-Term Wellbeing,"Background: Relationships between genetic risks for chronic diseases and long-run wellbeing are largely unexplored. We examined the associations between genetic predispositions to several chronic conditions and long-term functional health and socioeconomic status. Methods: We used data on a nationally representative sample of 9317 adults 65 years or older from the 1992-2012 Health and Retirement Survey in the US. Survey data were linked to genetic data on nearly 2 million SNPs. We measured individual-level genetic predispositions for coronary-artery disease, type 2 diabetes, obesity, rheumatoid arthritis, Alzheimer's disease, and major depressive disorder by polygenic risk scores derived from genome-wide association studies. The outcomes were self-rated health, depressive symptoms, cognitive ability, activities of everyday life, educational attainment and wealth. We employed regression analyses for the outcomes including all polygenic scores and adjusting for gender, birth period, and genetic ancestry. Results: The polygenic scores had important associations with functional health and socioeconomic status. An increase in genetic risk for all conditions except type 2 diabetes was significantly (p<0.01) associated with reduced functional health and socioeconomic outcomes. The magnitudes of functional health declines were meaningful and in many cases equivalent in magnitude to several years of aging. These associations were robust to several sensitivity checks for ancestry and adjustment for parental educational attainment and age at death or last interview if alive. Conclusion: Stronger genetic predispositions for leading chronic conditions are related to worse long-run health and SES outcomes, likely reflecting the adverse effects of the onset of these conditions on one's wellbeing.",Chronic conditions;polygenic scores;wellbeing,"Wehby, G. L.;Domingue, B. W.;Wolinsky, F. D.",2017,Aug 09,,0,
4738,Morbus diureticus in the elderly: Epidemic overuse of a widely applied group of drugs,"Diuretics (thiazides, loop diuretics) are established as treatments of common diseases: arterial hypertension, heart failure, and renal disease. In aging societies, their prevalence sharply rises with age. Thus, diuretic efficacy and safety need to be considered in the elderly as main consumers. Diuretics expose several disadvantages with particular relevance for the elderly. The most acknowledged side effects concern electrolyte disturbances. Hypokalemia (up to 8%) may not only precipitate cardiac arrhythmias and related sudden death but also adynamia by muscular weakness. Hyponatremia (up to 17%) may contribute to confusion, delirium, and irreversible brain damage adding to age-related dementia. Thiazides are the antihypertensive drugs with the strongest diabetogenic activity. In heart failure treatment, overdosing of diuretics is common, as doses often reflect requirements for acute recompensation, which is two- to threefold the requirement of that in maintenance therapy. Trial data demonstrate a positive correlation between mortality and diuretic use/dose, which may also be related to volume contraction, related ACE-inhibitor intolerance, renal impairment, and venous thromboembolism. Combining loop and thiazide diuretics may be indicated for severe cardiac or renal failure, but it is also excessively used in less severe stages, causing an even more severe threat to patients; thiazides are often added unintentionally if overlooked in combination pills. Diuretics may be used to treat peripheral ""edema"" in obese patients, patients on calcium antagonists, or those with venous thrombotic disease. Here they are not indicated and may even induce edema. In statistics on adverse drug reactions leading to hospitalization, diuretics are among the 5 leading drug classes. Misleading interpretations of clinical trials and their low cost have pushed them into the front position of hypertension treatment. Here, side effects, including the urge of voiding, lead to the lowest adherence rate among first-line antihypertensives.It is proposed to term the syndrome of inappropriate diuretic application ""morbus diureticus."" It should be diagnosed by history taking, force assessment (timed-up-and-go, chair-rise tests), clinical hydration assessment, and laboratory tests (electrolytes, creatinine). In heart failure, dose reductions/step-down from loop to thiazide diuretics should be tested routinely at 3- to 6-month intervals. In hypertension treatment, diuretics should be third in line if control by RAS inhibitors and long-acting dihydropyridine calcium antagonists is insufficient. If symptoms improve after diuretic step-down (including improved tolerance to RAS inhibitors or renal function), this diagnosis may also be made ""ex juvantibus."" © 2013 American Medical Directors Association, Inc.",dipeptidyl carboxypeptidase inhibitor;diuretic agent;potassium;thiazide diuretic agent;article;asthenia;brain damage;confusion;delirium;diabetogenesis;disease classification;drug abuse;drug efficacy;drug overdose;drug safety;elderly care;electrolyte disturbance;epidemic;extracellular space;heart arrhythmia;heart failure;hospitalization;human;hypertension;hypokalemia;hyponatremia;hypovolemia;kidney dysfunction;maintenance therapy;medical terminology;metabolic disorder;morbus diureticus;mortality;muscle weakness;patient compliance;peripheral edema;prevalence;sudden death;urinary urgency;vein thrombosis,"Wehling, M.",2013,,,0,
4739,Psychological status of senile patients with coronary heart disease after coronary stenting,"OBJECTIVE: To evaluate the psychological status and prognosis of senile patients with coronary heart disease (CHD) after coronary stenting (CS). METHOD: Totally 86 senile patients with CHD in the Department of Cardiovascular Internal Medicine, The Fifth Affiliated Hospital of Guangxi Medical University from June 2005 to June 2007 were selected. Hamilton anxiety scale, Hamilton depression scale and the self-completed HAD scale was performed to survey psychological status following CS. According to anxiety-depression state, patients with anxiety-depression state were served as the positive group, and the other was negative group. General condition and the occurrence of cardiovascular events after CS were compared in both groups after 1 year follow up. RESULTS: There were 47 patients in the positive group and 39 patients in the negative group, and the incident rate of anxiety-depression symptoms was 54.65% in the senile patients with CHD after CS. The correlative factors of anxiety-depression symptoms may be gender, educational degree, and financial problems (P < 005). The recurrence of angina pectoris of the positive group was higher than that of the negative control group (P < 005). CONCLUSION: There was high incident rate of anxiety-depression symptoms in the senile patients with CHD after CS, and early intervention should be strengthened to reduce the long-term risk of cardiovascular events.",acute heart infarction;aged;aging;angina pectoris;anxiety disorder;article;cardiovascular disease;clinical evaluation;controlled study;coronary stent;depression;disease course;educational status;female;finance;gender;Hamilton Anxiety Scale;Hamilton Depression Rating Scale;health survey;heart death;Hospital Anxiety and Depression Scale;human;incidence;internal medicine;ischemic heart disease;major clinical study;male;mental health;prognosis;psychologic assessment;recurrent disease;risk factor;senility;cerebrovascular accident;surgical risk;symptom;university hospital,"Wei, X.;Zhou, Y.;Zhang, L. C.",2009,,,0,
4740,Effects of Intensive Antihypertensive Treatment on Chinese Hypertensive Patients Older Than 70 Years,"This study was performed to investigate whether intensive antihypertensive treatment with achieved blood pressure (BP) ≤140/90 mm Hg, as compared with standard treatment with achieved BP ≤150/90 mm Hg, could further improve cardiovascular outcomes in Chinese hypertensive patients older than 70 years. A total of 724 participants were randomly assigned to intensive or standard antihypertensive treatment. After a mean follow-up of 4 years, the mean achieved BP was 135.7/76.2 mm Hg in the intensive treatment group and 149.7/82.1 mm Hg in the standard treatment group. The visit-to-visit variability in systolic BP and diastolic BP was lower in the intensive group than that in the standard group. Intensive antihypertensive treatment, compared with the standard treatment, decreased total and cardiovascular mortality by 41.7% and 50.3%, respectively, and reduced fatal/nonfatal stroke by 42.0% and heart failure death by 62.7%. Cox regression analysis indicated that the mean systolic BP (P=.020; 95% confidence interval, 1.006-1.069) and the standard deviation of systolic BP (P=.033; 95% confidence interval, 1.006-1.151) were risk factors for cardiovascular endpoint events. Intensive antihypertensive treatment with achieved 136/76 mm Hg was beneficial for Chinese hypertensive patients older than 70 years. Long-term visit-to-visit variability in systolic BP was positively associated with the incidence of cardiovascular events. © 2013 Wiley Periodicals, Inc.",amlodipine;bisoprolol;enalapril;indapamide;metoprolol;acute heart infarction;aged;antihypertensive therapy;article;blood pressure measurement;blood pressure regulation;blood pressure variability;brain hemorrhage;brain ischemia;cardiovascular mortality;cardiovascular risk;Chinese;diastolic blood pressure;female;femur fracture;follow up;geriatric care;heart failure;human;hypertension;incidence;long term care;major clinical study;male;multiinfarct dementia;percutaneous coronary intervention;priority journal;prospective study;single blind procedure;systolic blood pressure,"Wei, Y.;Jin, Z.;Shen, G.;Zhao, X.;Yang, W.;Zhong, Y.;Wang, J.",2013,,,0,
4741,"Blood pressure, gait speed, and mortality in very old individuals: A population-based cohort study","Objectives: Clinical trials and observational studies have produced contradictory results regarding the association of blood pressure (BP) and mortality in people aged 80years or older. Gait speed at usual pace has been shown to moderate this association in a population of noninstitutionalized people aged 65years or older. The aims of this study were to investigate the association of BP with all-cause mortality in a representative sample of people aged 85years or older and to assess whether gait speed moderates this association. Design, Setting, and Participants: A total of 806 participants in the population-based prospective Umeå 85+/GERDA study aged 85, 90, and 95years or older. Measurements: Gait speed at usual pace was measured over 2.4m. The main outcome was hazard ratios (HRs) for all-cause mortality according to systolic and diastolic BP categories in the total sample and in faster-walking (≥0.5m/s, n=312) and slower-walking (<0.5m/s, n=433) subcohorts; the latter also included habitually nonwalking participants. Comprehensive adjustments were made for sociodemographic and clinical characteristics associated with death. Results: Mean age and baseline systolic and diastolic BP were 89.6±4.6years, 146.8±23.9mm Hg, and 74.8±11.1mm Hg, respectively. Most (n=561 [69%]) participants were women, 315 (39%) were care facility residents, and 566 (70%) were prescribed BP-lowering drugs. Within 5years, 490 (61%) participants died. In the total sample and slower-walking subcohort, systolic BP appeared to be inversely associated with mortality, although not independent of adjustments. Among faster-walking participants, mortality risk after adjustment was more than 2 times higher in those with systolic BP of 140 to 149mm Hg (HR=2.25, 95% confidence interval [CI]=1.03-4.94) and 165mm Hg or higher (HR=2.13, 95% CI=1.01-4.49), compared with systolic BP of 126 to 139mm Hg. Mortality risk was also independently higher in faster-walking participants with diastolic BP higher than 80mm Hg, compared with diastolic BP of 75 to 80mm Hg (HR=1.76, 95% CI=1.07-2.90). Conclusion: The gait speed threshold of 0.5m/s may be clinically useful for the distinction of very old people with and without increased all-cause mortality risk due to elevated systolic and diastolic BP.",dipeptidyl carboxypeptidase inhibitor;diuretic agent;aged;angina pectoris;article;blood pressure;cause of death;cerebrovascular disease;cohort analysis;congestive heart failure;dementia;depression;diastolic blood pressure;female;gait;atrial fibrillation;hip fracture;human;hypertension;major clinical study;male;population research;prescription;prospective study;residential care;survival rate;systolic blood pressure;very elderly;walking speed,"Weidung, B.;Boström, G.;Toots, A.;Nordström, P.;Carlberg, B.;Gustafson, Y.;Littbrand, H.",2015,,,0,
4742,The association between SBP and mortality risk differs with level of cognitive function in very old individuals,"Objective: Cognitive impairment and dementia are highly prevalent in very old populations. Cardiovascular disease is a common cause of death in people with dementia. This study investigated whether the association of blood pressure (BP) with mortality differed with respect to mini-mental state examination (MMSE) score in a representative sample of very old individuals. Methods: The sample consisted of 1115 participants aged 85, 90, and at least 95 years from the Umea85+/GErontological Regional DAtabase cohort study. The main outcome was all-cause mortality within 2 years according to BP and MMSE score, using Cox proportional-hazard regression models adjusted for sociodemographic and clinical characteristics associated with death. Results: Mean age, MMSE score, and SBP and DBP were 89.4±4.6 years, 21.1±7.6, 146.1±23.4mmHg, and 74.1±11.7mmHg, respectively. Within 2 years, 293 (26%) participants died. BP was not associated independently with mortality risk, except among participants with MMSE scores of 0-10 among whom mortality risk was increased in association with SBP at least 165mmHg and 125mmHg or less, compared with 126-139mmHg (adjusted hazard ratio 4.54, 95% confidence interval=1.52-13.60 and hazard ratio 2.23, 95% confidence interval=1.12-4.45, respectively). In age and sex-adjusted analyses, SBP 125mmHg or less was associated with increased mortality risk in participants with MMSE scores at least 18. Conclusion: In people aged at least 85 years, the association of SBP with mortality appears to differ with respect to MMSE score. Very old individuals with very severe cognitive impairment and low or high BP may have increased mortality risk.",age distribution;aged;angina pectoris;article;atrial fibrillation;Barthel index;cardiovascular mortality;cardiovascular risk;cerebrovascular disease;cognition;congestive heart failure;depression;disease association;female;frail elderly;hazard ratio;hip fracture;human;major clinical study;male;Mini Mental State Examination;prevalence;priority journal;pulse pressure;sex ratio;survival rate;systolic blood pressure;very elderly,"Weidung, B.;Littbrand, H.;Nordström, P.;Carlberg, B.;Gustafson, Y.",2016,,,0,
4743,"Immunoglobulin therapy: History, indications, and routes of administration",,immunoglobulin;anaphylaxis;antiinflammatory activity;arthralgia;article;aseptic meningitis;autoimmune disease;backache;bullous skin disease;chill;combined immunodeficiency;cost benefit analysis;coughing;dementia;dizziness;drug blood level;drug cost;drug dose regimen;drug eruption;drug indication;drug tolerability;edema;erythema;fatigue;fever;headache;heart infarction;human;immune deficiency;immunotherapy;injection pain;kidney failure;lung embolism;multiple organ failure;myalgia;nausea and vomiting;pemphigoid;pemphigus vulgaris;pruritus;rigor;serum sickness;side effect;skin disease;sore throat;cerebrovascular accident;sweating;faintness;thorax pain;urticaria;wheezing,"Weiler, C. R.",2004,,,0,
4744,L-2 hydroxyglutaric aciduria as a rare cause of leukencephalopathy in adults,,2 hydroxyglutaric acid;anticonvulsive agent;levo 2 hydroxyglutaric acid;unclassified drug;aciduria;adult;anticonvulsant therapy;arm movement;ataxia;bone atrophy;case report;dementia;disease severity;dysarthria;dysphagia;exon;falling;gene mutation;genetic screening;heart ventricle hypertrophy;homozygosity;human;hyperkinesia;involuntary movement;l 2 hydroxyglutaric aciduria;language disability;leukoencephalopathy;male;motor dysfunction;nerve injury;neuroimaging;neurologic examination;nuclear magnetic resonance imaging;peroneus nerve;protein cerebrospinal fluid level;seizure;short survey;spasticity;tibia;urinalysis;urinary excretion;vertigo;white matter,"Weimar, C.;Schlamann, M.;Krägeloh-Mann, I.;Schöls, L.",2013,,,0,
4745,Ankle-Brachial Index but Neither Intima Media Thickness Nor Coronary Artery Calcification is Associated With Mild Cognitive Impairment,"BACKGROUND: Several studies have reported an association of atherosclerosis with mild cognitive impairment (MCI) and dementia independent of cardiovascular risk factors. OBJECTIVE: To compare the cross-sectional association of the ankle-brachial index (ABI), intima media thickness (IMT), and coronary artery calcification (CAC) with MCI and its subtypes, amnestic MCI (aMCI) and non-amnestic MCI (naMCI) in the population-based Heinz Nixdorf Recall cohort study. METHODS: 4,086 participants performed a validated brief cognitive assessment at the first follow-up examination (2006-2008). MCI was diagnosed according to previously published criteria. Prevalence ratio (PR) regression models adjusted for age, gender, education, cardiovascular risk factors, and APOE genotype were used to compare the association of the ABI, the CAC-Agatston score and the IMT with MCI and its subtypes. RESULTS: We identified 490 participants with MCI (mean age 66.1 +/- 7.8, 46.9 % male, aMCI n = 249, naMCI n = 241) and 1,242 cognitively normal participants. A decreasing ABI (per 0.1) was significantly associated with a higher MCI prevalence in fully adjusted models (PR 1.06; 95% confidence interval (CI) 1.01-1.11), whereas an increasing CAC (log(CAC+1)) or IMT (per 0.1 mm) were not associated after adjustment. A decreasing ABI was also significantly associated with naMCI in fully adjusted models (PR 1.12; CI 1.03-1.21) but not with aMCI. CONCLUSIONS: Our data show that the degree of generalized atherosclerosis as measured by the ABI is associated with MCI and with naMCI in a population-based cohort.",Aged;Amnesia/epidemiology/physiopathology/radiography/ultrasonography;*Ankle Brachial Index;Calcinosis/*physiopathology/radiography;*Carotid Intima-Media Thickness;Cohort Studies;Coronary Artery Disease/*physiopathology/radiography;Cross-Sectional Studies;Female;Follow-Up Studies;Humans;Male;Middle Aged;Mild Cognitive;Impairment/epidemiology/*physiopathology/radiography/*ultrasonography;Prevalence;Psychological Tests;Aging;ankle-brachial index;atherosclerosis;cognition;coronary artery calcification;intima media thickness;mild cognitive impairment;peripheral arterial disease;population-based studies,"Weimar, C.;Winkler, A.;Dlugaj, M.;Lehmann, N.;Hennig, F.;Bauer, M.;Kroger, K.;Kalsch, H.;Mahabadi, A. A.;Dragano, N.;Moebus, S.;Hoffmann, B.;Jockel, K. H.;Erbel, R.",2015,,10.3233/jad-150218,0,
4746,Quality improvement case study: Issues involving elopement of residents,,captopril;digoxin;risperidone;aged;behavior disorder;case study;cause of death;cerebrovascular accident;clinical protocol;cold exposure;dementia;follow up;general practitioner;geriatric care;health care delivery;health care management;health care policy;health care quality;heart infarction;human;malpractice;medical staff;note;nursing home;patient monitoring;resident;training,"Weinberg, A. D.;Weinberg, A. D.",2003,,,0,
4747,Alzheimer's disease under managed care: implications from Medicare utilization and expenditure patterns,"BACKGROUND: Little information is available about the costs, utilization patterns, and the delivery system used by Medicare beneficiaries with chronic illnesses. This information will become increasingly important as more Medicare beneficiaries with chronic illness enroll in managed care plans and delivery systems must be developed to meet their needs. OBJECTIVES: To analyze health care expenditures and utilization patterns for Medicare beneficiaries with dementia of the Alzheimer type (DAT) and compare them with those of all Medicare beneficiaries. DESIGN: A cross-sectional study. SETTING: Practices providing services to Medicare beneficiaries in the U.S. SUBJECTS: Aged Medicare beneficiaries with DAT in fiscal year (FY) 1992. MEASUREMENTS: Medical expenditures and utilization patterns. RESULTS: In FY 1992, per capita Medicare expenditures for 9323 patients with DAT were $6208, or 1.9 times the per capita expenditure for all 1,221,615 beneficiaries in our sample. Inpatient care accounted for 62.7% of expenditures. Internal medicine was the specialty identified with the largest proportion of expenditures, but no single specialty accounted for the majority of care. Payments increased with comorbid conditions such as heart failure, chronic pulmonary diseases, and cerebrovascular disease. CONCLUSION: Current Medicare capitation payments to managed care plans may not meet the higher expected annual costs of care for beneficiaries with DAT. In turn, physicians (or physician groups) who accept capitation for Medicare beneficiaries with DAT should also consider how capitation rates are established by managed care plans and should learn ways to reduce financial risk.",Aged;Alzheimer Disease/*economics/epidemiology;Comorbidity;Cross-Sectional Studies;Female;Geriatric Assessment/statistics & numerical data;Health Expenditures/*statistics & numerical data;Health Services Needs and Demand/economics/statistics & numerical data;Humans;Male;Managed Care Programs/*economics/utilization;Medicare/*economics/utilization;Patient Admission/economics/statistics & numerical data;Patient Care Team/economics/utilization;United States/epidemiology,"Weiner, M.;Powe, N. R.;Weller, W. E.;Shaffer, T. J.;Anderson, G. F.",1998,Jun,,0,
4748,The relationship of cardiovascular risk factors to Alzheimer disease in Choctaw Indians,"OBJECTIVES: To test the hypothesis that cardiovascular risk factors (CRFs) influence predisposition to and the clinical course of Alzheimer disease (AD), the authors compared Choctaw Indians, a group with known high CRF with white persons with AD. In addition to CRF history, the authors investigated the frequency of apolipoprotein E4 (apoE4) genotype andplasma homocysteine (HC) levels. METHOD: The authors compared 39 Choctaw Indians with AD and 39 Choctaw Indians without AD to 39 white persons with AD with all groups similar in age. CRF history included diabetes, hypertension, high cholesterol or hypolipidemic agent use, or myocardial infarction. The authors also compared plasma HC concentration and apoE4 allele frequency. RESULTS: Choctaw persons with AD differed significantly from white persons with AD in history of hypertension, diabetes, and in HC values but not from Indians without AD. There was a significantly lower apoE4 allele frequency in Choctaw Indian AD than white persons with AD, and both AD groups had an affected first degree relative significantly more often than Indian controls. There was no relationship between the number of CRF and age at onset among Indians or whites, whereas HC concentration was associated with significantly earlier age of onset for Choctaw Indians but not for whites. CONCLUSIONS: This small study suggests that in Choctaw Indians modifiable risk factors may play more of a role in disease pathogenesis than in whites and that nonmodifiable risk factors such as apoE4 may play less of a role.","Adult;Age of Onset;Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology/*ethnology/genetics;Apolipoprotein E4/blood/*genetics;Cardiovascular Diseases/*epidemiology/*ethnology/genetics;Case-Control Studies;Diabetes Mellitus/ethnology;European Continental Ancestry Group/genetics;Female;Gene Frequency/genetics;Genetic Predisposition to Disease;Genotype;Homocysteine/*blood;Humans;Hypertension/ethnology;Indians, North American/genetics;Male;Middle Aged;Oklahoma/epidemiology;Risk Factors;Statistics, Nonparametric","Weiner, M. F.;Hynan, L. S.;Rossetti, H.;Womack, K. B.;Rosenberg, R. N.;Gong, Y. H.;Qu, B. X.",2011,May,10.1097/JGP.0b013e3181e89a46,0,
4749,Atherosclerosis risk factors in American Indians with Alzheimer disease: preliminary findings,"Factors predisposing to and associated with atherosclerosis may impact the onset and progression of Alzheimer disease (AD). The high prevalence of atherosclerosis and associated risk factors in American Indians makes them ideal subjects to test this association. We compared frequency of history of hypertension, myocardial infarction, stroke, diabetes, and high cholesterol in 34 American Indians with AD with 34 age-matched American Indian controls, and 34 age-matched whites with probable AD. We also measured waist size, height, and weight, and acquired blood for determination of plasma homocysteine and apolipoprotein E genotype. The 3 groups did not differ significantly in age or sex. History of hypertension and diabetes was significantly more common among American Indian AD patients than Indian controls or whites with AD. The 3 groups did not differ in history of stroke or myocardial infarction. Body mass index was significantly greater in both Indian groups than the white AD group. Plasma homocysteine levels were greater, but not significantly so, in the Indian AD than the Indian control group. Thus, there is preliminary evidence of a modest association between history of hypertension and diabetes and AD in a small sample of American Indians. This suggests that changes in lifestyle factors could influence the expression of AD in American Indians.","Aged;Aged, 80 and over;Alzheimer Disease/*complications/*epidemiology/genetics;Apolipoprotein E4/genetics;Atherosclerosis/*complications/*epidemiology/genetics;Body Mass Index;Diabetes Mellitus/epidemiology;Female;Homocysteine/blood;Humans;Hypertension/epidemiology;Indians, North American;Male;Middle Aged;Prevalence;Risk Factors","Weiner, M. F.;Rosenberg, R. N.;Womack, K. B.;Svetlik, D. A.;Fuller, C.;Fields, J.;Hynan, L. S.",2008,Jul-Sep,10.1097/WAD.0b013e318169d701,0,
4750,Low-dose sip feeding in individuals with malnutrition - Effects on the nutritional parameters,,protein;aged;assessment of humans;body mass;body weight;caloric intake;cerebrovascular accident;dementia;diabetes mellitus;feeding;female;food intake;heart failure;human;hypertension;letter;low dose sip feeding;major clinical study;male;malnutrition;medical education;Mini Nutritional Assessment;muscle mass;nutritional assessment;nutritional parameters;Parkinson disease;skinfold thickness;Subjective Global Assessment;therapy effect;treatment duration;very elderly;weight gain,"Weinrebe, W.;Meister, R.;Stippler, D.;Füsgen, I.",2015,,,0,
4751,Treatment practices of mild cognitive impairment in California Alzheimer's disease centers,"OBJECTIVES: To examine ""real world"" treatments for patients with mild cognitive impairment (MCI). DESIGN: Cross-sectional. SETTING: California Department of Public Health Alzheimer's Disease (AD) Research Centers of California. PARTICIPANTS: Five hundred seventy-eight patients diagnosed with MCI. MEASUREMENTS: All patients underwent comprehensive neurological and neuropsychological evaluations. Logistic regression models were used to determine patient characteristics associated with use of anti-AD medications, statins, antioxidants, and folic acid. RESULTS: One hundred sixty-six patients (28.7%) were taking anti-AD medications; use was associated with greater functional impairment, higher education, MCI subtype, and older age (P<.05 for all). Two hundred fifty-two patients (43.6%) were taking statins; use was associated with diabetes mellitus, hypertension, myocardial infarct, male sex, and MCI subtype (P<.05 for all). One hundred fifteen patients (19.9%) were taking antioxidants; use was associated with higher education and diabetes mellitus and varied according to site (P<.05 for all). Thirty-seven patients (6.4%) were taking folic acid; use was associated with nonwhite race, male sex, and greater functional impairment (P<.05 for all). CONCLUSION: This study suggests that patients with MCI are frequently being treated with ""off label"" cholinesterase inhibitors and memantine, as well as other possible cognition-enhancing drugs. Further investigation of the effect of treatment patterns on the clinical course of MCI is needed. © 2009 The American Geriatrics Society.",alpha tocopherol;antioxidant;ascorbic acid;atorvastatin;cerivastatin;cholinesterase inhibitor;donepezil;fluindostatin;folic acid;galantamine;Ginkgo biloba extract;hydroxymethylglutaryl coenzyme A reductase inhibitor;memantine;mevinolin;pravastatin;rivastigmine;rosuvastatin;simvastatin;ubidecarenone;aged;aging;amnesia;article;controlled study;cross-sectional study;diabetes mellitus;disease severity;educational status;female;heart infarction;human;hypertension;logistic regression analysis;major clinical study;male;mental health center;mild cognitive impairment;neurologic examination;neuropsychological test;off label drug use;race difference;sex ratio;United States,"Weinstein, A. M.;Barton, C.;Ross, L.;Kramer, J. H.;Yaffe, K.",2009,,,0,
4752,Body height and late-life cognition among patients with atherothrombotic disease,"BACKGROUND/AIMS: Height is associated with a lower risk of stroke and dementia. We tested the hypothesis that higher stature is also associated with better cognitive performance, and examined whether these associations were mediated through the extent of vascular disease. METHODS: A subgroup of patients (mean age at baseline 57.9+/-6.6 y; 94.6% males) with coronary heart disease who previously participated in a clinical trial (1990 to 1997) was assessed for cognitive function and measures of atherosclerosis 15+/-3 years later. Cognitive performance was assessed using the Mindstreams computerized battery. Measures of overall battery performance and in specific cognitive domains were obtained, and a score of </=85 (1 SD below the mean) was defined as cognitive impairment overall and in a specific domain. We compared the risk of cognitive impairment and means of cognitive scores by quartiles of height. RESULTS: Among 536 patients, 23.2% were cognitively impaired. After controlling for potential risk factors and correcting for multiple comparisons, odds ratios for impairment in the visual-spatial domain decreased with increasing height quartiles (P for trend =0.018), and odds ratio (95% confidence interval) associated with being at the top versus the bottom quartile was 0.40 (0.18-0.88). An increment of 1 SD of height was associated with a higher global score (beta=1.98; 95% confidence interval, 0.73-4.49; P=0.004) and with higher executive function, attention, and visual-spatial scores. CONCLUSIONS: Among our sample of coronary heart disease patients, a higher stature is associated with a lower risk of impairment in the visual-spatial function and with better cognitive performance.",Aged;Body Height/*physiology;Cognition Disorders/complications/*epidemiology;*Coronary Artery Disease/complications;Female;Humans;Male;Middle Aged;Neuropsychological Tests;Prevalence,"Weinstein, G.;Goldbourt, U.;Tanne, D.",2013,Apr-Jun,10.1097/WAD.0b013e31825ca9ef,0,
4753,Serum total cholesterol: a mortality predictor in elderly hospitalized patients,"BACKGROUND & AIMS: Elevated serum total cholesterol levels are associated with increased risk of cardiovascular mortality among middle aged adults, but not the elderly. We therefore examined whether increased serum total cholesterol reduces mortality risk in the hospitalized elderly. METHODS: Of 1852 patients consecutively admitted to an acute geriatric department from 1/1/99-12/31/00, only 298 (49.6% males, mean age 81.36 +/- 6.3 years) who had measured serum total cholesterol and albumin levels were included in the study and followed until August 31, 2004. Mortality data were extracted from their death certificates. RESULTS: During follow-up of 3.47 +/- 1.87 years, 248 patients died. These patients had significantly lower levels of baseline serum total cholesterol (183.3 +/- 45.4 vs. 200.2 +/- 37.9, p = 0.01) and albumin (3.6 +/- 0.5 vs. 3.8 +/- 0.3 g/l, p = 0.002) than the survivors. In the Cox regression analysis, serum total cholesterol emerged as a significant, independent predictor of mortality in this cohort. Specifically, each 1 mg/dl increase in serum total cholesterol reduced risk of death by 0.4%. This association persisted even after controlling for serum creatinine, age, body mass index, dementia and congestive heart failure. These factors were also significantly, independently associated with mortality. CONCLUSION: In very elderly hospitalized subjects, increased levels of serum total cholesterol and albumin may be associated with reduced mortality risk.","Aged;Aged, 80 and over;Body Mass Index;Cholesterol/*blood;Female;Follow-Up Studies;Heart Failure/blood/*mortality;Hospitalization;Humans;Male;Prospective Studies;Regression Analysis;Risk Factors","Weiss, A.;Beloosesky, Y.;Schmilovitz-Weiss, H.;Grossman, E.;Boaz, M.",2013,Aug,10.1016/j.clnu.2012.11.012,0,
4754,Need for evidence-based recommendations in guidelines with relevance to healthcare provision in older patients in Germany,,aged;asthma;chronic obstructive lung disease;controlled study;dementia;depression;diagnostic procedure;dysuria;elderly care;epidemiological data;evidence based medicine;femur fracture;geriatrics;Germany;heart failure;human;hypertension;incontinence;letter;medical practice;pneumonia;practice guideline;prognosis;risk factor;cerebrovascular accident,"Weiss, B.;Von Renteln-Kruse, W.",2010,,,0,
4755,Aging: Is your patient taking too many pills?,"Before you prescribe another drug, consider whether new symptoms might be caused by the medications the patient is already taking.",alprazolam;digoxin;diphenhydramine;donepezil;furosemide;guaifenesin;insulin glargine;levothyroxine;metformin;metoprolol;naproxen;omeprazole;salbutamol;simvastatin;tolterodine;zolpidem;aged;article;case report;chronic obstructive lung disease;dementia;electronic prescribing;female;heart failure;human;inappropriate prescribing;medical record;medication therapy management;non insulin dependent diabetes mellitus;patient safety;polypharmacy;urge incontinence;urine incontinence,"Weiss, B. D.;Lee, J. K.",2012,,,0,
4756,Head-to-head comparison of fee-for-service and diagnosis related groups in two tertiary referral hospitals in Switzerland: An observational study,"BACKGROUND: Reimbursement for inpatients in Switzerland differed among states until 2012. Some hospitals used diagnosis related groups (DRG) and others used fee-for-service (FFS). We compared length of hospital stay (LOS), patient satisfaction and quality of life between the two systems before a nation-wide implementation of DRG. METHODS: In a prospective, two-centre observational cohort study, we identified all patients with a main diagnosis of either community-acquired pneumonia, exacerbation of chronic pulmonary obstructive disease, acute heart failure or hip fracture from January to June 2011 and performed a systematic questionnaire survey 2-4 months after hospital discharge. RESULTS: Of 1,093 inpatients, 450 were included. Mean age was 71.1 (±SD 19.5) years (48% male). Patients in the FFS hospital were older (mean age 74.8 vs. 65.2 years; p <0.001) and suffered from more co-morbidities. Mean LOS was 9 days and shorter in the all-patient DRG (AP-DRG) hospital (unadjusted mean 8.2 vs. 9.5 days, p = 0.04). After multivariate adjustment, no significant difference in LOS was found (p = 0.24). More patients from the FFS hospital were re-hospitalised for any reason (35% vs. 17.5%; p = 0.01), re-admitted to acute-care institutions (11.7% vs. 5.2%; p = 0.014), not satisfied with the discharge process (15.3% vs. 9.7%; p = 0.02), showed problems with selfcare (93.8% vs. 88%; p = 0.03) and usual activities (79.3% vs. 76%; p = 0.02). DISCUSSION: This study suggested that the AP-DRG hospital showed higher patient satisfaction regarding discharge, lower re-hospitalisation rates and shorter LOS partly explained by a lower burden of co-morbidities and disease severity. This study needs validation in a larger cohort of patients and at multiple time points.",acute heart failure;adult;aged;article;chronic kidney failure;chronic obstructive lung disease;community acquired pneumonia;comorbidity;congestive heart failure;dementia;diabetes mellitus;diagnosis related group;disease exacerbation;female;hip fracture;hip prosthesis;hospital discharge;hospital readmission;human;hypertension;ischemic heart disease;length of stay;lower respiratory tract infection;major clinical study;male;medical fee;observational study;patient satisfaction;prospective study;quality of life;Switzerland,"Weissenberger, N.;Thommen, D.;Schuetz, P.;Mueller, B.;Reemts, C.;Holler, T.;Schifferli, J. A.;Gerber, M.;Hug, B. L.",2013,,,0,
4757,Geographic variation in diagnosis frequency and risk of death among Medicare beneficiaries,"CONTEXT: Because diagnosis is typically thought of as purely a patient attribute, it is considered a critical factor in risk-adjustment policies designed to reward efficient and high-quality care. OBJECTIVE: To determine the association between frequency of diagnoses for chronic conditions in geographic areas and case-fatality rate among Medicare beneficiaries. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of the mean number of 9 serious chronic conditions (cancer, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, peripheral artery disease, severe liver disease, diabetes with end-organ disease, chronic renal failure, and dementia) diagnosed in 306 hospital referral regions (HRRs) in the United States; HRRs were divided into quintiles of diagnosis frequency. Participants were 5,153,877 fee-for-service Medicare beneficiaries in 2007. MAIN OUTCOME MEASURES: Age/sex/race-adjusted case-fatality rates. RESULTS: Diagnosis frequency ranged across HRRs from 0.58 chronic conditions in Grand Junction, Colorado, to 1.23 in Miami, Florida (mean, 0.90 [95% confidence interval {CI}, 0.89-0.91]; median, 0.87 [interquartile range, 0.80-0.96]). The number of conditions diagnosed was related to risk of death: among patients diagnosed with 0, 1, 2, and 3 conditions the case-fatality rate was 16, 45, 93, and 154 per 1000, respectively. As regional diagnosis frequency increased, however, the case fatality associated with a chronic condition became progressively less. Among patients diagnosed with 1 condition, the case-fatality rate decreased in a stepwise fashion across quintiles of diagnosis frequency, from 51 per 1000 in the lowest quintile to 38 per 1000 in the highest quintile (relative rate, 0.74 [95% CI, 0.72-0.76]). For patients diagnosed with 3 conditions, the corresponding case-fatality rates were 168 and 137 per 1000 (relative rate, 0.81 [95% CI, 0.79-0.84]). CONCLUSION: Among fee-for-service Medicare beneficiaries, there is an inverse relationship between the regional frequency of diagnoses and the case-fatality rate for chronic conditions.","Aged;Aged, 80 and over;Chronic Disease/*mortality;Cross-Sectional Studies;*Diagnosis;Fee-for-Service Plans/statistics & numerical data;Female;Geography;Humans;Male;Medicare/*statistics & numerical data;Mortality/*trends;Outcome Assessment (Health Care);Quality of Health Care;Risk;United States/epidemiology","Welch, H. G.;Sharp, S. M.;Gottlieb, D. J.;Skinner, J. S.;Wennberg, J. E.",2011,Mar 16,10.1001/jama.2011.307,0,
4758,Thalamic infarct presenting as catastrophic life-threatening event in an older adult,"An 84 year old woman with history of moderate Alzheimer's disease, depression, and an anxiety disorder presented to our emergency room at Victoria Hospital, London, Ontario in an 'unresponsive' state. The patient was akinetic with mutism, and clonic perseveration induced in the upper limbs was evident while she was examined. Heart attack, massive stroke, or intracranial bleed were ruled out, and an electroencephalogram showed no epileptiform activity. Despite a normal CT, a magnetic resonance scan was ordered and showed bilateral acute paramedian thalamogeniculate infarction arising from occlusion of the artery of Percheron. Bilateral thalamic infarcts can cause sudden onset of akinetic mutism with clonic perseveration, which may be confused with coma and seizures due to life threatening conditions such as a massive stroke. Thorough clinical assessment and early use of MRI scanning will assist physicians with a more accurate diagnosis of older adults with this kind of presentation. ©2011, Editrice Kurtis.",aged;akinesia;Alzheimer disease;anxiety disorder;article;brain hemorrhage;brain infarction;case report;clonus;coma;computer assisted tomography;depression;diagnostic accuracy;disease severity;electroencephalogram;emergency ward;female;human;mutism;nuclear magnetic resonance imaging;cerebrovascular accident;thalamus,"Wells, M.;Jacques, R.;Odasso, M. M.",2011,,,0,
4759,Impact of tooth loss on walking speed decline over time in older adults: a population-based cohort study,"Background: Tooth loss has been linked to poor health such as chronic diseases and mobility limitations. Prospective evidence on the association between tooth loss and walking speed decline is however lacking. Aims: To examine the impact of tooth loss on walking speed over time and explore whether inflammation may account for this association. Methods: This study included 2695 persons aged 60 years and older, who were free from severe mobility limitation at baseline. Information on dental status was assessed through self-report during the nurse interview at baseline. Walking speed baseline and at 3- and 6-year follow-ups was assessed when participants walked at their usual pace. Covariates included age, sex, education, lifestyle-related factors, and chronic diseases. Blood samples were taken, and C-reactive protein (CRP) was tested. Results: At baseline, 389 (13.1 %) participants had partial tooth loss and 204 (6.9 %) had complete tooth loss. Mixed-effects models showed that tooth loss was associated with a greater decline in walking speed over time after adjustment for lifestyle-related factors and chronic diseases (p = 0.001 for interaction between time and tooth loss on walking speed decline); however, when further adjusting for inflammation (CRP), the association was attenuated and no longer significant. Conclusion: Tooth loss was associated with an accelerated decline in walking speed in older adults. Inflammation may play a role in the association between tooth loss and walking speed decline.",C reactive protein;age;aged;alcohol consumption;arthritis;article;atrial fibrillation;blood sampling;body mass;cerebrovascular accident;dementia;diabetes mellitus;disease association;educational status;exercise;female;follow up;heart failure;human;hypertension;inflammation;ischemic heart disease;lifestyle;major clinical study;male;malignant neoplasm;nutritional status;osteoarthritis;periodontal disease;physical activity;self report;sensitivity analysis;sex;smoking;very elderly;walking difficulty;walking speed,"Welmer, A. K.;Rizzuto, D.;Parker, M. G.;Xu, W.",2017,,10.1007/s40520-016-0630-6,0,
4760,Comorbidities and their impact on transitions of care,"The existence of one or more comorbidities is common among older adults. These comorbidities can complicate both the treatment of an acute condition and the transitions of care. Examples of such comorbidities include altered mental status, vision and hearing impairment, heart disease, diabetes, Parkinson's disease, arthritis, lung disease, cancer, and stroke. Comorbidities greatly impact the need for home and community-based services or to be appropriate for a range of housing and care options. Other factors that influence decision making around transitions of care include differences in cultural values from those of the dominant American culture such as autonomy, independence, and expectations of family caregiving. Well-coordinated interdisciplinary teams can improve the outcomes of transitions of care for persons with multiple comorbidities and can reduce unnecessary readmissions to the hospital. Case examples are provided to illustrate the increasing complexity of transitions of care for older adults with multiple serious comorbidities. © 2011 Springer Publishing Company.",article;assisted living facility;caregiver;comorbidity;congestive heart failure;coronary artery disease;cultural anthropology;cultural factor;daily life activity;decision making;delirium;dementia;depression;disease exacerbation;disease severity;elderly care;falling;family;follow up;health care delivery;health care facility;health care personnel;health service;hearing impairment;heart infarction;hip fracture;hospice care;hospital discharge;hospital readmission;human;insurance;language;late life depression;living will;nursing home;osteoarthritis;Parkinson disease;patient autonomy;patient safety;postoperative cognitive dysfunction;postoperative period;prevalence;reimbursement;sensory dysfunction;social welfare;telemedicine,"Wen, A. B.;Blanchette, P. L.",2012,,,0,
4761,"Significance of the evaluation of characterization of mitochondrial transfer RNA genes polymorphic frequency and variations on the pathogenic risk of diabetes mellitus, dementia and cardiomyopathy in 646 human sequences","Aim: To explore the polymorphic frequency and variation types of mitochondrial tRNA gene in human mitochondrial sequences. Methods: The 646 sequences of human mtDNA tRNA genes from Gen-Bank were collected and compared with the revised Cambridge reference sequences. Results: Totally 513 variations in 107 positions of 22 tRNA genes had been found, the mean variation density was 0.052 variations in 100 bases per person. The dominant type of variation was transition (94.17%), followed by transversion (2.53%). The most common transition types were A→ G and T→C. The number of tRNALeu was the most at np15 888 - 15 953, and polymorphic variations were found at 15 positions of 66 nucleotides, variations rate was about 22.72% and significantly higher than that of other 21 tRNA genes. Conclusion: High frequency of polymorphism can be observed in the mitochondrial tRNA genes. The evaluation of variation frequency in these genes provides a good reference for other studies aiming at the relationship of mitochondrial DNA polymorphism with pathogenetic risk of diseases related to diabetes mellitus, dementia and cardiomyopathy.",adenine;cytosine;guanine;leucine transfer RNA;mitochondrial DNA;mitochondrial RNA;nucleotide;thymine;transfer RNA;article;cardiomyopathy;controlled study;dementia;diabetes mellitus;DNA polymorphism;GenBank;gene frequency;human;nucleic acid base substitution;pathogenesis;RNA sequence,"Wen, Y.;Tan, D. J.;Liu, L. L.;Wang, S. W.;Xu, B.;Wong, L. C.",2004,,,0,
4762,Recognition of acute myocardial infarction in the deteriorated elderly psychotic patient,,"*Acute Disease;Aged;*Cardiovascular Diseases;*Dementia;Humans;*Myocardial Infarction;*Psychotic Disorders;*Myocardial infarct;*Psychoses, senile","Wendkos, M. H.",1963,Jun,,0,
4763,Preventing coronary heart disease in women: What you-and your patients-can do,,acetylsalicylic acid;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;fibrinolytic agent;hormone;Alzheimer disease;blood clot lysis;breast cancer;smoking;coronary artery bypass graft;coronary risk;diabetes mellitus;diagnostic test;emergency ward;heart infarction;heart protection;hormone substitution;human;ischemic heart disease;menopause;mortality;note;osteoporosis;percutaneous transluminal angioplasty;priority journal;risk factor;aspirin,"Wenger, N. K.",2002,,,0,
4764,HT and CVD prevention from myth to reality,Menopausal hormone therapy has no evidence-based role for the primary or secondary prevention of coronary heart disease. Coronary prevention should involve lifestyle and pharmacologic interventions documented as beneficial in randomized clinical trials and promulgated in national guidelines. © 2003 American Society for Reproductive Medicine Published by Elsevier Inc.,conjugated estrogen plus medroxyprogesterone acetate;estradiol;estrogen;hydroxymethylglutaryl coenzyme A reductase inhibitor;placebo;vitamin;article;behavior modification;breast cancer;cancer risk;cardiovascular disease;cardiovascular risk;clinical trial;coronary artery disease;dementia;drug approval;drug labeling;evidence based medicine;female;food and drug administration;hormonal therapy;human;lifestyle;medical documentation;meta analysis;patient care;postmenopause osteoporosis;practice guideline;primary prevention;priority journal;quality of life;risk benefit analysis;risk reduction;secondary prevention;smoking cessation;cerebrovascular accident;survival rate;treatment outcome;United States,"Wenger, N. K.",2003,,,0,
4765,Menopausal hormone therapy for cardiovascular protection-unfulfilled expectations,"Despite biologically plausible mechanisms of benefit and data from observational studies suggesting cardioprotection from menopausal hormone therapy, the results of randomized clinical trials in both healthy women and women with established coronary heart disease failed to show benefit and indeed imparted some harm. In 2009, menopausal hormone therapy is not indicated for the primary prevention of coronary heart disease or of cardiovascular disease. Prevention of cardiovascular disease in women should be addressed by the aggressive identification and modification of established cardiovascular risk factors. Much remains unknown about the mechanisms of menopausal hormone therapy action and the issue of whether there is a therapeutic window of opportunity for its use. © 2009 Springer Science+Business Media, LLC.",conjugated estrogen;estrogen;homocysteine;medroxyprogesterone acetate;placebo;article;atherosclerosis;biliary tract surgery;blood clotting;breast cancer;cardiovascular risk;clinical trial;coronary artery disease;dementia;fibrinolysis;heart infarction;heart protection;hormonal therapy;human;ischemic heart disease;menopause;priority journal;side effect;cerebrovascular accident;treatment indication;vascular smooth muscle;venous thromboembolism,"Wenger, N. K.",2009,,,0,
4766,"Epidemiology of do-not-resuscitate orders. Disparity by age, diagnosis, gender, race, and functional impairment","BACKGROUND: The relationship of do-not-resuscitate (DNR) orders to patient and hospital characteristics has not been well characterized. METHODS: This observational study of a nationally representative sample of 14,008 Medicare patients hospitalized with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture evaluated the relationship of DNR orders to patient sickness at admission, functional impairment, age, disease, race, gender, preadmission residence, insurance status, and hospital characteristics. RESULTS: Of the 14,008 patients, DNR orders were assigned to 11.6%. Patients with greater sickness at admission and functional impairment received more DNR orders (P < .001) but even among patients in the sickest quartile (with a 65% chance of death within 180 days), only 31% received DNR orders. The DNR orders were assigned more often to older patients after adjustment for sickness at admission and functional impairment (P < .001), and DNR order rates differed by diagnosis (P < .001). After adjustment for patient and hospital characteristics, DNR orders were assigned more often to women and patients with dementia or incontinence and were assigned less often to black patients, patients with Medicaid insurance, and patients in rural hospitals. CONCLUSIONS: Do-not-resuscitate orders are assigned more often to sicker patients but may be underused even among the most sick. Sickness at admission and functional impairment do not explain the increase in DNR orders with age or the disparity across diagnosis. Further evaluation is needed into whether variation in DNR order rates with age, diagnosis, race, gender, insurance status, and rural location represents differences in patient preferences or care compromising patient autonomy.","Age Distribution;Aged;Aged, 80 and over;Cerebrovascular Disorders/epidemiology;Epidemiology/trends;Female;Heart Failure/epidemiology;Hip Fractures/epidemiology;Hospitals;Humans;Insurance, Health;Male;Medicare;Myocardial Infarction/epidemiology;Patient Selection;Pneumonia/epidemiology;Residence Characteristics;*Resuscitation Orders;Severity of Illness Index;Sex Distribution;United States;Withholding Treatment;Death and Euthanasia;Empirical Approach;Medicaid","Wenger, N. S.;Pearson, M. L.;Desmond, K. A.;Harrison, E. R.;Rubenstein, L. V.;Rogers, W. H.;Kahn, K. L.",1995,Oct 23,,0,
4767,Diabetes and cognitive outcomes in a nationally representative sample: The National Health and Aging Trends Study,"Background: The prevalence of both type II diabetes mellitus (DM) and cognitive impairment is high and increasing in older adults. We examined the extent to which DM diagnosis was associated with poorer cognitive performance and dementia diagnosis in a population-based cohort of US older adults. Methods: We studied 7,606 participants in the National Health and Aging Trends Study, a nationally representative cohort of Medicare beneficiaries aged 65 years and older. DM and dementia diagnosis were based on self-report from participants or proxy respondents, and participants completed a word-list memory test, the Clock Drawing Test, and gave a subjective assessment of their own memory. Results: In unadjusted analyses, self-reported DM diagnosis was associated with poorer immediate and delayed word recall, worse performance on the Clock Drawing Test, and poorer self-rated memory. After adjusting for demographic characteristics, body mass index, depression and anxiety symptoms, and medical conditions, DM was associated with poorer immediate and delayed word recall and poorer self-rated memory, but not with the Clock Drawing Test performance or self-reported dementia diagnosis. After excluding participants with a history of stroke, DM diagnosis was associated with poorer immediate and delayed word recall and the Clock Drawing Test performance, and poorer self-rated memory, but not with self-reported dementia diagnosis. Conclusions: In this recent representative sample of older Medicare enrollees, self-reported DM was associated with poorer cognitive test performance. Findings provide further support for DM as a potential risk factor for poor cognitive outcomes. Studies are needed that investigate whether DM treatment prevents cognitive decline.",aged;anxiety;arthritis;article;body mass;Caucasian;cerebrovascular accident;clock drawing test;cognition;cognitive defect;cohort analysis;controlled study;dementia;depression;depth perception;drawing;education;female;Framingham risk score;generalized anxiety disorder;hearing impairment;heart disease;heart infarction;human;hypertension;Likert scale;lung disease;major clinical study;male;medicare;non insulin dependent diabetes mellitus;osteoporosis;Patient Health Questionnaire;risk factor;self report;speech disorder;task performance;United States;very elderly;word list recall;word recognition,"Wennberg, A. M. V.;Gottesman, R. F.;Kaufmann, C. N.;Albert, M. S.;Chen-Edinboro, L. P.;Rebok, G. W.;Kasper, J. D.;Spira, A. P.",2014,,,0,
4768,Hormonal treatment in menopausal women,,alpha tocopherol;clonidine;conjugated estrogen plus medroxyprogesterone acetate;estriol;estrogen;gestagen;isoflavone;methyldopa;phytoestrogen;Alzheimer disease;breast cancer;cancer risk;climacterium;clinical trial;cognition;colorectal carcinoma;depression;dyspareunia;dysuria;endometrium carcinoma;estrogen deficiency;fracture;heart infarction;hormonal therapy;human;ischemic heart disease;libido;menopause;meta analysis;nonhodgkin lymphoma;osteoporosis;ovary carcinoma;short survey;cerebrovascular accident;thromboembolism;vagina atrophy,"Wepner, U.",2003,,,0,
4769,Occupational and environmental health in the aluminum industry: Key points for health practitioners,,aluminum;aluminum oxide;polycyclic aromatic hydrocarbon;acute heart infarction;alternating current;aluminum factory;Alzheimer disease;article;asthma;cancer incidence;cancer mortality;cancer risk;chemoprophylaxis;coughing;dengue;dialysate;dialysis encephalopathy;dust exposure;electricity;electrochemical analysis;electrolysis;electromagnetic field;emporiatrics;environmental health;ergonomics;fatigue;follow up;health hazard;health practitioner;hearing;hearing impairment;heart rate;heart rhythm;heat;heat injury;heat stress;human;humidity;inert anode;longitudinal study;lung fibrosis;lung function;magnetic field;malaria;malignant neoplastic disease;device material;melanoma;mining;mortality;neurofibrillary tangle;noise;noise injury;occupational disease;occupational exposure;occupational hazard;occupational health;periodic medical examination;protective clothing;psychological aspect;public health;radiation exposure;reduction;respiratory tract disease;rhinitis;risk assessment;risk factor;risk management;risk reduction;smelter;social psychology;stress;sun exposure;tinnitus;ultraviolet radiation;vibration;wheezing,"Wesdock, J. C.;Arnold, I. M. F.",2014,,,0,
4770,"Pneumonia severity, comorbidity and 1-year mortality in predominantly older adults with community-acquired pneumonia: A cohort study","Background: In patients with community-acquired pneumonia (CAP), short-term mortality is largely dependent on pneumonia severity, whereas long-term mortality is considered to depend on comorbidity. However, evidence indicates that severity scores used to assist management decisions at disease onset may also be associated with long-term mortality. Therefore, the objective of the study was to investigate the performance of the pneumonia severity scores CURB-65 and CRB-65 compared to the Charlson Comorbidity Index (CCI) for predicting 1-year mortality in adults discharged from hospital after inpatient treatment for CAP. Methods: From a single centre, all cases of patients with CAP treated consecutively as inpatients between 2005 and 2009 and surviving at least 30 days after admission were analysed. The patients' vital status was obtained from the relevant local register office. CURB-65, CRB-65 and CCI were compared using receiver operating characteristics (ROC) analysis. Results: Of 498 cases analysed, 106 (21.3%) patients died within 1 year. In univariate analysis, age ≥ 65 years, nursing home residency, hemiplegia, dementia and congestive heart failure were significantly associated with mortality. CURB-65, CRB-65 and CCI were also all associated with mortality at 1 year. ROC analysis yielded a weak, yet comparable test performance for CURB-65 (AUC and corresponding 95% confidence interval [CI] for risk categories: 0.652 [0.598-0.706]) and CCI (AUC [CI]: 0.631 [0.575-0.688]; for CRB-65 0.621 [0.565-0.677] and 0.590 [0.533-0.646]). Conclusions: Neither CURB-65 or CRB-65 nor CCI allow excellent discrimination in terms of predicting longer term mortality. However, CURB-65 is significantly associated with long-term mortality and performed equally to the CCI in this respect. This fact may help to identify CAP survivors at higher risk after discharge from hospital.",adult;aged;aging;article;Charlson Comorbidity Index;cohort analysis;community acquired pneumonia;comorbidity;congestive heart failure;CRB 65;CURB 65;dementia;disease severity;female;hemiplegia;human;major clinical study;male;mortality;nursing home;receiver operating characteristic;risk factor;scoring system;very elderly,"Wesemann, T.;Nüllmann, H.;Nüllmann, H.;Nüllmann, H.;Pientka, L.;Thiem, U.",2015,,,0,
4771,"Mitochondrial encephalomyopathy: Clinical pattern, CT-morphology, neuropathology","Basing on the example of two cases, the clinical and morphological variability of mitochondrial encephalomyopathies is demonstrated. Both patients were of short build, and the clinical signs and symptoms were dementia, ataxia, epilepsy and hardness of hearing, whereas signs of myopathy were very mild or absent. Computed tomography showed infratentorial pronounced atrophy of the brain and basal ganglia calcifications, in one case additionally ischemic infarctions, as can be seen in 'mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes syndrome' (MELAS). A CT follow-up over 8 years with a progression of the abnormalities parallel to the progressive clinical course is demonstrated. Besides typical 'ragged red fibres-myopathy' different abnormalities of mitochondria were seen by the electron microscope. One of the patients died; he had exceptional pathological anatomical findings with mitochondrial cardiomyopathy, angioma and necrotising encephalopathy of Leigh's type. The two case reports show that in patients with such multisystemic neurological signs and CT-findings mitochondrial encephalomyopathy should be considered and a muscle biopsy should be performed.",adult;autopsy;brain disease;case report;clinical feature;computer analysis;computer assisted tomography;diagnosis;electroencephalography;evoked response;fatality;histology;human;hyperlactatemia;male;mitochondrial myopathy;muscle biopsy;prognosis;short survey;cerebrovascular accident;ultrastructure,"Wessel, K.;Poremba, M.;Pfeiffer, J.;Roggendorf, W.",1988,,,0,
4772,"Selenium content of tissues in Finnish infants and adults with various diseases, and studies on the effects of selenium supplementation in neuronal ceroid lipofuscinosis patients","A low blood selenium level has previously been observed in healthy inhabitants of Finland (Westermarck et al. 1977). In this study even lower blood selenium values were observed in patients with acrodermatitis enteropathica, dystrophia musculorum progressiva (Duchenne), infantile and juvenile type of neuronal ceroid lipofuscinosis (NCL), severe mental retardation caused by various factors, and myocardial infarction. The selenium content of the brain, heart, kidney and liver in patients of different ages was also determined. The highest selenium level was found in the kidney. The mean liver selenium concentrations in stillborn, premature and full-term neonates were 1.11 ± 0.23 (8), 1.21 ± 0.17 (12) and 0.93 ± 0.16 μg/g dry weight (12) respectively (the number of subjects in parentheses). The selenium values are considerably higher than those in infants of from one to nine months of age and adults, whose liver selenium values were 0.58 ± 0.21 (8) and 0.67 ± 0.08 μg/g dry weight (8) respectively. The vitamin E levels of serum in patients with NCL, as well as in subjects with severe mental retardation (controls), were low compared with values in healthy normal subjects. Sodium selenite supplementation in patients with NCL produced at least a transitory improvement without causing any toxic effects during one year of administration.",alpha tocopherol;myoselen;selenium;sodium selenite;unclassified drug;age;child;drug distribution;Finland;major clinical study;mental deficiency;nerve cell;neuronal ceroid lipofuscinosis,"Westermarck, T.",1977,,,0,
4773,Clinical trial with the cholinergic drug RS 86 in Alzheimer's disease (AD) and senile dementia of the Alzheimer type (SDAT),"The muscarinic agonist RS 86 was administered to patients with Alzheimer's disease (AD) and senile dementia of the Alzheimer type (SDAT) in a series of controlled clinical trials. Daily doses were up to 3.0 mg orally for a maximum duration of 18 weeks. RS 86 produced typical peripheral cholinergic effects, but appeared to be better tolerated than similar drugs, such as physostigmine and arecoline. Positive clinical changes with regard to cognitive functions, mood, and social behavior were seen in a minority of AD and SDAT patients. Psychometric tests suggested improvement of functions entailing a speed component. RS 86 is a suitable drug for further clinical experiments in AD and SDAT.","2 ethyl 8 methyl 2,8 diazaspiro[4.5]decane 1,3 dione;cholinergic receptor stimulating agent;new drug;placebo;adverse drug reaction;Alzheimer disease;angina pectoris;cardiotoxicity;central nervous system;clinical article;clinical trial;controlled study;dementia;diagnosis;drug efficacy;drug therapy;gastrointestinal toxicity;heart;heart arrest;human;intoxication;malaise;memory;mouth;nausea;nervous system;neurotoxicity;oral drug administration;priority journal;psychological aspect;psychometry;psychosis;salivation;sweating;therapy;vertigo;rs 86","Wettstein, A.;Spiegel, R.",1984,,,0,
4774,A controlled study of 2 doses of idebenone in the treatment of Alzheimer's disease,"Two doses of idebenone were studied in a prospective, randomized, double-blind, placebo-controlled multicentre study in patients suffering from dementia of the Alzheimer type (DAT) of mild to moderate degree. Diagnosis was based on DSM-III-R (primary degenerative dementia) and NINCDSADRDA criteria (probable Alzheimer's disease). A total of 300 patients were randomized to either placebo, idebenone 30 mg tid, or 90 mg tid. (n = 100, each) and treated for 6 months. The primary outcome measure was the total score of the Alzheimer's Disease Assessment Scale (ADAS-Total) at month 6. Secondary outcome measures were the ADAS cognitive (ADAS-Cog) and noncognitive scores (ADAS-Noncog), the clinical global response (CGI-Improvement), the MMSE, the Digit Symbol Substitution test (DSS) and several scales for the assessment of daily activities (the self- and observer-rating scales NAA and NAB of the Nuremberg Age Inventory NAI and Greene's Assessment). Safety parameters were adverse events, vital signs, ECG and clinical laboratory parameters. Clinical and psychometric evaluations were performed at baseline, and after 1, 3 and 6 months of treatment. After month 6 idebenone 90 mg tid. showed statistically significant improvement in the primary efficacy variable ADAS-Total and in ADAS-Cog. An analysis of therapy responders performed for 3 outcome measures (CGI-global improvement, ADAS-Cog, ADAS-Noncog), selected to represent different domains of assessment, revealed significant superiority of idebenone 90 mg tid. with respect to placebo in each of the 3 variables and in the concordance of responses across the 3 measures. Exploratory results for a subgroup of patients (ADAS-Total ≤ 20) showed dose-related superiority of idebenone additionally on ADAS-Noncog and the CGI-Improvement scale. Safety results were inconspicuous for all assessments. The study results demonstrate the efficacy and safety of idebenone in the treatment of DAT patients.",idebenone;nootropic agent;adult;aged;Alzheimer disease;angina pectoris;article;bronchitis;clinical trial;controlled clinical trial;controlled study;daily life activity;disease severity;double blind procedure;drug efficacy;drug safety;electrocardiography;female;headache;heartburn;human;major clinical study;male;multicenter study;nausea;oral drug administration;priority journal;psychometry;randomized controlled trial;rating scale;side effect;time;treatment outcome;vertigo;cv 2619,"Weyer, G.;Babej-Dölle, R. M.;Hadler, D.;Hofmann, S.;Herrmann, W. M.",1997,,,0,
4775,Histopathology: A canvas and landscape of disease in drug and diagnostic development,"The aims of diagnostic and therapeutic development are to accurately diagnose and cure disease, respectively. For the past century and a half, histopathology—the microscopic examination of cells and tissues—has been considered a “gold standard” for the diagnosis of many diseases. As an introduction to this volume on molecular histopathology and tissue biomarkers in drug and diagnostic development, I explore the relationship between histopathology and the nature of disease itself. A lack of agreement on the meaning of “disease” has led to widespread and indiscriminate use of the term. Here, I propose that the term “disease” be reserved for conditions where there exists some knowledge of alterations in cells or their products that participate in cause-effect relationships in lesional (diseased) tissue. This is a definition that simultaneously lends legitimacy to the term’s use while enabling revision and testing of hypotheses based on rapidly emerging scientific knowledge. With this perspective, histopathology, as a preferred means to visualize and depict the cellular events that constitute disease as it impacts tissue structure and function, will remain essential to develop new diagnostic tests and targeted therapies for the foreseeable future.",cystic fibrosis transmembrane conductance regulator;interleukin 17;messenger RNA;parathyroid hormone;protein Patched 1;sonic hedgehog protein;tumor necrosis factor alpha;Wnt protein;acquired immune deficiency syndrome;addiction;Alzheimer disease;article;autopsy;basal cell nevus syndrome;cardiomyopathy;CFTR gene;channelopathy;chronic myeloid leukemia;companion diagnostic test;criminal behavior;cystic fibrosis;diabetes mellitus;Diagnostic and Statistical Manual of Mental Disorders;disease course;enzyme activity;enzyme linked immunosorbent assay;enzyme synthesis;functional disease;gastrointestinal stromal tumor;gene mutation;gene sequence;genetic association;genetic heterogeneity;gold standard;hemoglobinopathy;histopathology;human;Human immunodeficiency virus infection;hyperlipoproteinemia;hypertension;ICD-9;laboratory developed test;laboratory test;large cell lymphoma;male infertility;microscopy;nucleic acid hybridization;obesity;pathogenesis;pathologist;personality disorder;physician;polymerase chain reaction;predictive value;priority journal;PTCH1 gene;risk factor;secondary hyperparathyroidism;social status;systemic lupus erythematosus;xanthoma,"Wharton, K. A.",2015,,,0,
4776,Assessing Health Status Differences Between Veterans Affairs Home-Based Primary Care and State Medicaid Waiver Program Clients,"Objectives: Comprehensive health care for older adults is complex, involving multiple comorbidities and functional impairments of varying degrees and numbers. In response to this complexity and associated barriers to care, home-based care models have become prevalent. The home-based primary care (HBPC) model, based at a Michigan Department of Veterans Affairs Medical Center, and the Michigan Waiver Program (MWP) that includes home-based care are 2 of these. Although both models are formatted to address barriers to effective and efficient health care, there are differences in disease prevalence and functional performance between groups. The objective of this study was to explore the differences between the 2 groups, to shed some light on potential trends that could suggest areas for resource allocation by service providers. Design: Using a retrospective analysis of data collected using the interRAI-home care, we examined a cross-sectional representation of clients enrolled in HBPC and MWP in 2008. Participants: The HBPC sample had 89 participants. The MWP database contained 9324 participants from across the State of Michigan and were weighted to be comparable to the HBPC population in sex and age, and to simulate the HBPC sample size. Results: Veterans were more independent in basic activities of daily living performance, but there was no difference in the rate of reported falls between the 2 groups. Veterans had more pain and a higher prevalence of coronary artery disease (z = 7.0; P < .001), Chronic obstructive pulmonary disease (z = 3.9; P < .001), and cancer (z = 8.5; P < .001). There was no statistically significant difference between the 2 groups in terms of the prevalence of geriatric syndromes. Scores on subscales of the interRAI-home care indicated a lower risk of serious health decline and adverse outcomes for MWP compared with HBPC clients (1.4 ± 1.1 vs 0.9 ± 0.1; z = 2.5; P = .012). Veterans receiving home-based care through the Veterans Affairs Medical Center were more burdened by chronic disease and had higher degrees of loneliness than their MWP counterparts- factors, which may increase their likelihood of hospitalizations. MWP participants had more cases of cerebrovascular accident (z = 2.1; P = .039), as well as a higher rate of diagnosed dementias (z = 2.7; P = .006). Though not different, stress among caregivers in both groups, and depression in clients of both groups were substantial. Overall, sleep, pain, coronary artery disease, chronic obstructive pulmonary disease, and cancer are significant issues for Veteran clients, and clients treated through MWP home-care in Michigan have higher than national average rates of dementias, diabetes, hypertension, and coronary artery disease. Conclusion: With expanded home care models of service on the horizon, comparisons such as the one presented here could identify more efficient and effective service, with potential for improved client health outcomes. © 2013.",aged;article;caregiver;cerebrovascular accident;chronic obstructive lung disease;coronary artery disease;daily life activity;dementia;depression;diabetes mellitus;falling;female;functional status;geriatric disorder;government;health status;home based primary care;home care;hospitalization;human;hypertension;loneliness;major clinical study;male;medicaid;michigan waiver program;pain;prevalence;primary medical care;stress;veterans health,"Wharton, T. C.;Nnodim, J.;Hogikyan, R.;Mody, L.;James, M.;Montagnini, M.;Fries, B. E.",2013,,,0,
4777,"Chronic obstructive pulmonary disease, hospital visits, and comorbidities: National Survey of Residential Care Facilities, 2010","OBJECTIVE: To characterize the prevalence of chronic obstructive pulmonary disease (COPD) among residential care facility (RCF) residents in the United States, and to compare patterns of hospital visits and comorbidities with residents without COPD. METHOD: Resident data from the 2010 National Survey of Residential Care Facilities were analyzed. Medical history and information on past-year hospital visits for 8,089 adult residents were obtained from interviews with RCF staff. RESULTS: COPD prevalence was 12.4%. Compared with residents without COPD, emergency department visits or overnight hospital stays in the previous year were more prevalent (p < .05) among residents with COPD. Less than 3% of residents with COPD had no comorbidities. Arthritis, depression, congestive heart failure (CHF), diabetes, coronary heart disease, and asthma were more common (p < .05) among residents with COPD than those without COPD, but Alzheimer's disease was less common. DISCUSSION: COPD is associated with more emergency department visits, hospital stays, and comorbidities among RCF residents.","Adolescent;Adult;Aged;Aged, 80 and over;Assisted Living Facilities/*statistics & numerical data;Case-Control Studies;Comorbidity;Emergency Service, Hospital/*utilization;Female;Hospitalization/*statistics & numerical data;Humans;Male;Middle Aged;Prevalence;Pulmonary Disease, Chronic Obstructive/*epidemiology/therapy;Residential Facilities/*statistics & numerical data;United States/epidemiology;Young Adult;chronic obstructive pulmonary disease;hospitalization;residential facilities","Wheaton, A. G.;Ford, E. S.;Cunningham, T. J.;Croft, J. B.",2015,Apr,10.1177/0898264314552419,0,
4778,The loss of topography in the microbial communities of the upper respiratory tract in the elderly,"Rationale: The microbial communities inhabiting the upper respiratory tract protect from respiratory infection. The maturity of the immune system is a major influence on the composition of the microbiome and, in youth, the microbiota and immune system are believed to mature in tandem. With age, immune function declines and susceptibility to respiratory infection increases. Whether these changes contribute to the microbial composition of the respiratory tract is unknown. Objectives: Our goal was to determine whether the microbes of the upper respiratory tract differ between mid-aged adults (18-40 yr) and the elderly (.65 yr). Methods: Microbiomes of the anterior nares and oropharynx of elderly individuals were evaluated by 16S rRNA gene sequencing. These communities were compared with data on mid-aged adults obtained from the Human Microbiome Project. Measurements and Main Results: The microbiota of the elderly showed no associations with sex, comorbidities, residence, or vaccinations. Comparisons of mid-aged adults and the elderly demonstrated significant differences in the composition of the anterior nares and oropharynx, including a population in the anterior nares of the elderly that more closely resembled the oropharynx than the anterior nares of adults. The elderly oropharyngeal microbiota were characterized by increased abundance of streptococci, specifically, Streptococcus salivarius group species, but not Streptococcus pneumoniae, carriage of which was low (,3% of participants), as demonstrated by PCR (n = 4/123). Conclusions: Microbial populations of the upper respiratory tract in mid-aged adults and the elderly differ; it is possible that these differences contribute to the increased risk of respiratory infections experienced by the elderly. Copyright © 2014 by the American Thoracic Society.",adult;aged;article;asthma;biogeography;Canada;chronic obstructive lung disease;clinical article;comorbidity;congestive heart failure;controlled study;coronary artery disease;dementia;female;gene sequence;human;male;microbial community;microbiome;nursing home;oropharynx;polymerase chain reaction;sex;Streptococcus pneumoniae;Streptococcus salivarius;topography;upper respiratory tract;vaccination;very elderly,"Whelan, F. J.;Verschoor, C. P.;Stearns, J. C.;Rossi, L.;Luinstra, K.;Loeb, M.;Smieja, M.;Johnstone, J.;Surette, M. G.;Bowdish, D. M. E.",2014,,,0,
4779,"Costs of inpatient care among medicare beneficiaries with heart failure, 2001 to 2004","Background-Inpatient care is the primary driver of costs for patients with heart failure. It is unclear whether recent advances in heart failure care have reduced the costs to Medicare for the care of inpatients with heart failure. Methods and Results-In a retrospective cohort study of 1 363 977 elderly Medicare beneficiaries hospitalized with heart failure between January 1, 2001, and December 31, 2004, we examined costs to Medicare for all inpatient care, inpatient cardiovascular care, and inpatient heart failure care and the adjusted relationships between patient characteristics and costs. Among 1 363 977 Medicare beneficiaries with an index heart failure hospitalization, 901 885 (66%) had a subsequent inpatient claim during the following year. Noncardiovascular costs accounted for 57% of total inpatient costs, and costs associated with heart failure hospitalizations accounted for 15% of total inpatient costs. No significant changes occurred in total, cardiovascular, and heart failure inpatient costs over time. Conclusions-The costs of inpatient care for patients with heart failure are high, but most subsequent inpatient costs are attributable to noncardiovascular and non-heart failure admissions. Further research is needed to identify predictors of costs, so that patients can be stratified according to risk, and to evaluate strategies that target primary cost drivers for patients with heart failure. © 2010 American Heart Association, Inc.",aged;article;chronic obstructive lung disease;cohort analysis;comorbidity;coronary artery bypass surgery;cost effectiveness analysis;defibrillator;dementia;diabetes mellitus;female;health care cost;heart failure;hospital cost;hospital patient;hospitalization;human;hypertension;ischemic heart disease;kidney failure;length of stay;major clinical study;male;medicare;mental disease;patient care;priority journal;retrospective study;transluminal coronary angioplasty,"Whellan, D. J.;Greiner, M. A.;Schulman, K. A.;Curtis, L. H.",2010,,,0,
4780,An imprinted rheumatoid arthritis methylome signature reflects pathogenic phenotype,"Background: A DNA methylation signature has been characterized that distinguishes rheumatoid arthritis (RA) fibroblast like synoviocytes (FLS) from osteoarthritis (OA) FLS. The presence of epigenetic changes in long-term cultured cells suggest that rheumatoid FLS imprinting might contribute to pathogenic behavior. To understand how differentially methylated genes (DMGs) might participate in the pathogenesis of RA, we evaluated the stability of the RA signature and whether DMGs are enriched in specific pathways and ontology categories.Methods: To assess the RA methylation signatures the Illumina HumanMethylation450 chip was used to compare methylation levels in RA, OA, and normal (NL) FLS at passage 3, 5, and 7. Then methylation frequencies at CpGs within the signature were compared between passages. To assess the enrichment of DMGs in specific pathways, DMGs were identified as genes that possess significantly differential methylated loci within their promoter regions. These sets of DMGs were then compared to pathway and ontology databases to establish enrichment in specific categories.Results: Initial studies compared passage 3, 5, and 7 FLS from RA, OA, and NL. The patterns of differential methylation of each individual FLS line were very similar regardless of passage number. Using the most robust analysis, 20 out of 272 KEGG pathways and 43 out of 34,400 GO pathways were significantly altered for RA compared with OA and NL FLS. Most interestingly, we found that the KEGG 'Rheumatoid Arthritis' pathway was consistently the most significantly enriched with differentially methylated loci. Additional pathways involved with innate immunity (Complement and Coagulation, Toll-like Receptors, NOD-like Receptors, and Cytosolic DNA-sensing), cell adhesion (Focal Adhesion, Cell Adhesion Molecule), and cytokines (Cytokine-cytokine Receptor). Taken together, KEGG and GO pathway analysis demonstrates non-random epigenetic imprinting of RA FLS.Conclusions: The DNA methylation patterns include anomalies in key genes implicated in the pathogenesis of RA and are stable for multiple cell passages. Persistent epigenetic alterations could contribute to the aggressive phenotype of RA synoviocytes and identify potential therapeutic targets that could modulate the pathogenic behavior. © 2013 Whitaker et al.; licensee BioMed Central Ltd.",cell adhesion molecule;complement;cytokine receptor;nucleotide binding oligomerization domain like receptor;toll like receptor;African trypanosomiasis;antigen presentation;article;asthma;cell adhesion;Chagas disease;controlled study;correlation analysis;CpG island;DNA methylation;epigenetics;extracellular matrix;extracellular space;focal adhesion;gene frequency;gene identification;gene locus;gene mapping;genetic database;genome imprinting;human;human tissue;innate immunity;insulin dependent diabetes mellitus;methylation;muscle contraction;nucleotide sequence;osteoarthritis;pathogenesis;phagosome;phenotype;prion disease;priority journal;promoter region;rheumatoid arthritis;signal transduction;synoviocyte;transcription initiation site,"Whitaker, J. W.;Shoemaker, R.;Boyle, D. L.;Hillman, J.;Anderson, D.;Wang, W.;Firestein, G. S.",2013,,,0,
4781,"Identification of genes associated with dissociation of cognitive performance and neuropathological burden: Multistep analysis of genetic, epigenetic, and transcriptional data","Introduction: The molecular underpinnings of the dissociation of cognitive performance and neuropathological burden are poorly understood, and there are currently no known genetic or epigenetic determinants of the dissociation. Methods and findings: “Residual cognition” was quantified by regressing out the effects of cerebral pathologies and demographic characteristics on global cognitive performance proximate to death. To identify genes influencing residual cognition, we leveraged neuropathological, genetic, epigenetic, and transcriptional data available for deceased participants of the Religious Orders Study (n = 492) and the Rush Memory and Aging Project (n = 487). Given that our sample size was underpowered to detect genome-wide significance, we applied a multistep approach to identify genes influencing residual cognition, based on our prior observation that independent genetic and epigenetic risk factors can converge on the same locus. In the first step (n = 979), we performed a genome-wide association study with a predefined suggestive p < 10−5, and nine independent loci met this threshold in eight distinct chromosomal regions. Three of the six genes within 100 kb of the lead SNP are expressed in the dorsolateral prefrontal cortex (DLPFC): UNC5C, ENC1, and TMEM106B. In the second step, in the subset of participants with DLPFC DNA methylation data (n = 648), we found that residual cognition was related to differential DNA methylation of UNC5C and ENC1 (false discovery rate < 0.05). In the third step, in the subset of participants with DLPFC RNA sequencing data (n = 469), brain transcription levels of UNC5C and ENC1 were evaluated for their association with residual cognition: RNA levels of both UNC5C (estimated effect = −0.40, 95% CI −0.69 to −0.10, p = 0.0089) and ENC1 (estimated effect = 0.0064, 95% CI 0.0033 to 0.0096, p = 5.7 × 10−5) were associated with residual cognition. In secondary analyses, we explored the mechanism of these associations and found that ENC1 may be related to the previously documented effect of depression on cognitive decline, while UNC5C may alter the composition of presynaptic terminals. Of note, the TMEM106B allele identified in the first step as being associated with better residual cognition is in strong linkage disequilibrium with rs1990622A(r2= 0.66), a previously identified protective allele for TDP-43 proteinopathy. Limitations include the small sample size for the genetic analysis, which was underpowered to detect genome-wide significance, the evaluation being limited to a single cortical region for epigenetic and transcriptomic data, and the use of categorical measures for certain non-amyloid-plaque, non-neurofibrillary-tangle neuropathologies. Conclusions: Through a multistep analysis of cognitive, neuropathological, genomic, epigenomic, and transcriptomic data, we identified ENC1 and UNC5C as genes with convergent genetic, epigenetic, and transcriptomic evidence supporting a potential role in the dissociation of cognition and neuropathology in an aging population, and we expanded our understanding of the TMEM106B haplotype that is protective against TDP-43 proteinopathy.",aging;arteriolosclerosis;article;atherosclerosis;brain region;cognition;cognitive defect;dementia;disease severity;DNA methylation;epigenetics;genetic analysis;genetic association;genome-wide association study;heart infarction;hippocampal sclerosis;Lewy body;neurofibrillary tangle;neuropathology;neuropsychiatry;phenotype;RNA sequence;TDP 43 proteinopathy;transcriptomics;vascular amyloidosis,"White, C. C.;Yang, H. S.;Yu, L.;Chibnik, L. B.;Dawe, R. J.;Yang, J.;Klein, H. U.;Felsky, D.;Ramos-Miguel, A.;Arfanakis, K.;Honer, W. G.;Sperling, R. A.;Schneider, J. A.;Bennett, D. A.;De Jager, P. L.",2017,,10.1371/journal.pmed.1002287,0,
4782,Nonmelanoma skin cancer is associated with reduced Alzheimer disease risk,"OBJECTIVE: To explore the association of nonmelanoma skin cancer (NMSC) and Alzheimer disease (AD) in the Einstein Aging Study, an epidemiologic study of aging in New York City. METHODS: Community-residing volunteers aged 70 years or older were assessed annually, followed by multidisciplinary diagnostic consensus. Cancer status and type was obtained by self-report. Cox proportional hazards models were used to test associations between NMSC and subsequent risk of developing a neurocognitive disorder. To deduce a biologically specific association between AD and NMSC, we considered 3 nested outcomes groups: only AD (probable or possible AD as the sole diagnosis), any AD (probable AD or possible AD, as well as mixed AD/vascular dementia), and all-cause dementia. RESULTS: We followed 1,102 adults with a mean age of 79 years at enrollment. Prevalent NMSC was associated with reduced risk of only AD (hazard ratio = 0.21; 95% confidence interval = 0.051-0.87; p = 0.031) among subjects after adjustment for demographics, hypertension, diabetes, and coronary heart disease. APOE epsilon4 genotypes were available in 769 individuals. The association was similar in magnitude, but nonsignificant, when the number of APOE epsilon4 alleles was included in the model. No significant association was found between NMSC and subsequent development of any AD or all-cause dementia. CONCLUSIONS: This population-based longitudinal study shows that individuals older than 70 years with NMSC have a significantly reduced risk of developing AD compared with individuals without NMSC. We deduce Alzheimer-specific neuroprotection, because the effect is attenuated or eliminated when considering less-specific diagnoses such as AD with another diagnosis (any AD) or all-cause dementia.","Aged;Aged, 80 and over;Alzheimer Disease/*epidemiology/psychology;Cohort Studies;Female;Follow-Up Studies;Humans;Longitudinal Studies;Male;*Melanoma;*Population Surveillance/methods;Risk Factors;Skin Neoplasms/*diagnosis/*epidemiology/psychology","White, R. S.;Lipton, R. B.;Hall, C. B.;Steinerman, J. R.",2013,May 21,10.1212/WNL.0b013e3182941990,0,
4783,Obesity in middle age and future risk of dementia: A 27 year longitudinal population based study,"Objective: To evaluate any association between obesity in middle age, measured by body mass index and skinfold thickness, and risk of dementia later in life. Design: Analysis of prospective data from a multiethnic population based cohort. Setting: Kaiser Permanente Northern California Medical Group, a healthcare delivery organisation. Participants: 10 276 men and women who underwent detailed health evaluations from 1964 to 1973 when they were aged 40-45 and who were still members of the health plan in 1994. Main outcome measures: Diagnosis of dementia from January 1994 to April 2003. Time to diagnosis was analysed with Cox proportional hazard models adjusted for age, sex, race, education, smoking, alcohol use, marital status, diabetes, hypertension, hyperlipidaemia, stroke, and ischaemic heart disease. Results: Dementia was diagnosed in 713 (6.9%) participants. Obese people (body mass index ≥ 30) had a 74% increased risk of dementia (hazard ratio 1.74, 95% confidence interval 1.34 to 2.26), while overweight people (body mass index 25.0-29.9) had a 35% greater risk of dementia (1.35, 1.14 to 1.60) compared with those of normal weight (body mass index 18.6-24.9). Compared with those in the lowest fifth, men and women in the highest fifth of the distribution of subscapular or tricep skinfold thickness had a 72% and 59% greater risk of dementia, respectively (1.72, 1.36 to 2.18, and 1.59, 1.24 to 2.04). Conclusions: Obesity in middle age increases the risk of future dementia independently of comorbid conditions.",academic achievement;adult;age distribution;alcohol consumption;article;body mass;comorbidity;dementia;diabetes mellitus;ethnology;female;human;hyperlipidemia;hypertension;ischemic heart disease;longitudinal study;major clinical study;male;marriage;obesity;population research;priority journal;prospective study;risk factor;sex ratio;skinfold thickness;statistical analysis;cerebrovascular accident;United States,"Whitmer, R. A.;Gunderson, E. P.;Barrett-Connor, E.;Quesenberry Jr, C. P.;Yaffe, K.",2005,,,0,
4784,Body mass index in midlife and risk of Alzheimer disease and vascular dementia,"Prior work has suggested that obesity and overweight as measured by body mass index (BMI) increases risk of dementia. It is unknown if there is a difference in the risk of developing Alzheimer disease (AD) versus vascular dementia (VaD) associated with high body weight. The goal of this study was to examine the association between midlife BMI and risk of both AD and VaD an average of 36 years later in a large (N= 10,136) and diverse cohort of members of a health care delivery system. Participants aged 40-45 participated in health exams between 1964 and 1968. AD and VaD diagnoses were obtained from Neurology visits between January 1, 1994 and June 15, 2006. Those with diagnoses of general dementia from primary care providers were excluded from the study. BMI was analyzed in WHO categories of underweight, overweight and obese, as well as in subdivisions of WHO categories. All models were fully adjusted for age, education, race, sex, marital status, smoking, hyperlipidemia, hypertension, diabetes, ischemic heart disease and stroke. Cox proportional hazard models showed that compared to those with a normal BMI (18.5-24.9), those obese (BMI ≥ 30) at midlife had a 3.10 fold increase in risk of AD (fully adjusted model, Hazard Ratio=3.10, 95% CI 2.19-4.38), and a five fold increase in risk of VaD (fully adjusted model, HR=5.01, 95% CI 2.98-8.43) while those overweight (BMI ≥ 25 and <30) had a two fold increase in risk of AD and VaD (fully adjusted model, HR=2.09, 95% CI 1.69-2.60 for AD and HR=1.95, 95% CI 1.29-2.96 for VaD). These data suggest that midlife BMI is strongly predictive of both AD and VaD, independent of stroke, cardiovascular and diabetes co morbidities. Future studies need to unveil the mechanisms between adiposity and excess risk of AD and VaD. ©2007 Bentham Science Publishers Ltd.",adult;Alzheimer disease;article;body mass;comorbidity;controlled study;female;health care delivery;human;life cycle;major clinical study;male;multiinfarct dementia;neurologic examination;priority journal;proportional hazards model;risk assessment,"Whitmer, R. A.;Gunderson, E. P.;Quesenberry Jr, C. P.;Zhou, J.;Yaffe, K.",2007,,,0,
4785,Influence of serotonin-transporter-linked promoter region polymorphism on platelet activation in geriatric depression,"OBJECTIVE: Depression has been associated with increased platelet activation. Variations in the serotonin-transporter-linked promoter region (5-HTTLPR) polymorphism may influence the degree of activation. The authors examined the association among depression, platelet activation, and 5-HTTLPR genotype. METHOD: Elderly subjects with (N=61) and without (N=12) major depression were assessed for cognitive impairment, cardiovascular disease, and two indices of platelet activation. The depressed subjects were genotyped for the 5-HTTLPR polymorphism. RESULTS: The depressed subjects were older, were more cognitively impaired, and had higher platelet factor 4 and beta-thromboglobulin levels; cardiovascular disease was minimal in both groups. In the depressed group, subjects with the 5-HTTLPR l/l genotype had significantly higher platelet factor 4 and beta-thromboglobulin levels. CONCLUSIONS: Platelet activation is increased in elderly depressed patients, especially those with the 5-HTTLPR l/l genotype. This finding suggests how genetic differences may influence cardiovascular mortality in depressed patients with ischemic heart disease.","Aged;Aged, 80 and over;Alzheimer Disease/blood/genetics;Carrier Proteins/*genetics;Coronary Thrombosis/blood/genetics;Depressive Disorder, Major/blood/*genetics;Female;Humans;Male;Membrane Glycoproteins/*genetics;*Membrane Transport Proteins;Mental Status Schedule;*Nerve Tissue Proteins;Platelet Activation/*genetics;Platelet Factor 4/metabolism;Polymorphism, Genetic/*genetics;Promoter Regions, Genetic/*genetics;Risk Factors;Serotonin Plasma Membrane Transport Proteins;beta-Thromboglobulin/metabolism","Whyte, E. M.;Pollock, B. G.;Wagner, W. R.;Mulsant, B. H.;Ferrell, R. E.;Mazumdar, S.;Reynolds, C. F., 3rd",2001,Dec,10.1176/appi.ajp.158.12.2074,0,
4786,NSAID Use and Incident Cognitive Impairment in a Population-based Cohort,"Nonsteroidal anti-inflammatory drugs (NSAIDs) may prevent dementia, but previous studies have yielded conflicting results. This study estimated the association of prior NSAID use with incident cognitive impairment in the population-based Epidemiology of Hearing Loss Study (EHLS, n=2422 without cognitive impairment in 1998-2000). Prospectively collected medication data from 1988-1990, 1993-1995, and 1998-2000 were used to categorize NSAID use history at the cognitive baseline (1998-2000). Aspirin use and nonaspirin NSAID use were separately examined. Cox regression models were used to estimate the associations between NSAID use history at baseline and incident cognitive impairment in 2003-2005 or 2009-2010. Logistic regression analyses were used to estimate associations with a second outcome, mild cognitive impairment/dementia, available in 2009-2010. Participants using aspirin at baseline but not 5 years prior were more likely to develop cognitive impairment (adjusted hazard ratio=1.77; 95% confidence interval=1.11, 2.82; model 2), with nonsignificant associations for longer term use. Nonaspirin NSAID use was not associated with incident cognitive impairment or mild cognitive impairment/dementia odds. These results provided no evidence to support a potential protective effect of NSAIDs against dementia.",acetylsalicylic acid;apolipoprotein E4;hydroxymethylglutaryl coenzyme A reductase inhibitor;nonsteroid antiinflammatory agent;aged;angina pectoris;arthritis;article;body mass;cerebrovascular accident;cognition assessment;cognitive defect;cohort analysis;controlled study;dementia;diabetes mellitus;digit symbol substitution test;drinking behavior;drug use;educational status;exercise;female;follow up;health status;heart infarction;human;hypertension;longitudinal study;major clinical study;male;medical history;mild cognitive impairment;Mini Mental State Examination;neuroprotection;population research;primary prevention;priority journal;Rey auditory verbal learning test;Short Form 36;smoking;trail making test;treatment duration;aspirin,"Wichmann, M. A.;Cruickshanks, K. J.;Carlsson, C. M.;Chappell, R.;Fischer, M. E.;Klein, B. E. K.;Klein, R.;Schubert, C. R.",2016,,,0,
4787,Dementia: Many shades of gray,,cholinesterase inhibitor;memantine;agnosia;Alzheimer disease;amnesia;apraxia;article;bradykinesia;brain cortex;brain function;compulsion;congestive heart failure;decision making;diabetes mellitus;diffuse Lewy body disease;early diagnosis;extrapyramidal symptom;falling;frontal lobe;frontotemporal dementia;gait disorder;human;ischemic heart disease;language disability;memory;mild cognitive impairment;mixed depression and dementia;mood;motor performance;multiinfarct dementia;patient care;personality disorder;psychosis;risk factor;senility;survival,"Wick, J. Y.",2013,,,0,
4788,Direct catheter-based thrombectomy for acute ischemic stroke: Outcomes of consecutive patients treated in interventional cardiology centers in close cooperation with neurologists,,acute heart infarction;brain hemorrhage;brain ischemia;cerebrovascular accident;computer assisted tomography;human;letter;mechanical thrombectomy;mental deterioration;middle cerebral artery occlusion;nuclear magnetic resonance imaging;outcome assessment;percutaneous thrombectomy;priority journal;treatment indication,"Widimsky, P.;Asil, T.;Abelson, M.;Koznar, B.;Tasal, A.;Roos, J.;Vasko, P.;Peisker, T.;Deniz, C.;Vavrova, J.;Yamac, H. A.;Stetkarova, I.;Bacaksiz, A.;Ay, N. K.;Tuzgen, S.;Maly, M.;Goktekin, O.",2015,,,0,
4789,Circulating humanin levels are associated with preserved coronary endothelial function,"Humanin is a small endogenous antiapoptotic peptide, originally identified as protective against Alzheimer's disease, but subsequently also found on human endothelium as well as carotid artery plaques. Endothelial dysfunction is a precursor to the development of atherosclerotic plaques, which are characterized by a highly proinflammatory, reactive oxygen species, and apoptotic milieu. Previous animal studies demonstrated that humanin administration may improve endothelial function. Thus the aim of this study was to test the hypothesis that patients with coronary endothelial dysfunction have reduced systemic levels of humanin. Forty patients undergoing coronary angiography and endothelial function testing were included and subsequently divided into two groups based on coronary blood flow (CBF) response to intracoronary acetylcholine (normal >/= 50% increase from baseline, n = 20 each). Aortic plasma samples were obtained at the time of catheterization for the analysis of humanin levels and traditional biomarkers of atherosclerosis including C-reactive protein, Lp-Pla(2), and homocysteine. Baseline characteristics were similar in both groups. Patients with coronary endothelial dysfunction (change in CBF = -33 +/- 25%) had significantly lower humanin levels (1.3 +/- 1.1 vs. 2.2 +/- 1.5 ng/ml, P = 0.03) compared with those with normal coronary endothelial function (change in CBF = 194 +/- 157%). There was a significant and positive correlation between improved CBF and humanin levels (P = 0.0091) not seen with changes in coronary flow reserve (P = 0.76). C-reactive protein, Lp-Pla(2), and homocysteine were not associated with humanin levels. Thus we observed that preserved human coronary endothelial function is uniquely associated with higher systemic humanin levels, introducing a potential diagnostic and/or therapeutic target for patients with coronary endothelial function.","Acetylcholine;Adult;Atherosclerosis/blood/physiopathology;Biomarkers;Blood Chemical Analysis;Coronary Angiography;Coronary Circulation/physiology;Coronary Disease/*physiopathology;Coronary Vessels/*physiology/physiopathology;Diabetes Mellitus, Type 2/blood;Endothelium, Vascular/*physiology;Female;Heart Failure/physiopathology;Hemodynamics/physiology;Humans;Hypertension/blood;Intracellular Signaling Peptides and Proteins/*metabolism/*physiology;Lipids/blood;Male;Microcirculation/physiology;Middle Aged;Vasodilator Agents","Widmer, R. J.;Flammer, A. J.;Herrmann, J.;Rodriguez-Porcel, M.;Wan, J.;Cohen, P.;Lerman, L. O.;Lerman, A.",2013,Feb 1,10.1152/ajpheart.00765.2012,0,
4790,Completed suicide in a case of clinically diagnosed progressive supranuclear palsy,"We present the clinical history and the cognitive and behavioral presentations of a male patient with suspected progressive supranuclear palsy (PSP) who fatally shot himself in the head. We believe his act of suicide was the consequence of impulsivity, rather than primary depression or mood disturbance. In cases of suspected PSP and other atypical parkinsonisms, health professionals must be aware of neurobehavioral risk factors for suicide attempts and completions to promote patient safety; however, the literature on this topic is sparse. Our case highlights the potentially lethal consequences of impulsivity and other neuropsychiatric symptoms in PSP and related syndromes.",alprazolam;clonazepam;levodopa;sertraline;aged;article;behavior change;brain stem;cardiovascular risk;case report;Caucasian;cognition;coronary artery bypass graft;coronary artery disease;daily life activity;dementia;depression;diabetic neuropathy;drug dose increase;emergency ward;executive function;follow up;frontal variant frontotemporal dementia;health practitioner;heart infarction;human;hypertension;impulsiveness;male;mental health;mood disorder;neuroimaging;non insulin dependent diabetes mellitus;nuclear magnetic resonance imaging;paranoia;parkinsonism;patient safety;positron emission tomography;priority journal;progressive supranuclear palsy;risk factor;shuffling gait;suicide;suicide attempt;transient ischemic attack;very elderly,"Wiener, J.;Moran, M. T.;Haut, M. W.",2015,,,0,
4791,Quality indicators for in-hospital pharmaceutical care of dutch elderly patients: Development and validation of an ACOVE-based quality indicator set,"Background: In 2001, the ACOVE (Assessing Care Of Vulnerable Elders) quality indicators (QIs) were developed in the US to measure the quality of care of vulnerable elderly patients. However, the ACOVE QI set was developed mainly to assess the overall quality of care of community-dwelling vulnerable elders (as opposed to hospitalized elderly). Therefore, they need to be adapted when used in a non-US hospital setting. In addition, the ACOVE QIs depend on patient and caretaker interviews to assess the quality of care. Objective: The aim of this study was to develop and validate a set of explicitly phrased QIs to measure (without the need for interviews) the quality of pharmaceutical care of elderly hospitalized patients in the Netherlands. Study Design: The QI set was developed based on the ACOVE QIs, Dutch national guidelines, evidence from the literature and expert opinion. The QI set focused on in-hospital pharmaceutical care and was evaluated in terms of whether the QIs were able to assess the quality of care using medical records and a hospital information system. In three review rounds, the QI set was adapted and judged on face and content validity. The feasibility of implementation of the QI set and inter-rater reliability were determined. Setting: The study was conducted between September 2007 and August 2008 in a tertiary 1002-bed university hospital. Research Team: Two pharmacists were responsible for the selection and adaptation of QIs. An internist-geriatrician, a physician with experience in quality assurance and internal medicine and a senior hospital pharmacist formed the expert panel responsible for reviewing the QIs. Measurements: Fleiss k values and the intraclass correlation coefficient were calculated for inter-rater reliability. Results: An 87-item QI set was accepted by the expert panel. Of this set, 49 QIs were based on ACOVE QIs and 38 QIs were newly added. The QI set demonstrated excellent inter-rater reliability and good feasibility. Conclusions: We developed a valid and reliable set of QIs to efficiently assess the quality of the in-hospital pharmaceutical care provided to elderly Dutch patients. © 2011 Adis Data Information BV. All rights reserved.",agents acting on the eye;antipain;anxiolytic agent;cholinesterase inhibitor;corticosteroid;coumarin;dipeptidyl carboxypeptidase inhibitor;diuretic agent;nonsteroid antiinflammatory agent;opiate;article;Assessing Care Of Vulnerable Elders quality indicator;cognitive defect;content validity;delirium;dementia;depression;diabetes mellitus;endocarditis;face validity;falling;feasibility study;geriatric patient;gout;health care personnel;health care quality;heart arrhythmia;heart failure;hospital information system;human;hypertension;interrater reliability;interview;ischemic heart disease;major clinical study;medical care;medical literature;medical record;medical specialist;Netherlands;osteoarthritis;osteoporosis;Parkinson disease;patient attitude;pharmacist;pneumonia;practice guideline;priority journal;quality control;cerebrovascular accident;validation process;venous thromboembolism,"Wierenga, P. C.;Klopotowska, J. E.;Smorenburg, S. M.;Van Kan, H. J.;Bijleveld, Y. A.;Dijkgraaf, M. G.;De Rooij, S. E.",2011,,,0,
4792,Comorbidity is an independent prognostic factor in patients with advanced-stage diffuse large B-cell lymphoma treated with R-CHOP: A population-based cohort study,"An observational population-based cohort study was performed to investigate the role of comorbidity on outcome and treatment-related toxicity in patients with newly diagnosed advanced-stage diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). Data for the clinical characteristics of 154 patients (median age 69 years), including Charlson Comorbidity Index (CCI), treatment, toxicity and outcome were evaluated. Forty-five percent of the patients had an International Prognistic index ≥3 and 16% had a CCI ≥2. The planned R-CHOP schedule was completed by 84% and 75% reached complete remission (CR). In those with CCI ≥2, 67% completed treatment with 46% CR. In patients with a CCI <2, overall survival (OS) after 1, 2 and 5 years was 84%, 79% and 65% respectively and it was 64%, 48% and 48% for those with CCI ≥2. Grade III/IV toxicity was documented in 53%, most frequently febrile neutropenia (27%) and infections (23%). In multivariate analysis CCI ≥2 and IPI ≥3 were independent risk indicators for OS and grade III/IV toxicity. In conclusion, comorbidity is an independent risk indicator for worse OS in patients with advanced DLBCL treated with R-CHOP by interference with intensive treatment schedules and more grade III/IV toxicity. Future studies are warranted to determine the optimal treatment approach in patients with significant comorbidities. © 2014 John Wiley & Sons Ltd.",cyclophosphamide;doxorubicin;granulocyte colony stimulating factor;prednisone;rituximab;vincristine;acquired immune deficiency syndrome;adult;advanced cancer;aged;article;blood toxicity;cancer combination chemotherapy;cancer prognosis;cancer radiotherapy;cancer regression;cancer staging;cardiotoxicity;cerebrovascular disease;chronic lung disease;cohort analysis;comorbidity;congestive heart failure;connective tissue disease;dementia;diabetes mellitus;disease course;febrile neutropenia;female;follow up;heart infarction;hemiplegia;human;infection;kidney disease;large cell lymphoma;leukemia;liver disease;lung toxicity;major clinical study;male;malignant neoplastic disease;observational study;overall survival;peripheral vascular disease;population research;priority journal;prospective study;risk factor;solid tumor;treatment outcome;ulcer;venous thromboembolism;very elderly,"Wieringa, A.;Boslooper, K.;Hoogendoorn, M.;Joosten, P.;Beerden, T.;Storm, H.;Kibbelaar, R. E.;Veldhuis, G. J.;Van Kamp, H.;Van Rees, B.;Kluin-Nelemans, H. C.;Veeger, N. J. G. M.;Van Roon, E. N.",2014,,,0,
4793,Microvascular diseases: Is a new era coming?,"The microvascular bed is an anatomical entity which comprises myriads of small arterioles, capillaries and venules. Microvessels and surrounding tissue metabolism are tightly coupled; consequently they are equipped with many, very specific and fine-tuned mechanisms allowing permanent, precise regulation of nutrient delivery. The review thoroughly describes the structure and physiology of arterioles and capillaries as well as the specialized means to investigate them. Microcirculation has been largely neglected for decades, mainly because of lack of technical possibilities for visualization and quantitation. However the past years have completely renewed the scientific interest, due to the combination of the availability of new techniques in human research and the recognition that the microcirculation is autonomically and causally involved in diseases previously thought to be essentially a question of macrocirculation. Today we start to see that microangiopathy is not only a consequence of large vessel diseases but can be the source of many pathologies in both cardiovascular and metabolic disorders, the best example -developed here- being the cardiometabolic syndrome or prediabetes. With very few exceptions, pentoxifylline and the antidiabetic metformin, no specific treatments have been developed for treating disorders at the microcirculatory level. Metformin has unique, intrinsic actions specifically at the level of terminal arterioles, which are completely independent of its antidiabetic effect. Other drugs are shortly described which have revealed a potential interest in this field. Our review aims at showing that microcirculation is entering a new era, starting with rapidly increasing knowledge of its intimate functioning and worth specific pharmacological developments. © 2012 Bentham Science Publishers.",bosentan;caveolin 1;endothelial nitric oxide synthase;fibric acid derivative;fish oil;Ginkgo biloba extract;guanine nucleotide binding protein;indapamide;integrin;ion channel;metformin;nicorandil;pentoxifylline;perindopril;polyphenol;pycnogenol;safflower oil;xanthinol nicotinate;acromegaly;Alzheimer disease;arteriole;artery;article;Behcet disease;blood brain barrier;blood rheology;blood vessel permeability;calcium transport;capillary flow;caveola;coronary artery disease;diabetes mellitus;diabetic foot;diabetic microangiopathy;diabetic retinopathy;diet supplementation;endoplasmic reticulum;erythrocyte;erythrocyte aggregation;glycation;glycocalyx;gout;heart infarction;heart muscle ischemia;hemochromatosis;human;hypertension;impaired glucose tolerance;insulin resistance;laser Doppler flowmetry;low birth weight;microangiopathy;microcirculation;microvasculature;non insulin dependent diabetes mellitus;nonalcoholic fatty liver;oxidative stress;peripheral vascular disease;pregnancy diabetes mellitus;pulmonary hypertension;reperfusion injury;rheumatoid arthritis;skin ulcer;sleep disordered breathing;cerebrovascular accident;systemic sclerosis;tea;vasodilatation;vein insufficiency;egb 761,"Wiernsperger, N.;Rapin, J. R.",2012,,,0,
4794,Trauma-related dispatch criteria for Helicopter Emergency Medical Services in Europe,"Introduction: Helicopter Emergency Medical Services (HEMS) are used worldwide in order to provide potentially life-saving pre-hospital medical support to trauma patients at the accident scene. It is currently unclear how much overlap exists regarding the number and type of dispatch criteria used by individual HEMS organisations. The aim of the current study was to provide an overview of dispatch criteria for trauma cases used by HEMS organisations within Europe, and search for similarities and differences, between countries and HEMS stations. Materials and methods: HEMS dispatch criteria related to trauma care were obtained from the literature and divided into four groups of criteria and processed in a questionnaire. HEMS providing organisations were identified and contacted by telephone and via email. Results: Fifty-five of the 65 organisations (85%) that were contacted completed the questionnaire. The criteria ""Fall from height"", ""Lengthy extrication and significant injury"" and ""Multiple casualty incidents"" were used most frequently. Criteria from the subgroup ""Patient Characteristics - Co-morbidities and Age"" were used the least. In 44 of the organisations the Central Dispatch Centre (CDC) was primarily responsible for HEMS dispatch. Conclusion: This overview demonstrates the lack of uniformity in the use of dispatch criteria for trauma assistance on a national and international level. Furthermore, the activation of HEMS is not only depending on dispatch criterion protocols, but is also influenced by organisational factors like the education of the dispatcher, the training of the EMS personnel, the familiarity with the dispatch criteria, and the responses of bystanders. Future research should aim to identify a general set of criteria with the highest discriminating potential. © 2010 Elsevier Ltd. All rights reserved.",abdominal penetrating trauma;age distribution;amputation;article;blast injury;blunt trauma;burn;capillary flow;comorbidity;dispatch criteria;diving;drowning;electric accident;electric injury;emergency health service;emergency treatment;Europe;falling;finger amputation;flail chest;fracture;Glasgow coma scale;head and neck injury;health care access;heart arrest;helicopter emergency medical services;hypotension;injury;limb ischemia;lung burn;mass disaster;mental deterioration;motor dysfunction;multiple trauma;near drowning;occupational accident;patient coding;patient identification;penetrating trauma;priority journal;questionnaire;respiratory distress;resuscitation;shock;skull fracture;speech disorder;spine injury;sport injury;tachycardia;thorax penetrating trauma;thumb amputation;traffic accident,"Wigman, L. D.;Van Lieshout, E. M. M.;De Ronde, G.;Patka, P.;Schipper, I. B.",2011,,,0,
4795,Late life depression and dementia: a mental health literacy survey of Australian general practitioners,"BACKGROUND: Whilst previous surveys of mental health literacy of general practitioners (GPs) have shown high rates of recognition of common mental disorders, few studies have been carried out into GPs' understanding of presentations in late life. This study aims to determine GPs' recognition of mental disorders in older people, their intentions regarding investigation, specialist referral and treatment, and their beliefs about prognosis. METHODS: Australian GPs who attended an educational seminar were administered questions based on clinical vignettes describing older people with depression, dementia and coronary heart disease. RESULTS: There was a high rate of recognition of all disorders amongst the 436 respondents. GPs demonstrated a high level of consistency about screening questionnaires, investigations and specialist referral in the dementia vignette. In contrast, less than half of GPs endorsed using a screening questionnaire or neuroimaging, and considered referral to a variety of medical specialties in the depression vignette. For both the depression and dementia vignettes, self-help treatments like walking, dietary advice or alcohol reduction were endorsed more frequently than an antidepressant or cholinesterase inhibitor respectively. Dementia tended to be viewed as having a poor prognosis, and late-life depression a moderate prognosis. CONCLUSIONS: Actual or intended rates of diagnostic recognition, specialist referral and benzodiazepine prescription found in this study may not translate into clinical practice for a number of reasons. Non-specific treatments without a clear evidence base were considered as often as those with a stronger evidence base. There is a need to improve the knowledge of GPs with regard to screening and investigating late life depression and managing dementia.",Aged;Alzheimer Disease/*diagnosis/psychology/therapy;Antidepressive Agents/therapeutic use;Attitude of Health Personnel;Cholinesterase Inhibitors/therapeutic use;*Clinical Competence;Comorbidity;Coronary Disease/psychology;Depressive Disorder/*diagnosis/psychology/therapy;*Education;Evidence-Based Medicine;Family Practice/*education;Female;Humans;Life Style;Male;New South Wales;Prognosis;Referral and Consultation;Self Care/psychology;Surveys and Questionnaires,"Wijeratne, C.;Harris, P.",2009,Apr,10.1017/s1041610208008235,0,
4796,High-sensitivity cardiac troponin T is associated with cognitive decline in older adults at high cardiovascular risk,"Aims Cardiac troponin T (cTnT), measured with a high-sensitivity (hs) assay, is associated with cognitive decline, but the underlying mechanism is unknown. We investigated the association of hs-cTnT with cognitive function and decline, and studied whether this association was independent of cardiovascular diseases or risk factors, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Methods and results We studied 5407 participants (mean age 75.31 years) from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), who all had cardiovascular diseases or risk factors thereof. Participants with pre-existent advanced clinical heart failure were excluded. Hs-cTnT and NT-proBNP obtained after 6 months of follow-up were related with cognitive function, tested repeatedly during a mean follow-up of 3.2 years. Participants with higher hs-cTnT performed worse at baseline on Stroop test (mean baseline score (standard error (SE)) lowest vs highest third 65.91 (1.16) vs 69.40 (1.10) seconds, p < 0.001), Letter-Digit Coding test (23.35 (0.32) vs 22.40 (0.31) digits coded, p < 0.001), immediate Picture-Word Learning test (9.45 (0.09) vs 9.31 (0.08) pictures remembered, p = 0.002) and delayed Picture-Word Learning test (10.33 (0.12) vs 10.10 (0.12) pictures remembered, p = 0.013). Furthermore, participants with higher hs-cTnT had steeper decline on Stroop test (mean annual change (SE) lowest vs highest third 0.34 (0.12) vs 1.06 (0.12) seconds, p = 0.013), Letter-Digit Coding test (-0.29 (0.03) vs -0.46 (0.03) digits coded, p < 0.001), immediate Picture-Word Learning test (0.01 (0.01) vs -0.06 (0.01) pictures remembered, p < 0.001) and delayed Picture-Word Learning test (-0.03 (0.01) vs -0.12 (0.02) pictures remembered, p = 0.001). Associations were independent of cardiovascular diseases risk factors or Apolipoprotein E genotype. Further adjusting for NT-proBNP levels revealed the same results. Conclusions Higher levels of hs-cTnT associate with worse cognitive function and steeper cognitive decline in older adults independent of cardiovascular diseases, risk factors and NT-proBNP.",amino terminal pro brain natriuretic peptide;apolipoprotein E;high density lipoprotein;low density lipoprotein;pravastatin;triacylglycerol;troponin T;adult;aged;article;cardiovascular disease;cardiovascular risk;cognition;cognitive function test;controlled study;disease association;double blind procedure;female;follow up;genotype;human;learning test;major clinical study;male;mental deterioration;Mini Mental State Examination;priority journal;prospective study;randomized controlled trial;Stroop test;triacylglycerol blood level,"Wijsman, L. W.;De Craen, A. J. M.;Trompet, S.;Sabayan, B.;Muller, M.;Stott, D. J.;Ford, I.;Welsh, P.;Westendorp, R. G. J.;Jukema, J. W.;Sattar, N.;Mooijaart, S. P.",2016,,,0,
4797,"Antiagregation and anticoagulation, relationship with upper gastrointestinal bleeding","Introduction: the high prevalence of cardiovascular diseases in the modern society brings a high prescription of platelet antiaggre-gation and anticoagulant medications. These treatments have been related to an increased incidence of upper gastrointestinal bleedings (UGB). Our aim was to estimate the fraction of UGB s presented to our hospital that was related to this kind of treatments and describe their clinical features in our environment. Material and methods: a retrospective search was performed in the archives of our hospital of all the patients with diagnosis of UGB admitted during the period 2004-2007 both years inclusive. Patients on antiplatelet and/or anticoagulant treatment were included. We analyzed the information regarding the use of medication, the bleeding lesion, the severity of the bleeding, recurrences, mortality and their clinical features. Results: we found 523 episodes of UGB. Of these 137 (26.1%) were patients receiving platelet antiaggregation or anticoagulant drugs. The patients were male 60.2%, and had a mean age of 75.6 (± 10.8) years. The 65.5% (74) had HBP, 43.4% (49) diabetes melli-tus and 37.2% (42) dislypemia and 13.3% (22) dementia. The drug most frequently implicated was ASA in 36.3% (41), followed by acenocumarol in 27.4% (31), clopidogrel 18.6% (21), double therapy (ASA + clopidogrel) in 6.2% (7), triple therapy (ASA + clopidogrel + acenocumarol) in 0.9% (1), triflusal 4.4% (5), low molecular weight heparin 5.3% (5), and ticlopidine in one patient (0.9%). Only 36.3% (41) were on treatment with proton pump inhibitors. There were 24 recurrences and 4 deaths. Conclusions: the 26.1% of the UGB attended in our environment were of iatrogenic origin. We also found a low use of proton pump inhibitors. © 2011 ARÁN EDICIONES, S. L.",acenocoumarol;acetylsalicylic acid;anticoagulant agent;antithrombocytic agent;clopidogrel;low molecular weight heparin;proton pump inhibitor;ticlopidine;triflusal;aged;article;cardiovascular disease;cerebrovascular accident;controlled study;dementia;diabetes mellitus;dyslipidemia;female;atrial fibrillation;human;hypertension;ischemic heart disease;lung embolism;major clinical study;male;mortality;recurrent disease;retrospective study;Spain;transient ischemic attack;upper gastrointestinal bleeding,"Wikman-Jorgensen, P.;López-Calleja, E.;Safont-Gasó, P.;Matarranz-del-Amo, M.;Andrés-Navarro, R.;Merino-Sánchez, J.",2011,,,0,
4798,"Donepezil in vascular dementia: A randomized, placebo-controlled study","Objective: To evaluate the efficacy and tolerability of donepezil in patients with vascular dementia (VaD). Methods: Patients (n = 616; mean age, 75.0 years) with probable or possible VaD, according to National Institute of Neurological Disorders and Stroke - Association Internationale pour la Recherche en l'Enseignement en Neurosciences criteria, were randomized to receive donepezil 5 mg/day (n = 208), donepezil 10 mg/day (after 5 mg/day for the first 28 days) (n = 215), or placebo (n = 193) for 24 weeks. Results: Seventy-six percent of the patients enrolled had probable VaD. A total of 75.3% of the 10 mg donepezil group and 80.8% of the 5 mg group completed the study compared with 83.4% of the placebo group. Both donepezil-treated groups showed improvements in cognitive function on the Alzheimer's Disease Assessment Scale - cognitive subscale compared with placebo, with a mean endpoint treatment difference, as measured by the change from baseline score, of approximately 2 points (donepezil 5 mg, -1.65 [p = 0.0031; 10 mg, -2.09 [p = 0.0002]) Greater improvements on the Clinician's Interview-Based Impression of Change - plus version were observed with both donepezil groups than with the placebo group (overall donepezil treatment vs placebo p = 0.008); 25% of the placebo group showed improvement compared with 39% (p = 0.004) of the 5 mg group and 32% (p = 0.047) of the 10 mg group. Withdrawal rates due to adverse events were low (placebo, 8.8%; donepezil 5 mg, 10.1%; 10 mg, 16.3%). Conclusions: Donepezil-treated patients demonstrated significant improvements in cognition and global function compared with placebo-treated patients, and donepezil was well tolerated.",donepezil;placebo;adult;aged;agitation;Alzheimer disease;angina pectoris;anorexia;article;asthenia;backache;brain function;clinical trial;cognition;colitis;confusion;constipation;controlled clinical trial;controlled study;convulsion;depression;diarrhea;double blind procedure;drug efficacy;drug safety;drug tolerability;drug withdrawal;dyspepsia;female;fracture;headache;human;hypertension;infection;insomnia;leg cramp;major clinical study;male;measurement;multiinfarct dementia;nausea;nightmare;pain;peripheral edema;pneumonia;priority journal;randomized controlled trial;rash;rating scale;rhinitis;skin abrasion;skin cancer;cerebrovascular accident;faintness;transient ischemic attack;treatment outcome;urinary tract infection;urine incontinence;vertigo;vomiting,"Wilkinson, D.;Doody, R.;Helme, R.;Taubman, K.;Mintzer, J.;Kertesz, A.;Pratt, R. D.",2003,,,0,
4799,Memantine and brain atrophy in alzheimer's disease: A 1-year randomized controlled trial,"The primary objective of this study was to evaluate the rate of total brain atrophy (TBA) with serial magnetic resonance imaging (MRI), using the Brain Boundary Shift Integral (BBSI), in patients with probable Alzheimer's disease (AD) over the course of 52 weeks of treatment with memantine or placebo. This was a multi-national, randomized, double-blind, placebo-controlled, fixed-dose 1-year study. Patients were randomized (1: 1) to treatment with placebo or memantine. Patients randomized to memantine were up-titrated to the target dose of 20 mg/day over 4 weeks. MRI scans were collected at screening and at Weeks 4, 42, and 52. Secondary efficacy assessments included several cognitive and behavioral scales. 518 patients were screened, 278 patients were randomized, and 217 patients completed the study. In the primary efficacy analysis, the differences in TBA rates between memantine (15.2 mL/year) and placebo (15.3 mL/year) were not statistically significant (-0.04 mL/year [(95% CI:-2.60, 2.52), p = 0.98]). There was a statistically significant correlation between change in TBA and change in most cognitive and behavioral scale scores. Patients who were not treated with acetyl cholinesterase inhibitors (AChEIs) showed a significantly lower TBA rate than patients treated with AChEIs. Memantine had a placebo-level incidence of adverse events. There were no statistically significant differences between memantine and placebo in total brain or hippocampal atrophy rates in patients with probable AD treated for 1 year. The biological relevance of cerebral atrophy was supported by a significant correlation between rate of atrophy and decline in cognitive and behavioral outcomes. © 2012-IOS Press and the authors. All rights reserved.",NCT00862940;cholinesterase inhibitor;donepezil;galantamine;memantine;rivastigmine;aged;agitation;Alzheimer disease;ankle fracture;article;brain atrophy;constipation;controlled study;delusion;double blind procedure;drug dose escalation;drug dose titration;drug efficacy;drug fatality;drug safety;drug tolerability;drug withdrawal;exploratory research;falling;female;headache;atrial fibrillation;heart failure;hippocampus;human;incidence;major clinical study;male;mental disease;multicenter study;neurologic disease;nuclear magnetic resonance imaging;priority journal;randomized controlled trial;rating scale;side effect;treatment duration;visual acuity;vital sign;weight gain;weight reduction,"Wilkinson, D.;Fox, N. C.;Barkhof, F.;Phul, R.;Lemming, O.;Scheltens, P.",2012,,,0,
4800,Geriatrics Literature 2016 Year in Review,"We present 10 of the most effective articles from 2016 in geriatric medicine. They address wide-ranging topics including the use of antipsychotics for delirium in palliative care, fall prevention and mobility interventions, efficacy and potential risks of testosterone, cranberry capsules and their effect on bacteriuria and pyuria, beta-blockers after acute myocardial infarction in a nursing home population, the effect of a healthy lifestyle on disability, a goals-of-care intervention in individuals with advanced dementia, the benefits of regional anesthesia in hip repair, and mindfulness in chronic pain management.",2016;Geriatrics;Literature Update,"Willham, K.;Covinsky, K.;Widera, E.",2017,Oct,,0,
4801,Influence of comorbidity on racial differences in receipt of surgery among US veterans with early-stage non-small-cell lung cancer,"Purpose It is unclear why racial differences exist in the frequency of surgery for lung cancer treatment. Comorbidity is an important consideration in selection of patients for lung cancer treatment, including surgery. To assess whether comorbidity contributes to the observed racial differences, we evaluated racial differences in the prevalence of comorbidity and their impact on receipt of surgery. Patients and Methods A total of 1,314 patients (1,135 white, 179 black) in the Veterans Health Administration diagnosed with early-stage non-small-cell lung cancer in 2007 were included. The effect of comorbidity on surgery was determined by using generalized linear models with a logit link accounting for patient clustering within Veterans Administration Medical Centers. Results Compared with whites, blacks had greater prevalence of hypertension, liver disease, renal disease, illicit drug abuse, and poor performance status, but lower prevalence of respiratory disease. The impact of most individual comorbidities on receipt of surgery was similar between blacks and whites, and comorbidity did not influence the race-surgery association in a multivariable analysis. The proportion of blacks not receiving surgery as well as refusing surgery was greater than that among whites. Conclusion Blacks had a greater prevalence of several comorbid conditions and poor performance status; however, the overall comorbidity score did not differ by race. In general, the effect of comorbidity on receipt of surgery was similar in blacks and whites. Racial differences in comorbidity do not fully explain why blacks undergo lung cancer surgery less often than whites. © 2012 by American Society of Clinical Oncology.",alcohol;illicit drug;acquired immune deficiency syndrome;adult;African American;aged;angina pectoris;article;cancer patient;cancer surgery;cerebrovascular accident;comorbidity;congestive heart failure;coronary artery disease;dementia;diabetes mellitus;early cancer;enteropathy;European American;female;functional status;heart arrhythmia;heart infarction;human;Human immunodeficiency virus infection;hypertension;kidney disease;kidney failure;liver disease;non small cell lung cancer;lung surgery;major clinical study;male;mental disease;morbid obesity;neoplasm;neuromuscular disease;pancreas disease;paralysis;peripheral occlusive artery disease;prevalence;priority journal;race difference;respiratory tract disease;rheumatic disease;stomach disease;substance abuse;United States;vein disease;veteran,"Williams, C. D.;Stechuchak, K. M.;Zullig, L. L.;Provenzale, D.;Kelley, M. J.",2013,,,0,
4802,Prior statin use is not associated with improved outcome in emergency patients admitted with infection: A prospective observational study,"Objectives: The objective was to determine whether prior statin use is associated with lower mortality in emergency patients admitted with infection. Methods: A prospective observational study was conducted at the emergency department (ED) of a tertiary adult hospital with an annual census of over 73,000 patients. Patients presenting to the ED who were subsequently hospitalized with a primary diagnosis of infection were identified within 24 hours of presentation. Data were abstracted from patients' charts and from hospital electronic databases. Patients were stratified according to reported regular statin use on presentation. The outcome measure was in-hospital mortality truncated at 30 days. An association between statin use and mortality was sought using logistic regression analysis. Results: Data were collected over a 60-week period from 2,642 admissions. Patients taking a statin on admission had a higher unadjusted mortality risk (odds ratio [OR] = 2.14, 95% confidence interval [CI] = 1.32 to 3.46) compared to those not on a statin. However, this result became nonsignificant (OR = 0.96, 95% CI = 0.55 to 1.69) after adjusting for age, severity of disease, comorbid status, and propensity score. Conclusions: These data do not support an independent association between current preadmission statin use and lower 30-day in-hospital mortality in emergency patients admitted with infection. This result is contrary to most previously published studies. © 2011 by the Society for Academic Emergency Medicine.",hydroxymethylglutaryl coenzyme A reductase inhibitor;adult;aged;article;bacteremia;cerebrovascular disease;chronic lung disease;clinical trial;cohort analysis;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;disease severity;drug use;electronic medical record;emergency patient;emergency ward;female;heart infarction;hospital admission;hospital patient;human;infection;kidney failure;liver disease;major clinical study;male;mortality;observational study;outcome assessment;peptic ulcer;peripheral vascular disease;priority journal;prospective study;risk factor;scoring system;sepsis;septic shock;systemic inflammatory response syndrome;tertiary health care;treatment outcome,"Williams, J. M.;Greenslade, J. H.;Chu, K.;Brown, A. F. T.;Paterson, D.;Lipman, J.",2011,,,0,
4803,Monitor,,absenteeism;alcohol consumption;body mass;cardiovascular disease;cardiovascular risk;dementia;female;health behavior;hemorrhoid;human;hypertension;ischemic heart disease;lifestyle;male;note;obesity;priority journal;risk assessment;social status;somnolence;stress;traffic accident;varicosis,"Williams, N.",2003,,,0,
4804,Public attitudes to life-sustaining treatments and euthanasia in dementia,"Background: Issues surrounding end of life care, such as how aggressively to treat life threatening medical conditions in patients with dementia and when, if ever, to withhold or withdraw treatment require further scrutiny and debate. Methods: We conducted a cross-sectional survey to elicit the views of the general public on euthanasia and life-sustaining treatments in the face of dementia. Results: Seven hundred and twenty-five members of the general public completed this questionnaire throughout London and the South East. In the face of severe dementia, less than 40% of respondents would wish to be resuscitated after a heart attack, nearly three-quarters wanted to be allowed to die passively and almost 60% agreed with physician assisted suicide. Respondents were more likely to be in favour of life-sustaining treatments for their partner than for themselves and the opposite was true regarding euthanasia. White respondents were significantly more likely to refuse life-sustaining treatment and to agree to euthanasia compared with black and Asian respondents. Conclusion: Our survey suggests that a large proportion of the UK general public do not wish for life-sustaining treatments if they were to become demented and the majority agreed with various forms of euthanasia. Copyright © 2007 John Wiley & Sons, Ltd.",antibiotic agent;adolescent;adult;aged;article;artificial ventilation;Asian;attitude to illness;controlled study;dementia;disease severity;elderly care;ethnic difference;euthanasia;female;health survey;heart infarction;human;lung infection;male;Black person;patient attitude;public opinion;questionnaire;resuscitation;terminal care;treatment refusal;treatment withdrawal;feeding apparatus;United Kingdom,"Williams, N.;Dunford, C.;Knowles, A.;Warner, J.",2007,,,0,
4805,The relationship of walking intensity to total and cause-specific mortality. Results from the national walkers' health study,"Purpose: Test whether: 1) walking intensity predicts mortality when adjusted for walking energy expenditure, and 2) slow walking pace (≥24-minute mile) identifies subjects at substantially elevated risk for mortality. Methods: Hazard ratios from Cox proportional survival analyses of all-cause and cause-specific mortality vs. usual walking pace (min/mile) in 7,374 male and 31,607 female recreational walkers. Survival times were left censored for age at entry into the study. Other causes of death were treated as a competing risk for the analyses of cause-specific mortality. All analyses were adjusted for sex, education, baseline smoking, prior heart attack, aspirin use, diet, BMI, and walking energy expenditure. Deaths within one year of baseline were excluded. Results: The National Death Index identified 1968 deaths during the average 9.4-year mortality surveillance. Each additional minute per mile in walking pace was associated with an increased risk of mortality due to all causes (1.8% increase, P=10-5), cardiovascular diseases (2.4% increase, P=0.001, 637 deaths), ischemic heart disease (2.8% increase, P=0.003, 336 deaths), heart failure (6.5% increase, P=0.001, 36 deaths), hypertensive heart disease (6.2% increase, P=0.01, 31 deaths), diabetes (6.3% increase, P=0.004, 32 deaths), and dementia (6.6% increase, P=0.0004, 44 deaths). Those reporting a pace slower than a 24-minute mile were at increased risk for mortality due to all-causes (44.3% increased risk, P=0.0001), cardiovascular diseases (43.9% increased risk, P=0.03), and dementia (5.0-fold increased risk, P=0.0002) even though they satisfied the current exercise recommendations by walking ?7.5 metabolic equivalent (MET)-hours per week. Conclusions: The risk for mortality: 1) decreases in association with walking intensity, and 2) increases substantially in association for walking pace ≥24 minute mile (equivalent to <400m during a six-minute walk test) even among subjects who exercise regularly.",adult;all cause mortality;article;body mass;cardiovascular risk;cause specific mortality;dementia;diabetes mellitus;energy expenditure;female;heart failure;high risk population;human;hypertension;ischemic heart disease;male;mortality;physical activity;prospective study;sex difference;survival time;walking;walking intensity;walking speed,"Williams, P. T.;Thompson, P. D.",2013,,,0,
4806,Shared genetic susceptibility of vascular-related biomarkers with ischemic and recurrent stroke,"Objective: To investigate the genetic contributors to cerebrovascular disease and variation in biomarkers of ischemic stroke. Methods: The Vitamin Intervention for Stroke Prevention Trial (VISP) was a randomized, controlled clinical trial of B vitamin supplementation to prevent recurrent stroke, myocardial infarction, or death. VISP collected baseline measures of C-reactive protein (CRP), fibrinogen, creatinine, prothrombin fragments F 1+2, thrombin-antithrombin complex, and thrombomodulin prior to treatment initiation. Genome-wide association scans were conducted for these traits and follow-up replication analyses were performed. Results: We detected an association between CRP single nucleotide polymorphisms (SNPs) and circulating CRP levels (most associated SNP, rs2592902, p 1.14 × 10 -9) in 2,100 VISP participants. We discovered a novel association for CRP level in the AKR1D1 locus (rs2589998, p 7.3 × 10 -8, approaching genome-wide significance) that also is an expression quantitative trait locus for CRP gene expression. We replicated previously identified associations of fibrinogen with SNPs in the FGB and LEPR loci. CRP-associated SNPs and CRP levels were significantly associated with risk of ischemic stroke and recurrent stroke in VISP as well as specific stroke subtypes in METASTROKE. Fibrinogen levels but not fibrinogen-associated SNPs were also found to be associated with recurrent stroke in VISP. Conclusions: Our data identify a genetic contribution to inflammatory and hemostatic biomarkers in a stroke population. Additionally, our results suggest shared genetic contributions to circulating CRP levels measured poststroke and risk for incident and recurrent ischemic stroke. These data broaden our understanding of genetic contributors to biomarker variation and ischemic stroke risk, which should be useful in clinical risk evaluation.",biological marker;C reactive protein;creatinine;cyanocobalamin;fibrinogen;prothrombin;pyridoxine;thrombin antithrombin complex;thrombomodulin;adult;article;brain ischemia;female;gene replication;genetic association;genetic susceptibility;human;major clinical study;male;priority journal;quantitative trait locus;recurrent disease;single nucleotide polymorphism,"Williams, S. R.;Hsu, F. C.;Keene, K. L.;Chen, W. M.;Nelson, S.;Southerland, A. M.;Madden, E. B.;Coull, B.;Gogarten, S. M.;Furie, K. L.;Dzhivhuho, G.;Rowles, J. L.;Mehndiratta, P.;Malik, R.;Dupuis, J.;Lin, H.;Seshadri, S.;Rich, S. S.;Sale, M. M.;Worrall, B. B.",2016,,,0,
4807,"The Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes Study (ACCORD-MIND): rationale, design, and methods","Type 2 diabetes mellitus and cognitive impairment are 2 of the most common chronic conditions found in persons aged > or = 60 years. Clinical studies have shown a greater prevalence of global cognitive impairment, incidence of cognitive decline, and incidence of Alzheimer disease in patients with type 2 diabetes. To date, there have been no randomized trials of the effects of long-term glycemic control on cognitive function and structural brain changes in patients with type 2 diabetes. The primary aim of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Memory in Diabetes Study (ACCORD-MIND) is to test whether there is a difference in the rate of cognitive decline and structural brain change in patients with diabetes treated with standard-care guidelines compared with those treated with intensive-care guidelines. This comparison will be made in a subsample of 2,977 patients with diabetes participating in the ongoing ACCORD trial, a clinical trial sponsored by the National Heart, Lung, and Blood Institute (NHLBI) with support from the National Institute on Aging (NIA). Data from this ACCORD substudy on the possible beneficial or adverse effects of intensive treatment on cognitive function will be obtained from a 30-minute test battery, administered at baseline and 20-month and 40-month visits. In addition, full-brain magnetic resonance imaging will be performed on 630 participants at baseline and at 40 months to assess the relation between the ACCORD treatments and structural brain changes. The general aim of ACCORD-MIND is to determine whether the intensive treatment of diabetes, a major risk factor for Alzheimer disease and vascular dementia, can reduce the early decline in cognitive function that could later evolve into more cognitively disabling conditions. This report presents the design, rationale, and methods of the ACCORD-MIND substudy.","Alzheimer Disease/blood/pathology/*prevention & control;Coronary Artery Disease/blood/*prevention & control;*Diabetes Mellitus, Type 2;Diabetic Angiopathies/blood/*prevention & control;Humans;Magnetic Resonance Imaging;Randomized Controlled Trials as Topic;Research Design","Williamson, J. D.;Miller, M. E.;Bryan, R. N.;Lazar, R. M.;Coker, L. H.;Johnson, J.;Cukierman, T.;Horowitz, K. R.;Murray, A.;Launer, L. J.",2007,Jun 18,10.1016/j.amjcard.2007.03.029,0,
4808,Disparities in deep brain stimulation surgery among insured elders with Parkinson disease,"Objective: To identify sociodemographic, clinical, and physician/practice factors associated with deep brain stimulation (DBS). DBS is a proven surgical therapy for Parkinson disease (PD), but is recommended only for patients with excellent health, results in significant out-of-pocket costs, and requires substantial physician involvement. Methods: Retrospective cohort study of more than 657,000 Medicare beneficiaries with PD. Multivariable logistic regression models examined the association between demographic, clinical, socioeconomic status (SES), and physician/practice factors, and DBS therapy. Results: There were significant disparities in the use of DBS therapy among Medicare beneficiaries with PD. The greatest disparities were associated with race: black (adjusted odds ratio [AOR] 0.20, 95% confidence interval [CI] 0.16-0.25) and Asian (AOR 0.55, 95% CI 0.44-0.70) beneficiaries were considerably less likely to receive DBS than white beneficiaries. Women (AOR 0.79, 95% CI 0.75-0.83) also had lower odds of receiving DBS compared with men. Eighteen percent of procedures were performed on patients with PD who had cognitive impairment/dementia, a reported contraindication to DBS. Beneficiaries treated in minority-serving PD practices were less likely to receive DBS, regardless of individual race (AOR 0.76, 95% CI 0.66-0.87). Even after adjustment for demographic and clinical covariates, high neighborhood SES was associated with 1.4-fold higher odds of receiving DBS (AOR 1.42, 95% CI 1.33-1.53). Conclusions: Among elderly Medicare beneficiaries with PD, race, sex, and neighborhood SES are strong independent predictors of DBS receipt. Racial disparities are amplified when adjusting for physician/clinic characteristics. Future investigations of the demographic differences in clinical need/usefulness of DBS, ease of DBS attainment, and actual/opportunity DBS costs are needed to inform policies to reduce DBS disparities and improve PD quality of care.",acute heart infarction;aged;American Indian;article;Asian;brain depth stimulation;breast cancer;Caucasian;cerebrovascular accident;Charlson Comorbidity Index;chronic kidney disease;chronic obstructive lung disease;cognitive defect;cohort analysis;colorectal cancer;craniotomy;dementia;demography;depression;diabetes mellitus;female;geriatric disorder;atrial fibrillation;heart failure;Hispanic;human;ischemic heart disease;lung cancer;major clinical study;male;medicare;Black person;neighborhood;Parkinson disease;priority journal;prostate cancer;race;retrospective study;social status;transient ischemic attack;very elderly,"Willis, A. W.;Schootman, M.;Kung, N.;Wang, X. Y.;Perlmutter, J. S.;Racette, B. A.",2014,,,0,
4809,Midlife fitness and the development of chronic conditions in later life,"Background: The association between cardiorespiratory fitness (fitness) and mortality is well described. However, the association between midlife fitness and the development of nonfatal chronic conditions in older age has not been studied. Methods: To examine the association between midlife fitness and chronic disease outcomes in later life, participant data from the Cooper Center Longitudinal Study were linked with Medicare claims. We studied 18 670 healthy participants (21.1% women; median age, 49 years) who survived to receive Medicare coverage from January 1, 1999, to December 31, 2009. Fitness estimated by Balke treadmill time was analyzed as a continuous variable (in metabolic equivalents [METs]) and according to age- and sex-specific quintiles. Eight common chronic conditions were defined using validated algorithms, and associations between midlife fitness and the number of conditions were assessed using a modified Cox proportional hazards model that stratified the at-risk population by the number of conditions while adjusting for age, body mass index, blood pressure, cholesterol and glucose levels, alcohol use, and smoking. Results: After 120 780 person-years of Medicare exposure with amedian follow-up of 26 years, the highest quintile of fitness (quintile 5) was associated with a lower incidence of chronic conditions compared with the lowest quintile (quintile 1) in men (15.6 [95% CI, 15.0-16.2] vs 28.2 [27.4-29.0] per 100 person-years) and women (11.4 [10.5-12.3] vs 20.1 [18.7 vs 21.6] per 100 person-years). After multivariate adjustment, higher fitness (in METs) was associated with a lower risk of developing chronic conditions in men (hazard ratio, 0.95 [95% CI, 0.94-0.96] per MET) and women (0.94 [0.91-0.96] per MET). Among decedents (2406 [12.9%]), higher fitness was associated with lower risk of developing chronic conditions relative to survival (compression hazard ratio, 0.90 [95% CI, 0.88-0.92] per MET), suggesting morbidity compression. Conclusions: In this cohort of healthy middle-aged adults, fitness was significantly associated with a lower risk of developing chronic disease outcomes during 26 years of follow-up. These findings suggest that higher midlife fitness may be associated with the compression of morbidity in older age. ©2012 American Medical Association. All rights reserved.",cholesterol;glucose;age;aged;alcohol consumption;Alzheimer disease;article;billing and claims;blood pressure;body mass;cerebrovascular accident;cholesterol blood level;chronic disease;chronic kidney disease;colon cancer;congestive heart failure;diabetes mellitus;female;fitness;glucose blood level;human;ischemic heart disease;longitudinal study;lung cancer;major clinical study;male;medicare;physical activity;priority journal;risk assessment;smoking;survival rate;treadmill exercise,"Willis, B. L.;Gao, A.;Leonard, D.;DeFina, L. F.;Berry, J. D.",2012,,,0,
4810,Relation of neurological findings after cardiac arrest to outcome,"Routine neurological examination of patients one hr after cardiac arrest seems to be of value in determining the prognosis for life and likelihood of intellectual impairment. In 48 patients, 53 episodes of cardiac arrest were followed by serial neurological examinations. Patients were divided into 2 groups according to neurological findings one hr after cardiac arrest. Patients in group 1 were unresponsive or at most responded in a reflex fashion to painful stimuli at one hr; these patients died or survived with intellectual damage. Patients in group 2 responded purposefully at one hr and survived without neurological damage. These patients commonly showed transient confusional states and a variety of other nonfocal abnormalities, and focal signs were seen occasionally.",brain;brain hypoxia;confusion;dementia;etiology;exteroceptive reflex;extraocular muscle;heart arrest;intellectual function;major clinical study;neurology;pain;speech disorder,"Willoughby, J. O.;Leach, B. G.",1974,,,0,
4811,"Transdermal nicotine administration in Alzheimer's disease: effects on cognition, behavior and cardiac function",,Sr-dementia,"Wilson, Al;McCarten, Jr;Langley, Lk;Bauer, T;Monley, J;Rottunda, S;McFalls, E;Kovera, C",1995,,,0,4812
4812,"Transdermal nicotine administration in Alzheimer's disease: effects on cognition, behavior and cardiac function",,Sr-dementia,"Wilson, A. L.;McCarten, J. R.;Langley, L. K.;Bauer, T.;Monley, J.;Rottunda, S.;McFalls, E.;Kovera, C.",1995,,,0,
4813,"Vascular Disease, Depression and Cognitive Impairment",,acetylsalicylic acid;antidepressant agent;calcium channel blocking agent;cholinesterase inhibitor;citalopram;hydroxymethylglutaryl coenzyme A reductase inhibitor;lithium;mirtazapine;placebo;serotonin uptake inhibitor;sertraline;Alzheimer disease;amnesia;article;brain atrophy;cerebrovascular disease;clinical trial;cognitive defect;computer assisted tomography;controlled clinical trial;depression;disease association;elderly care;electroconvulsive therapy;electroencephalogram;Europe;follow up;group therapy;heart disease;heart infarction;human;life stress;multiinfarct dementia;nuclear magnetic resonance imaging;peripheral vascular disease;positron emission tomography;prognosis;pseudodementia;quality of life;randomized controlled trial;risk factor;single photon emission computer tomography;cerebrovascular accident;transcranial magnetic stimulation;transient ischemic attack;treatment duration;vascular depression;vascular disease;aspirin,"Wilson, K.",2008,,,0,
4814,"An official American thoracic society workshop report a framework for addressing multimorbidity in clinical practice guidelines for pulmonary disease, critical illness, and sleep disorders","Coexistence ofmultiple chronic conditions (i.e., multimorbidity) is the most common chronic health problem in adults. However, clinical practice guidelines have primarily focused on patients with a single disease, resulting in uncertainty about the care of patients with multimorbidity. The American Thoracic Society convened a workshop with the goal of establishing a strategy to address multimorbidity within clinical practice guidelines. In this Workshop Report, we describe a framework that addresses multimorbidity in each of the key steps of guideline development: topic selection, panel composition, identifying clinical questions, searching for and synthesizing evidence, rating the quality of that evidence, summarizing benefits and harms, formulating recommendations, and rating the strength of the recommendations. For the consideration of multimorbidity in guidelines to be successful and sustainable, the process must be both feasible and pragmatic. It is likely that this will be achieved best by the step-wise addition and refinement of the various components of the framework.",Alzheimer disease;anemia;arthritis;article;asthma;chronic kidney disease;chronic obstructive lung disease;clinical outcome;critical illness;depression;diabetes mellitus;functional disease;functional status;heart failure;hospital readmission;human;hyperlipidemia;hypertension;ischemic heart disease;lung disease;major clinical study;medical society;morbidity;practice guideline;quality of life;sleep disorder,"Wilson, K. C.;Gould, M. K.;Krishnan, J. A.;Boyd, C. M.;Brozek, J. L.;Cooke, C. R.;Douglas, I. S.;Goodman, R. A.;Joo, M. J.;Lareau, S.;Mularski, R. A.;Patel, M. R.;Rosenfeld, R. M.;Shanawani, H.;Slatore, C.;Sockrider, M.;Sufian, B.;Thomson, C. C.;Wiener, R. S.",2016,,,0,
4815,Change in depressive symptoms during the prodromal phase of Alzheimer disease,"Context: Prospective studies have established an association between depressive symptoms and risk of dementia, but how depressive symptoms change during the evolution of dementia is uncertain. Objective: To test the hypothesis that depressive symptoms increase during the prodromal phase of Alzheimer disease (AD). Design: Prospective cohort study. Participants and Setting: For up to 13 years, 917 older Catholic nuns, priests, and monks without dementia at study onset completed annual clinical evaluations that included administration of the 10-item Center for Epidemiologic Studies Depression Scale and clinical classification of mild cognitive impairment and AD. Main Outcome Measure: Change in depressive symptoms reported on the Center for Epidemiologic Studies Depression Scale. Results: At baseline, participants reported a mean (SD) of 1.0 (1.5) depressive symptoms. Those who developed AD (n=190) showed no increase in depressive symptoms before the diagnosis was made, and this finding was not modified by age, sex, education, memory complaints, vascular burden, or personality. There was no systematic change in depressive symptoms after the AD diagnosis, although symptoms tended to decrease in women relative to men and in those with a higher premorbid level of openness and a lower premorbid level of agreeableness. Among those without cognitive impairment at baseline, depressive symptoms did not increase in those who subsequently developed mild cognitive impairment. Conclusion: We found no evidence of an increase in depressive symptoms during the prodromal phase of AD. ©2008 American Medical Association. All rights reserved.",adult;age distribution;aged;Alzheimer disease;article;Center for Epidemiological Studies Depression Scale;claudication;cognitive defect;dementia;depression;diabetes mellitus;diagnostic value;disease classification;education;extraversion;female;gender;heart infarction;human;hypertension;major clinical study;male;neurosis;prospective study;religion;risk assessment;risk factor;self report;smoking;cerebrovascular accident;symptomatology;validation study;vascular disease,"Wilson, R. S.;Arnold, S. E.;Beck, T. L.;Bienias, J. L.;Bennett, D. A.",2008,,,0,
4816,Terminal cognitive decline: Accelerated loss of cognition in the last years of life,"OBJECTIVE: To test the hypothesis that rate of cognitive decline accelerates in the last years of life. METHODS: Participants are 853 older persons without dementia at study onset. For up to 8 years, they underwent annual clinical evaluations that included a battery of 19 cognitive tests from which previously established composite measures of global cognition and specific cognitive domains were derived. In analyses, we used linear mixed-effects models that allowed rate of cognitive decline to change at a given point before death to estimate the onset of a terminal decline period and rate of cognitive decline before and after that point. In subsequent analyses, we tested potential modifiers of terminal decline. RESULTS: There were 115 deaths. Those who died did not differ from survivors in their level of global cognitive function at study onset, but beginning a mean of 42 months before death, their rate of global cognitive decline sharply increased. The duration and rapidity of terminal decline in global cognition differed from person to person. Terminal cognitive decline was not modified by age, sex, education, or the presence of mild cognitive impairment, but it was not present in those with vascular disease (e.g., stroke and heart attack) or in those without at least one copy of the apolipoprotein E ε4 allele, suggesting that Alzheimer's disease pathology may contribute to the phenomenon. CONCLUSIONS: In old age, cognitive decline markedly accelerates during the last 3 to 4 years of life, consistent with the terminal decline hypothesis. Copyright © 2007 by American Psychosomatic Society.",apolipoprotein E4;aged;allele;Alzheimer disease;article;cognitive defect;controlled study;course evaluation;female;heart infarction;human;hypothesis;lifespan;major clinical study;male;periodic medical examination;priority journal;psychologic assessment;sample size;senescence;statistical model;cerebrovascular accident;survivor,"Wilson, R. S.;Beck, T. L.;Bienias, J. L.;Bennett, D. A.",2007,,,0,
4817,Rapid identification of ApoE alleles by multiple-single-strand conformation polymorphism (SSCP) analysis,,"*Alleles;Alzheimer Disease/genetics;Apolipoproteins E/*genetics;Base Sequence;Coronary Disease/genetics;Genes;Humans;Molecular Sequence Data;*Polymorphism, Single-Stranded Conformational","Wilton, S.;Lim, L.",1995,Sep,,0,
4818,Management of hypertension in older people,"WIN and TEO: Management of Hypertension in Older People: Systolic hypertension above > 160 mmHg is associated with cardiac, renal and cerebrovascular complications. In older people, treating hypertension offers cardiovascular benefits. Reduced salt intake and weight loss for obese older people improves blood pressure without any risk of adverse drug reactions. Blood pressure reduction is more important than the type of antihypertensive for cardiovascular risk reduction. The recommended drugs to start an older patient with isolated systolic hypertension are thiazides, calcium-channel blockers or angiotensin II receptor blocker. Studies were performed on relatively fit older patients, so benefits may not be generalisable to frail elderly. Alpha-blockers and beta-blockers are not recommended for first line therapy of hypertension but may be considered if there are other indications for their use.",amlodipine;atenolol;bendroflumethiazide;candesartan;captopril;chlortalidone;doxazosin;enalapril;felodipine;hydrochlorothiazide;indapamide;lisinopril;losartan;nitrendipine;perindopril;placebo;trandolapril;valsartan;verapamil;add on therapy;antihypertensive therapy;article;blood pressure monitoring;cardiovascular disease;cardiovascular mortality;cerebrovascular accident;cognitive defect;dementia;diabetes mellitus;drug dose reduction;heart failure;heart infarction;human;hypertension;isolated systolic hypertension;monotherapy;obesity;practice guideline;prescription;sodium restriction;systolic blood pressure;systolic hypertension;weight reduction,"Win, N. T.;Teo, S. P.",2017,,,0,
4819,Inpatient Mortality Risk Scores and Postdischarge Events in Hospitalized Heart Failure Patients: A Community-Based Study,"Background The Acute Decompensated Heart Failure National Registry (ADHERE) and Get With The Guidelines (GWTG) registries have developed simple heart failure (HF) in-hospital mortality risk scores. We hypothesized that HF scores predictive of in-hospital mortality would perform as well for early postdischarge mortality risk stratification. Methods and Results In this single-center, community-based, retrospective study of all consecutive primary HF hospitalizations (6203 hospitalizations in 3745 patients) from 2000 to 2013, the ADHERE and GWTG risk scores were calculated from admission data. There were 176 (3.0%) and 399 (6.7%), 869 (14.7%), and 1272 (21.5%) deaths in-hospital and at 30, 90, and 180 days postdischarge, respectively. The GWTG but not ADHERE risk score was well calibrated for in-hospital mortality. Both the ADHERE (C statistic 0.66 and 0.67, 0.64, and 0.64) and GWTG (C statistic 0.74 and 0.73, 0.71, and 0.70) HF risk scores were similarly predictive of in-hospital and 30-, 90-, and 180-day postdischarge mortality. The ADHERE risk score identified 10% and the GWTG risk score identified 20% of hospitalizations where 180-day postdischarge mortality was 50%, a prognostic bench mark for hospice referral. In contrast, hospitalizations characterized as lowest risk by the ADHERE (57% of hospitalizations; 180-day mortality 16.2%) or GWTG score (20% of hospitalizations; 180-day mortality 8.0%) had substantially lower mortality (odds ratios high versus low risk of 5-8 [ADHERE] and 11-18 [GWTG] across time points; P<0.0001 for all). Conclusions The simple ADHERE and GWTG scores stratify hospitalized HF patients for both inpatient and early postdischarge mortality risk, allowing comprehensive risk assessment on admission.",aldosterone antagonist;angiotensin receptor antagonist;creatinine;dipeptidyl carboxypeptidase inhibitor;hemoglobin;loop diuretic agent;sodium;age;aged;algorithm;article;atrial fibrillation;body mass;cardiovascular mortality;Charlson Comorbidity Index;chronic obstructive lung disease;clinical outcome;cohort analysis;community assessment;comparative study;coronary artery bypass graft;deceleration;dementia;diabetes mellitus;disease registry;female;heart failure;heart rate;hospice;hospital discharge;hospital mortality;hospital patient;hospital readmission;human;hypertension;length of stay;major clinical study;male;medical history;mortality risk;postdischarge mortality;predictive value;predictor variable;priority journal;prognostic assessment;retrospective study;risk assessment;systolic blood pressure;urea nitrogen blood level,"Win, S.;Hussain, I.;Hebl, V. B.;Dunlay, S. M.;Redfield, M. M.",2017,,10.1161/circheartfailure.117.003926,0,
4820,3-Year study of donepezil therapy in Alzheimer's disease: Effects of early and continuous therapy,"Delays in the diagnosis of Alzheimer's disease, and, therefore, delays in treatment, may have a detrimental effect on a patient's long-term well-being. This study assessed the effects of postponing donepezil treatment for 1 year by comparing patients treated continuously for 3 years with those who received placebo for 1 year followed by open-label donepezil for 2 years. Patients (n = 286) with possible or probable Alzheimer's disease (according to DSM-IV, NINCDS-ADRDA, and Mini-Mental State Examination criteria; see text) were randomized to receive donepezil (5 mg/day for 4 weeks, 10 mg/day thereafter) or placebo (delayed-start group) for 1 year. Of the 192 completers, 157 began a 2-year, open-label phase of donepezil treatment. Outcome measures were the Gottfries-Bråne-Steen scale, the Mini-Mental State Examination, the Global Deterioration Scale, the Progressive Deterioration Scale, the Neuropsychiatric Inventory, and safety (adverse events). Mixed regression analysis was used to compare changes between the groups over 3 years on the efficacy measures. There was a trend for patients receiving continuous therapy to have less global deterioration (Gottfries-Bråne-Steen scale) than those who had delayed treatment (p = 0.056). Small but statistically significant differences between the groups were observed for the secondary measures of cognitive function (Mini-Mental State Examination; p = 0.004) and cognitive and functional abilities (Global Deterioration Scale; p = 0.0231) in favor of continuous donepezil therapy. Over 90% of the patients in both cohorts experienced one treatment-emergent adverse event; most were considered mild or moderate. In conclusion, patients in whom the start of treatment is delayed may demonstrate slightly reduced benefits as compared with those seen in patients starting donepezil therapy early in the course of Alzheimer's disease. These data support the long-term efficacy and safety of donepezil. Copyright © 2006 S. Karger AG.",donepezil;placebo;abdominal pain;adult;aged;agitation;Alzheimer disease;anemia;anxiety;arthralgia;article;asthenia;backache;bradycardia;clinical assessment tool;clinical trial;cognition;cohort analysis;confusion;constipation;controlled clinical trial;controlled study;cystitis;delayed diagnosis;delusion;depression;deterioration;diarrhea;dizziness;double blind procedure;drug dose regimen;drug efficacy;drug safety;female;fracture;hallucination;headache;heart arrest;atrial fibrillation;hip osteoarthritis;hostility;human;insomnia;major clinical study;male;multicenter study;muscle hypertonia;nausea;outcome assessment;priority journal;randomized controlled trial;respiratory tract infection;side effect;faintness;therapy delay;treatment duration;urinary tract infection;vertigo;vomiting,"Winblad, B.;Wimo, A.;Engedal, K.;Soininen, H.;Verhey, F.;Waldemar, G.;Wetterholm, A. L.;Haglund, A.;Zhang, R.;Schindler, R.",2006,,,0,
4821,Genetics of cardiovascular disease: Importance of sex and ethnicity,"Sex differences in incidence and prevalence of and morbidity and mortality from cardiovascular disease are well documented. However, many studies examining the genetic basis for cardiovascular disease fail to consider sex as a variable in the study design, in part, because there is an inherent difficulty in studying the contribution of the sex chromosomes in women due to X chromosome inactivation. This paper will provide general background on the X and Y chromosomes (including gene content, the pseudoautosomal regions, and X chromosome inactivation), discuss how sex chromosomes have been ignored in Genome-wide Association Studies (GWAS) of cardiovascular diseases, and discuss genetics influencing development of cardiovascular risk factors and atherosclerosis with particular attention to carotid intima-medial thickness, and coronary arterial calcification based on sex-specific studies. In addition, a brief discussion of how ethnicity and hormonal status act as confounding variables in sex-based analysis will be considered along with methods for statistical analysis to account for sex in cardiovascular disease.",apolipoprotein E4;carbamoyl phosphate synthase;conjugated estrogen;cyclin D2;endothelial nitric oxide synthase;estradiol;estrogen;estrogen receptor alpha;estrogen receptor beta;G protein coupled receptor;gastric inhibitory polypeptide;gelatinase B;glucose;high density lipoprotein cholesterol;hydroxymethylglutaryl coenzyme A reductase;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;nitric oxide;noradrenalin;osteocalcin;osteopontin;peroxisome proliferator activated receptor gamma;proteochondroitin sulfate;sex hormone;testosterone;testosterone 17beta dehydrogenase;triacylglycerol;tyrosine 3 monooxygenase;abdominal obesity;Alzheimer disease;arterial wall thickness;article;atherosclerosis;CAG repeat;cardiovascular disease;cardiovascular risk;cerebrovascular accident;chromosome segregation;clinical trial (topic);confounding variable;coronary artery calcification;coronary artery disease;drug efficacy;dyslipidemia;ethnicity;fatty acid oxidation;gene frequency;genetic association;genetic polymorphism;genetic variability;heart failure;heart infarction;heredity;human;hyperlipidemia;hypertension;insulin resistance;lifestyle;male infertility;meta analysis (topic);metabolic syndrome X;non insulin dependent diabetes mellitus;obesity;ovary polycystic disease;priority journal;sex difference;single nucleotide polymorphism;smoking;statistical analysis;X chromosome inactivation;Y chromosome,"Winham, S. J.;de Andrade, M.;Miller, V. M.",2015,,,0,
4822,Underuse of ACE inhibitors and angiotensin II receptor blockers in elderly patients with diabetes,"Background: National guidelines recommend angiotensin-converting enzyme (ACE)-inhibitor or angiotensin receptor blocker (ARB) therapy in patients with diabetes who also have hypertension and/or proteinuria to retard the progression of renal damage. However, little is known about the adequacy of adherence to these guidelines in elderly patients with diabetes and predictors of such appropriate ACE-inhibitor or ARB use. Methods: Using linked medical claims from Medicare and the Pennsylvania Pharmaceutical Assistance Contract for the Elderly program, we studied a cohort of patients older than 65 years with diabetes. Baseline variables ascertained included age, sex, race, income, and several specific comorbid conditions. The outcome measure was at least 1 filled prescription for any ACE inhibitor or ARB during the quarter after the baseline year. We used multivariate logistic regression to measure predictors of use of the agents studied. Results: Of 30,750 patients with diabetes studied, 21,138 patients (68.7%) also had hypertension and/or proteinuria. Of these, only 50.7% (95% confidence interval, 50.0 to 51.4) were administered an ACE inhibitor or ARB in the quarter studied. In multivariate analyses, failure to be administered either agent was associated significantly with older age, male sex, chronic lung disease, depression, dementia, and other mental illness. Greater rates of ACE-inhibitor or ARB use were found in patients with coronary artery disease or congestive heart failure. Conclusion: Only half the elderly patients with diabetes studied received recommended treatment with ACE inhibitors or ARBs. This shortfall could provide an opportunity for quality-improvement interventions that could result in important benefits in clinical outcomes for these high-risk patients. © 2005 by the National Kidney Foundation, Inc.",angiotensin 2 receptor antagonist;dipeptidyl carboxypeptidase inhibitor;insulin;oral antidiabetic agent;age;aged;article;chronic lung disease;comorbidity;congestive heart failure;controlled study;coronary artery disease;dementia;demography;depression;diabetes mellitus;disease course;female;high risk patient;human;hypertension;income;major clinical study;male;medicare;mental disease;multivariate logistic regression analysis;outcomes research;practice guideline;prescription;proteinuria;race;sex role;statistical analysis;statistical significance,"Winkelmayer, W. C.;Fischer, M. A.;Schneeweiss, S.;Wang, P. S.;Levin, R.;Avorn, J.",2005,,,0,
4823,Genetic analysis for a shared biological basis between migraine and coronary artery disease,"Objective: To apply genetic analysis of genome-wide association data to study the extent and nature of a shared biological basis between migraine and coronary artery disease (CAD). Methods: Four separate methods for cross-phenotype genetic analysis were applied on data from 2 large-scale genome-wide association studies of migraine (19,981 cases, 56,667 controls) and CAD (21,076 cases, 63,014 controls). The first 2 methods quantified the extent of overlapping risk variants and assessed the load of CAD risk loci in migraineurs. Genomic regions of shared risk were then identified by analysis of covariance patterns between the 2 phenotypes and by querying known genome-wide significant loci. Results: We found a significant overlap of genetic risk loci for migraine and CAD. When stratified by migraine subtype, this was limited to migraine without aura, and the overlap was protective in that patients with migraine had a lower load of CAD risk alleles than controls. Genes indicated by 16 shared risk loci point to mechanisms with potential roles in migraine pathogenesis and CAD, including endothelial dysfunction (PHACTR1) and insulin homeostasis (GIP). Conclusions: The results suggest that shared biological processes contribute to risk of migraine and CAD, but surprisingly this commonality is restricted to migraine without aura and the impact is in opposite directions. Understanding the mechanisms underlying these processes and their opposite relationship to migraine and CAD may improve our understanding of both disorders.",gastric inhibitory polypeptide;allele;article;cardiovascular risk;controlled study;coronary artery disease;endothelial dysfunction;female;gene;gene locus;genetic analysis;genetic association;genetic risk;genetic variability;human;male;migraine;migraine without aura;pathogenesis;PHACTR1 gene;priority journal;single nucleotide polymorphism,"Winsvold, B. S.;Nelson, C. P.;Malik, R.;Gormley, P.;Anttila, V.;Heiden, J. V.;Elliott, K. S.;Jacobsen, L. M.;Palta, P.;Amin, N.;De Vries, B.;Hämäläinen, E.;Freilinger, T.;Ikram, M. A.;Kessler, T.;Koiranen, M.;Ligthart, L.;McMahon, G.;Pedersen, L. M.;Willenborg, C.;Won, H. H.;Olesen, J.;Artto, V.;Assimes, T. L.;Blankenberg, S.;Boomsma, D. I.;Cherkas, L.;Smith, G. D.;Epstein, S. E.;Erdmann, J.;Ferrari, M. D.;Göbel, H.;Hall, A. S.;Jarvelin, M. R.;Kallela, M.;Kaprio, J.;Kathiresan, S.;Lehtimäki, T.;McPherson, R.;März, W.;Nyholt, D. R.;O'Donnell, C. J.;Quaye, L.;Rader, D. J.;Raitakari, O.;Roberts, R.;Schunkert, H.;Schürks, M.;Stewart, A. F. R.;Terwindt, G. M.;Thorsteinsdottir, U.;Van Den Maagdenberg, A. M. J. M.;Van Duijn, C.;Wessman, M.;Kurth, T.;Kubisch, C.;Dichgans, M.;Chasman, D. I.;Cotsapas, C.;Zwart, J. A.;Samani, N. J.;Palotie, A.",2015,,,0,
4824,Gene editing technique successfully corrects mutation in human embryos,,CRISPR Cas system;cystic fibrosis;DNA repair;DNA template;embryo;gene;gene editing;gene mutation;genetic disorder;human;human embryo;Huntington chorea;hypertrophic cardiomyopathy;in vitro fertilization;incidence;infertility;intracytoplasmic sperm injection;medical ethics;mosaicism;MYBPC3 gene;note;oocyte;preimplantation genetic diagnosis;priority journal;risk reduction;sudden death;zygote,"Wise, J.",2017,,10.1136/bmj.j3726,0,
4825,Statins in the prevention and treatment of senile 'dementias'?,,hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein;reactive oxygen metabolite;aged;Alzheimer disease;article;atherosclerotic plaque;brain dysfunction;brain hypoxia;brain ischemia;cognitive defect;diabetes mellitus;evidence based medicine;heart infarction;human;lipoprotein blood level;oxidative stress;senile dementia;cerebrovascular accident,"Wiseman, A.",2006,,,0,
4826,Beta-protein immunoreactivity in the human brain after cardiac arrest,"Brain of twelve, 44-78 years old non-demented patients affected by total ischemia after cardiac arrest, were used in the study. All of them were resuscitated within a few minutes after cardiac arrest and they survived for 3 to 36 days afterward. In all cases, after cardiac arrest, beta PP overexpression was found by immunocytochemical methods in many cortical and subcortical neurons as well as in ependymal and choroid plexus cells. This overexpression of beta PP, was concomitant with formation of many A beta nonfibrillar (thioflavine-negative) plaques in the neuropil. Because of a break in the blood-brain barrier around many vessels, weakly A beta-immunoreactive material was also found. The data presented provided strong evidence that the total brain ischemia resulting from cardiac arrest is a risk factor for beta-amyloidosis.",amyloid beta protein;adult;Alzheimer disease;article;brain;brain ischemia;comparative study;culture technique;heart arrest;human;immunology;middle aged;pathophysiology;ultrastructure,"Wiśniewski, H. M.;Maślińska, D.",1996,,,0,
4827,Turning old age into a disease?: Better evidence is the answer,,aging;cognitive defect;delirium;dementia;falling;general practitioner;geriatric patient;geriatrics;health care personnel;health practitioner;health service;heart failure;hospital patient;human;hypertension;letter;long term care;maintenance therapy;medical education;national health service;osteoporosis;palliative therapy;physical capacity;priority journal;senescence,"Witham, M. D.",2009,,,0,
4828,Duloxetine for the long-term treatment of Major Depressive Disorder in patients aged 65 and older: An open-label study,"Background: Late-life depression is a common, chronic and recurring disorder for which guidelines recommend long-term therapy. The safety and efficacy of duloxetine for the treatment of major depressive disorder (MDD) were evaluated using data from elderly patients (age ≥ 65 years; n = 101) who participated in a large, multinational, open-label study. Methods: Patients meeting DSM-IV criteria for MDD received duloxetine 80 mg/d (40 mg twice daily (BID)) to 120 mg/d (60 mg BID) for up to 52 weeks. Efficacy measures included the Clinical Global Impression of Severity (CGI-S) scale, the 17-item Hamilton Rating Scale for Depression (HAMD17), the Beck Depression Inventory-II (BDI-II), the Patient Global Impression of Improvement (PGI-I) scale, and the Sheehan Disability Scale (SDS). Safety and tolerability were evaluated using discontinuation rates, spontaneously reported adverse events, and changes in vital signs, ECG, and laboratory analytes. Results: Mean changes in HAMD17 total score at Weeks 6, 28, and 52 were -13.0, -17.4 and -17.5 (all p-values <.001). Significant improvement (p < .001) in both clinician- (CGI-S) and patient-rated (PGI-I) measures of improvement were observed at Week 1 and sustained throughout the study. Observed case response rates at Weeks 6, 28, and 52 were 62.9%, 84.9%, and 89.4%, respectively, while the corresponding rates of remission were 41.4%, 69.8%, and 72.3%. Adverse events led to discontinuation in 27 (26.7%) patients. Treatment-emergent adverse events reported by >10% of patients included dizziness, nausea, constipation, somnolence, insomnia, dry mouth, and diarrhea. Most events occurred early in the study. Mean changes at endpoint in blood pressure and body weight were less than 2.0 mm Hg, and -0.1 kg, respectively. Conclusions: In this open-label study, duloxetine was effective, safe, and well tolerated in the longterm treatment of MDD in patients aged 65 and older. © 2004 Wohlreich et al; licensee BioMed Central Ltd.",duloxetine;abdominal pain;adult;aged;agitation;angina pectoris;anorexia;anxiety;article;atherosclerosis;backache;blood pressure;body weight;cerebrovascular disease;confusion;constipation;controlled study;dementia;diarrhea;dizziness;drug efficacy;drug safety;drug tolerability;drug withdrawal;female;Hamilton Depression Rating Scale;headache;heart muscle ischemia;hip fracture;human;hypomania;insomnia;major clinical study;major depression;male;nausea;remission;side effect;somnolence;sweating;tremor;vomiting;xerostomia,"Wohlreich, M. M.;Mallinckrodt, C. H.;Watkin, J. G.;Hay, D. P.",2004,,,0,
4829,Age and other risk factors of pneumonia among residents of Polish long-term care facilities,"Background: Pneumonia is one of the leading causes of morbidity and mortality in the elderly population. Nursing home-acquired pneumonia (NHAP) is probably the largest health problem in long-term care facilities (LTCFs). It is the second most common infection in LTCFs and frequently requires hospitalization. The aim of this study was to investigate the incidence rate of NHAP among LTCF residents, its microbial etiology, and the frequency of multidrug-resistant microorganisms. Risk factors for NHAP were analyzed. Methods: This was a prospective study conducted on a group of 217 elderly subjects aged ≥65 years, recruited from the inhabitants of LTCFs, with disabled elderly individuals living in the community serving as controls. Continuous surveillance was carried out from December 1, 2009 to November 30, 2010. Results: The incidence rate of NHAP in the observed population of Polish residents was 0.6/1000 resident-days. Vulnerability to NHAP was due to the poor general condition of residents, expressed by low Barthel index values (relative risk (RR) 1.6), the activities of daily living (ADL) score (RR 1.7), the Katz scale (RR 1.2), and limited physical activity (RR 1.6). Also significant were malnutrition (RR 2.3), the use of a bladder catheter (RR 1.3), dysphagia (RR 1.7), tracheotomy tube (RR 3.1), and gastric feeding tube (RR 3.5). Enterobacteriaceae were the predominant etiological agents of NHAP (56.3%). Conclusions: The significance of risk factors for NHAP among residents in LTCFs was confirmed. Unfortunately, we also found that a lack of proper supervision with regard to the microbiology of infections is characteristic of Polish health care and LTCFs. There is an opportunity to improve the medical care of patients with severe disabilities, limit the rise in antimicrobial resistance and the need for hospitalization, and improve the prognosis. © 2012 International Society for Infectious Diseases.",aged;antibiotic resistance;article;Barthel index;body weight;cerebrovascular accident;chronic obstructive lung disease;controlled study;daily life activity;decubitus;dementia;depression;diabetes mellitus;disease surveillance;dysphagia;enteric feeding;Enterobacteriaceae;feces incontinence;feeding apparatus;female;heart failure;home care;human;incidence;infection risk;ischemic heart disease;long term care;major clinical study;male;malnutrition;mental test;microbiological examination;mortality;multidrug resistance;neoplasm;nursing home;nursing home acquired pneumonia;nursing home patient;palliative therapy;personal hygiene;physical activity;pneumonia;Poland;poor general condition;prognosis;prospective study;prostate adenoma;residential home;risk factor;tracheostomy tube;tracheotomy;urinary catheter;varicosis,"Wójkowska-Mach, J.;Gryglewska, B.;Romaniszyn, D.;Natkaniec, J.;Pobiega, M.;Adamski, P.;Grodzicki, T.;Kubicz, D.;Heczko, P. B.",2013,,,0,
4830,"Aβ and C(lot), but not D(egradation)",,amyloid beta protein;fibrin;fibrinogen;plasminogen;Alzheimer disease;bleeding;blood clotting;brain ischemia;cardiovascular disease;dissolution;fibrinolysis;heart infarction;hemophilia;hemostasis;human;lysis;note;priority journal;protein binding;protein interaction;protein localization;risk factor;thrombosis;venous thromboembolism,"Wolberg, A. S.",2012,,,0,
4831,Reversible intellectual impairment: an internist's perspective,"A review of the relevant literature was stimulated by recent publications urging extensive laboratory assessment of elderly patients presenting with intellectual impairment. Published data regarding reversible causes of impairment are limited and exist only for hospitalized patients, with rare exceptions. The frequencies of azotemia, hyponatremia, volume depletion, hypoglycemia, cardiac arrhythmia, cerebrovascular disease, sensory impairment, hypercarbia, congestive heart failure, infections, subdural hematoma, and chemical intoxications as causes of the intellectual impairment are entirely unknown. It is reported that 8 per cent of patients hospitalized for dementia are depressed; alcoholism is causative in 8 to 13 per cent of patients with mental impairment; normal pressure hydrocephalus is reported in 7 to 12 per cent. The frequency of the latter conditions in outpatients is not known. While estimates exist for the frequencies of hypothyroidism, hyperparathyroidism, neurosyphilis, and vitamin B12 and folate deficiencies among the elderly, no prevalence data exist for these disorders among the intellectually impaired.",Aged;Alcoholism/complications;Dementia/etiology;Female;Humans;Hydrocephalus/complications;Infection/complications;Male;Mental Disorders/*etiology;Middle Aged;Neurosyphilis/complications;Nutrition Disorders/complications;Substance-Related Disorders/complications;Thyroid Diseases/complications,"Wolff, M. L.",1982,Oct,,0,
4832,Time-dependent study entries and exposures in cohort studies can easily be sources of different and avoidable types of bias,"OBJECTIVES: To display and discuss the reasons and consequences of length and time-dependent bias. They might occur in presence of a time-dependent study entry or a time-dependent exposure which might change from unexposed to exposed. STUDY DESIGN AND SETTING: Recalling the popular study of Oscar nominees and using a real-data example from hospital epidemiology, we give innovative and easy-to-understand graphical presentations of how these biases corrupt the analyses via distorted time-at-risk. Cumulative hazard plots and Cox proportional hazards models were used. We are building bridges to medical disciplines such as critical care medicine, hepatology, pharmaco-epidemiology, transplantation medicine, neurology, gynecology and cardiology. RESULTS: In presence of time-dependent bias, the hazard ratio (comparing exposed with unexposed) is artificially underestimated. The length bias leads to an artificial underestimation of the overall hazard. When both biases coexist it can lead to different directions of biased hazard ratios. CONCLUSION: Since length and time-dependent bias might occur in several medical disciplines, we conclude that understanding and awareness are the best prevention of survival bias.","Abortion, Spontaneous/epidemiology;Alzheimer Disease/mortality;*Cohort Studies;Coronary Disease/epidemiology;Cross Infection/epidemiology;*Data Interpretation, Statistical;Diabetes Mellitus/epidemiology;Female;Heart Transplantation/mortality;Humans;Length of Stay/statistics & numerical data;Liver Cirrhosis/mortality;Pregnancy;Proportional Hazards Models;*Selection Bias;*Survival Analysis;Time Factors","Wolkewitz, M.;Allignol, A.;Harbarth, S.;de Angelis, G.;Schumacher, M.;Beyersmann, J.",2012,Nov,10.1016/j.jclinepi.2012.04.008,0,
4833,Ethnicity-dependent genetic association of ABCA2 with sporadic Alzheimer's disease,"A recent study demonstrated a significant genetic association between the ATP-binding cassette transporter A2 (ABCA2) and the risk for Alzheimer's disease (AD) in a large Caucasian sample. The rare T allele of the synonymous exonic single nucleotide polymorphism (SNP) rs908832 was overrepresented in early-onset AD patients as compared to cognitively healthy controls. Here we confirm the association of rs908832 with AD in a Western European population (n = 291, P = 0.008). In a second sample from Southern Europe, rs908832 was not associated with AD. Interestingly, rs908832 was not polymorphic in a Japanese sample. Furthermore, rs908832 was not associated with either serum cholesterol levels or with the risk for coronary artery disease, but seemed to be related to cholesterol levels in the cerebrospinal fluid. These data suggest that ABCA2 may exert population-dependent effects on the genetic risk for sporadic AD and support a role of ABC lipid transporters in the pathogenesis of this disease.","ATP-Binding Cassette Transporters/*genetics;Alzheimer Disease/cerebrospinal fluid/ethnology/*genetics;Asian Continental Ancestry Group/genetics;Cholesterol/cerebrospinal fluid;European Continental Ancestry Group/genetics;Gene Frequency;Genetic Predisposition to Disease/ethnology/*genetics;Genotype;Greece;Humans;Japan;Polymorphism, Single Nucleotide;Switzerland","Wollmer, M. A.;Kapaki, E.;Hersberger, M.;Muntwyler, J.;Brunner, F.;Tsolaki, M.;Akatsu, H.;Kosaka, K.;Michikawa, M.;Molyva, D.;Paraskevas, G. P.;Lutjohann, D.;von Eckardstein, A.;Hock, C.;Nitsch, R. M.;Papassotiropoulos, A.",2006,Jul 5,10.1002/ajmg.b.30345,0,
4834,Aortic Valve Calcification and the Risk of dementia: A Population-Based Study,"The association of aortic valve calcification (AVC) with dementia remains unknown. In 2,428 non-demented participants from the population-based Rotterdam Study, we investigated the association of CT-assessed AVC with risk of dementia and cognitive decline. AVC was present in 33.1% of the population. During a median follow-up of 9.3 years, 160 participants developed dementia. We found no association between presence of AVC and risk of all-cause dementia [hazard ratio (HR): 0.89 (95% confidence interval (CI):0.63;1.26)]. Presence of AVC was not associated with cognitive decline on any of the cognitive tests, nor with a measure of global cognition.",Aortic valve pathology;calcification;dementia;epidemiology;imaging,"Wolters, F. J.;Bos, D.;Vernooij, M. W.;Franco, O. H.;Heart-Brain Connection collaborative research, group;Hofman, A.;Koudstaal, P. J.;van der Lugt, A.;Ikram, M. A.",2017,,,0,
4835,Serotonin Syndrome After Methylene Blue Administration During Cardiac Surgery: A Case Report and Review,,aspartate aminotransferase;clonazepam;creatine kinase;creatinine;desflurane;esketamine;granisetron;haloperidol;methylene blue;paroxetine;quetiapine;vasopressin;adult;adverse outcome;article;aspartate aminotransferase blood level;blood examination;cardiopulmonary bypass;case report;computer assisted tomography;creatinine blood level;depression;drug withdrawal;female;glomerulus filtration rate;heart surgery;human;hyperkalemia;kidney function;liver function test;medical history;mental deterioration;middle aged;mitral valve regurgitation;mitral valve repair;muscle hypertonia;mydriasis;nystagmus;postoperative delirium;priority journal;serotonin syndrome;vasoplegia,"Wolvetang, T.;Janse, R.;ter Horst, M.",2016,,10.1053/j.jvca.2015.11.019,0,
4836,Access to new medicines in New Zealand compared to Australia,"Aim To compare access to new prescription-only medicines in New Zealand (NZ) with that in Australia. Method The range of new prescription medicines and the timing of their regulatory approval and reimbursement in NZ and Australia in the period 2000 to 2009 were compared. Results 136 new prescription medicines were first listed in the Australian Schedule of Pharmaceutical Benefits in the study period and 59 (43%) of these were listed in the NZ Pharmaceutical Schedule. Listing of these 59 medicines for reimbursement occurred later in NZ (mean difference=32.7 months; 95% CI 24.2 to 41.2 months; p<0.0001) due largely to a longer time from registration to listing (mean difference=23.7 months; 95% CI 14.9 to 32.4 months; p<0.0001). The remaining 77 medicines that are reimbursed in Australia but not in NZ cover a wide range of therapeutic areas, including some diseases for which there are no reimbursed medicines in NZ. Four new medicines were listed in NZ but not Australia. Conclusion In the last decade, public access to new medicines in NZ has been more limited and delayed compared to Australia. © NZMA.",abatacept;amisulpride;amprenavir;anecortave;bimatoprost;bisoprolol;eplerenone;eptifibatide;fenofibrate;glimepiride;hirulog;insulin detemir;lanthanum;meloxicam;parathyroid hormone[1-34];pioglitazone;prasugrel;prescription drug;ranibizumab;recombinant interleukin 1 receptor blocking agent;rosiglitazone;rosuvastatin;sevelamer;strontium;tenofovir;tiotropium bromide;tipranavir;travoprost;unindexed drug;verteporfin;acromegaly;acute coronary syndrome;acute heart infarction;Alzheimer disease;article;aspergillosis;asthma;atopic dermatitis;Australia;bone metastasis;breast cancer;chronic kidney disease;colorectal cancer;controlled study;depression;dyslipidemia;epilepsy;health care access;heart failure;hepatitis B;human;Human immunodeficiency virus infection;hyperphosphatemia;hypertension;kidney transplantation;larynx cancer;liver cell carcinoma;non small cell lung cancer;motor neuron disease;multiple myeloma;multiple sclerosis;myeloid leukemia;narcolepsy;nausea and vomiting;New Zealand;non insulin dependent diabetes mellitus;osteoarthritis;osteoporosis;pain;Parkinson disease;prostate cancer;psoriasis vulgaris;pulmonary hypertension;radiotherapy;reimbursement;age related macular degeneration;rheumatoid arthritis;sepsis;squamous cell carcinoma,"Wonder, M.;Milne, R.",2011,,,0,
4837,Embracing new paradigms in managing coronary disease: Is there yet a missing link to be connected?,,alirocumab;antilipemic agent;evolucumab;placebo;ticagrelor;unclassified drug;amnesia;anatomical variation;attention disturbance;bleeding;cardiovascular risk;cognitive defect;computed tomographic angiography;coronary artery disease;delirium;dementia;disease association;drug safety;drug tolerability;electrocardiogram;eye disease;high risk patient;human;injection site reaction;letter;mental disease;myalgia;outcome assessment;perception disorder;percutaneous coronary intervention;priority journal;risk assessment;risk benefit analysis;risk factor;scoring system,"Wong, C. K.",2015,,,0,
4838,Palliative care presentations to emergency departments in a secondary and a sub-acute hospital: A one year incidence study,"Introduction: There is growing concern that Emergency Departments (ED) are ill equipped to manage rising palliative care demand, but actual demand is unknown. The aim of this study was to estimate the annual incidence of patients with palliative care need presenting to EDs. Methods: Retrospective case review study across two New Zealand emergency departments from 1 July 2010 to 30 June 2011. We used a two-step process where (1) administrative databases were screened for patients who had presented with 12 diseases associated with palliative care need and (2) the Gold Standard Framework Prognostic Indicator Guidance (GSF PIG) criteria were applied to the clinical records of a random sample of patients meeting the disease criterion. Results: Fifty-three thousand and fifty-seven patients presented to the EDs; 4488 (8.5%) patients had diagnostic codes indicating potential palliative care need and 1024 were randomly sampled. One hundred and eighty-eight patients (18.4%, 95%CI 16.0–20.8%) from the random sample were identified as meeting GSF PIG criteria for palliative care need. The leading diseases were cancer (26.1%), COPD (26.1%) and heart failure (22.9%). Extrapolating from the estimated incidence, 826 of the 4488 patients with 12 diseases would have met GSF PIG criteria, suggesting only 1.6% of all patients presenting to ED meet GSF PIG criteria. Conclusions: The incidence of patients with actual palliative care need presenting to EDs was lower than anticipated. Further research is needed to examine for secular trends in palliative care presentations and if the incidence rates are consistent in across ED settings.",adolescent;adult;aged;article;cancer patient;chronic obstructive lung disease;dementia;emergency ward;female;human;ICD-10;incidence;kidney failure;major clinical study;male;medical record;motor neuron disease;multiple sclerosis;pain;palliative therapy;Parkinson disease;secondary care center;very elderly,"Wong, J.;Gott, M.;Frey, R.;McLay, J.;Jull, A.",2017,,10.1080/09699260.2017.1365407,0,
4839,Mitochondrial syndromes with leukoencephalopathies,"White matter involvement has recently been recognized as a common feature in patients with multisystem mitochondrial disorders that may be caused by molecular defects in either the mitochondrial genome or the nuclear genes. It was first realized in classical mitochondrial syndromes associated with mitochondrial DNA (mtDNA) mutations, such as mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS), Leigh's disease, and Kearns-Sayre's syndrome. Deficiencies in respiratory chain complexes I, II, IV, and V often cause Leigh's disease; most of them are due to nuclear defects that may lead to severe early-onset leukoencephalopathies. Defects in a group of nuclear genes involved in the maintenance of mtDNA integrity may also affect the white matter; for example, mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) caused by thymidine phosphorylase deficiency, Navajo neurohepatopathy (NNH) due to MPV17 mutations, and Alpers syndrome due to defects in DNA polymerase gamma (POLG). More recently, leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL) has been reported to be caused by autosomal recessive mutations in a mitochondrial aspartyl-tRNA synthetase, DARS2 gene. A patient with leukoencephalopathy and neurologic complications in addition to a multisystem involvement warrants a complete evaluation for mitochondrial disorders. A definite diagnosis may be achieved by molecular analysis of candidate genes based on the biochemical, clinical, and imaging results. © 2012 by Thieme Medical Publishers, Inc.",aspartate transfer RNA ligase;methionine;mitochondrial DNA;phenylalanine;thymidine phosphorylase;Alpers disease;article;blood analysis;brain atrophy;cerebellar ataxia;cerebral blindness;cerebrospinal fluid;cerebrospinal fluid analysis;complex II deficiency;cytochrome c oxidase deficiency;disease severity;disorders of mitochondrial functions;gastrointestinal motility disorder;hemiparesis;human;Kearns Sayre syndrome;lactic acidosis;Leber hereditary optic neuropathy;Leigh disease;leukoencephalopathy;MELAS syndrome;mental deterioration;MERRF syndrome;microcephaly;migraine;missense mutation;MNGIE syndrome;molecular diagnosis;molecular interaction;muscle biopsy;muscle weakness;nuclear magnetic resonance imaging;nuclear magnetic resonance spectroscopy;onset age;oxygen consumption;perception deafness;point mutation;posterior reversible encephalopathy syndrome;priority journal;ptosis;pyruvate dehydrogenase complex deficiency;recurrent disease;respiratory chain;tonic clonic seizure;white matter,"Wong, L. J. C.",2012,,,0,
4840,Early and late mortality in hospitalised patients with raised cardiac troponin T,"Aims Cardiac troponins are measured in acute coronary syndrome (ACS) and other conditions. The authors investigate the prognostic significance of cardiac troponin T (TnT) test and comorbid medical conditions. Methods Consecutive patients admitted to the Aintree University Hospital, Liverpool, between 2 January 2004 and 29 February 2004 who had TnT measurement were included. Patients were separated into normal (<0.01 μg/l) or raised TnT levels (≥0.01 μg/l), and further categorised into: (1) normal TnT with unstable angina; (2) normal TnT with non-ACS; (3) raised TnT with ACS; and (4) raised TnT with non-ACS. Cox regression was used to identify prognostic variables, and logrank test to compare 7-year survival. Results Of 1021 patients, 313 had raised TnT (195 ACS, 118 non-ACS) and 708 normal TnT (80 ACS, 628 non-ACS). Age (HR 1.06; 95% CI 1.05 to 1.07), congestive cardiac failure (HR 1.37; 95% CI 1.11 to 1.69), cerebrovascular disease (HR 1.37; 95% CI 1.10 to 1.71), chronic obstructive airway disease (HR 1.44; 95% CI 1.19 to 1.75), liver disease (HR 4.16; 95% CI 2.37 to 7.31), renal disease (HR 1.83; 95% CI 1.27 to 2.64), tumour (HR 1.39; 95% CI 1.07 to 1.79), lymphoma (HR 4.81; 95% CI 2.07 to 11.16), metastatic cancer (HR 3.55; 95% CI 2.32 to 5.45) and a higher Charlson's comorbidity score (HR 1.20, 95% CI 1.13 to 1.26) were adverse predictors. Both raised TnT with ACS (HR 1.92, 95% CI 1.54 to 2.39) and raised TnT with non-ACS (HR 2.37, 95% CI 1.87 to 3.00) were associated with worse survival. Raised TnT with non-ACS had a worse survival than raised TnT with ACS (p1/40.001). Conclusion Hospitalised patients with raised TnT levels from any cause predicted a higher mortality than normal TnT, with worst survival in those without an obvious ACS.",troponin T;adult;aged;angina pectoris;article;cerebrovascular disease;chronic obstructive lung disease;cohort analysis;comorbidity;congestive heart failure;coronary artery bypass graft;dementia;diabetes mellitus;female;heart infarction;heart muscle revascularization;hospital admission;hospital patient;human;hypertension;kidney disease;leukemia;liver disease;lymphoma;major clinical study;male;metastasis;mortality;percutaneous coronary intervention;peripheral vascular disease;predictor variable;prognosis;prospective study;solid tumor;transient ischemic attack;university hospital,"Wong, P. S. C.;Jones, J. D.;Ashrafi, R.;Khanzada, O.;Wickramarachchi, U.;Keen, T. H.;Robinson, D. R.",2012,,,0,
4841,Validation of a prediction score model to distinguish acute coronary syndromes from other conditions causing raised cardiac troponin T levels,"OBJECTIVE: Serum cardiac troponins can be elevated in acute coronary syndromes (ACS) and other non-ACS conditions. We investigated the usefulness of a prediction score model comprising clinical variables to distinguish patients with ACS from other non-ACS conditions. Methods: Two independent, non-randomized observational cohorts (groups 1 and 2) were examined, comprising consecutive patients who were admitted to a university teaching hospital and found to have a raised serum troponin T level (≥0.01'μg/l). The international definition was used to confirm acute myocardial infarction. Multivariate logistic regression identified clinical variables in the first cohort, which were used to construct a score model for distinguishing between ACS and non-ACS, and this score was re-evaluated in the second cohort. Results: Of the 313 patients in group 1, a score model was formulated using logarithm troponin T, ischaemic chest pain, ST depression and atrial fibrillation or flutter. Using a score of more than or equal to 1.5, sensitivity and specificity for predicting non-ACS were 0.81 and 0.84. The area under the curve was 0.900 (95% confidence interval 0.867-0.934). Sensitivity and specificity for predicting non-ACS among the 341 patients in group 2 using the same model and a score of more than or equal to 1.5 were 0.76 and 0.89, respectively, and the area under the curve was 0.918 (confidence interval 0.887-0.945). Conclusion: A prediction score model using simple clinical variables has been validated, and this can help clinicians in distinguishing patients with ACS from other non-ACS conditions. Copyright © 2010 Lippincott Williams & Wilkins.",troponin T;acute heart infarction;aged;angina pectoris;area under the curve;article;asthma;chronic obstructive lung disease;congestive heart failure;coronary artery bypass graft;dementia;diabetes mellitus;dyspnea;electrocardiography;female;atrial fibrillation;heart atrium flutter;heart bundle branch block;human;hypertension;kidney disease;leukemia;lymphoma;major clinical study;male;mathematical model;mortality;multivariate logistic regression analysis;percutaneous coronary intervention;peripheral vascular disease;predictive validity;priority journal;protein blood level;scoring system;sensitivity and specificity;smoking;solid tumor,"Wong, P. S. C.;Rao, G. K.;Innasimuthu, A. L.;Saeed, Y.;Van Heyningen, C.;Robinson, D. R.",2010,,,0,
4842,A clinical assessment of wilson disease in patients with concurrent liver disease,"Goals: To investigate variations in clinical epidemiology of Wilson disease in patients with concurrent liver disease and the effect of coexisting disease on current diagnostic algorithms. Background: Wilson disease is a rare disorder and few studies exist on diagnosis and natural history. Currently available tools have limited efficacy in complex patients, and the presence of coexisting diseases may further limit their use. More in-depth analyses of Wilson disease among complex patients with concurrent diseases will help improve algorithms for earlier diagnosis and treatment. STUDY: A retrospective cohort study using data from a large tertiary-care center to carry out a clinical assessment of Wilson disease among patients with coexisting liver disease. Results: Forty-two Wilson disease patients were identified; 9 had comorbid liver diseases. The average age of diagnosis was significantly older in patients with concurrent liver disease compared with those without underlying disease (49.1 y vs. 26.8 y, P<0.0001). Patients with concurrent liver disease had more evidence of cirrhosis at presentation (9/9, 100% vs. 15/33, 45.5%), and showed greater mortality (4/8, 50% vs. 4/29, 13.8%, P=0.0222). Without mutation analysis data, a definitive diagnosis of Wilson disease using Leipzig criteria was made in 44% of patients with concurrent liver diseases. Conclusions: Patients with concurrent liver diseases were diagnosed with Wilson disease at significantly older ages, presented with more liver cirrhosis, and showed greater mortality. Mutation analysis is crucial for definitive diagnosis among complex cohorts and those with intermediate Leipzig scores. Copyright © 2011 by Lippincott Williams & Wilkins.",alkaline phosphatase;ceruloplasmin;copper;penicillamine;trientine;zinc;adult;age distribution;algorithm;alkaline phosphatase blood level;article;autoimmune liver disease;cardiogenic shock;cause of death;ceruloplasmin blood level;clinical article;clinical assessment;clinical feature;cohort analysis;comorbidity;controlled study;dementia;depression;diagnostic approach route;disease classification;female;genetic analysis;heart arrest;hemochromatosis;hepatitis C;human;insomnia;leipzig criteria;liver cell carcinoma;liver disease;liver level;liver transplantation;male;medical error;memory disorder;mortality;multiple organ failure;mutational analysis;neuropsychiatry;overall survival;paranoia;priority journal;prognosis;respiratory failure;retrospective study;septic shock;tertiary health care;tremor;Wilson disease,"Wong, R. J.;Gish, R.;Schilsky, M.;Frenette, C.",2011,,,0,
4843,Prognostic Significance of Dementia in Older Adults with Solid Tumors,"BACKGROUND: The public health burden of cancer and dementia in the geriatric population is well documented. There is limited data on how dementia predicts mortality among geriatric patients with solid tumors. The objective of this study is to determine the prognostic significance of dementia on survival in patients with solid tumors. METHODS: We performed a 5-year retrospective study on elderly subjects aged >/=60 years with and without dementia that were diagnosed with solid tumors. RESULTS: Among 3,460 patients with solid tumors, 132 (3.8%) patients were found to have dementia. The median age at diagnosis was 71 years. Kaplan-Meier curves demonstrated that patients with dementia had an inferior median survival compared to the nondemented group (30 vs. 56 months; log-rank p < 0.001). Cox proportional hazard regression modeling identified age >80 years, female gender, diabetes mellitus, congestive heart failure, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease, dementia, and radiation therapy as risk factors for decreased overall survival. CONCLUSIONS: We demonstrated that dementia is associated with shorter overall survival in elderly patients with solid tumors.",,"Wongrakpanich, S.;Hurst, A.;Bustamante, J.;Candelario, N.;Biso, S.;Chaiwatcharayut, W.;Dourado, C.;Rosenzweig, A.",2017,,,0,
4844,Epidemiology and outcomes in community-acquired versus hospital-acquired AKI,"BACKGROUND AND OBJECTIVE: Compared with AKI in hospitalized patients, little is known about patients sustaining AKI in the community and how this differs from AKI in hospital. This study compared epidemiology, risk factors, and short- and long-term outcomes for patients with community-acquired (CA) and hospital-acquired (HA) AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 15,976 patients admitted to two district general hospitals between July 11, 2011, and January 15, 2012 were studied. Through use of an electronic database and the AKI Network classification, 686 patients with CA-AKI and 334 patients with HA-AKI were identified. Patients were followed up for 14 months, and data were collated on short-term and long-term renal and patient outcomes. RESULTS: The incidence of CA-AKI among all hospital admissions was 4.3% compared with an incidence of 2.1% of HA-AKI, giving an overall AKI incidence of 6.4%. Patients with CA-AKI were younger than patients with HA-AKI. Risks for developing HA and CA-AKI were similar and included preexisting CKD, cardiac failure, ischemic heart disease, hypertension, diabetes, dementia, and cancer. Patients with CA-AKI were more likely to have stage 3 AKI and had shorter lengths of hospital stay than patients with HA-AKI. Those with CA-AKI had better (multivariate-adjusted) survival than patients with HA-AKI (hazard ratio, 1.8 [95% CI, 1.44-2.13; P<0.001] for HA-AKI group). Mortality for the CA-AKI group was 45%; 43.7% of these deaths were acute in-hospital deaths. Mortality for the HA-AKI group was 62.9%, with 68.1% of these deaths being acute in-hospital deaths. Renal referral rates were low across the cohorts (8.3%). Renal outcomes were similar in both CA-AKI and HA-AKI groups, with 39.4% and 33.6% of patients in both groups developing de novo CKD or progression of preexisting CKD within 14 months, respectively. CONCLUSION: Patients with CA-AKI sustain more severe AKI than patients with HA-AKI. Despite having risk factors similar to those of patients with HA-AKI, patients with CA AKI have better short- and long-term outcomes.","Acute Kidney Injury/*epidemiology/mortality;Age Factors;Aged;Aged, 80 and over;Comorbidity;Dementia/epidemiology;Diabetes Mellitus/epidemiology;Female;Heart Failure/epidemiology;Hospital Mortality;Humans;Hypertension/epidemiology;Incidence;Length of Stay;Male;Middle Aged;Myocardial Ischemia/epidemiology;Neoplasms/epidemiology;Prevalence;Renal Insufficiency, Chronic/*epidemiology;Risk Factors;Severity of Illness Index;Survival Rate;Wales/epidemiology;acute renal failure;chronic kidney disease;clinical nephrology","Wonnacott, A.;Meran, S.;Amphlett, B.;Talabani, B.;Phillips, A.",2014,Jun 6,10.2215/cjn.07920713,0,
4845,"Relationships among diet, physical activity and other lifestyle factors and debilitating diseases in the elderly","Diet and physical activity are two major lifestyle factors that play a role in the prevention or management of debilitating conditions affecting older people. Both under- and overnutrition predispose to diseases. Low sodium and high potassium intakes, as well as the consumption of fruits and vegetables are associated with a reduction of hypertension and diseases arising from hypertension such as stroke and dementia. Dietary patterns (consumption of quantity and types of fats, cholesterol, vegetable oils, fish) are important in the prevention of coronary heart disease. Calcium and vitamin D intakes are important factors in the development of osteoporosis, while various dietary factors have been linked to the development of cancer. Physical activity is important in the prevention of functional decline and increased survival, reduced incidence of falls and fractures, and has various cardiovascular health benefits. Apart from prevention of diseases, exercise also has an important role in improving function in some chronic diseases such as heart failure or chronic obstructive pulmonary disease. Both diet and exercise interact, so that public health recommendations often take the form of lifestyle modification advice in the prevention of disease and disability.",calcium;potassium;sodium;vegetable oil;vitamin D;aged;aging;article;calcium intake;neoplasm;cardiovascular function;cholesterol intake;chronic obstructive lung disease;controlled study;dementia;diet;disease predisposition;falling;fat intake;fracture;fruit;functional disease;heart failure;human;hypertension;ischemic heart disease;lifestyle;malnutrition;osteoporosis;overnutrition;physical activity;potassium intake;sodium intake;cerebrovascular accident;survival;vegetable;vitamin intake,"Woo, J.",2000,,,0,
4846,Voltage-programming-based capillary gel electrophoresis for the fast detection of angiotensin-converting enzyme insertion/deletion polymorphism with high sensitivity,"A voltage-programming-based capillary gel electrophoresis method with a laser-induced fluorescence detector was developed for the fast and highly sensitive detection of DNA molecules related to angiotensin-converting enzyme insertion/deletion polymorphism, which has been reported to influence predisposition to various diseases such as cardiovascular disease, high blood pressure, myocardial infarction, and Alzheimer's disease. Various voltage programs were investigated for fast detection of specific DNA molecules of angiotensin-converting enzyme insertion/deletion polymorphism as a function of migration time and separation efficiency to establish the effect of voltage strength to resolution. Finally, the amplified products of the angiotensin-converting enzyme insertion/deletion polymorphism (190 and 490 bp DNA) were analyzed in 3.2 min without losing resolution under optimum voltage programming conditions, which were at least 75 times faster than conventional slab gel electrophoresis. In addition, the capillary gel electrophoresis method also successfully applied to the analysis of real human blood samples, although no polymorphism genes were detected by slab gel electrophoresis. Consequently, the developed voltage-programming capillary gel electrophoresis method with laser-induced fluorescence detection is an effective, rapid analysis technique for highly sensitive detection of disease-related specific DNA molecules.",Angiotensin-converting enzyme;Capillary gel electrophoresis;Deoxyribonucleic acid;Insertion/deletion polymorphism;Voltage programming,"Woo, N.;Kim, S. K.;Kang, S. H.",2016,Aug,10.1002/jssc.201600439,0,
4847,Mortality in patients with ST-segment elevation myocardial infarction who do not undergo reperfusion,"Reperfusion therapy reduces mortality in patients presenting with ST-segment elevation myocardial infarctions (STEMI). However, some patients may not receive thrombolytic therapy or undergo primary percutaneous coronary intervention. The decision making and clinical outcomes of these patients have not been well described. In this study, 139 patients were identified from a total of 1,126 patients with STEMI who did not undergo reperfusion therapy at a high-volume percutaneous coronary intervention center from October 2006 to March 2011. Clinical data, reasons for no reperfusion, management, and mortality were obtained by chart review. The mean age was 80 ± 13 years (61% women, 31% diabetic, and 37% known coronary artery disease). Of the 139 patients, 72 (52%) presented with primary diagnoses other than STEMI, and 39 (28%) developed STEMI >24 hours after admission. The most common reasons for no reperfusion were advanced age, co-morbid conditions, acute or chronic kidney injury, delayed presentation, advance directives precluding reperfusion, patient preference, and dementia. Eighty-four patients (60%) had <3 reasons for no reperfusion. Factors associated with hospital mortality were cardiogenic shock, intubation, and advance directives prohibiting reperfusion after physician consultation. In hospital and 1-year mortality were 53% and 69%, respectively. In conclusion, at a high-volume percutaneous coronary intervention center, most patients presenting with STEMI underwent immediate catheterization. The decision for no reperfusion was multifactorial, with advanced age reported as the most common factor. Outcomes were poor in this population, and fewer than half of these patients survived to hospital discharge. © 2012 Elsevier Inc. All rights reserved.",acetylsalicylic acid;angiotensin receptor antagonist;beta adrenergic receptor blocking agent;clopidogrel;dipeptidyl carboxypeptidase inhibitor;heparin;hydroxymethylglutaryl coenzyme A reductase inhibitor;low molecular weight heparin;prasugrel;aged;article;cardiogenic shock;cerebrovascular accident;comorbidity;coronary artery disease;decision making;dementia;diabetes mellitus;female;human;hyperlipidemia;hypertension;intubation;kidney injury;living will;major clinical study;male;mortality;neoplasm;outcome assessment;patient preference;priority journal,"Wood, F. O.;Leonowicz, N. A.;Vanhecke, T. E.;Dixon, S. R.;Grines, C. L.",2012,,,0,
4848,Direct evidence of progressive cardiac dysfunction in a transgenic mouse model of Huntington's disease,"HD is a progressive genetic neurological disorder, characterized by motor as well as cognitive impairments. The gene carrying the mutation causing Huntington's disease (HD) is not brain specific, and there is increasing evidence for peripheral, as well as brain pathology in this disorder. Here, we used in vivo and ex vivo techniques to assess the cardiac function of mice transgenic for the HD mutation. Using magnetic resonance imaging (MRI) of the beating heart, we show that abnormalities previously reported in end-stage mice are present by mid-stages of the disease. We also found abnormalities that have not been hitherto reported, including changes in cardiac efficiency and a mechanical distortion of the beating heart. Using the Langendorff preparation, we show reduced coronary blood flow, impaired myocardial contractility and reduced left ventricular developed pressure in HD mouse hearts. Together, our findings suggest that there is significant pathology of the HD mouse heart, even by mid stages of disease. Previous clinical research has demonstrated that the risk of cognitive symptoms increases markedly in patients with heart failure. R6/2 mice show significant progressive cognitive abnormalities, so we hypothesize that cardiac pathology in the R6/2 mouse may contribute, not only to their progressive decline and death, but also to their cognitive dysfunction. We suggest that closer attention should be paid to cardiovascular symptoms in HD patients.","Animals;Disease Models, Animal;Female;Heart/*physiopathology;Heart Function Tests;Huntington Disease/*pathology/*physiopathology;Magnetic Resonance Imaging;Male;Mice;Mice, Transgenic;Myocardium/*pathology;Huntington's disease;Langendorff;Mri;R6/2 mouse;cardiac dysfunction","Wood, N. I.;Sawiak, S. J.;Buonincontri, G.;Niu, Y.;Kane, A. D.;Carpenter, T. A.;Giussani, D. A.;Morton, A. J.",2012,,10.3233/jhd-2012-120004,0,
4849,Psychological medicine. Organic illness,,"Adrenal Insufficiency/complications;Age Factors;Amnesia/etiology;Anemia/complications;Antidepressive Agents/therapeutic use;Anxiety;Anxiety Disorders/drug therapy;Brain Neoplasms/complications;Bronchopneumonia/complications;Confusion/etiology;Dementia/etiology;Depression/drug therapy;Epilepsy, Temporal Lobe/complications;Female;Humans;Huntington Disease/complications;Hydrocephalus, Normal Pressure/complications;Hypoglycemia/complications;Hypothyroidism/complications;Ischemic Attack, Transient/complications;Male;Myocardial Infarction/complications;*Neurocognitive Disorders/etiology;Schizophrenia/etiology;Syphilis/complications;Vitamin B 12 Deficiency/complications","Wood, R. A.",1975,Mar 29,,0,
4850,Comfort always. The Rainey Hospice House: South Carolina's first inpatient hospice,"The Rainey Hospice House, South Carolina's first stand-alone inpatient facility opened in September 1998. During the year 2000, 220 inpatients were served in the house. Patients ranged in age from 23 to 107 years old (average age 73). Cancer was the most common hospice diagnosis, followed by congestive heart failure, cardiovascular disease and cerebrovascular disease, dementia, cirrhosis, renal failure, and COPD. Thirty-three percent of patients were in the program less than ten days. Over 98 percent of deaths under hospice care were described as peaceful. During 2000, our outpatients and our inpatients were similar in age, insurance coverage, diagnoses, and time in the program. Inpatient hospice is highly valued by families and patients alike. It is especially useful for the following patients: those with uncontrolled symptoms, those with exhausted care givers, those with no caregivers, those who require total care, and those very close to death. The symptoms most likely to precipitate inpatient admission include pain, nausea, confusion, and agitation. Given the graying of South Carolina's population and the increase in outpatient hospice care, more areas of the state will need inpatient facilities in the future.","Adult;Aged;Aged, 80 and over;Hospice Care/organization & administration/statistics & numerical data/*trends;Humans;Inpatients;Middle Aged;South Carolina","Woodall, H. E.;Dennis, W.",2003,Aug,,0,
4851,Treating chronically ill people with diabetes mellitus with limited life expectancy: implications for performance measurement,"OBJECTIVES: To develop an algorithm to identify individuals with limited life expectancy and examine the effect of limited life expectancy on glycemic control and treatment intensification in individuals with diabetes mellitus. DESIGN: Individuals with diabetes mellitus and coexisting congestive heart failure, chronic obstructive pulmonary disease, dementia, end-stage liver disease, and/or primary or metastatic cancer with limited life expectancy were identified. To validate the algorithm, 5-year mortality was assessed in individuals identified as having limited life expectancy. Rates of meeting performance measures for glycemic control between individuals with and without limited life expectancy were compared. In individuals with uncontrolled glycosylated hemoglobin (HbA(1c) ) levels, the effect of limited life expectancy on treatment intensification within 90 days was examined. SETTING: One hundred ten Department of Veterans Affairs facilities; October 2006 to September 2007. PARTICIPANTS: Eight hundred eighty-eight thousand six hundred twenty-eight individuals with diabetes mellitus. MEASUREMENTS: HbA(1c) ; treatment intensification within 90 days of index HbA(1c) reading. RESULTS: Twenty-nine thousand sixteen (3%) participants had limited life expectancy. Adjusting for age, 5-year mortality was five times as high in participants with limited life expectancy than in those without. Participants with limited life expectancy had poorer glycemic control than those without (glycemic control: 77.1% vs 78.1%; odds ratio (OR) = 0.84, 95% confidence interval (CI) = 0.81-0.86) and less-frequent treatment intensification (treatment intensification: 20.9% vs 28.6%; OR = 0.71, 95% CI = 0.67-0.76), even after controlling for patient-level characteristics. CONCLUSION: Participants with limited life expectancy were less likely than those without to have controlled HbA(1c) levels and to receive treatment intensification, suggesting that providers treat these individuals less aggressively. Quality measurement and performance-based reimbursement systems should acknowledge the different needs of this population.","Aged;Algorithms;Chronic Disease;Diabetes Mellitus/*blood/drug therapy;Female;Hemoglobin A, Glycosylated/*analysis;Humans;Life Expectancy;Male;Middle Aged;Treatment Outcome","Woodard, L. D.;Landrum, C. R.;Urech, T. H.;Profit, J.;Virani, S. S.;Petersen, L. A.",2012,Feb,10.1111/j.1532-5415.2011.03784.x,0,
4852,Report from Great Britain,,amfebutamone;amphotericin B;antibiotic agent;beta adrenergic receptor stimulating agent;beta interferon;caspofungin;codeine;donepezil;doxorubicin;glatiramer;hormone;hydroxymethylglutaryl coenzyme A reductase inhibitor;itraconazole;linezolid;morphine;mumps vaccine;oral contraceptive agent;peginterferon alpha2a;probiotic agent;steroid;theophylline;varicella zoster vaccine;Alzheimer disease;amyloidosis;angina pectoris;article;asthma;drug formulation;drug industry;hormone substitution;human;immune response;infusion;Internet;ischemic heart disease;meningitis;multiple sclerosis;national health service;non insulin dependent diabetes mellitus;obesity;patient information;postmenopause;thromboembolism;United Kingdom;aricept;caelyx;pegasys;varilrix,"Woodhouse, R. J.",2002,,,0,4854
4853,Report from Great Britain,,alpha adrenergic receptor blocking agent;antineoplastic agent;azithromycin;bortezomib;bosentan;dutasteride;imatinib;macrolide;magnesium;memantine;metformin;paroxetine;pimecrolimus;proteasome;tacrolimus;tamsulosin;unclassified drug;article;atopic dermatitis;neoplasm;chronic myeloid leukemia;clinical trial;dementia;diabetes mellitus;drug cost;drug industry;drug manufacture;drug marketing;financial management;heart infarction;homeopathy;human;phase 2 clinical trial;prostate hypertrophy;pulmonary hypertension;United Kingdom;ebixa;elidel;protopic;seroxat;tracleer,"Woodhouse, R. J.",2003,,,0,4854
4854,Report from Great Britain,,atorvastatin;bevacizumab;donepezil;drospirenone;drospirenone plus estradiol;estradiol;finasteride;galantamine;metformin;insulin;ivabradine;lansoprazole;memantine;methamphetamine;olopatadine;oseltamivir;phentermine;Pneumococcus vaccine;rivastigmine;sildenafil;tetrahydrolipstatin;tipranavir;Alzheimer disease;angina pectoris;article;chlamydiasis;diabetes mellitus;dose response;drug industry;drug manufacture;Helicobacter infection;human;Human immunodeficiency virus infection;medical society;postmenopause osteoporosis;United Kingdom;adipex;angeliq;aptivus;aricept;avastin;ebixa;exelon;glucophage sr;lipitor;opatanol;prevenar;procoralan;propecia;reminyl;tamiflu;viagra;xenical,"Woodhouse, R. J.",2006,,,0,
4855,Risperidone (Risperdal): Increased rate of cerebrovascular events in dementia trials,,adrenergic receptor;cholinesterase inhibitor;clozapine;dopamine receptor;haloperidol;histamine receptor;neuroleptic agent;olanzapine;quetiapine;risperidone;serotonin receptor;aggression;cardiovascular risk;cerebrovascular disease;dementia;diabetes mellitus;drug efficacy;drug mechanism;extrapyramidal symptom;heart failure;heart infarction;heart muscle ischemia;human;lipid blood level;medical decision making;negative syndrome;obesity;receptor blocking;risk assessment;risk management;short survey;cerebrovascular accident;transient ischemic attack,"Wooltorton, E.",2002,,,0,
4856,The ageing immune system and its clinical implications,"Ageing is associated with multiple changes in many different components of the immune system. A healthy immune system exists in a state of balance between efficient effector responses against pathogens and tolerance to self antigens. This balance is changed with age; functions such as antigen recognition, phagocytosis, antigen presentation, chemotaxis, cytokine secretion and killing ability are all compromised. Aberrant cellular responses lead to an altered cytokine network with increases in inflammatory cytokines and decreases in anti-inflammatory cytokines leading to a pro-inflammatory state. Consequently older patients require extra care in diagnosis of infections as symptoms may be perturbed, resulting in unusual presentations of common conditions. The defects in immunity due to immunosenescence also mean that older patients require more care and screening than other patients in the same disease cohort. Though it is generally understood by clinicians that older patients are more at risk from multiple infections, the wider clinical effects of immunosenescence are less understood. The immune system is involved in several neurodegenerative conditions and the inflammatory conditions of immunosenescence may be a key factor in pathogenesis. Similarly, there is reason to believe that immunosenescence might be a key factor explaining the increased incidence of cancer in older age. With increasing understanding of the immune system's involvement in many of these pathological processes, and the contribution that immunosenescence makes to these, more efficient vaccines and novel therapies may be developed to prevent/treat these conditions. © Copyright Cambridge University Press 2010.",antiretrovirus agent;B7 antigen;C reactive protein;CD16 antigen;CD86 antigen;gamma interferon;granulocyte macrophage colony stimulating factor;influenza vaccine;interleukin 1;interleukin 10;interleukin 12;interleukin 18;interleukin 2;interleukin 4;interleukin 6;interleukin 8;lipopolysaccharide;major histocompatibility antigen class 2;Pneumococcus vaccine;protein tyrosine phosphatase SHP 1;T lymphocyte receptor;toll like receptor;tumor necrosis factor alpha;tumor necrosis factor receptor;acquired immune deficiency syndrome;adaptive immunity;aging;Alzheimer disease;antigen specificity;apoptosis;article;atherosclerosis;autoimmunity;B lymphocyte;bone marrow;cancer incidence;carcinogenesis;cardiovascular disease;CD4+ T lymphocyte;cell migration;cell population;cell surface;community acquired pneumonia;cytokine production;cytokine release;cytomegalovirus infection;cytotoxic T lymphocyte;dendritic cell;diagnostic accuracy;drug efficacy;falling;genetic polymorphism;heart infarction;helper cell;highly active antiretroviral therapy;human;Human immunodeficiency virus infection;immune deficiency;immune system;immunomodulation;immunosenescence;immunosurveillance;inflammation;influenza;influenza vaccination;innate immunity;intracellular signaling;leukocyte count;longevity;lymphocyte;lymphocyte proliferation;macrophage;macrophage function;memory cell;monocyte;neutrophil;opsonization;Parkinson disease;pathogenesis;prognosis;protein expression;protein intake;regulatory T lymphocyte;respiratory burst;scoring system;sedentary lifestyle;senescence;Streptococcus pneumonia;stretching exercise;cerebrovascular accident;test strip;urinary tract infection;virus reactivation,"Wordsworth, D. T. H. J.;Dunn-Walters, D. K.",2011,,,0,
4857,Tricyclic antidepressant prescribing by psychiatrists and other physicians,,amitriptyline;desipramine;doxepin;imipramine;nortriptyline;tricyclic antidepressant agent;adult;aged;anticholinergic effect;closed angle glaucoma;congestive heart failure;dementia;depression;drug cost;drug efficacy;drug marketing;drug response;human;information processing;maintenance therapy;major clinical study;note;oral drug administration;orthostatic hypotension;prescription;priority journal;prostate hypertrophy;questionnaire;reliability;risk factor;scoring system;seizure,"Woster, P. S.;Montgomery, P. A.;Guthrie, S. K.",1994,,,0,
4858,Cognitive disorders in elderly patients with permanent atrial fibrillation,"BACKGROUND: Atrial fibrillation (AF) is a risk factor for development of thromboembolic events with an annual stroke rate of 4.5%. In subjects over 80 years AF is the single leading cause of major stroke. Moreover, about 25% of patients with AF in the absence of neurological deficits have tomographic signs of one or more silent cerebral infarcts. AIM: To investigate whether cognitive function in patients with permanent AF is significantly worse than in patients with sinus rhythm. METHODS: We included subjects aged > 65 years, without previous cerebrovascular events or dementia, with permanent arrhythmia lasting > 12 months. The AF group comprised 51 patients, aged 75.8 years. The control group consisted of 43 patients with sinus rhythm. The main points of the study protocol were: clinical history recording, physical examination, biochemical analyses, standard 12-lead ECG and transthoracic echocardiography. Cognitive status was assessed by Mini Mental State Examination (MMSE). RESULTS: Patients had established AF with a median duration of 4.9 years (range 1-21 years). Of the 51 patients, 51% had hypertension, 37% coronary artery disease, 12% presented sick sinus syndrome or atrioventricular advanced block with a VVI pacemaker implanted. There were no significant differences between the two groups though AF patients presented left ventricular hypertrophy and history of myocardial infarction more frequently. Patients in the sinus group had a lower-risk profile and received antithrombotic therapy less frequently than the AF group. However, a significant proportion of patients, particularly in the AF group received less than optimal thromboembolic prophylactic treatment with anticoagulants. Cognitive status was found to be significantly lower in the AF group, compared with the sinus rhythm group: 24.8 +/- 3.1 vs. 27.1 +/- 2.6 (p < 0.05). There were 43% patients with cognitive impairment in the AF group and 14% in the sinus rhythm group. CONCLUSIONS: Permanent AF in patients aged over 65 years seems to be associated with lower MMSE score compared with subjects with sinus rhythm. Cognitive impairment in older patients is a multifactorial disorder. One of the causes of low cognitive function in these patients appears to be permanent AF. Further prospective clinical trials should help determine the possible role of inadequate anticoagulant treatment, and its association with the deterioration of cognitive function in AF patients.","Aged;Aged, 80 and over;Atrial Fibrillation/*complications;Chronic Disease;Cognition Disorders/diagnosis/*etiology;Cross-Sectional Studies;Female;Humans;Male;Prospective Studies","Wozakowska-Kaplon, B.;Opolski, G.;Kosior, D.;Jaskulska-Niedziela, E.;Maroszynska-Dmoch, E.;Wlosowicz, M.",2009,May,,0,
4859,Absence of Chlamydia pneumoniae in brain of vascular dementia patients,"We recently detected cytomegalovirus (CMV) in brains of 83% of vascular dementia (VaD) patients and 34% of age-matched normal people. Since CMV and also Chlamydia pneumoniae (Cpn) have been found in some studies to be associated with coronary artery disease (which shares several risk factors with VaD), we sought Cpn DNA in VaD brain DNA. We examined brain specimens from 19 VaD patients, 16 elderly normal people and four Alzheimer's disease (AD) patients for the presence of a sequence in the Cpn gene for rRNA, using polymerase chain reaction (PCR) and taking stringent precautions against contamination. We did not detect Cpn DNA in any of the brain specimens, the sensitivity of detection being 10 copies or fewer bacterial DNA sequences per tube or, in terms of infectious units (IFU), 0.025 IFU. Our results do not support a role for Cpn in the aetiology of VaD, either in the 83% of patients in whose brains we detected CMV, or in the remaining 17% without CMV in brain.","Aged;Aged, 80 and over;Alzheimer Disease/microbiology;Brain/*microbiology;Chlamydia Infections/*diagnosis;Chlamydophila pneumoniae/genetics/*isolation & purification;Cytomegalovirus/genetics/isolation & purification;DNA, Bacterial/analysis;DNA, Viral/analysis;Dementia, Vascular/*microbiology;Female;Humans;Male;Matched-Pair Analysis;Middle Aged;Polymerase Chain Reaction;Reference Values","Wozniak, M. A.;Cookson, A.;Wilcock, G. K.;Itzhaki, R. F.",2003,Oct,,0,
4860,Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons,"Objective: To determine factors associated with baseline neurocognitive performance in HIV-infected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy. Methods: Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores <-2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression. Results: The 292 participants had a median CD4 cell count of 536 cells/mm, 88% had an HIV viral load ≤400 copies/mL, and 92% were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was-0.72; 14% of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not. Conclusions: In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation. © 2010 by AAN Enterprises, Inc.",antihypertensive agent;antilipemic agent;antiretrovirus agent;high density lipoprotein cholesterol;adult;article;Australia;Brazil;cardiovascular disease;cardiovascular risk;CD4 lymphocyte count;cholesterol blood level;cognition;cognitive defect;congestive heart failure;demography;education;female;gender;heart infarction;HIV associated dementia;human;Human immunodeficiency virus;Human immunodeficiency virus infected patient;Human immunodeficiency virus infection;hypercholesterolemia;hypertension;ischemic heart disease;major clinical study;male;North America;peripheral vascular disease;priority journal;race;Thailand;virus load,"Wright, E. J.;Grund, B.;Robertson, K.;Brew, B. J.;Roediger, M.;Bain, M. P.;Drummond, F.;Vjecha, M. J.;Hoy, J.;Miller, C.;Penalva De Oliveira, A. C.;Pumpradit, W.;Shlay, J. C.;El-Sadr, W.;Price, R. W.",2010,,,0,
4861,"Review and Update 1996. Therapeutics Letter, issue 16, November/December 1996",,amlodipine;amoxicillin;antihypertensive agent;beta adrenergic receptor blocking agent;bismuth;calcium channel blocking agent;clarithromycin;dipeptidyl carboxypeptidase inhibitor;estrogen;fenoterol;gestagen;hydrochlorothiazide;isradipine;lansoprazole;metronidazole;nifedipine;nimodipine;omeprazole;salbutamol;tetracycline;Alzheimer disease;angina pectoris;asthma;bleeding;clinical trial;drug information;gastritis;gastroesophageal reflux;Gram negative infection;heart infarction;hormonal therapy;human;hypertension;menopausal syndrome;meta analysis;peptic ulcer;prescription;short survey;stomach cancer;stomach fundoplication;vascular disease;albuterol,"Wright, J. M.",1997,,,0,
4862,SPRINT and implications for target organ protection in african americans,,acute coronary syndrome;acute heart failure;African American;article;cardiovascular disease;cerebrovascular accident;chronic kidney disease;cognitive defect;dementia;disease course;educational status;elevated blood pressure;glomerulus filtration rate;groups by age;heart death;heart infarction;heart left ventricle hypertrophy;hospitalization;human;intervention study;kidney disease;medicaid;mortality;nuclear magnetic resonance imaging;randomized controlled trial (topic);social status;systolic blood pressure,"Wright, J. T.;Fine, L. J.",2016,,,0,
4863,Purulent Pericarditis and Abscessed Myocardium with Acute Myocardial Infarction,,acetylsalicylic acid;ceftriaxone;clopidogrel;hemoglobin A1c;hypertensive factor;insulin;acute heart infarction;adult;antibiotic sensitivity;artery thrombosis;case report;deterioration;drug eluting stent;dyspnea;echocardiography;electrocardiogram;epigastric pain;female;fever;heart abscess;heart arrest;heart catheterization;heart tamponade;hospital admission;human;hyperglycemia;hyperthermia;hypotension;Klebsiella pneumoniae;letter;mental deterioration;pericardial effusion;pericardiocentesis;pericardiotomy;pericarditis;priority journal;purulent pericarditis;respiratory failure;shock;sinus tachycardia,"Wright, N. R.;Pfahl, K. W.;Bush, C. A.",2016,,,0,
4864,Underuse of indicated medications among physically frail older US veterans at the time of hospital discharge: results of a cross-sectional analysis of data from the Geriatric Evaluation and Management Drug Study,"BACKGROUND: Medication underutilization, or the omission of a potentially beneficial medication indicated for disease management, is common among older adults but poorly understood. OBJECTIVES: The aims of this work were to assess the prevalence of medication underuse and to determine whether polypharmacy or comorbidity was associated with medication underuse among physically frail older veterans transitioning from the hospital to the community. METHODS: This was a cross-sectional analysis of patients who were discharged from 11 US veterans' hospitals to outpatient care, based on data from the Geriatric Evaluation and Management Drug Study, a substudy of the Veterans Affairs Cooperative Study of geriatric evaluation and management. Patients were enrolled between August 31, 1995, and January 31, 1999. To qualify for the study, patients had to be aged > or =65 years, hospitalized in a medical or surgical ward for >48 hours, and meet > or =2 of the following criteria: moderate functional disability; recent cerebrovascular accident with residual neurological deficit; history of > or =1 fall in the previous 3 months; documented difficulty with walking (ie, requiring personal assistance or equipment), not including preadmission use of a wheelchair with ability to transfer to and from chair independently; malnutrition (admission serum albumin of 3.5 g/dL, <80% of ideal body weight, or recent > or =15-lb weight loss reported in admission history); dementia; depression; documented diagnosis of new fracture or revision needed of older fracture; unplanned admission within 3 months of previous admission; and prolonged bed rest. Clinical pharmacist/physician pairs reviewed medical records and medication lists and independently applied the Assessment of Underutilization (AOU) index to determine omissions of indicated medications. Discordances in index ratings were resolved during clinical consensus conferences. The primary outcome measure was the percentage of patients with > or =1 medication omission detected by the AOU. Multivariable logistic regression analyses identified factors associated with underuse. RESULTS: A total of 384 patients were included in the study. The majority (53.6%) were between the ages of 65 and 74 years, and the mean (SD) Charlson comorbidity index was 2.44 (1.93). Overall, 374 patients (97.4%) were men and 274 (71.4%) were white. Medication undertreatment occurred in 238 participants (62.0%). Diseases of the Accepted for publication October 26, 2009. circulatory, endocrine/nutritional, musculoskeletal, and respiratory systems were the most commonly undertreated conditions. The indicated medications most likely to be omitted were nitrates for those with a history of myocardial infarction, multivitamins in those with malnutrition, and inhaled anticholinergics for chronic obstructive airways disease. Statistically significant factors associated with medication underuse included limitations in activities of daily living (adjusted odds ratio [AOR], 2.17 [95% CI, 1.27-3.71]; P = 0.01), being white (AOR, 1.70 [95% CI, 1.06-2.71]; P = 0.03), and Charlson comorbidity index (AOR, 1.13 for each 1-point increase [95% CI, 1.00-1.27]; P = 0.04). Discharge from a general medicine service as opposed to a surgical service was associated with lower risk of medication underuse (AOR, 0.61 [95% CI, 0.38-0.98]; P = 0.04). CONCLUSIONS: Medication underuse was relatively common in this study. Patients with greater comorbidity, but not polypharmacy, had increased odds of undertreatment.","Activities of Daily Living;Aged;Aged, 80 and over;Comorbidity;Cross-Sectional Studies;Female;Frail Elderly/statistics & numerical data;Humans;Logistic Models;Male;Patient Discharge/*statistics & numerical data;Pharmaceutical Preparations/*administration & dosage;*Polypharmacy;Retrospective Studies;United States;Veterans/*statistics & numerical data","Wright, R. M.;Sloane, R.;Pieper, C. F.;Ruby-Scelsi, C.;Twersky, J.;Schmader, K. E.;Hanlon, J. T.",2009,Oct,10.1016/j.amjopharm.2009.11.002,0,
4865,The effects of anti-dementia and nootropic treatments on the mortality of patients with dementia: A population-based cohort study in Taiwan,"Background: Few studies have examined the contribution of treatment on the mortality of dementia based on a population-based study. Objective: To investigate the effects of anti-dementia and nootropic treatments on the mortality of dementia using a population-based cohort study. Methods: 12,193 incident dementia patients were found from 2000 to 2010. Their data were compared with 12,193 age- and sex-matched non-dementia controls that were randomly selected from the same database. Dementia was classified into vascular (VaD) and degenerative dementia. Mortality incidence and hazard ratios (HRs) were calculated. Results: The median survival time was 3.39 years (95% confidence interval [CI]: 2.88-3.79) for VaD without medication, 6.62 years (95% CI: 6.24-7.21) for VaD with nootropics, 3.01 years (95% CI: 2.85-3.21) for degenerative dementia without medication, 8.11 years (95% CI: 6.30-8.55) for degenerative dementia with anti-dementia medication, 6.00 years (95% CI: 5.73-6.17) for degenerative dementia with nootropics, and 9.03 years (95% CI: 8.02-9.87) for degenerative dementia with both anti-dementia and nootropic medications. Compared to the non-dementia group, the HRs among individuals with degenerative dementia were 2.69 (95% CI: 2.55-2.83) without medication, 1.46 (95% CI: 1.39-1.54) with nootropics, 1.05 (95% CI: 0.82-1.34) with anti-dementia medication, and 0.92 (95% CI: 0.80-1.05) with both nootropic and anti-dementia medications. VaD with nootropics had a lower mortality (HR: 1.25, 95% CI: 1.15-1.37) than VaD without medication (HR: 2.46, 95% CI: 2.22-2.72). Conclusion: Pharmacological treatments have beneficial effects for patients with dementia in prolonging their survival.",dihydroergocristine;dihydroergotamine;donepezil;galantamine;Ginkgo folium extract;memantine;nootropic agent;piracetam;plant extract;rivastigmine;unclassified drug;age;aged;article;cerebrovascular disease;Charlson Comorbidity Index;chronic lung disease;cohort analysis;congestive heart failure;controlled study;degenerative dementia;degenerative disease;dementia;diabetes mellitus;drug effect;female;Ginkgo folium;Ginkgophyta;hemiplegia;human;incidence;kidney disease;major clinical study;male;metastasis;mortality;multiinfarct dementia;neoplasm;paraplegia;peptic ulcer;peripheral vascular disease;population research;reimbursement;retrospective study;survival time;Taiwan;very elderly,"Wu, C. Y.;Hu, H. Y.;Chow, L. H.;Chou, Y. J.;Huang, N.;Wang, P. N.;Li, C. P.",2015,,,0,
4866,Outcomes of acute renal failure patients having received renal replacement therapy in the Intensive Care Unit,"Objective: The aim of the present study was to investigate both the outcomes and prognostic factors of ARF patients requiring RRT in our Intensive Care Unit. Design: It was a retrospective observational study. Setting: Pamela Youde Nethersole Eastern Hospital, a 20-bed medico-surgical ICU. Patients and participants: ARF patients who had received RRT from January 2005 to December 2006 were recruited. Interventions: The primary outcome was hospital mortality. Secondary outcomes were: dialysis dependency at hospital discharge, ICU and hospital length of stay. Relationship between demographics, premorbidities and clinical parameters with primary outcome was studied. Measurements and results: One hundred and thirty-fve patients were included in the fnal analysis. Hospital mortality rate was 63.7%. The median survival was 24 days (IQR 7 to 746 days). Mechanical ventilation (HR 2.96, 95% CI 2.04 to 3.89) and hepatorenal syndrome (HR 2.29, 95% CI 1.63 to 2.95) were independently associated with hospital mortality. Dialysis dependency rate after hospital discharge as on day 60 was 4.1%. Conclusion: ARF in ICU was associated with a high mortality rate which was correlated with hepatorenal syndrome and mechanical ventilation. Most of the hospital survivors were free from dialysis.",creatinine;urea;acute kidney failure;adult;aged;anticoagulation;article;artificial ventilation;blood flow velocity;cardiogenic shock;chronic kidney failure;chronic lung disease;comorbidity;creatinine blood level;dementia;female;glomerulus filtration rate;heart disease;hepatorenal syndrome;hollow fiber membrane;hospital discharge;human;hypovolemic shock;intensive care unit;length of stay;liver disease;major clinical study;male;metabolic disorder;mortality;observational study;obstructive uropathy;prognosis;renal replacement therapy;retrospective study;rhabdomyolysis;scoring system;sepsis;survival time;treatment duration;treatment outcome;ultrafiltration;urea blood level,"Wu, H. H. L.;Chan, K. K. C.;Lau, A. C. W.;Yan, W. W.",2010,,,0,
4867,Incidence of serious upper and lower gastrointestinal events in older adults with and without Alzheimer's disease,"Objectives To estimate and compare the incidence of serious upper and lower gastrointestinal (GI) events in individuals aged 65 and older with and without Alzheimer's disease (AD). Design Retrospective cohort study. Setting PharMetrics, a large population-based health insurance claims database was used for the study. Participants Individuals aged 65 and older with a diagnosis of AD (International Classification of Diseases, Ninth Revision, Clinical Modification Code 331.0) were identified between January 1, 2003, and December 31, 2006, using the PharMetrics database. The control cohort consisted of a random sample of health plan enrollees matched to the AD cohort according to age, sex, location, and index year in a 1:1 ratio. Measures The outcomes of interest were serious GI events, including ulceration, perforation, and bleeding in the upper or lower GI tract. Results Twenty-seven thousand seventy-six individuals with AD were identified. Approximately 66% of them were age 80 and older, and 65% were female. Participants with AD had higher incidence of serious GI events (upper GI: AD vs non-AD: 27.4 vs 17.1/1000 person-years, HR = 1.49, 95%CI = 1.34-1.65; lower GI: AD vs non-AD: 9.4 vs 6.9/1000 person-years, HR = 1.26, 95%CI = 1.06-1.48). The association was also present in participants without a history of GI bleeding (upper GI: HR = 1.54, 95%CI = 1.37-1.73; lower GI: HR = 1.37, 95%CI = 1.14-1.64). Conclusion Participants with AD had higher incidence of serious upper and lower GI events, compared to those without AD. Physicians should recognize the high risk of serious GI events that exists in individuals with AD. © 2011, The American Geriatrics Society.",cholinesterase inhibitor;memantine;age;aged;Alzheimer disease;article;brain hemorrhage;brain ischemia;chronic obstructive lung disease;colon hemorrhage;comorbidity;comparative study;congestive heart failure;controlled study;diabetes mellitus;diverticulitis;diverticulosis;drug abuse;drug use;duodenum ulcer;enteritis;female;gastritis;gastrointestinal symptom;gender;geography;health insurance;heart infarction;hematemesis;hospitalization;human;incidence;intestine perforation;major clinical study;male;medical history;medicare;nursing home patient;osteoarthritis;peptic ulcer;rectum hemorrhage;rectum ulcer;retrospective study;rheumatoid arthritis;stomach ulcer,"Wu, J. H.;Guo, Z.;Kumar, S.;Lapuerta, P.",2011,,,0,
4868,Impact of acetylcholinesterase inhibitors on the occurrence of acute coronary syndrome in patients with dementia,"The study aimed to investigate the association of acetylcholinesterase inhibitors (AChEIs) use with the risk of acute coronary syndrome (ACS). We conducted a population-based retrospective cohort study of dementia patients during 1 January 1999 to 31 December 2008 using the National Health Insurance Database in Taiwan. New AChEI users during the study period were matched with AChEI nonusers in age-matched and gender-matched cohorts. The risk of ACS associated with use of AChEIs was analyzed using modified Kaplan-Meier analysis and Cox proportional hazard models after adjustment for competing death risk. Use of AChEIs was associated with a lower incidence of ACS (212.8/10,000 person-years) compared to the matched reference cohort (268.7/10,000 person-years). The adjusted hazard ratio for ACS in patients with dementia treated with AChEIs was 0.836 (95% confidence interval, 0.750-0.933; P < 0.001). Further sensitivity analysis of different study populations demonstrated consistent results. A statistical dose-response relationship for AChEI use and ACS risk was significant for the patients with dementia. In patients with dementia, AChEI treatment was associated with decreased risk of ACS.","Acute Coronary Syndrome/*epidemiology/*etiology;Aged;Aged, 80 and over;Cause of Death;Cholinesterase Inhibitors/*adverse effects/therapeutic use;Comorbidity;Dementia/*complications/drug therapy/*epidemiology;Female;Follow-Up Studies;Humans;Incidence;Male;Middle Aged;Patient Outcome Assessment;Population Surveillance;Proportional Hazards Models;Retrospective Studies;Risk;Socioeconomic Factors;Taiwan/epidemiology","Wu, P. H.;Lin, Y. T.;Hsu, P. C.;Yang, Y. H.;Lin, T. H.;Huang, C. T.",2015,Nov 18,10.1038/srep15451,0,4869
4869,Impact of acetylcholinesterase inhibitors on the occurrence of acute coronary syndrome in patients with dementia,"The study aimed to investigate the association of acetylcholinesterase inhibitors (AChEIs) use with the risk of acute coronary syndrome (ACS). We conducted a population-based retrospective cohort study of dementia patients during 1 January 1999 to 31 December 2008 using the National Health Insurance Database in Taiwan. New AChEI users during the study period were matched with AChEI nonusers in age-matched and gender-matched cohorts. The risk of ACS associated with use of AChEIs was analyzed using modified Kaplan-Meier analysis and Cox proportional hazard models after adjustment for competing death risk. Use of AChEIs was associated with a lower incidence of ACS (212.8/10,000 person-years) compared to the matched reference cohort (268.7/10,000 person-years). The adjusted hazard ratio for ACS in patients with dementia treated with AChEIs was 0.836 (95% confidence interval, 0.750-0.933; P < 0.001). Further sensitivity analysis of different study populations demonstrated consistent results. A statistical dose-response relationship for AChEI use and ACS risk was significant for the patients with dementia. In patients with dementia, AChEI treatment was associated with decreased risk of ACS.",cholinesterase inhibitor;acute coronary syndrome;aged;cause of death;comorbidity;complication;dementia;female;follow up;health survey;human;incidence;male;middle aged;outcome assessment;proportional hazards model;retrospective study;risk;socioeconomics;Taiwan;very elderly,"Wu, P. H.;Lin, Y. T.;Hsu, P. C.;Yang, Y. H.;Lin, T. H.;Huang, C. T.",2015,,10.1038/srep15451,0,
4870,A new phenanthrene derivative and two diarylheptanoids from the roots of Brassica rapa ssp. campestris inhibit the growth of cancer cell lines and LDL-oxidation,"Brassica rapa ssp. campestris (Brassicaceae) is a conical, deep purple, edible root vegetable commonly known as a turnip. We initiated phytochemical and pharmacological studies to search for biological active compounds from the roots of B. rapa ssp. campestris. We isolated a novel phenanthrene derivative, 6-methoxy-1-[10-methoxy-7-(3-methylbut-2-enyl)phenanthren-3-yl]undecane-2, 4-dione, named brassicaphenanthrene A (3) along with two known diarylheptanoid compounds, 6-paradol (1) and trans-6-shogaol (2), through the repeated silica gel (SiO2), octadecyl silica gel, and Sephadex LH-20 column chromatography. The chemical structures of the compounds were determined by spectroscopic data analyses including nuclear magnetic resonance, mass spectrometry, ultraviolet spectroscopy, and infra-red spectroscopy. All compounds exhibited high inhibitory activity against the growth of human cancer lines, HCT-116, MCF-7, and HeLa, with IC50 values ranging from 15.0 to 35.0 μM and against LDL-oxidation with IC50 values ranging from 2.9 to 7.1 μM. © 2013 The Pharmaceutical Society of Korea.",6 paradol;brassicaphenanthrene a;heptane derivative;low density lipoprotein cholesterol;oxidized low density lipoprotein;phenanthrene derivative;trans 6 shogaol;unclassified drug;Alzheimer disease;artery;article;atherosclerosis;Brassica rapa;Brassica rapa campestris;cancer cell culture;cancer growth;cerebrovascular accident;female;heart infarction;human;human cell;mass spectrometry;nuclear magnetic resonance imaging;plant root;ultraviolet spectroscopy,"Wu, Q.;Cho, J. G.;Yoo, K. H.;Jeong, T. S.;Park, J. H.;Kim, S. Y.;Kang, J. H.;Chung, I. S.;Choi, M. S.;Lee, K. T.;Chung, H. G.;Bang, M. H.;Baek, N. I.",2013,,,0,
4871,Functional Improvement Among Short-Stay Nursing Home Residents in the MDS 3.0,"OBJECTIVES: To examine the completeness of the activities of daily living (ADL) items on admission and discharge assessments and the improvement in ADL performance among short-stay residents in the newly adopted Minimum Data Set (MDS) 3.0. DESIGN: Retrospective analysis of MDS admission and discharge assessments. SETTING: Nursing homes from July 1, 2011, to June 30, 2012. PARTICIPANTS: New nursing home residents admitted from acute hospitals with corresponding admission and discharge assessments between July 1, 2011, and June 30, 2012, who had a length of stay of 100 days or less. MEASUREMENTS: ADL self-performance items, including bed mobility, transfer, walking in room, walking in corridor, locomotion on unit, locomotion off unit, dressing, eating, toilet use, and personal hygiene, at admission and discharge. RESULTS: The ADL self-performance items are complete at both admission and discharge, with less than 1% missing for any item. More than 60% of residents improved over the course of their post-acute stay. New short-stay nursing home residents with conditions such as cognitive impairment, delirium, dementia, heart failure, and stroke showed less improvement in ADL performance during their stay. CONCLUSION: The discharge assessment data in the MDS 3.0 provide new information to researchers and providers to examine and track ADL performance. Nursing homes can identify and track patients who require more intensive therapies or targeted interventions to achieve functional improvement during their stay. Future research can examine facility-level measures to better understand how ADL improvement varies across facilities.",*Activities of Daily Living;Aged;Datasets as Topic;Female;Humans;Length of Stay/*statistics & numerical data;Male;*Nursing Homes;*Recovery of Function;Retrospective Studies;Minimum Data Set (MDS);Nursing home;functional improvement,"Wysocki, A.;Thomas, K. S.;Mor, V.",2015,Jun 1,10.1016/j.jamda.2014.11.018,0,
4872,A fluorometric high-performance liquid chromatography procedure for simultaneous determination of methylamine and aminoacetone in blood and tissues,"Methylamine and aminoacetone are endogenous aliphatic amines found in human blood and urine. They can be oxidized by semicarbazide-sensitive amine oxidase (SSAO), leading to the production of toxic aldehydes such as formaldehyde and methylglyoxal as well as hydrogen peroxide and ammonia. SSAO is localized on the surface of vascular endothelial and smooth muscle cells and of adipocytes. Increases in SSAO activity are linked to vascular disorders associated with pathological conditions such as diabetic complications, heart failure, and vascular dementia. Quantitative assessment of methylamine and acetonitrile in tissues has been hampered due to the volatility and hydrolipophilicity of these amines as well as interference by complex biological constituents. We have overcome this problem and developed an FMOC/HPLC (9-fluorenylmethyl chloroformate-Cl/high-performance liquid chromatography) method for simultaneous assessment of methylamine and aminoacetone. This method has been validated using rodent tissues with a detection limit at the picogram level. Methylamine and aminoacetone distributed unevenly among different tissues ranged from 0.1 to 27 nmol/g. To our knowledge, this is the first report on simultaneous determination of methylamine and aminoacetone in mammal tissues.","Acetone/*analogs & derivatives/analysis/blood;Amine Oxidase (Copper-Containing)/metabolism;Animals;Chromatography, High Pressure Liquid/instrumentation/*methods;Fluorenes/chemistry;Male;Methylamines/*analysis/blood;Mice;Mice, Inbred Strains;Reproducibility of Results;Spectrometry, Fluorescence","Xiao, S.;Yu, P. H.",2009,Jan 1,10.1016/j.ab.2008.09.029,0,
4873,The common biological basis for common complex diseases: evidence from lipoprotein lipase gene,"The lipoprotein lipase (LPL) gene encodes a rate-limiting enzyme protein that has a key role in the hydrolysis of triglycerides. Hypertriglyceridemia, one widely prevalent syndrome of LPL deficiency and dysfunction, may be a risk factor in the development of dyslipidemia, type II diabetes (T2D), essential hypertension (EH), coronary heart disease (CHD) and Alzheimer's disease (AD). Findings from earlier studies indicate that LPL may have a role in the pathology of these diseases and therefore is a common or shared biological basis for these common complex diseases. To examine this hypothesis, we reviewed articles on the molecular structure, expression and function of the LPL gene, and its potential role in the etiology of diseases. Evidence from these studies indicate that LPL dysfunction is involved in dyslipidemia, T2D, EH, CHD and AD; and support the hypothesis that there is a common or shared biological basis for these common complex diseases.","Alzheimer Disease/genetics;Coronary Disease/genetics;Diabetes Mellitus, Type 2/genetics;Disease/*genetics;Dyslipidemias/genetics;Humans;Hypertension/genetics;Lipoprotein Lipase/*genetics/*metabolism;*Models, Biological","Xie, C.;Wang, Z. C.;Liu, X. F.;Yang, M. S.",2010,Jan,10.1038/ejhg.2009.134,0,
4874,Incidence of disturbance in sleep behavior and its related factors in dementia patients and population of community,"Aim: To survey the prevalence rate of disturbance in sleep and related risk factors in persons of community and light and moderate dementia patients. Methods: The investigation was conducted between January 2002 and January 2003. The random community non-demented sample of 3 108 adults aged 40 year-old and above were residents living within Beijing 8 urban areas and rural area, such as Beijing Wanshoulu Area and Tongzhou Countryside, etc. All the participants had no cognitive impairment complaints and with a Mini-Mental State Examination score above or equal 26 points. The sleep problem was also analyzed in a population of 373 dementia patients that came from out-patients clinic of cooperating wordplace. The disturbance in sleep behavior was surveyed with international Neuropsychiatric Inventory (NPI) that included with or without sleep disorder and its frequency and level of severity. The score on product of multiplication of frequency and level of severity was the score of investigation. If the score was over 0, the sleep disorder existed. Meanwhile, 14 diseases, such as cerebral infarction, cardiac disease and diabetes, etc. were investigated, and their disease indexes were calculated as the sum of the number of above-mentioned disease, zero as non-suffering any above-mentioned disease, 14 as suffering all of above-mentioned diseases. Results: All the 3 108-commu nity participants and 373 dementia patients completed the survey and were involved in the result analysis. 1 Among the 3 108 community participants, 8.3% reported sleep disturbance, in which 29.1% reported one or more of the co-existing diseases, with heart disease, digestive disease and neurological disease being the most common. Multiple factor logistic regression analysis found that age, education level. and female were risk factors for sleep disturbance in community participants with the odds ratio (OR) of 1,22, 1.13, 1,32, respectively (P < 0.05). While cumulative disease index (OR=2.12) and education (OR=2.06) were risk factors for people aged 85 years old and above (P < 0.05). 2 Of the 373 demented individuals, 19.8% of them exhibited sleep disturbances, in which 68.9% reported one or more of the co-existing diseases, and 23.0% had three or more conditions, with heart, brain, lung disease and diabetes mellitus being the most common, of which there were significant differences when compared with participants without sleep disturbance (P < 0.05). The cumulative disease index and city residents were main risk factors for sleep disturbance in demented participants with the odds ratio of 1.45, 4.33, respectively (P < 0.05). Conclusion: The disturbance in sleep behavior is a frequent complaint in both normal aging and the dementias. Geriatric sleep complaint is not only the result of age per se, but also due to the co-exiting conditions.",adult;aged;aging;article;brain infarction;China;community care;comorbidity;dementia;diabetes mellitus;disease association;disease severity;female;gastrointestinal disease;geriatric care;health survey;heart disease;human;incidence;lung disease;major clinical study;male;mathematical computing;Mini Mental State Examination;multivariate logistic regression analysis;neurologic disease;population research;prevalence;risk assessment;risk factor;rural area;sleep disorder;sleep pattern;social status;urban area,"Xie, H. G.;Wang, L. N.;Yu, X.;Wang, H. L.;Wang, W.;Yang, L. J.;Ma, T. X.;Zhang, X. H.;Yang, L. J.;Xu, X. H.;Peng, D. T.;Zhang, Z. X.;Wei, J.;Wang, Y. H.;Jia, J. P.;Guan, X. T.;Feng, F.",2005,,,0,
4875,Methylene blue induces macroautophagy through 5' adenosine monophosphate-activated protein kinase pathway to protect neurons from serum deprivation,"Methylene blue has been shown to be neuroprotective in multiple experimental neurodegenerative disease models. However, the mechanisms underlying the neuroprotective effects have not been fully elucidated. Previous studies have shown that macroautophagy has multiple beneficial roles for maintaining normal cellular homeostasis and that induction of macroautophagy after myocardial ischemia is protective. In the present study we demonstrated that methylene blue could protect HT22 hippocampal cell death induced by serum deprivation, companied by induction of macroautophagy. We also found that methylene blue-mediated neuroprotection was abolished by macroautophagy inhibition. Interestingly, 5' adenosine monophosphate-activated protein kinase (AMPK) signaling, but not inhibition of mammalian target of rapamycin signaling, was activated at 12 and 24 h after methylene blue treatment in a dose-dependent manner. Methylene blue-induced macroautophagy was blocked by AMPK inhibitor. Consistent with in vitro data, macroautophagy was induced in the cortex and hippocampus of mouse brains treated with methylene blue. Our findings suggest that methylene blue-induced neuroprotection is mediated, at least in part, by macroautophagy though activation of AMPK signaling.",Ampk;Alzheimer disease;macroautophagy;methylene blue;neuroprotection,"Xie, L.;Li, W.;Winters, A.;Yuan, F.;Jin, K.;Yang, S.",2013,,10.3389/fncel.2013.00056,0,
4876,Performance of the Automated Neuropsychological Assessment Metrics (ANAM) in detecting cognitive impairment in heart failure patients,"Objective: Evaluate capacity of the Automated Neuropsychological Assessment Metrics (ANAM) to detect cognitive impairment (CI) in heart failure (HF) patients. Background: CI is a key prognostic marker in HF. Though the most widely used cognitive screen in HF, the Mini-Mental State Examination (MMSE) is insufficiently sensitive. The ANAM has demonstrated sensitivity to cognitive domains affected by HF, but has not been assessed in this population. Methods: Investigators administered the ANAM and MMSE to 57 HF patients, compared against a composite model of cognitive function. Results: ANAM efficiency (p < 05) and accuracy scores (p < .001) successfully differentiated CI and non-CI. ANAM efficiency and accuracy scores classified 97.7% and 93.0% of non-CI patients, and 14.3% and 21.4% with CI, respectively. Conclusions: The ANAM is more effective than the MMSE for detecting CI, but further research is needed to develop a more optimal cognitive screen for routine use in HF patients.",accuracy;adult;aged;article;assessment of humans;Automated Neuropsychological Assessment Metrics;cognition;cognitive defect;dementia;educational status;female;heart failure;human;learning;major clinical study;male;Mini Mental State Examination;prediction;priority journal;response time;validity;very elderly;working memory,"Xie, S. S.;Goldstein, C. M.;Gathright, E. C.;Gunstad, J.;Dolansky, M. A.;Redle, J.;Hughes, J. W.",2015,,,0,
4877,Anti-complementary agents from natural products,"Inappropriate activation of complement is involved in the pathogenesis of many auto-immune disorders, inflammatory diseases and inflammation responses seen in the conditions such as cardiopulmonary by-pass and bacterial infections. But there is still no desirable therapeutic compound available on the market for complement inhibition. Numerous naturally occurring agents have been shown to have anti-complementary effects, and they offer the prospect of inexpensive and non-toxic strategies for the therapeutic inhibition of complement. In the present paper, the natural anticomplementary ingredients are summarized and classified according to their chemical nature and complement inhibiting efficacy, especially the future application of them was highlighted. The approaches used to develop the natural occurring anticomplementary agents were also discussed in this report.",alternative complement pathway C3 C5 convertase;Angelica acutiloba extract;artemisia princeps extract;cnidium officinale extract;complement component C1;complement component C3;complement component C5;complement component C6;complement component C7;complement component C8;complement component C9;Curcuma longa extract;Dipsacus asperoide extract;fucoidin;Ganoderma lucidum extract;ginseng extract;Glycyrrhiza uralensis extract;immunoglobulin;kaempferol derivative;Lithospermum euchromum extract;natural product;Paeonia lactiflora extract;plant extract;Plantago asiatica extract;polysaccharide sulfate;quercetin derivative;stigmasterol;Thymus vulgaris extract;unclassified drug;unindexed drug;Ziziphus jujuba extract;Achyrocline;achyrocline satureioides;adult respiratory distress syndrome;alternative medicine;Alzheimer disease;Angelica;angelica acutiloba;Artemisia;artemisia princeps;article;autoimmune disease;bacterial infection;capillary leak syndrome;cardiopulmonary bypass;Cnidium;cnidium officinale;complement activation;complement alternative pathway;complement inhibition;Curcuma longa;Caprifoliaceae;drug structure;Ganoderma lucidum;ginseng;glomerulonephritis;Glycyrrhiza uralensis;graft rejection;heart infarction;human;jujube;Lithospermum;Lithospermum euchromum;multiple organ failure;multiple sclerosis;myasthenia gravis;Paeonia;Paeonia lactiflora;pathogenesis;Plantago;Plantago asiatica;rheumatoid arthritis;systemic inflammatory response syndrome;systemic lupus erythematosus;thyme,"Xu, H.;Zhang, Y. Y.;Zhang, J. W.;Chen, D. F.",2007,,,0,
4878,"Serum lipoprotein levels, statin use, and cognitive function in older women","BACKGROUND: Few strategies are available for the prevention of cognitive impairment in elderly persons. Serum lipoprotein levels may be important predictors of cognitive function, and drugs that lower cholesterol may be effective for the prevention of cognitive impairment. OBJECTIVE: To determine whether serum lipoprotein levels, the 4-year change in serum lipoprotein levels, and the use of statin drugs are associated with cognition in older women without dementia. DESIGN, SETTING, AND PARTICIPANTS: An observational study of 1037 postmenopausal women with coronary heart disease enrolled in the Heart and Estrogen/progestin Replacement Study (participants at 10 of 20 centers). MAIN OUTCOME MEASURE: The Modified Mini-Mental State Examination was administered at the end of the study after 4 years of follow-up. Women whose score was less than 84 points (>1.5 SDs below the mean) were classified as having cognitive impairment. Lipoprotein levels (total, high-density lipoprotein, and low-density lipoprotein [LDL] cholesterol and triglycerides) were measured at baseline and at the end of the study; statin use was documented at each visit. RESULTS: Compared with women in the lower quartiles, women in the highest LDL cholesterol quartile at cognitive testing had worse mean plus minus SD Modified Mini-Mental State Examination scores (93.7 plus minus 6.0 vs 91.9 plus minus 7.6; P =.002) and an increased likelihood of cognitive impairment (adjusted odds ratio, 1.76; 95% confidence interval, 1.04-2.97). A reduction in the LDL cholesterol level during the 4 years tended to be associated with a lower odds of impairment (adjusted odds ratio, 0.61; 95% confidence interval, 0.36-1.03) compared with women whose levels increased. Higher total and LDL cholesterol levels, corrected for lipoprotein(a) levels, were also associated with a worse Modified Mini-Mental State Examination score and a higher likelihood of impairment, whereas high-density lipoprotein cholesterol and triglyceride levels were not associated with cognition. Compared with nonusers, statin users had higher mean plus minus SD Modified Mini-Mental State Examination scores (92.7 plus minus 7.1 vs 93.7 plus minus 6.1; P =.02) and a trend for a lower likelihood of cognitive impairment (odds ratio, 0.67; 95% confidence interval, 0.42-1.05), findings that seemed to be independent of lipid levels. CONCLUSIONS: High LDL and total cholesterol levels are associated with cognitive impairment, and lowering these lipoprotein levels may be a strategy for preventing impairment. The association between statin use and better cognitive function in women without dementia requires further study.",Aging [blood];Cognition [drug effects];Cohort Studies;Hydroxymethylglutaryl-CoA Reductase Inhibitors [therapeutic use];Hypolipidemic Agents [therapeutic use];Lipoproteins [blood];Mental Status Schedule;Aged[checkword];Female[checkword];Humans[checkword];Middle Aged[checkword],"Yaffe, K.;Barrett-Connor, E.;Lin, F.;Grady, D.",2002,,,0,4879
4879,"Serum lipoprotein levels, statin use, and cognitive function in older women","OBJECTIVETo determine whether serum lipoprotein levels, the 4-year change in serum lipoprotein levels, and the use of statin drugs are associated with cognition in older women without dementia.DESIGN, SETTING, AND PARTICIPANTSAn observational study of 1037 postmenopausal women with coronary heart disease enrolled in the Heart and Estrogen/progestin Replacement Study (participants at 10 of 20 centers).MAIN OUTCOME MEASUREThe Modified Mini-Mental State Examination was administered at the end of the study after 4 years of follow-up. Women whose score was less than 84 points (>1.5 SDs below the mean) were classified as having cognitive impairment. Lipoprotein levels (total, high-density lipoprotein, and low-density lipoprotein [LDL] cholesterol and triglycerides) were measured at baseline and at the end of the study; statin use was documented at each visit.RESULTSCompared with women in the lower quartiles, women in the highest LDL cholesterol quartile at cognitive testing had worse mean plus minus SD Modified Mini-Mental State Examination scores (93.7 plus minus 6.0 vs 91.9 plus minus 7.6; P =.002) and an increased likelihood of cognitive impairment (adjusted odds ratio, 1.76; 95% confidence interval, 1.04-2.97). A reduction in the LDL cholesterol level during the 4 years tended to be associated with a lower odds of impairment (adjusted odds ratio, 0.61; 95% confidence interval, 0.36-1.03) compared with women whose levels increased. Higher total and LDL cholesterol levels, corrected for lipoprotein(a) levels, were also associated with a worse Modified Mini-Mental State Examination score and a higher likelihood of impairment, whereas high-density lipoprotein cholesterol and triglyceride levels were not associated with cognition. Compared with nonusers, statin users had higher mean plus minus SD Modified Mini-Mental State Examination scores (92.7 plus minus 7.1 vs 93.7 plus minus 6.1; P =.02) and a trend for a lower likelihood of cognitive impairment (odds ratio, 0.67; 95% confidence interval, 0.42-1.05), findings that seemed to be independent of lipid levels.CONCLUSIONSHigh LDL and total cholesterol levels are associated with cognitive impairment, and lowering these lipoprotein levels may be a strategy for preventing impairment. The association between statin use and better cognitive function in women without dementia requires further study.BACKGROUNDFew strategies are available for the prevention of cognitive impairment in elderly persons. Serum lipoprotein levels may be important predictors of cognitive function, and drugs that lower cholesterol may be effective for the prevention of cognitive impairment.",Aging [blood];Cognition [drug effects];Cohort Studies;Hydroxymethylglutaryl-CoA Reductase Inhibitors [therapeutic use];Hypolipidemic Agents [therapeutic use];Lipoproteins [blood];Mental Status Schedule;Aged[checkword];Female[checkword];Humans[checkword];Middle Aged[checkword],"Yaffe, K;Barrett-Connor, E;Lin, F;Grady, D",2002,,,0,
4880,"Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia","Objectives: To determine if prevalent and incident diabetes mellitus (DM) increase risk of cognitive decline and if, among elderly adults with DM, poor glucose control is related to worse cognitive performance. Design: Prospective cohort study. Setting: Health, Aging, and Body Composition Study at 2 community clinics. Participants: A total of 3069 elderly adults (mean age, 74.2 years; 42% black; 52% female). Main Outcome Measures: Participants completed the Modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST) at baseline and selected intervals over 10 years. Diabetes mellitus status was determined at baseline and during follow-up visits. Glycosylated hemoglobin A1c level was measured at years 1 (baseline), 4, 6, and 10 from fasting whole blood. Results: At baseline, 717 participants (23.4%) had prevalent DM and 2352 (76.6%) were without DM, 159 of whom developed incidentDMduring follow-up. Participants with prevalent DM had lower baseline test scores than participants withoutDM(3MS: 88.8 vs 90.9; DSST: 32.5 vs 36.3, respectively; t = 6.09; P = .001 for both tests). Results from mixed-effects models showed a similar pattern for 9-year decline (3MS: -6.0- vs -4.5-point decline; t = 2.66; P = .008; DSST: -7.9- vs -5.7-point decline; t = 3.69; P = .001, respectively). Participants with incident DM tended to have baseline and 9-year decline scores between the other 2 groups but were not statistically different from the group without DM. Multivariate adjustment for demographics and medical comorbidities produced similar results. Among participants with prevalent DM, glycosylated hemoglobin A1c level was associated with lower average mean cognitive scores (3MS: F = 8.2; P for overall = .003; DSST: F = 3.4; P for overall = .04), even after multivariate adjustment. Conclusion: Among well-functioning older adults, DM and poor glucose control among those with DM are associated with worse cognitive function and greater decline. This suggests that severity of DM may contribute to accelerated cognitive aging. ©2012 American Medical Association. All rights reserved.",glycosylated hemoglobin;aged;aging;article;blood glucose monitoring;body composition;body mass;cognition;cognitive defect;cohort analysis;comorbidity;controlled study;dementia;depression;diabetes mellitus;digit symbol substitution test;education;female;heart infarction;human;hypertension;incidence;major clinical study;male;Mini Mental State Examination;Black person;prevalence;priority journal;prospective study;psychologic test;race difference;risk factor;scoring system;sex difference;cerebrovascular accident,"Yaffe, K.;Falvey, C.;Hamilton, N.;Schwartz, A. V.;Simonsick, E. M.;Satterfield, S.;Cauley, J. A.;Rosano, C.;Launer, L. J.;Strotmeyer, E. S.;Harris, T. B.",2012,,,0,
4881,Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus,"IMPORTANCE: Hypoglycemia commonly occurs in patients with diabetes mellitus (DM) and may negatively influence cognitive performance. Cognitive impairment in turn can compromise DM management and lead to hypoglycemia. OBJECTIVE: To prospectively evaluate the association between hypoglycemia and dementia in a biracial cohort of older adults with DM. DESIGN AND SETTING: Prospective population-based study. PARTICIPANTS: We studied 783 older adults with DM (mean age, 74.0 years; 47.0% of black race/ethnicity; and 47.6% female) who were participating in the prospective population-based Health, Aging, and Body Composition Study beginning in 1997 and who had baseline Modified Mini-Mental State Examination scores of 80 or higher. MAIN OUTCOME MEASURES: Dementia diagnosis was determined during the follow-up period from hospital records indicating an admission associated with dementia or the use of prescribed dementia medications. Hypoglycemic events were determined during the follow-up period by hospital records. RESULTS: During the 12-year follow-up period, 61 participants (7.8%) had a reported hypoglycemic event, and 148 (18.9%) developed dementia. Those who experienced a hypoglycemic event had a 2-fold increased risk for developing dementia compared with those who did not have a hypoglycemic event (34.4% vs 17.6%, P < .001; multivariate-adjusted hazard ratio, 2.1; 95% CI, 1.0-4.4). Similarly, older adults with DM who developed dementia had a greater risk for having a subsequent hypoglycemic event compared with participants who did not develop dementia (14.2% vs 6.3%, P < .001; multivariate-adjusted hazard ratio, 3.1; 95% CI, 1.5-6.6). Further adjustment for stroke, hypertension, myocardial infarction, and cognitive change scores produced similar results. CONCLUSION AND RELEVANCE: Among older adults with DM, there seems to be a bidirectional association between hypoglycemia and dementia.",African Continental Ancestry Group/statistics & numerical data;Age Factors;Aged;Apolipoprotein E4/genetics;Dementia/*epidemiology;Diabetes Mellitus/*epidemiology;European Continental Ancestry Group/statistics & numerical data;Female;Follow-Up Studies;Humans;Hypoglycemia/*epidemiology;Male;Multivariate Analysis;Neuropsychological Tests;Proportional Hazards Models;Prospective Studies;Risk Factors,"Yaffe, K.;Falvey, C. M.;Hamilton, N.;Harris, T. B.;Simonsick, E. M.;Strotmeyer, E. S.;Shorr, R. I.;Metti, A.;Schwartz, A. V.",2013,Jul 22,10.1001/jamainternmed.2013.6176,0,
4882,"Time trends in Staphylococcus aureus bacteremia, 1988-2010, in a tertiary center with high methicillin resistance rates","INTRODUCTION: Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates. METHODS: We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988-1994 (342 patients), 1998-2004 (597 patients) and 2005-2010 (753 patients). RESULTS: In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005-2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005-2010. CONCLUSIONS: In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.",Bacteremia;Mortality;Staphylococcus aureus;Time;Trends,"Yahav, D.;Shaked, H.;Goldberg, E.;Yassin, S.;Eliakim-Raz, N.;Paul, M.;Bishara, J.;Leibovici, L.",2016,Jul 13,10.1007/s15010-016-0919-6,0,
4883,"Time trends in Staphylococcus aureus bacteremia, 1988–2010, in a tertiary center with high methicillin resistance rates","Introduction: Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates. Methods: We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988–1994 (342 patients), 1998–2004 (597 patients) and 2005–2010 (753 patients). Results: In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005–2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005–2010. Conclusions: In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.",aged;artificial ventilation;comorbidity;controlled study;dementia;drug resistance;endocarditis;external validity;functional status;heart failure;human;immobility;kidney disease;major clinical study;mortality;penicillin resistance;pneumonia;septic shock;staphylococcal bacteremia;urinary catheter;meticillin,"Yahav, D.;Shaked, H.;Goldberg, E.;Yassin, S.;Eliakim-Raz, N.;Paul, M.;Bishara, J.;Leibovici, L.",2016,,,0,4882
4884,Brain hemorrhages in cerebral amyloid angiopathy,"Cerebral amyloid angiopathy (CAA) is cerebrovascular amyloid deposition. It is classified into several types according to the cerebrovascular amyloid proteins involved. Sporadic amyloid β-protein (Aβ)-type CAA is commonly found in elderly individuals and patients with Alzheimer disease. CAA-related disorders include hemorrhagic and ischemic stroke and dementia. CAA-related hemorrhages include intracerebral lobar macrohemorrhages, cortical microhemorrhages, and focal subarachnoidal hemorrhages/superficial siderosis. CAA-associated vasculopathies, such as microaneurysmal formation with fibrinoid necrosis, underlie such cerebrovascular events. Sensitive magnetic resonance imaging procedures, such as gradient-echo T2* imaging and susceptibility-weighted images, are useful to detect microhemorrhagic lesions. Amyloid images with amyloid-binding positron emission tomography ligands can detect CAA, although they cannot discriminate vascular from parenchymal amyloid deposits. Hemorrhage-inducing factors for sporadic Aβ-type CAA include apolipoprotein E genotype, thrombolytic, anticoagulation, and antiplatelet therapies, hypertension, minor head trauma, and antiamyloid therapies. We need future strategies for protection of vessel walls against amyloid-related vascular damage, such as toxicity of Aβ oligomers, Aβ-induced oxidative stress, and inflammation, as well as development of antiamyloid therapies for CAA. © 2013 by Thieme Medical Publishers, Inc.",alpha 1 antichymotrypsin;amyloid beta protein[1-40];amyloid beta protein[1-42];apolipoprotein E;biological marker;cystatin C;gelsolin;low density lipoprotein receptor related protein;membrane metalloendopeptidase;oligomer;Pittsburgh compound B;prealbumin;presenilin 1;prion protein;scleroprotein;acute heart infarction;anticoagulation;article;basal ganglion;blood clot lysis;blood pressure;brain hemorrhage;brain ischemia;brain stem;cerebrovascular disease;clinical feature;cognition;computer assisted tomography;consciousness;dementia;diagnostic accuracy;disease course;DNA polymorphism;fatality;fibrinolytic therapy;genotype;gray matter;head injury;headache;heredity;human;hyaline degeneration;hypertension;immunotherapy;inflammation;ligand binding;lung embolism;meningoencephalitis;migraine aura;mild cognitive impairment;molecular pathology;nuclear magnetic resonance imaging;oxidative stress;paresis;pathophysiology;perfusion;positron emission tomography;postoperative hemorrhage;priority journal;protein blood level;protein expression;risk factor;seizure;siderosis;subarachnoid hemorrhage;susceptibility weighted imaging;thalamus;transient ischemic attack;vascular amyloidosis;white matter lesion,"Yamada, M.",2013,,,0,
4885,No association of paraoxonase genotype or atherosclerosis with cerebral amyloid angiopathy,"Background and Purpose - Both cerebral amyloid angiopathy (CAA) and paraoxonase have been reported to be related to lipid metabolism and atherosclerosis. We investigated whether the paraoxonase gene (PON1) polymorphism and atherosclerosis are associated with risk of CAA. Methods - Associations of the PON1 polymorphism and atherosclerosis of the aorta and coronary and cerebral arteries with the severity of CAA were investigated in 154 elderly Japanese individuals, including 47 patients with Alzheimer's disease. Results - The PON1 polymorphism or severity of atherosclerosis of the arteries was not associated with the severity of CAA. Conclusions - The PON1 polymorphism and atherosclerosis would not appear to be associated with risk of CAA in the elderly, although further study with larger samples is necessary for confirmation.",aryldialkylphosphatase;adult;aged;Alzheimer disease;aorta atherosclerosis;article;atherosclerosis;brain atherosclerosis;coronary artery atherosclerosis;disease association;disease severity;genetic polymorphism;human;Japan;lipid metabolism;major clinical study;priority journal;risk assessment;risk factor;vascular amyloidosis,"Yamada, M.;Sodeyama, N.;Itoh, Y.;Otomo, E.;Matsushita, M.;Mizusawa, H.",2002,,,0,
4886,The frailty-based prognostic criteria in heart failure patients. A multicenter prospective cohort study (FLAGSHIP study): design and preliminary data,"Background: Frailty has been recently well documented as a clinical marker for management of patients with heart failure (HF). However, frailty criteria specific to prognosis of HF have not been established. We therefore started a multicenter prospective cohort study to develop frailty-based prognostic criteria in HF patients (FLAGSHIP study). Methods: FLAGSHIP study is designed to investigate (1) development of frailty criteria specific to HF patients, (2) associated factors of frailty in HF at the time of discharge, and (3) clinical strategy to manage HF frailty. In-patients with HF who can walk for 20m at discharge are eligible for the study. Patients with dementia, mental disorder, short-term vital prognosis, or difficulty in answering questionnaires are excluded. Each subject receives comprehensive assessment including frailty, nutrition, depression, and clinical state during hospitalization. Frailty is measured using phenotype as follows: weight loss, weak grip strength, slow walking speed, exhaustion, and physical inactivity. Data regarding etiology, medical history, echocardiography, blood tests, and prescription were obtained from medical records. Follow-up survey is conducted for two years after discharge. Main outcomes of this study include HF readmission, cardiac events, fracture due to fall, and all-cause death. Frailty criteria will be established based on the HF types (HFrEF or HFpEF). Results: Thirty-five medical centers have participated in the study, and 30 of them have already enrolled 600 subjects until July 2016. Mean age is 72.1 +/- 13.3 and 61.4% are male. The prevalence of HF with preserved ejection fraction (LVEF50%) is 47.4%. According to our temporary criteria (Yamada S, et al. ESC Heart Failure 2015), the prevalence of frail HF is 17.2%. Conclusion: FLAGSHIP study will provide the world's first frailty criteria in Asian patients with HF after three years later. The design and latest preliminary data in more will be discussed.",aged;Asian;blood;cause of death;clinical trial;controlled clinical trial;controlled study;dementia;doctor patient relation;echocardiography;exhaustion;female;follow up;fracture;frailty;grip strength;health status;heart failure with preserved ejection fraction;heart failure with reduced ejection fraction;hospital readmission;hospitalization;human;major clinical study;male;medical history;medical record;multicenter study;nutrition;phenotype;physical inactivity;prescription;prevalence;prognosis;prospective study;questionnaire;walking speed;weight reduction,"Yamada, S;Izawa, H;Murohara, T;Kondo, T;Adachi, T",2016,,10.1002/jcsm.12164,0,
4887,Concomitant alpha-synuclein pathology in an autopsy case of amyotrophic lateral sclerosis presenting with orthostatic hypotension and cardiac arrests,"A 74-year-old man gradually developed muscular weakness in the upper extremities, followed by dyspnea and dysarthria over a 6-month period. He was admitted to our facility and diagnosed as having amyotrophic lateral sclerosis (ALS) based on clinical and neurophysiological findings. Two months later, transtracheal positive pressure ventilation (TPPV) was started. During his clinical course, orthostatic hypotension occurred a few times. He also had two episodes of transient cardiac arrest, and he died 15 months after disease onset. At autopsy, the brain, weighing 850g, showed diffuse cortical atrophy, preferentially involving the frontal lobes. Microscopic findings included severe loss of neurons in the motor cortex, the motor nuclei of the brainstem and the anterior horns of the spinal cord, and mild loss of axons and myelin in the corticospinal tract. Trans-activation response DNA protein 43 (TDP-43) immunoreactive cytoplasmic inclusions, the pathognomonic findings for ALS, were noted in the nucleus facialis, nucleus ambiguus, and in the anterior horn of the spinal cord. In addition, Lewy bodies and Lewy neurites were found in the brainstem and in the nucleus intermediolateralis of the thoracic cord. The concomitant alpha-synuclein pathology may have been partly related to possible autonomic dysfunction underlying the two episodes of cardiac arrest. © 2013 Japanese Society of Neuropathology.",alpha synuclein;deoxyribonucleoprotein;trans activation response dna 43;unclassified drug;aged;ambiguus nucleus;amyotrophic lateral sclerosis;article;autonomic dysfunction;autopsy;Babinski reflex;case report;cell inclusion;clinical examination;day hospital;dementia;diabetes mellitus;disease course;dysarthria;dysphagia;dyspnea;electromyogram;fasciculation;frontal lobe;heart arrest;heart failure;hospital admission;hospital discharge;hospital readmission;hospitalization;human;immunoreactivity;Lewy body;limb weakness;male;medical personnel;motoneuron;motoneuron nucleus;motor cortex;muscle atrophy;nerve fiber;neurophysiology;non invasive positive pressure ventilation;orthostatic hypotension;outcome assessment;parkinsonism;positive end expiratory pressure;priority journal;pyramidal tract,"Yamada, T.;Itoh, K.;Matsuo, K.;Yamamoto, Y.;Hosokawa, Y.;Koizumi, T.;Shiga, K.;Mizuno, T.;Nakagawa, M.;Fushiki, S.",2014,,,0,
4888,Neuropathological correlates of temporal pole white matter hyperintensities in CADASIL,"BACKGROUND AND PURPOSE-: White matter (WM) hyperintensities on MRI or leukoaraiosis is characteristic of stroke syndromes. Increased MRI signals in the anterior temporal pole are suggested to be diagnostic for cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), with 90% sensitivity and 100% specificity. The structural correlates of these specific WM hyperintensities seen on T2-weighted and FLAIR sequences in the temporal pole of CADASIL are unclear. We assessed pathological changes in postmortem tissue from the temporal pole to reveal the cause of CADASIL-specific WM hyperintensities. METHODS-: A combination of tinctorial and immunostaining approaches and in vitro imaging methods were used to quantify the extent of perivascular space (PVS), arteriosclerosis determined as the sclerotic index, WM myelination as the myelin index, and damage within the WM as accumulated degraded myelin basic protein in samples of the anterior temporal pole from 9 CADASIL and 8 sporadic subcortical ischemic vascular dementia cases, and 5 similarly aged (young) and 5 older controls. Luxol fast blue-stained serial sections from a CADASIL case were also used to reconstruct the temporal pole, which was then compared to the MR images. RESULTS-: Luxol fast blue sections used to reconstruct the temporal pole revealed an abundance of enlarged PVS in the WM that topographically appeared as indistinct opaque regions. The mean and total areas of the PVS per WM area (%PVS) were significantly greater in CADASIL compared to the controls. The myelin index was severely reduced in CADASIL in relation to the subcortical ischemic vascular dementia and control sample that was consistent with increased immunoreactivity of degraded myelin basic protein, indicating myelin degeneration. Cerebral microvessels associated with the PVS exhibited a 4.5-fold greater number of basophilic (hyalinized) vessels and a 57% increase in the sclerotic index values in CADASIL subjects compared to young controls. A significant correlation between the quantity of hyalinized vessels and sclerotic index values was also apparent (P<0.05). CONCLUSIONS-: Our findings suggest that MRI hyperintensities in the temporal pole of CADASIL patients are explained by enlarged PVS and degeneration of myelin accompanied by lack of drainage of the interstitial fluid rather than lacunar infarcts. Consistent with the lack of MR hypersignals in the temporal pole of older subcortical ischemic vascular dementia subjects, our observations imply greater progression of pathological changes in CADASIL patients. © 2009 American Heart Association, Inc.",fast blue;myelin basic protein;aged;aging;arteriosclerosis;article;brain blood vessel;CADASIL;cadaver;clinical article;controlled study;correlation analysis;demyelination;disease course;female;histopathology;human;human tissue;image reconstruction;immunohistochemistry;immunoreactivity;in vitro study;interstitial fluid;leukoaraiosis;leukoencephalopathy;male;microvasculature;multiinfarct dementia;myelination;neuropathology;nuclear magnetic resonance imaging;priority journal;cerebrovascular accident;white matter,"Yamamoto, Y.;Ihara, M.;Tham, C.;Low, R. W. C.;Slade, J. Y.;Moss, T.;Oakley, A. E.;Polvikoski, T.;Kalaria, R. N.",2009,,,0,
4889,The effect of a telephone follow-up intervention on illness perception and lifestyle after myocardial infarction in China: a randomized controlled trial,"SETTINGS: Cardiac care units in four major general hospitals in Guangzhou, China. PARTICIPANTS: Inclusion criteria were being diagnosed with an initial acute MI, being able to communicate orally in Mandarin or Cantonese and read in Chinese, and living in Guangzhou. Exclusion criteria were with continuing uncontrolled arrhythmias or heart failure, being illiteracy, or with a history of major psychiatric illness, exercise-induced asthma, uncontrolled diabetes, or evidence of dementia. METHOD: 124 patients admitted with the first acute MI were randomized to receive either routine care or routine care plus a telephone follow-up intervention, which consist of a pre-discharge education and three telephone follow-up instructions. Data were collected before discharge, at the 6th and the 12th week after discharge from hospital, respectively. RESULTS: At the 6th and the 12th week after discharge, patients in the intervention group had significantly positive perceptions about symptoms of MI (mean difference 3.27, 95% confidence interval 2.48-4.07, p<.001; mean difference 2.12, 95% confidence interval 1.34-2.89, p<.001 respectively) and how long their illness would last (mean difference -0.69, 95% confidence interval -0.91 to -0.47, p<.001; mean difference -0.74, 95% confidence interval -0.96 to -0.51, p<.001 respectively) compared with the control group. The intervention group also had more positive beliefs about the controllability (F=4.23, p=.04) and more improved beliefs about the causes of MI than the control group. Moreover, the intervention improved the patients' nutrition (F=5.16, p=.03) and physical activity at the 12-week follow-up (mean difference 0.37, 95% confidence interval 0.17-0.58, p<.001). CONCLUSION: This telephone follow-up intervention can result in improved illness perception and lifestyle after MI. It could be incorporated into current hospital treatment regimens for MI to improve patients' quality of life. BACKGROUND: Lifestyle modification is an integral component of cardiac secondary prevention, while it has been confirmed that myocardial infarction (MI) patients' health-related behaviors are heavily influenced by their illness perception. OBJECTIVES: To evaluate the effect of a telephone follow-up intervention for improving MI patients' illness perception and lifestyle. DESIGN: A randomized controlled trial, longitudinal research design was employed.",aged;China;controlled study;female;follow up;heart infarction;human;illness behavior;lifestyle;male;middle aged;pathophysiology;randomized controlled trial;telephone,"Yan, J.;You, L.;Liu, B.;Jin, S.;Zhou, J.;Lin, C.;Li, Q.;Gu, J.",2014,,,0,
4890,The effect of a telephone follow-up intervention on illness perception and lifestyle after myocardial infarction in China: a randomized controlled trial,"OBJECTIVESTo evaluate the effect of a telephone follow-up intervention for improving MI patients' illness perception and lifestyle.DESIGNA randomized controlled trial, longitudinal research design was employed.SETTINGSCardiac care units in four major general hospitals in Guangzhou, China.PARTICIPANTSInclusion criteria were being diagnosed with an initial acute MI, being able to communicate orally in Mandarin or Cantonese and read in Chinese, and living in Guangzhou. Exclusion criteria were with continuing uncontrolled arrhythmias or heart failure, being illiteracy, or with a history of major psychiatric illness, exercise-induced asthma, uncontrolled diabetes, or evidence of dementia.METHOD124 patients admitted with the first acute MI were randomized to receive either routine care or routine care plus a telephone follow-up intervention, which consist of a pre-discharge education and three telephone follow-up instructions. Data were collected before discharge, at the 6th and the 12th week after discharge from hospital, respectively.RESULTSAt the 6th and the 12th week after discharge, patients in the intervention group had significantly positive perceptions about symptoms of MI (mean difference 3.27, 95% confidence interval 2.48-4.07, p<.001; mean difference 2.12, 95% confidence interval 1.34-2.89, p<.001 respectively) and how long their illness would last (mean difference -0.69, 95% confidence interval -0.91 to -0.47, p<.001; mean difference -0.74, 95% confidence interval -0.96 to -0.51, p<.001 respectively) compared with the control group. The intervention group also had more positive beliefs about the controllability (F=4.23, p=.04) and more improved beliefs about the causes of MI than the control group. Moreover, the intervention improved the patients' nutrition (F=5.16, p=.03) and physical activity at the 12-week follow-up (mean difference 0.37, 95% confidence interval 0.17-0.58, p<.001).CONCLUSIONThis telephone follow-up intervention can result in improved illness perception and lifestyle after MI. It could be incorporated into current hospital treatment regimens for MI to improve patients' quality of life.BACKGROUNDLifestyle modification is an integral component of cardiac secondary prevention, while it has been confirmed that myocardial infarction (MI) patients' health-related behaviors are heavily influenced by their illness perception.",China;Follow-Up Studies;Illness Behavior;Life Style;Myocardial Infarction [physiopathology];Telephone;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword],"Yan, J;You, Lm;Liu, Bl;Jin, Sy;Zhou, Jj;Lin, Cx;Li, Q;Gu, J",2014,,10.1016/j.ijnurstu.2013.10.011,0,
4891,Dementia complicated with Takotsubo cardiomyopathy associated with unconsciousness induced by Wernicke's encephalopathy,"An 85-year-old woman who had been living alone and eating an unbalanced diet suddenly entered a neighbour 's house. Her house was hot and humid due to lack of air conditioning caused by a loss of electrical power. After arrival, the patient exhibited disorientation, paresis of the right upper extremity, a tendency towards right conjugated deviation and perseveration. Electrocardiogram showed ST segment elevation and prolongation of the QT interval. Echocardiography suggested Takotsubo cardiomyopathy. The cardiac wall motion and neurological abnormalities improved after admission. The serum thiamine level was found to be low, which was compatible with a diagnosis of Wernicke's encephalopathy. Hasegawa dementia score was 10 points and the patient was suspected to have frontotemporal dementia. She was transferred to a nursing home with continuing dementia. In this case, psychological stress trigged by poor living circumstances induced by dementia and Wernicke's encephalopathy may result in the occurrence of Takotsubo cardiomyopathy. Copyright 2013 BMJ Publishing Group. All rights reserved.",acetylsalicylic acid;creatine kinase;manidipine;oxatomide;pravastatin;prednisolone;thiamazole;thiamine;troponin T;aged;akinesia;anamnesis;article;brain atrophy;cardiomegaly;cardiovascular mortality;case report;dehydration;dementia;diffusion weighted imaging;disease association;echocardiography;electroencephalography;female;follow up;frontotemporal dementia;Glasgow coma scale;Hasegawa dementia score;heart disease;heart ejection fraction;heart ventriculography;hospitalization;human;hyperkinesia;hyperlipidemia;hypertension;hypotension;ischemic heart disease;mental stress;nuclear magnetic resonance imaging;oxygen saturation;prescription;priority journal;protein blood level;rating scale,"Yanagawa, Y.;Mikasa, M.;Nishioka, K.;Hirano, K.",2013,,,0,
4892,Limitations of Sacubitril/Valsartan in the Management of Heart Failure,"BACKGROUND: The PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) trial was a double-blind trial that randomized 8442 patients with heart failure (HF) with reduced ejection fraction (HFrEF) to receive twice daily dosing of either 200 mg of LCZ696 or 10 mg of enalapril in addition to standard medical therapy for HF. AREAS OF UNCERTAINTY: Limitations of this trial include (1) sacubitril has not been tested by itself in the treatment of HFrEF; (2) the maximum recommended dose of valsartan for the treatment of HFrEF was used in this trial, but the maximum recommended dose of enalapril for the treatment of HFrEF was not used; (3) a run-in phase was used in this trial to test the tolerability of LCZ696, and patients who had adverse effects in this period were excluded from randomization; (4) the percent of blacks enrolled in this trial was only 5%; (5) LCZ696 caused a 14% incidence of hypotension; (6) neprilysin inhibition might favor the development of Alzheimer dementia, which was not assessed in the PARADIGM-HF trial; (7) patients with severe symptomatic HF were underrepresented in this trial; (8) major exclusions from this trial included an acute coronary event in the last 3 months, severe pulmonary disease, hepatic impairment, and an estimated glomerular filtration rate <30 mL per minute per 1.73 m. DATA SOURCES: Review of the PARADIGM-HF trial. RESULTS: At 27-month follow-up, the PARADIGM-HF trial showed that compared with enalapril, LCZ696 reduced the composite of cardiovascular death or hospitalization for HF 20% (absolute risk reduction 4.7%, P < 0.001). CONCLUSIONS: The numerous limitations discussed under the areas of uncertainty should be considered when prescribing LCZ696 for the treatment of HFrEF.",0 (Aminobutyrates);0 (Angiotensin Receptor Antagonists);0 (lcz 696);0 (Tetrazoles);EC 3.4.24.11 (Neprilysin);African Americans;Alzheimer Disease/epidemiology;Aminobutyrates/ therapeutic use;Angiotensin Receptor Antagonists/ therapeutic use;European Continental Ancestry Group;Heart Failure/ drug therapy;Humans;Hypotension/chemically induced;Neprilysin/ antagonists & inhibitors;Patient Dropouts;Randomized Controlled Trials as Topic;Risk Factors;Tetrazoles/ therapeutic use,"Yandrapalli, S.;Aronow, W. S.;Mondal, P.;Chabbott, D. R.",2017,Mar/Apr,,0,
4893,The adult with congenital heart disease,"Background: The study show the most important demographic and clinical data of a cohort composed by adults treated in a congenital heart clinic. Material and methods: In a retrospective, observational and longitudinal study, data from patients with congenital heart disease, older than 18 years, seen between May 2010 and May 2013, were analyzed. Results: The cohort comprised 409 patients, 280 of them female (69%), whose mean age at the time of the fi rst evaluation was 36.7 ± 14.2 years (range, 18 to 75 years). Thirty-four of them (8%) had cyanotic congenital heart disease (14 cases of tetralogy of Fallot, the rest with a univentricular heart and Eisenmenger). The mean age when heart disease was diagnosed was 33.6 ± 15.9 years (range, from birth to 75 years). One hundred fi ve patients (38%) were aware of having heart disease but did not have regular follow-up. The reason for referral was heart murmur in 143 subjects (35%); in 143 (35%) for deterioration of functional class due to progressive dyspnea; supraventricular arrhythmias in 24 (6%); chest pain in 16 (4%), in 12 arterial hypertension (3%) and in 8 (2%) history of cerebral vascular event. On regard of the types of congenital heart disease, 71% were intracardiac defects (mainly interatrial and interventricular septal defects), 10% left and right obstructive lesions, as well as aortic coarctation, 7% mixed valve lesions, 2% cardiomyopathy, and the rest with diseases like anomalous origin of the left coronary artery, double discordance and univentricular heart. In 188 patients (46%) surgical treatment was opted, meanwhile in other 138 (34%) interventional percutaneous treatments were chosen, and in 83 (20%) medical treatment was selected. Fifteen patients suffered complications related to treatment, 50% of them infections, arrhythmias or heart failure. Mortality occurred in six cases, all from the surgical group. The cause of death was refractory heart failure and cardiogenic shock in the postoperative phase. Pulmonary pressure descended from 48.3 ± 20.4 mmHg before the therapeutic procedure to 36.3 ± 16.2 mmHg after it (p < 0.001). Conclusions: Adults with congenital heart disease form a complex study group that in addition to the underlying disease, have a combination of other diseases and/or cardiovascular risk factors as well as several complications related to previous therapeutic procedures.",adult;aged;article;cardiogenic shock;cardiomyopathy;cardiovascular mortality;cardiovascular risk;cause of death;congenital heart disease;Eisenmenger complex;Fallot tetralogy;female;follow up;heart murmur;heart single ventricle;heart supraventricular arrhythmia;human;hypertension;longitudinal study;lung pressure;major clinical study;male;mental deterioration;observational study;patient referral;postoperative period;retrospective study;thorax pain,"Yáñez-Gutiérrez, L.;López-Gallegos, D.;Cerrud-Sánchez, C. E.;Márquez-González, H.;García-Pacheco, M. B.;Jiménez-Santos, M.;Santiago-Hernández, J. A.;Ramírez-Reyes, H. A.;Riera-Kinkel, C.",2015,,,0,
4894,Validity of the age-adjusted charlson comorbidity index on clinical outcomes for patients with nasopharyngeal cancer post radiation treatment: A 5-year nationwide cohort study,"Purpose: To characterize the impact of comorbidity on survival outcomes for patients with nasopharyngeal carcinoma (NPC) post radiotherapy (RT). Methods: A total of 4095 patients with NPC treated by RT or RT plus chemotherapy (CT) in the period from 2007 to 2011 were included through Taiwan's National Health Insurance Research Database. Information on comorbidity present prior to the NPC diagnosis was obtained and adapted to the Charlson Comorbidity Index (CCI), Age-Adjusted Charlson Comorbidity Index (ACCI) and a revised head and neck comorbidity index (HN-CCI). The prevalence of comorbidity and the influence on survival were calculated and analyzed. Results: Most of the patients (75%) were male (age 51±13 years) and 2470 of them (60%) had at least one comorbid condition. The most common comorbid condition was diabetes mellitus. According to these three different comorbidity index (CCI, ACCI and HN-CCI), higher scores were associated with worse overall survival (P < 0.001). The Receiver Operating Characteristic (ROC) curve was used to assess the discriminating ability of CCI, AACI and HN-CCI scores and it demonstrated the predictive ability for mortality with the ACCI (0.693, 95% CI 0.670-0.715) was superior to that of the CCI (0.619, 95% CI 0.593-0.644) and HN-CCI (0.545, 95%CI 0.519-0.570). Conclusion: Comorbidities greatly influenced the clinical presentations, therapeutic interventions, and outcomes of patients with NPC post RT. Higher comorbidity index scores accurately was associated with worse survival. The ACCI seems to be a more appropriate prognostic indicator and should be considered in further clinical studies.",acquired immune deficiency syndrome;adult;Age Adjusted Charlson Comorbidity Index;area under the curve;article;cancer radiotherapy;cerebrovascular disease;Charlson Comorbidity Index;chemoradiotherapy;chronic kidney disease;chronic obstructive lung disease;cohort analysis;comorbidity;comorbidity assessment;congestive heart failure;connective tissue disease;controlled study;dementia;diabetes mellitus;female;heart infarction;hemiplegia;human;incidence;intermethod comparison;leukemia;liver disease;lymphoma;major clinical study;male;mortality;nasopharynx cancer;overall survival;peptic ulcer;peripheral vascular disease;population research;prevalence;receiver operating characteristic;revised head and neck Charlson Comorbidity Index;solid tumor;survival rate;survival time;Taiwan,"Yang, C. C.;Chen, P. C.;Hsu, C. W.;Chang, S. L.;Lee, C. C.",2015,,,0,
4895,Cerebral Hemodynamics in the Elderly: A Transcranial Doppler Study in the Einstein Aging Study Cohort,"OBJECTIVES: We sought to describe the relationship between age, sex, and race/ethnicity with transcranial Doppler hemodynamic characteristics from major intracerebral arterial segments in a large elderly population with varying demographics. METHODS: We analyzed 369 stroke-free participants aged 70 years and older from the Einstein Aging Study. Single-gate, nonimaging transcranial Doppler sonography, a noninvasive sonographic technique that assesses real-time cerebrovascular hemodynamics, was used to interrogate 9 cerebral arterial segments. Individual Doppler spectra and cerebral blood flow velocities were acquired, and the pulsatility index and resistive index were calculated by the device's automated waveform-tracking function. Multiple linear regression models were used to examine the independent associations of age, sex, and race/ethnicity with transcranial Doppler measures, adjusting for hypertension, history of myocardial infarction or revascularization, and history of diabetes. RESULTS: Among enrolled participants, 303 individuals had at least 1 vessel insonated (mean age [SD], 80 [6] years; 63% women; 58% white; and 32% black). With age, transcranial Doppler measures of mean blood flow velocity were significantly decreased in the basilar artery (P = .001) and posterior cerebral artery (right, P = .003; left, P = .02). Pulsatility indices increased in the left middle cerebral artery (P = .01) and left anterior cerebral artery (P = .03), and the resistive index was increased in the left middle cerebral artery (P = .007) with age. Women had higher pulsatility and resistive indices compared to men in several vessels. CONCLUSIONS: We report a decreased mean blood flow velocity and weakly increased arterial pulsatility and resistance with aging in a large elderly stroke-free population. These referential trends in cerebrovascular hemodynamics may carry important implications in vascular diseases associated with advanced age, increased risk of cerebrovascular disease, cognitive decline, and dementia.",aging;blood flow velocities;cerebral hemodynamics;head and neck ultrasound;pulsatiliy index;resistive index;transcranial Doppler sonography,"Yang, D.;Cabral, D.;Gaspard, E. N.;Lipton, R. B.;Rundek, T.;Derby, C. A.",2016,Sep,10.7863/ultra.15.10040,0,4896
4896,Cerebral Hemodynamics in the Elderly: A Transcranial Doppler Study in the Einstein Aging Study Cohort,"OBJECTIVES: We sought to describe the relationship between age, sex, and race/ethnicity with transcranial Doppler hemodynamic characteristics from major intracerebral arterial segments in a large elderly population with varying demographics. METHODS: We analyzed 369 stroke-free participants aged 70 years and older from the Einstein Aging Study. Single-gate, nonimaging transcranial Doppler sonography, a noninvasive sonographic technique that assesses real-time cerebrovascular hemodynamics, was used to interrogate 9 cerebral arterial segments. Individual Doppler spectra and cerebral blood flow velocities were acquired, and the pulsatility index and resistive index were calculated by the device's automated waveform-tracking function. Multiple linear regression models were used to examine the independent associations of age, sex, and race/ethnicity with transcranial Doppler measures, adjusting for hypertension, history of myocardial infarction or revascularization, and history of diabetes. RESULTS: Among enrolled participants, 303 individuals had at least 1 vessel insonated (mean age [SD], 80 [6] years; 63% women; 58% white; and 32% black). With age, transcranial Doppler measures of mean blood flow velocity were significantly decreased in the basilar artery (P = .001) and posterior cerebral artery (right, P = .003; left, P = .02). Pulsatility indices increased in the left middle cerebral artery (P = .01) and left anterior cerebral artery (P = .03), and the resistive index was increased in the left middle cerebral artery (P = .007) with age. Women had higher pulsatility and resistive indices compared to men in several vessels. CONCLUSIONS: We report a decreased mean blood flow velocity and weakly increased arterial pulsatility and resistance with aging in a large elderly stroke-free population. These referential trends in cerebrovascular hemodynamics may carry important implications in vascular diseases associated with advanced age, increased risk of cerebrovascular disease, cognitive decline, and dementia.",age;aged;aging;ancestry group;blood flow velocity;brain artery;brain circulation;brain vein;cohort analysis;diagnostic imaging;ethnic group;female;geriatric assessment;hemodynamics;human;male;pathophysiology;physiology;procedures;sex difference;statistics and numerical data;transcranial Doppler ultrasonography;very elderly,"Yang, D.;Cabral, D.;Gaspard, E. N.;Lipton, R. B.;Rundek, T.;Derby, C. A.",2016,,10.7863/ultra.15.10040,0,
4897,Bone marrow cells differentiation into organ cells using stem cell therapy,"Bone marrow cells (BMC) are progenitors of bone, cartilage, skeletal tissue, the hematopoiesis-supporting stroma and adipocyte cells. BMCs have the potential to differentiate into neural cells, cardiac myocytes, liver hepatocytes, chondrocytes, renal, corneal, blood, and myogenic cells. The bone marrow cell cultures from stromal and mesenchymal cells are called multipotent adult progenitor cells (MAPCs). MAPCs can differentiate into mesenchymal cells, visceral mesoderm, neuroectoderm and endoderm in vitro. It has been shown that the stem cells derived from bone marrow cells (BMCs) can regenerate cardiac myocytes after myocardial infarction (MI). Adult bone marrow mesenchymal stem cells have the ability to regenerate neural cells. Neural stem/progenitor cells (NS/PC) are ideal for treating central nervous system (CNS) diseases, such as Alzheimer's, Parkinson's and Huntington disease. However, there are important ethical issues about the therapeutic use of stem cells. Neurons, cardiac myocytes, hepatocytes, renal cells, blood cells, chondrocytes and adipocytes regeneration from BMCs are very important in disease control. It is known that limbal epithelial stem cells in the cornea can repair the eye sight and remove symptoms of blindness. Stem cell therapy (SCT) is progressing well in animal models, but the use of SCT in human remains to be explored further.",,"Yang, Y. J.;Li, X. L.;Xue, Y.;Zhang, C. X.;Wang, Y.;Hu, X.;Dai, Q.",2016,Jul,,0,
4898,Psychological stress associated with dementia in middle-aged women,,amyloid beta protein;tau protein;aged;aging;Alzheimer disease;anxiety;brain atrophy;cerebrovascular disease;Diagnostic and Statistical Manual of Mental Disorders;disease association;disease course;disease duration;environmental stress;female;follow up;hazard ratio;human;infection;ischemic heart disease;mental stress;middle aged;multiinfarct dementia;note;outcome assessment;posttraumatic stress disorder;priority journal;risk factor;veteran,"Yankelevich, D.",2011,,,0,
4899,Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients,"Objectives: This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients. Methods: We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n=183, median 24 points). Results: CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P<0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima-media thickness (IMT)], hazard ratio 2.5-2.9 (all P<0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P=0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction. Conclusion: Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.",adult;age;aged;aged hospital patient;albuminuria;arterial wall thickness;article;cardiovascular disease;cardiovascular risk;cerebrovascular accident;cognitive defect;congestive heart failure;coronary artery disease;disease association;female;geriatric disorder;glomerulus filtration rate;heart ventricle hypertrophy;high risk patient;human;hypertension;major clinical study;male;Mini Mental State Examination;prevalence;priority journal;prospective study;sudden cardiac death;systolic blood pressure;target organ,"Yano, Y.;Bakris, G. L.;Inokuchi, T.;Ohba, Y.;Tamaki, N.;Nagata, M.;Kuwabara, M.;Yokota, N.;Eto, T.;Kuroki, M.;Shimada, K.;Kario, K.",2014,,,0,
4900,Subclinical cerebral abnormalities in chronic kidney disease,"BACKGROUND AND PURPOSE: Impaired kidney function or chronic kidney disease (CKD), as measured by estimated glomerular filtration rate (eGFR), is associated with incident stroke risk. However, few studies have examined the relationship between CKD and subclinical cerebral abnormalities. METHODS: We examined 675 elderly subjects (mean age 69.9 years), who were living independently at home without apparent dementia, using magnetic resonance imaging. Serum creatinine values, measured by the enzymatic method, were used for the Japanese equation of eGFR. RESULTS: Subclinical lacunar infarction, deep white matter lesions, and periventricular hyperintensities were detected in 88 (13.0%), 240 (35.6%) and 158 (23.4%) of the 675 participants, respectively. In the forward stepwise method of logistic analysis, age (OR 2.081/10, 95% CI 1.541-2.810), hypertension (OR 3.656, 95% CI 2.184-6.119), diabetes mellitus (OR 1.961, 95% CI 1.007-3.820), alcohol intake (OR 2.130, 95% CI 1.283-3.535), and eGFR <45 ml/min/1.73 m(2) were significant factors concerning subclinical lacunar infarction. CKD defined as eGFR <60 ml/min/1.73 m(2) was not significantly associated with subclinical lacunar infarction. Decreased eGFR was not a significant factor associated with white matter lesions (WMLs). Age (OR 2.781/10, 95% CI 2.252-3.435), hypertension (OR 1.746, 95% CI 1.231-2.477), diabetes mellitus (OR 1.854, 95% CI 1.070-3.213), but not eGFR were significant factors concerning WMLs. CONCLUSIONS: The present study showed that community-dwelling elderly subjects with late stage 3 CKD were at high risk for prevalent subclinical lacunar infarction. The identification of CKD-specific modifiable risk factors for SBI and WMLs is of increased importance for prevention of subclinical brain ischemic lesions.","Age Factors;Aged;Aged, 80 and over;Alcohol Drinking/epidemiology;Atrial Fibrillation/epidemiology;Brain/*pathology;Brain Ischemia/prevention & control;Comorbidity;Creatinine/blood;Cross-Sectional Studies;Diabetes Mellitus/blood/epidemiology;Dyslipidemias/blood/epidemiology;Female;Glomerular Filtration Rate;Humans;Hypertension/epidemiology;Hypertrophy, Left Ventricular/epidemiology;Independent Living;Japan/epidemiology;Magnetic Resonance Imaging;Male;Middle Aged;Prevalence;Renal Insufficiency, Chronic/blood/*epidemiology/pathology;Sampling Studies;Smoking/epidemiology;Stroke, Lacunar/*epidemiology/pathology","Yao, H.;Takashima, Y.;Hashimoto, M.;Uchino, A.;Yuzuriha, T.",2013,,10.1159/000346719,0,
4901,Extensive white matter hyperintensities may increase brain volume in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy,"Background and Purpose: The extent of white matter hyperintensities (WMH) is associated with cerebral atrophy in elderly people. WMH is a radiological hallmark of cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), but their relationship with brain volume remains poorly understood. The association between WMH and brain volume was analyzed in a large population of patients with CADASIL. Methods: Demographic and MRI data of 278 patients recruited from a prospective cohort study were analyzed. Volumes of WMH and lacunar infarcts, number of cerebral microbleeds, and brain parenchymal fraction were measured. Multivariate analysis was used to study the impact of WMH on brain volume at baseline. Results: In univariate analyses, brain parenchymal fraction was negatively associated with age, male sex, and all MRI markers. Multiple regression modeling showed that brain parenchymal fraction was inversely related to age, number of cerebral microbleeds, and normalized volume of lacunar infarcts but positively related to normalized volume of WMH (P<0.001). This positive relationship was independent of the presence/absence of lacunar infarcts or of cerebral microbleeds. Subgroup analysis showed that this association was significant in subjects having normalized volume of WMH ≥6.13 or brain parenchymal fraction ≥86.37% (median values, both P≤0.001). Conclusion - The results of the present study suggest that extensive WMH may be associated with increase of brain volume in CADASIL. In this disorder, WMH may be related not only to loss of white matter components, but also to a global increase of water content in the cerebral tissue. © 2012 American Heart Association, Inc.",adult;aged;article;brain hemorrhage;brain size;CADASIL;cohort analysis;demography;disease association;female;human;lacunar stroke;major clinical study;male;multiple regression;multivariate analysis;nervous system parameters;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;priority journal;prospective study;univariate analysis;white matter hyperintensity,"Yao, M.;Jouvent, E.;During, M.;Godin, O.;Hervé, D.;Guichard, J. P.;Zhu, Y. C.;Gschwendtner, A.;Opherk, C.;Dichgans, M.;Chabriat, H.",2012,,,0,
4902,Hippocampal perivascular spaces are related to aging and blood pressure but not to cognition,"The risk factors of hippocampal dilated perivascular spaces (H-dPVS), their radiological relevance and their impact on cognitive performance remain under investigation. These aspects were evaluated in 1818 stroke- and dementia-free participants enrolled in the 3C-Dijon MRI study, using logistic regression, multiple linear regression, and Cox models. At study entry, the load of H-dPVS was found strongly associated with age and hypertension (degree 2 vs. degree 0: odds ratio: 1.16; 95% confidence interval: 1.02-1.33 and odds ratio: 1.98; 95% confidence interval: 1.39-2.81, respectively) and positively related to the presence of lacunar infarcts, white-matter hyperintensities volume, and hippocampal volume (p ≤ 0.024). Load of H-dPVS was not related to baseline cognitive performance (p > 0.05). Cox regression modeling did not show a significant relationship between the load of H-dPVS and incident dementia risk (p > 0.05). The present results support that both aging and blood pressure do play a key role in the development of H-dPVS in the older population. In contrast with the dilated perivascular spaces located in white matter or basal ganglia, the load of H-dPVS does not appear associated with occurrence of dementia. © 2014 Elsevier Inc.",antihypertensive agent;age;aged;aging;allele;apoE4 gene;article;blood pressure;brain damage;brain size;cerebrovascular disease;cognition;cohort analysis;controlled study;dementia;depression;diabetes mellitus;diastolic blood pressure;disease association;disease classification;drinking;female;follow up;gender;gene;genotype;hippocampal perivascular spaces;hippocampal volume;hippocampus;human;human tissue;hypercholesterolemia;hypertension;incidence;ischemic heart disease;lacunar stroke;logistic regression analysis;major clinical study;male;mental performance;multiple linear regression analysis;nuclear magnetic resonance imaging;nuclear magnetic resonance scanner;priority journal;proportional hazards model;risk factor;smoking;systolic blood pressure;white matter hyperintensities volume;3C-Dijon;Magnetom,"Yao, M.;Zhu, Y. C.;Soumaré, A.;Dufouil, C.;Mazoyer, B.;Tzourio, C.;Chabriat, H.",2014,,,0,
4903,Enriched environment prevents cognitive impairment and tau hyperphosphorylation after chronic cerebral hypoperfusion,"Chronic cerebral hypoperfusion (CCH) has been gradually prevalent in the patients over middle age, especially the old over 60 years. It has been proved that CCH is highly related with cognitive impairment. CCH emerges not only in vascular dementia (VaD), but also in Alzheimer's disease (AD), which regarded as a critical causative for cognitive impairment in these diseases. Nevertheless, the mechanisms underlying cognitive deficit remain elusive. Moreover, there are no dramatically effective preventions. In the present study, by employing a recognized CCH rat model, we found that CCH induced spatial learning/memory deficits with simultaneously increasing tau hyperphosphorylation at multiple Alzheimer-related phosphorylation sites with activation of glycogen synthase kinase-3beta (GSK-3beta), Cyclin-dependent kinase (Cdk5), Calcium/calmodulin-dependent protein kinase II (CaMKII), and protein kinase B (Akt), and inhibition of protein phosphatase (PP) 2A (PP-2A). Interestingly, enriched environment (EE) treatment, an effect environment stimuli filled with various novel objects, could prevent rats from the EE-induced memory deficits and alterations of tau hyperphosphorylation. Our data suggested that EE might be potentially used for attenuating the detrimental cognition induced by CCH through regulating tau hyperphosphorylation.","Animals;Brain/pathology;*Cognition Disorders/etiology/metabolism/prevention & control;Coronary Occlusion/complications;Cyclin-Dependent Kinase 5/metabolism;Disease Models, Animal;*Environment;Gene Expression Regulation/physiology;Glycogen Synthase Kinase 3/metabolism;Hypoxia-Ischemia, Brain/*complications/etiology/*metabolism;MAP Kinase Signaling System/physiology;Male;Maze Learning/physiology;Mitogen-Activated Protein Kinase Kinases/metabolism;Neurons/physiology;Phosphoric Monoester Hydrolases/metabolism;Phosphorylation/physiology;Rats;Rats, Sprague-Dawley;Reaction Time;tau Proteins/*metabolism","Yao, Z. H.;Zhang, J. J.;Xie, X. F.",2012,Aug,,0,
4904,Complement regulators C1 inhibitor and CD59 do not significantly inhibit complement activation in Alzheimer disease,"Proteins characteristic of activated complement are associated with Alzheimer disease (AD) lesions. The classical complement pathway can be activated only when the influence of such endogenous regulators as C1-inhibitor (C1-inh) and CD59 are overcome. We used the techniques of reverse transcriptase-polymerase chain reaction and Western blotting to assess the mRNA and protein levels of C1-inh and CD59 in AD and control brains in comparison with levels of the complement components with which they interact. The inhibitors were only slightly upregulated and then only in heavily affected areas of AD brain such as the entorhinal cortex, hippocampus, midtemporal gyrus and midfrontal gyrus. The ratio of AD to control mRNAs in these four areas was 1.17 for C1-inh and 1.12 for CD59, compared to 3.06 for C1r, 2.67 for C1s, 2.35 for C5, 2.56 for C6, 2.42 for C7, 5. 08 for C8 and 16.3 for C9. Peripheral organ expression of C1-inh and CD59 mRNAs was no different in AD than controls but was slightly upregulated in infarcted heart tissue. Again, the increase was small compared with that of the competitive complement components. These data indicate that the forces which upregulate and activate complement in AD and myocardial infarction are not effectively suppressed by the endogenous regulators, C1-inh and CD59.","Adult;Aged;Aged, 80 and over;Alzheimer Disease/*metabolism;Antigens, CD59/genetics/*metabolism;Blotting, Western;Brain Chemistry/physiology;Complement C1/*metabolism;Complement C1 Inactivator Proteins/genetics/*metabolism;Complement C1 Inhibitor Protein;DNA Primers;Entorhinal Cortex/metabolism;Gene Expression/physiology;Hippocampus/metabolism;Humans;Kidney/metabolism;Liver/metabolism;Middle Aged;Myocardial Infarction/metabolism;Myocardium/metabolism;Neurons/metabolism;Polymerase Chain Reaction;RNA, Messenger/analysis","Yasojima, K.;McGeer, E. G.;McGeer, P. L.",1999,Jul 3,,0,
4905,Distribution of cyclooxygenase-1 and cyclooxygenase-2 mRNAs and proteins in human brain and peripheral organs,"We used the techniques of reverse transcriptase-polymerase chain reaction, Western blotting and immunohistochemistry to evaluate the expression of cyclooxygenase (COX)-1 and -2 in brain and peripheral organs of Alzheimer disease (AD) and control cases. We found both COX-1 and COX-2 to be constitutively expressed in all organs tested, i.e., brain, heart, liver, kidney, spleen and intestine. COX-2 was substantially upregulated in affected areas of AD brain and in infarcted areas of human heart. COX-1 was only mildly upregulated in AD brain. Immunohistochemically, COX-2 was strongly expressed in the perinuclear, dendritic and axonal areas of pyramidal neurons, with enhanced staining in AD. These data suggest a special role for COX-2 in neuronal function.","Adult;Aged;Aged, 80 and over;Brain Chemistry/*physiology;Cyclooxygenase 1;Cyclooxygenase 2;Humans;Intestines/chemistry;Isoenzymes/*genetics;Kidney/chemistry;Liver/chemistry;Membrane Proteins;Middle Aged;Myocardium/chemistry;Nerve Tissue Proteins/*analysis;Organ Specificity;Prostaglandin-Endoperoxide Synthases/*genetics;Proteins/*analysis;RNA, Messenger/*analysis;Reverse Transcriptase Polymerase Chain Reaction;Spleen/chemistry","Yasojima, K.;Schwab, C.;McGeer, E. G.;McGeer, P. L.",1999,Jun 5,,0,
4906,Aerococcal infection at three US tertiary care hospitals,"Objectives: The aim of the present study was to determine clinical features of Aerococcus infections and the significance of the Aerococcus species isolated from any clinical samples. Methods: Electronic records of all cultures yielding Aerococcus species from 2002 to 2012 were obtained from three tertiary care hospitals. We performed an in-depth review of medical records. Results: Aerococcus was isolated from ≥1 site in 93 patients. Blood cultures were positive in 64 patients; 15 with definite bacteremia, including 3 with endocarditis, 7 with urinary tract infections, 13 with probable bacteremia, and 36 in which Aerococcus was judged to be a possible contaminant. Of 19 urine isolates, 10 were from patients with symptomatic urinary tract infections and 7 were from patients with asymptomatic bacteriuria; in 2 cases, urine isolates were regarded as possible contaminants. Most patients with urinary isolates had underlying urological abnormalities. Other sources for Aerococcus included synovial fluid, bile, bone, intraabdominal abscess, and ovarian abscess. All of the isolates tested with ampicillin, cefazolin, clindamycin, and vancomycin were susceptible. A total of two patients with definite Aerococcus infection died, but all of the others responded to antibiotic therapy. Conclusions: Aerococcus often is considered a contaminant; however, in our case series, 35% of cases in which Aerococcus was isolated from any site indicated a definite infection. In patients with positive blood cultures for Aerococcus, at least 23% were associated with infection. Appropriate attention needs to be directed to Aerococcus when it is isolated from a normally sterile site.",ampicillin;cefazolin;clindamycin;cotrimoxazole;oxacillin;tetracycline;vancomycin;abdominal abscess;adult;Aerococcus;Aerococcus infection;Aerococcus urinae;Aerococcus viridans;antibiotic sensitivity;antibiotic therapy;aorta aneurysm;aortic valve endocarditis;arteriovenous fistula;article;ascites;asymptomatic bacteriuria;bacteremia;bacterial arthritis;bacterial endocarditis;bacterial peritonitis;bacterium culture;bacterium isolate;bile;bladder cancer;blood culture;bone;catheter infection;cerebrospinal fluid;cerebrovascular accident;cholangitis;chronic lymphatic leukemia;colon cancer;comorbidity;controlled study;debridement;dementia;diabetes mellitus;empyema;Enterococcus;Enterococcus faecalis;Escherichia coli;female;gallstone;Gram positive infection;heart arrest;hepatobiliary disease;human;indwelling catheter;kidney failure;Klebsiella pneumoniae;liver abscess;liver cirrhosis;major clinical study;male;malignant neoplastic disease;microbiological examination;minimum inhibitory concentration;mitral valve endocarditis;neurogenic bladder;osteomyelitis;pancreatitis;peripheral vascular disease;prostate cancer;prostate hypertrophy;Proteus mirabilis;Proteus vulgaris;soft tissue infection;synovial fluid;tertiary care center;tuboovarian abscess;United States;urethra stenosis;urinalysis;urinary tract disease;urinary tract infection,"Yasukawa, K.;Afzal, Z.;Mbang, P.;Stager, C. E.;Musher, D. M.",2014,,,0,
4907,The continued need to synthesize the results of genetic associations across multiple studies,,Alzheimer disease;breast tumor;coronary artery disease;gene sequence;genetic association;genetic variability;genomics;heart infarction;human;hypertension;insulin dependent diabetes mellitus;letter;lung tumor;medical genetics;medical literature;non insulin dependent diabetes mellitus;obesity;schizophrenia,"Yesupriya, A.;Yu, W.;Clyne, M.;Gwinn, M.;Khoury, M. J.",2008,,,0,
4908,β-blockers and Neovascular Age-related Macular Degeneration,,beta adrenergic receptor blocking agent;age related macular degeneration;article;cerebrovascular disease;chronic lung disease;congestive heart failure;dementia;diabetes mellitus;heart infarction;human;hypertension;kidney disease;myopia;peripheral vascular disease;priority journal;wet macular degeneration,"Yeung, L.;Huang, T. S.;Lin, Y. H.;Hsu, K. H.;Chien-Chieh Huang, J.;Sun, C. C.",2017,,10.1016/j.ophtha.2016.10.023,0,
4909,First-in-man unprotected left main stenting with Stentys Xposition S self-apposing sirolimus eluting stent and optical coherence tomography guidance: The emerging panacea for left main intervention,,acute coronary syndrome;aged;Alzheimer disease;angina pectoris;angiocardiography;balloon catheter;case report;conscious sedation;coronary artery circumflex branch;coronary artery disease;coronary artery ectasia;coronary stenting;guiding catheter;human;left anterior descending coronary artery;left coronary artery;letter;male;optical coherence tomography;optical coherence tomography device;paclitaxel eluting coronary stent;percutaneous coronary intervention;priority journal;right coronary artery;self expanding stent;sirolimus eluting coronary stent;treatment planning;treatment response;vascular access;Judkins;Xposition S,"Yew, K. L.;Kang, Z.",2015,,,0,
4910,Factors associated with survival and neurological outcome after cardiopulmonary resuscitation of neurosurgical intensive care unit patients 12,,Alzheimer disease;amyotrophic lateral sclerosis;angiography;critically ill patient;dementia;Doppler echography;electroencephalography;electrophysiology;heart arrest;human;intensive care unit;letter;multiple sclerosis;neurologic disease;neurosurgery;outcome assessment;priority journal;resuscitation;retrospective study;survival;traumatic brain injury;treatment outcome,"Yi, H. J.",2007,,,0,
4911,Agent Orange exposure and disease prevalence in Korean Vietnam veterans: The Korean veterans health study,"Between 1961 and 1971, military herbicides were used by the United States and allied forces for military purposes. Agent Orange, the most-used herbicide, was a mixture of 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4,5-trichlorophenoxyacetic acid, and contained an impurity of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Many Korean Vietnam veterans were exposed to Agent Orange during the Vietnam War. The aim of this study was to evaluate the association between Agent Orange exposure and the prevalence of diseases of the endocrine, nervous, circulatory, respiratory, and digestive systems. The Agent Orange exposure was assessed by a geographic information system-based model. A total of 111,726 Korean Vietnam veterans were analyzed for prevalence using the Korea National Health Insurance claims data from January 2000 to September 2005. After adjusting for covariates, the high exposure group had modestly elevated odds ratios (ORs) for endocrine diseases combined and neurologic diseases combined. The adjusted ORs were significantly higher in the high exposure group than in the low exposure group for hypothyroidism (OR=1.13), autoimmune thyroiditis (OR=1.93), diabetes mellitus (OR=1.04), other endocrine gland disorders including pituitary gland disorders (OR=1.43), amyloidosis (OR=3.02), systemic atrophies affecting the nervous system including spinal muscular atrophy (OR=1.27), Alzheimer disease (OR=1.64), peripheral polyneuropathies (OR=1.09), angina pectoris (OR=1.04), stroke (OR=1.09), chronic obstructive pulmonary diseases (COPD) including chronic bronchitis (OR=1.05) and bronchiectasis (OR=1.16), asthma (OR=1.04), peptic ulcer (OR=1.03), and liver cirrhosis (OR=1.08). In conclusion, Agent Orange exposure increased the prevalence of endocrine disorders, especially in the thyroid and pituitary gland; various neurologic diseases; COPD; and liver cirrhosis. Overall, this study suggests that Agent Orange/2,4-D/TCDD exposure several decades earlier may increase morbidity from various diseases, some of which have rarely been explored in previous epidemiologic studies. © 2014 Elsevier Inc.","2,3,7,8 tetrachlorodibenzo para dioxin;2,4,5 trichlorophenoxyacetic acid;adult;Alzheimer disease;amyloidosis;angina pectoris;article;asthma;autoimmune thyroiditis;brain hemorrhage;brain infarction;bronchiectasis;cardiovascular disease;cerebrovascular accident;chronic bronchitis;chronic obstructive lung disease;controlled study;Crohn disease;demyelinating disease;diabetes mellitus;digestive system disease;duodenitis;emphysema;endocrine disease;environmental exposure;epilepsy;gastritis;geographic information system;heart failure;heart muscle conduction disturbance;human;hypothyroidism;ICD-10;Korea;liver cirrhosis;major clinical study;morbidity;mortality;multiple sclerosis;neurologic disease;Parkinson disease;peptic ulcer;peripheral vascular disease;pneumonia;prevalence;priority journal;respiratory tract disease;spinal muscular atrophy;ulcerative colitis;veterans health","Yi, S. W.;Hong, J. S.;Ohrr, H.;Yi, J. J.",2014,,,0,
4912,Statin and Aspirin Pretreatment Are Associated with Lower Neurological Deterioration and Platelet Activity in Patients with Acute Ischemic Stroke,"Background Aspirin and statin are recommended for the treatment of acute ischemic stroke. However, whether aspirin and statin pretreatment is associated with clinical outcomes has not been well addressed. This study aimed to evaluate the effect of pre-existing statin and aspirin use on platelet activation and clinical outcome in acute ischemic stroke patients. Methods We conducted a prospective, multicenter observational study in patients with acute ischemic stroke. Platelet aggregation and platelet–leukocyte aggregates were measured on admission and during 7-10 days after admission. The primary outcome of the study was neurological deterioration (ND) within 10 days after admission. The secondary outcome was a composite of recurrent ischemic stroke, myocardial infarction, and death during the first 3 months after admission. Physical disability was evaluated using the modified Rankin Scale score at 3 months after admission. Results Among 1124 enrolled patients, 270 (24%) experienced ND. Higher platelet aggregation and platelet–leukocyte aggregates on admission and during 7-10 days were associated with ND. Platelet aggregation and platelet–leukocyte aggregates on admission were significantly lower in the patients with pre-existing statin or aspirin use than those without treatment. Patients with prestroke concomitant statin and aspirin treatment had significantly lower incidence of ND than those without treatment. Diabetes mellitus, fasting glucose, platelet–leukocyte aggregates, and prestroke concomitant statin and aspirin use were independently associated with ND. Conclusions Prestroke concomitant statin and aspirin use is associated with lower neurological deterioration and platelet activity in patients with acute ischemic stroke.",acetylsalicylic acid;adenosine diphosphate;arachidonic acid;atorvastatin;glucose;hemoglobin A1c;high density lipoprotein cholesterol;hydroxymethylglutaryl coenzyme A reductase inhibitor;low density lipoprotein cholesterol;rosuvastatin;triacylglycerol;aged;article;brain ischemia;cholesterol blood level;clinical outcome;computed tomographic angiography;controlled study;death;diabetes mellitus;drug dose reduction;female;glucose blood level;heart infarction;Holter monitoring;hospital admission;human;hypertension;leukocyte;leukocyte aggregation;lymphocyte;magnetic resonance angiography;major clinical study;male;mental deterioration;monocyte;National Institutes of Health Stroke Scale;neurologic disease;neuroprotection;neutrophil;observational study;physical disability;priority journal;prospective study;Rankin scale;recurrent disease;stroke patient;thrombocyte activation;thrombocyte aggregation;triacylglycerol blood level;aspirin,"Yi, X.;Han, Z.;Wang, C.;Zhou, Q.;Lin, J.",2017,,10.1016/j.jstrokecerebrovasdis.2016.09.030,0,
4913,20-Hydroxyeicosatetraenoic Acid as a Predictor of Neurological Deterioration in Acute Minor Ischemic Stroke,"Background and Purpose - The relationship between high plasma 20-hydroxyeicosatetraenoic acid (20-HETE) levels and neurological deterioration (ND) has not been investigated in patients with acute minor ischemic stroke. Method - We conducted a prospective, multicenter observational study in patients with acute minor ischemic stroke. Plasma levels of 20-HETE were measured at admission in all patients. The primary end point of the study was ND within 10 days after admission. The degree of disability was assessed using modified Rankin scale at 3 months after admission. Results - A total of 322 patients were enrolled, of which 85 patients (26.4%) developed ND. Mean 20-HETE level was 1687±158 pmol/L. On multivariate analyses, high level (>1675 pmol/L) of 20-HETE was an independent predictor of ND (third and fourth quartiles). Neurological deterioration was associated with a higher risk of poor outcome (modified Rankin scale scores 3-6) at 3 months. Conclusions - ND is fairly common in acute minor ischemic stroke and is associated with poor prognosis. Elevated plasma level of 20-HETE may be a predictor for ND in acute minor ischemic stroke.",20 hydroxyicosatetraenoic acid;article;brain ischemia;clinical outcome;controlled study;disease association;fatty acid blood level;heart infarction;hospital admission;human;major clinical study;mental deterioration;observational study;priority journal;prospective study;Rankin scale;stroke patient,"Yi, X.;Han, Z.;Zhou, Q.;Lin, J.;Liu, P.",2016,,10.1161/strokeaha.116.015146,0,
4914,"Interaction among COX-2, P2Y1 and GPIIIa gene variants is associated with aspirin resistance and early neurological deterioration in Chinese stroke patients","Background: The effect of genetic variants on aspirin resistance (AR) remains controversial. We sought to assess the association of genetic variants with AR and early clinical outcomes in patients with acute ischemic stroke (IS). Methods: A total of 850 acute IS patients were consecutively enrolled. Platelet aggregation was measured before and after a 7-10 day aspirin treatment. The sequences of 14 variants of COX-1, COX-2, GPIb, GPIIIa, P2Y1 and P2Y12 were determined using matrix-assisted laser desorption/ionization time of flight mass spectrometry. Gene-gene interactions were analyzed using generalized multifactor dimensionality reduction (GMDR). The primary outcome was early neurological deterioration (END) within 10 days of admission. The secondary outcome was a composite of early recurrent ischemic stroke (ERIS), myocardial infarction (MI) and death within 10 days of admission. Results: 175 (20.6%) patients were AR, 45 (5.3%) were aspirin semi-resistant, 121 (14.2%) developed END, 17 (0.2%) had ERIS, 2 (0.2%) died, and 6 (0.7%) had MI. Single locus analysis indicated that only rs1371097 was associated with AR. However, GMDR analysis indicated that the following three sets of gene-gene interactions were significantly associated with AR: rs20417CC/rs1371097TT/rs2317676GG; rs20417CC/rs1371097TT/rs2317676GG; rs20417CC/rs1371097CT/rs2317676AG. END occurred significantly more frequently in patients with AR or high-risk interactive genotypes. Moreover, AR and high-risk interactive genotypes were independently associated with END. Conclusion: Sensitivity of IS patients to aspirin and END may be multifactorial and is not significantly associated with a single gene polymorphism. Combinational analysis may useful for further insight into the genetic risks for AR.",acetylsalicylic acid;cyclooxygenase 1;cyclooxygenase 2;glucose;purinergic P2Y1 receptor;purinergic P2Y12 receptor;age;aged;article;brain ischemia;Chinese;clinical outcome;controlled study;correlational study;COX 1 gene;COX 2 gene;diabetes mellitus;drug response;early neurological deterioration;female;gender;gene frequency;gene interaction;gene locus;generalized multifactor dimensionality reduction;genotype;glucose blood level;GPIb gene;GPIIIa gene;heart infarction;hospital admission;human;major clinical study;male;matrix assisted laser desorption ionization time of flight mass spectrometry;mental deterioration;mortality;multifactor dimensionality reduction;P2Y1 gene;P2Y12 gene;receptor gene;recurrent disease;risk factor;single nucleotide polymorphism;stroke patient;thrombocyte aggregation;wild type,"Yi, X.;Wang, C.;Zhou, Q.;Lin, J.",2017,,10.1186/s12883-016-0788-8,0,
4915,Atrial fibrillation may be a hidden factor for the development of cognitive impairment in patients with heart failure,,brain natriuretic peptide;ambulatory monitoring;atrial fibrillation;brain blood flow;brain disease;brain perfusion;cardiovascular risk;cerebrovascular accident;CHADS2 score;cognitive defect;comorbidity;congestive heart failure;dementia;diabetes mellitus;diastolic blood pressure;disease association;disease duration;disease exacerbation;electrocardiogram;heart arrhythmia;heart failure;heart left ventricle ejection fraction;human;hypertension;incidence;letter;microembolism;New York Heart Association class;paroxysmal atrial fibrillation;permanent atrial fibrillation;persistent atrial fibrillation;population;prevalence;risk assessment;risk factor;systolic blood pressure;systolic dysfunction;thromboembolism;transient ischemic attack;vascular disease,"Yiginer, O.;Tokatli, A.;Dogan, M.;Erdal, E.",2015,,,0,
4916,Inverse relationship between apolipoprotein A-I and cerebral white matter lesions: a cross-sectional study in middle-aged and elderly subjects,"BACKGROUND: Apolipoprotein A-I (apoA-I), the major protein for high density lipoprotein, is essential for reverse cholesterol transport. Decreased serum levels of apoA-I have been reported to correlate with subcortical infarction and dementia, both of which are highly related to white matter lesions (WMLs). However, the association between apoA-I and WMLs has never been investigated. In this study, we sought to investigate the association between apoA-I and the presence of WMLs in middle-aged and elderly subjects. METHODS: Consecutive patients aged 50 years and older of our department were prospectively enrolled in this study (n = 1282, 606 men and 676 women, 65.9 +/- 9.4 years). All participants underwent MRI scans to assess the presence and severity of WMLs. Multivariate logistic regression analyses were performed to examine the association of apoA-I with WMLs. RESULTS: Patients with WMLs were older and showed significantly higher proportion of male sex, hypertension, diabetes mellitus, previous stroke, and coronary heart disease whereas levels of total cholesterol, high density lipoprotein cholesterol, and apoA-I were lower. After adjustment for potential confounders, the lowest apoA-I quartile was independently associated with an increased risk of WMLs (odds ratio: 1.87, 95% confidence interval: 1.29-2.72). In sex-specific analyses, this relationship was observed only in women. CONCLUSIONS: Our findings demonstrated that apoA-I was inversely associated with the presence of WMLs in middle-aged and elderly subjects. This results suggest that therapies which increase apoA-I concentration may be beneficial to reduce the risk of WMLs, dementia and stroke.",Aged;Apolipoprotein A-I/*metabolism;Cross-Sectional Studies;Female;Humans;Leukoaraiosis/*epidemiology/*metabolism;Magnetic Resonance Imaging;Male;Middle Aged;Risk,"Yin, Z. G.;Li, L.;Cui, M.;Zhou, S. M.;Yu, M. M.;Zhou, H. D.",2014,,10.1371/journal.pone.0097113,0,
4917,Association of dietary cholesterol and egg intakes with the risk of incident dementia or Alzheimer disease: the Kuopio Ischaemic Heart Disease Risk Factor Study,"BACKGROUND: There is little information about the associations of intakes of cholesterol and eggs, a major source of dietary cholesterol, with the risk of cognitive decline in general populations or in carriers of apolipoprotein E varepsilon4 (APO-E4), a major risk factor for dementia. OBJECTIVE: We investigated the associations of cholesterol and egg intakes with incident dementia, Alzheimer disease (AD), and cognitive performance in middle-aged and older men from Eastern Finland. DESIGN: A total of 2497 dementia-free men, aged 42-60 y in 1984-1989 at the baseline examinations of the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study, were included in the study. Information on the apolipoprotein E (Apo-E) phenotype was available for 1259 men. Data on cognitive performance tests at the 4-y re-examinations were available for 480 men. Dietary intakes were assessed with the use of 4-d food records at baseline. Dementia and AD diagnoses were based on Finnish health registers. Cox regression and ANCOVA were used for the analyses. RESULTS: During the 21.9-y follow-up, 337 men were diagnosed with dementia, and 266 men were diagnosed with AD. Neither cholesterol nor egg intake was associated with a higher risk of incident dementia or AD. For example, when evaluated continuously, each intake of 100 mg cholesterol/d was associated with a multivariable-adjusted HR of 0.90 (95% CI: 0.79, 1.02) for incident dementia, and each additional 0.5 egg (27 g)/d was associated with an HR of 0.89 (95% CI: 0.78, 1.01). However, egg intake was associated with better performance on neuropsychological tests of the frontal lobe and executive functioning, the Trail Making Test, and the Verbal Fluency Test. The Apo-E4 phenotype did not modify the associations of cholesterol or egg intake (P-interactions > 0.11). CONCLUSIONS: Neither cholesterol nor egg intake is associated with an increased risk of incident dementia or AD in Eastern Finnish men. Instead, moderate egg intake may have a beneficial association with certain areas of cognitive performance.","0 (Apolipoprotein E4);0 (Apolipoproteins E);0 (Cholesterol, Dietary);Adult;Alzheimer Disease/blood/ epidemiology;Animals;Apolipoprotein E4/blood;Apolipoproteins E/blood;Cholesterol, Dietary/ adverse effects;Cognition;Cross-Sectional Studies;Dementia/blood/ epidemiology;Eggs/ adverse effects;Energy Intake;Executive Function;Finland;Follow-Up Studies;Humans;Linear Models;Male;Middle Aged;Myocardial Ischemia/blood/epidemiology;Neuropsychological Tests;Prospective Studies;Risk Factors;Sensitivity and Specificity;Alzheimer disease;apolipoprotein E4;cholesterol;cognitive function;cognitive performance;dementia;eggs;population study","Ylilauri, M. P.;Voutilainen, S.;Lonnroos, E.;Mursu, J.;Virtanen, H. E.;Koskinen, T. T.;Salonen, J. T.;Tuomainen, T. P.;Virtanen, J. K.",2017,Feb,,0,
4918,Prolonged delirium secondary to Hypoxic-ischemic encephalopathy following cardiac arrest,"Hypoxic-ischemic brain injury encompasses a complex constellation of pathophysiological and cellular brain injury induced by hypoxia, ischemia, cytotoxicity, or combinations of these mechanisms and can result in poor outcomes including significant changes in personality and cognitive impairments in memory, cognition, and attention. We report a case of a male patient with normal premorbid functioning who developed prolonged delirium following hypoxic-ischemic brain insults subsequent to cardiac arrest. The case highlights the importance of adopting a multidisciplinary treatment approach involving the coordinated care of medical and nursing teams to optimise management of patients suffering from such a debilitating organic brain syndrome. © 2013, Korean College of Neuropsychopharmacology.",carbamazepine;clopidogrel;furosemide;gliclazide;haloperidol;lithium;olanzapine;perindopril;quetiapine;risperidone;simvastatin;sulpiride;valproic acid;adult;aggression;agitation;article;case report;delirium;dementia;drug efficacy;drug safety;drug substitution;drug withdrawal;extracorporeal circulation;extrapyramidal syndrome;heart arrest;heart left ventricle hypertrophy;human;hypoxic ischemic encephalopathy;maculopapular rash;male;medical care;Mini Mental State Examination;nursing care;organic brain syndrome;orthostatic hypertension;postoperative complication;Stevens Johnson syndrome;treatment outcome,"Yogaratnam, J.;Jacob, R.;Naik, S.;Magadi, H.;Sim, K.",2013,,,0,
4919,An elderly patient with Takayasu's arteritis associated with antiphospholipid antibodies,"We report a patient with Takayasu's arteritis associated with antiphospholipid antibodies. An 84-year-old woman gradually developed gait and visual disturbances, dementia, myocardial infarction, and gangrene in all four limbs during a period of 8 years. Persistent inflammatory signs also continued for at least 8 years. Positive reaction for lupus anticoagulant by the diluted Russel viper venous time and positive reactions for cardiolipin antibodies were confirmed. However, she did not develop SLE. MR angiography revealed multiple and extensive occlusive changes in large vessels such as the aorta and its major branches. We believe antiphospholipid antibodies may have been related to severe occlusive vasculopathy in this patient.",phospholipid antibody;aged;angiography;aorta arch syndrome;aorta occlusion;arteritis;article;case report;female;human,"Yokoi, K.;Akaike, M.;Shigekiyo, T.;Saito, S.",1994,,,0,
4920,Cognitive dysfunction and malnutrition are independent predictor of dysphagia in patients with acute exacerbation of congestive heart failure,"Early detection and intervention for dysphagia is important in patients with congestive heart failure (CHF). However, previous studies have focused on how many patients with dysphagia develop CHF. Studies focusing on the comorbidity of dysphagia in patients with CHF are rare. Additionally, risk factors for dysphagia in patients with CHF are unclear. Thus, the aim of this study was to clarify risk factors for dysphagia in patients with acute exacerbation of CHF. A total of 105 patients, who were admitted with acute exacerbation of CHF, were enrolled. Clinical interviews, blood chemistry analysis, electrocardiography, echocardiography, Mini-Mental State Examination (MMSE), exercise tolerance tests, phonatory function tests, and evaluation of activities of daily living (ADL) and nutrition were conducted on admission. After attending physicians permitted the drinking of water, swallowing screening tests were performed. Patients were divided into a dysphagia group (DG) or a non-dysphagia group (non-DG) based on Functional Oral Intake Scale level. Among the 105 patients, 38 had dysphagia. A greater number of patients had history of aspiration pneumonia and dementia, and there was a higher age, N-terminal pro-B-type natriuretic peptide level in the DG compared with the non-DG. MMSE scores, exercise tolerance, phonatory function, status of ADL, nutrition, albumin, and transthyretin were lower in the DG compared with the non-DG. In multivariate analysis, after adjusting for age and sex, MMSE, BI score, and transthyretin was independently associated with dysphagia. Comorbidity of dysphagia was 36.1% in patients with acute exacerbation of CHF, and cognitive dysfunction and malnutrition may be an independent predictor of dysphagia.",albumin;amino terminal pro brain natriuretic peptide;C reactive protein;hemoglobin;prealbumin;acute exacerbation;age distribution;aged;article;aspiration pneumonia;assessment of humans;blood chemistry;clinical interview;cognitive defect;comorbidity;comparative study;congestive heart failure;controlled study;daily life activity;dementia;disease exacerbation;dysphagia;echocardiography;electrocardiography;exercise tolerance;female;function test;Functional Oral Intake Scale;grip strength;heart failure with preserved ejection fraction;hematocrit;human;interview;major clinical study;male;malnutrition;medical history;Mini Mental State Examination;New York Heart Association class;nutrition;phonatory function test;predictive value;prospective study;risk assessment;swallowing screening test;urea nitrogen blood level;very elderly,"Yokota, J.;Ogawa, Y.;Yamanaka, S.;Takahashi, Y.;Fujita, H.;Yamaguchi, N.;Onoue, N.;Ishizuka, T.;Shinozaki, T.;Kohzuki, A.",2016,,10.1371/journal.pone.0167326,0,
4921,Real-world evidence for the safety of ipragliflozin in elderly Japanese patients with type 2 diabetes mellitus (STELLA-ELDER): final results of a post-marketing surveillance study,"Objective: To investigate the real-world safety of ipragliflozin in elderly Japanese patients with type 2 diabetes mellitus (T2DM). Research design and methods: Japanese patients (≥65 years old) who were first prescribed ipragliflozin within 3 months after its launch in April 2014 were registered in this post-marketing surveillance (PMS). Final data collection was in July 2015. Survey items included demographics, treatments, adverse drug reactions (ADRs), vital signs, and laboratory variables. Results: The PMS included 8505 patients (4181 males/4324 females). The mean age and diabetes duration were 72.3 years and 10.6 years, respectively. In 84.3% of patients, ipragliflozin was prescribed at 50 mg/day, which was continued unchanged. Overall, 16.91% of patients experienced 1880 ADRs, and 165 ADRs were classified as serious in 127 patients (1.49%). ADRs of special interest included skin complications, volume depletion, polyuria/pollakiuria, genital infection, urinary tract infection, renal disorders, hypoglycemia, cerebrovascular disease, cardiovascular disease, malignant tumor, fracture, and ketone body-related events. Conclusions: This 1-year PMS revealed probable ADRs in elderly Japanese patients with T2DM prescribed ipragliflozin in real-world settings, with no new safety concerns. The risk factors for ADRs varied but could be rationalized. The results should help physicians to identify possible treatment-emergent ADRs in ipragliflozin-treated patients.",alanine aminotransferase;alpha 1 microglobulin;alpha glucosidase inhibitor;antidiabetic agent;antihypertensive agent;antithrombocytic agent;antiulcer agent;aspartate aminotransferase;biguanide derivative;bilirubin;creatinine;dipeptidyl peptidase IV inhibitor;diuretic agent;glucagon like peptide 1 receptor agonist;glucose;hemoglobin A1c;hydroxymethylglutaryl coenzyme A reductase inhibitor;insulin;ipragliflozin;serum albumin;sulfonylurea derivative;thiazolidine derivative;urea;acute heart failure;acute heart infarction;aged;alanine aminotransferase blood level;angina pectoris;article;aspartate aminotransferase blood level;atrial fibrillation;bilirubin blood level;brain hemorrhage;brain infarction;brain stem infarction;breast disease;cardiopulmonary insufficiency;cardiovascular disease;cerebellum infarction;cerebrovascular disease;colon cancer;complete heart block;connective tissue disease;coronary artery disease;coronary artery obstruction;creatinine blood level;deep vein thrombosis;dementia;diabetic ketoacidosis;diabetic nephropathy;diabetic neuropathy;diabetic retinopathy;disease duration;drug dose increase;drug eruption;drug safety;dyslipidemia;eczema;endocrine disease;estimated glomerular filtration rate;eye disease;female;femur neck fracture;fracture;gastrointestinal disease;genital system disease;genital tract infection;glucose blood level;heart failure;heart infarction;heart ventricle extrasystole;hepatobiliary disease;human;hypertension;hyperuricemia;hypoglycemia;inner ear disease;insulin treatment;intracranial aneurysm;Japanese (people);ketoacidosis;ketonuria;kidney disease;lacunar stroke;lung cancer;major clinical study;male;malignant neoplastic disease;mental disease;metabolic acidosis;metabolic disorder;morning dosage;musculoskeletal disease;neurologic disease;non insulin dependent diabetes mellitus;nutritional disorder;pancreas carcinoma;peripheral occlusive artery disease;pollakisuria;polyuria;postmarketing surveillance;prescription;pruritus;putaminal hemorrhage;radius fracture;rash;side effect;skin disease;stomach cancer;transient ischemic attack;urea nitrogen blood level;urinary tract infection;urticaria;vascular disease;very elderly;vital sign,"Yokote, K.;Terauchi, Y.;Nakamura, I.;Sugamori, H.",2016,,,0,
4922,"Risk factors associated with abnormal cognition in Japanese outpatients with diabetes, hypertension or dyslipidemia","Aims: According to the recent increase in life expectancy in patients with diabetes, the incidence of dementia with diabetes is increasing drastically in Japan. However, the number of studies on the prevalence of abnormal cognition and the associated risk factors in a large number of outpatients with diabetes in a primary care setting is very limited. Methods: The Mini-Mental State Examination (MMSE) test was performed in 1,449 outpatients aged ≥50 years with diabetes, hypertension or dyslipidemia (126 without and 1,323 with diabetes). Prevalence of abnormal cognition defined as an MMSE score <24 and the associated risk factors were explored. Results: Prevalence of abnormal cognition was 5.8 % in total, and was 8.3 % in outpatients aged ≥65 years with diabetes. Logistic regression analysis after adjustment for age, sex, BMI and smoking indicated that abnormal cognition was associated with lower serum albumin and higher uric acid levels in all subjects. In subjects with diabetes, in addition to the associations with serum albumin and uric acid levels, lower renal function, retinopathy, use of insulin and α-glucosidase inhibitor, and non-use of pioglitazone and metformin were significantly associated with abnormal cognition independent of the effect of duration of diabetes, hypertension, dyslipidemia, and history of coronary heart disease and stroke. Conclusions: Because of the higher prevalence of abnormal cognition in aged outpatients with diabetes found in primary care practice and significant associations with serum albumin, uric acid, renal function, retinopathy and antidiabetic drugs, there is a need for early diagnosis and strategies against dementia.",albumin;alpha glucosidase inhibitor;insulin;metformin;pioglitazone;sulfonylurea;uric acid;adult;aged;albumin blood level;article;body mass;cerebrovascular accident;cognitive defect;diabetic nephropathy;diabetic neuropathy;diabetic retinopathy;dyslipidemia;female;human;hypertension;ischemic heart disease;Japanese (people);major clinical study;male;Mini Mental State Examination;non insulin dependent diabetes mellitus;outpatient;prevalence;primary medical care;priority journal;risk assessment;risk factor;smoking;uric acid blood level,"Yokoyama, H.;Ogawa, M.;Honjo, J.;Okizaki, S.;Yamada, D.;Shudo, R.;Shimizu, H.;Sone, H.;Haneda, M.",2015,,,0,
4923,Cerebral edema induced by hyperammonemia: a case report,,ammonia;branched chain amino acid;catecholamine;heparin;lactulose;aged;article;brain edema;case report;coma;computer assisted tomography;consciousness disorder;defibrillation;dementia;disease severity;electroencephalogram;emergency ward;epileptic state;female;Glasgow coma scale;heart failure;heart ventricle fibrillation;hemodiafiltration;human;hyperammonemia;inferior cava vein shunt;laboratory test;lacunar stroke;long term care;mesenteric vein shunt;occipital lobe;physical examination;portal vein thrombosis;priority journal;resuscitation;seizure;vein disease;ventilator;verbal communication,"Yonai, R.;Sato, R.;Nasu, M.",2016,,10.1016/j.ajem.2016.05.065,0,
4924,Transurethral resection of the prostate for patients with dementia,"During the period from July 1995 to June 1996 we performed transurethral resection of the prostate (TURP) on 824 patients with benign prostatic hyperplasia (BPH). Among them, 13 were dementia patients between 74 and 96 years old; they presented with urinary hesitancy in 6, retention in 4, frequency in 2 and incontinence in 1 patient. Past history included stroke in 7, hypertension in 6, pulmonary tuberculosis in 4, diabetes in 3, asthma in 2, angina pectoris in 1, Parkinson's disease in 1, pneumonia in 1, and hepatitis in 1. Careful preoperative examination revealed that they were proper candidates for TURP. They underwent TURP under spinal anesthesia. The mean operative time was 34 min, ranging from 20 to 60 min. The adenoma resected weighed 24 g on the average, ranging from 7.5 to 48 g. During surgery, although hypotension was noted in 2 patients, there was no serious morbidity. Their mental condition was well controlled with ketamine and diazepam during and after surgery. Postoperative complications included acute myocardial infarction in 1, multiple gastric ulcer in 1, and decubitus in 1. None died within 3 months after TURP, 3 died there after, and 10 patients were alive at the mean follow-up period of 26 months. Six patients reported good urination, 3 reported some improvement in urination after surgery, although requiring intermittent catheterization and 1 developed mild incontinence. In conclusion, TURP appears to provide some benefit in selected patients with dementia and should not be considered to be a contraindication for such patients.","Aged;Aged, 80 and over;Anesthesia, Spinal;Anesthetics, Dissociative;Anesthetics, Intravenous;Dementia/*complications;Diazepam;Humans;Ketamine;Male;*Prostatectomy;Prostatic Hyperplasia/complications/*surgery;Urination Disorders/*surgery","Yonou, H.;Kagawa, H.;Oda, A.;Nagano, M.;Gakiya, M.;Niimura, K.;Hatano, T.;Ogawa, Y.",1999,Apr,,0,
4925,Correlates of major depressive disorder with and without comorbid alcohol use disorder nationally in the veterans health administration,"Background and Objectives This study assesses medical and psychiatric comorbidities, service utilization, and psychotropic medication prescriptions in veterans with comorbid major depressive disorder (MDD) and alcohol use disorder (AUD) relative to veterans with MDD alone. Methods Using cross-sectional administrative data (fiscal year [FY]2012: October 1, 2011-September 30, 2012) from the Veterans Health Administration (VHA), we identified veterans with a diagnosis of current (12-month) MDD nationally (N = 309,374), 18.8% of whom were also diagnosed with current (12-month) AUD. Veterans with both MDD and AUD were compared to those with MDD alone on sociodemographic characteristics, current (12-month) medical and psychiatric disorders, service utilization, and psychotropic prescriptions. We then used logistic regression analyses to calculate odds ratio and 95% confidence interval of characteristics that were independently different between the groups. Results Dually diagnosed veterans with MDD and AUD, relative to veterans with MDD alone, had a greater number of comorbid health conditions, such as liver disease, drug use disorders, and bipolar disorder as well as greater likelihood of homelessness and higher service utilization. Conclusions and Scientific Significance Dually diagnosed veterans with MDD and AUD had more frequent medical and psychiatric comorbidities and more frequently had been homeless. These data suggest the importance of assessing the presence of comorbid medical/psychiatric disorders and potential homelessness in order to provide appropriately comprehensive treatment to dually diagnosed veterans with MDD and AUD and indicate a need to develop more effective treatments for combined disorders.",psychotropic agent;adult;alcohol use disorder;anxiety disorder;article;bipolar disorder;cannabis addiction;cerebrovascular accident;chronic obstructive lung disease;cocaine dependence;comorbidity;connective tissue disease;cross-sectional study;dementia;diabetes mellitus;female;fibromyalgia;headache;health care utilization;heart infarction;homelessness;human;Human immunodeficiency virus infection;insomnia;liver disease;major clinical study;major depression;male;metastasis;musculoskeletal pain;neoplasm;opiate addiction;paraplegia;peptic ulcer;peripheral vascular disease;personality disorder;posttraumatic stress disorder;schizophrenia;seizure;veteran,"Yoon, G.;Petrakis, I. L.;Rosenheck, R. A.",2015,,,0,
4926,Long-term prognosis after endoscopic submucosal dissection for early gastric cancer in super-elderly patients,"Background: No previous study has confirmed the safety of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the super-elderly patient population. The current study aimed to evaluate the validity of ESD for EGC in super-elderly patients aged ≥85 years with comorbidities. Methods: Our study group included 85 super-elderly patients (102 EGCs) who were diagnosed at Hiroshima University Hospital between April 2002 and October 2014. We evaluated the en bloc resection rates, R0 resection rates, complication rates, and prognosis in relation to the degree of comorbidities (group A–H, patients with high-risk comorbidities; group A–L, patients with low-risk comorbidities; group B, patients without comorbidities; and group C, patients followed without ESD). Results: The en bloc resection rates were 100, 96, and 100 % in groups A–H, A–L, and B, respectively. R0 resection rates were 94, 96, and 94 % in groups A–H, A–L, and B, respectively. There were no severe complications related to ESD. During the follow-up period, there was a significantly higher frequency of death in group A than in group B (p < 0.01), and there were no significant differences between groups A–H and A–L. However, there were no cases of death related to gastric cancer. Conclusions: ESD was performed safely, and death related to gastric cancer was prevented in super-elderly patients with comorbidities, regardless of the degree of the disease. However, patients with comorbidities are at a high risk of poor prognosis.",acute heart infarction;advanced cancer;aged;article;brain infarction;cancer prognosis;cancer surgery;cancer survival;cause of death;comorbidity;conservative treatment;delayed bleeding;early cancer;en bloc resection;endoscopic submucosal dissection;female;human;human tissue;kidney failure;length of stay;lymphoma;major clinical study;male;malignant neoplastic disease;outcome assessment;overall survival;pneumonia;postoperative complication;postoperative hemorrhage;priority journal;retrospective study;risk;senility;stomach cancer;stomach perforation;validity;very elderly,"Yoshifuku, Y.;Oka, S.;Tanaka, S.;Sanomura, Y.;Miwata, T.;Numata, N.;Hiyama, T.;Chayama, K.",2016,,,0,
4927,The pathological and biochemical identification of possible seed-lesions of transmitted transthyretin amyloidosis after domino liver transplantation,"The most serious issue in domino liver transplantation (DLT) using liver grafts from patients with transthyretin (TTR)-related familial amyloid polyneuropathy (FAP) is the development of iatrogenic transmitted amyloidosis (de novo amyloidosis) in DLT-recipients. However, little is known regarding the mechanisms of the initial stage of amyloid formation in these recipients. We detected initial lesions (possible seed-lesions) of this iatrogenic amyloidosis in two recipients following liver grafting from FAP patients. Patient 1 underwent DLT at age 65 from an FAP patient with a Val30Met TTR variant and patient 2 received DLT from an FAP patient with a Val30Leu TTR variant at age 32. Patient 2 was started on diflunisal administration from 4 years after DLT. While neither patient had symptoms of FAP, small amyloid deposits were detected on the gastroduodenal mucosae 14 months and 12 years after DLT in patient 1 and patient 2, respectively. The amyloid was analyzed using a laser microdissection system and tandem mass spectrometry. Biochemical analysis indicated that the amyloid was composed mostly of variant TTR produced from the transplanted liver in both patients. In patient 1, wild-type TTR amyloid was detectable in the duodenal mucosa obtained 2 years after DLT. This is the first study to successfully capture the pathological and biochemical features of initial-stage amyloid lesions in DLT recipients. The findings clearly indicate that amyloid deposition can start by deposition of variant TTR followed by deposition of wild-type TTR, and blocking of amyloid seed formation from variant TTR may be a key to prevent or delay the development of DLT-associated amyloidosis.",amyloid;diflunisal;methionine;prealbumin;tacrolimus;tafamidis;valine;abdominal fat aspiration biopsy;adult;aged;amyloidosis;article;cardiomyopathy;citrullinemia type II;clinical article;congestive heart failure;controlled study;domino liver transplantation;donor;duodenum biopsy;duodenum mucosa;familial amyloid polyneuropathy;female;gene;histopathology;human;human tissue;iatrogenic disease;immunohistochemistry;Japanese (people);laser microdissection;liquid chromatography;liver cell carcinoma;liver cirrhosis;liver graft;liver transplantation;male;mass spectrometry;muscle action potential;peripheral neuropathy;priority journal;recipient;tandem mass spectrometry;tissue section;transmitted transthyretin amyloidosis;TTR gene,"Yoshinaga, T.;Yazaki, M.;Sekijima, Y.;Kametani, F.;Miyashita, K.;Hachiya, N.;Tanaka, T.;Kokudo, N.;Higuchi, K.;Ikeda, S. i",2016,,,0,
4928,Valve surgery in active endocarditis patients complicated by intracranial haemorrhage: The influence of the timing of surgery on neurological outcomes,"Objectives: The risk of neurological deterioration during valve surgery using cardiopulmonary bypass under systemic heparinization in infective endocarditis (IE) patients with intracranial haemorrhage (ICH) is unknown. The objective of this retrospective study was to investigate the stratified risk related to the timing of valve surgery on neurological outcomes in patients with active IE and preoperative ICH. Methods: From 2004 to 2012, 246 patients underwent valve surgery for IE in hospitals enrolled in the Osaka Cardiovascular Research Group. Of these, a group of 30 patients had preoperative ICH, and they included 18 patients with cerebral haemorrhage, 8 with subarachnoid haemorrhage and 4 with haemorrhagic infarction. The preoperative characteristics, neurological statuses and postoperative results of these patients were retrospectively explored to analyse the effects of the timing of surgery on neurological outcomes. Results: Twenty-one patients had symptomatic ICH, and the median modified Rankin score was 1.5 (95% confidence interval [CI] 1.2-2.8). Eight patients were diagnosed with mycotic aneurysms, and 7 of these patients underwent aneurysm resection or clipping before valve surgery. All 30 patients underwent valve surgery, and the median interval between ICH onset and surgery was 22.5 (95% CI 15.5-39.4) days. Four patients died of multiple organ dysfunction or heart failure. The interval between ICH onset and valve surgery was within 7 days for 5 cases, between 8 and 14 days for 6, between 15 and 28 days for 9 and >29 days for 10. Postoperative neuroimaging showed that neither neurological deterioration nor exacerbation of haemorrhagic lesions had occurred among the 30 patients, regardless of the timing of surgery. However, 2 cases who underwent valve surgery 8 and 81 days after the onset of ICH developed new ectopic asymptomatic haemorrhages postoperatively. Conclusions: The risk of postoperative neurological deterioration resulting from the exacerbation of haemorrhagic lesions seemed relatively low, even in IE patients who underwent valve surgery within 2 weeks of ICH onset. However, further evaluation of the sizes and aetiologies of haemorrhagic lesions is vital to establish a safe interval between the ICH onset and surgery. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.",adult;anticoagulant therapy;anticoagulation;aorta valve;article;bacterial endocarditis;blood clotting time;brain damage;brain hemorrhage;cardiopulmonary bypass;clinical article;computed tomographic angiography;computer assisted tomography;female;heart failure;heart valve replacement;heart valve surgery;hemorrhagic infarction;heparinization;human;magnetic resonance angiography;male;mental deterioration;mitral valve;multiple organ failure;mycotic aneurysm;neuroimaging;outcome assessment;priority journal;Rankin scale;retrospective study;subarachnoid hemorrhage;transthoracic echocardiography,"Yoshioka, D.;Toda, K.;Sakaguchi, T.;Okazaki, S.;Yamauchi, T.;Miyagawa, S.;Nishi, H.;Yoshikawa, Y.;Fukushima, S.;Saito, T.;Sawa, Y.",2014,,,0,
4929,Is Aging in Place Delaying Nursing Home Admission?,"OBJECTIVES: This study examines whether aging in place (community-based living before admission to a nursing home) delays nursing home admission among New York State home health care recipients. DESIGN: Retrospective cohort study (January 2007-December 2012). SETTING: New York State. PARTICIPANTS: Adults age 65+ who received home health services for at least 2 months before permanent nursing home admission. MEASUREMENT AND ANALYSIS: Permanent transition is defined as home care patients who are discharged to and stay at a nursing home for more than 3 months. Data were abstracted from the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS). Descriptive and bivariate Kruskal-Wallis and chi(2) tests were performed. RESULTS: The average age of nursing home residents at admission remained steady at 83 years between 2007 and 2012. The proportion of minority populations (Asian, black, Hispanic/Latino) increased, whereas the white population declined (P < .0001). The average length of stay at home increased 8 months, from 17 months in 2007 to 25 months in 2012 (P < .0001). Chronic conditions with significant increases in prevalence during the study period were hypertension (P < .0009), dementia (P < .0001), heart failure (P = .05), urinary incontinence (P < .0001), and bowel incontinence (P < .0001). Increases in functional disabilities requiring extensive human assistance included toileting, dressing, personal hygiene, and transferring (all P < .001). CONCLUSION: Home health services enabled recipients to remain at home 8 months longer, thus delaying nursing home entry. Given the increase in prevalence of comorbidities and disability, we anticipate a concomitant increase in support services at the nursing home. These results may inform policy and staffing decisions regarding adjustments in required caregivers' credentials and nurse-patient ratios.","Activities of Daily Living;Aged;Aged, 80 and over;Chronic Disease/epidemiology;Cohort Studies;Female;Home Care Services/*utilization;Humans;*Independent Living;Male;New York/epidemiology;*Nursing Homes;Patient Admission/statistics & numerical data;Retrospective Studies;Time Factors;ADLs;Aging in place;home and community-based services;nursing home","Young, Y.;Kalamaras, J.;Kelly, L.;Hornick, D.;Yucel, R.",2015,Oct 1,10.1016/j.jamda.2015.07.017,0,
4930,Increasing burden of psychiatric comorbidities amongst patients with Ischaemic Heart Disease,,aged;alcohol abuse;anxiety disorder;bipolar disorder;comorbidity;dementia;depression;disease association;drug overdose;female;human;ischemic heart disease;letter;major clinical study;male;mental disease;phobia;priority journal;schizophrenia;suicide attempt,"Yssennagger, L.;Gollop, N. D.;Gorantla, R. S.;Nimmagadda, M.;Potluri, S.;Uppal, H.;Chandran, S.;Potluri, R.",2015,,,0,
4931,Weight history and all-cause and cause-specific mortality in three prospective cohort studies,"Background: The relationship between body mass index (BMI) and mortality is controversial. Objective: To investigate the relationship between maximum BMI over 16 years and subsequent mortality. Design: 3 prospective cohort studies. Setting: Nurses' Health Study I and II and Health Professionals Follow-Up Study. Participants: 225 072 men and women with 32 571 deaths observed over a mean of 12.3 years of follow-up. Measurements: Maximum BMI over 16 years of weight history and all-cause and cause-specific mortality. Results: Maximum BMIs in the overweight (25.0 to 29.9 kg/m2) (multivariate hazard ratio [HR], 1.06 [95% CI, 1.03 to 1.08]), obese I (30.0 to 34.9 kg/m2) (HR, 1.24 [CI, 1.20 to 1.29]), and obese II (≥35.0 kg/m2) (HR, 1.73 [CI, 1.66 to 1.80]) categories were associated with increases in risk for all-cause death. The pattern of excess risk with a maximum BMI above normal weight was maintained across strata defined by smoking status, sex, and age, but the excess was greatest among those youngerthan 70 years and never-smokers. In contrast, a significant inverse association between overweight and mortality (HR, 0.96 [CI, 0.94 to 0.99]) was observed when BMI was defined using a single baseline measurement. Maximum overweight was also associated with increased cause-specific mortality, including death from cardiovascular disease and coronary heart disease. Limitation: Residual confounding and misclassification. Conclusion: The paradoxical association between overweight and mortality is reversed in analyses incorporating weight history. Maximum BMI may be a useful metric to minimize reverse causation bias associated with a single baseline BMI assessment. Primary Funding Source: National Institutes of Health.",accident;adult;age;aged;all cause mortality;Alzheimer disease;article;body mass;body weight;cardiovascular disease;cause of death;cause specific mortality;cerebrovascular accident;cohort analysis;confounding variable;death;disease association;female;follow up;heart failure;human;infection;ischemic heart disease;major clinical study;male;malignant neoplasm;medical history;middle aged;mortality;obesity;priority journal;prospective study;respiratory tract disease;risk factor;sex;smoking;underweight,"Yu, E.;Ley, S. H.;Manson, J. E.;Willett, W.;Satija, A.;Hu, F. B.;Stokes, A.",2017,,10.7326/m16-1390,0,
4932,Trend of centenarian deaths in Hong Kong between 2001 and 2010,"Aim: To examine the trends in the leading causes of deaths in centenarians in Hong Kong. Methods: Descriptive analyses of vital statistics data on mortality in Hong Kong from 2001 to 2010 were carried out. Results: The number of centenarians’ deaths increased by 136% in 10 years, from less than 28 men and 166 women in 2001 to 80 men and 378 women in 2010. During the study period, the top leading cause of death was pneumonia, accounting for 33.8% of all deaths. In contrast, the other leading causes accounted for much smaller percentages; for example, the second and third leading causes were chronic ischemic heart disease and unspecified dementia, and account for 4.3% and 4.2% of the total, respectively. This cause-of-death pattern has remained fairly stable between 2001 and 2010. A total of 985 (30.8%) deaths occurred in January to March. The correlation between the average monthly temperature and the number of deaths was –0.720 (P < 0.01). Conclusions: The number of deaths continues to increase in Hong Kong. These trends have major implications for healthcare in an aging population. Geriatr Gerontol Int 2017; 17: 931–936.",acute heart infarction;aged;article;bladder tumor;bronchus tumor;cause of death;cerebrovascular accident;chronic obstructive lung disease;colon tumor;congestive heart failure;dementia;female;Hong Kong;human;ischemic heart disease;lung tumor;major clinical study;male;pneumonia;priority journal;seasonal variation;stomach tumor;temperature;trend study;very elderly,"Yu, R.;Tam, W.;Woo, J.",2017,,10.1111/ggi.12812,0,
4933,"The relationships among age, chronic conditions, and healthcare costs","Objective: To learn how age and chronic illness affect costs in the Veterans Affairs healthcare system. Study Design: Veterans Affairs patients 65 years or older were identified from administrative data. We noted their healthcare utilization, cost, and diagnosis of any of 29 common chronic conditions (CCs). We examined how those 80 years or older differed from the younger patients. Results: The Department of Veterans Affairs spent $8.5 billion to treat 1.6 million older patients in fiscal year 2000. Age was less important than chronic illness in explaining cost differences. The oldest patients incurred a mean of $1295 greater costs than the younger patients, primarily because they were more likely to have a high-cost CC. The oldest patients incurred higher total costs than the younger patients in only 14 of 29 groups defined by CC. Long-term care accounted for most of the extra cost of the oldest patients. When this cost was excluded, the oldest patients incurred only $266 more cost than the younger patients. Conclusions: Growth in the population of the oldest patients will increase the number of individuals with CCs requiring long-term care. With its limited long-term care benefit, Medicare will avoid much of this financial consequence. In contrast, the financial risk of acute and long-term care gives the Department of Veterans Affairs an incentive to develop strategies to prevent CCs associated with long-term care.",acquired immune deficiency syndrome;age;aged;alcoholism;Alzheimer disease;arthritis;article;asthma;cerebrovascular disease;chronic disease;chronic obstructive lung disease;colorectal cancer;congestive heart failure;controlled study;dementia;depression;diabetes mellitus;diagnosis related group;headache;health care cost;health care system;health care utilization;hepatitis C;hospital care;human;Human immunodeficiency virus infection;hypertension;intensive care unit;ischemic heart disease;kidney failure;long term care;low back pain;lung cancer;major clinical study;medicare;mental health care;mortality;multiple sclerosis;nursing home;Parkinson disease;peripheral vascular disease;priority journal;prostate cancer;prostate hypertrophy;psychosis;rehabilitation medicine;soldier;spinal cord injury;cerebrovascular accident;substance abuse,"Yu, W.;Ravelo, A.;Wagner, T. H.;Barnett, P. G.",2004,,,0,
4934,Prevalence and Costs of Chronic Conditions in the VA Health Care System,"Chronic conditions are among the most common causes of death and disability in the United States. Patients with such conditions receive disproportionate amounts of health care services and therefore cost more per capita than the average patient. This study assesses the prevalence among the Department of Veterans Affairs (VA) health care users and VA expenditures (costs) of 29 common chronic conditions. The authors used regression to identify the marginal impact of these conditions on total, inpatient, outpatient, and pharmacy costs. Excluding costs of contracted medical services at non-VA facilities, total VA health care expenditures in fiscal year 1999 (FY1999) were $14.3 billion. Among the 3.4 million VA patients in FY1999, 72 percent had 1 or more of the 29 chronic conditions, and these patients accounted for 96 percent of the total costs ($13.7 billion). In addition, 35 percent (1.2 million) of VA health care users had 3 or more of the 29 chronic conditions. These individuals accounted for 73 percent of the total cost. Overall, VA health care users have more chronic diseases than the general population.",adult;Alzheimer disease;article;chronic disease;chronic obstructive lung disease;congestive heart failure;dementia;female;government;health care cost;health care system;health care utilization;health service;hospitalization;human;kidney failure;lung cancer;major clinical study;male;medical care;mental health;middle aged;mortality;veteran,"Yu, W.;Ravelo, A.;Wagner, T. H.;Phibbs, C. S.;Bhandari, A.;Chen, S.;Barnett, P. G.",2003,,10.1177/1077558703257000,0,
4935,Using individual patient data in meta-analyses of glucose-lowering studies,,cholesterol;glucose;blood pressure;cardiovascular disease;cardiovascular risk;cholesterol blood level;clinical protocol;clinical trial;dementia;follow up;glucose blood level;glycemic control;hazard ratio;heart infarction;human;hypoglycemia;ischemic heart disease;letter;mortality;patient coding;priority journal;quality of life;risk factor;risk reduction;cerebrovascular accident;sudden death;systematic error,"Yudkin, J. S.;Richter, B.",2010,,,0,
4936,Advance care planning for 600 Chinese patients with end-stage renal disease,"Background/purpose There is increasing recognition of the need to integrate advance care planning (ACP) into end-stage renal disease (ESRD) care with attention to medical, ethical, psychosocial, and spiritual issues but publications comparing patients who chose renal replacement therapy (RRT) and renal palliative care (RPC) is scarce. We here share our experience on ACP for ESRD patients in a center with renal replacement and palliative programs in place. Methods From June 2006 to December 2011, ESRD patients were empowered to make an informed choice of future medical care in a structured ACP that was emphasized to be an ongoing process. Patients who opted for RRT and RPC would be followed up at the predialysis clinic and the one-stop multidisciplinary RPC clinic, respectively. This was a single-center study in a secondary care hospital. A total of 600 patients (265 RRT, 335 RPC) were enrolled and followed up over a median of 782 days. Results The majority of patients and relatives declined dialysis because of perceived physical burden. Only 1.6% of palliative care patients changed their decision and commenced dialysis. Baseline characteristics differed between patients who chose RRT or RPC. Survival declined according to the modified Charlson comorbidity index scores. Older age, mental incompetence, hyperlipidemia, high modified Charlson comorbidity index, low estimated glomerular filtration rate, and low albumin were important independent predictors of poor survival. Factors affecting the ACP decision were discussed in the Chinese culture context. Conclusion A structured ACP could empower the patient to make an informed decision on the management of ESRD. (ACP)，， ，，，265，335，782 ，",albumin;calcium phosphate;hemoglobin;adult;age;albumin blood level;article;Charlson Comorbidity Index;congestive heart failure;dementia;end stage renal disease;female;follow up;glomerulus filtration rate;hemoglobin blood level;human;hyperlipidemia;major clinical study;male;mental capacity;neoplasm;palliative therapy;patient care;predictive value;prevalence;priority journal;renal replacement therapy;Short Form 36;social security;survival,"Yuen, S. K.;Suen, H. P.;Kwok, O. L.;Yong, S. P.;Tse, M. W.",2016,,,0,
4937,Cognitive and cardiovascular benefits of docosahexaenoic acid in aging and cognitive decline,"Memory loss is a prominent health concern, second only to heart disease for older individuals. Docosahexaenoic acid (DHA), the principle omega-3 fatty acid in brain and heart, plays an important role in neural and cardiac function. Decreases in plasma DHA are associated with cognitive decline in healthy elderly and Alzheimer's patients. Higher DHA intake and plasma levels are inversely correlated with increased relative risk of Alzheimer's disease (AD) and fatal coronary heart disease. DHA provides well known cardiovascular benefits (e.g. lower triglycerides, increased HDL cholesterol, decreased resting heart rate) in older adults. Preclinically, DHA supplementation restores brain DHA levels, enhances learning and memory tasks in aged animals, and significantly reduces beta amyloid, plaques, and tau in transgenic AD models. To date, clinical studies with DHA+EPA supplementation have shown some positive effects in mild cognitive impairment but not in AD, suggesting that early intervention may be a key factor to providing effective therapies. A recent clinical study examined individual effects of 900mg/d algal DHA as a nutritional supplement for age-related cognitive decline (ARCD). This randomized, double-blind, placebo-controlled study (n=485) found significantly fewer CANTAB® Paired Associate Learning errors with algal DHA at six months versus placebo (diff. score -1.63±0.76, p=0.03). Positive effects on Verbal Recognition Memory (p<0.02) and significant decreases in resting heart rate with DHA (p<0.03) were observed, indicating improved learning and episodic memory functions and cardiovascular benefits for ARCD. Collectively, data reveal a potentially beneficial role for DHA in preventing or ameliorating cognitive decline and cardiovascular disease in the aged. © 2010 Bentham Science Publishers Ltd.",amyloid beta protein;apolipoprotein E;docosahexaenoic acid;high density lipoprotein cholesterol;icosapentaenoic acid;placebo;triacylglycerol;aging;Alzheimer disease;amnesia;article;atherosclerosis;clinical trial;cognition;cognitive defect;controlled clinical trial;diastolic blood pressure;diet supplementation;drug effect;heart arrhythmia;heart infarction;heart rate;human;ischemic heart disease;memory;priority journal;randomized controlled trial,"Yurko-Mauro, K.",2010,,,0,
4938,Neucrotizing herpes simplex encephalitis as a cause of progressive dementia,"History and findings: A 65-year-old woman was twice hospitalized because of disorientation and insomnia with depression. In the course of antidepressive treatment the symptoms regressed each time so that the diagnosis was made of pseudodementia during depression. About a year after the first admission the symptoms recurred, despite continued antidepressive treatment. Clinical criteria now suggested Alzheimer-type dementia as the diagnosis. Course and treatment: The symptoms of dementia increased markedly and generalized seizures requiring anticonvulsive drugs occurred after 4 months. Although IgG antibodies against Herpes simplex virus (HSV) were demonstrated in cerebrospinal fluid (CSF), no antiviral treatment was instituted because HSV encephalitis appeared unlikely at this stage. But the patient's mental and physical state further deteriorated in subsequent months. During an attack of pneumonia the patients became somnolent and went into status epilepticus. Repeat virological examination of CSF now revealed IgG and IgM antibodies against HSV, confirming encephalitis. Her condition markedly improved over 12 days on aciclovir, 750 mg 3 times daily intravenously. 6 weeks later the pneumonia recurred, as did the encephalitis, with apnoeic phases and massive left heart failure. The patient died a few days later. Immunohistochemical tests of brain tissue were positive for HSV type II. Conclusions: This case report demonstrates that an investigation on dementia must include a complete liquor analysis. If HSV encephalitis is suspected, an antiviral therapy must be administered immediately. Even in adults who seem to have normal immunity HSV type II can cause HSV encephalitis.",aciclovir;aged;article;case report;dementia;depression;diagnostic accuracy;female;herpes simplex encephalitis;human;insomnia;intravenous drug administration,"Zachhuber, C.;Leblhuber, F.;Jellinger, K.;Bancher, C.;Tilz, G. P.;Binder, L.",1995,,,0,
4939,Predisposition to infection in the elderly,,analgesic agent;antibiotic agent;anticonvulsive agent;antidepressant agent;antidiabetic agent;antihypertensive agent;antirheumatic agent;antithyroid agent;diuretic agent;hypnotic sedative agent;neuroleptic agent;steroid;abscess;aging;Alzheimer disease;appendicitis;article;aspiration pneumonia;bacteremia;cellulitis;cholecystitis;chronic bronchitis;chronic obstructive lung disease;Peptoclostridium difficile;colitis;community acquired pneumonia;congestive heart failure;decubitus;dementia;depression;diabetes mellitus;diabetic foot;disease predisposition;diverticulitis;elderly care;endocarditis;gastroenteritis;herpes zoster;human;Human immunodeficiency virus infection;immobilization;immune deficiency;immunization;infection;infection prevention;infection risk;infectious diarrhea;kidney failure;phlebitis;polypharmacy;protein calorie malnutrition;pyelonephritis;senescence;sinusitis;syphilis;tuberculosis;urinary tract infection;urosepsis;vaccination;virus encephalitis;wound infection,"Zagaria, M. A. E.",2011,,,0,
4940,Vascular risk factors and white matter hyperintense lesions in Alzheimer's disease,"INTRODUCTION: Cerebrovascular injury and amyloid β deposition are associated with cognitive impairment. The relationship of these factors in Alzheimer's disease (AD) has been studied in other populations. OBJECTIVE: To describe the frequency of white matter hyperintensities using magnetic resonance imaging (MRI) in patients with AD. METHODS: In this retrospective, observational study we reviewed records of patients with diagnosis of dementia. We included in the analysis 35 patients with clinical classification criteria for probable AD, having examination by means of MRI. RESULTS: Mean age was 79.3 ó 6.5 years; 63% (n = 22) were female, the average years of schooling was 9.9 ó 6.4. The mean MMSE score was 20.4 ó 6.9. The prevalence of vascular risk factors at diagnosis of dementia was as follows: dyslipidemia 43%, smoking 43%, hypertension 34%, coronary artery disease 14% and cerebrovascular disease 2.8%. A 88.5% had white matter hyperintense lesions, almost a half with Fazekas 1 (48.6%). CONCLUSIONS: These findings support the theory of a vascular mechanism in EA or the existence of a single heterogeneous entity: mixed dementia.",aged;Alzheimer disease;article;cardiovascular risk;cerebrovascular disease;clinical article;clinical classification;coronary artery disease;dyslipidemia;female;human;hypertension;male;medical record review;nuclear magnetic resonance imaging;observational study;retrospective study;smoking;white matter lesion,"Zaira, M. L.;Jazmín, P. L. T.;Gloria, A. N. S.;José, M. A. A.",2013,,,0,
4941,Anemia and early mortality in patients with decompensation of chronic heart failure,"Objectives: The possible independent effect of mild-to-moderate anemia (hemoglobin value not <9 g/dl) on the short-term mortality of patients with decompensation of NYHA class III/IV chronic heart failure has not been investigated yet. Methods: A total of 725 consecutive hospitalized patients were studied. All-cause mortalities during hospitalization and by day 31 were the prespecified study end points. Results: A total of 76 (10.5%) and 133 (18.3%) patients died during hospital stay and by day 31 of follow-up, respectively. Patients in the first hemoglobin tertile were at a significantly higher risk of death than those in the second (p = 0.003 and p < 0.001 for unadjusted in-hospital and 31-day mortality, respectively) or third terile (p < 0.001 and p < 0.001, for unadjusted in-hospital and 31-day mortality, respectively). However, after adjustment for concomitant baseline comorbidities and biochemical parameters, there was no significant difference in the risk of death among hemoglobin tertiles. Conclusions: Mild-to-moderate anemia seems not to contribute independently to short-term mortality in patients with decompensation of NYHA class III/IV chronic heart failure. An adverse concomitant baseline risk profile may have a key role in the induction of mild-to-moderate anemia and in the increased risk of death in these patients. Copyright © 2011 S. Karger AG, Basel.",angiotensin receptor antagonist;beta adrenergic receptor blocking agent;dipeptidyl carboxypeptidase inhibitor;hemoglobin;inotropic agent;spironolactone;adult;aged;anemia;article;cerebrovascular accident;chronic respiratory failure;comorbidity;dementia;depression;diabetes mellitus;disease association;female;follow up;heart failure;hemoglobin blood level;hospital patient;hospitalization;human;hypoalbuminemia;hyponatremia;major clinical study;male;mortality;priority journal,"Zairis, M. N.;Patsourakos, N. G.;Georgilas, A. T.;Melidonis, A.;Argyrakis, K. S.;Prekates, A. A.;Mytas, D. Z.;Karidis, K. S.;Batika, P. C.;Fakiolas, C. N.;Foussas, S. G.",2011,,,0,
4942,Desaturases of fatty acids (FADS) and their physiological and clinical implication,"States associated with insulin resistance, as overweight/obesity, type 2 diabetes mellitus (DM2), cardiovascular diseases (CVD), some cancers and neuropsychiatric diseases are characterized with a decrease of long-chain polyunsaturated fatty acids (LC-PUFA) levels. Amounts of LC-PUFA depend on the exogenous intake of their precursors [linoleic (LA) and alpha-linolenic acid (ALA)] and by rate of their metabolism, which is influenced by activities of enzymes, such as Delta6-desaturase (D6D, FADS2), D5D, FADS1, elongases (Elovl2, -5, 6).Altered activities of D5D/D6D were described in plenty of diseases, e.g. neuropsychiatric (depressive disorders, bipolar disorder, dementia), metabolic (obesity, metabolic syndrome, DM2) and cardiovascular diseases (arterial hypertension, coronary heart disease), inflammatory states and allergy (Crohns disease, atopic eczema) or some malignancies. Similar results were obtained in studies dealing with the associations between genotypes/haplotypes of FADS1/FADS2 and above mentioned diseases, or interactions of dietary intake of LA and ALA on one hand and of the polymorphisms of minor allels of FADS1/FADS2, usually characterized by lower activities, on the other hand.The decrease of the desaturases activities leads to decreased concentrations of products with concomitant increased concentrations of substrates. Associations of some SNP FADS with coronary heart disease, concentrations of plasma lipids, oxidative stress, glucose homeostasis, and inflammatory reaction, were described. Experimental studies on animal models and occurrence of rare diseases, associated with missing or with marked fall activities of D5D/D6D emphasized the significance of desaturases for healthy development of organism as well as for pathogenesis of some disease.",cardiovascular and metabolic diseases.;delta-5-desaturase;delta-6-desaturase;genes FADS1/FADS2;inflammation;oxidative stress;polyunsaturated fatty acids,"Zak, A.;Slaby, A.;Tvrzicka, E.;Jachymova, M.;Macasek, J.;Vecka, M.;Zeman, M.;Stankova, B.",2016,,,0,
4943,Association of Braden subscales with the risk of development of pressure ulcer,"Pressure ulcers (PU) may increase the incidence of hospital complications, and one should prevent this damage. The Braden Scale stands out as a tool to assess the risk of PU. The study aimed to identify changes in the score of the Braden subscales are associated with the risk of developing PCU. Logistic regression was used in a retrospective cohort study conducted in Hospital de Clínicas de Porto Alegre in adults hospitalized in surgical clinical units from October 2005 to June 2006. We evaluated the records database of 1503 patients with a mean aged 55.5 +/- 16 years, 52.7% female. The incidence of PU was 1.8% and was associated with diabetes and heart failure. There was a higher PU in patients worst in sensory perception, mobility, and activity and the presence of moisture. No association was found between nutrition and PU. Except nutrition, the other Braden sub-scales shown to be predictive of PU.",aged;article;chronic kidney failure;comorbidity;decubitus;dementia;diabetes mellitus;disease predisposition;female;heart failure;human;humidity;male;middle aged;motor activity;neoplasm;nursing;nutritional status;predictive value;risk factor;sensory dysfunction;severity of illness index;walking difficulty,"Zambonato, B. P.;de Assis, M. C.;Beghetto, M. G.",2013,,,0,
4944,Risk prediction score of in-hospital mortality in acute heart failure patient group of hospital without invasive procedures,"Introduction: Patients with acute heart failure (AHF) have a high risk of mortality. Most of them are hospitalized in community hospitals, often in emergency departments. Heterogeneity of AHF patients results in various risk-prediction models. The risk-score of in-hospital mortality obtained in community hospital may be useful for clinical practice. Aim of the study was to calculate a risk score of in-hospital mortality in acute heart failure based on simple variables obtained on admission. Material and methods: The study group consisted of 328 patients hospitalized for acute heart failure in cardiac care unit (CCU) of community hospital in 2006 and 2007. There were 158 men and 170 women. The median of age was 77 years. The group of 109 patients who died in the hospital was compared with 2 times bigger group (219) of discharged patients. Patients were admitted to CCU directly (D-CCU) or transferred to CCU from other hospital departments (T-CCU). The diagnosis of AHF was established based on European Society of Cardiology (ESC) Guidelines given in 2005. The 5 clinical features of AHF were established: decompensated heart failure (HF), pulmonary oedema, HF and hypertension, cardiogenic shock and right HF. 26 variables easily obtained on admission were analyzed. Univariate and multivariate regression coefficients were computed and compared with Pearson's correlation coefficients. According to these results continuous variables were scaled and a scoring system was developed to predict mortality. Results: The decompensated HF was the most frequent feature of AHF (58%) and was the one with statistically higher mortality in T-CCU patients as compared to D-CCU patients. Significant influence on in-hospital mortality was established for: hepatic cirrhosis, pneumonia or other acute respiratory infection, dementia, history of stroke, acute coronary syndrome, prior myocardial infarction, age, systolic blood pressure, number of leucocytes, glycemia, estimated glomerular filtration rate and natremia. All of them except prior myocardial infarction and absence of systolic blood pressure drop were connected with higher mortality. The final score included 12 variables and had prognostic implication. Conclusions: In the group of 328 patients hospitalized in CCU the variables significantly influenced in-hospital mortality were established. Mathematical model of index for risk was calculated based on variables assessed at admittance. Application of this risk-prediction score can be helpful in identifying patients at high risk who might benefit from intensive monitoring and intervention. Copyright © 2012 Cornetis.",acute coronary syndrome;acute heart failure;aged;article;cardiogenic shock;clinical feature;clinical practice;community hospital;dementia;female;glomerulus filtration rate;glucose blood level;heart infarction;human;hypertension;leukocyte differential count;liver cirrhosis;lung edema;major clinical study;male;mortality;pneumonia;practice guideline;prognosis;respiratory tract infection;risk assessment;scoring system;cerebrovascular accident;systolic blood pressure,"Zambrzycki, J.;Napiórkowski, K.",2012,,,0,
4945,Association between statin use and Alzheimer's disease,"Context: 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have been associated with a decreased risk for Alzheimer's disease (AD). Objective: To evaluate the association between statin use and AD adjusted for comorbid medical conditions. Design: A nested case-control study. Patients: Patients at the Veterans Affairs Medical Center in Birmingham, Ala., USA with a new diagnosis of AD (cases) between 1997 and 2001 (n = 309) and age-matched non-AD controls (n = 3,088). Main Outcome Measure: Odds ratio for association between AD and statin use. Results: Statin users had a 39% lower risk of AD relative to nonstatin users (odds ratio 0.61, 95% confidence interval 0.42-0.87). This association appeared to be modified by the presence of certain chronic medical conditions (i.e., hypertension, ischemic heart disease and cerebrovascular disease) in that the reduced risk was observed among those with these diseases, whereas no association was observed among those without any of these conditions. Conclusions: In this study, following adjustment for confounding factors, a statistically significant inverse association between statin use and AD was observed. The results lend support to looking at AD outcomes in trials of statins to further evaluate their possible beneficial effects. Copyright © 2004 S. Karger AG, Basel.",hydroxymethylglutaryl coenzyme A reductase inhibitor;aged;Alzheimer disease;article;comorbidity;controlled study;female;human;major clinical study;male;risk factor;risk reduction;treatment outcome,"Zamrini, E.;McGwin, G.;Roseman, J. M.",2004,,,0,
4946,Medical comorbidity in black and white patients with Alzheimer's disease,"BACKGROUND: Little is known about co-medical illnesses in black and white patients with probable Alzheimer's disease (AD). METHODS: To address this question, we used two methods. In the first (Group I), black and white probable AD patients were matched on age at presentation to the clinic, age of onset of AD, duration of illness, and Mini-Mental State Examination scores; then, a variety of co-medical illnesses were compared between blacks and whites. In Group II, whites were randomly matched to blacks on the variables listed above. RESULTS: In Group I, blacks were found to have a higher rate of hypertension than whites, whereas whites had a higher incidence of atrial fibrillation and cancer than blacks. In Group II, age at presentation to the clinic was found to be shorter for men than for women; duration of illness was shorter for black men than for white men, white women, and black women; and Mini-Mental State Examination scores were lower in blacks than whites. As in Group I, blacks were found to have a higher rate of hypertension, whereas whites had higher rates of atrial fibrillation, cancer, coronary artery disease, high cholesterol, and gastrointestinal disease. CONCLUSION: In both groups, black patients with probable AD had a higher rate of hypertension than white patients with probable AD, and whites had higher rates of atrial fibrillation and cancer. This finding suggests that these comorbid illnesses in black and white patients with probable AD is not due to a statistical Type II error, but rather to differences in these groups.",African Continental Ancestry Group/*statistics & numerical data;Aged;Alzheimer Disease/*ethnology;Atrial Fibrillation/ethnology;Comorbidity;Coronary Artery Disease/ethnology;European Continental Ancestry Group/*statistics & numerical data;Female;Gastrointestinal Diseases/ethnology;Humans;Hypercholesterolemia/ethnology;Hypertension/ethnology;Male;Neoplasms/ethnology;Neuropsychological Tests;Sex Factors;United States/epidemiology,"Zamrini, E.;Parrish, J. A.;Parsons, D.;Harrell, L. E.",2004,Jan,10.1097/01.smj.0000077061.01235.42,0,
4947,Impact of 18F-florbetapir PET imaging of β-amyloid neuritic plaque density on clinical decision-making,"18F-florbetapir positron emission tomography (PET) imaging of the brain is now approved by the Food and Drug Administration (FDA) approved for estimation of β-amyloid neuritic plaque density when evaluating patients with cognitive impairment. However, its impact on clinical decision-making is not known. We present 11 cases (age range 67-84) of cognitively impaired subjects in whom clinician surveys were done before and after PET scanning to document the theoretical impact of amyloid imaging on the diagnosis and treatment plan of cognitively impaired subjects. Subjects have been clinically followed for about 5 months after the PET scan. Negative scans occurred in five cases, leading to a change in diagnosis for four patients and a change in treatment plan for two of these cases. Positive scans occurred in six cases, leading to a change in diagnosis for four patients and a change in treatment plan for three of these cases. Following the scan, only one case had indeterminate diagnosis. Our series suggests that both positive and negative florbetapir PET scans may enhance diagnostic certainty and impact clinical decision-making. Controlled longitudinal studies are needed to confirm our data and determine best practices. © 2013 © 2013 Taylor & Francis.",amyloid beta protein;amyloid protein;antidepressant agent;cholinesterase inhibitor;florbetapir f 18;memantine;tau protein;thiamine;aged;alcoholism;Alzheimer disease;article;ataxia;atrophy;brain atrophy;clinical article;clinical decision making;computer assisted tomography;depression;differential diagnosis;female;frontotemporal dementia;gastrointestinal symptom;hand tremor;heart left ventricle hypertrophy;human;hypertension;leukoaraiosis;macrocytic anemia;male;mild cognitive impairment;Mini Mental State Examination;mixed depression and dementia;neuropsychological test;normochromic normocytic anemia;nuclear magnetic resonance imaging;nystagmus;obesity;positron emission tomography;senile plaque;spasticity;very elderly,"Zannas, A. S.;Doraiswamy, P. M.;Shpanskaya, K. S.;Murphy, K. R.;Petrella, J. R.;Burke, J. R.;Wong, T. Z.",2014,,,0,
4948,Predictable removal of anticardiolipin antibody by therapeutic plasma exchage (TPE) in catastrophic antiphospholipid antibody syndrome (CAPS),"Catastrophic antiphospholipid antibody syndrome (CAPS) is a rare life-threatening variant of antiphospholipid antibody syndrome (APS), with an associated mortality rate of > 50%. Treatment recommendations are aggressive and consist of intravenous heparin, steroids, immunoglobulins and/or therapeutic plasma exchange (TPE). At present, insufficient data exist to make precise recommendations regarding the most effective therapy for CAPS. Accumulating evidence over recent years is encouraging and may lead to future guidelines. We report predictive and effective removal of pathological anticardiolipin antibody (aCL AB) in a patient with CAPS. The case report and discussion provide valuable insight into aCL AB production and its removal by first- order kinetics using TPE. ©2008 Dustri-Verlag Dr. K. Feistle.",cardiolipin antibody;fresh frozen plasma;heparin;immunoglobulin;immunoglobulin G;immunoglobulin M;labetalol;meprednisone;warfarin;acute kidney failure;adult;anamnesis;article;autoimmune disease;brain infarction;case report;catastrophic antiphospholipid antibody syndrome;clinical effectiveness;clinical feature;creatinine blood level;deep vein thrombosis;drug dose reduction;echocardiography;endotracheal intubation;female;headache;heart infarction;heart left ventricle ejection fraction;hematuria;hemiplegia;human;immunoglobulin blood level;intensive care;lung edema;malignant hypertension;mental deterioration;mitral valve regurgitation;nuclear magnetic resonance imaging;patient compliance;plasmapheresis;proteinuria;rare disease;seizure;spontaneous abortion;tricuspid valve regurgitation;visual field defect,"Zar, T.;Kaplan, A. A.",2008,,,0,
4949,Risperidone in the elderly: A pharmacoepidemiologic study,"Background: The possibly limited adverse effects of risperidone encourage interest in its use in geriatric patients. Method: Medical records of 122 hospitalized psychogeriatric patients (≤ 65 years old) newly treated with risperidone were reviewed and scored for indications, doses, and effects of this novel neuroleptic. Results: Subjects (83 women, 39 men), mean ± SD age = 76.5± 6.8 years (range, 65-95), were given risperidone for agitation or psychosis associated with dementia (53%), a major mood disorder (29%), or other disorders (18%). Most (77%) were also medically ill and received other psychotropic (76%) or cardiovascular agents (70%). Daily doses of risperidone averaged 1.6 ±1.1 mg (range, 0.25-8.0) (0.025 mg/kg body wt.); 78% received 2.0 mg. Risperidone appeared to be effective in 85% of cases, but 18% were discontinued due to intolerability (11%) or inefficacy (7%). Adverse events occurred in 32% of the patients (36% of those discontinued). These adverse events included hypotension (29%) or symptomatic orthostasis (10%), cardiac arrest (1.6%) with fatality (0.8%), and extrapyramidal effects (11%) or delirium (1.6%). Benefits were associated with younger age and male gender, but not risperidone dose. Adverse effects were associated with cardiovascular disease and its treatment, cotreatment with an SRI antidepressant or valproate, and relatively rapid dose increases. Conclusion: Risperidone appeared to be effective and may be safe for many elderly psychiatric patients with comorbid medical conditions provided that doses are low and increased slowly. Particular caution is advised in the presence of cardiovascular disease or cotreatment with other psychotropic agents.",benzatropine;benzatropine mesilate;carbamazepine;clonazepam;glibenclamide;levothyroxine;levothyroxine sodium;lorazepam;metoprolol;metoprolol tartrate;nifedipine;oxybutynin;paroxetine;phenytoin;psychotropic agent;ranitidine;risperidone;serotonin uptake inhibitor;trazodone;valproate semisodium;valproic acid;affective neurosis;aged;agitation;article;drug efficacy;drug indication;drug tolerability;elderly care;extrapyramidal symptom;fatality;female;gerontopsychiatry;heart arrest;human;hypotension;major clinical study;male;medical record;pharmacoepidemiology;priority journal;psychosis;adalat;ativan;cogentin;depakote;desyrel;diabeta;dilantin;ditropan;dridase;klonopin;lopressor;paxil;procardia;risperdal;synthroid;tegretol;zantac,"Zarate Jr, C. A.;Baldessarini, R. J.;Siegel, A. J.;Nakamura, A.;McDonald, J.;Muir-Hutchinson, L. A.;Cherkerzian, T.;Tohen, M.",1997,,,0,
4950,Clinical burden and nonpharmacologic management of nursing facility residents with overactive bladder and/or urinary incontinence,"OBJECTIVE: To identify clinical characteristics of residents with a diagnosis of overactive bladder (OAB) and/or urinary incontinence (UI) to determine the prevalence of comorbidities, severe mobility impairment (SMI), moderate-to-severe cognitive impairment (MSCI), and a toileting program and the response to that program. DESIGN: Cross-sectional retrospective analysis. SETTING: Skilled nursing facilities. PATIENTS, PARTICIPANTS: Residents with a diagnosis of OAB and/or UI and an age range, and gender frequency-matched 1:1 control cohort without OAB and/or UI. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): De-identified Minimum Data Set data 3.0 records (October 1, 2010, to September 30, 2012). RESULTS: Of the 175,632 residents, 65% had a diagnosis of UI and 1% had a diagnosis of OAB. Those with UI and/or OAB were more likely to have MSCI (mean Brief Inventory of Mental Status score 10.2 ± 4.5 vs. 12.5 ± 3.6; P = 0.001) and SMI (49.4% vs. 26.4%; P < 0.001), multiple comorbid conditions, falls and falls with injury, hip fractures (5.5% vs. 4.9%; P < 0.001), urinary tract infections (21.4% vs. 16.5%; P = 0.001), and moisture-associated skin damage (5.2% vs. 2.6%; P = 0.001) than the control cohort. Toileting programs were attempted more often (17.0% vs. 5.1%; P < 0.001) in those with UI and/or OAB but were only minimally successful, with 4.2% having decreased wetness and 0.9% being completely dry. CONCLUSION: Residents with UI and/or OAB exhibit a higher burden of MSCI, SMI, and comorbidities than do residents without these diagnoses. Nonpharmacologic therapies such as toileting programs should be a primary focus in the nursing facility.",anxiolytic agent;diuretic agent;neuroleptic agent;aged;anemia;anxiety disorder;article;cerebrovascular accident;child rearing;cognitive defect;comorbidity;controlled study;cross-sectional study;dementia;depression;diabetes mellitus;falling;female;gastroesophageal reflux;heart failure;hip fracture;human;hyperlipidemia;hypertension;kidney failure;major clinical study;male;nursing home;overactive bladder;prostate hypertrophy;resident;retrospective study;skin defect;transient ischemic attack;urinary tract infection;urine incontinence,"Zarowitz, B. J.;Allen, C.;O'Shea, T.;Tangalos, E.;Berner, T.;Ouslander, J. G.",2015,,,0,
4951,"Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment","Chronic obstructive pulmonary disease (COPD) is prevalent in nursing home residents. National and international guidelines exist for management of COPD; however, little is known about ""real-world"" management of COPD in this population. Nursing home patients with significant cognitive impairment may have difficulty utilizing handheld device (HHD) formulations of respiratory medications and may be clinically appropriate candidates for nebulized therapy. To determine (a) the prevalence, clinical characteristics, and treatment of patients with a diagnosis of ""emphysema/COPD"" per Minimum Data Set (MDS) version 2.0 records in U.S. nursing homes and (b) the relationship of nebulized versus HHD formulations of medication to prevalence of shortness of breath in a cohort of cognitively impaired nursing home residents. In a descriptive, retrospective analysis of a large data repository of skilled nursing home residents with COPD, prescription claims and MDS data from October 1, 2009, through September 30, 2010, were extracted, linked, and de-identified. Measures included medications, diagnoses, and selected outcome parameters from the MDS. Cognitive impairment was defined as a score of 3-6 on the Cognitive Performance Scale derived from MDS records. A proxy of ≤ 14-day courses of respiratory antibiotics, oral corticosteroids, or both was used to identify COPD exacerbations. Shortness of breath (SOB) in the last 7 days was captured from Section J1.l. of the MDS. The total number of unique patients with at least 1 MDS record during the study period was 126,121. Of those, 27,106 (21.5%) had COPD. The prevalence rates of diagnoses concurrent with COPD were as follows: asthma = 8.6%, Alzheimer's disease or other dementia = 37.2%, congestive heart failure = 37.5%, anxiety disorder = 23%, depression = 50.1%, pneumonia = 21.2%, and respiratory infection = 9%. 58% of patients with COPD were white females aged 75 years or older. According to the MDS, 62% of COPD patients had a short-term memory problem, while 43.3% of patients had moderately or severely impaired cognitive skills for daily decision making. 83% of COPD patients with pharmacy claims (17,395/27,106) received at least 1 medication used to treat COPD; 9,711 (17.1%) received no respiratory medications. Use of beta-agonists (53.9%), anticholinergic medications (41.2%), long-acting beta-agonist/corticosteroid (LABA/ICS) combinations (28%) in HHD, and nebulized beta-agonist/anticholinergic combinations (26.6%) was prevalent. Inhaled LABA/ICS and long-acting anticholinergic therapy was received by 28% and 22% residents, respectively. 22% (n = 5,085) of patients exhibited at least 2 exacerbations of COPD, and 33% were noted to have SOB. Monotherapy with short-acting beta-agonists (SABA) was evident in 48.7% of cognitively impaired COPD patients. SOB within the previous 7 days was noted in 39.1% of cognitively impaired COPD patients treated with nebulized SABA monotherapy. 38% of these patients exhibited 2 or more COPD exacerbations, and 57.9% were hospitalized at least once during the 12-month period. LABA monotherapy or combined LABA/SABA use represented ≤ 1% of beta-agonist use for unique COPD patients with cognitive impairment. In this retrospective analysis of administrative data, 21.5% of nursing home residents had a diagnosis of COPD, and 17% of these residents received no respiratory medications. These residents had significant cognitive and functional impairment and concurrent diagnoses. 22% of residents experienced at least 2 exacerbations of COPD during the 12 months of study. As many as 60% were not receiving inhaled LABA/ICS or inhaled tiotropium, and 33% exhibited SOB. There is significant use of nebulized SABA monotherapy, which may be contributing to SOB and exacerbations or hospitalizations in nursing home residents with COPD.",beta adrenergic receptor stimulating agent;cholinergic receptor blocking agent;glucocorticoid;aged;article;chronic obstructive lung disease;cognitive defect;drug combination;dyspnea;equipment design;female;human;inhalational drug administration;male;middle aged;nebulizer;nursing home;pathophysiology;practice guideline;prevalence;psychological rating scale;retrospective study;statistics;United States,"Zarowitz, B. J.;O'Shea, T.",2012,,,0,
4952,Feasibility and toxicity of dose-dense adjuvant chemotherapy in older women with breast cancer,"Introduction: The objective of this study was to examine the feasibility and toxicity of adjuvant dose-dense chemotherapy in older women with breast cancer. Methods: A search of the Memorial Sloan-Kettering Cancer Center (MSKCC) breast cancer database was performed to identify all patients age 60 and older who underwent an initial consultation with a breast medical oncologist between October 1, 2002 and June 28, 2005. Inclusion criteria were: (1) age ≥ 60, (2) follow-up care obtained at MSKCC, (3) intent to treat with adjuvant dose-dense AC-T (doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 every 2 weeks for 4 cycles followed by paclitaxel 175 mg/m2 every 2 weeks for 4 cycles, with white blood cell growth factor support). Results: One hundred sixty-two patients (mean age 66, range 60-76) with breast cancer, stages I (n = 5), II (n = 111), and III (n = 46) according to the sixth edition of the AJCC staging system, were included in this analysis. Forty-one percent (n = 67) experienced a grade 3 or 4 toxicity, 9% a grade 3 infection (n = 14), 6% grade 3 fatigue (n = 9), 5% neutropenic fever (n = 8), and 4% thromboembolic events (n = 7). Twenty-two percent (n = 36) did not complete the planned 8 cycles of treatment. There was no statistically significant association between age and either toxicity or treatment discontinuation. In multivariate analysis including age, pretreatment hemoglobin, and comorbidity, the presence of comorbidity (Charlson score ≥ 1) and a lower baseline hemoglobin score were associated with an increased risk of any grade 3 or 4 toxicity. Conclusions: We found that the risk of toxicity depended more on comorbid medical conditions and baseline hemoglobin value than age in this cohort of older adults receiving dose-dense adjuvant chemotherapy. © 2008 Springer Science+Business Media, LLC.",cyclophosphamide;docetaxel;doxorubicin;erythropoietin;hemoglobin;paclitaxel;adjuvant therapy;adult;age distribution;aged;anemia;article;brain ischemia;breast cancer;cancer adjuvant therapy;cancer combination chemotherapy;cancer staging;cerebrovascular disease;chronic kidney failure;comorbidity;confusion;congestive heart failure;connective tissue disease;consultation;controlled study;dementia;depression;diabetes mellitus;diarrhea;dizziness;drug dose reduction;drug eruption;drug hypersensitivity;drug substitution;drug withdrawal;dysphagia;dyspnea;embolism;fatigue;febrile neutropenia;female;follow up;fracture;heart infarction;heart muscle ischemia;hemiplegia;human;hyperglycemia;hypertension;hypokalemia;hyponatremia;infection;leukemia;leukopenia;liver disease;lung embolism;lymphoma;major clinical study;male;mucosa inflammation;multiple cycle treatment;myopathy;nausea;neutropenia;pain;peripheral vascular disease;pneumonia;priority journal;sensory neuropathy;side effect;sinus tachycardia;faintness;thorax pain;thrombocytopenia;thrombosis;treatment outcome;ulcer,"Zauderer, M.;Patil, S.;Hurria, A.",2009,,,0,
4953,Phytotherapy in cardiovascular medicine,"There is widespread use of herbal medicine in patients suffering from cardiovascular diseases. The discussion about the benefit of these drugs is still controversial because of lack of scientific evidence. Ginkgo biloba, Crataegus and Garlic are often recommended substances for patients with cardiovascular diseases. For these substances there is a lot of data available from experimental and clinical studies, unfortunately not always adhering to the criteria of evidence based medicine. Extracts from ginkgo biloba contain several active constituents, mainly flavonoids and terpens, which have antioxidative properties and an inhibitory effect on platelet aggregation by inhibiting platelet activation factor PAF. Ginkgo is mainly used in vascular dementia and peripheral vascular disease. Garlic shows a modest lipid-lowering effect in the same range as a low-cholesterol diet. Effect on blood pressure seems to be at best minor. Crataegus is often used in patients with heart failure because of its positive inotropic effect. Additionally, crataegus acts as an antiarrhythmic substance by prolonging refractory period of the action potential.","Cardiovascular Diseases/*drug therapy;Clinical Trials as Topic;Dose-Response Relationship, Drug;Humans;*Phytotherapy;Plant Extracts/adverse effects/*therapeutic use;Treatment Outcome","Zbinden, S.;Seiler, C.",2002,Jun,10.1024/0040-5930.59.6.301,0,
4954,Nonpharmacological treatment for Alzheimer's disease: A mind-brain approach,"A new paradigm is needed that focuses on minimizing the symptoms of Alzheimer's disease and related dementias rather than focusing only on a search for a cure. To include Alzheimer's in the same class of diseases as cancer, multiple sclerosis, diabetes, congestive heart failure, and degenerative arthritis places Alzheimer's in the realm of the medically and psychosocially understandable and manageable. A critical first step toward making this shift is to examine carefully the way in which we define the disease. An approach to care for people with Alzheimer's results in treatment when it systematically compensates for functional losses of dementia by linking care giving actions and environments to specific brain dysfunctions; namely, the neuropathology of the disease. The ultimate measures of success of such a treatment approach are improved quality of life, delayed institutionalization, slowed rate of progression of the disease, people who achieve their potential, and reduced need for medication.",Alzheimer disease;article;brain;caregiver;clinical feature;disease course;environmental factor;human;institutionalization;neuropathology;psychological aspect;quality of life;social aspect;symptom;syndrome delineation,"Zeisel, J.;Raia, P.",2000,,,0,
4955,The association of vitamin b 12 and folate blood levels with mortality and cardiovascular morbidity incidence in the old old: the Bronx aging study,"OBJECTIVE: An elevated homocysteine level in the blood has been identified as an independent risk factor for vascular disease, including coronary atherosclerosis and venoembolic disease. A deficiency of vitamins B ( 6 ), B ( 12 ), or folate in the blood can cause increased blood levels of homocysteine. We set out to determine whether there was a relationship between blood levels of folate and B ( 12 ) and the subsequent development of cardiovascular disease and mortality in old old ambulatory men and women. DESIGN: Four hundred forty subjects (mean age, 79 years; 64% female) were followed in the Bronx Longitudinal Aging Study, a prospective study of 10 years duration, designed to assess risk factors for cardiovascular and cerebrovascular diseases and dementia in an ambulatory old old cohort. METHODS: Serum levels of vitamin B ( 12 ) and folate were measured and related to the incidence of total all-cause mortality, stroke, myocardial infarction, coronary heart disease, and cardiovascular disease. RESULTS: No statistical gender- or age-related differences were found in the mean levels of folate or B ( 12 ). The concentration of folate in the blood was not related to the incidence of mortality, myocardial infarction, stroke, or overall cardiovascular disease. However, by logistical regression and Cox proportional-hazards regression analyses, there was an increased incidence of mortality and coronary heart disease in those subjects having increased vitamin B ( 12 ) levels in the blood. Each 100-pg increase in B ( 12 ) was associated with a 10% increase in mortality and coronary heart disease incidence. CONCLUSION: These results suggest that in elderly subjects, vitamin B ( 12 ) supplementation should not be routinely provided unless there are clear indications for doing so (a deficiency state), and then only to replace enough B ( 12 ) to correct the deficiency. A suggested treatment paradigm is provided for managing vitamin deficiency states and hyperhomocysteinemia in elderly subjects.","Aged;Aged, 80 and over;Coronary Disease/blood/*epidemiology;Dietary Supplements;Female;Folic Acid/*blood;Humans;Longitudinal Studies;Male;*Mortality;Regression Analysis;Vitamin B 12/*blood","Zeitlin, A.;Frishman, W. H.;Chang, C. J.",1997,Jul-Aug,,0,
4956,Reduced heart rate variability is associated with worse cognitive performance in elderly Mexican Americans,"Reduced heart rate variability is a strong predictor of cardiovascular risk factors, cardiovascular events, and mortality and thus may be associated with cognitive neurodegeneration. Yet, this has been relatively unexplored, particularly in minority populations with high cardiovascular burden. We used data from the Sacramento Area Latino Study on Aging to examine the cross-sectional association of reduced heart rate variability with cognitive function among elderly Mexican Americans. A total of 869 participants (mean age, 75 years; 59% women) had their 6-minute heart rate variability measured using an ECG monitor and respiration pacer in response to deep breathing. We used the mean circular resultant, known as R bar, as a measure of heart rate variability and categorized it into quartiles (Q1 to Q4 of R bar: reduced to high heart rate variability). Cognitive function was assessed using the modified Mini-Mental State Examination, a 100-point test of global cognitive function, and the Spanish and English verbal learning test, a 15-point test of verbal memory recall. In fully adjusted linear regression models, participants in quartile 1 had a 4-point lower modified Mini-Mental State Examination score (P<0.01), those in quartile 2 had a 2-point lower score (P=0.04), and those in quartile 3 had a 1-point lower score (P=0.35) compared with those in the highest quartile of R bar. Reduced R bar was not associated with verbal memory. Our results suggest that reduced heart rate variability is associated with worse performance on the test of global cognitive function, above and beyond traditional cardiovascular risk factors. © 2013 American Heart Association, Inc.",C reactive protein;glucose;insulin;interleukin 6;adult;aged;article;body mass;breathing;cardiovascular risk;cerebrovascular accident;cognition;cohort analysis;comorbidity;congestive heart failure;controlled study;cross-sectional study;dementia;diabetes mellitus;diastolic blood pressure;diet restriction;electrocardiogram;electrocardiography monitoring;female;glucose blood level;heart rate variability;Hispanic;human;hyperpnea;hypertension;insulin blood level;learning;major clinical study;male;memory consolidation;middle aged;Mini Mental State Examination;priority journal;recall;systolic blood pressure;verbal memory;very elderly,"Zeki Al Hazzouri, A.;Haan, M. N.;Deng, Y.;Neuhaus, J.;Yaffe, K.",2014,,,0,
4957,"Mild cognitive impairment, degenerative and vascular dementia as predictors of intra-hospital, short- and long-term mortality in the oldest old","Background and aims: The relative weight of various etiologies of dementia and mild cognitive impairment (MCI) as predictors of intra-hospital, short- and long-term mortality in very old acutely ill patients suffering from multiple comorbid conditions remains unclear. We investigated intra-hospital, 1-and 5-year mortality risk associated with dementia and its various etiologies in a very old population after discharge from acute care. Methods: Prospective cohort study of 444 patients (mean age 85 years; 74% female) discharged from the acute geriatric unit of Geneva University Hospital. On admission, each subject underwent standardized evaluation of cognitive and comorbid conditions. Patients were followed yearly by the same team. Predictive variables were age, sex, cognitive diagnosis, dementia etiology and severity. Survival during hospitalization, at 1- and 5-year follow-ups was the outcome of interest evaluated with Cox proportional hazard models. Results: Two hundred and six patients were cognitively normal, 48 had MCI, and 190 had dementia: of these, there were 75 cases of Alzheimer's disease (AD), 20 of vascular dementia (VaD), 82 of mixed dementia (MD) and 13 of other types of dementia. The groups compared were statistically similar in age, sex, education level and comorbidity score. After 5 years of follow-up, 60% of the patients had died. Regarding intra-hospital mortality, none of the predictive variables was associated with mortality. MCI, AD and MD were not predictive of short- or long-term mortality. Features significantly associated with reduced survival at 1 and 5 years were being older, male, and having vascular or severe dementia. When all the variables were added in the multiple model, the dementia effect completely disappeared. Conclusions: Dementia (all etiologies) is not predictive of mortality. The observed VaD effect is probably linked to cardiovascular risk comorbidities: hypertension, stroke and hyperlipidemia. ©2011, Editrice Kurtis.",aged;alcohol related dementia;Alzheimer disease;anemia;article;cardiovascular risk;cognition;comorbidity;corticobasal dementia;Creutzfeldt Jakob disease;dementia;diabetes mellitus;disease severity;dyslipidemia;evaluation and follow up;female;frontotemporal dementia;gastrointestinal disease;geriatric patient;heart arrhythmia;heart disease;hepatobiliary disease;hospital discharge;hospitalization;human;hydrocephalus;hyperlipidemia;hypertension;ischemic heart disease;kidney disease;Lewy body;major clinical study;male;mild cognitive impairment;Mini Mental State Examination;mortality;multiinfarct dementia;musculoskeletal disease;neoplasm;neurologic disease;neurologic examination;neuropsychological test;nonvascular neurologic disease;outcome assessment;Parkinson disease;parkinsonism;peripheral vascular disease;predictor variable;proportional hazards model;prospective study;psychologic assessment;respiratory tract disease;risk assessment;cerebrovascular accident;survival,"Zekry, D.;Herrmann, F. R.;Graf, C. E.;Giannelli, S.;Michel, J. P.;Gold, G.;Krause, K. H.",2011,,,0,
4958,A rapid and accurate DHPLC assay for determination of apolipoprotein E genotypes,"The variants of apolipoprotein E (apoE) are closely related to hyperlipidemia III, Alzheimer's disease (AD), coronary artery disease (CAD) and many other human lipid metabolism-related problems. A rapid and accurate genotyping method specific for polymorphisms of the APOE gene is needed for population screening as well as diagnosis of apoE-related diseases in both the research and clinical setting. A polymerase chain reaction (PCR) method was designed to generate a 191-bp amplicon, which contains two common polymorphisms located in codons 112 and 158 of exon 4 of the APOE gene. The PCR amplicons for each sample were subjected to denaturing high-performance liquid chromatography (DHPLC) analysis, which was performed under partially denaturing conditions as determined by profiling the mixture of a tested sample and a homozygous standard control amplicon at the given ratio. A total of 297 DNA samples from Chinese population were enrolled to evaluate the specificity of the assay. A blinded validation study was then performed on 130 samples randomly selected from each of the six genotype groups as determined by DHPLC profiling. The genotypes obtained with the DHPLC method were in full agreement with those obtained by direct sequencing (130/130). We have developed a PCR/DHPLC genotyping assay capable of simultaneously determining all six genotypes of APOE gene in unknown test samples at one time. © 2007 - IOS Press and the authors. All rights reserved.",apolipoprotein E;genomic DNA;Alzheimer disease;article;assay;cardiovascular disease;coronary artery disease;denaturing high performance liquid chromatography;genotype;human;human cell;hyperlipidemia;leukocyte;lipid metabolism;neurologic disease;nucleotide sequence;polymerase chain reaction;priority journal,"Zeng, Y.;Miao, F.;Li, L.;Sun, D. H.;Xu, X. M.",2007,,,0,
4959,General surgical care in the nursing home patient: results of a dedicated geriatric surgery consult service,"BACKGROUND: Although recent interest has centered on diseases that require operation in the elderly, few data are available about the effects of surgical intervention on the frail nursing home patient. STUDY DESIGN: A longitudinal study was conducted of the nature of illness requiring operation and intervention in residents of a geriatric center associated with a tertiary care medical center. A unique consult service for the patients was established and all referrals were prospectively followed up. RESULTS: The actuarial 18-month survival of patients referred was 35 percent. Although maintenance care (e.g., decubitus ulcer, stoma, and enteral tube care) made up a substantial number of referrals (32.5 percent), common surgical diseases of the abdomen, breast, and vascular system were routinely encountered (55 percent). In patients undergoing surgery, the 30-day mortality rate was 8.5 percent, and the complication rate 9.4 percent. Although patients undergoing major abdominal and vascular procedures had a higher complication rate (17.6) percent than those undergoing lesser procedures (6.3 percent, p = 0.05), there was no difference in the 30-day mortality (9.8 compared with 6.3 percent, respectively) or 18-month actuarial survival (33 compared with 32 percent, respectively) rates. The overall actuarial survival was adversely affected by the presence of coronary artery disease (relative risk [RR], 3.27) and dementia (Mini-Mental State Examination score less than 24; RR, 2.39) and age older than 70 years (RR, 2.03). The overall survival was unaffected by the actual need for operation, the magnitude of the procedure performed, gender, the number of comorbid conditions, and the preoperative code (resuscitative) status. CONCLUSIONS: Although nursing home patients referred for surgical intervention have poor survival rates, the use of surgical procedures does not adversely affect overall survival. This supports the idea that care for this patient population is not futile, and quality of life, patient dignity, and relief of suffering can provide a alternative to curative therapy.","Actuarial Analysis;Aged;Aged, 80 and over;Comorbidity;Female;*Frail Elderly;*Health Services for the Aged;*Homes for the Aged;Humans;Longitudinal Studies;Male;*Nursing Homes;Palliative Care;Proportional Hazards Models;Quality of Life;Referral and Consultation;Surgical Procedures, Operative/mortality/*utilization;Survival Analysis","Zenilman, M. E.;Bender, J. S.;Magnuson, T. H.;Smith, G. W.",1996,Oct,,0,
4960,Myxomatous degeneration of the mitral valve and multiple infarction in a young patient,A 25-year-old female patient with mitral valve prolapse syndrome and multi-infarct dementia was investigated. Myxomatous degeneration of the mitral valve was diagnosed by two-dimensional echocardiography.,case report;central nervous system;diagnosis;echocardiography;heart;heart infarction;human;mitral valve disease;mitral valve prolapse;multiinfarct dementia;peripheral vascular system,"Zenker, G.;Bone, G.;Ladurner, G.",1984,,,0,
4961,Successful use of clopidogrel for cerebrovascular accident in a patient with suspected ticlopidine-induced hepatotoxicity,"OBJECTIVE: To report a case of successful clopidogrel use in a patient who developed suspected ticlopidine-induced hepatotoxicity during therapy for a cerebrovascular accident. CASE REPORT: A 79-year-old white woman with a history of hypertension, type 2 diabetes, Alzheimer disease, and coronary artery disease started receiving ticlopidine 250 mg twice daily three days after hospital admission for a cerebrovascular accident. Medications prior to admission included quinapril, furosemide, insulin, atorvastatin, conjugated estrogen, medroxyprogesterone, donepezil, and vitamin E. The estrogen, medroxyprogesterone, and donepezil were discontinued on admission. Laboratory tests on admission revealed that total bilirubin, alkaline phosphatase, and aspartate aminotransferase (AST) were within normal limits. On day 39 of hospitalization, laboratory tests showed marked increases in alkaline phosphatase, AST, alanine aminotransferase, γ-glutamyl-transferase, and 5' nucleotidase. Physical examination revealed no signs of jaundice or hepatomegaly, and laboratory tests for viral hepatitis were negative. A presumptive diagnosis of ticlopidine-induced hepatotoxicity was made and ticlopidine was discontinued. The following day, clopidogrel 75 mg/d was initiated. Liver function tests returned to baseline over the following four months with ongoing clopidogrel therapy. DISCUSSION: Ticlopidine-induced hepatotoxicity is well documented in the literature. In the present case, clopidogrel, a structurally similar thienopyridine, was substituted for ticlopidine following the development of presumptive ticlopidine-induced hepatotoxicity. Serum liver enzyme concentrations returned to baseline with continued clopidogrel therapy, suggesting that clopidogrel is a suitable alternative in patients who develop ticlopidine-induced hepatotoxicity. CONCLUSIONS: Clopidogrel may be a suitable alternative for patients who develop ticlopidine-induced hepatotoxicity.",alpha tocopherol;antithrombocytic agent;atorvastatin;clopidogrel;conjugated estrogen;donepezil;furosemide;insulin;medroxyprogesterone;quinapril;aged;Alzheimer disease;article;case report;cerebrovascular accident;coronary artery disease;diabetes mellitus;drug induced disease;female;geriatric patient;hepatomegaly;human;hypercholesterolemia;hypertension;liver function test;liver toxicity;priority journal,"Zeolla, M. M.;Carson, J. J.",1999,,,0,
4962,On a Case of Encephalitis with Electrocardiographic Changes and Mental Disorders of an Amential Type (Encephalomyocarditis),,Adolescent;*Dementia;*Electrocardiography;*Encephalitis;Humans;*Mental Disorders;*Myocarditis;*Adolescence,"Zerbi, F.;Torre, E.;Kauchtschischwili, G.",1964,Jul-Aug,,0,
4963,"Emotional effects and aging, interval passing between emotional factor and illness; autopsy observations",,Arteriosclerosis/pathology;Coronary Disease/pathology;Dementia/*diagnosis;Humans;Psychophysiologic Disorders/*diagnosis,"Zerman, A. M.",1967,May,,0,
4964,Hypoxia due to cardiac arrest induces a time-dependent increase in serum amyloid β levels in humans,"Amyloid β (Aβ) peptides are proteolytic products from amyloid precursor protein (APP) and are thought to play a role in Alzheimer disease (AD) pathogenesis. While much is known about molecular mechanisms underlying cerebral Aβ accumulation in familial AD, less is known about the cause(s) of brain amyloidosis in sporadic disease. Animal and postmortem studies suggest that Aβ secretion can be up-regulated in response to hypoxia. We employed a new technology (<underline>S</underline>ingle <underline>Mo</underline>lecule <underline>A</underline>rrays, SiMoA) capable of ultrasensitive protein measurements and developed a novel assay to look for changes in serum Aβ42 concentration in 25 resuscitated patients with severe hypoxia due to cardiac arrest. After a lag period of 10 or more hours, very clear serum Aβ42 elevations were observed in all patients. Elevations ranged from approximately 80% to over 70-fold, with most elevations in the range of 3-10-fold (average approximately 7-fold). The magnitude of the increase correlated with clinical outcome. These data provide the first direct evidence in living humans that ischemia acutely increases Aβ levels in blood. The results point to the possibility that hypoxia may play a role in the amyloidogenic process of AD. © 2011 Zetterberg et al.",amyloid beta protein[1-42];accuracy;adult;aged;Alzheimer disease;article;assay;brain hypoxia;clinical article;female;heart arrest;human;limit of quantitation;male;predictive value;protein blood level;protein determination;protein secretion;resuscitation;sensitivity and specificity;single molecule array;time,"Zetterberg, H.;Mörtberg, E.;Song, L.;Chang, L.;Provuncher, G. K.;Patel, P. P.;Ferrell, E.;Fournier, D. R.;Kan, C. W.;Campbell, T. G.;Meyer, R.;Rivnak, A. J.;Pink, B. A.;Minnehan, K. A.;Piech, T.;Rissin, D. M.;Duffy, D. C.;Rubertsson, S.;Wilson, D. H.;Blennow, K.",2011,,,0,
4965,Smoking and Alzheimer's disease among Mongolian and Han Chinese aged 55 years and over living in the Inner Mongolia farming area of China,"Residents aged 55 years or older from 27 communities and two settlements in Xilingol League of Inner Mongolia were selected for participation in an Alzheimer's disease epidemiological investigation from June 2008 to June 2009, including 3 259 Mongolians and 5 887 Han Chinese. The Mongolian subjects in the Alzheimer's disease group were at age of 55 years or older (on average), and more of them were male, illiterate and/or had a history of coronary artery disease and/or diabetes compared with the Mongolian subjects in the non-Alzheimer's disease group. The Han Chinese subjects in the Alzheimer's disease group were at age of 55 years or older (on average) and more of them were women, illiterate and/or had a history of coronary artery disease, and less of them had a history of alcohol consumption compared with the non-Alzheimer's disease group. Non-conditional multivariate stepwise logistic regression identified that male gender, increasing age and having a history of diabetes and/or coronary heart disease were associated with higher odds of Alzheimer's disease among Mongolians while having an educational background was associated with lower odds (OR = 0.259, 95%CI 0.174-0.386). Among the Han Chinese subjects, male gender, increasing age and having a history of coronary heart disease and/or hypertension was associated with higher odds of Alzheimer's disease, while having an educational background was associated lower odds (OR = 0.271, 95%CI 0.192-0.381). The results also indicated that extremely heavy smoking may be a risk factor for Alzheimer's disease in Mongolian males aged over 55 years. There was no significant difference in smoking habits between the Mongolian and Han Chinese subjects with Alzheimer's disease.",Alzheimer's disease;Han Chinese population;Mongolian;elderly;epidemiology;protection factor;risk factor,"Zhang, C.;Da, L.;Zhao, S.;Wang, D.;Niu, G.;Huriletemuer",2012,Jul 15,10.3969/j.issn.1673-5374.2012.20.007,0,
4966,Degree centrality for semantic abstraction summarization of therapeutic studies,"Automatic summarization has been proposed to help manage the results of biomedical information retrieval systems. Semantic MEDLINE, for example, summarizes semantic predications representing assertions in MEDLINE citations. Results are presented as a graph which maintains links to the original citations. Graphs summarizing more than 500 citations are hard to read and navigate, however. We exploit graph theory for focusing these large graphs. The method is based on degree centrality, which measures connectedness in a graph. Four categories of clinical concepts related to treatment of disease were identified and presented as a summary of input text. A baseline was created using term frequency of occurrence. The system was evaluated on summaries for treatment of five diseases compared to a reference standard produced manually by two physicians. The results showed that recall for system results was 72%, precision was 73%, and F-score was 0.72. The system F-score was considerably higher than that for the baseline (0.47). © 2011 Elsevier Inc.",Alzheimer disease;article;brain depth stimulation;citation analysis;clinical evaluation;comorbidity;heart failure;human;medical information system;Medline;melanoma;migraine;pallidotomy;Parkinson disease;peptic ulcer;priority journal;semantic abstraction summarization;semantics;substitution therapy;supplementation;thalamotomy;transcranial magnetic stimulation,"Zhang, H.;Fiszman, M.;Shin, D.;Miller, C. M.;Rosemblat, G.;Rindflesch, T. C.",2011,,,0,
4967,Sense of Coherence Buffers Relationships of Chronic Stress with Fasting Glucose Levels,"Sense of coherence (SOC) was examined as a buffer of the relationship of chronic stress with fasting glucose and insulin levels. Spouse caregivers of persons with diagnoses of Alzheimer's disease (AD) (n = 73) were compared to controls [spouses of nondemented persons (n = 69)], group-matched on age/gender. After controlling for anger and coronary heart disease (CHD), interactions of SOC and gender explained variance in glucose (but not insulin) at study entry (T1) and 15-18 months later (T2). However, this occurred only in caregivers. At both times SOC and glucose were negatively related in men caregivers but not in women caregivers or in controls. In caregivers (but not controls), SOC at TI predicted glucose at T2, independent of gender, anger, and glucose at T1; and hassles at T1 appeared to mediate this relationship. Future research should examine SOC as a buffer of other chronic stressors and metabolic variables.",adult;aged;Alzheimer disease;anger;article;caregiver;cognition;controlled study;diet restriction;female;glucose blood level;human;insulin blood level;ischemic heart disease;major clinical study;male;sex difference;stress,"Zhang, J.;Vitaliano, P. P.;Lutgendorf, S. K.;Scanlan, J. M.;Savage, M. V.",2001,,,0,
4968,Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study,"OBJECTIVES: To identify factors that predict repeat admission to hospital for adverse drug reactions (ADRs) in older adults. DESIGN: Population based retrospective cohort study. SETTING: All public and private hospitals in Western Australia. PARTICIPANTS: 28 548 patients aged >or=60 years with an admission for an ADR during 1980-2000 followed for three years using the Western Australian data linkage system. RESULTS: 5056 (17.7%) patients had a repeat admission for an ADR. Repeat ADRs were associated with sex (hazard ratio 1.08, 95% confidence interval 1.02 to 1.15, for men), first admission in 1995-9 (2.34, 2.00 to 2.73), length of hospital stay (1.11, 1.05 to 1.18, for stays >or=14 days), and Charlson comorbidity index (1.71, 1.46 to 1.99, for score >or=7); 60% of comorbidities were recorded and taken into account in analysis. In contrast, advancing age had no effect on repeat ADRs. Comorbid congestive cardiac failure (1.56, 1.43 to 1.71), peripheral vascular disease (1.27, 1.09 to 1.48), chronic pulmonary disease (1.61, 1.45 to 1.79), rheumatological disease (1.65, 1.41 to 1.92), mild liver disease (1.48, 1.05 to 2.07), moderate to severe liver disease (1.85, 1.18 to 2.92), moderate diabetes (1.18, 1.07 to 1.30), diabetes with chronic complications (1.91, 1.65 to 2.22), renal disease (1.93, 1.71 to 2.17), any malignancy including lymphoma and leukaemia (1.87, 1.68 to 2.09), and metastatic solid tumours (2.25, 1.92 to 2.64) were strong predictive factors. Comorbidities requiring continuing care predicted a reduced likelihood of repeat hospital admissions for ADRs (cerebrovascular disease 0.85, 0.73 to 0.98; dementia 0.62, 0.49 to 0.78; paraplegia 0.73, 0.59 to 0.89). CONCLUSIONS: Comorbidity, but not advancing age, predicts repeat admission for ADRs in older adults, especially those with comorbidities often managed in the community. Awareness of these predictors can help clinicians to identify which older adults are at greater risk of admission for ADRs and, therefore, who might benefit from closer monitoring.",Age Factors;Aged;Chronic Disease;Comorbidity;Drug-Related Side Effects and Adverse Reactions/*epidemiology;Epidemiologic Methods;Female;Humans;Length of Stay/statistics & numerical data;Male;Middle Aged;Patient Readmission/*statistics & numerical data;Socioeconomic Factors;Treatment Outcome;Western Australia/epidemiology,"Zhang, M.;Holman, C. D.;Price, S. D.;Sanfilippo, F. M.;Preen, D. B.;Bulsara, M. K.",2009,Jan 07,10.1136/bmj.a2752,0,
4969,Smartphone applications providing information about stroke: Are we missing stroke risk computation preventive applications?,,atrial fibrillation;brain injury;brain ischemia;dementia;health care personnel;heart left ventricle hypertrophy;human;letter;medical information;public health;publication;scientific literature;smartphone,"Zhang, M. W. B.;Ho, R. C. M.",2017,,10.5853/jos.2016.01004,0,
4970,NLRP3 rs35829419 polymorphism is associated with increased susceptibility to multiple diseases in humans,"Using a meta-analysis framework, we investigated the association between the NLRP3 rs35829419 polymorphism and increased susceptibility to diverse diseases in humans. Relevant published studies were identified through a comprehensive and systematic electronic search, using the following scientific literature databases: Science Citation Index, the Cochrane Library, PubMed, Embase, CINAHL, Current Contents Index, Chinese Biomedical, the Chinese Journal Full-Text, and the Weipu Journal. Statistical analysis of data extracted from the selected high quality studies was performed using the Version 12.0 STATA software. A total of 13 case-control studies met our stringent inclusion and exclusion criteria for the present meta-analysis. These 13 high quality studies contained relevant information on 7719 patients with various diseases and 7094 healthy controls. Our meta-analysis results showed that the NLRP3 gene rs35829419 C>A polymorphism was associated with a significantly increased risk of developing multiple diseases in humans under 5 genetic models (all P < 0.05). Data stratification and subgroup analysis based on the disease type revealed that rs35829419 C>A carriers displayed a markedly increase susceptibility to leprosy, colorectal cancer, HIV-1 infection, rheumatoid arthritis, abdominal aortic aneurysms, inflammatory bowel disease, ulcerative colitis, and atopic dermatitis. In summary, our meta-analysis results revealed the first identified strong correlation between the NLRP3 rs35829419 polymorphism and increased susceptibility to various diseases in humans.",cryopyrin;abdominal aorta aneurysm;Alzheimer disease;ankylosing spondylitis;article;atopic dermatitis;colorectal cancer;Crohn disease;diseases;genetic association;genetic model;genetic risk;genetic susceptibility;genetic variability;heart infarction;heterozygote;human;Human immunodeficiency virus 1 infection;insulin dependent diabetes mellitus;leprosy;malignant mesothelioma;multiple disease;NLRP3 gene;polymerase chain reaction;rheumatoid arthritis;risk factor;single nucleotide polymorphism;ulcerative colitis,"Zhang, Q.;Fan, H. W.;Zhang, J. Z.;Wang, Y. M.;Xing, H. J.",2015,,,0,
4971,Mining biomarkers in human sera using proteomic tools,"One of the major difficulties in mining low abundance biomarkers from serum or plasma is due to the fact that a small number of proteins such as albumin, α2-macroglobulin, transferrin, and immunoglobulins, may represent as much as 80% of the total serum protein. The large quantity of these proteins makes it difficult to identify low abundance proteins in serum using traditional 2-dimensional electrophoresis. We recently used a combination of multidimensional liquid chromatography and gel electrophoresis coupled to matrix-assisted laser desorption/ionization-quadrupole-time of flight and Ion Trap liquid chromatography-tandem mass spectrometry to identify protein markers in sera of Alzheimer's disease (AD), insulin resistance/type-2 diabetes (IR/ D2), and congestive heart failure (CHF) patients. We identified 8 proteins that exhibit higher levels in control sera and 36 proteins that exhibit higher levels in disease sera. For example, haptoglobin and hemoglobin are elevated in sera of AD, IR/D2, and CHF patients. The levels of several other proteins including fibrinogen and its fragments, alpha 2-macroglobulin, transthyretin, pro-platelet basic protein, protease inhibitors clade A and C, as well as proteins involved in the classical complement pathway such as complement C3, C4, and C1 inhibitor, were found to differ between IR/D2 and control sera. The sera levels of proteins, such as the 10 kDa subunit of vitronectin, alpha 1-acid glycoprotein, apolipoprotein B100, fragment of factor H, and histidine-rich glycoprotein were observed to be different between AD and controls. The differences observed in these biomarker candidates were confirmed by Western blot and the enzyme-linked immunosorbent assay. The biological meaning of the proteomic changes in the disease states and the potential use of these changes as diagnostic tools or for therapeutic intervention will be discussed.",albumin;alpha 2 macroglobulin;apolipoprotein B100;basic protein;biological marker;complement component C1s inhibitor;complement component C3;complement component C4;complement factor H;fibrinogen;glycoprotein;haptoglobin;hemoglobin;histidine;immunoglobulin;orosomucoid;prealbumin;proteinase inhibitor;transferrin;vitronectin;Alzheimer disease;article;complement classical pathway;congestive heart failure;controlled study;enzyme linked immunosorbent assay;human;insulin resistance;ion trap mass spectrometry;liquid chromatography;matrix assisted laser desorption ionization time of flight mass spectrometry;non insulin dependent diabetes mellitus;nucleotide sequence;priority journal;protein analysis;protein blood level;proteomics;two dimensional gel electrophoresis;Western blotting,"Zhang, R.;Barker, L.;Pinchev, D.;Marshall, J.;Rasamoelisolo, M.;Smith, C.;Kupchak, P.;Kireeva, I.;Ingratta, L.;Jackowski, G.",2004,,,0,
4972,Implications of Orthostatic Hypotension in Older Persons With and Without Diabetes,,adrenal insufficiency;adverse outcome;aged;anemia;aortic aneurysm;cardiac patient;carotid artery obstruction;cerebrovascular accident;chronic kidney failure;cohort analysis;comparative study;connective tissue disease;coronary artery disease;dementia;diabetes mellitus;diabetic patient;diastolic blood pressure;disease association;falling;female;frailty;gastrointestinal hemorrhage;geriatric disorder;head tilting;heart arrhythmia;heart failure;hospitalization;human;hyperlipidemia;incidence;kidney artery stenosis;letter;liver cirrhosis;lung disease;major clinical study;male;medical record review;mortality;neoplasm;organ transplantation;orthostatic hypotension;outcome assessment;peripheral vascular disease;prevalence;retrospective study;seizure;sleep disordered breathing;standing;systolic blood pressure;thyroid disease;venous thromboembolism,"Zhang, R.;Malmstrom, T. K.",2017,,10.1016/j.jamda.2016.10.002,0,
4973,"Protective effect of melatonin on soluble Abeta1-42-induced memory impairment, astrogliosis, and synaptic dysfunction via the Musashi1/Notch1/Hes1 signaling pathway in the rat hippocampus","BACKGROUND: Amyloid-beta (Abeta) plays a key role in Alzheimer's disease (AD) pathogenesis, and soluble Abeta oligomers are more cytotoxic than Abeta fibrils. Recent evidence suggests that Notch signaling is affected by AD and other brain diseases. Melatonin exerts beneficial effects on many aspects of AD and may protect against myocardial ischemia via Notch1 signaling regulation. Therefore, we hypothesized that the Notch1 signaling pathway is involved in the neuroprotective role of melatonin against soluble Abeta1-42. METHODS: An AD rat model was established via repeated intracerebroventricular administration of soluble Abeta1-42. Melatonin treatment was administered 24 hours prior to Abeta1-42 administration via an intraperitoneal injection. The effects of melatonin on spatial learning and memory, synaptic plasticity, and astrogliosis were investigated. The expression of several Notch1 signaling components, including Notch1, the Notch1 intracellular domain (NICD), Hairy and enhancer of split 1 (Hes1, a downstream effector of Notch), and Musashi1 (a positive regulator of Notch), were examined using immunohistochemistry, western blotting, and quantitative real-time PCR. In vitro studies were conducted to determine whether the melatonin-mediated protection against Abeta1-42 was inhibited by DAPT, an inhibitor of Notch signaling. RESULTS: Melatonin improved the Abeta1-42-induced impairment in spatial learning and memory, attenuated synaptic dysfunction, and reduced astrogliosis. Melatonin also ameliorated the effects of Abeta1-42 on Notch1, NICD, Hes1, and Musashi1. The in vitro studies demonstrated that DAPT effectively blocked the neuroprotective effect of melatonin against Abeta1-42. CONCLUSIONS: These findings suggest that melatonin may improve the soluble Abeta1-42-induced impairment of spatial learning and memory, synaptic plasticity, and astrogliosis via the Musashi1/Notch1/Hes1 signaling pathway.",Hes1;Learning and memory;Melatonin;Musashi1;Neuroplasticity;Notch1;Soluble Abeta1-42,"Zhang, S.;Wang, P.;Ren, L.;Hu, C.;Bi, J.",2016,Sep 15,10.1186/s13195-016-0206-x,0,
4974,Shengmai Formula Ameliorates Pathological Characteristics in AD C. elegans,"Shengmai (SM) formula, a classical traditional Chinese medicine formula, is composed of Panax ginseng (Pg), Ophiopogon japonicus (Oj), and Schisandra Chinesis (Sc). SM has been clinically used to treat heart failure and ischemic heart disease. Although SM formula has been reported to be potential for fighting against Alzheimer's disease (AD) by previous works, there are many gaps in our knowledge on its usage in AD treatment on an organism level and will then need to be further clarified. In this study, transgenic Caenorhabditis elegans expressing human Abeta1-42 are used to evaluate SM formula efficacy to treat AD phenotype and to investigate its underlying mechanism. The results showed that SM formula ameliorated AD pathological characteristics of paralysis behavior and chemotaxis defect in transgenic C. elegans. With SM treatment, the number of Abeta deposits decreased, the levels of gene expressions of hsp16-2, hsp16-41, ace-1, ace-2, and TNFA1P1 homolog genes were down-regulated. Our results also showed that Oj exhibited more stronger effect on delaying paralysis in worms than Pg and Sc did, and synergistic action was observed between Pg and Oj, and Sc further enhanced the activity of Pg/Oj combination on delaying paralysis behavior. Further, SM with herbs of Pg, Oj, and Sc at a dose proportion of 9:9:6 exhibited superior therapeutic efficacy in comparison with herbs at other dose proportions. After SM formula extracted by ethanol, it delayed AD symptoms on a wider dose from 0.2 to 10.0 mg/mL with no toxic effect. These results provided more evidence for SM formula being potential to be used to treat AD.",Ad;Caenorhabditis elegans;Chemotaxis;Paralysis,"Zhang, W.;Zhi, D.;Ren, H.;Wang, D.;Wang, X.;Zhang, Z.;Fei, D.;Zhu, H.;Li, H.",2016,Nov,10.1007/s10571-015-0326-z,0,
4975,The association between co-morbidity and the use of antidiabetics or adjunctive cardiovascular medicines in Australian veterans with diabetes,"OBJECTIVE: To examine the association between co-morbidities and the use of antidiabetic medications or adjunctive cardiovascular medicines among Australian veterans with diabetes. METHODS: data were sourced from the Australian Department of Veterans' Affairs Health Claims database. All veterans aged 65 years and over who were dispensed medicines for diabetes from July to December 2006 were included. Dispensings of antidiabetic and adjunctive cardiovascular medicines over the first six months of 2007 were examined. Log binominal regression models were used to calculate the relative risks of the dispensing of medications for various co-morbidities, taking into account potential confounders. RESULTS: among the 14,802 veterans who were dispensed medicines for diabetes, 70% had five or more co-morbidities. Patients who had diabetes-related co-morbidities had significantly less dispensing of metformin monotherapy and more dispensing of insulin than those without these conditions. Patients who had cardiovascular disease were more likely to have three or more oral antidiabetics dispensed (RR=1.16, 95% CI: 1.04-1.30), particularly those who had heart failure (RR=1.24, 95% CI: 1.05-1.47). Patients with renal disease were more likely to have glitazones dispensed (RR=1.46, 95% CI: 1.24-1.72). Adjunctive cardiovascular medicines were significantly less likely to be dispensed to those with established heart conditions and non-related co-morbidities, particularly dementia. CONCLUSIONS: consistent with guideline recommendations, in this cohort more intensive antidiabetic and cardiovascular therapy is used in those with more severe disease as measured by related co-morbidities. Cardiovascular medicines however may be underutilised in those with un-related co-morbidities.","Aged;Aged, 80 and over;Aging;Australia/epidemiology;Cardiovascular Agents/*therapeutic use;Cardiovascular Diseases/*drug therapy/*epidemiology;Cohort Studies;Comorbidity;Databases, Factual;Diabetes Complications/drug therapy/epidemiology;Diabetes Mellitus/*drug therapy/*epidemiology;Drug Prescriptions/statistics & numerical data;Female;Humans;Hypoglycemic Agents/*therapeutic use;Risk;*Veterans/statistics & numerical data;Veterans Health","Zhang, Y.;Vitry, A.;Caughey, G.;Roughead, E. E.;Ryan, P.;Gilbert, A.;Shakib, S.;McDermott, R.",2011,Jan,10.1016/j.diabres.2010.10.006,0,
4976,"Comparative study of damage to cognitive function and mental behavior in patients with general paresis of the insane, Alzheimer’s disease, and frontotemporal dementia","Dementia is a group of cognitive functional disorders with staggering worldwide morbidity and mortality. Recognition of the differences between types of dementia is important for clinical diagnosis and effective treatment. This study compared and analyzed differences in cognitive functions and mental behaviors of patients with three types of dementia: general paresis of the insane (GPI), Alzheimer’s disease (AD), and frontotemporal dementia (FTD). The study cohort of 90 subjects included 30 subjects each in AD, GPI, and FTD groups. Clinical data of gender, age, duration of disease, education, family history of dementia, diagnosis of diabetes, diagnosis of hypertension, diagnosis of coronary heart disease, smoking habits, drinking habits, mini-mental state examination (MMSE) score, Montreal cognitive assessment (MoCA) score, neuropsychiatric inventory (NPI) score, and clinical dementia rating of patients were observed and compared. MMSE scores were significantly higher in the GPI group than AD or FTD groups. MoCA scores were significantly higher in the AD group than the FTD group. NPI scores were significantly higher in the FTD group than GPI or AD groups. Age, family history of dementia, and incidence of hypertension were significantly higher in AD and FTD groups than the GPI group. MMSE, MoCA, and NPI scores were significantly correlated with degree of dementia. In addition, degree of dementia was significantly correlated with age (OR = 1.845), family history of dementia (OR = 1.613), MMSE score (OR = 0.752), MoCA score (OR = 0.536), and NPI score (OR = 2.055). In brief, AD, FTD, and GPI patients display characteristic damage to cognitive function and mental behavior, and that damage correlates with the condition of disease. These characteristics can help effectively diagnose and classify types of dementia to improve patient prognosis. Clinicians should acknowledge such characteristic changes to ensure accurate diagnosis and allow early intervention for dementia patients.",adult;age;aged;Alzheimer disease;article;assessment of humans;behavior;Clinical Dementia Rating;cognitive defect;controlled study;dementia;diabetes mellitus;disease duration;educational status;family history;female;frontotemporal dementia;gender;human;hypertension;incidence;ischemic heart disease;major clinical study;male;middle aged;Mini Mental State Examination;Montreal cognitive assessment;neuropsychiatric inventory;paresis;smoking,"Zhao, W.;Bi, P.;Li, S.;Yin, C.;Yang, Y.;Sun, L.",2016,,,0,
4977,Identification of Risk Pathways and Functional Modules for Coronary Artery Disease Based on Genome-wide SNP Data,"Coronary artery disease (CAD) is a complex human disease, involving multiple genes and their nonlinear interactions, which often act in a modular fashion. Genome-wide single nucleotide polymorphism (SNP) profiling provides an effective technique to unravel these underlying genetic interplays or their functional involvements for CAD. This study aimed to identify the susceptible pathways and modules for CAD based on SNP omics. First, the Wellcome Trust Case Control Consortium (WTCCC) SNP datasets of CAD and control samples were used to assess the joint effect of multiple genetic variants at the pathway level, using logistic kernel machine regression model. Then, an expanded genetic network was constructed by integrating statistical gene–gene interactions involved in these susceptible pathways with their protein–protein interaction (PPI) knowledge. Finally, risk functional modules were identified by decomposition of the network. Of 276 KEGG pathways analyzed, 6 pathways were found to have a significant effect on CAD. Other than glycerolipid metabolism, glycosaminoglycan biosynthesis, and cardiac muscle contraction pathways, three pathways related to other diseases were also revealed, including Alzheimer's disease, non-alcoholic fatty liver disease, and Huntington's disease. A genetic epistatic network of 95 genes was further constructed using the abovementioned integrative approach. Of 10 functional modules derived from the network, 6 have been annotated to phospholipase C activity and cell adhesion molecule binding, which also have known functional involvement in Alzheimer's disease. These findings indicate an overlap of the underlying molecular mechanisms between CAD and Alzheimer's disease, thus providing new insights into the molecular basis for CAD and its molecular relationships with other diseases.",cell adhesion molecule;glycerolipid;phospholipase C;Alzheimer disease;app gene;article;binding affinity;controlled study;coronary artery disease;enzyme activity;epistasis;gene;gene frequency;gene interaction;genetic association;genetic risk;genetic susceptibility;genetic variability;genome-wide association study;glycosaminoglycan metabolism;heart contraction;human;Huntington chorea;lipid metabolism;major clinical study;molecular pathology;nonalcoholic fatty liver;pik3r1 gene;protein protein interaction;single nucleotide polymorphism,"Zhao, X.;Luan, Y. Z.;Zuo, X.;Chen, Y. D.;Qin, J.;Jin, L.;Tan, Y.;Lin, M.;Zhang, N.;Liang, Y.;Rao, S. Q.",2016,,10.1016/j.gpb.2016.04.008,0,
4978,Cerebral atherosclerosis is associated with cystic infarcts and microinfarcts but not alzheimer pathologic changes,"Background and Purpose-Some studies have reported associations between intracranial atherosclerosis and Alzheimer disease pathology. We aimed to correlate severity of cerebral atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy with neurofibrillary tangles, neuritic plaques, and cerebral infarcts. Methods-This autopsy study (n=163) was drawn from a longitudinal study of subcortical ischemic vascular disease, Alzheimer disease, and normal aging. Multivariable logistic regression models were used to test associations among the 3 forms of cerebrovascular disease and the presence of ischemic and neurodegenerative brain lesions. Apolipoprotein E genotype was included as a covariate in these multivariable models. Results-Cerebral atherosclerosis was positively associated with microinfarcts (odds ratio [OR], 2.3 95% confidence interval [CI], 1.2-4.4) and cystic infarcts (OR, 2.0 95% CI, 1.0-4.2) but not Alzheimer disease pathology. Arteriolosclerosis showed a positive correlation with lacunar infarcts (OR, 2.0 95% CI, 1.0-4.2) but not Alzheimer disease pathology. Cerebral amyloid angiopathy was inversely associated with lacunar infarcts (OR, 0.6 95% CI, 0.41-1.1), but positively associated with Braak and Braak stage (OR, 1.5 95% CI, 1.1-2.1) and Consortium to Establish a Registry for Alzheimer Disease plaque score (OR, 1.5 95% CI, 1.1-2.2). Conclusions- Microinfarcts, which have been correlated with severity of cognitive impairment, were most strongly associated with atherosclerosis. Possible pathogenetic mechanisms include artery-to-artery emboli, especially microemboli that may include atheroemboli or platelet-fibrin emboli. Arteriolosclerosis was positively, whereas cerebral amyloid angiopathy was negatively correlated with lacunar infarcts, which might prove helpful in clinical differentiation of arteriolosclerotic from cerebral amyloid angiopathy-related vascular brain injury. © 2013 American Heart Association, Inc.",apolipoprotein E;aged;aging;Alzheimer disease;arteriolosclerosis;article;brain atherosclerosis;brain damage;brain infarction;cerebrovascular disease;disease association;disease severity;female;genotype;human;human tissue;lacunar stroke;longitudinal study;major clinical study;male;neurofibrillary tangle;priority journal;register;senile plaque;vascular amyloidosis;vascular disease,"Zheng, L.;Vinters, H. V.;Mack, W. J.;Zarow, C.;Ellis, W. G.;Chui, H. C.",2013,,,0,
4979,Diabetes mellitus may induce cardiovascular disease by decreasing neuroplasticity,"Neuroplasticity has been defined ""the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections"". The nervous system monitors and coordinates internal organ function. Thus neuroplasticity may be associated with the pathogenesis of other diseases besides neuropsychiatric diseases. Decreased neuroplasticity is associated with cardiovascular disease (CVD) and a disease related to decreased neuroplasticity may confer a greater CVD risk. Diabetes mellitus (DM) is related to CVD and DM induces decreased neuroplasticity, which is manifested as depression, Alzheimer's disease and diabetic neuropathy. Therefore we conclude that DM may induce CVD by decreasing neuroplasticity.",brain derived neurotrophic factor;CCAAT enhancer binding protein;glucocorticoid;insulin;somatomedin;Alzheimer disease;article;autonomic neuropathy;brain metabolism;cardiovascular disease;cognitive defect;coronary artery disease;depression;diabetes mellitus;diabetic cardiomyopathy;disease association;human;hyperglycemia;insulin resistance;insulin treatment;nerve cell plasticity;non insulin dependent diabetes mellitus;risk factor;visual memory,"Zheng, Z.;Wu, J.;Wang, R.;Zeng, Y.",2014,,,0,
4980,Over-expression of IL-33 leads to spontaneous pulmonary inflammation in mIL-33 transgenic mice,"IL-33 plays an important role in inflammatory diseases including hypersensitive diseases like asthma, autoimmune diseases like rheumatoid arthritis, cardiovascular diseases like heart failure and neurodegenerative diseases like Alzheimer's disease. Here we reported the generation of an IL-33 transgenic mouse, in which mouse IL-33 full-length cDNA was controlled under the CMV promoter. The transgenic IL-33 was released as a cleaved form with molecular weight of 18kDa in pulmonary, nephritic, cardiac and pancreatic tissues in transgenic mice and the pI of 18kDa peptide was about pH 3-5 on the 2D PAGE which was similar with the activated peptide of IL-33. Histological analysis showed massive airway inflammation with infiltration of eosinophils around bronchi and small blood vessels, hyperplasia of goblet cells and accumulation of mucus-like material in pulmonary tissue of transgenic mice. An increase of IL-5, IL-8, IL-13 and IgE was detected in bronchoalveolar lavage fluid (BALF) of transgenic mice, which are inflammatory factors. These findings suggest transgenic IL-33 could be cleaved and secreted in an activated form and play an important role in the pathogenesis of pulmonary inflammation.","Animals;Bronchoalveolar Lavage Fluid/chemistry;Cell Movement/genetics;Cytokines/genetics/*metabolism;Eosinophils/pathology;Goblet Cells/pathology;Hyperplasia;Inflammation Mediators/metabolism;Interleukin-33;Interleukins/genetics/*immunology/metabolism;Mice;Mice, Inbred C57BL;Mice, Transgenic;Mucociliary Clearance/genetics/immunology;Pneumonia/*genetics/*immunology/metabolism/physiopathology;Transgenes/genetics/immunology","Zhiguang, X.;Wei, C.;Steven, R.;Wei, D.;Wei, Z.;Rong, M.;Zhanguo, L.;Lianfeng, Z.",2010,Jul 8,10.1016/j.imlet.2010.04.005,0,
4981,The relationship between glucose excursion and cognitive function in aged type 2 diabetes patients,"OBJECTIVE: Evidence suggests that type 2 diabetes (T2DM) is associated with an increased risk of dementia and that glucose variability is an independent risk factor for diabetic complications. This study investigated the relationship between glucose excursion and cognitive function in aged T2DM patients. METHODS: A total of 248 aged T2DM patients wore a continuous glucose monitoring system (CGMS) for 3 days in order to evaluate glucose excursion, including mean amplitude of glycemic excursions (MAGE) and mean of daily difference (MODD). All subjects were evaluated with a number of accepted cognitive function tests, including the mini-mental status examination (MMSE). The relationship between MAGE and MODD and performance on these cognitive tests was assessed. RESULTS: The MAGE and MMSE score were negatively correlated, likewise with the correlation between MODD and MMSE. Liner multivariate regression analysis showed that MAGE and MODD were also negatively related to MMSE independent of age, sex, glycemic control, hypertension, smoking, or coronary heart disease history. CONCLUSION: Glucose excursion is related to cognitive function in aged T2DM patients. Elevated glucose excursion decreased the MMSE score, which reflects general cognitive function. Thus, therapy aimed at controlling glucose excursion may be beneficial for maintaining cognitive function in aged T2DM patients.","Aged;Aged, 80 and over;Blood Glucose/*metabolism;*Cognition;Diabetes Mellitus, Type 2/blood/*psychology;Female;Humans;Linear Models;Male;Multivariate Analysis","Zhong, Y.;Zhang, X. Y.;Miao, Y.;Zhu, J. H.;Yan, H.;Wang, B. Y.;Jin, J.;Hu, T. J.;Jia, W. P.",2012,Feb,10.3967/0895-3988.2012.01.001,0,
4982,Association of chronic obstructive pulmonary disease with cognitive decline in very elderly men,"AIM: To determine the change in cognitive function in very elderly men with chronic obstructive pulmonary disease (COPD) over a 3-year period relative to age-and education-matched controls. METHODS: In this hospital-based, prospective case-control study, we evaluated a consecutive series of 110 very elderly men with COPD and 110 control subjects who were hospitalized between January and December 2007. All the subjects performed cognitive tests at baseline and underwent annual evaluations (for 3 years), which included the Mini-Mental State Examination, word list recall, delayed recall, animal category fluency, and the symbol digit modalities test. RESULTS: In mixed-effects models adjusted for hypertension and coronary heart disease, COPD was associated with a more rapid rate of cognitive decline based on the Mini-Mental State Examination, word list recall, delayed recall, animal category fluency, and the symbol digit modalities test (all p < 0.01) compared to controls. CONCLUSION: COPD is associated with a more rapid rate of cognitive decline in very elderly persons.",Chronic obstructive pulmonary disease;Cognitive decline;Dementia;Very elderly men,"Zhou, G.;Liu, J.;Sun, F.;Xin, X.;Duan, L.;Zhu, X.;Shi, Z.",2012,Jan,10.1159/000338378,0,
4983,Type of symptomatology of cognitive impairment in patients with acute ischemic stroke,"Objective To investigate the type of symptomatology of cognitive impairment in patients with acute ischemic stroke. Methods A total of 208 consecutive patients with acute ischemic stroke admitted to the Department of Neurology, the First Affiliated Hospital of Zhejiang University (ra = 155) and the Department of Neurology, Jiaxing Second Hospital (n =53) from November 2013 to November 2014 were collected prospectively. The cognitive function was assessed by the Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and Clinical Dementia Rating Scale (CDRS). Cognitive impairment was diagnosed according to the diagnostic criteria of vascular dementia and vascular mild cognitive impairment from National Institute for Neurological Disorders and Stroke and Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) and the American Heart Association/American Stroke Association (AHA/ASA). Mean while,on the basis of score weight of each cognitive domain on the ADAS-cog, the symptom typing was conduced. The baseline characteristics, imaging, and neurological deficits of each type were compared. Results The patients with acute ischemic stroke were divided into 5 types according the characteristics of cognitive impairment:normal type 61 patients (29.3%). memory impairment predominated type 10 (4.8%) .language impairment predominated type 35 (16. 8%) .operating impairment predominated type 14 (6. 7%). and complex type 88 (42. 3%). There were significant differences in age.years of education, and sex of patients in each type (all P < 0. 05) .while there were no significant differences among the histories of diabetes. hypertension, hyperlipidemia and stroke (all P >0. 05). There were no significant differences in the imaging infarct location and the number of infarction in each type (all P >0. 05). There were no significant differences in the comparison of the modified Ranking scale (MRS) scores and the National Institute of Health Stroke Scale (NIHSS) scores on admission in each type (all P >0.05). Conclusions Most of the patients with acute ischemic stroke have cognitive impairment. According to the symptomatology, vascular cognitive impairment can be divided into 5 types. This typing reflects the heterogeneity of vascular cognitive impairment; however, there are no significant differences in imaging and neurological deficit performance in each type.",Alzheimer's Disease Assessment Scale cognitive subscale;article;brain ischemia;cerebrovascular accident;Clinical Dementia Rating;cognition;cognitive defect;dementia assessment;diabetes mellitus;human;hyperlipidemia;hypertension;language disability;major clinical study;medical society;memory disorder;Mini Mental State Examination;multiinfarct dementia;National Institutes of Health Stroke Scale;neuroimaging;symptomatology,"Zhou, P.;Yuan, H.;Ji, R.;Ruan, J.;Wei, G.;Shen, H.;Zhou, Q.;Luo, B.",2016,,,0,
4984,Association of smoking and alcohol drinking with dementia risk among elderly men in China,"Background: Previous studies relating smoking and alcohol drinking with the incidence of dementia have been inconsistent. Objectives: We assessed whether smoking and alcohol drinking was associated with the risk of dementia, including Alzheimer disease (AD) and vascular dementia (VaD) after seven years of follow-up. Design: We prospectively analysed the incidence of dementia from 2004 to 2011 among 2959 elderly men, according to their smoking and alcohol drinking status. Setting: six neighbourhoods from three districts mentioned in Chongqing city. Participants: A total of 3170 men were followed up annually for 7 years. Measurements: Cox proportional hazards models were established to evaluate the association between smoking, alcohol drinking and the risk of dementia. Results: The incidences of AD and VaD were higher respectively in current smoking than never smoking, daily drinking than never drinking over 7 years of follow-up (p<0.01). After adjusting for age and other potential confounders, current smoking was associated with increased risk of AD (HR= 2.14, 95% CI 1.20-4.46) and VaD (HR= 3.28, 95% CI 1.14-4.52), meanwhile, daily drinking was related to increased risk of AD (HR= 2.25, 95% CI 1.43-3.97) and VaD (HR= 3.42, 95% CI 1.18-4.51). In addition, co-smoking and drinking were related to with a significantly higher risk of AD and VaD than non-smoking and drinking (HR= 3.03, 95% CI 1.65-4.19) and VaD (HR= 3.96, 95% CI 1.64-4.71). Moreover, co-smoking and drinking had higher risk of AD and VaD compared with current smoking and daily drinking. Conclusions: Current smoking and daily drinking were found to be significantly associated with dementia in elderly men.",age;aged;Alzheimer disease;article;body mass;cerebrovascular accident;China;dementia;diabetes mellitus;diffuse Lewy body disease;drinking behavior;educational status;follow up;frontotemporal dementia;human;Huntington chorea;hypercholesterolemia;hypertension;ischemic heart disease;major clinical study;male;multiinfarct dementia;Parkinson disease;priority journal;prospective study;smoking,"Zhou, S.;Zhou, R.;Zhong, T.;Li, R.;Tan, J.;Zhou, H.",2014,,,0,
4985,Investigation in prevalences of chronic diseases in retired cadres in Chongming county of Shanghai,"Objective To investigate the prevalences of 9 common chronic diseases in retired cadres in Chongming County of Shanghai. Methods General epidemiological investigation was conducted in all retired cadres (re =268) living in Chongming County of Shanghai, and all data were collected from the cadre clinic, physical examination center and ward of cadres of Chongming Branch of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine and on-site investigation. The diagnostic standard of classification of diseases referred to the standards of International Classification of Diseases ICD-10. Two hundred and forty-nine people were investigated actually, and the response rate was 92. 9%. The prevalences of chronic diseases and distribution of diseases in retired cadres were retrospectively analysed. Results The prevalences of chronic diseases were 98. 39% (245/249), and the prevalences of coronary heart disease, hypertension, stroke, chronic obstructive pulmonary disease, gastritis and gastric ulcer, diabetes mellitus, chronic kidney disease, dementia and malignant tumors were 73. 1%, 72.3%, 35.7%, 34.5%, 33.7%, 28. 1%, 20.5%, 14.5% and 14.1%, respectively. The prevalence of having 3 diseases in the same cadre was 83. 5%, that of having 7 diseases in the same cadre was 9. 1%, and that of tumor was 14. 1%. Conclusion Cardiovascular and cerebrovascular diseases dominate the disease spectrum of retired cadres. Various diseases may seize the same retired cadres at the same time, which is the most important epidemiological characteristics. The prevalence of tumors is higher in old people. Appropriate preventive measures should be taken, and proper treatment should be performed in the cadres.",article;China;chronic disease;chronic kidney disease;chronic obstructive lung disease;dementia;diabetes mellitus;disease classification;gastritis;human;hypertension;ischemic heart disease;major clinical study;malignant neoplastic disease;physical examination;prevalence;stomach ulcer;cerebrovascular accident;ward,"Zhou, X. L.;Liang, H.",2011,,,0,
4986,Berberine chloride can ameliorate the spatial memory impairment and increase the expression of interleukin-1beta and inducible nitric oxide synthase in the rat model of Alzheimer's disease,"BACKGROUND: Berberine is the major alkaloidal component of Rhizoma coptidis, and has multiple pharmacological effects including inhibiting acetylcholinesterase, reducing cholesterol and glucose, lowering mortality in patients with chronic congestive heart failure and anti-inflammation etc. Thus berberine is a promising drug for diabetes, hyperlipemia, coronary artery disease and ischemic stroke etc. The present study was carried out to investigate the effect of berberine chloride on the spatial memory, inflammation factors interleukin-1 beta (IL-1beta) and inducible nitric oxide synthase (iNOS) expression in the rat model of Alzheimer's disease (AD) which was established by injecting Abeta (1-40) (5 microgram) into the rats hippocampuses bilaterally. RESULTS: The rats were given berberine chloride (50 mg/kg) by intragastric administration once daily for 14 days. The spatial memory was assayed by Morris water maze test, IL-1beta and iNOS in the hippocampus were assayed by immunohistochemistry and real time polymerase chain reaction (PCR). Intragastric administration of berberine significantly ameliorated the spatial memory impairment and increased the expression of IL-1beta, iNOS in the rat model of AD. CONCLUSION: Berberine might be beneficial to AD by intragastric administration though it might exaggerate the inflammation reaction.","Alzheimer Disease/complications/*drug therapy/*metabolism;Animals;*Disease Models, Animal;Dose-Response Relationship, Drug;Gene Expression/drug effects;Interleukin-1beta/*metabolism;Male;Memory Disorders/etiology/*metabolism/*prevention & control;Nitric Oxide Synthase Type II/*metabolism;Rats;Rats, Sprague-Dawley;Treatment Outcome","Zhu, F.;Qian, C.",2006,Dec 01,10.1186/1471-2202-7-78,0,
4987,Lack of genetic association of cholesteryl ester transfer protein polymorphisms with late onset Alzheimers disease,"Dysregulation of cholesterol homeostasis may be associated with the pathogenesis of coronary artery disease (CAD) and Alzheimers disease (AD). Recently, several single nucleotide polymorphisms (SNPs) in cholesteryl ester transfer protein (CETP) were associated with altered plasma CETP concentrations, cholesterol concentrations and CAD. Hence, these CETP SNPs represent excellent candidates for evaluating association with AD. To date, one study has evaluated the association between a single CETP SNP and AD. In this study, we examined three CETP SNPs to evaluate the genetic association of CETP with late onset AD on two study cohorts: the Religious Orders Study (ROS) series, including 85 AD and 70 non-AD individuals, and the University of Kentucky (UKY) series, including 78 AD and 84 non-AD individuals. Significant association between CETP genotypes or haplotypes and late onset AD was not detected in these two study cohorts. Moreover, the CETP genotypes and haplotypes were not significantly associated with AD when the populations were stratified for the presence or absence of apolipoprotein E4 (apoE4). In summary, CETP genetic variants were not associated with AD in two series.","Aged;Aged, 80 and over;Alzheimer Disease/*enzymology/genetics/*metabolism;Carrier Proteins/*genetics;Cholesterol Ester Transfer Proteins;Cohort Studies;DNA Mutational Analysis/methods;Female;Genetic Predisposition to Disease/*epidemiology;Genetic Testing/*methods;Glycoproteins/*genetics;Humans;Incidence;Kentucky/epidemiology;Male;*Polymorphism, Genetic;Risk Assessment/*methods;Risk Factors;Statistics as Topic","Zhu, H.;Gopalraj, R. K.;Kelly, J. F.;Bennett, D. A.;Estus, S.",2005,Jun 10-17,10.1016/j.neulet.2005.01.078,0,
4988,Lack of association of hepatic lipase polymorphisms with late-onset Alzheimer's disease,"Several polymorphisms in hepatic lipase (LIPC) are similar to apoE4 because they associate with cholesterol concentrations and, for rs6084, coronary artery disease (CAD). Since apoE4 is also a primary genetic risk factor for late-onset Alzheimer's disease (LOAD), LIPC single nucleotide polymorphisms (SNP)s represent excellent candidates for LOAD association studies. Because this issue has not been addressed previously, we evaluated LIPC SNP association with LOAD. In a population from the Religious Orders Study (ROS), rs6084 was nominally associated with LOAD odds (p=0.015 by chi(2) test). However, this association was not confirmed in two subsequent series based at the University of Kentucky (UKY, p=0.15) or the Mayo Clinic in Jacksonville (MCJ, p=0.97). Hence, rs6084 is not consistently associated with LOAD.","Aged;Aged, 80 and over;Alzheimer Disease/enzymology/*epidemiology/*genetics;Female;Genetic Predisposition to Disease/epidemiology/genetics;Humans;Lipase/*genetics;Male;Polymorphism, Single Nucleotide/*genetics;Prevalence;Risk Assessment/*methods;Risk Factors;Statistics as Topic;United States/epidemiology","Zhu, H.;Taylor, J. W.;Bennett, D. A.;Younkin, S. G.;Estus, S.",2008,May,10.1016/j.neurobiolaging.2006.11.015,0,
4989,CD147: A novel modulator of inflammatory and immune disorders,"CD147, a transmembrane glycoprotein, is expressed on all leukocytes, platelets, and endothelial cells. It has been implicated in a variety of physiological and pathological activities through interacting with multiple partners, including cyclophilins, monocarboxylate transporters, Caveolin-1, and integrins. While CD147 is best known as a potent inducer of extracellular matrix metalloproteinases (hence also called EMMPRIN), it can also function as a key mediator of inflammatory and immune responses. Increased expression of CD147 has been implicated in the pathogenesis of a number of diseases, such as asthma-mediated lung inflammation, rheumatoid arthritis, multiple sclerosis, myocardial infarction and ischemic stroke. Therapeutic targeting of CD147 has yielded encouraging effects in a number of experimental models of human diseases, suggesting CD147 as an attractive target for treatment of inflammation-related diseases. Here we review the current understanding of CD147 expression and functions in inflammatory and immune responses and potential implications for treatment of inflammatory disorders. © 2014 Bentham Science Publishers.",caveolin 1;CD147 antigen;cyclophilin;integrin;monocarboxylate transporter;allergic asthma;Alzheimer disease;article;atherosclerosis;brain ischemia;CD4+ T lymphocyte;CD8+ T lymphocyte;cell differentiation;cell function;cell membrane;disease severity;endothelium cell;heart infarction;immune response;immunopathology;inflammatory disease;ischemia;leukocyte;lung injury;multiple sclerosis;neutrophil;pneumonia;protein protein interaction;rheumatoid arthritis;T lymphocyte activation;thrombocyte activation;virus hepatitis,"Zhu, X.;Song, Z.;Zhang, S.;Nanda, A.;Li, G.",2014,,,0,
4990,Effect of six-month standardized tertiary rehabilitation program on the activities of daily living in stroke patients with hemiplegia,"Background: At present, there are many studies on the rehabilitation therapy of stroke patients with hemiplegia, but there is deficiency of corresponding standardized rehabilitation program. Objective: To explore the effects of standardized tertiary rehabilitation on the activities of daily living in stroke patients with hemiplegia within 6 months after attack. Design: A clinical observation. Setting: Department of Rehabilitation Medicine, Huashan Hospital of Fudan University. Participants: Eighty-two outpatients and inpatients with acute stroke were selected from the Department of Neurology, Shanghai Huashan Hospital from January 1999 to June 2003, including 49 males and 33 females, 40 - 80 years of age, with a mean age of (65±11) years old. Inclusive criteria: According to the diagnostic standards for cerebrovascular diseases set by Fourth National Academic Meeting for Cerebrovascular Disease in 1995, the patients were diagnosed as new attack of cerebral infarction or cerebral hemorrhage, and confirmed by CT or MRI to be initial patients; They should be accorded with the following conditions, including within 1 week after stabilization of life signs, Glasgow coma score > 8 points, 40 - 80 years of age, with disturbance of limb function. Informed consents were obtained from all the patients or their relatives. Exclusive criteria: Patients were excluded due to active liver disease, liver and kidney malfunction, congestive heart failure, malignant tumor, history of dementia, failure in respiratory function, tetraplegia; cerebral infarction or cerebral hemorrhage for more than 3 weeks; unable to be followed up due to in other cities and provinces; psychiatric history; deafness and muteness. According to the will of the patients or their relatives, the patients who accepted the standardized rehabilitation program were enrolled as the treatment group (n =42), and the others as the control group (n =40). Approval was obtained from the ethical committee of the hospital. Methods: All the patients were given routine therapies of internal medicine after admission. According to the conditions of Brunnstom recovery 6-phase evaluation, the patients in the treatment group were trained with the pre-designed comprehensive standardized rehabilitation program for corresponding period. At early period (within about 1 month after attack), the patients received rehabilitative interventions in the Department of Emergency or Department of Neurology, once a day, 45 minutes for each time, 5 times a week; At middle period (about 1 - 3 months after attack), the patients received rehabilitative interventions in the rehabilitation ward or center, once to twice a day, 30 - 45 minutes for each time, 4 - 5 days a week; At late period (about 3 - 6 months after attack), the patients received rehabilitative intervention mainly assisted by rehabilitation physician in the community, relatives and volunteers, 3 - 4 times a week, and they were followed in the house or outpatient department once every two weeks. Main outcome measures: The patients were evaluated blindly by the same rehabilitation physician using scale of modified Barthel index at admission and 1, 3 and 6 months after attack respectively. Results: Totally 82 patients with acute stroke were enrolled, and 3 cases in the treatment group missed, including 2 cases died at 1 month after admission, and 1 case refused the follow up 10 days later, all the others were involved in the analysis of results. The scores of modified Barthel index at corresponding time points after admission in the treatment group were all obviously higher than those in the control group (P < 0.01), and the score differences were also obviously higher than those in the control group (P < 0.01). The activities of daily living at admission and 1, 3 and 6 months after admission in the treatment group were 22.50%, 46.43%, 75.95% and 89.52% of that of normal people respectively, and those in the control group were 17.09%, 25.77%, 43.38% and 55.00% respectively. The activities of daily living at admission and 1, 3 and 6 month in the treatment group were 131.66%, 180.17%, 175.08% and 162.76% of those in the control group. As compared with at admission, the percentage of the score difference to the total score at the ends of the 1st, 3rd and 6th months were 23.93%, 53.45% and 67.02% in the treatment group, while 8.67%, 25.36% and 36.98% in the control group. Conclusion: Standardized tertiary rehabilitation can obviously promote the activities of daily living in stroke patients with hemiplegia.",adult;aged;article;Barthel index;brain hemorrhage;brain infarction;cerebrovascular disease;clinical observation;computer assisted tomography;controlled study;daily life activity;disease duration;female;functional disease;Glasgow coma scale;hemiplegia;hospital patient;human;informed consent;major clinical study;male;nuclear magnetic resonance imaging;occupational therapy;outpatient;physiotherapy;rehabilitation care;stroke patient;treatment outcome,"Zhu, Y.;Hu, Y.;Wu, Y.;Jiang, C.;Fan, W.;Sun, L.;Xie, Z.;Shen, L.;Zhu, B.;Bai, Y.",2007,,,0,
4991,"Severity of dilated virchow-robin spaces is associated with age, blood pressure, and MRI markers of small vessel disease: A population-based study","Background and Purpose: Little is known about the risk factors of dilated Virchow-Robin spaces (dVRS) and their relation with other markers of brain small vessel disease. We investigated both issues in a large population-based sample of elderly individuals. Methods: Severity of dVRS was semiquantitatively graded in both white matter and basal ganglia using high-resolution 3-dimensional MRI images taken from 1818 stroke-and dementia-free subjects enrolled in the Three-City Dijon MRI study. Multinomial logistic regression models were used to model the association of cardiovascular risk factors, APOE genotype, brain atrophy, and MRI markers of small vessel disease with the degree of dVRS. Results: Severity of dVRS was found to be strongly associated with age in both basal ganglia (degree 4 versus 1: OR, 2.1; 95% CI, 1.4 to 3.2) and white matter (OR, 1.5; 95% CI, 1.2 to 1.9). The proportion of hypertensive subjects increased with the degrees of dVRS in both basal ganglia (P=0.02) and white matter (P=0.048). Men presented a higher risk of severe dVRS in basal ganglia than women, particularly degree 4 (OR, 6.0; 95% CI, 1.8 to 19.8). The degree of dVRS was associated with the volume of white matter hyperintensities and the prevalence of lacunes, but not with brain atrophy. CONCLUSION-: In this large cohort study of elderly subjects, the degree of dVRS appears independently associated with age, hypertension, volume of white matter hyperintensities, and lacunar infarctions. dVRS should be considered as another MRI marker of cerebral small vessel disease in the elderly with regional variations in their severity. © 2010 American Heart Association, Inc.",apolipoprotein E4;age;aged;article;basal ganglion;blood pressure;brain atrophy;brain infarction;cardiovascular risk;cerebrospinal fluid analysis;cerebrovascular disease;cohort analysis;controlled study;dilated Virchow Robin space;disease association;disease marker;disease severity;elderly care;female;genotype;gray matter;high risk population;human;hypertension;image analysis;major clinical study;male;microangiopathy;neuroimaging;nuclear magnetic resonance imaging;population research;priority journal;quantitative analysis;risk factor;three dimensional imaging;white matter,"Zhu, Y. C.;Tzourio, C.;Soumaré, A.;Mazoyer, B.;Dufouil, C.;Chabriat, H.",2010,,,0,
4992,Detecting the genetic link between Alzheimer's disease and obesity using bioinformatics analysis of GWAS data,"Alzheimer's disease (AD) represents the major form of dementia in the elderly. In recent years, accumulating evidence indicate that obesity may act as a risk factor for AD, while the genetic link between the two conditions remains unclear. This bioinformatics analysis aimed to detect the genetic link between AD and obesity on single nucleotide polymorphisms (SNPs), gene, and pathway levels based on genome-wide association studies data. A total of 31 SNPs were found to be shared by AD and obesity, which were linked to 7 genes. These genes included PSMC3, CELF1, MYBPC3, SPI1, APOE, MTCH2 and RAPSN. Further functional enrichment analysis of these genes revealed the following biological pathways, including proteasome, osteoclast differentiation, hypertrophic cardiomyopathy, dilated cardiomyopathy, Epstein-Barr virus and TLV-I infection, as well as several cancer associated pathways, to be common among AD and obesity. The findings deepened our understanding on the genetic basis linking obesity and AD and may help shape possible prevention and treatment strategies.",Alzheimer's disease;Gerotarget;bioinformatics;genome-wide association studies;obesity;single nucleotide polymorphisms,"Zhuang, Q. S.;Zheng, H.;Gu, X. D.;Shen, L.;Ji, H. F.",2017,Aug 22,,0,
4993,"Dazed, confused, and asystolic:Possible signs of Anti–N-Methyl-D-Aspartate receptor encephalitis","Anti–N-methyl-d-aspartate (NMDA) receptor encephalitis is a rare panencephalitis that can present with severe cardiac dysrhythmias. We present a case of a 19-year-old woman with no significant medical history who presented with progressive changes in mental status and profound ictal asystole that necessitated the placement of an external temporary pacemaker. She was diagnosed with and treated for anti-NMDA receptor encephalitis, and she recovered after a prolonged and complicated hospitalization. We review the pathophysiology and management of anti-NMDA receptor encephalitis, as well as its cardiac manifestations.",etiracetam;lorazepam;n methyl dextro aspartic acid receptor;phenytoin;steroid;adult;anti n methyl d aspartate receptor encephalitis;article;case report;cerebrospinal fluid analysis;cystectomy;echography;electrocardiography;electroencephalography;epileptic state;external pacemaker;female;follow up;headache;heart arrest;heart catheterization;human;magnetic resonance angiography;memory disorder;mental instability;nuclear magnetic resonance imaging;ovary cyst;ovary teratoma;plasmapheresis,"Ziaeian, B.;Shamsa, K.",2015,,,0,
4994,"Following positive epidemiologic studies, statins to enter clinical trials for cancer prevention",,atorvastatin;cholesterol;hydroxymethylglutaryl coenzyme A reductase;hydroxymethylglutaryl coenzyme A reductase inhibitor;inulin;mevalonic acid;mevinolin;placebo;Ras protein;Rho factor;sulindac;Alzheimer disease;antiinflammatory activity;breast cancer;cancer research;cancer risk;cholesterol synthesis;clinical trial;colorectal cancer;drug effect;drug mechanism;dyslipidemia;enzyme inhibition;epidemiological data;esophagus cancer;human;ischemic heart disease;lung cancer;malignant neoplastic disease;medical literature;medical society;melanoma;methodology;multiple sclerosis;nevus;note;pancreas cancer;patient selection;prenylation;prescription;priority journal;prostate cancer;protein synthesis;risk reduction;sample size;treatment outcome;clinoril;lipitor;mevacor,"Zielinski, S. L.",2005,,,0,
4995,Relation between certain diseases and frequency of depression in geriatric patients,"The higher prevalence of depression in specific diseases and older persons is discussed. This prevalence varies greatly according to the method used to collect data. A risk group can only be defined if information on diseases and other influencing factors are collected uniformly. The target diagnoses Parkinson's disease, stroke, myocardial infarction, cancer, diabetes mellitus, chronic pain, multiple infarct syndrome, Alzheimer's and other dementia were recorded from 1208 geriatric patients of the ZAGF municipal hospital in Munich, Germany. Logistic regression was used to identify chronic pain as the main cofactor for an association with depression (clinical diagnoses by ICD-10) and depressive symptoms (via GDS [Geriatric Depression Scale]). This association was also found for multimorbid patients with chronic pain. Impairment of the activities of daily living and the clinical setting were important additional cofactors. Pain patients are therefore at higher risk for depression. © 2007 Springer Medizin Verlag.",Alzheimer disease;article;neoplasm;chronic pain;daily life activity;data analysis;depression;diabetes mellitus;disease association;Geriatric Depression Scale;Germany;heart infarction;human;information processing;International Classification of Diseases;logistic regression analysis;major clinical study;Mini Mental State Examination;morbidity;Parkinson disease;rating scale;cerebrovascular accident,"Zietemann, V.;Zietemann, P.;Weitkunat, R.;Kwetkat, A.",2007,,,0,
4996,Economics at the end of life: Hospital and ICU perspectives,"Not all feasible care is desirable care. At the end of life, aggressive interventions may not only be futile but also inappropriate because they may impair the quality of the remaining life for both the patient and the caregiver. Although it is challenging to identify patients with a poor prognosis, certain terminal conditions among the elderly, such as end-stage dementia, heart failure, and metastatic cancer, demand a more measured use of aggressive care. Frank discussions with patients and family about their desires in the context of the prognosis, as well as symptom support, can yield both economic savings and better quality of life. © 2012 by Thieme Medical Publishers, Inc.",article;artificial ventilation;dementia;health care cost;health care utilization;health economics;heart failure;hospital care;hospital running cost;hospitalization;human;intensive care;length of stay;medicare;metastasis;priority journal;prognosis;quality of life;terminal care,"Zilberberg, M. D.;Shorr, A. F.",2012,,,0,
4997,Plasma lipids and lipoproteins and the incidence of cardiovascular disease in the very elderly. The Bronx Aging Study,"The Bronx Aging Study is a 10-year prospective investigation of very elderly volunteers (mean age at study entry, 79 years; range, 75-85 years) designed to assess risk factors for dementia and coronary and cerebrovascular (stroke) diseases. Entry criteria included the absence of terminal illness and dementia. All subjects (n = 350) included in this report had at least two lipid and lipoprotein determinations. Overall, more than one third of subjects showed at least a 10% change in lipid and lipoprotein levels between the initial and final measurements. Moreover, mean levels for women were consistently different than those for men, and because of this finding subjects were classified into potential-risk categories based on the changes observed by using their sex-specific lipid and lipoprotein distributions. The incidences of cardiovascular disease, dementia, and death were compared between risk groups. Proportional-hazards analysis showed that in men a consistently low high density lipoprotein cholesterol level (less than or equal to 30 mg/dl) was independently associated with the development of myocardial infarction (p = 0.006), cardiovascular disease (p = 0.002), or death (p = 0.002). For women, however, a consistently elevated low density lipoprotein cholesterol level (greater than or equal to 171 mg/dl) was associated with myocardial infarction (p = 0.032). Thus, low high density lipoprotein cholesterol remains a powerful predictor of coronary heart disease risk for men even into old age, while elevated low density lipoprotein cholesterol continues to play a role in the development of myocardial infarction in women. The findings suggest that an unfavorable lipoprotein profile increases the risk of cardiovascular morbidity and mortality even at advanced ages for both men and women.","Aged;Aged, 80 and over;*Aging;Cardiovascular Diseases/blood/*epidemiology;Cholesterol, HDL/blood;Cholesterol, LDL/blood;Dementia/blood;Female;Humans;Lipids/*blood;Lipoproteins/*blood;Male;New York City;Prospective Studies;Risk Factors","Zimetbaum, P.;Frishman, W. H.;Ooi, W. L.;Derman, M. P.;Aronson, M.;Gidez, L. I.;Eder, H. A.",1992,Apr,,0,
4998,Challenges in improving prognosis and therapy: The ongoing telmisartan alone and in combination with ramipril global end point trial programme,"Hypertension is one of the most important modifiable risk factors for cardiovascular pathology, such as atherosclerosis and cardiac left ventricular hypertrophy, including acute events such as stroke and myocardial infarction (MI). In particular, the risk of ischaemic and haemorrhagic stroke is directly and continuously related to high blood pressure levels. The renin-angiotensin system (RAS) plays an important role in volume homeostasis and blood pressure regulation. It also helps to prevent cell and organ damage from ischaemia during acute volume loss. However, angiotensin-II (A-II) - the main effector peptide of the RAS - also exerts a number of pathological effects, which are mediated by the AT1 receptor. The Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial (ONTARGET) programme consists of two parallel trials where ONTARGET as a large, long-term study compares the efficacy of the angiotensin-receptor antagonist, telmisartan, the renin-angiotensin-converting enzyme (ACE) inhibitor, ramipril and combination therapy with telmisartan plus ramipril for reducing cardiovascular and cerebral risk. Telmisartan, due to its long duration of action, compares favourably with other angiotensin-receptor antagonists. In the Heart Outcomes Prevention Evaluation (HOPE) study, ramipril was shown to reduce the risk for MI and other cardiovascular events in patients at high risk for pathological cardiac events, but without heart failure or a low ejection fraction. The cardiovascular outcomes of high-risk patients using the same criteria as those of the HOPE study will be assessed in both trials. TRANSCEND differs from ONTARGET in that this trial will enrol patients who do not tolerate ACE inhibitors. This parallel study will therefore be able to compare telmisartan and placebo treatment. Both ONTARGET and TRANSCEND trials feature the same primary composite end point: death caused by cardiovascular disease, acute MI, stroke and hospitalisation because of congestive heart failure. The secondary end points will focus on reductions in the development of Type 2 diabetes mellitus, nephropathy, cognitive decrease and dementia as well as atrial fibrillation. 2004 © Ashley Publications Ltd.",acetylsalicylic acid;aldosterone;amlodipine;angiotensin;angiotensin 1 receptor;angiotensin 1 receptor antagonist;antilipemic agent;atenolol;candesartan;captopril;dipeptidyl carboxypeptidase inhibitor;enalapril;losartan;placebo;ramipril;renin;telmisartan;valsartan;acute heart infarction;article;atherosclerosis;bleeding disorder;blood pressure regulation;blood volume;cardiovascular disease;cardiovascular risk;cell damage;cerebrovascular disease;clinical trial;cognitive defect;congestive heart failure;dementia;dose response;drug dose regimen;drug efficacy;drug elimination;drug half life;drug mechanism;drug megadose;drug tolerability;atrial fibrillation;heart ejection fraction;heart failure;heart infarction;heart left ventricle hypertrophy;heart muscle ischemia;high risk patient;homeostasis;hospitalization;human;hypertension;kidney disease;long term care;mortality;non insulin dependent diabetes mellitus;parallel design;pathophysiology;prognosis;renin angiotensin aldosterone system;risk factor;risk reduction;side effect;cerebrovascular accident;treatment outcome;aspirin,"Zimmerman, M.;Unger, T.",2004,,,0,
4999,Challenges in improving prognosis and therapy: the Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial programme,"Hypertension is one of the most important modifiable risk factors for cardiovascular pathology, such as atherosclerosis and cardiac left ventricular hypertrophy, including acute events such as stroke and myocardial infarction (MI). In particular, the risk of ischaemic and haemorrhagic stroke is directly and continuously related to high blood pressure levels. The renin-angiotensin system (RAS) plays an important role in volume homeostasis and blood pressure regulation. It also helps to prevent cell and organ damage from ischaemia during acute volume loss. However, angiotensin-II (A-II)--the main effector peptide of the RAS--also exerts a number of pathological effects, which are mediated by the AT 1 receptor. The Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial (ONTARGET) programme consists of two parallel trials where ONTARGET as a large, long-term study compares the efficacy of the angiotensin-receptor antagonist, telmisartan, the renin-angiotensin-converting enzyme (ACE) inhibitor, ramipril and combination therapy with telmisartan plus ramipril for reducing cardiovascular and cerebral risk. Telmisartan, due to its long duration of action, compares favourably with other angiotensin-receptor antagonists. In the Heart Outcomes Prevention Evaluation (HOPE) study, ramipril was shown to reduce the risk for MI and other cardiovascular events in patients at high risk for pathological cardiac events, but without heart failure or a low ejection fraction. The cardiovascular outcomes of high-risk patients using the same criteria as those of the HOPE study will be assessed in both trials. TRANSCEND differs from ONTARGET in that this trial will enrol patients who do not tolerate ACE inhibitors. This parallel study will therefore be able to compare telmisartan and placebo treatment. Both ONTARGET and TRANSCEND trials feature the same primary composite end point: death caused by cardiovascular disease, acute MI, stroke and hospitalisation because of congestive heart failure. The secondary end points will focus on reductions in the development of Type 2 diabetes mellitus, nephropathy, cognitive decrease and dementia as well as atrial fibrillation.","Angiotensin II [adverse effects] [metabolism];Angiotensin II Type 1 Receptor Blockers;Benzimidazoles [pharmacology] [therapeutic use];Benzoates [pharmacology] [therapeutic use];Clinical Trials as Topic [methods];Diabetes Mellitus, Type 2 [complications] [prevention & control];Drug Therapy, Combination;Germany;Heart Diseases [drug therapy] [mortality] [prevention & control];Hypertension [complications] [drug therapy];Prognosis;Ramipril [pharmacology] [therapeutic use];Receptor, Angiotensin, Type 1 [drug effects] [therapeutic use];Renin-Angiotensin System [physiology];Risk Reduction Behavior;Treatment Outcome;Humans[checkword];Sr-endoc","Zimmermann, M;Unger, T",2004,,10.1517/14656566.5.5.1201,0,
5000,Reliability of morbidity data reported by GPs. Results of a longitudinal study in primary care,"Data on prevalence of chronic diseases are important for planning health care services. Such prevalence data are mostly based on patient self-reports, claims data, or other research data-with limited validity and reliability partially due to their cross-sectional character. Currently, only claims data of statutory health insurance offer longitudinal information. In Germany, these data show a loss of diagnoses of chronic health conditions over time. This study investigated whether there is a similar tendency of loss in the documentation of chronic diseases in data specifically collected for a longitudinal cohort study by general practitioners. In addition, the explanatory power of patient or GP characteristics regarding these losses is investigated. A total of 3,327 patients aged 75 years and older were recruited for the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). For 1,765 patients, GP diagnoses of four chronic conditions at three time points were available for a total period of 4.5 years. In order to explain the loss of chronic diagnoses, a multilevel mixed-effects logistic regression was performed. Over the course of 4.5 years, 18.6% of the diagnoses of diabetes mellitus, 34.5% of the diagnoses of coronary heart disease, and 44.9% of the diagnoses of stroke disappeared in the GP documentation for the longitudinal study. The diagnosis of coronary heart disease was less often lost in men than in women. The risk of losing the diagnosis of diabetes was higher in patients who were well known by the GP for a long time. An essential part of the variance of the losses can be explained by practice (owner) effects. Data on morbidity collected in epidemiological studies and reported by physicians should always be checked for validity and reliability. Appropriate options (e.g., an investigator collecting the data directly in the field or the comparison of the data with health insurance companies' claims data) are presented and discussed.",aged;article;chronic disease;documentation;female;general practitioner;Germany;human;longitudinal study;male;prevalence;primary health care;reproducibility;sensitivity and specificity;statistics,"Zimmermann, T.;Kaduszkiewicz, H.;vd Bussche, H.;Schön, G.;Wegscheider, K.;Werle, J.;Weyerer, S.;Wiese, B.;Olbrich, J.;Weeg, D.;Riedel-Heller, S.;Luppa, M.;Jessen, F.;Abholz, H. H.;Maier, W.;Pentzek, M.",2012,,,0,
5001,Measuring the quality of care provided to dually enrolled medicare and medicaid beneficiaries living in nursing homes,"Objectives: To adapt the Assessing Care of Vulnerable Elders project nursing home (NH) specific quality indicators (QIs), for use with routinely collected data, and to evaluate which clinical conditions and types of care were inadequately measured using these data sources. Design: Retrospective cohort study. Setting: Nursing homes. Participants: NH residents 66 years of age and older dually enrolled in Medicare and Medicaid in 19 California counties between 1999 and 2000. Measurements: Identification of care inaccessible to measurement by Medicare and Medicaid claims linked to the Minimum Data Set (MDS). Assessment of care provided for measurable QIs by condition (eg, heart failure) and by intervention type (eg, medication use). Results: Only 50 of 283 QIs were captured using linked claims data. The 21,657 patients triggered 152,376 QIs (7.0 QIs/person). The overall QI pass rate (receipt of recommended care) for eligible participants was 76%. In this sample, QIs with the highest pass rates measured avoidance of adverse medications and appropriate medication use. Fewer than half of the QIs were passed for ischemic heart disease, stroke, and osteoporosis. The MDS permitted assessment of 8 QIs that focus on geriatric care. No measured QIs assessed history taking or nursing care. Conclusions: The use of claims data linked to MDS to measure the quality of care process measures is feasible for NH populations, but would be more valuable if additional data elements focused on geriatric and residential care. QIs that could be applied to patients in this study suggested areas of care needing improvement. © 2009 by Lippincott Williams & Wilkins.",aged;anamnesis;article;cohort analysis;decubitus;dementia;depression;diabetes mellitus;female;geographic distribution;geriatric care;health care quality;health insurance;hearing impairment;atrial fibrillation;heart failure;human;hypertension;influenza;ischemic heart disease;major clinical study;male;malnutrition;medicaid;medicare;nursing home;osteoarthritis;osteoporosis;patient care;pneumonia;residential care;retrospective study;sample size;cerebrovascular accident;total quality management;United States;urine incontinence;visual impairment,"Zingmond, D. S.;Saliba, D.;Wilber, K. H.;MacLean, C. H.;Wenger, N. S.",2009,,,0,
5002,Percutaneous endoscopic gastrostomy (PEG) in critically ill patients performed at bed in Intensive Care Unit: Report of our experience,"Background and Aim. Patients with severe brain injures and severe neurological diseases frequently require prolonged nutritional support during their hospitalization as well as during their rehabilitation period. Since 1980, the percutaneous endoscopic gastrostomy (PEG) has become the method of choice for long term feeding. The aim of the present study was to present our experience concerning the placement of PEG in critically ill patients, recovered in Intensive Care Unit (ICU). Materials and Methods. From 3-05-2001 to 28-09-2005, 36 patients (13 female, 23 male) with a median age of 63 years [range: 18-86 years], recovered in ICU of the Sandro Pertini Hospital, underwent PEG. These patients were retrospectively evaluated in terms of complications, indications to the procedures, durability of gastrostomy and mortality. Intravenous antibiotic prophylaxis was administered 1 h before the procedure (ceftriaxone 2gr). The entire PEG was placed in ICU at patient's bed, with the assistance of the anaesthetist. Propofol was used e.v. for sedation and fentanest for analgesia while lidocaine was used for local anesthesia. A 16-Fr or 20-Fr tube was inserted by the ""pull method"", after a complete upper gastroduodenoscopy. Results. PEG was performed mainly for neurological disorders including cerebrovascular accidents (13), SLA (8), post-traumatic coma (7), post-cardiac arrest coma (7) and dementia (1). Procedure related -mortality was 0%. The tube was changed in 4 patients due to clogging. The durability of the tube was a median of 2 months (range: 1-12 months). In 23 patients the placement of the PEG was definitive. Conclusions. Our experience underlines that PEG, in selected critically ill patients, is a safe technique easy to perform even in ICU.",ceftriaxone;propofol;adult;aged;amyotrophic lateral sclerosis;anesthesist;antibiotic prophylaxis;antibiotic therapy;article;bacterial infection;cerebrovascular accident;clinical article;clinical evaluation;colon perforation;coma;convalescence;critically ill patient;dementia;duodenoscopy;female;gastrointestinal hemorrhage;gastroscopy;gastrostomy;heart arrest;human;inflammation;intensive care unit;local anesthesia;male;mortality;necrotizing fasciitis;percutaneous endoscopic gastrostomy;pneumoperitoneum;retrospective study;stomach tube;wound infection,"Zippi, M.;Fiorani, S.;De Felici, I.;Febbraro, I.;Mattei, E.;Traversa, G.;Barbaro, F.;Scafetti, S.;Occhigrossi, G.",2009,,,0,
5003,Specific effects of anti-hypertensive treatment in an older patient with dementia,"Dementia is one of the most common health problems in the world. Alzheimer’s disease (AD) is the most common form of dementia. The presence of vascular risk factors such as hypertension (HT) may increase the risk of AD [1,2]. The relation between blood pressure (BP) and dementia has been the subject of numerous epidemiological studies, midlife HT is a risk factor for dementia and AD [3-7] but the association between HT and risk of dementia is lower in the older population [8]. A fair modulation of an antihypertensive treatment, based on the cognitive status of the elderly, can avoid multiple complications. A case of an older for whom cognitive improvement and reduced risk of falls were noticed after mild blood pressure elevation is reported.",acetylsalicylic acid;alendronic acid plus colecalciferol;antihypertensive agent;bisoprolol;ezetimibe;fentanyl;nicorandil;olmesartan;aged;arterial pressure;article;blood pressure monitoring;brain atrophy;case report;Charlson Comorbidity Index;Clinical Dementia Rating;clock drawing test;cognitive defect;confusion;dementia;drug dose reduction;drug withdrawal;DSM-IV;dyslipidemia;episodic memory;extrapyramidal symptom;falling;female;Geriatric Depression Scale;hearing impairment;human;hypertension;insomnia;ischemic heart disease;leukoencephalopathy;memory disorder;mental disease assessment;Mini Mental State Examination;neuropsychological test;nuclear magnetic resonance imaging;priority journal;quality of life;Rey Osterrieth complex figure test;thromboembolism;trail making test;very elderly,"Zmudka, J. A.;Sérot, J. M.;Dao, S.;Sorel, C.;Macaret, A. S.;Balédent, O.",2017,,10.2174/1874205x01711010015,0,
5004,Vascular risk factors and mild cognitive impairment in the elderly population in southwest China,"Objectives: Increasing evidence has demonstrated that vascular risk factors (VRFs) contribute to cognitive impairment in the elderly population. Prevention and administration of VRFs can be a vital strategy for delaying cognitive impairment. This study aimed to determine the impact of VRFs on cognitive function of the aged people from Chongqing, Southwest China. Methods: A total of 597 participants (≥60 years) from hospital and community population were enrolled in the cross-sectional study. Participants were screened for hypertension, coronary heart disease (CHD), and cerebrovascular disease (CVD). Blood pressure (BP) and blood lipid were also measured. Cognitive function was assessed with Mini-Mental State Examination and Clinical Dementia Rating. Logistic regression analysis was used to look for VRFs impacting mild cognitive impairment (MCI). Then we investigated the relationship between different types of vascular diseases and MCI. Results: A total of 457 participants showed normal cognitive function and 140 participants showed MCI. After adjusting for age, gender, and education, logistic regression analysis demonstrated that hypertension, CHD, systolic BP, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were independently associated with MCI; however, CVD, diastolic BP, triglyceride, and high-density lipoprotein cholesterol were not associated with MCI. Moreover, vascular diseases significantly contributed to MCI compared with no vascular disease; however, no significant difference in incident MCI was found among different combinations of vascular diseases. Conclusions: Hypertension, CHD, TC, and LDL-C are independent risk factors for MCI. Moreover, patients with vascular diseases have a higher risk of MCI; however, the amount of vascular diseases does not increase the risk of MCI. © The Author(s) 2013.",high density lipoprotein cholesterol;low density lipoprotein cholesterol;triacylglycerol;adult;aged;article;blood pressure measurement;cardiovascular risk;cerebrovascular disease;China;cholesterol blood level;Clinical Dementia Rating;cognition;cross-sectional study;diastolic blood pressure;dyslipidemia;female;geriatric disorder;human;hypertension;ischemic heart disease;lipid blood level;major clinical study;male;mild cognitive impairment;Mini Mental State Examination;population research;systolic blood pressure;triacylglycerol blood level;very elderly,"Zou, Y.;Zhu, Q.;Deng, Y.;Duan, J.;Pan, L.;Tu, Q.;Dai, R.;Zhang, X.;Chu, L. W.;Lü, Y.",2014,,,0,
5005,Low blood pressure and the risk of dementia in very old individuals,,"Aged;Aged, 80 and over;Comorbidity;Dementia/*epidemiology/etiology;Follow-Up Studies;Heart Diseases/complications/*epidemiology;Heart Failure/epidemiology;Humans;Hypotension/complications/*epidemiology;Incidence;Myocardial Infarction/epidemiology","Zuccala, G.;Bernabei, R.",2004,Aug 10,,0,
5006,Low blood pressure and the risk of dementia in very old individuals 4 (multiple letters),,aged;aging;cognitive defect;dementia;diastolic blood pressure;disease association;heart disease;heart failure;human;hypotension;letter;priority journal;risk;sex difference;systolic blood pressure;systolic hypotension,"Zuccalà, G.;Bernabei, R.;Verghese, J.",2004,,,0,
5007,Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure,"OBJECTIVES: Cognitive impairment has been reported in middle aged patients with end stage heart failure. This cross sectional study assessed the prevalence and determinants of cognitive dysfunction in older patients with mild to moderate heart failure. METHODS: 57 consecutive patients (mean age 76.7 years) with chronic heart failure underwent physical examination, blood chemistry, urinalysis, chest radiography ECG, Doppler echocardiography, and the mini mental state examination (MMSE), mental deterioration battery, depression scale of the Center for Epidemiological Studies (CES-D), Katz activities of daily living, and instrumental activities of daily living 24 hours before hospital discharge. RESULTS: MMSE scores <24 were found in 53% of participants. The MMSE score was associated with left ventricular ejection fraction according to a non-linear correlation, so that cognitive performance was significantly lower in subjects with left ventricular ejection fraction < or =30%. The same pattern of correlation was evidenced between left ventricular ejection fraction and both the attention sub-item of MMSE and the Raven test score. In a multivariate linear regression model, after adjusting for age, sex, and a series of clinical data and objective tests, both age (beta=-0.30; P=0.038) and the natural log of left ventricular ejection fraction (beta=0.58; P=0.001) were associated with the MMSE score. CONCLUSION: Cognitive impairment in older patients with chronic heart failure is common, and independently associated with lower left ventricular ejection fraction. Given the overwhelming incidence and prevalence of heart failure in older populations, early detection of cognitive impairment in these subjects with prompt, intensive treatment of left ventricular systolic dysfunction may prevent or delay a remarkable proportion of dementia in advanced age.","Aged;Analysis of Variance;Cognition Disorders/diagnosis/*etiology;Female;Functional Laterality;Heart Failure/*complications;Humans;Male;Neuropsychological Tests;Severity of Illness Index;Ventricular Dysfunction, Left/*complications","Zuccala, G.;Cattel, C.;Manes-Gravina, E.;Di Niro, M. G.;Cocchi, A.;Bernabei, R.",1997,Oct,,0,
5008,Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure,"Aims: Cognitive dysfunction is a prevalent condition among patients with heart failure, and is independently associated with disability and mortality. Angiotensin-converting enzyme (ACE)-inhibitors might increase cerebral blood flow in subjects with heart failure. Our aim was to assess whether starting treatment with ACE-inhibitors might improve cognition in patients with heart failure. Methods and results: Analyses involved 12 081 subjects, 1220 of whom had a verified diagnosis of heart failure, enrolled in a multi-centre pharmaco-epidemiology survey. None of these participants received ACE-inhibitors before hospitalisation. Among participants with heart failure, cognitive performance improved in 30% of 446 participants who started ACE-inhibitors, but only in 22% of remaining patients (P = 0.001). Among participants without heart failure, cognition improved in 19% of those receiving ACE-inhibitors, and in 18% of untreated patients (P = 0.765). Use of ACE-inhibitors among patients with heart failure was associated with improving cognition (odds ratio = 1.57; 95% Cl 1.18-2.08) also in the multivariable regression modelling, independently of baseline or discharge blood pressure levels. The probability of improving cognitive performance was higher for dosages above the median values, as compared with lower doses (odds ratios = 1.90 and 1.42; P for trend = 0.001), and increased with duration of treatment (odds ratios for the lower, middle, and upper tertiles = 1.25, 1.34, and 1.59; P for trend = 0.007). Conclusion: Treatment with ACE-inhibitors might selectively improve cognitive performance in patients with heart failure. However, up-titration of these agents might be required to yield the greatest benefit.",antithrombocytic agent;beta adrenergic receptor blocking agent;calcium antagonist;captopril;digitalis;dipeptidyl carboxypeptidase inhibitor;diuretic agent;enalapril;fosinopril;lisinopril;nitrate;quinapril;ramipril;aged;article;blood pressure;brain blood flow;cognition;cognitive defect;controlled study;disability;dose response;drug effect;epidemiological data;female;health survey;heart failure;hospitalization;human;major clinical study;male;mortality;multicenter study;priority journal;regression analysis;treatment outcome,"Zuccalà, G.;Onder, G.;Marzetti, E.;Lo Monaco, M. R.;Cesari, M.;Cocchi, A.;Carbonin, P.;Bernabei, R.",2005,,,0,
5009,Hypotension and cognitive impairment: Selective association in patients with heart failure,"BACKGROUND: Arterial hypotension has been associated with increased risk of dementia in some large prospective studies; and cognitive impairment is common among elderly with left ventricular function. The authors assessed whether arterial hypotension might be associated with cognitive impairment among older subjects with heart failure. METHODS: This study involved all 13,635 patients (of whom 1,583 had heart failure) without cerebrovascular disease or AD, admitted to 81 Italian academic hospitals in 1995 and 1997. The association between blood pressure and cognitive impairment (as indicated by a Hodkinson Mental Test score < 7) according to the presence of heart failure was assessed by univariate analyses, including linear discriminant analysis. This association was also verified by multivariate analyses after stratifying for diagnosis of heart failure. RESULTS: Cognitive impairment was found in 26% of patients with heart failure and in 19% of remaining subjects (Fisher exact p < 0.0001). Blood pressure levels did not differ according to diagnosis of heart failure, but discriminant analysis indicated that systolic blood pressure levels below 130 mm Hg predicted cognitive impairment only among participants with heart failure. Among such participants, systolic blood pressure was associated with cognitive impairment in multiple logistic regression modeling (for 10 mm Hg intervals, OR = 0.78; 95% CI = 0.71 to 0.86). Again, this association was not found among participants without heart failure. CONCLUSIONS: Systolic hypotension is selectively associated with cognitive impairment in older patients with heart failure. As early treatment of cardiac low-output states can reverse cognitive dysfunction, the routine management of heart failure should include systematic assessment of cognitive performance.","Aged;Aged, 80 and over;Blood Pressure/physiology;Brain/blood supply;Brain Ischemia/diagnosis/*etiology/physiopathology;Cognition Disorders/diagnosis/*etiology/physiopathology;Dementia/diagnosis/*etiology/physiopathology;Female;Heart Failure/*complications/diagnosis/physiopathology;Humans;Hypotension/*complications/diagnosis/physiopathology;Male;Neuropsychological Tests;Risk Factors;Systole/physiology;Ventricular Dysfunction, Left/complications/diagnosis/physiopathology;Ventricular Function, Left/physiology","Zuccala, G.;Onder, G.;Pedone, C.;Carosella, L.;Pahor, M.;Bernabei, R.;Cocchi, A.",2001,Dec 11,,0,
5010,Cognitive dysfunction as a major determinant of disability in patients with heart failure: results from a multicentre survey. On behalf of the GIFA (SIGG-ONLUS) Investigators,"Cognitive dysfunction is a frequent finding among older patients with left ventricular systolic dysfunction; however, the clinical outcomes of such a finding are unknown. Also, disability is a common condition in heart failure, poorly responding to commonly used cardiovascular medications. The association between cognitive dysfunction and disability was assessed in 1583 patients with heart failure, but without cerebrovascular disease, previous stroke, or Alzheimer's disease, who were enrolled during 2 years of a multicentre pharmacoepidemiology survey. The association between groups of variables (demographics, comorbid conditions, medications, and objective tests, including the Hodkinson abbreviated mental test) and functional disability (as indicated by need for intensive assistance in at least one of Katz' activities of daily living) was first analysed using separate age and sex adjusted logistic regression models. Those variables, significant at a p<0.1 level in these models, were simultaneously entered into an age and sex adjusted summary regression model. Among 1583 patients suitable for analysis, cognitive dysfunction (as detected by abbreviated mental test score <7) was detected in 265/461 disabled patients, and in 150/1122 independent subjects (p<0.0001). According to logistic regression analysis, cognitive dysfunction was associated with disability (OR=6.49; 95% CI=4.39-9.59) after adjusting for potential confounders.Thus, cognitive dysfunction in patients with heart failure is independently associated with disability, which currently represents an overwhelming medical and financial problem to patients, caregivers, and public health services. As early recognition and treatment of low cardiac output states might reverse cognitive dysfunction, cost effective treatment for heart failure should include systematic diagnostic and therapeutic approaches to cognitive dysfunction.","Aged;Aged, 80 and over;Cognition Disorders/*physiopathology;Female;Heart Failure/*physiopathology;Humans;Male;Multicenter Studies as Topic;Regression Analysis","Zuccala, G.;Onder, G.;Pedone, C.;Cocchi, A.;Carosella, L.;Cattel, C.;Carbonin, P. U.;Bernabei, R.",2001,Jan,,0,
5011,Takotsubo Cardiomyopathy in an Elderly Woman with Alzheimer's Disease: A Rare Association. Case Report and Mini-Review of the Literature,,amino terminal pro brain natriuretic peptide;angiotensin receptor antagonist;beta adrenergic receptor blocking agent;clopidogrel;digoxin;lormetazepam;low molecular weight heparin;lysine acetylsalicylate;memantine;mineralocorticoid antagonist;torasemide;troponin I;aged;Alzheimer disease;asthenia;blood pressure measurement;case report;delirium;disease association;disorientation;diverticulosis;dyspnea;electrocardiogram;emergency ward;female;follow up;geriatric disorder;glaucoma;Graves disease;heart catheterization;heart left ventricle ejection fraction;heart rate;heart ventriculography;hospital admission;human;letter;medical history;Mini Mental State Examination;osteoporosis;oxygen saturation;oxygen therapy;permanent atrial fibrillation,"Zuin, M.;Dal Santo, P.;Picariello, C.;Conte, L.;Zuliani, G.;D'Elia, K.;Roncon, L.",2016,,,0,
5012,High interleukin-6 plasma levels are associated with functional impairment in older patients with vascular dementia,"In older individuals, inflammatory mechanisms have been linked to the pathogenesis of both dementia and functional impairment. In this cross-sectional study we have investigated the possible association between some markers of systemic inflammation and functional status, in a sample of one hundred and forty older demented patients including 60 patients with late onset Alzheimer's disease (LOAD) and 80 with vascular dementia (VD). Functional status was evaluated by Barthel Index (BI); the total score ranged from 0 (total dependency) to 20 (total autonomy). Interleukin-1beta, Tumor Necrosis Factor-alpha, Interleukin- 6, Interleukin- 8, and Transforming Grow Factor beta were quantified by ELISA. Among the cytokines evaluated, only IL-6 was correlated with the BI (r: -0.32, p < 0.001). The mean levels of IL-6 progressively decreased from I (9.50 pg/mL), to II (6.40 pg/mL), to III BI tertile (4.80 pg/mL) (p < 0.02). At multiple regression analysis, IL-6 was associated with BI in the whole sample and in VD, but not in LOAD, independent of age, gender, smoking, alcohol consumption, hypertension, diabetes, coronary heart disease, previous stroke, and mini mental state examination score. Our study suggests the existence of an independent and negative relationship between IL-6 plasma levels and functional status in older individuals with vascular dementia. This finding might contribute to explain the 'excess of disability' phenomenon described in older demented patients.","Activities of Daily Living/classification;Aged;Aged, 80 and over;Alzheimer Disease/blood/diagnosis;Biomarkers/blood;Dementia, Vascular/*blood/diagnosis;*Disability Evaluation;Female;*Geriatric Assessment;Humans;Inflammation/blood;Interleukin-1beta/blood;Interleukin-6/*blood;Interleukin-8/blood;Male;Statistics as Topic;Transforming Growth Factor beta/blood;Tumor Necrosis Factor-alpha/blood","Zuliani, G.;Guerra, G.;Ranzini, M.;Rossi, L.;Munari, M. R.;Zurlo, A.;Ble, A.;Volpato, S.;Atti, A. R.;Fellin, R.",2007,Apr,10.1002/gps.1674,0,
5013,Plasma cytokines profile in older subjects with late onset Alzheimer's disease or vascular dementia,"Some cytokines have been involved in the pathogenesis of late onset Alzheimer's disease (LOAD). A possible increase in plasma cytokines levels has been reported in LOAD and vascular dementia (VD), but the results of previous studies are conflicting. We evaluated the plasma levels of IL-6, TNF-alpha, IL-1beta, and IL-10 in four groups of older individuals: 60 patients with LOAD, 80 patients with VD, 40 subjects with cerebrovascular disease but without dementia (CDND), and 42 controls (C). By analysis of covariance (adjustment for age, gender, coronary heart disease, diabetes, hypertension, smoking, and alcohol consumption) we found that: *IL-1beta was higher in VD, LOAD, and CDND compared with controls (p<0.005). *TNF-alpha was higher in VD and LOAD compared to C (p<0.05), and in VD compared to LOAD (p<0.03). *IL-6 was higher in VD compared with LOAD (p<0.03). No differences in IL-10 values were found (Kruskal-Wallis, Asymp. Sig. 0.14). By logistic regression analysis, we demonstrated that high levels (defined as above the median) of IL-1beta and TNF-alpha, but not of IL-6, were associated with increased likelihood of having VD and LOAD compared to C, while high IL-6 levels were associated with a increased probability of having VD, compared with LOAD. Our study support the notion of a low-grade systemic inflammation in older patients with LOAD or VD, characterized by an increase in plasma IL-1beta and TNF-alpha levels. The high IL-6 levels found in VD might be not a specific finding, as it might come from several conditions including atherosclerosis and related vascular risk factors, comorbidity, and frailty.","Aged;Aged, 80 and over;Alzheimer Disease/diagnosis/*immunology/psychology;Cerebrovascular Disorders/diagnosis/immunology/psychology;Cytokines/*blood;Dementia, Vascular/diagnosis/*immunology/psychology;Female;Humans;Inflammation/diagnosis/immunology;Interleukin-10/blood;Interleukin-1beta/blood;Interleukin-6/blood;Likelihood Functions;Logistic Models;Male;Mental Status Schedule;Reference Values;Risk Factors;Tumor Necrosis Factor-alpha/metabolism","Zuliani, G.;Ranzini, M.;Guerra, G.;Rossi, L.;Munari, M. R.;Zurlo, A.;Volpato, S.;Atti, A. R.;Ble, A.;Fellin, R.",2007,Oct,10.1016/j.jpsychires.2006.02.008,0,
5014,Combined measurement of serum albumin and high-density lipoprotein cholesterol strongly predicts mortality in frail older nursing-home residents,"Background and aims: The aim of this study was to verify the hypothesis that a combined measurement of albumin and HDL-C might predict total mortality in institutionalized frail older residents. Methods: Participants were 344 older subjects (272 F, 72 M), living in the ""Istituto Riposo Anziani"" (I.R.A.), a nursing-home located in Padova, North-east Italy. Functional status, comorbidity, and clinical chemistry parameters were evaluated at entry. All-cause mortality was evaluated after 2 and 4 years. The sample was divided into 4 groups by using the 50° percentile of albumin and HDL-C as cut-off value. The mortality odds ratio (OR) was estimated by multivariate logistic regression analysis. Results: Total mortality was 36.8% after 2 years and 51.8% after four years. A trend toward an increase in mortality from group 1 to 4 was observed (p for trend: 0.01). The OR for 2 and 4 years mortality was 3.83 (95% CI 1.86-7.58) and 2.66 (95% CI 1.37-5.17), respectively, in group 4 compared with group 1, after adjustment for age, gender, number of chronic diseases, functional status, BMI, diabetes, dementia, stroke, CHD, CHF, hypertension, depression, COPD, and total cholesterol levels. Conclusions: Among frail older nursing-home residents, simple measurement of serum albumin and HDL-C levels may be useful in identifying varying degrees of frailty. © 2004, Editrice Kurtis.",albumin;high density lipoprotein cholesterol;aged;aging;albumin blood level;article;body mass;cerebrovascular accident;cholesterol blood level;chronic disease;chronic obstructive lung disease;clinical chemistry;comorbidity;congestive heart failure;dementia;depression;diabetes mellitus;female;functional assessment;geriatric care;health status;human;hypertension;ischemic heart disease;Italy;major clinical study;male;mortality;multivariate logistic regression analysis;nursing home;prediction;risk assessment;risk factor,"Zuliani, G.;Volpato, S.;Romagnoni, F.;Soattin, L.;Bollini, C.;Leoci, V.;Fellin, R.",2004,,,0,
5015,Increased prevalence of silent myocardial ischaemia and severe ventricular arrhythmias in untreated patients with Alzheimer's disease and mild cognitive impairment without overt coronary artery disease,"OBJECTIVE: To assess the prevalence and the characteristics of silent myocardial ischaemia (SMI) and ventricular arrhythmias (VA) in subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI) and their relationships with QT interval dispersion (QTD). METHODS: Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy control subjects matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled. Each subject underwent clinical and cognitive examination, a structural brain imaging study, electrocardiogram (ECG), 24-h ECG recording, 24-h blood pressure monitoring, and echocardiogram. Detection and characterization of QT dispersion, SMI and VA were performed. RESULTS: The three groups were comparable regarding demographic and basal cardiovascular characteristics: notwithstanding this, SMI episodes were observed only in AD and MCI patients (19 and 14, respectively). A significantly greater prevalence of repetitive ventricular premature beats was observed in AD (mean 8.56+/-13.1) and in MCI (1.8+/-7.2) vs. control (0.7+/-1.7). The QTD, the ischaemic burden and the number of repetitive ventricular beats revealed to be significantly related. CONCLUSIONS: Increased prevalence of SMI and potentially ominous VA were found in AD and, to a lesser extent, in MCI. SMI and repetitive VA were significantly related with QTD. These findings could be related to an increased risk of sudden cardiac death in AD and MCI patients.","Aged;Alzheimer Disease/*complications/epidemiology/mortality;Arrhythmias, Cardiac/complications/*epidemiology/mortality;Blood Pressure Monitoring, Ambulatory;Cognition Disorders/*complications/epidemiology/mortality;Coronary Artery Disease/complications/mortality;Echocardiography;Electrocardiography;Female;Humans;Magnetic Resonance Imaging;Male;Myocardial Ischemia/complications/*epidemiology/mortality;Psychiatric Status Rating Scales;Tomography, X-Ray Computed","Zulli, R.;Nicosia, F.;Borroni, B.;Agosti, C.;Prometti, P.;Donati, P.;De Vecchi, M.;Turini, D.;Romanelli, G.;Grassi, V.;Padovani, A.",2008,Sep,10.1016/j.clineuro.2008.05.002,0,
5016,Effect of an intensive outpatient program to augment primary care for high-need veterans affairs patients a randomized clinical trial,"IMPORTANCE Many organizations are adopting intensive outpatient care programs for high-need patients, yet little is known about their effectiveness in integrated systems with established patient-centered medical homes. OBJECTIVE To evaluate how augmenting the Veterans Affairs (VA) medical home (Patient Aligned Care Teams [PACT]) with an Intensive Management program (ImPACT) influences high-need patients' costs, health care utilization, and experience. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at a single VA facility. Among 583 eligible high-need outpatients whose health care costs or hospitalization risk were in the top 5%for the facility, 150 were randomly selected for ImPACT; the remaining 433 received standard PACT care. INTERVENTIONS The ImPACT multidisciplinary team addressed health care needs and quality of life through comprehensive patient assessments, intensive case management, care coordination, and social and recreational services. MAIN OUTCOMES AND MEASURES Primary difference-in-difference analyses examined changes in health care costs and acute and extended care utilization over a 16-month baseline and 17-month follow-up period. Secondary analyses estimated the intervention's effect on ImPACT participants (using randomization as an instrument) and for patients with key sociodemographic and clinical characteristics. ImPACT participants' satisfaction and activation levels were assessed using responses to quality improvement surveys administered at baseline and 6 months. RESULTS Of 140 patients assigned to ImPACT, 96 (69%) engaged in the program (mean [SD] age, 68.3 [14.2] years; 89 [93%] male; mean [SD] number of chronic conditions, 10 [4]; 62 [65%] had a mental health diagnosis; 21 [22%] had a history of homelessness). After accounting for program costs, adjusted person-level monthly health care expenditures decreased similarly for ImPACT and PACT patients (difference-in-difference [SE] ?101 [623]), as did acute and extended care utilization rates. Among respondents to the ImPACT follow-up survey (n = 54 [56%response rate]), 52 (96%) reported that they would recommend the program to others, and pre-post analyses revealed modest increases in satisfaction with VA care (mean [SD] increased from 2.90 [0.72] to 3.16 [0.60]; P = .04) and communication (mean [SD] increased from 2.99 [0.74] to 3.18 [0.60]; P = .03). CONCLUSIONS AND RELEVANCE Intensive outpatient care for high-need patients did not reduce acute care utilization or costs compared with standard VA care, although there were positive effects on experience among patients who participated. Implementing intensive outpatient care programs in integrated settings with well-established medical homesmay not prevent hospitalizations or achieve substantial cost savings.",NCT02932228;adult;aged;arthropathy;article;chronic disease;clinical feature;comparative study;controlled study;coronary artery disease;dementia;depression;drug dependence;female;health care cost;health care delivery;health care need;health care utilization;health program;heart failure;homelessness;hospitalization;human;hypertension;ICD-9;major clinical study;male;malignant neoplasm;medicare;middle aged;outpatient care;patient assessment;patient satisfaction;posttraumatic stress disorder;primary medical care;priority journal;randomized controlled trial;recreation;recreational therapy;social welfare;social work;subacute care;total quality management;veteran,"Zulman, D. M.;Chee, C. P.;Ezeji-Okoye, S. C.;Shaw, J. G.;Holmes, T. H.;Kahn, J. S.;Asch, S. M.",2017,,10.1001/jamainternmed.2016.8021,0,
5017,Factors predicting mortality in rural elderly hospitalized for pneumonia,"To identify predictors of mortality, the records of 133 elderly patients with pneumonia admitted to a small rural midwestern hospital were examined using a retrospective cohort design. All recorded clinical information available to the patient's physician within the first hours of admission was reviewed. Twenty-one (15.8%) patients died during the hospitalization. Patients with preexisting coronary heart disease, dementia, urinary incontinence, and impaired mobility were more likely to die. Impaired mental status, absence of fever, rapid respiratory rate, hypotension, cyanosis, and diffuse abnormalities on chest examination were also associated with mortality. Logistic regression analysis revealed five predictive indicators of mortality: impaired level of consciousness (odds ratio [OR] = 11.3), tachypnea (OR = 10.8), temperature lower than normal (OR = 14.2), white cell count higher than 20 X 10(9)/L (20,000 mm-3) (OR = 12.2), and cyanosis (OR = 8.6). A risk score based on this regression model demonstrated that 1 of 95 patients with a score lower than 3 (1%), 7 of 22 with a score of 3 (32%), and 13 of 15 patients with a score higher than 3 (87%) died during their hospitalization. The validity of this risk-scoring system was confirmed in another sample of 40 patients. Studies such as this may be useful in identifying information of important prognostic value that enables physicians, patients, and family members to make more effective decisions.","Aged;Body Temperature;Cardiovascular Diseases/complications;Cohort Studies;Dementia/complications;Female;Follow-Up Studies;Hospital Bed Capacity, under 100;Hospitals/*utilization;Hospitals, Rural/*utilization;Humans;Male;Middle Aged;Missouri/epidemiology;Models, Statistical;Pneumonia/complications/*mortality/physiopathology;Retrospective Studies;Risk Factors;Rural Population","Zweig, S.;Lawhorne, L.;Post, R.",1990,Feb,,0,
5018,Helping older patients and their families decide about end-of-life care,"Three-fourths of those who die in America are 65 or older. In all but the cases where death is sudden and unexpected, decisions frequently must be made about whether to limit treatment. In this paper, we provide a framework and specific tools that may help physicians in talking to older patients and their family members about end-of-life care. After briefly reviewing the demography of dying and methods of advance care planning, we propose a four-step process for deciding about end-of-life care: 1. Identifying patient preferences. 2. Communicating about medical prognosis. 3. Defining goals of care. 4. Implementing a management plan consistent with those goals. The paper concludes with special considerations about four common experiences of dying as an older person: chronic diseases with acute exacerbations (e.g. congestive heart failure or chronic obstructive lung disease), cancer, end stage dementia, and unexpected catastrophic decline.",Advance Directives/*psychology;Aged;Decision Making;Family/*psychology;Goals;Humans;Prognosis;Terminal Care/*psychology;United States,"Zweig, S.;Mehr, D. R.",2003,Jan-Feb,,0,
5019,Cost-effectiveness of antihypertensive treatment in patients 80 years of age or older in Switzerland: An Analysis of the HYVET study from a Swiss perspective,,antihypertensive agent;placebo;aged;antihypertensive therapy;cost control;cost effectiveness analysis;dementia;drug cost;geriatric care;heart failure;heart infarction;human;hypertension;life expectancy;note;sensitivity analysis;cerebrovascular accident;Switzerland,"Zweiker, R.",2010,,,0,